Παιδιατρική | Τόμος 65 • Τεύχος 4 • Ιούλιος - Αύγουστος 2002

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ISSN 0377-2551

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TEYXO™ 4

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ETO™ 2002

πÔ‡ÏÈÔ˜ - ∞‡ÁÔ˘ÛÙÔ˜ 2002 . ∆fiÌÔ˜ 65 . ∆‡¯Ô˜ 4

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

EDITORIAL 219

∂. µ·Ï¿ÛÛË-∞‰¿Ì

E. Valassi-Adam

∞¡∞™∫O¶∏™∂π™ ÷ڷÎÙËÚÈÛÙÈο ÙˆÓ Ì˘ÂÏÔ¸ÂÚÏ·ÛÙÈÎÒÓ Û˘Ó‰ÚfiÌˆÓ ÛÙËÓ ·È‰È΋ ËÏÈΛ·

REVIEW ARTICLES 222

™. ¶ÔÏ˘¯ÚÔÓÔÔ‡ÏÔ˘-∞Ó‰ÚÔ˘Ï·Î¿ÎË

¡ÂÎÚˆÙÈ΋ ÂÓÙÂÚÔÎÔÏ›Ùȉ·: ¡ÂfiÙÂÚ˜ ·fi„ÂȘ

232

ORIGINAL ARTICLES 241

¶AI¢IATPIKH

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TOMO™ 65

π. ∫·‚·ÏÈÒÙ˘, ∞. ¡¿ÓÔ˘, ™. ¶ÂÙÚ›‰Ô˘ 248

256

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

261

π. §·Ì·‰·Ú›‰Ë˜, ª. £ÂÔ‰ˆÚ¿ÎË, ª. ªˆÚ·˝ÙÔ˘, ¡. ¡ÈÎÔÏ·˝‰Ô˘, π. ™·Ô˘¿ÎÈÙ, Ã. ∫·Ú‹˜, ∂. ªÈ¯ÂϷοÎË

∂›‰· ÏÈȉ›ˆÓ Î·È ÏÈÔÚˆÙÂ˚ÓÒÓ Û ·È‰ÈÎfi ÏËı˘ÛÌfi Ù˘ ‰˘ÙÈ΋˜ £ÂÛÛ·ÏÔӛ΢

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

∞. ™ÈÒÌÔ˘, ª. ∆˙Ô‡ÊË, ∂. °·Ï·Ó¿Î˘, ∂. ∫ÚËÙÈÎÔ‡, ∞. ∫ˆÛÙԇϷ, ∞. ™È·ÌÔÔ‡ÏÔ˘-ª·˘Ú›‰Ô˘, ∑. ¶··‰ÔÔ‡ÏÔ˘-∫Ô˘ÏÔ˘Ì‹

∂›‰· Ï·ÛÌ·ÏÔÁfiÓˆÓ Û ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿

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

™. ¶ÂÙÚ›‰Ô˘, ∂. ∑¢Á·Ú›‰Ô˘, ∞. ∂˘ı˘Ì›Ô˘, ∞. ¡¿ÓÔ˘, π. ∫·‚·ÏÈÒÙ˘

ÕÙ˘˜ ÂΉËÏÒÛÂȘ Ù˘ ÏÔÈÌÒ‰Ô˘˜ ÌÔÓÔ˘Ú‹ÓˆÛ˘ ÛÙ· ‚Ú¤ÊË Î·È Ù· ÌÈÎÚ¿ Ó‹È·

Necrotizing enterocolitis: New concepts C. Hatziioannidis

Eƒ∂À¡∏∆π∫∂™ ∂ƒ°∞™π∂™

ªËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋ ÌËÓÈÁÁ›Ùȉ·: ·Ú·ÙËÚ‹ÛÂȘ Û 1070 ·ÛıÂÓ›˜

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

∫. ÷Ù˙Ë˚ˆ·ÓÓ›‰Ë˜

¶Ó¢ÌÔÓÈÔÎÔÎÎÈ΋ ÌËÓÈÁÁ›Ùȉ· ÛÙËÓ ·È‰È΋ ËÏÈΛ·. ¶·Ú·ÙËÚ‹ÛÂȘ ÂÚÈfi‰Ô˘ 30 ÂÙÒÓ

Lessons obtained following the outbreak of congenital rubella

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

265

Lipid and lipoprotein levels in children residing in west Thessaloniki area

∂. ¶··‰ÔÔ‡ÏÔ˘-∞Ï·Ù¿ÎË, ∫. ¶··‰ÔÔ‡ÏÔ˘§ÂÁÌ¤ÏÔ˘, µ. ∫Ô˘ÏÔ˘Ú›‰·

E. Papadopoulou-Alataki, K. PapadopoulouLegmpelou, V. Koulourida

∏ Û˘Ó¤¯ÂÈ· ÙˆÓ ÂÚȯÔÌ¤ÓˆÓ ÛÙËÓ ÚÒÙË ÂÛˆÙÂÚÈ΋ ÛÂÏ›‰·

Continuation of table of contents inside title page

July - August 2002 . Volume 65 . No 4

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πÔ‡ÏÈÔ˜ - ∞‡ÁÔ˘ÛÙÔ˜ 2002 . ∆fiÌÔ˜ 65 . ∆‡¯Ô˜ 4

™˘Ó¤¯ÂÈ· ÂÚȯÔ̤ӈÓ

Continuation of table of contents

CASE REPORTS

E¡¢π∞º∂ƒOÀ™∂™ ¶∂ƒπ¶∆ø™∂π™ ∂ȉËÌ›· Û˘Ó‰ÚfiÌÔ˘ Û˘ÁÁÂÓÔ‡˜ ÂÚ˘ıÚ¿˜ (™™∂) ÙÔ ¤ÙÔ˜ 1999

273

A. Andreou, V. Peristeri, A. Balaska

∞. ∞Ó‰Ú¤Ô˘, µ. ¶ÂÚÈÛÙ¤ÚË, ∞. ª·Ï¿Ûη

∞ÈÌÔÚÚ·ÁÈΤ˜ ÎÂÓÒÛÂȘ ·fi ÙËÓ ÚÒÙË Ë̤ڷ ˙ˆ‹˜ Û ÓÂÔÁÓfi Ì ·ÏÏÂÚÁ›· ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜

278

282

287

CURRENT ISSUES

∂¶π∫∞πƒ∞ £∂ª∞∆∞ 293

Restrictions for children with epilepsy A. Skardoutsou

∞. ™Î·Ú‰Ô‡ÙÛÔ˘

AWARD-WINNING ARTICLE

Bƒ∞µ∂Àª∂¡∏ ∂ƒ°∞™π∞ ¢È·ÙÚÔÊ‹ ηٿ ÙËÓ ÂÁ΢ÌÔÛ‡ÓË Î·È ‚¿ÚÔ˜ ÓÂÔÁÓÔ‡

¡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

¢. π. ∑·ÊÂÈÚ›Ô˘, ¶. ∆ÚÈ·ÓٷʇÏÏÔ˘, ¡. °ÔÌ¿Î˘, ∂. µ·ÚÁÈ¿ÌË, Ã. ∆Û¿ÓÙ·ÏË, ∂. ªÈ¯ÂϷοÎË, M. Vanier

∞·ÁÔÚ‡ÛÂȘ ÛÙ· ·È‰È¿ Ù· ÔÔ›· ¿Û¯Ô˘Ó ·fi ÂÈÏË„›·

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

∞. ∞Ó‰Ú¤Ô˘, °. µ·ÛÈÏ›Ԣ, µ. ¶··‚·ÛÈÏ›Ԣ, ∞. ∞Ó·ÛÙ·Û›Ô˘, ∞. ™ÙÚ·ÙÔ˘‰¿Î˘

¡fiÛÔ˜ Niemann Pick C: ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ Î·È ·Ó·ÛÎfiËÛË Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜

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

∂. ÷Ù˙ˉ¿ÎË, ∞. ª·ÓÔ˘Ú¿, ∂. ∫ÔڷοÎË, ∂. °·Ï·Ó¿Î˘, Ã. °È·ÓÓ·ÎÔÔ‡ÏÔ˘

∞ÏËı‹˜ Û˘ÓÔÛÙˆÙÈ΋ Ô›ÛıÈ· Ï·ÁÈÔÎÂÊ·Ï›· Û ‚Ú¤ÊÔ˜

Sizable epidemic of congenital rubella syndrome in 1999

298

Nutrition during pregnancy in relation to birthweight

∂. ¶ÂÙÚ›‰Ô˘, Õ. ™Î·ÏΛ‰Ô˘, ª. ™ÙÔ˚Λ‰Ô˘, ¡. ¢ÂÛ‡Ú˘, ¢. ∆ÚȯfiÔ˘ÏÔ˜

E. Petridou, A. Skalkidou, M. Stoikidou, N. Dessypris, D. Trichopoulos

™˘Ó¯›˙ÔÓÙ·È

Continued

July - August 2002 . Volume 65 . No 4

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πÔ‡ÏÈÔ˜ - ∞‡ÁÔ˘ÛÙÔ˜ 2002 . ∆fiÌÔ˜ 65 . ∆‡¯Ô˜ 4

™˘Ó¤¯ÂÈ· ÂÚȯÔ̤ӈÓ

∂¶π™∆O§∏ ¶ƒO™ ∆∏ ™À¡∆∞•∏

Continuation of table of contents

307

∏. ¢. ¢ÂÏÏ·ÁÚ·ÌÌ¿ÙÈη˜

BÈ‚ÏÈÔ·Úo˘Û›·ÛË

308

¶∂ƒπ§∏æ∂π™ ∞ƒ£ƒø¡ ∞¶O ∆∏ µπµ§πO°ƒ∞ºπ∞ ∏ Û˘ÌÏËڈ̷ÙÈ΋ ¯ÔÚ‹ÁËÛË ·ÚÁÈÓ›Ó˘ ÚÔÊ˘Ï¿ÛÛÂÈ ·fi ÙËÓ ÂÌÊ¿ÓÈÛË ÓÂÎÚˆÙÈ΋˜ ÂÓÙÂÚÔÎÔÏ›Ùȉ·˜ ÛÙ· ÚfiˆÚ· ÓÂÔÁÓ¿

255

260

™˘ÓÙÔÌÔÁڷʛ˜

Use of vasopressin in refractory hypotension in children with vasodilatory shock: Five cases and a review of the literature Liedel JL, Meadow W, Nachman J, Koogler T, Kaharna MD Greek translation: Hatzis Anastasios

264

Hernandez E, Khoshoo V, Thoppil D, Edell D, Ross G ∞fi‰ÔÛË ÛÙ· ∂ÏÏËÓÈο: ∆ÛÈÏÈÁÈ¿ÓÓ˘ £ÂÔÊ¿Ó˘

¶ÚÔÛ¯‹ ™˘Ó¤‰ÚÈ·

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

Liedel JL, Meadow W, Nachman J, Koogler T, Kaharna MD ∞fi‰ÔÛË ÛÙ· ∂ÏÏËÓÈο: ÷Ù˙‹˜ ∞Ó·ÛÙ¿ÛÈÔ˜

∂ÈÛÚfiÊËÛË: ŒÓ·˜ ·Ú¿ÁÔÓÙ·˜ Û ٷ¯¤ˆ˜ ÂȉÂÈÓÔ‡ÌÂÓË ‚ÚÔÁ¯ÈÔÏ›Ùȉ· Û ÚÒËÓ ˘ÁÈ‹ ‚Ú¤ÊË;

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

Sullivan SE, Staba SL, Gersting JA, Hutson AD, Theriaque D, Christensen RD et al ∞fi‰ÔÛË ÛÙ· ∂ÏÏËÓÈο: ºˆÙfiÔ˘ÏÔ˜ ™‡ÚÔ˜

ÃÔÚ‹ÁËÛË ·ÁÁÂÈÔÈÂÛ›Ó˘ Û ·È‰È¿ Ì ηٷÏËÍ›·: ¶ÂÚÈÁÚ·Ê‹ 5 ÂÚÈÙÒÛÂˆÓ Î·È ·Ó·ÛÎfiËÛË Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜

Book Review LITERATURE ABSTRACTS

231

Amin HJ, Zamora SA, McMillan DD, Fick GH, Butzner JD, Parsons HG et al ∞fi‰ÔÛË ÛÙ· ∂ÏÏËÓÈο: ºˆÙfiÔ˘ÏÔ˜ ™‡ÚÔ˜

∫˘ÎÏÔÊÔÚÔ‡Û˜ Û˘ÁÎÂÓÙÚÒÛÂȘ ¯˘ÌÔÎÈÓÒÓ Û ·›Ì· ÔÌÊ¿ÏÈÔ˘ ÏÒÚÔ˘ Û ÓÂÔÁÓ¿ Î·È ÂÓ‹ÏÈΘ

LETTER TO THE EDITOR H. D. Dellagrammatikas

Aspiration: A factor in rapidly deteriorating bronchiolitis in previously healthy infants?

Hernandez E, Khoshoo V, Thoppil D, Edell D, Ross G Greek translation: Tsiligiannis Th.

xi

xvii

Scheduled Medical Meetings Abbreviations

J u l y - A u g u s t 2 0 0 2 . V o l u m e 6 5 .N o 4

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πÔ‡ÏÈÔ˜ - ∞‡ÁÔ˘ÛÙÔ˜ 2002 . ∆fiÌÔ˜ 65

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∆‡¯Ô˜ 4

¢ÈÌËÓÈ·›· ¤Î‰ÔÛË E›ÛËÌÔ ¶ÂÚÈÔ‰ÈÎfi Ù˘ EÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ EÙ·ÈÚ›·˜

Bimonthly Publication The Official Journal of the Hellenic Paediatric Society

EΉfiÙ˘ K. °ÚÈ‚¤·˜

Publisher K. Griveas

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Scientific President Editor Members

ºÈÏÔÏÔÁÈ΋ EÈ̤ÏÂÈ· ∂È̤ÏÂÈ· ÂÏÏËÓÈÎÒÓ ÎÂÈÌ¤ÓˆÓ I. K·Ú·‚Ú¿ÓÔ˘

Manuscript Editing

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English Editing Z. Papadopoulou-Couloumbis

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O‰ËÁ›Â˜ ÚÔ˜ ÙÔ˘˜ ™˘ÁÁÚ·Ê›˜ A. °ÂÓÈΤ˜ ¶ÏËÚÔÊÔڛ˜ ∆Ô ÂÚÈÔ‰ÈÎfi “¶∞π¢π∞∆ƒπ∫H” Â›Ó·È Ë Â›ÛËÌË ÂÈÛÙËÌÔÓÈ΋ ¤Î‰ÔÛË Î·È È‰ÈÔÎÙËÛ›· Ù˘ EÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ EÙ·ÈÚ›·˜. Œ¯ÂÈ ˆ˜ ‚·ÛÈÎÔ‡˜ ÛÙfi¯Ô˘˜ ÙËÓ ·ÔÙ‡ˆÛË ÙÔ˘ ·È‰È·ÙÚÈÎÔ‡ ¤ÚÁÔ˘ ÛÙËÓ ∂ÏÏ¿‰· Î·È ÙË Û˘Ó¯‹ È·ÙÚÈ΋ ÂÓË̤ڈÛË Î·È ÂÈÌfiÚʈÛË ÙˆÓ EÏÏ‹ÓˆÓ ¶·È‰È¿ÙÚˆÓ. °È· ÙÔ ÛÎÔfi ·˘Ùfi ‰¤¯ÂÙ·È ÁÈ· ‰ËÌÔÛ›Â˘ÛË ÔÈÎÈÏ›· ¿ÚıÚˆÓ Î·È Û˘ÁÎÂÎÚÈ̤ӷ: ¿ÚıÚ· Û‡ÓÙ·Í˘ (ÌÂÙ¿ ·fi ÚfiÛÎÏËÛË Ù˘ EÈÛÙËÌÔÓÈ΋˜ ™˘ÓÙ·ÎÙÈ΋˜ EÈÙÚÔ‹˜), ·Ó·ÛÎÔ‹ÛÂȘ, Â›Î·ÈÚ· ı¤Ì·Ù·, ÂÍÂÏ›ÍÂȘ ÛÙËÓ π·ÙÚÈ΋ ∂ÈÛÙ‹ÌË, ÚˆÙfiÙ˘˜ ÂÚ¢ÓËÙÈΤ˜ ÌÂϤÙ˜ Ì ·È‰È·ÙÚÈÎfi ‹ È·ÙÚÔÎÔÈÓˆÓÈÎfi ÂÚȯfiÌÂÓÔ, ÁÂÓÈο ı¤Ì·Ù· Ô˘ ·ÊÔÚÔ‡Ó ÙÔÓ ÚÔÁÚ·ÌÌ·ÙÈÛÌfi Î·È ÙËÓ ÔÚÁ¿ÓˆÛË Ù˘ È·ÙÚÈ΋˜ ÂÎ·›‰Â˘Û˘ Î·È ˘Á›·˜, ‚Ú·‚Â˘Ì¤Ó˜ ÂÚÁ·Û›Â˜, ÂÈÏÂÁ̤Ó˜ Û˘˙ËÙ‹ÛÂȘ ÛÙÚÔÁÁ˘ÏÒÓ ÙÚ·Â˙ÒÓ, ÂӉȷʤÚÔ˘Û˜ ÎÏÈÓÈΤ˜ Î·È ·ÂÈÎÔÓÈÛÙÈΤ˜ ÂÚÈÙÒÛÂȘ, ‚Ú·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ, ‚È‚ÏÈÔÎÚÈۛ˜, ÂÈÛÙÔϤ˜ ÚÔ˜ ÙË Û‡ÓÙ·ÍË, ÂÚÈÏ‹„ÂȘ Ù˘ ÂÏÏËÓÈ΋˜ Î·È Í¤Ó˘ ‚È‚ÏÈÔÁÚ·Ê›·˜, ·Ó·ÎÔÈÓÒÛÂȘ ÚÔÛ¯ÒÓ Û˘ÌÔÛ›ˆÓ Î·È Û˘Ó‰ڛˆÓ Û ı¤Ì·Ù· Û¯ÂÙÈο Ì ÙËÓ ¶·È‰È·ÙÚÈ΋ Î·È ·Ó·ÊÔÚ¤˜ Ó¤ˆÓ ÂΉfiÛˆÓ, ÂÏÏËÓÈÎÒÓ Î·È Í¤ÓˆÓ, ·È‰È·ÙÚÈÎÔ‡ ÂӉȷʤÚÔÓÙÔ˜.

H EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ‰È·ÙËÚ› ÙÔ ‰Èη›ˆÌ· Ó· ‰ËÌÔÛȇÂÈ ¿ÚıÚ· Ì ȉȷ›ÙÂÚÔ ÂÈÛÙËÌÔÓÈÎfi ÂӉȷʤÚÔÓ ¯ˆÚ›˜ Ó· ÙËÚÂ›Ù·È Ë ÛÂÈÚ¿ ˘Ô‚ÔÏ‹˜ Î·È Ó· ·ÔÊ·Û›˙ÂÈ ÁÈ· ÙË ‰ËÌÔÛ›Â˘ÛË ÂÚÁ·ÛÈÒÓ Ô˘ ¤¯Ô˘Ó ‚Ú·‚¢ı› ÛÙ· Ï·›ÛÈ· ÙÔ˘ ÂÙ‹ÛÈÔ˘ ¶·È‰È·ÙÚÈÎÔ‡ ™˘Ó‰ڛԢ, ÙËÓ ÔÏÈ΋ ‹ ÌÂÚÈ΋ ‰ËÌÔÛ›Â˘ÛË ÛÙÚÔÁÁ˘ÏÒÓ ÙÚ·Â˙ÒÓ È‰È·›ÙÂÚÔ˘ ÂӉȷʤÚÔÓÙÔ˜, Î·È ÙËÓ ÔÏÈ΋ ‹ ÌÂÚÈ΋ ‰ËÌÔÛ›Â˘ÛË ÂÈÛÙÔÏÒÓ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È Û ‰ËÌÔÛÈÂ˘Ì¤Ó· ÂÈÛÙËÌÔÓÈο ¿ÚıÚ· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. µ. ÀÔ‚ÔÏ‹ Î·È ¢ËÌÔÛ›Â˘ÛË ÙˆÓ ∂ÚÁ·ÛÈÒÓ OÈ ÂÚÁ·Û›Â˜ Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È ÚÔ˜ ÎÚ›ÛË ÁÈ· ‰ËÌÔÛ›Â˘ÛË ÛÙÔ ÂÚÈÔ‰ÈÎfi “¶∞π¢π∞∆ƒπ∫H” ·ÔÛÙ¤ÏÏÔÓÙ·È ÂȘ ÙÚÈÏÔ‡Ó ÛÙË ‰È‡ı˘ÓÛË: EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ EÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ EÙ·ÈÚ›· Mȯ·Ï·ÎÔÔ‡ÏÔ˘ 92 115 28 Aı‹Ó· ŸÏ˜ ÔÈ ÂÚÁ·Û›Â˜ Ú¤ÂÈ Ó· Û˘Óԉ‡ÔÓÙ·È ·fi ÂÈÛÙÔÏ‹, Ë ÔÔ›· ı· Û˘Ó˘ÔÁÚ¿ÊÂÙ·È ·fi fiÏÔ˘˜ ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ ÛÙËÓ ÔÔ›· ı· ‰ËÏÒÓÂÙ·È fiÙÈ Ë ÂÚÁ·Û›· ‰ÂÓ ¤¯ÂÈ ÂÓ Ì¤ÚÂÈ ‹ ÂÍ ÔÏÔÎÏ‹ÚÔ˘ ‰ËÌÔÛÈ¢ı› ‹ ˘Ô‚ÏËı› ÁÈ· ÎÚ›ÛË Û ¿ÏÏÔ ÂÚÈÔ‰ÈÎfi Î·È fiÙÈ ÔÈ Û˘ÁÁÚ·Ê›˜ ÂÁÎÚ›ÓÔ˘Ó ÙË ‰ËÌÔÛ›Â˘Û‹ Ù˘ ÛÙÔ ÂÚÈÔ‰ÈÎfi “¶∞π¢π∞∆ƒπ∫H”. ∂ÈϤÔÓ, ı· Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È Ù˘¯fiÓ ÂȉÔÙ‹ÛÂȘ - ¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢. ŸÏ˜ ÔÈ ÎÏÈÓÈΤ˜ ¤Ú¢Ó˜ Ú¤ÂÈ Ó· Û˘Óԉ‡ÔÓÙ·È ·fi ÁÚ·Ù‹ ‰‹ÏˆÛË ÙˆÓ Û˘ÁÁڷʤˆÓ fiÙÈ ¤ÁÈÓ·Ó ÌÂÙ¿ ·fi ÏËÚÔÊÔÚË̤ÓË Û˘Ó·›ÓÂÛË ÙˆÓ ÌÂÙ¯fiÓÙˆÓ ‹ ÙˆÓ ÓÔÌ›ÌˆÓ ÂÎÚÔÛÒˆÓ ÙÔ˘˜ Û‡Ìʈӷ Ì ÙȘ ‰È·ÎËÚ‡ÍÂȘ ÙÔ˘ EÏÛ›ÓÎÈ Î·È ÙÔ˘ TfiÎÈÔ. ŸÏ˜ ÔÈ ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ÂÚÁ·Û›Â˜ ıˆÚÔ‡ÓÙ·È È‰ÈÔÎÙËÛ›· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ “¶∞π¢π∞∆ƒπ∫H” Î·È Ë ÔÏÈ΋ ‹ ÌÂ-

ÚÈ΋ ·Ó·‰ËÌÔÛ›Â˘Û‹ ÙÔ˘˜ ÂÈÙÚ¤ÂÙ·È ÌfiÓÔ ÌÂÙ¿ ·fi ¤ÁÁÚ·ÊË Û˘ÁηٿıÂÛË ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. ∏ ¶∞π¢π∞∆ƒπ∫∏ ÚÔÙ›ÓÂÈ Ó· ·ÎÔÏÔ˘ıÔ‡ÓÙ·È ÔÈ “∫ÔÈÓ¤˜ ¶ÚԉȷÁڷʤ˜ ÁÈ· ÃÂÈÚfiÁÚ·Ê· Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È Û µÔ˚·ÙÚÈο ¶ÂÚÈÔ‰Èο” (Uniform Requirements for Manuscripts Submitted to Biomedical Journals) Ô˘ ‰ËÌÔÛȇÙËÎ·Ó ÛÙÔ JAMA 1997;277:927934, http://jama.ama-assn.org/info/auinst_req.html.

OÈ ·fi„ÂȘ Î·È Ù· Û˘ÌÂÚ¿ÛÌ·Ù· ÙˆÓ Û˘ÁÁڷʤˆÓ Ô˘ ‰È·Ù˘ÒÓÔÓÙ·È ÛÙȘ ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ÂÚÁ·Û›Â˜ ‰ÂÓ ·ÓÙÈηÙÔÙÚ›˙Ô˘Ó ··Ú·›ÙËÙ· ·˘Ù¤˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. H ηٷ¯ÒÚËÛË ‰È·ÊËÌ›ÛÂˆÓ ÛÙÔ ÂÚÈÔ‰ÈÎfi ‰ÂÓ ˘Ô‰ËÏÒÓÂÈ ÔˆÛ‰‹ÔÙ ¤ÁÎÚÈÛË ÙˆÓ ÂÚȯÔÌ¤ÓˆÓ ÙÔ˘˜ ·fi ÙËÓ EÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ EÙ·ÈÚ›·, ÙËÓ EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ‹ ·fi ÙÔÓ EΉfiÙË ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡.

EÊfiÛÔÓ Ë ÂÚÁ·Û›· Á›ÓÂÈ ·Ô‰ÂÎÙ‹, ÙÔ ‰ÈÔÚıˆÌ¤ÓÔ Û‡Ìʈӷ Ì ÙȘ ˘ԉ›ÍÂȘ ÙˆÓ ÎÚÈÙÒÓ Î·È ÂÎ Ó¤Ô˘ ‰·ÎÙ˘ÏÔÁÚ·ÊË̤ÓÔ Î›ÌÂÓÔ Ú¤ÂÈ Ó· ˘Ô‚¿ÏÂÙ·È ÛÙËÓ EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ Û˘Óԉ¢fiÌÂÓÔ ·fi ‰ÈÛΤٷ Ô˘ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ÂÚÁ·Û›· Û ÚfiÁÚ·ÌÌ· Word.doc ‹ MacWrite Î·È ÙÔ˘˜ ›Ó·Î˜, ·Ó Â›Ó·È ‰˘Ó·ÙfiÓ, Û ÚfiÁÚ·ÌÌ· Excel ηıÒ˜ Î·È ÂÈÛÙÔÏ‹ fiÔ˘ Ó· ·Ó·Ê¤ÚÔÓÙ·È ·Ó·Ï˘ÙÈο ÔÈ ÙÚÔÔÔÈ‹ÛÂȘ ‹ ÔÈ ·ÓÙÈÚÚ‹ÛÂȘ ÛÙȘ ÚÔÙ¿ÛÂȘ ÙˆÓ ÎÚÈÙÒÓ. H ηı˘ÛÙ¤ÚËÛË Ù˘ Â·Ó˘Ô‚ÔÏ‹˜ ÙÔ˘ ÙÚÔÔÔÈË̤ÓÔ˘ ÎÂÈ̤ÓÔ˘ ¤Ú·Ó ÙˆÓ 30 ËÌÂÚÒÓ Û˘ÓÂ¿ÁÂÙ·È Ó¤· ˘Ô‚ÔÏ‹. °È· Ó· ÂÈÙ¢¯ı› Ë ¤ÁηÈÚË ‰ËÌÔÛ›Â˘ÛË Ù˘ ÂÚÁ·Û›·˜ Â›Ó·È ··Ú·›ÙËÙÔ Ó· ÂÈÛÙÚ¤ÊÂÙ·È ÙÔ ‰ÈÔÚıˆÌ¤ÓÔ Ù˘ÔÁÚ·ÊÈÎfi ‰ÔΛÌÈÔ ·fi ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ ̤۷ Û ‰‡Ô (2) Ë̤Ú˜.

T· ¤ÍÔ‰· ÙˆÓ ÊÈÏ̘ Î·È ÙˆÓ ·Ó·Ù‡ˆÓ ‚·Ú‡ÓÔ˘Ó ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ Î·È Ú¤ÂÈ Ó· ÏËÚÒÓÔÓÙ·È Ì ÙËÓ ·ÔÛÙÔÏ‹ ÙÔ˘ ÚÒÙÔ˘ ‰ÔÎÈÌ›Ô˘ ηÙ¢ı›·Ó ÛÙÔÓ Ù˘ÔÁÚ¿ÊÔ.

T· ΛÌÂÓ· ÙˆÓ ÂÚÁ·ÛÈÒÓ Ô˘ ‰ÂÓ Á›ÓÔÓÙ·È ·Ô‰ÂÎÙ¤˜ ÁÈ· ‰ËÌÔÛ›Â˘ÛË ‰ÂÓ ÂÈÛÙÚ¤ÊÔÓÙ·È. MÔÚ› Ó· ÂÈÛÙÚ·ÊÔ‡Ó, ÂÊfiÛÔÓ ˙ËÙËı›, Ù· Û¯‹Ì·Ù· Î·È ÔÈ ÊˆÙÔÁڷʛ˜ Ô˘ Ù· Û˘Óԉ‡ԢÓ. °. ™‡ÓÙ·ÍË ÙˆÓ ∂ÚÁ·ÛÈÒÓ TÔ Û‡ÓÔÏÔ Ù˘ ÂÚÁ·Û›·˜ (Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ ÙˆÓ ÈÓ¿ÎˆÓ Î·È ÙˆÓ Ù›ÙÏˆÓ ÙˆÓ ÂÈÎfiÓˆÓ) Ú¤ÂÈ Ó· Â›Ó·È ‰·ÎÙ˘ÏÔÁÚ·ÊË̤ÓÔ ÛÙË ÌÈ· fi„Ë Ï¢ÎÔ‡ ¯·ÚÙÈÔ‡ ÌÂÁ¤ıÔ˘˜ A4 (22x28 cm) Ì ‰ÈÏfi ‰È¿ÛÙËÌ· ÌÂٷ͇ ÙˆÓ ÁÚ·ÌÌÒÓ Î·È Ê·Ú‰È¿ ÂÚÈıÒÚÈ· (2,5 cm) ÛÙȘ ‰‡Ô Ï¢ڤ˜.

TÔ Î›ÌÂÓÔ Ú¤ÂÈ Ó· ¤¯ÂÈ ÙËÓ ·ÎfiÏÔ˘ıË ‰È¿Ù·ÍË: ÛÂÏ›‰· Ù›ÙÏÔ˘, ‚Ú·¯‡˜ Ù›ÙÏÔ˜, ÂÚ›ÏË„Ë ÛÙ· ÂÏÏËÓÈο Î·È Ù· ·ÁÁÏÈο, ΛÌÂÓÔ, ¢¯·ÚÈÛٛ˜ ηıÒ˜ Î·È ·Ó·ÊÔÚ¿ Û ÂȉÔÙ‹ÛÂȘ-¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢, ‚È‚ÏÈÔÁÚ·Ê›·, ›Ó·Î˜, ÂÈÎfiÓ˜, Ù›ÙÏÔÈ ÂÈÎfiÓˆÓ, ηٿÏÔÁÔ˜ Û˘ÓÙÌ‹ÛˆÓ. K¿ı ¤Ó· ·fi Ù· ·Ú·¿Óˆ ÛÙÔȯ›· Ú¤ÂÈ Ó· ·Ú¯›˙ÂÈ Û ¯ˆÚÈÛÙfi ʇÏÏÔ Î·È ÔÈ ÛÂÏ›‰Â˜ Ó· ·ÚÈıÌÔ‡ÓÙ·È ‰È·‰Ô¯Èο ·Ú¯›˙ÔÓÙ·˜ Ì ÙË ÛÂÏ›‰· Ù›ÙÏÔ˘.

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™ÂÏ›‰·6

H ¤ÎÙ·ÛË ÚÔÛ‰ÈÔÚ›˙ÂÙ·È ÁÈ· ÙȘ ·Ó·ÛÎÔ‹ÛÂȘ Û 15-25, ÁÈ· ÙȘ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜ Û 12-15 ÛÂÏ›‰Â˜, ÁÈ· Ù· Â›Î·ÈÚ· ı¤Ì·Ù· Î·È ÙȘ ÂӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ Û 3-5 ‰·ÎÙ˘ÏÔÁÚ·ÊË̤Ó˜ ÛÂÏ›‰Â˜, ÂÓÒ ÁÈ· ÙȘ ‚Ú·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ Û 1000 ϤÍÂȘ Î·È ÁÈ· ÙȘ ÂÈÛÙÔϤ˜ Û 250-300 ϤÍÂȘ. ™ÂÏ›‰· Ù›ÙÏÔ˘ ¶Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ: - ÙÔÓ Ù›ÙÏÔ (<14 ϤÍÂȘ) ηıÒ˜ Î·È ÙÔÓ ‚Ú·¯‡ Ù›ÙÏÔ (<5 ϤÍÂȘ) ÙÔ˘ ¿ÚıÚÔ˘. ¢ÂÓ ÂÈÙÚ¤ÔÓÙ·È Û˘ÓÙÌ‹ÛÂȘ, - ÙÔ fiÓÔÌ· Î·È ÙÔ ÂÒÓ˘ÌÔ Î¿ıÂ Û˘ÁÁڷʤ· ÛÙËÓ ÔÓÔÌ·ÛÙÈ΋, - ÙÔ ÂÈÛÙËÌÔÓÈÎfi ΤÓÙÚÔ (›‰Ú˘Ì·, ÎÏÈÓÈ΋, ÂÚÁ·ÛÙ‹ÚÈÔ) ·fi fiÔ˘ ÚÔ¤Ú¯ÂÙ·È Ë ÂÚÁ·Û›·. ™Â ÂÚ›ÙˆÛË ¤ÏÏÂȄ˘ Û˘ÓÂÚÁ·Û›·˜ ÌÂ Û˘ÁÎÂÎÚÈ̤ӷ ΤÓÙÚ·, Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÂÙ·È Ë È‰ÈfiÙËÙ· ÙÔ˘/ÙˆÓ Û˘ÁÁڷʤˆÓ (.¯. ȉÈÒÙ˘ ·È‰›·ÙÚÔ˜) Î·È Ô ÙfiÔ˜ ‰È·ÌÔÓ‹˜ ÙÔ˘/ÙˆÓ, - ÙËÓ Ï‹ÚË ‰È‡ı˘ÓÛË Î·È ÙÔ ÙËϤʈÓÔ ÙÔ˘ Û˘ÁÁڷʤ· Ì ÙÔÓ ÔÔ›Ô Á›ÓÂÙ·È Ë ·ÏÏËÏÔÁÚ·Ê›·. ¶ÂÚÈÏ‹„ÂȘ H ÂÚ›ÏË„Ë Ú¤ÂÈ Ó· ·Ó·ÎÂÊ·Ï·ÈÒÓÂÈ ÙÔ˘˜ ÛÙfi¯Ô˘˜ Ù˘ ÂÚÁ·Û›·˜, ÙË ÌÂıÔ‰ÔÏÔÁ›·, Ù· ΢ÚÈfiÙÂÚ· ·ÔÙÂϤÛÌ·Ù· Î·È Ù· Û˘ÌÂÚ¿ÛÌ·Ù· Ù˘ ÌÂϤÙ˘. ¢ÂÓ Ú¤ÂÈ Ó· ˘ÂÚ‚·›ÓÂÈ ÙȘ 250 ϤÍÂȘ. ™ÙËÓ ÂÚ›ÏË„Ë ÛÙ· ·ÁÁÏÈο Ú¤ÂÈ Ó· ·Ó·ÁÚ¿ÊÔÓÙ·È ÛÙËÓ ·Ú¯‹ ÙÔ˘ ÎÂÈ̤ÓÔ˘ Ô Ù›ÙÏÔ˜ Ù˘ ÂÚÁ·Û›·˜ Î·È Ù· ÔÓfiÌ·Ù· ÙˆÓ Û˘ÁÁڷʤˆÓ ÛÙ· ·ÁÁÏÈο. TÔ ÂÚȯfiÌÂÓÔ ÙÔ˘ ·ÁÁÏÈÎÔ‡ ÎÂÈ̤ÓÔ˘ ‰ÂÓ Ú¤ÂÈ Ó· ‰È·Ê¤ÚÂÈ ·fi ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ÂÏÏËÓÈÎfi.

T· ¿ÚıÚ· Û‡ÓÙ·Í˘ Î·È ÔÈ ·ÂÈÎÔÓÈÛÙÈΤ˜ ÂÚÈÙÒÛÂȘ ¤¯Ô˘Ó ÌfiÓÔ ·ÁÁÏÈ΋ ÂÚ›ÏË„Ë.

K¿Ùˆ ·fi ÙËÓ ÂÏÏËÓÈ΋ Î·È ÙËÓ ·ÁÁÏÈ΋ ÂÚ›ÏË„Ë ÛËÌÂÈÒÓÔÓÙ·È ÙÚÂȘ ¤ˆ˜ ¤ÓÙ ϤÍÂȘ ÎÏÂȉȿ Ô˘ ı· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó ÁÈ· ÙÔ ıÂÌ·ÙÈÎfi ¢ÚÂÙ‹ÚÈÔ.

K›ÌÂÓÔ OÈ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó: ÂÈÛ·ÁˆÁ‹, ÌÂıfi‰Ô˘˜, ·ÔÙÂϤÛÌ·Ù· Î·È Û˘˙‹ÙËÛË. H ∂ÈÛ·ÁˆÁ‹ ÂÚÈÏ·Ì‚¿ÓÂÈ Ù· ÙÂÏÂ˘Ù·›· ‰Â‰Ô̤ӷ Ù˘ ¤Ú¢ӷ˜ ÛÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ ı¤Ì· Ì ÙȘ ΢ÚÈfiÙÂÚ˜ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜ Î·È ÙÔ ÛÎÔfi Ù˘ ÂÚÁ·Û›·˜. H ÂÚÈÁÚ·Ê‹ ÙˆÓ ªÂıfi‰ˆÓ Ú¤ÂÈ Ó· Â›Ó·È ·ÎÚÈ‚‹˜ Î·È ·ÚÎÂÙ¿ ÏÂÙÔÌÂÚ‹˜ ÒÛÙ ӷ ÂÈÙÚ¤ÂÈ ÙËÓ ·Ó··Ú·ÁˆÁ‹ ÙÔ˘˜ ·fi ¿ÏÏÔ˘˜ ÂÚ¢ÓËÙ¤˜. T· ∞ÔÙÂϤÛÌ·Ù· Ú¤ÂÈ Ó· ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ì ۷ʋÓÂÈ· Î·È Ó· Û˘Óԉ‡ÔÓÙ·È ·fi ÙËÓ ··Ú·›ÙËÙË ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË. H ™˘˙‹ÙËÛË Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ Ù· Û˘ÌÂÚ¿ÛÌ·Ù· Ô˘ ÚÔ·ÙÔ˘Ó ·fi ÙËÓ ÂÚÁ·Û›·, ÙË ÛËÌ·Û›· Ô˘ ÌÔÚ› Ó· ¤¯Ô˘Ó Î·È ÙËÓ Èı·Ó‹ Û˘Û¯¤ÙÈÛ‹ ÙÔ˘˜ Ì ·Ú·ÙËÚ‹ÛÂȘ ¿ÏÏˆÓ ÂÚ¢ÓËÙÒÓ.

OÈ ÂӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Û‡ÓÙÔÌË ÂÈÛ·ÁˆÁ‹, ÂÚÈÁÚ·Ê‹ Ù˘ ÂÚ›ÙˆÛ˘ Î·È ‚Ú·¯Â›· Û˘˙‹ÙËÛË. OÈ ·ÂÈÎÔÓÈÛÙÈΤ˜ ÂÚÈÙÒÛÂȘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Û‡ÓÙÔÌË ÂÚÈÁÚ·Ê‹ Ù˘ ÂÚ›ÙˆÛ˘ ηÈ

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‚Ú·¯Â›· Û˘˙‹ÙËÛË Ì ¤ÌÊ·ÛË ÛÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË. T· ˘fiÏÔÈ· ı¤Ì·Ù· ¤¯Ô˘Ó ÂχıÂÚË ‰ÔÌ‹ ηٿ ÙËÓ ÎÚ›ÛË ÙˆÓ Û˘ÁÁڷʤˆÓ ÙÔ˘˜. ∂˘¯·ÚÈÛٛ˜ ‹ ·Ó·ÁÓˆÚ›ÛÂȘ (·Ó·ÊÔÚ¿ Û ÂȉÔÙ‹ÛÂȘ - ¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢) ı· Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔ Ù¤ÏÔ˜ ÙÔ˘ ÎÂÈ̤ÓÔ˘ Î·È ÚÈÓ ·fi ÙȘ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜.

TÈ̤˜ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛÂˆÓ OÈ ÙÈ̤˜ 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· ̤۷ Û ·Ú¤ÓıÂÛË. ¶›Ó·Î˜ ÌÂÙ·ÙÚÔ‹˜ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÛÙÔ JAMA 1986;255:2329-2339. ™˘ÓÙÔÌÔÁڷʛ˜ OÈ Û˘ÓÙÔÌÔÁڷʛ˜ Ô˘ ¤¯Ô˘Ó ÂÈ‚ÏËı› ‰ÈÂıÓÒ˜ ‰ËÌÔÛȇÔÓÙ·È Û οı Ù‡¯Ô˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. ™‡ÓıÂÙÔÈ Î·È Ì·ÎÚÔÛÎÂÏ›˜ fiÚÔÈ Ô˘ Â·Ó·Ï·Ì‚¿ÓÔÓÙ·È Û˘¯Ó¿ ÛÙÔ Î›ÌÂÓÔ ÌÔÚÔ‡Ó Ó· ·ÓÙÈηı›ÛÙ·ÓÙ·È ·fi Û˘ÓÙÔÌÔÁڷʛ˜ Ô˘ ÂÂÍËÁÔ‡ÓÙ·È ·fi ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ Û ÂȉÈÎfi ηٿÏÔÁÔ Ô ÔÔ›Ô˜ ˘Ô‚¿ÏÏÂÙ·È Ì·˙› Ì ÙËÓ ÂÚÁ·Û›·. OÈ Û˘ÓÙÔÌÔÁڷʛ˜ ·Ó·Ê¤ÚÔÓÙ·È Û ·Ú¤ÓıÂÛË ÌfiÓÔ ÛÙȘ ÂÚÈÏ‹„ÂȘ.

BÈ‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜ ™ÙÔ ÙÌ‹Ì· Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜ ηٷ¯ˆÚÔ‡ÓÙ·È fiϘ ÔÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜ Ì ÙË ÛÂÈÚ¿ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔ Î›ÌÂÓÔ. ™ÙÔ Î›ÌÂÓÔ ÔÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜ ·Ó·Ê¤ÚÔÓÙ·È Ì ·Ú·‚ÈÎÔ‡˜ ·ÚÈıÌÔ‡˜ Û ·Ú¤ÓıÂÛË. OÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜ ‰ÂÓ Ú¤ÂÈ Ó· ˘ÂÚ‚·›ÓÔ˘Ó ÙȘ 70 ÛÙȘ ·Ó·ÛÎÔ‹ÛÂȘ, ÙȘ 30 ÛÙȘ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜, ÙȘ 12 ÛÙ· Â›Î·ÈÚ· ı¤Ì·Ù· Î·È ÙȘ ÂӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ, ÙȘ 5 ÛÙȘ ‚Ú·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ.

H Û‡ÓÙ·ÍË ÙˆÓ ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·ÔÌÒÓ Á›ÓÂÙ·È Û‡Ìʈӷ Ì ÙȘ ÚԉȷÁڷʤ˜ Ù˘ International Committee of Medical Journal Editors / Uniform Requirements for Manuscripts Submitted to Biomedical Journals (JAMA 1997;277:927-934), http://jama.amaassn.org/info/auinst_req.html. OÈ Û˘ÓÙÌ‹ÛÂȘ ÙˆÓ Ù›ÙÏˆÓ ÙˆÓ ÂÚÈÔ‰ÈÎÒÓ Á›ÓÔÓÙ·È Ì ‚¿ÛË ÙÔ Cumulated Index Medicus (List of Journals Indexed in Index Medicus, http://www.nlm.nih.gov). ¶·Ú·‰Â›ÁÌ·Ù· ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·ÔÌÒÓ I. ¶ÂÚÈÔ‰Èο AÓ ÔÈ Û˘ÁÁÚ·Ê›˜ Â›Ó·È ¤ˆ˜ ¤ÍÈ ·Ó·ÁÚ¿ÊÔÓÙ·È fiÏÔÈ, ·Ó Â›Ó·È ÂÙ¿ ‹ ÂÚÈÛÛfiÙÂÚÔÈ ·Ó·ÁÚ¿ÊÔÓÙ·È ÔÈ ÚÒÙÔÈ ¤ÍÈ Î·È ÚÔÛÙ›ıÂÙ·È “et al” ‹ “Î·È Û˘Ó”.

T·ÎÙÈ΋ ¤Î‰ÔÛË ÂÚÈÔ‰ÈÎÔ‡: ∞ÏÂ͛Ԣ ¢, ª¿Ú· Ã, °È·ÓÓ·ÎÔÔ‡ÏÔ˘ Ã. ∂Ì‚fiÏÈ·, ·ÚfiÓ Î·È Ì¤ÏÏÔÓ: Â›‰Ú·ÛË ÛÙËÓ ÂȉËÌÈÔÏÔÁ›· ÙˆÓ ÏÔÈ̈‰ÒÓ ÓÔÛËÌ¿ÙˆÓ Î·È ÙËÓ ·È‰È·ÙÚÈ΋ Ú¿ÍË. ¶·È‰È·ÙÚÈ΋ 1996;59:272-279.

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Proesmans W. Bartter syndrome and its neonatal variant. Eur J Pediatr 1997;156:669-679.

elderly’s access and utilization [dissertation]. St. Louis (Mo): Washington Univ.; 1995.

™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜ ÂÚÈÔ‰ÈÎÔ‡: Flyvbjerg A. Role of growth hormone, insulin-like growth factors (IGFs) and IGF-binding proteins in the renal complications of diabetes. Kidney Int 1997;52 (60 Suppl):S12-S19.

¶›Ó·Î˜ Î·È EÈÎfiÓ˜ AÔÛÙ¤ÏÏÔÓÙ·È ÂȘ ÙÚÈÏÔ‡Ó (¤Ó· ÚˆÙfiÙ˘Ô+‰‡Ô ʈÙÔ·ÓÙ›ÁÚ·Ê·). ¶Ú¤ÂÈ Ó· ¤¯Ô˘Ó Ï¿ÙÔ˜ ›ÛÔ Ì ÙÔ Ï¿ÙÔ˜ ÙÔ˘ ÌÔÓfiÛÙËÏÔ˘ (8 cm) ‹ Ì ÙÔ Ï¿ÙÔ˜ fiÏ˘ Ù˘ ÛÂÏ›‰·˜ (16,8 cm). TÔ Ì¤ÁÈÛÙÔ Ì‹ÎÔ˜ ÙÔ˘˜, Ì·˙› Ì ÙÔ˘˜ Ù›ÙÏÔ˘˜, ‰ÂÓ Ú¤ÂÈ Ó· Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ ·fi 22 cm.

OÈ ›Ó·Î˜ ·ÚÈıÌÔ‡ÓÙ·È Ì ·Ú·‚ÈÎÔ‡˜ ·ÚÈıÌÔ‡˜ Ì ÙË ÛÂÈÚ¿ Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÔ Î›ÌÂÓÔ. ¶ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ‚Ú·¯‡ Ù›ÙÏÔ Î·È ÂÂÍ‹ÁËÛË ÙˆÓ Û˘ÓÙÌ‹ÛÂˆÓ ÛÙÔ Î¿Ùˆ ̤ÚÔ˜. ™ÙÔ˘˜ ›Ó·Î˜ Ú¤ÂÈ Ó· ·ÔʇÁÔÓÙ·È ÔÈ Î¿ıÂÙ˜ ÁÚ·Ì̤˜. ŸÏÔ ÙÔ ·ÂÈÎÔÓÈÛÙÈÎfi ˘ÏÈÎfi (Û¯‹Ì·Ù·, ‰È·ÁÚ¿ÌÌ·Ù·, ʈÙÔÁڷʛ˜, ÎÏ.) ¯·Ú·ÎÙËÚ›˙ÂÙ·È ˆ˜ ÂÈÎfiÓ˜. £· Ú¤ÂÈ Ó· Â›Ó·È ¿ÚÈÛÙ˘ ÔÈfiÙËÙ·˜ Ì ÌÔÚÊ‹ ʈÙÔÁÚ·ÊÈÒÓ ‹ Î·È ÚˆÙÔÙ‡ˆÓ. ™ÙÔ ›Ûˆ ̤ÚÔ˜ ÙˆÓ ÂÈÎfiÓˆÓ Ú¤ÂÈ Ó· ÛËÌÂÈÒÓÂÙ·È Ì ÌÔχ‚È Ô ·ÚÈıÌfi˜ Ù˘ ÂÈÎfiÓ·˜ Î·È ÙÔ fiÓÔÌ· ÙÔ˘ ÚÒÙÔ˘ Û˘ÁÁڷʤ·, ηıÒ˜ Î·È ¤Ó· ‚¤ÏÔ˜ ÙÔ ÔÔ›Ô Ó· ‰Â›¯ÓÂÈ ÙÔ ¿Óˆ ̤ÚÔ˜ Ù˘ ÂÈÎfiÓ·˜. ™ÙȘ ʈÙÔÁڷʛ˜ ·ÛıÂÓÒÓ ‰ÂÓ Ú¤ÂÈ Ó· ·Ó·ÁÓˆÚ›˙ÂÙ·È Ë Ù·˘ÙfiÙËÙ¿ ÙÔ˘˜. OÈ ·ÛıÂÓ›˜ ‰ÂÓ Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È ÔÓÔÌ·ÛÙÈο.

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Neurofibromatosis conference statement. Arch Neurol 1988;45:575-578. ¶ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù‡Ô˘ ¿ÚıÚÔ˘: ∫Ô˘Ú›‰Ë˜ Ã, ∫Ô˘Ú›‰Ë˜ °. ¶·¯˘Û·ÚΛ· Î·È ˘ÂÚÏÈȉ·ÈÌ›· Û ·È‰È¿ ‚ÔÚÂÈÔ‰˘ÙÈ΋˜ ∫‡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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II. µÈ‚Ï›· ∫ÂÊ¿Ï·ÈÔ Û ‚È‚Ï›Ô: Clark AG, Barratt TM. Steroid-responsive nephrotic syndrome. In: Barratt TM, Arner ED, Harmon WE, editors. Pediatric Nephrology. 4th ed. Baltimore: Lippincott William Wilkins; 1999. p. 742. ™‡ÁÁÚ·ÌÌ· ‹ ÌÔÓÔÁÚ·Ê›·: Gorlin RJ, Cohen MM, Levin LS. Syndromes of the head and neck. 3rd ed. New York: Oxford University Press; 1990. ¢ËÌÔÛ›Â˘ÛË Û ÙfiÌÔ Ú·ÎÙÈÎÒÓ: Bauer AW. The two definitions of bacterial resistance. In: Smith AJ, Rogers CA, eds. Proceedings of the Third International Congress of Chemotherapy; 1962 May 29-31; New York: International Society of Chemotherapy; 1963. p. 484-500.

¶ÚÈÓ ·ÔÛÙ›ÏÂÙ ÙËÓ ÂÚÁ·Û›· Û·˜ ‚‚·Èˆı›Ù fiÙÈ ÂÚÈÏ·Ì‚¿ÓÂÈ: - ÂÈÛÙÔÏ‹ ˘Ô‚ÔÏ‹˜ - ‰‹ÏˆÛË ÌË ÚÔÁÂÓ¤ÛÙÂÚ˘ ‰ËÌÔÛ›Â˘Û˘ Ù˘ ÂÚÁ·Û›·˜ - 3 ·ÓÙ›ÁÚ·Ê· ÙÔ˘ ÎÂÈ̤ÓÔ˘ Ù˘ ÂÚÁ·Û›·˜ - ÛÂÏ›‰· Ù›ÙÏÔ˘ (¯ˆÚÈÛÙ‹ ÛÂÏ›‰·): ÂÚÈÏ·Ì‚¿ÓÂÈ - Ù›ÙÏÔ Î·È ‚Ú·¯‡ Ù›ÙÏÔ ÂÚÁ·Û›·˜ - fiÓÔÌ· Î·È ÂÒÓ˘ÌÔ Û˘ÁÁڷʤˆÓ (ÔÏÔÁڿʈ˜), ÂÈÛÙËÌÔÓÈÎfi/¿ ΤÓÙÚÔ/· fiÔ˘ ¤ÁÈÓÂ Ë ÂÚÁ·Û›· - fiÓÔÌ·, ‰È‡ı˘ÓÛË Î·È ÙËϤʈÓÔ Û˘ÁÁڷʤ· ÁÈ· ·ÏÏËÏÔÁÚ·Ê›· - ÂÚ›ÏË„Ë ÂÏÏËÓÈ΋-·ÁÁÏÈ΋, ϤÍÂȘ ÎÏÂȉȿ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) - ηٿÏÔÁÔ Û˘ÓÙÔÌÔÁÚ·ÊÈÒÓ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) - ΛÌÂÓÔ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) - ¢¯·ÚÈÛٛ˜ ‹ ·Ó·ÁÓˆÚ›ÛÂȘ (·Ó·ÊÔÚ¿ Û ÂȉÔÙ‹ÛÂȘ¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢) - ‚È‚ÏÈÔÁÚ·Ê›· (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) - ›Ó·Î˜ (Ô Î·ı¤Ó·˜ Û ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) ÂȘ ÙÚÈÏÔ‡Ó - ÂÈÎfiÓ˜, Ì ‚¤ÏÔ˜ ÛÙÔ ›Ûˆ ̤ÚÔ˜ Ó· ‰Â›¯ÓÂÈ ÚÔ˜ Ù· Â¿Óˆ, ·ÚÈıÌË̤Ó˜, ÂȘ ÙÚÈÏÔ‡Ó - Ù›ÙÏÔÈ ÂÈÎfiÓˆÓ (‰ÈÏfi ‰È¿ÛÙËÌ· - Ô Î·ı¤Ó·˜ Û ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) ÂȘ ÙÚÈÏÔ‡Ó.

¢È‰·ÎÙÔÚÈ΋ ‰È·ÙÚÈ‚‹: ¡ÙÔ˘ÓÙÔ˘Ï¿Î˘ π. ∏ ¯ÂÈÚÔ˘ÚÁÈ΋ ıÂÚ·›· ÙÔ˘ Û˘ÁÁÂÓÔ‡˜ ÂÍ·ÚıÚ‹Ì·ÙÔ˜ ÙÔ˘ ÈÛ¯›Ô˘ Û ·È‰È¿ οو ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜ [‰È‰·ÎÙÔÚÈ΋ ‰È·ÙÚÈ‚‹]. ∞ı‹Ó·: ¶·ÓÂÈÛÙ‹ÌÈÔ ∞ıËÓÒÓ; 1979.

Kaplan SJ. Post hospital home health care: the

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¶·È‰È·ÙÚÈ΋ 2002;65:219-221

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Paediatriki 2002;65:219-221

EDITORIAL

¶¿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

¶ÂÚ›ÏË„Ë: ∏ ·Ó·ÛÎfiËÛË ÙˆÓ ÂÓÂÚÁÂÈÒÓ Ô˘ ·ÎÔÏÔ‡ıËÛ·Ó ÙËÓ ÚˆÙÔÊ·Ó‹ ·‡ÍËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Û˘ÁÁÂÓÔ‡˜ ÂÚ˘ıÚ¿˜ Û 25,6/100.000 ηٿ ÙËÓ ÂȉËÌ›· ÙÔ˘ 1993, ‰Â›¯ÓÂÈ fiÙÈ ‰ÂÓ ÌÔÚÔ‡Ó Ó· ıˆÚËıÔ‡Ó Â·ÚΛ˜. ¶ÚÔÙ›ÓÂÙ·È ÛÙÔ˘˜ ·È‰È¿ÙÚÔ˘˜, ·ÍÈÔÔÈÒÓÙ·˜ ÙËÓ Â·Ê‹ ÙÔ˘˜ Ì ÙÔ˘˜ ÁÔÓ›˜, Ó· ÙÔ˘˜ ÂÓËÌÂÚÒÛÔ˘Ó ÁÈ· Ù· ··Ú·›ÙËÙ· ̤ÙÚ· Ô˘ Ú¤ÂÈ Ó· ÂÊ·ÚÌfiÛÔ˘Ó Û ·ÙÔÌÈÎfi Â›‰Ô. ¶ÚÔÙ›ÓÂÙ·È, Â›Û˘, Ó· ·ÍÈÔÔÈËı› Ë ‰˘Û¿ÚÂÛÙË ÂÌÂÈÚ›· ·fi ÙÔÓ ·Û˘ÓÙfiÓÈÛÙÔ Î·È ÌÂÚÈÎfi ÂÌ‚ÔÏÈ·ÛÌfi ÙÔ˘ ·È‰ÈÎÔ‡ ÏËı˘ÛÌÔ‡ ηٿ Ù˘ ÂÚ˘ıÚ¿˜, ÒÛÙ ӷ ÌËÓ Â·Ó·ÏËÊı› Ì ¿ÏÏ· ·Ó¿ÏÔÁ· ÂÌ‚fiÏÈ·. ∂ÎÊÚ¿˙ÂÙ·È Ë ÂÏ›‰· ÔÈ ·È‰›·ÙÚÔÈ Ó· ··ÈÙÔ‡Ó ÙË ‰È·ÌfiÚʈÛË Î·È ÙËÓ ÎÔÈÓÔÔ›ËÛË ÙÔ˘ ∂ıÓÈÎÔ‡ ¶ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÂÌ‚ÔÏÈ·ÛÌÒÓ, Ì ÙÔ ÔÔ›Ô ı· Û˘ÌÌÔÚÊÒÓÔÓÙ·È.

Abstract: An unprecedented increase of congenital rubella cases amounting to 25.6/100000 was observed during the 1993 outbreak in Greece.

The preventive measures that were implemented cannot be considered adequate. It is suggested that pediatricians should take advantage of their contacts with parents and inform them personally of the necessary precautions needed for the prevention of the disease. It is also stressed that the sad phenomenon of the increase in congenital rubella cases was due to partial and uncoordinated immunization of the population. This mistake should not be repeated when new vaccines are introduced. Pediatricians should demand for the restructure and implementation of national immunization policies to which they should all subsequently conform.

§¤ÍÂȘ ÎÏÂȉȿ: ÂÌ‚ÔÏÈ·ÛÌÔ›, ÚfiÏË„Ë, ·ÁˆÁ‹ ˘Á›·˜, Û‡Ó‰ÚÔÌÔ Û˘ÁÁÂÓÔ‡˜ ÂÚ˘ıÚ¿˜.

Key words: immunizations, prevention, health education, congenital rubella syndrome.

™ÙË ÛÂÏ›‰· 273 ·˘ÙÔ‡ ÙÔ˘ Ù‡¯Ô˘˜ ‰ËÌÔÛȇÂÙ·È ¿ÚıÚÔ Ì ÙÔÓ Ôχ ÂÒ‰˘ÓÔ Ù›ÙÏÔ “∂ȉËÌ›· Û˘Ó‰ÚfiÌÔ˘ Û˘ÁÁÂÓÔ‡˜ ÂÚ˘ıÚ¿˜ (™™∂) ÙÔ ¤ÙÔ˜ 1999” ÙˆÓ ∞. ∞Ó‰Ú¤Ô˘, µ. ¶ÂÚÈÛÙ¤ÚË, ∞. ª·Ï¿Ûη, fiÔ˘ ÂÚÈÁÚ¿ÊÔÓÙ·È ¤ÓÙ ÂÚÈÙÒÛÂȘ Ô˘ ÓÔÛ‹ÏÂ˘Û·Ó ÔÈ ›‰ÈÔÈ ÔÈ Û˘ÁÁÚ·Ê›˜ Î·È ·Ó·Ê¤ÚÔÓÙ·È ¿ÏϘ Ù¤ÛÛÂÚȘ Ô˘ ·Ó·ÎÔÈÓÒıËÎ·Ó ·fi ¿ÏÏË ÔÌ¿‰· ÌÂÙ¿ ÙËÓ ›‰È· ÂȉËÌ›· (1). ∂ÎÊÚ¿˙ÂÙ·È Ô Êfi‚Ô˜ fiÙÈ ·˘Ù¤˜ ÔÈ ÂÚÈÙÒÛÂȘ ·ÔÙÂÏÔ‡Ó ÌfiÓÔ ÙËÓ ÎÔÚ˘Ê‹ ÙÔ˘ ·Áfi‚Ô˘ÓÔ˘. ∫¿ı ÊÚ¿ÛË Ù˘ Ôχ ÂÌÂÚÈÛٷو̤Ó˘ Û˘˙‹ÙËÛ˘ ÂÎÊÚ¿˙ÂÈ, ÓÔÌ›˙ˆ, Ù· Û˘Ó·ÈÛı‹Ì·Ù· fiÏˆÓ ÙˆÓ ·È‰È¿ÙÚˆÓ, Û˘Ó·ÈÛı‹Ì·Ù· ·ÔÁÔ‹Ù¢Û˘, Û˘ÏÏÔÁÈ΋˜ ÂÓÔ¯‹˜, ÚÔ‚ÏËÌ·ÙÈÛÌÔ‡ Î·È ·ÓËÛ˘¯›·˜ ÁÈ· ÙÔ Ì¤ÏÏÔÓ. ∆Ô ÈÛÙÔÚÈÎfi ÙÔ ÂȉËÌÈÔÏÔÁÈÎÔ‡ Ê·ÈÓÔ̤ÓÔ˘ Ù˘ Â·ÓÂÌÊ¿ÓÈÛ˘ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Ù˘ Û˘ÁÁÂÓÔ‡˜ ÂÚ˘ıÚ¿˜ Â›Ó·È ÁÓˆÛÙfi (2-4): ∆Ô “¿ıËÌ·” Ù˘

∂ÏÏ¿‰·˜ ÂÈÛËÌ¿ÓıËΠÌÂÙ¿ ÙËÓ ÂȉËÌ›· ÙÔ˘ 1993, ·ÔÙ¤ÏÂÛ “ÚˆÙÈ¿” ‰ÈÂıÓÒ˜ Î·È ÚÔοÏÂÛ ÛÔ‚·ÚÔ‡˜ ÚÔ‚ÏËÌ·ÙÈÛÌÔ‡˜ ÛÙÔ˘˜ ÂȉËÌÈÔÏfiÁÔ˘˜. ªÂÙ¿ ·fi ›ÎÔÛÈ ¯ÚfiÓÈ· ·Û˘ÓÙfiÓÈÛÙÔ˘, ·ÙÂÏÔ‡˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÁÈ· ÙËÓ ÂÚ˘ıÚ¿ ÂÈÙ‡¯·Ì ӷ ¤¯Ô˘Ì ÏËı˘ÛÌfi Â›ÓÔÛÔ, Û ÔÛÔÛÙfi ÌÂÁ·Ï‡ÙÂÚÔ ·fi fi,ÙÈ ÚÈÓ ·fi ÙËÓ Î˘ÎÏÔÊÔÚ›· ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ (·fi 12% ÙË ‰ÂηÂÙ›· ÙÔ˘ ’70 Û 36% ÙÔ 1990-91) Î·È Ó· ÌÂÙ·ÙÂı› Ë ËÏÈΛ· ÓfiÛËÛ˘, Ì ·ÔÙ¤ÏÂÛÌ· Ó· ÂÌÊ·ÓÈÛÙÔ‡Ó 25 ÂÚÈÙÒÛÂȘ Û˘Ó‰ÚfiÌÔ˘ Û˘ÁÁÂÓÔ‡˜ ÂÚ˘ıÚ¿˜. ∏ Û˘¯ÓfiÙËÙ· 24,6/100.000 ‹Ù·Ó ÚˆÙÔÊ·Ó‹˜. ™˘¯ÓfiÙËÙ˜ 11,1 Î·È 5 ·Ó¿ 100.000, fiÙ·Ó ‰È·ÈÛÙÒıËÎ·Ó ÛÙË ªÂÁ¿ÏË µÚÂÙ·Ó›· Î·È ÛÙȘ ∏¶∞, ÚÔοÏÂÛ·Ó ¤ÓÙÔÓ˜ ˘ÁÂÈÔÓÔÌÈΤ˜ ÎÈÓËÙÔÔÈ‹ÛÂȘ. ∫·È ÛÙËÓ ∂ÏÏ¿‰·, ÙÔ ‰˘Û¿ÚÂÛÙÔ ÂȉËÌÈÔÏÔÁÈÎfi Ê·ÈÓfiÌÂÓÔ Û˘ÓÙ¿Ú·ÍÂ, ÚÔ‚ÏËÌ¿ÙÈÛÂ Î·È ÎÈÓËÙÔÔ›ËÛ ÙÔÓ ·È‰È·ÙÚÈÎfi ÎfiÛÌÔ. ∞fi ÙÔ 1993

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¶·È‰È·ÙÚÈ΋ 2002;65:219-221

¤¯Ô˘Ó ‰ËÌÔÛÈ¢Ù› 19 Û¯ÂÙÈο ¿ÚıÚ· Û 7 ÂÈÛÙËÌÔÓÈο ÂÚÈÔ‰Èο, Î·È fi¯È ÌfiÓÔ ·È‰È·ÙÚÈο, ¤¯Ô˘Ó Á›ÓÂÈ 18 ·Ó·ÎÔÈÓÒÛÂȘ Û 7 Û˘Ó¤‰ÚÈ· (5), ¤¯Ô˘Ó ÂΉÔı› ‚È‚Ï›· (6,7), ˘Ô‚Ï‹ıËÎ·Ó ÂÎı¤ÛÂȘ ÛÙÔ ·ÚÌfi‰ÈÔ ÀÔ˘ÚÁÂ›Ô (8), ÂÛÙ¿ÏËÛ·Ó ÂÁ·ÎÏÈÔÈ (9), ÚÔÎÏ‹ıËÎ·Ó Û˘˙ËÙ‹ÛÂȘ ÂȉËÌÈÔÏfiÁˆÓ ÛÙȘ ÛًϘ ÙÔ˘ British Medical Journal (2-4,10), ÏÂÈÙÔ‡ÚÁËÛ·Ó Û Â›Â‰Ô ÀÔ˘ÚÁ›Ԣ ÂÈÙÚÔ¤˜ ÂÌ‚ÔÏÈ·ÛÌÒÓ Ì ÙÔ˘˜ ϤÔÓ ·ÚÌfi‰ÈÔ˘˜ ÂÈÛÙ‹ÌÔÓ˜, ÂÎÚÔÛÒÔ˘˜ Ù˘ ¶·È‰È·ÙÚÈ΋˜ ∂Ù·ÈÚ›·˜ Î·È Î·ıËÁËÙ¤˜ Ù˘ ·È‰È·ÙÚÈ΋˜. ∫ÈÓËÙÔÔÈËı‹Î·Ì fiÏÔÈ ÔÈ ·È‰›·ÙÚÔÈ, ·fi ÙË ı¤ÛË Ô˘ ‚Ú›ÛÎÂÙ·È Ô Î·ı¤Ó·˜. ∂›Ì·ÛÙÂ, fï˜, ·ÔÙÂÏÂÛÌ·ÙÈÎÔ›; O ıÏÈ‚ÂÚfi˜ ·ÔÏÔÁÈÛÌfi˜ ·Ú·Ì¤ÓÂÈ 9 ÙÂÎÌËÚȈ̤Ó˜ ÂÚÈÙÒÛÂȘ ™™∂ ÛÙËÓ ÂȉËÌ›· ÙÔ˘ 1999, Ô˘ ‹Ù·Ó ÌÈÎÚfiÙÂÚË ·fi ÂΛÓË ÙÔ˘ 1993 (2480 ÎÚÔ‡ÛÌ·Ù· ¤Ó·ÓÙÈ 10.000) (11). ™Â ·˘Ù‹ ÙËÓ ÂȉËÌ›· Ì¿ÏÈÛÙ· ¤ÁÈÓÂ Î·È “ÂÍ·ÁˆÁ‹” ÛÙËÓ ∞ÁÁÏ›· Ì ŒÏÏËÓ˜ ÊÔÈÙËÙ¤˜ (1). ∆È ‰ÂÓ Î¿Ó·Ì ۈÛÙ¿; ∆È ·ÌÂÏ‹Û·ÌÂ; ¶Ô‡ ¯ˆÏ·›ÓÂÈ ÙÔ Û‡ÛÙËÌ¿ Ì·˜; ∆È ÌÔÚԇ̠ӷ ‰ÈÔÚıÒÛÔ˘ÌÂ; O ∞Ó‰Ú¤Ô˘ Î·È ÔÈ Û˘ÓÂÚÁ¿Ù˜ ÙÔ˘ ·Ó·Ê¤ÚÔ˘Ó Ì ۷ʋÓÂÈ· Ù· ·‰‡Ó·Ù· ÛËÌ›· ÙÔ˘ ı¤Ì·ÙÔ˜: ¤ÁÎ˘Â˜ Ì ÎËÏȉԂϷÙȉ҉˜ ÂÍ¿ÓıËÌ· Ô˘ ‰ÂÓ ¤‚·Ï Û ˘Ô„›· ÙÔÓ Ì·ÈÂ˘Ù‹Ú· ‹ ›Ûˆ˜ Î·È Ó· ÌËÓ ·Ó·Ê¤ÚıËΠÛÙÔ Ì·ÈÂ˘Ù‹Ú·, Û ̛· ÂÚ›ÙˆÛË ¤ÁÈÓ ÚÔÛ‰ÈÔÚÈÛÌfi˜ ·ÓÙÈۈ̿وÓ, ·ÏÏ¿ Ë Î‡ËÛË Û˘Ó¯›ÛÙËÎÂ, Û ¿ÏÏË ÂÚ›ÙˆÛË Ô ÁÈ·ÙÚfi˜ ÂÌÈÛÙ‡ÙËΠÙË ‰È¿ÁÓˆÛË ÓfiÛËÛ˘ Ô˘ ‹Ù·Ó ÁÚ·Ì̤ÓË ÛÙÔ ‚È‚ÏÈ¿ÚÈÔ ˘Á›·˜, ηÌÈ¿ ¤ÁÎ˘Ô˜ ‰ÂÓ Â›¯Â ÂÌ‚ÔÏÈ·ÛÙ› (1).

OÈ ÛÙÚ·ÙËÁÈΤ˜ Ô˘ ¯ÚÂÈ¿˙ÔÓÙ·È ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜ Â›Ó·È ÁÓˆÛÙ¤˜, ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› Â·ÓÂÈÏËÌ̤ӷ ÎÈ Â›Ó·È ÈÎÚfi Ó· ·Ó·Áο˙ÂÙ·È Ó· ÁÚ¿ÊÂÈ Î·Ó›˜ Ù· ›‰È· Î·È Ù· ›‰È· (1,5,7,8,11). ∆È ÂÚÈÛÛfiÙÂÚÔ ÌÔÚԇ̠ӷ οÓÔ˘Ì ·’ fiÛ· ‹‰Ë ¤ÁÈÓ·Ó; ∏ ÂÌ‚ÔÏÈ·ÛÙÈ΋ Î¿Ï˘„Ë ÙˆÓ ÓË›ˆÓ Ê·›ÓÂÙ·È fiÙÈ ¤Êı·Û È· Û ÔÛÔÛÙfi >90% (12). ∞˘Ùfi, ·ÛÊ·ÏÒ˜, Â›Ó·È Â›Ù¢ÁÌ· ÙˆÓ ·È‰È¿ÙÚˆÓ, Ô˘ fï˜ ‰ÂÓ Ú¤ÂÈ Ó· Ì·˜ ÂÊËÛ˘¯¿˙ÂÈ. ∞Ó ‰ÂÓ ÏËÊıÔ‡Ó ÂÈϤÔÓ Ì¤ÙÚ·, ÁÈ· ·ÚÎÂÙ¿ ¯ÚfiÓÈ· ı· ˘¿Ú¯ÂÈ ÌÂÁ¿ÏÔ ÔÛÔÛÙfi Â›ÓÔÛˆÓ Ó·ÚÒÓ ÂÓËÏ›ÎˆÓ Î·È ‰ÂÓ ı· ¤¯ÂÈ ÂÍ·ÛÊ·ÏÈÛÙ› ÙÔ›¯Ô˜ ·ÓÔÛ›·˜ ÛÙËÓ ÎÔÈÓfiÙËÙ·. ¢ËÏ·‰‹, ÔÈ ÂȉË̛˜ ÂÚ˘ıÚ¿˜ ı· Û˘Ó¯›˙ÔÓÙ·È (8). ∏ ·ÓÔÛ›· ÙˆÓ Ó·ÚÒÓ ÂÓËÏ›ÎˆÓ Ú¤ÂÈ Ó· ÂÍ·ÛÊ·ÏÈÛÙ› Ì ÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi ÙÔ˘˜. ∏ ÂÁ·ÎÏÈÔ˜ ÙÔ˘ ÀÔ˘ÚÁ›Ԣ ÀÁ›·˜ Î·È ¶ÚfiÓÔÈ·˜ ÙÔ˘ 1999 Û˘ÓÈÛÙ¿ ÙÔÓ “¤ÏÂÁ¯Ô ÙˆÓ ‚È‚ÏÈ·Ú›ˆÓ ˘Á›·˜ fiÏˆÓ ÙˆÓ Ì·ıËÙÒÓ Á˘ÌÓ·Û›ˆÓ Î·È Ï˘Î›ˆÓ Ù˘ ¯ÒÚ·˜ Î·È ÙËÓ ·ÓÔÛÔÔ›ËÛ‹ ÙÔ˘˜ Ì ÙË ‰Â‡ÙÂÚË ‰fiÛË ÂÌ‚ÔÏ›Ô˘ ÂÚ˘ıÚ¿˜”. ™˘ÓÈÛÙ¿, Â›Û˘, ÙÔÓ “ÂÌ‚ÔÏÈ·ÛÌfi ÙˆÓ ·ÓÂÌ‚ÔÏ›·ÛÙˆÓ ıËϤˆÓ 12 ÂÙÒÓ Î·È

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¿Óˆ”, ηıÒ˜ Î·È “...ÙËÓ ¤ÁηÈÚË ÎÈÓËÙÔÔ›ËÛË ÁÈ· ÂÓË̤ڈÛË ÙˆÓ Â˘·ıÒÓ ÔÌ¿‰ˆÓ” (9). ™ÙȘ Û˘ÛÙ¿ÛÂȘ, fï˜, ‰ÂÓ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È Ú·ÎÙÈΤ˜ Ô‰ËÁ›Â˜ ÁÈ· ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙÔ˘˜. ªÂ Ï‹ÚË Â›ÁÓˆÛË ÙˆÓ ‰˘Ó·ÙÔÙ‹ÙˆÓ Î·È ÙˆÓ ÚÔÔÙÈÎÒÓ ÙÔ˘ ˘ÁÂÈÔÓÔÌÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, Ë ˘ÔÁÚ¿ÊÔ˘Û· ÙÔÏÌ¿ Ó· ÚÔÙ›ÓÂÈ ÛÙÔ˘˜ Û˘Ó·‰¤ÏÊÔ˘˜ ÈÔ ¤ÌÚ·ÎÙË ÎÈÓËÙÔÔ›ËÛË ¤Ú· ·fi ‰ËÌÔÛȇÛÂȘ Î·È ÂÈÛËÁ‹ÛÂȘ ÂÚ› ÙÔ˘ Ú·ÎÙ¤Ô˘. ∆Ô ÚÒÙÔ ÂÊÈÎÙfi Î·È ·Ó¤ÍÔ‰Ô Ì¤ÙÚÔ Â›Ó·È Ë ÂÓË̤ڈÛË ÙˆÓ ÂÓËϛΈÓ. OÈ ·È‰›·ÙÚÔÈ ÌÔÚÔ‡Ó Ó· ·ÍÈÔÔÈ‹ÛÔ˘Ó ÙËÓ Â·Ê‹ ÙÔ˘˜ Ì ÙÔ˘˜ ÁÔÓ›˜ Î·È ÙÔ Î‡ÚÔ˜ Ô˘ ·Ó·ÌÊÈÛ‚‹ÙËÙ· ‰È·ı¤ÙÔ˘Ó ÁÈ· Ó· ÂÂÎÙ›ÓÔ˘Ó ÛÙÔ˘˜ ÂÓËÏ›ÎÔ˘˜ Î·È ÛÙÔ˘˜ ÂÊ‹‚Ô˘˜ ÙËÓ ÂÈÙ˘¯›· Ô˘ ›¯·Ó ÛÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi ÙÔ˘ ÓËÈ·ÎÔ‡ ÏËı˘ÛÌÔ‡: ™Â οı ÂÌ‚ÔÏÈ·ÛÌfi ÓË›Ô˘ ÁÈ· ÂÚ˘ıÚ¿, ηıÒ˜ Î·È Û οı ¤ÏÂÁ¯Ô ‚È‚ÏÈ·Ú›Ô˘ ˘Á›·˜ ·È‰ÈÔ‡ Ó· ÂÓËÌÂÚÒÓÔ˘Ó ÙȘ ÌËÙ¤Ú˜ fiÙÈ: ·) ÙÔ ÈÛÙÔÚÈÎfi ÓfiÛËÛ˘ ·fi ÂÚ˘ıÚ¿ ‰ÂÓ ÙÂÎÌËÚÈÒÓÂÈ ·ÓÔÛ›·, ‚) Ú¤ÂÈ ÔÈ ›‰È˜ Ó· ¤¯Ô˘Ó οÓÂÈ ‰‡Ô ‰fiÛÂȘ ÂÌ‚ÔÏ›Ô˘ ‹ Ó· ¤¯Ô˘Ó ÔÚÔÏÔÁÈ΋ ·fi‰ÂÈÍË ·ÓÔÛ›·˜ ‹ Ó· ÂÌ‚ÔÏÈ·ÛÙÔ‡Ó ÙÒÚ·, ÚÈÓ ·fi ÙËÓ ÂfiÌÂÓË Â›ÛÎÂ„Ë ÛÙÔ È·ÙÚ›Ô, ¿Û¯ÂÙ· ·fi ÙÔ ·Ó ÚÔÁÚ·ÌÌ·Ù›˙Ô˘Ó Ó· οÓÔ˘Ó ¿ÏÏÔ ·È‰›, Á) Ú¤ÂÈ Ó· ¤¯Ô˘Ó οÓÂÈ ‰‡Ô ‰fiÛÂȘ ÂÌ‚ÔÏ›Ô˘ ÂÚ˘ıÚ¿˜ fiÏÔÈ ÔÈ ¤ÊË‚ÔÈ Ù˘ ¯ÒÚ·˜ Î·È ‰) ÙÔ ÎfiÛÙÔ˜ ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ ηχÙÂÙ·È ·fi fiÏ· Ù· ·ÛÊ·ÏÈÛÙÈο Ù·Ì›·. ∞˜ ·Ó·ÚÙ‹ÛÔ˘Ì ̛· ·Ó·ÎÔ›ÓˆÛË ÛÙÔ È·ÙÚÂ›Ô Ì·˜ Ô˘ Ó· ı˘Ì›˙ÂÈ fiÙÈ Ú¤ÂÈ Ó· οÓÔ˘Ó ÂÌ‚fiÏÈÔ ÂÚ˘ıÚ¿˜ fiÏ· Ù· ¿ÙÔÌ· ËÏÈΛ·˜ ¿Óˆ ÙˆÓ 12 ÂÙÒÓ, ·ÎfiÌË ÎÈ ·Ó ¤¯Ô˘Ó ÂÌ‚ÔÏÈ·ÛÙ› Û ‚ÚÂÊÈ΋ ËÏÈΛ·, ·ÎfiÌË ÎÈ ·Ó ¤¯ÂÈ Î·Ù·ÁÚ·Ê› ÛÙÔ µÈ‚ÏÈ¿ÚÈÔ ÀÁ›·˜ ÙÔ˘ ·È‰ÈÔ‡ Ë ÎÏÈÓÈ΋ ‰È¿ÁÓˆÛË ÂÚ˘ıÚ¿˜. ∏ ÂÓË̤ڈÛË Î·È Â˘·ÈÛıËÙÔÔ›ËÛË ÙÔ˘ ÏËı˘ÛÌÔ‡ Ê·›ÓÂÙ·È fiÙÈ ·ÔÙÂÏ› Ôχ ÛËÌ·ÓÙÈÎfi ·Ú¿ÁÔÓÙ· ÛÙËÓ ÂÈÙ˘¯›· ÚÔÁÚ·ÌÌ¿ÙˆÓ ·ÓÔÛÔÔ›ËÛ˘ (4).

OÈ ÂȉËÌÈÔÏfiÁÔÈ Ô˘ ÂÓËÌÂÚÒıËÎ·Ó ÁÈ· ÙËÓ “ÂÏÏËÓÈ΋ ÂÌÂÈÚ›·” ·fi ÙÔÓ ·ÙÂÏ‹ ÂÌ‚ÔÏÈ·ÛÌfi ÙÔ˘ ÏËı˘ÛÌÔ‡ ÁÈ· ÙËÓ ÂÚ˘ıÚ¿ ·ÓËÛ‡¯ËÛ·Ó ÁÈ· ÙÔ ÙÈ ÌÔÚ› Ó· Û˘Ì‚Â› Î·È ÛÙÔ˘˜ ‰ÈÎÔ‡˜ ÙÔ˘˜ ÏËı˘ÛÌÔ‡˜, ·Ó ÌÂȈı› Ë ÂÌ‚ÔÏÈ·ÛÙÈ΋ Î¿Ï˘„Ë ÁÈ· ‰È¿ÊÔÚ· ÓÔÛ‹Ì·Ù·, ·fi ÙËÓ ·˘Í·ÓfiÌÂÓË Ù¿ÛË ¿ÚÓËÛ˘ ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ·fi ÙÔ ÎÔÈÓfi (3,4). ∂›Ó·È Ì›· Ù¿ÛË Ô˘ Â˘Ù˘¯Ò˜ ‰ÂÓ ·Ú·ÙËÚÂ›Ù·È ·ÎfiÌË ÛÙË ¯ÒÚ· Ì·˜. °È· ÂÌ¿˜, ÙÔ ÛËÌ·ÓÙÈÎfiÙÂÚÔ Ì¿ıËÌ· Ô˘ Ú¤ÂÈ Ó· ¿ÚÔ˘Ì ·fi ÙÔ “¿ıËÌ·” ÙÔ˘ ·Û˘ÓÙfiÓÈÛÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÁÈ· ÙËÓ ÂÚ˘ıÚ¿ Â›Ó·È fiÙÈ ÙÔ ÂȉËÌÈÔÏÔÁÈÎfi Ê·ÈÓfiÌÂÓÔ ÌÔÚ› Ó· Â·Ó·ÏËÊı› Ì ¿ÏÏ· ÓÔÛ‹Ì·Ù· Î·È ¿ÏÏÔ˘˜ Ó¤Ô˘˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡˜. ∏ ÂÌÊ¿ÓÈÛË ÎÚÔ˘ÛÌ¿ÙˆÓ Û˘Ó‰ÚfiÌÔ˘ Û˘ÁÁÂÓÔ‡˜ ÂÚ˘ıÚ¿˜ ÂȂ‚·›ˆÛ ÙËÓ ÔÚıfiÙËÙ· Ù˘

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ÁÓˆÛÙ‹˜ Ô‰ËÁ›·˜ ÙˆÓ ÂȉËÌÈÔÏfiÁˆÓ: ªËÓ ÂÈÛ¿ÁÂÙ ÛÙÔ ÚfiÁÚ·ÌÌ¿ Û·˜ Ó¤· ÂÌ‚fiÏÈ·, ·Ó ‰ÂÓ ÂÍ·ÛÊ·Ï›ÛÂÙ ÙË ‰˘Ó·ÙfiÙËÙ· Ù˘ ÂÏ¿¯ÈÛÙ˘ ··Ú·›ÙËÙ˘ Î¿Ï˘„˘ ÙÔ˘ ÏËı˘ÛÌÔ‡ Ì ·˘Ù¿ (7). ∞Ó, ÁÈ· ·Ú¿‰ÂÈÁÌ·, ÂÈÛ·¯ı› ÙÔ ÂÌ‚fiÏÈÔ Ù˘ ·ÓÂÌ¢ÏÔÁÈ¿˜ ¯ˆÚ›˜ Ó· ÂÚÈÏËÊı› ÛÙÔ ∂ıÓÈÎfi ¶ÚfiÁÚ·ÌÌ· ∂Ì‚ÔÏÈ·ÛÌÒÓ, ˘¿Ú¯ÂÈ Î›Ó‰˘ÓÔ˜ Ó· ÂÌ‚ÔÏÈ·ÛÙÔ‡Ó Î¿ÔÈ· ˘ÁÈ‹ ·È‰È¿ ÛÙÔÓ È‰ÈˆÙÈÎfi ÙÔ̤· (Ì ÙË ÁÓˆÛÙ‹ ›ÂÛË ÙˆÓ ÁÔÓ¤ˆÓ ÁÈ· fiÛÔ ÂÚÈÛÛfiÙÂÚ· ÂÌ‚fiÏÈ· Á›ÓÂÙ·È). ∆fiÙÂ, Â›Ó·È ‚¤‚·ÈÔ fiÙÈ ı· Â·Ó·ÏËÊı› ÙÔ ¿ıËÌ· Ù˘ ÂÚ˘ıÚ¿˜: ı· ÌÂȈıÔ‡Ó ÔÈ ÂȉË̛˜ ·ÓÂÌ¢ÏÔÁÈ¿˜ ÛÙËÓ ·È‰È΋ ËÏÈΛ· (fiˆ˜ ¤ÁÈÓÂ Î·È Ì ÙËÓ ÂÚ˘ıÚ¿), ı· ·˘ÍËı› ÙÔ ÔÛÔÛÙfi ÙˆÓ Â›ÓÔÛˆÓ ÂÓËÏ›ÎˆÓ Ô˘ Û‹ÌÂÚ· ˘ÔÏÔÁ›˙ÂÙ·È Û <10% (fiˆ˜ ¤ÁÈÓÂ Î·È Ì ÙËÓ ÂÚ˘ıÚ¿), ı· ÌÂÙ·ÙÂı› Ë ËÏÈΛ· ÓfiÛËÛ˘ ÚÔ˜ Ù· ¿Óˆ (fiˆ˜ ¤ÁÈÓÂ Î·È Ì ÙËÓ ÂÚ˘ıÚ¿) Î·È Ë ·ÓÂÌ¢ÏÔÁÈ¿, Ô˘ ˆ˜ ÓfiÛËÌ· Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ Â›Ó·È ‹ÈÔ Ì ÂÈÏÔΤ˜ Û¿ÓȘ Î·È Î·Ï‹˜ ÚfiÁÓˆÛ˘, ı· ÌÂÙ·ÙÚ·› Û ÓfiÛËÌ· ÙˆÓ ÂÓËÏ›ÎˆÓ Ì ıÓËÙfiÙËÙ· Î·È ÔÏϤ˜ ÛÔ‚·Ú¤˜ ÂÈÏÔΤ˜. ∆Ô Ì¿ıËÌ· Ô˘ Ú¤ÂÈ Ó· ¿ÚÔ˘Ì ·fi ÙÔ ¿ıËÌ· Ù˘ ÂÚ˘ıÚ¿˜ Û˘ÓÔ„›˙ÂÙ·È ÛÙ· ÂÍ‹˜: ·) ÔÙ¤ È· ·ÙÔÌÈΤ˜ ·ÔÊ¿ÛÂȘ 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· ÎÔÈÓÔÔÈÂ›Ù·È ÂıÓÈ΋ ÛÙÚ·ÙËÁÈ΋ Î·È Ó· Û˘ÌÌÔÚÊÒÓÔÓÙ·È fiÏÔÈ Û ·˘Ù‹, Á) ÙÔ ‰È˜ ÂÍ·Ì·ÚÙÂ›Ó Ì ·Ó¿ÏÔÁ˜ ·Ûı¤ÓÂȘ, .¯. ·ÓÂÌ¢ÏÔÁÈ¿, ‰ÂÓ ı· Ì·˜ ηÎÔ¯·Ú·ÎÙËÚ›ÛÂÈ ·ÏÒ˜ ˆ˜ ÌË ÛÔÊÔ‡˜, ·ÏÏ¿ ÎÈÓ‰˘Ó‡ԢÌ ӷ Á›ÓÔ˘Ì ˘fiÏÔÁÔÈ ı·Ó¿ÙˆÓ Î·È ÂÈÏÔÎÒÓ Û Ó·ÚÔ‡˜ ·ÓÂÌ‚ÔÏ›·ÛÙÔ˘˜ ÂÓËÏ›ÎÔ˘˜ Ô˘ ¯ˆÚ›˜ ÙÔÓ ·ÙÂÏ‹ ÂÌ‚ÔÏÈ·ÛÌfi ÙÔ˘ ÏËı˘ÛÌÔ‡ ı· ›¯·Ó ·ÔÎÙ‹ÛÂÈ Ê˘ÛÈ΋ ·ÓÔÛ›· ·fi ÙËÓ ·È‰È΋ ÙÔ˘˜ ËÏÈΛ· Î·È ‰) ÛÙÔ˘˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡˜ ‰ÂÓ ·ÚΛ ÙÔ “ˆÊÂϤÂÈÓ” ÙÔ˘˜ ÂÏ¿Ù˜ Ì·˜, ÂÈ‚¿ÏÏÂÙ·È Û˘Á¯ÚfiÓˆ˜ ÙÔ “ÌË ‚Ï¿ÙÂÈÓ” fiÛÔ˘˜ ‰ÂÓ ¤¯Ô˘Ó ÙÔ ÚÔÓfiÌÈÔ Ó· Â›Ó·È ÂÏ¿Ù˜ Ì·˜. µÈ‚ÏÈÔÁÚ·Ê›· 1. ∞Ó‰Ú¤Ô˘ ∞, ¶ÂÚÈÛÙ¤ÚË µ. ª·Ï¿Ûη˜ ∞. ∂ȉËÌ›· Û˘Ó‰ÚfiÌÔ˘ Û˘ÁÁÂÓÔ‡˜ ÂÚ˘ıÚ¿˜ (™™∂) ÙÔ ¤ÙÔ˜ 1999. ¶·È‰È·ÙÚÈ΋ 2002;65:273-277.

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2. Panagiotopoulos T, Antoniadou I, Valassi-Adam E. Increase in congenital rubella after immunization in Greece: retrospective survey and systematic review. BMJ 1999;319:1462-1467.

3. Berger A. How does herd immunity work? BMJ 1999;319:1467.

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

5. πƒπ™, µ¿ÛË ∂ÏÏËÓÈ΋˜ µÈ‚ÏÈÔÁÚ·Ê›·˜ ÁÈ· ÙËÓ ÀÁ›· 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¿Ì˘ Ã, ÂÈÌ. ™˘ÌfiÛÈ·. 21Ô ∂Ù‹ÛÈÔ ¶·ÓÂÏÏ‹ÓÈÔ π·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ. ∞ı‹Ó·: π·ÙÚÈ΋ ∂Ù·ÈÚ›· ∞ıËÓÒÓ; 1995. ÛÂÏ. 28-36.

7. ¶·Ó·ÁȈÙfiÔ˘ÏÔ˜ ∆. ∆Ô Ê·ÈÓfiÌÂÓÔ Ù˘ Û˘ÏÏÔÁÈ΋˜ ·ÓÔÛ›·˜ Î·È Ë Ú·ÎÙÈ΋ ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡. ™ÙÔ: µ·Ï¿ÛÛË-∞‰¿Ì ∂, ¶·Ó·ÁȈÙfiÔ˘ÏÔ˜ ∆, ÂÈÌ. ∂Ì‚ÔÏÈ·ÛÌÔ›. ∞Ú¯¤˜ Î·È ‰ÈÏ‹ÌÌ·Ù· ÛÙËÓ ÎÏÈÓÈ΋ Ú¿ÍË. ∫ÏÈÓÈο ÊÚÔÓÙÈÛÙ‹ÚÈ·. ∞ı‹Ó·: π·ÙÚÈ΋ ∂Ù·ÈÚ›· ∞ıËÓÒÓ; 2000. ÛÂÏ. 70-83.

8. ¶·Ó·ÁȈÙfiÔ˘ÏÔ˜ ∆, ∞ÓÙˆÓÈ¿‰Ô˘ π, µ·Ï¿ÛÛË-∞‰¿Ì ∂. ŒÎıÂÛË πÀ¶. ªÂÁ¿ÏË ÂȉËÌ›· Û˘ÁÁÂÓÔ‡˜ ÂÚ˘ıÚ¿˜ ÙÔ 1993 ÛÙËÓ ∂ÏÏ¿‰·: ∂›ÁÔÓ Úfi‚ÏËÌ· ‰ËÌfiÛÈ·˜ ˘Á›·˜. ¢ÂÎ 1995, ∞ı‹Ó·.

9. ∂Á·ÎÏÈÔ˜ ÙÔ˘ ÀÔ˘ÚÁ›Ԣ ÀÁ›·˜ Î·È ¶ÚfiÓÔÈ·˜: ∞ÓÔÛÔÔ›ËÛË Î·Ù¿ Ù˘ πÏ·Ú¿˜-∂Ú˘ıÚ¿˜-¶·ÚˆÙ›Ùȉ·˜ ∞.¶. µ1/ÔÈÎ 2138, 29-4-1999.

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

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

12. µ·Ï¿ÛÛË-∞‰¿Ì ∂. ∞‰ËÌÔÛ›Â˘Ù˜ ÏËÚÔÊÔڛ˜ ·fi ¤Ú¢ӷ ÙÔ˘ πÀ¶ 2001.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 24-05-2002 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 28-05-2002 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∂ϤÓË µ·Ï¿ÛÛË-∞‰¿Ì À·Î›ÓıˆÓ 29, ∆.∫. 154 52, ¶. æ˘¯ÈÎfi E-mail: evadam@otenet.gr

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÷ڷÎÙËÚÈÛÙÈο ÙˆÓ Ì˘ÂÏÔ¸ÂÚÏ·ÛÙÈÎÒÓ Û˘Ó‰ÚfiÌˆÓ ÛÙËÓ ·È‰È΋ ËÏÈΛ· ™. ¶ÔÏ˘¯ÚÔÓÔÔ‡ÏÔ˘ - ∞Ó‰ÚÔ˘Ï·Î¿ÎË

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

¶ÂÚ›ÏË„Ë: ∆· Ì˘ÂÏÔ¸ÂÚÏ·ÛÙÈο Û‡Ó‰ÚÔÌ· (ªÀ™) ÛÙ· ·È‰È¿ ·ÔÙÂÏÔ‡Ó ÂӉȷʤÚÔ˘Û˜ ÎÏÈÓÈΤ˜ ÔÓÙfiÙËÙ˜, ÔÈ Ôԛ˜ ÏfiÁˆ Ù˘ Û·ÓÈfiÙËÙ¿˜ ÙÔ˘˜ ηٿ ÙËÓ ·È‰È΋ ËÏÈΛ·, ÌfiÏȘ ÚfiÛÊ·Ù· ¤¯Ô˘Ó ·Ú¯›ÛÂÈ Ó· ÌÂÏÂÙÒÓÙ·È ϤÔÓ ÂÈÛٷ̤ӷ. ∫·Ù’ ·Ó·ÏÔÁ›· Ì ÙȘ ·ÓÙ›ÛÙÔȯ˜ ÎÏÈÓÈΤ˜ ÔÓÙfiÙËÙ˜ ÙˆÓ ÂÓËϛΈÓ, ÛÙ· ªÀ™ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È Ë ¯ÚfiÓÈ· Ì˘ÂÏÔÁÂÓ‹˜ Ï¢¯·ÈÌ›· Ù‡Ô˘ ÂÓËÏ›ÎÔ˘, Ë ·ÏËı‹˜ ÔÏ˘Î˘ÙÙ·Ú·ÈÌ›·, Ë È‰ÈÔ·ı‹˜ ıÚÔÌ‚Ô΢ÙÙ·Ú·ÈÌ›·, Ë È‰ÈÔ·ı‹˜ Ì˘ÂÏÔ˝ÓˆÛË, ÂÓÒ È‰È·›ÙÂÚË ÔÓÙfiÙËÙ· Ì˘ÂÏÔ¸ÂÚÏ·ÛÙÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ Ô˘ ··ÓÙ¿Ù·È ·ÔÎÏÂÈÛÙÈο ÛÙËÓ ·È‰È΋ ËÏÈΛ· ·ÔÙÂÏ› Ë Ó·ÓÈÎÔ‡ Ù‡Ô˘ Ì˘ÂÏÔÌÔÓÔ΢ÙÙ·ÚÈ΋ Ï¢¯·ÈÌ›·. ¶·Ú¿ ÙÔ fiÙÈ ÔÈ ·ÓˆÙ¤Úˆ ÔÓÙfiÙËÙ˜ ÂÚÈÎÏ›ÔÓÙ·È ÛÙËÓ ›‰È· ÔÌ¿‰· ÙˆÓ ªÀ™, ÂοÛÙË ÂÍ ·˘ÙÒÓ ·ÚÔ˘ÛÈ¿˙ÂÈ È‰È·ÈÙÂÚfiÙËÙ˜ ÛÙËÓ ÎÏÈÓÈ΋ ÚÔ‚ÔÏ‹, ÙËÓ ÂÚÁ·ÛÙËÚȷ΋ ÂÈÎfiÓ· Î·È Ù· ˘ÔΛÌÂÓ· ‚ÈÔÏÔÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο. ∫ÔÈÓ¿ ÛÙÔȯ›· Ô˘, ˆ˜ Â› ÙÔ Ï›ÛÙÔÓ, ÙȘ Û˘Ó‰¤Ô˘Ó ·ÔÙÂÏÔ‡Ó: ·) Ô ÎψÓÈÎÔ‡ Ù‡Ô˘ ÔÏÏ·Ï·ÛÈ·ÛÌfi˜ ÂÓfi˜ ·ÓÒÌ·ÏÔ˘ ·Ú¯¤ÁÔÓÔ˘ ·ÈÌÔÔÈËÙÈÎÔ‡ ΢ÙÙ¿ÚÔ˘, ‚) Ë Û˘ÌÌÂÙÔ¯‹ fiÏˆÓ ÙˆÓ Î˘ÙÙ·ÚÈÎÒÓ ÛÂÈÚÒÓ ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ (ªO) ÛÙËÓ ·ıÔÏÔÁÈ΋ ‰È·‰Èηۛ·, ·Ú¿ ÙÔ fiÙÈ ÛÙÔ ·›Ì· ‰˘Ó·ÙfiÓ Ó· ÂΉËÏÒÓÔÓÙ·È Ì ȉȷ›ÙÂÚ· ÂÚÁ·ÛÙËÚȷο ¯·Ú·ÎÙËÚÈÛÙÈο, Á) Ë ÔÈΛÏÔ˘ ‚·ıÌÔ‡ ÚÔ‹ ÙÔ˘˜ ÁÈ· ÂͤÏÈÍË Û ÔÍ›· Ï¢¯·ÈÌ›· Î·È ‰) ÔÈ Û˘¯Ó¿, ·Ú¯Èο, ·ÏÏËÏÔÂÈÎ·Ï˘ÙfiÌÂÓ˜ ÎÏÈÓÈΤ˜ Î·È ÂÚÁ·ÛÙËÚȷΤ˜ ÂÈÎfiÓ˜, ÔÈ Ôԛ˜ ÛÙËÓ ÔÚ›· ¿ÏÏÔÙÂ Û˘ÁÎÏ›ÓÔ˘Ó Î·È ¿ÏÏÔÙ ·ÔÎÏ›ÓÔ˘Ó ˘¤Ú ‰È·ÊÔÚÂÙÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ. OÈ ˘ÔΛÌÂÓÔÈ ·ıÔÁÂÓÂÙÈÎÔ› Ì˯·ÓÈÛÌÔ› Â›Ó·È ÂÓ ÔÏÏÔ›˜ ¿ÁÓˆÛÙÔÈ, ÙÔ˘Ï¿¯ÈÛÙÔÓ ÛÙ· ·È‰È¿, ·ÏÏ¿ Ê·›ÓÂÙ·È fiÙÈ ·ÔÙÂÏÔ‡Ó ·ÓÙ·Ó·ÎÏ¿ÛÂȘ ÙˆÓ ÁÂÓÂÙÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ Ô˘ ¤¯Ô˘Ó ÂÈÛ˘Ì‚Â› ÛÙÔÓ ·ıÔÏÔÁÈÎfi ·ÈÌÔÔÈËÙÈÎfi ÎÏÒÓÔ.

Abstract: The myeloproliferative syndromes (MPS) in children represent interesting clinicohaematological entities which, due to their rarity during childhood, have been studied thoroughly only recently. In comparison to their equivalent adult haematological types, chronic myeloid leukemia (Philadelphia positive-adult type), polycythemia vera, essential thrombocythemia and idiopathic myelofilibrosis are included in childhood MPS, while juvenile myelomonocytic leukaemia (JMML) occurs almost exclusively in children. In spite of the fact that all the above entities are grouped within the same type of diseases in that they all show myeloproliferative characteristics, nevertheless each one of them has a distinct clinical and/or haematological presentation, while differences in the underlying pathophysiology have recently been identified. Common pathogenetic links that are similar among this group of diseases include: a) abnormal clonal growth of a genetically defective hemopoietic stem cell clone which results in a multilineage clonal process, b) existence of lineage heterogeneity among particular diseases, because of hierarchically different levels of clonal generation, c) the existence of a pathologically and clinically distinct disease variety, due to different sets of genetic lesions responsible for them and d) the various tendency, because of the inherent genetic instability of the transformed cell, to clonal evolution and indigenous disease transformation to acute leukemia. Nevertheless, the underlying pathogenetic mechanisms still remain unknown at least among children, reflecting a wide spectrum of different genetic alterations of the abnormally disturbed haemopoietic clone.

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

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

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july-aug02TELIKO

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™ÂÏ›‰·223

¶·È‰È·ÙÚÈ΋ 2002;65:222-231

Paediatriki 2002;65:222-231

§¤ÍÂȘ ÎÏÂȉȿ: ¯ÚfiÓÈ· Ì˘ÂÏÔÁÂÓ‹˜ Ï¢¯·ÈÌ›· Ù‡Ô˘ ÂÓËÏ›ÎÔ˘, ·ÏËı‹˜ ÔÏ˘Î˘ÙÙ·Ú·ÈÌ›·, ȉÈÔ·ı‹˜ ıÚÔÌ‚Ô΢ÙÙ·Ú·ÈÌ›·, ȉÈÔ·ı‹˜ Ì˘ÂÏÔ˝ÓˆÛË, Ó·ÓÈÎÔ‡ Ù‡Ô˘ Ì˘ÂÏÔÌÔÓÔ΢ÙÙ·ÚÈ΋ Ï¢¯·ÈÌ›·, Ì˘ÂÏÔ¸ÂÚÏ·ÛÙÈο Û‡Ó‰ÚÔÌ·, ·È‰È΋ ËÏÈΛ·.

Key words: chronic myeloid leukemia, polycythemia vera, essential thrombocythemia, idiopathic myelofibrosis, juvenile myelomonocytic leukemia, myeloproliferative syndromes, child-hood.

÷ڷÎÙËÚÈÛÙÈο ÙˆÓ Ì˘ÂÏÔ¸ÂÚÏ·ÛÙÈÎÒÓ Û˘Ó‰ÚfiÌˆÓ ÛÙËÓ ·È‰È΋ ËÏÈΛ· ∆· Ì˘ÂÏÔ¸ÂÚÏ·ÛÙÈο Û‡Ó‰ÚÔÌ· (ªÀ™) ÛÙ· ·È‰È¿ Û˘ÓÈÛÙÔ‡Ó Û¿ÓȘ, ·ÏÏ¿ ÂÍ·ÈÚÂÙÈο ÂӉȷʤÚÔ˘Û˜ ÎÏÈÓÈΤ˜ ÔÓÙfiÙËÙ˜, ÏfiÁˆ ‰Â Ù˘ Û·ÓÈfiÙËÙ¿˜ ÙÔ˘˜ ÌfiÏȘ ÚfiÛÊ·Ù· ¤¯Ô˘Ó ·Ú¯›ÛÂÈ Ó· ÌÂÏÂÙÒÓÙ·È ϤÔÓ ÂÈÛٷ̤ӷ ÛÙËÓ ·È‰È΋ ËÏÈΛ· (1,2). ∞ÓÙ›ıÂÙ·, ÛÙÔ ¯ÒÚÔ Ù˘ ·ÈÌ·ÙÔÏÔÁ›·˜ ÙˆÓ ÂÓËϛΈÓ, Ù· ªÀ™ Â›Ó·È ÁÓˆÛÙ¿ ·fi ÙÔ 1951 fiÙ·Ó ÚˆÙÔÂÚÈÁÚ¿ÊËÎ·Ó ·fi ÙÔÓ Dameshek, Ô ÔÔ›Ô˜ ˘fi ÙÔ ÁÂÓÈÎfi ·˘Ùfi fiÚÔ Â›¯Â Û˘ÌÂÚÈÏ¿‚ÂÈ ÙËÓ ·ÏËı‹ ÔÏ˘Î˘ÙÙ·Ú·ÈÌ›· (∞¶), ÙË Ì˘ÂÏÔ˝ÓˆÛË ‹ Ì˘ÂÏÔÂȉ‹ ÌÂÙ·Ï·Û›· (ªª), ÙËÓ È‰ÈÔ·ı‹ ıÚÔÌ‚Ô΢ÙÙ·Ú·ÈÌ›· (π£) Î·È ÙË ¯ÚfiÓÈ· Ì˘ÂÏÔÁÂÓ‹ Ï¢¯·ÈÌ›· (ê§) (3). ∆· ªÀ™ Û˘ÁηٷϤÁÔÓÙ·È ÛÙȘ ÚÔÏ¢¯·ÈÌÈΤ˜ ηٷÛÙ¿ÛÂȘ, ÂÌÊ·Ó›˙ÔÓÙ·˜ ·˘ÍË̤ÓË Ù¿ÛË ÂͤÏÈ͢ Û ϤÔÓ ÂÈıÂÙÈο ÎψÓÈÎÔ‡ Ù‡Ô˘ ÓÔÛ‹Ì·Ù· (4). OÈ ·Ú¿ÁÔÓÙ˜, ÔÈ ÔÔ›ÔÈ Ì ÙËÓ ‰Ú¿ÛË ÙÔ˘˜ ‰ËÌÈÔ˘ÚÁÔ‡Ó ‹ ÂÈϤÁÔ˘Ó ˘¤Ú ÂÓfi˜ ·ıÔÏÔÁÈÎÔ‡ ΢ÙÙ·ÚÈÎÔ‡ ÎÏÒÓÔ˘ Ô˘ ÛÙË Û˘Ó¤¯ÂÈ· ·Ó·Ù‡ÛÛÂÙ·È ˘¤ÚÌÂÙÚ·, Â›Ó·È ÂÓ ÔÏÏÔ›˜ ¿ÁÓˆÛÙÔÈ. ÕÁÓˆÛÙÔ ·ÎfiÌË ·Ú·Ì¤ÓÂÈ ÙÈ Ô‰ËÁ› ÛÙËÓ ÙÂÏÈ΋ ÂÈÎÚ¿ÙËÛË Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ÎÏÈÓÈÎÒÓ Î·È ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂΉËÏÒÛÂˆÓ ÌÂٷ͇ ÙˆÓ ‰È·ÊfiÚˆÓ Ì˘ÂÏÔ¸ÂÚÏ·ÛÙÈÎÒÓ Û˘Ó‰ÚfïÓ. ¶Èı·Ófiٷٷ, fï˜, ·ÔÙÂÏÔ‡Ó ·ÓÙ·Ó·ÎÏ¿ÛÂȘ ÙˆÓ ÁÂÓÂÙÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ ÙÔ˘ DNA Ô˘ ¤¯Ô˘Ó ÂÈÛ˘Ì‚Â› ÛÙ· ۈ̷ÙÈο ·ÙÙ·Ú· ÙÔ˘ ·ıÔÏÔÁÈÎÔ‡ ·ÈÌÔÔÈËÙÈÎÔ‡ ÎÏÒÓÔ˘ (2-4). ™Ù· ÁÂÓÈο Î·È ÎÔÈÓ¿ ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ªÀ™ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È Ë ·‡ÍËÛË, ÌÂÌÔӈ̤ӷ ‹ ÛÂ Û˘Ó‰˘·ÛÌfi, ÙˆÓ Ï¢ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ, ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ Î·È ÙˆÓ ÂÚ˘ıÚÔ΢ÙÙ¿ÚˆÓ, ÂÓÒ Û fiϘ ۯ‰fiÓ ÙȘ ÂÚÈÙÒÛÂȘ ‰È·ÈÛÙÒÓÂÙ·È ÎÏÈÓÈο ÛÏËÓÔÌÂÁ·Ï›· (3). ∞Ó Î·È Ë ÎÏÈÓÈ΋ ÂÌÊ¿ÓÈÛË Î·È Ë ·ıÔÁ¤ÓÂÈ¿ ÙÔ˘˜ ‰È·Ê¤ÚÂÈ ·fi ÙËÓ ÔÌ¿‰· ÙˆÓ Ì˘ÂÏÔ‰˘ÛÏ·ÛÙÈÎÒÓ Û˘Ó‰ÚfiÌˆÓ (ª¢™), Û˘¯Ó¿ Ë ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ÌÂٷ͇ ÙˆÓ ‰‡Ô ·˘ÙÒÓ ÔÓÙÔÙ‹ÙˆÓ Â›Ó·È ‰˘Û¯ÂÚ‹˜ (5). ™ÙËÓ ·È‰È΋ ËÏÈΛ·, Ù· ªÀ™ ÂÎÚÔÛˆÔ‡ÓÙ·È Î·Ù¿ ·ÚÈÔ ÏfiÁÔ ·fi ÙËÓ Ãª§ ÂÓËÏ›ÎÔ˘ Ù‡Ô˘, ÙË Ó·ÓÈÎÔ‡ Ù‡Ô˘ Ì˘ÂÏÔÌÔÓÔ΢ÙÙ·ÚÈ΋ Ï¢¯·ÈÌ›· (JMML), ÙËÓ ·ÏËı‹ ÔÏ˘Î˘ÙÙ·Ú·ÈÌ›·, ÙËÓ È‰ÈÔ·ı‹ ıÚÔÌ‚Ô΢ÙÙ¿ÚˆÛË, ÂÓÒ ÔÈ ÏÔÈ¤˜ ÌÔÚʤ˜ ªÀ™ Â›Ó·È ÂÍ·ÈÚÂÙÈο Û¿ÓȘ (1,2,5). ™·Ó ÚԉȷıÂÛÈÎÔ› ·Ú¿ÁÔÓÙ˜ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ÙˆÓ ªÀ™ ÛÙ· ·È‰È¿ ıˆÚÔ‡ÓÙ·È Ù· Û‡Ó‰ÚÔÌ· Down, Kostmann,

Noonan Î·È Schwachmann, Ë ·Ó·ÈÌ›· Fanconi, Ô ÌˆÛ·˚ÎÈÛÌfi˜ Ù˘ ÙÚÈۈ̛·˜ 8, Ë Ó¢ÚÔ˚ӈ̿وÛË Ù‡Ô˘ 1, ÔÈ ·ÓÔÛÔ·ÓÂ¿ÚÎÂȘ, Ù˘¯fiÓ ÚÔËÁËı›۷ ¯ËÌÂÈÔıÂÚ·›· Î.Ï. (1,2,5). ÃÚfiÓÈ· Ì˘ÂÏÔÁÂÓ‹˜ Ï¢¯·ÈÌ›· Ù‡Ô˘ ÂÓËÏ›ÎÔ˘ (ê§) ∞ÔÙÂÏ› ÙÔ 2-5% ÙÔ˘ Û˘ÓfiÏÔ˘ Ù˘ ·È‰È΋˜ Ï¢¯·ÈÌ›·˜ Î·È Ë ÂÙ‹ÛÈ· Â›ÙˆÛË ÙÔ˘ ÓÔÛ‹Ì·ÙÔ˜ Â›Ó·È ÌÈÎÚfiÙÂÚË ·fi 1/105 ¿ÙÔÌ· ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ 20 ÂÙÒÓ. ∏ ·ÈÙÈÔÏÔÁ›· Ù˘ ÓfiÛÔ˘ ÁÂÓÈο ·Ú·Ì¤ÓÂÈ ¿ÁÓˆÛÙË, ·Ó Î·È ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙ› Ì ÙËÓ ÈÔÓ›˙Ô˘Û· ·ÎÙÈÓÔ‚ÔÏ›· ÏfiÁˆ ·‡ÍËÛ˘ ÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ ¤ˆ˜ Î·È 7 ÊÔÚ¤˜ ·fi ÙÔ ·Ó·ÌÂÓfiÌÂÓÔ ÛÙ· ÌÈÎÚ¿ ·È‰È¿, ÌÂÙ¿ ·fi ÙËÓ ˘ÚËÓÈ΋ ¤ÎÚËÍË ÛÙË ÃÈÚÔ̷ۛ Î·È ÙÔ ¡·ÁηۿÎÈ (1,2). ÷ڷÎÙËÚÈÛÙÈÎfi ΢ÙÙ·ÚÔÁÂÓÂÙÈÎfi ‡ÚËÌ· Ù˘ ÓfiÛÔ˘ ·ÔÙÂÏ› Ë ÌÂÙ¿ıÂÛË t (9;22), ÁÓˆÛÙ‹ Î·È ˆ˜ ¯ÚˆÌfiۈ̷ ºÈÏ·‰¤ÏÊÂÈ·˜, Ë ÔÔ›· Ì ÙȘ ÎÏ·ÛÈΤ˜ ΢ÙÙ·ÚÔÁÂÓÂÙÈΤ˜ ÌÂıfi‰Ô˘˜ ·ÓȯÓ‡ÂÙ·È ÛÙÔ 90%, ÂÓÒ Ì ÌÔÚÈ·ÎÔ‡˜ ·ÓȯÓÂ˘Ù¤˜ ÛÙÔ 100% ÙˆÓ ·Û¯fiÓÙˆÓ. ∏ ÏÂÙÔÌÂÚ‹˜ ·Ó¿Ï˘ÛË ÙˆÓ ÛËÌ›ˆÓ ıÚ·‡Û˘ ÙˆÓ ¯ÚˆÌÔÛˆÌ¿ÙˆÓ ÛÙȘ ı¤ÛÂȘ 9q34 Î·È 22q11 ¤‰ˆÛ ÙËÓ Â˘Î·ÈÚ›· Î·È ÙË ‰˘Ó·ÙfiÙËÙ· ηٷÓfiËÛ˘ ÛËÌ·ÓÙÈÎÔ‡ ÙÌ‹Ì·ÙÔ˜ Ù˘ ·ıÔÁ¤ÓÂÈ·˜ Ù˘ ê§ (5). ∂›Ó·È ÁÓˆÛÙfi Û‹ÌÂÚ· fiÙÈ ÛÙÔ ¯ÚˆÌfiۈ̷ 9 Î·È ÛÙËÓ ÂÚÈÔ¯‹ 9q34 ‰ڿ˙ÂÙ·È ÙÔ ÚˆÙÔ-ÔÁÎÔÁÔÓ›‰ÈÔ abl, ÙÔ ÔÔ›Ô Îˆ‰ÈÎÔÔÈ› ÚˆÙ½ÓË Ô˘ ¤¯ÂÈ ‰Ú¿ÛË ÎÈÓ¿Û˘ Ù˘ Ù˘ÚÔÛ›Ó˘ Î·È Ô ÏÂÈÙÔ˘ÚÁÈÎfi˜ Ù˘ ÚfiÏÔ˜ ·ÊÔÚ¿ ÛÙËÓ ÂÓ‰Ô΢ÙÙ¿ÚÈ· ÌÂÙ·ÁˆÁ‹ Û‹Ì·ÙÔ˜, Û˘ÌÌÂÙ¤¯ÔÓÙ·˜ ÛËÌ·ÓÙÈο ÛÙÔÓ ÔÏÏ·Ï·ÛÈ·ÛÌfi Î·È ÙË ‰È·ÊÔÚÔÔ›ËÛË ÙˆÓ Ì˘ÂÏÈÎÒÓ Î˘ÙÙ¿ÚˆÓ (2). ªÂ ÙË ÌÂÙ¿ıÂÛË Î·È Û‡ÓÙËÍË ÙˆÓ ÂÚÈÔ¯ÒÓ bcr/abl Û¯ËÌ·Ù›˙ÂÙ·È ·ıÔÏÔÁÈ΋ ÚˆÙ½ÓË ÌÂÁ¤ıÔ˘˜ 210 kd, Ë ÔÔ›· ÂÌÊ·Ó›˙ÂÈ ¯·Ú·ÎÙËÚÈÛÙÈο ÂÓÂÚÁÔÔÈË̤Ó˘ ÎÈÓ¿Û˘ Ù˘ Ù˘ÚÔÛ›Ó˘. ∏ ·ÚÈ· ‰Ú¿ÛË Ù˘ p210 Â›Ó·È Ë ÊˆÛÊÔÚ˘Ï›ˆÛË ÛÂÈÚ¿˜ ΢ÙÙ·ÚÈÎÒÓ ÚˆÙÂ˚ÓÒÓ, ·Ó¿ÌÂÛ· ÛÙȘ Ôԛ˜ Û˘ÁηٷϤÁÔÓÙ·È Î·È ÌfiÚÈ· ˘‡ı˘Ó· ÁÈ· ÙÔÓ ÔÏÏ·Ï·ÛÈ·ÛÌfi Î·È ‰È·ÊÔÚÔÔ›ËÛË ÙÔ˘ ΢ÙÙ¿ÚÔ˘. ∆ÂÏÈÎfi ·ÔÙ¤ÏÂÛÌ· fiÏ˘ ·˘Ù‹˜ Ù˘ ‰È·‰Èηۛ·˜ Â›Ó·È Ë ÌÂÙ·ÁˆÁ‹ ÚÔ˜ ÙÔÓ ˘Ú‹Ó· ÙÔ˘ ΢ÙÙ¿ÚÔ˘ Û˘Ó¯ԇ˜ Û‹Ì·ÙÔ˜, Ô˘ Ô‰ËÁ› Û ÌË ÂÏÂÁ¯fiÌÂÓÔ ÔÏÏ·Ï·ÛÈ·ÛÌfi Î·È ÂÎÙÚÔ‹ ÙÔ˘ Û ηÎfiËı˜ (2). ∞Ó¿ÏÔÁË ÌÂÙ¿ıÂÛË ¤¯ÂÈ ·Ú·ÙËÚËı› Î·È ÛÙȘ ÔÍ›˜ ÏÂÌÊÔ‚Ï·ÛÙÈΤ˜ Ï¢¯·È̛˜ (O§§), ·ÏÏ¿ ÛÙËÓ ÚÔÎÂÈ̤ÓË ÂÚ›ÙˆÛË ÚfiÎÂÈÙ·È ÁÈ· ‰È·ÊÔÚÂÙÈ΋

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ÚˆÙ½ÓË, ÙÔ Ì¤ÁÂıÔ˜ Ù˘ ÔÔ›·˜ ·Ó¤Ú¯ÂÙ·È ÛÙ· 185 kd. ∏ p185 ÚÔ¤Ú¯ÂÙ·È Î·È ·˘Ù‹ ·fi ÙË Û‡ÓÙËÍË ÙˆÓ 2 ·Ó·ÊÂÚı¤ÓÙˆÓ ÁÔÓȉ›ˆÓ bcr-abl, Ù· ÔÔ›· fï˜ ¤¯Ô˘Ó ˘ÔÛÙ› ıÚ·‡ÛË Û ‰È·ÊÔÚÂÙÈο ÛËÌ›· Î·È Î·Ù’ Â¤ÎÙ·ÛË Î·È Ë ÏÂÈÙÔ˘ÚÁÈ΋ Ù˘ ‰Ú¿ÛË ÂÓ¤¯ÂÈ ‰È·ÊÔÚ¤˜ Û ۯ¤ÛË Ì ÙËÓ p210 (2,4). ∫ÏÈÓÈ΋ ÚÔ‚ÔÏ‹ ∏ Û˘Ìو̷ÙÔÏÔÁ›· ÂÍ·ÚÙ¿Ù·È ¿ÌÂÛ· ·fi ÙËÓ ·ıÔÁ¤ÓÂÈ· Ù˘ ÓfiÛÔ˘ Ô˘ Ô‰ËÁ› Û ˘¤ÚÌÂÙÚË ·‡ÍËÛË ÙˆÓ ·ÒÚˆÓ Î·È ˆÚ›ÌˆÓ ÎÔÎÎÈÔ΢ÙÙ¿ÚˆÓ, ηıÒ˜ Î·È ÛÙË Û˘Ó˘¿Ú¯Ô˘Û· ÂÎÛÂÛËÌ·Ṳ̂ÓË ÛÏËÓÔÌÂÁ·Ï›·. ∞Ó·ÈÌ›·, ˘ÚÂÙfi˜, ȉÚÒÙ˜, ·ÒÏÂÈ· ‚¿ÚÔ˘˜, ‰˘ÛÂÙÈο ÂÓԯϋ̷ٷ, ηÎÔ˘¯›·, ÎÔÈÏȷο ¿ÏÁË, ·ÈÌÔÚÚ·ÁÈ΋ ‰È¿ıÂÛË, ÔÛÙÈο ¿ÏÁË ‹ ·ÚıÚ·ÏÁ›Â˜, ·ÔÙÂÏÔ‡Ó Ù· Û˘¯ÓfiÙÂÚ· ÂÌÊ·ÓÈ˙fiÌÂÓ· Û˘ÌÙÒÌ·Ù·. §fiÁˆ ÙÔ˘ ·˘ÍË̤ÓÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ Ï¢ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ Û˘¯ÓfiÙÂÚ· ÛÙ· ·È‰È¿ ÂÌÊ·Ó›˙ÂÙ·È Ï¢ÎfiÛÙ·ÛË, Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÂÌÊ¿ÓÈÛË ·ÛÙ¿ıÂÈ·˜, Û·ÛÌÒÓ Î·È ÚÈ·ÈÛÌÔ‡. ∞fi ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË ‰È·ÈÛÙÒÓÂÙ·È ÛÏËÓÔÌÂÁ·Ï›·, Ë ÔÔ›· Û˘¯Ó¿ Â›Ó·È ÂÎÛÂÛËÌ·Ṳ̂ÓË, ¯ˆÚ›˜ Ó· Û˘Óԉ‡ÂÙ·È ·fi ‰ÈfiÁΈÛË ‹·ÙÔ˜ ‹ ÏÂÌÊ·‰¤ÓˆÓ, ÂÓÒ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ÛËÌ›· Ï¢ÎfiÛÙ·Û˘, ÂÈϤÔÓ, ·Ó¢ڛÛÎÔÓÙ·È Ô›‰ËÌ· ÔÙÈÎÒÓ ıËÏÒÓ, ·ÚÂÁÎÂÊ·ÏȉÈ΋ ÛËÌÂÈÔÏÔÁ›· Î·È ‰ÂÚÌ·ÙÈο Ô˙›‰È· ÔÊÂÈÏfiÌÂÓ· Û ÂÍˆÌ˘ÂÏÈ΋ ·ÈÌÔÔ›ËÛË (1,2).

O ·ÚÈıÌfi˜ ÙˆÓ Ï¢ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ Û˘¯Ó¿ ˘ÂÚ‚·›ÓÂÈ Ù· 105/Îί, ÂÓÒ Û·ÓÈfiÙÂÚ· ·Ó¤Ú¯ÂÙ·È Î·È ¿Óˆ ÙˆÓ 106/Îί, ÙÔ ‰Â Â›¯ÚÈÛÌ· ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜ ÂÚÈÏ·Ì‚¿ÓÂÈ Î‡ÙÙ·Ú· Ù˘ Ì˘ÂÏÈ΋˜ ÛÂÈÚ¿˜ Û fiϘ ÙȘ ‚·ıÌ›‰Â˜ ˆÚ›Ì·ÓÛ˘. ™ÙÔ Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ (ªO) ‰È·ÈÛÙÒÓÂÙ·È ˘ÂÚÔ¯‹ Ù˘ Ï¢΋˜ ÛÂÈÚ¿˜, ·‡ÍËÛË ÙˆÓ ÌÔÓÔ‡ÚËÓˆÓ, ·Ó‡ÚÂÛË ‰˘ÛÏ·ÛÙÈÎÒÓ ‚·ÛÂfiÊÈÏˆÓ Î·È ËˆÛÈÓfiÊÈÏˆÓ Î·È ÛÙË ¯ÚfiÓÈ· Ê¿ÛË Ù˘ ÓfiÛÔ˘ Ù· ‚Ï·ÛÙÈο ·ÙÙ·Ú· Â›Ó·È Î¿Ùˆ ÙÔ˘ 5%. ™ÙËÓ ÔÛÙÂÔÌ˘ÂÏÈ΋ ‚ÈÔ„›· (Oµ) ·Ó¢ڛÛÎÂÙ·È ›ÓˆÛË, Ë ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ·ÏηÏÈ΋˜ ʈÛÊ·Ù¿Û˘ ÙˆÓ Ï¢ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ (LAP score) Â›Ó·È ÂÏ·Ùو̤ÓË, ÂÓÒ ·˘ÍË̤ÓË ·Ó¢ڛÛÎÂÙ·È Ë ÚˆÙ½ÓË Ô˘ ‰ÂÛ̇ÂÈ ÙË ‚ÈÙ·Ì›ÓË µ12. ∞·Ú·›ÙËÙÔ ÛÙÔÈ¯Â›Ô ÁÈ· ÙË ‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘ ·ÔÙÂÏ› Ë ·Ó‡ÚÂÛË Ù˘ ÌÂÙ¿ıÂÛ˘ t(9;22), Ë ÔÔ›· Û˘¯Ó¿ ·ÓȯÓ‡ÂÙ·È Î·È Û ÂÚÈfi‰Ô˘˜ ‡ÊÂÛ˘ Ù˘ ê§ (2). ∏ ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË Ù˘ ê§ Ù‡Ô˘ ÂÓËÏ›ÎÔ˘ ÂÚÈÏ·Ì‚¿ÓÂÈ ÓÔÛ‹Ì·Ù· fiˆ˜ Ë Ó·ÓÈÎÔ‡ Ù‡Ô˘ Ì˘ÂÏÔÌÔÓÔ΢ÙÙ·ÚÈ΋ Ï¢¯·ÈÌ›· (juvenile myelomonocytic leukaemia-JMML) (¶›Ó·Î·˜ 1), Ë ÔÍ›· Ì˘ÂÏÔÁÂÓ‹˜ Ï¢¯·ÈÌ›· (Oª§) (Â› ‚Ï·ÛÙÈ΋˜ ÎÚ›Ûˆ˜) Î·È ÔÈ ‰È·ÊfiÚÔ˘ ·ÈÙÈÔÏÔÁ›·˜ Ï¢¯·ÈÌÔÂȉ›˜ ·ÓÙȉڿÛÂȘ fiˆ˜ Â› ÛÔ‚·ÚÒÓ ÏÔÈÌÒ͈Ó, Û˘ÁÁÂÓÒÓ Î·Ú‰È·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ Î.¿. ™ÙË ‚Ï·ÛÙÈ΋ ÎÚ›ÛË Ù˘, Ë Ãª§ ÂÓ›ÔÙ ‰ËÌÈÔ˘ÚÁ›

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Úfi‚ÏËÌ· ‰È·ÊÔÚÈ΋˜ ‰È¿ÁÓˆÛ˘ ·fi ÙË de novo ÔÍ›· ÏÂÌÊÔ‚Ï·ÛÙÈ΋ Ï¢¯·ÈÌ›· (O§§), ÙÔ ÔÔ›Ô ÂÈχÂÙ·È ·fi ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙÔ˘ ÌÂÁ¤ıÔ˘˜ Ù˘ ÚˆÙ½Ó˘ Ô˘ ·Ú¿ÁÂÙ·È ·fi ÙË Û‡ÓÙËÍË ÙˆÓ ÁÔÓȉ›ˆÓ bcr/abl. ∏ ‚Ï·ÛÙÈ΋ ÎÚ›ÛË ÛÙ· ·È‰È¿ Ì ê§ Û˘Ó‹ıˆ˜ ÂÌÊ·Ó›˙ÂÙ·È ÂÓÙfi˜ 3 ¯ÚfiÓˆÓ ·fi ÙËÓ ·Ú¯È΋ ‰È¿ÁÓˆÛË, ÛÙ· 2/3 ÙˆÓ ÂÚÈÙÒÛÂˆÓ ·ÊÔÚ¿ ÙË Ì˘ÂÏÈ΋ Î·È ÛÙÔ 1/3 ÙË ÏÂÌÊÈ΋ ÛÂÈÚ¿. ™ÙËÓ ÙÂÏÂ˘Ù·›· ÂÚ›ÙˆÛË, ÙÔ Ï¢¯·ÈÌÈÎfi ·ÙÙ·ÚÔ Â›Ó·È µ-΢ÙÙ·ÚÈ΋˜ ÚÔ¤Ï¢Û˘ Î·È ÛÙ· ·ÙÙ·Ú· ÙÔ˘ ªO ηٿ ηÓfiÓ· ÂÌÊ·Ó›˙ÔÓÙ·È ÂÈÚfiÛıÂÙ˜ ΢ÙÙ·ÚÔÁÂÓÂÙÈΤ˜ ‚Ï¿‚˜ (2). ∏ ÓfiÛÔ˜ Û˘Ó‹ıˆ˜ ÂÌÊ·Ó›˙ÂÙ·È ÛÙËÓ ¯ÚÔÓ›· Ù˘ Ê¿ÛË, Ë ÔÔ›· ‰È·ÚΛ ÂÚ›Ô˘ ̤¯ÚÈ 3 ¤ÙË. ∏ ÂÈÙ·¯˘ÓfiÌÂÓË Ê¿ÛË Ù˘ ê§ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ·ÓıÂÎÙÈÎfiÙËÙ· ÙˆÓ Ï¢¯·ÈÌÈÎÒÓ Î˘ÙÙ¿ÚˆÓ ÛÙ· ‹‰Ë ¯ÔÚËÁÔ‡ÌÂÓ· ¯ËÌÂÈÔıÂÚ·¢ÙÈο Û΢¿ÛÌ·Ù·, ·‡ÍËÛË ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙÔ˘ ÛÏËÓfi˜, ·Ó·ÈÌ›· Î·È ·ÒÏÂÈ· ‚¿ÚÔ˘˜. ∫·Ù¿ ηÓfiÓ· ·ÎÔÏÔ˘ı› Ë ‚Ï·ÛÙÈ΋ ÎÚ›ÛË Ô˘ ÌÔÚ› Ó· ÚÔ¤Ú¯ÂÙ·È, fiˆ˜ ‹‰Ë ·Ó·Ê¤ÚıËÎÂ, ·fi ·ÙÙ·ÚÔ Ù˘ Ì˘ÂÏÈ΋˜ ‹ Ù˘ ÏÂÌÊÈ΋˜ ÛÂÈÚ¿˜ (1,2). ∏ ıÂÚ·›· Ù˘ ÓfiÛÔ˘ ÛÙË ¯ÚfiÓÈ· Ê¿ÛË ·Ï·ÈfiÙÂÚ· ÛÙËÚÈ˙fiÙ·Ó Û ¯ÔÚ‹ÁËÛË ˘‰ÚÔ͢Ԣڛ·˜ Î·È ‚Ô˘ÛÔ˘ÏÊ¿Ó˘. ∆· ÙÂÏÂ˘Ù·›·, fï˜, ¯ÚfiÓÈ· ˘¿Ú¯ÂÈ Ë Ù¿ÛË ¯ÔÚ‹ÁËÛ˘ ÈÓÙÂÚÊÂÚfiÓ˘-· Ì ‹ ¯ˆÚ›˜ ¯ËÌÂÈÔıÂÚ·›· Ô˘ ΢ڛˆ˜ ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ·Ú·Û˘Ù›ÓË. ¶¿ÓÙˆ˜, ˆ˜ ıÂÚ·›· ÂÎÏÔÁ‹˜ ÁÈ· ÙÔ˘˜ ·È‰È·ÙÚÈÎÔ‡˜ ·ÛıÂÓ›˜ ıˆÚÂ›Ù·È Ë ‰ÈÂÓ¤ÚÁÂÈ· ÂÙÂÚfiÏÔÁ˘ ÌÂÙ·ÌfiÛ¯Â˘Û˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ ·fi Û˘Ì‚·Ùfi Û˘ÁÁÂÓ‹ ‹ ÌË Û˘ÁÁÂÓ‹ ‰fiÙË, Ì Èı·ÓfiÙËÙ· Ì·ÎÚ¿˜ ÂÈ‚›ˆÛ˘ ÙˆÓ ·ÛıÂÓÒÓ Û ÔÛÔÛÙfi ÌÂÁ·Ï‡ÙÂÚÔ ÙÔ˘ 80% (1,2). ª˘ÂÏÔÌÔÓÔ΢ÙÙ·ÚÈ΋ Ï¢¯·ÈÌ›· Ó·ÓÈÎÔ‡ Ù‡Ô˘ (Juvenile myelomonocytic leukaemia - JMML) ∏ JMML ·Ó‹ÎÂÈ ÛÙ· ÎψÓÈÎÔ‡ Ù‡Ô˘ ·ÈÌ·ÙÔÏÔÁÈο ÓÔÛ‹Ì·Ù· Î·È ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ·ÚÔ˘Û›· ÂÌ‚Ú˘˚ÎÔ‡ Ù‡Ô˘ ·ÈÌÔÔ›ËÛ˘. ¶·Ú¿ ÙÔ fiÙÈ, ·fi ÔÚÈṲ̂ÓÔ˘˜ ÂÚ¢ÓËÙ¤˜ Û˘˙ËÙÂ›Ù·È Î·È ‰ÈÂÚÂ˘Ó¿Ù·È ÛÙÔ Ï·›ÛÈÔ ÙˆÓ ª¢™ ÙˆÓ ·È‰ÈÒÓ, ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ ÈÛÙÂ‡Ô˘Ó fiÙÈ ÂÈÎÚ·Ù› Ë Ì˘ÂÏÔ¸ÂÚÏ·ÛÙÈ΋ ʇÛË Ù˘ ÓfiÛÔ˘ Î·È ÔÊ›ÏÂÈ Ó· ıˆÚÂ›Ù·È ˆ˜ ªÀ™ ‹ Ó· ηٷ¯ˆÚÂ›Ù·È ˆ˜ ÂӉȿÌÂÛË, ÌÂٷ͇ ÙˆÓ ‰‡Ô ·ÓˆÙ¤Úˆ, ÎÏÈÓÈ΋ ÔÓÙfiÙËÙ· (bridging disorder) (5). ™˘Ó‹ıˆ˜, Ë ÓfiÛÔ˜ ÚÔÛ‚¿ÏÏÂÈ ·ÁfiÚÈ· (·Ó·ÏÔÁ›· ·ÁÔÚÈÒÓ ÚÔ˜ ÎÔÚ›ÙÛÈ· ÂÚ›Ô˘ 3:1) ËÏÈΛ·˜ 0-4 ÂÙÒÓ (‰È¿ÌÂÛË ËÏÈΛ· 1,8 ¤ÙË) Î·È ÚÔ‚¿ÏÏÂÈ Ì ˘ÚÂÙfi, ÂÌ̤ÓÔ˘Û˜ ÏÔÈÌÒÍÂȘ, ·ÈÌÔÚÚ·ÁÈΤ˜ ÂΉËÏÒÛÂȘ Î·È ÛÙ·ÛÈÌfiÙËÙ· ·Ó¿Ù˘Í˘, ÂÓÒ Û·ÓÈfiÙÂÚ· ÚÔÛÙ›ıÂÓÙ·È ÛÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ‚‹¯·˜ Î·È Ù·¯‡ÓÔÈ·. ∞ÓÙÈÎÂÈÌÂÓÈο ‰È·ÈÛÙÒÓÂÙ·È ÂÎÛÂÛËÌ·Ṳ̂ÓË Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›·, ÁÂÓÈÎÂ˘Ì¤ÓË ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ·, Í·ÓıÒÌ·Ù· ‰¤ÚÌ·ÙÔ˜,

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¶›Ó·Î·˜ 1. ∫ÏÈÓÈο Î·È ÂÚÁ·ÛÙËÚȷο ¯·Ú·ÎÙËÚÈÛÙÈο ‰È·ÊÔÚÈ΋˜ ‰È¿ÁÓˆÛ˘ ÌÂٷ͇ Ù˘ ê§ Ù‡Ô˘ ÂÓËÏ›ÎÔ˘ Î·È Ù˘ JMML ÷ڷÎÙËÚÈÛÙÈÎfi

JMML

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<4 ÂÙÒÓ 3:1 ∞Û‡ÓËı˜ ™‡ÓËı˜ ™˘Ó‹ıˆ˜ ÂÏ·Ùو̤ӷ ™‡ÓËı˜ ¡·È ™‡ÓËı˜ ¡·È ¡·È ™‡ÓËı˜ ¡·È ¶ÔÈΛÏÏÂÈ Ÿ¯È 1-2 ¤ÙË ∞Û˘Ó‹ı˘

>4 ÂÙÒÓ 1,8:1 ™‡ÓËı˜ ¶ÔÈΛÏÏÂÈ ™˘Ó‹ıˆ˜ ·˘ÍË̤ӷ ∞Û‡ÓËı˜ ∞Û‡ÓËı˜ Ÿ¯È Ÿ¯È Ÿ¯È ∞Û‡ÓËı˜ ∞Û‡ÓËı˜ ™‡ÓËı˜ >90-95% 4-5 ¤ÙË ™˘Ó‹ı˘

∏ÏÈΛ· ∞ÁfiÚÈ·:∫ÔÚ›ÙÛÈ· §Â˘Î¿ ·ÈÌÔÛÊ·›ÚÈ· ¿Óˆ ÙˆÓ 10x105/L ∞ÈÌÔÛÊ·ÈÚ›ÓË <12 gr/dL ∞ÈÌÔÂÙ¿ÏÈ· ªÔÓÔ΢ÙÙ¿ÚˆÛË ¶ÚÔÓÔÚÌÔ‚Ï¿ÛÙ˜ ∞˘ÍË̤ӷ Â›‰· HbF §ÂÌÊ·‰ÂÓÔ¿ıÂÈ· ¢ÂÚÌ·ÙÈÎfi ÂÍ¿ÓıËÌ· µ·ÎÙËÚȷΤ˜ ÏÔÈÌÒÍÂȘ ∞ÈÌÔÚÚ·Á›· ªÂȈ̤ÓË ·ÏηÏÈ΋ ʈÛÊ·Ù¿ÛË (∞º) Ï¢ÎÒÓ ÃÚˆÌfiۈ̷ Ph ‹ ÌÂÙ¿ıÂÛË bcr/abl ¢È¿ÌÂÛË ÂÈ‚›ˆÛË µÏ·ÛÙÈ΋ ÎÚ›ÛË

¯·Ú·ÎÙËÚÈÛÙÈÎfi ÂÍ¿ÓıËÌ· ÚÔÛÒÔ˘ ‹ Î·È ÂÎ˙ÂÌ·ÙÔÂȉ‹ ‰ÂÚÌ·ÙÈο ÛÙÔȯ›· (1). ™ÙË ÁÂÓÈ΋ ÂͤٷÛË ·›Ì·ÙÔ˜ ‰È·ÈÛÙÒÓÂÙ·È ÌÂÙÚ›Ô˘ ‚·ıÌÔ‡ Ï¢ÎÔ΢ÙÙ¿ÚˆÛË, Ô˘ ‰ÂÓ ÍÂÂÚÓ¿ fï˜ Ù· 105/Îί Î·È Û˘Óԉ‡ÂÙ·È ·fi ·ÚÔ˘Û›· ‰˘ÛÏ·ÛÙÈÎÒÓ ÎÔÎÎÈÔ΢ÙÙ¿ÚˆÓ, ÌÈÎÚfi ·ÚÈıÌfi ‚Ï·ÛÙÒÓ, ·˘ÍË̤ÓÔ ·ÚÈıÌfi ÌÔÓÔ΢ÙÙ¿ÚˆÓ, ·ÚÔ˘Û›· ÂÌ‡ÚËÓˆÓ ÂÚ˘ıÚÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ, ‹È· ·Ó·ÈÌ›· Î·È ıÚÔÌ‚ÔÂÓ›·. ∆· Â›‰· Ù˘ HbF Â›Ó·È Û˘Ó‹ıˆ˜ ˘„ËÏ¿, ·ÓÂÚ¯fiÌÂÓ· ηٿ ηÓfiÓ· ¿Óˆ ÙÔ˘ 10%, ÂÓ›ÔÙ ÍÂÂÚÓÔ‡Ó Î·È ÙÔ 70%, Û‡ÓËı˜ ‰Â ‡ÚËÌ· ·ÔÙÂÏ› Î·È Ë ˘ÂÚÁ·ÌÌ·ÛÊ·ÈÚÈÓ·ÈÌ›· (2).

