Παιδιατρική | Τόμος 65 • Τεύχος 6 • Νοέμβριος - Δεκέμβριος 2002

COVER NoV-dEc02

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ISSN 0377-2551

¶AI¢IATPIKH

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TOMO™ 65

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TEYXO™ 6

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ETO™ 2002

¡Ô¤Ì‚ÚÈÔ˜ - ¢ÂΤ̂ÚÈÔ˜ 2002 . ∆fiÌÔ˜ 65 . ∆‡¯Ô˜ 6

∞¡∞™∫O¶∏™∂π™ °ÂÓÂÙÈΤ˜ ÌÔÚʤ˜ ·¯˘Û·ÚΛ·˜ ÛÙËÓ ·È‰È΋ ËÏÈΛ·

REVIEW ARTICLES 387

Ã.°. ÷Ù˙Ë·ı·Ó·Û›Ô˘, Ã. £ÂÔ‰ˆÚ›‰Ë˜

AÒÙÂÚ˜ ÂÈÏÔΤ˜ Ù˘ ÚÔˆÚfiÙËÙ·˜

C.G. Hadjiathanasiou, C. Theodoridis 394

∞. ª·ÓÔ˘Ú¿, Ã. °È·ÓÓ·ÎÔÔ‡ÏÔ˘

¶ÚˆÙÔ·ı‹˜ ‰˘ÛÎÈÓËÛ›· ÙˆÓ ÎÚÔÛÛÒÓ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ ÂÈıËÏ›Ô˘: ‰È·ÁÓˆÛÙÈ΋ Î·È ıÂÚ·¢ÙÈ΋ ÚÔÛ¤ÁÁÈÛË

403

ORIGINAL ARTICLES 413

¶. ∑ÒÛË, ¢. ∫·Ú·Î·˚‰fi˜, °. ∆ÚÈ·ÓÙ·Ê˘ÏÏ›‰Ë˜, °. O˘˙Ô‡ÓË, ™. ¶È˙¿ÓÈ·˜, Ã. ∫·Ú‹˜ 419

424

Study of childhood asthma in Sitia region E. Tsapaki, C. Souga, G. Trimis, I. Germanakis, M. Malathraki, S. Goundras, H. Michailidou, A. Nearchou

433

¡. ¶··‰ÔÔ‡ÏÔ˘, ∫. ∆Û·Ì·Ó‰Ô˘Ú¿ÎË, §. ÃÔ˘ÏÈ¿Ú·, ∂. ¶¿‚Ë, °. ∆Ô‡ÓÙ·˜

Evaluation of the effectiveness of a health education CD-ROM: alcohol or driving N. Papadopoulou, ∫. ∆samandouraki, L. Houliara, E. Pavi, Y. ∆ountas

EN¢π∞º∂ƒOÀ™∂™ ¶∂ƒπ¶∆ø™∂π™ ∫˘„ÂÏȉ҉˜ ηÚΛӈ̷ ·ÚˆÙ›‰·˜ Û ·È‰›. ª›· ÂӉȷʤÚÔ˘Û· ÂÚ›ÙˆÛË

Antiregurgitation milk-formula as a treatment for mild and moderate gastroesophageal reflux in infants I. Xinias, V. Demertzidou, E. Karatza, C. Panteliadis, K. Spiroglou

Œ. ∆Û·¿ÎË, ∫. ™Ô‡Áη, °. ∆Ú›Ì˘, π. °ÂÚÌ·Ó¿Î˘, ª. ª·Ï·ıÚ¿ÎË, ™. °ÎÔ‡ÓÙÚ·˜, ∂. ªÈ¯·ËÏ›‰Ô˘, ∞. ¡Â¿Ú¯Ô˘

∞ÁˆÁ‹ ˘Á›·˜ ÛÙ· Û¯ÔÏ›·. ∞ÍÈÔÏfiÁËÛË ÔÙÈÎÔ·ÎÔ˘ÛÙÈÎÔ‡ ̤ÛÔ˘ ÁÈ· ÙÔÓ ÂÚÈÔÚÈÛÌfi Ù˘ ηٷӿψÛ˘ ·ÏÎÔfiÏ

Bone mineral density before and during treatment with a LHRH analog Triptoreline (3.75 mg) in children with central precocious puberty P. Zosi, D. Karakaidos, G. Triantafyllidis, G. Ouzouni, S. Pizanias, C. Karis

π. •˘ÓÈ¿˜, µ. ¢ÂÌÂÚÙ˙›‰Ô˘, ∂. ∫·Ú·Ù˙¿, Ã. ¶·ÓÙÂÏÈ¿‰Ë˜, ∫. ™‡ÚÔÁÏÔ˘

ªÂϤÙË ·È‰ÈÎÔ‡ ‚ÚÔÁ¯ÈÎÔ‡ ¿ÛıÌ·ÙÔ˜ ÛÙËÓ ÂÚÈÔ¯‹ Ù˘ ™ËÙ›·˜

Primary ciliary dyskinesia: clinical features diagnostic approach and management R. Valeri, I.N. Tsanakas

Eƒ∂À¡∏∆π∫∂™ ∂ƒ°∞™π∂™

ÃÔÚ‹ÁËÛË ·ÓÙÈ·Ó·ÁˆÁÈÎÔ‡ Á¿Ï·ÙÔ˜ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ‹È·˜ Î·È Ì¤ÙÚÈ·˜ Á·ÛÙÚÔÔÈÛÔÊ·ÁÈ΋˜ ·ÏÈÓ‰ÚfiÌËÛ˘ Û ‚Ú¤ÊË

Long-term outcome of premature infants A. Manoura, Ch. Giannakopoulou

ƒ. µ·ÏÂÚ‹, π.¡. ∆۷ӿη˜

∏ ÔÛÙÈ΋ ˘ÎÓfiÙËÙ· ÚÈÓ Î·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ıÂÚ·›·˜ Ì ÙÔ Û˘ÓıÂÙÈÎfi ·Ó¿ÏÔÁÔ Triptoreline (3,75 mg) Û ·È‰È¿ Ì ÎÂÓÙÚÈ΋ ÚÒÈÌË ‹‚Ë

Genetic syndromes associated with obesity

CASE REPORTS 439

Acinic cell carcinoma of the parotid gland: a case report

£. ¡ÙfiÏ·Ù˙·˜, ∞. ∞Ú‚ÂÏ¿Î˘, ∞. ∫·ÌÔ‡ÚË, °. ÷ÚÌ¿Ó˘, ∞. ¶·Ó·Á›‰Ë˜, π. ∞ÏÂÍ¿Ó‰ÚÔ˘, ¡. §·˚Ó¿Î˘, ™. ª·ÚÌ·Á·‰¿ÎË

Th. Dolatzas, A. Arvelakis, A. Kambouri, G. Harmanis, A. Panagidis, I. Alexandrou, N. Lainakis, S. Barbagadaki

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

Continuation of table of contents inside title page

¡ovember - December 2002 . Volume 65 . No 6

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14-05-03

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¡Ô¤Ì‚ÚÈÔ˜ - ¢ÂΤ̂ÚÈÔ˜ 2002 . ∆fiÌÔ˜ 65 . ∆‡¯Ô˜ 6

™˘Ó¤¯ÂÈ· ÂÚȯÔ̤ӈÓ

™‡Ó‰ÚÔÌÔ Swyer-James (Mac Leod): Û¿ÓÈ· ÂÈÏÔ΋ Û ‚Ú¤ÊÔ˜ ÌÂÙ¿ Ïԛ̈ÍË ·fi ÎÔηÙË

Continuation of table of contents

442

G. Trimis, M. Theodoridou, G. Mostrou, K. Kakavakis

°. ∆Ú›Ì˘, ª. £ÂÔ‰ˆÚ›‰Ô˘, °. ªÔÛÙÚÔ‡, ∫. ∫·Î·‚¿Î˘

µÈÔ¯ËÌÈ΋ ‰È¿ÁÓˆÛË Û˘Ó‰ÚfiÌÔ˘ Smith Lemli Opitz

447

CURRENT ISSUES

∂¶π∫∞πƒ∞ £∂ª∞∆∞ 452

Pediatrician’s role in recognizing attention deficit hyperactivity disorder M. Tzenaki, E. Karakonstadaki, M. Linardakis, S. Micheloyannis

ª. ∆˙ÂÓ¿ÎË, ∂. ∫·Ú·ÎˆÓÛÙ·ÓÙ¿ÎË, ª. §ÈÓ·Ú‰¿Î˘, ™. ªÈ¯ÂÏÔÁÈ¿ÓÓ˘

AWARD-WINNING ARTICLE

µƒ∞µ∂Àª∂¡∏ ∂ƒ°∞™π∞ ∞ÓÔÛÔÊ·ÈÓÔÙ˘È΋ ÌÂϤÙË ÙˆÓ ·ÈÌ·ÙÔÁÔÓ›ˆÓ Î·È ‰È·ÌfiÚʈÛË ÛÙÚ·ÙËÁÈ΋˜ ÁÈ· ÙËÓ ·Ó·˙‹ÙËÛË Ù˘ ÂÏ¿¯ÈÛÙ˘ ˘ÔÏÂÈfiÌÂÓ˘ ÓfiÛÔ˘ Û ·È‰È¿ Ì ‚-΢ÙÙ·ÚÈ΋˜ ÚÔ¤Ï¢Û˘ ÔÍ›· ÏÂÌÊÔ‚Ï·ÛÙÈ΋ Ï¢¯·ÈÌ›· (µ-O§§) ηٿ ÙȘ Ê¿ÛÂȘ ıÂÚ·›·˜ ÙÔ˘ ÚˆÙÔÎfiÏÏÔ˘ ALL-BFM ’95

Biochemical diagnosis of Smith Lemli Opitz syndrome A. Andreou, M. Goudesidou, V. Papavasiliou, X. Sarantari

∞. ∞Ó‰Ú¤Ô˘, ª. °Ô˘‰ÂÛ›‰Ô˘, µ. ¶··‚·ÛÈÏ›Ԣ, Ã. ™·Ú·ÓÙ¿ÚË

O ÚfiÏÔ˜ ÙÔ˘ ·È‰È¿ÙÚÔ˘ ÛÙËÓ ·Ó›¯Ó¢ÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ÂÏÏÂÈÌÌ·ÙÈ΋˜ ÚÔÛÔ¯‹˜ Ì ˘ÂÚÎÈÓËÙÈÎfiÙËÙ·

Swyer-James (Mac Leod) syndrome: a rare complication in an infant following pertussis infection

463

Immunophenotypic study of calla positive B lymphoid progenitors (hematogones) in children’s marrow enables the formulation of a strategy for the assessment of minimal residual disease (MRD) in B-cell precursor acute lymphoblastic leukemia (B prec-ALL), during the intensive treatment of ALL-BFM ’95 protocol S. Polychronopoulou, G. Paterakis, V. Rouli, D. Skoumi, J.P. Panagiotou, S.A. Haidas

™. ¶ÔÏ˘¯ÚÔÓÔÔ‡ÏÔ˘, °. ¶·ÙÂÚ¿Î˘, µ. ƒÔ‡ÏË, ¢. ™ÎÔ˘Ì‹, π.¶. ¶·Ó·ÁÈÒÙÔ˘, ™.∞. ÷˚‰¿˜

∫ÚÈÙ¤˜ ÙÔ˘ ÙfiÌÔ˘ 65

482

Reviewers of Manuscripts, Volume 65

∂˘ÚÂÙ‹ÚÈÔ ™˘ÁÁڷʤˆÓ ÙÔ˘ ÙfiÌÔ˘ 65

483

Author Index, Volume 65

§¤ÍÂȘ ÎÏÂȉȿ ÙÔ˘ ÙfiÌÔ˘ 65

486

Subject Index, Volume 65

™˘Ó¯›˙ÔÓÙ·È

Continued

November - December 2002 . Volume 65 . No 6

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¡Ô¤Ì‚ÚÈÔ˜ - ¢ÂΤ̂ÚÈÔ˜ 2002 . ∆fiÌÔ˜ 65 . ∆‡¯Ô˜ 6

™˘Ó¤¯ÂÈ· ÂÚȯÔ̤ӈÓ

Continuation of table of contents

¶∂ƒπ§∏æ∂π™ ∞ƒ£ƒø¡ ∞¶O ∆∏ µπµ§πO°ƒ∞ºπ∞ ∏ ıÂÚ·›· ÙˆÓ ·È‰ÈÒÓ Ì ÔÍ›· ˘ÂÏÔÓÂÊÚ›Ùȉ·: Ì›· ÚÔ‰ÚÔÌÈ΋, Ù˘¯·ÈÔÔÈË̤ÓË ÌÂϤÙË

LITERATURE ABSTRACTS 418

Levtchenko E, Lahy C, Levy J, Ham H, Piepsz A ∞fi‰ÔÛË ÛÙ· ∂ÏÏËÓÈο: ™ÙÂÊ·Ó›‰Ë˜ ∫.π.

¶ÚÒÈÌÔÈ ‰È·ÁÓˆÛÙÈÎÔ› ‰Â›ÎÙ˜ ÓÂÔÁÓÈ΋˜ Û‹„˘: Û‡ÁÎÚÈÛË C-·ÓÙȉÚÒÛ·˜ ÚˆÙ½Ó˘, ÈÓÙÂÚÏ¢ΛÓ˘-6, ˘‰·ÙÔ‰È·Ï˘ÙÒÓ ˘Ô‰Ô¯¤ˆÓ ÙÔ˘ ·Ú¿ÁÔÓÙ· Ó¤ÎÚˆÛ˘ ÙˆÓ fiÁÎˆÓ Î·È ÙˆÓ ˘‰·ÙÔ‰È·Ï˘ÙÒÓ ÌÔÚ›ˆÓ ÚÔÛÎfiÏÏËÛ˘

Levtchenko E, Lahy C, Levy J, Ham H, Piepsz A Greek translation: Stefanidis CJ 432

Dollner H, Vatten L, Austgulen R ∞fi‰ÔÛË ÛÙ· ∂ÏÏËÓÈο: ºˆÙfiÔ˘ÏÔ˜ ™.

∏ ÓÂÊÚÔ¿ıÂÈ· Ù˘ ΢ÛÙÂÔÔ˘ÚËÙËÚÈ΋˜ ·ÏÈÓ‰ÚfiÌËÛ˘ ÛÙ· ·È‰È¿

Treatment of children with acute pyelonephritis: a prospective randomized study

Early diagnostic markers for neonatal sepsis: comparing C-reactive protein, interleukin-6, soluble tumour necrosis factor receptors and soluble adhesion molecules Dollner H, Vatten L, Austgulen R Greek translation: Fotopoulos S.

446

Reflux nephropathy in children

Stefanidis CJ

Stefanidis CJ

∞fi‰ÔÛË ÛÙ· ∂ÏÏËÓÈο: ™ÙÂÊ·Ó›‰Ë˜ ∫.π.

Greek translation: Stefanidis CJ

ªÂϤÙË Ù˘ ηډȷ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ Û ·ÛıÂÓ›˜ Ì ÔÛÙÈÎÔ‡˜ fiÁÎÔ˘˜ Î·È Ì·ÎÚ¿ ÂÈ‚›ˆÛË Ì¤¯ÚÈ Î·È 19 ¯ÚfiÓÈ· ÌÂÙ¿ ·fi ıÂÚ·›· Ì Doxorubicin: Ì›· ‰È·¯ÚÔÓÈ΋ ÌÂϤÙË

451

Postma A, Elzenga NJ, Haaksma J, Schasfoort-Van Leeuwen MJM, Kamps WA, Bink-Boelkens MTE ∞fi‰ÔÛË ÛÙ· ∂ÏÏËÓÈο: ¶ÔÏ˘¯ÚÔÓÔÔ‡ÏÔ˘ ™.

∞˘ÙÔ·ÓÙÈÛÒÌ·Ù· Û¯ÂÙÈ˙fiÌÂÓ· Ì ÙÔ Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË Ù‡Ô˘ π Î·È ·È‰È΋ ·˘ÙÔ¿ÓÔÛË Ë·Ù›Ùȉ·

Cardiac status in bone tumor survivors up to nearly 19 years after treatment with Doxorubicin: a longitudinal study Postma A, Elzenga NJ, Haaksma J, Schasfoort-Van Leeuwen MJM, Kamps WA, Bink-Boelkens MTE Greek translation: Polychronopoulou S.

481

da Silva ME, Porta G, Golberg AC, Bittencourt PL, Fukui RT, Correia MR et al ∞fi‰ÔÛË ÛÙ· ∂ÏÏËÓÈο: ƒÔ‡ÛÛÔ ÿ.

Diabetes mellitus-related autoantibodies in childhood autoimmune hepatitis da Silva ME, Porta G, Golberg AC, Bittencourt PL, Fukui RT, Correia MR et al Greek translation: Rousso I.

¶ÚÔÛ¯‹ ™˘Ó¤‰ÚÈ·

xiii

Scheduled Medical Meetings

™˘ÓÙÔÌÔÁڷʛ˜

xvii

Abbreviations

November - December 2002 . Volume 65 . No 6

NoV-dEc-02

14-05-03

14:25

™ÂÏ›‰·3

¡Ô¤Ì‚ÚÈÔ˜ - ¢ÂΤ̂ÚÈÔ˜ 2002

. ∆fiÌÔ˜

65

. ∆‡¯Ô˜

6

¢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

I‰ÈÔÎÙ‹Ù˘© EÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ EÙ·ÈÚ›· Mȯ·Ï·ÎÔÔ‡ÏÔ˘ 92 Aı‹Ó·È 115 28

Owner© Hellenic Paediatric Society Michalakopoulou 92 Athens 115 28

TËÏ.: 210-7771 140 / 210-7771 663, Fax: 210-7758 354

Tel.: 210-7771 140 / 210-7771 663, Fax: 210-7758 354

EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ¶Úfi‰ÚÔ˜ : ∞. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜ ¢È¢ı˘ÓÙ‹˜ : ™. ÷˚‰¿˜ M¤ÏË : º. Aı·Ó·ÛÈ¿‰Ô˘-¶ÈÂÚÔÔ‡ÏÔ˘ : °. µ·ÚÏ¿Ì˘ : ª. ∏Ï›· : π. ¶··‰¿ÙÔ˜ : ¡. ¶··‰fiÔ˘ÏÔ˜ : ™. ¶ÔÏ˘¯ÚÔÓÔÔ‡ÏÔ˘ : ∫. ¶ÚÔ‡ÓÙ˙Ô˘-∫·ÛÛÈÔ‡ : ∫. ™ÙÂÊ·Ó›‰Ë˜ : ª. ∆ÛÔÏÈ¿ : ™. ºˆÙfiÔ˘ÏÔ˜

Scientific President Editor Members

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

Manuscript Editing

∞ÏÏËÏÔÁÚ·Ê›· ∂ÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ ∂Ù·ÈÚ›· ªÈ¯·Ï·ÎÔÔ‡ÏÔ˘ 92 ∞ı‹Ó·È 115 28 ∆ËÏ: 210-7771 140 / 210-7771 663, Fax: 210-7758 354

Correspondence Hellenic Paediatric Society Michalakopoulou 92 Athens 115 28 Tel: 210-7771 140 / 210-7771 663, Fax: 210-7758 354

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Editorial Board : A. Constantopoulos : S. Haidas : F. Athanassiadou-Piperopoulou : G. Varlamis : M. Ilia : I. Papadatos : N. Papadopoulos : S. Polychronopoulou : K. Prountzou-Kassiou : C. Stefanidis : M. Tsolia : S. Fotopoulos

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November-December 2002 . Volume 65 . No 6

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14:25

™ÂÏ›‰·5

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 (21x29.7 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˘.

v

NoV-dEc-02

14-05-03

14:25

™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

vi

‚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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™˘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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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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Paediatriki 2002;65:387-393

REVIEW ARTICLE

°ÂÓÂÙÈΤ˜ ÌÔÚʤ˜ ·¯˘Û·ÚΛ·˜ ÛÙËÓ ·È‰È΋ ËÏÈΛ· Ã. °. ÷Ù˙Ë·ı·Ó·Û›Ô˘, Ã. £ÂÔ‰ˆÚ›‰Ë˜

Genetic syndromes associated with obesity C. G. Hadjiathanasiou, C. Theodoridis

¶ÂÚ›ÏË„Ë: ∏ ·¯˘Û·ÚΛ· ·ÔÙÂÏ› ÎÔÈÓ‹ ÂΉ‹ÏˆÛË ‰È·ÊfiÚˆÓ ÁÂÓÂÙÈÎÒÓ Û˘Ó‰ÚfïÓ, fiˆ˜ ÙÔ Û‡Ó‰ÚÔÌÔ Prader-Willi, ÙÔ Û‡Ó‰ÚÔÌÔ Bardet-Biedl, Ô „¢‰Ô¸Ô·Ú·ı˘ÚÂÔÂȉÈÛÌfi˜ Ù‡Ô˘ Ia, ηıÒ˜ Î·È ¿ÏÏˆÓ Û·ÓÈfiÙÂÚˆÓ Û˘Ó‰ÚfïÓ. OÈ ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ˘Ôı·Ï·ÌÔ-˘ÔÊ˘ÛÈ·ÎÔ‡ ¿ÍÔÓ· ıˆÚÔ‡ÓÙ·È Èı·Ó¤˜ ·Èٛ˜ ÔÚÈÛÌ¤ÓˆÓ ·fi Ù· Û‡Ó‰ÚÔÌ· ·˘Ù¿, Ô ·ÎÚÈ‚‹˜ fï˜ ·ıÔÊ˘ÛÈÔÏÔÁÈÎfi˜ Ì˯·ÓÈÛÌfi˜ Ù˘ ·¯˘Û·ÚΛ·˜ ‰ÂÓ ¤¯ÂÈ Ï‹Úˆ˜ ‰È¢ÎÚÈÓÈÛÙ›. ∏ ¯ÚˆÌÔÛˆÌÈ΋ ÂÓÙfiÈÛË Â›Ó·È ÁÓˆÛÙ‹ Û ÔÏÏ¿ ·fi ·˘Ù¿, ÔÈ ÌÂϤÙ˜ fï˜ ÁÈ· ÙËÓ Ù·˘ÙÔÔ›ËÛË ÙˆÓ ˘‡ı˘ÓˆÓ ÁÔÓȉ›ˆÓ Û˘Ó¯›˙ÔÓÙ·È. ∏ ‰ÈÂÚ‡ÓËÛË Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ ÙˆÓ ÁÔÓȉ›ˆÓ ·˘ÙÒÓ ı· Û˘ÓÙ›ÓÂÈ ÛÙË ‰È·Ï‡ηÓÛË ÙÔ˘ Ì˯·ÓÈÛÌÔ‡ Ù˘ fiÚÂ͢, ÙÔ˘ ÎÔÚÂÛÌÔ‡ Î·È Ù˘ ·¯˘Û·ÚΛ·˜ ÛÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi. ™ÙËÓ ÂÚÁ·Û›· ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ù· ÙÂÏÂ˘Ù·›· ÎÏÈÓÈο Î·È ÁÂÓÂÙÈο ‰Â‰Ô̤ӷ, Ù· ÔÔ›· ·ÊÔÚÔ‡Ó Ù· Û‡Ó‰ÚÔÌ· Ì ÂΉ‹ÏˆÛË ·¯˘Û·ÚΛ·˜ ÛÙËÓ ·È‰È΋ ËÏÈΛ·.

Abstract: Obesity occurs in several genetic disorders, including Prader-Willi syndrome, BardetBiedl syndrome, type 1a pseudohypoparathyroidism, as well as some more rare disorders.

The chromosomal location of many of these syndromes is known and studies are ongoing to identify the responsible genes. Further delineation of the functions of the underlying genes will likely be instructive regarding mechanisms of appetite, satiety and obesity in the general population. This paper details current knowledge of the clinical and genetic findings of genetic syndromes associated with obesity.

§¤ÍÂȘ ÎÏÂȉȿ: Û‡Ó‰ÚÔÌÔ Prader-Willi, Û‡Ó‰ÚÔÌÔ Bardet-Biedl, „¢‰Ô¸Ô·Ú·ı˘ÚÂÔÂȉÈÛÌfi˜, ·¯˘Û·ÚΛ·, ÁÂÓÂÙÈ΋.

Key words: Prader-Willi syndrome, Bardet-Biedl syndrome, pseudohypoparathyroidism, obesity, genetics.

™˘ÓÙÔÌÔÁڷʛ˜

∂ÈÛ·ÁˆÁ‹ ∏ ·È‰È΋ ·¯˘Û·ÚΛ· ·ÔÙÂÏ› ¤Ó· ·fi Ù· ÈÔ ÂÚ›ÏÔη ÎÏÈÓÈο Û‡Ó‰ÚÔÌ· ÛÙËÓ ·È‰È·ÙÚÈ΋ Ú¿ÍË. ∂›Ó·È ÁÓˆÛÙfi fiÙÈ ÁÂÓÂÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ‰È·‰Ú·Ì·Ù›˙Ô˘Ó ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ÂΉ‹ÏˆÛË Ù˘

·¯˘Û·ÚΛ·˜, ˘¿Ú¯Ô˘Ó fï˜ Û˘ÁÎÂÎÚÈ̤ӷ ÁÂÓÂÙÈο Û‡Ó‰ÚÔÌ·, ÛÙ· ÔÔ›· Ë ·¯˘Û·ÚΛ· ·ÔÙÂÏ› ÎÔÈÓ‹ ÂΉ‹ÏˆÛË, ÏfiÁˆ ‰È·Ù·Ú·¯ÒÓ ÙÔ˘ ÂÓÂÚÁÂÈ·ÎÔ‡ ÈÛÔ˙˘Á›Ô˘, fiˆ˜ ÙÔ Û‡Ó‰ÚÔÌÔ Prader-Willi, ÙÔ Û‡Ó‰ÚÔÌÔ Bardet-Biedl, Ô „¢‰Ô¸Ô·Ú·ı˘ÚÂÔÂȉÈÛÌfi˜ Ù‡Ô˘ πa Î·È ¿ÏÏ· Û·ÓÈfiÙÂÚ· Û‡Ó‰ÚÔÌ·. ∏ ¯ÚˆÌÔÛˆÌÈ΋ ÂÓÙfiÈÛË ÔÏÏÒÓ ·fi Ù· Û‡Ó‰ÚÔÌ· ·˘Ù¿ Â›Ó·È ÁÓˆÛÙ‹, ··ÈÙÂ›Ù·È fï˜ ÂÚ·ÈÙ¤Úˆ ¤Ú¢ӷ ÁÈ· ÙËÓ Ù·˘ÙÔÔ›ËÛË ÙˆÓ ˘‡ı˘ÓˆÓ ÁÔÓ›‰ÈˆÓ, Ë ÔÔ›· ı· ÌÔÚÔ‡Û ӷ Û˘Ì‚¿ÏÂÈ ÛÙË ‰È·Ï‡ηÓÛË Ù˘ ·ıÔÊ˘ÛÈÔÏÔÁ›· Ù˘ ·¯˘Û·ÚΛ·˜,

∂Ó‰ÔÎÚÈÓÔÏÔÁÈÎfi ∆Ì‹Ì·, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó·

Department of Endocrinology, “P. & A. Kyriakou” Children’s Hospital, Athens

PWS BBS PHP PTH

™‡Ó‰ÚÔÌÔ Prader-Willi ™‡Ó‰ÚÔÌÔ Bardet-Biedl 梉ԸÔ·Ú·ı˘ÚÂÔÂȉÈÛÌfi˜ ¶·Ú·ıÔÚÌfiÓË

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ÙfiÛÔ ÛÙËÓ ·È‰È΋ ËÏÈΛ· fiÛÔ Î·È ÛÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi. ∆· ΢ÚÈfiÙÂÚ· ÁÂÓÂÙÈο Û‡Ó‰ÚÔÌ· Ì ÂΉ‹ÏˆÛË ·¯˘Û·ÚΛ·˜ ÛÙËÓ ·È‰È΋ ËÏÈΛ· Â›Ó·È ÙÔ Û‡Ó‰ÚÔÌÔ Prader-Willi, ÙÔ Û‡Ó‰ÚÔÌÔ Bardet-Biedl, Ô „¢‰Ô¸Ô·Ú·ı˘ÚÂÔÂȉÈÛÌfi˜ Ù‡Ô˘ Ia, ÙÔ Û‡Ó‰ÚÔÌÔ Alstrom, ÙÔ Û‡Ó‰ÚÔÌÔ Carpenter Î·È ÙÔ Û‡Ó‰ÚÔÌÔ Cohen. ™‡Ó‰ÚÔÌÔ Prader-Willi ∆Ô Û‡Ó‰ÚÔÌÔ Prader-Willi (PWS) ·ÔÙÂÏ› ÙË Û˘¯ÓfiÙÂÚË ÁÂÓÂÙÈ΋ ÌÔÚÊ‹ ·¯˘Û·ÚΛ·˜. ∏ Û˘¯ÓfiÙËÙ¿ ÙÔ˘ ˘ÔÏÔÁ›˙ÂÙ·È Û 1/10000-15000 (1). ¶ÚfiÎÂÈÙ·È ÁÈ· Ì›· ÔÏ˘Û˘ÛÙËÌ·ÙÈ΋ ‰È·Ù·Ú·¯‹, Ë ÔÔ›· ÚÔÛ‚¿ÏÏÂÈ Î˘Ú›ˆ˜ ÙÔ ÎÂÓÙÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ·, Ì ȉȷ›ÙÂÚË ÂÓÙfiÈÛË ÛÙÔÓ ˘Ôı¿Ï·ÌÔ (1,2). ∫ÏÈÓÈ΋ ÂÈÎfiÓ· ∆· ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ PWS ÂΉËÏÒÓÔÓÙ·È Û 4 ÛÙ¿‰È·, ·Ó¿ÏÔÁ· Ì ÙËÓ ËÏÈΛ· (3,4): ·) ∂Ì‚Ú˘˚Îfi Î·È ÓÂÔÁÓÈÎfi ÛÙ¿‰ÈÔ. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÌ‚Ú˘˚΋˜ ˙ˆ‹˜, Ë ÎÈÓËÙÈÎfiÙËÙ· ÙÔ˘ ÂÌ‚Ú‡Ô˘ Â›Ó·È ÌÂȈ̤ÓË. ∫·Ù¿ ÙË ÓÂÔÁÓÈ΋ ËÏÈΛ·, Ù· ·È‰È¿ Â›Ó·È ˘ÔÙÔÓÈο Î·È ·ÚÔ˘ÛÈ¿˙Ô˘Ó ‰È·Ù·Ú·¯¤˜ Û›ÙÈÛ˘, Ì ·ÔÙ¤ÏÂÛÌ· Ó· ··ÈÙÂ›Ù·È ÙÔÔı¤ÙËÛË ÚÈÓÔÁ·ÛÙÚÈÎÔ‡ ηıÂÙ‹Ú·. ∏ ˘ÔÙÔÓ›· ·ÊÔÚ¿ ΢ڛˆ˜ ÛÙÔÓ ÙÚ¿¯ËÏÔ, ÂÓÒ Ù· ̤ÏË ¤¯Ô˘Ó Ê˘ÛÈÔÏÔÁÈÎfi ÙfiÓÔ ‹ Ï·Ì‚¿ÓÔ˘Ó ‰˘ÛÙÔÓÈΤ˜ ı¤ÛÂȘ (∂ÈÎfiÓ· 1). ∆Ô ÎÏ¿Ì· Â›Ó·È ·ÛıÂÓ¤˜ ‹ ·Ô˘ÛÈ¿˙ÂÈ. ∆Ô Û¿ÏÈÔ Â›Ó·È ÎÔÏÏ҉˜. ™Ù· ·ÁfiÚÈ· Û˘¯Ó¿ ·Ú·ÙËÚÂ›Ù·È ˘ÔÏ·Û›· ÙÔ˘ ÔÛ¯¤Ô˘, ÎÚ˘„ÔÚ¯›· Î·È ÌÈÎÚfi ¤Ô˜, ÂÓÒ ÛÙ· ÎÔÚ›ÙÛÈ· Ë ˘ÔÏ·Û›· ÙˆÓ ÁÂÓÓËÙÈÎÒÓ ÔÚÁ¿ÓˆÓ ‡ÎÔÏ· ÌÔÚ› Ó· ‰È·Ê‡ÁÂÈ Ù˘ ÚÔÛÔ¯‹˜. ‚) ™Ù¿‰ÈÔ ‚ÚÂÊÈ΋˜ Î·È ÚÒÙ˘ ·È‰È΋˜ ËÏÈΛ·˜. ™ÙÔ ÛÙ¿‰ÈÔ ·˘Ùfi ·Ú·ÙËÚÂ›Ù·È ‚ÂÏÙ›ˆÛË Ù˘ ˘ÔÙÔÓ›·˜, ÂÍ·ÎÔÏÔ˘ı› fï˜ Ó· ˘¿Ú¯ÂÈ ‰˘ÛÎÔÏ›· ÛÙË Û›ÙÈÛË, Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·ÓÂ·Ú΋ ÚfiÛÏË„Ë ‚¿ÚÔ˘˜. ¶·Ú·ÙËÚ›ٷÈ, Â›Û˘, ηı˘ÛÙ¤ÚËÛË „˘¯ÔÎÈÓËÙÈ΋˜ ·Ó¿Ù˘Í˘, Ë ÔÔ›· ·ÊÔÚ¿

Paediatriki 2002;65:387-393

΢ڛˆ˜ ÛÙËÓ ·‰Ú‹ ÎÈÓËÙÈÎfiÙËÙ· Î·È ÙËÓ ÔÌÈÏ›·. ∫·Ù¿ ÙË Ê¿ÛË ·˘Ù‹ Á›ÓÂÙ·È ÂÌÊ·Ó¤˜ ÙÔ Ù˘ÈÎfi ÚÔÛˆÂ›Ô ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘, ÙÔ ÔÔ›Ô ÂÚÈÏ·Ì‚¿ÓÂÈ ÛÙÂÓfi ÚfiÛˆÔ ‹ ÛÙÂÓ‹ ÌÂÙˆÈ·›· ‰È¿ÌÂÙÚÔ, ·Ì˘Á‰·ÏˆÙfi Û¯‹Ì· ‚ÏÂÊ·ÚÈÎÒÓ Û¯ÈÛÌÒÓ, ÌÈÎÚfi ÛÙfiÌ· Ì ÏÂÙfi ¿Óˆ ¯Â›ÏÔ˜ Î·È ÙÒÛË Ù˘ ÁˆÓ›·˜ ÙÔ˘ ÛÙfiÌ·ÙÔ˜ (∂ÈÎfiÓ· 2). ∂›Û˘, ÔÈ ·ÛıÂÓ›˜ ¤¯Ô˘Ó Û˘Ó‹ıˆ˜ ·ÓÔȯÙfi¯ÚˆÌÔ ‰¤ÚÌ· Î·È Ì·ÏÏÈ¿, Á·Ï¿˙È· Ì¿ÙÈ·, ηıÒ˜ Î·È ÌÈÎÚ¿ ¯¤ÚÈ· Î·È fi‰È·. Á) ™Ù¿‰ÈÔ ·È‰È΋˜ ËÏÈΛ·˜. ÷ڷÎÙËÚ›˙ÂÙ·È ·fi ÂÓÙÔÓfiÙ·ÙË ˘ÂÚÊ·Á›·, Ë ÔÔ›· Ô‰ËÁ› Û ·Ó¿Ù˘ÍË ·¯˘Û·ÚΛ·˜ Û ËÏÈΛ· 1-6 ÂÙÒÓ. ∏ ˘ÂÚÊ·Á›· ÔÊ›ÏÂÙ·È Û ˘Ôı·Ï·ÌÈ΋ ·ÓˆÌ·Ï›·, Ô˘ ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·Ô˘Û›· ÙÔ˘ ·ÈÛı‹Ì·ÙÔ˜ ÙÔ˘ ÎÔÚÂÛÌÔ‡. ∆· ·È‰È¿ ·Ó·˙ËÙÔ‡Ó Â›ÌÔÓ· Ê·ÁËÙfi Î·È ‰ÂÓ Â›Ó·È Û¿ÓȘ ÔÈ ÂÚÈÙÒÛÂȘ Ô˘ ηٷӷÏÒÓÔ˘Ó ÙÚÔʤ˜ ·fi Ù· ÛÎÔ˘›‰È·, ÙËÓ Î·Ù¿„˘ÍË ‹ ÁÈ· ηÙÔÈΛ‰È· ˙Ò·. ∏ ·¯˘Û·ÚΛ· Â›Ó·È ÎÂÓÙÚÈÎÔ‡ Ù‡Ô˘. ¶·Ú·ÙËÚÂ›Ù·È Ù¿ÛË ÂÓ·fiıÂÛ˘ Ï›Ô˘˜ ÛÙËÓ ÎÔÈÏÈ¿, ÙÔ˘˜ ÁÏÔ˘ÙÔ‡˜ Î·È ÙÔ˘˜ ÌËÚÔ‡˜, ·ÎfiÌË Î·È Û ·ÛıÂÓ›˜ Ô˘ ‰ÂÓ Â›Ó·È ·¯‡Û·ÚÎÔÈ. ∏ ·¯˘Û·ÚΛ· ·ÔÙÂÏ› ÙËÓ Î‡ÚÈ· ·ÈÙ›· ÓÔÛËÚfiÙËÙ·˜ Î·È ıÓËÛÈÌfiÙËÙ·˜ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì PWS, ÔÈ ÔÔ›ÔÈ Û ÌÂÙ·ÁÂÓ¤ÛÙÂÚ· ÛÙ¿‰È· ÌÔÚÔ‡Ó Ó· ÂÌÊ·Ó›ÛÔ˘Ó Î·Ú‰ÈÔÓ¢ÌÔÓÈΤ˜ ÂÈÏÔΤ˜, ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË Ù‡Ô˘ ππ, ˘¤ÚÙ·ÛË, ıÚÔÌ‚ÔÊÏ‚›Ùȉ· Î·È ¯ÚfiÓÈ· Ôȉ‹Ì·Ù· ÙˆÓ Î¿Ùˆ ¿ÎÚˆÓ. ™ÙÔ ÛÙ¿‰ÈÔ ·˘Ùfi ÂÌÊ·Ó›˙ÔÓÙ·È ‰È·Ù·Ú·¯¤˜ Û˘ÌÂÚÈÊÔÚ¿˜, Ì ÂÎÚ‹ÍÂȘ ÔÚÁ‹˜ ÛÙËÓ ÚÔÛ¿ıÂÈ· ÙˆÓ ÁÔÓ¤ˆÓ Ó· ÂÏ·ÙÙÒÛÔ˘Ó ÙÔ Ê·ÁËÙfi. ¶·Ú·ÙËÚ›ٷÈ, Â›Û˘, Û˘¯Ó¿ Ù¿ÛË ·˘ÙÔÙÚ·˘Ì·ÙÈÛÌÔ‡ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜, Ë ÔÔ›· ÂȉÂÈÓÒÓÂÙ·È ·ÚÁfiÙÂÚ· ÏfiÁˆ ÌÂȈ̤Ó˘ ¢·ÈÛıËÛ›·˜ ÛÙÔÓ fiÓÔ Î·È ÌÔÚ› Ó· ÂÌ‚¿ÏÂÈ Û ˘Ô„›· ηÎÔÔ›ËÛ˘ ÙÔ˘ ·È‰ÈÔ‡. ∆· ·È‰È¿ ÂÌÊ·Ó›˙Ô˘Ó, Â›Û˘, Û˘¯Ó¿ ‰È·Ù·Ú·¯¤˜ Ù˘ ÚfiÛÊ·Ù˘ ÌÓ‹Ì˘. §fiÁˆ ÙÔ˘

™ÙÂÓ‹ ÌÂÙˆÈ·›· ‰È¿ÌÂÙÚÔ˜ ∞Ì˘Á‰·ÏˆÙ¿ Ì¿ÙÈ·

§ÂÙfi ¿Óˆ ¯Â›ÏÔ˜ ¶ÙÒÛË ÁˆÓ›·˜ ÙÔ˘ ÛÙfiÌ·ÙÔ˜

∂ÈÎfiÓ· 1. ÀÔÙÔÓ›· Û ‚Ú¤ÊÔ˜ Ì ۇӉÚÔÌÔ Prader-Willi.

388

∂ÈÎfiÓ· 2. ÷ڷÎÙËÚÈÛÙÈÎfi ÚÔÛˆÂ›Ô ·È‰ÈÔ‡ Ì ۇӉÚÔÌÔ Prader-Willi.

NoV-dEc-02

14-05-03

14:25

™ÂÏ›‰·389

¶·È‰È·ÙÚÈ΋ 2002;65:387-393

·¯‡ÚÚ¢ÛÙÔ˘ Û¿ÏÈÔ˘, Û˘¯Ó‹ Â›Ó·È Ë ·ÚÔ˘Û›· ÙÂÚˉfiÓ·˜ ÙˆÓ ÓÂÔÁÈÏÒÓ ‰ÔÓÙÈÒÓ. ∫·Ù¿ ÙË Û¯ÔÏÈ΋ ÂÚ›Ô‰Ô, ÂÌÊ·Ó›˙ÂÙ·È Î·ı˘ÛÙ¤ÚËÛË ÛˆÌ·ÙÈ΋˜ ·Ó¿Ù˘Í˘, ÂÓÒ ÙÔ ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÚÔÛˆ›Ô, Ë ·¯˘Û·ÚΛ· Î·È Ë ˘ÔÏ·Û›· ÙˆÓ ÁÂÓÓËÙÈÎÒÓ ÔÚÁ¿ÓˆÓ Û˘ÌÏËÚÒÓÔ˘Ó ÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ· (∂ÈÎfiÓ· 3). ™ÙÔ ÛÙ¿‰ÈÔ ·˘Ùfi ÌÔÚ›, Â›Û˘, Ó· ÂÌÊ·ÓÈÛÙ› ÛÎÔÏ›ˆÛË, Ë ÔÔ›· ÂȉÂÈÓÒÓÂÙ·È Î·Ù¿ ÙËÓ ÂÊ˂›·. ‰) ∂ÊË‚ÈÎfi ÛÙ¿‰ÈÔ. ™ÙËÓ ÂÊ˂›· Á›ÓÔÓÙ·È ¤Î‰ËϘ ÔÈ ‰È·Ù·Ú·¯¤˜ Ù˘ Û˘ÌÂÚÈÊÔÚ¿˜ Î·È ÔÈ Ì·ıËÛȷΤ˜ ‰˘ÛÎÔϛ˜. ∂ÂÈÛfi‰È· ηٷÙÔÓ›·˜ Î·È „¢‰ÔÛ·ÛÌÒÓ ÌÔÚÔ‡Ó Ó· ÂÎÏËÊıÔ‡Ó ˆ˜ ÂÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ. ™˘¯Ó‹ Â›Ó·È Ë Î·ı˘ÛÙ¤ÚËÛË ÂÓ‹‚ˆÛ˘, Ë ÔÔ›· ÛÙ· ·ÁfiÚÈ· ¯ÚÂÈ¿˙ÂÙ·È Û˘Ó‹ıˆ˜ ·ÓÙÈÌÂÙÒÈÛË Ì ÙÂÛÙÔÛÙÂÚfiÓË. ∞ÈÙÈÔÏÔÁ›· Î·È ÁÂÓÂÙÈ΋ OÈ ÂÚÈÛÛfiÙÂÚ˜ ·fi ÙȘ ÂΉËÏÒÛÂȘ ÙÔ˘ PWS ÔÊ›ÏÔÓÙ·È Û ˘Ôı·Ï·ÌÈ΋ ·ÓÂ¿ÚÎÂÈ·, Ë ÔÔ›· ıˆÚÂ›Ù·È ÏÂÈÙÔ˘ÚÁÈ΋, ‰Â‰Ô̤ÓÔ˘ fiÙÈ ‰ÂÓ ¤¯Ô˘Ó ‚ÚÂı› ‰ÔÌÈΤ˜ ·ÓˆÌ·Ï›Â˜ ÛÙËÓ ÂÚÈÔ¯‹ (1,2).

∂ÈÎfiÓ· 3. ∆˘È΋ ÎÏÈÓÈ΋ ÂÈÎfiÓ· Û˘Ó‰ÚfiÌÔ˘ Prader-Willi Û ·ÁfiÚÈ ËÏÈΛ·˜ 11 ÂÙÒÓ.

Paediatriki 2002;65:387-393

ŸÛÔÓ ·ÊÔÚ¿ ÛÙË ÁÂÓÂÙÈ΋ ‚¿ÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘, ÛÙÔ 75% ÂÚ›Ô˘ ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÔÊ›ÏÂÙ·È Û ¤ÏÏÂÈÌÌ· ÂÚÈÔ¯‹˜ ÙÔ˘ ÂÁÁ‡˜ ÙÌ‹Ì·ÙÔ˜ ÙÔ˘ Ì·ÎÚÔ‡ ÛΤÏÔ˘˜ ÙÔ˘ ·ÙÚÈÎÔ‡ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ 15(q11q13) Î·È ÙËÓ ˆ˜ ÂÎ ÙÔ‡ÙÔ˘ ·Ô˘Û›· Ê˘ÛÈÔÏÔÁÈο ÂÓÂÚÁÒÓ ÁÔÓȉ›ˆÓ ·ÙÚÈ΋˜ ÚÔ¤Ï¢Û˘ (1,4,5). ∆· ·ÓÙ›ÛÙÔȯ· ÁÔÓ›‰È· ÌËÙÚÈ΋˜ ÚÔ¤Ï¢Û˘ Â›Ó·È Ê˘ÛÈÔÏÔÁÈο ·ÓÂÓÂÚÁ¿ (genetic imprinting). ™ÙȘ ˘fiÏÔÈ˜ ÂÚÈÙÒÛÂȘ ·Ú·ÙËÚÂ›Ù·È Û˘Ó‹ıˆ˜ ÌËÙÚÈ΋ ÌÔÓÔÁÔÓÂ˚΋ ‰Èۈ̛·, Ì ·ÚÔ˘Û›· ÙˆÓ ‰‡Ô ¯ÚˆÌÔÛˆÌ¿ÙˆÓ 15 Ù˘ ÌËÙ¤Ú·˜ (ÂÙÂÚÔ‰Èۈ̛·) ‹ ‰‡Ô ·ÓÙÈÁÚ¿ÊˆÓ ÙÔ˘ ÂÓfi˜ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ 15 Ù˘ ÌËÙ¤Ú·˜ (ÈÛÔ‰Èۈ̛·) (1,4,5). ™ÙÔ 5% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ·Ú·ÙËÚÂ›Ù·È ÌÂÙ¿ıÂÛË ‹ ¿ÏϘ ‰ÔÌÈΤ˜ ·ÓˆÌ·Ï›Â˜ ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ 15, ÔÈ Ôԛ˜ ¤¯Ô˘Ó ˆ˜ Û˘Ó¤ÂÈ· ¤ÏÏÂÈÌÌ· Ù˘ ÂȉÈ΋˜ ÂÚÈÔ¯‹˜ ÙÔ˘ PWS ‹ ÌËÙÚÈ΋ ÌÔÓÔÁÔÓÂ˚΋ ‰Èۈ̛·. ∆Ô ÚÒÙÔ ÁÔÓ›‰ÈÔ Ô˘ ¯·ÚÙÔÁÚ·Ê‹ıËΠÎÔÓÙ¿ ÛÙËÓ ÂȉÈ΋ ÂÚÈÔ¯‹ ÙÔ˘ PWS Â›Ó·È ÙÔ SNRP¡, ÙÔ ÔÔ›Ô ÂÎÊÚ¿˙ÂÙ·È ÌfiÓÔ ÛÙÔ ¯ÚˆÌfiۈ̷ 15 Ô˘ ÎÏËÚÔÓÔÌÂ›Ù·È ·fi ÙÔÓ ·Ù¤Ú· (1,4,5). ¢‡Ô ¿ÏÏ· ÁÔÓ›‰È·, ÙÔ IPW Î·È Nedcin, ÂÎÊÚ¿˙ÔÓÙ·È Â›Û˘ ÌfiÓÔ ÛÙÔ ¯ÚˆÌfiۈ̷ 15 ·ÙÚÈ΋˜ ÚÔ¤Ï¢Û˘ (4). ¢È¿ÁÓˆÛË Î·È ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ¶ÚÈÓ ·ÎfiÌË ·Ó·Ù˘¯ıÔ‡Ó Â˘·›ÛıËÙ˜ Î·È ÂȉÈΤ˜ ÂÚÁ·ÛÙËÚȷΤ˜ Ù¯ÓÈΤ˜ ÁÈ· ÙË ‰È¿ÁÓˆÛË ÙÔ˘ PWS, ηıÈÂÚÒıËÎ·Ó ÎÚÈÙ‹ÚÈ· (6), Ù· ÔÔ›· ¤¯Ô˘Ó ÚfiÛÊ·Ù· ÙÚÔÔÔÈËı› (1) Î·È ÂÍ·ÎÔÏÔ˘ıÔ‡Ó Ó· ¤¯Ô˘Ó ȉȷ›ÙÂÚË ‰È·ÁÓˆÛÙÈ΋ ·Í›·. ∆· ÎÚÈÙ‹ÚÈ· ·˘Ù¿ ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1. °È· ÙËÓ ÂȂ‚·›ˆÛË Ù˘ ‰È¿ÁÓˆÛ˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Ù¯ÓÈΤ˜ ÌÔÚȷ΋˜ ÁÂÓÂÙÈ΋˜ ·Ó¿Ï˘Û˘ (˘‚ÚȉÈÛÌfi˜ ηٿ Southern Î·È ÊıÔÚ›˙Ô˘Û· in situ ˘‚ÚȉÔÔ›ËÛË-FISH) ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô Ù˘ ÂȉÈ΋˜ ÂÚÈÔ¯‹˜ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ (4,5). ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ¤¯ÂÈ Î·Ù·ÛÙ› ‰˘Ó·Ù‹ Î·È Ë ÚÔÁÂÓÓËÙÈ΋ ‰È¿ÁÓˆÛË (1). ∏ ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ÙÔ˘ PWS ÂÚÈÏ·Ì‚¿ÓÂÈ ¿ÏϘ ·Èٛ˜ ÓÂÔÁÓÈ΋˜ ˘ÔÙÔÓ›·˜, ȉȷ›ÙÂÚ· Ó¢ÚÔÌ˘˚Τ˜ ‰È·Ù·Ú·¯¤˜. ∫·Ù¿ ÙËÓ ·È‰È΋ Î·È ÂÊË‚È΋ ËÏÈΛ· Ú¤ÂÈ Ó· ·ÔÎÏÂÈÛÙÔ‡Ó Î·Ù·ÛÙ¿ÛÂȘ ÛÙȘ Ôԛ˜ Û˘Ó˘¿Ú¯Ô˘Ó ·¯˘Û·ÚΛ· Î·È ÓÂ˘Ì·ÙÈ΋ ηı˘ÛÙ¤ÚËÛË, fiˆ˜ ÙÔ Û‡Ó‰ÚÔÌÔ Bardet-Biedl, Ë ÎÏËÚÔÓÔÌÈ΋ ÔÛÙÂÔ‰˘ÛÙÚÔÊ›· ÙÔ˘ Albright Î·È ÙÔ Û‡Ó‰ÚÔÌÔ Cohen (1). ∂›Û˘, Ú¤ÂÈ Ó· ·ÔÎÏÂÈÛÙÔ‡Ó Ù· Û‡Ó‰ÚÔÌ· ÙÔ˘ ‡ıÚ·˘ÛÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ Ã Î·È Angelman, ÛÙ· ÔÔ›· fï˜ Ë ·¯˘Û·ÚΛ· ·Ó¢ڛÛÎÂÙ·È ÌfiÓÔ ÂÚÈÛÙ·Ûȷο. ∆¤ÏÔ˜, Ú¤ÂÈ Ó· ·ÔÎÏ›ÔÓÙ·È ˘Ôı·Ï·ÌÈΤ˜ ‚Ï¿‚˜ ÌÂÙ¿ ·fi ηÎÒÛÂȘ, fiÁÎÔ˘˜ ‹ Ó¢ÚÔ¯ÂÈÚÔ˘ÚÁÈΤ˜ ÂÂÌ‚¿ÛÂȘ (1). ∞ÓÙÈÌÂÙÒÈÛË ∏ ·¯˘Û·ÚΛ· ÌÔÚ› Ó· ÂÏÂÁ¯ı› Ì ̛· ÈÛÔÚÚÔË̤ÓË ÔÏÈÁÔıÂÚÌȉÈ΋ ‰›·ÈÙ· (1000-1200 Kcal/ 24ˆÚÔ), Ì ·˘ÛÙËÚ‹ ÂÈÙ‹ÚËÛË, ηıÒ˜ Î·È Ù·ÎÙÈ΋

389

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Paediatriki 2002;65:387-393

¶›Ó·Î·˜ 1. ∫ÏÈÓÈο ‰È·ÁÓˆÛÙÈο ÎÚÈÙ‹ÚÈ· Û˘Ó‰ÚfiÌÔ˘ Prader-Willi ∏ ‰È¿ÁÓˆÛË ıˆÚÂ›Ù·È Ôχ Èı·Ó‹ Û ·È‰È¿ ËÏÈΛ·˜ <3 ÂÙÒÓ, ÂÊfiÛÔÓ Û˘ÁÎÂÓÙÚÒÓÔÓÙ·È 5 ‚·ıÌÔ›, ÂÎ ÙˆÓ ÔÔ›ˆÓ ÔÈ 3 ÚÔ¤Ú¯ÔÓÙ·È ·fi Ù· Ì›˙ÔÓ· ÎÚÈÙ‹ÚÈ·. ™Â ·È‰È¿ ËÏÈΛ·˜ >3 ÂÙÒÓ, Ë ‰È¿ÁÓˆÛË ıˆÚÂ›Ù·È Èı·Ó‹ Ì 8 ‚·ıÌÔ‡˜, ÂÎ ÙˆÓ ÔÔ›ˆÓ ÔÈ 4 ÚÔ¤Ú¯ÔÓÙ·È ·fi Ù· Ì›˙ÔÓ· ÎÚÈÙ‹ÚÈ·. ªÂ›˙ÔÓ· ÎÚÈÙ‹ÚÈ· (1 ‚·ıÌfi˜ ÁÈ· οı ÎÚÈÙ‹ÚÈÔ) µÚÂÊÈ΋ ÎÂÓÙÚÈ΋ ˘ÔÙÔÓ›· ¢È·Ù·Ú·¯¤˜ Û›ÙÈÛ˘ / ÛÙ·ÛÈÌfiÙËÙ· ‚¿ÚÔ˘˜ ∞fiÙÔÌË ÚfiÛÏË„Ë ‚¿ÚÔ˘˜ ÌÂٷ͇ ËÏÈΛ·˜ 1 Î·È 6 ÂÙÒÓ Ã·Ú·ÎÙËÚÈÛÙÈÎfi ÚÔÛˆÂ›Ô ÀÔÁÔÓ·‰ÈÛÌfi˜: ˘ÔÏ·Û›· ÁÂÓÓËÙÈÎÒÓ ÔÚÁ¿ÓˆÓ, ηı˘ÛÙ¤ÚËÛË ÂÓ‹‚ˆÛ˘ ¶ÓÂ˘Ì·ÙÈ΋ / ·Ó·Ù˘Íȷ΋ ηı˘ÛÙ¤ÚËÛË ∂Ï¿ÛÛÔÓ· ÎÚÈÙ‹ÚÈ· (0,5 ‚·ıÌÔ› ÁÈ· οı ÎÚÈÙ‹ÚÈÔ) ∂Ï·Ùو̤ÓË ÎÈÓËÙÈÎfiÙËÙ· ÙÔ˘ ÂÌ‚Ú‡Ô˘ Î·È Ï‹ı·ÚÁÔ˜ ηٿ ÙË ‚ÚÂÊÈ΋ ËÏÈΛ· ¢È·Ù·Ú·¯¤˜ Û˘ÌÂÚÈÊÔÚ¿˜ ¢È·Ù·Ú·¯¤˜ ‡ÓÔ˘ / ¿ÓÔÈ· ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘ ÷ÌËÏfi ·Ó¿ÛÙËÌ· ∞ÓÔȯÙfi¯ÚˆÌÔ ‰¤ÚÌ· Î·È Ì·ÏÏÈ¿ ªÈÎÚ¿ ¯¤ÚÈ· Î·È fi‰È· ™ÙÂÓ¿ ¯¤ÚÈ· Ì ·ÓˆÌ·Ï›Â˜ Ù˘ ˆÏ¤Ó˘ ™˘ÁÎÏ›ÓˆÓ ÛÙÚ·‚ÈÛÌfi˜, Ì˘ˆ›· ¶·¯‡ÚÚ¢ÛÙÔ, ÈÍ҉˜ Û¿ÏÈÔ ¢È·Ù·Ú·¯¤˜ ¿ÚıÚˆÛ˘ ÙÔ˘ ÏfiÁÔ˘ ∞˘ÙÔÙÚ·˘Ì·ÙÈÛÌfi˜ ‰¤ÚÌ·ÙÔ˜ ∂ÓÈÛ¯˘ÙÈο ÎÚÈÙ‹ÚÈ· (0 ‚·ıÌÔ›) À„ËÏfi˜ Ô˘‰fi˜ fiÓÔ˘ ªÂȈ̤ÓË Ù¿ÛË ÚÔ˜ ¤ÌÂÙÔ ¢È·Ù·Ú·¯¤˜ ıÂÚÌÔÚÚ‡ıÌÈÛ˘ ™ÎÔÏ›ˆÛË / ·ʈÛË ¶ÚÒÈÌË ·‰ÚÂÓ·Ú¯‹ OÛÙÂÔfiÚˆÛË ∞Û˘Ó‹ıÈÛÙË ÂȉÂÍÈfiÙËÙ· Û ·È¯Ó›‰È· Û˘Ó·ÚÌÔÏfiÁËÛ˘ (puzzles) º˘ÛÈÔÏÔÁÈÎfi˜ Ó¢ÚÔÌ˘˚Îfi˜ ¤ÏÂÁ¯Ô˜

ۈ̷ÙÈ΋ ¿ÛÎËÛË (30 min ηıËÌÂÚÈÓ¿) (1,3). ¶ÚfiÛÊ·Ù· ¤¯ÂÈ Î·Ù·‰Âȯı› Ë Â˘ÂÚÁÂÙÈ΋ Â›‰Ú·ÛË Ù˘ ıÂÚ·›·˜ Ì ·˘ÍËÙÈ΋ ÔÚÌfiÓË ÛÙÔ PWS, Ë ÔÔ›· ‚ÂÏÙÈÒÓÂÈ ÙËÓ ·‡ÍËÛË Î·È ÙË ÛˆÌ·ÙÈ΋ Û‡ÛÙ·ÛË (body composition) (7-9). ¶Ú¤ÂÈ Ó· ¯ÔÚËÁÂ›Ù·È Ì ÚÔÛÔ¯‹ Û ·ÛıÂÓ›˜ Ì ÛÎÔÏ›ˆÛË, ÂÓÒ Ù· ·ÔÙÂϤÛÌ·Ù¿ Ù˘ ‰ÂÓ ‰È·ÙËÚÔ‡ÓÙ·È ÌÂÙ¿ ÙË ‰È·ÎÔ‹ Ù˘. ∏ ıÂÚ·›· ˘ÔηٿÛÙ·Û˘ Ì ÛÙÂÚÔÂȉ‹ ÙÔ˘ ʇÏÔ˘ ·Ó·Ù‡ÛÛÂÈ ÙÔ˘˜ ‰Â˘ÙÂÚÔÁÂÓ›˜ ¯·Ú·ÎÙ‹Ú˜ Î·È ÌÔÚ› Ó· ‚ÂÏÙÈÒÛÂÈ ÙËÓ ÔÛÙÂÔfiÚˆÛË (1). ™Â ÔÚÈṲ̂Ó˜ ÂÚÈÙÒÛÂȘ, Ë ¯ÚËÛÈÌÔÔ›ËÛË ·Ó·ÛÙÔϤˆÓ Ù˘ Â·Ó·ÚfiÛÏ˄˘ Ù˘ ÛÂÚÔÙÔÓ›Ó˘, fiˆ˜ Ë ÊÏÔ˘ÔÍÂÙ›ÓË (LADOSE®), ÌÔÚ› Ó· ·Ô‰Âȯı› ¯Ú‹ÛÈÌË Î·È Ó· ‚ÂÏÙÈÒÛÂÈ ÙË ‚Ô˘ÏÈÌ›· Î·È ÙȘ ‰È·Ù·Ú·¯¤˜ Ù˘ Û˘ÌÂÚÈÊÔÚ¿˜ (1). ™‡Ó‰ÚÔÌÔ Bardet-Biedl ¶ÚfiÎÂÈÙ·È ÁÈ· ÎÏËÚÔÓÔÌÈ΋ ‰È·Ù·Ú·¯‹, Ë ÔÔ›· ÌÂÙ·‚È‚¿˙ÂÙ·È Ì ÙÔÓ ·˘ÙÔۈ̷ÙÈÎfi ˘ÔÏÂÈfiÌÂÓÔ ¯·Ú·ÎÙ‹Ú·. ∏ Û˘¯ÓfiÙËÙ¿ Ù˘ ˘ÔÏÔÁ›˙ÂÙ·È Û 1/160000 ÛÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi (10).

390

∫ÏÈÓÈ΋ ÂÈÎfiÓ· ÷ڷÎÙËÚÈÛÙÈÎfiÙÂÚË ÂΉ‹ÏˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Bardet-Biedl (BBS) ·ÔÙÂÏ› Ë ÔÊı·ÏÌÔ¿ıÂÈ·, Ì ·ÚÔ˘Û›· ‰˘ÛÙÚÔÊ›·˜ ÙÔ˘ ·ÌÊÈ‚ÏËÛÙÚÔÂȉԇ˜ Î·È ¤ÎÙˆÛË Ù˘ ÔÙÈ΋˜ Ô͇ÙËÙ·˜ Û Ó·ڋ ËÏÈΛ· (10-12). ¶Ú·ÎÙÈο, fiÏÔÈ ÔÈ ·ÛıÂÓ›˜ Ì BBS ¤¯Ô˘Ó ·ÒÏÂÈ· fiÚ·Û˘ ÚÈÓ ·fi ÙËÓ ËÏÈΛ· ÙˆÓ 30 ÂÙÒÓ. ™˘¯Ó¿ ηٿ ÙËÓ ·È‰È΋ ËÏÈΛ·, ÚÈÓ ·ÎfiÌË ÂÌÊ·ÓÈÛÙÔ‡Ó ‚Ï¿‚˜ ÙÔ˘ ·ÌÊÈ‚ÏËÛÙÚÔÂȉԇ˜, ÔÈ ·ÛıÂÓ›˜ ÌÔÚÔ‡Ó Ó· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó ÛÙÚ·‚ÈÛÌfi ‹ Ì˘ˆ›·, ÂΉËÏÒÛÂȘ ÔÈ Ôԛ˜ Ú¤ÂÈ Ó· ÂÌ‚¿ÏÔ˘Ó ÙÔÓ ÎÏÈÓÈÎfi ÁÈ·ÙÚfi Û ˘Ô„›·, ÂÊfiÛÔÓ Û˘Ó˘¿Ú¯Ô˘Ó Î·È ¿ÏÏ· ¯·Ú·ÎÙËÚÈÛÙÈο Â˘Ú‹Ì·Ù· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ (12). ∏ ·¯˘Û·ÚΛ·, Û˘Ó‹ıˆ˜ ÌÂÙÚ›Ô˘ ÚÔ˜ ÛÔ‚·ÚÔ‡ ‚·ıÌÔ‡, ·ÊÔÚ¿ ΢ڛˆ˜ ÛÙÔÓ ÎÔÚÌfi Î·È ÙÔ˘˜ ÌËÚÔ‡˜ (10-12) (∂ÈÎfiÓ· 4). OÈ ·ÛıÂÓ›˜ ÂÌÊ·Ó›˙Ô˘Ó Â›Û˘ ˘ÔÁÔÓ·‰ÈÛÌfi, Ô ÔÔ›Ô˜ ·Ô‰›‰ÂÙ·È Û ˘Ôı·Ï·ÌÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·. ™˘¯Ó‹ ›ӷÈ, Â›Û˘, Ë ·ÚÔ˘Û›· ‰˘ÛÌÔÚÊÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ, fiˆ˜ ÔÏ˘‰·ÎÙ˘Ï›·˜ - ΢ڛˆ˜ ÙˆÓ Ô‰ÈÒÓ, Û˘Ó‰·ÎÙ˘Ï›·˜, ‚Ú·¯˘‰·ÎÙ˘Ï›·˜ Î·È ÎÏÈÓÔ‰·ÎÙ˘Ï›·˜

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ÙÔ˘ 5Ô˘ ‰·ÎÙ‡ÏÔ˘, ηıÒ˜ Î·È ·ÓˆÌ·ÏÈÒÓ ÙÔ˘ ηÚÔ‡ Î·È Ù˘ ˆÏ¤Ó˘ (10-12). ™˘¯Ó¤˜ ›ӷÈ, Â›Û˘, ÛÙÔ BBS ÔÈ ÏÂÈÙÔ˘ÚÁÈΤ˜ Î·È ·Ó·ÙÔÌÈΤ˜ ÓÂÊÚÈΤ˜ ·ÓˆÌ·Ï›Â˜, ÔÈ Ôԛ˜ ¢ı‡ÓÔÓÙ·È ÁÈ· ÙÔ 50% ÙˆÓ ı·Ó¿ÙˆÓ. ∫˘ÚÈfiÙÂÚ˜ ÂΉËÏÒÛÂȘ ·ÔÙÂÏÔ‡Ó Ë ÔÏ˘‰È„›·, Ë ÔÏ˘Ô˘Ú›·, Ë ÌÂȈ̤ÓË Û˘Ì˘ÎÓˆÙÈ΋ ÈηÓfiÙËÙ· ÙÔ˘ ÓÂÊÚÔ‡ Î·È Ë ˘¤ÚÙ·ÛË (10). ™ÙÔ˘˜ ·ÛıÂÓ›˜ ·Ó¢ڛÛÎÔÓÙ·È Û˘¯Ó¿ ΢ÛÙÂÔÔ˘ÚËÙËÚÈ΋ ·ÏÈÓ‰ÚfiÌËÛË, ηıÒ˜ Î·È ·ÓˆÌ·Ï›Â˜ ÙˆÓ ÓÂÊÚÈÎÒÓ Î·Ï‡ÎˆÓ (10,13). ∂›Û˘, Û ÔÚÈṲ̂ÓÔ˘˜ ·ÛıÂÓ›˜ ·Ú·ÙËÚÔ‡ÓÙ·È ÓÂ˘Ì·ÙÈΤ˜ Î·È Û˘Ó·ÈÛıËÌ·ÙÈΤ˜ ‰È·Ù·Ú·¯¤˜, ηıÒ˜ Î·È Ì·ıËÛȷΤ˜ ‰˘ÛÎÔϛ˜, ¯ˆÚ›˜ fï˜

∂ÈÎfiÓ· 4. ™‡Ó‰ÚÔÌÔ Bardet-Biedl.

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ÓÂ˘Ì·ÙÈ΋ ηı˘ÛÙ¤ÚËÛË (10-12). ÕÏϘ ÂΉËÏÒÛÂȘ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ·ÔÙÂÏÔ‡Ó Ô Û·Î¯·Ú҉˘ ‰È·‚‹Ù˘, ÔÈ Î·Ú‰ÈÔ¿ıÂȘ, Ë ÛȉËÚÔÂÓÈ΋ ·Ó·ÈÌ›·, ÙÔ Û‡Ó‰ÚÔÌÔ ÙÔ˘ ÎÂÓÔ‡ ÙÔ˘ÚÎÈÎÔ‡ ÂÊÈ›Ô˘ Î·È Ë ÂÈÊ˘Ûȷ΋ ‰˘ÛÁÂÓÂÛ›· (10). ∆Ô BBS ‰È·ÎÚ›ÓÂÙ·È ·fi ÙÔ Û·ÓÈfiÙÂÚÔ Û‡Ó‰ÚÔÌÔ Laurence-Moon, ÛÙÔ ÔÔ›Ô Ë ·ÌÊÈ‚ÏËÛÙÚÔÂȉÔ¿ıÂÈ·, Ô ˘ÔÁÔÓ·‰ÈÛÌfi˜ Î·È Ë ÓÂ˘Ì·ÙÈ΋ ηı˘ÛÙ¤ÚËÛË Û˘Ó‰˘¿˙ÔÓÙ·È Ì ÚÔ˚Ô‡Û· Ì˘˚΋ ·‰˘Ó·Ì›·, ¯ˆÚ›˜ ·ÚÔ˘Û›· ÔÏ˘‰·ÎÙ˘Ï›·˜ ‹ ·¯˘Û·ÚΛ·˜ (11,13). °ÂÓÂÙÈ΋ ∆Ô BBS Â›Ó·È ÁÂÓÂÙÈο ÂÙÂÚÔÁÂÓ¤˜ Û‡Ó‰ÚÔÌÔ. ª¤¯ÚÈ Û‹ÌÂÚ· ¤¯Ô˘Ó ¯·ÚÙÔÁÚ·ÊËı› 4 ÂÚÈÔ¯¤˜ Ô˘ ¤¯Ô˘Ó Û¯¤ÛË Ì ÙÔ Û‡Ó‰ÚÔÌÔ: Ë ÂÚÈÔ¯‹ 11q13 (BBS1), Ë ÔÔ›· ÂÓ¤¯ÂÙ·È ÛÙÔ 45% ÙˆÓ ÂÚÈÙÒÛÂˆÓ Î·È ÔÈ ÂÚÈÔ¯¤˜ 16q22 (BBS2), 3p13 (BBS3) Î·È 15q21 (BBS4) (10). ¢È¿ÁÓˆÛË ¶ÚfiÛÊ·Ù· ¤¯Ô˘Ó ÚÔÙ·ı› Ó¤· ‰È·ÁÓˆÛÙÈο ÎÚÈÙ‹ÚÈ·, Ù· ÔÔ›· ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2 (12). O ¶›Ó·Î·˜ 3 ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÔÓ ·Ú¯ÈÎfi ¤ÏÂÁ¯Ô, ηıÒ˜ Î·È ÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË Ô˘ Û˘ÓÈÛÙ¿Ù·È Û ·ÛıÂÓ›˜ Ì BBS (12). 梉ԸÔ·Ú·ı˘ÚÂÔÂȉÈÛÌfi˜ Ù‡Ô˘ Ia O „¢‰Ô¸Ô·Ú·ı˘ÚÂÔÂȉÈÛÌfi˜ (ƒ∏ƒ) Â›Ó·È Ì›· ÎÏËÚÔÓÔÌÈ΋ ‰È·Ù·Ú·¯‹, ÛÙËÓ ÔÔ›· ˘¿Ú¯ÂÈ ·ÓÙ›ÛÙ·ÛË ÛÙË ‰Ú¿ÛË Ù˘ ·Ú·ıÔÚÌfiÓ˘ (PTH) (14). ∫ÏÈÓÈ΋ ÂÈÎfiÓ· ¢È·ÎÚ›ÓÔÓÙ·È ‰‡Ô ÌÔÚʤ˜ ƒ∏ƒ: ·) Ô Ù‡Ô˜ πb, ÛÙÔÓ ÔÔ›Ô ·Ú·ÙËÚÂ›Ù·È ÌÂÌÔӈ̤ÓË ·ÓÙ›ÛÙ·ÛË ÛÙË ‰Ú¿ÛË Ù˘ ƒ∆∏ Ì ·ÚÔ˘Û›· ˘·Û‚ÂÛÙÈ·ÈÌ›·˜, ˘ÂÚʈÛÊ·Ù·ÈÌ›·˜ Î·È ‰Â˘ÙÂÚÔ·ıÔ‡˜ ˘ÂÚ·Ú·ı˘ÚÂÔÂȉÈÛÌÔ‡ (14) Î·È ‚) Ô Ù‡Ô˜ πa, ÛÙÔÓ ÔÔ›Ô, ÂÎÙfi˜ ·fi Ù· ÈÔ ¿Óˆ ‚ÈÔ¯ËÌÈο Â˘Ú‹Ì·Ù·, Û˘Ó˘¿Ú¯ÂÈ ¯·Ú·ÎÙËÚÈÛÙÈÎfi˜ Ê·ÈÓfiÙ˘Ô˜, ÁÓˆÛÙfi˜ ˆ˜ ÎÏËÚÔÓÔÌÈ΋ ÔÛÙÂÔ‰˘ÛÙÚÔÊ›· ÙÔ˘ Albright (14,15). O Ê·ÈÓfiÙ˘Ô˜ ·˘Ùfi˜ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ¯·ÌËÏfi ·Ó¿ÛÙËÌ·, ·¯˘Û·ÚΛ·, ÎÚ·ÓÈÔÚÔÛˆÈΤ˜ ·ÓˆÌ·Ï›Â˜ (‚Ú·¯‡˜ ·˘¯¤Ó·˜, ÛÙÚÔÁÁ˘Ïfi ÚfiÛˆÔ, ·ÔÏ·Ù˘Ṳ̂ÓË Ì‡ÙË, ˘ÔÏ·Û›· ‰ÔÓÙÈÒÓ), ·ÎÚÔÌÈÎÚ›· ÏfiÁˆ ‚Ú·¯˘‰·ÎÙ˘Ï›·˜ ‹ ‚Ú·¯¤ˆÓ ÌÂٷηÚ›ˆÓ (Û˘Ó‹ıˆ˜ 4Ô˘ Î·È 5Ô˘) Î·È ˘Ô‰fiÚȘ Â·Û‚ÂÛÙÒÛÂȘ (∂ÈÎfiÓ· 5). ™ÙÔ˘˜ ·ÛıÂÓ›˜ Û˘¯Ó¿ ·Ú·ÙËÚ›ٷÈ, Â›Û˘, ¯·ÌËÏÔ‡ ¤ˆ˜ ÌÂÙÚ›Ô˘ ‚·ıÌÔ‡ ÓÔËÙÈ΋ ˘ÛÙ¤ÚËÛË. ™˘Ó‹ı˘ Â›Ó·È Ë ÂÌÊ¿ÓÈÛË ˘Ôı˘ÚÂÔÂȉÈÛÌÔ‡, fiˆ˜ Î·È ‰È·Ù·Ú·¯ÒÓ Ù˘ ·Ó··Ú·ÁˆÁÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ Ì ·Ú·ÈÔÌËÓfiÚÚÔÈ· ÛÙȘ Á˘Ó·›Î˜ Î·È ÛÙÂÈÚfiÙËÙ· ÛÙÔ˘˜ ¿Ó‰Ú˜ (15,16). ∏ ηٿÛÙ·ÛË Î·Ù¿ ÙËÓ ÔÔ›· ·Ú·ÙËÚÂ›Ù·È Ô ¯·Ú·ÎÙËÚÈÛÙÈÎfi˜ Ê·ÈÓfiÙ˘Ô˜ Ù˘ ÔÛÙÂÔ‰˘ÛÙÚÔÊ›·˜ ÙÔ˘ Albright, ¯ˆÚ›˜ fï˜ ‰È·Ù·Ú·¯¤˜ ÙÔ˘

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¶›Ó·Î·˜ 2. ¢È·ÁÓˆÛÙÈο ÎÚÈÙ‹ÚÈ· Û˘Ó‰ÚfiÌÔ˘ Bardet-Biedl °È· ÙË ‰È¿ÁÓˆÛË ··ÈÙÔ‡ÓÙ·È 4 ·ÚÈ· ¯·Ú·ÎÙËÚÈÛÙÈο ‹ 3 ·ÚÈ· Î·È 2 ‰Â˘ÙÂÚ‡ÔÓÙ·. ∫‡ÚÈ· ¯·Ú·ÎÙËÚÈÛÙÈο ¢˘ÛÙÚÔÊ›· ·ÌÊÈ‚ÏËÛÙÚÔÂȉԇ˜ ¶ÔÏ˘‰·ÎÙ˘Ï›· ¶·¯˘Û·ÚΛ· ª·ıËÛȷΤ˜ ‰˘ÛÎÔϛ˜ ÀÔÁÔÓ·‰ÈÛÌfi˜ ÛÙÔ˘˜ ¿ÚÚÂÓ˜ ¡ÂÊÚÈΤ˜ ·ÓˆÌ·Ï›Â˜ ¢Â˘ÙÂÚ‡ÔÓÙ· ¯·Ú·ÎÙËÚÈÛÙÈο ∫·ı˘ÛÙ¤ÚËÛË / ‰È·Ù·Ú·¯¤˜ ÔÌÈÏ›·˜ ™ÙÚ·‚ÈÛÌfi˜ / ηٷÚÚ¿ÎÙ˘ / ·ÛÙÈÁÌ·ÙÈÛÌfi˜ µÚ·¯˘‰·ÎÙ˘Ï›· / Û˘Ó‰·ÎÙ˘Ï›· ∞Ó·Ù˘Íȷ΋ ηı˘ÛÙ¤ÚËÛË ¶ÔÏ˘Ô˘Ú›· / ÔÏ˘‰È„›· ∞Ù·Í›· / ‰È·Ù·Ú·¯¤˜ ÈÛÔÚÚÔ›·˜ ªÂÙÚ›Ô˘ ‚·ıÌÔ‡ Û·ÛÙÈÎfiÙËÙ· (΢ڛˆ˜ οو ¿ÎÚˆÓ) ™·Î¯·Ú҉˘ ‰È·‚‹Ù˘ £Ôψً ˘ÂÚÒ· ÀÂÚÙÚÔÊ›· ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ / Û˘ÁÁÂÓ‹˜ ηډÈÔ¿ıÂÈ· ∫›ÚÚˆÛË ‹·ÙÔ˜ ¶›Ó·Î·˜ 3. ™˘ÓÈÛÙÒÌÂÓÔ˜ ·Ú¯ÈÎfi˜ ¤ÏÂÁ¯Ô˜ Î·È ·Ú·ÎÔÏÔ‡ıËÛË ·ÛıÂÓÒÓ Ì ۇӉÚÔÌÔ Bardet-Biedl ∞Ú¯ÈÎfi˜ ¤ÏÂÁ¯Ô˜ ñ ∏ÏÂÎÚÔ·ÌÊÈ‚ÏËÛÙÚÔÂȉÔÁÚ¿ÊËÌ· / ÔÙÈο ÚÔÎÏËÙ¿ ‰˘Ó·ÌÈο ñ U/S ÓÂÊÚÒÓ ñ ∂Ó‰ÔÊϤ‚È· ˘ÂÏÔÁÚ·Ê›· ‹ ÛÈÓıËÚÔÁÚ¿ÊËÌ· Ì DMSA/DTPA ñ ∏∫° + echo ηډȿ˜ ñ ∞ÔÎÏÂÈÛÌfi˜ Û˘Ó‰ÚfiÌÔ˘ Prader-Willi Ì ÌÔÚȷ΋ ÁÂÓÂÙÈ΋ ·Ó¿Ï˘ÛË ñ CT/MRI ÂÁÎÂÊ¿ÏÔ˘/ÓÂÊÚÒÓ ñ ∏∂° ∞Ó¿ 6 Ì‹Ó˜ ñ °ÂÓÈ΋ Ô‡ÚˆÓ ∞Ó¿ ¤ÙÔ˜ ñ ¶ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ô˘Ú›·˜ Î·È ÎÚ·ÙÈÓ›Ó˘

ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙÔ˘ ·Û‚ÂÛÙ›Ô˘, ηÏÂ›Ù·È „¢‰Ô„¢‰Ô¸Ô·Ú·ı˘ÚÂÔÂȉÈÛÌfi˜ (14). º˘ÛÈÔ·ıÔÏÔÁ›· - °ÂÓÂÙÈ΋ O PHP Ù‡Ô˘ πa ÔÊ›ÏÂÙ·È ÛÙËÓ ·ÒÏÂÈ· ÂÓfi˜ ·ÏÏËÏ›Ô˘ ÙÔ˘ ÁÔÓȉ›Ô˘ GN∞S1, ÙÔ ÔÔ›Ô Îˆ‰ÈÎÔÔÈ› ÙËÓ ˘ÔÌÔÓ¿‰· · Ù˘ ÚˆÙ½Ó˘ Gs, Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÂÏ¿ÙÙˆÛË Ù˘ ‰Ú¿Û˘ Ù˘ Î·È ÙËÓ ·Ó·ÛÙÔÏ‹ ÂÓÂÚÁÔÔ›ËÛ˘ ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ·‰ÂÓ˘ÏÔ΢ÎÏ¿Û˘-cAMP, ̤ۈ ÙÔ˘ ÔÔ›Ô˘ ‰Ú· Ë PTH ÛÙ· fiÚÁ·Ó· ÛÙfi¯Ô˘˜ (14,15,17). ∏ ÂÏ·Ùو̤ÓË ‰Ú·ÛÙÈÎfiÙËÙ· Ù˘ ÚˆÙ½Ó˘ Gs Â›Ó·È ˘‡ı˘ÓË Î·È ÁÈ· ÙËÓ ·ÓÙ›ÛÙ·ÛË Û ¿ÏϘ ÔÚÌfiÓ˜ (TSH, LH, FSH), Ë ÔÔ›· ·Ú·ÙËÚÂ›Ù·È ÛÙÔ˘˜ ·ÛıÂÓ›˜ ·˘ÙÔ‡˜ (15,17).

O ƒHƒ Ù‡Ô˘ πa ÎÏËÚÔÓÔÌÂ›Ù·È Ì ÙÔÓ ÂÈÎÚ·ÙÔ‡ÓÙ· ·˘ÙÔۈ̷ÙÈÎfi ¯·Ú·ÎÙ‹Ú·.

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∂ÈÎfiÓ· 5. ∫ÏËÚÔÓÔÌÈ΋ ÔÛÙÂÔ‰˘ÛÙÚÔÊ›· ÙÔ˘ Albright Û ·ÁfiÚÈ Ì „¢‰Ô¸Ô·Ú·ı˘ÚÂÔÂȉÈÛÌfi Ù‡Ô˘ πa.

¢È¿ÁÓˆÛË ∏ ‰È¿ÁÓˆÛË Á›ÓÂÙ·È fiÙ·Ó ˘¿Ú¯Ô˘Ó ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ˘·Û‚ÂÛÙÈ·ÈÌ›·˜ Û ¿ÙÔÌ· Ì ٷ ÌÔÚÊÔÏÔÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘. ∂Ȃ‚·ÈÒÓÂÙ·È Ì ÙË Ì¤ÙÚËÛË Ù˘ ƒTH, Ë ÔÔ›· ·Ó¢ڛÛÎÂÙ·È Û˘Ó‹ıˆ˜ ·˘ÍË̤ÓË, ÂÓÒ Ë ¯ÔÚ‹ÁËÛË Û˘ÓıÂÙÈ΋˜ PTH ‰ÂÓ ÚÔηÏ› ·‡ÍËÛË ÙÔ˘ ÓÂÊÚÈÎÔ‡ cAMP (14,15). ∏ ıÂÚ·›· ÙÔ˘ ƒ∏ƒ Â›Ó·È Ë ›‰È· Ì ÙË ıÂÚ·›· ÙÔ˘ ˘Ô·Ú·ı˘ÚÂÔÂȉÈÛÌÔ‡ Î·È Û˘Ó›ÛÙ·Ù·È ÛÙË ¯ÔÚ‹ÁËÛË ·Û‚ÂÛÙ›Ô˘ Î·È ‚ÈÙ·Ì›Ó˘ D (14). ÕÏÏ· Û·ÓÈfiÙÂÚ· ÁÂÓÂÙÈο Û‡Ó‰ÚÔÌ· Ì ÂΉ‹ÏˆÛË ·¯˘Û·ÚΛ·˜ Â›Ó·È Ù· ÂÍ‹˜: ™‡Ó‰ÚÔÌÔ Alstrom: ∫ÏËÚÔÓÔÌÂ›Ù·È Ì ·˘ÙÔۈ̷ÙÈÎfi ˘ÔÏÂÈfiÌÂÓÔ ¯·Ú·ÎÙ‹Ú·. ∏ ·¯˘Û·ÚΛ· ÂÁηı›ÛÙ·Ù·È Û ËÏÈΛ· 2 ¤ˆ˜ 5 ÂÙÒÓ Î·È Û˘Óԉ‡ÂÙ·È ·fi ÚÔԉ¢ÙÈ΋ ÌÂÏ·Á¯ÚˆÌ·ÙÈ΋ ·ÌÊÈ‚ÏËÛÙÚÔÂȉÔ¿ıÂÈ·, Ó¢ÚÔ·ÈÛıËÙËÚȷ΋ ÎÒʈÛË, ÌË ÈÓÛÔ˘ÏÈÓÔÂÍ·ÚÙÒÌÂÓÔ Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË Î·È ÓÂÊÚÔ¿ıÂÈ· ÛÙ· ÙÂÏÈο ÛÙ¿‰È· Ù˘ ÓfiÛÔ˘

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(18). ÕÏϘ ÂΉËÏÒÛÂȘ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ·ÔÙÂÏÔ‡Ó Ë Ë·ÙÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·, Ë Ì˘ÔηډÈÔ¿ıÂÈ· Î·È Ô ˘ÔÁÔÓ·‰ÈÛÌfi˜ ÛÙÔ˘˜ ¿Ó‰Ú˜. ™‡Ó‰ÚÔÌÔ Carpenter: ∫ÏËÚÔÓÔÌÂ›Ù·È Ì ·˘ÙÔۈ̷ÙÈÎfi ˘ÔÏÂÈfiÌÂÓÔ ¯·Ú·ÎÙ‹Ú·. OÈ ·ÛıÂÓ›˜, ÂÎÙfi˜ ·fi ÙËÓ ·¯˘Û·ÚΛ·, ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ô͢ÎÂÊ·Ï›·, ‰˘ÛÌÔÚÊ›· ÚÔÛÒÔ˘, ÔÏ˘‰·ÎÙ˘Ï›· Î·È Û˘Ó‰·ÎÙ˘Ï›·, ηıÒ˜ Î·È ÌÂÙÚ›Ô˘ ‚·ıÌÔ‡ ÓÂ˘Ì·ÙÈ΋ ηı˘ÛÙ¤ÚËÛË, ¯ˆÚ›˜ ‰È·Ù·Ú·¯¤˜ ·‡ÍËÛ˘ (19). ™Â ÔÚÈṲ̂ÓÔ˘˜ ·ÛıÂÓ›˜ ·Ú·ÙËÚ›ٷÈ, Â›Û˘, Û˘ÁÁÂÓ‹˜ ηډÈÔ¿ıÂÈ· Î·È ˘ÔÁÔÓ·‰ÈÛÌfi˜. ™‡Ó‰ÚÔÌÔ Cohen: ∫ÏËÚÔÓÔÌÂ›Ù·È Ì ·˘ÙÔۈ̷ÙÈÎfi ˘ÔÏÂÈfiÌÂÓÔ ¯·Ú·ÎÙ‹Ú· Î·È ÙÔ ÁÔÓ›‰ÈÔ ÂÓÙÔ›˙ÂÙ·È ÛÙÔ 8q22-q23. ∏ ·¯˘Û·ÚΛ· Â›Ó·È ÎÂÓÙÚÈÎÔ‡ Ù‡Ô˘ Î·È ÂÌÊ·Ó›˙ÂÙ·È ÛÙÔ Ì¤ÛÔÓ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜, ÌÂÙ¿ ·fi ÈÛÙÔÚÈÎfi ÓÂÔÁÓÈ΋˜ ˘ÔÙÔÓ›·˜. OÈ ·ÛıÂÓ›˜ ¤¯Ô˘Ó ÛÙÂÓ¿ ¯¤ÚÈ· Î·È fi‰È· Î·È ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÚÔÛˆ›Ô. ÕÏϘ ÂΉËÏÒÛÂȘ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ·ÔÙÂÏÔ‡Ó Ë „˘¯ÔÎÈÓËÙÈ΋ ηı˘ÛÙ¤ÚËÛË, Ë ÌÈÎÚÔÎÂÊ·Ï›·, Ë ‰˘ÛÙÚÔÊ›· ÙÔ˘ ·ÌÊÈ‚ÏËÛÙÚÔÂȉԇ˜ Î·È ¯ÔÚÈÔÂȉԇ˜ ¯ÈÙÒÓ· Î·È Ë Ô˘‰ÂÙÂÚÔÂÓ›· (20,21). ∂›ÏÔÁÔ˜ ™ÙËÓ ·Ó·ÛÎfiËÛË ·Ó·Ï‡ıËÎ·Ó Ù· ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο Î·È Ù· ÙÂÏÂ˘Ù·›· ‰Â‰Ô̤ӷ Ù˘ ÌÔÚȷ΋˜ ÁÂÓÂÙÈ΋˜ ·Ó¿Ï˘Û˘ ÙˆÓ ÁÂÓÂÙÈÎÒÓ Û˘Ó‰ÚfiÌˆÓ Ì ÂΉ‹ÏˆÛË ·¯˘Û·ÚΛ·˜. ∞·ÈÙÂ›Ù·È ÂÚ·ÈÙ¤Úˆ ¤Ú¢ӷ ÁÈ· ÙËÓ Ù·˘ÙÔÔ›ËÛË fiÏˆÓ ÙˆÓ ˘‡ı˘ÓˆÓ ÁÔÓȉ›ˆÓ Î·È ÙË ‰ÈÂÚ‡ÓËÛË Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘˜, Ë ÔÔ›· ı· ÌÔÚÔ‡Û ӷ Û˘Ì‚¿ÏÂÈ ÛÙË ‰È·Ï‡ηÓÛË Ù˘ ·ıÔÊ˘ÛÈÔÏÔÁ›·˜ Ù˘ ·¯˘Û·ÚΛ·˜, ÙfiÛÔ ÛÙËÓ ·È‰È΋ ËÏÈΛ· fiÛÔ Î·È ÛÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi. µÈ‚ÏÈÔÁÚ·Ê›· 1. Cassidy SB. Prader-Willi syndrome. J Med Genet 1997;34:917-923.

2. Swaab DF. Prader-Willi syndrome and the hypothalamus.

Acta Paediatr 1997;423 (Suppl):50-54.

3. Donaldson MD, Chu CE, Cooke A, Wilson A, Greene SA, Stephenson JB. The Prader-Willi syndrome. Arch Dis Child 1994;70:58-63.

4. Couper R. Prader-Willi syndrome. J Paediatr Child Health 1999;35:331-334.

5. Brondum-Nielsen K. The genetic basis for Prader-Willi syndrome: the importance of imprinted genes. Acta Paediatr 1997;423 (Suppl):55-57.

6. Holm VA, Cassidy SB, Butler MG, Hanchett JM, Greenswag LR, Whitman BY et al. Prader-Willi syndrome: consensus diagnostic criteria. Pediatrics 1993;91:398-402.

7. Davies PS. Body composition in Prader-Willi syndrome: assessment and effects of growth hormone administration.

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8. Ritzen EM, Lindgren AC, Hagenas L, Marcus C, Muller J, Blichfeldt S. Growth hormone treatment of patients with Prader-Willi syndrome. J Pediatr Endocrinol Metab 1999;12 (Suppl 1):345-349.

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∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 22-03-2002 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 06-09-2002 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ÷ڿϷÌÔ˜ °. ÷Ù˙Ë·ı·Ó·Û›Ô˘ ¶·È‰›·ÙÚÔ˜-∂Ó‰ÔÎÚÈÓÔÏfiÁÔ˜ ªÈ¯·Ï·ÎÔÔ‡ÏÔ˘ 180, T.K. 115 27, ∞ı‹Ó·

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∞¡∞™∫O¶∏™∏

Paediatriki 2002;65:394-402

REVIEW ARTICLE

∞ÒÙÂÚ˜ ÂÈÏÔΤ˜ Ù˘ ÚÔˆÚfiÙËÙ·˜ ∞. ª·ÓÔ˘Ú¿, Ã. °È·ÓÓ·ÎÔÔ‡ÏÔ˘

Long-term outcome of premature infants A. Manoura, Ch. Giannakopoulou

¶ÂÚ›ÏË„Ë: ∏ ÌÂÁ¿ÏË ÚfiÔ‰Ô˜ Ô˘ ¤¯ÂÈ ÂÈÙ¢¯ı› Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÛÙËÓ ÂÓÙ·ÙÈ΋ ÓÔÛËÏ›· ÙˆÓ ÓÂÔÁÓÒÓ ¤¯ÂÈ ÂÈʤÚÂÈ Ì›· ı·̷ÙÈ΋ ·‡ÍËÛË ÛÙËÓ ÂÈ‚›ˆÛË ÙˆÓ Ôχ ÌÈÎÚÔ‡ ‚¿ÚÔ˘˜, ΢ڛˆ˜, ÚÔÒÚˆÓ. øÛÙfiÛÔ, ‰ÂÓ ¤¯ÂÈ ÂÈÙ¢¯ı› ·ÓÙ›ÛÙÔÈ¯Ë Ì›ˆÛË ÛÙË ÓÔÛËÚfiÙËÙ·. ∆· ÚfiˆÚ· ÓÂÔÁÓ¿ ·ÔÙÂÏÔ‡Ó Ì›· ¢·›ÛıËÙË ÔÌ¿‰· Ì ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÓÔÛËÚfiÙËÙ·˜ ηٿ Ù· ÚÒÙ· ¯ÚfiÓÈ· Ù˘ ˙ˆ‹˜. ∆· Ì·ÎÚÔ¯ÚfiÓÈ· ÚÔ‚Ï‹Ì·Ù¿ ÙÔ˘˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙËÓ Ùˆ¯‹ ۈ̷ÙÈ΋ ·Ó¿Ù˘ÍË, ÙȘ ÂÈÏÔΤ˜ Ù˘ ÓÂÎÚˆÙÈ΋˜ ÂÓÙÂÚÔÎÔÏ›Ùȉ·˜, ÙȘ ‰È·Ù·Ú·¯¤˜ ·ÎÔ‹˜ Î·È fiÚ·Û˘, ÙËÓ „˘¯ÔÎÈÓËÙÈ΋ ηı˘ÛÙ¤ÚËÛË, ÙË ¯ÚfiÓÈ· Ó¢ÌÔÓÈ΋ ÓfiÛÔ Î·È ¿ÏÏ·, ÈÔ ·Ï¿ ηıËÌÂÚÈÓ¿ ÚÔ‚Ï‹Ì·Ù· Û›ÙÈÛ˘ Î·È Î·ıËÌÂÚÈÓ‹˜ ÊÚÔÓÙ›‰·˜. ™ÙË Û¯ÔÏÈ΋ ËÏÈΛ· ·ÚÔ˘ÛÈ¿˙Ô˘Ó Û ·˘ÍË̤ÓÔ ÔÛÔÛÙfi Ì·ıËÛȷΤ˜ ‰˘ÛÎÔϛ˜ Î·È ÚÔ‚Ï‹Ì·Ù· Û˘ÌÂÚÈÊÔÚ¿˜. ∏ Û˘ÛÙËÌ·ÙÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË ·fi ÔÌ¿‰· ÂȉÈÎÒÓ ÁÈ· ÙËÓ ÂÓÙfiÈÛË Î·È ÙËÓ ¤ÁηÈÚË ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÔÈÎ›ÏˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ ÙÔ˘˜ Â›Ó·È ··Ú·›ÙËÙË. ∏ ÚÔ·ÁˆÁ‹ Ù˘ Ó¢ÚÔ·Ó·Ù˘Íȷ΋˜ ÊÚÔÓÙ›‰·˜ ÁÈ· Ù· ¢·›ÛıËÙ· ÚfiˆÚ· Èı·Ó¿ ÌÔÚ› Ó· ‚ÂÏÙÈÒÛÂÈ ÙËÓ ÚfiÁÓˆÛË.

Abstract: Advances in neonatal intensive care over the last decade have resulted in an impressive increase in survival of very low birth weight premature infants. Yet, morbidity has remained constant over time. Premature infants are at increased risk for rehospitalization during the first years of life. High-risk neonates are prone to growth failure, visual and hearing problems, neurodevelopmental impairements, chronic lung disease and feeding difficulties. During school age, they demonstrate learning disabilities and behavioral problems. Follow-up of these high-risk neonates is necessary for identification of their problems and early intervention. Neurodevelopmental care of the vulnerable premature neonates may improve their prognosis.

§¤ÍÂȘ ÎÏÂȉȿ: ÚÔˆÚfiÙËÙ·, ÚfiÁÓˆÛË, „˘¯ÔÎÈÓËÙÈ΋ ÂͤÏÈÍË.

Key words: prematurity, outcome, psychomotor development.

∂ÈÛ·ÁˆÁ‹ ∏ ·Ó¿Ù˘ÍË Ù¯ÓÈÎÒÓ ˘Ô‚ÔËıÔ‡ÌÂÓ˘ ·Ó··Ú·ÁˆÁ‹˜ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙË ÌÂÁ¿ÏË ÚfiÔ‰Ô Ô˘ ¤¯ÂÈ ÂÈÙ¢¯ı› Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÛÙËÓ ÂÓÙ·ÙÈ΋ ÓÔÛËÏ›· ÙˆÓ ÓÂÔÁÓÒÓ, ¤¯ÂÈ Û·Ó ·ÔÙ¤ÏÂÛÌ· ÙË ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË ÙˆÓ ÓÂÔÁÓÒÓ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘. ™ÙȘ ∏ӈ̤Ó˜ ¶ÔÏÈÙ›˜, ÙÔ ÔÛÔÛÙfi ÙˆÓ ÓÂÔÁÓÒÓ Ôχ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ (<1500 g) ·˘Í‹ıËΠ·fi 1,2% ÙÔ 1980 Û 1,4% ÙÔ 1996 (1,2). ¶·Ú¿ÏÏËÏ·, ¤¯Ô˘Ó ÂÈÙ¢¯ı› ˘„ËÏ¿

ÔÛÔÛÙ¿ ÂÈ‚›ˆÛ˘ ÙˆÓ ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ. ¶ÚÈÓ ·fi ÙË ‰ÂηÂÙ›· ÙÔ˘ ’70, ÙÔ 90% ÙˆÓ ÓÂÔÁÓÒÓ Ì ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ ÌÈÎÚfiÙÂÚÔ ·fi 1000 g η٤ÏËÁ (1). ™‹ÌÂÚ·, ÙÔ 93% ÙˆÓ ÓÂÔÁ¤ÓÓËÙˆÓ Ì ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ 1001-1500 g ÂÈ‚ÈÒÓÂÈ, ÂÓÒ ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ÔÛÔÛÙfi ÁÈ· ÓÂÔÁÓ¿ Ì ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ 7511000 g Â›Ó·È 85% Î·È ÏËÛÈ¿˙ÂÈ ÙÔ 50% ÁÈ· ÓÂÔÁÓ¿ Ì ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ 501-750 g (2-4). ∏ ı·̷ÙÈ΋ ·˘Ù‹ ·‡ÍËÛË ÛÙ· ÔÛÔÛÙ¿ ÂÈ‚›ˆÛ˘ ·ÊÔÚ¿ ΢ڛˆ˜ ÛÙȘ ÔÌ¿‰Â˜ ÙˆÓ ÓÂÔÁÓÒÓ Ôχ ÌÈÎÚÔ‡

¡ÂÔÁÓÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘

Department of Neonatology of University of Crete

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(≤1500 g) Î·È ÂÍ·ÈÚÂÙÈο ÌÈÎÚÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ (≤1000 g) (1,5). ∞Ó¿ÏÔÁË Â›Ó·È Ë Ì›ˆÛË Ù˘ ıÓËÛÈÌfiÙËÙ·˜ Î·È ÛÙËÓ ∂ÏÏ¿‰·, fiÔ˘ ·Ó·Ê¤ÚÂÙ·È ÙÒÛË Î·Ù¿ 68% Î·È 83,7% ÙËÓ ÙÂÏÂ˘Ù·›· ‰ÂηÂÓÙ·ÂÙ›·, ÁÈ· ÓÂÔÁÓ¿ Ì ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ 501-1000 g Î·È 1001-1500 g, ·ÓÙ›ÛÙÔȯ· (6). ∂›Ó·È ÁÓˆÛÙfi fiÙÈ Ô ‚·ıÌfi˜ ˆÚÈÌfiÙËÙ·˜ ÙÔ˘ ÓÂÔÁ¤ÓÓËÙÔ˘, Ô˘ ·ÓÙ·Ó·ÎÏ¿Ù·È Û˘Ó‹ıˆ˜ ÛÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛ˘, Â›Ó·È Ô ÈÔ ÛÙ·ıÂÚfi˜ ‰Â›ÎÙ˘ ‰˘ÛÌÂÓÔ‡˜ ÚfiÁÓˆÛ˘ ÛÙ· ÚfiˆÚ· ÓÂÔÁÓ¿ (1,7). ∂‡ÏÔÁ·, ÏÔÈfiÓ, ¤¯Ô˘Ó ‰ËÌÈÔ˘ÚÁËı› ÛÔ‚·Ú¤˜ ·ÓËÛ˘¯›Â˜ fiÛÔÓ ·ÊÔÚ¿ ÛÙ· ·ÒÙÂÚ· ÚÔ‚Ï‹Ì·Ù· Î·È ÙËÓ ÚfiÁÓˆÛË ÙˆÓ Ôχ ÌÈÎÚÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓÒÓ, Ù· ÔÔ›· Û‹ÌÂÚ· ÂÈ‚ÈÒÓÔ˘Ó Û ÛËÌ·ÓÙÈÎfi ÔÛÔÛÙfi. ∏ ÔÈfiÙËÙ· Ù˘ ÂÈ‚›ˆÛ˘ Â›Ó·È ÙÔ ÛËÌ·ÓÙÈÎfi ÂÚÒÙËÌ· Ô˘ Ù›ıÂÙ·È, Û‹ÌÂÚ·, Ô˘ ÔÏÔ¤Ó· ÂÚÈÛÛfiÙÂÚ· Î·È ÌÈÎÚfiÙÂÚ· ÓÂÔÁÓ¿ ÂÈ‚ÈÒÓÔ˘Ó. ∏ ·Ó·ÛÎfiËÛË ·˘Ù‹ ÛÎÔfi ¤¯ÂÈ Ó· ÂÚÈÁÚ¿„ÂÈ Ù· ÚÔ‚Ï‹Ì·Ù· ÙˆÓ ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ ÌÂÙ¿ ÙËÓ ¤ÍÔ‰fi ÙÔ˘˜ ·fi ÙË ÌÔÓ¿‰· ÂÓÙ·ÙÈ΋˜ ÓÔÛËÏ›·˜, Ó· ‰ÒÛÂÈ ¤Ó· Û¯‹Ì· ·Ú·ÎÔÏÔ‡ıËÛ˘, Ó· Û˘ÓÔ„›ÛÂÈ ÙËÓ ÚfiÁÓˆÛË Î·È Ó· ÂÓÙÔ›ÛÂÈ Ù· ‰›· Ô˘ Â›Ó·È Èı·Ófi Ó· ÙË ‚ÂÏÙÈÒÛÔ˘Ó. ∞ÒÙÂÚ· ÚÔ‚Ï‹Ì·Ù· ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ ∏ ¤ÍÔ‰Ô˜ ÙÔ˘ ÚfiˆÚÔ˘ ÓÂÔÁÓÔ‡ ·fi ÙË ÌÔÓ¿‰· ÂÓÙ·ÙÈ΋˜ ÓÔÛËÏ›·˜ ‰ÂÓ Û˘ÓÂ¿ÁÂÙ·È Î·È ÙÔ Ù¤ÏÔ˜ ÙˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ ÙÔ˘. ∆· ÂÚÈÛÛfiÙÂÚ· ·fi ·˘Ù¿ ··ÈÙÔ‡Ó È‰È·›ÙÂÚË ÊÚÔÓÙ›‰· ÁÈ· ÙËÓ ·Ó¿Ù˘Í‹ ÙÔ˘˜, ÂÓÒ ÔÏϤ˜ ·fi ÙȘ ÓÔÛÔÏÔÁÈΤ˜ ηٷÛÙ¿ÛÂȘ Ô˘ ·ÓÙÈÌÂÙÒÈÛ·Ó Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÓÔÛËÏ›·˜ ÙÔ˘˜ ¤¯Ô˘Ó Ì·ÎÚÔ¯ÚfiÓȘ Û˘Ó¤ÂȘ Ô˘ Ù· Ù·Ï·ÈˆÚÔ‡Ó ÁÈ· ÌÂÁ¿ÏÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· (8,9). ∆· ÚfiˆÚ· ÓÂÔÁÓ¿ ¤¯Ô˘Ó ·˘ÍË̤ÓË Èı·ÓfiÙËÙ· Â·ÓÂÈÛ·ÁˆÁ‹˜ ÛÙÔ ÓÔÛÔÎÔÌ›Ô. ∂ÎÙÈÌ¿Ù·È fiÙÈ ÙÔ 33% ÙˆÓ ÓÂÔÁÓÒÓ Ôχ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ Â·ÓÂÈÛ¿ÁÂÙ·È ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÚÒÙÔ˘ ¯ÚfiÓÔ˘ ˙ˆ‹˜ Î·È 10% ηٿ ÙÔ ‰Â‡ÙÂÚÔ Î·È ÙÚ›ÙÔ ¯ÚfiÓÔ (9). ∆· Ì·ÎÚÔ¯ÚfiÓÈ· ÚÔ‚Ï‹Ì·Ù· ÙˆÓ ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙË ¯ÚfiÓÈ· Ó¢ÌÔÓÈ΋ ÓfiÛÔ, ÙȘ ÂÈÏÔΤ˜ Ù˘ ÓÂÎÚˆÙÈ΋˜ ÂÓÙÂÚÔÎÔÏ›Ùȉ·˜, ÙȘ ‰È·Ù·Ú·¯¤˜ ·ÎÔ‹˜ Î·È fiÚ·Û˘, ÙËÓ „˘¯ÔÎÈÓËÙÈ΋ ηı˘ÛÙ¤ÚËÛË, ÙËÓ Ùˆ¯‹ ۈ̷ÙÈ΋ ·Ó¿Ù˘ÍË Î·È ¿ÏÏ·, ÈÔ ·Ï¿ ηıËÌÂÚÈÓ¿ ÚÔ‚Ï‹Ì·Ù· Û›ÙÈÛ˘ Î·È Î·ıËÌÂÚÈÓ‹˜ ÊÚÔÓÙ›‰·˜. ÃÚfiÓÈ· Ó¢ÌÔÓÈ΋ ÓfiÛÔ˜ ÙÔ˘ ÓÂÔÁÓÔ‡ ¶·Ú’ fiÏÔ Ô˘ Ë ¯Ú‹ÛË ÙÔ˘ Â͈ÁÂÓÔ‡˜ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ¤¯ÂÈ ÂÈʤÚÂÈ ÛËÌ·ÓÙÈ΋ ‚ÂÏÙ›ˆÛË fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÂÈ‚›ˆÛË ÙˆÓ ÌÈÎÚÒÓ ÚÔÒÚˆÓ, ‰ÂÓ ¤¯ÂÈ ÌÂÈÒÛÂÈ ÙËÓ Â›ÙˆÛË Ù˘ ¯ÚfiÓÈ·˜ Ó¢ÌÔÓÈ΋˜ ÓfiÛÔ˘ ÙˆÓ ÓÂÔÁÓÒÓ (10). ÀÔÏÔÁ›˙ÂÙ·È fiÙÈ 5-20% ÙˆÓ ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ Ì ۇӉÚÔÌÔ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜ Ô˘ ¯ÚÂÈ¿-

Paediatriki 2002;65:394-402

ÛÙËÎ·Ó Ì˯·ÓÈ΋ ˘ÔÛÙ‹ÚÈÍË Ù˘ ·Ó·ÓÔ‹˜, ·ÚÔ˘ÛÈ¿˙ÂÈ ¯ÚfiÓÈ· Ó¢ÌÔÓÈ΋ ÓfiÛÔ (11). ∆· ÓÂÔÁÓ¿ ·˘Ù¿ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·˘ÍË̤ÓË ıÓËÛÈÌfiÙËÙ· Î·È ÓÔÛËÚfiÙËÙ· ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÚÒÙÔ˘ ¯ÚfiÓÔ˘ Ù˘ ˙ˆ‹˜ (9,10). ¶ÂÚÈÛÛfiÙÂÚÔ ·fi 50% ÙˆÓ ÓÂÔÁÓÒÓ Ì ¯ÚfiÓÈ· Ó¢ÌÔÓÈ΋ ÓfiÛÔ ¯ÚÂÈ¿˙ÂÙ·È Â·ÓÂÈÛ·ÁˆÁ‹ ÛÙÔ ÓÔÛÔÎÔÌ›Ô, ΢ڛˆ˜ ÏfiÁˆ ÏÔÈÌÒÍÂˆÓ ÙÔ˘ ηÙÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ (9). OÈ ÏÔÈÌÒÍÂȘ ·fi ÙÔÓ ·Ó·Ó¢ÛÙÈÎfi Û˘Á΢ÙÈ·Îfi Èfi Â›Ó·È ÛÔ‚·Ú¤˜ ÛÙ· ‚Ú¤ÊË ·˘Ù¿ Î·È ÌÔÚ› Ó· ·Ô‚Ô‡Ó ·ÂÈÏËÙÈΤ˜ ÁÈ· ÙË ˙ˆ‹ ÙÔ˘˜ (12). °È· ÙÔ ÏfiÁÔ ·˘Ùfi, Û˘ÓÈÛÙ¿Ù·È Ë ÚÔʇϷÍË Ì ÙÔ ÂÍ·ÓıÚˆÔÔÈË̤ÓÔ ÌÔÓÔÎψÓÈÎfi ·Óٛۈ̷ ηٿ ÙÔ˘ ÈÔ‡ (13,14). °È· Ù· ÓÂÔÁÓ¿ ·˘Ù¿ Û˘ÓÈÛٿٷÈ, Â›Û˘, Ô ÂÌ‚ÔÏÈ·ÛÌfi˜ Ì ÙÔ ÂÌ‚fiÏÈÔ Ù˘ ÁÚ›˘ ÌÂÙ¿ ÙËÓ ËÏÈΛ· ÙˆÓ 6 ÌËÓÒÓ (4). ªÂ ÙËÓ ¿ÚÔ‰Ô ÙÔ˘ ¯ÚfiÓÔ˘, Ù· Û˘ÌÙÒÌ·Ù· Û˘Ó‹ıˆ˜ ˘Ê›ÂÓÙ·È. ¶·Ú’ fiÏÔ Ô˘ Î·È ÛÙÔ Ù¤ÏÔ˜ Ù˘ ÂÊË‚È΋˜ ËÏÈΛ·˜ Ù· ·È‰È¿ ·˘Ù¿ ÂÍ·ÎÔÏÔ˘ıÔ‡Ó Ó· ·ÚÔ˘ÛÈ¿˙Ô˘Ó Î¿ÔÈÔ˘ ‚·ıÌÔ‡ ‰È·Ù·Ú·¯‹ ÙˆÓ Ó¢ÌÔÓÈÎÒÓ ‰ÔÎÈÌ·ÛÈÒÓ, ÂÓÒ Û˘Ó‹ıˆ˜ Â›Ó·È ·Û˘Ìو̷ÙÈο, ÙÂÏÈο, Ì ÙËÓ ¿ÚÔ‰Ô Ù˘ ËÏÈΛ·˜, Ë Ó¢ÌÔÓÈ΋ ÏÂÈÙÔ˘ÚÁ›· ·Ôηı›ÛÙ·Ù·È ÛÙÔ Ê˘ÛÈÔÏÔÁÈÎfi (12). ∆Ô 44% ÙˆÓ ·È‰ÈÒÓ Ì ÈÛÙÔÚÈÎfi ‚ÚÔÁ¯ÔÓ¢ÌÔÓÈ΋˜ ‰˘ÛÏ·Û›·˜ ·ÚÔ˘ÛÈ¿˙ÂÈ ¿ÛıÌ· (15). ∆· Ó¢ÚÔ·Ó·Ù˘Íȷο ÚÔ‚Ï‹Ì¿Ù· ÙˆÓ ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ Ì ¯ÚfiÓÈ· Ó¢ÌÔÓÈ΋ ÓfiÛÔ Â›Ó·È ·˘ÍË̤ӷ, ηıÒ˜ Â›Û˘ Î·È ÔÈ Ì·ıËÛȷΤ˜ ‰˘ÛÎÔϛ˜ Î·È Ù· ÚÔ‚Ï‹Ì·Ù· Û˘ÌÂÚÈÊÔÚ¿˜ (12,16).

OÊı·ÏÌÔÏÔÁÈο ÚÔ‚Ï‹Ì·Ù· ∏ ·ÌÊÈ‚ÏËÛÙÚÔÂȉÔ¿ıÂÈ· Ù˘ ÚÔˆÚfiÙËÙ·˜ ·ÔÙÂÏ› ÙÔ Î‡ÚÈÔ Î·È ÛÔ‚·ÚfiÙÂÚÔ ÔÊı·ÏÌÔÏÔÁÈÎfi Úfi‚ÏËÌ· ÙˆÓ ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ. ∞ÔÙÂÏ› ‰È·Ù·Ú·¯‹ Ù˘ ·Ó¿Ù˘Í˘ ÙˆÓ ·ÁÁ›ˆÓ ÙÔ˘ ·ÌÊÈ‚ÏËÛÙÚÔÂȉ‹ ηٿ ÙË ÓÂÔÁÓÈ΋ ÂÚ›Ô‰Ô Î·È ·ÊÔÚ¿ Û ÓÂÔÁÓ¿ ÛÙ· ÔÔ›· ‰ÂÓ ¤¯ÂÈ ÔÏÔÎÏËÚˆı› Ë ·ÁÁ›ˆÛË ÙÔ˘ ¯ÈÙÒÓ· (2). ¢È¿ÊÔÚÔÈ ·Ú¿ÁÔÓÙ˜ ¤¯Ô˘Ó Û˘Û¯ÂÙÈÛÙ› Ì ÙËÓ ÚfiÎÏËÛË Ù˘ ‰È·Ù·Ú·¯‹˜, fiˆ˜ Â›Ó·È Ë ˘ÂÚÔÍ›·, Ë ¿ÓÔÈ·, Ë ˘ÂÚηÓ›·, Ë ˘ÔηÓ›·, Ë ˘ÔÍ›·, Ë ÔͤˆÛË, Ë ¤ÎıÂÛË Û ¤ÓÙÔÓÔ Êˆ˜, ηıÒ˜ Î·È ¿ÏÏÔÈ ·Ú¿ÁÔÓÙ˜ Ô˘ ÂËÚ¿˙Ô˘Ó ÙËÓ ·ÈÌ¿ÙˆÛË ÙÔ˘ ·ÌÊÈ‚ÏËÛÙÚÔÂȉԇ˜. øÛÙfiÛÔ, Û‹ÌÂÚ· Â›Ó·È ÁÓˆÛÙfi fiÙÈ Ô ÈÔ ÛËÌ·ÓÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ·ÌÊÈ‚ÏËÛÙÚÔÂȉÔ¿ıÂÈ·˜ Â›Ó·È Ë ÂÎÛÂÛËÌ·Ṳ̂ÓË ÚÔˆÚfiÙËÙ· (2). ∏ Û˘¯ÓfiÙËÙ¿ Ù˘ Â›Ó·È ·ÓÙ›ÛÙÚÔÊ· ·Ó¿ÏÔÁË Ù˘ ËÏÈΛ·˜ ·ËÛ˘ Î·È ÙÔ˘ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘, ÂÓÒ ˘ÔÏÔÁ›˙ÂÙ·È fiÙÈ ÙÔ 55-70% ÙˆÓ ¿Ú· Ôχ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ ÓÂÔÁÓÒÓ ·ÚÔ˘ÛÈ¿˙ÂÈ ·ÌÊÈ‚ÏËÛÙÚÔÂȉÔ¿ıÂÈ· Ù˘ ÚÔˆÚfiÙËÙ·˜ (2,17). ∆Ô 6-9,5% ·fi ·˘Ù¿ ·ÚÔ˘ÛÈ¿˙ÂÈ ÛÙ¿‰ÈÔ 3 Î·È 4 Ù˘ ÓfiÛÔ˘, ÂÓÒ ÙÔ 3-7,5% ÙˆÓ ÂÍ·ÈÚÂÙÈο ÌÈÎÚÔ‡ ‚¿ÚÔ˘˜ ÚÔÒÚˆÓ ÌÔÚ› Ó· Ô‰ËÁËı› Û هÊψÛË (17-19). øÛÙfiÛÔ, ·ÎfiÌ· Î·È Ù· ÓÂÔÁÓ¿ Ì ·ÌÊÈ‚ÏËÛÙÚÔÂȉÔ¿ıÂÈ· Ô˘ ˘Ô¯ÒÚËÛÂ, ‰È·ÙÚ¤¯Ô˘Ó ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ

395

NoV-dEc-02

14-05-03

14:26

™ÂÏ›‰·396

¶·È‰È·ÙÚÈ΋ 2002;65:394-402

ÁÈ· ‰È·ıÏ·ÛÙÈΤ˜ ·ÓˆÌ·Ï›Â˜, ·Ì‚Ï˘ˆ›· Î·È ÛÙÚ·‚ÈÛÌfi (2,20). ª˘ˆ›· ÂÌÊ·Ó›˙ÂÙ·È Û ·˘ÍË̤ÓÔ ÔÛÔÛÙfi ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ, Ô˘ ÍÂÂÚÓ¿ ÙÔ 30% ÁÈ· Ù· ÂÍ·ÈÚÂÙÈο ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓ¿ Î·È Â›Ó·È ·ÓÂÍ¿ÚÙËÙË ·fi ÙËÓ ÂÌÊ¿ÓÈÛË ·ÌÊÈ‚ÏËÛÙÚÔÂȉÔ¿ıÂÈ·˜ (2,20). ¶ÚÔ‚Ï‹Ì·Ù· ·ÎÔ‹˜ ∏ Â›ÙˆÛË ÛÔ‚·Ú‹˜ Ó¢ÚÔ·ÈÛıËÙ‹ÚÈ·˜ ‚·ÚËÎÔ˝·˜ ÂÎÙÈÌ¿Ù·È Û ÔÛÔÛÙfi 1-3% ÛÙ· ÚfiˆÚ· ÓÂÔÁÓ¿ (2,18). ¶·Ú¿ÁÔÓÙ˜ Ô˘ ı¤ÙÔ˘Ó Ù· ÓÂÔÁÓ¿ Û ΛӉ˘ÓÔ ·ÒÏÂÈ·˜ Ù˘ ·ÎÔ‹˜ Â›Ó·È Ë ˘ÔÍ›·, Ë ˘ÂÚ¯ÔÏÂÚ˘ıÚÈÓ·ÈÌ›·, ÔÈ ÏÔÈÌÒÍÂȘ, Ë ·ÛÙ·ı‹˜ ·ÚÙËÚȷ΋ ›ÂÛË, Ù· ˆÙÔÙÔÍÈο Ê¿Ú̷η Î·È Ô ıfiÚ˘‚Ô˜ ·fi ÙÔ ÂÚÈ‚¿ÏÏÔÓ Ù˘ ÌÔÓ¿‰·˜ ÂÓÙ·ÙÈ΋˜ ÓÔÛËÏ›·˜. O ıfiÚ˘‚Ô˜ Û ̛· ÌÔÓ¿‰· Î˘Ì·›ÓÂÙ·È ÌÂٷ͇ 70 dB Î·È 80 dB, ÂÓÒ ÔÈ ıÂÚÌÔÎÔÈÙ›‰Â˜ ÙÔÓ ÂÈÙ›ÓÔ˘Ó Ì¿ÏÏÔÓ ·Ú¿ ÙÔÓ ÌÂÈÒÓÔ˘Ó (21,22). ÀÔÛÙËÚ›˙ÂÙ·È fiÙÈ Ë ·ÓÒÚÈÌË Ì˘ÂϛӈÛË Ù˘ ·ÎÔ˘ÛÙÈ΋˜ Ô‰Ô‡ ·˘Í¿ÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ÙÔ˘ ÚfiˆÚÔ˘ ÓÂÔÁÓÔ‡ ÁÈ· ‚Ï¿‚Ë ·fi ıfiÚ˘‚Ô, ÂÓÒ Ë ¤ÎıÂÛË Û Â›‰· ıÔÚ‡‚Ô˘ ÌÂÁ·Ï‡ÙÂÚ· ·fi 80 dB ¤¯ÂÈ ÂÓÔ¯ÔÔÈËı› Û·Ó ·›ÙÈÔ ·ÒÏÂÈ·˜ ·ÎÔ‹˜ Û ÌÈÎÚ¿ ·È‰È¿ (8,21,22). ∏ ÂÏ·ÊÚ¿ ‚·ÚËÎÔ˝· Ô˘ ÚÔηÏ› ηı˘ÛÙ¤ÚËÛË ÛÙË ÁψÛÛÈ΋ ÂͤÏÈÍË, ·ÏÏ¿ Â›Ó·È Û˘Ì‚·Ù‹ Ì ÁψÛÛÈ΋ ÂÈÎÔÈÓˆÓ›·, Û˘Ì‚·›ÓÂÈ Û ÔÛÔÛÙfi 6-8% ÛÙ· ÚfiˆÚ· ÓÂÔÁÓ¿ (2). ∞˘ÍË̤ÓË Â›Ó·È Â›Û˘ Î·È Ë Û˘¯ÓfiÙËÙ· Ù˘ ¯ÚfiÓÈ·˜ ̤Û˘ ÔÚÒ‰Ô˘˜ ˆÙ›Ùȉ·˜ (20-30%) Î·È Ù˘ ‚·ÚËÎÔ˝·˜ ·ÁˆÁ‹˜ (2,23). À‡ı˘ÓË ıˆÚÂ›Ù·È Î¿ÔÈÔ˘ ‚·ıÌÔ‡ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Ù˘ ¢ÛÙ·¯È·Ó‹˜ Û¿ÏÈÁÁ·˜, ·fiÚÚÔÈ· Û˘Ó‰˘·ÛÌÔ‡ ‰ÔÏȯÔÎÂÊ·Ï›·˜, Ì˘˚΋˜ ˘ÔÙÔÓ›·˜ Î·È ·Ú·ÙÂٷ̤Ó˘ ÂÓ‰ÔÙÚ·¯Âȷ΋˜ ‰È·ÛˆÏ‹ÓˆÛ˘ (2). ∂ÈÏÔΤ˜ ÓÂÎÚˆÙÈ΋˜ ÂÓÙÂÚÔÎÔÏ›Ùȉ·˜ ∏ ÓÂÎÚˆÙÈ΋ ÂÓÙÂÚÔÎÔÏ›Ùȉ· ·ÔÙÂÏ› Ì›· Û¯ÂÙÈο Û˘¯Ó‹ ¿ıËÛË ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ ÙˆÓ ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ. ∆· ÔÛÔÛÙ¿ ÂÈ‚›ˆÛ˘ Î˘Ì·›ÓÔÓÙ·È ·fi 75% ¤ˆ˜ 80% (24). OÈ Û˘Ó‹ıÂȘ ÂÈÏÔΤ˜ Ù˘ ÓÂÎÚˆÙÈ΋˜ ÂÓÙÂÚÔÎÔÏ›Ùȉ·˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙÔ Û‡Ó‰ÚÔÌÔ ‚Ú·¯¤Ô˜ ÂÓÙ¤ÚÔ˘ Î·È ÙȘ ÛÙÂÓÒÛÂȘ. ™ÙÂÓÒÛÂȘ ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔ 10-35% ÙˆÓ ÓÂÔÁÓÒÓ Ô˘ ·Ó¿ÚÚˆÛ·Ó ·fi ÙË ÓfiÛÔ, ·ÊÔÚÔ‡Ó Û˘Ó‹ıˆ˜ ÛÙÔ ·¯‡ ¤ÓÙÂÚÔ Î·È ‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È ·fi ÙËÓ ÂԇψÛË Ì ۯËÌ·ÙÈÛÌfi Ô˘Ï‹˜ Û ÈÛ¯·ÈÌÈΤ˜ ÂÚÈÔ¯¤˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘ Ô˘ ‰ÂÓ ·ÚÔ˘Û›·Û·Ó Ú‹ÍË (24). OÈ ÛÙÂÓÒÛÂȘ ÔÏϤ˜ ÊÔÚ¤˜ Â›Ó·È ·Û˘Ìو̷ÙÈΤ˜. ∞ÔÙÂÏÔ‡Ó ÙËÓ ÈÔ Û˘¯Ó‹ ·ÈÙ›· Â›ÌÔÓ˘ ·ÈÌÔÚÚ·Á›·˜ ÂÙÈÎÔ‡ Û ‚Ú¤ÊË Ô˘ ·ÚÔ˘Û›·Û·Ó ÓÂÎÚˆÙÈ΋ ÂÓÙÂÚÔÎÔÏ›Ùȉ· (24,25).

OÈ ÛÙÂÓÒÛÂȘ, ÔÏϤ˜ ÊÔÚ¤˜, Ô‰ËÁÔ‡Ó Û Ï‹ÚË ‹, Û˘¯ÓfiÙÂÚ·, ·ÙÂÏ‹ ÂÓÙÂÚÈ΋ ·fiÊÚ·ÍË Ô˘ ÂΉËÏÒÓÂÙ·È Ì Â̤ÙÔ˘˜, ÌÂÙˆÚÈÛÌfi, Â›ÌÔÓË ‰˘ÛÎÔÈÏÈfiÙËÙ· Î·È fiÓÔ (24,25). O ΛӉ˘ÓÔ˜ Ù˘ ·fiÊڷ͢ ·˘Í¿ÓÂÈ ÛËÌ·ÓÙÈο fiÙ·Ó Ë ÓÂÎÚˆÙÈ΋

396

Paediatriki 2002;65:394-402

ÂÓÙÂÚÔÎÔÏ›Ùȉ· ¯ÚÂÈ¿˙ÂÙ·È ¯ÂÈÚÔ˘ÚÁÈ΋ ·ÓÙÈÌÂÙÒÈÛË, ÔfiÙÂ Â›Ó·È Èı·Ó‹ Ë ‰ËÌÈÔ˘ÚÁ›· ÌÂÙÂÁ¯ÂÈÚËÙÈÎÒÓ Û˘ÌʇÛˆÓ. ∞ӷʤÚÂÙ·È fiÙÈ ÙÔ˘Ï¿¯ÈÛÙÔÓ ÙÔ 5% ÙˆÓ ÓÂÔÁÓÒÓ Ô˘ ¯ÂÈÚÔ˘ÚÁ‹ıËÎ·Ó ÁÈ· ÓÂÎÚˆÙÈ΋ ÂÓÙÂÚÔÎÔÏ›Ùȉ· ÂΉËÏÒÓÂÈ ·fiÊÚ·ÍË ÂÓÙ¤ÚÔ˘ (24). ∆Ô Û‡Ó‰ÚÔÌÔ ‚Ú·¯¤Ô˜ ÂÓÙ¤ÚÔ˘ ·ÔÙÂÏ› ÙË ÛÔ‚·ÚfiÙÂÚË ÂÈÏÔ΋ Ù˘ ÓÂÎÚˆÙÈ΋˜ ÂÓÙÂÚÔÎÔÏ›Ùȉ·˜ Î·È ÂΉËÏÒÓÂÙ·È ÛÙÔ 20% ÂÚ›Ô˘ ÙˆÓ ÓÂÔÁÓÒÓ Ô˘ ˘¤ÛÙËÛ·Ó ¯ÂÈÚÔ˘ÚÁÈ΋ ·Ê·›ÚÂÛË ÙÌ‹Ì·ÙÔ˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘ (26). OÊ›ÏÂÙ·È Û ÌÂȈ̤ÓË ·ÔÚÚÔÊËÙÈ΋ ÂÈÊ¿ÓÂÈ·, ·ÓÂ¿ÚÎÂÈ· ÂÓ˙‡ÌˆÓ Î·È ˘ÂÚÎÈÓËÙÈÎfiÙËÙ· ÙÔ˘ ÂÓÙ¤ÚÔ˘ (8,27). O ‚·ıÌfi˜ Ù˘ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ ηıÔÚ›˙ÂÙ·È ·fi ÙËÓ ¤ÎÙ·ÛË Ù˘ ÂÓÙÂÚÂÎÙÔÌ‹˜, ÙÔ ÙÌ‹Ì· ÙÔ˘ ÂÓÙ¤ÚÔ˘ Ô˘ ·Ê·ÈÚ¤ıËÎÂ Î·È ÙË ‰È·Ù‹ÚËÛË ‹ fi¯È Ù˘ ÂÈÏÂÔÙ˘ÊÏÈ΋˜ ‚·Ï‚›‰·˜ (24). °ÂÓÈο, ÛËÌ·ÓÙÈ΋ ‰˘Û·ÔÚÚfiÊËÛË ÂΉËÏÒÓÂÙ·È ÌÂÙ¿ ·fi ¢Ú›· ÂÓÙÂÚÂÎÙÔÌ‹, fiÔ˘ ·Ê·ÈÚÂ›Ù·È ÂÚÈÛÛfiÙÂÚÔ ·fi ÙÔ 50% ÙÔ˘ ÏÂÙÔ‡ ÂÓÙ¤ÚÔ˘ (24,27). ∆· Û˘ÌÙÒÌ·Ù· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ‚Ú·¯¤Ô˜ ÂÓÙ¤ÚÔ˘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ¯ÚfiÓÈ· ‰È¿ÚÚÔÈ·, ‰˘Û·ÔÚÚfiÊËÛË Î·È Î·ı˘ÛÙ¤ÚËÛË Ù˘ ·Ó¿Ù˘Í˘. ∏ ¯Ú‹ÛË Ù˘ ÔÏÈ΋˜ ·ÚÂÓÙÂÚÈ΋˜ ‰È·ÙÚÔÊ‹˜ ¤¯ÂÈ ‚ÂÏÙÈÒÛÂÈ ÙËÓ ÚfiÁÓˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘, ‰ÈfiÙÈ ‰›ÓÂÙ·È ÙÔ ¯ÚÔÓÈÎfi ÂÚÈıÒÚÈÔ ÛÙÔ ÂÓÙÂÚÈÎfi ÎÔÏfi‚ˆÌ· Ó· ÚÔÛ·ÚÌÔÛÙ› ÚÔ¿ÁÔÓÙ·˜ ÙËÓ ÂÓÙÂÚÈ΋ ˘ÂÚÙÚÔÊ›·, ÙËÓ ÂÈÌ‹Î˘ÓÛË Î·È ‰È¿Ù·ÛË (27). ∏ ÚfiÁÓˆÛË Â›Ó·È Û¯ÂÙÈο ηϋ ·Ó ¤¯Ô˘Ó ·Ú·Ì›ÓÂÈ ·Ó¤·Ê· 20 cm ÏÂÙÔ‡ ÂÓÙ¤ÚÔ˘ ¯ˆÚ›˜ ÙËÓ ÂÈÏÂÔÙ˘ÊÏÈ΋ ‚·Ï‚›‰· ‹ 15 cm ·Ó ˘¿Ú¯ÂÈ Î·È Ë ‚·Ï‚›‰· (28). °·ÛÙÚÔÔÈÛÔÊ·ÁÈ΋ ·ÏÈÓ‰ÚfiÌËÛË ∂ÌÊ·Ó›˙ÂÙ·È Ì ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· ÛÙ· ÚfiˆÚ· ÓÂÔÁÓ¿ (12,21). ∂ΉËÏÒÓÂÙ·È Û˘Ó‹ıˆ˜ Ì Â̤ÙÔ˘˜ ̤۷ ÛÙȘ ‰‡Ô ÚÒÙ˜ ÒÚ˜ ·fi ÙÔ Á‡̷ (21). ™Â ÛÔ‚·Ú¤˜ ÂÚÈÙÒÛÂȘ ÌÔÚ› Ó· ÂÌÊ·ÓÈÛÙ› ·ÓÂ·Ú΋˜ ÚfiÛÏË„Ë ‚¿ÚÔ˘˜, ÔÈÛÔÊ·Á›Ùȉ· Î·È ÂÈÛÚfiÊËÛË, Ì ·ÔÙ¤ÏÂÛÌ· Ó¢ÌÔÓ›· ‹ Û˘ÚÈÁÌfi (12). ™ÙȘ ÂÈÏÔΤ˜ Ù˘ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È Î·È Ù· ÂÂÈÛfi‰È· ¿ÓÔÈ·˜ Î·È ‚Ú·‰˘Î·Ú‰›·˜ (21). ∏ Á·ÛÙÚÔÔÈÛÔÊ·ÁÈ΋ ·ÏÈÓ‰ÚfiÌËÛË Ú¤ÂÈ Ó· ÂÚÂ˘Ó¿Ù·È Û fiÏ· Ù· ÚfiˆÚ· Ì ÂÂÈÛfi‰È· ¿ÓÔÈ·˜ Ô˘ ÂÈ̤ÓÔ˘Ó ¤Ú· ·fi ÙËÓ 40‹ ‚‰ÔÌ¿‰· ·fi ÙË Û‡ÏÏË„Ë (21). ¶ÚÔ‚Ï‹Ì·Ù· Û›ÙÈÛ˘ ¶·Ú’ fiÏÔ Ô˘ Ë ‰˘ÛÎÔÏ›· ÛÙË Û›ÙÈÛË Â›Ó·È Û˘¯ÓfiÙÂÚË ÛÙË ÓÂÔÁÓÈ΋ ÂÚ›Ô‰Ô, ÔÏÏ¿ ÚfiˆÚ· ÓÂÔÁÓ¿ Û˘Ó¯›˙Ô˘Ó Î·È ÛÙË ‚ÚÂÊÈ΋ ËÏÈΛ· Ó· ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÚÔ‚Ï‹Ì·Ù· ıËÏ·ÛÌÔ‡ Î·È Î·Ù¿ÔÛ˘. ∆· ·ÓÙ·Ó·ÎÏ·ÛÙÈο Ù˘ ηٿÔÛ˘ Ô˘ ÂÈÙÚ¤Ô˘Ó ÙË Û›ÙÈÛË Î·È ÚÔÛÙ·ÙÂ‡Ô˘Ó ·fi ÙËÓ ÂÈÛÚfiÊËÛË, Èı·Ófiٷٷ ‰ÂÓ ÏÂÈÙÔ˘ÚÁÔ‡Ó Ê˘ÛÈÔÏÔÁÈο ÛÙ· ÚfiˆÚ· ÓÂÔÁÓ¿, ÌÂ Û˘Ó¤ÂÈ· ÙË ÌÂÁ¿ÏË ‰˘Û¯¤ÚÂÈ· ÛÙË Û›ÙÈÛË (28). ∞˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ Ó·

NoV-dEc-02

14-05-03

14:26

™ÂÏ›‰·397

¶·È‰È·ÙÚÈ΋ 2002;65:394-402

·ÓÙÈÌÂÙˆ›ÛÔ˘Ó Ù¤ÙÔÈ· ÚÔ‚Ï‹Ì·Ù· ‰È·ÙÚ¤¯Ô˘Ó Ù· ÚfiˆÚ· ÓÂÔÁÓ¿ Ô˘ ηı˘ÛÙ¤ÚËÛ·Ó Ó· ÛÈÙÈÛÙÔ‡Ó, ÓÂÔÁÓ¿ Ì Ó¢ÚÔÏÔÁÈÎfi ¤ÏÏÂÈÌÌ·, Ì ¯ÚfiÓÈ· ·Ó·Ó¢ÛÙÈ΋ ÓfiÛÔ ‹ Ì Á·ÛÙÚÔÔÈÛÔÊ·ÁÈ΋ ·ÏÈÓ‰ÚfiÌËÛË (28). ∏ Û›ÙÈÛË ÙˆÓ ÓÂÔÁÓÒÓ ·˘ÙÒÓ, ·fi ËÁ‹ ÈηÓÔÔ›ËÛ˘, Á›ÓÂÙ·È ËÁ‹ ¿Á¯Ô˘˜ Î·È ÂÎÓ¢ÚÈÛÌÔ‡, ÙfiÛÔ ÁÈ· Ù· ›‰È· Ù· ÓÂÔÁÓ¿ fiÛÔ Î·È ÁÈ· ÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘˜. ™‡Ó‰ÚÔÌÔ ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ ∆· ÚfiˆÚ· ÓÂÔÁÓ¿ ‚Ú›ÛÎÔÓÙ·È Û ÌÂÁ·Ï‡ÙÂÚÔ Î›Ó‰˘ÓÔ ·fi Ù· ÙÂÏÂÈfiÌËÓ· Ó· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó ÙÔ Û‡Ó‰ÚÔÌÔ ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ ÙˆÓ ‚ÚÂÊÒÓ (29,30). ¶¿Óˆ ·fi 18% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ·ÚÔ˘ÛÈ¿˙ÂÙ·È Û ÚfiˆÚ· ÓÂÔÁÓ¿. ¶·Ú’ fiÏÔ Ô˘ Ù· ÚfiˆÚ· ÓÂÔÁÓ¿ ÂÌÊ·Ó›˙Ô˘Ó Û˘¯Ó¿ ÂÂÈÛfi‰È· ¿ÓÔÈ·˜ Î·È ‚Ú·‰˘Î·Ú‰›·˜ ηٿ ÙËÓ ·Ú·ÌÔÓ‹ ÙÔ˘˜ ÛÙË ª∂¡, ÛÙ· Ï·›ÛÈ· Ù˘ ·ÓˆÚÈÌfiÙËÙ·˜, ‰ÂÓ ¤¯ÂÈ ·Ô‰Âȯı› οÔÈ· Û¯¤ÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Ì ÙËÓ ¿ÓÔÈ· Ù˘ ÚÔˆÚfiÙËÙ·˜ (29). ªÂÁ¿Ï˜ ÂȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜ ¤‰ÂÈÍ·Ó fiÙÈ Ë ¿ÓÔÈ· Ù˘ ÚÔˆÚfiÙËÙ·˜ ‰ÂÓ Â›Ó·È ÚԉȷıÂÛÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Î·È Ë ÂÓÙfiÈÛË ÙˆÓ ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ Û ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ‰ÂÓ Â›Ó·È ‰˘Ó·Ù‹ (29,31). ¡Â˘ÚÔ·Ó·Ù˘ÍȷΤ˜ ‰È·Ù·Ú·¯¤˜ ∆· ÌÈÎÚÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓ¿ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÔÈΛÏ˘ ‚·Ú‡ÙËÙ·˜ Ó¢ÚÔÏÔÁÈο Î·È „˘¯ÔÎÈÓËÙÈο ÚÔ‚Ï‹Ì·Ù·, ÛÂ Û˘¯ÓfiÙËÙ· Ô˘ Â›Ó·È ·ÓÙ›ÛÙÚÔÊ· ·Ó¿ÏÔÁË Ì ÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ (2). ∆· ÚÔ‚Ï‹Ì·Ù· ·˘Ù¿ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙËÓ ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË, ÙË ÓÔËÙÈ΋ ηı˘ÛÙ¤ÚËÛË, ÙÔ˘˜ Û·ÛÌÔ‡˜, ÙȘ ·ÈÛıËÙËÚȷΤ˜ ‰È·Ù·Ú·¯¤˜, ÙÔÓ ˘‰ÚÔΤʷÏÔ Î·È ÙȘ Ì·ıËÛȷΤ˜ ‰˘ÛÎÔϛ˜ (2). ·) ∂ÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË (Û·ÛÙÈ΋ ‰ÈÏËÁ›·, Û·ÛÙÈ΋ ÙÂÙÚ·ÏËÁ›·, Û·ÛÙÈ΋ ËÌÈÏËÁ›·). ∏ ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË Â›Ó·È Ë Û˘¯ÓfiÙÂÚË ·fi ÙȘ Ì›˙ÔÓ˜ ·Ó·Ëڛ˜ Ô˘ ·Ú·ÙËÚÔ‡ÓÙ·È ÛÙ· ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓ¿. ∏ Â›ÙˆÛ‹ Ù˘ Î˘Ì·›ÓÂÙ·È ÌÂٷ͇ 6-10%, ÂÓÒ ÙÔ 40% ÙˆÓ ·È‰ÈÒÓ Ì ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË Â›Ó·È ÚfiˆÚ· (2). ∆· Ôχ ÌÈÎÚÔ‡ ‚¿ÚÔ˘˜ ÚfiˆÚ· ‰È·ÙÚ¤¯Ô˘Ó 40 Ì 100 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚÔ Î›Ó‰˘ÓÔ ·fi Ù· Ê˘ÛÈÔÏÔÁÈÎÔ‡ ‚¿ÚÔ˘˜ ÓÂÔÁÓ¿ Î·È ·ÔÙÂÏÔ‡Ó ¿Óˆ ·fi ÙÔ 25% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÂÁÎÂÊ·ÏÈ΋˜ ·Ú¿Ï˘Û˘ (32). ∏ Â›ÙˆÛË Û ·˘Ù‹ ÙËÓ ÔÌ¿‰· ·Ó·Ê¤ÚÂÙ·È Û ÔÛÔÛÙfi 10-18% (17,18,33). ∏ Û·ÛÙÈ΋ ‰ÈÏËÁ›· Â›Ó·È Ô Û˘¯ÓfiÙÂÚÔ˜ Ù‡Ô˜ ÂÁÎÂÊ·ÏÈ΋˜ ·Ú¿Ï˘Û˘ Ô˘ ÂÌÊ·Ó›˙ÂÙ·È ÛÙ· ÚfiˆÚ· ÓÂÔÁÓ¿ Î·È ·ÔÙÂÏ› ÙËÓ ÎÏÈÓÈ΋ ¤ÎÊÚ·ÛË Ù˘ ÂÚÈÎÔÈÏȷ΋˜ Ï¢ÎÔ̷ϷΛ·˜ (2,34). ∏ ·ÂÈÎfiÓÈÛË Û Â·Ó·Ï·Ì‚·ÓfiÌÂÓ· ˘ÂÚ˯ÔÁÚ·Ê‹Ì·Ù· ·˘ÍË̤Ó˘ ˯ÔÁ¤ÓÂÈ·˜ ÂÚÈÎÔÈÏȷο Ô˘ ·ÎÔÏÔ˘ıÂ›Ù·È ·fi ÙÔ Û¯ËÌ·ÙÈÛÌfi ÌÂÁ¿ÏˆÓ ·ÌÊÔÙÂÚfiÏÂ˘ÚˆÓ Î‡ÛÙˆÓ, ηٿ 80-85% ÂΉËÏÒÓÂÙ·È Ì ÌfiÓÈÌË ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË ÙÔ˘

Paediatriki 2002;65:394-402

Ù‡Ô˘ Ù˘ Û·ÛÙÈ΋˜ ‰ÈÏËÁ›·˜ (2,35,36).

