ISSN 0377-2551
∞¡∞™∫O¶∏™∂π™ OÈ Ì˘ÔηډÈÔ¿ıÂȘ ÛÙ· ·È‰È¿
REVIEW ARTICLES 405
∂. ∞ÔÛÙfiÏÔ˘, ∞. ∆ÛÈÏÈÌÈÁοÎË
°ÂÓÂÙÈο ÙÚÔÔÔÈË̤ӷ ÙÚfiÊÈÌ·: Èı·Ó¤˜ ÂÈÙÒÛÂȘ ÛÙËÓ ·ÏÏÂÚÁÈÔÁÔÓÈÎfiÙËÙ·
Cardiomyopathies in children H. Apostolou, A. Tsilimigaki
418
∞. µ·ÛÈÏÔÔ‡ÏÔ˘, ¡. °. ¶··‰fiÔ˘ÏÔ˜, º. ™·ÍÒÓË-¶··ÁˆÚÁ›Ô˘
Genetically modified food: potential effects on allergenicity E. Vassilopoulou, N. G. Papadopoulos, F. Saxoni-Papageorgiou
¶AI¢IATPIKH
●
TOMO™ 66
●
TEYXO™ 6
●
ETO™ 2003
¡Ô¤Ì‚Ú ÈÔ˜ - ¢ÂΤ̂ÚÈ Ô˜ 2003 . ∆fiÌÔ˜ 66 . ∆‡¯Ô˜ 6
OÈÎÔÏÔÁ›·, ÂȉËÌÈÔÏÔÁ›· Î·È ÂÚÁ·ÛÙËÚȷ΋ ‰È¿ÁÓˆÛË Ì˘ÎËÙÈ¿ÛÂˆÓ ÙÔ˘ ÙÚȯˆÙÔ‡ Ù˘ ÎÂÊ·Ï‹˜ Û ·È‰È¿
426
∂. ºÚ·ÁÎÔ‡ÏË
E. Frangoulis
µƒ∞µ∂Àª∂¡∏ ∂ƒ°∞™π∞ ∞ÍÈÔÏfiÁËÛË 10 ÂÙÒÓ ·fi ÙËÓ ¤Ó·ÚÍË ÚÔÁÚ¿ÌÌ·ÙÔ˜ ·ÁˆÁ‹˜ ˘Á›·˜ ÛÙ· Û¯ÔÏ›· Ù˘ ∫Ú‹Ù˘
AWARD-WINNING ARTICLE 436
ª. §ÈÓ·Ú‰¿Î˘, ∫. ™·ÚÚ‹, º. ªÂÚ‚·Ó¿ÎË, ∂. ª¿ÚηÙ˙Ë, Ã. ÷Ù˙‹˜, ™. ºÏÔ˘Ú‹, ∞. ∫·Ê¿ÙÔ˜
ORIGINAL ARTICLES 448
ª. ™¯ÔÈÓ¿, °. ™¯ÔÈÓ¿˜, ∫. ¶·ÙÂÚfiÔ˘ÏÔ˜
¶ÚÔ‚Ï‹Ì·Ù· ˘Á›·˜ ·È‰ÈÒÓ-·Ú·ıÂÚÈÛÙÒÓ Û ÓËÛ› ÙˆÓ ∫˘ÎÏ¿‰ˆÓ
Is there consistency in immunization of children who live in the countryside? Study of the child population of a Rural Health Centre M. Schina, G. Schinas, K. Pateropoulos
452
∂. ¶·Ú·Ûο΢, ª. ∆ÛÈÌÈÓfi˜, ∫. ∫·Ú·Ó¿ÛÈÔ˘, ¡. ª·Î·ÚÒÓ·˜, ∂. °·Ï·Ó¿Î˘
¡Â˘ÚÔÏÔÁÈΤ˜ ÂΉËÏÒÛÂȘ ·È‰ÈÒÓ Ì ·ÈÌÔÏ˘ÙÈÎfi-Ô˘Ú·ÈÌÈÎfi Û‡Ó‰ÚÔÌÔ
Ten-year evaluation of the initiation of a health education program in the schools of Crete M. Linardakis, K. Sarri, F. Bervanaki, I. Markatzi, C. Hatzis, S. Flouri, A. Kafatos
∂ƒ∂À¡∏∆π∫∂™ ∂ƒ°∞™π∂™ À¿Ú¯ÂÈ Û˘Ó¤ÂÈ· ÛÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi ÙˆÓ ·È‰ÈÒÓ ÛÙËÓ Â·Ú¯›·; ŒÚ¢ӷ Û ·È‰ÈÎfi ÏËı˘ÛÌfi ∫¤ÓÙÚÔ˘ ÀÁ›·˜
Ecology, epidemiology and diagnosis of tinea capitis in children
Health problems of child-tourists in a Cycladic island E. Paraskakis, M. Tsimbinos, K. Karanasiou, N. Makaronas, E. Galanakis
456
Neurological complications of children with haemolytic-uraemic syndrome
∫. µÔ‡‰Ú˘, ∫. ™ÙÂÊ·Ó›‰Ë˜, ∞. ™Î·Ú‰Ô‡ÙÛÔ˘, ∂. ∫·ÙÛ·ÚÔ‡, ™. ª·ÛÙÚÔÁÈ¿ÓÓË, ∂. µ·ÁÈ¿ÎÔ˘
K. Voudris, C. Stefanidis, A. Skardoutsou, E. Katsarou, S. Mastroyianni, E. Vagiakou
∏ Û˘Ó¤¯ÂÈ· ÙˆÓ ÂÚȯÔÌ¤ÓˆÓ ÛÙËÓ ÚÒÙË ÂÛˆÙÂÚÈ΋ ÛÂÏ›‰·
Continuation of table of contents inside title page
Hellenic Paediatric Society November - December 2003 . Volume 66 . No 6
NÔ¤Ì‚Ú ÈÔ˜ - ¢ÂΤ̂ÚÈ Ô˜ 2003 . ∆fiÌÔ˜ 66 . ∆‡¯Ô˜ 6
™˘Ó¤¯ÂÈ· ÂÚȯÔ̤ӈÓ
∫˘ÙÙ·ÚÔÁÂÓÂÙÈο Î·È ÂȉËÌÈÔÏÔÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο 533 ·ÛıÂÓÒÓ Ì ۇӉÚÔÌÔ Down Ù· ¤ÙË 1973-2001
Continuation of table of contents
461
H. Hatzissevastou-Loukidou, P. Kambouridou
Ã. ÷Ù˙ËÛ‚·ÛÙÔ‡-§Ô˘Î›‰Ô˘, ¶. ∫·ÌÔ˘Ú›‰Ô˘
CASE REPORTS
EN¢π∞º∂ƒOÀ™∂™ ¶∂ƒπ¶∆ø™∂π™ ∞Ó¿ÚÎÂÈ· Ù˘ ÔÚÓÈıÈÓÈ΋˜ ÙÚ·ÓÛηڂ·Ì˘Ï¿Û˘ - ˘Ô͇˜ Ù‡Ô˜. ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘
467
Hellenic Paediatric Society
471
Cushing’s disease in a 15ó year-old girl. A case report E. Kostakioti, C. Theodoridis, E. Kousta, A. Tertipi, C. Hadjiathanasiou, V. Petrou, A. Papathanasiou
∂. ∫ˆÛÙ·ÎÈÒÙË, Ã. £ÂÔ‰ˆÚ›‰Ë˜, ∂. ∫Ô‡ÛÙ·, ∞. ∆ÂÚÙ›Ë, Ã. ÷Ù˙Ë·ı·Ó·Û›Ô˘, µ. ¶¤ÙÚÔ˘, ∞. ¶··ı·Ó·Û›Ô˘
N∂∞ ∞¶O ∆O ¢π∞¢π∫∆ÀO
Late onset ornithine transcarbamylase deficiency. A case report S. Fessatou, A. Attilakos, H. Tsapra, G. Maropoulos, H. Michelakakis, K. Schulpis
™. ºÂÛÛ¿ÙÔ˘, ∞. ∞ÙÙÈÏ¿ÎÔ˜, ∂. ∆Û¿Ú·, °. ª·ÚfiÔ˘ÏÔ˜, ∂. ªÈ¯ÂϷοÎË, ∫. ™Ô‡ÏË
¡fiÛÔ˜ Cushing Û ÎÔÚ›ÙÛÈ ËÏÈΛ·˜ 15ó ÂÙÒÓ. ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘
Cytogenetic and epidemiological characteristics of 533 patients with Down syndrome between the years 1973-2001
475
NEWS FROM THE INTERNET
Greek Paediatric Society ™˘Ó¯›˙ÔÓÙ·È
Continued
Hellenic Paediatric Society November - December 2003 . Volume 66 . No 6
¡Ô¤Ì‚Ú ÈÔ˜ - ¢ÂΤ̂ÚÈ Ô˜ 2003 . ∆fiÌÔ˜ 66 . ∆‡¯Ô˜ 6
™˘Ó¤¯ÂÈ· ÂÚȯÔ̤ӈÓ
Continuation of table of contents
∫ÚÈÙ¤˜ ÙÔ˘ ÙfiÌÔ˘ 66
478
Reviewers of Manuscripts, Volume 66
∂˘ÚÂÙ‹ÚÈÔ ™˘ÁÁڷʤˆÓ ÙÔ˘ ÙfiÌÔ˘ 66
479
Author Index, Volume 66
§¤ÍÂȘ ÎÏÂȉȿ ÙÔ˘ ÙfiÌÔ˘ 66
482
Subject Index, Volume 66
¶ÚÔÛ¯‹ ™˘Ó¤‰ÚÈ·
xi
Scheduled Medical Meetings
™˘ÓÙÔÌÔÁڷʛ˜
xv
Abbreviations
Hellenic Paediatric Society
Greek Paediatric Society
Hellenic Paediatric Society November - December 2003 .Volume 66 . No 6
¡Ô¤Ì‚Ú ÈÔ˜ - ¢ÂΤ̂ÚÈ Ô˜ 2003
.
∆fiÌÔ˜ 66
. ∆‡¯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·ÎÔÔ‡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
EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ¶Úfi‰ÚÔ˜ : ∞. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜ ¢È¢ı˘ÓÙ‹˜ : ™. ÷˚‰¿˜ M¤ÏË : º. Aı·Ó·ÛÈ¿‰Ô˘-¶ÈÂÚÔÔ‡ÏÔ˘ : °. µ·ÚÏ¿Ì˘ : ª. ∏Ï›· : π. ¶··‰¿ÙÔ˜ : ¡. ¶··‰fiÔ˘ÏÔ˜ : ™. ¶ÔÏ˘¯ÚÔÓÔÔ‡ÏÔ˘ : ∫. ¶ÚÔ‡ÓÙ˙Ô˘-∫·ÛÛÈÔ‡ : ∫. ™ÙÂÊ·Ó›‰Ë˜ : ª. ∆ÛÔÏÈ¿ : ™. ºˆÙfiÔ˘ÏÔ˜
Scientific President Editor Members
ºÈÏÔÏÔÁÈ΋ EÈ̤ÏÂÈ· ∂È̤ÏÂÈ· ÂÏÏËÓÈÎÒÓ ÎÂÈÌ¤ÓˆÓ I. K·Ú·‚Ú¿ÓÔ˘
Manuscript Editing
EÈ̤ÏÂÈ· ·ÁÁÏÈÎÒÓ ÎÂÈÌ¤ÓˆÓ ™. ¡¿ÎÔ˘
English Editing S. Nakou
∞ÏÏËÏÔÁÚ·Ê›· ∂ÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ ∂Ù·ÈÚ›· ªÈ¯·Ï·ÎÔÔ‡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
™˘ÓÙÔÓÈÛÙ‹˜ ∂ΉfiÛˆ˜
Publishing Coordinator
E¶I™THMONIKE™ EK¢O™EI™ E.¶.E. ¶. ∆۷ω¿ÚË 3, 151 22 M·ÚÔ‡ÛÈ TËÏ.: 210-61 41 360-5 Fax: 210-61 41 366
SCIENTIFIC PUBLICATIONS Ltd P. Tsaldari 3, Marousi 151 22 Tel.: 210-61 41 360-5 Fax: 210-61 41 366
Hellenic Paediatric Society
Hellenic Paediatric Society
EÙ‹ÛÈ· ™˘Ó‰ÚÔÌ‹
40
EȉÈ΢fiÌÂÓÔÈ, ºÔÈÙËÙ¤˜:
20
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Editorial Board : A. Constantopoulos : S. Haidas : F. Athanassiadou-Piperopoulou : G. Varlamis : M. Ilia : I. Papadatos N. Papadopoulos Greek :Paediatric Society : S. Polychronopoulou Greek Paediatric Society : K. Prountzou-Kassiou : C. Stefanidis : M. Tsolia : S. Fotopoulos
Greek Editing I. Karavranou
Annual Subscription All foreign countries: US $ 50
Hellenic Paediatric Society November-December 2003 . Volume 66 . No 6
πSSN 0377-2551 i Greek Paediatric Society
O‰ËÁ›Â˜ ÚÔ˜ ÙÔ˘˜ ™˘ÁÁÚ·Ê›˜ A. °ÂÓÈΤ˜ ¶ÏËÚÔÊÔڛ˜ ∆Ô ÂÚÈÔ‰ÈÎfi “¶·È‰È·ÙÚÈ΋” Â›Ó·È Ë ÂÈÛÙËÌÔÓÈ΋ ¤Î‰ÔÛË Î·È È‰ÈÔÎÙËÛ›· Ù˘ EÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ EÙ·ÈÚ›·˜, Ô˘ ‰È·Ó¤ÌÂÙ·È ÛÙ· ̤ÏË Ù˘. Œ¯ÂÈ ˆ˜ ‚·ÛÈÎÔ‡˜ ÛÙfi¯Ô˘˜ ÙËÓ ·ÔÙ‡ˆÛË ÙÔ˘ ·È‰È·ÙÚÈÎÔ‡ ÂÈÛÙËÌÔÓÈÎÔ‡ ¤ÚÁÔ˘ Î·È ÙË Û˘Ó¯‹ ÂÓË̤ڈÛË ÙˆÓ ¶·È‰È¿ÙÚˆÓ. °È· ÙÔ ÛÎÔfi ·˘Ùfi ‰¤¯ÂÙ·È ÁÈ· ‰ËÌÔÛ›Â˘ÛË ÔÈÎÈÏ›· ¿ÚıÚˆÓ Î·È Û˘ÁÎÂÎÚÈ̤ӷ: 1. ÕÚıÚ· Û‡ÓÙ·Í˘ (ÌÂÙ¿ ·fi ÚfiÛÎÏËÛË Ù˘ EÈÛÙËÌÔÓÈ΋˜ ™˘ÓÙ·ÎÙÈ΋˜ EÈÙÚÔ‹˜). 2. ∞Ó·ÛÎÔ‹ÛÂȘ. 3. µÚ·‚Â˘Ì¤Ó˜ ÂÚÁ·Û›Â˜. 4. ∂Ú¢ÓËÙÈΤ˜ ÌÂϤÙ˜. 5. ∂ÈÏÂÁ̤Ó˜ Û˘˙ËÙ‹ÛÂȘ ÛÙÚÔÁÁ˘ÏÒÓ ÙÚ·Â˙ÒÓ. 6. ∂›Î·ÈÚ· ı¤Ì·Ù·. 7. £¤Ì·Ù· Âη›‰Â˘Û˘ Î·È ÔÚÁ¿ÓˆÛ˘ ˘Á›·˜. 8. ∫ÏÈÓÈΤ˜ Î·È ·ÂÈÎÔÓÈÛÙÈΤ˜ ÂÚÈÙÒÛÂȘ. 9. ™‡ÓÙÔÌ· Ó¤·. 10. µÚ·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ. 11. ∂ÈÛÙÔϤ˜ ÚÔ˜ ÙË Û‡ÓÙ·ÍË. 12. ¶ÂÚÈÏ‹„ÂȘ Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜. 13. ∞Ó·ÎÔÈÓÒÛÂȘ ÚÔÛ¯ÒÓ Û˘Ó‰ڛˆÓ Î·È ÂÈÛÙËÌÔÓÈÎÒÓ ÂΉËÏÒÛÂˆÓ 14. ∞Ó·ÊÔÚ¤˜ Î·È ÎÚÈÙÈ΋ Ó¤ˆÓ ÂΉfiÛˆÓ, ÂÏÏËÓÈÎÒÓ Î·È Í¤ÓˆÓ, ·È‰È·ÙÚÈÎÔ‡ ÂӉȷʤÚÔÓÙÔ˜. H EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ‰È·ÙËÚ› ÙÔ ‰Èη›ˆÌ· Ó· ‰ËÌÔÛȇÂÈ ¿ÚıÚ· Ì ȉȷ›ÙÂÚÔ ÂÈÛÙËÌÔÓÈÎfi ÂӉȷʤÚÔÓ Î·ıÒ˜ Î·È ¿ÚıÚ· Ì ›ηÈÚ· ı¤Ì·Ù· ¯ˆÚ›˜ Ó· ÙËÚÂ›Ù·È Ë ÛÂÈÚ¿ ˘Ô‚ÔÏ‹˜. ∂›Û˘, ÌÔÚ› Ó· ·ÔÊ·Û›˙ÂÈ ÁÈ· ÙË ‰ËÌÔÛ›Â˘ÛË ÂÚÁ·ÛÈÒÓ Ô˘ ¤¯Ô˘Ó ·ÚÔ˘ÛÈ·Ûı› ÛÙÔ ÂÙ‹ÛÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ, ÙËÓ ÔÏÈ΋ ‹ ÌÂÚÈ΋ ‰ËÌÔÛ›Â˘ÛË ·ÚÔ˘ÛÈ¿ÛÂˆÓ È‰È·›ÙÂÚÔ˘ ÂӉȷʤÚÔÓÙÔ˜ Î·È ÙËÓ ÔÏÈ΋ ‹ ÌÂÚÈ΋ ‰ËÌÔÛ›Â˘ÛË ÂÈÛÙÔÏÒÓ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È Û ‰ËÌÔÛÈÂ˘Ì¤Ó· ÂÈÛÙËÌÔÓÈο ¿ÚıÚ· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. ™ÙȘ ÂÚÁ·Û›Â˜ Ì ›ηÈÚ· ı¤Ì·Ù· Ú¤ÂÈ Ó· ·Ó·ÁÚ¿ÊÂÙ·È ÛÙËÓ ÚÒÙË ÛÂÏ›‰· Ë ÚfiıÂÛË ÙˆÓ Û˘ÁÁڷʤˆÓ ÁÈ· ÙËÓ ·Ó·ÁηÈfiÙËÙ· Ù˘ Ù·¯Â›·˜ ‰ËÌÔÛ›Â˘Û˘. ∏ ∂ÈÙÚÔ‹ ™‡ÓÙ·Í˘ ‰È·ÙËÚ› ÙÔ ‰Èη›ˆÌ· Ù˘ ·Ô‰Ô¯‹˜ Ù˘ Ù·¯Â›·˜ ‰ËÌÔÛ›Â˘Û˘. µ. ÀÔ‚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 “¶·È‰È·ÙÚÈ΋” ·ÔÛÙ¤ÏÏÔÓÙ·È ÂȘ ÙÚÈÏÔ‡Ó ÛÙË ‰È‡ı˘ÓÛË: EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ EÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ EÙ·ÈÚ›· Mȯ·Ï·ÎÔÔ‡ÏÔ˘ 92 115 28 Aı‹Ó· ŸÏ˜ ÔÈ ÂÚÁ·Û›Â˜ Ú¤ÂÈ Ó· Û˘Óԉ‡ÔÓÙ·È ·fi ÂÈÛÙÔÏ‹, Ë ÔÔ›· ı· Û˘Ó˘ÔÁÚ¿ÊÂÙ·È ·fi fiÏÔ˘˜ ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ ÛÙËÓ ÔÔ›· 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 “¶·È‰È·ÙÚÈ΋”. ∂ÈϤÔÓ, ı· Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È Ù˘¯fiÓ ÂȉÔÙ‹ÛÂȘ - ¯ÔÚË-