O Ì˘ÂÏfi˜ ÙˆÓ ÔÛÙÒÓ (ªO) Â›Ó·È ˘ÂÚ΢ÙÙ·ÚÈÎfi˜, ÂÌÊ·Ó›˙ÂÈ ˘ÂÚÏ·Û›· Ù˘ Ì˘ÂÏÈ΋˜ ÛÂÈÚ¿˜ Ì ٷ˘Ùfi¯ÚÔÓË Ì›ˆÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÌÂÁ·Î·Ú˘Ô΢ÙÙ¿ÚˆÓ. O ηڢfiÙ˘Ô˜ ÙˆÓ Ì˘ÂÏÈÎÒÓ Î˘ÙÙ¿ÚˆÓ ÛÙÔ 40-67% ÙˆÓ ·ÛıÂÓÒÓ Â›Ó·È Ê˘ÛÈÔÏÔÁÈÎfi˜, ÛÙÔ 25-35% ·ÚÔ˘ÛÈ¿˙ÂÈ ÌÔÓÔۈ̛· 7 Î·È ÌfiÓÔ ÙÔ 10-25% ÙˆÓ ·ÛıÂÓÒÓ ÂÌÊ·Ó›˙ÂÈ ¿ÏÏÔ˘ Ù‡Ô˘ ¯ÚˆÌÔۈ̷ÙÈΤ˜ ‚Ï¿‚˜. ∂Í ÔÚÈÛÌÔ‡, Ë ÓfiÛÔ˜ ‰ÂÓ Û˘Ó‰˘¿˙ÂÙ·È Ì ÌÂÙ¿ıÂÛË t (9;22) (2). ¶ÚfiÛÊ·Ù·, ÌÂÙ¿ ·fi ‰ÈÂıÓ‹ Û˘Ìʈӛ· Ô˘ ÂÂÙ‡¯ıË ÌÂٷ͇ ÙÔ˘ International JMML Working Group Î·È ÙÔ˘ European Working Group on MDS in Childhood (EWOG - MDS), ¤¯Ô˘Ó ıÂÛÈÛÙ› Ì›˙ÔÓ· Î·È ÂÏ¿ÛÛÔÓ· ‰È·ÁÓˆÛÙÈο ÎÏÈÓÈο Î·È ÂÚÁ·ÛÙËÚȷο ÎÚÈÙ‹ÚÈ· Ù˘ ÓfiÛÔ˘, ̤¯ÚȘ fiÙÔ˘ ηıÔÚÈÛÙÔ‡Ó Ï‹Úˆ˜ ÔÈ ‚Ï¿‚˜ ÔÈ Ôԛ˜ Û ÌÔÚÈ·Îfi Â›Â‰Ô ·ÓȯÓ¢fiÌÂÓ˜ ı· ÙËÓ Ù·˘ÙÔÔÈÔ‡Ó ‰È·ÁÓˆÛÙÈο. ø˜ ÂÎ ÙÔ‡ÙÔ˘, Û‹ÌÂÚ· Ë ‰È¿ÁÓˆÛË Ù˘ JMML Ú¤ÂÈ Ó· ÛÙËÚ›˙ÂÙ·È ÛÂ Û˘ÁÎÂÎÚÈ̤ӷ ‰È·ÁÓˆÛÙÈο ÎÚÈÙ‹ÚÈ· (68), fiˆ˜ ·Ó·ÁÚ¿ÊÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2. ∏ Û˘Ó‡·ÚÍË Ù˘ JMML ÂȉÈÎfiÙÂÚ· Ì ÌÔÓÔۈ̛· 7, ·Ï·ÈfiÙÂÚ· ›¯Â ¯·Ú·ÎÙËÚÈÛÙ› Û·Ó “Û‡Ó‰ÚÔÌÔ ‚ÚÂÊÈ΋˜ ÌÔÓÔۈ̛·˜ 7”. ™‹ÌÂÚ·, Ë ‰È¿ÎÚÈÛË Ù˘ ÔÓÙfiÙËÙ·˜ ·˘Ù‹˜ ‰ÂÓ ·Ó·ÁÓˆÚ›˙ÂÙ·È ÂÊfiÛÔÓ Ù·

ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο Î·È Ë ÂÈ‚›ˆÛË ÙˆÓ ·ÛıÂÓÒÓ Ì JMML Î·È ÌÔÓÔۈ̛· 7 ‰ÂÓ ‰È·Ê¤ÚÔ˘Ó ·fi ÂΛӷ ÙˆÓ ·ÛıÂÓÒÓ ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ηڢfiÙ˘Ô ‹ Ì ¿ÏϘ ηڢÔÙ˘ÈΤ˜ ·ÓˆÌ·Ï›Â˜ (9). ∏ ·ıÔÁ¤ÓÂÈ· Ù˘ JMML ¤¯ÂÈ ÛËÌ·ÓÙÈο ‰ÈÂÚ¢ÓËı› ̤ۈ ÙˆÓ Î˘ÙÙ·ÚÈÎÒÓ Î·ÏÏÈÂÚÁÂÈÒÓ ÙˆÓ Ì˘ÂÏÈÎÒÓ Î˘ÙÙ¿ÚˆÓ. ÷ڷÎÙËÚÈÛÙÈÎfi Ù˘ ‡ÚËÌ·, ÙÔ ÔÔ›Ô Û‹ÌÂÚ· ıˆÚÂ›Ù·È “ÂÎ ÙˆÓ ˆÓ ԢΠ¿Ó¢” ÛÙÔÈ¯Â›Ô Ù˘ ‰È¿ÁÓˆÛ˘ Ù˘ ÓfiÛÔ˘, ·ÔÙÂÏ› Ë ·Ó‡ÚÂÛË ·˘ÙfiÌ·Ù˘ ·Ó¿Ù˘Í˘ ·ÔÈÎÈÒÓ Ù˘ ÎÔÎÎÈÒ‰Ô˘˜ - ÌÔÓÔ΢ÙÙ·ÚÈ΋˜ ÛÂÈÚ¿˜ (CFU-GM) ¯ˆÚ›˜ ÙËÓ Â͈ÁÂÓ‹ ÚÔÛı‹ÎË ·˘ÍËÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ÙˆÓ ÎÔÎÎÈÔ΢ÙÙ¿ÚˆÓ/ÌÔÓÔ‡ÚËÓˆÓ (Granulocyte-monocyte colony stimulating factor - GMCSF) Û ΢ÙÙ·ÚÈΤ˜ ηÏÏȤÚÁÂȘ Ì˘ÂÏÈÎÒÓ Î˘ÙÙ¿ÚˆÓ (2). ∂›Ó·È ÁÓˆÛÙfi fiÙÈ Ù· Ê˘ÛÈÔÏÔÁÈο ·ÙÙ·Ú· ÙÔ˘ ªO ··ÈÙÔ‡Ó Â͈ÁÂÓ‹ ÚÔÛı‹ÎË ·˘ÍËÙÈÎÒÓ ·ÈÌÔÔÈËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ÁÈ· Ó· ·Ó·Ù˘¯ıÔ‡Ó in vitro Î·È Ó· Û¯ËÌ·Ù›ÛÔ˘Ó ·ÔÈ˘, ÁÂÁÔÓfi˜ Ô˘ ·Ó·ÈÚÂ›Ù·È ÛÙËÓ JMML, fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÎÔÎÎÈÒ‰Ë-ÌÔÓÔ΢ÙÙ·ÚÈ΋ ÛÂÈÚ¿ Î·È Û·ÊÒ˜ ˘Ô‰ÂÈÎÓ‡ÂÈ ÙÔÓ Ì˘ÂÏÔ¸ÂÚÏ·ÛÙÈÎfi Ù˘ ¯·Ú·ÎÙ‹Ú·. ∞Í›˙ÂÈ Ó· ÛËÌÂȈı› ÂÈÚfiÛıÂÙ· fiÙÈ Ë ·˘ÙfiÌ·ÙË ·Ó¿Ù˘ÍË Ù˘ Ì˘ÂÏÔÌÔÓÔ΢ÙÙ·ÚÈ΋˜ ÛÂÈÚ¿˜ ÛÙË JMML in vitro ·Ó·ÛÙ¤ÏÏÂÙ·È ÌÂÙ¿ ·fi: ·) ·Ê·›ÚÂÛË ÙˆÓ ÌÔÓÔ΢ÙÙ¿ÚˆÓ ·fi ÙÔÓ ªO Î·È ‚) ÚÔÛı‹ÎË ÛÙȘ ΢ÙÙ·ÚÈΤ˜ ηÏÏȤÚÁÂȘ ·ÓÙÈÛˆÌ¿ÙˆÓ Ô˘ ÛÙÚ¤ÊÔÓÙ·È Î·Ù¿ ÙÔ˘ GM-CSF Î·È ÙÔ˘ ·Ú¿ÁÔÓÙ· Ó¤ÎÚˆÛ˘ ÙÔ˘ fiÁÎÔ˘ · (Tumor necrosis factor · TNF·). ∞fi Ù· ·ÓˆÙ¤Úˆ ÂÈÚ·Ì·ÙÈο ‰Â‰Ô̤ӷ ÚÔ·ÙÂÈ fiÙÈ Ù· ÚÔÁÔÓÈο ·ÙÙ·Ú· Ù˘ ÎÔÎÎÈÒ‰Ô˘˜-ÌÔÓÔ΢ÙÙ·ÚÈ΋˜ ÛÂÈÚ¿˜ ÂÌÊ·Ó›˙Ô˘Ó ·˘ÍË̤ÓË Â˘·ÈÛıËÛ›· ÛÙÔÓ GM-CSF, ¯ˆÚ›˜ Ó· ‰È·ÈÛÙÒÓÂÙ·È ÛÙÔÓ ÔÚfi ·ıÔÏÔÁÈ΋ ·‡ÍËÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙÔ˘ Û˘ÁÎÂÎÚÈ̤ÓÔ˘ ·Ú¿ÁÔÓÙ·. ∏ fiÏË ÓfiÛÔ˜ ıˆÚÂ›Ù·È ˆ˜ Ë ÎÏÈÓÈ΋ Î·È ÂÚÁ·ÛÙËÚȷ΋ ·ÓÙ·Ó¿ÎÏ·ÛË, Ù˘ ·ıÔÏÔÁÈ΋˜ ·ÚÔ˘Û›·˜ ÛÙÔÓ ÔÚÁ·ÓÈÛÌfi,

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¶›Ó·Î·˜ 2. ªÂ›˙ÔÓ· Î·È ÂÏ¿ÛÛÔÓ· ‰È·ÁÓˆÛÙÈο ÎÚÈÙ‹ÚÈ· Ù˘ JMML ∂Ó‰ÂÈÎÙÈο ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο

∂Ï¿ÛÛÔÓ· ÂÚÁ·ÛÙËÚȷο ÎÚÈÙ‹ÚÈ· (Ó· ÏËÚÔ‡ÓÙ·È Î·È Ù· 3)

¶ÂÚ·ÈÙ¤Úˆ ‰È·ÁÓˆÛÙÈο ÎÚÈÙ‹ÚÈ· ˘Ô‰ÂÈÎÓ‡ÔÓÙ· Û·Ê‹ ‰È¿ÁÓˆÛË (··ÈÙÔ‡ÓÙ·È ÙÔ˘Ï¿¯ÈÛÙÔÓ 2)

ñ ∏·ÙÔÛÏËÓÔÌÂÁ·Ï›· ñ §ÂÌÊ·‰ÂÓÔ¿ıÂÈ·

ñ µÏ¿ÛÙ˜ ªO <20% ñ ∞ÚÓËÙÈÎfi ¯ÚˆÌfiۈ̷ ºÈÏ·‰¤ÏÊÂÈ· ‹ ·Ó›¯Ó¢ÛË ÌÂÙ¿ıÂÛ˘ bcr-abl ñ ªÔÓÔ·ÙÙ·Ú· ÛÙÔ ÂÚÈÊÂÚÈÎfi ·›Ì· (¶∞) ¿Óˆ ÙˆÓ 1x109/L

ñ ∞˘ÍË̤ӷ Â›‰· HbF Û ۯ¤ÛË Ì ÙËÓ ËÏÈΛ· ñ ¶·ÚÔ˘Û›· ÛÙÔ ¶∞ ¿ˆÚˆÓ ÌÔÚÊÒÓ Ù˘ Ì˘ÂÏÈ΋˜ ÛÂÈÚ¿˜

ñ ø¯ÚfiÙËÙ· ñ ¶˘ÚÂÙfi˜ ñ ¢ÂÚÌ·ÙÈÎfi ÂÍ¿ÓıËÌ·

‰ÈÂÁÂÚÌ¤ÓˆÓ ÌÔÓÔ΢ÙÙ¿ÚˆÓ (10). ∂ӉȷʤÚÔÓ Â‡ÚËÌ·, Â›Û˘, ·ÔÙÂÏ› Ë ‰È·›ÛÙˆÛË fiÙÈ ÙÔ cisÚÂÙÈÓÔ˚Îfi Ô͇ ÌÂÈÒÓÂÈ ÙË ‰Ú¿ÛË ÙÔ˘ GM-CSF ÛÙ· ÚÔÁÔÓÈο ·ÙÙ·Ú· Ù˘ JMML, ÁÂÁÔÓfi˜ Ô˘ ÌÔÚ› Ó· ¤¯ÂÈ ‰È·ÁÓˆÛÙÈ΋, ·ÏÏ¿ Î·È ıÂÚ·¢ÙÈ΋ ·Í›· (1,2,5). ∏ Û˘Û¯¤ÙÈÛË Ù˘ JMML Ì ÙË Ó¢ÚÔ˚ӈ̿وÛË Ù‡Ô˘ π (NF1) ¤¯ÂÈ ·ÔÙÂϤÛÂÈ ¤Ó· ÂÈϤÔÓ ‰›Ô ¤Ú¢ӷ˜ Ù˘ ·ıÔÁ¤ÓÂÈ·˜ Ù˘ ÓfiÛÔ˘, ‰Â‰Ô̤Ó˘ Ù˘ ·˘ÍË̤Ó˘ Â›ÙˆÛ˘ Ù˘ JMML Û ·ÛıÂÓ›˜ Ì NF1. ªÂ ÎÏÈÓÈο ÎÚÈÙ‹ÚÈ·, 14% ÙˆÓ JMML ·ÛıÂÓÒÓ ÂÌÊ·Ó›˙ÂÈ NF1, ÂÓÒ 7% ÂÌÊ·Ó›˙ÂÈ ¿ÏϘ Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜ ÂÎÙfi˜ ·fi NF1 (11). ÷ڷÎÙËÚÈÛÙÈο ·Ó·Ê¤ÚÂÙ·È fiÙÈ Ë Â›ÙˆÛË Ù˘ JMML Û ·È‰È¿ Ì NF1 Â›Ó·È 350 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚË Û ۯ¤ÛË Ì ÙËÓ Â›ÙˆÛË Ô˘ ÂÌÊ·Ó›˙Ô˘Ó ·È‰È¿ ¯ˆÚ›˜ NF1 (11). ∆Ô ÁÔÓ›‰ÈÔ NF1 ¤¯ÂÈ ‚ÚÂı› fiÙÈ Îˆ‰ÈÎÔÔÈ› ÚˆÙ½ÓË (neurofibromin) Ô˘ ÂÌϤÎÂÙ·È ÛÙËÓ ÂÓ‰Ô΢ÙÙ¿ÚÈ· ÌÂÙ·ÁˆÁ‹ Û‹Ì·ÙÔ˜ ̤ۈ Ù˘ Ô‰Ô‡ ÙÔ˘ ras. Àfi Ê˘ÛÈÔÏÔÁÈΤ˜ Û˘Óı‹Î˜, ÙÔ ÁÔÓ›‰ÈÔ NF1 ‰Ú· ·Ó·ÛÙ·ÏÙÈο ÛÙËÓ Ô‰fi ÌÂÙ·‚›‚·Û˘ Û‹Ì·ÙÔ˜ ÙÔ˘ ras, ÂÓ¤¯ÔÓÙ·˜ ȉÈfiÙËÙ˜ ÔÁÎÔηٷÛÙ·ÏÙÈÎÔ‡ ÁÔÓȉ›Ô˘ Û ÚÒÈÌË Ê¿ÛË Ù˘ Ì˘ÂÏÔÔ›ËÛ˘. ªÂ ÙËÓ ·Ô˘Û›· ‹ ÙË ÏÂÈÙÔ˘ÚÁÈ΋ ·‰Ú·ÓÔÔ›ËÛË ÙÔ˘ NF1 ÁÔÓȉ›Ô˘ Î·È ÙËÓ ¿ÚÛË Ù˘ ·Ó·ÛÙ·ÏÙÈ΋˜ ÙÔ˘ ‰Ú¿Û˘ Â› Ù˘ ras Ô‰Ô‡, ÚÔ·ÙÂÈ ÌË ÂÏÂÁ¯fiÌÂÓÔ˜ ÔÏÏ·Ï·ÛÈ·ÛÌfi˜ ÙˆÓ Ì˘ÂÏÈÎÒÓ Î˘ÙÙ¿ÚˆÓ, Ì ıˆÚËÙÈ΋ ηٿÏËÍË ÙËÓ ÂÌÊ¿ÓÈÛË Ù˘ JMML (2,6,7,12,13). ™ËÌÂȷΤ˜ ÌÂÙ·ÏÏ¿ÍÂȘ ÙÔ˘ ras ¤¯Ô˘Ó Â›Û˘ ÂÓÔ¯ÔÔÈËı› fiÙÈ ÂÓ¤¯ÔÓÙ·È ÛÙËÓ ·ıÔÁ¤ÓÂÈ· Ù˘ JMML ÏfiÁˆ ÂÓÂÚÁÔÔ›ËÛ˘ Ù˘ ·ÓˆÙ¤Úˆ Ô‰Ô‡ ÌÂÙ·‚›‚·Û˘ ÙÔ˘ Û‹Ì·ÙÔ˜ (6). ∏ ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘ ÂÚÈÏ·Ì‚¿ÓÂÈ ÔÈΛϘ ηٷÛÙ¿ÛÂȘ ·Ó¿ÏÔÁ˘ ÎÏÈÓÈÎÔÂÚÁ·ÛÙËÚȷ΋˜ ÚÔ‚ÔÏ‹˜, fiˆ˜ Û˘ÁÁÂÓ›˜ ÏÔÈÌÒÍÂȘ Î·È Û˘Ó‰˘·Ṳ̂Ó˜ ·ÓÔÛÔ·ÓÂ¿ÚÎÂȘ. π‰È·›ÙÂÚË ÚÔÛÔ¯‹ ··ÈÙÂ›Ù·È ÛÙË ‰È·ÊÔÚԉȿÁÓˆÛË Ù˘ ÓfiÛÔ˘ ·fi ÙË Ïԛ̈ÍË Ì ÙÔÓ Èfi Epstein-Barr (EBV) (1,2,9).

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ñ §Â˘Î¿ ·ÈÌÔÛÊ·›ÚÈ· ¿Óˆ ÙˆÓ 10x109/L ñ ¶·ÚÔ˘Û›· ÎψÓÈÎÔ‡ Ù‡Ô˘ ‰È·Ù·Ú·¯‹˜ ÂÚÈÏ·Ì‚·ÓÔ̤Ó˘ Î·È Ù˘ ÌÔÓÔۈ̛·˜ 7 ñ ÀÂÚ¢·ÈÛıËÛ›· ÛÙÔÓ GM-CSF ÙˆÓ Ì˘ÂÏÈÎÒÓ ÚÔÁÔÓÈÎÒÓ Î˘ÙÙ¿ÚˆÓ in vitro

¶ÔÈÎÈÏ›· ıÂÚ·¢ÙÈÎÒÓ Û¯ËÌ¿ÙˆÓ ¤¯ÂÈ ‰ÔÎÈÌ·ÛÙ› ÛÙËÓ ÚÔÛ¿ıÂÈ· Â›Ù¢Í˘ Ï‹ÚÔ˘˜ ‹ ÙÔ˘Ï¿¯ÈÛÙÔÓ ÌÂÚÈ΋˜ ‡ÊÂÛ˘ Ù˘ JMML (14-17). ÷ڷÎÙËÚÈÛÙÈο ·Ó·Ê¤ÚÔÓÙ·È Ù· οوıÈ: ·) ∂ÓÙ·ÙÈ΋ ¯ËÌÂÈÔıÂÚ·›· (ê£) Ù‡Ô˘ ÔÍ›·˜ Ì˘ÂÏÔÁÂÓÔ‡˜ Ï¢¯·ÈÌ›·˜ Û·Ó›ˆ˜ ÂÈÛ¿ÁÂÈ ÙÔ˘˜ ·ÛıÂÓ›˜ Û ‡ÊÂÛË Î·È ·Ó ÙÔ‡ÙÔ ÂÈÙ¢¯ı›, ‰È·ÚΛ ÌÈÎÚfi ÌfiÓÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·. ∆Ô ÁÂÁÔÓfi˜ Ù˘ ·˘ÍË̤Ó˘ ÓÔÛËÚfiÙËÙ·˜ Î·È ıÓËÙfiÙËÙ·˜ Ù¤ÙÔÈˆÓ ıÂÚ·¢ÙÈÎÒÓ Û¯ËÌ¿ÙˆÓ ¤¯ÂÈ Ô‰ËÁ‹ÛÂÈ ÛÙËÓ ÂÁηٿÏÂÈ„‹ ÙÔ˘˜ Î·È ÛÙË ¯ÚËÛÈÌÔÔ›ËÛ‹ ÙÔ˘˜ ÌfiÓÔ ÂÓ Â›‰ÂÈ ÚÔ·Ú·Û΢·ÛÙÈÎÒÓ Û¯ËÌ¿ÙˆÓ ÚÔ ÌÂÙ·ÌfiÛ¯Â˘Û˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ (ªªO). ‚) ◊È· ê£ Ì ¯·ÌËϤ˜ ‰fiÛÂȘ 6-ÌÂÚηÙÔÔ˘Ú›Ó˘ Î·È ·Ú·Û˘Ù›Ó˘ ¤¯ÂÈ ‰ÔÎÈÌ·ÛÙ›, ¯ˆÚ›˜ fï˜ ·ÈÛÈfi‰ÔÍ· ÌËӇ̷ٷ. Á) ¶·ÚfiÙÈ ¤¯ÂÈ ‚ÚÂı› fiÙÈ Ë ÈÓÙÂÚÊÂÚfiÓË-· ¤¯ÂÈ ·Ó·ÛÙ·ÏÙÈ΋ ‰Ú¿ÛË ÛÙËÓ ·˘ÙfiÌ·ÙË ·Ó¿Ù˘ÍË ÙˆÓ CFU-GM ·ÔÈÎÈÒÓ Û in vitro ΢ÙÙ·ÚÈΤ˜ ηÏÏȤÚÁÂȘ, Û ıÂÚ·¢ÙÈ΋ ‚¿ÛË ‰ÂÓ ¤¯ÂÈ ÚÔÛʤÚÂÈ ıÂÙÈο ·ÔÙÂϤÛÌ·Ù·. ‰) ∞Ó¿ÏÔÁË Ì ÙËÓ ÈÓÙÂÚÊÂÚfiÓË-· ‰Ú¿ÛË, Û in vitro ÌÂϤÙ˜, ¤¯ÂÈ ·ÚÔ˘ÛÈ¿ÛÂÈ Î·È ÙÔ 13 cis-ÚÂÙÈÓÔ˚Îfi Ô͇ Î·È Û ıÂÚ·¢ÙÈÎfi Â›Â‰Ô ˘fiÛ¯ÂÙ·È Î·Ï‡ÙÂÚË ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·, ηıfiÛÔÓ ÙÔ 4050% ÙˆÓ ·ÛıÂÓÒÓ ·ÓÙ·ÔÎÚ›ÓÂÙ·È ¯ˆÚ›˜ ȉȷ›ÙÂÚË ÙÔÍÈÎfiÙËÙ· Û ‰fiÛÂȘ ÂÚ› Ù· 200 mg/m2 ∂™. Â) ∂˘ÓÔ˚ÎÔ› ÚÔÁÓˆÛÙÈÎÔ› ‰Â›ÎÙ˜ ÁÈ· ÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ÚfiÎÂÈÙ·È Ó· ˘Ô‚ÏËıÔ‡Ó Û ¯ËÌÂÈÔıÂÚ·›· ‹ ¿ÏϘ ıÂÚ·¢ÙÈΤ˜ ÚÔÛ¿ıÂȘ ÏËÓ ªªO ıˆÚÔ‡ÓÙ·È: Ë ÙÈÌ‹ ·ÈÌÔÂÙ·Ï›ˆÓ ¿Óˆ ÙˆÓ 33x109/L, ËÏÈΛ· οو ÙˆÓ 2 ÂÙÒÓ Î·È Â›‰· HbF ηÙÒÙÂÚ· ÙÔ˘ 15%. ÛÙ) ∏ ÌÂÙ·ÌfiÛ¯Â˘ÛË ÚÔÁÔÓÈÎÒÓ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ Â›Ó·È Û‹ÌÂÚ· Ë ÌÔÓ·‰È΋ ıÂÚ·›· Ô˘ ¤¯ÂÈ ÂÈÙ‡¯ÂÈ, Û ¤Ó· ÔÛÔÛÙfi ·ÛıÂÓÒÓ Î˘Ì·ÈÓfiÌÂÓÔ ·Ó¿ ÌÂϤÙË ·fi 20-30%, 5ÂÙ‹ Û˘ÓÔÏÈ΋ ÂÈ‚›ˆÛË. ø˜ ËÁ¤˜ ÌÔÛ¯Â˘Ì¿ÙˆÓ ¤¯Ô˘Ó ̤¯ÚÈ Û‹ÌÂÚ· ¯ÚËÛÈÌÔÔÈËı› Û˘ÁÁÂÓ›˜ Î·È ÌË Û˘ÁÁÂÓ›˜ Ï‹Úˆ˜ Û˘Ì‚·ÙÔ› ‹ Î·È Ì ÌÂÚÈ΋ Û˘Ì‚·ÙfiÙËÙ·

july-aug02TELIKO

14-05-03

13:31

™ÂÏ›‰·227

¶·È‰È·ÙÚÈ΋ 2002;65:222-231

‰fiÙ˜, ηıÒ˜ Î·È ÔÌÊ¿ÏÈÔ ÌfiÛ¯Â˘Ì·. ∏ Èı·ÓfiÙËÙ· ˘ÔÙÚÔ‹˜ ÌÂÙ¿ ªªO ·Ó¤Ú¯ÂÙ·È ÂÚ›Ô˘ ÛÙÔ 50%. °È· ηχÙÂÚ· ·ÔÙÂϤÛÌ·Ù· Û ÂÚ›ÙˆÛË ·ÚÔ˘Û›·˜ ÂÎÛÂÛËÌ·Ṳ̂Ó˘ ÛÏËÓÔÌÂÁ·Ï›·˜ ¤¯ÂÈ Û˘ÛÙ·ı› ·fi ÔÚÈṲ̂ÓÔ˘˜ Ó· ÚÔËÁÂ›Ù·È Ù˘ ªªO ÛÏËÓÂÎÙÔÌ‹, ¯ˆÚ›˜ fï˜ ÙÔ‡ÙÔ Ó· Â›Ó·È Â˘Ú‡ÙÂÚ· ·Ô‰ÂÎÙfi. ˙) ¢Â‰ÔÌ¤ÓˆÓ ÙˆÓ Ì¤¯ÚÈ Û‹ÌÂÚ· ·Ó·ÊÂÚı¤ÓÙˆÓ Ì¿ÏÏÔÓ ·ÔÁÔËÙ¢ÙÈÎÒÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ, Ӥ˜ ıÂÚ·¢ÙÈΤ˜ ÚÔÛÂÏ¿ÛÂȘ ÂȯÂÈÚÔ‡ÓÙ·È ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ JMML ·fi Û˘ÁÎÏ›ÓÔ˘Û˜ ‰ÈÂıÓ›˜ ıÂÚ·¢ÙÈΤ˜ ÔÌ¿‰Â˜, ÔÈ Ôԛ˜ ΢ڛˆ˜ ·ÊÔÚÔ‡Ó ÛÙË ¯ÔÚ‹ÁËÛË: i) ·ÓÙ·ÁˆÓÈÛÙÈÎÒÓ ÙÔ˘ GMCSF ·Ó·ÏfiÁˆÓ, ii) Ó¤ˆÓ ·Ú·ÁÒÁˆÓ ÙÔ˘ ÚÂÙÈÓÔ˚ÎÔ‡ ÔͤԘ, iii) ‰ÈÊıÂÚÈÙÈ΋˜ ÙÔ͛Ӣ Û˘Ó‰˘·Ṳ̂Ó˘ ÁÂÓÂÙÈο Ì GM-CSF Î·È iv) ·Ó·ÛÙÔϤˆÓ Ù˘ ÙÚ·ÓÛÊÂÚ¿Û˘ Ù˘ farnesyl-protein. ∞ÏËı‹˜ ÔÏ˘Î˘ÙÙ·Ú·ÈÌ›· (∞¶) ∞ÔÙÂÏ› ÂÍ·ÈÚÂÙÈο Û¿ÓÈ· ÎψÓÈÎÔ‡ Ù‡Ô˘ ·ÈÌ·ÙÔÏÔÁÈ΋ ‰È·Ù·Ú·¯‹ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜. ∏ ‚Ï¿‚Ë Ù˘ ∞¶ ÂÓÙÔ›˙ÂÙ·È ÛÙÔ ·Ú¯¤ÁÔÓÔ ÔÏ˘‰‡Ó·ÌÔ Î‡ÙÙ·ÚÔ (SC) Î·È Ë ÓfiÛÔ˜ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ·‡ÍËÛË Ù˘ ÂÚ˘ıÚÔ΢ÙÙ·ÚÈ΋˜ Ì¿˙·˜ Î·È Ù˘ ÚԉȿıÂÛ˘ ÁÈ· ıÚÔÌ‚ˆÙÈο ÂÂÈÛfi‰È· (3,4). ∞ÈÙÈÔ·ıÔÁÂÓÂÙÈο, Ë ∞¶ ‰ÂÓ ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙ› ÌÂ Û˘ÁÎÂÎÚÈ̤ÓË Î˘ÙÙ·ÚÔÁÂÓÂÙÈ΋ ‚Ï¿‚Ë. ™ÙȘ ΢ÙÙ·ÚÈΤ˜ ηÏÏȤÚÁÂȘ ‰È·ÈÛÙÒÓÂÙ·È ·˘ÙfiÌ·ÙË ·Ó¿Ù˘ÍË Î·Ù’ ÂÍÔ¯‹Ó ÙˆÓ BFU-E ·ÔÈÎÈÒÓ, ¯ˆÚ›˜ ÙËÓ Â͈ÁÂÓ‹ ÚÔÛı‹ÎË ÂÚ˘ıÚÔÔÈËÙ›Ó˘ (∂¶O). ∆Ô‡ÙÔ ‰ËÏÒÓÂÈ ÙËÓ ·ÓÂÍ¿ÚÙËÙË Ê‡ÛË Ù˘ ÓfiÛÔ˘ ·fi Ù· Â›‰· Ù˘ ∂¶O in vivo, Ù· ÔÔ›· ¿ÏψÛÙ ·ÓȯÓ‡ÔÓÙ·È ÛÙÔÓ ÔÚfi ÙˆÓ ·ÛıÂÓÒÓ ÂÓÙfi˜ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÔÚ›ˆÓ (18,19). ∂Ú¢ÓËÙÈΤ˜ ÚÔÛ¿ıÂȘ ‰ÂÓ ¤¯Ô˘Ó ̤¯ÚÈ ÛÙÈÁÌ‹˜ ‰È·ÏÂ˘Î¿ÓÂÈ Ï‹Úˆ˜ ÙËÓ ·ıÔÁ¤ÓÂÈ· ÙÔ˘ ÓÔÛ‹Ì·ÙÔ˜, ·fi ÔÚÈṲ̂Ó˜ fï˜ ÌÂϤÙ˜ (3,4,20-23) ¤¯Ô˘Ó ÚÔ·„ÂÈ ÛËÌ·ÓÙÈο Û˘ÌÂÚ¿ÛÌ·Ù·, ÂÎ ÙˆÓ ÔÔ›ˆÓ ÂÈÁÚ·ÌÌ·ÙÈο ÛËÌÂÈÒÓÔÓÙ·È: ·) Ë ‰ÔÌÈ΋ Î·È ÏÂÈÙÔ˘ÚÁÈ΋ ·ÎÂÚ·ÈfiÙËÙ· ÙÔ˘ ˘Ô‰Ô¯¤· Ù˘ ∂¶O, ‚) Ë ·˘ÍË̤ÓË ¤ÎÊÚ·ÛË ÙˆÓ ÚˆÙÂ˚ÓÒÓ Bcl-x Î·È ÂȉÈÎfiÙÂÚ· Ù˘ Bcl-xL, ÔÈ Ôԛ˜ ‰ÚÔ˘Ó ·Ó·ÛÙ¤ÏÏÔÓÙ·˜ ÙËÓ ·fiÙˆÛË Î·È Û˘ÌÌÂÙ¤¯ÔÓÙ·˜ ıˆÚËÙÈο ÛÙËÓ ÙÂÏÈ΋ ·‡ÍËÛË Ù˘ ÂÚ˘ıÚÔ΢ÙÙ·ÚÈ΋˜ Ì¿˙·˜. ∞ÓÙ›ıÂÙ·, ·Ú·ÙËÚÂ›Ù·È ÂÎÛÂÛËÌ·Ṳ̂ÓË Ì›ˆÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙÔ˘ ˘Ô‰Ô¯¤· Ù˘ ıÚÔÌ‚ÔÔÈËÙ›Ó˘ Î·È Ù˘ ÌÂÙ·ÁˆÁ‹˜ ÙÔ˘ ÂÓ‰Ô΢ÙÙ¿ÚÈÔ˘ Û‹Ì·ÙÔ˜, ÛÙË ÌÂÁ·Î·Ú˘Ô΢ÙÙ·ÚÈ΋ ÛÂÈÚ¿, Á) Ë in vitro ·˘ÍË̤ÓË Â˘·ÈÛıËÛ›· Ù˘ ÂÚ˘ıÚ¿˜ ÛÂÈÚ¿˜ ÛÙËÓ ∂¶O, ÙÔÓ ·˘ÍËÙÈÎfi ·Ú¿ÁÔÓÙ· Ù˘ ÈÓÛÔ˘Ï›Ó˘ (Insulin Growth Factor 1 - IGF-1) Î·È ÙÔ˘˜ ·˘ÍËÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Ù˘ Ï¢΋˜ ÛÂÈÚ¿˜, ÁÂÁÔÓfi˜ Ô˘ Èı·Ó¿ ÂÚÌËÓ‡ÂÈ Î·È ÙËÓ ·ÚÔ˘Û›· ·˘ÍËÌ¤ÓˆÓ Ï¢ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ ˘fi Û˘Óı‹Î˜ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÂÈ¤-

Paediatriki 2002;65:222-231

‰ˆÓ ÙˆÓ ·ÓˆÙ¤ÚˆÓ ·Ú·ÁfiÓÙˆÓ Î·È ‰) Ë ·˘ÙfiÌ·ÙË ·Ó¿Ù˘ÍË, ¯ˆÚ›˜ Â͈ÁÂÓ‹ ÚÔÛı‹ÎË ÙˆÓ ·ÓÙ›ÛÙÔȯˆÓ ·˘ÍËÙÈÎÒÓ ·ÈÌÔÔÈËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ, Ù˘ ÂÚ˘ıÚ¿˜ ΢ڛˆ˜ ‹/Î·È Ù˘ Ï¢΋˜ ÛÂÈÚ¿˜. ∏ ÎÏÈÓÈ΋ ÂÈÎfiÓ· Ù˘ ∞¶ ÔÈΛÏÏÂÈ Î·È Î·Ù’ Ô˘Û›· ÔÊ›ÏÂÙ·È ÛÙËÓ ·‡ÍËÛË ÙˆÓ ÙÈÌÒÓ Ù˘ ·ÈÌÔÛÊ·ÈÚ›Ó˘ Î·È ÙÔ˘ ·ÈÌ·ÙÔÎÚ›ÙË, ÂÓÒ ·Ú¿ÏÏËÏ· ·ÓÙ·Ó·ÎÏ¿ ÙËÓ ·˘ÍË̤ÓË Ù¿ÛË Ô˘ ÂÌÊ·Ó›˙Ô˘Ó ÔÈ ¿Û¯ÔÓÙ˜ ÁÈ· ıÚÔÌ‚ÒÛÂȘ. ∆Ô ·›ÛıËÌ· ˙¿Ï˘, Ë ÎÂÊ·Ï·ÏÁ›·, Ë Â‡ÎÔÏË ÎfiˆÛË, Ô ÎÓËÛÌfi˜ Î·È ÔÈ Ó˘¯ÙÂÚÈÓÔ› ȉÚÒÙ˜ Â›Ó·È Ù· Û˘¯ÓfiÙÂÚ· Û˘ÌÙÒÌ·Ù· Ô˘ ÂÌÊ·Ó›˙Ô˘Ó Ù· ·È‰È¿ Ì ∞¶. ∆· ıÚÔÌ‚ˆÙÈο ÂÂÈÛfi‰È·, Ô˘ ·ÔÙÂÏÔ‡Ó ÙË Û˘¯ÓfiÙÂÚË ÂΉ‹ÏˆÛË Ù˘ ÓfiÛÔ˘ ÛÙÔ˘˜ ÂÓ‹ÏÈΘ ¿Û¯ÔÓÙ˜, Â›Ó·È Û¿ÓÈ· ÛÙËÓ ·È‰È΋ ËÏÈΛ·. ∞fi ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË ‰È·ÈÛÙÒÓÂÙ·È Û fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ ÛÏËÓÔÌÂÁ·Ï›· (1,2,5,24). ∞fi ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô, Ë ‰È¿ÁÓˆÛË Ù˘ ∞¶ Ù›ıÂÙ·È ÂÊfiÛÔÓ ·ÔÎÏÂÈÛÙÔ‡Ó ¿ÏϘ ·ıÔÏÔÁÈΤ˜ ηٷÛÙ¿ÛÂȘ Û˘Ó‰˘·˙fiÌÂÓ˜ Ì ÔÏ˘ÂÚ˘ıÚ·ÈÌ›·. °È· ÙË ‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘, Ë Polycythemia Vera Study Group (PVSG) ¤¯ÂÈ ıÂÛ›ÛÂÈ ÎÚÈÙ‹ÚÈ· ‚¿ÛÂÈ ÙˆÓ ÔÔ›ˆÓ ‰ڷÈÒÓÂÙ·È Ë ‰È¿ÁÓˆÛË (3,25,26). ∆Ô‡Ù· ·ÊÔÚÔ‡Ó ÛÙËÓ ·Ó‡ÚÂÛË: ·) Ì¿˙·˜ ÂÚ˘ıÚÒÓ ÌÂÁ·Ï‡ÙÂÚ˘ ·fi 36 ÁÈ· ÙÔ˘˜ ¿Ó‰Ú˜ Î·È 32 mL/kg µ™ ÁÈ· ÙȘ Á˘Ó·›Î˜, ‚) ÎÔÚÂÛÌÔ‡ ·ÚÙËÚÈ·ÎÔ‡ ·›Ì·ÙÔ˜ ¿Óˆ ÙÔ˘ 92% Î·È Á) ÛÏËÓÔÌÂÁ·Ï›·˜ ÛÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË. ™Â ÂÚ›ÙˆÛË Î·Ù¿ ÙËÓ ÔÔ›· ‰ÂÓ ··ÓÙÒÓÙ·È Î·È ÔÈ ÙÚÂȘ ÚÔ·Ó·ÊÂÚı›Û˜ ÚÔ¸Ôı¤ÛÂȘ, ÙfiÙ ··ÈÙÂ›Ù·È Ë ·Ó‡ÚÂÛË ‰‡Ô ÙÔ˘Ï¿¯ÈÛÙÔÓ ÙˆÓ ·ÓˆÙ¤Úˆ ÎÚÈÙËÚ›ˆÓ, Ì ۇÁ¯ÚÔÓË ·ÚÔ˘Û›·: ·) ÙÈÌ‹˜ ·ÈÌÔÂÙ·Ï›ˆÓ ¿Óˆ ÙˆÓ 400.000/Îί, ‚) ·ÚÈıÌÔ‡ Ï¢ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ ¿Óˆ ·fi 12.000/Îί, ¯ˆÚ›˜ Û˘Ó‡·ÚÍË ˘ÚÂÙÔ‡ ‹ ÛËÌ›ˆÓ Ïԛ̈͢, Á) ·˘ÍË̤Ó˘ ·ÏηÏÈ΋˜ ʈÛÊ·Ù¿Û˘ Ï¢ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ (LAP score ¿Óˆ ÙÔ˘ 100) Î·È ‰) ‰ÂÛÌ¢ÙÈ΋˜ ÈηÓfiÙËÙ·˜ ‚ÈÙ·Ì›Ó˘ µ12 ÌÂÁ·Ï‡ÙÂÚ˘ ·fi 2.200. ™ÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË Ù˘ ∞¶ ÂÓÙ¿ÛÛÔÓÙ·È ÓÔÛ‹Ì·Ù· Ô˘ Û˘Ó‰¤ÔÓÙ·È Ì ÂÌÊ¿ÓÈÛË ‰Â˘ÙÂÚÔ·ıÔ‡˜ ÔÏ˘ÂÚ˘ıÚ·ÈÌ›·˜, ›Ù ÏfiÁˆ ÈÛÙÈ΋˜ ˘ÔÍ›·˜ ›Ù ÏfiÁˆ ÏÂÈÙÔ˘ÚÁÈ΋˜ ‰È·Ù·Ú·¯‹˜ ÙÔ˘ ˘Ô‰Ô¯¤· Ù˘ ∂¶O (3,22,27). ™ËÌ·ÓÙÈ΋ ·Ú¿ÌÂÙÚÔ ·ÔÙÂÏ› Ë ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ÙˆÓ ÚˆÙÔ·ıÒÓ ·fi ÙȘ ‰Â˘ÙÂÚÔ·ı›˜ ÔÏ˘ÂÚ˘ıÚ·È̛˜, ÙȘ ÚÔηÏÔ‡ÌÂÓ˜ ·fi ˘ÊÈÛÙ¿ÌÂÓË ÈÛÙÈ΋ ˘ÔÍ›· (.¯. ·ÚÔ˘Û›· ·ÈÌÔÛÊ·ÈÚÈÓÒÓ Ì ˘„ËÏÔ‡ ‚·ıÌÔ‡ Û˘ÁÁ¤ÓÂÈ· Ì ÙÔ O2, ¤ÏÏÂÈ„Ë ÙÔ˘ 2,3 DPG) Î·È ÙË Û˘Ó·ÎfiÏÔ˘ıË ·‡ÍËÛË ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ ∂¶O. ™Â ÔÚÈṲ̂Ó˜ ÂÚÈÙÒÛÂȘ ‰È·ÈÛÙÒÓÂÙ·È ˘¤ÚÌÂÙÚË ·Ú·ÁˆÁ‹ ∂¶O ̤ۈ ·‰È¢ÎÚ›ÓÈÛÙˆÓ Ì¤¯ÚÈ Û‹ÌÂÚ· ·ÈÙÈÔ·ıÔÁÂÓÂÙÈÎÒÓ Ì˯·ÓÈÛÌÒÓ. ø˜ ¤Ó·˜ Ù¤ÙÔÈÔ˜ Ì˯·ÓÈÛÌfi˜ ·Ó·Ê¤ÚÂÙ·È Ë ·‰˘Ó·Ì›· ÙˆÓ Î˘ÙÙ¿ÚˆÓ Ó· ·ÓÙÈÏËÊıÔ‡Ó

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¶·È‰È·ÙÚÈ΋ 2002;65:222-231

ÙËÓ Â¿ÚÎÂÈ· O2 Ô˘ ÙÔ˘˜ ÚÔÛʤÚÂÙ·È Ì¤Ûˆ Ù˘ ·ÈÌ·ÙÈ΋˜ Ô‰Ô‡, Ì Â·ÎfiÏÔ˘ıË ÙËÓ ·Ï›Ó‰ÚÔÌË ÌÂÙ·‚›‚·ÛË ÂÓÈÛ¯˘ÙÈÎÔ‡ Û‹Ì·ÙÔ˜ ÁÈ· ÂÚ·ÈÙ¤Úˆ ·‡ÍËÛË Ù˘ ·Ú·ÁˆÁ‹˜ Ù˘ ∂¶O (1,2). ∏ ÚˆÙÔ·ı‹˜ ÔÈÎÔÁÂÓ‹˜ Î·È Ë Û˘ÁÁÂÓ‹˜ ÔÏ˘ÂÚ˘ıÚ·ÈÌ›· (primary familial and congenital polycythaemia - PFCP) ·ÔÙÂÏÔ‡Ó ˘ÔÔÌ¿‰Â˜ ÙˆÓ ÔÈÎÔÁÂÓÒÓ ÔÏ˘Î˘ÙÙ·Ú·ÈÌÈÒÓ Ô˘ ··ÓÙÒÓÙ·È ÛÙË Ó·ڋ ‹ ÂÊË‚È΋/·È‰È΋ ËÏÈΛ·. OÈ ÂÚÈÛÛfiÙÂÚ˜ ÂÍ ·˘ÙÒÓ Â›Ó·È Â›ÎÙËÙ˜, ·ÏÏ¿ ˘¿Ú¯Ô˘Ó Î·È ÎÏËÚÔÓÔÌÔ‡ÌÂÓ˜ ÌÔÚʤ˜ Ù˘ ÓfiÛÔ˘. ™ÙȘ ÎÏËÚÔÓÔÌÔ‡ÌÂÓ˜ PFCP, Ë ÓfiÛÔ˜ ηٿ ηÓfiÓ· ÌÂÙ·‚È‚¿˙ÂÙ·È Ì ÙÔÓ ÛˆÌ·ÙÈÎfi ÂÈÎÚ·ÙÔ‡ÓÙ· ¯·Ú·ÎÙ‹Ú·, Û·ÓÈfiÙÂÚ· Ì ÙÔÓ ˘ÔÏÂÈfiÌÂÓÔ ÛˆÌ·ÙÈÎfi, ·ÏÏ¿ ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› Î·È ÛÔÚ·‰ÈΤ˜ ÌÔÚʤ˜ (1,27). £ÂˆÚËÙÈο ·Ó·Ê¤ÚÔÓÙ·È ·ÚÎÂÙÔ› Èı·ÓÔ› ·ıÔÁÂÓÂÙÈÎÔ› Ì˯·ÓÈÛÌÔ› Î·È ·›ÙÈ· ˘‡ı˘Ó· ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË Ù˘ PFCP. ™Ù· ·›ÙÈ· ·˘Ù¿ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È Ë ·˘ÍË̤ÓË Â˘·ÈÛıËÛ›· ÙˆÓ ÓÂÊÚÈÎÒÓ ·ÈÛıËÙËÚ›ˆÓ Ì˯·ÓÈÛÌÒÓ ÛÙ· Â›‰· ÙÔ˘ O2, Ô ÌÂÁ¿ÏÔ˜ ·ÚÈıÌfi˜ ÙˆÓ ˘Ô‰Ô¯¤ˆÓ Ù˘ ∂¶O Ô˘ ÂÌÊ·Ó›˙Ô˘Ó Ù· ÚÔÁÔÓÈο ·ÙÙ·Ú· Ù˘ ÂÚ˘ıÚ¿˜ ÛÂÈÚ¿˜ ηÈ, Ù¤ÏÔ˜, Ë ˘„ËÏ‹ Û˘ÁÁ¤ÓÂÈ· ÌÂٷ͇ Ù˘ ∂¶O Î·È ÙÔ˘ ˘Ô‰Ô¯¤· Ù˘ (3).

O ˘Ô‰Ô¯¤·˜ Ù˘ ∂¶O Â›Ó·È ÁÓˆÛÙfi fiÙÈ ·ÔÙÂÏÂ›Ù·È ·fi 3 ÙÌ‹Ì·Ù·, ÙÔ ÂÍˆÎ˘ÙÙ¿ÚÈÔ, ÙÔ ‰È·ÌÂÌ‚Ú·ÓÈÎfi Î·È ÙÔ Î˘ÙÙ·ÚÔÏ·ÛÌ·ÙÈÎfi. ™ÙÔ Ï·›ÛÈÔ Ù˘ ÂÚ¢ÓËÙÈ΋˜ ÚÔÛ¤ÁÁÈÛ˘ Ù˘ PFCP ¤¯Ô˘Ó ÂÓÙÔÈÛÙ› 7 ‰È·ÊÔÚÂÙÈΤ˜ ÌÂÙ·ÏÏ¿ÍÂȘ ÙÔ˘ ÁÔÓȉ›Ô˘ Ô˘ Έ‰ÈÎÔÔÈ› ÙÔÓ ˘Ô‰Ô¯¤· Ù˘ ∂¶O Û ¿Û¯ÔÓÙ˜. ŸÏ˜ ÔÈ ÌÂÙ·ÏÏ¿ÍÂȘ ¤¯ÂÈ ‚ÚÂı› fiÙÈ Â‰Ú¿˙ÔÓÙ·È ÛÙÔ ÂÍfiÓÈÔ 8, Û ÂÚÈÔ¯‹ Ô˘ Έ‰ÈÎÔÔÈ› ·ÚÓËÙÈ΋ Ú˘ıÌÈÛÙÈ΋ ‰Ú¿ÛË ÙÔ˘ ˘Ô‰Ô¯¤·, Ì ·ÔÙ¤ÏÂÛÌ· ̤ۈ ÙˆÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ ·˘ÙÒÓ Ó· ·›ÚÂÙ·È Î·È Ë ·ÓˆÙ¤Úˆ ·Ó·ÊÂÚı›۷ ‰˘Ó·ÙfiÙËÙ· ·ÚÓËÙÈ΋˜ Ú‡ıÌÈÛ˘ Ù˘ ÂÚ˘ıÚÔÔ›ËÛ˘ (3,22). ø˜ ¯·Ú·ÎÙËÚÈÛÙÈο ÁÓˆÚ›ÛÌ·Ù· Ù˘ PFCP ıˆÚÔ‡ÓÙ·È: ·) Ë ·‡ÍËÛË Ù˘ ÂÚ˘ıÚÔ΢ÙÙ·ÚÈ΋˜ Ì¿˙·˜, ¯ˆÚ›˜ fï˜ ‰È·¯ÚÔÓÈΤ˜ ‰È·Î˘Ì¿ÓÛÂȘ, ‚) Ë ·Ô˘Û›· ¿ÏÏˆÓ ·ÈÙ›ˆÓ Ô˘ ÚÔηÏÔ‡Ó ‰Â˘ÙÂÚÔ·ı‹ ÔÏ˘ÂÚ˘ıÚ·ÈÌ›·, Á) Ë ·Ô˘Û›· ÎÏÈÓÈÎÔÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂӉ›ÍÂˆÓ Ô˘ Ó· Û˘ÓËÁÔÚÔ‡Ó ˘¤Ú ∞¶, ÂÚÈÏ·Ì‚·ÓÔ̤Ó˘ Î·È Ù˘ ·ÒÙÂÚ˘ Èı·ÓfiÙËÙ·˜ ÂͤÏÈ͢ Û ÔÍ›· Ï¢¯·ÈÌ›· Î·È ‰) Ë Â›‰ÂÈÍË ·fi Ù· ÚÔÁÔÓÈο ·ÙÙ·Ú· Ù˘ ÂÚ˘ıÚ¿˜ ÛÂÈÚ¿˜ ·˘ÍË̤Ó˘ ¢·ÈÛıËÛ›·˜ ÛÙËÓ ∂¶O Û Â›‰· Ê˘ÛÈÔÏÔÁÈο ‹ Î·È ¯·ÌËÏfiÙÂÚ· ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ in vitro Û ΢ÙÙ·ÚÈΤ˜ ηÏÏȤÚÁÂȘ, ¯ˆÚ›˜ fï˜ Ó· ‰È·ÈÛÙÒÓÂÙ·È Î·È ·˘ÙfiÌ·ÙË ·Ó¿Ù˘ÍË BFU-E ·ÔÈÎÈÒÓ, ÁÂÁÔÓfi˜ Ô˘ ·ÓÙ›ıÂÙ· ¯·Ú·ÎÙËÚ›˙ÂÈ ÙËÓ ∞¶. £ÂÚ·¢ÙÈο, ˆ˜ ·Ú¯È΋ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ∞¶ ˘‹ÚÍ·Ó ÔÈ ·Ê·ÈÌ¿ÍÂȘ. ªÂ ÙËÓ ¿ÚÔ‰Ô ÙÔ˘ ¯Úfi-

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ÓÔ˘, fï˜, ‰È·ÈÛÙÒıËΠfiÙÈ Ì ÙȘ ·Ê·ÈÌ¿ÍÂȘ ·˘Í·ÓfiÙ·Ó Ë Èı·ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ Ì˘ÂÏÔ˝ÓˆÛ˘ Î·È ·ÎÔÏÔ‡ıˆ˜ ÂÁηٷÏ›ÊıËÎÂ Û·Ó ıÂÚ·¢ÙÈ΋ ̤ıÔ‰Ô˜, ȉȷ›ÙÂÚ· ÛÙ· Ó·ڿ ¿ÙÔÌ· (28). ∞ÓÙ›ıÂÙ·, ıˆÚÂ›Ù·È fiÙÈ ÔÈ ·Ê·ÈÌ¿ÍÂȘ ÌÔÚ› Ó· ·ÔÙÂÏÔ‡Ó ıÂÚ·›· ÂÎÏÔÁ‹˜ Û ·ÛıÂÓ›˜ Ì ·ÌÈÁ‹ ÔÏ˘ÂÚ˘ıÚ·ÈÌ›·, ÔÈ ÔÔ›ÔÈ ‰ÂÓ ÂÌÊ·Ó›˙Ô˘Ó ÚÔÔÙÈο ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ Ì˘ÂÏÔ˝ÓˆÛ˘ (29). O Ú·‰ÈÂÓÂÚÁfi˜ ÊÒÛÊÔÚÔ˜ (32ƒ) ·Ó‹ÎÂÈ ÛÙÔ˘˜ Ôχ ·ÔÙÂÏÂÛÌ·ÙÈÎÔ‡˜ Î·È Î·Ï¿ ·ÓÂÎÙÔ‡˜ ıÂÚ·¢ÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜, ÚÔÛʤÚÔÓÙ·˜ Ì·ÎÚ¿ ÂÈ‚›ˆÛË Ì ηϋ ÔÈfiÙËÙ· ˙ˆ‹˜. ∏ ¯Ú‹ÛË ÙÔ˘ ÂÁ΢ÌÔÓ› ÎÈÓ‰‡ÓÔ˘˜ ÂÌÊ¿ÓÈÛ˘ ÔÍ›·˜ Ï¢¯·ÈÌ›·˜ Î·È ‰ÂÓ Û˘ÓÈÛÙ¿Ù·È Û Ó·ڋ˜ ËÏÈΛ·˜ ·ÛıÂÓ›˜, ÙˆÓ ÔÔ›ˆÓ ÙÔ ÚÔÛ‰fiÎÈÌÔ ÂÈ‚›ˆÛ˘ Â›Ó·È Ì·ÎÚfi (29). ∏ ˘‰ÚÔ͢Ԣڛ· Â›Ó·È ÈÛ¯˘Úfi˜ ÌË ·Ï΢ÏÈÔ‡ÓÙ·˜ Ì˘ÂÏÔηٷÛÙ·ÏÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ Ô˘ ·Ó·ÛÙ¤ÏÏÂÈ ÙÔÓ ÔÏÏ·Ï·ÛÈ·ÛÌfi ÙˆÓ Î˘ÙÙ¿ÚˆÓ Ì¤Ûˆ Ì›ˆÛ˘ Ù˘ Û‡ÓıÂÛ˘ ÙÔ˘ DNA. ™Ù· ÏÂÔÓÂÎÙ‹Ì·Ù· ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Û˘ÁηٷϤÁÔÓÙ·È Ë Â‡ÎÔÏË Ï‹„Ë ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜ Î·È Ë Î·Ï‹ ·ÓÔ¯‹, Ô˘ ÙÔ Î·ıÈÛÙÔ‡Ó È‰È·›ÙÂÚ· ¯Ú‹ÛÈÌÔ Û ̷ÎÚÔ¯ÚfiÓÈ· ·ÁˆÁ‹. ∏ ˘‰ÚÔ͢Ԣڛ· ÌÂÈÒÓÂÈ Ù· Â›‰· ÙÔ˘ ·ÈÌ·ÙÔÎÚ›ÙË, ÙÔÓ ·ÚÈıÌfi ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ Î·È ·Ó·ÎÔ˘Ê›˙ÂÈ ·fi ÙÔ ·›ÛıËÌ· ÎÓËÛÌÔ‡ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ∞¶. ∏ ·ÒÙÂÚË Ï¢¯·ÈÌÔÁfiÓÔ˜ ‰Ú¿ÛË Ù˘, ·Ó Î·È ˘·ÚÎÙ‹, ıˆÚÂ›Ù·È Û¯ÂÙÈο ¯·ÌËÏ‹ ÂÓÒ Ê·›ÓÂÙ·È Ì¿ÏÏÔÓ fiÙÈ ÌÂÈÒÓÂÈ ÎÏÈÓÈο Ù· ıÚÔÌ‚ˆÙÈο ÂÂÈÛfi‰È·, Ù· ÔÔ›· ·ÔÙÂÏÔ‡Ó Î·È Ì›˙ÔÓ· ·Ú¿ÁÔÓÙ· ÓÔÛËÚfiÙËÙ·˜ Î·È ıÓËÛÈÌfiÙËÙ·˜. °È· ÙÔ ÏfiÁÔ ·˘Ùfi ·ÔÙÂÏ› Û‹ÌÂÚ· ıÂÚ·›· ÂÎÏÔÁ‹˜ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ∞¶ (30). π‰ÈÔ·ı‹˜ ıÚÔÌ‚Ô΢ÙÙ·Ú·ÈÌ›· (Essential thrombocythaemia - ET) H ET Â›Ó·È ÂÍ·ÈÚÂÙÈο Û¿ÓÈ· ÓÔÛÔÏÔÁÈ΋ ÔÓÙfiÙËÙ· ÛÙËÓ ·È‰È΋ ËÏÈΛ· Î·È Ì¤¯ÚÈ Û‹ÌÂÚ· ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· ÂÚ› ÙȘ 20 ÂÚÈÙÒÛÂȘ (31,32). ™·Ó ·ÈÌ·ÙÔÏÔÁÈÎfi ÓfiÛËÌ· Û˘ÁηٷϤÁÂÙ·È ÛÙȘ ÎψÓÈÎÔ‡ Ù‡Ô˘ ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ·Ú¯¤ÁÔÓÔ˘ ·ÈÌÔÔÈËÙÈÎÔ‡ ΢ÙÙ¿ÚÔ˘, ·ÚfiÙÈ ˘¿Ú¯Ô˘Ó ÔÚÈṲ̂Ó˜ ÌÂϤÙ˜ Ô˘ Û˘ÓËÁÔÚÔ‡Ó, Û οÔȘ ÂÚÈÙÒÛÂȘ, ˘¤Ú ÔÏ˘ÎψÓÈÎÔ‡ ÓÔÛ‹Ì·ÙÔ˜. ŸÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ·ıÔÁ¤ÓÂÈ· Ù˘ ÓfiÛÔ˘, ‰ÂÓ ¤¯ÂÈ ·Ô‰Âȯı› Û˘Û¯¤ÙÈÛ‹ Ù˘ ÌÂ Û˘ÁÎÂÎÚÈ̤ÓÔ ÁÔÓ›‰ÈÔ, ÂÓÒ ÔÈ ¯ÚˆÌÔۈ̷ÙÈΤ˜ ‚Ï¿‚˜ Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÔ˘˜ ¿Û¯ÔÓÙ˜ Â›Ó·È ÂÍ·ÈÚÂÙÈο Û¿ÓȘ (3). ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÙÔ ÂÚ¢ÓËÙÈÎfi ÂӉȷʤÚÔÓ ¤¯ÂÈ ÛÙÚ·Ê› ÛÙËÓ ·ÏÏËÏÂ›‰Ú·ÛË Ù˘ ıÚÔÌ‚ÔÔÈËÙ›Ó˘ (∆ƒO) Ì ÙÔÓ Î˘ÙÙ·ÚÈÎfi Ù˘ ˘Ô‰Ô¯¤· (c-Mpl) Î·È ÙËÓ ÂÓ‰Ô΢ÙÙ¿ÚÈ· ÌÂÙ·ÁˆÁ‹ Û‹Ì·ÙÔ˜. ∞˘Ùfi Ô˘ ¤¯ÂÈ ‰È·ÈÛÙˆı› Â›Ó·È fiÙÈ Ù· Â›‰· Ù˘ ∆ƒO, ηٿ ·ÚÈÔ ÏfiÁÔ, Ú˘ıÌ›˙ÔÓÙ·È ·fi

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ÙÔ ‚·ıÌfi Û‡Ó‰ÂÛ‹˜ Ù˘ Ì ÙÔÓ c-Mpl. º·›ÓÂÙ·È ‰Â fiÙÈ ˘„ËÏ¿ Â›‰· Ù˘ ∆ƒO ‰˘Ó·ÙfiÓ Ó· ÚÔ·ÙÔ˘Ó ÏfiÁˆ ÂÓ‰ÔÁÂÓÔ‡˜ ÌÂÙ·ÁÚ·ÊÈÎÔ‡ ÂÏÏ›ÌÌ·ÙÔ˜ ÙÔ˘ c-Mpl, Ì ·ÔÙ¤ÏÂÛÌ· Ë Î¿ı·ÚÛË Ù˘ ∆ƒO Ó· Â›Ó·È ÌÂȈ̤ÓË Î·È ¿Ú· Ù· Â›‰¿ Ù˘ ÛÙÔÓ ÔÚfi ηıÒ˜ Î·È Ë ÏÂÈÙÔ˘ÚÁÈ΋ Ù˘ ‰Ú·ÛÙËÚÈfiÙËÙ· ÛÙÔ˘˜ ¿Û¯ÔÓÙ˜ Ó· Â›Ó·È ·˘ÍË̤ӷ (4). ∆· ÎÚÈÙ‹ÚÈ· Ô˘ ¤¯ÂÈ ıÂÛ›ÛÂÈ Ë PVSG ÁÈ· ÙË ‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘ Û ÂÓ‹ÏÈΘ Î·È ·È‰È·ÙÚÈÎÔ‡˜ ·ÛıÂÓ›˜ Â›Ó·È Ù· ÂÍ‹˜ (3): ·) ÙÈÌ‹ ·ÈÌÔÂÙ·Ï›ˆÓ ¿Óˆ ÙˆÓ 600x109/L Û 2 ÌÂÙÚ‹ÛÂȘ Ì ‰È·ÊÔÚ¿ ÂÓfi˜ ÌËÓfi˜, ‚) ·ÔÎÏÂÈÛÌfi˜ ¿ÏÏˆÓ Î·Ù·ÛÙ¿ÛÂˆÓ Ô˘ ÚÔηÏÔ‡Ó ıÚÔÌ‚Ô΢ÙÙ¿ÚˆÛË, Á) ÙÈÌ‹ ·ÈÌ·ÙÔÎÚ›ÙË Î¿Ùˆ ÙÔ˘ 40% ‹ Ê˘ÛÈÔÏÔÁÈ΋ Ì¿˙· ÂÚ˘ıÚÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ, ·Ó¿ÏÔÁ· Ì ÙÔ Ê‡ÏÔ ÙˆÓ ·ÛıÂÓÒÓ, ‰) Ê˘ÛÈÔÏÔÁÈΤ˜ ÙÈ̤˜ MCV, ÊÂÚÚÈÙ›Ó˘ ÔÚÔ‡ ‹ Ûȉ‹ÚÔ˘ ÛÙÔ Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ (ªO), Â) ·Ô˘Û›· ›ÓˆÛ˘ ÙÔ˘ ªO ‹ ›ÓˆÛË ÙÔ˘ ªO Û ÌÈÎÚfiÙÂÚÔ ÙÔ˘ 1/3 ÙÔ˘ ˘ÏÈÎÔ‡ Ù˘ ÔÛÙÂÔÌ˘ÂÏÈ΋˜ ‚ÈÔ„›·˜, ¯ˆÚ›˜ ·˘Ù‹ Ó· Û˘Óԉ‡ÂÙ·È ·fi ÛÏËÓÔÌÂÁ·Ï›· ‹ Ï¢ÎÔÂÚ˘ıÚÔ‚Ï·ÛÙÈ΋ ·ÓÙ›‰Ú·ÛË Î·È ÛÙ) ·Ô˘Û›· ¯ÚˆÌÔÛÒÌ·ÙÔ˜ ºÈÏ·‰¤ÏÊÂÈ·˜ ‹ ¿ÏÏ˘ ÌÂÙ¿ıÂÛ˘ ÙˆÓ ÂÚÈÔ¯ÒÓ bcr/abl. ∏ Û˘¯ÓfiÙËÙ· Ù˘ ÓfiÛÔ˘ Â›Ó·È ·Ó¿ÏÔÁË Ì ·˘Ù‹ Ù˘ ∞¶, Ë ‰È¿ÌÂÛË ËÏÈΛ· ‰È¿ÁÓˆÛ˘ Ù· 65 ¤ÙË, ÂÓÒ ÌfiÓÔ ÙÔ 10-25% ÙˆÓ ·Û¯fiÓÙˆÓ ‰È·ÁÈÁÓÒÛÎÂÙ·È Û ËÏÈΛ· ÌÈÎÚfiÙÂÚË ÙˆÓ 40 ÂÙÒÓ Î·È, ηٿ Û˘Ó¤ÂÈ·, ÂÌÊ·Ó›˙ÂÙ·È ÂÍ·ÈÚÂÙÈο Û¿ÓÈ· ÛÙËÓ ·È‰È΋ ËÏÈΛ· (1,2,5,31,33,34). ∏ ÎÏÈÓÈ΋ ÂÈÎfiÓ· Ù˘ ÓfiÛÔ˘ ÂÚÈÏ·Ì‚¿ÓÂÈ ·ÈÌÔÚÚ·Á›Â˜, ıÚÔÌ‚ÒÛÂȘ, ÌÈÎÚÔ·ÁÁÂȷο ¤ÌÊÚ·ÎÙ· Ì ÏÂÈÙÔ˘ÚÁÈο Û˘ÌÙÒÌ·Ù·, fiˆ˜ ·Ú·ÈÛıËÛ›·, ÎÂÊ·Ï·ÏÁ›·, ·ÈÛıËÙÈΤ˜ ‰È·Ù·Ú·¯¤˜, ηٷÛÙ¿ÛÂȘ ÔÈ Ôԛ˜ Ô‰ËÁÔ‡Ó ÌÂÚÈΤ˜ ÊÔÚ¤˜ Û ÛÔ‚·Ú‹ ÓÔÛËÚfiÙËÙ· (35). ™Ô‚·Ú¿ ıÚÔÌ‚ˆÙÈο ÂÂÈÛfi‰È· ÂÌÊ·Ó›˙ÂÈ ÙÔ 20-30% ÙˆÓ ·Û¯fiÓÙˆÓ, Ì ·ÚÈÔ˘˜ ÂÈ‚·Ú˘ÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ÙË ÌÂÁ¿ÏË ËÏÈΛ·, ÙË Ì·ÎÚfi¯ÚÔÓË ÓfiÛÔ Î·È ÙÔ ıÂÙÈÎfi ÈÛÙÔÚÈÎfi ÁÈ· ıÚÔÌ‚ÒÛÂȘ. ™¿ÓÈ· Û˘Ó˘¿Ú¯ÂÈ ÛÏËÓÔÌÂÁ·Ï›· Î·È ·Í›˙ÂÈ Ó· ÛËÌÂȈı› fiÙÈ ÛÙÔ 30% ÙˆÓ ·ÛıÂÓÒÓ Ë ‰È¿ÁÓˆÛË Ù›ıÂÙ·È Ù˘¯·›· (2). £ÂÚ·¢ÙÈο ¤¯ÂÈ ÂȯÂÈÚËı› Ë ¯ÔÚ‹ÁËÛË Ú·‰ÈÂÓÂÚÁÔ‡ 32ƒ, ‚Ô˘ÛÔ˘ÏÊ¿Ó˘, ˘‰ÚÔ͢Ԣڛ·˜ Î·È ÈÓÙÂÚÊÂÚfiÓ˘-· (28,36). ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ∂∆ ¤¯ÂÈ ‰ÔÎÈÌ·ÛÙ› Ë ·Ó·ÁÎÚÂÏ›‰Ë Ô˘ ‰Ú· ΢ڛˆ˜ Û·Ó ·ÓÙÈ-cAMP ʈÛÊÔ‰ÈÂÛÙÂÚ¿ÛË, ¤¯ÂÈ Ôχ ηϋ ‚ÈԉȷıÂÛÈÌfiÙËÙ· Î·È ‰ÂÓ Ê·›ÓÂÙ·È Ó· ÂËÚ¿˙ÂÈ ÙȘ ¿ÏϘ Ì˘ÂÏÈΤ˜ ÛÂÈÚ¤˜ (37-39). ∏ ÂÊ·ÚÌÔÁ‹ Ù˘ ¤¯ÂÈ ÍÂÎÈÓ‹ÛÂÈ ·fi Ù· ̤۷ Ù˘ ‰ÂηÂÙ›·˜ ÙÔ˘ ’80 Î·È ÂÌÊ·Ó›˙ÂÈ ÂÓı·ÚÚ˘ÓÙÈο ·ÔÙÂϤÛÌ·Ù·, Ì ·ÓÙ·fiÎÚÈÛË Ô˘ Î˘Ì·›ÓÂÙ·È ÛÙÔ 90% ÙˆÓ ·ÛıÂÓÒÓ. ™ÙȘ ·ÚÂÓ¤ÚÁÂȘ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Û˘ÁηٷϤÁÔÓÙ·È Ë ‰ÔÛÔÂÍ·ÚÙÒÌÂÓË Î·È ·Ó·ÛÙÚ¤„ÈÌË Ì›ˆÛË Ù˘ ·ÓÙ›ÛÙ·Û˘ ÙˆÓ

Paediatriki 2002;65:222-231

·ÁÁ›ˆÓ Î·È Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘, Ë ·‡ÍËÛË ÙÔ˘ ηډȷÎÔ‡ Ú˘ıÌÔ‡ Î·È Ù˘ Û˘ÛÙ·ÏÙÈÎfiÙËÙ·˜ ÙˆÓ ÎÔÈÏÈÒÓ, Ë Î·Ù·ÎÚ¿ÙËÛË ˘ÁÚÒÓ, ÙÔ ·›ÛıËÌ· ˙¿Ï˘, ÔÈ ‰È·ÚÚÔ˚Τ˜ ÎÂÓÒÛÂȘ, ÙÔ ‰ÂÚÌ·ÙÈÎfi ÂÍ¿ÓıËÌ·, ‹È· ·Ó·ÈÌ›· Î.¿. ¶Ú¤ÂÈ, ¿ÓÙˆ˜, Ó· ÛËÌÂȈı› fiÙÈ ÔÈ ·ÚÂÓ¤ÚÁÂȘ Ù˘ ·Ó·ÁÎÚÂÏ›‰Ë˜ Û˘ÓÔÏÈο ÎÚ›ÓÔÓÙ·È ˆ˜ ÂÏ¿ÛÛÔÓ˜ Î·È Û‹ÌÂÚ· ·ÔÙÂÏ› ÙË ıÂÚ·›· ÂÎÏÔÁ‹˜ ΢ڛˆ˜ ÁÈ· Ù· Ó·ڿ ¿ÙÔÌ·, ·ÊÂÓfi˜ ÏfiÁˆ Ù˘ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ¿˜ Ù˘, ΢ڛˆ˜ fï˜ ÏfiÁˆ Ù˘ ÌË Ï¢¯·ÈÌÔÁfiÓÔ˘ ·ÒÙÂÚ˘ ‰Ú¿Û˘ Ù˘ (40). π‰ÈÔ·ı‹˜ Ì˘ÂÏÔ˝ÓˆÛË ∏ ÓfiÛÔ˜ ÛÙËÓ ·È‰È΋ ËÏÈΛ· Â›Ó·È ÂÍ·ÈÚÂÙÈο Û¿ÓÈ· Î·È ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ÛÔÚ·‰ÈΤ˜ ÂÚÈÙÒÛÂȘ, ÔÚÈṲ̂Ó˜ ÙˆÓ ÔÔ›ˆÓ ¤¯Ô˘Ó ÔÈÎÔÁÂÓ‹ Â›ÙˆÛË (1,2,5). ÷ڷÎÙËÚ›˙ÂÙ·È ·fi ÚÔԉ¢ÙÈ΋ ›ÓˆÛË ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ, ÛÏËÓÔÌÂÁ·Ï›· Î·È ÂÍˆÌ˘ÂÏÈ΋ ·ÈÌÔÔ›ËÛË. ™ÙÔ ÂÚÈÊÂÚÈÎfi ·›Ì· ‰È·ÈÛÙÒÓÂÙ·È Ë ·ÚÔ˘Û›· ÔÈÎÈÏÔ΢ÙÙ¿ÚˆÛ˘, Û˘Óԉ¢fiÌÂÓ˘ ·fi ‰·ÎÚ˘Ô·ÙÙ·Ú· Î·È Ï¢ÎÔÂÚ˘ıÚÔ‚Ï¿ÛÙˆÛË. ™˘¯Ó¿ Û˘Ó˘¿Ú¯ÂÈ ‹ÈÔ˘ ‚·ıÌÔ‡ ·Ó·ÈÌ›·, ÂÓÒ Ù· ·ÈÌÔÂÙ¿ÏÈ· Î·È Ù· ÏÂ˘Î¿ ·ÈÌÔÛÊ·›ÚÈ· ÌÔÚ› Ó· Â›Ó·È ÛÂ Ê˘ÛÈÔÏÔÁÈο, ¯·ÌËÏ¿ ‹ Î·È ˘„ËÏ¿ Â›‰·. ∏ ÔÚ›· Ù˘ ÓfiÛÔ˘ ÌÔÚ› Ó· ÂÌÊ·Ó›ÛÂÈ ‡ÊÂÛË ·˘ÙfiÌ·ÙË ‹ ÌÂÙ¿ ·fi ¯ÔÚ‹ÁËÛË ÛÙÂÚÔÂȉÒÓ Î·È Û·ÓÈfiÙÂÚ· Ó· ÂÎÙÚ·› Û ¿ÏÏÔ Î·ÎfiËı˜ ·ÈÌ·ÙÔÏÔÁÈÎfi ÓfiÛËÌ·. ¢Â‰Ô̤Ó˘ Ù˘ Û·ÓÈfiÙËÙ·˜ ÙÔ˘ ÓÔÛ‹Ì·ÙÔ˜, ‰ÂÓ ˘¿Ú¯Ô˘Ó Û·Ê›˜ ıÂÚ·¢ÙÈΤ˜ Ô‰ËÁ›Â˜ ÁÈ· ÙÔ˘˜ ·È‰È·ÙÚÈÎÔ‡˜ ·ÛıÂÓ›˜ (2). ∂›ÏÔÁÔ˜ ∆· Ì˘ÂÏÔ¸ÂÚÏ·ÛÙÈο ÛÂ Û˘Ó‰˘·ÛÌfi Ì ٷ Ì˘ÂÏÔ‰˘ÛÏ·ÛÙÈο Û‡Ó‰ÚÔÌ· Ù˘ ·È‰È΋˜ ËÏÈΛ·˜, ¤¯Ô˘Ó ·ÔÙÂϤÛÂÈ ‰›Ô ÂÓÙ·ÙÈ΋˜ ÂÈÛÙËÌÔÓÈ΋˜ ¤Ú¢ӷ˜ ÙËÓ ÙÂÏÂ˘Ù·›· ÂÓÙ·ÂÙ›·. §fiÁˆ, fï˜, Ù˘ Û·ÓÈfiÙËÙ¿˜ ÙÔ˘˜ ÛÙËÓ ·È‰È΋ ËÏÈΛ·, ¤¯ÂÈ Á›ÓÂÈ ·fiÏ˘Ù· ·ÓÙÈÏËÙfi ·fi fiÏÔ˘˜ ÙÔ˘˜ ÂÚ¢ÓËÙ¤˜ Î·È ÛÙȘ ‰‡Ô Ï¢ڤ˜ ÙÔ˘ ∞ÙÏ·ÓÙÈÎÔ‡, fiÙÈ ÌfiÓÔ Ì¤Ûˆ ÂÓÔÔÈËÌ¤ÓˆÓ ÚÔÔÙÈÎÒÓ ÌÂÏÂÙÒÓ, Ì ÎÔÈÓ¿ ‰È·ÁÓˆÛÙÈο ÎÚÈÙ‹ÚÈ· ı· Â¤ÏıÂÈ ÚfiÔ‰Ô˜ ÙfiÛÔ Û Â›Â‰Ô ‰ÈÂÚ‡ÓËÛ˘ Ù˘ ·ıÔÁ¤ÓÂÈ·˜, fiÛÔ Î·È Û Â›Â‰Ô Î·Ù·ÓfiËÛ˘ 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‹ÛÂÈ Î·È Û ıÂÚ·¢ÙÈΤ˜ ϤÔÓ ·ÔÙÂÏÂÛÌ·ÙÈΤ˜ χÛÂȘ Î·È ÛÙ· ·È‰È¿. µÈ‚ÏÈÔÁÚ·Ê›· 1. Cotter FE. Childhood myeloproliferative disorders.

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40. Petitt RM, Silverstein MN, Petrone ME. Anagrelide for control of thrombocythemia in polycythemia and other myeloproliferative disorders. Semin Hematol 1997;34:51-54.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 28-01-2002 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 28-05-2002 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ™. ¶ÔÏ˘¯ÚÔÓÔÔ‡ÏÔ˘∞Ó‰ÚÔ˘Ï·Î¿ÎË πˆ¿ÓÓÔ˘ °ÂÓÓ·‰›Ô˘ 14∞, ∆.∫. 115 21, ∞ı‹Ó· E-mail: sophopol@otenet.gr

¶ÂÚ›ÏË„Ë ¿ÚıÚÔ˘ ·fi ÙË µÈ‚ÏÈÔÁÚ·Ê›· ∏ Û˘ÌÏËڈ̷ÙÈ΋ ¯ÔÚ‹ÁËÛË ·ÚÁÈÓ›Ó˘ ÚÔÊ˘Ï¿ÛÛÂÈ ·fi ÙËÓ ÂÌÊ¿ÓÈÛË ÓÂÎÚˆÙÈ΋˜ ÂÓÙÂÚÔÎÔÏ›Ùȉ·˜ ÛÙ· ÚfiˆÚ· ÓÂÔÁÓ¿1 ™ÎÔfi˜: ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ó· ÚÔÛ‰ÈÔÚÈÛÙ› ·Ó Ë Û˘ÌÏËڈ̷ÙÈ΋ ¯ÔÚ‹ÁËÛË L-·ÚÁÈÓ›Ó˘ ÂÏ·ÙÙÒÓÂÈ ÙË Û˘¯ÓfiÙËÙ· fiÏˆÓ ÙˆÓ ÛÙ·‰›ˆÓ Ù˘ ÓÂÎÚˆÙÈ΋˜ ÂÓÙÂÚÔÎÔÏ›Ùȉ·˜ (¡∂∫) Û ÚfiˆÚ· ÓÂÔÁÓ¿ Ì ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ <1250 g Î·È ËÏÈΛ·˜ ·ËÛ˘ <32 ‚‰ÔÌ¿‰ˆÓ. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ™ÙË ÌÂϤÙË, Ô˘ ‹Ù·Ó Ù˘¯·ÈÔÔÈË̤ÓË, ‰ÈÏ‹ Ù˘ÊÏ‹, ÂÏÂÁ¯fiÌÂÓË, ÂÚÈÂÏ‹ÊıËÛ·Ó ÚÔ‰ÚÔÌÈο 152 ÚfiˆÚ· ÓÂÔÁÓ¿. ∂‚‰ÔÌ‹ÓÙ· ¤ÓÙ (ÔÌ¿‰· ∞) ‹Ú·Ó L-·ÚÁÈÓ›ÓË (1,5 mmol/kg/Ë̤ڷ) Î·È Ù· ˘fiÏÔÈ· 77, ÔÌ¿‰· ÂϤÁ¯Ô˘, ‹Ú·Ó placebo (ÔÌ¿‰· µ), Ì ÙËÓ ÂÓÙÂÚÈ΋ ‹ Î·È ·ÚÂÓÙÂÚÈ΋ ‰È·ÙÚÔÊ‹ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÚÒÙˆÓ 28 ËÌÂÚÒÓ Ù˘ ˙ˆ‹˜ ÙÔ˘˜. ∏ ‰È·ÙÚÔÊÈ΋ ÚfiÛÏË„Ë Î·È ÔÈ Û˘ÁÎÂÓÙÚÒÛÂȘ ·Ì̈ӛ·˜, ·ÚÁÈÓ›Ó˘ Î·È ·ÌÈÓÔͤˆÓ ÙÔ˘ Ï¿ÛÌ·ÙÔ˜ ÌÂÙÚ‹ıËÎ·Ó Û fiÏ· Ù· ÓÂÔÁÓ¿ ÙËÓ 3Ë, ÙË 14Ë Î·È ÙËÓ 28Ë Ë̤ڷ, ηıÒ˜ Â›Û˘ Î·È Î·Ù¿ ÙË ‰È¿ÁÓˆÛË Ù˘ ¡∂∫. ∞ÔÙÂϤÛÌ·Ù·: ¡∂∫ ·ÚÔ˘Û›·Û·Ó 5 ÓÂÔÁÓ¿ Ù˘ ÔÌ¿‰·˜ ∞, Û˘ÁÎÚÈÓfiÌÂÓ· Ì 21 ÓÂÔÁÓ¿ Ù˘ ÔÌ¿‰·˜ µ (p<0,001). ∏ ÚÔÛÏ·Ì‚·ÓfiÌÂÓË ·ÚÁÈÓ›ÓË Î·È ÔÈ Û˘ÁÎÂÓÙÚÒÛÂȘ Ù˘ ÛÙÔ Ï¿ÛÌ· ‹Ù·Ó ›‰È˜ Î·È ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜ ÙˆÓ ÓÂÔÁÓÒÓ Î·Ù¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ÌÂϤÙ˘ (fiˆ˜ ·Ó·ÌÂÓfiÙ·Ó) Î·È ·˘ÍË̤Ó˜ ÙË 14Ë Î·È 28Ë Ë̤ڷ ÛÙ· ÓÂÔÁÓ¿ Ù˘ ÔÌ¿‰·˜ ∞. OÈ Û˘ÁÎÂÓÙÚÒÛÂȘ Ù˘ ·ÚÁÈÓ›Ó˘ ÛÙÔ Ï¿ÛÌ· ‹Ù·Ó ¯·ÌËϤ˜, ηٿ ÙË ‰È¿ÁÓˆÛË Ù˘ ¡∂∫ Î·È ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜ ÙˆÓ ÓÂÔÁÓÒÓ. ¢ÂÓ

˘‹Ú¯·Ó ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÛÙ· ÌËÙÚÈο Î·È ÓÂÔÁÓÈο ‰ËÌÔÁÚ·ÊÈο ¯·Ú·ÎÙËÚÈÛÙÈο, ÛÙË ‰È·ÙÚÔÊÈ΋ ÚfiÛÏË„Ë, ÛÙËÓ ·Ì̈ӛ· ÙÔ˘ Ï¿ÛÌ·ÙÔ˜ Î·È ÛÙȘ Û˘ÁÎÂÓÙÚÒÛÂȘ ÙˆÓ ÔÏÈÎÒÓ Î·È ÙˆÓ ··Ú·›ÙËÙˆÓ ·ÌÈÓÔͤˆÓ, ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ÙˆÓ ÌÂÏÂÙËı¤ÓÙˆÓ ÓÂÔÁÓÒÓ. ™˘ÌÂÚ¿ÛÌ·Ù·: ∏ Û˘ÌÏËڈ̷ÙÈ΋ ¯ÔÚ‹ÁËÛË ·ÚÁÈÓ›Ó˘ (1,5 mmol/kg/Ë̤ڷ) ÛÙ· ÚfiˆÚ· ÓÂÔÁÓ¿ ÂÏ·ÙÙÒÓÂÈ ÙÔ ÔÛÔÛÙfi fiÏˆÓ ÙˆÓ ÛÙ·‰›ˆÓ ¡∂∫.

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

ºˆÙfiÔ˘ÏÔ˜ ™‡ÚÔ˜ ¶·È‰›·ÙÚÔ˜-¡ÂÔÁÓÔÏfiÁÔ˜ ¢È‰¿ÎÙˆÚ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ∞Ó·ÏËÚˆÙ‹˜ ¢È¢ı˘ÓÙ‹˜ µ’ ª∂¡ ¡ÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ “∏ ∞Á›· ™ÔÊ›·”

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∞¡∞™∫O¶∏™∏

Paediatriki 2002;65:232-240

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¡ÂÎÚˆÙÈ΋ ÂÓÙÂÚÔÎÔÏ›Ùȉ·: ¡ÂfiÙÂÚ˜ ·fi„ÂȘ ∫. ÷Ù˙Ë˚ˆ·ÓÓ›‰Ë˜

Necrotizing enterocolitis: New concepts C. Hatziioannidis

¶ÂÚ›ÏË„Ë: ∏ ÓÂÎÚˆÙÈ΋ ÂÓÙÂÚÔÎÔÏ›Ùȉ· Â›Ó·È ÊÏÂÁÌÔÓ҉˘ ÓfiÛÔ˜, Ô˘ ¤¯ÂÈ ‚·ÚÈ¿ ÎÏÈÓÈ΋ ÂÈÎfiÓ·, ÛÔ‚·Ú¤˜ ÂÈÏÔΤ˜ 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· Ôχ ÌÈÎÚ¿ ÓÂÔÁÓ¿ (ÙÔ 90% ÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ ·ÊÔÚ¿ ÚfiˆÚ·). ∏ ·ÈÙÈÔÏÔÁ›· Ù˘ Â›Ó·È Ì¤¯ÚÈ Û‹ÌÂÚ· ¿ÁÓˆÛÙË. ∏ ·ıÔÁ¤ÓÂÈ¿ Ù˘, ·Ú¿ ÙȘ ÂÓÙ·ÙÈΤ˜ ¤Ú¢Ó˜, ‰ÂÓ ¤¯ÂÈ ÍÂηı·ÚÈÛÙ› Ï‹Úˆ˜. ∏ Û‡Á¯ÚÔÓË ıˆڛ· ˘ÔÛÙËÚ›˙ÂÈ fiÙÈ Ë ·ıÔÁ¤ÓÂÈ· Ù˘ ÓfiÛÔ˘ Â›Ó·È ÔÏ˘·Ú·ÁÔÓÙÈ΋. OÚÈṲ̂ÓÔÈ ·Ú¿ÁÔÓÙ˜ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÂÓÂÚÁÔÔÈÔ‡Ó ÚÔÊÏÂÁÌÔÓÒ‰ÂȘ ÌÂÛÔÏ·‚ËÙ¤˜, Ì ÙÂÏÈÎfi ·ÔÙ¤ÏÂÛÌ· ÙË Ó¤ÎÚˆÛË ÙÔ˘ ÂÓÙ¤ÚÔ˘. OÈ Î˘ÚÈfiÙÂÚÔÈ ÚÔÊÏÂÁÌÔÓÒ‰ÂȘ ÌÂÛÔÏ·‚ËÙ¤˜ Â›Ó·È ÔÈ Î˘ÙÔΛÓ˜, Ô ·Ú¿ÁÔÓÙ·˜ ÂÓÂÚÁÔÔ›ËÛ˘ ·ÈÌÔÂÙ·Ï›ˆÓ, ÙÔ ÌÔÓÔÍ›‰ÈÔ ÙÔ˘ ·˙ÒÙÔ˘ Î.Ï. ¶ÔÏÏÔ› ÂÚ¢ÓËÙ¤˜ ÚÔÛ¿ıËÛ·Ó Ó· ‚ÚÔ˘Ó ÂȉÈÎÔ‡˜ ‰Â›ÎÙ˜ ÁÈ· ÙËÓ ÚÒÈÌË ‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘, ÌÂٷ͇ ÙˆÓ ÔÔ›ˆÓ Â›Ó·È Î·È ÙÔ ªRI. ∏ ıÂÚ·›· Ù˘ ÓfiÛÔ˘ ·ÔÛÎÔ› ÛÙË ‰ÈfiÚıˆÛË fiÏˆÓ ÙˆÓ ‰È·Ù·Ú·¯ÒÓ Ô˘ ÚÔ·ÙÔ˘Ó, ÙËÓ ÂÓÙ·ÙÈ΋ ˘ÔÛÙ‹ÚÈÍË ÙÔ˘ ÓÂÔÁÓÔ‡ Î·È ÙË ¯ÔÚ‹ÁËÛË ·ÓÙÈ‚›ˆÛ˘. ∏ ¯ÂÈÚÔ˘ÚÁÈ΋ ıÂÚ·›· ÂÊ·ÚÌfi˙ÂÙ·È fiÙ·Ó ˘¿Ú¯Ô˘Ó ÂӉ›ÍÂȘ Ó¤ÎÚˆÛ˘ ÙÔ˘ ÂÓÙ¤ÚÔ˘. ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, Ë ÂÚÈÙÔÓ·˚΋ ·ÚÔ¯¤Ù¢ÛË ÂÊ·ÚÌfi˙ÂÙ·È Ì ÂÈÙ˘¯›· Û ÌÈÎÚ¿ ÚfiˆÚ·, ηıÒ˜ Î·È Û ÂÈÏÂÁ̤Ó˜ ÂÚÈÙÒÛÂȘ. ∏ ηχÙÂÚË Î·Ù·ÓfiËÛË Ù˘ ·ıÔÁ¤ÓÂÈ·˜ Ù˘ ¡∂∫ Û˘Ó¤‚·Ï ÛÙËÓ ·Ó¿Ù˘ÍË ÚÔÏËÙÈÎÒÓ ÛÙÚ·ÙËÁÈÎÒÓ. ™Â ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ ¤¯ÂÈ ‚ÚÂı› ÂÏ¿ÙÙˆÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ Ù˘ ÓfiÛÔ˘ Ì ÙÔ ÌËÙÚÈÎfi ıËÏ·ÛÌfi, Û˘Ìϋڈ̷ Ì IgA Î·È ÙËÓ ÚÔÊ˘Ï·ÎÙÈ΋ ¯ÔÚ‹ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ, ʈÛÊÔÏÈ›‰È· ·˘ÁÔ‡ Î·È ÂÚ˘ıÚÔÔÈËÙ›ÓË.

Abstract: Necrotizing enterocolitis (NEC) is an inflammatory condition with severe clinical presentation, many complications and high mortality. N∂C affects the immature intestine and consequently it affects primarily the premature infants and, in 90% of the cases, the very low birth weight infants. The aetiology is unknown and the pathogenesis remains unclear despite extensive research during the last decades. According to recent studies the pathophysiology is multifactorial. Various high-risk factors activate proinflammatory mediators resulting in intestinal necrosis. The most important of these mediators include the cytokines, the platelet-activating factor (PAF) and nitric oxide (NO). For many years investigators have attempted to identify specific tests for the early diagnosis of the disease, MRI being one of those. Treatment consists of management of all the co-existing disorders, intensive care management and treatment with antibiotics. Surgical intervention is required when there is evidence of intestinal necrosis. Peritoneal drainage has been successfully used recently in VLBW infants and in selected cases. Better understanding of the pathogenesis of NEC has allowed the development of preventive strategies.

Clinical trials have reported reduction of disease incidence by using breast milk feeding, IgA supplementation, enteral antibiotic prophylaxis, egg phospholipid supplementation and erythropoietin.

µ’ ¡ÂÔÁÓÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ ∞¶£, ¡ÔÛÔÎÔÌÂ›Ô ∞Ã∂¶∞, £ÂÛÛ·ÏÔÓ›ÎË

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

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Paediatriki 2002;65:232-240

§¤ÍÂȘ ÎÏÂȉȿ: ÓÂÎÚˆÙÈ΋ ÂÓÙÂÚÔÎÔÏ›Ùȉ·, ÚÔÊÏÂÁÌÔÓÒ‰ÂȘ ·Ú¿ÁÔÓÙ˜, Ó¤ÎÚˆÛË ÂÓÙ¤ÚÔ˘.

Key words: necrotizing enterocolitis, proinflammatory factors, intestinal necrosis.

∂ÈÛ·ÁˆÁ‹ ∏ ÓÂÎÚˆÙÈ΋ ÂÓÙÂÚÔÎÔÏ›Ùȉ· (¡∂∫) Â›Ó·È ÊÏÂÁÌÔÓ҉˘ ÓfiÛÔ˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘, Ô˘ ¤¯ÂÈ ‚·ÚÈ¿ ÎÏÈÓÈ΋ ÂÈÎfiÓ·, ÛÔ‚·Ú¤˜ ÂÈÏÔΤ˜ Î·È ÌÂÁ¿ÏË ıÓËÙfiÙËÙ·.

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

O ÚfiÏÔ˜ Ù˘ ÂÓÙÂÚÈ΋˜ ÈÛ¯·ÈÌ›·˜ ÛÙË ¡∂∫ ¤¯ÂÈ ÌÂÏÂÙËı› Û ÌÔÓ٤Ϸ ÂÈÚ·Ì·Ùfi˙ˆˆÓ Î·È Û ÂȉËÌÈÔÏÔÁÈΤ˜ ·Ó·Ï‡ÛÂȘ Û ÚfiˆÚ· ÓÂÔÁÓ¿. ™Â ÂÈÚ·Ì·Ùfi˙ˆ·, Ï‹Ú˘ ÈÛ¯·ÈÌ›· ÙÔ˘ ÂÓÙ¤ÚÔ˘ ‡ÛÙÂÚ· ·fi ·ÔϛӈÛË Ù˘ ÌÂÛÂÓÙÂÚ›Ô˘ ·ÚÙËÚ›·˜, ÚÔηÏ› ÂÏ·ÊÚ¤˜ ÈÛÙÔÏÔÁÈΤ˜ ·ÏÏÔÈÒÛÂȘ, ·ÏÏ¿ ‡ÛÙÂÚ· ·fi ÙËÓ Â·Ó·ÈÌ¿ÙˆÛË ÚÔηÏÂ›Ù·È ÛÔ‚·Ú‹ ÂÓÙÂÚÈ΋ Ó¤ÎÚˆÛË (7). ∏ ÚÒÈÌË ¤Ó·ÚÍË Û›ÙÈÛ˘ Â›Ó·È ¤Ó·˜ ÛËÌ·ÓÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÁÈ· ÙË ¡∂∫ Î·È ¤¯ÂÈ ‚ÚÂı› Û ÌÂϤÙ˜ fiÙÈ ÙÔ ÌËÙÚÈÎfi Á¿Ï· ÂÏ·ÙÙÒÓÂÈ ÙË Û˘¯ÓfiÙËÙ· Ù˘ ¡∂∫ Û ۇÁÎÚÈÛË Ì ÙÔ ÙÚÔÔÔÈË̤ÓÔ Á¿Ï· ·ÁÂÏ¿‰·˜ (8). ∏ ·ÓˆÚÈÌfiÙËÙ· ÙÔ˘ ÂÓÙ¤ÚÔ˘ ‰Ú· ηٷÛÙ·ÏÙÈο ÛÙËÓ ÎÈÓËÙÈÎfiÙËÙ· ÙÔ˘ ÂÓÙ¤ÚÔ˘ Î·È ÛÙË ‰Ú·ÛÙÈÎfiÙËÙ· Ù˘ Ï·ÎÙ¿Û˘, Ì ·ÔÙ¤ÏÂÛÌ· ÂÚ›ÛÛÂÈ· ¿ÂÙ˘ Ï·ÎÙfi˙˘ ÛÙÔ ¤ÓÙÂÚÔ Ô˘ ¢ÓÔ› ÙËÓ ·Ó¿Ù˘ÍË ÙˆÓ ÌÈÎÚÔ‚›ˆÓ. ∏ Ï·ÎÙfi˙Ë ‰È·Û¿Ù·È ·fi Ù· ÌÈÎÚfi‚È· Û ‚Ú·¯Â›·˜ ·Ï‡ÛÔ˘ ÏÈ·Ú¿ Ôͤ·, ∏2 Î·È CO2. ∏ ˘ÂÚÛ›ÙÈÛË ·˘Í¿ÓÂÈ ÙË ‰˘Û·ÔÚÚfiÊËÛË Ù˘ Ï·ÎÙfi˙˘, Ù˘ ÚˆÙ½Ó˘ Î·È ÙÔ˘ Ï›Ô˘˜, Ú¿ÁÌ· Ô˘ ÂȉÂÈÓÒÓÂÈ ÙËÓ ÈÛ¯·ÈÌÈ΋ ÂÓÙÂÚÈ΋ ‚Ï¿‚Ë Î·È ÚÔηÏ› ‰È¿Ù·ÛË ·fi ·¤ÚÈ·, Ù· ÔÔ›· Â›Û˘ ÂÏ·ÙÙÒÓÔ˘Ó ÙËÓ ·ÈÌ¿ÙˆÛË ÙÔ˘ ‚ÏÂÓÔÁfiÓÓÔ˘ (3).

OÈ ÂÈ‚·Ú˘ÓÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ Ô˘ ·Ó·Ê¤Ú·ÌÂ, ÛÙÔ ¤‰·ÊÔ˜ ÂÓfi˜ ·ÓÒÚÈÌÔ˘ ÂÓÙ¤ÚÔ˘, ÂÓÂÚÁÔÔÈÔ‡Ó ÚÔÊÏÂÁÌÔÓÒ‰ÂȘ ÌÂÛÔÏ·‚ËÙ¤˜, Ì ·ÔÙ¤ÏÂÛÌ· ÙÔ ÙÂÏÈÎfi ÛÙ¿‰ÈÔ Ù˘ ¡∂∫, Ô˘ Â›Ó·È Ë Ó¤ÎÚˆÛË ÙÔ˘ ÂÓÙ¤ÚÔ˘. OÈ Î˘ÚÈfiÙÂÚÔÈ ·fi ÙÔ˘˜ ÚÔÊÏÂÁÌÔÓÒ‰ÂȘ ÌÂÛÔÏ·‚ËÙ¤˜ Â›Ó·È ÔÈ Î˘ÙÔΛÓ˜ [ÈÓÙÂÚÏ¢ΛÓË-1 (πL-1) Î·È ÈÓÙÂÚÏ¢ΛÓË-6 (πL-6), ÁÈÓÙÂÚÊÂÚfiÓË Î·È Ô ·Ú¿ÁÔÓÙ·˜ Ó¤ÎÚˆÛ˘ fiÁÎÔ˘ (∆¡F)], Ô ·Ú¿ÁÔÓÙ·˜ ÂÓÂÚÁÔÔ›ËÛ˘ ·ÈÌÔÂÙ·Ï›ˆÓ (PAF), ÙÔ ÌÔÓÔÍ›‰ÈÔ ÙÔ˘ ·˙ÒÙÔ˘ (¡O) Î·È Ë ÂÓ‰ÔıËÏ›ÓË. ¶ÂÈÚ·Ì·ÙÈΤ˜ ÌÂϤÙ˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ ·˘ÍË̤ӷ Â›‰· ·˘ÙÒÓ ÙˆÓ ·Ú·ÁfiÓÙˆÓ ÛÙÔ ·›Ì· Î·È ÙÔ ÂÓÙÂÚÈÎfi ÙÔ›¯ˆÌ· ÓÂÔÁÓÒÓ Ì ¡∂∫ Î·È ÂÈÚ·Ì·Ùfi˙ˆˆÓ Ì ÂÓÙÂÚÈ΋ ‚Ï¿‚Ë. ∂ÈϤÔÓ, ÔÏÏÔ› ·fi ·˘ÙÔ‡˜ ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜, ‡ÛÙÂÚ· ·fi ÂÓ‰ÔÊϤ‚È· ¯ÔÚ‹ÁËÛË Û ÂÈÚ·Ì·Ùfi˙ˆ·, ¤¯Ô˘Ó ÚÔηϤÛÂÈ ÂÓÙÂÚÈ΋ Ó¤ÎÚˆÛË. º¿Ú̷η ‹ ·ÓÙ·ÁˆÓÈÛÙ¤˜ Ô˘ ÂÌÔ‰›˙Ô˘Ó ÙËÓ ·Ú·ÁˆÁ‹ ‹ ÙË ‰Ú¿ÛË ·˘ÙÒÓ ÙˆÓ ·Ú·ÁfiÓÙˆÓ, ·Ó·ÛÙ¤ÏÏÔ˘Ó ÙËÓ ¤Ó·ÚÍË Ù˘ ¡∂∫. OÈ ÌÂÛÔÏ·‚ËÙ¤˜ ·˘ÙÔ›, Ì ÙË ÛÂÈÚ¿ ÙÔ˘˜, ÚÔηÏÔ‡Ó ‰È·Ù·Ú·¯‹ ÛÙÔ Î˘ÙÙ·ÚÈÎfi Â›Â‰Ô ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ÙÔȯÒÌ·ÙÔ˜ Ô˘ Ô‰ËÁ› ÛÂ

™˘¯ÓfiÙËÙ· ∏ ¡∂∫ ÚÔÛ‚¿ÏÏÂÈ Î˘Ú›ˆ˜ ÙÔ ·ÓÒÚÈÌÔ ¤ÓÙÂÚÔ, ÁÈ’ ·˘Ùfi Â›Ó·È Û˘¯Ó‹ ÛÙ· ÚfiˆÚ·, Û·ÓÈfiÙÂÚË ÛÙ· ÙÂÏÂÈfiÌËÓ· Î·È Ôχ Û¿ÓÈ· ÛÙË ‚ÚÂÊÈ΋ Î·È ÛÙË ÌÂÁ·Ï‡ÙÂÚË ËÏÈΛ·. ∏ Û˘¯ÓfiÙËÙ¿ Ù˘ ÛÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi Â›Ó·È 1-2,4 ÂÚÈÙÒÛÂȘ ÛÙ· 1000 ˙ÒÓÙ· ÓÂÔÁÓ¿. ¶ÚÔÛ‚¿ÏÏÂÈ ÙÔ 1-5% ÙˆÓ ÓÂÔÁÓÒÓ Ô˘ ÂÈÛ¿ÁÔÓÙ·È ÛÙȘ ªÔÓ¿‰Â˜ ∂ÓÙ·ÙÈ΋˜ ¡ÔÛËÏ›·˜ ¡ÂÔÁÓÒÓ (ª∂¡¡). ∞fi ÙÔ ÔÛÔÛÙfi ·˘Ùfi, ÙÔ 7-13% ·ÊÔÚ¿ Û ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿ Î·È ÙÔ ˘fiÏÔÈÔ ÛÙ· ÚfiˆÚ·. ¶ÚfiˆÚ· ÓÂÔÁÓ¿ <34 ‚‰ÔÌ¿‰Â˜ ·ËÛ˘ Ô˘ ÓÔÛËχÔÓÙ·È Û ª∂¡¡, ÚÔÛ‚¿ÏÏÔÓÙ·È Û ÔÛÔÛÙfi 3,922,4% Ì ̤ÛË Û˘¯ÓfiÙËÙ· 10% (1,2). ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, Ë Û˘¯ÓfiÙËÙ· ·˘Ù‹ ¤¯ÂÈ ÂÏ·ÙÙˆı› ·ÚÎÂÙ¿ Û ÔÚÈṲ̂Ó˜ ¯ÒÚ˜, fiˆ˜ Ë ∞˘ÛÙÚ·Ï›· Î·È Ë π·ˆÓ›·. ŒÙÛÈ, ÛÙËÓ ∞˘ÛÙÚ·Ï›· Ù· ÙÂÏÂ˘Ù·›· ÙÚ›· ¯ÚfiÓÈ· Û ÚfiˆÚ· <32 ‚‰ÔÌ¿‰Â˜ ·ËÛ˘, ÙÔ ÔÛÔÛÙfi ·˘Ùfi ¤¯ÂÈ ÂÏ·ÙÙˆı› ·fi 8% Û 3% (3). ∞ÈÙÈÔÏÔÁ›· ∏ ·ÈÙÈÔÏÔÁ›· Ù˘ ¡∂∫ ·Ú·Ì¤ÓÂÈ ‚·ÛÈο ¿ÁÓˆÛÙË Î·È ·Û·Ê‹˜. ∏ ÌfiÓË ÂȂ‚·ÈˆÌ¤ÓË ÛÙ·ıÂÚ‹ Û˘Û¯¤ÙÈÛË Ì ÙË ¡∂∫ Â›Ó·È Ë ÚÔˆÚfiÙËÙ·, ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙËÓ ÚÒÈÌË ¤Ó·ÚÍË Ù˘ ÂÓÙÂÚÈ΋˜ Û›ÙÈÛ˘. ∞Ó Î·È ·Ú¯Èο Ë ¡∂∫ ›¯Â ·Ô‰Ôı› Û ÔÈÎÈÏ›· ·Ú·ÁfiÓÙˆÓ Ô˘ ÚÔηÏÔ‡Ó ÂÚÈÁÂÓÓËÙÈÎfi stress, ÚÔÛÂÎÙÈΤ˜ ÂȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜ ‰ÂÓ ¤¯Ô˘Ó ‰Â›ÍÂÈ Û˘Û¯¤ÙÈÛË Ì ÂÌ‚Ú˘˚΋ ‰˘Û¯¤ÚÂÈ·, ÚÒÈÌË Ú‹ÍË ÌÂÌ‚Ú·ÓÒÓ, ¯·ÌËÏfi Apgar score, ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ· Î·È ¿ÓÔÈ·. O ΢ÚÈfiÙÂÚÔ˜ ·Ú¿ÁÔÓÙ·˜ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ Â›Ó·È Ë ÚÔˆÚfiÙËÙ·. ∂͈ÙÂÚÈÎÔ› ·Ú¿ÁÔÓÙ˜ Ô˘ ÌÔÚ› Ó· ÂËÚ¿ÛÔ˘Ó ÙËÓ ÂÌÊ¿ÓÈÛË Ù˘ ¡∂∫ Â›Ó·È Ô ¯ÚfiÓÔ˜ ¤Ó·Ú͢ Û›ÙÈÛ˘, Ë Ù·¯‡ÙËÙ· ¯ÔÚ‹ÁËÛ˘ Á¿Ï·ÎÙÔ˜, Ô Ù‡Ô˜ ÙÔ˘ Á¿Ï·ÎÙÔ˜ (ÌËÙÚÈÎfi Á¿Ï·, ¤Ó·ÓÙÈ ÙÚÔÔÔÈË̤ÓÔ˘ Á¿Ï·ÎÙÔ˜ ·ÁÂÏ¿‰·˜) Î·È Ë ·Ó¿Ù˘ÍË ÌÈÎÚÔ‚›ˆÓ. ∆¤ÏÔ˜, Ë ÂÓÙÂÚÈ΋ ÈÛ¯·ÈÌ›· ¤¯ÂÈ ÂÓÔ¯ÔÔÈËı› ÛÙËÓ ·ÈÙÈÔÏÔÁ›· Ù˘ ¡∂∫ (4,5). ¶·ıÔÁ¤ÓÂÈ· ∏ ·ıÔÁ¤ÓÂÈ· Ù˘ ¡∂∫, ·Ú¿ ÙȘ ÂÓÙ·ÙÈΤ˜ ¤Ú¢Ó˜ ÙˆÓ ÙÂÏÂ˘Ù·›ˆÓ ÙÚÈ¿ÓÙ· ÂÙÒÓ, ‰ÂÓ ¤¯ÂÈ ‰È¢ÎÚÈÓÈÛÙ› Ï‹Úˆ˜. ∏ Û‡Á¯ÚÔÓË ıˆڛ· ˘ÔÛÙËÚ›˙ÂÈ fiÙÈ Ë ·ıÔÁ¤ÓÂÈ· Ù˘ ÓfiÛÔ˘ Â›Ó·È ÔÏ˘·Ú·ÁÔÓÙÈ΋. ¶·Ú¿ÁÔÓÙ˜ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘, fiˆ˜ Ë

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13:31

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¶·È‰È·ÙÚÈ΋ 2002;65:232-240

ñ ∞ÛÊ˘Í›· ñ ÀfiÙ·ÛË ñ ¶ÔÏ˘ÂÚ˘ı·ÈÌ›· ñ OͤˆÛË ñ ¶ÚÔˆÚfiÙËÙ·

Paediatriki 2002;65:232-240

ñ ∞ÓÔÛÔÏÔÁÈ΋ ·ÓˆÚÈÌfiÙËÙ· ñ ¶ÚÔÛÎfiÏÏËÛË Î·È ‰›Ô‰Ô˜ ·ıÔÁfiÓˆÓ ÌÈÎÚÔ‚›ˆÓ + ñ •¤ÓÔ Á¿Ï·

πÛ¯·ÈÌ›·

∞ÒÏÂÈ· ÂÈıËÏÈ·ÎÔ‡ ÂÓÙÂÚÈÎÔ‡ ÊÚ·ÁÌÔ‡ TNF, PAF, IL-6 ºÏÂÁÌÔÓ‹ ‚ÏÂÓÓÔÁfiÓÔ˘

¡∂∫ ™¯‹Ì· 1. ¶·ıÔÁ¤ÓÂÈ· ¡∂∫.

‰È¿Û·ÛË ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ÊÚ·ÁÌÔ‡, ÊÏÂÁÌÔÓ‹ Î·È Â›ÛÔ‰Ô ·ıÔÁfiÓˆÓ ÌÈÎÚÔ‚›ˆÓ ÛÙÔ ÂÓÙÂÚÈÎfi ÙÔ›¯ˆÌ·, Ì ÙÂÏÈÎfi ·ÔÙ¤ÏÂÛÌ· ÙË Ó¤ÎÚˆÛË ÙÔ˘ ÂÓÙ¤ÚÔ˘ (™¯‹Ì· 1) (6,9). ∏ ÌÈÎÚԂȷ΋ ‰È‹ıËÛË Â›Ó·È ·Ó·ÌÊ›‚ÔÏ· ‰Â˘ÙÂÚÔ·ı‹˜ ·Ú¿ÁÔÓÙ·˜ ÛÙËÓ ·ıÔÁ¤ÓÂÈ· Ù˘ ¡∂∫, ·ÏÏ¿ Â›Ó·È ¿ÁÓˆÛÙÔ Â¿Ó Ù· ÌÈÎÚfi‚È· Â›Ó·È ·fi ÙÔ˘˜ ·Ú¯ÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Ô˘ ÂÓÂÚÁÔÔÈÔ‡Ó ÙËÓ ¤Ó·ÚÍË Ù˘ ÓfiÛÔ˘. OÈ ÂȉËÌÈΤ˜ ÌÔÚʤ˜ Ù˘ ¡∂∫ Ô˘ Û˘Ó·ÓÙÒÓÙ·È ÛÙȘ ª∂¡¡ ˘Ôı¤ÙÔ˘Ó ¤Ó·Ó ¿ÌÂÛÔ ÚfiÏÔ ÙˆÓ ÌÈÎÚÔ‚›ˆÓ ÛÙËÓ ·ıÔÁ¤ÓÂÈ· Ù˘ ÓfiÛÔ˘ (3,9). ∆Ô ÚfiˆÚÔ ÓÂÔÁÓfi ÂÎÙ›ıÂÙ·È Û ÔÏÏÔ‡˜ ·Ú¿ÁÔÓÙ˜ Ô˘ ÚÔηÏÔ‡Ó ÂÚÈÁÂÓÓËÙÈÎfi stress, fiˆ˜ ˘fiÙ·ÛË, ˘ÔıÂÚÌ›·, ˘ÔÍ›·, Û›ÙÈÛË Î·È ·Ó·ÈÌ›·. ŸÏ· ·˘Ù¿ ·›˙Ô˘Ó ÚfiÏÔ ÛÙËÓ ·ıÔÁ¤ÓÂÈ· Ù˘ ÈÛ¯·ÈÌÈ΋˜ ‚Ï¿‚˘ ÛÙÔ ÓÂÔÁÓÈÎfi ¤ÓÙÂÚÔ. ∆Ô ¤ÓÙÂÚÔ ÙÔ˘ ÓÂÔÁÓÔ‡ ¤¯ÂÈ Ôχ ÂÏ·Ùو̤ÓË ÈηÓfiÙËÙ· ÛÙË Ú‡ıÌÈÛË Ù˘ ÚÔ‹˜ ÙÔ˘ ·›Ì·ÙÔ˜ Î·È Ù˘ Ô͢ÁfiÓˆÛ˘. OÈ ÂχıÂÚ˜ Ú›˙˜ ÙÔ˘ O2 ÂÓÔ¯ÔÔÈÔ‡ÓÙ·È Û·Ó ÌÂÛÔÏ·‚ËÙ¤˜ ÛÙË ‚Ï¿‚Ë ÙÔ˘ ‚ÏÂÓÓÔÁfiÓÔ˘ ÛÙË ¡∂∫. ∞ÎfiÌË, οÔÈÔ ÚfiÏÔ ÛÙËÓ ·ıÔÁ¤ÓÂÈ· Ù˘ ¡∂∫ Ê·›ÓÂÙ·È Ó· ¤¯Ô˘Ó ÔÍÂȉˆÙÈΤ˜ Ô˘Û›Â˜ Î·È ÚˆÙ¿Û˜, Ô˘ ·Ú¿ÁÔÓÙ·È ·fi Ô˘‰ÂÙÂÚfiÊÈÏ· ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ‚ÏÂÓÓÔÁfiÓÔ˘, ηıÒ˜ Î·È ÙÔÈο ·Ú·ÁfiÌÂÓ˜ ÚÔÛÙ·ÁÏ·Ó‰›Ó˜ Î·È Ï¢ÎÔÙÚȤÓ˜ (10,11). ¶·Ú¿ÁÔÓÙ˜ Ô˘ Û˘Ì‚¿ÏÏÔ˘Ó ÛÙËÓ ·ıÔÁ¤ÓÂÈ· Ù˘ ¡∂∫ O ·Ú¿ÁÔÓÙ·˜ ÂÓÂÚÁÔÔ›ËÛ˘ ·ÈÌÔÂÙ·Ï›ˆÓ (PAF) Â›Ó·È ¤Ó·˜ ʈÛÊÔÏÈȉÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ Ô˘ Ê·›ÓÂÙ·È fiÙÈ ·›˙ÂÈ ¤Ó· ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ

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·ıÔÊ˘ÛÈÔÏÔÁ›· Ù˘ ¡∂∫. ™˘ÓÙ›ıÂÙ·È ÌÂÙ¿ ÙËÓ ÂÓÂÚÁÔÔ›ËÛË Ù˘ ʈÛÊÔÏÈ¿Û˘ ∞2ππ (PLA2) Î·È ‰È·Û¿Ù·È ·fi ÙÔ ¤Ó˙˘ÌÔ PAF-·ÎÂÙ˘Ï˘‰ÚÔÏ¿ÛË (PAF-AH). O PAF ·ÛΛ ÙË ‰Ú¿ÛË ÙÔ˘ ̤ۈ Ù˘ ÂÓÂÚÁÔÔ›ËÛ˘ ÙÔ˘ ˘Ô‰Ô¯¤· G-ÚˆÙ½ÓË-˙‡ÁÔ˜ PAF, Ô˘ Â›Ó·È ·ÚÒÓ ÛÙ· ÂÚÈÛÛfiÙÂÚ· ·ÙÙ·Ú·, ·ÏÏ¿ ΢ڛˆ˜ ÛÙÔ ÂÓÙÂÚÈÎfi ÂÈı‹ÏÈÔ (12). ∂Ó‰ÔÊϤ‚È· ¯ÔÚ‹ÁËÛË ÙÔ˘ PAF Û ÂÓ‹ÏÈη ÎÔ˘Ó¤ÏÈ· ÚÔηÏ› ÈÛ¯·ÈÌÈ΋ ÂÓÙÂÚÈ΋ Ó¤ÎÚˆÛË, fiÌÔÈ· Ì ÙË ÓfiÛÔ Ù˘ ÓÂÔÁÓÈ΋˜ ¡∂∫. ªÂϤÙ˜ Û ÓÂÔÁÓ¿ Ì ¡∂∫ ¤¯Ô˘Ó ‰Â›ÍÂÈ ·˘ÍË̤ӷ Â›‰· ÙÔ˘ PAF ÛÙÔ Ï¿ÛÌ· Î·È ÛÙ· ÎfiÚ·Ó·. ∏ ·ÛÊ˘Í›· ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙË Û›ÙÈÛË Ì ÙÚÔÔÔÈË̤ÓÔ Á¿Ï· ·ÁÂÏ¿‰·˜ ·˘Í¿ÓÔ˘Ó Ù· ÂÓÙÂÚÈο PLA2-IImRNA Î·È ÙË ‰Ú·ÛÙÈÎfiÙËÙ· ÙÔ˘ ÂÓ˙‡ÌÔ˘ Î·È PAF-˘Ô‰Ô¯¤· mRNA Û ÓÂÔÁÓ¿ ˙ÒˆÓ. ∂ÈϤÔÓ, ıÂÚ·›· Ì ·ÓÙ·ÁˆÓÈÛÙ¤˜ ÙÔ˘ PAF-˘Ô‰Ô¯¤· ÂÏ·ÙÙÒÓÂÈ ÙË Û˘¯ÓfiÙËÙ· Ù˘ ÂÓÙÂÚÈ΋˜ ‚Ï¿‚˘ Î·È Ù˘ ıÓËÙfiÙËÙ·˜. ∂›Û˘, ÂÈÚ·Ì·Ùfi˙ˆ· ÛÙ· ÔÔ›· ¯ÔÚËÁ‹ıËΠÙÔ ¤Ó˙˘ÌÔ PAF-AH ›¯·Ó Ì›· ÛËÌ·ÓÙÈ΋ ÂÏ¿ÙÙˆÛË ÛÙË Û˘¯ÓfiÙËÙ· Ù˘ ¡∂∫. ∏ ‰Ú·ÛÙÈÎfiÙËÙ· ÙÔ˘ ÂÓ˙‡ÌÔ˘ Â›Ó·È ÂÏ·Ùو̤ÓË ÛÙ· ÓÂÔÁÓ¿, ÂÓÒ Â›Ó·È ˘·ÚÎÙ‹ ÛÙÔ ÌËÙÚÈÎfi Á¿Ï· Î·È fi¯È ÛÙÔ ÙÚÔÔÔÈË̤ÓÔ Á¿Ï· ·ÁÂÏ¿‰·˜. ∏ ÚÔÛı‹ÎË ÙÔ˘ Û˘ÛÙ·ÙÈÎÔ‡ ·˘ÙÔ‡ ÛÙÔ Á¿Ï· ÊfiÚÌÔ˘Ï·˜ ÙˆÓ ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ ‰ÈηÈÔÏÔÁ› ÂÈÚfiÛıÂÙË ¤Ú¢ӷ (13-15). ¶ÂÈÚ·Ì·ÙÈο ‰Â‰Ô̤ӷ ‰ËÏÒÓÔ˘Ó fiÙÈ ÔÈ ·Ú¿ÁÔÓÙ˜ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙË ¡∂∫ ‰ÈÂÁ›ÚÔ˘Ó ÙËÓ ·Ú·ÁˆÁ‹ ÙÔ˘ PAF, Ô˘ ¤¯ÂÈ Û·Ó ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÂÌÊ¿ÓÈÛË ÂÓÙÂÚÈ΋˜ Ó¤ÎÚˆÛ˘ (16). ¶ÔÏϤ˜ ÌÂϤÙ˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ Ô PAF ‰ÈÂÁ›ÚÂÈ ÙËÓ ·Ú·ÁˆÁ‹ ‰È·ÊfiÚˆÓ ‰Â˘ÙÂÚ¢fiÓÙˆÓ ÌÂÛÔÏ·‚ËÙÒÓ, fiˆ˜ TNF, IL1, NO, Ú›˙˜ Ô͢ÁfiÓÔ˘, ıÚÔÌ‚ÔÍ¿Ó˜ Î·È Ï¢ÎÔÙÚȤÓ˜, Ô˘ Ì ÙË ÛÂÈÚ¿ ÙÔ˘˜ Û˘Ì‚¿ÏÏÔ˘Ó ÛÙËÓ ·Ó¿Ù˘ÍË Ù˘ ÂÓÙÂÚÈ΋˜ Ó¤ÎÚˆÛ˘ (9). À¿Ú¯ÂÈ Ë ˘fiıÂÛË fiÙÈ Ô PAF Î·È ¿ÏÏÔÈ ÌÂÛÔÏ·‚ËÙ¤˜ ÂÓÂÚÁÔÔÈÔ‡Ó ÙËÓ ·fiÙˆÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ÂÈıËÏ›Ô˘, Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·ÒÏÂÈ· Ù˘ ÈÛ¯˘Ú‹˜ Û˘Ó‰ÂÙÈ΋˜ ·ÎÂÚ·ÈfiÙËÙ·˜ ÙÔ˘ ÂÈıËÏ›Ô˘, ÙËÓ ·‡ÍËÛË Ù˘ ‰È·ÂÚ·ÙfiÙËÙ·˜ ÙÔ˘ ‚ÏÂÓÓÔÁfiÓÔ˘ Î·È ÙËÓ Â›ÛÔ‰Ô ÌÈÎÚÔ‚›ˆÓ ÛÙÔ ÂÓÙÂÚÈÎfi ÙÔ›¯ˆÌ· (9). ∏ ΢ÎÏÔÔ͢ÁÂÓ¿ÛË-2 (COX-2) Î·È Ô ˘ÚËÓÈÎfi˜ ·Ú¿ÁˆÓ-∫µ (NF-KB) ¤¯ÂÈ ‚ÚÂı› Û ÂÈÚ·Ì·ÙÈΤ˜ ÌÂϤÙ˜ fiÙÈ Ú¤ÂÈ Ó· ·›˙Ô˘Ó ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ·ıÔÁ¤ÓÂÈ· Ù˘ ¡∂∫. ∏ ΢ÎÏÔÔ͢ÁÂÓ¿ÛË (COX), ÁÈ· ÙËÓ ÔÔ›· ¤¯Ô˘Ó ·Ó·ÁÓˆÚÈÛÙ› ‰‡Ô Ù‡ÔÈ, Ë COX-1 Î·È Ë COX-2, ηٷχÂÈ ÙÔÓ ÌÂÙ·‚ÔÏÈÛÌfi ÙÔ˘ ·Ú·¯È‰ÔÓÈÎÔ‡ ÔͤԘ Û ÚÔÛÙ·ÁÏ·Ó‰›Ó˜, Ï¢ÎÔÙÚȤÓ˜ Î·È ıÚÔÌ‚ÔÍ¿Ó˜. ∏ ‰Ú·ÛÙÈÎfiÙËÙ¿ Ù˘ ·˘Í¿ÓÂÙ·È ·fi ÚÔÊÏÂÁÌÔÓÒ‰ÂȘ ΢ÙÔΛÓ˜, fiˆ˜ IL-1, IL-6 Î·È TNF Î·È ¤¯ÂÈ ‚ÚÂı› fiÙÈ ·˘Í¿ÓÂÈ Û ÊÏÂÁÌÔÓÒ‰ÂȘ ηٷÛÙ¿ÛÂȘ ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ ۈϋӷ. ∂›Û˘, Ô NF-KB Â›Ó·È Ì›·

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¶·È‰È·ÙÚÈ΋ 2002;65:232-240

ÛËÌ·ÓÙÈ΋ ÚˆÙ½ÓË Ô˘ Û˘Ì‚¿ÏÏÂÈ ÛÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÔÏÏÒÓ ÊÏÂÁÌÔÓˆ‰ÒÓ ÌÂÛÔÏ·‚ËÙÒÓ Î·È Î˘ÙÔÎÈÓÒÓ (17). ∏ ÈÓ‰ÔÌÂı·Î›ÓË, ¤Ó·˜ ÌË ÂȉÈÎfi˜ ·Ó·ÛÙÔϤ·˜ Ù˘ COX-1 Î·È COX-2, ÚÔηÏ› ·ÁÁÂÈÔÛ˘ÛÙÔÏ‹ Î·È ¤¯ÂÈ ¯ÚËÛÈÌÔÔÈËı› ·ÔÙÂÏÂÛÌ·ÙÈο Û ÓÂÔÁÓ¿ ÁÈ· ÙÔ ÎÏ›ÛÈÌÔ ÙÔ˘ ·ÚÙËÚÈ·ÎÔ‡ fiÚÔ˘. ∞Ù˘¯Ò˜, fï˜, Û˘Óԉ‡ÂÙ·È ·fi Ì›· ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· ¡∂∫ ÏfiÁˆ ÂÏ·Ùو̤Ó˘ ·ÈÌ¿ÙˆÛ˘ ÙÔ˘ ÌÂÛÂÓÙÂÚ›Ô˘, Ô˘ Ô‰ËÁ› Û ÈÛ¯·ÈÌ›· ÙÔ˘ ‚ÏÂÓÓÔÁfiÓÔ˘ Î·È Â·ÎfiÏÔ˘ıË ‰È‹ıËÛË ·fi ÌÈÎÚfi‚È· (18,19). ∆Ô ¡O Î·È Ë ÂÈÛ·ÁˆÁÈ΋ Û˘ÓıÂÙ¿ÛË ÙÔ˘ ¡O (π¡O™) ¤¯Ô˘Ó ÂÓÔ¯ÔÔÈËı› ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË Ù˘ ¡∂∫. OÈ Ford Î·È Û˘Ó ‚Ú‹Î·Ó fiÙÈ ÙÔ ¡O ·Ú¿ÁÂÙ·È Û ÌÂÁ¿Ï˜ ÔÛfiÙËÙ˜ ·fi Ù· ÂÓÙÂÚÔ·ÙÙ·Ú· ·ÛıÂÓÒÓ Ì ¡∂∫. ∞Ó·ÛÙÔÏ›˜ ÙÔ˘ ¡O ¤¯ÂÈ ‚ÚÂı› fiÙÈ ·Ó·ÛÙ¤ÏÏÔ˘Ó ‹ ηٷÚÁÔ‡Ó ÙȘ ˘ÔÙ·ÛÈΤ˜ ÂÈÙÒÛÂȘ ÙÔ˘ TNF. ∞ÎfiÌË, ÂÓ‰ÔÊϤ‚È· ¯ÔÚ‹ÁËÛË ÓÈÙÚÔÁÏ˘ÎÂÚ›Ó˘, ÂÓfi˜ ÂÓÈÛ¯˘Ù‹ ÙÔ˘ ¡O, ÂÏ·ÙÙÒÓÂÈ ÙËÓ ÂÓÙÂÚÈ΋ ‚Ï¿‚Ë Û ÎÔ˘Ó¤ÏÈ· Ô˘ ¿Û¯Ô˘Ó ·fi ¡∂∫ (20,21). ∏ ÈÓ‰ÔÌÂı·Î›ÓË, Ë ‚ÈÙ·Ì›ÓË ∂, Ë Î·Ê½ÓË, Ë ıÂÔÊ˘ÏÏ›ÓË, Ë ¯Ú‹ÛË ÎÔη˝Ó˘ ·fi ÙË ÌËÙ¤Ú· Î·È ¿ÏÏ· ÂȉÈο Ê·ÚÌ·ÎÔÏÔÁÈο ÚÔ˚fiÓÙ· ¤¯Ô˘Ó ÂÓÔ¯ÔÔÈËı› ÁÈ· ÙËÓ ¤Ó·ÚÍË Ù˘ ¡∂∫ (22). ∂›Û˘, ÔÈ ÈÓÙÂÚÏ¢ΛÓ˜ ¤¯Ô˘Ó Û˘Û¯ÂÙÈÛÙ› Ì ÙËÓ ·ıÔÁ¤ÓÂÈ· Ù˘ ¡∂∫. ∏ πL-4 ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙ› Ì ÙËÓ ·Ó·ÛÙÔÏ‹ Ù˘ ¤Ó·Ú͢ ¤ÎÊÚ·Û˘ ÙÔ˘ ¡O Î·È ÙËÓ ÂÏ¿ÙÙˆÛË Ù˘ Û‡ÓıÂÛ˘ ÙÔ˘ ¡O (23). ∏ πL-6 ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙ› Ì ÙË ¡∂∫ Ì ‰È·ÊÔÚÂÙÈÎÔ‡˜ ÙÚfiÔ˘˜. OÈ Û˘ÁÎÂÓÙÚÒÛÂȘ Ù˘ πL-6 ÛÙÔ ·›Ì· ÙÔ˘ ÔÌÊ¿ÏÈÔ˘ ÏÒÚÔ˘ Â›Ó·È ·˘ÍË̤Ó˜ Û ÓÂÔÁÓ¿ Ô˘ ÂÌÊ¿ÓÈÛ·Ó ·ÚÁfiÙÂÚ· ÛÔ‚·Ú¤˜ ÂÈÏÔΤ˜, fiˆ˜ Û‹„Ë, Ó¢ÌÔÓ›·, ¡∂∫ Î·È ÂÓ‰ÔÎÔÈÏȷ΋ ÂÁÎÂÊ·ÏÈ΋ ·ÈÌÔÚÚ·Á›·. ™Â ÓÂÔÁÓ¿ Ì ¡∂∫ ÔÈ Û˘ÁÎÂÓÙÚÒÛÂȘ ‚Ú¤ıËÎ·Ó ·˘ÍË̤Ó˜ ÌfiÓÔ Û ÂÚÈÙÒÛÂȘ ÚÔ¯ˆÚË̤Ó˘ ÓfiÛÔ˘, Ô˘ Û˘Óԉ‡ÔÓÙ·È ·fi ÂÓÙÂÚÈ΋ Ó¤ÎÚˆÛË Î·È ÂȉÈÎfiÙÂÚ· fiÙ·Ó ˘¿Ú¯ÂÈ ÌÈÎÚÔ‚È·ÈÌ›· (24,25). ∏ πL-8 ¤¯ÂÈ ‚ÚÂı› ÛËÌ·ÓÙÈο ·˘ÍË̤ÓË Û ÓÂÔÁÓ¿ Ì ¡∂∫ ÙÚ›ÙÔ˘ ÛÙ·‰›Ô˘ (26). ∏ πL-1 ¤¯ÂÈ ‚ÚÂı› ·˘ÍË̤ÓË ÛÙÔ ÂÚÈÙÔÓ·˚Îfi ˘ÁÚfi ÓÂÔÁÓÒÓ Ì ¡∂∫ Ô˘ ¯ÂÈÚÔ˘ÚÁ‹ıËηÓ. ∂›Û˘, ÔÈ Û˘ÁÎÂÓÙÚÒÛÂȘ ÛÙÔÓ ÔÚfi πL-1 Î·È πL-1 receptor antagonist (IL1ra) Â›Ó·È ·˘ÍË̤Ó˜ Û ÛÔ‚·Ú¤˜ ÂÚÈÙÒÛÂȘ ¡∂∫, Ô˘ ÛËÌ·›ÓÂÈ Î¿ÔÈ· Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ¡∂∫ Î·È ·˘Ù‹˜ Ù˘ ÚÔÊÏÂÁÌÔÓÒ‰Ô˘˜ ΢ÙÔΛÓ˘ (26,27). ∏ πL-2 ·˘Í¿ÓÂÈ ÙË ‰›Ô‰Ô ÌÈÎÚÔ‚›ˆÓ ·fi ÙÔÓ ÂÓÙÂÚÈÎfi ۈϋӷ ÛÙÔ˘˜ ÌÂÛÂÓÙ¤ÚÈÔ˘˜ ÏÂÌÊ·‰¤Ó˜. ∂ÎÙfi˜ ·fi ÙÔÓ Èı·Ófi ÚfiÏÔ Ù˘ ÛÙËÓ ÚfiÎÏËÛË Ù˘ ÂÓÙÂÚÈ΋˜ ‚Ï¿‚˘, Ë πL-2 ·›˙ÂÈ Î¿ÔÈÔ ÚfiÏÔ ÛÙËÓ ›·ÛË ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ÙÔȯÒÌ·ÙÔ˜ (28,29). ∫ÏÈÓÈ΋ ÂÈÎfiÓ· ∏ ÎÏÈÓÈ΋ ÂÈÎfiÓ· Ù˘ ¡∂∫ ÂÚÈÏ·Ì‚¿ÓÂÈ ÁÂÓÈο Û˘ÌÙÒÌ·Ù· Î·È Û˘ÌÙÒÌ·Ù· ·fi ÙÔ ÂÙÈÎfi. ∆·

Paediatriki 2002;65:232-240

ÁÂÓÈο Û˘ÌÙÒÌ·Ù· Â›Ó·È ‰ÈÂÁÂÚÛÈÌfiÙËÙ·, ˘ÓËÏ›·, ¿ÓÔÈ· Î·È ıÂÚÌÔÚÚ˘ıÌÈÛÙÈ΋ ·ÛÙ¿ıÂÈ·. ∆· Û˘ÌÙÒÌ·Ù· ·fi ÙÔ ÂÙÈÎfi Â›Ó·È ‰È·Ù·Ú·¯¤˜ Û›ÙÈÛ˘ Ì ˘fiÏÂÈÌÌ· Á¿Ï·ÙÔ˜, ¤ÌÂÙÔÈ, ÌÂÙˆÚÈÛÌfi˜ Î·È ·ÈÌÔÚÚ·ÁÈΤ˜ ÎÂÓÒÛÂȘ. ∆· Û˘ÌÙÒÌ·Ù· ·˘Ù¿ ‰ÂÓ Â›Ó·È ÂȉÈο Î·È ·ÔÙÂÏÔ‡Ó ÌfiÓÔ Ì›· ¤Ó‰ÂÈÍË ÂÈΛÌÂÓ˘ Û‹„˘. ªÂÁ¿ÏË ·ÈÌÔÚÚ·Á›· ·fi ÙÔ ¤ÓÙÂÚÔ Û˘Ì‚·›ÓÂÈ Û 25-63% ÙˆÓ ÂÚÈÙÒÛˆÓ, ÂÓÒ ÌË ÂÌÊ·Ó‹˜ ·ÈÌÔÚÚ·Á›· ˘¿Ú¯ÂÈ ÛÙÔ 22-59% (20,29,30). À¿Ú¯Ô˘Ó ÔÚÈṲ̂Ó˜ ÌÈÎÚ¤˜ ‰È·ÊÔÚ¤˜ ÛÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ· Ù˘ ¡∂∫ ·Ó¿ÌÂÛ· ÛÙ· Ôχ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓ¿ (¶Ãµ°¡) Î·È Ù· ¿ÏÏ· ÓÂÔÁÓ¿. ∂›Ó·È ÛËÌ·ÓÙÈÎfi Ó· ı˘ÌfiÌ·ÛÙ fiÙÈ Ù· ÎÏÈÓÈο Â˘Ú‹Ì·Ù· ÛÙ· ¶Ãµ°¡ Â›Ó·È ‰‡ÛÎÔÏÔ Ó· ·Ó·ÁÓˆÚÈÛÙÔ‡Ó, ÏfiÁˆ ÙÔ˘ ÌÈÎÚÔ‡ ÙÔ˘˜ ‚¿ÚÔ˘˜, Ù˘ Û˘Ó˘¿Ú¯Ô˘Û·˜ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜, ÙÔ˘ Ì˯·ÓÈÎÔ‡ ·ÂÚÈÛÌÔ‡, ÙˆÓ ÔÏÏÒÓ ËÏÂÎÙÚÔ‰›ˆÓ ·fi Ù· monitors Î·È ÙˆÓ ÂÓ‰ÔÊϤ‚ÈˆÓ ÁÚ·ÌÌÒÓ. ∆· ¶Ãµ°¡ ¤¯Ô˘Ó ˘„ËÏfiÙÂÚÔ ·ÈÌ·ÙÔÎÚ›ÙË, ¯·ÌËÏfiÙÂÚ· ·ÈÌÔÂÙ¿ÏÈ· Î·È ÌÂÁ·Ï‡ÙÂÚË ÔͤˆÛË ·fi Ù· ¿ÏÏ· ÓÂÔÁÓ¿ (20,31).