H Û·ÛÙÈ΋ ÙÂÙÚ·ÏËÁ›· ·ÊÔÚ¿ Î·È ÛÙ· Ù¤ÛÛÂÚ· ¿ÎÚ· Î·È Â›Ó·È Ë ÛÔ‚·ÚfiÙÂÚË ÌÔÚÊ‹ ÂÁÎÂÊ·ÏÈ΋˜ ·Ú¿Ï˘Û˘. ™˘Ó‹ıˆ˜, Â›Ó·È Û˘Ó¤ÂÈ· ÂÚÈÁÂÓÓËÙÈ΋˜ ·ÛÊ˘Í›·˜, ÂÎÛÂÛËÌ·Ṳ̂Ó˘ ·ÌÊÔÙÂÚfiÏ¢Ú˘ ÂÓ‰ÔÎÔÈÏȷ΋˜ ·ÈÌÔÚÚ·Á›·˜ ÌÂ Û˘ÓÔ‰fi ‰È¿Ù·ÛË ÙˆÓ ÎÔÈÏÈÒÓ, ·Ú·ÙÂÙ·Ì¤ÓˆÓ ÓÂÔÁÓÈÎÒÓ Û·ÛÌÒÓ ‹ Ïԛ̈͢ ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ (2). ∏ Û·ÛÙÈ΋ ËÌÈÏËÁ›·, Ô˘ Û˘Ó‹ıˆ˜ ·ÊÔÚ¿ ÂÚÈÛÛfiÙÂÚÔ ÛÙÔ ¯¤ÚÈ ·fi fi,ÙÈ ÛÙÔ fi‰È, Û˘¯Ó¿ Û˘Óԉ‡ÂÙ·È ·fi ˘ÂÚ˯ÔÁÚ·ÊÈ΋ ·ÂÈÎfiÓÈÛË ÂÙÂÚfiÏ¢ÚÔ˘ ÂÚÈÎÔÈÏÈ·ÎÔ‡ ·ÈÌÔÚÚ·ÁÈÎÔ‡ ¤ÌÊÚ·ÎÙÔ˘ Ô˘ ÂÍÂÏ›ÛÛÂÙ·È Û ·ÛÙË. ¡ÔËÙÈ΋ ˘ÛÙ¤ÚËÛË Û˘Óԉ‡ÂÈ Û ÌÂÁ¿ÏÔ ÔÛÔÛÙfi ÙË Û·ÛÙÈ΋ ÙÂÙÚ·ÏËÁ›·, ÂÓÒ ·È‰È¿ Ì Û·ÛÙÈ΋ ‰ÈÏËÁ›· Û˘¯Ó¿ ¤¯Ô˘Ó ÓÔËÌÔÛ‡ÓË Ê˘ÛÈÔÏÔÁÈ΋ ‹ ÔÚȷ΋ (2,9). ∏ ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË ÂΉËÏÒÓÂÙ·È Ì ÚÔԉ¢ÙÈÎfi ÙÚfiÔ (2). ¶Ôχ ÚÒÈÌ· Ó¢ÚÔÏÔÁÈο ÛËÌ›· ÔÏϤ˜ ÊÔÚ¤˜ ·Ô‰ÂÈÎÓ‡ÔÓÙ·È ·ÚÔ‰Èο, ÂÓÒ ·ÓÙ›ıÂÙ·, ‚Ú¤ÊË Ì ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË, ΢ڛˆ˜ ÙÔ˘ Ù‡Ô˘ Ù˘ Û·ÛÙÈ΋˜ ‰ÈÏËÁ›·˜ ‹ ËÌÈÏËÁ›·˜, ·Ú¯Èο Ê·›ÓÔÓÙ·È ·Û˘Ìو̷ÙÈο Ì ۯÂÙÈο Ê˘ÛÈÔÏÔÁÈ΋ Ó¢ÚÔÏÔÁÈ΋ ÂͤٷÛË Î·Ù¿ ÙËÓ ¤ÍÔ‰Ô ·fi ÙË ÌÔÓ¿‰· ‹ Î·È ÙÔ˘˜ ÚÒÙÔ˘˜ Ì‹Ó˜ ˙ˆ‹˜. ∆· ÓÂÔÁÓ¿ Ô˘ ·Ó·Ù‡ÛÛÔ˘Ó ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË ·ÚÔ˘ÛÈ¿˙Ô˘Ó Û˘Ó¯Ҙ ·˘Í·ÓfiÌÂÓ˜ ·ÓˆÌ·Ï›Â˜ ÙÔ˘ Ì˘˚ÎÔ‡ ÙfiÓÔ˘, Ù˘ ÛÙ¿Û˘ ÙÔ˘ ÛÒÌ·ÙÔ˜ Î·È ÙˆÓ ·ÓÙ·Ó·ÎÏ·ÛÙÈÎÒÓ, ȉȷ›ÙÂÚ· ÌÂٷ͇ ÙÔ˘ 6Ô˘ Î·È ÙÔ˘ 18Ô˘ Ì‹Ó· ˙ˆ‹˜ (2,9). ‚) ¡ÔËÙÈ΋ ˘ÛÙ¤ÚËÛË. ∏ ÓÔËÙÈ΋ ˘ÛÙ¤ÚËÛË (ÓÔËÙÈÎfi ËÏ›ÎÔ ÂÚÈÛÛfiÙÂÚÔ ·fi ‰‡Ô ÛÙ·ıÂÚ¤˜ ·ÔÎÏ›ÛÂȘ οو ·fi ÙË Ì¤ÛË ÙÈÌ‹, ÁÈ· ÙË ‰ÈÔÚıˆÌ¤ÓË ËÏÈΛ·) Û˘¯Ó¿ Û˘Ó˘¿Ú¯ÂÈ Ì ̛· ¿ÏÏË Ì›˙ÔÓ· Ó¢ÚÔÏÔÁÈ΋ ‰È·Ù·Ú·¯‹, Û˘¯ÓfiÙÂÚ· Ì ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË. ¶·Ú·ÙËÚÂ›Ù·È Û ÔÛÔÛÙfi 4-5% ÙˆÓ Ôχ ÌÈÎÚÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓÒÓ Ô˘ ·Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·È Ì¤¯ÚÈ ÙË Û¯ÔÏÈ΋ ËÏÈΛ· (2). Á) ªÂı·ÈÌÔÚÚ·ÁÈÎfi˜ ˘‰ÚÔΤʷÏÔ˜. ¶·Ú’ fiÏÔ Ô˘ ÙÔ 25-45% ÙˆÓ Ôχ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓÒÓ ·ÚÔ˘ÛÈ¿˙ÂÈ ˘ÂÚ˯ÔÁÚ·ÊÈο Â˘Ú‹Ì·Ù· ÂÓ‰ÔÎÚ¿ÓÈ·˜ ·ÈÌÔÚÚ·Á›·˜, Ô ÌÂı·ÈÌÔÚÚ·ÁÈÎfi˜ ÚÔԉ¢ÙÈÎfi˜ ˘‰ÚÔΤʷÏÔ˜ Ô˘ ¯ÚÂÈ¿˙ÂÙ·È ÎÔÈÏÈÔÂÚÈÙÔÓ·˚΋ ·ÚÔ¯¤Ù¢ÛË ·Ú·ÙËÚÂ›Ù·È Û 2-4% ÙˆÓ ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ (2). O ˘‰ÚÔΤʷÏÔ˜ ÂÌÊ·Ó›˙ÂÙ·È Û˘Ó‹ıˆ˜ Û ËÏÈΛ· 2-8 ‚‰ÔÌ¿‰ˆÓ Î·È Û˘Óԉ‡ÂÙ·È Û˘¯Ó¿ ·fi ·ıÔÏÔÁÈ΋ Ó¢ÚÔ·Ó·Ù˘Íȷ΋ ÂͤÏÈÍË (2). ‰) ∂Ï¿ÛÛÔÓ˜ ‰È·Ù·Ú·¯¤˜. ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ¤¯ÂÈ ‰Ôı› ÌÂÁ·Ï‡ÙÂÚË ÚÔÛÔ¯‹ Û ۯÂÙÈο ËÈfiÙÂÚ˜ ‰È·Ù·Ú·¯¤˜ Ô˘ ·ÊÔÚÔ‡Ó ÛÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ ÏfiÁÔ˘, ÙËÓ ÈÛÔÚÚÔ›·, ÙÔÓ ÔÙÈÎÔÎÈÓËÙÈÎfi Û˘ÓÙÔÓÈÛÌfi Î·È ÙȘ ·ÓÙÈÏËÙÈΤ˜ ÈηÓfiÙËÙ˜. ¶·Ú’ fiÏÔ Ô˘ Ù· ·ÔÙÂϤÛÌ·Ù· Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ù·

397

NoV-dEc-02

14-05-03

14:26

™ÂÏ›‰·398

¶·È‰È·ÙÚÈ΋ 2002;65:394-402

ÚfiˆÚ· Û ÓÔËÙÈΤ˜ ‰ÔÎÈ̷ۛ˜ ÌÔÚ› Ó· Â›Ó·È ÛÙ· Ï·›ÛÈ· ÙÔ˘ Ê˘ÛÈÔÏÔÁÈÎÔ‡, ÔÈ ÂȉfiÛÂȘ ÛÙÔ Û¯ÔÏÂ›Ô ˘ÛÙÂÚÔ‡Ó Û ÛËÌ·ÓÙÈÎfi ‚·ıÌfi Û ۯ¤ÛË Ì ٷ ÌÂÁ·Ï‡ÙÂÚ· ÚfiˆÚ· Î·È Ù· ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿ (9,21,37,38). OÈ ‰È·Ù·Ú·¯¤˜ Û˘Ó·ÈÛı‹Ì·ÙÔ˜ Î·È Û˘ÌÂÚÈÊÔÚ¿˜ ›ӷÈ, Â›Û˘, ·˘ÍË̤Ó˜ ÛÙ· ÌÈÎÚÔ‡ ‚¿ÚÔ˘˜ ÚfiˆÚ· ÓÂÔÁÓ¿ Î·È ÂÌÊ·Ó›˙ÔÓÙ·È ‰‡Ô Ì ¤ÓÙ ÊÔÚ¤˜ Û˘¯ÓfiÙÂÚ· Û ۯ¤ÛË Ì ٷ ÙÂÏÂÈfiÌËÓ· (39). ∆· ÚÔ‚Ï‹Ì·Ù· ·˘Ù¿ Á›ÓÔÓÙ·È ·ÓÙÈÏËÙ¿ Û ÌÂÁ·Ï‡ÙÂÚË ËÏÈΛ· Î·È Û¯ÂÙ›˙ÔÓÙ·È Ì ̷ıËÛȷΤ˜ ‰˘ÛÎÔϛ˜. ∆Ô ÔÛÔÛÙfi ÙˆÓ ‰È·Ù·Ú·¯ÒÓ ·˘Í¿ÓÂÙ·È ·ÓÙ›ÛÙÚÔÊ· Ì ÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ Î·È Â›Ó·È ÌÂÁ·Ï‡ÙÂÚÔ ÛÙ· ·ÁfiÚÈ·. ∏ Â›ÙˆÛ‹ ÙÔ˘˜ Î˘Ì·›ÓÂÙ·È ·fi 15-25%, ÂÓÒ ÛÙËÓ ÔÌ¿‰· ÙˆÓ Ôχ ÌÈÎÚÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓÒÓ, ÙÔ ÔÛÔÛÙfi Ô˘ ¯ÚÂÈ¿˙ÂÙ·È ÂȉÈ΋ ÂÎ·›‰Â˘ÛË ÛÙË Û¯ÔÏÈ΋ ËÏÈΛ· ·Ó·Ê¤ÚÂÙ·È Ì¤¯ÚÈ Î·È 50% (21). ∂ÈϤÔÓ, ‰È·ÈÛÙÒıËΠfiÙÈ ÚfiˆÚ· ÓÂÔÁÓ¿ ¯ˆÚ›˜ Ì›˙ÔÓ· ÚÔ‚Ï‹Ì·Ù·, fiÙ·Ó Û˘ÁÎÚ›ÓÔÓÙ·È Ì ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿ ÛÙËÓ ›‰È· ËÏÈΛ·, ˘ÛÙÂÚÔ‡Ó Î˘Ú›ˆ˜ ÛÙȘ ‰ÔÎÈ̷ۛ˜ Ô˘ ·ÊÔÚÔ‡Ó ÛÙÔÓ ÔÙÈÎÔÎÈÓËÙÈÎfi Û˘ÓÙÔÓÈÛÌfi Î·È ÙȘ Ì·ıËÌ·ÙÈΤ˜ ÈηÓfiÙËÙ˜ (38). ∆Ô Û‡Ó‰ÚÔÌÔ ‰È¿Û·Û˘ Ù˘ ÚÔÛÔ¯‹˜ Î·È ˘ÂÚÎÈÓËÙÈÎfiÙËÙ·˜ Â›Ó·È ÛËÌ·ÓÙÈο ·˘ÍË̤ÓÔ (3 Ì 5 ÊÔÚ¤˜) ÛÙ· ÚfiˆÚ· ÓÂÔÁÓ¿ (ÂÚ›Ô˘ 15%) Û ۯ¤ÛË Ì ÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi (21,37). ∏ ÚÔˆÚfiÙËÙ· Î·È Ë Û˘ÓÂ·ÎfiÏÔ˘ıË Î·ı˘ÛÙ¤ÚËÛË ÛÙËÓ ˆÚ›Ì·ÓÛË, ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙË Ì·ÎÚ¿ ·Ú·ÌÔÓ‹ ÙÔ˘ ÓÂÔÁÓÔ‡ ÛÙË ª∂¡, ‰˘Û¯ÂÚ·›ÓÔ˘Ó ÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ Ê˘ÛÈÔÏÔÁÈÎÔ‡ ‰ÂÛÌÔ‡ Î·È Ù˘ ıÂÙÈ΋˜ ·ÏÏËÏÂ›‰Ú·Û˘ ÙÔ˘ ÚÔÒÚÔ˘ Ì ÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘ Î·È Èı·Ó¿ Û˘Ì‚¿ÏÏÔ˘Ó ÛÙË ‰ËÌÈÔ˘ÚÁ›· ÙˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ ·˘ÙÒÓ. Â) ¶·ÚÔ‰Èο Ó¢ÚÔÏÔÁÈο ÚÔ‚Ï‹Ì·Ù·. ∆· ÚfiˆÚ· ÓÂÔÁÓ¿ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Û ÔÛÔÛÙfi 4080% ·ÚÔ‰Èο ·ıÔÏÔÁÈο Ó¢ÚÔÏÔÁÈο Â˘Ú‹Ì·Ù·, fiˆ˜ ‰È·Ù·Ú·¯¤˜ ÙÔ˘ Ì˘˚ÎÔ‡ ÙfiÓÔ˘, Ô˘ ÂΉËÏÒÓÂÙ·È Ì Ùˆ¯fi ¤ÏÂÁ¯Ô Ù˘ ÎÂÊ·Ï‹˜, ·ÓÂ·Ú΋ ÛÙ‹ÚÈÍË Ù˘ Ï¿Ù˘ ÛÙËÓ ËÏÈΛ· ÙˆÓ 4-8 ÌËÓÒÓ ‹ Ì ÂÏ·ÊÚ¿ ·˘ÍË̤ÓÔ Ì˘˚Îfi ÙfiÓÔ ÙˆÓ ¿Óˆ ¿ÎÚˆÓ (9). ∆· Â˘Ú‹Ì·Ù· ·˘Ù¿ Û˘Ó‹ıˆ˜ ˘Ô¯ˆÚÔ‡Ó ÛÙÔ Ù¤ÏÔ˜ ÙÔ˘ ÚÒÙÔ˘ ¯ÚfiÓÔ˘ ‹ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‰Â‡ÙÂÚÔ˘ ¯ÚfiÓÔ˘ (9). øÛÙfiÛÔ, Ù· ·È‰È¿ Ô˘ ·ÚÔ˘Û›·Û·Ó ·ÚÔ‰Èο Ó¢ÚÔÏÔÁÈο ÚÔ‚Ï‹Ì·Ù· ·Ó·Ê¤ÚÂÙ·È fiÙÈ ·ÚÁfiÙÂÚ· ÌÔÚ› Ó· ÂΉËÏÒÛÔ˘Ó ÛËÌ›· ÂÏ¿ÛÛÔÓÔ˜ ÂÁÎÂÊ·ÏÈ΋˜ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·˜ (9). ™ˆÌ·ÙÈ΋ ·Ó¿Ù˘ÍË ∆· ÓÂÔÁÓ¿ Ì ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ ÌÈÎÚfiÙÂÚÔ ·fi 1500 g ·ÚÔ˘ÛÈ¿˙Ô˘Ó Û ÌÂÁ¿ÏÔ ÔÛÔÛÙfi Ùˆ¯‹ ۈ̷ÙÈ΋ ·Ó¿Ù˘ÍË Î·Ù¿ ÙË ÓÂÔÁÓÈ΋ ÂÚ›Ô‰Ô Ô˘ Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ·ÓÂ·Ú΋ ıÂÚÌȉÈ΋ Î¿Ï˘„Ë Î·Ù¿ ÙËÓ ·Ú¯È΋ Ê¿ÛË Ù˘ ÓÔÛËÏ›·˜ ÙÔ˘˜ ηÈ, ÛÙË Û˘Ó¤¯ÂÈ·, Ì ‰˘Û·ÓÂÍ›· ÛÙË Û›ÙÈÛË, ηıÒ˜ ηÈ

398

Paediatriki 2002;65:394-402

Ì ‰È¿ÊÔÚ· ¯ÚfiÓÈ· ÚÔ‚Ï‹Ì·Ù· Ô˘ Ô‰ËÁÔ‡Ó Û ·˘ÍË̤Ó˜ ıÂÚÌȉÈΤ˜ ·Ó¿ÁΘ (9). ¶ÚfiˆÚ· ÓÂÔÁÓ¿ ÌÂ Û˘ÌÙÒÌ·Ù· ‰˘Û·ÔÚÚfiÊËÛ˘ ÌÂÙ¿ ·fi ÓÂÎÚˆÙÈ΋ ÂÓÙÂÚÔÎÔÏ›Ùȉ· ‹ Û˘¯ÓÔ‡˜ Â̤ÙÔ˘˜ ·fi Á·ÛÙÚÔÔÈÛÔÊ·ÁÈ΋ ·ÏÈÓ‰ÚfiÌËÛË ¤¯Ô˘Ó ·˘ÍË̤Ó˜ ·ÒÏÂȘ Î·È ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·ÓÂ·Ú΋ ÚfiÛÏË„Ë ‚¿ÚÔ˘˜ (28). ¡ÂÔÁÓ¿ Ì ÔÈÛÔÊÔÁ›Ùȉ· ÏfiÁˆ Á·ÛÙÚÔÔÈÛÔÊ·ÁÈ΋˜ ·ÏÈÓ‰ÚfiÌËÛ˘ ‹ Ì Ó¢ÚÔÏÔÁÈÎfi ¤ÏÏÂÈÌÌ· ·ÚÔ˘ÛÈ¿˙Ô˘Ó ‰˘Û¯¤ÚÂÈ· ÛÙË Û›ÙÈÛË Î·È Î·Î‹ ۈ̷ÙÈ΋ ·Ó¿Ù˘ÍË (28). ∫·ıÒ˜ Ù· ÚÔ‚Ï‹Ì·Ù· ·˘Ù¿ ˘Ô¯ˆÚÔ‡Ó Ì ÙËÓ ¿ÚÔ‰Ô ÙÔ˘ ¯ÚfiÓÔ˘, Ù· ÌÈÎÚ¿ ÚfiˆÚ· ·Ú¯›˙Ô˘Ó Ó· ·Ó·Ù‡ÛÛÔÓÙ·È Ù·¯‡ÙÂÚ· Î·È Û˘Ó‹ıˆ˜ ÂÈÙ˘Á¯¿ÓÔ˘Ó ÈηÓÔÔÈËÙÈο ۈ̷ÙÔÌÂÙÚÈο ÛÙÔȯ›· ·ÚÁfiÙÂÚ· ÛÙËÓ ·È‰È΋ ËÏÈΛ· (9,28,40). ∆Ô Úfi‚ÏËÌ· Ù˘ Ùˆ¯‹˜ ۈ̷ÙÈ΋˜ ·Ó¿Ù˘Í˘ Â›Ó·È ÂÓÙÔÓfiÙÂÚÔ ÁÈ· Ù· ÓÂÔÁÓ¿ Ì ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ ÌÈÎÚfiÙÂÚÔ ·fi 1000 g (9). ∆· ÓÂÔÁÓ¿ ·˘Ù¿ ·Ó·Ù‡ÛÛÔÓÙ·È Ì ·ÚÁfi Ú˘ıÌfi ηٿ Ù· ÚÒÙ· ¯ÚfiÓÈ· Ù˘ ˙ˆ‹˜ ÙÔ˘˜, Ô˘ fï˜ ÂÈÙ·¯‡ÓÂÙ·È Ì ÙËÓ ¿ÚÔ‰Ô ÙÔ˘ ¯ÚfiÓÔ˘ Î·È ÊÙ¿ÓÔ˘Ó ÛÂ Ê˘ÛÈÔÏÔÁÈο Â›‰· ‚¿ÚÔ˘˜ Î·È ‡„Ô˘˜ ÏËÛÈ¿˙ÔÓÙ·˜ ÙËÓ ÂÊ˂›· (9,41). ¶ÚÔ‚Ï‹Ì·Ù· Û¯ÂÙÈο Ì ÙËÓ Î·ıËÌÂÚÈÓ‹ ÊÚÔÓÙ›‰· ÙÔ˘ ÓÂÔÁÓÔ‡ ∆Ô ÚfiˆÚÔ ÓÂÔÁÓfi, ·ÎfiÌ· Î·È fiÙ·Ó Û˘ÌÏËÚÒÛÂÈ ÙȘ 40 ‚‰ÔÌ¿‰Â˜ ·fi ÙË Û‡ÏÏË„Ë, Ê·›ÓÂÙ·È fiÙÈ ‰ÂÓ ¤¯ÂÈ ÙËÓ ˆÚÈÌfiÙËÙ· ÙÔ˘ Ê˘ÛÈÔÏÔÁÈÎÔ‡ ÙÂÏÂÈfiÌËÓÔ˘ ÓÂÔÁÓÔ‡ (8). Œ¯ÂÈ ‚ÚÂı› Ì›· ‰È·ÊÔÚ¿ ÛÙË Ì˘ÂϛӈÛË Ù˘ Ê·È¿˜ Î·È Ù˘ Ï¢΋˜ Ô˘Û›·˜, ηıÒ˜ Î·È ÛÙË ÌÂÙ·‚ÔÏÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· ÌÂٷ͇ ·˘ÙÒÓ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ÓÂÔÁÓÒÓ Î·È Ê·›ÓÂÙ·È fiÙÈ Ù· ÚfiˆÚ· ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ì›· ‰ÔÌÈ΋, ·ÏÏ¿ Î·È ÏÂÈÙÔ˘ÚÁÈ΋ ηı˘ÛÙ¤ÚËÛË ÛÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ (42). ∆· ÚfiˆÚ· ÓÂÔÁÓ¿ ¤¯Ô˘Ó ÂÏ·Ùو̤ÓÔ Ì˘˚Îfi ÙfiÓÔ Î·È ·ÛÙ·ı¤˜ ·Ú·Û˘Ì·ıËÙÈÎfi Û‡ÛÙËÌ· Ô˘ ·ÓÙ·Ó·ÎÏ¿Ù·È Û ¤ÓÙÔÓ˜ ÌÂÙ·‚ÔϤ˜ ÛÙÔ ¯ÚÒÌ· ÙÔ˘ ‰¤ÚÌ·ÙÔ˜, ÛÙÔÓ Î·Ú‰È·Îfi Ú˘ıÌfi Î·È ÛÙË Û˘¯ÓfiÙËÙ· ·Ó·ÓÔ‹˜ Î·È ‰ËÌÈÔ˘ÚÁ› Ì›· ·›ÛıËÛË ·ÓˆÚÈÌfiÙËÙ·˜ Î·È Â˘ıÚ·˘ÛÙfiÙËÙ·˜ ÛÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘˜ (8). ∏ Û¯ÂÙÈ΋ ·˘Ù‹ ·ÓˆÚÈÌfiÙËÙ· ÙÔ˘ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÂΉËÏÒÓÂÙ·È Ì ̛· ‰È·ÊÔÚÂÙÈ΋ Û˘ÌÂÚÈÊÔÚ¿ ÙfiÛÔ ÛÙÔÓ ‡ÓÔ, fiÛÔ Î·È ÛÙÔ ÎÏ¿Ì· Î·È ÛÙËÓ ·ÓÙ·fiÎÚÈÛË ÛÙ· ‰È¿ÊÔÚ· ÂÚÂı›ÛÌ·Ù· (2,4,8). ∆· ÙÂÏÂÈfiÌËÓ· ‚Ú¤ÊË ÌÔÚÔ‡Ó Û˘Ó‹ıˆ˜ Ó· ÎÔÈÌËıÔ‡Ó Û˘Ó¯Ҙ ÁÈ· 6 Ì 8 ÒÚ˜, ·fi ÙËÓ ËÏÈΛ· ÙˆÓ 4 ÌËÓÒÓ. ∞˘ÙfiÓ ÙÔÓ Û˘Ó¯‹ ‡ÓÔ, Ù· ÚfiˆÚ· ÙÔÓ ÂÈÙ˘Á¯¿ÓÔ˘Ó ·ÚÁfiÙÂÚ·, ÌÂÙ¿ ÙË ‰ÈÔÚıˆÌ¤ÓË ËÏÈΛ· ÙˆÓ 6 ÌËÓÒÓ (8). ∏ ‰˘Ó·ÙfiÙËÙ· ÂÁÚ‹ÁÔÚÛ˘ Â›Ó·È ÌÂȈ̤ÓË. ∆Ô ÎÏ¿Ì· ÙÔ˘˜ Â›Ó·È Û˘¯ÓfiÙÂÚÔ, ÈÔ ¤ÓÙÔÓÔ Î·È ·ÚËÁÔÚÔ‡ÓÙ·È ÈÔ ‰‡ÛÎÔÏ· ·fi Ù· ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿ (4,8). OÈ Û˘ÓËıÈṲ̂ÓÔÈ ÙÚfiÔÈ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡Ó ÔÈ ÁÔÓ›˜ ÁÈ· Ó· ·ÚËÁÔÚ‹ÛÔ˘Ó ¤Ó· ̈Úfi, ÔÈ ÔÔ›ÔÈ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ¤Ó· Û˘Ó‰˘·ÛÌfi ·ÙÈÎÒÓ Î·È

NoV-dEc-02

14-05-03

14:26

™ÂÏ›‰·399

¶·È‰È·ÙÚÈ΋ 2002;65:394-402

·ÎÔ˘ÛÙÈÎÒÓ ÂÚÂıÈÛÌ¿ÙˆÓ, Û˘¯Ó¿ ¤¯Ô˘Ó ÙÔ ·ÓÙ›ıÂÙÔ ·ÔÙ¤ÏÂÛÌ· ÛÙÔ ÚfiˆÚÔ. ∂›Ó·È Èı·Ófi Ó· ·ÔÛ˘ÓÙÔÓ›˙ÂÙ·È ÙÔ ·ÓÒÚÈÌÔ ‚Ú¤ÊÔ˜ ·fi ÙËÓ ÏËıÒÚ· ÙˆÓ ·ÈÛıËÙËÚÈ·ÎÒÓ ÂÚÂıÈÛÌ¿ÙˆÓ, Ì ·ÔÙ¤ÏÂÛÌ· Ó· Á›ÓÂÙ·È ÂÚÈÛÛfiÙÂÚÔ ·Ó‹Û˘¯Ô Ì ÙÔ˘˜ Û˘ÓËıÈṲ̂ÓÔ˘˜ ¯ÂÈÚÈÛÌÔ‡˜ ÙˆÓ ÁÔÓ¤ˆÓ (8). ™Ù· ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿ ·Ó·ÁÓˆÚ›˙ÔÓÙ·È ¤ÍÈ Â›‰· ÂÁÚ‹ÁÔÚÛ˘ ·fi ÙÔ ‚·ı‡ ‡ÓÔ Ì¤¯ÚÈ ÙÔ ¤ÓÙÔÓÔ ÎÏ¿Ì·. ∏ ÌÂÙ·‹‰ËÛË ·fi ÙÔ ¤Ó· Â›Â‰Ô ÛÙÔ ¿ÏÏÔ Á›ÓÂÙ·È Ì ¤Ó· Û˘Ó¯‹ Î·È Û¯ÂÙÈο ÚԂϤ„ÈÌÔ ÙÚfiÔ, Ì ·ÔÙ¤ÏÂÛÌ· Ó· ÌÂÈÒÓÂÙ·È ÙÔ ¿Á¯Ô˜ ÙˆÓ ÁÔÓ¤ˆÓ (8). ™Ù· ÚfiˆÚ·, ·ÓÙ›ıÂÙ·, Ë ÌÂÙ·‹‰ËÛË Á›ÓÂÙ·È Ì ¤Ó·Ó ·Úfi‚ÏÂÙÔ ÙÚfiÔ, ·fi Ì›· ηٿÛÙ·ÛË ÂÁÚ‹ÁÔÚÛ˘, Â› ·Ú·‰Â›ÁÌ·ÙÈ, Û ‚·ı‡ ‡ÓÔ ‹ Û ¤ÓÙÔÓÔ ÎÏ¿Ì·, Í·ÊÓÈο, ¯ˆÚ›˜ ÂӉȿÌÂÛ˜ ηٷÛÙ¿ÛÂȘ (8). ∏ ·ÓÔÚÁ¿ÓˆÙË ·˘Ù‹ Û˘ÌÂÚÈÊÔÚ¿ ÌÔÚ› Ó· ÂÈ̤ÓÂÈ Ì¤¯ÚÈ Î·È ÙË ‰ÈÔÚıˆÌ¤ÓË ËÏÈΛ· ÙˆÓ 6 ÌËÓÒÓ Î·È Ó· ·ÔÙÂÏ› ËÁ‹ ¤ÓÙÔÓÔ˘ ¿Á¯Ô˘˜ Î·È ·Ó·ÛÊ¿ÏÂÈ·˜ ÛÙÔ˘˜ ÁÔÓ›˜ (2,8). ¶·Ú·ÎÔÏÔ‡ıËÛË ÙÔ˘ ÚfiˆÚÔ˘ ÓÂÔÁÓÔ‡ ∆· ÔÈΛϷ ÚÔ‚Ï‹Ì·Ù· ÙˆÓ ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ ··ÈÙÔ‡Ó ·Ú·ÎÔÏÔ‡ıËÛË ·fi ÔÌ¿‰· ÂȉÈÎÒÓ, Ô˘ ı· Ù· ÂÓÙÔ›ÛÂÈ ¤ÁηÈÚ· Î·È ı· Ù· ·ÓÙÈÌÂÙˆ›ÛÂÈ Î·Ù¿ÏÏËÏ·. ∏ ȉ·ÓÈ΋ ÔÌ¿‰· ·Ú·ÎÔÏÔ‡ıËÛ˘ ÂÚÈÏ·Ì‚¿ÓÂÈ ·È‰ÔÓ¢ÚÔÏfiÁÔ, ·È‰›·ÙÚÔ Ì ÂÍÂȉ›Î¢ÛË ÛÙËÓ ·Ó·Ù˘Íȷ΋ ·È‰È·ÙÚÈ΋, ÔÊı·ÏÌ›·ÙÚÔ, ˆÙÔÚÈÓÔÏ·Ú˘ÁÁÔÏfiÁÔ, Ê˘ÛÈÎÔıÂÚ·Â˘Ù‹, ÂÚÁ·ÛÈÔıÂÚ·Â˘Ù‹, ÏÔÁÔıÂÚ·Â˘Ù‹ Î·È „˘¯ÔÏfiÁÔ (2). ∏ ·Ú·ÎÔÏÔ‡ıËÛË fiÏˆÓ ÙˆÓ ÓÂÔÁÓÒÓ Ô˘ ÓÔÛËχÔÓÙ·È ÛÙË ª∂¡ Â›Ó·È Ú·ÎÙÈο ·‰‡Ó·ÙË, ÁÈ’ ·˘Ùfi ηıÔÚ›˙ÔÓÙ·È ÎÚÈÙ‹ÚÈ· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ÂÈÏÔÁ‹ ÙˆÓ ÓÂÔÁÓÒÓ Ô˘ ı· ÂÓÙ·¯ıÔ‡Ó ÛÙÔ ÚfiÁÚ·ÌÌ· ·Ú·ÎÔÏÔ‡ıËÛ˘. ∆· ÌÈÎÚÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓ¿ Â›Ó·È Ì›· ÌÂÁ¿ÏË ÔÌ¿‰· Ô˘ ¯ÚÂÈ¿˙ÂÙ·È ·Ú·ÎÔÏÔ‡ıËÛË, ˆÛÙfiÛÔ, ÙÔ fiÚÈÔ ‚¿ÚÔ˘˜ ηıÔÚ›˙ÂÙ·È ·Ó¿ÏÔÁ· Î·È Ì ÙȘ ‰˘Ó·ÙfiÙËÙ˜ ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ·Ú·ÎÔÏÔ‡ıËÛ˘ (<1250 g, <1200 g ‹ ·ÎfiÌ· Î·È <1000 g) (2). ™ÙÔ ÚfiÁÚ·ÌÌ· ÂÓÙ¿ÛÛÔÓÙ·È Î·È ÌÂÁ·Ï‡ÙÂÚ· ÓÂÔÁÓ¿ Ì ÛÔ‚·ÚÔ‡˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ (ÏÈÔ‚·Ú‹, ÓÂÔÁÓ¿ Ì ÂÚÈÁÂÓÓËÙÈ΋ ·ÛÊ˘Í›·, ‚ÚÔÁ¯ÔÓ¢ÌÔÓÈ΋ ‰˘ÛÏ·Û›·, ÛÔ‚·Ú‹ ÂÓ‰ÔÎÚ¿ÓÈ· ·ÈÌÔÚÚ·Á›·, Ïԛ̈ÍË ÎÂÓÙÚÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, ÔÏÏ·Ϥ˜ Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜) (2). ∏ ‰È¿ÚÎÂÈ· Ù˘ ·Ú·ÎÔÏÔ‡ıËÛ˘ ÔÈΛÏÂÈ. ∂Âȉ‹ Ù· Ó¢ÚÔÏÔÁÈο ÂÏÏ›ÌÌ·Ù· ÔÏϤ˜ ÊÔÚ¤˜ ‰ÂÓ Â›Ó·È ÂÌÊ·Ó‹ ÛÙËÓ ÚÒÙË ‚ÚÂÊÈ΋ ËÏÈΛ·, Ë ÂÎÙ›ÌËÛË ÙÔ˘Ï¿¯ÈÛÙÔÓ Ù· ‰‡Ô ÚÒÙ· ¯ÚfiÓÈ· ˙ˆ‹˜ Â›Ó·È ··Ú·›ÙËÙË (2,9,23). ∏ ·Ú¯È΋ ÂͤٷÛË Ú¤ÂÈ Ó· Á›ÓÂÙ·È 8-10 Ë̤Ú˜ ÌÂÙ¿ ÙËÓ ¤ÍÔ‰Ô ·fi ÙÔ ÓÔÛÔÎÔÌ›Ô. ∏ ÂͤٷÛË ·˘Ù‹ ÛÎÔfi ¤¯ÂÈ ÙËÓ ÂÎÙ›ÌËÛË Ù˘ ÚÔÛ·ÚÌÔÁ‹˜ ÙÔ˘ ÚfiˆÚÔ˘ ÓÂÔÁÓÔ‡ ÛÙÔ ÂÚÈ‚¿ÏÏÔÓ ÙÔ˘

Paediatriki 2002;65:394-402

ÛÈÙÈÔ‡ (9). ∏ ÂfiÌÂÓË ÂͤٷÛË Á›ÓÂÙ·È ÛÙË ‰ÈÔÚıˆÌ¤ÓË ËÏÈΛ· ÙˆÓ 4 ÌËÓÒÓ. ™ÙËÓ ËÏÈΛ· ·˘Ù‹ ÌÔÚ› Ó· ÂÎÙÈÌËı› ·ÊÂÓfi˜ Ë Î·Ï‹ ۈ̷ÙÈ΋ ·Ó¿Ù˘ÍË ÙÔ˘ ‚Ú¤ÊÔ˘˜ Î·È ·ÊÂÙ¤ÚÔ˘ Ó· ÂÓÙÔÈÛÙÔ‡Ó ÛÔ‚·Ú¤˜ Ó¢ÚÔÏÔÁÈΤ˜ ‰È·Ù·Ú·¯¤˜ Î·È Ó· ·ÓÙÈÌÂÙˆÈÛÙÔ‡Ó Î·Ù¿ÏÏËÏ· (2,9). ™ÙËÓ ·ÍÈÔÏfiÁËÛË Ù˘ ۈ̷ÙÈ΋˜ ·Ó¿Ù˘Í˘ ÙÔ˘ ‚Ú¤ÊÔ˘˜ ¯ÚËÛÈÌÔÔÈÂ›Ù·È Ë ‰ÈÔÚıˆÌ¤ÓË ËÏÈΛ· ̤¯ÚÈ Ù· 2,5 ¯ÚfiÓÈ· ÂÚ›Ô˘. ∏ ËÏÈΛ· ÙˆÓ 8 ÌËÓÒÓ Â›Ó·È Î·Ù¿ÏÏËÏË ÁÈ· Ó· ÂȂ‚·Èˆı› Ë ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË ‹ ¿ÏϘ Ó¢ÚÔÏÔÁÈΤ˜ ‰È·Ù·Ú·¯¤˜ Î·È Ó· ‰Ôı› Ì›· ·Ú¯È΋ ·Ó·Ù˘Íȷ΋ ÂÎÙ›ÌËÛË (9). ™ÙÔ Ù¤ÏÔ˜ ÙÔ˘ ‰Â‡ÙÂÚÔ˘ ¯ÚfiÓÔ˘ (18-24 Ì‹Ó˜), Ù· ·ÚÔ‰Èο Ó¢ÚÔÏÔÁÈο ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù· ¤¯Ô˘Ó ˘Ô¯ˆÚ‹ÛÂÈ Î·È ÌÔÚ› Ó· Á›ÓÂÈ Ì›· ÂÎÙ›ÌËÛË Ù˘ ÓÔËÙÈ΋˜ ·Ó¿Ù˘Í˘ ÙÔ˘ ‚Ú¤ÊÔ˘˜. ™ÙËÓ ËÏÈΛ· ÙˆÓ 3 ÂÙÒÓ ÌÔÚ› Ó· ÂÏÂÁ¯ı› Ë ·Ó¿Ù˘ÍË ÙÔ˘ ÏfiÁÔ˘ Î·È Ë ·Ó·Ù˘Íȷ΋ ÂÎÙ›ÌËÛË Â›Ó·È ÈÔ ·ÍÈfiÈÛÙË. ™ÙËÓ ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ· (4-5 ¤ÙË) ÂϤÁ¯ÔÓÙ·È ‹È· Ó¢ÚÔÏÔÁÈο Î·È ÔÙÈÎÔÎÈÓËÙÈο ÚÔ‚Ï‹Ì·Ù·, ηıÒ˜ Î·È ÚÔ‚Ï‹Ì·Ù· Û˘ÌÂÚÈÊÔÚ¿˜ (2,9). °È· ÙËÓ ·ÍÈÔÏfiÁËÛË ÙˆÓ ·Ó·Ù˘ÍÈ·ÎÒÓ ‰ÔÎÈÌ·ÛÈÒÓ Â›Ó·È ÛÎfiÈÌÔ Ó· ¯ÚËÛÈÌÔÔÈÂ›Ù·È Ë ‰ÈÔÚıˆÌ¤ÓË ËÏÈΛ· ÛÙ· ÚfiˆÚ· ÓÂÔÁÓ¿, ̤¯ÚÈ ÙËÓ ËÏÈΛ· ÙˆÓ 3 ¯ÚfiÓˆÓ (2). ¶·Ú¿ÏÏËÏ·, Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÔÊı·ÏÌÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ Û fiÏ· Ù· ÓÂÔÁÓ¿ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ Î·È Ó· Â·Ó·Ï·Ì‚¿ÓÂÙ·È ÛÙËÓ ËÏÈΛ· ÙˆÓ 12-24 ÌËÓÒÓ (9). ∞ÎÔÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜, Ì ·Ú·Ù‹ÚËÛË Ù˘ ·˘ÙfiÌ·Ù˘ ·ÓÙ·Ó·ÎÏ·ÛÙÈ΋˜ ·ÓÙ›‰Ú·Û˘ ÙÔ˘ ÓÂÔÁÓÔ‡ Û ‰È¿ÊÔÚÔ˘˜ ‹¯Ô˘˜ ‹, ηχÙÂÚ·, Ì ·ÎÔ˘ÛÙÈο ÚÔÎÏËÙ¿ ‰˘Ó·ÌÈο ÙÔ˘ ÂÁÎÂÊ·ÏÈÎÔ‡ ÛÙÂϤ¯Ô˘˜, Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÚÈÓ ÙËÓ ¤ÍÔ‰Ô ·fi ÙË ÌÔÓ¿‰· (9). ∏ ·ÎÔ‹ Ú¤ÂÈ Ó· Â·ÓÂÍÂÙ¿˙ÂÙ·È ÛÙËÓ ËÏÈΛ· ÙˆÓ 12-24 ÌËÓÒÓ (9). ∏ ÔÌ¿‰· ·Ú·ÎÔÏÔ‡ıËÛ˘ ȉ·ÓÈο ÂÚÈÏ·Ì‚¿ÓÂÈ, Â›Û˘, ÎÔÈÓˆÓÈ΋ ÏÂÈÙÔ˘ÚÁfi Î·È „˘¯ÔÏfiÁÔ Ô˘ Â›Ó·È ÂÈÊÔÚÙÈṲ̂ÓÔÈ Ì ÙËÓ ÂÓË̤ڈÛË, ˘ÔÛÙ‹ÚÈÍË Î·È Î·ıÔ‰‹ÁËÛË ÙˆÓ ÁÔÓ¤ˆÓ. ¶ÚfiÁÓˆÛË ∏ Ì›ˆÛË Ù˘ ıÓËÙfiÙËÙ·˜, Ô˘ ·ÊÔÚ¿ ΢ڛˆ˜ ÛÙ· Ôχ ÌÈÎÚÔ‡ ‚¿ÚÔ˘˜ ÓÂÔÁ¤ÓÓËÙ·, ‰ÂÓ Ê·›ÓÂÙ·È Ó· Û˘Óԉ‡ÂÙ·È ·fi ·Ó¿ÏÔÁË Ì›ˆÛË Ù˘ ÓÔÛËÚfiÙËÙ·˜ (1,43). OÈ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÁ·Û›Â˜ Û˘ÌʈÓÔ‡Ó fiÙÈ Ë ÓÔÛËÚfiÙËÙ· ¤¯ÂÈ Ì›ÓÂÈ Û¯ÂÙÈο ÛÙ·ıÂÚ‹ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, ·Ú’ fiÏÔ Ô˘ ¤Ó·˜ ÛËÌ·ÓÙÈο ·˘ÍË̤ÓÔ˜ ·ÚÈıÌfi˜ ÌÈÎÚÒÓ Î·È Â˘·›ÛıËÙˆÓ ÓÂÔÁÓÒÓ ÂÈ˙› Î·È ·Ú·Ï·Ì‚¿ÓÂÙ·È ·fi ÙÔ˘˜ ÁÔÓ›˜ (7). ÀÔÏÔÁ›˙ÂÙ·È fiÙÈ ÁÈ· οı ·È‰› Ì ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË Ô˘ ÂÈ‚ÈÒÓÂÈ ¯¿ÚË ÛÙË ‚ÂÏÙ›ˆÛË Ù˘ ÂÚÈÁÂÓÓËÙÈ΋˜ ÊÚÔÓÙ›‰·˜, ·ÓÙÈÛÙÔÈ¯Ô‡Ó 11 ˘ÁÈ‹ ÚfiˆÚ· ÓÂÔÁÓ¿. ™Â ·fiÏ˘ÙÔ˘˜ ·ÚÈıÌÔ‡˜ ˘ÔÏÔÁ›˙ÂÙ·È, Ì ‚¿ÛË ÙȘ ÁÂÓÓ‹ÛÂȘ ÙÔ˘ 1984 Î·È Ù· ÛËÌÂÚÈÓ¿ ÔÛÔÛÙ¿ ÂÈ‚›ˆÛ˘, fiÙÈ ÛÙȘ

399

NoV-dEc-02

14-05-03

14:26

™ÂÏ›‰·400

¶·È‰È·ÙÚÈ΋ 2002;65:394-402

∏¶∞ ÂÈ‚ÈÒÓÔ˘Ó 2200 ·Ó¿ËÚ· ÓÂÔÁÓ¿ Ô˘ Ì ٷ ‰Â‰Ô̤ӷ ÙÔ˘ 1975 ı· ›¯·Ó Âı¿ÓÂÈ Î·È 15200 ÚfiˆÚ· ˘ÁÈ‹ ÓÂÔÁÓ¿, Ù· ÔÔ›· Â›Û˘ ‰ÂÓ ı· ›¯·Ó ÂÈ‚ÈÒÛÂÈ (21). ¶ÈÔ Û˘ÁÎÂÎÚÈ̤ӷ, ˘ÔÏÔÁ›˙ÂÙ·È fiÙÈ ÁÈ· Ù· Ôχ ÌÈÎÚÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓ¿, ÙÔ 50-60% ı· ¤¯ÂÈ Î·Ï‹ ÚfiÁÓˆÛË Î·È ÙÔ 40-50% ı· ¤¯ÂÈ Î¿ÔÈÔ˘ ‚·ıÌÔ‡ ·Ó·ËÚ›·, Ô˘ Î˘Ì·›ÓÂÙ·È ·fi ̤ÙÚÈ· (20-30%) ̤¯ÚÈ ÛÔ‚·Ú‹ (ÂÚ›Ô˘ 20%) (9,21,44). ∂¿Ó ‚¤‚·È· ÏËÊıÔ‡Ó ˘’ fi„ÈÓ ÔÈ Ì·ıËÛȷΤ˜ ‰˘ÛÎÔϛ˜ Î·È Ù· ÚÔ‚Ï‹Ì·Ù· Û˘ÌÂÚÈÊÔÚ¿˜ Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È Û ·˘ÍË̤ӷ ÔÛÔÛÙ¿ ÛÙ· Ôχ ÚfiˆÚ· ÓÂÔÁÓ¿, Ù· ÔÛÔÛÙ¿ ·ÏÏ¿˙Ô˘Ó. ∂ÎÙÈÌ¿Ù·È fiÙÈ ¤Ó· ÛËÌ·ÓÙÈÎfi ÔÛÔÛÙfi ÙˆÓ Ôχ ÌÈÎÚÒÓ ÚÔÒÚˆÓ Ô˘ Î˘Ì·›ÓÂÙ·È ·fi 40% ̤¯ÚÈ 50% ¯ÚÂÈ¿˙ÂÙ·È ÂȉÈ΋ ÂÎ·›‰Â˘ÛË (21,37,43). ∆· ÂÍ·ÈÚÂÙÈο ÌÈÎÚÔ‡ ‚¿ÚÔ˘˜ ÓÂÔÁÓ¿ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·˘ÍË̤ӷ ÔÛÔÛÙ¿ ·Ó·ËÚ›·˜. ¡ÂÔÁÓ¿ Ì ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ <750 g Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó ÛÙË Û¯ÔÏÈ΋ ËÏÈΛ· ˆ˜ ÚÔ˜ ÙȘ ηıËÌÂÚÈÓ¤˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜, ·ÚÔ˘Û›·˙·Ó Û ÔÛÔÛÙfi 86% οÔÈÔ˘ ‚·ıÌÔ‡ ÌÂÈÔÓÂÍ›·, ÂÓÒ ÛÔ‚·Ú‹ ·Ó·ËÚ›· ‰È·ÈÛÙÒÓÂÙ·È ÛÙÔ 25% ÙˆÓ Ôχ ·ÓÒÚÈÌˆÓ ·˘ÙÒÓ ÓÂÔÁÓÒÓ (18,43). ∏ ÚfiÁÓˆÛË Â›Ó·È ·Ô‰ÂÎÙfi fiÙÈ Â›Ó·È ·ÓÙ›ÛÙÚÔÊ· ·Ó¿ÏÔÁË Ì ÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ Î·È ÙËÓ ËÏÈΛ· ·ËÛ˘ (7,21). øÛÙfiÛÔ, Ê·›ÓÂÙ·È fiÙÈ ÔÈ ‰‡Ô ·˘ÙÔ› ·Ú¿ÁÔÓÙ˜ ‰ÂÓ ·ÚÎÔ‡Ó ÁÈ· Ó· ηıÔÚ›ÛÔ˘Ó ÙËÓ ÚfiÁÓˆÛË ÙˆÓ ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ. ∏ ‚ÚÔÁ¯ÔÓ¢ÌÔÓÈ΋ ‰˘ÛÏ·Û›·, Ë ÂÚÈÎÔÈÏȷ΋ Ï¢ÎÔ̷ϷΛ·, Ë ÛÔ‚·Ú‹ ÂÓ‰ÔÎÔÈÏȷ΋ ·ÈÌÔÚÚ·Á›· Î·È Ë ÂÚÈÁÂÓÓËÙÈ΋ ·ÛÊ˘Í›· Â›Ó·È ·Ú¿ÁÔÓÙ˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÊÙˆ¯‹ Ó¢ÚÔ·Ó·Ù˘Íȷ΋ ÂͤÏÈÍË (7,21,44). ¶·Ú¿ÏÏËÏ·, ÔÈ ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎÔ› ·Ú¿ÁÔÓÙ˜ Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÙËÓ ÚfiÁÓˆÛË (1,7,21). º·›ÓÂÙ·È fiÙÈ Ù· ÛÔ‚·Ú¿ Ó¢ÚÔÌ˘˚ο ÚÔ‚Ï‹Ì·Ù·, Ë ÛÔ‚·Ú‹ ÓÔËÙÈ΋ ηı˘ÛÙ¤ÚËÛË Î·È ÔÈ ·ÈÛıËÙËÚȷΤ˜ ‰È·Ù·Ú·¯¤˜ Û¯ÂÙ›˙ÔÓÙ·È Î˘Ú›ˆ˜ Ì ÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ Î·È Ù· ÛÔ‚·Ú¿ ÂÚÈÁÂÓÓËÙÈο ÚÔ‚Ï‹Ì·Ù·, ÂÓÒ ÔÈ Ì·ıËÛȷΤ˜ ‰˘ÛÎÔϛ˜, Ù· ÚÔ‚Ï‹Ì·Ù· Û˘ÌÂÚÈÊÔÚ¿˜ Î·È Ë ÂÏ·ÊÚ¿ ÓÔËÙÈ΋ ηı˘ÛÙ¤ÚËÛË Û¯ÂÙ›˙ÔÓÙ·È ÏÈÁfiÙÂÚÔ Ì ÂÚÈÁÂÓÓËÙÈÎÔ‡˜ Î·È ÂÚÈÛÛfiÙÂÚÔ Ì ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ (7,39,45). µÂÏÙ›ˆÛË Ù˘ „˘¯ÔÎÈÓËÙÈ΋˜ ÂͤÏÈ͢ ¶·Ú¿ ÙËÓ ÂÓı·ÚÚ˘ÓÙÈ΋ ·Ú·Ù‹ÚËÛË fiÙÈ Ë Ì›ˆÛË Ù˘ ÂÚÈÁÂÓÓËÙÈ΋˜ ıÓËÙfiÙËÙ·˜ ÙˆÓ Ôχ ÌÈÎÚÒÓ ÚÔÒÚˆÓ ‰ÂÓ Â¤ÊÂÚ ·‡ÍËÛË Ù˘ ·ÒÙÂÚ˘ ÓÔÛËÚfiÙËÙ·˜, ˆÛÙfiÛÔ, ÙÔ ÔÛÔÛÙfi ÙˆÓ ·È‰ÈÒÓ Ì οÔÈÔ˘ ‚·ıÌÔ‡ ·Ó·ËÚ›· ·Ú·Ì¤ÓÂÈ ˘„ËÏfi. ªÂ ‰Â‰Ô̤ÓÔ ÙËÓ Ï·ÛÙÈÎfiÙËÙ· ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ ÛÙËÓ ÚÒÙË ·È‰È΋ ËÏÈΛ·, Â›Ó·È Î·Ù·ÓÔË-

400

Paediatriki 2002;65:394-402

Ùfi fiÙÈ Ë ÚÒÈÌË ·Ú¤Ì‚·ÛË ÛÙ· ÓÂÔÁÓ¿ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ı· ‚ÂÏÙÈÒÛÂÈ Ù· ·ÒÙÂÚ· ·ÔÙÂϤÛÌ·Ù· ÁÈ· Ù· ÓÂÔÁÓ¿ ·˘Ù¿ (21). °È· ÙÔ ÏfiÁÔ ·˘Ùfi, Â›Ó·È ÛËÌ·ÓÙÈ΋ ÁÈ· ÙËÓ ÚfiÁÓˆÛË ÙÔ˘ ÚfiˆÚÔ˘ ÓÂÔÁÓÔ‡ Ë Û˘ÛÙËÌ·ÙÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË ·fi ÔÌ¿‰·, ·ÏÏ¿ Î·È Ë Â˘·ÈÛıËÙÔÔ›ËÛË ÙÔ˘ ·È‰È¿ÙÚÔ˘ ÁÈ· ÙËÓ ¤ÁηÈÚË ÂÓÙfiÈÛË Ó¢ÚÔÏÔÁÈ΋˜ ‹ ·Ó·Ù˘Íȷ΋˜ ‰È·Ù·Ú·¯‹˜ (21). ¶·Ú¿ÏÏËÏ·, ‰È¿ÊÔÚ˜ Ê·Ú̷΢ÙÈΤ˜ Ô˘Û›Â˜ (ÈÓ‰ÔÌÂı·Î›ÓË, ¯·ÌËϤ˜ ‰fiÛÂȘ Ê·ÈÓÔ‚·Ú‚ÈÙ¿Ï˘, ıÂÈÈÎfi Ì·ÁÓ‹ÛÈÔ) Ô˘ ¯ÔÚËÁÔ‡ÓÙ·È ÚÔÁÂÓÓËÙÈο, ·Ó·Ê¤ÚÂÙ·È fiÙÈ ÌÂÈÒÓÔ˘Ó ÙËÓ Â›ÙˆÛË Ù˘ ÂÁÎÂÊ·ÏÈ΋˜ ·ÈÌÔÚÚ·Á›·˜ Î·È ÚÔÛÙ·ÙÂ‡Ô˘Ó ·fi ÙËÓ ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË (21,32, 46). øÛÙfiÛÔ, η̛· ·fi ·˘Ù¤˜ ‰ÂÓ ·ÔÙÂÏ› ÚÔ˜ ÙÔ ·ÚfiÓ ÙÂÎÌËÚȈ̤ÓË, ÚÔÊ˘Ï·ÎÙÈ΋ ÁÈ· ÙÔ ÓÂÔÁÓfi, ıÂÚ·›·. ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ¤¯ÂÈ ·Ó·ÁÓˆÚÈÛÙ› Ë Û˘Û¯¤ÙÈÛË ·Ó¿ÌÂÛ· ÛÙÔ ¿Á¯Ô˜ Î·È ÙË Ó¢ÚÔ·Ó·Ù˘Íȷ΋ ÂͤÏÈÍË ÙÔ˘ ÓÂÔÁÓÔ‡ (7,21,38). ∏ ÂÚ›Ô‰Ô˜ ·fi ÙËÓ 24Ë Â‚‰ÔÌ¿‰· ̤¯ÚÈ ÙËÓ 3840‹ ‚‰ÔÌ¿‰· ıˆÚÂ›Ù·È ÂÍ·ÈÚÂÙÈο ¢·›ÛıËÙË, ÁÈ·Ù› ÔÈ Ó¢ÚÒÓ˜ ˘Ê›ÛÙ·ÓÙ·È ÛËÌ·ÓÙÈΤ˜ ‰ÔÌÈΤ˜ Î·È ÏÂÈÙÔ˘ÚÁÈΤ˜ ‰È·ÊÔÚÔÔÈ‹ÛÂȘ οو ·fi ÙËÓ Â›‰Ú·ÛË ÙˆÓ ÂÈÛÂÚ¯fiÌÂÓˆÓ ÛËÌ¿ÙˆÓ Î·È Ô ÊÏÔÈfi˜ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ ·ÔÎÙ¿ ÙË Ê˘ÛÈÔÏÔÁÈ΋ ÙÔ˘ ÔÚÁ¿ÓˆÛË (7,47). O ÚfiˆÚÔ˜ ÙÔÎÂÙfi˜ ‰È·ÎfiÙÂÈ ÙË Ê˘ÛÈÔÏÔÁÈ΋ ‰È·‰Èηۛ· Ù˘ ÔÚÁ¿ÓˆÛ˘ Î·È ·ÔÌ·ÎÚ‡ÓÂÈ ÙÔÓ ·ÓÒÚÈÌÔ ÔÚÁ·ÓÈÛÌfi ·fi ÙÔ ÊÈÏÈÎfi ÂÓ‰ÔÌ‹ÙÚÈÔ ÂÚÈ‚¿ÏÏÔÓ. ∆Ô ·Ó·ÙÔÌÈο Î·È ÏÂÈÙÔ˘ÚÁÈο ·ÓÒÚÈÌÔ Ó¢ÚÈÎfi Û‡ÛÙËÌ· ÙÔ˘ Ôχ ÚfiˆÚÔ˘ ÓÂÔÁÓÔ‡ Â›Ó·È ·Ó›Î·ÓÔ Ó· ¤¯ÂÈ Ì›· ÔÚÁ·ÓˆÌ¤ÓË ·ÔÙÂÏÂÛÌ·ÙÈ΋ ·¿ÓÙËÛË ÛÙÔ Â͈̋ÙÚÈÔ ÂÚÈ‚¿ÏÏÔÓ (7,21). ∆Ô ÓÂÔÁÓfi ¤¯ÂÈ Ó· ·ÓÙÈÌÂÙˆ›ÛÂÈ ÙÔ ÎÚ‡Ô, ÙÔ Êˆ˜, ÙÔ ıfiÚ˘‚Ô, ÙÔÓ fiÓÔ Î·È ÙȘ ‰È¿ÊÔÚ˜ ıÂÚ·¢ÙÈΤ˜ Î·È ‰È·ÁÓˆÛÙÈΤ˜ Ú·ÎÙÈΤ˜ Ù˘ ª∂¡, ·Ú¿ÁÔÓÙ˜ Ô˘ ÙÔ˘ ‰ËÌÈÔ˘ÚÁÔ‡Ó ¿Á¯Ô˜ (7). ∂›Ó·È Èı·Ófi, ÔÈ Ó¢ÚÔ·Ó·Ù˘ÍȷΤ˜ ‰È·ÊÔÚ¤˜ Ô˘ ·Ú·ÙËÚÔ‡ÓÙ·È ÛÙ· ·È‰È¿ Ô˘ ÁÂÓÓ‹ıËÎ·Ó ÚfiˆÚ· Ó· ·ÓÙÈÚÔÛˆÂ‡Ô˘Ó ‰Â˘ÙÂÚÔÁÂÓ›˜ ÙÚÔÔÔÈ‹ÛÂȘ Î·È ·Ó·ÚÔÛ·ÚÌÔÁ¤˜ Ù˘ ·Ó¿Ù˘Í˘ Î·È ÔÚÁ¿ÓˆÛ˘ ÙÔ˘ ÊÏÔÈÔ‡ ·fi Ù· ÂÚÂı›ÛÌ·Ù· ÙÔ˘ Â͈̋ÙÚÈÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ (47). ∏ ÚÔÛ¿ıÂÈ· ‚ÂÏÙÈÛÙÔÔ›ËÛ˘ ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜, ÛÙÔ ÔÔ›Ô ÙÔ ÚfiˆÚÔ ÓÂÔÁÓfi ÂÎÙ¤ıËΠÚÒÈÌ·, Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ‚ÔËı‹ÛÂÈ ÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ ¢·ıÔ‡˜ ÂÁÎÂÊ¿ÏÔ˘ Î·È Ó· ‚ÂÏÙÈÒÛÂÈ ÙËÓ ÚfiÁÓˆÛË (21). ∞˘Ùfi ÌÔÚ› Ó· ÂÈÙ¢¯ı› ÌÂ ÙˆÓ ÂÚÈÔÚÈÛÌfi ÙˆÓ ·Á¯ÔÁfiÓˆÓ ÂÚÂıÈÛÌ¿ÙˆÓ, ÙËÓ ·Ó·ÁÓÒÚÈÛË ÙÔ˘ ¿Á¯Ô˘˜ ÛÙÔ ÓÂÔÁÓfi Î·È ÙËÓ ÙÚÔÔÔ›ËÛË ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ ·Ó¿ÏÔÁ· (7,21,48). ª¤Û· ÛÙË ÌÔÓ¿‰· ÂÓÙ·ÙÈ΋˜ ÓÔÛËÏ›·˜ ÓÂÔÁÓÒÓ, Ë Ó¢ÚÔ·Ó·Ù˘Íȷ΋ ÊÚÔÓÙ›‰· ÌÔÚ› Ó· ÂÊ·ÚÌÔÛÙ› Ì ÙÚÔÔÔ›ËÛË ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜, ‰ËÏ·‰‹ Ì ÚÔÛ¿ıÂÈ· ÂÚÈÔÚÈÛÌÔ‡ ÙÔ˘ ıÔÚ‡‚Ô˘,

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™ÂÏ›‰·401

¶·È‰È·ÙÚÈ΋ 2002;65:394-402

ÙÔ˘ ¤ÓÙÔÓÔ˘ ʈÙfi˜, ÙˆÓ ÔÏÏÒÓ ¯ÂÈÚÈÛÌÒÓ Î·È Ù˘ ‰È·ÎÔ‹˜ ÙÔ˘ ‡ÓÔ˘ ÙÔ˘ ÚfiˆÚÔ˘ ÓÂÔÁÓÔ‡, Ì ÙË ¯Ú‹ÛË È›Ï·˜, Ì ÙËÓ ÚÔ·ÁˆÁ‹ Ù˘ Û˘ÌÌÂÙÔ¯‹˜ ÙˆÓ ÁÔÓ¤ˆÓ ÛÙË ÊÚÔÓÙ›‰· ÙÔ˘ ÚfiˆÚÔ˘ ·È‰ÈÔ‡ ÙÔ˘˜ Î·È ÛÙËÓ ·Ó·ÁÓÒÚÈÛË ÙˆÓ ·Ó·ÁÎÒÓ ÙÔ˘ (7,21). ∆· ·ÔÙÂϤÛÌ·Ù· ·fi ÂÈÚ·Ì·ÙÈ΋ ÂÊ·ÚÌÔÁ‹ Ó¢ÚÔ·Ó·Ù˘Íȷ΋˜ ÊÚÔÓÙ›‰·˜ ÛÙ· ÚfiˆÚ· ÓÂÔÁÓ¿ Â›Ó·È ÂÓı·ÚÚ˘ÓÙÈο (7,49,50).

Paediatriki 2002;65:394-402

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™˘ÌÂÚ¿ÛÌ·Ù· ∏ ‚ÂÏÙ›ˆÛË Ù˘ ÂÓÙ·ÙÈ΋˜ ıÂÚ·›·˜ ÙˆÓ ÓÂÔÁÓÒÓ Î·È Ë ÂÊ·ÚÌÔÁ‹ ‰È·ÊfiÚˆÓ ıÂÚ·¢ÙÈÎÒÓ ·ÚÂÌ‚¿ÛÂˆÓ ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÚÈÁÂÓÓËÙÈ΋˜ Î·È ÓÂÔÁÓÈ΋˜ ÂÚÈfi‰Ô˘, ΢ڛˆ˜ ÙˆÓ ÎÔÚÙÈÎÔÂȉÒÓ ÚÔÁÂÓÓËÙÈο Î·È ÙÔ˘ Â͈ÁÂÓÔ‡˜ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ·, ¤¯Ô˘Ó Ô‰ËÁ‹ÛÂÈ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· Û ̛· ı·̷ÙÈ΋ ·‡ÍËÛË Ù˘ ÂÈ‚›ˆÛ˘ ÙˆÓ ÂÍ·ÈÚÂÙÈο ÌÈÎÚÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓÒÓ. øÛÙfiÛÔ, Ë ÓÔÛËÚfiÙËÙ¿ ÙÔ˘˜ ·Ú·Ì¤ÓÂÈ ÛÙ·ıÂÚ‹. ∆· ÌÈÎÚÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓ¿ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·˘ÍË̤ÓË ÓÔÛËÚfiÙËÙ· Ù· ÚÒÙ· ¯ÚfiÓÈ· Ù˘ ˙ˆ‹˜ Î·È ‰È·ÙÚ¤¯Ô˘Ó ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ Ó¢ÚÔ·Ó·Ù˘ÍÈ·ÎÒÓ Î·È ·ÈÛıËÙËÚÈ·ÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ, Ì·ıËÛÈ·ÎÒÓ ‰È·Ù·Ú·¯ÒÓ Î·È ÚÔ‚ÏËÌ¿ÙˆÓ Û˘ÌÂÚÈÊÔÚ¿˜. ∏ ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÓÂÔÁÓÒÓ Î·È Ë ¤ÁηÈÚË ·Ú¤Ì‚·ÛË ‚ÂÏÙÈÒÓÔ˘Ó ÙËÓ ÚfiÁÓˆÛË. ∏ ÂÊ·ÚÌÔÁ‹ Ù˘ Ó¢ÚÔ·Ó·Ù˘Íȷ΋˜ ÊÚÔÓÙ›‰·˜ ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ÓÔÛËÏ›·˜ ÙˆÓ Â˘·›ÛıËÙˆÓ ÌÈÎÚÔ‡ ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ ¤¯ÂÈ ‰ÒÛÂÈ ÂÓı·ÚÚ˘ÓÙÈο ·ÔÙÂϤÛÌ·Ù· fiÛÔÓ ·ÊÔÚ¿ ÛÙË Ó¢ÚÔ·Ó·Ù˘Íȷ΋ ÂͤÏÈÍ‹ ÙÔ˘˜.

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2. Bennett FC. Developmental outcome. In: Avery GB, Fletcher MA, MacDonald MG, editors. Neonatology: Pathophysiology and Management of the Newborn. 4th ed.

Philadelphia: JB Lippincott Co; 1994. p. 1367-1386.

3. Msall ME, Tremont MR. Functional outcomes in self-care, mobility, communication, and learning in extremely lowbirth weight infants. Clin Perinatol 2000;27:381-401.

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REVIEW ARTICLE

¶ÚˆÙÔ·ı‹˜ ‰˘ÛÎÈÓËÛ›· ÙˆÓ ÎÚÔÛÛÒÓ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ ÂÈıËÏ›Ô˘: ‰È·ÁÓˆÛÙÈ΋ Î·È ıÂÚ·¢ÙÈ΋ ÚÔÛ¤ÁÁÈÛË ƒ. µ·ÏÂÚ‹1, π. ¡. ∆۷ӿη˜2

Primary ciliary dyskinesia: clinical features diagnostic approach and management R. Valeri1, I. N. Tsanakas2

¶ÂÚ›ÏË„Ë: ∆Ô Û‡Ó‰ÚÔÌÔ ÚˆÙÔ·ıÔ‡˜ ‰˘ÛÎÈÓËÛ›·˜ ÙˆÓ ÎÚÔÛÛÒÓ (¶¢∫) Â›Ó·È Ì›· Û¯ÂÙÈο Û¿ÓÈ· ÁÂÓÂÙÈ΋ ÓfiÛÔ˜ Ô˘ ÔÊ›ÏÂÙ·È Û ÏÂÈÙÔ˘ÚÁÈΤ˜ Î·È ‰ÔÌÈΤ˜ ·ÓˆÌ·Ï›Â˜ ÙˆÓ ÎÚÔÛÛÒÓ ÙÔ˘ ÎÚÔÛÛˆÙÔ‡ ÂÈıËÏ›Ô˘, Ë ÔÔ›· ÂΉËÏÒÓÂÙ·È ÎÏÈÓÈο Ì ˘ÔÙÚÔÈ¿˙Ô˘Û˜ ÏÔÈÌÒÍÂȘ ÙÔ˘ ·ÓÒÙÂÚÔ˘ Î·È Î·ÙÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, ÂÓÒ Û˘Ó˘¿Ú¯ÂÈ ·Ó·ÛÙÚÔÊ‹ ÛÏ¿¯ÓˆÓ ÛÙÔ 50% ÙˆÓ ÂÚÈÙÒÛˆÓ. ∆Ô ™¶¢∫ ÂΉËÏÒÓÂÙ·È Ì ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ· Î·È Â›ÌÔÓË ÚÈÓ›Ùȉ· ÛÙË ÓÂÔÁÓÈ΋ ÂÚ›Ô‰Ô, ÂÓÒ ÛÙË ‚ÚÂÊÈ΋ ‹ ·È‰È΋ ËÏÈΛ· Ì ˘ÔÙÚÔÈ¿˙Ô˘Û˜ ‹ ¯ÚfiÓȘ ˆÙ›Ùȉ˜-ÈÁÌÔÚ›Ùȉ˜, ‚ÚÔÁ¯ÔÓ¢ÌÔӛ˜ Î·È ˘ÔÁÔÓÈÌfiÙËÙ· ‹ ÛÙÂÈÚfiÙËÙ· ÛÙÔ˘˜ ¿Ó‰Ú˜. ∆Ô ™¶¢∫ Û˘ÌÂÚÈÏ·Ì‚¿ÓÂÙ·È ÛÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ÙˆÓ ‚ÚÔÁ¯ÈÂÎÙ·ÛÈÒÓ, ÙÔ˘ ¿Ù˘Ô˘ ‚ÚÔÁ¯ÈÎÔ‡ ¿ÛıÌ·ÙÔ˜ Î·È ÙˆÓ ÛÔ‚·ÚÒÓ ·ı‹ÛÂˆÓ Ì ·Û˘Ó‹ıÂȘ ÂΉËÏÒÛÂȘ ·fi ÙÔ ·ÓÒÙÂÚÔ ·Ó·Ó¢ÛÙÈÎfi Û‡ÛÙËÌ·. ∏ ‰ÈÂÚ‡ÓËÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ÂÚÈÏ·Ì‚¿ÓÂÈ ÙË Ì¤ÙÚËÛË Ù˘ ‚ÏÂÓÓÔÎÚÔÛÛˆÙ‹˜ οı·ÚÛ˘ Ì ÙË Ì¤ıÔ‰Ô Ù˘ ۷ί·Ú›Ó˘ ‹ Ù˘ ¯ÚˆÛÙÈ΋˜ ·Ó¿ÏÔÁ· Ì ÙËÓ ËÏÈΛ·, ÙËÓ ÔÙÈ΋ ÂÎÙ›ÌËÛË Ù˘ ÎÈÓËÙÈÎfiÙËÙ·˜ ÙˆÓ ÎÚÔÛÛÒÓ ÛÙÔ ÎÔÈÓfi ÌÈÎÚÔÛÎfiÈÔ ·ÓÙ›ıÂÙ˘ Ê¿Ûˆ˜ Î·È ÙË ÌÂϤÙË Ù˘ ‰ÔÌ‹˜ ÙˆÓ ÎÚÔÛÛÒÓ ÛÙÔ ËÏÂÎÙÚÔÓÈÎfi ÌÈÎÚÔÛÎfiÈÔ. ∂Âȉ‹ ÛÙ· ·È‰È¿ Ì ™¶¢∫ Ù· Â›‰· ÙÔ˘ ÂÎÓÂfiÌÂÓÔ˘ ·fi ÙË Ì‡ÙË ÌÔÓÔÍÂȉ›Ô˘ ÙÔ˘ ·˙ÒÙÔ˘ (¡O) Â›Ó·È ¯·ÌËÏ¿, Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙÔ˘ ÌÔÚ› Ó· ·ÔÙÂϤÛÂÈ Ì›· ‡ÎÔÏË ÌË ÂÂÌ‚·ÙÈ΋ ‰ÔÎÈÌ·Û›· ÁÈ· ÙËÓ ·Ó›¯Ó¢ÛË ·È‰ÈÒÓ Ì ™¶¢∫. ∏ ¤ÁηÈÚË ‰È·›ÛÙˆÛË Ù˘ ÚˆÙÔ·ıÔ‡˜ ‚Ï¿‚˘ ÙˆÓ ÎÚÔÛÛÒÓ ¤¯ÂÈ ÌÂÁ¿ÏË ÎÏÈÓÈ΋ ÛËÌ·Û›· Î·È ÛÙԯ‡ÂÈ ÛÙËÓ ÚfiÏË„Ë ÙˆÓ ‚ÚÔÁ¯ÈÂÎÙ·ÛÈÒÓ Î·È ÙˆÓ ÛÔ‚·ÚÒÓ ÂÈÏÔÎÒÓ ·fi ÙÔ ·ÓÒÙÂÚÔ ·Ó·Ó¢ÛÙÈÎfi Û‡ÛÙËÌ· (·˘ÙÈ¿, ̇ÙË, ·Ú·ÚÚ›ÓÈÔ˘˜ ÎfiÏÔ˘˜). ∏ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ··ÈÙ›

Abstract: Primary ciliary dyskinesia (PCD) is a rare genetic condition caused by abnormal structure or function of the cilia. The clinical manifestations consist of symptoms of the upper and lower tract, in association with visceral mirror image in 50% of cases. The PCD is expressed in neonates with respiratory distress, persistent rhinitis, in infants and older children with recurrent or chronic otitis, sinopulmonary infections and in males with subfertility or infertility. PCD should be included in the differential diagnosis of bronchiectasis, atypical asthma and persistent upper airway disease. The diagnostic procedure includes the assessment of mucociliary clearance using the saccharin test or inert colouring test, the measurement of ciliary beat frequency on light microscopy and the identification of the ciliary phenotype ultrastructure in electron microscopy.

Nasal nitric oxide is low in children with PCD and this method seems to be a useful screening test for the detection of children with PCD. Early diagnosis is very important in order to prevent the development of bronchiectasis and to avoid the severe complications from the upper respiratory system (ear, nose, sinus). The management of PCD requires an intergraded multidisciplinary approach involving a number of clinical specialties (medical practitioner, respiratory physicians, audiology experts, physiotherapists) in order to optimize care and improve patients’ quality of life. This review article presents the current data concerning the clinical manifestation, the diagnostic approach and the treatment of this disease and gives the algorithm for the investigations of PCD used in our clinic and internationally.

1 ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ∞ÚÈÛÙÔÙ¤ÏÂÈÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ £ÂÛÛ·ÏÔӛ΢ 2 ¶·È‰ÔÓ¢ÌÔÓÔÏÔÁÈ΋ ªÔÓ¿‰·, °’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ∞ÚÈÛÙÔÙ¤ÏÂÈÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ £ÂÛÛ·ÏÔӛ΢

1 1st Pediatric Clinic, Aristotelion University of Thessaloniki 2 Division of Pediatric Pulmonology, 3rd Pediatric Clinic of Aristotelion University, Thessaloniki

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ÙË Û˘ÓÂÚÁ·Û›· ·È‰È¿ÙÚˆÓ, ·È‰ÔÓ¢ÌÔÓÔÏfiÁˆÓ, ˆÙÔÚÈÓÔÏ·Ú˘ÁÁÔÏfiÁˆÓ Î·È Ê˘ÛÈÔıÂÚ·¢ÙÒÓ, Ì ÛÎÔfi ÙË ‚ÂÏÙ›ˆÛË ÙÔ˘ ÙÚfiÔ˘ ˙ˆ‹˜ ÙˆÓ ÌÈÎÚÒÓ ·ÛıÂÓÒÓ. ™ÙËÓ ·Ó·ÛÎfiËÛË ·˘Ù‹ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÔÈ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘, ÌÂıԉ‡ÂÙ·È Ë ‰È·ÁÓˆÛÙÈ΋ ÚÔÛ¤ÁÁÈÛË, Ë ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘ Î·È ·Ú·Ù›ıÂÙ·È Ô ‰È·ÁÓˆÛÙÈÎfi˜ ·ÏÁfiÚÈıÌÔ˜ Ô˘ ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÙfiÛÔ ÛÙËÓ ÎÏÈÓÈ΋ Ì·˜ fiÛÔ Î·È ‰ÈÂıÓÒ˜. §¤ÍÂȘ ÎÏÂȉȿ: Û‡Ó‰ÚÔÌÔ ·Î›ÓËÙÔ˘ ÎÚÔÛÛÔ‡, Û‡Ó‰ÚÔÌÔ Kartagener, ÎÚÔÛÛÔ›, ‚ÚÔÁ¯ÈÂÎٷۛ˜.

Key words: primary ciliary dyskinesia, Kartagener’s syndrome, cillia, bronchiectasis.

™˘ÓÙÔÌÔÁڷʛ˜

Ô˘˜ ÎfiÏÔ˘˜ 300 cm2, ÛÙËÓ ÙÚ·¯Â›· Î·È ÙÔ˘˜ ‚ÚfiÁ¯Ô˘˜ ÂÚ›Ô˘ 5000 cm2 (7,8). ∫ÚÔÛÛÔ› ‰ÂÓ ˘¿Ú¯Ô˘Ó ÛÙËÓ ¿Óˆ ÚÈÓÈ΋ ÎfiÁ¯Ë, ÛÙËÓ ¿Óˆ ÂÈÊ¿ÓÂÈ· Ù˘ ÂÈÁψÙÙ›‰·˜ Î·È ÛÙ· ¯Â›ÏË ÙˆÓ ÊˆÓËÙÈÎÒÓ ¯ÔÚ‰ÒÓ, ÂÓÒ ÌÂÙ¿ Ù· ÙÂÏÈο ‚ÚÔÁ¯ÈfiÏÈ· ·Ú·ÈÒÓÔ˘Ó Ôχ (11-13).

OÈ ÎÚÔÛÛÔ› ·ÔÙÂÏÔ‡Ó ÙȘ ΢ÙÙ·ÚÔÏ·ÛÌ·ÙÈΤ˜ ÚÔÛÂ΂ÔϤ˜ ÂÈıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ, ¤¯Ô˘Ó ‰ÔÌ‹ ÔχÏÔÎË Î·È ÏÂÈÙÔ˘ÚÁ›· Û·ÊÒ˜ ηıÔÚÈṲ̂ÓË. Œ¯Ô˘Ó Û¯‹Ì· ΢ÏÈÓ‰ÚÈÎfi, Ì‹ÎÔ˜ 2-7 Ìm ·Ó¿ÏÔÁ· Ì ÙË ı¤ÛË ÙÔ˘˜ Î·È ‰È¿ÌÂÙÚÔ 0,25-0,33 Ìm. ∫¿ı ÂÈıËÏÈ·Îfi ÎÚÔÛÛˆÙfi ·ÙÙ·ÚÔ Ê¤ÚÂÈ ÂÚ›Ô˘ 200-275 ÎÚÔÛÛÔ‡˜ ÙÔÔıÂÙË̤ÓÔ˘˜ Û ·Ú¿ÏÏËϘ ÛÂÈÚ¤˜, Ì ÙÔÓ ÂÈÌ‹ÎË ¿ÍÔÓ· οıÂÙÔ ÛÙËÓ ÂχıÂÚË ÂÈÊ¿ÓÂÈ¿ ÙÔ˘. ∫¿ı ÎÚÔÛÛfi˜ ·ÔÙÂÏÂ›Ù·È ·fi Ì›· ÂχıÂÚË ÌÔ›Ú·, ÙÔ Û٤ϯԘ ‹ ·ÍfiÓËÌ· Î·È Ì›· ÌÔ›Ú· ÂÌÊ˘ÙÂ˘Ì¤ÓË ÛÙÔ Î˘ÙÙ·ÚfiÏ·ÛÌ· Ô˘ ÔÓÔÌ¿˙ÂÙ·È Ú›˙·. ªÂٷ͇ Ù˘ Ú›˙·˜ Î·È ÙÔ˘ ÛÙÂϤ¯Ô˘˜ ˘¿Ú¯ÂÈ ¤Ó· ÌÈÎÚfi ۈ̿ÙÈÔ, ÙÔ ‚·ÛÈÎfi ۈ̿ÙÈÔ ‹ ÎÈÓÂÙfiÛˆÌÔ, ÙÔ ÔÔ›Ô ·ÚÈÛÙ¿ÓÂÈ ÙÔ ÎÈÓËÙÈÎfi ΤÓÙÚÔ ÙÔ˘ ÎÚÔÛÛÔ‡. ∏ ‰ÔÌ‹ ÙÔ˘ ÎÚÔÛÛÔ‡ Ê·›ÓÂÙ·È Ì ÙÔ ËÏÂÎÙÚÔÓÈÎfi ÌÈÎÚÔÛÎfiÈÔ Î·È Û˘Ó›ÛÙ·Ù·È Û 9 ÂÚÈÊÂÚÈο ˙‡ÁË ÌÈÎÚÔÛˆÏËÓ·Ú›ˆÓ, Ì ۷ÊÒ˜ ηıÔÚÈṲ̂ÓË ·fiÛÙ·ÛË ÌÂٷ͇ ÙÔ˘˜, Ù· ÔÔ›· Û¯ËÌ·Ù›˙Ô˘Ó ¤Ó·Ó ·ÎÏÔ, ÛÙÔ Î¤ÓÙÚÔ ÙÔ˘ ÔÔ›Ô˘ ˘¿Ú¯ÂÈ ¤Ó· ÌÔÓfi ˙‡ÁÔ˜ (∂ÈÎfiÓ· 1). ∆· ÌÈÎÚÔÛˆÏËÓ¿ÚÈ· οı ÂÚÈÊÂÚÈÎÔ‡ ˙‡ÁÔ˘˜ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È Ì ٷ ÁÚ¿ÌÌ·Ù· ∞ Î·È µ. ¢‡Ô ‚Ú·¯›ÔÓ˜ ·ÔÙÂÏÔ‡ÌÂÓÔÈ ·fi Ì›· ÚˆÙ½ÓË, ÙË ‰˘Ó½ÓË, ÂÎÙ›ÓÔÓÙ·È ·fi ÙÔ ∞ ÌÈÎÚÔÛˆÏËÓ¿ÚÈÔ Î¿ı ÂÚÈÊÂÚÈÎÔ‡ ˙‡ÁÔ˘˜ ÚÔ˜ ÙÔ µ ÌÈÎÚÔÛˆÏËÓ¿ÚÈÔ ÙÔ˘ ÚÔËÁÔ‡ÌÂÓÔ˘ ˙‡ÁÔ˘˜. ∞˘ÙÔ› ÔÈ ‚Ú·¯›ÔÓ˜ ‰˘Ó½Ó˘ (ÂÛˆÙÂÚÈÎÔ› Î·È Â͈ÙÂÚÈÎÔ›) Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÙË ‰ËÌÈÔ˘ÚÁ›· Û˘ÓÙÔÓÈṲ̂ÓÔ˘ Î˘Ì·ÙÈÛÌÔ‡ (1,4,5,13,14). ÕÏÏÔÈ ·ÎÙÈÓÔÂȉҘ ÊÂÚfiÌÂÓÔÈ ‚Ú·¯›ÔÓ˜ ÂÎÙ›ÓÔÓÙ·È ·fi Ù· ÂÚÈÊÂÚÈο ÌÈÎÚÔÛˆÏËÓ¿ÚÈ· ÚÔ˜ ÙÔ ÎÂÓÙÚÈÎfi ˙‡ÁÔ˜ Î·È ·ÔÙÂÏÔ‡Ó ÙÔ˘˜ ·ÎÙÈÓˆÙÔ‡˜ Û˘Ó‰¤ÛÌÔ˘˜. OÈ ·ÎÙÈÓˆÙÔ› Û‡Ó‰ÂÛÌÔÈ Â›Ó·È ··Ú·›ÙËÙÔÈ ÁÈ· ÙÔ Û˘Á¯ÚÔÓÈÛÌfi ÙˆÓ ÎÚÔÛÛÒÓ, ÂÂȉ‹

¶¢∫ ™¶¢∫ µ∫∫

¶ÚˆÙÔ·ı‹˜ ‰˘ÛÎÈÓËÛ›· ÎÚÔÛÛÒÓ ™‡Ó‰ÚÔÌÔ ÚˆÙÔ·ıÔ‡˜ ‰˘ÛÎÈÓËÛ›·˜ ÎÚÔÛÛÒÓ µÏÂÓÓÔÎÚÔÛÛˆÙ‹ οı·ÚÛË

∂ÈÛ·ÁˆÁ‹ O fiÚÔ˜ ‰˘ÛÎÈÓËÛ›· ÙˆÓ ÎÚÔÛÛÒÓ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ ÂÈıËÏ›Ô˘ ÂÚÈÏ·Ì‚¿ÓÂÈ Ì›· ÔÌ¿‰· ÓÔÛËÌ¿ÙˆÓ Û˘ÁÁÂÓÒÓ ‹ Â›ÎÙËÙˆÓ Ô˘ ¤¯Ô˘Ó ÎÔÈÓfi ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÙË ‰ÔÌÈ΋ ‹ ÏÂÈÙÔ˘ÚÁÈ΋ ·ÓˆÌ·Ï›· ÙˆÓ ÎÚÔÛÛÒÓ ÙÔ˘ ÎÚÔÛÛˆÙÔ‡ ÂÈıËÏ›Ô˘. ∫ÏÈÓÈο ÂΉËÏÒÓÔÓÙ·È Î˘Ú›ˆ˜ ÌÂ Û˘¯Ó¤˜ Î·È ˘ÔÙÚÔÈ¿˙Ô˘Û˜ ÏÔÈÌÒÍÂȘ ÙÔ˘ ·ÓÒÙÂÚÔ˘ Î·È Î·ÙÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, ÂÓÒ ÛÙÔ 50% Û˘Ó˘¿Ú¯ÂÈ ·Ó·ÛÙÚÔÊ‹ ÛÏ¿¯ÓˆÓ Î·È ÛÙÂÈÚfiÙËÙ· ÛÙÔ˘˜ ¿Ó‰Ú˜ (1-5). ™ÙËÓ ·Ó·ÛÎfiËÛË ·˘Ù‹: ·) ÂÚÈÁÚ¿ÊÂÙ·È Ë ‰ÔÌ‹ Î·È Ë ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ ÎÚÔÛÛÒÓ, Ë ÎÏÈÓÈ΋ ÛËÌÂÈÔÏÔÁ›· (Û˘Ìو̷ÙÔÏÔÁ›·) ·fi ÙȘ ‰ÔÌÈΤ˜ ‹ Î·È ÏÂÈÙÔ˘ÚÁÈΤ˜ ‰È·Ù·Ú·¯¤˜, Ì ·ÚÈ· ÂΛÓË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ÚˆÙÔ·ıÔ‡˜ ‰˘ÛÎÈÓËÛ›·˜ ÙˆÓ ÎÚÔÛÛÒÓ (¶¢∫), ‚) ÂȯÂÈÚÂ›Ù·È Ë ‰È·ÁÓˆÛÙÈ΋ ÚÔÛ¤Ï·ÛË Î·È Á) Á›ÓÂÙ·È ·Ó·ÊÔÚ¿ ÛÙË Û‡Á¯ÚÔÓË ıÂÚ·¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘. ¢ÔÌ‹ Î·È ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ ÎÚÔÛÛÒÓ ™ÙÔÓ ·ÓıÚÒÈÓÔ ÔÚÁ·ÓÈÛÌfi ˘¿Ú¯ÂÈ ·ÊıÔÓ›· ÎÚÔÛÛˆÙÒÓ Î˘ÙÙ¿ÚˆÓ, Ù· ÔÔ›· ÂÎÙfi˜ ·fi ÙÔ˘˜ ·Ú·ÚÚ›ÓÈÔ˘˜ ÎfiÏÔ˘˜, ÙÔ ÚÈÓÈÎfi ‚ÏÂÓÓÔÁfiÓÔ Î·È ÙÔ ‚ÚÔÁ¯ÈÎfi ‰¤Ó‰ÚÔ ˘¿Ú¯Ô˘Ó Î·È Û ¿ÏÏ· ÛËÌ›· Î·È Û˘ÛÙ‹Ì·Ù· ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡, fiˆ˜ ÛÙÔ Ì¤ÛÔ Ô˘˜, Û ÙÌ‹Ì·Ù· ÙÔ˘ ÁÂÓÓËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ (ÛÂÚÌ·ÙÔ˙ˆ¿ÚÈ·, Û¿ÏÈÁÁ˜, ÙÚ¿¯ËÏÔ Ì‹ÙÚ·˜) Î·È ÛÙÔ Â¤Ó‰˘Ì· ÙˆÓ ÎÔÈÏÈÒÓ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ (1,2,5,6). TÔ ÌÂÁ·Ï‡ÙÂÚÔ Ì¤ÚÔ˜ ÙˆÓ ÎÚÔÛÛˆÙÒÓ Î˘ÙÙ¿ÚˆÓ ÛÙÔÓ ·ÓıÚÒÈÓÔ ÔÚÁ·ÓÈÛÌfi ·Ó¢ڛÛÎÂÙ·È ÛÙÔ ·Ó·Ó¢ÛÙÈÎfi ÂÈı‹ÏÈÔ, fiÔ˘ ηχÙÂÈ Ì›· ¤ÎÙ·ÛË ÂÚ›Ô˘ 5500 cm2 Î·È Û˘ÁÎÂÎÚÈ̤ӷ, ÛÙȘ ÚÈÓÈΤ˜ ÎÔÈÏfiÙËÙ˜ 150 cm2 ÛÙÔ˘˜ ·Ú·ÚÚ›ÓÈ-

404

NoV-dEc-02

14-05-03

14:26

™ÂÏ›‰·405

¶·È‰È·ÙÚÈ΋ 2002;65:403-412

Paediatriki 2002;65:403-412

º˘ÛÈÔÏÔÁÈÎfi˜ ÎÚÔÛÛfi˜ · ñ 2 ÎÂÓÙÚÈο ÌÈÎÚÔÛˆÏËÓ¿ÚÈ· (1) ñ 9 ˙‡ÁË ÂÚÈÊ. ÌÈÎÚÔÛˆÏËÓ·Ú›ˆÓ (2) ñ µÚ·¯›ÔÓ˜ ‰˘Ó½Ó˘ (3) ñ ∞ÎÙÈÓˆÙÔ› Û‡Ó‰ÂÛÌÔÈ (4) ñ ™‡Ó‰ÂÛË ÓÂ͛Ӣ (5) ñ ∫˘ÙÙ·ÚÈ΋ ÌÂÌ‚Ú¿ÓË (6)

‚

2 1 5

4 3 6

∂ÈÎfiÓ· 1. ™¯ËÌ·ÙÈ΋ ·ÂÈÎfiÓÈÛË ‰ÔÌ‹˜ Ê˘ÛÈÔÏÔÁÈÎÔ‡ ÎÚÔÛÛÔ‡ ·Ó·Ó¢ÛÙÈÎÔ‡ ÂÈıËÏ›Ô˘ (ÂÁοÚÛÈ· ‰È·ÙÔÌ‹), fiˆ˜ Ê·›ÓÂÙ·È ÛÙÔ ËÏÂÎÙÚÔÓÈÎfi ÌÈÎÚÔÛÎfiÈÔ (∞˚‚¿˙˘ µ, 1992).

ÂÌÔ‰›˙Ô˘Ó ÙË Û˘Ì›ÂÛË Î·È ÙË ÛÙÚÔÊ‹ ·˘ÙÒÓ (811,15). OÈ Û‡Ó‰ÂÛÌÔÈ Ù˘ ÓÂ͛Ӣ Ô˘ ÂÓÒÓÔ˘Ó Ù· ÌÈÎÚÔÛˆÏËÓ¿ÚÈ· ÌÂٷ͇ ÙÔ˘˜ ÂÌÔ‰›˙Ô˘Ó ÙËÓ ¤ÓÙÔÓË ÌÂٷΛÓËÛË Î·Ù¿ ÙËÓ Î›ÓËÛË ÙˆÓ ÎÚÔÛÛÒÓ. ∏ Ê˘ÛÈÔÏÔÁÈ΋ ÎÈÓËÙÈÎfiÙËÙ· ÙˆÓ ÎÚÔÛÛÒÓ ÙÚÔÊÔ‰ÔÙÂ›Ù·È ·fi ÙË ‚ÈÔ¯ËÌÈ΋ ÂÓ¤ÚÁÂÈ· Ô˘ ·Ú¿ÁÂÙ·È ·fi ÌÂÚÈΤ˜ ÚˆÙÂ˚ÓÈΤ˜ ‰Ô̤˜ ÙÔ˘ ·ÍÔÓ‹Ì·ÙÔ˜. ∞fi ·˘Ù¤˜, Ë ‰˘Ó½ÓË ¤¯ÂÈ ÚˆÙ·Ú¯ÈÎfi Î·È Î˘Ú›·Ú¯Ô ÚfiÏÔ, ÙfiÛÔ ÛÙË ‰ÔÌ‹ ÙˆÓ ÎÚÔÛÛÒÓ fiÛÔ Î·È ÛÙË ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘˜, Â›Ó·È ˘„ËÏÔ‡ ÌÔÚÈ·ÎÔ‡ ‚¿ÚÔ˘˜ Î·È ·Ó‹ÎÂÈ ÛÙËÓ ÔÌ¿‰· ÙˆÓ ¯ËÌÈÎÒÓ-Ì˯·ÓÈÎÒÓ ATP ÚˆÙÂ˚ÓÒÓ, Ë ÔÔ›· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙË Ì˘ÔÛ›ÓË Î·È ÙËÓ ÎÈÓÂÙ›ÓË. £ÂˆÚÂ›Ù·È ˘‡ı˘ÓË ÁÈ· ÙÔ ÁÏ›ÛÙÚËÌ· ÙˆÓ ÌÈÎÚÔÛˆÏËÓ·Ú›ˆÓ, ÙÔ˘ ÂÓfi˜ Û ۯ¤ÛË Ì ÙÔ ¿ÏÏÔ, fiÙ·Ó Ô ÎÚÔÛÛfi˜ ÂÎÙÂÏ› ÙËÓ Î¿Ì„Ë, ÙËÓ ÔÚÁ¿ÓˆÛË Î·È ÙÔÓ Û˘ÓÙÔÓÈÛÌfi ·˘ÙÒÓ, Ì·˙› Ì ÙȘ ¿ÏϘ ÚˆÙ½Ó˜, fiˆ˜ Ë ÙÔ˘ÌÔ˘Ï›ÓË, Ë ÛˆÏËÓ›ÓË, Ë ÁÔ˘·Ó›ÓË Î·È Ë ÓÂÍ›ÓË Ô˘ ÂÚÈÎÏ›ÔÓÙ·È ÛÙ· ÎÂÓÙÚÈο ÌÈÎÚÔÛˆÏËÓ¿ÚÈ· (10,16). ŸÏÔÈ ÔÈ ÎÚÔÛÛÔ› ÂÎÙÂÏÔ‡Ó Ú˘ıÌÈΤ˜ ‰ÔÓ‹ÛÂȘ ÌÂ Û˘¯ÓfiÙËÙ· 12-15 Hertz ·Ó¿ ÏÂÙfi, Ì ηÙ‡ı˘ÓÛË ÚÔ˜ ÙÔÓ ÔÚÔÊ¿Ú˘ÁÁ·. OÈ ‰ÔÓ‹ÛÂȘ ÙˆÓ ÎÚÔÛÛÒÓ ·ÎÔÏÔ˘ıÔ‡Ó 2 Ê¿ÛÂȘ. ∞Ú¯Èο, ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ì›· Ù·¯Â›· Î¿Ì„Ë ÚÔ˜ Ù· ÂÌÚfi˜ (effective stroke) ηÈ, ηÙfiÈÓ, ‚Ú·‰Â›· ·ÓÙ›ÛÙÚÔÊË Î›ÓËÛË Â·Ófi‰Ô˘ (recovery stroke), Ì ÙÂÏÈÎfi ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·Ú·ÁˆÁ‹ ÂÓfi˜ Û˘Á¯ÚÔÓÈṲ̂ÓÔ˘ Ú˘ıÌÈÎÔ‡ Î˘Ì·ÙÈÛÌÔ‡ (∂ÈÎfiÓ· 2). O ÛÎÔfi˜ ·˘Ù‹˜ Ù˘ ΛÓËÛ˘ Â›Ó·È Ë ÚÔÒıËÛË Ù˘ ‚ϤÓÓ˘ Î·È ÙˆÓ ÌÈÎÚÔۈ̷Ùȉ›ˆÓ Ô˘ ÚÔÛÎÔÏÏÒÓÙ·È Û ·˘Ù‹, Û˘Ì‚¿ÏÏÔÓÙ·˜ ¤ÙÛÈ ÛÙË Ì˯·ÓÈ΋ ·ÔÌ¿ÎÚ˘ÓÛ‹ ÙÔ˘˜ ·fi ÙÔ˘˜ Ó‡ÌÔÓ˜ (1,5,17,18). µÏÂÓÓÔÎÚÔÛÛˆÙ‹ οı·ÚÛË (µ∫∫) ∏ ‚ÏÂÓÓÔÎÚÔÛÛˆÙ‹ οı·ÚÛË, ‰ËÏ·‰‹ Ë Ì˯·ÓÈ΋ ·Ô‚ÔÏ‹ ÙˆÓ ÂÎÎÚÈÌ¿ÙˆÓ ·fi ÙÔ˘˜ ·ÂÚ·ÁˆÁÔ‡˜, Â›Ó·È ÙÔ ·ÔÙ¤ÏÂÛÌ· Ì›·˜ ÔχÏÔ΢ ‰ÈÂÚÁ·Û›·˜ Ù˘ ‚ϤÓÓ˘ Î·È Ù˘ ÎÈÓËÙÈÎfiÙËÙ·˜ ÙˆÓ ÎÚÔÛÛÒÓ. ÿÚË Û ·˘Ùfi ÙÔÓ Ì˯·ÓÈÛÌfi, ÔÈ ·ÓfiÚÁ·Ó˜ Î·È ÔÚÁ·ÓÈΤ˜ Ô˘Û›Â˜ ÙÔ˘ ·ÙÌÔÛÊ·ÈÚÈÎÔ‡ ·¤Ú· ·ÔÌ·ÎÚ‡ÓÔÓÙ·È ·fi ÙÔ ·Ó·Ó¢ÛÙÈÎfi Û‡-

∂ÈÎfiÓ· 2. ∏ ΛÓËÛË ÙˆÓ ÎÚÔÛÛÒÓ ‰È·ÎÚ›ÓÂÙ·È Û 2 Ê¿ÛÂȘ: Ì›· Ù·¯Â›· ÚÔ˜ Ù· ÂÌÚfi˜ (·) Î·È Ì›· ‚Ú·‰Â›· Â·Ófi‰Ô˘ (‚).

ÛÙËÌ·. ªÂ ÙË ‚ÏÂÓÓÔÎÚÔÛÛˆÙ‹ οı·ÚÛË ÂÈÙ˘Á¯¿ÓÂÙ·È: ·) Ë Î·Ù·ÎÚ¿ÙËÛË Î·È ·Ô‚ÔÏ‹ ÌÈÎÚÔۈ̷Ùȉ›ˆÓ ÛÎfiÓ˘, ÔÚÁ·ÓÈÎÒÓ Î·È ·ÓfiÚÁ·ÓˆÓ Ô˘ÛÈÒÓ ÙÔ˘ ·ÙÌÔÛÊ·ÈÚÈÎÔ‡ ·¤Ú·, ‚) Ë ‡ÁÚ·ÓÛË ÙÔ˘ ÂÈÛÓÂfiÌÂÓÔ˘ ·¤Ú· Î·È Á) Ë ‰È·Ù‹ÚËÛË ÛÙ·ıÂÚÔ‡ pH >6,5 (10,15,18,19). ∏ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙÔ˘ Ì˯·ÓÈÛÌÔ‡ Ù˘ µ∫∫ ÂÍ·ÚÙ¿Ù·È ·fi 2 ‚·ÛÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜: ·) ÙËÓ ·ÎÂÚ·ÈfiÙËÙ· Ù˘ ‰ÔÌ‹˜ Î·È ÏÂÈÙÔ˘ÚÁ›·˜ ÙˆÓ ÎÚÔÛÛÒÓ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ ÂÈıËÏ›Ô˘ Î·È ‚) ·fi ÙȘ Ê˘ÛÈΤ˜ ȉÈfiÙËÙ˜ Ù˘ ‚ϤÓÓ˘ (ÔÈfiÙËÙ·-ÔÛfiÙËÙ·). ∏ ‚ϤÓÓË ·Ú¿ÁÂÙ·È ·fi ÙÔÓ ·Ó·Ó¢ÛÙÈÎfi ‚ÏÂÓÓÔÁfiÓÔ Ê˘ÛÈÔÏÔÁÈÎÔ‡ ·ÙfiÌÔ˘ Û ÔÛfiÙËÙ· 10100 ml ÙÔ 24ˆÚÔ Î·È ·ÔÙÂÏÂ›Ù·È ·fi ˘ÁÚ¿ ÙˆÓ ÈÛÙÒÓ, ¤Ó˙˘Ì·, ·ÓÔÛÔÛÊ·ÈÚ›Ó˜ Î·È Î˘ÙÙ·ÚÈο ÛÙÔȯ›·. ∆· ·ÚÈ· Û˘ÛÙ·ÙÈο Ù˘ Â›Ó·È Û˘ÌϤÁÌ·Ù· ‚ÏÂÓÓÔÔÏ˘Û·Î¯·ÚÈÙÒÓ Î·È ÁÏ˘ÎÔÚˆÙÂ˚ÓÒÓ, Ì ‚·ÛÈ΋ ÏÂÈÙÔ˘ÚÁÈ΋ ·ÔÛÙÔÏ‹ ÙËÓ ÚÔÛٷ٢ÙÈ΋ Â¤Ó‰˘ÛË ÙÔ˘ ‚ÏÂÓÓÔÁfiÓÔ˘ (20,21). OÈ ‰ÔÓ‹ÛÂȘ ÙˆÓ ÎÚÔÛÛÒÓ ÌÂÙ·ÎÈÓÔ‡Ó ÙÔ ÛÙÚÒÌ· ‚ϤÓÓ˘ ÙˆÓ ‚ÚfiÁ¯ˆÓ ηÈ, ‰È’ ·˘Ù‹˜, ÙˆÓ ÌÈÎÚÔۈ̷Ùȉ›ˆÓ Ô˘ ÂÈοıÔÓÙ·È Ì ٷ¯‡ÙËÙ· 5-20 mm/min, ÂÈÙÂÏÒÓÙ·˜ ¤ÙÛÈ ÙÔÓ Ì˯·ÓÈÎfi ÙÚfiÔ Î¿ı·ÚÛ˘ ÙˆÓ ·ÂÚÔÊfiÚˆÓ Ô‰ÒÓ (1,15,21) (∂ÈÎfiÓ· 3). ∏ ÏÂÈÙÔ˘ÚÁÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· ÙÔ˘ ‚ÏÂÓÓÔÎÚÔÛÛˆÙÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ‚Ú›ÛÎÂÙ·È Û˘Ó¯Ҙ οو ·fi ÙËÓ Â›‰Ú·ÛË ‰È·ÊfiÚˆÓ ·Ú·ÁfiÓÙˆÓ, ¤Ó·˜ ·fi ÙÔ˘˜ ÔÔ›Ô˘˜ Â›Ó·È ÙÔ pH Ù˘ ‚ϤÓÓ˘ Ô˘ Ê˘ÛÈÔÏÔÁÈο Â›Ó·È >6,5. ∞Ó ÙÔ pH Â›Ó·È <6,5, fiˆ˜ ÛÙȘ ÂÚÈÙÒÛÂȘ ˘„ËÏÒÓ Û˘ÁÎÂÓÙÚÒÛÂˆÓ Na++ ÛÙÔ˘˜ ·ÂÚ·ÁˆÁÔ‡˜ (¯ÔÚ‹ÁËÛË Ê˘ÛÈÔÏÔÁÈÎÔ‡ ÔÚÔ‡ ÛÙË Ì‡ÙË ‹ ÙÔÈο ¿ÏÏˆÓ ÂÓÛÙ·Ï·˙fiÌÂÓˆÓ Ô˘ÛÈÒÓ), ÚÔηÏ› ÛËÌ·ÓÙÈ΋ ÂÏ¿ÙÙˆÛË Ù˘ ÎÈÓËÙÈÎfiÙËÙ·˜ ÙÔ˘ ÎÚÔÛÛˆÙÔ‡ ÂÈıËÏ›Ô˘ (21-24). ÕÏÏÔÈ ÛËÌ·ÓÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ›ӷÈ: ·) ÔÈ ÏÔÈÌÒÍÂȘ, ÌÈÎÚԂȷΤ˜ ‹ ÈÔÁÂÓ›˜ (22,25-30) ‚) ÙÔÍÈΤ˜ Ô˘Û›Â˜ ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜, fiˆ˜ ÙÔ ÌÔÓÔÍ›‰ÈÔ (CO) ‹ ‰ÈÔÍ›‰ÈÔ ÙÔ˘ ¿Óıڷη (CO2), ÙÔ ‰ÈÔÍ›‰ÈÔ ÙÔ˘ ·˙ÒÙÔ˘ (NO2) ‹ ÙÔ˘ ı›Ԣ (SO2), ÙÔ fi˙ÔÓ (O3), Ë ·Ì̈ӛ· NH3 Î·È ¿ÏϘ. OÈ Riechelman et al (1995) ‰È·›ÛÙˆÛ·Ó ÌÔÚÊÔÏÔÁÈΤ˜ ·ÏÏÔÈÒÛÂȘ

405

NoV-dEc-02

14-05-03

14:26

™ÂÏ›‰·406

¶·È‰È·ÙÚÈ΋ 2002;65:403-412

Paediatriki 2002;65:403-412

∫›ÓËÛË Ù˘ ‚ϤÓÓ˘ µÏ¤ÓÓË

πÍ҉˘ ‚ϤÓÓË ∆·¯Â›· ο̄Ë

∫›ÓËÛË Â·Ófi‰Ô˘

∂ÈÎfiÓ· 3. ªË¯·ÓÈÛÌfi˜ ‚ÏÂÓÓÔÎÚÔÛÛˆÙ‹˜ οı·ÚÛ˘. ∏ ÌÂÙ·ÊÔÚ¿ Ù˘ ÈÍÒ‰Ô˘˜ ‚ϤÓÓ˘ (mucus) Á›ÓÂÙ·È Î·Ù¿ ÙËÓ ·’ Ê¿ÛË Ù˘ ‰fiÓËÛ˘ ÙÔ˘ ÎÚÔÛÛÔ‡ (effective stroke) Î·È Ù˘ ˘‰·ÚÔ‡˜ ‚ϤÓÓ˘ (pericilliary layer) ηٿ ÙË ‚’ Ê¿ÛË Â·Ófi‰Ô˘ (recovery stroke).

ÛÙÔ ·Ó·Ó¢ÛÙÈÎfi ÂÈı‹ÏÈÔ (ÂÍÔ›‰ËÛË ÌÈÙÔ¯ÔÓ‰Ú›ˆÓ, Û‡ÓıÂÙÔÈ ÎÚÔÛÛÔ›, Û¯ËÌ·ÙÈÛÌfi˜ ÎÂÓÔÙÔÈÒ‰Ô˘˜ ΢ÙÙ·ÚÔÏ¿ÛÌ·ÙÔ˜) Û ¤ÎıÂÛË ≥75 mg/m3 SO2 (31-33). ∞˘Ùfi Û˘Ì‚·›ÓÂÈ È‰È·›ÙÂÚ· ÛÙȘ ‚ÈÔÌ˯·ÓÈΤ˜ ÂÚÈÔ¯¤˜, ·ÏÏ¿ Î·È fiÙ·Ó ˘¿Ú¯Ô˘Ó ˘Ô‚·ıÌÈṲ̂Ó˜ Û˘Óı‹Î˜ ‰È·ÌÔÓ‹˜ Î·È ‰È·‚›ˆÛ˘ ‹ ÛÈÙÈ΋ Î·È ÂÚÈ‚·ÏÏÔÓÙÈ΋ ÌfiÏ˘ÓÛË ‹ ηΤ˜ Û˘Óı‹Î˜ ı¤ÚÌ·ÓÛ˘ (Ì ıÂÚÌ¿ÛÙÚ˜ ͇ÏÔ˘, ˘ÁÚ·ÂÚ›Ô˘ Î.Ï.) (33-35) Á) ÙÔ ·ıËÙÈÎfi Î·È ÂÓÂÚÁËÙÈÎfi οÓÈÛÌ· (34-36) Ô˘ Ì ٷ ‰È¿ÊÔÚ· ·Ú¿ÁˆÁ·, fiˆ˜ ÙÔ CO fiÙ·Ó ÍÂÂÚÓ¿ Ù· 9 ppm, ÙË ÓÈÎÔÙ›ÓË, ÙÔ ˘‰ÚÔ΢¿ÓÈÔ, ÙÔ ‚¤Ó˙Ô-·-˘Ú¤ÓÈÔ Î·È ÙË µ-Ó·Êı·Ï·Ì›ÓË, ηٷÛÙÚ¤ÊÂÈ ÙÔ ·Ó·Ó¢ÛÙÈÎfi ÂÈı‹ÏÈÔ (36) ‰) Ù· ‰È¿ÊÔÚ· ÛÚ¤È Ì·ÏÏÈÒÓ, fiÔ˘ fï˜ Ë Î·Ù·ÛÙÔÏ‹ Â›Ó·È ·ÚÔ‰È΋ (38), Ë ÛÎfiÓË Ì ÙȘ ‰È¿ÊÔÚ˜ ÂÚÂıÈÛÙÈΤ˜ Ô˘Û›Â˜, ·ÓÙÈÁfiÓ· (37) Î·È Ë ·ÎÙÈÓÔ‚ÔÏ›· Ô˘ ηٷÛÙÚ¤ÊÂÈ Ù· Ê˘ÛÈÔÏÔÁÈο ·ÙÙ·Ú· Î·È ÂËÚ¿˙ÂÈ ÙËÓ ¤ÎÎÚÈÛË ÂÓ˙‡ÌˆÓ Î·È ‚ϤÓÓ˘ Î·È Â) Ù· ‰È¿ÊÔÚ· Ê¿Ú̷η ȉȷ›ÙÂÚ· Ù· ·Ó·ÈÛıËÙÈο.

OÈ ·Ú¿ÁÔÓÙ˜ Ô˘ ·Ó·Ê¤ÚıËÎ·Ó ·Ú·¿Óˆ ÚÔηÏÔ‡Ó ‰È¿ÊÔÚ˜ ·ÓˆÌ·Ï›Â˜ ÛÙÔ˘˜ ÎÚÔÛÛÔ‡˜, ÔÈ Ôԛ˜ fï˜ Â›Ó·È ·Ó·ÛÙÚ¤„È̘ Î·È ·Ôηı›ÛÙ·ÓÙ·È Û ‰È¿ÛÙËÌ· 2-10 ‚‰ÔÌ¿‰ˆÓ ÌÂÙ¿ ÙËÓ Â›‰Ú·ÛË ÙˆÓ ·Ú·ÁfiÓÙˆÓ ·˘ÙÒÓ (22,26,27, 40,41). ∏ ·Ó·ÈÛıËÛ›· ‰Ú· ·ÚÓËÙÈο ÛÙËÓ Î¿ı·ÚÛË Ù˘ ‚ϤÓÓ˘, ·Ó·ÛÙ¤ÏÏÔÓÙ·˜ ÙÔ ‚‹¯· Î·È ÂÚÈÔÚ›˙ÔÓÙ·˜ ÙËÓ ÎÈÓËÙÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· ÙˆÓ ÎÚÔÛÛÒÓ (39). °ÂÓÂÙÈ΋ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ¶¢∫ ∆Ô Û‡Ó‰ÚÔÌÔ ÎÏËÚÔÓÔÌÂ›Ù·È Ì ÙÔÓ ·˘ÙÔۈ̷ÙÈÎfi ˘ÔÏÂÈfiÌÂÓÔ ¯·Ú·ÎÙ‹Ú·, ·Ó Î·È ¤¯Ô˘Ó ·Ó·ÊÂÚı› Î·È ¿ÏÏÔÈ ÙÚfiÔÈ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜. O ·-

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ıÔÏÔÁÈÎfi˜ ÁfiÓÔ˜ ˘ÔÛÙËÚ›˙ÂÙ·È fiÙÈ Â‰Ú¿˙ÂÙ·È ÛÙÔ ¯ÚˆÌfiۈ̷ 7 (1,42-44). À¿Ú¯ÂÈ ÁÂÓÂÙÈ΋ ÂÙÂÚÔÁ¤ÓÂÈ· ÛÙÔ Û‡Ó‰ÚÔÌÔ, ÁÈ·Ù› Â›Ó·È ·Ó·Áη›ÔÈ ÔÏÏÔ› ÁfiÓÔÈ ÁÈ· ÙËÓ Îˆ‰ÈÎÔÔ›ËÛË ÙˆÓ ÔÏÏ·ÏÒÓ ÚˆÙÂ˚ÓÒÓ Ô˘ Â›Ó·È ··Ú·›ÙËÙ˜ ÁÈ· ÙË ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ ÎÚÔÛÛÒÓ, ÂÓÒ Ë ¤ÏÏÂÈ„Ë Û ̛· ·fi ·˘Ù¤˜ ÙȘ ÚˆÙ½Ó˜ ÌÔÚ› Ó· ·ÔÙÂϤÛÂÈ ÙÔ ·›ÙÈÔ Ù˘ ÓfiÛÔ˘ Î·È Ó· Ô‰ËÁ‹ÛÂÈ Û ʷÈÓÔÙ˘ÈΤ˜ ÂΉËÏÒÛÂȘ ÔÈΛÏ˘ ‚·Ú‡ÙËÙ·˜. O ÁÂÓÂÙÈÎfi˜ ¯·Ú·ÎÙ‹Ú·˜ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ÂȂ‚·ÈÒÓÂÙ·È Ì ÙȘ ·Ú·ÙËÚ‹ÛÂȘ fiÙÈ ÙÔ Û‡Ó‰ÚÔÌÔ Â›Ó·È Û˘¯Ófi Û ̤ÏË Ù˘ ›‰È·˜ ÔÈÎÔÁ¤ÓÂÈ·˜, Û ÂÚÈÔ¯¤˜ Ì ˘„ËÏ‹ Û˘¯ÓfiÙËÙ· Û˘ÁÁ¤ÓÂÈ·˜ ÌÂٷ͇ ÙˆÓ ÁÔÓ¤ˆÓ ÙˆÓ ·ÛıÂÓÒÓ, ηıÒ˜ Î·È fiÙÈ ÛÙËÓ ›‰È· ÔÈÎÔÁ¤ÓÂÈ· ·Ó¢ڛÛÎÔÓÙ·È ¿ÚÚˆÛÙÔÈ Î·È ˘ÁÈ›˜ Î·È ÔÈ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ÂÌÊ·Ó›˙ÔÓÙ·È ‹‰Ë ÛÙËÓ ÓÂÔÁÓÈ΋ ÂÚ›Ô‰Ô (43,44). ∫ÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ∆Ô Ê¿ÛÌ· ÙˆÓ ÛËÌ›ˆÓ Î·È ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙË ‰È·Ù·Ú·¯‹ Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ ‹ Ù˘ ‰ÔÌ‹˜ ÙˆÓ ÎÚÔÛÛÒÓ, ÂÚÈÏ·Ì‚¿ÓÂÈ Û˘¯Ó¤˜ ÏÔÈÌÒÍÂȘ ÙÔ˘ ·ÓÒÙÂÚÔ˘ Î·È Î·ÙÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Ì ˆÙ›Ùȉ˜, ˘ÔÙÚÔÈ¿˙Ô˘Û˜ ·Ú·ÚÚÈÓÔÎÔÏ›Ùȉ˜, ‚ÚÔÁ¯ÔÓ¢ÌÔӛ˜ Î·È ‚ÚÔÁ¯ÈÂÎٷۛ˜. ªÔÚ›, Â›Û˘, Ó· ˘¿Ú¯ÂÈ ÛÙÂÈÚfiÙËÙ· ÛÙÔ˘˜ ¿Ó‰Ú˜ ‹ ˘ÔÁÔÓÈÌfiÙËÙ· ÛÙȘ Á˘Ó·›Î˜, ηıÒ˜ Î·È ·Ó·ÛÙÚÔÊ‹ ÛÏ¿¯ÓˆÓ Û ÔÛÔÛÙfi 50% ÙˆÓ ÂÚÈÙÒÛÂˆÓ (42,45). ∞˘Ù¤˜ ÔÈ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ¤¯Ô˘Ó ÛÙË ‚¿ÛË ÙÔ˘˜ ÙË ‰È·Ù·Ú·¯‹ Ù˘ ‚ÏÂÓÓÔÎÚÔÛÛˆÙ‹˜ οı·ÚÛ˘. ŸÙ·Ó Ë µ∫∫ Â›Ó·È ÌÂȈ̤ÓË, Ë ÌÂٷΛÓËÛË Ù˘ ‚ϤÓÓ˘ ηı˘ÛÙÂÚ›, Ì Â·ÎfiÏÔ˘ıË ÛÙ¿ÛË ÙˆÓ ÂÓ‰Ô‚ÚÔÁ¯ÈÎÒÓ ÂÎÎÚ›ÛÂˆÓ Ô˘ Ì ÙË ÛÂÈÚ¿ ÙÔ˘˜ ÚÔηÏÔ‡Ó ¯ÚfiÓÈÔ ‚‹¯· Î·È ‰ËÌÈÔ˘ÚÁÔ‡Ó ÙÔ ˘fiÛÙڈ̷ ÁÈ·

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∂ÈÎfiÓ· 4. π: º˘ÛÈÔÏÔÁÈ΋ ΛÓËÛË ÎÚÔÛÛÒÓ. ∞,µ,°,¢: ¶·ıÔÏÔÁÈΤ˜ ÎÈÓ‹ÛÂȘ ÎÚÔÛÛÒÓ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È ÌÂ Û˘ÁÁÂÓ›˜ ‰ÔÌÈΤ˜ ·ÓˆÌ·Ï›Â˜.

∂ÈÎfiÓ· 5. º˘ÛÈÔÏÔÁÈ΋ ÌÔÚÊÔÏÔÁ›· Î·È ÎÈÓËÙÈÎfiÙËÙ· ÙˆÓ ÎÚÔÛÛÒÓ ÙÔ˘ ÚÈÓÈÎÔ‡ ‚ÏÂÓÓÔÁfiÓÔ˘, fiˆ˜ ‰È·ÈÛÙÒÓÂÙ·È ÛÙÔ ÌÈÎÚÔÛÎfiÈÔ ·ÓÙ›ıÂÙ˘ Ê¿Ûˆ˜.

∂ÈÎfiÓ· 6. ªÔÚÊÔÏÔÁ›· ÎÚÔÛÛˆÙÔ‡ ΢ÙÙ¿ÚÔ˘, fiˆ˜ Ê·›ÓÂÙ·È ÛÙÔ ÌÈÎÚÔÛÎfiÈÔ ·ÓÙ›ıÂÙ˘ Ê¿Ûˆ˜: ·Ú·ÈÔ› ÎÚÔÛÛÔ› Î·È Î·Ù¿ ÙfiÔ˘˜ ηÙÂÛÙÚ·Ì̤ÓÔÈ.

·Ó·Ó¢ÛÙÈΤ˜ ÏÔÈÌÒÍÂȘ. ∆· ÎÏÈÓÈο Â˘Ú‹Ì·Ù· ÂÌÊ·Ó›˙ÔÓÙ·È ‹‰Ë ·fi ÙË Á¤ÓÓËÛË Î·È ÁÈ’ ·˘Ùfi Ú¤ÂÈ Ó· ‰›ÓÂÙ·È È‰È·›ÙÂÚË ÚÔÛÔ¯‹ ÛÙËÓ ¤ÁηÈÚË ‰È¿ÁÓˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘. ŒÙÛÈ, ÛÙËÓ ÚÔÁÂÓÓËÙÈ΋ ÂÚ›Ô‰Ô Û˘ÓÈÛÙ¿Ù·È ˘ÂÚ˯ÔÁÚ·ÊÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙˆÓ ÂÁ·ˆÓ Ì ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ, ‰ËÏ·‰‹ fiÛˆÓ ¤¯Ô˘Ó ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ· ¿ÙÔÌÔ Ì ™¶¢∫, ÁÈ· ÙËÓ Èı·ÓfiÙËÙ· ‰È·›ÛÙˆÛ˘ ·Ó·ÛÙÚÔÊ‹˜ ÙˆÓ ÛÏ¿¯ÓˆÓ ÛÙÔ ¤Ì‚Ú˘Ô. ∏ ·Ó·ÛÙÚÔÊ‹ ÛÏ¿¯ÓˆÓ ‰ËÌÈÔ˘ÚÁÂ›Ù·È ÏfiÁˆ Ù˘ ·ÎÈÓËÛ›·˜ ÙˆÓ ÎÚÔÛÛÒÓ Î·Ù¿ ÙËÓ ÎÚ›ÛÈÌË ÂÚ›Ô‰Ô Ù˘ ÂÌ‚Ú˘˚΋˜ ˙ˆ‹˜, fiÙ·Ó ÙÔ ·Ú¯¤ÓÙÂÚÔ (Ô˘ ηχÙÂÙ·È ·fi ÎÚÔÛÛˆÙ¿ ·ÙÙ·Ú·) Ú¤ÂÈ Ó· Ú·ÁÌ·ÙÔÔÈ‹ÛÂÈ ÙË ‰ÂÍÈ¿ ÛÙÚÔÊ‹. ∞Ó Ù· ÂÌ‚Ú˘˚ο ·ÙÙ·Ú· Â›Ó·È ·Î›ÓËÙ·, Ë ÛÙÚÔÊ‹ Á›ÓÂÙ·È Ù˘¯·›·, ÙfiÛÔ ÚÔ˜ Ù· ‰ÂÍÈ¿ fiÛÔ Î·È ÚÔ˜ Ù· ·ÚÈÛÙÂÚ¿. ŒÙÛÈ, ÛÙÔ 50% ÙˆÓ ÂÚÈÙÒÛÂˆÓ Ô˘ Ë Ù˘¯·›· ÛÙÚÔÊ‹ ı· Á›ÓÂÈ ÚÔ˜ Ù· ·ÚÈÛÙÂÚ¿, ı· ¤¯Ô˘Ì ÙËÓ ·ÚÔ˘Û›· ·Ó·ÛÙÚÔÊ‹˜ ÙˆÓ ÛÏ¿¯ÓˆÓ ‹ Î·È ÙË ‰ËÌÈÔ˘ÚÁ›· Û‡ÓıÂÙˆÓ, ÔχÏÔÎˆÓ Î·Ú‰ÈÔ·ıÂÈÒÓ (1,45,46). ™ÙË ÓÂÔÁÓÈ΋ ÂÚ›Ô‰Ô, Ù· ·ÚÈ· Û˘ÌÙÒÌ·Ù· Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙÔ Û‡Ó‰ÚÔÌÔ Â›Ó·È Ë Ù·¯‡ÓÔÈ· ‹ Ë Ó¢ÌÔÓ›· ¯ˆÚ›˜ Û·Ê‹ ·ÈÙÈÔÏfiÁËÛË, Ë Â›ÌÔÓË ÛÔ‚·Ú‹ ÚÈÓÈ΋ ·fiÊÚ·ÍË ‹ ÚÈÓÈ΋ ηٷÚÚÔ‹. ⁄ÔÙ· ıˆÚÔ‡ÓÙ·È Î·È Ù· ÓÂÔÁÓ¿ Ì ·Ó·ÛÙÚÔÊ‹ ÛÏ¿¯ÓˆÓ ‹ Ì ۇÓıÂÙ˜ ηډÈÔ¿ıÂȘ, ·ÙÚËÛ›· ÔÈÛÔÊ¿ÁÔ˘, ·ÙÚËÛ›· ¯ÔÏËÊfiÚˆÓ, ˘‰ÚÔΤʷÏÔ, ÛÔ‚·Ú‹ Á·ÛÙÚÔÔÈÛÔÊ·ÁÈ΋ ·ÏÈÓ‰ÚfiÌËÛË ‹ Ì ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi (47-49). ™Ù· ‚Ú¤ÊË Î·È Ù· ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿, Ù· Û˘ÌÙÒÌ·Ù· ·fi ÙÔ ·ÓÒÙÂÚÔ ·Ó·Ó¢ÛÙÈÎfi ÂÈ̤ÓÔ˘Ó (ÚÈÓÈ΋ ηٷÚÚÔ‹, ¯ÚfiÓÈ· ÚÈÓ›Ùȉ·) Î·È Û ·˘Ù¿ ÚÔÛÙ›ıÂÙ·È Ì›· ÛÂÈÚ¿ ÌÈÎÚÔ‚È·ÎÒÓ ÂÈÏÔÎÒÓ, fiˆ˜ ˘ÔÙÚÔÈ¿˙Ô˘Û˜ ÈÁÌÔÚ›Ùȉ˜, ˆÙ›Ùȉ˜ Ì ‚·ÚËÎÔ˝· ·ÁˆÁÈÌfiÙËÙ·˜, ÚÈÓÈ΋ ÔÏ˘Ô‰›·ÛË Î·È Û·ÓÈfiÙÂÚ· ·ÓÔÛÌ›·. OÈ ÁÔÓ›˜ ¯·Ú·ÎÙËÚÈÛÙÈο ·Ó·Ê¤ÚÔ˘Ó fiÙÈ ÙÔ ·È‰› ÁÂÓÓ‹ıËΠ̠ÚÈÓ›Ùȉ·. O ÍËÚfi˜ ‹ Î·È ·Ú·ÁˆÁÈÎfi˜ ‚‹¯·˜ Â›Ó·È ¯·Ú·ÎÙËÚÈÛÙÈÎfi Û‡Ìو̷ ÛÙË ‰Â‡ÙÂÚË ‚ÚÂÊÈ΋ ËÏÈΛ· Î·È ÔÈΛÏÂÈ ˆ˜ ÚÔ˜ ÙÔ ‚·ıÌfi Ù˘ ¤ÓÙ·Û˘ Î·È Ù˘ Û˘¯ÓfiÙËÙ·˜, Û˘Óԉ¢fiÌÂÓÔ˜ ÂÓ›ÔÙ Ì ÔÈΛÏÔ˘ ‚·ıÌÔ‡ ‰‡ÛÓÔÈ· ‹ Î·È ‚ÚÔÁ¯fiÛ·ÛÌÔ (¿Ù˘Ô ¿ÛıÌ·). OÈ ÂΉËÏÒÛÂȘ ·fi ÙÔ Î·ÙÒÙÂÚÔ ·Ó·Ó¢ÛÙÈÎfi Â›Ó·È Î˘Ú›ˆ˜ ÔÈ ˘ÔÙÚÔÈ¿˙Ô˘Û˜ ‚ÚÔÁ¯›Ùȉ˜ ‹ ‚ÚÔÁ¯ÔÓ¢ÌÔӛ˜, Ì ÙÂÏÈ΋ ηٿÏËÍË ÙË ‰ËÌÈÔ˘ÚÁ›· ‚ÚÔÁ¯ÈÂÎÙ·ÛÈÒÓ (1,49). OÈ ‚ÚÔÁ¯ÈÂÎٷۛ˜ Â›Ó·È ÙÔÈΤ˜, Â›ÎÙËÙ˜, ‰Â˘ÙÂÚÔ·ı›˜ Ô˘ ÚÔηÏÔ‡ÓÙ·È Â›Ù ·fi ÙËÓ ·Ú·ÌÔÓ‹ Ù˘ ‚ϤÓÓ˘ ÂÓ‰Ô‚ÚÔÁ¯Èο, ›Ù ·fi ÙË ¯ÚfiÓÈ· ÊÏÂÁÌÔÓ‹, ÙÔ ‚‹¯· Î·È ÙȘ ·ÙÂÏÂÎٷۛ˜ Ô˘ ÚÔηÏÔ‡Ó ÙËÓ ·Ó·ÙÔÌÈ΋ ‚Ï¿‚Ë ÙÔ˘ ÙÔȯÒÌ·ÙÔ˜ ÙˆÓ ‚ÚfiÁ¯ˆÓ. ∞ÏÏÔÈÒÛÂȘ ÙÔ˘ Ó¢ÌÔÓÈÎÔ‡ ·ÚÂÁ¯‡Ì·ÙÔ˜ ÂΉËÏÒÓÔÓÙ·È Û˘¯Ó¿ Ì ·ÈÌÔÙ‡ÛÂȘ Î·È Î·Ù·Ï‹ÁÔ˘Ó Û ¯ÚfiÓÈ· ηډÈÔ·Ó·Ó¢ÛÙÈ΋ ·ÓÂ¿ÚÎÂÈ·. ∏ ‡·ÚÍË ÏËÎÙÚÔ‰·ÎÙ˘Ï›·˜

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¶·È‰È·ÙÚÈ΋ 2002;65:403-412

¶›Ó·Î·˜ 1. ¢ÔÌÈΤ˜ ·ÓˆÌ·Ï›Â˜ ÙˆÓ ÎÚÔÛÛÒÓ ¶ÚˆÙÔ·ı›˜ ‰ÔÌÈΤ˜ ·ÓˆÌ·Ï›Â˜ ñ OÏÈ΋ ¤ÏÏÂÈ„Ë ‚Ú·¯ÈfiÓˆÓ Ù˘ ‰˘Ó½Ó˘ (ÂÛˆÙÂÚÈÎÔ› Î·È Â͈ÙÂÚÈÎÔ› ‚Ú·¯›ÔÓ˜) ñ ŒÏÏÂÈ„Ë ÌfiÓÔ ÂÛˆÙÂÚÈÎÒÓ ‚Ú·¯ÈfiÓˆÓ ñ ŒÏÏÂÈ„Ë ÌfiÓÔ Â͈ÙÂÚÈÎÒÓ ‚Ú·¯ÈfiÓˆÓ ñ ªÂÚÈ΋ ‹ ÔÏÈ΋ ¤ÏÏÂÈ„Ë ÙˆÓ ·ÎÙÈÓˆÙÒÓ Û˘Ó‰¤ÛÌˆÓ ñ ŒÏÏÂÈ„Ë ÌÈÎÚÔÛˆÏËÓ·Ú›ˆÓ ÂÚÈÊÂÚÈÎÒÓ ‹ ÎÂÓÙÚÈÎÒÓ ñ ÕÙ·ÎÙË ı¤ÛË ÎÂÓÙÚÈÎÒÓ ‹ ÂÚÈÊÂÚÈÎÒÓ ÌÈÎÚÔÛˆÏËÓ·Ú›ˆÓ ñ ¶·ÚÔ˘Û›· ˘ÂÚ¿ÚÈıÌˆÓ ÌÈÎÚÔÛˆÏËÓ·Ú›ˆÓ ñ ¶Ï‹Ú˘ ·Ï·Û›· ÎÚÔÛÛÒÓ ñ ∞ÓÒÌ·ÏÔ˜ ÚÔÛ·Ó·ÙÔÏÈÛÌfi˜ ÎÂÓÙÚÈÎÒÓ ÌÈÎÚÔÛˆÏËÓ·Ú›ˆÓ ÁÂÈÙÔÓÈÎÒÓ ÎÚÔÛÛÒÓ ¢Â˘ÙÂÚÔ·ı›˜ ‰ÔÌÈΤ˜ ·ÓˆÌ·Ï›Â˜ ñ ™‡ÓıÂÙÔÈ ÎÚÔÛÛÔ› ñ ¢È·Ù·Ú·¯¤˜ ÌÈÎÚÔÛˆÏËÓ·Ú›ˆÓ

˘ÔÛËÌ·›ÓÂÈ ÙË ¯ÚÔÓÈfiÙËÙ· Ù˘ ÓfiÛÔ˘. ™ÙÔ˘˜ ÂÊ‹‚Ô˘˜ Î·È ÙÔ˘˜ ÂÓ‹ÏÈΘ, Ù· Û˘ÌÙÒÌ·Ù· Â›Ó·È ·ÚfiÌÔÈ· Ì ·˘Ù¿ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜, ÂÓÒ ÚÔÛÙ›ıÂÙ·È ÛÙÂÈÚfiÙËÙ· ÛÙÔ˘˜ ¿Ó‰Ú˜ Î·È ˘ÔÁÔÓÈÌfiÙËÙ· ÛÙȘ Á˘Ó·›Î˜, ÔÈ Ôԛ˜ ¤¯Ô˘Ó Î·È ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ Â͈̋ÙÚÈ·˜ ·ËÛ˘. ∏ ‰È¿ÁÓˆÛË ÙÔ˘ ™¶¢∫ ÌÔÚ› Û˘¯Ó¿ Ó· ‰È·Ê‡ÁÂÈ Î·È Ó· Á›ÓÂÈ Î·ı˘ÛÙÂÚË̤ӷ ÛÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹, ÏfiÁˆ ÂÌÊ¿ÓÈÛ˘ ÛÙ›ڈÛ˘ (46,50). ¢È·ÁÓˆÛÙÈ΋ ÚÔÛ¤ÁÁÈÛË ∏ ‰ÈÂÚ‡ÓËÛË ·È‰ÈÔ‡ Ì ÎÏÈÓÈ΋ ˘Ô„›· Û˘Ó‰ÚfiÌÔ˘ ‰˘ÛÎÈÓËÛ›·˜ ÙˆÓ ÎÚÔÛÛÒÓ ÂÚÈÏ·Ì‚¿ÓÂÈ: ·) ÙËÓ ÂÎÙ›ÌËÛË Ù˘ ‚ÏÂÓÓÔÎÚÔÛÛˆÙ‹˜ οı·ÚÛ˘ (µ∫∫) Î·È ‚) ÙË ÌÂϤÙË, Û ËÏÂÎÙÚÔÓÈÎfi ÌÈÎÚÔÛÎfiÈÔ, ÙˆÓ ÎÚÔÛÛÒÓ Ô˘ Ï·Ì‚¿ÓÔÓÙ·È Ì ‚ÈÔ„›· ‹ ·fi ͤÛÌ·Ù· ‚Ô‡ÚÙÛ·˜ (brushing epithelial cell) ·fi ÙË Ì¤ÛË ÚÈÓÈ΋ ÎfiÁ¯Ë ‹ ‚ÚÔÁ¯ÔÛÎÔÈο ·fi οÔÈÔ ¿ÏÏÔ ÛËÌÂ›Ô ÙÔ˘ ÙÚ·¯ÂÈÔ‚ÚÔÁ¯ÈÎÔ‡ ‰¤Ó‰ÚÔ˘. ·) ∂ÎÙ›ÌËÛË ‚ÏÂÓÓÔÎÚÔÛÛˆÙ‹˜ οı·ÚÛ˘ (µ∫∫) ∏ µ∫∫ (clearance) ÂϤÁ¯ÂÙ·È Ì ‰È¿ÊÔÚ˜ Ù¯ÓÈΤ˜ Î·È ÌÂıfi‰Ô˘˜ in vivo Ô˘ ‰È·Ê¤ÚÔ˘Ó ÌÂٷ͇ ÙÔ˘˜ ˆ˜ ÚÔ˜ ÙËÓ Ô˘Û›· Ô˘ ¯ÚËÛÈÌÔÔÈÂ›Ù·È (·ÓÂÓÂÚÁ‹˜ Ô˘Û›· ‹ Ú·‰ÈÔÂÓÂÚÁfi˜) Î·È ÛÙÔÓ ÙÚfiÔ Ì¤ÙÚËÛ˘. ∆ÚÂȘ Â›Ó·È ÔÈ Û˘¯ÓfiÙÂÚ· ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓ˜ ̤ıÔ‰ÔÈ: i) Ë Ì¤ıÔ‰Ô˜ Ù˘ ۷ί·Ú›Ó˘, ii) Ë Ì¤ıÔ‰Ô˜ ÙˆÓ ¯ÚˆÛÙÈÎÒÓ Ô˘ÛÈÒÓ Î·È iii ) Ë ÂÎÙ›ÌËÛË Ù˘ ÎÈÓËÙÈÎfiÙËÙ·˜ ÙˆÓ ÎÚÔÛÛÒÓ, Ì ÌÈÎÚÔÛÎfiÈÔ ·ÓÙ›ıÂÙ˘ Ê¿Ûˆ˜. i) ª¤ıÔ‰Ô˜ Ù˘ ۷ί·Ú›Ó˘. ∏ ̤ıÔ‰Ô˜ ·˘Ù‹, Ô˘ ÂÈÓfiËÛ ÚÒÙÔ˜ Ô Adersen (1974) Î·È ÙÚÔÔÔ›ËÛÂ Ô Rutlahd-Cole (1981), ¯ÚËÛÈÌÔÔÈÂ›Ù·È Â˘Ú¤ˆ˜ ÁÈ· ÙË Ì¤ÙÚËÛË Ù˘ µ∫∫ (51-54). ∂›Ó·È ·Ï‹, ‡¯ÚËÛÙË Î·È ‰›ÓÂÈ ÏËÚÔÊÔڛ˜ Û¯ÂÙÈο Ì ÙËÓ ÂÓÂÚÁËÙÈÎfiÙËÙ· ÙˆÓ ÎÚÔÛÛÒÓ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ ÂÈıËÏ›Ô˘ (50,51). ªÂÈÔÓ¤ÎÙËÌ· Ù˘ ÌÂıfi‰Ô˘ ıˆÚÂ›Ù·È Ë ·‰˘Ó·Ì›· Ù˘ ÛÙË ‰È¿ÎÚÈÛË ÂÚÈ-

408

Paediatriki 2002;65:403-412

ÙÒÛÂˆÓ ‰ÔÌÈ΋˜ ·ÓˆÌ·Ï›·˜ ÎÚÔÛÛÒÓ, Ô˘ fï˜ ‰È·ÙËÚÔ‡Ó Î¿ÔÈ· ÎÈÓËÙÈÎfiÙËÙ· (54). ∏ ‰È·‰Èηۛ· Â›Ó·È ·Ï‹: ÌÈÎÚ‹ ÔÛfiÙËÙ· ÎfiÎÎˆÓ Û·Î¯·Ú›Ó˘ ‰È·Ì¤ÙÚÔ˘ 1-2 mm ÙÔÔıÂÙÂ›Ù·È ÛÙÔ ÚfiÛıÈÔ ¿ÎÚÔ Ù˘ οو ÚÈÓÈ΋˜ ÎfiÁ¯Ë˜ Î·È ˘ÔÏÔÁ›˙ÂÙ·È Ô ¯ÚfiÓÔ˜ Ô˘ ··ÈÙÂ›Ù·È ÁÈ· Ó· ·ÈÛı·Óı› Ô ·ÛıÂÓ‹˜ ÙË ÁÏ˘ÎÈ¿ Á‡ÛË. O ¿ÚÚˆÛÙÔ˜ ‰ÂÓ Ú¤ÂÈ Ó· Ù·ÚÓ›˙ÂÙ·È, Ó· ÔÛÊÚ·›ÓÂÙ·È, Ó· ÙÚÒÂÈ ‹ Ó· ›ÓÂÈ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ‰ÔÎÈÌ·Û›·˜. ¶Ú¤ÂÈ Ó· Â›Ó·È Î·ıÈṲ̂ÓÔ˜ Ì ÎÏ›ÛË ÙÔ˘ ·˘¯¤Ó· ÚÔ˜ Ù· ÂÌÚfi˜, ÒÛÙ ӷ ÂÌÔ‰›˙ÂÙ·È Ë ·¢ı›·˜ οıÔ‰Ô˜ Ù˘ ۷ί·Ú›Ó˘ ÛÙÔ Ê¿Ú˘ÁÁ·. ÃÚfiÓÔ˜ ÌÂÁ·Ï‡ÙÂÚÔ˜ ·fi 60 ÏÂÙ¿ Â›Ó·È ·ıÔÏÔÁÈÎfi˜ Î·È ıˆÚÂ›Ù·È ‰ËψÙÈÎfi˜ Ù˘ ‰È·Ù·Ú·¯‹˜ ÙÔ˘ ‚ÏÂÓÓÔÎÚÔÛÛˆÙÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. º˘ÛÈÔÏÔÁÈÎfi˜ ıˆÚÂ›Ù·È Ô ¯ÚfiÓÔ˜ οو ·fi 40 ÏÂÙ¿, ÂÓÒ ÔÚÈ·Îfi˜ ıˆÚÂ›Ù·È ÌÂٷ͇ 40-60 ÏÂÙÒÓ. ∏ ̤ıÔ‰Ô˜ ·ԉ›¯ÙËΠ·ÍÈfiÈÛÙË ÛÙËÓ Î·ıËÌÂÚÈÓ‹ ÎÏÈÓÈ΋ Ú¿ÍË. ∞·ÈÙ›ٷÈ, fï˜, Ë Û˘ÓÂÚÁ·Û›· ÙÔ˘ ·ÛıÂÓÔ‡˜ Î·È ÁÈ’ ·˘Ùfi ÂÚÈÔÚ›˙ÂÙ·È Û ·È‰È¿ ÌÂÁ·Ï‡ÙÂÚ· ÙˆÓ 8 ¯ÚfiÓˆÓ. ªÂÚÈÎÔ› ÂÚ¢ÓËÙ¤˜ ÂÊ·ÚÌfi˙Ô˘Ó ÙË Ì¤ıÔ‰Ô ·˘Ù‹ Î·È ÛÙ· ‚Ú¤ÊË Ô˘ ‰ÂÓ Û˘ÓÂÚÁ¿˙ÔÓÙ·È, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ Ú·‰ÈÔÛÂÛËÌ·Ṳ̂ÓË Û·Î¯·Ú›ÓË Ì Tc99 Î·È ·Ú·ÎÔÏÔ˘ıÒÓÙ·˜ ÙËÓ Î›ÓËÛ‹ Ù˘ ̤ۈ Á-οÌÂÚ·˜ (1,54). ii) ª¤ıÔ‰Ô˜ ÙˆÓ ¯ÚˆÛÙÈÎÒÓ. O Ornestan (1946) (55) ÚÒÙÔ˜ ¯ÚËÛÈÌÔÔ›ËÛ ¯ÚˆÛÙÈ΋ ·fi ÛÔ˘ÏÊ·ıÈ·˙fiÏË, ÂÎÙÈÌÒÓÙ·˜ ÙÔ ¯ÚfiÓÔ Ô˘ ··ÈÙÂ›Ù·È ÁÈ· ÙËÓ Î¿ıÔ‰Ô Ù˘ ¯ÚˆÛÙÈ΋˜ ·˘Ù‹˜ ÛÙÔ Ê¿Ú˘ÁÁ·, ÂÓÒ Ô K·Ó·‰fi˜ Temble (1948) ‚ÂÏÙ›ˆÛ ÙË Ì¤ıÔ‰Ô ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ Û·Ó ¯ÚˆÛÙÈ΋ ÙÔ Edicol Orange (56). ∏ ̤ıÔ‰Ô˜ ÌÔÚ› Ó· ÂÊ·ÚÌÔÛÙ› ¯ˆÚ›˜ ÙËÓ ·fiÏ˘ÙË Û˘ÓÂÚÁ·Û›· ÙÔ˘ ·ÚÚÒÛÙÔ˘ Î·È ‰ÂÓ ÂÍ·ÚÙ¿Ù·È ·fi ÂÚÈ‚·ÏÏÔÓÙÈΤ˜ Û˘Óı‹Î˜ ıÂÚÌÔÎÚ·Û›·˜ ‹ ˘ÁÚ·Û›·˜ (56,57). ∏ Ù¯ÓÈ΋ Â›Ó·È Ë ·ÎfiÏÔ˘ıË: ÌÈÎÚ‹ ÔÛfiÙËÙ· Ì›ÁÌ·ÙÔ˜ ‰ÈÛfiÍÈÓÔ˘ ʈÛÊÔÚÈÎÔ‡ ·Û‚ÂÛÙ›Ô˘ (CaHPO4H2O) 97% Î·È Edicol Orange 3% ÙÔÔıÂÙÂ›Ù·È ÛÙËÓ ¿Óˆ ÂÈÊ¿ÓÂÈ· Ù˘ ÎÂÊ·Ï‹˜ Ù˘ οو ÚÈÓÈ΋˜ ÎfiÁ¯Ë˜. O ¯ÚfiÓÔ˜ ÌÂÙ·ÊÔÚ¿˜ Ù˘ ‚ϤÓÓ˘ ˘ÔÏÔÁ›˙ÂÙ·È ·fi ÙË ÛÙÈÁÌ‹ ·˘Ù‹ ̤¯ÚȘ fiÙÔ˘ Ë Ô˘Û›· Ô˘ ¯ÚˆÌ·Ù›˙ÂÈ ÙÔ ÚÈÓÈÎfi ‚ÏÂÓÓÔÁfiÓÔ Û ÎfiÎÎÈÓÔ-ÔÚÙÔηϛ ¯ÚÒÌ· ·Ó¢ÚÂı› ÛÙËÓ Ï¿ÁÈ· Ê·Ú˘ÁÁÈ΋ ÎÔÈÏfiÙËÙ· ÛÙÔ ‡„Ô˜ Ù˘ ÔÛÙÈ΋˜ ˘ÂÚÒ·˜. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂͤٷÛ˘, Ô ·ÛıÂÓ‹˜ Ú¤ÂÈ Ó· ÂÎÙÂÏ› ηٷÔÙÈΤ˜ ÎÈÓ‹ÛÂȘ οı 30 ‰Â˘ÙÂÚfiÏÂÙ·. ∏ ÈÛÙÔÔ›ËÛË Ù˘ ·ÚÔ˘Û›·˜ Ù˘ ¯ÚˆÛÙÈ΋˜ ÛÙÔ Ê¿Ú˘ÁÁ· ÌÔÚ› Ó· Á›ÓÂÈ Ì ÙÔ ÂÚÈÔ‰ÈÎfi ¿ÁÁÈÁÌ· ÙÔ˘ ÛÙ˘ÏÂÔ‡ ÛÙËÓ ÂÚÈÔ¯‹, ÂÓÒ ·Ô‰ÂÈÎÓ‡ÂÙ·È Î·È ÔÙÈο. º˘ÛÈÔÏÔÁÈο, Ô ¯ÚfiÓÔ˜ ÌÂÙ·ÊÔÚ¿˜ Ù˘ ‚ϤÓÓ˘ ̤¯ÚÈ ÙËÓ Ï¿ÁÈ· Ê·Ú˘ÁÁÈ΋ ¯ÒÚ· Â›Ó·È 5-14 ÏÂÙ¿. ÃÚfiÓÔ˜ ¿Óˆ ·fi 30 ÏÂÙ¿ ıˆÚÂ›Ù·È Û·ÊÒ˜ ·ıÔÏÔÁÈÎfi˜, ÂÓÒ ÂӉȿÌÂÛ˜ ÙÈ̤˜ >15 ¤ˆ˜ 29 ÏÂÙÒÓ, ˘Ô‰ËÏÒÓÔ˘Ó

NoV-dEc-02

14-05-03

14:26

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¶·È‰È·ÙÚÈ΋ 2002;65:403-412

Paediatriki 2002;65:403-412

∂ÈÎfiÓ· 7. ∞ӈ̷ϛ· ÛÙË ‰È¿Ù·ÍË Î·È ÙÔÓ ÚÔÛ·Ó·ÙÔÏÈÛÌfi ÙˆÓ ÌÈÎÚÔÛˆÏËÓ·Ú›ˆÓ Û ·ÛıÂÓ‹ Ì ™¶¢∫, fiˆ˜ Ê·›ÓÂÙ·È ÛÙÔ ËÏÂÎÙÚÔÓÈÎfi ÌÈÎÚÔÛÎfiÈÔ.