Á›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 ÂÎÚÔÛÒˆÓ ÙÔ˘˜ Û‡Ìʈӷ Ì ÙȘ ‰È·ÎËÚ‡ÍÂȘ ÙÔ˘ EÏÛ›ÓÎÈ Î·È ÙÔ˘ TfiÎÈÔ. ∫·ıÒ˜ Î·È fiÙÈ ÙËÚ‹ıËÎ·Ó ÔÈ Ô‰ËÁ›Â˜ ÁÈ· ÙË ÊÚÔÓÙ›‰· ÂÈÚ·Ì·Ùfi˙ˆˆÓ ÙÔ˘ ∂ıÓÈÎÔ‡ πÓÛÙÈÙÔ‡ÙÔ˘ ÀÁ›·˜ ÙˆÓ ∏¶∞ (DHEW Publication, NIH, 80-23). ™ÙȘ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ ı· Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÂÙ·È fiÙÈ ¤¯Ô˘Ó ÂÁÎÚÈı› ·fi ÙËÓ ÂÈÙÚÔ‹ ∏ıÈ΋˜ Î·È ¢ÂÔÓÙÔÏÔÁ›·˜ ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ. ŸÏ˜ ÔÈ ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ÂÚÁ·Û›Â˜ ıˆÚÔ‡ÓÙ·È È‰ÈÔÎÙËÛ›· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ “¶·È‰È·ÙÚÈ΋” Î·È Ë ÔÏÈ΋ ‹ ÌÂÚÈ΋ ·Ó·‰ËÌÔÛ›Â˘Û‹ ÙÔ˘˜ ÂÈÙÚ¤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 µÈÔ˚·ÙÚÈο ¶ÂÚÈÔ‰Èο” (Uniform Requirements for Manuscripts Submitted to Biomedical Journals) Ô˘ ‰ËÌÔÛȇÙËÎ·Ó ÛÙÔ JAMA 1997;277:927-934 http://jama.ama-assn.org/info/auinst_req.html OÈ ·fi„ÂȘ Î·È Ù· Û˘ÌÂÚ¿ÛÌ·Ù· ÙˆÓ Û˘ÁÁڷʤˆÓ Ô˘ ‰È·Ù˘ÒÓÔÓÙ·È ÛÙȘ ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ÂÚÁ·Û›Â˜ ‰ÂÓ ·ÓÙÈηÙÔÙÚ›˙Ô˘Ó ··Ú·›ÙËÙ· ·˘Ù¤˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. H ηٷ¯ÒÚËÛË ‰È·ÊËÌ›ÛÂˆÓ ÛÙÔ ÂÚÈÔ‰ÈÎfi ‰ÂÓ ˘Ô‰ËÏÒÓÂÈ ÔˆÛ‰‹ÔÙ ¤ÁÎÚÈÛË ÙˆÓ ÂÚȯÔÌ¤ÓˆÓ ÙÔ˘˜ ·fi ÙËÓ EÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ EÙ·ÈÚ›·, ÙËÓ EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ‹ ·fi ÙÔÓ EΉfiÙË ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. EÊfiÛÔÓ Ë ÂÚÁ·Û›· Á›ÓÂÈ ·Ô‰ÂÎÙ‹, ÙÔ ‰ÈÔÚıˆÌ¤ÓÔ Û‡Ìʈӷ Ì ÙȘ ˘Ô‰Â›ÍÂȘ ÙˆÓ ÎÚÈÙÒÓ Î·È ÂÎ Ó¤Ô˘ ‰·ÎÙ˘ÏÔÁÚ·ÊË̤ÓÔ Î›ÌÂÓÔ Ú¤ÂÈ Ó· ˘Ô‚¿ÏÏÂÙ·È ÛÙËÓ EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ Û˘Óԉ¢fiÌÂÓÔ ·fi ‰ÈÛΤٷ Ô˘ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ÂÚÁ·Û›· Û ÚfiÁÚ·ÌÌ· Word Î·È ÙÔ˘˜ ›Ó·Î˜, ·Ó Â›Ó·È ‰˘Ó·ÙfiÓ, Û ÚfiÁÚ·ÌÌ· Excel, ηıÒ˜ Î·È ÂÈÛÙÔÏ‹ fiÔ˘ Ó· ·Ó·Ê¤ÚÔÓÙ·È ·Ó·Ï˘ÙÈο ÔÈ ÙÚÔÔÔÈ‹ÛÂȘ ‹ ÔÈ ·ÓÙÈÚÚ‹ÛÂȘ ÛÙȘ ÚÔÙ¿ÛÂȘ ÙˆÓ ÎÚÈÙÒÓ. H ηı˘ÛÙ¤ÚËÛË Ù˘ ·ӢԂÔÏ‹˜ ÙÔ˘ ÙÚÔÔÔÈË̤ÓÔ˘ ÎÂÈ̤ÓÔ˘ ¤Ú·Ó ÙˆÓ 30 ËÌÂÚÒÓ Û˘Ó¿ÁÂÙ·È Ó¤· ˘Ô‚ÔÏ‹. °È· Ó· ÂÈÙ¢¯ı› Ë ¤ÁηÈÚË ‰ËÌÔÛ›Â˘ÛË Ù˘ ÂÚÁ·Û›·˜ Â›Ó·È ··Ú·›ÙËÙÔ Ó· ÂÈÛÙÚ¤ÊÂÙ·È ÙÔ ‰ÈÔÚıˆÌ¤ÓÔ Ù˘ÔÁÚ·ÊÈÎfi ‰ÔΛÌÈÔ ·fi ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ ̤۷ Û ‰‡Ô (2) Ë̤Ú˜. T· ¤ÍÔ‰· ÙˆÓ ÊÈÏÌ 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 ÂÈÛÙÚ¤ÊÔÓÙ·È. MÔÚ› Ó· ÂÈÛÙÚ·ÊÔ‡Ó, ÂÊfiÛÔÓ ˙ËÙËı› ÂÓÙfi˜ ÂÍ·Ì‹ÓÔ˘, 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˘ÌÂÚÈÏ·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˘˜
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A4 (21x29.7 cm) Ì ‰ÈÏfi ‰È¿ÛÙËÌ· ÌÂٷ͇ ÙˆÓ ÁÚ·ÌÌÒÓ Î·È ÂÚÈıÒÚÈ· ÙÔ˘Ï¿¯ÈÛÙÔÓ 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 ÂȉÔÙ‹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˘. H ¤ÎÙ·ÛË ÚÔÛ‰ÈÔÚ›˙ÂÙ·È ÁÈ·: ·. ÙȘ ·Ó·ÛÎÔ‹ÛÂȘ Û 2000-3000 ϤÍÂȘ. ‚. ÙȘ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜ Î·È ÙȘ ÂӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ Û 1500-2500 ϤÍÂȘ. Á. ÙȘ ‚Ú·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ Û 1000-1500 ϤÍÂȘ. ‰. ÙȘ ÂÈÛÙÔϤ˜ Û 250-500 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 ÂÈÙÚ¤ÔÓÙ·È Û˘ÓÙÌ‹ÛÂȘ, - ÙÔ fiÓÔÌ· Î·È ÙÔ ÂÒÓ˘ÌÔ Î¿ıÂ Û˘ÁÁڷʤ· ÛÙËÓ ÔÓÔÌ·ÛÙÈ΋, - ÙÔ ÂÈÛÙËÌÔÓÈÎfi ΤÓÙÚÔ (›‰Ú˘Ì·, ÎÏÈÓÈ΋, ÂÚÁ·ÛÙ‹ÚÈÔ) ·fi fiÔ˘ 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 ÙfiÔ˜ ‰È·ÌÔÓ‹˜ ÙÔ˘/ÙˆÓ, - ÙËÓ Ï‹ÚË ‰È‡ı˘ÓÛË, e-mail Î·È ÙÔ ÙËϤʈÓÔ ÙÔ˘ Û˘ÁÁڷʤ· Ì ÙÔÓ ÔÔ›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˘ÌÂÚ¿ÛÌ·Ù· Ù˘ ÌÂϤÙ˘. £· Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÔ˘Ï¿¯ÈÛÙÔÓ 200 ϤÍÂȘ, fï˜ ‰ÂÓ ı· Ú¤ÂÈ Ó· ˘ÂÚ‚·›ÓÂÈ ÙȘ 250 ϤÍÂȘ. ∏ ÂÚ›ÏË„Ë ÙˆÓ ÂÚÁ·ÛÈÒÓ Ú¤ÂÈ Ó· Â›Ó·È ‰ÔÌË̤ÓË ÛÙȘ ÂÍ‹˜ ·Ú·ÁÚ¿ÊÔ˘˜: ÂÈÛ·ÁˆÁ‹, ̤ıÔ‰ÔÈ, ·ÔÙÂϤÛÌ·Ù· Î·È Û˘ÌÂÚ¿ÛÌ·Ù·. ™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˘ Ú¤ÂÈ Ó· Â›Ó·È ‰ÔÌË̤ÓÔ Û ÂÈÛ·ÁˆÁ‹ (background), ̤ıÔ‰ÔÈ (methods), ·ÔÙÂϤÛÌ·Ù· (results) Î·È Û˘ÌÂÚ¿ÛÌ·Ù· (conclusions). H ÂÚ›ÏË„Ë ÛÙ· ·ÁÁÏÈο ‰ÂÓ Ú¤ÂÈ Ó· ‰È·Ê¤ÚÂÈ ·fi ÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë ÛÙ· ÂÏÏËÓÈο. T· ¿ÚıÚ· Û‡ÓÙ·Í˘ Î·È ÔÈ ·ÂÈÎÔÓÈÛÙÈΤ˜ ÂÚÈÙÒÛÂȘ ¤¯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· ¯ÚËÛÈÌÔÔÈËıÔ‡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 ÂÈÛ·ÁˆÁ‹ ÂÚÈÏ·Ì‚¿ÓÂÈ Ù· ÙÂÏÂ˘Ù·›· ‰Â‰Ô̤ӷ Ù˘ ¤Ú¢ӷ˜ ÛÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ ı¤Ì· Ì ÙȘ ΢ÚÈfiÙÂÚ˜ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·-
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Ô̤˜ Î·È ÙÔ ÛÎÔfi Ù˘ ÂÚÁ·Û›·˜. H ÂÚÈÁÚ·Ê‹ ÙˆÓ ÌÂıfi‰ˆÓ Ú¤ÂÈ Ó· Â›Ó·È ·ÎÚÈ‚‹˜ Î·È ·ÚÎÂÙ¿ ÏÂÙÔÌÂÚ‹˜ ÒÛÙ ӷ ÂÈÙÚ¤ÂÈ ÙËÓ ·Ó··Ú·ÁˆÁ‹ ÙÔ˘˜ ·fi ¿ÏÏÔ˘˜ ÂÚ¢ÓËÙ¤˜. ∂›Û˘, Ú¤ÂÈ Ì ÏÂÙÔ̤ÚÂȘ Ó· ·Ó·Ê¤ÚÔÓÙ·È ÔÈ ÛÙ·ÙÈÛÙÈΤ˜ ̤ıÔ‰ÔÈ ·Ó¿Ï˘Û˘ Î·È ·ÍÈÔÏfiÁËÛ˘ ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ. 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 Û˘˙‹ÙËÛË Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ Ù· Û˘ÌÂÚ¿ÛÌ·Ù· Ô˘ ÚÔ·ÙÔ˘Ó ·fi ÙËÓ ÂÚÁ·Û›·, ÙË ÛËÌ·Û›· Ô˘ ÌÔÚ› Ó· ¤¯Ô˘Ó Î·È ÙËÓ Èı·Ó‹ Û˘Û¯¤ÙÈÛ‹ ÙÔ˘˜ Ì ·Ú·ÙËÚ‹ÛÂȘ ¿ÏÏˆÓ ÂÚ¢ÓËÙÒÓ. OÈ ÂӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Û‡ÓÙÔÌË ÂÈÛ·ÁˆÁ‹, ÂÚÈÁÚ·Ê‹ Ù˘ ÂÚ›ÙˆÛ˘ Î·È ‚Ú·¯Â›· Û˘˙‹ÙËÛË. OÈ ·ÂÈÎÔÓÈÛÙÈΤ˜ ÂÚÈÙÒÛÂȘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Û‡ÓÙÔÌË ÂÚÈÁÚ·Ê‹ Ù˘ ÂÚ›ÙˆÛ˘ Î·È ‚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 ÂȉÔÙ‹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·Ô̤˜. 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 ÂÈ‚ÏËı› ‰ÈÂıÓÒ˜ ‰ËÌÔÛȇÔÓÙ·È Û οı Ù‡¯Ô˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. ™‡ÓıÂÙÔÈ Î·È Ì·ÎÚÔÛÎÂÏ›˜ fiÚÔÈ Ô˘ ·ӷϷ̂¿ÓÔÓÙ·È Û˘¯Ó¿ ÛÙÔ Î›ÌÂÓÔ ÌÔÚÔ‡Ó Ó· ·ÓÙÈηı›ÛÙ·ÓÙ·È ·fi Û˘ÓÙÔÌÔÁڷʛ˜ Ô˘ ÂÂÍËÁÔ‡ÓÙ·È ·fi ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ Û ÂȉÈÎfi ηٿÏÔÁÔ, Ô ÔÔ›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·Ô̤˜ ™ÙÔ ÙÌ‹Ì· Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜ ηٷ¯ˆÚÔ‡ÓÙ·È fiϘ ÔÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·Ô̤˜ Ì ÙË ÛÂÈÚ¿ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔ Î›ÌÂÓÔ. ™ÙÔ Î›ÌÂÓÔ ÔÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·Ô̤˜ ·Ó·Ê¤ÚÔÓÙ·È Ì ·Ú·‚ÈÎÔ‡˜ ·ÚÈıÌÔ‡˜ Û ·Ú¤ÓıÂÛË. OÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·Ô̤˜ ‰ÂÓ Ú¤ÂÈ Ó· ˘ÂÚ‚·›ÓÔ˘Ó ÙȘ 70 ÛÙȘ ·Ó·ÛÎÔ‹ÛÂȘ, ÙȘ 30 ÛÙȘ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜, ÙȘ 12 ÛÙ· ›ηÈÚ· ı¤Ì·Ù· Î·È ÙȘ ÂӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ, ÙȘ 5 ÛÙȘ ‚Ú·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ Î·È ÛÙȘ ÂÈÛÙÔϤ˜. H Û‡ÓÙ·ÍË ÙˆÓ ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·ÔÌÒÓ 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·ÔÌÒÓ I. ¶ÂÚÈÔ‰Èο AÓ ÔÈ Û˘ÁÁÚ·Ê›˜ Â›Ó·È ¤ˆ˜ ¤ÍÈ ·Ó·ÁÚ¿ÊÔÓÙ·È fiÏÔÈ, ·Ó Â›Ó·È ÂÙ¿ ‹ ÂÚÈÛÛfiÙÂÚÔÈ ·Ó·ÁÚ¿ÊÔÓÙ·È ÔÈ ÚÒÙÔÈ ¤ÍÈ Î·È ÚÔÛÙ›ıÂÙ·È “et al” ‹ “Î·È Û˘Ó”. T·ÎÙÈ΋ ¤Î‰ÔÛË ÂÚÈÔ‰ÈÎÔ‡: ∞ÓÙˆÓ›Ô˘ ¢, ª¿Ú· Ã, °È·ÓÓ¿ÙÔ˘ Ã. ∂Ì‚fiÏÈ·: ›‰Ú·ÛË ÛÙËÓ ÂȉËÌÈÔÏÔÁ›· ÙˆÓ ÏÔÈ̈‰ÒÓ ÓÔÛËÌ¿ÙˆÓ Î·È ÙËÓ ·È‰È·ÙÚÈ΋ Ú¿ÍË. ¶·È‰È·ÙÚÈ΋ 1999;59:272-279. Proesmans W. Bartter syndrome and its neonatal variant. Eur J Pediatr 1997;156:669-679. ™˘ÌÏËڈ̷ÙÈÎfi 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. Èڛ˜ Û˘ÁÁڷʤ·: National Institutes of Health Consensus Development Conference. Neurofibromatosis conference statement. Arch Neurol 1988;45:575-578. ¶ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù‡Ô˘ ¿ÚıÚÔ˘: ÷ڷϷ̛‰Ë˜ π, ¶··‰fiÔ˘ÏÔ˜ ∞. ¶·¯˘Û·ÚΛ· Î·È ˘ÂÚÏÈȉ·ÈÌ›· [¶ÂÚ›ÏË„Ë]. 36Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ; 1998 5-7 πÔ˘Ó›Ô˘; ¶¿ÊÔ˜, ∫‡ÚÔ˜; 1998. ÛÂÏ. 199. Schreiner GF, Lange L. Ethanol modulation of macrophage influx in glomerulonephritis [abstract]. J Am Soc Nephrol 1991;2:562. Should antileukotriene therapies be used instead of inhaled corticosteroids in asthma? [Editorial]. Am J Respir Crit Care Med 1998;158:1697-1701. Laux-End R, Inaebnit D, Gerber HA, Bianchetti MG. Vasculitis associated with levamisole and circulating autoantibodies [letter]. Arch Dis Child 1996;75:355-356. 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. ¢È‰·ÎÙÔÚÈ΋ ‰È·ÙÚÈ‚‹: ¶··‰fiÔ˘ÏÔ˜ Ã.. ∏ ıÂڷ›· ÙÔ˘ ÛÙÚ·‚ÈÛÌÔ‡. [‰È‰·ÎÙÔÚÈ΋ ‰È·ÙÚÈ‚‹]. ∞ı‹Ó·: ¶·ÓÂÈÛÙ‹ÌÈÔ ∞ıËÓÒÓ; 1979. Kaplan SJ. Post hospital home health care: the elderly’s access and utilization [dissertation]. St. Louis (Mo): Washington Univ.; 1995. ¶›Ó·Î˜ Î·È EÈÎfiÓ˜ AÔÛÙ¤ÏÏÔÓÙ·È ÂȘ ÙÚÈÏÔ‡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 ÂÂÍ‹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˜, Î.Ï.) ¯·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 ÔÔ›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. ¶ÚÈÓ ·ÔÛÙ›ÏÂÙ ÙËÓ ÂÚÁ·Û›· Û·˜ ‚‚·Èˆı›Ù fiÙÈ ÂÚÈÏ·Ì‚¿ÓÂÈ: 1. ∂ÈÛÙÔÏ‹ ˘Ô‚ÔÏ‹˜. 2. ¢‹ÏˆÛË ÌË ÚÔÁÂÓ¤ÛÙÂÚ˘ ‰ËÌÔÛ›Â˘Û˘ Ù˘ ÂÚÁ·Û›·˜. 3. 3 ·ÓÙ›ÁÚ·Ê· ÙÔ˘ ÎÂÈ̤ÓÔ˘ Ù˘ ÂÚÁ·Û›·˜. 4. ™ÂÏ›‰· Ù›ÙÏÔ˘ (¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) ÂÚÈÏ·Ì‚¿ÓÂÈ: ·. Ù›ÙÏÔ Î·È ‚Ú·¯‡ Ù›ÙÏÔ ÂÚÁ·Û›·˜, ‚. fiÓÔÌ· Î·È ÂÒÓ˘ÌÔ Û˘ÁÁڷʤˆÓ (ÔÏÔÁڿʈ˜), Á. ÂÈÛÙËÌÔÓÈÎfi/¿ ΤÓÙÚÔ/· fiÔ˘ ¤ÁÈÓÂ Ë ÂÚÁ·Û›·, ‰. fiÓÔÌ·, ‰È‡ı˘ÓÛË Î·È ÙËϤʈÓÔ Û˘ÁÁڷʤ· ÁÈ· ·ÏÏËÏÔÁÚ·Ê›·. 5. ¶ÂÚ›ÏË„Ë ÂÏÏËÓÈ΋-·ÁÁÏÈ΋, ϤÍÂȘ ÎÏÂȉȿ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·). 6. ∫·Ù¿ÏÔÁÔ Û˘ÓÙÔÌÔÁÚ·ÊÈÒÓ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·). 7. ∫›ÌÂÓÔ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·). 8. ∂˘¯·ÚÈÛٛ˜ ‹ ·Ó·ÁÓˆÚ›ÛÂȘ (·Ó·ÊÔÚ¿ Û ÂȉÔÙ‹ÛÂȘ-¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢). 9. µÈ‚ÏÈÔÁÚ·Ê›· (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·). 10. ¶›Ó·Î˜ (Ô Î·ı¤Ó·˜ Û ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) ÂȘ ÙÚÈÏÔ‡Ó. 11. ∂ÈÎfiÓ˜, Ì ‚¤ÏÔ˜ ÛÙÔ ›Ûˆ ̤ÚÔ˜ Ó· ‰Â›¯ÓÂÈ ÚÔ˜ Ù· ¿ӈ, ·ÚÈıÌË̤Ó˜, ÂȘ ÙÚÈÏÔ‡Ó. 12. ∆›ÙÏÔÈ ÂÈÎfiÓˆÓ (‰ÈÏfi ‰È¿ÛÙËÌ· - Ô Î·ı¤Ó·˜ Û ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) ÂȘ ÙÚÈÏÔ‡Ó.