O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ Ù˘ ¡∂∫ ÌÔÚ› Ó· Â›Ó·È Ê˘ÛÈÔÏÔÁÈÎfi˜ ‹ Ó· ˘¿Ú¯ÂÈ Ô˘‰ÂÙÂÚÔÂÓ›·, ıÚÔÌ‚ÔÂÓ›·, ÔͤˆÛË Î·È ËÏÂÎÙÚÔÏ˘ÙÈΤ˜ ‰È·Ù·Ú·¯¤˜. À¿Ú¯ÂÈ ‰È·ÊÔÚ¿ ÛÙ· ÌÈÎÚfi‚È· Ô˘ ·ÔÌÔÓÒÓÔÓÙ·È ÛÙÔ ·›Ì· Î·È ÙÔ ÂÚÈÙÔÓ·˚Îfi ˘ÁÚfi ÙˆÓ ¶Ãµ°¡ Ì ¡∂∫ ·fi Ù· ˘fiÏÔÈ· ÓÂÔÁÓ¿. ™Ù· ¶Ãµ°¡ ·Ó¢ڛÛÎÂÙ·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›· ÌÈÎÚÔ‚›ˆÓ, fiˆ˜ Clostridium SP, Pseudomonas SP, Klebsiella SP, Staphylococcus coagulase ·ÚÓËÙÈÎfi˜ Î·È ÂÓÙÂÚfiÎÔÎÎÔ˜ (32).

O ·ÎÙÈÓÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÎÔÈÏ›·˜ ‰Â›¯ÓÂÈ ‰È·ÙÂٷ̤Ó˜ ÂÓÙÂÚÈΤ˜ ¤ÏÈΘ, ·¤Ú· ÛÙÔ ÂÓÙÂÚÈÎfi ÙÔ›¯ˆÌ· ‹ ÛÙËÓ ˘Ï·›· ÊϤ‚·. ™¿ÓÈ· ÛÙ· ¶Ãµ°¡ ·Ó·ÁÓˆÚ›˙ÂÙ·È ·¤Ú·˜ ÛÙÔ ˘Ï·›Ô Û‡ÛÙËÌ·, ÏfiÁˆ ÙÔ˘ ÌÈÎÚÔ‡ ÌÂÁ¤ıÔ˘˜ Ù˘ ÎÔÈÏ›·˜ ÙÔ˘˜ (31).

O ‚·ıÌfi˜ Î·È Ë ‚·Ú‡ÙËÙ· Ù˘ ÂÓÙÂÚÈ΋˜ ‚Ï¿‚˘ ÔÈΛÏÏÂÈ Û ÌÂÁ¿ÏÔ ‚·ıÌfi Î·È ÂÚÈÏ·Ì‚¿ÓÂÈ ·fi ÙÔÈ΋ ¤ÏΈÛË ÙÔ˘ ‚ÏÂÓÓÔÁfiÓÔ˘ Î·È Ó¤ÎÚˆÛË ÙÔ˘ ÂÛˆÙÂÚÈÎÔ‡ ÂÓÙÂÚÈÎÔ‡ ÙÔȯÒÌ·ÙÔ˜ ̤¯ÚÈ Ï‹ÚË Ó¤ÎÚˆÛË ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ÙÔȯÒÌ·ÙÔ˜, ‰È¿ÙÚËÛË, ÂÚÈÙÔÓ›Ùȉ· Î·È Û‹„Ë. OÈ ÂÚÈÔ¯¤˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘ Ô˘ ÚÔÛ‚¿ÏÏÔÓÙ·È Û˘Ó‹ıˆ˜ Â›Ó·È Ô ÙÂÏÈÎfi˜ ÂÈÏÂfi˜ Î·È ÙÔ ÂÁÁ‡˜ ÎfiÏÔÓ, fï˜ fiϘ ÔÈ ÂÚÈÔ¯¤˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÚÔÛ‚ÏËıÔ‡Ó. ∆Ô Â˘Ú‡ Ê¿ÛÌ· Ù˘ ÂÓÙÂÚÈ΋˜ ‚Ï¿‚˘ ÂÍËÁ› ÙËÓ ÔÈÎÈÏ›· ÙˆÓ ÎÏÈÓÈÎÒÓ ÂΉËÏÒÛˆÓ. ŒÙÛÈ, ·Ó¿ÏÔÁ· Ì ٷ ÎÏÈÓÈο 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˘¯ı› ‰È¿ÊÔÚ˜ ̤ıÔ‰ÔÈ ÁÈ· ÙËÓ ¤ÁηÈÚË ·Ó·ÁÓÒÚÈÛË Ù˘

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¶·È‰È·ÙÚÈ΋ 2002;65:232-240

Paediatriki 2002;65:232-240

¶›Ó·Î·˜ 1. ∆ÚÔÔÔÈË̤ӷ ÎÚÈÙ‹ÚÈ· ÛÙ·‰ÈÔÔ›ËÛ˘ Ù˘ ¡∂∫ ηٿ Bell ™Ù¿‰ÈÔ

∆·ÍÈÓfiÌËÛË

™˘ÛÙËÌ·ÙÈο ÛËÌ›·

™ËÌ›· ·fi ÙÔ ¤ÓÙÂÚÔ

∞ÎÙÈÓÔÏÔÁÈο ÛËÌ›·

π∞

ñ ⁄ÔÙË ¡∂∫

ñ £ÂÚÌÔÚÚ˘ıÌÈÛÙÈ΋ ·ÛÙ¿ıÂÈ·, ¿ÓÔÈ·, ‚Ú·‰˘Î·Ú‰›·, Ï‹ı·ÚÁÔ˜

ñ º˘ÛÈÔÏÔÁÈο ‹ ÂÓÙÂÚÈ΋ ‰È¿Ù·ÛË, ‹ÈÔ˜ ÂÈÏÂfi˜

πµ

ñ ⁄ÔÙË ¡∂∫

ñ ÿ‰È·, fiˆ˜ π∞

ππ∞

ñ ∞ԉ‰ÂÈÁ̤ÓË ¡∂∫, ‡ÔÙË ÓfiÛÔ˜

ñ ÿ‰È·, fiˆ˜ π∞

ππµ

ñ ∞ԉ‰ÂÈÁ̤ÓË ¡∂∫, ̤ÙÚÈ· ÓfiÛÔ˜

ñ ÿ‰È·, fiˆ˜ π∞. ∂ÈϤÔÓ, ‹È· ÌÂÙ·‚ÔÏÈ΋ ÔͤˆÛË Î·È ‹È· ıÚÔÌ‚ÔÂÓ›·

πππ∞

ñ ¶ÚÔ¯ˆÚË̤ÓË ñ ÿ‰È·, fiˆ˜ ππµ. ∂ÈϤÔÓ, ¡∂∫, ÛÔ‚·Ú‹ ˘fiÙ·ÛË, ‚Ú·‰˘Î·Ú‰›·, ÓfiÛËÛË, ÚÔÛ‚ÔÏ‹ ÛÔ‚·Ú‹ ¿ÓÔÈ·, ÂÓÙ¤ÚÔ˘ Û˘Ó‰˘·ÛÌfi˜ ·Ó·Ó¢ÛÙÈ΋˜ Î·È ÌÂÙ·‚ÔÏÈ΋˜ ÔͤˆÛ˘, ‰È¿¯˘ÙË ÂÓ‰·ÁÁÂȷ΋ ‹ÍË Î·È Ô˘‰ÂÙÂÚÔÂÓ›· ñ ¶ÚÔ¯ˆÚË̤ÓË ñ ÿ‰È·, fiˆ˜ πππ∞ ¡∂∫, ÛÔ‚·Ú‹ ÓfiÛËÛË, ‰È¿ÙÚËÛË ÂÓÙ¤ÚÔ˘

ñ ∞˘ÍË̤ÓÔ Á·ÛÙÚÈÎfi ˘fiÏÂÈÌÌ·, ‰È¿Ù·ÛË Ì¤Û˘ ÎÔÈÏ›·˜, ¤ÌÂÙÔÈ, ıÂÙÈÎfi ÙÂÛÙ ∏‚ ÛÙ· ÎfiÚ·Ó· ñ ∞ÓÔÈÎÙfi ÎfiÎÎÈÓÔ ·›Ì· ·fi ÙÔÓ ÚˆÎÙfi ñ ÿ‰È·, fiˆ˜ πµ. ∂ÈϤÔÓ, ·Ô˘Û›· ÂÓÙÂÚÈÎÒÓ ‹¯ˆÓ Ì ‹ ¯ˆÚ›˜ ÎÔÈÏȷ΋ ¢·ÈÛıËÛ›· ñ ÿ‰È·, fiˆ˜ ππ∞. ∂ÈϤÔÓ, ·Ô˘Û›· ÂÓÙÂÚÈÎÒÓ ‹¯ˆÓ. ∂›ÛËÌÔ˜ ÌÂÙˆÚÈÛÌfi˜ Ì ‹ ¯ˆÚ›˜ ÎÔÈÏȷ΋ ΢ÙÙ·Ú›Ùȉ· ‹ Ì¿˙· ÛÙÔ ‰ÂÍÈfi οو ÙÂÙ·ÚÙËÌfiÚÈÔ Ù˘ ÎÔÈÏ›·˜ ñ ÿ‰È·, fiˆ˜ ππµ. ∂ÈϤÔÓ, ÛËÌ›· ÁÂÓÈÎÂ˘Ì¤Ó˘ ÂÚÈÙÔÓ›Ùȉ·˜, ¤ÓÙÔÓË Â˘·ÈÛıËÛ›·, ÌÂÙˆÚÈÛÌfi˜ ÎÔÈÏ›·˜

πππµ

ñ ÿ‰È·, fiˆ˜ πππ∞

ñ ÿ‰È·, fiˆ˜ π∞ ñ ¢È¿Ù·ÛË ÂÓÙ¤ÚÔ˘, ÂÈÏÂfi˜, ÂÓÙÂÚÈ΋ ÓÂ˘Ì¿ÙˆÛË

ñ ÿ‰È·, fiˆ˜ ππ∞. ∂ÈϤÔÓ, Â›ÛËÌÔ˜ ·ÛΛÙ˘

ñ ÿ‰È·, fiˆ˜ ππ∞. ∂ÈϤÔÓ, Â›ÛËÌÔ˜ ·ÛΛÙ˘

ñ ÿ‰È·, fiˆ˜ πππ∞. ∂ÈϤÔÓ, Ó¢ÌÔÂÚÈÙfiÓ·ÈÔ

¡∂∫. OÈ Ì¤ıÔ‰ÔÈ ·˘Ù¤˜ Â›Ó·È Ë ÙÔÓÔÌÂÙÚ›· ÙÔ˘ ÂÙÈÎÔ‡, Ë Ì¤ÙÚËÛË ÙÔ˘ D-Á·Ï·ÎÙÈÎÔ‡ ÛÙ· Ô‡Ú· Î·È ÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜. ∫·Ì›·, fï˜, ·fi ·˘Ù¤˜ ÙȘ ÌÂıfi‰Ô˘˜ ‰ÂÓ Â›Ó·È ÂȉÈ΋ Î·È ¤¯Ô˘Ó ÂÚÈÔÚÈṲ̂ÓË ÎÏÈÓÈ΋ ÛËÌ·Û›·. ∆ÂÏÂ˘Ù·›·, ÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜ ¯ÚËÛÈÌÔÔÈÂ›Ù·È fiÏÔ Î·È ÂÚÈÛÛfiÙÂÚÔ ÁÈ· ÙËÓ ÂÍ·ÎÚ›‚ˆÛË Ù˘ ·ÚÔ˘Û›·˜ Î·È ÂÓÙÔÈÛÌÔ‡ ·ÛÎÈÙÈÎÔ‡ ˘ÁÚÔ‡, Ô˘ ‰È¢ÎÔχÓÂÈ ÙËÓ ·Ú·Î¤ÓÙËÛË ÎÔÈÏ›·˜. ∞ÎfiÌË, ÔÈ ˘¤Ú˯ÔÈ ÛÙÔ Ì¤ÏÏÔÓ ı· ·›ÍÔ˘Ó Î¿ÔÈÔ ÚfiÏÔ ÛÙÔÓ Î·ıÔÚÈÛÌfi Ù˘ ·ÚÔ˘Û›·˜ Ù˘ ÂÓÙÂÚÈ΋˜ ÈÛ¯·ÈÌ›·˜ Ì ÙËÓ ÂͤٷÛË ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ÙÔȯÒÌ·ÙÔ˜, ÙÔ˘ ‚ÏÂÓÓÔÁfiÓÔ˘ Î·È ÙˆÓ ÌÂÛÂÓÙ¤ÚÈˆÓ ·ÁÁ›ˆÓ (34).

Â›Ó·È ‰Â›ÎÙ˘ ÂÈıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ Î·È ·ÂÏ¢ıÂÚÒÓÂÙ·È ÛÙË Û˘ÛÙËÌ·ÙÈ΋ ΢ÎÏÔÊÔÚ›·. ª›· ¿ÏÏË ÚfiÛÊ·ÙË ÌÂϤÙË ¯ÚËÛÈÌÔÔ›ËÛ ÙË Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· (ªRI) ÁÈ· ÙËÓ ·Ó·›Ì·ÎÙË ‰È¿ÁÓˆÛË Ù˘ ÂÓÙÂÚÈ΋˜ Ó¤ÎÚˆÛ˘ Û ÚfiˆÚ· ÓÂÔÁÓ¿ Ì ˘Ô„›· ¡∂∫. ¶ÚfiˆÚ· ÓÂÔÁÓ¿ Ì ¡∂∫ Ô˘ ¯ÂÈÚÔ˘ÚÁ‹ıËÎ·Ó Î·È Â›¯·Ó Ó¤ÎÚˆÛË ÙÔ˘ ÂÓÙ¤ÚÔ˘ ›¯·Ó ·ÚÔ˘ÛÈ¿ÛÂÈ ÛÙÔ ªRI ÂÈÎfiÓ· Ê˘Û·Ï›‰ˆÓ ÛÙÔ ¤ÓÙÂÚÔ. ∞Ó Î·È Ë Ì¤ıÔ‰Ô˜ ·˘Ù‹ ¤¯ÂÈ ÂÚÈÔÚÈṲ̂ÓË ¯ÚËÛÈÌfiÙËÙ· ÛÙÔ Û‡Á¯ÚÔÓÔ ÓÂÔÁÓÈÎfi ÂÚÈ‚¿ÏÏÔÓ, ÌÂÏÏÔÓÙÈΤ˜ ÌÂϤÙ˜ Ô˘ ı· ÂÚ¢ÓÔ‡Ó ÏÂÈÙÔ˘ÚÁÈΤ˜ ÂÈÎfiÓ˜ ÙÔ˘ MRI, ÌÔÚ› Ó· ‚ÔËı‹ÛÔ˘Ó ÛÙËÓ ÚfiÁÓˆÛË Ù˘ ÂͤÏÈ͢ Ù˘ ÂÓÙÂÚÈ΋˜ ‚Ï¿‚˘ Û ÏËı˘ÛÌfi ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ (35-37).

¶ÚÒÈÌË ‰È¿ÁÓˆÛË °È· ÔÏÏ¿ ¯ÚfiÓÈ· ÂÚ¢ÓËÙ¤˜ ¤¯Ô˘Ó ÚÔÛ·ı‹ÛÂÈ Ó· ·Ó·ÁÓˆÚ›ÛÔ˘Ó ÂȉÈÎÔ‡˜ ‰Â›ÎÙ˜ Ô˘ ı· Â¤ÙÚÂ·Ó ÙËÓ ÚÒÈÌË ‰È¿ÁÓˆÛË Î·È ıÂÚ·›· Ù˘ ¡∂∫. ™‹ÌÂÚ·, ·ÚfiÙÈ ˘¿Ú¯ÂÈ ÛËÌ·ÓÙÈÎfi ÂӉȷʤÚÔÓ ÛÙË Ì¤ÙÚËÛË ÔÈÎ›ÏˆÓ ¯ËÌÈÎÒÓ ÌÂÛÔÏ·‚ËÙÒÓ ÁÈ· ÙËÓ ÚfiÁÓˆÛË Ù˘ ÓfiÛÔ˘, ‰ÂÓ ˘¿Ú¯ÂÈ ÔÌÔʈӛ· ÁÈ· ÙË ¯ÚËÛÈÌÔÔ›ËÛË Î¿ÔÈ·˜ ·Ú·‰ÂÎÙ‹˜ ÌÂıfi‰Ô˘. ª›· ÚfiÛÊ·ÙË ÌÂϤÙË Ì¤ÙÚËÛ ÙË ‰ÂÛÌÂ˘Ì¤ÓË Ì ÏÈ·Ú¿ Ôͤ· ÂÓÙÂÚÈ΋ ÚˆÙ½ÓË, Ô˘

£ÂÚ·›· ™Â ˘Ô„›· ¡∂∫, ı· Ú¤ÂÈ Ó· ·Ú¯›˙ÂÈ ¤ÁηÈÚË Î·È ÂÈıÂÙÈ΋ ıÂÚ·›·. ∏ ıÂÚ·›· ÂÚÈÏ·Ì‚¿ÓÂÈ ÂÓ‰ÔÊϤ‚È· ¯ÔÚ‹ÁËÛË ˘ÁÚÒÓ, ·ÔÛ˘ÌÊfiÚËÛË ÙÔ˘ ÂÓÙ¤ÚÔ˘ Ì ÚÈÓÔÁ·ÛÙÚÈÎfi ηıÂÙ‹Ú·, ‰ÈfiÚıˆÛË ·Ó·ÈÌ›·˜ Î·È ıÚÔÌ‚ÔÂÓ›·˜ Î·È ÂÌÂÈÚÈ΋ ¯ÔÚ‹ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ Î·Ù¿ Ù˘ ÂÓÙÂÚÈ΋˜ ¯ÏˆÚ›‰·˜. ™˘Ó‹ıˆ˜, Ô Û˘Ó‰˘·ÛÌfi˜ ·ÓÙÈ‚ÈÔÙÈÎÒÓ ÂÚÈÏ·Ì‚¿ÓÂÈ ·ÌÈÎÈÏÏ›ÓË ‹ ‚·ÓÎÔÌ˘Î›ÓË Î·È ÁÂÓÙ·Ì˘Î›ÓË ‹ ÎÂÊÔÙ·Í›ÌË.

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¶·È‰È·ÙÚÈ΋ 2002;65:232-240

∏ ÚfiÛıÂÙË ¯ÔÚ‹ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ ÁÈ· ·Ó·ÂÚfi‚È· ÌÈÎÚfi‚È· (ÎÏÈÓ‰·Ì˘Î›ÓË ‹ ÌÂÙÚÔÓȉ·˙fiÏË) ‰ÂÓ ÂӉ›ÎÓ˘Ù·È ÁÈ· ‡ÔÙ˜ ÂÚÈÙÒÛÂȘ, ·Ú¿ ÌfiÓÔÓ ÂÊfiÛÔÓ ¤¯ÂÈ Û˘Ì‚Â› ‰È¿ÙÚËÛË ‹ ÂÚÈÙÔÓ›Ùȉ·. ∆· ·ÓÙÈ‚ÈÔÙÈο, ‚¤‚·È·, ÙÚÔÔÔÈÔ‡ÓÙ·È ·Ó¿ÏÔÁ· Ì ÙȘ ηÏÏȤÚÁÂȘ ÙˆÓ ÎÔÚ¿ÓˆÓ, ÙÔ˘ ·›Ì·ÙÔ˜ Î·È ÙÔ˘ ∂¡À. ÃÔÚ‹ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ ÁÈ· 3 Ë̤Ú˜ Â›Ó·È ·ÚÎÂÙ‹, ÂÊfiÛÔÓ ˘¿Ú¯ÂÈ ÎÏÈÓÈ΋ ‚ÂÏÙ›ˆÛË Î·È Ù· ÂÚÁ·ÛÙËÚȷο Â›Ó·È ·ÚÓËÙÈο. ¡ÂÔÁÓ¿ Ì ·ԉ‰ÂÈÁ̤ÓË ¡∂∫ ¯ÚÂÈ¿˙ÔÓÙ·È ıÂÚ·›· ÙÔ˘Ï¿¯ÈÛÙÔÓ ÁÈ· 8-10 Ë̤Ú˜. ¡ÂÔÁÓ¿ Ì ¡∂∫ ÙÚ›ÙÔ˘ ÛÙ·‰›Ô˘ ¯ÚÂÈ¿˙ÔÓÙ·È ÂÓÙ·ÙÈ΋ ÓÔÛËÏ›·, Ô˘ ÂÚÈÏ·Ì‚¿ÓÂÈ Ì˯·ÓÈ΋ ˘ÔÛÙ‹ÚÈÍË ·Ó·ÓÔ‹˜, Û˘Ó¯‹ ·Ú·ÎÔÏÔ‡ıËÛË ˙ˆÙÈÎÒÓ ÛËÌ›ˆÓ Ì monitors, ·ÎÙÈÓÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô ÎÔÈÏ›·˜ οı 6-8 ÒÚ˜, ‰ÈfiÚıˆÛË ÔͤˆÛ˘ Î·È ËÏÂÎÙÚÔÏ˘ÙÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ, ¯ÔÚ‹ÁËÛË ÎÔÏÏÔÂȉÒÓ, ·Ú·ÁÒÁˆÓ ·›Ì·ÙÔ˜, fiˆ˜ ÊÚ¤ÛÎÔ˘ ηÙ„˘Á̤ÓÔ˘ Ï¿ÛÌ·ÙÔ˜ Î·È ·ÈÌÔÂÙ·Ï›ˆÓ. °È· ÙË ‚ÂÏÙ›ˆÛË Ù˘ ·ÈÌ¿ÙˆÛ˘ ÙˆÓ ÔÚÁ¿ÓˆÓ Î·È ÙËÓ ÂÓ›Û¯˘ÛË ÙÔ˘ Ì˘Ôηډ›Ô˘ Â›Ó·È ··Ú·›ÙËÙ· ÈÓfiÙÚÔ· ·ÁÁÂÈÔÛ˘ÛÙ·ÏÙÈο, fiˆ˜ ÓÙÔ·Ì›ÓË Î·È ÓÙÔ‚Ô˘Ù·Ì›ÓË Ì ·Ú¯È΋ ‰fiÛË 5 Ìg/kg/min ¤ˆ˜ 20 Ìg/kg/min. ∆· ÓÂÔÁÓ¿ ·˘Ù¿ ¯ÚÂÈ¿˙ÔÓÙ·È ıÂÚ·›· ÁÈ· 14-21 Ë̤Ú˜ (10,20,33). ∂ÊfiÛÔÓ Ë ÓfiÛÔ˜ ÂÍÂÏ›ÛÛÂÙ·È ·Ú¿ ÙËÓ ¤ÓÙÔÓË Û˘ÓÙËÚËÙÈ΋ ·ÁˆÁ‹, ÙfiÙÂ Ë ¯ÂÈÚÔ˘ÚÁÈ΋ Â¤Ì‚·ÛË Â›Ó·È ·Ó·Áη›·. OÈ ÂӉ›ÍÂȘ ÁÈ· ¯ÂÈÚÔ˘ÚÁÈ΋ Â¤Ì‚·ÛË ‰È·Ê¤ÚÔ˘Ó ÌÂٷ͇ ÙˆÓ ‰È·ÊfiÚˆÓ Î¤ÓÙÚˆÓ. °ÂÓÈο, Ë ÂÌÊ¿ÓÈÛË ÚÔԉ¢ÙÈ΋˜ Âȉ›ӈÛ˘ Ì ·˘Í·ÓfiÌÂÓË ÌÂÙ·‚ÔÏÈ΋ ÔͤˆÛË, ıÚÔÌ‚ÔÂÓ›·, ÚÔԉ¢ÙÈÎfi shock ·fi ·ÒÏÂȘ ÙÚ›ÙÔ˘ ¯ÒÚÔ˘ Î·È ·‡ÍËÛË ÙÔ˘ ÌÂÙˆÚÈÛÌÔ‡ Ù˘ ÎÔÈÏ›·˜, ·ÔÙÂÏ› ¤Ó‰ÂÈÍË Ì·˙È΋˜ ÂÓÙÂÚÈ΋˜ Ó¤ÎÚˆÛ˘. ∏ ·ÎÙÈÓÔÏÔÁÈ΋ ÂÈÎfiÓ· Ì ‰È·ÙÂٷ̤Ó˜ ÂÓÙÂÚÈΤ˜ ¤ÏÈΘ Û˘Óԉ¢fiÌÂÓ˜ Ì ÂÓÙÂÚÈ΋ ‰È¿Ù·ÛË Â›Ó·È Û˘¯Ó¿ ¤Ó‰ÂÈÍË ÂÓÙÂÚÈ΋˜ Ó¤ÎÚˆÛ˘ Î·È ÚÔ¿ÁÁÂÏÔ˜ ‰È¿ÙÚËÛ˘. ∂Ӊ›ÍÂȘ ÁÈ· ¿ÌÂÛË ¯ÂÈÚÔ˘ÚÁÈ΋ Â¤Ì‚·ÛË Â›Ó·È ÙÔ Ó¢ÌÔÂÚÈÙfiÓ·ÈÔ Î·È ÂÚ˘ıÚfiÙËÙ· ‹ Ô›‰ËÌ· ÙÔ˘ ÎÔÈÏÈ·ÎÔ‡ ÙÔȯÒÌ·ÙÔ˜. OÈ ‚·ÛÈΤ˜ ¯ÂÈÚÔ˘ÚÁÈΤ˜ ·Ú¯¤˜ Ù˘ ÂÓÙÂÚÈ΋˜ ·ÔÛ˘Ì›ÂÛ˘ Â›Ó·È Ë ÂÎÙÔÌ‹ ÙÔ˘ ÓÂÎÚˆı¤ÓÙÔ˜ ÂÓÙÂÚÈÎÔ‡ ÙÌ‹Ì·ÙÔ˜ Î·È Ë ·ÚÔ¯¤Ù¢ÛË Ù˘ ÚÔ‹˜ ÙˆÓ ÎÔÚ¿ÓˆÓ. ∏ ·Ê·›ÚÂÛË ÙÔ˘ ÚÔۂ‚ÏË̤ÓÔ˘ ÂÓÙÂÚÈÎÔ‡ ÙÌ‹Ì·ÙÔ˜ Ì ·Ú¯È΋ ·Ó·ÛÙfïÛË Ê·›ÓÂÙ·È fiÙÈ Â›Ó·È ·ÛÊ·Ï‹˜ Û ÛÙ·ıÂÚÔÔÈË̤ӷ ÓÂÔÁÓ¿, ÛÙ· ÔÔ›· ÙÔ ÂÓ·ÔÌÂ›Ó·Ó ¤ÓÙÂÚÔ Ê·›ÓÂÙ·È ˘ÁȤ˜ Î·È ‰ÂÓ ¤¯ÂÈ Û˘Ì‚Â› ÌÂÁ¿ÏË ÂÚÈÙÔÓ·˚΋ ÚÔÛ‚ÔÏ‹. ªÂÙ¿ ·fi Ì›· ÈηÓÔÔÈËÙÈ΋ ÂÚ›Ô‰Ô ıÂÚ·›·˜ ÌÔÚ› Ó· Á›ÓÂÈ ÂÈÏÂÎÙÈο Â·Ó·ÛÙfïÛË Û ¤Ó· ‰Â‡ÙÂÚÔ ÛÙ¿‰ÈÔ (10,20,33,38-40). ∏ ¯ÚËÛÈÌÔÔ›ËÛË ÂÚÈÙÔÓ·˚΋˜ ·ÚÔ¯¤Ù¢Û˘ Ì ÙÔÈ΋ ·Ó·ÈÛıËÛ›· Û ÂÈÏÂÁ̤ӷ ÓÂÔÁÓ¿ Ì ÛÔ‚·Ú‹ ¡∂∫ ¤¯ÂÈ Û˘ÛÙ·ı› ·fi ÙÔ˘˜ Janik Î·È Û˘Ó.

Paediatriki 2002;65:232-240

∞˘Ù‹ Ë Ì¤ıÔ‰Ô˜ ÂÈÙÚ¤ÂÈ ÛÙ·ıÂÚÔÔ›ËÛË Î·È ·ÚÁfiÙÂÚ·, Â¿Ó ¯ÚÂÈ·ÛÙ›, ¯ÂÈÚÔ˘ÚÁÈ΋ Â¤Ì‚·ÛË. ∏ ̤ıÔ‰Ô˜ Ê·›ÓÂÙ·È fiÙÈ Â›Ó·È Â˘ÂÚÁÂÙÈ΋ ÌfiÓÔ Û ÓÂÔÁÓ¿ ÌÈÎÚfiÙÂÚ· ·fi 1000 g, Û ÚÔÛÂÎÙÈο ÂÈÏÂÁ̤Ó˜ ÂÚÈÙÒÛÂȘ Î·È ‰ÂÓ ÌÔÚ› Ó· ÂÊ·ÚÌfi˙ÂÙ·È ÁÂÓÈο (41-43). ¶ÚfiÏË„Ë ∏ ηχÙÂÚË Î·Ù·ÓfiËÛË Ù˘ ·ıÔÁ¤ÓÂÈ·˜ Ù˘ ¡∂∫ ÂÈÙÚ¤ÂÈ ÙËÓ ·Ó¿Ù˘ÍË ÚÔÏËÙÈÎÒÓ Î·È ıÂÚ·¢ÙÈÎÒÓ ÛÙÚ·ÙËÁÈÎÒÓ. £ÂˆÚËÙÈο, Ë ÚfiÏË„Ë Ù˘ ¡∂∫ ı· Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ÂÚÈÔÚÈÛÌfi ÙˆÓ ÂÈΛӉ˘ÓˆÓ ·Ú·ÁfiÓÙˆÓ Ô˘ Û˘Ì‚¿ÏÏÔ˘Ó ÛÙËÓ ÂÓÙÂÚÈ΋ ÈÛ¯·ÈÌ›· ÙÔ˘ ·ÓÒÚÈÌÔ˘ ÂÓÙ¤ÚÔ˘, ¯ÚËÛÈÌÔÔ›ËÛË ÙÔ˘ ÌËÙÚÈÎÔ‡ Á¿Ï·ÎÙÔ˜ Ô˘ ÂÚȤ¯ÂÈ ÔÏÏ¿ Û˘ÛÙ·ÙÈο Ô˘ ÚÔÛÙ·ÙÂ‡Ô˘Ó ÙÔ ¤ÓÙÂÚÔ Î·È, Ù¤ÏÔ˜, ¯ÚËÛÈÌÔÔ›ËÛË ¿ÏÏˆÓ Ô˘ÛÈÒÓ Ô˘ ‚ÂÏÙÈÒÓÔ˘Ó ÙË ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ· ÙÔ˘ ÂÓÙ¤ÚÔ˘ Î·È ·Ó·ÛÙ¤ÏÏÔ˘Ó ÙÔ˘˜ ·ıÔÁÂÓÂÙÈÎÔ‡˜ Ì˯·ÓÈÛÌÔ‡˜ Ô˘ Ô‰ËÁÔ‡Ó ÛÙË ¡∂∫ (3).

O ‚ÏÂÓÓÔÁfiÓÔ˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘ Û¯ËÌ·Ù›˙ÂÈ ÙÔÓ ÚÒÙÔ ÊÚ·ÁÌfi ÛÙ· ·ÓÙÈÁfiÓ· Ô˘ ÚÔÛ‚¿ÏÏÔ˘Ó ÙÔ ÂÈı‹ÏÈfi ÙÔ˘. O ÊÚ·ÁÌfi˜ ·˘Ùfi˜ Û˘Ó›ÛÙ·Ù·È ·fi ‰È¿ÊÔÚÔ˘˜ ·Ú¿ÁÔÓÙ˜, fiˆ˜ ÙÔ Á·ÛÙÚÈÎfi pH, Á·ÛÙÚÈο Î·È ·ÁÎÚ·ÙÈο ¤Ó˙˘Ì·, ÂÈÊ¿ÓÂÈ· ‚ÏÂÓÓÔÁfiÓÔ˘ ÏÔ‡ÛÈ· Û ÁÏ˘ÎÔÚˆÙ½Ó˜ Î·È ·ÓÔÛÔÛÊ·ÈÚ›Ó˜ (16,44). ∏ Ê˘ÛÈÔÏÔÁÈ΋ ÌÈÎÚԂȷ΋ ¯ÏˆÚ›‰· ÙÔ˘ ÂÓÙ¤ÚÔ˘ ÛÙÔ ÓÂÔÁÓfi, ˆ˜ ÁÓˆÛÙfiÓ, ·ÔÙÂÏÂ›Ù·È ·fi Á·Ï·ÎÙÔ‚¿ÎÈÏÔ˘˜ (·Ó·ÂÚfi‚È· ÌÈÎÚfi‚È·, fiˆ˜ bacteroides Î·È Bifidobacterium), ΢ڛˆ˜ ÛÙ· ıËÏ¿˙ÔÓÙ· ÓÂÔÁÓ¿ Î·È ÙÔ ÌË ·ıÔÁfiÓÔ ÎÔÏÔ‚·ÎÙËÚ›‰ÈÔ Î·È ÂÓÙÂÚfiÎÔÎÎÔ˘˜. To ¤ÓÙÂÚÔ, fï˜, ÙˆÓ ÓÂÔÁÓÒÓ Ô˘ ÓÔÛËχÔÓÙ·È Û ÂÓÙ·ÙÈΤ˜ ÌÔÓ¿‰Â˜ ·ÔÈΛ˙ÂÙ·È ·fi ÌÂÁ¿ÏÔ ·ÚÈıÌfi ·ıÔÁfiÓˆÓ ÌÈÎÚÔ‚›ˆÓ, Ô˘ ÌÂÙ¿ ÙË ‰È¿Û·ÛË ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ‚ÏÂÓÓÔÁfiÓÔ˘ ‰È·ÂÚÓÔ‡Ó ÙÔÓ ÂÓÙÂÚÈÎfi ‚ÏÂÓÓÔÁfiÓÔ Î·È ÂÈÛ¤Ú¯ÔÓÙ·È ÛÙÔ ÂÓÙÂÚÈÎfi ÙÔ›¯ˆÌ·. ∆· ÌÈÎÚfi‚È· ·˘Ù¿ Â›Ó·È clostridium difficile, E. Coli, Klebsiella pneumoniae, staphylococcus aureus Î·È epidermidis. ¶ÚfiÛÊ·Ù˜ ÌÂϤÙ˜ Û˘ÌÂÚ·›ÓÔ˘Ó fiÙÈ Ù· ¶Ãµ°¡ ˘ÔÏ›ÔÓÙ·È ÛÙÔÓ ·ÔÈÎÈÛÌfi ÙÔ˘ ÂÓÙ¤ÚÔ˘ ·fi ·Ó·ÂÚfi‚È· ÌÈÎÚfi‚È· Î·È Ë ÌË ‡·ÚÍË ·˘ÙÒÓ ÙˆÓ ÌÈÎÚÔ‚›ˆÓ ÂÈÙÚ¤ÂÈ ÙËÓ ˘ÂÚ-·Ó¿Ù˘ÍË ÂÚÈÛÛfiÙÂÚÔ ·ıÔÁfiÓˆÓ ÌÈÎÚÔ‚›ˆÓ, Ô˘ Ô‰ËÁÔ‡Ó ÛÙËÓ ¤Ó·ÚÍË Ù˘ ¡∂∫ (9,45). °È· ÙËÓ ÚfiÏË„Ë Ù˘ ¡∂∫ ¤¯Ô˘Ó ¯ÚËÛÈÌÔÔÈËı› Û ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ Ô˘Û›Â˜ Î·È Ê¿Ú̷η, ÛÙËÓ ÚÔÛ¿ıÂÈ· Ó· ÂÏ·ÙÙÒÛÔ˘Ó ÙË ‚·Ú‡ÙËÙ¿ Ù˘ Î·È Ó· ‚ÂÏÙÈÒÛÔ˘Ó ÙËÓ ¤Î‚·Û‹ Ù˘. ∆¤ÙÔȘ Ô˘Û›Â˜ Î·È Ê¿Ú̷η Â›Ó·È ÙÔ ÌËÙÚÈÎfi Á¿Ï·, ÙÔ Û˘Ìϋڈ̷ IgA, Ë ÚÔÊ˘Ï·ÎÙÈ΋ ¯ÔÚ‹ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ, ΢ڛˆ˜ ‚·ÓÎÔÌ˘Î›Ó˘, Ë ¯ÔÚ‹ÁËÛË ‰ÂÍ·ÌÂı·˙fiÓ˘, ʈÛÊÔÏÈȉ›ˆÓ ·˘ÁÔ‡ Û·Ó Û˘Ìϋڈ̷ ÛÙÔ

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Á¿Ï·, ÂÚ˘ıÚÔÔÈËÙ›Ó˘ Î·È Ù¤ÏÔ˜ Ù· ÚÔ‚ÈÔÙÈο (46-50). ∆Ô ÌËÙÚÈÎfi Á¿Ï· ÂÚȤ¯ÂÈ ÔÈÎÈÏ›· ·Ú·ÁfiÓÙˆÓ Ô˘ ¤¯ÂÈ ‚ÚÂı› fiÙÈ ¤¯Ô˘Ó ·ÓÙÈÊÏÂÁÌÔÓÒ‰ÂȘ ȉÈfiÙËÙ˜ Î·È ÌÔÚÔ‡Ó Ó· ÚÔÛٷهÛÔ˘Ó ÙÔ ¤ÓÙÂÚÔ ·fi ÙȘ ÙÔ͛Ә. ∆¤ÙÔÈÔÈ ·Ú¿ÁÔÓÙ˜ Â›Ó·È Î˘ÙÙ·ÚÔÚÔÛٷ٢ÙÈÎÔ›, fiˆ˜ PGE2, PGF2, EGF Î·È Ï·ÎÙÔÊÂÚÚ›ÓË, ˆÚÈÌ·ÓÙÈÎÔ› ·Ú¿ÁÔÓÙ˜, fiˆ˜ ÛÙÂÚÔÂȉ‹ Î·È ı˘ÚÔÚÌfiÓ˜, ¤Ó˙˘Ì·, fiˆ˜ PAFacetylhydrolase, Ï˘ÛÔ˙‡Ì˜, ÂÎÎÚÈÙÈ΋ IgA Î·È ·ÓÙÈÔÍÂȉˆÙÈΤ˜ Ô˘Û›Â˜, fiˆ˜ ·-ÙÔÎÔÊÂÚfiÏË, ·ÛÎÔÚ‚ÈÎfi, ‚-ηÚÔÙ›ÓË Î·È Ô˘ÚÈÎfi Ô͇. ™Â Ì›· ÂÚÁ·Û›· ‚Ú¤ıËΠfiÙÈ Û ÓÂÔÁÓ¿ Ô˘ ÛÈÙ›˙ÔÓÙ·Ó ·ÔÎÏÂÈÛÙÈο Ì ͤÓÔ Á¿Ï· Ë ¡∂∫ ‹Ù·Ó 6-10 ÊÔÚ¤˜ ÈÔ Û˘¯Ó‹ ·’ fi,ÙÈ Û ·˘Ù¿ Ô˘ ÛÈÙ›˙ÔÓÙ·Ó Ì ÌËÙÚÈÎfi Á¿Ï· Î·È 3 ÊÔÚ¤˜ Û ۯ¤ÛË Ì ÂΛӷ Ô˘ ÛÈÙ›˙ÔÓÙ·Ó Ì ÌÈÎÙfi (ÌËÙÚÈÎfi Î·È Í¤ÓÔ) (16,51). ∏ ÂÚ˘ıÚÔÔÈËÙ›ÓË Ô˘ ‚Ú›ÛÎÂÙ·È ÛÙÔ ÌËÙÚÈÎfi Á¿Ï· ¤¯ÂÈ Î¿ÔÈÔ ÚfiÏÔ ÛÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ ۈϋӷ. ∂Ô̤ӈ˜, Ë ÂÚ˘ıÚÔÔÈËÙ›ÓË Ú¤ÂÈ Ó· ¤¯ÂÈ ÚÔÛٷ٢ÙÈÎfi ÚfiÏÔ ÛÙËÓ ÂΉ‹ÏˆÛË Ù˘ ¡∂∫. ™Â Ì›· ·Ó·‰ÚÔÌÈ΋ ÌÂϤÙË ÙˆÓ Ledbetter DJ Î·È Û˘Ó ‚Ú¤ıËΠfiÙÈ ÚfiˆÚ· ‚¿ÚÔ˘˜ 500-1200 g, ÛÙ· ÔÔ›· ¯ÔÚËÁ‹ıËΠÂÚ˘ıÚÔÔÈËÙ›ÓË, ·ÚÔ˘Û›·Û·Ó ¡∂∫ Û ÌÈÎÚfiÙÂÚË Û˘¯ÓfiÙËÙ· (52). ∂›Û˘, Ô GM-CSF ¤¯ÂÈ ‚ÚÂı› fiÙÈ ÂÏ·ÙÙÒÓÂÈ ÛËÌ·ÓÙÈο ÙË ıÓËÙfiÙËÙ· ·fi Ô˘‰ÂÙÂÚÔÂÓÈ΋ ÛË„·ÈÌ›·, Ô˘ Û˘Óԉ‡ÂÙ·È Ì ¡∂∫ (53). Œ¯ÂÈ ‚ÚÂı› fiÙÈ Ë ¯ÔÚ‹ÁËÛË Á¿Ï·ÎÙÔ˜ ÂÌÏÔ˘ÙÈṲ̂ÓÔ˘ Ì ʈÛÊÔÏÈ›‰È· ·˘ÁÔ‡ Û ÚfiˆÚ· Û˘Ì‚¿ÏÏÂÈ Û ÂÏ¿ÙÙˆÛË Î·Ù¿ 6 ÊÔÚ¤˜ Ù˘ Û˘¯ÓfiÙËÙ·˜ Ù˘ ¡∂∫. ∞˘Ù¿ Ù· ʈÛÊÔÏÈ›‰È· Â›Ó·È Û˘ÛÙ·ÙÈο ÙˆÓ ÌÂÌ‚Ú·ÓÒÓ ÙÔ˘ ‚ÏÂÓÓÔÁfiÓÔ˘ Î·È ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ·Ú¿ÁÔÓÙ· Î·È Ù· Û˘ÛÙ·ÙÈο ÙÔ˘˜ ·Ú·¯È‰ÔÓÈÎfi Î·È ¯ÔÏ›ÓË ¤¯Ô˘Ó ÈηÓÔÔÈËÙÈΤ˜ ÚÔÛٷ٢ÙÈΤ˜ ȉÈfiÙËÙ˜ (49,54). ∏ PAF-acetylhydrolase ¤¯ÂÈ ‚ÚÂı› ÛÙÔ ÌËÙÚÈÎfi Á¿Ï· Î·È ÙÔ ¤Ó˙˘ÌÔ ·˘Ùfi Ú¤ÂÈ Ó· ÚÔÛٷهÂÈ ·fi ÙË ¡∂∫ (55). ŒÓ· Û··ÛÌ· ·fi ÙÔ ÛÙfiÌ· Ù˘ IgA Î·È Ë ÔÍÈÓÔÔ›ËÛË Ù˘ ÂÓÙÂÚÈ΋˜ ÙÚÔÊ‹˜ ¤¯ÂÈ ‚ÚÂı› fiÙÈ ÂÏ·ÙÙÒÓÔ˘Ó ÙË Û˘¯ÓfiÙËÙ· Ù˘ ¡∂∫ (46). ∆· ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹, Ô˘ ¤¯ÂÈ ‚ÚÂı› fiÙÈ ·˘Í¿ÓÔ˘Ó ÙËÓ ÂÓÙÂÚÈ΋ ÎÈÓËÙÈÎfiÙËÙ· Î·È ÂÏ·ÙÙÒÓÔ˘Ó ÙËÓ ÂÓÙÂÚÈ΋ ‰È·ÂÚ·ÙfiÙËÙ· Î·È ÌÂٷΛÓËÛË ÙˆÓ ÌÈÎÚÔ‚›ˆÓ, fiÙ·Ó ¯ÔÚËÁÔ‡ÓÙ·È ÚÔÁÂÓÓËÙÈο, ÂÏ·ÙÙÒÓÔ˘Ó ÛËÌ·ÓÙÈο ÙÔÓ Î›Ó‰˘ÓÔ Ù˘ ¡∂∫. ∏ Û‡Á¯ÚÔÓË ¯ÔÚ‹ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ Ì·˙› Ì ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹ Û ÚÒÈÌË Ú‹ÍË ı˘Ï·Î›Ô˘ ÂÏ·ÙÙÒÓÂÈ Ù· ÂÂÈÛfi‰È· ¡∂∫ (47). ∆Ô ¡O, fiˆ˜ ·Ó·Ê¤ÚıËÎÂ, Â›Ó·È ÛËÌ·ÓÙÈÎfi˜ Ú˘ıÌÈÛÙ‹˜ ÙÔ˘ ·ÁÁÂÈ·ÎÔ‡ ÙfiÓÔ˘ Ù˘ ·Ó·Ù˘ÛÛfiÌÂÓ˘ ΢ÎÏÔÊÔÚ›·˜ ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ ۈϋӷ. ∂Ó‰ÔıËÏȷ΋ ·Ú·ÁˆÁ‹ ÙÔ˘ ¡O Û ηÓÔÓÈΤ˜ Ô-

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ÛfiÙËÙ˜ ‰È·ÙËÚ› ÂÏ·Ùو̤ÓË ÙËÓ ·ÁÁÂȷ΋ ·ÓÙ›ÛÙ·ÛË ÛÙÔ ÓÂÔÁÓÈÎfi Á·ÛÙÚÂÓÙÂÚÈÎfi ۈϋӷ. ∞˘Ù‹ Ë ·Ú·ÁˆÁ‹ ÙÔ˘ ¡O ÚÔÛٷهÂÈ ÙÔÓ ÂÓÙÂÚÈÎfi ‚ÏÂÓÓÔÁfiÓÔ ·fi ˘ÔÍÈΤ˜-ÈÛ¯·ÈÌÈΤ˜ ‚Ï¿‚˜ Î·È ÚÒÈÌÔ ÂÓ‰ÔÙÔÍÈÎfi shock. ∞ÓÙ›ıÂÙ·, fï˜, ÌÂÁ¿ÏË ·Ú·ÁˆÁ‹ ÙÔ˘ ¡O ·fi ÌÂÁ¿ÏË ‰Ú·ÛÙÈÎfiÙËÙ· Ù˘ Û˘ÓıÂÙ¿Û˘ ÙÔ˘ ¡O (INOS), Ô˘ ·Ú·ÙËÚÂ›Ù·È Û ÚÔ¯ˆÚË̤ӷ ÛÙ¿‰È· ÊÏÂÁÌÔÓ‹˜, ÌÔÚ› Ó· ÚÔηϤÛÂÈ ÙÔÍÈο Â›‰· ¡O. °È’ ·˘Ùfi ¤¯ÂÈ ˘ÔÙÂı› fiÙÈ ÂȉÈÎÔ› ·Ó·ÛÙÔÏ›˜ Ù˘ π¡O™ ÌÔÚ› Ó· ÂÏ·ÙÙÒÛÔ˘Ó ÙË ‚·Ú‡ÙËÙ· Ù˘ ÂÓÙÂÚÈ΋˜ ‚Ï¿‚˘ ÛÙË ¡∂∫ (3,55). ∆· ÚÔ‚ÈÔÙÈο ·ÔÙÂÏÔ‡ÓÙ·È ·fi ·Ó·ÂÚfi‚È· ÌÈÎÚfi‚È· Ô˘ ·ÔÙÂÏÔ‡Ó Ì¤ÚÔ˜ Ù˘ Ê˘ÛÈÔÏÔÁÈ΋˜ ¯ÏˆÚ›‰·˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘ Î·È ÂÚȤ¯Ô˘Ó ΢ڛˆ˜ bifidobacterium infantis (bifido) Î·È Lactobacillus acidophilus. OÈ ÂȉÈÎÔ› Ì˯·ÓÈÛÌÔ› ÙˆÓ ÚÔ‚ÈÔÙÈÎÒÓ ÛÙËÓ ÚÔÛÙ·Û›· ·fi ÙË ¡∂∫ ‰ÂÓ ¤¯Ô˘Ó ÍÂηı·ÚÈÛÙ› Ï‹Úˆ˜. ∆· ÚÔ‚ÈÔÙÈο ÌÔÚÔ‡Ó Ó· ÌÂÙ·‚¿ÏÔ˘Ó ÙÔ˘˜ Ì˯·ÓÈÛÌÔ‡˜ Ù˘ ÂÓÙÂÚÈ΋˜ ÊÏÂÁÌÔÓ‹˜, fiˆ˜ ÙÔÓ ·ÔÈÎÈÛÌfi ·fi ·ıÔÁfiÓ· ÌÈÎÚfi‚È·, ÙËÓ ·Ú·ÁˆÁ‹ ÊÏÂÁÌÔÓˆ‰ÒÓ ÌÂÛÔÏ·‚ËÙÈÎÒÓ Û˘ÛÙ·ÙÈÎÒÓ, ÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÙÔ˘ ·ÓÔÛÔÏÔÁÈÎÔ‡ Ì˯·ÓÈÛÌÔ‡ ÙÔ˘ ÂÓÙ¤ÚÔ˘ Î·È ÙËÓ ÂÓ›Û¯˘ÛË ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ÊÚ·ÁÌÔ‡. O ÂȉÈÎfi˜ ¢ÂÚÁÂÙÈÎfi˜ ÚfiÏÔ˜ ·˘ÙÒÓ ÙˆÓ ÌÈÎÚÔ‚›ˆÓ Û˘Ó›ÛÙ·Ù·È ÛÙËÓ ·Ó·ÛÙÔÏ‹ ·Ó¿Ù˘Í˘ ·ÂÚfi‚ÈˆÓ ·ıÔÁfiÓˆÓ ÌÈÎÚÔ‚›ˆÓ Î·È ÚÔÛÎfiÏÏËÛ˘ ·˘ÙÒÓ ÛÙÔÓ ÂÓÙÂÚÈÎfi ‚ÏÂÓÓÔÁfiÓÔ. ∞˘Ùfi ÂÈÙ˘Á¯¿ÓÂÙ·È Ì ÙËÓ ·Ú·ÁˆÁ‹ ÙÔÍÈÎÒÓ Ô˘ÛÈÒÓ, fiˆ˜ ÌÂı·ÓfiÏ˘, ·ÎÂÙfiÓ˘ Î·È ÔͤˆÓ, fiˆ˜ ÔÍÂ˚ÎÔ‡ Î·È Á·Ï·ÎÙÈÎÔ‡, Ô˘ Ô‰ËÁÔ‡Ó ÛÙËÓ ÂÏ¿ÙÙˆÛË ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ pH (35,45,50,56). ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ˘¿Ú¯Ô˘Ó ·ÚÎÂÙ¤˜ ÌÂϤÙ˜ Û ÂÈÚ·Ì·Ùfi˙ˆ· Ô˘ ‰Â›¯ÓÔ˘Ó ÙÔÓ Â˘ÂÚÁÂÙÈÎfi ÚfiÏÔ ÙˆÓ ÚÔ‚ÈÔÙÈÎÒÓ ÛÙË ¡∂∫. ™ÙȘ ÌÂϤÙ˜ ·˘Ù¤˜ ‚Ú¤ıËΠfiÙÈ Ù· ÚÔ‚ÈÔÙÈο ÂÏ·ÙÙÒÓÔ˘Ó ÙËÓ ÂÓ‰ÔÙÔÍÈÓ·ÈÌ›·, ÙË ‰È·ÂÚ·ÙfiÙËÙ· ÙÔ˘ ‚ÏÂÓÓÔÁfiÓÔ˘ Î·È ·˘Í¿ÓÔ˘Ó ÙË ÊˆÛÊÔÏÈ¿ÛË ∞2 ππ Ô˘ Û˘Ì‚¿ÏÏÂÈ ÛÙË Û‡ÓıÂÛË ÙÔ˘ PAF. ∆· ÚÔ‚ÈÔÙÈο ¤¯Ô˘Ó ¯ÔÚËÁËı› ÚÔÏËÙÈο Î·È Û ÓÂÔÁÓ¿, ·ÏÏ¿ ÔÈ ˘¿Ú¯Ô˘Û˜ ÙÂÎÌËÚȈ̤Ó˜ ÂÚÁ·Û›Â˜ Â›Ó·È Ï›Á˜. OÈ ÂÚÁ·Û›Â˜ ·˘Ù¤˜, ·ÚfiÙÈ Â›Ó·È Ï›Á˜, ‰Â›¯ÓÔ˘Ó fiÙÈ Ù· ÚÔ‚ÈÔÙÈο ÂÏ·ÙÙÒÓÔ˘Ó ÙË Û˘¯ÓfiÙËÙ· Ù˘ ¡∂∫, ηıÒ˜ Î·È ÙË ıÓËÙfiÙËÙ· ·fi ·˘Ù‹Ó (35,57).

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ORIGINAL ARTICLE

¶Ó¢ÌÔÓÈÔÎÔÎÎÈ΋ ÌËÓÈÁÁ›Ùȉ· ÛÙËÓ ·È‰È΋ ËÏÈΛ·. ¶·Ú·ÙËÚ‹ÛÂȘ ÂÚÈfi‰Ô˘ 30 ÂÙÒÓ π. ∫·‚·ÏÈÒÙ˘, ∞. ¡¿ÓÔ˘, ™. ¶ÂÙÚ›‰Ô˘

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

¶ÂÚ›ÏË„Ë: O Streptococcus pneumoniae (PN) Â›Ó·È Ì›˙ÔÓ ·›ÙÈÔ ÌÈÎÚԂȷ΋˜ ÌËÓÈÁÁ›Ùȉ·˜ ÛÙ· ·È‰È¿ ÚÔηÏÒÓÙ·˜ ‰˘ÓËÙÈο ı·Ó·ÙËÊfiÚÔ Ïԛ̈ÍË Ì ˘„ËÏfi ÔÛÔÛÙfi Ó¢ÚÔÏÔÁÈÎÒÓ ˘ÔÏÂÈÌÌ¿ÙˆÓ. ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ·˘Ù‹˜ ‹Ù·Ó Ë ÂÎÙ›ÌËÛË ÙˆÓ ÎÏÈÓÈÎÔ-ÂȉËÌÈÔÏÔÁÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ Ù˘ Ó¢ÌÔÓÈÔÎÔÎÎÈ΋˜ ÌËÓÈÁÁ›Ùȉ·˜ ÛÙËÓ ·È‰È΋ ËÏÈΛ·. ªÂÏÂÙ‹ıËÎ·Ó 116 ÂÚÈÙÒÛÂȘ Ó¢ÌÔÓÈÔÎÔÎÎÈ΋˜ ÌËÓÈÁÁ›Ùȉ·˜ Ô˘ ÓÔÛËχÙËÎ·Ó ÛÙËÓ ÎÏÈÓÈ΋ ÙË ¯ÚÔÓÈ΋ ÂÚ›Ô‰Ô 1970-1999 (30 ¤ÙË). ∏ ËÏÈΛ· ÙˆÓ ·ÛıÂÓÒÓ Î˘Ì·ÈÓfiÙ·Ó ·fi ÙÔÓ 1 Ì‹Ó· ¤ˆ˜ Ù· 14 ¤ÙË (‰È¿ÌÂÛË ËÏÈΛ· 12 Ì‹Ó˜). ¶·Ú·ÙËÚ‹ıËΠ˘ÂÚÔ¯‹ ÙˆÓ ·ÁÔÚÈÒÓ (80/116, 69%). ™Â 45/116 ·È‰È¿ ‰È·ÈÛÙÒıËÎÂ Ë ‡·ÚÍË Î¿ÔÈ·˜ ˘ÔΛÌÂÓ˘ ηٿÛÙ·Û˘. ™Â 21 ÂÚÈÙÒÛÂȘ Û˘Ó˘‹Ú¯Â ˘ÔΛÌÂÓÔ ÓfiÛËÌ· (ÎÚ·ÓÈÔÂÁÎÂÊ·ÏÈ΋ οΈÛË, ÛÏËÓÂÎÙÔÌ‹, Û˘ÁÁÂÓ‹˜ ηډÈÔ¿ıÂÈ·, ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ·, ÂÈÏË„›·), ÂÓÒ Û 24 ·ÛıÂÓ›˜ ·Ú·ÙËÚ‹ıËΠÔÍ›· Ïԛ̈ÍË Ï›ÁÔ ÚÈÓ ÙËÓ ¤Ó·ÚÍË Ù˘ ÌËÓÈÁÁ›Ùȉ·˜. ∂ÈÏÔΤ˜ ·Ú·ÙËÚ‹ıËÎ·Ó Û ÌÂÁ¿ÏÔ ·ÚÈıÌfi ·ÛıÂÓÒÓ: Û·ÛÌÔ›, ΢ڛˆ˜ ÙÔÓÈÎÔÎÏÔÓÈÎÔ›, Û 40 ·ÛıÂÓ›˜ (35%), ‰È·Ù·Ú·¯¤˜ Û˘Ó›‰ËÛ˘ Û 61 (53%), Ó¢ÚÔÏÔÁÈΤ˜ ‰È·Ù·Ú·¯¤˜ Û 25 (22%) Î·È ·Ó·Ó¢ÛÙÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Û 14 (12%). ¢¤Î· ÙÚÂȘ ·ÛıÂÓ›˜ ·‚›ˆÛ·Ó (11,2%). ÀÔÏÂÈÌÌ·ÙÈΤ˜ ‚Ï¿‚˜, fiˆ˜ ÎÒʈÛË, ÂÈÏË„›·, ÎÈÓËÙÈΤ˜ Î·È Ó¢ÚÔÏÔÁÈΤ˜ ‰È·Ù·Ú·¯¤˜ Î·È ‰È·ÓÔËÙÈ΋ ηı˘ÛÙ¤ÚËÛË, ·Ú·ÙËÚ‹ıËÎ·Ó Û 32 ·ÛıÂÓ›˜ (31%) ηٿ ÙËÓ ¤ÍÔ‰fi ÙÔ˘˜ ·fi ÙËÓ ÎÏÈÓÈ΋. ™‡ÁÎÚÈÛË ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ·‚›ˆÛ·Ó Ì ̛· ÔÌ¿‰· ·È‰ÈÒÓ ·Ó¿ÏÔÁ˘ ËÏÈΛ·˜ Î·È Ê‡ÏÔ˘ Ô˘ ıÂÚ·‡ÙËηÓ, ¤‰ÂÈÍ fiÙÈ Ë ıÓËÙfiÙËÙ· ‹Ù·Ó ˘„ËÏfiÙÂÚË Û ·ÛıÂÓ›˜ Ì ÂÈÏÔΤ˜, ‰È·Ù·Ú·¯¤˜ Û˘Ó›‰ËÛ˘, ·Ó·Ó¢ÛÙÈΤ˜ ‰È·Ù·Ú·¯¤˜, ˘„ËÏfi χΈ̷ ÛÙÔ ∂¡À Î·È ¯·ÌËÏfi ۿί·ÚÔ ÛÙÔ ∂¡À.

Abstract: Streptococcus pneumoniae is a major bacterial meningitis pathogen in children. It still remains a significant cause of lethal meningitis.

The aim of this study was to evaluate the clinical and epidemiological characteristics of children with pneumococcal meningitis. The study group consisted of 116 patients with pneumococcal meningitis who were admitted to our department during a period of 30 years (1970-1999). Patients’ age ranged from 1 month to 14 years (median: 12 months). There was a male preponderance (69%).

In 45/116 (39%) patients an underlying condition was found. Twenty one had an underlying disease (head injury, splenectomy, renal disease, epilepsy, congenital heart disease) and twenty four had a preceding acute infection shortly before meningitis. Complications occurred in a large percentage of patients: seizures, mainly generalized tonicclonic, in 40 patients (35%); consciousness disorders in 61 (53%); neurological dysfunction in 25 (22%); systemic manifestations in 5 (4%) and respiratory dysfunction in 14 (12%). 18% of the patients (21/116) presented with seizures during the first 3 days of the disease. Thirteen patients died (11.2%). Sequelae, including hearing loss, epilepsy, motor defects, neurological deficits and mental retardation, were present on discharge in 32 patients (31%). Comparison of the patients who died with a group of children matched for age and sex that recovered, showed that lethal outcome was observed more frequently in patients with complications, consciousness disorders, respiratory disturbances, high CSF protein and low CSF glucose. Despite early diagnosis and appro-priate therapy, pneumococcal meningitis is

¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋, ¡ÔÛÔÎÔÌÂ›Ô ∂ȉÈÎÒÓ ¶·ı‹ÛˆÓ, £ÂÛÛ·ÏÔÓ›ÎË

Department of Paediatrics, Infectious Diseases Hospital, Thessaloniki

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¶·Ú¿ ÙË ‰˘Ó·ÙfiÙËÙ· ¤ÁηÈÚ˘ ‰È¿ÁÓˆÛ˘ Î·È Î·Ù¿ÏÏËÏ˘ ıÂÚ·¢ÙÈ΋˜ ·ÁˆÁ‹˜, Ë Ó¢ÌÔÓÈÔÎÔÎÈÎ΋ ÌËÓÈÁÁ›Ùȉ· ÂÍ·ÎÔÏÔ˘ı› Ó· Û¯ÂÙ›˙ÂÙ·È Ì η΋ ÚfiÁÓˆÛË, ˘ÔÏÂÈÌÌ·ÙÈΤ˜ ‚Ï¿‚˜ Î·È ˘„ËÏfi ÔÛÔÛÙfi ıÓËÙfiÙËÙ·˜.

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

§¤ÍÂȘ ÎÏÂȉȿ: Ó¢ÌÔÓÈfiÎÔÎÎÔ˜, ÌËÓÈÁÁ›Ùȉ·, ÌÈÎÚԂȷΤ˜ ÏÔÈÌÒÍÂȘ, ·È‰È¿.

Key words: pneumococcus, meningitis, bacterial infections, children.

∂ÈÛ·ÁˆÁ‹ O Streptococcus pneumoniae ·ÔÙÂÏ› Ì›· ·fi ÙȘ ·ÚȘ ·Èٛ˜ ÛÔ‚·ÚÒÓ ÏÔÈÌÒÍÂˆÓ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ ‰ÈÂıÓÒ˜ Î·È Ì›˙ÔÓ ·›ÙÈÔ Ù˘ ÌÈÎÚԂȷ΋˜ ÌËÓÈÁÁ›Ùȉ·˜ Ì ˘„ËÏfi ÔÛÔÛÙfi ıÓËÙfiÙËÙ·˜ Î·È Ó¢ÚÔÏÔÁÈÎÒÓ ˘ÔÏÂÈÌÌ¿ÙˆÓ. O ÂÚÈÔÚÈÛÌfi˜ Ì¿ÏÈÛÙ· ÙÔ˘ Haemophilus influenzae type b (Hib) ˆ˜ ·ÈÙ›Ô˘ Ù˘ ÌËÓÈÁÁ›Ùȉ·˜ ·‡ÍËÛ ηٿ Ôχ ÙË Û˘ÌÌÂÙÔ¯‹ ÙÔ˘ S. pneumoniae ÛÙË ‚·ÚÈ¿ ·˘Ù‹ Ïԛ̈ÍË Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ (1). ∏ ·ÓÙÔ¯‹, Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, ÙˆÓ ÛÙÂϯÒÓ ÙÔ˘ Ó¢ÌÔÓÈÔÎfiÎÎÔ˘ ÛÙ· ·ÓÙÈ‚ÈÔÙÈο ·ÔÙÂÏ›, Â›Û˘, ¤Ó· ÛËÌ·ÓÙÈÎfi Úfi‚ÏËÌ· Ô˘ ·ÊÔÚ¿ Î·È ÛÙË ıÂÚ·›· Ù˘ ÌÈÎÚԂȷ΋˜ ÌËÓÈÁÁ›Ùȉ·˜ (2). ŒÙÛÈ, Ë ÁÓÒÛË Ù˘ ÂȉËÌÈÔÏÔÁ›·˜ Ù˘ Ó¢ÌÔÓÈÔÎÔÎÎÈ΋˜ ÌËÓÈÁÁ›Ùȉ·˜ Â›Ó·È ¿ÓÙ· ¯Ú‹ÛÈÌË. ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ·˘Ù‹˜ ‹Ù·Ó Ë ÂÎÙ›ÌËÛË ÙˆÓ ÂȉËÌÈÔÏÔÁÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ, ÙˆÓ ÎÏÈÓÈÎÒÓ ÛÙÔȯ›ˆÓ Î·È ÙˆÓ ÚÔÁÓˆÛÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ Ù˘ Ó¢ÌÔÓÈÔÎÔÎÎÈ΋˜ ÌËÓÈÁÁ›Ùȉ·˜ Û ·È‰È¿ Ù˘ µ. ∂ÏÏ¿‰Ô˜ Ì ‚¿ÛË Ù· ÛÙÔȯ›· Ù˘ ÎÏÈÓÈ΋˜ Ì·˜.

∏ ·ÈÌÔηÏÏȤÚÁÂÈ· ‹Ù·Ó ıÂÙÈ΋ ÛÙÔ 10,3% ÙˆÓ ÂÚÈÙÒÛˆÓ, ÂÓÒ Ô Ó¢ÌÔÓÈfiÎÔÎÎÔ˜ ·ÔÌÔÓÒıËΠ·fi ÙËÓ Î·ÏÏȤÚÁÂÈ· ∂¡À ÛÙÔ 90% ÙˆÓ ÂÚÈÙÒÛÂˆÓ (¶›Ó·Î·˜ 1). ∫·Ó¤Ó· ·È‰› ‰ÂÓ Â›¯Â Ï¿‚ÂÈ ÔÔÈÔ‰‹ÔÙ ·ÓÙÈÓ¢ÌÔÓÈÔÎÔÎÎÈÎfi ÂÌ‚fiÏÈÔ ÚÈÓ ÓÔÛ‹ÛÂÈ. °È· ÙËÓ ÂÎÙ›ÌËÛË ‰È·ÊfiÚˆÓ ÛÙÔȯ›ˆÓ, fiÔ˘ Î·È ·Ó ¯ÚÂÈ¿ÛÙËΠÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË, ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÔÈ Ì¤ıÔ‰ÔÈ x-ÙÂÙÚ¿ÁˆÓÔ Î·È t-students test.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ∏ ÌÂϤÙË ·ÊÔÚ¿ ÙË µ. ∂ÏÏ¿‰· Ì ÏËı˘ÛÌfi ÂÚ›Ô˘ 3.000.000 (1/3 ÂÚ›Ô˘ ÙÔ˘ Û˘ÓÔÏÈÎÔ‡ ÏËı˘ÛÌÔ‡ Ù˘ ¯ÒÚ·˜). ∆Ô ¡ÔÛÔÎÔÌÂ›Ô ∂ȉÈÎÒÓ ¶·ı‹ÛÂˆÓ Â›Ó·È ÙÔ Î‡ÚÈÔ Î¤ÓÙÚÔ ·Ó·ÊÔÚ¿˜ ÁÈ· ÌÈÎÚԂȷ΋ ÌËÓÈÁÁ›Ùȉ· ÛÙË µ. ∂ÏÏ¿‰·. ∂Ï¿¯ÈÛÙ· ÂÚÈÛÙ·ÙÈο Ó¢ÌÔÓÈÔÎÔÎÎÈ΋˜ ÌËÓÈÁÁ›Ùȉ·˜ Ô˘ ÓÔÛËχıËηÓ, Ù· ÙÂÏÂ˘Ù·›· ΢ڛˆ˜ ¯ÚfiÓÈ·, Û ¿ÏÏ· ÓÔÛÔÎÔÌ›· Ù˘ £ÂÛÛ·ÏÔӛ΢ ÈÛÙ‡ԢÌ fiÙÈ ‰ÂÓ ·ÏÏÔÈÒÓÔ˘Ó ÙË Û˘ÓÔÏÈ΋ ÂÈÎfiÓ· ÙÔ˘ ÓÔÛ‹Ì·ÙÔ˜. ∆Ô ˘ÏÈÎfi Ù˘ ÌÂϤÙ˘ ·ÔÙ¤ÏÂÛ·Ó ·È‰È¿ Ì ÂÚÁ·ÛÙËÚȷο ÙÂÎÌËÚȈ̤ÓË Ó¢ÌÔÓÈÔÎÔÎÎÈ΋ ÌËÓÈÁÁ›Ùȉ· Ô˘ ÓÔÛËχıËÎ·Ó ÛÙËÓ ÎÏÈÓÈ΋ ÙËÓ ÂÚ›Ô‰Ô 1970-1999. ∞Ó·ÛÎÔ‹ıËÎ·Ó ÔÈ Ê¿ÎÂÏÔÈ ÓÔÛËÏ›·˜ ÙˆÓ ·ÛıÂÓÒÓ Î·È ÂÍ‹¯ıËÛ·Ó ÛÙÔȯ›· Ô˘ ·ÊÔÚÔ‡Û·Ó ‰ËÌÔÁÚ·ÊÈο, ÎÏÈÓÈο Î·È ÂÚÁ·ÛÙËÚȷο ‰Â‰Ô̤ӷ, Ì ‚¿ÛË ÂȉÈÎfi Î·È Û˘ÁÎÂÎÚÈ̤ÓÔ ‰ÂÏÙ›Ô Î·Ù·ÁÚ·Ê‹˜ ÛÙÔȯ›ˆÓ. ∫ÚÈÙ‹ÚÈ· ÂÈÛ·ÁˆÁ‹˜ ÛÙË ÌÂϤÙË ‹Ù·Ó: ·) ÛËÌ›· Î·È Û˘ÌÙÒÌ·Ù· ÌËÓÈÁÁ›Ùȉ·˜, ‚) ÂÚÁ·ÛÙËÚȷΤ˜ ÂӉ›ÍÂȘ ·fi ÙÔ ∂¡À Û˘Ì‚·Ù¤˜ Ì ÌÈÎÚԂȷ΋ ÌËÓÈÁÁ›Ùȉ· (Ï¢ÎÔ·ÙÙ·Ú· >20/mm3, Ô˘‰ÂÙÂÚÔÊÈÏ›·, ·˘ÍË̤ÓË ÚˆÙ½ÓË, ÂÏ·Ùو̤ÓË ÁÏ˘Îfi˙Ë) Î·È Á) ·ÔÌfiÓˆÛË ÙÔ˘ S. pneumoniae ·fi ηÏÏȤÚÁÂÈ· ∂¡À ‹/Î·È ·›Ì·ÙÔ˜ ‹ Î·È ·Ó›¯ÓÂ˘Û‹ ÙÔ˘ Ì ÙÔ slidex test.

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∞ÔÙÂϤÛÌ·Ù· ∏ÏÈΛ· Î·È Ê‡ÏÔ: ∆ËÓ ÂÚ›Ô‰Ô 1/1/197031/12/1999 ÓÔÛËχıËÎ·Ó ÛÙËÓ ∫ÏÈÓÈ΋ 116 ÂÚÈÙÒÛÂȘ Ó¢ÌÔÓÈÔÎÔÎÎÈ΋˜ ÌËÓÈÁÁ›Ùȉ·˜. ∏ ‰È¿ÌÂÛË ËÏÈΛ· ÙˆÓ ·ÛıÂÓÒÓ ‹Ù·Ó 12 Ì‹Ó˜ (‡ÚÔ˜: 1 Ì‹Ó·˜ ¤ˆ˜ 14 ¯ÚfiÓÈ·). OÈ 80 ‹Ù·Ó ·ÁfiÚÈ· (69%). ∏ ËÏÈÎȷ΋ ηٷÓÔÌ‹ ¤‰ÂÈÍ ÌÂÁ·Ï‡ÙÂÚË Û˘¯ÓfiÙËÙ· Ù˘ ÓfiÛÔ˘ Û ËÏÈ˘ <2 ¯ÚfiÓˆÓ (∂ÈÎfiÓ· 1). ∂Ù‹ÛÈ· Î·È Âԯȷ΋ ηٷÓÔÌ‹: ∏ ÂÙ‹ÛÈ· ηٷÓÔÌ‹ Ù˘ ÓfiÛÔ˘ ¤‰ÂÈÍ ̛· ÂÚ›Ô˘ ÛÙ·ıÂÚ‹ ÔÚ›·, ÂÓÒ ˘‹ÚÍ·Ó Î¿ÔȘ ÂÚ›Ô‰ÔÈ Ì ·˘ÍË̤ÓÔ ·ÚÈıÌfi ÎÚÔ˘ÛÌ¿ÙˆÓ (∂ÈÎfiÓ· 2). ∏ Ù˘È΋ Âԯȷ΋ ηٷÓÔÌ‹ ÙˆÓ ÂÚÈÙÒÛÂˆÓ Ó¢ÌÔÓÈÔÎÔÎÎÈ΋˜ ÌËÓÈÁÁ›Ùȉ·˜ ·Ú·ÙËÚ‹ıËÎÂ Î·È ÛÙÔ ˘ÏÈÎfi Ì·˜. ∆Ô 72% (84/116) ÙˆÓ ÂÈÛ·ÁˆÁÒÓ ¤ÁÈÓ ·fi ÙÔÓ OÎÙÒ‚ÚÈÔ ¤ˆ˜ Î·È ÙÔÓ ∞Ú›ÏÈÔ (∂ÈÎfiÓ· 3). ∂›ÙˆÛË Ù˘ ÓfiÛÔ˘: ∏ ̤ÛË ÂÙ‹ÛÈ· Â›ÙˆÛË Ù˘ Ó¢ÌÔÓÈÔÎÔÎÎÈ΋˜ ÌËÓÈÁÁ›Ùȉ·˜ ÛÙË £ÂÛÛ·ÏÔÓ›ÎË ÂÎÙÈÌ‹ıËΠÛÙÔ 0,48/100.000 ÏËı˘ÛÌÔ‡ (¶›Ó·Î·˜ 2). ÀÔΛÌÂÓ˜ ηٷÛÙ¿ÛÂȘ: ™Â 45 ·fi ÙÔ˘˜ 116 ·ÛıÂÓ›˜ (39%) ‰È·ÈÛÙÒıËÎÂ Ë ‡·ÚÍË ˘ÔΛÌÂÓˆÓ ‹ Û˘Ó˘·Ú¯Ô˘ÛÒÓ Î·Ù·ÛÙ¿ÛÂˆÓ Ô˘ ÌÔÚ› Ó· Û˘Ó¤‚·Ï·Ó ÛÙËÓ ÂÌÊ¿ÓÈÛË Ù˘ ÌËÓÈÁÁ›Ùȉ·˜. ∂›ÎÔÛÈ ¤Ó·˜ (18%) ·ÛıÂÓ›˜ ›¯·Ó ˘ÔΛÌÂÓÔ ÓfiÛËÌ·: ÎÚ·Óȷ΋ οΈÛË (8, 38%), ¯ÚfiÓÈ· ̤ÛË ¶›Ó·Î·˜ 1. £¤ÛË ·ÔÌfiÓˆÛ˘ S. pneumoniae Û 116 ·ÛıÂÓ›˜ Ì ÌËÓÈÁÁ›Ùȉ· ∞ÚÈıÌfi˜ ·ÛıÂÓÒÓ 6 6 43 21 40

∫·ÏÏȤÚÁÂÈ· ∂¡À

∫·ÏÏȤÚÁÂÈ· ·›Ì·ÙÔ˜

Slidex test

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∂ÈÎfiÓ· 1. ∏ÏÈÎȷ΋ ηٷÓÔÌ‹ Û 116 ·ÛıÂÓ›˜ Ì Ó¢ÌÔÓÈÔÎÔÎÎÈ΋ ÌËÓÈÁÁ›Ùȉ· (1970-1999).

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98

ŒÙË ∂ÈÎfiÓ· 2. ∂Ù‹ÛÈ· ηٷÓÔÌ‹ Û 116 ·ÛıÂÓ›˜ Ì Ó¢ÌÔÓÈÔÎÔÎÎÈ΋ ÌËÓÈÁÁ›Ùȉ· (1970-1999).

ˆÙ›Ùȉ· (6, 28%), ÛÏËÓÂÎÙÔÌ‹ (3, 14%), Û˘ÁÁÂÓ‹ ηډÈÔ¿ıÂÈ· (2, 9%), ÓÂÊÚÔ¿ıÂÈ· (1, 5%), ÂÈÏË„›· (1, 5%). ∂›ÎÔÛÈ Ù¤ÛÛÂÚȘ ·ÛıÂÓ›˜ (21%) ·ÚÔ˘Û›·Û·Ó οÔÈ· ÔÍ›· Ïԛ̈ÍË ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡, Ï›ÁÔ ÚÈÓ ÙËÓ ÂΉ‹ÏˆÛË Ù˘ ÌËÓÈÁÁ›Ùȉ·˜. ¢¤Î· ·fi ÙÔ˘˜ ·ÛıÂÓ›˜ (42%) ›¯·Ó ÔÍ›· ̤ÛË ˆÙ›Ùȉ·, Ë ÔÔ›· ‰È·ÁÓÒÛıËΠÚÈÓ ‹ ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ·ÛıÂÓÔ‡˜ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô Î·È ÙË ‰È¿ÁÓˆÛË Ù˘ ÌËÓÈÁÁ›Ùȉ·˜. ŒÍÈ ·fi ·˘ÙÔ‡˜ ÙÔ˘˜ ·ÛıÂÓ›˜ ›¯·Ó Ï¿‚ÂÈ ·ÓÙÈ‚›ˆÛË ÚÈÓ ÙËÓ ÂÈÛ·ÁˆÁ‹. ŒÓ·˜ ·‚›ˆÛÂ, ¤Ó·˜ ‰È·ÎÔÌ›ÛÙËΠ۠ÌÔÓ¿‰· ÂÓÙ·ÙÈ΋˜ ÓÔÛËÏ›·˜ Î·È ¤Ó·˜ Û ˆÙÔÚÈÓÔÏ·Ú˘ÁÁÔÏÔÁÈ΋ ÎÏÈÓÈ΋ (ÌÂÙ¿ ÙË ıÂÚ·›· Ù˘ ÌËÓÈÁÁ›Ùȉ·˜ Î·È ÁÈ· ¯ÂÈÚÔ˘ÚÁÈ΋ ·ÓÙÈÌÂÙÒÈÛË ‰˘ÛÏ·Û›·˜ Ù˘ Ì·ÛÙÔÂȉԇ˜ ·fiÊ˘Û˘). ™Â 14/24 ·ÛıÂÓ›˜ (58%) ›¯Â ÚÔËÁËı› Ù˘ ÌËÓÈÁÁ›Ùȉ·˜ Ïԛ̈ÍË ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, Û 7 ·fi ÙÔ˘˜ ÔÔ›Ô˘˜ ·ÊÔ-

ÚÔ‡Û ÙÔ Î·ÙÒÙÂÚÔ ·Ó·Ó¢ÛÙÈÎfi. ∞ÁˆÁ‹ ÚÈÓ ÙËÓ ÂÈÛ·ÁˆÁ‹: OÈ 36/116 ·ÛıÂÓ›˜ (31%) ›¯·Ó Ï¿‚ÂÈ ·ÓÙÈ‚›ˆÛË ·ÚÂÓÙÂÚÈÎÒ˜ ÙÔ ÚÔËÁÔ‡ÌÂÓÔ 24ˆÚÔ ·fi ÙËÓ ÂÈÛ·ÁˆÁ‹. ∏ ·ÁˆÁ‹ ·ÊÔÚÔ‡Û ·ÌÈÎÈÏÏ›ÓË (22, 61%) ‹ ÎÂÊÙÚÈ·ÍfiÓË (12, 33%) ‹ ÁÂÓÙ·Ì˘Î›ÓË (2, 5,5%). OÈ ·ÛıÂÓ›˜ ›¯·Ó ‰È·ÎÔÌÈÛÙ› ·fi ¿ÏÏ· ÓÔÛËÏ¢ÙÈο ȉڇ̷ٷ ‹ ΤÓÙÚ· ˘Á›·˜. ∆ÚÂȘ ·fi ÙÔ˘˜ ·ÛıÂÓ›˜ ·˘ÙÔ‡˜ ·‚›ˆÛ·Ó. ∫ÏÈÓÈο Â˘Ú‹Ì·Ù· ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹: ∏ ÎÏÈÓÈ΋ ηٿÛÙ·ÛË Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ¯·Ú·ÎÙËÚ›ÛÙËΠˆ˜ ÛÔ‚·Ú‹ (33, 28%), ̤ÙÚÈ· (57, 49%) ‹ ηϋ (26, 22%). ∆· Û˘¯ÓfiÙÂÚ· Â˘Ú‹Ì·Ù· ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ‹Ù·Ó: ˘ÚÂÙfi˜ (95, 82%), ¤ÌÂÙÔÈ (77, 66%), ÎÂÊ·Ï·ÏÁ›· (29, 25%) Î·È Û·ÛÌÔ› (21, 18%). ∏ ̤ÛË ıÂÚÌÔÎÚ·Û›· ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ‹Ù·Ó 38,2ÔC ± 1,08 (‡ÚÔ˜: 36-40,5ÔC). ¶ÔÚ›· ÓfiÛÔ˘: ∏ ‰È¿ÚÎÂÈ· ÓÔÛËÏ›·˜ Î˘Ì¿ÓıËΠ·fi 1 ¤ˆ˜ 15 Ë̤Ú˜ ÛÙÔ 55% Î·È 16 ¤ˆ˜ 23

243

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16 14 12 10 %

8 6 4 2 0 π·Ó.

ºÂ‚.

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∞Ú.

ª¿ÈÔ˜

πÔ‡Ó.

πÔ‡Ï.

∞‡Á.

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OÎÙ.

¡Ô¤Ì.

¢ÂÎ.

ª‹Ó˜ ∂ÈÎfiÓ· 3. ∂ԯȷ΋ ηٷÓÔÌ‹ Û 116 ·ÛıÂÓ›˜ Ì Ó¢ÌÔÓÈÔÎÔÎÎÈ΋ ÌËÓÈÁÁ›Ùȉ· (1970-1999). ¶›Ó·Î·˜ 2. ª¤ÛË ÂÙ‹ÛÈ· Û˘¯ÓfiÙËÙ· Ó¢ÌÔÓÈÔÎÔÎÎÈ΋˜ ÌËÓÈÁÁ›Ùȉ·˜ ÛÙË £ÂÛÛ·ÏÔÓ›ÎË (1970-1999) ŒÙË 1970-1979 1980-1989 1990-1999

¶ÏËı˘ÛÌfi˜ (̤ÛÔ˜)

∞ÚÈıÌfi˜ ·ÛıÂÓÒÓ

™˘¯ÓfiÙËÙ·

871.580 946.864 1.005.431

22 10 14

0,25 0,1 0,13

Ë̤Ú˜ ÛÙÔ 27% ÙˆÓ ÂÚÈÙÒÛˆÓ. ∏ ̤ÛË ‰È¿ÚÎÂÈ· ˘ÚÂÙÔ‡ ηٿ ÙË ÓÔÛËÏ›· ‹Ù·Ó 7 Ë̤Ú˜. ∂›ÎÔÛÈ ÙÚÂȘ ·ÛıÂÓ›˜ (20%) ·ÚÔ˘Û›·Û·Ó ·Ú·ÙÂÈÓfiÌÂÓÔ ˘ÚÂÙfi. ∂ÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù·: ∆· ·ÔÙÂϤÛÌ·Ù· ÂϤÁ¯Ô˘ ·›Ì·ÙÔ˜ Î·È ∂¡À ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹ Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 3. ¢Â‡ÙÂÚË ÔÛÊ˘ÔÓˆÙÈ·›· ·Ú·Î¤ÓÙËÛË ¤ÁÈÓ Û 102 ·ÛıÂÓ›˜ ÌÂÙ¿ ÙÔ ¤Ú·˜ Ù˘ ıÂÚ·›·˜. O ̤ÛÔ˜ ·ÚÈıÌfi˜ Ï¢ÎÔ΢ÙÙ¿ÚˆÓ ÛÙÔ ∂¡À ‹Ù·Ó 25,6 ± 4,5/mm3, Ë Ì¤ÛË ÙÈÌ‹ ÚˆÙ½Ó˘ 55,9 ± 60,2 mg% Î·È Ë Ì¤ÛË ÙÈÌ‹ ÁÏ˘Îfi˙˘ 53,8 ± 68,8 mg%. ∂ÈÏÔΤ˜: ∂ÈÏÔΤ˜ Î·È Ó¢ÚÔÏÔÁÈΤ˜ ÂΉËÏÒÛÂȘ ·Ú·ÙËÚ‹ıËÎ·Ó Û ÌÂÁ¿ÏÔ ·ÚÈıÌfi ·ÛıÂÓÒÓ (89/116, 77%) (¶›Ó·Î·˜ 4). ŒÍÈ ·ÛıÂÓ›˜ ·ÚÔ˘Û›·Û·Ó ‰È·Ù·Ú·¯¤˜ Û˘Ó›‰ËÛ˘ Ì ‰È¿ÚÎÂÈ· ·fi 1 ¤ˆ˜ 7 Ë̤Ú˜. ™·ÛÌÔ‡˜ ÂΉ‹ÏˆÛ ÙÔ 34% ÙˆÓ ·ÛıÂÓÒÓ. OÈ Û·ÛÌÔ› ‹Ù·Ó ΢ڛˆ˜ ÁÂÓÈÎÂ˘Ì¤ÓÔÈ ÙÔÓÈÎÔÎÏÔÓÈÎÔ›, ÔÏÈÁfiÏÂÙ˘ ‰È¿ÚÎÂÈ·˜. ™Â 9 ·ÛıÂÓ›˜ (22%) Ë ‰È¿ÚÎÂÈ· ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚË ·fi 30 min. ŒÓ·˜ ·ÛıÂÓ‹˜ ·ÚÔ˘Û›·Û ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ıÂÚ·›·˜ ·ÚÔ‰È΋ ¯ÔÏÔÏÈı›·ÛË. ∞ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜: ∞ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ¤ÁÈÓ Û 12 ·ÛıÂÓ›˜ Î·È ‹Ù·Ó ·ıÔÏÔÁÈ΋ ÛÙÔ˘˜ 11. ™Â 31 ·ÛıÂÓ›˜ ¯ÚÂÈ¿ÛÙËΠӷ Á›ÓÂÈ ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ·. ™ÙÔ˘˜ 18 ÙÔ ∏∂° ‹Ù·Ó ·ıÔÏÔÁÈÎfi.

244

£ÂÚ·›·: OÈ ·ÛıÂÓ›˜ ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó Ì ·ÓÙÈ‚ÈÔÙÈο Î·È Û˘Ìو̷ÙÈ΋ ·ÁˆÁ‹, Û‡Ìʈӷ Ì ٷ ÈÛ¯‡ÔÓÙ· ÚˆÙfiÎÔÏÏ· Ù˘ ÎÏÈÓÈ΋˜ Ì·˜. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ 30 ¯ÚfiÓˆÓ ˘‹ÚÍ·Ó 3 ıÂÚ·¢ÙÈο Û¯‹Ì·Ù·: ·ÌÈÎÈÏÏ›ÓË ‹ ÂÓÈÎÈÏÏ›ÓË, ·ÌÈÎÈÏÏ›ÓË Î·È ¯ÏˆÚ·ÌÊÂÓÈÎfiÏË Î·È, ÙÂÏÈο, ÎÂÊÙÚÈ·ÍfiÓË. ∏ ÎÂÊ·ÏÔÛÔÚ›ÓË ·ÓÙÈη٤ÛÙËÛ ÙÔ ÚÔËÁÔ‡ÌÂÓÔ ıÂÚ·¢ÙÈÎfi Û¯‹Ì· ηٿ Ù· Ù¤ÏË Ù˘ ‰ÂηÂÙ›·˜ ÙÔ˘ ’80. ŸÏ· Ù· ·ÔÌÔÓˆı¤ÓÙ· ÛÙÂϤ¯Ë ‹Ù·Ó ¢·›ÛıËÙ· ÛÙ· ·ÓÙÈ‚ÈÔÙÈο Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÁÈ· ÙË ıÂÚ·›· ÙˆÓ Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ·ÛıÂÓÒÓ. ÀÔÙÚÔ¤˜ ÌËÓÈÁÁ›Ùȉ·˜: ∂ÓÓ¤· ·fi ÙÔ˘˜ 116 ·ÛıÂÓ›˜ (8%) ›¯·Ó ÓÔÛ‹ÛÂÈ Î·È ·Ï·ÈfiÙÂÚ· ·fi ÌÈÎÚԂȷ΋ ÌËÓÈÁÁ›Ùȉ·, Ì›· ÊÔÚ¿ ÔÈ 8 Î·È ‰‡Ô ÊÔÚ¤˜ Ô ¤Ó·˜. ™Ù· Ù¤ÛÛÂÚ· ·fi Ù· ‰¤Î· ·˘Ù¿ ÂÂÈÛfi‰È· ›¯Â ·ÔÌÔÓˆı› Ó¢ÌÔÓÈfiÎÔÎÎÔ˜, ÂÓÒ ÛÙ· ˘fiÏÔÈ· Ë ÌÈÎÚԂȷ΋ ÌËÓÈÁÁ›Ùȉ· ‹Ù·Ó ¿ÁÓˆÛÙ˘ ·ÈÙÈÔÏÔÁ›·˜. ÀÔΛÌÂÓ˜ ηٷÛÙ¿ÛÂȘ ›¯·Ó ÔÈ 8 ·fi ÙÔ˘˜ 9 ·ÛıÂÓ›˜ (89%): ÛÏËÓÂÎÙÔÌ‹ (1), ¯ÚfiÓÈ· ̤ÛË ˆÙ›Ùȉ· Î·È ‰˘ÛÏ·Û›· ̤ÛÔ˘ ˆÙfi˜ (1), οٷÁÌ· ÎÚ·Ó›Ô˘ (4), ÂÈÏË„›· (1) Î·È ÎÚ·ÓÈÔÂÁÎÂÊ·ÏÈ΋ οΈÛË Ì ÂÁÎÂÊ·ÏÈ΋ ‰È¿ÛÂÈÛË (1). ∫·Ó¤Ó·˜ ·fi ÙÔ˘˜ 9 ·ÛıÂÓ›˜ ‰ÂÓ ·ÚÔ˘Û›·Û Û·ÛÌÔ‡˜ ηٿ ÙË ÓÔÛËÏ›·, ‰‡Ô ·ÚÔ˘Û›·Û·Ó ÎÒÌ· Î·È ‰‡Ô Û˘ÁÎÏ›ÓÔÓÙ· ÛÙÚ·‚ÈÛÌfi Î·È ËÌÈ·ÓÔ„›·. ŸÏÔÈ ÔÈ ·ÛıÂÓ›˜ ıÂÚ·‡ıËηÓ. ∫·Ù¿ ÙËÓ ¤ÍÔ‰Ô ·fi ÙËÓ ∫ÏÈÓÈ΋, Ó¢ÚÔÏÔÁÈο ˘ÔÏ›ÌÌ·Ù· ·ÚÔ˘Û›·˙·Ó 3 ·ÛıÂÓ›˜ (33%): ÚÈÓÈ΋ ËÌÈ·ÓÔ„›·, ÎÒʈÛË Î·È ‚·ÚËÎÔ˝·. ŒÎ‚·ÛË: ∫·Ù¿ ÙË Û˘ÓÔÏÈ΋ ¯ÚÔÓÈ΋ ‰È¿ÚÎÂÈ· Ù˘ ÌÂϤÙ˘ ·‚›ˆÛ·Ó 13 ·ÛıÂÓ›˜ (11,2%) (¶›Ó·Î·˜ 5). ∏ ̤ÛË ËÏÈΛ· ·˘ÙÒÓ ‹Ù·Ó 30,5 Ì‹Ó˜ (30 Ë̤Ú˜ ¤ˆ˜ 9 ¯ÚfiÓÈ·). OÈ ı¿Ó·ÙÔÈ Û˘Ó¤‚ËÛ·Ó ÓˆÚ›˜ ηٿ ÙËÓ ÔÚ›· Ù˘ ÓfiÛÔ˘, Ï›Á˜ Ë̤Ú˜

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¶›Ó·Î·˜ 3. ∂ÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· (·›Ì· Î·È ∂¡À) ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹, Û 116 ·ÛıÂÓ›˜ Ì Ó¢ÌÔÓÈÔÎÔÎÎÈ΋ ÌËÓÈÁÁ›Ùȉ· (1970-1999) % Hb (g/dl) <10 >10 §Â˘ÎÔ·ÙÙ·Ú· (/Ìl) <10000 >10000 ∆∫∂ (mm/h) <20 20-50 50-100 >100 ∫‡ÙÙ·Ú· ∂¡À (/mm3) <500 501-1000 1001-2000 >2000 °Ï˘Îfi˙Ë ∂¡À (mg%) <20 21-40 >40 ¶ÚˆÙ½ÓË ∂¡À (mg%) <100 101-200 >200

ñ ¢È·Ù·Ú·¯¤˜ Û˘Ó›‰ËÛ˘ ∫ÒÌ· ™˘Á¯˘ÙÈ΋ ηٿÛÙ·ÛË ÀÓËÏ›· ñ ™·ÛÌÔ› °ÂÓÈÎÂ˘Ì¤ÓÔÈ ÙÔÓÈÎÔÎÏÔÓÈÎÔ› ∂ÛÙÈ·ÎÔ› ñ ¡Â˘ÚÔÏÔÁÈΤ˜ ¶·Ú¿Ï˘ÛË ÎÚ·ÓÈ·ÎÒÓ Ó. ÀÔÛÎÏËÚ›‰È· Û˘ÏÏÔÁ‹ ∏ÌÈ¿ÚÂÛË À‰ÚÔΤʷÏÔ˜ ñ ∞Ó·Ó¢ÛÙÈΤ˜ ∞Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ· ∞Ó·ÓÔ‹ Cheyne-Stokes ÕÓÔÈ· ñ ™˘ÛÙËÌ·ÙÈΤ˜ Shock ¢∂¶

∂‡ÚÔ˜

10 ± 1,74

5,55-14,4

12370 ± 5917

1000-40000

81,7 ± 33,8

5-156

1650 ± 2772,4

5-25000

32 ± 20,5

0-108

230 ± 155,2

24-879

45 55 34 66 5 13 50 42 38 13 13 36 28 43 27 18 31 51

¶›Ó·Î·˜ 4. ∂ÈÏÔΤ˜ Û 116 ·ÛıÂÓ›˜ Ì Ó¢ÌÔÓÈÔÎÔÎÎÈ΋ ÌËÓÈÁÁ›Ùȉ· (1970-1999) ∂ÈÏÔΤ˜

ª¤ÛË ÙÈÌ‹ ± ™∞

™‡ÓÔÏÔ

∞ÚÈıÌfi˜ ·ÛıÂÓÒÓ

61

%

¶›Ó·Î·˜ 5. £ÓËÙfiÙËÙ· Î·È ˘ÔÏÂÈÌÌ·ÙÈΤ˜ ‚Ï¿‚˜ ηٿ ÙËÓ ¤ÍÔ‰Ô ·fi ÙÔ ÓÔÛÔÎÔÌÂ›Ô Û 116 ·ÛıÂÓ›˜ Ì Ó¢ÌÔÓÈÔÎÔÎÎÈ΋ ÌËÓÈÁÁ›Ùȉ· (1970-1999) ∞ÚÈıÌfi˜ ·ÛıÂÓÒÓ

53 20 12 29

40

34 31 9

25

21 12 7 4 2

14

∞ÛıÂÓ›˜ £¿Ó·ÙÔÈ ∂È˙ÒÓÙ˜ ÀÔÏ›ÌÌ·Ù· ηٿ ÙËÓ ¤ÍÔ‰Ô - ¡Â˘ÚÔÏÔÁÈο ˘ÔÏ›ÌÌ·Ù·: ΢ڛˆ˜ ·Ú¿Ï˘ÛË ÎÚ·ÓÈ·ÎÒÓ ÓÂ‡ÚˆÓ Î·È ˘ÔÛÎÏËÚ›‰È· Û˘ÏÏÔÁ‹ - ¢È·Ù·Ú·¯¤˜ ·ÎÔ‹˜ - ∂ÈÏË„›· - ∫ÈÓËÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ - ¢È·ÓÔËÙÈ΋ ηı˘ÛÙ¤ÚËÛË

116 13 103 32

15 6 2 2 3

% 11,2 31

47 19 6 6 9

12 2 4 8

5

4 2 3

ÌÂÙ¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙˆÓ ·ÛıÂÓÒÓ ÛÙÔ ÓÔÛÔÎÔÌ›Ô. ∆ËÓ ÚÒÙË ‰ÂηÂÙ›· Ù˘ ÌÂϤÙ˘ ˘‹ÚÍ·Ó 8 ı¿Ó·ÙÔÈ Û 51 ·ÛıÂÓ›˜ (16%), ÙË ‰Â‡ÙÂÚË ‰ÂηÂÙ›· 4 ı¿Ó·ÙÔÈ Û 31 ·ÛıÂÓ›˜ (13%) Î·È ÙËÓ ÙÂÏÂ˘Ù·›· ‰ÂηÂÙ›· 1 ı¿Ó·ÙÔ˜ Û 34 ·ÛıÂÓ›˜ (3%). ÀÔÏÂÈÌÌ·ÙÈΤ˜ ‚Ï¿‚˜ ηٿ ÙËÓ ¤ÍÔ‰Ô ·ÚÔ˘Û›·Û·Ó 32 ·fi ÙÔ˘˜ 103 ÂÈ˙‹Û·ÓÙ˜ ·ÛıÂÓ›˜ (31%). ™˘¯ÓfiÙÂÚ· ‹Ù·Ó Ù· Ó¢ÚÔÏÔÁÈο ˘ÔÏ›ÌÌ·Ù·.

™‡ÁÎÚÈÛË ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ·‚›ˆÛ·Ó Ì ÔÌ¿‰· ·ÛıÂÓÒÓ Ô˘ ÂÈ‚›ˆÛ·Ó (·Ó¿ÏÔÁ˘ ËÏÈΛ·˜ Î·È Ê‡ÏÔ˘) (¶›Ó·Î·˜ 6) ¤‰ÂÈÍ fiÙÈ Ë ÚÒÙË ÔÌ¿‰· ›¯Â ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ Ì ÙË ‰Â‡ÙÂÚË (p<0,01) ÛÙȘ ÂÍ‹˜ ·Ú·Ì¤ÙÚÔ˘˜: ·ÚÔ˘Û›· ÂÈÏÔÎÒÓ, ‰È·Ù·Ú·¯¤˜ Û˘Ó›‰ËÛ˘, ·Ó·Ó¢ÛÙÈΤ˜ ‰È·Ù·Ú·¯¤˜, ˘„ËÏfi χΈ̷ Î·È ¯·ÌËÏfi ۿί·ÚÔ ÛÙÔ ∂¡À. OÈ 9/13 ·ÛıÂÓ›˜ Ô˘ ·‚›ˆÛ·Ó (69%) ÂÈÛ‹¯ıËÛ·Ó ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô ÛÙÔ ÚÒÙÔ (6) ‹ ÛÙÔ ‰Â‡ÙÂÚÔ 24ˆÚÔ Ù˘ ÓfiÛÔ˘. ™˘ÌÂÚ¿ÛÌ·Ù· O S. Pneumoniae Â›Ó·È Ë Î‡ÚÈ· ·ÈÙ›· ÛÔÚ·‰ÈÎÒÓ ÎÚÔ˘ÛÌ¿ÙˆÓ ÌÈÎÚԂȷ΋˜ ÌËÓÈÁÁ›Ùȉ·˜ ÛÂ

245

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

∞Ô‚ÈÒÛ·ÓÙ˜ (n=13) n ª¤ÛË ÙÈÌ‹

∂È˙‹Û·ÓÙ˜ (n=30) n ª¤ÛË ÙÈÌ‹

º‡ÏÔ (·ÁfiÚÈ) ∏ÏÈΛ· (Ì‹Ó˜) ≤12 ÌËÓÒÓ ¶ÚԉȷıÂÛÈ΋ ηٿÛÙ·ÛË ∫Ú·ÓÈÔÂÁÎÂÊ·ÏÈ΋ οΈÛË ª·ÎÚ‡ ÈÛÙÔÚÈÎfi ÚÈÓ ÙËÓ ÂÈÛ·ÁˆÁ‹ (>48 h) µÚ·¯‡ ÈÛÙÔÚÈÎfi ÚÈÓ ÙËÓ ÂÈÛ·ÁˆÁ‹ (<48 h) ∞ÓÙÈ‚›ˆÛË ÚÈÓ ÙËÓ ÂÈÛ·ÁˆÁ‹ ¢È·Ù·Ú·¯¤˜ Û˘Ó›‰ËÛ˘ ∫ÒÌ· ™·ÛÌÔ› ∞Ó·Ó¢ÛÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ ∂ÈÏÔΤ˜ ∏̤ڷ ÓfiÛÔ˘ ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ¢È¿ÚÎÂÈ· ˘ÚÂÙÔ‡ ÚÈÓ ÙËÓ ÂÈÛ·ÁˆÁ‹ (ÒÚ˜) ¶˘ÚÂÙfi˜ ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹ (ÔC) ≥38,5ÔC ¢È¿ÚÎÂÈ· ˘ÚÂÙÔ‡ ηٿ ÙË ÓÔÛËÏ›· (ÒÚ˜) ∫‡ÙÙ·Ú· ∂¡À (/mm3) ≤100 101-500 ¶ÚˆÙ½ÓË ∂¡À (mg%) °Ï˘Îfi˙Ë ∂¡À (mg%) §Â˘ÎÔ·ÙÙ·Ú· ·›Ì·ÙÔ˜ (Ìg/dl) ≤5000 5001-10000 ∆∫∂ (mm/h) ≤20 ≥50 Hb ≤10 gr/dl

8

20 30,5

9 (69%) 3 0 4 9 4 11 7 4 9 8 3 60 38,4

<0,01 <0,01

15 (50%)

2 (15,4%) 5 (38,4%)

7 1289 5 (16,6%) 7 (23,3%)

391,5 18,3 11700 1 (7,7%) 4 (30,7%)

217 35 11800

<0,01 <0,01

3 (10%) 7 (23,3%) 111

0 8 (61,5%) 8 (61,5%)

<0,01

2,5 50 38,3

3 999

‚Ú¤ÊË Î·È ·È‰È¿, ÂȉÈο Û ¯ÒÚ˜ fiÔ˘ ÙÔ ÂÌ‚fiÏÈÔ Î·Ù¿ ÙÔ˘ ∏. influenzae type b ¤¯ÂÈ ÂÈÛ·¯ı› ÛÙÔ ÂıÓÈÎfi ÚfiÁÚ·ÌÌ· ÂÌ‚ÔÏÈ·ÛÌÔ‡ ηÈ, Û˘ÓÂÒ˜, ¤¯ÂÈ Ô‰ËÁ‹ÛÂÈ ÛÙËÓ Ô˘ÛÈ·ÛÙÈ΋ ÂÍ¿ÏÂÈ„‹ ÙÔ˘ ˆ˜ ·ÈÙ›Ô˘ Ù˘ ÌÈÎÚԂȷ΋˜ ÌËÓÈÁÁ›Ùȉ·˜. ∏ ÓfiÛÔ˜ ·Ú·ÙËÚÂ›Ù·È Û fiϘ ÙȘ ËÏÈÎȷΤ˜ ÔÌ¿‰Â˜ Î·È ¤¯ÂÈ ˘„ËÏ¿ ÔÛÔÛÙ¿ ıÓËÙfiÙËÙ·˜ Ô˘ Î˘Ì·›ÓÔÓÙ·È ·fi 10% ¤ˆ˜ 60% ·Ó¿ÏÔÁ· Ì ÙËÓ ËÏÈΛ·, ÙË ÁˆÁÚ·ÊÈ΋ ÂÚÈÔ¯‹ ‹ Ù˘¯fiÓ ˘ÔΛÌÂÓË ÓfiÛÔ. OÈ ˘ÔÏÂÈÌÌ·ÙÈΤ˜ ‚Ï¿‚˜ ÌÂٷ͇ ÙˆÓ ÂÈ˙ÒÓÙˆÓ Â›Ó·È, Â›Û˘, Û˘¯Ó¤˜ Î·È ÚÔÛÂÁÁ›˙Ô˘Ó ÙÔ 50% ÙˆÓ ·ÛıÂÓÒÓ (4-8). ™ÙË ÌÂϤÙË Ì·˜, ÙÔ ÔÛÔÛÙfi ıÓËÙfiÙËÙ·˜ ‹Ù·Ó 11,2%. ∆Ô ÔÛÔÛÙfi ·˘Ùfi ÔÈΛÏÏÂÈ Û ‰È¿ÊÔÚ˜ ¯ÒÚ˜. ∆· ‰Èο Ì·˜ Â˘Ú‹Ì·Ù· Â›Ó·È Î¿Ô˘ ÛÙÔ Ì¤ÛÔÓ (7-21% Û ÔÚÈṲ̂Ó˜ ‰˘ÙÈΤ˜ ¯ÒÚ˜) (3,57,9,10). ∞Ó, ‚¤‚·È·, ÌÂÏÂÙ‹ÛÔ˘Ì ÙË ıÓËÙfiÙËÙ· ·Ó¿ ‰ÂηÂÙ›·, ‰È·ÈÛÙÒÓÔ˘Ì fiÙÈ ˘¿Ú¯ÂÈ ‚·ıÌÈ·›· ÂÏ¿ÙÙˆÛË ÙÔ˘ ÔÛÔÛÙÔ‡ ıÓËÙfiÙËÙ·˜ ·fi ÙËÓ ÚÒÙË ¤ˆ˜ ÙËÓ ÙÚ›ÙË ‰ÂηÂÙ›·. ∞˘Ùfi ÌÔÚ› Ó· ·Ô‰Ôı› ÛÙËÓ ·˘ÍË̤ÓË ˘Ô„›· ÙˆÓ ÁÈ·ÙÚÒÓ ÁÈ· ÙË ÌËÓÈÁÁ›Ùȉ· Î·È ¿Ú· ÛÙËÓ Ù·¯‡ÙÂÚË ‰È¿ÁÓˆÛË

246

26 17 (56,6%) 4 2 10 12 8 10 2 9 1 2

7 (53,8%)

™Ù·ÙÈÛÙÈ΋ ‰È·ÊÔÚ¿ (p)

8,3

80,3 0 24 (80%) 16 (53,3%)

10,2

Î·È ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂÚË ıÂÚ·›·. ™ÙË Ì›ˆÛË ·˘Ù‹ Ú¤ÂÈ Ó· ¤·ÈÍ ÚfiÏÔ Î·È Ë ·Ó¿Ù˘ÍË ÌÔÓ¿‰ˆÓ ÂÓÙ·ÙÈ΋˜ ÓÔÛËÏ›·˜ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·. ∏ ıÓËÙfiÙËÙ· (6%) Û ۯÂÙÈ΋ ÌÂϤÙË ÛÙËÓ ÂÚÈÔ¯‹ ÙˆÓ ∞ıËÓÒÓ (11), ÙËÓ ÂÚ›Ô‰Ô 1995-1999, ‹Ù·Ó ·Ó¿ÏÔÁË Ù˘ ıÓËÙfiÙËÙ·˜ Ô˘ ÂÌ›ÙÂÈ ÛÙËÓ ÙÂÏÂ˘Ù·›· ‰ÂηÂÙ›· Ù˘ ÌÂϤÙ˘ Ì·˜. ¶Ú¤ÂÈ Ó· ÛËÌÂȈı› fiÙÈ Î·Ó¤Ó· Û٤ϯԘ S. pneumoniae ‰ÂÓ ‹Ù·Ó ·ÓıÂÎÙÈÎfi ÛÙ· ·ÓÙÈ‚ÈÔÙÈο Ô˘ ¯ÔÚËÁ‹ıËÎ·Ó ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì·˜.

OÈ ·ÛıÂÓ›˜ Ô˘ η٤ÏËÍ·Ó Â›¯·Ó ‚Ú·¯‡ÙÂÚÔ ÈÛÙÔÚÈÎfi ÚÈÓ ÙËÓ ÂÈÛ·ÁˆÁ‹, ÂÚÈÛÛfiÙÂÚ˜ ÂÈÏÔΤ˜, Û˘¯ÓfiÙÂÚ˜ ‰È·Ù·Ú·¯¤˜ Û˘Ó›‰ËÛ˘ Î·È ¯·ÌËÏfiÙÂÚ˜ ÙÈ̤˜ Hb Û ۯ¤ÛË Ì ÙÔ˘˜ ÂÈ˙‹Û·ÓÙ˜ ·ÛıÂÓ›˜. ∏ ÌÈÎÚ‹ ËÏÈΛ· ·ÔÙÂÏÔ‡ÛÂ, Â›Û˘, ·Ú¿ÁÔÓÙ· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘. ∆Ô 60% ÙˆÓ ·ÛıÂÓÒÓ ‹Ù·Ó <24 ÌËÓÒÓ. ªÂϤÙ˜ ‰Â›¯ÓÔ˘Ó fiÙÈ ·Ó Ô ·ÛıÂÓ‹˜ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚÔ˜ ÙÔ˘ ÎÚÈÙÈÎÔ‡ ÔÚ›Ô˘ ÙˆÓ 12 ÌËÓÒÓ, Ë ÚfiÁÓˆÛË Â›Ó·È Ôχ ηχÙÂÚË (12). À„ËÏfi ‹Ù·Ó Î·È ÙÔ ÔÛÔÛÙfi ÙˆÓ ˘ÔÏÂÈÌÌ·ÙÈÎÒÓ ‚Ï·‚ÒÓ (31%). ∞˘Ùfi Â›Ó·È Û‡ÌʈÓÔ Î·È Ì ¿ÏϘ ÌÂϤÙ˜ (4,6,9) Î·È ‚Ú›ÛÎÂÙ·È ÎÔÓÙ¿ ÛÙÔ

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ÔÛÔÛÙfi ÚÔËÁÔ‡ÌÂÓ˘ ÌÂϤÙ˘ Ì·˜ Ô˘ ·ÊÔÚÔ‡Û ̷ÎÚÔ¯ÚfiÓÈ· ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ·ÛıÂÓÒÓ (13). OÈ ‰È·Ù·Ú·¯¤˜ ·ÎÔ‹˜ ·Ú·Ì¤ÓÔ˘Ó ÙÔ ÛËÌ·ÓÙÈÎfiÙÂÚÔ ˘fiÏÂÈÌÌ· Ù˘ Ó¢ÌÔÓÈÔÎÔÎÎÈ΋˜ ÌËÓÈÁÁ›Ùȉ·˜ (14,15). ∏ ÎÒʈÛË ‹Ù·Ó ÌfiÓÈÌË Û fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ Ì·˜ Ì ÙËÓ ÂÈÏÔ΋ ·˘Ù‹ (19%). ™‡Ìʈӷ Ì ÚfiÛÊ·ÙË ÌÂϤÙË (16), ÌfiÓÔ ÙÔ 2,4% ·fi 124 ·È‰È¿ Ì ÌÈÎÚԂȷ΋ ÌËÓÈÁÁ›Ùȉ· ·fi N. meningitidis Î·È S. pneumoniae ›¯Â ÌfiÓÈÌË ÎÒʈÛË. OÈ Û˘ÁÁÚ·Ê›˜ ÈÛÙÂ‡Ô˘Ó fiÙÈ ˘¿Ú¯ÂÈ Ì›· “Â·ÏÏ¿ÛÛÔ˘Û· ‹ Î˘Ì·ÈÓfiÌÂÓË” ·ÒÏÂÈ· ·ÎÔ‹˜ ÛÙËÓ ÔÍ›· ÌÈÎÚԂȷ΋ ÌËÓÈÁÁ›Ùȉ·. ™ËÌ·ÓÙÈÎfi˜ ·ÚÈıÌfi˜ ·ÛıÂÓÒÓ Ì·˜ ›¯Â οÔÈ· ˘ÔΛÌÂÓË Î·Ù¿ÛÙ·ÛË ‹ ÓfiÛÔ (10,14,17). ∆Ô Î¿Ù·ÁÌ· ÎÚ·Ó›Ô˘ ·Ú·Ì¤ÓÂÈ Ì›˙ˆÓ ÚÔÁÓˆÛÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÁÈ· ÔÍ›· ‹ ˘ÔÙÚÔÈ¿˙Ô˘Û· Ó¢ÌÔÓÈÔÎÔÎÎÈ΋ ÌËÓÈÁÁ›Ùȉ· (13). ∂›Ó·È ÂӉȷʤÚÔÓ fiÙÈ Î·Ó¤Ó·˜ ·fi ÙÔ˘˜ 9 ·ÛıÂÓ›˜ Ì·˜ Ì ˘ÔÙÚÔÈ¿˙Ô˘Û· ÌËÓÈÁÁ›Ùȉ· ‰ÂÓ Â›¯Â η΋ ¤Î‚·ÛË. ™ÙÔ˘˜ ·ÛıÂÓ›˜ ·˘ÙÔ‡˜, ÙÔ ÔÛÔÛÙfi ˘ÔΛÌÂÓ˘ ÓfiÛÔ˘ ‹Ù·Ó ˘„ËÏfiÙÂÚÔ ·fi ·˘Ùfi ÙˆÓ ¿ÏÏˆÓ ·ÛıÂÓÒÓ (88% ¤Ó·ÓÙÈ 12%). ∆· ˘„ËÏ¿ ÔÛÔÛÙ¿ ıÓËÙfiÙËÙ·˜ Î·È ˘ÔÏÂÈÌÌ¿ÙˆÓ ‰Â›¯ÓÔ˘Ó fiÙÈ Ë ÚÔʇϷÍË ·fi ÙËÓ Ó¢ÌÔÓÈÔÎÔÎÎÈ΋ ÌËÓÈÁÁ›Ùȉ· Â›Ó·È ÛËÌ·ÓÙÈ΋. ∂›Ó·È Ôχ Èı·Ófi Ó· ‰Ôı› χÛË ÛÙÔ Úfi‚ÏËÌ· Ì ٷ Ó¤· Û˘˙¢Á̤ӷ ÂÌ‚fiÏÈ· Ô˘ ÌÂÏÂÙÒÓÙ·È ‹ Ô˘ ¤¯Ô˘Ó ΢ÎÏÔÊÔÚ‹ÛÂÈ. ¶·Ú¿ ÙË ‰˘Ó·ÙfiÙËÙ· ¤ÁηÈÚ˘ ‰È¿ÁÓˆÛ˘ Î·È Î·Ù¿ÏÏËÏ˘ ıÂÚ·›·˜, Ë Ó¢ÌÔÓÈÔÎÔÎÎÈ΋ ÌËÓÈÁÁ›Ùȉ· ·Ú·Ì¤ÓÂÈ Ì›· ÛÔ‚·Ú‹ Ïԛ̈ÍË Ì ˘„ËÏfi ÔÛÔÛÙfi ıÓËÙfiÙËÙ·˜.

Paediatriki 2002;65:241-247

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HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 16-11-2001 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 21-05-2002 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: π. ∫·‚·ÏÈÒÙ˘ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¡ÔÛÔÎÔÌ›Ԣ ∂ȉÈÎÒÓ ¶·ı‹ÛÂˆÓ °Ú. §·ÌÚ¿ÎË 13, ∆.∫. 546 38, £ÂÛÛ·ÏÔÓ›ÎË

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Paediatriki 2002;65:248-255

ORIGINAL ARTICLE

ªËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋ ÌËÓÈÁÁ›Ùȉ·: ·Ú·ÙËÚ‹ÛÂȘ Û 1070 ·ÛıÂÓ›˜ ™. ¶ÂÙÚ›‰Ô˘, ∂. ∑¢Á·Ú›‰Ô˘, ∞. ∂˘ı˘Ì›Ô˘, ∞. ¡¿ÓÔ˘, π. ∫·‚·ÏÈÒÙ˘

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

¶ÂÚ›ÏË„Ë: O ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˜ ·ÔÙÂÏ› ÙÔ ÛËÌ·ÓÙÈÎfiÙÂÚÔ ·›ÙÈÔ ÌÈÎÚԂȷ΋˜ ÌËÓÈÁÁ›Ùȉ·˜ ·ÁÎÔÛÌ›ˆ˜. ¶·Ú¿ ÙËÓ Î·Ù¿ÏÏËÏË ·ÓÙÈÌÈÎÚԂȷ΋ ıÂÚ·›· Î·È ÙËÓ ÂÏ¿ÙÙˆÛË Ù˘ Û˘¯ÓfiÙËÙ¿˜ ÙÔ˘, ÌÔÚ› Ó· ÚÔηϤÛÂÈ ÂȉË̛˜ Ì ÛÔ‚·Ú¤˜ Û˘Ó¤ÂȘ. ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ·˘Ù‹˜ Â›Ó·È Ë ·Ó¿Ï˘ÛË ÙˆÓ ÎÏÈÓÈÎÔ-ÂȉËÌÈÔÏÔÁÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ Ù˘ ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋˜ ÌËÓÈÁÁ›Ùȉ·˜ Ù· ÙÂÏÂ˘Ù·›· 30 ¯ÚfiÓÈ·. ∫·Ù¿ ÙË ¯ÚÔÓÈ΋ ÂÚ›Ô‰Ô19701999, ÓÔÛËχÙËÎ·Ó ÛÙËÓ ∫ÏÈÓÈ΋ Û˘ÓÔÏÈο 1070 ·ÛıÂÓ›˜ Ì ÌËÓÈÁÁ›Ùȉ· ·fi ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ. ∏ ÔÌ¿‰· ·˘Ù‹ ÂÚÈÏ·Ì‚¿ÓÂÈ 357 ÂÚÈÙÒÛÂȘ Ô˘ ¯·Ú·ÎÙËÚ›ÛÙËÎ·Ó ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈΤ˜ Ì ‚¿ÛË ÎÏÈÓÈο ÎÚÈÙ‹ÚÈ· (·˘ÛÙËÚ¿ Ù˘ÈÎfi ·ÈÌÔÚÚ·ÁÈÎfi ÂÍ¿ÓıËÌ· Ì ÓÂÎÚÒÛÂȘ), ηıÒ˜ Î·È ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· ·fi ÙÔ ∂¡À Û˘Ì‚·Ù¿ Ì ÌËÓÈÁÁ›Ùȉ·. ∏ ÌÂϤÙË ‰ÂÓ ÂÚÈÏ·Ì‚¿ÓÂÈ ·È‰È¿ Ì ÌËÓÈÁÁÈÙȉÔÎÔÎηÈÌ›· Î·È ÌfiÓÔÓ. ∏ ̤ÛË ËÏÈΛ· ÙˆÓ ·ÛıÂÓÒÓ ‹Ù·Ó 3,6±3,2 ¤ÙË (30 ËÌÂÚÒÓ ¤ˆ˜ 14 ÂÙÒÓ). ∆Ô 57% (608/1070) ‹Ù·Ó ·ÁfiÚÈ·. ∏ ÂÙ‹ÛÈ· ηٷÓÔÌ‹ ¤‰ÂÈÍ ÛËÌ·ÓÙÈ΋ ÂÏ¿ÙÙˆÛË Ù˘ Â›ÙˆÛ˘ ÌÂÙ¿ ÙÔ 1980. ∆ËÓ ÂÚ›Ô‰Ô 1996-1999 ·Ú·ÙËÚ‹ıËΠÂȉËÌ›· Ù˘ ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋˜ ÓfiÛÔ˘ Ì ۯÂÙÈο ÌÈÎÚfi ·ÚÈıÌfi ·ÛıÂÓÒÓ. ∏ ÎÏÈÓÈ΋ ÔÚ›· Ù˘ ÓfiÛÔ˘ ‹Ù·Ó ÁÂÓÈο ηϋ. ∆Ô 10% ÙˆÓ ·ÛıÂÓÒÓ ·ÚÔ˘Û›·Û Û·ÛÌÔ‡˜, ΢ڛˆ˜ ÁÂÓÈÎÂ˘Ì¤ÓÔ˘˜ Î·È Î˘Ú›ˆ˜ ÙȘ ‰‡Ô ÚÒÙ˜ Ë̤Ú˜ Ù˘ ÓfiÛÔ˘. ¢È·Ù·Ú·¯¤˜ Û˘Ó›‰ËÛ˘ ÛËÌÂÈÒıËÎ·Ó ÛÙÔ 50% ÙˆÓ ·È‰ÈÒÓ, ÂÓÒ Î·Ù·ÏËÍ›· ÛÙÔ 6% ÙˆÓ ·ÛıÂÓÒÓ. ∆Ô 9% ÙˆÓ ·ÛıÂÓÒÓ ·ÚÔ˘Û›·Û ÂÈÏÔΤ˜ (97/1070, ΢ڛˆ˜ ·ÚıÚ›Ùȉ·). ¡Â˘ÚÔÏÔÁÈο ˘ÔÏ›ÌÌ·Ù· ·Ú·ÙËÚ‹ıËÎ·Ó Û 26/1058 (3%) ·È‰È¿. ∏ ıÓËÙfiÙËÙ· ‹Ù·Ó 1,1% (12/1070 ·ÛıÂÓ›˜). ∏ Û‡ÁÎÚÈÛË ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ·‚›ˆÛ·Ó Ì ÔÌ¿‰· ·ÚfiÌÔÈ·˜

Abstract: Neisseria meningitidis (NM) is the most important cause of bacterial meningitis (BM) worldwide. The aim of this study was to determine the clinico-epidemiological characteristics of NM meningitis in the last 30 years. During the period 1970-1999, a total of 1070 cases of BM due to NM were hospitalized in our Department (study group). This group included 357 cases without bacteriological confirmation of NM, but with laboratory findings compatible with BM and clinical features strictly typical for meningococcal infection (characteristic hemorrhagic rash with necrosis). It did not include cases with meningococcemia alone. There was a male preponderance (608/1070, 57%). The median age of the children was 3.6±3.25 years (30 days to 14 years). The annual distribution revealed a significant decrease in the incidence of NM meningitis after the year 1980. During 1996-1999 an outbreak of meningococcal disease occurred, but with a relatively small number of patients. The clinical course was good in the majority of cases. About 10% of the patients presented with seizures, usually generalized, occuring mainly during the first two days of the disease. Consciousness disorders occurred in 50%, shock in 6% and complications in 9% (mainly arthritis) of the patients. Neurological sequelae were observed in 26/1058 (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 that were cured, showed that the first group had a shorter pre-admission history, a higher rate of consciousness alterations and diffuse hemorrhagic

¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¡ÔÛÔÎÔÌ›Ԣ ∂ȉÈÎÒÓ ¶·ı‹ÛˆÓ, £ÂÛÛ·ÏÔÓ›ÎË

Department of Paediatrics, Infectious Diseases Hospital, Thessaloniki

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™ÂÏ›‰·249

¶·È‰È·ÙÚÈ΋ 2002;65:248-255

Paediatriki 2002;65:248-255

ËÏÈΛ·˜ Î·È Ê‡ÏÔ˘ Ô˘ È¿ıËÎ·Ó ¤‰ÂÈÍ fiÙÈ Ë ÚÒÙË ÔÌ¿‰· ›¯Â ‚Ú·¯‡ÙÂÚË ‰È¿ÚÎÂÈ· Ù˘ ÓfiÛÔ˘ ÚÈÓ ÙËÓ ÂÈÛ·ÁˆÁ‹, ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· ‰È·Ù·Ú·¯ÒÓ Û˘Ó›‰ËÛ˘ Î·È ‰È¿¯˘ÙÔ ·ÈÌÔÚÚ·ÁÈÎfi ÂÍ¿ÓıËÌ·. ∏ Û˘¯ÓfiÙÂÚË ÔÚÔ-ÔÌ¿‰· ÛÙË ÌÂϤÙË Ì·˜ ‹Ù·Ó Ë µ. ™ÙËÓ ÂȉËÌ›·, fï˜, ÙÔ˘ 1996-1999 ΢ÚÈ¿Ú¯ËÛÂ Ë ÔÚÔ-ÔÌ¿‰· C. ™˘ÌÂÚ·ÛÌ·ÙÈο: 1) Ë Â›ÙˆÛË Ù˘ ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋˜ ÌËÓÈÁÁ›Ùȉ·˜ Ê·›ÓÂÙ·È fiÙÈ ¤¯ÂÈ ÂÏ·ÙÙˆı› ÛÙËÓ ÂÚÈÔ¯‹ Ì·˜ Ì ÂÍ·›ÚÂÛË Î¿ÔȘ ÂÚÈfi‰Ô˘˜ ÂȉËÌÈÒÓ Î·È 2) Ë ÓfiÛÔ˜ ·ÚÔ˘ÛÈ¿˙ÂÈ ‹È· ÎÏÈÓÈ΋ ÔÚ›· Ì ÌÈÎÚfi ÔÛÔÛÙfi ˘ÔÏÂÈÌÌ¿ÙˆÓ Î·È ¯·ÌËÏ‹ ıÓËÙfiÙËÙ·.

rash. The most frequent serogroup of NM in our study was type B. However, serogroup C predominated in the 1996-1999 outbreak. As a conclusion: 1) the incidence of NM meningitis seems to have declined in our area with the exception of a few periods of disease outbreaks, 2) the disease has a mild clinical course, with few neurological sequelae and a low rate of mortality.