ÂÈ‚Ú¿‰˘ÓÛË (29,30,58). iii) ∂ÎÙ›ÌËÛË ÎÈÓËÙÈÎfiÙËÙ·˜ ÙˆÓ ÎÚÔÛÛÒÓ Ì ÌÈÎÚÔÛÎfiÈÔ. ∏ ·¢ı›·˜ ÔÙÈ΋ ÂÎÙ›ÌËÛË Ù˘ ΛÓËÛ˘ ÙÔ˘ ÎÚÔÛÛÔ‡ ıˆÚÂ›Ù·È ·fi ÙÔ 1981 Û·Ó Ë ÈÔ ·ÍÈfiÈÛÙË Ì¤ıÔ‰Ô˜ Ì·˙ÈÎÔ‡ ÂϤÁ¯Ô˘ ÁÈ· ÙËÓ ·Ó‡ÚÂÛË ·Û¯fiÓÙˆÓ ·fi ™¶¢∫ (1,2,59-61). ∏ Ï‹„Ë ÙˆÓ ÎÚÔÛÛˆÙÒÓ Î˘ÙÙ¿ÚˆÓ Á›ÓÂÙ·È ·fi ÙÔ ÚÈÓÈÎfi ‚ÏÂÓÓÔÁfiÓÔ Ù˘ οو ÚÈÓÈ΋˜ ÎfiÁ¯Ë˜ Ì ÂȉÈ΋ ‚Ô‡ÚÙÛ· (brushing nasal epithelium cell), ·ÊÔ‡ ÚÔËÁÔ˘Ì¤Óˆ˜ ¤¯ÂÈ ÚÔËÁËı› ηÏfi˜ ηı·ÚÈÛÌfi˜ Ù˘ ̇Ù˘. ∂Ó·ÏÏ·ÎÙÈο, Ù¤ÙÔÈ· ‰Â›ÁÌ·Ù· ÌÔÚ› Ó· ÏËÊıÔ‡Ó ‚ÚÔÁ¯ÔÛÎÔÈο ·fi ÙËÓ ÙÚ·¯Â›· ‹ ÙÔ˘˜ ‚ÚfiÁ¯Ô˘˜. ∆Ô ˘ÏÈÎfi ·˘Ùfi ÙÔÔıÂÙÂ›Ù·È Û ˘ÁÚfi ÁÈ· ηÏÏȤÚÁÂÈ· ΢ÙÙ¿ÚˆÓ (.¯. Medium 199, Minimal Essential Medium), ÂÍ·ÛÊ·Ï›˙ÔÓÙ·˜ ¤ÙÛÈ ÙËÓ ÂÈ‚›ˆÛË Î·È ÏÂÈÙÔ˘ÚÁÈ΋ ·ÎÂÚ·ÈfiÙËÙ· ÙˆÓ ÎÚÔÛÛˆÙÒÓ Î˘ÙÙ¿ÚˆÓ ÙÔ˘Ï¿¯ÈÛÙÔÓ ÁÈ· Ì›· ÒÚ·. ∏ ÂͤٷÛË Á›ÓÂÙ·È ÛÙÔ ÎÔÈÓfi ÌÈÎÚÔÛÎfiÈÔ ·ÓÙ›ıÂÙ˘ Ê¿Ûˆ˜, Û ÌÂÁ¤ı˘ÓÛË 16-40 ÊÔÚ¤˜. ™ÙË ıÂÚÌÔÎÚ·Û›· ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ Ù· ÎÚÔÛÛˆÙ¿ ·ÙÙ·Ú· ÂÈ‚Ú·‰‡ÓÔ˘Ó ÙÔ Ú˘ıÌfi ÙÔ˘˜, Û˘Ó¯›˙Ô˘Ó, fï˜, Ó· ÎÈÓÔ‡ÓÙ·È Ì ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÙÚfiÔ. ∆¤ÏÔ˜, Ë ÂÚ·ÈÙ¤Úˆ ÌÂϤÙË Ù˘ ΛÓËÛ˘ ÙˆÓ ÎÚÔÛÛÒÓ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ ÂÈıËÏ›Ô˘ ̤ۈ Ù˘ video Ì·ÁÓËÙÔÛÎfiËÛ˘ (60,61) ¤¯ÂÈ ÂÈÙÚ¤„ÂÈ Ó· ηٷÓÔ‹ÛÔ˘Ì ηχÙÂÚ· ÙȘ Û¯¤ÛÂȘ Ô˘ ˘¿Ú-

¯Ô˘Ó ÌÂٷ͇ ÙˆÓ ‰ÔÌÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ ÙˆÓ ÎÚÔÛÛÒÓ Î·È ÙˆÓ ‰È·ÊÔÚÂÙÈÎÒÓ ÌÔÚÊÒÓ Î›ÓËÛ˘ ÙˆÓ ÚÔۂ‚ÏËÌ¤ÓˆÓ ÎÚÔÛÛÒÓ (∂ÈÎfiÓ· 4). ∆ËÓ ·Ú·¿Óˆ ̤ıÔ‰Ô ÂÊ·ÚÌfi˙Ô˘Ì ۋÌÂÚ· Î·È ÛÙËÓ ÎÏÈÓÈ΋ Ì·˜ (∂ÈÎfiÓ· 5 Î·È 6). ‚) ªÂϤÙË Ù˘ ‰ÔÌ‹˜ ÙˆÓ ÎÚÔÛÛÒÓ Ì ËÏÂÎÙÚÔÓÈÎfi ÌÈÎÚÔÛÎfiÈÔ ∏ ÂȂ‚·›ˆÛË Ù˘ ‚Ï¿‚˘ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ ÂÈıËÏ›Ô˘ ÛÙËÓ ¶¢∫ Á›ÓÂÙ·È Ì ËÏÂÎÙÚÔÓÈÎfi ÌÈÎÚÔÛÎfiÈÔ (∏ª) ‰È¤Ï¢Û˘. ∆Ô ˘ÏÈÎfi, ÚÔÂÚ¯fiÌÂÓÔ Â›Ù ·fi ÚÈÓÈÎfi ›Ù ·fi ‚ÚÔÁ¯ÈÎfi ‚ÏÂÓÓÔÁfiÓÔ, ÌÔÓÈÌÔÔÈÂ›Ù·È ·Ú¯Èο Û ÁÏÔ˘Ù·Ú·Ï‰Â˛‰Ë 3% ÁÈ· 2 ÒÚ˜ ηÈ, ÛÙË Û˘Ó¤¯ÂÈ·, Û ÙÂÙÚÔÍ›‰ÈÔ ÙÔ˘ ÔÛÌ›Ô˘ 2%. ∞ÎÔÏÔ˘ı› ¯ÚÒÛË Ì ÔÍÂ˚Îfi Ô˘Ú·Ó‡ÏÈÔ 1%, ÂÁÎÏÂÈÛÌfi˜ ÙÔ˘ ÈÛÙÔ‡ Û ÚËÙ›Ó˜ Î·È ÌÂϤÙË ÛÙÔ ∏ª ÌÂÙ¿ ·fi ¯ÚÒÛË ÏÂÙÒÓ ÙÔÌÒÓ Ì ÌfiÏ˘‚‰Ô. ¶·ıÔÏÔÁÈÎfi ‡ÚËÌ· Û˘Ì‚·Ùfi Ì ™¶¢∫ ıˆÚÂ›Ù·È Ë ·Ó‡ÚÂÛË ÂÚÈÛÛfiÙÂÚÔ˘ ·fi ÙÔ 70% ÙˆÓ ÎÚÔÛÛÒÓ Ì ‰ÔÌÈΤ˜ ·ÓˆÌ·Ï›Â˜ (ÙÔ ‰Â›ÁÌ· ıˆÚÂ›Ù·È Ê˘ÛÈÔÏÔÁÈÎfi ·fi 0-10% Î·È ÂÓ‰ÂÈÎÙÈÎfi ¯ÚfiÓÈ·˜ ÊÏÂÁÌÔÓ‹˜ Û ÔÛÔÛÙfi 25-60%), ȉȷ›ÙÂÚ· ·ÓˆÌ·Ï›Â˜ Ô˘ ·ÊÔÚÔ‡Ó ÛÙËÓ Î·Ù¿Ù·ÍË ‹ ÙÔÓ ÚÔÛ·Ó·ÙÔÏÈÛÌfi ÙˆÓ ÌÈÎÚÔÛˆÏËÓ·Ú›ˆÓ (1,2,63). ™ËÌÂȈ٤ÔÓ fiÙÈ Ë ÙÂÏÂ˘Ù·›· ·˘Ù‹ ·ÓˆÌ·Ï›· ·Ó¢ڛÛÎÂÙ·È Î·È ÛÙ· ‰Â˘ÙÂÚÔ·ı‹ Û‡Ó‰ÚÔÌ· ‰˘ÛÎÈÓËÛ›·˜ ÙˆÓ ÎÚÔÛÛÒÓ, ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÈÔÁÂÓÔ‡˜ ‹ ÌÈÎÚԂȷ΋˜

409

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Paediatriki 2002;65:403-412

¶›Ó·Î·˜ 2. ∞ÏÁfiÚÈıÌÔ˜ ÁÈ· ÙË ‰ÈÂÚ‡ÓËÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ‰˘ÛÎÈÓËÛ›·˜ ÙˆÓ ÎÚÔÛÛÒÓ

Ïԛ̈͢ Î·È Â›Ó·È ·ÚÔ‰È΋. °È· ÙÔ ÏfiÁÔ ·˘Ùfi, Ô ¤ÏÂÁ¯Ô˜ Ú¤ÂÈ Ó· Á›ÓÂÙ·È ¿ÓÙ· ÌÂÙ¿ ÙËÓ ¿ÚÔ‰Ô 4-6 ‚‰ÔÌ¿‰ˆÓ ·fi Èı·Ó‹ Ïԛ̈ÍË, ÒÛÙ ӷ ·ÔÎÏ›ÂÙ·È Ë ÂÚ›ÙˆÛË ÙÔ˘ ‰Â˘ÙÂÚÔ·ıÔ‡˜ Û˘Ó‰ÚfiÌÔ˘ ‰˘ÛÎÈÓËÛ›·˜ (1,2,62,63). ªÂ ÙÔ ËÏÂÎÙÚÔÓÈÎfi ÌÈÎÚÔÛÎfiÈÔ ÌÔÚÔ‡Ó Ó· ÂÚ¢ÓËıÔ‡Ó ‰È¿ÊÔÚ˜ ‰ÔÌÈΤ˜ ·ÓˆÌ·Ï›Â˜ ÙˆÓ ÎÚÔÛÛÒÓ (¶›Ó·Î·˜ 1) (∂ÈÎfiÓ· 7). ¶ÚfiÛÊ·Ù·, ¯ÚËÛÈÌÔÔÈÂ›Ù·È Ë Ì¤ÙÚËÛË ÙÔ˘ ÂÎÓÂfiÌÂÓÔ˘ ÌÔÓÔÍÂȉ›Ô˘ ÙÔ˘ ·˙ÒÙÔ˘ (¡O) Û·Ó Ì›· ·Ó·›Ì·ÎÙË ÌË ÂÂÌ‚·ÙÈ΋ ̤ıÔ‰Ô˜ ÁÈ· ÙËÓ ·Ó‡ÚÂÛË ·È‰ÈÒÓ Ì ™¶¢∫. ∏ ̤ıÔ‰Ô˜ ·˘Ù‹ ··ÈÙ› ÔχÏÔÎÔ ÂÍÔÏÈÛÌfi Î·È ¯ÚÂÈ¿˙ÔÓÙ·È ÂÚÈÛÛfiÙÂÚ˜ ÌÂϤÙ˜ ÁÈ· ÙËÓ ÙÂÎÌËÚ›ˆÛË Î·È ÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘ ÛÙËÓ ÎÏÈÓÈ΋ Ú¿ÍË (1,64,65).

O ·ÏÁfiÚÈıÌÔ˜ Ô˘ ¯ÚËÛÈÌÔÔÈԇ̠ۋÌÂÚ· ÁÈ· ÙË ‰ÈÂÚ‡ÓËÛË ·È‰ÈÔ‡ Ì ÎÏÈÓÈ΋ ˘Ô„›· Û˘Ó‰ÚfiÌÔ˘ ‰˘ÛÎÈÓËÛ›·˜ ÙˆÓ ÎÚÔÛÛÒÓ Ê·›ÓÂÙ·È ÛÙÔÓ

410

¶›Ó·Î· 2. O ¤ÏÂÁ¯Ô˜ Ù˘ ‚ÏÂÓÓÔÎÚÔÛÛˆÙ‹˜ οı·ÚÛ˘ ·Ó¿ÏÔÁ· Ì ÙËÓ ËÏÈΛ·, ·Ú¯Èο, Á›ÓÂÙ·È Ì ÙË Ì¤ıÔ‰Ô Ù˘ ۷ί·Ú›Ó˘ ‹ Ù˘ ¯ÚˆÛÙÈ΋˜. ∞Ó ÔÈ ÙÈ̤˜ Â›Ó·È ·ıÔÏÔÁÈΤ˜ Û 2 ‰È·‰Ô¯ÈΤ˜ ÌÂÙÚ‹ÛÂȘ Û ‰È¿ÛÙËÌ· 1 ‚‰ÔÌ¿‰·˜ Î·È Ì ÙËÓ ÚÔ¸fiıÂÛË fiÙÈ Ô ·ÛıÂÓ‹˜ ‰ÂÓ Â›¯Â ·Ó·Ó¢ÛÙÈ΋ Ïԛ̈ÍË ÙȘ ÚÔËÁÔ‡ÌÂÓ˜ 4-6 ‚‰ÔÌ¿‰Â˜, ÚÔ¯ˆÚԇ̠۠ÚÈÓÈÎfi brushing Î·È ÌÂϤÙË ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ÛÙÔ ÎÔÈÓfi ÌÈÎÚÔÛÎfiÈÔ ·ÓÙ›ıÂÙ˘ Ê¿Ûˆ˜. ∞Ó ‰È·ÈÛÙˆı› ·ıÔÏÔÁÈ΋ ÎÈÓËÙÈÎfiÙËÙ· ÙˆÓ ÎÚÔÛÛÒÓ ‹ ·ıÔÏÔÁÈ΋ ÌÔÚÊÔÏÔÁ›· ·˘ÙÒÓ, ÙfiÙ ÚÔ¯ˆÚԇ̠۠ÂͤٷÛË Ì ËÏÂÎÙÚÔÓÈÎfi ÌÈÎÚÔÛÎfiÈÔ. ∞ÓÙÈÌÂÙÒÈÛË Ÿˆ˜ Û οı ¯ÚfiÓÈÔ ÓfiÛËÌ·, Ë ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ·È‰ÈÔ‡ Ì ™¶¢∫ ··ÈÙ› ÙË Û˘ÓÂÚÁ·Û›· ÔÏÏÒÓ ÂȉÈÎÔًوÓ, fiˆ˜ ÁÂÓÈÎÔ‡ ·È‰È¿ÙÚÔ˘, ·È‰ÔÓ¢ÌÔÓÔÏfiÁÔ˘, ˆÙÔÚÈÓÔÏ·Ú˘ÁÁÔÏfiÁÔ˘,

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ÂÓ›ÔÙ ԢÚÔÏfiÁÔ˘ ‹ Î·È Á˘Ó·ÈÎÔÏfiÁÔ˘, ηıÒ˜ Î·È Ê˘ÛÈÔıÂÚ·¢ÙÒÓ. ∏ ÁÂÓÂÙÈ΋ ‰È·Ù·Ú·¯‹ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ‰ÂÓ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ‰ÈÔÚıˆı› Î·È Ó· ·ÔηٷÛÙ·ı› Ë ÎÈÓËÙÈÎfiÙËÙ· ÙˆÓ ÎÚÔÛÛÒÓ Ì ʷÚ̷΢ÙÈ΋ ·ÁˆÁ‹. ∏ ıÂÚ·›·, ÂÔ̤ӈ˜, Â›Ó·È Û˘Ìو̷ÙÈ΋ Î·È Û˘Ó›ÛٷٷÈ: ·) ÛÙËÓ ÂÏ¿ÙÙˆÛË Ù˘ ·Ú·ÌÔÓ‹˜ Ù˘ ‚ϤÓÓ˘, ‚) ÛÙËÓ ÂÓÂÚÁËÙÈ΋ ıÂÚ·›· ÙˆÓ ÂÈÏÔÎÒÓ ÛÙȘ ·ÂÚÔÊfiÚÔ˘˜ Ô‰Ô‡˜ ÙÔ˘ ·ÓÒÙÂÚÔ˘ Î·È Î·ÙÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Î·È Á) ÛÙËÓ ÚfiÏË„Ë ÙˆÓ ÂÈÏÔÎÒÓ, ΢ڛˆ˜ ·fi ÙÔ Î·ÙÒÙÂÚÔ ·Ó·Ó¢ÛÙÈÎfi Û‡ÛÙËÌ·. ŒÙÛÈ, Ë ÂÓÂÚÁËÙÈ΋ ηıËÌÂÚÈÓ‹ ηٿÏÏËÏË Ê˘ÛÈÔıÂÚ·›· ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡, Ë ÂÈıÂÙÈ΋ Î·È ·Ú·ÙÂٷ̤ÓË ·ÓÙÈ‚ÈÔÙÈ΋ ·ÁˆÁ‹ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÂÍ¿ÚÛÂˆÓ ÙˆÓ ·Ó·Ó¢ÛÙÈÎÒÓ ÏÔÈÌÒ͈Ó, Ë Û˘ÛÙËÌ·ÙÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË Î·È Ë Î·Ù¿ÏÏËÏË ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ ·fi ÙË Ì‡ÙË, Ù· ·˘ÙÈ¿ Î·È ÙÔ˘˜ ·Ú·ÚÚ›ÓÈÔ˘˜ ÎfiÏÔ˘˜ (Ì˘ÚÈÁÁÔÙÔÌ‹, ÔÏ˘Ô‰ÂÎÙÔÌ‹, ·ÚÔ¯¤Ù¢ÛË ÎfiÏˆÓ) ı· ‚ÂÏÙÈÒÛÔ˘Ó ÙËÓ ÔÈfiÙËÙ· ˙ˆ‹˜ ÙˆÓ ÌÈÎÚÒÓ ·ÛıÂÓÒÓ. ¶Ú¤ÂÈ Ó· ÁÓˆÚ›˙Ô˘Ì fiÙÈ ÙÔ ™¶¢∫ Â›Ó·È Ôχ Û¿ÓÈÔ. ÃÚÂÈ¿˙ÂÙ·È Â˘·ÈÛıËÙÔÔ›ËÛË ÙÔ˘ ·È‰È¿ÙÚÔ˘ ÁÈ· ÙËÓ ·Ó·˙‹ÙËÛ‹ ÙÔ˘. ∏ ¤ÁηÈÚË ‰È¿ÁÓˆÛË Î·È ·ÓÙÈÌÂÙÒÈÛË ı· ÂÍ·ÛÊ·Ï›ÛÔ˘Ó Ì·ÎÚÔÚfiıÂÛÌ· ÛÙÔ˘˜ ÌÈÎÚÔ‡˜ ·ÛıÂÓ›˜ ‡ÊÂÛË Û˘ÌÙˆÌ¿ÙˆÓ Î·È Î·Ï‹ ÔÈfiÙËÙ· ˙ˆ‹˜. µÈ‚ÏÈÔÁÚ·Ê›· 1. Meeks M, Bush A. Primary ciliary dyskinesia. Pediatr Pulmonol 2000;29:307-316.

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ORIGINAL ARTICLE

∏ ÔÛÙÈ΋ ˘ÎÓfiÙËÙ· ÚÈÓ Î·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ıÂÚ·›·˜ Ì ÙÔ Û˘ÓıÂÙÈÎfi ·Ó¿ÏÔÁÔ Triptoreline (3,75 mg) Û ·È‰È¿ Ì ÎÂÓÙÚÈ΋ ÚÒÈÌË ‹‚Ë ¶. ∑ÒÛË, ¢. ∫·Ú·Î·˚‰fi˜, °. ∆ÚÈ·ÓÙ·Ê˘ÏÏ›‰Ë˜, °. O˘˙Ô‡ÓË, ™. ¶È˙¿ÓÈ·˜, Ã. ∫·Ú‹˜

Bone mineral density before and during treatment with a LHRH analog Triptoreline (3.75 mg) in children with central precocious puberty P. Zosi, D. Karakaidos, G. Triantafyllidis, G. Ouzouni, S. Pizanias, C. Karis

¶ÂÚ›ÏË„Ë: ∫·Ù¿ ÙËÓ ÂÊ˂›·, ÂÎÙfi˜ ·fi ÙËÓ ÂÌÊ¿ÓÈÛË ÙˆÓ ‰Â˘ÙÂÚÔÁÂÓÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ÙÔ˘ ʇÏÔ˘ Î·È ÙËÓ ÂÈÙ¿¯˘ÓÛË ÙÔ˘ Ú˘ıÌÔ‡ ·‡ÍËÛ˘, ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛËÌ·ÓÙÈΤ˜ ÌÂÙ·‚ÔϤ˜ ÛÙË Û‡ÛÙ·ÛË ÙÔ˘ ÛÒÌ·ÙÔ˜ Î·È ÙËÓ ÔÛÙÈ΋ ˘ÎÓfiÙËÙ· (O¶) (1-4). ™ÙËÓ ÂÚÁ·Û›· ·˘Ù‹ ÌÂÏÂÙ‹ıËÎÂ Ë ÔÛÙÈ΋ ˘ÎÓfiÙËÙ· Î·È Ô ÔÛÙÈÎfi˜ ÌÂÙ·‚ÔÏÈÛÌfi˜ Û 12 ÎÔÚ›ÙÛÈ· Ì ÎÂÓÙÚÈ΋ ÚÒÈÌË ‹‚Ë, ÚÈÓ Î·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· 24ÌËÓ˘ ıÂÚ·›·˜ Ì ÙÔ Û˘ÓıÂÙÈÎfi ·Ó¿ÏÔÁÔ LHRH ÙÚÈÙÔÚÂÏ›ÓË (D-Trp-6 LHRH). ∏ ÔÛÙÈ΋ ˘ÎÓfiÙËÙ· ÌÂÙÚ‹ıËΠ̠ÙË Ì¤ıÔ‰Ô Ù˘ ·ÔÚÚfiÊËÛ˘ ‰ÈÏ‹˜ ÂÓ¤ÚÁÂÈ·˜ ‰¤ÛÌ˘ ʈÙÔÓ›ˆÓ ˘„ËÏ‹˜ ÂÓ¤ÚÁÂÈ·˜ (D∂Ã∞)ÛÙËÓ ÔÛÊ˘˚΋ ÌÔ›Ú· Ù˘ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘ O1-O4. ∆·˘Ùfi¯ÚÔÓ·, ÌÂÙÚ‹ıËÎ·Ó ÚÔ Î·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ıÂÚ·›·˜ ÔÈ ÙÈ̤˜ ·Û‚ÂÛÙ›Ô˘, ʈÛÊfiÚÔ˘, ·ÏηÏÈ΋˜ ʈÛÊ·Ù¿Û˘, ÔÛÙÂÔηÏÛ›Ó˘ Î·È 1,25 ‰È¸‰ÚÔ͢‚ÈÙ·Ì›Ó˘ D. ∞fi Ù· ·ÔÙÂϤÛÌ·Ù¿ Ì·˜ ÚÔ·ÙÂÈ fiÙÈ Ë Ì¤ÛË ÔÛÙÈ΋ ˘ÎÓfiÙËÙ· ·ÚÔ˘ÛÈ¿˙ÂÈ ·‡ÍËÛË ÙÔ˘˜ 6 ÚÒÙÔ˘˜ Ì‹Ó˜, ÂÏ·ÙÙÒÓÂÙ·È ÛÙÔ˘˜ 12 Ì‹Ó˜ Î·È ÌÂÙ¿ ·fi 2 ¯ÚfiÓÈ· ‰ÂÓ ‰È·Ê¤ÚÂÈ ÛËÌ·ÓÙÈο ·fi ÙÔ˘˜ Ê˘ÛÈÔÏÔÁÈÎÔ‡˜ Ì¿ÚÙ˘Ú˜. ∞Û‚¤ÛÙÈÔ Î·È ÊˆÛÊfiÚÔ˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο ηı’ fiÏË ÙË ‰È¿ÚÎÂÈ· Ù˘ ıÂÚ·›·˜. ∞ÓÙ›ıÂÙ·, ÔÈ Ì¤Û˜ ÙÈ̤˜ ÔÛÙÂÔηÏÛ›Ó˘ Î·È ·ÏηÏÈ΋˜ ʈÛÊ·Ù¿Û˘, ÂÓÒ ‹Ù·Ó ·˘ÍË̤Ó˜ ÛÙËÓ ¤Ó·ÚÍË, ÌÂÈÒıËÎ·Ó ÛÙÔ ¯ÚfiÓÔ Î·È ·Ú¤ÌÂÈÓ·Ó Ê˘ÛÈÔÏÔÁÈΤ˜ ηı’ fiÏË ÙË ‰È¿ÚÎÂÈ· Ù˘ ıÂÚ·›·˜.

Abstract: Major changes in bone mineral density (BMD) occur during puberty. In the present study we evaluated the BMD and bone metabolism of twelve girls with central precocious puberty before and during 24 months of treatment with a LHRH analog (D-Trp-6 LHRH). The bone densities were measured at the lumbar spine using dual energy xray absorptiometry. Serum calcium, phosphate, alkaline phosphatase, osteocalcin and 1,25 dihydroxyvitamin D levels were also measured.

Mean lumbar spine BMD increased during the first 6 months of therapy and decreased after one year of treatment. After two years of treatment lumbar spine BMD was not significantly different from normal. Serum calcium and phosphate were normal at baseline and did not change during the treatment period. Mean osteocalcin and alkaline phosphatase were higher at baseline, had decreased after 6 months of therapy and became normal 12 months after treatment.

§¤ÍÂȘ ÎÏÂȉȿ: ÎÂÓÙÚÈ΋ ÚÒÈÌË ‹‚Ë, ÔÛÙÈ΋ ˘ÎÓfiÙËÙ·, ÔÛÙÈÎfi˜ ÌÂÙ·‚ÔÏÈÛÌfi˜.

Key words: central precocious puberty, bone density, LHRH analog, dual energy x-ray absorptiometry.

∂ÈÛ·ÁˆÁ‹ ∫·Ù¿ ÙËÓ ÂÊ˂›·, ·Ú¿ÏÏËÏ· Ì ÙËÓ ÂÌÊ¿ÓÈÛË ÙˆÓ ‰Â˘ÙÂÚÔÁÂÓÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ÙÔ˘ ʇÏÔ˘,

ÂÌÊ·Ó›˙ÂÙ·È Î·È Ì›· ·fiÙÔÌË ÂÈÙ¿¯˘ÓÛË ÙÔ˘ Ú˘ıÌÔ‡ ·‡ÍËÛ˘ (1-4), ÂÓÒ Û˘Á¯ÚfiÓˆ˜ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛËÌ·ÓÙÈΤ˜ ÌÂÙ·‚ÔϤ˜ ÙfiÛÔ ÛÙË Û‡ÛÙ·ÛË ÙÔ˘

¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶ÂÚÈÊÂÚÂÈ·ÎÔ‡ °ÂÓÈÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ “ÕÁÈÔ˜ ¶·ÓÙÂÏ‹̈Ӕ, ¡›Î·È·-¶ÂÈÚ·È¿˜

Pediatric Clinic of Peripheral General Hospital “St. Panteleimon”, Nikea-Piraeus

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ÛÒÌ·ÙÔ˜, fiÛÔ Î·È ÛÙËÓ ÔÛÙÈ΋ ˘ÎÓfiÙËÙ·. ™ÙËÓ ÎÂÓÙÚÈ΋ ÚÒÈÌË ‹‚Ë, Ô ¿ÍÔÓ·˜ ˘Ôı·Ï¿ÌÔ˘ ˘fiÊ˘Û˘ ÁÔÓ¿‰ˆÓ ÂÓÂÚÁÔÔÈÂ›Ù·È ÚÈÓ ·fi ÙËÓ ËÏÈΛ· ÙˆÓ 8 ¯ÚfiÓˆÓ ÛÙ· ÎÔÚ›ÙÛÈ· Î·È ÙˆÓ 9 ¯ÚfiÓˆÓ ÛÙ· ·ÁfiÚÈ·. ∏ ÚÒÈÌË ‹‚Ë Û˘Ó‰¤ÂÙ·È Ì ÚÒÈÌË Î·È Ù·¯Â›· ÛÎÂÏÂÙÈ΋ ˆÚ›Ì·ÓÛË, Ë ÔÔ›· Ô‰ËÁ› Û ÌÂȈ̤ÓÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· Û ۯ¤ÛË Ì ÙÔ ÚÔÛ‰ÔÎÒÌÂÓÔ ÛÙÔ˘˜ ÂÚÈÛÛfiÙÂÚÔ˘˜ ·ÛıÂÓ›˜ (5,6). ™‹ÌÂÚ·, ÁÈ· ÙË ıÂÚ·›· Ù˘ ÚÒÈÌ˘ ‹‚˘ ¯ÚËÛÈÌÔÔÈÂ›Ù·È ¤Ó·˜ ·ÁˆÓÈÛÙ‹˜ Ù˘ ˘‡ı˘Ó˘ ÔÚÌfiÓ˘ ÁÈ· ÙËÓ ¤ÎÎÚÈÛË ÙˆÓ ÁÔÓ·‰ÔÙÚÔÈÓÒÓ (GnR∏), Ì ÛÎÔfi Ó· ·Ó·¯·ÈÙÈÛÙ› Ë ‰È·‰Èηۛ· Ù˘ ÂÓ‹‚ˆÛ˘ Î·È Ó· ·ÔÊ¢¯ıÔ‡Ó Ù· „˘¯ÔÎÔÈÓˆÓÈο ÚÔ‚Ï‹Ì·Ù· (7-9). ∏ ıÂÚ·›· Ô‰ËÁ› Û ÂÏ¿ÙÙˆÛË ÙÔ˘ ÂÈ¤‰Ô˘ ÙˆÓ ÛÙÂÚÔÂȉÒÓ ÔÚÌÔÓÒÓ ÙÔ˘ ʇÏÔ˘, Ë ÔÔ›· Ì ÙË ÛÂÈÚ¿ Ù˘ ÌÔÚ› Ó· ¤¯ÂÈ Â›‰Ú·ÛË ÛÙËÓ ÔÛÙÈ΋ ˘ÎÓfiÙËÙ·, ÙÔÓ ÔÛÙÈÎfi ÌÂÙ·‚ÔÏÈÛÌfi Î·È ÙË Û‡ÓıÂÛË ÙÔ˘ ÛÒÌ·ÙÔ˜.

OÚÈṲ̂Ó˜ ÌÂϤÙ˜ ̤ÙÚËÛ˘ Ù˘ ÔÛÙÈ΋˜ ˘ÎÓfiÙËÙ·˜ Ô˘ ¤ÁÈÓ·Ó Û ·È‰È¿ Ì ÚÒÈÌË ‹‚Ë ¤‰ÂÈÍ·Ó ·ÓÙÈÎÚÔ˘fiÌÂÓ· ·ÔÙÂϤÛÌ·Ù· (7). ÕÏÏÔÈ ÂÚ¢ÓËÙ¤˜ ‰È·›ÛÙˆÛ·Ó ÂÏ¿ÙÙˆÛË Ù˘ ÔÛÙÈ΋˜ ˘ÎÓfiÙËÙ·˜ ÌÂÙ¿ ·fi 6 Î·È 12 Ì‹Ó˜ ıÂÚ·›·˜ Ì ÙÔ Û˘ÓıÂÙÈÎfi ·Ó¿ÏÔÁÔ (10-11), ÂÓÒ ¿ÏϘ ÌÂϤÙ˜ ‰ÂÓ ÂȂ‚·›ˆÛ·Ó Ù· ÚÔËÁÔ‡ÌÂÓ· ·ÔÙÂϤÛÌ·Ù·.

O ÛÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÂÚÁ·Û›·˜ ‹Ù·Ó Ó· ‰ÈÂÚ¢ÓËı› Ë ÔÛÙÈ΋ ˘ÎÓfiÙËÙ· Î·È Ô ÔÛÙÈÎfi˜ ÌÂÙ·‚ÔÏÈÛÌfi˜ ·È‰ÈÒÓ Ì ÚÒÈÌË ‹‚Ë ÚÈÓ Î·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· 24ÌËÓ˘ ıÂÚ·›·˜ Ì ÙÔ Û˘ÓıÂÙÈÎfi ·Ó¿ÏÔÁÔ LHRH ÙÚÈÙÔÚÂÏ›ÓË (3,75 mg). ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ¢Ò‰Âη ÎÔÚ›ÙÛÈ· Ì ÚÒÈÌË ‹‚Ë Û˘ÌÌÂÙ›¯·Ó ÛÙË ÌÂϤÙË (¶›Ó·Î·˜ 1). ŸÏÔÈ ÔÈ ·ÛıÂÓ›˜ ›¯·Ó ÈÛÙÔÚÈÎfi ·˘ÍË̤Ó˘ Ù·¯‡ÙËÙ·˜ ·‡ÍËÛ˘, ·Ó¿Ù˘Í˘ Ì·ÛÙÒÓ ÛÙ·‰›Ô˘ ππ Î·È ÙÚ›¯ˆ-

Û˘ ÂÊË‚·›Ô˘ ππ-πππ ηٿ Tanner Î·È ÔÛÙÈ΋ ËÏÈΛ· Ô˘ ÚÔËÁÔ‡ÓÙ·Ó Ù˘ ¯ÚÔÓÔÏÔÁÈ΋˜ ·fi 1,5-2 ¤ÙË. ∏ ·ÓÙ·fiÎÚÈÛË ÙˆÓ ÁÔÓ·‰ÔÙÚÔÈÓÒÓ ÛÙË ‰È¤ÁÂÚÛË Ì LHRH ‹Ù·Ó ÂÊË‚ÈÎÔ‡ Ù‡Ô˘ (LHRH test) (¶›Ó·Î·˜ 2). ™Â ÂÙ¿ ÎÔÚ›ÙÛÈ·, Ë ÂÌÊ¿ÓÈÛË Ù˘ ‹‚˘ ¿Ú¯ÈÛ ÚÈÓ ·fi ÙËÓ ËÏÈΛ· ÙˆÓ 6 ÂÙÒÓ, ÂÓÒ ÛÙ· ¿ÏÏ· ¤ÓÙ ÚÈÓ ·fi Ù· 8 ¤ÙË. ∫·Ù¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜, Ë Ì¤ÛË ËÏÈΛ· ‹Ù·Ó 6,55±0,910 ¤ÙË. ŸÏÔÈ ÔÈ ·ÛıÂÓ›˜ ¤Ï·‚·Ó ıÂÚ·›· Ì ÙÚÈÙÔÚÂÏ›ÓË (3,75 mg) ÂÓ‰ÔÌ˘˚ÎÒ˜ οı 27 Ë̤Ú˜. ∏ ηٷÛÙÔÏ‹ Ù˘ ‹‚˘ ·ÍÈÔÏÔÁ‹ıËΠ̠ÎÏÈÓÈ΋ ÂÎÙ›ÌËÛË, ·Ó¿ ÙÚ›ÌËÓÔ Î·È Ì Â·Ó¿ÏË„Ë Î·È ÚÔÛ‰ÈÔÚÈÛÌfi ÙˆÓ ÂÈ¤‰ˆÓ FSH, L∏, ∂2 Ì ÙÔ ÙÂÛÙ LHRH ·Ó¿ ¤ÙÔ˜. ∏ ÔÛÙÈ΋ ËÏÈΛ· ÚÔÛ‰ÈÔÚÈ˙fiÙ·Ó Î¿ı 12 Ì‹Ó˜ Ì ·/· ·ÚÈÛÙÂÚÔ‡ ηÚÔ‡. ªÂÙÚ‹ÛÂȘ ÔÛÙÈ΋˜ ˘ÎÓfiÙËÙ·˜ (µªD), ·ÍÈÔÏfiÁËÛË ‚ÈÔ¯ËÌÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ ÙˆÓ ÔÛÙÒÓ, ηıÒ˜ Î·È ·ÓıÚˆÔÌÂÙÚÈΤ˜ ÌÂÙÚ‹ÛÂȘ Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó ÚÈÓ Î·È 6, 12 Î·È 24 Ì‹Ó˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜ Ì LHRH ·Ó¿ÏÔÁÔ. ∆Ô ‡„Ô˜ ÌÂÙÚ‹ıËΠ̠·Ó·ÛÙËÌfiÌÂÙÚÔ Î·È Û˘ÁÎÚ›ıËΠ̠ÙÈ̤˜ ·Ó·ÊÔÚ¿˜ ·È‰ÈÒÓ ·Ó¿ÏÔÁ˘ ËÏÈΛ·˜ Î·È Ê‡ÏÔ˘. O ‰Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ (µªπ) ˘ÔÏÔÁ›ÛÙËΠ̠‚¿ÛË ÙÔ ÏfiÁÔ ‚¿ÚÔ˜/‡„Ô˜2 (kg/m2‰Â›ÎÙ˘ Quatelet) Î·È Û˘ÁÎÚ›ıËΠ̠ÙȘ ÙÈ̤˜ ·Ó·ÊÔÚ¿˜ ÙÔ˘ ›‰ÈÔ˘ ʇÏÔ˘ Î·È ËÏÈΛ·˜. O ‚·ıÌfi˜ ÂÓ‹‚ˆÛ˘ ηıÔÚ›ÛÙËΠۇÌʈӷ Ì ÙË ÛÙ·‰ÈÔÔ›ËÛË Î·Ù¿ Tanner. ∏ ÔÛÙÈ΋ ˘ÎÓfiÙËÙ· (µªD) (g/cm2) Ù˘ ÔÛÊ˘˚΋˜ ÌÔ›Ú·˜ Ù˘ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘ ÌÂÙÚ‹ıËΠ̠ÙË Ì¤ıÔ‰Ô ·ÔÚÚfiÊËÛ˘ ‰ÈÏ‹˜ ÂÓ¤ÚÁÂÈ·˜ ‰¤ÛÌ˘ ʈÙÔÓ›ˆÓ ˘„ËÏ‹˜ ÂÓ¤ÚÁÂÈ·˜ (D∂Ã∞). ¢¤Î· ¤ÓÙ ·È‰È¿ ·Ó¿ÏÔÁ˘ ËÏÈΛ·˜ Î·È Ê‡ÏÔ˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó Û·Ó Ì¿ÚÙ˘Ú˜. ∏ ÔÛÙÈ΋ ËÏÈΛ· ÂÎÙÈÌ‹ıËΠ̠‚¿ÛË ÙËÓ ·ÎÙÈÓÔÁÚ·Ê›· Ù˘ ·ÚÈÛÙÂÚ‹˜ ¿ÎÚ·˜ ¯ÂÈÚfi˜, Û‡Ìʈӷ Ì ÙË Ì¤ıÔ‰Ô ÙˆÓ Greunlich Î·È ƒyle ÛÙËÓ ¤Ó·ÚÍË Î·È ÌÂÙ¿ ·fi 12 Î·È 24 Ì‹Ó˜. ¶ÚÔÛ‰ÈÔÚÈÛÌÔ› ·Û‚ÂÛÙ›Ô˘ (Ca), ʈÛÊfiÚÔ˘ (ƒ), ·ÏηÏÈ΋˜ ʈÛÊ·Ù¿Û˘ (∞Lƒ), 1,25 ‰È¸‰ÚÔ͢‚ÈÙ·Ì›Ó˘ D Î·È ÔÛÙÂÔηÏÛ›Ó˘ ÔÚÔ‡ ¤ÁÈÓ·Ó ÚÈÓ, ηıÒ˜ Î·È ÛÙÔ˘˜ 6, 12 Î·È 24 Ì‹Ó˜ ıÂÚ·›·˜. ∆· Â›‰· Ù˘ ı˘Ï·ÎÈÔÙÚfiÔ˘ Î·È ˆ¯ÚÈÓÔÙÚfiÔ˘ ÔÚÌfiÓ˘ (FSH, LH), fiˆ˜ Î·È ·˘Ù¿ Ù˘ ÔÈÛÙÚ·‰ÈfiÏ˘ (∂2) ÚÔÛ‰ÈÔÚ›ÛÙËÎ·Ó Ì ڷ‰ÈÔ·ÓÔÛÔÏÔÁÈΤ˜ ÌÂıfi‰Ô˘˜.

¶›Ó·Î·˜ 1. ∫ÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο ·È‰ÈÒÓ Ì ÎÂÓÙÚÈ΋ ÚÒÈÌË ‹‚Ë ™Ù¿‰ÈÔ ÂÓ‹‚ˆÛ˘ ηٿ Tanner ∞ÛıÂÓ›˜

∏Ï. ÂÌÊ¿ÓÈÛ˘

1 2 3 4 5 6 7 8 9 10 11 12

5,9 6,1 5,7 6 5,8 6,3 6,2 5,6 7,9 7,6 7,8 7,9 ª∆ 6,550±0,910

414

∆Ú›¯ˆÛË ∆Ú›¯ˆÛË Ì·Û¯¿Ï˘ ∞∏1 ÂÊË‚·›Ô˘ ƒ∏1 ++ + ++ + ± ++ + + ++

+ + ++ + ++ +++ ++ ++ ++ ++ ++ ++

∞Ó¿Ù˘ÍË Ì·ÛÙÒÓ

OÛÙÈ΋ ËÏÈΛ· ÚÔ

OÛÙÈ΋ ËÏÈΛ· ÌÂÙ¿ 24 Ì‹Ó˜

+ ++ ++ + + ++ ± ± ± + + +

7,5 8,2 7,4 7,3 7,5 9,3 7,9 7,8 9,6 8,8 8,11 10,1 ª∆ 8,29±0,94

8,5 9,3 9,5 7,8 8,6 10,3 8,9 8,6 10,5 9,9 9,3 11 ª∆ 9,35±0,94

14-05-03

14:26

™ÂÏ›‰·415

¶·È‰È·ÙÚÈ΋ 2002;65:413-418

Paediatriki 2002;65:413-418

¶›Ó·Î·˜ 2. ∆È̤˜ ÁÔÓ·‰ÔÙÚÔÈÓÒÓ Î·È ∂2 ¤Ó·Ú͢

1 2 3 4 5 6 7 8 9 10 11 12

FSH (IU/ml)

LH (IU/ml)

E2 (pg/ml)

8,0 24 5,8 2,0 4,9 2,8 1,7 2,3 2,4 4,0 2,2 5,8 ª∆ 5,49 ± 6,14

2,9 0,1 2,6 0,1 1,3 0,8 0,4 0,2 0,5 0,1 0,3 3,3 ª∆ 1,05 ± 1,19

9 <10 12 6 5 19 8 4 8 5 6 13 ª∆ 8,66 ± 4,27

LHRH test

LH (IU/L)

80 70 60

¶ÚÈÓ

50

12 Ì‹Ó˜

40

ªÂÙ¿ 24 Ì‹Ó˜

30 20 10 0

0

30

60

90

120

§ÂÙ¿

LHRH test 10 ¶ÚÈÓ 8 FSH (IU/L)

NoV-dEc-02

12 Ì‹Ó˜

6

ªÂÙ¿ 24 Ì‹Ó˜

4 2 0 0

30

60

90

120

§ÂÙ¿

∞ÔÙÂϤÛÌ·Ù· ∆· ·ÔÙÂϤÛÌ·Ù· ÙˆÓ ÌÂÙÚ‹ÛÂˆÓ Ù˘ ÔÛÙÈ΋˜ ˘ÎÓfiÙËÙ·˜, ÙÔ˘ ‡„Ô˘˜, ÙÔ˘ ‰Â›ÎÙË Ì¿˙·˜ ÛÒÌ·ÙÔ˜ Î·È ÙˆÓ ‚ÈÔ¯ËÌÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ ÙˆÓ ÔÛÙÒÓ ÚÈÓ Î·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ıÂÚ·›·˜ Ì LHRH ·Ó¿ÏÔÁÔ Ê·›ÓÔÓÙ·È ÛÙÔ˘˜ ¶›Ó·Î˜ 3 Î·È 4. ∏ ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ¤ÁÈÓ Ì ÙË ‰ÔÎÈÌ·Û›· t-test ÁÈ· ·ÓÂ-

Í¿ÚÙËÙ· ‰Â›ÁÌ·Ù·. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ıÂÚ·›·˜ Ì ÙÔ Û˘ÓıÂÙÈÎfi ·Ó¿ÏÔÁÔ LHRH, Ë Ì¤ÛË ÙÈÌ‹ Ù˘ ÔÛÙÈ΋˜ ˘ÎÓfiÙËÙ·˜ ·˘Í‹ıËΠÛÙË ‰È¿ÚÎÂÈ· ÙˆÓ 6 ÚÒÙˆÓ ÌËÓÒÓ ıÂÚ·›·˜, ‰È·ÊÔÚ¿ Ë ÔÔ›· ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÌË ÛËÌ·ÓÙÈ΋, ÂÓÒ ·ÚÔ˘Û›·Û ÂÏ¿ÙÙˆÛË ÌÂÙ¿ ÙÔÓ 1Ô ¯ÚfiÓÔ ıÂÚ·›·˜. ™ÙÔ ‰Â‡ÙÂÚÔ ¯ÚfiÓÔ ‰ÂÓ ‰È¤ÊÂÚ ·fi ÙÔ˘˜ ˘ÁÈ›˜ Ì¿ÚÙ˘Ú˜. ∞ÓÙ›ıÂÙ·, Ë Ì¤ÛË ÙÈÌ‹ ÙÔ˘ ‰Â›ÎÙË Ì¿˙·˜ ÛÒÌ·ÙÔ˜ ·˘Í‹ıËΠηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ıÂÚ·›·˜. ∆· Â›‰· Ca Î·È P ·Ú¤ÌÂÈÓ·Ó ·ÌÂÙ¿‚ÏËÙ· ηı’ fiÏË ÙË ‰È¿ÚÎÂÈ· Ù˘ ıÂÚ·›·˜. ∞ÓÙ›ıÂÙ·, ÔÈ Ì¤Û˜ ÙÈ̤˜ ÔÛÙÂÔηÏÛ›Ó˘ Î·È ·ÏηÏÈ΋˜ ʈÛÊ·Ù¿Û˘, ÂÓÒ ·ÚÔ˘Û›·Û·Ó ·‡ÍËÛË ÛÙËÓ ¤Ó·ÚÍË, ÂÏ·ÙÙÒıËÎ·Ó ÌÂÙ¿ ·fi 6 Ì‹Ó˜ ıÂÚ·›·˜ Î·È Â·Ó‹Ïı·Ó ÛÂ Ê˘ÛÈÔÏÔÁÈο Â›‰· ÌÂÙ¿ ·fi 12 Ì‹Ó˜ ıÂÚ·›·˜.

OÈ ‚·ıÌÔ› Ù˘È΋˜ ·fiÎÏÈÛ˘ (SDS) ÙÔ˘ ‡„Ô˘˜, Ë ÛÙ·‰ÈÔÔ›ËÛË Î·Ù¿ Tanner Î·È ÔÈ ‚ÈÔ¯ËÌÈΤ˜ ·Ú¿ÌÂÙÚÔÈ ÙˆÓ ÔÛÙÒÓ ‰ÂÓ Û˘Û¯ÂÙ›ÛÙËÎ·Ó Ì ÙËÓ ÔÛÙÈ΋ ˘ÎÓfiÙËÙ· Ù˘ ÔÛÊ˘˚΋˜ ÌÔ›Ú·˜. ™˘˙‹ÙËÛË ∏ ¤ÁηÈÚË ·Ó›¯Ó¢ÛË ÙˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ÔÛÙÂÔÂÓÈ΋˜ ÓfiÛÔ˘ Â›Ó·È ÎÂÊ·Ï·ÈÒ‰Ô˘˜ ÛËÌ·Û›·˜, ·ÊÂÓfi˜ ÌÂÓ ‰ÈfiÙÈ ÌÔÚ› Ó· Û˘Ì‚¿ÏÂÈ ÛÙËÓ ÚfiÏË„‹ Ù˘, ·ÊÂÙ¤ÚÔ˘ ‰Â Ó· ‚ÂÏÙÈÒÛÂÈ ÙËÓ ÚfiÁÓˆÛË ÙÔ˘ ÓÔÛ‹Ì·ÙÔ˜. ∏ ÔÛÙÈ΋ ·Ó·Î·Ù·Û΢‹ (9) ÂÈÙÂÏÂ›Ù·È ·fi ÌÔÓ¿‰Â˜ ΢ÙÙ¿ÚˆÓ (ÔÛÙÂÔ‚Ï¿ÛÙ˜, ÔÛÙÂÔÎÏ¿ÛÙ˜, ÔÛÙÂÔ·ÙÙ·Ú·) Î·È Ú˘ıÌ›˙ÂÙ·È ÙfiÛÔ ·fi Û˘ÛÙËÌ·ÙÈÎÔ‡˜ (ÔÚÌfiÓ˜, ÌÂÙ·‚Ôϛ٘, ‚ÈÙ·Ì›ÓË D, ·Û‚¤ÛÙÈÔ), fiÛÔ Î·È ·fi ÙÔÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ (·˘ÍËÙÈÎÔ›, ÔÛÙÈÎÔ›, ΢ÙÙ·ÚÔΛÓ˜, ÚÔÛÙ·ÁÏ·Ó‰›Ó˜, Ï·ÛÌ›ÓË). OÚÈṲ̂ÓÔÈ ·fi ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ ·˘ÙÔ‡˜ ›Ù ¢ÓÔÔ‡Ó ÙËÓ Â›Ù¢ÍË ÎÔÚ˘Ê·›·˜ ÔÛÙÈ΋˜ ˘ÎÓfiÙËÙ·˜, ›Ù ·ÚÂÌÔ‰›˙Ô˘Ó ÙË ‰È·Ù‹ÚËÛ‹ Ù˘, Û˘Ì‚¿ÏÏÔÓÙ·˜ ÂÔ̤ӈ˜ ÛÙËÓ ÔÛÙÈ΋ ·ÒÏÂÈ·. ªÂ ÙÔÓ fiÚÔ ÎÔÚ˘Ê·›· ÔÛÙÈ΋ ˘ÎÓfiÙËÙ· ÂÓÓÔԇ̠ÙË Ì¤ÁÈÛÙË ‰˘Ó·Ù‹ ˘ÎÓfiÙËÙ· Ô˘ ÂÈÙ˘Á¯¿ÓÂÙ·È Î·Ù¿ ÙË ÛÎÂÏÂÙÈ΋ ˆÚ›Ì·ÓÛË Î·È Ë ÔÔ›· ηıÔÚ›˙ÂÙ·È ·fi ÁÂÓÂÙÈÎÔ‡˜, ÔÚÌÔÓÈÎÔ‡˜, Ì˯·ÓÈÎÔ‡˜ Î·È ÂÚÈ‚·ÏÏÔÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜. ∞Ó·Ï˘ÙÈÎfiÙÂÚ·: ·) Ë ÎÏËÚÔÓÔÌÈ΋ ÚԉȿıÂÛË ‰È·‰Ú·Ì·Ù›˙ÂÈ ÚˆÙ‡ÔÓÙ· ÚfiÏÔ ÛÙËÓ Â›Ù¢ÍË ÎÔÚ˘Ê·›·˜ ÔÛÙÈ΋˜ ˘ÎÓfiÙËÙ·˜, ‚) ÔÚÌÔÓÈÎÔ› ·Ú¿ÁÔÓÙ˜ ÓÔÛ‹Ì·Ù· - Ê·Ú̷΢ÙÈΤ˜ Ô˘Û›Â˜: ÔÈ ‰È·Ù·Ú·¯¤˜ Ù˘ ÔÚÌÔÓÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ Û˘ÓÂ¿ÁÔÓÙ·È Î·È ‰È·Ù·Ú·¯¤˜ Ù˘ ÛÎÂÏÂÙÈ΋˜ ˆÚ›Ì·ÓÛ˘. O ˘ÔÁÔÓ·‰ÈÛÌfi˜, Ë ·ÌËÓfiÚÚÔÈ·, Ë ÚfiˆÚË Î‡ËÛË Î·È Ë Á·ÏÔ˘¯›·, Ô ˘Ôı˘ÚÂÔÂȉÈÛÌfi˜, Ô Ó·ÓÈÎfi˜ ۷ί·Ú҉˘ ‰È·‚‹Ù˘, ηıÒ˜ Î·È Ë ÂÏ·Ùو̤ÓË ¤ÎÎÚÈÛË ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ ÂËÚ¿˙Ô˘Ó ÛËÌ·ÓÙÈο ÙËÓ ÎÔÚ˘Ê·›· ÔÛÙÈ΋ ˘ÎÓfiÙËÙ·, ÚÔηÏÒÓÙ·˜ ÂÏ¿ÙÙˆÛË Ù˘ ÔÛÙÈ΋˜ Ì¿˙·˜. ∆· ÔÈÛÙÚÔÁfiÓ· (10)

415

NoV-dEc-02

14-05-03

14:26

™ÂÏ›‰·416

¶·È‰È·ÙÚÈ΋ 2002;65:413-418

Paediatriki 2002;65:413-418

¶›Ó·Î·˜ 3. OÛÙÈ΋ ˘ÎÓfiÙËÙ· (g/cm2) L1-L4

ŒÓ·ÚÍË 0,798 1,010 0,889 0,821 0,865 0,986 1,038 1,132 0,655 0,819 1,249 0,702 ª∆ 0,913 ± 0,174

6 Ì‹Ó˜

∞ÛıÂÓ›˜ (n=12) 12 Ì‹Ó˜

ª¿ÚÙ˘Ú˜ (n=15) 24 Ì‹Ó˜

0,794 1,050 0,913 0,908 0,861 1,111 1,023 1,239 0,710 0,775 1,170 0,674 ª∆ 0,935 ± 0,18

0,818 0,998 0,867 0,964 0,900 1,088 0,981 1,162 0,680 0,810 1,143 0,716 ª∆ 0,927 ± 0,15

0,804 0,999 0,872 0,860 0,846 1,022 1,000 1,160 0,668 0,778 1,181 0,677 ª∆ 0,907 ± 0,16

0,658 0,598 0,935 0,717 1,015 0,850 0,769 0,909 0,925 1,885 0,798 0,895 0,951 0,905 0,950 ª∆ 0,917 ± 0,29

™Â Û¯¤ÛË Ì ÙÔ˘˜ Ì¿ÚÙ˘Ú˜ ‰ÂÓ ˘‹Ú¯·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ (p>0,05) ¶›Ó·Î·˜ 4. ∞ÔÙÂϤÛÌ·Ù· ÌÂÙÚ‹ÛÂˆÓ ÔÛÙÈ΋˜ ˘ÎÓfiÙËÙ·˜, ‡„Ô˘˜, ‰Â›ÎÙË Ì¿˙·˜ ÛÒÌ·ÙÔ˜ Î·È ‚ÈÔ¯ËÌÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ ÙˆÓ ÔÛÙÒÓ ÚÈÓ Î·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ıÂÚ·›·˜ Ì LHRH ·Ó¿ÏÔÁÔ ŒÓ·ÚÍË n=12 ⁄„Ô˜ (cm) BMD (g/cmÇ) BMI OÛÙÂÔηÏÛ›ÓË (Ìg/l) ∞ÏηÏÈ΋ ʈÛÊ·Ù¿ÛË (U/L) 1,25 ‰È¸‰ÚÔ͢‚ÈÙ·Ì›ÓË D (pmol/l) Ca (mg/dl) P (mg/dl) OÛÙÈ΋ ËÏÈΛ· ÛÙËÓ ¤Ó·ÚÍË ÃÚÔÓÔÏÔÁÈ΋ ËÏÈΛ·

114,6 0,913 17,5 22,5 290 135 9,01 3,82 8,29 6,55

± ± ± ± ± ± ± ± ± ±

5,3 0,174 1 7 73 47 0,40 0,60 0,94 0,910

6 Ì‹Ó˜ n=12 116,3 0,935 18,2 19 217 128

·›˙Ô˘Ó Î·ıÔÚÈÛÙÈÎfi ÚfiÏÔ ÛÙËÓ ÂÈÌÂÙ¿ÏψÛË Î·È ÙÔ ÌÂÙ·‚ÔÏÈÛÌfi ÙˆÓ ÔÛÙÒÓ ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ‹‚˘, ÂÓÒ ÂÍ›ÛÔ˘ ÛËÌ·ÓÙÈÎfi˜ Î·È Ú˘ıÌÈÛÙÈÎfi˜ Â›Ó·È Ô ÚfiÏÔ˜ ÙÔ˘˜ ÛÙËÓ ·Ú·ÁˆÁ‹ Î·È ·ÂÏ¢ı¤ÚˆÛË Î˘ÙÔÎÈÓÒÓ, ÚÔÛÙ·ÁÏ·Ó‰ÈÓÒÓ, ηÏÛÈÙÔÓ›Ó˘ Î·È ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘. ™ÙËÓ ‹‚Ë ·Ú·ÙËÚ›ٷÈ, Ê˘ÛÈÔÏÔÁÈο, ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË Ù˘ ÔÛÙÈ΋˜ ˘ÎÓfiÙËÙ·˜. ∏ ̤ÁÈÛÙË ÔÛÙÈ΋ Ì¿˙· (peak bone mass), ‰ËÏ·‰‹ ÙÔ ˘„ËÏfiÙÂÚÔ ÔÛfi ÔÛÙÔ‡ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ˙ˆ‹˜, ÂÈÙ˘Á¯¿ÓÂÙ·È ÛÙÔ Ù¤ÏÔ˜ Ù˘ ÂÓ‹‚ˆÛ˘. ™Ù· ÎÔÚ›ÙÛÈ·, Ë Ì¤ÁÈÛÙË ÔÛÙÈ΋ Ì¿˙· ·Ú·ÙËÚÂ›Ù·È ÛÙËÓ ËÏÈΛ· ÙˆÓ 16 ¯ÚfiÓˆÓ ‹ 2-4 ¯ÚfiÓÈ· ÌÂÙ¿ ÙËÓ ÂÌÌËÓ·Ú¯‹, ÂÓÒ ÛÙ· ·ÁfiÚÈ· ÛÙËÓ ËÏÈΛ· ÙˆÓ 18 ¯ÚfiÓˆÓ. O Ú˘ıÌfi˜ ·‡ÍËÛ˘ Ù˘ ÔÛÙÈ΋˜ ˘ÎÓfiÙËÙ·˜ ˘ÛÙÂÚ› ¯ÚÔÓÈο Û ۯ¤ÛË Ì ÙÔ Ú˘ıÌfi ·‡ÍËÛ˘ Û ‡„Ô˜. ™˘ÁÎÂÎÚÈ̤ӷ, Î·È ÛÙ· ‰‡Ô ʇϷ, Ë Ì¤ÁÈ-

416

± ± ± ± ± ±

4,5 0,18 1,5 5,3 47 52

12 Ì‹Ó˜ n=12 119,5 0,927 19,8 15,6 221 118 9,05 4,13

± ± ± ± ± ± ± ±

3,5 0,15 1,8 3,8 53 42 0,44 0,23

24 Ì‹Ó˜ n=12 121,1 0,907 20,8 16,2 205 122 9,30 4,42 9,35 8,31

± ± ± ± ± ± ± ± ± ±

2,3 0,16 2,5 3,5 55 28 0,34 0,35 0,94 1,29

ª¿ÚÙ˘Ú˜ n=15 0,917 16,3 18,1 235 127 9,30 3,7

± ± ± ± ± ± ±

0,29 1,9 6,5 65 35 1,13 1,69

ÛÙË Ù·¯‡ÙËÙ· ·‡ÍËÛ˘ Ù˘ ÔÛÙÈ΋˜ ˘ÎÓfiÙËÙ·˜ Û˘Ì‚·›ÓÂÈ 1-1,5 ¯ÚfiÓÔ ÌÂÙ¿ ÙË Ì¤ÁÈÛÙË Ù·¯‡ÙËÙ· ·‡ÍËÛ˘ ÙÔ˘ ‡„Ô˘˜. ∏ ·fiÎÙËÛË Ù˘ ̤ÁÈÛÙ˘ ÔÛÙÈ΋˜ ˘ÎÓfiÙËÙ·˜, fiˆ˜ ÚԷӷʤڷÌÂ, ÂËÚ¿˙ÂÙ·È Î·È ·fi ÔÚÌÔÓÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜, ΢ÚÈfiÙÂÚÔÈ ·fi ÙÔ˘˜ ÔÔ›Ô˘˜ Â›Ó·È ÔÈ ÔÚÌfiÓ˜ ÙÔ˘ ʇÏÔ˘ Î·È Ë ·˘ÍËÙÈ΋ ÔÚÌfiÓË. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÊ˂›·˜, ÛÙÔ Ì¤ÛÔ Î·È ÚÔ˜ ÙÔ Ù¤ÏÔ˜ Ù˘, ·˘Í¿ÓÂÙ·È ÙfiÛÔ Ë ¤ÎÎÚÈÛË Ù˘ GHRH, fiÛÔ Î·È Ù˘ GH (12). ∏ ·‡ÍËÛË ·˘Ù‹ Â›Ó·È ·ÔÙ¤ÏÂÛÌ· Ù˘ ·‡ÍËÛ˘ ÙÔ˘ ‡„Ô˘˜ ÙˆÓ ÂÎÎÚÈÙÈÎÒÓ Î˘Ì¿ÙˆÓ Ù˘ GH, ȉ›ˆ˜ ηٿ ÙË Ó‡¯Ù·, ÂÓÒ Ë Û˘¯ÓfiÙËÙ· ÙˆÓ ·È¯ÌÒÓ ‰ÂÓ ·ÏÏ¿˙ÂÈ. ∂›Ó·È ÁÓˆÛÙfi fiÙÈ Ë ·˘ÍË̤ÓË ·˘Ù‹ ¤ÎÎÚÈÛË GH Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ·‡ÍËÛË ÙˆÓ ÛÙÂÚÔÂȉÒÓ ÙÔ˘ ʇÏÔ˘. Œ¯ÂÈ ‰Âȯı› fiÙÈ ¯·ÌËϤ˜ ‰fiÛÂȘ ÔÈÛÙÚ·‰ÈfiÏ˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ·‡ÍËÛË ÙÔ˘ ‡„Ô˘˜ ÙˆÓ ·È¯ÌÒÓ Ù˘

NoV-dEc-02

14-05-03

14:26

™ÂÏ›‰·417

¶·È‰È·ÙÚÈ΋ 2002;65:413-418

GH ¯ˆÚ›˜ ·‡ÍËÛË Ù˘ Û˘¯ÓfiÙËÙ¿˜ ÙÔ˘˜, ÂÓÒ ˘„ËϤ˜ ‰fiÛÂȘ ÔÈÛÙÚÔÁfiÓˆÓ ·Ó·ÛÙ¤ÏÏÔ˘Ó ÙËÓ ¤ÎÎÚÈÛË Ù˘ GH, ÁÂÁÔÓfi˜ Ô˘ Û˘Ì‚·›ÓÂÈ ÛÙÔ Ù¤ÏÔ˜ Ù˘ ÂÊ˂›·˜. ∏ ¯ÔÚ‹ÁËÛË LHRH ·Ó·ÏfiÁˆÓ ¤¯ÂÈ Û·Ó ·ÔÙ¤ÏÂÛÌ· Ó· ηı›ÛÙ·Ù·È ÚÔÂÊË‚È΋ Ë ·¿ÓÙËÛË Ù˘ LH Û 2-4 ‚‰ÔÌ¿‰Â˜, ÂÓÒ Ë ¤ÎÎÚÈÛË ÙˆÓ ÛÙÂÚÔÂȉÒÓ ÙÔ˘ ʇÏÔ˘ ηٷÛÙ¤ÏÏÂÙ·È Û 4-12 ‚‰ÔÌ¿‰Â˜. ∏ ÙÒÛË ÙˆÓ ÛÙÂÚÔÂȉÒÓ ÙÔ˘ ʇÏÔ˘ ¤¯ÂÈ Û·Ó ·ÔÙ¤ÏÂÛÌ· Î·È ÙËÓ ÙÒÛË ÙÔ˘ ‡„Ô˘˜ ÙˆÓ ÂÎÎÚÈÙÈÎÒÓ ·È¯ÌÒÓ Ù˘ GH Î·È ‰Â‰Ô̤ÓÔ˘ fiÙÈ Ë ÂÈÙ¿¯˘ÓÛË ÙÔ˘ ÂÙ‹ÛÈÔ˘ Ú˘ıÌÔ‡ ·‡ÍËÛ˘ (spurt) Ù˘ ÂÊ˂›·˜ ÔÊ›ÏÂÙ·È ÛÙË Û˘Ó‰˘·Ṳ̂ÓË ‰Ú¿ÛË Ù˘ GH Î·È ÙˆÓ ÛÙÂÚÔÂȉÒÓ ÙÔ˘ ʇÏÔ˘ (10-12), ·˘Ù¤˜ ÔÈ ÔÚÌÔÓÈΤ˜ ÌÂÙ·‚ÔϤ˜ ¤¯Ô˘Ó ·ÚÓËÙÈ΋ Â›‰Ú·ÛË ÙfiÛÔ ÛÙËÓ Î·Ù¿ Ì‹ÎÔ˜ ·‡ÍËÛË ÙˆÓ ÔÛÙÒÓ, fiÛÔ Î·È ÛÙËÓ ÂÈÌÂÙ¿Ïψۋ ÙÔ˘˜. ™‡Ìʈӷ Ì ٷ ·Ú·¿Óˆ, Ë ¯ÔÚ‹ÁËÛË LHRH ·Ó·ÏfiÁˆÓ ÚÔηÏ› Ô˘ÛÈ·ÛÙÈο Ì›· ·Ú¿Ù·ÛË Ù˘ ÂÚÈfi‰Ô˘ ·‡ÍËÛ˘ ÁÈ· fiÛÔ ¯ÚfiÓÔ ¯ÔÚËÁÂ›Ù·È Î·È Èı·Ó¿ Ì›· ·Ú¿Ù·ÛË Ù˘ ÂÈÌÂÙ¿ÏψÛ˘ ÙˆÓ ÔÛÙÒÓ Ô˘ ÌÔÚ› Ó· ·ÓÙÈÛÙ·ıÌ›˙ÂÈ ÙËÓ ·ÚÓËÙÈ΋ Â›‰Ú·ÛË ÛÙËÓ ÔÛÙÈ΋ ˘ÎÓfiÙËÙ· Ô˘ ¤¯ÂÈ Ë Û¯ÂÙÈ΋ ·ÓÂ¿ÚÎÂÈ· ÔÈÛÙÚÔÁfiÓˆÓ Î·È GH ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ıÂÚ·›·˜ Ì LHRH ·Ó¿ÏÔÁ·. ÀÔıÂÙÈο, Ë Â› ÙÔȘ ÂηÙfi ·‡ÍËÛË Ù˘ ÔÛÙÈ΋˜ ˘ÎÓfiÙËÙ·˜ ı· Ú¤ÂÈ Ó· Â›Ó·È Û˘Ì‚·Ù‹ Ì ·˘Ù‹ Ô˘ ·Ó·Ì¤ÓÂÙ·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ê˘ÛÈÔÏÔÁÈÎÒÓ ÚÔÂÊË‚ÈÎÒÓ ¯ÚfiÓˆÓ, ÙfiÙ Ô˘ Ë ¤ÎÎÚÈÛË ÙˆÓ ÔÈÛÙÚÔÁfiÓˆÓ Â›Ó·È ¯·ÌËÏ‹, Ë Ù·¯‡ÙËÙ· ·‡ÍËÛ˘ (growth velocity) Â›Ó·È ¯·ÌËÏfiÙÂÚË ·’ fiÙÈ ÛÙËÓ ÂÊ˂›· Î·È ÙÔ Î¤Ú‰Ô˜ Û ÔÛÙÈ΋ ˘ÎÓfiÙËÙ· (BMD) Â›Ó·È ·Ó¿ÏÔÁÔ Ì ÙÔ Î¤Ú‰Ô˜ Û ‡„Ô˜ Î·È ‚¿ÚÔ˜. ÀÔıÂÙÈο, ·Ú·ÙËÚÂ›Ù·È Ì›· Û˘Ó¯È˙fiÌÂÓË ·‡ÍËÛË Ù˘ µªD ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ıÂÚ·›·˜ Ì LHRH ·Ó¿ÏÔÁ· ÁÈ· ÚÒÈÌË ‹‚Ë, ·Ó¿ÏÔÁË Ì ·˘Ù‹ Ô˘ ·Ú·ÙËÚÂ›Ù·È ÚÔÂÊË‚Èο. ™‡Ìʈӷ Ì ٷ ·Ú·¿Óˆ, ¤¯Ô˘Ì ԢÛÈ·ÛÙÈο Ì›· ÌÂÙ·ÙfiÈÛË Ù˘ ÂÚÈfi‰Ô˘ Ô˘ ·Ú·ÙËÚÂ›Ù·È Ë Ì¤ÁÈÛÙË ÔÛÙÈ΋ ·Ó¿Ù˘ÍË ÙfiÛÔ Î·Ù¿ Ì‹ÎÔ˜, fiÛÔ Î·È Û·Ó ÔÛÙÈ΋ ˘ÎÓfiÙËÙ·. µ¤‚·È·, Ë ÔÛÙÈ΋ ˘ÎÓfiÙËÙ· ÂËÚ¿˙ÂÙ·È Î·È ·fi ¿ÏÏÔ˘˜ ·Ú¿ÁÔÓÙ˜, fiˆ˜ Ë ÚfiÛÏË„Ë ·Û‚ÂÛÙ›Ô˘ Î·È Ë ¿ÛÎËÛË (fiÏ· Ù· ·È‰È¿ Ô˘ Û˘ÌÌÂÙ›¯·Ó ÛÙË ÌÂϤÙË Â›¯·Ó ÙȘ ›‰È˜ ‰È·ÈÙËÙÈΤ˜ Û˘Ó‹ıÂȘ Î·È ÙȘ Û˘Ó‹ıÂȘ Ê˘ÛÈÔÏÔÁÈΤ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜). ™ÎÔfi˜ Ù˘ ÂÚÁ·Û›·˜ ‹Ù·Ó Ó· ÌÂÏÂÙËı› Ë Â›‰Ú·ÛË ÙˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ¯·ÌËÏ‹˜ ÔÛÙÈ΋˜ ˘ÎÓfiÙËÙ·˜ ÛÙ· ·È‰È¿ Ì ÚÒÈÌË ‹‚Ë ‰‡Ô ¯ÚfiÓÈ· ÌÂÙ¿ ÙË ıÂÚ·›· Ì ÙÔ Û˘ÓıÂÙÈÎfi ·Ó¿ÏÔÁÔ LHRH. ∞fi Ù· ·ÔÙÂϤÛÌ·Ù¿ Ì·˜ ÚÔ·ÙÂÈ fiÙÈ Ù· ·È‰È¿ Ì ÚÒÈÌË ‹‚Ë Â›¯·Ó Ê˘ÛÈÔÏÔÁÈ΋ ÔÛÙÈ΋ ˘ÎÓfiÙËÙ· ÛÙËÓ ÔÛÊ˘˚΋ ÌÔ›Ú· Ù˘ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘ (Oª™™) Î·È ÔÏfiÎÏËÚÔ˘ ÙÔ˘ ÛÒÌ·ÙÔ˜ ÙfiÛÔ ÛÙËÓ ¤Ó·ÚÍË, fiÛÔ Î·È ÌÂÙ¿

Paediatriki 2002;65:413-418

·fi ‰‡Ô ¯ÚfiÓÈ· ıÂÚ·›·˜, Û‡Ìʈӷ Ì ÙË ¯ÚÔÓÔÏÔÁÈ΋ ÙÔ˘˜ ËÏÈΛ·. ∞ÓÙ›ıÂÙ·, Û˘ÁÎÚÈÓfiÌÂÓ· Ì ÙËÓ ÔÛÙÈ΋ ÙÔ˘˜ ËÏÈΛ·, ÂÌÊ¿ÓÈ˙·Ó ¯·ÌËÏ‹ ÔÛÙÈ΋ ˘ÎÓfiÙËÙ· Î·È ÛÙËÓ ¤Ó·ÚÍË, fiˆ˜ Î·È ÛÙ· ‰‡Ô ¯ÚfiÓÈ· ıÂÚ·›·˜ Ì ÙÔ Û˘ÓıÂÙÈÎfi ·Ó¿ÏÔÁÔ. ™‡Ìʈӷ Ì ¿ÏÏÔ˘˜ ÂÚ¢ÓËÙ¤˜, Û ÎÔÚ›ÙÛÈ· Ì ÚÒÈÌË ‹‚Ë ‚Ú¤ıËΠ·˘ÍË̤ÓË ÌÂÓ ÔÛÙÈ΋ ˘ÎÓfiÙËÙ· Û‡Ìʈӷ Ì ÙË ¯ÚÔÓÔÏÔÁÈ΋ ËÏÈΛ·, Ê˘ÛÈÔÏÔÁÈ΋ ‰Â Û˘ÁÎÚÈÓfiÌÂÓË Ì ÙËÓ ÔÛÙÈ΋ ËÏÈΛ· (Ë Ì¤ÙÚËÛË ¤ÁÈÓ Ì ÙË Ì¤ıÔ‰Ô Ù˘ ·ÔÚÚfiÊËÛ˘ ‰ÈÏ‹˜ ÂÓ¤ÚÁÂÈ·˜ ‰¤ÛÌ˘ ʈÙÔÓ›ˆÓ ˘„ËÏ‹˜ ÂÓ¤ÚÁÂÈ·˜). ™ÙË ‰È΋ Ì·˜ ÂÚÁ·Û›·, ηٿ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜ ·Ú·ÙËÚ‹ıËΠÌÈÎÚ‹ ·‡ÍËÛË Ù˘ ÔÛÙÈ΋˜ ˘ÎÓfiÙËÙ·˜ Û ۯ¤ÛË Ì ÙË ¯ÚÔÓÔÏÔÁÈ΋, ÂÏ·Ùو̤ÓË ˆÛÙfiÛÔ, Û‡Ìʈӷ Ì ÙËÓ ÔÛÙÈ΋ ËÏÈΛ·. ∏ ‰È·ÊÔÚ¿ ·˘Ù‹ Èı·Ófiٷٷ ÔÊ›ÏÂÙ·È Û ‰È·ÊÔÚ¤˜ ÛÙȘ ÙÈ̤˜ ·Ó·ÊÔÚ¿˜, ÛÙËÓ ÂÎÙ›ÌËÛË Ù˘ ÔÛÙÈ΋˜ ËÏÈΛ·˜, ηıÒ˜ Î·È Û ‰È·ÊÔÚ¤˜ ˆ˜ ÚÔ˜ ÙË ¯ÚÔÓÈ΋ ÛÙÈÁÌ‹ ¤Ó·Ú͢ Ù˘ ıÂÚ·›·˜. ∂›Û˘, Ë ·‡ÍËÛË Ù˘ ÔÛÙÈ΋˜ ˘ÎÓfiÙËÙ·˜ ÛÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜ Èı·Ófiٷٷ ÚÔÎÏ‹ıËΠÂÍ›ÛÔ˘ ·fi Ù· ·˘ÍË̤ӷ Â›‰· Ù˘ ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘, ·ÏÏ¿ Î·È ÙˆÓ ÔÈÛÙÚÔÁfiÓˆÓ ÙÔ˘ ÚÒÈÌÔ˘ ÛÙ·‰›Ô˘ Ù˘ ‹‚˘. ª›· ¿ÏÏË ·ÈÙÈÔÏÔÁ›· Ô˘ ÌÔÚ› Ó· ÂÍËÁ‹ÛÂÈ ÙËÓ ·Ú¯È΋ ·‡ÍËÛË Ù˘ ÔÛÙÈ΋˜ ˘ÎÓfiÙËÙ·˜ Èı·ÓfiÓ Ó· Â›Ó·È Ë ·ÙÂÏ‹˜ ηٷÛÙÔÏ‹ Ù˘ ‹‚˘ ÛÙÔ˘˜ ÚÒÙÔ˘˜ Ì‹Ó˜ ıÂÚ·›·˜. ªÂÙ¿ ·fi ·˘Ù‹ ÙËÓ ÂÚ›Ô‰Ô, fï˜, Ë ÂÏ¿ÙÙˆÛË Ù˘ ÔÛÙÈ΋˜ ˘ÎÓfiÙËÙ·˜ Â›Ó·È Èı·Ófi Ó· ÚÔηÏÂ›Ù·È ·fi ÙË Ì›ˆÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ÔÈÛÙÚÔÁfiÓˆÓ Î·È Ù˘ ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘. ™˘ÌÂÚ·ÛÌ·ÙÈο, ÌÔÚԇ̠ӷ ԇ̠fiÙÈ Ù· ·È‰È¿ Ì ÚÒÈÌË ‹‚Ë ÚÔ Î·È ÌÂÙ¿ ‰‡Ô ¯ÚfiÓÈ· ıÂÚ·›·˜ Ì ÙÔ Û˘ÓıÂÙÈÎfi ·Ó¿ÏÔÁÔ LHRH ¤¯Ô˘Ó Ê˘ÛÈÔÏÔÁÈ΋ ÔÛÙÈ΋ ˘ÎÓfiÙËÙ· ÁÈ· ÙË ¯ÚÔÓÔÏÔÁÈ΋ ÙÔ˘˜ ËÏÈΛ·, ·ÏÏ¿ ÂÏ·Ùو̤ÓË ÁÈ· ÙËÓ ÔÛÙÈ΋ ÙÔ˘˜ ËÏÈΛ·. ∆Ô ÂÚÒÙËÌ· Ô˘ ·Ú·Ì¤ÓÂÈ, fï˜, Â›Ó·È ·Ó Ë ÔÛÙÈ΋ ˘ÎÓfiÙËÙ· ·˘Í¿ÓÂÙ·È Ê˘ÛÈÔÏÔÁÈο Î·È ÌÂÙ¿ ÙË ‰È·ÎÔ‹ Ù˘ ıÂÚ·›·˜ Î·È ·Ó ÔÈ ·ÛıÂÓ›˜ ·ÔÎÙÔ‡Ó ÙÂÏÈο Ê˘ÛÈÔÏÔÁÈ΋ ÔÛÙÈ΋ Ì¿˙·. °È’ ·˘Ùfi ¯ÚÂÈ¿˙ÔÓÙ·È ·ÚÎÂÙ¤˜ ‰È·¯ÚÔÓÈΤ˜ ÌÂϤÙ˜ ·ÎfiÌË ÁÈ· ÙËÓ ·ÍÈÔÏfiÁËÛË Ù˘ ÔÛÙÈ΋˜ ˘ÎÓfiÙËÙ·˜, ·ÏÏ¿ Î·È Ù˘ Û‡ÓıÂÛ˘ ÙÔ˘ ÛÒÌ·ÙÔ˜ ÌÂÙ¿ ÙË ‰È·ÎÔ‹ Ù˘ ıÂÚ·›·˜. µÈ‚ÏÈÔÁÚ·Ê›· 1. Boot AM, de Ridder MA, Pols HA, Krenning EP, de Muinck Keizer-Schrama SM. Bone mineral density in children and adolescents: relation to puberty, calcium intake and physical activity. J Clin Endocrinol Metab 1997;82:57-62.

2. Boot AM, Bouquet J, de Ridder MA, Krenning EP, de Muinck Keizer-Schrama SM. Determinants of body composition measured by dual-energy X-ray absorptiometry in Dutch children and adolescents. Am J Clin Nutr 1997;66:232-238.

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4. Oostdijk W, Rikken B, Schreuder S, Otten B, Odink R, Rouwe C et al. Final height in central precocious puberty after long term treatment with a slow release GnRH agonist. Arch Dis Child 1996;75:292-297.

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12. DiMartino-Nardi J, Wu R, Varner R, Wong WL, Saenger P. The effect of luteinizing hormone-releasing hormone analog for central precocious puberty on growth hormone (GH) and GH-binding protein. J Clin Endocrinol Metab 1994;78:664-668.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 28-02-2002 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 11-07-2002 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ÃÚ›ÛÙÔ˜ ∫·Ú‹˜ ∑·Î‡ÓıÔ˘ 2, ÷ϿӉÚÈ, ∆.∫. 132 52, ∞ı‹Ó·

¶ÂÚ›ÏË„Ë ¿ÚıÚÔ˘ ·fi ÙË µÈ‚ÏÈÔÁÚ·Ê›· ∏ ıÂÚ·›· ÙˆÓ ·È‰ÈÒÓ Ì ÔÍ›· ˘ÂÏÔÓÂÊÚ›Ùȉ·: Ì›· ÚÔ‰ÚÔÌÈ΋, Ù˘¯·ÈÔÔÈË̤ÓË ÌÂϤÙË1 ∂ÈÛ·ÁˆÁ‹: ∂›Ó·È ÁÓˆÛÙfi fiÙÈ ‰ÂÓ ˘¿Ú¯ÂÈ ÔÌÔʈӛ· ÁÈ· ÙË ıÂÚ·›· Ù˘ ÔÍ›·˜ ˘ÂÏÔÓÂÊÚ›Ùȉ·˜ (O¶). ∂›Û˘, Ë ÂÈÏÔÁ‹ ÙˆÓ ·ÓÙÈ‚ÈÔÙÈÎÒÓ, ÙÔ˘ ÙÚfiÔ˘ ¯ÔÚ‹ÁËÛ‹˜ ÙÔ˘˜ (ÂÓ‰ÔÊϤ‚È· ‹ ·fi ÙÔ ÛÙfiÌ·) Î·È Ù˘ ‰È¿ÚÎÂÈ·˜ Ù˘ ıÂÚ·›·˜ Â›Ó·È Û˘Ó‹ıˆ˜ ÂÌÂÈÚÈ΋. ™Ùfi¯Ô˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ó· Û˘ÁÎÚÈı› Ë ¤Î‚·ÛË Ù˘ 7‹ÌÂÚ˘ (ÔÌ¿‰· ∞) Î·È 3‹ÌÂÚ˘ (ÔÌ¿‰· µ) ıÂÚ·›·˜ Ù˘ O¶ Ì ÂÓ‰ÔÊϤ‚È· ¯ÔÚ‹ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÔ‡. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: OÁ‰fiÓÙ· ÂÊÙ¿ ·È‰È¿ Ì ÎÏÈÓÈο Î·È ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· O¶ ÌÂÙ¿ ·fi 3 Ë̤Ú˜ ÂÓ‰ÔÊϤ‚È·˜ ¯ÔÚ‹ÁËÛ˘ ·ÓÙÈ‚ÈÔÙÈÎÔ‡ Ù˘¯·ÈÔÔÈ‹ıËÎ·Ó ÛÙȘ ÔÌ¿‰Â˜ ∞ Î·È µ. ŸÏÔÈ ÔÈ ·ÛıÂÓ›˜, ÌÂÙ¿ ÙËÓ ÂÓ‰ÔÊϤ‚È· ·ÁˆÁ‹, ‹Ú·Ó ·ÓÙÈ‚ÈÔÙÈÎfi ·fi ÙÔ ÛÙfiÌ· ̤¯ÚÈ Ó· Û˘ÌÏËÚˆıÔ‡Ó Û˘ÓÔÏÈο 21 Ë̤Ú˜ ıÂÚ·›·˜ Î·È ÙÔ˘˜ ‰fiıËΠ¯ËÌÂÈÔÚÔʇϷÍË ÁÈ· 6 Ì‹Ó˜. ∞ÔÙÂϤÛÌ·Ù·: ∆Ô 77% ÙˆÓ ·È‰ÈÒÓ Ù˘ ÔÌ¿‰·˜ ∞ Î·È ÙÔ 59% Ù˘ ÔÌ¿‰·˜ µ ›¯·Ó ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù· ÛÙÔ ÛÙ·ÙÈÎfi ÛÈÓıËÚÔÁÚ¿ÊËÌ· ÓÂÊÚÒÓ DMSA (dimercaptosuccinic acid scan) Ô˘ ¤ÁÈÓ ÛÙȘ 3 ÚÒÙ˜ Ë̤Ú˜ ÓÔÛËÏ›·˜. ªÂÙ¿ ·fi 6 Ì‹Ó˜ ¤ÁÈÓ ‰Â‡ÙÂÚÔ ÛÈÓıËÚÔÁÚ¿ÊËÌ· ÓÂÊÚÒÓ DMSA. ™Â fiÏ· Ù· ·È‰È¿ ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ·Ú¯ÈÎfi ÛÈÓıËÚÔÁÚ¿ÊËÌ· ÓÂÊÚÒÓ DMSA ‰ÂÓ ‰È·ÈÛÙÒıËÎ·Ó ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù· ÛÙÔ ‰Â‡ÙÂÚÔ ÛÈÓıËÚÔÁÚ¿ÊËÌ·. ŸÌˆ˜, 8/25 ·È‰È¿ (32%) Ù˘ ÔÌ¿‰·˜ ∞ Î·È 11/15 ·È‰È¿ (73%) Ù˘ ÔÌ¿‰·˜ µ Ì ·ıÔÏÔÁÈÎfi DMSA Û˘Ó¤¯ÈÛ·Ó Ó· ¤¯Ô˘Ó ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·. OÈ ‰È·ÊÔÚ¤˜ ·˘Ù¤˜ ‰ÂÓ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜. ∂›Û˘,

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‰ÂÓ ‰È·ÈÛÙÒıËÎ·Ó ‰È·ÊÔÚ¤˜ ÛÙËÓ ¤Î‚·ÛË ÙˆÓ ·È‰ÈÒÓ Ù˘ ÔÌ¿‰·˜ ∞ Ô˘ ¿Ú¯ÈÛ·Ó ÙË ıÂÚ·›· ÌÂÙ¿ ·fi ηı˘ÛÙ¤ÚËÛË Ì›·˜ ‚‰ÔÌ¿‰·˜, Û ۯ¤ÛË Ì ·˘Ù¿ Ô˘ ›¯·Ó ¤ÁηÈÚË ·ÓÙÈÌÂÙÒÈÛË. ∞ÓÙ›ıÂÙ·, ‰È·ÈÛÙÒıËΠÛËÌ·ÓÙÈο ¯ÂÈÚfiÙÂÚË ¤Î‚·ÛË ÛÙ· ·È‰È¿ Ù˘ ÔÌ¿‰·˜ µ, Ô˘ ηı˘ÛÙ¤ÚËÛÂ Ë ıÂÚ·›·. ™˘ÌÂÚ¿ÛÌ·Ù·: ∆Ô ÔÛÔÛÙfi ·ÛıÂÓÒÓ Ì ¯ÂÈÚfiÙÂÚË ¤Î‚·ÛË ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚÔ ÛÙ· ·È‰È¿ Ì 3‹ÌÂÚË Û ۯ¤ÛË Ì 7‹ÌÂÚË ÂÓ‰ÔÊϤ‚È· ¯ÔÚ‹ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÔ‡. ŸÌˆ˜, Ë ‰È·ÊÔÚ¿ ·˘Ù‹ ‰ÂÓ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋. ™˘ÓÂÒ˜, Ë ÌÂÁ·Ï‡ÙÂÚ˘ ‰È¿ÚÎÂÈ·˜ ÂÓ‰ÔÊϤ‚È· ¯ÔÚ‹ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÔ‡ Èı·ÓÒ˜ Ó· Â›Ó·È ‰ÈηÈÔÏÔÁË̤ÓË ÛÙ· ·È‰È¿ Ì ·ıÔÏÔÁÈÎfi ·Ú¯ÈÎfi ÛÈÓıËÚÔÁÚ¿ÊËÌ· ÓÂÊÚÒÓ DMSA, ȉ›ˆ˜ fiÙ·Ó Î·ı˘ÛÙÂÚ› Ë ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜.

1 Levtchenko E, Lahy C, Levy J, Ham H, Piepsz A Treatment of children with acute pyelonephritis: a prospective randomized study Pediatr Nephrol 2001;16:878-884

™ÙÂÊ·Ó›‰Ë˜ ∫.π. ∞Ó·ÏËÚˆÙ‹˜ ¢È¢ı˘ÓÙ‹˜ ¡ÂÊÚÔÏÔÁÈÎÔ‡ ∆Ì‹Ì·ÙÔ˜ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”

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∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞

Paediatriki 2002;65:419-423

ORIGINAL ARTICLE

ÃÔÚ‹ÁËÛË ·ÓÙÈ·Ó·ÁˆÁÈÎÔ‡ Á¿Ï·ÙÔ˜ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ‹È·˜ Î·È Ì¤ÙÚÈ·˜ Á·ÛÙÚÔÔÈÛÔÊ·ÁÈ΋˜ ·ÏÈÓ‰ÚfiÌËÛ˘ Û ‚Ú¤ÊË π. •˘ÓÈ¿˜, µ. ¢ÂÌÂÚÙ˙›‰Ô˘, ∂. ∫·Ú·Ù˙¿, Ã. ¶·ÓÙÂÏÈ¿‰Ë˜, ∫. ™‡ÚÔÁÏÔ˘

Antiregurgitation milk-formula as a treatment for mild and moderate gastroesophageal reflux in infants I. Xinias, V. Demertzidou, E. Karatza, C. Panteliadis, K. Spiroglou

¶ÂÚ›ÏË„Ë: ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ë ‰ÈÂÚ‡ÓËÛË Ù˘ ÎÏÈÓÈ΋˜ Î·È ÂÚÁ·ÛÙËÚȷ΋˜ ‚ÂÏÙ›ˆÛ˘ ‚ÚÂÊÒÓ Ì Á·ÛÙÚÔÔÈÛÔÊ·ÁÈ΋ ·ÏÈÓ‰ÚfiÌËÛË (°O¶), ÌÂÙ¿ ·fi ¯ÔÚ‹ÁËÛË “·ÓÙÈ·Ó·ÁˆÁÈÎÔ‡” Á¿Ï·ÙÔ˜. ªÂÏÂÙ‹ıËÎ·Ó 68 ‚Ú¤ÊË Ì ÂÌÂÙÔ‡˜ Î·È ·Ó·ÁˆÁ¤˜ ËÏÈΛ·˜ 37 ËÌÂÚÒÓ-4 ÌËÓÒÓ. ∞ÔÎÏ›ÛÙËÎ·Ó ·È‰È¿ Ì ÂÈÏÔΤ˜ °O¶ ‹ ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù·. ∆· ·È‰È¿ ‰È·ÙÚ¤ÊÔÓÙ·Ó ·ÔÎÏÂÈÛÙÈο Ì ÙÚÔÔÔÈË̤ÓÔ Á¿Ï· ·ÁÂÏ¿‰·˜ 1˘ ‚ÚÂÊÈ΋˜ ËÏÈΛ·˜. ™Â fiÏ· Ù· ‚Ú¤ÊË ¤ÁÈÓ 24ˆÚË pHÌÂÙÚ›·. ™Ù· ·È‰È¿ Ô˘ ›¯·Ó ·ÏÈÓ‰ÚfiÌËÛË Î·Ù¿ ÙËÓ p∏ÌÂÙÚ›· ηٷÁÚ¿ÊËÎ·Ó ÔÈ ÛˆÌ·ÙÔÌÂÙÚÈΤ˜ ·Ú¿ÌÂÙÚÔÈ, ÔÈ ·Ó·ÁˆÁ¤˜ Î·È ÔÈ ¤ÌÂÙÔÈ ·Ó¿ Ë̤ڷ, ηıÒ˜ Î·È Ë Û˘¯ÓfiÙËÙ· Î·È Ë Û‡ÛÙ·ÛË ÙˆÓ ÎÂÓÒÛˆÓ. ÃÔÚËÁ‹ıËΠÂȉÈÎfi “·ÓÙÈ·Ó·ÁˆÁÈÎfi” Á¿Ï· (Ì ¿Ì˘ÏÔ ·Ú·‚ÔÛ›ÙÔ˘) ÁÈ· 4 ‚‰ÔÌ¿‰Â˜ Î·È ·ÎÔÏÔ‡ıËÛ pHÌÂÙÚ›· Â·ÓÂϤÁ¯Ô˘. °O¶ ‰È·ÈÛÙÒıËΠÛÙÔ 47,1% ÙˆÓ ‚ÚÂÊÒÓ. ∞fi ·˘Ù¿, ÙÔ 25% ›¯Â ·ÏÈÓ‰ÚfiÌËÛË ‹ÈÔ˘ ‚·ıÌÔ‡, ÙÔ 53,1% ̤ÙÚÈÔ˘ Î·È ÙÔ 21,9% ÛÔ‚·ÚÔ‡ ‚·ıÌÔ‡. ªÂÙ¿ ·fi 4 ‚‰ÔÌ¿‰Â˜, ÔÈ ¤ÌÂÙÔÈ Î·È ÔÈ ·Ó·ÁˆÁ¤˜ ÌÂÈÒıËÎ·Ó ÛËÌ·ÓÙÈο, ÂÓÒ Ë ÚfiÛÏË„Ë ‚¿ÚÔ˘˜ Î·È Ë Î·Ù¿ Ì‹ÎÔ˜ ·‡ÍËÛË ‹Ù·Ó ÂÓÙfi˜ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÔÚ›ˆÓ. ∏ pHÌÂÙÚ›· Â·ÓÂϤÁ¯Ô˘ ÛÙ· ·È‰È¿ Ì ‹È· ·ÏÈÓ‰ÚfiÌËÛË ‹Ù·Ó ·ÚÓËÙÈ΋ Û ÔÛÔÛÙfi 87,5%. ∞fi Ù· ·È‰È¿ Ì ̤ÙÚÈ· °O¶, ÙÔ 41,2% ›¯Â ·ÚÓËÙÈ΋ pHÌÂÙÚ›· Â·ÓÂϤÁ¯Ô˘ Î·È ÙÔ 29,4% ‚ÂÏÙ›ˆÛË ÙÔ˘ ‚·ıÌÔ‡ Ù˘ ·ÏÈÓ‰ÚfiÌËÛ˘. ∆· ·È‰È¿ Ì ÛÔ‚·Ú‹ °O¶ ›¯·Ó ‚ÂÏÙ›ˆÛË ÌfiÓÔ ÙÔ˘ ‚·ıÌÔ‡ ·ÏÈÓ‰ÚfiÌËÛ˘ ÛÙÔÓ Â·Ó¤ÏÂÁ¯Ô. ™˘ÌÂÚ·ÛÌ·ÙÈο, Ë ·ÓÙÈÌÂÙÒÈÛË Ù˘ ‹È·˜ Î·È Ì¤ÙÚÈ·˜ °O¶ Û ‚Ú¤ÊË ÌÔÚ› Ó· Á›ÓÂÈ Ì ÙË ¯ÔÚ‹ÁËÛË ÂȉÈÎÔ‡ “·ÓÙÈ·Ó·ÁˆÁÈÎÔ‡” Á¿Ï·ÙÔ˜. ∏ ÎÏÈÓÈ΋ Î·È ÂÚÁ·ÛÙËÚȷ΋ ‚ÂÏÙ›ˆÛË Â›Ó·È Û·Ê‹˜ ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ Î·È Ë ·ÓÔ¯‹ ÙÔ˘ Á¿Ï·ÙÔ˜ ¿ÚÈÛÙË, ¯ˆÚ›˜

Abstract: The aim of the study was to determine the clinical and laboratory improvement of infants with gastroesophageal reflux (GER), after feeding with specific antiregurgitation milk-formula. Sixtyeight infants were included to the study aged 37 days-4 months. All infants suffered from recurrent vomiting and regurgitation. Children with chronic diseases or GER complications were excluded from the study. All children were bottle fed with infant milk formula. Twenty-four hour pHmonitoring was performed in all children. Children with GER at the pHmetry were further investigated for regurgitation, vomiting and stool-frequency as well as stool-composition. Weight and height were also noted. Antiregurgitation milk-formula (with corn starch) was given to all reflux-infants for 4 weeks, followed by second control pHmetry. Forty seven percent of the infants were found to have GER. Mild GER was found in 25%, moderate GER in 53.1% and severe GER in 21.9% of the positive cases. After 4 weeks feeding with antiregurgitation milk-formula, vomiting and regurgitation frequency decreased, whereas normal increase of weight and height was noted. Normal second pHmetry was noted in 87.5% of the mild-reflux cases. Infants with moderate reflux had normal second pHmetry in 41.2% whereas 29.4% had improvement of GER severity. Cases with severe reflux had only improvement of GER severity. In conclusion, mild and moderate GER in infants can be treated with antiregurgitation milk-formula. Clinical and laboratory improvement is clear in the majority of cases, and milk-formula is well tolerated without stool changes. Drug therapy is necessary in severe GER or in case of complications.

°’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋, ∞ÚÈÛÙÔÙ¤ÏÂÈÔ ¶·ÓÂÈÛÙ‹ÌÈÔ £ÂÛÛ·ÏÔӛ΢, π·ÙÚÈ΋ ™¯ÔÏ‹ πÔÎÚ¿ÙÂÈÔ˘ ¡ÔÛÔÎÔÌ›Ԣ £ÂÛÛ·ÏÔӛ΢

3rd Pediatric Clinic, Aristotelion University of Thessaloniki Medical School, Ippokration Hospital, Thessaloniki

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¶·È‰È·ÙÚÈ΋ 2002;65:419-423

Paediatriki 2002;65:419-423

Ó· ÂËÚ¿˙ÔÓÙ·È ÔÈ ÎÂÓÒÛÂȘ. º·Ú̷΢ÙÈ΋ ·Ú¤Ì‚·ÛË ¯ÚÂÈ¿˙ÂÙ·È Û ÛÔ‚·Ú‹ °O¶ ‹ Û ÂÈÏÔΤ˜. §¤ÍÂȘ ÎÏÂȉȿ: Á·ÛÙÚÔÔÈÛÔÊ·ÁÈ΋ ·ÏÈÓ‰ÚfiÌËÛË, ·ÓÙÈ·Ó·ÁˆÁÈÎfi Á¿Ï·.

Key words: gastroesophageal reflux, antiregurgitation milk-formula.

∂ÈÛ·ÁˆÁ‹ ∏ Û‡Á¯ÚÔÓË ·ÓÙÈÌÂÙÒÈÛË Ù˘ Á·ÛÙÚÔÔÈÛÔÊ·ÁÈ΋˜ ·ÏÈÓ‰ÚfiÌËÛ˘ (°O¶) ÂÚÈÏ·Ì‚¿ÓÂÈ ‰È¿ÊÔÚ· ̤ÙÚ·, fiˆ˜ Ë ı¤ÛË ÙÔ˘ ·È‰ÈÔ‡, ‰È·ÈÙËÙÈο ̤ÙÚ· Î·È Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ (1). °È· ÂÚÈÛÛfiÙÂÚ˜ ·fi 4 ‰ÂηÂٛ˜, Ë ‡ÎÓˆÛË ÙÔ˘ Á¿Ï·ÙÔ˜ ÌÂ Ô˘Û›Â˜ fiˆ˜ ÙÔ ¯·ÚÔ˘¿Ï¢ÚÔ, ÙÔ Ú‡˙È Î.¿. ·ÔÙ¤ÏÂÛ ¤Ó· Û˘¯Ófi ıÂÚ·¢ÙÈÎfi ̤ÙÚÔ (2). ∆· ·ÔÙÂϤÛÌ·Ù·, fï˜, ·˘ÙÒÓ ÙˆÓ ÌÂÏÂÙÒÓ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ °O¶ ‹Ù·Ó Û˘¯Ó¿ ·ÓÙÈÊ·ÙÈο. OÈ Ô˘Û›Â˜ ·˘Ù¤˜, ·Ú¿ Ù· ıÂÙÈο ÔʤÏË, ·˘Í¿ÓÔ˘Ó Û˘¯Ó¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÂÂÈÛÔ‰›ˆÓ ·ÏÈÓ‰ÚfiÌËÛ˘ (3,4) Î·È ÂȉÂÈÓÒÓÔ˘Ó Ù· Û˘ÌÙÒÌ·Ù·, ÂÓÒ ÂÌÊ·Ó›˙ÔÓÙ·È Û˘¯Ó¿ ÂΉËÏÒÛÂȘ fiˆ˜ ‰È¿ÚÚÔÈ·, ‰˘ÛÎÔÈÏÈfiÙËÙ· Î·È ÂÂÈÛfi‰È· ‚‹¯· (5-7). ¶ÚfiÛÊ·Ù· ΢ÎÏÔÊfiÚËÛ·Ó “·ÓÙÈ·Ó·ÁˆÁÈο” ‚ÚÂÊÈο Á¿Ï·Ù·, fiÔ˘ ̤ÚÔ˜ Ù˘ Ï·ÎÙfi˙˘ ¤¯ÂÈ ·ÓÙÈηٷÛÙ·ı› Ì ¿Ì˘ÏÔ Î·Ï·ÌÔÎÈÔ‡, ÂÓÒ ÂÚȤ¯Ô˘Ó Î·È ·˘ÍË̤ÓÔ ÔÛÔÛÙfi η˙½Ó˘. ∆· Á¿Ï·Ù· ·˘Ù¿ ıˆÚÂ›Ù·È fiÙÈ ¤¯Ô˘Ó ηχÙÂÚÔ Û˘ÓÙÂÏÂÛÙ‹ ÈÍÒ‰Ô˘˜, ¯ˆÚ›˜ Ó· ÂËÚ¿˙ÂÙ·È È‰È·›ÙÂÚ· Ë Á·ÛÙÚÈ΋ ΤӈÛË. ∏ η˙½ÓË Ô˘ ÂÚȤ¯Ô˘Ó ·ÛΛ Ú˘ıÌÈÛÙÈ΋ ‰Ú¿ÛË ÛÙÔ pH ÙÔ˘ ÛÙÔÌ¿¯Ô˘, ÂÓÒ Ù· ‹ÁÌ·Ù¿ Ù˘ ‰ÂÓ ·ÏÈÓ‰ÚÔÌÔ‡Ó fiˆ˜ ÙÔ ÔÚÔχΈ̷ (8,9). ¶·Ú’ fiÏ· ·˘Ù¿, Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ·˘ÙÔ‡ ÙÔ˘ Á¿Ï·ÙÔ˜ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ °O¶ ‰ÂÓ ¤¯ÂÈ ÌÂÏÂÙËı› ̤¯ÚÈ ÙÒÚ·. ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ó· ‰ÈÂÚ¢ÓËı› ÎÏÈÓÈο Î·È ÂÚÁ·ÛÙËÚȷο Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ·˘ÙÒÓ ÙˆÓ “·ÓÙÈ·Ó·ÁˆÁÈÎÒÓ” Á·Ï¿ÙˆÓ Û ‚Ú¤ÊË Ì ·ԉ‰ÂÈÁ̤ÓË °O¶, Ë ‰ÈÂÚ‡ÓËÛË Ù˘¯fiÓ ·ÓÂÈı‡ÌËÙˆÓ ÂΉËÏÒÛÂˆÓ (‚‹¯·˜ ‹ ÎÔÏÈÎÔ›, ÌÂÙ·‚ÔÏ‹ ÛÙË Û‡ÛÙ·ÛË Î·È ÙË Û˘¯ÓfiÙËÙ· ÙˆÓ ÎÂÓÒÛˆÓ) Î·È Ë Â›‰Ú·Û‹ ÙÔ˘˜ ÛÙȘ ۈ̷ÙÔÌÂÙÚÈΤ˜ ·Ú·Ì¤ÙÚÔ˘˜.

ŸÏ· Ù· ·È‰È¿ ‹Ù·Ó ÙÂÏÂÈfiÌËÓ· Î·È Ê·ÈÓÔÌÂÓÈο ˘ÁÈ‹, ¯ˆÚ›˜ ÎÏÈÓÈο Û˘ÌÙÒÌ·Ù· ‹ ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· Ô˘ Ó· ı¤ÙÔ˘Ó ˘fiÓÔÈ· ÂÈÏÔÎÒÓ °O¶, fiˆ˜ ·ÈÌ·Ù¤ÌÂÛË, ÛȉËÚÔÂÓÈ΋ ·Ó·ÈÌ›·, ÛÙ·ÛÈÌfiÙËÙ· ·Ó¿Ù˘Í˘, ‚ÚÔÁ¯ÔÓ¢ÌÔÓÈΤ˜ ÂΉËÏÒÛÂȘ Î.¿. ™Â ηӤӷ ·È‰› ‰ÂÓ Â›¯Â ÚÔËÁËı› οÔÈÔ Â›‰Ô˜ ıÂÚ·›·˜ Û˘ÓÙËÚËÙÈ΋˜ ‹ Ê·Ú̷΢ÙÈ΋˜ Î·È fiÏ· ÛÈÙ›˙ÔÓÙ·Ó ·ÔÎÏÂÈÛÙÈο Ì ÙÚÔÔÔÈË̤ÓÔ Á¿Ï· ·ÁÂÏ¿‰·˜ 1˘ ‚ÚÂÊÈ΋˜ ËÏÈΛ·˜. ™Â fiÏ· Ù· ‚Ú¤ÊË ÚÔ¯ˆÚ‹Û·Ì Û 24ˆÚË pHÌÂÙÚ›· Ì ‰ÈοӷÏÔ pHÌÂÙÚÔ Ù˘ ÂÙ·ÈÚ›·˜ Synectics Medical AB, Stockholm Sweden. ∏ Û˘Û΢‹ ηٷÁÚ·Ê‹˜ (Digitrapper Mk III) ¤ÊÂÚ ‰‡Ô ËÏÂÎÙÚfi‰È·, ÂÎ ÙˆÓ ÔÔ›ˆÓ ÙÔ ¤Ó· ‹Ù·Ó ÙÔ ËÏÂÎÙÚfi‰ÈÔ ·Ó·ÊÔÚ¿˜ Î·È ÂÈÎÔÏÏÔ‡ÓÙ·Ó ÛÙÔ ‰¤ÚÌ·, ÂÓÒ ÙÔ ¿ÏÏÔ ‹Ù·Ó ËÏÂÎÙÚfi‰ÈÔ Î·Ù·ÁÚ·Ê‹˜ ÙÔ˘ pH Ô˘ ¤ÊÂÚ ÛÙÔ ¿ÎÚÔ ÙÔ˘ ‰‡Ô ·ÈÛıËÙ‹Ú˜ ·ÓÙÈÌÔÓ›Ô˘ Û ·fiÛÙ·ÛË 5 cm ÌÂٷ͇ ÙÔ˘˜. ∏ ηٷÁÚ·Ê‹ ÙÔ˘ pH ÁÈÓfiÙ·Ó, ¤ÙÛÈ, Û ‰‡Ô ‰È·ÊÔÚÂÙÈο ÛËÌ›· ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘. ∆Ô ËÏÂÎÙÚfi‰ÈÔ Ì¤ÙÚËÛ˘ Î·È Î·Ù·ÁÚ·Ê‹˜ ÙÔ˘ pH ÙÔÔıÂÙÔ‡ÓÙ·Ó ÛÙÔÓ ÔÈÛÔÊ¿ÁÔ ‰È¿ Ù˘ ÚÈÓÈ΋˜ Ô‰Ô‡, Û‡Ìʈӷ Ì ÙÔÓ Î·ÓfiÓ· ÙÔ˘ Strobel, fiÔ˘ ÙÔ Ì‹ÎÔ˜ ̇Ù˘-ηÙÒÙÂÚÔ˘ ÔÈÛÔÊ·ÁÈÎÔ‡ ÛÊÈÁÎÙ‹Ú· (L) ˘ÔÏÔÁÈ˙fiÙ·Ó ·fi ÙÔÓ Ù‡Ô L(cm)=[(0,252 x ‡„Ô˜)+5] x 0,87 (10-12). ∂Ȃ‚·›ˆÛË Ù˘ ÛˆÛÙ‹˜ ı¤Û˘ ÙÔ˘ ËÏÂÎÙÚÔ‰›Ô˘ ÁÈÓfiÙ·Ó ·ÎÙÈÓÔÏÔÁÈο. ¶ÚÈÓ ÙËÓ ¤Ó·ÚÍË Ù˘ ηٷÁÚ·Ê‹˜, ÁÈÓfiÙ·Ó Ú‡ıÌÈÛË (calibration) ÙˆÓ ËÏÂÎÙÚÔ‰›ˆÓ Û ÂȉÈο Ú˘ıÌÈÛÙÈο ‰È·Ï‡Ì·Ù· (buffers). ∏ ‰È¿ÚÎÂÈ· Ù˘ ηٷÁÚ·Ê‹˜ ‹Ù·Ó 24 ÒÚ˜, ¯ˆÚ›˜ Ó· Á›ÓÂÈ ·ÏÏ·Á‹ ÛÙȘ Û˘Ó‹ıÂȘ ‰Ú·ÛÙËÚÈfiÙËÙ˜ ÙÔ˘ ·ÛıÂÓ‹, fiˆ˜ Ê·ÁËÙfi, ‡ÓÔ˜, ·È¯Ó›‰È, ÍÂÎÔ‡Ú·ÛË Î.Ï. ™‡Ìʈӷ Ì ÙȘ ÚԉȷÁڷʤ˜ Ù˘ ηٷÛ΢¿ÛÙÚÈ·˜ ÂÙ·ÈÚ›·˜ Î·È Ù· ‰ÈÂıÓ‹ ÂÈÛÙËÌÔÓÈο ‰Â‰Ô̤ӷ (10-12), ÙÈ̤˜ ÙÔ˘ ÔÈÛÔÊ·ÁÈÎÔ‡ pH ·ÔıË·ÔÓÙ·Ó ÛÙË ÌÓ‹ÌË Î¿ı 6 ‰Â˘ÙÂÚfiÏÂÙ· Î·È ÂÂÈÛfi‰È· ·ÏÈÓ‰ÚfiÌËÛ˘ ıˆÚÔ‡ÓÙ·Ó ·˘Ù¿ Ì ‰È¿ÚÎÂÈ· ÌÂÁ·Ï‡ÙÂÚË ÙˆÓ 15 ‰Â˘ÙÂÚÔϤÙˆÓ (13-15). ŸÍÈÓË ·ÏÈÓ‰ÚfiÌËÛË ıˆÚ›ÙÔ Ë ÙÈÌ‹ ÙÔ˘ pH Ô˘ ‹Ù·Ó ›ÛË ‹ ÌÈÎÚfiÙÂÚË ÙÔ˘ 4, ÂÓÒ ·ÏηÏÈ΋ fiÙ·Ó ‹Ù·Ó ›ÛË ‹ ÌÂÁ·Ï‡ÙÂÚË ÙÔ˘ 8 (16). ∆· ·ÔÙÂϤÛÌ·Ù· ·Ó·Ï‡ÔÓÙ·Ó Û ËÏÂÎÙÚÔÓÈÎfi ˘ÔÏÔÁÈÛÙ‹, Ì ÂȉÈÎfi ÚfiÁÚ·ÌÌ· Ù˘ ηٷÛ΢¿ÛÙÚÈ·˜ ÂÙ·ÈÚ›·˜. ∆· ÎÚÈÙ‹ÚÈ· Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÁÈ· ÙË ‰È¿ÁÓˆÛË Ù˘ °O¶ (11,15,17) Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÎÏÈÓÈÎÔ‡ Î·È ÂÚÁ·ÛÙËÚÈ·ÎÔ‡ ÂϤÁ¯Ô˘ Î·È ÚÈÓ ÙË ‰ÈÂÓ¤ÚÁÂÈ· Ù˘ pHÌÂÙÚ›·˜ (ÙÔ˘Ï¿¯ÈÛÙÔÓ 10 Ë̤Ú˜ ÚÈÓ), ‰›ÓÔÓÙ·Ó ÛÙÔ˘˜ ÁÔÓ›˜ ÏÂÙÔÌÂÚ›˜ Ô‰ËÁ›Â˜ ÚÔÎÂÈ̤ÓÔ˘ Ó· ηٷÁÚ¿„Ô˘Ó Û ÂȉÈÎfi ¤ÓÙ˘Ô, Ô˘ ۯ‰ȿÛÙËΠÁÈ· ÙȘ ·Ó¿ÁΘ Ù˘ ÌÂϤÙ˘, ÙȘ ۈ̷ÙÔÌÂÙÚÈΤ˜ ·Ú·Ì¤ÙÚÔ˘˜, ÙÔÓ ·ÚÈıÌfi ÙˆÓ ·Ó·ÁˆÁÒÓ Î·È ÂÌÂÙÒÓ ·Ó¿ Ë̤ڷ, ÙˆÓ ÂÂÈÛÔ‰›ˆÓ ‚‹¯· ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ 24ÒÚÔ˘ Î·È ÙÔÓ ·ÚÈıÌfi Î·È ÙË Û‡ÛÙ·ÛË ÙˆÓ ÎÂÓÒÛˆÓ. ∞̤ۈ˜ ÌÂÙ¿

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ™Â ‰È¿ÛÙËÌ· 3 ÂÙÒÓ ÌÂÏÂÙ‹ıËÎ·Ó 68 ÙÂÏÂÈfiÌËÓ· ‚Ú¤ÊË (39 ·ÁfiÚÈ· Î·È 29 ÎÔÚ›ÙÛÈ·) Ì ·Ó·ÁˆÁ¤˜ Î·È Â̤ÙÔ˘˜. ∆· ‚Ú¤ÊË ‹Ù·Ó ËÏÈΛ·˜ 37 ËÌÂÚÒÓ ¤ˆ˜ 4 ÌËÓÒÓ Î·È ·ÚÔ˘Û›·˙·Ó ·Ó·ÁˆÁ¤˜ Î·È ÂÌÂÙÔ‡˜ ÁÈ· ‰È¿ÛÙËÌ· ÌÂÁ·Ï‡ÙÂÚÔ ÙˆÓ 2 ‚‰ÔÌ¿‰ˆÓ. ∞fi ÙÔ ÈÛÙÔÚÈÎfi, ÙËÓ ÎÏÈÓÈ΋ ÂͤٷÛË Î·È ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô ·ÔÎÏ›ÛÙËÎ·Ó ‚Ú¤ÊË Ì ÓÔÛ‹Ì·Ù· Ô˘ ÚÔηÏÔ‡Ó Â̤ÙÔ˘˜ Î·È ·Ó·ÁˆÁ¤˜, fiˆ˜ ·ÏÏÂÚÁ›· ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜, ˘ÏˆÚÈ΋ ÛÙ¤ÓˆÛË, ‰˘ÛϷۛ˜ ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, ÓÔÛ‹Ì·Ù· ÙÔ˘ ∫¡™, ÙÔ˘ Ô˘ÚÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Î·È ÌÂÙ·‚ÔÏÈΤ˜ ‰È·Ù·Ú·¯¤˜. ∂›Û˘, ·ÔÎÏ›ÛÙËÎ·Ó fiÏ· Ù· ıËÏ¿˙ÔÓÙ· ‚Ú¤ÊË.

420

NoV-dEc-02

14-05-03

14:26

™ÂÏ›‰·421

¶·È‰È·ÙÚÈ΋ 2002;65:419-423

Paediatriki 2002;65:419-423

ÙË ‰È·›ÛÙˆÛË °O¶ Ì ÙËÓ pHÌÂÙÚ›·, ‰›ÓÔÓÙ·Ó Ú·ÎÙÈΤ˜ Ô‰ËÁ›Â˜ Û›ÙÈÛ˘ Î·È ı¤Û˘ ÙÔ˘ ‚Ú¤ÊÔ˘˜ Î·È ¯ÔÚËÁÔ‡ÓÙ·Ó ÂȉÈÎfi “·ÓÙÈ·Ó·ÁˆÁÈÎfi” Á¿Ï·. ∆Ô ÂȉÈÎfi ·˘Ùfi Á¿Ï· ÂÚȤ¯ÂÈ ·˘ÍË̤ÓÔ ÔÛÔÛÙfi η˙½Ó˘ (η˙½ÓË/ÔÚÔÏÂ˘ÎˆÌ·Ù›ÓË 80:20), ÂÓÒ Ì¤ÚÔ˜ Ù˘ Ï·ÎÙfi˙˘ (26%) ¤¯ÂÈ ·ÓÙÈηٷÛÙ·ı› ·fi ÚÔ„Ë̤ÓÔ ¿Ì˘ÏÔ Î·Ï·ÌÔÎÈÔ‡. ¶·Ú¿ÏÏËÏ·, ÁÈÓfiÙ·Ó ËÌÂÚ‹ÛÈ· ηٷÁÚ·Ê‹ ·fi ÙÔ˘˜ ÁÔÓ›˜, Û ÂȉÈÎfi ¤ÓÙ˘Ô, ÙˆÓ ÛˆÌ·ÙÔÌÂÙÚÈÎÒÓ ÛÙÔȯ›ˆÓ, ÙÔ˘ ·ÚÈıÌÔ‡ Î·È Ù˘ Û‡ÛÙ·Û˘ ÙˆÓ ÎÂÓÒÛˆÓ, ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÂÌ¤ÙˆÓ Î·È ·Ó·ÁˆÁÒÓ, ÙˆÓ ÂÂÈÛÔ‰›ˆÓ ‚‹¯· Î·È ÛËÌÂÈÒÓÔÓÙ·Ó, Â›Û˘, Ë ·ÓÔ¯‹ ÙÔ˘ Á¿Ï·ÙÔ˜ Î·È Ë ‰È¿ÚÎÂÈ· Ï‹„˘ ÙÔ˘ Á‡̷ÙÔ˜. ªÂÙ¿ ·fi 4 ‚‰ÔÌ¿‰Â˜ Î·È ˘fi ‰È·ÙÚÔÊ‹ Ì ÙÔ “·ÓÙÈ·Ó·ÁˆÁÈÎfi” Á¿Ï·, ·ÎÔÏÔ˘ıÔ‡Û ‰Â‡ÙÂÚË pHÌÂÙÚ›· Â·ÓÂϤÁ¯Ô˘. ™Ù·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË OÈ ˘ÔÏÔÁÈÛÌÔ› Î·È Ë ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ¤ÁÈÓ·Ó Ì ÙË ‚Ô‹ıÂÈ· ËÏÂÎÙÚÔÓÈÎÔ‡ ˘ÔÏÔÁÈÛÙ‹. ∆· ‰Â‰Ô̤ӷ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ˘fi ÌÔÚÊ‹Ó ÂÚÈÁÚ·ÊÈ΋˜ ÛÙ·ÙÈÛÙÈ΋˜. ∂Âȉ‹ οı ‚Ú¤ÊÔ˜ Ô˘ Û˘ÌÂÚÈÏ‹ÊıËΠÛÙË ÌÂϤÙË ·ÔÙÂÏÔ‡Û ‰˘ÓËÙÈο Î·È Ì¿ÚÙ˘Ú· ÙÔ˘ ·˘ÙÔ‡ ÙÔ˘, ÁÈ· ÙË Û‡ÁÎÚÈÛË ·ÚÈıÌËÙÈÎÒÓ Û˘Ó¯ÒÓ ÌÂÙ·‚ÏËÙÒÓ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë ÌË ·Ú·ÌÂÙÚÈ΋ ̤ıÔ‰Ô˜ “Wilcoxon signed-rank test for paired data”. ™Ù·ÙÈÛÙÈ΋ ÛËÌ·ÓÙÈÎfiÙËÙ· ÁÈÓfiÙ·Ó ‰ÂÎÙ‹ ÁÈ· ÙÈ̤˜ p<0,05.

∞ÔÙÂϤÛÌ·Ù· ∞fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ ‚ÚÂÊÒÓ Ì Â̤ÙÔ˘˜ Î·È ·Ó·ÁˆÁ¤˜ (¶›Ó·Î·˜ 2), °O¶ ›¯Â ÙÔ 47,1% (32/68 ‚Ú¤ÊË). ∞fi Ù· ·È‰È¿ ·˘Ù¿, ·ÏÈÓ‰ÚfiÌËÛË ‹ÈÔ˘ ‚·ıÌÔ‡ ·ÚÔ˘Û›·˙ ÙÔ 25% (8/32), ̤ÙÚÈÔ˘ ‚·ıÌÔ‡ ÙÔ 53,1% (17/32) Î·È ÛÔ‚·ÚÔ‡ ‚·ıÌÔ‡ ÙÔ 21,9% (7/32).

O Â·Ó¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍ fiÙÈ ·fi Ù· ‚Ú¤ÊË Ô˘ ›-

¯·Ó ‹È· ·ÏÈÓ‰ÚfiÌËÛË Î·Ù¿ ÙËÓ ÚÒÙË pHÌÂÙÚ›· (n=8), Ù· 7 (87,5%) ›¯·Ó ·ÚÓËÙÈ΋ pHÌÂÙÚ›· ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ ·ÓÙÈ·Ó·ÁˆÁÈÎÔ‡ Á¿Ï·ÙÔ˜ (¶›Ó·Î·˜ 2). ∞fi Ù· 17 ‚Ú¤ÊË Ì ̤ÙÚÈ· ·ÏÈÓ‰ÚfiÌËÛË, 7 (41,2%) ›¯·Ó ·ÚÓËÙÈ΋ pHÌÂÙÚ›· Â·ÓÂϤÁ¯Ô˘, ÂÓÒ 5 (29,4%) ›¯·Ó ‚ÂÏÙ›ˆÛË ÙÔ˘ ‚·ıÌÔ‡ Ù˘ °O¶ (·fi ̤ÙÚÈ· ¤ÁÈÓ ‹È·). ∆¤ÏÔ˜, ·fi Ù· ·È‰È¿ Ì ÛÔ‚·Ú‹ °O¶ (n=7), ηӤӷ ‰ÂÓ Â›¯Â ·ÚÓËÙÈ΋ pHÌÂÙÚ›· ηٿ ÙÔÓ Â·Ó¤ÏÂÁ¯Ô, ·ÏÏ¿ ÙÔ 71,4% ›¯Â ‚ÂÏÙ›ˆÛË ÙÔ˘ ‚·ıÌÔ‡ Ù˘ ·ÏÈÓ‰ÚfiÌËÛ˘ (·fi ÛÔ‚·Ú‹ ¤ÁÈÓ ̤ÙÚÈ·), ÂÓÒ ÙÔ ˘fiÏÔÈÔ 28,6% ‰ÂÓ Â›¯Â η̛· ‚ÂÏÙ›ˆÛË ÛÙËÓ pHÌÂÙÚ›·.

O ‰Â›ÎÙ˘ ·ÏÈÓ‰ÚfiÌËÛ˘ (Reflux Index) (¶›Ó·Î·˜ 3) ÛÙ· ·È‰È¿ Ì °O¶, ÚÈÓ ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ Á¿Ï·ÙÔ˜ ‹Ù·Ó 14,8±5,9%, ÂÓÒ ÌÂÙ¿ ·fi 4 ‚‰ÔÌ¿‰Â˜ ‹Ù·Ó 7,9±6,3% (p<0,0001). ∆Ô ›‰ÈÔ ÈÛ¯‡ÂÈ Î·È ÁÈ· ÙȘ ·Ó·ÁˆÁ¤˜ (¶›Ó·Î·˜ 3), ÔÈ Ôԛ˜ ÌÂÈÒıËÎ·Ó ·fi 6,6±3,7 ·Ó¿ Ë̤ڷ ÚÈÓ ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ Á¿Ï·ÙÔ˜ Û 3,3±2,8 ·Ó¿ Ë̤ڷ ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË (p<0,0001), ÂÓÒ ÔÈ ÂÌÂÙÔ› ÌÂÈÒıËÎ·Ó ÛÂ Û˘¯ÓfiÙËÙ· ·fi 4,3±2,7 ·Ó¿ Ë̤ڷ Û 1,5±1,6 ·Ó¿ Ë̤ڷ ÌÂÙ¿ ·fi ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ Á¿Ï·ÙÔ˜ (p<0,0001). ∞ÓÙ›ıÂÙ·, Ë Û˘¯ÓfiÙËÙ· ÙˆÓ ÎÂÓÒÛÂˆÓ Ô˘ ‹Ù·Ó 2,4±0,9 ·Ó¿ Ë̤ڷ, ‰ÂÓ ÌÂÙ·‚Ï‹ıËΠÛËÌ·ÓÙÈο ηٿ ÙË ‰È·ÙÚÔÊ‹ Ì ÙÔ “·ÓÙÈ·Ó·ÁˆÁÈÎfi” Á¿Ï· (p=0,54). Èڛ˜ ÌÂÙ·‚ÔÏ‹, Â›Û˘, ηٷÁÚ¿ÊËÎÂ Î·È Ë Û‡ÛÙ·ÛË ÙˆÓ ÎÔÚ¿ÓˆÓ Ì·ÎÚÔÛÎÔÈο. ∆Ô ›‰ÈÔ ÈÛ¯‡ÂÈ Î·È ÁÈ· Ù· ÂÂÈÛfi‰È· ‚‹¯· (¶›Ó·Î·˜ 3) Ô˘ ‹Ù·Ó 0,6±0,9 ·Ó¿ Ë̤ڷ ÚÈÓ ÙËÓ ¤Ó·ÚÍË Ù˘ ÌÂϤÙ˘ Î·È ‰ÂÓ ÌÂÙ·‚Ï‹ıËÎ·Ó (0,4±0,7 ·Ó¿ Ë̤ڷ) ηٿ ÙË ‰È¿ÚÎÂÈ· ¯ÔÚ‹ÁËÛ˘ ÙÔ˘ Á¿Ï·ÙÔ˜ (p=0,27).

¶›Ó·Î·˜ 1. ∫ÚÈÙ‹ÚÈ· ‰È¿ÁÓˆÛ˘ °O¶ ηٿ ÙË ‰ÈÂÓ¤ÚÁÂÈ· 24ˆÚ˘ pHÌÂÙÚ›·˜* ñ ¢Â›ÎÙ˘ ·ÏÈÓ‰ÚfiÌËÛ˘ (¢¶): ¶ÔÛÔÛÙfi Û˘ÓÔÏÈÎÔ‡ ¯ÚfiÓÔ˘ Ô˘ ÙÔ pH ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘ Â›Ó·È ÌÈÎÚfiÙÂÚÔ ÙÔ˘ 4 (Ê˘ÛÈÔÏÔÁÈΤ˜ ÙÈ̤˜ ̤¯ÚÈ 5% ÙÔ˘ Û˘ÓÔÏÈÎÔ‡ ¯ÚfiÓÔ˘ ηٷÁÚ·Ê‹˜**) ñ ∞ÚÈıÌfi˜ ÂÂÈÛÔ‰›ˆÓ Ì ‰È¿ÚÎÂÈ· ÌÂÁ·Ï‡ÙÂÚË ·fi 5 ÏÂÙ¿ (·ıÔÏÔÁÈÎfi˜ fiÙ·Ó Â›Ó·È >7 ÂÂÈÛfi‰È· ·Ó¿ 24ˆÚÔ) ñ ∫¿ı·ÚÛË ÔͤԘ. ø˜ οı·ÚÛË ÔͤԘ ÔÚ›˙ÂÙ·È ÙÔ ËÏ›ÎÔ Ù˘ Û˘ÓÔÏÈ΋˜ ‰È¿ÚÎÂÈ·˜ (Û ÏÂÙ¿) ÙˆÓ ÂÂÈÛÔ‰›ˆÓ °O¶ Ì pH ÌÈÎÚfiÙÂÚÔ ÙÔ˘ 4 ‰È¿ ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÂÂÈÛÔ‰›ˆÓ °O¶ (·ıÔÏÔÁÈ΋ ıˆÚÂ›Ù·È fiÙ·Ó Â›Ó·È >4 ÏÂÙ¿) Î·È ñ ªÂÁ·Ï‡ÙÂÚÔ Û ‰È¿ÚÎÂÈ· ÂÂÈÛfi‰ÈÔ (·ıÔÏÔÁÈÎfi fiÙ·Ó Â›Ó·È >20 ÏÂÙ¿) * ∆· ·Ú·¿Óˆ ÎÚÈÙ‹ÚÈ· ÈÛ¯‡Ô˘Ó ÁÈ· ÌÂÙÚ‹ÛÂȘ ¿Óˆ ·fi 16 ÒÚ˜. ∆Ô˘Ï¿¯ÈÛÙÔÓ 2 ·fi Ù· ÎÚÈÙ‹ÚÈ· Ú¤ÂÈ Ó· Â›Ó·È ·ıÔÏÔÁÈο ÁÈ· Ó· ÙÂı› Ë ‰È¿ÁÓˆÛË °O¶ ** ◊È· ıˆÚÂ›Ù·È Ë °O¶ fiÙ·Ó Ô ¢¶ Â›Ó·È 5-10% (ÙÔ˘ Û˘ÓÔÏÈÎÔ‡ ¯ÚfiÓÔ˘ ηٷÁÚ·Ê‹˜), ̤ÙÚÈ· ÌÂٷ͇ 10-20%, ÂÓÒ ÛÔ‚·Ú‹ ıˆÚÂ›Ù·È fiÙ·Ó Ô ¢¶ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚÔ˜ ÙÔ˘ 20%

¶›Ó·Î·˜ 2. µ·ıÌfi˜ °O¶ ÚÈÓ Î·È ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË “·ÓÙÈ·Ó·ÁˆÁÈÎÔ‡” Á¿Ï·ÙÔ˜

1Ë pHÌÂÙÚ›· (ÚÈÓ ÙË ¯ÔÚ‹ÁËÛË) 2Ë pHÌÂÙÚ›· (ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË)

º˘ÛÈÔÏÔÁÈ΋ ◊È· °O¶ ª¤ÙÚÈ· °O¶ ™Ô‚·Ú‹ °O¶

◊È· °O¶

ª¤ÙÚÈ· °O¶

™Ô‚·Ú‹ °O¶

8/32 (25%)

17/32 (53,1%)

7/32 (21,9%)

7/8 ·È‰È¿ (87,5%) 1/8 ·È‰È¿ (12,5%) -

7/17 ·È‰È¿ (41,2%) 5/17 ·È‰È¿ (29,4%) 5/17 ·È‰È¿ (29,4%) -

5/7 ·È‰È¿ (71,4%) 2/7 ·È‰È¿ (28,6%)

421

NoV-dEc-02

14-05-03

14:26

™ÂÏ›‰·422

¶·È‰È·ÙÚÈ΋ 2002;65:419-423

Paediatriki 2002;65:419-423

¶›Ó·Î·˜ 3. ¢Â›ÎÙ˘ ·ÏÈÓ‰ÚfiÌËÛ˘ (Reflux Index), ·Ó·ÁˆÁ¤˜, ¤ÌÂÙÔÈ, ÎÂÓÒÛÂȘ Î·È ÂÂÈÛfi‰È· ‚‹¯· ÚÈÓ Î·È ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË “·ÓÙÈ·Ó·ÁˆÁÈÎÔ‡” Á¿Ï·ÙÔ˜ Û ·È‰È¿ Ì °O¶.

¢Â›ÎÙ˘ ·ÏÈÓ‰ÚfiÌËÛ˘ (Reflux Index) ª¤ÛÔ˜ fiÚÔ˜ Â̤وÓ/Ë̤ڷ ª¤ÛÔ˜ fiÚÔ˜ ·Ó·ÁˆÁÒÓ/Ë̤ڷ ª¤ÛÔ˜ fiÚÔ˜ ÎÂÓÒÛˆÓ/Ë̤ڷ ª¤ÛÔ˜ fiÚÔ˜ ÂÂÈÛÔ‰›ˆÓ ‚‹¯·/Ë̤ڷ

¶ÚÈÓ ÙË ¯ÔÚ‹ÁËÛË ·ÓÙÈ·Ó·ÁˆÁÈÎÔ‡ Á¿Ï·ÙÔ˜

ªÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË ·ÓÙÈ·Ó·ÁˆÁÈÎÔ‡ Á¿Ï·ÙÔ˜

p

14,8±5,9% 4,3±2,7% 6,6±3,7% 2,4±0,9% 0,6±0,9%

7,9±6,3% 1,5±1,6% 3,3±2,8% 2,4±0,9% 0,4±0,7%

<0,0001 <0,0001 <0,0001 0,54 0,27

∏ ‰È¿ÚÎÂÈ· Ï‹„˘ ÙÔ˘ ·ÓÙÈ·Ó·ÁˆÁÈÎÔ‡ Á¿Ï·ÙÔ˜ ‹Ù·Ó 16,6±4,1 ÏÂÙ¿, ÂÓÒ ÙÔ˘ Û˘Ó‹ıÔ˘˜ Á¿Ï·ÙÔ˜ ‹Ù·Ó 15,8±4,4 ÏÂÙ¿ (p=0,062). ∏ ·ÓÔ¯‹ ÙÔ˘ Á¿Ï·ÙÔ˜ ‹Ù·Ó ηϋ Û fiÏ· Ù· ‚Ú¤ÊË. ™˘˙‹ÙËÛË ™‡Ìʈӷ Ì ‰È¿ÊÔÚ˜ ÌÂϤÙ˜, ÙÔ ¿ÓıÔ˜ ÔÚ‡˙˘ Ô˘ ÚÔÛÙ›ıÂÙ·È ÛÙÔ Á¿Ï·, ÂÎÙfi˜ ÙÔ˘ fiÙÈ ˘‰ÚÔχÂÙ·È ÁÚ‹ÁÔÚ· ÛÙÔ ÛÙÔÌ¿¯È Î·È ÌÂÈÒÓÂÙ·È Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ¿ ÙÔ˘, ηı˘ÛÙÂÚ› ÙÔÓ ¯ÚfiÓÔ Á·ÛÙÚÈ΋˜ ΤӈÛ˘ Î·È ÌÔÚ› Ó· ÚÔηϤÛÂÈ ‰˘ÛÎÔÈÏÈfiÙËÙ· (2,18). ∂›Û˘, ·Ó·Ê¤ÚÂÙ·È fiÙÈ ‚Ú¤ÊË Ô˘ Ï·Ì‚¿ÓÔ˘Ó Á¿Ï· Ô˘ ¤¯ÂÈ ˘ÎÓˆı› Ì ڇ˙È, ·ÚÔ˘ÛÈ¿˙Ô˘Ó Û˘¯ÓfiÙÂÚ· ÂÂÈÛfi‰È· ‚‹¯· (7). ∏ ‡ÎÓˆÛË Ì ¯·ÚÔ˘¿Ï¢ÚÔ Ê·›ÓÂÙ·È Ó· ·ÚÔ˘ÛÈ¿˙ÂÈ ÚÔ‚Ï‹Ì·Ù·, ‰ÈfiÙÈ Ù· ·Ú¿ÁˆÁ· ˙‡ÌˆÛ˘ Ô˘ ‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È ÛÙÔ ·¯‡ ¤ÓÙÂÚÔ, ÚÔηÏÔ‡Ó Û˘¯ÓfiÙÂÚ· ÎÔÏÈÎÔ‡˜, ÎÔÈÏȷο ¿ÏÁË Î·È ‰È¿ÚÚÔȘ. ∆¤ÏÔ˜, ‚Ú¤ıËΠfiÙÈ ÔÈ ‰È·ÙÚÔÊÈΤ˜ ÊfiÚÌÔ˘Ï˜ Ì ¯·ÌËÏfi Ï›Ô˜ Î·È ·˘ÍË̤ÓÔ ÔÛÔÛÙfi ˘‰·Ù·ÓıÚ¿ÎˆÓ ‰ÂÓ ‚ÂÏÙÈÒÓÔ˘Ó ÙÔ˘˜ ‰Â›ÎÙ˜ ·ÏÈÓ‰ÚfiÌËÛ˘ ÛÙËÓ pHÌÂÙÚ›· (19).

OÈ Vandenplas Î·È Sacre (6) ¯ÔÚËÁÔ‡Û·Ó Á¿Ï· ˘Îӈ̤ÓÔ Ì ¯·ÚÔ˘¿Ï¢ÚÔ Û 30 ‚Ú¤ÊË Ì °O¶ Î·È ÚÔ¤‚·ÈÓ·Ó Û pHÌÂÙÚ›· Â·ÓÂϤÁ¯Ô˘ Û 7-14 Ë̤Ú˜. ∆· ·ÔÙÂϤÛÌ·Ù¿ ÙÔ˘˜ ¤‰ÂÈÍ·Ó fiÙÈ ÛÙÔ 80% Ô ‰Â›ÎÙ˘ ·ÏÈÓ‰ÚfiÌËÛ˘ (¢¶) Î·È Ô ·ÚÈıÌfi˜ ÙˆÓ ÂÂÈÛÔ‰›ˆÓ ·ÏÈÓ‰ÚfiÌËÛ˘ ÛÙÔ 24ˆÚÔ ˘Ô¯ÒÚËÛ·Ó. ¶·Ú’ fiÏ· ·˘Ù¿, ·˘Í‹ıËÎ·Ó Ë ‰È¿ÚÎÂÈ· ÙÔ˘ ÌÂÁ·Ï‡ÙÂÚÔ˘ ÂÂÈÛÔ‰›Ô˘ ·ÏÈÓ‰ÚfiÌËÛ˘ Î·È Ô ·ÚÈıÌfi˜ ÙˆÓ ÂÂÈÛÔ‰›ˆÓ °O¶ Ì ‰È¿ÚÎÂÈ· >5 min. ∆Ô ˘fiÏÔÈÔ 20% ÙˆÓ ‚ÚÂÊÒÓ Â›¯Â Ê˘ÛÈÔÏÔÁÈ΋ pHÌÂÙÚ›· ηٿ ÙÔÓ Â·Ó¤ÏÂÁ¯Ô. ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, ÙÔ 87,5% ÙˆÓ ·È‰ÈÒÓ Ì ‹È· °O¶ ›¯Â ·ÚÓËÙÈ΋ ‰Â‡ÙÂÚË pHÌÂÙÚ›· Î·È ÙÔ 12,5% ‹È· °O¶, ÂÓÒ ÙÔ 41,2% ÙˆÓ ·È‰ÈÒÓ Ì ̤ÙÚÈ· °O¶ ›¯Â ·ÚÓËÙÈ΋ ‰Â‡ÙÂÚË pHÌÂÙÚ›· Î·È ÙÔ 29,4% ‚ÂÏÙ›ˆÛË ÙÔ˘ ‚·ıÌÔ‡ Ù˘ ·ÏÈÓ‰ÚfiÌËÛ˘. ∆· ·È‰È¿ Ì ÛÔ‚·Ú‹ ·ÏÈÓ‰ÚfiÌËÛË ‰ÂÓ Â›¯·Ó ·ÚÓËÙÈ΋ pHÌÂÙÚ›· Â·ÓÂϤÁ¯Ô˘, Û ÔÛÔÛÙfi fï˜ 71,4% ›¯·Ó ‚ÂÏÙ›ˆÛË ÙÔ˘ ‚·ıÌÔ‡ Ù˘ ·ÏÈÓ‰ÚfiÌËÛ˘ (·fi ÛÔ‚·Ú‹ ¤ÁÈÓ ̤ÙÚÈ·). ™ÙÔ Û‡ÓÔÏÔ ÙˆÓ ·È‰ÈÒÓ, ÙÔ ÔÛÔÛÙfi ›·Û˘ ‹Ù·Ó 43,8%. ∆· ·ÔÙÂϤÛÌ·Ù· ·˘Ù¿ Û˘Ì‚·‰›˙Ô˘Ó ÂÓ Ì¤ÚÂÈ Ì ÙËÓ

422

ÂÚÁ·Û›· ÙˆÓ Vandenplas Î·È Û˘Ó (2), fiÔ˘ ÙÔ 20% ÙˆÓ ‚ÚÂÊÒÓ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó Â›¯Â ·ÚÓËÙÈ΋ ‰Â‡ÙÂÚË pHÌÂÙÚ›· (¯ˆÚ›˜ Ó· Á›ÓÂÙ·È Û˘Û¯¤ÙÈÛË ÙÔ˘ ‚·ıÌÔ‡ ·ÏÈÓ‰ÚfiÌËÛ˘ Ì ÙÔ ıÂÚ·¢ÙÈÎfi ·ÔÙ¤ÏÂÛÌ·). øÛÙfiÛÔ, ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ·¿ÓÙËÛ˘ ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ·Ô‰›‰ÂÙ·È ÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ ¯ÔÚËÁ‹ıËΠÁ¿Ï· ˘Îӈ̤ÓÔ Ì ¿Ì˘ÏÔ ·Ú·‚ÔÛ›ÙÔ˘ Î·È ·˘ÍË̤ÓÔ ÔÛÔÛÙfi η˙½Ó˘, Ô˘ Ê·›ÓÂÙ·È Ó· Â›Ó·È ÈÔ ‰Ú·ÛÙÈÎfi. ∞ÎfiÌ·, Ë ÚÔËÁÔ‡ÌÂÓË ÌÂϤÙË ‰ÂÓ Û˘Û¯¤ÙÈÛ ÙË ‚·Ú‡ÙËÙ· Ù˘ ·ÏÈÓ‰ÚfiÌËÛ˘ Ì ÙÔ ıÂÚ·¢ÙÈÎfi ·ÔÙ¤ÏÂÛÌ·, ÁÂÁÔÓfi˜ Ô˘ Â‰Ò ‚Ú¤ıËΠ·ÓÙÈÛÙÚfiʈ˜ ·Ó¿ÏÔÁÔ (‹È· Î·È Ì¤ÙÚÈ· °O¶ ›¯·Ó ÙËÓ Î·Ï‡ÙÂÚË ıÂÚ·¢ÙÈ΋ ·ÓÙ·fiÎÚÈÛË, Ì ˘„ËÏfiÙÂÚ· ÔÛÔÛÙ¿ ·¿ÓÙËÛ˘).

OÈ Orenstein Î·È Û˘Ó (3), ÌÂÏÂÙÒÓÙ·˜ 21 ·È‰È¿ Ì ·ԉ‰ÂÈÁ̤ÓË Ì pHÌÂÙÚ›· °O¶, ‰ÂÓ ‚Ú‹Î·Ó ÂÏ¿ÙÙˆÛË ÙˆÓ ÌÂÙ·ÁÂ˘Ì·ÙÈÎÒÓ ·ÏÈÓ‰ÚÔÌ‹ÛÂˆÓ ÛÈÓıËÚÔÁÚ·ÊÈο, ¯ÔÚËÁÒÓÙ·˜ Á¿Ï· ˘Îӈ̤ÓÔ Ì ڢ˙¿Ï¢ÚÔ. ∞Í›˙ÂÈ Ó· ÙÔÓÈÛÙ› fiÙÈ Ù· ·È‰È¿ Ù˘ Û˘ÁÎÂÎÚÈ̤Ó˘ ÌÂϤÙ˘ ›¯·Ó ÂÈÏÔΤ˜ ·fi °O¶ (Û ·ÓÙ›ıÂÛË Ì ÙËÓ ·ÚÔ‡Û· ÛÂÈÚ¿). ∏ ‚ÂÏÙ›ˆÛË ÙˆÓ ·Ú·Ì¤ÙÚˆÓ Ù˘ pHÌÂÙÚ›·˜ Ô˘ ·Ú·ÙËÚ‹ıËΠ۠·˘Ù‹ ÙË ÌÂϤÙË, ÔÊ›ÏÂÙ·È ÚÔÊ·ÓÒ˜ ÛÙÔ ÂȉÈÎfi “·ÓÙÈ·Ó·ÁˆÁÈÎfi” Á¿Ï· Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ, ·ÏÏ¿ Î·È ÛÙÔ fiÙÈ ÔÈ ·ÛıÂÓ›˜ ‰ÂÓ Â›¯·Ó ÂÈÏÔΤ˜ ·fi °O¶. ∏ ÎÏÈÓÈ΋ ‚ÂÏÙ›ˆÛË ÙˆÓ ‚ÚÂÊÒÓ Ì °O¶ ÌÂÙ¿ ÙËÓ ‡ÎÓˆÛË ÙÔ˘ Á¿Ï·ÙÔ˜ Ì ¯·ÚÔ˘¿Ï¢ÚÔ ‹ Ú‡˙È ·Ó·Ê¤ÚÂÙ·È Û ‰È¿ÊÔÚ˜ ÌÂϤÙ˜ (3,6). OÈ Orenstein Î·È Û˘Ó (3) ‚Ú‹Î·Ó fiÙÈ ÔÈ ¤ÌÂÙÔÈ Î·È ÔÈ ·Ó·ÁˆÁ¤˜ ÌÂÈÒıËÎ·Ó ‰Ú·ÛÙÈο ¯ÔÚËÁÒÓÙ·˜ Á¿Ï· ˘Îӈ̤ÓÔ Ì ڇ˙È (33% Î·È 87%, ·ÓÙ›ÛÙÔȯ·). ™ÙÔ ›‰ÈÔ Û˘Ì¤Ú·ÛÌ· η٤ÏËÍ·Ó ÔÈ Vandenplas Î·È Û˘Ó (2), ÔÈ ÔÔ›ÔÈ ¯ÔÚ‹ÁËÛ·Ó Á¿Ï· ˘Îӈ̤ÓÔ Ì ¯·ÚÔ˘¿Ï¢ÚÔ. OÈ ·Ú·ÙËÚ‹ÛÂȘ ·˘Ù¤˜ Û˘Ì‚·‰›˙Ô˘Ó Ì ٷ ‰Â‰Ô̤ӷ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘, fiÔ˘ Ë Ì›ˆÛË ÙˆÓ ·Ó·ÁˆÁÒÓ Î·È ÙˆÓ ÂÌ¤ÙˆÓ ‹Ù·Ó Û·Ê‹˜ (p<0,0001). ∆· ·˘ÍË̤ӷ ÂÂÈÛfi‰È· ‚‹¯· Ô˘ ·Ú·ÙËÚ‹ıËÎ·Ó ÌÂÙ¿ ÙËÓ ‡ÎÓˆÛË Ì ڇ˙È Û ¿ÏϘ ·Ó·ÊÔÚ¤˜ (3,7) ‰ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ÛÙË Û˘ÁÎÂÎÚÈ̤ÓË ÂÚÁ·Û›·, ÂÓÒ Î·È Ë ·ÓÔ¯‹ ÙÔ˘ Á¿Ï·ÙÔ˜ ‹Ù·Ó ¿ÚÈÛÙË Û fiÏ· Ù· ‚Ú¤ÊË.

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∏ ·ÏÏ·Á‹ ÛÙË Û‡ÛÙ·ÛË ÙˆÓ ÎÂÓÒÛÂˆÓ ·Ó·Ê¤ÚÂÙ·È ÙfiÛÔ ÛÙËÓ ‡ÎÓˆÛË Ì ¯·ÚÔ˘¿Ï¢ÚÔ (‰È¿ÚÚÔȘ), fiÛÔ Î·È Û ·˘Ù‹ Ì ¿ÓıÔ˜ ÔÚ‡˙˘ (‰˘ÛÎÔÈÏÈfiÙËÙ·) (19). øÛÙfiÛÔ, ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ‰ÂÓ ·Ú·ÙËÚ‹ıËΠοÔÈ· ·ÏÏ·Á‹ ÛÙË Û‡ÛÙ·ÛË ‹ ÙË Û˘¯ÓfiÙËÙ· ÙˆÓ ÎÂÓÒÛÂˆÓ Ì ÙË ¯ÔÚ‹ÁËÛË Á¿Ï·ÙÔ˜ Ì ¿Ì˘ÏÔ Î·Ï·ÌÔÎÈÔ‡. ™˘ÌÂÚ·ÛÌ·ÙÈο, ÙÔ “·ÓÙÈ·Ó·ÁˆÁÈÎfi” Á¿Ï· Ì ·˘ÍË̤ÓÔ ÔÛÔÛÙfi η˙½Ó˘ (80/20) Î·È ¿Ì˘ÏÔ Î·Ï·ÌÔÎÈÔ‡ ÂӉ›ÎÓ˘Ù·È ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ‹È·˜ Î·È Ì¤ÙÚÈ·˜ Á·ÛÙÚÔÔÈÛÔÊ·ÁÈ΋˜ ·ÏÈÓ‰ÚfiÌËÛ˘ ¯ˆÚ›˜ ÂÈÏÔΤ˜. ∆· ·È‰È¿ Ô˘ Ï·Ì‚¿ÓÔ˘Ó ·˘Ùfi ÙÔ Á¿Ï· ¤¯Ô˘Ó Û‡ÓÙÔÌ· ÂÚÁ·ÛÙËÚȷ΋ Î·È ÎÏÈÓÈ΋ ‚ÂÏÙ›ˆÛË Û ÌÂÁ¿ÏÔ ÔÛÔÛÙfi. ∏ ·Ú·Ù‹ÚËÛË ·˘Ù‹ ¤Ú¯ÂÙ·È Ó· ·Ó·ÙÚ¤„ÂÈ Ù· ̤¯ÚÈ ÙÒÚ· ‰Â‰Ô̤ӷ ÁÈ· ÙȘ ·ÓÙÈ·ÏÈÓ‰ÚÔÌÈΤ˜ ȉÈfiÙËÙ˜ οÔÈˆÓ Ô˘ÛÈÒÓ, fiÔ˘ ˘‹Ú¯Â ÌÂÓ ÎÏÈÓÈ΋ ‚ÂÏÙ›ˆÛË, ·ÏÏ¿ ‰ÂÓ ˘‹Ú¯Â Î·È ÂÚÁ·ÛÙËÚȷ΋ ·fi‰ÂÈÍË (3,6,19). ∆Ô Á¿Ï· ·˘Ùfi ‰ÂÓ Ê·›ÓÂÙ·È Ó· ÚÔηÏ› Û˘¯ÓfiÙÂÚ· ÂÂÈÛfi‰È· ‚‹¯· Î·È ‰ÂÓ ÂËÚ¿˙ÂÈ ÙȘ ÎÂÓÒÛÂȘ. ∏ ·ÓÔ¯‹ Î·È Ë Â›‰Ú·ÛË ÛÙȘ ۈ̷ÙÔÌÂÙÚÈΤ˜ ·Ú·Ì¤ÙÚÔ˘˜ Â›Ó·È ·ÚfiÌÔȘ Ì ·˘Ù¤˜ ÙÔ˘ Û˘Ì‚·ÙÈÎÔ‡ Á¿Ï·ÙÔ˜, ÂÓÒ Ê·Ú̷΢ÙÈ΋ ·Ú¤Ì‚·ÛË ¯ÚÂÈ¿˙ÂÙ·È ÌfiÓÔ Û ÛÔ‚·ÚÔ‡ ‚·ıÌÔ‡ °O¶ ‹ Â› ÂÌÊ¿ÓÈÛ˘ ÂÈÏÔÎÒÓ. µÈ‚ÏÈÔÁÚ·Ê›· 1. Vandenplas Y, Belli D, Benhamou P, Cadranel S, Cezard JP, Cucchiara S et al. A critical appraisal of current management practices for infant regurgitation recommendations of a working party. Eur J Pediatr 1997;156:343-357.

2. Vandenplas Y, Ashkenazi A, Belli D, Boige N, Bouquet J, Cadranel S et al. A proposition for the diagnosis and treatment of gastroesophageal reflux disease in children.

Eur J Pediatr 1993;152:704-711.

3. Orenstein SR, Magill HL, Brooks P. Thickening of infant feedings for therapy of gastroesophageal reflux. J Pediatr 1987;110:181-186.

4. Cucchiara S, De Vizia B, Minella R, Calabrese F, Scoppa A, Emiliano M et al. Intragastric volume and osmolality affect mechanisms of gastroesophageal reflux in children with GOR disease [abstract]. J Pediatr Gastroenterol Nutr 1995;20:468.

5. Leape LL, Holder TM, Franklin JD, Amoury RA, Ashcraft KW. Respiratory arrest in infants secondary to gastroesophageal reflux. Pediatrics 1977;60:924-928.

6. Vandenplas Y, Sacre L. Milk-thickening agents as a treatment for gastroesophageal reflux. Clin Pediatr 1987;26:66-68.

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7. Orenstein SR, Shalaby TM, Putnam PE. Thickened feedings as a cause of increased coughing when used as therapy of gastroesophageal reflux in infants. J Pediatr 1992;121:913-915.

8. De Vizia B, Ciccimarra F, De Cicco N, Auricchio S. Digestibility of starches in infants and children. J Pediatr 1975;86:50-55.

9. Khoshoo V, Fried M, Pencharz P. Incidence of gastroesophageal reflux with casein and whey-based formulas. J Pediatr Gastroenterol Nutr 1993;17:116-117.

10. Roy C. Gastroesophageal reflux. In: Silvermann A. Pediatric Clinical Gastroenterology. 4th ed. New York: Mosby; 1995. p. 163-170.

11. Davies AE, Sandhu BK. Diagnosis and treatmeant of gastro-oesophageal reflux. Arch Dis Child 1995;73:82-86.

12. Strobel CT, Byrne WJ, Ament ME, Euler AR. Correlation of esophageal lengths in children with height: application of the Tuttle test without prior esophageal manometry. J Pediatr 1979;94:81-84.

13. Emde C, Garner A, Blum AL. Technical aspects of intraluminal pH-metry in man: current status and recommendations. Gut 1987;28:1177-1188.

14. Shaker R, Kahrilas PJ, Dodds WJ, Hogan WJ. Esophageal clearance of small amounts of acid [abstract].

Gastroenterology 1986;90:1628.

15. Ravelli AM, Milla PJ. Vomiting and gastroesophageal motor activity in children with disorders of the central nervous system. J Pediatr Gastroenterol Nutr 1998;26:56-63.

16. Boyle JT. Gastroesophageal reflux in the pediatric patient.

Gastroenterol Clin North Am 1989;18:315-337.

17. Sondheimer JM. Gastroesophageal reflux in children.

Clinical presentation and diagnostic evaluation.

Gastrointest Endosc Clin North Am 1994;4:55-74.

18. Minani H, McCallun RW. The physiology and pathophysiology of gastric emptying in humans.

Gastroenterology 1984;86:1592-1610.