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¶·È‰È·ÙÚÈ΋ 2003;66:405-417
∞¡∞™∫O¶∏™∏
Paediatriki 2003;66:405-417
REVIEW ARTICLE
OÈ Ì˘ÔηډÈÔ¿ıÂȘ ÛÙ· ·È‰È¿ ∂. ∞ÔÛÙfiÏÔ˘, ∞. ∆ÛÈÏÈÌÈÁοÎË
Cardiomyopathies in children H. Apostolou, A. Tsilimigaki
¶ÂÚ›ÏË„Ë: OÈ Ì˘ÔηډÈÔ¿ıÂȘ ·ÔÙÂÏÔ‡Ó ÛËÌ·ÓÙÈ΋ ·ÈÙ›· ÓÔÛËÚfiÙËÙ·˜ Î·È ıÓËÛÈÌfiÙËÙ·˜ Û fiÏÔ ÙÔÓ ÎfiÛÌÔ, ÙfiÛÔ ÛÙÔ˘˜ ÂÓ‹ÏÈΘ fiÛÔ Î·È ÛÙ· ·È‰È¿. OÈ Ì˘ÔηډÈÔ¿ıÂȘ ·ÔÙÂÏÔ‡Ó ·ı‹ÛÂȘ ÙÔ˘ ηډȷÎÔ‡ Ì˘fi˜ Î·È ¯ˆÚ›˙ÔÓÙ·È ÛÙËÓ ˘ÂÚÙÚÔÊÈ΋, ÙË ‰È·Ù·ÙÈ΋, ÙËÓ ÂÚÈÔÚÈÛÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ·, ÙËÓ ·ÚÚ˘ıÌÈÔÁfiÓÔ ‰˘ÛÏ·Û›· Ù˘ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜, ηıÒ˜ Î·È ÛÙÔ “ÌË Û˘Ì·Á¤˜ Ì˘ÔοډÈÔ” Ô˘ ÂÚÈÁÚ¿ÊËΠÚfiÛÊ·Ù·. OÈ Ú·Á‰·›Â˜ ÂÍÂÏ›ÍÂȘ Ô˘ ÛËÌÂÈÒÓÔÓÙ·È ÛÙË ÌÔÚȷ΋ ÁÂÓÂÙÈ΋, ¤¯Ô˘Ó Û˘Ì‚¿ÏÏÂÈ ÛÙËÓ Î·Ï‡ÙÂÚË Î·Ù·ÓfiËÛË Ù˘ ·ÈÙÈÔÏÔÁ›·˜ ÙˆÓ Ì˘ÔηډÈÔ·ıÂÈÒÓ, Ù˘ ÂͤÏÈ͢, ηıÒ˜ Î·È ÛÙËÓ ÙÚÔÔÔ›ËÛË ˆ˜ ¤Ó· ‚·ıÌfi Ù˘ ıÂڷ¢ÙÈ΋˜ ÛÙÚ·ÙËÁÈ΋˜.
Abstract: Cardiomyopathies represent a variety of cardiac diseases that are an important cause of morbidity and mortality throughout the world, in both children and adults. They are classified into categories of hypertrophic, dilated and restrictive cardiomyopathy, arrythmiogenic right ventricular dysplasia, and the recently described noncompaction of the left ventricle. The recent advances in molecular genetics have contributed to the better understanding of the aetiology of the cardiomyopathies, the therapeutic interventions and the prognosis.
§¤ÍÂȘ ÎÏÂȉȿ: Ì˘ÔηډÈÔ¿ıÂȘ, ‰È·Ù·ÙÈ΋, ˘ÂÚÙÚÔÊÈ΋, ÂÚÈÔÚÈÛÙÈ΋, ·ÚÚ˘ıÌÈÔÁfiÓÔ˜ ‰˘ÛÏ·Û›· Ù˘ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜, ÌË Û˘Ì·Á¤˜ Ì˘ÔοډÈÔ.
Key words: cardiomyopathies, dilated, hypertrophic, restrictive, arrythmiogenic right ventricular dysplasia, non-compaction of the left ventricle.
∂ÈÛ·ÁˆÁ‹ OÈ Ì˘ÔηډÈÔ¿ıÂȘ ·ÔÙÂÏÔ‡Ó Ì›· ÔÌ¿‰· ÓfiÛˆÓ, ·ÚÈÔ ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÙˆÓ ÔÔ›ˆÓ Â›Ó·È Ë ÚÔÛ‚ÔÏ‹ ÙÔ˘ ›‰ÈÔ˘ ÙÔ˘ ηډȷÎÔ‡ Ì˘fi˜, ÂÓÒ Û˘ÓÈÛÙÔ‡Ó ‰ÔÌÈΤ˜ ‹ ÏÂÈÙÔ˘ÚÁÈΤ˜ ·ÓˆÌ·Ï›Â˜ ÙÔ˘ ηډȷÎÔ‡ Ì˘fi˜ Ô˘ ‰ÂÓ Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ˘¤ÚÙ·Û˘, ‚·Ï‚ȉԿıÂÈ·˜ ‹ Û˘ÁÁÂÓÔ‡˜ ·ÓˆÌ·Ï›·˜ ÙÔ˘ Ì˘Ôηډ›Ô˘ (1). ∏ ÙÂÏÂ˘Ù·›· Ù·ÍÈÓfiÌËÛË ÙˆÓ Ì˘ÔηډÈÔ·ıÂÈÒÓ ·fi ÙËÓ ¶·ÁÎfiÛÌÈ· OÚÁ¿ÓˆÛË ÀÁ›·˜ Ê·›ÓÂÙ·È ÛÙÔÓ ¶›Ó·Î· 1 (1). OÈ Ì˘ÔηډÈÔ¿ıÂȘ, Ì ‚¿ÛË ÙË ÏÂÈÙÔ˘ÚÁÈ΋ ÙÔ˘˜ ‰È·Ù·Ú·¯‹, Ù·ÍÈÓÔÌÔ‡ÓÙ·È ÛÂ: ·) ‰È·Ù·ÙÈ΋ ‹ Û˘ÌÊÔÚËÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ·, ÛÙËÓ ÔÔ›· Ë ·ÚÈÛÙÂÚ‹ ‹ Î·È ÔÈ ‰‡Ô ÎÔÈϛ˜ Â›Ó·È ‰È·ÙÂٷ̤Ó˜ Î·È ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÌÂȈ̤ÓË Û˘ÛÙ·ÏÙÈÎfiÙËÙ·, ‚) ˘ÂÚÙÚÔÊÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ·, Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ˘ÂÚÙÚÔÊ›· Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜, Û˘Ó‹ıˆ˜ ·Û‡Ì-
ÌÂÙÚË, Á) ÂÚÈÔÚÈÛÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ·, Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÛËÌ·ÓÙÈο ‰È·ÙÂٷ̤ÓÔ˘˜ ÎfiÏÔ˘˜, ÌÂ Ê˘ÛÈÔÏÔÁÈΤ˜ ‰È·ÛÙ¿ÛÂȘ ÙˆÓ ÎÔÈÏÈÒÓ (3) (¶›Ó·Î·˜ 2), ‰) ·ÚÚ˘ıÌÈÔÁfiÓÔ ‰˘ÛÏ·Û›· Ù˘ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜, ÛÙËÓ ÔÔ›· Ù· ·ÙÙ·Ú· ÙÔ˘ Ì˘Ôηډ›Ô˘ ·ÓÙÈηı›ÛÙ·ÓÙ·È ·fi ÏÈÒ‰Ë Î·È ÈÓÒ‰Ë ÈÛÙfi (4) Î·È Â) ÌË Û˘Ì·Á¤˜ Ì˘ÔοډÈÔ, Ì›· Ì˘ÔηډÈÔ¿ıÂÈ· Ô˘ ÂÚÈÁÚ¿ÊËΠÚfiÛÊ·Ù·. ªÂ ÙË Ú·Á‰·›· ÂͤÏÈÍË ÛÙÔÓ ÙÔ̤· Ù˘ ÌÔÚȷ΋˜ ‚ÈÔÏÔÁ›·˜ Î·È Ì ÙË ‚ÂÏÙ›ˆÛË ÙˆÓ ‰È·ÁÓˆÛÙÈÎÒÓ Ì¤ÛˆÓ, ÔÈ Ì˘ÔηډÈÔ¿ıÂȘ ·Ó·ÁÓˆÚ›˙ÔÓÙ·È ˆ˜ ÛËÌ·ÓÙÈ΋ ·ÈÙ›· ÓÔÛËÚfiÙËÙ·˜ Î·È ıÓËÛÈÌfiÙËÙ·˜, ÙfiÛÔ ÛÙÔ˘˜ ÂÓ‹ÏÈΘ fiÛÔ Î·È ÛÙ· ·È‰È¿.
µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ µÂÓÈ˙¤ÏÂÈÔ˘ ¡ÔÛÔÎÔÌ›Ԣ, ∏Ú¿ÎÏÂÈÔ ∫Ú‹Ù˘
2nd Paediatric Clinic of Venizelion Hospital, Heraklion, Crete
¢È·Ù·ÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· ∏ ‰È·Ù·ÙÈ΋ ‹ Û˘ÌÊÔÚËÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· (¢ª∫) Â›Ó·È Ë ÈÔ Û˘¯Ó‹ ÌÔÚÊ‹ Ì˘ÔηډÈÔ¿ıÂÈ·˜,
405
¶·È‰È·ÙÚÈ΋ 2003;66:405-417
Paediatriki 2003;66:405-417
Ì ÂÙ‹ÛÈ· ›وÛË 40-50 ÂÚÈÙÒÛÂȘ ·Ó¿ 100.000 ÏËı˘ÛÌÔ‡ ÛÙȘ ∏.¶.∞. Î·È ÙËÓ ∂˘ÚÒË (5,6). ÷ڷÎÙËÚ›˙ÂÙ·È ·fi ‰È¿Ù·ÛË Î·È ÌÂȈ̤ÓË Û˘ÛÙ·ÏÙÈÎfiÙËÙ· Ù˘ ·ÚÈÛÙÂÚ‹˜ ‹ Î·È ÙˆÓ ‰‡Ô ÎÔÈÏÈÒÓ. ∞ÈÙÈÔÏÔÁ›· ∏ ¢ª∫ ·ÔÙÂÏ› Ì›· ÎÔÈÓ‹ ¤ÎÊÚ·ÛË Ì˘Ôηډȷ΋˜ ‚Ï¿‚˘ Ô˘ ÚÔ‹Ïı ·fi Ì›· ÔÈÎÈÏ›· ÌË Ï‹Úˆ˜ ‰È¢ÎÚÈÓÈÛÌ¤ÓˆÓ ‚Ï·ÙÈÎÒÓ ÂȉڿÛÂˆÓ Â› ÙÔ˘ Ì˘Ôηډ›Ô˘ (¶›Ó·Î·˜ 3). ∏ ¤Ú¢ӷ Û¯ÂÙÈο Ì ÙËÓ ·ıÔÁ¤ÓÂÈ· ¤¯ÂÈ ÂÛÙÈ·ÛÙ› Û 4 ‚·ÛÈÎÔ‡˜ Ì˯·ÓÈÛÌÔ‡˜: ÔÈÎÔÁÂÓ›˜ Î·È ÁÂÓÂÙÈÎÔ› ·Ú¿ÁÔÓÙ˜, ÈÔÁÂÓ‹˜ Ì˘Ôηډ›Ùȉ·, ·ÓÔÛÔÏÔÁÈΤ˜ Î·È ÌÂÙ·‚ÔÏÈΤ˜ ‰È·Ù·Ú·¯¤˜ (7). ∏ ÔÈÎÔÁÂÓ‹˜ ÌÂÙ·‚›‚·ÛË Ù˘ ‰È·Ù·ÙÈ΋˜ Ì˘ÔηډÈÔ¿ıÂÈ·˜ Â›Ó·È Û˘¯ÓfiÙÂÚË ·fi fi,ÙÈ Û˘Ó‹ıˆ˜ ·Ó·ÁÓˆÚ›˙ÂÙ·È. ™Â ÔÛÔÛÙfi 20% ÙˆÓ ·ÛıÂÓÒÓ, ¤Ó·˜ ÚÒÙÔ˘ ‚·ıÌÔ‡ Û˘ÁÁÂÓ‹˜ ÂÌÊ·Ó›˙ÂÈ ÂӉ›ÍÂȘ ¢ª∫
‹ ˘ÔÎÏÈÓÈ΋ ÓfiÛÔ, ÁÂÁÔÓfi˜ Ô˘ ˘Ô‰ÂÈÎÓ‡ÂÈ fiÙÈ Ë ÔÈÎÔÁÂÓ‹˜ ÌÂÙ·‚›‚·ÛË Â›Ó·È Ôχ Û˘¯Ó‹ (8). ªÂ ÏÈÁfiÙÂÚÔ ·˘ÛÙËÚ¿ ÎÚÈÙ‹ÚÈ·, Û ÔÛÔÛÙfi ÂÚ›Ô˘ 3548% ÙˆÓ ·ÛıÂÓÒÓ Ì ¢ª∫, ıˆÚÂ›Ù·È fiÙÈ Â›Ó·È ÔÈÎÔÁÂÓ‹˜ (9,10). ∏ ÈÔ Û˘¯Ó‹ ÌÔÚÊ‹ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜ Â›Ó·È Ì ÙÔÓ ·˘ÙÔۈ̷ÙÈÎfi ÂÈÎÚ·ÙÔ‡ÓÙ· ¯·Ú·ÎÙ‹Ú· (>90%), Ì ÔÈÎÈÏÔÌÔÚÊ›· ÛÙËÓ ¤ÎÊÚ·ÛË ·ÎfiÌ· Î·È Ì¤Û· ÛÙËÓ ›‰È· ÔÈÎÔÁ¤ÓÂÈ· Î·È Ì ‰ÈÂÈÛ‰˘ÙÈÎfiÙËÙ· Ô˘ ÂÍ·ÚÙ¿Ù·È ·fi ÙËÓ ËÏÈΛ· (9-11). ∏ ÓfiÛÔ˜ Â›Ó·È ÁÂÓÂÙÈο ·ÓÔÌÔÈÔÁÂÓ‹˜ Î·È ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ÂÚÈÙÒÛÂȘ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜ Ì ÙÔÓ ·˘ÙÔۈ̷ÙÈÎfi ˘ÔÏÂÈfiÌÂÓÔ, ÌÂ Ê˘ÏÔÛ‡Ó‰ÂÙÔ ¯·Ú·ÎÙ‹Ú·, ·ÏÏ¿ Î·È ÌÂÙ·ÏÏ¿ÍÂȘ ÛÙÔ ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi DNA (12,13). ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ¤¯ÂÈ ÌÂÏÂÙËı› ·ÚÎÂÙ¿ Ë ÁÂÓÂÙÈ΋ ‚¿ÛË Ù˘ ÔÈÎÔÁÂÓÔ‡˜ ‰È·Ù·ÙÈ΋˜ Ì˘ÔηډÈÔ¿ıÂÈ·˜ Î·È ¤¯Ô˘Ó ÂÓÔ¯ÔÔÈËı› 8 ‰È·ÊÔÚÂÙÈο ·˘ÙÔۈ̷ÙÈο ÁÔÓ›‰È· Î·È 8 ÂÈÚfiÛıÂÙ˜ ÂÚÈÔ¯¤˜ ¯ÚˆÌÔۈ̿وÓ