§¤ÍÂȘ ÎÏÂȉȿ: ÌËÓÈÁÁ›Ùȉ·, ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˜, ÏÔÈÌÒÍÂȘ, ·È‰È¿.

Key words: meningitis, meningococcus, infectious diseases, children.

∂ÈÛ·ÁˆÁ‹ ∏ N. meningitidis Â›Ó·È Ë Î‡ÚÈ· ·ÈÙ›· ÌËÓÈÁÁ›Ùȉ·˜ ·ÁÎÔÛÌ›ˆ˜. ∏ ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋ ÓfiÛÔ˜ ·ÔÙÂÏ› Úfi‚ÏËÌ· ÁÈ· ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ¯ÒÚ˜, ÂÓÒ ÂΉËÏÒÓÔÓÙ·È ·ÎfiÌË ÌÂÁ¿Ï˜ ÂȉË̛˜ Û ÔÏϤ˜ ÂÚÈÔ¯¤˜ ÙÔ˘ ÎfiÛÌÔ˘, fiˆ˜ ÛÙËÓ ∂˘ÚÒË (ƒˆÛ›·, ™Î·Ó‰ÈÓ·‚›· Î.Ï.), ÛÙËÓ ∞ÊÚÈ΋ (·ÎfiÌË Î·È ÂÎÙfi˜ “˙ÒÓ˘ ÌËÓÈÁÁ›Ùȉ·˜”), ÛÙÔÓ ∫·Ó·‰¿, ÛÙËÓ ∞˘ÛÙÚ·Ï›· (1-3). ∏ ÁÓÒÛË Ù˘ ÂȉËÌÈÔÏÔÁ›·˜ Ù˘ ÓfiÛÔ˘ Â›Ó·È ¿ÓÙ· ¯Ú‹ÛÈÌË, ÂȉÈο ÙÒÚ· Ô˘ ΢ÎÏÔÊÔÚÔ‡Ó ‹ ı· ΢ÎÏÔÊÔÚ‹ÛÔ˘Ó Î·È Ó¤· Û˘˙¢Á̤ӷ ÂÌ‚fiÏÈ· ÁÈ· ÔÚÈṲ̂Ó˜ ÔÚÔ-ÔÌ¿‰Â˜ ÙÔ˘ ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘. ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ô Î·ıÔÚÈÛÌfi˜ ÙˆÓ ÎÏÈÓÈÎÔÂȉËÌÈÔÏÔÁÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ Ù˘ ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋˜ ÌËÓÈÁÁ›Ùȉ·˜ ÛÙ· ÙÂÏÂ˘Ù·›· 30 ¯ÚfiÓÈ·, Ì ‚¿ÛË Ù· ÛÙÔȯ›· Ù˘ ∫ÏÈÓÈ΋˜ Ì·˜.

ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ·, ÙÔ˘Ï¿¯ÈÛÙÔÓ 4 ‚‰ÔÌ¿‰Â˜ Î·È ϤÔÓ ÚÈÓ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ·ÛıÂÓÔ‡˜-‰Â›ÎÙË ÛÙÔ ÓÔÛÔÎÔÌ›Ô, Á) ¢Â˘ÙÂÚÔ·ı¤˜ ÎÚÔ‡ÛÌ·: ·˘Ùfi Ô˘ Û˘Ì‚·›ÓÂÈ Û ¿ÙÔÌ· ÙÔ˘ ÛÙÂÓÔ‡ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ ÙÔ˘ ·ÛıÂÓÔ‡˜ ÙÔ˘Ï¿¯ÈÛÙÔÓ 24 ÒÚ˜ Î·È ϤÔÓ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ÓfiÛÔ˘ ÛÙÔÓ ·ÛıÂÓ‹-‰Â›ÎÙË, ‰) ∂ÈÏÔΤ˜: ·ÚÔ˘Û›· Û˘ÌÙˆÌ¿ÙˆÓ Î·È ÛËÌ›ˆÓ Ô˘ ‰ÂÓ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÛÙ· Û˘Ó‹ıË ÎÏÈÓÈο ÛÙÔȯ›· Ù˘ ÌËÓÈÁÁ›Ùȉ·˜ (ÎÒÌ·, Û·ÛÌÔ› ÌÂÙ¿ 3 Ë̤Ú˜ ıÂÚ·›·˜, Û‡Ó‰ÚÔÌÔ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜, ·ÚıÚ›Ùȉ·, ÂÚÈηډ›Ùȉ·, ˘ÔÛÎÏËÚ›‰È· Û˘ÏÏÔÁ‹), Â) ÀÔÏ›ÌÌ·Ù·: ÔÔÈÔ‰‹ÔÙ ·ıÔÏÔÁÈÎfi ‡ÚËÌ· ηٿ ÙËÓ ¤ÍÔ‰Ô ÙÔ˘ ·ÛıÂÓÔ‡˜ ·fi ÙÔ ÓÔÛÔÎÔÌÂ›Ô (‰È·Ù·Ú·¯¤˜ ·ÎÔ‹˜, ·Ú¿Ï˘ÛË ÎÚ·ÓÈ·ÎÒÓ Ó‡ڈÓ, ‰È·Ù·Ú·¯¤˜ fiÚ·Û˘, ˘‰ÚÔΤʷÏÔ˜, ‰È·ÓÔËÙÈ΋ ηı˘ÛÙ¤ÚËÛË, ÎÈÓËÙÈΤ˜ ‰È·Ù·Ú·¯¤˜, Ô˘Ï¤˜ ÙˆÓ ‰ÂÚÌ·ÙÈÎÒÓ ÓÂÎÚÒÛˆÓ), ÛÙ) ÷ÌËÏ‹ Û˘ÛÙÔÏÈ΋ ›ÂÛË: ÔÚ›ÛÙËΠ̠‚¿ÛË ÙËÓ ËÏÈΛ· ÙÔ˘ ·ÛıÂÓÔ‡˜ Î·È Ù· ÂÍ‹˜ fiÚÈ· ÁÈ· ÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë ËÏÈÎȷ΋ ÔÌ¿‰· (¤ˆ˜ 1 ÌËÓfi˜ <70 mmHg, 1 ÌËÓfi˜-5 ÂÙÒÓ <80 mmHg, 5 ÂÙÒÓ Î·È ÌÂÁ·Ï‡ÙÂÚ· <90 mmHg). ∆· fiÚÈ· ·˘Ù¿ ·ÓÙÈÚÔÛˆÂ‡Ô˘Ó Û˘ÛÙÔÏÈ΋ ›ÂÛË ÙÔ˘Ï¿¯ÈÛÙÔÓ 1 ™∞ (ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË) οو ·fi ÙËÓ Î·ÙÒÙÂÚË Ê˘ÛÈÔÏÔÁÈ΋ ÙÈÌ‹ Î·È ˙) ¶ÏÂÈÔ΢ÙÙ¿ÚˆÛË: ·ÙÙ·Ú· ∂¡À ≥20/mm3. ∫ÚÈÙ‹ÚÈ· ÂÈÛ·ÁˆÁ‹˜ ÛÙË ÌÂϤÙË: ∫ÚÈÙ‹ÚÈ· ÂÈÛ·ÁˆÁ‹˜ ÛÙË ÌÂϤÙË ‹Ù·Ó: i) ÛËÌ›· Î·È Û˘ÌÙÒÌ·Ù· ÌËÓÈÁÁ›Ùȉ·˜, ii) ÂÚÁ·ÛÙËÚȷΤ˜ ÂӉ›ÍÂȘ ·fi ÙÔ ∂¡À Û˘Ì‚·Ù¤˜ Ì ÌÈÎÚԂȷ΋ ÌËÓÈÁÁ›Ùȉ· (ÏÂÈÔ΢ÙÙ¿ÚˆÛË, Ô˘‰ÂÙÂÚÔÊÈÏ›·, ˘„ËÏfi χΈ̷, ¯·ÌËÏfi ۿί·ÚÔ), iii) ·ÔÌfiÓˆÛË Ù˘ N. meningitidis ·fi ηÏÏȤÚÁÂÈ· ∂¡À ‹/Î·È ·›Ì·ÙÔ˜ ‹ Î·È ·Ó›¯Ó¢ÛË Ù˘ Ì ÙÔ slidex test Î·È iv) ÂÚÈÙÒÛÂȘ ¯ˆÚ›˜ ·ÔÌfiÓˆÛË Ù˘ N. meningitidis, ·ÏÏ¿ Ì ÎÏÈÓÈο Î·È ÂÚÁ·ÛÙËÚȷο (Ï¢ÎÔ·ÙÙ·Ú· ∂¡À >20/mm3, Ô˘‰ÂÙÂÚÔÊÈÏ›·, ·˘ÍË̤ÓË ÚˆÙ½ÓË, ÂÏ·Ùو̤ÓË ÁÏ˘Îfi˙Ë) Â˘Ú‹Ì·Ù· ·Ôχو˜ Û˘Ì‚·Ù¿ Ì ÌÈÎÚԂȷ΋ ÌËÓÈÁÁ›Ùȉ· Î·È ·ÈÌÔÚÚ·ÁÈÎfi ÂÍ¿ÓıËÌ· ·˘ÛÙËÚ¿ Î·È ·fiÏ˘Ù· Ù˘ÈÎfi Ù˘ ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋˜ Ïԛ̈͢. ∆Ô 59,4% ÙˆÓ ·ÛıÂÓÒÓ ·˘ÙÒÓ Â›¯Â Ï¿‚ÂÈ ·ÓÙÈ‚›ˆÛË πV ÚÈÓ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô Î·È Ê˘ÛÈο ÚÈÓ ÙË Ï‹„Ë Î·ÏÏÈÂÚÁÂÈÒÓ ·›Ì·ÙÔ˜ Î·È ∂¡À. OÈ ·ÛıÂÓ›˜ ·˘ÙÔ› ·ÔÊ·Û›ÛÙËΠӷ Û˘ÌÂÚÈÏËÊıÔ‡Ó ÛÙË ÌÂϤÙË, ‰ÈfiÙÈ ÈÛÙ‡ԢÌ fiÙÈ Ô ·ÔÎÏÂÈÛÌfi˜ ÙÔ˘˜ ı· ›¯Â ˆ˜ ·ÔÙ¤ÏÂÛÌ·

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ∞ÛıÂÓ›˜: ∏ ÔÌ¿‰· ÌÂϤÙ˘ ÂÚÈÏ·Ì‚¿ÓÂÈ ·È‰È¿ Ì ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋ ÌËÓÈÁÁ›Ùȉ· (n=1070) Ô˘ ÓÔÛËχıËÎ·Ó ÛÙËÓ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ ∂ȉÈÎÒÓ ¶·ı‹ÛÂˆÓ £ÂÛÛ·ÏÔӛ΢ ÙËÓ ÂÚ›Ô‰Ô 1970-1999 (30 ¯ÚfiÓÈ·). ™˘ÏÏÔÁ‹ ÛÙÔȯ›ˆÓ: ∏ ÌÂϤÙË Â›Ó·È ·Ó·‰ÚÔÌÈ΋. ªÂ ‚¿ÛË ÂȉÈÎfi ‰ÂÏÙ›Ô Û˘ÏÏÔÁ‹˜ ÛÙÔȯ›ˆÓ ·Ó·ÛÎÔ‹ıËÎ·Ó ÔÈ Ê¿ÎÂÏÏÔÈ ÓÔÛËÏ›·˜ ÙˆÓ ·ÛıÂÓÒÓ Î·È Û˘ÁÎÂÓÙÚÒıËÎ·Ó ÛÙÔȯ›· ÁÈ· ‰È¿ÊÔÚ˜ ·Ú·Ì¤ÙÚÔ˘˜: ‰ËÌÔÁÚ·ÊÈο ‰Â‰Ô̤ӷ, ÚԉȷıÂÙÈÎÔ› ·Ú¿ÁÔÓÙ˜, ÈÛÙÔÚÈÎfi ÌËÓÈÁÁ›Ùȉ·˜, ÎÏÈÓÈ΋ Û˘Ìو̷ÙÔÏÔÁ›·, ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù·, ·ÓÙÈ‚ÈÔıÂÚ·›· Î·È ÂͤÏÈÍË Ù˘ ÓfiÛÔ˘.

OÚÈÛÌÔ›: °È· ÙȘ ·Ó¿ÁΘ Ù˘ ÌÂϤÙ˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÔÈ ·Ú·Î¿Ùˆ ÔÚÈÛÌÔ› ÁÈ· Ù· ·ÓÙ›ÛÙÔȯ· ‰Â‰Ô̤ӷ: ·) ¶ÚԉȷıÂÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ÁÈ· ÌËÓÈÁÁ›Ùȉ·: ·ÚÔ˘Û›· ηÎÔ‹ıÂÈ·˜, ·ÚÔ˘Û›· ·ÔÊÚ·ÎÙÈ΋˜ Ó¢ÌÔÓÔ¿ıÂÈ·˜, ÈÛÙÔÚÈÎfi ÚÔËÁËı›۷˜ ÌÈÎÚԂȷ΋˜ ÌËÓÈÁÁ›Ùȉ·˜, ηÎÒÛÂȘ ÎÚ·Ó›Ô˘-ÂÁÎÂÊ¿ÏÔ˘, ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·, ÛÏËÓÂÎÙÔÌ‹, Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜, ‚) £ÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÁÈ· ÌËÓÈÁÁ›Ùȉ·: ·ÚÔ˘Û›· ÂÚ›ÙˆÛ˘ ÌÈÎÚԂȷ΋˜ ÌËÓÈÁÁ›Ùȉ·˜

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Paediatriki 2002;65:248-255

ÛÙÚ¤‚ψÛË Ù˘ ÂÈÎfiÓ·˜ Ù˘ ÓfiÛÔ˘. ∞ÔÎÏÂÈÛÌfi˜ ·ÛıÂÓÒÓ: ¢ÂÓ Û˘ÌÂÚÈÂÏ‹ÊıËÛ·Ó ÛÙË ÌÂϤÙË ·ÛıÂÓ›˜ Ì ÌËÓÈÁÁÈÙȉÔÎÔÎηÈÌ›· ÌfiÓÔ Î·È fi¯È ÌËÓÈÁÁ›Ùȉ·. ø˜ ÌËÓÈÁÁÈÙȉÔÎÔÎηÈÌ›· ıˆڋ۷Ì ÙËÓ Î·Ù¿ÛÙ·ÛË Ì ٷ ÂÍ‹˜ ¯·Ú·ÎÙËÚÈÛÙÈο: ˘ÚÂÙfi˜ >38ÔC, ÂÙ¤¯ÂȘ ‹ ÔÚÊ˘ÚÈÎfi ÂÍ¿ÓıËÌ· ‹ ÎÂÚ·˘ÓÔ‚fiÏÔ˜ ÌÔÚÊ‹ ÛË„·ÈÌ›·˜ Ì ˘ÚÂÙfi, ÂÙ¤¯ÂȘ ‹ ÔÚʇڷ Ù·¯¤ˆ˜ ÂÍ·ÏÔ‡ÌÂÓ˜, ·ÈÌÔ‰˘Ó·ÌÈ΋ ·ÛÙ¿ıÂÈ· Î·È ·ÔÌfiÓˆÛË Ù˘ N. meningitidis. ∫·Ó¤Ó· ·È‰› ‰ÂÓ Â›¯Â Ï¿‚ÂÈ ÔÔÈÔ‰‹ÔÙ ·ÓÙÈÌËÓÈÁÁÈÙȉÔÎÔÎÎÈÎfi ÂÌ‚fiÏÈÔ ÚÈÓ ÓÔÛ‹ÛÂÈ.

ÓfiÛÔ˘ ‹Ù·Ó ˘„ËÏfiÙÂÚË ÛÙ· ·È‰È¿ <2 ÂÙÒÓ (499/1070, 47%) Î·È ÌÂȈÓfiÙ·Ó ¤ÓÙÔÓ· ÌÂÙ¿ Ù· 2 ¯ÚfiÓÈ· Ù˘ ˙ˆ‹˜ (∂ÈÎfiÓ· 1). ∂ȉËÌÈÔÏÔÁÈο ‰Â‰Ô̤ӷ: ∏ ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋ ÓfiÛÔ˜ ¤¯ÂÈ ·ÁÎfiÛÌÈ· ηٷÓÔÌ‹ Î·È ÂÌÊ·Ó›˙ÂÙ·È Â›Ù Ì ÂÓ‰ËÌÈ΋, ›Ù Ì ÂȉËÌÈ΋ ÌÔÚÊ‹. ™ÙËÓ ÂÚ›Ô‰Ô Ù˘ ÌÂϤÙ˘ Ì·˜ ·Ú·ÙËÚ‹ıËΠÊı›ÓÔ˘Û· ÔÚ›· Ù˘ ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋˜ ÌËÓÈÁÁ›Ùȉ·˜, ÂÓÒ Û ÔÚÈṲ̂Ó˜ ¯ÚÔÓÈΤ˜ ÂÚÈfi‰Ô˘˜ ˘‹ÚÍ ·˘ÍË̤ÓÔ˜ ·ÚÈıÌfi˜ ÎÚÔ˘ÛÌ¿ÙˆÓ (∂ÈÎfiÓ· 2). ∆ÂÏÂ˘Ù·›· ÂȉËÌÈ΋ ¤Í·ÚÛË ‹Ù·Ó Ù˘ ÂÚÈfi‰Ô˘ 1996-1999. ∏ ̤ÛË ÂÙ‹ÛÈ· Û˘¯ÓfiÙËÙ· Ù˘ ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋˜ ÌËÓÈÁÁ›Ùȉ·˜ ÛÙËÓ fiÏË Ù˘ £ÂÛÛ·ÏÔӛ΢ ‹Ù·Ó 1,2 ÂÚÈÙÒÛÂȘ ·Ó¿ 100.000 ÏËı˘ÛÌfi, Ì ‰È·Î‡Ì·ÓÛË 0,3-2,8 (¶›Ó·Î·˜ 1). ∏ Âԯȷ΋ ηٷÓÔÌ‹ ¤‰ÂÈÍ ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ·, ΢ڛˆ˜ ÙÔ˘˜ ¯ÂÈÌÂÚÈÓÔ‡˜ Î·È Â·ÚÈÓÔ‡˜ Ì‹Ó˜

∞ÔÙÂϤÛÌ·Ù· °ÂÓÈο ÛÙÔȯ›·: ∫·Ù¿ ÙËÓ ÂÚ›Ô‰Ô 1970-1999 ÓÔÛËχıËÎ·Ó ÛÙËÓ KÏÈÓÈ΋ 1070 ·ÛıÂÓ›˜ (608 ·ÁfiÚÈ·) Ì ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋ ÌËÓÈÁÁ›Ùȉ·. ∏ ËÏÈΛ· ÙˆÓ ·ÛıÂÓÒÓ Î˘Ì·ÈÓfiÙ·Ó ·fi 30 Ë̤Ú˜ ¤ˆ˜ 14 ¯ÚfiÓÈ· (‰È¿ÌÂÛË 30 Ì‹Ó˜). ∏ Û˘¯ÓfiÙËÙ· Ù˘

300

AÚÈıÌfi˜ ·ÛıÂÓÒÓ

250 200 150 100 50 0

1

3

2

7

6

5

4

8

9

10

11

12

'92

'94

13

14

ŒÙË ∂ÈÎfiÓ· 1. ∏ÏÈÎȷ΋ ηٷÓÔÌ‹ ÂÚÈÙÒÛÂˆÓ ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋˜ ÌËÓÈÁÁ›Ùȉ·˜.

160 140 AÚÈıÌfi˜ ·ÛıÂÓÒÓ

july-aug02TELIKO

120 100 80 60 40 20 0

'70

'72

'74

'76

'78

'80

'82

'84

'86

'88

'90

ŒÙË ∂ÈÎfiÓ· 2. ∂Ù‹ÛÈ· ηٷÓÔÌ‹ ÂÚÈÙÒÛÂˆÓ ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋˜ ÌËÓÈÁÁ›Ùȉ·˜ (1970-1999).

250

'96

'98

july-aug02TELIKO

14-05-03

13:31

™ÂÏ›‰·251

¶·È‰È·ÙÚÈ΋ 2002;65:248-255

Paediatriki 2002;65:248-255

(∂ÈÎfiÓ· 3). ∏ Û˘¯ÓfiÙÂÚË ÔÚÔ-ÔÌ¿‰· Ô˘ ·Ú·ÙËÚ‹ıËΠÛÙÔ ˘ÏÈÎfi Ù˘ ÌÂϤÙ˘ Ì·˜ ‹Ù·Ó Ë B. øÛÙfiÛÔ, ÛÙËÓ ÂȉËÌ›· ÙÔ˘ 1996-1999 ÂÈÎÚ¿ÙËÛÂ Ë ÔÚÔ-ÔÌ¿‰· C (∂ÈÎfiÓ· 4). ¢Â˘ÙÂÚÔ·ı›˜ ÂÚÈÙÒÛÂȘ - ¶ÚԉȷıÂÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ - πÛÙÔÚÈÎfi ÌËÓÈÁÁ›Ùȉ·˜: ∏ ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋ ÌËÓÈÁÁ›Ùȉ· Â›Ó·È Ì›· ÌÂÙ·‰ÔÙÈ΋ ÓfiÛÔ˜ Ô˘ ‰È·Û›ÚÂÙ·È ÙfiÛÔ ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ· fiÛÔ Î·È ÛÙËÓ ÎÔÈÓfiÙËÙ·. ¢Â˘ÙÂÚÔ·ı›˜ ÂÚÈÙÒÛÂȘ ÌËÓÈÁÁ›Ùȉ·˜ ÛÙËÓ ›‰È· ÔÈÎÔÁ¤ÓÂÈ· ·Ú·ÙËÚ‹ıËÎ·Ó Û 7 ·ÛıÂÓ›˜-‰Â›ÎÙ˜ (0,65%), ÂÓÒ ‰Â˘ÙÂÚÔ·ı›˜ ÂÚÈÙÒÛÂȘ Û ‚ÚÂÊÔÓËÈ·ÎÔ‡˜ ÛÙ·ıÌÔ‡˜ ‹ Û¯ÔÏÂ›Ô ÛËÌÂÈÒıËÎ·Ó Û 3 ·ÛıÂÓ›˜-‰Â›ÎÙ˜ (0,3%). ∏ ‡·ÚÍË ÚԉȷıÂÙÈÎÒÓ Î·Ù·ÛÙ¿ÛÂˆÓ ‹ ˘ÔΛÌÂÓˆÓ ÓfiÛˆÓ ‹Ù·Ó Û¿ÓÈ· Î·È ‰È·ÈÛÙÒıËΠ۠17 ·ÛıÂÓ›˜ (ηÎÔ‹ıÂÈ· 1, ÚÔËÁÔ‡ÌÂÓÔ ÂÂÈÛfi‰ÈÔ ÌËÓÈÁÁ›Ùȉ·˜ 7, ¯ÚfiÓÈ· ·ÔÊÚ·ÎÙÈ΋ Ó¢ÌÔÓÔ¿ıÂÈ· 1, Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜ 2, ÎÚ·ÓÈÔÂÁÎÂÊ·ÏÈΤ˜ ηÎÒÛÂȘ 4, ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ· 1 Î·È ÛÏËÓÂÎÙÔÌ‹ 1). £ÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÁÈ· ÌÈÎÚԂȷ΋ ÌËÓÈÁÁ›Ùȉ· ˘‹ÚÍ Û 10 ·fi ÙÔ˘˜ 1070 ·ÛıÂÓ›˜ (0,93%). ¢Â‰Ô̤ӷ ÚÈÓ ÙËÓ ÂÈÛ·ÁˆÁ‹: ¶˘ÚÂÙfi ÚÈÓ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô Â›¯·Ó 1068/1070 (99,8%) ·È‰È¿. ∏ ̤ÛË ‰È¿ÚÎÂÈ· ˘ÚÂÙÔ‡ ‹Ù·Ó 37 ÒÚ˜. ∞ÓÙÈ‚›ˆÛË (IV ‹ IM) ›¯·Ó Ï¿‚ÂÈ 345/1070 (32%) ·ÛıÂÓ›˜: ·ÌÈÎÈÏÏ›ÓË 241, ÎÂÊ·ÏÔÛÔÚ›ÓË ¶›Ó·Î·˜ 1. ª¤ÛË ÂÙ‹ÛÈ· Û˘¯ÓfiÙËÙ· Ù˘ ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋˜ ÌËÓÈÁÁ›Ùȉ·˜ ÛÙË £ÂÛÛ·ÏÔÓ›ÎË ¶ÂÚ›Ô‰Ô˜

¶ÏËı˘ÛÌfi˜ (̤ÛË ÙÈÌ‹)

∞ÚÈıÌfi˜ ·ÛıÂÓÒÓ

™˘¯ÓfiÙËÙ·

1970-1979 1980-1989 1990-1999

871.580 946.864 1.005.431

243 46 31

2,8 0,5 0,3

84 Î·È ·ÌÈÓÔÁÏ˘ÎÔÛ›‰Ë 11. ™Â 9 ÂÚÈÙÒÛÂȘ ‰ÂÓ ·Ó·ÊÂÚfiÙ·Ó ÙÔ Â›‰Ô˜ ÙÔ˘ ·ÓÙÈ‚ÈÔÙÈÎÔ‡ Ô˘ ›¯Â ¯ÔÚËÁËı›. ¢Â‰Ô̤ӷ ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹: OÈ ·ÛıÂÓ›˜ ÂÈÛ‹¯ıËÛ·Ó ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô Â›Ù ̤ۈ ÙÔ˘ ·È‰È¿ÙÚÔ˘ ÙÔ˘˜, ›Ù ̤ۈ ¿ÏÏÔ˘ ÓÔÛÔÎÔÌ›Ԣ ‹ ΤÓÙÚÔ˘ ˘Á›·˜. ∆Ô 90% (963/1070) ÙˆÓ ·È‰ÈÒÓ ÂÈÛ‹¯ıËΠÂÓÙfi˜ 3 ËÌÂÚÒÓ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ÓfiÛÔ˘. ∏ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ‹Ù·Ó ηϋ Û 220/1070 (21%), ̤ÙÚÈ· Û 661/1070 (62%) Î·È ÛÔ‚·Ú‹ Û 189/1070 (18%) ·ÛıÂÓ›˜. ∆· ·ÚÈ· Û˘ÌÙÒÌ·Ù· ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹ Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2. ¶˘ÚÂÙfi ›¯·Ó ÌfiÓÔ ÔÈ 664/1070 ·ÛıÂÓ›˜. ¢È·Ù·Ú·¯¤˜ Û˘ÓÂȉ‹Ûˆ˜ ÔÈ 537/1070, ÂÓÒ Û ÎÒÌ· ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ‹Ù·Ó ÌfiÓÔ 41/1070 (4%) ·ÛıÂÓ›˜. ÀfiÙ·ÛË ‰È·ÈÛÙÒıËΠ۠97/1070 ·ÛıÂÓ›˜, ΢ڛˆ˜ ÌÈÎÚfiÙÂÚÔ˘˜ ÙˆÓ 5 ÂÙÒÓ (72/97). ∆· ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· ·fi ÙÔ ∂¡À ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹ Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 3. O ̤ÛÔ˜ ·ÚÈıÌfi˜ Ï¢ÎÔ΢ÙÙ¿ÚˆÓ ‹Ù·Ó 2263. À„ËϤ˜ ÙÈ̤˜ Ï¢ÎÒÌ·ÙÔ˜ Î·È ¯·ÌËϤ˜ ÙÈ̤˜ ÁÏ˘Îfi˙˘ ‚Ú¤ıËÎ·Ó ÛÙÔ 66% Î·È ÛÙÔ 64% ÙˆÓ ·ÛıÂÓÒÓ ·ÓÙÈÛÙÔ›¯ˆ˜. ∆· ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· ·fi ÙȘ ·Ó·Ï‡ÛÂȘ ·›Ì·ÙÔ˜ Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 4. §Â˘ÎÔ΢ÙÙ¿ÚˆÛË ·Ú·ÙËÚ‹ıËΠÛÙÔ 69% ÙˆÓ ·ÛıÂÓÒÓ. ÷ÌËÏ‹ ÙÈÌ‹ ·ÈÌÔÛÊ·ÈÚ›Ó˘ ÛÙÔ ÂÚÈÊÂÚÈÎfi ·›Ì· ‰È·ÈÛÙÒıËΠÛÙÔ 39% ÙˆÓ ·ÛıÂÓÒÓ. ∏ ∆∫∂ ‹Ù·Ó >50 mm/1Ë ÒÚ· ÛÙÔ 66% Î·È >100 mm/1Ë ÒÚ· ÛÙÔ 17% ÙˆÓ ·ÛıÂÓÒÓ. ∫ÏÈÓÈ΋ ÔÚ›·: ∏ ̤ÛË ‰È¿ÚÎÂÈ· ÓÔÛËÏ›·˜ ‹Ù·Ó 13 Ë̤Ú˜. ¡ÔÛËÏ›· ¿Óˆ ·fi 4 ‚‰ÔÌ¿‰Â˜ ¯ÚÂÈ¿ÛÙËΠÙÔ 5% ÙˆÓ ·ÛıÂÓÒÓ. ∏ ̤ÛË ‰È¿ÚÎÂÈ· ˘ÚÂÙÔ‡ ‹Ù·Ó 3 Ë̤Ú˜ (‡ÚÔ˜ 0-30 Ë̤Ú˜). ™Â 71 ·ÛıÂÓ›˜ Ô ˘ÚÂÙfi˜ ‰È‹ÚÎÂÛ ¿Óˆ ·fi 10 Ë̤Ú˜. ™ÙÔ˘˜ ·ÛıÂÓ›˜ ·˘ÙÔ‡˜ ·Ú·ÙËÚ‹ıËΠ·˘ÍË̤ÓË

200 180

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∂ÈÎfiÓ· 3. ∂ԯȷ΋ ηٷÓÔÌ‹ ÂÚÈÙÒÛÂˆÓ ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋˜ ÌËÓÈÁÁ›Ùȉ·˜.

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35 OÚÔ-ÔÌ¿‰· µ OÚÔ-ÔÌ¿‰· C

30

25 ¶ÂÚÈÙÒÛÂȘ ¡Ô

july-aug02TELIKO

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15

10

5

0

78 979 980 981 982 983 984 985 986 987 988 989 990 991 992 993 994 995 996 997 998 999 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

19

ŒÙË ∂ÈÎfiÓ· 4. ∫·Ù·ÓÔÌ‹ ÔÚÔ-ÔÌ¿‰ˆÓ Û ÂÚÈÙÒÛÂȘ ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋˜ Ïԛ̈͢. ¶›Ó·Î·˜ 2. ∫ÏÈÓÈο ÛÙÔȯ›· ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹ Û 1070 ·È‰È¿ Ì ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋ ÌËÓÈÁÁ›Ùȉ· ™˘ÌÙÒÌ·Ù· ¶˘ÚÂÙfi˜ 38-39ÔC 39,1-40,5ÔC >40,6ÔC ∂Í¿ÓıËÌ· ŒÌÂÙÔÈ ¢È·Ù·Ú·¯¤˜ Û˘Ó›‰ËÛ˘ ∂˘ÂÚÂıÈÛÙfiÙËÙ· ∫ÒÌ· ÀÓËÏ›· ∞Ó·Ó¢ÛÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ ∫ÂÊ·Ï·ÏÁ›· ÀfiÙ·ÛË Shock ™·ÛÌÔ›

∞ÚÈıÌfi˜

%

664 518 142 4 818 870 537 118 41 378 51 495 97 64 84

62 48 13 0,4 76 81 50 11 4 35 5 46 9 6 8

Û˘¯ÓfiÙËÙ· ÂÈÏÔÎÒÓ: ‰È·Ù·Ú·¯¤˜ Û˘Ó›‰ËÛ˘ (42/71), ·ÚıÚ›Ùȉ· (14/71), ÂÚÈηډ›Ùȉ· (2/71), Û·ÛÌÔ› (2/71), ˘ÔÛÎÏËÚ›‰È· Û˘ÏÏÔÁ‹ (3/71). ∞ÈÌÔÚÚ·ÁÈÎfi ÂÍ¿ÓıËÌ· ·ÚÔ˘Û›·Û·Ó 818 ·fi ÙÔ˘˜ 1070 ·ÛıÂÓ›˜ (76%). ™ÙÔ˘˜ 86 ·fi ·˘ÙÔ‡˜ (8%) ˘‹Ú¯·Ó Î·È ÓÂÎÚÒÛÂȘ. ∆Ô ÂÍ¿ÓıËÌ· ‹Ù·Ó ‰È¿Û·ÚÙÔ (484/818, 59%), ·Ú·Èfi (298/818, 36%) ‹ ÂÓÙÔÈṲ̂ÓÔ ÛÙ· οو ¿ÎÚ· (36/818, 4%). ™Â 123/1070 ·ÛıÂÓ›˜ (11%) ·Ú·ÙËÚ‹ıËΠÎËÏȉԂϷÙȉ҉˜ ÂÍ¿ÓıËÌ· ÙËÓ ÚÒÙË Ë̤ڷ Ù˘ ÓfiÛÔ˘: ÙÔ 86% Û ·ÛıÂÓ›˜ Ì ·ÈÌÔÚÚ·ÁÈÎfi ÂÍ¿ÓıËÌ· Î·È ÙÔ 14% Û ·ÛıÂÓ›˜ ¯ˆÚ›˜ ¿ÏÏÔ˘ Ù‡Ô˘

252

ÂÍ¿ÓıËÌ·. ™Â 29 ¿ÏÏÔ˘˜ ·ÛıÂÓ›˜ ·Ú·ÙËÚ‹ıËΠÎËÏȉԂϷÙȉ҉˜ ÂÍ¿ÓıËÌ· ηٿ ÙËÓ ÔÚ›· Ù˘ ÓfiÛÔ˘ Î·È Û 11 Ê˘Û·ÏÏȉ҉˜ ÂÍ¿ÓıËÌ·. ∂ȯ›ÏÈÔ ¤ÚËÙ· ÂÌÊ¿ÓÈÛ·Ó 106/1070 (10%) ·ÛıÂÓ›˜. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÓÔÛËÏ›·˜, ¤Ó·˜ ·ÚÈıÌfi˜ ·ÛıÂÓÒÓ ·ÚÔ˘Û›·Û ‰È¿ÊÔÚ· Ó¢ÚÔÏÔÁÈο Û˘ÌÙÒÌ·Ù·: Û·ÛÌÔ› (26), ¿ÚÂÛË ÎÚ·ÓÈ·ÎÒÓ ÓÂ‡ÚˆÓ (9), ÛÙÚ·‚ÈÛÌfi˜ (7), ·ÚÂÁÎÂÊ·ÏȉÈ΋ ·Ù·Í›· (6), ÎÈÓËÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ (6), Û‡Ó‰ÚÔÌÔ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜ (4), ‰Èψ›· (2), Ó˘ÛÙ·ÁÌfi˜ (1). ∂ÈÏÔΤ˜ ·Ú·ÙËÚ‹ıËÎ·Ó Û 97/1070 (9%) ·ÛıÂÓ›˜: ·ÚıÚ›Ùȉ·, ÌÔÓÔ- ‹ ÔÏ˘- (82), ˘ÔÛÎÏËÚ›‰È· Û˘ÏÏÔÁ‹ (6), ÔÛÙÂÔÌ˘ÂÏ›Ùȉ· (3), ÂÚÈηډ›Ùȉ· (2), ˘Ô‰fiÚÈ· Ô˙›‰È· (4). ¢‡Ô ·ÛıÂÓ›˜ ·Ó¤Ù˘Í·Ó Ï‹ÚË Û˘Ó‰ÚÔÌ‹ ∫awasaki, ÓˆÚ›˜ ηٿ ÙËÓ ÔÚ›· Ù˘ ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋˜ ÌËÓÈÁÁ›Ùȉ·˜. ŒÎ‚·ÛË: ∏ ıÓËÙfiÙËÙ· ÛÙÔ ˘ÏÈÎfi Ì·˜ ‹Ù·Ó 1,1% (12/1070 ·ÛıÂÓ›˜). ŸÏÔÈ ÔÈ ı¿Ó·ÙÔÈ Û˘Ó¤‚ËÛ·Ó ÙËÓ ÂÚ›Ô‰Ô 1970-1982. ŒÎÙÔÙÂ, ‰ÂÓ ·Ú·ÙËÚ‹ıËΠı¿Ó·ÙÔ˜ ·fi ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋ ÌËÓÈÁÁ›Ùȉ·. ÀÔÏ›ÌÌ·Ù· ·ÚÔ˘Û›·Û·Ó ÔÈ 26 ·fi ÙÔ˘˜ 1058 ÂÈ˙‹Û·ÓÙ˜ (2,4%). O Ù‡Ô˜ ÙˆÓ ˘ÔÏÂÈÌÌ¿ÙˆÓ Ê·›ÓÂÙ·È ÛÙÔÓ ¶›Ó·Î· 5. ™˘¯ÓfiÙÂÚÔ ˘fiÏÂÈÌÌ· ‹Ù·Ó Ë ·Ú¿Ï˘ÛË ÎÚ·ÓÈ·ÎÔ‡ Ó‡ÚÔ˘ (17/1058) Î·È Ë ‰È·Ù·Ú·¯‹ Ù˘ ·ÎÔ‹˜ (9/1058). ™˘˙‹ÙËÛË ∏ ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋ Ïԛ̈ÍË ·Ú·Ì¤ÓÂÈ Ì›· ·ÂÈÏËÙÈ΋ ÓfiÛÔ˜ ÁÈ· ÙË ˙ˆ‹ Î·È ·ÔÙÂÏ› ·ÎfiÌË

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¶›Ó·Î·˜ 3. ∂˘Ú‹Ì·Ù· ·fi ÙÔ ∂¡À Û 1070 ·È‰È¿ Ì ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋ ÌËÓÈÁÁ›Ùȉ·

3

ñ §Â˘ÎÔ·ÙÙ·Ú· (/mm ) 0-500 501-1000 1001-2000 >2000 ñ °Ï˘Îfi˙Ë (mg/dl) 0-20 21-40 >40 ñ §Â‡ÎˆÌ· (mg/dl) <100 101-200 >200

ª¤ÛË ÙÈÌ‹ ± ™∞

¢È·Î‡Ì·ÓÛË

∞ÚÈıÌfi˜

2263 ± 2253

20-27.000

1065 191 73 149 652 1036 290 371 375 1006 346 282 378

36 ± 23

184 ± 140

0-150

10-980

% 18 7 14 62 28 36 36 34 28 38

¶›Ó·Î·˜ 4. ∂ÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· Û 1070 ·È‰È¿ Ì ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋ ÌËÓÈÁÁ›Ùȉ·

ñ Hb (g/dl) <10 >10 ñ §Â˘ÎÔ·ÙÙ·Ú· (/mm3) <10.000 >10.000 ñ ∆∫∂ (mm/1Ë ÒÚ·) <20 20-50 51-100 >100 ñ ÃÚ. ÚÔıÚÔÌ‚›Ó˘ <20 >20 ñ πÓˆ‰ÔÁfiÓÔ (mg/dl) <300 >300

ª¤ÛË ÙÈÌ‹ ± ™∞

¢È·Î‡Ì·ÓÛË

∞ÚÈıÌfi˜

10,6 ± 1,7

4,5-16,3

1030 402 628 1053 322 731 986 93 246 477 170 256 238 18 215 103 112

14281 ± 6783

67 ± 33,8

13 ± 0,5

431 ± 137

·ÁÎfiÛÌÈÔ Úfi‚ÏËÌ· (4). øÛÙfiÛÔ, Ú¤ÂÈ Ó· ÙÔÓÈÛÙ› fiÙÈ Î‡ÚÈÔ˜ Êfi‚Ô˜ Â›Ó·È Ë ÎÂÚ·˘ÓÔ‚fiÏÔ˜ ÌÔÚÊ‹ Ù˘ ÓfiÛÔ˘, Ë ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋ ÛË„·ÈÌ›·, Ì ıÓËÙfiÙËÙ· Ô˘ ˘ÂÚ‚·›ÓÂÈ ÙÔ >10% (4-8). ∞ÓÙ›ıÂÙ·, Ë ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋ ÌËÓÈÁÁ›Ùȉ· ¤¯ÂÈ ÌÈÎÚfi ÔÛÔÛÙfi ıÓËÙfiÙËÙ·˜, fiˆ˜ ÚÔ·ÙÂÈ ÙfiÛÔ ·fi ‰È¿ÊÔÚ˜ (7,9-11) fiÛÔ Î·È ·fi ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË. ∏ ÛËÌ·ÓÙÈÎfiÙÂÚË ·Ú¿ÌÂÙÚÔ˜ ÁÈ· ÙË ÓfiÛÔ Â›Ó·È Ë ¤ÁηÈÚË ·Ó·ÁÓÒÚÈÛ‹ Ù˘ ·fi ÙÔÓ È·ÙÚfi, οÙÈ Ô˘ ÔÏϤ˜ ÊÔÚ¤˜ ÌÔÚ› Ó· Â›Ó·È Ì›· ‰‡ÛÎÔÏË ‰ÈÂÚÁ·Û›·. ŸÏÔÈ ÔÈ ÁÈ·ÙÚÔ› Ú¤ÂÈ Ó· ¤¯Ô˘Ó ˘„ËÏfi ‰Â›ÎÙË ˘fiÓÔÈ·˜ ÁÈ· ÙË ÓfiÛÔ, ‰ÈfiÙÈ Ë ·Ú¯È΋ ‰È¿ÁÓˆÛË ‚·Û›˙ÂÙ·È ÌfiÓÔ Û ÎÏÈÓÈο ÎÚÈÙ‹ÚÈ·. ∆Ô ÂÍ¿ÓıËÌ·, Ô˘ ·ÔÙÂÏ› ¤Ó· ·fi Ù· ¯·Ú·ÎÙËÚÈÛÙÈο Ù˘ ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋˜ Ïԛ̈͢, ·Ô˘ÛÈ¿˙ÂÈ ÔÏϤ˜ ÊÔÚ¤˜, ÂÓÒ, ·Ó ˘¿Ú¯ÂÈ, ÌÔÚ› Ó· Â›Ó·È ÎËÏȉԂϷÙȉ҉˜ ÛÙ· ·Ú¯Èο ÛÙ¿‰È· Ù˘ ÓfiÛÔ˘ (12-14). ∆Ô 23% ÙˆÓ ·ÛıÂÓÒÓ Ì·˜ ‰ÂÓ Â›¯Â ÂÍ¿ÓıËÌ· Î·È ÙÔ 11% ›¯Â ÌfiÓÔ ÎËÏȉԂϷÙȉ҉˜ ÂÍ¿ÓıËÌ·. ∏ ·Ó·˙‹ÙËÛË Î·È ÌË ‰È·›ÛÙˆÛË Ù˘ ÎÏ·ÛÈ΋˜ Û˘Ìو̷ÙÔÏÔÁ›·˜ Ù˘ ÌËÓÈÁÁ›Ùȉ·˜ (˘ÚÂÙfi˜, ÎÂ-

1600-51700

3-141

12-70

6-866

% 39 61 30 69 9 25 48 17 93 7 48 52

Ê·Ï·ÏÁ›·, ¤ÌÂÙÔÈ, ÌËÓÈÁÁÈÛÌfi˜, ‰È·Ù·Ú·¯¤˜ Û˘Ó›‰ËÛ˘, ÂÙ¤¯ÂȘ) ‰ÂÓ ı· Ú¤ÂÈ Ó· ÂÊËÛ˘¯¿˙ÂÈ ÙÔÓ È·ÙÚfi, ‰ÈfiÙÈ ÔÏϤ˜ ÊÔÚ¤˜ Ë ÎÏ·ÛÈ΋ ·˘Ù‹ Û˘Ìو̷ÙÔÏÔÁ›· ÂÏÏ›ÂÈ ‹ Â›Ó·È ÌÂÚÈÎÒ˜ ¤Î‰ËÏË. ¢È·Ù·Ú·¯¤˜ Û˘Ó›‰ËÛ˘ Î·È ÎÂÊ·Ï·ÏÁ›· ›¯Â ÙÔ 50% ÙˆÓ ·ÛıÂÓÒÓ Ì·˜. ∂̤ÙÔ˘˜ ÂÌÊ¿ÓÈÛ ÙÔ 81%, ÂÓÒ ˘ÚÂÙfi ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ›¯Â ÌfiÓÔ ÙÔ 62% ÙˆÓ ·ÛıÂÓÒÓ. πÛÙÔÚÈÎfi, fï˜, ˘ÚÂÙÔ‡ ·Ó¤ÊÂÚ ÙÔ 99% ÙˆÓ ·ÛıÂÓÒÓ. ∏ ‰È·ÊÔÚ¿ ·˘Ù‹ ÙÔ˘ ÔÛÔÛÙÔ‡ ÙÔ˘ ˘ÚÂÙÔ‡ ÚÈÓ Î·È Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹, ·Ô‰›‰ÂÙ·È ÛÙË Ï‹„Ë ·ÓÙÈ˘ÚÂÙÈÎÒÓ, ΢ڛˆ˜ ÛÙ· ÓÔÛÔÎÔÌ›· ‹ ÛÙ· ΤÓÙÚ· ˘Á›·˜ ·fi fiÔ˘ ÂÛÙ¿ÏËÛ·Ó Ù· ·È‰È¿. ∏ Ï‹„Ë ·ÓÙÈ‚ÈÔÙÈÎÒÓ (Ô˘ ‰È¤Ú¯ÔÓÙ·È ÙÔ ∂¡À) ÚÈÓ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÂÚÈÔÚÈ˙fiÙ·Ó Û 1 ‹ 2 ‰fiÛÂȘ ·ÌÈÎÈÏÏ›Ó˘ ‹ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· Û 1 ‰fiÛË ÎÂÊÙÚÈ·ÍfiÓ˘. ∂›Ó·È ÁÓˆÛÙfi fiÙÈ ÛÙË ÌËÓÈÁÁ›Ùȉ· ˘ÚÂÙfi ÌÔÚ› Ó· ÌËÓ ÂΉËÏÒÛÔ˘Ó Ù· ÓÂÔÁÓ¿ Î·È ‚Ú¤ÊË ‹ ÔÈ ‚·ÚÈ¿ ¿Û¯ÔÓÙ˜ (1). ∏ Ïԛ̈ÍË ·fi N. meningitidis Â›Ó·È Ì›· ÏÔÈÌ҉˘ ÓfiÛÔ˜ Ô˘ ÌÂÙ·‰›‰ÂÙ·È ·fi ¿ÙÔÌÔ Û ¿ÙÔÌÔ Ì ÙËÓ ·Ó·Ó¢ÛÙÈ΋ Ô‰fi Î·È ¤¯ÂÈ ÙËÓ Ù¿ÛË Ó·

253

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¶›Ó·Î·˜ 5. ÀÔÏ›ÌÌ·Ù· ηٿ ÙËÓ ¤ÍÔ‰Ô ·fi ÙÔ ÓÔÛÔÎÔÌÂ›Ô Û 1058 ·È‰È¿ Ì ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋ ÌËÓÈÁÁ›Ùȉ·

¶·Ú¿Ï˘ÛË ÎÚ·ÓÈ·ÎÒÓ ÓÂ‡ÚˆÓ ¢È·Ù·Ú·¯¤˜ ·ÎÔ‹˜ O˘Ï¤˜ ‰ÂÚÌ·ÙÈÎÒÓ ÓÂÎÚÒÛÂˆÓ À‰ÚÔΤʷÏÔ˜

∞ÚÈıÌfi˜

%

17 9 2 1

1,6 0,8 0,2 0,1

‰È·Û›ÚÂÙ·È ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ· Î·È ÛÙËÓ ÎÔÈÓfiÙËÙ·.

O ΛӉ˘ÓÔ˜ ÂÓ‰Ô-ÔÈÎÔÁÂÓÂȷ΋˜ ÌÂÙ¿‰ÔÛ˘ ·Ó·Ê¤ÚÂÙ·È Û ÔÛÔÛÙfi 4-5% (8). O Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜ ÁÈ· ÙÔ˘˜ ‚ÚÂÊÔÓËÈ·ÎÔ‡˜ ÛÙ·ıÌÔ‡˜ Â›Ó·È ÌÈÎÚfiÙÂÚÔ˜, ·ÏÏ¿ fi¯È ·ÌÂÏËÙ¤Ô˜ (8,15). ™ÙÔ ˘ÏÈÎfi Ù˘ ÌÂϤÙ˘ Ì·˜ ‰Â‡ÙÂÚÔ ÎÚÔ‡ÛÌ· ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ· ·Ú·ÙËÚ‹ıËΠ۠ÔÛÔÛÙfi 0,65%, ÂÓÒ ‰Â‡ÙÂÚÔ ÎÚÔ‡ÛÌ· Û ‚ÚÂÊÔÓËÈ·Îfi ÛÙ·ıÌfi Û ÔÛÔÛÙfi 0,3%. ∂ӉȷʤÚÔ˘Û· Â›Ó·È Ë ·Ú·ÙËÚÔ‡ÌÂÓË ÛÙ·ıÂÚ‹ Ì›ˆÛË Ù˘ ÓfiÛÔ˘ ÛÙËÓ ÂÚÈÔ¯‹ Ì·˜. ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· Ù˘ ÌÂϤÙ˘ (1996-1999) ·Ú·ÙËÚ‹ıËΠÂȉËÌ›· Ù˘ ÓfiÛÔ˘, ÙfiÛÔ ÛÙËÓ ÂÚÈÔ¯‹ Ì·˜ fiÛÔ Î·È ÛÙË ÏÔÈ‹ ¯ÒÚ· (16). OÈ ÂÚÈÙÒÛÂȘ ‹Ù·Ó ۯ‰fiÓ ‰ÈÏ¿ÛȘ ÙˆÓ ÚÔËÁÔ‡ÌÂÓˆÓ ÂÙÒÓ, ¯ˆÚ›˜ fï˜ Ó· Êı¿ÛÔ˘Ó ÙÔÓ ·ÚÈıÌfi ·ÛıÂÓÒÓ ÙˆÓ ÚÒÙˆÓ 10 ÂÙÒÓ Ù˘ ÌÂϤÙ˘. ∫‡ÚÈ· ÔÚÔ-ÔÌ¿‰· ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂȉËÌ›·˜ ‹Ù·Ó Ë C. ∫·Ù¿ ÙË ¯ÚÔÓÈ΋ ÂÚ›Ô‰Ô, fï˜, Ù˘ ÌÂϤÙ˘, ·ÚÈ· ÔÚÔÔÌ¿‰· Û˘ÓÔÏÈο ‹Ù·Ó Ë µ (16). ∞‡ÍËÛË Ù˘ ÔÚÔÔÌ¿‰·˜ C ÙËÓ ÂÚ›Ô‰Ô 1996-1999 ·Ú·ÙËÚ‹ıËÎÂ Î·È Û ¿ÏϘ ¯ÒÚ˜ Ù˘ ∂˘ÚÒ˘ Î·È Ù˘ ∞ÌÂÚÈ΋˜ (11,17,18). ∆Ô Û‡Ó‰ÚÔÌÔ Kawasaki Ô˘ ·Ú·ÙËÚ‹ıËΠηٿ ÙË ‰È·‰ÚÔÌ‹ Ù˘ ÌËÓÈÁÁ›Ùȉ·˜ Û 2 ·ÛıÂÓ›˜, ·ÔÙÂÏ› ˆ˜ ÁÓˆÛÙfiÓ Ì›· ÔÏ˘Û˘ÛÙËÌ·ÙÈ΋ Û˘Ó‰ÚÔÌ‹ Ô˘ ÚÔÛ‚¿ÏÏÂÈ Ù· ·ÁÁ›·. ∏ ·ÈÙÈÔÏÔÁ›· Ù˘ Â›Ó·È ¿ÁÓˆÛÙË, ·Ó Î·È ¤¯ÂÈ Û˘Ó‰Âı› Ì ÔÏÏÔ‡˜ ÏÔÈÌÔÁfiÓÔ˘˜ ·Ú¿ÁÔÓÙ˜. º˘ÛÈο, ‰ÂÓ ÌÔÚԇ̠ӷ Û˘ÌÂÚ¿ÓÔ˘Ì ·Ó Ë ÂΉ‹ÏˆÛË Ù˘ ÓfiÛÔ˘ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì·˜ ‹Ù·Ó ÂÈÏÔ΋ Ù˘ ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋˜ ÌËÓÈÁÁ›Ùȉ·˜ ‹ Ì›· Û˘Ì·ÚÔÌ·ÚÙÔ‡Û· ÓfiÛÔ˜. ∏ ıÓËÙfiÙËÙ· ·fi ÙË ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋ ÌËÓÈÁÁ›Ùȉ· ‹Ù·Ó ÌÈÎÚ‹ Î·È ÂÚÈÔÚ›ÛÙËΠ̤¯ÚÈ ÙÔ 1982. ™‡ÁÎÚÈÛË ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ·‚›ˆÛ·Ó Ì ÔÌ¿‰· ·ÛıÂÓÒÓ ›‰ÈÔ˘ ʇÏÔ˘, ËÏÈΛ·˜ Î·È ‚·Ú‡ÙËÙ·˜ ÓfiÛÔ˘ Ô˘ Â¤˙ËÛ·Ó, ¤‰ÂÈÍ fiÙÈ ÔÈ ·Ô‚ÈÒÛ·ÓÙ˜ ·ÛıÂÓ›˜ ›¯·Ó ‚Ú·¯‡ÙÂÚÔ ÈÛÙÔÚÈÎfi ÚÈÓ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘˜ ÛÙÔ ÓÔÛÔÎÔÌ›Ô, ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ‰È·Ù·Ú·¯ÒÓ Û˘Ó›‰ËÛ˘ Î·È ˘„ËÏfiÙÂÚÔ ÔÛÔÛÙfi ‰È¿¯˘ÙÔ˘ ·ÈÌÔÚÚ·ÁÈÎÔ‡ ÂÍ·Óı‹Ì·ÙÔ˜ (¶›Ó·Î·˜ 6). ∏ ̤ÛË ËÏÈΛ· ÙˆÓ ı·ÓfiÓÙˆÓ ‹Ù·Ó 36 Ì‹Ó˜. OÈ ÂÚÈÛÛfiÙÂÚÔÈ ·fi ·˘ÙÔ‡˜ ÂÈÛ‹¯ıËÛ·Ó ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô ÙÔ ÚÒÙÔ 24ˆÚÔ Ù˘ ÓfiÛÔ˘ Î·È ÙÔ 75% ·‚›ˆÛ ÙËÓ ÚÒÙË Ë̤ڷ ÂÈÛ·ÁˆÁ‹˜. ™Ù·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ‰ÂÓ ¤ÁÈÓÂ, ‰ÈfiÙÈ Ô ·ÚÈıÌfi˜ ÙˆÓ ı·ÓfiÓÙˆÓ

254

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ıˆڋıËΠÌÈÎÚfi˜ ÁÈ· ÂÍ·ÁˆÁ‹ Û˘ÌÂÚ·ÛÌ¿ÙˆÓ. ™˘ÌÂÚ·ÛÌ·ÙÈο, Ë ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋ ÌËÓÈÁÁ›Ùȉ· Ê·›ÓÂÙ·È fiÙÈ ·ÚÔ˘ÛÈ¿˙ÂÈ ÙˆÙÈ΋ Ù¿ÛË ÛÙËÓ ÂÚÈÔ¯‹ Ì·˜, ¤¯ÂÈ ‹È· ÎÏÈÓÈ΋ ÔÚ›·, ÌÈÎÚfi ÔÛÔÛÙfi ıÓËÙfiÙËÙ·˜ (Ë ÌËÓÈÁÁ›Ùȉ·, fi¯È Ë ÌËÓÈÁÁÈÙȉÔÎÔÎηÈÌ›·) Î·È ¯·ÌËÏfi, Â›Û˘, ÔÛÔÛÙfi ˘ÔÏÂÈÌÌ¿ÙˆÓ. µÈ‚ÏÈÔÁÚ·Ê›· 1. Apicella MA. N. meningitidis. In: Mandell, Douglas and Bennett’s, eds. Principle and practice of infectious diseases. 5th ed (electronic). London: Churchill; 2000.

2. Feigin RD, Pearlman E. Bacterial meningitis beyond the neonatal period. In: Feigin RD, Cherry FD, eds. Textbook of Pediatric Infectious Diseases. 4th ed. London: WB Saunders Co; 1998. p. 400-429.

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

4. American Academy of Pediatrics. Meningococcal disease prevention and central strategies for practice based physicians. Pediatrics 1996;97:404-412.

5. Rosenstein NE, Perkins BA, Stephens DS, Popovic T, Hughes JM. Meningococcal disease. N Engl J Med 2001;344:1378-1388.

6. Malley R, Inkelis SH, Coelho P, Huskins WC, Kupperman N. Cerebrospinal fluid pleocytosis and prognosis in invasive meningococcal disease in children. Pediatr Infect Dis J 1998;17:855-859.

7. Van Deuren M, Brandtzaeg P, van der Meer J. Update on meningococcal disease with emphasis on pathogenesis and clinical management. Clin Microbiol Rev 2000;13:144-166.

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

9. Juncal AR, Molino ML, Rodriguez I, Cid A, Guillan B, Pardo F. Clinical and epidemiologic study of meningococcal meningitis 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 of meningococcal 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

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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 Infect 1992;25:321-328.

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

15. De Wols P, Hertoge L, Borlee-Grimee I. Meningococcal disease in Belgium. Secondary attack rate among household day care nursery and pre-elementary school contacts. 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 of serogroup C meningococcal disease in Greece. FEMS Immunol Med Microbiol 1999;23:49-51.

Paediatriki 2002;65:248-255

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

18. Ferreiros CM, Gomez JA, Criado M. Prevention of meningococcal disease: present and future. Rev Med Microbiol 1998;9:29-37.

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¶ÂÚ›ÏË„Ë ¿ÚıÚÔ˘ ·fi ÙË µÈ‚ÏÈÔÁÚ·Ê›· ∫˘ÎÏÔÊÔÚÔ‡Û˜ Û˘ÁÎÂÓÙÚÒÛÂȘ ¯˘ÌÔÎÈÓÒÓ Û ·›Ì· ÔÌÊ¿ÏÈÔ˘ ÏÒÚÔ˘ Û ÓÂÔÁÓ¿ Î·È ÂÓ‹ÏÈΘ1 ∂ÈÛ·ÁˆÁ‹: OÈ ¯˘ÌÔΛÓ˜ Â›Ó·È ÛËÌ·ÓÙÈΤ˜ ÁÈ· ÙËÓ ÎÈÓËÙÈÎfiÙËÙ· ÙˆÓ Ï¢ÎÔ΢ÙÙ¿ÚˆÓ. Œ¯ÂÈ ‚ÚÂı› fiÙÈ Ë ¯ËÌÂÈÔÙ·Í›· Â›Ó·È ·ÓÂ·Ú΋˜ ÛÙ· ÓÂÔÁÓ¿ Î·È È‰È·›ÙÂÚ· ÛÙ· ÚfiˆÚ·. ∏ ·ÓÂ¿ÚÎÂÈ· ·˘Ù‹ Èı·Ó¿ Û˘Ì‚¿ÏÏÂÈ ÛÙËÓ ·˘ÍË̤ÓË Â˘·ÈÛıËÛ›· Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ù· ÓÂÔÁÓ¿ ÛÙË Û‹„Ë. ¢ÂÓ ¤¯ÂÈ ‰ËÌÔÛÈ¢ı› ÔȘ Â›Ó·È ÔÈ Û˘ÁÎÂÓÙÚÒÛÂȘ ÙˆÓ ¯˘ÌÔÎÈÓÒÓ ÛÙ· ÓÂÔÁÓ¿, Ô‡ÙÂ Â›Ó·È ÁÓˆÛÙfi Â¿Ó ÔÈ ¯·ÌËϤ˜ ·˘Ù¤˜ Û˘ÁÎÂÓÙÚÒÛÂȘ Û˘Ì‚¿ÏÏÔ˘Ó ÛÙËÓ ·ÓÂ·Ú΋ ¯ËÌÂÈÔÙ·Í›· Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ù· ÓÂÔÁ¤ÓÓËÙ·. ™ÎÔfi˜: ¢È·Ù˘ÒÛ·Ì ÙËÓ ˘fiıÂÛË fiÙÈ ÔÈ Û˘ÁÎÂÓÙÚÒÛÂȘ ÙˆÓ ¯˘ÌÔÎÈÓÒÓ ÙÔ˘ ÔÚÔ‡: 1) ı· Ú¤ÂÈ Ó· Â›Ó·È ¯·ÌËÏfiÙÂÚ˜ ÛÙ· ÚfiˆÚ· Û˘ÁÎÚÈÓfiÌÂÓ˜ Ì ÂΛӘ ÙˆÓ ÙÂÏÂÈfiÌËÓˆÓ Î·È 2) ı· Ú¤ÂÈ, Â›Û˘, Ó· Â›Ó·È ¯·ÌËÏfiÙÂÚ˜ ÙfiÛÔ ÛÙ· ÚfiˆÚ· fiÛÔ Î·È ÛÙ· ÙÂÏÂÈfiÌËÓ·, ·fi ÙȘ ·ÓÙ›ÛÙÔȯ˜ Û˘ÁÎÂÓÙÚÒÛÂȘ ÙˆÓ ÂÓËϛΈÓ. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ¢Â›ÁÌ·Ù· ·›Ì·ÙÔ˜ ÂÏ‹ÊıËÛ·Ó ·fi ÚfiˆÚ· Î·È ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿ ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ÙÔÓ ·fiÏ˘ÙÔ ·ÚÈıÌfi ÙˆÓ ÔÏ˘ÌÔÚÊÔ‡ÚËÓˆÓ Î·È ËˆÛÈÓÔÊ›ÏˆÓ ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜. ∂›Û˘, ÂÏ‹ÊıË ‰Â›ÁÌ· ·›Ì·ÙÔ˜ ÔÌÊ¿ÏÈÔ˘ ÏÒÚÔ˘ ÚfiˆÚˆÓ Î·È ÙÂÏÂÈfiÌËÓˆÓ ÓÂÔÁÓÒÓ ·fi ÂÁ΢ÌÔÓÔ‡Û˜ Ô˘ ‰ÂÓ Â›¯·Ó ÎÏÈÓÈΤ˜ ÂӉ›ÍÂȘ ¯ÔÚÈÔ·ÌÓÈÔÓ›Ùȉ·˜, ηıÒ˜ Â›Û˘ Î·È ·fi ˘ÁÈ›˜ ÂıÂÏÔÓÙ¤˜ ÂÓ‹ÏÈΘ. ∏ Ù¯ÓÈ΋ ELISA ¯ÚËÛÈÌÔÔÈ‹ıËΠÁÈ· ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙˆÓ Û˘ÁÎÂÓÙÚÒÛÂˆÓ ÛÙÔÓ ÔÚfi ÙˆÓ ¯˘ÌÔÎÈÓÒÓ: ∂¡∞-78 (epithelial neutrophil activating peptide-78), ÙÔ˘ GRO-· (growth-related oncogene-·), Ù˘ eotaxin ÙÔ˘ RANTES (regulated upon

activation, normal T cell expressed and secreted) Î·È ÙÔ˘ ªπƒ-1· (macrophage inflammatory protein 1·). ∞ÔÙÂϤÛÌ·Ù·: ∆· Â›‰· ÙˆÓ ¯˘ÌÔÎÈÓÒÓ ÛÙÔÓ ÔÚfi ÙˆÓ ÚÔÒÚˆÓ ‹Ù·Ó ›Ù ›‰È· ‹ Î·È ˘„ËÏfiÙÂÚ· ·fi ÂΛӷ Ô˘ ‚Ú¤ıËÎ·Ó ÛÙ· ÙÂÏÂÈfiÌËÓ· Î·È ÙÔ˘˜ ÂÓ‹ÏÈΘ. ™˘ÌÂÚ¿ÛÌ·Ù·: ¶ÈÛÙ‡ԢÌ fiÙÈ Ë ¯ËÌÂÈÔÙ·ÎÙÈ΋ ·ÓÂ¿ÚÎÂÈ· Ô˘ ·Ú·ÙËÚÂ›Ù·È ÛÙ· ÚfiˆÚ· ÓÂÔÁÓ¿ ‰ÂÓ Û¯ÂÙ›˙ÂÙ·È Ì ÙȘ ÂÏ·Ùو̤Ó˜ Û˘ÁÎÂÓÙÚÒÛÂȘ ÛÙÔÓ ÔÚfi ÔÔÈ·Û‰‹ÔÙ ·fi ÙȘ ÂȉÈΤ˜ ¯˘ÌÔΛÓ˜ Ô˘ ÚÔÛ‰ÈÔÚ›ÛÙËηÓ.

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

ºˆÙfiÔ˘ÏÔ˜ ™‡ÚÔ˜ ¶·È‰›·ÙÚÔ˜-¡ÂÔÁÓÔÏfiÁÔ˜ ¢È‰¿ÎÙˆÚ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ∞Ó·ÏËÚˆÙ‹˜ ¢È¢ı˘ÓÙ‹˜ µ’ ª∂¡ ¡ÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ “∏ ∞Á›· ™ÔÊ›·”

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ORIGINAL ARTICLE

ÕÙ˘˜ ÂΉËÏÒÛÂȘ Ù˘ ÏÔÈÌÒ‰Ô˘˜ ÌÔÓÔ˘Ú‹ÓˆÛ˘ ÛÙ· ‚Ú¤ÊË Î·È Ù· ÌÈÎÚ¿ Ó‹È· ∞. ™ÈÒÌÔ˘1, ª. ∆˙Ô‡ÊË1, ∂. °·Ï·Ó¿Î˘1, ∂. ∫ÚËÙÈÎÔ‡1, ∞. ∫ˆÛÙԇϷ2, ∞. ™È·ÌÔÔ‡ÏÔ˘ - ª·˘Ú›‰Ô˘1, ∑. ¶··‰ÔÔ‡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

¶ÂÚ›ÏË„Ë: H ÏÔÈÌ҉˘ ÌÔÓÔ˘Ú‹ÓˆÛË (§M) ·fi ÙÔÓ Èfi Epstein-Barr (EBV) Ê·›ÓÂÙ·È fiÙÈ Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ Û˘¯Ó‹ ÛÙË ÌÈÎÚ‹ ·È‰È΋ ËÏÈΛ·, ·’ fiÛÔ ıˆÚÔ‡ÓÙ·Ó ÛÙÔ ·ÚÂÏıfiÓ. ™Â ·ÓÙ›ıÂÛË Ì ÙÔ˘˜ ÂÓ‹ÏÈΘ Î·È Ù· ÌÂÁ·Ï‡ÙÂÚ˘ ËÏÈΛ·˜ ·È‰È¿, Ë Ïԛ̈ÍË ÛÙË ‚ÚÂÊÈ΋ Î·È ÚÒÈÌË ÓËȷ΋ ËÏÈΛ· ¯·Ú·ÎÙËÚ›˙ÂÙ·È Û˘Ó‹ıˆ˜ ·fi ‹È· Û˘Ìو̷ÙÔÏÔÁ›·. øÛÙfiÛÔ, Û ÔÚÈṲ̂Ó˜ ÂÚÈÙÒÛÂȘ ÔÈ ÂΉËÏÒÛÂȘ Ù˘ ÌÔÚ› Ó· Â›Ó·È È‰È·›ÙÂÚ· ¿Ù˘˜ ·ÏÏ¿ Î·È ·ÓËÛ˘¯ËÙÈΤ˜. ¶·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ù· ÎÏÈÓÈο Î·È ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· Ù˘ Ïԛ̈͢ ·fi ÙÔÓ EBV Û ٤ÛÛÂÚ· ·È‰È¿, ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ 2 ÂÙÒÓ, Ô˘ ÓÔÛËχÙËÎ·Ó ÛÙËÓ ¶·ÓÂÈÛÙËÌȷ΋ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ πˆ·ÓÓ›ÓˆÓ, Ì ȉȷ›ÙÂÚ· ¿Ù˘˜ ÂΉËÏÒÛÂȘ Ù˘ ÓfiÛÔ˘. H ÚÒÙË ÂÚ›ÙˆÛË ÂÌÊ·Ó›ÛÙËΠ̠·Ú·ÙÂÈÓfiÌÂÓÔ ÂÌ‡ÚÂÙÔ, Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›·, ıÚÔÌ‚ÔÂÓ›· Î·È ·Ú¿Ù·ÛË ÙÔ˘ ¯ÚfiÓÔ˘ ÂÓÂÚÁÔÔÈË̤Ó˘ ÌÂÚÈ΋˜ ıÚÔÌ‚ÔÏ·ÛÙ›Ó˘ (APTT) ÂÍ·ÈÙ›·˜ Ù˘ ‡·Ú͢ ıÂÙÈÎÔ‡ ·ÓÙÈËÎÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ÙÔ˘ χÎÔ˘. H ‰Â‡ÙÂÚË ·ÚÔ˘ÛÈ¿ÛÙËΠ̠˘ÂÚ˘ÚÂÍ›·, Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›·, Ë·ÙÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·, ›ÎÙÂÚÔ, Ï¢ÎÔÂÓ›·, ıÚÔÌ‚ÔÂÓ›·, ·Ó·ÈÌ›·, ÌÂÁ¿ÏË ·‡ÍËÛË LDH Î·È ÊÂÚÚÈÙ›Ó˘, Â˘Ú‹Ì·Ù· ÂÓ‰ÂÈÎÙÈο ‡·Ú͢ ·ÈÌÔÊ·ÁÔ΢ÙÙ·ÚÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘. ™ÙËÓ ÙÚ›ÙË ÂÚ›ÙˆÛË ÛËÌÂÈÒıËΠ¤ÓÙÔÓË Ï¢ÎÔ΢ÙÙ¿ÚˆÛË, ÂÓÒ ÛÙËÓ Ù¤Ù·ÚÙË, ¤Ú·Ó Ù˘ ÂÎÛÂÛËÌ·Ṳ̂Ó˘ Ï¢ÎÔ΢ÙÙ¿ÚˆÛ˘, Û˘Ó˘‹Ú¯Â Â›ÌÔÓË ‚Ï·Ùȉ҉˘ ·ÎÚÔ‰ÂÚÌ·Ù›Ùȉ· (ˆ˜ Â› Û˘Ó‰ÚfiÌÔ˘ GianottiCrosti). ™˘ÌÂÚ·ÛÌ·ÙÈο, Ê·›ÓÂÙ·È fiÙÈ Ë §M ÛÙ· ‚Ú¤ÊË Î·È Ù· ÌÈÎÚ¿ Ó‹È· ÌÔÚ› Ó· ÂΉËψı› Ì ¿Ù˘· Î·È ÛÔ‚·Ú¿ Û˘ÌÙÒÌ·Ù·, ·ÏÏ¿ Î·È Ì ȉȷ›ÙÂÚ· ·ÈÌ·ÙÔÏÔÁÈο ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· ηÈ

Abstract: Epstein-Barr virus infectious mononucleosis appears to occur more frequently during early childhood than it was considered in the past.

In contrast to the adults and older children, the infection in infants and toddlers is usually characterized by mild symptoms. However, in some cases, the clinical manifestations may be rather atypical and severe. We present the clinical and laboratory findings of EBV infection in four children younger than 2 years of age, who were admitted to the Department of Pediatrics of the University Hospital of Ioannina, with very unusual manifestations. The first case presented with persistent pyrexia, hepatosplenomegaly, thrombocytopenia and prolonged activated partial thromboplastin time (APTT) due to the presence of lupus anticoagulant. The second presented with hyperpyrexia, hepatosplenomegaly, liver dysfunction, jaundice, leukocytopenia, thrombocytopenia, anemia and significant elevation of LDH and ferritin levels, findings compatible with hemophagocytic syndrome. In the third case there was marked leukocytosis, while in the fourth, besides the presence of leucocytosis, there was also persistent papular acrodermatitis (resembling the Gianotti-Crosti syndrome). In conclusion, it seems that infectious mononucleosis in infants and toddlers may be manifested with atypical and severe symptoms as well as specific hematological laboratory findings and should, therefore, be included in the differential diagnosis of hematologic abnormalities in infancy and early childhood.

1 ∆Ô̤·˜ ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡, ¶·ÓÂÈÛÙËÌÈ·Îfi ¡ÔÛÔÎÔÌÂ›Ô πˆ·ÓÓ›ÓˆÓ 2 ªÈÎÚÔ‚ÈÔÏÔÁÈÎfi ∂ÚÁ·ÛÙ‹ÚÈÔ, ¶·ÓÂÈÛÙËÌÈ·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

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Paediatriki 2002;65:256-260

¤ÙÛÈ Ú¤ÂÈ Ó· Û˘ÌÂÚÈÏ·Ì‚¿ÓÂÙ·È ÛÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ÙˆÓ ·ÈÌ·ÙÔÏÔÁÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ ÛÙË ‚ÚÂÊÈ΋ Î·È ÚÒÈÌË ÓËȷ΋ ËÏÈΛ·. §¤ÍÂȘ ÎÏÂȉȿ: ÏÔÈÌ҉˘ ÌÔÓÔ˘Ú‹ÓˆÛË, Èfi˜ Epstein-Barr, ·ÈÌÔÊ·ÁÔ΢ÙÙ·ÚÈÎfi Û‡Ó‰ÚÔÌÔ, APTT, ·ÓÙÈËÎÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÙÔ˘ χÎÔ˘.

Key words: infectious mononucleosis, EpsteinBarr virus, hemophagocytic syndrome, APTT, lupus anticoagulant.

™˘ÓÙÔÌÔÁڷʛ˜

ÀÏÈÎfi Î·È Ì¤ıÔ‰Ô˜

§M EBV VCA ·ÓÙÈÛÒÌ·Ù·

§ÔÈÌ҉˘ ÌÔÓÔ˘Ú‹ÓˆÛË πfi˜ Epstein-Barr ∞ÓÙÈη„ȉÈο ·ÓÙÈÛÒÌ·Ù·

∂ÈÛ·ÁˆÁ‹ H ÏÔÈÌ҉˘ ÌÔÓÔ˘Ú‹ÓˆÛË (§M) ·ÔÙÂÏ› ÙÔ ÈÔ ÁÓˆÛÙfi ÎÏÈÓÈÎfi Û‡Ó‰ÚÔÌÔ Ïԛ̈͢ ·fi ÙÔÓ Èfi Epstein-Barr (EBV), Ô ÔÔ›Ô˜ ¢ı‡ÓÂÙ·È ÂÚ›Ô˘ ÁÈ· ÙÔ 90% ÙˆÓ ÂÚÈÙÒÛÂˆÓ §M (1). ∂ÌÊ·Ó›˙ÂÙ·È Î˘Ú›ˆ˜ Û Ó·ÚÔ‡˜ ÂÓ‹ÏÈΘ, ·ÏÏ¿ Û˘¯Ó¿ ÓÔÛÔ‡Ó Î·È ·È‰È¿ Î·È Ì¿ÏÈÛÙ· ÂÚÈÛÛfiÙÂÚÔ Û˘¯Ó¿ Û ۯ¤ÛË Ì fi,ÙÈ ÈÛÙ¢fiÙ·Ó ·Ï·ÈfiÙÂÚ·. ™ÙË ‚ÚÂÊÈ΋ Î·È ÙËÓ ÚÒÈÌË ÓËȷ΋ ËÏÈΛ· Ë ÓfiÛÔ˜ ·ÚÔ˘ÛÈ¿˙ÂÙ·È Û¯ÂÙÈο Û¿ÓÈ· Î·È ÌÔÚ› Ó· ‰È·Ê‡ÁÂÈ Ë ‰È¿ÁÓˆÛ‹ Ù˘, ÙfiÛÔ ÏfiÁˆ ÙˆÓ ¿Ù˘ˆÓ ÎÏÈÓÈÎÒÓ ÂΉËÏÒÛˆÓ, fiÛÔ Î·È ÏfiÁˆ Ù˘ Û¿ÓÈ·˜ ·Ó‡ÚÂÛ˘ ıÂÙÈÎÒÓ ÂÙÂÚfiÊÈÏˆÓ ·ÓÙÈÛˆÌ¿ÙˆÓ (Monotest) (1,2). ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, fï˜, ÔÈ ‰È·ÁÓˆÛÙÈΤ˜ ‰˘Ó·ÙfiÙËÙ˜ ¤¯Ô˘Ó ‚ÂÏÙȈı› ÛËÌ·ÓÙÈο, ‰Èο ˆ˜ ÚÔ˜ ÙËÓ ·Ó›¯Ó¢ÛË ÙˆÓ ÂȉÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ Î·Ù¿ ÙÔ˘ ÈÔ‡, Û˘ÓËı¤ÛÙÂÚ· ÙˆÓ ·ÓÙÈη„ȉÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ (IgM, IgG Virus-Capsid Antigen: VCA), ·ÏÏ¿ Î·È ÙˆÓ ·ÓÙÈÛˆÌ¿ÙˆÓ Î·Ù¿ ÙÔ˘ ÚÒÈÌÔ˘ ·ÓÙÈÁfiÓÔ˘ (Early Antigen) Î·È ÙˆÓ ·ÓÙÈÁfiÓˆÓ ÙÔ˘ ˘Ú‹Ó· (Nuclear Antigen) (2).

H §M Û˘Ó‹ıˆ˜ ÂÌÊ·Ó›˙ÂÙ·È ˆ˜ ÁÂÓÈÎÂ˘Ì¤ÓË ·˘ÙÔÂÚÈÔÚÈ˙fiÌÂÓË ÓfiÛÔ˜ Ì ˘ÚÂÙfi, Ê·Ú˘ÁÁ›Ùȉ·, ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ· Î·È Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›·. ™Â ·È‰È¿, fï˜, ÌÈÎÚfiÙÂÚ· ÙˆÓ 4 ÂÙÒÓ, Ë Ïԛ̈ÍË Û·Ó›ˆ˜ ÂΉËÏÒÓÂÙ·È Ì ٷ ıˆÚÔ‡ÌÂÓ· ˆ˜ ÎÏ·ÛÈο Û˘ÌÙÒÌ·Ù· Î·È Û˘Ó‹ıˆ˜ Â›Ó·È ·Û˘Ìو̷ÙÈ΋ ‹ ÂÌÊ·Ó›˙ÂÙ·È ÌÂ Û˘ÌÙÒÌ·Ù· ¿ÏÏˆÓ ÎÔÈÓÒÓ ÏÔÈÌÒÍÂˆÓ (ÚÈÓ›Ùȉ·, ‚‹¯·˜) (1). øÛÙfiÛÔ, Â›Ó·È ‰˘Ó·ÙfiÓ Û ¤Ó· Û¯ÂÙÈο ÌÈÎÚfi ÔÛÔÛÙfi ÙˆÓ ·È‰ÈÒÓ Ó· ÂÌÊ·ÓÈÛÙÔ‡Ó ÛÔ‚·Ú¤˜ ÂÈÏÔΤ˜ ·fi ‰È¿ÊÔÚ· Û˘ÛÙ‹Ì·Ù· ηٿ ÙËÓ ÔÚ›· Ù˘ ÓfiÛÔ˘. ¶ÔÏϤ˜ ·fi ÙȘ ÂÈÏÔΤ˜ ·˘Ù¤˜ Â›Ó·È ·ÔÙ¤ÏÂÛÌ· Ù˘ ·ÓÔÛÔÏÔÁÈ΋˜ ‰È¤ÁÂÚÛ˘ Î·È ÔÏ˘ÎψÓÈ΋˜ ÂÓÂÚÁÔÔ›ËÛ˘ ÛÙ· Ï·›ÛÈ· Ù˘ Ïԛ̈͢ ·fi ÙÔÓ EBV (1,3-6). ™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ Â›Ó·È Ë ÂÚÈÁÚ·Ê‹ ÙÂÛÛ¿ÚˆÓ ÂÚÈÙÒÛÂˆÓ ÚˆÙÔ·ıÔ‡˜ Ïԛ̈͢ ·fi ÙÔÓ EBV, Ì ȉȷ›ÙÂÚ· ÎÏÈÓÈο Î·È ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù·.

™ÙË ÌÂϤÙË Û˘ÌÂÚÈÏ‹ÊıËÛ·Ó Ù¤ÛÛÂÚ· ·È‰È¿ ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ 2 ÂÙÒÓ Ì Ïԛ̈ÍË ·fi ÙÔÓ EBV, Ù· ÔÔ›· ÓÔÛËχÙËÎ·Ó ÛÙËÓ ¶·ÓÂÈÛÙËÌȷ΋ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ πˆ·ÓÓ›ÓˆÓ, Ì ȉȷ›ÙÂÚ· ¿Ù˘· ÎÏÈÓÈο Î·È ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù·. H ‰È¿ÁÓˆÛË ‚·Û›ÛÙËΠÛÙ· ÎÏÈÓÈο Î·È ÔÚÔÏÔÁÈο ÎÚÈÙ‹ÚÈ· Ù˘ ÔÍ›·˜ Ïԛ̈͢: ·Ó‡ÚÂÛË IgM VCA ·ÓÙÈÛˆÌ¿ÙˆÓ Î·È/‹ ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË Ù˘ ÙÈÌ‹˜ ÙˆÓ IgG, ÛÙËÓ ÔÚ›· Ù˘ ÓfiÛÔ˘. ™Â ÔÚÈṲ̂Ó˜ ÂÚÈÙÒÛÂȘ ·ÓȯÓ‡ıËÎ·Ó Â›Û˘ Î·È Ù· ·ÓÙÈÛÒÌ·Ù· ηٿ ÙÔ˘ ÚÒÈÌÔ˘ ·ÓÙÈÁfiÓÔ˘ Î·È ÙˆÓ ·ÓÙÈÁfiÓˆÓ ÙÔ˘ ˘Ú‹Ó·. °È· ÙËÓ ·Ó›¯Ó¢ÛË ÙˆÓ IgG Î·È IgMVCA ·ÓÙÈÛˆÌ¿ÙˆÓ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë ·ÓÔÛÔÂÓ˙˘ÌÈ΋ ̤ıÔ‰Ô˜ (ELISA) Ì ¤ÙÔÈÌ· ·ÓÙȉڷÛÙ‹ÚÈ· ÙÔ˘ Ô›ÎÔ˘ Meridian Diagnostics, Inc. H ¢·ÈÛıËÛ›· Ù˘ ÌÂıfi‰Ô˘, Û˘ÁÎÚÈÓfiÌÂÓË Ì ÙË Ì¤ıÔ‰Ô ÙÔ˘ ¤ÌÌÂÛÔ˘ ·ÓÔÛÔÊıÔÚÈÛÌÔ‡ (Indirect fluorescent Antibody: IFA), ‹Ù·Ó ·ÓÙ›ÛÙÔȯ· 100% Î·È 99,4%, Ì fiÚÈ· ·ÍÈÔÈÛÙ›·˜ 95,3-100%, Û‡Ìʈӷ Ì ÙËÓ ·Ú·Û΢·ÛÙÈ΋ ÂÙ·ÈÚ›·. °È· ÙËÓ ·Ó›¯Ó¢ÛË ÙˆÓ IgM-VCA ·ÓÙÈÛˆÌ¿ÙˆÓ Î·È ÚÔ˜ ·ÔÊ˘Á‹Ó „¢‰Ò˜ ıÂÙÈÎÒÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ, ÚÔËÁ‹ıËΠÚÔÛÚfiÊËÛË ÙÔ˘ ÚÂ˘Ì·ÙÔÂȉԇ˜ ·Ú¿ÁÔÓÙ· ÛÙÔÓ ÔÚfi Ì ÙË ¯Ú‹ÛË ÂȉÈÎÔ‡ sorbent. °È· ÙËÓ ·Ó›¯Ó¢ÛË ÙˆÓ ·ÓÙÈÛˆÌ¿ÙˆÓ Î·Ù¿ ÙÔ˘ ÚÒÈÌÔ˘ ·ÓÙÈÁfiÓÔ˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë Ì¤ıÔ‰Ô˜ ÙÔ˘ ¤ÌÌÂÛÔ˘ ·ÓÔÛÔÊıÔÚÈÛÌÔ‡ (EBV-EA IFA test, Meridian Diagnostics, Inc.). °È· ÙËÓ ·Ó›¯Ó¢ÛË ÙˆÓ ·ÓÙÈÛˆÌ¿ÙˆÓ Î·Ù¿ ÙˆÓ ·ÓÙÈÁfiÓˆÓ ÙÔ˘ ˘Ú‹Ó· ¯ÚËÛÈÌÔÔÈ‹ıËΠÙÔ EBV-NA test, ÙÔ ÔÔ›Ô ·ÓÙÈÚÔÛˆ‡ÂÈ Â˘·›ÛıËÙË Ì¤ıÔ‰Ô ¤ÌÌÂÛÔ˘ ·ÓÔÛÔÊıÔÚÈÛÌÔ‡ Ì ·ÓÙÈÛ˘Ìϋڈ̷ (ACIF, Meridian Diagnostics, Inc.), Ì ÂȉÈÎfiÙËÙ· Î·È Â˘·ÈÛıËÛ›· 98,6% Î·È 100% ·ÓÙ›ÛÙÔȯ·. H ·Ó‡ÚÂÛË ÙÔ˘ ·ÓÙÈËÎÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ÙÔ˘ χÎÔ˘, Û‡Ìʈӷ Ì ٷ ÎÚÈÙ‹ÚÈ· Ù˘ ¢ÈÂıÓÔ‡˜ ∂Ù·ÈÚ›·˜ £ÚfiÌ‚ˆÛ˘ Î·È ∞ÈÌfiÛÙ·Û˘, ÛÙËÚ›¯ıËΠÛÙËÓ ·Ú¿Ù·ÛË ÙÔ˘ APTT, ÛÙÔ ıÂÙÈÎfi ·ÔÙ¤ÏÂÛÌ· ÙˆÓ ÌÂÏÂÙÒÓ ·Ó¿ÌÂÈ͢ 1:1 Ê˘ÛÈÔÏÔÁÈÎÔ‡ Ï¿ÛÌ·ÙÔ˜ Î·È Ï¿ÛÌ·ÙÔ˜ ÙÔ˘ ·ÛıÂÓÔ‡˜ Î·È ÛÙËÓ ÂȂ‚·›ˆÛË Ù˘ ‡·Ú͢ ÂÓfi˜ ʈÛÊÔÏÈÔÂȉÔÂÍ·ÚÙÒÌÂÓÔ˘ ·ÓÙÈËÎÙÈÎÔ‡ (Dade Behring) (7).

¶ÂÚÈÁÚ·Ê‹ ÂÚÈÙÒÛÂˆÓ ¶ÂÚ›ÙˆÛË ÚÒÙË ÕÚÚÂÓ ·ÛıÂÓ‹˜ ËÏÈΛ·˜ 19 ÌËÓÒÓ, Ì ÈÛÙÔÚÈÎfi ˘ÂÚ˘ÚÂÍ›·˜ Î·È ÛÏËÓÔÌÂÁ·Ï›·˜ ·fi 10Ë̤ÚÔ˘. ∏ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË ¤‰ÂÈÍ £ 38,5ÔC, Â›¯ÚÈÛÌ· ·Ì˘Á‰·ÏÒÓ, Ë·ÙÔÌÂÁ·Ï›· (2 cm), ÛÏËÓÔÌÂÁ·Ï›· (3 cm). ∂ÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù·: ÏÂ˘Î¿ 8.700/mm3

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(ÏÂÌÊÔ·ÙÙ·Ú· 23%), Ht 29%, AM¶ 115.000/mm3, TKE 45 mm/1Ë ÒÚ·, CRP 48 mg/L, APTT 60/31 sec, INR 0,9, ÈÓˆ‰ÔÁfiÓÔ 309 mg/dl, ¯ÚfiÓÔÈ ‹Í˘: Kº, ÂÙÂÚfiÊÈÏ· ·ÓÙÈÛÒÌ·Ù· (-). µÈÔ„›· Ì˘ÂÏÔ‡: ‹È· ‰˘ÛÏ·Û›· ÂÚ˘ıÚ‹˜ ÛÂÈÚ¿˜, ÌÈÎÚ‹ ·‡ÍËÛË ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ.

OÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜: EBV IgM-VCA (-), IgG (+) (1,958/0,900 Î·È ÌÂÙ¿ 10 Ë̤Ú˜ 2,849/0,900), ·ÓÙÈÛÒÌ·Ù· ηٿ ÙÔ˘ ÚÒÈÌÔ˘ ·ÓÙÈÁfiÓÔ˘ (+), ηٿ ·ÓÙÈÁfiÓˆÓ ÙÔ˘ ˘Ú‹Ó· (-), ·ÓÙÈ·ÈÌÔÂÙ·Ïȷο (), ¿ÌÂÛË-¤ÌÌÂÛË Coombs (-), ·ÓÙÈηډÈÔÏÈÈÓÈο (), ANA (-), ·ÓÙÈËÎÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ χÎÔ˘ (+). ™ËÌÂÈÒıËΠ‡ÊÂÛË ÂÌ˘Ú¤ÙÔ˘ ÙËÓ 23Ë Ë̤ڷ, ˘Ô¯ÒÚËÛË Ë·ÙÔÌÂÁ·Ï›·˜-ÛÏËÓÔÌÂÁ·Ï›·˜ Î·È ıÚÔÌ‚ÔÂÓ›·˜ ÙËÓ 30Ë Ë̤ڷ. ªÂÙ¿ 11 Ì‹Ó˜: AM¶ 248.000/mm3, APTT 35/32 sec, ·ÓÙÈËÎÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ χÎÔ˘ (-). ¶ÂÚ›ÙˆÛË ‰Â‡ÙÂÚË £‹Ï˘ 22 ÌËÓÒÓ, Ì ÈÛÙÔÚÈÎfi ˘ÂÚ˘ÚÂÍ›·˜ ·fi 4Ë̤ÚÔ˘, ÈÎÙÂÚÈ΋ ¯ÚÔÈ¿ ‰¤ÚÌ·ÙÔ˜ Î·È ÛÎÔÙÂÈÓfi¯ÚÔ· Ô‡Ú· ·fi 24ÒÚÔ˘. ∏ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË ¤‰ÂÈÍ £ 39,5ÔC, Ë·ÙÔÌÂÁ·Ï›· (3 cm), ÛÏËÓÔÌÂÁ·Ï›· (3 cm). ∂ÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù·: ÏÂ˘Î¿ 2.550/mm3 (Ô˘‰ÂÙÂÚfiÊÈÏ· 688/mm3, ÏÂÌÊÔ·ÙÙ·Ú· 64%), TKE 30 mm/1Ë ÒÚ·, CRP 14 mg/L, Ht 30%, ¢EK 1,0%, AM¶ 50.000/mm3, APTT 37/31 sec, INR 1, ÈÓˆ‰ÔÁfiÓÔ 110 mg/dl, TBL 7 mg/dl, DBL 4,8 mg/dl), AST 314 U/L, ALT 287 U/L, ÁGT 110 mg/dl, LDH 6.800 U/L, ¯ÔÏËÛÙÂÚfiÏË 177 mg/dl, ÙÚÈÁÏ˘ÎÂÚ›‰È· 364 mg/dl, ÊÂÚÚÈÙ›ÓË 16.273 ng/ml, ÂÙÂÚfiÊÈÏ· ·ÓÙÈÛÒÌ·Ù· (-). µÈÔ„›· Ì˘ÂÏÔ‡: ·ÓÂ·Ú΋˜ Ï‹„Ë ÈÛÙÔ‡.

OÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜: EBV IgM-VCA (+) (0,941/0,618), IgG (+) (0,669/0,452 Î·È ÌÂÙ¿ 15 Ë̤Ú˜: 2,354/0,452). ™ËÌÂÈÒıËΠ‡ÊÂÛË ÂÌ˘Ú¤ÙÔ˘ ÙËÓ 7Ë Ë̤ڷ, ˘Ô¯ÒÚËÛË Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›·˜ Î·È ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ·˜ ÙËÓ 21Ë Î·È 28Ë Ë̤ڷ ·ÓÙ›ÛÙÔȯ· Î·È ·ÔηٿÛÙ·ÛË ÂÚÁ·ÛÙËÚÈ·ÎÒÓ Â˘ÚËÌ¿ÙˆÓ ÙËÓ 30Ë Ë̤ڷ. ¶ÂÚ›ÙˆÛË ÙÚ›ÙË £‹Ï˘ 20 ÌËÓÒÓ, Ì ÈÛÙÔÚÈÎfi ÂÌ˘Ú¤ÙÔ˘ Î·È ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ·˜ ·fi 4Ë̤ÚÔ˘. ∂ÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜: ÏÂ˘Î¿ 27.750/mm3 (ÏÂÌÊÔ·ÙÙ·Ú· 83%, ¿Ù˘· 15%), AM¶ 297.000/mm3, Ht 43%, TKE 28 mm/1Ë ÒÚ·, CRP 14 mg/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 Ì ÈÛÙÔÚÈÎfi ÂÌ˘Ú¤ÙÔ˘, ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ·˜, Ë·ÙÔÌÂÁ·Ï›·˜, ‚Ï·ÙÈ‰Ò‰Ô˘˜ ·ÎÚÔ‰ÂÚÌ·Ù›Ùȉ·˜ ·fi 3Ë̤ÚÔ˘.

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∂ÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜: ÏÂ˘Î¿ 37.070/mm3 (ÏÂÌÊÔ·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 ·ÔÙÂÏ› ÎÔÈÓfi ÓfiÛËÌ· Ù˘ ·È‰È΋˜ ËÏÈΛ·˜. øÛÙfiÛÔ, ÛÙ· ‚Ú¤ÊË Î·È ÛÙ· ÌÈÎÚ¿ Ó‹È· (ÌÈÎÚfiÙÂÚ· ÙˆÓ 2 ÂÙÒÓ) ‰ÂÓ Â›Ó·È È‰È·›ÙÂÚ· Û˘¯Ó‹ Î·È ‰È·‰Ú¿ÌÂÈ ˘ÔÎÏÈÓÈο, ÂÓÒ Ë ÎÏ·ÛÈ΋ ÂÈÎfiÓ·, fiˆ˜ ·˘Ù‹ ÂÌÊ·Ó›˙ÂÙ·È ÛÙÔ˘˜ Ó·ÚÔ‡˜ ÂÓ‹ÏÈΘ, ·Ú·ÙËÚÂ›Ù·È Î˘Ú›ˆ˜ Û ÌÂÁ·Ï‡ÙÂÚ˘ ËÏÈΛ·˜ ·È‰È¿ (1).

H ‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘ ÛÙËÚ›˙ÂÙ·È Û ÎÏÈÓÈο Î·È ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù·, fiˆ˜ Ë ·Ó‡ÚÂÛË ÙˆÓ ÂÙÂÚfiÊÈÏˆÓ Î·È ÙˆÓ ÂȉÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ Î·Ù¿ ÙÔ˘ ÈÔ‡, Û˘ÓËı¤ÛÙÂÚ· ÙˆÓ IgM Î·È IgG VCA ·ÓÙÈۈ̿وÓ. ∫·È ÛÙ· 4 Ó‹È·, Ù· ÂÙÂÚfiÊÈÏ· ·ÓÙÈÛÒÌ·Ù· ‹Ù·Ó ·ÚÓËÙÈο, Èı·ÓfiÓ ÏfiÁˆ Ù˘ ÌÈÎÚ‹˜ ÙÔ˘˜ ËÏÈΛ·˜, ηıÒ˜ Â›Ó·È ÁÓˆÛÙfi fiÙÈ ·Ó¢ڛÛÎÔÓÙ·È ıÂÙÈο ÌfiÓÔ ÛÙÔ 5% ÙˆÓ ·È‰ÈÒÓ ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ 2 ÂÙÒÓ (2). ™ÙÔÓ ÚÒÙÔ ·ÛıÂÓ‹, Ù· IgM-VCA ·ÓÙÈÛÒÌ·Ù· ‹Ù·Ó ·ÚÓËÙÈο, ÂÓÒ Ë ÙÈÌ‹ ÙˆÓ IgG ·ÓÙÈÛˆÌ¿ÙˆÓ ·˘Í‹ıËΠÌÂÙ¿ ·fi 10 Ë̤Ú˜. H ·Ô˘Û›· ÙˆÓ IgM ·ÓÙÈÛˆÌ¿ÙˆÓ ‰ÂÓ ·Ó·ÈÚÔ‡Û ÙËÓ ÔÚÔÏÔÁÈ΋ ‰È¿ÁÓˆÛË Ù˘ ÔÍ›·˜ Ïԛ̈͢, ηıÒ˜ ¤¯ÂÈ ‚ÚÂı› fiÙÈ Û ÔÛÔÛÙfi 17% ÙˆÓ ·È‰ÈÒÓ ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ 4 ÂÙÒÓ ‰ÂÓ ·ÓȯÓ‡ÔÓÙ·È IgM ·ÓÙÈÛÒÌ·Ù· ηٿ ÙËÓ ÔÍ›· Ê¿ÛË Ù˘ ÓfiÛÔ˘ (0-3 ‚‰ÔÌ¿‰Â˜) (2). H ‰È¿ÁÓˆÛË Ù˘ ÚˆÙÔ·ıÔ‡˜ Ïԛ̈͢ ÛÙÔÓ ·ÛıÂÓ‹ ·˘Ùfi ÛÙËÚ›¯ıËΠÛÙËÓ ·‡ÍËÛË Ù˘ ÙÈÌ‹˜ ÙˆÓ IgG ·ÓÙÈۈ̿وÓ, ÛÙËÓ ·Ó‡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‹ıËΠÂ›Û˘ ·ÚÔ‰È΋ ·Ú¿Ù·ÛË ÙÔ˘ APTT, ıÂÙÈÎfi˜ ·ÓÙÈËÎÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÙÔ˘ χÎÔ˘ Î·È ÂÈ̤ÓÔ˘Û· ıÚÔÌ‚ÔÂÓ›·. O ·ÓÙÈËÎÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÙÔ˘ χÎÔ˘ Î·È Ù· ·ÓÙÈÛÒÌ·Ù· ηٿ ηډÈÔÏÈ›Ó˘ ·ÔÙÂÏÔ‡Ó Ì›· ÂÙÂÚÔÁÂÓ‹ ÔÌ¿‰· ·˘ÙÔ·ÓÙÈۈ̿وÓ, Ù· ÏÂÁfiÌÂÓ· ·ÓÙÈʈÛÊÔÏÈȉÈο ·ÓÙÈÛÒÌ·Ù·, Ù· ÔÔ›· ÛÙÚ¤ÊÔÓÙ·È Î·Ù¿ ÙˆÓ Û˘Ó‰Â‰ÂÌ¤ÓˆÓ Ì ٷ ʈÛÊÔÏÈÔÂȉ‹ ÚˆÙÂ˚ÓÒÓ ÙÔ˘ Ï¿ÛÌ·ÙÔ˜. ∫ÏÈÓÈο, ·Ó Î·È ¤¯Ô˘Ó Û˘Û¯ÂÙÈÛı› Ì ÙËÓ ÚfiÎÏËÛË ıÚÔÌ‚ˆÙÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ, in vitro ÚÔηÏÔ‡Ó ·Ú¿Ù·ÛË ÙÔ˘ APTT (3). ™Ù· ·È‰È¿ Ê·›ÓÂÙ·È Ó· ˘¿Ú¯Ô˘Ó ‰‡Ô Ù‡ÔÈ ·ÓÙÈËÎÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ÙÔ˘ χÎÔ˘. O ÚÒÙÔ˜ Â›Ó·È Î·ÏÔ‹ı˘ Î·È ·ÚÔ‰ÈÎfi˜ (Èı·Ó¿ ÌÂÙ·ÏÔÈÌ҉˘) Î·È Î·Ù¿ ηÓfiÓ· ‰ÂÓ ÚÔηÏ› Û˘ÌÙÒÌ·Ù· (4), fiˆ˜ Î·È ÛÙÔ ‰ÈÎfi Ì·˜ ·ÛıÂÓ‹ fiÔ˘ η̛· ÂÈÏÔ΋ ‰ÂÓ ÛËÌÂÈÒıËΠηٿ ÙËÓ ÂÚ›Ô‰Ô

july-aug02TELIKO

14-05-03

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Ù˘ ·ÚÔ˘Û›·˜ ÙÔ˘. øÛÙfiÛÔ, Û·ÓÈfiÙÂÚ·, Ë ·ÚÔ‰È΋ ·ÚÔ˘Û›· ·ÓÙÈËÎÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ÙÔ˘ χÎÔ˘ Û ·È‰È¿ ¯ˆÚ›˜ ˘ÔΛÌÂÓÔ ÓfiÛËÌ· ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙ› Ì ÙËÓ ÂÌÊ¿ÓÈÛË Î·È ·ÈÌÔÚÚ·ÁÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ (5). O ‰Â‡ÙÂÚÔ˜ Ù‡Ô˜ Â›Ó·È Ô ÏÂÁfiÌÂÓÔ˜ “·˘ÙÔ¿ÓÔÛÔ˜”, Ô ÔÔ›Ô˜ ÂÌÊ·Ó›˙ÂÙ·È Û˘Ó‹ıˆ˜ ÛÙËÓ ÂÊ˂›·, ÂÈ̤ÓÂÈ Î·È Û˘Ó‰˘¿˙ÂÙ·È Ì ÙËÓ ÂÌÊ¿ÓÈÛË ıÚÔÌ‚ÔÂÌ‚ÔÏÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ (4). ™ÙÔ˘˜ ÂÓ‹ÏÈΘ ¯ˆÚ›˜ ˘ÔΛÌÂÓÔ ÓfiÛËÌ·, Ë ·Ó‡ÚÂÛË ÙÔ˘ ·ÓÙÈËÎÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ÙÔ˘ χÎÔ˘ ¤¯ÂÈ Û˘Ó‰˘·ÛÙ› Ì Ïԛ̈ÍË ·fi ÙÔÓ EBV (6), ÂÓÒ ÛÙ· ·È‰È¿ Ì Ïԛ̈ÍË ·fi ¿ÏÏÔ˘˜ ÈÔ‡˜ fiˆ˜ CMV, ·‰ÂÓÔ˚Ô‡˜ (8), ·ÓÂÌ¢ÏÔÁÈ¿˜-¤ÚËÙ· ˙ˆÛÙ‹Ú· (9). ™‡Ìʈӷ Ì ÙË ÁÓˆÛÙ‹ Û ÂÌ¿˜ ‚È‚ÏÈÔÁÚ·Ê›·, ‰ÂÓ ¤¯ÂÈ Á›ÓÂÈ ·ÓÙ›ÛÙÔÈ¯Ë ÂÚÈÁÚ·Ê‹ Û ‚‚·ÈˆÌ¤ÓË Ïԛ̈ÍË ·fi ÙÔÓ EBV ÛÙËÓ ·È‰È΋ ËÏÈΛ·. ™ÙË ‰Â‡ÙÂÚË ·ÛıÂÓ‹ ‹Ù·Ó ÂÓÙ˘ˆÛȷ΋ Ë ‚·ÚÈ¿ ÎÏÈÓÈ΋ ÂÈÎfiÓ·, Ë ÌÂÁ¿ÏË ·‡ÍËÛË Ù˘ LDH Î·È ÊÂÚÚÈÙ›Ó˘, ηıÒ˜ Î·È Ë ÂÏ¿ÙÙˆÛË ÙˆÓ Ï¢ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ, ·ÈÌÔÂÙ·Ï›ˆÓ Î·È ÙÔ˘ ÈÓˆ‰ÔÁfiÓÔ˘. H ÂÚÁ·ÛÙËÚȷ΋ ·˘Ù‹ ÂÈÎfiÓ·, ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙÔÓ ›ÎÙÂÚÔ Î·È ÙËÓ ¤ÓÙÔÓË Ë·ÙÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Ô˘ ÂÌÊ¿ÓÈ˙ ÙÔ ·È‰›, Ô‰ËÁÔ‡Û ÛÙËÓ Èı·Ó‹ ‰È¿ÁÓˆÛË ÙÔ˘ ·ÈÌÔÊ·ÁÔ΢ÙÙ·ÚÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘, Û¯ÂÙÈ˙fiÌÂÓÔ˘ Ì ÙËÓ ÔÍ›· Ïԛ̈ÍË ·fi ÙÔÓ EBV (10). O EBV ·ÔÙÂÏ› ÙÔ Û˘ÓËı¤ÛÙÂÚÔ ÏÔÈÌ҉˜ ·›ÙÈÔ ÙÔ˘ ·ÈÌÔÊ·ÁÔ΢ÙÙ·ÚÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ (74%), ÂÓÒ ÂÓÔ¯ÔÔÈÔ‡ÓÙ·È Î·È ¿ÏÏÔÈ ÈÔ›, fiˆ˜ Ô ÂÚËÙÔ˚fi˜ 6, CMV, ·‰ÂÓÔ˚Ô›, ·Ú‚Ô˚fi˜, Èfi˜ ·ÓÂÌ¢ÏÔÁÈ¿˜-¤ÚËÙ· ˙ˆÛÙ‹Ú·, ηıÒ˜ Î·È ÙÔ˘ ·ÏÔ‡ ¤ÚËÙ·, ÙÔ˘ ˘ÚÂÙÔ‡ Q Î·È Ù˘ ÈÏ·Ú¿˜ (11). ∆· ÎÏÈÓÈο Â˘Ú‹Ì·Ù· ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ·Ú·ÙÂÈÓfiÌÂÓÔ ÂÌ‡ÚÂÙÔ, ·Ó΢ÙÙ·ÚÔÂÓ›·, Ë·ÙÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·, Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›·, ‰È·Ù·Ú·¯¤˜ Ù˘ ËÎÙÈÎfiÙËÙ·˜, ›ÎÙÂÚÔ, ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ· Î·È Û˘ÌÌÂÙÔ¯‹ ÙÔ˘ KN™. ∂ÚÁ·ÛÙËÚȷο ‰È·ÈÛÙÒÓÔÓÙ·È ˘ÂÚÙÚ·ÓÛ·ÌÈÓ·Û·ÈÌ›·, ·‡ÍËÛË Ù˘ ÊÂÚÚÈÙ›Ó˘, Ù˘ LDH, ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ Î·È ÂÏ¿ÙÙˆÛË ÙÔ˘ ÈÓˆ‰ÔÁfiÓÔ˘. H ‰È¿ÁÓˆÛË ÂȂ‚·ÈÒÓÂÙ·È Ì ÙËÓ ·Ó‡ÚÂÛË ÛÙË ‚ÈÔ„›· ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ÏÂÌÊÔ˚ÛÙÈÔ΢ÙÙ¿ÚˆÓ Ì ·ÈÌÔÊ·ÁÔ·ÙÙ·Ú· (10). ∞fi ÙȘ ÂÚÈÙÒÛÂȘ ÙÔ˘ ·ÈÌÔÊ·ÁÔ΢ÙÙ·ÚÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ Ô˘ Û¯ÂÙ›˙ÂÙ·È Ì Ïԛ̈ÍË, ‰˘ÛÌÂÓ¤ÛÙÂÚË ÚfiÁÓˆÛË ÂÌÊ·Ó›˙Ô˘Ó Î˘Ú›ˆ˜ Ù· ÌÈÎÚ¿ Ó‹È· (ı·Ó·ÙËÊfiÚÔ Û ÔÛÔÛÙfi 60% Û ·È‰È¿ ÌÈÎÚfiÙÂÚ· ÙˆÓ 3 ÂÙÒÓ Î·È 69% Û ÌÈÎÚfiÙÂÚ· ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜) (11) Î·È ÂΛӷ Ì ˘Ô˚Óˆ‰ÔÁÔÓ·ÈÌ›· Î·È ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›· (12,13). ™ÙËÓ ÂÚ›ÙˆÛË Ù˘ ÌÈÎÚ‹˜ ·ÛıÂÓÔ‡˜, ·Ó Î·È Ù· ÎÏÈÓÈο Î·È ÂÚÁ·ÛÙËÚȷο ‰Â‰Ô̤ӷ ‹Ù·Ó Û˘Ì‚·Ù¿ Ì ÙËÓ ‡·ÚÍË ·ÈÌÔÊ·ÁÔ΢ÙÙ·ÚÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘, Ë ‰È¿ÁÓˆÛË ‰ÂÓ ÂȂ‚·ÈÒıËΠÁÈ·Ù› ·¤Ù˘¯Â Ù¯ÓÈο Ë ‚ÈÔ„›· Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ. ¶·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÙÔ ·ÈÌÔÊ·ÁÔ΢ÙÙ·ÚÈÎfi Û‡Ó‰ÚÔÌÔ Û¯ÂÙÈ˙fiÌÂÓÔ Ì ÔÍ›· Ïԛ̈ÍË ·fi

Paediatriki 2002;65:256-260

ÙÔÓ EBV ÂÌÊ·Ó›˙ÂÈ ÙË ‰˘ÛÌÂÓ¤ÛÙÂÚË ÚfiÁÓˆÛË ·fi Ù· ˘fiÏÔÈ· ÏÔÈÌÒ‰Ë ·›ÙÈ·, ηıÒ˜ ·Ó·Ê¤ÚÂÙ·È ı·Ó·ÙËÊfiÚ· ¤Î‚·ÛË ÛÙÔ 73% (11), Ë ÔÚ›· Ù˘ ·ÛıÂÓÔ‡˜ Ì·˜, ·Ú¿ ÙË ÌÈÎÚ‹ Ù˘ ËÏÈΛ·, ‹Ù·Ó ÂÍ·ÈÚÂÙÈο ηϋ. ¶·ÚÔ˘Û›·Û ÎÏÈÓÈ΋ Î·È ÂÚÁ·ÛÙËÚȷ΋ ‚ÂÏÙ›ˆÛË ÌÂÙ¿ ÙËÓ ¿ÚÔ‰Ô 10 ËÌÂÚÒÓ Î·È Ï‹ÚË ·ÔηٿÛÙ·ÛË ÌÂÙ¿ ¤Ó· Ì‹Ó·. ™ÙËÓ ÙÚ›ÙË Î·È Ù¤Ù·ÚÙË ·ÛıÂÓ‹ ÛËÌÂÈÒÓÂÙ·È È‰È·›ÙÂÚ· Ë ¤ÓÙÔÓË Ï¢ÎÔ΢ÙÙ¿ÚˆÛË, ¯ˆÚ›˜ fï˜ ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË Ù˘ TKE Î·È CRP, ‡ÚËÌ· Û˘Ì‚·Ùfi Ì ٷ ·ÔÙÂϤÛÌ·Ù· Î·È ¿ÏÏ˘ ÌÂϤÙ˘ Ô˘ Ú·ÁÌ·ÙÔÔÈ‹ıËΠÛÙËÓ ÎÏÈÓÈ΋ Ì·˜, fiÔ˘ ¤ÁÈÓ ·Ó·‰ÚÔÌÈ΋ ÂÎÙ›ÌËÛË Û fiϘ ÙȘ §M Ì›·˜ 7ÂÙ›·˜ (14). ™ÙË ÌÂϤÙË ÙˆÓ Sumaya Î·È Û˘Ó (1) ·Ó·Ê¤ÚÂÙ·È fiÙÈ Ô Ì¤ÛÔ˜ fiÚÔ˜ ÙˆÓ Ï¢ÎÔ΢ÙÙ¿ÚˆÓ ÛÙ· ·È‰È¿ ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ 4 ÂÙÒÓ ‹Ù·Ó 14.775±5.155/mm3 (MO±SD), ÂÓÒ ÛÙ· ÌÂÁ·Ï‡ÙÂÚ· ‹Ù·Ó 11.150±3.586/mm3. øÛÙfiÛÔ, ÛÙËÓ ÙÚ›ÙË Î·È Ù¤Ù·ÚÙË ·ÛıÂÓ‹, Ô ·ÚÈıÌfi˜ ÙˆÓ Ï¢ÎÔ΢ÙÙ¿ÚˆÓ ‹Ù·Ó ηٿ Ôχ ˘„ËÏfiÙÂÚÔ˜ ·fi ÙÔÓ ·Ó·ÊÂÚfiÌÂÓÔ ÛÙËÓ ·Ú·¿Óˆ ÌÂϤÙË ÁÈ· ·È‰È¿ ·ÓÙ›ÛÙÔȯ˘ ËÏÈΛ·˜. π‰È·›ÙÂÚÔ Â‡ÚËÌ· ÛÙËÓ Ù¤Ù·ÚÙË ·ÛıÂÓ‹ ‹Ù·Ó Ë ÂÌÊ¿ÓÈÛË Â›ÌÔÓ˘ ‚Ï·ÙÈ‰Ò‰Ô˘˜ ·ÎÚÔ‰ÂÚÌ·Ù›Ùȉ·˜ (Û‡Ó‰ÚÔÌÔ Gianotti-Crosti). H ÂÌÊ¿ÓÈÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ·˘ÙÔ‡ ›¯Â ·Ô‰Ôı› ÛÙÔ ·ÚÂÏıfiÓ ·ÔÎÏÂÈÛÙÈο ÛÙÔÓ Èfi Ù˘ Ë·Ù›Ùȉ·˜ B, ÛÙË Û˘Ó¤¯ÂÈ· fï˜ ÂÓÔ¯ÔÔÈ‹ıËÎ·Ó Î·È ¿ÏÏÔÈ ÈÔ› fiˆ˜ ÔÈ EBV, CMV, RSV, ÂÓÙÂÚÔ˚Ô›, ·ÏÏ¿ Î·È Ô ‚-·ÈÌÔÏ˘ÙÈÎfi˜ ÛÙÚÂÙfiÎÔÎÎÔ˜ Ù˘ ÔÌ¿‰·˜ A (15). ∫ÏÈÓÈο ÙÔ ÂÍ¿ÓıËÌ· ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÙËÓ ÂÌÊ¿ÓÈÛË ÂÚ˘ıÚˆÒÓ ‚Ï·Ù›‰ˆÓ ÌÂ Û˘ÌÌÂÙÚÈ΋ ÂÓÙfiÈÛË ÛÙ· ¿ÎÚ·, ÙÔ˘˜ ÁÏÔ˘ÙÔ‡˜ Î·È ÏÈÁfiÙÂÚÔ ÛÙÔÓ ÎÔÚÌfi. H ¤Îı˘ÛË ÙÔ˘ ÂÍ·Óı‹Ì·ÙÔ˜ ÂÈ̤ÓÂÈ Û˘Ó‹ıˆ˜ ÁÈ· 3-4 ‚‰ÔÌ¿‰Â˜, fiˆ˜ Î·È ÛÙËÓ ÂÚ›ÙˆÛË Ù˘ ‰È΋˜ Ì·˜ ·ÛıÂÓÔ‡˜ (15). ™˘ÌÂÚ·ÛÌ·ÙÈο, Ë ÚˆÙÔ·ı‹˜ Ïԛ̈ÍË ·fi ÙÔÓ EBV ÛÙ· ‚Ú¤ÊË Î·È Ù· ÌÈÎÚ¿ Ó‹È· ÌÔÚ› Ó· ÂÌÊ·Ó›˙ÂÈ ‹È· ‹ ÂӉ¯Ô̤ӈ˜ ȉȷ›ÙÂÚ· ·ÓËÛ˘¯ËÙÈο ÎÏÈÓÈο Î·È ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· Î·È Ú¤ÂÈ Ó· Û˘ÌÂÚÈÏ·Ì‚¿ÓÂÙ·È ÛÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ÙˆÓ ·ÈÌ·ÙÔÏÔÁÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ ÛÙË ‚ÚÂÊÈ΋ Î·È ÚÒÈÌË ÓËȷ΋ ËÏÈΛ·. µÈ‚ÏÈÔÁÚ·Ê›· 1. Sumaya CV, Ench Y. Epstein-Barr virus infectious mononucleosis in children. I. Clinical and general laboratory findings. Pediatrics 1985;75:1003-1010.

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Janka G, Imashuku S, Elinder G, Schneider M, Henter JI. Infection and malignancy associated hemophagocytic

∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 18-01-2002 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 12-04-2002 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: AÈηÙÂÚ›ÓË ™ÈÒÌÔ˘ ∆Ô̤·˜ ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡ π·ÙÚÈ΋ ™¯ÔÏ‹, ¶·ÓÂÈÛÙ‹ÌÈÔ πˆ·ÓÓ›ÓˆÓ ∆.£. 1186, ∆.∫. 451 10, πˆ¿ÓÓÈÓ·

¶ÂÚ›ÏË„Ë ¿ÚıÚÔ˘ ·fi ÙË µÈ‚ÏÈÔÁÚ·Ê›· ÃÔÚ‹ÁËÛË ·ÁÁÂÈÔÈÂÛ›Ó˘ Û ·È‰È¿ Ì ηٷÏËÍ›·: ¶ÂÚÈÁÚ·Ê‹ 5 ÂÚÈÙÒÛÂˆÓ Î·È ·Ó·ÛÎfiËÛË Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜1 ∂ÈÛ·ÁˆÁ‹: ∏ ˘fiÙ·ÛË, Ô˘ Û˘Óԉ‡ÂÈ ÙË Û˘ÛÙËÌ·ÙÈ΋ ÊÏÂÁÌÔÓÒ‰Ë ·¿ÓÙËÛË, ÂÓ›ÔÙÂ Â›Ó·È ·ÓıÂÎÙÈ΋ ÛÙ· Û˘Ó‹ıË ·ÁÁÂÈÔ‰Ú·ÛÙÈο Ê¿Ú̷η. ¶ÚfiÛÊ·Ù·, Ë ·ÁÁÂÈÔÈÂÛ›ÓË ¯ÚËÛÈÌÔÔÈ‹ıËΠÂÈÙ˘¯Ò˜ Û ÂÓ‹ÏÈΘ Ì ‚·ÚÈ¿ ˘fiÙ·ÛË, ÛÙÔ˘˜ ÔÔ›Ô˘˜ Ù· Û˘Ó‹ıË ÈÓÔÙÚfi· Î·È ·ÁÁÂÈÔ‰Ú·ÛÙÈο Ê¿Ú̷η ›¯·Ó ·ÔÙ‡¯ÂÈ. ™ÙË ÌÂϤÙË ·˘Ù‹ ÂÚÈÁÚ¿ÊÔÓÙ·È ¤ÓÙ ÂÚÈÙÒÛÂȘ ·È‰ÈÒÓ Ì ÛÔ‚·Ú‹ ˘fiÙ·ÛË, ÛÙ· ÔÔ›· ¯ÔÚËÁ‹ıËÎÂ Ë ·ÁÁÂÈÔÈÂÛ›ÓË. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ∂ÚfiÎÂÈÙÔ ÁÈ· (·) ¤Ó· ÙÂÏÂÈfiÌËÓÔ ÓÂÔÁÓfi ÌÂ Û˘ÁÁÂÓ‹ ‰È·ÊÚ·ÁÌ·ÙÔ΋ÏË, (‚) ¤Ó· ÚfiˆÚÔ ÓÂÔÁÓfi Ì ÓÂÎÚˆÙÈ΋ ÂÓÙÂÚÔÎÔÏ›Ùȉ·, (Á) ¤Ó· ÎÔÚ›ÙÛÈ ËÏÈΛ·˜ 7 ÂÙÒÓ Ì ·ÈÌÔÊ·ÁÔ΢ÙÙ·ÚÈÎfi Û‡Ó‰ÚÔÌÔ ÌÂÙ¿ ·fi ÌÂÙ·ÌfiÛ¯Â˘ÛË Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ Î·È ÛËÙÈ΋ ηٷÏËÍ›· ·fi „¢‰ÔÌÔÓ¿‰·, (‰) ¤Ó· ·ÁfiÚÈ ËÏÈΛ·˜ 13 ÂÙÒÓ Ì Ó¢ÚÔ‚Ï¿Ûو̷ ÌÂÙ¿ ·fi ÌÂÙ·ÌfiÛ¯Â˘ÛË Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ Î·È ÛËÙÈ΋ ηٷÏËÍ›· ·fi ·ÓÎÔÏ›Ùȉ· Î·È (Â) ¤Ó· ·ÁfiÚÈ ËÏÈΛ·˜ 14 ÂÙÒÓ Ì ÔÍ›· Ì˘ÂÏÔÁÂÓ‹ Ï¢¯·ÈÌ›· Î·È ÔÏÏ·Ϥ˜ ÏÔÈÌÒÍÂȘ ÏfiÁˆ Ô˘‰ÂÙÂÚÔÂÓ›·˜. ∫·È ÛÙȘ ¤ÓÙ ÂÚÈÙÒÛÂȘ ›¯Â ÚÔËÁËı›, ¯ˆÚ›˜ ·ÔÙ¤ÏÂÛÌ·, ¯ÔÚ‹ÁËÛË ˘„ËÏÒÓ ‰fiÛÂˆÓ ÈÓÔÙÚfiˆÓ. ∏ ·ÁÁÂÈÔÈÂÛ›ÓË ¯ÔÚËÁ‹ıËΠ̤۠ÁÈÛÙË ‰fiÛË 0,008 ÌÔÓ¿‰Â˜ ·Ó¿ ¯ÈÏÈfiÁÚ·ÌÌÔ ‚¿ÚÔ˘˜ ÛÒÌ·ÙÔ˜/ÏÂÙfi ÛÂ Û˘Ó¯‹ ÂÓ‰ÔÊϤ‚È· ¤Á¯˘ÛË Î·È Â›¯Â ˆ˜ ·ÔÙ¤ÏÂÛÌ· Î·È ÙËÓ ·‡ÍËÛË Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ Î·È ÙËÓ ¤Ó·ÚÍË Ù˘ ‰ÈÔ‡ÚËÛ˘.

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∞ÔÙÂϤÛÌ·Ù·: ∆Ú›· ·fi Ù· ¤ÓÙ ·È‰È¿ η٤ÏËÍ·Ó. ™˘ÌÂÚ¿ÛÌ·Ù·: ªÂ ‚¿ÛË Ù· ·Ú·¿Óˆ ·ÔÙÂϤÛÌ·Ù·, ·ÏÏ¿ Î·È ·fi ¿ÏϘ ÌÂϤÙ˜ Û ÂÓ‹ÏÈΘ, Û˘ÓÈÛÙ¿Ù·È Ë ¯ÔÚ‹ÁËÛË Ù˘ ·ÁÁÂÈÔÈÂÛ›Ó˘ Û ·È‰È¿ Ì ηٷÏËÍ›· ·fi ·ÁÁÂÈÔÏËÁ›·, Ô˘ ‰ÂÓ ·ÓÙ·ÔÎÚ›ÓÂÙ·È ÛÙË ¯ÔÚ‹ÁËÛË ÙˆÓ ÎÏ·ÛÈÎÒÓ ÈÓÔÙÚfiˆÓ Î·È ·ÁÁÂÈÔ‰Ú·ÛÙÈÎÒÓ Ô˘ÛÈÒÓ.

1

Liedel JL, Meadow W, Nachman J, Koogler T, Kaharna MD Use of vasopressin in refractory hypotension in children with vasodilatory shock: Five cases and a review of the literature Paediatr Crit Care Med 2002;3:15-18

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∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞

Paediatriki 2002;65:261-264

ORIGINAL ARTICLE

∂›‰· Ï·ÛÌ·ÏÔÁfiÓˆÓ Û 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¯ÂϷοÎË2

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·‰Èο ˆ˜ ÚÔ˜ ÙË ‰ÔÌ‹ ÙÔ˘˜ ʈÛÊÔÏÈ›‰È·. ∞Ó¢ڛÛÎÔÓÙ·È ÛÙ· ÂÚÈÛÛfiÙÂÚ· ·ÙÙ·Ú· Î·È ÈÛÙÔ‡˜, ·ÔÙÂÏÔ‡Ó ‰Â ÙÔ 80-90% ÙˆÓ ÊˆÛÊÔÏÈȉ›ˆÓ Ù˘ Ì˘ÂÏ›Ó˘. ∆· ‰‡Ô ÚÒÙ· ÛÙ¿‰È· Ù˘ Û‡ÓıÂÛ‹˜ ÙÔ˘˜ ÂÓÙÔ›˙ÔÓÙ·È Î·Ù’ ·ÔÎÏÂÈÛÙÈÎfiÙËÙ· ÛÙ· ˘ÂÚÔ͢ÛÒÌ·Ù·. ∏ ‚ÈÔÏÔÁÈ΋ ÛËÌ·Û›· ÙˆÓ ÌÔÚ›ˆÓ ·˘ÙÒÓ Î·Ù·‰ÂÈÎÓ‡ÂÙ·È ·fi ÙËÓ ‡·ÚÍË ÎÏËÚÔÓÔÌÈÎÒÓ ÓÔÛËÌ¿ÙˆÓ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙË ÌÂȈ̤ÓË Û‡ÓıÂÛ‹ ÙÔ˘˜. ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ÌÂÙÚ‹ıËÎ·Ó Ù· Â›‰· Ï·ÛÌ·ÏÔÁfiÓˆÓ ÛÙȘ ÌÂÌ‚Ú¿Ó˜ ÂÚ˘ıÚÔ΢ÙÙ¿ÚˆÓ ÙÂÏÂÈfiÌËÓˆÓ ÓÂÔÁÓÒÓ ËÏÈΛ·˜ 1-4 ËÌÂÚÒÓ. ™‡Ìʈӷ Ì ٷ ·ÔÙÂϤÛÌ·Ù¿ Ì·˜, Ù· Â›‰· Ï·ÛÌ·ÏÔÁfiÓˆÓ ÙˆÓ ÓÂÔÁÓÒÓ ‹Ù·Ó ¯·ÌËÏfiÙÂÚ· ·fi ·˘Ù¿ ÙˆÓ ÌÂÁ·Ï‡ÙÂÚˆÓ ·È‰ÈÒÓ ËÏÈΛ·˜ 6 ÌËÓÒÓ-8 ÂÙÒÓ. ∏ ‰È·ÊÔÚ¿ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ (p<0,001). ∆· ¯·ÌËÏ¿ Â›‰· Ï·ÛÌ·ÏÔÁfiÓˆÓ ÛÙ· ÓÂÔÁÓ¿ ı· Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÔÓÙ·È ˘’ fi„Ë ÛÙËÓ ÂÚÁ·ÛÙËÚȷ΋ ‰ÈÂÚ‡ÓËÛË ÙˆÓ ˘ÂÚÔÍ˘ÛˆÌÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ. ∂ÈϤÔÓ, ‰Â‰Ô̤ÓÔ˘ fiÙÈ Ù· Ï·ÛÌ·ÏÔÁfiÓ· ıˆÚÔ‡ÓÙ·È ÂÓ‰ÔÁÂÓ›˜ ·ÓÙÈÔÍÂȉˆÙÈÎÔ› ·Ú¿ÁÔÓÙ˜, Ù· ÌÂȈ̤ӷ Â›‰¿ ÙÔ˘˜ ÛÙË ÓÂÔÁÓÈ΋ ËÏÈΛ· ÌÔÚ› Ó· ·ÔÙÂÏÔ‡Ó ÚԉȷıÂÛÈÎfi ·Ú¿ÁÔÓÙ· ÔÍÂȉˆÙÈ΋˜ ‚Ï¿‚˘ ÛÙË Û˘ÁÎÂÎÚÈ̤ÓË ËÏÈÎȷ΋ ÔÌ¿‰·.

Abstract: Plasmalogens are structurally unique phospholipids. They are found in most cells and tissues and they are particularly abundant in brain where they constitute 80-90% of the myelin phospholipids. Peroxisomes are essential for their biosynthesis since the first two enzymes of the relevant pathway are exclusively located on peroxisomal membranes.

The biological importance of plasmalogens is highlighted by the existence of inherited metabolic disorders associated with their diminished synthesis. In the present study the levels of red blood cell plasmalogens were measured in neonates 1-4 days old. According to our results the above levels were lower in neonates compared to older children 6 months-8 years old. The difference was statistically significant (p<0.001). The low levels of plasmalogens in neonates should be taken into account when investigating for peroxisomal disorders. Furthermore, since it is believed that plasmalogens act as endogenous antioxidants, their low levels in early life may be a predisposing factor for oxidative damage in neonates.