19. Sutphen JL, Dillard VL. Dietary caloric density and osmolality influence gastroesophageal reflux in infants.

Gastroenterology 1989;97:601-604.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 11-12-2001 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 04-10-2002 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ™‡ÚÔÁÏÔ˘ ∫ÏÂÔ̤Ó˘ °’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ∞¶£ πÔÎÚ¿ÙÂÈÔ ¡ÔÛÔÎÔÌÂ›Ô £ÂÛÛ·ÏÔӛ΢ ∫ˆÓÛÙ·ÓÙÈÓÔ˘fiψ˜ 46, ∆.∫. 546 42, £ÂÛÛ·ÏÔÓ›ÎË E-mail: klspirog@med.auth.gr

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ORIGINAL ARTICLE

ªÂϤÙË ·È‰ÈÎÔ‡ ‚ÚÔÁ¯ÈÎÔ‡ ¿ÛıÌ·ÙÔ˜ ÛÙËÓ ÂÚÈÔ¯‹ Ù˘ ™ËÙ›·˜ Œ. ∆Û·¿ÎË1, ∫. ™Ô‡Áη1, °. ∆Ú›Ì˘1, π. °ÂÚÌ·Ó¿Î˘1, ª. ª·Ï·ıÚ¿ÎË1, ™. °ÎÔ‡ÓÙÚ·˜2, ∂. ªÈ¯·ËÏ›‰Ô˘3, ∞. ¡Â¿Ú¯Ô˘1

Study of childhood asthma in Sitia region E. Tsapaki1, C. Souga1, G. Trimis1, I. Germanakis1, M. Malathraki1, S. Goundras2, H. Michailidou3, A. Nearchou1

¶ÂÚ›ÏË„Ë: O ÂÈÔÏ·ÛÌfi˜ ÙÔ˘ ·È‰ÈÎÔ‡ ¿ÛıÌ·ÙÔ˜ ÂËÚ¿˙ÂÙ·È ·fi ÁÂÓÂÙÈÎÔ‡˜ Î·È ÂÚÈ‚·ÏÏÔÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜. ªÂ ÛÎÔfi ÙËÓ ÂÎÙ›ÌËÛË ÙÔ˘ ·ıÚÔÈÛÙÈÎÔ‡ ÂÈÔÏ·ÛÌÔ‡ ÙÔ˘ ·È‰ÈÎÔ‡ ‚ÚÔÁ¯ÈÎÔ‡ ¿ÛıÌ·ÙÔ˜, ÌÂÏÂÙ‹ıËÎ·Ó ÛÙË ™ËÙ›· ∫Ú‹Ù˘ ·È‰È¿ ËÏÈΛ·˜ 6-14 ÂÙÒÓ ÙËÓ ÂÚ›Ô‰Ô 1993-1997. ÃÚËÛÈÌÔÔÈ‹ıËΠÂȉÈÎfi ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Ô˘ ¯ÔÚËÁ‹ıËΠ۠fiÏ· Ù· ·È‰È¿ ÙÔ˘ ¢‹ÌÔ˘ ™ËÙ›·˜ Î·È ÙˆÓ ÂÚȯÒÚˆÓ Î·È Û˘ÌÏËÚÒıËΠÚÔ·ÈÚÂÙÈο ·fi ÙÔ˘˜ ÁÔÓ›˜. ∂ÎÙfi˜ ·fi Ù· ‰ËÌÔÁÚ·ÊÈο, ηٷÁÚ¿ÊËÎ·Ó Î·È Ù· ÛÙÔȯ›· ·fi ÙÔ ÎÏËÚÔÓÔÌÈÎfi, ÙÔ ·ÙÔÌÈÎfi ·Ó·ÌÓËÛÙÈÎfi Î·È ÙÔ˘˜ ÂÎÏ˘ÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Ô˘ Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ÂΉ‹ÏˆÛË ·ÛıÌ·ÙÈÎÒÓ ·ÚÔ͢ÛÌÒÓ. ∂ÈϤÔÓ, ·ÍÈÔÏÔÁ‹ıËÎ·Ó ÏËÚÔÊÔڛ˜ ÁÈ· ·ÚÔ˘Û›· Ó˘¯ÙÂÚÈÓÒÓ Û˘Ìو̿وÓ, ηıÒ˜ Î·È ¿ÛıÌ·ÙÔ˜ ÌÂÙ¿ ·fi ¿ÛÎËÛË Î·È Î·Ù·ÁÚ¿ÊËÎÂ Ë Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ Ô˘ ›¯Â ¯ÔÚËÁËı›. ∆Ú›· ¯ÚfiÓÈ· ·ÚÁfiÙÂÚ·, Ù· ·È‰È¿ Ô˘ ·ÚÔ˘Û›·˙·Ó Û˘¯Ó¿ ÂÂÈÛfi‰È· Û˘ÚÈÁÌÔ‡, ÂÎÏ‹ıËÛ·Ó Ó· ‰ÒÛÔ˘Ó ÂÎ Ó¤Ô˘ ÏËÚÔÊÔڛ˜ ÁÈ· ÙËÓ ÂͤÏÈÍË Ù˘ ÓfiÛÔ˘. ∂ÈϤÔÓ, ·ÍÈÔÏÔÁ‹ıËΠ۠ۇÁÎÚÈÛË Ì ÔÌ¿‰· ˘ÁÈÒÓ Ì·ÚÙ‡ÚˆÓ Ë Ì¤ÁÈÛÙË ÂÎÓ¢ÛÙÈ΋ ÚÔ‹ (PEFR) Ì ÚÔÔÌÂÙÚ›·. ™Â Û‡ÓÔÏÔ 1081 ·È‰ÈÒÓ, Û˘ÌÏËÚÒıËÎ·Ó 748 ¤Á΢ڷ ÂÚˆÙËÌ·ÙÔÏfiÁÈ· (69,2%). ∂ηÙfiÓ Â›ÎÔÛÈ ¤ÓÙ ·ÛıÂÓ›˜ (16,7%) ·ÚÔ˘Û›·˙·Ó Û˘¯Ó¤˜ ·ÛıÌ·ÙÈΤ˜ ÎÚ›ÛÂȘ Î·È ÂÏ¿Ì‚·Ó·Ó ‚ÚÔÁ¯Ô‰È·ÛÙ·ÏÙÈ΋ ·ÁˆÁ‹. ¢Âη٤ÛÛÂÚ· ·fi Ù· 125 ·È‰È¿ (11,2%) ÂÏ¿Ì‚·Ó·Ó ·ÓÙÈÊÏÂÁÌÔÓÒ‰Ë ıÂÚ·›· ÁÈ· ¿ÛıÌ·. ∏ PEFR ÛÙ· ·È‰È¿ ÌÂ Û˘¯Ó¤˜ ·ÛıÌ·ÙÈΤ˜ ÎÚ›ÛÂȘ ‹Ù·Ó Û ÔÛÔÛÙfi 95,8% <90Ë ∂£, ÂÓÒ ÛÙËÓ ÔÌ¿‰· Ì·ÚÙ‡ÚˆÓ 53,8% ÙˆÓ ·È‰ÈÒÓ Â›¯Â PEFR <90Ë ∂£ (p<0,0001, 95% CI: 36,65-49,21%). ∆¤ÏÔ˜, Ù· ·È‰È¿ Ì ·ÛıÌ·ÙÈΤ˜ ÎÚ›ÛÂȘ ›¯·Ó Û ÌÂÁ·Ï‡ÙÂÚÔ

Abstract: The prevalence of childhood asthma is determined by genetic as well as environmental factors. Aiming to estimate the cumulative prevalence of childhood bronchial asthma in our region, we studied school children aged 6-14 years, in Sitia, Crete, during the period 1993-1997.

We used a special questionnaire, which was given to all school children of our region to be filled out by their parents. Apart from demographic data, details concerning personal and family history were recorded, as well as data concerning known risk factors for asthma exacerbations. In addition we recorded the presence of night symptoms, exercise-induced asthma attacks and the type of treatment prescribed by the physician. Three years later, those children with recurrent episodes of asthma were called back in order to obtain further information Ôn their disease progress. Peak expiratory flow rate (PEFR) was measured in this group and compared to PEFR obtained in a group of healthy children of similar age. Among 1081 school children, 748 questionnaires were successfully completed (69.2%). 125/748 (16.7%) children were found to have frequent episodes of acute asthma exacerbations for which they received appropriate treatment for severe asthma symptoms. Of these 125 patients, 14 (11.2%) received anti-inflammatory medication for asthma. In 95.8% of children with asthma the PEFR was <90th percentile while in the control group only 53.8% of children showed PEFR <90th percentile (p<0.0001, 95% CI: 36.6549.21%). Finally, a lower proportion of children with asthma had a positive family history for atopy

1 ¶·È‰È·ÙÚÈÎfi ∆Ì‹Ì·, °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ™ËÙ›·˜, ∫Ú‹ÙË 2 ¶Ó¢ÌÔÓÔÏÔÁÈÎfi ∆Ì‹Ì·, °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ™ËÙ›·˜, ∫Ú‹ÙË 3 ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋, ¶·ÓÂÈÛÙËÌÈ·Îfi ¡ÔÛÔÎÔÌÂ›Ô ∏Ú·ÎÏ›Ԣ, ∫Ú‹ÙË

1 Pediatric Division, General Hospital of Sitia, Crete 2 Pulmonology Division, General Hospital of Sitia, Crete 3 Pediatric Clinic, University Hospital of Heraklion, Crete

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¶·È‰È·ÙÚÈ΋ 2002;65:424-432

Paediatriki 2002;65:424-432

ÔÛÔÛÙfi ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi Î·È Î·ÓÈÛÙ¤˜ ÁÔÓ›˜, Û˘ÁÎÚÈÙÈο Ì ÌË ·ÛıÌ·ÙÈο ·È‰È¿. ™˘ÌÂÚ·ÛÌ·ÙÈο, Ô ÂÈÔÏ·ÛÌfi˜ ÙÔ˘ ·È‰ÈÎÔ‡ ‚ÚÔÁ¯ÈÎÔ‡ ¿ÛıÌ·ÙÔ˜ ÛÙËÓ ÂÚÈÔ¯‹ Ù˘ ™ËÙ›·˜ ıˆÚÂ›Ù·È ˘„ËÏfi˜ (16,7%). ∏ Ù·˘ÙÔÔ›ËÛË Î·È Ë ·ÔÊ˘Á‹ ÙˆÓ ÂÎÏ˘ÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ı· ÌÔÚÔ‡Û ӷ Û˘Ì‚¿ÏÂÈ ÛÙÔÓ ¤ÏÂÁ¯Ô Ù˘ ÓfiÛÔ˘.

and for parental smoking as compared to controls.

In conclusion, the cumulative prevalence of childhood asthma in Sitia region appears to be high (16.7%). ∆he identification and avoidance of risk factors could contribute to the better control of childhood asthma in our region.

§¤ÍÂȘ ÎÏÂȉȿ: ‚ÚÔÁ¯ÈÎfi ¿ÛıÌ·, ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘, PEFR.

Key words: bronchial asthma, risk factors, PEFR.

∂ÈÛ·ÁˆÁ‹ ∆Ô ‚ÚÔÁ¯ÈÎfi ¿ÛıÌ· Â›Ó·È Ë ÈÔ Û˘¯Ó‹ ¯ÚfiÓÈ· ¿ıËÛË ÛÙ· ·È‰È¿. O ÂÈÔÏ·ÛÌfi˜ Ù˘ ÓfiÛÔ˘ ÂËÚ¿˙ÂÙ·È ·fi ÁÂÓÂÙÈÎÔ‡˜ Î·È ÂÚÈ‚·ÏÏÔÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Î·È ÔÈΛÏÏÂÈ Û ‰È·ÊÔÚÂÙÈΤ˜ ¯ÒÚ˜ ‹ ÁˆÁÚ·ÊÈΤ˜ ÂÚÈÔ¯¤˜. ¶·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Û‹ÌÂÚ· ˘¿Ú¯ÂÈ ÌÂÁ¿ÏË ÔÈÎÈÏ›· ·ÔÙÂÏÂÛÌ·ÙÈÎÒÓ ·ÓÙÈ·ÛıÌ·ÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ Î·È Ë ¯Ú‹ÛË ÙÔ˘˜ Û˘Ó¯Ҙ ‰È¢ڇÓÂÙ·È, ÙÔ ¿ÛıÌ· ÂÍ·ÎÔÏÔ˘ı› Ó· ·ÔÙÂÏ› ÛËÌ·ÓÙÈÎfi Úfi‚ÏËÌ· ÌÂ Û˘Ó¯Ҙ ·˘Í·ÓfiÌÂÓË ÓÔÛËÚfiÙËÙ· ηÈ, Û ÌÂÚÈΤ˜ ¯ÒÚ˜, ıÓËÛÈÌfiÙËÙ· (1,2). ø˜ ‰Â›ÎÙ˜ ÓÔÛËÚfiÙËÙ·˜ Û˘¯Ó¿ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Ô ·ÚÈıÌfi˜ ÙˆÓ ÂÈÛ·ÁˆÁÒÓ ·ÛıÌ·ÙÈÎÒÓ ·È‰ÈÒÓ Î·È ÔÈ ÂÈÛΤ„ÂȘ ÏfiÁˆ ·ÛıÌ·ÙÈÎÒÓ ·ÚÔ͢ÛÌÒÓ ÛÙ· ÙÌ‹Ì·Ù· ÂÂÈÁfiÓÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ ÙÔ˘ ÓÔÛÔÎÔÌ›Ԣ. ∆· ·›ÙÈ· Ù˘ ·‡ÍËÛ˘ ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÂÈÛ·ÁˆÁÒÓ ÙˆÓ ·ÛıÌ·ÙÈÎÒÓ ·È‰ÈÒÓ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô Â›Ó·È ·Û·Ê‹. ∂ÎÙfi˜ ·fi ÙËÓ ·‡ÍËÛË ÙÔ˘ ÛÙÈÁÌÈ·›Ô˘ Î·È ·ıÚÔÈÛÙÈÎÔ‡ ÂÈÔÏ·ÛÌÔ‡ Ù˘ ÓfiÛÔ˘, ÂÓÔ¯ÔÔÈÔ‡ÓÙ·È ‰È¿ÊÔÚÔÈ ÂÎÏ˘ÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ¢ԉˆÙÈÎÔ› ·ÛıÌ·ÙÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ, Ë ·‡ÍËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ ÙÔ˘ ÛÔ‚·ÚÔ‡ ¿ÛıÌ·ÙÔ˜ Î·È Ë ÂÊ·ÚÌÔÁ‹ ·ÓÂ·ÚÎÔ‡˜ ÚÔÏËÙÈ΋˜ ·ÁˆÁ‹˜ (1-3). ∏ ™ËÙ›· Â›Ó·È Û¯ÂÙÈο ·ÔÌ·ÎÚ˘Ṳ̂ÓË ·Ú·ı·Ï¿ÛÛÈ· fiÏË 10.000 ηÙԛΈÓ, ÛÙËÓ ∞Ó·ÙÔÏÈ΋ ∫Ú‹ÙË. ∆Ô ÔÛÔÛÙfi ˘ÁÚ·Û›·˜ Â›Ó·È 70,2% ÙÔ ¯ÂÈÌÒÓ· Î·È 62,2% ÙÔ Î·ÏÔη›ÚÈ. ∏ ̤ÛË ıÂÚÌÔÎÚ·Û›· Â›Ó·È 14,8ÔC Î·È 22,7ÔC, ·ÓÙ›ÛÙÔȯ· (ÌÂÙˆÚÔÏÔÁÈÎfi ·Ú¯Â›Ô ™ËÙ›·˜). ™ÎÔfi˜ Ù˘ Û˘ÁÎÂÎÚÈ̤Ó˘ ÌÂϤÙ˘ ‹Ù·Ó Ë ·ÍÈÔÏfiÁËÛË ÙÔ˘ ·ıÚÔÈÛÙÈÎÔ‡ ÂÈÔÏ·ÛÌÔ‡ ÙÔ˘ ·È‰ÈÎÔ‡ ‚ÚÔÁ¯ÈÎÔ‡ ¿ÛıÌ·ÙÔ˜ ÛÙË ™ËÙ›·, ηıÒ˜ Î·È Ù˘ ÎÏËÚÔÓÔÌÈ΋˜ ÂÈ‚¿Ú˘ÓÛ˘ Î·È ÙˆÓ ÂÈ‚·Ú˘ÓÙÈÎÒÓ ÂÚÈ‚·ÏÏÔÓÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ Ô˘ ÌÔÚ› Ó· ÂËÚ¿˙Ô˘Ó ÙËÓ Â›ÙˆÛË Ù˘ ÓfiÛÔ˘ ÛÙÔÓ ·È‰ÈÎfi ÏËı˘ÛÌfi Ù˘ ÂÚÈÔ¯‹˜.

™ÙÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ·˘Ùfi Û˘ÌÂÚÈÏ‹ÊıËÎ·Ó ÂÚˆÙ‹ÛÂȘ Û¯ÂÙÈΤ˜ Ì ٷ Û˘ÌÙÒÌ·Ù· ÙÔ˘ ·È‰ÈÎÔ‡ ¿ÛıÌ·ÙÔ˜, ‰ËÏ·‰‹ ·Ó Ù· ·È‰È¿ ·ÚÔ˘Û›·˙·Ó ÂÂÈÛfi‰È· Â›ÌÔÓÔ˘ ‚‹¯· ‹ ˘ÔÙÚÔÈ¿˙ÔÓÙ· ÂÂÈÛfi‰È· Û˘ÚÈÁÌÔ‡, ¿ÛıÌ·ÙÔ˜ ÌÂÙ¿ ·fi ¿ÛÎËÛË Î·È Ó˘¯ÙÂÚÈÓ¿ Û˘ÌÙÒÌ·Ù· ¿ÛıÌ·ÙÔ˜. ∂ÍÂÙ¿ÛÙËΠ·Ó Ù· ·È‰È¿ ›¯·Ó ·ÚÔ˘ÛÈ¿ÛÂÈ Û˘ÌÙÒÌ·Ù· ¿ÛıÌ·ÙÔ˜ Û οÔÈ· ÛÙÈÁÌ‹ Ù˘ ˙ˆ‹˜ ÙÔ˘˜ ̤¯ÚÈ ÙÔ Ù¤ÏÔ˜ ‰ÈÂÍ·ÁˆÁ‹˜ Ù˘ ÌÂϤÙ˘. ∂ÈϤÔÓ, Û˘ÌÂÚÈÏ‹ÊıËÎ·Ó ÂÚˆÙ‹ÛÂȘ Û¯ÂÙÈο Ì ÙËÓ ‡·ÚÍË ‹ fi¯È ıÂÙÈÎÔ‡ ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÈÛÙÔÚÈÎÔ‡ ÁÈ· ¿ÛıÌ· ‹ ¿ÏÏÔ˘ ·ÙÔÈÎÔ‡ ÓÔÛ‹Ì·ÙÔ˜ ÛÙÔ˘˜ Û˘ÁÁÂÓ›˜ ·’ Î·È ‚’ ‚·ıÌÔ‡, ÙËÓ ·ÚÔ˘Û›· ηÓÈÛÙÒÓ ÛÙÔ Û›ÙÈ, ηıÒ˜ Î·È ÙËÓ ·ÚÔ˘Û›· ÛÙÔ ÂÚÈ‚¿ÏÏÔÓ ¿ÏÏˆÓ ·Ú·ÁfiÓÙˆÓ Ô˘ ¤¯Ô˘Ó ÂÓÔ¯ÔÔÈËı› Î·È ı· ÌÔÚÔ‡Û·Ó Ó· ‰Ú¿ÛÔ˘Ó ˆ˜ ÂÎÏ˘ÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ·ÛıÌ·ÙÈÎÒÓ ·ÚÔ͢ÛÌÒÓ ÛÙ· ·È‰È¿, fiˆ˜ ΢ڛˆ˜ ÙÔ ¿Î·ÚÈ, ÔÈ Ì‡ÎËÙ˜, Ù· ηÙÔÈΛ‰È· ˙Ò·, Ù· Ê˘Ù¿ Î·È Ë ˘ÁÚ·Û›· ÛÙÔ˘˜ ÂÛˆÙÂÚÈÎÔ‡˜ ¯ÒÚÔ˘˜. ∞ÍÈÔÏÔÁ‹ıËÎÂ, Â›Û˘, Ë Û˘Ó‡·ÚÍË ‹ ·ÚÔ˘Û›· ¿ÏÏÔ˘ ·ÙÔÈÎÔ‡ ÓÔÛ‹Ì·ÙÔ˜. ∂›Û˘, ÛÙÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Û˘ÌÂÚÈÏ‹ÊıËÎ·Ó ÂÚˆÙ‹ÛÂȘ Û¯ÂÙÈΤ˜ Ì ÙÔ Â›‰Ô˜ Î·È ÙË ¯ÚÔÓÈfiÙËÙ· Ù˘ Ê·Ú̷΢ÙÈ΋˜ ·ÁˆÁ‹˜ (¶›Ó·Î·˜ 1). £ÂÙÈΤ˜ ··ÓÙ‹ÛÂȘ Ï¿‚·Ì ·fi 783 Ì·ıËÙ¤˜ (72,4%). ∆ÚÈ·ÓÙ·¤ÓÙ ÂÚˆÙËÌ·ÙÔÏfiÁÈ· ıˆڋıËÎ·Ó ¿Î˘Ú· ÏfiÁˆ Ï·Óı·ÛÌ¤ÓˆÓ ‹ ·ÓÂ·ÚÎÒÓ ÏËÚÔÊÔÚÈÒÓ. ™˘ÓÔÏÈο, Ë ÔÌ¿‰· Ù˘ ÌÂϤÙ˘ Ì·˜ ÂÚÈÂÏ¿Ì‚·Ó 748 ·È‰È¿ (69,2%). ∆· ¤ÓÙ˘· ‹Ù·Ó ·ÓÒÓ˘Ì·, Ì ·Ó·ÁÚ·Ê‹ ÙÔ˘ ʇÏÔ˘, ÙÔ˘ ÙËÏÂÊÒÓÔ˘ ηÈ, ÚÔ·ÈÚÂÙÈο, Ù˘ ‰È‡ı˘ÓÛ˘. ªÂÙ¿ ÙËÓ ÂÂÍÂÚÁ·Û›· ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ, ÂÈϤ¯ıËÎ·Ó fiÏ· Ù· ·È‰È¿ Ô˘ ·ÚÔ˘Û›·˙·Ó Û˘¯Ó¿ ·ÛıÌ·ÙÈΤ˜ ÎÚ›ÛÂȘ. ∏ Ù·ÍÈÓfiÌËÛË Ù˘ ‚·Ú‡ÙËÙ·˜ ÙÔ˘ ¿ÛıÌ·ÙÔ˜ Û ‹ÈÔ, ̤ÙÚÈÔ Î·È ÛÔ‚·Úfi ¿ÛıÌ· ¤ÁÈÓ Ì ‚¿ÛË ÙËÓ ÈÛ¯‡Ô˘Û· Ù·ÍÈÓfiÌËÛË ÙˆÓ ·Ú¯ÒÓ ÙÔ˘ ∂ıÓÈÎÔ‡ πÓÛÙÈÙÔ‡ÙÔ˘ ÀÁ›·˜ (NIH) ÙˆÓ ∏¶∞ ηٿ ÙËÓ ÂÚ›Ô‰Ô ¤Ó·Ú͢ ‰ÈÂÍ·ÁˆÁ‹˜ Ù˘ ÌÂϤÙ˘ (4). ™ÙË Û˘Ó¤¯ÂÈ·, Ù· ·È‰È¿ ·˘Ù¿ ÂÎÏ‹ıËÛ·Ó Û ÚÔÛˆÈ΋ Û˘Ó¤ÓÙ¢ÍË, ·ÚÔ˘Û›· ÙˆÓ ÁÔÓ¤ˆÓ ÙÔ˘˜, ÁÈ· Ï‹ÚË ÂÍ·ÎÚ›‚ˆÛË Ù˘ ËÏÈΛ·˜ ¤Ó·Ú͢ ÙˆÓ ÎÚ›ÛˆÓ, Ù˘ ÔÚ›·˜ Ù˘ ÓfiÛÔ˘ Î·È Ù˘ Ê·Ú̷΢ÙÈ΋˜ ·ÁˆÁ‹˜ Ô˘ ÙÔ˘˜ ›¯Â ¯ÔÚËÁËı›. ªÂÙ¿ ÙËÓ Ï‹ÚË ‰È·›ÛÙˆÛË ÙˆÓ ·Ó·ÁÚ·ÊfiÌÂÓˆÓ ÏËÚÔÊÔÚÈÒÓ, ÌÂÙÚ‹ıËΠ۠·˘Ù¿ Ù· ·È‰È¿, Û ÂÚ›Ô‰Ô ÂχıÂÚË Û˘Ìو̿وÓ, Ë Ì¤ÁÈÛÙË ÂÎÓ¢ÛÙÈ΋ ÚÔ‹ (PEFR) Ì ÚÔfiÌÂÙÚÔ Ù‡Ô˘ mini Wright ÌÂÙ¿ ·fi ηٿÏÏËÏË Â›‰ÂÈÍË ÚÈÓ Î·È ÌÂÙ¿ ·fi ‚ÚÔÁ¯Ô‰È·ÛÙÔÏ‹. ø˜ ÔÌ¿‰·

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ŒÓ· ÂȉÈÎfi ¤ÓÙ˘Ô ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ‰È·ÓÂÌ‹ıËΠ۠1081 Ì·ıËÙ¤˜ ÙÔ˘ ¢ËÌÔÙÈÎÔ‡ Î·È ÙÔ˘ °˘ÌÓ·Û›Ô˘ Ù˘ ™ËÙ›·˜, ËÏÈΛ·˜ 6-14 ÂÙÒÓ (̤ÛË ËÏÈΛ·: 10 ¤ÙË), ÁÈ· Ó· Û˘ÌÏËÚˆı› ÚÔ·ÈÚÂÙÈο ·fi ÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘˜.

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¶·È‰È·ÙÚÈ΋ 2002;65:424-432

Paediatriki 2002;65:424-432

¶›Ó·Î·˜ 1. ∂ÚˆÙËÌ·ÙÔÏfiÁÈÔ Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËΠÛÙË ÌÂϤÙË (Û‡Ìʈӷ Ì ÙȘ Ô‰ËÁ›Â˜ ÙÔ˘ ∂ıÓÈÎÔ‡ πÓÛÙÈÙÔ‡ÙÔ˘ ∏.¶.∞. ÁÈ· ÙË ‰È¿ÁÓˆÛË Î·È ıÂÚ·›· ÙÔ˘ ·È‰ÈÎÔ‡ ‚ÚÔÁ¯ÈÎÔ‡ ¿ÛıÌ·ÙÔ˜) ∂ÚˆÙËÌ·ÙÔÏfiÁÈÔ ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË ÙÔ˘ ÂÈÔÏ·ÛÌÔ‡ ÙÔ˘ ·È‰ÈÎÔ‡ ‚ÚÔÁ¯ÈÎÔ‡ ¿ÛıÌ·ÙÔ˜ ÛÙË ™ËÙ›· ñ ¢ËÌÔÁÚ·ÊÈο ÛÙÔȯ›· º‡ÏÔ, ËÌÂÚÔÌËÓ›· Á¤ÓÓËÛ˘, ÙËϤʈÓÔ ñ ∫·ÙÔÈΛ· ªÔÓÔηÙÔÈΛ·, ·ÚÈıÌfi˜ ‰ˆÌ·Ù›ˆÓ, ‰È·ÛÙ¿ÛÂȘ ηÙÔÈΛ·˜ ñ ÕÛÎËÛË ŒÎÏ˘ÛË ÎÚ›ÛÂˆÓ ÌÂÙ¿ ·fi ¿ÛÎËÛË ñ ∂ÎÏ˘ÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ÛÙÔ ÂÚÈ‚¿ÏÏÔÓ ∫¿ÓÈÛÌ· ÛÙÔ Û›ÙÈ ÕÏÏÔÈ ·Ú¿ÁÔÓÙ˜: ˘ÁÚ·Û›·, ηÙÔÈΛ‰È· ˙Ò·, Ê˘Ù¿, ÌÔ‡¯Ï· §ÔÈÌÒÍÂȘ ñ ∫ÏËÚÔÓÔÌÈÎfi ÈÛÙÔÚÈÎfi ıÂÙÈÎfi ÁÈ· ¿ÛıÌ· ÛÂ Û˘ÁÁÂÓ›˜ ·’ Î·È ‚’ ‚·ıÌÔ‡ ñ µ‹¯·˜ ‹/Î·È Û˘ÚÈÁÌfi˜ (± ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ·) ™˘¯ÓfiÙËÙ· ÙˆÓ ÂÂÈÛÔ‰›ˆÓ ÙÔ˘ ‚‹¯· ™˘¯Ó¤˜ ÎÚ›ÛÂȘ (<1-2 Ì‹Ó·) ª¤ÙÚȘ ÎÚ›ÛÂȘ (<1 ·Ó¿ ‚‰ÔÌ¿‰·) ™˘Ó¯›˜ ÎÚ›ÛÂȘ (ηıËÌÂÚÈÓ¿ Û˘ÌÙÒÌ·Ù·) µ·Ú‡ÙËÙ· ÙˆÓ ÂÂÈÛÔ‰›ˆÓ ÙÔ˘ ‚‹¯· ◊È· ‚Ú·¯Â›·˜ ‰È¿ÚÎÂÈ·˜ (2-3 Ë̤Ú˜) ª¤ÙÚÈ· (ÂÓÙÔÓfiÙÂÚ·, ÌÂÁ·Ï‡ÙÂÚ˘ ‰È¿ÚÎÂÈ·˜, Ó˘¯ÙÂÚÈÓfi˜ ‚‹¯·˜ >2 ÊÔÚ¤˜ ÙÔ Ì‹Ó·) ™Ô‚·Ú¿ (ÂÈÛ·ÁˆÁ‹ ÛÙÔ ÓÔÛÔÎÔÌ›Ô) ñ ¶·ÚÔ˘Û›· ¿ÏÏˆÓ ·ÙÔÈÎÒÓ ÓÔÛËÌ¿ÙˆÓ (ÚÈÓ›Ùȉ· ± ÂÈÂÊ˘Î›Ùȉ· ± ¤Î˙ÂÌ·) ñ £ÂÚ·›· ™˘Ìو̷ÙÈ΋ (‚ÚÔÁ¯Ô‰È·ÛÙ·ÏÙÈο) ÃÚfiÓÈ· ÚÔÊ˘Ï·ÎÙÈ΋ ıÂÚ·›· Ì ·ÓÙÈÊÏÂÁÌÔÓÒ‰Ë ¢È¿ÚÎÂÈ· ∞ÔÙÂϤÛÌ·Ù· ÂϤÁ¯Ô˘ PEFR ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó 207 Ì·ıËÙ¤˜ ›‰È·˜ ËÏÈΛ·˜ Î·È ‡„Ô˘˜ Ì ٷ ·ÛıÌ·ÙÈο ·È‰È¿. °È· ÙË ÛÙ·ÙÈÛÙÈ΋ ÂÂÍÂÚÁ·Û›· ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ, Û˘ÁÎÚ›ıËÎ·Ó Ù· ÔÛÔÛÙ¿ ·Ó¿ÌÂÛ· Û ·È‰È¿ ÌÂ Î·È ¯ˆÚ›˜ ¿ÛıÌ· Ì Hypothesis statistic test Î·È ÚÔÛ‰ÈÔÚÈÛÌfi ‰È·ÛÙ‹Ì·ÙÔ˜ ·ÍÈÔÈÛÙ›·˜ 95%.

∞ÔÙÂϤÛÌ·Ù· ∞fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ 1081 Ì·ıËÙÒÓ ËÏÈΛ·˜ 6-14 ÂÙÒÓ (̤ÛË ËÏÈΛ·: 10 ¤ÙË, ·ÁfiÚÈ· 560, ÎÔÚ›ÙÛÈ· 521), Ù· 748 Û˘ÌÏ‹ÚˆÛ·Ó ¤Á΢ڷ ÂÚˆÙËÌ·ÙÔÏfiÁÈ· (ÔÛÔÛÙfi 69,2%) Î·È ·ÔÙ¤ÏÂÛ·Ó ÙËÓ ÔÌ¿‰· ÌÂϤÙ˘, ÙË ¯ÚÔÓÈ΋ ÂÚ›Ô‰Ô 1993-1997. ∞fi ·˘Ù¿, Ù· 125 ·È‰È¿ (ÔÛÔÛÙfi 16,7%) ·ÚÔ˘Û›·˙·Ó Û˘¯Ó¤˜ ·ÛıÌ·ÙÈΤ˜ ÎÚ›ÛÂȘ (∂ÈÎfiÓ· 1). ∞fi Ù· 125 ·ÛıÌ·ÙÈο ·È‰È¿, Ù· 64 ‹Ù·Ó ·ÁfiÚÈ· (ÔÛÔÛÙfi 51,2%) Î·È Ù· 61 ÎÔÚ›ÙÛÈ· (ÔÛÔÛÙfi 48,8%) (NSS). ◊Ș ·ÛıÌ·ÙÈΤ˜ ÎÚ›ÛÂȘ ·ÚÔ˘Û›·˙·Ó 58 ·ÛıÂÓ›˜ (46,4%), ̤ÙÚȘ 53 ·ÛıÂÓ›˜ (42,4%) Î·È ÛÔ‚·Ú¤˜ 14 ·ÛıÂÓ›˜ (11,2%). ∞fi ÙË Û˘Û¯¤ÙÈÛË Ù˘ ÂΉ‹ÏˆÛ˘ ÙˆÓ ·ÛıÌ·ÙÈÎÒÓ ·ÚÔ͢ÛÌÒÓ Ì ‰È¿ÊÔÚÔ˘˜ ÂÎÏ˘ÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ÚԤ΢„ fiÙÈ 57 ·fi ÙÔ˘˜ ·ÛıÂÓ›˜ (45,6%) ·ÚÔ˘Û›·˙·Ó ·ÛıÌ·ÙÈÎÔ‡˜ ·ÚÔ͢ÛÌÔ‡˜, ÙfiÛÔ ÌÂÙ¿ ·fi ¤ÎıÂÛË Û ·ÏÏÂÚÁÈÔÁfiÓ·, fiÛÔ Î·È ÌÂÙ¿ ·fi ÈÔÁÂÓ›˜ ÏÔÈÌÒÍÂȘ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡

426

1081 783

748

623

125

™‡ÓÔÏÔ ·È‰ÈÒÓ ËÏÈΛ·˜ 6-14 ÂÙÒÓ

¶·È‰È¿ Ô˘ ·¿ÓÙËÛ·Ó ÛÙÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ (72,4%)

ŒÁ΢ڷ ÂÚˆÙËÌ·ÙÔÏfiÁÈ· (69,2%)

¶·È‰È¿ Ì ·ÛıÌ·ÙÈΤ˜ ÎÚ›ÛÂȘ (16,7%)

¶·È‰È¿ ¯ˆÚ›˜ ·ÛıÌ·ÙÈΤ˜ ÎÚ›ÛÂȘ (83,3%)

∂ÈÎfiÓ· 1. ∞ÚÈıÌfi˜ ·È‰ÈÒÓ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ Ô˘ ÂÎÏ‹ıËÛ·Ó Ó· Û˘ÌÌÂÙ¿Û¯Ô˘Ó Î·È ·¿ÓÙËÛ·Ó ÛÙÔ ÂȉÈÎfi ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ. ∞fi Ù· 748 ·È‰È¿ Ô˘ Â¤ÛÙÚ„·Ó ¤Á΢ڷ ÂÚˆÙËÌ·ÙÔÏfiÁÈ·, Ù· 125 (16,7%) ¤‰ˆÛ·Ó ıÂÙÈΤ˜ ··ÓÙ‹ÛÂȘ.

Û˘ÛÙ‹Ì·ÙÔ˜, 36 ·ÛıÂÓ›˜ (28,8%) ·ÚÔ˘Û›·˙·Ó ·ÛıÌ·ÙÈΤ˜ ÎÚ›ÛÂȘ ÌfiÓÔ Ì ÙËÓ Â˘Î·ÈÚ›· ·Ó·Ó¢ÛÙÈÎÒÓ ÏÔÈÌÒ͈Ó, ÂÓÒ 32 ·ÛıÂÓ›˜ (25,6%) ·ÚÔ˘Û›·˙·Ó ¤Í·ÚÛË ÙˆÓ ·ÛıÌ·ÙÈÎÒÓ ·ÚÔ͢ÛÌÒÓ Î˘Ú›ˆ˜ ÌÂÙ¿ ·fi ¤ÎıÂÛË Û ÎÔÈÓ¿ ·ÏÏÂÚÁÈÔÁfiÓ· (΢ڛˆ˜ ·Î¿Ú·, ÏÈÁfiÙÂÚÔ Û˘¯Ó¿ Û ̇ÎËÙ˜, Á‡ÚË ÂÏÈ¿˜, ÙÚÔʤ˜, ÂÈı‹ÏÈ· ˙ÒˆÓ) (∂ÈÎfiÓ· 2).

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∞fi Ù· 125 ·È‰È¿ Ô˘ ·ÚÔ˘Û›·˙·Ó ·ÛıÌ·ÙÈΤ˜ ÎÚ›ÛÂȘ, Ù· 107 (85,6%) ˙Ô‡Û·Ó Û ÂÚÈ‚¿ÏÏÔÓ Î·ÓÈÛÙÒÓ (Û ÔÛÔÛÙfi 43% ηÓÈÛÙ‹˜ ‹Ù·Ó Ô ·Ù¤Ú·˜, 5% ‹Ù·Ó Ë ÌËÙ¤Ú·, 16,5% Î·È ÔÈ ‰‡Ô, 21,1% ¿ÏÏÔÈ Û˘ÁÁÂÓ›˜ Ô˘ Û‡¯Ó·˙·Ó ÛÙÔ Û›ÙÈ), ÂÓÒ ·fi Ù· 623 ·È‰È¿ ¯ˆÚ›˜ ÎÚ›ÛÂȘ, Ù· 397 (63,7%) ˙Ô‡Û·Ó Û ·ÚfiÌÔÈÔ ÂÚÈ‚¿ÏÏÔÓ (p<0,0001, 95% CI: 14,66-29,1%) (∂ÈÎfiÓ· 3). ∂ÓÂÓ‹ÓÙ· ‰‡Ô ·fi Ù· 125 ·È‰È¿ (73,6%) Ô˘ ·ÚÔ˘Û›·˙·Ó ·ÛıÌ·ÙÈΤ˜ ÎÚ›ÛÂȘ ›¯·Ó ıÂÙÈÎfi ÎÏËÚÔÓÔÌÈÎfi ÈÛÙÔÚÈÎfi, ÂÓÒ 210 ·fi Ù· 623 ·È‰È¿ Ô˘ ‰ÂÓ ·ÚÔ˘Û›·˙·Ó ·ÛıÌ·ÙÈΤ˜ ÎÚ›ÛÂȘ (33,7%) ›¯·Ó ÎÏËÚÔÓÔÌÈÎfi ÈÛÙÔÚÈÎfi ¿ÛıÌ·ÙÔ˜ ÛÂ Û˘ÁÁÂÓ›˜ ·’ Î·È ‚’ ‚·ıÌÔ‡ ıÂÙÈÎfi ÁÈ· ¿ÛıÌ· (p<0,0001, 95% CI: 31,32-48,46%) (∂ÈÎfiÓ· 4). ™˘Ó‡·ÚÍË ‹ ·ÚÔ˘Û›· ¿ÏÏˆÓ ·ÙÔÈÎÒÓ ÓÔÛËÌ¿ÙˆÓ (ÚÈÓ›Ùȉ· ‹/Î·È ÂÈÂÊ˘Î›Ùȉ· ‹/Î·È ¤Î˙ÂÌ·) ‰È·ÈÛÙÒıËΠ۠38 ·fi Ù· 125 ·È‰È¿ (30,4%) Ô˘ ·ÚÔ˘Û›·˙·Ó Û˘¯Ó¤˜ ·ÛıÌ·ÙÈΤ˜ ÎÚ›ÛÂȘ. ∞ÓÙ›ıÂÙ·, 84 ·fi Ù· 623 (13,4%) ÌË ·ÛıÌ·ÙÈο ·È‰È¿ ·Ó¤ÊÂÚ·Ó ·ÚÔ˘Û›· ¿ÏÏÔ˘ ·ÙÔÈÎÔ‡ ÓÔÛ‹Ì·ÙÔ˜. ∏ ‰È·ÊÔÚ¿ ‰È·ÈÛÙÒıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ (p<0,0001, 95% CI: 8,42-25,41%) (∂ÈÎfiÓ· 5). ¢ÂÓ ˘‹Ú¯Â ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙ· ÔÛÔÛÙ¿ Û˘ÓÔ‰Ô‡ ·ÙÔÈÎÔ‡ ÓÔÛ‹Ì·ÙÔ˜ Û ·È‰È¿ ¢ËÌÔÙÈÎÔ‡ Î·È °˘ÌÓ·Û›Ô˘. ™˘ÁÎÂÎÚÈ̤ӷ, 20 ·fi Ù· 38 (52,6%) ·È‰È¿ Ì ¿ÛıÌ· Î·È Û˘ÓÔ‰fi ·ÙÔÈÎfi ÓfiÛËÌ· ‹Ù·Ó Ì·ıËÙ¤˜ ¢ËÌÔÙÈÎÔ‡ Û¯ÔÏ›Ԣ Î·È 18 Ì·ıËÙ¤˜ °˘ÌÓ·Û›Ô˘ (47,3%). ∞Ó¿ÏÔÁ·, ·fi Ù· 84 ·È‰È¿ ¯ˆÚ›˜ ¿ÛıÌ·, 40 ‹Ù·Ó Ì·ıËÙ¤˜ ¢ËÌÔÙÈÎÔ‡ (47,6%) Î·È 44 Ì·ıËÙ¤˜ °˘ÌÓ·Û›Ô˘ (52,3%). ™˘ÁÎÂÓÙÚˆÙÈο, ÔÈ ‰È·ÊÔÚ¤˜ ÙˆÓ ·Ú·Ì¤ÙÚˆÓ Ô˘ ÂϤÁ¯ıËÎ·Ó Û˘ÁÎÚÈÙÈο ·Ó¿ÌÂÛ· Û ·ÛıÌ·ÙÈο Î·È ÌË ·ÛıÌ·ÙÈο ·È‰È¿ (οÓÈÛÌ·, ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi, ·ÚÔ˘Û›· ¿ÏÏÔ˘ ·ÙÔÈÎÔ‡ ÓÔÛ‹Ì·ÙÔ˜) Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2. ™Â fiÏ· Ù· ·È‰È¿ Ì ·ÛıÌ·ÙÈΤ˜ ÎÚ›ÛÂȘ ¯ÔÚËÁ‹ıËÎ·Ó ‚ÚÔÁ¯Ô‰È·ÛÙ·ÏÙÈο (Û·Ï‚Ô˘Ù·ÌfiÏË Î·È

Paediatriki 2002;65:424-432

ıÂÔÊ˘ÏÏÈÓÔ‡¯· Û΢¿ÛÌ·Ù·) ηٿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ·ÛıÌ·ÙÈÎÒÓ ÎÚ›ÛˆÓ, Ì ηϋ ·ÓÙ·fiÎÚÈÛË. ÃÚfiÓÈ· ÚÔÊ˘Ï·ÎÙÈ΋ ·ÓÙÈÊÏÂÁÌÔÓ҉˘ ·ÁˆÁ‹ ›¯Â ¯ÔÚËÁËı› Û 14 ·È‰È¿ (11,2%) Ì ̤ÙÚȘ ¤ˆ˜ ÛÔ‚·Ú¤˜ ·ÛıÌ·ÙÈΤ˜ ÎÚ›ÛÂȘ. ™˘ÁÎÂÎÚÈ̤ӷ, 7 ·È‰È¿ ¤Ï·‚·Ó ÂÈÛÓÔ¤˜ ¯ÚˆÌÔÁÏ˘ÎÈÎÔ‡ Ó·ÙÚ›Ô˘ Î·È 7 ·È‰È¿ ÂÈÛÓÂfiÌÂÓ· ÎÔÚÙÈÎÔÂȉ‹ ÁÈ· ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÌÂÁ·Ï‡ÙÂÚÔ ·fi 3 Ì‹Ó˜. ™Ù· ·È‰È¿ Ì ·ÛıÌ·ÙÈΤ˜ ÎÚ›ÛÂȘ ¤ÁÈÓ ÂÎÙ›ÌËÛË Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ Ì ÙË ¯Ú‹ÛË ÚÔfiÌÂÙÚÔ˘ Ù‡Ô˘ mini Wright. ∏ PEFR ÛÙ· ·È‰È¿ ÌÂ Û˘¯Ó¤˜ ·ÛıÌ·ÙÈΤ˜ ÎÚ›ÛÂȘ ‹Ù·Ó, ÌÂÙ¿ ‚ÚÔÁ¯Ô‰È·ÛÙÔÏ‹, Û ÔÛÔÛÙfi 95,8% <90Ë ÂηÙÔÛÙÈ·›· ı¤ÛË (∂£), ÂÓÒ ÛÙËÓ ÔÌ¿‰· Ì·ÚÙ‡ÚˆÓ 53,8% ÙˆÓ ·È‰ÈÒÓ Â›¯·Ó PEFR <90Ë ∂£ (p<0,0001, 95% CI: 36,65-49,21%). ∫·Ó¤Ó· ·fi Ù· ·È‰È¿ Ì ·ÛıÌ·ÙÈΤ˜ ÎÚ›ÛÂȘ ‰ÂÓ Â›¯Â PEFR >95Ë ∂£ ÁÈ· ÙËÓ ËÏÈΛ· Î·È ÙÔ ‡„Ô˜. ™ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi (68,8%) Ë PEFR ‹Ù·Ó ÌÂٷ͇ 50Ë-90Ë ∂£ (∂ÈÎfiÓ· 6). ∞fi Ù· 125 ·È‰È¿ Ì ¿ÛıÌ·, 78 (62,4%) ·ÚÔ˘Û›·˙·Ó Û˘ÌÙÒÌ·Ù· ¿ÛıÌ·ÙÔ˜ ηٿ ÙËÓ ¿ÛÎËÛË Î·È 24 (19,2%) Ó˘¯ÙÂÚÈÓ¿ Û˘ÌÙÒÌ·Ù·. ∂ÓÂÚÁfi ¿ÛıÌ· ÌÂÙ¿ ÙËÓ ËÏÈΛ· ÙˆÓ ‰Ò‰Âη ÂÙÒÓ Â›¯Â ÙÔ 38% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ·È‰ÈÒÓ. ∆¤ÏÔ˜, ·fi Ù· ·È‰È¿ Ì ¿ÛıÌ·, 38 (30%) ›¯·Ó ÛÙÔ ÂÚÈ‚¿ÏÏÔÓ ÙÔ˘˜ ηÙÔÈΛ‰È· ˙Ò· (Û·ÏÔ ‹/Î·È Á¿Ù·), ÂÓÒ Ê˘Ù¿ ÂÛˆÙÂÚÈÎÔ‡ ¯ÒÚÔ˘ ›¯·Ó 90 ·fi Ù· 125 ·È‰È¿ (72%). ™˘˙‹ÙËÛË ∆o ¿ÛıÌ· Â›Ó·È ¯ÚfiÓÈ· ÊÏÂÁÌÔÓ҉˘ ÓfiÛÔ˜ ÙˆÓ ·ÂÚ·ÁˆÁÒÓ, ÛÙËÓ ÔÔ›· ·›˙Ô˘Ó ÚfiÏÔ ÔÏÏ¿ ÊÏÂÁÌÔÓÒ‰Ë Î‡ÙÙ·Ú· Î·È Î˘ÙÙ·ÚÈÎÔ› ÌÂÛÔÏ·‚ËÙ¤˜

¶·È‰È¿ Ì ·ÛıÌ·ÙÈΤ˜ ÎÚ›ÛÂȘ

¶·È‰È¿ ¯ˆÚ›˜ ·ÛıÌ·ÙÈΤ˜ ÎÚ›ÛÂȘ

¶ÂÚÈ‚¿ÏÏÔÓ Î·ÓÈÛÙÒÓ §ÔÈÌÒÍÂȘ ·Ó·Ó¢ÛÙÎÔ‡ ŒÎıÂÛË Û ÎÔÈÓ¿ ·ÏÏÂÚÁÈÔÁfiÓ· (¿Î·ÚÈ, ̇ÎËÙ˜, Á‡ÚË ÂÏÈ¿˜, ÙÚÔʤ˜, ÂÈı‹ÏÈ· ˙ÒˆÓ) §ÔÈÌÒÍÂȘ ·Ó·Ó¢ÛÙÎÔ‡ Î·È ¤ÎıÂÛË Û ÎÔÈÓ¿ ·ÂÚÔ·ÏÏÂÚÁÈÔÁfiÓ· ∂ÈÎfiÓ· 2. ™˘Û¯¤ÙÈÛË ·ÛıÌ·ÙÈÎÒÓ ·ÚÔ͢ÛÌÒÓ Ì Â͈ÁÂÓ›˜ ÂÎÏ˘ÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜.

¶ÂÚÈ‚¿ÏÏÔÓ ÌË Î·ÓÈÛÙÒÓ ∂ÈÎfiÓ· 3. ¶ÔÛÔÛÙ¿ ÁÔÓ¤ˆÓ ‹ ÏÔÈÒÓ Û˘ÁÁÂÓÒÓ Î·ÓÈÛÙÒÓ Î·È ÌË Î·ÓÈÛÙÒÓ ÛÙÔ ÂÚÈ‚¿ÏÏÔÓ ·È‰ÈÒÓ Ì ‹ ¯ˆÚ›˜ ·ÛıÌ·ÙÈΤ˜ ÎÚ›ÛÂȘ. °ÔÓ›˜ ηÓÈÛÙ¤˜ ›¯Â ÙÔ 85,6% ÙˆÓ ·ÛıÌ·ÙÈÎÒÓ ·È‰ÈÒÓ Î·È ÙÔ 63,7% ÙˆÓ ·È‰ÈÒÓ ¯ˆÚ›˜ ¿ÛıÌ· (p<0,0001, CI: 14,66-29,1%).

427

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¶·È‰È·ÙÚÈ΋ 2002;65:424-432

Paediatriki 2002;65:424-432

ÊÏÂÁÌÔÓ‹˜. ∏ ¯ÚfiÓÈ· ÊÏÂÁÌÔÓ‹ ÙˆÓ ·ÂÚ·ÁˆÁÒÓ ÚÔηÏ› ·‡ÍËÛË Ù˘ ‚ÚÔÁ¯È΋˜ ˘ÂÚ·ÓÙȉڷÛÙÈÎfiÙËÙ·˜, Ô˘ Ô‰ËÁ› Û ˘ÔÙÚÔÈ¿˙ÔÓÙ· ÂÂÈÛfi‰È· Û˘ÚÈÁÌÔ‡, ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜ Î·È ‚‹¯·, ȉȷ›ÙÂÚ· ηٿ ÙȘ Ó˘¯ÙÂÚÈÓ¤˜ Î·È ÚÒÙ˜ ÚˆÈÓ¤˜ ÒÚ˜. ∆· ÂÂÈÛfi‰È· ·˘Ù¿ Û˘Ó‹ıˆ˜ Û¯ÂÙ›˙ÔÓÙ·È Ì ‰È¿¯˘ÙË ·fiÊÚ·ÍË ÙˆÓ ·ÂÚ·ÁˆÁÒÓ, Ô˘ Û˘Ó‹ıˆ˜ ·Ó·ÛÙÚ¤ÊÔÓÙ·È ·˘ÙfiÌ·Ù· ‹ Ì ηٿÏÏËÏË Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ (1). ∂›Ó·È ÙÔ ÈÔ Û˘¯Ófi ¯ÚfiÓÈÔ ÓfiÛËÌ· Ù˘ ·È‰È΋˜ ËÏÈΛ·˜, ˘‡ı˘ÓÔ ÁÈ· ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ÙˆÓ Û¯ÔÏÈÎÒÓ ·Ô˘ÛÈÒÓ ÂÙËÛ›ˆ˜. O ·ıÚÔÈÛÙÈÎfi˜ ÂÈÔÏ·ÛÌfi˜ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÙÔ˘ ‚ÚÔÁ¯ÈÎÔ‡ ¿ÛıÌ·ÙÔ˜ ÛÙ· ·È‰È¿ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ ·ÚÔ˘ÛÈ¿˙ÂÈ Â˘Ú›· ‰È·Î‡Ì·ÓÛË ÛÙȘ ‰È¿ÊÔÚ˜ ÁˆÁÚ·ÊÈΤ˜ ÂÚÈÔ¯¤˜ Î·È ¯ÒÚ˜ ÙÔ˘ ÎfiÛÌÔ˘ (5). ™ÙËÓ ÚfiÛÊ·ÙË ‚È‚ÏÈÔÁÚ·Ê›· Î˘Ì·›ÓÂÙ·È ·fi 2,1% ÛÙËÓ πÓ‰ÔÓËÛ›· ¤ˆ˜ 32,2% ÛÙË ªÂÁ¿ÏË µÚÂÙ·Ó›·. OÈ ‰È·ÊÔÚ¤˜ ·˘Ù¤˜ ·Ô‰›‰ÔÓÙ·È Î˘Ú›ˆ˜ ÛÙËÓ Â›‰Ú·ÛË ÂÚÈ‚·ÏÏÔÓÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ Î·È ÂÁ›ÚÔ˘Ó ÙÔ ÂӉȷʤÚÔÓ ÁÈ· ÂÚ·ÈÙ¤Úˆ ¤Ú¢ӷ Î·È Û‡ÁÎÚÈÛË ÙˆÓ ÂÚÈ‚·ÏÏÔÓÙÈÎÒÓ ÂȉڿÛÂˆÓ ·Ó¿ÌÂÛ· Û ‰È·ÊÔÚÂÙÈΤ˜ ¯ÒÚ˜ Î·È ÏËı˘ÛÌÔ‡˜ (6). ∞‡ÍËÛË ÙÔ˘ ÂÈÔÏ·ÛÌÔ‡ ÙÔ˘ ·È‰ÈÎÔ‡ ‚ÚÔÁ¯ÈÎÔ‡ ¿ÛıÌ·ÙÔ˜ ÙȘ ÙÂÏÂ˘Ù·›Â˜ ‰ÂηÂٛ˜ ¤¯ÂÈ ·Ú·ÙËÚËı› ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ¯ÒÚ˜ ÙÔ˘ ÎfiÛÌÔ˘ Î·È ÂȉÈÎfiÙÂÚ· ÛÙËÓ ∞˘ÛÙÚ·Ï›·, ÙË ªÂÁ¿ÏË µÚÂÙ·Ó›· Î·È ÙË ™Ô˘Ë‰›·. ∞Ó¿ÏÔÁË ÌÂϤÙË ÛÙȘ ∏¶∞ ¤‰ÂÈÍÂ, Â›Û˘, ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË ÙÔ˘ ÂÈÔÏ·ÛÌÔ‡ Ù˘ ÓfiÛÔ˘ (7,8). ¶ÚfiÛÊ·Ù˜ ÌÂϤÙ˜ ‰Â›¯ÓÔ˘Ó, Â›Û˘, ·‡ÍËÛË ÙÔ˘ ÂÈÔÏ·ÛÌÔ‡ ÙÔ˘ ·È‰ÈÎÔ‡ ‚ÚÔÁ¯ÈÎÔ‡ ¿ÛıÌ·ÙÔ˜ ÛÙË ¯ÒÚ· Ì·˜. ™˘ÁÎÂÎÚÈ̤ӷ, Û ÌÂÁ¿ÏÔ ‰Â›ÁÌ· ·È‰ÈÎÔ‡ ÏËı˘-

¶·È‰È¿ Ì ·ÛıÌ·ÙÈΤ˜ ÎÚ›ÛÂȘ

¶·È‰È¿ ¯ˆÚ›˜ ·ÛıÌ·ÙÈΤ˜ ÎÚ›ÛÂȘ

£ÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÁÈ· ·ÙÔÈÎfi ÓfiÛËÌ· ∂ÈÎfiÓ· 4. ¶ÔÛÔÛÙ¿ ÎÏËÚÔÓÔÌÈ΋˜ ÂÈ‚¿Ú˘ÓÛ˘ Û ·È‰È¿ Ì ‹ ¯ˆÚ›˜ ·ÛıÌ·ÙÈΤ˜ ÎÚ›ÛÂȘ. £ÂÙÈÎfi ÈÛÙÔÚÈÎfi ÁÈ· ¿ÛıÌ· ÛÂ Û˘ÁÁÂÓ›˜ ·’ Î·È ‚’ ‚·ıÌÔ‡ ›¯Â ÙÔ 73,6% ·fi Ù· ·ÛıÌ·ÙÈο ·È‰È¿ Î·È ÙÔ 33,7% ·fi Ù· ·È‰È¿ ¯ˆÚ›˜ ¿ÛıÌ· (p<0,0001, 95% CI: 31,32-48,46%).

428

ÛÌÔ‡ ÛÙË ™ÙÂÚ¿ ∂ÏÏ¿‰· ÙËÓ ÙÂÏÂ˘Ù·›· ÂÈÎÔÛ·ÂÙ›·, Ô ÂÈÔÏ·ÛÌfi˜ ÙÔ˘ ÂÓÂÚÁÔ‡ ¿ÛıÌ·ÙÔ˜ ·˘Í‹ıËΠ·fi 1,5% Û 6% ηٿ ÙË ¯ÚÔÓÈ΋ ÂÚ›Ô‰Ô 1978-1998, ÂÓÒ ·Ú·ÙËÚ‹ıËÎÂ, Â›Û˘, ·‡ÍËÛË ÙÔ˘ ÂÈÔÏ·ÛÌÔ‡ ÙÔ˘ ÔÏÈÎÔ‡ ¿ÛıÌ·ÙÔ˜ ·fi 8% Û 9,6% ÙË ¯ÚÔÓÈ΋ ÂÚ›Ô‰Ô 1991-1998 ÛÙËÓ ›‰È· ÂÚÈÔ¯‹ (9). À„ËÏfi˜ ÔÏÈÎfi˜ ÂÈÔÏ·ÛÌfi˜ ·È‰ÈÎÔ‡ ¿ÛıÌ·ÙÔ˜ ¤¯ÂÈ, Â›Û˘, ·Ó·ÊÂÚı› Û ¿ÏϘ ÌÂϤÙ˜ ÛÙË µ. ∂ÏÏ¿‰· Î·È ÙËÓ ∫‡ÚÔ (10,11). ¶·Ú¿ ÙÔ fiÙÈ Ë ·ÁÎfiÛÌÈ· ·‡ÍËÛË ÙÔ˘ ÂÈÔÏ·ÛÌÔ‡ ÙÔ˘ ¿ÛıÌ·ÙÔ˜ ¤¯ÂÈ ·Ô‰Ôı› ηٿ ηÈÚÔ‡˜ Û ‰È¿ÊÔÚ˜ ·Èٛ˜, ÈÛÙ‡ÂÙ·È fiÙÈ ‰ÂÓ Â›Ó·È Ï·ÛÌ·ÙÈ΋ Î·È ·ÔÙÂÏ› Ú·ÁÌ·ÙÈÎfi Ê·ÈÓfiÌÂÓÔ (1,2,6,12). ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, Ô˘ ¤ÁÈÓ Ì ÙË ‚Ô‹ıÂÈ· ÂȉÈÎÔ‡ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ˘, ‰È·ÈÛÙÒıËΠ˘„ËÏfi˜ ÂÈÔÏ·ÛÌfi˜ ÙÔ˘ ·È‰ÈÎÔ‡ ‚ÚÔÁ¯ÈÎÔ‡ ¿ÛıÌ·ÙÔ˜ ÛÙË ™ËÙ›·. ∏ ¯Ú‹ÛË ÂÚˆÙËÌ·ÙÔÏÔÁ›ˆÓ ·ÔÙÂÏ› ÙÔÓ ÎÏ·ÛÈÎfi ÙÚfiÔ ÂÎfiÓËÛ˘ ÌÂÏÂÙÒÓ ÛÙÔ ·È‰ÈÎfi ‚ÚÔÁ¯ÈÎfi ¿ÛıÌ·. ∆Ô ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ‰ÈÂıÓÒ˜ ·ÔÙÂÏ› ·Ï‹, ·Ó·›Ì·ÎÙË, ·Ó¤ÍÔ‰Ë Î·È Ì·˙È΋ ̤ıÔ‰Ô ÁÈ· ÂȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜ (1,2). ∂ȉÈÎfiÙÂÚ· ÛÙË Û˘ÁÎÂÎÚÈ̤ÓË ÌÂϤÙË, Ë ·ÓÙÈÎÂÈÌÂÓÈÎfiÙËÙ· ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ Û ̷˙ÈÎfi Â›Â‰Ô ÂÓÈÛ¯‡ıËΠ·fi ÙË ¯Ú‹ÛË Ù˘ ·Ï‹˜ ÚÔÔÌÂÙÚ›·˜, Ô˘ η٤‰ÂÈÍ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ Ù˘ PEFR ·Ó¿ÌÂÛ· Û ·È‰È¿ Ì ‹ ¯ˆÚ›˜ ·ÛıÌ·ÙÈΤ˜ ÎÚ›ÛÂȘ. ∂›Ó·È ÁÓˆÛÙfi fiÙÈ Ë ÂΉ‹ÏˆÛË ÙÔ˘ ·È‰ÈÎÔ‡ ‚ÚÔÁ¯ÈÎÔ‡ ¿ÛıÌ·ÙÔ˜ ηıÔÚ›˙ÂÙ·È ·fi ÁÂÓÂÙÈÎÔ‡˜ Î·È ÂÚÈ‚·ÏÏÔÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ (13). ™ËÌ·ÓÙÈÎfi ÔÛÔÛÙfi ·fi ÙÔ˘˜ ·ÛıÂÓ›˜ Ù˘ ÌÂϤÙ˘ Ô˘

¶·È‰È¿ Ì ¶·È‰È¿ ¯ˆÚ›˜ ·ÛıÌ·ÙÈΤ˜ ÎÚ›ÛÂȘ ·ÛıÌ·ÙÈΤ˜ ÎÚ›ÛÂȘ ƒÈÓ›Ùȉ· ‹/Î·È ÂÈÂÊ˘Î›Ùȉ· ‹/Î·È ¤Î˙ÂÌ· ∂ÈÎfiÓ· 5. ™˘Ó‡·ÚÍË ‹ ·ÚÔ˘Û›· ¿ÏÏˆÓ ·ÙÔÈÎÒÓ ÓÔÛËÌ¿ÙˆÓ Û ·È‰È¿ Ì ‹ ¯ˆÚ›˜ ·ÛıÌ·ÙÈΤ˜ ÎÚ›ÛÂȘ. ™˘ÓÔ‰fi ·ÙÔÈÎfi ÓfiÛËÌ· (ÚÈÓ›Ùȉ·, ÂÈÂÊ˘Î›Ùȉ·, ¤Î˙ÂÌ·) ·Ó¤ÊÂÚ ÙÔ 30,4% ÙˆÓ ·ÛıÌ·ÙÈÎÒÓ ·È‰ÈÒÓ Î·È ÙÔ 13,4% ÙˆÓ ·È‰ÈÒÓ ¯ˆÚ›˜ ¿ÛıÌ· (p<0,0001, 95% CI: 8,42-25,41%).

NoV-dEc-02

14-05-03

14:26

™ÂÏ›‰·429

¶·È‰È·ÙÚÈ΋ 2002;65:424-432

Paediatriki 2002;65:424-432

¶›Ó·Î·˜ 2. ¢È·ÊÔÚ¤˜ ÙˆÓ ·Ú·Ì¤ÙÚˆÓ Ô˘ ÂϤÁ¯ıËÎ·Ó Û ·ÛıÌ·ÙÈο Î·È ÌË ·ÛıÌ·ÙÈο ·È‰È¿ (οÓÈÛÌ· ÁÔÓ¤ˆÓ, ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi, ·ÚÔ˘Û›· ¿ÏÏÔ˘ ·ÙÔÈÎÔ‡ ÓÔÛ‹Ì·ÙÔ˜). ∆· ÔÛÔÛÙ¿ ÁÔÓ¤ˆÓ ηÓÈÛÙÒÓ, ıÂÙÈÎÔ‡ ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÈÛÙÔÚÈÎÔ‡ ÁÈ· ¿ÛıÌ· Û ¤Ó·Ó ‹ Î·È ÙÔ˘˜ ‰‡Ô ÁÔÓ›˜, ηıÒ˜ Î·È ·ÚÔ˘Û›·˜ Û˘ÓÔ‰Ô‡ ·ÙÔÈÎÔ‡ ÓÔÛ‹Ì·ÙÔ˜ ‚Ú¤ıËÎ·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚ· Û ·ÛıÌ·ÙÈο ·È‰È¿ ∞ÛıÌ·ÙÈο ÀÁÈ‹ ·È‰È¿ (%) ·È‰È¿ (%) ∫·ÓÈÛÙ¤˜ ÁÔÓ›˜

95% CI p

85,6%

63,7%

(14,6-29,1%) p<0,0001

OÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi 73,6% ÁÈ· ¿ÛıÌ· (+)

33,7%

(31,3-48,4%) p<0,0001

™˘Ó‡·ÚÍË ·ÙÔÈÎÔ‡ ÓÔÛ‹Ì·ÙÔ˜

13,4%

(8,4-25,4%) p<0,0001

30,4%

·ÚÔ˘Û›·˙·Ó ·ÛıÌ·ÙÈΤ˜ ÎÚ›ÛÂȘ, ÂÌÊ¿ÓÈ˙Â Û˘ÌÙÒÌ·Ù· ÌÂÙ¿ ·fi ¤ÎıÂÛË Û ÎÔÈÓ¿ ÂÈÛÓÂfiÌÂÓ· ‹ ¿ÏÏ· ·ÏÏÂÚÁÈÔÁfiÓ· (¿Î·ÚÈ, ̇ÎËÙ˜, Á‡ÚË, ÙÚÔʤ˜, ÂÈı‹ÏÈ· ˙ÒˆÓ). OÈ ·ÛıÂÓ›˜ Ô˘ ›¯·Ó ÈÛÙÔÚÈÎfi Âȉ›ӈÛ˘ ·ÛıÌ·ÙÈÎÒÓ ÎÚ›ÛÂˆÓ Ì ÎÔÈÓ¿ ·ÏÏÂÚÁÈÔÁfiÓ· ›¯·Ó ıÂÙÈΤ˜ ‰ÂÚÌ·ÙÈΤ˜ ‰ÔÎÈ̷ۛ˜ ‹/Î·È Rast ÛÙ· ·ÏÏÂÚÁÈÔÁfiÓ· ·˘Ù¿, fiˆ˜ ÂȂ‚·ÈÒıËΠ·fi ·ÏÏÂÚÁÈÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô Ô˘ Ú·ÁÌ·ÙÔÔÈ‹ıËΠ۠ÂȉÈο ΤÓÙÚ·.

O ·ÛÙÈÎÔÔÈË̤ÓÔ˜ (‰˘ÙÈÎfi˜) ÙÚfiÔ˜ ˙ˆ‹˜ Ô˘ Ë ™ËÙ›· ·ÎÔÏÔ˘ı› Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, ÚÔÎÂÈ̤ÓÔ˘ Ó· ·ÓÙ·ÔÎÚÈı› ÛÙÔ˘˜ ηÓfiÓ˜ ÙÔ˘ ÂÎÛ˘Á¯ÚÔÓÈÛÌÔ‡ Î·È Ù˘ ‚ÈÔÌ˯·ÓÔÔ›ËÛ˘ Ô˘ ·ÎÔÏÔ˘ı› fiÏË Ë ∫Ú‹ÙË, Ô‰‹ÁËÛ Û ‰È·ÊÔÚÔÔ›ËÛË ÙÔ˘ ÂÓ‰Ô- Î·È Â͈-ÔÈÎÈ·ÎÔ‡ ÂÚÈ‚¿ÏÏÔÓÙÔ˜, Ì ·‡ÍËÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ·ÏÏÂÚÁÈÔÁfiÓˆÓ Î·È Ù˘ ¤ÎıÂÛ˘ Û ·˘Ù¿. ∆· ·È‰È¿, Û‹ÌÂÚ·, ·Ó·ÏÒÓÔ˘Ó ·ÚÎÂÙfi ¯ÚfiÓÔ Û ÎÏÂÈÛÙÔ‡˜ ¯ÒÚÔ˘˜ (Û¯ÔÏ›·, Á˘ÌÓ·ÛÙ‹ÚÈ·, ÊÚÔÓÙÈÛÙ‹ÚÈ·, ·›ıÔ˘Û˜ ÂΉËÏÒÛˆÓ), fiÔ˘ ÂÈÎÚ·ÙÔ‡Ó Û˘Óı‹Î˜ ·ÓÂ·ÚÎÔ‡˜ ·ÂÚÈÛÌÔ‡ Î·È ·˘ÍË̤Ó˘ ıÂÚÌÔÎÚ·Û›·˜. ∏ ·‡ÍËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ ÙˆÓ ¯ÚfiÓÈˆÓ ÓÔÛËÌ¿ÙˆÓ, fiˆ˜ ÙÔ ¿ÛıÌ·, ›Ûˆ˜ ·ÔÙÂÏ› ̤ÚÔ˜ ·fi ÙÔ Ù›ÌËÌ· ÙÔ˘ ·Ó·fiÊ¢ÎÙÔ˘ ÂÍÂ˘Úˆ·˚ÛÌÔ‡ (14). ∆Ô ÌÂÁ¿ÏÔ ÔÛÔÛÙfi ÂÈÔÏ·ÛÌÔ‡ ÙÔ˘ ·È‰ÈÎÔ‡ ¿ÛıÌ·ÙÔ˜ ÛÙËÓ ÂÚÈÔ¯‹ Ù˘ ™ËÙ›·˜ Â›Ó·È Èı·Ófi Ó· ÔÊ›ÏÂÙ·È Û ÌÂÁ¿ÏÔ ÔÛÔÛÙfi Î·È ÛÙË ÁÂÓÂÙÈ΋ ÚԉȿıÂÛË (ÌË ·Ó·ÓÂÒÛÈÌÔ ÁÂÓÂÙÈÎfi ˘ÏÈÎfi ÁÈ· ÔÏÏÔ‡˜ ·ÈÒÓ˜ ÏfiÁˆ ‰‡Û‚·ÙÔ˘ Ô‰ÈÎÔ‡ ‰ÈÎÙ‡Ô˘, ÂȉÈο ÚÈÓ ·fi ÙÔ 1960). ∞Ó Î·È Ì¤¯ÚÈ Û‹ÌÂÚ· Ë ·Ú¤Ì‚·ÛË ÛÙÔ ÁÂÓÂÙÈÎfi ·Ú¿ÁÔÓÙ· ‰ÂÓ Â›Ó·È ‰˘Ó·Ù‹, Ë ·Ó›¯Ó¢ÛË, Ë ·ÔÊ˘Á‹ ‹ Ô ¤ÏÂÁ¯Ô˜ ÁÓˆÛÙÒÓ ÂÎÏ˘ÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ÌÔÚÔ‡Ó Ó· ÌÂÈÒÛÔ˘Ó Ù· Û˘ÌÙÒÌ·Ù· ηÈ, Ì·ÎÚÔÚfiıÂÛÌ·, ÙË ÊÏÂÁÌÔÓ‹ ÙˆÓ ·ÂÚ·ÁˆÁÒÓ Î·È ÙË ‚ÚÔÁ¯È΋ ˘ÂÚ·ÓÙȉڷÛÙÈÎfiÙËÙ· (15,16).

∏ Û¯¤ÛË ÙˆÓ ·ÛıÌ·ÙÈÎÒÓ ·ÚÔ͢ÛÌÒÓ Ì ÙȘ ÏÔÈÌÒÍÂȘ Â›Ó·È ·fi Ù· ÈÔ Û˘˙ËÙË̤ӷ Î·È ·ÌÊÈÏÂÁfiÌÂÓ· ı¤Ì·Ù· Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜ ÁÈ· ÙÔ ·È‰ÈÎfi ¿ÛıÌ·. ∞Ó Î·È ÔÚÈṲ̂ÓÔÈ (˘fiıÂÛË ˘ÁÈÂÈÓ‹˜ Strachan) ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ ÔÈ Û˘¯Ó¤˜ ÏÔÈÌÒÍÂȘ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÚÒÈÌ˘ ·È‰È΋˜ ËÏÈΛ·˜ ÌÔÚ› Ó· ÂȉÚÔ‡Ó ÚÔÛٷ٢ÙÈο ÛÙËÓ ÂͤÏÈÍË ÙÔ˘ ¿ÛıÌ·ÙÔ˜, ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ Û˘ÌʈÓÔ‡Ó fiÙÈ ÔÈ ÈÔÁÂÓ›˜ ΢ڛˆ˜ ÏÔÈÌÒÍÂȘ Û ·È‰È¿ Ô˘ ‹‰Ë ¤¯Ô˘Ó ÂΉËÏÒÛÂÈ Û˘ÌÙÒÌ·Ù· ¿ÛıÌ·ÙÔ˜, ·ÔÙÂÏÔ‡Ó ÙÔ ‚·ÛÈÎfi ÂÎÏ˘ÙÈÎfi ·Ú¿ÁÔÓÙ· Ì›·˜ ·ÛıÌ·ÙÈ΋˜ ÎÚ›Û˘ (17-20). O Henderson ÙÔ 1979 ·Ó¤ÊÂÚ fiÙÈ Ô Èfi˜ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÁÎ˘Ù›Ô˘ (RSV), Ù˘ ·Ú·˚ÓÊÏÔ˘¤ÓÙ˙·, Ô ·‰ÂÓÔ˚fi˜ Î·È ÙÔ Ì˘ÎfiÏ·ÛÌ· Ù˘ Ó¢ÌÔÓ›·˜ ¢ı‡ÓÔÓÙ·È ÁÈ· ÙÔ 80% ÙˆÓ ÂÂÈÛÔ‰›ˆÓ ÙÔ˘ Û˘ÚÈÁÌÔ‡ (21). ∞ÚÁfiÙÂÚ·, ÔÈ Johnston Î·È Û˘Ó Û ̛· ÚÔÔÙÈ΋ ÌÂϤÙË 13 ÌËÓÒÓ ¤‰ÂÈÍ·Ó fiÙÈ ÛÙÔ 80-85% ÙˆÓ ·Ó·ÊÂÚÔÌ¤ÓˆÓ ÂÂÈÛÔ‰›ˆÓ ·ÛıÌ·ÙÈÎÒÓ ·ÚÔ͢ÛÌÒÓ Û ·È‰È¿ Ì ÈÛÙÔÚÈÎfi ‚‹¯· Î·È Û˘ÚÈÁÌÔ‡ ·ÔÌÔÓÒıËΠÈfi˜ ηÈ, ÂÍ ·˘ÙÒÓ, ÛÙ· 2/3 ÙˆÓ ÂÚÈÙÒÛÂˆÓ ‹Ù·Ó ÚÈÓÔ˚fi˜ (22). ∞ÎÔÏÔ‡ıˆ˜, ¿ÏÏÔÈ ÂÚ¢ÓËÙ¤˜ ˘ÔÛÙ‹ÚÈÍ·Ó, Â›Û˘, fiÙÈ ÔÈ ÈÔÁÂÓ›˜ ÏÔÈÌÒÍÂȘ ıˆÚÔ‡ÓÙ·È ·fi ÙÔ˘˜ ‚·ÛÈÎÔ‡˜ ÂÎÏ˘ÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ÙˆÓ ·ÛıÌ·ÙÈÎÒÓ ·ÚÔ͢ÛÌÒÓ ÛÙ· ·È‰È¿ Ì ¿ÛıÌ· (23,24). ∆· ‰Â‰Ô̤ӷ ·˘Ù¿ ‚Ú›ÛÎÔÓÙ·È ÛÂ Û˘Ìʈӛ· Ì ٷ Â˘Ú‹Ì·Ù· Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘, fiÔ˘ ‰È·ÈÛÙÒıËΠ¤Í·ÚÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÌÂÙ¿ ·fi ·Ó·Ó¢ÛÙÈ΋ Ïԛ̈ÍË ÛÙËÓ ÏÂÈÔ„ËÊ›· ÙˆÓ ·ÛıÂÓÒÓ ÌÂ Û˘¯Ó¤˜ ·ÛıÌ·ÙÈΤ˜ ÎÚ›ÛÂȘ. ∆· ·È‰È¿ ÌÂ Û˘¯Ó¤˜ ·ÛıÌ·ÙÈΤ˜ ÎÚ›ÛÂȘ Ô˘ Û˘ÌÂÚÈÏ‹ÊıËÎ·Ó ÛÙË ÌÂϤÙË ‚Ú¤ıËΠfiÙÈ Â›¯·Ó Û ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚÔ ÔÛÔÛÙfi ÁÔÓ›˜ ηÓÈÛÙ¤˜. ∆· Â˘Ú‹Ì·Ù· ·fi ÙË ÌÂϤÙË Ì·˜ ÂÓÈÛ¯‡Ô˘Ó ÙËÓ ÂÈÎÚ·ÙÔ‡Û·, ‚È‚ÏÈÔÁÚ·ÊÈο, ÂÓÙ‡ˆÛË ÁÈ· ÙÔ ÚfiÏÔ ÙÔ˘ ηÓ›ÛÌ·ÙÔ˜ ÛÙÔ ·È‰ÈÎfi ‚ÚÔÁ¯ÈÎfi ¿ÛıÌ·. ∞ÚÎÂÙ¤˜ ·Ó·ÛÎÔ‹ÛÂȘ ˘ÔÛÙËÚ›˙Ô˘Ó Û‹ÌÂÚ· fiÙÈ ÙÔ Î¿ÓÈÛÌ· ÙˆÓ ÁÔÓ¤ˆÓ ·ÔÙÂÏ› ÛËÌ·ÓÙÈÎfi ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ÂΉ‹ÏˆÛË ÛÔ‚·ÚÒÓ ·Ó·Ó¢ÛÙÈÎÒÓ ÏÔÈÌÒÍÂˆÓ Û ·È‰È¿ ËÏÈΛ·˜ <2 ÂÙÒÓ, ÙË ÌÂÙ¤ÂÈÙ· ÂΉ‹ÏˆÛË ¿ÛıÌ·ÙÔ˜ Î·È Â˘·ÈÛıËÙÔÔ›ËÛ˘ Û ÎÔÈÓ¿ ·ÂÚÔ·ÏÏÂÚÁÈÔÁfiÓ·. ªÔÚ›, Â›Û˘, Ó· ÂËÚ¿ÛÂÈ ÙȘ ·Ó·Ó¢ÛÙÈΤ˜ ÏÂÈÙÔ˘ÚÁÈΤ˜ ‰ÔÎÈ̷ۛ˜ (25,26). ∆· ·È‰È¿ ÌÂ Û˘¯Ó¤˜ ·ÛıÌ·ÙÈΤ˜ ÎÚ›ÛÂȘ ‚Ú¤ıËΠÛÙ·ÙÈÛÙÈο fiÙÈ ¤¯Ô˘Ó Û ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚÔ ÔÛÔÛÙfi ÙÔÓ ¤Ó· ‹ ÙÔ˘˜ ‰‡Ô ÁÔÓ›˜, ÙÔÓ ·Ô‡, ÙË ÁÈ·ÁÈ¿ ‹ Ù· ·‰¤ÏÊÈ· ·ÛıÌ·ÙÈÎÔ‡˜. ∞˘Ùfi ‹Ù·Ó ·Ó·ÌÂÓfiÌÂÓÔ, ηı’ fiÛÔÓ Ë Û¯¤ÛË ÙÔ˘ ·È‰ÈÎÔ‡ ¿ÛıÌ·ÙÔ˜ Ì ÙËÓ ·ÙÔ›· ıˆÚÂ›Ù·È ·ÚÎÂÙ¿ ÛÙÂÓ‹ (13). ™ÙȘ ÔÈÎÔÁ¤ÓÂȘ Ì ·ÙÔÈ΋ ÚԉȿıÂÛË, ¤Ú· ·fi ÙÔ ÚfiÏÔ Ù˘ ‰Â˘ÙÂÚÔÁÂÓÔ‡˜ ÚfiÏ˄˘ (·ÔÊ˘Á‹ ¤ÎıÂÛ˘ Û ·ÏÏÂÚÁÈÔÁfiÓ· Û ‹‰Ë

429

14-05-03

14:26

™ÂÏ›‰·430

¶·È‰È·ÙÚÈ΋ 2002;65:424-432

Paediatriki 2002;65:424-432

800

PEFR (l/min)

· 600 400 PEFR

200

95Ë ı¤ÛË 50Ë ı¤ÛË

0 106

139

149 ⁄„Ô˜ (cm)

159

169

5Ë ı¤ÛË

800 ‚ PEFR (l/min)

NoV-dEc-02

600 400 PEFR 95Ë ı¤ÛË

200

50Ë ı¤ÛË 0 142

5Ë ı¤ÛË 153

163

173

⁄„Ô˜ (cm) ∂ÈÎfiÓ· 6. PEFR Û ·È‰È¿ Ì ·ÛıÌ·ÙÈΤ˜ ÎÚ›ÛÂȘ Î·È PEFR ÛÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘. ∏ PEFR Û ·È‰È¿ ÌÂ Û˘¯Ó¤˜ ·ÛıÌ·ÙÈΤ˜ ÎÚ›ÛÂȘ (·) ‚Ú¤ıËΠ۠ÔÛÔÛÙfi 95,8% <90Ë ∂£. ™ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘ (‚), ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ÔÛÔÛÙfi ‚Ú¤ıËΠ53,8% (p<0,0001, 95% CI: 36,65-49,21%).

¢·ÈÛıËÙÔÔÈË̤ӷ ¿ÙÔÌ·), Ê·›ÓÂÙ·È Ó· ¤¯ÂÈ ı¤ÛË Î·È Ë ÚˆÙÔÁÂÓ‹˜ ÚfiÏË„Ë ÁÈ· ÙÔ ¿ÛıÌ· (·ÔÊ˘Á‹ ¢·ÈÛıËÙÔÔ›ËÛ˘ Û ÁÂÓÂÙÈο ÚԉȷÙÂıÂÈ̤ӷ ¿ÙÔÌ·) (15). ™Â ÚfiÛÊ·ÙË ÚÔ‰ÚÔÌÈ΋ ÌÂϤÙË, ·fi ÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË 97 ‚ÚÂÊÒÓ Ì ·ÙÔÈ΋ ‰ÂÚÌ·Ù›Ùȉ·, ‰È·ÈÛÙÒıËΠfiÙÈ Û ËÏÈΛ· 7 ÂÙÒÓ ÙÔ ¤Î˙ÂÌ· ›¯Â ·Ô‰Ú¿ÌÂÈ ‹ ‚ÂÏÙÈÒıËΠ۠82 ·fi Ù· 94 ‚Ú¤ÊË (87%), ·ÏÏ¿ ÙÔ 47% ›¯Â ÂΉËÏÒÛÂÈ ¿ÛıÌ·, ÙÔ 45% ·ÏÏÂÚÁÈ΋ ÚÈÓ›Ùȉ· Î·È 51% ›¯Â ÂÌÊ·Ó›ÛÂÈ ¤Ó· ÙÔ˘Ï¿¯ÈÛÙÔÓ ÂÂÈÛfi‰ÈÔ ÎÓ›‰ˆÛ˘ (27). ∞Ó Î·È Ë Ê˘ÛÈ΋ ÔÚ›· Ù˘ ·ÏÏÂÚÁÈ΋˜ ÓfiÛÔ˘ Â›Ó·È Ó· ÂÈϤÁÂÈ ‰È·ÊÔÚÂÙÈÎfi fiÚÁ·ÓÔ ‹ Û‡ÛÙËÌ· ¤ÎÊÚ·Û˘, ÚÔ˚Ô‡Û˘ Ù˘ ËÏÈΛ·˜ (·ÙÔÈ΋ ÔÚ›·), Ê·›ÓÂÙ·È fiÙÈ Î·È Ë Û˘Ó‡·ÚÍË ‰È·ÊÔÚÂÙÈÎÒÓ ·ÙÔÈÎÒÓ ÓÔÛËÌ¿ÙˆÓ ‰ÂÓ Â›Ó·È Û¿ÓÈ·. ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ‰È·ÈÛÙÒıËΠfiÙÈ ÙÔ 1/3 ÂÚ›Ô˘ ÙˆÓ ·È‰ÈÒÓ Ì ·ÛıÌ·ÙÈΤ˜ ÎÚ›ÛÂȘ ·Ó¤ÊÂÚÂ Û˘ÓÔ‰fi ·ÏÏÂÚÁÈ΋ ÚÈÓ›Ùȉ·, ÂÈÂÊ˘Î›Ùȉ· ‹ ¤Î˙ÂÌ· ÛÙË ‚ÚÂÊÈ΋ ‹ ÙË ÌÂÙ¤ÂÈÙ· ËÏÈΛ·. ∏ ·ÈÙ›· ÁÈ· ÙËÓ ÔÔ›· Ë ·ÏÏÂÚÁÈ΋ ÓfiÛÔ˜ ÂÎÊÚ¿˙ÂÙ·È Ì ‰È·ÊÔÚÂÙÈ΋ ÛÂÈÚ¿ Û οı fiÚÁ·ÓÔ ‹ Û ÂÚÈÛÛfiÙÂÚ· ·fi ¤Ó· fiÚÁ·Ó· Ì·˙› ‰ÂÓ Â›Ó·È ÁÓˆÛÙ‹. ÿÛˆ˜ ÚfiÎÂÈÙ·È ÁÈ· ‚ÈÔÏÔÁÈÎfi Ê·ÈÓfiÌÂÓÔ Ô˘ ¤¯ÂÈ Û¯¤ÛË ÙfiÛÔ ÌÂ

430

ÙÔ ‚·ıÌfi ¿Ì˘Ó·˜ ÙÔ˘ ÔÚÁ¿ÓÔ˘, fiÛÔ Î·È Ì ÙÔ ÊÔÚÙ›Ô ÙÔ˘ ·ÏÏÂÚÁÈÔÁfiÓÔ˘ ÛÙÔ ÔÔ›Ô ÂÎÙ›ıÂÙ·È (28). ™Ù· ·È‰È¿ Ô˘ Û˘ÌÂÚÈÏ‹ÊıËÎ·Ó ÛÙË ÌÂϤÙË Î·È ·ÚÔ˘Û›·˙·Ó Û˘¯Ó¤˜ ·ÛıÌ·ÙÈΤ˜ ÎÚ›ÛÂȘ, Ë ıÂÚ·¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ‹Ù·Ó ΢ڛˆ˜ Û˘Ìو̷ÙÈ΋. ¶ÚÔÏËÙÈ΋ ¯ÚfiÓÈ· ıÂÚ·›· Ì ·ÓÙÈÊÏÂÁÌÔÓÒ‰Ë Ê¿Ú̷η ›¯Â ¯ÔÚËÁËı› Û ÌÈÎÚfi ÔÛÔÛÙfi ·È‰ÈÒÓ Ì ̤ÙÚÈÔ ‹ ÛÔ‚·Úfi ¿ÛıÌ· (ÔÈ ÏËÚÔÊÔڛ˜ Ô˘ ›¯·Ì ÁÈ· ÙË Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ ·ÊÔÚÔ‡Ó ÛÙË ¯ÚÔÓÈ΋ ÂÚ›Ô‰Ô ÚÈÓ ·fi ÙÔ 1993, ÔfiÙÂ Î·È Û˘ÌÏËÚÒıËÎ·Ó Ù· ÂÚˆÙËÌ·ÙÔÏfiÁÈ·. ∞ÎÔÏÔ‡ıˆ˜, ÛÙËÓ ÂÚ›Ô‰Ô Ù˘ ·Ú·ÎÔÏÔ‡ıËÛ˘ ¤ˆ˜ ÙÔ 1997, fiÏ· Ù· ·È‰È¿ ÌÂ Û˘¯Ó¤˜ ·ÛıÌ·ÙÈΤ˜ ÎÚ›ÛÂȘ ¤Ï·‚·Ó ·ÓÙÈÊÏÂÁÌÔÓÒ‰Ë ·ÁˆÁ‹ ÁÈ· ÙÔ ¿ÛıÌ·). ™‡Ìʈӷ Ì ÙȘ Û˘ÛÙ¿ÛÂȘ Ù˘ ‰ÈÂıÓÔ‡˜ ÔÌÔʈӛ·˜ ÁÈ· ÙÔ ¿ÛıÌ·, Û˘ÛÙ‹ÓÂÙ·È Û‹ÌÂÚ· Ë ¯ÔÚ‹ÁËÛË ¯ÚfiÓÈˆÓ ÂÈÛÓÂfiÌÂÓˆÓ ·ÓÙÈÊÏÂÁÌÔÓˆ‰ÒÓ Ê·ÚÌ¿ÎˆÓ Û ·È‰È¿ Ì ̤ÙÚÈ·˜ ‚·Ú‡ÙËÙ·˜ Î·È ÛÔ‚·Úfi ¿ÛıÌ·. ∏ ηıȤڈÛË Ù˘ ÚÔÏËÙÈ΋˜ ·ÓÙÈÌÂÙÒÈÛ˘ ÙÔ˘ ¿ÛıÌ·ÙÔ˜ Ê·›ÓÂÙ·È fiÙÈ fi¯È ÌfiÓÔ ÂÏ·ÙÙÒÓÂÈ ÙË ÓÔÛËÚfiÙËÙ· ÙÔ˘ ·È‰ÈÎÔ‡ ‚ÚÔÁ¯ÈÎÔ‡ ¿ÛıÌ·ÙÔ˜, ·ÏÏ¿ ·Ú¿ÏÏËÏ· ÂÏ·ÙÙÒÓÂÈ ÙÔ „˘¯ÔÏÔÁÈÎfi, ÔÈÎÔÓÔÌÈÎfi Î·È ÎÔÈÓˆÓÈÎfi ÎfiÛÙÔ˜ Ù˘

NoV-dEc-02

14-05-03

14:26

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¶·È‰È·ÙÚÈ΋ 2002;65:424-432

¯ÚfiÓÈ·˜ ÓfiÛÔ˘ (1,2). ∆· ¯·ÌËÏ¿ ÔÛÔÛÙ¿ ¯ÔÚ‹ÁËÛ˘ ÚÔÊ˘Ï·ÎÙÈ΋˜ ·ÁˆÁ‹˜ Û ·È‰È¿ Ì ¿ÛıÌ· ÛÙË Û˘ÁÎÂÎÚÈ̤ÓË ÂÚÈÔ¯‹ ηٿ ÙËÓ ÂÚ›Ô‰Ô ‰ÈÂÍ·ÁˆÁ‹˜ Ù˘ ÌÂϤÙ˘ ¤‰ÂÈÍ·Ó fiÙÈ ¯ÚÂÈ¿˙ÂÙ·È Â·Ó·ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÓfiÛÔ˘ ˆ˜ ¯ÚfiÓÈÔ˘ ÓÔÛ‹Ì·ÙÔ˜ Î·È Â¤‚·Ï·Ó ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ηٿÛÙ·Û˘ Û‡Ìʈӷ Ì ٷ Û‡Á¯ÚÔÓ· ıÂÚ·¢ÙÈο ÚfiÙ˘· (1). ™˘ÌÂÚ·ÛÌ·ÙÈο, ηٿ ÙË ¯ÚÔÓÈ΋ ÂÚ›Ô‰Ô 1994-1997 ‰È·ÈÛÙÒÛ·Ì ˘„ËÏfi ÔÛÔÛÙfi ·ıÚÔÈÛÙÈÎÔ‡ ÂÈÔÏ·ÛÌÔ‡ ÙÔ˘ ·È‰ÈÎÔ‡ ‚ÚÔÁ¯ÈÎÔ‡ ¿ÛıÌ·ÙÔ˜ ÛÙË ™ËÙ›· (16,7%). ∏ ÂΉ‹ÏˆÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Ù˘ ÓfiÛÔ˘ Ê·›ÓÂÙ·È fiÙÈ, ÂÎÙfi˜ ·fi ÙÔ˘˜ ÁÂÓÂÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜, Û¯ÂÙ›˙ÂÙ·È Û ÛËÌ·ÓÙÈÎfi ‚·ıÌfi Ì ÙÔ Î¿ÓÈÛÌ· ÛÙÔ ÂÚÈ‚¿ÏÏÔÓ ÙˆÓ ·ÛıÌ·ÙÈÎÒÓ ·È‰ÈÒÓ Î·È ÙËÓ ·ÚÔ˘Û›· ÂÎÏ˘ÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ, ÂȉÈÎÒÓ (·ÏÏÂÚÁÈÔÁfiÓ·, ÙÚÔÊÈ΋ ·ÏÏÂÚÁ›·) Î·È ÌË ÂȉÈÎÒÓ (οÓÈÛÌ·, ÏÔÈÌÒÍÂȘ, ·ÙÌÔÛÊ·ÈÚÈ΋ Ú‡·ÓÛË). ∏ ÂÓË̤ڈÛË ÙˆÓ ÁÔÓ¤ˆÓ ·fi ¤ÌÂÈÚÔ ÚÔÛˆÈÎfi, Ë ·ÔÊ˘Á‹ ÙˆÓ ÂÎÏ˘ÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ, Ë Î·ıȤڈÛË ÚÔÏËÙÈ΋˜ ·ÓÙÈ·ÛıÌ·ÙÈ΋˜ ·ÁˆÁ‹˜, ·ÏÏ¿ Î·È Ë Ù·ÎÙÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ·ÚÚÒÛÙˆÓ ÌÔÚÔ‡Ó Ó· Ô‰ËÁ‹ÛÔ˘Ó Û Ì›ˆÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ Î·È Ù˘ ‚·Ú‡ÙËÙ·˜ Ù˘ ÓfiÛÔ˘ ÛÙËÓ ÂÚÈÔ¯‹ Ù˘ ™ËÙ›·˜ (1). µÈ‚ÏÈÔÁÚ·Ê›· 1. Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention NHLBI/WHO workshop report. National Institutes of Health. National Heart, Lung and Blood Institute Revised 2002. Updated from Global Initiative for Asthma (GINA), 1995, NIH publication 02-3659.

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¶ÂÚ›ÏË„Ë ¿ÚıÚÔ˘ ·fi ÙË µÈ‚ÏÈÔÁÚ·Ê›· ¶ÚÒÈÌÔÈ ‰È·ÁÓˆÛÙÈÎÔ› ‰Â›ÎÙ˜ ÓÂÔÁÓÈ΋˜ Û‹„˘: Û‡ÁÎÚÈÛË C-·ÓÙȉÚÒÛ·˜ ÚˆÙ½Ó˘, ÈÓÙÂÚÏ¢ΛÓ˘-6, ˘‰·ÙÔ‰È·Ï˘ÙÒÓ ˘Ô‰Ô¯¤ˆÓ ÙÔ˘ ·Ú¿ÁÔÓÙ· Ó¤ÎÚˆÛ˘ ÙˆÓ fiÁÎˆÓ Î·È ÙˆÓ ˘‰·ÙÔ‰È·Ï˘ÙÒÓ ÌÔÚ›ˆÓ ÚÔÛÎfiÏÏËÛ˘1 ™ÎÔfi˜: ™˘ÁÎÚ›ıËÎ·Ó ¤ÍÈ ÊÏÂÁÌÔÓÒ‰ÂȘ ÌÂÛÔÏ·‚ËÙ¤˜ Î·È Û˘ÁÎÂÎÚÈ̤ӷ Ë C-·ÓÙȉÚÒÛ· ÚˆÙ½ÓË (CRP), Ë ÈÓÙÂÚÏ¢ΛÓË-6 (IL-6), ÔÈ ˘ԉԯ›˜ p55 Î·È p57 ÙÔ˘ ·Ú¿ÁÔÓÙ· Ó¤ÎÚˆÛ˘ ÙˆÓ fiÁÎˆÓ (TNF-·) Î·È Ù· ‰È·Ï˘Ù¿ ÌfiÚÈ· ÚÔÛÎfiÏÏËÛ˘ (ICAM-1 Î·È E-selectin) Û·Ó ÚÒÈÌÔÈ ‰È·ÁÓˆÛÙÈÎÔ› ‰Â›ÎÙ˜ Ù˘ ÓÂÔÁÓÈ΋˜ Û‹„˘ Î·È ÛÙË Û˘Ó¤¯ÂÈ· ÌÂÏÂÙ‹ıËÎ·Ó Ù· Èı·Ó¿ ‰È·ÁÓˆÛÙÈο ÏÂÔÓÂÎÙ‹Ì·Ù· ·fi ÙÔ Û˘Ó‰˘·ÛÌfi ÙˆÓ ·Ú·Ì¤ÙÚˆÓ ·˘ÙÒÓ. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ¢Â›ÁÌ·Ù· ·›Ì·ÙÔ˜ ÂÏ‹ÊıËÛ·Ó ·fi 166 ‰È·‰Ô¯ÈÎÒ˜ ÂÈÛ·ÁfiÌÂÓ· ÓÂÔÁÓ¿, Ô˘ Èı·ÓÔÏÔÁ‹ıËΠfiÙÈ Â›¯·Ó Ïԛ̈ÍË Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÚÒÙ˘ ‚‰ÔÌ¿‰·˜ Ù˘ ˙ˆ‹˜ ÙÔ˘˜. ∆· ÓÂÔÁÓ¿ ·Ó·‰ÚÔÌÈο Ù·ÍÈÓÔÌ‹ıËÎ·Ó Û ÂΛӷ Ô˘ ›¯·Ó Ïԛ̈ÍË (Û‹„Ë, ÎÏÈÓÈ΋ Û‹„Ë ‹ Ó¢ÌÔÓ›·), Û ÂΛӷ Ì Èı·Ó‹ Ïԛ̈ÍË Î·È ÛÙ· ˘ÁÈ‹. ∞ÔÙÂϤÛÌ·Ù·: ∂›ÎÔÛÈ Ù¤ÛÛÂÚ· ÓÂÔÁÓ¿ Ì Ïԛ̈ÍË Â›¯·Ó ÛÙÔÓ ÔÚfi ÙÔ˘˜ ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚ· Â›‰· Î·È ÙˆÓ ¤ÍÈ ÌÂÏÂÙËı¤ÓÙˆÓ ÊÏÂÁÌÔÓˆ‰ÒÓ ÌÂÛÔÏ·‚ËÙÒÓ (p<0,05), ÂÓÒ ÛÙ· 18 ÓÂÔÁÓ¿ Ì Èı·Ó‹ Ïԛ̈ÍË ‚Ú¤ıËÎ·Ó ˘„ËÏfiÙÂÚ· Ù· Â›‰· ÙˆÓ CRP, IL-6, ICAM-1 Î·È Ù˘ E-selectin (p<0,05) Û˘ÁÎÚÈÓfiÌÂÓ· Ì ٷ ˘fiÏÔÈ· 124 ÓÂÔÁÓ¿ Ô˘ ‰ÂÓ Â›¯·Ó Ïԛ̈ÍË. OÈ ROC ηÌ‡Ï˜ (receiver operator characteristic plots) ¤‰ÂÈÍ·Ó fiÙÈ Ë CRP ‹Ù·Ó Ô Î·Ï‡ÙÂÚÔ˜ ‰È·ÁÓˆÛÙÈÎfi˜ ‰Â›ÎÙ˘. ∆· ÌÔÓ٤Ϸ ÔÏÏ·Ï‹˜ ÏÔÁ·ÚÈıÌÈ΋˜ ·ÏÈÓ‰ÚfiÌËÛ˘ (multiple logistic regression modeling) Ô˘ ÂÚÈÂÏ¿Ì‚·Ó·Ó ‰È¿ÊÔÚÔ˘˜ Û˘Ó‰˘·ÛÌÔ‡˜ Ì ‰‡Ô ·fi ÙÔ˘˜ ¤ÍÈ ÌÂÛÔÏ·‚ËÙ¤˜ ¤‰ÂÈÍ·Ó fiÙÈ ÂÎÙfi˜ ·fi ÙËÓ CRP Î·È Ë IL-6 ÚԂϤÂÈ ÙË Û‹„Ë. °È· fiÏ· Ì·˙› Ù· ÓÂÔÁÓ¿, Ì ۋ„Ë Î·È Èı·Ó‹ Û‹„Ë, Û·Ó ÔÌ¿-

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‰· ·Ó·ÊÔÚ¿˜, Ô Û˘Ó‰˘·ÛÌfi˜ Ù˘ CRP >10 mg/L ‹ Î·È Ù˘ IL-6 >20 pg/ml ›¯Â ¢·ÈÛıËÛ›· 85%, ÂȉÈÎfiÙËÙ· 62% Î·È ·ÚÓËÙÈÎfi ÏfiÁÔ Èı·ÓÔÊ¿ÓÂÈ·˜ 0,24 (likelihood ratio 0,24). ÃÚËÛÈÌÔÔÈÒÓÙ·˜ ÌfiÓÔ Ù· ÓÂÔÁÓ¿ Ì Ïԛ̈ÍË Û·Ó ÔÌ¿‰· ·Ó·ÊÔÚ¿˜ Î·È Ù· ÓÂÔÁÓ¿ Ì Èı·Ó‹ Ïԛ̈ÍË Û·Ó Ì¿ÚÙ˘Ú˜, Ë Â˘·ÈÛıËÛ›· ·˘Í‹ıËΠÛÙÔ 96% ÂÓÒ Ë ÂȉÈÎfiÙËÙ· ÌÂÈÒıËΠÛÙÔ 58%, Ì ·ÚÓËÙÈο Ù· ·ÔÙÂϤÛÌ·Ù· (CRP <10 mg/L Î·È IL-6 <20 pg/ml). ∏ Ïԛ̈ÍË ·ÔÎÏÂÈfiÙ·Ó Ì ÌÂÁ¿ÏË ‚‚·ÈfiÙËÙ· (ÏfiÁÔ˜ Èı·ÓÔÊ¿ÓÂÈ·˜: 0,07). ™˘ÌÂÚ¿ÛÌ·Ù·: ∏ CRP ·ÔÙÂÏ› ÙÔÓ ϤÔÓ ·ÍÈfiÈÛÙÔ ‰È·ÁÓˆÛÙÈÎfi ‰Â›ÎÙË ÁÈ· ÙË ÓÂÔÁÓÈ΋ Û‹„Ë. ∏ ‰È·ÁÓˆÛÙÈ΋ ·ÎÚ›‚ÂÈ·, fï˜, ‚ÂÏÙÈÒıËΠÂÚ·ÈÙ¤Úˆ Û˘Ó‰˘¿˙ÔÓÙ·˜ ÙË CRP Î·È ÙËÓ IL-6, ÂÓÒ ÔÈ ¿ÏϘ ·Ú¿ÌÂÙÚÔÈ (p55, p57, ICAM-1 Î·È Eselectin) ‰ÂÓ ÚÔÛ¤ÊÂÚ·Ó ÂÚ·ÈÙ¤Úˆ ‰È·ÁÓˆÛÙÈ΋ ‚Ô‹ıÂÈ·.

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ORIGINAL ARTICLE

∞ÁˆÁ‹ ˘Á›·˜ ÛÙ· Û¯ÔÏ›·. ∞ÍÈÔÏfiÁËÛË ÔÙÈÎÔ·ÎÔ˘ÛÙÈÎÔ‡ ̤ÛÔ˘ ÁÈ· ÙÔÓ ÂÚÈÔÚÈÛÌfi Ù˘ ηٷӿψÛ˘ ·ÏÎÔfiÏ ¡. ¶··‰ÔÔ‡ÏÔ˘1, ∫. ∆Û·Ì·Ó‰Ô˘Ú¿ÎË1, §. ÃÔ˘ÏÈ¿Ú·1, ∂. ¶¿‚Ë1, °. ∆Ô‡ÓÙ·˜1,2

Evaluation of the effectiveness of a health education CD-ROM: alcohol or driving N. Papadopoulou1, ∫. ∆samandouraki1, L. Houliara1, E. Pavi1, Y. ∆ountas1,2

¶ÂÚ›ÏË„Ë: ∏ ∂ÏÏ¿‰· ·ÚÔ˘ÛÈ¿˙ÂÈ ¤Ó·Ó ·fi ÙÔ˘˜ ˘„ËÏfiÙÂÚÔ˘˜ ‰Â›ÎÙ˜ ıÓËÛÈÌfiÙËÙ·˜ ·fi ÙÚÔ¯·›· ·Ù˘¯‹Ì·Ù· ·Ó¿ÌÂÛ· ÛÙȘ ¯ÒÚ˜ Ù˘ ∂˘Úˆ·˚΋˜ ŒÓˆÛ˘. ∆· ̤ÙÚ· ÚfiÏ˄˘ ÙˆÓ ÙÚÔ¯·›ˆÓ ·Ù˘¯ËÌ¿ÙˆÓ ÂÈÎÂÓÙÚÒÓÔÓÙ·È Û ÛËÌ·ÓÙÈÎfi ‚·ıÌfi ÛÙËÓ ÙÚÔÔÔ›ËÛË Ù˘ ·ÓıÚÒÈÓ˘ Û˘ÌÂÚÈÊÔÚ¿˜. ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ë ÂÎÙ›ÌËÛË Ù˘ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ ÂÓfi˜ CD-ROM Ô˘ ‰ËÌÈÔ˘ÚÁ‹ıËΠ̠ÛÎÔfi ÙËÓ Â˘·ÈÛıËÙÔÔ›ËÛË ÙˆÓ Ì·ıËÙÒÓ ÁÈ· ÙË Ï‹„Ë ÛˆÛÙÒÓ ·ÔÊ¿ÛÂˆÓ Î·È ÙËÓ ÙÚÔÔÔ›ËÛË Ù˘ Û˘ÌÂÚÈÊÔÚ¿˜ ÙÔ˘˜ Û¯ÂÙÈο Ì ÙËÓ Î·Ù·Ó¿ÏˆÛË ·ÏÎÔfiÏ Î·È ÙËÓ ÚÔÛÙ·Û›· ÙÔ˘˜ ·fi Ù· ÙÚÔ¯·›· ·Ù˘¯‹Ì·Ù·. °È· ÙËÓ ·ÍÈÔÏfiÁËÛË Ù˘ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ ÙÔ˘ CD-ROM, ÌÔÈÚ¿ÛÙËΠ۠200 Ì·ıËÙ¤˜ ËÏÈΛ·˜ 12-14 ¯ÚfiÓˆÓ ÂÌÈÛÙ¢ÙÈÎfi ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Ô˘ Û˘ÌÏ‹ÚˆÛ·Ó ÚÈÓ Î·È ÌÂÙ¿ ÙË ¯Ú‹ÛË ÙÔ˘. ∆· ‰Â‰Ô̤ӷ ·Ó·Ï‡ıËÎ·Ó Ì ÙËÓ ÂÊ·ÚÌÔÁ‹ ÌË ·Ú·ÌÂÙÚÈÎÒÓ ÌÂıfi‰ˆÓ. ªÂÙ¿ ÙË ¯Ú‹ÛË ÙÔ˘ CD-ROM ·Ú·ÙËÚ‹ıËΠ·ÏÏ·Á‹ ÛÙȘ ·fi„ÂȘ ÙˆÓ Ì·ıËÙÒÓ ÁÈ· οÔÈÔÓ Û˘ÓÔÌ‹ÏÈÎfi ÙÔ˘˜ Ô˘ ›ÓÂÈ, Û Â›Â‰Ô ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈÎfi (p<0,001). ¶ÚÔ·ÙÂÈ, Â›Û˘, ÛËÌ·ÓÙÈ΋ ÙÚÔÔÔ›ËÛË ÛÙȘ ·fi„ÂȘ Î·È ÁÓÒÛÂȘ ÙˆÓ Ì·ıËÙÒÓ Û¯ÂÙÈο Ì ÙËÓ Â›‰Ú·ÛË ÙÔ˘ ·ÏÎÔfiÏ ÛÙËÓ Ô‰‹ÁËÛË. ∏ ¯Ú‹ÛË ÙÔ˘ CD-ROM ·fi ÙÔ˘˜ Ì·ıËÙ¤˜ ·ÚÔ˘Û›·Û ıÂÙÈο ·ÔÙÂϤÛÌ·Ù· ÛÙËÓ ·ÏÏ·Á‹ ÙˆÓ ÛÙ¿ÛÂˆÓ Î·È ÙˆÓ ÁÓÒÛÂˆÓ ÙˆÓ Ì·ıËÙÒÓ.

Abstract: Greece has one of the highest mortality rates for road traffic accidents among the European Union countries. Prevention of these accidents focuses mainly on the modification of human behaviour. The aim of this study was to evaluate the effectiveness of a health education CD-ROM which was created with the objective of raising awareness of high school students on alcohol consumption issues, concerning mainly decision-making and behavioural change leading to protection from road traffic accidents. A purpose-made confidential questionnaire survey was carried out on 200 high school students aged 12- to 14-years-old. The questionnaire was completed before and after the use of the CDROM. Data were analyzed using non-parametric tests. Results suggest that after the use of the CDROM there is a change in students’ attitudes towards the image of a teenager who drinks alcohol (p<0.001). It is also found that there is a significant change in students’ knowledge and attitudes regarding the effect of alcohol consumption on driving behaviour. Findings indicate that the use of the CD-ROM by the students had a positive effect, changing their knowledge and attitudes in relatiion to alcohol consumption.

§¤ÍÂȘ ÎÏÂȉȿ: ·ÏÎÔfiÏ, ÙÚÔ¯·›· ·Ù˘¯‹Ì·Ù·, ÚfiÁÚ·ÌÌ· ·ÁˆÁ‹˜ ˘Á›·˜, ¤ÊË‚ÔÈ, ·ÍÈÔÏfiÁËÛË.

Key words: alcohol, road traffic accidents, health education program, adolescents, effectiveness.

∂ÈÛ·ÁˆÁ‹ ™ÙË ¯ÒÚ· Ì·˜ Ù· ÙÚÔ¯·›· ·Ù˘¯‹Ì·Ù· ·ÔÙÂÏÔ‡Ó ¤Ó· ·fi Ù· ÈÔ ÛËÌ·ÓÙÈο Û‡Á¯ÚÔÓ· ÚÔ-

‚Ï‹Ì·Ù· ‰ËÌfiÛÈ·˜ ˘Á›·˜, ÙÔ ÔÔ›Ô Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ¤¯ÂÈ ¿ÚÂÈ ‰È·ÛÙ¿ÛÂȘ ÂȉËÌ›·˜ (1). OÈ ı¿Ó·ÙÔÈ ·fi ÙÚÔ¯·›· ·Ù˘¯‹Ì·Ù·, ·fi 11,63 ·Ó¿

1 ∂ÏÏËÓÈ΋ ∂Ù·ÈÚ›· ¶ÚÔ·ÁˆÁ‹˜ Î·È ∞ÁˆÁ‹˜ ÀÁ›·˜, ∞ı‹Ó· 2 ∫¤ÓÙÚÔ ªÂÏÂÙÒÓ ÀËÚÂÛÈÒÓ ÀÁ›·˜, ∂ÚÁ·ÛÙ‹ÚÈÔ ÀÁÈÂÈÓ‹˜ Î·È ∂ȉËÌÈÔÏÔÁ›·˜, π·ÙÚÈÎfi ∆Ì‹Ì· ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ

1 Hellenic Society for Health Promotion and Education, Athens 2 Center for Health Services Research, Department of Hygiene and Epidemiology, Medical School, University of Athens

433

NoV-dEc-02

14-05-03

14:26

™ÂÏ›‰·434

¶·È‰È·ÙÚÈ΋ 2002;65:433-438

100.000 ¿ÙÔÌ· ÙÔ ¤ÙÔ˜ 1970, ·˘Í‹ıËÎ·Ó Û 22,3 ÙÔ 1996 (Ô ‰Â›ÎÙ˘ ıÓËÛÈÌfiÙËÙ·˜ ¤¯ÂÈ ÚÔÙ˘ˆı› ηٿ ËÏÈΛ· Ì ‚¿ÛË ÙÔ Û˘ÓÔÏÈÎfi ÏËı˘ÛÌfi ÙÔ˘ OO™∞ ÙÔ 1980) (2). ∂Í¿ÏÏÔ˘, Ù· ÙÚÔ¯·›· ·Ù˘¯‹Ì·Ù· ·ÔÙÂÏÔ‡Ó ÙËÓ Î˘ÚÈfiÙÂÚË ·ÈÙ›· ÚÒÈÌ˘ ıÓËÛÈÌfiÙËÙ·˜ Î·È ÛÙ· ‰‡Ô ʇϷ (19% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ¯·Ì¤ÓˆÓ ¯ÚfiÓˆÓ ˙ˆ‹˜ ÛÙÔ˘˜ ¿Ó‰Ú˜ Î·È 11% ÛÙȘ Á˘Ó·›Î˜ ÙÔ ¤ÙÔ˜ 1996) (3). ªÂٷ͇ ÙˆÓ ı˘Ì¿ÙˆÓ Ô˘ ¤¯·Û·Ó ÙË ˙ˆ‹ ÙÔ˘˜ Û ÙÚÔ¯·›Ô ·Ù‡¯ËÌ·, ¤Ó· ÛËÌ·ÓÙÈÎfi ÔÛÔÛÙfi ηٷϷ̂¿ÓÔ˘Ó ÔÈ Ó¤ÔÈ ËÏÈΛ·˜ 15-29 ÂÙÒÓ (4). ŸÛÔÓ ·ÊÔÚ¿ ÛÙËÓ Ô‰‹ÁËÛË, Ë Î·Ù·Ó¿ÏˆÛË ·ÏÎÔfiÏ ÂÓı·ÚÚ‡ÓÂÈ ÙË ÚÈ„ÔΛӉ˘ÓË Û˘ÌÂÚÈÊÔÚ¿ ¯ˆÚ›˜ ·ÈÙ›· Î·È ÌÂÈÒÓÂÈ ÙȘ ÈηÓfiÙËÙ˜ Ô‰‹ÁËÛ˘, ›Ù ·ÚÔ‰Èο ›Ù Û ÌÔÓÈÌfiÙÂÚË ‚¿ÛË (5). ÀÂÚ‚ÔÏÈ΋ ηٷӿψÛË ·ÏÎÔfiÏ Û ÂÚÈÛÙ·Ûȷ΋ ‚¿ÛË Á›ÓÂÙ·È Û˘Ó‹ıˆ˜ ·fi Ó¤Ô˘˜ Ô‰ËÁÔ‡˜, ÔÈ ÔÔ›ÔÈ ‰ÂÓ ÁÓˆÚ›˙Ô˘Ó ÙȘ Û˘Ó¤ÂȘ Ù˘ ̤ı˘ ÛÙË Û˘ÌÂÚÈÊÔÚ¿ ÙÔ˘˜ Î·È ‰ÂÓ ¤¯Ô˘Ó Â·Ú΋ Ô‰ËÁËÙÈ΋ ÂÌÂÈÚ›· (6). ∆· ÛÙÔȯ›· ·˘Ù¿ ηıÈÛÙÔ‡Ó ÂÈÙ·ÎÙÈ΋ ÙËÓ ·Ó¿ÁÎË Ù˘ ¤Á΢Ú˘ ÂÓË̤ڈÛ˘ Î·È ·fiÎÙËÛ˘ ‰ÂÍÈÔًوÓ, Ô˘ ı· Û˘Ì‚¿ÏÏÔ˘Ó ÛÙËÓ ÙÚÔÔÔ›ËÛË Ù˘ Û˘ÌÂÚÈÊÔÚ¿˜ Î·È ÛÙË Ï‹„Ë ˘‡ı˘ÓˆÓ ·ÔÊ¿ÛÂˆÓ ·¤Ó·ÓÙÈ ÛÙËÓ Î·Ù·Ó¿ÏˆÛË ·ÏÎÔfiÏ Î·È ÙËÓ Ô‰‹ÁËÛË. ∆Ô Û¯ÔÏÂ›Ô ·ÔÙÂÏ› ȉ·ÓÈÎfi ¯ÒÚÔ ÁÈ· ÙË ‰È·ÌfiÚʈÛË, ÙÚÔÔÔ›ËÛË ‹ ·ÏÏ·Á‹ ÙˆÓ ÛÙ¿ÛÂˆÓ Î·È Ù˘ Û˘ÌÂÚÈÊÔÚ¿˜ (7,8). ∞ÔÙÂÏ› ÙÔ Î·Ù¿ÏÏËÏÔ ÂÚÈ‚¿ÏÏÔÓ ÁÈ· ÙËÓ ÚÔÒıËÛË Î·È ÂÊ·ÚÌÔÁ‹ Ù˘ ∞ÁˆÁ‹˜ Î·È ¶ÚÔ·ÁˆÁ‹˜ ÀÁ›·˜, ¤ÙÛÈ ÒÛÙ ÔÈ Ì·ıËÙ¤˜ Ó· Û˘ÓÂȉËÙÔÔÈ‹ÛÔ˘Ó fiÙÈ Î·ıËÌÂÚÈÓ¤˜ ÂÈÏÔÁ¤˜, Ú¿ÍÂȘ ‹ Û˘ÌÂÚÈÊÔÚ¤˜ ÌÔÚÔ‡Ó Ó· ÂÈʤÚÔ˘Ó ·ÓÂÈı‡ÌËÙ˜ ·ÏÏ·Á¤˜ ÛÙËÓ ·ÙÔÌÈ΋ Î·È Û˘ÏÏÔÁÈ΋ ˘Á›· (9,10). ∆Ô ∫¤ÓÙÚÔ ªÂÏÂÙÒÓ ÀËÚÂÛÈÒÓ ÀÁ›·˜ ÙÔ˘ ∂ÚÁ·ÛÙËÚ›Ô˘ ÀÁÈÂÈÓ‹˜ Î·È ∂ȉËÌÈÔÏÔÁ›·˜ Ù˘ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ∞ıËÓÒÓ ÛÂ Û˘ÓÂÚÁ·Û›· Ì ÙËÓ ∂ÏÏËÓÈ΋ ∂Ù·ÈÚ›· ¶ÚÔ·ÁˆÁ‹˜ Î·È ∞ÁˆÁ‹˜ ÀÁ›·˜, ÛÙÔ Ï·›ÛÈÔ ÙˆÓ ÈÏÔÙÈÎÒÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ ∞ÁˆÁ‹˜ ÀÁ›·˜ ÙÔ˘ ÀÔ˘ÚÁ›Ԣ ¶·È‰Â›·˜, ‰ËÌÈÔ‡ÚÁËÛ·Ó ¤Ó· ÂÎ·È‰Â˘ÙÈÎfi CD-ROM, Ì ÛÙfi¯Ô ÙËÓ Â˘·ÈÛıËÙÔÔ›ËÛË ÙˆÓ Ì·ıËÙÒÓ fiÛÔÓ ·ÊÔÚ¿ ÛÙË Ï‹„Ë ÛˆÛÙÒÓ ·ÔÊ¿ÛÂˆÓ Î·È ÛÙËÓ ÙÚÔÔÔ›ËÛË Ù˘ Û˘ÌÂÚÈÊÔÚ¿˜ ÙÔ˘˜ Û¯ÂÙÈο Ì ÙËÓ Î·Ù·Ó¿ÏˆÛË ·ÏÎÔfiÏ Î·È ÙËÓ ÚÔÛÙ·Û›· ÙÔ˘˜ ·fi Ù· ÙÚÔ¯·›· ·Ù˘¯‹Ì·Ù·. ∆Ô CD-ROM, Ì ٛÙÏÔ “‹ ·ÏÎÔfiÏ ‹ Ô‰‹ÁËÛË”, ¤¯ÂÈ ÙË ÌÔÚÊ‹ ·È¯ÓȉÈÔ‡ Î·È ÂÚȤ¯ÂÈ, Â›Û˘, ¤Ó· Û‡ÓÙÔÌÔ ıˆÚËÙÈÎfi ̤ÚÔ˜. ∏ ÂÊ·ÚÌÔÁ‹ ˘ÏÔÔÈ‹ıËΠ̠¯Ú‹ÛË Ù¯ÓÔÏÔÁÈÒÓ ÔÏ˘Ì¤ÛˆÓ Î·È ÙÚÈۉȿÛÙ·ÙˆÓ ¯ÒÚˆÓ, Ì ‰˘Ó·ÙfiÙËÙ· ·ÏÏËÏÂ›‰Ú·Û˘ ¯Ú‹ÛÙË Î·È ·ÓÙÈÎÂÈ̤ӈÓ. ™ÙË ıˆڛ· ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÏËÚÔÊÔڛ˜ Û¯ÂÙÈΤ˜ Ì ÙËÓ ·Èı˘ÏÈ΋ ·ÏÎÔfiÏË Î·È ÙȘ ÂȉڿÛÂȘ

434

Paediatriki 2002;65:433-438

Ù˘ ÛÙËÓ ˘Á›·, ÙËÓ Â›‰Ú·ÛË ÙÔ˘ ·ÏÎÔfiÏ ÛÙËÓ Ô‰‹ÁËÛË, ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ Ô˘ ÂËÚ¿˙Ô˘Ó ÙËÓ Â›‰Ú·ÛË ·˘Ù‹, Ù· ÂÈÙÚÂÙ¿ fiÚÈ· ÙÔ˘ ·ÏÎÔfiÏ Î·Ù¿ ÙËÓ Ô‰‹ÁËÛË Î.¿. ∆Ô ·È¯Ó›‰È ÂÍÂÏ›ÛÛÂÙ·È Û 4 ‰È·ÊÔÚÂÙÈÎÔ‡˜ ¯ÒÚÔ˘˜, ÔÈ ÔÔ›ÔÈ ÔÓÔÌ¿˙ÔÓÙ·È ÎfiÛÌÔÈ. ™ÙÔÓ ÚÒÙÔ ÎfiÛÌÔ, Ô ·›ÎÙ˘ Â›Ó·È ÛÙÔ ¯ÒÚÔ ÙÔ˘ ÛÈÙÈÔ‡. ∞fi ÂΛ ÍÂÎÈÓ¿ Ó· ‰È·ÛΉ¿ÛÂÈ ÌfiÓÔ˜ ‹ Ì ʛÏÔ˘˜ Û ¤Ó· ΤÓÙÚÔ ‰È·ÛΤ‰·Û˘. ∂ÈϤÁÂÈ ·Ó ı· ¿ÂÈ Ì Ì˯·Ó¿ÎÈ ‹ ·˘ÙÔΛÓËÙÔ. O ‰Â‡ÙÂÚÔ˜ ÎfiÛÌÔ˜ Â›Ó·È Ë ‰È·‰ÚÔÌ‹ ÚÔ˜ ÙÔ Î¤ÓÙÚÔ ‰È·ÛΤ‰·Û˘, ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÔÔ›·˜ Ô ·›¯Ù˘ Ú¤ÂÈ Ó· Ô‰ËÁ› ÚÔÛÂÎÙÈο Î·È Ó· Û˘ÌÌÔÚÊÒÓÂÙ·È Ì ÙÔÓ ∫Ò‰Èη O‰È΋˜ ∫˘ÎÏÔÊÔÚ›·˜ ÁÈ· Ó· ·›ÚÓÂÈ fiÓÙÔ˘˜. ∂›Û˘, ı· Ú¤ÂÈ Ó· ··ÓÙ‹ÛÂÈ ÛˆÛÙ¿ Û ÂÚˆÙ‹ÛÂȘ Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È Î·Ù¿ ÙËÓ ÔÚ›· ÙÔ˘ ·˘Ù‹ (ÔÈ ··ÓÙ‹ÛÂȘ ‚Ú›ÛÎÔÓÙ·È ÛÙË ıˆڛ·), ÒÛÙ ӷ ÎÂÚ‰›ÛÂÈ ·ÎfiÌ· ÂÚÈÛÛfiÙÂÚÔ˘˜ fiÓÙÔ˘˜. O ÙÚ›ÙÔ˜ ÎfiÛÌÔ˜ Â›Ó·È ÙÔ Î¤ÓÙÚÔ ‰È·ÛΤ‰·Û˘. ∂Λ Ô ·›¯Ù˘ ‰È·ÛΉ¿˙ÂÈ ·ÎÔ‡ÁÔÓÙ·˜ ÌÔ˘ÛÈ΋ Î·È ÂÈϤÁÂÈ ÙÔ Â›‰Ô˜ Î·È ÙÔÓ ·ÚÈıÌfi ÙˆÓ ÔÙÒÓ Ô˘ ı· ÈÂÈ. ∆·˘Ùfi¯ÚÔÓ· ÌÔÚ› Ó· ÂÈϤÍÂÈ Ó· ÂÓËÌÂÚˆı› ÁÈ· οÔȘ “Ï¿Ó˜” Ô˘ ˘¿Ú¯Ô˘Ó Û¯ÂÙÈο Ì ÙË ¯Ú‹ÛË ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ. O ٤ٷÚÙÔ˜ ÎfiÛÌÔ˜ Â›Ó·È Ë ‰È·‰ÚÔÌ‹ ÂÈÛÙÚÔÊ‹˜ ÚÔ˜ ÙÔ Û›ÙÈ. ∞Ó¿ÏÔÁ· Ì ÙÔ ·Ó ‹È ‹ fi¯È Ô ·›ÎÙ˘ ÛÙÔ Î¤ÓÙÚÔ ‰È·ÛΤ‰·Û˘ Î·È Ì ÙÔ ·Ó Â¤ÏÂÍ ӷ Ô‰ËÁ‹ÛÂÈ ‹ fi¯È ηٿ ÙËÓ ÂÈÛÙÚÔÊ‹, ¯¿ÓÂÈ ‹ ÎÂÚ‰›˙ÂÈ fiÓÙÔ˘˜ ·ÓÙ›ÛÙÔȯ·. ∞Ó ¤¯ÂÈ ÈÂÈ Î·È ·ÔÊ·Û›ÛÂÈ Ó· Ô‰ËÁ‹ÛÂÈ, ÙfiÙ ¯¿ÓÂÈ ÔÏÏÔ‡˜ fiÓÙÔ˘˜ ·fi ÙËÓ ÂÈÏÔÁ‹ ÙÔ˘ ·˘Ù‹, ÂÓÒ ‰È·ÈÛÙÒÓÂÈ Ù·˘Ùfi¯ÚÔÓ· fiÙÈ ¤¯ÂÈ ÌÂȈı› Ë ÈηÓfiÙËÙ¿ ÙÔ˘ ÛÙËÓ Ô‰‹ÁËÛË, ÔfiÙÂ Â›Ó·È Ôχ ÈÔ Â‡ÎÔÏÔ Ó· οÓÂÈ Ï¿ıÔ˜ Î·È Ó· ¯¿ÛÂÈ fiÓÙÔ˘˜ ‹ Ó· ‚ÁÂÈ ÙÂÏ›ˆ˜ ·fi ÙÔ ·È¯Ó›‰È. ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË Á›ÓÂÙ·È ·ÍÈÔÏfiÁËÛË Ù˘ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ ÙÔ˘ CD-ROM “‹ ·ÏÎÔfiÏ ‹ Ô‰‹ÁËÛË” ̤ۈ Ù˘ ·ÍÈÔÏfiÁËÛ˘ ÙˆÓ ÁÓÒÛÂˆÓ Î·È ÛÙ¿ÛÂˆÓ ÙˆÓ Ì·ıËÙÒÓ ÚÈÓ Î·È ÌÂÙ¿ ÙË ¯Ú‹ÛË ÙÔ˘. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ™ÙË ÌÂϤÙË Ô˘ ‰ÈÂÍ‹¯ıË ·fi ÙÔÓ OÎÙÒ‚ÚÈÔ Ì¤¯ÚÈ ÙÔ ¢ÂΤ̂ÚÈÔ ÙÔ˘ 1999 Û˘ÌÌÂÙ›¯·Ó 200 Ì·ıËÙ¤˜ ËÏÈΛ·˜ 12-14 ÂÙÒÓ ·fi Ù¤ÛÛÂÚ· Á˘ÌÓ¿ÛÈ· Ù˘ ÓÔÌ·Ú¯›·˜ ¶ÂÈÚ·È¿. ∆· Û¯ÔÏ›· ÂÈϤ¯ıËÎ·Ó ÌÂ Ù˘¯·›Ô ÙÚfiÔ, ·fi ηٿÏÔÁÔ Ô˘ ÂÚÈÂÏ¿Ì‚·Ó ٷ Á˘ÌÓ¿ÛÈ· Ù˘ ÓÔÌ·Ú¯›·˜ ¶ÂÈÚ·È¿ Ô˘ ‰È¤ıÂÙ·Ó ËÏÂÎÙÚÔÓÈÎÔ‡˜ ˘ÔÏÔÁÈÛÙ¤˜. ∆Ô ‰Â›ÁÌ· ÙˆÓ Ì·ıËÙÒÓ (50 ·fi οı ۯÔÏ›Ô) ÂÈϤ¯ıËΠ̠·Ï‹ Ù˘¯·›· ‰ÂÈÁÌ·ÙÔÏË„›· ·fi ÙÔ˘˜ ηٷÏfiÁÔ˘˜ ÙˆÓ Ì·ıËÙÒÓ. ™Â οı ۯÔÏÂ›Ô ÂÁηٷÛÙ¿ıËΠÙÔ CD-ROM, ¤ÁÈÓÂ Ë Î·Ù¿ÏÏËÏË ÂÓË̤ڈÛË ÛÙÔ˘˜ Ì·ıËÙ¤˜ Ô˘ ›¯·Ó ÂÈϯı› Î·È ÛÙË Û˘Ó¤¯ÂÈ· ‰fiıËΠÂÚÈıÒÚÈÔ 2 ÌËÓÒÓ Ì¤Û· ÛÙÔ ÔÔ›Ô ·˘ÙÔ› ÌÔÚÔ‡Û·Ó Ó· ·›ÍÔ˘Ó fiÛ˜ ÊÔÚ¤˜ ‹ıÂÏ·Ó. ∏ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙÔ˘ CD-ROM ÂÎÙÈÌ‹ıËΠ·fi ÙË

NoV-dEc-02

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Û‡ÁÎÚÈÛË ÙˆÓ ÔÛÔÛÙÒÓ ÙˆÓ ··ÓÙ‹ÛÂˆÓ Ô˘ ¤‰ˆÛ·Ó ÔÈ Ì·ıËÙ¤˜ Û ÂÌÈÛÙ¢ÙÈÎfi ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Ô˘ Û˘ÌÏ‹ÚˆÛ·Ó ÚÈÓ Î·È ÌÂÙ¿ ÙË ¯Ú‹ÛË ÙÔ˘ CD-ROM. O ÂÚ¢ÓËÙ‹˜ ‹Ù·Ó Ô ›‰ÈÔ˜ Î·È ÛÙ· Ù¤ÛÛÂÚ· Û¯ÔÏ›·, ¤ÙÛÈ ÒÛÙ ӷ ‰›ÓÔÓÙ·È ÔÈ ›‰È˜ ‰È¢ÎÚÈÓ›ÛÂȘ ηٿ ÙË Û˘ÌÏ‹ÚˆÛ‹ ÙÔ˘ ·fi ÙÔ˘˜ Ì·ıËÙ¤˜. ∏ ·ÍÈÔÈÛÙ›· ÙÔ˘ ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘ ÂϤÁ¯ıËΠ۠ÌÂϤÙË Ô˘ ¤ÁÈÓ Û ÌÈÎÚfi ‰Â›ÁÌ· Ì·ıËÙÒÓ 2 Ì‹Ó˜ ÚÈÓ ÙËÓ Î‡ÚÈ· ÌÂϤÙË.

OÈ ÂÚˆÙ‹ÛÂȘ Ô˘ ÂÚÈÂÏ¿Ì‚·Ó ÙÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ·ÊÔÚÔ‡Û·Ó ·ÙÔÌÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ Ì·ıËÙÒÓ, ÙËÓ Î·Ù·Ó¿ÏˆÛË ÔÈÓÔÓÂ˘Ì·Ùˆ‰ÒÓ ÔÙÒÓ, ÙȘ ÁÓÒÛÂȘ Î·È ÛÙ¿ÛÂȘ ÙÔ˘˜ Û¯ÂÙÈο Ì ÙÔ ·ÏÎÔfiÏ Î·È ÙËÓ Ô‰‹ÁËÛË, ηıÒ˜ Î·È ÙË ÁÓÒÌË ÙÔ˘˜ ÁÈ· ÙÔ CD-ROM. ∆Ô ÂÚȯfiÌÂÓÔ ÙÔ˘ ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘ Ù˘ ÌÂϤÙ˘ ·ÚÔ˘ÛÈ¿˙ÂÙ·È Û˘ÓÔÙÈο ÛÙÔÓ ¶›Ó·Î· 1. ™ÙËÓ ·Ó¿Ï˘ÛË ÙˆÓ ÛÙÔȯ›ˆÓ Û˘ÌÂÚÈÂÏ‹ÊıËÛ·Ó 194 Ì·ıËÙ¤˜, ÔÈ ÔÔ›ÔÈ Û˘ÌÏ‹ÚˆÛ·Ó ÙÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Î·È ÙȘ ‰‡Ô ÊÔÚ¤˜. ∏ ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ¤ÁÈÓ Ì ÙË ‚Ô‹ıÂÈ· ÙÔ˘ ÛÙ·ÙÈÛÙÈÎÔ‡ ·Î¤ÙÔ˘ SPSS-PC. ∏ Û‡ÁÎÚÈÛË ÌÂٷ͇ ÙˆÓ ÔÛÔÛÙÒÓ ÚÈÓ Î·È ÌÂÙ¿ ÙË ¯Ú‹ÛË ÙÔ˘ CD-ROM ¤ÁÈÓ Ì ÙË ¯Ú‹ÛË ÌË ·Ú·ÌÂÙÚÈÎÒÓ ÌÂıfi‰ˆÓ (Â¤ÎÙ·ÛË ÙÔ˘ McNemar’s test).

∞ÔÙÂϤÛÌ·Ù· ∏ ηٷÓÔÌ‹ ÙˆÓ ·È‰ÈÒÓ Î·Ù¿ ʇÏÔ Î·È Ù¿ÍË ÊÔ›ÙËÛ˘ ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÛÙÔÓ ¶›Ó·Î· 2. ™¯ÂÙÈο Ì ÙËÓ Î·Ù·Ó¿ÏˆÛË ÔÈÓÔÓÂ˘Ì·Ùˆ‰ÒÓ

ÔÙÒÓ, ÛÙËÓ ∂ÈÎfiÓ· 1 Ê·›ÓÂÙ·È fiÙÈ 43 ·È‰È¿ ËÏÈΛ·˜ 12-14 ÂÙÒÓ (ÔÛÔÛÙfi 22,2%) ‰ÂÓ ¤¯Ô˘Ó ÈÂÈ ÔÙ¤ ̤¯ÚÈ Û‹ÌÂÚ·, ÂÓÒ 84 ·È‰È¿ (43,3%) ¤¯Ô˘Ó ÈÂÈ 1-2 ÊÔÚ¤˜, 37 ·È‰È¿ (19,1%) 3-10 ÊÔÚ¤˜ Î·È 29 ·È‰È¿ (15%) ¤¯Ô˘Ó ÈÂÈ ¿Óˆ ·fi 10 ÊÔÚ¤˜. ¢ÂÓ ·Ú·ÙËÚÔ‡ÓÙ·È ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÛÙËÓ Î·Ù·Ó¿ÏˆÛË ·ÏÎÔfiÏ ·Ó¿ÌÂÛ· ÛÙ· ‰‡Ô ʇϷ. ™ÙËÓ ∂ÈÎfiÓ· 2 Ê·›ÓÂÙ·È fiÙÈ ÙÔ 25,8% ÙˆÓ Ì·ıËÙÒÓ ‹È ÁÈ· ÚÒÙË ÊÔÚ¿ ÔÈÓÔÓÂ˘Ì·Ù҉˜ ÔÙfi ÛÙËÓ ∞’ Á˘ÌÓ·Û›Ô˘, ÂÓÒ ¤Ó· ÔÛÔÛÙfi 19,1% ‹È ÁÈ· ÚÒÙË ÊÔÚ¿ ·ÏÎÔfiÏ Û ÌÈÎÚfiÙÂÚË ËÏÈΛ· (™∆’ ‰ËÌÔÙÈÎÔ‡). ™ÙÔÓ ¶›Ó·Î· 3 ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÔÈ ·fi„ÂȘ ÙˆÓ ·È‰ÈÒÓ Û ̛· ÛÂÈÚ¿ ·fi ¯·Ú·ÎÙËÚÈÛÙÈο, Ù· ÔÔ›· ÂÚÈÁÚ¿ÊÔ˘Ó ¤Ó· ·È‰› Ù˘ ËÏÈΛ·˜ ÙÔ˘˜ Ô˘ ›ÓÂÈ. º·›ÓÂÙ·È fiÙÈ ÌÂÙ¿ ÙË ¯Ú‹ÛË ÙÔ˘ CDROM ÌÂÈÒÓÂÙ·È ÙÔ ÔÛÔÛÙfi ÙˆÓ Ì·ıËÙÒÓ Ô˘ ÚÔÛ‰›‰Ô˘Ó ıÂÙÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÛÙÔ˘˜ Û˘ÓÔÌ‹ÏÈÎÔ‡˜ ÙÔ˘˜ Ô˘ ›ÓÔ˘Ó. ∂ȉÈÎfiÙÂÚ·, ÌÂÈÒÓÂÙ·È Û Â›Â‰Ô ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈÎfi ÙÔ ÔÛÔÛÙfi ÙˆÓ Ì·ıËÙÒÓ Ô˘ ÈÛÙÂ‡Ô˘Ó fiÙÈ ¤Ó· ·È‰› Ô˘ ›ÓÂÈ ‰Â›¯ÓÂÈ Û›ÁÔ˘ÚÔ ÁÈ· ÙÔÓ Â·˘Ùfi ÙÔ˘, ÂÓÒ ·˘Í¿ÓÂÙ·È ÙÔ ÔÛÔÛÙfi ·˘ÙÒÓ Ô˘ ÈÛÙÂ‡Ô˘Ó fiÙÈ ¤Ó· ·È‰› Ù˘ ËÏÈΛ·˜ ÙÔ˘˜ ›ÓÂÈ ÁÈ·Ù› ÚÔÛ·ı› Ó· ‰Â›ÍÂÈ

¶›Ó·Î·˜ 1. ¶ÂÚȯfiÌÂÓÔ ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘ ÌÂϤÙ˘ 1 º‡ÏÔ 2 ∏ÌÂÚÔÌËÓ›· Á¤ÓÓËÛ˘ 3 ∆¿ÍË ÊÔ›ÙËÛ˘ 4 Œ¯ÂȘ ÈÂÈ ÔÙ¤ Ì‡Ú·, ÎÚ·Û›, Ô‡˙Ô, Ô˘›ÛÎÈ, ‚fiÙη ‹ ¿ÏÏÔ ÔÈÓÔÓÂ˘Ì·Ù҉˜ ÔÙfi; 5 ¶fiÛ˜ ÊÔÚ¤˜ ‹Ș οÔÈÔ ÔÈÓÔÓÂ˘Ì·Ù҉˜ ÔÙfi Û fiÏË ÙË ˙ˆ‹ ÛÔ˘ ̤¯ÚÈ Û‹ÌÂÚ·; 6 ¶fiÙ ‹Ș ÁÈ· ÚÒÙË ÊÔÚ¿ οÔÈÔ ÔÈÓÔÓÂ˘Ì·Ù҉˜ ÔÙfi; 7 ¶ÈÛÙ‡ÂȘ fiÙÈ ÙÔ Ó· ›ÓÂÈ ¤Ó· ·È‰› Ù˘ ËÏÈΛ·˜ ÛÔ˘ ÙÔ Î¿ÓÂÈ Ó· ‰Â›¯ÓÂÈ: ñ ™›ÁÔ˘ÚÔ ÁÈ· ÙÔÓ Â·˘Ùfi ÙÔ˘ ñ ¢˘Ó·ÌÈÎfi ñ flÚÈÌÔ Ì ÚÔÛˆÈÎfiÙËÙ· ñ ¶ÚÔÛ·ı› Ó· ‰Â›ÍÂÈ fiÙÈ Â›Ó·È ÌÂÁ¿ÏÔ˜ ñ ∫¿ÓÂÈ ·ÏÒ˜ fiÙÈ Î·È ÔÈ ¿ÏÏÔÈ ñ ÕÏÏÔ 8 ™Â ÔÈÔ ‚·ıÌfi Û˘ÌʈÓ›˜ ‹ ‰È·ÊˆÓ›˜ Ì οı ̛· ·fi ÙȘ ·ÎfiÏÔ˘ı˜ ÊÚ¿ÛÂȘ; ñ “OÈ ÈηÓÔ› Ô‰ËÁÔ› ‰ÂÓ ÂËÚ¿˙ÔÓÙ·È ·fi ÙÔ ·ÏÎÔfiÏ” ñ “ŒÓ· ¿ÙÔÌÔ ÌÔÚ› Ó· ¤¯ÂÈ ÙÚÔ¯·›Ô ·Ù‡¯ËÌ·, ¤ÛÙˆ ÎÈ ·Ó ¤¯ÂÈ ÈÂÈ Ï›ÁÔ” ñ "∆Ô Ó· ‰ÔÎÈÌ¿ÛÂȘ ·ÏÎÔfiÏ ·ÔÙÂÏ› ̤ÚÔ˜ ÙÔ˘ Ó· ÌÂÁ·ÏÒÓÂȘ” ñ “ŸÙ·Ó ¤¯ÂȘ ÈÂÈ ¤ÛÙˆ Î·È Ï›ÁÔ ·ÓÙȉڿ˜ ÈÔ ·ÚÁ¿ Û οÙÈ Ô˘ Û˘Ì‚·›ÓÂÈ ÙËÓ ÒÚ· Ô˘ Ô‰ËÁ›˜” ñ “∏ ÎÔ‡Ú·ÛË Î·È ÙÔ Ôχ Ê·ÁËÙfi ÂȉÂÈÓÒÓÔ˘Ó ÙËÓ Â›‰Ú·ÛË ÙÔ˘ ·ÏÎÔfiÏ ÛÙËÓ Ô‰‹ÁËÛË” ñ “∞Ó ¤¯ÂȘ ÌÂı‡ÛÂÈ Î·È ÈÂȘ ÛΤÙÔ Î·Ê¤ ÌÔÚ›˜ Ó· ÍÂÌÂı‡ÛÂȘ” ñ “ŒÓ· ¿ÙÔÌÔ ÌÔÚ› Ó· ¤¯ÂÈ ÙÚÔ¯·›Ô ·Ù‡¯ËÌ· ÌfiÓÔ ·Ó ¤¯ÂÈ ÈÂÈ Ôχ” 9 ¶ÔÈ· Â›Ó·È Ë ÁÓÒÌË ÛÔ˘ ÁÈ· ÙÔ CD-ROM; ¶›Ó·Î·˜ 2. ∫·Ù·ÓÔÌ‹ ·È‰ÈÒÓ Î·Ù¿ Ù¿ÍË Î·È Ê‡ÏÔ º‡ÏÔ ∞’ °˘ÌÓ·Û›Ô˘

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¶·È‰È·ÙÚÈ΋ 2002;65:433-438

Paediatriki 2002;65:433-438

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ÙÔ Óˆ ˆÛ ¿ Ó È ÕÁ η

∂ÈÎfiÓ· 1. ∫·Ù·ÓÔÌ‹ ··ÓÙ‹ÛÂˆÓ ÛÙËÓ ÂÚÒÙËÛË: “¶fiÛ˜ ÊÔÚ¤˜ ¤¯ÂȘ ÈÂÈ ÔÈÓÔÓÂ˘Ì·Ù҉˜ ÔÙfi Û fiÏË ÙË ˙ˆ‹ ÛÔ˘ ̤¯ÚÈ Û‹ÌÂÚ·;”

fiÙÈ Â›Ó·È ÌÂÁ¿ÏÔ˜. ™ÙÔÓ ¶›Ó·Î· 4 ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÔÈ ·fi„ÂȘ Î·È ÔÈ ÁÓÒÛÂȘ ÙˆÓ Ì·ıËÙÒÓ Û¯ÂÙÈο Ì ÙËÓ Â›‰Ú·ÛË ÙÔ˘ ·ÏÎÔfiÏ ÛÙËÓ Ô‰‹ÁËÛË. OÈ ·fi„ÂȘ Ô˘ Ú·ÁÌ·Ù‡ÔÓÙ·È ÙÔ Î·Ù¿ fiÛÔ ÔÈ ÈηÓÔ› Ô‰ËÁÔ› ÂËÚ¿˙ÔÓÙ·È ·fi ÙËÓ Î·Ù·Ó¿ÏˆÛË ·ÏÎÔfiÏ Î·È ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ¤Ó· ÙÚÔ¯·›Ô ·Ù‡¯ËÌ· ÌÔÚ› Ó· ÚÔÎÏËı› ·ÎfiÌ· Î·È Ì ÌÈÎÚ‹ ηٷӿψÛË ÔÈÓÔÓ‡̷ÙÔ˜, Ê·›ÓÂÙ·È Ó· ÂËÚ¿˙ÔÓÙ·È Û Â›Â‰Ô ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈÎfi. ™ÙÔÓ ¶›Ó·Î· 5 ·ÚÔ˘ÛÈ¿˙ÂÙ·È Ë ÁÓÒÌË ÙˆÓ ·È‰ÈÒÓ ÁÈ· ÙÔ CD-ROM. ™Ù· 152 ·È‰È¿ (ÔÛÔÛÙfi 78,3%) Ë ÂÓÙ‡ˆÛË ‹Ù·Ó ·ÚÎÂÙ¿ ¤ˆ˜ Ôχ ηϋ, ÂÓÒ Û 10 ÌfiÓÔ ·È‰È¿ (ÔÛÔÛÙfi 5,2%) ‰ÂÓ ¿ÚÂÛ ηıfiÏÔ˘. ™˘˙‹ÙËÛË ∆· ÚÔÁÚ¿ÌÌ·Ù· ∞ÁˆÁ‹˜ Î·È ¶ÚÔ·ÁˆÁ‹˜ ÀÁ›·˜ ÛÙÔ¯Â‡Ô˘Ó ÛÙË ‚ÂÏÙ›ˆÛË Ù˘ ˘Á›·˜ ·fi ÙÔ ›‰ÈÔ ÙÔ ¿ÙÔÌÔ. ™Ùfi¯Ô˜ Ù˘ ∞ÁˆÁ‹˜ ÀÁ›·˜ ÛÙÔ Û¯ÔÏÂ›Ô Â›Ó·È Ó· ‰È¢ÎÔχÓÂÈ Ù· Ó·ڿ ¿ÙÔÌ· Ó· ·ÔÊ·Û›ÛÔ˘Ó Û˘ÓÂȉËÙ¿ ÁÈ· ı¤Ì·Ù· Ô˘ ·ÊÔÚÔ‡Ó ÙËÓ ˘Á›· ÙÔ˘˜. ¶ÔÏÏÔ› ‰ÈÂıÓ›˜ ÔÚÁ·ÓÈÛÌÔ› ¤¯Ô˘Ó Â·ÓÂÈÏËÌ̤ӷ ÂÈÛËÌ¿ÓÂÈ ÙË ÛËÌ·Û›· ÙÔ˘ Û¯ÔÏ›Ԣ ÛÙË ‰È·‰Èηۛ· ‰È·ÌfiÚʈÛ˘ ÛˆÛÙÒÓ Û˘ÌÂÚÈÊÔÚÒÓ ˘Á›·˜ ÛÙ· ·È‰È¿. ∆Ô Û¯ÔÏÂ›Ô Â›Ó·È Ô ÙfiÔ˜ Ô˘ ÂÚÓÔ‡Ó ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ Ì¤ÚÔ˜ Ù˘ Ë̤ڷ˜ ÙÔ˘˜ Ù· ·È‰È¿ ηÈ, ÂÔ̤ӈ˜, ˘¿Ú¯ÂÈ Ë Â˘Î·ÈÚ›· Ù˘ ¿ÌÂÛ˘ ÂÈÎÔÈÓˆÓ›·˜ Î·È Ë ‰˘Ó·ÙfiÙËÙ· ÂÊ·ÚÌÔÁ‹˜ ÚÔÁÚ·ÌÌ¿ÙˆÓ ∞ÁˆÁ‹˜ ÀÁ›·˜ (11,12).