¶›Ó·Î·˜ 1. ∞ÈÙÈÔÏÔÁÈ΋ Ù·ÍÈÓfiÌËÛË ÙˆÓ Ì˘ÔηډÈÔ·ıÂÈÒÓ ¢Â˘ÙÂÚÔ·ı›˜ ÀÂÚÙ·ÛÈ΋ µ·Ï‚ȉÈ΋ πÛ¯·ÈÌÈ΋ ™˘ÛÙËÌ·ÙÈ΋˜ ÓfiÛÔ˘ ºÏÂÁÌÔÓ҉˘
¶ÚˆÙÔ·ı›˜
∞Ù·ÍÈÓfiÌËÙ˜
¢È·Ù·ÙÈ΋ ÀÂÚÙÚÔÊÈ΋ ¶ÂÚÈÔÚÈÛÙÈ΋ ∞ÚÚ˘ıÌÈÔÁfiÓÔ˜ ‰˘ÛÏ·Û›· Ù˘ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜
πÓÔÂÏ¿ÛÙˆÛË ªË Û˘Ì·Á¤˜ Ì˘ÔοډÈÔ ªÈÙÔ¯ÔÓ‰Úȷ΋
∆ÚÔÔÔÈË̤ÓÔ ·fi Circulation 1996;93:341-342 ¶›Ó·Î·˜ 2. ∫ÏÈÓÈο, ·ÈÌÔ‰˘Ó·ÌÈο Î·È ÌÔÚÊÔÏÔÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ Ì˘ÔηډÈÔ·ıÂÈÒÓ
∫ÏÈÓÈο ñ ∫·Ú‰È·Î‹ ·Ó¿ÚÎÂÈ· ñ ∞ÚÚ˘ı̛˜
ñ ∞ÈÊÓ›‰ÈÔ˜ ı¿Ó·ÙÔ˜ ∞ÈÌÔ‰˘Ó·ÌÈο ñ ™˘ÛÙÔÏÈ΋ ÏÂÈÙÔ˘ÚÁ›· ñ ¢È·ÛÙÔÏÈ΋ ÏÂÈÙÔ˘ÚÁ›· ªÔÚÊÔÏÔÁÈο ñ ª¤ÁÂıÔ˜ ÎÔÈÏÔÙ‹ÙˆÓ ∫ÔÈϛ˜ ∫fiÏÔÈ
ñ ¶¿¯Ô˜ ÙÔȯÒÌ·ÙÔ˜
ÀÂÚÙÚÔÊÈ΋
¢È·Ù·ÙÈ΋
∞ÚÚ˘ıÌÈÔÁfiÓÔ˜ ‰˘ÛÏ·Û›· Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜
¶ÂÚÈÔÚÈÛÙÈ΋
™ÔÚ·‰Èο ∫ÔÈÏȷΤ˜ Î·È ˘ÂÚÎÔÈÏȷΤ˜ ·ÚÚ˘ı̛˜
™˘¯Ó¿ ∫ÔÈÏȷΤ˜ Î·È ˘ÂÚÎÔÈÏȷΤ˜ ·ÚÚ˘ı̛˜, ‰È·Ù·Ú·¯¤˜ ·ÁˆÁ‹˜ ™˘¯Ó¿
™˘¯Ó¿ ∫ÔÈÏȷ΋ Ù·¯˘Î·Ú‰›·, ‰È·Ù·Ú·¯¤˜ ·ÁˆÁ‹˜
™˘¯Ó¿ ∫ÔÏÈ΋ Ì·ÚÌ·Ú˘Á‹
™˘¯Ó¿
1-5%/¤ÙÔ˜
∂Ï·Ùو̤ÓË
º˘ÛÈÔÏÔÁÈ΋/ ÂÏ·Ùو̤ÓË
º˘ÛÈÔÏÔÁÈ΋
∂Ï·Ùو̤ÓË
∂Ï·Ùو̤ÓË
™ËÌ·ÓÙÈο ÂÏ·Ùو̤ÓË
∞˘ÍË̤ÓË ·ÚÈÛÙÂÚ‹ ÎÔÈÏ›· ‹ Î·È ÔÈ ‰‡Ô ÎfiÏÔÈ ∞˘ÍË̤ÓÔ˜ ·ÚÈÛÙÂÚfi˜ ‹ Î·È ÔÈ ‰‡Ô ÎfiÏÔÈ
∞˘ÍË̤ÓÔ (‰ÂÍÈ¿ ÎÔÈÏ›·)
º˘ÛÈÔÏÔÁÈÎfi ‹ ÂÏ·Ùو̤ÓÔ (Î·È ÔÈ ‰‡Ô ÎÔÈϛ˜) ∞˘ÍË̤ÓÔ (Î·È ÔÈ ‰‡Ô ÎfiÏÔÈ)
0,7-11%/¤ÙÔ˜
ÀÂÚ‰˘Ó·ÌÈ΋, ·fiÊÚ·ÍË ÙÔ˘ ¯ÒÚÔ˘ ÂÍfi‰Ô˘ ∂Ï·Ùو̤ÓË
∂Ï·Ùو̤ÓÔ
º˘ÛÈÔÏÔÁÈÎfi/ ·˘ÍË̤ÓÔ (·ÚÈÛÙÂÚfi˜ ÎfiÏÔ˜) ∞Û‡ÌÌÂÙÚË ¿¯˘ÓÛË (·ÚÈÛÙÂÚ‹ ÎÔÈÏ›·)
∆ÚÔÔÔÈË̤ÓÔ ·fi Lancet 2001;358:1628
406
º˘ÛÈÔÏÔÁÈÎfi ‹ ÂÏ·Ùو̤ÓÔ
∞˘ÍË̤ÓÔ (‰ÂÍÈfi˜ ÎfiÏÔ˜) º˘ÛÈÔÏÔÁÈÎfi/ ÂÏ·Ùو̤ÓÔ (‰ÂÍÈ¿ ÎÔÈÏ›·)
º˘ÛÈÔÏÔÁÈÎfi
¶·È‰È·ÙÚÈ΋ 2003;66:405-417
(6,11). ∏ ÔÈÎÔÁÂÓ‹˜ ‰È·Ù·ÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· ÌÔÚ› Ó· ¯ˆÚÈÛÙ› Û 4 ·ÚȘ ÔÌ¿‰Â˜ Ì ‚¿ÛË ÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ· Î·È ÙÔÓ ˘Â‡ı˘ÓÔ ·ÈÙÈÔÏÔÁÈÎfi ·Ú¿ÁÔÓÙ·: ·) ‰È·Ù·ÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· Ì ÁÚ‹ÁÔÚË Âȉ›ӈÛË ÛÙÔ˘˜ Ó·ÚÔ‡˜ ¿Ó‰Ú˜, Ô˘ ÔÊ›ÏÂÙ·È Î˘Ú›ˆ˜ Û ÌÂÙ·ÏÏ¿ÍÂȘ ÙˆÓ ÁÔÓȉ›ˆÓ Ô˘ Έ‰ÈÎÔÔÈÔ‡Ó ÙȘ ÚˆÙ½Ó˜ ‰˘ÛÙÚÔÊ›ÓË Î·È Ù·Ê·˙›ÓË, ‚) ‰È·Ù·ÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· Ô˘ ÂΉËÏÒÓÂÙ·È Î˘Ú›ˆ˜ Ì ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜, fiÔ˘ ÔÈ ˘Â‡ı˘Ó˜ ÚˆÙ½Ó˜ Ô˘ ¤¯Ô˘Ó ˘ÔÛÙ› ÌÂÙ¿ÏÏ·ÍË Â›Ó·È Ë ÙÚÔÔÓ›ÓË ∆, Ë ‰-Û·ÚÎÔÁÏ˘Î¿ÓË, Ë ‚-MHC (‚·ÚÈ¿ ¿Ï˘ÛÔ˜ Ù˘ ‚-Ì˘ÔÛ›Ó˘) Î·È Ë ·ÎÙ›ÓË, Á) ‰È·Ù·ÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· Ì ÚÒÈÌË ‰È·Ù·Ú·¯‹ Ù˘ ·ÁˆÁ‹˜, Ì ‚Ï¿‚Ë ÛÙȘ ÚˆÙ½Ó˜ ÙÔ˘ ˘Ú‹Ó· Ϸ̛Ә A Î·È C Î·È ÛÙË ‰ÂÛÌ›ÓË, ‰) ‰È·Ù·ÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· Ô˘ Û˘Ó˘¿Ú¯ÂÈ Ì Ó¢ÚÔ·ÈÛıËÙ‹ÚÈÔ ‚·ÚËÎÔ˝· Î·È ÔÊ›ÏÂÙ·È Û ÌÂÙ¿ÏÏ·ÍË Ù˘ ı¤Û˘ ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ 6q23-24 (∂ÈÎfiÓ· 1) (4,9). ŒÓ·˜ ·ıÔÁÂÓÂÙÈÎfi˜ Ì˯·ÓÈÛÌfi˜ Ù˘ ‰È·Ù·ÙÈ΋˜ Ì˘ÔηډÈÔ¿ıÂÈ·˜ Â›Ó·È ÔÈ ÌÂÙ·ÏÏ¿ÍÂȘ ÁÔÓȉ›ˆÓ Ô˘ Έ‰ÈÎÔÔÈÔ‡Ó ÚˆÙ½Ó˜ ÙÔ˘ ΢ÙÙ·ÚÔÛÎÂÏÂÙÔ‡, fiˆ˜ Ë ‰˘ÛÙÚÔÊ›ÓË (¯ÚˆÌfiۈ̷ Ãp21), Ë Ù·Ê·˙›ÓË (¯ÚˆÌfiۈ̷ Xq28), Ë ‰-Û·ÚÎÔÁÏ˘Î¿ÓË (¯ÚˆÌfiۈ̷ 5q33-q34) Î·È Ë ‰ÂÛÌ›ÓË (¯ÚˆÌfiۈ̷ 2q35) (14). ¶›Ó·Î·˜ 3. AÈÙÈÔÏÔÁ›· ‰È·Ù·ÙÈ΋˜ Ì˘ÔηډÈÔ¿ıÂÈ·˜ ªÂÙ·‚ÔÏÈο ∂Ó‰ÔÎÚÈÓÔÏÔÁÈο
¡fiÛÔÈ ÂÓ·Ôı¤Ûˆ˜
ÀÔÛÈÙÈÛÌfi˜ ∞Ó¿ÚÎÂÈ· ηÚÓÈÙ›Ó˘ ∞Ó¿ÚÎÂÈ· ‚-ÎÂÙÔÏ¿Û˘ ÀÂÚÙ·˘ÚÈÓÔ˘Ú›· OÈÎÔÁÂÓ‹˜ Ì˘ÔηډÈÔ¿ıÂÈ·
∫ÏËÚÔÓÔÌÈΤ˜ ‰È·Ù·Ú·¯¤˜ ª˘˚Τ˜ ‰˘ÛÙÚÔʛ˜
ªÈÙÔ¯ÔÓ‰ÚȷΤ˜ ‰È·Ù·Ú·¯¤˜ ÕÏÏ·
£˘ÚÂÔÙÔ͛ΈÛË ÀÔı˘ÚÂÔÂȉÈÛÌfi˜ ¢È·‚ËÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· ÀÔÁÏ˘Î·ÈÌ›· º·ÈÔ¯ÚˆÌÔ·Ùو̷ ¡Â˘ÚÔ‚Ï¿Ûو̷ °Ï˘ÎÔÁÔÓÈ¿ÛÂȘ µÏÂÓÓÔÔÏ˘Û·Î¯·ÚȉÒÛÂȘ ™ÊÈÁÁÔÏÈȉÒÛÂȘ Kwashiorkor Beriberi
π‰ÈÔ·ı‹˜ (·˘Ùo ۈ̷ÙÈ΋ ÂÈÎÚ·ÙÔ‡Û·, ˘ÔÏÂÈfiÌÂÓË, Ê˘ÏÔÛ‡Ó‰ÂÙË, ÛÔÚ·‰È΋) º˘ÏÔÛ‡Ó‰ÂÙË Î·Ú‰ÈÔÛÎÂÏÂÙÈ΋ Ì˘Ô¿ıÂÈ· (Û. Barth)
Duchene-Becker Emery-Dreiffus ª˘ÔÙÔÓÈ΋ ‰˘ÛÙÚÔÊ›· ™. Kearns-Sayre ∞Ó¿ÚÎÂÈ· ÙÔ˘ NADH-Co Q ∞ÈÌÔÏ˘ÙÈÎfi-Ô˘Ú·ÈÌÈÎfi Û‡Ó‰ÚÔÌÔ ª˘ÔηډÈÔ¿ıÂÈ· Ù˘ Ïԯ›·˜ ∞ÙÂÏ‹˜ ÔÛÙÂÔÁ¤ÓÂÛË §ÔÈÌ҉˘ Ì˘Ôηډ›Ùȉ·
∆ÚÔÔÔÈË̤ÓÔ ·fi Curr Opin Pediatr 1995;7:587-594
Paediatriki 2003;66:405-417
O Ê·ÈÓfiÙ˘Ô˜ Ù˘ Ê˘ÏÔÛ‡Ó‰ÂÙ˘ ‰È·Ù·ÙÈ΋˜ Ì˘ÔηډÈÔ¿ıÂÈ·˜ Ô˘ ÔÊ›ÏÂÙ·È Û ÌÂÙ·ÏÏ¿ÍÂȘ ÙÔ˘ ÁÔÓȉ›Ô˘ Ô˘ Έ‰ÈÎÔÔÈ› ÙËÓ ÚˆÙ½ÓË ‰˘ÛÙÚÔÊ›ÓË (Ãp21), Û˘Ó‹ıˆ˜ ·Ó·ÁÓˆÚ›˙ÂÙ·È ÛÙËÓ ÂÊ˂›· ‹ Û ӤԢ˜ ¿ÚÚÂÓ˜ Î·È Û˘¯Ó¿ Û˘Ó‰˘¿˙ÂÙ·È Ì ÙË Ì˘˚΋ ‰˘ÛÙÚÔÊ›· Duchenne Î·È Becker, ·Ú’ fiÏÔ Ô˘ ¤¯Ô˘Ó ÂÓÙÔÈÛÙ› ÌÂÙ·ÏÏ¿ÍÂȘ Ô˘ ÚÔηÏÔ‡Ó ‰È·Ù·ÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· ¯ˆÚ›˜ Û˘ÌÌÂÙÔ¯‹ ÙÔ˘ Ì˘ÔÛÎÂÏÂÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ (15-17). ∏ Ê˘ÏÔÛ‡Ó‰ÂÙË Ì˘ÔηډÈÔ¿ıÂÈ· Ô˘ Û˘Ó‰˘¿˙ÂÙ·È Ì ÌÂÙ·ÏÏ¿ÍÂȘ Ù˘ Ù·Ê·˙›Ó˘ (Û‡Ó‰ÚÔÌÔ Barth), ÂÌÊ·Ó›˙ÂÙ·È Ù˘Èο ÛÙË ‚ÚÂÊÈ΋ ËÏÈΛ· Î·È Â›Ó·È ı·Ó·ÙËÊfiÚÔ˜ (17). ªÂÙ·ÏÏ¿ÍÂȘ ÙˆÓ ÁÔÓȉ›ˆÓ Ô˘ Έ‰ÈÎÔÔÈÔ‡Ó ÚˆÙ½Ó˜ ÙÔ˘ Û·ÚÎÔÌÂÚȉ›Ô˘, fiˆ˜ Ë ‰ÂÛÌ›ÓË, Ë ‰-Û·ÚÎÔÁÏ˘Î¿ÓË, Ë ·ÎÙ›ÓË Î·È Ë ÙÈÙ›ÓË, ÌÂÙ·‚È‚¿˙ÔÓÙ·È Ì ÙÔÓ ·˘ÙÔۈ̷ÙÈÎfi ÂÈÎÚ·ÙÔ‡ÓÙ· ¯·Ú·ÎÙ‹Ú· (18-21) (∂ÈÎfiÓ· 1). ∞ӈ̷ϛ˜ ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ·ÁˆÁ‹˜ ¤¯Ô˘Ó ·Ú·ÙËÚËı› ÛÙË Ì˘˚΋ ‰˘ÛÙÚÔÊ›· EmeryDreifus, Ô˘ ÎÏËÚÔÓÔÌÂ›Ù·È Â›Ù ÌÂ Ê˘ÏÔÛ‡Ó‰ÂÙÔ ¯·Ú·ÎÙ‹Ú· Î·È ÔÊ›ÏÂÙ·È Û ÌÂÙ·ÏÏ¿ÍÂȘ ÙÔ˘ ÁÔÓȉ›Ô˘ Ù˘ ÂÌÂÚ›Ó˘, ›Ù Ì ·˘ÙÔۈ̷ÙÈÎfi ÂÈÎÚ·ÙÔ‡ÓÙ· ¯·Ú·ÎÙ‹Ú· Î·È ÔÊ›ÏÂÙ·È Û ÌÂÙ·ÏÏ¿ÍÂȘ ÁÔÓȉ›ˆÓ Ô˘ Έ‰ÈÎÔÔÈÔ‡Ó ÙȘ ÚˆÙ½Ó˜ ÙÔ˘ ˘Ú‹Ó· Ϸ̛Ә A Î·È C (22,23). ∫¿ÔÈ· Û‡Ó‰ÚÔÌ· Û˘Ó‰˘¿˙ÔÓÙ·È Ì ‰È·Ù·ÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· Î·È ‚·ÚËÎÔ˝· Ó¢ÚÔ·ÈÛıËÙËÚÈ·ÎÔ‡ Ù‡Ô˘, fiˆ˜ ÙÔ Û‡Ó‰ÚÔÌÔ Alstrom (24), ÌÂÙ·ÏÏ¿ÍÂȘ ÛÙÔ ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi tRNA Î·È ÌÂÙ·ÏÏ¿ÍÂȘ ÛÙÔ ¯ÚˆÌfiۈ̷ 6q23-24 (25). ¡ÂfiÙÂÚ˜ ÌÂϤÙ˜ ·Ó·Ê¤ÚÔÓÙ·È Û ÌÂÙ·ÏÏ¿ÍÂȘ Î·È ¿ÏÏˆÓ ‰ÔÌÈÎÒÓ ÚˆÙÂ˚ÓÒÓ ÙÔ˘ Û·ÚÎÔÌÂÚȉ›Ô˘, fiˆ˜ Ë ÚˆÙ½ÓË LIM (Lin-11, Isl-1 Î·È Mec-3) (26) Î·È Ë ÌÂÙ·‚ÈÎÔ˘Ï›ÓË (27). ∂›Ó·È Èı·Ófi fiÙÈ ¤Ó· ÂÂÈÛfi‰ÈÔ ˘ÔÎÏÈÓÈ΋˜ ÈÔÁÂÓÔ‡˜ Ì˘Ôηډ›Ùȉ·˜ ÌÔÚ› Ó· ÎÈÓËÙÔÔÈ‹ÛÂÈ ·ÓÔÛÔÏÔÁÈ΋ ·ÓÙ›‰Ú·ÛË, Ô‰ËÁÒÓÙ·˜ ÛÙËÓ ·Ó¿Ù˘ÍË ‰È·Ù·ÙÈ΋˜ Ì˘ÔηډÈÔ¿ıÂÈ·˜ (28,29). ¢È·Ù·Ú·¯¤˜, ÙfiÛÔ Ù˘ ΢ÙÙ·ÚÈ΋˜ fiÛÔ Î·È Ù˘ ¯˘ÌÈ΋˜ ·ÓÔÛ›·˜, ¤¯Ô˘Ó ‚ÚÂı› Û ·ÛıÂÓ›˜ Ì ‰È·Ù·ÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ·. Œ¯ÂÈ ‰È·Ù˘ˆı› Ë ˘fiıÂÛË fiÙÈ ÂȉÈο ·ÓÙÈÁfiÓ· Ù˘ ηÙËÁÔÚ›·˜ HLA Ù¿Í˘ ππ (HLA-DR4 Î·È HLA-DQB1) ÛÙÔ ¯ÚˆÌfiۈ̷ 6, Â›Ó·È ÁÂÓÂÙÈÎÔ› ‰Â›ÎÙ˜ Ù˘ ÚԉȿıÂÛ˘ ÁÈ· ·Ó¿Ù˘ÍË ¢ª∫ (3). ∂›Û˘, ¤¯Ô˘Ó ·ÓȯÓ¢ı› ÌfiÚÈ· ÚÔÛÎfiÏÏËÛ˘ ÙˆÓ Î˘ÙÙ¿ÚˆÓ Û ‚ÈÔ„›Â˜ Ì˘Ôηډ›Ô˘ ·ÛıÂÓÒÓ Ì ¢ª∫, fiˆ˜ ÔÈ ÛÂÏÂÎÙ›Ó˜ CD62E Î·È CD62P, ‚2 ÈÓÙÂÁÎÚ›Ó˜ CD29, ÌfiÚÈ· ÚÔÛÎfiÏÏËÛ˘ ÛÙ· ÙÔȯÒÌ·Ù· ÙˆÓ ·ÁÁ›ˆÓ (VCAM-1) Î·È ÌfiÚÈ· ÚÔÛÎfiÏÏËÛ˘ ÛÙ· ·ÙÙ·Ú· (30). Œ¯Ô˘Ó ‰È·ÈÛÙˆı› ΢ÎÏÔÊÔÚÔ‡ÓÙ· ·ÓÙÈÌ˘Ôηډȷο ·ÓÙÈÛÒÌ·Ù· ÂÓ·ÓÙ›ˆÓ ÔÈÎ›ÏˆÓ ·ÓÙÈÁfiÓˆÓ, fiˆ˜ Ë ‚·ÚÈ¿ ¿Ï˘ÛÔ˜ Ù˘ Ì˘ÔÛ›Ó˘, ÔÈ ‚-·‰ÚÂÓÂÚÁÈÎÔ› ˘Ô‰Ô¯Â›˜, Ô ÌÔ˘ÛηÚÈÓÈÎfi˜ ˘Ô‰Ô¯¤·˜, Ë Ï·Ì›ÓË Î·È Ù· ÌÈÙÔ¯fiÓ‰ÚÈ· (31). ∆· ·ÓÙÈÌ˘Ôηډȷο ·ÓÙÈÛÒÌ·Ù· ·ÓȯÓ‡ÔÓÙ·È Î·È Û ÌË Û˘Ìو̷ÙÈÎÔ‡˜ Û˘ÁÁÂÓ›˜ ·ÛıÂÓÒÓ Ì ‰È·Ù·ÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· Î·È Â›Ó·È ÚÔÁÓˆÛÙÈÎÔ› ‰Â›ÎÙ˜
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¶·È‰È·ÙÚÈ΋ 2003;66:405-417
Paediatriki 2003;66:405-417
‰-Û·ÚÎÔÁÏ˘Î¿ÓË
Ï·ÌÈÓ›ÓË ·-2 ‰˘ÛÙÚÔÁÏ˘Î¿Ó˜ ÂÌÂÚ›ÓË
ÁÏ˘ÎÔÚˆÙ½Ó˜ Ù˘ ‰˘ÛÙÚÔÊ›Ó˘
ÂÍˆÎ˘ÙÙ¿ÚÈ· Ô˘Û›· ΢ÙÙ·ÚÔÏ·ÛÌ·ÙÈ΋ ÌÂÌ‚Ú¿ÓË Ï·Ì›ÓË A/C
‰˘ÛÙÚÔÊ›ÓË ˘Ú‹Ó·˜ ¯ÚˆÌ·Ù›ÓË ¢π∞∆∞∆π∫∏
‰ÂÛÌ›ÓË
‚·ÚÈ¿ ¿Ï˘ÛÔ˜ ‚-Ì˘ÔÛ›Ó˘
·ÎÙ›ÓË
À¶∂ƒ∆ƒOºπ∫∏
ÙÈÙ›ÓË
ÚˆÙ½ÓË C Û‡Ó‰ÂÛ˘ Ù˘ Ì˘ÔÛ›Ó˘ ÂÏ·ÊÚ¤˜ ¿Ï˘ÛÔÈ Ì˘ÔÛ›Ó˘ 1/2
∞¢¢∫
·-ÙÚÔÔÌ˘ÔÛ›ÓË ·-·ÎÙÈÓ›ÓË ÙÚÔÔÓ›ÓË π ÙÚÔÔÓ›ÓË ∆ ·-ηÙÂÓ›ÓË Ï·ÎÔÛÊ·ÈÚ›ÓË Î˘ÙÙ·ÚfiÏ·ÛÌ· η¯ÂÚ›Ó˜
΢ÙÙ·ÚÔÏ·ÛÌ·ÙÈ΋ ÌÂÌ‚Ú¿ÓË
∂ÈÎfiÓ· 1. ∏ ÌÔÚȷ΋ ·ÏÏËÏ›‰Ú·ÛË ÙˆÓ ÚÔۂ‚ÏËÌ¤ÓˆÓ ÚˆÙÂ˚ÓÒÓ ÛÙË ‰È·Ù·ÙÈ΋, ÙËÓ ˘ÂÚÙÚÔÊÈ΋ Î·È ÙËÓ ·ÚÚ˘ıÌÈÔÁfiÓÔ ‰˘ÛÏ·Û›· Ù˘ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜ (∞¢¢∫) (ÙÚÔÔÔÈË̤ÓÔ ·fi Lancet 2001;358:1630). ∫fiÎÎÈÓÔ: ÔÈ ÚÔۂ‚ÏË̤Ó˜ ÚˆÙ½Ó˜ Ô˘ ÚÔηÏÔ‡Ó ‰È·Ù·ÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ·, ∫›ÙÚÈÓÔ: ÔÈ ÚÔۂ‚ÏË̤Ó˜ ÚˆÙ½Ó˜ Ô˘ ÚÔηÏÔ‡Ó ˘ÂÚÙÚÔÊÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· Î·È ¶Ú¿ÛÈÓÔ: ÔÈ ÚÔۂ‚ÏË̤Ó˜ ÚˆÙ½Ó˜ Ô˘ ÚÔηÏÔ‡Ó ∞¢¢∫, ÂÓÒ ªÏÂ: ÔÈ ÚÔۂ‚ÏË̤Ó˜ ÚˆÙ½Ó˜ Ô˘ ÚÔηÏÔ‡Ó ‹ ‰È·Ù·ÙÈ΋ ‹ ˘ÂÚÙÚÔÊÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ·.
ÂͤÏÈ͢ Ù˘ ÓfiÛÔ˘ (32). ∞ӈ̷ϛ˜ ˘ÔÏËı˘ÛÌÒÓ ∆ ΢ÙÙ¿ÚˆÓ, ÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ ÙˆÓ Î˘ÙÙ·ÚÔÙÔÍÈÎÒÓ ∆ ΢ÙÙ¿ÚˆÓ, ÙˆÓ Î·Ù·ÛÙ·ÏÙÈÎÒÓ ∆ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Î·È ÙˆÓ Ê˘ÛÈÎÒÓ Î˘ÙÙ¿ÚˆÓ-ÊÔÓ¤ˆÓ, ¤¯Ô˘Ó ‚ÚÂı› Û ÌÂÚÈΤ˜ ÌÂϤÙ˜ (33). Œ¯ÂÈ ˘ÔÛÙËÚȯı› fiÙÈ ·˘Ù¤˜ ÔÈ ·ÓÔÛÔÏÔÁÈΤ˜ ‰È·Ù·Ú·¯¤˜ ÌÔÚ› Ó· Â›Ó·È Û˘Ó¤ÂÈ· ÈÔÁÂÓÔ‡˜ Ì˘Ôηډ›Ùȉ·˜. £ÂˆÚÂ›Ù·È fiÙÈ Û˘ÛÙ·ÙÈο ÙˆÓ ÈÒÓ ÌÔÚ› Ó· ¤¯Ô˘Ó ÂÓۈ̷وı› ÛÙÔ Û·ÚΛÏËÌ· ÙˆÓ Ì˘ÔηډȷÎÒÓ Î˘ÙÙ¿ÚˆÓ Î·È ‰ÚÔ˘Ó ˆ˜ ·ÓÙÈÁÔÓÈ΋ ËÁ‹ Ô˘ ηÙ¢ı‡ÓÂÈ ÙËÓ ·ÓÔÛÔÏÔÁÈ΋ ·¿ÓÙËÛË ÚÔ˜ ÙÔ Ì˘ÔοډÈÔ. ¶·ıÔÊ˘ÛÈÔÏÔÁ›· ™ÙË ‰È·Ù·ÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ·, Ë ·ÚÈÛÙÂÚ‹ ‹ Î·È ÔÈ ‰‡Ô ÎÔÈϛ˜ Â›Ó·È ‰È·ÙÂٷ̤Ó˜ Î·È ·ÚÔ˘ÛÈ¿˙Ô˘Ó ˘ÔÛ˘ÛÙ·ÏÙÈÎfiÙËÙ·. ª·ÎÚÔÛÎÔÈο, Ë Î‡ÚÈ· ÌÔÚÊÔÏÔÁÈ΋ ·ÓˆÌ·Ï›· Â›Ó·È Ë ‰È¿Ù·ÛË ÙˆÓ ‰‡Ô ÎÔÈÏÈÒÓ, ηıÒ˜ Î·È Ë ‰È¿Ù·ÛË ÙˆÓ ÎfiψÓ. ∏ ηډȿ ¤¯ÂÈ ÛÊ·ÈÚÈ΋ ÂÌÊ¿ÓÈÛË Î·È ÙÔ Ì˘ÔοډÈÔ Â›Ó·È ˆ¯Úfi ηÈ, ÌÂÚÈΤ˜ ÊÔÚ¤˜, ‰È¿ÛÙÈÎÙÔ. ∆Ô ÂÓ‰ÔοډÈÔ Â›Ó·È ÏÂÙfi Î·È ‰È¿Ê·ÓÔ, Ì ÛËÌ›· ÙÔÈ΋˜ ÛÎÏ‹Ú˘ÓÛ˘. πÛÙÔÏÔÁÈο ·Ú·ÙËÚÂ›Ù·È ˘ÂÚÙÚÔÊ›· ÙˆÓ Ì˘ÔηډȷÎÒÓ Î˘ÙÙ¿ÚˆÓ Î·È ÂÎʇÏÈÛË, ·ÏÏ¿ ·Ó¢ڛÛÎÂÙ·È Î·È ‰È¿ÌÂÛË ›ÓˆÛË (2,3,5). ∏ ÂÏ¿ÙÙˆÛË Ù˘ Û˘ÛÙ·ÏÙÈÎfiÙËÙ·˜ ÙÔ˘ Ì˘Ôηډ›-
408
Ô˘ Ô‰ËÁ› Û ÂÏ·Ùو̤ÓÔ ÎÏ¿ÛÌ· ‚Ú¿¯˘ÓÛ˘, ÎÏ¿ÛÌ· ÂÍÒıËÛ˘ Î·È Î·Ú‰È·Î‹ ·ÚÔ¯‹, Ô˘ Ô‰ËÁÔ‡Ó Û ϛÌÓ·ÛË ·›Ì·ÙÔ˜ ÛÙȘ ÎÔÈÏfiÙËÙ˜ Î·È Û ‰Â˘ÙÂÚÔ·ı‹ ·‡ÍËÛË ÙÔ˘ ÙÂÏԉȷÛÙÔÏÈÎÔ‡ fiÁÎÔ˘ Î·È ›ÂÛ˘, ηıÒ˜ Î·È Ù˘ ›ÂÛ˘ Ï‹ÚˆÛ˘ ÙˆÓ ÎÔÈÏÈÒÓ. °È· Ó· ‰È·ÙËÚËı› ·Ú΋˜ ηډȷ΋ ·ÚÔ¯‹, ÔÈ ÎÔÈϛ˜ ‰È·Ù›ÓÔÓÙ·È Î·È ÙÔ Ì˘ÔοډÈÔ ˘ÂÚÙÚ¤ÊÂÙ·È Û οÔÈÔ ‚·ıÌfi. ∏ ‰È¿Ù·ÛË ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·‡ÍËÛË Ù˘ ÙÔȯˆÌ·ÙÈ΋˜ Ù¿Û˘ Î·È ÙËÓ ·‡ÍËÛË ÙˆÓ ·Ó·ÁÎÒÓ ÙÔ˘ Ì˘Ôηډ›Ô˘ Û Ô͢ÁfiÓÔ. ∫·ıÒ˜ ÂÏ·ÙÙÒÓÂÙ·È Ë Î·Ú‰È·Î‹ ·ÚÔ¯‹, ÂÏ·ÙÙÒÓÂÙ·È Î·È Ë ·ÈÌ¿ÙˆÛË ÙˆÓ ÓÂÊÚÒÓ. ¶·Ú·ÙËÚÂ›Ù·È ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ Ó¢ÚÔÔÚÌÔÓÈÎÒÓ Ì˯·ÓÈÛÌÒÓ, ΢ڛˆ˜ ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ÚÂÓ›Ó˘-·ÁÁÂÈÔÙÂÓÛ›Ó˘-·Ï‰ÔÛÙÂÚfiÓ˘ Î·È ÙÔ˘ Û˘Ì·ıËÙÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ∆˘Èο, ·˘Ù¤˜ ÔÈ ·ÏÏ·Á¤˜ Á›ÓÔÓÙ·È ·ÚÁ¿ Î·È Ô‰ËÁÔ‡Ó ÛÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ· Ù˘ ηډȷ΋˜ ·Ó¿ÚÎÂÈ·˜ Î·È Ù˘ Ó¢ÌÔÓÈ΋˜ ˘¤ÚÙ·Û˘, ÂÓÒ Ë ›ÓˆÛË ÙÔ˘ ÎÔÈÏÈ·ÎÔ‡ Ì˘Ôηډ›Ô˘ ‰ËÌÈÔ˘ÚÁ› ÂÛٛ˜ ÎÔÈÏÈ·ÎÒÓ ·ÚÚ˘ıÌÈÒÓ (3,6). ∫ÏÈÓÈ΋ ÂÈÎfiÓ· ŸÙ·Ó ‰ÂÓ Â›Ó·È ‰˘Ó·Ù‹ Ë ‰È·Ù‹ÚËÛË Â·ÚÎÔ‡˜ ηډȷ΋˜ ·ÚÔ¯‹˜, ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛËÌ›· Î·È Û˘ÌÙÒÌ·Ù· ηډȷ΋˜ ·Ó¿ÚÎÂÈ·˜ (2,3,6). ∞Ú¯Èο, Ù· Û˘ÌÙÒÌ·Ù· ÌÔÚ› Ó· Â›Ó·È ˘ÔÎÏÈÓÈο Î·È Ó·
¶·È‰È·ÙÚÈ΋ 2003;66:405-417