§¤ÍÂȘ ÎÏÂȉȿ: Ï·ÛÌ·ÏÔÁfiÓ·, ÓÂÔÁÓ¿, ÔÍÂȉˆÙÈÎfi stress.

Key words: plasmalogens, neonates, oxidative stress.

∂ÈÛ·ÁˆÁ‹ ∆· Ï·ÛÌ·ÏÔÁfiÓ· Â›Ó·È ÌÔÓ·‰Èο ˆ˜ ÚÔ˜ ÙË ‰ÔÌ‹ ÙÔ˘˜ ÁÏ˘ÎÂÚÔʈÛÊÔÏÈ›‰È·. ™˘ÁÎÂÎÚÈ̤ӷ, ÛÙË ı¤ÛË sn-1 ÂÚȤ¯Ô˘Ó Ì›· 1,2 ·ÎfiÚÂÛÙË ·ÏÎÔfiÏË Ì·ÎÚ¿˜ ·Ï˘Û›‰·˜ ·ÓıÚ¿ÎˆÓ Ô˘ ÚÔÛ‰¤ÓÂÙ·È ÛÙË ÁÏ˘ÎÂÚfiÏË Ì ¤Ó· ‚ÈÓ˘Ï-·ÈıÂÚÈÎfi ‰ÂÛÌfi. ∞ÓÙ›-

ıÂÙ·, Ù· ˘fiÏÔÈ· ÁÏ˘ÎÂÚÔʈÛÊÔÏÈ›‰È· ÛÙËÓ ›‰È· ı¤ÛË ¤¯Ô˘Ó ¤Ó· ÏÈ·Úfi Ô͇ Ô˘ ÚÔÛ‰¤ÓÂÙ·È ÛÙË ÁÏ˘ÎÂÚfiÏË Ì ÂÛÙÂÚÈÎfi ‰ÂÛÌfi. ∞ÔÙÂÏÔ‡Ó ÙÔ 5-20% ÙˆÓ ÊˆÛÊÔÏÈȉ›ˆÓ ÙˆÓ Î˘ÙÙ·ÚÈÎÒÓ ÌÂÌ‚Ú·ÓÒÓ ÙÔ˘ ·ÓıÚÒÔ˘. ∞Ó¢ڛÛÎÔÓÙ·È Û ȉȷ›ÙÂÚ· ÌÂÁ¿Ï˜ Û˘ÁÎÂÓÙÚÒÛÂȘ ÛÙËÓ Î·Ú‰È¿, ÛÙÔ

1 ª∂¡ ¡ÂÔÁÓÒÓ & ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶°¡ ¡›Î·È·˜, ¶ÂÈÚ·È¿˜ 2 ¢/ÓÛË ∂Ó˙˘ÌÔÏÔÁ›·˜ Î·È ∫˘ÙÙ·ÚÈ΋˜ §ÂÈÙÔ˘ÚÁ›·˜, πÓÛÙÈÙÔ‡ÙÔ ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡, ∞ı‹Ó·

1 Neonatal ICU & Pediatric Clinic of the General Hospital of Nikea, Piraeus 2 Center of Enzymology & Cellular Function, Institute of Child Health, Athens

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Ó¢ÚÈÎfi Û‡ÛÙËÌ·, ÛÙ· Ô˘‰ÂÙÂÚfiÊÈÏ· Î·È Ù· Ì·ÎÚÔÊ¿Á·. π‰È·›ÙÂÚ· ÛÙË Ì˘ÂÏ›ÓË, ÙÔ 80-90% ÙˆÓ ·Èı·ÓÔÏ·ÌÈÓÔ-ʈÛÊÔÏÈȉ›ˆÓ Â›Ó·È Ï·ÛÌ·ÏÔÁfiÓ· (1,2). ∞·Ú·›ÙËÙË ÁÈ· ÙË Û‡ÓıÂÛ‹ ÙÔ˘˜ Â›Ó·È Ë ‡·ÚÍË ÏÂÈÙÔ˘ÚÁÈÎÒÓ ˘ÂÚÔÍ˘ÛˆÌ¿ÙˆÓ (3). ∏ ‡·ÚÍË ÎÏËÚÔÓÔÌÈÎÒÓ ÌÂÙ·‚ÔÏÈÎÒÓ ÓÔÛËÌ¿ÙˆÓ Ô˘ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ÙËÓ ÂÏÏÈ‹ Û‡ÓıÂÛË Ï·ÛÌ·ÏÔÁfiÓˆÓ ·Ó·‰ÂÈÎÓ‡ÂÈ ÙË ‚ÈÔÏÔÁÈ΋ ÛËÌ·Û›· ÙˆÓ ÌÔÚ›ˆÓ ·˘ÙÒÓ (1,2,4). ™ÂÈÚ¿ ·fi ÂÚ¢ÓËÙÈο ‰Â‰Ô̤ӷ ‰Â›¯ÓÔ˘Ó ˆ˜ Ù· Ï·ÛÌ·ÏÔÁfiÓ· ‰ÂÓ Â›Ó·È ÌfiÓÔ ‰ÔÌÈο Û˘ÛÙ·ÙÈο ÙˆÓ Î˘ÙÙ·ÚÈÎÒÓ ÌÂÌ‚Ú·ÓÒÓ, ·ÏÏ¿ ¤¯Ô˘Ó ÎÈ ¿ÏϘ ÛËÌ·ÓÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜. ™Â ·˘Ù¤˜ Û˘ÌÂÚÈÏ·Ì‚¿ÓÔÓÙ·È Ë ·Ôı‹Î¢ÛË ·Ú·¯È‰ÔÓÈÎÔ‡ ÔͤԘ, Ë Û˘ÌÌÂÙÔ¯‹ ÙÔ˘˜ ÛÙË Û‡ÓÙËÍË ÌÂÌ‚Ú·ÓÒÓ, ÛÙË ÌÂÙ·ÊÔÚ¿ ÈfiÓÙˆÓ Î·È ÛÙËÓ ÂÎÚÔ‹ ¯ÔÏËÛÙÂÚfiÏ˘. ∂ÈϤÔÓ, Ù· Ï·ÛÌ·ÏÔÁfiÓ· Ê·›ÓÂÙ·È fiÙÈ Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÙËÓ ·ÓÙÈÔÍÂȉˆÙÈ΋ ¿Ì˘Ó· ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ ¤Ó·ÓÙÈ ‰Ú·ÛÙÈÎÒÓ ÌÔÚÊÒÓ ÙÔ˘ Ô͢ÁfiÓÔ˘ (oxygen reactive species, ROS) (5-9). ∆Ô ÔÍÂȉˆÙÈÎfi stress ·ÔÙÂÏ› ÛÔ‚·Úfi ÂÈ‚·Ú˘ÓÙÈÎfi ·Ú¿ÁÔÓÙ· ÁÈ· Ù· ÓÂÔÁÓ¿ Î·È ıˆÚÂ›Ù·È fiÙÈ Û˘ÌÌÂÙ¤¯ÂÈ ÌÂٷ͇ ¿ÏÏˆÓ ÛÙËÓ ·Ó¿Ù˘ÍË ·ÌÊÈ‚ÏËÛÙÚÔÂȉÔ¿ıÂÈ·˜ Ù˘ ÚÔˆÚfiÙËÙ·˜, Ï¢ÎÔ̷ϷΛ·˜, ‚ÚÔÁ¯ÔÓ¢ÌÔÓÈ΋˜ ‰˘ÛÏ·Û›·˜ Î·È ÓÂÎÚˆÙÈ΋˜ ÂÓÙÂÚÔÎÔÏ›Ùȉ·˜ (10). ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ÌÂÙÚ‹ıËÎ·Ó Ù· Â›‰· ÙˆÓ Ï·ÛÌ·ÏÔÁfiÓˆÓ ÛÙ· ÂÚ˘ıÚÔ·ÙÙ·Ú· Ê˘ÛÈÔÏÔÁÈÎÒÓ ÙÂÏÂÈfiÌËÓˆÓ ÓÂÔÁÓÒÓ. ∆· ·ÔÙÂϤÛÌ·Ù· Û˘ÁÎÚ›ıËÎ·Ó Ì ÙȘ ·ÓÙ›ÛÙÔȯ˜ ÙÈ̤˜ ·È‰ÈÒÓ ËÏÈΛ·˜ 6 ÌËÓÒÓ-8 ÂÙÒÓ. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ªÂÏÂÙ‹ıËÎ·Ó 25 ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿ ËÏÈΛ·˜ 1-4 ËÌÂÚÒÓ Î·È 15 ·È‰È¿ ËÏÈΛ·˜ 6 ÌËÓÒÓ-8 ÂÙÒÓ. °È· ÙȘ ÌÂÙÚ‹ÛÂȘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó Ù· ÂÚ˘ıÚÔ·ÙÙ·Ú· ·fi ‰Â›ÁÌ·Ù· ·›Ì·ÙÔ˜ Ô˘ Ï‹ÊıËÎ·Ó ÁÈ· ··Ú·›ÙËÙ˜ ÂÚÁ·ÛÙËÚȷΤ˜ ÂÍÂÙ¿ÛÂȘ. ∆· Â›‰· Ï·ÛÌ·ÏÔÁfiÓˆÓ ÌÂÙÚ‹ıËÎ·Ó Û Âί‡ÏÈÛÌ· ÏÈȉ›ˆÓ Ù˘ ÌÂÌ‚Ú¿Ó˘ ÙˆÓ ÂÚ˘ıÚÔ΢ÙÙ¿ÚˆÓ Ì ·¤ÚÈ· ¯ÚˆÌ·ÙÔÁÚ·Ê›·. O ·ÎfiÚÂÛÙÔ˜ ·ÈıÂÚÈÎfi˜ ‰ÂÛÌfi˜ ÙˆÓ Ï·ÛÌ·ÏÔÁfiÓˆÓ ÌÂÙÂÙÚ¿Ë ÛÙË ‰ÈÌÂı˘Ï·ÎÂÙ¿ÏË Ù˘ ·ÓÙ›ÛÙÔÈ-

¯Ë˜ ·Ï‰Â˛‰Ë˜. ∏ Â› ÙÔȘ ÂηÙfi Û¯ÂÙÈ΋ Û˘ÁΤÓÙÚˆÛË ÙˆÓ Ï·ÛÌ·ÏÔÁfiÓˆÓ ˘ÔÏÔÁ›ÛÙËΠˆ˜ ÙÔ ËÏ›ÎÔ Ù˘ C18:0 ‰ÈÌÂı˘Ï·ÎÂÙ¿Ï˘ ÚÔ˜ ÙÔ ÌÂı˘ÏÛÙ·ÚÈÎfi (C18:0 DMA / C18:0) Î·È Ù˘ C16:0 ‰ÈÌÂı˘Ï·ÎÂÙ¿Ï˘ ÚÔ˜ ÙÔ ÌÂı˘Ï·ÏÌÈÙÈÎfi (C16:0 DMA / C16:0) (11).

H ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ¤ÁÈÓ Ì ÙË ‰ÔÎÈÌ·Û›· t-test.

∞ÔÙÂϤÛÌ·Ù· - ™˘˙‹ÙËÛË ∆· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘ Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1. ™‡Ìʈӷ Ì ÙȘ ÌÂÙÚ‹ÛÂȘ Ì·˜ Ù· ÓÂÔÁÓ¿ ¤¯Ô˘Ó ¯·ÌËÏfiÙÂÚ· Â›‰· Ï·ÛÌ·ÏÔÁfiÓˆÓ ·’ fi,ÙÈ Ù· ·È‰È¿ ÌÂÁ·Ï‡ÙÂÚ˘ ËÏÈΛ·˜. ∏ ‰È·ÊÔÚ¿ ·˘Ù‹ Â›Ó·È ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋, fiˆ˜ ·ÔÎ¿Ï˘„Â Ë ‰ÔÎÈÌ·Û›· t-test. ∞Í›˙ÂÈ Ó· ÛËÌÂȈı› ˆ˜ Ù· Â›‰· ÙˆÓ Ï·ÛÌ·ÏÔÁfiÓˆÓ Û ·ÛıÂÓ‹ Ì ‰È·Ù·Ú·¯‹ Ù˘ ‚ÈÔÁ¤ÓÂÛ˘ ÙˆÓ ˘ÂÚÔÍ˘ÛˆÌ¿ÙˆÓ Î·È ·ԉ‰ÂÈÁ̤ÓË Ì›ˆÛË Ù˘ Û‡ÓıÂÛ‹˜ ÙÔ˘˜, Ô˘ ‰È·ÁÓÒÛıËΠÛÙÔ ÂÚÁ·ÛÙ‹ÚÈfi Ì·˜, ‹Ù·Ó ÛÙ· ηÙÒÙÂÚ· Â›‰· ·˘ÙÒÓ Ô˘ ÌÂÙÚ‹ıËÎ·Ó Û ÓÂÔÁÓ¿ (¶›Ó·Î·˜ 1). ∏ ·ÚÔ‡Û· ÂÚÁ·Û›· ·ÔÙÂÏ› ÙËÓ ÚÒÙË ‰ËÌÔÛÈÂ˘Ì¤ÓË ÌÂϤÙË ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ Ï·ÛÌ·ÏÔÁfiÓˆÓ ÛÙ· ÂÚ˘ıÚÔ·ÙÙ·Ú· ÓÂÔÁÓÒÓ. ∏ ̤ÙÚËÛË ÙˆÓ Ï·ÛÌ·ÏÔÁfiÓˆÓ Â›Ó·È Ì›· ·fi ÙȘ ·Ú·Ì¤ÙÚÔ˘˜ Ô˘ ÂÎÙÈÌÒÓÙ·È ÛÙË ‰È¿ÁÓˆÛË ÙˆÓ ˘ÂÚÔÍ˘ÛˆÌÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ (4). ∆· Â˘Ú‹Ì·Ù¿ Ì·˜ Â›Ó·È È‰È·›ÙÂÚ· ÛËÌ·ÓÙÈο ˆ˜ ÚÔ˜ ·˘Ù‹ ÙËÓ Î·Ù‡ı˘ÓÛË Î·È ‰Â›¯ÓÔ˘Ó ÙËÓ ·Ó¿ÁÎË ¯ÚËÛÈÌÔÔ›ËÛ˘ ‰È·ÊÔÚÂÙÈÎÒÓ ÙÈÌÒÓ ·Ó·ÊÔÚ¿˜ ÁÈ· Ù· Ï·ÛÌ·ÏÔÁfiÓ· ÛÙË ‰ÈÂÚ‡ÓËÛË ÓÂÔÁÓÒÓ ‡ÔÙˆÓ ÁÈ· ˘ÂÚÔÍ˘ÛˆÌȷο ÓÔÛ‹Ì·Ù·.

O ÚfiÏÔ˜ ÙˆÓ Ï·ÛÌ·ÏÔÁfiÓˆÓ, 75 ¯ÚfiÓÈ· ÌÂÙ¿ ÙËÓ ·Ó·Î¿Ï˘„‹ ÙÔ˘˜, ·Ú·Ì¤ÓÂÈ ˘fi ÂͤٷÛË. ™ÂÈÚ¿ ÌÂÏÂÙÒÓ ‰Â›¯ÓÂÈ ˆ˜ ÂÓ¤¯ÔÓÙ·È Û ÔÏϤ˜ Î·È ÛËÌ·ÓÙÈΤ˜ ‚ÈÔÏÔÁÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜. ∆· Ï·ÛÌ·ÏÔÁfiÓ· ÂÚȤ¯Ô˘Ó ÔÏ˘·ÎfiÚÂÛÙ· ÏÈ·Ú¿ Ôͤ· ÛÙË ı¤ÛË sn-2. £ÂˆÚÔ‡ÓÙ·È È‰È·›ÙÂÚ· ÛËÌ·ÓÙÈ΋ ‰ÂÍ·ÌÂÓ‹ ·Ú·¯È‰ÔÓÈÎÔ‡ ÔͤԘ, ÙÔ ÔÔ›Ô ·ÂÏ¢ıÂÚÒÓÂÙ·È Ì ÙË ‰Ú¿ÛË Ù˘ ÂȉÈ΋˜ ʈÛÊÔÏÈ¿Û˘ ∞2 ÁÈ· Ó· ÌÂÙ·‚ÔÏÈÛÙ› Û ÚÔÛÙ·ÁÏ·‰›Ó˜ Î·È ¿ÏϘ

¶›Ó·Î·˜ 1. ∂›‰· Ï·ÛÌ·ÏÔÁfiÓˆÓ Û ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿, ·È‰È¿ Î·È ‰‡Ô ·ÛıÂÓ›˜ Ì ‰È·Ù·Ú·¯‹ Ù˘ ‚ÈÔÁ¤ÓÂÛ˘ ÙˆÓ ˘ÂÚÔÍ˘ÛˆÌ¿ÙˆÓ ∆ÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿ (n=25) C16:0DMA/C16:0(%)

C18:0DMA/C18:0 (%)

ª.∆.: ̤ÛË ÙÈÌ‹ *p<0,001

262

∂‡ÚÔ˜: 6,6-9,4* ª.∆.: 7,7 SD: 0,76 E‡ÚÔ˜: 13,5-21,5* ª.∆.: 16,8 SD: 1,9

¶·È‰È¿ (n=15) 9,4-12,4 10,9 0,84 18,0-24,0 21,9 1,0

AÛıÂÓ›˜ Ì ‰È·Ù·Ú·¯‹ ‚ÈÔÁ¤ÓÂÛ˘ ÙˆÓ ˘ÂÚÔÍ˘ÛˆÌ¿ÙˆÓ 6,6

1,0

13,9

1,2

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‚ÈÔÏÔÁÈο ‰Ú·ÛÙÈΤ˜ Ô˘Û›Â˜ (12). ∂ÈϤÔÓ, ¤¯ÂÈ ÚÔÙ·ı› ˆ˜ Ù· Ï·ÛÌ·ÏÔÁfiÓ· ‚ÂÏÙÈÛÙÔÔÈÔ‡Ó ÙË ÏÂÈÙÔ˘ÚÁ›· ˘Ô‰Ô¯¤ˆÓ, ÂÓ˙‡ÌˆÓ Î·È ·ÓÙÏÈÒÓ ÈfiÓÙˆÓ, Û˘ÌÌÂÙ¤¯Ô˘Ó Û ‰È·‰Èηۛ˜ Û‡ÓÙË͢ ΢ÙÙ·ÚÈÎÒÓ ÌÂÌ‚Ú·ÓÒÓ Î·È ÛÙËÓ ÂÎÚÔ‹ ¯ÔÏËÛÙÂÚfiÏ˘ ̤ۈ Ù˘ HDL (6-8). ∂Í·ÈÚÂÙÈ΋˜ ÛËÌ·Û›·˜ Ê·›ÓÂÙ·È ˆ˜ Â›Ó·È Ô ÚfiÏÔ˜ ÙÔ˘˜ ˆ˜ ÂÓ‰ÔÁÂÓÒÓ ·ÓÙÈÔÍÂȉˆÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ. ∏ ·ÓÙÈÔÍÂȉˆÙÈ΋ ‰Ú¿ÛË ÙˆÓ Ï·ÛÌ·ÏÔÁfiÓˆÓ ÈÛÙ‡ÂÙ·È ˆ˜ ÔÊ›ÏÂÙ·È ÛÙÔ ‚ÈÓ˘Ï-·ÈıÂÚÈÎfi ‰ÂÛÌfi ÛÙË ı¤ÛË sn-1, ·ÏÏ¿ Î·È ÛÙËÓ ·ÚÔ˘Û›· ÔÏ˘·ÎfiÚÂÛÙˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ ÛÙË ı¤ÛË sn-2 (12). Œ¯ÂÈ ‚ÚÂı› ˆ˜ Ë ˘ÔÍ›·/ÈÛ¯·ÈÌ›· Ô‰ËÁ› Û Ì›ˆÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ Ï·ÛÌ·ÏÔÁfiÓˆÓ, ȉȷ›ÙÂÚ· ÂÎÂ›ÓˆÓ Ô˘ ÂÚȤ¯Ô˘Ó ·Ú·¯È‰ÔÓÈÎfi Ô͇ (13), ÂÓÒ RAW ·ÙÙ·Ú· Ì ¤ÏÏÂÈÌÌ· Ï·ÛÌ·ÏÔÁfiÓˆÓ, ·ÏÏ¿ Î·È Î‡ÙÙ·Ú· ·ÛıÂÓÒÓ Ì ۇӉÚÔÌÔ Zellweger, ÂÌÊ·Ó›˙Ô˘Ó ·˘ÍË̤ÓË Â˘·ÈÛıËÛ›· ÛÙÔ ÔÍÂȉˆÙÈÎfi stress (9,14).

In vitro ÌÂϤÙ˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ ˆ˜ Ë ·ÚÔ˘Û›· Ï·ÛÌ·ÏÔÁfiÓˆÓ ÚÔÛٷهÂÈ Ù· ÔÏ˘·ÎfiÚÂÛÙ· ÏÈ·Ú¿ Ôͤ· Î·È ÙȘ ÏÈÔÚˆÙ½Ó˜ ¯·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜ (LDL) ·fi ÙËÓ ÔÍ›‰ˆÛË Ì ۇÁ¯ÚÔÓË Î·Ù·Ó¿ÏˆÛË ÙÔ˘ ‚ÈÓ˘Ï-·ÈıÂÚÈÎÔ‡ ‰ÂÛÌÔ‡ (15). ∏ ‰Ú¿ÛË ÙÔ˘˜ Â›Ó·È Û˘Ó·ÁˆÓÈÛÙÈ΋ Î·È ÚÔÛıÂÙÈ΋ Ù˘ ‰Ú¿Û˘ Ù˘ ·-ÙÔÎÔÊÂÚfiÏ˘. Œ¯ÂÈ ‰Â ÚÔÙ·ı› ˆ˜ Ô ÚfiÏÔ˜ ÙˆÓ Ï·ÛÌ·ÏÔÁfiÓˆÓ ÛÙËÓ ÚÔÛÙ·Û›· ¤Ó·ÓÙÈ ÙˆÓ ‰Ú·ÛÙÈÎÒÓ ÌÔÚÊÒÓ Ô͢ÁfiÓÔ˘ Â›Ó·È ÙÔ˘Ï¿¯ÈÛÙÔÓ ÙfiÛÔ ÛËÌ·ÓÙÈÎfi˜, fiÛÔ Î·È Ù˘ ·ÙÔÎÔÊÂÚfiÏ˘ (16). ∆Ô ÔÍÂȉˆÙÈÎfi stress ·›˙ÂÈ ÂÍ·ÈÚÂÙÈο ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ·ıÔÏÔÁ›· ÙÔ˘ ÓÂÔÁÓÔ‡. OÈ ‰Ú·ÛÙÈΤ˜ ÌÔÚʤ˜ Ô͢ÁfiÓÔ˘ ÂÓ¤¯ÔÓÙ·È ÛÙËÓ ˘ÔÍÈ΋/ ÈÛ¯·ÈÌÈ΋ ÂÁÎÂÊ·ÏÔ¿ıÂÈ·, ÙË ‚ÚÔÁ¯ÔÓ¢ÌÔÓÈ΋ ‰˘ÛÏ·Û›·, ÙËÓ ·ÌÊÈ‚ÏËÛÙÚÔÂȉÔ¿ıÂÈ· Ù˘ ÚÔˆÚfiÙËÙ·˜, ÙË ÓÂÎÚˆÙÈ΋ ÂÓÙÂÚÔÎÔÏ›Ùȉ· Î.¿. (17). ∏ ·ÓÙÈÔÍÂȉˆÙÈ΋ ¿Ì˘Ó· ·ÔÙÂÏÂ›Ù·È ·fi ÂÍˆÎ·È ÂÓ‰Ô΢ÙÙ·ÚÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Ô˘ ‰ÚÔ˘Ó Û˘ÓÂÚÁ·ÙÈο ÁÈ· Ó· ‰È·ÙËÚËı› Ë ‚¤ÏÙÈÛÙË ÔÍÂȉԷӷÁˆÁÈ΋ ÈÛÔÚÚÔ›· (9,17). ∆· Ï·ÛÌ·ÏÔÁfiÓ·, Û‡Ìʈӷ Ì ٷ ̤¯ÚÈ ÙÒÚ· ÂÚ¢ÓËÙÈο ‰Â‰Ô̤ӷ, Â›Ó·È ¤Ó·˜ ·fi ·˘ÙÔ‡˜ ÙÔ˘˜ ·ÓÙÈÔÍÂȉˆÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜. ∞Í›˙ÂÈ Ó· ÛËÌÂȈı› ˆ˜ ÚfiˆÚ· ÓÂÔÁÓ¿ Ì ˘„ËϤ˜ Û˘ÁÎÂÓÙÚÒÛÂȘ Ï·ÛÌ·ÏÔÁfiÓˆÓ Î·È ÔÏ˘·ÎfiÚÂÛÙˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ Û ÙÚ·¯ÂȷΤ˜ ÂÎÎÚ›ÛÂȘ, Û¿ÓÈ· ·Ó·Ù‡ÛÛÔ˘Ó ‚ÚÔÁ¯ÔÓ¢ÌÔÓÈ΋ ‰˘ÛÏ·Û›· (18). ∆Ô fiÛÔ Â˘¿ÏˆÙÔ˜ Â›Ó·È ¤Ó·˜ ÔÚÁ·ÓÈÛÌfi˜ ÛÙÔ ÔÍÂȉˆÙÈÎfi stress ÂÍ·ÚÙ¿Ù·È ·fi ÙËÓ ·ÓÙÈÔÍÂȉˆÙÈ΋ ÙÔ˘ ¿Ì˘Ó·, ·fi ÙÔ ÊÔÚÙ›Ô ÙÔ˘ ÔÍÂȉˆÙÈÎÔ‡ stress, ·ÏÏ¿ Î·È ÙË ¯ËÌÈ΋ Û‡ÛÙ·ÛË ÙˆÓ ‰È·ÊfiÚˆÓ ÔÚÁ¿ÓˆÓ ÙÔ˘ ÙË Û˘ÁÎÂÎÚÈ̤ÓË ¯ÚÔÓÈ΋ ÛÙÈÁÌ‹ (19). ∆· ¯·ÌËÏfiÙÂÚ· Â›‰· Ï·ÛÌ·ÏÔÁfiÓˆÓ Ô˘ ‚Ú¤ıËÎ·Ó ÛÙË ÌÂϤÙË Ì·˜ ıˆÚԇ̠fiÙÈ ·Ô-

Paediatriki 2002;65:261-264

ÙÂÏÔ‡Ó ·Ú¿ÁÔÓÙ· ·˘ÍË̤ÓÔ˘ ÎÈÓ‰‡ÓÔ˘ Î·È Î·ıÈÛÙÔ‡Ó Ù· ÓÂÔÁÓ¿ ÈÔ Â˘¿ÏˆÙ· Û ÂӉ¯fiÌÂÓÔ ÔÍÂȉˆÙÈÎfi stress. µÈ‚ÏÈÔÁÚ·Ê›· 1. Gould SJ, Raymond GV, Valle D. The peroxisome biogenesis disorders. In: Scriver CR, Beaudet AL, Sly WS, Valle D, eds. Childs B, Kinzler KW, Vogelstein B assoc. eds. The metabolic and molecular bases of inherited diseases. 8th ed. New York: McGraw-Hill; 2001. p. 3181-3218.

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19. Graham EM, Mishra OP, Delivoria-Papadopoulos M. Antioxidants and oxidative stress injuries to the brain in the perinatal period. Semin Neonatol 1998;3:75-85.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 18-01-2002 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 20-03-2002 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∂ϤÓË ªÈ¯ÂϷοÎË πÓÛÙÈÙÔ‡ÙÔ ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·” ∆.∫. 115 27, ∞ı‹Ó· E-mail: inchildh@otenet.gr

¶ÂÚ›ÏË„Ë ¿ÚıÚÔ˘ ·fi ÙË µÈ‚ÏÈÔÁÚ·Ê›· ∂ÈÛÚfiÊËÛË: ŒÓ·˜ ·Ú¿ÁÔÓÙ·˜ Û ٷ¯¤ˆ˜ ÂȉÂÈÓÔ‡ÌÂÓË ‚ÚÔÁ¯ÈÔÏ›Ùȉ· Û ÚÒËÓ ˘ÁÈ‹ ‚Ú¤ÊË;1 ™ÎÔfi˜: ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ó· ÂÎÙÈÌËı› Ë ·ÚÔ˘Û›· ÂӉ›ÍÂˆÓ ÂÈÛÚfiÊËÛ˘ Û ÚÒËÓ ˘ÁÈ‹ ‚Ú¤ÊË Ì ‚ÚÔÁ¯ÈÔÏ›Ùȉ· ·fi Èfi ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÁÎ˘Ù›Ô˘, Ù· ÔÔ›· ÂÌÊ¿ÓÈÛ·Ó Ù·¯Â›· Âȉ›ӈÛË Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ ÙÔ˘˜ ÏÂÈÙÔ˘ÚÁ›·˜. ÀÏÈÎfi Î·È Ì¤ıÔ‰Ô˜: O ‰Â›ÎÙ˘ ÙˆÓ ÏÈÔÂȉÒÓ Ì·ÎÚÔÊ¿ÁˆÓ ÂÎÙÈÌ‹ıËΠ۠¤ÍÈ ÚÒËÓ ˘ÁÈ‹ ‚Ú¤ÊË Ì ‚ÚÔÁ¯ÈÔÏ›Ùȉ· ·fi ·Ó·Ó¢ÛÙÈÎfi Û˘Á΢ÙÈ·Îfi Èfi Î·È ¯ˆÚ›˜ ÚÔËÁÔ‡ÌÂÓÔ ÈÛÙÔÚÈÎfi ÂÈÛÚfiÊËÛ˘, Ù· ÔÔ›· ·ÚÔ˘Û›·Û·Ó ÌÈ· Ôχ Ù·¯Â›· Âȉ›ӈÛË Ù˘ ηٿÛÙ·Û‹˜ ÙÔ˘˜, Ë ÔÔ›· ¯ÚÂÈ¿ÛÙËΠÌ˯·ÓÈÎfi ·ÂÚÈÛÌfi. ∞ÔÙÂϤÛÌ·Ù·: ∆· ¤ÓÙ ·fi Ù· ¤ÍÈ ·È‰È¿ ›¯·Ó ‰Â›ÎÙË ÏÈÔÂȉÒÓ Ì·ÎÚÔÊ¿ÁˆÓ ¿Óˆ ·fi 100, Â›Â‰Ô Ô˘ Â›Ó·È Ôχ ÂÓ‰ÂÈÎÙÈÎfi ÁÈ· ÂÈÛÚfiÊËÛË. ™˘ÌÂÚ¿ÛÌ·Ù·: ∏ ÂÈÛÚfiÊËÛË Â›Ó·È Èı·Ófi Ó· ·›˙ÂÈ ¤Ó· Úfi-

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ÏÔ, fiÙ·Ó ÂÈÛ˘Ì‚·›ÓÂÈ Ù·¯Â›· Âȉ›ӈÛË Û ·È‰È¿ Ì ‚ÚÔÁ¯ÈÔÏ›Ùȉ· ·fi ·Ó·Ó¢ÛÙÈÎfi Û˘Á΢ÙÈ·Îfi Èfi.

1 Hernandez E, Khoshoo V, Thoppil D, Edell D, Ross G Aspiration: A factor in rapidly deteriorating bronchiolitis in previously healthy infants?

Pediatr Pulmonol 2002;33:30-31

∆ÛÈÏÈÁÈ¿ÓÓ˘ £ÂÔÊ¿Ó˘ ¢È¢ı˘ÓÙ‹˜ ¶·È‰È·ÙÚÈÎÔ‡ ∆Ì‹Ì·ÙÔ˜ ¡·˘ÙÈÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ ∞ıËÓÒÓ

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ORIGINAL ARTICLE

∂›‰· ÏÈȉ›ˆÓ Î·È ÏÈÔÚˆÙÂ˚ÓÒÓ Û ·È‰ÈÎfi ÏËı˘ÛÌfi Ù˘ ‰˘ÙÈ΋˜ £ÂÛÛ·ÏÔӛ΢ ∂. ¶··‰ÔÔ‡ÏÔ˘ - ∞Ï·Ù¿ÎË, ∫. ¶··‰ÔÔ‡ÏÔ˘ - §ÂÁÌ¤ÏÔ˘, µ. ∫Ô˘ÏÔ˘Ú›‰·

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

¶ÂÚ›ÏË„Ë: ∏ ˘ÂÚÏÈȉ·ÈÌ›· Â›Ó·È ·fi ÙÔ˘˜ ÛËÌ·ÓÙÈÎfiÙÂÚÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ·ıËڈ̿وÛ˘ Î·È Î·Ú‰È·ÁÁÂȷ΋˜ ÓfiÛÔ˘. ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ë ‰ÈÂÚ‡ÓËÛË ÙÔ˘ ÏÈȉÔÁÚ¿ÌÌ·ÙÔ˜ ·È‰ÈÒÓ ÙˆÓ ‰˘ÙÈÎÒÓ Û˘ÓÔÈÎÈÒÓ Ù˘ £ÂÛÛ·ÏÔӛ΢ Ì·˙› Ì ÛÙÔȯ›· ·fi ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi Î·È ÙËÓ ÎÏÈÓÈ΋ ÂͤٷÛË, ÒÛÙ ӷ ÂÍ·¯ıÔ‡Ó Û˘ÌÂÚ¿ÛÌ·Ù· ˆ˜ ÚÔ˜ ÙËÓ ¤ÎÙ·ÛË ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜ ÛÙÔÓ ·È‰ÈÎfi ÏËı˘ÛÌfi Ù˘ ÂÚÈÔ¯‹˜ ·˘Ù‹˜. ∆Ô ˘ÏÈÎfi Ù˘ ÌÂϤÙ˘ ·ÔÙ¤ÏÂÛ·Ó 171 ·È‰È¿ ËÏÈΛ·˜ 3-16 ÂÙÒÓ, Ô˘ ÚÔÛ‹Ïı·Ó ÛÙ· Ù·ÎÙÈο Â͈ÙÂÚÈο È·ÙÚ›·. ™Â οı ·È‰› ¤ÁÈÓ ÎÏÈÓÈ΋ ÂͤٷÛË, ηٷÁÚ·Ê‹ ÙÔ˘ ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÈÛÙÔÚÈÎÔ‡, ˘ÔÏÔÁÈÛÌfi˜ ÙÔ˘ ¢Â›ÎÙË ª¿˙·˜ ™ÒÌ·ÙÔ˜ (¢ª™) Î·È ÌÂÙÚ‹ıËÎ·Ó Ë ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË (TC), Ù· ÙÚÈÁÏ˘ÎÂÚ›‰È· (TG), HDL- Î·È LDL-¯ÔÏËÛÙÂÚfiÏË, Ë ·ÔÏÈÔÚˆÙ½ÓË ∞-π (ApoA-π), Ë ·ÔÏÈÔÚˆÙ½ÓË µ (ApoB) Î·È Ë ÏÈÔÚˆÙ½ÓË (·) [Lp(a)] Û ÚˆÈÓfi ‰Â›ÁÌ· ÔÚÔ‡ ÌÂÙ¿ 12ˆÚË ÓËÛÙ›·. ¢È·ÈÛÙÒıËÎ·Ó 1-5 ÌË ·Ô‰ÂÎÙÔ› ÁÈ· ÙËÓ ËÏÈΛ· ÙÔ˘˜ ÏÈȉ·ÈÌÈÎÔ› ‰Â›ÎÙ˜ Û 31,5% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ·È‰ÈÒÓ Î·È ÂȉÈÎfiÙÂÚ·: ·) Û 57,1% ÙˆÓ ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ Ì ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi, ‚) Û 52% ÙˆÓ ·È‰ÈÒÓ ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi µ™ Î·È ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi, Á) Û 31,6% ÙˆÓ ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ Ì ·ÚÓËÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi Î·È ‰) Û 18,9% ÙˆÓ ·È‰ÈÒÓ ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi µ™ Î·È ·ÚÓËÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi. ∞fi ÙË Û‡ÁÎÚÈÛË ÌÂٷ͇ ÙˆÓ ·È‰ÈÒÓ ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi µ™ ‚Ú¤ıËΠfiÙÈ ·˘Ù¿ Ô˘ ›¯·Ó ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ›¯·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ·˘ÍË̤Ó˜ ÙÈ̤˜ TC Î·È LDL-C Û ۯ¤ÛË Ì ·˘Ù¿ Ô˘ ›¯·Ó ·ÚÓËÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi. O ¢ª™ ‚Ú¤ıËΠfiÙÈ ¤¯ÂÈ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË ÌfiÓÔ Ì ٷ Â›‰· ÙˆÓ TG. ŸÛÔÓ ·ÊÔÚ¿ ÛÙ· ·È‰È¿

Abstract: Hyperlipidemia is one of the main risk factors for the development of atherosclerosis and cardiovascular disease. The objective of this study was to examine the lipid profile in children living in west Thessaloniki areas and to assess the role of obesity and positive family history in an attempt to evaluate the extent of the problem in this area. We studied 171 children aged 3-16 years, who were examined on an outpatient basis. A complete physical examination was performed and the family history was carefully recorded. Body Mass Index (BMI) was calculated for every child and serum levels 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 obtained following an overnight fasting. Non acceptable levels of 1-5 lipimic indices according to age were observed in 31.5% of all the children studied and particularly: a) in 57.1% of obese children with positive family history b) in 52% of the children with positive family history and normal body weight c) in 31.6% of obese children without positive history and d) in 18.9% of the children without predisposing factors. Family history was found to be associated with TC and LDL-C (p<0.001), while BMI was found to be positively correlated with TG (p<0.001).

73.7% of children with a history of parental hypercholesterolemia presented with hyperlipidemia, mainly TC and LDL-C. Lipid disorders in children residing in west Thessaloniki area are very frequent, even among those who have a negative family history and normal Body Mass Index. It is suggested that lipid profile screening should be performed in all children for the early detection and prompt management of dyslipidemia in childhood.

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

Pediatric Division, General Peripheral Hospital “Papageorgiou”, Thessaloniki

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Paediatriki 2002;65:265-272

ÁÔÓ¤ˆÓ Ô˘ ¿Û¯Ô˘Ó ·fi ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·, ‰È·ÈÛÙÒıËΠ˘ÂÚÏÈȉ·ÈÌ›· Û ÔÛÔÛÙfi 73,7%, Ì ·ÚÈ· ·‡ÍËÛË ÙˆÓ TC Î·È LDL-C. OÈ ‰È·Ù·Ú·¯¤˜ ÙˆÓ ÏÈȉ›ˆÓ ÛÙ· ·È‰È¿ Ù˘ ‰˘ÙÈ΋˜ £ÂÛÛ·ÏÔӛ΢ Â›Ó·È Ôχ Û˘¯Ó¤˜, ·ÎfiÌË Î·È ÌÂٷ͇ ·˘ÙÒÓ Ì ÂχıÂÚÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi Î·È Ê˘ÛÈÔÏÔÁÈÎfi ۈ̷ÙÈÎfi ‚¿ÚÔ˜. ∫Ú›ÓÂÙ·È ÛÎfiÈÌÔ Ô ÚÔÏËÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙˆÓ ÏÈȉ›ˆÓ Ó· ¤¯ÂÈ Â˘Ú‡ÙÂÚË ÂÊ·ÚÌÔÁ‹ ÛÙ· ·È‰È¿, Ì ÛÙfi¯Ô ÙËÓ ÚÒÈÌË ·Ó›¯Ó¢ÛË Î·È ¤ÁηÈÚË ·Ú¤Ì‚·ÛË Î·Ù¿ Ù˘ ·ıËڈ̿وÛ˘. §¤ÍÂȘ ÎÏÂȉȿ: ÏÈ›‰È·, ÏÈÔÚˆÙ½Ó˜, ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi, ·¯˘Û·ÚΛ·.

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

™˘ÓÙÔÌÔÁڷʛ˜

ÍËÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙÔ˘˜ Î·È ÙËÓ ÔÍÂȉˆÙÈ΋ ÙÔ˘˜ ÙÚÔÔÔ›ËÛË (7). ∞ÎfiÌË, Ô Ú˘ıÌfi˜ ÚfiÛÏ˄˘ Ù˘ LDL ·fi ÙÔ˘˜ ÈÛÙÔ‡˜ ÂÍ·ÚÙ¿Ù·È Î˘Ú›ˆ˜ ·fi ÙËÓ ÂÓ‰Ô΢ÙÙ¿ÚÈ· ¯ÔÏËÛÙÂÚfiÏË Ô˘ Ú˘ıÌ›˙ÂÈ ÙË ‰Ú·ÛÙËÚÈfiÙËÙ· ÙˆÓ LDL ˘Ô‰Ô¯¤ˆÓ. ∏ ÚfiÛÏË„Ë ÎÂÎÔÚÂÛÌ¤ÓˆÓ ÏÈÒÓ Î·Ù·ÛÙ¤ÏÏÂÈ ·˘Ù‹ ÙË ‰Ú·ÛÙËÚÈfiÙËÙ· ηÈ, Û˘ÓÂÒ˜, ÙËÓ ·fiÛ˘ÚÛË Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ (8).

OÈ ÈÔ ÚfiÛÊ·Ù˜ ÌÂϤÙ˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÛÙË ÌÂϤÙË ÙÔ˘ ÏÈȉÔÁÚ¿ÌÌ·ÙÔ˜ ÙË Ì¤ÙÚËÛË ÙˆÓ ·ÔÏÈÔÚˆÙÂ˚ÓÒÓ ∞-π Î·È µ, ηıÒ˜ Â›Û˘ Ù˘ ÏÈÔÚˆÙ½Ó˘ (·) [Lp(a)]. ∏ ·ÔÏÈÔÚˆÙ½ÓË µ Ô˘ Â›Ó·È Ô ÌÂÙ·ÊÔÚ¤·˜ Ù˘ LDL ¯ÔÏËÛÙÂÚfiÏ˘ Î·È Ë ·ÔÏÈÔÚˆÙ½ÓË ∞-π, Ô ÌÂÙ·ÊÔÚ¤·˜ Ù˘ HDL ¯ÔÏËÛÙÂÚfiÏ˘, ıˆÚÔ‡ÓÙ·È ÈÔ ÂÍÂȉÈÎÂ˘Ì¤ÓÔÈ ‰Â›ÎÙ˜ ÁÈ· ÙËÓ ÚfiÏË„Ë Ù˘ ™¡. ∞Ó Î·È Ë ÏÂÈÙÔ˘ÚÁ›· Ù˘ ÏÈÔÚˆÙ½Ó˘ (·) ‰ÂÓ Â›Ó·È Ï‹Úˆ˜ ÂÍ·ÎÚÈ‚ˆÌ¤ÓË, Ê·›ÓÂÙ·È fiÙÈ Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ Î·Ú‰È·Î‹ ÚÔÛ‚ÔÏ‹, ÙË ÛÙ¤ÓˆÛË ÙˆÓ ·ÚÙËÚÈÒÓ Î·È ÙËÓ Â·Ó·ÛÙ¤ÓˆÛË ÙˆÓ ·ÁÁ›ˆÓ ÌÂÙ¿ ·fi ÂÁ¯Â›ÚËÛË bypass Î·È ·Ó·ÁÓˆÚ›˙ÂÙ·È Û·Ó ¤Ó·˜ ·ÓÂÍ¿ÚÙËÙÔ˜ ·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ™¡ (9,10). ∞˘ÍË̤ӷ Â›‰· Ù˘ Lp(a) ¤¯Ô˘Ó ÂÓÔ¯ÔÔÈËı› ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË Ù˘ ·ıËڈ̿وÛ˘ Î·È ÂÁÎÂÊ·ÏÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ (11-13). ∆· ·ÓˆÙ¤Úˆ ‰Â‰Ô̤ӷ Ô‰ËÁÔ‡Ó ÛÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ Ë ·Ó›¯Ó¢ÛË ÙˆÓ ‰È·Ù·Ú·¯ÒÓ ÙˆÓ ÏÈȉ›ˆÓ Î·È Ë ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘˜ ÌÔÚ› Ó· ÂÈ‚Ú·‰‡ÓÂÈ ÙËÓ ÂͤÏÈÍË Ù˘ ·ıËڈ̿وÛ˘. ∏ ÚfiÏË„Ë Ô˘ ÚÔÙ›ÓÂÙ·È ·fi ÙËÓ ∂ÈÙÚÔ‹ ¢È·ÙÚÔÊ‹˜ Ù˘ ∞ÌÂÚÈηÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ ∞η‰ËÌ›·˜ (∞∞P) Û˘ÓÈÛÙ¿ Ó· Á›ÓÂÙ·È ÂÈÏÂÎÙÈο ÚÔÏËÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙˆÓ ÏÈȉ›ˆÓ Û ·È‰È¿ ÌÂÁ·Ï‡ÙÂÚ· ÙˆÓ 2 ÂÙÒÓ, fiÙ·Ó ˘¿Ú¯ÂÈ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÚÒÈÌ˘ ÂΉ‹ÏˆÛ˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘ (¤ÌÊÚ·ÁÌ· ‹ ÂÁÎÂÊ·ÏÈÎfi ÂÂÈÛfi‰ÈÔ ÛÂ Û˘ÁÁÂÓ‹ 1Ô˘ ‹ 2Ô˘ ‚·ıÌÔ‡ Û ËÏÈΛ· <55 ÂÙÒÓ) ‹/Î·È ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·˜ Û ¤Ó·Ó ÙÔ˘Ï¿¯ÈÛÙÔÓ ÁÔÓ¤· (ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË >240 mg/dl) (14,15).

TC TG LDL-C HDL-C ApoA-π ApoB Lp(a) ¢ª™ ∂£ §O NS µ™

OÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË ∆ÚÈÁÏ˘ÎÂÚ›‰È· ÃÔÏËÛÙÂÚfiÏË ÏÈÔÚˆÙÂ˚ÓÒÓ ¯·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÃÔÏËÛÙÂÚfiÏË ÏÈÔÚˆÙÂ˚ÓÒÓ ˘„ËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ∞ÔÏÈÔÚˆÙ½ÓË ∞-π ∞ÔÏÈÔÚˆÙ½ÓË µ §ÈÔÚˆÙ½ÓË (·) ¢Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ ∂ηÙÔÛÙÈ·›· ı¤ÛË §È·Ú¿ Ôͤ· ™Ù·ÙÈÛÙÈο ÌË ÛËÌ·ÓÙÈÎfi µ¿ÚÔ˜ ÛÒÌ·ÙÔ˜

∂ÈÛ·ÁˆÁ‹ ∏ ·‡ÍËÛË ÙˆÓ ÏÈȉ›ˆÓ ÙÔ˘ ÔÚÔ‡ ÛÙËÓ ·È‰È΋ ËÏÈΛ· Û˘Ì‚¿ÏÏÂÈ ÛÙËÓ ÚÒÈÌË ¤Ó·ÚÍË Ù˘ ·ıËڈ̿وÛ˘ Î·È ÙËÓ ÂÌÊ¿ÓÈÛË Ù˘ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ (™¡) ÛÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹ (1). ¶·Ú¿ÁÔÓÙ˜ Ô˘ Úԉȷı¤ÙÔ˘Ó, Â›Û˘, ÛÙËÓ ÂÌÊ¿ÓÈÛË ·ıËڈ̿وÛ˘ Â›Ó·È ÙÔ Î¿ÓÈÛÌ·, Ë ˘¤ÚÙ·ÛË, Ë ·¯˘Û·ÚΛ· Î·È Ô Û·Î¯·Ú҉˘ ‰È·‚‹Ù˘ (2-5). Œ¯ÂÈ ‰È·ÈÛÙˆı› fiÙÈ Û ÔÈÎÔÁ¤ÓÂȘ Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ˘„ËÏ‹ Û˘¯ÓfiÙËÙ· ™¡, ˘¿Ú¯ÂÈ Â›Û˘ Û ˘„ËÏ‹ Û˘¯ÓfiÙËÙ· ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· (2,6).

OÈ ÏÈÔÚˆÙ½Ó˜ Ê·›ÓÂÙ·È fiÙÈ ·›˙Ô˘Ó ÛÔ˘‰·›Ô ÚfiÏÔ ÛÙËÓ ÂͤÏÈÍË Ù˘ ·ıËڈ̷ÙÈ΋˜ ‰È·‰Èηۛ·˜.

OÈ ·˘ÍË̤Ó˜ ÙÈ̤˜ ÙˆÓ LDL-ÏÈÔÚˆÙÂ˚ÓÒÓ Ô˘ Â›Ó·È ‚·ÛÈÎÔ› ÊÔÚ›˜ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ ÛÙÔ ·›Ì· Î·È ÔÈ ÂÏ·Ùو̤Ó˜ ÙÈ̤˜ ÙˆÓ HDL-ÏÈÔÚˆÙÂ˚ÓÒÓ ·˘Í¿ÓÔ˘Ó ÙÔÓ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛ˘ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ (6). OÈ LDL ÌÂٷʤÚÔ˘Ó ÙË ¯ÔÏËÛÙÂÚfiÏË Î·È ÙËÓ ÂÈÛ¿ÁÔ˘Ó ÛÙÔ˘˜ ÂÚÈÊÂÚÈÎÔ‡˜ ÈÛÙÔ‡˜ ‰È·Ì¤ÛÔ˘ ÙˆÓ ApoB100 Ô˘ ÂȉÚÔ‡Ó ÛÙÔ˘˜ ·ÓÙ›ÛÙÔÈ¯Ô˘˜ ˘ԉԯ›˜. ªÂÙ·ÏÏ·Á‹ ÙÔ˘ ÁÔÓȉ›Ô˘ ÙˆÓ ˘Ô‰Ô¯¤ˆÓ Ù˘ LDL Ô‰ËÁ› Û ÏËÌÌÂÏ‹ ‹ ÌË ÚfiÛÏË„Ë ÙˆÓ ÌÔÚ›ˆÓ LDL, ÌÂ Û˘Ó¤ÂÈ· ÙËÓ ·‡-

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¢È¿ÊÔÚ˜ ÌÂϤÙ˜, fï˜, ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ Ë ·Ó›¯Ó¢ÛË Ù˘ ÚÒÈÌ˘ ÂΉ‹ÏˆÛ˘ ™¡ ‰ÂÓ ÌÔÚ› Ó· ‚·ÛÈÛÙ› ÌfiÓÔ ÛÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi Ù˘ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·˜, ‰ÈfiÙÈ ¤ÙÛÈ ‰ÂÓ ·ÓȯÓ‡ÂÙ·È ¤Ó·˜ ÌÂÁ¿ÏÔ˜ ·ÚÈıÌfi˜ ·È‰ÈÒÓ Ì ·˘ÍË̤Ó˜ ÙÈ̤˜ ¯ÔÏËÛÙÂÚfiÏ˘ (16-20). °È’ ·˘Ùfi, ÙÔ NCEP (National Cholesterol Education Program for Children and Adolescents) ‰ËÌÔÛ›Â˘Û ԉËÁ›Â˜ ÁÈ· ÙËÓ ·Ó›¯Ó¢ÛË ·È‰ÈÒÓ Ì ˘„ËÏfi ΛӉ˘ÓÔ Ó· ·Ó·Ù‡ÍÔ˘Ó ™¡. ™‡Ìʈӷ Ì ·˘Ù¤˜, ÂÎÙfi˜ ·fi ÙȘ ÚÔ·Ó·ÊÂÚı›Û˜ ÂӉ›ÍÂȘ, ÂϤÁ¯ÔÓÙ·È ÁÈ· Èı·Ó‹ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· ·È‰È¿ ÛÙ· ÔÔ›· ‰ÂÓ ÌÔÚ› Ó· ·ÓȯÓ¢ı› ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ‹ ˘¿Ú¯Ô˘Ó ÂÈÚfiÛıÂÙ· ¿ÏÏÔÈ ·Ú¿ÁÔÓÙ˜ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ™¡, fiˆ˜ ·¯˘Û·ÚΛ·, οÓÈÛÌ·, ·˘ÍË̤ÓË ÚfiÛÏË„Ë ÏÈ·ÚÒÓ Î·È ¯ÔÏËÛÙÂÚfiÏ˘, ÈÛÙÔÚÈÎfi ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË ‹ ˘¤ÚÙ·Û˘ (21). ™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‹Ù·Ó Ë ‰ÈÂÚ‡ÓËÛË ÙÔ˘ ÏÈȉÔÁÚ¿ÌÌ·ÙÔ˜ ·È‰ÈÒÓ ÙˆÓ ‰˘ÙÈÎÒÓ Û˘ÓÔÈÎÈÒÓ Ù˘ £ÂÛÛ·ÏÔӛ΢ Ì·˙› Ì ÛÙÔȯ›· ·fi ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi Î·È ÙËÓ ÎÏÈÓÈ΋ ÂͤٷÛË, ÒÛÙ ӷ ÂÍ·¯ıÔ‡Ó Û˘ÌÂÚ¿ÛÌ·Ù· ˆ˜ ÚÔ˜ ÙËÓ ¤ÎÙ·ÛË ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜ ÛÙÔÓ ·È‰ÈÎfi ÏËı˘ÛÌfi Ù˘ 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· ∆·ÎÙÈο ∂͈ÙÂÚÈο π·ÙÚ›· ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ ηٿ ÙÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ·fi ÙÔÓ π·ÓÔ˘¿ÚÈÔ Ì¤¯ÚÈ ÙÔ ¢ÂΤ̂ÚÈÔ 2001, ÁÈ· ÔÈΛϘ ·Èٛ˜. ∏ ËÏÈΛ· ÙÔ˘˜ Î˘Ì·›ÓÔÓÙ·Ó ·fi 3 ¤ˆ˜ 16 ¤ÙË (̤ÛË ËÏÈΛ· 9,3 ± 3,5 ¤ÙË). ∞fi ÙË ÌÂϤÙË ·ÔÎÏ›ÛÙËÎ·Ó ·È‰È¿ Ô˘ ›¯·Ó ÚfiÛÊ·ÙÔ ÂÌ‡ÚÂÙÔ ‹ ¤·ÈÚÓ·Ó Ê¿Ú̷η, ηıÒ˜ Â›Û˘ ·È‰È¿ Ì ÓÔÛ‹Ì·Ù· ÙÔ˘ ‹·ÙÔ˜, ÙˆÓ ÓÂÊÚÒÓ ‹ ÙÔ˘ ı˘ÚÂÔÂȉ‹. O ÛÎÔfi˜ Ù˘ ÌÂϤÙ˘ ÂÍËÁ‹ıËΠÛÙÔ˘˜ ÁÔÓ›˜ Î·È Ù· ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿ Î·È ‹Ù·Ó fiÏÔÈ Û‡ÌʈÓÔÈ. ™Â fiÏ· Ù· ·È‰È¿ ¤ÁÈÓ ÎÏÈÓÈ΋ ÂͤٷÛË, ηٷÁÚ·Ê‹ ÙÔ˘ ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÈÛÙÔÚÈÎÔ‡, ̤ÙÚËÛË ÙˆÓ ÛˆÌ·ÙÔÌÂÙÚÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ (‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜, Ì‹ÎÔ˜ ÛÒÌ·ÙÔ˜ Î·È ‰Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜), ̤ÙÚËÛË Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ Î·È Ï‹„Ë ËÏÂÎÙÚÔηډÈÔÁÚ·Ê‹Ì·ÙÔ˜. ∆Ô ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ıˆڋıËΠıÂÙÈÎfi fiÙ·Ó ˘‹Ú¯Â ¤ÌÊÚ·ÁÌ· ‹ ÂÁÎÂÊ·ÏÈÎfi ÂÂÈÛfi‰ÈÔ ÛÙÔ˘˜ Û˘ÁÁÂÓ›˜ ÚÒÙÔ˘ ‹ ‰Â‡ÙÂÚÔ˘ ‚·ıÌÔ‡ Û ËÏÈΛ· <55 ÂÙÒÓ ‹ ·‡ÍËÛË Ù˘ ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ >240 mg/dl (14,15). O ‰Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ (¢ª™) ˘ÔÏÔÁ›ÛÙËΠ·fi ÙÔ ËÏ›ÎÔ ÙÔ˘ ‚¿ÚÔ˘˜ ÛÒÌ·ÙÔ˜ (µ™) Û kg ‰È¿ ÙÔ˘ ‡„Ô˘˜ Û m ÛÙÔ ÙÂÙÚ¿ÁˆÓÔ (BMI=kg/m2). ¶·¯‡Û·Úη ıˆڋıËÎ·Ó Ù· ·È‰È¿ Î·È ÔÈ ¤ÊË‚ÔÈ Ì ¢ª™ >95Ë ÂηÙÔÛÙÈ·›· ı¤ÛË ÁÈ· ÙËÓ ËÏÈΛ· Î·È ÙÔ Ê‡ÏÔ ÙÔ˘˜, Û‡Ìʈӷ Ì ÂȉÈο ÓÔÚÌÔÁÚ¿ÌÌ·Ù· (22). ∆· ·È‰È¿ Ù˘ ÌÂϤÙ˘ Ù·ÍÈÓÔÌ‹ıËÎ·Ó Û 4 ÔÌ¿‰Â˜, ·Ó¿ÏÔÁ· Ì ÙÔ ¢ª™ Î·È ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi, ˆ˜ ÂÍ‹˜: Ë ÔÌ¿‰· ∞ ÂÚÈÂÏ¿Ì‚·Ó 19 ·È‰È¿ Ô˘ ‹Ù·Ó ·¯‡Û·Úη ÌÂ

Paediatriki 2002;65:265-272

·ÚÓËÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi, Ë ÔÌ¿‰· µ ÂÚÈÂÏ¿Ì‚·Ó 7 ·È‰È¿ Ô˘ ‹Ù·Ó ·¯‡Û·Úη Ì ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi, Ë ÔÌ¿‰· ° ÂÚÈÂÏ¿Ì‚·Ó 50 ·È‰È¿ ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi µ™ Î·È ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi Î·È Ë ÔÌ¿‰· ¢ ÂÚÈÂÏ¿Ì‚·Ó 95 ·È‰È¿ ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi µ™ Î·È ·ÚÓËÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi. ™Â ÚˆÈÓfi ‰Â›ÁÌ· ·›Ì·ÙÔ˜ ÌÂÙ¿ 12ˆÚË ÓËÛÙ›· ÚÔÛ‰ÈÔÚ›ÛÙËηÓ: ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË (TC), ÙÚÈÁÏ˘ÎÂÚ›‰È· (TG), HDL ¯ÔÏËÛÙÂÚfiÏË (HDL-C), LDL ¯ÔÏËÛÙÂÚfiÏË (LDL-C), ·ÔÏÈÔÚˆÙ½ÓË ∞-π (ApoA-π), ·ÔÏÈÔÚˆÙ½ÓË µ (ApoB), ÏÈÔÚˆÙ½ÓË (·) [Lp(a)] Î·È ·ıËڈ̷ÙÈÎfi˜ ‰Â›ÎÙ˘. O ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘, ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ Î·È Ù˘ HDL-¯ÔÏËÛÙÂÚfiÏ˘ ¤ÁÈÓ Ì ÂÓ˙˘Ì·ÙÈ΋ ¯ÚˆÌ·ÙÔÌÂÙÚÈ΋ ̤ıÔ‰Ô, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÙÔÓ ·˘ÙfiÌ·ÙÔ ‚ÈÔ¯ËÌÈÎfi ·Ó·Ï˘Ù‹ Olympus Au 560 Î·È Olympus Au 400 Ù˘ ÂÙ·ÈÚ›·˜ Medicon. H ÙÈÌ‹ Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘ ˘ÔÏÔÁ›ÛÙËΠ̠‚¿ÛË ÙÔÓ Ù‡Ô Friedewald: (¯ÔÏËÛÙÂÚfiÏË-ÙÚÈÁÏ˘ÎÂÚ›‰È·/5)HDL Î·È ÙÔ˘ ·ıËڈ̷ÙÈÎÔ‡ ‰Â›ÎÙË Ì ‚¿ÛË ÙÔ ËÏ›ÎÔ ¯ÔÏËÛÙÂÚfiÏË/HDL-C. OÈ ApoA-π, ApoB Î·È Lp(a) ÚÔÛ‰ÈÔÚ›ÛÙËÎ·Ó Ì ·ÓÔÛÔÓÂÊÂÏÔÌÂÙÚ›·, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÙÔ ÓÂÊÂÏfiÌÂÙÚÔ Beckman Array 360 System. ŸÏÔÈ ÔÈ ÚÔÛ‰ÈÔÚÈÛÌÔ› ¤ÁÈÓ·Ó Ì¤Û· Û ‰‡Ô ¤ˆ˜ ÂÙ¿ Ë̤Ú˜ ·fi ÙËÓ ·ÈÌÔÏË„›· Î·È ÔÈ ÔÚÔ› ÙÔ˘ ·›Ì·ÙÔ˜ Ê˘Ï¿¯ıËÎ·Ó Û ηٿ„˘ÍË ÛÙÔ˘˜ -20ÔC ¤ˆ˜ -50ÔC. ∏ ·ÍÈÔÏfiÁËÛË ÙˆÓ ÙÈÌÒÓ ÙˆÓ ÏÈȉ›ˆÓ Î·È ÏÈÔÚˆÙÂ˚ÓÒÓ ¤ÁÈÓ ۇÌʈӷ Ì ÚÔËÁÔ‡ÌÂÓ˜ ÂÏÏËÓÈΤ˜ ÌÂϤÙ˜ ÙˆÓ ∫·‚·˙·Ú¿ÎË Î·È Û˘Ó (1998), ∆ÛfiÏ· Î·È Û˘Ó (1999) Î·È Shulpis Î·È Û˘Ó (1998) Û ÌÂÁ¿ÏÔ˘˜ ·È‰È·ÙÚÈÎÔ‡˜ ÏËı˘ÛÌÔ‡˜ (23-25). OÈ Ê˘ÛÈÔÏÔÁÈΤ˜ ÙÈ̤˜ Ì ÙȘ ÂηÙÔÛÙÈ·›Â˜ ı¤ÛÂȘ (∂£) ·Ó¿ ËÏÈΛ· Î·È Ê‡ÏÔ ·ÔÙ¤ÏÂÛ·Ó ÛËÌÂ›Ô ·Ó·ÊÔÚ¿˜ ÁÈ· ÙËÓ ·Ó›¯Ó¢ÛË ·ıÔÏÔÁÈÎÒÓ ÙÈÌÒÓ ÛÙ· ·È‰È¿ Ù˘ ÌÂϤÙ˘ Ì·˜. ø˜ fiÚÈÔ ·Ô‰ÂÎÙÒÓ ÙÈÌÒÓ ıˆڋıËÎÂ Ë 75Ë ∂£ ÁÈ· ÙËÓ TC, TG, LDL-C Î·È ApoB Î·È Ë 25Ë ∂£ ÁÈ· ÙËÓ HDL-C Î·È ApoA-π, Û‡Ìʈӷ Ì ÙË ÌÂϤÙË ÙˆÓ ∫·‚·˙·Ú¿ÎË Î·È Û˘Ó (1998). ¶·ıÔÏÔÁÈΤ˜ ÙÈ̤˜ ÁÈ· ÙË ÏÈÔÚˆÙ½ÓË (·) ıˆڋıËÎ·Ó ÙÈ̤˜ ˘„ËÏfiÙÂÚ˜ ·fi ·˘Ù¤˜ Ô˘ ·ÓÙÈÛÙÔÈ¯Ô‡Ó ÛÙËÓ 95Ë ∂£ ÁÈ· ÙËÓ ËÏÈΛ· Î·È ÙÔ Ê‡ÏÔ Î·È ÔˆÛ‰‹ÔÙ ÙÈÌ‹ ÌÂÁ·Ï‡ÙÂÚË ·fi 30 mg/dl (9,10). ø˜ ‰˘ÛÏÈȉ·ÈÌ›· ıˆڋıËÎÂ Ë ‡·ÚÍË ÌË ·Ô‰ÂÎÙ‹˜ ÙÈÌ‹˜ ÙÔ˘Ï¿¯ÈÛÙÔÓ ÁÈ· ¤Ó·Ó ·fi ÙÔ˘˜ ÏÈȉ·ÈÌÈÎÔ‡˜ ‰Â›ÎÙ˜ Ô˘ ÌÂÏÂÙ‹ıËηÓ. ™Ù·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ∏ ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ¤ÁÈÓ Ì ÙË ‚Ô‹ıÂÈ· ËÏÂÎÙÚÔÓÈÎÔ‡ ˘ÔÏÔÁÈÛÙ‹ (∏/À) Î·È Ì ÙÔ ÛÙ·ÙÈÛÙÈÎfi ÚfiÁÚ·ÌÌ· SPSS 10.0. ∏ ‰È·‰Èηۛ· Ù˘ ÛÙ·ÙÈÛÙÈ΋˜ ·Ó¿Ï˘Û˘ ÂÚÈÂÏ¿Ì‚·Ó ˘ÔÏÔÁÈÛÌfi ÁÈ· οı ÌÂÙ·‚ÏËÙ‹ Ù˘ ̤Û˘ ÙÈÌ‹˜ (mean) Î·È Ù˘ Ù˘È΋˜ ·fiÎÏÈÛ˘ (SD). ∏ Û‡ÁÎÚÈÛË ÙˆÓ ÏÈȉ›ˆÓ Î·È ÙˆÓ ÛˆÌ·ÙÔÌÂÙÚÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ ÌÂٷ͇ ÙˆÓ ‰‡Ô Ê‡ÏˆÓ ¤ÁÈÓ Ì t-test. ∏ Û˘Û¯¤ÙÈÛË ÙˆÓ ·Ú·Ì¤ÙÚˆÓ ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ ·ÛıÂÓÒÓ ¤ÁÈÓ Ì ÙË ÛÙ·ÙÈÛÙÈ΋ ̤ıÔ‰Ô Pearson, ÂÓÒ ÁÈ· ÙË Û‡ÁÎÚÈÛË ÙˆÓ ·Ú·Ì¤ÙÚˆÓ ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë ÌË ·Ú·ÌÂÙÚÈ΋ ̤ıÔ‰Ô˜ Mann Whitney. ø˜ fiÚÈÔ ÛÙ·ÙÈÛÙÈ΋˜ ÛËÌ·ÓÙÈÎfiÙËÙ·˜ ıˆڋıËÎÂ Ë ÙÈÌ‹ p<0,05.

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¶›Ó·Î·˜ 1. ™ˆÌ·ÙÔÌÂÙÚÈο ¯·Ú·ÎÙËÚÈÛÙÈο Î·È ÏÈ›‰È· ·›Ì·ÙÔ˜ ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ ·È‰ÈÒÓ Î·È Î·Ù¿ ʇÏÔ ¶·Ú¿ÌÂÙÚÔ˜

™‡ÓÔÏÔ ·È‰ÈÒÓ (n=171)

∞ÁfiÚÈ· (n=84)

∫ÔÚ›ÙÛÈ· (n=87)

p

9,2±3,5 37,9±17,2 138,6±19,2 18,6±4,3 173,5±29 76,4±42,2 102,3±26,2 56,3±11,6 137±28,9 78,3±21,9 23,9±25,9

NS NS NS NS NS NS NS NS NS NS NS

ª¤ÛË ÙÈÌ‹ (±SD) ∏ÏÈΛ· (¤ÙË) µ¿ÚÔ˜ ÛÒÌ·ÙÔ˜ (cm) ª‹ÎÔ˜ ÛÒÌ·ÙÔ˜ (cm) ¢ª™ (kg/m2) OÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË (mg/dl) ∆ÚÈÁÏ˘ÎÂÚ›‰È· (mg/dl) LDL-C (mg/dl) HDL-C (mg/dl) ApoA-I (mg/dl) ApoB (mg/dl) Lp(a) (mg/dl)

9,3±3,5 38,2±17,7 137,9±19,7 18,9±4,3 172±29,1 75,4±37,1 101,6±26,3 55±13,4 134,5±27,3 77,6±20,8 21,4±19

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

∞ µ ° ¢ ™‡ÓÔÏÔ

n

%

19 7 50 95 171

11,1 4,1 29,2 55,6

ªË ·Ô‰ÂÎÙÔ› ÏÈȉ·ÈÌÈÎÔ› ‰Â›ÎÙ˜ n % 6/19 4/7 26/50 18/95 54

31,6 57,1 52 18,9 31,5

∞ÔÙÂϤÛÌ·Ù· ∞fi ÙË Û‡ÁÎÚÈÛË ÙˆÓ ÛˆÌ·ÙÔÌÂÙÚÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ Î·È ÙˆÓ ÙÈÌÒÓ ÙˆÓ ÏÈȉ›ˆÓ ÌÂٷ͇ ÙˆÓ ‰‡Ô Ê‡ÏˆÓ ‰ÂÓ ‰È·ÈÛÙÒıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ (¶›Ó·Î·˜ 1), ÁÈ’ ·˘Ùfi fiÏÔÈ ÔÈ ÂÚ·ÈÙ¤Úˆ ˘ÔÏÔÁÈÛÌÔ› ¤ÁÈÓ·Ó ÌÂÙ¿ ·fi ÔÌ·‰ÔÔ›ËÛË ÙˆÓ ‰‡Ô ʇψÓ. Ÿˆ˜ Ê·›ÓÂÙ·È Î·È ÛÙÔÓ ¶›Ó·Î· 2, ÙÔ 15,2% ÙˆÓ ·È‰ÈÒÓ ‹Ù·Ó ·¯‡Û·Úη (ÂÎ ÙˆÓ ÔÔ›ˆÓ ÙÔ 11,1% ›¯Â ·ÚÓËÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi Î·È ÙÔ 4,1% ›¯Â ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi), ÂÓÒ ÙÔ 29,2% ÙˆÓ ·È‰ÈÒÓ ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi µ™ ›¯Â ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi Î·È ÙÔ 55,6% ›¯Â ·ÚÓËÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi. ∞fi Ù· 171 ·È‰È¿ Ù˘ ÌÂϤÙ˘ Ù· 54 (31,5%) ›¯·Ó 1-5 ÌË ·Ô‰ÂÎÙÔ‡˜ ÁÈ· ÙËÓ ËÏÈΛ· ÙÔ˘˜ ÏÈȉ·ÈÌÈÎÔ‡˜ ‰Â›ÎÙ˜. ∆Ô ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ÌË ·Ô‰ÂÎÙÒÓ ÙÈÌÒÓ Â›¯·Ó Ù· ·È‰È¿ Ì ·¯˘Û·ÚΛ· Î·È ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi (57,1%), ·ÎÔÏÔ˘ıÔ‡Û·Ó Ù· ·È‰È¿ ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi µ™ Î·È ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi (52%), Ë ÔÌ¿‰· ÙˆÓ ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ Ì ·ÚÓËÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi (31,6%) Î·È Ù¤ÏÔ˜ Ë ÔÌ¿‰· ÙˆÓ ·È‰ÈÒÓ ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi µ™ Î·È ·ÚÓËÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi (18,9%). ∏ ̤ÛË ÙÈÌ‹ ÙˆÓ ÏÈȉ›ˆÓ Î·È ÏÈÔÚˆÙÂ˚ÓÒÓ ÙÔ˘ ÔÚÔ‡ Û οı ÔÌ¿‰· Ê·›ÓÂÙ·È ·Ó·Ï˘ÙÈο ÛÙÔÓ ¶›Ó·Î· 3. ∞fi ÙË ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ÙˆÓ ·ÓˆÙ¤Úˆ ÙÈÌÒÓ ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ ‰È·ÈÛÙÒıËΠfiÙÈ Ù· ·È‰È¿ Ù˘ ÔÌ¿‰·˜ ∞ (·¯‡Û·Úη Ì ·ÚÓËÙÈÎfi ÔÈ-

268

9,4±3,4 38,5±18,3 137,6±20,2 19±4,1 170±29,7 75,1±36,6 105,8±30,1 54,4±15 132,1±25,7 76,2±19,7 19,6±19,8

ÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi) ¤¯Ô˘Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ·˘ÍË̤ӷ Â›‰· TG Û ۇÁÎÚÈÛË Ì ÙËÓ ÔÌ¿‰· ¢ (Ê˘ÛÈÔÏÔÁÈÎÔ‡ µ™ Î·È Ì ·ÚÓËÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi) (p<0,004) Î·È ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ·˘ÍË̤ÓË Lp(a) Û ۇÁÎÚÈÛË Ì ÙËÓ ÔÌ¿‰· µ (·¯‡Û·Úη Ì ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi) (p<0,02). ∆· ·È‰È¿ Ù˘ ÔÌ¿‰·˜ µ (·¯‡Û·Úη Ì ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi) ¤¯Ô˘Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ÂÏ·Ùو̤ÓË ApoA-I (p<0,04) Î·È ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ·˘ÍË̤ÓË Lp(a) (p<0,005) Û ۇÁÎÚÈÛË Ì ÙËÓ ÔÌ¿‰· ° (Ê˘ÛÈÔÏÔÁÈÎÔ‡ µ™ Ì ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi) Î·È Û ۇÁÎÚÈÛË Ì ÙËÓ ÔÌ¿‰· ¢ (Ê˘ÛÈÔÏÔÁÈÎÔ‡ µ™ Ì ·ÚÓËÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi) (p<0,04). ∆· ·È‰È¿ Ù˘ ÔÌ¿‰·˜ ° (Ê˘ÛÈÔÏÔÁÈÎÔ‡ µ™ Ì ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi) ¤¯Ô˘Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ·˘ÍË̤Ó˜ ÙÈ̤˜ TC Î·È LDL-C Û ۇÁÎÚÈÛË Ì ÙËÓ ÔÌ¿‰· ¢ (Ê˘ÛÈÔÏÔÁÈÎÔ‡ µ™ Ì ·ÚÓËÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi) (p<0,004) (¶›Ó·Î·˜ 4). ∏ ‰ÔÎÈÌ·Û›· Pearson ¤‰ÂÈÍ fiÙÈ ˘¿Ú¯ÂÈ ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÙÔ˘ ¢ª™ Î·È ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ (r=0,28, p<0,001) Î·È ÌÂٷ͇ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ Î·È Ù˘ 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 ·ıËڈ̷ÙÈÎÔ‡ ‰Â›ÎÙË (r=0,38, p<0,001). ∆· ÙÚÈÁÏ˘ÎÂÚ›‰È· ¤¯Ô˘Ó ·ÚÓËÙÈ΋ Û˘Û¯¤ÙÈÛË Ì ÙËÓ HDL-C (r=-0,25, p<0,001) Î·È ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË Ì ÙËÓ ApoB (r=0,22, p<0,01). ∏ Lp(a) ¤¯ÂÈ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË Ì 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 ·ıËڈ̷ÙÈÎfi˜ ‰Â›ÎÙ˘ ¤¯ÂÈ ÛËÌ·ÓÙÈ΋ Û˘Û¯¤ÙÈÛË Ì fiϘ ÙȘ ·Ú·Ì¤ÙÚÔ˘˜, ÂÎÙfi˜ ·fi ÙËÓ Lp(a). ∞fi Ù· 50 ·È‰È¿ Ì ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi, Ù· 19 ·Ó‹ÎÔ˘Ó Û 9 ÔÈÎÔÁ¤ÓÂȘ fiÔ˘ Ô ¤Ó·˜ ·fi ÙÔ˘˜ ‰‡Ô ÁÔÓ›˜ ¤¯ÂÈ ÁÓˆÛÙ‹ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· (TC>240 mg/dl), ÁÈ· ÙËÓ ÔÔ›· ˘Ô‚¿ÏÏÂÙ·È Û ‰È·ÈÙËÙÈ΋ ‹/Î·È Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹. ∞ÍÈÔÛËÌ›ˆÙÔ Â›Ó·È ·ÎfiÌË ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Î·Ó¤Ó·

july-aug02TELIKO

14-05-03

13:31

™ÂÏ›‰·269

¶·È‰È·ÙÚÈ΋ 2002;65:265-272

Paediatriki 2002;65:265-272

¶›Ó·Î·˜ 3. ª¤ÛË ÙÈÌ‹ Î·È ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË ÙˆÓ ÏÈȉ›ˆÓ Î·È ÏÈÔÚˆÙÂ˚ÓÒÓ ·Ó¿ ÔÌ¿‰· ÌÂϤÙ˘ OÌ¿‰· A B ° ¢ ™‡ÓÔÏÔ

TC

TG

LDL-C

HDL-C

ApoA-I

ApoB

Lp(a)

TC/HDL-C

167,79 35,07 170,43 30,53 184,04 31,97 166,55 24,43 171,96 29,14

92,53 35,58 88,86 43,82 80,28 45,23 68,38 30,52 75,38 37,16

94,95 33,89 81,88 30,15 110,68 26,38 97,10 23,39 100,49 27,17

54,05 20,26 48,29 14,45 57,52 12,55 55,15 12,08 55,44 13,44

128,59 29,68 114,51 21,87 136,05 26,10 136,43 27,51 134,48 27,29

75,659 23,362 69,657 11,164 82,968 25,384 75,220 17,261 77,487 20,863

25,573 26,062 7,59 3,584 29,415 29,979 16,913 16,683 21,360 23,183

3,315 1,002 3,747 1,125 3,268 0,578 3,115 0,724 3,208 0,746

¶›Ó·Î·˜ 4. ™‡ÁÎÚÈÛË ÙˆÓ Û˘ÁÎÂÓÙÚÒÛÂˆÓ ÙˆÓ ÏÈȉ›ˆÓ Ô˘ ›¯·Ó ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ

TC TG LDL-C ApoA-I Lp(a)

OÌ¿‰Â˜

p

°-¢ ∞-¢ °-¢ µ-° µ-¢ ∞-µ µ-° µ-¢

<0,004 <0,004 <0,004 <0,04 <0,04 <0,02 <0,005 <0,04

·fi Ù· 19 ·È‰È¿ ‰ÂÓ ‹Ù·Ó ·¯‡Û·ÚÎÔ. ™Â 4/9 ÔÈÎÔÁ¤ÓÂȘ ·Ú·ÙËÚ‹ıËÎ·Ó ‰˘ÛÏÈȉ·ÈÌÈΤ˜ ‰È·Ù·Ú·¯¤˜ Û fiÏ· Ù· ·‰¤ÏÊÈ·-̤ÏË. ªË ·Ô‰ÂÎÙÔ› ÏÈȉ·ÈÌÈÎÔ› ‰Â›ÎÙ˜ ‚Ú¤ıËÎ·Ó Û 14/19 ·È‰È¿ (73,7%). ŸÏ˜ ÔÈ ÂÚÈÙÒÛÂȘ ·ÊÔÚÔ‡Û·Ó ·˘ÍË̤ÓË TC, Ë ÔÔ›· Û˘Óԉ¢fiÙ·Ó Î·È ·fi ¿ÏÏÔ˘˜ ·ıÔÏÔÁÈÎÔ‡˜ ‰Â›ÎÙ˜, fiˆ˜ Ê·›ÓÂÙ·È ÛÙÔÓ ¶›Ó·Î· 5. ¢È·Ù·Ú·¯¤˜ Ù˘ LDL-C ‚Ú¤ıËÎ·Ó Û 13/14 ·È‰È¿, 6 ·fi Ù· ÔÔ›· ›¯·Ó ÔÚȷΤ˜ ÙÈ̤˜ (110129 mg/dl), ÂÓÒ Ù· ˘fiÏÔÈ· 7 ›¯·Ó ·ıÔÏÔÁÈΤ˜ ÙÈ̤˜ (>130 mg/dl) (¶›Ó·Î·˜ 5). À„ËÏfiÙÂÚ˜ ̤Û˜ ÙÈ̤˜ TC, LDL-C Î·È Lp(a) ›¯·Ó Ù· ·È‰È¿ Ì ÙËÓ “ÔÈÎÔÁÂÓ‹ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·” Û˘ÁÎÚÈÓfiÌÂÓ· Ì ·˘Ù¿ ¯ˆÚ›˜ ÂÈ‚·Ú˘ÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ (Ê˘ÛÈÔÏÔÁÈÎfi µ™ Î·È ·ÚÓËÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi), fiˆ˜ Ê·›ÓÂÙ·È ÛÙÔ ™¯‹Ì· 1. ™˘˙‹ÙËÛË ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ÚÔÛ‰ÈÔÚ›˙ÔÓÙ·È ÔÈ Û˘ÁÎÂÓÙÚÒÛÂȘ ÙˆÓ TC, TG, LDL-C, HDL-C, ApoA-π, ApoB Î·È Lp(a) Û ·È‰È¿ ÙˆÓ ‰˘ÙÈÎÒÓ Û˘ÓÔÈÎÈÒÓ Ù˘ £ÂÛÛ·ÏÔӛ΢ ÌÂÙ¿ ·fi ·ÔÎÏÂÈÛÌfi ÙˆÓ Û˘ÓËı¤ÛÙÂÚˆÓ ·ÈÙ›ˆÓ ‰Â˘ÙÂÚÔ·ıÔ‡˜ ‰˘ÛÏÈȉ·ÈÌ›·˜ Î·È Á›ÓÂÙ·È Û˘Û¯ÂÙÈÛÌfi˜ Ì ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi Î·È ÙÔ ¢ª™. ¢È·ÈÛÙÒÓÂÙ·È fiÙÈ ÙÔ Ê‡ÏÔ ‰ÂÓ ¤¯ÂÈ È‰È·›ÙÂÚË ÛËÌ·Û›· ÁÈ· Ù· Â›‰· ÙˆÓ ÏÈȉ›ˆÓ ÙÔ˘ ÔÚÔ‡, ÁÈ·Ù› fiˆ˜ ÚԤ΢„ ·fi ÙË ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ÔÈ ‰È·ÊÔÚ¤˜ Û˘ÁÎÂÓÙÚÒÛÂˆÓ ÙˆÓ ÏÈȉ›ˆÓ ·Ó¿ÌÂÛ· Û ·ÁfiÚÈ· Î·È ÎÔÚ›ÙÛÈ· ‰ÂÓ ‹Ù·Ó ÛËÌ·ÓÙÈΤ˜.

∆Ô ‰Â‰Ô̤ÓÔ ·˘Ùfi Û˘ÌʈÓ› Ì ÙȘ ÌÂϤÙ˜ ÙˆÓ ∫·‚·˙·Ú¿ÎË Î·È Û˘Ó (1998), ∆ÛfiÏ· Î·È Û˘Ó (1999) Î·È ™¿‚‚· Î·È Û˘Ó (2000) (23,24,26). ∂χıÂÚÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ›¯·Ó 114/171 ·È‰È¿ Ù˘ ÌÂϤÙ˘ Ì·˜ (66,6%) Û ۇÁÎÚÈÛË Ì 52,2% ÙˆÓ Diller Î·È Û˘Ó (1995) Î·È 69,5% ÙˆÓ ∆ÛfiÏ· Î·È Û˘Ó (1999) (27,24). ∏ Û˘¯ÓfiÙËÙ· Ù˘ ·¯˘Û·ÚΛ·˜ ÛÙÔ Û˘ÓÔÏÈÎfi ‰Â›ÁÌ· ÙˆÓ ·È‰ÈÒÓ Ì·˜ ·Ó¤Ú¯ÂÙ·È Û 15,2% (‰ÂÓ ˘‹Ú¯Â ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÌÂٷ͇ ÙˆÓ ‰‡Ô Ê‡ÏˆÓ (p=0,72) (¶›Ó·Î·˜ 1). ¶ÚfiÛÊ·ÙË ÌÂϤÙË ·fi ÙË µ. ∂ÏÏ¿‰· Û 8000 ·È‰È¿-ÂÊ‹‚Ô˘˜ ‰È·›ÛÙˆÛÂ Û˘¯ÓfiÙËÙ· ·¯˘Û·ÚΛ·˜ 12,5%, ¤¯ÔÓÙ·˜ fiˆ˜ Î·È ÂÌ›˜ ˆ˜ ÎÚÈÙ‹ÚÈÔ ¢ª™ >95Ë ∂£ (28). ¢˘ÛÏÈȉ·ÈÌ›· ‰È·ÈÛÙÒıËΠÛÙÔ 38,4% ÙˆÓ ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ Ù˘ ÌÂϤÙ˘ Ì·˜, ÂÓÒ Û ·ÓÙ›ÛÙÔÈ¯Ë ÌÂϤÙË ÙˆÓ ∆ÛfiÏ· Î·È Û˘Ó (1999) ‹Ù·Ó ¯·ÌËÏfiÙÂÚË (21,6-29,8%) (24). ™ÙËÓ ÔÌ¿‰· ÙˆÓ ·È‰ÈÒÓ Ì ÙÔ ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi, Ë ‰˘ÛÏÈȉ·ÈÌ›· Êı¿ÓÂÈ ÛÙÔ 52%, ÂÓÒ Û ÚÔËÁÔ‡ÌÂÓË ÂÏÏËÓÈ΋ ÌÂϤÙË Â›Ó·È ÌfiÏȘ 30,7-34,8% (24). ¶·Ï·ÈfiÙÂÚË ÌÂϤÙË ÙˆÓ °ÚËÁÔÚ¤· Î·È Û˘Ó (1990) Û ·È‰È¿ ÂÌÊÚ·ÁÌ·ÙÈÒÓ ÁÔÓ¤ˆÓ ¤‰ÂÈÍ ‰˘ÛÏÈȉ·ÈÌ›· Û ÔÛÔÛÙfi 63,8% (29). ¢È·ÈÛÙÒıËΠfiÙÈ Ô ¢ª™ ·ÚÔ˘ÛÈ¿˙ÂÈ ÛÙ·ÙÈÛÙÈÎÒ˜ ÛËÌ·ÓÙÈ΋ Û¯¤ÛË Ì ٷ TG. ∆· ·È‰È¿ Ì ·˘ÍË̤ÓÔ ¢ª™ Î·È ıÂÙÈÎfi ÈÛÙÔÚÈÎfi ¤¯Ô˘Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ÂÏ·Ùو̤ÓË ApoA-π Û ۇÁÎÚÈÛË Ì ÙȘ ¿ÏϘ ÔÌ¿‰Â˜. ∆· Â˘Ú‹Ì·Ù¿ Ì·˜ Û˘ÌʈÓÔ‡Ó Ì ÚÔËÁÔ‡ÌÂÓ˜ ÌÂϤÙ˜ ÙˆÓ ∆ÛfiÏ· Î·È Û˘Ó (1999), fiÔ˘ ·Ú·ÙËÚ‹ıËΠÛËÌ·ÓÙÈ΋ Û˘Û¯¤ÙÈÛË ÙÔ˘ ¢ª™ Ì ٷ TG Î·È ApoA-π Î·È ÙˆÓ ™¿‚‚· Î·È Û˘Ó (2000), fiÔ˘ ‚Ú¤ıËΠıÂÙÈ΋ Û˘Û¯¤ÙÈÛË ÙÔ˘ ¢ª™ Ì ÙËÓ LDL-C Î·È Ù· TG Î·È ·ÚÓËÙÈ΋ Û˘Û¯¤ÙÈÛË Ì ÙËÓ HDL-C. ™ÙË ÌÂϤÙË ÙˆÓ ™Ô‡ÏË Î·È Û˘Ó (1991) Û 42 ·¯‡Û·Úη ·È‰È¿ ÚÔÂÊË‚È΋˜ ËÏÈΛ·˜ ‰È·ÈÛÙÒıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË Ù˘ LDL-C Î·È ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ÂÏ¿ÙÙˆÛË Ù˘ ∏DL-C Û ۇÁÎÚÈÛË Ì ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘ (30). ∂›Û˘, ‰È·ÈÛÙÒıËΠfiÙÈ Ù· ·È‰È¿ ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi µ™ Î·È ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi

269

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¶›Ó·Î·˜ 5. ∆È̤˜ ÏÈȉ›ˆÓ Î·È ÏÈÔÚˆÙÂ˚ÓÒÓ ÙˆÓ ·È‰ÈÒÓ Ì ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· Û ¤Ó·Ó ·fi ÙÔ˘˜ ÁÔÓ›˜ n

º‡ÏÔ

OÈÎÔÁ¤ÓÂÈ·

∏ÏÈΛ· (¤ÙË)

∞ÁˆÁ‹

TC*

TG*

LDL*

HDL*

ApoA-I*

ApoB*

Lp(a)*

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

∫ ∞ ∫ ∞ ∞ ∞ ∫ ∫ ∫ ∞ ∫ ∞ ∞ ∫ ∫ ∞ ∫ ∞ ∫

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

11 12 5 3 11 8 11 11 10 9,5 8 12,5 8,5 13 11 4 10 8 10

¢›·ÈÙ·

221 194 225 192 190 238 215 241 207 241 220 229 153 215 200 216 221 194 215

73 55 62 91 49 131 147 66 163 96 67 101 79 95 68 53 54 48 46

148 131 143 120 100 144 128 168 114 166 156 156 96 98 123 125 122 118 110

58 52 70 54 80 68 58 60 60 56 51 53 41 67 60 80 88 66 96

164 155 155 165 164 156 156 105 124 115 115 140 100 132 128 185 144 121 172

10,3 80 110 99 72,3 162 140 91 78,4 111 97,5 113 71 67 82 43,6 73,6 71,9 69,1

10 10 16 10 12 80 80 2,48 2 23,5 7 85 18,2 74 254 89,9 6,5 8,5 9,5

¢›·ÈÙ·

¢›·ÈÙ· ¢›·ÈÙ· ¢›·ÈÙ· ¢›·ÈÙ· ¢›·ÈÙ·

*mg/dl

ÔÈÎÔÁÂÓ‹˜ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· ¯ˆÚ›˜ ÂÈ‚·Ú˘ÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜

250

mg/dl

200

150

100

50

0 TC

TG

LDL-C

HDL-C

ApoA1

ApoB

Lp(a)

™¯‹Ì· 1. ™¯ËÌ·ÙÈ΋ ·ÂÈÎfiÓÈÛË ÙˆÓ ÏÈȉ›ˆÓ (̤Û˜ ÙÈ̤˜) ÙˆÓ ·È‰ÈÒÓ Ì “ÔÈÎÔÁÂÓ‹ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·” Î·È ·˘ÙÒÓ ¯ˆÚ›˜ ÂÈ‚·Ú˘ÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜.

·ÚÔ˘ÛÈ¿˙Ô˘Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ TC Î·È LDL-C, Û ۇÁÎÚÈÛË Ì ٷ ·È‰È¿ ¯ˆÚ›˜ ÂÈ‚·Ú˘ÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜. ∆· Â˘Ú‹Ì·Ù¿ Ì·˜ Û˘ÌʈÓÔ‡Ó Ì ÙË ÌÂϤÙË ÙˆÓ ∆ÛfiÏ· Î·È Û˘Ó (1999), ÛÙËÓ ÔÔ›· ‰È·ÈÛÙÒıËΠfiÙÈ ÙÔ ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ›¯Â ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ Û¯¤ÛË ÌfiÓÔ Ì ÙËÓ TC Î·È ÙËÓ LDL-C, ηıÒ˜ Î·È Ì ÙË ÌÂϤÙË ÙˆÓ ™¿‚‚· Î·È Û˘Ó (2000), ÛÙËÓ ÔÔ›· Ë ÔÏ˘·Ú·ÁÔÓÙÈ΋ ·Ó¿Ï˘ÛË Ô˘ ¤ÁÈÓ ÁÈ· ÙËÓ Â›‰Ú·ÛË ‰È·ÊfiÚˆÓ ·Ú·Ì¤ÙÚˆÓ ÛÙ· ÏÈ›‰È· ¤‰ÂÈÍ ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË ÙÔ˘ ıÂÙÈÎÔ‡ ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÈÛÙÔÚÈÎÔ‡ Ì ٷ Â›‰· Ù˘ TC, TG Î·È LDL-C.

270

™ÙËÓ ÔÌ¿‰· ÙˆÓ ·È‰ÈÒÓ ¯ˆÚ›˜ ÂÈ‚·Ú˘ÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ‰È·ÈÛÙÒıËÎ·Ó ‰È·Ù·Ú·¯¤˜ ÙˆÓ ÏÈȉ›ˆÓ Û ÔÛÔÛÙfi 18,9%, ÂÓÒ ÛÙË ÌÂϤÙË ÙˆÓ ∆ÛfiÏ· Î·È Û˘Ó (1999) ÙÔ ÔÛÔÛÙfi ·˘Ùfi ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚÔ ÙÔ˘ 20% (24). ™Ù· 19 ·fi Ù· 50 ·È‰È¿ Ì ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi (38%) ‰È·ÈÛÙÒıËΠ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· Û ¤Ó·Ó ·fi ÙÔ˘˜ ‰‡Ô ÁÔÓ›˜, ¤Ó·ÓÙÈ 42,2% ÛÙË ÌÂϤÙË ÙˆÓ ∆ÛfiÏ· Î·È Û˘Ó (1999) (24). ∏ ÏÂÈÔ„ËÊ›· ÙˆÓ ·È‰ÈÒÓ ·˘ÙÒÓ (73,7%) ›¯Â ·˘ÍË̤ÓË TC, ÂÓÒ Û˘Ó˘‹Ú¯Â ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË Ù˘ LDL-C ÛÙÔ 36,8% Î·È Ù˘ Lp(a) ÛÙÔ 31,5%. ™‡Ìʈӷ ÌÂ

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ÙÔ˘˜ Diller Î·È Û˘Ó (1995) ÛÙÔ 40% ÙˆÓ ·È‰ÈÒÓ Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È Û ¤ÏÂÁ¯Ô ÏfiÁˆ ÁÔÓÂ˚΋˜ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·˜, ‰È·ÈÛÙÒÓÂÙ·È ·‡ÍËÛË Ù˘ LDL-C Î·È Î·Ù¿ ÙÔ˘˜ Hennermann Î·È Û˘Ó (1998) ÛÙÔ 39,4% ‰È·ÈÛÙÒÓÂÙ·È ·‡ÍËÛË Ù˘ Lp(a) (27,31). ∏ ÔÈÎÔÁÂÓ‹˜ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· ÂÚÈÁÚ¿ÊÂÙ·È Â›Ù ˆ˜ ÔÌfi˙˘ÁË (Û˘¯ÓfiÙËÙ· 1/1.000.000), Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ˘ÂÚ‚ÔÏÈ΋ ·‡ÍËÛË Ù˘ TC (>600 mg%), ›Ù ˆ˜ ÂÙÂÚfi˙˘ÁË ÌÔÚÊ‹ (Û˘¯ÓfiÙËÙ· 1/500), fiÔ˘ ·Ú·ÙËÚÂ›Ù·È ·‡ÍËÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ TC>300 mg% Î·È LDL>200 mg%. ∆· ÂÚÈÛÛfiÙÂÚ·, fï˜, ·È‰È¿ Î·È ¤ÊË‚ÔÈ Ì Â›‰· LDL ÌÂÙÚ›ˆ˜ ·˘ÍË̤ӷ ‰ÂÓ ÓÔÛÔ‡Ó ·fi ÔÈÎÔÁÂÓ‹ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·. ∏ ˘ÂÚÏÈȉ·ÈÌ›· ·Ô‰›‰ÂÙ·È Û ÔÏ˘ÁÔÓȉȷ΋ ÎÏËÚÔÓÔÌÈ΋ ‰È·Ù·Ú·¯‹ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ηΤ˜ ‰È·ÙÚÔÊÈΤ˜ Û˘Ó‹ıÂȘ Î·È ¿ÏÏÔ˘˜ ÂÈ‚·Ú˘ÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜, .¯. ·¯˘Û·ÚΛ· Î·È ÂÏ·Ùو̤ÓË Ê˘ÛÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ·. ∏ Û˘Ó‹ıˆ˜ ̤ÙÚÈ· ·‡ÍËÛË ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ LDL ‰›ÓÂÈ ÙË ı¤ÛË Ù˘ Û ̛· ηٿÛÙ·ÛË ·ÍÈÔÛËÌ›ˆÙ˘ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·˜ ηٿ ÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹ (8). ∏ ̤ÙÚËÛË Ù˘ LDL Â›Ó·È Î·Ï‡ÙÂÚÔ˜ ÚÔÁÓˆÛÙÈÎfi˜ ‰Â›ÎÙ˘ ·fi ÙȘ ÙÈ̤˜ Ù˘ TC, ÂÓÒ Ë ˘ÔÏÈȉ·ÈÌÈ΋ ‰›·ÈÙ· ·ÔÙÂÏ› ÙÔÓ ·ÎÚÔÁˆÓÈ·›Ô Ï›ıÔ Î·Ù¿ Ù˘ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·˜ ÛÙËÓ ·È‰È΋ ËÏÈΛ·. °È· ÙÔ ÏfiÁÔ ·˘Ùfi, ÛÙ· ·È‰È¿ Ù˘ ÌÂϤÙ˘ Ì·˜ Ì ÙËÓ “ÔÈÎÔÁÂÓ‹ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·” Ô˘ ›¯·Ó ·ıÔÏÔÁÈο ·˘ÍË̤Ó˜ ÙÈ̤˜ TC Î·È LDL (¶›Ó·Î·˜ 5), Á›ÓÂÙ·È ‰È·ÈÙËÙÈ΋ ·Ú¤Ì‚·ÛË ÛÙ·‰›Ô˘ π (ÔÏÈÎfi Ï›Ô˜ 30%, ÎÂÎÔÚÂṲ̂ӷ §O<10%, ÔÏ˘·ÎfiÚÂÛÙ· §O<10%, ÌÔÓÔ·ÎfiÚÂÛÙ· §O<15% ÙˆÓ ÔÏÈÎÒÓ ıÂÚÌ›‰ˆÓ, ¯ÔÏËÛÙÂÚfiÏË <300 mg%, ˘‰·Ù¿ÓıڷΘ 55%, ÚˆÙ½Ó˜ 15-20% ËÌÂÚËÛ›ˆ˜) Î·È Ù·ÎÙÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË. ™˘ÌÂÚ·ÛÌ·ÙÈο, ÙÔ ÔÛÔÛÙfi ÙˆÓ ·È‰ÈÒÓ Ì ‰È·Ù·Ú·¯¤˜ ÙˆÓ ÏÈȉ›ˆÓ ÛÙȘ ‰˘ÙÈΤ˜ Û˘ÓÔÈ˘ Ù˘ £ÂÛÛ·ÏÔӛ΢ ‚Ú¤ıËΠ·˘ÍË̤ÓÔ (31,5%). ∆Ô 18,9% ÙˆÓ ·È‰ÈÒÓ Ì ·ıÔÏÔÁÈÎfi ÏÈȉfiÁÚ·ÌÌ· ‰ÂÓ Â›¯Â ÂÈ‚·Ú˘ÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜. ∫Ú›ÓÂÙ·È, ÏÔÈfiÓ, ÛÎfiÈÌÔ Ô ¤ÏÂÁ¯Ô˜ ÙˆÓ ÏÈȉ›ˆÓ Î·È ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ Ó· ¤¯ÂÈ Â˘Ú‡ÙÂÚË ÂÊ·ÚÌÔÁ‹ ÛÙ· ·È‰È¿, Ì ·ÒÙÂÚÔ ÛÙfi¯Ô ÙËÓ ÙÚÔÔÔ›ËÛË ÙÔ˘ ‚·ıÌÔ‡ ÂÈÎÈÓ‰˘ÓfiÙËÙ·˜ ÂΉ‹ÏˆÛ˘ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ ηٿ ÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹.

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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 artery disease documented by angiography. Circulation 1986;74:758-765.

Murai A, Miyahara I, Fujimoto N, Matsuda M, Kameyama M. Lp(a) lipoprotein as a risk factor for coronary heart disease and cerebral infarction. Atherosclerosis 1986;59:199-206. §·˙·Ú›‰Ô˘ ™, µ·ÚÏ¿Ì˘ °. ∞ÓÙÈÌÂÙÒÈÛË ·È‰ÈÒÓ Ì ˘ÂÚÏÈȉ·ÈÌ›·. ¶·È‰È·ÙÚ ÃÚÔÓÈο 1994;21,3:215-220.

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

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Dennison BA, Kikuchi DA, Srinivasan SR, Webber LS, Berenson GS. Serum total cholesterol screening for the detection of elevated low-density lipoprotein in children and adolescents: the Bogalusa Heart Study. Pediatrics 1990;85:472-479.

Meyerson DA, Santanello NC. Pediatric lipid screening based upon criteria of high-risk family history fails to identify two-thirds of higher-risk children. Circulation

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19. Davidson DM, Van Camp J, Iftner CA, Landry SM, Bradley BJ, Wong ND. Family history fails to detect the majority of children with high capillary blood total cholesterol. J Sch Health 1991;61:75-80.

20. Steiner NJ, Neinstein LS, Pennbridge J. Hypercholesterolemia in adolescents: effectiveness of screening strategies based on selected risk factors. Pediatrics 1991;88:269-275.

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23. ∫·‚·˙·Ú¿Î˘ ∂, ∆ÛfiÏ·˜ °, ™ÎÔ‡ÚÔ˘-÷Ù˙Ë·ÚÁ˘ÚÔ‡ ¢, ºÔ˘ÛÙÔ‡ÎÔ˘ ª, ¢‹ÌÔ˘ ™, ¢ÂÏËÁÈ¿ÓÓË µ. ∫·Ù·ÓÔÌ‹ ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘, ÏÈÔÚˆÙÂ˚ÓÒÓ Î·È ·ÔÏÈÔÚˆÙÂ˚ÓÒÓ Û ‚Ú¤ÊË Î·È ·È‰È¿. ¶·È‰È·ÙÚÈ΋ 1998;61:148-160.

24. ∆ÛfiÏ·˜ °, ¢Ú·Î¿ÙÔ˜ ∞, ∆ÛÔ˘Î¿ÙÔ˘ £, ºˆÙÂÈÓÔ‡ ∞, ¶·Ó·ÁÔ‡ÏÈ· ª, ∫·‚·˙·Ú¿Î˘ ∂. ¶ÚÔÏËÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÁÈ· ÙËÓ ·Ó›¯Ó¢ÛË Ù˘ ˘ÂÚÏÈȉ·ÈÌ›·˜ ÛÙ· ·È‰È¿. ¶·È‰È·ÙÚÈ΋ 1999;62:295-304.

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26. ™¿‚‚·˜ ™Ã, ∆ÔÚÓ·Ú›Ù˘ ª, ∂ÈÊ·Ó›Ô˘-™¿‚‚·˜ ª, ∫Ô˘Ú›‰Ë˜ °, ÷Ù˙ËÁˆÚÁ›Ô˘ Ã, ™È·ÌÔ‡ÓÎË ª. ∂›‰· ÏÈȉ›ˆÓ

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Diller PM, Huster GA, Leach AD, Laskarzewski PM, Sprecher DL. Definition and application of the discretionary screening indicators according to the National Cholesterol Education Program for Children and Adolescents. J Pediatr 1995;126:345-352. ¶··¯Ú‹ÛÙÔ˘ ∞, ∞˚‚¿˙˘ µ, ªËÙÛ¤·˜ ¶, ºÈ‰¿ÓË ™, ¶·˘Ï¿ÙÔ˜ ™, ªÔ˘ÚÏ‹ ∂. ∂ÎÙ›ÌËÛË Ù˘ ·¯˘Û·ÚΛ·˜ ·fi ÙÔ ‚¿ÚÔ˜ Î·È ÙËÓ Ù˘¯‹ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ ÙÔ˘ ÙÚÈΤʷÏÔ˘ Û ·È‰È¿ 6-18 ¯ÚfiÓˆÓ. ¶·È‰È·ÙÚ ÃÚÔÓ 1998;23:181-189. °ÚËÁÔÚ¤·˜ Ã, ¡Ù·Ú›Ï˘ ∂, ∆¿ÛË-¶··ı¤Ô˘ ¢, ∞˘ÁÔ˘ÛÙ›‰Ô˘-™·‚‚ÔÔ‡ÏÔ˘ ¶, ∫·Ú·Ì¤Ú˘ ™, ª·Ï·Î¿-∑·ÊÂÈÚ›Ô˘ ∫. ∂›‰· Î·È ‰È·Ù·Ú·¯¤˜ ÏÈȉ›ˆÓ-ÏÈÔÚˆÙÂ˚ÓÒÓ ÔÚÔ‡ Û ·È‰È¿ ÂÌÊÚ·ÁÌ·ÙÈÒÓ ÁÔÓ¤ˆÓ. ¶·È‰È·ÙÚÈ΋ 1990; 53:152-161. ™Ô‡ÏË ∫∂, ª·ÓÙ˙·ÁÚÈÒÙË-ªÂ˚Ì·Ú›‰Ë ª, µÚÂÙÙfi˜ ∫. ∂›‰· ¯ÔÏËÛÙÂÚfiÏ˘, ÎÏ·ÛÌ¿ÙˆÓ ¯ÔÏËÛÙÂÚfiÏ˘ Î·È ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ Û ۯ¤ÛË Ì ÙÔ˘˜ ·ÓıÚˆÔÌÂÙÚÈÎÔ‡˜ ‰Â›ÎÙ˜ ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ ÚÔÂÊË‚È΋˜ ËÏÈΛ·˜. ¶·È‰È·ÙÚÈ΋ 1991;54:129-136.

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HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 29-01-2002 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 21-05-2002 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∂˘ÊËÌ›· ¶··‰ÔÔ‡ÏÔ˘-∞Ï·Ù¿ÎË ∞ÓÙÈÛı¤ÓÔ˘˜ 28, ∆.∫. 542 50, £ÂÛÛ·ÏÔÓ›ÎË E-mail: efiala@otenet.gr

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∂¡¢π∞º∂ƒOÀ™∞ ¶∂ƒπ¶∆ø™∏

Paediatriki 2002;65:273-277

CASE REPORT

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

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

¶ÂÚ›ÏË„Ë: ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÎÏÈÓÈ΋ ÂÈÎfiÓ· ¤ÓÙ ÂÚÈÛÙ·ÙÈÎÒÓ ™™∂, Ô˘ ÓÔÛËχıËÎ·Ó ÛÙÔ ÙÌ‹Ì· Ì·˜ ÌÂÙ¿ ÙËÓ Â˘ÌÂÁ¤ıË ÂȉËÌ›· ÂÚ˘ıÚ¿˜ ÙÔ˘ 1999. OÈ ÈÔ Û˘¯Ó¤˜ ‚Ï¿‚˜ ‹Ù·Ó Ë ·ÌÊÔÙÂÚfiÏ¢ÚË ÎÒʈÛË, Ô ·ÌÊÔÙÂÚfiÏ¢ÚÔ˜ ηٷÚÚ¿ÎÙ˘, ÙÔ ÌÈÎÚfi ‚¿ÚÔ˜ ÁÈ· ÙËÓ ËÏÈΛ· ·ËÛ˘ Î·È ÔÈ ÂÁÎÂÊ·ÏÈΤ˜ Â·Û‚ÂÛÙÒÛÂȘ. OÈ Â˘ÌÂÁ¤ıÂȘ ÂȉË̛˜ ÂÚ˘ıÚ¿˜ Î·È ™™∂ ÌÔÚÔ‡Ó Ó· ÚÔÏËÊıÔ‡Ó Ì ÙÔÓ Ù·˘Ùfi¯ÚÔÓÔ ÂÌ‚ÔÏÈ·ÛÌfi fiÏˆÓ ÙˆÓ ·È‰ÈÒÓ Î·È fiÏˆÓ ÙˆÓ ÌË ÂÁ·ˆÓ, ÌË ¿ÓÔÛˆÓ Á˘Ó·ÈÎÒÓ ·Ó··Ú·ÁˆÁÈ΋˜ ËÏÈΛ·˜, Ô˘ ‰ÂÓ ¤¯Ô˘Ó ·ÓÔÛ›· ηٿ Ù˘ ÂÚ˘ıÚ¿˜. ∂ÍÂÙ¿˙ÔÓÙ·È ÂÎÙÂÓÒ˜, Ë ·‡ÍËÛË ÙˆÓ ·Ó·ÊÂÚı¤ÓÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ ™™∂ ÛÙȘ ‰‡Ô ÙÂÏÂ˘Ù·›Â˜ ÂȉË̛˜ ÂÚ˘ıÚ¿˜ Î·È Ù· ̤ÙÚ· Ô˘ Ú¤ÂÈ Ó· ÏËÊıÔ‡Ó ÁÈ· ÙÔÓ ÂÚÈÔÚÈÛÌfi ÙÔ˘˜.

Abstract: The clinical presentation of congenital rubella syndrome (CRS) is described in 5 infants admitted to our department following the 1999 sizable rubella outbreak. The most frequent CRSrelated defects observed were bilateral deafness, bilateral catarracts, small weight for gestational age and cerebral calcifications. Sizable rubella and CRS outbreaks could be prevented by immunizing all children as well as all non-pregnant women of child-bearing age who lack rubella immunity. The increase of reported CRS cases during the last two rubella outbreaks and the appropriate preventing actions that should be implemented are extensively discussed.

§¤ÍÂȘ ÎÏÂȉȿ: Û‡Ó‰ÚÔÌÔ Û˘ÁÁÂÓÔ‡˜ ÂÚ˘ıÚ¿˜, ÂȉËÌ›· ÂÚ˘ıÚ¿˜, ÚfiÏË„Ë Û˘ÁÁÂÓÔ‡˜ Û˘Ó‰ÚfiÌÔ˘ ÂÚ˘ıÚ¿˜.

Key words: congenital rubella syndrome, rubella epidemic, prevention of congenital rubella syndrome.

∂ÈÛ·ÁˆÁ‹ OÈ ÂȉË̛˜ ÂÚ˘ıÚ¿˜ ÂÍ·ÎÔÏÔ˘ıÔ‡Ó Ó· Û˘Ì‚·›ÓÔ˘Ó ÛÙËÓ ∂ÏÏ¿‰· Ì ÙË ¯·Ú·ÎÙËÚÈÛÙÈ΋ Û˘¯ÓfiÙËÙ· ÙˆÓ 6-9 ÂÙÒÓ, ÛËÌÂ›Ô ÂÓ‰ÂÈÎÙÈÎfi ÙˆÓ ¯·ÌËÏÒÓ ÂÈ¤‰ˆÓ ·ÓÔÛ›·˜ ÙÔ˘ ÏËı˘ÛÌÔ‡, ·Ú¿ ÙËÓ ¤Ó·ÚÍË ˘Ô¯ÚˆÙÈÎÔ‡ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÛÙÔÓ ·È‰ÈÎfi ÏËı˘ÛÌfi ·fi ÙÔ 1989. ∆Ș ÂȉË̛˜ ·˘Ù¤˜ ·ÎÔÏÔ˘ı› Ë ÂȉËÌÈ΋ ÂÌÊ¿ÓÈÛË ÎÚÔ˘ÛÌ¿ÙˆÓ ™™∂ Ô˘ ÚÔηÏ› ÛÔ‚·Ú¤˜ ÌfiÓÈ̘ ‚Ï¿‚˜ Ì ÚÒÈÌË Î·È fi„ÈÌË ÂÌÊ¿ÓÈÛË ·fi ÔÏÏ¿ fiÚÁ·Ó· (1). ™ÙËÓ ÂȉËÌ›· ÂÚ˘ıÚ¿˜ ÙÔ˘ 1993 ›¯·Ì ÓÔÛËχÛÂÈ ‰‡Ô ÓÂÔÁÓ¿ Ì ™™∂ (2), ÂÓÒ Â›¯·Ó ·Ó·ÊÂÚı›/‰ËÌÔÛÈ¢ı› Î·È ¿ÏÏ· 23 ÂÚÈÛÙ·ÙÈο, ΢ڛˆ˜ ·fi ÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ÓÔÌÔ‡ ∞ÙÙÈ΋˜ (3). ∏ ÂÚÈ-

ÁÚ·Ê‹ ÙfiÛˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ ™™∂ ‹Ù·Ó ÚˆÙÔÊ·Ó‹˜ ÁÈ· Ù· ÂÏÏËÓÈο Î·È ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·ÊÈο ‰Â‰Ô̤ӷ Î·È ·ÔÙ¤ÏÂÛ ·ÓÙÈΛÌÂÓÔ ÂÈÛÙËÌÔÓÈ΋˜ ·ÓÙÈ·Ú¿ıÂÛ˘ ÌÂٷ͇ ∂ÏÏ‹ÓˆÓ “ÂȉÈÎÒÓ” Î·È ÂÎÚÔÛÒˆÓ “ÊÔÚ¤ˆÓ”, ̤۷ ·fi ÙȘ ÛÂÏ›‰Â˜ ͤÓÔ˘ È·ÙÚÈÎÔ‡ ÂÚÈÔ‰ÈÎÔ‡ (4,5). ™˘ÁÎÂÎÚÈ̤ӷ, ˘ÔÛÙËÚ›¯ıËΠfiÙÈ ˘‹Ú¯Â Ú·ÁÌ·ÙÈ΋ ‰È·¯ÚÔÓÈ΋ ·‡ÍËÛË ÎÚÔ˘ÛÌ¿ÙˆÓ ™™∂, Ô˘ ·Ô‰fiıËΠÛÙÔÓ ˘Ô¯ÚˆÙÈÎfi ÂÌ‚ÔÏÈ·ÛÌfi ÌfiÓÔ ÙˆÓ ·È‰ÈÒÓ, Ì ·ÔÙ¤ÏÂÛÌ· ÙË ÌÂÙ·ÙfiÈÛË Ù˘ ¢·›ÛıËÙ˘ ÛÙËÓ ÂÚ˘ıÚ¿ ËÏÈΛ·˜ ÛÙ· ¿ÙÔÌ· Ù˘ ·Ó··Ú·ÁˆÁÈ΋˜ ËÏÈΛ·˜ (5). ∆· ÛÙ·ÙÈÛÙÈο ‰Â‰Ô̤ӷ ÛÙ· ÔÔ›· ÛÙËÚ›¯ıËÎÂ Ë ¿Ô„Ë ·˘Ù‹, ·ÓÙÈÎÚÔ‡ÛÙËÎ·Ó Û·Ó ·ÓÂ·Ú΋ Î·È ·Ó·ÍÈfiÈÛÙ· ·fi ¿ÏÏÔ˘˜, Ô˘ ˘ÔÛÙ‹ÚÈÍ·Ó fiÙÈ

¡ÂÔÁÓÔÏÔÁÈÎfi ∆Ì‹Ì· ∂™À, πÔÎÚ¿ÙÂÈÔ ¡ÔÛÔÎÔÌÂ›Ô £ÂÛÛ·ÏÔӛ΢

Division of Neonatology, Ippokration General Hospital, Thessaloniki

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ÛÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ· ˘¿Ú¯ÂÈ ‰È·¯ÚÔÓÈ΋ Ì›ˆÛË ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ (4). ∆ËÓ ¿Ô„Ë ·˘Ù‹ ÛÙ‹ÚÈÍ·Ó Î·È ÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ, ̤¯ÚÈ ÂΛÓË ÙË ÛÙÈÁÌ‹, ›¯·Ó ·Ó·ÊÂÚı› ÌfiÓÔ 4 ÎÚÔ‡ÛÌ·Ù· ™™∂ ÛÙËÓ ÂȉËÌ›· ÂÚ˘ıÚ¿˜ ÙÔ˘ 1999 (4,6). ™ÙËÓ ›‰È· ÂȉËÌ›· (1999) ÓÔÛËχ۷Ì 5 ÓÂÔÁÓ¿ Ì ™™∂, Ù· ÔÔ›· Î·È ÂÚÈÁÚ¿ÊÔ˘ÌÂ. ™ÎÔfi˜ Ù˘ ·Ó·ÊÔÚ¿˜ ·˘Ù‹˜ Â›Ó·È Ó· ÙÔÓ›ÛÔ˘Ì ͷӿ ÙË ÛÔ‚·ÚfiÙËÙ· Ù˘ ¿ıËÛ˘ ·˘Ù‹˜ Î·È ÙËÓ ·Ó¿ÁÎË Ï‹„˘ ÈÔ ‰Ú·ÛÙÈÎÒÓ Ì¤ÙÚˆÓ, ÁÈ· ÙË Ì›ˆÛË, ηْ ·Ú¯¿˜, ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ ™™∂. ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ¶ÂÚ›ÙˆÛË ÚÒÙË ¡ÂÔÁÓfi ı‹Ï˘, ÁÂÓÓ‹ıËΠÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ÙÔÎÂÙfi ÌÂÙ¿ ·fi ‰È¿ÚÎÂÈ· ·ËÛ˘ (¢∫) 34 ‚‰ÔÌ¿‰ˆÓ, ·fi ÌËÙ¤Ú· ‰Â˘ÙÂÚfiÙÔÎË, ËÏÈΛ·˜ 30 ÂÙÒÓ. ∏ ‚·ıÌÔÏÔÁ›· ∞pgar ‹Ù·Ó ÛÙÔ 1Ô min 8 Î·È ÛÙÔ 5Ô min 9. ¢È·ÎÔÌ›ÛÙËΠÛÙÔ ÙÌ‹Ì· Ì·˜, ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË, ÁÈ·Ù› ‹Ù·Ó ÌÈÎÚfi ÁÈ· ÙË ‰È¿ÚÎÂÈ· ·ËÛ˘. ∏ ÌËÙ¤Ú· ·Ó·Ê¤ÚÂÈ ÂÍ¿ÓıËÌ· ÎËÏȉԂϷÙȉ҉˜ ÛÙÔÓ ÎÔÚÌfi Î·È Ù· ¿ÎÚ· Î·È ˘Ú¤ÙÈÔ ÛÙÔ 1Ô ÙÚ›ÌËÓÔ Ù˘ ·ËÛ˘. ∏ fiÏË Î·Ù¿ÛÙ·ÛË ·ÓÙÈÌÂÙˆ›ÛÙËÎÂ Û·Ó ·ÏÏÂÚÁÈÎfi ÂÍ¿ÓıËÌ· ·fi ÙÔÓ ıÂÚ¿ÔÓÙ· ÁÈ·ÙÚfi, ¯ˆÚ›˜ ηӤӷ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô. ∆Ô ˘ÂÚ˯ÔÁÚ¿ÊËÌ· (À/Ã) ÙÔ˘ ÂÌ‚Ú‡Ô˘ ¤‰ÂÈÍ ÂÓ‰ÔÌ‹ÙÚÈ· ηı˘ÛÙ¤ÚËÛË ·Ó¿Ù˘Í˘. ∆Ô ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ (µ°) ‹Ù·Ó 1340 g (<10Ë ÂÎ. ı¤ÛË), ÙÔ Ì‹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˘ÛÈ΋ ÂͤٷÛË Î·Ù¿ Û˘ÛÙ‹Ì·Ù· ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋. O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍÂ: Ht 48%, ÏÂ˘Î¿ 6700 mm3, ( 59%, Ï 36%), ·ÈÌÔÂÙ¿ÏÈ· 63.000 mm3. ∆Ô À/à ηډȿ˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi, fiˆ˜ Î·È Ô Ï‹Ú˘ ÔÊı·ÏÌÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜. ∏ ·ÎÙÈÓÔÁÚ·Ê›· (·/·) Ì·ÎÚÒÓ ÔÛÙÒÓ ¤‰ÂÈÍ ‰È·˘Á·ÛÙÈΤ˜ Ù·Èӛ˜ ÛÙȘ ÌÂٷʇÛÂȘ ÙˆÓ Ì·ÎÚÒÓ ÔÛÙÒÓ, ‡ÚËÌ· Û˘Ì‚·Ùfi Ì ™™∂. ∆· ·ÎÔ˘ÛÙÈο ÚÔÎÏËÙ¿ ‰˘Ó·ÌÈο (∞¶¢) ÛÙÔ ·ÚÈÛÙÂÚfi ·˘Ù› ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο, ÂÓÒ ÛÙÔ ‰ÂÍ› ¤‰ÂÈÍ·Ó Ì¤ÙÚÈÔ˘ ‚·ıÌÔ‡ ‚·ÚËÎÔ˝·. ∆Ô À/à ÂÁÎÂÊ¿ÏÔ˘ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi. O ÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÁÈ· ÂÚ˘ıÚ¿ ¤‰ÂÈÍ ıÂÙÈο IgM ·ÓÙÈÛÒÌ·Ù· (ELIZA) ÁÈ· ÙÔ ÓÂÔÁÓfi Î·È ·ÚÓËÙÈο ÁÈ· ÙË ÌËÙ¤Ú·. OÈ Ù›ÙÏÔÈ ÙˆÓ ÂȉÈÎÒÓ πgG ·ÓÙÈÛˆÌ¿ÙˆÓ ÙÔ˘ ÓÂÔÁÓÔ‡ ‹Ù·Ó 244 IU/ml Î·È Ù˘ ÌËÙ¤Ú·˜ 612 IU/ml. ™ÙËÓ ËÏÈΛ· ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜, Ë „˘¯ÔÎÈÓËÙÈ΋ ·Ó¿Ù˘ÍË ÙÔ˘ ‚Ú¤ÊÔ˘˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋ Î·È ÙÔ Úfi‚ÏËÌ· Ù˘ ·ÎÔ‹˜ ·Ú¤ÌÂÓ ÙÔ ›‰ÈÔ. ¶ÂÚ›ÙˆÛË ‰Â‡ÙÂÚË ¡ÂÔÁÓfi ı‹Ï˘, ÁÂÓÓ‹ıËΠ̠ηÈÛ·ÚÈ΋ ÙÔÌ‹ ÏfiÁˆ ·ÏÏÔ›ˆÛ˘ ·ÏÌÒÓ, ÌÂÙ¿ ·fi ¢∫ 36 ‚‰ÔÌ¿‰ˆÓ, ·fi ÌËÙ¤Ú· ÚˆÙfiÙÔÎË, ËÏÈΛ·˜ 24 ÂÙÒÓ. ∏ ‚·ıÌÔÏÔÁ›· Apgar ‹Ù·Ó ÛÙÔ 1Ô min 2 Î·È ÛÙÔ 5Ô

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min 6. ¢È·ÎÔÌ›ÛÙËΠÛÙÔ ÙÌ‹Ì· Ì·˜, ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË, ÁÈ· ÂÚÈÁÂÓÓËÙÈ΋ ·ÛÊ˘Í›· Î·È ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ·. ∆Ô ÂÚÈÁÂÓÓËÙÈÎfi ÈÛÙÔÚÈÎfi ‹Ù·Ó ÂχıÂÚÔ. ∫·Ù¿ ÙËÓ Î‡ËÛË ‰ÂÓ ¤ÁÈÓ ÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÛÙË ÌËÙ¤Ú· ÁÈ· Û˘ÁÁÂÓ›˜ ÏÔÈÌÒÍÂȘ. ∆· ۈ̷ÙÔÌÂÙÚÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ ÓÂÔÁÓÔ‡ ‹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). ∏ ÎÏÈÓÈ΋ ÂͤٷÛË Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ¤‰ÂÈÍ Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›·, ÂÏ·Ùو̤ÓÔ Ì˘˚Îfi ÙfiÓÔ Î·È ÓˆıÚ¿ ·Ú¯¤ÁÔÓ· ·ÓÙ·Ó·ÎÏ·ÛÙÈο. O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍÂ: ∏t 37%, ÏÂ˘Î¿ 8.600 mm3 ( 45%, Ï 50%), ·ÈÌÔÂÙ¿ÏÈ· 55.000 mm3. ™ÙÔ Ù¤ÏÔ˜ Ù˘ ÚÒÙ˘ ‚‰ÔÌ¿‰·˜ ˙ˆ‹˜ ÙÔ ÓÂÔÁÓfi ·ÚÔ˘Û›·Û ¿ÌÂÛË ˘ÂÚ¯ÔÏÂÚ˘ıÚÈÓ·ÈÌ›·, Ô˘ ·Ú‹Ïı ÌÂÙ¿ ·fi ÌÂÚÈΤ˜ Ë̤Ú˜. ∏ Ï‹Ú˘ ÔÊı·ÏÌÔÏÔÁÈ΋ ÂͤٷÛË ¤‰ÂÈÍ ˘ÚËÓÈÎfi ηٷÚÚ¿ÎÙË ¿Ìʈ. ∆· ∞¶¢ ¤‰ÂÈÍ·Ó ‚·ÚËÎÔ˝· ÛÙ· fiÚÈ· Ù˘ ÎÒʈÛ˘ ¿Ìʈ. ™ÙËÓ ·/· Ì·ÎÚÒÓ ÔÛÙÒÓ ˘‹Ú¯·Ó ‰È·˘Á·ÛÙÈΤ˜ Ù·Èӛ˜ ÛÙȘ ÌÂٷʇÛÂȘ ÙˆÓ Ì·ÎÚÒÓ ÔÛÙÒÓ, ‡ÚËÌ· Û˘Ì‚·Ùfi Ì ™™∂. ∞fi ÙËÓ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ ‰È·ÈÛÙÒıËÎ·Ó 2 ÛÙÈÎÙ¤˜ Â·Û‚ÂÛÙÒÛÂȘ ÛÙ· fiÚÈ· Ê·È¿˜ Ï¢΋˜ Ô˘Û›·˜, ‚ÚÂÁÌ·ÙÈο ¿Ìʈ. ∆Ô À/à ηډȿ˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi.

O ÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÁÈ· ÂȉÈο ÁÈ· ÂÚ˘ıÚ¿ IgM ·ÓÙÈÛÒÌ·Ù· (∂LISA) ‹Ù·Ó ıÂÙÈÎfi˜ ÛÙÔ ÓÂÔÁÓfi Î·È ÛÙË ÌËÙ¤Ú·. O Ù›ÙÏÔ˜ ÙˆÓ ÂȉÈÎÒÓ ÁÈ· ÂÚ˘ıÚ¿ IgG ·ÓÙÈÛˆÌ¿ÙˆÓ ÙÔ˘ ÓÂÔÁÓÔ‡ ‹Ù·Ó 226 IU/ml Î·È Ù˘ ÌËÙ¤Ú·˜ 400 IU/ml. ∆o ‚Ú¤ÊÔ˜ ¯ÂÈÚÔ˘ÚÁ‹ıËΠÁÈ· ·Ê·›ÚÂÛË ÙÔ˘ ηٷÚÚ¿ÎÙË ¿Ìʈ Û ËÏÈΛ· 15 ËÌÂÚÒÓ. ™Â ËÏÈΛ· 6 ÌËÓÒÓ ÙÔÔıÂÙ‹ıËÎ·Ó ·ÌÊÔÙÂÚfiÏ¢ڷ ÎÔ¯Ïȷο ÂÌÊ˘Ù‡̷ٷ. ∏ ·Ú·ÎÔÏÔ‡ıËÛË ÛÙ· Â͈ÙÂÚÈο È·ÙÚ›· Ù˘ ÎÏÈÓÈ΋˜ ̤¯ÚÈ ÙÔÓ ÚÒÙÔ ¯ÚfiÓÔ ˙ˆ‹˜ ¤‰ÂÈÍ ‚·ÚÈ¿ „˘¯ÔÎÈÓËÙÈ΋ ηı˘ÛÙ¤ÚËÛË Î·È ÁÂÓÈÎÂ˘Ì¤ÓË ˘ÔÙÔÓ›·. ¶ÂÚ›ÙˆÛË ÙÚ›ÙË ¡ÂÔÁÓfi ¿ÚÚÂÓ, ÁÂÓÓ‹ıËΠÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ÙÔÎÂÙfi ÌÂÙ¿ ·fi ¢∫ 39 ‚‰ÔÌ¿‰ˆÓ ·fi ÌËÙ¤Ú· ÚˆÙfiÙÔÎË, ËÏÈΛ·˜ 16 ÂÙÒÓ. ∏ ÌËÙ¤Ú· ÂÌÊ¿ÓÈÛ ÛÙÔ Ù¤ÏÔ˜ ÙÔ˘ ÚÒÙÔ˘ ÙÚÈÌ‹ÓÔ˘ Ù˘ ·ËÛ˘ ˘Ú¤ÙÈÔ Î·È ÎËÏȉԂϷÙȉ҉˜ ÂÍ¿ÓıËÌ· Û fiÏÔ ÙÔ ÛÒÌ· Ù˘, Ô˘ ·Ô‰fiıËÎ·Ó Û ÈÔÁÂÓ‹ Ïԛ̈ÍË. ™ÙÔ ‚È‚ÏÈ¿ÚÈÔ ˘Á›·˜ Ù˘ ÌËÙ¤Ú·˜ ·Ó·ÁÚ·ÊfiÙ·Ó fiÙÈ Â›¯Â ÓÔÛ‹ÛÂÈ ·fi ÂÚ˘ıÚ¿ ÛÙËÓ ·È‰È΋ ËÏÈΛ·. ∆Ô À/à ÂÌ‚Ú‡Ô˘ ¤‰ÂÈÍ ηı˘ÛÙ¤ÚËÛË Ù˘ ·Ó¿Ù˘Í˘. ∏ ‚·ıÌÔÏÔÁ›· Apgar ‹Ù·Ó ÛÙÔ 10Ô min 9 Î·È ÛÙÔ 5Ô min 10. ∆Ô ÓÂÔÁÓfi ‰È·ÎÔÌ›ÛÙËΠÛÙÔ ÙÌ‹Ì· Ì·˜ Û ËÏÈΛ· 1 Ë̤ڷ˜, ÏfiÁˆ ·ÌÊÔÙÂÚfiÏ¢ÚÔ˘ ηٷÚÚ¿ÎÙË. ∆· ۈ̷ÙÔÌÂÙÚÈο ¯·Ú·ÎÙËÚÈÛÙÈο ‹Ù·Ó: µ° 1850 g (<10Ë ÂÎ. ı¤ÛË), ¶∫ 31,5 cm (<10Ë ÂÎ. ı¤ÛË), ª™ 45 cm (<10Ë ÂÎ. ı¤ÛË). ∫·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹, Ë ÂͤٷÛË Î·Ù¿ Û˘ÛÙ‹Ì·Ù·

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¶·È‰È·ÙÚÈ΋ 2002;65:273-277

¤‰ÂÈÍÂ Û˘ÛÙÔÏÈÎfi ʇÛËÌ· 1/6 ÛÙÔ ÚÔοډÈÔ 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/à ηډȿ˜ ¤‰ÂÈÍ ·Ú·ÌÔÓ‹ ·ÓÔÈÎÙÔ‡ ·ÚÙËÚÈ·ÎÔ‡ fiÚÔ˘ Î·È ‰˘ÛÏ·ÛÙÈ΋ Ó¢ÌÔÓÈ΋ ‚·Ï‚›‰·. ∆· ∞¶¢ η٤ÁÚ·„·Ó ·ÌÊÔÙÂÚfiÏ¢ÚË Ó¢ÚÔ·ÈÛıËÙËÚȷ΋ ‚·ÚËÎÔ˝· ÛÙ· fiÚÈ· Ù˘ ÎÒʈÛ˘. ∏ ·/· Ì·ÎÚÒÓ ÔÛÙÒÓ ·ÂÈÎfiÓÈ˙ ÌË ÂȉÈΤ˜ ·ÏÏÔÈÒÛÂȘ ÛÙȘ ÌÂٷʇÛÂȘ. O ÔÊı·ÏÌÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ·ÔÎ¿Ï˘„ ·ÌÊÔÙÂÚfiÏ¢ÚÔ ˘ÚËÓÈÎfi ηٷÚÚ¿ÎÙË. ™ÙËÓ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ ˘‹Ú¯·Ó ÂÓ‰ÔÎÚ·ÓȷΤ˜ Â·Û‚ÂÛÙÒÛÂȘ ÛÙÔ ÌÂÛÔÏfi‚ÈÔ Î·È ÂÓ‰Ô·ÚÂÁ¯˘Ì·ÙÈο ¿Ìʈ Î·È ‰È¿Ù·ÛË ÙÔ˘ ÎÔÈÏÈ·ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜.

O ÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍ ÙËÓ ‡·ÚÍË ÂȉÈÎÒÓ ÁÈ· ÂÚ˘ıÚ¿ πgM ·ÓÙÈÛˆÌ¿ÙˆÓ ÛÙÔ ÓÂÔÁÓfi Î·È ÛÙË Ï¯ˆ›‰· ÌËÙ¤Ú·. OÈ Ù›ÙÏÔÈ ÙˆÓ ÂȉÈÎÒÓ ÁÈ· ÂÚ˘ıÚ¿ IgG ·ÓÙÈÛˆÌ¿ÙˆÓ ‹Ù·Ó >400 IU/ml Î·È ÛÙÔ ÓÂÔÁÓfi Î·È ÛÙË ÌËÙ¤Ú·. ™Â ËÏÈΛ· 7 ËÌÂÚÒÓ ˙ˆ‹˜ ¤ÁÈÓ ¯ÂÈÚÔ˘ÚÁÈ΋ ·Ê·›ÚÂÛË ÙÔ˘ ηٷÚÚ¿ÎÙË ¿Ìʈ. ™Â ËÏÈΛ· 7 ÌËÓÒÓ ÙÔÔıÂÙ‹ıËÎ·Ó ·ÌÊÔÙÂÚfiÏ¢ڷ ÎÔ¯Ïȷο ÂÌÊ˘Ù‡̷ٷ. ∏ ·Ú·ÎÔÏÔ‡ıËÛË ÛÙ· Â͈ÙÂÚÈο È·ÙÚ›· ̤¯ÚÈ ÙËÓ ËÏÈΛ· ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜ ¤‰ÂÈÍ ÁÂÓÈÎÂ˘Ì¤ÓË ˘ÂÚÙÔÓ›· Î·È ‚·ÚÈ¿ „˘¯ÔÎÈÓËÙÈ΋ ηı˘ÛÙ¤ÚËÛË. ¶ÂÚ›ÙˆÛË Ù¤Ù·ÚÙË Î·È ¤ÌÙË ¶ÚfiÎÂÈÙ·È ÁÈ· ‰›‰˘Ì· ÓÂÔÁÓ¿ Ô˘ ÁÂÓÓ‹ıËÎ·Ó Ì ηÈÛ·ÚÈ΋ ÙÔÌ‹ ÏfiÁˆ ÚÔˆÚfiÙËÙ·˜ Î·È Èۯȷ΋˜ ÚÔ‚ÔÏ‹˜ ÙÔ˘ ÚÒÙÔ˘ ‰È‰‡ÌÔ˘, ÌÂÙ¿ ·fi ¢∫ 33 ‚‰ÔÌ¿‰ˆÓ ·fi ÌËÙ¤Ú· ÚˆÙfiÙÔÎË, ËÏÈΛ·˜ 26 ÂÙÒÓ. ∏ ·ËÛË ‹Ù·Ó ‰È¯ÔÚȷ΋, ‰È·ÌÓȷ΋. ™ÙÔ 2Ô Ì‹Ó· Ù˘ ·ËÛ˘ Ë ÌËÙ¤Ú· ÂÌÊ¿ÓÈÛ ˘Ú¤ÙÈÔ, ÎËÏȉԂϷÙÈÙ҉˜ ÂÍ¿ÓıËÌ· Û fiÏÔ ÙÔ ÛÒÌ· Î·È ‰ÈfiÁΈÛË ÔÈÛıÔˆÙÈ·›ˆÓ ÏÂÌÊ·‰¤ÓˆÓ. ∆¤ıËΠÎÏÈÓÈο Ë ‰È¿ÁÓˆÛË ÂÚ˘ıÚ¿˜ Î·È ¤ÁÈÓ ÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÌfiÓÔ Ì IgG ·ÓÙÈÛÒÌ·Ù· ÛÙÔÓ 4Ô Î·È 5Ô Ì‹Ó· Ù˘ ·ËÛ˘, Ô˘ ¤‰ÂÈÍ ÙÈ̤˜ 240 IU/ml Î·È 214 IU/ml, ·ÓÙ›ÛÙÔȯ·. ∏ ÌËÙ¤Ú· ‰ÂÓ ‰¤¯ÙËΠ‰È·ÎÔ‹ Ù˘ ·ËÛ˘. ∆· ÓÂÔÁÓ¿ ÂÈÛ‹¯ıËÛ·Ó ÛÙÔ ÙÌ‹Ì· ÏfiÁˆ ÙÔ˘ ÈÛÙÔÚÈÎÔ‡ Î·È Ù˘ ÚÔˆÚfiÙËÙ·˜. ∆Ô ÚÒÙÔ ‰›‰˘ÌÔ ‹Ù·Ó ·ÁfiÚÈ Î·È Â›¯Â ‚·ıÌÔÏÔÁ›· ∞pgar ÛÙÔ 1Ô min 6 Î·È ÛÙÔ 5Ô min 9. ∆· ۈ̷ÙÔÌÂÙÚÈο ¯·Ú·ÎÙËÚÈÛÙÈο ‹Ù·Ó: µ™ 1630 g (25Ë<p<50Ë), ¶∫ 29 cm (10Ë<p<50Ë), ª™ 42 cm (25Ë ÂÎ. ı¤ÛË). ∏ ÂͤٷÛË Î·Ù¿ Û˘ÛÙ‹Ì·Ù· ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ¤‰ÂÈÍ ‹ÈÔ Û˘ÛÙÔÏÈÎfi ʇÛËÌ· ÛÙÔ ÚÔοډÈÔ. O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ‹Ù·Ó: ∏t 52%, ÏÂ˘Î¿ 13.600 mm3 ( 41%, Ï 50%), ·ÈÌÔÂÙ¿ÏÈ· 170.000 mm3. ∆Ô À/à ηډȿ˜ ¤‰ÂÈÍ ·Ú·ÌÔÓ‹ ·ÓÔÈÎÙÔ‡ ·ÚÙËÚÈ·ÎÔ‡ fiÚÔ˘. ∏ ÔÊı·ÏÌÔÏÔÁÈ΋ ÂͤٷÛË ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋. ∏ ·/· Ì·ÎÚÒÓ ÔÛÙÒÓ Â›¯Â ·Û·Ê›˜ ·Ú·ÈˆÙÈΤ˜ ÂÛٛ˜ Î·È ÂÏ·ÊÚ¿ ·Óˆ-

Paediatriki 2002;65:273-277

Ì·Ï›· ·Ú˘Ê‹˜ ÛÙȘ ¿Óˆ ÌÂٷʇÛÂȘ ÙˆÓ ÌËÚÈ·›ˆÓ ÔÛÙÒÓ. ∆Ô À/à ÂÁÎÂÊ¿ÏÔ˘ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi. ∆· ∞¶¢ ¤‰ÂÈÍ·Ó ÛÔ‚·ÚÔ‡ ‚·ıÌÔ‡ ·ÌÊÔÙÂÚfiÏ¢ÚË Ó¢ÚÔ·ÈÛıËÙËÚȷ΋ ‚·ÚËÎÔ˝· ÛÙ· fiÚÈ· Ù˘ ÎÒʈÛ˘. O ÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ‹Ù·Ó ıÂÙÈÎfi˜ ÁÈ· ÂȉÈο ÁÈ· ÂÚ˘ıÚ¿ IgM ·ÓÙÈÛÒÌ·Ù·. OÈ Ù›ÙÏÔÈ ÁÈ· Ù· ÂȉÈο ÁÈ· ÂÚ˘ıÚ¿ πgG ·ÓÙÈÛÒÌ·Ù· ‹Ù·Ó 296 IU/ml. ™Â ËÏÈΛ· 3 ÌËÓÒÓ ¤ÁÈÓ ¯ÂÈÚÔ˘ÚÁÈ΋ Û‡ÁÎÏÈÛË ÙÔ˘ ·ÓÔÈÎÙÔ‡ ·ÚÙËÚÈ·ÎÔ‡ fiÚÔ˘. ™Â ËÏÈΛ· 8 ÌËÓÒÓ ÙÔÔıÂÙ‹ıËÎ·Ó ÎÔ¯Ïȷο ÂÌÊ˘Ù‡̷ٷ ¿Ìʈ. ™ÙËÓ ËÏÈΛ· ÙÔ˘ 1 ¤ÙÔ˘˜ ·ÚÔ˘Û›·˙ ÌÈÎÚÔÎÂÊ·Ï›·, ÂÓÒ Ë „˘¯ÔÎÈÓËÙÈ΋ ÙÔ˘ ·Ó¿Ù˘ÍË ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋. ∆Ô ‰Â‡ÙÂÚÔ ‰›‰˘ÌÔ ‹Ù·Ó ı‹Ï˘ Î·È Â›¯Â ‚·ıÌÔÏÔÁ›· Apgar ÛÙÔ 1Ô min 8 Î·È ÛÙÔ 5Ô min 10. ∆· ۈ̷ÙÔÌÂÙÚÈο ¯·Ú·ÎÙËÚÈÛÙÈο ‹Ù·Ó: µ° 1555 g (10Ë<p<25Ë), ¶∫ 28,5 cm (10Ë<p<25Ë), ª™ 40,5 cm (10Ë<p<25Ë). ∏ ÎÏÈÓÈ΋ ÂͤٷÛË, ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË, ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋. O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍÂ: ∏t 50%, ÏÂ˘Î¿ 12.800 mm3 ( 52%, Ï 45%), ·ÈÌÔÂÙ¿ÏÈ· 210.000 mm3. ∆Ô À/à ηډȿ˜ ¤‰ÂÈÍ ·ÓÔȯÙfi ·ÚÙËÚÈ·Îfi fiÚÔ Ô˘ ¤ÎÏÂÈÛ ·˘ÙfiÌ·Ù· Û ϛÁ˜ Ë̤Ú˜. ∏ ·/· Ì·ÎÚÒÓ ÔÛÙÒÓ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋, fiˆ˜ Î·È Ë ÔÊı·ÏÌÔÏÔÁÈ΋ ÂͤٷÛË. ∆· ∞¶¢ ¤‰ÂÈÍ·Ó Ó¢ÚÔ·ÈÛıËÙËÚȷ΋ ‚·ÚËÎÔ˝· ÌÂÁ¿ÏÔ˘ ‚·ıÌÔ‡, ÛÙ· fiÚÈ· Ù˘ ÎÒʈÛ˘ ¿Ìʈ. ∆Ô À/à ÂÁÎÂÊ¿ÏÔ˘ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi. O ÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍ ÙËÓ ‡·ÚÍË ÂȉÈÎÒÓ Igª ·ÓÙÈÛˆÌ¿ÙˆÓ ÁÈ· ÂÚ˘ıÚ¿. ∆· Â›‰· ÙˆÓ ÂȉÈÎÒÓ ÁÈ· ÂÚ˘ıÚ¿ IgG ·ÓÙÈÛˆÌ¿ÙˆÓ ‹Ù·Ó 204 IU/ml. ™Â ËÏÈΛ· 8 ÌËÓÒÓ ÙÔÔıÂÙ‹ıËÎ·Ó ÎÔ¯Ïȷο ÂÌÊ˘Ù‡̷ٷ ¿Ìʈ. ™ÙËÓ ËÏÈΛ· ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜ ›¯Â Ê˘ÛÈÔÏÔÁÈ΋ ۈ̷ÙÈ΋ Î·È „˘¯ÔÎÈÓËÙÈ΋ ·Ó¿Ù˘ÍË. ™˘˙‹ÙËÛË ∏ ‰È¿ÁÓˆÛË ÙÔ˘ ™™∂ ÙÂÎÌËÚÈÒıËÎÂ Î·È ÛÙ· ¤ÓÙ ÂÚÈÛÙ·ÙÈο Ì·˜ Ì ÙËÓ ·Ó‡ÚÂÛË ÂȉÈÎÒÓ ÁÈ· ÂÚ˘ıÚ¿ IgM ·ÓÙÈۈ̿وÓ. ŸÏ· Ù· ÓÂÔÁÓ¿ ›¯·Ó ÛÔ‚·Ú¤˜ ·ÈÛıËÙËÚȷΤ˜ ‚Ï¿‚˜, fiˆ˜ ·ÌÊÔÙÂÚfiÏ¢ÚË ÎÒʈÛË (4), ÂÙÂÚfiÏ¢ÚË ÛÔ‚·Ú‹ ‚·ÚËÎÔ˝· (1) Î·È ·ÌÊÔÙÂÚfiÏ¢ÚÔ Î·Ù·ÚÚ¿ÎÙË (2). ¢‡Ô ÓÂÔÁÓ¿ ›¯·Ó ÛÔ‚·Ú‹ „˘¯ÔÎÈÓËÙÈ΋ ηı˘ÛÙ¤ÚËÛË ÛÙËÓ ËÏÈΛ· ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜. ∫·Ì›· ÌËÙ¤Ú· ‰ÂÓ Â›¯Â ÂÌ‚ÔÏÈ·ÛÙ› ηٿ Ù˘ ÂÚ˘ıÚ¿˜. ¶·ÚfiÙÈ Â›¯Â ÚÔËÁËı› ÂȉËÌ›· ÂÚ˘ıÚ¿˜, ‰ÂÓ Ù¤ıËÎÂ Ë ˘Ô„›· ÓfiÛËÛ˘ ·fi ÂÚ˘ıÚ¿ Û ‰‡Ô ·fi ÙȘ ÙÚÂȘ ¤ÁÎ˘Â˜ Ô˘ ›¯·Ó ·ÚÔ˘ÛÈ¿ÛÂÈ ÎËÏȉԂϷÙȉ҉˜ ÂÍ¿ÓıËÌ·. OÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ¤ÁÈÓ Û ̛· ÌfiÓÔ ¤ÁÎ˘Ô Ì ÎËÏȉԂϷÙȉ҉˜ ÂÍ¿ÓıËÌ· ‡ÔÙÔ ÁÈ· ÂÚ˘ıÚ¿, ·ÏÏ¿ ‹Ù·Ó ·ÙÂÏ‹˜ Î·È ÌË ‰È·ÁÓˆÛÙÈÎfi˜ (ÌfiÓÔ πgG ·ÓÙÈÛÒÌ·Ù·). ª›· ¤ÁÎ˘Ô˜, ÚÔÂÚ¯fiÌÂÓË ·fi ·Ó·ÙÔÏÈΤ˜ ¯ÒÚ˜, ›¯Â ÁÚ·Ì̤ÓÔ ÛÙÔ ‚È‚ÏÈ¿ÚÈÔ ˘Á›·˜ fiÙÈ

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ÓfiÛËÛ ·fi ÂÚ˘ıÚ¿ ÛÙË ·È‰È΋ ËÏÈΛ·. O Ì·ÈÂ˘Ù‹Ú·˜ Ù˘ ıÂÒÚËÛ ÂÚÈÙÙ‹ ÙË ‰ÈÂÚ‡ÓËÛË/ÂȂ‚·›ˆÛË Ù˘ ·ÓÔÛÔÏÔÁÈ΋˜ Ù˘ ηٿÛÙ·Û˘ Ì ÔÚÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô, fiÙ·Ó ·˘Ù‹ ·ÚÔ˘Û›·Û ÎËÏȉԂϷÙȉ҉˜ ÂÍ¿ÓıËÌ·. ∆Ô ÓÂÔÁÓfi Ô˘ ÁÂÓÓ‹ıËΠ›¯Â ÛÔ‚·Ú¤˜ Î·È ¯·Ú·ÎÙËÚÈÛÙÈΤ˜ ‚Ï¿‚˜ ™™∂ ·fi ÙËÓ ÚÒÙË Ë̤ڷ Ù˘ ˙ˆ‹˜ (ÏÈÔ‚·Ú¤˜, ηٷÚÚ¿ÎÙ˘ ¿Ìʈ), ¯ˆÚ›˜ Ó· ÚÔηϤÛÂÈ ˘Ô„›· ÁÈ· ÙÔ ™™∂ ÛÙÔÓ ·È‰›·ÙÚÔ Ô˘ ÙÔ ÂͤٷÛÂ, ÚÈÓ ÙÔ ‰È·ÎÔÌ›ÛÂÈ ÛÙÔ ÙÌ‹Ì· Ì·˜. ∆· ·Ú·¿Óˆ ‰Â›¯ÓÔ˘Ó ‰˘ÛÎÔϛ˜, Ï¿ıË Î·È ·Ú·Ï›„ÂȘ, Ô˘ Û ηÈÚfi ÂȉËÌ›·˜ ÌÔÚÔ‡Ó Ó· ·ÔʇÁÔÓÙ·È ‹ Ó· ÂÏ·¯ÈÛÙÔÔÈÔ‡ÓÙ·È. °ÂÓÈο, Ë ·‰˘Ó·Ì›· ‰È¿ÁÓˆÛ˘ Ù˘ ÂÚ˘ıÚ¿˜ Î·È ÙÔ˘ ™™∂, fiÙ·Ó ˘¿Ú¯Ô˘Ó ÛÔÚ·‰Èο ÎÚÔ‡ÛÌ·Ù·, ı· ÌÔÚÔ‡Û ӷ ‰ÈηÈÔÏÔÁËı› ÏfiÁˆ Û·ÓÈfiÙËÙ·˜. ™Â ηÈÚfi, fï˜, ÂȉËÌ›·˜, ÔÈ “˘ÁÂÈÔÓÔÌÈΤ˜ ·Ú¯¤˜” ¤¯Ô˘Ó ·ÚÎÂÙfi ¯ÚfiÓÔ ÁÈ· Ï‹„Ë Ì¤ÙÚˆÓ Î·È ÂÓË̤ڈÛË fiÏˆÓ fiÛˆÓ ÊÚÔÓÙ›˙Ô˘Ó ¤ÁÎ˘Â˜, Á˘Ó·›Î˜ ·Ó··Ú·ÁˆÁÈ΋˜ ËÏÈΛ·˜ Î·È ‚Ú¤ÊË. ∞’ fiÛÔ ÁÓˆÚ›˙Ô˘ÌÂ, Ù¤ÙÔÈ· ÂÓË̤ڈÛË ‰ÂÓ ˘‹ÚÍ Û ηӤӷ ÊÔÚ¤· ˘Á›·˜. ∆· 5 ·ÚfiÓÙ· ÎÚÔ‡ÛÌ·Ù·, Ì·˙› Ì ¿ÏÏ· 4 Ô˘ ·Ó·ÎÔÈÓÒıËÎ·Ó ·fi ¿ÏÏË ÎÏÈÓÈ΋ (6), Â›Ó·È Ë ÎÔÚ˘Ê‹ ÙÔ˘ ·Áfi‚Ô˘ÓÔ˘, Â¿Ó ˘ÔÏÔÁ›ÛÔ˘ÌÂ: ·) ÙËÓ ÂÏÏÈ‹ ÔÚÁ¿ÓˆÛË Î·Ù·ÁÚ·Ê‹˜ ÎÚÔ˘ÛÌ¿ÙˆÓ ™™∂, ‚) ÙËÓ, ÁÈ· ·ÓÙÈÎÂÈÌÂÓÈÎÔ‡˜ ÏfiÁÔ˘˜, ·‰˘Ó·Ì›· ÂÎ·›‰Â˘Û˘/ÂÓË̤ڈÛ˘ ÙˆÓ ÁÈ·ÙÚÒÓ ¿Óˆ ÛÙÔ ı¤Ì· ·˘Ùfi, Á) ÙËÓ ·ÓÂÏÏ·‰È΋ ¤ÏÏÂÈ„Ë ÂÚÁ·ÛÙËÚ›ˆÓ Ì ‰˘Ó·ÙfiÙËÙ· ηÏÏȤÚÁÂÈ·˜ ÙÔ˘ ÈÔ‡, ÂͤٷÛ˘ ¯Ú‹ÛÈÌ˘ ÁÈ· ÙË ‰È¿ÁÓˆÛË ÙˆÓ ‡ÔÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ Ô˘ ¤¯Ô˘Ó ·ÚÓËÙÈο IgM Î·È ‰) fiÙÈ ¤Ó· ÌÂÁ¿ÏÔ ÔÛÔÛÙfi Û˘ÁÁÂÓÒÓ ÏÔÈÌÒÍÂˆÓ ·fi ÂÚ˘ıÚ¿ Â›Ó·È ·Û˘Ìو̷ÙÈÎfi ηٿ ÙË Á¤ÓÓËÛË Î·È ÌÔÚ› Ó· ÂÌÊ·Ó›ÛÂÈ ‚Ï¿‚˜ ·ÚÎÂÙ¿ ·ÚÁfiÙÂÚ·. Œ¯Ô˘Ó ÂÚ¿ÛÂÈ ‰‡Ô ¯ÚfiÓÈ· ÌÂÙ¿ ÙËÓ ÂȉËÌ›· Ù˘ ÂÚ˘ıÚ¿˜ Î·È ·ÎfiÌ· ‰ÂÓ ¤¯Ô˘Ì οÔÈ· Â›ÛËÌË ÂÓË̤ڈÛË ÁÈ· ÙÔÓ ·ÚÈıÌfi ÙˆÓ ‰ËÏˆÌ¤ÓˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ ™™∂. ∏ ÚÔÛÙ·Û›· ÙÔ˘ ÂÌ‚Ú‡Ô˘ ηٿ Ù˘ ÂÚ˘ıÚ¿˜ Á›ÓÂÙ·È Î˘Ú›ˆ˜ Ì ÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi ÙÔ˘ ÁÂÓÈÎÔ‡ ÏËı˘ÛÌÔ‡. °È· ÙÔ ÛÎÔfi ·˘Ùfi ¤¯Ô˘Ó ÚÔÙ·ı› ‰‡Ô ‚·ÛÈΤ˜ ÛÙÚ·ÙËÁÈΤ˜: ·) Ë ÁÂÓÈÎÂ˘Ì¤ÓË ·ÓÔÛÔÔ›ËÛË ÛÙËÓ ·È‰È΋ ËÏÈΛ· (¤ÌÌÂÛË ÚÔʇϷÍË) Î·È ‚) Ô ÂÎÏÂÎÙÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ ÙˆÓ Á˘Ó·ÈÎÒÓ ·Ó··Ú·ÁˆÁÈ΋˜ ËÏÈΛ·˜ (¿ÌÂÛË ÚÔʇϷÍË) (7). ∏ ÔÏ˘ÂÙ‹˜ ÂÌÂÈÚ›· ¤¯ÂÈ ‰Â›ÍÂÈ fiÙÈ Â›Ó·È ·Ó·Áη›· Ë ÔÏÔÎÏ‹ÚˆÛË Î·È ÙˆÓ ‰‡Ô ÛÙÚ·ÙËÁÈÎÒÓ ÁÈ· ÙËÓ Â›Ù¢ÍË ÙÔ˘ ̤ÁÈÛÙÔ˘ ÂϤÁ¯Ô˘ ÛÙÔ ‚Ú·¯‡ÙÂÚÔ ‰˘Ó·Ùfi ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· (8). ∞fi ÌfiÓ˜ ÙÔ˘˜ Î·È ÔÈ ‰‡Ô ÛÙÚ·ÙËÁÈΤ˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·ÚÎÂÙ¿ ÌÂÈÔÓÂÎÙ‹Ì·Ù· Î·È ¯ÚÂÈ¿˙ÔÓÙ·È ÔÏÏ¿ ¯ÚfiÓÈ· ÁÈ· Ó· ¤¯Ô˘Ó ÛËÌ·ÓÙÈ΋ Â›‰Ú·ÛË (7,8).

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ŸÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ·ÓÔÛÔÔ›ËÛË ÛÙËÓ ·È‰È΋ ËÏÈΛ·, ÔÈ ÌÂϤÙ˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ fiÙ·Ó ¤Ó·˜ ÈηÓÔÔÈËÙÈÎfi˜ ·ÚÈıÌfi˜ ·È‰ÈÒÓ Ì›·˜ ÎÔÈÓfiÙËÙ·˜ ·ÓÔÛÔÔÈËı› ηٿ Ì›·˜ ÓfiÛÔ˘ ÁÈ· ÙËÓ ÔÔ›· ˘¿Ú¯ÂÈ ÂÌ‚fiÏÈÔ, ÙfiÙ ÂÍ·ÛÊ·Ï›˙ÂÙ·È ÚÔÛÙ·Û›· ηٿ Ù˘ ÓfiÛÔ˘ ·˘Ù‹˜ ÁÈ· οı ¿ÙÔÌÔ Ù˘ ÎÔÈÓfiÙËÙ·˜ (9). °È· ÙȘ ÓfiÛÔ˘˜ Ì ÌÂÁ¿ÏË ÌÂÙ·‰ÔÙÈÎfiÙËÙ·, fiˆ˜ Ë ÂÚ˘ıÚ¿ Î·È Ë ÈÏ·Ú¿, Ú¤ÂÈ Ó· ·ÓÔÛÔÔÈËı› ˘„ËÏfi ÔÛÔÛÙfi ·È‰ÈÒÓ (>90%) ÁÈ· Ó· ˘¿Ú¯ÂÈ ÚÔÛÙ·Û›· ÁÈ· ÙÔÓ Î·ı¤Ó· (9). ™ÙËÓ ∂ÏÏ¿‰·, Ô ˘Ô¯ÚˆÙÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ ηٿ Ù˘ ÂÚ˘ıÚ¿˜ ¿Ú¯ÈÛ ÙÔ 1989 ·fi ÙËÓ ·È‰È΋ ËÏÈΛ· Î·È ÙÔ ÔÛÔÛÙfi ÂÌ‚ÔÏÈ·ÛÌÔ‡, ̤¯ÚÈ Û‹ÌÂÚ·, ıˆÚÂ›Ù·È fiÙÈ Â›Ó·È ÌÈÎÚfiÙÂÚÔ ·fi ÙÔ ÔÛÔÛÙfi Ô˘ ÚÔÛٷهÂÈ ·fi ÙËÓ ÂȉËÌÈ΋ ¤ÎÚËÍË Ù˘ ÓfiÛÔ˘ (3). ∆Ô Úfi‚ÏËÌ· ÂÚÈϤÎÂÙ·È ·Ó ·Ó·ÏÔÁÈÛÙԇ̠ÙË Ì·˙È΋ ÂÈÛ‚ÔÏ‹ ÌÂÙ·Ó·ÛÙÒÓ ·fi ¯ÒÚ˜ Ô˘ ‰ÂÓ Á›ÓÔÓÙ·È ÂÌ‚ÔÏÈ·ÛÌÔ›, ηıÒ˜ Î·È ÙËÓ ·ıÚfi· Ù·ÍȉȈÙÈ΋ ΛÓËÛË ÌÂٷ͇ ¯ˆÚÒÓ Ì ‰È·ÊÔÚÂÙÈΤ˜ ÔÏÈÙÈΤ˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡. ŒÙÛÈ, ηٿ ÙËÓ ÂȉËÌ›· ÂÚ˘ıÚ¿˜ ÙÔ˘ 1999, ÊÔÈÙËÙ¤˜ ·fi ÙËÓ ∂ÏÏ¿‰· ÌÂÙ¤ÊÂÚ·Ó ÙË ÓfiÛÔ ÛÙËÓ ∞ÁÁÏ›·, Ì ·ÔÙ¤ÏÂÛÌ· Ó· ˘¿ÚÍÔ˘Ó ÌÈÎÚÔ-ÂȉË̛˜ ÂÚ˘ıÚ¿˜ Û 4 ·ÓÂÈÛÙ‹ÌÈ·, fiÔ˘ ÊÔÈÙÔ‡Û·Ó, ηıÒ˜ Î·È ¤Ó· ÎÚÔ‡ÛÌ· ™™∂ (10). ∏ ÛÙÚ·ÙËÁÈ΋ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜, Ô˘ ÂÊ·ÚÌfiÛÙËΠÛÙËÓ ∂ÏÏ¿‰·, ›¯Â Û·Ó Â·ÎfiÏÔ˘ıÔ Ó· ÌÂÙ·ÙÔÈÛÙ› Ë ËÏÈΛ· ÓfiÛËÛ˘ ¤Ó·ÓÙÈ Ù˘ ÂÚ˘ıÚ¿˜ ÛÙËÓ ÂÓ‹ÏÈÎË Î·È ·Ó··Ú·ÁˆÁÈ΋ ËÏÈΛ· (3). ŒÙÛÈ, ÌÔÚ› Ó· ÂÍËÁËı› ηٿ ¤Ó· ̤ÚÔ˜ Ë ·˘ÍË̤ÓË ·Ó·ÊÔÚ¿ ÎÚÔ˘ÛÌ¿ÙˆÓ ™™∂ ÛÙȘ ÙÂÏÂ˘Ù·›Â˜ ÂȉË̛˜ ÂÚ˘ıÚ¿˜ (3). ™ÙËÓ ·˘ÍË̤ÓË ·Ó·ÊÔÚ¿ ÎÚÔ˘ÛÌ¿ÙˆÓ ™™∂ Û˘Ó¤‚·Ï·Ó Î·È ¿ÏÏÔÈ ·Ú¿ÁÔÓÙ˜, fiˆ˜ Ë ‰˘Ó·ÙfiÙËÙ· ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛÂˆÓ (ÂȉÈο 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, Ì ÙË ‰ËÌÈÔ˘ÚÁ›· ÓÂÔÁÓÔÏÔÁÈÎÒÓ ÙÌËÌ¿ÙˆÓ Ô˘ ¿Ú¯ÈÛ ·fi Ù· ̤۷ Ù˘ ‰ÂηÂÙ›·˜ ÙÔ˘ 1980. ¢ÂÓ Â›Ó·È Ù˘¯·›Ô ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ‰ÂÓ ·Ó·Ê¤ÚıËÎ·Ó ÛÙËÓ ÙÂÏÂ˘Ù·›· ÂȉËÌ›· ÎÚÔ‡ÛÌ·Ù· ™™∂, ‚‚·ÈˆÌ¤Ó· ‹ Èı·Ó¿, Û ËÏÈ˘ ÌÂÁ·Ï‡ÙÂÚ˜ Ù˘ ÓÂÔÁÓÈ΋˜, ÂÓÒ ÛÙËÓ ÂȉËÌ›· ÙÔ˘ 1993 Ë Û˘ÓÙÚÈÙÈ΋ ÏÂÈÔ„ËÊ›· ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ ·ÊÔÚÔ‡Û ÛÙË ÓÂÔÁÓÈ΋ Î·È ¿ÌÂÛË ÌÂÙ·ÓÂÔÁÓÈ΋ ËÏÈΛ·. ŸÛÔÓ ·ÊÔÚ¿ ÛÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi ÙˆÓ Á˘Ó·ÈÎÒÓ ·Ó··Ú·ÁˆÁÈ΋˜ ËÏÈΛ·˜ ÁÈ· ÚÔÛÙ·Û›· ·fi ÙËÓ ÂÚ˘ıÚ¿, ¤¯Ô˘Ó ÚÔÙ·ı› ÙÚÂȘ ÛÙÚ·ÙËÁÈΤ˜ (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·ÙËÁÈ΋ ·˘Ù‹ ·ÔÛÎÔ› ÛÙËÓ ÚÔÛÙ·Û›· ÙˆÓ ÂfiÌÂÓˆÓ

july-aug02TELIKO

14-05-03

13:31

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΢‹ÛˆÓ. ™ÙȘ ∏¶∞ ÙÔ 38% ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ ™∂ Ù˘ ÙÂÏÂ˘Ù·›·˜ ‰ÂηÂÙ›·˜ Û˘Ó¤‚Ë Û ‰Â˘ÙÂÚfiÙÔΘ ¤ÁÎ˘Â˜ Ô˘ ‰ÂÓ Â›¯·Ó ·ÓÔÛ›· ηٿ Ù˘ ÂÚ˘ıÚ¿˜ (8) Î·È Á) ÚfiÁÚ·ÌÌ· ÂÌ‚ÔÏÈ·ÛÌÔ‡ Û χÎÂÈ·, ·ÓÂÈÛÙ‹ÌÈ·, ÓÔÛÔÎÔÌ›· ηÈ, ÁÂÓÈο, ¯ÒÚÔ˘˜ ÂÚÁ·Û›·˜. ÀÔÏÔÁ›ÛÙËΠfiÙÈ Ë ÚÒÙË ÛÙÚ·ÙËÁÈ΋ ı· ÌÔÚÔ‡Û ӷ ÌÂÈÒÛÂÈ Î·Ù¿ 45% Î·È Ë ‰Â‡ÙÂÚË Î·Ù¿ 56% Ù· ÎÚÔ‡ÛÌ·Ù· ™™∂ Ô˘ ηٷÁÚ¿ÊËÎ·Ó ÙËÓ ÙÂÏÂ˘Ù·›· ‰ÂηÂÙ›· ÛÙȘ ∏¶∞ (7). ∏ ÙÚ›ÙË ÛÙÚ·ÙËÁÈ΋ ‰ÂÓ Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈ΋, fiÙ·Ó Ù· ÎÚÔ‡ÛÌ·Ù· ÂÚ˘ıÚ¿˜ Û˘Ì‚·›ÓÔ˘Ó Û ÌË ÂÚÁ·˙fiÌÂÓ˜ Á˘Ó·›Î˜. ¶ÂÚÈÔÚÈÛÌfi˜ ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ ™™∂ ÌÔÚ› Ó· ÂÈÙ¢¯ı› ·ÎfiÌ· Î·È ÛÙÔ Í¤Û·ÛÌ· ÂȉËÌ›·˜ ÂÚ˘ıÚ¿˜, ·Ó ·ÎÔÏÔ˘ıËı› Ì›· ÁÚ‹ÁÔÚË Î·È ÂÈıÂÙÈ΋ ÛÙÚ·ÙËÁÈ΋ Ì ·ÔÌfiÓˆÛË ÙˆÓ ‡ÔÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ ‹ ÂÎÙÂı¤ÓÙˆÓ ·ÙfïÓ, ÚÔÛÙ·Û›· ÙˆÓ ÂÁ·ˆÓ, ÂÌ‚ÔÏÈ·ÛÌfi ÙˆÓ Â˘·›ÛıËÙˆÓ ·ÙfiÌˆÓ (ÂÍ·›ÚÂÛË ÔÈ ¤ÁÎ˘Â˜) Î·È ÂȂ‚·›ˆÛË Ù˘ ·ÓÔÛÔÏÔÁÈ΋˜ ηٿÛÙ·Û˘ ÙˆÓ ÂÎÙÂı¤ÓÙˆÓ ÂÁ·ˆÓ (8). ™ÙËÓ ∂ÏÏ¿‰·, Ë ÛÙÚ·ÙËÁÈ΋ ·˘Ù‹ ÌÔÚ› Ó· ·Ô‰Âȯı› Ôχ ¯Ú‹ÛÈÌË, ‰ÈfiÙÈ Î·Ù¿ ηÓfiÓ· ÔÈ ÂȉË̛˜ ÂÚ˘ıÚ¿˜ ·Ú¯›˙Ô˘Ó ·fi ÙÔ ÛÙÚ·Ùfi Î·È ÌÂÙ¿ ÂÂÎÙ›ÓÔÓÙ·È ÛÙȘ ÎÔÈÓfiÙËÙ˜ (4). ∞˘Ùfi ‰›ÓÂÈ ÔχÙÈÌÔ ¯ÚfiÓÔ ÛÙȘ ˘ÁÂÈÔÓÔÌÈΤ˜ ·Ú¯¤˜ ÁÈ· ÂÓË̤ڈÛË Î·È Ï‹„Ë Î·Ù¿ÏÏËÏˆÓ Ì¤ÙÚˆÓ, fiˆ˜ ·˘Ù¿ Ô˘ ÚԷӷʤÚıËηÓ. ∂ÈϤÔÓ, Ô ÂÌ‚ÔÏÈ·ÛÌfi˜ ÙˆÓ ÌË ¿ÓÔÛˆÓ ÓÂÔÛ˘ÏϤÎÙˆÓ ÌÔÚ› Ó· ÂÍ·Ï›„ÂÈ Ì›· ËÁ‹ ÂȉËÌÈÒÓ, fiˆ˜ ¤ÁÈÓÂ Î·È Û ¿ÏÏ· ÎÚ¿ÙË (11). ∏ ·Ó¿ÁÎË ÁÈ· Â›Ù¢ÍË Î·È ‰È·Ù‹ÚËÛË ˘„ËÏÔ‡ ÂÈ¤‰Ô˘ ·ÓÔÛ›·˜, Û˘Ó¯ԇ˜ Â·ÁÚ‡ÓËÛ˘ Î·È ¿ÌÂÛ˘ ÂÊ·ÚÌÔÁ‹˜ ̤ÙÚˆÓ ÂϤÁ¯Ô˘ Â›Ó·È ÎÚ›ÛÈÌ˘ ÛËÌ·Û›·˜ ÁÈ· Ó· ÂÍ·Ê·ÓÈÛÙ› ÙÔ ™™∂ (12) ‹ ÁÈ· Ó· ÛÙ·Ì·Ù‹ÛÂÈ Ë ÌÂÁ·ÏÔ-ÂȉËÌÈ΋ ÂÌÊ¿ÓÈÛË ÎÚÔ˘ÛÌ¿ÙˆÓ ÂÚ˘ıÚ¿˜ Î·È ™™∂ ÛÙËÓ ∂ÏÏ¿‰·. ∏ ÔÚÈÛÙÈ΋ ÂÍ¿ÏÂÈ„Ë ÙÔ˘ ™™∂ Ê·›ÓÂÙ·È ‰‡ÛÎÔÏÔ˜ Î·È Ì·ÎÚÈÓfi˜ ÛÙfi¯Ô˜ ÁÈ· Ù· ÂÏÏËÓÈο ‰Â‰Ô̤ӷ, ·Ó ·Ó·ÏÔÁÈÛÙ› ηÓ›˜ ÙȘ ˘¿Ú¯Ô˘Û˜ ‰Ô̤˜ Î·È ÙË Û˘Ó¯‹ ›ÛÔ‰Ô ÌÂÙ·Ó·ÛÙÒÓ ·fi ¯ÒÚ˜ Ô˘ ‰ÂÓ Á›ÓÔÓÙ·È ÂÌ‚ÔÏÈ·ÛÌÔ›. ∆Ô Úfi‚Ï‹Ì· ·ÓÔÛÔÔ›ËÛ˘ ÙˆÓ ÌÂÙ·Ó·ÛÙÒÓ ··Û¯ÔÏ› Û‹ÌÂÚ· ÙȘ ÚÔËÁ̤Ó˜ ¯ÒÚ˜ Ô˘ ¤¯Ô˘Ó χÛÂÈ ÙÔ Úfi‚ÏËÌ· ÙÔ˘ ™™∂ ÛÙÔÓ ÂÓ‰ÔÁÂÓ‹ ÏËı˘ÛÌfi (7,12). °È· Ù· ÂÏÏËÓÈο ‰Â‰Ô̤ӷ, ÌÂٷ͇ ÙˆÓ ¿ÏψÓ, ÈÛÙ‡ԢÌ fiÙÈ ÛÙȘ ‰È¿ÊÔÚ˜ “·ÚÌfi‰È˜ ˘ÁÂÈÔÓÔÌÈΤ˜ ÂÈÙÚÔ¤˜” ÁÈ· ÙȘ Û˘ÁÁÂÓ›˜ ÏÔÈÌÒÍÂȘ Ô˘ ˘¿Ú¯Ô˘Ó Ú¤ÂÈ Ó· Û˘ÌÌÂÙ¤¯Ô˘Ó Ì ·ÚÈÔ ÚfiÏÔ Î·È ÂΛÓÔÈ ÔÈ ÁÈ·ÙÚÔ›, ÔÈ ÔÔ›ÔÈ ÚÒÙÔÈ ‰È·ÁÈÁÓÒÛÎÔ˘Ó ÙȘ ·ı‹ÛÂȘ ·˘Ù¤˜, fiˆ˜ ÔÈ Ì·ÈÂ˘Ù‹Ú˜ Î·È ÔÈ ÓÂÔÁÓÔÏfiÁÔÈ.

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2. ™È·Ì›ÛË ¶, ∆·Ì·ÎÔ‡‰Ë˜ ¶, ¶··‚·ÛÈÏ›Ԣ µ, °ÎÚÈÌ›˙˘ °, ª·ÓÙ·ÏÂÓ¿Î˘ ™, ∞Ó‰Ú¤Ô˘ ∞. ™˘ÁÁÂÓ‹˜ ÂÚ˘ıÚ¿ (·Ó·ÊÔÚ¿ ‰‡Ô ÂÚÈÙÒÛˆÓ). ∂ÏÏËÓÈ΋ ª·È¢ÙÈ΋ Î·È °˘Ó·ÈÎÔÏÔÁ›· 1995;7:246-248.

3. ¶·Ó·ÁȈÙfiÔ˘ÏÔ˜ ∆, ∞ÓÙˆÓÈ¿‰Ô˘ π, µ·Ï¿ÛÛË-∞‰¿Ì ∂. ∂ȉËÌ›· Û˘ÁÁÂÓÔ‡˜ ÂÚ˘ıÚ¿˜ ÙÔ 1993 ÛÙËÓ ∂ÏÏ¿‰·. ∫·Ù·ÁÚ·Ê‹ 25 ÂȂ‚·ÈˆÌ¤ÓˆÓ ÂÚÈÙÒÛˆÓ. ¶·È‰È·ÙÚÈ΋ 1997;60:582-591.

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

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7. Schluter WW, Reef SE, Redd SC, Dykewicz CA. Changing epidemiology of congenital rubella syndrome in the United States. 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.

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9. Berger A. How does herd immunity work? [Editorial]. BMJ 1999;319:1467.

10. Tookey P, Molyneaux P, Helms P. UK case of congenital rubella can be linked to Greek cases [letter]. BMJ 2000;321:766.

11. Preblud SR, Serdula MK, Frank JA Jr, Brandling-Bennett AD, 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 congenital rubella syndrome (CRS): summary of a workshop on CRS elimination in the United States. Clin Infect Dis 2000;31:85-95.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 14-12-2001 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 21-05-2002 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∞. ∞Ó‰Ú¤Ô˘ ÃÂÈ̈ӛ‰Ô˘ 15, ∆.∫. 551 33, ∫·Ï·Ì·ÚÈ¿ E-mail: aalex@spark.net.gr

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∂¡¢π∞º∂ƒOÀ™∞ ¶∂ƒπ¶∆ø™∏

Paediatriki 2002;65:278-281

CASE REPORT

∞ÈÌÔÚÚ·ÁÈΤ˜ ÎÂÓÒÛÂȘ ·fi ÙËÓ ÚÒÙË Ë̤ڷ ˙ˆ‹˜ Û ÓÂÔÁÓfi Ì ·ÏÏÂÚÁ›· ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜ ∂. ÷Ù˙ˉ¿ÎË1, ∞. ª·ÓÔ˘Ú¿1, ∂. ∫ÔڷοÎË1, ∂. °·Ï·Ó¿Î˘2, Ã. °È·ÓÓ·ÎÔÔ‡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

¶ÂÚ›ÏË„Ë: O fiÚÔ˜ ·ÏÏÂÚÁ›· ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜ ·Ó·Ê¤ÚÂÙ·È ÛÙȘ ·ÓÂÈı‡ÌËÙ˜ ÂΉËÏÒÛÂȘ Ô˘ ÚÔηÏÔ‡ÓÙ·È Ì ÙË ÌÂÛÔÏ¿‚ËÛË ·ÓÔÛÔÏÔÁÈÎÒÓ Ì˯·ÓÈÛÌÒÓ ¤Ó·ÓÙÈ ÙˆÓ ÚˆÙÂ˚ÓÒÓ ÙÔ˘ Á¿Ï·ÎÙÔ˜ ·ÁÂÏ¿‰·˜. ∏ ·ÏÏÂÚÁ›· ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜ Â›Ó·È ÓfiÛÔ˜ Ù˘ ‚ÚÂÊÈ΋˜ ΢ڛˆ˜ ËÏÈΛ·˜. ™Â Û¿ÓȘ ÂÚÈÙÒÛÂȘ Ë ÎÏÈÓÈ΋ Û˘Ìو̷ÙÔÏÔÁ›· ÂÌÊ·Ó›˙ÂÙ·È ÙÔÓ ÚÒÙÔ Ì‹Ó· Ù˘ ˙ˆ‹˜ ‹ ÌÂÙ¿ ÙÔÓ ‰ˆ‰¤Î·ÙÔ Ì‹Ó·. ™ÙË ‚È‚ÏÈÔÁÚ·Ê›· ˘¿Ú¯Ô˘Ó ÂÏ¿¯ÈÛÙ˜ ·Ó·ÊÔÚ¤˜ ÂÚÈÙÒÛÂˆÓ ·ÏÏÂÚÁ›·˜ ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜, Ô˘ ÂÌÊ·Ó›ÛÙËÎ·Ó ÙËÓ ÚÒÙË Â‚‰ÔÌ¿‰· Ù˘ ˙ˆ‹˜. ¶ÂÚÈÁÚ¿ÊÂÙ·È ÂÚ›ÙˆÛË ·ÏÏÂÚÁ›·˜ ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜ Ô˘ ÂÌÊ·Ó›ÛÙËΠ·fi ÙËÓ ÚÒÙË Ë̤ڷ Ù˘ ˙ˆ‹˜ Ì ·ÈÌÔÚÚ·ÁÈΤ˜ ÎÂÓÒÛÂȘ Û ÙÂÏÂÈfiÌËÓÔ ÓÂÔÁÓfi. ∞fi ÙËÓ ˘¿Ú¯Ô˘Û· ‚È‚ÏÈÔÁÚ·Ê›· ÚÔ·ÙÂÈ fiÙÈ ÚfiÎÂÈÙ·È ÁÈ· ÙËÓ ÚÒÙË ÂÚ›ÙˆÛË ·ÏÏÂÚÁ›·˜ ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜ Ì ÙË ÌÂÛÔÏ¿‚ËÛË ÔÏÈ΋˜ ·ÓÔÛÔÛÊ·ÈÚ›Ó˘ E Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È Û ÙÂÏÂÈfiÌËÓÔ ÓÂÔÁÓfi, Ì ÂÌÊ¿ÓÈÛË ·ÈÌÔÚÚ·ÁÈÎÒÓ ÎÂÓÒÛÂˆÓ Ï›Á˜ ÌfiÓÔ ÒÚ˜ ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË ÂÍ·ÓıÚˆÔÔÈË̤ÓÔ˘ Á¿Ï·ÎÙÔ˜ ·ÁÂÏ¿‰·˜.

Abstract: Cow’s milk allergy is an immune system reaction to milk protein. It is a disease of early infancy. The onset of clinical presentation rarely occurs before the first month of life and after the age of twelve months. There have been only a few cases of cow’s milk allergy described on the first week of life. We report a case of cow’s milk allergy, that presented with bloody stools starting on the twentieth hour of life, in a full term otherwise healthy neonate. To the best of our knowledge, our case is the first case of immunoglobulin E mediated reaction to cow’s milk protein in a full term neonate, that presented with bloody stools a few hours after commencing formula feeding and before the end of the first twenty-four hours of life.

§¤ÍÂȘ ÎÏÂȉȿ: ·ÈÌÔÚÚ·ÁÈΤ˜ ÎÂÓÒÛÂȘ, ·ÏÏÂÚÁ›· ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜, ÓÂÔÁÓfi.

Key words: bloody stools, cow’s milk allergy, neonate.

∂ÈÛ·ÁˆÁ‹ O fiÚÔ˜ ·ÏÏÂÚÁ›· ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜ ·Ó·Ê¤ÚÂÙ·È ÛÙȘ ·ÓÂÈı‡ÌËÙ˜ ÂΉËÏÒÛÂȘ Ô˘ ÚÔηÏÔ‡ÓÙ·È Ì ÙË ÌÂÛÔÏ¿‚ËÛË ·ÓÔÛÔÏÔÁÈÎÒÓ Ì˯·ÓÈÛÌÒÓ ¤Ó·ÓÙÈ ÙˆÓ ÚˆÙÂ˚ÓÒÓ ÙÔ˘ Á¿Ï·ÎÙÔ˜ ·ÁÂÏ¿‰·˜. ∏ Û˘¯ÓfiÙËÙ· Ù˘ ·ÏÏÂÚÁ›·˜ ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜ ÛÙË ‚ÚÂÊÈ΋ ËÏÈΛ· Â›Ó·È 2-3% (1,2). ∞Ó¿ÏÔÁ· Ì ÙÔÓ ˘ÔΛÌÂÓÔ ·ÓÔÛÔÏÔÁÈÎfi Ì˯·ÓÈÛÌfi Ù·ÍÈÓÔÌ›ٷÈ: ·) Û ·ÓÔÛÔÏÔÁÈ΋ ·ÓÙ›‰Ú·ÛË Ô˘

ÚÔηÏÂ›Ù·È Ì ÙË ÌÂÛÔÏ¿‚ËÛË IgE Î·È ÚÔ‚¿ÏÏÂÈ ÎÏÈÓÈο Ì ·ÁÁÂÈÔÔ›‰ËÌ·, Û˘ÚÈÁÌfi, ÚÈÓ›Ùȉ·, Â̤ÙÔ˘˜, ¤Î˙ÂÌ· ‹ ·Ó·Ê˘Ï·Í›· Î·È ‚) Û ·ÓÔÛÔÏÔÁÈ΋ ·ÓÙ›‰Ú·ÛË ¯ˆÚ›˜ ÙË ÌÂÛÔÏ¿‚ËÛË IgE Ô˘ ÌÔÚ› Ó· ÂÌÊ·ÓÈÛÙ› Ì ÙË ÌÔÚÊ‹ Ó¢ÌÔÓÈ΋˜ ·ÈÌÔÛȉ‹ÚˆÛ˘, ‰˘Û·ÔÚÚfiÊËÛ˘, ÎÔÏ›Ùȉ·˜, ÔÈÛÔÊ·Á›Ùȉ·˜ ‹ Á·ÛÙÚÔÔÈÛÔÊ·ÁÈ΋˜ ·ÏÈÓ‰ÚfiÌËÛ˘. ∂ÓÙÔ‡ÙÔȘ, Â›Ó·È ‰‡ÛÎÔÏÔ Ó· ηıÔÚÈÛÙ› Û ÔÈÔ ‚·ıÌfi Û˘ÌÌÂÙ¤¯ÂÈ Ô Î·ı¤Ó·˜ ·fi ÙÔ˘˜ ·Ú·¿Óˆ

1 ¡ÂÔÁÓÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘ 2 ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘

1 Department of Neonatology of University of Crete 2 Pediatric Clinic of University of Crete

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¶·È‰È·ÙÚÈ΋ 2002;65:278-281

·ÓÔÛÔÏÔÁÈÎÔ‡˜ Ì˯·ÓÈÛÌÔ‡˜ ÛÙËÓ ÚfiÎÏËÛË Ù˘ ÈÛÙÈ΋˜ ‚Ï¿‚˘. OÈ ·ÈÌÔÚÚ·ÁÈΤ˜ ÎÂÓÒÛÂȘ Û·Ó ÎÏÈÓÈ΋ ÂΉ‹ÏˆÛË Ù˘ ·ÏÏÂÚÁ›·˜ ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜ ‰ÂÓ ıˆÚÂ›Ù·È fiÙÈ ÚÔηÏÔ‡ÓÙ·È ·fi ·ÓÔÛÔÏÔÁÈ΋ ·ÓÙ›‰Ú·ÛË Ì ÙË ÌÂÛÔÏ¿‚ËÛË IgE (3). ∏ ·ÏÏÂÚÁ›· ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜ Â›Ó·È Ì›· ÓfiÛÔ˜ Ù˘ ‚ÚÂÊÈ΋˜ ËÏÈΛ·˜ Î·È Ë ÏÂÈÔ„ËÊ›· ÙˆÓ ‚ÚÂÊÒÓ ÂÌÊ·Ó›˙ÂÈ ÙËÓ ÎÏÈÓÈ΋ Û˘Ìو̷ÙÔÏÔÁ›· ÙÔ˘˜ ÚÒÙÔ˘˜ Ì‹Ó˜ Ù˘ ˙ˆ‹˜. ™Â Û¿ÓȘ ÂÚÈÙÒÛÂȘ, Ë Û˘Ìو̷ÙÔÏÔÁ›· ÂÌÊ·Ó›˙ÂÙ·È ÙÔÓ ÚÒÙÔ Ì‹Ó· Ù˘ ˙ˆ‹˜ ‹ ÌÂÙ¿ ÙÔÓ ‰ˆ‰¤Î·ÙÔ Ì‹Ó· (3,4). ™ÙË ‚È‚ÏÈÔÁÚ·Ê›· ˘¿Ú¯Ô˘Ó ÂÏ¿¯ÈÛÙ˜ ·Ó·ÊÔÚ¤˜ ÂÚÈÙÒÛÂˆÓ ·ÏÏÂÚÁ›·˜ ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜ Ô˘ ÂÌÊ·Ó›ÛÙËÎ·Ó ÙËÓ ÚÒÙË Â‚‰ÔÌ¿‰· Ù˘ ˙ˆ‹˜ (5-8). ¶ÂÚÈÁÚ¿ÊÂÙ·È ÂÚ›ÙˆÛË ·ÏÏÂÚÁ›·˜ ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜ Ô˘ ÂÌÊ·Ó›ÛÙËΠ·fi ÙËÓ ÚÒÙË Ë̤ڷ Ù˘ ˙ˆ‹˜ Ì ·ÈÌÔÚÚ·ÁÈΤ˜ ÎÂÓÒÛÂȘ Û ÙÂÏÂÈfiÌËÓÔ ÓÂÔÁÓfi. ∞fi ÙËÓ ˘¿Ú¯Ô˘Û· ‚È‚ÏÈÔÁÚ·Ê›· ÚÔ·ÙÂÈ fiÙÈ ÚfiÎÂÈÙ·È ÁÈ· ÙËÓ ÚÒÙË ÂÚ›ÙˆÛË ·ÏÏÂÚÁ›·˜ ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜ Ì ÙË ÌÂÛÔÏ¿‚ËÛË IgE Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È Û ÙÂÏÂÈfiÌËÓÔ ÓÂÔÁÓfi, Ì ÂÌÊ¿ÓÈÛË ·ÈÌÔÚÚ·ÁÈÎÒÓ ÎÂÓÒÛÂˆÓ Ï›Á˜ ÌfiÓÔ ÒÚ˜ ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË ÂÍ·ÓıÚˆÔÔÈË̤ÓÔ˘ Á¿Ï·ÎÙÔ˜ ·ÁÂÏ¿‰·˜. ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ¶ÚfiÎÂÈÙ·È ÁÈ· ÓÂÔÁÓfi ¿ÚÚÂÓ Ô˘ ÂÌÊ¿ÓÈÛ ·ÈÌÔÚÚ·ÁÈΤ˜ ÎÂÓÒÛÂȘ ·fi ÙËÓ 20‹ ÒÚ· Ù˘ ˙ˆ‹˜ ÙÔ˘. ∆Ô ÓÂÔÁÓfi ÁÂÓÓ‹ıËΠÙÂÏÂÈfiÌËÓÔ, Ë Î‡ËÛË ·Ó·Ê¤ÚıËΠ¯ˆÚ›˜ ȉȷ›ÙÂÚ· ÚÔ‚Ï‹Ì·Ù· Î·È Ô ÙÔÎÂÙfi˜ ¤ÁÈÓ Ì ÚÔÁÚ·ÌÌ·ÙÈṲ̂ÓË Î·ÈÛ·ÚÈ΋ ÙÔÌ‹ ÏfiÁˆ ‰˘Û·Ó·ÏÔÁ›·˜. ∆Ô ÓÂÔÁÓfi ‰ÂÓ ¯ÚÂÈ¿ÛÙËΠ·Ó¿ÓË„Ë Î·È ÛÈÙ›ÛÙËΠ̠ÂÍ·ÓıÚˆÔÔÈË̤ÓÔ Á¿Ï· ·ÁÂÏ¿‰·˜ ·fi ÙËÓ 3Ë ÒÚ· Ù˘ ˙ˆ‹˜ ÙÔ˘. ∂›Ó·È ÙÔ ‰Â‡ÙÂÚÔ ·È‰› Ê·ÈÓÔÙ˘Èο ˘ÁÈÒÓ ÁÔÓ¤ˆÓ. ∆Ô ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ‹Ù·Ó ÂχıÂÚÔ. ∞fi ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË ‰ÂÓ ‰È·ÈÛÙÒıËÎ·Ó ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·. OÈ ÎÂÓÒÛÂȘ ‹Ù·Ó ˘‰·ÚÔ‡˜ Û‡ÛÙ·Û˘, Ì ¿ÊıÔÓË ÔÛfiÙËÙ· ·›Ì·ÙÔ˜. ∞fi ÙÔÓ ·Ú¯ÈÎfi ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô ‰È·ÈÛÙÒıËÎÂ: Hct 38,8%, Hb 13,8 g/dL, ·ÈÌÔÂÙ¿ÏÈ· 309000/mm3, ÏÂ˘Î¿ 4500/mm3, (Ì 38% ÔÏ˘ÌÔÚÊÔ‡ÚËÓ· Ô˘‰ÂÙÂÚfiÊÈÏ·, 33% ÏÂÌÊÔ·ÙÙ·Ú·, 10% ÌÔÓÔ·ÙÙ·Ú· Î·È 19% ˈÛÈÓfiÊÈÏ·), Ë C-·ÓÙȉÚÒÛ· ÚˆÙ½ÓË ‹Ù·Ó 0,4 mg/dL. O ‚ÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÚÔ˘Ù›Ó·˜ Î·È Ô ¤ÏÂÁ¯Ô˜ ËÎÙÈÎfiÙËÙ·˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜. ∞fi ÙÔÓ ·ÎÙÈÓÔÏÔÁÈÎfi Î·È ÙÔÓ ˘ÂÚ˯ÔÁÚ·ÊÈÎfi ¤ÏÂÁ¯Ô Ù˘ ÎÔÈÏÈ¿˜ ‰ÂÓ ‰È·ÈÛÙÒıËÎ·Ó ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·. ∏ Û›ÙÈÛË ÙÔ˘ ÓÂÔÁÓÔ‡ ‰È·ÎfiËÎÂ Î·È ¯ÔÚËÁ‹ıËΠ·ÚÂÓÙÂÚÈ΋ ‰È·ÙÚÔÊ‹. ªÂ ÙËÓ ˘Ô„›· Ïԛ̈͢, ÙÔ ÓÂÔÁÓfi ηχÊıËΠ̠·ÓÙÈ‚ÈÔÙÈ΋ ·ÁˆÁ‹, Ë ÔÔ›· ‰È·ÎfiËΠ·ÊÔ‡ ·fi ÙȘ ηÏÏȤÚÁÂȘ ·›Ì·ÙÔ˜, Ô‡ÚˆÓ, ÎÔÚ¿ÓˆÓ Î·È ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô˘

Paediatriki 2002;65:278-281

˘ÁÚÔ‡ ‰ÂÓ ·ÔÌÔÓÒıËΠÌÈÎÚÔÔÚÁ·ÓÈÛÌfi˜. ∆Ô ÓÂÔÁÓfi Û˘Ó¤¯È˙ ӷ ·ÚÔ˘ÛÈ¿˙ÂÈ ·ÈÌÔÚÚ·ÁÈΤ˜ ÎÂÓÒÛÂȘ Î·È ÙËÓ Ù¤Ù·ÚÙË Ë̤ڷ ˙ˆ‹˜ ‰ÈÂÓÂÚÁ‹ıËΠÎÔÏÔÓÔÛÎfiËÛË. O ‚ÏÂÓÓÔÁfiÓÔ˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘ ‹Ù·Ó ‡ıÚ˘ÙÔ˜, ÔȉËÌ·Ù҉˘, Ì ÚfiÛÊ·Ù· ÛÙÔȯ›· ·ÈÌÔÚÚ·Á›·˜. ∞fi ÙȘ ‚ÈÔ„›Â˜ Ô˘ ÂÏ‹ÊıËÛ·Ó ‰È·ÈÛÙÒıËÎÂ Ë ·ÚÔ˘Û›· ‰ÈËı‹ÛˆÓ, ΢ڛˆ˜ ·fi ˈÛÈÓfiÊÈÏ· Î·È Û¿ÓÈ· ·fi Ô˘‰ÂÙÂÚfiÊÈÏ·. ∆Ô ÓÂÔÁÓfi Û˘Ó¤¯È˙ ӷ ·Ô‚¿ÏÂÈ ÎfiÚ·Ó· Ì ÚÔԉ¢ÙÈο ÌÂÈÔ‡ÌÂÓË ÔÛfiÙËÙ· ·›Ì·ÙÔ˜ ̤¯ÚÈ ÙËÓ ¤ÎÙË Ë̤ڷ Ù˘ ˙ˆ‹˜ ÙÔ˘. ∆ËÓ ›‰È· Ë̤ڷ ¤ÁÈÓ ÚÔÛ¿ıÂÈ· Â·Ó·Û›ÙÈÛ˘ Ì ÂÍ·ÓıÚˆÔÔÈË̤ÓÔ Á¿Ï· ·ÁÂÏ¿‰·˜. §›Á˜ ÒÚ˜ ·ÚÁfiÙÂÚ·, ÙÔ ÓÂÔÁÓfi ·ÚÔ˘Û›·Û ÎÂÓÒÛÂȘ Ì ¿ÊıÔÓË ÔÛfiÙËÙ· ·›Ì·ÙÔ˜ Î·È Ë Û›ÙÈÛË ‰È·ÎfiËÎÂ. ∏ ÔÏÈ΋ IgE ÙËÓ ¤ÎÙË Ë̤ڷ ˙ˆ‹˜ ‹Ù·Ó 60,2 IU/mL, ÂÓÒ Ë ÂȉÈ΋ ÛÙËÓ ÚˆÙ½ÓË ÙÔ˘ Á¿Ï·ÎÙÔ˜ IgE ‹Ù·Ó 3,8 Au/ml, Ù¿ÍË 3. ∏ ·ÏÏÂÚÁ›· ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜ ıˆڋıËΠˆ˜ Ë ϤÔÓ Èı·Ó‹ ‰È¿ÁÓˆÛË. ÃÔÚËÁ‹ıËΠÂÓÙÂÚÈ΋ Û›ÙÈÛË Ì Á¿Ï· ·fi ÂχıÂÚ· ·ÌÈÓÔͤ· ·fi ÙËÓ ¤‚‰ÔÌË Ë̤ڷ ˙ˆ‹˜, Ë ÔÔ›· ¤ÁÈÓ ηϿ ·ÓÂÎÙ‹ ·fi ÙÔ ÓÂÔÁÓfi. OÈ ÎÂÓÒÛÂȘ ÙÔ˘ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈΤ˜ Û ۇÛÙ·ÛË Î·È ÛÂ Û˘¯ÓfiÙËÙ·, ÂÓÒ Ë ÚfiÛÏË„Ë ‚¿ÚÔ˘˜ ‹Ù·Ó ÈηÓÔÔÈËÙÈ΋, ÙfiÛÔ Î·Ù¿ ÙËÓ ¤ÍÔ‰fi ÙÔ˘ ·fi ÙËÓ ÎÏÈÓÈ΋ Ì·˜, fiÛÔ Î·È ÛÙËÓ ËÏÈΛ· ÙˆÓ 3 ÌËÓÒÓ Ô˘ Â·ÓÂÎÙÈÌ‹ıËΠÛÙÔ Â͈ÙÂÚÈÎfi Ì·˜ È·ÙÚ›Ô. ™˘˙‹ÙËÛË O ‚ÏÂÓÓÔÁfiÓÔ˜ ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÂÎÙ›ıÂÙ·È Î·ıËÌÂÚÈÓ¿ Û ÔÏÏ¿ ÙÚÔÊÈο ·ÓÙÈÁfiÓ·, ‰ÂÓ ÂÈÙÚ¤ÂÈ fï˜ ÙËÓ ·ÔÚÚfiÊËÛË ·ÓÔÛÔÏÔÁÈο ·Ó·ÁÓˆÚ›ÛÈÌˆÓ ÌÔÚ›ˆÓ. ∞˘Ùfi ÔÊ›ÏÂÙ·È ÛÙȘ ȉÈfiÙËÙ˜ Ô˘ ÙÔ˘ ÂÈÙÚ¤Ô˘Ó Ó· ÏÂÈÙÔ˘ÚÁ› ˆ˜ “ÊÚ·ÁÌfi˜”. ∫·Ù¿ ÙË ÓÂÔÁÓÈ΋ ÂÚ›Ô‰Ô, ÂÍ·ÈÙ›·˜ Ù˘ ·ÓˆÚÈÌfiÙËÙ·˜, ·ÓÔÛÔÏÔÁÈο ·Ó·ÁÓˆÚ›ÛÈÌ· ÌfiÚÈ· ÌÔÚ› ‰˘ÓËÙÈο Ó· ·ÔÚÚÔÊËıÔ‡Ó, Ó· ÂÚ¿ÛÔ˘Ó ÛÙËÓ Î˘ÎÏÔÊÔÚ›· Î·È Ó· ÚÔηϤÛÔ˘Ó ·ÓÔÛÔÏÔÁÈ΋ ·ÓÙ›‰Ú·ÛË (1). ™ÙÔ ÓÂÔÁÓfi Ô˘ ÂÚÈÁÚ¿ÊÔ˘ÌÂ Ë Û˘Ìو̷ÙÔÏÔÁ›· ÂÌÊ·Ó›ÛÙËΠÔχ ÓˆÚ›˜, Ï›Á˜ ÌfiÓÔ ÒÚ˜ ÌÂÙ¿ ÙÔ ÚÒÙÔ Á‡̷ Ì ÂÍ·ÓıÚˆÔÔÈË̤ÓÔ Á¿Ï· ·ÁÂÏ¿‰·˜, ÁÂÁÔÓfi˜ Ô˘ Ì·˜ οÓÂÈ Ó· ÈÛÙ‡ԢÌ fiÙÈ Ë Â˘·ÈÛıËÙÔÔ›ËÛË ¤ÁÈÓ ÛÙËÓ ÂÓ‰ÔÌ‹ÙÚÈ· ˙ˆ‹. ∂Ó‰ÔÌ‹ÙÚÈ· ¢·ÈÛıËÙÔÔ›ËÛË ¤¯ÂÈ ·Ó·ÊÂÚı› ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· ›Ù ÌÂÙ¿ ·fi ‰È·Ï·ÎÔ˘ÓÙȷ΋ ÌÂÙ·ÊÔÚ¿ ·ÓÙÈÁfiÓˆÓ, ›Ù ÌÂÙ¿ ·fi ·ÚÔ˘Û›· ·ÓÙÈÁÔÓÈÎÒÓ ÛÙÔȯ›ˆÓ ÛÙÔ ·ÌÓÈ·Îfi ˘ÁÚfi (6,7,9). O ·ÎÚÈ‚‹˜, fï˜, Ì˯·ÓÈÛÌfi˜ ‰ÂÓ Â›Ó·È ÁÓˆÛÙfi˜. ∏ Â͈̋ÙÚÈ· Â·Ê‹ Ì ÙȘ ÚˆÙ½Ó˜ ÙÔ˘ ·ÁÂÏ·‰ÈÓÔ‡ Á¿Ï·ÎÙÔ˜ Â¿ÁÂÈ ÙËÓ ÎÏÈÓÈ΋ ¤ÎÊÚ·ÛË Ù˘ ·ÏÏÂÚÁ›·˜ Û ¤Ó· ¢·ÈÛıËÙÔÔÈË̤ÓÔ ¿ÙÔÌÔ. °ÂÓÈο, Ë ·ÈÌÔÚÚ·Á›· ·fi ÙÔ Î·ÙÒÙÂÚÔ Á·ÛÙÚÂÓÙÂÚÈÎfi Û‡ÛÙËÌ· ıˆÚÂ›Ù·È fiÙÈ

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¶·È‰È·ÙÚÈ΋ 2002;65:278-281

Û¯ÂÙ›˙ÂÙ·È Ì ·ÓÔÛÔÏÔÁÈ΋ ·ÓÙ›‰Ú·ÛË ¯ˆÚ›˜ ÙË ÌÂÛÔÏ¿‚ËÛË IgE (3). OÈ ·˘ÍË̤Ó˜, fï˜, ÙÈ̤˜ Ù˘ IgE, ÙfiÛÔ Ù˘ ÔÏÈ΋˜ fiÛÔ Î·È Ù˘ ÂȉÈ΋˜, ÛÙȘ ÚˆÙ½Ó˜ ÙÔ˘ Á¿Ï·ÎÙÔ˜ ·ÁÂÏ¿‰·˜ Ô˘ ‰È·ÈÛÙÒıËÎ·Ó ÛÙÔ ÓÂÔÁÓfi Ì·˜, Ì·˜ οÓÂÈ Ó· ÈÛÙ‡ԢÌ fiÙÈ ·ÓÔÛÔÏÔÁÈÎfi˜ Ì˯·ÓÈÛÌfi˜ Ì ÙË ÌÂÛÔÏ¿‚ËÛË IgE ¢ı‡ÓÂÙ·È ÙÔ˘Ï¿¯ÈÛÙÔÓ Û οÔÈÔ ‚·ıÌfi ÁÈ· ÙËÓ ÚfiÎÏËÛË Ù˘ ÈÛÙÈ΋˜ ‚Ï¿‚˘. ∆Ô 50-70% ÙˆÓ ‚ÚÂÊÒÓ Ì ·ÏÏÂÚÁ›· ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜ ÂÌÊ·Ó›˙ÂÈ Û˘ÌÙÒÌ·Ù· ·fi ÙÔ ‰¤ÚÌ·, ÙÔ 50-60% ÂÌÊ·Ó›˙ÂÈ Û˘ÌÙÒÌ·Ù· ·fi ÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi Û‡ÛÙËÌ·, ÂÓÒ 20-30% ÂÌÊ·Ó›˙ÂÈ Û˘ÌÙÒÌ·Ù· ·fi ÙÔ ·Ó·Ó¢ÛÙÈÎfi Û‡ÛÙËÌ·. ¶ÂÚÈÛÛfiÙÂÚÔ ·fi ÙÔ 70% ÙˆÓ ‚ÚÂÊÒÓ ÂÌÊ·Ó›˙ÂÈ ÔÏÏ·Ï‹ ÎÏÈÓÈ΋ Û˘Ìو̷ÙÔÏÔÁ›· ·fi ‰‡Ô ÙÔ˘Ï¿¯ÈÛÙÔÓ ‰È·ÊÔÚÂÙÈο ÔÚÁ·ÓÈο Û˘ÛÙ‹Ì·Ù· (3,4). ∏ ·ÚÔ˘Û›· ·›Ì·ÙÔ˜ ÛÙ· ÎfiÚ·Ó· ‰ÂÓ Â›Ó·È ·Û‡ÓËı˜ ÁÂÁÔÓfi˜ ÛÙ· ¿ÚÚˆÛÙ· ÚfiˆÚ· ÓÂÔÁÓ¿ Ì ¯·ÌËÏfi ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ Ô˘ ÓÔÛËχÔÓÙ·È ÛÙȘ ªÔÓ¿‰Â˜ ∂ÓÙ·ÙÈ΋˜ ¡ÔÛËÏ›·˜ ¡ÂÔÁÓÒÓ, Û ·ÓÙ›ıÂÛË Ì ٷ ÙÂÏÂÈfiÌËÓ· ˘ÁÈ‹ ÓÂÔÁÓ¿. ∆Ô ÓÂÔÁÓfi Ô˘ ÂÚÈÁÚ¿ÊÔ˘ÌÂ Â›Ó·È ¤Ó· ˘ÁȤ˜ ÙÂÏÂÈfiÌËÓÔ ÓÂÔÁÓfi Ô˘ ÙËÓ 20‹ ÒÚ· Ù˘ ˙ˆ‹˜ ÙÔ˘ ·ÚÔ˘Û›·Û ·ÈÌÔÚÚ·ÁÈΤ˜ ÎÂÓÒÛÂȘ, ¯ˆÚ›˜ ηӤӷ ¿ÏÏÔ Û‡Ìو̷, ÂÓÒ ‚ÚÈÛÎfiÙ·Ó Û Ôχ ηϋ ÁÂÓÈ΋ ηٿÛÙ·ÛË. ŸÛÔÓ ·ÊÔÚ¿ ÛÙË ‰È·ÊÔÚԉȷÁÓˆÛÙÈ΋ Ì·˜ ÚÔÛ¤ÁÁÈÛË: Ë Î·Ù¿ÔÛË ·›Ì·ÙÔ˜ Ù˘ ÌËÙ¤Ú·˜ ηٿ ÙÔÓ ÙÔÎÂÙfi ‹ ηٿ ÙË ‰È¿ÚÎÂÈ· ıËÏ·ÛÌÔ‡ Û ÂÚ›ÙˆÛË ‡·Ú͢ Ú·Á¿‰ˆÓ ÛÙȘ ıËϤ˜ ÙˆÓ Ì·ÛÙÒÓ Ù˘, Ë ·ÚÔ˘Û›· Ú·Á¿‰·˜ ÙÔ˘ ‰·ÎÙ˘Ï›Ô˘ ‹ Ô ÙÚ·˘Ì·ÙÈÛÌfi˜ ÙÔ˘ ÔÚıÔ‡ ·fi ÙËÓ Î·Î‹ Î·È ‚›·ÈË ÙÔÔı¤ÙËÛË ıÂÚÌÔ̤ÙÚÔ˘ ·ÔÎÏ›ÛÙËÎ·Ó ¿ÌÂÛ· ÙfiÛÔ ·fi ÙË ¯ÚÔÈ¿ ÙÔ˘ ·›Ì·ÙÔ˜, fiÛÔ Î·È ·fi ÙËÓ ÎÏÈÓÈ΋ ÂͤٷÛË Î·È ÙȘ ÏËÚÔÊÔڛ˜ Ô˘ ‹Ú·Ì ·fi ÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘. ¢È·Ù·Ú·¯¤˜ ËÎÙÈÎfiÙËÙ·˜ ·ÔÎÏ›ÛÙËÎ·Ó ·fi ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô. ÕÏϘ ηٷÛÙ¿ÛÂȘ Ô˘ Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì ·ÈÌÔÚÚ·ÁÈΤ˜ ÎÂÓÒÛÂȘ, fiˆ˜ Û˘ÛÙÚÔÊ‹ ÂÓÙ¤ÚÔ˘, ÂÓÙÂÚÈ΋ ·fiÊÚ·ÍË, Ôχԉ˜, ÓÂÎÚˆÙÈ΋ ÂÓÙÂÚÔÎÔÏ›Ùȉ·, ÓfiÛÔ˜ Hirschprung’s, ÂÁÎÔÏ·ÛÌfi˜ ‹ ·ÈÌÔÚÚ·Á›· ·fi ÙÔ ·ÓÒÙÂÚÔ Á·ÛÙÚÂÓÙÂÚÈÎfi Û‡ÛÙËÌ· ‰ÂÓ ıˆڋıËÎ·Ó Ôχ Èı·Ó¤˜ Û·Ó ·Èٛ˜, Ï·Ì‚¿ÓÔÓÙ·˜ ˘’ fi„ÈÓ Ù· Â˘Ú‹Ì·Ù· ·fi ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË, Ù· ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· Î·È Ù· Â˘Ú‹Ì·Ù· ·fi ÙËÓ ÎÔÏÔÓÔÛÎfiËÛË Û ¤Ó· ÙÂÏÂÈfiÌËÓÔ ÓÂÔÁÓfi Û Ôχ ηϋ ÁÂÓÈ΋ ηٿÛÙ·ÛË (10,11). ªÂ ‚¿ÛË Ù· ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù·, Ù· Â˘Ú‹Ì·Ù· ·fi ÙËÓ ÎÔÏÔÓÔÛÎfiËÛË, Ù· ÈÛÙÔ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù· ·fi ÙË ‚ÈÔ„›· ÙÔ˘ ÔÚıÔÛÈÁÌÔÂȉԇ˜ Î·È ÙËÓ Â·ÓÂÌÊ¿ÓÈÛË ÙˆÓ ·ÈÌÔÚÚ·ÁÈÎÒÓ ÎÂÓÒÛÂˆÓ ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙËÓ Â·Ó·Û›ÙÈÛË Ì ÂÍ·ÓıÚˆÔÔÈË̤ÓÔ Á¿Ï· ·ÁÂÏ¿‰·˜ Û ¤Ó· ηٿ Ù· ¿ÏÏ· ˘ÁȤ˜ ÙÂÏÂÈfiÌËÓÔ ÓÂÔÁÓfi, Ë ·Ï-

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ÏÂÚÁ›· ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜ Ì‹Î ϤÔÓ ÈÛ¯˘Ú¿ ÛÙË ‰È·ÊÔÚԉȷÁÓˆÛÙÈ΋ Ì·˜ ÛΤ„Ë. ªÂ ‚¿ÛË Ù· ÎÚÈÙ‹ÚÈ· Ô˘ ÚfiÙÂÈÓ·Ó ÔÈ Savilathi, Bahna Î·È Gandhi, Ù· ÔÔ›· ÚÔÛ·ÚÌfiÛÙËÎ·Ó ·fi ÙËÓ ∂˘Úˆ·˚΋ ∂Ù·ÈÚ›· ¶·È‰È·ÙÚÈ΋˜ °·ÛÙÚÂÓÙÂÚÔÏÔÁ›·˜ Î·È ÙËÓ ∂˘Úˆ·˚΋ ∞η‰ËÌ›· ∞ÏÏÂÚÁ›·˜ Î·È ∫ÏÈÓÈ΋˜ ∞ÓÔÛÔÏÔÁ›·˜, Ô˘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ˘Ô¯ÒÚËÛË Ù˘ Û˘Ìو̷ÙÔÏÔÁ›·˜ ÌÂÙ¿ ·fi ·ÔÌ¿ÎÚ˘ÓÛË ÙÔ˘ Á¿Ï·ÎÙÔ˜ ·ÁÂÏ¿‰·˜ ·fi ÙË ‰È·ÙÚÔÊ‹ ÙÔ˘ ‚Ú¤ÊÔ˘˜, Â·ÓÂÌÊ¿ÓÈÛË Ù˘ Û˘Ìو̷ÙÔÏÔÁ›·˜ ÌÂÙ¿ ÙËÓ ÚÔÛı‹ÎË ÙÔ˘ Á¿Ï·ÎÙÔ˜ ·ÁÂÏ¿‰·˜ ÛÙÔ ‰È·ÈÙÔÏfiÁÈÔ ÙÔ˘ ‚Ú¤ÊÔ˘˜, ˘Ô¯ÒÚËÛË Ù˘ Û˘Ìو̷ÙÔÏÔÁ›·˜ ÌÂÙ¿ ·fi ÂÎ Ó¤Ô˘ ·ÔÌ¿ÎÚ˘ÓÛË ÙÔ˘ Á¿Ï·ÎÙÔ˜ ·ÁÂÏ¿‰·˜ ·fi ÙË ‰È·ÙÚÔÊ‹, ·ÔÎÏÂÈÛÌfi Ù˘ ‰˘Û·ÓÂÍ›·˜ ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜ Î·È ÙˆÓ ÏÔÈÌÒÍÂˆÓ (12), Ë ·ÏÏÂÚÁ›· ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜ ıˆڋıËΠˆ˜ Ë ϤÔÓ Èı·Ó‹ ‰È¿ÁÓˆÛË. £ÂÚ·¢ÙÈο Û˘ÓÈÛÙ¿Ù·È Ë Ï‹Ú˘ ·ÔÊ˘Á‹ ÙÔ˘ Á¿Ï·ÎÙÔ˜ ·ÁÂÏ¿‰·˜ Î·È ÙˆÓ ÚÔ˚fiÓÙˆÓ ÙÔ˘ ·fi ÙË ‰È·ÙÚÔÊ‹ ·˘ÙÒÓ ÙˆÓ ‚ÚÂÊÒÓ. ∆Ô ÌËÙÚÈÎfi Á¿Ï· ·ÔÙÂÏ› ·Ó·ÌÊÈÛ‚‹ÙËÙ· ÙËÓ È‰·ÓÈÎfiÙÂÚË ÙÚÔÊ‹ ÁÈ· ÙË Û›ÙÈÛË ÙˆÓ ‚ÚÂÊÒÓ ·˘ÙÒÓ. ™ÙȘ Û¿ÓȘ ÂÚÈÙÒÛÂȘ ‚ÚÂÊÒÓ Ô˘ ·ÚÔ˘Û›·Û·Ó ·ÏÏÂÚÁ›· ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜ ÂÓÒ ‰È·ÙÚ¤ÊÔÓÙ·Ó ·ÔÎÏÂÈÛÙÈο Ì ÌËÙÚÈÎfi ıËÏ·ÛÌfi, ÚÔÙ›ÓÂÙ·È Ë ·ÔÊ˘Á‹ ÙÔ˘ Á¿Ï·ÎÙÔ˜ ·ÁÂÏ¿‰·˜ Î·È ÙˆÓ ÚÔ˚fiÓÙˆÓ ÙÔ˘ ·fi ÙË ‰›·ÈÙ· Ù˘ ÌËÙ¤Ú·˜. À¿Ú¯Ô˘Ó ÛÙÔ ÂÌfiÚÈÔ ‰È¿ÊÔÚ· Á¿Ï·Ù· Ô˘ ‰È·Ê¤ÚÔ˘Ó ˆ˜ ÚÔ˜ ÙÔ Â›‰Ô˜ Ù˘ ÚˆÙ½Ó˘ Î·È ÙÔ ‚·ıÌfi ˘‰ÚfiÏ˘Û˘. ªÂÚÈο ‚Ú¤ÊË Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÌËÓ ·Ó¯ÙÔ‡Ó Á¿Ï·Ù· Ì ˘‰ÚÔÏ˘Ì¤ÓË ÏÂ˘ÎˆÌ·Ù›ÓË ‹ ˘‰ÚÔÏ˘Ì¤ÓË Î·˙½ÓË, ÔfiÙÂ Î·È Û˘ÓÈÛÙ¿Ù·È Ë ¯ÔÚ‹ÁËÛË Á¿Ï·ÎÙÔ˜ Ì ÂχıÂÚ· ·ÌÈÓÔͤ· (13). ™ÙÔ ÓÂÔÁÓfi Ì·˜, Ï·Ì‚¿ÓÔÓÙ·˜ ˘’ fi„ÈÓ ÙË ÌÂÁ¿ÏË ÔÛfiÙËÙ· ·›Ì·ÙÔ˜ Ô˘ ˘‹Ú¯Â ÛÙ· ÎfiÚ·Ó·, ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ë ·ÚÔ˘Û›· ÙÔ˘ ·›Ì·ÙÔ˜ ·ÊÂÓfi˜ ÌÂÓ Â¤ÌÂÓÂ Î·È ·ÊÂÙ¤ÚÔ˘ Â·ÓÂÌÊ·Ó›ÛÙËΠ۠ÛËÌ·ÓÙÈ΋ ÔÛfiÙËÙ· ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙËÓ Â·Ó·¯ÔÚ‹ÁËÛË ÙÔ˘ ÂÍ·ÓıÚˆÔÔÈË̤ÓÔ˘ Á¿Ï·ÎÙÔ˜ Î·È ÙÔ fiÙÈ Ë Û˘Ìو̷ÙÔÏÔÁ›· ÂÌÊ·Ó›ÛÙËΠÔχ ÓˆÚ›˜, ·fi ÙËÓ ÚÒÙË Ë̤ڷ Ù˘ ˙ˆ‹˜, ·ÔÊ·Û›Û·Ì ӷ ¯ÔÚËÁ‹ÛÔ˘Ì Á¿Ï· Ì ·ÌÈÓÔͤ·. ∏ ÎÏÈÓÈ΋ ÔÚ›· Ù˘ ·ÏÏÂÚÁ›·˜ ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜ ÔÈΛÏÏÂÈ. ™Â ÌÂÚÈο ·È‰È¿ Â›Ó·È ·ÚÔ‰È΋ Î·È ˘Ô¯ˆÚ› ¯ˆÚ›˜ Ó· ‰ËÌÈÔ˘ÚÁ› ȉȷ›ÙÂÚ· ÚÔ‚Ï‹Ì·Ù·, ÂÓÒ Û οÔÈ· ¿ÏÏ· ÌÔÚ› Ó· Â›Ó·È ÛÔ‚·ÚfiÙÂÚË ‹ Ó· ·ÂÈÏ› ·ÎfiÌ· Î·È ÙË ˙ˆ‹ ÙÔ˘˜. ∏ ‡·ÚÍË ÁÂÓÂÙÈ΋˜ ÚԉȿıÂÛ˘ Â›Ó·È Î·ıÔÚÈÛÙÈ΋˜ ÛËÌ·Û›·˜ ÁÈ· ÙËÓ ÂÈÌÔÓ‹ ‹ fi¯È Ù˘ Û˘Ìو̷ÙÔÏÔÁ›·˜. ™ÙÔ 45-55% ÙˆÓ ‚ÚÂÊÒÓ Ë Û˘Ìو̷ÙÔÏÔÁ›· ¤¯ÂÈ ˘Ô¯ˆÚ‹ÛÂÈ ÙÔÓ ÚÒÙÔ ¯ÚfiÓÔ Ù˘ ˙ˆ‹˜, ÛÙÔ 60-75% ÙÔÓ ‰Â‡ÙÂÚÔ, ÛÙÔ 85-90% ÙÔÓ

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ÙÚ›ÙÔ Î·È ÛÙÔ 92% ÙÔÓ ¤ÌÙÔ Ì ‰¤Î·ÙÔ ¯ÚfiÓÔ Ù˘ ˙ˆ‹˜ (3,4). ¶ÂÚÈÁÚ¿ÊÔ˘Ì ÙËÓ ÂÚ›ÙˆÛË ˘ÁÈÔ‡˜ ÙÂÏÂÈfiÌËÓÔ˘ ÓÂÔÁÓÔ‡ Ì ·ÏÏÂÚÁ›· ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜ Ô˘ ·ÚÔ˘Û›·Û ·ÈÌÔÚÚ·ÁÈΤ˜ ÎÂÓÒÛÂȘ ·fi ÙËÓ ÚÒÙË Ë̤ڷ Ù˘ ˙ˆ‹˜ ÙÔ˘. ∏ ·ÏÏÂÚÁ›· ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜ Â›Ó·È ÂÍ·ÈÚÂÙÈο Û¿ÓÈ· Û ·˘Ù‹ ÙËÓ ËÏÈΛ·. ∏ ·‡ÍËÛË Ù˘ ÔÏÈ΋˜ IgE Î·È Ù˘ ÂȉÈ΋˜ ÛÙËÓ ÚˆÙ½ÓË ÙÔ˘ Á¿Ï·ÎÙÔ˜ IgE Ì¿˜ οÓÔ˘Ó Ó· ÈÛÙ‡ԢÌ fiÙÈ ·ÓÔÛÔÏÔÁÈ΋ ·ÓÙ›‰Ú·ÛË Ô˘ ÚÔηÏÂ›Ù·È Ì ÙË ÌÂÛÔÏ¿‚ËÛË IgE ÌÔÚ›, ÙÔ˘Ï¿¯ÈÛÙÔÓ ÂÓ Ì¤ÚÂÈ, Ó· Û˘ÌÌÂÙ¤¯ÂÈ ÛÙÔÓ ·ÓÔÛÔÏÔÁÈÎfi Ì˯·ÓÈÛÌfi ÚfiÎÏËÛ˘ Ù˘ ÈÛÙÈ΋˜ ‚Ï¿‚˘. ∏ ÂÌÊ¿ÓÈÛË Ù˘ Û˘Ìو̷ÙÔÏÔÁ›·˜ ·fi ÙËÓ ÚÒÙË ÎÈfiÏ·˜ Ë̤ڷ Ù˘ ˙ˆ‹˜ ÛÙÔ ÓÂÔÁÓfi Ì·˜ ı¤ÙÂÈ ÈÛ¯˘Ú¿ ÙËÓ Èı·ÓfiÙËÙ· Ù˘ ÂÓ‰ÔÌ‹ÙÚÈ·˜ ¢·ÈÛıËÙÔÔ›ËÛ˘. ™˘ÌÂÚ·ÛÌ·ÙÈο, Ë ·ÏÏÂÚÁ›· ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜ ÂÌÊ·Ó›˙ÂÙ·È Û¿ÓÈ· ÛÙË ÓÂÔÁÓÈ΋ ÂÚ›Ô‰Ô. ∏ ·ÚÔ˘Û›· ·›Ì·ÙÔ˜ ÛÙ· ÎfiÚ·Ó· Û ¤Ó· ηٿ Ù· ¿ÏÏ· ˘ÁȤ˜ ÙÂÏÂÈfiÌËÓÔ ÓÂÔÁÓfi ·ÎfiÌ· Î·È ÙËÓ ÚÒÙË Ë̤ڷ Ù˘ ˙ˆ‹˜ ÌÔÚ› Ó· ÔÊ›ÏÂÙ·È Û ·ÏÏÂÚÁ›· ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜. ∏ ¢·ÈÛıËÙÔÔ›ËÛË ÙÔ˘ ÎÏÈÓÈÎÔ‡ ıˆÚÂ›Ù·È Ì›˙ÔÓÔ˜ ÛËÌ·Û›·˜ ÁÈ· ÙË Î·Ù¿ ÙÔ ‰˘Ó·ÙfiÓ Û˘ÓÙÔÌfiÙÂÚË ‰È·ÁÓˆÛÙÈ΋ ÚÔÛ¤ÁÁÈÛË Î·È ·ÔÊ˘Á‹ ¿ÛÎÔˆÓ Î·È Â›ÔÓˆÓ ÁÈ· ÙÔ ÓÂÔÁÓfi ‰È·ÁÓˆÛÙÈÎÒÓ ·ÚÂÌ‚¿ÛˆÓ. µÈ‚ÏÈÔÁÚ·Ê›· 1. Sampson HA. Food allergy. Part 1: immunopathogenesis and clinical disorders. J Allergy Clin Immunol 1999;103:717-728.

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Hypoallergenic infant formulas. Pediatrics 2000;106(2 Pt 1):346-349.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 22-01-2002 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 28-05-2002 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ÃÚÈÛÙ›Ó· °È·ÓÓ·ÎÔÔ‡ÏÔ˘ ∞ÙÏ·ÓÙ›‰Ô˜ 37, ∆.∫. 713 05, ∏Ú¿ÎÏÂÈÔ ∫Ú‹Ù˘

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∂¡¢π∞º∂ƒOÀ™∞ ¶∂ƒπ¶∆ø™∏

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CASE REPORT

∞ÏËı‹˜ Û˘ÓÔÛÙˆÙÈ΋ Ô›ÛıÈ· Ï·ÁÈÔÎÂÊ·Ï›· Û ‚Ú¤ÊÔ˜ ∞. ∞Ó‰Ú¤Ô˘1, °. µ·ÛÈÏ›Ԣ1, µ. ¶··‚·ÛÈÏ›Ԣ1, ∞. ∞Ó·ÛÙ·Û›Ô˘2, ∞. ™ÙÚ·ÙÔ˘‰¿Î˘3

A case of true synostotic posterior plagiocephaly A. Andreou1, G. Vasileiou1, V. Papavasileiou1, A. Anastasiou2, A. Stratoudakis3

¶ÂÚ›ÏË„Ë: ¶ÂÚÈÁÚ¿ÊÂÙ·È ‚Ú¤ÊÔ˜ Ì ‰ÂÍÈ¿ ·ÏËı‹ Û˘ÓÔÛÙˆÙÈ΋ Ô›ÛıÈ· Ï·ÁÈÔÎÂÊ·Ï›·. ∏ ‰È¿ÁÓˆÛË Ù¤ıËΠ̠‚¿ÛË ÎÏÈÓÈο ÎÚÈÙ‹ÚÈ·, fiˆ˜ ·˘Ù¿ ÂÚÈÁÚ¿ÊËÎ·Ó ÚfiÛÊ·Ù· Î·È ÂȂ‚·ÈÒıËΠ̠ÙÚÈۉȿÛÙ·ÙË ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÎÚ·Ó›Ô˘. ™˘˙ËÙÔ‡ÓÙ·È Ù· ÓÂfiÙÂÚ· ‰Â‰Ô̤ӷ ÁÈ· ÙËÓ ·‡ÍËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ Ù˘ Ô›ÛıÈ·˜ Ï·ÁÈÔÎÂÊ·Ï›·˜ (O¶), Ù· ·›ÙÈ¿ Ù˘, ÙË ‰È¿ÁÓˆÛ‹ Ù˘, ÙË ‰È·ÊÔÚԉȿÁÓˆÛË ÌÂٷ͇ ·ÏËıÔ‡˜ Û˘ÓÔÛÙˆÙÈ΋˜ O¶ Î·È ·Ú·ÌÔÚʈÙÈ΋˜ O¶ Î·È ÙËÓ ·ÓÙÈÌÂÙÒÈÛË.

Abstract: A case of true synostotic posterior plagiocephaly on the right side is reported. The diagnosis was based on clinical criteria, as they were described recently, and confirmed by 3-D axial tomography of the skull. The new data concerning the increased incidence of posterior plagiocephaly is discussed, as well as the causes, diagnosis, differential diagnosis and management.

§¤ÍÂȘ ÎÏÂȉȿ: ·ÏËı‹˜ Û˘ÓÔÛÙˆÙÈ΋ Ô›ÛıÈ· Ï·ÁÈÔÎÂÊ·Ï›·, Ô›ÛıÈ· Ï·ÁÈÔÎÂÊ·Ï›·, ·Ú·ÌÔÚʈÙÈ΋ Ï·ÁÈÔÎÂÊ·Ï›·.

Key words: true synostotic posterior plagiocephaly, posterior plagiocephaly, deformational plagiocephaly.

™˘ÓÙÔÌÔÁڷʛ˜

∂ÈÛ·ÁˆÁ‹ ¶Ï·ÁÈÔÎÂÊ·Ï›· Â›Ó·È ¤Ó·˜ fiÚÔ˜ Ô˘ ‰ËÏÒÓÂÈ ÂÙÂÚfiÏ¢ÚË (·Û‡ÌÌÂÙÚË) ÂÈ¤‰ˆÛË ÙÔ˘ ÎÚ·Ó›Ô˘. ™ÙËÓ O¶, Ë ÂÈ¤‰ˆÛË ·ÊÔÚ¿ ÙÔ ÈÓÈ·Îfi ÔÛÙfi. ∆· ÈÔ Û˘¯Ó¿, ÌË Û˘Ó‰ÚÔÌÈο, ·›ÙÈ· O¶ ÔÊ›ÏÔÓÙ·È Û ·Ú·ÌfiÚʈÛË ÙÔ˘ ÎÂÊ·ÏÈÔ‡ ·fi ‰˘Ó¿ÌÂȘ Ô˘ ÂȉÚÔ‡Ó ÙfiÛÔ ÂÓ‰ÔÌ‹ÙÚÈ· (‰È‰˘Ì›·, ÚÔˆÚfiÙËÙ·, Ú·È‚fiÎÚ·ÓÔ, ηı‹ÏˆÛË ÙÔ˘ Ï·ÈÌÔ‡), fiÛÔ Î·È Â͈̋ÙÚÈ·, ·fi ÙË Û˘Ó¯‹ ‡ÙÈ· ı¤ÛË ÙÔ˘ ÎÂÊ·ÏÈÔ‡. ™ÙȘ ÂÚÈÙÒÛÂȘ ·˘Ù¤˜, Ë Ú·Ê‹ Â›Ó·È ¿ÓÙÔÙ ·ÓÔÈÎÙ‹. §ÈÁfiÙÂÚÔ Û˘¯Ó¿, Ë O¶ ÔÊ›ÏÂÙ·È Û ÂÙÂÚfiÏ¢ÚË ·ÏËı‹ Û˘ÓÔÛÙ¤ˆÛË

Ù˘ Ï·Ì‚‰ÔÂȉԇ˜ Ú·Ê‹˜ (∞™§ƒ) Ì ·Ó·ÙÔÌÈ΋ Û‡ÁÎÏÂÈÛ‹ Ù˘. ∞fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ Ô›ÛıÈˆÓ Ï·ÁÈÔÎÂÊ·ÏÈÒÓ, Ë ·Ú·ÌÔÚʈÙÈ΋ Ô›ÛıÈ· Ï·ÁÈÔÎÂÊ·Ï›· (¶O¶) ·ÔÙÂÏ› ÙÔ 97%-99% ÙˆÓ ÂÚÈÙÒÛÂˆÓ Î·È Ë ·ÏËı‹˜ Û˘ÓÔÛÙˆÙÈ΋ Ô›ÛıÈ· Ï·ÁÈÔÎÂÊ·Ï›· (∞™O¶) ÙÔ ˘fiÏÔÈÔ 1%-3% (1,2). ∏ ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ÌÂٷ͇ ∞™O¶ Î·È ¶O¶ Â›Ó·È ÎÚ›ÛÈÌ˘ ÛËÌ·Û›·˜, ÁÈ·Ù› Ë ıÂÚ·›· Ù˘ ∞™O¶ Â›Ó·È Û¯Â‰fiÓ ¿ÓÙÔÙ ¯ÂÈÚÔ˘ÚÁÈ΋, ÂÓÒ Ë ıÂÚ·›· Ù˘ ¶O¶ Â›Ó·È Î·Ù¿ ηÓfiÓ· Û˘ÓÙËÚËÙÈ΋ (1-3). ∏ Û¯¤ÛË ÌÂٷ͇ ¶O¶ Î·È ∞™O¶ ¤ÁÈÓ ÂÎ Ó¤Ô˘ ·ÓÙÈΛÌÂÓÔ ÂӉȷʤÚÔÓÙÔ˜ ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›· Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, ÂÍ·ÈÙ›·˜ Ù˘ ·‡ÍËÛ˘ ÙÔ˘ ·ÚÈıÌÔ‡ ·Ú·ÔÌÒÓ ÂÚÈÙÒÛÂˆÓ O¶ (1,2,4-6), Ô˘ ·Ô‰fiıËΠÛÙË Û‡ÛÙ·ÛË Ù˘ ∞ÌÂÚÈηÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ ∂Ù·ÈÚ›·˜, ÙÔ 1992, Ó· ÎÔÈÌÔ‡ÓÙ·È Ù· ‚Ú¤ÊË ‡ÙÈ·, ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂÏ·ÙÙˆı› Ô Î›Ó‰˘ÓÔ˜ ÙÔ˘ ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ (7). ¶ÚÈÓ Ï›Á· ¯ÚfiÓÈ·, ÔÏϤ˜ ÂÚÈÙÒÛÂȘ ¶O¶

1 ¡ÂÔÁÓÔÏÔÁÈÎfi ∆Ì‹Ì· ∂™À πÔÎÚ¿ÙÂÈÔ˘ °¶¡ £ÂÛÛ·ÏÔӛ΢ 2 ∞ÎÙÈÓÔÏÔÁÈÎfi ∆Ì‹Ì· πÔÎÚ¿ÙÂÈÔ˘ °¶¡ £ÂÛÛ·ÏÔӛ΢ 3 ¶Ï·ÛÙÈÎfi˜ ÃÂÈÚÔ˘ÚÁfi˜, π‰ÈˆÙÈÎfi˜ È·ÙÚfi˜

1 Neonatal Department, NHS Ippokratio Hospital of Thessaloniki 2 Radiology Department, Ippokratio Hospital of Thessaloniki 3 Plastic Surgeon, private practice

O¶ ∞™§ƒ ¶O¶ ∞™O¶ ∞∆∫

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O›ÛıÈ· Ï·ÁÈÔÎÂÊ·Ï›· ∞ÏËı‹˜ Û˘ÓÔÛÙ¤ˆÛË Ù˘ Ï·Ì‚‰ÔÂȉԇ˜ Ú·Ê‹˜ ¶·Ú·ÌÔÚʈÙÈ΋ Ô›ÛıÈ· Ï·ÁÈÔÎÂÊ·Ï›· ∞ÏËı‹˜ Û˘ÓÔÛÙˆÙÈ΋ Ô›ÛıÈ· Ï·ÁÈÔÎÂÊ·Ï›· ∞ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÎÚ·Ó›Ô˘

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ÂÎÏ·Ì‚¿ÓÔÓÙ·Ó Û·Ó ∞™O¶, ÂÓÒ ·Ô‰ÂÈÎÓ˘fiÙ·Ó Î·Ù¿ ÙËÓ ÂÁ¯Â›ÚËÛË Î·È ÙËÓ ÈÛÙÔÏÔÁÈ΋ ÂͤٷÛË fiÙÈ Ë Ú·Ê‹ ‰ÂÓ ‹Ù·Ó ·Ó·ÙÔÌÈο Û˘ÁÎÂÎÏÂÈṲ̂ÓË. ∆Ô 1996, Ô Huang ÂÚȤÁÚ·„ Ì ÏÂÙÔ̤ÚÂȘ Ù· ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο Ù˘ ÎÚ·Óȷ΋˜ ·Ú·ÌfiÚʈÛ˘, Ô˘ ÚÔ¤Ú¯ÂÙ·È ÙfiÛÔ ·fi ÙËÓ ∞™O¶ fiÛÔ Î·È ·fi ÙËÓ ¶O¶ Î·È Û˘Ì¤Ú·Ó fiÙÈ Ì ‚¿ÛË ·˘Ù¿ ÌÔÚ› Ó· Á›ÓÂÈ ‰È·ÊÔÚԉȿÁÓˆÛË ÌÂٷ͇ ÙˆÓ ‰‡Ô ·ı‹ÛÂˆÓ (2). ¶ÂÚÈÁÚ¿ÊÔ˘Ì ¤Ó· ÂÚÈÛÙ·ÙÈÎfi ∞™O¶ ÁÈ· ÙË Û·ÓÈfiÙËÙ¿ ÙÔ˘ Î·È ÁÈ· Ó· ·Ó·Ê¤ÚÔ˘Ì ÙȘ Ӥ˜ ÂÍÂÏ›ÍÂȘ ÛÙÔ Úfi‚ÏËÌ· Ù˘ O¶. ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ∫ÔÚ›ÙÛÈ ËÏÈΛ·˜ 6 ÌËÓÒÓ ÚÔÛÎÔÌ›ÛÙËΠÛÙ· Â͈ÙÂÚÈο È·ÙÚ›· ÙÔ˘ ÙÌ‹Ì·ÙÔ˜ ÁÈ· ¤ÏÂÁ¯Ô ·Û˘ÌÌÂÙÚ›·˜ ÎÚ·Ó›Ô˘. ∆Ô ÔÈÎÔÁÂÓÂÈ·Îfi, Ì·È¢ÙÈÎfi Î·È ÂÚÈÁÂÓÓËÙÈÎfi ÈÛÙÔÚÈÎfi ‹Ù·Ó ÂχıÂÚ·. ∏ Ê˘ÛÈ΋ ÂͤٷÛË ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋. ∆Ô ‚Ú¤ÊÔ˜ ‰ÂÓ ÎÔÈÌfiÙ·Ó ·ÔÎÏÂÈÛÙÈο Û ‡ÙÈ· ı¤ÛË. ™Â ËÏÈΛ· 2 ÌËÓÒÓ ·Ú·ÙËÚ‹ıËΠÁÈ· ÚÒÙË ÊÔÚ¿ ·Û˘ÌÌÂÙÚ›· ÙÔ˘ ÎÚ·Ó›Ô˘ Ì ÂÈ¤‰ˆÛË Ù˘ ÈÓȷ΋˜ ÂÚÈÔ¯‹˜ ‰ÂÍÈ¿. §fiÁˆ Ù˘ ÚÔԉ¢ÙÈ΋˜ Âȉ›ӈÛ˘, ¤ÁÈÓ Û ËÏÈΛ· 4 ÌËÓÒÓ ·Ï‹ ·ÎÙÈÓÔÁÚ·Ê›· Î·È ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÎÚ·Ó›Ô˘ (∞∆∫) Ô˘ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο. ∏ ·Ú·ÌfiÚʈÛË ÙÔ˘ ÎÚ·Ó›Ô˘ Î·È ÙÔ˘ ÚÔÛÒÔ˘ ‹Ù·Ó ·ÚÎÂÙ¿ ÂÌÊ·Ó‹˜, Û ‚·ıÌfi Ô˘ ÔÈ ÁÔÓ›˜ ÓÙÚ¤ÔÓÙ·Ó Ó· ΢ÎÏÔÊÔÚ‹ÛÔ˘Ó Ì ÙÔ ·È‰› ÙÔ˘˜ ÂÎÙfi˜ ÛÈÙÈÔ‡. ∏ Ê˘ÛÈ΋ ÂͤٷÛË ÙÔ˘ ÎÚ·Ó›Ô˘ Î·È ÙÔ˘ ÚÔÛÒÔ˘ ¤‰ÂÈÍ ÂÎÛÂÛËÌ·Ṳ̂ÓË O¶ ‰ÂÍÈ¿, Ì ¤ÓÙÔÓ· „ËÏ·ÊËÙ‹ ÔÛÙÈ΋ ·ÎÚÔÏÔÊ›· ηٿ Ì‹ÎÔ˜ Ù˘ ‰ÂÍÈ¿˜ Ï·Ì‚‰ÔÂȉԇ˜ Ú·Ê‹˜. ™‡ÛÙÔȯ· ÚÔ˜ ÙËÓ Ï·ÁÈÔÎÂÊ·Ï›· „ËÏ·ÊfiÙ·Ó ÔÛÙÈ΋ ‰ÈfiÁΈÛË ÛÙËÓ ÈÓÈÔÌ·ÛÙÔÂȉ‹ ÂÚÈÔ¯‹, ‰È·ÛÙ¿ÛÂˆÓ 4x5 cm (∂ÈÎfiÓ· 1·). ∞ÓÙ›ÛÙÔȯ· ÚÔ˜ ÙË ‚Ï¿‚Ë ˘‹Ú¯Â ÛÙÚÔÁÁ˘Ï‹ ÚÔ¤ÙÂÈ· Ù˘ ‚ÚÂÁÌ·ÙÈ΋˜ ÂÚÈÔ¯‹˜ ÚÔ˜ Ù· ¤Íˆ Î·È ¿Óˆ (∂ÈÎfiÓ· 1·). ∆Ô ÎÚ·Ó›Ô fiˆ˜ Ê·ÈÓfiÙ·Ó ·fi ¿Óˆ ›¯Â Û¯‹Ì· ÙÚ·Â˙›Ô˘ (∂ÈÎfiÓ· 2‚), ÂÓÒ fiˆ˜ Ê·ÈÓfiÙ·Ó ·fi ›Ûˆ ›¯Â Û¯‹Ì· ·Ú·ÏÏËÏÔÁÚ¿ÌÌÔ˘ (∂ÈÎfiÓ· 1·). ∆Ô ÎÂÊ¿ÏÈ Â›¯Â ÂÌÊ·Ó‹ ÎÏ›ÛË ÚÔ˜ Ù· ‰ÂÍÈ¿ (∂ÈÎfiÓ· 3), Ì ·ÓÙÈÛÙ·ıÌÈÛÙÈ΋ ·Ú·ÌfiÚʈÛË Ù˘ ·˘¯ÂÓÈ΋˜ ÌÔ›Ú·˜ Ù˘ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘. ∆Ô ÚfiÛˆÔ ‹Ù·Ó ÂÏ·ÊÚ¿ ·Û‡ÌÌÂÙÚÔ Ì ÌÈÎÚfiÙÂÚÔ ¿ÓÔÈÁÌ· ÔÊı·ÏÌÔ‡ Û‡ÛÙÔȯ·, ‡„Ô˜ Û‡ÛÙÔÈ¯Ô˘ ÔÊÚ‡Ô˜ ¯·ÌËÏfiÙÂÚÔ ·fi ÙÔ ·ÓÙ›ÛÙÔȯÔ, ÂÏ·ÊÚ¿ ÎÏ›ÛË Ù˘ ÚÈÓfi˜ ÚÔ˜ ÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë ÏÂ˘Ú¿ Î·È Ôχ ‹È· ÛÙÚÔÁÁ˘Ï‹ ÚÔ‚ÔÏ‹ ÙÔ˘ ÌÂÙˆÈ·›Ô˘ ·ÓÙ›ÛÙÔȯ·. ∆Ô ·˘Ù› ‹Ù·Ó ÌÂÙ·ÙÔÈṲ̂ÓÔ ÚÔ˜ Ù· οو Î·È ÂÌÚfi˜ (∂ÈÎfiÓ· 4). ∆· ÎÏÈÓÈο Â˘Ú‹Ì·Ù· ¤ıÂÛ·Ó ÙË ‰È¿ÁÓˆÛË O¶ ·fi ·ÏËı‹ Û˘ÓÔÛÙ¤ˆÛË Ù˘ ‰ÂÍÈ¿˜ Ï·Ì‚‰ÔÂȉԇ˜ Ú·Ê‹˜. ∏ ÙÚÈۉȿÛÙ·ÙË ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÎÚ·Ó›Ô˘ ¤‰ÂÈÍÂ

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∂ÈÎfiÓ· 1. ™¯ËÌ·ÙÈ΋ ·Ú¿ÛÙ·ÛË ÙÔ˘ Û¯‹Ì·ÙÔ˜ ÙÔ˘ ÎÂÊ·ÏÈÔ‡ Û ‰ÂÍÈ¿ O¶. O›ÛıÈ· ı¤·. ·) ∞™O¶. º·›ÓÂÙ·È ÙÔ ·Ú·ÏÏËÏfiÁÚ·ÌÌÔ Û¯‹Ì· ÙÔ˘ ÎÂÊ·ÏÈÔ‡, Ë ÂÍ¿ÏÂÈ„Ë Ù˘ ‰ÂÍÈ¿˜ Ï·Ì‚‰ÔÂȉԇ˜ Ú·Ê‹˜, Ë ‰ÈfiÁΈÛË ÛÙËÓ ÈÓÈÔÌ·ÛÙÔÂȉ‹ ÂÚÈÔ¯‹ (‰ÂÍÈfi οو, ·ÓÔÈÎÙfi ‚¤ÏÔ˜), Ë ÚÔ¤ÙÂÈ· ÛÙË ‚ÚÂÁÌ·ÙÈ΋ ÂÚÈÔ¯‹ ·ÓÙ›ÛÙÔȯ· ÚÔ˜ ÙË ‚Ï¿‚Ë (·ÚÈÛÙÂÚfi ¿Óˆ, ·ÓÔÈÎÙfi ‚¤ÏÔ˜), Ë ÎÏ›ÛË Ù˘ ÎÂÊ·Ï‹˜ Û‡ÛÙÔȯ· ÚÔ˜ ÙË ‚Ï¿‚Ë (ÎÏÂÈÛÙfi ‚¤ÏÔ˜) Î·È ÌÂÙ·ÙfiÈÛË ÙÔ˘ Û‡ÛÙÔÈ¯Ô˘ ·˘ÙÈÔ‡ ÚÔ˜ Ù· οو. ‚) ¶O¶. º·›ÓÂÙ·È ÙÔ ÛÙÚÔÁÁ˘Ïfi Û¯‹Ì· ÙÔ˘ ÎÂÊ·ÏÈÔ‡ Î·È Ë ·ÚÔ˘Û›· Ù˘ Ï·Ì‚‰ÔÂȉԇ˜ Ú·Ê‹˜.

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∂ÈÎfiÓ· 2. ™¯ËÌ·ÙÈ΋ ·Ú¿ÛÙ·ÛË ÙÔ˘ Û¯‹Ì·ÙÔ˜ ÙÔ˘ ÎÂÊ·ÏÈÔ‡ Û ‰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˘ ÌÂÙÒÔ˘, Ë ÚÔ˜ Ù· ÂÌÚfi˜ ÌÂÙ·ÙfiÈÛË ÙÔ˘ Û‡ÛÙÔÈ¯Ô˘ ·˘ÙÈÔ‡. ‚) ∞™O¶. º·›ÓÂÙ·È ÙÔ ÙÚ·Â˙ÔÂȉ¤˜ Û¯‹Ì· ÙÔ˘ ÎÂÊ·ÏÈÔ‡, Ë Û‡ÛÙÔÈ¯Ë ÈÓÈÔÌ·ÛÙÈ΋ ‰ÈfiÁΈÛË (‰ÂÍÈfi οو ‚¤ÏÔ˜), Ë ·ÓÙ›ÛÙÔÈ¯Ë ÚÔ¤ÙÂÈ· ÙÔ˘ ‚ÚÂÁÌ·ÙÈÎÔ‡ ÔÛÙÔ‡, Ë ·ÓÙ›ÛÙÔÈ¯Ë ÚÔ¤ÙÂÈ· ÙÔ˘ ÌÂÙˆÈ·›Ô˘ ÔÛÙÔ‡ Î·È Ë ÚÔ˜ Ù· ›Ûˆ ·ÚÂÎÙfiÈÛË ÙÔ˘ Û‡ÛÙÔÈ¯Ô˘ ·˘ÙÈÔ‡.

ÔÛÙÈ΋ ·ÎÚÔÏÔÊ›· ÛÙË ı¤ÛË Ù˘ ‰ÂÍÈ¿˜ Ï·Ì‚‰ÔÂȉԇ˜ Ú·Ê‹˜ Î·È ÂÍ¿ÏÂÈ„Ë Ù˘ Ú·Ê‹˜, ÛËÌ›· Ô˘ Û˘ÓËÁÔÚÔ‡Û·Ó ÁÈ· ∞™O¶ (∂ÈÎfiÓ· 5). ∏ ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ¤ÁÈÓ ·fi ÙËÓ O¶, Ô˘ ÔÊ›ÏÂÙ·È ÛÙË Û˘Ó¯‹ ‡ÙÈ· ı¤ÛË Ù˘ ÎÂÊ·Ï‹˜. ∆·

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¶·È‰È·ÙÚÈ΋ 2002;65:282-286

Paediatriki 2002;65:282-286

∂ÈÎfiÓ· 3. O›ÛıÈ· ʈÙÔÁÚ¿ÊÈÛË ÙÔ˘ ÎÂÊ·ÏÈÔ‡. º·›ÓÂÙ·È Ë ÎÏ›ÛË ÙÔ˘ ÎÂÊ·ÏÈÔ‡ Û‡ÛÙÔȯ· ÚÔ˜ ÙË ‚Ï¿‚Ë.

΢ÚÈfiÙÂÚ· ‰È·ÊÔÚԉȷÁÓˆÛÙÈο ÎÚÈÙ‹ÚÈ· ÂÚÈÁÚ¿ÊÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1 Î·È Ê·›ÓÔÓÙ·È ÛÙȘ ∂ÈÎfiÓ˜ 1 Î·È 2. ∏ Ï·ÁÈÔÎÂÊ·Ï›· ‰ÈÔÚıÒıËΠ¯ÂÈÚÔ˘ÚÁÈο Û ËÏÈΛ· 7 ÌËÓÒÓ. ∆ÚÂȘ Ì‹Ó˜ ÌÂÙ¿ ÙËÓ ÂÁ¯Â›ÚËÛË ˘‹Ú¯Â Û·Ê‹˜ ‚ÂÏÙ›ˆÛË Ù˘ ·Ú·ÌfiÚʈÛ˘ ÙÔ˘ ÎÚ·Ó›Ô˘ Î·È ÙÔ˘ ÚÔÛÒÔ˘ Î·È ¤Ó· ¯ÚfiÓÔ ·ÚÁfiÙÂÚ· Ë ·Ú·ÌfiÚʈÛË ÙÔ˘ ÎÚ·Ó›Ô˘ ‹Ù·Ó ‰‡ÛÎÔÏ· ·ÓÙÈÏËÙ‹ ·fi ÙÔ˘˜ ÌË ÁÓˆÚ›˙ÔÓÙ˜. ªfiÓÔ Ë ‰ÈfiÁΈÛË ÛÙËÓ ÈÓÈÔÌ·ÛÙÔÂȉ‹ ÂÚÈÔ¯‹ ·Ú¤ÌÂÓÂ, ·Ú¿ ÙË ‚ÂÏÙ›ˆÛË, ‡ÎÔÏ· ·ÓÙÈÏËÙ‹, fiÙ·Ó ‰ÂÓ Î·Ï˘ÙfiÙ·Ó ·fi Ù· Ì·ÏÏÈ¿ ÙÔ˘ ÎÂÊ·ÏÈÔ‡. ™˘˙‹ÙËÛË °È· ·ÚÎÂÙ¿ ¯ÚfiÓÈ·, Ë ‰È¿ÎÚÈÛË ÌÂٷ͇ ¶O¶ Î·È ∞™O¶ ‚·ÛÈ˙fiÙ·Ó fi¯È ÛÙȘ ‰È·ÊÔÚ¤˜ ÙÔ˘ Û¯‹Ì·ÙÔ˜ ÙÔ˘ ÎÂÊ·ÏÈÔ‡, ·ÏÏ¿ ÂÚÈÛÛfiÙÂÚÔ ÛÙÔ ÛÙÔÈ¯Â›Ô Ù˘ ÚÔfi‰Ô˘ Ù˘ ·Ú·ÌfiÚʈÛ˘ ηٿ ÙË ‰È·¯ÚÔÓÈ΋ ÎÏÈÓÈ΋ ÂͤٷÛË. OÈ ·ÛıÂÓ›˜ Ì ·Ú·ÌÔÚʈÙÈ΋ Ï·ÁÈÔÎÂÊ·Ï›· ·fi ÂÓ‰ÔÌ‹ÙÚÈ· Û˘Ì›ÂÛË ıˆÚÔ‡ÓÙ·Ó fiÙÈ ‚ÂÏÙÈÒÓÔÓÙ·È ÌÂÙ¿ ÙË Á¤ÓÓËÛË. ŸÛÔÈ ·ÛıÂÓ›˜ Ì O¶ ‰ÂÓ ‚ÂÏÙÈÒÓÔÓÙ·Ó ÌÂÙ¿ ÙË Á¤ÓÓËÛË, ıˆÚÔ‡ÓÙ·Ó fiÙÈ Â›¯·Ó Û˘ÁÎÂÎÏÂÈṲ̂ÓË Ï·Ì‚‰ÔÂȉ‹ Ú·Ê‹ Î·È ıÂÚ·‡ÔÓÙ·Ó ¯ÂÈÚÔ˘ÚÁÈο. ŸÌˆ˜, ÛÙÔ ¯ÂÈÚÔ˘ÚÁÂ›Ô ÁÈÓfiÙ·Ó ·ÓÙÈÏËÙfi fiÙÈ ÔÈ Ú·Ê¤˜ ‰ÂÓ Â›¯·Ó ÎÏ›ÛÂÈ ÚfiˆÚ· Î·È ÔÈ ÂÚÈÙÒÛÂȘ ·˘Ù¤˜ ÔÓÔÌ¿˙ÔÓÙ·Ó “ÏÂÈÙÔ˘ÚÁÈ΋ Û˘ÓÔÛÙ¤ˆÛË Ù˘ Ï·Ì‚‰ÔÂȉԇ˜”. ™‡ÓÙÔÌ·, ¤ÁÈÓ ·ÓÙÈÏËÙfi fiÙÈ ÔÈ ·Ú·ÌÔÚÊÒÛÂȘ ·˘Ù¤˜ ÔÊ›ÏÔÓÙ·È ÛÙË ı¤ÛË ÙÔ˘ ÎÂÊ·ÏÈÔ‡ Î·È ·Ó·Ù‡ÛÛÔÓÙ·È fiÙ·Ó ÙÔ ‚Ú¤ÊÔ˜ Û·Ù·Ï¿ ·Ú·ÙÂٷ̤ÓÔ ¯ÚfiÓÔ ‡ÙÈ· ÛÙËÓ ÎÔ‡ÓÈ· ÙÔ˘ ‹ ÙË ı¤ÛË ÙÔ˘ ·˘ÙÔÎÈÓ‹ÙÔ˘. ∏ Û˘Ó¯‹˜ ‡ÙÈ· ı¤ÛË ÌÔÚ› Ó· ÚÔηϤÛÂÈ O¶ Û ¤Ó· Ê˘ÛÈÔÏÔÁÈÎfi ηٿ ÙË Á¤ÓÓËÛË ÎÂÊ¿ÏÈ ‹ Ó· ÂȉÂÈÓÒÛÂÈ Ì›· ‹È· ·Ú·ÌfiÚʈÛË ÙÔ˘ ÎÂÊ·ÏÈÔ‡ Ô˘ Û˘Ó¤‚Ë ÂÓ‰ÔÌ‹ÙÚÈ· ·fi ÂÚÈÔÚÈÛÙÈΤ˜ ‰˘Ó¿ÌÂȘ.

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∂ÈÎfiÓ· 4. ºˆÙÔÁÚ·Ê›· ÚÔÛÒÔ˘. 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· οو ·ÚÂÎÙfiÈÛË ÙÔ˘ Û‡ÛÙÔÈ¯Ô˘ ·˘ÙÈÔ‡ Î·È Ë ÚÔ¤ÙÂÈ· ÙÔ˘ ·ÓÙ›ÛÙÔÈ¯Ô˘ ˙˘ÁˆÌ·ÙÈÎÔ‡.

∂ÈÎfiÓ· 5. ∆ÚÈۉȿÛÙ·ÙË ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÎÚ·Ó›Ô˘. º·›ÓÂÙ·È Ë Ï‹Ú˘ ÂÍ¿ÏÂÈ„Ë Ù˘ ‰ÂÍÈ¿˜ Ï·Ì‚‰ÔÂȉԇ˜ Ú·Ê‹˜ Î·È Ë ·ÓÙÈηٿÛÙ·Û‹ Ù˘ ·fi ÔÛÙÈ΋ ·ÎÚÔÏÔÊ›·, Î·È Ë ÔÛÙÈ΋ ‰ÈfiÁΈÛË ÛÙËÓ ÈÓÈÔÌ·ÛÙÔÂȉ‹ ÂÚÈÔ¯‹.

ªÂÙ¿ ÙÔ 1992 ˘‹ÚÍ ÌÂÁ¿ÏË ·‡ÍËÛË ÙˆÓ O¶, Ô˘ ·Ô‰fiıËΠÛÙË Û‡ÛÙ·ÛË Ù˘ ∞ÌÂÚÈηÓÈ΋˜ ∞η‰ËÌ›·˜ ¶·È‰È·ÙÚÈ΋˜ Ó· ÙÔÔıÂÙÔ‡ÓÙ·È Ù· ‚Ú¤ÊË ‡ÙÈ· ÁÈ· ÙËÓ ÂÏ¿ÙÙˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ·fi ÙÔ Û‡Ó‰ÚÔÌÔ ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ (7). ™Â ¤Ó· ÎÚ·ÓÈÔÚÔÛˆÈÎfi ΤÓÙÚÔ ÙˆÓ ∏¶∞, ÂÓÒ ÙÔ 1992 ÌfiÓÔ 30% ÙˆÓ Ï·ÁÈÔÎÂÊ·ÏÈÒÓ ÔÊÂÈÏfiÙ·Ó Û Ô›ÛıȘ Ï·ÁÈÔÎÂʷϛ˜ Î·È 70% Û ÚfiÛıȘ, ÙÔ 1998 ÙÔ 95% ÙˆÓ Ï·ÁÈÔÎÂÊ·ÏÈÒÓ ÔÊÂÈÏfiÙ·Ó Û Ô›ÛıȘ Ï·ÁÈÔÎÂʷϛ˜ Î·È ÌfiÓÔ 5% Û ÚfiÛıȘ (1). ∞˘Ù‹ Ë Ì·˙È΋ ·‡ÍËÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÓÂÔÁÓÒÓ Ì ¶O¶ ·Ú›¯Â Ì›· ‚¿ÛË ‰Â‰ÔÌ¤ÓˆÓ ÁÈ·

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¶·È‰È·ÙÚÈ΋ 2002;65:282-286

Paediatriki 2002;65:282-286

¶›Ó·Î·˜ 1. ∫ÏÈÓÈ΋ ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË Ô›ÛıÈ·˜ Ï·ÁÈÔÎÂÊ·Ï›·˜ ∂˘Ú‹Ì·Ù·

¶·Ú·ÌÔÚʈÙÈ΋ O¶

™˘ÓÔÛÙˆÙÈ΋ O¶

∂ÙÂÚfiÏ¢ÚË Ô›ÛıÈ· ‰ÈfiÁΈÛË ªÂÙˆÈ·›· ‰ÈfiÁΈÛË OÌfiÏ¢ÚË ‰ÈfiÁΈÛË ÈÓÈÔÌ·ÛÙÔÂȉԇ˜ µ¿ÛË ÎÚ·Ó›Ô˘ Î·È ÚfiÛˆÔ OÛÙÈ΋ ·ÎÚÔÏÔÊ›· ™¯‹Ì· ÎÂÊ·ÏÈÔ‡: ı¤· ·fi ¿Óˆ ™¯‹Ì· ÎÂÊ·ÏÈÔ‡: ı¤· ·fi ›Ûˆ ∫·Ù¿ÛÙ·ÛË Ï·Ì‚ÔÂȉԇ˜ Ú·Ê‹˜ ¶·ÚÂÎÙfiÈÛË ÔÌfiÏ¢ÚÔ˘ ·˘ÙÈÔ‡ ¶·ÚÂÎÙfiÈÛË ÔÌfiÏ¢ÚÔ˘ ÊÚ˘‰ÈÔ‡ ∫Ï›ÛË Ì‡Ù˘ ¶ÚÔ¤ÙÂÈ· ˙˘ÁˆÌ·ÙÈÎÔ‡

πÓÈ·Îfi ÔÛÙÔ‡Ó OÌfiÏ¢ڷ ∞Ô‡Û· Èڛ˜ ÎÏ›ÛË ∞Ô‡Û· ¶·Ú·ÏÏËÏfiÁÚ·ÌÌÔ º˘ÛÈÔÏÔÁÈÎfi ∞ÓÔÈÎÙ‹ ¶ÚfiÛıÈ· ∫·Ì›· Ÿ¯È OÌfiÏ¢ڷ

µÚÂÁÌ·ÙÈÎfi ÔÛÙÔ‡Ó ∂ÙÂÚfiÏ¢ڷ ¶·ÚÔ‡Û· ∫Ï›ÛË ÚÔ˜ Ù· οو ÔÌfiÏ¢ڷ ¶·ÚÔ‡Û· ∆Ú·¤˙ÈÔ ¶·Ú·ÏÏËÏfiÁÚ·ÌÌÔ ∫ÏÂÈÛÙ‹ ¶ÔÈΛÏË ¶ÚÔ˜ Ù· οو ∂ÙÂÚfiÏ¢ڷ ∂ÙÂÚfiÏ¢ڷ

ÌÂϤÙË, Ë ÔÔ›· ‰ÂÓ ˘‹Ú¯Â Ù· ÚÔËÁÔ‡ÌÂÓ· ¯ÚfiÓÈ·. ∞˘Ùfi Â¤ÙÚ„ ÙÔ 1996 ÛÙÔÓ Huang Î·È Û˘Ó Ó· ÌÔÚ¤ÛÂÈ Ó· ·ÓÙȉȷÛÙ›ÏÂÈ ÙËÓ ¶O¶ ·fi ÙËÓ ∞™O¶, Û ̛· ÚÔÁÚ·ÌÌ·ÙÈṲ̂ÓË ÌÂϤÙË 102 ÂÚÈÛÙ·ÙÈÎÒÓ O¶, fiÔ˘ ηٷÁÚ¿ÊËÎ·Ó Ì ÏÂÙÔ̤ÚÂÈ·, ·fi ÂȉÈÎÔ‡˜, Ù· ÎÏÈÓÈο, ·ÂÈÎÔÓÈÛÙÈο, ‰ÈÂÁ¯ÂÈÚËÙÈο Î·È ÈÛÙÔÏÔÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο (¶›Ó·Î·˜ 1). µÚ¤ıËΠfiÙÈ Ë ÎÚ·Óȷ΋ ·Ú·ÌfiÚʈÛË ÏfiÁˆ ∞™O¶ ¤¯ÂÈ ¯·Ú·ÎÙËÚÈÛÙÈο Ô˘ Â›Ó·È ‰È·ÊÔÚÂÙÈο ‹ ÙÂÏ›ˆ˜ ·ÓÙ›ıÂÙ· ·fi ·˘Ù¿ Ù˘ ¶O¶ (¶›Ó·Î·˜ 1, ∂ÈÎfiÓ· 1 Î·È 2). O Mulliken (1), ÙÔ 1999, ÂȂ‚·›ˆÛ ٷ Â˘Ú‹Ì·Ù· ÙÔ˘ Huang Ì ÔÚÈṲ̂Ó˜ ÂÏ·ÊÚ¤˜ ÙÚÔÔÔÈ‹ÛÂȘ/‰È¢ÎÚÈÓ›ÛÂȘ. ŒÓ· ÛËÌÂ›Ô Ô˘ ÙÚÔÔÔ›ËÛ ‹Ù·Ó Ë ÌÂÙ·ÙfiÈÛË ÙÔ˘ Û‡ÛÙÔÈ¯Ô˘ ÚÔ˜ ÙË ‚Ï¿‚Ë ·˘ÙÈÔ‡ ÛÙËÓ ∞™O¶, Ô˘ ÂÎÙfi˜ ·fi ÚÔ˜ Ù· ›Ûˆ Î·È Î¿Ùˆ Ô˘ ÂÚȤÁÚ·„Â Ô Huang, ÌÔÚ› Ó· Â›Ó·È ÚÔ˜ Ù· ÂÌÚfi˜ ‹ ¯ˆÚ›˜ ÌÂÙ·ÙfiÈÛË.

OÈ ‰È·ÊÔÚ¤˜ ÛÙËÓ ·Ú·ÌfiÚʈÛË ÙÔ˘ ÎÚ·Ó›Ô˘ ÌÂٷ͇ ¶O¶ Î·È ∞™O¶ ÔÊ›ÏÔÓÙ·È ÛÙÔ ‰È·ÊÔÚÂÙÈÎfi Ì˯·ÓÈÛÌfi ÚfiÎÏËÛ˘. ™ÙËÓ ¶O¶ Ë ·Ú·ÌfiÚʈÛË ÔÊ›ÏÂÙ·È Û ‰Â˘ÙÂÚÔ·ı›˜, ÌË Ê˘ÛÈÔÏÔÁÈΤ˜ Â͈ÙÂÚÈΤ˜ ‰˘Ó¿ÌÂȘ, Ô˘ ‰ÚÔ˘Ó Â¿Óˆ Û ÂÓ‰ÔÁÂÓÒ˜ Ê˘ÛÈÔÏÔÁÈÎfi Î·È ·Ó·Ù˘ÛÛfiÌÂÓÔ ÎÚ·Ó›Ô. ™ÙËÓ ∞™O¶ ˘¿Ú¯ÂÈ ÚˆÙ·Ú¯Èο ÌË Ê˘ÛÈÔÏÔÁÈ΋ ·Ó¿Ù˘ÍË Ù˘ Ú·Ê‹˜ (Û‡ÁÎÏÂÈÛË), Ô˘ ·ÔÙÚ¤ÂÈ ÙËÓ ÂÁοÚÛÈ· ÚÔ˜ ·˘Ù‹Ó ÌÂÏÏÔÓÙÈ΋ Â¤ÎÙ·ÛË ÙÔ˘ ÎÚ·Ó›Ô˘. ™˘Á¯ÚfiÓˆ˜, Ô ·˘Í·ÓfiÌÂÓÔ˜ ÂÁΤʷÏÔ˜ ·ÛΛ ÂÛˆÙÂÚÈ΋ ›ÂÛË ÚÔ˜ ÙȘ ·ÓÔÈÎÙ¤˜ ڷʤ˜ Î·È Ì·˙› Ì ÙÔÓ ÚÔËÁÔ‡ÌÂÓÔ Ì˯·ÓÈÛÌfi Ù˘ ·ÔÙÚÔ‹˜ Ù˘ Â¤ÎÙ·Û˘ ·Ú·ÌÔÚÊÒÓÔ˘Ó ÙÔ ıfiÏÔ ÙÔ˘ ÎÚ·Ó›Ô˘ Û ·ÓÒÌ·ÏÔ Û¯‹Ì·. ∏ ·Û˘ÌÌÂÙÚ›· ÙÔ˘ ÚÔÛÒÔ˘ Â›Ó·È Û˘Ó‹ıˆ˜ ‹È· Î·È ÛÙËÓ ∞™O¶ ÔÊ›ÏÂÙ·È ÛÙËÓ ÎÏ›ÛË Ù˘ ‚¿Û˘ ÙÔ˘ ÎÂÊ·ÏÈÔ‡ ÚÔ˜ ÙË ÌÂÚÈ¿ Ù˘ ‚Ï¿‚˘, ÂÓÒ ÛÙËÓ ¶O¶ ÔÊ›ÏÂÙ·È ÛÙËÓ ¤ÓÙÔÓË ‰ÈfiÁΈÛË ÙÔ˘ Û‡ÛÙÔÈ¯Ô˘ ÌÂÙˆÈ·›Ô˘ Î·È ˙˘ÁˆÌ·ÙÈÎÔ‡ ÔÛÙÔ‡.

O ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ù˘ O¶ Ì ÙËÓ ·Ï‹ ·ÎÙÈÓÔÁÚ·Ê›· ÎÚ·Ó›Ô˘ Â›Ó·È ·ÚÎÂÙ¤˜ ÊÔÚ¤˜ ÌË ‰È·ÁÓˆÛÙÈÎfi˜. ∏ ∞∆∫ Â›Ó·È ·ÍÈfiÈÛÙË, ·ÏÏ¿ fi¯È ÛÂ

fiϘ ÙȘ ÂÚÈÙÒÛÂȘ. ∆fiÛÔ Ë ·Ï‹ ·ÎÙÈÓÔÁÚ·Ê›· ÎÚ·Ó›Ô˘, fiÛÔ Î·È Ë ∞∆∫ ‹Ù·Ó ÌË ‰È·ÁÓˆÛÙÈΤ˜ ÛÙÔ ÂÚÈÛÙ·ÙÈÎfi Ì·˜. ¶ÈÔ ·ÍÈfiÈÛÙË Â›Ó·È Ë ÚfiÛÊ·Ù· ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓË Ù¯ÓÈ΋ Ù˘ ÙÚÈۉȿÛÙ·Ù˘ ∞∆∫, Ô˘ ıˆÚÂ›Ù·È Ë Î·Ï‡ÙÂÚË Ì¤ıÔ‰Ô˜ ·Ó‡ÚÂÛ˘ ‡·Ú͢ ‹ ·Ô˘Û›·˜ ∞™§ƒ (1). ∆· ·ÂÈÎÔÓÈÛÙÈο Â˘Ú‹Ì·Ù· ÔÛÙÈ΋˜ ·ÎÚÔÏÔÊ›·˜ ÛÙË ı¤ÛË Ù˘ Ï·Ì‚‰ÔÂȉԇ˜ Î·È Ë Ï‹Ú˘ ÂÍ¿ÏÂÈ„Ë Ù˘ Ú·Ê‹˜, fiˆ˜ Ê¿ÓËÎÂ Î·È ÛÙÔ ÂÚÈÛÙ·ÙÈÎfi Ì·˜ (∂ÈÎfiÓ· 5), Â›Ó·È ÂÓ‰ÂÈÎÙÈο ÁÈ· ∞™O¶ (1,2). ∞ÏÏ¿ Î·È Ë ÙÚÈۉȿÛÙ·ÙË ∞∆∫ ·ÚÔ˘ÛÈ¿˙ÂÈ, ˘fi ÔÚÈṲ̂Ó˜ ÚÔ¸Ôı¤ÛÂȘ, Ù¯ÓÈΤ˜ ‰˘ÛÎÔϛ˜ Ô˘ ÌÔÚ› Ó· ‰ÒÛÔ˘Ó ··ÙËÏ‹ ÂÈÎfiÓ· Û˘ÓÔÛÙ¤ˆÛ˘ (1). ™˘ÌÂÚ·ÛÌ·ÙÈο, Ë Ê˘ÛÈ΋ ÂͤٷÛË ·fi ÌfiÓË Ù˘ ‹ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙÚÈۉȿÛÙ·ÙË ∞∆∫ ÌÔÚ› Ó· ‰È·ÊÔÚԉȷÁÓÒÛÂÈ Ì ·ÎÚ›‚ÂÈ· ÙËÓ ∞™O¶ ·fi ÙËÓ ¶O¶. ªÂ ‚¿ÛË Ù· ÎÚÈÙ‹ÚÈ· ·˘Ù¿, ÙÔ ÔÛÔÛÙfi Ù˘ ∞™O¶ ÌÂٷ͇ fiÏˆÓ ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÌÂÌÔӈ̤Ó˘ Û˘ÓÔÛÙ¤ˆÛ˘ Â›Ó·È 1,3%-3% (1) Î·È fi¯È 15%-20%, fiˆ˜ ·Ó¤ÊÂÚ·Ó ÚÔËÁÔ‡ÌÂÓ· ·ÚÎÂÙÔ› ÂÚ¢ÓËÙ¤˜ (8-10). ∂›Ó·È ÚÔÊ·Ó¤˜ fiÙÈ Ë ‰È¿ÁÓˆÛ‹ ÙÔ˘˜ ‹Ù·Ó Ï·Óı·Ṳ̂ÓË, Ì ·ÔÙ¤ÏÂÛÌ· ÌÂÁ¿ÏÔ˜ ·ÚÈıÌfi˜ ‚ÚÂÊÒÓ Ó· ˘ÔÛÙ› ¯ˆÚ›˜ ÏfiÁÔ Ì›˙ÔÓ· ÂÓ‰ÔÎÚ·Óȷ΋ ¯ÂÈÚÔ˘ÚÁÈ΋ Â¤Ì‚·ÛË. ∏ ¤ÁηÈÚË Î·È ÛˆÛÙ‹ ‰È·ÊÔÚԉȿÁÓˆÛË ÌÂٷ͇ ∞™O¶ Î·È ¶O¶ Â›Ó·È ÎÚÈÙÈ΋˜ ÛËÌ·Û›·˜ ÁÈ· ÙËÓ Î·Ù¿ÏÏËÏË ıÂÚ·›·. ∏ ıÂÚ·›· Ù˘ ∞™O¶ Á›ÓÂÙ·È Î·Ù¿ ηÓfiÓ· ¯ÂÈÚÔ˘ÚÁÈο Î·È Â›Ó·È ·ÏÔ‡ÛÙÂÚË Î·È Ì ¿ÚÈÛÙ· ·ÔÙÂϤÛÌ·Ù· fiÙ·Ó Á›ÓÂÈ ÙÔ˘˜ ÚÒÙÔ˘˜ 6 Ì‹Ó˜ ˙ˆ‹˜. ªÂٷ͇ 6-12 ÌËÓÒÓ Ë ÂÁ¯Â›ÚËÛË Â›Ó·È ÈÔ ÔχÏÔÎË Î·È Ë ÚfiÁÓˆÛË ·ÚÎÂÙ¿ ηϋ, ÂÓÒ ÌÂÙ¿ ÙÔÓ ÚÒÙÔ ¯ÚfiÓÔ ˙ˆ‹˜ Ë ÚfiÁÓˆÛË Â›Ó·È ÂÈÊ˘Ï·ÎÙÈ΋ ÁÈ·Ù› ¤¯Ô˘Ó ‹‰Ë ÂÁηٷÛÙ·ı› ÌfiÓÈ̘ ·Ú·ÌÔÚÊÒÛÂȘ. §›Á˜ ÂÚÈÙÒÛÂȘ ∞™O¶, Ô˘ ‰ÂÓ Û˘Óԉ‡ÔÓÙ·È ·fi ÛÔ‚·Ú‹ ·Ú·ÌfiÚʈÛË, ÌÔÚÔ‡Ó Ó· ·ÓÙÈÌÂÙˆÈÛÙÔ‡Ó Û˘ÓÙËÚËÙÈο. ™ÙËÓ ¶O¶ Ë ·ÓÙÈÌÂÙÒÈÛË Â›Ó·È Î˘Ú›ˆ˜ Û˘ÓÙËÚËÙÈ΋ Î·È Ú¤ÂÈ Ó· ·Ú¯›˙ÂÈ ÙȘ ÚÒÙ˜ ‚‰ÔÌ¿‰Â˜ ˙ˆ‹˜. ™Ù· Û˘ÓÙËÚËÙÈο ̤ÙÚ· ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È Ë Û˘¯Ó‹ ·ÏÏ·Á‹ ı¤Ûˆ˜ ÙÔ˘ ÎÂÊ·ÏÈÔ‡, Ë

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ÙÔÔı¤ÙËÛË ·ÊÚˆ‰ÒÓ ÛÊËÓÒÓ Î·È Ë ÚËÓ‹˜ ÙÔÔı¤ÙËÛË fiÙ·Ó ÙÔ ‚Ú¤ÊÔ˜ ÂÚ¿ÛÂÈ ÙËÓ ËÏÈΛ· ÙˆÓ 6 ÌËÓÒÓ (1). ªÂÁ¿ÏË ÚfiÔ‰Ô ÛÙË Û˘ÓÙËÚËÙÈ΋ ıÂÚ·›· ¤ÊÂÚÂ Ë ¯Ú‹ÛË ÂȉÈÎÒÓ ÎÚ·ÓÒÓ Ô˘ ‰ÚÔ˘Ó Â›Ù Ì ·ıËÙÈÎfi ‹ ‰˘Ó·ÌÈÎfi ÙÚfiÔ (1,11). ∏ ıÂÚ·›· Ì ÎÚ¿ÓÔ˜ Ú¤ÂÈ Ó· ·Ú¯›˙ÂÈ ÚÈÓ ·fi ÙÔÓ 6Ô Ì‹Ó· ˙ˆ‹˜ Î·È Û˘Ó‹ıˆ˜ ‰È·ÚΛ 4-5 Ì‹Ó˜ (11). ªÂÙ¿ ÙÔÓ 1Ô ¯ÚfiÓÔ ˙ˆ‹˜ Â›Ó·È ÂÏ¿¯ÈÛÙ· ·ÔÙÂÏÂÛÌ·ÙÈ΋ (1,11). §›ÁÔÈ ·ÛıÂÓ›˜ Ì ¶O¶ ¤¯Ô˘Ó ÂÍ·Ú¯‹˜ ÛÔ‚·Ú‹, ÚÔ˚Ô‡Û· ·Ú·ÌfiÚʈÛË Ô˘ ‰ÂÓ ··ÓÙ¿ ÛÙ· Û˘ÓÙËÚËÙÈο ̤ÙÚ·. ∆· ·›ÙÈ· ÛÙȘ ÂÚÈÙÒÛÂȘ ·˘Ù¤˜, Û‡Ìʈӷ Ì ̛· ÌÂϤÙË, ÌÔÚ› Ó· Â›Ó·È ÁÂÓÂÙÈο (3). ™ÙȘ ÂÚÈÙÒÛÂȘ ·˘Ù¤˜ Î·È Û ÂΛӘ Ô˘ ‰È·ÁÓÒÛıËÎ·Ó ·ÚÁÔÔÚË̤ӷ ··ÈÙÂ›Ù·È ¯ÂÈÚÔ˘ÚÁÈ΋ ‰ÈfiÚıˆÛË (2,3). ∞fi fiÛÔ ÁÓˆÚ›˙Ô˘ÌÂ, ÙÔ Úfi‚ÏËÌ· Ù˘ O¶ ‰ÂÓ ¤¯ÂÈ ··Û¯ÔÏ‹ÛÂÈ È‰È·›ÙÂÚ· ÙËÓ ÂÏÏËÓÈ΋ ‚È‚ÏÈÔÁÚ·Ê›·, Ô‡Ù ÙËÓ ÂÓË̤ڈÛË/ÂÎ·›‰Â˘ÛË ÙˆÓ ·È‰È¿ÙÚˆÓ. ∏ Û‡ÛÙ·ÛË Î·È ·fi ÙÔ˘˜ ŒÏÏËÓ˜ ·È‰È¿ÙÚÔ˘˜ Ó· ÎÔÈÌÔ‡ÓÙ·È Ù· ‚Ú¤ÊË ‡ÙÈ·, ¿Ú¯ÈÛ ٷ ÙÂÏÂ˘Ù·›· Ï›Á· ¯ÚfiÓÈ· Î·È ·Ó·Ì¤ÓÂÙ·È Ó· ·˘Í‹ÛÂÈ Ù· ÂÚÈÛÙ·ÙÈο O¶. ∏ ÂÓË̤ڈÛË/ ÂÎ·›‰Â˘ÛË ÙˆÓ ·È‰È¿ÙÚˆÓ ÛÙȘ ÂΉËÏÒÛÂȘ Ù˘ ÂÙÂÚfiÏ¢Ú˘ ∞™§ƒ Â›Ó·È ·Ó·Áη›·, ‰ÈfiÙÈ ÁÂÓÈο ı· ÂÈÙÚ¤„ÂÈ ·ÎÚÈ‚¤ÛÙÂÚË ‰È¿ÁÓˆÛË Î·È Î·Ù·ÏÏËÏfiÙÂÚË ıÂÚ·›· Ù˘ O¶ Î·È ÂȉÈο ı· ·ÔÙÚ¤„ÂÈ ÌË ·Ó·Áη›· ¯ÂÈÚÔ˘ÚÁÈ΋ Â¤Ì‚·ÛË Û ·ÛıÂÓ›˜ Ì ¶O¶.

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3. Lin KY, Nolen AA, Gampper TJ, Jane JA, Opperman LA, Ogle RC. Elevated levels of transforming growth factors beta 2 and beta 3 in lambdoid sutures from children with persistent plagiocephaly. Cleft Palate Cran J 1997; 34:331-337.

4. Argenta LC, David LR, Wilson JA, Bell WO. An increase in infant cranial deformity with supine sleeping position. J Craniofac Surg 1996;7:5-11.

5. Turk AE, McCarthy JG, Thorne CH, Wisoff JH. The “back to sleep campaign” and deformational plagiocephaly: is there cause for concern? J Craniofac Surg 1996;7:12-18.

6. Gonzalez de Dios J, Moya M, Jimenez L, Alcala-Santaella R, Carratala F. Increase in the incidence of occipital plagiocephaly. Rev Neurol 1998;27:782-784.

7. American Academy of Pediatrics Task Force on infant positioning and SIDS: Positioning and SIDS. Pediatrics 1992;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 Sick Children, 1972-1982. J Neurosurg 1984;61:340-347.

10. Jimenez DF, Barone CM, Argamaso RV, Goodrich JT, Shprintzen RJ. Asterion region synostosis. Cleft Palate Cran J 1994;31:136-141.

11. Eppley BL. Helmet versus nonhelmet treatment in nonsynostotic positional posterior plagiocephaly. J Cran Surg 2001;12:97.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Mulliken JB, Vander Woude DL, Hansen M, LaBrie RA, Scott RM. Analysis of posterior plagiocephaly: deformational versus synostotic. Plast Reconstr Surg 1999;103:371-380.

2. Huang MH, Gruss JS, Clarren SK, Mouradian WE, Cunningham ML, Roberts TS et al. The differential diagnosis of posterior plagiocephaly: the true lambdoid synostosis versus positional molding. Plast Reconstr Surg 1996;98:765-774.

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CASE REPORT

¡fiÛÔ˜ Niemann Pick C: ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ Î·È ·Ó·ÛÎfiËÛË Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜ ¢. π. ∑·ÊÂÈÚ›Ô˘1, ¶. ∆ÚÈ·ÓٷʇÏÏÔ˘1, ¡. °ÔÌ¿Î˘1, ∂. µ·ÚÁÈ¿ÌË1, Ã. ∆Û¿ÓÙ·ÏË1, ∂. ªÈ¯ÂϷοÎË2, 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

¶ÂÚ›ÏË„Ë: ∏ ÓfiÛÔ˜ Niemann-Pick Ù‡Ô˘ C (¡PC) ÎÏËÚÔÓÔÌÂ›Ù·È Ì ÙÔÓ ·˘ÙÔۈ̷ÙÈÎfi ˘ÔÏÂÈfiÌÂÓÔ ¯·Ú·ÎÙ‹Ú· Î·È ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ·ÓÂ¿ÚÎÂÈ· Ù˘ ÚˆÙ½Ó˘ NP-C1 ‹ ∏∂1 Ô˘ Ô‰ËÁ› Û ‰È·Ù·Ú·¯‹ ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘. ∏ ÎÏÈÓÈ΋ ÂÈÎfiÓ· Û˘¯Ó¿ ÂÚÈÏ·Ì‚¿ÓÂÈ ÚÒÈÌË Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›·, ·Ù·Í›·, ‰˘ÛÙÔÓ›·, ηٷÏËÍ›·, ‰˘Û·ÚıÚ›· Î·È ¿ÓÔÈ·. ¶ÂÚÈÁÚ¿ÊÂÙ·È ÂÚ›ÙˆÛË ·ÁÔÚÈÔ‡ ËÏÈΛ·˜ 3,5 ÂÙÒÓ, ÙÔ ÔÔ›Ô ÂÈÛ‹¯ıË ÛÙËÓ ∫ÏÈÓÈ΋ ÁÈ· ¤ÏÂÁ¯Ô „˘¯ÔÎÈÓËÙÈ΋˜ ·ÏÈÓ‰ÚfiÌËÛ˘ Ì ‰È·Ù·Ú·¯¤˜ Û˘ÌÂÚÈÊÔÚ¿˜ Î·È ÔÌÈÏ›·˜, ηıÒ˜ Î·È ·ÛÙ¿ıÂÈ· ‚¿‰ÈÛ˘ ÌÂ Û˘¯Ó¤˜ ÙÒÛÂȘ. ∫·Ù¿ ÙËÓ ÎÏÈÓÈ΋ ÂͤٷÛË ‰È·ÈÛÙÒıËÎ·Ó Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›·, ·Ù·Í›·, ‰˘Û·ÚıÚ›· Î·È ‰˘ÛÎÔÏ›· ÛÙËÓ Î›ÓËÛË ÙˆÓ ÔÊı·ÏÌÒÓ ÚÔ˜ Ù· ¿Óˆ ÛÙÔÓ Î¿ıÂÙÔ ¿ÍÔÓ·.

O Ó¢ÚÔÊ˘ÛÈÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙˆÓ Ù·¯˘Ù‹ÙˆÓ ·ÁˆÁÈÌfiÙËÙ·˜ ÓÂ‡ÚˆÓ ¤‰ˆÛÂ Â˘Ú‹Ì·Ù· Û˘Ì‚·Ù¿ Ì ‹È· ·ÔÌ˘ÂÏÈÓˆÙÈ΋ ÂÚÈÊÂÚÈ΋ Ó¢ÚÔ¿ıÂÈ·. ∏ ÂͤٷÛË ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ ¤‰ÂÈÍ ·ÚÔ˘Û›· ¿ÊıÔÓˆÓ ÈÛÙÈÔ΢ÙÙ¿ÚˆÓ Ì ·ÊÚ҉˜ ΢ÙÙ·ÚfiÏ·ÛÌ·, ÂÓÒ Û ηÏÏȤÚÁÂÈ· ÈÓÔ‚Ï·ÛÙÒÓ ‰¤ÚÌ·ÙÔ˜ ‰È·ÈÛÙÒıËÎ·Ó ·˘ÍË̤ӷ Â›‰· ÌË ÂÛÙÂÚÔÔÈË̤Ó˘ ¯ÔÏËÛÙÂÚfiÏ˘ (ÌÂÙ¿ ·fi ÈÛÙÔ¯ËÌÈ΋ ¯ÚÒÛË Ì ÊÈÏÈ›ÓË) Î·È ¯·ÌËÏ¿ Â›‰· Û‡ÓıÂÛ˘ ÂÛÙ¤ÚˆÓ ¯ÔÏËÛÙÂÚfiÏ˘, Â˘Ú‹Ì·Ù· Û˘Ì‚·Ù¿ Ì ÓfiÛÔ NP-C. ªÂ ·ÊÔÚÌ‹ ÙËÓ ÂÚ›ÙˆÛË ·˘Ù‹ Á›ÓÂÙ·È Ì›· ·Ó·ÛÎfiËÛË Ù˘ ˘¿Ú¯Ô˘Û·˜ ‚È‚ÏÈÔÁÚ·Ê›·˜ Ô˘ ·ÊÔÚ¿ ÛÙË ÓfiÛÔ NP-C, ηıÒ˜ Î·È Ì›· ·ÚÔ˘Û›·ÛË ÙˆÓ ÂÚ¢ÓËÙÈÎÒÓ ıÂÚ·¢ÙÈÎÒÓ ‰˘Ó·ÙÔًوÓ.

Abstract: Niemann-Pick type C (NP-C) disease is an autosomal-recessive inherited neurovisceral lipid storage disorder. It is due either to protein NPC1 or to HE1 deficiency, which leads to disturbance of cholesterol metabolism and is characterized by early hepatosplenomegaly and progressive ataxia, dystonia, cataplexy, dysarthria and dementia. We describe a 3.5 year-old Greek patient with NP-C disease, who presented with regression both in cognitive and motor domains.

Almost 10 months before admission, the child developed progressive speech and behavioural changes, as well as gait disturbances with frequent falls.

The examination demonstrated hepatosplenomegaly, ataxia and vertical gaze palsy. Nerve conduction velocities revealed mild demyelinating peripheral neuropathy. Bone marrow examination demonstrated the presence of foam cells, while cholesterol esterification studies showed massive accumulation of unesterified cholesterol and very low intracellular esterification of exogenous lipoprotein-derived cholesterol, results indicative of NP-C disease. The current literature as well as the therapeutic modalities regarding NP-C are extensively reviewed.

§¤ÍÂȘ ÎÏÂȉȿ: ÓfiÛÔ˜ Niemann-Pick C, Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›·, οıÂÙË ¿ÚÂÛË ‚ϤÌÌ·ÙÔ˜, ÏÈ›‰ˆÛË, ÂÚÈÊÂÚÈ΋ Ó¢ÚÔ¿ıÂÈ·, „˘¯ÔÎÈÓËÙÈ΋ ·ÏÈÓ‰ÚfiÌËÛË, ÌÂÙ·‚ÔÏÈÛÌfi˜ ¯ÔÏËÛÙÂÚfiÏ˘.

Key words: Niemann-Pick type C, hepatosplenomegaly, vertical gaze palsy, lipidosis, peripheral neuropathy, psychomotor regression, cholesterol metabolism.

1 A’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ∞¶£ 2 πÓÛÙÈÙÔ‡ÙÔ ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡, ∞ı‹Ó· 3 Laboratoire Fondation Gillet-Marcel Merieux, Centre Hospitalier Lyon-Sud, France

1 1st Pediatric Clinic of Aristotelion University, Thessaloniki 2 Institute of Child Health, Athens 3 Laboratoire Fondation Gillet-Marcel Merieux, Centre Hospitalier Lyon-Sud, France

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∂ÈÛ·ÁˆÁ‹ ∏ ÓfiÛÔ˜ Niemann-Pick (NP) ·ÊÔÚ¿ Ì›· ÂÙÂÚÔÁÂÓ‹ ÔÌ¿‰· Ï˘ÛÔÛˆÌÈ·ÎÒÓ ·ıÚÔÈÛÙÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ ÙˆÓ ÏÈȉ›ˆÓ, Ô˘ Ì ‚¿ÛË Î˘ÙÙ·ÚÔ‚ÈÔ¯ËÌÈο ‰Â‰Ô̤ӷ ˘ԉȷÈÚÂ›Ù·È Û ‰‡Ô ηÙËÁÔڛ˜: Ë ÚÒÙË ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ¤ÏÏÂÈ„Ë ÙÔ˘ ÂÓ˙‡ÌÔ˘ ÛÊÈÁÁÔÌ˘ÂÏÈÓ¿ÛË Ì ·ÔÙ¤ÏÂÛÌ· ÙË Û˘ÛÛÒÚ¢ÛË ÛÊÈÁÁÔÌ˘ÂÏ›Ó˘ Î·È ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÔ˘˜ Ù‡Ô˘˜ ∞ Î·È µ, ÂÓÒ Ë ‰Â‡ÙÂÚË ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ·ÓÂ¿ÚÎÂÈ· Ù˘ ÚˆÙ½Ó˘ NP-C1 ‹ ∏∂1 Ô˘ Ô‰ËÁ› Û ‰È·Ù·Ú·¯‹ ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ Î·È ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÔ˘˜ Ù‡Ô˘˜ C Î·È D. ∏ ÓfiÛÔ˜ ÎÏËÚÔÓÔÌÂ›Ù·È Ì ÙÔÓ ·˘ÙÔۈ̷ÙÈÎfi ˘ÔÏÂÈfiÌÂÓÔ ¯·Ú·ÎÙ‹Ú·. ∏ ·ÚÔ˘Û›· ·ÊÚˆ‰ÒÓ Î˘ÙÙ¿ÚˆÓ ÛÙÔ Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ Î·È ¿ÏÏÔ˘˜ ÈÛÙÔ‡˜, ηıÒ˜ Î·È Ë ÔÈΛÏÔ˘ ‚·ıÌÔ‡ ÔÚÁ·ÓÔÌÂÁ·Ï›·, ·ÔÙÂÏÔ‡Ó ÎÔÈÓ¿ ¯·Ú·ÎÙËÚÈÛÙÈο fiÏˆÓ ÙˆÓ ÌÔÚÊÒÓ, ÂÓÒ ÛÔ‚·Ú‹ Ó¢ÚÔÏÔÁÈ΋ Û˘ÌÌÂÙÔ¯‹ ·ÊÔÚ¿ ÙÔ˘˜ Ù‡Ô˘˜ A Î·È C, Î·È fi¯È ÙÔÓ Ù‡Ô µ Ù˘ ÓfiÛÔ˘ (1,2).

O Ù‡Ô˜ C Ù˘ ÓfiÛÔ˘ Niemann Pick (NP-C) ·ÔÙÂÏ› Û¿ÓÈ· ‰È·Ù·Ú·¯‹ ÌÂ Û˘¯ÓfiÙËÙ· 1 ÛÙȘ 10.000 ÁÂÓÓ‹ÛÂȘ ˙ÒÓÙˆÓ ÓÂÔÁÓÒÓ Î·È ÎÏËÚÔÓÔÌÂ›Ù·È Ì ÙÔÓ ·˘ÙÔۈ̷ÙÈÎfi ˘ÔÏÂÈfiÌÂÓÔ ¯·Ú·ÎÙ‹Ú· (3). ∏ ÁÂÓÂÙÈ΋ Î·È ÎÏÈÓÈ΋ ÂÙÂÚÔÁ¤ÓÂÈ· Ù˘ ÓfiÛÔ˘ ‰›ÓÂÈ ¤Ó· ¢ڇ Ê¿ÛÌ· Ê·ÈÓÔÙ‡ˆÓ Ô˘ ‰È·Ê¤ÚÔ˘Ó ˆ˜ ÚÔ˜ ÙËÓ ËÏÈΛ· ¤Ó·Ú͢ ÙˆÓ Û˘Ìو̿وÓ, ÙÔ ‚·ıÌfi Û˘ÌÌÂÙÔ¯‹˜ ÔÚÁ·ÓÔÌÂÁ·Ï›·˜ Î·È ÙÔ ‚·ıÌfi Ó¢ÚÔÏÔÁÈ΋˜ ÂÎʇÏÈÛ˘ Î·È ‰˘ÛÏÂÈÙÔ˘ÚÁ›·˜. ™˘Ó‹ıˆ˜ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi Ë·ÙÔÛÏËÓÈÎfi Û‡Ó‰ÚÔÌÔ Î·È ÂÍÂÏÈÎÙÈ΋ Ó¢ÚÔÏÔÁÈ΋ ÂÎʇÏÈÛË, Ù· ÔÔ›· Û ÌÔÚÈ·Îfi Â›Â‰Ô ÔÊ›ÏÔÓÙ·È Û ‰È·Ù·Ú·¯‹ ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘, Ì ¿ıÚÔÈÛË Ù˘ ÌË ÂÛÙÂÚÔÔÈË̤Ó˘ ÌÔÚÊ‹˜ Ù˘ ÛÙ· Ï˘ÛÔۈ̿ÙÈ· ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÙÔ˘ ∫¡™ Î·È ¿ÏÏˆÓ ÈÛÙÒÓ, ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÌÂÙ·ÏÏ¿ÍÂˆÓ ÛÙÔ ÁÔÓ›‰ÈÔ NP-C1 (ÁÈ· ÙÔ 95% ÙˆÓ ·ÛıÂÓÒÓ) ‹ ÛÙÔ ÁÔÓ›‰ÈÔ NP-C2 (ÁÈ· ÙÔ ˘fiÏÔÈÔ 5% ÙˆÓ ·ÛıÂÓÒÓ) (4-7). ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ÂÓfi˜ ·ÁÔÚÈÔ‡ 3,5 ÂÙÒÓ Ì ÓfiÛÔ NP-C1 Ô˘ ‰È·ÁÓÒÛıËΠÛÙ· Ï·›ÛÈ· ÂϤÁ¯Ô˘ „˘¯ÔÎÈÓËÙÈ΋˜ ·ÏÈÓ‰ÚfiÌËÛ˘, Ì ÙËÓ ·ÚÔ˘Û›· Ë·ÙÔÛÏËÓÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ ÁÓˆÛÙÔ‡ ·fi ÙËÓ ËÏÈΛ· ÙˆÓ 3 ÌËÓÒÓ. ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ∞ÁfiÚÈ ËÏÈΛ·˜ 3,5 ÂÙÒÓ ÂÈÛ¿ÁÂÙ·È ÛÙËÓ ∫ÏÈÓÈ΋ ÁÈ· ¤ÏÂÁ¯Ô „˘¯ÔÎÈÓËÙÈ΋˜ ·ÏÈÓ‰ÚfiÌËÛ˘. ∂›Ó·È ÙÔ ‰Â‡ÙÂÚÔ ·È‰› 6ÌÂÏÔ‡˜ ÔÈÎÔÁ¤ÓÂÈ·˜, Ê·ÈÓÔÙ˘Èο ˘ÁÈÒÓ ÁÔÓ¤ˆÓ, Ô˘ ÁÂÓÓ‹ıËΠÌÂÙ¿ ·fi ÙÂÏÂÈfiÌËÓË Î‡ËÛË ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ÙÔÎÂÙfi. ∆· ۈ̷ÙÔÌÂÙÚÈο ÛÙÔȯ›· ηٿ ÙË Á¤ÓÓËÛË ‹Ù·Ó ÂÓÙfi˜ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÔÚ›ˆÓ Î·È Ë ÂÚÈÁÂÓÓËÙÈ΋ ÂÚ›Ô-

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‰Ô˜ ·Ó·Ê¤ÚÂÙ·È ÔÌ·Ï‹. ∞fi ÙÔ ·ÙÔÌÈÎfi ÈÛÙÔÚÈÎfi ÙÔ˘ ·È‰ÈÔ‡ ·Ó·Ê¤ÚÂÙ·È ÓÔÛËÏ›· Û ËÏÈΛ· 3 ÌËÓÒÓ ÁÈ· ¤ÏÂÁ¯Ô Ë·ÙÔÛÏËÓÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘, ¯ˆÚ›˜ ˆÛÙfiÛÔ Ó· ‰È·ÈÛÙˆı› Û˘ÁÎÂÎÚÈ̤ÓË ‰È·Ù·Ú·¯‹ ·fi ÙÔÓ ÎÏÈÓÈÎfi Î·È ·Ú·ÎÏÈÓÈÎfi ¤ÏÂÁ¯Ô. ¢¤Î· Ì‹Ó˜ ÚÈÓ ÙËÓ ÂÈÛ·ÁˆÁ‹ ·Ó·Ê¤ÚÂÙ·È ·ÏÏ·Á‹ Û˘ÌÂÚÈÊÔÚ¿˜ Ì ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ı˘ÌÈÎÔ‡, ÂÌÊ¿ÓÈÛË ÂÈıÂÙÈÎfiÙËÙ·˜ Î·È ·ÓÙÈÎÔÈÓˆÓÈ΋˜ Û˘ÌÂÚÈÊÔÚ¿˜, ·ÏÈÓ‰ÚfiÌËÛË ÔÌÈÏ›·˜, ‰È·Ù·Ú·¯¤˜ ÎÈÓËÙÈÎfiÙËÙ·˜ Ì ·ÛÙ¿ıÂÈ· ‚¿‰ÈÛ˘ Î·È Û˘¯Ó¤˜ ÙÒÛÂȘ, ηıÒ˜ Î·È ‰Â˘ÙÂÚÔ·ı‹˜ ·ÒÏÂÈ· ÂϤÁ¯Ô˘ ÙˆÓ ÛÊÈÁÎÙ‹ÚˆÓ. ∫·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÛÙËÓ ∫ÏÈÓÈ΋, ÙÔ ·È‰› ÂÈÛÎÔÈο ·ÚÔ˘Û›·˙ Âί˘ÌÒÛÂȘ ÛÙÔ ÛÏ·¯ÓÈÎfi ÎÚ·Ó›Ô ÏfiÁˆ ÙˆÓ Û˘¯ÓÒÓ ÙÒÛˆÓ, ÂÓÒ Î·Ù¿ ÙËÓ „ËÏ¿ÊËÛË Ù˘ ÎÔÈÏ›·˜ ‰È·ÈÛÙÒıËΠË·ÙÔÛÏËÓÔÌÂÁ·Ï›· (·ÚÈÛÙÂÚfi˜ ÏÔ‚fi˜ „ËÏ·ÊËÙfi˜ 2-3 cm Î·È ÛÏ‹Ó·˜ „ËÏ·ÊËÙfi˜ 2-3 cm οوıÂÓ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ Ï¢ÚÈÎÔ‡ ÙfiÍÔ˘). ∞fi ÙË Ó¢ÚÔÏÔÁÈ΋ ÂͤٷÛË ‰È·ÈÛÙÒıËΠ·Ù·Í›· Î·È ‰˘ÛÎÔÏ›· ÛÙËÓ Î›ÓËÛË ÙˆÓ ÔÊı·ÏÌÒÓ ÚÔ˜ Ù· ¿Óˆ ÛÙÔÓ Î¿ıÂÙÔ ¿ÍÔÓ· (οıÂÙË ¿ÚÂÛË ‚ϤÌÌ·ÙÔ˜).

O ·ÈÌ·ÙÔÏÔÁÈÎfi˜ Î·È ‚ÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ ‹Ù·Ó ÂÓÙfi˜ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÔÚ›ˆÓ, Ì ÂÍ·›ÚÂÛË ÌÈÎÚ‹ ·‡ÍËÛË Ù˘ SGOT (134 IU/dl). O ˘ÂÚ˯ÔÁÚ·ÊÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÎÔÈÏ›·˜ ÂȂ‚·›ˆÛ ÙËÓ ·ÚÔ˘Û›· Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›·˜, ÂÓÒ Ë Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘, Ù· ÛÙÂϯȷ›· ·ÎÔ˘ÛÙÈο, Ù· ÔÙÈο Î·È Ù· ۈ̷ÙÔ·ÈÛıËÙÈο ÚÔÎÏËÙ¿ ‰˘Ó·ÌÈο ‹Ù·Ó ¯ˆÚ›˜ ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·. OÈ Ù·¯‡ÙËÙ˜ ·ÁˆÁÈÌfiÙËÙ·˜ ÙˆÓ ÂÚÈÊÂÚÈÎÒÓ ÓÂ‡ÚˆÓ ¤‰ÂÈÍ·Ó Â˘Ú‹Ì·Ù· ÂÓ‰ÂÈÎÙÈο ‹È·˜ ·ÔÌ˘ÂÏÈÓˆÙÈ΋˜ ÔÏ˘Ó¢ÚÔ¿ıÂÈ·˜. OÈ ÎÈÓËÙÈΤ˜ Ù·¯‡ÙËÙ˜ ·ÁˆÁÈÌfiÙËÙ·˜ ÙÔ˘ ÂÚÔÓÈ·›Ô˘ Î·È ÎÓËÌÈ·›Ô˘ Ó‡ÚÔ˘ ‹Ù·Ó 33,2 Î·È 32,0 m/sec ·ÓÙ›ÛÙÔȯ· Ì ηÙÒÙÂÚ˜ Ê˘ÛÈÔÏÔÁÈΤ˜ ÙÈ̤˜ 46,7 Î·È 38,2 m/sec ·ÓÙ›ÛÙÔȯ· Î·È Ê˘ÛÈÔÏÔÁÈο Û‡ÓıÂÙ· Ì˘˚ο ‰˘Ó·ÌÈο, ÂÓÒ ÔÈ ·ÈÛıËÙÈΤ˜ Ù·¯‡ÙËÙ˜ ·ÁˆÁÈÌfiÙËÙ·˜ ÙÔ˘ ̤ÛÔ˘ Î·È Á·ÛÙÚÔÎÓËÌÈ·›Ô˘ Ó‡ÚÔ˘ ‹Ù·Ó 35,3 Î·È 40,0 m/sec ·ÓÙ›ÛÙÔȯ· Ì ηÙÒÙÂÚ˜ Ê˘ÛÈÔÏÔÁÈΤ˜ ÙÈ̤˜ 42,8 Î·È 46,7 m/sec ·ÓÙ›ÛÙÔȯ· Î·È Ê˘ÛÈÔÏÔÁÈο Û‡ÓıÂÙ· ·ÈÛıËÙÈο ‰˘Ó·ÌÈο. ∏ ÔÚÁ·ÓÔÌÂÁ·Ï›· ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙË Ó¢ÚÔÏÔÁÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ¤ıÂÛ·Ó ÙËÓ ˘fiÓÔÈ· Èı·ÓÔ‡ ÌÂÙ·‚ÔÏÈÎÔ‡ ÓÔÛ‹Ì·ÙÔ˜, ÁÈ· ÙË ‰ÈÂÚ‡ÓËÛË ÙÔ˘ ÔÔ›Ô˘ ·ÎÔÏÔ‡ıËÛ ÂͤٷÛË Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ (ªÈÎÚÔ‚ÈÔÏÔÁÈÎfi ∂ÚÁ·ÛÙ‹ÚÈÔ ¶·È‰È·ÙÚÈ΋˜ ∫ÏÈÓÈ΋˜) Ô˘ ¤‰ÂÈÍ ‰Â›ÁÌ· ΢ÙÙ·ÚÔ‚ÚÈı¤˜ Ì ·ÚÔ˘Û›· ¿ÊıÔÓˆÓ ÈÛÙÈÔ΢ÙÙ¿ÚˆÓ Ì ·ÊÚ҉˜ ΢ÙÙ·ÚfiÏ·ÛÌ·, ÂÓ‰ÂÈÎÙÈο Ù˘ ÓfiÛÔ˘ NP (∂ÈÎfiÓ· 1). °È· ÙËÓ ÂȂ‚·›ˆÛË Ù˘ ‰È¿ÁÓˆÛ˘ Î·È ÙÔÓ Î·ıÔÚÈÛÌfi ÙÔ˘ Ù‡Ô˘ Ù˘ ÓfiÛÔ˘ ÂÏ‹ÊıË ‚ÈÔ„›· ‰¤ÚÌ·ÙÔ˜ ÁÈ· ηÏÏȤÚÁÂÈ· ÈÓÔ‚Ï·ÛÙÒÓ, fiÔ˘

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∂ÈÎfiÓ· 1. ∆˘Èο ÈÛÙÈÔ·ÙÙ·Ú· Ì ·ÊÚ҉˜ ΢ÙÙ·ÚfiÏ·ÛÌ· ÂÓ‰ÂÈÎÙÈο Ù˘ ÓfiÛÔ˘ Niemann-Pick C.

‰È·ÈÛÙÒıËÎ·Ó ·˘ÍË̤ӷ Â›‰· ÌË ÂÛÙÂÚÔÔÈË̤Ó˘ ¯ÔÏËÛÙÂÚfiÏ˘ (ÌÂÙ¿ ·fi ÈÛÙÔ¯ËÌÈ΋ ¯ÚÒÛË Ì ÊÈÏÈ›ÓË) Î·È ¯·ÌËÏ¿ Â›‰· ÂÓ‰Ô΢ÙÙ·ÚÈ΋˜ Û‡ÓıÂÛ˘ ÂÛÙ¤ÚˆÓ ¯ÔÏËÛÙÂÚfiÏ˘ (·ÛıÂÓ‹˜ 70 pmol/mg ÚˆÙ½Ó˘ ÌÂÙ¿ ·fi 4,5 ÒÚ˜, Ì¿ÚÙ˘Ú˜ 2950±1200 pmol/mg ÚˆÙ½Ó˘), Â˘Ú‹Ì·Ù· Û˘Ì‚·Ù¿ Ì ÓfiÛÔ NP-C. ¶ÂÚ·ÈÙ¤Úˆ ÌÂϤÙ˜ Ù·˘ÙÔÔ›ËÛ˘ (complementation studies) Î·Ù¤Ù·Í·Ó ÙÔÓ ·ÛıÂÓ‹ ÛÙËÓ ÔÌ¿‰· NP-C1. ¶·Ú¿ Ù·‡Ù·, ÁÔÓȉȷ΋ ÌÂϤÙË ÁÈ· ÙËÓ ÎÔÈÓ‹ ÌÂÙ¿ÏÏ·ÍË NP-C1, Ë ÔÔ›· ·Ó¢ڛÛÎÂÙ·È ÛÙÔ 95% ÙˆÓ ÂÚÈÙÒÛÂˆÓ (4-7), ·¤‚Ë ·ÚÓËÙÈ΋. ™˘˙‹ÙËÛË ¶·Ú¿ ÙËÓ ÎÏÈÓÈ΋ ÂÙÂÚÔÁ¤ÓÂÈ· Ù˘ ÓfiÛÔ˘ NP-C Ô˘ ·ÊÔÚ¿ ÙfiÛÔ ÛÙËÓ ËÏÈΛ· ÂÌÊ¿ÓÈÛ˘ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ fiÛÔ Î·È ÛÙÔ ‚·ıÌfi ÔÚÁ·ÓÔÌÂÁ·Ï›·˜ Î·È Ó¢ÚÔÏÔÁÈ΋˜ Û˘ÌÌÂÙÔ¯‹˜, ÂÚÈÁÚ¿ÊÔÓÙ·È ÙÚÂȘ ÎÔÈÓÔ› Ê·ÈÓfiÙ˘ÔÈ (1,2,4): ·) ÚÒÈÌË ¤Ó·ÚÍË ÛÙË ‚ÚÂÊÈ΋ ËÏÈΛ· Ì ٷ¯Â›· ÂͤÏÈÍË Ô˘ Û¯ÂÙ›˙ÂÙ·È Ì Ë·ÙÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Î·È „˘¯ÔÎÈÓËÙÈ΋ ηı˘ÛÙ¤ÚËÛË, ‚) ¤Ó·ÚÍË ÛÙËÓ ·È‰È΋ ËÏÈΛ· (Û˘Ó‹-

ıˆ˜ Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ÎÔÈÓ‹ ÌÂÙ¿ÏÏ·ÍË NP-C1) Ô˘ ÂΉËÏÒÓÂÙ·È Ì ̷ıËÛȷΤ˜ ‰˘ÛÎÔϛ˜ ‹ „˘¯ÔÎÈÓËÙÈ΋ ·ÏÈÓ‰ÚfiÌËÛË Î·È Á) ηı˘ÛÙÂÚË̤ÓË ¤Ó·ÚÍË Ù˘ ÓfiÛÔ˘ ÛÙËÓ ÂÊË‚È΋ ‹ ÂÓ‹ÏÈÎË ˙ˆ‹. µÈ‚ÏÈÔÁÚ·ÊÈο ·Ó·Ê¤ÚÂÙ·È ˆ˜ Ë ÓfiÛÔ˜ ÌÔÚ› Ó· ÂΉËψı› Û ÔÔÈ·‰‹ÔÙ ËÏÈΛ·, ·fi ÙË ÓÂÔÁÓÈ΋ ÂÚ›Ô‰Ô Ì¤¯ÚÈ ÙËÓ 4Ë ‹ 5Ë ‰ÂηÂÙ›· Ù˘ ˙ˆ‹˜, Û˘¯ÓfiÙÂÚ· fï˜ ÛÙÔ 2Ô-3Ô ¯ÚfiÓÔ Ù˘ ˙ˆ‹˜ (1,2). ∏ ÔÚÁ·ÓÔÌÂÁ·Ï›· Ì ÙË ÌÔÚÊ‹ Ù˘ ÛÏËÓÔ‹/Î·È Ë·ÙÔÌÂÁ·Ï›·˜ ÌÔÚ› Ó· ÚÔËÁÂ›Ù·È ‹ Ó· ¤ÂÙ·È ÙˆÓ Ó¢ÚÔÏÔÁÈÎÒÓ ÂΉËÏÒÛˆÓ. OÈ Imrie Î·È Wraith ¤¯Ô˘Ó ·Ó·ÎÔÈÓÒÛÂÈ Ù¤ÛÛÂÚȘ ÂÚÈÙÒÛÂȘ ·È‰ÈÒÓ Ì NP-C Ô˘ ÁÈ· ÔÏÏ¿ ¯ÚfiÓÈ· ÙÔ ÌÔÓ·‰ÈÎfi ÎÏÈÓÈÎfi ÛËÌÂ›Ô Ù˘ ÓfiÛÔ˘ ‹Ù·Ó Ë ÛÏËÓÔÌÂÁ·Ï›· (4). ŒÓ· ¢ڇ Ê¿ÛÌ· Ê·ÈÓÔÙ‡ˆÓ ·ÊÔÚ¿ ÛÙȘ Ó¢ÚÔÏÔÁÈΤ˜ ÂΉËÏÒÛÂȘ Ù˘ ÓfiÛÔ˘ (1,2,4,6). ™Â ÌÂÚÈÎÔ‡˜ ·ÛıÂÓ›˜ ÂÚÈÁÚ¿ÊÂÙ·È Ê˘ÛÈÔÏÔÁÈ΋ ·Ó¿Ù˘ÍË Î·Ù¿ ÙË ‚ÚÂÊÈ΋ Î·È ÚÒÙË ÓËȷ΋ ËÏÈΛ·, Ì ÙËÓ ÂÌÊ¿ÓÈÛË ·ÚÁfiÙÂÚ· Ì·ıËÛÈ·ÎÒÓ ‰˘ÛÎÔÏÈÒÓ ‹ „˘¯ÔÎÈÓËÙÈ΋˜ ·ÏÈÓ‰ÚfiÌËÛ˘, ÂÓÒ Û ¿ÏÏÔ˘˜ ·ÚÔ˘ÛÈ¿˙ÂÙ·È ˘ÔÙÔÓ›· Î·È „˘¯ÔÎÈÓËÙÈ΋

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ηı˘ÛÙ¤ÚËÛË ·fi ÙË ‚ÚÂÊÈ΋ ËÏÈΛ·. ∏ ÎÏÈÓÈ΋ ÂÈÎfiÓ· Û˘¯Ó¿ ÂÚÈÏ·Ì‚¿ÓÂÈ ·Ù·Í›·, ‰˘ÛÙÔÓ›·, ηٷÏËÍ›· (Ì ÙËÓ ÂÈÎfiÓ· Ù˘ ·ÈÊÓ›‰È·˜ ·ÒÏÂÈ·˜ ÙÔ˘ Ì˘˚ÎÔ‡ ÙfiÓÔ˘ Ô˘ Ô‰ËÁ› Û ÙÒÛÂȘ), ‰˘Û·ÚıÚ›· Î·È ¿ÓÔÈ·. §ÈÁfiÙÂÚÔ Û˘¯Ó¿ ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÌÊ¿ÓÈÛË ÙÚfiÌÔ˘ ‹ Î·È Û·ÛÌÒÓ (Ô˘ ‰ÂÓ ÂϤÁ¯ÔÓÙ·È Â‡ÎÔÏ·). ŒÓ· ÂȉÈÎfi ‡ÚËÌ· Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È ÛÙÔ˘˜ ÂÚÈÛÛfiÙÂÚÔ˘˜ ·ÛıÂÓ›˜ Ì NP-C Â›Ó·È Ë ‰˘ÛÎÔÏ›· ΛÓËÛ˘ ÙˆÓ ÔÊı·ÏÌÈÎÒÓ ‚ÔÏ‚ÒÓ ÛÙÔ Î¿ıÂÙÔ Â›Â‰Ô (οıÂÙË ·Ú¿Ï˘ÛË ‚ϤÌÌ·ÙÔ˜ ‹ οıÂÙË ˘ÂÚ˘ÚËÓÈ΋ ÔÊı·ÏÌÔÏËÁ›·) (1,2,4,7). øÛÙfiÛÔ, ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› Î·È ÌÔÚʤ˜ Ù˘ ÓfiÛÔ˘ ¯ˆÚ›˜ Ó¢ÚÔÏÔÁÈΤ˜ ‰È·Ù·Ú·¯¤˜ (2,4,6,8). ∞ӷʤÚÂÙ·È ˆ˜ Ë NP-C ÌÔÚ› Ó· ·ÔÙÂϤÛÂÈ ·›ÙÈÔ ÂÌ‚Ú˘˚ÎÔ‡ ‡‰Úˆ· ‹ Ó· ÂÌÊ·ÓÈÛÙ› ˆ˜ ÔÍ›· ÓÂÔÁÓÈ΋ Ë·Ù›Ùȉ· (1,6) Î·È ·ÎfiÌË Ì ÙË ÌÔÚÊ‹ ‰È¿ÌÂÛ˘ Ó¢ÌÔÓ›·˜ Ô˘ Ô‰ËÁ› Û ÛÔ‚·Ú‹ ·Ó·Ó¢ÛÙÈ΋ ·ÓÂ¿ÚÎÂÈ· Î·È ·ÊÔÚ¿ Û˘¯ÓfiÙÂÚ· ÛÙȘ ÂÚÈÙÒÛÂȘ ÌÂÙ¿ÏÏ·Í˘ ÛÙÔ ÁÔÓ›‰ÈÔ NP-C2 (1,9).

OÈ ·ÛıÂÓ›˜ Ì ÚÒÈÌË ¤Ó·ÚÍË ÌÔÚ› Ó· ηٷϋÍÔ˘Ó ÚÈÓ ÙË Û¯ÔÏÈ΋ ËÏÈΛ·, ÂÓÒ ·Ó Ë ÚÒÙË ÂΉ‹ÏˆÛË Ù˘ ÓfiÛÔ˘ ·ÊÔÚ¿ ÛÙË Û¯ÔÏÈ΋ ËÏÈΛ·, ÌÔÚ› Ó· ÂÈ˙‹ÛÔ˘Ó Ì¤¯ÚÈ ÙË 2Ë ‰ÂηÂÙ›· Ù˘ ˙ˆ‹˜ ÙÔ˘˜ (4). O ·ÛıÂÓ‹˜ Ì·˜ ·ÚÔ˘Û›·Û Ë·ÙÔÛÏËÓÈÎfi Û‡Ó‰ÚÔÌÔ ·fi ÙË ‚ÚÂÊÈ΋ ËÏÈΛ·, ˆÛÙfiÛÔ Ë ˘Ô„›· Î·È ‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘ Ù¤ıËΠ۠ËÏÈΛ· 3,5 ÂÙÒÓ, fiÙ·Ó ÛÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÚÔÛÙ¤ıËÎ·Ó Î·È Û˘ÌÙÒÌ·Ù· ·fi ÙÔ ∫¡™. ¶ÚfiÎÂÈÙ·È ÁÈ· ÙË ‰Â‡ÙÂÚË ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ÓfiÛÔ˘ NP-C ÛÙËÓ ÂÏÏËÓÈ΋ ‚È‚ÏÈÔÁÚ·Ê›·. H ÚÒÙË ·ÊÔÚÔ‡Û ÂÚ›ÙˆÛË ÎÔÚÈÙÛÈÔ‡ 7 ÌËÓÒÓ Ô˘ ÚÔ¤‚·Ï Ì ÂÈÎfiÓ· ·ÔÊÚ·ÎÙÈÎÔ‡ ÈÎÙ¤ÚÔ˘ Î·È Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›· Î·È ÙÔ ÔÔ›Ô ‰ÂÓ Â›¯Â Ó¢ÚÔÏÔÁÈ΋ Û˘ÌÌÂÙÔ¯‹ ¤ˆ˜ ÙËÓ ËÏÈΛ· Ù˘ ÙÂÏÂ˘Ù·›·˜ ÂͤٷÛ˘ (3 ÂÙÒÓ) (10). ¶·Ú¿ Ù·‡Ù·, ¤ÍÈ ÂÈϤÔÓ ·‰ËÌÔÛ›Â˘Ù˜ ÂÚÈÙÒÛÂȘ Ù˘ ÓfiÛÔ˘ (∂. ªÈ¯ÂϷοÎË, πÓÛÙÈÙÔ‡ÙÔ ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡, ÚÔÛˆÈ΋ ÂÈÎÔÈÓˆÓ›·) ·˘Í¿ÓÔ˘Ó ÙÔÓ ·ÚÈıÌfi ÙˆÓ ÂÚÈÙÒÛÂˆÓ Ù˘ ÓfiÛÔ˘ ÛÙÔÓ ∂ÏÏ·‰ÈÎfi ¯ÒÚÔ Û ÔÎÙÒ. ∏ ÂÚÈÊÂÚÈ΋ ÔÏ˘Ó¢ÚÔ¿ıÂÈ· ·ÔÌ˘ÂÏÈÓˆÙÈÎÔ‡ Ù‡Ô˘ ‹Ù·Ó ¤Ó· ÂÈϤÔÓ Â‡ÚËÌ· Û˘ÌÌÂÙÔ¯‹˜ ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Ô˘ Èı·Ófiٷٷ Ó· Û˘ÓÂÈÛʤÚÂÈ Î·Ù¿ ¤Ó· ÔÛÔÛÙfi ÛÙË Ó¢ÚÔÏÔÁÈ΋ ÂÈÎfiÓ· ÙÔ˘ ·ÛıÂÓÔ‡˜ Ì·˜. ∞ÛÙ¿ıÂÈ· ‚¿‰ÈÛ˘, Û˘¯Ó¤˜ ÙÒÛÂȘ, ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÏËÌÌÂÏ‹ ÔÊı·ÏÌÔÎÈÓËÙÈ΋ Û˘Ó¤ÚÁÂÈ· (Û˘ÓÂ›· Ù˘ ¿ÚÂÛ˘ ÙÔ˘ οıÂÙÔ˘ ‚ϤÌÌ·ÙÔ˜), ·ÏÏ¿ Î·È È‰ÈfiÌÔÚʘ ÎÚ›ÛÂȘ “ηٷÏËÍ›·˜” Â›Û˘ ÂÚÈÁÚ¿ÊÔÓÙ·È Û ·ÛıÂÓ›˜ Ì NP-C. ∂ȉÈÎfiÙÂÚ· fiÛÔÓ ·ÊÔÚ¿ ÛÙË Û˘¯ÓfiÙËÙ· Ù˘ ÂÚÈÊÂÚÈ΋˜ Ó¢ÚÔ¿ıÂÈ·˜ ÛÙË NP-C, ÌfiÓÔ 3 ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ÂÚÈÙÒÛÂȘ ˘¿Ú¯Ô˘Ó ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›· (11-13).

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º·›ÓÂÙ·È fï˜ fiÙÈ Â›Ó·È Û˘¯ÓfiÙÂÚË ·’ fi,ÙÈ ÂÚÈÁÚ¿ÊÂÙ·È (ª. Vanier, ÚÔÛˆÈ΋ ÂÈÎÔÈÓˆÓ›·). ¶¿ÓÙˆ˜, Ë Û˘ÌÌÂÙÔ¯‹ ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Â›Ó·È ‰Â‰Ô̤ÓË ÛÙÔ ÂÈÚ·Ì·ÙÈÎfi ÌÔÓÙ¤ÏÔ Ù˘ ÓfiÛÔ˘ (BALB/c ÔÓÙ›ÎÈ·) Î·È Ì¿ÏÈÛÙ· ·Ó·ÛÙÚ¤ÊÂÙ·È Ì ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË ÂÌ‚Ú˘˚ÎÒÓ Ë·ÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ, Ù· ÔÔ›· ‰ÈÔÚıÒÓÔ˘Ó ÙËÓ ÂÓ·fiıÂÛË ÙˆÓ ÏÈȉ›ˆÓ ÛÙÔ˘˜ ‰È¿ÊÔÚÔ˘˜ ÈÛÙÔ‡˜ (14). ∏ Ù·˘ÙÔÔ›ËÛË ÙÔ˘ ÁÔÓȉ›Ô˘ NP-C1 ·fi ÙÔÓ Castea Î·È Û˘Ó ÙÔ 1997 (15) ¤‰ˆÛ Ӥ· ÒıËÛË ÛÙËÓ ¤Ú¢ӷ Û¯ÂÙÈο Ì ÙË ÓfiÛÔ NP-C. ∆Ô ÁÔÓ›‰ÈÔ NP-C1 ¤¯ÂÈ ¯·ÚÙÔÁÚ·ÊËı› ÛÙÔ ¯ÚˆÌfiۈ̷ 18q11-12 Î·È Îˆ‰ÈÎÔÔÈ› Ì›· ÁÏ˘ÎÔÚˆÙ½ÓË Ì ÌÔÚÈ·Îfi ‚¿ÚÔ˜ 142 KDa ·ÔÙÂÏÔ‡ÌÂÓË ·fi 1278 ·ÌÈÓÔͤ· (1,5,16,17). OÈ ÌÂÙ·ÏÏ¿ÍÂȘ ÛÙÔ NP-C1 ÁÔÓ›‰ÈÔ Â˘ı‡ÓÔÓÙ·È ÁÈ· ÙÔ 95% ÙˆÓ ÂÚÈÙÒÛÂˆÓ NP-C (4,18). °È· ÙÔ ˘fiÏÔÈÔ 5% Ê·›ÓÂÙ·È ˆ˜ ¢ı‡ÓÂÙ·È ¤Ó· ‰Â‡ÙÂÚÔ ÁÔÓ›‰ÈÔ, ÙÔ NP-C2. ∆Ô ÁÔÓ›‰ÈÔ ·˘Ùfi Έ‰ÈÎÔÔÈ› ÙËÓ ÚˆÙ½ÓË ∏∂1 Î·È ¤¯ÂÈ ¯·ÚÙÔÁÚ·ÊËı› ÛÙÔ ¯ÚˆÌfiۈ̷ 14q24.3 (3). OÈ ÌÂÙ·ÏÏ¿ÍÂȘ ÛÙÔ NP-C1 ‹ NP-C2 ÁÔÓ›‰ÈÔ Ê·›ÓÂÙ·È fiÙÈ ÂËÚ¿˙Ô˘Ó ÙËÓ ›‰È· Ô‰fi ÂÓ‰Ô΢ÙÙ¿ÚÈÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘, ·Ó·ÛÙ¤ÏÏÔÓÙ·˜ Èı·ÓfiÓ ÙË ÌÂÙ·ÊÔÚ¿ Ù˘ ÌË ÂÛÙÂÚÔÔÈË̤Ó˘ Ù˘ ÌÔÚÊ‹˜ ÛÙÔ ÂÓ‰ÔÏ·ÛÌ·ÙÈÎfi ‰›ÎÙ˘Ô, ÌÂ Û˘Ó¤ÂÈ· ÙËÓ ¿ıÚÔÈÛ‹ Ù˘ ÛÙ· Ï˘ÛÔۈ̿ÙÈ· ‹/Î·È fi„ÈÌ· ÂÓ‰Ôۈ̿ÙÈ·. ∂ÓÒ Â›Ó·È ÁÓˆÛÙ‹ Ë ‰ÈÂÚÁ·Û›· ÌÂÙ·ÊÔÚ¿˜ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ ·fi ÙÔ Ï¿ÛÌ· ÛÙÔ ÂÛˆÙÂÚÈÎfi ÙˆÓ Î˘ÙÙ¿ÚˆÓ Î·È ÛÙË Û˘Ó¤¯ÂÈ· ÛÙ· Ï˘ÛÔۈ̿ÙÈ· ‹/Î·È fi„ÈÌ· ÂÓ‰Ôۈ̿ÙÈ·, ‰ÂÓ ¤¯ÂÈ ·ÎfiÌË ÂÍ·ÎÚÈ‚ˆı› Ô ÙÚfiÔ˜ ÌÂÙ·ÊÔÚ¿˜ Ù˘ ·fi Ù· Ï˘ÛÔۈ̿ÙÈ· ÛÙÔ ÂÓ‰ÔÏ·ÛÌ·ÙÈÎfi ‰›ÎÙ˘Ô. OÈ ÂÚ¢ÓËÙ¤˜ ˘Ôı¤ÙÔ˘Ó ˆ˜ Ë ÚˆÙ½ÓË NP-C1, Ô˘ ÂÓÙÔ›˙ÂÙ·È ÛÙË ÌÂÌ‚Ú¿ÓË ÙˆÓ Ï˘ÛÔۈ̷ٛˆÓ, ·ÔÙÂÏ› ÚˆÙ½ÓË-ÌÂÙ·ÊÔÚ¤· Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ ·fi ·˘Ù¿, ηıÒ˜ ÔÈ ÌÂÙ·ÏÏ¿ÍÂȘ Ù˘ Ô˘ ·ÊÔÚÔ‡Ó ÙȘ ÂÚÈÙÒÛÂȘ NP-C1 Û¯ÂÙ›˙ÔÓÙ·È Ì ¿ıÚÔÈÛË Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ ÛÙ· Ï˘ÛÔۈ̿ÙÈ·. øÛÙfiÛÔ, Û ÚfiÛÊ·ÙË ÌÂϤÙË, ÔÈ J. Davies Î·È Û˘Ó (19) ¤‰ÂÈÍ·Ó ˆ˜ Ë ÚˆÙ½ÓË NP-C1 Ê·›ÓÂÙ·È Ó· ÏÂÈÙÔ˘ÚÁ› ˆ˜ ‰È·ÌÂÌ‚Ú·ÓÈ΋ ·ÓÙÏ›· Ô˘ ÌÂٷʤÚÂÈ ·fi ÙÔ Û‡ÛÙËÌ· Ï˘ÛÔۈ̷ٛˆÓ/ÂÓ‰Ôۈ̷ٛˆÓ ÏÈÔÊÈÏÈο ÌfiÚÈ· (fiˆ˜ ÏÈ·Ú¿ Ôͤ·), fi¯È fï˜ Î·È ¯ÔÏËÛÙÂÚfiÏË Î·È ›Ûˆ˜ ÚfiÎÂÈÙ·È ÁÈ· ¢ηڢˆÙÈÎfi ̤ÏÔ˜ Ì›·˜ ÔÈÎÔÁ¤ÓÂÈ·˜ RND (resistance-nodulatin-division) ÚÔηڢˆÙÈÎÒÓ ÂÚÌ·ÛÒÓ. ∏ ‰Ú¿ÛË Ù˘ ˆ˜ ÂÚÌ¿Û˘ Ê·›ÓÂÙ·È Ó· Â›Ó·È ÛËÌ·ÓÙÈ΋ ÛÙË ‰È·Ù‹ÚËÛË Ù˘ ÂÓ‰Ô΢ÙÙ¿ÚÈ·˜ ÔÌÔÈfiÛÙ·Û˘ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘. ¶·Ú·Ì¤ÓÂÈ, ˆÛÙfiÛÔ, ·‰È¢ÎÚ›ÓÈÛÙÔ Ò˜ ÌÈ· ‰È·Ù·Ú·¯‹ ÛÙË ÌÂÙ·ÊÔÚ¿ ÙˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û ¿ıÚÔÈÛË ¯ÔÏËÛÙÂÚfiÏ˘, fiˆ˜ Û˘Ì‚·›ÓÂÈ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì NP-C (1,3-5,16-19).

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∏ ∏∂1 Â›Ó·È Ì›· Ï˘ÛÔÛˆÌȷ΋ ÚˆÙ½ÓË Ì ‰˘Ó·ÙfiÙËÙ· ‰¤ÛÌ¢Û˘ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘. ¶·Ú·Ì¤ÓÂÈ ·Û·Ê¤˜ Ò˜ ·ÎÚÈ‚Ò˜ Ë ∏∂1 Û˘ÓÂÈÛʤÚÂÈ ÛÙË ÌÂÙ·ÊÔÚ¿ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ ·fi Ù· Ï˘ÛÔۈ̿ÙÈ·, ηıÒ˜ Î·È Ò˜ Û˘Û¯ÂÙ›˙ÂÙ·È Ô ÚfiÏÔ˜ Ù˘ Ì ÙË ‰Ú¿ÛË Ù˘ NP-C1 (3,18-20). £· Ú¤ÂÈ Ó· ˘Ô„È·ÛÙԇ̠ÙË ÓfiÛÔ NP-C, ·Ú¿ ÙÔ Â˘Ú‡ Ê¿ÛÌ· ÎÏÈÓÈÎÒÓ ÂΉËÏÒÛˆÓ, Û οı ‚Ú¤ÊÔ˜ ‹ ·È‰› Ì ·ÁÓÒÛÙÔ˘ ·ÈÙÈÔÏÔÁ›·˜ ÔÚÁ·ÓÔÌÂÁ·Ï›· ‹/Î·È Ó¢ÚÔÏÔÁÈ΋ Û˘Ó‰ÚÔÌ‹ Ì ÙË ÌÔÚÊ‹ „˘¯ÔÎÈÓËÙÈ΋˜ ηı˘ÛÙ¤ÚËÛ˘ ‹ ·ÏÈÓ‰ÚfiÌËÛ˘ Î·È ·ÚÁfiÙÂÚ· ·Ù·Í›·˜, ‰˘Û·ÚıÚ›·˜ Î·È Î¿ıÂÙ˘ ÔÊı·ÏÌÔÏËÁ›·˜. O ·Ú¯ÈÎfi˜ ‰È·ÁÓˆÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ·ÊÔÚ¿ ÛÙËÓ ·Ó·˙‹ÙËÛË ·ÊÚˆ‰ÒÓ Î˘ÙÙ¿ÚˆÓ ÛÙÔ Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ, ÂÓÒ Ë ÙÂÎÌËÚ›ˆÛË Ù˘ ‰È¿ÁÓˆÛ˘ ı· Á›ÓÂÈ Ì ÙËÓ ·Ó‡ÚÂÛË ·˘ÍËÌ¤ÓˆÓ ÂÈ¤‰ˆÓ ÌË ÂÛÙÂÚÔÔÈË̤Ó˘ ¯ÔÏËÛÙÂÚfiÏ˘ Û ηÏÏȤÚÁÂÈ· ÈÓÔ‚Ï·ÛÙÒÓ ·fi ‚ÈÔ„›· ‰¤ÚÌ·ÙÔ˜ Î·È ¯·ÌËÏÒÓ ÂÈ¤‰ˆÓ ÂÛÙ¤ÚˆÓ ¯ÔÏËÛÙÂÚfiÏ˘, ηıÒ˜ Î·È ÁÔÓȉȷ΋ ÌÂϤÙË ÙˆÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙË ÓfiÛÔ (1,2,4). ¶ÚÔÁÂÓÓËÙÈ΋ ‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘ NP-C Â›Ó·È ‰˘Ó·Ù‹ Ì ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙÔ˘ ÂÈ¤‰Ô˘ ÌË ÂÛÙÂÚÔÔÈË̤Ó˘ ¯ÔÏËÛÙÂÚfiÏ˘ Û ηÏÏȤÚÁÂȘ ΢ÙÙ¿ÚˆÓ ÙÔ˘ ·ÌÓÈ·ÎÔ‡ ˘ÁÚÔ‡. ∂ÈϤÔÓ, Â›Ó·È ‰˘Ó·Ù‹ Ë ·Ó›¯Ó¢ÛË ÌÂÙ·ÏÏ¿ÍÂˆÓ ÛÙÔ ÁÔÓ›‰ÈÔ NP-C1 Û ηÏÏȤÚÁÂȘ ΢ÙÙ¿ÚˆÓ ÙÔ˘ ·ÌÓÈ·ÎÔ‡ ˘ÁÚÔ‡ Ì ÌÔÚȷΤ˜ Î·È ‚ÈÔ¯ËÌÈΤ˜ ÌÂıfi‰Ô˘˜ (21,22). ¢ÂÓ ˘¿Ú¯Ô˘Ó ȉȷ›ÙÂÚ˜ ‰˘Ó·ÙfiÙËÙ˜ ıÂÚ·¢ÙÈ΋˜ ·Ú¤Ì‚·Û˘ ÛÙ· ·È‰È¿ Ì NP-C. ∏ Û‡ÛÙ·ÛË ÁÈ· ‰È·ÙÚÔÊ‹ Ì ¯·ÌËÏ¿ ÏÈ·Ú¿, ηıÒ˜ Î·È Ë Ï‹„Ë Ê·Ú̷΢ÙÈÎÒÓ Û΢·ÛÌ¿ÙˆÓ ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô ÙˆÓ ÂÈ¤‰ˆÓ ¯ÔÏËÛÙÂÚfiÏ˘, Èı·ÓfiÓ Ó· ÂÚÈÔÚ›˙ÂÈ ÙËÓ ¿ıÚÔÈÛË ÏÈȉ›ˆÓ ÛÙÔ ‹·Ú, ˆÛÙfiÛÔ ‰ÂÓ ¤¯Ô˘Ó ηÌÈ¿ Â›‰Ú·ÛË ÛÙËÓ ÂͤÏÈÍË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ·fi ÙÔ ∫¡™ (1,23). ¶ÚfiÛÊ·Ù˜ ÌÂϤÙ˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ ˆ˜ ÛÙË ÓfiÛÔ NP-C, ¤Ú· ·fi ÙË Ï˘ÛÔÛˆÌȷ΋ ¿ıÚÔÈÛË ¯ÔÏËÛÙÂÚfiÏ˘, ·Ú·ÙËÚÂ›Ù·È Î·È ·ÓÂ¿ÚÎÂÈ· ÙˆÓ ÂÚÔÍ˘ÛˆÌ·Ù›ˆÓ. ™Â ÂÈÚ·Ì·Ùfi˙ˆ· ¤¯Ô˘Ó ‹‰Ë ‰ÔÎÈÌ·ÛÙ› ·Ú¿ÁÔÓÙ˜ Ô˘ ‰ÚÔ˘Ó ‰ÈÂÁÂÚÙÈο ÛÙ· ÂÚÔÍ˘ÛˆÌ¿ÙÈ·, fiˆ˜ Ë ÎÏÔÊÈÌÚ¿ÙË Î·È ÙÔ ÂÚÊÏÔ˘ÚÔÎÙ·ÓÈÎfi Ô͇, ÚÔηÏÒÓÙ·˜ ‚ÂÏÙ›ˆÛË Ù˘ ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ·˜ ÙˆÓ ÂÚÔÍ˘ÛˆÌ·Ù›ˆÓ, ·ÏÏ¿ Î·È ÂÚÈÔÚÈÛÌfi Ù˘ Ï˘ÛÔÛˆÌȷ΋˜ ¿ıÚÔÈÛ˘ ¯ÔÏËÛÙÂÚfiÏ˘ ÛÙÔ ‹·Ú, ÁÂÁÔÓfi˜ ȉȷ›ÙÂÚ· ÂÓı·ÚÚ˘ÓÙÈÎfi ÁÈ· Èı·Ó‹ ÂÊ·ÚÌÔÁ‹ Ù˘ ÌÂıfi‰Ô˘ Î·È Û ·ÓıÚÒÔ˘˜ (24). ªÂϤÙ˜ Ô˘ ·ÊÔÚÔ‡Ó ÛÙËÓ ÂÓ˙˘ÌÈ΋ ˘ÔηٿÛÙ·ÛË Ì ÌÂÙ·ÌfiÛ¯Â˘ÛË ‚Ô›Ԣ Ì˘ÂÏÔ‡ Â›Ó·È ‹‰Ë Û ÂͤÏÈÍË, ÂÓÒ Ë ÚfiÛÊ·ÙË ¯·ÚÙÔÁÚ¿ÊËÛË ÙˆÓ ˘‡ı˘ÓˆÓ ÁÔÓȉ›ˆÓ ‰ËÌÈÔ˘ÚÁ› ÂÏ›‰Â˜ ÁÈ· ÙË ‰˘Ó·ÙfiÙËÙ· ÁÔÓȉȷ΋˜ ıÂÚ·›·˜ ÛÙÔ Ì¤ÏÏÔÓ (1,25,26). ∂ÈϤÔÓ, ۯ‰ȿ˙ÂÙ·È Ë ÎÏÈÓÈ΋ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ Ê·ÚÌ¿-

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Hsu YS, Hwu WL, Huang SF, Lu MY, Chen RL, Lin DT et al. Niemann-Pick disease type C (a cellular cholesterol lipidosis) treated by bone marrow transplantation. Bone Marrow Transplant 1999;24:103-107.

Erlich S, Miranda SR, Visser JW, Dagan A, Gatt S, Schuchman EH. Fluorescence-based selection of genecorrected hematopoietic stem and progenitor cells from acid sphingomyelinase-deficient mice: implications for Niemann-Pick disease gene therapy and the development of improved stem cell gene transfer procedures. Blood 1999;93:80-86. http://www.npdf.org/treatmt.htm Barranger JA. Risks of Gaucher’s treatment. Lancet 2000;356:1353-1354.

Kranda M. Treatment of Gaucher’s disease with OGT 918.

Lancet 2000;356:677.

Mistry PK. Treatment of Gaucher’s disease with OGT 918.

Lancet 2000;356:676-677.

Mellor HR, Adam A, Platt FM, Dwek RA, Butter TD, Cox T et al. Novel oral treatment of Gaucher’s disease with Nbutyldeoxynojirimycin (OGT 918) to decrease substrate biosynthesis. Lancet 2000;355:1481-1485.

Abe A, Gregory S, Lee L, Killen PD, Brady RO, Kulkarni A et al. Reduction of globotriaosylceramide in Fabry disease mice by substrate deprivation. J Clin Invest 2000;105:1563-1571.

Abe A, Arend LJ, Lee L, Lingwood C, Brady RO, Shayman JA. Glycosphingolipid depletion in Fabry disease lymphoblasts with potent inhibitors of glucosylceramide synthase. Kidney Int 2000;57:446-454.

∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 18-01-2002 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 16-04-2002 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: Dr ¢ËÌ‹ÙÚÈÔ˜ π. ∑·ÊÂÈÚ›Ô˘ ¶·È‰›·ÙÚÔ˜-¶·È‰ÔÓ¢ÚÔÏfiÁÔ˜ ∂ÁÓ·Ù›·˜ 106, ∆.∫. 546 22, £ÂÛÛ·ÏÔÓ›ÎË E-mail: jeff@med.auth.gr

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E¶π∫∞πƒ∞ £∂ª∞∆∞

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CURRENT ISSUES

∞·ÁÔÚ‡ÛÂȘ ÛÙ· ·È‰È¿ Ù· ÔÔ›· ¿Û¯Ô˘Ó ·fi ÂÈÏË„›· ∞. ™Î·Ú‰Ô‡ÙÛÔ˘

Restrictions for children with epilepsy A. Skardoutsou

¶ÂÚ›ÏË„Ë: ∏ ηχÙÂÚË Î·Ù·ÓfiËÛË Ù˘ ÂÈÏË„›·˜ ÙËÓ ÙÂÏÂ˘Ù·›· ‰ÂηÂÙ›· Î·È Ë ¯ÚËÛÈÌÔÔ›ËÛË ÔÏÏÒÓ Ó¤ˆÓ ·ÓÙÈÂÈÏËÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ ¤¯Ô˘Ó ·ÏÏ¿ÍÂÈ ÙËÓ ·ÓÙ›ÏË„‹ Ì·˜ ÁÈ· ÙÔ Ì¤ÁÂıÔ˜ ÙÔ˘ Ê˘ÛÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘ ÙÔÓ ÔÔ›Ô ·ÓÙÈÌÂÙˆ›˙Ô˘Ó Ù· ¿ÙÔÌ· Ì ÂÈÏË„›·. ™‹ÌÂÚ· ıˆÚÂ›Ù·È fiÙÈ Ù· ¿ÙÔÌ· ·˘Ù¿ ı· Ú¤ÂÈ Ó· ÂÓı·ÚÚ‡ÓÔÓÙ·È Ó· ˙Ô˘Ó fiÛÔ ÙÔ ‰˘Ó·ÙfiÓ Ê˘ÛÈÔÏÔÁÈ΋ ˙ˆ‹ Î·È Ó· Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÙȘ ‰Ú·ÛÙËÚÈfiÙËÙ˜ ÔÈ Ôԛ˜ ‰ÂÓ Û˘ÓÂ¿ÁÔÓÙ·È ÛÔ‚·Úfi ΛӉ˘ÓÔ ÛˆÌ·ÙÈ΋˜ ‚Ï¿‚˘. ∂ÓÙÔ‡ÙÔȘ, ÔÚÈṲ̂Ó˜ ÚÔÊ˘Ï¿ÍÂȘ ÎÚ›ÓÔÓÙ·È ÛÎfiÈ̘. ¶ÂÚÈÁÚ¿ÊÔÓÙ·È ÔÈ ÛËÌ·ÓÙÈÎÔ› ΛӉ˘ÓÔÈ ÔÈ ÔÔ›ÔÈ ·ÂÈÏÔ‡Ó Ù· ¿ÙÔÌ· Ì ÂÈÏË„›·, ηıÒ˜ Î·È Ô‰ËÁ›Â˜ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘˜ ‚¿ÛÂÈ ÌÈ·˜ ‰ËÌÔÛ›Â˘Û˘ ÂÌÂÈÚÔÁÓˆÌfiÓˆÓ Ù˘ ¢ÈÂıÓÔ‡˜ ŒÓˆÛ˘ ÁÈ· ÙËÓ ∫·Ù·ÔϤÌËÛË Ù˘ ∂ÈÏË„›·˜ (International League Against Epilepsy) (7).

Abstract: Children with epilepsy should be encouraged to live as normal life as possible.

However many children with seizure disorders must take special precautions because of seizure related injuries. The specific injuries from a seizure and a set of guidelines based on a report of the International League against Epilepsy (7) is presented.

§¤ÍÂȘ ÎÏÂȉȿ: ÂÈÏË„›·, ·È‰È¿, ÙÚ·˘Ì·ÙÈÛÌÔ›, ··ÁÔÚ‡ÛÂȘ, Û˘ÛÙ¿ÛÂȘ.

Key words: epilepsy, children, injuries, restrictions, recommendations.

∂ÈÛ·ÁˆÁ‹ OÈ ÁÔÓ›˜ ÙˆÓ ·È‰ÈÒÓ Ù· ÔÔ›· ¿Û¯Ô˘Ó ·fi ÂÈÏË„›· ·ÓËÛ˘¯Ô‡Ó ȉȷ›ÙÂÚ· Ì‹ˆ˜ ÙÔ ·È‰› ÙÔ˘˜ ÙÚ·˘Ì·ÙÈÛÙ› ÛÔ‚·Ú¿ ηٿ ÙË ‰È¿ÚÎÂÈ· ÂÓfi˜ ÂÂÈÛÔ‰›Ô˘ ·ÒÏÂÈ·˜ Ù˘ Û˘Ó›‰ËÛ˘. ™˘¯Ó¿ ÂÈ‚¿ÏÏÔ˘Ó ÂÚÈÔÚÈÛÌÔ‡˜ ÛÙȘ ‰Ú·ÛÙËÚÈfiÙËÙ˜ ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘˜, ÔÈ Ôԛ˜ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÔ˘Ó Û ÌÂÙ·‚ÔÏ‹ ÛÙËÓ ÔÈfiÙËÙ· Ù˘ ˙ˆ‹˜, ·ÏÏ¿ Î·È Û ‰È·Ù·Ú·¯¤˜ ÛÙË Û˘ÌÂÚÈÊÔÚ¿ ÙÔ˘. Ÿˆ˜ Ê·›ÓÂÙ·È fï˜ ·fi ÙËÓ ·Ó·ÛÎfiËÛË Ù˘ Û¯ÂÙÈ΋˜ ‚È‚ÏÈÔÁÚ·Ê›·˜, Ô Î›Ó‰˘ÓÔ˜ ۈ̷ÙÈ΋˜ ‚Ï¿‚˘ ÛÙ· ·È‰È¿ Ì ÂÈÏË„›· Â›Ó·È ÂÏ¿¯ÈÛÙ· ·˘ÍË̤ÓÔ˜ Î·È Û¯Â‰fiÓ ÂÚÈÔÚ›˙ÂÙ·È ÛÙȘ ÂÚÈÙÒÛÂȘ ÂΛӘ Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ôχ Û˘¯Ó¤˜ ‹ ·ÓıÂÎÙÈ-

Τ˜ ÛÙ· Ê¿Ú̷η ÎÚ›ÛÂȘ (1-5). ¶ÂÚÈÁÚ¿ÊÔÓÙ·È ÔÈ ÛËÌ·ÓÙÈÎÔ› ΛӉ˘ÓÔÈ Ô˘ ·ÓÙÈÌÂÙˆ›˙Ô˘Ó Ù· ¿ÙÔÌ· Ì ÂÈÏË„›·, ·È‰È¿ Î·È ÂÓ‹ÏÈΘ, ηıÒ˜ Î·È Ô‰ËÁ›Â˜ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘˜ Ì ‚¿ÛË ÌÈ· ‰ËÌÔÛ›Â˘ÛË ÂÌÂÈÚÔÁÓˆÌfiÓˆÓ Ù˘ ¢ÈÂıÓÔ‡˜ ŒÓˆÛ˘ ÁÈ· ÙËÓ ∫·Ù·ÔϤÌËÛË Ù˘ ∂ÈÏË„›·˜ (7).

µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó·

2nd Pediatric Clinic of University of Athens Children’s Hospital “P. & A. Kyriakou”, Athens

∂ȉÈΤ˜ ‚Ï¿‚˜ ¶ÓÈÁÌfi˜: O ÓÈÁÌfi˜, ÏfiÁˆ Ù˘ ηٷ‚‡ıÈÛ˘ ÙÔ˘ ÎÂÊ·ÏÈÔ‡ ÛÙÔ ÓÂÚfi, Â›Ó·È ÙÔ Û˘¯ÓfiÙÂÚÔ ı·Ó·ÙËÊfiÚÔ ·Ù‡¯ËÌ·. ∏ Û˘¯ÓfiÙËÙ· ÙÔ˘ ÓÈÁÌÔ‡ ÛÙ· ¿ÙÔÌ· Ì ÂÈÏË„›· Â›Ó·È 4-7 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚË ·fi ÂΛÓË ÛÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi (3,4). £¿Ó·ÙÔ˜ ˆ˜ Û˘Ó¤ÂÈ· ÓÈÁÌÔ‡ ¤¯ÂÈ ÂÚÈÁÚ·Ê›

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Û ÂÈÏËÙÈÎÔ‡˜ ÂÓ‹ÏÈΘ ̤Û˘ ËÏÈΛ·˜ 20-30 ÂÙÒÓ, ÂÓÒ Â›Ó·È Û¿ÓÈÔ˜ ÛÙ· ÌÈÎÚfiÙÂÚ· ·È‰È¿ Ù· ÔÔ›· ›¯·Ó ηϋ ÂÈÙ‹ÚËÛË Î·Ù¿ ÙÔ ‰È¿ÛÙËÌ· Ù˘ Â·Ê‹˜ ÙÔ˘˜ Ì ÙÔ ÓÂÚfi (3-5). ™Â fiÛ· ·È‰È¿ ¤ÁÈÓ ¤ÁηÈÚË Î·È ÛˆÛÙ‹ ·Ó¿ÓË„Ë ‰ÂÓ ·Ú¤ÌÂÈÓ·Ó Ó¢ÚÔÏÔÁÈο ηٿÏÔÈ·. ™Ù· ·È‰È¿ ËÏÈΛ·˜ οو ÙˆÓ 5 ÂÙÒÓ, Ë Û˘¯ÓfiÙËÙ· ÓÈÁÌÔ‡ ‰ÂÓ ‰È·Ê¤ÚÂÈ ·fi ÂΛÓË ÛÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi, ›Ûˆ˜ ÏfiÁˆ Ù˘ ηχÙÂÚ˘ ÂÈÙ‹ÚËÛ˘ ÛÙËÓ ËÏÈΛ· ·˘Ù‹ (4). ∆· ·È‰È¿ Ì ÂȉÈΤ˜ ·Ó¿ÁΘ Î·È ÂΛӷ Ì ÊÙˆ¯fi ¤ÏÂÁ¯Ô ÙˆÓ ÎÚ›ÛÂˆÓ ¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚÔ Î›Ó‰˘ÓÔ Î·Ù·‚‡ıÈÛ˘ Î·È ¯ÚÂÈ¿˙ÔÓÙ·È È‰È·›ÙÂÚË ÚÔÛÔ¯‹ Î·È Û˘Ó¯‹ Â›‚Ï„Ë. ¶ÓÈÁÌfi˜ ¤¯ÂÈ ÂÚÈÁÚ·Ê› ÛÙË ı¿Ï·ÛÛ·, ÛÙË Ì·ÓȤڷ ÙÔ˘ ÛÈÙÈÔ‡, ÛÙËÓ ÈÛ›Ó· ÎÔχ̂ËÛ˘, ·ÎfiÌË Î·È ÛÙËÓ ÈÛ›Ó· ˘‰ÚÔıÂÚ·›·˜. ¶ÈÔ ÂÈΛӉ˘ÓÔ˜ ¯ÒÚÔ˜ Â›Ó·È ÙÔ Ì¿ÓÈÔ ÙÔ˘ ÛÈÙÈÔ‡, ÂÊ’ fiÛÔÓ ÂÚÈÛÛfiÙÂÚ· ·fi Ù· ÌÈÛ¿ ¿ÙÔÌ· Ô˘ ›¯·Ó ·Ù‡¯ËÌ· ÂΛ ·‚›ˆÛ·Ó. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÌÈ·˜ ÂÈÏËÙÈ΋˜ ÎÚ›Û˘, ÙÔ ¿ÙÔÌÔ ÂÍ·Ê·Ó›˙ÂÙ·È ÁÚ‹ÁÔÚ· οو ·fi ÙËÓ ÂÈÊ¿ÓÂÈ· ÙÔ˘ ÓÂÚÔ‡, Û˘Ó‹ıˆ˜ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÙÔÓÈ΋˜ Ê¿Û˘ ÙÔ˘ ÁÂÓÈÎÂ˘Ì¤ÓÔ˘ ÙÔÓÈÎÔÎÏÔÓÈÎÔ‡ Û·ÛÌÔ‡. ∏ ‰È¿ÛˆÛË Â›Ó·È Â˘ÎÔÏfiÙÂÚË ÛÙÔ Î·ı·Úfi Î·È Û¯ÂÙÈο Ú˯fi ÓÂÚfi Ù˘ ÈÛ›Ó·˜, Û ۯ¤ÛË Ì ÙÔ ıÔÏfi ÓÂÚfi ÙÔ˘ ÔÙ·ÌÔ‡ Î·È Ù˘ Ï›ÌÓ˘. ∆Ú·‡Ì· ÙÔ˘ ÎÂÊ·ÏÈÔ‡: ∂›Ó·È Ô Û˘¯ÓfiÙÂÚÔ˜ Ù‡Ô˜ ·Ù˘¯‹Ì·ÙÔ˜ Ô˘ ÌÔÚ› Ó· Û˘Ì‚Â› ÛÙ· ¿ÙÔÌ· Ì ÂÈÏË„›·, Û¿ÓÈ· fï˜ ÛÙ· ·È‰È¿ ÙÔ ÙÚ·‡Ì· Â›Ó·È ÙfiÛÔ ÛÔ‚·Úfi ÒÛÙ ӷ ÚÔηϤÛÂÈ ÂÈÏÔΤ˜, fiˆ˜ Â›Ó·È ÙÔ Î¿Ù·ÁÌ· ÙÔ˘ ÎÚ·Ó›Ô˘ Î·È Ë ˘ÔÛÎÏËÚ›‰È· Û˘ÏÏÔÁ‹. ∆¤ÙÔȘ ÂÈÏÔΤ˜ ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› Û ÂÓ‹ÏÈΘ Ì ·ÓıÂÎÙÈ΋ ÛÙ· Ê¿Ú̷η ÂÈÏË„›·, ÔÈ ÔÔ›ÔÈ ‰È¤ÌÂÓ·Ó Û ȉڇ̷ٷ (1). ∂Áη‡Ì·Ù·: ™Â ÂÓ‹ÏÈΘ Ì ÂÈÏË„›· ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ÂÁη‡Ì·Ù·, Ù· ÔÔ›· Û˘Ó‹ıˆ˜ Û˘Ì‚·›ÓÔ˘Ó ÛÙÔ Û›ÙÈ ·fi ÙÔ ˙ÂÛÙfi ÓÂÚfi ÛÙËÓ ÎÔ˘˙›Ó· Î·È ÙÔ Ì¿ÓÈÔ, ÙÔ ËÏÂÎÙÚÈÎfi Û›‰ÂÚÔ, ÙȘ ËÏÂÎÙÚÈΤ˜ Û˘Û΢¤˜ Î·È ÙË ÊˆÙÈ¿ ÙÔ˘ Ù˙·ÎÈÔ‡ (6). ∆· ÛÔ‚·ÚfiÙÂÚ· Â›Ó·È ÂΛӷ ÛÙÔ Ì¿ÓÈÔ. ∆· ÂÁη‡Ì·Ù· ·˘Ù¿ ÌÔÚÔ‡Ó Û ÌÂÁ¿ÏÔ ‚·ıÌfi Ó· ÚÔÏËÊıÔ‡Ó ÛÙ· ·È‰È¿. ∞Ó·ÁηÈfiÙËÙ· ÙˆÓ ÂÚÈÔÚÈÛÌÒÓ ªÂ ÛÎÔfi Ó· ÂÎÙÈÌËı› Ë ·Ó·ÁηÈfiÙËÙ· ÁÈ· ÂÚÈÔÚÈÛÌÔ‡˜ ÛÙȘ ‰Ú·ÛÙËÚÈfiÙËÙ˜ ÙˆÓ ·ÙfiÌˆÓ Ô˘ ¿Û¯Ô˘Ó ·fi ÂÈÏË„›·, Û˘ÁÎÚÔÙ‹ıËΠ̛· ÂÈÙÚÔ‹ ÂÌÂÈÚÔÁÓˆÌfiÓˆÓ ˘fi ÙËÓ ·ÈÁ›‰· Ù˘ ¢ÈÂıÓÔ‡˜ ŒÓˆÛ˘ ηٿ Ù˘ ∂ÈÏË„›·˜. ∆Ô ÁÂÓÈÎfi Û˘Ì¤Ú·ÛÌ· Ô˘ ‰È·Ù˘ÒıËΠ‹Ù·Ó fiÙÈ ·Ó Î·È ‰ÂÓ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÂÊ·ÚÌÔÛÙÔ‡Ó Î·ÓfiÓ˜ ÎÔÈÓÔ› ÁÈ· fiÏ· Ù· ·È‰È¿, ÔÚÈṲ̂Ó˜ ··ÁÔÚ‡ÛÂȘ Û·Ó ·Ú¯‹ ÎÚ›ÓÔÓÙ·È ÛÎfiÈ̘ (7). OÈ ··ÁÔÚ‡ÛÂȘ, fiˆ˜ ·Ó·ÁÚ¿ÊÔÓÙ·È ÛÙÔ ·ÚfiÓ Î›ÌÂÓÔ, ÚÔ¤Ú¯ÔÓÙ·È

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ηٿ ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ Ì¤ÚÔ˜ ÙÔ˘˜ ·fi ÙȘ ·ÔÊ¿ÛÂȘ Ù˘ ·ÓˆÙ¤Úˆ ÂÈÙÚÔ‹˜ ÂÌÂÈÚÔÁÓˆÌfiÓˆÓ, fiˆ˜ ·ÎÚÈ‚Ò˜ ¤¯Ô˘Ó ‰ËÌÔÛÈ¢ı› ÛÙÔÓ ÂÈÛÙËÌÔÓÈÎfi Ù‡Ô (7). ∏ ·fiÊ·ÛË ÁÈ· ÙÔ Â›‰Ô˜ Ù˘ ··ÁfiÚ¢Û˘ Ú¤ÂÈ Ó· ·ÔÚÚ¤ÂÈ ·fi ÙËÓ ÎÔÈÓ‹ ÏÔÁÈ΋, ÒÛÙ ӷ ÌËÓ ‰È·Ù·Ú¿ÛÛÂÙ·È Ë ÈÛÔÚÚÔ›· ÌÂٷ͇ Ù˘ ·Ó¿Á΢ ÙÔ˘ ·È‰ÈÔ‡ ÁÈ· Ê˘ÛÈ΋ ÚÔÛÙ·Û›· ·ÊÂÓfi˜ Î·È Û˘Ó¯È˙fiÌÂÓË ÁÓÒÛË Î·È ·˘ÙÔÂÎÙ›ÌËÛË ·ÊÂÙ¤ÚÔ˘. O ÚfiÏÔ˜ ÙÔ˘ ÁÈ·ÙÚÔ‡ ÛÙȘ ÂÚÈÙÒÛÂȘ ·˘Ù¤˜ Â›Ó·È Ó· ‰È¢ÎÔχÓÂÈ ÙËÓ ÂÊ¢ÚÂÙÈÎfiÙËÙ· ÙˆÓ ÁÔÓ¤ˆÓ Ó· ÚÔÛ·ÚÌfiÛÔ˘Ó ÙȘ Û¯ÂÙÈΤ˜ ··ÁÔÚ‡ÛÂȘ ÛÙÔÓ ÙÚfiÔ ˙ˆ‹˜ Î·È ÙËÓ ÚÔÛˆÈÎfiÙËÙ· ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘˜.

OÈ ÂÚÈÔÚÈÛÌÔ› Â͢ËÚÂÙÔ‡Ó ÙÚÂȘ ·ÚÈÔ˘˜ ÏfiÁÔ˘˜. O ÚÒÙÔ˜ Â›Ó·È Ó· ÂÚÈÔÚÈÛÙ› Ô Î›Ó‰˘ÓÔ˜ ۈ̷ÙÈ΋˜ ‚Ï¿‚˘, fiˆ˜ Â›Ó·È Ë ÙÒÛË, ÙÔ ¤Áη˘Ì·, ÔÈ ıÏ¿ÛÂȘ, Ë ÂΉÔÚ¿, ÙÔ Î¿Ù·ÁÌ· ÙˆÓ ÔÛÙÒÓ Î·È ÙˆÓ ‰ÔÓÙÈÒÓ Î·È ÙÔ ÂÍ¿ÚıÚËÌ· ÙÔ˘ ÈÛ¯›Ô˘. O ‰Â‡ÙÂÚÔ˜ ÏfiÁÔ˜ Â›Ó·È Ó· ÂÚÈÔÚÈÛÙ› Ë ¤ÎıÂÛË ÙÔ˘ ·È‰ÈÔ‡ Û ·Ú¿ÁÔÓÙ˜ Ô˘ ÌÔÚ› Û ÔÚÈṲ̂Ó˜ ÂÚÈÙÒÛÂȘ Ó· ÂÈÛ‡ÛÔ˘Ó ÙËÓ ÂÌÊ¿ÓÈÛË Û·ÛÌÒÓ, fiˆ˜ Â›Ó·È Ù· ‰È·Ï›ÔÓÙ· ʈÙÂÈÓ¿ ÂÚÂı›ÛÌ·Ù·, Ë ÛÙ¤ÚËÛË ÙÔ˘ ‡ÓÔ˘ Î·È Ë ·ÏÎÔfiÏË. ŒÓ·˜ ÙÚ›ÙÔ˜ ÏfiÁÔ˜ ›ӷÈ, ÁÈ· ÔÚÈṲ̂Ó˜ ÂÚÈÙÒÛÂȘ, Ë ÚfiÏË„Ë ÙÔ˘ Û˘Ó·ÈÛıËÌ·ÙÈÎÔ‡ ÙÚ·‡Ì·ÙÔ˜.

OÈ ÂÚÈÔÚÈÛÌÔ› ÈÛ¯‡Ô˘Ó ÁÈ· Û˘ÁÎÂÎÚÈ̤ÓÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·, ÛÙȘ ·ÎfiÏÔ˘ı˜ ÂÚÈÙÒÛÂȘ: ·) ÁÈ· ‰È¿ÛÙËÌ· 2-3 ÌËÓÒÓ ÌÂÙ¿ ·fi ¤Ó· ÚÒÙÔ ÂÈÏËÙÈÎfi ÂÂÈÛfi‰ÈÔ ÁÈ· ÙÔ ÔÔ›Ô ‰ÂÓ ¤¯ÂÈ ‰Ôı› Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹, ‚) ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ Ê·Ú̷΢ÙÈ΋˜ ·ÁˆÁ‹˜ Î·È Ì¤¯ÚȘ fiÙÔ˘ ÂÎÙÈÌËı› fiÙÈ ‰ÂÓ Â›Ó·È Ôχ Èı·Ófi Ó· ·ÎÔÏÔ˘ı‹ÛÔ˘Ó Î·È ¿ÏÏ· ÂÂÈÛfi‰È· Î·È Á) ÁÈ· Ï›ÁÔ˘˜ Ì‹Ó˜ ÌÂÙ¿ ÙË ‰È·ÎÔ‹ ÙˆÓ ·ÓÙÈÂÈÏËÙÈÎÒÓ Ê·Ú̿ΈÓ.

OÈ ÂÚÈÔÚÈÛÌÔ› ÌÔÚ› Ó· ‰È·ÙËÚËıÔ‡Ó ÁÈ· ·ÚÔÛ‰ÈfiÚÈÛÙÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÛÙ· ·È‰È¿ Ì Â›ÌÔÓÔ˘˜ Û·ÛÌÔ‡˜, ÔÈ ÔÔ›ÔÈ ‰ÂÓ ·ÓÙ·ÔÎÚ›ÓÔÓÙ·È ÛÙË ıÂÚ·›·. ªÂÚÈο ·fi ·˘Ù¿ ¿Û¯Ô˘Ó ·fi ÂÍÂÏÈÎÙÈο ÂÈÏËÙÈο Û‡Ó‰ÚÔÌ·. ™Â ·Ó¿ÏÔÁ˜ ÂÚÈÙÒÛÂȘ, ÔÈ ··ÁÔÚ‡ÛÂȘ ÌÔÚ› Ó· ÙÚÔÔÔÈËıÔ‡Ó Ì ÙËÓ ¿ÚÔ‰Ô ÙÔ˘ ¯ÚfiÓÔ˘. ¶·Ú¿ÁÔÓÙ˜ ÔÈ ÔÔ›ÔÈ ÂËÚ¿˙Ô˘Ó ÙËÓ ·fiÊ·ÛË ÁÈ· ÙÔ˘˜ ÂÚÈÔÚÈÛÌÔ‡˜ ∏ÏÈΛ· ÙÔ˘ ·È‰ÈÔ‡: OÈ ÂÈÙÚÂfiÌÂÓ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜ ı· Ú¤ÂÈ Ó· Â›Ó·È ·Ó¿ÏÔÁ˜ Ì ÙËÓ ËÏÈΛ· ÙÔ˘ ·È‰ÈÔ‡ Î·È Ó· Ù·ÈÚÈ¿˙Ô˘Ó Ì ÙÔ ¯·Ú·ÎÙ‹Ú· Î·È ÙËÓ ÈηÓfiÙËÙ¿ ÙÔ˘ Ó· ηٷÓÔ›. °È· Ù· ·È‰È¿ οو ÙˆÓ 8 ÂÙÒÓ, ÔÈ ÂÚÈÔÚÈÛÌÔ› ¤¯Ô˘Ó ÙÔÓ ¯·Ú·ÎÙ‹Ú· ÙˆÓ Î·ÓfiÓˆÓ. ∆· ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿ Û˘Ó‹ıˆ˜ ηٷÓÔÔ‡Ó ÙË ÛËÌ·Û›· Î·È ÙËÓ ·Ó·ÁηÈfiÙËÙ· ÙˆÓ ÂÚÈÔÚÈÛÌÒÓ Î·È ı· Ú¤ÂÈ Ó· ÂȉÈÒÎÂÙ·È

july-aug02TELIKO

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¶·È‰È·ÙÚÈ΋ 2002;65:293-297

Ë Û˘Ó·›ÓÂÛ‹ ÙÔ˘˜, ·ÊÔ‡ ÚÒÙ· ÙÔ˘˜ ÂÍËÁËı› fiÙÈ ı· ÈÛ¯‡ÛÔ˘Ó ÁÈ· ÂÚÈÔÚÈṲ̂ÓÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·. ∆‡Ô˜ ÙˆÓ ÂÈÏËÙÈÎÒÓ ÎÚ›ÛˆÓ: ŸÙ·Ó ÔÈ ÎÚ›ÛÂȘ Û˘Ì‚·›ÓÔ˘Ó ÌfiÓÔ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘ ‹ ‰ÂÓ ÚÔηÏÔ‡Ó ·ÒÏÂÈ· Ù˘ Û˘Ó›‰ËÛ˘, ‰ÂÓ ¯ÚÂÈ¿˙ÂÙ·È ÌÂÙ·‚ÔÏ‹ ÛÙÔÓ ÙÚfiÔ Ù˘ ˙ˆ‹˜ ÙÔ˘ ·È‰ÈÔ‡. ∞ÓÙ›ıÂÙ·, ÔÈ ÎÚ›ÛÂȘ Ô˘ ÚÔηÏÔ‡Ó ‚·ıÈ¿ ·ÒÏÂÈ· Ù˘ Û˘Ó›‰ËÛ˘, ‚¿˙Ô˘Ó ÙÔ ·È‰› Û ÌÂÁ·Ï‡ÙÂÚÔ Î›Ó‰˘ÓÔ fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ Èı·ÓfiÙËÙ· ÚfiÎÏËÛ˘ Ê˘ÛÈ΋˜ ‚Ï¿‚˘. ªÂÚÈο ·È‰È¿ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·Ú·ÙÂٷ̤ÓË ÌÂÙÂÎÚÈÙÈ΋ Ê¿ÛË ˘ÓËÏ›·˜ Î·È Î·Ù¿ ÙÔ ‰È¿ÛÙËÌ· ·˘Ùfi ¯ÚÂÈ¿˙ÔÓÙ·È ·Ú·ÎÔÏÔ‡ıËÛË. ™˘¯ÓfiÙËÙ· ÙˆÓ ÎÚ›ÛˆÓ: ŸÙ·Ó ÔÈ ÂÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ Â›Ó·È ·Ú·È¤˜, ÌÔÚ› Ó· ÌËÓ ¯ÚÂÈ¿˙ÂÙ·È Î·Ó¤Ó·˜ ÂÚÈÔÚÈÛÌfi˜. ∂¿Ó ¤¯ÂÈ ÂÚ¿ÛÂÈ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÌÂÁ·Ï‡ÙÂÚÔ ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜ ¯ˆÚ›˜ ÂÂÈÛfi‰ÈÔ Û·ÛÌÒÓ, Â›Ó·È ÏÔÁÈÎfi ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ ÂÚÈÔÚÈÛÌÔ› ÛÙ·‰È·Î¿ Ó· ‰È·ÎfiÙÔÓÙ·È. ∞ÓÙ›ıÂÙ·, ÛÙ· ·È‰È¿ Ì Ôχ Û˘¯Ó¤˜ ÎÚ›ÛÂȘ, fiˆ˜ Â›Ó·È Û˘Ó‹ıˆ˜ ÔÈ ·Ê·ÈÚ¤ÛÂȘ, ÔÈ Ì˘ÔÎÏÔÓÈÎÔ›, ÔÈ ·ÙÔÓÈÎÔ› ‹ ÔÈ ÙÔÓÈÎÔ› Û·ÛÌÔ›, fiˆ˜ Î·È ÛÙËÓ ÂÚ›ÙˆÛË ÚˆÙԉȷÁÓˆÛı›۷˜ ÂÈÏË„›·˜, ÔÈ ÂÚÈÔÚÈÛÌÔ› Ú¤ÂÈ Ó· Û˘Ó¯›˙ÔÓÙ·È Ì¤¯ÚȘ fiÙÔ˘ ÂÈÙ¢¯ı› ÈηÓÔÔÈËÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙˆÓ ÎÚ›ÛˆÓ. ÃÚfiÓÔ˜ Î·È ÙfiÔ˜ Ô˘ Û˘Ì‚·›ÓÔ˘Ó ÔÈ ÂÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ: ™Â ÔÚÈṲ̂Ó˜ ÂÚÈÙÒÛÂȘ, ÔÈ ÎÚ›ÛÂȘ ÂÈÛ‡‰ÔÓÙ·È ·fi Ù· ‰È·Ï›ÔÓÙ· ʈÙÂÈÓ¿ ÂÚÂı›ÛÌ·Ù·, Ù· ÔÔ›· ÂÎ¤ÌÂÈ Ë ÔıfiÓË Ù˘ ÙËÏÂfiÚ·Û˘, ÙÔ˘ ‚›ÓÙÂÔ Î·È Ë ÓÙÈÛÎÔÙ¤Î. OÈ Û˘Óı‹Î˜ ·˘Ù¤˜ Ú¤ÂÈ Ó· ·ÔʇÁÔÓÙ·È ‹ Ó· ÌÂÈÒÓÂÙ·È Ë Â›‰Ú·Û‹ ÙÔ˘˜ Ì ÙÔ Ó· ·ÔʇÁÂÈ ÙÔ Â˘·›ÛıËÙÔ ¿ÙÔÌÔ Ó· ÎÔÈÙ¿˙ÂÈ ÙË ÊˆÙÂÈÓ‹ ËÁ‹ ‹ Ó· ÎÏ›ÓÂÈ ÙÔ ¤Ó· ÙÔ˘ Ì¿ÙÈ fiÙ·Ó ·ÈÛı¿ÓÂÙ·È Î¿ÔÈ· ‰˘ÛÊÔÚ›·.

Paediatriki 2002;65:293-297

™˘ÌÌfiÚʈÛË: ∏ ˘¢ı˘ÓfiÙËÙ· ÙÔ˘ ·È‰ÈÔ‡ Ó· ·›ÚÓÂÈ Ù· ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η Û ηÓÔÓÈο ‰È·ÛÙ‹Ì·Ù· Â›Ó·È ÛËÌ·ÓÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ Ô˘ ÂËÚ¿˙ÂÈ ÙËÓ ·Ó¿ÁÎË ÁÈ· ÂÚÈÔÚÈÛÌÔ‡˜, ȉȷ›ÙÂÚ· ηٿ ÙËÓ ÂÊË‚È΋ ËÏÈΛ·, fiˆ˜ Î·È Ë ÔÈÎÔÓÔÌÈ΋ ¢¯¤ÚÂÈ· Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ Ó· ·ÁÔÚ¿˙ÂÈ Û˘ÛÙËÌ·ÙÈο Ù· Ê¿Ú̷η, ·Ó Î·È Ù· ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η Û‹ÌÂÚ· ¯ÔÚËÁÔ‡ÓÙ·È ¯ˆÚ›˜ ÔÈÎÔÓÔÌÈ΋ Û˘ÌÌÂÙÔ¯‹. ™˘ÓÓÔÛËÚfiÙËÙ·: ∏ Û˘Ó‡·ÚÍË Ù˘ ÂÈÏË„›·˜ Ì ¿ÏÏÔ ¯ÚfiÓÈÔ ÓfiÛËÌ· Â›Ó·È ÛËÌ·ÓÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ Ô˘ ÂËÚ¿˙ÂÈ (·˘Í¿ÓÂÈ) ÙËÓ ·Ó¿ÁÎË ÁÈ· ÂÚÈÔÚÈÛÌÔ‡˜. ¢˘ÓËÙÈΤ˜ ··ÁÔÚ‡ÛÂȘ OÈ ·ÎfiÏÔ˘ı˜ ··ÁÔÚ‡ÛÂȘ ÎÚ›ÓÔÓÙ·È ÛÎfiÈ̘ ÁÈ· Ù· ·È‰È¿ Ì ÂÈÏË„›·, fiÔ˘ Ô Î›Ó‰˘ÓÔ˜ ηٿ ÙË ‰È¿ÚÎÂÈ· ÌÈ·˜ ÎÚ›Û˘ ÂÎÙÈÌ¿Ù·È fiÙÈ Â›Ó·È ÛÔ‚·ÚfiÙÂÚÔ˜ ·fi ÙȘ ÂÈÙÒÛÂȘ Ù˘ ··ÁfiÚ¢Û˘. ™ÙÔ Û›ÙÈ: ∆· ·È‰È¿ ‰ÂÓ Ú¤ÂÈ ÔÙ¤ Ó· ̤ÓÔ˘Ó ÌfiÓ· ÙÔ˘˜ ÛÙÔ Ì¿ÓÈÔ. ∆· ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿ Ú¤ÂÈ Ó· ÂÓı·ÚÚ‡ÓÔÓÙ·È Ó· ¯ÚËÛÈÌÔÔÈÔ‡Ó ÙÔ ÓÙÔ˘˜ Î·È Ó· ·›ÚÓÔ˘Ó ÔÚÈṲ̂Ó˜ ÚÔÊ˘Ï¿ÍÂȘ (¶›Ó·Î·˜ 1). ∞ÒÏÂÈ· Ù˘ Û˘Ó›‰ËÛ˘ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û ÙÒÛË ÛÙÔ Ì¿ÓÈÔ Î·È ÓÈÁÌfi. ∫ÏÈÓÔÛÎÂ¿ÛÌ·Ù· Ù· ÔÔ›· ÌÔÚ› Ó· ÚÔηϤÛÔ˘Ó ·ÛÊ˘Í›·, fiˆ˜ Â›Ó·È Ù· ʷډȿ ηχÌÌ·Ù· ÙˆÓ Ì·ÍÈÏ·ÚÈÒÓ Î·È ÙÔ˘ ·ÏÒÌ·ÙÔ˜, Ù· Ôχ ÌÂÁ¿Ï· Î·È Ì·Ï·Î¿ Ì·ÍÈÏ¿ÚÈ· Î·È Ù· ËÏÂÎÙÚÈο ·ÏÒÌ·Ù·, Ú¤ÂÈ Ó· ·ÔʇÁÔÓÙ·È, ȉȷ›ÙÂÚ· ÛÙ· ‚Ú¤ÊË Î·È Ù· Ôχ ÌÈÎÚ¿ ·È‰È¿. ∂›Û˘, Ú¤ÂÈ Ó· ·ÔʇÁÔÓÙ·È ÔÈ ·ÓÔȯÙÔ› ÊÔ‡ÚÓÔÈ, Ù· ·ÓÔȯٿ Ù˙¿ÎÈ· Î·È ÔÈ ÛοϘ ¯ˆÚ›˜ ÚÔÛٷ٢ÙÈÎfi ÎÈÁÎÏ›‰ˆÌ· ·ÛÊ·Ï›·˜. ÕÏÏÔÈ ÎˉÂÌfiÓ˜ ÂÎÙfi˜ ·fi ÙÔ˘˜ ÁÔÓ›˜: ∏ ÌÂ˚ÌÈÛ›ÙÂÚ, ÙÔ ÚÔÛˆÈÎfi ÙÔ˘ ·È‰ÈÎÔ‡ ÛÙ·ıÌÔ‡ ηÈ

¶›Ó·Î·˜ 1. ™˘ÛÙ¿ÛÂȘ ÁÈ· ÙËÓ ÚÔÛÙ·Û›· ÙˆÓ ·È‰ÈÒÓ Ô˘ ¿Û¯Ô˘Ó ·fi ÂÈÏË„›·, ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ·Ú·ÌÔÓ‹˜ ÙÔ˘˜ ÛÙÔ ÓÂÚfi (Kemp Î·È Sibert) ∫ÔχÌÈ ñ ¡· ÎÔÏ˘Ì¿ Ì·˙› Ì οÔÈÔ Ê›ÏÔ ÙÔ˘ ‹ ÂÓ‹ÏÈη Ô˘ ͤÚÂÈ Î·Ïfi ÎÔχÌÈ ñ ∫·Ï‹ ÂÈÙ‹ÚËÛË ÛÙËÓ ÈÛ›Ó·. O ÂÈÙËÚËÙ‹˜ Ó· ¤¯ÂÈ ÂÎ·È‰Â˘Ù› ÛÙËÓ Î·Ú‰ÈÔ·Ó·Ó¢ÛÙÈ΋ ·Ó¿ÓË„Ë Î·È Ó· ÁÓˆÚ›˙ÂÈ ÏÂÙÔ̤ÚÂȘ ÁÈ· ÙËÓ ÂÈÏË„›· ÙÔ˘ ·È‰ÈÔ‡ ñ ¡· ·ÔʇÁÂÙ·È ÙÔ ÎÔχÌÈ ÛÙ· ÔÙ¿ÌÈ· Î·È ÙȘ Ï›ÌÓ˜ §Ô˘ÙÚfi ηı·ÚÈfiÙËÙ·˜ ñ ¡· ÏÔ‡˙ÂÙ·È Ì ÙÔ ÙËϤʈÓÔ ÙÔ˘ ÓÙÔ˘˜ ÛÙÔ ¯¤ÚÈ Î·È Ó· ÌËÓ ˘¿Ú¯ÂÈ ‰È·¯ˆÚÈÛÙÈÎfi ·fi Á˘·Ï› ÛÙË Ì·ÓȤڷ, ÒÛÙ ӷ ÚÔÏËÊı› ÙÚ·˘Ì·ÙÈÛÌfi˜ ÙÔ˘ ÎÂÊ·ÏÈÔ‡ ñ ∆Ô ÌÈÎÚfi ·È‰› Ó· ‚Ú›ÛÎÂÙ·È ˘fi Û˘Ó¯‹ Â›‚ÏÂ„Ë ñ ∏ fiÚÙ· ÙÔ˘ Ì¿ÓÈÔ˘ Ó· ÌËÓ ÎÏÂȉÒÓÂÈ ¶·È‰È¿ Ì ÊÙˆ¯fi ¤ÏÂÁ¯Ô ÙˆÓ ÎÚ›ÛÂˆÓ ñ ™˘Ó¯‹˜ Â›‚ÏÂ„Ë ·fi ÂÓ‹ÏÈη Û fiÏË ÙË ‰È¿ÚÎÂÈ· Ù˘ ÎÔχ̂ËÛ˘ ‹ ÙÔ˘ ÏÔ˘ÙÚÔ‡ ñ ∆Ô ÏÔ˘ÙÚfi ηı·ÚÈfiÙËÙ·˜ Ó· Á›ÓÂÙ·È Ì ÙÔ ·È‰› ηıÈṲ̂ÓÔ Û ηÚÂÎÏ¿ÎÈ, Ì ÙË ‚·Ï‚›‰· Ù˘ ·Ô¯¤Ù¢Û˘ ·ÓÔȯً Î·È ÙÔ ÙËϤʈÓÔ ÙÔ˘ ÓÙÔ˘˜ ÛÙÔ ¯¤ÚÈ ñ ™ÙÔ Ì¿ÓÈÔ Ó· ˘¿Ú¯ÂÈ ıÂÚÌÔÛÙ·ÙÈ΋ Ì·Ù·Ú›· ηÈ, Â¿Ó Â›Ó·È ‰˘Ó·ÙfiÓ, ÂȉÈÎfi ÂÍ¿ÚÙËÌ· ÛÙÔ ÓÙÔ˘˜ ÙÔ ÔÔ›Ô ‰È·ÎfiÙÂÈ ÙË ÚÔ‹ ÙÔ˘ ˙ÂÛÙÔ‡ ÓÂÚÔ‡ fiÙ·Ó ·˘Ùfi ÍÂÂÚ¿ÛÂÈ ÙËÓ ÚÔηıÔÚÈṲ̂ÓË ıÂÚÌÔÎÚ·Û›· ñ ∏ ÌËÙ¤Ú· Ô˘ ¿Û¯ÂÈ ·fi ÂÈÏË„›· Ó· Û˘Óԉ‡ÂÙ·È ·fi ¿ÏÏÔ ¿ÙÔÌÔ fiÙ·Ó Î¿ÓÂÈ Ì¿ÓÈÔ ÙÔ ‚Ú¤ÊÔ˜ ‹ ÙÔ Ó‹ÈÔ ·È‰› Ù˘.

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¶·È‰È·ÙÚÈ΋ 2002;65:293-297

ÙÔ˘ Û¯ÔÏ›Ԣ, fiˆ˜ Î·È Î¿ı ¿ÙÔÌÔ ÙÔ ÔÔ›Ô ÊÚÔÓÙ›˙ÂÈ ÙÔ ·È‰› Ú¤ÂÈ Ó· ÂÓËÌÂÚˆıÔ‡Ó fiÙÈ ÙÔ ·È‰› ÂÓ‰¤¯ÂÙ·È Ó· ·ÚÔ˘ÛÈ¿ÛÂÈ ÎÚ›ÛÂȘ ÂÈÏË„›·˜. ∂È‚¿ÏÏÂÙ·È ÔÈ ÎˉÂÌfiÓ˜ Ó· ·ÔÎÙ‹ÛÔ˘Ó ÙȘ ‚·ÛÈΤ˜ ÁÓÒÛÂȘ Û¯ÂÙÈο Ì ÙË ÓfiÛÔ, ÙȘ ÚÔÊ˘Ï¿ÍÂȘ Î·È ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÌÈ·˜ ÎÚ›Û˘. OÈ ÎˉÂÌfiÓ˜ Û˘¯Ó¿ ÊÔ‚Ô‡ÓÙ·È fiÙÈ ‰ÂÓ ı· Â›Ó·È Û ı¤ÛË Ó· ·Ó·ÁÓˆÚ›ÛÔ˘Ó Ì›· ÎÚ›ÛË ‹ Ó· ‰ÒÛÔ˘Ó ÛˆÛÙ¿ ÙȘ ÚÒÙ˜ ‚Ô‹ıÂȘ Â¿Ó ¯ÚÂÈ·ÛÙ›. OÈ ÁÔÓ›˜ ı· Ú¤ÂÈ Ó· ‰ÒÛÔ˘Ó ÏÂÙÔÌÂÚ‹ ÂÚÈÁÚ·Ê‹ Ù˘ ÎÚ›Û˘ Î·È ÏËÚÔÊÔڛ˜ ÁÈ· ÙȘ ÚÒÙ˜ ‚Ô‹ıÂȘ, ηıÒ˜ Î·È ÔÈÔÓ ı· ηϤÛÔ˘Ó fiÙ·Ó Û˘Ì‚Â› Ì›· ÎÚ›ÛË. OÈ ÎˉÂÌfiÓ˜ Ú¤ÂÈ Ó· ·ÓÙȉڿÛÔ˘Ó Ì „˘¯Ú·ÈÌ›·, ÒÛÙ ӷ ÌËÓ ÙÚÔÌÔÎÚ·ÙËı› ÙÔ ·È‰› Î·È ÔÈ ¿ÏÏÔÈ ·Ú¢ÚÈÛÎfiÌÂÓÔÈ. ªÂÙ¿ ÙÔ ÂÂÈÛfi‰ÈÔ ÔÏÏ¿ ·È‰È¿ Â›Ó·È Û˘¯Ó¿ Û˘Á¯˘ÙÈο Î·È ÙÚÔÌ·Á̤ӷ Î·È ¯ÚÂÈ¿˙ÔÓÙ·È Î·ıËÛ‡¯·ÛË. ∂¿Ó ˘¿Ú¯ÂÈ ÁÈ·ÙÚfi˜ ‹ ·‰ÂÏÊ‹ ÓÔÛÔÎfiÌÔ˜ ÛÙÔ Û¯ÔÏ›Ô, Ú¤ÂÈ Ó· ÂÓËÌÂÚÒÓÂÙ·È ·fi ÙÔ˘˜ ÁÔÓ›˜ Û¯ÂÙÈο Ì ÙȘ ÚÔÊ˘Ï¿ÍÂȘ Î·È ÙÔ˘˜ ÂÚÈÔÚÈÛÌÔ‡˜ Ô˘ Â›Ó·È ··Ú·›ÙËÙÔÈ. ∆Ô ·È‰› ÂÈÙÚ¤ÂÙ·È Ó· Û˘ÌÌÂÙ¤¯ÂÈ ÛÙË Á˘ÌÓ·ÛÙÈ΋ Î·È ÛÙȘ ·ıÏËÙÈΤ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜ Ô˘ Á›ÓÔÓÙ·È ÛÙÔ Û¯ÔÏ›Ô. ∏ Ù·ÎÙÈ΋ Ê˘ÛÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· Î·È ÔÈ Î·ÓÔÓÈΤ˜ Û˘Óı‹Î˜ ÌÂϤÙ˘ ‰ÂÓ ÂÈÛ‡‰Ô˘Ó ÙȘ ÂÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ. ªÂÚÈο ·È‰È¿ Ôχ Û¿ÓÈ· ¤¯Ô˘Ó ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ Ó· ÂΉËÏÒÛÔ˘Ó status epilepticus. ∂¿Ó Ô ÎˉÂÌfiÓ·˜ ÙÔ˘˜ Û ·˘Ù¤˜ ÙȘ ÂÚÈÙÒÛÂȘ ¤¯ÂÈ ÂÎ·È‰Â˘Ù› Ó· ¯ÔÚËÁ‹ÛÂÈ ·ÓÙÈÂÈÏËÙÈο Ù·¯Â›·˜ ‰Ú¿Û˘ fiˆ˜ Â›Ó·È Ë ‰È·˙Â¿ÌË ·fi ÙÔ ÔÚıfi, ÔÈ ··ÁÔÚ‡ÛÂȘ Û ·˘Ù¤˜ ÙȘ ÂÚÈÙÒÛÂȘ ÌÔÚ› Ó· Á›ÓÔ˘Ó ÏÈÁfiÙÂÚÔ ·˘ÛÙËÚ¤˜. ∂¿Ó ÙÔ ·È‰› Û οı ÎÚ›ÛË ¯¿ÓÂÈ Ô‡Ú·, ηÏfi Â›Ó·È Ó· ‰È·ı¤ÙÂÈ ÌÈ· ·ÏÏ·ÍÈ¿ Ë ÔÔ›· Ó· ·Ú·Ì¤ÓÂÈ ÛÙÔ Û¯ÔÏÂ›Ô ÙÔ˘. °ÂÓÈο, ÔÈ Û˘ÌÌ·ıËÙ¤˜ ı· Ú¤ÂÈ Ó· ÂÓËÌÂÚÒÓÔÓÙ·È fiÙÈ ÙÔ ·È‰› ¿Û¯ÂÈ ·fi ÂÈÏË„›·, ÂȉÈο fiÙ·Ó ÔÈ ÎÚ›ÛÂȘ Â›Ó·È ÁÂÓÈÎÂ˘Ì¤Ó˜ ‹ Á›ÓÔÓÙ·È Â‡ÎÔÏ· ·ÓÙÈÏËÙ¤˜. ÃÚÂÈ¿˙ÂÙ·È Ôχ˜ ¯ÚfiÓÔ˜ ÁÈ· Ó· ÂÈÛı› ‹ Ó· ·ÔÊ·Û›ÛÂÈ Ë ÔÈÎÔÁ¤ÓÂÈ· fiÙÈ Ú¤ÂÈ Ó· ·ÔÎ·Ï˘Êı› ÙÔ È·ÙÚÈÎfi Úfi‚ÏËÌ· ÙÔ˘ ·È‰ÈÔ‡, fï˜ ı· Ú¤ÂÈ Ó· ÂÓı·ÚÚ‡ÓÂÙ·È Û¯ÂÙÈο Ì ·˘Ùfi ÙÔ ı¤Ì·. ∞ıÏ‹Ì·Ù· Î·È „˘¯·ÁˆÁÈΤ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜ ∫ÔχÌÈ, ηÓfi, ΈËÏ·Û›·, ÈÛÙÈÔÏÔ˝· ∆Ô ÎÔχÌÈ ÛÙË ı¿Ï·ÛÛ· Î·È ÙËÓ ÈÛ›Ó· ‰ÂÓ ··ÁÔÚ‡ÂÙ·È, ˘fi ÙËÓ ÚÔ¸fiıÂÛË fiÙÈ ÙÔ ·È‰› ‚Ú›ÛÎÂÙ·È Î¿Ùˆ ·fi ÙËÓ ¿ÁÚ˘ÓË ·Ú·ÎÔÏÔ‡ıËÛË ÂÓfi˜ ÂÓ‹ÏÈη, Ô ÔÔ›Ô˜ Ó· ͤÚÂÈ Î·Ïfi ÎÔχÌÈ Î·È Î·Ú‰ÈÔ·Ó·Ó¢ÛÙÈ΋ ·Ó¿ÓË„Ë. °È· Ù· ¿ÏÏ· ·ıÏ‹Ì·Ù· ı· Ú¤ÂÈ Ó· ÏËÊıÔ‡Ó ˘’ fi„ÈÓ Ë ËÏÈΛ· ÙÔ˘ ·È‰ÈÔ‡, Ë Û˘¯ÓfiÙËÙ· ÙˆÓ ÎÚ›ÛÂˆÓ Î·È ÙÔ fiÛÔ Î·Ï‹ ı· Â›Ó·È Ë Â›‚Ï„‹ ÙÔ˘ ηٿ ÙË ‰È¿ÚÎÂÈ·

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Paediatriki 2002;65:293-297

Ù˘ ·Ú·ÌÔÓ‹˜ ÙÔ˘ ÛÙÔ ÓÂÚfi. ∏ ·¿ÓÙËÛË ÂÍ·ÙÔÌÈ·ÂÙ·È ·Ó¿ÏÔÁ· Ì ÙËÓ ÂÚ›ÙˆÛË. ∫·Ïfi Â›Ó·È Ó· ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÛÙ· ·ıÏ‹Ì·Ù· ·˘Ù¿ ÂȉÈÎfi ÛˆÛ›‚ÈÔ ÎÔÚÌÔ‡. ∆Ô ÎÔχÌÈ ÛÙ· ÔÙ¿ÌÈ· Î·È ÙȘ Ï›ÌÓ˜ ··ÁÔÚ‡ÂÙ·È.

OÚÂÈ‚·Û›· Ì ۯÔÈÓ›, ·Ó·ÚÚ›¯ËÛË Û ‰¤ÓÙÚ· ‹ ·fiÙÔÌÔ˘˜ ‚Ú¿¯Ô˘˜ O ΛӉ˘ÓÔ˜ Ô˘ Û˘Óԉ‡ÂÈ Ù· ·ıÏ‹Ì·Ù· Ô˘ Á›ÓÔÓÙ·È Û ÌÂÁ¿ÏÔ ‡„Ô˜ Â›Ó·È ÛËÌ·ÓÙÈÎfi˜ Î·È ÁÈ’ ·˘Ùfi ı· Ú¤ÂÈ Ó· ··ÁÔÚ‡ÔÓÙ·È fiˆ˜ ÂÈ‚¿ÏÏÂÈ Ë ÎÔÈÓ‹ ÏÔÁÈ΋, fi¯È ÌfiÓÔ ÛÙ· ·È‰È¿ Ì ÂÈÏË„›· ·ÏÏ¿ Î·È Û οı ¿ÏÏÔ ·È‰›. ¶Ô‰‹Ï·ÙÔ, ·ÙÈÓ¿˙, ·Ù›ÓÈ Ì ÙÈÌfiÓÈ ‹ ·Ù›ÓÈ Ì Úfi‰Â˜ (skateboard) ŸÏ· Ù· ·È‰È¿ ı· Ú¤ÂÈ Ó· ·ÔʇÁÔ˘Ó ÙÔ Ô‰‹Ï·ÙÔ Û ÔÏ˘Û‡¯Ó·ÛÙÔ˘˜ ‰ÚfiÌÔ˘˜ Î·È È‰È·›ÙÂÚ· ÂΛӷ Ô˘ ¿Û¯Ô˘Ó ·fi ÂÈÏË„›·. ∫¿ı ·È‰› Ô˘ Û˘ÌÌÂÙ¤¯ÂÈ Û ·˘Ù¤˜ ÙȘ ‰Ú·ÛÙËÚÈfiÙËÙ˜ ı· Ú¤ÂÈ Ó· ÊÔÚ¿ÂÈ ÚÔÛٷ٢ÙÈÎfi ÎÚ¿ÓÔ˜ Î·È ÂÈÁÔÓ¿ÙÈ· ÚÔÛٷ٢ÙÈο ηχÌÌ·Ù·, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙËÓ ÚԉȿıÂÛ‹ ÙÔ˘ Ó· οÓÂÈ Û·ÛÌÔ‡˜. ∂¿Ó ÔÈ ÂÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ ‰ÂÓ ÂϤÁ¯ÔÓÙ·È Ì ٷ Ê¿Ú̷η Î·È Ë ‰È¿ÁÓˆÛË Â›Ó·È Ôχ ÚfiÛÊ·ÙË, ÙÔ Ô‰‹Ï·ÙÔ, ÙÔ ·ÙÈÓ¿˙ Î·È ÙÔ ·Ù›ÓÈ Ì ÙÈÌfiÓÈ ‹ Ì Úfi‰Â˜ ı· Ú¤ÂÈ Ó· ··ÁÔÚ‡ÔÓÙ·È, ÙÔ˘Ï¿¯ÈÛÙÔÓ ÛÙËÓ ·Ú¯‹. ™ÎÈ Û ÌÂÁ¿Ï˜ ·ÔÛÙ¿ÛÂȘ, ÙÚ¤ÍÈÌÔ Û ÌÂÁ¿Ï˜ ·ÔÛÙ¿ÛÂȘ Î·È ¿ÏÏ· ·ıÏ‹Ì·Ù· ·ÓÙÔ¯‹˜ O ο̷ÙÔ˜ Ô˘ ÚÔηÏÔ‡Ó Ù· ·ıÏ‹Ì·Ù· ·˘Ù¿ ‰ÂÓ ·˘Í¿ÓÂÈ ÙËÓ Èı·ÓfiÙËÙ· Ó· ÂΉËψı› ÂÈÏËÙÈ΋ ÎÚ›ÛË. ∂Ó‰ÂÈÎÙÈÎfi ‰È¿ÛÙËÌ· ÁÈ· ÙÔ Â¿Ó ı· ÚÔÎÏËı› ÎÚ›ÛË ‹ fi¯È Â›Ó·È Ë ÂÚ›Ô‰Ô˜ Ù˘ ÚÔfiÓËÛ˘ ÛÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ ¿ıÏËÌ·. ¶Ô‰fiÛÊ·ÈÚÔ, Ì¿ÛÎÂÙ, ‚fiϸ, Ù¤ÓÓȘ, Ú¿ÁÎÌ˘, ¯fiθ (·ıÏ‹Ì·Ù· Â·Ê‹˜) ªÈÎÚÔÙÚ·˘Ì·ÙÈÛÌÔ› ÙÔ˘ ÎÂÊ·ÏÈÔ‡ ηٿ ÙË ‰È¿ÚÎÂÈ· ·˘ÙÒÓ ÙˆÓ ·ıÏËÌ¿ÙˆÓ Â›Ó·È ·›ı·ÓÔ Ó· ÂÈÛ‡ÛÔ˘Ó Ì›· ÂÈÏËÙÈ΋ ÎÚ›ÛË. ∫·Ù·‰‡ÛÂȘ ÛÙÔ ‚˘ıfi Î·È ÂχıÂÚ˜ ÙÒÛÂȘ ÛÙÔÓ ·¤Ú· Ì ·ÏÂÍ›ÙˆÙÔ (sky diving) OÈ Î·Ù·‰‡ÛÂȘ ÛÙÔ ‚˘ıfi Î·È ÔÈ ÂχıÂÚ˜ ÙÒÛÂȘ ÛÙÔÓ ·¤Ú· Â›Ó·È ·fi ÙȘ Ï›Á˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜ ÔÈ Ôԛ˜ Ú¤ÂÈ Ó· ··ÁÔÚ‡ÔÓÙ·È. ∫·Ù·Û΋ӈÛË Î·È ‰È·Ó˘ÎÙ¤Ú¢ÛË ÛÙÔ Û›ÙÈ ÂÓfi˜ Ê›ÏÔ˘ ∏ Û˘ÌÌÂÙÔ¯‹ Û ηٷÛ΋ӈÛË ‹ Ë ‰È·Ó˘ÎÙ¤Ú¢ÛË ÛÙÔ Û›ÙÈ Ê›ÏˆÓ ‹ Û˘ÁÁÂÓÒÓ ÂÈÙÚ¤ÔÓÙ·È, ˘fi ÙËÓ ÚÔ¸fiıÂÛË fiÙÈ fiˆ˜ ·ÎÚÈ‚Ò˜ Û˘Ì‚·›ÓÂÈ Î·È Ì ÙÔ Û¯ÔÏÂ›Ô Î·È Ù· ·ıÏ‹Ì·Ù· „˘¯·ÁˆÁ›·˜, οÔÈÔ ˘‡ı˘ÓÔ ¿ÙÔÌÔ ı· Â›Ó·È ÂÓËÌÂڈ̤ÓÔ ÁÈ· ÙÔÓ Ù‡Ô ÙˆÓ ÎÚ›ÛÂˆÓ Ô˘ ·ÚÔ˘ÛÈ¿˙ÂÈ ÙÔ ·È‰› Î·È ı· ͤÚÂÈ Ò˜ Ú¤ÂÈ Ó· ‰ÒÛÂÈ ÙȘ ÚÒÙ˜ ‚Ô‹ıÂȘ Î·È Ó· ÂȉÔÔÈ‹ÛÂÈ ÙÔ˘˜ ÁÔÓ›˜ Â¿Ó ·Ú·ÛÙ› ·Ó¿ÁÎË.

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∆·Í›‰È· Ì ÙÔ ·ÂÚÔÏ¿ÓÔ ‹ Û ÂÚÈÔ¯¤˜ ¯·ÌËÏ‹˜ ·ÚÔ¯‹˜ È·ÙÚÈÎÒÓ ˘ËÚÂÛÈÒÓ ∆· Ù·Í›‰È· Ì ‰È¿ÊÔÚ· ̤۷ ‰ÂÓ ··ÁÔÚ‡ÔÓÙ·È ÛÙ· ·È‰È¿ Ì ÂÈÏË„›·, ·ÚΛ Ó· Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ‰ÔıÔ‡Ó ÔÈ ÚÒÙ˜ ‚Ô‹ıÂȘ fiÙ·Ó ¯ÚÂÈ·ÛÙ›.