OÈ ÂÎ·È‰Â˘ÙÈΤ˜ ̤ıÔ‰ÔÈ ·ÁˆÁ‹˜ Î·È ÚÔ·ÁˆÁ‹˜ ˘Á›·˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÂÎÙfi˜ ·fi ÙȘ ·ıËÙÈΤ˜ ÌÂıfi‰Ô˘˜ (ÔÌÈϛ˜, ‰È·Ê¿ÓÂȘ, ·Ê›Û˜, ÂÓË-

436

25,8

25

40 ¶ÔÛÔÛÙfi %

NoV-dEc-02

˘ ‡ ‡ ‡ ‡ Ô˘ Ô˘ ÔÙ¤ ÈÎÔ ÙÈÎÔ ÙÈÎÔ ÙÈÎÔ ·Û›Ô ·Û› Û› ¶ Ù · Ô Ô Ô Ô Ó Ó Ó ËÌ ¢ËÌ ¢ËÌ ¢ËÌ °˘Ì ˘Ì °˘Ì ° ¢ ’ °’ µ’ °’ ∂’ ¢’ ∞’ ™∆

∂ÈÎfiÓ· 2. ∫·Ù·ÓÔÌ‹ ··ÓÙ‹ÛÂˆÓ ÛÙËÓ ÂÚÒÙËÛË: “¶fiÙ ‹Ș ÁÈ· ÚÒÙË ÊÔÚ¿ οÔÈÔ ÔÈÓÔÓÂ˘Ì·Ù҉˜ ÔÙfi;”

ÌÂÚˆÙÈο Ê˘ÏÏ¿‰È· Î.¿.) Î·È ÌÂıfi‰Ô˘˜ ÂÓÂÚÁËÙÈ΋˜ Û˘ÌÌÂÙÔ¯‹˜ (¤Ú¢ӷ, ·È¯Ó›‰È, ‰Ú·Ì·ÙÔÔ›ËÛË, ·ÏÏËÏԉȉ·Ûηϛ· Î.¿.). ∂›Ó·È ÁÂÁÔÓfi˜ fiÙÈ ·ÚÂÌ‚¿ÛÂȘ fiˆ˜ ÙÔ ·›ÍÈÌÔ ÚfiψÓ, Ë ‰Ú·Ì·ÙÔÔ›ËÛË, Ë ÚÔ‚ÔÏ‹ Ù·ÈÓÈÒÓ ‚›ÓÙÂÔ Î·È Ù· CD-ROM, Â›Ó·È ÈÔ ·ÔÙÂÏÂÛÌ·ÙÈο ̤۷ ÁÈ· ÙË Ì›ˆÛË ÚÈ„ÔΛӉ˘ÓˆÓ Û˘ÌÂÚÈÊÔÚÒÓ ·fi Ó¤Ô˘˜ ·ÓıÚÒÔ˘˜ Û ۯ¤ÛË Ì ÈÔ ·Ú·‰ÔÛȷΤ˜ ·ÚÂÌ‚¿ÛÂȘ, fiˆ˜ ÔÈ ‰È·Ï¤ÍÂȘ ·fi Â·ÁÁÂÏ̷ٛ˜ ˘Á›·˜, ÁÈ·Ù› ÛÙÔ¯Â‡Ô˘Ó ÛÙËÓ ¿ÌÂÛË Û˘ÌÌÂÙÔ¯‹ ÙÔ˘ ÏËı˘ÛÌÔ‡ ÛÙÔÓ ÔÔ›Ô ·¢ı‡ÓÔÓÙ·È (13-23). ŒÙÛÈ, ·fi ÙȘ ·Ú¯¤˜ Ù˘ ‰ÂηÂÙ›·˜ ÙÔ˘ ’90, ¿Ú¯ÈÛ ӷ ÂÊ·ÚÌfi˙ÂÙ·È Ì›· ÈÔ ÔÏÈÛÙÈ΋ ÚÔÛ¤ÁÁÈÛË ÛÙ· ÚÔÁÚ¿ÌÌ·Ù· ∞ÁˆÁ‹˜ ÀÁ›·˜ Ì ÙË ‚Ô‹ıÂÈ· ηÈÓÔ‡ÚÈˆÓ Ù¯ÓÔÏÔÁÈÒÓ Î·È Ì ÛÎÔfi ÙË Ì·ÎÚÔÚfiıÂÛÌË ÂÈÚÚÔ‹ ÛÂ Û˘ÌÂÚÈÊÔÚ¤˜ Î·È ÛÙ¿ÛÂȘ ˘Á›·˜. OÈ Û‡Á¯ÚÔÓ˜ ̤ıÔ‰ÔÈ ∞ÁˆÁ‹˜ ÀÁ›·˜ ÍÂʇÁÔ˘Ó ·fi Ù· ·˘ÛÙËÚ¿ ‰È‰·ÛηÏÈο ÚfiÙ˘· Î·È ÂÈÙÚ¤Ô˘Ó ÛÙÔ˘˜ Ì·ıËÙ¤˜ Ó· ÂÓËÌÂÚˆıÔ‡Ó ÁÈ· ı¤Ì·Ù· ˘Á›·˜ Û ¤Ó· ÈÔ ¯·Ï·Úfi Î·È Â˘¯¿ÚÈÛÙÔ ÂÚÈ‚¿ÏÏÔÓ (22). ™Ù· Ï·›ÛÈ· ·˘ÙÒÓ ÙˆÓ Û‡Á¯ÚÔÓˆÓ Ù¿ÛÂˆÓ ‰ËÌÈÔ˘ÚÁ‹ıËΠÙÔ CD-ROM Ì ı¤Ì· “‹ ·ÏÎÔfiÏ ‹ Ô‰‹ÁËÛË”, Ì ÛÙfi¯Ô ÙËÓ Â˘·ÈÛıËÙÔÔ›ËÛË ÙˆÓ Ì·ıËÙÒÓ ÛÙË Ï‹„Ë ˘‡ı˘ÓˆÓ ·ÔÊ¿ÛÂˆÓ ·¤Ó·ÓÙÈ ÛÙËÓ Î·Ù·Ó¿ÏˆÛË ·ÏÎÔfiÏ Î·È ÙËÓ Ô‰‹ÁËÛË. ™‡Ìʈӷ Ì ٷ ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘, Ë ¯Ú‹ÛË ÙÔ˘ CD-ROM ·fi ÙÔ˘˜ Ì·ıËÙ¤˜ ›¯Â ıÂÙÈ΋ Â›‰Ú·ÛË ÛÙȘ ÁÓÒÛÂȘ, ÙȘ ÛÙ¿ÛÂȘ Î·È ÙȘ ·fi„ÂȘ ÙÔ˘˜. ∞Ó Î·È ‰ÂÓ ÌÔÚ› Ó· ·ÔÎÏÂÈÛÙ› ÙÔ ÂӉ¯fiÌÂÓÔ Ó· ˘¿Ú¯ÂÈ Î¿ÔÈÔ˜ ¿ÏÏÔ˜ Û˘Á¯˘ÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ Ô˘ Ó· Âȉڿ ÛÙ· ·ÔÙÂϤÛÌ·Ù·, ÌÔÚ› Ó· ıˆÚËı› fiÙÈ Ë ÙÚÔÔÔ›ËÛË ·˘Ù‹ ÔÊ›ÏÂÙ·È ÛÙË ¯Ú‹ÛË ÙÔ˘ CD-ROM. ∏ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ¯Ú‹Û˘ ÙÔ˘ CD-ROM ˆ˜ Ó¤Ô˘ ÂÎ·È‰Â˘ÙÈÎÔ‡ ÂÚÁ·Ï›Ԣ ÛÙËÓ ÂÊ·ÚÌÔÁ‹ ÚÔÁÚ·ÌÌ¿ÙˆÓ

NoV-dEc-02

14-05-03

14:26

™ÂÏ›‰·437

¶·È‰È·ÙÚÈ΋ 2002;65:433-438

Paediatriki 2002;65:433-438

¶›Ó·Î·˜ 3. ∫·Ù·ÓÔÌ‹ ··ÓÙ‹ÛÂˆÓ ÛÙËÓ ÂÚÒÙËÛË: “¶ÈÛÙ‡ÂȘ fiÙÈ ÙÔ Ó· ›ÓÂÈ ¤Ó· ·È‰› Ù˘ ËÏÈΛ·˜ ÛÔ˘ ÙÔ Î¿ÓÂÈ Ó· ‰Â›¯ÓÂÈ:” ¶ÚÈÓ ÙË ¯Ú‹ÛË ÙÔ˘ CD-ROM

MÂÙ¿ ÙË ¯Ú‹ÛË ÙÔ˘ CD-ROM

∞ÚÈıÌfi˜ ·È‰ÈÒÓ

¶ÔÛÔÛÙfi %

∞ÚÈıÌfi˜ ·È‰ÈÒÓ

¶ÔÛÔÛÙfi %

™›ÁÔ˘ÚÔ ÁÈ· ÙÔÓ Â·˘Ùfi ÙÔ˘ ¢˘Ó·ÌÈÎfi flÚÈÌÔ Ì ÚÔÛˆÈÎfiÙËÙ· ¶ÚÔÛ·ı› Ó· ‰Â›ÍÂÈ fiÙÈ Â›Ó·È ÌÂÁ¿ÏÔ˜ ∫¿ÓÂÈ ·ÏÒ˜ fiÙÈ Î·È ÔÈ ¿ÏÏÔÈ ¢ÂÓ ·¿ÓÙËÛ·Ó

30 21 8 100 29 6

15,5 10,9 4,1 51,5 14,9 3,1

14 17 1 129 28 5

7,2 8,7 0,5 66,5 14,4 2,6

™‡ÓÔÏÔ

194

100

194

100

∆ÈÌ‹ ÎÚÈÙËÚ›Ô˘ ƒ

0,006 0,571 0,039 0,001 1,000

¶›Ó·Î·˜ 4. ∫·Ù·ÓÔÌ‹ ··ÓÙ‹ÛÂˆÓ ÛÙËÓ ÂÚÒÙËÛË: “™Â ÔÈÔ ‚·ıÌfi Û˘ÌʈÓ›˜ ‹ ‰È·ÊˆÓ›˜ Ì ÙȘ ·ÎfiÏÔ˘ı˜ ÊÚ¿ÛÂȘ;” ∞ÚÈıÌfi˜ ·È‰ÈÒÓ Ô˘ ·¿ÓÙËÛ·Ó (ÔÛÔÛÙfi %) ∆ÈÌ‹ ¶ÚÈÓ ÙË ¯Ú‹ÛË ÙÔ˘ CD-ROM ªÂÙ¿ ÙË ¯Ú‹ÛË ÙÔ˘ CD-ROM ÎÚÈÙËÚ›Ô˘ P ¢ÂÓ ¢ÂÓ ™˘ÌʈÓÒ ¢È·ÊˆÓÒ ·¿ÓÙËÛ·Ó ™˘ÌʈÓÒ ¢È·ÊˆÓÒ ·¿ÓÙËÛ·Ó OÈ ÈηÓÔ› Ô‰ËÁÔ› ‰ÂÓ ÂËÚ¿˙ÔÓÙ·È ·fi ÙÔ ·ÏÎÔfiÏ

29 (15)

140 (72,1)

25 (12,9)

19 (9,8)

150 (77,3)

25 (12,8)

0,002

ŒÓ· ¿ÙÔÌÔ ÌÔÚ› Ó· ¤¯ÂÈ ÙÚÔ¯·›Ô ·Ù‡¯ËÌ· ¤ÛÙˆ Î·È ·Ó ¤¯ÂÈ ÈÂÈ Ï›ÁÔ

109 (56,2)

80 (41,2)

5 (2,6)

133 (68,6)

59 (30,4)

2 (1,0)

0,010

∆Ô Ó· ‰ÔÎÈÌ¿ÛÂȘ ·ÏÎÔfiÏ ·ÔÙÂÏ› ̤ÚÔ˜ ÙÔ˘ Ó· ÌÂÁ·ÏÒÓÂȘ

16 (8,3)

149 (76,8)

29 (14,9)

13 (6,7)

158 (81,5)

23 (11,8)

0,304

ŸÙ·Ó ¤¯ÂȘ ÈÂÈ ¤ÛÙˆ Î·È Ï›ÁÔ ·ÓÙȉڿ˜ ÈÔ ·ÚÁ¿ Û οÙÈ Ô˘ Û˘Ì‚·›ÓÂÈ ÙËÓ ÒÚ· Ô˘ Ô‰ËÁ›˜

142 (73,2)

46 (23,7)

6 (3,1)

146 (75,3)

47 (24,2)

1 (0,5)

0,077

∏ ÎÔ‡Ú·ÛË Î·È ÙÔ Ôχ Ê·ÁËÙfi ÂÓÙ›ÓÔ˘Ó ÙËÓ Â›‰Ú·ÛË ÙÔ˘ ·ÏÎÔfiÏ ÛÙËÓ Ô‰‹ÁËÛË

135 (69,6)

51 (26,3)

8 (4,1)

140 (72,2)

51 (26,3)

3 (1,5)

0,109

∞Ó ¤¯ÂȘ ÌÂı‡ÛÂÈ Î·È ÈÂȘ ÛΤÙÔ Î·Ê¤, 129 ÌÔÚ›˜ Ó· ÍÂÌÂı‡ÛÂȘ (66,5)

56 (28,9)

9 (4,6)

111 (57,2)

81 (41,8)

2 (1,0)

0,198

ŒÓ· ¿ÙÔÌÔ ÌÔÚ› Ó· ¤¯ÂÈ ÙÚÔ¯·›Ô ·Ù‡¯ËÌ· ÌfiÓÔ ·Ó ¤¯ÂÈ ÈÂÈ Ôχ

113 (58,2)

3 (1,5)

60 (30,9)

133 (68,6)

1 (0,5)

0,821

78 (40,2)

¶›Ó·Î·˜ 5. ∫·Ù·ÓÔÌ‹ ··ÓÙ‹ÛÂˆÓ ÛÙËÓ ÂÚÒÙËÛË: “¶ÔÈ· Â›Ó·È Ë ÁÓÒÌË ÛÔ˘ ÁÈ· ÙÔ CD-ROM;” ∞ÚÈıÌfi˜ ·È‰ÈÒÓ

¶ÔÛÔÛÙfi (%)

ªÔ˘ ¿ÚÂÛ ϛÁÔ ªÔ˘ ¿ÚÂÛ ·ÚÎÂÙ¿ ªÔ˘ ¿ÚÂÛ Ôχ ¢ÂÓ ÌÔ˘ ¿ÚÂÛ ηıfiÏÔ˘ ¢ÂÓ ··ÓÙÒ / ÕÏÏË ·¿ÓÙËÛË

19 60 92 10 13

9,8 30,9 47,4 5,2 6,7

™‡ÓÔÏÔ

194

100

·ÁˆÁ‹˜ ˘Á›·˜ Û ̷ıËÙ¤˜, ¤¯ÂÈ ·Ó·ÊÂÚı› Î·È Û ¿ÏϘ ÌÂϤÙ˜ (24-26). ∆Ô ÁÂÁÔÓfi˜ fiÙÈ ÔÚÈṲ̂Ó˜ ·fi ÙȘ ·fi„ÂȘ ÙˆÓ Ì·ıËÙÒÓ ‰ÂÓ Ê·›ÓÂÙ·È Ó· ÂËÚ¿ÛÙËÎ·Ó Â·ÚÎÒ˜

·fi ÙË ¯Ú‹ÛË ÙÔ˘ CD-ROM ı· ÌÔÚÔ‡Û ӷ ·Ô‰Ôı› ·ÊÂÓfi˜ ÛÙÔ fiÙÈ ÙÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· Ô˘ ›¯·Ó ÔÈ Ì·ıËÙ¤˜ ÁÈ· Ó· ·Û¯ÔÏËıÔ‡Ó Ì ÙÔ CD-ROM ‰ÂÓ ‹Ù·Ó ·ÚÎÂÙfi, ‰ÈfiÙÈ ÌÂÛÔÏ¿‚ËÛ·Ó ·ÂÚÁ›Â˜ ·ÊÂÙ¤ÚÔ˘ ÛÙÔ fiÙÈ ÏfiÁˆ ÌÈÎÚÔ‡ ·ÚÈıÌÔ‡ ËÏÂÎÙÚÔÓÈÎÒÓ ˘ÔÏÔÁÈÛÙÒÓ Û οı ۯÔÏ›Ô, ‰ÂÓ ˘‹Ú¯Â Ë ‰˘Ó·ÙfiÙËÙ· Ó· ·›˙Ô˘Ó Û˘¯Ó¿ Î·È ÁÈ· ÌÂÁ¿ÏÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·. ∂›Ó·È Èı·Ófi, fï˜, ÔÚÈṲ̂Ó˜ ·fi„ÂȘ Î·È ÛÙ¿ÛÂȘ ÙˆÓ Ì·ıËÙÒÓ Á‡Úˆ ·fi ı¤Ì·Ù· ˘Á›·˜ Ó· ÌËÓ ÂËÚ¿˙ÔÓÙ·È ·fi Ù¤ÙÔÈÔ˘ Ù‡Ô˘ ·ÚÂÌ‚¿ÛÂȘ, ·ÏÏ¿ Ó· ··ÈÙÔ‡Ó Î·È ¿ÏϘ ÂÎ·È‰Â˘ÙÈΤ˜ ÌÂıfi‰Ô˘˜. ™˘ÌÂÚ·ÛÌ·ÙÈο, ÙÔ CD-ROM “‹ ·ÏÎÔfiÏ ‹ Ô‰‹ÁËÛË” Ê·›ÓÂÙ·È Ó· Û˘Ó¤‚·Ï ÛÙËÓ ·ÏÏ·Á‹ ÙˆÓ

437

NoV-dEc-02

14-05-03

14:26

™ÂÏ›‰·438

¶·È‰È·ÙÚÈ΋ 2002;65:433-438

·fi„ÂˆÓ Î·È ÛÙ¿ÛÂˆÓ ÙˆÓ Ì·ıËÙÒÓ ÙÔ˘ Á˘ÌÓ·Û›Ô˘ ÛÙ· ı¤Ì·Ù· Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ Î·Ù·Ó¿ÏˆÛË ·ÏÎÔfiÏ Î·Ù¿ ÙËÓ Ô‰‹ÁËÛË. °È’ ·˘Ùfi ÙÔ ÏfiÁÔ, ÌÔÚ›, ÌÂ Û˘ÛÙËÌ·ÙÈ΋ ¯Ú‹ÛË, Ó· ·ÔÙÂϤÛÂÈ ¤Ó· ÛËÌ·ÓÙÈÎfi ÂÚÁ·ÏÂ›Ô ÛÙËÓ ÂÎ·›‰Â˘ÛË Î·È Î˘ÎÏÔÊÔÚȷ΋ ·ÁˆÁ‹ ÙˆÓ Ó¤ˆÓ Ì ÛÎÔfi ÙË Ì›ˆÛË ÙˆÓ ÙÚÔ¯·›ˆÓ ·Ù˘¯ËÌ¿ÙˆÓ. µÈ‚ÏÈÔÁÚ·Ê›· 1. ¶ÂÙÚ›‰Ô˘ ∂, ∆ÚȯfiÔ˘ÏÔ˜ ¢. ∆Ô ÂıÓÈÎfi Úfi‚ÏËÌ· ˘Á›·˜ Ù˘ ∂ÏÏ¿‰·˜: ÙÚÔ¯·›· ·Ù˘¯‹Ì·Ù·. ¶·È‰È·ÙÚÈ΋ 1998;61:31-36.

2. OO™∞. Health Data; CD Version 4.1; 1999.

3. ∆Ô‡ÓÙ·˜ °. ∏ ˘Á›· ÛÙËÓ ∂ÏÏ¿‰·. ™ÙÔ: ∆Ô‡ÓÙ·˜ °, ÂΉ. ∫ÔÈÓˆÓ›· Î·È ÀÁ›·. ∞ı‹Ó·: O‰˘ÛÛ¤·˜ / ¡¤· ÀÁ›·; 2000. ÛÂÏ.

371-390.

4. Chliaoutakis JE, Darviri C, Demakakos PT. The impact of young drivers’ lifestyle on their road traffic accident risk in greater Athens area. Accid Anal Prev 1999;31:771-780.

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14. °ÎÔ‡‚Ú· ª, ¶ÂÙÚ›‰Ô˘ ∂. ƒˆÙÒ Î·È Ì·ı·›Óˆ ÁÈ· ÙÔ AIDS. ∂ÏÏËÓÈ΋ ∂Ù·ÈÚ›· ∫ÔÈÓˆÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ Î·È ¶ÚÔ·Áˆ-

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Am J Prev Med 2000;18:69-76.

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CASE REPORT

∫˘„ÂÏȉ҉˜ ηÚΛӈ̷ ·ÚˆÙ›‰·˜ Û ·È‰›. ª›· ÂӉȷʤÚÔ˘Û· ÂÚ›ÙˆÛË £. ¡ÙfiÏ·Ù˙·˜, ∞. ∞Ú‚ÂÏ¿Î˘, ∞. ∫·ÌÔ‡ÚË, °. ÷ÚÌ¿Ó˘, ∞. ¶·Ó·Á›‰Ë˜, π. ∞ÏÂÍ¿Ó‰ÚÔ˘, ¡. §·˚Ó¿Î˘, ™. ª·ÚÌ·Á·‰¿ÎË

Acinic cell carcinoma of the parotid gland: a case report Th. Dolatzas, A. Arvelakis, A. Kambouri, G. Harmanis, A. Panagidis, I. Alexandrou, N. Lainakis, S. Barbagadaki

¶ÂÚ›ÏË„Ë: ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ÂÓfi˜ 12¯ÚÔÓÔ˘ ÎÔÚÈÙÛÈÔ‡ Ô˘ ·ÚÔ˘ÛÈ¿ÛÙËΠ̛̠· „ËÏ·ÊËÙ‹ Ì¿˙· ÛÙËÓ ·ÚÈÛÙÂÚ‹ ÁÓ·ıÔÚÔÛˆÈ΋ ÂÚÈÔ¯‹. ∏ ·ÎÙÈÓÔÏÔÁÈ΋ ÂÎÙ›ÌËÛË ¤‰ÂÈÍ fiÙÈ ÚfiÎÂÈÙ·È ÁÈ· ·ÚˆÙȉÈ΋ Ì¿˙· Î·È Ë ·ÛıÂÓ‹˜ ˘‚ϋıË Û ÔÏÈ΋ ·ÚˆÙȉÂÎÙÔÌ‹. ∏ ÈÛÙÔÏÔÁÈ΋ ÂͤٷÛË ¤‰ÂÈÍ fiÙÈ ÚfiÎÂÈÙ·È ÁÈ· ηÚΛӈ̷ ·fi ΢„ÂÏȉˆÙ¿ ·ÙÙ·Ú· Ù˘ ·ÚˆÙ›‰·˜.

Abstract: A case of a 12-year-old girl is presented who was admitted with palpable mass in the left maxilofacial area. The radiologic evaluation showed a parotid mass and the patient underwent total parotidectomy. The histology revealed acinic cell carcinoma of the parotid gland.

§¤ÍÂȘ ÎÏÂȉȿ: ·ÚˆÙ›‰·, ÓÂfiÏ·ÛÌ· ÛÈÂÏÔÁfiÓˆÓ ·‰¤ÓˆÓ, ηÚΛӈ̷ ·fi ΢„ÂÏÔÂȉ‹ ·ÙÙ·Ú· ÛÙ· ·È‰È¿.

Key words: parotid gland, salivary neoplasm, acinic cell carcinoma.

∂ÈÛ·ÁˆÁ‹ OÈ fiÁÎÔÈ Ù˘ ·ÚˆÙ›‰·˜ Â›Ó·È Û¿ÓÈÔÈ ÛÙËÓ ·È‰È΋ ËÏÈΛ· Î·È ‰È·Ê¤ÚÔ˘Ó ÛËÌ·ÓÙÈο ÛÙÔÓ Ù‡Ô Î·È ÙË Û˘¯ÓfiÙËÙ· ·Ó¿ÌÂÛ· Û ·È‰È¿ Î·È ÂÓ‹ÏÈΘ.

OÈ ÂÚÈÛÛfiÙÂÚÔÈ Û˘Ì·Á›˜ fiÁÎÔÈ Ù˘ ·ÚˆÙ›‰·˜ ÛÙËÓ ·È‰È΋ ËÏÈΛ· ¤¯Ô˘Ó ·ÁÁÂȷ΋ ÚԤϢÛË, ÂÓÒ ÔÈ ˘fiÏÔÈÔÈ Â›Ó·È Î·ÎÔ‹ıÂȘ ‹ ‰˘ÓËÙÈο ηÎÔ‹ıÂȘ. ∆Ô ·‰ÂÓÔηÚΛӈ̷ ·fi ΢„ÂÏÔÂȉ‹ ·ÙÙ·Ú· ·ÔÙÂÏ› ÙÔ 4% ÙˆÓ ÓÂÔÏ·ÛÌ¿ÙˆÓ Ù˘ ·ÚˆÙ›‰·˜ ÛÙ· ·È‰È¿. ¶·ÚÔ˘ÛÈ¿˙Ô˘Ì ¤Ó· ÂÚÈÛÙ·ÙÈÎfi 12¯ÚÔÓÔ˘ ÎÔÚÈÙÛÈÔ‡ Ì ηÚΛӈ̷ ·fi ΢„ÂÏÔÂȉ‹ ·ÙÙ·Ú· Ù˘ ·ÚˆÙ›‰·˜ Î·È ·Ú·ı¤ÙÔ˘Ì ÙË Û¯ÂÙÈ΋ ‚È‚ÏÈÔÁÚ·Ê›·.

21,5 cm Î·È ÂÚÈ‚·ÏÏfiÙ·Ó ÌÂÚÈÎÒ˜ ·fi ο„·. ™Â ÙÔÌ‹ ·ÚÔ˘Û›·˙ ¿ÛÚÔ ÁÎÚÈ ¯ÚÒÌ· Î·È Û˘Ì·Á‹ ˘Ê‹. ∏ ÈÛÙÔÏÔÁÈ΋ Î·È Ë ·ÓÔÛÔ˚ÛÙÔ¯ËÌÈ΋ (keratine 7,20,19, high molecular keratine, EMA, CEA,S-100 proteine, actine, GFAP, A1-antithrypsine, lysozyme) ÂͤٷÛË ¤‰ÂÈÍ·Ó ¤Ó· ÙÌ‹Ì· Ù˘ ·ÚˆÙ›‰·˜ Ó· ¤¯ÂÈ ·‰ÂÓÔηÚΛӈ̷ ·fi ΢„ÂÏȉˆÙ¿ ·ÙÙ·Ú·. ∂Âȉ‹ ÙÔ ·‰ÂÓÔηÚΛӈ̷ ·fi ΢„ÂÏȉˆÙ¿ ·ÙÙ·Ú· ¤¯ÂÈ Î·ÎÔ‹ıË Û˘ÌÂÚÈÊÔÚ¿, ·ÔÊ·Û›ÛÙËΠÂ·ÓÂ¤Ì‚·ÛË ÌÂÙ¿ ·fi 30 Ë̤Ú˜, fiÔ˘ Ú·ÁÌ·ÙÔÔÈ‹ıËΠÔÏÈ΋ ·ÚˆÙȉÂÎÙÔÌ‹. ∏ Â¤Ì‚·ÛË ¤ÁÈÓ ¤Ó· Ì‹Ó· ÌÂÙ¿ ·fi ÙËÓ ÚÒÙË, ÁÈ·Ù› fiÏÔ˜ Ô ·ÎÙÈÓÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ì CT Î·È MRI ‰ÂÓ ¤‰ÂÈÍ·Ó ÌÂÙ·ÛÙ·ÙÈΤ˜ ÂÛٛ˜. ∏ ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ ÔÚ›· ‹Ù·Ó ÔÌ·Ï‹. ŒÓ· ¯ÚfiÓÔ ÌÂÙ¿, Ë ·ÛıÂÓ‹˜ Â›Ó·È ·fiÏ˘Ù· ˘ÁÈ‹˜ Î·È ÛÙÔÓ Â·Ó¤ÏÂÁ¯Ô ‰ÂÓ ·ÚÔ˘ÛÈ¿ÛÙËΠԇÙ ˘fiÏÂÈÌÌ·, Ô‡Ù ˘ÔÙÚÔ‹ Ù˘ ÓfiÛÔ˘.

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ŒÓ· 12¯ÚÔÓÔ ÎÔÚ›ÙÛÈ ÚÔÛ‹Ïı ÛÙËÓ ÎÏÈÓÈ΋ Ì ̛· ·ÓÒ‰˘ÓË ‰ÈfiÁΈÛË ÛÙËÓ ÂÚÈÔ¯‹ Ù˘ ·ÚˆÙ›‰·˜. ∏ ÎÏÈÓÈ΋, ÂÚÁ·ÛÙËÚȷ΋ Î·È ·ÎÙÈÓÔÏÔÁÈ΋ ÂͤٷÛË ‰ÂÓ ·Ó¤‰ÂÈÍ οÔÈ· ¿ÏÏË ·ıÔÏÔÁÈ΋ ÔÓÙfiÙËÙ·. ŒÁÈÓÂ Ë ÂÈÛ·ÁˆÁ‹ Ù˘ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô Î·È ˘‚ϋıË Û ÙÔÈ΋ ÂÎÙÔÌ‹ Ù˘ Ì¿˙·˜ ˘fi ÁÂÓÈ΋ ·Ó·ÈÛıËÛ›·.

H Ì¿˙·, Ô‚¿Ï Û¯‹Ì·ÙÔ˜, ›¯Â ‰È·ÛÙ¿ÛÂȘ 2,5 x ∞’ ¶·È‰Ô¯ÂÈÚÔ˘ÚÁÈ΋ ∫ÏÈÓÈ΋, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó·

gland

™˘˙‹ÙËÛË OÈ fiÁÎÔÈ ÙˆÓ ÛÈÂÏÔÁfiÓˆÓ ·‰¤ÓˆÓ Â›Ó·È Û¿ÓÈÔÈ ÛÙ· ·È‰È¿. ∞ÔÙÂÏÔ‡Ó ÏÈÁfiÙÂÚÔ ·fi ÙÔ 8% ÙˆÓ ·È‰È·ÙÚÈÎÒÓ fiÁÎˆÓ Ù˘ ÎÂÊ·Ï‹˜ Î·È ÙÔ˘ ÙÚ·¯‹ÏÔ˘ (1). ™Â ·Ó·ÛÎÔÈÎfi ¿ÚıÚÔ Ô˘ ÂÚÈÏ·Ì‚¿ÓÂÈ 1st Pediatric Surgery Clinic, “Agia Sophia” Children’s Hospital, Athens

439

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ÛÙÔȯ›· ·fi 6 ÂÚ¢ÓËÙÈο ΤÓÙÚ· ·Ó·Ê¤ÚÂÙ·È fiÙÈ ÏÈÁfiÙÂÚÔ ·fi ÙÔ 5% ÙˆÓ fiÁÎˆÓ ÙˆÓ ÛÈÂÏÔÁfiÓˆÓ ·‰¤ÓˆÓ ·Ó·Ê¤ÚÂÙ·È ÛÙ· ·È‰È¿ (2). OÈ ÈÔ Û˘¯Ó¤˜ ‚Ï¿‚˜ ÙˆÓ ÛÈÂÏÔÁfiÓˆÓ ·‰¤ÓˆÓ ÛÙ· ·È‰È¿ Â›Ó·È ÊÏÂÁÌÔÓÒ‰Ô˘˜ ·ÈÙÈÔÏÔÁ›·˜, fiˆ˜ Ë ·ÚˆÙ›Ùȉ· (3). ∞ÁÁÂȷΤ˜ ‚Ï¿‚˜, fiˆ˜ ÏÂÌÊ·ÁÁÂÈÒÌ·Ù· Î·È ·ÈÌ·ÁÁÂÈÒÌ·Ù·, Â›Ó·È ÔÈ ÈÔ Û˘¯Ó¤˜ ·Èٛ˜ ‰ÈÔÁÎÒÛÂˆÓ ÙÚ·¯ËÏÈ΋˜ ¯ÒÚ·˜ ÛÙ· ÓÂÔÁÓ¿ Î·È Ù· ‚Ú¤ÊË. ∆Ô ÔÛÔÛÙfi ÙˆÓ Î·ÎÔ‹ıˆÓ fiÁÎˆÓ ÛÙ· ·È‰È¿ Î˘Ì·›ÓÂÙ·È ·fi 35-40% (4), ÂÓÒ ÛÙÔ˘˜ ÂÓ‹ÏÈΘ ÙÔ ÔÛÔÛÙfi ·˘Ùfi Î˘Ì·›ÓÂÙ·È ·fi 15-25% (5). ∏ Û˘ÓÙÚÈÙÈ΋ ÏÂÈÔ„ËÊ›· ÙˆÓ fiÁÎˆÓ ÙˆÓ ÛÈÂÏÔÁfiÓˆÓ ·‰¤ÓˆÓ ÛÙ· ·È‰È¿ ÂÌÊ·Ó›˙ÂÙ·È ÛÙËÓ ·ÚˆÙ›‰· Û ÔÛÔÛÙfi 87,1% Î·È ÛÙÔÓ ˘ÔÁÓ¿ıÈÔ ·‰¤Ó· Û ÔÛÔÛÙfi 11,7% (6). ¶·Ú·ÙËÚÂ›Ù·È ›ÛË Î·Ù·ÓÔÌ‹ ·Ó¿ÌÂÛ· Û ·ÁfiÚÈ· Î·È ÎÔÚ›ÙÛÈ·. OÈ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ ÂÈıËÏÈ·ÎÒÓ fiÁÎˆÓ ÙˆÓ ÛÈÂÏÔÁfiÓˆÓ ·‰¤ÓˆÓ ÛÙÔÓ ·È‰È·ÙÚÈÎfi ÏËı˘ÛÌfi ÂÌÊ·Ó›˙ÔÓÙ·È ·fi Ù· 8 ˆ˜ Ù· 20 ¯ÚfiÓÈ·. ∏ ̤ÛË ËÏÈΛ· ÁÈ· ÙË ¯ÂÈÚÔ˘ÚÁÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ Î·ÏÔ‹ıˆÓ fiÁÎˆÓ Â›Ó·È Ù· 15,4 ¯ÚfiÓÈ·, ÂÓÒ ÁÈ· ÙÔ˘˜ ηÎÔ‹ıÂȘ fiÁÎÔ˘˜ Â›Ó·È Ù· 10,5 ¯ÚfiÓÈ· (6). ™‡Ìʈӷ Ì ÔÏϤ˜ ÌÂϤÙ˜ ÂÚ¢ÓËÙÈÎÒÓ Î¤ÓÙÚˆÓ Ô˘ ·Ú·ı¤ÙÔ˘Ó ÛÂÈÚ¤˜ ÂÚÈÛÙ·ÙÈÎÒÓ Î·ÎÔ‹ıˆÓ fiÁÎˆÓ ·ÚˆÙ›‰·˜, ÔÈ fiÁÎÔÈ ·˘ÙÔ› Ù·ÍÈÓÔÌÔ‡ÓÙ·È ÛÙȘ ÂÍ‹˜ ηÙËÁÔڛ˜: ΢ÛÙÈÎfi ·‰ÂÓÔÂȉ¤˜ ηÚΛӈ̷, ‚ÏÂÓÓÔÂȉÂÚÌÔÂȉ¤˜ ηÚΛӈ̷, ΢„ÂÏȉˆÙfi ηÚΛӈ̷, ÔÚ҉˜ ηÚΛӈ̷, ·‰ÂÓÔηÚΛӈ̷, ÏÂȉÔÂȉ¤˜ ηÚΛӈ̷, Ú·‚‰ÔÌ˘ÔÛ¿ÚΈ̷ Î·È Û¿ÚΈ̷ (7,8). ∆Ô Î˘„ÂÏȉˆÙfi ηÚΛӈ̷ ·ÔÙÂÏ› ÂÚ›Ô˘ ÙÔ 4% fiÏˆÓ ÙˆÓ ·ÚˆÙȉÈÎÒÓ fiÁÎˆÓ Î·È ÙÔ 12% ÙˆÓ Î·ÎÔ‹ıˆÓ fiÁÎˆÓ ÛÙ· ·È‰È¿ (9). ¶·ÚfiÌÔÈ· ÔÛÔÛÙ¿ ·Ó·Ê¤ÚÔÓÙ·È Î·È ÛÙÔ˘˜ ÂÓ‹ÏÈΘ. ∂›Ó·È ÂÍ·ÈÚÂÙÈο Û¿ÓÈ· οو ·fi ÙËÓ ËÏÈΛ· ÙˆÓ 16 ¯ÚfiÓˆÓ (10). §fiÁˆ Ù˘ Û·ÓÈfiÙËÙ·˜, Á›ÓÂÙ·È ·Ó·‰ÚÔÌ‹ ÛÙËÓ ÂÏÏËÓÈ΋ Î·È ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›· Î·È ·ÚÔ˘Û›·ÛË Ù˘ Û˘ÁÎÂÎÚÈ̤Ó˘ ÂÚ›ÙˆÛ˘.

Paediatriki 2002;65:439-441

∏ ·ıÔÁ¤ÓÂÛË ·˘Ù‹˜ Ù˘ Û¿ÓÈ·˜ ÔÓÙfiÙËÙ·˜ ‰ÂÓ Â›Ó·È ÂÍ·ÎÚÈ‚ˆÌ¤ÓË, ηıÒ˜ ‰ÂÓ ¤¯ÂÈ ÌÂÏÂÙËı› ȉȷ›ÙÂÚ·. °È· ÙËÓ ·Ó¿Ù˘Í‹ Ù˘ ÂÓÔ¯ÔÔÈÔ‡ÓÙ·È Ë ·ÎÙÈÓÔ‚ÔÏ›· (11), Ë ¯ËÌÂÈÔıÂÚ·›·, Ë ¯Ú‹ÛË ·Ï΢ÏÈÎÒÓ ·Ú·ÁfiÓÙˆÓ Ô˘ ıˆÚÔ‡ÓÙ·È ‰˘ÓËÙÈο ηÚÎÈÓÔÁfiÓÔÈ, ·ÏÏ¿ Î·È ÔÈ ÏÔÈÌÒÍÂȘ ·fi ÙÔÓ Èfi Epstein Barr (12). ™˘Ó‹ıˆ˜, ÔÈ fiÁÎÔÈ Â›Ó·È ÌÔÓ‹ÚÂȘ, ηϿ ·ÊÔÚÈṲ̂ÓÔÈ, Û¿ÓÈ· ÔÏ˘Ô˙Ò‰ÂȘ. ∆Ș ÂÚÈÛÛfiÙÂÚ˜ ÊÔÚ¤˜ ÂÚÈ‚¿ÏÏÔÓÙ·È ÌÂÚÈÎÒ˜ ·fi ο„·. ªÈÎÚÔÛÎÔÈο, Û˘¯Ó¿ ¤¯Ô˘Ó ηÏÔ‹ıË fi„Ë Ì ÌÈÎÚfi ΢ÙÙ·ÚÈÎfi ÏÂÈÔÌÔÚÊÈÛÌfi. ∆Ô ˘fiÛÙڈ̷ Â›Ó·È ÎÚ˘ÛÙ·ÏÏÔÂȉ¤˜, ·ÁÁÂÈ·Îfi Î·È ÌÔÚ› Ó· ÂÚȤ¯ÂÈ ÏÂÌÊÈÎfi ÈÛÙfi. ∆· ·ÙÙ·Ú· Û˘Ó‹ıˆ˜ ¤¯Ô˘Ó ¿ÊıÔÓÔ ÎÔÎÎ҉˜ ΢ÙÙ·ÚfiÏ·ÛÌ· Ô˘ ÌÔÈ¿˙ÂÈ Ì ÔÚÒ‰Ë Î˘„ÂÏ›‰·. ª·˙› Ì ٷ ÎÔÎÎÒ‰Ë Î‡ÙÙ·Ú· ÌÔÚ›, Â›Û˘, Ó· ˘¿Ú¯Ô˘Ó ηı·Ú¿ ·ÙÙ·Ú·, ÎÂÓÔÙÔÈÒ‰Ë ÔÚÒ‰Ë Î‡ÙÙ·Ú· Î·È ÎÂÓÔÙÔÈ҉˜ ¿Ù˘Ô ·‰ÂÓÔÂȉ¤˜ ÂÈı‹ÏÈÔ. Œ¯Ô˘Ó ·Ó·ÊÂÚı›, Â›Û˘, ΢„ÂÏȉˆÙ¿ ηÚÎÈÓÒÌ·Ù· ·fi ·Ôχو˜ ηı·Ú¿ ·ÙÙ·Ú·. ¢ÔÌÈΤ˜, ÈÛÙÔ¯ËÌÈΤ˜ Î·È ÌÔÚÊÔÏÔÁÈΤ˜ ÌÂϤÙ˜ ¤‰ÂÈÍ·Ó fiÙÈ ÙÔ Î‡ÚÈÔ Î‡ÙÙ·ÚÔ Â›Ó·È ÙÔ ·ÚÂÌ‚·ÏÏfiÌÂÓÔ ÔÚ҉˜ ·ÙÙ·ÚÔ (13). ™ÙȘ ÈÛÙÔÏÔÁÈΤ˜ ÂÈÎfiÓ˜ Ù˘ Û˘ÁÎÂÎÚÈ̤Ó˘ ÂÚ›ÙˆÛ˘ (∂ÈÎfiÓ· 1 Î·È 2) ·ÚÔ˘ÛÈ¿˙ÂÙ·È Ë ÈÛÙÔÏÔÁÈ΋ ÂÈÎfiÓ· ÙÔ˘ ΢„ÂÏȉˆÙÔ‡ ηÚÎÈÓÒÌ·ÙÔ˜ Ù˘ ·ÚˆÙ›‰·˜ Ô˘ ·ÓÙÈÌÂÙˆ›ÛÙËΠÛÙËÓ ÎÏÈÓÈ΋, Ë ÔÔ›· Û˘Ì‚·‰›˙ÂÈ Ì ·˘Ù‹ Ô˘ ·Ó·Ê¤ÚÂÙ·È ÛÙË ‚È‚ÏÈÔÁÚ·Ê›·. ¶·Ú·ÙËÚÔ‡ÓÙ·È ÓÂÔÏ·ÛÌ·ÙÈο ·ÙÙ·Ú· Ì ÎÔÎÎ҉˜ Î·È Î·ı·Úfi ΢ÙÙ·ÚfiÏ·ÛÌ· Î·È ÌÈÎÚÔ΢ÛÙÈÎÔ‡˜ ¯ÒÚÔ˘˜ Ô˘ ·ÚÂÌ‚¿ÏÏÔÓÙ·È ·Ó¿ÌÂÛ¿ ÙÔ˘˜. ™‡Ìʈӷ Ì ÙËÓ Î·ÎÔ‹ıË ‰˘Ó·ÙfiÙËÙ¿ ÙÔ˘˜, ÔÈ fiÁÎÔÈ Ù˘ ·ÚˆÙ›‰·˜ ·fi ΢„ÂÏȉˆÙ¿ ·ÙÙ·Ú· ¯ˆÚ›˙ÔÓÙ·È ÛÂ: ÚÒÙÔ˘ ‚·ıÌÔ‡ (̤ÙÚÈ·˜ ηÎÔ‹ıÂÈ·˜) Ì ηÌÈ¿ ÙÔÈ΋ ‰È‹ıËÛË, ‰Â˘Ù¤ÚÔ˘ ‚·ıÌÔ‡ (̤ÙÚÈ·˜ ηÎÔ‹ıÂÈ·˜) fiÔ˘ ÚfiÎÂÈÙ·È ÁÈ· fiÁÎÔ˘˜ Ô˘ ‰Â›¯ÓÔ˘Ó ÛËÌ›· ‰È‹ıËÛ˘ Ù˘ ο„·˜ ηÈ

∂ÈÎfiÓ· 1 Î·È 2. πÛÙÔÏÔÁÈ΋ ÂÈÎfiÓ·: ·Ú·ÙËÚÔ‡ÓÙ·È ÓÂÔÏ·ÛÌ·ÙÈο ·ÙÙ·Ú· Ì ÎÔÎÎ҉˜ ΢ÙÙ·ÚfiÏ·ÛÌ·, ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ ΢„ÂÏȉÈÎÔ‡ ηÚÎÈÓÒÌ·ÙÔ˜ Ù˘ ·ÚˆÙ›‰·˜.

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¶·È‰È·ÙÚÈ΋ 2002;65:439-441

ÙÚ›ÙÔ˘ ‚·ıÌÔ‡ (˘„ËÏÔ‡ ‚·ıÌÔ‡ ηÎÔ‹ıÂÈ·˜) ÁÈ· ÙÔ˘˜ fiÁÎÔ˘˜ Ô˘ ¤¯Ô˘Ó ıËÏÒ‰ÂȘ ΢ÛÙÈΤ˜ ˙ÒÓ˜ Î·È ‰ÈËı‹ÛÂȘ Û ÁÂÈÙÔÓÈÎÔ‡˜ ÈÛÙÔ‡˜ (9). ∆Ô Î·ÚΛӈ̷ ·fi ΢„ÂÏȉˆÙ¿ ·ÙÙ·Ú· ÌÂı›ÛÙ·Ù·È Û ÔÛÔÛÙfi 5-10% Û ÙÔÈÎÔ‡˜ ÏÂÌÊ·‰¤Ó˜ Î·È Û ·ÔÌ·ÎÚ˘Ṳ̂ӷ fiÚÁ·Ó· (Ó‡ÌÔÓ˜ Î·È ÔÛÙ¿). ∏ Ì¿˙· ÛÙËÓ ·ÚˆÙ›‰· Â›Ó·È ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÊÔÚ¤˜ ·ÓÒ‰˘ÓË Î·È ÌÂÁ·ÏÒÓÂÈ ·ÚÁ¿, fiˆ˜ ÛÙËÓ ·ÚÔ‡Û· ÂÚ›ÙˆÛË. ™Â Û¿ÓȘ ÂÚÈÙÒÛÂȘ, ·ÚÔ˘ÛÈ¿˙ÂÙ·È Ì ¿ÏÁÔ˜, ÁÚ‹ÁÔÚË ·Ó¿Ù˘ÍË, ¿ÚÂÛË ÚÔÛˆÈÎÔ‡ Ó‡ÚÔ˘ ‹ ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ·, Û˘ÌÙÒÌ·Ù· Î·È ÛËÌ›· Ô˘ Û˘Ó‹ıˆ˜ Ô‰ËÁÔ‡Ó ÙÔ ÁÈ·ÙÚfi ÛÙË ÛΤ„Ë ÁÈ· ηÎÔ‹ıÂÈ·. ™˘Ó‹ıˆ˜, Ë ‰È¿ÁÓˆÛË ‰ÂÓ Â›Ó·È Â‡ÎÔÏË. ∂›Ó·È ‰‡ÛÎÔÏÔ ·fi ÙË Ê˘ÛÈ΋ ÂͤٷÛË Ó· ·Ó·ÁÓˆÚ›ÛÔ˘Ì ÙË Ê‡ÛË Ù˘ Ì¿˙·˜ (4). ∏ ‚ÈÔ„›· ‰È¿ ‚ÂÏfiÓ˘ (FNA) Â›Ó·È ¯Ú‹ÛÈÌË ÛÙËÓ ÂÎÙ›ÌËÛË ÙˆÓ fiÁÎˆÓ Î·È ‰Â›¯ÓÂÈ Ó· ¤¯ÂÈ ·ÎÚ›‚ÂÈ· 91% Î·È Â˘·ÈÛıËÛ›· 96% fiÙ·Ó ˘¿Ú¯Ô˘Ó ·ÙÙ·Ú· Ô˘ ¤¯Ô˘Ó ÚÔÛ‚ÏËı›. ¶ÔÏÏÔ› Û˘ÁÁÚ·Ê›˜, ˆÛÙfiÛÔ, ÈÛÙÂ‡Ô˘Ó fiÙÈ Ë ¯ÚËÛÈÌfiÙËÙ· Ù˘ FNA Â›Ó·È ˘fi Û˘˙‹ÙËÛË (13). ∏ ‚ÈÔ„›· ‰È¿ ‚ÂÏfiÓ˘ Û ¤Ó· ÌË Û˘ÓÂÚÁ¿ÛÈÌÔ ·È‰› Â›Ó·È ÂÈΛӉ˘ÓË, ÁÈ·Ù› ˘¿Ú¯ÂÈ Ë Èı·ÓfiÙËÙ· οΈÛ˘ ÙÔ˘ ÚÔÛˆÈÎÔ‡ Ó‡ÚÔ˘. ∂›Û˘, Ë ·ÎÚ›‚ÂÈ· ·˘Ù‹˜ Ù˘ ÂͤٷÛ˘ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË ÛÙÔ ÏÂÈÔÌÔÚÊÈÎfi ·‰¤ÓˆÌ·, ·Ú¿ ÛÙÔ Î˘„ÂÏȉˆÙfi ηÚΛӈ̷. °È· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ì›·˜ Ù¤ÙÔÈ·˜ ηٿÛÙ·Û˘, Û‡Ìʈӷ Î·È Ì ÙË ‚È‚ÏÈÔÁÚ·ÊÈ΋ ·Ó·ÛÎfiËÛË Ô˘ Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ, ·ÊÔ‡ ¤¯Ô˘Ó ·ÔÎÏÂÈÛÙ› ÊÏÂÁÌÔÓÒ‰ÂȘ ηٷÛÙ¿ÛÂȘ, Ô ÈÔ ÛˆÛÙfi˜ ÙÚfiÔ˜ Â›Ó·È Ó· ÂÍ·ÈÚÂı› Ë Ì¿˙· Î·È Ó· Á›ÓÂÈ Ì›· ÈÛÙÔÏÔÁÈ΋ ÂͤٷÛË. ∂¿Ó ·˘Ù‹ Â›Ó·È ·ÎfiÌË ˘fi ·ÌÊÈÛ‚‹ÙËÛË, Ë ÔÚÈÛÙÈ΋ Â¤Ì‚·ÛË Ú¤ÂÈ Ó· ηı˘ÛÙÂÚ‹ÛÂÈ. ∏ Â¤Ì‚·ÛË ÂÎÏÔÁ‹˜ ÁÈ· ÙÔ Î·ÚΛӈ̷ ·fi ΢„ÂÏȉˆÙ¿ ·ÙÙ·Ú· Â›Ó·È Î˘Ú›ˆ˜ ¯ÂÈÚÔ˘ÚÁÈ΋. ¶ÔÏÏÔ› Û˘ÁÁÚ·Ê›˜ ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ ··ÈÙÂ›Ù·È ÔÏÈ΋ ·ÚˆÙȉÂÎÙÔÌ‹, Ì ‰È·Ù‹ÚËÛË ÙÔ˘ ÚÔÛˆÈÎÔ‡ Ó‡ÚÔ˘. ∏ ÂÎÙÔÌ‹ ÙÔ˘ ÚÔÛˆÈÎÔ‡ Ó‡ÚÔ˘ Â›Ó·È ·Ó·fiÊ¢ÎÙË, fiÙ·Ó Ô fiÁÎÔ˜ ‰ÈËı› Ó¢ÚÈΤ˜ ·ÔÏ‹ÍÂȘ (9). ∏ ÂÎÙÔÌ‹ ÙˆÓ Ï¿ÁÈˆÓ ÙÚ·¯ËÏÈÎÒÓ ÏÂÌÊ·‰¤ÓˆÓ Ô˘ ÚÔÙ¿ıËΠ·fi ÙÔÓ Eneroth (14) Ú¤ÂÈ Ó· ÂÊ·ÚÌfi˙ÂÙ·È ÌfiÓÔ Û ·ÛıÂÓ›˜ Ô˘ ¤¯Ô˘Ó ÂÎÛÂÛËÌ·Ṳ̂ÓË ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ·. ∏ ·ÎÙÈÓÔıÂÚ·›· Â›Ó·È ˘fi ·ÌÊÈÛ‚‹ÙËÛË Î·È ÌÔÚ› Ó· ¯ÚËÛÈÌÔÔÈËı› ÌfiÓÔ Û ÂÚÈÙÒÛÂȘ ÙÔÈο ·Ó·Ù˘Á̤Ó˘ ÓfiÛÔ˘ ˆ˜ ·Ó·ÎÔ˘ÊÈÛÙÈ΋ ̤ıÔ‰Ô˜ (14,15). ∏ ÓÔÛËÚfiÙËÙ· ·fi ÙËÓ ÔÏÈ΋ ·ÚˆÙȉÂÎÙÔÌ‹ ÛÙ· ·È‰È¿ Â›Ó·È ÂÍ·ÈÚÂÙÈο ÌÈÎÚ‹. ∆Ô Û‡Ó‰ÚÔÌÔ Frey ·Ó·Ê¤ÚÂÙ·È ÛÙȘ ÌÈÛ¤˜ ÂÚ›Ô˘ ÂÚÈÙÒÛÂȘ Î·È Ù· ·Ú¿ÔÓ· ÁÈ· ·È̈‰›Â˜ ÛÙÔ ÚfiÛˆÔ ·Ú·ÙËÚÔ‡ÓÙ·È ÛÙÔ ¤Ó· ÙÚ›ÙÔ. ÀÂÚÙÚÔÊÈ΋ Ô˘Ï‹ ·Ó·Ì¤ÓÂÙ·È ÛÙÔ ¤Ó· ¤ÌÙÔ ÙˆÓ ·ÛıÂÓÒÓ. ∏ Û˘-

Paediatriki 2002;65:439-441

¯ÓfiÙËÙ· Ù˘ ÂÌÊ¿ÓÈÛ˘ ÌfiÓÈÌ˘ ·‰˘Ó·Ì›·˜ ÙÔ˘ ÚÔÛˆÈÎÔ‡ Â›Ó·È Û¿ÓÈ·, ÂÎÙfi˜ ·Ó ˘¿Ú¯ÂÈ Î·ÎÔ‹ı˘ ‰È‹ıËÛË ÙÔ˘ Ó‡ÚÔ˘ (15). ∏ ÂÓÙ·ÂÙ‹˜ ÂÈ‚›ˆÛË ÌÂÙ¿ ÙËÓ ·ÚˆÙȉÂÎÙÔÌ‹ Î˘Ì·›ÓÂÙ·È ·fi 89-96%. ∏ Û˘¯ÓfiÙËÙ· ·˘Ù‹ ÛÙËÓ ÂÈÎÔÛ·ÂÙ›· ¤ÊÙÂÈ ÛÙÔ 56% (14,15). µÈ‚ÏÈÔÁÚ·Ê›· 1. Kessler A, Handler SD. Salivary gland neoplasms in children: a 10-year survey at the Children’s Hospital of Philadelphia.

Int J Pediatr Otorhinolaryngol 1994;29:195-202.

2. Luna MA, Batsakis JG, el-Naggar AK. Salivary gland tumors in children. Ann Otol Rhinol Laryngol 1991;100:869-871.

3. Krolls SO, Trodahl JN, Boyers RC. Salivary gland lesions in children: a survey of 430 cases. Cancer 1972;30:459-469.

4. Orvidas LJ, Kasperbauer JL, Lewis JE, Olsen KD, Lesnick TG. Pediatric parotid masses. Arch Otolaryngol Head Neck Surg 2000;126:177-184.

5. Baker SR, Malone B. Salivary gland malignancies in children. Cancer 1985;55:1730-1736.

6. Dahlqvist A, Ostberg Y. Malignant salivary gland tumors in children. Acta Otolaryngol 1982;94:175-179.

7. Rogers DA, Rao BN, Bowman L, Marina N, Fleming ID, Schropp KP et al. Primary malignancy of the salivary gland in children. J Pediatr Surg 1994;29:44-47.

8. Callender DL, Frankenthaler RA, Luna MA, Lee SS, Goepfert H. Salivary gland neoplasms in children. Arch Otolaryngol Head Neck Surg 1992;118:472-476.

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CASE REPORT

™‡Ó‰ÚÔÌÔ Swyer-James (Mac Leod): Û¿ÓÈ· ÂÈÏÔ΋ Û ‚Ú¤ÊÔ˜ ÌÂÙ¿ Ïԛ̈ÍË ·fi ÎÔηÙË °. ∆Ú›Ì˘1, ª. £ÂÔ‰ˆÚ›‰Ô˘1, °. ªÔÛÙÚÔ‡1, ∫. ∫·Î·‚¿Î˘2

Swyer-James (Mac Leod) syndrome: a rare complication in an infant following pertussis infection G. Trimis1, M. Theodoridou1, G. Mostrou1, K. Kakavakis2

¶ÂÚ›ÏË„Ë: ¶ÂÚÈÁÚ¿ÊÂÙ·È ÂÚ›ÙˆÛË ¿ÚÚÂÓÔ˜ ‚Ú¤ÊÔ˘˜ 8 ÌËÓÒÓ Ô˘ ÂÌÊ¿ÓÈÛ ÙËÓ Ù˘È΋ ·ÎÙÈÓÔÏÔÁÈ΋ ÂÈÎfiÓ· ÙÔ˘ ÂÙÂÚfiÏ¢ÚÔ˘ ˘Âډȷ˘Á¿˙ÔÓÙ· Ó‡ÌÔÓ· ‹ Û˘Ó‰ÚfiÌÔ˘ Swyer-James (Mac Leod). ∆Ô ‚Ú¤ÊÔ˜ ÚÔÛ‚Ï‹ıËΠ·fi ÎÔηÙË Û ËÏÈΛ· 20 ËÌÂÚÒÓ Î·È ·ÎÔÏÔ‡ıˆ˜ ÂΉ‹ÏˆÓÂ Û˘¯Ó¿ ÏÔÈÌÒÍÂȘ ÙÔ˘ ηÙÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ̤¯ÚÈ ÙËÓ ÂÁηٿÛÙ·ÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘. ŒÁÈÓ Ï‹Ú˘ ·ÎÙÈÓÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ Î·È Ë ·ÓÙÈÌÂÙÒÈÛË Â›Ó·È ÚÔ˜ ÙÔ ·ÚfiÓ Û˘ÓÙËÚËÙÈ΋ Ì ·ÓÙÈ·ÛıÌ·ÙÈ΋ ıÂÚ·›·.

Abstract: A case of an 8-month-old male infant is described who developed typical radiographic findings of unilateral hyperlucent lung or SwyerJames (Mac Leod) syndrome. The infant suffered from pertussis when he was 20 days old. He subsequently had recurrent lower respiratory tract infections until the syndrome was established. A complete radiographic investigation was performed. Treatment was conservative with antiasthmatic drugs.

§¤ÍÂȘ ÎÏÂȉȿ: Û‡Ó‰ÚÔÌÔ Swyer-James (Mac Leod), ÂÙÂÚfiÏ¢ÚÔ˜ ‰È·˘Á¿˙ˆÓ Ó‡ÌÔÓ·˜, ÎÔÎ·Ù˘.

Key words: Swyer-James (Mac Leod) syndrome, unilateral hyperlucent lung, pertussis.

∂ÈÛ·ÁˆÁ‹ ∆Ô Û‡Ó‰ÚÔÌÔ Swyer-James (Mac Leod) ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·ÎÙÈÓÔÏÔÁÈο ·fi ÂÙÂÚfiÏ¢ÚÔ ˘Âډȷ˘Á¿˙ÔÓÙ· Ó‡ÌÔÓ·, Û˘Ó‹ıˆ˜ ÌÈÎÚfiÙÂÚÔ˘ ÌÂÁ¤ıÔ˘˜, fiÔ˘ ‰È·ÈÛÙÒÓÂÙ·È ·Á›‰Â˘ÛË ·¤Ú· Î·È ‰Â˘ÙÂÚÔ·ı‹˜ ÌÂȈ̤ÓË ·ÁÁ›ˆÛË (1). ∞Ó Î·È Ë ‰È¿ÁÓˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Ù›ıÂÙ·È ·fi ÙËÓ ·Ï‹ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜, Ë ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· Î·È ÙÔ ÛÈÓıËÚÔÁÚ¿ÊËÌ· ÙˆÓ Ó¢ÌfiÓˆÓ ·Ú¤¯Ô˘Ó ÂÈÚfiÛıÂÙ˜ ÏËÚÔÊÔڛ˜ ÁÈ· ÙËÓ Î·Ù·ÓÔÌ‹ Î·È ÙË ‚·Ú‡ÙËÙ· Ù˘ ÓfiÛÔ˘ (2). ø˜ ·ÈÙÈÔÏÔÁÈÎÔ› ·Ú¿ÁÔÓÙ˜ ÂÓÔ¯ÔÔÈÔ‡ÓÙ·È ÏÔÈÌÒÍÂȘ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Ô˘ Û˘Ì‚·›ÓÔ˘Ó ÛÙË ‚ÚÂÊÈ΋ ËÏÈΛ· ‹ Ï›ÁÔ ÌÂÙ¿ Î·È ÚÔηÏÔ‡Ó ÂÚÈ‚ÚÔÁ¯È΋ ›ÓˆÛË (2,3). OÈ ·ÛıÂÓ›˜ ÂΉËÏÒÓÔ˘Ó ˘ÔÙÚÔÈ¿˙Ô˘Û˜ ÏÔÈÌÒÍÂȘ ÌÂ Û˘ÚÈÁÌfi, ‚‹¯· Î·È ·fi¯ÚÂÌ„Ë, ÌÂ

Û˘¯Ófi Â·ÎfiÏÔ˘ıÔ ÙËÓ ¤ÎÙˆÛË ÙˆÓ Ó¢ÌÔÓÈÎÒÓ ÏÂÈÙÔ˘ÚÁÈÒÓ Î·È ÙËÓ ÚfiÎÏËÛË ‚ÚÔÁ¯ÈÂÎÙ·ÛÈÒÓ Î·È Ó¢ÌÔÓÈÎÒÓ ·ÔÛÙËÌ¿ÙˆÓ. ∏ ·ÓÙÈÌÂÙÒÈÛË Â›Ó·È Î·Ù’ ·Ú¯‹Ó Û˘ÓÙËÚËÙÈ΋ Ì ·ÓÙÈ·ÛıÌ·ÙÈ΋ ıÂÚ·›· ηÈ, Â› ÂӉ›ÍˆÓ, ¯ÂÈÚÔ˘ÚÁÈ΋. ∏ ÚfiÁÓˆÛË Â›Ó·È ÂÈÊ˘Ï·ÎÙÈ΋ (4). ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ‚Ú¤ÊÔ˘˜ Ô˘ ÚÔÛ‚Ï‹ıËΠ·fi ÎÔηÙË Û ËÏÈΛ· 20 ËÌÂÚÒÓ, ·ÎÔÏÔ‡ıˆ˜ ÂÌÊ¿ÓÈÛ ˘ÔÙÚÔÈ¿˙Ô˘Û˜ ·Ó·Ó¢ÛÙÈΤ˜ ÏÔÈÌÒÍÂȘ Î·È 7 Ì‹Ó˜ ÌÂÙ¿ ·ÚÔ˘Û›·Û ÙËÓ Ù˘È΋ ·ÎÙÈÓÔÏÔÁÈ΋ ÂÈÎfiÓ· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘.

1 ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó· 2 ∞ÎÙÈÓÔÏÔÁÈÎfi ∆Ì‹Ì·, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó·

1 1st Pediatric Clinic of University of Athens, “Agia Sophia” Children’s Hospital, Athens 2 Department of Radiology, “Agia Sophia” Children’s Hospital, Athens

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ȉ›ˆ˜ ÙȘ Ó˘¯ÙÂÚÈÓ¤˜ ÒÚ˜, ‰È¿ÚÎÂÈ·˜ 4 ËÌÂÚÒÓ. ¶·Ú·ÙËÚ‹ıËΠÚÔԉ¢ÙÈ΋ Âȉ›ӈÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Î·È ÂΉ‹ÏˆÛË ·ÓÔ˚ÎÒÓ ÎÚ›ÛÂˆÓ 24 ÒÚ˜ ÚÔ Ù˘ ÂÈÛ·ÁˆÁ‹˜ ÙÔ˘. ∞ӷʤÚÂÙ·È fiÙÈ ı›Ԙ ÙÔ˘ ÓÂÔÁÓÔ‡, Ô ÔÔ›Ô˜ ÙÔ ÂÈÛΤÊıËΠ2 ÊÔÚ¤˜ ÛÙÔ Ì·ÈÂ˘Ù‹ÚÈÔ, ·ÚÔ˘Û›·˙ Â›ÌÔÓÔ ÂÚÂıÈÛÙÈÎfi ‚‹¯· ·fi ÌËÓfi˜. ¶ÚfiÎÂÈÙ·È ÁÈ· ÓÂÔÁÓfi Ì ÂχıÂÚÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi, ‰Â‡ÙÂÚÔ ·È‰› Ê·ÈÓÔÙ˘Èο ˘ÁÈÒÓ ÁÔÓ¤ˆÓ Ô˘ ÁÂÓÓ‹ıËΠÌÂÙ¿ ·fi ÙÂÏÂÈfiÌËÓË Î‡ËÛË ¯ˆÚ›˜ ÂÈÏÔΤ˜, Ì ηÈÛ·ÚÈ΋ ÙÔÌ‹. ∏ ÂÚÈÁÂÓÓËÙÈ΋ ÂÚ›Ô‰Ô˜ ‹Ù·Ó ÔÌ·Ï‹ Î·È ÙËÓ ¤ÌÙË Ë̤ڷ ˙ˆ‹˜ ÙÔ ÓÂÔÁÓfi ˘Ô‚Ï‹ıËΠ۠ʈÙÔıÂÚ·›· ÏfiÁˆ ÓÂÔÁÓÈÎÔ‡ ÈÎÙ¤ÚÔ˘. ∫·Ù¿ ÙË Ê˘ÛÈ΋ ÂͤٷÛË ÛÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘, ÙÔ ÓÂÔÁÓfi ‹Ù·Ó ·‡ÚÂÙÔ, ÓˆıÚfi, ÂÏ·ÊÚÒ˜ ·Ê˘‰·ÙˆÌ¤ÓÔ. ∂›¯Â Ù·¯‡ÓÔÈ· (75 ·Ó·ÓÔ¤˜/min), ÎÂÓÙÚÈ΋ Î·È ÂÚÈÊÂÚÈ΋ ΢¿ÓˆÛË Î·Ù¿ ÙȘ ‚˯ÈΤ˜ ÒÛÂȘ, ÂÓÒ Î·Ù¿ ÙËÓ ·ÎÚfi·ÛË ÙˆÓ Ó¢ÌfiÓˆÓ ‰ÂÓ ‰È·ÈÛÙÒıËÎ·Ó ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·. ™ÙË ÁÂÓÈ΋ ·›Ì·ÙÔ˜ ‚Ú¤ıËΠÏÂÌÊÔ΢ÙÙ¿ÚˆÛË, Ht: 42%, Hb: 14,2 gr/dl, WBC: 27300/Ìl (¶: 21%, §: 64%, ª: 15%), PLT: 386000/Ìl. OÈ ‰Â›ÎÙ˜ ÊÏÂÁÌÔÓ‹˜ ‹Ù·Ó ¯·ÌËÏÔ› (∆∫∂: 4 mm, CRP: 20 mg/L) Î·È Ô ‚ÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ê˘ÛÈÔÏÔÁÈÎfi˜. ∏ ·Ï‹ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ ¤‰ÂÈÍ ˘ÂÚ·ÂÚÈÛÌfi ÙˆÓ Ó¢ÌfiÓˆÓ. ∏ ‰È¿ÁÓˆÛË ÙÔ˘ ÎÔηÙË ıˆڋıËΠÈı·Ó‹ Î·È ¯ÔÚËÁ‹ıËΠ·ÓÙÈÎÔÎ΢ÙÈ΋ ıÂÚ·›· Ì ÎÏ·ÚÈıÚÔÌ˘Î›ÓË Î·È Û·Ï‚Ô˘Ù·ÌfiÏË ·fi ÙÔ ÛÙfiÌ· Î·È ‰ÂÍ·ÌÂı·˙fiÓË ÂÓ‰ÔÊÏ‚›ˆ˜. ∆·˘Ùfi¯ÚÔÓ·, ¤ÁÈÓ ÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÁÈ· ·Ó›¯Ó¢ÛË ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ RSV, ·‰ÂÓÔ˚ÒÓ, ÈÒÓ ÁÚ›˘ Î·È ·Ú·ÁÚ›˘, ηıÒ˜ Î·È ¤Ó·ÓÙÈ ÙÔ˘ Chlamydia trachomatis Î·È ÙÔ˘ Ì˘ÎÔÏ¿ÛÌ·ÙÔ˜ hominis. O ›‰ÈÔ˜ ¤ÏÂÁ¯Ô˜ Â·Ó·Ï‹ÊıËÎÂ Î·È ÌÂÙ¿ ·fi 15 Ë̤Ú˜, fï˜ ‹Ù·Ó Î·È ÙȘ ‰‡Ô ÊÔÚ¤˜ ·ÚÓËÙÈÎfi˜. ∏ ηÏÏȤÚÁÂÈ· ÚÈÓÔÊ·Ú˘ÁÁÈÎÔ‡ ÂȯڛÛÌ·ÙÔ˜ ‹Ù·Ó ÛÙ›ڷ ÎÔÈÓÒÓ ‚·ÎÙËÚ›ˆÓ. ™Â ÚÈÓÈÎfi ¤ÎÏ˘Ì· ¤ÁÈÓ ·ÓÔÛÔÊıÔÚÈÛÌfi˜ ÁÈ· ·Ó›¯Ó¢ÛË ÙÔ˘ ·ÓÙÈÁfiÓÔ˘ ÙÔ˘ RSV Ô˘ ‹Ù·Ó ·ÚÓËÙÈÎfi˜ Î·È PCR ‰‡Ô Á‡ÚˆÓ (nested PCR) Ì ÙË Ì¤ıÔ‰Ô TaqMan ÁÈ· ÂÓÙÔÈÛÌfi ̤ÚÔ˘˜ ÙÔ˘ ÁÔÓȉÈÒÌ·ÙÔ˜ ÙÔ˘ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡ Bordetella pertussis. ª¤Ûˆ Ù˘ ÙÂÏÂ˘Ù·›·˜ ÂͤٷÛ˘ ÂȂ‚·ÈÒıËÎÂ Ë ‰È¿ÁÓˆÛË ÙÔ˘ ÎÔηÙË. ∏ ÎÏÈÓÈ΋ ηٿÛÙ·ÛË ÙÔ˘ ÓÂÔÁÓÔ‡ ÚÔԉ¢ÙÈο ÂȉÂÈÓÒıËÎÂ, ηıÒ˜ ·˘Ùfi ·ÚÔ˘Û›·Û ¤ÓÙÔÓË ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ· Î·È ÁÔÁÁ˘ÛÌfi. ∆· ·¤ÚÈ· ·ÚÙËÚÈ·ÎÔ‡ ·›Ì·ÙÔ˜ ¤‰ÂÈÍ·Ó ˘ÔÍ·ÈÌ›· (PO2: 62 mmHg, PCO2: 36,1 mmHg, HCO3: 27 mmol/L, pH: 7,27) Î·È ¯ÔÚËÁ‹ıËΠO2. ™Â Ó¤· ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ ‰È·ÈÛÙÒıËÎÂ Î·È ¿ÏÈ ÂÌʇÛËÌ· ÙˆÓ Ó¢ÌfiÓˆÓ, fï˜ Û˘Á¯ÚfiÓˆ˜ ‚Ú¤ıËΠ·ÙÂÏÂÎÙ·Û›· ηٿ ÙÔÓ ·ÚÈÛÙÂÚfi ¿Óˆ Î·È Î¿Ùˆ ÏÔ‚fi. §fiÁˆ

Paediatriki 2002;65:442-446

ÙˆÓ Â˘ÚËÌ¿ÙˆÓ ·˘ÙÒÓ ¯ÔÚËÁ‹ıËΠÎÂÊÔÙ·Í›ÌË ÂÓ‰ÔÊÏ‚›ˆ˜. ∞ÎÔÏÔ‡ıˆ˜, ˘‹ÚÍ ·ÚÁ‹ ÎÏÈÓÈ΋ ‚ÂÏÙ›ˆÛË, ÛÙ·‰È·Î‹ ‰È·ÎÔ‹ Ù˘ ¯ÔÚËÁÔ‡ÌÂÓ˘ ·ÁˆÁ‹˜ Î·È ÙÔ ·È‰› ÂÍ‹Ïı ÌÂÙ¿ ·fi ÓÔÛËÏ›· 25 ËÌÂÚÒÓ Û ηϋ ÁÂÓÈ΋ ηٿÛÙ·ÛË (SatO2: 97%). ∏ ·Ï‹ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ ÚÔ Ù˘ ÂÍfi‰Ô˘ ¤‰ÂÈÍ ·Ú·ÌÔÓ‹ ÙˆÓ ·ÙÂÏÂÎÙ·ÛÈÒÓ ÛÙÔÓ ·ÚÈÛÙÂÚfi Ó‡ÌÔÓ· Î·È Û˘ÛÙ‹ıËΠÂ·Ó¤ÏÂÁ¯Ô˜ Û ¤Ó· Ì‹Ó·. ∆Ô ‚Ú¤ÊÔ˜ Â·Ó‹Ïı ÌÂÙ¿ ·fi ¤Ó· ÙÚ›ÌËÓÔ Ì ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ·. ŒÁÈÓ Ӥ· ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ fiÔ˘ ‰ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ·ÙÂÏÂÎٷۛ˜, ·Ú¿ ÌfiÓÔ Ì¤ÙÚÈÔ ÂÌʇÛËÌ· Ó¢ÌfiÓˆÓ. ∆¤ıËÎÂ Ë ‰È¿ÁÓˆÛË Ù˘ ÔÍ›·˜ ‚ÚÔÁ¯ÈÔÏ›Ùȉ·˜ Î·È ¯ÔÚËÁ‹ıËÎ·Ó ÂÈÛÓÔ¤˜ Û·Ï‚Ô˘Ù·ÌfiÏ˘ Î·È ‚ÚˆÌÈÔ‡¯Ô˘ ÈÚ·ÙÚÔ›Ô˘. ¶·ÚfiÌÔÈÔ ÂÂÈÛfi‰ÈÔ, Ô˘ ·ÓÙÈÌÂÙˆ›ÛÙËΠ̠ÙËÓ ›‰È· ·ÁˆÁ‹, ÂÌÊ¿ÓÈÛ ÌÂÙ¿ ·fi ‰›ÌËÓÔ. ∂·Ó·Ï‹ÊıËΠÈÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜, ·ÚfiÌÔÈÔ˜ Ì ·˘ÙfiÓ Ù˘ ÚÒÙ˘ ÂÈÛ·ÁˆÁ‹˜, Ô ÔÔ›Ô˜ ‹Ù·Ó Î·È ¿ÏÈ ·ÚÓËÙÈÎfi˜. ŒÁÈÓ ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ ·ÓÔÛÔÛÊ·ÈÚÈÓÒÓ, ÙÔ˘ Û˘ÌÏËÚÒÌ·ÙÔ˜ Î·È Ù˘ ·1 ·ÓÙÈıÚ˘„›Ó˘ ÛÙÔÓ ÔÚfi, Rast ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜ Î·È ‰ÔÎÈÌ·Û›· ȉÚÒÙ· ¯ˆÚ›˜ ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·. ∆Ô ‚Ú¤ÊÔ˜ ÛÙ· ÌÂÛԉȷÛÙ‹Ì·Ù· ÙˆÓ ÎÚ›ÛÂˆÓ ‹Ù·Ó ÂχıÂÚÔ Û˘Ìو̿وÓ, fï˜ o ÎÔÚÂÛÌfi˜ ÙÔ˘ O2 ÛÙÔ ·ÚÙËÚÈ·Îfi ·›Ì· Î˘Ì·ÈÓfiÙ·Ó ·fi 95-97%. ∆Ô ‚Ú¤ÊÔ˜ Û ËÏÈΛ· 8 ÌËÓÒÓ, ÌÂÙ¿ ·fi Ó¤· Ïԛ̈ÍË ÙÔ˘ ηÙÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡, ˘Ô‚Ï‹ıËΠ۠·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜, fiÔ˘ ‰È·ÈÛÙÒıËΠÂÏ¿ÙÙˆÛË ÙÔ˘ fiÁÎÔ˘ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ Ó‡ÌÔÓ· Î·È ˘Âډȷ‡Á·ÛË ·˘ÙÔ‡ Ì ۷ʋ ÂÏ¿ÙÙˆÛË Ù˘ ·ÁÁ›ˆÛ‹˜ ÙÔ˘, ÂÓÒ ÛÙÔ ‰ÂÍÈfi Ó‡ÌÔÓ·, Ô˘ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜, ·Ú·ÙËÚ‹ıËΠÚfiÛıÈ· Î·È Ô›ÛıÈ· οو ΋ÏË (∂ÈÎfiÓ· 1). ∆· Â˘Ú‹Ì·Ù· ·˘Ù¿ ¤ıÂÛ·Ó ÙË ‰È¿ÁÓˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ SwyerJames (Mac Leod), ÙÔ ÔÔ›Ô ıˆڋıËΠˆ˜ ÂÈÏÔ΋ Ù˘ Ïԛ̈͢ ·fi ÎÔηÙË ÚÔ 7Ì‹ÓÔ˘. °È· ÙËÓ ÂȂ‚·›ˆÛË Î·È ÙÔÓ ·ÎÚÈ‚‹ ÚÔÛ‰ÈÔÚÈÛÌfi Ù˘ ¤ÎÙ·Û˘ Ù˘ ÓfiÛÔ˘ ¤ÁÈÓ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ıÒڷη, fiÔ˘ ‰È·ÈÛÙÒıËÎ·Ó ÔÏÏ·Ϥ˜ ÂÛٛ˜ ˘Âډȷ‡Á·Û˘ ÛÙÔÓ ·ÚÈÛÙÂÚfi Ó‡ÌÔÓ· Î·È ÌÂÚÈΤ˜ ·ÓÙ›ÛÙÔȯ˜ ÂÛٛ˜ ÛÙÔ ‰ÂÍÈfi. ∂›Û˘, ÂȂ‚·ÈÒıËÎÂ Ë ÂÏ¿ÙÙˆÛË ÙÔ˘ fiÁÎÔ˘ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ Ó‡ÌÔÓ· Î·È Ë ÌÂȈ̤ÓË ·ÁÁ›ˆÛË ·˘ÙÔ‡ (∂ÈÎfiÓ· 2).

O ¤ÏÂÁ¯Ô˜ ÔÏÔÎÏËÚÒıËΠ̠ÛÈÓıËÚÔÁÚ¿ÊËÌ· ·ÈÌ¿ÙˆÛ˘ ÙˆÓ Ó¢ÌfiÓˆÓ, fiÔ˘ ηٷÁÚ¿ÊËÎÂ Ë ‰È¿¯˘Ù· ÌÂȈ̤ÓË ·ÈÌ¿ÙˆÛË ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ Ó‡ÌÔÓ·, Ô ÔÔ›Ô˜ Û˘ÌÌÂÙ›¯Â ηٿ 31% ÛÙË Û˘ÓÔÏÈ΋ ·ÈÌ¿ÙˆÛË ÙˆÓ Ó¢ÌfiÓˆÓ. ∞ÔÊ·Û›ÛÙËÎÂ Ë ¯ÔÚ‹ÁËÛË ÂÈÛÓÂfiÌÂÓ˘ ÊÏÔ˘ÙÈη˙fiÓ˘ 50 Ìg x 2

443

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14-05-03

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¶·È‰È·ÙÚÈ΋ 2002;65:442-446

∂ÈÎfiÓ· 1. ∞ÎÙÈÓÔÁÚ·Ê›· ıÒڷη. ¢È·ÈÛÙÒÓÂÙ·È Ë ÂÏ¿ÙÙˆÛË ÙÔ˘ fiÁÎÔ˘ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ Ó‡ÌÔÓ· Î·È Ë ˘Âډȷ‡Á·ÛË ·˘ÙÔ‡. ¶·Ú·ÙËÚ›ٷÈ, Â›Û˘, Ë ÚfiÛıÈ· Î·È Ë Ô›ÛıÈ· οو ΋ÏË ÙÔ˘ ‰ÂÍÈÔ‡ Ó‡ÌÔÓ·, Ô ÔÔ›Ô˜ Ê·›ÓÂÙ·È Î·Ù¿ Ù· ÏÔÈ¿ Ê˘ÛÈÔÏÔÁÈÎfi˜.

ÁÈ· ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· 3 ÌËÓÒÓ, ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂÎÙÈÌËı› Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ¿ Ù˘ ÛÙËÓ ÚfiÏË„Ë ÙˆÓ ÂÈÏÔÎÒÓ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘. ™˘˙‹ÙËÛË ∆Ô Û‡Ó‰ÚÔÌÔ Swyer-James (Mac Leod) ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÙË ‰È·›ÛÙˆÛË, Û ·Ï‹ ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη, ÂÙÂÚfiÏ¢ÚÔ˘ ˘Âډȷ˘Á¿˙ÔÓÙ· Ó‡ÌÔÓ· (1). ∂ΉËÏÒÓÂÙ·È Û˘Ó‹ıˆ˜ ÛÙË ‚ÚÂÊÈ΋ ‹ ÚÒÈÌË ·È‰È΋ ËÏÈΛ·, 6 Ì‹Ó˜ ¤ˆ˜ 6 ¯ÚfiÓÈ· ÌÂÙ¿ ÙËÓ ·Ô‰ÚÔÌ‹ Ì›·˜ Ïԛ̈͢ ÙÔ˘ ηÙÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ (2). ¶ÂÚÈÁÚ¿ÊËΠ·Ú¯Èο ÙÔ 1953 ·fi ÙÔ˘˜ Swyer Î·È James Û ·ÁfiÚÈ 6 ÂÙÒÓ (5), ÂÓÒ ¤Ó· ¯ÚfiÓÔ ·ÚÁfiÙÂÚ· Ô Mac Leod ÂÚȤÁÚ·„ ·ÚfiÌÔÈ· ·ÎÙÈÓÔÏÔÁÈο Â˘Ú‹Ì·Ù· Û ÂÓ‹ÏÈÎÔ˘˜ ·ÛıÂÓ›˜ (6). O ·‰ÂÓÔ˚fi˜, ÙÔ Ì˘ÎfiÏ·ÛÌ·, Ô Èfi˜ Ù˘ ÁÚ›˘, Ë ÈÏ·Ú¿, ÙÔ Ì˘ÎÔ‚·ÎÙËÚ›‰ÈÔ Ù˘ Ê˘Ì·Ù›ˆÛ˘ Î·È Ô ÎÔÎ·Ù˘ ¤¯Ô˘Ó Û˘Û¯ÂÙÈÛÙ› Ì ÙËÓ ÚfiÎÏËÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ÛÙËÓ ·È‰È΋ ËÏÈΛ·, ÂÓÒ ÁÈ· ÙËÓ ÚÒÙË ÂÌÊ¿ÓÈÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Û ÂÓËÏ›ÎÔ˘˜, Ô˘ Â›Ó·È Û·ÓÈfiÙÂÚÔ, ÂÓÔ¯ÔÔÈÔ‡ÓÙ·È Ë ÂÈÛÓÔ‹ ¯ËÌÈÎÒÓ Ô˘ÛÈÒÓ, Ë ¯Ú‹ÛË Ê·ÚÌ¿ÎˆÓ fiˆ˜ Ë ÂÓÈÎÈÏÏ·Ì›ÓË, Ë ·ÎÙÈÓÔıÂÚ·›·, ÔÈ ÓfiÛÔÈ ÙÔ˘ Û˘Ó‰ÂÙÈÎÔ‡ ÈÛÙÔ‡ Î·È Ë ¯ÚfiÓÈ· ÓfiÛÔ˜ ÌÔۯ‡̷ÙÔ˜ ÂÓ·ÓÙ›ÔÓ ÍÂÓÈÛÙ‹ (3). ∏ ·ıÔÁ¤ÓÂÈ· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ·Ô‰›‰ÂÙ·È ÛÙËÓ ·Ó¿Ù˘ÍË ÊÏÂÁÌÔÓÒ‰Ô˘˜ ÎÔÎÎȈ̷ÙÒ‰Ô˘˜ ÈÛÙÔ‡ ÂÚÈ‚ÚÔÁ¯Èο, Ô˘ ÚÔηÏ› ·Á›‰Â˘ÛË ·¤Ú· Ì Ì˯·ÓÈÛÌfi ‚·Ï‚›‰·˜ ÛÙÔ˘˜ ÌÈÎÚÔ‡˜ ·ÂÚ·ÁˆÁÔ‡˜. ø˜ ·ÔÙ¤ÏÂÛÌ·, ÌÂÈÒÓÂÙ·È Ë ¤ÎÙ˘ÍË ÙÔ˘ ¿Û¯ÔÓÙÔ˜ Ó‡ÌÔÓ·, Ô ·ÂÚÈÛÌfi˜ ÙÔ˘ Â›Ó·È ·ÓÂ·Ú΋˜ Î·È ÚÔηÏÂ›Ù·È ·ÓÙ·Ó·ÎÏ·ÛÙÈ΋ Ì›ˆÛË Ù˘ ·ÁÁ›ˆÛ˘ ̤ۈ ·ÁÁÂÈÔÛ·ÛÌÔ‡ ÏfiÁˆ ˘ÔÍ›·˜ (7). ™Â ‚ÚÔÁ¯Ô-

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∂ÈÎfiÓ· 2. ÀÔÏÔÁÈÛÙÈ΋ ÙÔÌÔÁÚ·Ê›· ıÒڷη. ∂Ȃ‚·ÈÒÓÂÙ·È Ë ÂÏ¿ÙÙˆÛË ÙÔ˘ fiÁÎÔ˘ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ Ó‡ÌÔÓ· Î·È Ë ˘Âډȷ‡Á·ÛË ·˘ÙÔ‡. ¶·Ú·ÙËÚÔ‡ÓÙ·È, Â›Û˘, ÌÂÚÈΤ˜ ÂÛٛ˜ ˘Âډȷ‡Á·Û˘ Î·È ÛÙÔ ‰ÂÍÈfi Ó‡ÌÔÓ·.

΢„ÂÏȉÈÎfi ¤ÎÏ˘Ì· ·Û¯fiÓÙˆÓ ¤¯ÂÈ ·Ó¢ÚÂı› ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË ÙˆÓ Î˘ÙÙ·ÚÔÙÔÍÈÎÒÓ ∆ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ, ÂÓ‰ÂÈÎÙÈ΋ ·ÓÔÛÔÏÔÁÈ΋˜ ‰È·Ù·Ú·¯‹˜ (8). ™Â ˘ÏÈÎfi ‚ÈÔ„›·˜ ÂÚÈÁÚ¿ÊÂÙ·È ÂÚÈ‚ÚÔÁ¯È΋ ›ÓˆÛË, ηٷÛÙÚÔÊ‹ Ù˘ ·Ú¯ÈÙÂÎÙÔÓÈ΋˜ ÙˆÓ Î˘„ÂÏ›‰ˆÓ, ‰È¿Ù·ÛË ÙˆÓ ÌÈÎÚÒÓ ‚ÚfiÁ¯ˆÓ Î·È ÙˆÓ ‚ÚÔÁ¯ÈÔÏ›ˆÓ, ÂÓÒ ÌÂÚÈΤ˜ ÊÔÚ¤˜ ·Ó¢ڛÛÎÔÓÙ·È ‚ÚÔÁ¯ÈÂÎٷۛ˜ (9,10).

O ·ÛıÂÓ‹˜ Ì·˜ ÏËÚÔ‡Û fiÏ· Ù· ÎÚÈÙ‹ÚÈ· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘: ·) ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜, fiÔ˘ ·ÂÈÎÔÓÈ˙fiÙ·Ó ÂÙÂÚfiÏ¢ÚË Ì›ˆÛË fiÁÎÔ˘ ÙÔ˘ Ó‡ÌÔÓ· Ì ·Á›‰Â˘ÛË ·¤Ú· Î·È ˘Âډȷ‡Á·ÛË ·˘ÙÔ‡, ‚) ·ÔÎÏÂÈÛÌfi˜ ÎÂÓÙÚÈ΋˜ ‚ÚÔÁ¯È΋˜ ·fiÊڷ͢, ·ÛÙ˘ ‹ ·ÁÁÂȷ΋˜ ·ÓˆÌ·Ï›·˜ ˆ˜ ·›ÙÈÔ Ù˘ ˘Âډȷ‡Á·Û˘ ÙÔ˘ Ó‡ÌÔÓ· ÌÂÙ¿ ·fi ‰ÈÂÓ¤ÚÁÂÈ· CT ıÒÚ·ÎÔ˜ Î·È Á) ÛÈÓıËÚÔÁÚ¿ÊËÌ· ·ÈÌ¿ÙˆÛ˘ Ó¢ÌfiÓˆÓ, fiÔ˘ ·ÂÈÎÔÓÈ˙fiÙ·Ó ÂÙÂÚfiÏ¢ÚË ÌÂȈ̤ÓË ·ÈÌ¿ÙˆÛË (1,2). ø˜ ˘‡ı˘ÓÔ ·›ÙÈÔ ÂÓÔ¯ÔÔÈ‹ıËÎÂ Ô ÎÔÎ·Ù˘, ÁÈ·Ù› ˘‹Ú¯Â Èı·Ó‹ ËÁ‹ ÌÂÙ¿‰ÔÛ˘ ÛÙÔ ÂÚÈ‚¿ÏÏÔÓ. ∏ ̤ıÔ‰Ô˜ ·Ó›¯Ó¢Û˘ ̤ÚÔ˘˜ ÙÔ˘ ÁÔÓȉÈÒÌ·ÙÔ˜ ÙÔ˘ ‚·ÎÙËÚ›Ô˘ Ì PCR ‹Ù·Ó ·ÍÈfiÈÛÙË ¤¯ÔÓÙ·˜ ¢·ÈÛıËÛ›· 100% Î·È ÂȉÈÎfiÙËÙ· 97,4% (11). ∞ÔÎÏ›ÛÙËÎ·Ó Ù· ˘fiÏÔÈ· Èı·Ó¿ ·›ÙÈ· ÌÂÙ¿ ·fi ÂÎÙÂٷ̤ÓÔ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô, ÂÓÒ Î·È ÙÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· Ô˘ ·Ú‹Ïı ̤¯ÚÈ ÙËÓ ÂÁηٿÛÙ·ÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ (7 Ì‹Ó˜) ‹Ù·Ó Û˘Ì‚·Ùfi. ∆· Â˘Ú‹Ì·Ù· ÛÙËÓ ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη ‹Ù·Ó ÂÙÂÚfiÏ¢ڷ, ηıÒ˜ Ô ÚÔۂ‚ÏË̤ÓÔ˜ ·ÚÈÛÙÂÚfi˜ Ó‡ÌÔÓ·˜ ‹Ù·Ó ÂÏ·Ùو̤ÓÔ˜ Û fiÁÎÔ, ÂÓÒ Û˘Á¯ÚfiÓˆ˜ ˘‹Ú¯Â ·ÓÙ·Ó·ÎÏ·ÛÙÈ΋ Ì›ˆÛË Ù˘ ·ÁÁ›ˆÛ‹˜ ÙÔ˘ ÏfiÁˆ ÙÔ˘ ÂÏ·Ùو̤ÓÔ˘ ·ÂÚÈÛÌÔ‡.

O ˘ÁÈ‹˜ Ó‡ÌÔÓ·˜ ˘ÂÚÂÎÙ˘ÛÛfiÙ·Ó Î·È ·ˆıÔ‡Û ÙÔ ÌÂÛÔıˆÚ¿ÎÈÔ ÚÔ˜ ÙËÓ ·ÓÙ›ıÂÙË ÏÂ˘Ú¿

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(4). ∏ Èı·ÓfiÙËÙ· ÎÂÓÙÚÈ΋˜ ·fiÊڷ͢ ·fi ÓÂÔÏ·ÛÌ·ÙÈ΋ ÂÍÂÚÁ·Û›·, ÏÂÌÊ·‰¤Ó˜ ‹ ͤÓÔ ÛÒÌ· ·ÔÎÏ›ÛÙËΠ̠ÙË ‰ÈÂÓ¤ÚÁÂÈ· CT ıÒÚ·ÎÔ˜, fiˆ˜ ·ÔÎÏ›ÛÙËÎ·Ó Î·È ÔÈ ÚˆÙÔ·ı›˜ ‰È·Ù·Ú·¯¤˜ Ù˘ ·ÁÁ›ˆÛ˘, fiÔ˘ Ë ˘Âډȷ‡Á·ÛË Â›Ó·È ÏÈÁfiÙÂÚÔ ¤ÓÙÔÓË (7). ∆Ô ÁÂÁÔÓfi˜ fiÙÈ ÔÈ ˘Âډȷ˘Á·ÛÙÈΤ˜ ÂÚÈÔ¯¤˜ ‰ÂÓ ÂÚÈ‚¿ÏÏÔÓÙ·Ó ·fi ÙÔ›¯ˆÌ·, ÙȘ ͯˆÚ›˙ÂÈ ·fi ÙȘ Û˘ÁÁÂÓ›˜ ·ÛÙ˜ Î·È ÙȘ ÓÂÎÚˆÙÈΤ˜ Ê˘Û·ÏÏ›‰Â˜ (bullae) (3). ∏ CT ıÒÚ·ÎÔ˜ Ì·˜ ·Ú›¯Â, Â›Û˘, ÂÚÈÛÛfiÙÂÚ˜ ÏËÚÔÊÔڛ˜ ÁÈ· ÙËÓ ¤ÎÙ·ÛË, ÙËÓ Î·Ù·ÓÔÌ‹ ηÈ, Û˘ÓÂÒ˜, ÙË ‚·Ú‡ÙËÙ· Ù˘ ÓfiÛÔ˘. ∏ ÙÌËÌ·ÙÈ΋ ÚÔÛ‚ÔÏ‹ Î·È Ë ÌÈÎÚ‹ ¤ÎÙ·ÛË ÙˆÓ ˘Âډȷ˘Á¿ÛÂˆÓ ·Ô‰ÂÈÎÓ‡Ô˘Ó fiÙÈ Ë ‰È·Ù·Ú·¯‹ ÂÓÙÔÈ˙fiÙ·Ó ÛÙÔ˘˜ ÌÈÎÚÔ‡˜ ·ÂÚ·ÁˆÁÔ‡˜ (3). ™Â ·˘Ù‹ ÙËÓ ÂͤٷÛË ·ÂÈÎÔÓ›˙ÔÓÙ·Ó ÙÌËÌ·ÙÈΤ˜ ˘Âډȷ˘Á¿ÛÂȘ Ì ·Î·ıfiÚÈÛÙ· fiÚÈ·, ·Î·ÓfiÓÈÛÙÔ ‹ ÛÊËÓÔÂȉ¤˜ Û¯‹Ì·, Ô˘ ‰ÂÓ ‹Ù·Ó ÔÚ·Ù¤˜ ÛÙËÓ ·Ï‹ ·ÎÙÈÓÔÁÚ·Ê›· Î·È Â‰Ú¿˙ÔÓÙ·Ó Î·È ÛÙÔ˘˜ ‰‡Ô Ó‡ÌÔÓ˜. ∏ CT ıÒÚ·ÎÔ˜ ·¤ÎÏÂÈÛ ÙËÓ ‡·ÚÍË ‚ÚÔÁ¯ÈÂÎÙ·ÛÈÒÓ, ÔÈ Ôԛ˜ Â›Ó·È Û˘¯Ófi ‡ÚËÌ· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Î·È ÂÈ‚·Ú‡ÓÔ˘Ó È‰È·›ÙÂÚ· ÙËÓ ÚfiÁÓˆÛË (3,4). ÃÚ‹ÛÈÌË ·ÂÈÎÔÓÈÛÙÈ΋ ÂͤٷÛË Â›Ó·È ÙÔ ÛÈÓıËÚÔÁÚ¿ÊËÌ· ·ÈÌ¿ÙˆÛ˘, fiÔ˘ ‰È·ÈÛÙÒıËÎÂ Ë ÌÂȈ̤ÓË ·ÈÌ¿ÙˆÛË ÙÔ˘ ¿Û¯ÔÓÙÔ˜ Ó‡ÌÔÓ· (12). ™Â ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿ ÌÔÚ› Ó· Á›ÓÂÈ Î·È ÛÈÓıËÚÔÁÚ¿ÊËÌ· ·ÂÚÈÛÌÔ‡, fiÔ˘ ÚÔ‚¿ÏÏÂÈ ¤ÓÙÔÓ· Ô ˘Ô·ÂÚÈÛÌfi˜ ÙˆÓ ÚÔۂ‚ÏËÌ¤ÓˆÓ ÂÚÈÔ¯ÒÓ. ∏ ‚ÚÔÁ¯ÔÁÚ·Ê›·, ÌÂÙ¿ ÙËÓ ¤Ï¢ÛË ÙˆÓ ·ÍÔÓÈÎÒÓ ÙÔÌÔÁÚ·ÊÈÒÓ ˘„ËÏ‹˜ ¢ÎÚ›ÓÂÈ·˜, ‰ÂÓ Â›Ó·È ··Ú·›ÙËÙË. ∂›Û˘, ‚ÈÔ„›· Ó‡ÌÔÓ· Á›ÓÂÙ·È ÌfiÓÔ Û ÂÈÏÂÁ̤Ó˜ ÂÚÈÙÒÛÂȘ, fiÔ˘ Ù›ıÂÙ·È ı¤Ì· ‰È·ÊÔÚÈ΋˜ ‰È¿ÁÓˆÛ˘, ÁÈ’ ·˘Ùfi ‰ÂÓ ¤ÁÈÓ ÛÙÔÓ ·ÛıÂÓ‹ Ì·˜ (13). ∆Ô Û‡Ó‰ÚÔÌÔ Swyer-James (Mac Leod) ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÌÂÁ¿ÏË ÂÙÂÚÔÁ¤ÓÂÈ· ÎÏÈÓÈÎÒÓ ÂΉËÏÒÛÂˆÓ Î·È Ë ÔÚ›· ÙˆÓ ·ÛıÂÓÒÓ ÂÍ·ÚÙ¿Ù·È Î˘Ú›ˆ˜ ·fi ÙËÓ ·ÚÔ˘Û›· ΢ÛÙÈÎÒÓ ‚ÚÔÁ¯ÈÂÎÙ·ÛÈÒÓ (4). ∞ÛıÂÓ›˜, ÛÙÔ Ó¢ÌÔÓÈÎfi ·Ú¤Á¯˘Ì· ÙˆÓ ÔÔ›ˆÓ ‰ÂÓ ‰È·ÈÛÙÒÓÔÓÙ·È Ù¤ÙÔȘ ‚Ï¿‚˜, ÂΉËÏÒÓÔ˘Ó ÌfiÓÔ ‹Ș ÏÔÈÌÒÍÂȘ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Ô˘ ‰ÂÓ ÂÈ‚·Ú‡ÓÔ˘Ó ÙË ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ Ó¢ÌfiÓˆÓ, ÂÓÒ ÚÔԉ¢ÙÈο ·Ú·ÙËÚÂ›Ù·È ·˘ÙfiÌ·ÙË ‡ÊÂÛË ÙˆÓ Û˘Ìو̿وÓ, ¯ˆÚ›˜ Âȉ›ӈÛË Ù˘ ·ÎÙÈÓÔÏÔÁÈ΋˜ ÂÈÎfiÓ·˜. ™ÙËÓ Î·ÙËÁÔÚ›· ·˘Ù‹ ·Ó‹ÎÂÈ Ô ‰ÈÎfi˜ Ì·˜ ·ÛıÂÓ‹˜, fï˜ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ‰ÂÓ ¤¯ÂÈ ·Ú¤ÏıÂÈ ÈηÓfi ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ·fi ÙËÓ ÂÁηٿÛÙ·ÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ηıÈÛÙ¿ ÙËÓ ÚfiÁÓˆÛË ÚÔ˜ ÙÔ ·ÚfiÓ ÂÈÊ˘Ï·ÎÙÈ΋. OÈ ˘fiÏÔÈÔÈ ·ÛıÂÓ›˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ˘ÔÙÚÔÈ¿˙Ô˘Û˜ Ó¢ÌÔӛ˜ ‹ ‚ÚÔÁ¯›Ùȉ˜ Ì ‚·ÚÈ¿ ÎÏÈÓÈ΋ ÂÈÎfiÓ·, Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÚfiÎÏËÛË Ó¢ÌÔÓÔ¿ıÂÈ·˜ ÂÚÈÔÚÈÛÙÈÎÔ‡ ‹ ·ÔÊÚ·ÎÙÈÎÔ‡ Ù‡Ô˘, fiˆ˜ ÂȂ‚·ÈÒÓÂÙ·È ÌÂÙ¿ ÙËÓ ÂÎÙ¤ÏÂÛË ÙˆÓ ÏÂÈÙÔ˘ÚÁÈÎÒÓ ‰Ô-

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ÎÈÌ·ÛÈÒÓ ÙˆÓ Ó¢ÌfiÓˆÓ (4,7). ∏ ·ÓÙÈÌÂÙÒÈÛË Â›Ó·È Û˘Ó‹ıˆ˜ Û˘ÓÙËÚËÙÈ΋ Ì ¯Ú‹ÛË ‚ÚÔÁ¯Ô‰È·ÛÙ·ÏÙÈÎÒÓ Î·Ù’ Â›ÎÏËÛË, Ê˘ÛÈÔıÂÚ·›· Î·È ¤ÁηÈÚË ¯ÔÚ‹ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ Û ˘fiÓÔÈ· Ïԛ̈͢ (1,7). ∏ ¯ÔÚ‹ÁËÛË ÂÈÛÓÂfiÌÂÓˆÓ ÎÔÚÙÈÎÔÛÙÂÚÔÂȉÒÓ Ú¤ÂÈ Ó· ‰ÔÎÈÌ¿˙ÂÙ·È ÁÈ· 2-3 Ì‹Ó˜ Î·È Ó· Û˘Ó¯›˙ÂÙ·È Û fiÛÔ˘˜ ·ÛıÂÓ›˜ ·Ú·ÙËÚÂ›Ù·È ‚ÂÏÙ›ˆÛË Ù˘ ÎÏÈÓÈ΋˜ ÔÚ›·˜ (2,3). ™Â ÂÚ›ÙˆÛË ‰ËÌÈÔ˘ÚÁ›·˜ Ó¢ÌÔÓÈÎÔ‡ ·ÔÛÙ‹Ì·ÙÔ˜, Ô ·ÛıÂÓ‹˜ ˘Ô‚¿ÏÏÂÙ·È Û ·Ê·›ÚÂÛË ÙÔ˘ ÚÔۂ‚ÏË̤ÓÔ˘ ÙÌ‹Ì·ÙÔ˜. ªÂÚÈÎÔ› ¯ÂÈÚÔ˘ÚÁË̤ÓÔÈ ·ÛıÂÓ›˜ ¤¯Ô˘Ó ÈηÓÔÔÈËÙÈ΋ ÔÚ›· (10). ™˘ÌÂÚ·ÛÌ·ÙÈο, ÙÔ Û‡Ó‰ÚÔÌÔ Swyer-James (Mac Leod) Â›Ó·È Ì›· ÂÓÂÚÁ‹ ÊÏÂÁÌÔÓ҉˘ ‰È·‰Èηۛ· ÙˆÓ Ó¢ÌfiÓˆÓ Ì ·‚¤‚·ÈË ÚfiÁÓˆÛË Ô˘ ˘ÚÔ‰ÔÙÂ›Ù·È ·fi ÔÚÈṲ̂Ó˜ ·Ó·Ó¢ÛÙÈΤ˜ ÏÔÈÌÒÍÂȘ Ô˘ Û˘Ì‚·›ÓÔ˘Ó ÛÙË ‚ÚÂÊÈ΋ Î·È ÚÒÈÌË ·È‰È΋ ËÏÈΛ·. O ÎÔÎ·Ù˘, ÂÎÙfi˜ ·fi ÙȘ ÁÓˆÛÙ¤˜ ¿ÌÂÛ˜ ÂÈÏÔΤ˜ ÙÔ˘, ÂÓÔ¯ÔÔÈÂ›Ù·È Î·È ÁÈ· ÙËÓ ÚfiÎÏËÛË ·˘ÙÔ‡ ÙÔ˘ ÂÈΛӉ˘ÓÔ˘ Û˘Ó‰ÚfiÌÔ˘. µÈ‚ÏÈÔÁÚ·Ê›· 1. Braunschweig M, Gal I. Swyer-James syndrome. JBR-BTR 2001;84:57.

2. Chalmers JH Jr. Swyer-James syndrome. Semin Respir Infect 1999;14:295-297.

3. Moore AD, Godwin JD, Dietrich PA, Verschakelen JA, Henderson WR Jr. Swyer-James syndrome: CT findings in eight patients. Am J Roentgenol 1992;158:1211-1215.

4. Lucaya J, Gartner S, Garcia-Pena P, Cobos N, Roca I, Linan S. Spectrum of manifestations of Swyer-JamesMacLeod syndrome. J Comput Assist Tomogr 1998;22: 592-597.

5. Swyer PR, James CCW. A case of unilateral pulmonary emphysema. Thorax 1953;8:133-136.

6. MacLeod WM. Abnormal translucency of one lung. Thorax 1954;9:147-153.

7. Ohri SK, Rutty G, Fountain SW. Acquired segmental emphysema: the enlarging spectrum of Swyer-James/ MacLeod’s syndrome. Ann Thorac Surg 1993;56:120-124.

8. Bernardi F, Cazzato S, Poletti V, Tassinari D, Burnaccini M, Zompatori M et al. Swyer-James syndrome: bronchoalveolar lavage findings in two patients. Eur Respir J 1995; 8:654-657.

9. Koyama T, Osada H, Kitanaka Y, Funaki S, Hiekata T. Surgically treated Swyer-James syndrome. Jpn J Thorac Cardiovasc Surg 2001;49:671-674.

10. Wang JY, Chen KY, Chang YC, Chang YL, Lee LN. SwyerJames syndrome complicated by lung abscess. J Formos Med Assoc 2000;99:252-256.

11. Chan EL, Antonishyn N, McDonald R, Maksymiw T, Pieroni P, Nagle E et al. The use of TaqMan PCR assay for detection of Bordetella pertussis infection from clinical specimens. Arch Pathol Lab Med 2002;126:173-176.

12. Kiratli PO, Caglar M, Bozkurt MF. Unilateral absence of pulmonary perfusion in Swyer-James syndrome. Clin Nucl

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13. Salmanzadeh A, Pomeranz SJ, Ramsingh PS. Ventilationperfusion scintigraphic correlation with multimodality imaging in a proven case of Swyer-James (MacLeod’s) syndrome. Clin Nucl Med 1997;22:115-118.

Paediatriki 2002;65:442-446

∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 28-05-2002 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 06-09-2002 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: °ÈÒÚÁÔ˜ ∆Ú›Ì˘ ∏Ï›· ∑ÂÚ‚Ô‡ 72, ∆.∫. 111 44, ∞ı‹Ó·

¶ÂÚ›ÏË„Ë ¿ÚıÚÔ˘ ·fi ÙË µÈ‚ÏÈÔÁÚ·Ê›· ∏ ÓÂÊÚÔ¿ıÂÈ· Ù˘ ΢ÛÙÂÔÔ˘ÚËÙËÚÈ΋˜ ·ÏÈÓ‰ÚfiÌËÛ˘ ÛÙ· ·È‰È¿1 O fiÚÔ˜ ÓÂÊÚÔ¿ıÂÈ· Ù˘ ΢ÛÙÂÔÔ˘ÚËÙËÚÈ΋˜ ·ÏÈÓ‰ÚfiÌËÛ˘ (¡∫O¶) ÂÚÈÁÚ¿ÊÂÈ ÙȘ ÓÂÊÚÈΤ˜ Ô˘Ï¤˜ Ô˘ Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì ∫O¶ Î·È Ô˘ÚÔÏԛ̈ÍË. ŸÌˆ˜, Â›Ó·È ‰˘Ó·Ùfi Ó· ‰È·ÈÛÙˆıÔ‡Ó ÓÂÊÚÈΤ˜ Ô˘Ï¤˜ Î·È Û ·È‰È¿ Ì ÔÍ›· ˘ÂÏÔÓÂÊÚ›Ùȉ· Ô˘ ‰ÂÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ∫O¶. ™ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ·È‰ÈÒÓ, ÔÈ ÓÂÊÚÈΤ˜ Ô˘Ï¤˜ ‰È·ÈÛÙÒÓÔÓÙ·È Ì ÙË ‰È¿ÁÓˆÛË Ù˘ ∫O¶ Î·È Ó¤Â˜ Ô˘Ï¤˜ Û˘Ó‹ıˆ˜ ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙ· ‰‡Ô ÚÒÙ· ¯ÚfiÓÈ· Ù˘ ˙ˆ‹˜ ηÈ, Û¿ÓÈ·, ÌÂÙ¿ ÙÔ ‰Â‡ÙÂÚÔ ¯ÚfiÓÔ. ¶·Ï·ÈfiÙÂÚ·, ÔÈ ‚Ï¿‚˜ Ù˘ ¡∫O¶ ›¯·Ó ·Ô‰Ôı› ÛÙËÓ ·‡ÍËÛË Ù˘ ÂÓ‰Ô·˘ÏÈ΋˜ ›ÂÛ˘ ÙÔ˘ ·ÓÒÙÂÚÔ˘ Ô˘ÚÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, Û·Ó ·ÔÙ¤ÏÂÛÌ· Ù˘ ∫O¶, ·ÊÔ‡ ›¯Â ‰È·ÈÛÙˆı› Î·È Û ÂÈÚ·Ì·ÙÈο ÌÔÓ٤Ϸ Ì ∫O¶. ŸÌˆ˜, Ù· ÂÈÚ·Ì·ÙÈο Â˘Ú‹Ì·Ù· Û ¯ÔÈÚ›‰È· ÚÔÎÏ‹ıËÎ·Ó Ì ÙÈ̤˜ ÂÓ‰Ô΢ÛÙÈÎÒÓ ȤÛˆÓ, Ô˘ ‰ÂÓ ‹Ù·Ó ·Ó¿ÏÔÁ˜ ·˘ÙÒÓ Ô˘ ‰È·ÈÛÙÒÓÔÓÙ·È Û ·È‰È¿ Ì ȉÈÔ·ı‹ ∫O¶. ™‹ÌÂÚ·, Â›Ó·È ÁÂÓÈο ·Ô‰ÂÎÙfi fiÙÈ Ë ∫O¶ ‰ÂÓ ÚÔηÏ› ÓÂÊÚÈΤ˜ ‚Ï¿‚˜ fiÙ·Ó ‰ÂÓ Û˘Ó˘¿Ú¯ÂÈ ÔÍ›· ˘ÂÏÔÓÂÊÚ›Ùȉ·. °ÂÓÂÙÈ΋ Ù˘ ∫O¶: ∏ ∫O¶ Â›Ó·È ÙÔ ÈÔ Û˘¯Ófi Úfi‚ÏËÌ· Ô˘ ÎÏËÚÔÓÔÌÂ›Ù·È Ì ÂÈÎÚ·ÙÔ‡ÓÙ· ۈ̷ÙÈÎfi ¯·Ú·ÎÙ‹Ú·. ¶ÚfiÛÊ·Ù·, ÙÔ ÁÔÓ›‰ÈÔ Ù˘ ∫O¶ Ù·˘ÙÔÔÈ‹ıËΠÛÙÔ ¯ÚˆÌfiۈ̷ 1. O ÔÏ˘ÌÔÚÊÈÛÌfi˜ ÙÔ˘ ÁÔÓȉ›Ô˘ ÙÔ˘ ÌÂÙ·ÙÚÂÙÈÎÔ‡ ÂÓ˙‡ÌÔ˘ Ù˘ ·ÁÁÂÈÔÙ·Û›Ó˘ π, Ô˘ ‚Ú›ÛÎÂÙ·È ÛÙÔ ¯ÚˆÌfiۈ̷ 17, ¤¯ÂÈ ÛËÌ·Û›· ÁÈ· ÙË ‰ËÌÈÔ˘ÚÁ›· Ó¤ˆÓ ÓÂÊÚÈÎÒÓ Ô˘ÏÒÓ. ŒÙÛÈ, ‰È·ÈÛÙÒıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙËÓ ÂÌÊ¿ÓÈÛË Ó¤ˆÓ ÓÂÊÚÈÎÒÓ Ô˘ÏÒÓ Û ÔÌfi˙˘ÁÔ˘˜ ·ÛıÂÓ›˜ ÁÈ· ÙÔ ·ÏÏËÏfiÌÔÚÊÔ ÁÔÓ›‰ÈÔ ··ÏÔÈÊ‹˜ (gene detection - ÁÔÓfiÙ˘Ô˜ DD) ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ Ù˘ ÚÂÓ›Ó˘-·ÁÁÂÈÔÙ·Û›Ó˘. ¢È¿ÁÓˆÛË Ù˘ ¡∫O¶: ™‹ÌÂÚ·, Ë ÂÓ‰ÔÊϤ‚È· ˘ÂÏÔÁÚ·Ê›· ¤¯ÂÈ Ô˘ÛÈ·ÛÙÈο ·ÓÙÈηٷÛÙ·ı› ·fi ÙÔ ÛÙ·ÙÈÎfi ÛÈÓıËÚÔÁÚ¿ÊËÌ· ÓÂÊÚÒÓ DMSA (dimercaptosuccinic acid scan) Ô˘ ¤¯ÂÈ ÌÂÁ·Ï‡ÙÂÚË Â˘·ÈÛıËÛ›· ÛÙË ‰È¿ÁÓˆÛË ÓÂÊÚÈÎÒÓ Ô˘ÏÒÓ. ŸÌˆ˜, Ì ÙÔ ÛÙ·ÙÈÎfi ÛÈÓıËÚÔÁÚ¿ÊËÌ· ÓÂÊÚÒÓ DMSA ‰ÂÓ Â›Ó·È ‰˘Ó·Ù‹ Ë ‰È¿ÎÚÈÛË ÌÂٷ͇ ÓÂÊÚÈÎÒÓ Ô˘ÏÒÓ, ‰˘ÛÏ·ÛÙÈÎÒÓ ÂÚÈÔ¯ÒÓ ÙÔ˘ ÓÂÊÚÈÎÔ‡ ·ÚÂÁ¯‡Ì·ÙÔ˜ Î·È ·ÏÏÔÈÒÛÂˆÓ Ù˘ ÔÍ›·˜ ÊÏÂÁÌÔÓ‹˜ ÙÔ˘ ÊÏÔÈÔ‡ ÙÔ˘ ÓÂÊÚÔ‡. ¡∫O¶ Î·È ÙÂÏÈÎfi ÛÙ¿‰ÈÔ ÓÂÊÚÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ (∆™¡∞): ∏ ¡∫O¶ Â›Ó·È Û¯ÂÙÈο Û˘¯Ó‹ ∆™¡∞, fï˜, Ô Û˘ÓÔÏÈÎfi˜ ·ÚÈıÌfi˜ ÙˆÓ ·ÛıÂÓÒÓ Ì ∆™¡∞ Î·È ¡∫O¶ Â›Ó·È Û¯ÂÙÈο ÌÈÎÚfi˜ ÛÂ

446

Û¯¤ÛË Ì ÙÔ Û˘ÓÔÏÈÎfi ·ÚÈıÌfi ·ÛıÂÓÒÓ Ì ¡∫O¶. ∞Ó Î·È Ô ·ÚÈıÌfi˜ ·˘Ùfi˜ ‰ÂÓ Â›Ó·È ÁÓˆÛÙfi˜, ÌÔÚ› Ó· ÂÎÙÈÌËı› ·fi ÙÔ fiÙÈ ∫O¶ ·ÚÔ˘ÛÈ¿˙ÂÈ ÙÔ 0,4-2% ÙÔ˘ ÏËı˘ÛÌÔ‡ Î·È 1023% ÙˆÓ ·ÛıÂÓÒÓ Ì ∫O¶ ÂÌÊ·Ó›˙Ô˘Ó ‰È·ÊfiÚÔ˘ ‚·ıÌÔ‡ ¡∫O¶. ™˘ÓÂÒ˜, Ë Èı·ÓfiÙËÙ· Ó· ·ÚÔ˘ÛÈ¿ÛÂÈ ∆™¡∞ ¤Ó· ·È‰› Ì ¡∫O¶ Â›Ó·È Ôχ ÌÈÎÚ‹ Î·È Â›Ó·È ·ÎfiÌ· ÏÈÁfiÙÂÚÔ Èı·Ófi Ó· ÂÌÊ·ÓÈÛÙ› ÙÔ Úfi‚ÏËÌ· ·˘Ùfi ÛÙËÓ ·È‰È΋ ËÏÈΛ·. ∆· ·È‰È¿ Ì ¡∫O¶ Ô˘ ı· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó ∆™¡∞ ¤¯Ô˘Ó Û˘Ó‹ıˆ˜ ÌÂÁ¿ÏÔ˘ ‚·ıÌÔ‡ ∫O¶ Î·È ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·fi ÙË Á¤ÓÓËÛ‹ ÙÔ˘˜ ÂÏ¿ÙÙˆÛË Ù˘ ÓÂÊÚÈ΋˜ ÙÔ˘˜ ÏÂÈÙÔ˘ÚÁ›·˜, Ô˘ ÂȉÂÈÓÒÓÂÙ·È ÛÙËÓ ·È‰È΋ ËÏÈΛ· ·fi ÙË ÌË ¤ÁηÈÚË Î·È ·ÔÙÂÏÂÛÌ·ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ Ô˘ÚÔÏÔÈÌÒ͈Ó. O ΛӉ˘ÓÔ˜ ÂÌÊ¿ÓÈÛ˘ ·ÚÙËÚȷ΋˜ ˘¤ÚÙ·Û˘ Û ·ÛıÂÓ›˜ Ì ¡∫O¶ Â›Ó·È Û¯ÂÙÈο ÌÈÎÚfi˜ ÛÙËÓ ·È‰È΋ ËÏÈΛ·, ·˘Í¿ÓÂÙ·È ÛÙËÓ ÂÊË‚È΋ ËÏÈΛ· Î·È Ô˘ÛÈ·ÛÙÈο Â›Ó·È Úfi‚ÏËÌ· ÙˆÓ ÂÓËÏ›ÎˆÓ Î·È ·ÔÙÂÏ› ÛËÌ·ÓÙÈ΋ ·ÈÙ›· Ù˘ Âȉ›ӈÛ˘ Ù˘ ÓÂÊÚÈ΋˜ ÙÔ˘˜ ÏÂÈÙÔ˘ÚÁ›·˜. ™˘ÌÂÚ¿ÛÌ·Ù·: ·) ∏ ÌÂÁ¿ÏÔ˘ ‚·ıÌÔ‡ ∫O¶ Â›Ó·È ÁÂÓÂÙÈο ÚÔηıÔÚÈṲ̂ÓË, Â›Ó·È ‰˘Ó·Ùfi Ó· ‰È·ÁÓˆÛÙ› ÛÙËÓ ÂÌ‚Ú˘˚΋ ÂÚ›Ô‰Ô Î·È Û˘Ó‹ıˆ˜ Û˘Û¯ÂÙ›˙ÂÙ·È Ì ÙË ¡∫O¶. ‚) ∏ ÚfiÏË„Ë Ù˘ ÂÌÊ¿ÓÈÛ˘ ÓÂÊÚÈÎÒÓ Ô˘ÏÒÓ ÂÍ·ÚÙ¿Ù·È ·fi: i) ÙËÓ ¤ÁηÈÚË Ù·˘ÙÔÔ›ËÛË ·ÛıÂÓÒÓ Ô˘ Â›Ó·È Èı·Ófi Ó· ·ÚÔ˘ÛÈ¿˙Ô˘Ó ∫O¶ (‰ËÏ·‰‹ ÙˆÓ ÓÂÔÁÓÒÓ Ì ÂÌ‚Ú˘˚΋ ‰È¿ÁÓˆÛË ˘‰ÚÔÓ¤ÊÚˆÛ˘, ÙˆÓ ÓÂÔÁÓÒÓ Î·È ‚ÚÂÊÒÓ Ì ԢÚÔÏԛ̈ÍË Î·È ÙˆÓ Û˘ÁÁÂÓÒÓ ·ÛıÂÓÒÓ Ì ∫O¶), ii) ÙËÓ ÚfiÏË„Ë ÙˆÓ Ô˘ÚÔÏÔÈÌÒÍÂˆÓ ÛÙ· ·È‰È¿ Ì ∫√¶ Ì ÙË Ì·ÎÚfi¯ÚÔÓË ¯ÔÚ‹ÁËÛË ¯ËÌÂÈÔÚÔʇϷ͢ ‹ Ì ¯ÂÈÚÔ˘ÚÁÈ΋ ‰ÈfiÚıˆÛË Ù˘ ∫O¶ Â› ·ÔÙ˘¯›·˜ Ù˘ Û˘ÓÙËÚËÙÈ΋˜ ·ÁˆÁ‹˜ Î·È iii) ÙËÓ ¤ÁηÈÚË Î·È ·ÔÙÂÏÂÛÌ·ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÔÍ›·˜ ˘ÂÏÔÓÂÊÚ›Ùȉ·˜.

1 Stefanidis CJ Reflux nephropathy in children Nephrol Dial Transplant 2001;16:117-119

™ÙÂÊ·Ó›‰Ë˜ ∫.π. ∞Ó·ÏËÚˆÙ‹˜ ¢È¢ı˘ÓÙ‹˜ ¡ÂÊÚÔÏÔÁÈÎÔ‡ ∆Ì‹Ì·ÙÔ˜ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”

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Paediatriki 2002;65:447-451

CASE REPORT

µÈÔ¯ËÌÈ΋ ‰È¿ÁÓˆÛË Û˘Ó‰ÚfiÌÔ˘ Smith Lemli Opitz ∞. ∞Ó‰Ú¤Ô˘, ª. °Ô˘‰ÂÛ›‰Ô˘, µ. ¶··‚·ÛÈÏ›Ԣ, Ã. ™·Ú·ÓÙ¿ÚË

Biochemical diagnosis of Smith Lemli Opitz syndrome A. Andreou, M. Goudesidou, V. Papavasiliou, X. Sarantari

¶ÂÚ›ÏË„Ë: ∆Ô Û‡Ó‰ÚÔÌÔ Smith Lemli Opitz (ÛSLO) ‹ Û‡Ó‰ÚÔÌÔ RSH Â›Ó·È ·fi Ù· ÈÔ ÎÔÈÓ¿ Û‡Ó‰ÚÔÌ· ÔÏÏ·ÏÒÓ Û˘ÁÁÂÓÒÓ ·ÓˆÌ·ÏÈÒÓ Î·È ÎÏËÚÔÓÔÌÂ›Ù·È Ì ÙÔÓ ·˘ÙÔۈ̷ÙÈÎfi ˘ÔÏÂÈfiÌÂÓÔ ¯·Ú·ÎÙ‹Ú·. ¶ÚfiÛÊ·Ù· ‚Ú¤ıËΠfiÙÈ Ë ·ÈÙ›· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Â›Ó·È Ë ·ÓÂ¿ÚÎÂÈ· ÙÔ˘ ÂÓ˙‡ÌÔ˘ ¢-Ú‰ԢÎÙ¿ÛË Ù˘ 7-‰È¸‰ÚÔ¯ÔÏËÛÙÂÚfiÏ˘ Ô˘ Â›Ó·È ··Ú·›ÙËÙÔ ÛÙÔ ÌÂÙ·‚ÔÏÈÛÌfi, ‰ËÏ·‰‹ ÙË ‚ÈÔÛ‡ÓıÂÛË Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘. ¶ÂÚÈÁÚ¿ÊÔ˘Ì ¤Ó· ‚Ú¤ÊÔ˜ ı‹Ï˘, ËÏÈΛ·˜ 3,5 ÌËÓÒÓ, Ì ÛSLO Î·È ¯·Ú·ÎÙËÚÈÛÙÈ΋ ÎÏÈÓÈ΋ ÂÈÎfiÓ· Ô˘ ÂÚÈÂÏ¿Ì‚·Ó ÙÒÛË ‚ÏÂÊ¿ÚˆÓ, ·ÓÂÛÙÚ·Ì̤ӷ ÚÔ˘ıÔ‡ÓÈ·, ¯·ÌËÏ‹ ÚfiÛÊ˘ÛË ·˘ÙÈÒÓ Ì ·ÓÒÌ·ÏË ÂϛΈÛË, ‰ÈÏ‹ ·Ú˘Ê‹ Ô‡ÏˆÓ ¿Óˆ ÁÓ¿ıÔ˘, ˘ÂÚˆ˚ÔÛ¯ÈÛÙ›·, ÌÈÎÚÔÁÓ·ıÈÛÌfi, ÂÍ·‰·ÎÙ˘Ï›· ¿Óˆ ¿ÎÚˆÓ, Û˘Ó‰·ÎÙ˘Ï›· 2Ô˘ Î·È 3Ô˘ ‰·ÎÙ‡ÏÔ˘ ¿ÎÚˆÓ Ô‰ÒÓ, ˘ÂÚÙÔÓ›·, ˘„›Û˘¯ÓË ÊˆÓ‹, ‰˘ÛÊ·Á›· Î·È ‰˘ÛÙÚÔÊ›·. ∏ ‰È¿ÁÓˆÛË ÂȂ‚·ÈÒıËΠ̠‚ÈÔ¯ËÌÈÎfi ¤ÏÂÁ¯Ô Ô˘ ¤‰ÂÈÍ ÌÂÁ¿ÏË ·‡ÍËÛË Ù˘ 7-‰È¸‰ÚÔ¯ÔÏËÛÙÂÚfiÏ˘ ÛÙÔ Ï¿ÛÌ·, ÂÓÒ Ë ¯ÔÏËÛÙÂÚfiÏË ‹Ù·Ó ¯·ÌËÏ‹. ™Â ËÏÈΛ· 16 ÌËÓÒÓ ÙÔ ‚Ú¤ÊÔ˜ ÂÍ·ÎÔÏÔ˘ıÔ‡Û ӷ ¤¯ÂÈ ÌÂÁ¿ÏË ‰˘ÛÊ·Á›·, ‰˘ÛÙÚÔÊ›· Î·È ·ÚÔ˘Û›·˙ ‚·ÚÈ¿ „˘¯ÔÎÈÓËÙÈ΋ ηı˘ÛÙ¤ÚËÛË.

Abstract: The Smith Lemli Opitz syndrome (SLOS) or RSH syndrome is one of the archetypical multiple congenital malformation syndromes that has recently been proven to be a congenital autosomal recessive metabolic disorder. Recently it was found that the cause of the syndrome is 7-dehydrocholesterol reductase (DHCR7) deficiency, an enzyme that is necessary for cholesterol metabolism, i.e. biosynthesis. We describe a 3.5 months baby girl with SLOS and clinical features such as: eyelids ptosis, low set ears with abnormal auricles, anteverted nares, broad alveolar ridges, cleft palate, micrognathia, polydactyly of hands, syndactyly between 2nd and 3rd toes in both feet, increased muscle tone, high pitched voice, dysphagia and dystrophia. The biochemical test which revealed high plasma 7dehydrocholesterol and low cholesterol, confirmed our diagnosis. At the age of 16 months she was still having feeding problems, dystrophia and developed severe psychomotor retardation.

§¤ÍÂȘ ÎÏÂȉȿ: Û‡Ó‰ÚÔÌÔ Smith Lemli Opitz, ‚ÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜.

Key words: Smith Lemli Opitz syndrome, biochemical analysis.

∂ÈÛ·ÁˆÁ‹ ∆Ô Û‡Ó‰ÚÔÌÔ Smith Lemli Opitz (ÛSLO) ‹ Û‡Ó‰ÚÔÌÔ RSH ÂÚÈÁÚ¿ÊËΠÁÈ· ÚÒÙË ÊÔÚ¿ ÙÔ 1964 (1) Î·È Â›Ó·È ·fi Ù· ÈÔ ÎÔÈÓ¿ Û‡Ó‰ÚÔÌ· ÔÏÏ·ÏÒÓ Û˘ÁÁÂÓÒÓ ·ÓˆÌ·ÏÈÒÓ. OÈ ·ÛıÂÓ›˜ Ì ÛSLO ÂÌÊ·Ó›˙Ô˘Ó ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÚÔÛˆ›Ô, ˘ÂÚˆ˚ÔÛ¯ÈÛÙ›·, ÌÈÎÚÔÎÂÊ·Ï›·, ηı˘ÛÙ¤ÚËÛË ·‡ÍËÛ˘, ·ÓˆÌ·Ï›Â˜ ·fi Ù· ¿ÎÚ· Î·È Ù· ÁÂÓÓËÙÈο fiÚÁ·Ó·

Î·È ¤¯Ô˘Ó ۯ‰fiÓ fiÏÔÈ ÙÔ˘˜ ÛÔ‚·Ú‹ ÓÔËÙÈ΋ ˘ÛÙ¤ÚËÛË (2). ª›· ÈÔ ÛÔ‚·Ú‹ ÌÔÚÊ‹ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘, Ô˘ Â›Ó·È ı·Ó·ÙËÊfiÚ· ÛÙË ÓÂÔÁÓÈ΋ ËÏÈΛ·, ÂÚÈÁÚ¿ÊËΠÙÔ 1987 Î·È ÔÓÔÌ¿ÛÙËΠÛSLO Ù‡Ô˘ ππ (3). O Ù‡Ô˜ ππ ¤¯ÂÈ ÙÔ Ê·ÈÓfiÙ˘Ô ÙÔ˘ ÎÏ·ÛÈÎÔ‡ ÛSLO Î·È ÂÈϤÔÓ Ì›˙ÔÓ˜ ‰ÔÌÈΤ˜ ·ÓˆÌ·Ï›Â˜ Ô˘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Î·È „¢‰ÂÚÌ·ÊÚÔ‰ÈÙÈÛÌfi. ∫·È ÛÙÔ˘˜ ‰‡Ô Ù‡Ô˘˜, Ë ÎÏËÚÔÓÔÌÈÎfiÙËÙ· Â›Ó·È Î·Ù¿

¡ÂÔÁÓÔÏÔÁÈÎfi ∆Ì‹Ì· ∂™À, πÔÎÚ¿ÙÂÈÔ °¶¡ £ÂÛÛ·ÏÔӛ΢

Neonatal Department NHS, Ippokration General Hospital, Thessaloniki

447

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¶·È‰È·ÙÚÈ΋ 2002;65:447-451

Paediatriki 2002;65:447-451

ÙÔÓ ·˘ÙÔۈ̷ÙÈÎfi ˘ÔÏÂÈfiÌÂÓÔ ¯·Ú·ÎÙ‹Ú·. ∆Ô 1993-1994 ·ÔηχÊıËÎÂ Ë ‚ÈÔ¯ËÌÈ΋ ·ÈÙ›· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Î·È ·ÎÔÏÔ‡ıˆ˜ ÙÔ ÛSLO Â·Ó·Î·ıÔÚ›ÛÙËÎÂ Û·Ó Ì›· Û‡ÌÊ˘ÙË ‚Ï¿‚Ë ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡, ‰ËÏ. Ù˘ ‚ÈÔÛ‡ÓıÂÛ˘ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ (4). ∏ ‚Ï¿‚Ë ÔÊ›ÏÂÙ·È Û ·ÓÂ¿ÚÎÂÈ· ÙÔ˘ ÂÓ˙‡ÌÔ˘ ¢Ú‰ԢÎÙ¿ÛË Ù˘ 7-‰È¸‰ÚÔ¯ÔÏËÛÙÂÚfiÏ˘ (DHCR7). ∆Ô ·ÓıÚÒÈÓÔ ÁÔÓ›‰ÈÔ ÙÔ˘ ÂÓ˙‡ÌÔ˘ Ù˘ DHCR7 ¤¯ÂÈ ¯·ÚÙÔÁÚ·ÊËı› ÛÙË ı¤ÛË 11q12-13 (5,6). ∆Ô 1990 ‰ËÌÔÛȇıËΠ¤Ó· ÂÚÈÛÙ·ÙÈÎfi ÛSLO Ù‡Ô˘ π, fiÔ˘ Ë ‰È¿ÁÓˆÛË ÛÙËÚ›¯ıËΠ۠ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο (7). ¶·Ú·Î¿Ùˆ ÂÚÈÁÚ¿ÊÂÙ·È ¤Ó· ÂÚÈÛÙ·ÙÈÎfi ÛSLO Ô˘ ‰È·ÁÓÒÛıËΠÎÏÈÓÈο Î·È ÂȂ‚·ÈÒıËΠ̠‚ÈÔ¯ËÌÈÎfi ¤ÏÂÁ¯Ô. ¶ÂÚÈÁÚ¿ÊÔÓÙ·È ·ÎfiÌ· ÔÈ Ó¤Â˜ ÂÍÂÏ›ÍÂȘ ÛÙË ‰È¿ÁÓˆÛË, ÙËÓ ·ÈÙÈÔÏÔÁ›· Î·È ÙËÓ ·ıÔÁ¤ÓÂÈ· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘. ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ¶ÚfiÎÂÈÙ·È ÁÈ· ÎÔÚ›ÙÛÈ, 3Ô ·È‰› Ê·ÈÓÔÌÂÓÈο ˘ÁÈÒÓ ÁÔÓ¤ˆÓ, ÌË Û˘ÁÁÂÓÒÓ ÌÂٷ͇ ÙÔ˘˜, Ô˘ ÁÂÓÓ‹ıËΠÙÂÏÂÈfiÌËÓÔ ÌÂÙ¿ ·fi Ê˘ÛÈÔÏÔÁÈ΋ ·ËÛË Î·È ÙÔÎÂÙfi, Ì µ° 2200 g. ∆Ô˘˜ 3 ÚÒÙÔ˘˜ Ì‹Ó˜ Ù˘ ˙ˆ‹˜ ÙÔ˘ ÓÔÛËχıËΠ۠‰È¿ÊÔÚ˜ ·È‰È·ÙÚÈΤ˜ Î·È ·È‰Ô¯ÂÈÚÔ˘ÚÁÈΤ˜ ÎÏÈÓÈΤ˜ ÏfiÁˆ ÔÏÏ·ÏÒÓ Û˘ÁÁÂÓÒÓ ·ÓˆÌ·ÏÈÒÓ Î·È ‰˘ÛÊ·Á›·˜. ™ÙÔ ‰È¿ÛÙËÌ· ·˘Ùfi, Û ËÏÈΛ· 8 ËÌÂÚÒÓ, ¤ÁÈÓ ÓËÛÙȉÈÔÛÙÔÌ›· ÏfiÁˆ ·‰˘Ó·Ì›·˜ Û›ÙÈÛ˘, ›¯Â ¤Ó· ÂÂÈÛfi‰ÈÔ Û‹„˘ ·fi Klebsiella Î·È ¯ÚÂÈ¿ÛÙËΠ̛· ÌÂÙ¿ÁÁÈÛË ·›Ì·ÙÔ˜ ÁÈ· ‰ÈfiÚıˆÛË ·Ó·ÈÌ›·˜. ∏ ÓËÛÙȉÈÔÛÙÔÌ›· ·Ú¤ÌÂÈÓ ÁÈ· ¤Ó· Ì‹Ó·. ™Â ËÏÈΛ· 3,5 ÌËÓÒÓ ÂÈÛ‹¯ıË ÛÙÔ ÙÌ‹Ì· Ì·˜ ÁÈ· ‰˘ÛÊ·Á›·. ∏ Ê˘ÛÈ΋ ÂͤٷÛË ¤‰ÂÈÍ ¤Ó· ÓˆıÚfi, ¤ÓÙÔÓ· ‰˘ÛÙÚÔÊÈÎfi ‚Ú¤ÊÔ˜. ∆Ô µ™, ª™ Î·È ¶∫ ‹Ù·Ó οو ·fi ÙËÓ 3Ë ÂηÙÔÛÙÈ·›· ı¤ÛË. ™ÙÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÙˆÓ 3,5 ÌËÓÒÓ ˙ˆ‹˜ ÙÔ µ™ ›¯Â ·˘ÍËı› ÌfiÓÔ Î·Ù¿ 450 g. ∆Ô ÚÔÛˆÂ›Ô ‹Ù·Ó ·Û‡ÓËı˜ Ì ÙÒÛË ‚ÏÂÊ¿ÚˆÓ, ¢ڇ ¿ÎÚÔ ÚÈÓfi˜, ·ÓÂÛÙÚ·Ì̤ӷ ÚÔ˘ıÔ‡ÓÈ·, ¯·ÌËÏ‹ ÚfiÛÊ˘ÛË ·˘ÙÈÒÓ Ì ·ÓÒÌ·ÏË ÂϛΈÛË, ‰ÈÏ‹ ·Ú˘Ê‹ Ô‡ÏˆÓ ¿Óˆ ÁÓ¿ıÔ˘, ˘ÂÚˆ˚ÔÛ¯ÈÛÙ›· Î·È ÌÈÎÚÔÁÓ·ıÈÛÌfi (∂ÈÎfiÓ· 1). ŸÛÔÓ ·ÊÔÚ¿ ÛÙ· ¿ÎÚ·, ˘‹Ú¯Â ÂÍ·‰·ÎÙ˘Ï›· ¿Óˆ ¿ÎÚˆÓ Î·È ÌÂÙ·ÍÔÓÈ΋ ÔÏ˘Û˘Ó‰·ÎÙ˘Ï›· οو ¿ÎÚˆÓ Ì ÂÍ·‰·ÎÙ˘Ï›· Î·È Û˘Ó‰·ÎÙ˘Ï›· 2Ô˘-3Ô˘, 5Ô˘-6Ô˘ ‰·ÎÙ‡ÏÔ˘ ·ÚÈÛÙÂÚ¿ Î·È Û˘Ó‰·ÎÙ˘Ï›· 2Ô˘-3Ô˘ ‰·ÎÙ‡ÏÔ˘ ‰ÂÍÈ¿ (∂ÈÎfiÓ· 2). ∞fi ÙÔ Ó¢ÚÔÌ˘˚Îfi Û‡ÛÙËÌ· ˘‹Ú¯Â ‹È· ÁÂÓÈÎÂ˘Ì¤ÓË ˘ÂÚÙÔÓ›·, ˘ÂÚ‰ÈÂÁÂÚÛÈÌfiÙËÙ· Î·È ˘„›Û˘¯ÓË ÊˆÓ‹. ∏ ˘fiÏÔÈË Î·Ù¿ Û˘ÛÙ‹Ì·Ù· Ê˘ÛÈ΋ ÂͤٷÛË ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋. ∆Ô ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜/ÓÂÊÚÒÓ, ÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ηډȿ˜, Ë ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘, Ô ·ÎÔ˘ÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ì ÚÔÎÏËÙ¿ ‰˘Ó·ÌÈο, ÙÔ ËÏÂÎÙÚÔÌ˘ÔÁÚ¿ÊËÌ· ÙˆÓ Ì˘ÒÓ

448

∂ÈÎfiÓ· 1. ¶ÙÒÛË ‚ÏÂÊ¿ÚˆÓ, ¢ڇ ¿ÎÚÔ ÚÈÓfi˜, ·ÓÂÛÙÚ·Ì̤ӷ ÚÔ˘ıÔ‡ÓÈ·, ¯·ÌËÏ‹ ÚfiÛÊ˘ÛË ·˘ÙÈÒÓ Ì ·ÓÒÌ·ÏË ÂϛΈÛË, ÌÈÎÚÔÁÓ·ıÈÛÌfi˜.

Ù˘ ηٿÔÛ˘ Î·È Ô Ï‹Ú˘ ÔÊı·ÏÌÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο. O ηڢfiÙ˘Ô˜ ‹Ù·Ó 46, ÃÃ.

O ·ÈÌ·ÙÔÏÔÁÈÎfi˜ Î·È ‚ÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÚÔ˘Ù›Ó·˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜. ∏ ¯ÔÏËÛÙÂÚfiÏË ÔÚÔ‡ ‹Ù·Ó 62 mg/dl (º∆ >66 mg/dl). ∏ 7-‰È¸‰ÚÔ¯ÔÏËÛÙÂÚfiÏË ‹Ù·Ó 265,3 Ìmol/l (º∆ 0,7-1,96 Ìmol/l), Ë ¯ÔÏÂÛÙ·ÓfiÏË 0,84 Ìmol/l (º∆ 3,87-18,4 Ìmol/l), ÂÓÒ ‹Ù·Ó ·ÓȯÓ‡ÛÈÌË Î·È Ë 8-‰È¸‰ÚÔ¯ÔÏËÛÙÂÚfiÏË ÛÙÔ ‚ÈÔ¯ËÌÈÎfi ¤ÏÂÁ¯Ô Ï¿ÛÌ·ÙÔ˜ Ô˘ ¤ÁÈÓ Ì ÙË Ì¤ıÔ‰Ô GC-MS ÛÙÔ Institute of Child Health ÛÙÔ §ÔÓ‰›ÓÔ. ∆· ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο Î·È Ô ‚ÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ ¤ıÂÛ·Ó ÙË ‰È¿ÁÓˆÛË ÛSLO Ù‡Ô˘ π. ∆Ô ‚Ú¤ÊÔ˜ ÓÔÛËχÙËΠÛÙÔ ∆Ì‹Ì· Ì·˜ ÁÈ· ¤Ó· Ì‹Ó· Ì ¤ÓÙÔÓ· ÚÔ‚Ï‹Ì·Ù· ‰˘ÛÊ·Á›·˜ Î·È ‰˘ÛÙÚÔÊ›·˜. ∂Í‹Ïı Ì ԉËÁ›Â˜ ÁÈ· Û›ÙÈÛË Ì ÛÙÔÌ·ÙÔÁ·ÛÙÚÈÎfi ηıÂÙ‹Ú·. ™Â ËÏÈΛ· 16 ÌËÓÒÓ ·ÚÔ˘Û›·˙ ÌÂÁ¿ÏË ‰˘ÛÊ·Á›·, ‰˘ÛÙÚÔÊ›· Î·È ‚·ÚÈ¿ „˘¯ÔÎÈÓËÙÈ΋ ηı˘ÛÙ¤ÚËÛË.

NoV-dEc-02

14-05-03

14:26

™ÂÏ›‰·449

¶·È‰È·ÙÚÈ΋ 2002;65:447-451

∂ÈÎfiÓ· 2. ªÂÙ·ÍÔÓÈ΋ ÔÏ˘Û˘Ó‰·ÎÙ˘Ï›· οو ¿ÎÚˆÓ Ì ÂÍ·‰·ÎÙ˘Ï›· Î·È Û˘Ó‰·ÎÙ˘Ï›· 2Ô˘-3Ô˘, 5Ô˘-6Ô˘ ‰·ÎÙ‡ÏÔ˘ ·ÚÈÛÙÂÚ¿ Î·È Û˘Ó‰·ÎÙ˘Ï›· 2Ô˘-3Ô˘ ‰·ÎÙ‡ÏÔ˘ ‰ÂÍÈ¿.