·ÚÔ˘ÛÈ·ÛÙÔ‡Ó Û ηٷÛÙ¿ÛÂȘ ·˘ÍË̤ÓÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡, .¯. Û ÏÔÈÌÒÍÂȘ, fiÙ·Ó Ë Î·Ú‰È·Î‹ ·ÚÔ¯‹ ‰ÂÓ Â·ÚΛ ÁÈ· Ó· ηχ„ÂÈ ÙȘ ·Ó¿ÁΘ ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡. ªÂÁ·Ï‡ÙÂÚ· ·È‰È¿ ‹ ¤ÊË‚ÔÈ ÌÔÚ› Ó· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó ÂÏ·Ùو̤ÓË ·ÓÔ¯‹ ÛÙËÓ ¿ÛÎËÛË ‹ ‰‡ÛÓÔÈ· ÛÙËÓ ÚÔÛ¿ıÂÈ·. ∆· ‚Ú¤ÊË ÌÔÚ› Ó· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó Ù·¯‡ÓÔÈ·, ·Ó·Ú΋ ÚfiÛÏË„Ë ‚¿ÚÔ˘˜ Î·È ÛËÌ›· ηډȷ΋˜ ·Ó¿ÚÎÂÈ·˜. ™Â ÔÛÔÛÙfi 13% ÙˆÓ ·È‰ÈÒÓ ÂÌÊ·Ó›˙ÔÓÙ·È Û˘ÁÎÔÙÈο ÂÂÈÛfi‰È· Î·È ·›ÛıËÌ· ·ÏÌÒÓ (3). º˘ÛÈ΋ ÂͤٷÛË ∆· Â˘Ú‹Ì·Ù· Ù˘ Ê˘ÛÈ΋˜ ÂͤٷÛ˘ ÌÔÚ› Ó· ÔÈΛÏÏÔ˘Ó, ·Ó¿ÏÔÁ· Ì ÙÔ ÛÙ¿‰ÈÔ Ù˘ ÓfiÛÔ˘. ∆Ô 7080% ÙˆÓ ·ÙfiÌˆÓ Ô˘ ¿Û¯Ô˘Ó ·fi ‰È·Ù·ÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ·, ·ÚÔ˘ÛÈ¿˙ÂÈ ÛËÌ›· ηډȷ΋˜ ·Ó¿ÚÎÂÈ·˜ (3,5). ∆· ¿ÙÔÌ· ·˘Ù¿ Û˘Ó‹ıˆ˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ù·¯‡ÓÔÈ·, Ù·¯˘Î·Ú‰›· Î·È ˆ¯ÚfiÙËÙ·. ∞fi ÙËÓ ·ÎÚfi·ÛË ÙˆÓ Ó¢ÌfiÓˆÓ ÌÔÚ› Ó· ˘¿Ú¯Ô˘Ó ˘ÁÚÔ› ÚfiÁ¯ÔÈ ‹ Ì›ˆÛË ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ „Èı˘Ú›ÛÌ·ÙÔ˜ ÏfiÁˆ ·ÙÂÏÂÎÙ·Û›·˜ ÙÔ˘ Ó‡ÌÔÓ· ·fi ÙËÓ ˘ÂÚÌÂÁ¤ıË Î·Ú‰È¿. ∏ ·ÎÚfi·ÛË Ù˘ ηډȿ˜ ·ÔηχÙÂÈ Û˘Ó‹ıˆ˜ ηϷÛÙÈÎfi Ú˘ıÌfi ηÈ, Û¿ÓÈ·, Û˘ÛÙÔÏÈÎfi ʇÛËÌ· ·Ó¿ÚÎÂÈ·˜ ÌÈÙÚÔÂȉԇ˜. OÈ ÂÚÈÊÂÚÈΤ˜ ÛʇÍÂȘ Â›Ó·È ·ÛıÂÓ›˜. ∆Ô ‹·Ú Î·È Ô ÛÏ‹Ó·˜ Â›Ó·È „ËÏ·ÊËÙ¿ fiÙ·Ó ˘¿Ú¯ÂÈ Û˘ÌÊfiÚËÛË ÙˆÓ Û˘ÛÙËÌ·ÙÈÎÒÓ ÊÏ‚ÒÓ. ¢È¿ÁÓˆÛË ™ÙËÓ ·ÎÙÈÓÔÁÚ·Ê›· ·Ú·ÙËÚÂ›Ù·È ·‡ÍËÛË Ù˘ ηډȷ΋˜ ÛÎÈ¿˜ ÂÍ·ÈÙ›·˜ Ù˘ ‰È·ÙÂٷ̤Ó˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ Î·È ÙÔ˘ ÎfiÏÔ˘. ªÔÚ›, ›Û˘, Ó· ˘¿Ú¯Ô˘Ó ÂÚÈÔ¯¤˜ Ì ·ÙÂÏÂÎÙ·Û›· ÛÙÔÓ ·ÚÈÛÙÂÚfi Ó‡ÌÔÓ· ÂÍ·ÈÙ›·˜ Ù˘ Û˘Ì›ÂÛ˘ ÙˆÓ ‚ÚfiÁ¯ˆÓ ·fi ÙÔÓ ‰È·ÙÂٷ̤ÓÔ ·ÚÈÛÙÂÚfi ÎfiÏÔ Î·È ÙË ‰È·ÙÂٷ̤ÓË ·ÚÈÛÙÂÚ‹ Ó¢ÌÔÓÈ΋ ·ÚÙËÚ›·. ™ËÌ›· Ó¢ÌÔÓÈ΋˜ ˘¤ÚÙ·Û˘ Î·È Ó¢ÌÔÓÈÎÔ‡ Ôȉ‹Ì·ÙÔ˜ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Û ηډȷ΋ Î¿Ì„Ë (3). ∆Ô ËÏÂÎÙÚÔηډÈÔÁÚ¿ÊËÌ· ·ÔηχÙÂÈ ÊÏ‚ÔÎÔÌ‚È΋ Ù·¯˘Î·Ú‰›·, ˘ÂÚÙÚÔÊ›· Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜, ¯·ÌËÏ¿ ‰˘Ó·ÌÈο ÛÙȘ ÚÔοډȘ ··ÁˆÁ¤˜, ηıÒ˜ Î·È ÌË ÂȉÈΤ˜ ·ÏÏÔÈÒÛÂȘ ÙÔ˘ ST Î·È T. ∞ӷʤÚÂÙ·È fiÙÈ ÂÚ›Ô˘ ÙÔ 46% ÙˆÓ ·È‰ÈÒÓ Ì ‰È·Ù·ÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· ·ÚÔ˘ÛÈ¿˙ÂÈ ·ÚÚ˘ı̛˜ ÛÙËÓ 24ˆÚË Î·Ù·ÁÚ·Ê‹ ÙÔ˘ ∏∫°, ÙfiÛÔ ˘ÂÚÎÔÈÏȷΤ˜ fiÛÔ Î·È ÎÔÈÏȷΤ˜, ÔÈ Ôԛ˜ ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙÔÈΤ˜ ÂÛٛ˜ ÛÙÔ ˘ÂÓ‰ÔοډÈÔ ‹ ÛÙȘ ˘ÔÂÈηډȷΤ˜ ÛÙÈ‚¿‰Â˜ (34,35). O ·ÎÚÔÁˆÓÈ·›Ô˜ Ï›ıÔ˜ Ù˘ ‰È¿ÁÓˆÛ˘ Ù˘ ‰È·Ù·ÙÈ΋˜ Ì˘ÔηډÈÔ¿ıÂÈ·˜ Â›Ó·È ÙÔ Ë¯ÔηډÈÔÁÚ¿ÊËÌ·, Ì ÙÔ ÔÔ›Ô ‰È·ÈÛÙÒÓÂÙ·È ‰È¿Ù·ÛË Î·È ˘ÔÛ˘ÛÙ·ÏÙÈÎfiÙËÙ· ÙˆÓ ÎÔÈÏÈÒÓ, ΢ڛˆ˜ Ù˘ ·ÚÈÛÙÂÚ‹˜ (‰È·ÛÙ¿ÛÂȘ ηٿ ÙË ‰È·ÛÙÔÏ‹ >95Ë ∂£ ÁÈ· ÙËÓ ÂÈÊ¿ÓÂÈ· ÛÒÌ·ÙÔ˜ Î·È ÎÏ¿ÛÌ· ÂÍÒıËÛ˘ <50%). ∂›Û˘, ‰È·ÈÛÙÒÓÂÙ·È Î·È ‰È¿ÊÔÚÔ˘ ‚·ıÌÔ‡ ·Ó¿ÚÎÂÈ· ÌÈÙÚÔÂȉԇ˜, Ô˘ Â›Ó·È ·ÔÙ¤ÏÂÛÌ· Ù˘ ‰È¿Ù·-
Paediatriki 2003;66:405-417
Û˘ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ Î·È Ù˘ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·˜ ÙˆÓ ıËÏÔÂȉÒÓ Ì˘ÒÓ (3,6). ∂Ӊ›ÍÂȘ ÁÈ· ηıÂÙËÚÈ·ÛÌfi Î·È ·ÁÁÂÈÔÁÚ·Ê›· ·ÔÙÂÏÔ‡Ó Ë Ï‹„Ë ‚ÈÔ„›·˜ ·fi ÙÔÓ Î·Ú‰È·Îfi Ì˘ Î·È Ë ÛÎÈ·ÁÚ¿ÊËÛË ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ ·ÁÁ›ˆÓ. ∞Ó¿ÏÔÁ· Ì ÙËÓ ËÏÈΛ· ÂÌÊ¿ÓÈÛ˘ Ù˘ ÓfiÛÔ˘, Â›Ó·È ¯Ú‹ÛÈ̘ ‰È¿ÊÔÚ˜ ÂÚÁ·ÛÙËÚȷΤ˜ ÂÍÂÙ¿ÛÂȘ, fiˆ˜ Ô Ï‹Ú˘ ¤ÏÂÁ¯Ô˜ ÁÈ· ÌÂÙ·‚ÔÏÈο ÓÔÛ‹Ì·Ù· (36), ÂÓÒ ‰È·ÁÓˆÛÙÈ΋ ÌÔÚ› Ó· Â›Ó·È Ë ·Ó¿Ï˘ÛË DNA ÁÈ· ÙËÓ ·Ó·ÁÓÒÚÈÛË ÙˆÓ ˘Â‡ı˘ÓˆÓ ÌÂÙ·ÏϿ͈Ó. ∏ ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË (¶›Ó·Î·˜ 4) ı· Û˘ÓÙÂϤÛÂÈ ÛÙËÓ ·Ó·ÁÓÒÚÈÛË Èı·Ó¿ È¿ÛÈÌˆÓ ·ÈÙ›ˆÓ. £Âڷ›· ∞Ó ‰ÂÓ ·Ó·ÁÓˆÚÈÛÙ› οÔÈÔ È¿ÛÈÌÔ ·›ÙÈÔ, Ë ıÂڷ›· Â›Ó·È Û˘Ìو̷ÙÈ΋ Î·È Û˘Ó›ÛÙ·Ù·È ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ Û˘ÌÊÔÚËÙÈ΋˜ ηډȷ΋˜ ·Ó¿ÚÎÂÈ·˜, ÙˆÓ ·ÚÚ˘ıÌÈÒÓ Î·È ÙˆÓ ıÚÔÌ‚ÔÂÌ‚ÔÏÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ. ∆· ÂÓ‰ÔÊϤ‚È· ÈÓfiÙÚÔ· (ÓÙÔ·Ì›ÓË, ÓÙÔÌÔ˘Ù·Ì›ÓË), ÔÈ ·Ó·ÛÙÔÏ›˜ Ù˘ ʈÛÊÔ‰ÈÂÛÙÂÚ¿Û˘ (·ÌÚÈÓfiÓË, ÌÈÏÚÈÓÏfiÓË), Ù· ‰ÈÔ˘ÚËÙÈο, ÔÈ ·Ó·ÛÙÔÏ›˜ ÙÔ˘ ÌÂÙ·ÙÚÂÙÈÎÔ‡ ÂÓ˙‡ÌÔ˘ Î·È Ë ‰ÈÁÔÍ›ÓË ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÔÍ›·˜ ηډȷ΋˜ ·Ó¿ÚÎÂÈ·˜ (3,6). ∏ ¯Ú‹ÛË ÙˆÓ ‚·‰ÚÂÓÂÚÁÈÎÒÓ ·ÔÎÏÂÈÛÙÒÓ ¤¯ÂÈ, ›Û˘, ÂÓı·ÚÚ˘ÓÙÈο ·ÔÙÂϤÛÌ·Ù· (37). °È· ÙË ıÂڷ›· ÙˆÓ ·ÚÚ˘ıÌÈÒÓ, Ô˘ Â›Ó·È ·ÚÎÂÙ¿ Û˘¯Ó¤˜ ÛÙ· ·È‰È¿, ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ·ÓÙÈ·ÚÚ˘ıÌÈο Ê¿Ú̷η. ∂› ·ÚÔ˘Û›·˜ ıÚÔÌ‚ÔÂÌ‚ÔÏÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ, ı· Ú¤ÂÈ Ó· ¯ÚËÛÈÌÔÔÈÂ›Ù·È ·ÓÙÈËÎÙÈ΋ ıÂڷ›·. ∆ÂÏÂ˘Ù·›·, ¤¯ÂÈ ¯ÚËÛÈÌÔÔÈËı› ¯ˆÚ›˜ ÂÈÙ˘¯›· Ë ·ÓÔÛÔıÂڷ›· Ì ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹, ·˙·ıÂÈÔÚ›ÓË ‹ ΢ÎÏÔÛÔÚ›ÓË, ΢ڛˆ˜ Û ·ÛıÂÓ›˜ Ì ÏÂÌÊÔ΢ÙÙ·ÚÈ΋ ‰È‹ıËÛË ÙÔ˘ Ì˘Ôηډ›Ô˘. ™ÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ Ë ‰È·Ù·ÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ÌÂÙ·‚ÔÏÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ, ··ÈÙÂ›Ù·È Ë ¿ÌÂÛË ·ÔηٿÛÙ·ÛË ÙˆÓ ‚ÈÔ¯ËÌÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ. ∂¿Ó ‰ÂÓ ˘¿ÚÍÂÈ ·ÓÙ·fiÎÚÈÛË ÛÙË Ê·Ú̷΢ÙÈ΋ ıÂڷ›·, ÙfiÙ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÂÂÌ‚·ÙÈΤ˜ ̤ıÔ‰ÔÈ, fiˆ˜ ÔÈ Û˘Û΢¤˜ ˘ÔÛÙ‹ÚÈ͢ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜, Ë ÂÓ‰Ô·ÔÚÙÈ΋ ·ÓÙÏ›· Î·È Ë Û˘Û΢‹ Â͈ۈ̷ÙÈ΋˜ ΢ÎÏÔÊÔÚ›·˜. ™ÙȘ Ôχ ÛÔ‚·Ú¤˜ ÂÚÈÙÒÛÂȘ ··ÈÙÂ›Ù·È ÌÂÙ·ÌfiÛ¯Â˘ÛË Î·Ú‰È¿˜ (2,3,6). ¶ÚfiÁÓˆÛË ∏ ÚfiÁÓˆÛË Ù˘ ‰È·Ù·ÙÈ΋˜ Ì˘ÔηډÈÔ¿ıÂÈ·˜ ÛÙ· ·È‰È¿ ÔÈΛÏÏÂÈ Î·È ·ÓÙ·Ó·ÎÏ¿ ÙËÓ ÂÙÂÚÔÁÂÓ‹ ·ÈÙÈÔÏÔÁ›· Ù˘ ÓfiÛÔ˘. ∞ӷʤÚÂÙ·È 5ÂÙ‹˜ ıÓËÙfiÙËÙ· ¤ˆ˜ 80% ÛÙ· ·È‰È¿ (38). ø˜ ‰Â›ÎÙ˜ η΋˜ ÚfiÁÓˆÛ˘ ¤¯Ô˘Ó ·Ó·ÊÂÚı› Ë ÂÎÛÂÛËÌ·Ṳ̂ÓË ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ ηٿ ÙË ÛÙÈÁÌ‹ Ù˘ ‰È¿ÁÓˆÛ˘ ‹ ÛÙËÓ Â·ÓÂͤٷÛË, ÂÈ̤ÓÔÓÙ· Û˘ÌÙÒÌ·Ù· ηډȷ΋˜ ·Ó¿ÚÎÂÈ·˜, ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi Ì˘ÔηډÈÔ¿ıÂÈ·˜, Ù· ÈÛÙÔÏÔÁÈο Â˘Ú‹Ì·Ù· ÂÓ‰Ôηډȷ΋˜ ÈÓÔÂÏ¿ÛÙˆÛ˘ Î·È Ë ·Ó¿ÁÎË ·ÓÙÈËÎÙÈ΋˜ ıÂڷ›·˜ (38).