OÈ ÁÔÓ›˜ ı· Ú¤ÂÈ Ó· ۯ‰ȿÛÔ˘Ó Î·È Ó· ÚԂϤ„Ô˘Ó ÙÈ ÌÔÚ› Ó· ¯ÚÂÈ·ÛÙ› Î·È Ò˜ ı· ·ÓÙȉڿÛÔ˘Ó ÛÙËÓ ÂÚ›ÙˆÛË ÌÈ·˜ ÎÚ›Û˘ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ Ù·ÍȉÈÔ‡ Î·È ı· Ú¤ÂÈ Ó· ‰È·ı¤ÙÔ˘Ó ·ÓÙÈÂÈÏËÙÈο Ù·¯Â›·˜ ‰Ú¿Ûˆ˜ Û ÎχÛÌ·Ù· ‹ Î·È ·ÌԇϘ ÁÈ· Ó· Ù· ¯ÔÚËÁ‹ÛÔ˘Ó ·fi ÙÔ ÔÚıfi. ™Â ÌÂÚÈΤ˜ ÂÚÈÙÒÛÂȘ ÌÔÚ› ÙÔ Ù·Í›‰È Ó· ·Ó·‚ÏËı› ÁÈ· Ï›ÁÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· (·È‰› Ì ÚfiÛÊ·ÙÔ Ì˘ÔÎÏÔÓÈÎfi status epilepticus ‹ fiÙ·Ó ·Ó·Ì¤ÓÂÙ·È Î·Ï‡ÙÂÚË Ú‡ıÌÈÛË ÙˆÓ ÎÚ›ÛˆÓ).

O‰‹ÁËÛË ·˘ÙÔÎÈÓ‹ÙÔ˘ ‹ ¿ÏÏÔ˘ ΢ÎÏÔÊÔÚÈ·ÎÔ‡ ̤ÛÔ˘ OÈ ÓfiÌÔÈ Ô˘ ·ÊÔÚÔ‡Ó ÙÔ˘˜ ÂÚÈÔÚÈÛÌÔ‡˜ Ù˘ Ô‰‹ÁËÛ˘ ÔÈΛÏÏÔ˘Ó ·fi ¯ÒÚ· Û ¯ÒÚ·. ™Â ÌÂÚÈΤ˜ ¯ÒÚ˜ ‰ÂÓ ÈÛ¯‡Ô˘Ó ÂÚÈÔÚÈÛÌÔ›, ˘fi ÙËÓ ÚÔ¸fiıÂÛË fiÙÈ Ô ıÂÚ¿ˆÓ È·ÙÚfi˜ ‰›ÓÂÈ ÙËÓ ¤ÁÎÚÈÛ‹ ÙÔ˘ ÁÈ’ ·˘Ùfi. ™Â ¿ÏϘ ¯ÒÚ˜ ÈÛ¯‡ÂÈ fiÙÈ Ô ·ÛıÂÓ‹˜ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ, ˘fi ÙËÓ ÚÔ¸fiıÂÛË fiÙÈ ·Ú·Ì¤ÓÂÈ ÂχıÂÚÔ˜ ÎÚ›ÛÂˆÓ ÁÈ· ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ·fi 3 Ì‹Ó˜ ¤ˆ˜ Î·È ¤Ó· ¯ÚfiÓÔ (8). ŸÛ· ¿ÙÔÌ· Ô‰ËÁÔ‡Ó ÂÓÒ Û˘Ó¯›˙Ô˘Ó Ó· ¤¯Ô˘Ó ÂÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ, ı· Ú¤ÂÈ Ó· ÂÓËÌÂÚÒÓÔÓÙ·È ÁÚ·ÙÒ˜ ÁÈ· ÙÔ˘˜ ÎÈÓ‰‡ÓÔ˘˜ ÙÔ˘˜ ÔÔ›Ô˘˜ Û˘ÓÂ¿ÁÂÙ·È Ë Ô‰‹ÁËÛË. OÈ ¿Û¯ÔÓÙ˜ Ô˘ ‰ÂÓ Û˘ÌÌÔÚÊÒÓÔÓÙ·È Ì ÙȘ ˘ԉ›ÍÂȘ ÙÔ˘ ÁÈ·ÙÚÔ‡ Ó· ·›ÚÓÔ˘Ó Ù· Ê¿Ú̷ο ÙÔ˘˜ Ù·ÎÙÈο, ‰ÂÓ ı· Ú¤ÂÈ Ó· Ô‰ËÁÔ‡Ó ÂÓÒ Ú¤ÂÈ Ó· ÚÔÂȉÔÔÈÔ‡ÓÙ·È fiÙÈ ÛÙËÓ ·ÓÙ›ıÂÙË ÂÚ›ÙˆÛË Â¿Ó Û˘Ì‚Â› οÔÈÔ ·Ù‡¯ËÌ· ÁÈ· ÙÔ ÔÔ›Ô ı· Â›Ó·È ˘·›ÙÈÔÈ, Ë ·ÛÊ·ÏÈÛÙÈ΋ ÂÙ·ÈÚ›· ‰ÂÓ ı· ÙÔ˘˜ ηχ„ÂÈ. ∞Ó Î·È ÔÈ ÓÔÌÔıÂۛ˜ ‰È·Ê¤ÚÔ˘Ó ÛÙȘ ‰È¿ÊÔÚ˜ ¯ÒÚ˜, fiÙ·Ó ¤Ó· ¿ÙÔÌÔ ·ÚÔ˘ÛÈ¿˙ÂÈ ÎÚ›ÛÂȘ ηٿ ÙË ‰È¿ÚÎÂÈ· ·ÏÏ·Á‹˜ ÛÙ· ÂÈÏËÙÈο Ê¿Ú̷η Ë ÔÔ›· 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 ÚÔËÁÔ‡ÌÂÓˆÓ Ê·ÚÌ¿ÎˆÓ ı· Â·Ó·Ê¤ÚÂÈ ÙÔÓ ¤ÏÂÁ¯Ô ÙˆÓ ÎÚ›ÛˆÓ. ∏ ‰È·ÎÔ‹ ÙˆÓ ·ÓÙÈÂÈÏËÙÈÎÒÓ Ê·Ú-

Paediatriki 2002;65:293-297

Ì¿ÎˆÓ ı¤ÙÂÈ ¤Ó· ‰›ÏËÌÌ· ÁÈ· ·ÌÊfiÙÂÚÔ˘˜ ÁÈ·ÙÚfi Î·È ·ÛıÂÓ‹. ™Â ·ÛıÂÓ›˜ Ì 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‹Ó˜ ÌÂÙ¿ ÙË ‰È·ÎÔ‹ ÙˆÓ Ê·Ú̿ΈÓ. OÈ ¿Û¯ÔÓÙ˜, ÁÂÓÈο, ‰ÂÓ Ú¤ÂÈ Ó· Ô‰ËÁÔ‡Ó Û ·˘Ùfi ÙÔ ‰È¿ÛÙËÌ·. ™˘ÌÂÚ·ÛÌ·ÙÈο, Ù· ·È‰È¿ Ù· ÔÔ›· ¿Û¯Ô˘Ó ·fi ÂÈÏË„›· ı· Ú¤ÂÈ Ó· ÂÓı·ÚÚ‡ÓÔÓÙ·È Ó· Û˘ÌÌÂÙ¤¯Ô˘Ó Û fiϘ ÙȘ ‰Ú·ÛÙËÚÈfiÙËÙ˜, ÔÈ Ôԛ˜ ‰ÂÓ Û˘ÓÂ¿ÁÔÓÙ·È ÛÔ‚·Úfi ΛӉ˘ÓÔ Ê˘ÛÈ΋˜ ‚Ï¿‚˘. °È· Ó· ÂÏ·¯ÈÛÙÔÔÈËıÔ‡Ó ÔÈ ÂÚÈÔÚÈÛÌÔ› ÛÙ· ¿ÙÔÌ· Ì ÂÈÏË„›· ı· Ú¤ÂÈ Ó· ·˘ÍËı› Ë ÂÎ·›‰Â˘ÛË ÙfiÛÔ ÙˆÓ ÁÔÓ¤ˆÓ fiÛÔ Î·È Ù˘ ÎÔÈÓˆÓ›·˜. ∆Ô ı¤Ì· Ù˘ ηٷÏÏËÏfiÙËÙ·˜ ÙˆÓ ÂÚÈÔÚÈÛÌÒÓ, Ù˘ ‰È¿ÚÎÂÈ¿˜ ÙÔ˘˜ fiˆ˜ Î·È ÙˆÓ ÂÈÙÒÛÂˆÓ ·fi ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙÔ˘˜ ·Ú·Ì¤ÓÂÈ ·ÓÔȯÙfi ÁÈ· ÂÚ·ÈÙ¤Úˆ ÂÈÛÙËÌÔÓÈ΋ ¤Ú¢ӷ. 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 for burn treatment and prevention. Epilepsia 2000;41:453-456.

7. Commission of Pediatrics of the ILAE. Restrictions for children with epilepsy. Epilepsia 1997;38:1054-1056.

8. Krumholz A. Driving and epilepsy: a historical perspective and review of current regulations. Epilepsia 1994;35:668-674.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 22-11-2001 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 04-04-2002 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ™Î·Ú‰Ô‡ÙÛÔ˘ ∞ÁÁÂÏÈ΋ ªÈ¯·Ï·ÎÔÔ‡ÏÔ˘ 54, ∆.∫. 115 28, ∞ı‹Ó·

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AWARD-WINNING ARTICLE

¢È·ÙÚÔÊ‹ ηٿ ÙËÓ ÂÁ΢ÌÔÛ‡ÓË Î·È ‚¿ÚÔ˜ ÓÂÔÁÓÔ‡ ∂. ¶ÂÙÚ›‰Ô˘1,2, Õ. ™Î·ÏΛ‰Ô˘1, ª. ™ÙÔ˚Λ‰Ô˘3, ¡. ¢ÂÛ‡Ú˘1, ¢. ∆ÚȯfiÔ˘ÏÔ˜1,2

Nutrition during pregnancy in relation to birthweight E. Petridou1,2, A. Skalkidou1, M. Stoikidou3, N. Dessypris1, D. Trichopoulos1,2

¶ÂÚ›ÏË„Ë: ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ Â›Ó·È Ë ‰ÈÂÚ‡ÓËÛË Ù˘ Û¯¤Û˘ ÌÂٷ͇, ·ÊÂÓfi˜ Ù˘ ÚfiÛÏ˄˘ ‰È·ÙÚÔÊÈÎÒÓ ÛÙÔȯ›ˆÓ ‰È·ÊfiÚˆÓ ‰È·ÙÚÔÊÈÎÒÓ ÔÌ¿‰ˆÓ ηٿ ÙËÓ ÂÁ΢ÌÔÛ‡ÓË Î·È ·ÊÂÙ¤ÚÔ˘ ÙÔ˘ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ˘ÁÈÒÓ, ÙÂÏÂÈfiÌËÓˆÓ ÓÂÔÁÓÒÓ. ∏ ÌÂϤÙË Û˘ÌÂÚȤϷ‚ ÙÚÈ·ÎfiÛȘ ÂÍ‹ÓÙ· ÔÎÙÒ Á˘Ó·›Î˜, ÔÈ Ôԛ˜ Á¤ÓÓËÛ·Ó ÛÂ Û˘ÁÎÂÎÚÈ̤Ó˜ ËÌÂÚÔÌËӛ˜ ÌÈ·˜ ÂÚÈfi‰Ô˘ ÔÎÙÒ ÌËÓÒÓ, Û ¤ÍÈ ÌÂÁ¿Ï˜ ª·È¢ÙÈΤ˜ ∫ÏÈÓÈΤ˜ ‰‡Ô ÌÂÁ¿ÏˆÓ ÂÏÏËÓÈÎÒÓ fiψÓ. ŒÁÈÓ ÚÔÛˆÈ΋ Û˘Ó¤ÓÙ¢ÍË Ì οı Ï¯ˆ˝‰·, Ô˘ ‚·Û›ÛÙËΠ۠ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ÂÏÂÁ̤Ó˘ ·ÍÈÔÈÛÙ›·˜. ∂ÎÙfi˜ ·fi ÙȘ ËÌÈÔÛÔÙÈΤ˜ ·Ú·Ì¤ÙÚÔ˘˜ ‰È·ÙÚÔÊ‹˜, ÙÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Û˘ÌÂÚÈÏ¿Ì‚·Ó ÂÚˆÙ‹ÛÂȘ Û¯ÂÙÈο Ì ÎÔÈÓˆÓÈÎÔ‰ËÌÔÁÚ·ÊÈΤ˜ ÌÂÙ·‚ÏËÙ¤˜, ηıÒ˜ Î·È ÌÂÙ·‚ÏËÙ¤˜ Ô˘ ·ÊÔÚÔ‡Û·Ó ·Ó··Ú·ÁˆÁÈΤ˜ ·Ú·Ì¤ÙÚÔ˘˜ Î·È ÙÔÓ ÙÚfiÔ ˙ˆ‹˜. ∆· ÛÙÔȯ›· ·Ó·Ï‡ıËÎ·Ó Ì ÔÏ˘·Ú·ÁÔÓÙÈ΋ ÌÂıÔ‰ÔÏÔÁ›·. ŒÁÈÓ ¤ÏÂÁ¯Ô˜ ÙˆÓ ‰È·ÙÚÔÊÈÎÒÓ ÌÂÙ·‚ÏËÙÒÓ ˆ˜ ÚÔ˜ ÙË ıÂÚÌȉÈ΋ ÚfiÛÏË„Ë, ηıÒ˜ Î·È ÙÔ˘˜ ÌË ‰È·ÙÚÔÊÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛ˘. ∞fi ÙȘ ÔÌ¿‰Â˜ ÙÚÔʛ̈Ó, ÙÔ ÎÚ¤·˜ Î·È Ù· ·Ú¿ÁˆÁ¿ ÙÔ˘, ηıÒ˜ Î·È ÙÔ „¿ÚÈ Î·È Ù· ¿ÏÏ· ı·Ï·ÛÛÈÓ¿ ‚Ú¤ıËÎ·Ó Ó· Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì ·˘ÍË̤ÓÔ ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ (ÙÈÌ‹ ÎÚÈÙËÚ›Ô˘ p ‰‡Ô ‰È¢ı‡ÓÛÂˆÓ 0,08 Î·È 0,16 ·ÓÙ›ÛÙÔȯ·). ∞fi Ù· ‰È·ÙÚÔÊÈο ÛÙÔȯ›· Ì ıÂÚÌȉÈ΋ ·fi‰ÔÛË, Ù· ÌÔÓÔ·ÎfiÚÂÛÙ· Ï›Ë Û˘Û¯ÂÙ›˙ÔÓÙ·È ıÂÙÈο Ì ÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ Î·È ·ÚÎÂÙ¿ ·fi ·˘Ù¿ Û ‚·ıÌfi ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈÎfi, Û ÔÏÏ¿ ·fi Ù· ÌÔÓ٤Ϸ

Abstract: The aim of the study was to investigate the relation between consumption of various food groups and intake of energygenerating macronutrients on one hand, and birthweight on the other, among apparently healthy, term singletons. Three hundred sixty eight women out of 400, who delivered in six Maternity Clinics in two Greek cities during a specified period, completed an interviewer-administered, validated, semiquantitative food frequency questionnaire. Study participants also provided information on sociodemographic, reproductive and lifestyle variables. Data were analyzed through multiple regression modeling. Nutritional variables were energy-adjusted, and non nutritional correlates of birthweight were accounted for. The analysis revealed most of the established non nutritional associations of birthweight - an indication of study validity. Among food groups, meat and meat products and fish and sea food were suggestively associated with increased birthweight (two tailed p-values 0.08 and 0.16 respectively). Among energy-generating nutrients, monounsaturated fat was positively associated with birthweight and significantly so in several of the models. Our findings are considered as being compatible with the hypotheses that links fish and meat intake to fetal growth, and are indicative of a positive association between intake of monounsaturated fat and birthweight.

1 ∂ÚÁ·ÛÙ‹ÚÈÔ ÀÁÈÂÈÓ‹˜ Î·È ∂ȉËÌÈÔÏÔÁ›·˜, π·ÙÚÈ΋ ™¯ÔÏ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ 2 ∆Ì‹Ì· ∂ȉËÌÈÔÏÔÁ›·˜, ™¯ÔÏ‹ ¢ËÌfiÛÈ·˜ ÀÁ›·˜, ¶·ÓÂÈÛÙ‹ÌÈÔ ∏arvard 3 ∆Ì‹Ì· ∂ÈÛÎÂÙÚÈÒÓ ÀÁ›·˜, ™¯ÔÏ‹ ∂ÈÛÙËÌÒÓ ÀÁ›·˜, ∞ı‹Ó·

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 Sciences and Welfare, Athens Polytechnic

µÚ·‚Â›Ô “£Ú¤„Ë Î·È ¢È·ÙÚÔÊ‹” 36Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ, 1998

Award on “Diet and Nutrition” 36th Panhellenic Meeting, 1998

298

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13:32

™ÂÏ›‰·299

¶·È‰È·ÙÚÈ΋ 2002;65:298-306

Paediatriki 2002;65:298-306

Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÛÙËÓ ·Ó¿Ï˘ÛË. ∆· ·ÔÙÂϤÛÌ·Ù· ·˘Ù¿ ıˆÚÔ‡ÓÙ·È Û˘Ì‚·Ù¿ Ì ÙËÓ ˘fiıÂÛË fiÙÈ Ë ÚfiÛÏË„Ë ÎÚ¤·ÙÔ˜ Î·È „·ÚÈÔ‡ Û¯ÂÙ›˙ÂÙ·È ıÂÙÈο Ì ÙÔ ‚¿ÚÔ˜ ÙÔ˘ ÓÂÔÁÓÔ‡ Î·È ˘Ô‰ËÏÒÓÔ˘Ó ÙËÓ ‡·ÚÍË ·ÓÙ›ÛÙÔȯ˘ Û¯¤Û˘ ÙˆÓ ÌÔÓÔ·ÎfiÚÂÛÙˆÓ ÏÈÒÓ Ì ÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛ˘. §¤ÍÂȘ ÎÏÂȉȿ: ·‡ÍËÛË ÓÂÔÁÓÔ‡, ‚¿ÚÔ˜ Á¤ÓÓËÛ˘, ÌÔÓÔ·ÎfiÚÂÛÙ· ÏÈ›‰È·, „¿ÚÈ Î·È ÎÚ¤·˜, ˆÌ¤Á· 3ÏÈ·Ú¿ Ôͤ·.

Key words: fetal growth, birthweight, monounsaturated fat, fish and meat, omega-3 fatty acids.

∂ÈÛ·ÁˆÁ‹ ¶ÔÏϤ˜ ÌÂϤÙ˜ ¤¯Ô˘Ó ÂÍÂÙ¿ÛÂÈ ÙË Û¯¤ÛË ÌË ‰È·ÙÚÔÊÈÎÒÓ ·Ú·ÁfiÓÙˆÓ Ì ÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ Î·È ¤¯Ô˘Ó ‚ÚÂÈ fiÙÈ ÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ ÙÔ˘ ÚÒÙÔ˘ ·È‰ÈÔ‡ Â›Ó·È ¯·ÌËÏfiÙÂÚÔ ·fi ÂΛÓÔ ÙˆÓ ÂfiÌÂÓˆÓ ÙfiÎˆÓ (1,2). ∂›Û˘, Á˘Ó·›Î˜ ÌÈÎÚ‹˜ ‹ Ôχ ÌÂÁ¿Ï˘ ËÏÈΛ·˜ ·ËÛ˘ (1,3), ¯·ÌËÏÔ‡ ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎÔ‡ ÂÈ¤‰Ô˘ (1,4,5) Î·È ÌÈÎÚ‹˜ ۈ̷ÙÈ΋˜ ‰È¿Ï·Û˘ (6-11), Û˘Ó‹ıˆ˜ ÁÂÓÓÔ‡Ó ÓÂÔÁÓ¿ Ì ÌÈÎÚfiÙÂÚÔ ÛˆÌ·ÙÈÎfi ‚¿ÚÔ˜. H ·ÈÌÔÚÚ·Á›· ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÁ΢ÌÔÛ‡Ó˘, ȉȷ›ÙÂÚ· ηٿ ÙÔ ÙÚ›ÙÔ ÙÚ›ÌËÓÔ (12-14), Ë ˘¤ÚÙ·ÛË (15), Ë ÙÔÍÈÓ·ÈÌ›· ηٿ ÙËÓ Î‡ËÛË (16), ηıÒ˜ Î·È ÙÔ ÈÛÙÔÚÈÎfi ·Ô‚ÔÏÒÓ (17,18), ¤¯Ô˘Ó Û˘Û¯ÂÙÈÛÙ› Ì ÌÈÎÚfi ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ ÙÔ˘ ÓÂÔÁÓÔ‡. ∂›Û˘, ˘¿Ú¯Ô˘Ó ÂÚÈÔÚÈṲ̂Ó˜ ÂӉ›ÍÂȘ Ô˘ Û˘ÓËÁÔÚÔ‡Ó fiÙÈ ˘¿Ú¯ÂÈ ıÂÙÈ΋ Û¯¤ÛË ÙÔ˘ ÈÛÙÔÚÈÎÔ‡ ÂÎÙÚÒÛÂˆÓ Ì ÙÔ ÌÈ-

ÎÚfi ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ ÙÔ˘ ÓÂÔÁÓÔ‡ (17). ∏ ·‡ÍËÛË ÙÔ˘ ‚¿ÚÔ˘˜ Ù˘ ÌËÙ¤Ú·˜ ηٿ ÙËÓ ÂÁ΢ÌÔÛ‡ÓË (19,20), Ô˘ ÂÓ Ì¤ÚÂÈ ·ÓÙ·Ó·ÎÏ¿ ÙËÓ ˘„ËÏfiÙÂÚË ıÂÚÌȉÈ΋ ÚfiÛÏË„Ë Ù˘ ÂÁ·Ԣ, Û˘Û¯ÂÙ›˙ÂÙ·È Ì ÌÂÁ·Ï‡ÙÂÚÔ ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓÔ‡, ÂÓÒ ÙÔ Î¿ÓÈÛÌ· ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÁ΢ÌÔÛ‡Ó˘ (3,10,21,22) Î·È Ë Î·Ù·Ó¿ÏˆÛË Î·Ê¤ (23,26) Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì ÌÈÎÚfiÙÂÚÔ ‚¿ÚÔ˜ Á¤ÓÓËÛ˘. ∏ ÌÂÁ¿ÏË Î·Ù·Ó¿ÏˆÛË ÔÈÓÔÓ‡̷ÙÔ˜ ηٿ ÙËÓ ÂÁ΢ÌÔÛ‡ÓË ¤¯ÂÈ ÙÔÍÈ΋ Â›‰Ú·ÛË ÛÙÔ ¤Ì‚Ú˘Ô, ÂÓÒ ·ÓÙ›ıÂÙ·, Ë Ï‹„Ë ÌÈÎÚ‹˜ ÔÛfiÙËÙ·˜ ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ Ê·›ÓÂÙ·È Ó· ÌË Û¯ÂÙ›˙ÂÙ·È ‹ ÂÓ‰¤¯ÂÙ·È ·ÎfiÌ· Î·È Ó· Û¯ÂÙ›˙ÂÙ·È ıÂÙÈο Ì ÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ (1,27,28). ∂ÓÒ ¤¯ÂÈ ÙÂÎÌËÚȈı› Ë Û¯¤ÛË ÌÂٷ͇ ˘ÔÛÈÙÈÛÌÔ‡ Ù˘ ÌËÙ¤Ú·˜ Î·È ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ (1,20,29), Ï›Á˜ ÌÂϤÙ˜ ¤¯Ô˘Ó ·Û¯ÔÏËı› Ì ÙË

¶›Ó·Î·˜ 1. ∆·ÍÈÓfiÌËÛË Û ÔÌ¿‰Â˜ ÙˆÓ ‰È·ÊfiÚˆÓ ÂȉÒÓ ÙÚÔÊ›ÌˆÓ Ô˘ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÛÙÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Ù˘ Û˘¯ÓfiÙËÙ·˜ Ï‹„˘ ÙÚÔÊÒÓ OÌ¿‰Â˜ ÙÚÔʛ̈Ó

∂›‰Ô˜ ÙÚÔʛ̈Ó

¢ËÌËÙÚȷο Î·È ·Ì˘ÏÒ‰Ë

ÕÛÚÔ „ˆÌ›, Ì·‡ÚÔ „ˆÌ›, ·Ú·‰ÔÛÈ·Îfi „ˆÌ›, Ú‡˙È, ̷ηÚfiÓÈ·, ÔÈΛϷ ‰ËÌËÙÚȷο ÁÈ· ÚˆÈÓfi, ÙÚ·¯·Ó¿˜, Ù˘ÚfiÈÙ· (1/2), ÎÚ·ÙfiÈÙ· (1/2), Ï·¯·ÓfiÈÙ· (1/2), ›ÙÛ· (1/2), ·ÛÙ›ÙÛÈÔ (1/2), ·Ù¿Ù˜ ∑¿¯·ÚË, ÌÈÛÎfiÙ·, ÛÔÎÔÏ¿Ù·, ÁÎÔÊÚ¤Ù˜, Ì·ÎÏ·‚¿˜, ηÓÙ·˝ÊÈ Î·È ¿ÏÏ· ÂÏÏËÓÈο ÁÏ˘Î¿, ÁÏ˘Î¿ ÎÔ˘Ù·ÏÈÔ‡, ˙ÂϤ, ÊÚÔ˘˚ÙÔÁÏ·Û¤, ÁÏ˘Î¿ Ì Îڤ̘, ÙËÁ·Ó›Ù˜, ηڷ̤Ϙ, ̤ÏÈ, ÎÔÌfiÛÙ· (1/2) •ËÚ¿ Ê·ÛfiÏÈ·, Ú‚›ıÈ·, ʷΤ˜, Ê¿‚·, Ê·ÛfiÏÈ· Á›Á·ÓÙ˜, ÍËÚÔ› ηÚÔ› ºÚ¤ÛÎȘ ÙÔÌ¿Ù˜, Ì·ÁÂÈÚÂ̤Ó˜ ÙÔÌ¿Ù˜, ·ÁÁÔ‡ÚÈ·, ÈÂÚȤ˜, ÊÚ¤ÛÎÔ Ï¿¯·ÓÔ, Ì·ÁÂÈÚÂ̤ÓÔ Ï¿¯·ÓÔ, Ì·ÚÔ‡ÏÈ, ÊÚ¤ÛÎÔ Î·ÚfiÙÔ, Ì·ÁÂÈÚÂ̤ӷ ηÚfiÙ·, ÎÚÂÌ̇‰È·, ÊÚ¤Ûη Ê·ÛÔÏ¿ÎÈ·, ÌÂÏÈÙ˙¿Ó˜, Û·Ó¿ÎÈ, Ú¿Û·, Ì¿ÌȘ, ·ÁÚÈÔÚ·‰›ÎÈ·, ·ÁÎÈÓ¿Ú˜, ÊÚ¤Ûη ʷډȿ Ê·ÛfiÏÈ·, ·Ú·Î¿˜, ÎÔ˘ÓÔ˘›‰È, ÌÚfiÎÔÏ·, ÎÔÎÎÈÓÔÁÔ‡ÏÈ·, Ì·ÓÈÙ¿ÚÈ·, Ï·¯·ÓfiÈÙ·, ÌÔ˘Û·Î¿˜ ∫·ÚÔ‡˙È, ÂfiÓÈ, Ì·ÓÙ·Ú›ÓÈ·, ÔÚÙÔοÏÈ·, Ì‹Ï·, ÚÔ‰¿ÎÈÓ·, ·¯Ï¿‰È·, ÛٷʇÏÈ·, ‚ÂÚ›ÎÔη, ÎÂÚ¿ÛÈ·, ÊÚ¿Ô˘Ï˜, Ì·Ó¿Ó˜, ۇη, ·Ó·Ó¿˜, ÁÎÚ¤È-ÊÚÔ˘Ù, ÊÚ¤ÛÎÔ˜ ¯˘Ìfi˜ ÊÚÔ‡ÙˆÓ, ·ÔÍËڷ̤ӷ ÊÚÔ‡Ù·, ÎÔÌfiÛÙ· (1/2) ÃÔÈÚÈÓfi, ÌÔÛ¯¿ÚÈ, ·ÚÓ›, ηÙÛ›ÎÈ, ÎÔÙfiÔ˘ÏÔ, Á·ÏÔԇϷ, ηÓÈÛÙfi ¯ÔÈÚÈÓfi, ÏÔ˘Î¿ÓÈη, Û˘ÎÒÙÈ Î·È ¿ÏϘ ÂÓÙÚ¿‰Â˜, ·˘Á¿, ÎÚ·ÙfiÈÙ· (1/2), ÌÔ˘Û·Î¿˜ (1/2), ·ÛÙ›ÙÛÈÔ (1/2) æ¿ÚÈ· Î·È ÔÛÙÚ·ÎÔÂȉ‹ ∆˘Ú› ʤٷ, ηۤÚÈ, ¿ÏÏ· Ù˘ÚÈ¿, Ï‹Ú˜ Á¿Ï·, ·Ô‚Ô˘Ù˘ÚˆÌ¤ÓÔ Á¿Ï·, ÁÈ·Ô‡ÚÙÈ Ï‹ÚˆÓ ÏÈ·ÚÒÓ Î·È ÌÂÈˆÌ¤ÓˆÓ ÏÈ·ÚÒÓ, Ô˘Ù›Áη Ì Á¿Ï·, Ô˘Ù›Áη Ì Á¿Ï· Î·È Ú‡˙È, ·ÁˆÙfi, Ù˘ÚfiÈÙ· Î·È ›ÙÛ· (1/2) µÔ‡Ù˘ÚÔ ÛÙÔ „ˆÌ›, Ì·ÁÂÈÚÈÎfi ‚Ô‡Ù˘ÚÔ, Ì·ÚÁ·Ú›ÓË Û „ˆÌ›, Ì·ÁÂÈÚÈ΋ Ì·ÚÁ·Ú›ÓË, ÛÔڤϷÈÔ, ÂÏ·ÈfiÏ·‰Ô, ÂÏȤ˜

°Ï˘Î¿ Î·È ÎÔÌfiÛÙ˜

ŸÛÚÈ·, ÍËÚÔ› ηÚÔ› Î·È ÛfiÚÔÈ §·¯·ÓÈο

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∆Ô (1/2) ÛËÌÂÈÒÓÂÙ·È ÁÈ· Ù· Ì·ÁÂÈÚÂ̤ӷ Á‡̷ٷ Ô˘ ÌÔÈÚ¿ÛÙËÎ·Ó Û ‰‡Ô ÔÌ¿‰Â˜ ÙÚÔʛ̈Ó

299

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13:32

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¶·È‰È·ÙÚÈ΋ 2002;65:298-306

Paediatriki 2002;65:298-306

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N

ñ ∏ÏÈΛ· ÌËÙ¤Ú·˜ (¤ÙË) ≤19 14 20-24 83 25-29 156 30-34 94 35-39 18 ≥40 3 ñ ∂Î·›‰Â˘ÛË ÌËÙ¤Ú·˜ (¤ÙË) ≤11 54 12 154 13-15 88 ≥16 72 ñ ⁄„Ô˜ ÌËÙ¤Ú·˜ (cm) ≤159 40 160-164 141 165-169 121 170-174 55 ≥175 11 ñ πÛÙÔÚÈÎfi ·Ô‚ÔÏÒÓ ¡·È 42 Ÿ¯È 326 ñ πÛÙÔÚÈÎÒÓ ÂÎÙÚÒÛÂˆÓ ¡·È 58 Ÿ¯È 310 ñ ∞ÈÌÔÚÚ·Á›· ¡·È 70 Ÿ¯È 298 ñ ŒÌÂÙÔ˜ ¡·È 81 Ÿ¯È 287 ñ ∫¿ÓÈÛÌ· (ÙÛÈÁ¿Ú·/Ë̤ڷ) 0 248 1-5 67 6-10 43 ≥11 10 ñ OÈÓÔÓÂ˘Ì·ÙÒ‰Ë ÔÙ¿ ¶ÔÙ¤ 239 ∂˘Î·ÈÚȷο 129 ñ ∫·Ê¤˜ (ÊÏ˘Ù˙¿ÓÈ·/Ë̤ڷ) 0 123 <1 60 1 118 >1 67 ñ ™Î¢¿ÛÌ·Ù· Ê˘ÏÏÈÎÔ‡ Ôͤˆ˜ ¡·È 127 Ÿ¯È 241 ñ ªËÙÚÈ΋ ÚfiÛÏË„Ë ‚¿ÚÔ˘˜ (kg) ≤7 21 8-9 30 10-11 67 12-13 86 14-15 70 16-17 43 18-19 19 ≥20 32 ñ ∆ÔÎÂÙfi˜ º˘ÛÈÔÏÔÁÈÎfi˜ 247 ∫·ÈÛ·ÚÈ΋ ÙÔÌ‹ 121

300

% 3,8 22,6 42,4 25,5 4,9 0,8 14,7 41,8 23,9 19,6 10,9 38,3 32,9 14,9 3,0 11,4 88,6 15,8 84,2 19,0 81,0 22,0 78,0 67,4 18,2 11,7 2,7 64,9 35,1 33,4 16,3 32,1 18,2 34,5 65,5 5,7 8,1 18,2 23,4 19,0 11,7 5,2 8,7 67,1 32,9

ñ ™ÂÈÚ¿ Á¤ÓÓËÛ˘ 1 ≥2 ñ º‡ÏÔ ∞ÁfiÚÈ ∫ÔÚ›ÙÛÈ ñ µ¿ÚÔ˜ Á¤ÓÓËÛ˘ (g) ≤2500 2501-3000 3001-3500 3501-4000 >4001

207 161

56,2 43,8

173 195

47,0 53,0

17 56 158 111 26

4,6 15,2 42,9 30,2 7,1

Û¯¤ÛË ·Ó¿ÌÂÛ· ÛÙȘ ‰È·ÙÚÔÊÈΤ˜ Û˘Ó‹ıÂȘ Ù˘ ÌËÙ¤Ú·˜ Î·È ÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ ÙÔ˘ ÓÂÔÁÓÔ‡ Û ¯ÒÚ˜ fiÔ˘ ‰ÂÓ ·Ú·ÙËÚÂ›Ù·È ˘ÔÛÈÙÈÛÌfi˜ (9,2935). Œ¯ÂÈ ÚÔÙ·ı› fiÙÈ Ë Î·Ù·Ó¿ÏˆÛË „·ÚÈÔ‡ Î·È ·ÎfiÚÂÛÙˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ Ì·ÎÚ¿˜ ·Ï‡ÛÔ˘ (ˆÌ¤Á· 3-ÏÈ·Ú¿ Ôͤ· ÙˆÓ „·ÚÈÒÓ) ÂÓ‰¤¯ÂÙ·È Ó· Â›Ó·È ÛËÌ·ÓÙÈ΋ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ ÂÌ‚Ú‡Ô˘ (3638), ·Ó Î·È Ë Î˘Ú›·Ú¯Ë ¿Ô„Ë Â›Ó·È fiÙÈ Ë ÔÈÔÙÈ΋ Û‡ÛÙ·ÛË Ù˘ ‰È·ÙÚÔÊ‹˜ ÛÙȘ ·Ó·Ù˘Á̤Ó˜ ¯ÒÚ˜ ‰ÂÓ Û¯ÂÙ›˙ÂÙ·È ÛËÌ·ÓÙÈο Ì ÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ (31). ™ÙËÓ ∂ÏÏ¿‰·, ÙÔ ÌÈÎÚfi ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ Â›Ó·È Û¿ÓÈÔ (39). ™ÙÔ Ï·›ÛÈÔ ÂÓfi˜ ÚÔÁÚ¿ÌÌ·ÙÔ˜ Ô˘ ›¯Â ˆ˜ ÛÙfi¯Ô ÙË ‰ÈÂÚ‡ÓËÛË Ù˘ ÂȉËÌÈÔÏÔÁ›·˜ ÂÚÈÁÂÓÓËÙÈÎÒÓ Û˘ÓıËÎÒÓ (40,41), ÂÚ¢ӋıËÎÂ Ë Û¯¤ÛË ÌÂٷ͇ Ù˘ ηٷӿψÛ˘ ‰È·ÙÚÔÊÈÎÒÓ ÔÌ¿‰ˆÓ Î·È ÚfiÛÏ˄˘ ÙÚÔÊ›ÌˆÓ ˘„ËÏ‹˜ ıÂÚÌȉÈ΋˜ ÂÓ¤ÚÁÂÈ·˜ ·ÊÂÓfi˜ Î·È ÙÔ˘ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ·ÊÂÙ¤ÚÔ˘, ÌÂÙ¿ ·fi ¤ÏÂÁ¯Ô ÁÈ· ÙÂÎÌËÚȈ̤ÓÔ˘˜ Î·È Èı·ÓÔ‡˜ ÌË ‰È·ÙÚÔÊÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛ˘. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ™ÙË ÌÂϤÙË Û˘ÌÂÚÈÂÏ‹ÊıËÛ·Ó 400 Á˘Ó·›Î˜ Ô˘ Á¤ÓÓËÛ·Ó ¤Ó· ÙÂÏÂÈfiÌËÓÔ Î·È Ê·ÈÓÔÌÂÓÈο ˘ÁȤ˜ ÓÂÔÁÓfi, Û ¤ÍÈ Ì·ÈÂ˘Ù‹ÚÈ· Ù˘ ∞ı‹Ó·˜ Î·È Ù˘ §¿ÚÈÛ·˜ ·fi ÙÔ ª¿ÚÙÈÔ Ì¤¯ÚÈ ÙÔÓ OÎÙÒ‚ÚÈÔ ÙÔ˘ 1995. OÈ Á˘Ó·›Î˜ ·˘Ù¤˜ ‰ÂÓ ¤·Û¯·Ó ·fi ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË Î·È Á¤ÓÓËÛ·Ó Û ̛· ·fi ÙȘ Û˘ÁÎÂÎÚÈ̤Ó˜ Ë̤Ú˜ Ô˘ Ù· ¿ÙÔÌ· Ô˘ ¤·ÈÚÓ·Ó Û˘Ó¤ÓÙ¢ÍË ÂÈÛΤÊıËÎ·Ó Ù· Û˘ÓÂÚÁ·˙fiÌÂÓ· Ì·ÈÂ˘Ù‹ÚÈ·. ∞fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ Á˘Ó·ÈÎÒÓ, ÌfiÓÔ ÔÈ 32 ‰ÂÓ ‹Ù·Ó Û ı¤ÛË Ó· Û˘ÓÂÚÁ·ÛÙÔ‡Ó ‹ ‰ÂÓ ı¤ÏËÛ·Ó Ó· Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÙË ÌÂϤÙË. ªÂÙ¿ ·fi Û˘ÁηٿıÂÛË ÙˆÓ Ï¯ˆ˝‰ˆÓ, ‰‡Ô ÂȉÈο ÂÎ·È‰Â˘Ì¤Ó˜ ÂÈÛΤÙÚȘ ˘Á›·˜ ¤Î·Ó·Ó ÂÎÙÂٷ̤ÓË Û˘Ó¤ÓÙ¢ÍË Ì ‚¿ÛË ÚÔΈ‰ÈÎÔÔÈË̤ÓÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ, ÙÔ ÔÔ›Ô ÂÚÈÂÏ¿Ì‚·Ó ÎÔÈÓˆÓÈÎÔ‰ËÌÔÁÚ·ÊÈΤ˜ Î·È ‚ÈÔ˚·ÙÚÈΤ˜ ÌÂÙ·‚ÏËÙ¤˜, ηıÒ˜ Î·È ÂÚˆÙ‹ÛÂȘ Û¯ÂÙÈΤ˜ Ì ÙÔÓ ÙÚfiÔ ˙ˆ‹˜. ∂ÈϤÔÓ, Û˘ÌÏËÚÒıËÎÂ Î·È ¤Ó· ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ‰È·ÙÚÔÊ‹˜ Ì ËÌÈÔÛÔÙÈΤ˜ ÌÂÙ·‚ÏËÙ¤˜ Ô˘ Î¿Ï˘Ù·Ó ÂÚˆÙ‹ÛÂȘ ÁÈ· ÙËÓ Î·Ù·Ó¿ÏˆÛË 190 ÙÚÔÊ›ÌˆÓ Î·È ÔÙÒÓ (42). ªÂÙ¿ ·fi ÙȘ ·Ϥ˜ ‰È·ÍÔÓÈΤ˜ ÈÓ·ÎÔÔÈ‹ÛÂȘ ÙˆÓ ÛÙÔȯ›ˆÓ, ¤ÁÈÓ ÔÏ˘·Ú·ÁÔÓÙÈ΋ ·Ó¿Ï˘ÛË Ì ÂÍ·ÚÙË̤ÓË

july-aug02TELIKO

14-05-03

13:32

™ÂÏ›‰·301

¶·È‰È·ÙÚÈ΋ 2002;65:298-306

Paediatriki 2002;65:298-306

¶›Ó·Î·˜ 3. ∫·Ù·ÓÔÌ‹ ÙˆÓ 368 ÌËÙ¤ÚˆÓ ÌÔÓ‹ÚˆÓ Î˘‹ÛÂˆÓ ·Ó¿ÏÔÁ· Ì ÙË ‰È·ÙÚÔÊÈ΋ ÚfiÛÏË„Ë ªÂÙ·‚ÏËÙ‹ ñ OÏÈ΋ ıÂÚÌȉÈ΋ ÚfiÛÏË„Ë (kcal) ≤1999 2000-2299 2300-2599 2600-2999 ≥3000 ñ ¢ËÌËÙÚȷο Î·È ¿ÏÏ· ·Ì˘ÏÒ‰Ë ≤2 ·Ó¿ Ë̤ڷ 3 4 >4 ñ °Ï˘Î¿ Î·È ÎÔÌfiÛÙ˜ <1 ·Ó¿ Ë̤ڷ 1-2 3-4 >4 ñ ŸÛÚÈ·, ÍËÚÔ› ηÚÔ› Î·È ÛfiÚÔÈ ≤1 ·Ó¿ Ì‹Ó· 2-3 4-5 ≥6 ñ §·¯·ÓÈο ≤2 ·Ó¿ Ë̤ڷ 3 4 ≥5 ñ ºÚÔ‡Ù· ≤2 ·Ó¿ Ë̤ڷ 3 4 5 ≥6 ñ °¿Ï· Î·È Á·Ï·ÎÙÔÎÔÌÈο ≤3 ·Ó¿ Ë̤ڷ 4 5 6 ≥7 ñ ¶ÚfiÛıÂÙ· Ï›Ë Î·È ¤Ï·È· ≤2 ·Ó¿ Ë̤ڷ 3 ≥4 ñ ∫Ú¤·˜ Î·È ·Ú¿ÁˆÁ· ≤3 ÊÔÚ¤˜/‚‰ÔÌ¿‰· 4-5 6-7 >7 ñ æ¿ÚÈ· Î·È ı·Ï·ÛÛÈÓ¿ ≤1 ÊÔÚ¤˜/Ì‹Ó· 2-3 4-5 ≥6

N

%

80 73 69 71 75

21,7 19,9 18,7 19,3 20,4

69 123 106 70

18,8 33,4 28,8 19,0

156 95 84 33

42,4 25,8 22,8 9,0

75 106 101 86

20,4 28,8 27,4 23,4

43 101 129 95

11,7 27,4 35,1 25,8

57 108 99 63 41

15,5 29,3 26,9 17,2 11,1

85 90 80 48 65

23,1 24,5 21,7 13,0 17,7

113 147 108

30,7 40,0 29,3

83 117 90 78

22,6 31,7 24,5 21,2

78 87 115 88

21,2 23,6 31,3 23,9

ÌÂÙ·‚ÏËÙ‹ ÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ Û ÁÚ·ÌÌ¿ÚÈ·. ™Â fiÏ· Ù· ‚·ÛÈο ÌÔÓ٤Ϸ Û˘ÌÂÚÈÂÏ‹ÊıËÛ·Ó ÔÈ ÌÂÙ·‚ÏËÙ¤˜ Ô˘ ·ÊÔÚÔ‡Û·Ó ÙËÓ ÂÁ΢ÌÔÛ‡ÓË Î·È ÙÔÓ ÙÔÎÂÙfi, Ì ÙÔÓ ÙÚfiÔ Ô˘ ·Ó·Ê¤ÚÂÙ·È ÛÙËÓ ·Ú¿ÁÚ·ÊÔ ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ Ù˘ ÌÂϤÙ˘. OÈ ‰È·ÙÚÔÊÈΤ˜ ÌÂÙ·‚ÏËÙ¤˜ ·ÍÈÔÏÔÁ‹ıËÎ·Ó Ì ‚¿ÛË

ÙȘ ÔÌ¿‰Â˜ ÙÚÔÊ›ÌˆÓ Ô˘ ÚÔÙ¿ıËÎ·Ó ·fi ÙÔ˘˜ Davidson Î·È Passmore (43), Ì ÙË ‰È·ÊÔÚ¿ fiÙÈ ÛÙË ÌÂϤÙË ·˘Ù‹ ‰ËÌÈÔ˘ÚÁ‹ıËΠ̛· ÂÈϤÔÓ Î·ÙËÁÔÚ›· ÁÈ· Ù· „¿ÚÈ· Î·È Ù· ı·Ï·ÛÛÈÓ¿, ÂÓÒ Ù· ‰ËÌËÙÚȷο Î·È ¿ÏÏ· ·Ì˘ÏÒ‰Ë ˘ÔÏÔÁ›ÛÙËÎ·Ó Û ̛· ηÙËÁÔÚ›· (¶›Ó·Î·˜ 1). ∂ÈϤÔÓ, ·ÍÈÔÏfiÁËÛË ÙˆÓ ‰È·ÙÚÔÊÈÎÒÓ ÌÂÙ·‚ÏËÙÒÓ ¤ÁÈÓ ·Ó¿ÏÔÁ· Ì ÙË ıÂÚÌȉÈ΋ ·Í›· ÙˆÓ ÂÈ̤ÚÔ˘˜ ÙÚÔʛ̈Ó. ∞ıÚÔ›ÛÙËÎ·Ó ÔÈ Û˘¯ÓfiÙËÙ˜ ηٷӿψÛ˘ ÙÚÔÊ›ÌˆÓ Ù˘ ›‰È·˜ ÔÌ¿‰·˜ (44) Î·È ÁÈ· fiÛ˜ ÙÚÔʤ˜ ηٷӷÏÒÓÔÓÙ·È ÌfiÓÔ ÔÚÈṲ̂Ó˜ ÂÔ¯¤˜ ÙÔ˘ ¯ÚfiÓÔ˘, ¤ÁÈÓ ÚÔÙ‡ˆÛË ·Ó¿ÏÔÁ· Ì ÙËÓ ÂÔ¯ÈÎfiÙËÙ· Ù˘ ηٷӿψۋ˜ ÙÔ˘˜ ηٿ ÙËÓ ÂÚ›Ô‰Ô Ù˘ ÂÁ΢ÌÔÛ‡Ó˘. O ˘ÔÏÔÁÈÛÌfi˜ ÙˆÓ ıÂÚÌ›‰ˆÓ Ô˘ ÚÔÛʤÚÂÈ Ë ÚfiÛÏË„Ë ‰È·ÊfiÚˆÓ Ù‡ˆÓ ÙÚÔÊ›ÌˆÓ Î·È ÛÙË Û˘Ó¤¯ÂÈ· Ù˘ ÔÏÈ΋˜ ıÂÚÌȉÈ΋˜ ÚfiÛÏ˄˘ ÙÚÔÊ›ÌˆÓ Ú·ÁÌ·ÙÔÔÈ‹ıËΠ̠‚¿ÛË ÙÔ ¿ıÚÔÈÛÌ· ÙˆÓ ÁÈÓÔÌ¤ÓˆÓ Ù˘ ıÂÚÌȉÈ΋˜ ·Í›·˜ ÙÔ˘ Û˘ÁÎÂÎÚÈ̤ÓÔ˘ ÙÚÔÊ›ÌÔ˘ Â› ÙËÓ ÔÛfiÙËÙ· Î·È ÙË Û˘¯ÓfiÙËÙ· ηٷӿψÛ˘. ∏ ÂÓ¤ÚÁÂÈ· Î·È ÙÔ ‰È·ÙÚÔÊÈÎfi ÂÚȯfiÌÂÓÔ Î¿ı ÙÚÔÊ›ÌÔ˘ ˘ÔÏÔÁ›ÛÙËΠ̠‚¿ÛË ›Ó·Î˜ Ô˘ ·Ó·Ï‡Ô˘Ó ÙË Û‡ÛÙ·ÛË ÙˆÓ ÂÏÏËÓÈÎÒÓ Ê·ÁËÙÒÓ (45). ÀÔÏÔÁ›ÛÙËÎ·Ó Ù· ·ÎfiÏÔ˘ı· ‰È·ÙÚÔÊÈο ÛÙÔȯ›· Û ÁÚ·ÌÌ¿ÚÈ· ηٷӿψÛ˘ ·Ó¿ Ë̤ڷ: ÎÔÚÂṲ̂ӷ, ÌÔÓÔ·ÎfiÚÂÛÙ· Î·È ÔÏ˘·ÎfiÚÂÛÙ· Ï›Ë, ηıÒ˜ Î·È ˘‰·Ù¿ÓıڷΘ Î·È ÚˆÙ½Ó˜. ∏ ıÂÚÌȉÈ΋ ÚfiÛÏË„Ë ÌÂÙÚ‹ıËΠ۠Kcal ·Ó¿ Ë̤ڷ. ∏ ÔÏÈ΋ ıÂÚÌȉÈ΋ ÚfiÛÏË„Ë Û¯ÂÙ›˙ÂÙ·È ıÂÙÈο Ì ÙËÓ Î·Ù·Ó¿ÏˆÛË ÙˆÓ ÂÚÈÛÛfiÙÂÚˆÓ ÔÌ¿‰ˆÓ ÙÚÔÊ›ÌˆÓ (¶›Ó·Î·˜ 1) Î·È ÙˆÓ ÂÚÈÛÛfiÙÂÚˆÓ ‰È·ÙÚÔÊÈÎÒÓ ÛÙÔȯ›ˆÓ ıÂÚÌȉÈ΋˜ ·Í›·˜ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ·Ú·¿Óˆ. ™˘ÓÂÒ˜, ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂÏÂÁ¯ıÔ‡Ó ÔÈ Èı·Ó¤˜ Û˘Á¯˘ÙÈΤ˜ ÂȉڿÛÂȘ Ì ‚¿ÛË ÙȘ ·ÔÎÏ›ÛÂȘ Ù˘ ̤Û˘ ÙÈÌ‹˜ Ô˘ ÚÔ¤Ú¯ÔÓÙ·È ·fi ÌÔÓÔ·Ú·ÁÔÓÙÈΤ˜ ÂÍ·ÚÙ‹ÛÂȘ ÙˆÓ Ú·ÁÌ·ÙÈÎÒÓ ÙÈÌÒÓ ÙˆÓ ‰È·ÙÚÔÊÈÎÒÓ ÌÂÙ·‚ÏËÙÒÓ ·fi ÙËÓ ÔÏÈ΋ ıÂÚÌȉÈ΋ ÚfiÛÏË„Ë, ¤ÁÈÓ ÚÔÙ‡ˆÛË ÁÈ· ÙË ıÂÚÌȉÈ΋ ÚfiÛÏË„Ë ÁÈ· fiϘ ÙȘ ‰È·ÙÚÔÊÈΤ˜ ·Ú·Ì¤ÙÚÔ˘˜ (46).

∞ÔÙÂϤÛÌ·Ù· ™ÙÔÓ ¶›Ó·Î· 2 Ê·›ÓÂÙ·È Ë Î·Ù·ÓÔÌ‹ ÙˆÓ Á˘Ó·ÈÎÒÓ Ô˘ Û˘ÌÌÂÙ›¯·Ó ÛÙË ÌÂϤÙË Ì ‚¿ÛË ¯·Ú·ÎÙËÚÈÛÙÈο Ù˘ ÂÁ΢ÌÔÛ‡Ó˘ Î·È ÙÔ˘ ÙÔÎÂÙÔ‡, ÂÓÒ Ô ¶›Ó·Î·˜ 3 ·ÚÔ˘ÛÈ¿˙ÂÈ ÙȘ ·ÓÙ›ÛÙÔȯ˜ ηٷÓÔ̤˜ Û˘¯ÓÔÙ‹ÙˆÓ Ì ‚¿ÛË ÙËÓ Î·Ù·Ó¿ÏˆÛË ÙˆÓ ‰È·ÊfiÚˆÓ ÔÌ¿‰ˆÓ ÙÚÔʛ̈Ó. OÈ ›Ó·Î˜ ·˘ÙÔ› ¤¯Ô˘Ó ÂÚÈÁÚ·ÊÈ΋ ·Í›·. ™ÙÔÓ ¶›Ó·Î· 4 Ê·›ÓÔÓÙ·È ÔÈ ·ÌÔÈ‚·›ˆ˜ ÚÔÙ˘ˆÌ¤ÓÔÈ Û˘ÓÙÂÏÂÛÙ¤˜ Û˘Û¯ÂÙ›Ûˆ˜ Ô˘ ÚԤ΢„·Ó ·fi ÙËÓ ÔÏ˘·Ú·ÁÔÓÙÈ΋ ·Ó¿Ï˘ÛË Î·È ÂÚÈÁÚ¿ÊÔ˘Ó ÙË ÌÂÙ·‚ÔÏ‹ ÙÔ˘ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ Ô˘ Û˘ÓÂ¿ÁÂÙ·È Ë ÔÈÔÙÈ΋ ‹ ÔÛÔÙÈ΋ ÌÂÙ·‚ÔÏ‹ ÙˆÓ ÚԉȷıÂÛÈÎÒÓ ·Ú·ÁfiÓÙˆÓ. ∆· ¿ÚÚÂÓ· ÓÂÔÁÓ¿ ‹Ù·Ó Û ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈÎfi ‚·ıÌfi ‚·Ú‡ÙÂÚ· ·fi Ù· ı‹Ï· ηٿ 114 g. ∆· ÚˆÙfiÙÔη ÓÂÔÁÓ¿ Î·È ·˘Ù¿ ÙˆÓ ÔÔ›ˆÓ ÔÈ ÌËÙ¤Ú˜ ‹Ù·Ó ›Ù Ôχ Ӥ˜, ›Ù ۯÂÙÈο ËÏÈÎȈ̤Ó˜, ›¯·Ó ÌÈÎÚfiÙÂÚÔ

301

july-aug02TELIKO

14-05-03

13:32

™ÂÏ›‰·302

¶·È‰È·ÙÚÈ΋ 2002;65:298-306

Paediatriki 2002;65:298-306

¶›Ó·Î·˜ 4. ªÂÚÈÎÔ› Û˘ÓÙÂÏÂÛÙ¤˜ ÂÍ·ÚÙ‹Ûˆ˜ ba, ÛÙ·ıÂÚ¿ ÛÊ¿ÏÌ·Ù· (SE) Î·È ÙÈ̤˜ ÎÚÈÙËÚ›Ô˘ P ÁÈ· Úfi‚ÏÂ„Ë ÙÔ˘ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ Û ÁÚ·ÌÌ¿ÚÈ· ·fi ‚·ÛÈΤ˜ ÌÂÙ·‚ÏËÙ¤˜ Ù˘ ΢‹Ûˆ˜ Î·È ÙÔ˘ ÙÔÎÂÙÔ‡: ·ÔÙÂϤÛÌ·Ù· ÔÏ˘·Ú·ÁÔÓÙÈ΋˜ ·Ó¿Ï˘Û˘ ªÂÙ·‚ÏËÙ¤˜ ñ º‡ÏÔ ñ ™ÂÈÚ¿ Á¤ÓÓËÛ˘ ñ ∏ÏÈΛ· ÌËÙ¤Ú·˜

ñ ∂Î·›‰Â˘ÛË ÌËÙ¤Ú·˜

ñ ⁄„Ô˜ ÌËÙ¤Ú·˜ ñ πÛÙÔÚÈÎfi ·Ô‚ÔÏÒÓ ñ πÛÙÔÚÈÎfi ÂÎÙÚÒÛÂˆÓ ñ ∞ÈÌÔÚÚ·Á›· ñ ∫¿ÓÈÛÌ· ηٿ ÙËÓ ÂÁ΢ÌÔÛ‡ÓË ñ ∫·Ê¤˜ ñ OÈÓÔÓÂ˘Ì·ÙÒ‰Ë ÔÙ¿ ñ ªËÙÚÈ΋ ÚfiÛÏË„Ë ‚¿ÚÔ˘˜ ñ OÏÈ΋ ıÂÚÌȉÈ΋ ÚfiÛÏË„Ë ñ ™Î¢¿ÛÌ·Ù· Ê˘ÏÏÈÎÔ‡ Ôͤˆ˜ a

∫·ÙËÁÔÚ›· ‹ ÌÔÓ¿‰·

b

SE (b)

∆È̤˜ ÎÚÈÙËÚ›Ô˘ -P

∞ÁfiÚÈ ∫ÔÚ›ÙÛÈ 1 ≥2 ≤24 ¯ÚfiÓÈ· 25-34 ≥35 ≤11 ¯ÚfiÓÈ· 12 ≥13 5 cm ¡·È Ÿ¯È ¡·È Ÿ¯È ¡·È Ÿ¯È 5 ÙÛÈÁ¿Ú· 1 ÊÏ˘Ù˙¿ÓÈ/Ë̤ڷ Ÿ¯È ¡·È 2 kg 300 Kcal Ÿ¯È ¡·È

114 OÌ¿‰· ·Ó·ÊÔÚ¿˜ -94 OÌ¿‰· ·Ó·ÊÔÚ¿˜ -35 OÌ¿‰· ·Ó·ÊÔÚ¿˜ -75 -138 OÌ¿‰· ·Ó·ÊÔÚ¿˜ -84 34 -105 OÌ¿‰· ·Ó·ÊÔÚ¿˜ -21 OÌ¿‰· ·Ó·ÊÔÚ¿˜ -84 OÌ¿‰· ·Ó·ÊÔÚ¿˜ -87 -19 OÌ¿‰· ·Ó·ÊÔÚ¿˜ 163 77 -4 OÌ¿‰· ·Ó·ÊÔÚ¿˜ 108

47

0,02

52

0,07

59

0,54

82 73

0,36 0,06

53 24 74

0,11 0,15 0,15

66

0,75

60

0,16

31 23

<10-2 0,41

50 13 17

<10-2 10-4 0,81

50

0,03

ªÂÙ¿ ·fi ·ÌÔÈ‚·›Ô ¤ÏÂÁ¯Ô ÁÈ· fiϘ ÙȘ ÌÂÙ·‚ÏËÙ¤˜ ÙÔ˘ ÔÏ˘·Ú·ÁÔÓÙÈÎÔ‡ ÌÔÓÙ¤ÏÔ˘, Ô Û˘ÓÙÂÏÂÛÙ‹˜ ÌÂÚÈ΋˜ ÂÍ·ÚÙ‹Ûˆ˜ b ‰ËÏÒÓÂÈ ÙË Ì¤ÛË ÙÈÌ‹ ÌÂÙ·‚ÏËÙ‹˜, ‰ËÏ·‰‹ ÙÔ˘ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ Û g ÁÈ· ÌÂÙ·‚ÔÏ‹ Ù˘ ·ÓÂÍ¿ÚÙËÙ˘ ÌÂÙ·‚ÏËÙ‹˜ (.¯. ʇÏÔ˘, ÛÂÈÚ¿˜ Á¤ÓÓËÛ˘) ηٿ Ì›· ÌÔÓ¿‰·

‚¿ÚÔ˜ Á¤ÓÓËÛ˘, ·Ó Î·È ÔÈ ‰È·ÊÔÚ¤˜ Ô˘ ÚԤ΢„·Ó ‰ÂÓ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜. ¡ÂÔÁÓ¿ ÌËÙ¤ÚˆÓ Ì ̤ÛË ÂÎ·›‰Â˘ÛË (·ÔÏ˘Ù‹ÚÈÔ §˘Î›Ԣ) ›¯·Ó ÌÂÁ·Ï‡ÙÂÚÔ ‚¿ÚÔ˜ ·fi Ù· ÓÂÔÁÓ¿ ÌËÙ¤ÚˆÓ Ì ˘„ËÏfiÙÂÚË ‹ ¯·ÌËÏfiÙÂÚË ÌfiÚʈÛË, ·Ó Î·È ÔÈ ‰È·ÊÔÚ¤˜ ‹Ù·Ó ¿ÏÈ ÌË ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜. ∆Ô ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ ÙˆÓ ÓÂÔÁÓÒÓ ÌËÙ¤ÚˆÓ Ì ˘„ËÏfi ·Ó¿ÛÙËÌ· ‹Ù·Ó Ï›ÁÔ ÌÂÁ·Ï‡ÙÂÚÔ, ÂÓÒ ÙÔ ÈÛÙÔÚÈÎfi ·Ô‚ÔÏÒÓ Î·È ·ÈÌÔÚÚ·Á›·˜ ηٿ ÙËÓ ÂÁ΢ÌÔÛ‡ÓË Û¯ÂÙ›ÛÙËΠ̠ϛÁÔ ÌÈÎÚfiÙÂÚÔ ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓÔ‡. ∆Ô ÈÛÙÔÚÈÎfi ÂÎÙÚÒÛÂˆÓ ‰ÂÓ ‚Ú¤ıËΠӷ Û¯ÂÙ›˙ÂÙ·È Ì ÙÔ ‚¿ÚÔ˜ ÓÂÔÁÓÔ‡ ÂfiÌÂÓ˘ ÂÁ΢ÌÔÛ‡Ó˘. ∆Ô Î¿ÓÈÛÌ· ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÁ΢ÌÔÛ‡Ó˘ ·ÚÔ˘Û›·Û ÛËÌ·ÓÙÈÎÔ‡ ‚·ıÌÔ‡ ·ÚÓËÙÈ΋ Û˘Û¯¤ÙÈÛË Ì ÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛ˘, ÂÓÒ Ë Î·Ù·Ó¿ÏˆÛË Î·Ê¤ ·ÚÔ˘Û›·Û ·ÚÓËÙÈ΋, ·ÏÏ¿ ÌË ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ Û˘Û¯¤ÙÈÛË. ∂Í¿ÏÏÔ˘, Ë Ì¤ÙÚÈ· ηٷӿψÛË ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ (ηÌÈ¿ ·fi ÙȘ Á˘Ó·›Î˜ Ô˘ Û˘ÌÂÚÈÂÏ‹ÊıËÛ·Ó ÛÙË ÌÂϤÙË ‰ÂÓ ·Ó¤ÊÂÚ ηٷӿψÛË ÂÚÈÛÛfiÙÂÚˆÓ ·fi 7 ÔÙ‹ÚÈ· ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ ÙËÓ Â‚‰ÔÌ¿‰·) ·ÚÔ˘Û›·Û ıÂÙÈ΋ Î·È ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ Û˘Û¯¤ÙÈÛË Ì ÙÔ

302

‚¿ÚÔ˜ Á¤ÓÓËÛ˘. ∂ÓÒ Ë ·‡ÍËÛË ‚¿ÚÔ˘˜ Ù˘ ÌËÙ¤Ú·˜ ηٿ ÙËÓ ÂÁ΢ÌÔÛ‡ÓË ‚Ú¤ıËΠfiÙÈ ·ÔÙÂÏ› ÛËÌ·ÓÙÈÎfi ÚÔÁÓˆÛÙÈÎfi ·Ú¿ÁÔÓÙ· ÁÈ· ÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛ˘, Ë ÔÏÈ΋ ıÂÚÌȉÈ΋ ÚfiÛÏË„Ë, ÁÈ· ‰Â‰Ô̤ÓË ·‡ÍËÛË ‚¿ÚÔ˘˜ Ù˘ ÌËÙ¤Ú·˜, ‰ÂÓ ‚Ú¤ıËΠӷ Û¯ÂÙ›˙ÂÙ·È Ì ÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛ˘. ∆· ÓÂÔÁÓ¿ ÙˆÓ ÌËÙ¤ÚˆÓ Ô˘ Ï¿Ì‚·Ó·Ó Û΢¿ÛÌ·Ù· Ê˘ÏÏÈÎÔ‡ ÔͤԘ ηٿ ÙËÓ ÂÁ΢ÌÔÛ‡ÓË ‹Ù·Ó ‚·Ú‡ÙÂÚ·.

OÈ ¶›Ó·Î˜ 2 Î·È 4 ÂÚȤ¯Ô˘Ó ÙȘ ÌÂÙ·‚ÏËÙ¤˜ ÁÈ· ÙȘ Ôԛ˜ ˘¿Ú¯ÂÈ ÂÎ ÙˆÓ ÚÔÙ¤ÚˆÓ ˘fiıÂÛË fiÙÈ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛ˘. ÕÏϘ ÌÂÙ·‚ÏËÙ¤˜, fiˆ˜ .¯. Ô ÙfiÔ˜ ÌfiÓÈÌ˘ ηÙÔÈΛ·˜ Ù˘ ÌËÙ¤Ú·˜ Î·È Ë Ï‹„Ë ‚ÈÙ·ÌÈÓÒÓ Î·Ù¿ ÙËÓ ÂÁ΢ÌÔÛ‡ÓË, ÁÈ· ÙȘ Ôԛ˜ Ô‡Ù ·Ó·ÌÂÓfiÙ·Ó, ·ÏÏ¿ Ô‡ÙÂ Î·È ‚Ú¤ıËÎÂ Û˘Û¯¤ÙÈÛË Ì ÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛ˘, ‰ÂÓ ¤¯Ô˘Ó Û˘ÌÂÚÈÏËÊı› ÛÙÔ˘˜ ›Ó·Î˜.

OÈ ÌÂÙ·‚ÏËÙ¤˜ ÙÔ˘ ¶›Ó·Î· 4 ·ÔÙÂÏÔ‡Ó ÙÔ ‚·ÛÈÎfi ÌÔÓÙ¤ÏÔ, ÛÙÔ ÔÔ›Ô ÚÔÛÙ¤ıËÎ·Ó ÂÓ·ÏÏ·ÎÙÈο ÔÈ ÔÌ¿‰Â˜ ÙÚÔÊ›ÌˆÓ Ì ÙË ÛÂÈÚ¿ Ô˘ Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 3. ∆· ·ÔÙÂϤÛÌ·Ù· Û˘ÓÔ„›˙ÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 5. ∫·Ì›· ·fi ÙȘ ÔÌ¿‰Â˜ ÙÚÔÊ›ÌˆÓ ‰ÂÓ Û˘Û¯ÂÙ›ÛÙËΠ۠ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈÎfi ‚·ıÌfi Ì ÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛ˘, ·ÓÂÍ¿ÚÙËÙ· ·Ó Ë ÂÎÙ›ÌËÛË

july-aug02TELIKO

14-05-03

13:32

™ÂÏ›‰·303

¶·È‰È·ÙÚÈ΋ 2002;65:298-306

Paediatriki 2002;65:298-306

¶›Ó·Î·˜ 5. ªÂÚÈÎÔ› Û˘ÓÙÂÏÂÛÙ¤˜ ÂÍ·ÚÙ‹Ûˆ˜ ba, ÛÙ·ıÂÚ¿ ÛÊ¿ÏÌ·Ù· (SE) Î·È ÙÈ̤˜ ÎÚÈÙËÚ›Ô˘ P ÁÈ· Úfi‚ÏÂ„Ë ÙÔ˘ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ Û ÔÌ¿‰Â˜ ·fi ‰È·ÙÚÔÊÈΤ˜ ÌÂÙ·‚ÏËÙ¤˜: ·ÔÙÂϤÛÌ·Ù· ÔÏ˘·Ú·ÁÔÓÙÈ΋˜ ·Ó¿Ï˘Û˘ ªÂÙ·‚ÏËÙ¤˜

ªÔÓ¿‰·

1 2 3 4 5 6 7 8 9

¢ËÌËÙÚȷο Î·È ·Ì˘ÏÒ‰Ë 1 ·Ó¿ Ë̤ڷ °Ï˘Î¿ Î·È ÎÔÌfiÛÙ˜ 1 ·Ó¿ Ë̤ڷ ŸÛÚÈ·, ÍËÚÔ› ηÚÔ› Î·È ÛfiÚÔÈ 1 ·Ó¿ ‚‰ÔÌ¿‰· §·¯·ÓÈο 1 ·Ó¿ Ë̤ڷ ºÚÔ‡Ù· 1 ·Ó¿ Ë̤ڷ ∫Ú¤·˜ Î·È ·Ú¿ÁˆÁ· 1 ·Ó¿ ‚‰ÔÌ¿‰· æ¿ÚÈ· Î·È ı·Ï·ÛÛÈÓ¿ 1 ·Ó¿ ‚‰ÔÌ¿‰· °¿Ï· Î·È Á·Ï·ÎÙÔÎÔÌÈο 1 ·Ó¿ Ë̤ڷ §¿‰È Î·È Ï›Ë 1 ·Ó¿ Ë̤ڷ

10

∆·˘Ùfi¯ÚÔÓÔ ÌÔÓÙ¤ÏÔb

¢ËÌËÙÚȷο Î·È ·Ì˘ÏÒ‰Ë °Ï˘Î¿ Î·È ÎÔÌfiÛÙ˜ ŸÛÚÈ·, ÍËÚÔ› ηÚÔ› Î·È ÛfiÚÔÈ §·¯·ÓÈο ºÚÔ‡Ù· ∫Ú¤·˜ Î·È ·Ú¿ÁˆÁ· æ¿ÚÈ· Î·È ı·Ï·ÛÛÈÓ¿ °¿Ï· Î·È Á·Ï·ÎÙÔÎÔÌÈο §¿‰È Î·È Ï›Ë a b

1 ·Ó¿ Ë̤ڷ 1 ·Ó¿ Ë̤ڷ 1 ·Ó¿ ‚‰ÔÌ¿‰· 1 ·Ó¿ Ë̤ڷ 1 ·Ó¿ Ë̤ڷ 1 ·Ó¿ ‚‰ÔÌ¿‰· 1 ·Ó¿ ‚‰ÔÌ¿‰· 1 ·Ó¿ Ë̤ڷ 1 ·Ó¿ Ë̤ڷ

b

SE (b)

∆È̤˜ ÎÚÈÙËÚ›Ô˘ -P

31 4 -46 5 -8 19 55 -3 27

37 33 60 26 23 10 45 22 30

0,40 0,90 0,44 0,84 0,72 0,07 0,22 0,89 0,36

18 -2 -86 -8 -11 18 66 -5 12

38 32 61 27 23 10 47 18 30

0,63 0,96 0,16 0,76 0,62 0,08 0,16 0,79 0,69

‚Ϥ ˘ÔÛËÌ›ˆÛË ÛÙÔÓ ¶›Ó·Î· 4 ªÂÙ¿ ·fi ¤ÏÂÁ¯Ô ÁÈ· ÙȘ ÌÂÙ·‚ÏËÙ¤˜ ÙÔ˘ ‚·ÛÈÎÔ‡ ÌÔÓÙ¤ÏÔ˘ Ô˘ Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 4 ∏ ÔÏÈ΋ ıÂÚÌȉÈ΋ ÂÓ¤ÚÁÂÈ· ‰ÂÓ ÂÚÈÏ·Ì‚¿ÓÂÙ·È ÛÙÔ ÌÔÓÙ¤ÏÔ 10. OÈ ‰È·ÙÚÔÊÈΤ˜ ÌÂÙ·‚ÏËÙ¤˜ ÙÔ˘ Â¿Óˆ ÙÌ‹Ì·ÙÔ˜ ÙÔ˘ ¶›Ó·Î· ¤¯Ô˘Ó ÂÈÛ·¯ı› ÂÓ·ÏÏ·ÎÙÈο Î·È Ì›· οı ÊÔÚ¿ ÛÙ· ÌÔÓ٤Ϸ 1-9. OÈ ‰È·ÙÚÔÊÈΤ˜ ÌÂÙ·‚ÏËÙ¤˜ ÛÙÔ Î¿Ùˆ ÙÌ‹Ì· ÙÔ˘ ¶›Ó·Î· ¤¯Ô˘Ó ÂÈÛ·¯ı› Ù·˘Ùfi¯ÚÔÓ· ÁÈ· ·ÌÔÈ‚·›Ô ¤ÏÂÁ¯Ô ÙˆÓ Û˘Á¯˘ÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ

¶›Ó·Î·˜ 6. ª¤Û˜ ÙÈ̤˜ Î·È ÛÙ·ıÂÚ¤˜ ·ÔÎÏ›ÛÂȘ (SD) ÁÈ· ÂÓÂÚÁÂȷο ÚÔÙ˘ˆÌ¤Ó· ‰È·ÙÚÔÊÈο ÛÙÔȯ›·* ÛÙȘ 368 ÌËÙ¤Ú˜ ªÂÙ·‚ÏËÙ‹ £ÂÚÌ›‰Â˜ ∫ÔÚÂṲ̂ӷ Ï›Ë ªÔÓÔ·ÎfiÚÂÛÙ· Ï›Ë ¶ÔÏ˘·ÎfiÚÂÛÙ· Ï›Ë À‰·Ù¿ÓıڷΘ ¶ÚˆÙ½Ó˜

ªÔÓ¿‰·

ª¤ÛË ÙÈÌ‹

SD

Kcal g g g g g

2550 35 57 14 261 87

7 8 4 42 11

* BÈ‚ÏÈÔÁÚ·Ê›· 46

¤ÁÈÓ ÂÓ·ÏÏ·ÎÙÈο ÁÈ· οı ÔÌ¿‰· (ÌÔÓ٤Ϸ 1-9) ‹ Ù·˘Ùfi¯ÚÔÓ· (ÌÔÓÙ¤ÏÔ 10). ªfiÓÔ ÙÔ ÎÚ¤·˜ Î·È Ù· ·Ú¿ÁˆÁ¿ ÙÔ˘, ηıÒ˜ Î·È ÙÔ „¿ÚÈ Î·È Ù· ı·Ï·ÛÛÈÓ¿ ·ÚÔ˘Û›·Û·Ó ÔÚȷ΋ ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË Ì ÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛ˘. ∞Ó Î·È Â›Ó·È ÏÈÁfiÙÂÚÔ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋, Ë Û¯¤ÛË ·Ó¿ÌÂÛ· ÛÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ Î·È ÙËÓ ÚfiÛÏË„Ë „·ÚÈÒÓ Î·È ı·Ï·ÛÛÈÓÒÓ Â›Ó·È ›Ûˆ˜ ÂÚÈÛÛfiÙÂÚÔ ·ÍÈÔÛËÌ›ˆÙË, ÁÈ·Ù› Û¯ÂÙ›˙ÂÙ·È Ì ·‡ÍËÛË ‚¿ÚÔ˘˜ ÙÔ˘ ÓÂÔÁÓÔ‡ Ù˘ ٿ͈˜ ÙˆÓ 66 g, Û ۯ¤ÛË Ì ٷ 18 g ·‡ÍËÛ˘ Ô˘ Û˘ÓÂ¿ÁÂÙ·È Ë Ï‹„Ë Ì›·˜ ÌÔÓ¿‰·˜ ÎÚ¤·ÙÔ˜ Î·È ·Ú·ÁÒÁˆÓ ÙÔ˘. ™ÙÔÓ ¶›Ó·Î· 6 Ê·›ÓÔÓÙ·È ÔÈ Ì¤Û˜ ÙÈ̤˜ Î·È ÔÈ ·ÓÙ›ÛÙÔȯ˜ ÛÙ·ıÂÚ¤˜ ·ÔÎÏ›ÛÂȘ Ù˘ ÚfiÛÏ˄˘ ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÁ΢ÌÔÛ‡Ó˘ ‰È·ÙÚÔÊÈÎÒÓ Ì·-

ÎÚÔÛÙÔȯ›ˆÓ Ô˘ ÚÔÛʤÚÔ˘Ó ÂÓ¤ÚÁÂÈ·, ÌÂÙ¿ ·fi ¤ÏÂÁ¯Ô Ù˘ ıÂÚÌȉÈ΋˜ ÚfiÛÏ˄˘. OÈ ÚÔÙ˘ˆÌ¤Ó˜ ÁÈ· ıÂÚÌȉÈ΋ ÚfiÛÏË„Ë ÛÙ·ıÂÚ¤˜ ·ÔÎÏ›ÛÂȘ Ô˘ ·ÔÙ˘ÒÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 7, ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ˆ˜ ÌÔÓ¿‰Â˜ ÁÈ· ÙÔÓ ˘ÔÏÔÁÈÛÌfi ÙˆÓ ÌÂÚÈÎÒÓ Û˘ÓÙÂÏÂÛÙÒÓ ÂÍ¿ÚÙËÛ˘ Ô˘ ÚԤ΢„·Ó ·fi ÙËÓ ÔÏ˘·Ú·ÁÔÓÙÈ΋ ·Ó¿Ï˘ÛË. ∆· ÛÙÔȯ›· ÙÔ˘ ¶›Ó·Î· 7 ‰Â›¯ÓÔ˘Ó fiÙÈ ÛÙȘ ÔÌ¿‰Â˜ Ì·ÎÚÔÛÙÔȯ›ˆÓ Ô˘ ÌÂÏÂÙ‹ıËηÓ, ÌfiÓÔ Ù· ÌÔÓÔ·ÎfiÚÂÛÙ· Ï›Ë Ê·›ÓÂÙ·È fiÙÈ Û¯ÂÙ›˙ÔÓÙ·È ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο Ì ÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛ˘. ™˘ÁÎÂÎÚÈ̤ӷ, ÛÙÔ ¤ÎÙÔ ÌÔÓÙ¤ÏÔ, Ê·›ÓÂÙ·È fiÙÈ Ì›· ·‡ÍËÛË Ù˘ ٿ͈˜ ÙˆÓ 8 g (›ÛË Ì ̛· ÂÓÂÚÁÂȷο ÚÔÙ˘ˆÌ¤ÓË ÛÙ·ıÂÚ¿ ·fiÎÏÈÛË) ÛÙËÓ Î·ıËÌÂÚÈÓ‹ ÚfiÛÏË„Ë ÌÔÓÔ·ÎfiÚÂÛÙˆÓ ÏÈÒÓ, Û˘ÓÂ¿ÁÂÙ·È ·‡ÍËÛË ÙÔ˘ ‚¿ÚÔ˘˜ ÓÂÔÁÓÔ‡ ηٿ 49 g. ™˘˙‹ÙËÛË Ÿˆ˜ Û˘Ì‚·›ÓÂÈ Û οı ÂȉËÌÈÔÏÔÁÈ΋ ÌÂϤÙË, ÚÈÓ ÂȯÂÈÚ‹ÛÂÈ Î·Ó›˜ Ó· ÂÚÌËÓ‡ÛÂÈ Ù· ·ÔÙÂϤÛÌ·Ù· ÛÙÔ Ï·›ÛÈÔ ÙˆÓ ‚ÈÔ˚·ÙÚÈÎÒÓ ‰Â‰Ô̤ӈÓ, Â›Ó·È ·Ó·Áη›Ô Ó· ÂÍÂÙ·ÛÙÔ‡Ó Ù¤ÛÛÂÚ· ˙ËÙ‹Ì·Ù· (47): ·) ·Ó ˘¿Ú¯Ô˘Ó Û˘ÛÙËÌ·ÙÈο ÛÊ¿ÏÌ·Ù· ÂÈÏÔÁ‹˜, ‚) ·Ó ˘¿Ú¯Ô˘Ó Û˘ÛÙËÌ·ÙÈο ÛÊ¿ÏÌ·Ù· ÏËÚÔÊfiÚËÛ˘, Á) ·Ó ˘¿Ú¯Ô˘Ó Û˘Á¯˘ÙÈΤ˜ ÂȉڿÛÂȘ Î·È ‰) ÔÈ· Â›Ó·È Ë ÈÛ¯‡˜ Ù˘ ÌÂϤÙ˘.

303

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¶·È‰È·ÙÚÈ΋ 2002;65:298-306

Paediatriki 2002;65:298-306

¶›Ó·Î·˜ 7. ªÂÚÈÎÔ› Û˘ÓÙÂÏÂÛÙ¤˜ ÂÍ·ÚÙ‹Ûˆ˜ b, ÛÙ·ıÂÚ¿ ÛÊ¿ÏÌ·Ù· (SE) Î·È ÙÈ̤˜ ÎÚÈÙËÚ›Ô˘ P ÁÈ· Úfi‚ÏÂ„Ë ÙÔ˘ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ Û ÁÚ·ÌÌ¿ÚÈ· ·fi ‰È·ÙÚÔÊÈο ÛÙÔȯ›· ÁÈ· ÙȘ 368 ÔÌ¿‰Â˜: ·ÔÙÂϤÛÌ·Ù· ÔÏ˘·Ú·ÁÔÓÙÈ΋˜ ·Ó¿Ï˘Û˘ ªÔÓÙ¤ÏÔ 1 2 3 4 5

¢È·ÙÚÔÊÈÎfi ÛÙÔÈ¯Â›Ô (g)

b

SE (b)

∆ÈÌ‹ ÎÚÈÙËÚ›Ô˘ -P

∫ÔÚÂṲ̂ӷ Ï›Ë ªÔÓÔ·ÎfiÚÂÛÙ· Ï›Ë ¶ÔÏ˘·ÎfiÚÂÛÙ· Ï›Ë À‰·Ù¿ÓıڷΘ ¶ÚˆÙ½Ó˜

31 54 41 -22 17

23,7 22,9 24,3 26,7 22,8

0,19 0,02 0,09 0,41 0,46

49 29 26 3 48 29 25

24,0 25,3 22,9 28,3 26,3 25,4 25,9

0,04 0,24 0,24 0,91 0,06 0,24 0,33

4 47 29 -5 24

29,0 26,9 25,6 28,3 26,9

0,88 0,07 0,25 0,86 0,37

∆·˘ÙÔ¯ÚÔÓÈο ÌÔÓ٤Ϸ ÂÓ·ÏÏ·ÎÙÈÎÒÓ ‰È·ÙÚÔÊÈÎÒÓ ÛÙÔȯ›ˆÓ 6

ªÔÓÔ·ÎfiÚÂÛÙ· Ï›Ë ¶ÔÏ˘·ÎfiÚÂÛÙ· Ï›Ë ¶ÚˆÙ½Ó˜ À‰·Ù¿ÓıڷΘ ªÔÓÔ·ÎfiÚÂÛÙ· Ï›Ë ¶ÔÏ˘·ÎfiÚÂÛÙ· Ï›Ë ¶ÚˆÙ½Ó˜

7

™‡ÓÔÏÔ ‰È·ÙÚÔÊÈÎÒÓ ÛÙÔȯ›ˆÓ, ÂÍ·ÈÚÔ˘Ì¤Ó˘ Ù˘ ÔÏÈ΋˜ ıÂÚÌȉÈ΋˜ ÚfiÛÏ˄˘ 8

À‰·Ù¿ÓıڷΘ ªÔÓÔ·ÎfiÚÂÛÙ· Ï›Ë ¶ÔÏ˘·ÎfiÚÂÛÙ· Ï›Ë À‰·Ù¿ÓıڷΘ ¶ÚˆÙ½Ó˜

* ŒÏÂÁ¯Ô˜ ÁÈ· ÙȘ ÌÂÙ·‚ÏËÙ¤˜ ÙÔ˘ ‚·ÛÈÎÔ‡ ÌÔÓÙ¤ÏÔ˘ ÙÔ˘ ¶›Ó·Î· 4 ÛÙ· ÌÔÓ٤Ϸ 1-8. ™Ù· ÌÔÓ٤Ϸ 1-5 Ù· ÂÈ̤ÚÔ˘˜ ‰È·ÙÚÔÊÈο ÛÙÔȯ›· ÂÈÛ¿ÁÔÓÙ·È ¤Ó· οı ÊÔÚ¿. ™Â ηı¤Ó· ·fi Ù· ÌÔÓ٤Ϸ 6-7 ÔÈ ÂÚÈÁÚ·ÊfiÌÂÓ˜ ÌÂÙ·‚ÏËÙ¤˜ ÂÈÛ¿ÁÔÓÙ·È Ù·˘Ùfi¯ÚÔÓ·, ÂÓÒ Î·È ÔÈ ¤ÓÙ ÌÂÙ·‚ÏËÙ¤˜ ÂÈÛ¿ÁÔÓÙ·È Ù·˘Ùfi¯ÚÔÓ· ÛÙÔ ÌÔÓÙ¤ÏÔ 8. OÈ ÌÔÓ¿‰Â˜ ·‡ÍËÛ˘ Ù˘ οı ÌÂÙ·‚ÏËÙ‹˜ ÈÛÔ‡ÓÙ·È Ì ÙȘ ÂÓÂÚÁÂȷο ÚÔÙ˘ˆÌ¤Ó˜ ÙÈ̤˜ ÙˆÓ ÛÙ·ıÂÚÒÓ ·ÔÎÏ›ÛÂˆÓ ÙˆÓ ÛÙÔȯ›ˆÓ Ô˘ Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 6

∂ÌÊ·Ó‹ Û˘ÛÙËÌ·ÙÈο ÛÊ¿ÏÌ·Ù· ÂÈÏÔÁ‹˜ ‰ÂÓ Ú¤ÂÈ Ó· ˘¿Ú¯Ô˘Ó, ÂÂȉ‹ Ë ÂÈÏÔÁ‹ ÙˆÓ ËÌÂÚÒÓ Î·Ù¿ ÙȘ Ôԛ˜ ¤ÁÈÓ·Ó ÔÈ Û˘ÓÂÓÙ‡ÍÂȘ ÛÙ· Ì·ÈÂ˘Ù‹ÚÈ· ¤ÁÈÓÂ Ù˘¯·›·, ¯ˆÚ›˜ ÔÈ ËÌÂÚÔÌËӛ˜ Û˘ÏÏÔÁ‹˜ ‰Â‰ÔÌ¤ÓˆÓ Ó· ¤¯Ô˘Ó Û¯¤ÛË Ì ηÌÈ¿ ·fi ÙȘ ÌÂÙ·‚ÏËÙ¤˜ Ù˘ ÌÂϤÙ˘. ∂›Û˘, ‰ÂÓ Ê·›ÓÂÙ·È Ó· ˘¿Ú¯Ô˘Ó Û˘ÛÙËÌ·ÙÈο ÛÊ¿ÏÌ·Ù· ÏËÚÔÊfiÚËÛ˘, ÂÂȉ‹ ÔÈ Û˘ÓÂÓÙ‡ÍÂȘ Ì ÙȘ ϯˆ˝‰Â˜ Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó ÚÈÓ ·fi ÙËÓ ·Ó·˙‹ÙËÛË ÙÔ˘ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÙÔ˘ Û˘ÁÎÂÎÚÈ̤ÓÔ˘ ÓÂÔÁÓÔ‡ ÛÙÔ ·Ú¯Â›Ô Ù˘ ª·È¢ÙÈ΋˜ ∫ÏÈÓÈ΋˜. ∂Í¿ÏÏÔ˘, Ì ÙËÓ ÔÏ˘·Ú·ÁÔÓÙÈ΋ ·Ó¿Ï˘ÛË, ·ÔʇÁÔÓÙ·È Î·Ù¿ ÙÔ ‰˘Ó·ÙfiÓ ÔÈ ÂӉ¯fiÌÂÓ˜ Û˘Á¯˘ÙÈΤ˜ ÂȉڿÛÂȘ ·fi ÙÔ˘˜ ÌË ‰È·ÙÚÔÊÈÎÔ‡˜ ÚÔÛ‰ÈÔÚÈÛÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ÙÔ˘ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘, ηıÒ˜ Â›Û˘ Î·È ÔÈ ·ÌÔÈ‚·›Â˜ Û˘Á¯˘ÙÈΤ˜ ÂȉڿÛÂȘ ·Ó¿ÌÂÛ· ÛÙÔ˘˜ ‰È·ÙÚÔÊÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜. ∏ ·ÍÈÔÈÛÙ›· Ù˘ ÌÂϤÙ˘ ÂÓÈÛ¯‡ÂÙ·È Â›Û˘ ·fi ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ·Ó¤‰ÂÈÍ fiϘ ÙȘ ηıÈÂڈ̤Ó˜ Û˘Û¯ÂÙ›ÛÂȘ ·Ó¿ÌÂÛ· Û ÌË ‰È·ÙÚÔÊÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Î·È ÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛ˘. ∫·Ù¿ ÙÔ Û¯Â‰È·ÛÌfi Ù˘ ¤Ú¢ӷ˜, Ô ˘ÔÏÔÁÈÛÌfi˜ Ù˘ ÈÛ¯‡Ô˜ ¤ÁÈÓ Ì ٤ÙÔÈÔ ÙÚfiÔ ÒÛÙ ӷ ·Ó·‰Âȯı› Ë Î·ıÈÂڈ̤ÓË ·ÚÓËÙÈ΋ Û¯¤ÛË ·Ó¿ÌÂÛ· ÛÙÔ Î¿ÓÈÛÌ· Ù˘ ÂÁ·Ԣ Î·È ÙÔ ‚¿ÚÔ˜ Á¤ÓÓË-

304

Û˘. ŸÛÔÓ ·ÊÔÚ¿ ÛÙȘ ‰È·ÙÚÔÊÈΤ˜ ·Ú·Ì¤ÙÚÔ˘˜, Ë ÌfiÓË ‰fiÎÈÌË ·ÈÙÈÔÏÔÁÈ΋ ˘fiıÂÛË ·ÊÔÚÔ‡Û ÙË Û¯¤ÛË ÌÂٷ͇ ÙˆÓ ˆÌ¤Á· 3-ÏÈ·ÚÒÓ ÔͤˆÓ Î·È ÙÔ˘ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘. ŸÌˆ˜, ÁÈ· ÙËÓ ·ÍÈÔÏfiÁËÛË Ù˘ ·Ú·¿Óˆ ˘fiıÂÛ˘ ˘‹Ú¯·Ó ÂÁÁÂÓ›˜ ÂÚÈÔÚÈÛÌÔ›, ·ÊÔ‡ Ù· ‰Â‰Ô̤ӷ ÁÈ· Ù· Û˘ÛÙ·ÙÈο ÙˆÓ ÂÏÏËÓÈÎÒÓ Ê·ÁËÙÒÓ ‰ÂÓ ÂÌÂÚȤ¯Ô˘Ó ÏËÚÔÊÔڛ˜ Û¯ÂÙÈο Ì ÙËÓ ÂÚÈÂÎÙÈÎfiÙËÙ· Û ·ÎfiÚÂÛÙ· ÏÈ·Ú¿ Ôͤ· Ì·ÎÚ¿˜ ·Ï‡ÛÔ˘. ªÂÏÂÙ‹ıËÎ·Ó Û˘ÓÔÏÈο 400 ϯˆ˝‰Â˜, ÁÈ·Ù› Ô ·ÚÈıÌfi˜ ·˘Ùfi˜ ıˆڋıËΠ·ÚÎÂÙ¿ ÌÂÁ¿ÏÔ˜ ÁÈ· ÙËÓ ·Ó¿‰ÂÈÍË ÛËÌ·ÓÙÈÎÒÓ Û˘Û¯ÂÙ›ÛÂˆÓ Ú·ÎÙÈ΋˜ ÛËÌ·Û›·˜. ∆· ·ÔÙÂϤÛÌ·Ù· Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ fi¯È ÌfiÓÔ ‰ÂÓ ¤Ú¯ÔÓÙ·È Û ·ÓÙ›ıÂÛË, ·ÏÏ¿ ÌÔÚ› Ó· ıˆÚËı› fiÙÈ Â›Ó·È Û˘Ì‚·Ù¿ Ì ÙËÓ ˘fiıÂÛË fiÙÈ Ë ·˘ÍË̤ÓË ÚfiÛÏË„Ë „·ÚÈÔ‡ Î·È ı·Ï·ÛÛÈÓÒÓ Â˘Ô‰ÒÓÂÈ ÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ ÂÌ‚Ú‡Ô˘. ∂Í¿ÏÏÔ˘, Ù· ·ÔÙÂϤÛÌ·Ù· Û˘ÌʈÓÔ‡Ó Ì ÚÔËÁÔ‡ÌÂÓ˜ ÌÂϤÙ˜ (31,33,48) Ô˘ ÙÔÓ›˙Ô˘Ó fiÙÈ Ë ÚfiÛÏË„Ë ÎÚ¤·ÙÔ˜, ÙÚÔÊ‹˜ ÏÔ‡ÛÈ·˜ Û ÚˆÙ½Ó˜, ÌÔÚ› Ó· ·ÚÔ˘ÛÈ¿˙ÂÈ ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË Ì ÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛ˘. ¶·Ú’ fiÏ· ·˘Ù¿, η̛· ·fi ÙȘ ·Ú·¿Óˆ Û˘Û¯ÂÙ›ÛÂȘ ‰ÂÓ ÂÌÊ·Ó›˙ÂÙ·È ·ÚÎÂÙ¿ ÛËÌ·ÓÙÈ΋ ÁÈ· ¯¿Ú·ÍË Ó¤·˜ ÔÏÈÙÈ΋˜ fiÛÔÓ ·ÊÔÚ¿ ÛÙË ‰È·ÙÚÔÊ‹ ÙˆÓ ÂÁ·ˆÓ Á˘Ó·ÈÎÒÓ.

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Paediatriki 2002;65:307

LETTER TO THE EDITOR

∏ ÂÓË̤ڈÛË ÙÔ˘ ÎÔÈÓÔ‡ ÁÈ· ı¤Ì·Ù· ˘Á›·˜ ̤۷ ·fi ÌË È·ÙÚÈο ¤ÓÙ˘· Â›Ó·È ÂÈı˘ÌËÙ‹. ŸÙ·Ó Ù· ¤ÓÙ˘· ·˘Ù¿ ·ÔÙÂÏÔ‡Ó ¤ÓıÂÙ· ¿ÚıÚ· ‹ ΢ÎÏÔÊÔÚÔ‡Ó Ì ÙÔÓ ËÌÂÚ‹ÛÈÔ Ù‡Ô Û ÌÔÚÊ‹ ÂÚÈÔ‰ÈÎÔ‡, ÌÔÚ› Ó· ¤¯Ô˘Ó ÛËÌ·ÓÙÈÎfi ·Ó·ÁÓˆÛÙÈÎfi ÎÔÈÓfi Î·È ÂÔ̤ӈ˜ Ó· ·ÛÎÔ‡Ó ÛËÌ·ÓÙÈ΋ Â›‰Ú·ÛË. ªÂ ·˘Ùfi ÙÔ ÛÎÂÙÈÎfi, ÔÈ ÏËÚÔÊÔڛ˜ Ô˘ ·Ú¤¯Ô˘Ó fi¯È ÌfiÓÔÓ ı· Ú¤ÂÈ Ó· Â›Ó·È ‰È·Ù˘ˆÌ¤Ó˜ Ì ‡ÏËÙÔ ÙÚfiÔ, ·ÏÏ¿ ı· Ú¤ÂÈ Ó· Â›Ó·È ÂÈÛÙËÌÔÓÈο ·ÎÚȂ›˜ Î·È Û‡ÌʈÓ˜ Ì ÙËÓ ÙÚ¤¯Ô˘Û· ÂÈÛÙËÌÔÓÈ΋ Ú·ÎÙÈ΋. ™˘ÁÎÂÎÚÈ̤ӷ, ·Ó·Ê¤ÚÔÌ·È Û ¤ÓÙ˘Ô Ì ȷÙÚÈο ı¤Ì·Ù· ÁÓˆÛÙ‹˜ ÂÊËÌÂÚ›‰·˜ ÙÔ˘ ËÌÂÚ‹ÛÈÔ˘ Ù‡Ô˘ Ì ·ÓÂÏÏ·‰È΋ ÂÌ‚¤ÏÂÈ· Î·È Â˘Ú‡ ·Ó·ÁÓˆÛÙÈÎfi ÎÔÈÓfi. ŒÓ· ·fi Ù· ı¤Ì·Ù· Ô˘ ·ÚÔ˘ÛÈ¿ÛÙËÎ·Ó ÚfiÛÊ·Ù· ·Ó·ÊÂÚfiÙ·Ó ÛÙË ÛËÌ·Û›· ÙÔ˘ ÎÏ¿Ì·ÙÔ˜ ÙÔ˘ ÓÂÔÁÓÔ‡ ηÈ, ÌÂٷ͇ ¿ÏψÓ, ÛÙÔ ÎÏ¿Ì· ÙÔ˘ ÓÂÔÁÓÔ‡ ˆ˜ ̤ÛÔ˘ ÂΉ‹ÏˆÛ˘ ›ӷ˜. ™˘ÁÎÂÎÚÈ̤ӷ, ˘‹ÚÍÂ Ë ÂÈ̤ÚÔ˘˜ ÂÈÎÂÊ·Ï›‰·: “∫¿ı fiÙ ÎÏ·›ÂÈ ÙÔ ÌˆÚfi ÂÂȉ‹ ÂÈÓ¿ÂÈ” Î·È ÛÙË Û˘Ó¤¯ÂÈ· (Û ۯ¤ÛË Ì ÙË Û›ÙÈÛË): “∆È Û˘ÛÙ‹ÓÔ˘Ì”. ∂Λ ·Ó·Ê¤ÚÔÓÙ·È Ù· ·ÎfiÏÔ˘ı·, Ù· ÔÔ›· ÌÂٷʤڈ ·˘ÙÔÏÂÍ›: “∆¿ÈÛÌ· οı ‰˘fiÌÈÛÈ-Ù¤ÛÛÂÚȘ ÒÚ˜. ∞Ó Í˘Ó‹ÛÂÈ ÓˆÚ›ÙÂÚ· ÙÔ˘ ‰›ÓÔ˘Ì 20-30 g ÚfiÊËÌ·, ÁÈ· Ó· ËÛ˘¯¿ÛÂÈ, ÒÛÔ˘ Ó· ¤¯Ô˘Ó ÂÚ¿ÛÂÈ ‰˘fiÌÈÛÈ ÒÚ˜ ·fi ÙËÓ ¤Ó·ÚÍË ÙÔ˘ ÚÔËÁÔ‡ÌÂÓÔ˘ Á‡̷ÙÔ˜ Î·È Â¿Ó ‰ÂÓ ¤¯ÂÈ Í˘Ó‹ÛÂÈ ÛÙȘ Ù¤ÛÛÂÚȘ ÒÚ˜, ÙÔ Í˘Ó¿Ì ӷ Ê¿ÂÈ, ÂÎÙfi˜ ·fi ÙË Ó‡ÎÙ·, ÔfiÙ ı¤ÏÔ˘Ì ӷ ·ÔÎÙ‹ÛÂÈ ÙË Û˘Ó‹ıÂÈ· Ó· ÎÔÈÌ¿Ù·È ÂÚÈÛÛfiÙÂÚ˜ ÒÚ˜. ¢¤Î· ÏÂÙ¿ ÛÙÔ ÚÒÙÔ ÛÙ‹ıÔ˜, fiÛÔ ı¤ÏÂÈ ·fi ÙÔ ‰Â‡ÙÂÚÔ ÛÙ‹ıÔ˜ Î·È ·ÓÙ›ÛÙÚÔÊ· ÙËÓ ÂfiÌÂÓË ÊÔÚ¿”. ™ÙË Û˘Ó¤¯ÂÈ·, ·Ú·Ù›ıÂÓÙ·È ¿ÏÏ· ˙ËÙ‹Ì·Ù·. £¤Ïˆ ÏÔÈfiÓ Ó· Û¯ÔÏÈ¿Ûˆ Ù· ·ÓˆÙ¤Úˆ Û¯ÂÙÈο Ì ÙÔ ÚÔÙÂÈÓfiÌÂÓÔ ·˘ÛÙËÚfi “ˆÚ¿ÚÈÔ ıËÏ·ÛÌÔ‡” Î.Ï. Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÈÔ ¿Óˆ. ∏ Û›ÙÈÛË ÙÔ˘ ÙÂÏÂÈfiÌËÓÔ˘ ÓÂÔÁÓÔ‡ ηْ Â›ÎÏËÛË (feeding on demand) ·fi ÙÔ ÛÙ‹ıÔ˜ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÌÂÁ¿ÏË Û˘¯ÓfiÙËÙ· (8 ̤¯ÚÈ ÂÚÈÛÛfiÙÂÚ· ·fi 12 Á‡̷ٷ ÙÔ 24ˆÚÔ) Î·È ·fi ÌË Î·ÓÔÓÈÎfiÙËÙ·. ¢ËÏ·‰‹, ·Ú·ÙËÚÔ‡ÓÙ·È ÌÈÎÚfiÙÂÚ· ‹ ÌÂÁ·Ï‡ÙÂÚ· ‰È·ÛÙ‹Ì·Ù· ÌÂٷ͇ ıËÏ·ÛÌÒÓ Ì ٿÛË Û˘ÁΤÓÙÚˆÛ‹˜ ÙÔ˘˜ ÙËÓ Ë̤ڷ ‹ ÙË Ó‡¯Ù·, ·Ó¿ÏÔÁ· Ì ÙÔ Î¿ı ÓÂÔÁÓfi. °È· Ù· ÈÔ ¿Óˆ, Ë ÌËÙ¤Ú· fi¯È ÌfiÓÔ ı· Ú¤ÂÈ Ó· Â›Ó·È ÂÓËÌÂڈ̤ÓË, ·ÏÏ¿ ı· Ú¤ÂÈ Ó· Ù‡¯Ô˘Ó Û‚·ÛÌÔ‡ Î·È ÂÈϤÔÓ Ó· ÌËÓ ˘¿ÚÍÂÈ ÚÔÛ¿ıÂÈ· “ÙÈı¿Û¢Û˘” ÙÔ˘ ÓÂÔÁÓÔ‡ ÛÂ Û˘ÁÎÂÎÚÈ̤ÓÔ ÚÔηıÔÚÈṲ̂ÓÔ ÌÔÓÙ¤ÏÔ. ∏ ‰È¿ÚÎÂÈ· ÙÔ˘ ıËÏ·ÛÌÔ‡ ·fi ÙÔ ÛÙ‹ıÔ˜, Â›Û˘ ηıÔÚ›˙ÂÙ·È ·fi ÙÔ ÓÂÔÁÓfi. ∆Ô ÓÂÔÁÓfi ı· Ú¤ÂÈ Ó· Ì›ÓÂÈ ÛÙÔ ÛÙ‹ıÔ˜ ̤¯ÚÈ Ó· ÙÂÏÂÈÒÛÂÈ. ŸÙ·Ó ÙÂÏÂÈÒÛÂÈ, ‹ ı· ·Ê‹ÛÂÈ ÙÔ ÛÙ‹ıÔ˜ ‹ ı· ÎÔÈÌËı› Î·È ‰ÂÓ ı· ı¤ÏÂÈ Ó· ıËÏ¿ÛÂÈ ¿ÏÏÔ ÌÂÙ¿ ·fi ‹È· ÚÔÛ¿ıÂÈ· ·Ê‡ÓÈÛ‹˜ ÙÔ˘. ∞Ó¿ÏÔÁ· Ì ÙÔ ÔÛfi ÙÔ˘ Á¿Ï·ÎÙÔ˜ ÙÔ ÔÔ›Ô ÙÔ ÓÂÔÁÓfi ¤¯ÂÈ ÚÔÛÏ¿‚ÂÈ, ÙÔ ÌÂÛԉȿÛÙËÌ· ̤¯ÚÈ ÙÔÓ ÂfiÌÂÓÔ ıËÏ·ÛÌfi ı· Â›Ó·È ÌÈÎÚfiÙÂÚÔ ‹ ÌÂÁ·Ï‡ÙÂÚÔ. ŒÓ· ȉȷ›ÙÂÚ· ÛËÌ·ÓÙÈÎfi ˙‹ÙËÌ· Â›Ó·È Ë Ù¯ÓÈ΋ ÙÔ˘ ıËÏ·ÛÌÔ‡, fiˆ˜ Â›Ó·È ÙÔ Î·Ù¿ÏÏËÏÔ “Á¿ÓÙ˙ˆÌ·” ÙÔ˘ ÓÂÔÁÓÔ‡ ÛÙÔ ÛÙ‹ıÔ˜. ªÂ ·˘ÙfiÓ ÙÔÓ ÙÚfiÔ ·ÔʇÁÔÓÙ·È ÔÏÏ¿ ÚÔ‚Ï‹Ì·Ù·, fiˆ˜ ÔÈ Ú·Á¿‰Â˜ ÙˆÓ ıËÏÒÓ, Ë ÂÒ‰˘ÓË ‰È¿Ù·ÛË ÙˆÓ Ì·ÛÙÒÓ (ÙÔ “¤Ùڈ̿” ÙÔ˘˜), Ë ¯·ÌËÏ‹ ·Ú·ÁˆÁ‹ Á¿Ï·ÎÙÔ˜ Î·È Ë ÌË ÈηÓÔÔ›ËÛË ÙÔ˘ ÓÂÔÁÓÔ‡. ∂Ô̤ӈ˜, Ë Ú·ÎÙÈ΋ ‰È‰·Ûηϛ· ÙÔ˘ ıËÏ·ÛÌÔ‡ ¤¯ÂÈ È‰È·›ÙÂÚË ÛËÌ·Û›·. ∆Ô ÓÂÔÁÓfi ‰ÂÓ ¯ÚÂÈ¿˙ÂÙ·È ·Ú¿ ÌfiÓÔÓ ÙÔ Á¿Ï· Ù˘ ÌËÙ¤Ú·˜ ÙÔ˘. ∆›ÔÙ ¿ÏÏÔ. ∆· ÔÔÈ·‰‹ÔÙ ÚÔÊ‹Ì·Ù·, Û˘ÌÏËÚÒÌ·Ù· Î.Ï. ¤¯Ô˘Ó ·ÚÓËÙÈ΋ Â›‰Ú·ÛË ÛÙËÓ ÂÈÙ˘¯›· ÙÔ˘ ıËÏ·ÛÌÔ‡. ∞ÓÙ› Ó· ·Ô˙ËÙԇ̠ˆÚ¿ÚÈ·, ÔÛfiÙËÙ˜ Î·È ‚¿ÚË, ÔÈ “Â·ÁÁÂÏ̷ٛ˜ Ù˘ ˘Á›·˜” Î·È ÔÈ ÌËÙ¤Ú˜ ı· Ú¤ÂÈ Ó· Ì¿ıÔ˘Ó Ó· ‚·Û›˙ÔÓÙ·È ÛÂ Û˘ÌÂÚÈÊÔÚ¤˜ Î·È ÛˆÌ·ÙÈο ÎÚÈÙ‹ÚÈ·, Ô˘ ›Ù ¯·Ú·ÎÙËÚ›˙Ô˘Ó ÙËÓ ÂÈÙ˘¯›· ÙÔ˘ ıËÏ·ÛÌÔ‡ ‹ ·ÔÙÂÏÔ‡Ó ÚÔÂȉÔÔÈËÙÈο ÛËÌ›· ÚÔ‚ÏËÌ¿ÙˆÓ ÙÔ˘. °È· Ù· ·ÓˆÙ¤Úˆ ˘¿Ú¯ÂÈ ÏÔ‡ÛÈ· ‚È‚ÏÈÔÁÚ·Ê›· Û ȷÙÚÈο ÂÚÈÔ‰Èο, È·ÙÚÈο ‚È‚Ï›·, ·ÏÏ¿ Î·È ÛÙȘ Ô‰ËÁ›Â˜ Ù˘ ¶·ÁÎfiÛÌÈ·˜ OÚÁ¿ÓˆÛ˘ ÀÁ›·˜. À¿Ú¯Ô˘Ó Î·È ¿ÏÏ· ˙ËÙ‹Ì·Ù· Á‡Úˆ ·fi ÙÔ ıËÏ·ÛÌfi Ô˘ ı· ÌÔÚÔ‡Û·Ó Ó· ·Ó·Ù˘¯ıÔ‡Ó, ·ÏÏ¿ Ë ÚfiıÂÛ‹ ÌÔ˘ ‹Ù·Ó Ó· ÂÈÛËÌ¿Óˆ fiÙÈ ÂÓÒ ÔÈ ÊÔÈÙËÙ¤˜ Ù˘ È·ÙÚÈ΋˜, ÔÈ ÂȉÈ΢fiÌÂÓÔÈ È·ÙÚÔ› ÛÙËÓ ¶·È‰È·ÙÚÈ΋ ηÈ, Ù¤ÏÔ˜, ÔÈ ¶·È‰›·ÙÚÔÈ Â›Ó·È, ÛÙÔ ıˆÚËÙÈÎfi Â›‰Ô, Ôχ ηÏÔ› ÁÓÒÛÙ˜ ÙˆÓ ÏÂÔÓÂÎÙËÌ¿ÙˆÓ ÙÔ˘ ıËÏ·ÛÌÔ‡, ÙˆÓ ‰È·ÊÔÚÒÓ ÌÂٷ͇ Á·Ï¿ÙˆÓ Ù˘ ÚÒÙ˘ ‚ÚÂÊÈ΋˜ ËÏÈΛ·˜ Î·È ÙÔ˘ ÌËÙÚÈÎÔ‡ Á¿Ï·ÙÔ˜ Î·È ¿ÏÏ· Û˘Ó·Ê‹, Û˘¯Ó¿ ˘ÛÙÂÚÔ‡Ó ·ÂÏÈÛÙÈο ÛÙËÓ Ú·ÎÙÈ΋ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ıËÏ·ÛÌÔ‡. O ÏfiÁÔ˜; ∞ÏÔ‡Ûٷٷ, Ë fiÏË ÂÎ·›‰Â˘ÛË ÛÙËÓ ¶·È‰È·ÙÚÈ΋ ¤¯ÂÈ ÓÔÛÔÎÔÌÂÈ·Îfi ¯·Ú·ÎÙ‹Ú·, ͯÓÒÓÙ·˜ fiÙÈ Ë ¶·È‰È·ÙÚÈ΋ ‹ ηχÙÂÚ· Ë ÀÁ›· ÙÔ˘ ¶·È‰ÈÔ‡ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÏËıÒÚ· ˙ËÙËÌ¿ÙˆÓ/ÚÔ‚ÏËÌ¿ÙˆÓ ÛÙÔ Â͈ÓÔÛÔÎÔÌÂÈ·Îfi Â›‰Ô. ∏. ¢. ¢ÂÏÏ·ÁÚ·ÌÌ¿ÙÈη˜ ∞Ó·ÏËÚˆÙ‹˜ ∫·ıËÁËÙ‹˜ ¶·È‰È·ÙÚÈ΋˜-¡ÂÔÁÓÔÏÔÁ›·˜

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¶·È‰È·ÙÚÈ΋ 2002;65:308

Paediatriki 2002;65:308

µÈ‚ÏÈÔ·ÚÔ˘Û›·ÛË C. P. Panayiotopoulos: “Panayiotopoulos syndrome. A common and benign childhood epileptic syndrome” J. Libbey, London 2002, ÛÂÏ›‰Â˜ 174. ISBN: 0 86196 619 8

∂›Ó·È ÙÈÌ‹ ÁÈ· ̤ӷ Ë ·ÚÔ˘Û›·ÛË ÙÔ˘ ÙÂÏÂ˘Ù·›Ô˘ ‚È‚Ï›Ô˘ ÙÔ˘ Û˘Ó·‰¤ÏÊÔ˘ ∆fiÌË ¶·Ó·ÁȈÙfiÔ˘ÏÔ˘ Ô˘ ÂΉfiıËΠÙÔÓ ∞Ú›ÏÈÔ 2002. O Û˘ÁÁڷʤ·˜, ˘ÊËÁËÙ‹˜ Û ·Ï·ÈfiÙÂÚ˜ ÂÔ¯¤˜ Ù˘ ¡Â˘ÚÔÏÔÁÈ΋˜ ∫ÏÈÓÈ΋˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ˘‹ÚÍ ‰¿ÛηÏÔ˜ ÁÈ· ÔÏÏÔ‡˜ ŒÏÏËÓ˜ È·ÙÚÔ‡˜. °È· Û‡ÓÙÔÌÔ ‰È¿ÛÙËÌ· ‰ÈÂÙ¤ÏÂÛÂ Î·È ¢È¢ı˘ÓÙ‹˜ Ù˘ ¡Â˘ÚÔÏÔÁÈ΋˜ ∫ÏÈÓÈ΋˜ ÛÙÔ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∏ ∞Á›· ™ÔÊ›·”. ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· Â›Ó·È ¢È¢ı˘ÓÙ‹˜ ÙÔ˘ ∆Ì‹Ì·ÙÔ˜ ∫ÏÈÓÈ΋˜ ¡Â˘ÚÔÊ˘ÛÈÔÏÔÁ›·˜ Î·È ∂ÈÏË„›·˜ ÙÔ˘ St. Thomas’ Hospital ÛÙÔ §ÔÓ‰›ÓÔ Î·È ¤¯ÂÈ ·Ó·ÁÓˆÚÈÛÙ› ‰ÈÂıÓÒ˜ Û·Ó ¤Ó·˜ ·fi ÙÔ˘˜ ϤÔÓ ‰È·ÎÂÎÚÈ̤ÓÔ˘˜ ÂÈÏËÙÔÏfiÁÔ˘˜. ∆Ô ÂÈÏËÙÈÎfi Û‡Ó‰ÚÔÌÔ, ÛÙÔ ÔÔ›Ô ·Ó·Ê¤ÚÂÙ·È ÙÔ ‚È‚Ï›Ô, ·Ó·ÁÓˆÚ›ÛÙËΠÚfiÛÊ·Ù· ·fi ÙËÓ International League Against Epilepsy (ILAE) Û·Ó ·˘ÙfiÓÔÌÔ Û‡Ó‰ÚÔÌÔ Ì ÙÔ fiÓÔÌ· Û‡Ó‰ÚÔÌÔ ¶·Ó·ÁȈÙfiÔ˘ÏÔ˘ (Panayiotopoulos syndrome). Èڛ˜ ·ÌÊÈ‚ÔÏ›·, ηÏÔ› ÎÏÈÓÈÎÔ› ‹ ÂÚ¢ÓËÙ¤˜ È·ÙÚÔ› ˘¿Ú¯Ô˘Ó ·ÚÎÂÙÔ›. ∏ ÈηÓfiÙËÙ·, fï˜, ηıÔÚÈÛÌÔ‡ Ó¤Ô˘ Û˘Ó‰ÚfiÌÔ˘ Â›Ó·È Ôχ ‰‡ÛÎÔÏË ˘fiıÂÛË. ∏ ‰ÈÂıÓ‹˜ ·Ó·ÁÓÒÚÈÛË ÙÔ˘ ÂÈÏËÙÈÎÔ‡ ·˘ÙÔ‡ Û˘Ó‰ÚfiÌÔ˘ Ì ÙÔ fiÓÔÌ· “¶·Ó·ÁȈÙfiÔ˘ÏÔ˜”, ·ÛÊ·ÏÒ˜ ·ÔÙÂÏ› ÛÔ‚·Úfi Â›Ù¢ÁÌ· Î·È ÌÂÁ¿ÏË ÙÈÌ‹ ÁÈ· ÙÔÓ ›‰ÈÔ, ·ÏÏ¿ Î·È ÁÈ· ÙËÓ ∂ÏÏ¿‰·. ∆Ô Û‡Ó‰ÚÔÌÔ ¶·Ó·ÁȈÙfiÔ˘ÏÔ˘ ÂӉȷʤÚÂÈ È‰È·›ÙÂÚ· ÙÔÓ ¶·È‰›·ÙÚÔ. ª·˙› Ì ÙËÓ Î·ÏÔ‹ıË ÂÛÙȷ΋ ÂÈÏË„›· Ì ÎÂÓÙÚÔÎÚÔÙ·ÊÈΤ˜ ·È¯Ì¤˜ (benign epilepsy with centrotemporal spikes - BECTS) ·ÔÙÂÏÔ‡Ó ÙȘ Û˘¯ÓfiÙÂÚ˜ ÌÔÚʤ˜ ÂÈÏË„›·˜ ÛÙËÓ ·È‰È΋ ËÏÈΛ·. ∆Ô Û‡Ó‰ÚÔÌÔ ¶·Ó·ÁȈÙfiÔ˘ÏÔ˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÎÚ›ÛÂȘ 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›ÛÂȘ ÙÔ˘˜ Â›Ó·È Û¿ÓȘ Î·È Û˘Ì‚·›ÓÔ˘Ó Î˘Ú›ˆ˜ ÙË Ó‡¯Ù·. ™ÙËÓ Ù˘È΋ ÙÔ˘˜ ÌÔÚÊ‹, ÔÈ ÎÚ›ÛÂȘ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·Ú¯Èο ·fi ÂΉËÏÒÛÂȘ ·fi ÙÔ ·˘ÙfiÓÔÌÔ Û‡ÛÙËÌ·, ÂÓÒ Ô ·ÛıÂÓ‹˜ ‰È·ÙËÚ› ÙȘ ·ÈÛı‹ÛÂȘ ÙÔ˘ Î·È Â›Ó·È Û ı¤ÛË Ó· ÔÌÈÏ‹ÛÂÈ. ¶ÂÚÈÁÚ¿ÊÔÓÙ·È ˆ¯ÚfiÙËÙ· ‹ ÂÚ˘ıÚfiÙËÙ·, Ì˘‰Ú›·ÛË ‹ ̇ÛË, ˘ÂÚ¤ÎÎÚÈÛË ÛȤÏÔ˘, ÂÌÂÙfi˜, ‚‹¯·˜, ·ÒÏÂÈ· ÂϤÁ¯Ô˘ ÙˆÓ ÛÊÈÎÙ‹ÚˆÓ. O ÂÌÂÙfi˜ Â›Ó·È Û˘Ó‹ı˘, ηıÒ˜ ·ÊÔÚ¿ ÙÔ 70% ÙˆÓ ·ÛıÂÓÒÓ. ∞ÎÔÏÔ˘ı› ·ÒÏÂÈ· ·ÈÛı‹ÛˆÓ, ÛÙÚÔÊ‹ ÙÔ˘ ‚ϤÌÌ·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›ÛÂȘ ‰È·ÚÎÔ‡Ó ÂÚÈÛÛfiÙÂÚÔ ·fi 30 ÏÂÙ¿ (ÂÛÙȷ΋ ÂÈÏËÙÈ΋ ηٿÛÙ·ÛË). ™Â οÔȘ ÂÚÈÙÒÛÂȘ ÔÈ ÂΉËÏÒÛÂȘ ·fi ÙÔ ·˘ÙfiÓÔÌÔ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÚÔηϤÛÔ˘Ó Û‡Á¯˘ÛË ÛÙÔÓ È·ÙÚfi Î·È Ó· ıˆÚËıÔ‡Ó Û·Ó ÂΉËÏÒÛÂȘ ÂÁÎÂÊ·Ï›Ùȉ·˜ ‹ ËÌÈÎÚ·Ó›·˜. ∆Ô ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ· ÂÌÊ·Ó›˙ÂÈ ¯·Ú·ÎÙËÚÈÛÙÈΤ˜ ÂÎÊÔÚÙ›ÛÂȘ ·È¯ÌËÚÒÓ Î˘Ì¿ÙˆÓ Ô˘ Û˘Ó‹ıˆ˜ ÂÈÎÚ·ÙÔ‡Ó ÈÓȷο. ∏ ÚfiÁÓˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Â›Ó·È ¿ÚÈÛÙË, ηıÒ˜ Ù· ÂÂÈÛfi‰È· ÛÙ·Ì·ÙÔ‡Ó Ì¤Û· Û ¤Ó· Ì ‰‡Ô ¯ÚfiÓÈ·. O ΛӉ˘ÓÔ˜ ·Ó¿Ù˘Í˘ ÂÈÏË„›·˜ ÛÙÔ Ì¤ÏÏÔÓ Â›Ó·È ·ÚfiÌÔÈÔ˜ Ì ÙÔÓ ÎÔÈÓfi ÏËı˘ÛÌfi. ™ÙÔ ‚È‚Ï›Ô ·Ó·Ï‡ÔÓÙ·È Ì ÏÂÙÔ̤ÚÂÈ· Ù· ÎÏÈÓÈο Î·È ÂÁÎÂÊ·ÏÔÁÚ·ÊÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Î·È ÂÚÈÁÚ¿ÊÔÓÙ·È 60 ÂÚÈÙÒÛÂȘ ·ÛıÂÓÒÓ. ¶ÈÛÙ‡ˆ fiÙÈ ÙÔ ‚È‚Ï›Ô ·ÔÙÂÏ› ÔχÙÈÌÔ ‚Ô‹ıËÌ·, fi¯È ÌfiÓÔ ÁÈ· ÙÔ˘˜ Ó¢ÚÔÏfiÁÔ˘˜ Î·È ·È‰ÔÓ¢ÚÔÏfiÁÔ˘˜, ·ÏÏ¿ Î·È ÁÈ· ÙÔÓ ÁÂÓÈÎfi ·È‰›·ÙÚÔ.

™ˆÙ‹Ú˘ °. °ÈÔ˘ÚÔ‡ÎÔ˜ ¶·È‰ÔÓ¢ÚÔÏfiÁÔ˜ ÀÊËÁËÙ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ

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¶PO™EXH ™YNE¢PIA

24-28 ∞˘ÁÔ‡ÛÙÔ˘ 2002

29th World Congress of the International Society of Hematology ¶ÏËÚÔÊÔڛ˜: Hwa-Jung Lee Tel.: 82-2-3476-7700 Fax: 82-2-3476-8800 E-mail: ISH2002@koconex.com

Seoul, Korea (South)

4-7 ™ÂÙÂÌ‚Ú›Ô˘ 2002

Annual Congress of the European Society for Pediatric Research (ESPR) Tel.: 31-343-443888 Fax: 31-343-442043 E-mail: info@statusplus.nl

Utrecht, Netherlands

14-15 ™ÂÙÂÌ‚Ú›Ô˘ 2002

2Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ ÀÔÂȉÈÎÔÙ‹ÙˆÓ Ù˘ ¶·È‰È·ÙÚÈ΋˜ ¶ÏËÚÔÊÔڛ˜: C&C International A.E. Conventions & Congresses ∆ËÏ.: 010 - 68 89 100 Fax: 010 - 68 44 777 E-mail: congress@cnc.gr

∞ı‹Ó·

18-21 ™ÂÙÂÌ‚Ú›Ô˘ 2002

International Society of 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: siop2002@congrex.nl

Porto, Portugal

19-21 ™ÂÙÂÌ‚Ú›Ô˘ 2002

27 UMEMPS Congress Congress Secretariat: Viajes Pacifico, S.L. c/ Maria Cubi, 4 entlo Tel.: +34 93 238 8777 Fax: +34 93 238 7488 E-mail: pg@pacif-meetings.com

Alicante, Spain

20-25 ™ÂÙÂÌ‚Ú›Ô˘ 2002

9th International Child Neurology Congress and the 7th Asian and Oceanian Congress of Child Neurology ¶ÏËÚÔÊÔڛ˜: Dr. Yu-Wu Jiang, Xin-Hua Bao E-mail: icnc@public3.bta.net.cn Website: http://www.ciccst.org.cn/icnc2002

Beijing, China

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27-29 ™ÂÙÂÌ‚Ú›Ô˘ 2002

6Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ Ì ¢ÈÂıÓ‹ ™˘ÌÌÂÙÔ¯‹ Ù˘ ∂ÏÏËÓÈ΋˜ ∂Ù·ÈÚ›·˜ ÁÈ· ÙË ÛÎÏ‹Ú˘ÓÛË Î·Ù¿ Ͽη˜

£ÂÛÛ·ÏÔÓ›ÎË

28 ™ÂÙÂÌ‚Ú›Ô˘ 2002

∏ÌÂÚ›‰· Ì˘ÂÏÔ‰˘ÛÏ·ÛÙÈÎÒÓ Û˘Ó‰ÚfiÌˆÓ ∂ÏÏËÓÈ΋˜ ∞ÈÌ·ÙÔÏÔÁÈ΋˜ ∂Ù·ÈÚ›·˜ ¶ÏËÚÔÊÔڛ˜: ∂æπ§O¡ ∆ËÏ.: 010 - 72 54 360-2 Fax: 010 - 72 54 363 E-mail: epsilon@hol.gr

¡·‡ÏÈÔ

10-12 OÎÙˆ‚Ú›Ô˘ 2002

2Ô ¶·ÓËÂÈÚˆÙÈÎfi π·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ •ÂÓÔ‰Ô¯Â›Ô “Du Lac”

πˆ¿ÓÓÈÓ·

12-13 OÎÙˆ‚Ú›Ô˘ 2002

∂ÊË‚È΋ π·ÙÚÈ΋ 2002 ¶ÏËÚÔÊÔڛ˜: ∫¤ÓÙÚÔ ¢ËÌÔÛ›ˆÓ ™¯¤ÛˆÓ, ∂ϤÓË Ã·Ï˘‚›‰Ô˘ ∆ËÏ.: 010 - 77 11 673 & 77 56 336 Fax: 010 - 77 11 289

∞ı‹Ó·

19 OÎÙˆ‚Ú›Ô˘ 2002

16Ô ™ÂÌÈÓ¿ÚÈÔ ∂›ÁÔ˘Û·˜ Î·È ∞ı‹Ó· ∂ÓÙ·ÙÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ “∞Ù˘¯‹Ì·Ù·-∫·ÎÒÛÂȘ Î·È ∂ÓÙ·ÙÈ΋ £ÂÚ·›·” ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡” ¶ÏËÚÔÊÔڛ˜: °ÂˆÚÁ›· ™È‰¤ÚË ∆ËÏ.: 010 - 77 98 033

19-23 OÎÙˆ‚Ú›Ô˘ 2002

American Academy of Pediatrics 2002 Annual Meeting ¶ÏËÚÔÊÔڛ˜: Congress Secretariat Tel.: 847-228-5005 Fax: 847-228-5059

22-27 OÎÙˆ‚Ú›Ô˘ 2002

49th Annual Meeting of the American San Francisco, CA Academy of Child and Adolescent Psychiatry Tel.: 202-966-7300 Fax: 202-966-2891 E-mail: meetings@aacap.org

28-29 OÎÙˆ‚Ú›Ô˘ 2002

3rd European Conference on Pediatric Asthma ¶ÏËÚÔÊÔڛ˜: Conference Secretariat Castle House Medical Conferences Tel.: 44-0-1892-539-606 Fax: 44-0-1892-517-773 E-mail: asthma@castlehouse.co.uk

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Boston, MA

London, England

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™YNTOMO°PAºIE™

ABBREVIATIONS

™˘ÓÙÔÌÔÁڷʛ˜

EÏÏËÓÈÎÔ› fiÚÔÈ

AÁÁÏÈÎÔ› fiÚÔÈ

AIDS

Û‡Ó‰ÚÔÌÔ Â›ÎÙËÙ˘ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·˜

AMP, ADP, ATP

ÌÔÓÔ-, ‰È-, ÙÚÈʈÛÊÔÚÈ΋ ·‰ÂÓÔÛ›ÓË

ATPase cal CSF ‹ ENY CNS ‹ ∫¡™ cm CoA cmÑ cm2 cAMP ÆC CRP DNA ECG ‹ ∏∫° EEG ‹ ∏∂° ELISA ESR ‹ ∆∫∂ EDTA g Hct Hb HLA

ÙÚÈʈÛÊ·Ù¿ÛË Ù˘ ·‰ÂÓÔÛ›Ó˘ ıÂÚÌ›‰· ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚfi ÎÂÓÙÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ· ÂηÙÔÛÙfi Û˘Ó¤Ó˙˘ÌÔ ∞ ΢‚ÈÎfi ÂηÙÔÛÙfi ÙÂÙÚ·ÁˆÓÈÎfi ÂηÙÔÛÙfi ΢ÎÏÈÎfi AMP ‚·ıÌfi˜ KÂÏÛ›Ô˘ C-·ÓÙȉÚÒÛ· ÚˆÙ½ÓË ‰ÂÔ͢ÚÈ‚Ô˙ÔÓÔ˘ÎÏÂ˚ÓÈÎfi Ô͇ ËÏÂÎÙÚÔηډÈÔÁÚ¿ÊËÌ· ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ· ¤Ó˙˘ÌÔ-Û˘Ó‰¤Ù˘ ·ÓÔÛÔÚÔÛÚfiÊËÛ˘ ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù·¯‡ÙËÙ· ηıÈ˙‹Ûˆ˜ ÂÚ˘ıÚÒÓ Âı˘ÏÂÓԉȷÌÈÓÔÙÂÙÚ·ÔÍÂ˚Îfi Ô͇ ÁÚ·ÌÌ¿ÚÈo ·ÈÌ·ÙÔÎÚ›Ù˘ ·ÈÌÔÛÊ·ÈÚ›ÓË ·ÓÙÈÁfiÓÔ ÈÛÙÔÛ˘Ì‚·ÙfiÙËÙ·˜

Ig ICU ‹ ª∂£ IU i.m. ‹ ∂.ª. i.p. ‹ ∂.¶. i.v. ‹ ∂.º.

L log mol ªW ‹ MB MCH MCV mRNA m min n N NS ‹ ª™ Ôsm % PCR pH PCO2 PO2 p

·ÓÔÛÔÛÊ·ÈÚ›ÓË ÌÔÓ¿‰· ÂÓÙ·ÙÈ΋˜ ıÂÚ·›·˜ ‰ÈÂıÓ‹˜ ÌÔÓ¿‰· ÂÓ‰ÔÌ˘˚ο ÂÓ‰ÔÂÚÈÙÔÓ·˚ο ÂÓ‰ÔÊϤ‚È· Ï›ÙÚÔ(·) ÏÔÁ¿ÚÈıÌÔ˜ ÁÚ·ÌÌÔÌfiÚÈÔ ÌÔÚÈ·Îfi ‚¿ÚÔ˜ ̤ÛË ·ÈÌÔÛÊ·ÈÚ›ÓË ÂÚ˘ıÚÒÓ Ì¤ÛÔ˜ fiÁÎÔ˜ ÂÚ˘ıÚÒÓ ·ÁÁÂÏÈÔÊfiÚÔ˜ RNA ̤ÙÚÔ ÏÂÙfi ·ÚÈıÌfi˜ Ó¢ÙÒÓÈÔ ÌË ÛËÌ·ÓÙÈÎfi ÔÛÌÒÏÈÔ Â› ÙÔȘ ÂηÙfi ·Ï˘ÛȉˆÙ‹ ·ÓÙ›‰Ú·ÛË ÔÏ˘ÌÂÚ¿Û˘ Û˘ÁΤÓÙÚˆÛË ÈfiÓÙˆÓ ˘‰ÚÔÁfiÓÔ˘ ÌÂÚÈ΋ Ù¿ÛË CO2 ÌÂÚÈ΋ Ù¿ÛË Ô͢ÁfiÓÔ˘ Èı·ÓfiÙËÙ·

acquired immunodeficiency syndrome adenosine 5mono-, di-, triphosphate adenosine triphosphatase calorie cerebrospinal fluid central nervous system centimeter coenzyme A cubic centimeter square centimeter cyclic AMP degree(s) Celsius C-reactive protein deoxyribonucleic acid electrocardiogram electroencephalogram enzyme-linked immunoabsorbent assay erythrocyte sedimentation rate ethylenediaminetetracetate gram haematocrit haemoglobin (human) histocompatibility leucocyte antigen immunoglobulin intensive care unit international Unit intramuscular intraperitoneal intravenous liter logarithm mole molecular weight mean corpuscular haemoglobin mean corpuscular volume messenger RNA meter minute number newton not significant osmole percent polymerase chain reaction potentia hydrogenii carbon dioxide pressure oxygen pressure probability

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™˘ÓÙÔÌÔÁڷʛ˜

·fi ÙÔ ÛÙfiÌ· Ú·‰ÈÔ·ÓÔÛÔ·ÔÚÚÔÊËÙÈ΋ ‰ÔÎÈÌ·Û›· ÚÈ‚ÔÓÔ˘ÎÏÂ˚ÓÈÎfi Ô͇ Û‡Ó‰ÚÔÌÔ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÈ·˜ ‰Â˘ÙÂÚfiÏÂÙÔ ˘Ô‰fiÚÈ· ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË ÛÙ·ıÂÚfi ÛÊ¿ÏÌ· ÌÔÓ¿‰·

p.o.

RIA RNA RDS sec s.c. ‹ À.¢.

SD SE U

™˘Ó‰˘·˙fiÌÂÓ· ÚÔı¤Ì·Ù· 12

tera- (10 ) giga- (10 ) mega-(10 ) kilo- (10 ) hecto(10 ) deca (10 ) deci (10 ) centi- (10 ) milli(10 ) micro (10 ) nano (10 ) pico (10 ) femto (10 ) atto (10 ) 9

6

3

2

1

-1

-2

-3

-6

-9

-12

-15

-18

xvi

EÏÏËÓÈÎÔ› fiÚÔÈ

Combining prefixes T G M k h da d c m Ì n p f a

AÁÁÏÈÎÔ› fiÚÔÈ by mouth radioimmunoassay ribonucleic acid respiratory distress syndrome second subcutaneous standard deviation standard error unit