™˘˙‹ÙËÛË ∆Ô ÛSLO ÔÊ›ÏÂÙ·È ÛÙËÓ ·ÓÂ¿ÚÎÂÈ· ÙÔ˘ ÂÓ˙‡ÌÔ˘ DHCR7, ÙÔ ÔÔ›Ô Û˘ÌÌÂÙ¤¯ÂÈ ÛÙË ‚ÈÔÛ‡ÓıÂÛË Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘. ∞ÔÙ¤ÏÂÛÌ· Â›Ó·È Ë ÂÏ¿ÙÙˆÛË Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ ÛÙÔ Ï¿ÛÌ· ηÈ, Û˘Á¯ÚfiÓˆ˜, Ë ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË ÛÙÔ Ï¿ÛÌ· Î·È ÛÙÔ˘˜ ÈÛÙÔ‡˜ Ù˘ 7-‰È¸‰ÚÔ¯ÔÏËÛÙÂÚfiÏ˘ (7DHC), Úfi‰ÚÔÌ˘ Ô˘Û›·˜ ÛÙË Û‡ÓıÂÛË Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ (2,4,8). ∏ ·ÈÙ›· Ù˘ ·ÓÂ¿ÚÎÂÈ·˜ ÙÔ˘ ÂÓ˙‡ÌÔ˘ DHCR7 Â›Ó·È ÔÈ ÌÂÙ·ÏÏ¿ÍÂȘ ÛÙÔ ÁÔÓ›‰ÈÔ Ô˘ Â›Ó·È ˘‡ı˘ÓÔ ÁÈ· ÙÔ ¤Ó˙˘ÌÔ Î·È Â‰Ú¿˙ÂÙ·È ÛÙÔ ¯ÚˆÌfiۈ̷ 11q12-13 (6). Œ¯Ô˘Ó ÂÚÈÁÚ·Ê› ÙÔ˘Ï¿¯ÈÛÙÔÓ 36 ÌÂÙ·ÏÏ¿ÍÂȘ (9). ∆Ô ÛSLO ‹Ù·Ó ÙÔ ÚÒÙÔ ‰˘ÛÌÔÚÊÈÎfi Û‡Ó‰ÚÔÌÔ ÛÙÔ ÔÔ›Ô ‚Ú¤ıËΠ‰È·Ù·Ú·¯‹ ÛÙÔ ÌÂÙ·‚ÔÏÈÛÌfi Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘. ÕÏϘ ÔÓÙfiÙËÙ˜ Ì ‚Ï¿‚Ë ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ Â›Ó·È ÙÔ Û‡Ó‰ÚÔÌÔ Conradi-Hunermann, ÙÔ Û‡Ó‰ÚÔÌÔ CHILD, Ë ‰ÂÛÌÔÛÙÂÚfiÏ˘ÛË, Ë ‰˘ÛÏ·Û›· Greenberg Î·È Ë Ì‚·ÏÔÓÈ΋ Ô͢Ԣڛ·. ŸÏ˜ Ì·˙› ÚÔÙ›ÓÂÙ·È Ó· ηٷٷÁÔ‡Ó Û ̛· ÂȉÈ΋ ÔÌ¿‰· ÌÂÙ·‚ÔÏÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ Î·È Ó· ÔÓÔÌ·ÛÙÔ‡Ó ¯ÔÏËÛÙÂÚÔÏÔ¿ıÂȘ (10). ∏ Û˘¯ÓfiÙËÙ· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘, ÙËÓ ÂÔ¯‹ Ô˘ Ë ‰È¿ÁÓˆÛË ÛÙËÚÈ˙fiÙ·Ó ÌfiÓÔ Û ÎÏÈÓÈο ÎÚÈÙ‹ÚÈ·, ›¯Â ÂÎÙÈÌËı› fiÙÈ ‹Ù·Ó 1:10000-1:40000 ÁÂÓÓ‹ÛÂȘ ˙ÒÓÙˆÓ ÓÂÔÁÓÒÓ (10). ™‹ÌÂÚ·, Ô˘ Ë ‰È¿ÁÓˆÛË Ù›ıÂÙ·È ‚ÈÔ¯ËÌÈο, Ë Û˘¯ÓfiÙËÙ· ˘ÔÏÔÁ›˙ÂÙ·È Û 1:60000-1:100000 ÁÂÓÓ‹ÛÂȘ ˙ÒÓÙˆÓ ÓÂÔÁÓÒÓ (10,11). ∏ ‰È·ÊÔÚ¿ ·˘Ù‹ ÔÊ›ÏÂÙ·È ÚÔÊ·ÓÒ˜ Û ˘ÂډȿÁÓˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ÛÙ· ÎÏÈÓÈο ‡ÔÙ·

Paediatriki 2002;65:447-451

ÂÚÈÛÙ·ÙÈο, ÏfiÁˆ Ù˘ ÌÂÁ¿Ï˘ ÔÈÎÈÏ›·˜ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÙÔ˘ ÛSLO Î·È Ù˘ Û˘¯Ó‹˜ Û‡Á¯˘Û‹˜ ÙÔ˘ Ì ¿ÏÏ· Û‡Ó‰ÚÔÌ· Ô˘ ¤¯Ô˘Ó ·ÚfiÌÔÈ· Û˘ÌÙÒÌ·Ù·. ™ÙË ‰È¿ÚÎÂÈ· Ù˘ 15ÂÙÔ‡˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘ ÙÌ‹Ì·ÙÔ˜ Ì·˜ ›¯·Ì ‰‡Ô ÂÚÈÛÙ·ÙÈο ÛSLO: ¤Ó· Ô˘ ‰È·ÁÓÒÛÙËΠÌfiÓÔ ÎÏÈÓÈο ÙÔ 1990 (7) Î·È ÙÔ ·ÚfiÓ Ô˘ ‰È·ÁÓÒÛÙËΠÎÏÈÓÈο Î·È ÂȂ‚·ÈÒıËΠ‚ÈÔ¯ËÌÈο. ŒÓ· ÙÚ›ÙÔ ÂÚÈÛÙ·ÙÈÎfi Ì ·ÚÎÂÙ¿ ¯·Ú·ÎÙËÚÈÛÙÈο ÛSLO ‰ÂÓ ÂȂ‚·ÈÒıËΠ‚ÈÔ¯ËÌÈο. ∆Ô ÂÚÈÛÙ·ÙÈÎfi ·˘Ùfi ıˆڋıËΠfiÙÈ ‹Ù·Ó Û‡Ó‰ÚÔÌÔ ·Ï·Û›·˜ ÙÔ˘ ÛÎÒÏËη Ù˘ ·ÚÂÁÎÂÊ·Ï›‰·˜ ÌÂ Û˘ÓÔ‰¿ ¯·Ú·ÎÙËÚÈÛÙÈο ÂÓ‰ÂÈÎÙÈο ÙˆÓ Û˘Ó‰ÚfiÌˆÓ Meckel Î·È SLO (213010 OMIM). ∆· ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ ÛSLO ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1 (10). ªÂÙ¿ ÙÔ ‚ÈÔ¯ËÌÈÎfi ηıÔÚÈÛÌfi ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ‚Ú¤ıËΠfiÙÈ ÙÔ Ê¿ÛÌ· Ù˘ ÎÏÈÓÈ΋˜ ¤ÎÊÚ·Û˘ ‹Ù·Ó ÂÚÈÛÛfiÙÂÚÔ Â˘Ú‡, ·’ fiÙÈ ‹Ù·Ó ÁÓˆÛÙfi ÚÔËÁÔ‡ÌÂÓ·. ™ÙÔ Ê¿ÛÌ· ·˘Ùfi ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È Î·È ·ÛıÂÓ›˜ Ì ¿Ù˘Ô ÛSLO, fiˆ˜ ·˘ÙÔ› Ô˘ ¤¯Ô˘Ó ÌfiÓÔ Û˘Ó‰·ÎÙ˘Ï›· ÙˆÓ ‰·ÎÙ‡ÏˆÓ ÙÔ˘ Ô‰ÈÔ‡, ¿ÏÏÔÈ Ô˘ ¤¯Ô˘Ó ‹È· ÔÏÔÚÔÛÂÁÎÂÊ·Ï›· Î·È ¿ÏÏÔÈ Ô˘ ¤¯Ô˘Ó ÔÏÏ·Ϥ˜ ÛÏ·Á¯ÓÈΤ˜ ·ÓˆÌ·Ï›Â˜ Û˘Óԉ¢fiÌÂÓ˜ Ì ÂÓ‰ÔÌ‹ÙÚÈÔ ı¿Ó·ÙÔ (12). ∏ Û˘Ó‰·ÎÙ˘Ï›· ÌÂٷ͇ 2Ô˘-3Ô˘ ‰·ÎÙ‡ÏÔ˘ ÙÔ˘ Ô‰ÈÔ‡ ıˆÚÂ›Ù·È ·fi ÔÚÈṲ̂ÓÔ˘˜ Ë ÈÔ Û˘¯Ó¿ ··ÓÙÒÌÂÓË ·ÓˆÌ·Ï›· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ (12). ™ÙËÓ ÔÚ›· ÙÔ˘˜ Ù· ÂÚÈÛÙ·ÙÈο Ì ÛSLO, fiˆ˜ Î·È ÙÔ ·ÚfiÓ, ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÛÔ‚·Ú¤˜ ‰˘ÛÎÔϛ˜ ÛÙË Û›ÙÈÛË, ˘ÔÙÔÓ›· ÛÙË ‚ÚÂÊÈ΋ ËÏÈΛ· Î·È ˘ÂÚÙÔÓ›· ·ÚÁfiÙÂÚ·, ÌË ÚfiÛÏË„Ë ‚¿ÚÔ˘˜, ·˘ÍË̤ÓÔ ·ÚÈıÌfi ÏÔÈÌÒ͈Ó, ÌÂÁ¿ÏË Û˘¯ÓfiÙËÙ· ·ÏÏÂÚÁ›·˜ ÛÙËÓ ÚˆÙ½ÓË ÙÔ˘ Á¿Ï·ÎÙÔ˜ Î·È Ù˘ ÛfiÁÈ·˜ Î·È ÊˆÙÔ¢·ÈÛıËÛ›· (10,13). ™¯Â‰fiÓ fiÏ· Ù· ÂÚÈÛÙ·ÙÈο ·ÚÔ˘ÛÈ¿˙Ô˘Ó „˘¯ÔÎÈÓËÙÈ΋ ηı˘ÛÙ¤ÚËÛË. ∆Ô IQ ÙÔ˘˜ Î˘Ì·›ÓÂÙ·È Û˘Ó‹ıˆ˜ ÌÂٷ͇ 20-40. ¶ÂÚ›Ô˘ ÙÔ 10% ÙˆÓ ·È‰ÈÒÓ Ô˘ ¤¯Ô˘Ó ‰È·ÁÓˆÛÙ› ‚ÈÔ¯ËÌÈο ¤¯ÂÈ IQ 5070%. Œ¯Ô˘Ó, Â›Û˘, ÂÚÈÁÚ·Ê› Î·È Ï›Á˜ ÂÚÈÙÒÛÂȘ ÌÂ Ê˘ÛÈÔÏÔÁÈ΋ ‹ ÔÚȷο Ê˘ÛÈÔÏÔÁÈ΋ ·Ó¿Ù˘ÍË (14). ∆· ÂÚÈÛÙ·ÙÈο Ô˘ ‰ÂÓ Â›Ó·È ˘fi ıÂÚ·›· ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÛÔ‚·Ú¿ ÚÔ‚Ï‹Ì·Ù· Û˘ÌÂÚÈÊÔÚ¿˜ Î·È ·˘ÙÈÛÙÈΤ˜ ÂΉËÏÒÛÂȘ (11). ∏ ‰È¿ÁÓˆÛË ÛÙËÚ›˙ÂÙ·È ÛÙËÓ ·Ó‡ÚÂÛË ·˘ÍË̤Ó˘ 7DHC ÛÙÔ Ï¿ÛÌ·. ∏ ¯ÔÏËÛÙÂÚfiÏË Ï¿ÛÌ·ÙÔ˜ Â›Ó·È Û˘Ó‹ıˆ˜ ÂÏ·Ùو̤ÓË. ™Â 10% ÙˆÓ ÂÚÈÙÒÛÂˆÓ Â›Ó·È Ê˘ÛÈÔÏÔÁÈ΋. ¶Èı·ÓÔÏÔÁÂ›Ù·È fiÙÈ ˘¿Ú¯ÂÈ Î·È ¿ÏÏË ÁÂÓÂÙÈ΋ Ô‰fi˜ Û‡ÓıÂÛ˘ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ Ô˘ ‰ÂÓ ¯ÚÂÈ¿˙ÂÙ·È ÙÔ ¤Ó˙˘ÌÔ DHCR7 Î·È Ô˘ ‰ڿ˙ÂÙ·È ÛÙ· ÂÚÔ͢ÛÒÌ·Ù· (15). ∏ ÎÏÈÓÈ΋ ‚·Ú‡ÙËÙ· Û¯ÂÙ›˙ÂÙ·È Ì ٷ Â›‰· Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ ÛÙÔ Ï¿ÛÌ· ‹ Ì ÙÔ ÎÏ¿ÛÌ· Ù˘ 7DHC/ÔÏÈΤ˜ ÛÙÂÚfiϘ, fi¯È fï˜ Ì ٷ Â›‰·

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¶·È‰È·ÙÚÈ΋ 2002;65:447-451

Paediatriki 2002;65:447-451

¶›Ó·Î·˜ 1. ∂˘Ú‹Ì·Ù· Û 164 ÎÏÈÓÈο ‰È·ÁÓˆṲ̂Ó˜ Î·È ‚ÈÔ¯ËÌÈο ÂȂ‚·ÈˆÌ¤Ó˜ ÂÚÈÙÒÛÂȘ Û˘Ó‰ÚfiÌÔ˘ Smith Lemli Opitz ∂˘Ú‹Ì·Ù·

(%)

¡ÔËÙÈ΋ ˘ÛÙ¤ÚËÛË ∫·ı˘ÛÙ¤ÚËÛË ·Ó¿Ù˘Í˘ ÌÂÙ¿ ÙË Á¤ÓÓËÛË ªÈÎÚÔÎÂÊ·Ï›· ¢ÔÌÈΤ˜ ·ÓˆÌ·Ï›Â˜ ÂÁÎÂÊ¿ÏÔ˘ ¶ÙÒÛË ‚ÏÂÊ¿ÚˆÓ ∫·Ù·ÚÚ¿ÎÙ˘ ∞ÓÂÛÙÚ·Ì̤ӷ ÚÔ˘ıÔ‡ÓÈ· ÀÂÚˆ˚ÔÛ¯ÈÛÙ›· ™˘ÁÁÂÓ‹˜ ηډÈÔ¿ıÂÈ· ∞ÓÒÌ·ÏË Ïfi‚ˆÛË Ó¢ÌfiÓˆÓ ¶˘ÏˆÚÈ΋ ÛÙ¤ÓˆÛË ∞Á·ÁÁÏÈÔÓÈÎfi ÎfiÏÔÓ ¡ÂÊÚÈΤ˜ ·ÓˆÌ·Ï›Â˜ ∞ӈ̷ϛ˜ ÁÂÓÓËÙÈÎÒÓ ÔÚÁ¿ÓˆÓ ™˘Ó‰·ÎÙ˘Ï›· 2/3 ‰·ÎÙ‡ÏˆÓ Î¿Ùˆ ¿ÎÚˆÓ ¶ÔÏ˘‰·ÎÙ˘Ï›·, ÌÂÙ·ÍÔÓÈ΋

95 92 84 37 70 22 78 47 54 45 14 16 43 65 97 48

Ù˘ 7DHC ÛÙÔ Ï¿ÛÌ· (10,12).

OÈ ·ÛıÂÓ›˜ Ì ÛSLO Ô˘ ¤¯Ô˘Ó ÔÏÏ·Ϥ˜ ÂÛˆÙÂÚÈΤ˜ ·ÓˆÌ·Ï›Â˜ Î·È ÚÒÈÌÔ˘˜ ı·Ó¿ÙÔ˘˜, ¤¯Ô˘Ó ÁÂÓÈο Ôχ ¯·ÌËÏfiÙÂÚ· Â›‰· ÔÏÈÎÒÓ ÛÙÂÚÔÏÒÓ Ì ˘„ËÏfiÙÂÚ˜ ·Ó·ÏÔÁ›Â˜ 7DHC/ÔÏÈΤ˜ ÛÙÂÚfiϘ Û ۯ¤ÛË Ì ÙÔ˘˜ ÂÈ˙ÒÓÙ˜ ·ÛıÂÓ›˜. ¶ÈÛÙ‡ÂÙ·È, fï˜, fiÙÈ Ô ı¿Ó·ÙÔ˜ ÛÙÔ ÛSLO ÚÔηÏÂ›Ù·È Î·Ù¿ ÌÂÁ¿ÏÔ Ì¤ÚÔ˜ ·fi ÙË Û˘Ó‡·ÚÍË ÂȉÈÎÒÓ ÛÏ·Á¯ÓÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ, ·Ú¿ ·fi ‚ÈÔ¯ËÌÈο Â·ÎfiÏÔ˘ı· ÙˆÓ ÌË Ê˘ÛÈÔÏÔÁÈÎÒÓ ÂÈ¤‰ˆÓ ÙˆÓ ÛÙÂÚÔÏÒÓ (10). ¢ÂÓ ¤¯ÂÈ ·Ú·ÙËÚËı› Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÙÔ˘ ›‰Ô˘˜ Ù˘ ÌÂÙ¿ÏÏ·Í˘ Î·È ÙÔ˘ Ê·ÈÓfiÙ˘Ô˘, Ú¿ÁÌ· Ô˘ ‰Â›¯ÓÂÈ fiÙÈ Ô ‚·ıÌfi˜ ‚·Ú‡ÙËÙ·˜ ÌÔÚ› Ó· ÂËÚ¿˙ÂÙ·È Î·È ·fi ¿ÏÏÔ˘˜ ·Ú¿ÁÔÓÙ˜ (9). ∏ ÚÔÁÂÓÓËÙÈ΋ ‰È¿ÁÓˆÛË Á›ÓÂÙ·È Ì ÙËÓ ·Ó›¯Ó¢ÛË ·˘ÍËÌ¤ÓˆÓ ÂÈ¤‰ˆÓ 7DHC ÛÙÔ ·ÌÓÈ·Îfi ˘ÁÚfi (¿Óˆ ·fi 500 ÊÔÚ¤˜) (10,16). ™Â ÔÚÈṲ̂Ó˜ ΢‹ÛÂȘ, Ë ¯ÔÏËÛÙÂÚfiÏË ÛÙÔ ·ÌÓÈ·Îfi ˘ÁÚfi Â›Ó·È Ôχ ¯·ÌËÏ‹, ÂÓÒ Û ¿ÏϘ Ê˘ÛÈÔÏÔÁÈ΋. ∏ ¢ÎÔÏ›· Î·È Ë ·ÎÚ›‚ÂÈ· ÙÔ˘ ‚ÈÔ¯ËÌÈÎÔ‡ ÂϤÁ¯Ô˘ ηıÈÛÙ¿ ÙË ÌÔÚȷ΋ ·Ó¿Ï˘ÛË ÌË ··Ú·›ÙËÙË ÁÈ· ÙË ‰È¿ÁÓˆÛË. ™ÙȘ ÂÚÈÙÒÛÂȘ ÌÂ Ê˘ÛÈÔÏÔÁÈο Â›‰· ¯ÔÏËÛÙÂÚfiÏ˘ Î·È ÔÚȷο Â›‰· 7DHC Î·È 8DHC, Ë ‰È¿ÁÓˆÛË Ù›ıÂÙ·È Ì ÂÓ˙˘Ì·ÙÈΤ˜ ÌÂıfi‰Ô˘˜. ª›· ·fi ÙȘ ÚÒÙ˜ ÂӉ›ÍÂȘ ÁÈ· ¿Û¯ÔÓ ¤Ì‚Ú˘Ô Â›Ó·È Ë ·Ó‡ÚÂÛË ¯·ÌËÏÒÓ ÂÈ¤‰ˆÓ ÌË Û˘Ó‰Â‰Â̤Ó˘ ÔÈÛÙÚÈfiÏ˘ ÛÙÔÓ ÔÚfi Ù˘ ÌËÙ¤Ú·˜ (10). ∏ ıÂÚ·›· ̤¯ÚÈ ÚfiÛÊ·Ù· ‹Ù·Ó ηı·Ú¿ ˘ÔÛÙËÚÈÎÙÈ΋. ªÂÙ¿ ÙËÓ ·Ó‡ÚÂÛË Ù˘ ·ÓÂ¿ÚÎÂÈ·˜ ÛÙË ‚ÈÔÛ‡ÓıÂÛË Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘, Ë ıÂÚ·¢ÙÈ΋ ÊÚÔÓÙ›‰· ¤¯ÂÈ ·ÏÏ¿ÍÂÈ Ô˘ÛÈ·ÛÙÈο. ªÂϤÙ˜ ‰Â›¯ÓÔ˘Ó fiÙÈ Ë ¯ÔÚ‹ÁËÛË ·˘ÍËÌ¤ÓˆÓ ÔÛÔÙ‹ÙˆÓ ¯ÔÏËÛÙÂÚfiÏ˘ Ì ÙËÓ ÙÚÔÊ‹ ‹ ·ÚÂÓÙÂÚÈο

450

Ô‰ËÁ› Û ‚ÈÔ¯ËÌÈ΋ ‚ÂÏÙ›ˆÛË, ‚ÂÏÙ›ˆÛË Ù˘ ·‡ÍËÛ˘, ‚ÂÏÙ›ˆÛË Ù˘ Û˘ÌÂÚÈÊÔÚ¿˜, ‚ÂÏÙ›ˆÛË ÛÙË Ó¢ÚÔ·Ó·Ù˘Íȷ΋ ηٿÛÙ·ÛË, ηχÙÂÚË ·ÓÔ¯‹ ÛÙȘ ÏÔÈÌÒÍÂȘ, ‚ÂÏÙ›ˆÛË ÛÙ· Á·ÛÙÚÂÓÙÂÚÈο Û˘ÌÙÒÌ·Ù· Î·È ÂÏ¿ÙÙˆÛË Ù˘ ʈÙÔ¢·ÈÛıËÛ›·˜ Î·È ÙˆÓ ‰ÂÚÌ·ÙÈÎÒÓ ÂÍ·ÓıËÌ¿ÙˆÓ (17). ∏ ıÂÚ·›· Ì ¯ÔÏËÛÙÂÚfiÏË, fï˜, ‰ÂÓ ÌÔÚ› Ó· ÂËÚ¿ÛÂÈ ÙË ÁÓˆÛÙÈ΋ ·fi‰ÔÛË, ·fi ÙË ÛÙÈÁÌ‹ Ô˘ Ë ÓÔËÙÈ΋ ˘ÛÙ¤ÚËÛË ÛÙÔ ÛSLO Ê·›ÓÂÙ·È Ó· ·ÓÙ·Ó·ÎÏ¿ ÂÚÈÛÛfiÙÂÚÔ ÙËÓ ÂÌ‚Ú˘ÔÏÔÁÈ΋ ÌÈÎÚÔÂÁÎÂÊ·Ï›· Î·È ¿ÏϘ ·ÓˆÌ·Ï›Â˜ Ù˘ ·Ó¿Ù˘Í˘ ÙˆÓ ÂÁÎÂÊ·ÏÈÎÒÓ Ó¢ÚÒÓˆÓ Î·È fi¯È ÙÔ ˘¿Ú¯ÔÓ ¤ÏÏÂÈÌÌ· ÛÙË ¯ÔÏËÛÙÂÚfiÏË ‹ ÙËÓ ÙÔÍÈ΋ Â›‰Ú·ÛË Ù˘ 7DHC (10). ¶·Ú¿ ÙȘ ÚÔfi‰Ô˘˜ Ô˘ ¤¯Ô˘Ó Á›ÓÂÈ fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ·ÈÙÈÔÏÔÁ›· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘, ·ÚÎÂÙ¿ ÛËÌ›· Ù˘ ·ıÔÁ¤ÓÂÈ·˜ ·Ú·Ì¤ÓÔ˘Ó ·‰È¢ÎÚ›ÓÈÛÙ· Î·È ¯ÚÂÈ¿˙ÂÙ·È ·ÎfiÌË ·ÚÎÂÙ‹ ‰Ô˘ÏÂÈ¿ ÁÈ· Ó· ÌÔÚ¤ÛÔ˘Ì ӷ ÂÈÙ‡¯Ô˘Ì ̛· ¿ÚÈÛÙË ıÂÚ·›·. µÈ‚ÏÈÔÁÚ·Ê›· 1. Smith DW, Lemli L, Opitz JM. A newly recognized syndrome of multiple congenital anomalies. J Pediatr 1964;64:210-217.

2. Elias ER, Irons M. Abnormal cholesterol metabolism in Smith-Lemli-Opitz syndrome. Curr Opin Pediatr 1995;7:710-714.

3. Curry CJ, Carey JC, Holland JS, Chopra D, Fineman R, Golabi M et al. Smith-Lemli-Opitz syndrome-type II: multiple congenital anomalies with male pseudohermaphroditism and frequent early lethality. Am J Med Genet 1987;26:45-57.

4. Tint GS, Irons M, Elias ER, Batta AK, Frieden R, Chen TS et al. Defective cholesterol biosynthesis associated with the Smith-Lemli-Opitz syndrome. N Engl J Med 1994;330:107-113.

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6. Wassif CA, Maslen C, Kachilele-Linjewile S, Lin D, Linck LM, Connor WE et al. Mutations in the human sterol delta7-reductase gene at 11q12-13 cause Smith-LemliOpitz syndrome. Am J Hum Genet 1998;63:55-59.

7. ∞Ó‰Ú¤Ô˘ ∞, ∞Ó·ÛÙ·ÛÈ¿‰Ô˘-∫·Ú·ÁˆÚÁÔÔ‡ÏÔ˘ ∂, °ÂˆÚÁ›Ô˘ π, ™È·Î·‚¤Ï·˜ ∫. ¶ÂÚÈÁÚ·Ê‹ ÓÂÔÁÓÔ‡ Ì ۇӉÚÔÌÔ Smith-Lemli-Opitz. ¶·È‰È·ÙÚÈ΋ 1990;53:314-320.

8. Irons M, Elias ER, Tint GS, Salen G, Frieden R, Buie TM et al. Abnormal cholesterol metabolism in the Smith-LemliOpitz syndrome: report of clinical and biochemical findings in four patients and treatment in one patient. Am J Med Genet 1994;50:347-352.

9. Yu H, Lee MH, Starck L, Elias ER, Irons M, Salen G et al.

Spectrum of delta(7)-dehydrocholesterol reductase mutations in patients with the Smith-Lemli-Opitz (RSH) syndrome. Hum Mol Genet 2000;9:1385-1391.

10. Kelley RI, Hennekam RC. The Smith-Lemli-Opitz

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syndrome. J Med Genet 2000;37:321-335.

11. Ryan AK, Bartlett K, Clayton P, Eaton S, Mills L, Donnai D et al. Smith-Lemli-Opitz syndrome: a variable clinical and biochemical phenotype. J Med Genet 1998;35:558-565.

12. Cunniff C, Kratz LE, Moser A, Natowicz MR, Kelley RI. Clinical and biochemical spectrum of patients with RSH/Smith-Lemli-Opitz syndrome and abnormal cholesterol metabolism. Am J Med Genet 1997;68:263-269.

13. Anstey AV, Taylor CR. Photosensitivity in the Smith-LemliOpitz syndrome: the US experience of a new congenital photosensitivity syndrome. J Am Acad Dermatol 1999;41:121-123.

14. Lowry RB, Yong SL. Borderline normal intelligence in the Smith-Lemli-Opitz (RSH) syndrome. Am J Med Genet 1980;5:137-143.

15. Biardi L, Krisans SK. Compartmentalization of cholesterol biosynthesis. Conversion of mevalonate to farnesyl

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diphosphate occurs in the peroxisomes. J Biol Chem 1996;271:1784-1788.

16. Kratz LE, Kelley RI. Prenatal diagnosis of the RSH/SmithLemli-Opitz syndrome. Am J Med Genet 1999;82:376-381.

17. Irons M, Elias ER, Abuelo D, Bull MJ, Greene CL, Johnson VP et al. Treatment of Smith-Lemli-Opitz syndrome: results of a multicenter trial. Am J Med Genet 1997;68:311-314.

∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 31-05-2002 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 06-09-2002 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: µ¿Ûˆ ¶··‚·ÛÈÏ›Ԣ ÃÚ. ™Ì‡ÚÓ˘ 6-8, ∆.∫. 553 37, £ÂÛÛ·ÏÔÓ›ÎË

¶ÂÚ›ÏË„Ë ¿ÚıÚÔ˘ ·fi ÙË µÈ‚ÏÈÔÁÚ·Ê›· ªÂϤÙË Ù˘ ηډȷ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ Û ·ÛıÂÓ›˜ Ì ÔÛÙÈÎÔ‡˜ fiÁÎÔ˘˜ Î·È Ì·ÎÚ¿ ÂÈ‚›ˆÛË Ì¤¯ÚÈ Î·È 19 ¯ÚfiÓÈ· ÌÂÙ¿ ·fi ıÂÚ·›· Ì Doxorubicin: Ì›· ‰È·¯ÚÔÓÈ΋ ÌÂϤÙË1 ∂ÈÛ·ÁˆÁ‹: ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ÂÎÙÈÌ‹ıËΠ‰È·¯ÚÔÓÈο Ë Î·Ú‰ÈÔÙÔÍÈÎfiÙËÙ· ÏfiÁˆ Ù˘ ÚÔËÁËı›۷˜ ¯ÔÚ‹ÁËÛ˘ ·Óıڷ΢ÎÏÈÓÒÓ Û ·ÛıÂÓ›˜ Ì ηÎÔ‹ıÂȘ ÔÛÙÈÎÔ‡˜ fiÁÎÔ˘˜ Î·È Ì·ÎÚ¿ ÂÈ‚›ˆÛË. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ∏ ηٿÛÙ·ÛË Ù˘ ηډȷ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÂÎÙÈÌ‹ıËΠ۠29 ·ÛıÂÓ›˜, 14,1 (·fi 7 ¤ˆ˜ 18,7 ¤ÙË) ¤ÙË ÌÂÙ¿ ·fi ıÂÚ·›· Ì Doxorubicin Û ÂӉȿÌÂÛË ‰fiÛË 360 mg/m2 (·fi 225 ¤ˆ˜ 550 mg/m2). ∏ ÂӉȿÌÂÛË ËÏÈΛ· ÙˆÓ ·ÛıÂÓÒÓ Î·Ù¿ ÙË ¯ÚÔÓÈ΋ ÂÚ›Ô‰Ô Ù˘ ÌÂϤÙ˘ ‹Ù·Ó 32,5 ¤ÙË (·fi 19,7 ¤ˆ˜ 52). ∏ ÂÎÙ›ÌËÛË Ù˘ ηډȷ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ ¤ÁÈÓ Ì ËÏÂÎÙÚÔηډÈÔÁÚ¿ÊËÌ· (∏∫°), 24ˆÚË Î·Ù·ÁÚ·Ê‹ Ì Holter Î·È ˘ÂÚ˯ÔηډÈÔÁÚ·ÊÈÎfi ¤ÏÂÁ¯Ô. ∆· ·ÔÙÂϤÛÌ·Ù· Û˘ÁÎÚ›ıËÎ·Ó Ì ÂΛӷ ÚÔËÁÔ‡ÌÂÓ˘ ÌÂϤÙ˘ ÙˆÓ ›‰ÈˆÓ ·ÛıÂÓÒÓ, Ë ÔÔ›· ›¯Â ‰ÈÂÓÂÚÁËı› 5 ¯ÚfiÓÈ· ÓˆÚ›ÙÂÚ· Î·È 8,9 ¯ÚfiÓÈ· (·fi 2,3 ¤ˆ˜ 14,1) ·fi ÙËÓ ÚÔËÁËı›۷ Ì ·Óıڷ΢ÎÏ›ÓË ıÂÚ·›· (Postma et al. Med Pediatr Oncol 1996;26:230-237). ∞ÔÙÂϤÛÌ·Ù·: ™Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘ ·Ó·Ê¤ÚÂÙ·È fiÙÈ: ·) ‰ÂÓ ·ÓȯÓ‡ıËΠÚfiÔ‰Ô˜ ÙˆÓ ËÏÂÎÙÚÔηډÈÔÁÚ·ÊÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ, ÙˆÓ ·ÚÚ˘ıÌÈÒÓ ‹ ˘ÂÚ˯ÔηډÈÔÁÚ·ÊÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ, ‚) Ù· ÎÔÚ›ÙÛÈ· ¤Ó·ÓÙÈ ÙˆÓ ·ÚÚ¤ÓˆÓ ‚Ú¤ıËÎ·Ó Ó· ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÌÂÁ·Ï‡ÙÂÚÔ Î›Ó‰˘ÓÔ Ì›ˆÛ˘ Ù˘ Û˘ÛÙ·ÏÙÈÎfiÙËÙ·˜ (p=0,006) Î·È Á) Ë ÌÂÙ·‚ÏËÙfiÙËÙ· Ù˘ ηډȷ΋˜ Û˘¯ÓfiÙËÙ·˜ (HRV-heart rate variability) ‚Ú¤ıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ÂÏ·Ùو̤ÓË Û˘ÁÎÚÈÙÈο Ì ̿ÚÙ˘Ú˜ Ù˘ ›‰È·˜ ËÏÈ-

Λ·˜ Î·È Ê‡ÏÔ˘ Î·È Û˘ÁÎÚÈÙÈο Ì ٷ Â˘Ú‹Ì·Ù· Ù˘ ÚÔËÁÔ‡ÌÂÓ˘ ÌÂϤÙ˘. ™˘ÌÂÚ¿ÛÌ·Ù·: OÈ ÂÚ¢ÓËÙ¤˜ ηٷϋÁÔ˘Ó fiÙÈ ‰ÂÓ ˘‹ÚÍ ÂÚ·ÈÙ¤Úˆ Âȉ›ӈÛË Ì ÙËÓ ÚfiÔ‰Ô ÙÔ˘ ¯ÚfiÓÔ˘ ÙˆÓ ˘ÂÚ˯ÔηډÈÔÁÚ·ÊÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ Î·È ÙˆÓ ·ÚÚ˘ıÌÈÒÓ, Û ۯ¤ÛË Ì ÂΛӘ Ô˘ ·ÔηχÊıËÎ·Ó ÛÙËÓ ÚÒÙË ÌÂϤÙË ÙÔ˘˜, ‰ËÏ·‰‹ 8,9 ¯ÚfiÓÈ· ÌÂÙ¿ ÙË ¯ÔÚËÁËı›۷ ıÂÚ·›·. ∂ÓÙÔ‡ÙÔȘ, ‚Ú¤ıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ÂÏ¿ÙÙˆÛË Ù˘ HRV, ˘Ô‰ÂÈÎÓ‡ÔÓÙ·˜, Û‡Ìʈӷ Ì ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜, fiÙÈ Èı·Ó¿ Ë HRV Â›Ó·È ¤Ó·˜ ¢·›ÛıËÙÔ˜ ‰Â›ÎÙ˘ ÁÈ· ÙËÓ ·Ó¿‰ÂÈÍË Ù˘ ηډÈÔÙÔÍÈÎfiÙËÙ·˜ ÙˆÓ ·Óıڷ΢ÎÏÈÓÒÓ.

1 Postma A, Elzenga NJ, Haaksma J, Schasfoort-Van Leeuwen MJM, Kamps WA, Bink-Boelkens MTE Cardiac status in bone tumor survivors up to nearly 19 years after treatment with Doxorubicin: a longitudinal study Med Pediatr Oncol 2002;39:86-92

¶ÔÏ˘¯ÚÔÓÔÔ‡ÏÔ˘-∞Ó‰ÚÔ˘Ï·Î¿ÎË ™ÔÊ›· ¶·È‰›·ÙÚÔ˜-∞ÈÌ·ÙÔÏfiÁÔ˜-OÁÎÔÏfiÁÔ˜ ∂ÈÌÂÏ‹ÙÚÈ· ∞’ ÙÔ˘ ∆Ì‹Ì·ÙÔ˜ ¶·È‰È·ÙÚÈ΋˜ ∞ÈÌ·ÙÔÏÔÁ›·˜-OÁÎÔÏÔÁ›·˜ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”

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CURRENT ISSUES

O ÚfiÏÔ˜ ÙÔ˘ ·È‰È¿ÙÚÔ˘ ÛÙËÓ ·Ó›¯Ó¢ÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ÂÏÏÂÈÌÌ·ÙÈ΋˜ ÚÔÛÔ¯‹˜ Ì ˘ÂÚÎÈÓËÙÈÎfiÙËÙ· ª. ∆˙ÂÓ¿ÎË, ∂. ∫·Ú·ÎˆÓÛÙ·ÓÙ¿ÎË, ª. §ÈÓ·Ú‰¿Î˘, ™. ªÈ¯ÂÏÔÁÈ¿ÓÓ˘

Pediatrician’s role in recognizing attention deficit hyperactivity disorder ª. ∆zenaki, E. Karakonstadaki, M. Linardakis, S. Micheloyannis

¶ÂÚ›ÏË„Ë: ∏ ‰È·Ù·Ú·¯‹ ÂÏÏÂÈÌÌ·ÙÈ΋˜ ÚÔÛÔ¯‹˜ - ˘ÂÚÎÈÓËÙÈÎfiÙËÙ· (¢∂¶-À) ·ÔÙÂÏ› Ì›· ·fi ÙȘ Û˘¯ÓfiÙÂÚ˜ ‰È·Ù·Ú·¯¤˜ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜. ∂ËÚ¿˙ÂÈ ·ÚÓËÙÈο ÙËÓ ÂÎ·›‰Â˘ÛË ÙÔ˘ ·È‰ÈÔ‡ Î·È ÙȘ ‰È·ÚÔÛˆÈΤ˜ ÙÔ˘ Û¯¤ÛÂȘ. £ÂˆÚÂ›Ù·È fiÙÈ Ë ¤ÁηÈÚË ‰È¿ÁÓˆÛË Ù˘ ‰È·Ù·Ú·¯‹˜ Â›Ó·È Ô ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂÚÔ˜ ÙÚfiÔ˜ ÚfiÏ˄˘ ÙˆÓ ÔÏÏ·ÏÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ Ô˘ Ù·Ï·ÈˆÚÔ‡Ó ÙÔ ·È‰› Î·È ÙÔÓ ÂÓ‹ÏÈÎÔ Ì ¢∂¶-À Î·È ÙˆÓ ‰˘ÛÌÂÓÒÓ Û˘ÓÂÂÈÒÓ ÁÈ· ÙËÓ ÎÔÈÓˆÓ›·. OÈ ÂȉÈÎÔ› Ô˘ ÚÒÙÔÈ ¤Ú¯ÔÓÙ·È Û Â·Ê‹ Ì ٷ ·È‰È¿ Â›Ó·È ÔÈ ·È‰›·ÙÚÔÈ. ø˜ ÂÎ ÙÔ‡ÙÔ˘, ÔÈ ·È‰›·ÙÚÔÈ ‚·Ú‡ÓÔÓÙ·È Ì ÙÔ ¯Ú¤Ô˜ Ù˘ ·Ó›¯Ó¢Û˘ ÂӉ›ÍÂˆÓ Ù˘ ‰È·Ù·Ú·¯‹˜, Ì ÛÎÔfi ÙÔÓ ÂÓÙÔÈÛÌfi ÙˆÓ ·È‰ÈÒÓ Ô˘ ·Ó‹ÎÔ˘Ó Û ÔÌ¿‰· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÂÌÊ¿ÓÈÛ‹ Ù˘. ∏ Û˘ÓÂÚÁ·Û›· ÙÔ˘ ·È‰È¿ÙÚÔ˘ Ì ÂȉÈÎÔ‡˜ Ù˘ „˘¯È΋˜ ˘Á›·˜ Î·È ÚÔ¿ÓÙˆÓ Ì ÂÎ·È‰Â˘ÙÈÎÔ‡˜ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û ·ÔÙÂÏÂÛÌ·ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Î·È ·ÔηٿÛÙ·ÛË. ™Â ·˘Ù‹ ÙËÓ ¤Ú¢ӷ ¯ÔÚËÁ‹ıËΠÎϛ̷η Û¯ÔÏÈ΋˜ Â›‰ÔÛ˘ Î·È Îϛ̷η ·Ó›¯Ó¢Û˘ ˘ÂÚÎÈÓËÙÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ - ÂÏÏÂÈÌÌ·ÙÈ΋˜ ÚÔÛÔ¯‹˜ Û ‰Â›ÁÌ· 323 Ì·ıËÙÒÓ ‰ËÌÔÙÈÎÒÓ Û¯ÔÏ›ˆÓ ÙÔ˘ ∏Ú·ÎÏ›Ԣ. ∂ÎÙÈÌ‹ıËÎ·Ó Ë ˘ÂÚÎÈÓËÙÈÎfiÙËÙ·, Ë ·ÚÔÚÌËÙÈÎfiÙËÙ·, Ë ‰È¿Û·ÛË ÚÔÛÔ¯‹˜, Ë ÛÊ·›Ú· ÙÔ˘ ÏfiÁÔ˘, Ë ÎÈÓËÙÈ΋ ˆÚÈÌfiÙËÙ·, Ô ÔÙÈÎÔÎÈÓËÙÈÎfi˜ Û˘ÓÙÔÓÈÛÌfi˜ Î·È Ë Â›‰ÔÛË ÛÙË °ÏÒÛÛ·, Ù· ª·ıËÌ·ÙÈο Î·È ÙËÓ πÛÙÔÚ›·. µÚ¤ıËΠfiÙÈ Ù· ·È‰È¿ Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Û˘ÌÙÒÌ·Ù· ¢∂¶-À, ÂÌÊ·Ó›˙Ô˘Ó ÚÔ‚Ï‹Ì·Ù· ÛÙËÓ ÂÎ·›‰Â˘Û‹ ÙÔ˘˜ Î·È ¯·ÌËÏÔ‡˜ ‚·ıÌÔ‡˜. ¶ÂÚÈÁÚ¿ÊÔÓÙ·È Î¿ÔÈ· ·ÚÈ· ÛËÌ›·, Ù· ÔÔ›· Ú¤ÂÈ Ó· ¤¯Ô˘Ó ˘’ fi„ÈÓ ÔÈ ·È‰›·ÙÚÔÈ, ÒÛÙ ӷ ÌË ‰È·Ê‡ÁÔ˘Ó Ù˘ ÚÔÛÔ¯‹˜ ÙÔ˘˜ Ù· ·È‰È¿ Ô˘ ÎÈÓ‰˘ÓÂ‡Ô˘Ó Ó· ÂÌÊ·Ó›ÛÔ˘Ó ¢∂¶-À.

Abstract: Attention deficit hyperactivity disorder (ADHD) is one of the most common disorders of childhood. It affects the child’s education and interpersonal relationships. It is assumed that the early diagnosis of this disorder is the most effective way to prevent the child’s or adult’s ADHD problems and the adverse consequences for the society. Pediatricians are the specialists that first evaluate children. Therefore, pediatricians should look for signs of the disorder in order to identify high risk children. The pediatrician’s cooperation with mental health practitioners and particularly with school professionals might result to effective management of symptoms and treatment. An academic performance test and an attention deficit hyperactivity disorder test have been used to evaluate hyperactivity, impulsivity, attention deficit, language ability, movement capacity, visual-motor coordination, in a sample of 323 students of elementary schools in Heraklion.

School grades in Literature, Mathematics and History have also been used. It was found that children, who demonstrate symptoms of ADHD, get low grades and are difficult to educate. Some recommendations are offered to pediatricians for them to identify children in high risk for ADHD.

§¤ÍÂȘ ÎÏÂȉȿ: ÂÏÏÂÈÌÌ·ÙÈ΋ ÚÔÛÔ¯‹ - ˘ÂÚÎÈÓËÙÈÎfiÙËÙ·, ÂÎ·›‰Â˘ÛË, ·È‰›·ÙÚÔ˜.

Key words: attention deficit - hyperactivity, education, pediatrician.

¶·ÓÂÈÛÙ‹ÌÈÔ ∫Ú‹Ù˘, π·ÙÚÈ΋ ™¯ÔÏ‹ ∏Ú¿ÎÏÂÈÔ˘ ∫Ú‹Ù˘

University of Crete, Medical School of Heraklion, Crete

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¶·È‰È·ÙÚÈ΋ 2002;65:452-462

∂ÈÛ·ÁˆÁ‹ ∏ ‰È·Ù·Ú·¯‹ ÂÏÏÂÈÌÌ·ÙÈ΋˜ ÚÔÛÔ¯‹˜ Ì ˘ÂÚÎÈÓËÙÈÎfiÙËÙ· (¢∂¶-À), ÁÓˆÛÙ‹ ÛÙËÓ ·ÁÁÏÈ΋ ‚È‚ÏÈÔÁÚ·Ê›· ˆ˜ Attention Deficit Hyperactivity Disorder (ADHD), ÂÎÙfi˜ ÙÔ˘ fiÙÈ ·ÔÙÂÏ› Ì›· ·fi ÙȘ Û˘¯ÓfiÙÂÚ˜ ‰È·Ù·Ú·¯¤˜ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜, ¤¯ÂÈ ÂÈϤÔÓ Ôχ ÛÔ‚·Ú¤˜ ÂÈÙÒÛÂȘ. °È’ ·˘ÙÔ‡˜ ÙÔ˘˜ ÏfiÁÔ˘˜, fiÏÔ Î·È ÂÚÈÛÛfiÙÂÚÔÈ ÂÈÛÙ‹ÌÔÓ˜ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ·Û¯ÔÏÔ‡ÓÙ·È Ì ÙÔ ı¤Ì·. ¶ÚfiÎÂÈÙ·È ÁÈ· Ì›· Ó¢ÚÔ·Ó·Ù˘Íȷ΋ ‰È·Ù·Ú·¯‹ Ì ‚ÈÔ„˘¯ÔÎÔÈÓˆÓÈΤ˜ ÚÔÂÎÙ¿ÛÂȘ. ∂ËÚ¿˙ÂÈ ÙË Û˘ÌÂÚÈÊÔÚ¿ Î·È ÙËÓ ÚÔÛ·ÚÌÔÁ‹ ÙÔ˘ ·È‰ÈÔ‡, ÚÔηÏÒÓÙ·˜ Û˘ÌÙÒÌ·Ù· ‰È¿Û·Û˘ ÚÔÛÔ¯‹˜, ˘ÂÚÎÈÓËÙÈÎfiÙËÙ·˜ Î·È ·ÚÔÚÌËÙÈÎfiÙËÙ·˜. ∆· Ê·ÈÓfiÌÂÓ· ·˘Ù¿ Ù·Ï·ÈˆÚÔ‡Ó ÙÔ ·È‰› Î·È ÙËÓ ÔÈÎÔÁ¤ÓÂÈ¿ ÙÔ˘. ∂ȉÚÔ‡Ó ·ÚÓËÙÈο ÛÙȘ ‰È·ÚÔÛˆÈΤ˜ Û¯¤ÛÂȘ ÙÔ˘ ·È‰ÈÔ‡, fi¯È ÌfiÓÔ ÏfiÁˆ Ù˘ ÂÈıÂÙÈÎfiÙËÙ·˜ Ô˘ Û˘¯Ó¿ ÂΉËÏÒÓÂÙ·È, ·ÏÏ¿ Î·È ÏfiÁˆ ÂÏÏÂÈÌÌ¿ÙˆÓ ÛÙËÓ ÔÚÁ¿ÓˆÛË ÙˆÓ ÏËÚÔÊÔÚÈÒÓ Ô˘ ‰˘ÛÎÔÏÂ‡Ô˘Ó ÙËÓ ÂÈÎÔÈÓˆÓ›· Ì ÙÔ˘˜ ¿ÏÏÔ˘˜ (1). °ÂÓÈο, ‰˘Û¯ÂÚ·›ÓÔ˘Ó ÙËÓ ÔÈÎÔ‰fiÌËÛË ÎÔÈÓˆÓÈÎÒÓ ‰ÂÍÈÔًوÓ, ÔÈ Ôԛ˜ ÂÍ·ÛÊ·Ï›˙Ô˘Ó ÙËÓ ÔÌ·Ï‹ ¤ÓÙ·Í‹ ÙÔ˘ ÛÙÔ ÎÔÈÓˆÓÈÎfi Û‡ÓÔÏÔ. ™‡Ìʈӷ Ì ÙÔ ¢È·ÁÓˆÛÙÈÎfi Î·È ™Ù·ÙÈÛÙÈÎfi ∂Á¯ÂÈÚ›‰ÈÔ ÁÈ· ÙȘ æ˘¯È·ÙÚÈΤ˜ ¢È·Ù·Ú·¯¤˜ (DSMIV), ˘¿Ú¯Ô˘Ó ÙÚÂȘ ηÙËÁÔڛ˜ ·ÙfiÌˆÓ Ì ¢∂¶-À: ·) Ô Ù‡Ô˜ Ì ÂÏÏÂÈÌÌ·ÙÈ΋ ÚÔÛÔ¯‹, ÛÙÔÓ ÔÔ›Ô ÚÔÂÍ¿Ú¯ÔÓ ¯·Ú·ÎÙËÚÈÛÙÈÎfi Â›Ó·È Ë ÂÏÏÂÈÌÌ·ÙÈ΋ ÚÔÛÔ¯‹, ‚) Ô ˘ÂÚÎÈÓËÙÈÎfi˜ Ù‡Ô˜, fiÔ˘ ΢ÚÈ·Ú¯Ô‡Ó Ë ˘ÂÚÎÈÓËÙÈÎfiÙËÙ· Î·È Ë ·ÚÔÚÌËÙÈÎfiÙËÙ· Î·È Á) Ô Û˘Ó‰˘·Ṳ̂ÓÔ˜ Ù‡Ô˜, fiÔ˘ Û˘Ó˘¿Ú¯Ô˘Ó ÛÔ‚·Ú¿ ÂÏÏ›ÌÌ·Ù· Î·È ÛÙȘ ÙÚÂȘ ÂÚÈÔ¯¤˜ (2). ∫·Ù¿ ÙË ¢ÈÂıÓ‹ ∆·ÍÈÓfiÌËÛË ¡fiÛˆÓ (ICD-10), fï˜, ÌfiÓÔ fiÛÔÈ ÂÌÊ·Ó›˙Ô˘Ó ÙÔ Û˘Ó‰˘·Ṳ̂ÓÔ Ù‡Ô ÏËÚÔ‡Ó Ù· ÎÚÈÙ‹ÚÈ· ÁÈ· ¢∂¶-À, ‰ËÏ·‰‹ Ôχ ÏÈÁfiÙÂÚÔÈ ·’ fiÙÈ ˘ÔÏÔÁ›˙ÂÙ·È Û‡Ìʈӷ Ì ÙÔ DSM-IV (3,4). OÈ Jensen Î·È Û˘Ó (3,5) ÂÂÛ‹Ì·Ó·Ó fiÙÈ ı· Ú¤ÂÈ Ó· ‰ÈÂÚ¢ÓËı› Ë Èı·ÓfiÙËÙ· ‡·Ú͢ Î·È ¿ÏÏˆÓ ˘ÔÙ‡ˆÓ Ù˘ ‰È·Ù·Ú·¯‹˜, fiˆ˜ Ô ÂÈıÂÙÈÎfi˜ ˘ÔÙ‡Ô˜ Î·È Ô ·Á¯Ò‰Ë˜ ˘ÔÙ‡Ô˜ Î·È Ó· ηıÔÚÈÛÙ› ·Ó ·ÔÙÂÏÔ‡Ó Ó¤Â˜ ·˘ÙfiÓÔ̘ ‰È·ÁÓˆÛÙÈΤ˜ ηÙËÁÔڛ˜. Œ¯ÂÈ ÂÈÎÚ·Ù‹ÛÂÈ Ó· ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Ù· ÎÚÈÙ‹ÚÈ· ÙÔ˘ DSM-IV ÁÈ· ÙË ‰È¿ÁÓˆÛË Ù˘ ¢∂¶-À. ∆· ·È‰È¿ Ì ¢∂¶-À ·ÚÔ˘ÛÈ¿˙Ô˘Ó Û˘¯Ó¿ Î·È ÚfiÛıÂÙË „˘¯Ô·ıÔÏÔÁ›·. ÀÔÏÔÁ›˙ÂÙ·È fiÙÈ ÙÔ 5080% ÙˆÓ ·È‰ÈÒÓ Ì ¢∂¶-À ÏËÚÔ› ÎÚÈÙ‹ÚÈ· ÁÈ· ¿ÏϘ ‰È·Ù·Ú·¯¤˜, fiˆ˜ ‰È·Ù·Ú·¯‹ ‰È·ÁˆÁ‹˜ (conduct disorder), ÂÓ·ÓÙȈÙÈ΋ ÚÔÎÏËÙÈ΋ ‰È·Ù·Ú·¯‹ (oppositional defiant disorder), ·Á¯Ò‰Ë ‰È·Ù·Ú·¯‹, ηٿıÏÈ„Ë, ÂÓÒ ·˘Í¿ÓÂÙ·È Î·È Ô Î›Ó‰˘ÓÔ˜ ηٿ¯ÚËÛ˘ Ô˘ÛÈÒÓ Î·È ÚfiÎÏËÛ˘ ÙÚÔ¯·›ˆÓ ‹ ¿ÏÏˆÓ ·Ù˘¯ËÌ¿ÙˆÓ (3).

Paediatriki 2002;65:452-462

ªÂÁ¿ÏÔ ÂӉȷʤÚÔÓ ·ÚÔ˘ÛÈ¿˙ÂÈ Ë ‰ÈÂÚ‡ÓËÛË Ù˘ Û¯¤Û˘ Ù˘ ¢∂¶-À Ì ÙȘ Ì·ıËÛȷΤ˜ ‰˘ÛÎÔϛ˜. ¶ÚÔÁÂÓ¤ÛÙÂÚ˜ ¤Ú¢Ó˜ ÔÚ›˙Ô˘Ó ÙÔ ÔÛÔÛÙfi Ù˘ Ù·˘Ùfi¯ÚÔÓ˘ ÂÌÊ¿ÓÈÛ˘ Ù˘ ¢∂¶-À Î·È ÙˆÓ Ì·ıËÛÈ·ÎÒÓ ‰˘ÛÎÔÏÈÒÓ Û ·È‰È¿ ·fi 20-80% (1,3,6,7), ÂÓÒ ·Ó·Ê¤ÚÂÙ·È fiÙÈ ÙÔ 25-30% ÙˆÓ ÂÓËÏ›ÎˆÓ Ì ¢∂¶-À ·ÚÔ˘ÛÈ¿˙ÂÈ, Â›Û˘, ‰È·Ù·Ú·¯‹ ·Ó¿ÁÓˆÛ˘ (8,9). ∞ӷ̤ÓÂÙ·È fiÙÈ, ÏfiÁˆ Ì·ıËÛÈ·ÎÒÓ ‰˘ÛÎÔÏÈÒÓ, ÙÔ 56% ÙˆÓ ·È‰ÈÒÓ Ì ¢∂¶-À ı· ¯ÚÂÈ·ÛÙ› ÙË ‚Ô‹ıÂÈ· ÂȉÈÎÔ‡, ÂÚ›Ô˘ ÙÔ 30% ›Ûˆ˜ Â·Ó·Ï¿‚ÂÈ Î¿ÔÈ· Ù¿ÍË, ÙÔ 30% ›Ûˆ˜ ·Ú·ÎÔÏÔ˘ı‹ÛÂÈ Ì›· ÂȉÈ΋ Ù¿ÍË Î·È ÙÔ 10-35% ÙˆÓ ·È‰ÈÒÓ ÂÓ‰¤¯ÂÙ·È Ó· ÂÁηٷÏ›„ÂÈ ÙÔ Û¯ÔÏÂ›Ô (2). ™ÙÔ Û¯ÔÏ›Ô, Ù· Û˘ÌÙÒÌ·Ù· Ù˘ ‰È·Ù·Ú·¯‹˜ ‰˘Û¯ÂÚ·›ÓÔ˘Ó ÙËÓ ÚÔÛ·ÚÌÔÁ‹ Î·È ·fi‰ÔÛË ÙÔ˘ ·È‰ÈÔ‡, Û˘ÓÙÂÏÒÓÙ·˜ ¤ÙÛÈ ÛÙËÓ ·ÓÂ·Ú΋ ÂÎ·›‰Â˘ÛË Î·È ÛÙË Ì›ˆÛË Ù˘ ·˘ÙÔÂÎÙ›ÌËÛ‹˜ ÙÔ˘ (3). Œ¯ÂÈ ‚ÚÂı› fiÙÈ ·È‰È¿ Ì ¢∂¶-À ·ÚÔ˘ÛÈ¿˙Ô˘Ó Û˘¯Ó¿ ·‰ÂÍÈfiÙËÙ· ηÈ, ·Ú’ fiÏÔ Ô˘ ‰ÂÓ ¤¯ÂÈ ·ÔÎÏÂÈÛÙ› Ë Èı·ÓfiÙËÙ· ·˘Ù‹ (Ë ·‰ÂÍÈfiÙËÙ·) Ó· ÔÊ›ÏÂÙ·È ÛÙË ‰È¿Û·ÛË ÚÔÛÔ¯‹˜, ˘ÔÛÙËÚ›˙ÂÙ·È fiÙÈ ˘¿Ú¯ÂÈ Û¯¤ÛË Ù˘ ‰È·Ù·Ú·¯‹˜ Ì ·Ó·Ù˘ÍȷΤ˜ ÎÈÓËÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ (10). ª›· ÚfiÛÊ·ÙË ·ÂÈÎÔÓÈÛÙÈ΋ ÌÂϤÙË (11) Û‡ÁÎÚÈÓ ÙËÓ Â›‰ÔÛË ·È‰ÈÒÓ Ì ÙË ‰È·Ù·Ú·¯‹ Ì ÂΛÓË ·È‰ÈÒÓ ¯ˆÚ›˜ ÙË ‰È·Ù·Ú·¯‹, Û ̛· ‰ÔÎÈÌ·Û›· Ô˘ ··ÈÙÔ‡Û ÔÚÁ¿ÓˆÛË Ù˘ ÎÈÓËÙÈ΋˜ ·ÓÙ›‰Ú·Û˘. ∏ ÌÂϤÙË Û˘ÓËÁÔÚ› ˘¤Ú Ù˘ ‡·Ú͢ ÏÂÙÒÓ, ·ÏÏ¿ ÛËÌ·ÓÙÈÎÒÓ ‚Ï·‚ÒÓ Û ÂÚÈÔ¯¤˜ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ÔÙÈ΋ ÚÔÛÔ¯‹, ηıÒ˜ Î·È ÛÙȘ ÎÂÓÙÚÈΤ˜ Î·È ÚÔÎÈÓËÙÈΤ˜ ÂÚÈÔ¯¤˜. OÈ ›‰ÈÔÈ ÂÚ¢ÓËÙ¤˜ (12) Û‡ÁÎÚÈÓ·Ó ·È‰È¿ Ì ¢∂¶-À Ì ̛· ÔÌ¿‰· ÂϤÁ¯Ô˘ ˆ˜ ÚÔ˜ ÙËÓ Â›‰ÔÛ‹ ÙÔ˘˜ Û ̛· ÛÂÈÚ¿ ·fi Ó¢ÚÔÎÈÓËÙÈΤ˜ ‰ÔÎÈ̷ۛ˜ Î·È Û ̛· ‰ÔÎÈÌ·Û›· Ù·¯‡ÙËÙ·˜ ·ÓÙ›‰Ú·Û˘. µÚ‹Î·Ó fiÙÈ Ù· ·È‰È¿ Ì ¢∂¶-À ·ÚÔ˘Û›·˙·Ó ÌÈÎÚ¤˜ ‚Ï¿‚˜ ÛÙË ÏÂÙ‹ ÎÈÓËÙÈÎfiÙËÙ·, Ô˘ ·ÊÔÚÔ‡Û·Ó ÛÙËÓ ÔÈfiÙËÙ· Î·È ÛÙËÓ Ù·¯‡ÙËÙ· Ù˘ ΛÓËÛ˘. øÛÙfiÛÔ, ÔÈ ·‰˘Ó·Ì›Â˜ ÛÙËÓ ÎÈÓËÙÈÎfiÙËÙ· ‰ÂÓ ·ÚÎÔ‡Û·Ó ÁÈ· Ó· ‰È·ÊÔÚÔÔÈ‹ÛÔ˘Ó Ù· ·È‰È¿ Ì ¢∂¶-À ·fi ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘. ™Â ¿ÏÏË ¤Ú¢ӷ (13) ˘ÔÛÙËÚ›˙ÂÙ·È fiÙÈ Ù· ·È‰È¿ Ì ¢∂¶-À ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÚÔ‚Ï‹Ì·Ù· ÛÙËÓ ÎÈÓ·›ÛıËÛË, ÛÙËÓ ÈηÓfiÙËÙ· ‰ËÏ·‰‹ ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ Ó· ·ÊÔÌÔÈÒÓÂÈ ÏËÚÔÊÔڛ˜ ÁÈ· ÙË ı¤ÛË ÙÔ˘ ÛÒÌ·ÙÔ˜, ÙËÓ Î·Ù‡ı˘ÓÛË Î·È Ù·¯‡ÙËÙ· ÙˆÓ ÎÈÓ‹ÛˆÓ. ∞ÎfiÌË, ˘ÔÛÙËÚ›˙ÂÙ·È fiÙÈ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÚÔ‚Ï‹Ì·Ù· ÛÙË ÏÂÙ‹ ÎÈÓËÙÈÎfiÙËÙ·, Èı·Ó¿ ÏfiÁˆ ÙˆÓ ·‰˘Ó·ÌÈÒÓ ÛÙËÓ ÎÈÓ·›ÛıËÛË. ∞ÓÙ›ıÂÙ·, Ì›· ¿ÏÏË ÔÌ¿‰· ÂÚ¢ÓËÙÒÓ (14) ‰È·›ÛÙˆÛ fiÙÈ Ù· ÚÔ‚Ï‹Ì·Ù· ÎÈÓËÙÈÎfiÙËÙ·˜ ‰ÂÓ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ÎÈÓ·›ÛıËÛË. ¶·Ú’ fiÏÔ Ô˘ ÔÈ ÂÚ¢ÓËÙ¤˜ ‰È·Ù‡ˆÛ·Ó ÙËÓ ÂÈʇϷ͋ ÙÔ˘˜ ÁÈ· ÙÔ ÚfiÏÔ Ù˘ ‰È¿Û·Û˘ ÚÔÛÔ¯‹˜ ÛÙËÓ ÂÌÊ¿ÓÈÛË ÙˆÓ ÎÈÓËÙÈÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ

453

NoV-dEc-02

14-05-03

14:26

™ÂÏ›‰·454

¶·È‰È·ÙÚÈ΋ 2002;65:452-462

Paediatriki 2002;65:452-462

Û ·È‰È¿ Ì ¢∂¶-À, ¿Ô„Ë Ô˘ ˘ÔÛÙËÚ›˙ÂÙ·È ·fi ÙÔ DSM-IV, Ù· ·ÔÙÂϤÛÌ·Ù· ¤‰ÂÈÍ·Ó fiÙÈ ˘‹Ú¯Â Û¯¤ÛË Ù˘ ÛÔ‚·ÚfiÙËÙ·˜ Ù˘ ‰È¿Û·Û˘ ÚÔÛÔ¯‹˜ Ì ÙȘ ÎÈÓËÙÈΤ˜ ‰˘ÛÎÔϛ˜. OÈ ‰˘ÛÎÔϛ˜ ·˘Ù¤˜, Ì¿ÏÈÛÙ·, ‰È·ÊÔÚÔÔÈÔ‡ÓÙ·Ó ·Ó¿ÏÔÁ· Ì ÙÔÓ ˘ÔÙ‡Ô Ù˘ ‰È·Ù·Ú·¯‹˜. ŒÙÛÈ, Ù· ·È‰È¿ Ì ÚÔÂÍ¿Ú¯Ô˘Û· ‰È¿Û·ÛË ÚÔÛÔ¯‹˜ ›¯·Ó ÌÂÁ·Ï‡ÙÂÚË Èı·ÓfiÙËÙ· Ó· ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÚÔ‚Ï‹Ì·Ù· ÛÙË ÏÂÙ‹ ÎÈÓËÙÈÎfiÙËÙ·, ÂÓÒ Ù· ·È‰È¿ Ì ÙÔÓ ÌÂÈÎÙfi ˘ÔÙ‡Ô Â›¯·Ó ÌÂÁ·Ï‡ÙÂÚË Èı·ÓfiÙËÙ· Ó· ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÚÔ‚Ï‹Ì·Ù· ÛÙËÓ ·‰Ú‹ ÎÈÓËÙÈÎfiÙËÙ·. OÈ ÂÚ¢ÓËÙ¤˜ ÙfiÓÈÛ·Ó ÙËÓ ·Ó¿ÁÎË ÂÎÙ›ÌËÛ˘ ÙÔ˘ ÎÈÓËÙÈÎÔ‡ Û˘ÓÙÔÓÈÛÌÔ‡ ÛÙ· ·È‰È¿ Ì ¢∂¶-À. ∂›Ó·È ÁÓˆÛÙfi fiÙÈ Ù· ·È‰È¿ Ì ¢∂¶-À ·ÚÔ˘ÛÈ¿˙Ô˘Ó Û˘¯Ó¿ ·‰˘Ó·Ì›Â˜ ÛÙË ÛÊ·›Ú· ÙÔ˘ ÏfiÁÔ˘. ™‡Ìʈӷ Ì ËÏÂÎÙÚÔÓÈ΋ ‰ËÌÔÛ›Â˘ÛË Ù˘ ÔÚÁ¿ÓˆÛ˘ ÁÈ· ·È‰È¿ Î·È ÂÓ‹ÏÈΘ Ì ¢∂¶-À (9), Ù· ¿ÙÔÌ· Ì ÙË ‰È·Ù·Ú·¯‹ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Û˘¯Ó¿ ‰È·Ù·Ú·¯‹ ·Ó¿ÁÓˆÛ˘, Ë ÔÔ›· ÂÈ̤ÓÂÈ Î·È ÛÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹. ªÔÚ› Ó· Û˘Ó›ÛÙ·Ù·È Û ·‰˘Ó·Ì›· ·ÔΈ‰ÈÎÔÔ›ËÛ˘ ÙÔ˘ ÁÚ·ÙÔ‡ ÏfiÁÔ˘ Î·È Ó· ÔÊ›ÏÂÙ·È Û ÂÏÏ›ÌÌ·Ù· ÛÙË ÊˆÓÔÏÔÁÈ΋ ÂÓËÌÂÚfiÙËÙ· (phonological awareness), ÛÙËÓ Ù·¯Â›· ·˘ÙfiÌ·ÙË Î·ÙÔÓÔÌ·Û›· ·ÓÙÈÎÂÈÌ¤ÓˆÓ (rapid automatized naming) Î·È ÛÙËÓ ÔÚıÔÁÚ·ÊÈ΋ ÂÂÍÂÚÁ·Û›· (orthographic processing), Û ·‰˘Ó·Ì›· ηٷÓfiËÛ˘ ÙÔ˘ ÁÚ·ÙÔ‡ ÏfiÁÔ˘ ‹ Ó· ÔÊ›ÏÂÙ·È Û ÚÔ‚Ï‹Ì·Ù· ÛÙË ÌÓ‹ÌË ÂÚÁ·Û›·˜. ¶ÔÏÏÔ› ÂÚ¢ÓËÙ¤˜ ¤¯Ô˘Ó ÌÂÏÂÙ‹ÛÂÈ ÙË Û¯¤ÛË Ù˘ ¢∂¶-À Ì ÙËÓ ·Ó·ÁÓˆÛÙÈ΋ ÈηÓfiÙËÙ· (6,7,15-19), ·ÏÏ¿ ‰ÂÓ ¤¯Ô˘Ó ηٷϋÍÂÈ Û οÔÈÔ ·ÛʷϤ˜ Û˘Ì¤Ú·ÛÌ· ÁÈ· ÙÔ Â›‰Ô˜ Ù˘ Û¯¤Û˘. ™‡Ìʈӷ Ì ÚfiÛÊ·ÙÔ ¿ÚıÚÔ (1), Ù· ·È‰È¿ Ì ¢∂¶-À ‰ÂÓ ¤¯Ô˘Ó ÚÔ‚Ï‹Ì·Ù· Û ·˘Ù‹ ηı·˘Ù‹ ÙË ÛÊ·›Ú· ÙÔ˘ ÏfiÁÔ˘, ·ÏÏ¿ ÛÙËÓ ÂÎÙÂÏÂÛÙÈ΋ ‰È·‰Èηۛ·, ‰ËÏ·‰‹ ÛÙËÓ ·ÓÒÙÂÚË ÁÓˆÛÙÈ΋ ‰È·‰Èηۛ· Ô˘ ÂÌϤÎÂÙ·È ÛÙËÓ ÔÚÁ¿ÓˆÛË Ù˘ ÛΤ„˘, Ù˘ Û˘ÌÂÚÈÊÔÚ¿˜ Î·È ÙˆÓ ÛÙÚ·ÙËÁÈÎÒÓ Â›Ï˘Û˘ ÚÔ‚ÏËÌ¿ÙˆÓ Î·È ·ÔÌÓËÌfiÓ¢Û˘ ÏËÚÔÊÔÚÈÒÓ.

∏ ·Ó·ÁÓÒÚÈÛË Î¿ÔÈˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÌÔÚ› Ó· Á›ÓÂÈ ·fi ÂȉÈÎÔ‡˜ ‹‰Ë ·fi ÙË ‚ÚÂÊÈ΋ ËÏÈΛ·, ÂÓÒ Ù· Û˘ÌÙÒÌ·Ù· Û˘¯Ó¿ Û˘Ó¯›˙Ô˘Ó Ó· ÂÌÊ·Ó›˙ÔÓÙ·È Î·È ÛÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹. ∏ ÚfiÁÓˆÛË Ù˘ ‰È·Ù·Ú·¯‹˜ ÂÍ·ÚÙ¿Ù·È Û ÛËÌ·ÓÙÈÎfi ‚·ıÌfi ·fi ÙËÓ ¤ÁηÈÚË ‰È¿ÁÓˆÛË, Ë ÔÔ›· ÌÔÚ› Ó· ÂÈÙ¢¯ı› ηٿ ·ÚÈÔ ÏfiÁÔ ·fi ÙÔ˘˜ ·È‰È¿ÙÚÔ˘˜, ηıÒ˜ ÂΛÓÔÈ ¤Ú¯ÔÓÙ·È Û Â·Ê‹ Ì ÙÔ ·È‰› Ôχ ÓˆÚ›ÙÂÚ· ·fi ¿ÏÏÔ˘˜ ÂȉÈÎÔ‡˜ Î·È ÌÔÚÔ‡Ó Ó· ·Ú·¤Ì„Ô˘Ó ÙÔ˘˜ ÁÔÓ›˜ ÁÈ· Ì›· ·È‰Ô„˘¯È·ÙÚÈ΋ ÂÎÙ›ÌËÛË. ∞Ó Î·È ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· ·Ó·Ê¤ÚÂÙ·È fiÙÈ ¯·Ú·ÎÙËÚÈÛÙÈο Ù˘ ‰È·Ù·Ú·¯‹˜ Â›Ó·È ÂÌÊ·Ó‹ ‹‰Ë ·fi ÙÔÓ ÚÒÙÔ ¯ÚfiÓÔ ˙ˆ‹˜ (8), ÂÓÙÔ‡ÙÔȘ, Â›Ó·È ÁÓˆÛÙfi fiÙÈ ÛÙȘ Ó·ڤ˜ ËÏÈ˘ Â›Ó·È Ôχ ‰‡ÛÎÔÏË Ë ‰È·ÊÔÚԉȿÁÓˆÛË. ¶ÔÏϤ˜ ÊÔÚ¤˜ Ù· ·È‰È¿ ‰ÂÓ Û˘ÓÂÚÁ¿˙ÔÓÙ·È Ì ÙÔÓ ·È‰›·ÙÚÔ Î·Ù¿ ÙËÓ ÂͤٷÛË, ÂÓÒ ¿ÏϘ ÊÔÚ¤˜ ÂÌÊ·Ó›˙ÔÓÙ·È Ôχ Û˘ÁÎÂÓÙڈ̤ӷ Î·È Û˘ÁÎÚ·ÙË̤ӷ ÛÙÔ ¯ÒÚÔ ÙÔ˘ È·ÙÚ›Ԣ, ·Ú·Ï·ÓÒÓÙ·˜ ÙÔÓ ÂȉÈÎfi. ∏ Ï‹„Ë ÂÓfi˜ ÏÂÙÔÌÂÚÔ‡˜ ÈÛÙÔÚÈÎÔ‡ Â›Ó·È Û˘¯Ó¿ Ô ÌfiÓÔ˜ ÙÚfiÔ˜ Ó· ‰È·ÁÓˆÛÙ› ÙÔ Úfi‚ÏËÌ· Û ÓËȷ΋ ËÏÈΛ·. ∆Ô ¤ÚÁÔ Ù˘ ·Ó·ÁÓÒÚÈÛ˘ Ù˘ ‰È·Ù·Ú·¯‹˜ Â›Ó·È ÔχÏÔÎÔ, ηıÒ˜ Ú¤ÂÈ Ó· ‰È·¯ˆÚ›˙ÂÙ·È Ë ¢∂¶-À ·fi ÙËÓ ˘ÂÚÎÈÓËÙÈÎfiÙËÙ· Ô˘ ÂÌÊ·Ó›˙Ô˘Ó Î¿ÔÈ· ·È‰È¿ ÏfiÁˆ Û˘Ó·ÈÛıËÌ·ÙÈÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ ‹ „˘¯ÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ (2), ·ÏÏ¿ Î·È ·fi ÙËÓ ÂÏÏÂÈÌÌ·ÙÈ΋ ÚÔÛÔ¯‹ ¯ˆÚ›˜ ˘ÂÚÎÈÓËÙÈÎfiÙËÙ· (ADD) Ô˘ Â›Ó·È Ì›· ͯˆÚÈÛÙ‹ ‰È·Ù·Ú·¯‹ Ì ‰È·ÊÔÚÂÙÈο ¯·Ú·ÎÙËÚÈÛÙÈο (6,20). ªfiÓÔ Ô ·È‰Ô„˘¯›·ÙÚÔ˜ Â›Ó·È Û ı¤ÛË Ó· οÓÂÈ Ì›· ·ÛÊ·Ï‹ ‰È¿ÁÓˆÛË. ∏ ¢·ÈÛıËÙÔÔ›ËÛË, fï˜, ÙÔ˘ ·È‰È¿ÙÚÔ˘ ÛÙÔ Úfi‚ÏËÌ· Â›Ó·È È‰È·›ÙÂÚ· ‚ÔËıËÙÈ΋ ÁÈ· ÙËÓ ¤ÁηÈÚË ·Ó›¯ÓÂ˘Û‹ ÙÔ˘, ÒÛÙ ٷ ·È‰È¿ Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Î¿ÔÈ· ÂÈΛӉ˘Ó· ÛËÌ›· Ó· ·Ú·¤ÌÔÓÙ·È ÛÙÔÓ ·È‰Ô„˘¯›·ÙÚÔ fiÛÔ ÙÔ ‰˘Ó·ÙfiÓ ÓˆÚ›ÙÂÚ·. ™ÎÔfi˜ Ù˘ ¤Ú¢ӷ˜, Ë ÔÔ›· Ú·ÁÌ·ÙÔÔÈ‹ıËΠÛÙÔ ∏Ú¿ÎÏÂÈÔ Ù˘ ∫Ú‹Ù˘, ‹Ù·Ó Ó· ‰ÈÂÚ¢ÓËı› Ë Û¯¤ÛË Ù˘ ‰È·Ù·Ú·¯‹˜ Ì οÔȘ ·Ú·Ì¤ÙÚÔ˘˜ Ù˘ Û¯ÔÏÈ΋˜ Â›‰ÔÛ˘. ™˘ÁÎÂÎÚÈ̤ӷ, Ì ÙËÓ ÈηÓfiÙËÙ· ÏfiÁÔ˘, ÙËÓ ÎÈÓËÙÈ΋ ˆÚÈÌfiÙËÙ· ηÈ

¶›Ó·Î·˜ 1. ™¯ÔÏ›·, Ù¿ÍÂȘ Î·È ·ÚÈıÌfi˜ Ì·ıËÙÒÓ ∞’ Ù¿ÍË ™‡ÓÔÏÔ ∞ÁfiÚÈ· ∫ÔÚ›ÙÛÈ· 13Ô ‰ËÌÔÙÈÎfi Û¯ÔÏÂ›Ô 42Ô ‰ËÌÔÙÈÎfi Û¯ÔÏÂ›Ô ¢ËÌÔÙÈÎfi Û¯ÔÏÂ›Ô ™ÁÔ˘ÚÔÎÂÊ·Ï›Ô˘ ¢ËÌÔÙÈÎfi Û¯ÔÏÂ›Ô ªÔ¯Ô‡ ¢ËÌÔÙÈÎfi Û¯ÔÏÂ›Ô ∂ÈÛÎÔ‹˜ ¢ËÌÔÙÈÎfi Û¯ÔÏÂ›Ô ∂ÏÈ¿˜ ¢ËÌÔÙÈÎfi Û¯ÔÏÂ›Ô °ˆÓÈÒÓ ¢ËÌÔÙÈÎfi Û¯ÔÏÂ›Ô °Ô˘ÚÓÒÓ

43 23 6

29 11 3

14 12 3

20 9 3 8

12 3 2 3

8 6 1 5

™‡ÓÔÏÔ

112

454

°’ Ù¿ÍË ™‡ÓÔÏÔ ∞ÁfiÚÈ· ∫ÔÚ›ÙÛÈ· 34 18 6 13 18 10 5 104

13 6 2 11 6 7 4

21 12 4 2 12 3 1

™Ù’ Ù¿ÍË ™‡ÓÔÏÔ ∞ÁfiÚÈ· ∫ÔÚ›ÙÛÈ· 35 18 3 12 17 4 9 9 107

19 7 2 8 9 4 5 4

16 11 1 6 8 0 4 5

NoV-dEc-02

14-05-03

14:26

™ÂÏ›‰·455

¶·È‰È·ÙÚÈ΋ 2002;65:452-462

ÙÔÓ ÔÙÈÎÔÎÈÓËÙÈÎfi Û˘ÓÙÔÓÈÛÌfi, ηıÒ˜ Î·È Ì ÙË ‚·ıÌÔÏÔÁ›· ÛÙÔ Ì¿ıËÌ· Ù˘ ÁÏÒÛÛ·˜, ÙˆÓ Ì·ıËÌ·ÙÈÎÒÓ Î·È Ù˘ ÈÛÙÔÚ›·˜. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ∏ ¤Ú¢ӷ Ú·ÁÌ·ÙÔÔÈ‹ıËΠ۠ԯÙÒ ‰ËÌÔÙÈο Û¯ÔÏ›· ÙÔ˘ ÓÔÌÔ‡ ∏Ú·ÎÏ›Ԣ. ∆· Û¯ÔÏ›· ÂÈϤ¯ıËÎ·Ó ˆ˜ ·ÓÙÈÚÔÛˆ¢ÙÈο Ù˘ ÏËı˘ÛÌȷ΋˜ Û‡ÓıÂÛ˘ ÙÔ˘ ÓÔÌÔ‡. ∆Ô ‰Â›ÁÌ· ·ÔÙ¤ÏÂÛ·Ó 323 Ì·ıËÙ¤˜. ™˘ÁÎÂÎÚÈ̤ӷ, Û˘ÁÎÂÓÙÚÒıËÎ·Ó ÛÙÔȯ›· ÁÈ· 171 Ì·ıËÙ¤˜ ·ÛÙÈÎÒÓ ÂÚÈÔ¯ÒÓ Î·È 152 Ì·ıËÙ¤˜ ·ÁÚÔÙÈÎÒÓ ÂÚÈÔ¯ÒÓ. ∂ÈϤ¯ıËΠӷ ·ÍÈÔÏÔÁËıÔ‡Ó Ì·ıËÙ¤˜ Ù˘ ∞’, °’ Î·È ™∆’ Ù¿Í˘, ηıÒ˜ ·˘Ù¤˜ ÎÚ›ıËÎ·Ó ÔÈ ÂÚÈÛÛfiÙÂÚÔ ·ÓÙÈÚÔÛˆ¢ÙÈΤ˜ Ù¿ÍÂȘ ˆ˜ ·Ú¯‹, ̤ÛË Î·È Ù¤ÏÔ˜ Ù˘ ÚˆÙÔ‚¿ıÌÈ·˜ ÂÎ·›‰Â˘Û˘. ™˘ÁÎÂÎÚÈ̤ӷ, ÂÎÙÈÌ‹ıËÎ·Ó ÔÈ ÂȉfiÛÂȘ 112 Ì·ıËÙÒÓ Ù˘ ∞’ ‰ËÌÔÙÈÎÔ‡, 104 Ì·ıËÙÒÓ Ù˘ °’ ‰ËÌÔÙÈÎÔ‡ Î·È 107 Ì·ıËÙÒÓ Ù˘ ™∆’ ‰ËÌÔÙÈÎÔ‡ (¶›Ó·Î·˜ 1). ∏ Û˘ÌÏ‹ÚˆÛË ÙˆÓ ÂÚˆÙËÌ·ÙÔÏÔÁ›ˆÓ Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ¤ÁÈÓ ·fi ÙÔ˘˜ ÂÎ·È‰Â˘ÙÈÎÔ‡˜, ÔÈ ÔÔ›ÔÈ Â›¯·Ó ÂÈÌÔÚʈı› ˆ˜ ÚÔ˜ ÙË ¯Ú‹ÛË ÙÔ˘˜ Û ÛÂÌÈÓ¿ÚÈ· Ô˘ ÔÚÁ·ÓÒıËÎ·Ó ÛÙËÓ ÂÚÈʤÚÂÈ¿ ÙÔ˘˜. ∂ÈϤ¯ıËÎ·Ó ÔÈ ‰¿ÛηÏÔÈ Ô˘ ˘ÏÔÔÈÔ‡Û·Ó ÙÔ ‚·ÛÈÎfi ÚfiÁÚ·ÌÌ· Ù˘ Ù¿Í˘, ÔÈ ÔÔ›ÔÈ ÁÓÒÚÈ˙·Ó ηϿ ÙÔ˘˜ Ì·ıËÙ¤˜ ÙÔ˘˜. ™˘ÓÂÚÁ¿ÛÙËÎ·Ó fiÏÔÈ ÔÈ ‰¿ÛηÏÔÈ, ÂÎÙfi˜ ·fi ‰‡Ô ÂÚÈÙÒÛÂȘ fiÔ˘ Ë ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ÛÂÌÈÓ·Ú›ˆÓ ÎÚ›ıËΠ·ÓÂ·Ú΋˜. ŒÏ·‚·Ó Ô‰ËÁ›· Ó· ‰È·‚¿ÛÔ˘Ó ÚÔÛÂÎÙÈο Ù· ÂÚˆÙËÌ·ÙÔÏfiÁÈ· Î·È ¤ÂÈÙ· Ó· ·Ú·ÙËÚ‹ÛÔ˘Ó Î¿ı ̷ıËÙ‹ Î·È Ó· ÙÔÓ ·ÍÈÔÏÔÁ‹ÛÔ˘Ó ÛÙȘ ÂÚÈÁÚ·ÊfiÌÂÓ˜ Û˘ÌÂÚÈÊÔÚ¤˜, ÂÓËÌÂÚÒÓÔÓÙ·˜ ÙÔ˘˜ ÁÔÓ›˜ ÙˆÓ ·È‰ÈÒÓ ÁÈ· ÙË Û¯ÂÙÈ΋ ¤Ú¢ӷ Î·È ÙË ÛËÌ·Û›· Ù˘. ™Â ÂÚ›ÙˆÛË Ô˘ Ô ‰¿ÛηÏÔ˜ ‰ÂÓ Â›¯Â ÙË ‰˘Ó·ÙfiÙËÙ· Ó· ÂÎÙÈÌ‹ÛÂÈ Ì›· ÂÚÈÁÚ·ÊfiÌÂÓË Û˘ÌÂÚÈÊÔÚ¿, ‰ÂÓ ı· ¤ÚÂ ӷ ÙË ‚·ıÌÔÏÔÁ‹ÛÂÈ, ·ÏÏ¿ Ó· ·Ê‹ÛÂÈ ÎÂÓfi. ∆· ÛÙÔȯ›· ·˘Ù¿ ‰ÂÓ ÂÏ‹ÊıËÛ·Ó ˘’ fi„ÈÓ Î·Ù¿ ÙË ‰È·‰Èηۛ· ·Ó¿Ï˘Û˘ (missing values). ∫¿ı ÂÎ·È‰Â˘ÙÈÎfi˜ Û˘ÌÏ‹ÚˆÛ ÂÚˆÙËÌ·ÙÔÏfiÁÈ· ÁÈ· fiÏÔ˘˜ ÙÔ˘˜ Ì·ıËÙ¤˜ Ù˘ Ù¿Í˘ ÙÔ˘ Î·È Ù· ·Ú¤‰ˆÛ ·ÓÒÓ˘Ì·. ∫·Ó¤Ó·˜ Ì·ıËÙ‹˜ ‰ÂÓ ÂÍ·ÈÚ¤ıËΠ·fi ·˘Ù‹ ÙËÓ ·ÍÈÔÏfiÁËÛË. ∑ËÙ‹ıËΠ·ÎfiÌ· ·fi ÙÔ˘˜ ÂÎ·È‰Â˘ÙÈÎÔ‡˜ Ó· ·Ú·‰ÒÛÔ˘Ó ÙË ‚·ıÌÔÏÔÁ›· ÙÚÈÌ‹ÓÔ˘ ÙˆÓ Ì·ıËÙÒÓ ÛÙ· ª·ıËÌ·ÙÈο, ÙË °ÏÒÛÛ·, ÙË ªÂϤÙË ¶ÂÚÈ‚¿ÏÏÔÓÙÔ˜ / º˘ÛÈ΋, ÙËÓ πÛÙÔÚ›· Î·È ÙËÓ ∞ÈÛıËÙÈ΋ ∞ÁˆÁ‹. ¶·Ú’ fiÙÈ ÛÙËÓ ·Ó¿Ï˘ÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÌfiÓÔ ÔÈ ‚·ıÌÔ› ÛÙË °ÏÒÛÛ·, Ù· ª·ıËÌ·ÙÈο Î·È ÙËÓ πÛÙÔÚ›·, ‹Ù·Ó ¯Ú‹ÛÈÌÔ Ó· ˘¿Ú¯ÂÈ Ë ‚·ıÌÔÏÔÁ›· Î·È Û οÔÈ· ·fi Ù· ˘fiÏÔÈ· Ì·ı‹Ì·Ù· ÁÈ· ÙËÓ Î·Ï‡ÙÂÚË ÂÎÙ›ÌËÛË ÙÔ˘ ÂÈ¤‰Ô˘ ÙˆÓ Ì·ıËÙÒÓ. ∑ËÙ‹ıËΠ·fi ÙÔ˘˜ ÂÎ·È‰Â˘ÙÈÎÔ‡˜, ηْ ÂÍ·›ÚÂÛË, Ó· ÂÎÙÈÌ‹ÛÔ˘Ó ÙËÓ Â›‰ÔÛË Î·È ÙˆÓ Ì·ıËÙÒÓ Ù˘ ∞’ ‰ËÌÔÙÈÎÔ‡, ·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ‰ÂÓ ÚԂϤÂÙ·È ‚·ıÌÔÏfiÁËÛË Û ·˘Ù‹ ÙËÓ Ù¿ÍË. ™ÙȘ ÂÚÈÙÒÛÂȘ Ô˘ ‰fiıËΠÂÚÈÁÚ·ÊÈ΋ ·ÍÈÔÏfiÁËÛË, ¤ÁÈÓ ÌÂÙ·ÙÚÔ‹ Û ·ÚÈıÌËÙÈ΋ ‚·ıÌÔÏÔÁ›·, fiˆ˜ ·˘Ù‹ ÚԂϤÂÙ·È ıÂÛÌÈο. ¢ËÏ·‰‹, ÙÔ ∞ ÌÂÙ·ÙÚ¿ËΠ۠9 ‹ 10, ÙÔ µ Û 7 ‹ 8, ÙÔ ° Û 5 ‹ 6, ·Ó¿ÏÔÁ· Ì ÙË ÁÂÓÈÎfiÙÂÚË Â›‰ÔÛË ÙÔ˘ Ì·ıËÙ‹. ŒÙÛÈ, ·Ó ¤Ó·˜ Ì·ıËÙ‹˜

Paediatriki 2002;65:452-462

›¯Â ÌfiÓÔ ∞, ÙfiÙ ·˘Ùfi ÈÛÔ‰˘Ó·ÌÔ‡Û Ì 10. ∞Ó Â›¯Â ÂÚÈÛÛfiÙÂÚ· ∞, ÏÈÁfiÙÂÚ· µ Î·È Î·ıfiÏÔ˘ °, ÙÔ ∞ ÌÂÙ·ÙÚÂfiÙ·Ó Û 9 Î·È ÙÔ µ Û 8. ∞Ó, ¿ÏÈ, ›¯Â Ï›Á· ∞ Î·È ÂÚÈÛÛfiÙÂÚ· µ ‹ ›¯Â Î·È °, ÙfiÙ ÙÔ ∞ ÌÂÙ·ÙÚÂfiÙ·Ó Û 9, ÙÔ µ Û 7 Î·È ÙÔ ° Û 6. ∆¤ÏÔ˜, ÙÔ ° ÈÛÔ‰˘Ó·ÌÔ‡Û Ì 5, ·Ó Ô Ì·ıËÙ‹˜ ›¯Â ÂÚÈÛÛfiÙÂÚ· ° ·fi fi,ÙÈ µ Î·È Î·Ó¤Ó· ∞ ‹ ·Ó ›¯Â ÌfiÓÔ °.

OÈ ‚·ıÌÔÏÔÁ›Â˜ Ô˘ ·ÍÈÔÏÔÁ‹ıËÎ·Ó ÚÔ‹Ïı·Ó ·fi (‚Ï. ¶·Ú¿ÚÙËÌ·): ·) ¤Ó· ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Û¯ÔÏÈ΋˜ Â›‰ÔÛ˘, ÚÔÛ·ÚÌÔṲ̂ÓÔ Î·È ÂÏ¿¯ÈÛÙ· ÙÚÔÔÔÈË̤ÓÔ (21), ‚) Ì›· Îϛ̷η ˘ÂÚÎÈÓËÙÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ - ÂÏÏÂÈÌÌ·ÙÈ΋˜ ÚÔÛÔ¯‹˜ (22) Î·È Á) ÙÔ˘˜ Û¯ÔÏÈÎÔ‡˜ ‚·ıÌÔ‡˜ ÙÔ˘ ÙÚ›ÙÔ˘ ÙÚÈÌ‹ÓÔ˘ ÛÙË °ÏÒÛÛ·, Ù· ª·ıËÌ·ÙÈο Î·È ÙËÓ πÛÙÔÚ›·.

OÈ ‰‡Ô Îϛ̷Θ Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ‰ÂÓ Â›Ó·È ÛÙ·ıÌÈṲ̂Ó˜ Û ÂÏÏËÓÈÎfi ‰Â›ÁÌ·, ÁÈ’ ·˘Ùfi ÔÈ ‚·ıÌÔÏÔÁ›Â˜ Ô˘ ÚԤ΢„·Ó ‰ÂÓ ıˆÚÔ‡ÓÙ·È ‰È·ÁÓˆÛÙÈΤ˜. ∂ÓÙÔ‡ÙÔȘ, ÔÈ ÛÙ·ÙÈÛÙÈΤ˜ Û˘Û¯ÂÙ›ÛÂȘ ÌÔÚÔ‡Ó Ó· Ì·˜ ‰ÒÛÔ˘Ó ·ÍÈÔÏÔÁ‹ÛÈÌ· ·ÔÙÂϤÛÌ·Ù·. ∏ Îϛ̷η Ì·ıËÛȷ΋˜ Â›‰ÔÛ˘ ·ÔÙÂÏÂ›Ù·È ·fi 50 ÂÚˆÙ‹ÛÂȘ Ô˘ ÂÚÈÁÚ¿ÊÔ˘Ó Î¿ÔȘ ÈηÓfiÙËÙ˜ ‹ ·‰˘Ó·Ì›Â˜ Û ‰¤Î· Ì·ıËÛÈ·ÎÔ‡˜ ÙÔÌ›˜: ÛÙËÓ ·ÎÔ˘ÛÙÈ΋ ·ÓÙ›ÏË„Ë, ÙÔÓ ÚÔÊÔÚÈÎfi ÏfiÁÔ, ÙÔÓ ÚÔÛ·Ó·ÙÔÏÈÛÌfi, ÙË Û˘ÌÂÚÈÊÔÚ¿, ÙËÓ ÎÈÓËÙÈ΋ Û˘ÌÂÚÈÊÔÚ¿, Ù· ÁψÛÛÈο, ÙË ‰È¿Û·ÛË ÚÔÛÔ¯‹˜, ÙȘ ÔÙÈÎÔÎÈÓËÙÈΤ˜ ‰È·Ù·Ú·¯¤˜, ÙȘ ‰˘ÛÎÔϛ˜ ÛÙËÓ ·ÎÔ˘ÛÙÈ΋ ÂÂÍÂÚÁ·Û›· Î·È ÙȘ ·‰˘Ó·Ì›Â˜ ÌÓ‹Ì˘. °È· ÙȘ ·Ó¿ÁΘ Ù˘ ¤Ú¢ӷ˜, ¤ÁÈÓ·Ó Î¿ÔȘ ÔÌ·‰ÔÔÈ‹ÛÂȘ Î·È ÂÍÂÙ¿ÛÙËÎ·Ó ÙÂÏÈο ÙÚÂȘ ·Ú¿ÁÔÓÙ˜: ·) Ë ÛÊ·›Ú· ÙÔ˘ ÏfiÁÔ˘ (·ÎÔ˘ÛÙÈ΋ ·ÓÙ›ÏË„Ë, ÚÔÊÔÚÈÎfi˜ ÏfiÁÔ˜, ÁψÛÛÈο, ‰˘ÛÎÔϛ˜ ÛÙËÓ ·ÎÔ˘ÛÙÈ΋ ÂÂÍÂÚÁ·Û›·, ·‰˘Ó·Ì›Â˜ ÌÓ‹Ì˘), ‚) Ë ÎÈÓËÙÈ΋ ˆÚÈÌfiÙËÙ· (ÎÈÓËÙÈ΋ Û˘ÌÂÚÈÊÔÚ¿-ÈηÓfiÙËÙ·), Ô˘ ÂÎÙÈÌ¿ ÙËÓ ˆÚ›Ì·ÓÛË ÙÔ˘ ÎÈÓËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Î·È ÂÓÙÔ›˙ÂÈ ÂÏ·ÊÚ¿ Ó¢ÚÔÏÔÁÈο ÛËÌ›· (soft signs) Î·È Á) Ô ÔÙÈÎÔÎÈÓËÙÈÎfi˜ Û˘ÓÙÔÓÈÛÌfi˜ (ÔÙÈÎÔÎÈÓËÙÈΤ˜ ‰È·Ù·Ú·¯¤˜), Ô˘ ÂÎÙÈÌ¿ Ì›· ·ÓÒÙÂÚË ÂÁÎÂÊ·ÏÈ΋ ÏÂÈÙÔ˘ÚÁ›·, ÙÔ Û˘ÓÙÔÓÈÛÌfi ¯ÂÚÈÔ‡-Ì·ÙÈÔ‡. OÈ ÂÎ·È‰Â˘ÙÈÎÔ› ·ÍÈÔÏfiÁËÛ·Ó ÙÔ˘˜ Ì·ıËÙ¤˜ Û ̛· Îϛ̷η ·fi 03, fiÔ˘ Ì ÙÔ Ìˉ¤Ó ÂÎÊÚ¿˙ÂÙ·È Ë ·Ô˘Û›· ÚÔ‚ÏËÌ¿ÙˆÓ, ‰ËÏ·‰‹ Ë ¿ÚÈÛÙË Â›‰ÔÛË. ∏ Îϛ̷η ÙÔ˘ ˘ÂÚÎÈÓËÙÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ - ÂÏÏÂÈÌÌ·ÙÈ΋˜ ÚÔÛÔ¯‹˜ ·ÔÙÂÏÂ›Ù·È ·fi 26 ÂÚˆÙ‹ÛÂȘ Ô˘ ÂÚÈÁÚ¿ÊÔ˘Ó Ù· ¯·Ú·ÎÙËÚÈÛÙÈο Û˘ÌÙÒÌ·Ù· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘. OÈ ÂÚˆÙ‹ÛÂȘ ·˘Ù¤˜ Â›Ó·È ¯ˆÚÈṲ̂Ó˜ ÛÙËÓ ÔÌ¿‰· ˘ÂÚÎÈÓËÙÈÎfiÙËÙ·˜, ÙËÓ ÔÌ¿‰· ·ÚÔÚÌËÙÈÎfiÙËÙ·˜ Î·È ÙËÓ ÔÌ¿‰· ‰È¿Û·Û˘ ÚÔÛÔ¯‹˜. OÈ ÂÎ·È‰Â˘ÙÈÎÔ› ·ÍÈÔÏfiÁËÛ·Ó ÙÔ˘˜ Ì·ıËÙ¤˜ Û ̛· Îϛ̷η ·fi 0-2, fiÔ˘ ÙÔ Ìˉ¤Ó ÂÎÊÚ¿˙ÂÈ ÙËÓ ·Ô˘Û›· ÚÔ‚Ï‹Ì·ÙÔ˜. ŒÙÛÈ, ÚԤ΢„ ̛· ‚·ıÌÔÏÔÁ›· ˘ÂÚÎÈÓËÙÈÎfiÙËÙ·˜, Ì›· ‚·ıÌÔÏÔÁ›· ·ÚÔÚÌËÙÈÎfiÙËÙ·˜, Ì›· ‚·ıÌÔÏÔÁ›· ‰È¿Û·Û˘ ÚÔÛÔ¯‹˜ Î·È Ì›· Û˘ÓÔÏÈ΋ ‚·ıÌÔÏÔÁ›·. ŒÁÈÓ·Ó Û˘Û¯ÂÙ›ÛÂȘ Ì Pearson correlation test ÙˆÓ ÂÈ̤ÚÔ˘˜ ÙÈÌÒÓ ÛÙËÓ Îϛ̷η Ì·ıËÛȷ΋˜ Â›‰ÔÛ˘ (‰ËÏ·‰‹ ÙˆÓ ÙÈÌÒÓ ÛÙË ÛÊ·›Ú· ÙÔ˘ ÏfiÁÔ˘, ÙËÓ ÎÈÓËÙÈ΋ ˆÚÈÌfiÙËÙ· Î·È ÙÔÓ ÔÙÈÎÔÎÈÓËÙÈÎfi Û˘ÓÙÔÓÈÛÌfi) Ì ÙȘ ÙÈ̤˜ ˘ÂÚÎÈÓËÙÈÎfiÙËÙ·˜, ·ÚÔÚÌËÙÈÎfiÙËÙ·˜, ‰È¿Û·Û˘ ÚÔÛÔ¯‹˜ ͯˆÚÈÛÙ¿,

455

NoV-dEc-02

14-05-03

14:26

™ÂÏ›‰·456

¶·È‰È·ÙÚÈ΋ 2002;65:452-462

·ÏÏ¿ Î·È Ì ÙË Û˘ÓÔÏÈ΋ ÙÈÌ‹ Ù˘ Îϛ̷η˜ ˘ÂÚÎÈÓËÙÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘. ∂›Û˘, ¤ÁÈÓ·Ó Û˘Û¯ÂÙ›ÛÂȘ ÌÂٷ͇ οı ˘ÔÎϛ̷η˜ ÙˆÓ ‰‡Ô ÂÚˆÙËÌ·ÙÔÏÔÁ›ˆÓ Î·È ÙˆÓ ‚·ıÌÒÓ ÛÙ· Ì·ı‹Ì·Ù· Ù˘ ÁÏÒÛÛ·˜, ÙˆÓ Ì·ıËÌ·ÙÈÎÒÓ Î·È Ù˘ ÈÛÙÔÚ›·˜. ŒÂÈÙ·, ÁÈ· οı ˘ÔÎϛ̷η ÙÔ˘ ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘ ˘ÂÚÎÈÓËÙÈÎfiÙËÙ·˜ - ÂÏÏÂÈÌÌ·ÙÈ΋˜ ÚÔÛÔ¯‹˜, ÔÈ Ì·ıËÙ¤˜ ¯ˆÚ›ÛÙËÎ·Ó Û ‰‡Ô ÔÌ¿‰Â˜: ·) ÛÙÔ˘˜ Ì·ıËÙ¤˜ ¯ˆÚ›˜ Û˘ÌÙÒÌ·Ù· (‚·ıÌÔÏÔÁ›· = 0) Î·È ‚) ÛÙÔ˘˜ Ì·ıËÙ¤˜ Ì ̤ÙÚÈ· ‹ ÛÔ‚·Ú¿ Û˘ÌÙÒÌ·Ù· (‚·ıÌÔÏÔÁ›· ≥1). ∏ Â›‰ÔÛË ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ÛÙË °ÏÒÛÛ·, Ù· ª·ıËÌ·ÙÈο Î·È ÙËÓ πÛÙÔÚ›· ÂϤÁ¯ıËΠ̠Mann-Whitney Test.

∞ÔÙÂϤÛÌ·Ù· ™ÙÔÓ ¶›Ó·Î· 2 ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÔÈ Û˘Û¯ÂÙ›ÛÂȘ ÙˆÓ ÔÌ¿‰ˆÓ Ù˘ Îϛ̷η˜ ˘ÂÚÎÈÓËÙÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ Ì ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ Ì·ıËÛȷ΋˜ Â›‰ÔÛ˘ Î·È Ì ÙÔ˘˜ Û¯ÔÏÈÎÔ‡˜ ‚·ıÌÔ‡˜. OÈ ÂȉfiÛÂȘ ÛÙËÓ Îϛ̷η ˘ÂÚÎÈÓËÙÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ - ÂÏÏÂÈÌÌ·ÙÈ΋˜ ÚÔÛÔ¯‹˜ ›¯·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ Û¯¤ÛË Ì ÙËÓ Â›‰ÔÛË ÛÙË ÛÊ·›Ú· ÙÔ˘ ÏfiÁÔ˘ Î·È ÛÙȘ ˘ÔÎϛ̷Θ ÎÈÓËÙÈ΋˜ ˆÚÈÌfiÙËÙ·˜ Î·È ÔÙÈÎÔÎÈÓËÙÈÎÔ‡ Û˘ÓÙÔÓÈÛÌÔ‡ ÁÈ· Ù· ·È‰È¿ Ù˘ °’ Î·È ™∆’ Ù¿Í˘. ™ÙËÓ ∞’ Ù¿ÍË, ÔÈ ‚·ıÌÔÏÔÁ›Â˜ ˘ÂÚÎÈÓËÙÈÎfiÙËÙ·˜ Î·È ·ÚÔÚÌËÙÈÎfiÙËÙ·˜, ηıÒ˜ Î·È Ë Û˘ÓÔÏÈ΋ ‚·ıÌÔÏÔÁ›· ›¯·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ Û˘Û¯¤ÙÈÛË ÌfiÓÔ Ì ÙÔÓ ÔÙÈÎÔÎÈÓËÙÈÎfi Û˘ÓÙÔÓÈÛÌfi. ∏ ‰È¿Û·ÛË Ù˘ ÚÔÛÔ¯‹˜, ·ÓÙ›ıÂÙ·, Û¯ÂÙÈ˙fiÙ·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο Î·È Ì ÙÔ˘˜ ÙÚÂȘ ·Ú¿ÁÔÓÙ˜ Û¯ÔÏÈ΋˜ Â›‰ÔÛ˘ Ô˘ ÂÍÂÙ¿ÛÙËηÓ. ™Â fiϘ ÙȘ Ù¿ÍÂȘ ‚Ú¤ıËÎ·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ Û˘Û¯ÂÙ›ÛÂȘ ÌÂٷ͇ ÙˆÓ ‚·ıÌÒÓ ÛÙ· Ì·ı‹Ì·Ù· Î·È ÙˆÓ ·Ú·ÁfiÓÙˆÓ Û¯ÔÏÈ΋˜ Â›‰ÔÛ˘, ·ÏÏ¿ Î·È ÙˆÓ ‚·ıÌÔÏÔÁÈÒÓ ÛÙËÓ ˘ÂÚÎÈÓËÙÈÎfiÙËÙ·, ÙËÓ ·ÚÔÚÌËÙÈÎfiÙËÙ· Î·È ÙË ‰È¿Û·ÛË ÚÔÛÔ¯‹˜, ͯˆÚÈÛÙ¿ Î·È Û˘ÓÔÏÈο.

O ¶›Ó·Î·˜ 3 ·ÚÔ˘ÛÈ¿˙ÂÈ ÁÈ· οı ÔÌ¿‰· Ù˘ Îϛ̷η˜ ˘ÂÚÎÈÓËÙÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ ÙË Ì¤ÛË ‚·ıÌÔÏÔÁ›· ÛÙ· ª·ıËÌ·ÙÈο, ÙË °ÏÒÛÛ· Î·È ÙËÓ πÛÙÔÚ›· ÙˆÓ ·È‰ÈÒÓ ¯ˆÚ›˜ Û˘ÌÙÒÌ·Ù· Î·È ÙˆÓ ·È‰ÈÒÓ Ô˘ ÂÌÊ¿ÓÈ˙·Ó ¤ÛÙˆ Î·È Ì¤ÙÚÈ· Û˘ÌÙÒÌ·Ù·. ∂›Û˘, ·ÚÔ˘ÛÈ¿˙ÂÈ ÙË ÛÙ·ÙÈÛÙÈ΋ ÛËÌ·ÓÙÈÎfiÙËÙ· Ù˘ ‰È·ÊÔÚ¿˜ Â›‰ÔÛ˘ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ. Ÿˆ˜ Ê·›ÓÂÙ·È, Ë ÔÌ¿‰· ·È‰ÈÒÓ ¯ˆÚ›˜ Û˘ÌÙÒÌ·Ù· ›¯Â ÛËÌ·ÓÙÈο ηχÙÂÚË Â›‰ÔÛË Û fiÏ· Ù· Ì·ı‹Ì·Ù· Û ۯ¤ÛË Ì ٷ ·È‰È¿ Ô˘ ›¯·Ó ¤ÛÙˆ Î·È Û ÌÈÎÚfi ‚·ıÌfi Û˘ÌÙÒÌ·Ù· ˘ÂÚÎÈÓËÙÈÎfiÙËÙ·˜ ‹ ·ÚÔÚÌËÙÈÎfiÙËÙ·˜ ‹ ‰È¿Û·Û˘ ÚÔÛÔ¯‹˜ ‹ fiÏ· Ù· ·Ú·¿Óˆ. ∂Í·›ÚÂÛË ·ÔÙ¤ÏÂÛÂ Ë ™∆’ Ù¿ÍË, fiÔ˘ ·Ú·ÙËÚ‹ıËΠηχÙÂÚË Â›‰ÔÛË ÛÙË °ÏÒÛÛ· Î·È Ù· ª·ıËÌ·ÙÈο ÙˆÓ ·È‰ÈÒÓ ÌÂ Û˘ÌÙÒÌ·Ù· ·ÚÔÚÌËÙÈÎfiÙËÙ·˜ Û ۯ¤ÛË Ì ٷ ·È‰È¿ ¯ˆÚ›˜ Ù· Û˘ÁÎÂÎÚÈ̤ӷ Û˘ÌÙÒÌ·Ù·. ∏ ‰È·ÊÔÚ¿ ‰ÂÓ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋.

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¶·Ú¿ÚÙËÌ·. ∂ÚˆÙËÌ·ÙÔÏfiÁÈÔ ˘ÂÚÎÈÓËÙÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ - ‰È¿Û·Û˘ ÚÔÛÔ¯‹˜ (ADHDT) ™·˜ ·Ú·Î·Ïԇ̠ӷ ÛËÌÂÈÒÛÂÙÂ Â¿Ó ·ÚÔ˘ÛÈ¿˙ÂÙ·È ‹ fi¯È ¤Ó· ·fi Ù· ·Ú·Î¿Ùˆ ÚÔ‚Ï‹Ì·Ù·. ªÂ “0” ÛËÌÂÈÒÓÔ˘Ì fiÙ·Ó ‰ÂÓ ˘¿Ú¯ÂÈ ÙÔ Úfi‚ÏËÌ·, Ì “1” Â¿Ó ÙÔ Úfi‚ÏËÌ· ·ÚÔ˘ÛÈ¿˙ÂÙ·È Û ÌÈÎÚfi ‚·ıÌfi Î·È Ì “2” Â¿Ó ÙÔ Úfi‚ÏËÌ· Â›Ó·È ÌÂÁ¿ÏÔ. OÈ ÏËÚÔÊÔڛ˜ ‰›ÓÔÓÙ·È ÛÙ· Ï·›ÛÈ· ÂÎÙ›ÌËÛ˘ ÙÔ˘ Ì·ıËÙ‹ Î·È Ì ۇÌʈÓË ÁÓÒÌË ÙˆÓ ÁÔÓ¤ˆÓ.

OÓÔÌ·ÙÂÒÓ˘ÌÔ, ‰È‡ı˘ÓÛË, ÙËϤʈÓÔ: . . . . . . . . . . . . . ∏Ì. °ÂÓÓ‹Ûˆ˜ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ∏Ì. ™˘ÌÏ‹ÚˆÛ˘ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ¶fiÛÔ Î·ÈÚfi ÁÓˆÚ›˙ÂÙ ÙÔ ·È‰›; - ŸÓÔÌ·, ÙËϤʈÓÔ, ÏÔÈ¤˜ ÏËÚÔÊÔڛ˜ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ∂ÚˆÙ‹ÛÂȘ ÔÌ¿‰·˜ ˘ÂÚÎÈÓËÙÈÎfiÙËÙ·˜ 0 1 1 ∂›Ó·È “ıÔÚ˘‚҉˘” 2 ™˘Ó¤¯ÂÈ· ˘’ ·ÙÌfiÓ 3 ∆Ú¤¯ÂÈ, ˉ¿, ÛηÚÊ·ÏÒÓÂÈ Ôχ Û˘¯Ó¿ 4 ∫Ô˘ÓÈ¤Ù·È Î·È ÛÙÚÈÊÔÁ˘Ú›˙ÂÈ fiÙ·Ó Î¿ıÂÙ·È 5 ∂˘¤Í·ÙÔ˜ 6 ∞Ú¿˙ÂÈ (‰È¿ÊÔÚ·) Ú¿ÁÌ·Ù· 7 ªÈÏ¿ Ôχ 8 ¢˘ÛÎÔχÂÙ·È Ó· Ì›ÓÂÈ Î·ıÈÛÙfi˜ 9 ¶·›˙ÂÈ Û˘¯Ó¿ ÛÙ· ¯¤ÚÈ· ÙÔ˘ ‰È¿ÊÔÚ· ·ÓÙÈΛÌÂÓ· 10 ¢ÂÓ ÌÔÚ› Ó· ·›˙ÂÈ ‹Û˘¯· 11 ∫¿ÓÂÈ Ó¢ÚÈΤ˜ ÎÈÓ‹ÛÂȘ 12 ∂›Ó·È ·ÂÈΛÓËÙÔ˜, ·Ó‹Û˘¯Ô˜ 13 ™˘ÛÙÚ¤ÊÂÈ ÙÔ ÛÒÌ· ÙÔ˘ Û˘¯Ó¿ ™‡ÓÔÏÔ ............... ∂ÚˆÙ‹ÛÂȘ ÔÌ¿‰·˜ ·ÚÔÚÌËÙÈÎfiÙËÙ·˜ 0 1 14 ¢Ú· ÚÈÓ Ó· ÛÎÂÊÙ› 15 ªÂÙ·ˉ¿ ·fi Ì›· ‰Ú·ÛÙËÚÈfiÙËÙ· Û ̛· ¿ÏÏË 16 ¢ÂÓ ÌÔÚ› Ó· ÂÚÈ̤ÓÂÈ ÙË ÛÂÈÚ¿ ÙÔ˘ 17 ¢˘ÛÎÔχÂÙ·È Ó· ÂÚÈ̤ÓÂÈ ÛÙËÓ “Ô˘Ú¿” 18 ∞·ÓÙ¿ Û˘¯Ó¿ ·ÂÚ›ÛÎÂÙ· 19 ∂›Ó·È ·˘ıfiÚÌËÙÔ˜ 20 ¢È·ÎfiÙÂÈ Û˘˙ËÙ‹ÛÂȘ 21 ¶·ÚÂÌ‚·›ÓÂÈ Û ‰Ú·ÛÙËÚÈfiÙËÙ˜ ¿ÏÏˆÓ 22 ¢ÂÓ ÂÚÈ̤ÓÂÈ fiÙ·Ó Â›Ó·È Ó· ‰ÔıÔ‡Ó Ô‰ËÁ›Â˜ 23 ¢ÂÓ ·ÎÔÏÔ˘ı› ηÓfiÓ˜ ·È¯ÓȉÈÒÓ ™‡ÓÔÏÔ ............... ∂ÚˆÙ‹ÛÂȘ ÔÌ¿‰·˜ ‰È¿Û·Û˘ ÚÔÛÔ¯‹˜ 0 1 24 ¶·ÚÔ˘ÛÈ¿˙ÂÈ Ùˆ¯‹ Û˘ÁΤÓÙÚˆÛË 25 ¢ÂÓ Î·Ù·Ê¤ÚÓÂÈ Ó· ÙÂÏÂÈÒÛÂÈ Ì›· ‰Ô˘ÏÂÈ¿ 26 ∂›Ó·È ·Ô‰ÈÔÚÁ·ÓˆÌ¤ÓÔ˜ 27 ¶·ÚÔ˘ÛÈ¿˙ÂÈ Ùˆ¯‹ ÈηÓfiÙËÙ· Ó· ÚÔÁÚ·ÌÌ·Ù›ÛÂÈ 28 ∞Ê·ÈÚÂ›Ù·È 29 ∂›Ó·È ·ÚfiÛÂÎÙÔ˜ 30 ¢˘ÛÎÔχÂÙ·È Ó· ·ÎÔÏÔ˘ı‹ÛÂÈ Ô‰ËÁ›Â˜ 31 Œ¯ÂÈ ÌÈÎÚ‹ ‰È¿ÚÎÂÈ· ÚÔÛÔ¯‹˜ 32 ¢È·Û¿Ù·È ‡ÎÔÏ· 33 ¢˘ÛÎÔχÂÙ·È Ó· ‰È·ÙËÚ‹ÛÂÈ ÙËÓ ÚÔÛÔ¯‹ 34 ¢˘ÛÎÔχÂÙ·È Ó· Û˘Ó¯›ÛÂÈ fi,ÙÈ Î¿ÓÂÈ 35 ¢˘ÛÎÔχÂÙ·È Ó· ʤÚÂÈ ÂȘ ¤Ú·˜ fi,ÙÈ Î¿ÓÂÈ 36 ÿÓÂÈ Û˘¯Ó¿ Ú¿ÁÌ·Ù· ™‡ÓÔÏÔ ...............

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¶·È‰È·ÙÚÈ΋ 2002;65:452-462

Paediatriki 2002;65:452-462

∂ÚˆÙËÌ·ÙÔÏfiÁÈÔ Ì·ıËÛȷ΋˜ Â›‰ÔÛ˘ ∞Á·ËÙ¤/‹ ‰¿ÛηÏÂ/·. ∑ËÙ¿Ì ӷ ÂÓÙÔ›ÛÔ˘Ì ·È‰È¿ Ô˘ ¤¯Ô˘Ó ‰˘ÛÎÔϛ˜ ÛÙÔ Û¯ÔÏ›Ô, ·ÓÂÍ¿ÚÙËÙ· ÙÔ˘ Â¿Ó ¤¯Ô˘Ó Î·È È‰È·›ÙÂÚ· ÚÔÛfiÓÙ·. £· Û˘Ì‚¿ÏÏÂÈ Ó· ÂÓÙÔ›ÛÔ˘Ì ·Èٛ˜ Î·È ·˘Ùfi ı· ‚ÔËı‹ÛÂÈ ÔÏÏ¿ ·È‰È¿. ∞˘Ùfi˜ Â›Ó·È Ô ÛÎÔfi˜ ÙˆÓ ÂÚˆÙ‹ÛÂˆÓ Ô˘ ·ÎÔÏÔ˘ıÔ‡Ó. ™¯ÔÏÂ›Ô . . . . . . . . . . . . . .∆¿ÍË . . .∆ËϤʈÓÔ . . . . . . . . .

OÓÔÌ·ÙÂÒÓ˘ÌÔ Ì·ıËÙ‹: . . . . . . . . . . . . . . . . . . . . . . . . . µ·ıÌÔ› (1-10): ª·ıËÌ·ÙÈο . . . . . . .°ÏÒÛÛ· . . . . . . . . . . . . πÛÙÔÚ›· . . . . . . . . . . . . . . Œ¯ÂÈ È‰È·›ÙÂÚ· ηϋ Â›‰ÔÛË Û οÔÈÔ Ì¿ıËÌ·; ™Â ÔÈÔ; . . . . . . . . . . . . . . . . . . . . . . (µ·ıÌÔÏÔÁ‹ÛÙ ÛËÌÂÈÒÓÔÓÙ·˜ à ÛÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ÙÂÙÚ·ÁˆÓ¿ÎÈ, ˆ˜ ÂÍ‹˜: 3=Ôχ ηÎfi, 2=ÏÈÁfiÙÂÚÔ Î·Îfi, 1=‡ÔÙÔ, 0=ηÏfi) ∞ÎÔ˘ÛÙÈ΋ ·ÓÙ›ÏË„Ë 1 Œ¯ÂÈ ÙËÓ ÈηÓfiÙËÙ· Ó· ·ÎÔÏÔ˘ı‹ÛÂÈ ÚÔÊÔÚÈΤ˜ Ô‰ËÁ›Â˜; 2 ∞ÓÙÈÏ·Ì‚¿ÓÂÙ·È ÙË Û˘˙‹ÙËÛË ÛÙË Û¯ÔÏÈ΋ Ù¿ÍË; 3 Œ¯ÂÈ ÙËÓ ÈηÓfiÙËÙ· Ó· Û˘ÁÎÚ·Ù‹ÛÂÈ fi,ÙÈ ·ÎÔ‡ÂÈ ÛÙÔ Ì¿ıËÌ·; 4 ∞ÓÙÈÏ·Ì‚¿ÓÂÙ·È ÙË ÛËÌ·Û›· ÙˆÓ Ï¤ÍˆÓ; ¶ÚÔÊÔÚÈÎfi˜ ÏfiÁÔ˜ 5 ∏ ¤ÎÊÚ·Û‹ ÙÔ˘/Ù˘ Â›Ó·È Ï‹Ú˘ Î·È ·ÎÚÈ‚‹˜; 6 ÃÚËÛÈÌÔÔÈ› ÏÔ‡ÛÈÔ ÏÂÍÈÏfiÁÈÔ; 7 Œ¯ÂÈ ÙËÓ ÈηÓfiÙËÙ· Ó· ı˘Ì¿Ù·È ϤÍÂȘ; 8 Œ¯ÂÈ ÙËÓ ÈηÓfiÙËÙ· Ó· Û˘Û¯ÂÙ›˙ÂÈ ÂÌÂÈڛ˜; 9 Œ¯ÂÈ ÙËÓ ÈηÓfiÙËÙ· Ó· ‰È·ÌÔÚÊÒÓÂÈ È‰¤Â˜; ¶ÚÔÛ·Ó·ÙÔÏÈÛÌfi˜ 10 ¶ÚÔÛ·Ó·ÙÔÏ›˙ÂÙ·È ÁÚ‹ÁÔÚ·; 11 ¶ÚÔÛ·Ó·ÙÔÏ›˙ÂÙ·È Â‡ÎÔÏ· ÛÙÔ ¯ÒÚÔ; 12 ∂ÎÙÈÌ¿ ‡ÎÔÏ· ‰È¿ÊÔÚ· ÌÂÁ¤ıË, .¯. ·fiÛÙ·ÛË; 13 ª·ı·›ÓÂÈ Â‡ÎÔÏ· ηÙ¢ı‡ÓÛÂȘ; ™˘ÌÂÚÈÊÔÚ¿: ÙÔÓ/ÙË ‰È·ÎÚ›ÓÂÈ 14 ™˘ÓÂÚÁ·Û›· 15 ¶ÚÔÛÔ¯‹ 16 πηÓfiÙËÙ· ÁÈ· ÔÚÁ¿ÓˆÛË 17 πηÓfiÙËÙ· Ó· ·ÓÙÂÂͤگÂÙ·È Û Ӥ˜ ηٷÛÙ¿ÛÂȘ 18 ∫ÔÈÓˆÓÈ΋ ·Ô‰Ô¯‹ (.¯. ·fi ÙÔ˘˜ Û˘ÌÌ·ıËÙ¤˜ ÙÔ˘/Ù˘) 19 ∞Ó·Ï·Ì‚¿ÓÂÈ Ì ˘¢ı˘ÓfiÙËÙ· ˘Ô¯ÚÂÒÛÂȘ; 20 ∂ÎÙÂÏ› fiÙÈ ÙÔ˘/Ù˘ ·Ó·Ù›ıÂÙ·È; 21 ∆ÔÓ/ÙË ‰È·ÎÚ›ÓÂÈ ÏÂÙfiÙËÙ· ÛÙË Û˘ÌÂÚÈÊÔÚ¿; ∫ÈÓËÙÈ΋ Û˘ÌÂÚÈÊÔÚ¿ 22 OÈ ÎÈÓ‹ÛÂȘ ÙÔ˘/Ù˘ Â›Ó·È Û˘ÓÙÔÓÈṲ̂Ó˜; 23 ∆ÔÓ/ÙË ‰È·ÎÚ›ÓÂÈ ÈÛÔÚÚÔ›· ÛÙÔ ‚¿‰ÈÛÌ· Î·È ÙÔ ÙÚ¤ÍÈÌÔ; 24 ∆ÔÓ/ÙË ‰È·ÎÚ›ÓÂÈ ‰ÂÍÈÔÙ¯ӛ·; 25 Œ¯ÂÈ ‰˘ÛÎÔÏ›· ÛÙË ÁÚ·Ê‹ ÁÚ·ÌÌ¿ÙˆÓ Î·È ·ÚÈıÌÒÓ; ¶·Ú·ÙËÚÂ›Ù·È Î·ÎÔÁÚ·Ê›·; 26 ¢˘ÛÎÔχÂÙ·È ÛÙË ˙ˆÁÚ·ÊÈ΋; 27 ∂›Ó·È “¿ÙÛ·ÏÔ˜/Ë”; ¢˘ÛÎÔχÂÙ·È Ó· Ù·ÎÙÔÔÈ‹ÛÂÈ Ù· Ú¿ÁÌ·Ù¿ ÙÔ˘/Ù˘; 28 ∆Ô˘/Ù˘ ¤ÊÙÔ˘Ó Û˘¯Ó¿ Ú¿ÁÌ·Ù·; 29 ¢ÂÓ ÌÔÚ› Ó· ÁÚ¿„ÂÈ Ù·

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ÁÚ¿ÌÌ·Ù· ‹ ÙÔ˘˜ ·ÚÈıÌÔ‡˜ Û ÂÚÈÔÚÈṲ̂ÓÔ ¯ÒÚÔ (ÁÚ¿ÊÂÈ ¿ÓÙ· ÌÂÁ¿ÏÔ˘˜ ·ÚÈıÌÔ‡˜); °ÏˆÛÛÈο 30 ¢È·‚¿˙ÂÈ Ì ¢¯¤ÚÂÈ· ¯ˆÚ›˜ Ï¿ıË; 31 ™ÙËÓ ÚÔÊÔÚÈ΋ ¤ÎÊÚ·ÛË, ¯ÚËÛÈÌÔÔÈ› ÔÏÔÎÏËڈ̤Ó˜ ÚÔÙ¿ÛÂȘ ¯ˆÚ›˜ Ï¿ıË; 32 ∂›‰ÔÛË ÛÙËÓ ¤ÎıÂÛË 33 •Â¯ˆÚ›˙ÂÈ ˘ÔΛÌÂÓÔ, Ú‹Ì·, ·ÓÙÈΛÌÂÓÔ; 34 •Â¯ˆÚ›˙ÂÈ ÎÏÈÙ¿ Î·È ¿ÎÏÈÙ· ̤ÚË ÙÔ˘ ÏfiÁÔ˘; 35 ∫¿ÓÂÈ ÔÚıÔÁÚ·ÊÈο Ï¿ıË ÛÙȘ ηٷϋÍÂȘ ÙˆÓ Ï¤ÍˆÓ; ¢È¿Û·ÛË ÚÔÛÔ¯‹˜ 36 ¢˘ÛÎÔχÂÙ·È ÛÙË ‰È·Ù‹ÚËÛË Ù˘ ÚÔÛÔ¯‹˜ ÙÔ˘/Ù˘ ÛÙ· Ì·ı‹Ì·Ù· ‹ Û ‰È¿ÊÔÚ· ÛÙ¿‰È· Â›Ï˘Û˘ ÚÔ‚ÏËÌ¿ÙˆÓ; 37 ¢˘ÛÎÔχÂÙ·È ÛÙË ‰È·Ù‹ÚËÛË Ù˘ ÚÔÛÔ¯‹˜ Û ÛÔ‚·Ú¤˜ ¯ÚÔÓÈΤ˜ ÛÙÈÁ̤˜ (.¯. fiÙ·Ó Ô ‰¿ÛηÏÔ˜ ‰›ÓÂÈ Ô‰ËÁ›Â˜ ÁÈ· ÙÔ Ì¿ıËÌ· ‹ ÁÈ· ÙËÓ Â›Ï˘ÛË ÚÔ‚Ï‹Ì·ÙÔ˜); ¢È·Ù·Ú·¯¤˜ ÔÙÈÎÔÎÈÓËÙÈΤ˜ 38 ¢˘ÛÎÔχÂÙ·È, ¯ˆÚÔÙ·ÍÈο, ÛÙÔ Ê‡ÏÏÔ ¯·ÚÙÈÔ‡ Ô˘ ÂÚÁ¿˙ÂÙ·È; 39 ¢˘ÛÎÔχÂÙ·È ÛÂ Û˘ÌÌÂÙڛ˜ ‹ ·Ó·ÛÙÚÔʤ˜ (‰È¿ÎÚÈÛË ÌÂٷ͇ 6 Î·È 9, 2 Î·È 5, 17 Î·È 71, Â Î·È 3, Ú Î·È 9 Î.Ï.); 40 Œ¯ÂÈ ‰˘ÛÎÔϛ˜ Ì ٷ ÓÔÌ›ÛÌ·Ù·, Ù· ۇ̂ÔÏ· ÙˆÓ ڿ͈Ó, ÙÔ˘˜ ‰Â›ÎÙ˜ ÙÔ˘ ÚÔÏÔÁÈÔ‡; 41 ¢˘ÛÎÔχÂÙ·È Ó· ÁÚ¿„ÂÈ ÛÙÔ ¯·ÚÙ› Û ¢ı›· ÁÚ·ÌÌ‹; 42 ¢˘ÛÎÔχÂÙ·È Ôχ Û ̷ıËÌ·ÙÈο ÚÔ‚Ï‹Ì·Ù· fiÔ˘ Ú¤ÂÈ Ó· ÂÚÁ·ÛÙ› ÛÙÔ ¯ÒÚÔ, .¯. ÚÔ‚Ï‹Ì·Ù· Ô˘ ··ÈÙÔ‡Ó Û˘Û¯¤ÙÈÛË ÙˆÓ: ¿Óˆ-οو Î·È ·ÚÈÛÙÂÚ¿-‰ÂÍÈ¿ (fiˆ˜ οıÂÙË ÚfiÛıÂÛË), Ù·ÎÙÔÔ›ËÛË ·ÚÈıÌÒÓ Û ÔÌ¿‰Â˜, ÛÙÔȯÂÈÔı¤ÙËÛË ·˘ÙÒÓ; 43 ¢˘ÛÎÔχÂÙ·È Ó· ÁÚ¿„ÂÈ ¤Ó·Ó Ì·ÎÚ‡ ·ÚÈıÌfi ‹ ÌÂÁ¿ÏË Ï¤ÍË Û ¢ı›· ÁÚ·ÌÌ‹; ¢˘ÛÎÔϛ˜ ÛÙËÓ ·ÎÔ˘ÛÙÈ΋ ÂÂÍÂÚÁ·Û›· 44 ¢˘ÛÎÔχÂÙ·È Ó· οÓÂÈ ÚÔÊÔÚÈΤ˜ ·Û΋ÛÂȘ; 45 ¢ÂÓ ÌÔÚ› Ó· Û˘Ó¯›ÛÂÈ ÙÔ Ì¤ÙÚËÌ· Û ̛· ·ÎÔÏÔ˘ı›·; ∞‰˘Ó·Ì›Â˜ ÌÓ‹Ì˘ 46 ¢ÂÓ ÌÔÚ› Ó· Û˘ÁÎÚ·Ù‹ÛÂÈ Ó¤· ÏËÚÔÊÔÚ›· ‹, ȉ›ˆ˜, Ì·ıËÌ·ÙÈο ÓÔ‡ÌÂÚ·; 47 •Â¯Ó¿ ÛÙ¿‰È· Û ̷ıËÌ·ÙÈΤ˜ Ú¿ÍÂȘ; 48 ∏ ·fi‰ÔÛ‹ ÙÔ˘/Ù˘ Â›Ó·È ÊÙˆ¯‹ ÛÙËÓ Â·Ó¿ÏË„Ë Ì·ıËÌ¿ÙˆÓ ‹ ·ÓÙ›ÏË„Ë ÌÂÈÎÙÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ; 49 ¢˘ÛÎÔχÂÙ·È Ó· ÂÈ ÙËÓ ÒÚ·; 50 ¢˘ÛÎÔχÂÙ·È Ó· χÛÂÈ ÚÔÊÔÚÈο ÚÔ‚Ï‹Ì·Ù· Ô˘ ¤¯Ô˘Ó ÔÏÏ¿ ÛÙ¿‰È·;

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457

NoV-dEc-02

14-05-03

14:26

™ÂÏ›‰·458

¶·È‰È·ÙÚÈ΋ 2002;65:452-462

™˘˙‹ÙËÛË OÈ ·ÚÓËÙÈΤ˜ ÂȉڿÛÂȘ Ù˘ ¢∂¶-À ÛÙËÓ ÚÔÛˆÈ΋, Û¯ÔÏÈ΋, Â·ÁÁÂÏÌ·ÙÈ΋ Î·È ÎÔÈÓˆÓÈ΋ ˙ˆ‹ ÙˆÓ ·ÙfiÌˆÓ Î·È ÔÈ ‰˘Û¿ÚÂÛÙ˜ Û˘Ó¤ÂȤ˜ Ù˘ ÁÈ· ÙËÓ ÎÔÈÓˆÓ›· ‰ÈηÈÔÏÔÁÔ‡Ó ÙËÓ ÂÓ·Û¯fiÏËÛË ÔÏÏÒÓ ÂȉÈÎÒÓ Ì ÙÔ ı¤Ì· Î·È ÙËÓ ÚÔÛ¿ıÂÈ¿ ÙÔ˘˜ Ó· ˘ÔÏÔÁ›ÛÔ˘Ó ÙÔ ÔÛÔÛÙfi ÂÌÊ¿ÓÈÛ˘ Ù˘ ‰È·Ù·Ú·¯‹˜, Ó· ·Ó·Î·Ï‡„Ô˘Ó Ù· ·›ÙÈ· Î·È Ó· ‰È¢ÎÚÈÓ›ÛÔ˘Ó ÙË Û¯¤ÛË Ù˘ Ì ¿ÏϘ ‰È·Ù·Ú·¯¤˜. ¢È¿ÊÔÚ˜ ÌÂϤÙ˜ ·Ô‰›‰Ô˘Ó ÙË ‰È·Ù·Ú·¯‹ Û ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ÙˆÓ ÌÂÙˆÈ·›ˆÓ ‰ÔÌÒÓ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘, ÂÓÒ Û‡Ìʈӷ Ì οÔȘ ·fi„ÂȘ, ÙÔ Úfi‚ÏËÌ· ÂÓÙÔ›˙ÂÙ·È Î˘Ú›ˆ˜ ÛÙÔ ‰ÂÍ› ËÌÈÛÊ·›ÚÈÔ. ¡Â˘ÚÔ¯ËÌÈο, Ù· ¯·ÌËÏ¿ Â›‰· ÌÔÓÔ·ÌÈÓÒÓ Î·È ÂȉÈο Ù˘ ÓÙÔ·Ì›Ó˘ ıˆÚÔ‡ÓÙ·È ˘‡ı˘Ó· ÁÈ· ÙË ‰È·Ù·Ú·¯‹ (1,3). ¶ÚfiÛÊ·Ù˜ ÌÂϤÙ˜ ÂÓÙÔ›˙Ô˘Ó ÙÔ Úfi‚ÏËÌ· ÛÙËÓ ·‰˘Ó·Ì›· ÂϤÁ¯Ô˘ Î·È Î·Ù·ÛÙÔÏ‹˜ ÙˆÓ ·˘ÙfiÌ·ÙˆÓ Û˘ÌÂÚÈÊÔÚÒÓ. OÈ Swanson, Barkley Î·È Sergeant ¤¯Ô˘Ó Ô‰ËÁËı› Û ̛· Û¯ÂÙÈ΋ Û˘Ìʈӛ· ÁÈ· ÙËÓ ÂÌÏÔ΋ ÙÔ˘ ÂÎÙÂÏÂÛÙÈÎÔ‡ ‰ÈÎÙ‡Ô˘ Ù˘ ÚÔÛÔ¯‹˜ ÛÙÔ Úfi‚ÏËÌ· (23). ∫¿ÔÈÔÈ ÂÚ¢ÓËÙ¤˜ (24) Û˘Û¯ÂÙ›˙Ô˘Ó Ù· ·Ú·¿Óˆ ‰Â‰Ô̤ӷ ÌÂ Â˘Ú‹Ì·Ù· ·fi Ó¢ÚÔ·ÂÈÎÔÓÈÛÙÈΤ˜ ÌÂϤÙ˜ Û ˘ÁÈ‹ ¿ÙÔÌ·, Û‡Ìʈӷ Ì ٷ ÔÔ›· Ô ÌÂÙˆÈ·›Ô˜ ÏÔ‚fi˜ ·Ó·Ù‡ÛÛÂÙ·È Ì ·ÚÁfi Ú˘ıÌfi Î·È ÂÈÛËÌ·›ÓÔ˘Ó ÙÔ ÚfiÏÔ Ù˘ ÓÙÔ·Ì›Ó˘ Û ·˘Ù‹ ÙËÓ ·ÚÁ‹ Ó¢ÚÔÏÔÁÈ΋ ˆÚ›Ì·ÓÛË. À¿Ú¯Ô˘Ó ·ÎfiÌË ÂӉ›ÍÂȘ ˘¤Ú Ù˘ ÁÂÓÂÙÈ΋˜ ·fi„ˆ˜. ∫ÔÈÓÔ› ÁÂÓÂÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ¢ı‡ÓÔÓÙ·È Û ÌÂÁ¿ÏÔ ‚·ıÌfi Î·È ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ‰È·Ù·Ú·¯‹˜ ‰È·ÁˆÁ‹˜ Î·È ÂÓ·ÓÙȈÙÈ΋˜ ÚÔÎÏËÙÈ΋˜ ‰È·Ù·Ú·¯‹˜ ·ÏÏ¿ Î·È Ì·ıËÛÈ·ÎÒÓ ‰˘ÛÎÔÏÈÒÓ Û ·È‰È¿ Ì ¢∂¶-À. O ÙÚfiÔ˜ ÌÂÙ¿‰ÔÛ˘ Ù˘ ¢∂¶-À Â›Ó·È Èı·Ófiٷٷ ÔÏ˘ÁÔÓȉȷÎfi˜, ÂÌϤÎÔÓÙ·È ‰ËÏ·‰‹ ÂÚÈÛÛfiÙÂÚ· ·fi ¤Ó· ÁÔÓ›‰È·, ·ÎfiÌ· Î·È ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ÌÂÌÔÓˆÌ¤ÓˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Ù˘ ‰È·Ù·Ú·¯‹˜ (3). ¢È·ÊÔÚÂÙÈ΋, ·ÏÏ¿ ÂÍ›ÛÔ˘ ÂӉȷʤÚÔ˘Û·, Â›Ó·È Ë „˘¯·Ó·Ï˘ÙÈ΋ ÛÎÔÈ¿. ∫¿ÔÈÔÈ „˘¯·Ó·Ï˘Ù¤˜ ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ Ë ¢∂¶-À Â›Ó·È Ë ÂΉ‹ÏˆÛË Ì›·˜ ¤ÏÏÂȄ˘ ÈÛÔÚÚÔ›·˜ ÛÙË Û˘ÓıÂÙÈ΋, ··ÚÙȈÙÈ΋ Î·È ÔÚÁ·ÓˆÙÈ΋ ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ “∂ÁÒ” (25). ªÂ Ù· Û˘ÌÙÒÌ·Ù¿ ÙÔ˘˜ Ù· ·È‰È¿ ÂÎÊÚ¿˙Ô˘Ó ÙËÓ ÂÛˆÙÂÚÈ΋ ÙÔ˘˜ ·Ô‰ÈÔÚÁ¿ÓˆÛË. ÕÏÏÔÈ (26) ·Ú·ÙËÚÔ‡Ó fiÙÈ Ë ¢∂¶-À ÌÔÈ¿˙ÂÈ Ì ·ÓÙ›‰Ú·ÛË Û ÂÈΛÌÂÓË ·ÂÈÏ‹. ∞Ó·ÁÓˆÚ›˙ÔÓÙ·˜, ÏÔÈfiÓ, ÙÔ ‚ÈÔÏÔÁÈÎfi ˘fi‚·ıÚÔ Ù˘ ‰È·Ù·Ú·¯‹˜, ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ ·Ó Û ̛· ÎÚ›ÛÈÌË ÁÈ· ÙË Û˘Ó·ÈÛıËÌ·ÙÈ΋ ·Ó¿Ù˘ÍË ÂÚ›Ô‰Ô, ¤Ó· ·È‰› ‚ÈÒÛÂÈ Î¿ÔÈÔ ÙÚ·‡Ì·, ÙfiÙ ·ÚÔ˘ÛÈ¿˙ÂÈ Ì›· ·ÓÙ›‰Ú·ÛË “Ì¿¯Ë˜”. ™ÙËÓ ÂÚ›ÙˆÛË Ô˘ ÙÔ ·ÂÈÏËÙÈÎfi ÂÚ¤ıÈÛÌ· Â·Ó·ÏËÊı›, Ë ·ÓÙ›‰Ú·ÛË ·˘Ù‹ ‰ڷÈÒÓÂÙ·È Î·È Î·Ù·Ï‹ÁÂÈ Û ·˘Ùfi Ô˘ ÔÓÔÌ¿˙Ô˘Ì ¢∂¶-À. øÛÙfiÛÔ, ˘¿Ú¯Ô˘Ó

458

Paediatriki 2002;65:452-462

Î·È Î¿ÔÈÔÈ (27) Ô˘ ÂÎÊÚ¿˙Ô˘Ó ÛÔ‚·Ú¤˜ ·ÌÊÈ‚Ôϛ˜ ·ÎfiÌ· Î·È ÁÈ· ÙËÓ ‡·ÚÍË Ù˘ ‰È·Ù·Ú·¯‹˜ Î·È ÙÔÓ›˙Ô˘Ó ÙËÓ ·Í›· Ù˘ „˘¯ÔıÂÚ·¢ÙÈ΋˜ ‰Ô˘ÏÂÈ¿˜ Ì ÙËÓ ÔÈÎÔÁ¤ÓÂÈ· ÁÈ· ÙËÓ ˘ÔÛÙ‹ÚÈÍË ·È‰ÈÒÓ Ì ÚÔ‚Ï‹Ì·Ù·. ∏ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ‰È·Ù·Ú·¯‹˜ Û˘Ó›ÛٷٷÈ, ·Ó¿ÏÔÁ· Ì ÙËÓ ÂÚ›ÙˆÛË, Û ÂÎ·›‰Â˘ÛË ÙÔ˘ ·È‰ÈÔ‡ ÛÙÔÓ ¤ÏÂÁ¯Ô Ù˘ Û˘ÌÂÚÈÊÔÚ¿˜ ÙÔ˘, Û ʷÚÌ·ÎÔıÂÚ·›·, ÛÂ Û˘Ì‚Ô˘Ï¢ÙÈ΋ ÙˆÓ ÁÔÓ¤ˆÓ Ì ÛÙfi¯Ô ÙËÓ ÂÎÌ¿ıËÛË Ù¯ÓÈÎÒÓ ÂϤÁ¯Ô˘ Ù˘ Û˘ÌÂÚÈÊÔÚ¿˜ Î·È ÂÓ›Û¯˘Û˘ ÙˆÓ ıÂÙÈÎÒÓ Û˘ÌÂÚÈÊÔÚÒÓ Î·È ÛÂ Û˘Ó‰˘·ÛÌfi ÙˆÓ ·Ú·¿Óˆ. ™Â οÔȘ ÂÚÈÙÒÛÂȘ Û˘ÓÈÛÙ¿Ù·È ÔÈÎÔÁÂÓÂȷ΋ ‹ ·ÙÔÌÈ΋ „˘¯ÔıÂÚ·›· ‹, ·ÎfiÌË, ÔÌ·‰È΋ „˘¯ÔıÂÚ·›· ·ÙfiÌˆÓ Ì ÙËÓ ›‰È· ‰È·Ù·Ú·¯‹. ∏ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ·Ú¤Ì‚·Û˘ ÂÍ·ÚÙ¿Ù·È ÌÂٷ͇ ¿ÏÏˆÓ ·fi ÙÔ ¯ÚfiÓÔ Î·È ÙËÓ ·ÎÚ›‚ÂÈ· Ù˘ ‰È¿ÁÓˆÛ˘. ª›· ¤ÁηÈÚË ‰È¿ÁÓˆÛË Î·È ·Ú¤Ì‚·ÛË ·ÔÙÚ¤ÂÈ ÙËÓ ÂΉ‹ÏˆÛË ‰Â˘ÙÂÚÔÁÂÓÒÓ „˘¯ÔÏÔÁÈÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ. ª›· ·ÎÚÈ‚‹˜ ‰È¿ÁÓˆÛË ÂÈÙÚ¤ÂÈ ÙËÓ ·Ó·ÁÓÒÚÈÛË Î·È ¿ÏÏˆÓ ‰È·Ù·Ú·¯ÒÓ Ô˘ Û˘¯Ó¿ Û˘Ó˘¿Ú¯Ô˘Ó Ì ÙË ¢∂¶-À (1,2,8). ∏ ·ÚÔ‡Û· ¤Ú¢ӷ Û˘ÓËÁÔÚ› ˘¤Ú Ù˘ Û˘Û¯¤ÙÈÛ˘ Ù˘ ¢∂¶-À Ì ÙË Ì·ıËÛȷ΋ Â›‰ÔÛË, fiˆ˜ ·˘Ù‹ ÂÎÙÈÌ¿Ù·È ·fi ÙËÓ ÂȉÈ΋ Îϛ̷η Î·È ·fi ÙË Û¯ÔÏÈ΋ ‚·ıÌÔÏÔÁ›·, Û˘ÁÎÏ›ÓÔÓÙ·˜ ˘¤Ú Ù˘ ·fi„ˆ˜ fiÙÈ Ù· ·È‰È¿ Ì ¢∂¶-À ·ÔÙÂÏÔ‡Ó ÔÌ¿‰· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÂÌÊ¿ÓÈÛË Ì·ıËÛÈ·ÎÒÓ ‰˘ÛÎÔÏÈÒÓ. ªÂ ÙËÓ ¿Ô„Ë ·˘Ù‹ Û˘ÌʈÓÔ‡Ó ÚÔÁÂÓ¤ÛÙÂÚ˜ ¤Ú¢Ó˜ (3,5,7,15-19,28,29). ™˘ÁÎÂÎÚÈ̤ӷ, ÁÈ· ÙË °’ Î·È ÙË ™∆’ Ù¿ÍË ‚Ú¤ıËΠfiÙÈ ÔÈ ·Ú¿ÁÔÓÙ˜ ˘ÂÚÎÈÓËÙÈÎfiÙËÙ·, ·ÚÔÚÌËÙÈÎfiÙËÙ· Î·È ‰È¿Û·ÛË ÚÔÛÔ¯‹˜ ÂËÚ¿˙Ô˘Ó ÙËÓ ÈηÓfiÙËÙ· ÚÔÊÔÚÈÎÔ‡ Î·È ÁÚ·ÙÔ‡ ÏfiÁÔ˘, ÙËÓ ÎÈÓËÙÈ΋ ˆÚÈÌfiÙËÙ· Î·È ÙÔÓ ÔÙÈÎÔÎÈÓËÙÈÎfi Û˘ÓÙÔÓÈÛÌfi ÙˆÓ ·È‰ÈÒÓ. ™ÙËÓ ∞’ ‰ËÌÔÙÈÎÔ‡, Ë ˘ÂÚÎÈÓËÙÈÎfiÙËÙ· Î·È Ë ·ÚÔÚÌËÙÈÎfiÙËÙ· ‚Ú¤ıËÎ·Ó Ó· Û¯ÂÙ›˙ÔÓÙ·È ÌfiÓÔ Ì ÙÔÓ ÔÙÈÎÔÎÈÓËÙÈÎfi Û˘ÓÙÔÓÈÛÌfi. ª›· Èı·Ó‹ ÂÍ‹ÁËÛË Â›Ó·È fiÙÈ ÛÙËÓ ·Ú¯‹ Ù˘ Û¯ÔÏÈ΋˜ ÔÚ›·˜ ÙÔ˘ ·È‰ÈÔ‡ ‰›ÓÂÙ·È ÌÂÁ¿ÏË ¤ÌÊ·ÛË ÛÙËÓ ÈηÓfiÙËÙ· ·˘Ù‹ Î·È ¤ÙÛÈ ÔÈ ‰¿ÛηÏÔÈ ¤¯Ô˘Ó ÙËÓ Â˘Î·ÈÚ›· Ó· ÙËÓ ÂÎÙÈÌ‹ÛÔ˘Ó. ∞ÓÙ›ıÂÙ·, ÔÈ ˘ÂÚÎÈÓËÙÈΤ˜ Î·È ·ÚÔÚÌËÙÈΤ˜ Û˘ÌÂÚÈÊÔÚ¤˜ Û ·˘Ù‹ ÙËÓ ËÏÈΛ· Û˘Ó‹ıˆ˜ ‰ÂÓ ıˆÚÔ‡ÓÙ·È ·ıÔÏÔÁÈΤ˜. ∏ ‰È¿Û·ÛË ÚÔÛÔ¯‹˜ ‚Ú¤ıËΠӷ Û¯ÂÙ›˙ÂÙ·È ÛËÌ·ÓÙÈο Ì fiϘ ÙȘ Ì·ıËÛȷΤ˜ ÈηÓfiÙËÙ˜ Ô˘ ÂÍÂÙ¿ÛÙËηÓ, ‹‰Ë ·fi ÙËÓ ∞’ ‰ËÌÔÙÈÎÔ‡. ¶Ú¿ÁÌ·ÙÈ, Ë ·ÚÔÛÂÍ›· Î·È Ë ·ÊËÚËÌ¿‰· ÂÓÙÔ›˙ÔÓÙ·È ·fi Ôχ ÓˆÚ›˜ Î·È ·ÍÈÔÏÔÁÔ‡ÓÙ·È ·fi ÙÔ˘˜ ÂÎ·È‰Â˘ÙÈÎÔ‡˜ ˆ˜ ÚÔ‚ÏËÌ·ÙÈΤ˜ Û˘ÌÂÚÈÊÔÚ¤˜. ™Â fi,ÙÈ ·ÊÔÚ¿ ÛÙË ÛÊ·›Ú· ÙÔ˘ ÏfiÁÔ˘ Î·È ¿ÏÏÔÈ ÂÚ¢ÓËÙ¤˜ (15) ¤¯Ô˘Ó ÂÓÙÔ›ÛÂÈ ÙË ÛËÌ·ÓÙÈ΋ Û¯¤ÛË Ù˘

NoV-dEc-02

14-05-03

14:26

™ÂÏ›‰·459

¶·È‰È·ÙÚÈ΋ 2002;65:452-462

Paediatriki 2002;65:452-462

¶›Ó·Î·˜ 2. ™˘ÓÙÂÏÂÛÙ¤˜ Û˘Û¯¤ÙÈÛ˘ ÙˆÓ ÔÌ¿‰ˆÓ Ù˘ Îϛ̷η˜ ˘ÂÚÎÈÓËÙÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ Ì ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ Ì·ıËÛȷ΋˜ Â›‰ÔÛ˘ Î·È ÙË Û¯ÔÏÈ΋ ‚·ıÌÔÏÔÁ›·. ÀÂÚÎÈÓËÙÈÎfiÙËÙ·

¶·ÚÔÚÌËÙÈÎfiÙËÙ·

¢È¿Û·ÛË ÚÔÛÔ¯‹˜

™˘ÓÔÏÈο

∞’ Ù¿ÍË (Ó=112) ™Ê·›Ú· ÏfiÁÔ˘ ∫ÈÓËÙÈ΋ ˆÚÈÌfiÙËÙ· OÙÈÎÔÎÈÓËÙÈÎfi˜ Û˘ÓÙÔÓÈÛÌfi˜ ª·ıËÌ·ÙÈο °ÏÒÛÛ·

0,050 0,105 0,233* -0,359** -0,363**

0,050 0,091 0,267** -0,337** -0,355**

0,284** 0,213* 0,371** -0,660** -0,712**

0,180 0,178 0,360** -0,580** -0,613**

°’ Ù¿ÍË (Ó=104) ™Ê·›Ú· ÏfiÁÔ˘ ∫ÈÓËÙÈ΋ ˆÚÈÌfiÙËÙ· OÙÈÎÔÎÈÓËÙÈÎfi˜ Û˘ÓÙÔÓÈÛÌfi˜ ª·ıËÌ·ÙÈο °ÏÒÛÛ· πÛÙÔÚ›·

0,324** 0,383** 0,243* -0,274** -0,348** -0,341**

0,455** 0,471** 0,371** -0,385** -0,411** -0,346**

0,677** 0,517** 0,473** -0,705** -0,718** -0,696**

0,577** 0,526** 0,424** -0,551** -0,592** -0,561**

™Ù’ Ù¿ÍË (Ó=107) ™Ê·›Ú· ÏfiÁÔ˘ ∫ÈÓËÙÈ΋ ˆÚÈÌfiÙËÙ· OÙÈÎÔÎÈÓËÙÈÎfi˜ Û˘ÓÙÔÓÈÛÌfi˜ ª·ıËÌ·ÙÈο °ÏÒÛÛ· πÛÙÔÚ›·

0,357** 0,534** 0,394** -0,213* -0,188 -0,233*

0,321** 0,555** 0,411** -0,233* -0,209* -0,259**

0,701** 0,509** 0,501** -0,531** -0,497** -0,517**

0,509** 0,573** 0,472** -0,360** -0,329** -0,366**

# Pearson r-correlations * ™˘Û¯¤ÙÈÛË ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ Û Â›Â‰Ô ÛËÌ·ÓÙÈÎfiÙËÙ·˜ 0,05 ** ™˘Û¯¤ÙÈÛË ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ Û Â›Â‰Ô ÛËÌ·ÓÙÈÎfiÙËÙ·˜ 0,01

‰È¿Û·Û˘ ÚÔÛÔ¯‹˜ ηٿ ÙËÓ ÚÒÙË Ù¿ÍË Ì ÙËÓ ·Ó·ÁÓˆÛÙÈ΋ ÈηÓfiÙËÙ· Û ÌÂÁ·Ï‡ÙÂÚ˜ Ù¿ÍÂȘ Î·È ¤¯Ô˘Ó ÚÔÙ›ÓÂÈ Ó· Á›ÓÂÙ·È ÚÔÛ¿ıÂÈ· ·Ó›¯Ó¢Û˘ ÙˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ ÚÔÛÔ¯‹˜ ‹‰Ë ·fi ÙÔ ÓËÈ·ÁˆÁ›Ô. ª›· ¿ÏÏË ÂÚÌËÓ›· ÁÈ· ÙË ‰È·ÊÔÚÔÔ›ËÛË ÙˆÓ Û˘Û¯ÂÙ›ÛÂˆÓ ÛÙËÓ ∞’ Ù¿ÍË ÙÔ˘ ‰ËÌÔÙÈÎÔ‡ Â›Ó·È fiÙÈ ÔÈ Îϛ̷Θ Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ‰ÂÓ ¤¯Ô˘Ó ÛÙ·ıÌÈÛÙ› Û ÂÏÏËÓÈÎfi ‰Â›ÁÌ·. ™˘ÁÎÂÎÚÈ̤ӷ, Ë Îϛ̷η Ì·ıËÛȷ΋˜ Â›‰ÔÛ˘ ÂÚÈÏ·Ì‚¿ÓÂÈ ÂÚˆÙ‹ÛÂȘ Ô˘ ÔÈ ŒÏÏËÓ˜ ÂÎ·È‰Â˘ÙÈÎÔ› ‰ÂÓ ÌfiÚÂÛ·Ó Ó· ··ÓÙ‹ÛÔ˘Ó, ÚÔÊ·ÓÒ˜ ÂÂȉ‹ ·ÊÔÚÔ‡Û·Ó ÛÂ Û˘ÌÂÚÈÊÔÚ¤˜ Î·È ‰ÂÍÈfiÙËÙ˜ Ô˘ ÛÙË ¯ÒÚ· Ì·˜ ‰ÂÓ ·ÍÈÔÏÔÁÔ‡ÓÙ·È ·fi ÙfiÛÔ ÌÈÎÚ‹ ËÏÈΛ· (.¯. Ë ÂÚÒÙËÛË 33: “•Â¯ˆÚ›˙ÂÈ ˘ÔΛÌÂÓÔ, Ú‹Ì·, ·ÓÙÈΛÌÂÓÔ;” Î·È Ë ÂÚÒÙËÛË 40: “Œ¯ÂÈ ‰˘ÛÎÔϛ˜ Ì ٷ ÓÔÌ›ÛÌ·Ù·, Ù· ۇ̂ÔÏ· ÙˆÓ ڿ͈Ó, ÙÔ˘˜ ‰Â›ÎÙ˜ ÙÔ˘ ÚÔÏÔÁÈÔ‡;”). ∞˘Ù¿ ‰Â›¯ÓÔ˘Ó ÙËÓ ·Ó¿ÁÎË, fi¯È ÌfiÓÔ ÁÈ· ÙËÓ Â˘·ÈÛıËÙÔÔ›ËÛË ·È‰È¿ÙÚˆÓ, ÂÎ·È‰Â˘ÙÈÎÒÓ, „˘¯ÔÏfiÁˆÓ Î.Ï., ·ÏÏ¿ Î·È ÁÈ· ÙËÓ ÂÂÍÂÚÁ·Û›· ÙˆÓ ÂÚˆÙËÌ·ÙÔÏÔÁ›ˆÓ Û ¢Ú›· Îϛ̷η ÙÔ˘ ·È‰ÈÎÔ‡ ÏËı˘ÛÌÔ‡ ·fi ·È‰Ô„˘¯›·ÙÚÔ˘˜, ÁÂÁÔÓfi˜ Ô˘ ¤¯ÂÈ Á›ÓÂÈ ·ÓÙÈÏËÙfi Î·È ÚfiÎÂÈÙ·È Ó· Ú·ÁÌ·ÙÔÔÈËı› (1). ∏ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ Ù˘ ÛÔ‚·ÚfiÙËÙ·˜ Ù˘ ¢∂¶À Î·È ÙˆÓ ·‰˘Ó·ÌÈÒÓ ÛÙËÓ ÎÈÓËÙÈ΋ ˆÚÈÌfiÙËÙ· Û˘ÌʈÓ› Ì ٷ Â˘Ú‹Ì·Ù· ¿ÏÏˆÓ ÂÚ¢ÓÒÓ, Ô˘ ˘ÔÛÙËÚ›˙Ô˘Ó ÙËÓ ÂÌÊ¿ÓÈÛË ·Ó·Ù˘ÍÈ·ÎÒÓ ÎÈÓËÙÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ Û ·È‰È¿ Ì ¢∂¶-À (10-13). ∏ Û˘Û¯¤ÙÈ-

ÛË Ì ÙȘ ·‰˘Ó·Ì›Â˜ ÛÙÔÓ ÔÙÈÎÔÎÈÓËÙÈÎfi Û˘ÓÙÔÓÈÛÌfi Û˘ÓËÁÔÚ› ˘¤Ú Ù˘ ‡·Ú͢ ·‰˘Ó·ÌÈÒÓ ÛÙËÓ ·ÓÒÙÂÚË ÂÁÎÂÊ·ÏÈ΋ ÏÂÈÙÔ˘ÚÁ›·. ∂‰Ò, Èı·Ó¿, ˘ÂÈÛ¤Ú¯ÂÙ·È Î·È Ô ·Ú¿ÁÔÓÙ·˜ ‰È¿Û·Û˘ ÚÔÛÔ¯‹˜, fiˆ˜ ˘ÔÛÙËÚ›˙Ô˘Ó ÔÏÏÔ› ÂÚ¢ÓËÙ¤˜ (12,14).