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¶·È‰È·ÙÚÈ΋ 2003;66:405-417
Paediatriki 2003;66:405-417
¶›Ó·Î·˜ 4. ¢È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË Ù˘ ‰È·Ù·ÙÈ΋˜ Ì˘ÔηډÈÔ¿ıÂÈ·˜ ÛÙ· ·È‰È¿ ¶ÚÔÛ¤ÁÁÈÛË
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°Ï˘ÎÔÁÔÓ›·ÛË, ÔÚÁ·ÓÈ΋ Ô͢·ÈÌ›· ¢È·Ù·Ú·¯¤˜ Ù˘ ÔÍ›‰ˆÛ˘ ÙˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ, ·Ó¿ÚÎÂÈ· ηÚÓÈÙ›Ó˘ ¢È·Ù·ÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· ÌÂÙ¿ ·fi ·ÚÚ˘ıÌ›· ∞ӈ̷ϛ· Ù˘ ¤ÎÊ˘Û˘ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÛÙÂÊ·ÓÈ·›·˜ ·ÚÙËÚ›·˜ ·fi ÙËÓ Ó¢ÌÔÓÈ΋ ·ÚÙËÚ›·
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∆ÚÔÔÔÈË̤ÓÔ ·fi Eur J Pediatr 2000;159:803-810
ŸÙ·Ó ÙÂı› Ë ‰È¿ÁÓˆÛË Ù˘ ‰È·Ù·ÙÈ΋˜ Ì˘ÔηډÈÔ¿ıÂÈ·˜, Ú¤ÂÈ Ó· ÏËÊı› ¤Ó· ÏÂÙÔÌÂÚ¤˜ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÙˆÓ Û˘ÁÁÂÓÒÓ ÚÒÙÔ˘ Î·È ‰Â‡ÙÂÚÔ˘ ‚·ıÌÔ‡ (ηډȷ΋˜ ·Ó¿ÚÎÂÈ·˜, ‰È·Ù·ÙÈ΋˜ Ì˘ÔηډÈÔ¿ıÂÈ·˜, ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘, ·ÚÚ˘ıÌÈÒÓ Î.Ï.) ÁÈ· Ó· ‰ÈÂÚ¢ÓËı› Ë Èı·ÓfiÙËÙ· ÔÈÎÔÁÂÓÔ‡˜ Ì˘ÔηډÈÔ¿ıÂÈ·˜. ∆Ô ÈÛÙÔÚÈÎfi, ‚¤‚·È·, ‰ÂÓ ¤¯ÂÈ ÙfiÛÔ ÌÂÁ¿ÏË Â˘·ÈÛıËÛ›· fiÛÔ ÙÔ Ë¯ÔηډÈÔÁÚ¿ÊËÌ· fiÛÔÓ ·ÊÔÚ¿ ÛÙË ‰ÈÂÚ‡ÓËÛË ÙˆÓ Û˘ÁÁÂÓÒÓ Î·È Î·ıÒ˜ Ë ÔÈÎÔÁÂÓ‹˜ ‰È·Ù·ÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· ÌÂÙ·‚È‚¿˙ÂÙ·È Û˘¯ÓfiÙÂÚ· Ì ÙÔÓ ·˘ÙÔۈ̷ÙÈÎfi ÂÈÎÚ·ÙÔ‡ÓÙ· ¯·Ú·ÎÙ‹Ú·, ÚÔÙ›ÓÂÙ·È Ë ÎÏÈÓÈ΋ ÂÎÙ›ÌËÛË ÙˆÓ Û˘ÁÁÂÓÒÓ ÚÒÙÔ˘ ‚·ıÌÔ‡ (ÁÔÓ›˜, ·‰¤ÚÊÈ·, ·È‰È¿) Ó· Á›ÓÂÙ·È Ì ηϋ Ï‹„Ë ÈÛÙÔÚÈÎÔ‡, ÎÏÈÓÈ΋ ÂͤٷÛË, ËÏÂÎÙÚÔηډÈÔÁÚ¿ÊËÌ· Î·È Ë¯ÔηډÈÔÁÚ¿ÊËÌ· (8-11). ∂Âȉ‹ ÙfiÛÔ Ë ËÏÈΛ· ¤Ó·Ú͢ fiÛÔ Î·È Ë ÎÏÈÓÈ΋ ÂÌÊ¿ÓÈÛË Ù˘ ÔÈÎÔÁÂÓÔ‡˜ ‰È·Ù·ÙÈ΋˜ Ì˘ÔηډÈÔ¿ıÂÈ·˜ Â›Ó·È ·ÛÙ·ı‹ ·ÎfiÌ· Î·È Ì¤Û· ÛÙËÓ ›‰È· ÔÈÎÔÁ¤ÓÂÈ·, Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÂÚÈÔ‰ÈÎfi˜ ·ӤÏÂÁ¯Ô˜ ÛÙÔ˘˜ Û˘ÁÁÂÓ›˜ οı 3-5 ¯ÚfiÓÈ· (11). ÀÂÚÙÚÔÊÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· ∏ ˘ÂÚÙÚÔÊÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· (Àª∫) Â›Ó·È Ë ‰Â‡ÙÂÚË ÛÂ Û˘¯ÓfiÙËÙ· Ì˘ÔηډÈÔ¿ıÂÈ· ÛÙ· ·È‰È¿ Î·È ·ÔÙÂÏ› ÙÔ 20-30% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ Ì˘ÔηډÈÔ·ıÂÈÒÓ (3). ∏ ›وۋ Ù˘ ÛÙÔÓ ÁÂÓÈÎfi ÏËı˘ÛÌfi Â›Ó·È ÂÚ›Ô˘ 1/5000 ¤ˆ˜ 1/500 Ó·ÚÔ‡˜ ÂÓ‹ÏÈΘ, Ì ÌÂÁ¿ÏË ÂÙÂÚÔÁ¤ÓÂÈ· ÛÙËÓ ÎÏÈÓÈ΋ ÂÌÊ¿ÓÈÛË Î·È ‰ÈÂÈÛ‰˘ÙÈÎfiÙËÙ· (6,40,41). ŒÓ·˜ ÌÂÁ¿ÏÔ˜ ·ÚÈıÌfi˜ ·ı‹ÛÂˆÓ Â˘ı‡ÓÂÙ·È ÁÈ· ÙË ‰Â˘ÙÂÚÔ·ı‹ ˘ÂÚÙÚÔÊ›· ÙÔ˘ Ì˘Ôηډ›Ô˘ ÛÙ· ·È‰È¿, fiˆ˜ Ù· ÌÂÙ·‚ÔÏÈο ÓÔÛ‹Ì·Ù·, ‰È¿ÊÔÚ· Û‡Ó‰ÚÔÌ· Î·È Ó¢ÚÔÌ˘˚Τ˜ ‰È·Ù·Ú·¯¤˜ (5) (¶›Ó·Î·˜ 5), ÂÓÒ ÛÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi Ë ·ÈÙÈÔÏÔÁ›· Â›Ó·È ¿ÁÓˆÛÙË. ∏ ÔÈÎÔÁÂÓ‹˜ ÌÔÚÊ‹ ·ÔÙÂÏ› ÙÔ 50% ÙˆÓ ·ÈÙ›ˆÓ
410
Ù˘ ÓfiÛÔ˘ Î·È ÎÏËÚÔÓÔÌÂ›Ù·È Ì ÙÔÓ ·˘ÙfiÛˆÌÔ ÂÈÎÚ·ÙÔ‡ÓÙ· ¯·Ú·ÎÙ‹Ú· (6). OÈ ·ÛıÂÓ›˜ Ô˘ ‰ÂÓ ¤¯Ô˘Ó οÔÈÔÓ ¿Û¯ÔÓÙ· Û˘ÁÁÂÓ‹, ¤¯Ô˘Ó Èı·Ó¿ ÛÔÚ·‰ÈΤ˜ ÌÂÙ·ÏÏ¿ÍÂȘ Ù˘ ÓfiÛÔ˘ Ô˘ ‰‡ÛÎÔÏ· ·ÓȯÓ‡ÔÓÙ·È Î·È Ù·ÍÈÓÔÌÔ‡ÓÙ·È (6). ∞ÎfiÌ· Î·È Ì¤Û· ÛÙËÓ ›‰È· ÔÈÎÔÁ¤ÓÂÈ·, Ë ÓfiÛÔ˜ ·ÚÔ˘ÛÈ¿˙ÂÈ ÌÂÁ¿ÏË ÔÈÎÈÏ›· ÂΉËÏÒÛˆÓ. ¶ÈÛÙ‡ÂÙ·È fiÙÈ ¤¯ÂÈ ·ÙÂÏ‹ ‰ÈÂÈÛ‰˘ÙÈÎfiÙËÙ· ÛÙËÓ ·È‰È΋ Î·È ÂÊË‚È΋ ËÏÈΛ·, ÂÓÒ ÛÙÔ˘˜ ÂÓ‹ÏÈΘ ¤¯ÂÈ Ï‹ÚË ‰ÈÂÈÛ‰˘ÙÈÎfiÙËÙ· (3). ∏ ÁÂÓÂÙÈ΋ ·Ó¿Ï˘ÛË ¤¯ÂÈ ·ÔΈ‰ÈÎÔÔÈ‹ÛÂÈ 9 ‰È·ÊÔÚÂÙÈΤ˜ ÂÚÈÔ¯¤˜ ¯ÚˆÌ·ÙÔÛˆÌ¿ÙˆÓ ˆ˜ ·ÈÙÈÔÏÔÁÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Ù˘ ÔÈÎÔÁÂÓÔ‡˜ ˘ÂÚÙÚÔÊÈ΋˜ Ì˘ÔηډÈÔ¿ıÂÈ·˜, ÔÈ Ôԛ˜ Έ‰ÈÎÔÔÈÔ‡Ó ÚˆÙ½Ó˜ ÙÔ˘ Û·ÚÎÔÌÂÚȉ›Ô˘ (6,41). ŸÏ˜ ·˘Ù¤˜ ÔÈ ÚˆÙ½Ó˜ ¤¯Ô˘Ó ‰È·ÊÔÚÂÙÈÎÔ‡˜ ÚfiÏÔ˘˜ ÛÙÔÓ Î‡ÎÏÔ Û˘ÛÙÔÏ‹˜-¯¿Ï·Û˘ Î·È Û˘ÓÂÈÛʤÚÔ˘Ó ÛÙËÓ ÔÌÔÈfiÛÙ·ÛË Ù˘ ηډȿ˜ (6). ∏ ‚·ÚÈ¿ ¿Ï˘ÛÔ˜ Ù˘ ·-Ì˘ÔÛ›Ó˘ Î·È Ë ‚·ÚÈ¿ ¿Ï˘ÛÔ˜ Ù˘ ‚-Ì˘ÔÛ›Ó˘ ·ÏÏËÏÂȉÚÔ‡Ó Ì ÙËÓ ·ÎÙ›ÓË ÁÈ· ÙËÓ ·Ú·ÁˆÁ‹ Ì˯·ÓÈ΋˜ ÂÓ¤ÚÁÂÈ·˜, Ë ÙÚÔÔÓ›ÓË ∆, Ë ÙÚÔÔÓ›ÓË π, Ë ·-ÙÚÔÔÌ˘ÔÛ›ÓË Î·È Ë ÂÏ·ÊÚ¿ ¿Ï˘ÛÔ˜ Ù˘ Ì˘ÔÛ›Ó˘ ¤¯Ô˘Ó Ú˘ıÌÈÛÙÈÎfi ÚfiÏÔ, ÂÓÒ Ë ÚˆÙ½ÓË C Ô˘ Û˘Ó‰¤ÂÙ·È Ì ÙË Ì˘ÔÛ›ÓË Î·È Ë ÙÈÙ›ÓË ‚ÔËıÔ‡Ó ÛÙË ÌÂÙ·ÊÔÚ¿ ÂÓ¤ÚÁÂÈ·˜ (∂ÈÎfiÓ· 1) (42-50). ¶ÂÚÈÁÚ¿ÊÔÓÙ·È ÂÚÈÛÛfiÙÂÚ˜ ·fi 150 ÌÂÙ·ÏÏ¿ÍÂȘ ÁÔÓȉ›ˆÓ Ô˘ Έ‰ÈÎÔÔÈÔ‡Ó ÚˆÙ½Ó˜ ÙÔ˘ Û·ÚÎÔÌÂÚȉ›Ô˘ Ô˘ Â›Ó·È ˘Â‡ı˘Ó˜ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ˘ÂÚÙÚÔÊÈ΋˜ Ì˘ÔηډÈÔ¿ıÂÈ·˜ (41). ∆Ô ÂӉȷʤÚÔÓ ¤¯ÂÈ ÛÙÚ·Ê› ÛÙË ‰ÈÂÚ‡ÓËÛË Èı·Ó‹˜ Û˘Û¯¤ÙÈÛ˘ ÌÂٷ͇ ÙÔ˘ ÁÔÓfiÙ˘Ô˘ Î·È ÙÔ˘ Ê·ÈÓfiÙ˘Ô˘ ÙˆÓ ‰È·ÊfiÚˆÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ (41-43). OÈ ÌÂÙ·ÏÏ¿ÍÂȘ ÙÔ˘ ÁÔÓȉ›Ô˘ Ù˘ ‚·ÚÈ¿˜ ·Ï‡ÛÔ˘ Ù˘ ‚-Ì˘ÔÛ›Ó˘ (¯ÚˆÌfiۈ̷ 14q11.212) Â›Ó·È ÔÈ Û˘¯ÓfiÙÂÚ˜ Î·È ·ÓÙÈÛÙÔÈ¯Ô‡Ó ÛÙÔ 35-50% fiÏˆÓ ÙˆÓ ÂÚÈÙÒÛÂˆÓ (41). ∫¿ÔȘ ·fi ·˘Ù¤˜ ÙȘ ÌÂÙ·ÏÏ¿ÍÂȘ Û¯ÂÙ›˙ÔÓÙ·È Ì ‹È· ÎÏÈÓÈ΋ ÔÚ›· ηÈ
¶·È‰È·ÙÚÈ΋ 2003;66:405-417
¶›Ó·Î·˜ 5. ∞ÈÙÈÔÏÔÁ›· ˘ÂÚÙÚÔÊÈ΋˜ Ì˘ÔηډÈÔ¿ıÂÈ·˜ ñ ∞ӈ̷ϛ˜ Û˘ÛÙ·ÏÙÒÓ ÚˆÙÂ˚ÓÒÓ ñ MÂÙ·‚ÔÏÈο
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OÈÎÔÁÂÓ‹˜ ˘ÂÚÙÚÔÊÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· ∞Ó¿ÚÎÂÈ· ηÚÓÈÙ›Ó˘ °Ï˘ÎÔÁÔÓ›·ÛË Ù‡Ô˘ π Î·È ππ ∞Ó¿ÚÎÂÈ· ÛÂÏËÓ›Ô˘ §ÈÔ‰˘ÛÙÚÔʛ˜ ™. Hurler ¡fiÛÔ˜ ÙÔ˘ Fabry ª·ÓÓÔÛ›‰ˆÛË ¡ÂÔÁÓfi ‰È·‚ËÙÈ΋˜ ÌËÙ¤Ú·˜ ™. Noonan ™. Leopard ™. Friedreich’s ™. Beckwith-Wiedermann ªÈÙÔ¯ÔÓ‰Úȷ΋ Ì˘Ô¿ıÂÈ· À¤ÚÙ·ÛË ™. Swyer-James
∆ÚÔÔÔÈË̤ÓÔ ·fi Curr Opin Pediatr 1995;7:587-594
·˘ÍË̤ÓÔ ÚÔÛ‰fiÎÈÌÔ ÂÈ‚›ˆÛ˘, ÂÓÒ ¿ÏϘ ηÎÔ‹ıÂȘ ÌÂÙ·ÏÏ¿ÍÂȘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÂÎÛÂÛËÌ·Ṳ̂ÓË ÎÔÈÏȷ΋ ˘ÂÚÙÚÔÊ›· Î·È Ì›ˆÛË Î·Ù¿ 50% ÙÔ˘ ÚÔÛ‰fiÎÈÌÔ˘ ÂÈ‚›ˆÛ˘ (6,43-46). OÈ ÌÂÙ·ÏÏ¿ÍÂȘ ÙÔ˘ ÁÔÓȉ›Ô˘ Ù˘ ηډȷ΋˜ ÙÚÔÔÓ›Ó˘ ∆ (¯ÚˆÌfiۈ̷ 1q3) ¢ı‡ÓÔÓÙ·È ÁÈ· ÙÔ 15% ÙˆÓ ÂÚÈÙÒÛˆÓ, ÚÔηÏÔ‡Ó ‹È· ˘ÂÚÙÚÔÊ›· Î·È ¤¯Ô˘Ó η΋ ÚfiÁÓˆÛË (47,48). OÈ ÌÂÙ·ÏÏ¿ÍÂȘ ÙÔ˘ ÁÔÓȉ›Ô˘ Ù˘ Û˘Ó‰ÂfiÌÂÓ˘ Ì ÙËÓ Î·Ú‰È·Î‹ Ì˘ÔÛ›ÓË ÚˆÙ½Ó˘ C (¯ÚˆÌfiۈ̷ 11p11.2) ¢ı‡ÓÔÓÙ·È ÁÈ· ÙÔ 20% ÙˆÓ ÂÚÈÙÒÛˆÓ, Û¯ÂÙ›˙ÔÓÙ·È Ì ÈÔ ‹È· ÎÏÈÓÈ΋ ÔÚ›· Î·È Ì ÚÔԉ¢ÙÈ΋ ÂÌÊ¿ÓÈÛË Ù˘ ˘ÂÚÙÚÔÊ›·˜ ΢ڛˆ˜ Û ÌÂÁ¿ÏË ËÏÈΛ· (49-51), ÂÓÒ ÔÈ ÌÂÙ·ÏÏ¿ÍÂȘ Ù˘ ·-ÙÚÔÔÌ˘ÔÛ›Ó˘ (¯ÚˆÌfiۈ̷ 15q22) ¢ı‡ÓÔÓÙ·È ÁÈ· ÏÈÁfiÙÂÚÔ ·fi ÙÔ 3% ÙˆÓ ÂÚÈÙÒÛÂˆÓ (52). ÕÏϘ ÂÚÈÔ¯¤˜ ¯ÚˆÌÔÛˆÌ¿ÙˆÓ Ô˘ ¢ı‡ÓÔÓÙ·È ÁÈ· ÙËÓ Àª∫ ›ӷÈ: ÙÔ 19q13.4 Ô˘ Έ‰ÈÎÔÔÈ› ÙËÓ ÙÚÔÔÌ˘ÔÛ›ÓË π Î·È Ù· 3p21 Î·È 12q23-24.3 ÁÈ· ÙËÓ ÂÏ·ÊÚ¿ ¿Ï˘ÛÔ Ù˘ Ì˘ÔÛ›Ó˘ 1 Î·È 2, ·ÓÙ›ÛÙÔȯ· (6). ¶ÚfiÛÊ·Ù· ·Ó·Î·Ï‡ÊıËΠÌÂÙ¿ÏÏ·ÍË ÙÔ˘ ÁÔÓȉ›Ô˘ Ô˘ Έ‰ÈÎÔÔÈ› ÙË Á2 ˘ÔÔÌ¿‰· Ù˘ ∞ªƒ ÚˆÙÂ˚ÓÈ΋˜ ÎÈÓ¿Û˘, Ë ÔÔ›· Û˘Ó‰˘¿˙ÂÙ·È Ì ÙÔ Û‡Ó‰ÚÔÌÔ Wolf-Parkinson-White (6). ∂›Û˘, ˘¿Ú¯Ô˘Ó ÓÂfiÙÂÚ˜ ÌÂϤÙ˜ Ô˘ ‰Â›¯ÓÔ˘Ó ÙËÓ ‡·ÚÍË ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜ Î·È Ì ÙÔÓ ·˘ÙÔۈ̷ÙÈÎfi ˘ÔÏÂÈfiÌÂÓÔ ¯·Ú·ÎÙ‹Ú· (54). ¶·Ú’ fiÏÔ Ô˘ Ô Ù‡Ô˜ Ù˘ ÌÂÙ¿ÏÏ·Í˘ Ê·›ÓÂÙ·È Ó· ¢ı‡ÓÂÙ·È ÁÈ· Û˘ÁÎÂÎÚÈ̤ÓÔ Ê·ÈÓfiÙ˘Ô Ù˘ ÓfiÛÔ˘, ·Ú·ÙËÚÔ‡ÓÙ·È ‰È·ÊÔÚ¤˜ ÛÙËÓ ÂΉ‹ÏˆÛË Ù˘ ÓfiÛÔ˘ ÌÂٷ͇ ÌÂÏÒÓ Ù˘ ›‰È·˜ ÔÈÎÔÁ¤ÓÂÈ·˜ Ô˘ ʤÚÔ˘Ó ÙËÓ ›‰È· ÌÂÙ¿ÏÏ·ÍË. Œ¯Ô˘Ó ÂÓÔ¯ÔÔÈËı› ÁÈ’ ·˘Ùfi ÂÚÈ‚·ÏÏÔÓÙÈÎÔ› ·Ú¿ÁÔÓÙ˜, fiˆ˜ Ë ¿ÛÎËÛË Î·È Î·Ú‰È·ÁÁÂȷΤ˜ ·ÓˆÌ·Ï›Â˜, fiˆ˜ Ë ˘¤ÚÙ·ÛË (6). ∂›Û˘, ÙÔ ÁÂÓÂÙÈÎfi ˘fiÛÙڈ̷ οı ·ÙfiÌÔ˘ ·Ô‰ÂÈÎÓ‡ÂÙ·È ÛËÌ·ÓÙÈÎfi ηÈ, Û˘ÁÎÂÎÚÈ̤ӷ, Ù· Ú˘ıÌÈÛÙÈο ÁÔÓ›‰È· Ô˘ Έ‰ÈÎÔÔÈÔ‡Ó ÙÔ Û‡ÛÙËÌ· ÚÂÓ›Ó˘-·ÁÁÂÈÔÙÂÓÛ›Ó˘-·Ï‰Ô-