OÈ Û¯ÔÏÈÎÔ› ‚·ıÌÔ› ‚Ú¤ıËΠfiÙÈ ÌÂÈÒÓÔÓÙ·È fiÛÔ ÂÚÈÛÛfiÙÂÚ˜ ÂÏÏ›„ÂȘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ù· ·È‰È¿ ÛÙȘ ··ÈÙÔ‡ÌÂÓ˜ ·fi ÙÔ Û¯ÔÏÂ›Ô ÈηÓfiÙËÙ˜ ÏfiÁÔ˘ Î·È ÎÈÓËÙÈΤ˜ ‰ÂÍÈfiÙËÙ˜, ·ÏÏ¿ Î·È fiÛÔ ÈÔ ‰È·Ù·Ú·Á̤ÓË Â›Ó·È Ë Û˘ÌÂÚÈÊÔÚ¿ ÙÔ˘˜. µÚ¤ıËΠfiÙÈ Ë Â›‰ÔÛË ÛÙ· Ì·ı‹Ì·Ù· ÙˆÓ ·È‰ÈÒÓ Ô˘ ·ÚÔ˘Û›·˙·Ó ¤ÛÙˆ Î·È Ì¤ÙÚÈ· Û˘ÌÙÒÌ·Ù· ˘ÂÚÎÈÓËÙÈÎfiÙËÙ·˜ ‹ ·ÚÔÚÌËÙÈÎfiÙËÙ·˜ ‹ ‰È¿Û·Û˘ ÚÔÛÔ¯‹˜ ‹ ¤Ó· Û˘Ó‰˘·ÛÌfi ·˘ÙÒÓ, ‹Ù·Ó ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚË ·fi ÙËÓ Â›‰ÔÛË ÙˆÓ ·È‰ÈÒÓ Ô˘ ‰ÂÓ ÂÌÊ¿ÓÈ˙·Ó ηӤӷ Û‡Ìو̷. ™ÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›· ·Ó·Ê¤ÚÔÓÙ·È ‰È¿ÊÔÚ˜ Îϛ̷Θ ·Ó›¯Ó¢Û˘ Ù˘ ‰È·Ù·Ú·¯‹˜ Î·È ‰È¿ÊÔÚ˜ ̤ıÔ‰ÔÈ ·Ú¤Ì‚·Û˘ (8,30). ¶ÏÔ‡ÛÈ· ‚È‚ÏÈÔÁÚ·Ê›· ˘¿Ú¯ÂÈ Î·È ÁÈ· ÙÔ ı¤Ì· ÙˆÓ ÂȉÈÎÒÓ ÚÔÛ·ÚÌÔÁÒÓ ÛÙËÓ ÂÎ·È‰Â˘ÙÈ΋ ‰È·‰Èηۛ·, ÒÛÙ ·˘Ù‹ Ó· ·ÓÙ·ÔÎÚ›ÓÂÙ·È ÛÙȘ ȉȷÈÙÂÚfiÙËÙ˜ ÙˆÓ Ì·ıËÙÒÓ Ì ¢∂¶-À (31-34). ∫¿ÔÈÔÈ ÂÚ¢ÓËÙ¤˜ (15) ÚÔÙ›ÓÔ˘Ó ÙË ¯Ú‹ÛË Û‡ÓÙÔÌˆÓ ·ÓȯÓ¢ÙÈÎÒÓ ÙÂÛÙ (screening tests) ÛÙȘ ÚÒÙ˜ Ù¿ÍÂȘ ÙÔ˘ ‰ËÌÔÙÈÎÔ‡ Û¯ÔÏ›Ԣ ‹ Î·È ÛÙÔ ÓËÈ·ÁˆÁÂ›Ô ÁÈ· ÙËÓ ·Ó›¯Ó¢ÛË ÚÔ‚ÏËÌ¿ÙˆÓ ÚÔÛÔ¯‹˜. ∂›Û˘, ÚÔÙ›ÓÂÙ·È Ë Û˘ÌÏ‹ÚˆÛË ·ÓȯÓ¢ÙÈÎÒÓ ÂÚˆÙËÌ·ÙÔÏÔÁ›ˆÓ ·fi ÙÔ˘˜ ÁÔÓ›˜ ηٿ ÙËÓ ·Ó·ÌÔÓ‹, ÚÈÓ

459

NoV-dEc-02

14-05-03

14:26

™ÂÏ›‰·460

¶·È‰È·ÙÚÈ΋ 2002;65:452-462

Paediatriki 2002;65:452-462

¶›Ó·Î·˜ 3. ∏ Û¯ÔÏÈ΋ ‚·ıÌÔÏÔÁ›· ÌÂٷ͇ ·È‰ÈÒÓ Ì ̤ÙÚÈ· ‹ ÛÔ‚·Ú¿ Û˘ÌÙÒÌ·Ù· ¢∂¶-À Î·È ·È‰ÈÒÓ ¯ˆÚ›˜ Û˘ÌÙÒÌ·Ù·. OÈ Ì¤ÛÔÈ ‚·ıÌÔ› ÙˆÓ ·È‰ÈÒÓ ¯ˆÚ›˜ Û˘ÌÙÒÌ·Ù· Â›Ó·È ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚÔÈ ·fi ·˘ÙÔ‡˜ ÙˆÓ ·È‰ÈÒÓ ÌÂ Û˘ÌÙÒÌ·Ù·, ÂÎÙfi˜ ·fi ÙËÓ ÂÚ›ÙˆÛË ÙˆÓ Ì·ıËÙÒÓ Ù˘ ™∆’ Ù¿Í˘ Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·ÚÔÚÌËÙÈÎfiÙËÙ· ∞’ Ù¿ÍË ª·ıËÌ·ÙÈο ñ ¶·È‰È¿ ¯ˆÚ›˜ Û˘ÌÙÒÌ·Ù· ˘ÂÚÎÈÓËÙÈÎfiÙËÙ·˜ 9,0±1,5 (77)* ¶·È‰È¿ ÌÂ Û˘ÌÙÒÌ·Ù· ˘ÂÚÎÈÓËÙÈÎfiÙËÙ·˜ 8,0±1,9 (25) ñ ¶·È‰È¿ ¯ˆÚ›˜ Û˘ÌÙÒÌ·Ù· ·ÚÔÚÌËÙÈÎfiÙËÙ·˜ 9,0±1,5 (77) ¶·È‰È¿ ÌÂ Û˘ÌÙÒÌ·Ù· ·ÚÔÚÌËÙÈÎfiÙËÙ·˜ 8,0±1,9 (25) ñ ¶·È‰È¿ ¯ˆÚ›˜ Û˘ÌÙÒÌ·Ù· ‰È¿Û·Û˘ ÚÔÛÔ¯‹˜ 9,3±1,1 (69) ¶·È‰È¿ ÌÂ Û˘ÌÙÒÌ·Ù· ‰È¿Û·Û˘ ÚÔÛÔ¯‹˜ 7,6±2,0 (33) ñ ¶·È‰È¿ ¯ˆÚ›˜ Û˘ÌÙÒÌ·Ù· ¢∂¶-À (Û˘ÓÔÏÈ΋ ‚·ıÌÔÏÔÁ›· = 0) 9,5±0,9 (59) ¶·È‰È¿ ÌÂ Û˘ÌÙÒÌ·Ù· ¢∂¶-À (Û˘ÓÔÏÈ΋ ‚·ıÌÔÏÔÁ›· ≥1) 7,8±2,0 (43)

°ÏÒÛÛ· <0,001

8,9±1,6 (77)

<0,001

7,6±1,9 (25) <0,001

8,9±1,6 (77)

<0,001

7,6±1,9 (25) <0,001

9,2±1,2 (69)

<0,001

7,3±2,0 (33)

<0,001

9,4±1,1 (59)

<0,001

7,6±1,9 (43)

°’ Ù¿ÍË ñ ¶·È‰È¿ ¯ˆÚ›˜ Û˘ÌÙÒÌ·Ù· ˘ÂÚÎÈÓËÙÈÎfiÙËÙ·˜ ¶·È‰È¿ ÌÂ Û˘ÌÙÒÌ·Ù· ˘ÂÚÎÈÓËÙÈÎfiÙËÙ·˜ ñ ¶·È‰È¿ ¯ˆÚ›˜ Û˘ÌÙÒÌ·Ù· ·ÚÔÚÌËÙÈÎfiÙËÙ·˜ ¶·È‰È¿ ÌÂ Û˘ÌÙÒÌ·Ù· ·ÚÔÚÌËÙÈÎfiÙËÙ·˜ ñ ¶·È‰È¿ ¯ˆÚ›˜ Û˘ÌÙÒÌ·Ù· ‰È¿Û·Û˘ ÚÔÛÔ¯‹˜ ¶·È‰È¿ ÌÂ Û˘ÌÙÒÌ·Ù· ‰È¿Û·Û˘ ÚÔÛÔ¯‹˜ ñ ¶·È‰È¿ ¯ˆÚ›˜ Û˘ÌÙÒÌ·Ù· ¢∂¶-À (Û˘ÓÔÏÈ΋ ‚·ıÌÔÏÔÁ›· = 0) ¶·È‰È¿ ÌÂ Û˘ÌÙÒÌ·Ù· ¢∂¶-À (Û˘ÓÔÏÈ΋ ‚·ıÌÔÏÔÁ›· ≥1)

ª·ıËÌ·ÙÈο

7,4±1,6 (71)

9,4±0,9 (71)

7,5±1,4 (71)

™Ù’ Ù¿ÍË ñ ¶·È‰È¿ ¯ˆÚ›˜ Û˘ÌÙÒÌ·Ù· ˘ÂÚÎÈÓËÙÈÎfiÙËÙ·˜ ¶·È‰È¿ ÌÂ Û˘ÌÙÒÌ·Ù· ˘ÂÚÎÈÓËÙÈÎfiÙËÙ·˜ ñ ¶·È‰È¿ ¯ˆÚ›˜ Û˘ÌÙÒÌ·Ù· ·ÚÔÚÌËÙÈÎfiÙËÙ·˜ ¶·È‰È¿ ÌÂ Û˘ÌÙÒÌ·Ù· ·ÚÔÚÌËÙÈÎfiÙËÙ·˜ ñ ¶·È‰È¿ ¯ˆÚ›˜ Û˘ÌÙÒÌ·Ù· ‰È¿Û·Û˘ ÚÔÛÔ¯‹˜ ¶·È‰È¿ ÌÂ Û˘ÌÙÒÌ·Ù· ‰È¿Û·Û˘ ÚÔÛÔ¯‹˜ ñ ¶·È‰È¿ ¯ˆÚ›˜ Û˘ÌÙÒÌ·Ù· ¢∂¶-À (Û˘ÓÔÏÈ΋ ‚·ıÌÔÏÔÁ›· = 0) ¶·È‰È¿ ÌÂ Û˘ÌÙÒÌ·Ù· ¢∂¶-À (Û˘ÓÔÏÈ΋ ‚·ıÌÔÏÔÁ›· ≥1)

ª·ıËÌ·ÙÈο

°ÏÒÛÛ·

πÛÙÔÚ›·

8,3±1,7 (53)

°ÏÒÛÛ· <0,05

7,6±1,6 (51) 8,5±1,6 (51)

<0,001

8,3±1,3 (36)

<0,001

<0,001

<0,05

M.™.

7,7±1,7 (88)

<0,001

9,2±1,0 (33)

8,3±1,3 (36)

7,7±1,6 (43)

<0,001

8,8±1,0 (37)

<0,001

<0,05

8,8±0,9 (19)

7,6±1,4 (88)

9.3±0,9 (46)

9,4±0,9 (33)

8,3±1,5 (36)

ª.™.

7,6±1,9 (43)

<0,001

<0,001

<0,05

ª.™.

7,7±1,4 (64) <0,001

8,7±1,1 (37)

<0,001

7,1±1,6 (70)

<0,001

8,9±1,1 (19)

7,4±1,6 (88)

* Mann-Whitney ¤ÏÂÁ¯Ô˜ OÈ ÙÈ̤˜ Ù˘ ‚·ıÌÔÏÔÁ›·˜ ‰›ÓÔÓÙ·È ˆ˜ ÂÍ‹˜ : ̤ÛÔ˜ fiÚÔ˜ ± Ù˘È΋ ·fiÎÏÈÛË (̤ÁÂıÔ˜ ÔÌ¿‰·˜) ª.™.: ÛÙ·ÙÈÛÙÈο ÌË ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿

460

<0,001

7,3±1,6 (71)

7,3±1,4 (70)

<0,001

8,8±1,5 (51)

7,2±1,3 (58)

7,9±1,3 (64)

7,4±1,7 (70)

8,6±1,2 (19)

9,0±1,1 (46)

<0,05

7,4±1,3 (53)

7,6±1,5 (71)

8,0±1,6 (64) 8,8±1,0 (37)

<0,001

9,3±0,9 (58)

7,6±1,7 (71) 7,7±1,7 (43)

8,5±1,5 (51)

8,5±1,6 (53) 7,7±1,4 (51)

7,0±1,3 (53)

7,0±1,5 (58)

9,2±1,0 (33)

<0,05

7,3±1,5 (51)

7,4±1,7 (53) 9,1±1,0 (46)

8,2±1,6 (53)

πÛÙÔÚ›·

<0,001

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¶·È‰È·ÙÚÈ΋ 2002;65:452-462

ÙËÓ ÂͤٷÛË (30). ŸÙ·Ó ¤Ó·˜ ·È‰›·ÙÚÔ˜ ÂÓÙÔ›˙ÂÈ Ì›· ‡ÔÙË ÁÈ· ¢∂¶-À Û˘ÌÂÚÈÊÔÚ¿ ηÏfi ı· ›ӷÈ: ·) Ó· ‰ÈÂÚÂ˘Ó¿ ÙË Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ‹˜ Ù˘ Î·È ÙË ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Ô˘ ÚÔηÏ›. ∞Ó ¤Ó· ·È‰› ·ÚÔ˘ÛÈ¿˙ÂÈ Ù· Û˘ÌÙÒÌ·Ù· Ù˘ ‰È·Ù·Ú·¯‹˜, ·ÏÏ¿ ·˘Ù¿ ‰ÂÓ ÂËÚ¿˙Ô˘Ó ÙË ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ¿ ÙÔ˘, ‰ÂÓ Ù›ıÂÙ·È Ë ‰È¿ÁÓˆÛË. ‚) Ó· ‚‚·ÈÒÓÂÙ·È fiÙÈ Ë Û˘ÌÂÚÈÊÔÚ¿ ·˘Ù‹ ‰ÂÓ ÂÌÊ·Ó›˙ÂÙ·È Û ¤Ó· ÌfiÓÔ Ï·›ÛÈÔ Î·È, ÂÔ̤ӈ˜, ‰ÂÓ ÌÔÚ› Ó· ·Ô‰Ôı› Û Â͈ÙÂÚÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜, fiˆ˜ .¯. ÙÔ ÛÙÚ˜. ™˘Ó‹ıˆ˜, ÂÍÂÙ¿˙ÂÙ·È Ë Û˘ÌÂÚÈÊÔÚ¿ ÛÙÔ Û›ÙÈ Î·È ÛÙÔ Û¯ÔÏ›Ô. Á) Ó· ·ÓȯÓ‡ÂÈ ¿ÏϘ ‰È·Ù·Ú·¯¤˜ ‹ ηٷÛÙ¿ÛÂȘ Ô˘ ÌÔÚ› Ó· Ô‰ËÁÔ‡Ó ÛÙÔÓ ›‰ÈÔ Ê·ÈÓfiÙ˘Ô: ηÎÔÔ›ËÛË, ·ÈÛıËÙËÚȷΤ˜ ‚Ï¿‚˜, ·Ó·Ù˘ÍȷΤ˜ ‰È·Ù·Ú·¯¤˜, ÓÔËÙÈ΋ ηı˘ÛÙ¤ÚËÛË, Ï‹„Ë Ê·ÚÌ¿ÎˆÓ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ¯ÚfiÓÈˆÓ ·ı‹ÛÂˆÓ Î.¿. ∞˘Ùfi ı· ‚ÔËı‹ÛÂÈ ·ÚÁfiÙÂÚ· ÙÔÓ ·È‰Ô„˘¯›·ÙÚÔ Ó· ηٷϋÍÂÈ Û ̛· ‰È¿ÁÓˆÛË. ‰) Ó· ¯ÔÚËÁ› ÂȉÈΤ˜ Îϛ̷Θ ÁÈ· ¢∂¶-À Î·È ÁÈ· ¿ÏϘ ‰È·Ù·Ú·¯¤˜ Ô˘ Û˘¯Ó¿ Û˘Ó˘¿Ú¯Ô˘Ó Ì ·˘Ù‹Ó (ÛÂ Û˘ÓÂÚÁ·Û›· Ì ·È‰Ô„˘¯›·ÙÚÔ). Â) Ó· ÂȉÈÒÎÂÈ Â·ÓÂͤٷÛË ÙÔ˘ ·È‰ÈÔ‡, ÒÛÙ ӷ ¤¯ÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· ÚÔÛÂÎÙÈ΋˜ ·Ú·Ù‹ÚËÛ˘ Î·È Û˘ÏÏÔÁ‹˜ ÏËÚÔÊÔÚÈÒÓ. ÛÙ) Ù¤ÏÔ˜, Û ÂÚ›ÙˆÛË Ô˘ Ù· ÛÙÔȯ›· ÙÔ˘ Û˘ÁÎÏ›ÓÔ˘Ó ÛÙËÓ Èı·ÓfiÙËÙ· ‡·Ú͢ Ù˘ ‰È·Ù·Ú·¯‹˜, Ó· ·Ú·¤ÌÂÈ ÙÔ˘˜ ÁÔÓ›˜ ÛÙÔÓ ·È‰Ô„˘¯›·ÙÚÔ ÁÈ· Ì›· ÂÍÂȉÈÎÂ˘Ì¤ÓË ÂͤٷÛË Î·È Ó· Û˘ÓÂÚÁ¿˙ÂÙ·È Ì·˙› ÙÔ˘. Ÿˆ˜ ÚԷӷʤÚıËÎÂ, Ô ÚfiÏÔ˜ ÙˆÓ ·È‰È¿ÙÚˆÓ ÛÙËÓ ¤ÁηÈÚË ·Ó›¯Ó¢ÛË Ù˘ ‰È·Ù·Ú·¯‹˜ ÂÏÏÂÈÌÌ·ÙÈ΋˜ ÚÔÛÔ¯‹˜ - ˘ÂÚÎÈÓËÙÈÎfiÙËÙ·˜ Â›Ó·È Î·ıÔÚÈÛÙÈÎfi˜. ∏ Û˘ÓÂÚÁ·Û›· ·È‰È¿ÙÚˆÓ Î·È ÂÎ·È‰Â˘ÙÈÎÒÓ ˆ˜ Î·È ·È‰Ô„˘¯È¿ÙÚˆÓ Î·È „˘¯ÔÏfiÁˆÓ Ì ÛÙfi¯Ô ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ‰˘ÛÎÔÏÈÒÓ Ô˘ ·ÓÙÈÌÂÙˆ›˙Ô˘Ó Ù· ¿ÙÔÌ· Ì ¢∂¶-À ÛÙÔ Û›ÙÈ, ÛÙÔ Û¯ÔÏÂ›Ô Î·È ÛÙÔ Â˘Ú‡ÙÂÚÔ ÎÔÈÓˆÓÈÎfi ÂÚÈ‚¿ÏÏÔÓ, Â›Ó·È ··Ú·›ÙËÙË ÁÈ· ÙËÓ ÚfiÏË„Ë ÛÔ‚·ÚfiÙÂÚˆÓ ‰È·Ù·Ú·¯ÒÓ Î·È ÎÔÈÓˆÓÈÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ. µÈ‚ÏÈÔÁÚ·Ê›· 1. T˙›Ì·˜ °π. ∆Ô ˘ÂÚÎÈÓËÙÈÎfi ·È‰›. æ˘¯Ô‚ÈÔÏÔÁÈ΋-ÎÔÈÓˆÓÈ΋ Î·È ·È‰·ÁˆÁÈ΋ ÚÔÛ¤ÁÁÈÛË. ™‡Á¯ÚÔÓË ∂Î·›‰Â˘ÛË 2001;117:102-110 & 2001;118:101-108.

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Paediatriki 2002;65:463-481

AWARD-WINNING ARTICLE

∞ÓÔÛÔÊ·ÈÓÔÙ˘È΋ ÌÂϤÙË ÙˆÓ ·ÈÌ·ÙÔÁÔÓ›ˆÓ Î·È ‰È·ÌfiÚʈÛË ÛÙÚ·ÙËÁÈ΋˜ ÁÈ· ÙËÓ ·Ó·˙‹ÙËÛË Ù˘ ÂÏ¿¯ÈÛÙ˘ ˘ÔÏÂÈfiÌÂÓ˘ ÓfiÛÔ˘ Û ·È‰È¿ Ì ‚-΢ÙÙ·ÚÈ΋˜ ÚÔ¤Ï¢Û˘ ÔÍ›· ÏÂÌÊÔ‚Ï·ÛÙÈ΋ Ï¢¯·ÈÌ›· (µ-O§§) ηٿ ÙȘ Ê¿ÛÂȘ ıÂÚ·›·˜ ÙÔ˘ ÚˆÙÔÎfiÏÏÔ˘ ALL-BFM ’95* ™. ¶ÔÏ˘¯ÚÔÓÔÔ‡ÏÔ˘1, °. ¶·ÙÂÚ¿Î˘2, µ. ƒÔ‡ÏË1, ¢. ™ÎÔ˘Ì‹2, π. ¶. ¶·Ó·ÁÈÒÙÔ˘1, ™. ∞. ÷˚‰¿˜1

Immunophenotypic study of calla positive B lymphoid progenitors (hematogones) in children’s marrow enables the formulation of a strategy for the assessment of minimal residual disease (MRD) in B-cell precursor acute lymphoblastic leukemia (B prec-ALL), during the intensive treatment of ALL-BFM ’95 protocol* S. Polychronopoulou1, G. Paterakis2, V. Rouli1, D. Skoumi2, J. P. Panagiotou1, S. A. Haidas1

¶ÂÚ›ÏË„Ë: OÈ Úfi‰ÚÔÌÔÈ µ ÏÂÌÊÔ΢ÙÙ·ÚÈÎÔ› Ê˘ÛÈÔÏÔÁÈÎÔ› ÏËı˘ÛÌÔ›, CALLA ıÂÙÈÎÔ›, ÁÓˆÛÙÔ› Î·È ˆ˜ ·ÈÌ·ÙÔÁfiÓÈ·, ηıÒ˜ Î·È ÔÈ ÒÚÈÌÔÈ µ ÏÂÌÊÔ΢ÙÙ·ÚÈÎÔ› ˘ÔÏËı˘ÛÌÔ›, Â›Ó·È Ê˘ÛÈÔÏÔÁÈο ÛÙÔȯ›· Ô˘ ȉȷ›ÙÂÚ· ÚÔ‚¿ÏÏÔ˘Ó ÌÔÚÊÔÏÔÁÈο Î·È ·ÓÔÛÔÊ·ÈÓÔÙ˘Èο ÛÙÔ Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ·È‰ÈÒÓ. ∂ȉÈÎfiÙÂÚ·, fï˜, Û ÔÚÈṲ̂Ó˜ ÔÌ¿‰Â˜ ·È‰È·ÙÚÈÎÒÓ ·ÛıÂÓÒÓ, fiˆ˜ Û ηٷÛÙ¿ÛÂȘ ·Ï·Û›·˜ ‹ Û ·Ó¿Î·Ì„Ë ÌÂÙ¿ ·fi ¯ËÌÂÈÔıÂÚ·›·, Ù· ÔÛÔÛÙ¿ ÙˆÓ ·ÈÌ·ÙÔÁÔÓ›ˆÓ ·Ó¢ڛÛÎÔÓÙ·È È‰È·›ÙÂÚ· ·˘ÍË̤ӷ, Ì ·ÔÙ¤ÏÂÛÌ· Ó· ‰ËÌÈÔ˘ÚÁÂ›Ù·È ÚÔ‚ÏËÌ·ÙÈÛÌfi˜ ÁÈ· ÙËÓ Ù·˘ÙfiÙËÙ· Î·È ÙË ‰È¿ÎÚÈÛ‹ ÙÔ˘˜ ·fi ·ıÔÏÔÁÈÎÔ‡˜ ÏÂÌÊÔ΢ÙÙ·ÚÈÎÔ‡˜ ÏËı˘ÛÌÔ‡˜ Ô˘ Èı·Ó¿ Ó· Û˘Ó˘¿Ú¯Ô˘Ó ΢ڛˆ˜ ÛÙ· ·È‰È¿ Ì µ ΢ÙÙ·ÚÈ΋˜ ÚÔ¤Ï¢Û˘ ÔÍ›· ÏÂÌÊÔ‚Ï·ÛÙÈ΋ Ï¢¯·ÈÌ›· (B-O§§). ™ÎÔfi Ù˘ ÌÂϤÙ˘ Ì·˜ ·ÔÙ¤ÏÂÛ·Ó: 1) Ë Ï‹Ú˘ ·ÓÔÛÔÊ·ÈÓÔÙ˘È΋ ÌÂϤÙË ÙˆÓ ·ÈÌ·ÙÔÁÔÓ›ˆÓ Ì ÛÙfi¯Ô ÙËÓ Ù·˘ÙÔÔ›ËÛ‹ ÙÔ˘˜, ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙˆÓ ·ÓÔÛÔÊ·ÈÓÔÙ˘ÈÎÒÓ ÙÔ˘˜ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ Î·Ù¿ Ù· ‰È·‰Ô¯Èο ‚‹Ì·Ù· Ù˘ µ-ÏÂÌÊÔ΢ÙÙ·ÚÈ΋˜ ÔÓÙÔÁ¤ÓÂÛ˘ Î·È ÙË ‰È¿ÎÚÈÛ‹ ÙÔ˘˜ Û ˘ÔÏËı˘ÛÌÔ‡˜ ÛÙÔ Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ Î·È ÙÔ ÂÚÈÊÂÚÈÎfi ·›Ì· Û ·È‰È¿ Ì ÓÔÛ‹Ì·Ù· ‰È¿ÊÔÚ· Ù˘ µ-O§§ Î·È 2) Ë ÂÎÌÂÙ¿ÏÏ¢ÛË ÙˆÓ ·ÓˆÙ¤Úˆ, ÁÈ· ÙË ‰È·ÌfiÚʈÛË Ì›·˜ ÛÙÚ·ÙËÁÈ΋˜ ·Ó›¯Ó¢Û˘ Ù˘ ÂÏ¿¯ÈÛÙ˘ ˘ÔÏÂÈfiÌÂÓ˘ ÓfiÛÔ˘ (MRD) ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì·˜

Abstract: Normal B-lymphoid progenitors in bone marrow (BM) expressing common acute leukemia antigen (CALLA, CD10) have been called hematogones and are increased among children.

The distinction of the above from MRD in B precursor ALL (Bprec-ALL) represents a challenging procedure. The objective was to study the differentiation profiles of hematogones in pediatric marrow samples of patients with diseases other than Bprec-ALL and draw a comprehensive phenotypic panel to discriminate the immunophenotypic profile of hematogones from Bprec-ALL blasts in order to formulate a strategy for assessing MRD by flow cytometry. Twenty five pediatric patients (median age 1.4 yrs) suffering from solid tumors, idiopathic neutropenia/ thrombocytopenic purpura, who were investigated in relation to their disease and had high percentages of hematogones (10-25% of nucleated cells) were used for hematogone phenotypic study. Additionally, two hundred and twelve (212) BM samples from 34 children (median age 3.8 yrs) with Bprec-ALL treated according to BFM-ALL ’95 protocol, were examined by flow cytometry, at diagnosis and after treatment initiation on day 15, at the end of induction (day 33) and at several points during consolidation

1 ∆Ì‹Ì· ¶·È‰È·ÙÚÈ΋˜ ∞ÈÌ·ÙÔÏÔÁ›·˜-OÁÎÔÏÔÁ›·˜, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∏ ∞Á›· ™ÔÊ›·”, ∞ı‹Ó· 2 ∞ÓÔÛÔÏÔÁÈÎfi ∆Ì‹Ì·, ¶°¡∞ “°. °ÂÓÓËÌ·Ù¿˜”, ∞ı‹Ó·

1 Department of Pediatric Hematology-Oncology, “Agia Sophia” Children’s Hospital, Athens 2 Immunology Department, “G. Gennimatas” General Hospital, Athens

* µ’ ÈڤÌÂÈÔ Œ·ıÏÔ 40Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ, 2002

* 2nd “Choremio” Award 40th Panhellenic Pediatric Meeting, 2002

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Ì µ ΢ÙÙ·ÚÈ΋˜ ÚÔ¤Ï¢Û˘ O§§. ªÂÏÂÙ‹ıËÎ·Ó Ì ΢ÙÙ·ÚÔÌÂÙÚ›· ÚÔ‹˜ (FC) Î·È ÙË ¯Ú‹ÛË ÙÚÈÏÔ‡ ·ÓÔÛÔÊıÔÚÈÛÌÔ‡ 25 ‰Â›ÁÌ·Ù· Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ ·fi 25 ·È‰È¿ Ì ¿ÏÏ· ÓÔÛ‹Ì·Ù· ÏËÓ µO§§ (Û˘Ì·Á›˜ fiÁÎÔÈ ¯ˆÚ›˜ Ì˘ÂÏÈ΋ ‰È‹ıËÛË, ηÏÔ‹ı˘ Ô˘‰ÂÙÂÚÔÂÓ›· Ù˘ ·È‰È΋˜ ËÏÈΛ·˜, ÔÍ›· ȉÈÔ·ı‹˜ ıÚÔÌ‚ÔÂÓÈ΋ ÔÚʇڷ) ‰È¿ÌÂÛ˘ ËÏÈΛ·˜ 1,4 ÂÙÒÓ, Ì ÛÙfi¯Ô ÙËÓ ·ÓÔÛÔÊ·ÈÓÔÙ˘È΋ Ù·˘ÙÔÔ›ËÛË ÙˆÓ ·ÈÌ·ÙÔÁÔÓ›ˆÓ. ∞ÎÔÏÔ‡ıˆ˜, ÌÂÏÂÙ‹ıËÎ·Ó Ì FC 34 ·È‰È¿ Ì µ-O§§ (21 ¿ÚÚÂÓ˜) Ì ‰È¿ÌÂÛË ËÏÈΛ· Ù· 38 ¤ÙË, Ù· ÔÔ›· ‰È·ÁÓÒÛıËÎ·Ó ‰È·‰Ô¯Èο Î·È ıÂÚ·‡ıËÎ·Ó ÔÌÔÈÔÁÂÓÒ˜ Ì ‚¿ÛË ÙÔ ÚˆÙfiÎÔÏÏÔ ALL-BFM ’95. ∏ ‰È¿ÁÓˆÛË ÛÙËÚ›¯ıËΠÛÙ· ÌÔÚÊÔÏÔÁÈο, ·ÓÔÛÔÊ·ÈÓÔÙ˘Èο, ΢ÙÙ·ÚÔÁÂÓÂÙÈο Î·È ÌÔÚȷο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ‚Ï·ÛÙÒÓ. ∏ Ù·ÍÈÓfiÌËÛË ÙˆÓ ·ÛıÂÓÒÓ Û ÔÌ¿‰Â˜ ¯·ÌËÏÔ‡ (SRG), ÂӉȿÌÂÛÔ˘ (MRG) Î·È ˘„ËÏÔ‡ (HRG) ÎÈÓ‰‡ÓÔ˘ ¤ÁÈÓ Ì ‚¿ÛË Ù· ÎÚÈÙ‹ÚÈ· ÙÔ˘ ÚˆÙÔÎfiÏÏÔ˘. ∏ ÌÂϤÙË Ù˘ MRD ¤ÁÈÓ ÛÙÔ˘˜ ÚÔÁÚ·ÌÌ·ÙÈṲ̂ÓÔ˘˜ ·fi ÙÔ ÚˆÙfiÎÔÏÏÔ ¯ÚfiÓÔ˘˜, ÌÂ Û˘Ó‰˘·ÛÌÔ‡˜ ÌÔÓÔÎψÓÈÎÒÓ ·ÓÙÈۈ̿وÓ. ∂ÈÚfiÛıÂÙ·, ÌÂÏÂÙ‹ıËÎ·Ó 6 ·ÛıÂÓ›˜ Û ˘ÔÙÚÔ‹ Î·È 20 ·ÛıÂÓ›˜ ÔÈ ÔÔ›ÔÈ ‰ÂÓ Â›¯·Ó ÌÂÏÂÙËı› ‹ Ù·˘ÙÔÔÈËı› ηٿ ÙË ‰È¿ÁÓˆÛË Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ‡ÊÂÛ˘ Ù˘ ÓfiÛÔ˘, Û ‰È¿ÊÔÚ˜ ¯ÚÔÓÈΤ˜ ÛÙÈÁ̤˜ Ù˘ ıÂÚ·›·˜ Û˘ÓÙ‹ÚËÛ˘ Î·È ÛÙÔ Ù¤ÏÔ˜ ·˘Ù‹˜. ∞fi ÙÔ ÚÒÙÔ ÛΤÏÔ˜ Ù˘ ÌÂϤÙ˘ Ì·˜, ÙÔ ÔÔ›Ô ·ÊÔÚÔ‡Û ÙËÓ ·Ó›¯Ó¢ÛË, Ù·˘ÙÔÔ›ËÛË Î·È ‰È¿ÎÚÈÛË ÙˆÓ ·ÈÌ·ÙÔÁÔÓ›ˆÓ ÛÙÔ Ì˘ÂÏfi Î·È ÛÙÔ ·›Ì· Ù˘ ÔÌ¿‰·˜ ÙˆÓ ·È‰ÈÒÓ Ì ÌË µ-O§§, ÚԤ΢„·Ó ÙÚÂȘ Ù¿ÍÂȘ (∏1,∏2,∏3) ·ÈÌ·ÙÔÁÔÓ›ˆÓ Ì ‰È·ÎÚÈÙ¿ ·ÓÔÛÔÊ·ÈÓÔÙ˘Èο ¯·Ú·ÎÙËÚÈÛÙÈο: i) ·ÈÌ·ÙÔÁfiÓÈ· Ù¿Í˘ π (∏1): Tdt 100% (ÂÍ ÔÚÈÛÌÔ‡) Î·È ÂÈϤÔÓ ¯·Ú·ÎÙËÚÈÛÙÈο CD10 high, CD19 high, CD34 high, CD38 high, cÌ low/neg, (Î+Ï) 0%, Ì ·ÛıÂÓ‹ ¤ÓÙ·ÛË CD45 (dim), ii) ·ÈÌ·ÙÔÁfiÓÈ· Ù¿Í˘ ππ (∏2): Tdt 0% (ÂÍ ÔÚÈÛÌÔ‡), (Î+Ï) ÂÈÊ¿ÓÂÈ·˜ 0% (ÂÍ ÔÚÈÛÌÔ‡), CD10 high, CD19 high Î·È ÂÈϤÔÓ ¯·Ú·ÎÙËÚÈÛÙÈο CD38 high, CD34 neg, cÌ high, CD20 high, Ì ÂӉȿÌÂÛË ¤ÓÙ·ÛË CD45 (int) Î·È iii) ·ÈÌ·ÙÔÁfiÓÈ· Ù¿Í˘ πππ (∏3): CD10+ Ì (Î+Ï) ÂÈÊ¿ÓÂÈ·˜ 100% (ÂÍ ÔÚÈÛÌÔ‡) Î·È ÂÈϤÔÓ ¯·Ú·ÎÙËÚÈÛÙÈο CD38 high, CD20 high, cÌ high, CD79b high, FMC7 mid, CD5 low, CD23 neg, CD43 high, CD40 low, CD27 neg, bcl2 neg, IgM high, IgD mid, IgA mid Î·È ¤ÓÙÔÓË ¤ÓÙ·ÛË CD45 (bright). ∂ÈÛËÌ·›ÓÂÙ·È ÙÔ ‰È·ÊÔÚÂÙÈÎfi ÚfiÙ˘Ô ÂÌÊ¿ÓÈÛ˘ ÙˆÓ ·ÈÌ·ÙÔÁÔÓ›ˆÓ ηٿ ÙË ‰È·‰Èηۛ· Ù˘ Ê˘ÛÈÔÏÔÁÈ΋˜ ÔÓÙÔÁ¤ÓÂÛ˘ Ù˘ µ-ÏÂÌÊÈ΋˜ ÛÂÈÚ¿˜, ηıÒ˜ Î·È ÙÔ È‰È·›ÙÂÚ· ÛËÌ·ÓÙÈÎfi ÁÂÁÔÓfi˜ Ù˘ ÂÍfi‰Ô˘ Î·È ·Ó›¯Ó¢Û˘ ÒÚÈÌˆÓ ·ÔÁfiÓˆÓ ÙÔ˘˜ ÛÙÔ ·›Ì·, ÁÂÁÔÓfi˜ Ô˘ ÂÓ¤¯ÂÈ È‰È·›ÙÂÚË

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treatment. Additionally 22 Bprec-ALL at clinical and morphological remission during maintenance treatment and 6 patients at relapse, were analyzed for detection of MRD. Flow cytometry analysis was conducted by three colors, combining a series of antibodies to the constant pair of CD10 and CD45.

Antibodies examined were Tdt, CD19, CD38, CD34, CD20, CD9, CD123, CD79b, FMC7, CD40, CD27, CD95, bcl2, KOR-SA3544, NG2, CD117, CD135, AC133, surface and cytoplasmic Î, Ï light and Ì, Á, ‰, · heavy immunoglobulin chains.

Common phenotypic characteristics of all hematogones were the following: CD10+, CD38 high, CD9 high, KOR-SA3544-, CD135-, AC133-, CD117-, NG2-, bcl2-. Three major hematogone maturation stages were phenotypically defined: i) Type I (H1): characterized by CD45 low, Tdt 100%, CD10 high, CD34+, CD20 low/neg, CD123-, cÌ-, CD79b-, ii) Type II (H2): CD45 mid, Tdt-, CD10 mid, CD34-, CD123 low, cÌ+, CD20+, CD79b-, surface Î/Ï negative, and iii) Type III (H3): CD45 high, CD10+, CD38 high, surface Î/Ï positive and polyclonal, CD79b+, CD20 high, cÌ high, bcl2-.

The rest of the mature B cells were: CD10 negative, CD38 neg/low, CD40+ and bcl2+ clearly different from mature subpopulation H3. The phenotypic characteristics of hematogone subpopulations were highly consistent in all cases studied in contrast to the high phenotypic variability shown

by B-prec ALL lymphoblasts. This stability permitted the formulation of a strategy for assessing MRD based on the aberrations of BprecALL phenotypes from the corresponding hematogone subtype H1 pattern. The proposed MRD panel included three color combinations of ∆dt and CD45 combined with a third component derived from the limited panel of the following 6 antibodies CD123, KOR-SA3544, CD34, CD10, CD38 and cÌ. In all cases the assessment of MRD was possible due to the presence of 1 up to 5 aberrations from the normal hematogone prototype. There was no case of Bprec-ALL with exactly the same phenotype characteristics of the corresponding hematogone subtype as defined above. According to the findings of the B lymphocyte subpopulations during the assessment of MRD three groups of patients were defined: Group A) 17 cases without MRD detected at any time point and high levels of hematogones H1, detected at regeneration phases during consolidation, Group B) 16 cases with several levels of MRD, detected on day 15 and 33 while at consolidation phase there was no MRD found but

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ÛËÌ·Û›· ÛÙË ‰ÈÂÚ‡ÓËÛË Ù˘ ÎÈÓËÙÈ΋˜ ÙˆÓ Ê˘ÛÈÔÏÔÁÈο ÔÏÏ·Ï·ÛÈ·˙fiÌÂÓˆÓ µ-ÏÂÌÊÔ΢ÙÙ·ÚÈÎÒÓ ˘ÔÏËı˘ÛÌÒÓ. ∞ÎÔÏÔ‡ıˆ˜, Ì ‚¿ÛË Ù· ÛÙÔȯ›· Ù˘ ·ÓˆÙ¤Úˆ ÌÂϤÙ˘ ÙˆÓ ·ÈÌ·ÙÔÁÔÓ›ˆÓ Î·È Ù˘ ·Ú·ÙËÚËı›۷˜ ÛÙ·ıÂÚfiÙËÙ·˜ ÙˆÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ÙÔ˘˜ Û fiÏ· Ù· ÌÂÏÂÙËı¤ÓÙ· ‰Â›ÁÌ·Ù·, ‰È·ÌÔÚÊÒıËΠÛÙÚ·ÙËÁÈ΋ ·Ó·˙‹ÙËÛ˘ Ù˘ MRD ‚·ÛÈṲ̂ÓË ÛÙȘ Û˘ÓÂÎÊÚ¿ÛÂȘ Ù˘ Tdt Ì ٷ ·ÓÙÈÁfiÓ· CD10, CD38, CD123, KORSA3544, CD34 Î·È ÙËÓ ÂÓ‰Ô΢ÙÙ¿ÚÈ· Ì, ¿ÓÙÔÙ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙÔ CD45 ÛÙÔ ÙÚ›ÙÔ ¯ÚÒÌ·. ∏ ÂÈÏÔÁ‹ ·˘Ù‹ ¤ÁÈÓ Ì ÙË ÁÓÒÛË Ù˘ ¤ÎÊÚ·Û˘ Tdt Û ÔÛÔÛÙfi ¿Óˆ ÙÔ˘ 95% ÙˆÓ ÂÚÈÙÒÛÂˆÓ µ-O§§ Î·È Î‡ÚÈ· ¤ÌÊ·ÛË ‰fiıËΠÛÙË ‰È¿ÎÚÈÛË ÙˆÓ ‚Ï·ÛÙÒÓ ·fi Ù· ·ÈÌ·ÙÔÁfiÓÈ· Ù¿Í˘ π (Tdt+). ∏ ÂȂ‚·›ˆÛË Ù˘ MRD ÁÈÓfiÙ·Ó fiÙ·Ó Ô Ê·ÈÓfiÙ˘Ô˜ ÙˆÓ ‡ÔÙˆÓ Î˘ÙÙ¿ÚˆÓ ·ÚÔ˘Û›·˙ ÙÔ˘Ï¿¯ÈÛÙÔÓ ‰‡Ô ·ÔÎÏ›ÛÂȘ ·fi ÙÔ ÛÙ·ıÂÚfi ÚfiÙ˘Ô ÙˆÓ ·ÈÌ·ÙÔÁÔÓ›ˆÓ. ∞fi ÙÔ ‰Â‡ÙÂÚÔ ÛΤÏÔ˜ Ù˘ ÌÂϤÙ˘, ‰ËÏ·‰‹ Ù˘ ·Ó›¯Ó¢Û˘ ÙÔ˘ ˘ÔÏÂÈÌÌ·ÙÈÎÔ‡ µ-Ï¢¯·ÈÌÈÎÔ‡ ÛÙÔÈ¯Â›Ô˘ Û ·È‰È¿ Ì µO§§ ηٿ ÙË ‰È¿ÁÓˆÛË, ηıÒ˜ Î·È Û ‰È·ÊÔÚÂÙÈΤ˜ ÛÙÈÁ̤˜ ÂϤÁ¯Ô˘ ÙÔ˘ ›‰ÈÔ˘ ıÂÚ·¢ÙÈÎÔ‡ ÚˆÙÔÎfiÏÏÔ˘, ·Ó¢ڤıËÛ·Ó Û fiÏÔ˘˜ ÙÔ˘˜ ÂÍÂÙ·Ûı¤ÓÙ˜ ·ÛıÂÓ›˜ Û ‰È·ÊÔÚÂÙÈ΋ Û‡ÓıÂÛË Î·È ÔÛÔÛÙ¿ ηٿ ÙËÓ ÚfiÔ‰Ô Ù˘ ıÂÚ·›·˜, ÔÈ ÂÍ‹˜ µ ÏÂÌÊÔ΢ÙÙ·ÚÈÎÔ› ˘ÔÏËı˘ÛÌÔ›: ·) ˘ÔÏÂÈÌÌ·ÙÈÎfi ÛÙÔÈ¯Â›Ô Ù˘ ·Ú¯È΋˜ ÓfiÛÔ˘ (MRD), ‚) Ê˘ÛÈÔÏÔÁÈο CD10+ B-ÏÂÌÊÔ·ÙÙ·Ú· (·ÈÌ·ÙÔÁfiÓÈ·) Î·È Á) ÒÚÈÌ· µ-ÏÂÌÊÔ·ÙÙ·Ú·. O ·ÓÔÛÔÊ·ÈÓfiÙ˘Ô˜ ÙˆÓ ‚Ï·ÛÙÒÓ Û fiϘ ÙȘ ÂÚÈÙÒÛÂȘ ·È‰ÈÒÓ Ì µ-O§§ ÂÌÊ¿ÓÈ˙ ·ÔÎÏ›ÛÂȘ ·fi ÂΛÓÔ ÙˆÓ ·ÈÌ·ÙÔÁÔÓ›ˆÓ. ∞ÎÔÏÔ‡ıˆ˜ Î·È ·Ó¿ÏÔÁ· Ì ٷ Â˘Ú‹Ì·Ù· Ù˘ ΢ÙÙ·ÚÔÌÂÙÚÈ΋˜ ÌÂϤÙ˘, ÔÈ ·ÛıÂÓ›˜ ÂÈϤÔÓ ‰È·ÎÚ›ıËÎ·Ó ÛÂ: ∞) 17 ·ÛıÂÓ›˜ Ô˘ ÌÂÙ¿ ÙËÓ ¤ÊÔ‰Ô ·ÚÔ˘Û›·˙·Ó ÛÙÔ Ì˘ÂÏfi ÌfiÓÔ ÒÚÈÌ· µ-ÏÂÌÊÔ·ÙÙ·Ú·, ÛÙË ‰Â Ê¿ÛË ÛÙ·ıÂÚÔÔ›ËÛ˘ Ù˘ ‡ÊÂÛ˘ ÂÌÊ¿ÓÈ˙·Ó ·ÈÌ·ÙÔÁfiÓÈ· ¯ˆÚ›˜ Ó· ·ÓȯÓ‡ÂÙ·È Û η̛· Ê¿ÛË MRD, µ) 16 ·ÛıÂÓ›˜ Ì MRD ÌfiÓÔ Û ·Ú¯È΋ Ê¿ÛË Ù˘ ÂÊfi‰Ô˘ Î·È ·ÎÔÏÔ‡ıˆ˜ Ù·¯Â›· ÂÍ·Ê¿ÓÈÛ‹ Ù˘ Î·È ÌÂÙ·ÛÙÚÔÊ‹ Û ÒÚÈÌ· µ Î·È ·ÈÌ·ÙÔÁfiÓÈ· ˆ˜ ·ÓˆÙ¤Úˆ Î·È °) 1 ·ÛıÂÓ‹˜ Ì ·Ú·Ì¤ÓÔ˘Û· MRD ÂÍ·Ú¯‹˜. ªÂٷ͇ ÙˆÓ ·ÛıÂÓÒÓ ÙˆÓ ÔÌ¿‰ˆÓ ∞, µ Î·È ° ‰È·ÈÛÙÒıËΠÂÈÎÚ¿ÙËÛË ÙˆÓ ¯·ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ·ÛıÂÓÒÓ ÛÙËÓ ÔÌ¿‰· ∞ (10 SRG, 5 MRG, 2 HRG) ¤Ó·ÓÙÈ ÙˆÓ ·ÓÙ›ÛÙÔȯˆÓ SRG ·ÛıÂÓÒÓ ÛÙȘ ÔÌ¿‰Â˜ µ Î·È ° (2 SRG, 9 MRG, 6 HRG). ∆ÚÈ¿ÓÙ· ‰‡Ô ·fi ÙÔ˘˜ ·ÓˆÙ¤Úˆ 34 ·ÛıÂÓ›˜, ηٿ ÙÔ ‰È¿ÛÙËÌ· ·Ú·ÎÔÏÔ‡ıËÛ˘ (9-36 Ì‹Ó˜) Ì ‰È¿ÌÂÛÔ ¯ÚfiÓÔ 23 Ì‹Ó˜, ˙Ô˘Ó Û ÚÒÙË Ï‹ÚË ‡ÊÂÛË. ™Â ‰‡Ô ·fi ÙÔ˘˜ 22 ·ÛıÂÓ›˜, ÔÈ ÔÔ›ÔÈ ÌÂÏÂÙ‹ıËÎ·Ó ÌÂÌÔӈ̤ӷ ηٿ ÙË ‰È¿ÚÎÂÈ· ‹ ÙÔ Ù¤ÏÔ˜ Ù˘

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a high level of hematogones were present as previously, and C) including only one HRG patient with serially detected various levels of MRD and no presence of hematogones at any point of remission.

It is of note that risk groups as defined by the ALLBFM ’95 protocol showed significant statistical correlation (p=0.02) with the groups A, B and C as defined by MRD levels. Among these 34 patients during a median follow-up time of 22 months, 1 patient t(9;22)+ relapsed at 1 month post allogeneic BMT and another HRG patient relapsed at 5 months post BMT. Two among the 22 patients studied only during maintenance phase were found positive for MRD and one of them relapsed within 4 months while the other remains in a continuous hypoplastic phase for 2 months without evident relapse yet. No other patient has relapsed in a follow-up period of 28 months. In conclusion, normal CD10+ B lymphoid progenitors (hematogones) in the marrow of children without leukemia proved to have consistent phenotypic characteristics with three coexisting but clearly defined subpopulations (H1, H2, H3). The phenotypes of blasts in all the cases of Bprec-ALL, always deviated from the corresponding hematogone subtype, thus enabling the formulation of a flow cytometry strategy that was applied for MRD assessment during treatment.

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ıÂÚ·›·˜ Û˘ÓÙ‹ÚËÛ˘, ·ÓȯÓ‡ıËΠ΢ÙÙ·ÚÔÌÂÙÚÈο MRD, ÂÓÒ ‚Ú›ÛÎÔÓÙ·Ó Û ÎÏÈÓÈ΋ Î·È ÌÔÚÊÔÏÔÁÈ΋ ‡ÊÂÛË. ∆¤ÏÔ˜, Î·È ÛÙÔ˘˜ 6 ·ÛıÂÓ›˜ Ô˘ ÂϤÁ¯ıËÎ·Ó Û ʿÛË ˘ÔÙÚÔ‹˜, Ù· Â˘Ú‹Ì·Ù· ÂȂ‚·ÈÒıËÎ·Ó ·ÓÔÛÔÊ·ÈÓÔÙ˘Èο Ë ‰Â ÔÚ›· Ù˘ MRD ηٿ ÙËÓ Â·ÓÂÈÛ·ÁˆÁ‹ ÙÔ˘˜ Û ‡ÊÂÛË, ÂÎÙÈÌ‹ıËΠ·ÍÈfiÈÛÙ· ÚÔÔÙÈο ˆ˜ ·Ó·Ï‡ıËÎÂ Î·È ÛÙÔ˘˜ ÚÔËÁÔ˘Ì¤ÓÔ˘˜ ·ÛıÂÓ›˜. ™˘ÌÂÚ·ÛÌ·ÙÈο, Ì ‚¿ÛË ÙËÓ ·Ó·Ï˘ÙÈ΋ ·ÓÔÛÔÊ·ÈÓÔÙ˘È΋ ÌÂϤÙË ÙˆÓ ·ÈÌ·ÙÔÁÔÓ›ˆÓ η٤ÛÙË ‰˘Ó·Ù‹ Ë Ù·˘ÙÔÔ›ËÛ‹ ÙÔ˘˜ ηٿ Ù¿ÍÂȘ Î·È Ë ·Ó·ÁÓÒÚÈÛË Ù˘ Ê˘ÛÈÔÏÔÁÈ΋˜ ·ÚÔ˘Û›·˜ Î·È Ù˘ ÛËÌ·Û›·˜ ÙÔ˘˜ ÛÙÔ Ì˘ÂÏfi Î·È ÙÔ ·›Ì· Ì·ÚÙ‡ÚˆÓ Ì ÌË µ-O§§. ∞ÎÔÏÔ‡ıˆ˜, Ì ÙË ‰È·ÌfiÚʈÛË ÛÙÚ·ÙËÁÈ΋˜ ‚·ÛÈṲ̂Ó˘ ÛÙȘ Û˘ÓÂÎÊÚ¿ÛÂȘ Ù˘ Tdt Ì ÂÚÈÔÚÈṲ̂ÓÔ ·ÚÈıÌfi ·ÓÙÈÛˆÌ¿ÙˆÓ Â›¯·Ì ÙË ‰˘Ó·ÙfiÙËÙ· ·Ó·˙‹ÙËÛ˘ Ù˘ ˘ÔÏÂÈfiÌÂÓ˘ ÓfiÛÔ˘ Ì ̛· ·ÍÈfiÈÛÙË Î·È Ù˘ÔÔÈË̤ÓË Ì¤ıÔ‰Ô, Ì ÙÔ ÏÈÁfiÙÂÚÔ ‰˘Ó·Ùfi ÎfiÛÙÔ˜. ∂ÈÚfiÛıÂÙ·, ‰È·ÈÛÙÒÛ·Ì fiÙÈ ÔÈ ÌÂÙ·‚ÔϤ˜ ÙˆÓ µ-˘ÔÏËı˘ÛÌÒÓ ÛÙÔ Ì˘ÂÏfi ·È‰ÈÒÓ Ì µ-O§§ ÌÂÙ¿ ÙËÓ ¤ÊÔ‰Ô Î·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ıÂÚ·›·˜ ÛÙ·ıÂÚÔÔ›ËÛ˘ Ù˘ ‡ÊÂÛ˘ Î·È Ù˘ Û˘ÓÙ‹ÚËÛ˘ ÙÔ˘ ¢ڤˆ˜ ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓÔ˘ ıÂÚ·¢ÙÈÎÔ‡ ÚˆÙÔÎfiÏÏÔ˘ ALL-BFM ’95, ·ÎÔÏÔ˘ıÔ‡Ó ¤Ó· Û˘ÁÎÂÎÚÈ̤ÓÔ ÚfiÙ˘Ô, ÙÔ ÔÔ›Ô Ê·›ÓÂÙ·È Ó· Û˘Û¯ÂÙ›˙ÂÙ·È ÚÔÁÓˆÛÙÈο Ì ÙȘ ÔÌ¿‰Â˜ ÎÈÓ‰‡ÓÔ˘ ÙÔ˘ ÚˆÙÔÎfiÏÏÔ˘. §¤ÍÂȘ ÎÏÂȉȿ: ÔÍ›· ÏÂÌÊÔ‚Ï·ÛÙÈ΋ Ï¢¯·ÈÌ›·, ÂÏ¿¯ÈÛÙË ˘ÔÏÂÈfiÌÂÓË ÓfiÛÔ˜, ΢ÙÙ·ÚÔÌÂÙÚ›· ÚÔ‹˜, ·ÈÌ·ÙÔÁfiÓÈ·, ·È‰È΋ ËÏÈΛ·.

Key words: acute lymphoblastic leukemia, minimal residual disease, flow cytometry, hematogones, childhood.

∂ÈÛ·ÁˆÁ‹ ∏ ·ÏÌ·Ù҉˘ ÚfiÔ‰Ô˜ Ô˘ Û˘ÓÙÂÏÂ›Ù·È ·‰È¿ÎÔ· Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÛÙÔÓ ÙÔ̤· ÙˆÓ ‚·ÛÈÎÒÓ ÂÈÛÙËÌÒÓ Î·È Ù˘ Ù¯ÓÔÏÔÁ›·˜ Ô‰‹ÁËÛ Û ÂÈÙ‡ÁÌ·Ù·, Ô˘ ·ÊÂÓfi˜ ‰È›ۉ˘Û·Ó ÛÙË ‰ÈÂÚ‡ÓËÛË Ù˘ ‰È·‰Èηۛ·˜ Ù˘ Ï¢¯·ÈÌÔÁ¤ÓÂÛ˘, ·ÊÂÙ¤ÚÔ˘ ·¤‰ˆÛ·Ó ‰È·ÁÓˆÛÙÈΤ˜ ÌÂıfi‰Ô˘˜ Ì Ì›˙ÔÓ· ÂÊ·ÚÌÔÁ‹ ÛÙËÓ Ù·ÍÈÓfiÌËÛË Î·È ‰È¿ÁÓˆÛË ÙˆÓ ÔͤˆÓ Ï¢¯·ÈÌÈÒÓ (1,2). ¶¤Ú·Ó ÏÔÈfiÓ Ù˘ ·Ú¯È΋˜, ˘fi ÙÔ Êˆ˜ ÙÔ˘ ÌÈÎÚÔÛÎÔ›Ô˘, ÌÔÚÊÔÏÔÁÈ΋˜ Ù·ÍÈÓfiÌËÛ˘ (3), Û‹ÌÂÚ· Ë Ù·ÍÈÓfiÌËÛË Ù˘ ·È‰È΋˜ Ï¢¯·ÈÌ›·˜ ÂÚÈÏ·Ì‚¿ÓÂÈ ÂÎ ÙˆÓ ˆÓ ԢΠ¿Ó¢ ÛÙÔȯ›· ·fi Ù· ·ÓÔÛÔÊ·ÈÓÔÙ˘Èο ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ Ï¢¯·ÈÌÈÎÔ‡ ÎÏÒÓÔ˘ (4,5). ªÂÁ¿ÏË ÒıËÛË ÛÙËÓ ·ÓÔÛÔÊ·ÈÓÔÙ˘È΋ Ù·ÍÈÓfiÌËÛË Ù˘ ÔÍ›·˜ ÏÂÌÊÔ‚Ï·ÛÙÈ΋˜ Ï¢¯·ÈÌ›·˜ (O§§), Ô˘ ·ÔÙÂÏ› ÂÚ›Ô˘ ÙÔ 90% ÙÔ˘ Û˘ÓfiÏÔ˘ Ù˘ ·È‰È΋˜ Ï¢¯·ÈÌ›·˜, ¤‰ˆÛÂ Ë ·Ó¿Ù˘ÍË Ù˘ Ù¯ÓÔÏÔÁ›·˜ ÛÙÔ Â›Â‰Ô Ù˘ ΢ÙÙ·ÚÔÌÂÙÚ›·˜

ÚÔ‹˜ Î·È Ë ·Ú·ÁˆÁ‹ ÔÈÎÈÏ›·˜ ÌÔÓÔÎψÓÈÎÒÓ ·ÓÙÈۈ̿وÓ. ∆· ÌÔÓÔÎψÓÈο ·˘Ù¿ ·ÓÙÈÛÒÌ·Ù· ·Ó·ÁÓˆÚ›˙Ô˘Ó ÚˆÙÂ˚ÓÈο ÌfiÚÈ· Ô˘ ÂÎÊÚ¿˙ÔÓÙ·È ÛÙËÓ ÂÈÊ¿ÓÂÈ·, ÙÔ Î˘ÙÙ·ÚfiÏ·ÛÌ· ‹ ÙÔÓ ˘Ú‹Ó· ÙÔ˘ ΢ÙÙ¿ÚÔ˘. ªÂ ÙËÓ ·Ú¿ÏÏËÏË ¯Ú‹ÛË ·ÓȯÓ¢ÙÒÓ DNA ‹ RNA, Ô˘ Ù·˘ÙÔÔÈÔ‡Ó ·Ó·Û˘Ó‰˘·ÛÌÔ‡˜ ÁÔÓȉ›ˆÓ ·ÓÔÛÔÛÊ·ÈÚÈÓÒÓ ‹ ·ÓÙÈÁÔÓÈÎÒÓ ˘Ô‰Ô¯¤ˆÓ, Â›Ó·È ‰˘Ó·ÙfiÓ ÙÂÏÈο Ó· ηıÔÚÈÛÙ› Ë Î˘ÙÙ·ÚÈ΋ ÚԤϢÛË (∆ ‹ µ) Î·È ÙÔ ÛÙ¿‰ÈÔ ‰È·ÊÔÚÔÔ›ËÛ˘ ÙˆÓ ‚Ï·ÛÙÒÓ (1,6). ∏ ·ÓÔÛÔÊ·ÈÓÔÙ˘È΋ Ù·ÍÈÓfiÌËÛË Ù˘ O§§ ÛÙ· ·È‰È¿ ‚·Û›˙ÂÙ·È, fiˆ˜ Î·È ÛÙÔ˘˜ ÂÓ‹ÏÈΘ, ÛÙÔ Î˘ÙÙ·ÚÈÎfi Û¯‹Ì· ·ÓÙ›‰Ú·Û˘ Ì ̛· ÛÂÈÚ¿ ÌÔÓÔÎψÓÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ (cluster differentiation, CD), Ô˘ Û˘Ó‰¤ÔÓÙ·È Ì οı ΢ÙÙ·ÚÈ΋ ÛÂÈÚ¿ (lineage associated) Î·È Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È Î·Ù¿ Ù· ÛÙ¿‰È· ·Ó¿Ù˘Í˘ Î·È ‰È·ÊÔÚÔÔ›ËÛ˘ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ µ- Î·È ∆-ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ (1,5). °È· ÙËÓ Â˘Ú‡ÙÂÚË ÌÂϤÙË Ù˘ O§§ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È, ÂÈϤÔÓ Î·Ù¿ ÂÚ›ÙˆÛË Î·È ÌÔÓÔÎψÓÈο ·ÓÙÈÛÒÌ·Ù· ÌË

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¶·È‰È·ÙÚÈ΋ 2002;65:463-481

Û˘Ó‰ÂfiÌÂÓ· ηْ ·ÔÎÏÂÈÛÙÈÎfiÙËÙ· Ì ̛· ÌfiÓÔ Û˘ÁÎÂÎÚÈ̤ÓË Î˘ÙÙ·ÚÈ΋ ÛÂÈÚ¿, fiˆ˜ .¯. Ù· CD45, CD38, CD123, KOR-SA3544, CD34 (7). ªÂ ‚¿ÛË ÙËÓ ·ÓˆÙ¤Úˆ ‰ÈÂÚ‡ÓËÛË, ‰È·ÎÚ›ÓÔÓÙ·È ·ÓÔÛÔÊ·ÈÓÔÙ˘Èο Ù¤ÛÛÂÚȘ ·ÚȘ ÔÌ¿‰Â˜ ÛÙË µ-΢ÙÙ·ÚÈ΋˜ ÚÔ¤Ï¢Û˘ O§§: ·) ÚÒÈÌË ÚÔ-µ O§§ (early pre-B) ‚) ÎÔÈÓ‹-µ O§§ (common B) Á) ÚÔ-µ O§§ (pre-B) Î·È ‰) ÒÚÈÌË µ-O§§ (mature B) (8). ¶¤Ú·Ó Ù˘ ·Ú¯È΋˜, fï˜, ‰È·ÁÓˆÛÙÈ΋˜ ÚÔÛ¤ÁÁÈÛ˘ Ù˘ O§§, Ì ÙË ¯Ú‹ÛË ÂȉÈÎÒÓ Û˘Ó‰˘·ÛÌÒÓ ÌÔÓÔÎψÓÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ Î·È ÙË ¯Ú‹ÛË Î˘ÙÙ·ÚÔÌÂÙÚ›·˜ ÚÔ‹˜, Û˘ÓÙÂÏÂ›Ù·È ÂÈÚfiÛıÂÙ· Î·È Ë ·ÓÔÛÔÊ·ÈÓÔÙ˘È΋ ‰È¿ÎÚÈÛË ÌÂٷ͇ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ·ÈÌÔÔÈËÙÈÎÒÓ B-΢ÙÙ·ÚÈ΋˜ ÚÔ¤Ï¢Û˘ ˘ÔÏËı˘ÛÌÒÓ (·ÈÌ·ÙÔÁÔÓ›ˆÓ) Î·È ÙˆÓ Ï¢¯·ÈÌÈÎÒÓ Î˘ÙÙ¿ÚˆÓ. ∏ ‰È·‰Èηۛ· ·˘Ù‹ Â›Ó·È ıÂÌÂÏÈÒ‰Ô˘˜ ÛËÌ·Û›·˜ ÁÈ· ÙË ‰È¿ÁÓˆÛË Î·È ·Ú·ÎÔÏÔ‡ıËÛË Ù˘ ÔÍ›·˜ ÏÂÌÊÔ‚Ï·ÛÙÈ΋˜ Ï¢¯·ÈÌ›·˜ (O§§), ηıÒ˜ Î·È ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË Ù˘ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ Ù˘ ıÂÚ·›·˜ (9-11). ∂ÈϤÔÓ, ȉȷ›ÙÂÚË ÛËÌ·Û›· ÛÙË ‚ÚÂÊÈ΋ Î·È ·È‰È΋ ËÏÈΛ· ÚÔÛÏ·Ì‚¿ÓÂÈ Ë ÛËÌ·ÓÙÈο ·˘ÍË̤ÓË ·ÚÔ˘Û›· ÙÔ˘ Ê˘ÛÈÔÏÔÁÈÎÔ‡ ‚-ÚÔÁÔÓÈÎÔ‡ Î·È ÒÚÈÌÔ˘ B-΢ÙÙ·ÚÈÎÔ‡ ÛÙÔÈ¯Â›Ô˘. ™ÙȘ ËÏÈ˘ ·˘Ù¤˜, Ë ‰È¿ÎÚÈÛË ÌÂٷ͇ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ Î·È Ï¢¯·ÈÌÈÎÒÓ ˘ÔÏËı˘ÛÌÒÓ ‰˘Û¯ÂÚ·›ÓÂÙ·È ÂÚ·ÈÙ¤Úˆ ·fi ÙȘ ·Ú·ÙËÚÔ‡ÌÂÓ˜ ÌÔÚÊÔÏÔÁÈΤ˜ Î·È ·ÓÔÛÔÊ·ÈÓÔÙ˘ÈΤ˜ ÔÌÔÈfiÙËÙ˜ ÌÂٷ͇ ÙˆÓ ‚Ï·ÛÙÒÓ Î·È ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ B ÏÂÌÊÈÎÒÓ ÚÔÁÂÓÓËÙfiÚˆÓ (12).

OÈ B-ÏÂÌÊÔ΢ÙÙ·ÚÈÎÔ› ˘ÔÏËı˘ÛÌÔ› Ô˘ ·Ó¢ڛÛÎÔÓÙ·È ÛÙÔ Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ ·È‰ÈÒÓ Ì BO§§ Î·È Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÚÔÛ‰ÈÔÚÈÛÙÔ‡Ó Ì ΢ÙÙ·ÚÔÌÂÙÚ›· ÚÔ‹˜ Î·È Ì ÙË ¯Ú‹ÛË Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ÌÔÓÔÎψÓÈÎÒÓ ·ÓÙÈۈ̿وÓ, Â›Ó·È Ù· ÒÚÈÌ· B-ÏÂÌÊÔ·ÙÙ·Ú· Î·È Ù· Ê˘ÛÈÔÏÔÁÈο CD10+ B-ÏÂÌÊÔ·ÙÙ·Ú· (·ÈÌ·ÙÔÁfiÓÈ·). π‰È·›ÙÂÚ· ÂÈÛËÌ·›ÓÂÙ·È fiÙÈ Ë Ù·˘ÙfiÙËÙ· ÙˆÓ ·ÈÌ·ÙÔÁÔÓ›ˆÓ ηٿ Ù· ‰È·‰Ô¯Èο ÛÙ¿‰È· Ù˘ B-ÏÂÌÊÈ΋˜ ÔÓÙÔÁ¤ÓÂÛ˘, ÔÈ ÂÈ̤Úo˘˜ ‰È·ÊÔÚÔÔÈ‹ÛÂȘ ÙˆÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ÙÔ˘˜ Î·È ÂȉÈÎfiÙÂÚ· ÙˆÓ ·ÓÔÛÔÊ·ÈÓÔÙ˘ÈÎÒÓ, ηıÒ˜ Î·È Ë Û˘¯ÓfiÙËÙ· ÙˆÓ ‰È·Î˘Ì¿ÓÛÂÒÓ ÙÔ˘˜ Î·È Ë ÛËÌ·Û›· Ù˘ ·ÚÔ˘Û›·˜ ÙÔ˘˜ ÛÙÔ Ì˘ÂÏfi ‹ Î·È ÙÔ ·›Ì·, ‰ÂÓ ¤¯Ô˘Ó ÌÂÏÂÙËı› Â·ÚÎÒ˜ (11). ∆¤ÏÔ˜, fiˆ˜ ‹‰Ë ¤¯ÂÈ ·Ó·ÊÂÚı›, Û˘¯Ó¿ ‰ËÌÈÔ˘ÚÁÂ›Ù·È ‰È·ÊÔÚԉȷÁÓˆÛÙÈÎfi Úfi‚ÏËÌ· ÌÂٷ͇ Ù˘ ·Ó›¯Ó¢Û˘ ·ÚÔ˘Û›·˜ ·ÈÌ·ÙÔÁÔÓ›ˆÓ Î·È Ï¢¯·ÈÌÈÎÔ‡ ÛÙÔÈ¯Â›Ô˘ ηٿ ÙË ‰È·‰Èηۛ· ÚÔÛ‰ÈÔÚÈÛÌÔ‡ Ù˘ ÂÏ¿¯ÈÛÙ˘ ˘ÔÏÂÈfiÌÂÓ˘ ÓfiÛÔ˘ (Minimal Residual Disease-MRD), Ù˘ Ì›˙ÔÓÔ˜ ÚÔÁÓˆÛÙÈ΋˜ ·Ú·Ì¤ÙÚÔ˘ ÁÈ· ÙËÓ ÙÂÏÈ΋ ¤Î‚·ÛË ÙˆÓ ·ÛıÂÓÒÓ ·˘ÙÒÓ. ∏ Û˘¯ÓfiÙËÙ· ‰Â Î·È ÙÔ ÔÛÔ-

Paediatriki 2002;65:463-481

ÛÙfi ÙˆÓ ·ÈÌ·ÙÔÁÔÓ›ˆÓ Ô˘ ·Ó¢ڛÛÎÔÓÙ·È Î·Ù¿ ÙȘ ·ÏÏÂ¿ÏÏËϘ ıÂÚ·¢ÙÈΤ˜ Ê¿ÛÂȘ Î·È Ë Ù˘¯fiÓ ÚÔÁÓˆÛÙÈ΋ ÙÔ˘˜ ÛËÌ·Û›· ‰ÂÓ ¤¯Ô˘Ó ÌÂÏÂÙËı› ¢ڤˆ˜ (13). ™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ˘‹ÚÍÂ: 1) Ë Ù˘ÔÔ›ËÛË Î·Ù¿ ÙË ‰È·‰Èηۛ· Ù˘ ÔÓÙÔÁ¤ÓÂÛ˘ Ù˘ ÏÂÌÊÔÔ›ËÛ˘, ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ Úfi‰ÚÔÌˆÓ ÌÔÚÊÒÓ ÙÔ˘ µ-ÏÂÌÊÔ΢ÙÙ·ÚÈÎÔ‡ ÛÙÔÈ¯Â›Ô˘, Û ·È‰È¿ Ì ¿ÏÏ· ÓÔÛ‹Ì·Ù· ÏËÓ ÔÍ›·˜ µ-ÏÂÌÊÔ‚Ï·ÛÙÈ΋˜ Ï¢¯·ÈÌ›·˜ Î·È Ë ‰È¿ÎÚÈÛ‹ ÙÔ˘˜ ·Ó·ÏfiÁˆ˜ Ù˘ ‰È·ÊÔÚÔÔ›ËÛ‹˜ ÙÔ˘˜ ηٿ Ù¿ÍÂȘ, 2) Ë ‰È·ÌfiÚʈÛË ÛÙÚ·ÙËÁÈ΋˜ ‰È·¯ˆÚÈÛÌÔ‡ Ù˘ MRD ·fi Ù· ·ÈÌ·ÙÔÁfiÓÈ· Ì ‚¿ÛË ÙËÓ ·ÓÔÛÔÊ·ÈÓÔÙ˘È΋ ÌÂϤÙË ÙˆÓ µ-ÏÂÌÊÔ΢ÙÙ·ÚÈÎÒÓ ˘ÔÏËı˘ÛÌÒÓ ÛÙÔ Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ Û ·È‰È¿ Ì µ-΢ÙÙ·ÚÈ΋˜ ÚÔ¤Ï¢Û˘ ÔÍ›· ÏÂÌÊÔ‚Ï·ÛÙÈ΋ Ï¢¯·ÈÌ›· ηٿ ÙË ‰È¿ÁÓˆÛË Î·È 3) Ë ÂÊ·ÚÌÔÁ‹ Ù˘ ÂÓ ÏfiÁˆ ÛÙÚ·ÙËÁÈ΋˜ ÛÙȘ ·ÏÏËÏԉȿ‰Ô¯Â˜ Ê¿ÛÂȘ ıÂÚ·›·˜ Ô˘ ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÔ ‰ÈÂıÓ¤˜ ÚˆÙfiÎÔÏÏÔ ALLBFM ’95 ÁÈ· ÙËÓ ·Ó›¯Ó¢ÛË MRD. ∂ÈϤÔÓ, ·Ó·˙ËÙ‹ıËÎÂ Ë ‡·ÚÍË Û˘ÁÎÂÎÚÈ̤ÓÔ˘ ÚÔÙ‡Ô˘ ÌÂÙ·‚ÔÏÒÓ fiÏˆÓ ÙˆÓ µ-ÏÂÌÊÔ΢ÙÙ·ÚÈ΋˜ ÚÔ¤Ï¢Û˘ ÏËı˘ÛÌÒÓ ÛÙÔ Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ ·È‰ÈÒÓ Ì µO§§ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÓÙ·ÙÈ΋˜ ıÂÚ·›·˜ (¤ÊÔ‰Ô˜ Î·È ıÂÚ·›· ÛÙ·ıÂÚÔÔ›ËÛ˘) Î·È ÂÍÂÙ¿ÛÙËÎÂ Ë ‡·ÚÍË Ù˘¯fiÓ Û˘Û¯¤ÙÈÛ˘ ÙˆÓ ÌÂÙ·‚ÔÏÒÓ ·˘ÙÒÓ Ì ÙȘ ÔÌ¿‰Â˜ ÎÈÓ‰‡ÓÔ˘ ÙˆÓ ·ÛıÂÓÒÓ Ì ‚¿ÛË ÙÔ ÚˆÙfiÎÔÏÏÔ ALL BFM ’95. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ªÂÏÂÙ‹ıËÎ·Ó Î·Ù¿ ÙË ‰È¿ÁÓˆÛË Î·È Î·Ù¿ ÙËÓ ÚfiÔ‰Ô Ù˘ ıÂÚ·›·˜ 212 ‰Â›ÁÌ·Ù· Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ ·fi 34 ·È‰È¿ Ì ÔÍ›· ÏÂÌÊÔ‚Ï·ÛÙÈ΋ Ï¢¯·ÈÌ›· B ΢ÙÙ·ÚÈ΋˜ ÚÔ¤Ï¢Û˘ (µ-O§§), ·fi Ù· ÔÔ›· 21 ‹Ù·Ó ·ÁfiÚÈ· Î·È 13 ÎÔÚ›ÙÛÈ· (∞:∫=1,6). ∏ ËÏÈΛ· ÙÔ˘˜ Î˘Ì·ÈÓfiÙ·Ó ·fi 1 ¤ˆ˜ 14,8 ¯ÚfiÓÈ·, Ì ‰È¿ÌÂÛË ËÏÈΛ· Ù· 3,8 ¯ÚfiÓÈ·.

OÈ ·ÛıÂÓ›˜, ηٿ ÙË ‰È¿ÁÓˆÛË, ÌÂÏÂÙ‹ıËÎ·Ó ÌÔÚÊÔÏÔÁÈο (FAB) Î·È ÈÛÙÔ¯ËÌÈο, ·ÓÔÛÔÊ·ÈÓÔÙ˘Èο Ì ΢ÙÙ·ÚÔÌÂÙÚ›· ÚÔ‹˜ Î·È Ì ÌÂÁ¿ÏÔ Â‡ÚÔ˜ ÌÔÓÔÎψÓÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ (‚Ï. ηو٤ڈ), ΢ÙÙ·ÚÔÁÂÓÂÙÈο Î·È ÌÔÚȷο [22/34 ·ÛıÂÓ›˜ ÌÂÏÂÙ‹ıËÎ·Ó Ì ÊıÔÚ›˙ÔÓÙ· in situ ˘‚ÚȉÈÛÌfi (FISH) ÁÈ· ·Ó›¯Ó¢ÛË t(9;22), t(12;21) Î·È ·Ó·‰È·Ù¿ÍÂȘ (11q23) Î·È 15/34 ·ÛıÂÓ›˜ Ì RT-PCR ÁÈ· ·Ó›¯Ó¢ÛË t(9;22)]. ∫˘ÙÙ·ÚÔÁÂÓÂÙÈ΋ ·Ó¿Ï˘ÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÙÔ˘ Ì˘ÂÏÔ‡ ¤ÁÈÓ ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ ·ÛıÂÓÒÓ. ∂ÈÚfiÛıÂÙ·, ÌÂÏÂÙ‹ıËÎ·Ó 28 ‰Â›ÁÌ·Ù· ·fi 22 ·ÛıÂÓ›˜ Û ÌÔÚÊÔÏÔÁÈ΋ ‡ÊÂÛË Î·È Û ÔÈΛϘ ¯ÚÔÓÈΤ˜ ÛÙÈÁ̤˜ ηٿ ÙË ‰È¿ÚÎÂÈ· ‹ ÙÔ Ù¤ÏÔ˜ Ù˘ ıÂÚ·›·˜ Û˘ÓÙ‹ÚËÛ˘ Ù˘ ÓfiÛÔ˘, ηıÒ˜ Î·È 12 ‰Â›ÁÌ·Ù· Ì˘ÂÏÔ‡ ·fi 6 ·ÛıÂÓ›˜ Ì µ-O§§ Û ʿÛË ˘ÔÙÚÔ‹˜. ¶·Ú¿ÏÏËÏ·, ÌÂÏÂÙ‹ıËÎ·Ó 25 ‰Â›ÁÌ·Ù· Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ ·fi 25 ·È‰È·ÙÚÈÎÔ‡˜ ·ÛıÂÓ›˜ Ì ‰È¿ÌÂÛË ËÏÈΛ· 1,4 ¯ÚfiÓÈ· Î·È Ì ¿ÏÏ· ÓÔÛ‹Ì·Ù· (Û˘Ì·Á›˜ fiÁÎÔ˘˜ ¯ˆÚ›˜

467

NoV-dEc-02

14-05-03

14:26

™ÂÏ›‰·468

¶·È‰È·ÙÚÈ΋ 2002;65:463-481

‰È‹ıËÛË ÙÔ˘ Ì˘ÂÏÔ‡, ηÏÔ‹ı˘ Ô˘‰ÂÙÂÚÔÂÓ›· Ù˘ ·È‰È΋˜ ËÏÈΛ·˜, ȉÈÔ·ı‹˜ ıÚÔÌ‚ÔÂÓÈ΋ ÔÚʇڷ). ™ÙËÓ ÂÓ ÏfiÁˆ ÔÌ¿‰· ÂϤÁ¯Ô˘ ‰È·ÈÛÙÒıËΠ·ÚÔ˘Û›· ˘„ËÏÒÓ ÔÛÔÛÙÒÓ ·ÈÌ·ÙÔÁÔÓ›ˆÓ (10-25% ÙˆÓ ÂÌ‡ÚËÓˆÓ Î˘ÙÙ¿ÚˆÓ ÙÔ˘ Ì˘ÂÏÔ‡). ™Â ¤ÓÙ ·fi ÙȘ ÂÚÈÙÒÛÂȘ ·˘Ù¤˜ Ì ˘„ËÏfi ÔÛÔÛÙfi ·ÈÌ·ÙÔÁÔÓ›ˆÓ ÛÙÔÓ Ì˘ÂÏfi (20-25%) ¤ÁÈÓ ·Ó·Ï˘ÙÈ΋ Û˘ÁÎÚÈÙÈ΋ ÌÂϤÙË ÙÔ˘ µ ÏÂÌÊÈÎÔ‡ ÛÙÔÈ¯Â›Ô˘ ÛÙÔÓ Ì˘ÂÏfi Î·È ÙÔ ·›Ì·. £ÂÚ·¢ÙÈÎfi ÚˆÙfiÎÔÏÏÔ Î·È ¯ÚÔÓÈο Ï·›ÛÈ· ·Ó·˙‹ÙËÛ˘ ˘ÔÏÂÈfiÌÂÓ˘ ÓfiÛÔ˘ ŸÏÔÈ ÔÈ ·ÛıÂÓ›˜ ¤Ï·‚·Ó ıÂÚ·›· Ì ‚¿ÛË ÙÔ ıÂÚ·¢ÙÈÎfi ÚˆÙfiÎÔÏÏÔ ALL-BFM ’95. OÈ ˘fi ÌÂϤÙË ·ÛıÂÓ›˜, Û‡Ìʈӷ Ì ٷ ÎÚÈÙ‹ÚÈ· ÎÈÓ‰‡ÓÔ˘ ÙÔ˘ ÚˆÙÔÎfiÏÏÔ˘, ‰È·ÎÚ›ıËÎ·Ó Û ¯·ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ (SRG), ÂӉȿÌÂÛÔ˘ ÎÈÓ‰‡ÓÔ˘ (MRG) Î·È ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ (HRG), ÂÓÒ ·ÓÔÛÔÊ·ÈÓÔÙ˘Èο Ù·˘ÙÔÔÈ‹ıËÎ·Ó Î·È ¯·Ú·ÎÙËÚ›ÛÙËÎ·Ó ˆ˜ ·ÎÔÏÔ‡ıˆ˜: i) 2 ·ÛıÂÓ›˜ ˆ˜ ÚÒÈÌË ÚÔ-µ O§§ (CD10 ·ÚÓËÙÈÎfi, cÌ ·ÚÓËÙÈÎfi), 18 ·ÛıÂÓ›˜ Ì ÎÔÈÓ‹ O§§ (CD10 ıÂÙÈÎfi, cÌ ·ÚÓËÙÈÎfi), 13 ·ÛıÂÓ›˜ ÚÔ-µ O§§ (cÌ ıÂÙÈÎfi >30% Â› ÙˆÓ ‚Ï·ÛÙÒÓ, ÂÓÒ 1 ·ÛıÂÓ‹˜ ›¯Â ÒÚÈÌË µ-O§§ (Burkitt), ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ 34 ·ÛıÂÓÒÓ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó Î·Ù¿ ÙË ‰È¿ÁÓˆÛË Î·È ÚÔÔÙÈο ηٿ ÙËÓ ¤ÊÔ‰Ô Î·È ÙË ıÂÚ·›· ÛÙ·ıÂÚÔÔ›ËÛ˘, ii) 1 ·ÛıÂÓ‹˜ ˆ˜ ÚÒÈÌË ÚÔ-µ O§§, 17 ·ÛıÂÓ›˜ ˆ˜ ÎÔÈÓ‹ O§§ Î·È 4 ·ÛıÂÓ›˜ ˆ˜ ÚÔ-µ, ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ 22 ·ÛıÂÓÒÓ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó Û ÔÈΛϘ ¯ÚÔÓÈΤ˜ ÛÙÈÁ̤˜ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ıÂÚ·›·˜ Û˘ÓÙ‹ÚËÛ˘ ÙÔ˘ ÚˆÙÔÎfiÏÏÔ˘ Î·È Î˘Ú›ˆ˜ ηٿ ÙÔ Ù¤ÏÔ˜ ·˘Ù‹˜ Î·È iii) 2 ·ÛıÂÓ›˜ ˆ˜ ÎÔÈÓ‹ O§§, 2 ·ÛıÂÓ›˜ ˆ˜ ÚÔ-µ O§§ Î·È 1 ·ÛıÂÓ‹˜ ˆ˜ ÒÚÈÌË µ-O§§, ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ 6 ·ÛıÂÓÒÓ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó Û ʿÛË ˘ÔÙÚÔ‹˜. ŸÏÔÈ ÔÈ ·ÛıÂÓ›˜ Ô˘ ÂϤÁ¯ıËÎ·Ó Î·Ù¿ ÙË ‰È¿ÁÓˆÛË ˆ˜ ÚÔ˜ ÙËÓ Ù·˘ÙÔÔ›ËÛË ÙÔ˘ Ï¢¯·ÈÌÈÎÔ‡ ÛÙÔÈ¯Â›Ô˘ (34), ÛÙË Û˘Ó¤¯ÂÈ· ÂϤÁ¯ıËÎ·Ó ÚÔÔÙÈο ˆ˜ ÚÔ˜ ÙȘ ÌÂÙ·‚ÔϤ˜ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ µ ÏÂÌÊÔ΢ÙÙ·ÚÈÎÒÓ ˘ÔÏËı˘ÛÌÒÓ Î·È Ù˘ ÂÏ¿¯ÈÛÙ˘ ˘ÔÏÂÈfiÌÂÓ˘ ÓfiÛÔ˘ ηٿ ÙÔ˘˜ ¯ÚfiÓÔ˘˜ 15Ë, 33Ë Ë̤ڷ Ù˘ ÂÊfi‰Ô˘ Î·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÛÙ·ıÂÚÔÔ›ËÛ˘ Ù˘ ‡ÊÂÛ˘ (∂ÈÎfiÓ· 7). ∏ ·Ú·ÎÔÏÔ‡ıËÛË Ù˘ ˘ÔÏÂÈÔ̤Ó˘ ÓfiÛÔ˘ (MRD) ¤ÁÈÓ Ì ‚¿ÛË ÛÙÚ·ÙËÁÈ΋, Ë ÔÔ›· ÚԤ΢„ ·fi ÙË Û˘ÁÎÚÈÙÈ΋ ÌÂϤÙË ÙÔ˘ µ-΢ÙÙ·ÚÈ΋˜ ÚÔ¤Ï¢Û˘ Ï¢¯·ÈÌÈÎÔ‡ ÛÙÔÈ¯Â›Ô˘ ηٿ ÙË ‰È¿ÁÓˆÛË Î·È ÙˆÓ ·ÈÌ·ÙÔÁÔÓ›ˆÓ, fiˆ˜ ·Ó·Ï‡ÂÙ·È Î·ÙˆÙ¤Úˆ. ∫˘ÙÙ·ÚÔÌÂÙÚ›· ÚÔ‹˜ ªÔÓÔÎψÓÈο ·ÓÙÈÛÒÌ·Ù· Î·È ·Ú·Û΢‹ ‰ÂÈÁÌ¿ÙˆÓ: ∏ ·ÓÔÛÔÊ·ÈÓÔÙ˘È΋ ÌÂϤÙË ÙˆÓ Ì˘ÂÏÈÎÒÓ ÏÂÌÊÔ΢ÙÙ·ÚÈÎÒÓ ˘ÔÏËı˘ÛÌÒÓ ¤ÁÈÓ Ì ΢ÙÙ·ÚÔÌÂÙÚÈÎfi ·Ó·Ï˘Ù‹ Ortho Cytoron Absolute (Ortho, Raritan, N. Jersey) Ì laser Argon 488 nÌ Î·È ÙË ¯Ú‹ÛË Û˘Ó‰˘·ÛÌÒÓ ÙÚÈÒÓ ÊıÔÚÈÔ¯ÚˆÌ¿ÙˆÓ (ÚÒÙÔ ¯ÚÒÌ· ÊÏÔ˘ÔÚÂÛνÓË (FITC), ‰Â‡ÙÂÚÔ ¯ÚÒÌ· Ê˘ÎÔÂÚ˘ıÚ›ÓË (PE) Î·È ÙÚ›ÙÔ ¯ÚÒÌ· º˘ÎÔÂÚ˘ıÚ›ÓË 5’΢·Ó›ÓË (PeCy5). ∆· ÌÔÓÔÎψÓÈο ·ÓÙÈÛÒÌ·Ù· Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó (CD, ÎÏÒÓÔÈ, ÚԤϢÛË Î·È Û¯fiÏÈ· ÁÈ· Ù¯ÓÈΤ˜ ‹ ÙË ÛËÌ·Û›· ÙÔ˘˜) ·Ó·Ê¤ÚÔÓÙ·È Û˘ÓÔÏÈο ÛÙÔÓ ¶›Ó·Î· 1. ¢ÂÓ ÁÈÓfiÙ·Ó ·Ô¯ˆÚÈÛÌfi˜ ÛÙÔÈ‚¿‰·˜ ÌÔÓÔ‡ÚËÓˆÓ, ·Ï-

468

Paediatriki 2002;65:463-481

Ï¿ ÌÂϤÙË Ì ÂÚ˘ıÚÔ΢ÙÙ·ÚÈ΋ χÛË ÙˆÓ Ì˘ÂÏÈÎÒÓ ÂӷȈÚËÌ¿ÙˆÓ Ì ¯ÏˆÚÈÔ‡¯Ô ·ÌÌÒÓÈÔ. ŸÔ˘ ˘ÂÈÛ¤Ú¯ÂÙÔ ÂÓ‰Ô΢ÙÙ¿ÚÈÔ ·Óٛۈ̷ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÂÈÊ·ÓÂȷο ¯ÚËÛÈÌÔÔÈ‹ıËΠٯÓÈ΋ ÌÔÓÈÌÔÔ›ËÛ˘ Î·È ‰È·ÂÚ·ÙfiÙËÙ·˜ Ì kit ÂÌÔÚ›Ô˘ (∏arlan-Seralab,UK). ŸÙ·Ó ÁÈÓfiÙ·Ó ÌÂϤÙË ÂÈÊ·ÓÂÈ·ÎÒÓ ·ÓÔÛÔÛÊ·ÈÚÈÓÒÓ, ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·Ó Ï˘Ì¤Ó· ‰‡Ô ÊÔÚ¤˜ ‰Â›ÁÌ·Ù· Ì PBS. ™˘Ó‰˘·ÛÌÔ› ΢ÙÙ·ÚÔÌÂÙÚÈ΋˜ ·Ó¿Ï˘Û˘: 1) ªÂϤÙË ÏÂÌÊÔ‚Ï·ÛÙÒÓ. ™Ù·ıÂÚfi ÌÔÓÔÎψÓÈÎfi ·Óٛۈ̷ Û fiÏÔ˘˜ ÙÔ˘˜ Û˘Ó‰˘·ÛÌÔ‡˜ Û˘Ó‰Â‰Â̤ÓÔ Ì ÙÔ ÙÚ›ÙÔ ¯ÚÒÌ· ‹Ù·Ó ÙÔ CD45-PECy5. ∂›Û˘, ÙÔ CD19 ¯ÚËÛÈÌÔÔÈ‹ıËΠˆ˜ ‰Â‡ÙÂÚÔ ÛÙ·ıÂÚfi ÌÔÓÔÎψÓÈÎfi ·Óٛۈ̷. ∆· ˘fiÏÔÈ· ÌÔÓÔÎψÓÈο ·ÓÙÈÛÒÌ·Ù· Ô˘ ÌÂÙ·‚¿ÏÏÔÓÙ·Ó ÌÂٷ͇ ÙˆÓ Û˘Ó‰˘·ÛÌÒÓ Û˘Ì‚ÔÏ›˙ÔÓÙ·È Ì Ã: 1) ÂÈÊ¿ÓÂÈ·˜ Û˘Ó‰Â‰Â̤ӷ Ì FITC: CD10, CD38, CD9, CD34, CD20, Ì›ÁÌ· CD13 Î·È CD33 Î·È KOR-SA3544. ™˘Ó‰Â‰Â̤ӷ Ì PE AC133, CD117, CD135, CD123 Î·È NG2 Î·È 2) ÂÓ‰Ô΢ÙÙ¿ÚÈ·: ∆dt Î·È ‚·Ú›·˜ ·Ï‡ÛÔ˘ Ì (πgM). ŒÙÛÈ, ‰È·ÌÔÚÊÒıËÎ·Ó Û˘Ó‰˘·ÛÌÔ› ÙÔ˘ Ù‡Ô˘ Ã-FITC/CD19-PE/CD45-PeCy5 ™ÙȘ ÂÚÈÙÒÛÂȘ Ô˘ Ù· ·ÓÙÈÛÒÌ·Ù· ‹Ù·Ó ‰È·ı¤ÛÈÌ· ÌfiÓÔ Û ‰Â‡ÙÂÚÔ ¯ÚÒÌ·, ÔÈ Û˘Ó‰˘·ÛÌÔ› ‹Ú·Ó ÙË ÌÔÚÊ‹ CD19-FITC/XPE/CD45-PeCy5.

2) MÂϤÙË ·ÈÌ·ÙÔÁÔÓ›ˆÓ. ™ÙË ÌÂϤÙË ÙˆÓ ·ÈÌ·ÙÔÁÔÓ›ˆÓ ˆ˜ ÛÙ·ıÂÚfi Û fiÏÔ˘˜ ÙÔ˘˜ Û˘Ó‰˘·ÛÌÔ‡˜ ÌÔÓÔÎψÓÈÎfi ·Óٛۈ̷ Û˘Ó‰Â‰Â̤ÓÔ Ì ÙÚ›ÙÔ ¯ÚÒÌ· ¯ÚËÛÈÌÔÔÈ‹ıËΠÙÔ CD45 ‹ ÙÔ CD10-PeCy5. ∂›Û˘, ˆ˜ ‰Â‡ÙÂÚÔ ÛÙ·ıÂÚfi ÌÔÓÔÎψÓÈÎfi ·Óٛۈ̷ ÛÙÔ˘˜ Û˘Ó‰˘·ÛÌÔ‡˜ Ì ÙÔ CD45PeCy5 ÁÈ· ÙË ÌÂϤÙË ÙˆÓ ·ÈÌ·ÙÔÁÔÓ›ˆÓ ¯ÚËÛÈÌÔÔÈ‹ıËΠÙÔ CD10. ∆· ÂÈ̤ÚÔ˘˜ ÌÔÓÔÎψÓÈο ·ÓÙÈÛÒÌ·Ù· Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó Î·Ù¿ ÛÂÈÚ¿ Û˘Ì‚ÔÏ›˙ÔÓÙ·È Ì Ã. ŒÙÛÈ, ‰È·ÌÔÚÊÒıËÎ·Ó Û˘Ó‰˘·ÛÌÔ› ÙÔ˘ Ù‡Ô˘ Ã-FITC/CD10-PE/CD45. ™ÙȘ ÂÚÈÙÒÛÂȘ Ô˘ Ù· ·ÓÙÈÛÒÌ·Ù· ‹Ù·Ó ‰È·ı¤ÛÈÌ· ÌfiÓÔ Û ‰Â‡ÙÂÚÔ ¯ÚÒÌ·, ÔÈ Û˘Ó‰˘·ÛÌÔ› ‹Ú·Ó ÙË ÌÔÚÊ‹ CD10FITC/X-PE/CD45-PeCy5. ∂›Û˘, ÁÈ· ÙË ÌÂϤÙË ÙˆÓ Úfi‰ÚÔÌˆÓ ·ÈÌ·ÙÔÁÔÓ›ˆÓ ¯ÚËÛÈÌÔÔÈ‹ıËΠˆ˜ ÛÙ·ıÂÚfi Û fiÏÔ˘˜ ÙÔ˘˜ Û˘Ó‰˘·ÛÌÔ‡˜ ÂÓ‰Ô΢ÙÙ¿ÚÈÔ ÌÔÓÔÎψÓÈÎfi ·Óٛۈ̷ ¤Ó·ÓÙÈ Ù˘ Tdt ÛÂ Û˘Ó‰˘·ÛÌÔ‡˜ Tdt-FTC/X-PE/CD45PeCy5. °È· ÙË ÌÂϤÙË ÙˆÓ ÒÚÈÌˆÓ ·ÈÌ·ÙÔÁÔÓ›ˆÓ ˆ˜ ÛÙ·ıÂÚfi ·Óٛۈ̷ Û˘Ó‰Â‰Â̤ÓÔ Ì ÙÔ ÚÒÙÔ ¯ÚÒÌ· ¯ÚËÛÈÌÔÔÈ‹ıËΠ̛ÁÌ· Î-FITC (Dako) Î·È Ï-FITC (Dako) (ÂÈÊ¿ÓÂÈ·˜) Ì ÛÙ·ıÂÚfi CD10-PeCy5, fiˆ˜ ·Ó·Ê¤Ú·Ì ÚÔËÁÔ˘Ì¤Óˆ˜, ‹ÙÔÈ (Î+Ï)-FITC/X-PE/CD10-PeCy5 ‹ Ì›ÁÌ· ÎPE Î·È Ï-PE (Dako) Ì ÙÔ Û˘Ó‰˘·ÛÌfi Ã-FITC/(Î+Ï)PE/CD10-PeCy5. °È· ÙË ÌÂϤÙË ÙˆÓ ·ÈÌ·ÙÔÁÔÓ›ˆÓ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÂÎÙfi˜ ·fi Ù· ·ÓÙÈÛÒÌ·Ù· Ô˘ ·Ó·Ê¤ÚıËÎ·Ó ÛÙËÓ Ù˘ÔÔ›ËÛË ÙˆÓ ÏÂÌÊÔ‚Ï·ÛÙÒÓ, ÂÈϤÔÓ Ù· ·ÎfiÏÔ˘ı·: ·) ¤Ó·ÓÙÈ ‚·Ú›·˜ ·Ï‡ÛÔ˘ ·ÓÔÛÔÛÊ·ÈÚÈÓÒÓ Á IgG, ‰ IgD, · IgA Î·È ‚) Ù· ·ÓÙÈÛÒÌ·Ù· CD19, CD79a, CD79b, FMC7, CD5, CD23, CD27, CD43, CD95, CD7, CD3, CD79a ÎÏÒÓÔ˜ ZL7.4 Î·È bcl2.

3) ¢È·ÌfiÚʈÛË ·ÏÁÔÚ›ıÌÔ˘ ·Ó·˙‹ÙËÛ˘ Ù˘ ÂÏ¿¯ÈÛÙ˘ ˘ÔÏÂÈfiÌÂÓ˘ ÓfiÛÔ˘ (ªRD). ∏ ‰È·ÌfiÚʈÛË ÛÙÚ·ÙËÁÈ΋˜ ·Ó·˙‹ÙËÛ˘ Ù˘ MRD ¤ÁÈÓ Ì ‚¿ÛË ÙËÓ ·Ó·Ï˘ÙÈ΋ ÌÂϤÙË ÙˆÓ ·ÈÌ·ÙÔÁÔÓ›ˆÓ ηٿ Ù¿ÍÂȘ Û ·È‰È¿ ¯ˆÚ›˜ µ-

NoV-dEc-02

14-05-03

14:26

™ÂÏ›‰·469

¶·È‰È·ÙÚÈ΋ 2002;65:463-481

Paediatriki 2002;65:463-481

¶›Ó·Î·˜ 1. ∞ÓÙÈÛÒÌ·Ù· Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË Ì ·Ó·ÊÔÚ¿ Û ÎÏÒÓÔ˘˜, ηٷÛ΢·ÛÙ¤˜, Ù· Û˘Ó‰Â‰Â̤ӷ ÊıÔÚÈÔ¯ÚÒÌ·Ù·, Ù· Û¯ÂÙÈο ·ÓÙÈÁfiÓ· Î·È ÙȘ Ù¯ÓÈΤ˜ ¯ÚÒÛ˘ ∞Óٛۈ̷ CD45 CD10 CD10 ∆dt Î Ï CD19 CD19 CD79a CD79a CD3 CD13 CD33 CD7 CD38 KOR-SA3544 CD123 CD34 CD9 CD9 AC133 CD135 CD117 NG2 CD20 CD79b CD79b FMC7 CD5 CD23 CD43 Ì (IgM) IgM IgG IgD IgA CD40 CD27 bcl2 CD95 CD71

∫ÏÒÓÔ˜

∫·Ù·Û΢·ÛÙ‹˜

ºıÔÚÈfi¯ÚˆÌ·

J33 SS2/36 H110a HT-6 polyclonal rabbit polyclonal rabbit HD37 BC3 HM57 ZL7.4 UCHT1 WM-47 WM-54 8H8.1 T16 KOR-SA3544 VIC-67 BIRMA-K3 MM2/57 P1/33/2 AC133/2 BV10A4H2 104D2 7.1 B-Ly1 VI CD79.1 SN8 FMC7 DK23 MHM6 DF-T1 polyclonal rabbit polyclonal rabbit polyclonal rabbit polyclonal rabbit polyclonal rabbit 5C3 M-T271 124 DX3 T56/14

Coulter Dako Pharmingen Dako Dako Dako Dako Immunoquality Dako Serotec Dako Dako Dako Immunotech Immunotech Immunotech Pharmingen Dako Serotec Dako Miltenyi Caltag Caltag Immunotech Dako Pharmingen Dako Dako Dako Dako Dako Dako Dako Dako Dako Dako Pharmingen Dako Dako Dako Caltag

PeCy5 FITC, PE PeCy5 FITC FITC, PE FITC, PE FITC, PE PE PE FITC PE FITC, PE FITC, PE PE FITC, PE FITC, PE PE FITC, PE PE FITC PE PE PE PE FITC, PE PE FITC FITC FITC FITC FITC FITC, PE FITC, PE FITC FITC FITC FITC FITC FITC FITC PE

™¯fiÏÈ·

ÂÓ‰Ô΢ÙÙ¿ÚÈÔ˜ ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ï˘Ì¤Ó· ·ÙÙ·Ú· Ï˘Ì¤Ó· ·ÙÙ·Ú·

mb-1, ÂÓ‰Ô΢ÙÙ¿ÚÈÔ mb-1 ÂÈÊ¿ÓÂÈ·˜ ÂÓ‰Ô΢ÙÙ¿ÚÈÔ˜ ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÂÈÊ·ÓÂÈ·Îfi & ÂÓ‰Ô΢ÙÙ¿ÚÈÔ

CD66c ˘Ô‰Ô¯¤·˜ IL3 Class III ÔÈÎÔÁ¤ÓÂÈ· tetraspan ÔÈÎÔÁ¤ÓÂÈ· tetraspan CD133 (stem cells) Û˘Ó‰¤Ù˘ FLT3 c-kit chondroitin sulfate proteoglycan mb-2

ÂÓ‰Ô΢ÙÙ¿ÚÈÔ˜ ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ï˘Ì¤Ó· ·ÙÙ·Ú· Ï˘Ì¤Ó· ·ÙÙ·Ú· Ï˘Ì¤Ó· ·ÙÙ·Ú· Ï˘Ì¤Ó· ·ÙÙ·Ú·

ÂÓ‰Ô΢ÙÙ¿ÚÈÔ˜ ÚÔÛ‰ÈÔÚÈÛÌfi˜

FITC: ÊÏÔ˘ÔÚÂÛΛÓË, PE: Ê˘ÎÔÂÚ˘ıÚ›ÓË, PeCy5: PE ΢·Ó›ÓË 5’, CD: cluster of differentiation Dako (Glostrup, Denmark), Immunotech (Beckman Coulter), Coulter (Beckman Coulter), Pharmingen (San Diego, CA), Immunoquality (Groningen, The Netherlands), Caltag (Burlingame, CA), Serotec (Oxford, UK), Miltenyi Biotec (GmbH) O§§ Î·È ÙË Û‡ÁÎÚÈÛË Ì ٷ ·ÓÔÛÔÊ·ÈÓÔÙ˘Èο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ‚Ï·ÛÙÒÓ ÛÙȘ µ-O§§ ηٿ ÙË ‰È¿ÁÓˆÛË, fiˆ˜ ÂÚÈÁÚ¿ÊÂÙ·È ÛÙÔ ÎÂÊ¿Ï·ÈÔ ÙˆÓ ∞ÔÙÂÏÂÛÌ¿ÙˆÓ Î·È ÛÙÔÓ ¶›Ó·Î· 3. ∞Ú¯Èο, ÌÂÏÂÙ¿Ù·È ÙÔ ‰Â›ÁÌ· ÙÔ˘ Ì˘ÂÏÈÎÔ‡ ÂӷȈڋ̷ÙÔ˜ Ì ‚¿ÛË ÙÔ˘˜ Û˘Ó‰˘·ÛÌÔ‡˜ CD19-FITC/CD10PE/CD45-PeCY5 Î·È CD38-FITC/ CD79a (ÂÓ‰Ô΢ÙÙ¿ÚÈÔ)/ CD45-Pecy5. ™Ùfi¯Ô˜ Â›Ó·È Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙÔ˘ µ ÛÙÔÈ¯Â›Ô˘, ÙÔ ÔÔ›Ô ÂÎÊÚ¿˙ÂÙ·È Â› % Â› ÙˆÓ ÂÌ‡ÚËÓˆÓ Î˘ÙÙ¿ÚˆÓ ‹ ÙˆÓ Ï¢ÎÔ΢ÙÙ¿ÚˆÓ (ÂÌ‡ÚËÓ· Ì›ÔÓ ÂÚ˘ıÚÔ‚Ï¿ÛÙ˜) ÙÔ˘ Ì˘ÂÏÈÎÔ‡ ÂӷȈڋ̷ÙÔ˜. ∆Ô ÔÛÔÛÙfi ÂÚ˘ıÚÔ‚Ï·ÛÙÒÓ Î·È Ï¢ÎÔ΢ÙÙ¿ÚˆÓ ÌÂÏÂÙ¿Ù·È Û οı ÂÚ›ÙˆÛË Ì ÙË

ÊıÔÚ›˙Ô˘Û· ¤Ì‚ÈÔ ¯ÚÒÛË SYTO16 Ô˘ ÂÎ¤ÌÂÈ ÛÙ· 518 nÌ (Molecular Probes, Leiden, The Netherlands) ÛÂ Û˘Ó‰˘·ÛÌfi Ì ٷ ÌÔÓÔÎψÓÈο ·ÓÙÈÛÒÌ·Ù· CD71-PE Î·È CD45-PeCy5.

AÓ ‰ÂÓ ‚ÚÂı› µ ÛÙÔÈ¯Â›Ô Î·È Ì ٷ ÙÚ›· ‚·ÛÈο ·ÓȯÓ¢ÙÈο ÌÔÓÔÎψÓÈο ·ÓÙÈÛÒÌ·Ù· CD19, CD10 Î·È ÂÓ‰Ô΢ÙÙ¿ÚÈÔ CD79a, Ô ¤ÏÂÁ¯Ô˜ ÛÙ·Ì·Ù¿ ‰Ò. ∞Ó ‚ÚÂı› ·ÔÎÏÂÈÛÙÈο ÒÚÈÌÔ ÛÙÔÈ¯Â›Ô µ ¯ˆÚ›˜ ÂӉ›ÍÂȘ ÁÈ· Û˘Ó‡·ÚÍË Úfi‰ÚÔÌÔ˘ ·ıÔÏÔÁÈÎÔ‡ ‹ Ê˘ÛÈÔÏÔÁÈÎÔ‡ ÛÙÔÈ¯Â›Ô˘, Ô ¤ÏÂÁ¯Ô˜ ÛÙ·Ì·Ù¿ Î·È ¿ÏÈ Â‰Ò. ™Â οı ¿ÏÏË ÂÚ›ÙˆÛË, ·ÎfiÌË Î·È Â¿Ó Â›Ó·È ÚÔÊ·Ó‹˜ Ë ·ÚÔ˘Û›· ‡ÔÙÔ˘ ˘ÔÏÂÈÌÌ·ÙÈÎÔ‡ ÏËı˘ÛÌÔ‡ ‹ ·ÈÌ·ÙÔÁÔÓ›ˆÓ, Ô ¤ÏÂÁ¯Ô˜ Û˘Ó¯›˙ÂÙ·È ÚÔ˜ ÂȂ‚·›ˆÛË Ù˘ ʇÛ˘ ÙÔ˘ Úfi‰ÚÔÌÔ˘ µ ÛÙÔÈ¯Â›Ô˘ Ì ‚¿ÛË ¤Ó·

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ÂÚÈÔÚÈṲ̂ÓÔ ·ÚÈıÌfi ·ÓÙÈÛˆÌ¿ÙˆÓ (panel) Û ÙÚÈÏÔ‡˜ Û˘Ó‰˘·ÛÌÔ‡˜ Ù˘ ÌÔÚÊ‹˜ Tdt-FITC/X-PE/CD45-PeCy5 (fiÔ˘ Ã-PE Ù· ÌÔÓÔÎψÓÈο CD123 (˘Ô‰Ô¯¤·˜ IL3), cÌ (΢ÙÙ·ÚÔÏ·ÛÌ·ÙÈ΋ Ì), KOR-SA3544 (Â›ÙÔÔ˜ ÙÔ˘ CD66c), CD34, CD38 Î·È CD10. ∞Ó ‰È·ÈÛÙÒÓÂÙ·È ·ÚÈıÌfi˜ ·ÔÎÏ›ÛÂˆÓ (aberrations) ·fi ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ÚfiÙ˘Ô ÙˆÓ ·ÈÌ·ÙÔÁÔÓ›ˆÓ ÌÈÎÚfiÙÂÚÔ˜ ÙˆÓ 2, ÙfiÙÂ Ô ¤ÏÂÁ¯Ô˜ ÂÂÎÙ›ÓÂÙ·È Û ÂÚÈÛÛfiÙÂÚ· ·ÓÙÈÛÒÌ·Ù· CD135 (FLT3 ligand), CD117 (c-kit), CD13, CD33, CD9, AC133 (·ÓÙÈÁfiÓÔ stem cell), NG2 (chondroitin sulfate proteoglycan, Û¯ÂÙÈ˙fiÌÂÓÔ Ì ÁÔÓ›‰ÈÔ MLL). ∆· ÔÛÔÛÙ¿ ÂοÛÙÔ˘ Ù‡Ô˘ µ ÏÂÌÊÔ΢ÙÙ·ÚÈÎÔ‡ ˘ÔÏËı˘ÛÌÔ‡ (·ÈÌ·ÙÔÁÔÓ›ˆÓ, ÒÚÈÌˆÓ µ ‹ MRD) ·Ó·Ê¤ÚÔÓÙ·È ˆ˜ ÔÛÔÛÙ¿ Â› % Â› ÙÔ˘ µ ÛÙÔÈ¯Â›Ô˘. ∏ ·Ó·ÁˆÁ‹ Â› ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ Ï¢ÎÒÓ ‹ ÙˆÓ ÂÌ‡ÚËÓˆÓ Î˘ÙÙ¿ÚˆÓ ÙÔ˘ Ì˘ÂÏÈÎÔ‡ ÂӷȈڋ̷ÙÔ˜ Á›ÓÂÙ·È Ì ‚¿ÛË ÙÔ ÔÛÔÛÙfi ÙÔ˘ µ ÛÙÔÈ¯Â›Ô˘ Î·È ÙÔÓ ÏfiÁÔ ÂÚ˘ıÚÔ‚Ï·ÛÙÒÓ ÚÔ˜ ÏÂ˘Î¿ Ô˘ ˘ÔÏÔÁ›ÛÙËÎ·Ó Î˘ÙÙ·ÚÔÌÂÙÚÈο, fiˆ˜ ·Ó·Ê¤Ú·Ì ·ÓˆÙ¤Úˆ. H ·ÛÊ¿ÏÂÈ· ·Ó›¯Ó¢Û˘ MRD Ú¤ÂÈ Ó· ·Ó·ıˆÚÂ›Ù·È fiÙ·Ó ‰ÂÓ Û¯ËÌ·Ù›˙ÂÙ·È Û·Ê¤˜ ¿ıÚÔÈÛÌ· (cluster) ·ÔÙÂÏÔ‡ÌÂÓÔ ÙÔ˘Ï¿¯ÈÛÙÔÓ ·fi 50 ÁÂÁÔÓfiÙ· ·Ú›ıÌËÛ˘ (events) Î·È fiÙ·Ó ˘¿Ú¯ÂÈ ˘Ô„›· artifact Û‡Ó‰ÂÛ˘ Û ·ÔÙˆÙÈο ‹ ÓÂÎÚ¿ ·ÙÙ·Ú·, debris ‹ ·ÈÌÔÂÙ¿ÏÈ·.

∞ÔÙÂϤÛÌ·Ù· ∞ÓÔÛÔÊ·ÈÓÔÙ˘È΋ ÌÂϤÙË ·ÈÌ·ÙÔÁÔÓ›ˆÓ ∆· ·ÔÙÂϤÛÌ·Ù· Ù˘ ·ÓÔÛÔÊ·ÈÓÔÙ˘΋˜ ·Ó¿Ï˘Û˘ ÙˆÓ ·ÈÌ·ÙÔÁÔÓ›ˆÓ ÛÙÔÓ Ì˘ÂÏfi Ê·›ÓÔÓÙ·È ·Ó·Ï˘ÙÈο ÛÙÔÓ ¶›Ó·Î· 2 Î·È ·ÂÈÎÔÓ›˙ÔÓÙ·È ÛÙËÓ ∂ÈÎfiÓ· 1. ∏ ÌÔÚÊÔÏÔÁ›· ÙÔ˘˜ ÌÔÈ¿˙ÂÈ Ì ÏÂÌÊÔ‚Ï¿ÛÙ˜ L1, fiˆ˜ Ê·›ÓÂÙ·È ÛÙËÓ ∂ÈÎfiÓ· 2. ∆Ô ÔÛÔÛÙfi Ù˘ ¤ÎÊÚ·Û˘ οı ·ÓÙÈÛÒÌ·ÙÔ˜ ·Ó·Ê¤ÚÂÙ·È Â› ÙÔ˘ Û˘ÁÎÂÎÚÈ̤ÓÔ˘ ˘ÔÏËı˘ÛÌÔ‡ ·ÈÌ·ÙÔÁÔÓ›ˆÓ (‚Ï. ηو٤ڈ). ∞ÚÓËÙÈÎfi ıˆڋıËΠÔÛÔÛÙfi 0-10% Î·È Û˘Ì‚ÔÏ›ÛÙËΠ̠neg. ¶ÔÛÔÛÙfi ¤ÎÊÚ·Û˘ 10-20% ıˆڋıËΠ·ÛıÂÓ¤˜ Î·È ·ÌÊÈ‚fiÏÔ˘ ıÂÙÈÎfiÙËÙ·˜ ¯ˆÚ›˜ Ó· ÌÔÚ› Ó· ·ÁÓÔËı› Î·È Û˘Ì‚ÔÏ›ÛÙËΠ̠low. ¶ÔÛÔÛÙ¿ ÌÂÁ·Ï‡ÙÂÚ· ÙÔ˘ 20% ‹Ù·Ó ıÂÙÈο Î·È ‰È·ÎÚ›ıËÎ·Ó Û ÂӉȿÌÂÛ˘ ıÂÙÈÎfiÙËÙ·˜ 20-70% Ô˘ Û˘Ì‚ÔÏ›ÛıËÎ·Ó Ì mid Î·È ˘„ËÏ‹˜ ¤ÓÙÔÓ˘ ¤ÎÊÚ·Û˘ ¿Óˆ ÙÔ˘ 70% Ô˘ Û˘Ì‚ÔÏ›ÛıËÎ·Ó Ì high. O ¯·Ú·ÎÙËÚÈÛÌfi˜ Ù˘ ¤ÎÊÚ·Û˘ ÂÓfi˜ ·ÓÙÈÛÒÌ·ÙÔ˜ ÂÚȤϷ‚ Û ÔÚÈṲ̂Ó˜ ÂÚÈÙÒÛÂȘ ̤¯ÚÈ ‰‡Ô ÂÎÊÚ¿ÛÂȘ, ·fi ÙȘ Ôԛ˜ Ë ÚÒÙË ‹Ù·Ó Ë Û˘¯ÓfiÙÂÚ· ·Ú·ÙËÚÔ‡ÌÂÓË (.¯. AC133 neg/low ÛËÌ·›ÓÂÈ fiÙÈ Û˘Ó‹ıˆ˜ ˘¿Ú¯ÂÈ ¤ÎÊÚ·ÛË ÌÈÎÚfiÙÂÚË ÙÔ˘ 10%, ·ÏÏ¿ Û·ÓÈfiÙÂÚ· ÌÔÚ› Ó· ˘Âڂ› ÙÔ 20%). ∂ȉÈο ÁÈ· ÙÔ ·Óٛۈ̷ CD45 ‰ÂÓ ›Û¯˘Û·Ó ÔÈ ·ÓˆÙ¤Úˆ Û˘Ì‚ÔÏÈÛÌÔ›, ·ÏÏ¿ Ë ¤ÎÊÚ·Û‹ ÙÔ˘ ¯·Ú·ÎÙËÚ›ÛÙËΠÌfiÓÔ Ì ‚¿ÛË ÙÔ ÏfiÁÔ Ù˘ ¤ÓÙ·Û˘ ÙÔ˘ ÊıÔÚÈÛÌÔ‡ ÙˆÓ ·ÈÌ·ÙÔÁÔÓ›ˆÓ ˆ˜ ÚÔ˜ ÂΛÓË ÙˆÓ ÒÚÈÌˆÓ µ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Î·È Û˘Ì‚ÔÏ›ÛıËΠˆ˜ pi (positivity index). ∆· ·ÈÌ·ÙÔÁfiÓÈ· ‹Ù·Ó fiÏ· ÂÍ ÔÚÈÛÌÔ‡ CALLA

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(CD10) ıÂÙÈο Î·È ‰È·ÎÚ›ıËÎ·Ó ·ÓÔÛÔÊ·ÈÓÔÙ˘Èο Û ÙÚÂȘ ˘ÔηÙËÁÔڛ˜ Ô˘ ÔÓÔÌ¿ÛıËÎ·Ó “Ù¿ÍÂȘ” Î·È ÂÌÊ·Ó›˙Ô˘Ó Ù· ηو٤ڈ ·ÚÈ· ¯·Ú·ÎÙËÚÈÛÙÈο (¶›Ó·Î·˜ 2): ·) ∞ÈÌ·ÙÔÁfiÓÈ· Ù¿Í˘ π (∏1): Tdt 100% (ÂÍ ÔÚÈÛÌÔ‡) Î·È ÂÈϤÔÓ ¯·Ú·ÎÙËÚÈÛÙÈο CD34 high, cÌ low/neg, CD20 mid, CD38 high, CD9 high, CD123 neg/low, KOR-SA3544 neg, AC133 neg/low, CD135 neg/low, CD117 neg/low, NG2 neg. Œ¯Ô˘Ó ·ÛıÂÓ‹ ¤ÓÙ·ÛË CD45 (dim) Î·È ÙÔ pi Î˘Ì·›ÓÂÙ·È ·fi 0,10 ¤ˆ˜ 0,15. ‚) ∞ÈÌ·ÙÔÁfiÓÈ· Ù¿Í˘ ππ (∏2): Tdt 0% (ÂÍ ÔÚÈÛÌÔ‡), (Î+Ï) ÂÈÊ¿ÓÂÈ·˜ 0% (ÂÍ ÔÚÈÛÌÔ‡). ∂ÈϤÔÓ ¯·Ú·ÎÙËÚÈÛÙÈο ‹Ù·Ó: CD38 high, CD34 neg, cÌ high, CD20 high, CD38 high, CD9 high, CD123 low/mid, KOR-SA3544 neg. Œ¯Ô˘Ó ÂӉȿÌÂÛË ¤ÓÙ·ÛË CD45 (int) Î·È ÙÔ pi Î˘Ì·›ÓÂÙ·È ·fi 0,30 ¤ˆ˜ 0,40. Á) ∞ÈÌ·ÙÔÁfiÓÈ· Ù¿Í˘ πππ (∏3) Ì ¯·Ú·ÎÙËÚÈÛÙÈο: CD10+ (ÂÍ ÔÚÈÛÌÔ‡), (Î+Ï) ÂÈÊ¿ÓÂÈ·˜ 100% (ÂÍ ÔÚÈÛÌÔ‡). ∂ÈϤÔÓ ¯·Ú·ÎÙËÚÈÛÙÈο ‹Ù·Ó: CD20 high, cÌ high, CD79b high, FMC7 mid, CD5 low, CD23 neg, CD43 high, CD40 low, CD27 neg, bcl2 neg, IgM high, IgD mid, IgA mid. Œ¯Ô˘Ó ¤ÓÙÔÓË ¤ÓÙ·ÛË CD45 (bright) Î·È ÙÔ pi Î˘Ì·›ÓÂÙ·È ·fi 0,9 ¤ˆ˜ 1,0. ∆· ·ÈÌ·ÙÔÁfiÓÈ· Ù¿Í˘ π Û˘Ì‚ÔÏ›˙ÔÓÙ·È ∏1 Î·È Ù· ٿ͈˜ ππ Î·È πππ ∏2 Î·È ∏3, ·ÓÙ›ÛÙÔȯ·. ∆· ˘fiÏÔÈ· ÒÚÈÌ· µ ÏÂÌÊÔ·ÙÙ·Ú· ÛÙÔ Ì˘ÂÏfi ·ÛıÂÓÒÓ Ì ·ÈÌ·ÙÔÁfiÓÈ· Û˘Ì‚ÔÏ›˙ÔÓÙ·È ˆ˜ µ Î·È ÂÍ ÔÚÈÛÌÔ‡ ‹Ù·Ó CD10 neg Î·È Î+Ï ÂÈÊ¿ÓÂÈ·˜ ÂÓÙfiÓˆ˜ ıÂÙÈο (ÂÍ ÔÚÈÛÌÔ‡). ∂ÈϤÔÓ ¯·Ú·ÎÙËÚÈÛÙÈο ‹Ù·Ó CD20 high, CD79b high, FMC7 high, CD5 mid, CD23 low, CD43 mid, CD40 mid, CD27 low, bcl2 low/mid, πgM high, IgD mid, IgA mid. ∏ ¤ÓÙ·ÛË ÙÔ˘ CD45 ÂÍ ÔÚÈÛÌÔ‡ Â›Ó·È pi=1. ∂› ¤ÓÙ ÂÚÈÛÙ·ÙÈÎÒÓ Ù˘ ÔÌ¿‰·˜ ÙˆÓ Ì·ÚÙ‡ÚˆÓ Ì ·ÈÌ·ÙÔÁfiÓÈ· ¿Óˆ ÙÔ˘ 20% ÛÙÔ Ì˘ÂÏfi ÌÂÏÂÙ‹ıËÎ·Ó Ù· µ ÏÂÌÊÔ·ٷڷ Î·È ÛÙÔ ·›Ì· ·Ú¿ÏÏËÏ· Î·È ‚Ú¤ıËÎ·Ó Î‡ÙÙ·Ú· Ì ¯·Ú·ÎÙËÚÈÛÙÈο ·ÈÌ·ÙÔÁÔÓ›ˆÓ ∏3 (CD10+) Ì (Î+Ï) ÂÈÊ¿ÓÂÈ·˜ Û ÔÛÔÛÙfi 15-25% Â› ÙˆÓ Ï¢ÎÒÓ. ∆· Ê·ÈÓÔÙ˘Èο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ÂÓ ÏfiÁˆ ΢ÙÙ¿ÚˆÓ, Ù· ÔÔ›· ÔÓÔÌ¿ÛÙËÎ·Ó ∏3 ÙÔ˘ ·›Ì·ÙÔ˜, Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 4 Û˘ÁÎÚÈÙÈο Ì ٷ ·ÓÙ›ÛÙÔȯ· ∏2, ∏3 Î·È ˘fiÏÔÈ· ÒÚÈÌ· µ ÙÔ˘ Ì˘ÂÏÔ‡ Î·È ÙÔ˘ ·›Ì·ÙÔ˜ Î·È ·ÂÈÎÔÓ›˙ÔÓÙ·È ÛÙËÓ ∂ÈÎfiÓ· 3. ¶·Ú·ÙËÚ‹ıËΠ˘„ËÏfiÙÂÚË ¤ÎÊÚ·ÛË ÙÔ˘ CD5 Â› ÙˆÓ ∏3 ÙÔ˘ ·›Ì·ÙÔ˜ Û ۯ¤ÛË Ì ٷ ∏3 ÙÔ˘ Ì˘ÂÏÔ‡, fiˆ˜ Â›Û˘ ‰È·ÈÛÙÒıËΠ‰È·ÊÔÚ¿ ÌÂٷ͇ ÙˆÓ ∏3 ÙÔ˘ ·›Ì·ÙÔ˜ fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ¤ÎÊÚ·ÛË ÙˆÓ bcl2 Ì ·Ô˘Û›· ¤ÎÊÚ·Û˘ Â› ÙˆÓ ∏3 Î·È ıÂÙÈ΋ ¤ÎÊÚ·ÛË Â› ÙˆÓ ˘fiÏÔÈˆÓ µ. ∂›Û˘, Â› ÙˆÓ ∏3 ·Ú·ÙËÚ‹ıËΠÌÈÎÚ‹ ¤ÎÊÚ·ÛË CD40, Ë ÔÔ›· ‹Ù·Ó

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¶›Ó·Î·˜ 2. ∂ÎÙÂٷ̤ÓË ·ÓÔÛÔÊ·ÈÓÔÙ˘È΋ ÌÂϤÙË ÙˆÓ ·ÈÌ·ÙÔÁÔÓ›ˆÓ Î·È ÙˆÓ ˘fiÏÔÈˆÓ ÒÚÈÌˆÓ µ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ÛÙÔÓ Ì˘ÂÏfi ·È‰ÈÒÓ Ì·ÚÙ‡ÚˆÓ ¯ˆÚ›˜ O§§ µ-΢ÙÙ·ÚÈ΋˜ ÛÂÈÚ¿˜ ∞ÓÙÈÁfiÓ· CD45 CD10 ∆dt s(Î+Ï) CD19 cCD79a cCD3 cCD13 cÌ CD7 CD38 KOR-SA 3544 CD123 CD34 CD13+CD33 CD9 AC133 CD135 CD117 NG2 CD20 CD79b FMC7 sCD79a(ZL7.4) CD5 CD23 CD43 sIgM sIgG sIgD sIgA CD40 CD27 bcl2 CD95

H1

H2

H3

B

dim (pi=0,1-0,2) high 100% ÂÍ ÔÚÈÛÌÔ‡ neg high high neg neg low/neg neg high neg neg/low high/mid neg/low high neg/low neg/low neg/low neg mid neg neg neg neg neg high neg neg neg neg neg neg neg neg

int (pi=0,3-0,4) 100% ÂÍ ÔÚÈÛÌÔ‡ 0% ÂÍ ÔÚÈÛÌÔ‡ 0% ÂÍ ÔÚÈÛÌÔ‡ high high neg neg high neg high neg low/mid neg neg high neg neg neg neg high neg neg neg neg neg high mid neg neg neg neg neg neg neg

bright (pi=0,9-1,0) 100% ÂÍ ÔÚÈÛÌÔ‡ 0% ÂÍ ÔÚÈÛÌÔ‡ 100% ÂÍ ÔÚÈÛÌÔ‡ high high neg neg high neg high neg mid/low neg neg high neg neg neg neg high high mid high low neg high high low mid mid low neg neg neg

bright pi=1 ÂÍ ÔÚÈÛÌÔ‡ 0% ÂÍ ÔÚÈÛÌÔ‡ neg high high high neg neg high neg mid/high neg neg neg neg mid neg neg neg neg high high high high mid low mid high low/mid mid mid mid low low/mid neg

i) µ ˘ÔÏËı˘ÛÌÔ›: ·ÈÌ·ÙÔÁfiÓÈ· Ù¿Í˘ π Û˘Ì‚ÔÏ›˙ÔÓÙ·È (∏1) Î·È Ù· ٿ͈˜ ππ Î·È πππ (∏2 Î·È ∏3). ∆· ˘fiÏÔÈ· ÒÚÈÌ· µ ÏÂÌÊÔ·ÙÙ·Ú· Û˘Ì‚ÔÏ›˙ÔÓÙ·È ˆ˜ µ. EÍ ÔÚÈÛÌÔ‡, Ù· ∏1 Â›Ó·È 100% ıÂÙÈο ÁÈ· Tdt Î·È Ù· ∏2 Î·È ∏3 s(Î+Ï) 0% Î·È 100% ·ÓÙ›ÛÙÔȯ· Î·È ∆dt 0%. ii) ¶ÔÛÔÛÙ¿ ¤ÎÊÚ·Û˘ Â› ÙÔ˘ ‰Â‰Ô̤ÓÔ˘ ˘ÔÏËı˘ÛÌÔ‡ (·) 0-10% neg (‚) 10-20% low (Á) 20-70% mid (‰) ¿Óˆ ÙÔ˘ 70% high. O ¯·Ú·ÎÙËÚÈÛÌfi˜ Ù˘ ¤ÎÊÚ·Û˘ ÂÓfi˜ ·ÓÙÈÁfiÓÔ˘ ÌÔÚ› Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ‰‡Ô ÂÎÊÚ¿ÛÂȘ ‰È·¯ˆÚÈṲ̂Ó˜ Ì οıÂÙÔ (/), ÂÎ ÙˆÓ ÔÔ›ˆÓ Ë ÚÒÙË Â›Ó·È Ë Û˘¯ÓfiÙÂÚ· ·Ú·ÙËÚÔ‡ÌÂÓË. iii) ∂ȉÈο ÁÈ· ÙÔ ·Óٛۈ̷ CD45 ˘ÔÏÔÁ›˙ÂÙ·È Ô ÏfiÁÔ˜ Ù˘ ¤ÓÙ·Û˘ ÊıÔÚÈÛÌÔ‡ ÙˆÓ ·ÈÌ·ÙÔÁÔÓ›ˆÓ ÚÔ˜ ÂΛÓË ÙˆÓ ÒÚÈÌˆÓ µ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Ô˘ ÂÎÊÚ¿˙ÂÙ·È Ì ÙÔÓ ‰Â›ÎÙË pi. ∏ ·ÛıÂÓ‹˜ ¤ÓÙ·ÛË Û˘Ì‚ÔÏ›˙ÂÙ·È dim, Ë ÂӉȿÌÂÛË ¤ÓÙ·ÛË int Î·È Ë ¤ÓÙÔÓË bright. iv) ∆Ô c Û˘Ì‚ÔÏ›˙ÂÈ ÂÓ‰Ô΢ÙÙ¿ÚÈÔ Î·È ÙÔ s ÂÈÊ·ÓÂÈ·Îfi ·ÓÙÈÁfiÓÔ.

ÌÂÁ·Ï‡ÙÂÚË ÛÙ· ∏3 ÙÔ˘ ·›Ì·ÙÔ˜ Û ۯ¤ÛË Ì ÂΛӷ ÙÔ˘ Ì˘ÂÏÔ‡. ∆· ˘fiÏÔÈ· µ ÏÂÌÊÔ·ÙÙ·Ú· ÛÙÔ ·›Ì· Î·È ÙÔÓ Ì˘ÂÏfi ›¯·Ó ˘„ËÏfiÙÂÚË ¤ÎÊÚ·ÛË CD40 ·fi Ù· ·ÓÙ›ÛÙÔȯ· ·ÈÌ·ÙÔÁfiÓÈ·. ™‡ÁÎÚÈÛË ·ÓÔÛÔÊ·ÈÓfiÙ˘Ô˘ ÏÂÌÊÔ‚Ï·ÛÙÒÓ Î·È ·ÈÌ·ÙÔÁÔÓ›ˆÓ ∏1 ™Ù· ÌÂÏÂÙËı¤ÓÙ· ‰Â›ÁÌ·Ù· ·ÈÌ·ÙÔÁÔÓ›ˆÓ ‰È·ÈÛÙÒıËΠÛÙ·ıÂÚfiÙËÙ· Û ˘„ËÏfi ‚·ıÌfi Î·È Â·Ó¿ÏË„Ë ÙˆÓ ·ÓÔÛÔÊ·ÈÓÔÙ˘ÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ. ∞˘Ù‹ Ë ·Ô˘Û›· ÌÂÙ·‚ÏËÙfiÙËÙ·˜ Â¤ÙÚ„ ÙÔÓ Û¯Â‰È·ÛÌfi Ù˘ Û˘ÁÎÂÎÚÈ̤Ó˘ ÛÙÚ·ÙËÁÈ΋˜

·Ó›¯Ó¢Û˘ Î·È ·Ú·ÎÔÏÔ‡ıËÛ˘ Ù˘ ÂÏ¿¯ÈÛÙ˘ ˘ÔÏÂÈfiÌÂÓ˘ ÓfiÛÔ˘ (MRD) Ô˘ ÛÙËÚ›¯ıËΠ۠·ÔÎÏ›ÛÂȘ (aberrations) ÙˆÓ ÂÈ̤ÚÔ˘˜ ·ÓÙÈÁÔÓÈÎÒÓ ÂÎÊÚ¿ÛÂˆÓ ÙˆÓ Ï¢¯·ÈÌÈÎÒÓ ‚Ï·ÛÙÒÓ, ·fi ÂΛӘ ÙˆÓ ·ÈÌ·ÙÔÁÔÓ›ˆÓ. ™ÙËÓ ∂ÈÎfiÓ· 4 Ê·›ÓÔÓÙ·È Û˘ÁÎÚÈÙÈο ÔÈ Î·Ù·ÓÔ̤˜ (box & whisker) ÙˆÓ ÂÎÊÚ¿ÛÂˆÓ ÙˆÓ ·ÓÙÈÁfiÓˆÓ CD10, CD38, KORSA3544, CD123, CD34, cÌ, CD13,33, CD9, AC133, CD135, CD117 Î·È ¡G2 Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÛÙË ‰È¿ÎÚÈÛË ÏÂÌÊÔ‚Ï·ÛÙÒÓ Î·È ·ÈÌ·ÙÔÁÔÓ›ˆÓ ∏1. ∂›Û˘, ÔÈ ‰È·ÊÔÚ¤˜ ˆ˜ ÚÔ˜ ÙËÓ ¤ÓÙ·ÛË ÙÔ˘

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¶›Ó·Î·˜ 3. ¶ÚÔÙÂÈÓfiÌÂÓË ·ÏÁÔÚÈıÌÈ΋ ÚÔÛ¤ÁÁÈÛË ÛÙËÓ ·Ó·˙‹ÙËÛË Ù˘ ÂÏ¿¯ÈÛÙ˘ ˘ÔÏÂÈfiÌÂÓ˘ ÓfiÛÔ˘ (MRD) ÛÙË B ΢ÙÙ·ÚÈ΋˜ ÚÔ¤Ï¢Û˘ O§§ Î·È ÔÛÔÙÈÎÔÔ›ËÛË Ù˘ ¤ÎÊÚ·Û‹˜ Ù˘ µ‹Ì·Ù· ·ÏÁÔÚ›ıÌÔ˘

¢È·ÌfiÚʈÛË ·fiÊ·Û˘

¶ÔÛÔÙÈÎÔÔ›ËÛË

∞) ¶ÚÔÛ‰ÈÔÚÈÛÌfi˜ µ ÛÙÔÈ¯Â›Ô˘ ÌÂ Û˘Ó‰˘·Ṳ̂ÓË ¤ÎÊÚ·ÛË ÙˆÓ CD19/CD10 Î·È CD38/cCD79a Ì ÙÚ›ÙÔ ·Óٛۈ̷ ¿ÓÙÔÙ ÙÔ CD45 ÁÈ· ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi Ù˘ ˆÚÈÌfiÙËÙ·˜ Ì ‚¿ÛË ÙËÓ ¤ÓÙ·ÛË ÙÔ˘ CD45.

∞Ó ‰ÂÓ ˘¿Ú¯ÂÈ µ ÛÙÔȯ›Ô, Ô ¤ÏÂÁ¯Ô˜ ÛÙ·Ì·Ù¿ ‰Ò. ∞Ó ÙÔ B ÛÙÔÈ¯Â›Ô Â›Ó·È ·ÔÎÏÂÈÛÙÈο Î·È ÌfiÓÔ CD45bright, Ô ¤ÏÂÁ¯Ô˜ ÛÙ·Ì·Ù¿ ‰Ò. ™Â οı ¿ÏÏË ÂÚ›ÙˆÛË, Ô ¤ÏÂÁ¯Ô˜ Û˘Ó¯›˙ÂÙ·È.

∏ ÔÛÔÙÈ΋ ¤ÎÊÚ·ÛË ÙÔ˘ µ ÛÙÔÈ¯Â›Ô˘ ˘ÔÏÔÁ›˙ÂÙ·È Â› ÙˆÓ Ï¢ÎÒÓ, ·ÊÔ‡ Á›ÓÂÈ ·ÎÚÈ‚‹˜ ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù˘ ·Ó·ÏÔÁ›·˜ ÂÚ˘ıÚÔ‚Ï·ÛÙÒÓ/Ï¢ÎÒÓ ÛÙÔ Ì˘ÂÏÈÎfi ÂÓ·ÈÒÚËÌ· Ì ÙÔ ÚˆÙfiÎÔÏÏÔ SYTO16/CD71/CD45.

µ) Panel 1˘ ÁÚ·ÌÌ‹˜ Û˘ÓÂÎÊÚ¿ÛÂˆÓ ÙˆÓ ·ÓÙÈÁfiÓˆÓ CD123, cÌ, KOR-SA3544, CD34, CD38 Î·È CD10, Ì ÛÙ·ıÂÚÔ‡˜ Û˘Ó‰˘·ÛÌÔ‡˜ Ô˘ ¤¯Ô˘Ó ¿ÓÙÔÙ ∆dt Î·È CD45.

¶ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙÔ˘ Ù‡Ô˘ Î·È ÙÔ˘ ·ÚÈıÌÔ‡ ·ÔÎÏ›ÛÂˆÓ (aberrations) Ì ‚¿ÛË Ù· ÎÚÈÙ‹ÚÈ· Ô˘ ¤¯Ô˘Ó ÚÔÙ·ı›. ∞Ó Ô ·ÚÈıÌfi˜ ÙˆÓ ·ÔÎÏ›ÛÂˆÓ Â›Ó·È 0 ‹ 1, Ô ¤ÏÂÁ¯Ô˜ Û˘Ó¯›˙ÂÙ·È.

∏ ÔÛÔÙÈ΋ ¤ÎÊÚ·ÛË ÙˆÓ ·ÈÌ·ÙÔÁÔÓ›ˆÓ, ÒÚÈÌˆÓ µ Î·È ˘ÔÏÂÈfiÌÂÓ˘ ÓfiÛÔ˘ (MRD) ÂÎÊÚ¿˙ÂÙ·È % ÙÔ˘ µ ÛÙÔÈ¯Â›Ô˘ Î·È ·Ó¿ÁÂÙ·È Â› ÙˆÓ ÂÌ‡ÚËÓˆÓ ‹ ÙˆÓ Ï¢ÎÒÓ.

°) Panel 2˘ ÁÚ·ÌÌ‹˜ Û˘ÓÂÎÊÚ¿ÛÂˆÓ ÙˆÓ ·ÓÙÈÁfiÓˆÓ CD135, CD117, CD13, CD33, CD9, AC133, NG2, Ì ÛÙ·ıÂÚÔ‡˜ Û˘Ó‰˘·ÛÌÔ‡˜ Ô˘ ¤¯Ô˘Ó ¿ÓÙÔÙ ∆dt Î·È CD45.

∞Ó Ô ·ÚÈıÌfi˜ ÙˆÓ ·ÔÎÏ›ÛÂˆÓ Â›Ó·È ÙÔ˘Ï¿¯ÈÛÙÔÓ ‰‡Ô Î·È ÙÔ ÔÛfi Ù˘ ˘ÔÏÂÈfiÌÂÓ˘ ÓfiÛÔ˘ ÂÓÙfi˜ ÔÚ›ˆÓ ¢·ÈÛıËÛ›·˜ ·Ó›¯Ó¢Û˘ Ù˘ Ù¯ÓÈ΋˜ (‚Ï. ·Ú·χڈ˜), ÙÂÎÌËÚÈÒÓÂÙ·È MRD Ì ·ÛÊ¿ÏÂÈ·. ∂› Ì›·˜ ·fiÎÏÈÛ˘, Û˘ÓÂÎÙÈÌ¿Ù·È Ô Ù‡Ô˜ Ù˘ ·fiÎÏÈÛ˘ Î·È ÙÔ ÔÛfi Ù˘ MRD.

∆Ô ÔÛfi Ù˘ MRD Ú¤ÂÈ Ó· ·ÍÈÔÏÔÁÂ›Ù·È Ì ‚¿ÛË Ù· ·ÎfiÏÔ˘ı· ÎÚÈÙ‹ÚÈ·: ·) Ó· Û¯ËÌ·Ù›˙ÂÙ·È Û·Ê¤˜ cluster MRD Ì ÁÂÁÔÓfiÙ· ·Ú›ıÌËÛ˘ ÙÔ˘Ï¿¯ÈÛÙÔÓ >50 ‚) Ó· ÌËÓ Â›Ó·È artifact Û‡Ó‰ÂÛË ·ÓÙÈÛˆÌ¿ÙˆÓ ‹ ¿ÏϘ ·ÚÂÌ‚ÔϤ˜ fiˆ˜ debris, ·ÈÌÔÂÙ¿ÏÈ·, ·ÔÙˆÙÈο ·ÙÙ·Ú· Î.Ô.Î.

CD45 (pi) Ê·›ÓÔÓÙ·È ÛÙËÓ ∂ÈÎfiÓ· 5. ∂›Ó·È Û·Ê‹˜ Ë ÂÙÂÚÔÁ¤ÓÂÈ· ÙˆÓ ·ÓÙÈÁÔÓÈÎÒÓ ÂÎÊÚ¿ÛÂˆÓ Î·È Ë ‰È·ÛÔÚ¿ ÙˆÓ ÙÈÌÒÓ ÛÙȘ Ï¢¯·È̛˜, Û ·ÓÙ›ıÂÛË Ì ÙȘ ·Ú·ÙËÚÔ‡ÌÂÓ˜ ‰È·Î˘Ì¿ÓÛÂȘ ÛÙ· ·ÈÌ·ÙÔÁfiÓÈ·. ∞˘Ùfi ÂÈÙÚ¤ÂÈ ÙË ‰ËÌÈÔ˘ÚÁ›· ÎÚÈÙËÚ›ˆÓ, Ì ‚¿ÛË Ù· ÔÔ›· ηıÔÚ›˙ÔÓÙ·È ÔÈ ·ÔÎÏ›ÛÂȘ ÙˆÓ ·ÓÙÈÁÔÓÈÎÒÓ ÂÎÊÚ¿ÛÂˆÓ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ·Ó·Ï˘ÙÈο ÛÙÔÓ ¶›Ó·Î· 5. ™ÙÔÓ ¶›Ó·Î· 6 Ê·›ÓÂÙ·È Ô ·ÚÈıÌfi˜ ÙˆÓ ·ÔÎÏ›ÛÂˆÓ Û ÂÚÈÔÚÈṲ̂ÓÔ Î·È ÂÎÙÂٷ̤ÓÔ panel 7 ‹ 14 ·ÓÙÈÛˆÌ¿ÙˆÓ Ì ‚¿ÛË ÙËÓ ÚÔÙÂÈÓfiÌÂÓË ÛÙÚ·ÙËÁÈ΋. ∆· ÎÚÈÙ‹ÚÈ· ·ÛÊ·ÏÔ‡˜ ÂÓÙÔÈÛÌÔ‡ MRD Ú¤ÂÈ Î·Ù¿ ÙË ÁÓÒÌË Ì·˜ Ó· ÂÈ‚¿ÏÏÔ˘Ó ‰‡Ô ÙÔ˘Ï¿¯ÈÛÙÔÓ ·ÔÎÏ›ÛÂȘ ·fi ÙÔÓ Ê·ÈÓfiÙ˘Ô ÙˆÓ ∏1. ¢ÂÓ ·Ú·ÙËÚÂ›Ù·È ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ (88% ¤Ó·ÓÙÈ 91%) ÌÂٷ͇ ÙÔ˘ ÂÚÈÔÚÈṲ̂ÓÔ˘ Û ۯ¤ÛË Ì ÙÔ ÂÎÙÂٷ̤ÓÔ panel ·ÓÙÈÛˆÌ¿ÙˆÓ Ì ‚¿ÛË Ù· ÚÔÙÂÈÓfiÌÂÓ· ÎÚÈÙ‹ÚÈ·. ªÂ ‚¿ÛË ÙË Ì¤¯ÚÈ ÙÒÚ· ·ÔÎÙËı›۷ ÂÌÂÈÚ›· Ù˘ ·Ó¿Ï˘Û˘ ÙÔ˘ Ì˘ÂÏÈÎÔ‡ µ ÛÙÔÈ¯Â›Ô˘ ÛÙËÓ ·Ó·˙‹ÙËÛË Ù˘ MRD, ·Ú·ÙËÚ‹ıËÎ·Ó Ù· ·ÎfiÏÔ˘ı· ÚfiÙ˘· (patterns): i) ·ÓÙÂÏ‹˜ ·Ô˘Û›· ·ÓȯÓ‡ÛÈÌÔ˘ µ ÛÙÔÈ¯Â›Ô˘, ii) ·ÚÔ˘Û›· ÌfiÓÔ ÒÚÈÌÔ˘ µ ÛÙÔÈ¯Â›Ô˘, iii) ·ÚÔ˘Û›· ·ÈÌ·ÙÔÁÔÓ›ˆÓ ∏1-∏2-∏3 Ì·˙› Ì ÒÚÈÌÔ µ ÛÙÔÈ¯Â›Ô (Û˘Ó‹ıˆ˜ Ì ÂÈÎÚ¿ÙËÛË ÙˆÓ ·ÈÌ·ÙÔÁÔÓ›ˆÓ ∏2), iv) ·ÈÌ·ÙÔÁfiÓÈ· ¯ˆÚ›˜ ÒÚÈÌÔ µ ÛÙÔÈ¯Â›Ô Ì ˘ÂÚÔ¯‹ ÙˆÓ ∏1 ¤Ó·ÓÙÈ ÙˆÓ ∏2 ‹ ·ÎfiÌË Î·È ÌÔÓÔÌÂÚ‹˜ ηٷÓÔÌ‹ ∏1 Ô˘ ÚÔηÏ› Û‡Á¯˘ÛË fiÛÔÓ ·ÊÔÚ¿ ÛÙË ‰È¿ÎÚÈÛË ·fi ÙËÓ

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MRD, v) ·ÌÈÁ‹˜ ·ÚÔ˘Û›· ÓfiÛÔ˘ (Ì ‹ ¯ˆÚ›˜ ÒÚÈÌÔ µ ÛÙÔȯ›Ô) Î·È vi) Û˘Ó‡·ÚÍË MRD Î·È ·ÈÌ·ÙÔÁÔÓ›ˆÓ, fiÔ˘ ·Ô‰ÂÈÎÓ‡ÂÙ·È Ë ·ÚÔ˘Û›· Ù˘ ÓfiÛÔ˘ Ì ÙË ¯ÚËÛÈÌÔÔ›ËÛË ÂÈϤÔÓ ·ÓÙÈÁÔÓÈÎÒÓ ÂÎÊÚ¿ÛˆÓ, fiˆ˜ Ê·›ÓÂÙ·È ÛÙËÓ ∂ÈÎfiÓ· 6, fiÔ˘ ÙÔ ÛÙÔÈ¯Â›Ô Ù˘ ÓfiÛÔ˘ ÂÌÊ·Ó›˙ÂÈ ¤ÎÊÚ·ÛË KORSA3544. ∞ӷχÔÓÙ·˜ Ù· ÛÙÔȯ›· Ù˘ ·Ú·ÎÔÏÔ‡ıËÛ˘ ÙˆÓ ·ÛıÂÓÒÓ ÛÙ· ·Ó·ÊÂÚı¤ÓÙ· ¯ÚÔÓÈο ÛËÌ›· ÂϤÁ¯Ô˘ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ıÂÚ·›·˜, ‰È·ÈÛÙÒıËÎ·Ó ÔÈ Î·ÙˆÙ¤Úˆ Ù‡ÔÈ ÌÂÙ·‚ÔÏÒÓ ÙˆÓ µ ÏÂÌÊÔ΢ÙÙ·ÚÈÎÒÓ ˘ÔÏËı˘ÛÌÒÓ, ÔÈ Ôԛ˜ ÂÓ Û˘Ó¯›· Ô‰‹ÁËÛ·Ó ÛÙË ‰È¿ÎÚÈÛË ÙˆÓ ·ÛıÂÓÒÓ ÛÙȘ ηو٤ڈ ÙÚÂȘ ÔÌ¿‰Â˜: ·) OÌ¿‰· ∞ (17 ·ÛıÂÓ›˜). ªÂÙ¿ ÙËÓ ¤ÊÔ‰Ô ÂÌÊ¿ÓÈ˙·Ó ÌfiÓÔ ÒÚÈÌ· µ ÏÂÌÊÔ·ÙÙ·Ú· Î·È ÛÙË Ê¿ÛË Ù˘ ÛÙ·ıÂÚÔÔ›ËÛ˘, ·Ú¯Èο, ·ÈÌ·ÙÔÁfiÓÈ· ·ÚÎÂÙ¿ Û˘¯Ó¿ Ì ÂÈÎÚ¿ÙËÛË ÙˆÓ ∏1 ¤Ó·ÓÙÈ ÙˆÓ ∏2 ‹ ·ÎfiÌË Î·È ÌÂÌÔӈ̤ÓË ·ÚÔ˘Û›· ÙˆÓ ∏1 (ÂÓÒ ÛÙ· ‰Â›ÁÌ·Ù· Ù˘ ÔÌ¿‰·˜ ÙˆÓ Ì·ÚÙ‡ÚˆÓ ¯ˆÚ›˜ O§§ Ì ·ÈÌ·ÙÔÁfiÓÈ· ·Ú·ÙËÚ‹ıËΠηٿ ηÓfiÓ· ÙÚÈÌÂÚ‹˜ ‰ÔÌ‹ ÙˆÓ ·ÈÌ·ÙÔÁÔÓ›ˆÓ Ì ÂÈÎÚ¿ÙËÛË ÙˆÓ ∏2) (Ú‚Ï. ∂ÈÎfiÓ· 1). ™ÙËÓ ÔÌ¿‰· ∞ ‰ÂÓ ·ÓȯÓ‡ıËΠ۠η̛· Ê¿ÛË ˘ÔÏÂÈfiÌÂÓË ÓfiÛÔ˜ (∂ÈÎfiÓ· 7). ‚) OÌ¿‰· µ (16 ·ÛıÂÓ›˜) Ì ·Ó›¯Ó¢ÛË ·ÚÔ˘Û›·˜ ˘ÔÏÂÈfiÌÂÓ˘ ÓfiÛÔ˘ ηٿ ÙȘ ·Ú¯ÈΤ˜ Ê¿ÛÂȘ Ù˘ ıÂÚ·›·˜ (d15, d33). ∏ ªRD ÛÙÔ˘˜ ·ÛıÂÓ›˜ ·˘ÙÔ‡˜ Ù·¯¤ˆ˜ ÂÍ·Ê·Ó›ÛıËÎÂ Î·È ÛÙË

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∂ÈÎfiÓ· 2. ªÔÚÊÔÏÔÁ›· ·ÈÌ·ÙÔÁÔÓ›ˆÓ (∏) Ô˘ ı˘Ì›˙ÂÈ ‚Ï¿ÛÙ˜ L1 Û ‰Â›ÁÌ· fiÔ˘ Û˘Ó˘¿Ú¯Ô˘Ó Î·È ‚Ï¿ÛÙ˜ (BL). ∏ ‰È¿ÎÚÈÛË Ì ‚¿ÛË ÌfiÓÔ Ù· ÌÔÚÊÔÏÔÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÌÔÚ› Ó· ·Ԃ› ÂÈÛÊ·Ï‹˜.

∂ÈÎfiÓ· 1. ∫˘ÙÙ·ÚÔÌÂÙÚÈ΋ ·Ó¿Ï˘ÛË ÙˆÓ ·ÈÌ·ÙÔÁÔÓ›ˆÓ ÛÂ Ì˘ÂÏfi ·È‰ÈÔ‡ Ì ·‰È¢ÎÚ›ÓÈÛÙË Ô˘‰ÂÙÂÚÔÂÓ›· Ì ‚¿ÛË ÙËÓ ¤ÓÙ·ÛË ÙÔ˘ CD45, fiÔ˘ Ê·›ÓÂÙ·È Ë ÙÚÈÌÂÚ‹˜ ‰ÔÌ‹ Î·È Ë ‰È·ÊÔÚÂÙÈ΋ ¤ÓÙ·ÛË pi ÙÔ˘ CD45. ∆· ÂÌ‡ÚËÓ· ·ÙÙ·Ú· ‰È·¯ˆÚ›˙ÔÓÙ·È ·fi ÌË ÂȉÈο Û‹Ì·Ù· (debris, ·ÈÌÔÂÙ¿ÏÈ·, Ï˘Ì¤Ó· ÂÚ˘ıÚ¿) Ì ÙÔ ÊıÔÚÈfi¯ÚˆÌ· Syto-16 (Molecular Probes). ∆· ·ÈÌ·ÙÔÁfiÓÈ· ÚÔÛ‰ÈÔÚ›˙ÔÓÙ·È ˆ˜ CD10 ıÂÙÈο ÛÙÔȯ›·.

Û˘Ó¤¯ÂÈ· ÂÌÊ·Ó›ÛıËΠÏËı˘ÛÌfi˜ ÌfiÓÔ ÒÚÈÌˆÓ µ-ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Î·È ·ÎÔÏÔ‡ıˆ˜ ·ÈÌ·ÙÔÁÔÓ›ˆÓ, fiˆ˜ Î·È ÛÙËÓ ÔÌ¿‰· ∞ (∂ÈÎfiÓ· 7). Á) OÌ¿‰· ° (1 ·ÛıÂÓ‹˜). ™Ù·ıÂÚ‹ ·ÚÔ˘Û›· ˘ÔÏÂÈfiÌÂÓ˘ ÓfiÛÔ˘ ÂÍ·Ú¯‹˜ (∂ÈÎfiÓ· 7), Ì ‰È·Î‡Ì·ÓÛË ÌfiÓÔ ˆ˜ ÚÔ˜ ÙÔ ÊÔÚÙ›Ô Ù˘ ÓfiÛÔ˘. ∆ÚÈ¿ÓÙ· ‰‡Ô ·fi ÙÔ˘˜ ·ÓˆÙ¤Úˆ 34 ·ÛıÂÓ›˜, ηٿ ÙÔ ‰È¿ÛÙËÌ· ·Ú·ÎÔÏÔ‡ıËÛ˘ (9-36 Ì‹Ó˜) Ì ‰È¿ÌÂÛÔ ¯ÚfiÓÔ 23 Ì‹Ó˜, ˙Ô˘Ó Û ÚÒÙË Ï‹ÚË ‡ÊÂÛË. ™Â 58 ‰Â›ÁÌ·Ù· Ì˘ÂÏÔ‡ ÂÈÎÚ·ÙÔ‡Û·Ó Û ÔÛÔÛÙfi >3% Â› ÙˆÓ ÂÌ‡ÚËÓˆÓ ·ÈÌ·ÙÔÁfiÓÈ· ٿ͈˜ π (∂ÈÎfiÓ· 7). ™ÙȘ ÂÚÈÙÒÛÂȘ ·˘Ù¤˜ ‰ËÌÈÔ˘ÚÁ‹ıËÎ·Ó Û Â›Â‰Ô ÌÔÚÊÔÏÔÁÈÎfi, ÚÈÓ ÙËÓ ·ÓÔÛÔÊ·ÈÓÔÙ˘È΋ ÌÂϤÙË, ·ÌÊÈ‚Ôϛ˜ ÁÈ· Èı·Ó‹ ·Ú¯fiÌÂÓË ˘ÔÙÚÔ‹. ∏ ΢ÙÙ·ÚÔÌÂÙÚÈ΋ ÌÂϤÙË ÙÂÎÌËÚ›ˆÛ ÙË Ê‡ÛË ÙˆÓ ·ÈÌ·ÙÔÁÔÓ›ˆÓ Î·È Î·Ó¤-

Ó·˜ ·ÛıÂÓ‹˜ ÙˆÓ ÔÌ¿‰ˆÓ ∞ (14/17) Î·È µ (13/16) (∂ÈÎfiÓ· 7), ÛÙÔ˘˜ ÔÔ›Ô˘˜ ˘‹ÚÍ ¤ÓÙÔÓÔ ‰È·ÊÔÚԉȷÁÓˆÛÙÈÎfi Úfi‚ÏËÌ· ÌÂٷ͇ ·ÈÌ·ÙÔÁÔÓ›ˆÓ Î·È ÓfiÛÔ˘, ‰ÂÓ ˘ÔÙÚÔ›·Û ÛÙÔÓ ‰È¿ÌÂÛÔ ¯ÚfiÓÔ ·Ú·ÎÔÏÔ‡ıËÛ˘ Ù˘ ÌÂϤÙ˘, ÁÂÁÔÓfi˜ Ô˘ ÂȂ‚·ÈÒÓÂÈ ÙËÓ ·ÍÈÔÈÛÙ›· ÙÔ˘ ÂϤÁ¯Ô˘. ¢‡Ô ·ÛıÂÓ›˜ ·fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ 34, ¤Ó·˜ HRG t(9;22) ıÂÙÈÎfi˜ Ù˘ ÔÌ¿‰·˜ ∞ Î·È ¤Ó·˜ HRG ÌÂ Û˘Ó¯‹ ·ÚÔ˘Û›· ˘ÔÏÂÈfiÌÂÓ˘ ÓfiÛÔ˘, ÂÈ‚ÈÒÓÔ˘Ó Î·Ù¿ ÙÔÓ ¯ÚfiÓÔ Ù˘ ÌÂϤÙ˘, ÌÂÙ¿ ·fi ˘ÔÙÚÔ‹, Ë ÔÔ›· ÂÈÛ˘Ó¤‚Ë 1 Î·È 5 Ì‹Ó˜ ·ÓÙ›ÛÙÔȯ· ·fi ÙËÓ ÂÓ Ùˆ ÌÂٷ͇ ‰ÈÂÓÂÚÁËı›۷ Î·È ÛÙÔ˘˜ ‰‡Ô ·ÏÏÔÁÂÓ‹ ÌÂÙ·ÌfiÛ¯Â˘ÛË ·fi Û˘ÁÁÂÓ‹ Ï‹Úˆ˜ Û˘Ì‚·Ùfi ‰fiÙË. ªÂٷ͇ ÙˆÓ ·ÛıÂÓÒÓ ÙˆÓ ÔÌ¿‰ˆÓ ∞, µ Î·È ° ‚Ú¤ıËΠÂÈÎÚ¿ÙËÛË ÙˆÓ ¯·ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ·ÛıÂÓÒÓ ÛÙËÓ ÔÌ¿‰· ∞ (10 SRG, 5 MRG, 2 HRG) ¤Ó·ÓÙÈ ÙˆÓ ·ÓÙ›ÛÙÔȯˆÓ SRG ·ÛıÂÓÒÓ ÛÙȘ ÔÌ¿‰Â˜ µ Î·È ° (2 SRG, 9 ªRG, 6 HRG). µÚ¤ıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ ÎÈÓ‰‡ÓÔ˘ ÙÔ˘ ÚˆÙÔÎfiÏÏÔ˘ ALL-BFM ’95 Î·È ÙˆÓ ÔÌ¿‰ˆÓ A, B Î·È ° (Ã2=11,13, p=0,02). ™Â ‰‡Ô ·fi ÙÔ˘˜ 22 ·ÛıÂÓ›˜, ÔÈ ÔÔ›ÔÈ ÌÂÏÂÙ‹ıËÎ·Ó ÌÂÌÔӈ̤ӷ ηٿ ÙË ‰È¿ÚÎÂÈ· ‹ ÙÔ Ù¤ÏÔ˜ Ù˘ ıÂÚ·›·˜ Û˘ÓÙ‹ÚËÛ˘, ·ÓȯÓ‡ıËΠ΢ÙÙ·ÚÔÌÂÙÚÈο MRD, ÂÓÒ ‚Ú›ÛÎÔÓÙ·Ó Û ÎÏÈÓÈ΋ Î·È ÌÔÚÊÔÏÔÁÈ΋ ‡ÊÂÛË. O ¤Ó·˜ ÂÍ ·˘ÙÒÓ ˘ÔÙÚÔ›·Û Ï‹Úˆ˜ Î·È ÌÔÚÊÔÏÔÁÈο ÂÓÙfi˜ ÙˆÓ 4 ÌËÓÒÓ ·Ú·ÎÔÏÔ‡ıËÛ˘ Ô˘ ·ÎÔÏÔ‡ıËÛ·Ó, ÂÓÒ Ë ‰Â‡ÙÂÚË ·ÛıÂÓ‹˜ ·Ú·Ì¤ÓÂÈ ·ÎfiÌË Û ÌÔÚÊÔÏÔÁÈ΋ ‡ÊÂÛË, ·ÏÏ¿ Ì ÂÚÈÊÂÚÈ΋ ΢ÙÙ·ÚÔÂÓ›· ÛÙÔ˘˜ 2 Ì‹Ó˜ Ù˘ ̤¯ÚÈ ÙÒÚ· ·Ú·ÎÔÏÔ‡ıËÛ‹˜ Ù˘. ∆¤ÏÔ˜, Ù· Â˘Ú‹Ì·Ù· ÂȂ‚·ÈÒıËÎ·Ó ·ÓÔÛÔÊ·ÈÓÔÙ˘Èο Î·È ÛÙÔ˘˜ 6 ·ÛıÂÓ›˜ Ô˘ ÂϤÁ¯ıËÎ·Ó ÛÂ

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¶›Ó·Î·˜ 4. ™˘ÁÎÚÈÙÈ΋ ÌÂϤÙË ÙÔ˘ ·ÓÔÛÔÊ·ÈÓfiÙ˘Ô˘ ÙˆÓ ·ÈÌ·ÙÔÁÔÓ›ˆÓ ∏2, ∏3 Î·È ÙˆÓ ÏÔÈÒÓ µ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ÛÙÔÓ Ì˘ÂÏfi ·È‰ÈÒÓ Ì ·˘ÍË̤ÓÔ ÔÛÔÛÙfi ·ÈÌ·ÙÔÁÔÓ›ˆÓ ÛÙÔÓ Ì˘ÂÏfi Î·È ÙˆÓ ·ÈÌ·ÙÔÁÔÓ›ˆÓ ∏3 Î·È ÙˆÓ ˘fiÏÔÈˆÓ µ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ÛÙÔ ·›Ì· ∞ÓÙÈÁfiÓ· CD20 CD5 FMC7 CD23 CD43 CD38 CD9 bcl2 CD95 CD40

∏2 mid neg neg neg high high high neg neg neg

ª˘ÂÏfi˜ ∏3

∞›Ì· µ

high high low mid mid high neg neg/low high mid high mid/high high mid/high neg low neg neg low mid

∏3

µ

high high mid mid high high neg low/mid high mid high mid/high high mid/high low mid neg low mid high

i) µ ˘ÔÏËı˘ÛÌÔ›: ·ÈÌ·ÙÔÁfiÓÈ· ٿ͈˜ ππ Î·È πππ (∏2 Î·È ∏3). ∆· ˘fiÏÔÈ· ÒÚÈÌ· µ ÏÂÌÊÔ·ÙÙ·Ú· Û˘Ì‚ÔÏ›˙ÔÓÙ·È ˆ˜ µ. EÍ ÔÚÈÛÌÔ‡, Ù· ∏3 s(Î+Ï) 0% Î·È CD10+, ÂÓÒ Ù· µ CD10. ii) ¶ÔÛÔÛÙ¿ ¤ÎÊÚ·Û˘ Â› ÙÔ˘ ‰Â‰Ô̤ÓÔ˘ ˘ÔÏËı˘ÛÌÔ‡ (·) 0-10% neg (‚) 10-20% low (Á) 20-70% mid (‰) ¿Óˆ ÙÔ˘ 70% high. O ¯·Ú·ÎÙËÚÈÛÌfi˜ Ù˘ ¤ÎÊÚ·Û˘ ÂÓfi˜ ·ÓÙÈÁfiÓÔ˘ ÌÔÚ› Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ‰‡Ô ÂÎÊÚ¿ÛÂȘ ‰È·¯ˆÚÈṲ̂Ó˜ Ì οıÂÙÔ (/), ÂÎ ÙˆÓ ÔÔ›ˆÓ Ë ÚÒÙË Â›Ó·È Ë Û˘¯ÓfiÙÂÚË.

Ê¿ÛË ˘ÔÙÚÔ‹˜, Ë ‰Â ÔÚ›· Ù˘ MRD ηٿ ÙËÓ Â·ÓÂÈÛ·ÁˆÁ‹ ÙÔ˘˜ Û ‡ÊÂÛË, ÂÎÙÈÌ‹ıËΠ·ÍÈfiÈÛÙ· ÚÔÔÙÈο, ˆ˜ ‹‰Ë ·Ó·Ï‡ıËÎÂ Î·È ÛÙÔ˘˜ ÚÔËÁÔ˘Ì¤ÓÔ˘˜ ·ÛıÂÓ›˜. ™˘˙‹ÙËÛË ∏ ·Ó›¯Ó¢ÛË Ù˘ ˘ÔÏÂÈfiÌÂÓ˘ ÓfiÛÔ˘ (MRD) ÛÙË µ-΢ÙÙ·ÚÈ΋˜ ÚÔ¤Ï¢Û˘ ÔÍ›· ÏÂÌÊÔ‚Ï·ÛÙÈ΋ Ï¢¯·ÈÌ›· (B-O§§) Ù˘ ·È‰È΋˜ ËÏÈΛ·˜, ·ÔÙÂÏ› ıÂÌÂÏÈ҉˜ ÛÙÔÈ¯Â›Ô Ù˘ ·Ú·ÎÔÏÔ‡ıËÛ˘ ÙˆÓ ·ÛıÂÓÒÓ, ηı’ fiÛÔÓ ÚÔÔȈӛ˙ÂÈ ÙËÓ ÙÂÏÈ΋ ÔÚ›· Î·È ¤Î‚·ÛË (10). ¶ÚÔËÁÔ‡ÌÂÓ˜ ÌÂϤÙ˜ ·Ú·ÎÔÏÔ‡ıËÛ˘ Ù˘ MRD, ·ÓÔÛÔÊ·ÈÓÔÙ˘ÈΤ˜ ‹ Î·È ÌÔÚȷΤ˜, ÛÙËÚ›¯ıËÎ·Ó ÛÙË Û¯ÂÙÈ΋ ÔÛÔÙÈÎÔÔ›ËÛË ÙÔ˘ Ï¢¯·ÈÌÈÎÔ‡ ÎÏÒÓÔ˘, ›Ù ̤ۈ ·Ó›¯Ó¢Û˘ ·ıÔÏÔÁÈÎÒÓ Ï¢¯·ÈÌÈÎÒÓ Ê·ÈÓÔÙ‡ˆÓ ‰È¿ Ù˘ ΢ÙÙ·ÚÔÌÂÙÚ›·˜ ÚÔ‹˜ (FC) (14) ›Ù ̤ۈ ·Ó›¯Ó¢Û˘ ·ıÔÏÔÁÈÎÔ‡ ÁÂÓÔÌÈÎÔ‡ ÚÔ˚fiÓÙÔ˜ ‰È¿ Ù˘ ÌÂıfi‰Ô˘ Ù˘ ·Ï˘ÛȉˆÙ‹˜ ·ÓÙ›‰Ú·Û˘ Ù˘ ÔÏ˘ÌÂÚ¿Û˘ (PCR), ηٿ ÙË ‰È¿ÁÓˆÛË Î·È Î·Ù¿ ÙËÓ ÚfiÔ‰Ô Ù˘ ıÂÚ·›·˜ (15). OÈ ÌÂÙ·‚ÔϤ˜, fï˜, ÙˆÓ Â˘ÚËÌ¿ÙˆÓ ·˘ÙÒÓ ÌÂٷ͇ ÙˆÓ ÌÂıfi‰ˆÓ, ÙˆÓ ‰È·ÊÔÚÂÙÈÎÒÓ ¯ÚÔÓÈÎÒÓ ÛÙÈÁÌÒÓ ÂϤÁ¯Ô˘ Î·È ÙÔ˘ ÂοÛÙÔÙ ·ÓȯÓ¢fiÌÂÓÔ˘ ÂÈ¤‰Ô˘ Ù˘ ÓfiÛÔ˘, ‰ÂÓ ÚÔ¤‚ÏÂ·Ó ·Ú·Ì¤ÙÚÔ˘˜ Ô˘ ‰È·ÊÔÚÔÔÈÔ‡ÓÙ·Ó Î·Ù¿ ÙËÓ ÚfiÔ‰Ô Ù˘ ıÂÚ·›·˜ ‹ Î·È ÙËÓ ÔÚ›· Ù˘ ÓfiÛÔ˘, fiˆ˜ Ë ‰È·ÊÔÚÔÔ›ËÛË ÙˆÓ ÏÂÌÊÔ΢ÙÙ·ÚÈÎÒÓ ˘ÔÏËı˘-

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∂ÈÎfiÓ· 3. ™ÙÔ ·›Ì· ·È‰ÈÒÓ Ì ˘„ËÏfi ÔÛÔÛÙfi ·ÈÌ·ÙÔÁÔÓ›ˆÓ ÛÙÔÓ Ì˘ÂÏfi ·ÓȯÓ‡ÙËÎ·Ó CD10 ıÂÙÈο µ ÏÂÌÊÔ·ÙÙ·Ú· Ì ÂÈÊ·ÓÂȷΤ˜ Î Î·È Ï ·Ï˘Û›‰Â˜, Ù· ÔÔ›· ÔÌÔÈ¿˙Ô˘Ó Ì ٷ ·ÈÌ·ÙÔÁfiÓÈ· ∏3 ÙÔ˘ Ì˘ÂÏÔ‡. ∞fi ÙË Û˘ÁÎÚÈÙÈ΋ Ê·ÈÓÔÙ˘È΋ ·Ó¿Ï˘ÛË ÙˆÓ ∏3 Ì˘ÂÏÔ‡ Ì ٷ ∏3 ÙÔ˘ ·›Ì·ÙÔ˜ Ê·›ÓÂÙ·È fiÙÈ Ù· ‰Â‡ÙÂÚ· ÂÎÊÚ¿˙Ô˘Ó CD38 Û ˘„ËÏfi ‚·ıÌfi fiˆ˜ Î·È Ù· ∏3 ÙÔ˘ Ì˘ÂÏÔ‡, ÂÓÒ Ë ¤ÎÊÚ·ÛË ÙˆÓ ·ÓÙÈÁfiÓˆÓ CD5 Î·È CD40 Â›Ó·È ˘„ËÏfiÙÂÚË ÛÙ· ∏3 ÙÔ˘ ·›Ì·ÙÔ˜ ÛÙËÚ›˙ÔÓÙ·˜ ÙËÓ ˘fiıÂÛË fiÙÈ Ù· ∏3 Û˘ÓÈÛÙÔ‡Ó Ù· ·Úı¤Ó· µ ÏÂÌÊÔ·ÙÙ·Ú· (naïve) (‚Ï. ™˘˙‹ÙËÛË).

ÛÌÒÓ ÛÙÔ Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ ÙˆÓ ·ÛıÂÓÒÓ (13) ‹ Ë ·Ó¿Ù˘ÍË ‰Â˘ÙÂÚÔÁÂÓÒÓ, ÌÔÚȷο ‰È·ÊÔÚÂÙÈÎÒÓ ÎÏÒÓˆÓ (15), Ì ·ÔÙ¤ÏÂÛÌ· ÔÈ ÂÎÙÈÌ‹ÛÂȘ Ó· ÌËÓ Â›Ó·È ÌÂٷ͇ ÙÔ˘˜ Û˘ÁÎÚ›ÛÈ̘ Î·È Ë ÎÏÈÓÈ΋ ÛËÌ·Û›· ÙÔ˘ ÂÈ¤‰Ô˘ ·Ó›¯Ó¢Û˘ Ù˘ ÓfiÛÔ˘ ‰È¿ ÙˆÓ ÚÔËÁÔ‡ÌÂÓˆÓ ÌÂıfi‰ˆÓ ÛÙȘ ‰È·‰Ô¯ÈΤ˜ ¯ÚÔÓÈΤ˜ ÛÙÈÁ̤˜, Ó· ÌËÓ Â›Ó·È ·ÍÈÔÏÔÁ‹ÛÈÌË. ∆ÂÏÈÎfi ÛÙfi¯Ô Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ·ÔÙ¤ÏÂÛÂ Ë ‰È·ÌfiÚʈÛË Ì›·˜ ÔÏÔÎÏËڈ̤Ó˘ ÛÙÚ·ÙËÁÈ΋˜ ÂϤÁ¯Ô˘ Ù˘ ÂÏ¿¯ÈÛÙ˘ ˘ÔÏÂÈfiÌÂÓ˘ ÓfiÛÔ˘ (MRD) ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì µ-O§§ Ì ΢ÙÙ·ÚÔÌÂÙÚ›·

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∂ÈÎfiÓ· 5. ∫·Ù·ÓÔÌ‹ ÙˆÓ ÂÓÙ¿ÛÂˆÓ ÊıÔÚÈÛÌÔ‡ ÙÔ˘ ÎÔÈÓÔ‡ Ï¢ÎÔ΢ÙÙ·ÚÈÎÔ‡ ·ÓÙÈÁfiÓÔ˘ CD45 fiˆ˜ ÂÎÊÚ¿˙ÂÙ·È Ì ÙÔÓ ÚÔÙÂÈÓfiÌÂÓÔ ÏfiÁÔ pi Â› ÙˆÓ ÏÂÌÊÔ‚Ï·ÛÙÒÓ µ ΢ÙÙ·ÚÈ΋˜ ÚÔ¤Ï¢Û˘ O§§ Bpreq ALL. H ÛÎÈ·Ṳ̂ÓË ÂÚÈÔ¯‹ ·ÊÔÚ¿ ÛÙËÓ ÂÚÈÔ¯‹ ÙˆÓ ÂÓÙ¿ÛÂˆÓ CD45 Â› ÙˆÓ ·ÈÌ·ÙÔÁÔÓ›ˆÓ Ù¿Í˘ π (∏1) Ù· ÔÔ›· ÂÎÊÚ¿˙Ô˘Ó Tdt fiˆ˜ Î·È ÔÈ ‚Ï¿ÛÙ˜. ∏ ‰È·ÛÔÚ¿ ÙˆÓ ÂÓÙ¿ÛÂˆÓ Â› ÙˆÓ ∏1 Â›Ó·È Û·ÊÒ˜ ÂÚÈÔÚÈṲ̂ÓË Û ۯ¤ÛË Ì ÙÔ˘˜ ‚Ï¿ÛÙ˜.

∂ÈÎfiÓ· 4. ™˘ÁÎÚÈÙÈΤ˜ Box-Whisker ηٷÓÔ̤˜ (ÙˆÓ ·ÓÙÈÁfiÓˆÓ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÛÙÔÓ ·ÏÁfiÚÈıÌÔ Ù˘ ·Ó›¯Ó¢Û˘ ˘ÔÏÂÈfiÌÂÓ˘ ÓfiÛÔ˘) Â› ÏÂÌÊÔ‚Ï·ÛÙÒÓ µ ΢ÙÙ·ÚÈ΋˜ ÚÔ¤Ï¢Û˘ O§§ (B preq O§§) ·ÈÌ·ÙÔÁÔÓ›ˆÓ Ì ¤ÎÊÚ·ÛË Tdt (·ÈÌ·ÙÔÁÔÓ›ˆÓ Ù¿Í˘ π, ∏1). ∏ ‰È·ÛÔÚ¿ ÙˆÓ ·ÓÙÈÁÔÓÈÎÒÓ ÂÎÊÚ¿ÛÂˆÓ Î·È Ë ÂÙÂÚÔÁ¤ÓÂÈ¿ ÙÔ˘˜ Â›Ó·È Û·ÊÒ˜ ÌÂÁ·Ï‡ÙÂÚË ÛÙȘ B preq O§§ Û ۇÁÎÚÈÛË Ì ٷ ·ÈÌ·ÙÔÁfiÓÈ·.

ÚÔ‹˜ ηٿ ÙË ‰È¿ÁÓˆÛË, ·ÏÏ¿ Î·È Î·ı’ ÔÈ·Ó‰‹ÔÙ ¯ÚÔÓÈ΋ ÛÙÈÁÌ‹ ηٿ ÙËÓ ÚfiÔ‰Ô Ù˘ ıÂÚ·›·˜ ÂÈ‚·ÏÏfiÙ·Ó ‚¿ÛÂÈ ÙˆÓ ˘ԉ›ÍÂˆÓ ÙÔ˘ ·ÁÎÔÛÌ›ˆ˜ ¯ÚËÛÈÌÔÔÈË̤ÓÔ˘ ıÂÚ·¢ÙÈÎÔ‡ ÚˆÙÔÎfiÏÏÔ˘ ALL-BFM ’95, ÙÔ ÔÔ›Ô ·ÎÔÏÔ˘ıÔ‡ÌÂ Î·È ÛÙÔ ∆Ì‹Ì· Ì·˜. ∂ȉ›ˆÍ‹ Ì·˜ ‹Ù·Ó Ë ÛÙÚ·ÙËÁÈ΋ ·˘Ù‹ Ó· Â›Ó·È ·ÓÂÍ¿ÚÙËÙË ·fi ÙËÓ ˘Ô¯ÚˆÙÈ΋ ÁÓÒÛË ÙÔ˘ ·Ú¯ÈÎÔ‡ Ï¢¯·ÈÌÈÎÔ‡ Ê·ÈÓÔÙ‡Ô˘

ÂοÛÙÔ˘ ·ÛıÂÓÔ‡˜, Ó· ÂÈÙÚ¤ÂÈ ÙË ‰È¿ÎÚÈÛË ÙÔ˘ ‚Ï·ÛÙÈÎÔ‡ µ-ÛÙÔÈ¯Â›Ô˘ Ù˘ ÓfiÛÔ˘ ·fi ÙÔ Ê˘ÛÈÔÏÔÁÈο ˘¿Ú¯ÔÓ Úfi‰ÚÔÌÔ µ-ÏÂÌÊÔ΢ÙÙ·ÚÈÎfi ÛÙÔÈ¯Â›Ô (·ÈÌ·ÙÔÁfiÓÈ·) Î·È Ó· ·ÔÙÂÏ› Ì›· ÚÔÔÙÈο ÎÏÈÓÈο ·ÍÈÔÏÔÁ‹ÛÈÌË ÌÂıÔ‰ÔÏÔÁÈ΋ ÚÔÛ¤ÁÁÈÛË Ù˘ ÔÚ›·˜ Ù˘ ÓfiÛÔ˘ ÙˆÓ ·È‰ÈÒÓ Ì µO§§. ™˘ÓÂÒ˜, ÚÒÙÔ ‚‹Ì· Ù˘ Û˘ÓÔÏÈ΋˜ ÚÔÛ¤ÁÁÈÛ˘ ÙÔ˘ ı¤Ì·ÙÔ˜ ·ÔÙ¤ÏÂÛÂ Ë ÂÎÙÂٷ̤ÓË ÌÂϤÙË ÙˆÓ ·ÈÌ·ÙÔÁÔÓ›ˆÓ Ì ¤Ó· ¢ڇ Ê¿ÛÌ· ·ÓÙÈۈ̿وÓ, ÙÔ ÔÔ›Ô ÂÚÈÂÏ¿Ì‚·Ó ÎÏ·ÛÈο (¤Ó·ÓÙÈ ÙˆÓ ·ÓÙÈÁfiÓˆÓ CD10, CD38, CD20, ¤Ó·ÓÙÈ ·Ï˘Û›‰ˆÓ ÙˆÓ ·ÓÔÛÔÛÊ·ÈÚÈÓÒÓ), ·ÏÏ¿ Î·È ÓÂfiÙÂÚ· ÌÔÓÔÎψÓÈο ·ÓÙÈÛÒÌ·Ù·, fiˆ˜ Ï.¯. ÙÔ CD123 (¤Ó·ÓÙÈ ÙÔ˘ ˘Ô‰Ô¯¤· Ù˘ IL3) Î·È ¤Ó·ÓÙÈ ÙÔ˘ ·ÓÙÈÁfiÓÔ˘ KOR-SA3544 (Â›ÙÔÔ˜ ÙÔ˘ CD66c). ∏ ÂÈÏÔÁ‹ ÙˆÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ¤ÁÈÓ ·ÊÂÓfi˜ Ì ÛÙfi¯Ô ÙË ‰ÈÂÚ‡ÓËÛË Ù˘ ÛÙ·‰È·Î‹˜ ‰È·ÊÔÚÔÔ›ËÛ˘ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ÙÔ˘ µ ÛÙÔÈ¯Â›Ô˘ ÛÙÔ Ì˘ÂÏfi ̤¯ÚÈ Ù˘ ÙÂÏÈ΋˜ ˆÚ›Ì·ÓÛ˘ Î·È Ù˘ ÂÌÊ¿ÓÈÛ‹˜ ÙÔ˘˜ ÛÙÔ ·›Ì·, ·ÊÂÙ¤ÚÔ˘ Ì ÎÚÈÙ‹ÚÈÔ ÙËÓ Èı·Ó‹ ÌÂÏÏÔÓÙÈ΋ ¯ÚËÛÈÌfiÙËÙ¿ ÙÔ˘˜ ÛÙËÓ ·Ó›¯Ó¢ÛË Ù˘ ˘ÔÏÂÈfiÌÂÓ˘ ÓfiÛÔ˘, ÛÙË µ-O§§. ™ÙÔ ÛËÌÂ›Ô ·˘Ùfi ÙÔÓ›˙ÂÙ·È Ë ¯Ú‹ÛË Ù˘ ΢ÙÙ·ÚÔÌÂÙÚ›·˜ ÚÔ‹˜ ˆ˜ ÌÂıfi‰Ô˘ ÂϤÁ¯Ô˘ Î·È Ë Ì›˙ˆÓ ÛËÌ·Û›· Ù˘, ηı’ fiÛÔÓ ÂÈÙÚ¤ÂÈ ÙË Û‡Á¯ÚÔÓË ÂÎÙ›ÌËÛË

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Paediatriki 2002;65:463-481

¶›Ó·Î·˜ 5. ¢È¿ÊÔÚÔÈ Ù‡ÔÈ ·ÔÎÏ›ÛÂˆÓ (aberrations) ÙÔ˘ ·ÓÔÛÔÊ·ÈÓfiÙ˘Ô˘ 34 ÂÚÈÙÒÛÂˆÓ µ ΢ÙÙ·ÚÈ΋˜ ÚÔ¤Ï¢Û˘ O§§ Û˘ÁÎÚÈÙÈο Ì ÙÔÓ Ê·ÈÓfiÙ˘Ô ÙˆÓ Tdt ıÂÙÈÎÒÓ ·ÈÌ·ÙÔÁÔÓ›ˆÓ (∏1) Â› 25 Ì˘ÂÏÒÓ ·È‰ÈÒÓ Ì·ÚÙ‡ÚˆÓ ¯ˆÚ›˜ B-O§§ ∆‡Ô˜ ·fiÎÏÈÛ˘ ‚Ï·ÛÙÒÓ Û ۇÁÎÚÈÛË Ì ·ÈÌ·ÙÔÁfiÓÈ· ∏1 ∞˘ÍË̤ÓË ¤ÎÊÚ·ÛË ÙÔ˘ CD123 ∞˘ÍË̤ÓË ¤ÎÊÚ·ÛË ÙÔ˘ CD135 ÷ÌËÏ‹ ¤ÓÙ·ÛË ÙÔ˘ CD45 AÚfiÛÊÔÚË ˘„ËÏ‹ Û˘Ó¤ÎÊÚ·ÛË cÌ/Tdt ªÈÎÚ‹ ¤ÎÊÚ·ÛË CD34 ∞ÚfiÛÊÔÚË ¤ÎÊÚ·ÛË ÙÔ˘ ·ÓÙÈÁfiÓÔ˘ KOR-SA 3544 ∞˘ÍË̤ÓË ¤ÎÊÚ·ÛË ÙÔ˘ CD117 ªÈÎÚ‹ ¤ÎÊÚ·ÛË CD38 ∞ÚfiÛÊÔÚË ¤ÎÊÚ·ÛË Ì˘ÂÏÈÎÒÓ ·ÓÙÈÁfiÓˆÓ CD13 Î·È CD33 ªÈÎÚ‹ ¤ÎÊÚ·ÛË CD9 ∞˘ÍË̤ÓË ¤ÎÊÚ·ÛË ÙÔ˘ AC133 AÚfiÛÊÔÚË ¤ÎÊÚ·ÛË ÙÔ˘ NG2 ªÈÎÚ‹ ¤ÎÊÚ·ÛË CD10

OÚÈÛÌfi˜ ·fiÎÏÈÛ˘*

∞ÚÈıÌfi˜ Î·È %

>30% >30% pi<1,0 >30% <30% >20% >30% <50% >30% <50% >30% >20% <30%

31/34 (91%) 21/34 (62%) 16/34 (47%) 14/34 (41%) 12/34 (35%) 11/34 (32%) 8/34 (23%) 7/34 (21%) 6/34 (18%) 6/34 (18%) 6/34 (18%) 5/34 (15%) 2/34 (10%)

*(%) Â› ÙˆÓ ‚Ï·ÛÙÒÓ, (pi) ÏfiÁÔ˜ Û¯ÂÙÈÎÒÓ ÂÓÙ¿ÛÂˆÓ ÊıÔÚÈÛÌÔ‡ CD45 ÙˆÓ ‚Ï·ÛÙÒÓ ˆ˜ ÚÔ˜ Ù· ÒÚÈÌ· µ ÏÂÌÊÔ·ÙÙ·Ú· ¶›Ó·Î·˜ 6. ∞ÚÈıÌfi˜ ·ÔÎÏ›ÛÂˆÓ (aberrations) ÙÔ˘ ·ÓÔÛÔÊ·ÈÓfiÙ˘Ô˘ Â› 34 ÂÚÈÙÒÛÂˆÓ µ ΢ÙÙ·ÚÈ΋˜ ÚÔ¤Ï¢Û˘ O§§ Ì ¯Ú‹ÛË ÂÚÈÔÚÈṲ̂ÓÔ˘ panel 7 ·ÓÙÈÛˆÌ¿ÙˆÓ (CD123, CD45, cÌ, KORSA, CD34, CD38, CD10) ‹ ÂÂÎÙÂٷ̤ÓÔ˘ Ì ÂÈϤÔÓ Ù· CD135, CD117, CD13, CD33, CD9, AC133 Î·È NG2 ∞ÚÈıÌfi˜ ·ÔÎÏ›ÛÂˆÓ 1 2 3 4 5 6 7 8 9 ª›· ÙÔ˘Ï¿¯ÈÛÙÔÓ ·fiÎÏÈÛË ¢‡Ô ÙÔ˘Ï¿¯ÈÛÙÔÓ ·ÔÎÏ›ÛÂȘ ∆ÚÂȘ ÙÔ˘Ï¿¯ÈÛÙÔÓ ·ÔÎÏ›ÛÂȘ

panel 7 ·ÓÙÈۈ̿وÓ

panel 14 ·ÓÙÈۈ̿وÓ

4/34 (12%) 12/34 (35%) 12/34 (35%) 4/34 (12%) 2/34 (6%) 0/34 0/34 34/34 (100%) 30/34 (88%) 18/34 (53%)

3/34 (9%) 6/34 (18%) 9/34 (26%) 5/34 (15%) 4/34 (12%) 2/34 (6%) 2/34 (7%) 1/34 (3%) 2/34 (6%) 34/34 (100%) 31/34 (91%) 25/34 (73%)

Ù˘ Û˘Û¯¤ÙÈÛ˘ ÔÏÏ·ÏÒÓ ÂÈÊ·ÓÂÈ·ÎÒÓ Î·È Î˘ÙÙ·ÚÔÏ·ÛÌ·ÙÈÎÒÓ ·ÓÙÈÁfiÓˆÓ, ·ÏÏ¿ Î·È Ù˘ ¤ÓÙ·Û˘ ÙÔ˘ ÊıÔÚÈÛÌÔ‡, ·Ú¤¯ÔÓÙ·˜ ¤ÙÛÈ ÙË ‰˘Ó·ÙfiÙËÙ· ·Ó¿Ï˘Û˘ ‰È·ÎÚÈÙÒÓ ÂÙÂÚÔÁÂÓÒÓ Î˘ÙÙ·ÚÈÎÒÓ ÏËı˘ÛÌÒÓ. ªÂ ‚¿ÛË Ù· ÛÙÔȯ›· Ô˘ ÚԤ΢„·Ó ·fi ÙË ÌÂϤÙË Ì·˜, Á›ÓÂÙ·È ÁÈ· ÚÒÙË ÊÔÚ¿ Û·Ê‹˜ ÔÚÈÛÌfi˜ Ì ·ÓÔÛÔÊ·ÈÓÔÙ˘Èο ÎÚÈÙ‹ÚÈ· ÙˆÓ ÂÈ̤ÚÔ˘˜ ‚·ıÌ›‰ˆÓ ˆÚ›Ì·ÓÛ˘ ÙˆÓ ·ÈÌ·ÙÔÁÔÓ›ˆÓ, ÔÈ Ôԛ˜, ·Ó Î·È ÂÈÛËÌ·›ÓÔÓÙ·È ÛÙË ‚È‚ÏÈÔÁÚ·Ê›·, ‰ÂÓ ‰È·¯ˆÚ›˙ÔÓÙ·È Â·ÎÚÈ‚Ò˜ (16-18). ŒÙÛÈ, ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË Ù· ÚÒÈÌ· ÚÔ-µ ÏÂÌÊÔ·ÙÙ·Ú· ÔÚ›ÛÙËÎ·Ó Ì ‚¿ÛË ÙËÓ ¤ÎÊÚ·ÛË Tdt Î·È ÔÓÔÌ¿ÛÙËÎ·Ó ·ÈÌ·ÙÔÁfiÓÈ· ٿ͈˜ π. ∏ ¿ˆÚË ·ÓÔÛÔÊ·ÈÓÔÙ˘È΋ ÙÔ˘˜ Ù·˘ÙfiÙËÙ· ÂȂ‚·ÈÒıËΠ·fi ÙËÓ ˘„ËÏ‹ ¤ÎÊÚ·ÛË CD34 Î·È ÙËÓ ·Ô˘Û›· ΢ÙÙ·ÚÔÏ·ÛÌ·ÙÈ΋˜ ·Ï˘Û›‰·˜ Ì. ∏ ‰È¿ÎÚÈÛË ˆÚÈÌfiÙÂÚˆÓ Úo‚·ıÌ›‰ˆÓ ·ÈÌ·ÙÔÁÔÓ›ˆÓ Á›ÓÂÙ·È ÁÈ· ÚÒÙË ÊÔÚ¿ Ì ÙË ÌÂϤÙË Ù˘ ¤ÎÊÚ·Û˘ ÙÔ˘ ·ÓÙÈÁfiÓÔ˘ CD10 Â› µ ΢ÙÙ¿ÚˆÓ Ì ÂÏ·ÊÚ¤˜ ÂÈÊ·ÓÂȷΤ˜ ÔÏ˘ÎψÓÈΤ˜ ·Ï˘Û›‰Â˜ Î

476

Î·È Ï (‰ËÏ·‰‹ ÒÚÈÌˆÓ µ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ). ∆· ÂÓ ÏfiÁˆ ·ÙÙ·Ú·, ·Ó Î·È ¤¯Ô˘Ó ·Ú·ÙËÚËı› ·fi ÚÔËÁÔ‡ÌÂÓÔ˘˜ ÂÚ¢ÓËÙ¤˜ ÛÙÔ˘˜ ÏËı˘ÛÌÔ‡˜ ·ÈÌ·ÙÔÁÔÓ›ˆÓ ÙÔ˘ Ì˘ÂÏÔ‡, ‰ÂÓ ¤¯Ô˘Ó ÌÂÏÂÙËı› Ê·ÈÓÔÙ˘Èο Â·ÚÎÒ˜ Î·È ‰ÂÓ ¤¯ÂÈ ·Ó·˙ËÙËı› Ë ·ÚÔ˘Û›· ÙÔ˘˜ ÛÙÔ ·›Ì· (19,20). ™ÙË ÌÂϤÙË ·˘Ù‹ ÚÔÛ‰ÈÔÚ›ÛÙËηÓ, Â›Û˘, ·ÈÌ·ÙÔÁfiÓÈ· ٿ͈˜ πππ, ‰ËÏ·‰‹ ÒÚÈÌ· CD10+ µ ÏÂÌÊÔ·ÙÙ·Ú· Ô˘ ‰È·ÎÚ›ıËÎ·Ó ·fi Ù· ·ÈÌ·ÙÔÁfiÓÈ· ̤Û˘ ˆÚÈÌfiÙËÙ·˜, ‰ËÏ·‰‹ Ù· ·ÈÌ·ÙÔÁfiÓÈ· Ù· ÔÔ›· ·ÔÙÂÏÔ‡Ó ÙÔÓ Â˘Ú‡ÙÂÚ· ÁÓˆÛÙfi ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· ˘ÔÏËı˘ÛÌfi ·ÈÌ·ÙÔÁÔÓ›ˆÓ (16) (Â‰Ò ÔÓÔÌ¿ÛÙËÎ·Ó Ù¿Íˆ˜ ππ). °È· ÚÒÙË ÊÔÚ¿, ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË Á›ÓÂÙ·È Û˘ÁÎÚÈÙÈ΋ ÌÂϤÙË ÙˆÓ ·ÈÌ·ÙÔÁÔÓ›ˆÓ ÛÙÔÓ Ì˘ÂÏfi ÙˆÓ ·È‰ÈÒÓ ¯ˆÚ›˜ µ-O§§ Ì ٷ CD10 ıÂÙÈο µ ÏÂÌÊÔ·ÙÙ·Ú· Ô˘ ‚Ú¤ıËÎ·Ó ÛÙÔ ·›Ì·. ∞Ô‰ÂÈÎÓ‡ÂÙ·È Ë Û˘Ó¤¯ÂÈ· ˆÚ›Ì·ÓÛ˘ ÙˆÓ Ù¿Íˆ˜ πππ ·ÈÌ·ÙÔÁÔÓ›ˆÓ ÙÔ˘ Ì˘ÂÏÔ‡, ÚÔ˜ Ù· µ ÏÂÌÊÔ·ÙÙ·Ú· Ì ¯·Ú·ÎÙ‹Ú˜ ·Úı¤ÓˆÓ (naïve) CD5 ıÂÙÈÎÒÓ µ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ, ÛÙÔ ·›Ì·. °È· ÚÒÙË ÊÔÚ¿, ‰ËÏ·‰‹, Û˘Û¯ÂÙ›˙ÂÙ·È Ë ¤ÎÊÚ·ÛË ÙÔ˘ CD10,

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∂ÈÎfiÓ· 6. ™˘Ó‡·ÚÍË ˘ÔÏÂÈfiÌÂÓ˘ ÓfiÛÔ˘ (MRD) Î·È ·ÈÌ·ÙÔÁÔÓ›ˆÓ Ì ÙÚÈÌÂÚ‹ ‰ÔÌ‹ (H1,2,3) ÛÙÔ ›‰ÈÔ ‰Â›ÁÌ· Ì˘ÂÏÔ‡. ∏ ÓfiÛÔ˜ (MRD) ÂȂ‚·ÈÒÓÂÙ·È Ì ‚¿ÛË ÙËÓ ¤ÎÊÚ·ÛË ÙÔ˘ ·ÓÙÈÁfiÓÔ˘ KOR-SA3544, ÙÔ ÔÔ›Ô ‰ÂÓ ‚Ú¤ıËΠÔÙ¤ ıÂÙÈÎfi ÛÙ· ·ÈÌ·ÙÔÁfiÓÈ·.

ÂÓfi˜ ·ÓÙÈÁfiÓÔ˘ ÏÂÌÊÔ΢ÙÙ·ÚÈ΋˜ ·ˆÚfiÙËÙ·˜, Ì ÙÔ ·Úı¤ÓÔ CD5+ µ ÏÂÌÊÔ·ÙÙ·ÚÔ Î·È Ù· ·ÈÌ·ÙÔÁfiÓÈ· ÙÔ˘ Ì˘ÂÏÔ‡. ª›· ÌfiÓÔ ÚÔËÁÔ‡ÌÂÓË ·Ó·ÊÔÚ¿ ˘¿Ú¯ÂÈ ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· Ô˘ ·Ó·Ê¤ÚÂÙ·È ÛÙËÓ ·ÚÔ˘Û›· CD10 ıÂÙÈÎÒÓ µ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ÛÙÔ ÔÌÊ·ÏÈÎfi ·›Ì· Î·È ÙÔ ·›Ì· ÙˆÓ ÓÂÔÁÓÒÓ. ™ÙË ÌÂϤÙË ·˘Ù‹, ÔÈ Û˘ÁÁÚ·Ê›˜ ‰ÂÓ ÂÚÌËÓÂ‡Ô˘Ó ÙËÓ ·ÚÔ˘Û›· Ù¤ÙÔÈˆÓ Î˘ÙÙ¿ÚˆÓ ÛÙ· Ï·›ÛÈ· Ù˘ Ê·ÈÓÔÙ˘È΋˜ Û˘Ó¤¯ÂÈ·˜ ˆÚ›Ì·ÓÛ˘ Ù˘ µ ÛÂÈÚ¿˜ ·fi ÙÔÓ Ì˘ÂÏfi ÛÙÔ ·›Ì·, ·ÏÏ¿ ˆ˜ ÛÙÔÈ¯Â›Ô ·ˆÚfiÙËÙ·˜ ÙˆÓ µ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ÙˆÓ ÓÂÔÁÓÒÓ (21). ∏ ‰È¿ÎÚÈÛË ·ÈÌ·ÙÔÁÔÓ›ˆÓ ٿ͈˜ πππ ·fi Ù· ˘fiÏÔÈ· ÒÚÈÌ· µ ÏÂÌÊÔ·ÙÙ·Ú· ÙÔ˘ Ì˘ÂÏÔ‡ Î·È ÙÔ˘ ·›Ì·ÙÔ˜, fiˆ˜ Ê·›ÓÂÙ·È ÛÙ· ·ÔÙÂϤÛÌ·Ù· (¶›Ó·Î·˜ 4), ÂÎÙfi˜ ·fi ÙËÓ ¤ÎÊÚ·ÛË ÙÔ˘ CD10, Á›ÓÂÙ·È Ì ‚¿ÛË ÙËÓ ·ÚÓËÙÈ΋ ‹ ¯·ÌËÏ‹ ¤ÎÊÚ·ÛË bcl2 Î·È CD40 ÛÙ· ·ÈÌ·ÙÔÁfiÓÈ·, Û ·ÓÙ›ıÂÛË Ì ٷ ˘fiÏÔÈ· ÒÚÈÌ· µ ÏÂÌÊÔ·ÙÙ·Ú·, Ô˘ ‚Ú¤ıËÎ·Ó bcl2 Î·È CD40 ıÂÙÈο. ∂›Û˘, Ì ‚¿ÛË ÙË Û‡ÁÎÚÈÛË ÙˆÓ ·ÈÌ·ÙÔÁÔÓ›ˆÓ ٿ͈˜ πππ Ì˘ÂÏÔ‡ Î·È ·›Ì·ÙÔ˜, ÚԤ΢„Â Ë ˘„ËÏfiÙÂÚË ¤ÎÊÚ·ÛË ÙÔ˘ ·ÓÙÈÁfiÓÔ˘ CD5 ÛÙ· ·ÈÌ·ÙÔÁfiÓÈ· ÙÔ˘ ·›Ì·ÙÔ˜, ÛÙÔÈ¯Â›Ô ÂÓ‰ÂÈÎÙÈÎfi Ù˘ Û˘Ó¤¯ÂÈ·˜ ˆÚ›Ì·ÓÛ˘ ÚÔ˜ ÙÔ CD5 ıÂÙÈÎfi µ1 ·Úı¤ÓÔ ÏÂÌÊÔ·ÙÙ·ÚÔ (22). ∆· ‰Â‰Ô̤ӷ ·˘Ù¿ ÂÌÏÔ˘Ù›˙Ô˘Ó ÛÙÔȯ›· ÚÔËÁÔ‡ÌÂÓˆÓ Ê·ÈÓÔÙ˘ÈÎÒÓ ·Ó·Ï‡ÛÂˆÓ ·ÈÌ·ÙÔÁÔÓ›ˆÓ Î·È ‰ËÌÈÔ˘ÚÁÔ‡Ó ÙÔ̤˜ ÛÙÔ ÛΤÏÔ˜ Ù˘ Ù·˘ÙÔÔ›ËÛ˘ ÙˆÓ ·ÈÌ·ÙÔÁÔÓ›ˆÓ Î·È Ù˘ ÎÈÓËÙÈ΋˜ ÙÔ˘˜ ·Ó¿ÌÂÛ· ÛÙ· ·ÈÌÔÔÈËÙÈο ‰È·ÌÂÚ›ÛÌ·Ù·.

Paediatriki 2002;65:463-481

∂ÈÎfiÓ· 7. ∆· ·È‰È¿ Ì µ ΢ÙÙ·ÚÈ΋˜ ÚÔ¤Ï¢Û˘ O§§ Ì ‚¿ÛË Ù· ‰È·ÊÔÚÂÙÈο ÚfiÙ˘· (patterns) Û‡ÓıÂÛ˘ µ ÏÂÌÊÔ΢ÙÙ·ÚÈÎÒÓ ÏËı˘ÛÌÒÓ ÛÙÔÓ Ì˘ÂÏfi ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ıÂÚ·›·˜ (d15: Ë̤ڷ ÂÊfi‰Ô˘ 15, d33: ËÌ. 33, C1 ¤ˆ˜ 4 ‰Â›ÁÌ·Ù· ÛÙË Ê¿ÛË ÛÙ·ıÂÚÔÔ›ËÛ˘, consolidation) ‰È·ÎÚ›ıËÎ·Ó Û ÙÚÂȘ ÔÌ¿‰Â˜. ™ÙËÓ ÔÌ¿‰· ∞ ‰ÂÓ ·ÓȯÓ‡ÙËΠ۠η̛· Ê¿ÛË ÓfiÛÔ˜, ·ÏÏ¿ ÛÙËÓ ·Ú¯‹ ÌfiÓÔ ÒÚÈÌ· µ Î·È ÛÙË Û˘Ó¤¯ÂÈ· ·ÈÌ·ÙÔÁfiÓÈ·. ™ÙËÓ ÔÌ¿‰· µ ·Ú·ÙËÚ‹ıËΠÌÂÚÈ΋ ·Ú·ÌÔÓ‹ ÓfiÛÔ˘ ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÊfi‰Ô˘, ·ÏÏ¿ Ì ٷ¯Â›· ÂÍ·Ê¿ÓÈÛË Î·È ÚÔÛ·ÚÌÔÁ‹ ÛÙÔ ÚfiÙ˘Ô Ù˘ ÔÌ¿‰·˜ ∞. ™ÙËÓ ÔÌ¿‰· °, Û fiÏË ÙË ‰È¿ÚÎÂÈ· Ù˘ ıÂÚ·›·˜ ·ÓȯÓ¢fiÙ·Ó ÓfiÛÔ˜ Û ¿ÏÏÔÙ ¿ÏÏÔ ÔÛÔÛÙfi. ∂ÈÛËÌ·›ÓÂÙ·È fiÙÈ Ë ·ÚÔ˘Û›· ·ÈÌ·ÙÔÁÔÓ›ˆÓ ÛÙË Ê¿ÛË Ù˘ ÛÙ·ıÂÚÔÔ›ËÛ˘ ÂȉÈο Ì ÂÈÎÚ¿ÙËÛË ÙˆÓ Ù¿Íˆ˜ π Tdt+(∏1) Â›Ó·È Û˘¯Ó‹ ÛÙȘ ÔÌ¿‰Â˜ ∞ Î·È µ.

™ÙÔ ‰Â‡ÙÂÚÔ ÛΤÏÔ˜ Ù˘ ÌÂϤÙ˘ ÂȯÂÈÚ‹ıËÎÂ Ë ·Ó¿Ù˘ÍË Ì›·˜ ÛÙÚ·ÙËÁÈ΋˜ ΢ÙÙ·ÚÔÌÂÙÚÈ΋˜ ÚÔÛ¤ÁÁÈÛ˘ Ù˘ MRD ÛÙËÓ µ-O§§ Î·È ‰È¿ÎÚÈÛ˘ ‚Ï·ÛÙÒÓ ·fi ·ÈÌ·ÙÔÁfiÓÈ·. M ‚¿ÛË Ù· ·ÓÔÛÔÊ·ÈÓÔÙ˘Èο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ‚Ï·ÛÙÒÓ Ù˘ µO§§, ·‰È¿ÊÔÚ· Ì ÙÔÓ Ù‡Ô Ù·ÍÈÓfiÌËÛ˘ (ÚÒÈÌË, ÎÔÈÓ‹, ÚÔ-µ), ·Ú·ÙËÚ‹ıËΠıÂÙÈ΋ ¤ÎÊÚ·ÛË Tdt Û ÔÛÔÛÙfi ¿Óˆ ÙÔ˘ 95% ÙˆÓ ·ÛıÂÓÒÓ, Û‡Ìʈӷ Î·È Ì ÙË ‚È‚ÏÈÔÁÚ·Ê›· (23). ∞ÎÔÏÔ˘ıÒÓÙ·˜ ÙË ÁÓÒÛË fiÙÈ ÌfiÓÔ Ù· ·ÈÌ·ÙÔÁfiÓÈ· ٿ͈˜ π ÂÎÊÚ¿˙Ô˘Ó Tdt, ÙÔ Úfi‚ÏËÌ· Ù˘ ‰È¿ÎÚÈÛ˘ Ù˘ MRD ·fi Ù· ·ÈÌ·ÙÔÁfiÓÈ· ÚÔÛÂÏ¿ÛıËΠÛÙË ÌÂϤÙË ·˘Ù‹ Ì ‚¿ÛË ÙË Û‡ÁÎÚÈÛË ÙÔ˘ Ê·ÈÓÔÙ‡Ô˘ ÙˆÓ ·ÈÌ·ÙÔÁÔÓ›ˆÓ ٿ͈˜ π Ì ÂΛÓÔ ÙˆÓ Ï¢¯·ÈÌÈÎÒÓ Î˘ÙÙ¿ÚˆÓ. ™˘ÁÎÂÎÚÈ̤ӷ, ÂÍÂÙ·˙fiÙ·Ó ·Ó ÙÔ Tdt ıÂÙÈÎfi ÛÙÔÈ¯Â›Ô ÛÙÔÓ Ì˘ÂÏfi ÂÓfi˜ ·È‰ÈÔ‡ Û ‡ÊÂÛË ÂÌÊ¿ÓÈ˙ ·ÔÎÏ›ÛÂȘ ·fi ÙÔ ÛÙ·ıÂÚfi Ê·ÈÓÔÙ˘ÈÎfi

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¶·È‰È·ÙÚÈ΋ 2002;65:463-481

ÚfiÙ˘Ô ÙˆÓ ·ÈÌ·ÙÔÁÔÓ›ˆÓ ٿ͈˜ π. ™ÙËÓ ÂÚ›ÙˆÛË ·˘Ù‹ ¯·Ú·ÎÙËÚÈ˙fiÙ·Ó MRD. O ·ÚÈıÌfi˜ Î·È ÙÔ Â›‰Ô˜ ÙˆÓ ·ÓÙÈÁfiÓˆÓ Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÛÙËÓ ÙÂÏÈ΋ ÛÙÚ·ÙËÁÈ΋ ‚·Û›ÛÙËΠÛÙË Û˘¯ÓfiÙËÙ· ÙˆÓ ·ÛıÂÓÒÓ Ì µ-O§§ Ô˘ ÂÌÊ¿ÓÈ˙·Ó ·ÔÎÏ›ÛÂȘ ÛÙËÓ ¤ÎÊÚ·ÛË ÙˆÓ ·ÓÙÈÁfiÓˆÓ ·˘ÙÒÓ ·fi ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ÚfiÙ˘Ô ÙˆÓ ·ÈÌ·ÙÔÁÔÓ›ˆÓ. ŒÙÛÈ, Ï.¯. ·Ú·ÙËÚ‹ıËΠ·fiÎÏÈÛË ÙˆÓ ‚Ï·ÛÙÒÓ ·fi ÙÔ ÚfiÙ˘Ô Ù˘ ·ÚÓËÙÈ΋˜ ¤ÎÊÚ·Û˘ ÙÔ˘ CD123 ÙˆÓ ·ÈÌ·ÙÔÁÔÓ›ˆÓ Û ÔÛÔÛÙfi 91% ÙˆÓ ·ÛıÂÓÒÓ Î·È ·fiÎÏÈÛË ·fi ÙÔ ·ÚÓËÙÈÎfi ÚfiÙ˘Ô ¤ÎÊÚ·Û˘ ÙÔ˘ KOR-SA3544 ÛÙÔ 32% ÙˆÓ ·ÛıÂÓÒÓ (¶›Ó·Î·˜ 5). O Û˘Ó‰˘·ÛÌfi˜ 7 ·ÓÙÈۈ̿وÓ, ‰ËÏ·‰‹ ÙˆÓ CD45, CD123, KOR-SA3544, CD38, CD10, CD34 Î·È ¤Ó·ÓÙÈ Ù˘ ΢ÙÙ·ÚÔÏ·ÛÌ·ÙÈ΋˜ Ì, ·˘Í¿ÓÂÈ ÛËÌ·ÓÙÈο ÙËÓ Èı·ÓfiÙËÙ· ·Ó›¯Ó¢Û˘ Ì›·˜ ‹ ÂÚÈÛÛfiÙÂÚˆÓ ·ÔÎϛۈÓ. Ÿˆ˜ Ê·›ÓÂÙ·È ÛÙÔÓ ¶›Ó·Î· 6, ¤Ó· ÔÛÔÛÙfi 88% ÙˆÓ ÂÚÈÙÒÛÂˆÓ BO§§ ÂÌÊ¿ÓÈ˙ ÙÔ˘Ï¿¯ÈÛÙÔÓ ‰‡Ô ·ÔÎÏ›ÛÂȘ, ÂÓÒ fiϘ ÔÈ ÂÚÈÙÒÛÂȘ (100%) ÂÌÊ¿ÓÈ˙·Ó Ì›· ÙÔ˘Ï¿¯ÈÛÙÔÓ ·fiÎÏÈÛË. ŸÙ·Ó ÂÂÎÙ¿ıËÎÂ Ô ¤ÏÂÁ¯Ô˜ ηٿ 7 ·ÎfiÌË ·ÓÙÈÛÒÌ·Ù· (Û˘ÓÔÏÈο 14 ·ÓÙÈÁfiÓ·), ÙÔ ÔÛÔÛÙfi ·Ó›¯Ó¢Û˘ ‰‡Ô ÙÔ˘Ï¿¯ÈÛÙÔÓ ·ÔÎÏ›ÛÂˆÓ ·Ó‹Ïı ÛÙÔ 91% ÙˆÓ ÂÚÈÙÒÛÂˆÓ (¶›Ó·Î·˜ 6). ∏ ÌÈÎÚ‹ ·˘Ù‹ ·‡ÍËÛË ˘Ô‰ËÏÒÓÂÈ, ηٿ ÙË ÁÓÒÌË Ì·˜, fiÙÈ ÙÔ ÂÎÙÂٷ̤ÓÔ Ê¿ÛÌ· ÂϤÁ¯Ô˘ ‰ÂÓ ·ÓÙ·ÔÎÚ›ÓÂÙ·È Û ԢÛÈ·ÛÙÈ΋ ·‡ÍËÛË Ù˘ ¢·ÈÛıËÛ›·˜, Ë ÔÔ›· Ó· ‰ÈηÈÔÏÔÁ› ÙÔ ‰ÈÏ¿ÛÈÔ ÎfiÛÙÔ˜. ªÂ›˙ÔÓ ÏÂÔÓ¤ÎÙËÌ· Ù˘ ÛÙÚ·ÙËÁÈ΋˜ ·˘Ù‹˜ ·ÔÙÂÏ› ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù˘ MRD Â›Ó·È ·ÓÂÍ¿ÚÙËÙÔ˜ Ù˘ Â·ÎÚÈ‚Ô‡˜ ÁÓÒÛ˘ ÙÔ˘ ·Ú¯ÈÎÔ‡ Ê·ÈÓÔÙ‡Ô˘ ÂοÛÙÔ˘ ·ÚÚÒÛÙÔ˘ Û ·ÓÙ›ıÂÛË Ì ÙËÓ Ú·ÎÙÈ΋ Ô˘ ·ÎÔÏÔ˘ıÂ›Ù·È ·fi ¿ÏÏÔ˘˜ (24,25). ∏ ·Ó·˙‹ÙËÛË ¿Ù˘ˆÓ “Ï¢¯·ÈÌÈÎÒÓ” Û˘ÓÂÎÊÚ¿ÛÂˆÓ ÛÙË ‰ÈÂÚ‡ÓËÛË Ù˘ MRD ‰ÂÓ ·Ú¤¯ÂÈ ·ÛÊ·Ï›˜ ÔÛÔÙÈΤ˜ ÂÎÙÈÌ‹ÛÂȘ, Ô‡Ù ÂÊ·ÚÌfi˙ÂÙ·È ¿ÓÙ· ‡ÎÔÏ· ÛÙËÓ ÎÏÈÓÈ΋ Ú¿ÍË (26). ∞ÓÙ›ıÂÙ·, ̤ۈ ÙÔ˘ ·ÏÁÔÚ›ıÌÔ˘ Ô˘ ·ÎÔÏÔ˘ı‹ıËΠÛÙË ÌÂϤÙË (¶›Ó·Î·˜ 3) Û ÔÔÈ·‰‹ÔÙ ¯ÚÔÓÈ΋ ÛÙÈÁÌ‹ ÂϤÁ¯Ô˘ Ù˘ ÓfiÛÔ˘, ‹Ù·Ó ÂÊÈÎÙfi˜ Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù˘ MRD, ‰È¿ Ù˘ ÔÚÈÔıÂÙ‹Ûˆ˜ ÙÔ˘ Û˘ÓÔÏÈÎÔ‡ µ ÛÙÔÈ¯Â›Ô˘ Î·È Ù˘ ‰È¿ÎÚÈÛ˘ ÙˆÓ ·ÓÔÛÔÊ·ÈÓÔÙ˘Èο ÛÙ·ıÂÚÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ÙˆÓ ·ÈÌ·ÙÔÁÔÓ›ˆÓ ·fi ÙȘ ·ÓÔÛÔÊ·ÈÓÔÙ˘ÈΤ˜ ·ÔÎÏ›ÛÂȘ ÙÔ˘ Ï¢¯·ÈÌÈÎÔ‡ µ ÛÙÔÈ¯Â›Ô˘. °ÓˆÚ›˙ÔÓÙ·˜ ‰Â ÙÔ ÂÈ̤ÚÔ˘˜ ÔÛÔÛÙfi Â› % Ù˘ ÓfiÛÔ˘ Â› ÙÔ˘ Û˘ÓÔÏÈÎÔ‡ µ ÛÙÔÈ¯Â›Ô˘ Î·È ÙÔ ÔÛÔÛÙfi ÙÔ˘ Û˘ÓÔÏÈÎÔ‡ µ ÛÙÔÈ¯Â›Ô˘ Â› ÙˆÓ ÂÌ‡ÚËÓˆÓ, ÚÔ·ÙÂÈ ·fiÏ˘ÙË ÔÛÔÛÙÈÎÔÔ›ËÛË Ù˘ ÓfiÛÔ˘ Â› ÙˆÓ ÂÌ‡ÚËÓˆÓ Î˘ÙÙ¿ÚˆÓ. ∏ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ·ÓˆÙ¤Úˆ ·ÏÁÔÚ›ıÌÔ˘ ÚÔÔÙÈο Û ¤Ó· ÛËÌ·ÓÙÈÎfi ·ÚÈıÌfi 34 ·ÛıÂÓÒÓ Ì µÎ˘ÙÙ·ÚÈ΋˜ ÚÔ¤Ï¢Û˘ O§§, ÔÌÔÈÔÁÂÓÒ˜ ıÂÚ·-

478

Paediatriki 2002;65:463-481

¢fiÌÂÓˆÓ Û‡Ìʈӷ Ì ٷ ÎÚÈÙ‹ÚÈ· ÙÔ˘ ÚˆÙÔÎfiÏÏÔ˘ ALL-BFM ’95 ·fi ÙË ‰È¿ÁÓˆÛË Ì¤¯ÚÈ ÙËÓ ÔÏÔÎÏ‹ÚˆÛË Ù˘ ıÂÚ·›·˜ ÂÊfi‰Ô˘ Î·È ÛÙ·ıÂÚÔÔ›ËÛ˘ Ù˘ ‡ÊÂÛ˘, ·¤‰ÂÈÍ Ì ‚¿ÛË Ù· ·ÔÙÂϤÛÌ·Ù¿ Ì·˜ ÙËÓ ÎÏÈÓÈ΋ Â·Ï‹ı¢Û˘ Ù˘ ·Ú·ÎÔÏÔ‡ıËÛ˘ Ù˘ MRD Î·È ÙËÓ ·ÍÈÔÈÛÙ›· Ù˘ ÚÔÛ¤ÁÁÈÛ˘ Ù˘ ÔÚ›·˜ Ù˘ ÓfiÛÔ˘. ∂ÈÚfiÛıÂÙ·, Ë ›‰È· ÛÙÚ·ÙËÁÈ΋ ÂÊ·ÚÌfiÛÙËÎÂ Î·È Û ¤Ó· ¿ÏÏÔ Û‡ÓÔÏÔ 22 ·ÛıÂÓÒÓ, ÔÈ ÔÔ›ÔÈ ‰ÂÓ Â›¯·Ó Ù˘ÔÔÈËı› ηٿ ÙË ‰È¿ÁÓˆÛË Ì ٷ Ó¤· ÌÔÓÔÎψÓÈο ·ÓÙÈÛÒÌ·Ù·. OÈ ·ÛıÂÓ›˜ ·˘ÙÔ› ÂϤÁ¯ıËÎ·Ó Û ÔÈΛϘ ¯ÚÔÓÈΤ˜ ÛÙÈÁ̤˜ Ù˘ ıÂÚ·›·˜ Û˘ÓÙ‹ÚËÛ˘ ÙÔ˘ ÚˆÙÔÎfiÏÏÔ˘ Î·È Û ‰‡Ô ÂÍ ·˘ÙÒÓ ·ÓȯÓ‡ÙËΠMRD. ™ÙÔÓ ¤Ó·, Ô ÔÔ›Ô˜ ‚ÚÈÛÎfiÙ·Ó Â› ÙÚ›· ¯ÚfiÓÈ· Û ÛÙ·ıÂÚ‹ ÎÏÈÓÈ΋ Î·È ÌÔÚÊÔÏÔÁÈ΋ ‡ÊÂÛË, ·ÓȯÓ‡ıËΠMRD ÛÙÔ Ù¤ÏÔ˜ ıÂÚ·›·˜ Û˘ÓÙ‹ÚËÛ˘ Î·È ·ÎÔÏÔ‡ıˆ˜ ˘ÔÙÚÔ›·Û ÂÓÙfi˜ 4 ÌËÓÒÓ. ∏ ‰Â‡ÙÂÚË ·ÛıÂÓ‹˜, ÛÙËÓ ÔÔ›· ·ÓȯÓ‡ıËΠMRD ·ÓÔÛÔÊ·ÈÓÔÙ˘Èο ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ıÂÚ·›·˜ Û˘ÓÙ‹ÚËÛ˘ Û ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÌfiÏȘ 2 ÌËÓÒÓ ·Ú·ÎÔÏÔ‡ıËÛ˘, ·Ú·Ì¤ÓÂÈ Û ‡ÊÂÛË, ·ÏÏ¿ ΢ÙÙ·ÚÔÂÓÈ΋. ™ÙÔ ÛËÌÂ›Ô ·˘Ùfi, ı· ı¤Ï·Ì ȉȷ›ÙÂÚ· Ó· ÙÔÓ›ÛÔ˘Ì fiÙÈ Ë ÛËÌ·Û›· Ù˘ ·Ó·˙‹ÙËÛ˘ Ù˘ MRD Ì ÙËÓ ·ÚÔ‡Û· ÛÙÚ·ÙËÁÈ΋ ÚÔÛÏ·Ì‚¿ÓÂÈ È‰È·›ÙÂÚË ·Í›·, fi¯È ÌfiÓÔ ÁÈ· ÙËÓ ·Ó›¯Ó¢ÛË ÙÔ˘ ˘¿Ú¯ÔÓÙÔ˜ Ï¢¯·ÈÌÈÎÔ‡ ÊÔÚÙ›Ô˘, ·ÏÏ¿ Î·È ÁÈ· ÙË ‰È·ÎÚÈÙÈ΋ Ù˘ ÈηÓfiÙËÙ· ÌÂٷ͇ Ê˘ÛÈÔÏÔÁÈÎÔ‡ ÚÔ‰ÚfiÌÔ˘ Î·È Ï¢¯·ÈÌÈÎÔ‡ µ ÛÙÔÈ¯Â›Ô˘ Û ÔÏÏ·Ï¿ ‰Â›ÁÌ·Ù· Ì ˘„ËÏfi ÔÛÔÛÙfi ·ÈÌ·ÙÔÁÔÓ›ˆÓ Î·È ÂȉÈο ٿ͈˜ π (Tdt+, CD10+, CÌ-, Ì ÌÂȈ̤ÓË ¤ÎÊÚ·ÛË ÙÔ˘ CD45) (∂ÈÎfiÓ· 7), Ù· ÔÔ›· ·Ú·ÙËÚ‹ıËÎ·Ó Û˘¯Ó¿ ÛÙÔ˘˜ ·Ó·ÁÂÓÓÒÌÂÓÔ˘˜ Ì˘ÂÏÔ‡˜ ÙˆÓ ·È‰ÈÒÓ, ÌÂÙ¿ ÙÔ˘˜ ·ÎÏÔ˘˜ ¯ËÌÂÈÔıÂÚ·›·˜ ÙÔ˘ ÚˆÙÔÎfiÏÏÔ˘ ALL-BFM ’95. ∫·Ó¤Ó·˜ ·ÛıÂÓ‹˜ ÙˆÓ ÔÌ¿‰ˆÓ ∞ (14/17) Î·È µ (13/16) (∂ÈÎfiÓ· 7), ÛÙÔ˘˜ ÔÔ›Ô˘˜ ˘‹ÚÍ ¤ÓÙÔÓÔ ‰È·ÊÔÚԉȷÁÓˆÛÙÈÎfi Úfi‚ÏËÌ· ÌÂٷ͇ ·ÈÌ·ÙÔÁÔÓ›ˆÓ Î·È ÓfiÛÔ˘, ‰ÂÓ ˘ÔÙÚÔ›·Û ÛÙÔ ‰È¿ÌÂÛÔ ¯ÚfiÓÔ ·Ú·ÎÔÏÔ‡ıËÛ˘ Ù˘ ÌÂϤÙ˘. ∞ÓÙ›ıÂÙ·, Ë ·ÛıÂÓ‹˜ ÛÙËÓ ÔÔ›· ·ÓȯÓ¢fiÙ·Ó ÂÏ·ÙÙÔ‡ÌÂÓË ÌÂÓ ·ÏÏ¿ ÛÙ·ıÂÚ‹ ÓfiÛÔ˜ (∂ÈÎfiÓ· 7/°), ·Ú¿ ÙË Û˘Ó¯‹ ·Ú·ÌÔÓ‹ Ù˘ Û ÎÏÈÓÈ΋ Î·È ÌÔÚÊÔÏÔÁÈ΋ ‡ÊÂÛË Â› 1,5 ¯ÚfiÓÔ Î·È ÙË ‰ÈÂÓÂÚÁËı›۷ ·ÏÏÔÁÂÓ‹ ÌÂÙ·ÌfiÛ¯Â˘ÛË (µª∆) ·fi ÙÔÓ Û˘Ì‚·Ùfi ·‰ÂÏÊfi Ù˘, ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÚÒÙ˘ ‡ÊÂÛ˘ (6 Ì‹Ó˜ ·fi ÙË ‰È¿ÁÓˆÛË), ˘ÔÙÚÔ›·Û ÌÂÙ¿ ·fi ÙËÓ µª∆ Û ۇÓÙÔÌÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· (5 Ì‹Ó˜). ∏ ÌÔÓ·‰È΋ ˘ÔÙÚÔ‹ ÌÂٷ͇ ÙˆÓ ·ÛıÂÓÒÓ Ù˘ ÔÌ¿‰·˜ ∞, ·ÊÔÚ¿ Û ·ÛıÂÓ‹ Ì ‰È·ÌÂÙ¿ıÂÛË 9;22, ÛÙÔÓ ÔÔ›Ô ‰ÂÓ ·ÓȯÓ‡ıËΠÌÔÚÊÔÏÔÁÈο Î·È Î˘ÙÙ·ÚÔÌÂÙÚÈο ÓfiÛÔ˜ ̤¯ÚÈ Ù˘ ‰ÈÂÓ¤ÚÁÂÈ·˜ Ù˘ ·ÏÏÔÁÂÓÔ‡˜ ÌÂÙ·ÌfiÛ¯Â˘Û˘, Ë ÔÔ›·

NoV-dEc-02

14-05-03

14:26

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¶·È‰È·ÙÚÈ΋ 2002;65:463-481

¤ÁÈÓ ÛÙËÓ ÚÒÙË ‡ÊÂÛË. O ·ÛıÂÓ‹˜ ·˘Ùfi˜ ˘ÔÙÚÔ›·Û 1 Ì‹Ó· ÌÂÙ¿ ÙË ‰ÈÂÓ¤ÚÁÂÈ· Ù˘ µª∆ Î·È fiˆ˜ ·ԉ›¯ıËΠ·fi ÙȘ ·ÏÏÂ¿ÏÏËϘ Ù·¯Â›Â˜ ÌÔÚÊÔÏÔÁÈΤ˜ ˘Ê¤ÛÂȘ Î·È ˘ÔÙÚÔ¤˜ Ô˘ ·ÎÔÏÔ‡ıËÛ·Ó, ̤¯ÚÈ ÙË ‰ÈÂÓ¤ÚÁÂÈ· Ù˘ 2˘ ÌÂÙ·ÌfiÛ¯Â˘Û˘ ·fi ·ÙÙ·Ú· ÙÔ˘ ›‰ÈÔ˘ ‰fiÙË, Ô Î˘ÙÙ·ÚÈÎfi˜ Ï¢¯·ÈÌÈÎfi˜ ÎÏÒÓÔ˜ ÙÔ˘ ˘·ÎÔ‡ÂÈ ÈηÓÔÔÈËÙÈο ÛÙË ¯ÔÚËÁÔ‡ÌÂÓË ¯ËÌÂÈÔıÂÚ·›·, ·ÏÏ¿ ·˘Í¿ÓÂÙ·È ·ÈÊÓ›‰È· Î·È ˘¤ÚÌÂÙÚ· ÛÙ· ÌÂÛԉȷÛÙ‹Ì·Ù· ·˘Ù‹˜ (high leukemia regrowth), Ì ·ÔÙ¤ÏÂÛÌ· Ó· ÂÍÂÏ›ÛÛÂÙ·È Ë ˘ÔÙÚÔ‹ Û ‚Ú·¯‡ ÌÂÛԉȿÛÙËÌ· ÚÈÓ ÙÔÓ ÂfiÌÂÓÔ ¤ÏÂÁ¯Ô ÁÈ· MRD. ŸÛÔÓ ·ÊÔÚ¿ Û ¿ÏÏÔ˘˜ ÂÚ¢ÓËÙ¤˜ Ô˘ ÚÔÛÂÁÁ›˙Ô˘Ó ÙËÓ ·Ó·˙‹ÙËÛË Ù˘ MRD ̤ۈ ÌÂϤÙ˘ ‰ÈÏÒÓ ‹ ÙÂÙÚ·ÏÒÓ Û˘Ó‰˘·ÛÌÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ·ÓÙÈÁÔÓÈÎÒÓ ÂÈÙfiˆÓ ÙˆÓ Ï¢¯·ÈÌÈÎÒÓ ‚Ï·ÛÙÒÓ (24,25) ‹ ̤ۈ ·ıÔÏÔÁÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ ÛÙÔ ÚÔ˚fiÓ Ù˘ PCR (26), ‹‰Ë Â›Û˘ ÁÓˆÛÙÒÓ ÁÈ· ¤Ó· ¤Î·ÛÙÔ ·ÛıÂÓ‹ ·fi ÙË ‰È¿ÁÓˆÛË, Ê·›ÓÂÙ·È Î·È ÂΛ fiÙÈ Ù· ·ÔÙÂϤÛÌ·Ù· ÔÈΛÏÏÔ˘Ó Â˘Ú¤ˆ˜ ‹ ‰ÂÓ Â›Ó·È ¿ÓÙÔÙ ٷ ·Ó·ÌÂÓfiÌÂÓ·. ∆Ô‡ÙÔ ·Ô‰›‰ÂÙ·È ÛÙÔ fiÙÈ Ë ·Ó·˙‹ÙËÛË ÙˆÓ ÂȉÈÎÒÓ Û˘ÓÂÎÊÚ¿ÛÂˆÓ ‰ÂÓ Â›Ó·È ¿ÓÙ· ÂÊÈÎÙ‹ ÛÙËÓ ÔÚ›· Ù˘ ÓfiÛÔ˘, ¿ÏÏÔÙ ÁÈ·Ù› ÌÂÙ·‚¿ÏÏÂÙ·È Ê·ÈÓÔÙ˘Èο Ô Ï¢¯·ÈÌÈÎfi˜ ÎÏÒÓÔ˜ Î·È ¿ÏÏÔÙ ÁÈ·Ù› ÙÚÔÔÔÈÔ‡ÓÙ·È Ù· ÁÂÓÂÙÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ Ï¢¯·ÈÌÈÎÔ‡ ÎÏÒÓÔ˘ ηٿ ÙËÓ ÔÚ›· Ù˘ ÓfiÛÔ˘ (Úfi‚ÏËÌ· Ô˘ ·ÊÔÚ¿ ÛÙË ÌÔÚȷ΋ ·Ó·˙‹ÙËÛË Ù˘ MRD ‰È¿ Ù˘ PCR) (26,27). ∂ȉÈÎfiÙÂÚ· ‰Â ˆ˜ ÚÔ˜ ÙË ¯Ú‹ÛË Ù˘ PCR ˆ˜ ÂÓfi˜ ¢·›ÛıËÙÔ˘ ‰Â›ÎÙË Ù˘ MRD, ηı’ fiÛÔÓ ÌÔÚ› Ó· ·ÓȯÓ‡ÛÂÈ ¤Ó· ·ıÔÏÔÁÈÎfi ·ÙÙ·ÚÔ ·Ó¿ 104 ‹ 105 ·ÙÙ·Ú·, Ô ÂÈϤÔÓ ÚfiÏÔ˜ Ù˘ ˆ˜ ÂȉÈÎÔ‡ Î·È ·ÎÚÈ‚Ô‡˜ ‰Â›ÎÙË Ù˘ ÎÏÈÓÈ΋˜ ¤Î‚·Û˘ ÙˆÓ ·ÛıÂÓÒÓ ‰ÂÓ ¤¯ÂÈ ÛÙ·ıÂÚ¿ ·Ô‰Âȯı›. ∂›Ó·È ÁÓˆÛÙfi fiÙÈ ·ÛıÂÓ›˜ Ì ÛÙ·ıÂÚfi ‡ÚËÌ· PCR (+) ·Ú·Ì¤ÓÔ˘Ó Û ‡ÊÂÛË Â› ¯ÚfiÓÈ· (28). ∂Ó ÚÔÎÂÈ̤ӈ, ıˆÚԇ̠fiÙÈ Ì›˙ÔÓ ı¤Ì· Ô˘ ¯Ú‹˙ÂÈ È‰È·›ÙÂÚÔ˘ ÚÔ‚ÏËÌ·ÙÈÛÌÔ‡ ˆ˜ ÚÔ˜ ÙÔ˘˜ ıÂÚ·¢ÙÈÎÔ‡˜ ¯ÂÈÚÈÛÌÔ‡˜ ÙˆÓ ·ÛıÂÓÒÓ, Â›Ó·È ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ·Ó Î·È ¤Ó· ıÂÙÈÎfi ‰Â›ÁÌ· PCR Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÂÈÛËÌ·›ÓÂÈ ÙËÓ ·ÚÔ˘Û›· ÂÓfi˜ ÌÈÎÚÔ‡ ÏËı˘ÛÌÔ‡ ÎψÓÈÎÒÓ Î˘ÙÙ¿ÚˆÓ, ·Ó Î·È ÙÔ‡ÙÔ ÚÔÔȈӛ˙ÂÈ Î·È ÂÈΛÌÂÓË ˘ÔÙÚÔ‹, Â›Ó·È ·Ôχو˜ ·‚¤‚·ÈÔ. ™˘ÓÂÒ˜, ¯ÚÂÈ¿˙ÔÓÙ·È ÔÏϤ˜ ¢Ú›˜ ÌÂϤÙ˜ ÁÈ· Ó· ··ÓÙËı› ÙÔ ÂÚÒÙËÌ· Î·È Ó· ‰ÔıÔ‡Ó ıÂÚ·¢ÙÈΤ˜ Ô‰ËÁ›Â˜ ¯ÂÈÚÈÛÌÔ‡ Ù¤ÙÔÈˆÓ ·ÛıÂÓÒÓ. ∆¤ÏÔ˜, ·fi ÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘ ‹‰Ë ·Ó·ÊÂÚı›۷˜ ÛÙÚ·ÙËÁÈ΋˜ ·Ú·ÎÔÏÔ‡ıËÛ˘ ÙˆÓ ·ÛıÂÓÒÓ Ì·˜, Ô˘ fiˆ˜ ÙÔÓ›ÛÙËΠ‹Ù·Ó fiÏÔÈ ÔÌÔÈÔÁÂÓÒ˜ ıÂÚ·¢fiÌÂÓÔÈ Î·È ÂÏÂÁ¯fiÌÂÓÔÈ ÛÙ· ÛÙ·ıÂÚ¿ ÚÔÙÂÈÓfiÌÂÓ· ¯ÚÔÓÈο ÛËÌ›· ÙÔ˘ ÚˆÙÔÎfiÏÏÔ˘ ALLBFM ’95, ‚ڋηÌ ӷ ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙ· ‰Â›ÁÌ·Ù·

Paediatriki 2002;65:463-481

Ì˘ÂÏÔ‡ ÙÚ›· ‰È·ÊÔÚÂÙÈο ÚfiÙ˘· ÂÌÊ¿ÓÈÛ˘ ÏÂÌÊÔ΢ÙÙ·ÚÈÎÒÓ ÏËı˘ÛÌÒÓ (ÓfiÛÔ˜, ·ÈÌ·ÙÔÁfiÓÈ· Î·È ÒÚÈÌÔ µ ÛÙÔȯ›Ô). ∏ Û‡ÓıÂÛË ·˘Ù‹ ÙÔ˘ µ ÛÙÔÈ¯Â›Ô˘ ‰È¤ÎÚÈÓ ÙÔ˘˜ ·ÛıÂÓ›˜ ÛÙȘ ÔÌ¿‰Â˜ ∞, µ Î·È ° (‚Ï. ∞ÔÙÂϤÛÌ·Ù· Î·È ∂ÈÎfiÓ· 7). π‰È·›ÙÂÚ· ÛËÌ·ÓÙÈÎfi ıˆÚԇ̠ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ·Ô‰ÂÈÎÓ‡ÂÙ·È fiÙÈ Ù· ÙÚ›· ·˘Ù¿ ‰È·ÊÔÚÂÙÈο ÚfiÙ˘· ÂÌÊ¿ÓÈÛ˘ ÙˆÓ ˘ÔÏËı˘ÛÌÒÓ ÙÔ˘ µ ÛÙÔÈ¯Â›Ô˘ ÂÓ¤¯Ô˘Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ (p=0,02) Û˘Û¯¤ÙÈÛË Ì ÙȘ ÔÌ¿‰Â˜ ¯·ÌËÏÔ‡, ÂӉȿÌÂÛÔ˘ Î·È ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÙÔ˘ ÚˆÙÔÎfiÏÏÔ˘ ALL-BFM ’95, ˘Ô‰ÂÈÎÓ‡ÔÓÙ·˜ ¤ÙÛÈ ÙËÓ ÚÔÁÓˆÛÙÈ΋ ÛËÌ·Û›· ÙˆÓ ÔÌ¿‰ˆÓ ·˘ÙÒÓ. ∏ ÛËÌ·Û›· ·˘Ù‹ ·Ô‰›‰ÂÙ·È ÛÙ· ıÂÙÈο ÛÙÔȯ›· Ô˘ Û˘Óı¤ÙÂÈ Ë ·ÚÔ˘Û›· ·ÈÌ·ÙÔÁÔÓ›ˆÓ ÛÙÔÓ ·Ó·ÁÂÓÓÒÌÂÓÔ Ì˘ÂÏfi ÙˆÓ ·È‰ÈÒÓ Ì µ-O§§ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙË Û˘ÓÔ‰fi ·ÚÔ˘Û›· ‹ ÌË MRD ÛÙȘ ‰È·‰Ô¯ÈΤ˜ ¯ÚÔÓÈΤ˜ ÂϤÁ¯Ô˘ Ù˘ ÓfiÛÔ˘ Î·È Î˘Ú›ˆ˜ ÛÙȘ ÛËÌ·ÓÙÈΤ˜ ÛÙÈÁ̤˜ Ù˘ 15˘ Î·È 33˘ Ë̤ڷ˜ (29). ™ÙȘ ¯ÚÔÓÈΤ˜ ·˘Ù¤˜ ÛÙÈÁ̤˜ ÂϤÁ¯Ô˘, Ë ·ÚÔ˘Û›· ‹ ÌË ·ÓȯÓ‡ÛÈÌÔ˘ Ï¢¯·ÈÌÈÎÔ‡ ÊÔÚÙ›Ô˘ Û˘Ó‰˘¿˙ÂÙ·È Î·È Ì ÙËÓ Ù·¯Â›· ‹ ÌË Î¿ı·ÚÛ‹ ÙÔ˘. ™˘ÓÂÒ˜, Ë ÚÔÁÓˆÛÙÈ΋ ÙÔ˘˜ ·Í›· ÁÈ· ÙËÓ ¤Î‚·ÛË ÙˆÓ ·ÛıÂÓÒÓ Â›Ó·È ÁÓˆÛÙ‹ (30). ∆· ·ÓˆÙ¤Úˆ ÚfiÙ˘· ÙˆÓ ‰È·Î˘Ì¿ÓÛÂˆÓ ÙˆÓ µ ÏÂÌÊÔ΢ÙÙ·ÚÈÎÒÓ ˘ÔÏËı˘ÛÌÒÓ Î·È Ù˘ ÓfiÛÔ˘, fiˆ˜ ‰È·ÈÛÙÒıËÎ·Ó ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, ÂÈϤÔÓ, ‰›ÓÔ˘Ó ÏËÚÔÊÔڛ˜ ÁÈ· ÙËÓ ÔÚ›· Ù˘ ÏÂÌÊÔÔ›ËÛ˘ Ì ÙË ¯Ú‹ÛË Ù˘ Û˘ÁÎÂÎÚÈ̤Ó˘ ıÂÚ·¢ÙÈ΋˜ ÔÏÈÙÈ΋˜ ÙÔ˘ ÚˆÙÔÎfiÏÏÔ˘ ALL-BFM ’95, ÂÓÒ ÈÛÙ‡ԢÌ fiÙÈ Ë ÚÔÛı‹ÎË Ó¤ˆÓ ·ÛıÂÓÒÓ ÛÙË ÌÂϤÙË, Ë ÔÔ›· Û˘Ó¯›˙ÂÙ·È, ı· ÈÛ¯˘ÚÔÔÈ‹ÛÂÈ ÙËÓ ÚÔÁÓˆÛÙÈ΋ ·Í›· ÙˆÓ ·ÓˆÙ¤Úˆ ·Ó·ÊÂÚı¤ÓÙˆÓ ÚÔÙ‡ˆÓ (∞, µ, °). ™˘ÌÂÚ·ÛÌ·ÙÈο, ·fi ÙÔ ÚÒÙÔ ÛΤÏÔ˜ Ù˘ ‚·ÛÈ΋˜ ÌÂϤÙ˘ ηıÔÚ›ÛÙËÎ·Ó Â·ÎÚÈ‚Ò˜ Ù· ·ÓÔÛÔÊ·ÈÓÔÙ˘Èο ¯·Ú·ÎÙËÚÈÛÙÈο fiÏÔ˘ ÙÔ˘ Ê¿ÛÌ·ÙÔ˜ ˆÚ›Ì·ÓÛ˘ Î·È ‰È·ÊÔÚÔÔ›ËÛ˘ ÙÔ˘ µ ÏÂÌÊÔ΢ÙÙ·ÚÈÎÔ‡ ÛÙÔÈ¯Â›Ô˘, ·fi Ù· ÔÔ›· ÚԤ΢„·Ó Û˘ÁÎÂÎÚÈ̤Ó˜ Ù¿ÍÂȘ ·ÈÌ·ÙÔÁÔÓ›ˆÓ Î·È ‰ÈÂÚ¢ӋıËÎÂ Ë Î·Ù¿ ÛÂÈÚ¿ ÂÌÊ¿ÓÈÛË Î·È ÂÈÎÚ¿ÙËÛ‹ ÙÔ˘˜ ÛÙÔÓ ÂÓ ËÛ˘¯›· ‹ ·Ó·ÁÂÓÓÒÌÂÓÔ Ì˘ÂÏÒÓ ÙˆÓ ÔÛÙÒÓ ÙˆÓ ·È‰ÈÒÓ. ∂›Û˘, ȉȷ›ÙÂÚ· ÛËÌ·ÓÙÈÎfi ‡ÚËÌ· ·ԉ›¯ıËÎÂ Ë ·Ó‡ÚÂÛË ÛÙÔ ·›Ì· ÙˆÓ ·ÈÌ·ÙÔÁÔÓ›ˆÓ ٿ͈˜ πππ, Ù· ÔÔ›· Ê·ÈÓÔÙ˘Èο Ù·˘Ù›˙ÔÓÙ·È Ì ÙËÓ ÙÂÏÈ΋ ‚·ıÌ›‰· ‰È·ÊÔÚÔÔ›ËÛ˘ Ù˘ Îϛ̷η˜ Ù˘ µ ÏÂÌÊÔÔ›ËÛ˘ ÛÙÔÓ Ì˘ÂÏfi Î·È ıˆÚÔ‡ÓÙ·È ¿ÌÂÛÔÈ ÚfiÁÔÓÔÈ ÙˆÓ ·Úı¤ÓˆÓ CD5+ µ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ, Ô˘ ‚Ú›ÛÎÔÓÙ·È ·˘ÍË̤ӷ ÛÙÔÓ ÔÌÊ¿ÏÈÔ ÏÒÚÔ Î·È ÙÔ ·›Ì· ÙˆÓ ·ÛıÂÓÒÓ ÌÈÎÚ‹˜ ËÏÈΛ·˜. ™ÙÔ ‰Â‡ÙÂÚÔ ÛΤÏÔ˜ Ù˘ ÌÂϤÙ˘ ·Ó·Ï‡ıËÎÂ Ë ‰È·ÌfiÚʈÛË Ì›·˜ ÛÙÚ·ÙËÁÈ΋˜ ·ÓÔÛÔÊ·ÈÓÔÙ˘È΋˜ ÚÔÛ¤ÁÁÈÛ˘ Ù˘ ·Ó·˙‹ÙËÛ˘

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Ù˘ ÂÏ¿¯ÈÛÙ˘ ˘ÔÏÂÈfiÌÂÓ˘ ÓfiÛÔ˘, ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì µ ΢ÙÙ·ÚÈ΋˜ ÚÔ¤Ï¢Û˘ O§§, Ë ÔÔ›·, ·fi Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘, Ê¿ÓËΠ·ÍÈfiÈÛÙË ˆ˜ ÚÔ˜ ÙË ‰È¿ÎÚÈÛË ÌÂٷ͇ Ê˘ÛÈÔÏÔÁÈÎÒÓ Tdt+ µ ÏÂÌÊÈÎÒÓ ÚÔÁÂÓÓËÙfiÚˆÓ Î·È Tdt (+) Ï¢¯·ÈÌÈÎÒÓ ‚Ï·ÛÙÒÓ. ∏ ÂÊ·ÚÌÔÁ‹ Ù˘ ÛÙÚ·ÙËÁÈ΋˜ ·˘Ù‹˜ ı· ·ÍÈÔÏÔÁËı› ÂÚ·ÈÙ¤Úˆ Û ÂfiÌÂÓË ÚÔÔÙÈ΋ ÌÂϤÙË, Ô‡Ùˆ˜ ÒÛÙ ӷ ˘¿Ú¯Ô˘Ó ÛÙÔȯ›· ·fi ÂÚÈÛÛfiÙÂÚÔ˘˜ ·ÛıÂÓ›˜ Î·È Ì ̷ÎÚfiÙÂÚÔ ¯ÚfiÓÔ ·Ú·ÎÔÏÔ‡ıËÛ˘.

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¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ™ÔÊ›· ¶ÔÏ˘¯ÚÔÓÔÔ‡ÏÔ˘ πˆ¿ÓÓÔ˘ °ÂÓÓ·‰›Ô˘ 14∞, ∆.∫. 115 21, ∞ı‹Ó· E-mail: sophpol@otenet.gr

¶ÂÚ›ÏË„Ë ¿ÚıÚÔ˘ ·fi ÙË µÈ‚ÏÈÔÁÚ·Ê›· ∞˘ÙÔ·ÓÙÈÛÒÌ·Ù· Û¯ÂÙÈ˙fiÌÂÓ· Ì ÙÔ Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË Ù‡Ô˘ π Î·È ·È‰È΋ ·˘ÙÔ¿ÓÔÛË Ë·Ù›Ùȉ·1 ™ÎÔfi˜: ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ó· ηıÔÚ›ÛÂÈ ÙË Û˘¯ÓfiÙËÙ· Î·È ÙË ÛËÌ·Û›· ÙˆÓ Û¯ÂÙÈ˙fiÌÂÓˆÓ Ì ÙÔ Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË Ù‡Ô˘ π ·˘ÙÔ·ÓÙÈۈ̿وÓ, Û ·È‰È¿ Ì ·˘ÙÔ¿ÓÔÛË Ë·Ù›Ùȉ·. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ªÂÏÂÙ‹ıËÎ·Ó 28 ·È‰È¿ (25 ÎÔÚ›ÙÛÈ·), ËÏÈΛ·˜ 3,2-14,7 ¯ÚfiÓˆÓ, Ì ·˘ÙÔ¿ÓÔÛË Ë·Ù›Ùȉ·. ™Â fiÏ· Ù· ·È‰È¿ ÂϤÁ¯ıËÎÂ Ë ‡·ÚÍË ‹ fi¯È ·ÓÙÈÓËÛȉȷÎÒÓ, ·ÓÙÈÈÓÛÔ˘ÏÈÓÈÎÒÓ Î·È ¤Ó·ÓÙÈ Ù˘ ·ÔηڂÔÍ˘Ï¿Û˘ ÙÔ˘ ÁÏÔ˘Ù·ÌÈÓÈÎÔ‡ ÔͤԘ ·ÓÙÈÛˆÌ¿ÙˆÓ ÚÈÓ Î·È ÌÂÙ¿ ·fi 3-9 ¯ÚfiÓÈ· ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜ Ì ·˙·ıÈÔÚ›ÓË Î·È Ú‰ÓÈ˙fiÓË. ∞ÔÙÂϤÛÌ·Ù·: ∫ÏÈÓÈ΋ Î·È ‚ÈÔ¯ËÌÈ΋ ‡ÊÂÛË Ù˘ ·˘ÙÔ¿ÓÔÛ˘ Ë·Ù›Ùȉ·˜ ¤Ó· ¯ÚfiÓÔ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ·ÓÔÛÔηٷÛÙ·ÏÙÈ΋˜ ıÂÚ·›·˜ ·Ú·ÙËÚ‹ıËΠÛÙÔ 76% ÙˆÓ ·È‰ÈÒÓ. ∞ÓÙÈÓËÛȉȷο Î·È ·ÓÙÈÈÓÛÔ˘ÏÈÓÈο ·ÓÙÈÛÒÌ·Ù· ·ÓȯÓ‡ıËÎ·Ó ÛÙÔ 60,7% Î·È ÛÙÔ 18,5% ÙˆÓ ·ÛıÂÓÒÓ, ·ÓÙ›ÛÙÔȯ· Î·È Ù· ÔÔ›· ÌÂÈÒıËÎ·Ó ÛÙÔ 38,5% Î·È ÛÙÔ 12% 3-9 ¯ÚfiÓÈ· ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜. ∞ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ Ù˘ ·ÔηڂÔÍ˘Ï¿Û˘ ÙÔ˘ ÁÏÔ˘Ù·ÌÈÓÈÎÔ‡ ÔͤԘ ·Ó·ÁÓˆÚ›ÛÙËÎ·Ó Û ¤Ó· ÌfiÓÔ ·È‰›, Ô˘ ›¯Â Î·È ÓfiÛÔ ÙÔ˘ Graves Î·È ÙÔ ÔÔ›Ô, ÛÙË Û˘Ó¤¯ÂÈ·, ·Ó¤Ù˘Í ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË Ù‡Ô˘ π. ªÂÙ¿ ·fi 3-9 ¯ÚfiÓÈ·

·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜, fiÏÔÈ ÔÈ ·ÛıÂÓ›˜ ›¯·Ó Ê˘ÛÈÔÏÔÁÈ΋ ÁÏ˘Îfi˙Ë ÓËÛÙ›·˜ Î·È Ê˘ÛÈÔÏÔÁÈ΋ ÁÏ˘ÎÔ˙˘ÏȈ̤ÓË Hb (HbAIC) ηÈ, Ì ÂÍ·›ÚÂÛË ¤Ó·Ó ÌfiÓÔ ·ÛıÂÓ‹, Ê˘ÛÈÔÏÔÁÈ΋ ‰ÔÎÈÌ·Û›· ÊfiÚÙÈÛ˘ Ì ÁÏ˘Îfi˙Ë. ™˘ÌÂÚ¿ÛÌ·Ù·: ∏ ·˘ÙÔ¿ÓÔÛË Ë·Ù›Ùȉ· ÛÙËÓ ·È‰È΋ ËÏÈΛ· Û˘¯Ó¿ Û˘Óԉ‡ÂÙ·È ·fi ÙËÓ ·ÚÔ˘Û›· ·ÓÙÈÓËÛȉȷÎÒÓ Î·È ·ÓÙÈÈÓÛÔ˘ÏÈÓÈÎÒÓ ·ÓÙÈۈ̿وÓ, ¯ˆÚ›˜ fï˜ ·˘Ùfi Ó· Û˘ÓÂ¿ÁÂÙ·È Î·È ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ·Ó¿Ù˘Í˘ ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË Ù‡Ô˘ π.

1 da Silva ME, Porta G, Golberg AC, Bittencourt PL, Fukui RT, Correia MR et al Diabetes mellitus-related autoantibodies in childhood autoimmune hepatitis J Pediatr Endocrinol Metab 2002;15:831-840

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∂˘¯·ÚÈÛٛ˜ ÚÔ˜ ÙÔ˘˜ ∫ÚÈÙ¤˜ Ù˘ “¶·È‰È·ÙÚÈ΋˜” ∏ ¢È‡ı˘ÓÛË Î·È Ù· ̤ÏË Ù˘ ∂ÈÛÙËÌÔÓÈ΋˜ ™˘ÓÙ·ÎÙÈ΋˜ ∂ÈÙÚÔ‹˜ ¢¯·ÚÈÛÙÔ‡Ó ıÂÚÌ¿ ÙÔ˘˜ ÎÚÈÙ¤˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ “¶·È‰È·ÙÚÈ΋” Ô˘ ÚÔÛ¤ÊÂÚ·Ó ÙËÓ ›ڷ Î·È ÙÔ ¯ÚfiÓÔ ÙÔ˘˜ ÁÈ· Ó· ÂÍ·ÛÊ·Ï›ÛÔ˘ÌÂ Û˘ÛÙËÌ·ÙÈΤ˜, ÙÂÎÌËÚȈ̤Ó˜ Î·È ·ÓÙÈÎÂÈÌÂÓÈΤ˜ ·ÍÈÔÏÔÁ‹ÛÂȘ ÁÈ· ÙȘ ÂÈÛÙËÌÔÓÈΤ˜ ÂÚÁ·Û›Â˜ Ô˘ ‰ËÌÔÛȇıËÎ·Ó Î·Ù¿ ÙÔ ¤ÙÔ˜ 2002.

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81 261 387 442

∫ ∫·‚·ÏÈÒÙ˘ π. ∫·Î·‚¿Î˘ ∫. ∫·ÎÔ˘ÏÏ‹˜ ∫. ∫·Ï¤ÁÈ·˜ π. ∫·ÌÔ‡ÚË ∞. ∫·Ó·‚¿Î˘ ∂. ∫·ÓÙÂÚ¤-ªÂÎÈÒÙË ∂. ∫·ÂÙ·Ó¿Î˘ π. ∫·›ÎË ∞. ∫·Ú·ÁÈ¿ÓÓË ¶. ∫·Ú·Î·˚‰fi˜ ¢. ∫·Ú·Î·ÙÛ¿ÓË ∑. ∫·Ú·ÎˆÓÛÙ·ÓÙ¿ÎË ∂. ∫·Ú·ÎˆÓÛÙ·ÓÙ¿Î˘ £. ∫·Ú¿ÌÂÏ·˜ µ.

241,248 442 195 9,133,195,199,203 439 118 118 133 356 174 413 128,346 452 362 23

483

NoV-dEc-02

14-05-03

14:26

™ÂÏ›‰·484

¶·È‰È·ÙÚÈ΋ 2002;65:483-485

∫·Ú·Ù˙¿ ∂. ∫·Ú‹˜ Ã. ∫·ÙÛ¿Ú· ª. ∫·Ê·Ï›‰Ë˜ °. ∫·Ê¿ÙÔ˜ ∞. ∫·„ÈÌ¿ÏË ∑. ∫ÂÚ·Ì›‰·˜ ¢. ∫Ô‚¿Ó˘ ∞. ∫fiÎÔÚË ∂. ∫ÔÓ‰‡Ï˘ ∞. ∫ÔڷοÎË ∂. ∫ÔÚÔÔ‡ÏË ª. ∫ÔÛÌ›‰Ë ∂. ∫fiÙÛ·Ï˘ Ã. ∫Ô˘ÏÔ˘Ú›‰· µ. ∫Ô˘Ì·Ó›‰Ô˘ Ã. ∫Ô˘Ú¿Î˘ °. ∫Ô˘ÚÙ¤Û˘ ∞. ∫Ô‡ÛË ∞. ∫ÚÂÌÂÓfiÔ˘ÏÔ˜ °. ∫ÚËÙÈÎÔ‡ ∂. ∫Ú›ÎÔ˜ •. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜ ∞. ∫ÒÛÙ·ÏÔ˜ Ã. ∫ˆÛÙ·Ú›‰Ô˘ ™. ∫ˆÛÙԇϷ ∞. § §·˙ÔÔ‡ÏÔ˘ ¢. §·˚Ó¿Î˘ ¡. §·Ì·‰·Ú›‰Ë˜ π. §·ÙÔ‡ÊË ∂. §È¿ÚÔ˘ £. §ÈÓ·Ú‰¿Î˘ ª. §ÈÔÓ‹˜ Ã. ª ª·Ï·ıÚ¿ÎË ª. ª·ÌÔ˘Ï¿Î˘ ¢. ª·Ó¿ÎÔ˘ ¡. ª·ÓÈfi˜ °. ª·ÓÔ˘Ú¿ ∞. ª¿ÓÙ˙ÈÔ˘ £. ª·Ú·ÁοÎË ∂. ª¿Ú·Î· ™. ª·ÚÎÔ‡ÚË ª. ªËÙÛ¿ÎË ª. ª‹ÙÛÈη-∫·Ú·Ó¿ÛÔ˘ ∞. ª›¯·-°ÂˆÚÁÈÔÔ‡ÏÔ˘ ¶. ªÈ¯·ËÏ›‰Ô˘ ∂. ªÈ¯ÂϷοÎË ∂. ªÈ¯ÂÏÔÁÈ¿ÓÓ˘ ™. ª›¯Ô˜ ∞.

484

Paediatriki 2002;65:483-485

419 261,413 160 212 66 23 138 23 108 128,346 40,113,278 113 46 372 265 377 133 81 77 32,174 256 142 23 52,122,199,203,356,362 351 256

367 439 261 81 9 452 186

424 40,208 322 66 40,113,278,394 23 122 16,108 133 40 128 86 424 261,287 452 138,367

ªÔÛÙÚÔ‡ °. ªÔÛ¯·Ó‰Ú¤· π. ª¿Î· ª. ª·Ï¿Ûη ∞. ª·ÏÙÔÁÈ¿ÓÓ˘ ¡. ª·ÚÌ·Á·‰¿ÎË ™. ª·ÚÔ‡Ù˘ °. ªÈÙÛÒÚË ª. ªÔ˘¯Ô‡ÙÛÔ˘ ¢. ªÚÈ·ÛÔ‡Ï˘ °. ªˆÚ·˝ÙÔ˘ ª.

442 66 46 273 138 439 195,199 208 46 81 261

¡ ¡¿ÓÔ˘ ∞. ¡Â¿Ú¯Ô˘ ∞. ¡ÈÎÔÏ·˝‰Ë˜ ¡. ¡ÈÎÔÏ·˝‰Ô˘ ¡. ¡Ô‡ÙÛÈ· Ã. ¡Ù·ÓÙ¿Ì˘ Ã. ¡ÙfiÏ·Ù˙·˜ £.

241,248 424 174 261 32 118 439

• •˘ÏÔ‡ÚË ∂.

•˘ÓÈ¿˜ π.

186 419

O OÈÎÔÓÔÌ›‰Ô˘ O. OÈÎÔÓÔÌ›‰Ô˘ Ã.

OÈÎÔÓfiÌÔ˘ ª.

OÚÊ·ÓÔ‡ ∂.

O˘˙Ô‡ÓË °.

203 52 77 138 413

¶ ¶¿‚Ë ∂. ¶·˚‰Ô‡ÛË ∫. ¶·Ó·Á›‰Ë˜ ∞. ¶·Ó·ÁÈÒÙÔ˘ π.¶. ¶·Ó·ÁÈÒÙÔ˘-∞ÁÁÂÏ·ÎÔÔ‡ÏÔ˘ π. ¶·ÓÙÂÏÈ¿‰Ë˜ Ã. ¶··‚·ÛÈÏ›Ԣ µ. ¶··‰ÔÔ‡ÏÔ˘ ∞. ¶··‰ÔÔ‡ÏÔ˘ ¢. ¶··‰ÔÔ‡ÏÔ˘ ¡. ¶··‰ÔÔ‡ÏÔ˘-∞Ï·Ù¿ÎË ∂. ¶··‰ÔÔ‡ÏÔ˘-∫Ô˘ÏÔ˘Ì‹ ∑. ¶··‰ÔÔ‡ÏÔ˘-§ÂÁÌ¤ÏÔ˘ ∫. ¶·¿˙ÔÁÏÔ˘ ∫. ¶··ıˆÌ¿ ∂. ¶··Î˘ÚȷΛ‰Ô˘ ¶. ¶··Ó‰Ú¤Ô˘ ∂. ¶··ÛˆÙËÚ›Ô˘ π. ¶·Ú·Ûο΢ ∂. ¶·ÙÂÚ¿Î˘ °.

433 46 439 351,463 309, 419 282,447 86 122 433 265 182,256 265 160 203 32 138 362 113 463

NoV-dEc-02

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14:26

™ÂÏ›‰·485

¶·È‰È·ÙÚÈ΋ 2002;65:483-485

¶·˘Ï›‰Ë˜ π. ¶·Ê›Ù˘ Ã. ¶ÂÚÈÛÙ¤ÚË µ. ¶ÂÙÚ›‰Ô˘ ∂. ¶ÂÙÚ›‰Ô˘ ™. ¶ÂÙÚԯ›ÏÔ˘-¶¿Û¯Ô˘ µ. ¶È˙¿ÓÈ·˜ ™. ¶Ï·ÙÔÎÔ‡ÎË-∫ÔÌÈÙÔÔ‡ÏÔ˘ ∂. ¶ÔÏ˘¯ÚÔÓÔÔ‡ÏÔ˘-∞Ó‰ÚÔ˘Ï·Î¿ÎË ™. ¶Ô˘ÚÙÛ›‰Ë˜ ∞. ¶Ú›ÊÙË ∂. ¶Ú›ÊÙ˘ ∫. ƒ ƒÔ‡ÏË µ. ƒÒÌ·-°È·ÓÓ›ÎÔ˘ ∂. ™ ™·Î·Ï›‰Ô˘ ∞. ™·Îο ∂. ™·Ô˘¿ÎÈÙ π. ™·Ú·ÓÙ¿ÚË Ã. ™·Ú·Ê›‰Ë˜ ∫. ™Â‚·ÛÙÈ¿‰Ô˘ ™. ™È·ÌÔÔ‡ÏÔ˘-ª·˘Ú›‰Ô˘ ∞. ™ÈÒÌÔ˘ ∞. ™Î·ÏΛ‰Ô˘ Õ. ™Î·Ú‰Ô‡ÙÛÔ˘ ∞. ™ÎÔ˘Ì‹ ¢. ™ÎÔ˘Ù¤ÚË µ. ™Ì˘Ú¿ÎȘ ™. ™Ô‡Áη ∫. ™Ô‡ÏË ∫. ™·Ófi˜ £. ™‡ÚÔÁÏÔ˘ ∫. ™Ù·ÛÈÓÔÔ‡ÏÔ˘ ∞. ™ÙÂÊ¿ÓÔ˘-§Â‚ÂȉÈÒÙÔ˘ ™. ™ÙÔ˚Λ‰Ô˘ ª. ™ÙÚ·ÙÔ˘‰¿Î˘ ∞. ™˘Ú›ÁÔ˘-¶··‚·ÛÈÏ›Ԣ ∞. ™˘ÚÔÁÈ·ÓÓfiÔ˘ÏÔ˜ °. ∆ ∆˙·ÌÔ˘Ú¿ÓË π. ∆˙ÂÓ¿ÎË ª. ∆˙È‚¿Ú·˜ ∞. ∆˙ÈÔ˘‚¿Ú· Ã. ∆˙Ô‡ÊË ª. ∆˙ˆÚÙ˙¿ÙÔ˘ °. ∆Ô‡ÓÙ·˜ °. ∆ÚÈ·ÓÙ·Ê˘ÏÏ›‰Ë˜ °. ∆ÚÈ·ÓٷʇÏÏÔ˘ ¶. ∆Ú›Ì˘ °.

Paediatriki 2002;65:483-485

195 81 273 298 241,248 52,203 413 23,367,377 222,351,463 46 203 346

463 138,151

346 186 261 447 32,174,313 52,199 256 256 298 23,147,293 463 52 208 424 356,362 351 419 46 182 298 282 167,372 97

∆ÚȯfiÔ˘ÏÔ˜ ¢. ∆Û·ÁÚ‹˜ µ. ∆Û·Ì·Ó‰Ô˘Ú¿ÎË ∫. ∆۷ӿη˜ π.¡. ∆Û¿ÓÙ·ÏË Ã. ∆Û·¿ÎË Œ. ∆Û¿ÙÚ· π. ∆ÛÂÎÔ˘Ú¿ £. ∆ÛÈ‚ÈÙ·Ó›‰Ô˘ ª. ∆ÛÈ‚ÈÙ·Ó›‰Ô˘-∫¿ÎÔ˘ÚÔ˘ ∆. ∆ÛÈÏÈÁÁ›ÚË ª. ∆ÛÈÏÈÌÈÁοÎË ∞. ∆ÛfiÏ·˜ °. ∆ÛÔ˘Ì¿Î·˜ ∫. º º·Ú¿ÎÏ·˜ ¡. à ÷˚‰¿˜ ™.∞. ÷ڛÛË ª. ÷ÚÌ¿Ó˘ °. ÷ÚÔÎfiÔ˜ ∂. ÷Ù˙Ë·ı·Ó·Û›Ô˘ Ã.°. ÷Ù˙ËÁˆÚÁ›Ô˘ ¢. ÷Ù˙ˉ¿ÎË ∂. ÷Ù˙Ë˚ˆ·ÓÓ›‰Ë˜ ∫. ÷Ù˙‹˜ Ã. ÷Ù˙ËÛÙ·Ì·Ù›Ô˘ ∑. ÃÔ˘ÏÈ¿Ú· §. ÃÚÔÓÔÔ‡ÏÔ˘ °.

298 322 433 403 118,287 424 77 108 32 382 57 16,108,333 212 86

122

351,463 182 439 367 387 118 40,113,278 232 66 9,203 433 362

356 452 351 128 182,256 128 433 212,413 287 142,424,442

485

NoV-dEc-02

14-05-03

14:26

™ÂÏ›‰·486

¶·È‰È·ÙÚÈ΋ 2002;65:486-488

Paediatriki 2002;65:486-488

∂˘ÚÂÙ‹ÚÈÔ Ï¤ÍˆÓ-ÎÏÂȉÈÒÓ ÙÔ˘ ∆fiÌÔ˘ 65 24ˆÚË pH-ÌÂÙÚ›· Antiphospholipid syndrome Brain CNS infarct Lupus anticoagulant Myxoma RSV ‚ÚÔÁ¯ÈÔÏ›Ùȉ· Stroke Thromboembolism MRI ÂÁÎÂÊ¿ÏÔ˘ PEFR

309 4 1 4 4 4 57 1 1 372 424

∞ ∞ÁÚÔÙÈ΋ ÂÚÈÔ¯‹ 186 ∞ÁˆÁ‹ ˘Á›·˜ 66,219 ∞ÈÌ·ÙÔÁfiÓÈ· 463 ∞ÈÌ·ÙÔÏÔÁÈΤ˜ ηÎÔ‹ıÂȘ 351 ∞ÈÌ·ÙÔ˘Ú›· 367 ∞ÈÌÔÚÚ·ÁÈΤ˜ ÎÂÓÒÛÂȘ 278 ∞ÈÌÔÚÚÔÊÈÏ›· ∞ 367 ∞ÈÌÔÊ·ÁÔ΢ÙÙ·ÚÈÎfi Û‡Ó‰ÚÔÌÔ ∞ƒ∆∆ 256 ∞ÈÊÓ›‰ÈÔ˜ ηډȷÎfi˜ ı¿Ó·ÙÔ˜ 16 ∞ÏËı‹˜ ÔÏ˘Î˘ÙÙ·Ú·ÈÌ›· 222 ∞ÏËı‹˜ Û˘ÓÔÛÙˆÙÈ΋ Ô›ÛıÈ· Ï·ÁÈÔÎÂÊ·Ï›· 282 ∞ÏÎÔfiÏ 433 ∞ÏÏ·ÓÙÈ΋ ÙÔÍ›ÓË 147,167 ∞ÏÏÂÚÁ›· ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜ 278 ∞ÏÏÂÚÁ›· 346 ∞Ó·ÏÁËÙÈο Ê¿Ú̷η 212 ∞Ó¿ÓË„Ë Ì ˘ÁÚ¿ 160 ∞Ó·Û˘Ó‰˘·Ṳ̂ÓÔ˜ ÈÛÙÈÎfi˜ ÂÓÂÚÁÔÔÈËÙ‹˜ ÙÔ˘ Ï·ÛÌÈÓÔÁfiÓÔ˘ 377 ∞ÓÙÈ·Ó·ÁˆÁÈÎfi Á¿Ï· 419 ∞ÓÙÈÌÂÙÒÈÛË ÙÔ˘ fiÓÔ˘ 212 ∞ÓÙÈÌÂÙÒÈÛË 147 ∞ÓÙÈËÎÙÈÎfi ÙÔ˘ χÎÔ˘ 77 ∞ÓÙÈËÎÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÙÔ˘ χÎÔ˘ 256 ∞ÓÙÈʈÛÊÔÏÈȉÈο ·ÓÙÈÛÒÌ·Ù· 77 ∞ӈ̷ϛ· ÛÙÚÔÊ‹˜ ̤ÛÔ˘ ÂÓÙ¤ÚÔ˘ 138 ∞ÍÈÔÏfiÁËÛË 433 ∞·ÁÔÚ‡ÛÂȘ 293 ÕÛıÌ· 309,346 ÕÛÎËÛË 66 ∞‡ÍËÛË ÓÂÔÁÓÔ‡ 298 µ µ¿ÚÔ˜ Á¤ÓÓËÛ˘ µÂÓ˙ԉȷ˙Â›Ó˜ ‚-ı·Ï·ÛÛ·ÈÌ›· µÈÔËÏÂÎÙÚÈ΋ ·ÓÙ›ÛÙ·ÛË µÈÔÙÈÓȉ¿ÛË

486

298 133 118 122 356

µÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ µÚÔÁ¯ÈÂÎٷۛ˜ µÚÔÁ¯ÈÎfi ¿ÛıÌ· ° °·ÛÙÚÔÔÈÛÔÊ·ÁÈ΋ ·ÏÈÓ‰ÚfiÌËÛË (°O¶) °ÂÏ·ÛÙÈ΋ ÂÈÏË„›· °ÂÓÂÙÈ΋ ¢ ¢›·ÈÙ· ¢È·ÂÚ·ÙfiÙËÙ· ÙˆÓ ÙÚȯÔÂȉÒÓ ¢È·ÙÚÔÊ‹ ¢È¿¯˘ÙË ÊÏÂÁÌÔÓ҉˘ ·ÓÙ›‰Ú·ÛË ¢ÈÛΛÙȘ ¢ÚÂ·ÓÔ΢ÙÙ·ÚÈ΋ ·Ó·ÈÌ›·

447 403 424

309,419 372 387

66 160 186 160 89 118

∂ ∂ÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË 9,97,147,167 ∂ÁÎÂÊ·ÏÈÎfi ÂÂÈÛfi‰ÈÔ 81 ∂Î·›‰Â˘ÛË 452 ∂Ï¿¯ÈÛÙË ˘ÔÏÂÈfiÌÂÓË ÓfiÛÔ˜ 463 ∂ÏÎ҉˘ ÎÔÏ›ÙȘ 151 ∂ÏÏÂÈÌÌ·ÙÈ΋ ÚÔÛÔ¯‹ 452 ∂ÏÏÈÔ‚·Ú‹ 356 ∂Ì‚ÔÏÈ·ÛÌÔ› 219 ∂Ì‚ÔÏÈ·ÛÌfi˜ 351 ∂Ì‚ÔÏÈÎfi ÂÂÈÛfi‰ÈÔ 81 ∂Ì‚fiÏÈÔ ÂÚ˘ıÚ¿˜ 382 ∂Ì‚fiÏÈÔ ÈÏ·Ú¿˜ 382 ∂Ì‚fiÏÈÔ ·ÚˆÙ›Ùȉ·˜ 382 ∂ÓÙÂÚÔ˚Ô› 108 ∂Í·ÈÚÂÙÈο ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓ¿ 9,97 ∂ȉËÌ›· ÂÚ˘ıÚ¿˜ 273 ∂ȉËÌÈÔÏÔÁ›· 182 ∂›ÎÙËÙÔ˜ ·Ó·ÛÙÔϤ·˜ 77 ∂ÈÏË„›· 293 ∂ÈÌfiÏ˘ÓÛË 32 ∂ÚËÙÔ˚Ô› 6 Î·È 7 382 ∂ÙÂÚfiÏ¢ÚÔ Ï·ÁÈÔıˆÚ·ÎÈÎfi ÂÍ¿ÓıËÌ· 382 ∂ÙÂÚfiÏ¢ÚÔ˜ ‰È·˘Á¿˙ˆÓ Ó‡ÌÔÓ·˜ 442 ŒÊË‚ÔÈ 433 ∏ ∏·ÙÔÛÏËÓÔÌÂÁ·Ï›· ◊ÂÈÚÔ˜ ∏ˆÛÈÓÔÊÈÏ›· £ £ÂÚ·›· £ÚÂÙÈο Û˘ÛÙ·ÙÈο

287 182 40

322,333 66

NoV-dEc-02

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14:26

™ÂÏ›‰·487

¶·È‰È·ÙÚÈ΋ 2002;65:486-488

Paediatriki 2002;65:486-488

£ÚÔÌ‚ÔÂÌ‚ÔÏÈο ÂÂÈÛfi‰È· ÙÔ˘ ∫¡™ £ÚfiÌ‚ˆÛË ÓÂÊÚÈ΋˜ ÊϤ‚·˜ £ÚfiÌ‚ˆÛË

23 367 377

π π‰ÈÔ·ı‹˜ ıÚÔÌ‚Ô΢ÙÙ·Ú·ÈÌ›· π‰ÈÔ·ı‹˜ Ì˘ÂÏÔ˝ÓˆÛË ÿÎÙÂÚÔ˜ πÔÁÂÓ‹˜ ÌËÓÈÁÁ›Ùȉ· πfi˜ Epstein-Barr πÛÙÈÔ΢ÙÙ·ÚÈ΋ ÓÂÎÚˆÙÈ΋ ÏÂÌÊ·‰ÂÓ›Ùȉ· πÛ¯·ÈÌÈ΋ ÚÔÛ‚ÔÏ‹ ÙÔ˘ ∫¡™ πº¡∂

222 222 356 108 256 142 23 151

∫ ∫¿ıÂÙË ¿ÚÂÛË ‚ϤÌÌ·ÙÔ˜ ∫·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ· ∫·ÚΛӈ̷ ·fi ΢„ÂÏÔÂȉ‹ ·ÙÙ·Ú· ÛÙ· ·È‰È¿ ∫ÂÓÙÚÈ΋ ÚÒÈÌË ‹‚Ë ∫¡™ ∫ÔÎ·Ù˘ ∫ÔÏÏÔÂȉ‹ ∫Ú‹ÙË ∫ÚÔÛÛÔ› ∫Ú˘ÛÙ·ÏÏÔÂȉ‹ ∫˘ÙÙ·ÚÔÌÂÙÚ›· ÚÔ‹˜

439 413 46 442 160 108 403 160 463

§ §ÂÌÊ·‰ÂÓ›Ùȉ· §È›‰È· §È›‰ˆÛË §ÈÔÚˆÙ½Ó˜ §ÔÈÌ҉˘ ÌÔÓÔ˘Ú‹ÓˆÛË §ÔÈÌÒÍÂȘ §Ô›ÌˆÍË Ì HBV §Ô›ÌˆÍË

203 265 287 265 256 248 351 40

ª ªÂı·‰fiÓË ªÂÙ·‚ÔÏÈÛÌfi˜ ¯ÔÏËÛÙÂÚfiÏ˘ ªÂÙ·ÏÏ¿ÍÂȘ ªÂÙ·ÛÙ¿ÛÂȘ ª¤ÙÚËÛË ÔÈÛÔÊ·ÁÈÎÔ‡ pH ªË ¯ÔÏÂÚ˘ıÚÈÓÈÎÔ› ¯ÔÏfiÏÈıÔÈ ªËÓÈÁÁ›Ùȉ· ªËÓÈÁÁÈÙȉfiÎÔÎÎÔ˜ ªÈÎÚԂȷΤ˜ ÏÔÈÌÒÍÂȘ ªÔÓÔ·ÎfiÚÂÛÙ· ÏÈ›‰È· ª˘ÂÏÔ¸ÂÚÏ·ÛÙÈο Û‡Ó‰ÚÔÌ· ª‡ÍˆÌ· ·ÚÈÛÙÂÚÔ‡ ÎfiÏÔ˘ ª˘Ôηډ›Ùȉ·

287 333

133 287 118 46 346 128 241,248 248 241 298 222 81 57

¡ ¡Â·ÓÈÎÔ‡ Ù‡Ô˘ Ì˘ÂÏÔÌÔÓÔ΢ÙÙ·ÚÈ΋ Ï¢¯·ÈÌ›· 222 ¡¤ÎÚˆÛË ÂÓÙ¤ÚÔ˘ 232 ¡ÂÎÚˆÙÈ΋ ÂÓÙÂÚÔÎÔÏ›Ùȉ· 232 ¡ÂÔÁ¤ÓÓËÙÔ 195,199,203 ¡ÂÔÁÓ¿ 261 ¡ÂÔÁÓÈΤ˜ ÏÔÈÌÒÍÂȘ 313 ¡ÂÔÁÓÈ΋ ËÏÈΛ· 40 ¡ÂÔÁÓÈÎÔ› 9,97 ¡ÂÔÁÓÈÎfi˜ ›ÎÙÂÚÔ˜ 362 ¡ÂÔÁÓfi 52,278,377 ¡ÂfiÏ·ÛÌ· ÛÈÂÏÔÁfiÓˆÓ ·‰¤ÓˆÓ 439 ¡Â˘ÚÔ‚Ï¿Ûو̷ 46 ¡fiÛÔ˜ Crohn 151 ¡fiÛÔ˜ Kawasaki 208 ¡fiÛÔ˜ Kikuchi 142 ¡fiÛÔ˜ Kohler 86 ¡fiÛÔ˜ Niemann-Pick C 287 ¡Ô˘ÎÏÂÔÙ›‰È· 52 O OÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi OÍ›· ‚ÚÔÁ¯ÈÔÏ›Ùȉ· OÍ›· ÏÂÌÊÔ‚Ï·ÛÙÈ΋ Ï¢¯·ÈÌ›· OÍÂȉˆÙÈÎfi stress O›ÛıÈ· Ï·ÁÈÔÎÂÊ·Ï›· OÛÙÈ΋ ˘ÎÓfiÙËÙ· OÛÙÈÎfi˜ ÌÂÙ·‚ÔÏÈÛÌfi˜

265 57 463 261 282 413 413

¶ ¶·ıÔÊ˘ÛÈÔÏÔÁ›· 333 ¶·È‰› / ¶·È‰È¿ 23,66,122,151,182,241,248,293,333 ¶·È‰›·ÙÚÔ˜ 452 ¶·È‰È΋ ËÏÈΛ· 86,138,222,322,351,463 ¶·È¯Ó›‰È 186 ¶·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ 9,97,424 ¶·Ú¿ÁˆÓ V Leiden 377 ¶·Ú·ÌÔÚʈÙÈ΋ Ï·ÁÈÔÎÂÊ·Ï›· 282 ¶·Ú‚Ô˚fi˜ µ19 382 ¶·ÚˆÙ›‰· 439 ¶·¯˘Û·ÚΛ· 66,265,387 ¶ÂÙÈÎfi 52 ¶ÂÚÈÁÂÓÓËÙÈ΋ ıÓËÛÈÌfiÙËÙ· 113 ¶ÂÚÈÁÂÓÓËÙÈ΋ ÊÚÔÓÙ›‰· 113 ¶ÂÚÈηډ›Ùȉ· 57 ¶ÂÚÈÊÂÚÈ΋ Ó¢ÚÔ¿ıÂÈ· 287 ¶Ï·ÛÌ·ÏÔÁfiÓ· 261 ¶Ó¢ÌÔÓ›· ·fi ÂÈÛÚfiÊËÛË 309 ¶Ó¢ÌÔÓÈ΋ ˘ÔÏ·Û›· 313 ¶Ó¢ÌÔÓÈfiÎÔÎÎÔ˜ 241 ¶fiÓÔ˜ (¿ÏÁÔ˜) 212 ¶ƒ∂À 313

487

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¶·È‰È·ÙÚÈ΋ 2002;65:486-488

Paediatriki 2002;65:486-488

¶ÚÔÁÂÓÓËÙÈÎÔ› 9,97 ¶ÚfiÁÓˆÛË 394 ¶ÚfiÁÚ·ÌÌ· ·ÁˆÁ‹˜ ˘Á›·˜ 433 ¶ÚfiÏË„Ë Û˘ÁÁÂÓÔ‡˜ Û˘Ó‰ÚfiÌÔ˘ ÂÚ˘ıÚ¿˜ 273 ¶ÚfiÏË„Ë 219 ¶ÚÔÊÏÂÁÌÔÓÒ‰ÂȘ ·Ú¿ÁÔÓÙ˜ 232 ¶ÚfiˆÚ· ÓÂÔÁÓ¿ 32,174 ¶ÚfiˆÚ· 356,362 ¶ÚfiˆÚÔ 52 ¶ÚÔˆÚfiÙËÙ· 313,394 ƒ ƒÈÎÂÙÙÛÈÒÛÂȘ ™ ™·ÚÎÔ›‰ˆÛË ™‹„Ë ™ÈÁΤÏψÛË ™ÈÛ·Ú›‰Ë ™Î·ÊÔÂȉ¤˜ ÔÛÙÔ‡Ó ™·ÛÙÈÎfiÙËÙ· ™ÈÓıËÚÔÁÚ¿ÊËÌ· ™ÔÓ‰˘Ï›ÙȘ ™˘ÁÁÂÓ‹˜ Ê˘Ì·Ù›ˆÛË ™˘Ì‚·ÙÈÎfi˜ ·ÂÚÈÛÌfi˜ ™‡Ó‰ÚÔÌÔ Bardet-Biedl ™‡Ó‰ÚÔÌÔ Brugada ™‡Ó‰ÚÔÌÔ Kartagener ™‡Ó‰ÚÔÌÔ Prader-Willi ™‡Ó‰ÚÔÌÔ Smith Lemli Opitz ™‡Ó‰ÚÔÌÔ Swyer-James (Mac Leod) ™‡Ó‰ÚÔÌÔ ·Î›ÓËÙÔ˘ ÎÚÔÛÛÔ‡ ™‡Ó‰ÚÔÌÔ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜ ™‡Ó‰ÚÔÌÔ ·ÔÎÏÂÈÛÌÔ‡ ‰ÂÍÈÔ‡ ÛΤÏÔ˘˜ Î·È ·Ó¿Û·Û˘ ST ‰È·ÛÙ‹Ì·ÙÔ˜ ™‡Ó‰ÚÔÌÔ ‰È·Ê˘Á‹˜ ÙˆÓ ÙÚȯÔÂȉÒÓ ™‡Ó‰ÚÔÌÔ ÛÙ¤ÚËÛ˘ ÛÙË ÓÂÔÁÓÈ΋ ËÏÈΛ· ™‡Ó‰ÚÔÌÔ Û˘ÁÁÂÓÔ‡˜ ÂÚ˘ıÚ¿˜ ™‡ÓıÂÛË ÛÒÌ·ÙÔ˜ ™˘ÛÙ¿ÛÂȘ ™˘ÛÙÚÔÊ‹ ÌÂÛÂÓÙÂÚ›Ô˘ ™ˆÌ·ÙÈ΋ ˘ÁÈÂÈÓ‹ ™ˆÌ·ÙÈÎfi Ï›Ô˜

208

322 32 182 309 86 167 309 89 203 174 387 16 403 387 447 442 403 174,313 16 160 133 219,273 122 293 138 186 122

∆ ∆ËÏÂfiÚ·ÛË ∆Ú·˘Ì·ÙÈÛÌÔ› ∆Ú·¯ËÏÈ΋ ÏÂÌÊ·‰ÂÓ›Ùȉ· ∆ÚÔ¯·›· ·Ù˘¯‹Ì·Ù·

186 293 142 433

À À‰Ú·ÓÂÁÎÂÊ·Ï›· ÀÂÚÎÈÓËÙÈÎfiÙËÙ·

195 452

488

ÀÔı·Ï·ÌÈÎfi ·Ì¿Úو̷ À„›Û˘¯ÓÔ˜ ·ÂÚÈÛÌfi˜

372 174

º º·ÚÌ·ÎÔ·ÓıÂÎÙÈ΋ ÂÈÏË„›· ºÏ‚È΋ ıÚfiÌ‚ˆÛË ºÏÂÁÌÔÓ‹ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘ º˘ÛÈ΋ ηٿÛÙ·ÛË

372 367 89 66

à ÷ÏÎfi˜ ÷ÌËÏÔ‡ ÌÔÚÈ·ÎÔ‡ ‚¿ÚÔ˘˜ Ë·Ú›ÓË ÃÔÏËÛÙÂÚfiÏË ÃÔÏÔ΢ÛÙÂÎÙÔÌ‹ ÃÔÏÔÏÈı›·ÛË ÃÚfiÓÈ· ¿Ù˘· ÎÔÈÏȷο Û˘ÌÙÒÌ·Ù· ÃÚfiÓÈ· Ì˘ÂÏÔÁÂÓ‹˜ Ï¢¯·ÈÌ›· Ù‡Ô˘ ÂÓËÏ›ÎÔ˘ ÃÚfiÓÔ˜ ÂÓÂÚÁÔÔÈË̤Ó˘ ÌÂÚÈ΋˜ ıÚÔÌ‚ÔÏ·ÛÙ›Ó˘ Ã˘ÏÔıÒڷη˜

362 377 66 128 128 138 222 77 199

æ æ¿ÚÈ Î·È ÎÚ¤·˜ 梉ԸÔ·Ú·ı˘ÚÂÔÂȉÈÛÌfi˜ æ˘¯ÔÎÈÓËÙÈ΋ ÂͤÏÈÍË æ˘¯ÔÎÈÓËÙÈ΋ ·ÏÈÓ‰ÚfiÌËÛË

298 387 394 287

ø ø̤Á· 3-ÏÈ·Ú¿ Ôͤ·

298

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¶PO™EXH ™YNE¢PIA

8-9 ¡ÔÂÌ‚Ú›Ô˘ 2002

3Ô ™ÂÌÈÓ¿ÚÈÔ OÁÎÔÏÔÁÈÎÔ‡ ∆Ì‹Ì·ÙÔ˜ ¡ÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ “∞ÁÏ·˝· ∫˘ÚÈ·ÎÔ‡” “æ˘¯ÔÎÔÈÓˆÓÈ΋ ÛÙ‹ÚÈÍË ÙÔ˘ ·È‰ÈÔ‡ Ì ηÚΛÓÔ Î·È Ù˘ ÔÈÎÔÁ¤ÓÂÈ¿˜ ÙÔ˘” °Ú·ÌÌ·Ù›·: “∂æπ§O¡” ∆ËÏ.: 010 - 7254 360-2 Fax: 010 - 7254 363

∞ı‹Ó·

9 ¡ÔÂÌ‚Ú›Ô˘ 2002

13Ë ∂ÈÛÙËÌÔÓÈ΋ ¶·È‰È·ÙÚÈ΋ ∏ÌÂÚ›‰· “∂›Î·ÈÚ· ı¤Ì·Ù· ÛÙËÓ ¶·È‰È·ÙÚÈ΋” µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ∞.¶.£. °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ∞.Ã.∂.¶.∞.

£ÂÛÛ·ÏÔÓ›ÎË

9-10 ¡ÔÂÌ‚Ú›Ô˘ 2002

22Ô ªÂÙÂÎ·È‰Â˘ÙÈÎfi ™ÂÌÈÓ¿ÚÈÔ ¶·È‰È·ÙÚÈ΋˜ µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·Ó/Ì›Ô˘ ∞ıËÓÒÓ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶.&∞. ∫˘ÚÈ·ÎÔ‡” ∆ËÏ.: 010 - 7793 000

∞ı‹Ó·

22 ¡ÔÂÌ‚Ú›Ô˘ 2002

∏ÌÂÚ›‰· ¶·È‰È΋˜ ∫ÂÊ·Ï·ÏÁ›·˜ ¡Â˘ÚÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ ¡ÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ ¶ÂÓÙ¤Ï˘ ¶ÏËÚÔÊÔڛ˜: Triaena Tours & Congress ∆ËÏ.: 010 - 749 9300 Fax: 010 - 770 5752 E-mail: congress@triaenatours.gr

∞ı‹Ó·

27-30 ¡ÔÂÌ‚Ú›Ô˘ 2002

XVII ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ ƒÂ˘Ì·ÙÔÏÔÁ›·˜ ∂ÏÏËÓÈ΋ ƒÂ˘Ì·ÙÔÏÔÁÈ΋ ∂Ù·ÈÚ›· ¶ÏËÚÔÊÔڛ˜: AFEA Congress ∆ËÏ.: 010 - 360 4413 Fax: 010 - 364 3511 E-mail: info@afea.gr

∞ı‹Ó·

29 ¡ÔÂÌ‚Ú›Ô˘1 ¢ÂÎÂÌ‚Ú›Ô˘ 2002

6Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ º˘ÛÈ΋˜ π·ÙÚÈ΋˜ Î·È ∞ÔηٿÛÙ·Û˘ “¶ÔÈfiÙËÙ· ˙ˆ‹˜ - ¶ÔÈfiÙËÙ· ÊÚÔÓÙ›‰·˜” Triaena Tours & Congress A.E. ∆ËÏ.: 010 - 749 9300 Fax: 010 - 770 5752 E-mail: congress@triaenatours.gr

£ÂÛÛ·ÏÔÓ›ÎË

6-8 ¢ÂÎÂÌ‚Ú›Ô˘ 2002

6Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ æ˘¯ÔÎÔÈÓˆÓÈ΋˜ OÁÎÔÏÔÁ›·˜ ¶ÏËÚÔÊÔڛ˜: “∂æπ§O¡” ∆ËÏ.: 010 - 72 54 360-2 Fax: 010 - 72 54 363 E-mail: epsilonb@hol.gr

∞ı‹Ó·

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1-4 ºÂ‚ÚÔ˘·Ú›Ô˘ 2003

14th International Congress on Anti-Cancer Treatment ¶ÏËÚÔÊÔڛ˜: T.C.O. (Travel Congress Organization) Tel.: +33 1 42 94 87 32 Fax: +33 1 42 94 87 33 E-mail: laurenceherbin@wanadoo.fr

Paris, France

6-8 ª·ÚÙ›Ô˘ 2003

Stem Cell Transplantation in Children: Current Results and Controversies - Meeting #7 ¶ÏËÚÔÊÔڛ˜: Dr. Michael E. Trigg Tel.: 302 651 5565 Fax: 302 651 5575 E-mail: jdanbois@nemours.org

South Carolina, USA

12-15 ª·ÚÙ›Ô˘ 2003

5th International Symposium on Leukemia and Lymphoma ¶ÏËÚÔÊÔڛ˜: PAOG Course and Congress Organization Tel.: +31 (0)20 444 9372 Fax: +31 (0)20 444 8445 E-mail: post.paog@med.vu.nl Website: http://www.med.vu.nl/leuklymph2003

Amsterdam, The Netherlands

20-23 ª·ÚÙ›Ô˘ 2003

1Ô ¢ÈÂÙ·ÈÚÈÎfi ∞ÓÙÈηÚÎÈÓÈÎfi ™˘Ó¤‰ÚÈÔ ¶ÏËÚÔÊÔڛ˜: PRC Congress & Travel ∆ËÏ.: 010 - 7711 673 & 010 - 7756 336 Fax: 010 - 7711 289 E-mail: prc@compulink.gr

∞ı‹Ó·

15-18 ª·˝Ô˘ 2003

7th International Symposium on Myelodysplastic Syndromes ¶ÏËÚÔÊÔڛ˜: Pierre Fenaux / Myriam Cambie Tel.: 33 3 20 44 57 13 Fax: 33 3 20 44 47 08 E-mail: mcambie@oncospace.com pfenaux@chru-lille.fr Website: http://www.gfmgroup.org/myelo2002

Paris, France

18-21 ™ÂÙÂÌ‚Ú›Ô˘ 2003

ªÂÛÔÁÂÈ·Îfi ™˘Ó¤‰ÚÈÔ: 28th UMEMPS Congress Secretariat: Dr S. Afif - Pr. M. Oumlil Tel. & Fax: +212 22 22 6386 E-mail: smpcasa@wanadoo.net.ma

Marrakech, Morocco

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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

xvii

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™˘ÓÙÔÌÔÁڷʛ˜ p.o.

RIA RNA RDS sec s.c. ‹ À.¢.

SD SE U

·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¿‰·

™˘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

xviii

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