Paediatriki 2003;66:405-417
ÛÙÂÚfiÓ˘. ªÂϤÙ˜ ‰Â›¯ÓÔ˘Ó fiÙÈ ÔÏÏ·ÏÔ› ÔÏ˘ÌÔÚÊÈÛÌÔ› ÙÔ˘ ÌÂÙ·ÙÚÂÙÈÎÔ‡ ÂÓ˙‡ÌÔ˘ ÂËÚ¿˙Ô˘Ó ÙËÓ ˘ÂÚÙÚÔÊ›· ÙÔ˘ Ì˘Ôηډ›Ô˘ ÛÙËÓ ˘ÂÚÙÚÔÊÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· Î·È Û¯ÂÙ›˙ÔÓÙ·È Ì ÂÎÛÂÛËÌ·Ṳ̂ÓË Î·Ú‰È·Î‹ ˘ÂÚÙÚÔÊ›· Î·È Î›Ó‰˘ÓÔ ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ (54). ∞˘Ùfi ÈÛ¯‡ÂÈ Î·È ÁÈ· ÙÔ ¤Ó˙˘ÌÔ Î·Ú‰È·Î‹ ¯˘Ì¿ÛË Ô˘ Ú˘ıÌ›˙ÂÈ ÙËÓ ·ÁÁÂÈÔÙÂÓÛ›ÓË ππ ÛÙÔ Ì˘ÔοډÈÔ, ηıÒ˜ Î·È ÁÈ· ÁÔÓ›‰È· ÙÔ˘ ·ÁÁÂÈÔÙÂÓÛÈÓÔÁfiÓÔ˘ Î·È ÙˆÓ ˘Ô‰Ô¯¤ˆÓ Ù˘ ·ÁÁÂÈÔÙÂÓÛ›Ó˘ ππ (55,56). O ÚfiÏÔ˜ ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ÚÂÓ›Ó˘-·ÁÁÂÈÔÙÂÓÛ›Ó˘-·Ï‰ÔÛÙÂÚfiÓ˘ ÛÙËÓ ÙÚÔÔÔ›ËÛË ÙÔ˘ Ê·ÈÓfiÙ˘Ô˘ Ù˘ ˘ÂÚÙÚÔÊÈ΋˜ Ì˘ÔηډÈÔ¿ıÂÈ·˜ ·Ú·Ì¤ÓÂÈ ·ÌÊÈÏÂÁfiÌÂÓÔ˜ (55). ¶·Ú¿ÁÔÓÙ˜ fiˆ˜ Ë ÂÓ‰ÔıËÏ›ÓË-1 Î·È Ô ·Ú¿ÁÔÓÙ·˜ Ó¤ÎÚˆÛ˘ ÙˆÓ fiÁÎˆÓ ÂȉÚÔ‡Ó, ›Û˘, ÛÙËÓ ˘ÂÚÙÚÔÊ›· ÙÔ˘ Ì˘Ôηډ›Ô˘ (57). ∏ ˘ÂÚÙÚÔÊÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· ÌÔÚ›, ›Û˘, Ó· ·ÔÙÂÏ› ÌÈÙÔ¯ÔÓ‰Úȷ΋ ‰È·Ù·Ú·¯‹ Ô˘ ÎÏËÚÔÓÔÌÂ›Ù·È ·fi ÙË ÌËÙ¤Ú·, ÂÂȉ‹ ÙÔ ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi DNA Ù˘ ÌËÙ¤Ú·˜ ÌÂٷʤÚÂÙ·È Û fiÏ· Ù· ·È‰È¿ (·ÁfiÚÈ· Î·È ÎÔÚ›ÙÛÈ·) (58). ¶·ıÔÏÔÁÔ·Ó·ÙÔÌ›· ∏ ÈÔ ¯·Ú·ÎÙËÚÈÛÙÈ΋ ÌÔÚÊÔÏÔÁÈ΋ ·ÓˆÌ·Ï›· Ù˘ ηډȿ˜ ÙˆÓ ·ÛıÂÓÒÓ Ì ˘ÂÚÙÚÔÊÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· Â›Ó·È Ë ˘ÂÚÙÚÔÊ›· Î·È fi¯È Ë ‰È¿Ù·ÛË Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜, Ù˘Èο ·Û‡ÌÌÂÙÚË. ™ÙËÓ ÏÂÈÔ„ËÊ›· ÙˆÓ ·ÛıÂÓÒÓ (55-60%) ˘¿Ú¯ÂÈ ˘ÂÚÙÚÔÊ›· ÙÔ˘ ÌÂÛÔÎÔÈÏÈ·ÎÔ‡ ‰È·ÊÚ¿ÁÌ·ÙÔ˜ Î·È ÙÔ˘ Ô›ÛıÈÔ˘ ÂχıÂÚÔ˘ ÙÔȯÒÌ·ÙÔ˜ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜. ∞ӈ̷ϛ˜ ÙˆÓ ÂÓ‰ÔÙÔȯˆÌ·ÙÈÎÒÓ ÛÙÂÊ·ÓÈ·›ˆÓ ·ÚÙËÚÈÒÓ Ì ÂÏ¿ÙÙˆÛË ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙÔ˘ ·˘ÏÔ‡ Î·È ¿¯˘ÓÛË ÙÔ˘ ÙÔȯÒÌ·ÙÔ˜, ··ÓÙÒÓÙ·È Û ÂÚÈÛÛfiÙÂÚÔ ·fi ÙÔ 80% ÙˆÓ ·ÛıÂÓÒÓ, Û˘¯ÓfiÙÂÚ· ÛÙÔ ÌÂÛÔÎÔÈÏÈ·Îfi ‰È¿ÊÚ·ÁÌ· (2,3,6). ∏ ˘ÂÚÙÚÔÊ›· Â›Ó·È Û˘¯Ó¿ ·ÚÔ‡Û· ÛÙÔ ÙÔ›¯ˆÌ· ÙˆÓ ÌÈÎÚÒÓ ÂÓ‰ÔÙÔȯˆÌ·ÙÈÎÒÓ ÛÙÂÊ·ÓÈ·›ˆÓ ·ÁÁ›ˆÓ, Ô‰ËÁÒÓÙ·˜ Û ÈÛ¯·ÈÌ›· Î·È Û˘Ì›ÂÛË ÙˆÓ ÎÏ¿‰ˆÓ Ô˘ ·ÈÌ·ÙÒÓÔ˘Ó ÙÔ ÌÂÛÔÎÔÈÏÈ·Îfi ‰È¿ÊÚ·ÁÌ·. O ‚·ıÌfi˜ Î·È Ë ı¤ÛË Ù˘ ˘ÂÚÙÚÔÊ›·˜ ÌÔÚ› Ó· ÔÈΛÏÏÔ˘Ó (2,3,5). πÛÙÔÏÔÁÈο ·Ú·ÙËÚÂ›Ù·È ·Ô‰ÈÔÚÁ¿ÓˆÛË ÙˆÓ Î·Ú‰È·ÎÒÓ Î˘ÙÙ¿ÚˆÓ, ·ÓÙÈηٿÛÙ·Û‹ ÙÔ˘˜ ·fi ÈÓÒ‰Ë ÈÛÙfi, ˘ÂÚÙÚÔÊ›· ÙˆÓ Ì˘ÔηډȷÎÒÓ Î˘ÙÙ¿ÚˆÓ Ì ÔÈÎÈÏ›· ÛÙÔ Ì¤ÁÂıÔ˜ Î·È ÙÔ Û¯‹Ì· Î·È ·ÓˆÌ·Ï›Â˜ ÛÙ· ÂÓ‰ÔÙÔȯˆÌ·ÙÈο ÛÙÂÊ·ÓÈ·›· ·ÁÁ›· (58). ™Â ÌÈÎÚ¿ ·È‰È¿ Ì ˘ÂÚÙÚÔÊÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· Ô˘ ÔÊ›ÏÂÙ·È Û ÌÂÙ·‚ÔÏÈο ·›ÙÈ· ‹ ÌÈÙÔ¯ÔÓ‰ÚȷΤ˜ ‰È·Ù·Ú·¯¤˜, ·Ú·ÙËÚÂ›Ù·È ‰È‹ıËÛË ÙÔ˘ Ì˘Ôηډ›Ô˘ Ì ÁÏ˘ÎÔÁfiÓÔ. ∏ ·ÚÈ· ‰È·Ù·Ú·¯‹ Ù˘ ηډȷ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ Â›Ó·È Ë ‰È·ÛÙÔÏÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Î·È Ë ÂÏ·Ùو̤ÓË ÂÓ‰ÔÙÈÎfiÙËÙ· ÙˆÓ ÎÔÈÏÈÒÓ. ∂›Û˘, ·Ú·ÙËÚÂ›Ù·È Û˘ÛÙÔÏÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Ì ·‡ÍËÛË ÙÔ˘ ÎÏ¿ÛÌ·ÙÔ˜ ÂÍÒıËÛ˘ (~75%) Î·È ˘ÔÎÈÓËÛ›· ÙÔ˘ ÌÂÛÔÎÔÈÏÈ·ÎÔ‡ ‰È·ÊÚ¿ÁÌ·ÙÔ˜. ™Â ÌÂÚÈÎÔ‡˜ ·ÛıÂÓ›˜ ·Ú·ÙËÚÂ›Ù·È ·fiÊÚ·ÍË ÙÔ˘ ¯ÒÚÔ˘ ÂÍfi‰Ô˘ Ù˘ ·ÚÈÛÙÂÚ‹˜
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ÎÔÈÏ›·˜ Î·È ·Ó¿ÚÎÂÈ· ÌÈÙÚÔÂȉԇ˜ ‚·Ï‚›‰·˜. ™·ÓÈfiÙÂÚ·, οÔÈ· ·È‰È¿ ¤¯Ô˘Ó ÌÂÁ¿Ï˜ Î·È Ì ÌÂȈ̤ÓË ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ· ·ÚÈÛÙÂÚ¤˜ ÎÔÈÏfiÙËÙ˜, ÔÈ Ôԛ˜ ÛÙËÓ ÔÚ›· Ù˘ ÓfiÛÔ˘ ‰È·Ù›ÓÔÓÙ·È ÂÚ·ÈÙ¤Úˆ (2,3). ∫ÏÈÓÈο Â˘Ú‹Ì·Ù· ∆· ÛËÌ›· Î·È Ù· Û˘ÌÙÒÌ·Ù· Ù˘ ˘ÂÚÙÚÔÊÈ΋˜ Ì˘ÔηډÈÔ¿ıÂÈ·˜ Â›Ó·È ÔÈΛϷ Î·È ÂÍ·ÚÙÒÓÙ·È ·fi ÙËÓ ËÏÈΛ·. °ÂÓÈο, Ù· ‚Ú¤ÊË Ì ˘ÂÚÙÚÔÊÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· ·ÚÔ˘ÛÈ¿˙Ô˘Ó Û˘ÌÊÔÚËÙÈ΋ ηډȷ΋ ·Ó¿ÚÎÂÈ· Î·È ÔÏÏ¿ ηٷϋÁÔ˘Ó ÛÙÔ ÚÒÙÔ ¤ÙÔ˜ Ù˘ ˙ˆ‹˜ ÙÔ˘˜. ∆Ô 35% ÙˆÓ ‚ÚÂÊÒÓ Â›Ó·È ·Û˘Ìو̷ÙÈÎfi, ÂÓÒ ÙÔ 25% ÂÚ›Ô˘ ·ÚÔ˘ÛÈ¿˙ÂÈ Î·Ú‰È·Î‹ ·Ó¿ÚÎÂÈ·. ∞ÓÙ›ıÂÙ·, Ù· ·È‰È¿ Â›Ó·È Û˘¯Ó¿ ·Û˘Ìو̷ÙÈο. ∆Ô 40% ÙˆÓ ·È‰ÈÒÓ ·ÚÔ˘ÛÈ¿˙ÂÈ ‹È· Û˘ÌÙÒÌ·Ù·, ·ÏÏ¿ ÌfiÓÔ ÙÔ 6% ¤¯ÂÈ ÛËÌ·ÓÙÈÎfi ÂÚÈÔÚÈÛÌfi Ù˘ Ê˘ÛÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ηٿ ÙË ‰È¿ÁÓˆÛË. ™Â ¤Ó·Ó ¿ÁÓˆÛÙÔ ·ÚÈıÌfi ·È‰ÈÒÓ, Ë ÚÒÙË ÂΉ‹ÏˆÛË Ù˘ ÓfiÛÔ˘ Â›Ó·È Ô ·ÈÊÓ›‰ÈÔ˜ ı¿Ó·ÙÔ˜ (3,5). ∆· Û˘ÌÙÒÌ·Ù· Ô˘ ÌÔÚ› Ó· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó Ù· ·È‰È¿ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ‰‡ÛÓÔÈ·, ‡ÎÔÏË ÎfiˆÛË È‰›ˆ˜ ÛÙËÓ ¿ÛÎËÛË, ıˆÚ·ÎÈÎfi ¿ÏÁÔ˜, ÚÔÛ˘ÁÎÔ‹, Û˘ÁÎÔ‹ Î·È ·›ÛıËÌ· ·ÏÌÒÓ. ∫·Ú‰È·Î‹ ·Ó¿ÚÎÂÈ· Û˘Ì‚·›ÓÂÈ Û ÏÈÁfiÙÂÚÔ ·fi 4% ÙˆÓ ·È‰ÈÒÓ ËÏÈΛ·˜ ÌÂÁ·Ï‡ÙÂÚ˘ ÙÔ˘ 1 ¤ÙÔ˘˜ (3). ∫·Ù¿ ÙË Ê˘ÛÈ΋ ÂͤٷÛË, fiÙ·Ó ˘¿Ú¯ÂÈ ·fiÊÚ·ÍË ÙÔ˘ ¯ÒÚÔ˘ ÂÍfi‰Ô˘ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜, ‰È·ÈÛÙÒÓÂÙ·È ¤ÓÙÔÓÔ ÔÏÔÛ˘ÛÙÔÏÈÎfi ʇÛËÌ· ÂÍÒıËÛ˘, ÙÔ ÔÔ›Ô Á›ÓÂÙ·È ÂÓÙÔÓfiÙÂÚÔ ÛÙËÓ ¿ÛÎËÛË, Ì ÙË ‰ÔÎÈÌ·Û›· Valsava. O ‰Â‡ÙÂÚÔ˜ ÙfiÓÔ˜ Â›Ó·È ‰È¯·Ṳ̂ÓÔ˜ Î·È ÌÔÚ› Ó· ·ÎÔ˘ÛÙ› ÙÚ›ÙÔ˜ Î·È Ù¤Ù·ÚÙÔ˜ ÙfiÓÔ˜. ¢È¿ÁÓˆÛË ªÂ ÙËÓ ·ÎÙÈÓÔÁÚ·Ê›· ‰È·ÈÛÙÒÓÂÙ·È ÌÂÁ·ÏÔηډ›·. ¶·Ú’ fiÏÔ Ô˘ ÙÔ ËÏÂÎÙÚÔηډÈÔÁÚ¿ÊËÌ· Â›Ó·È Û˘Ó‹ıˆ˜ ·ıÔÏÔÁÈÎfi ÙfiÛÔ ÛÙ· ‚Ú¤ÊË fiÛÔ Î·È Û ÂÚÈÛÛfiÙÂÚÔ ·fi 90% ÙˆÓ ·È‰ÈÒÓ, Ù· Â˘Ú‹Ì·Ù· ‰ÂÓ Â›Ó·È ÂȉÈο. ™Ù· ‚Ú¤ÊË ·Ú·ÙËÚÔ‡ÓÙ·È ˘ÂÚÙÚÔÊ›· Ù˘ ·ÚÈÛÙÂÚ‹˜ ‹ Î·È Ù˘ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜ Î·È ÌË ÂȉÈΤ˜ ·ÏÏÔÈÒÛÂȘ ÙÔ˘ ST Î·È ∆. ™Ù· ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿ ·Ó¢ڛÛÎÔÓÙ·È ˘ÂÚÙÚÔÊ›· Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜, ·ÏÏ·Á¤˜ ÛÙ· ST ¿ÚÌ·Ù· Î·È ÛÙÔ Î‡Ì· ∆ Î·È ·ÓÒÌ·Ï· ·̷ٷ Q, ηıÒ˜ Î·È ·Ú¿Ù·ÛË ÙÔ˘ ‰È·ÛÙ‹Ì·ÙÔ˜ QT. ™Ù· ÌÂÁ¿Ï· ·È‰È¿ Î·È ÙÔ˘˜ ÂÓ‹ÏÈΘ ÙÔ ∏∫° ·ÔÙÂÏ› Ì›· ÈηÓÔÔÈËÙÈ΋ ̤ıÔ‰Ô ·Ú·ÎÔÏÔ‡ıËÛ˘. ÕÏÏ· Â˘Ú‹Ì·Ù· Ô˘ ÌÔÚ› Ó· ˘¿Ú¯Ô˘Ó Â›Ó·È ·ÚÚ˘ı̛˜, fiˆ˜ ÊÏ‚ÔÎÔÌ‚È΋ ‚Ú·‰˘Î·Ú‰›·, ˘ÂÚÎÔÈÏȷ΋ Ù·¯˘Î·Ú‰›·, ÚÒÈ̘ ¤ÎÙ·ÎÙ˜ ÎÔÈÏȷΤ˜ Û˘ÛÙÔϤ˜ Î·È ÎÔÏÔÎÔÈÏÈ·Îfi˜ ·ÔÎÏÂÈÛÌfi˜ (59). ªÂ ÙÔ Ë¯ÔηډÈÔÁÚ¿ÊËÌ· Ù›ıÂÙ·È Î·È Ë ‰È¿ÁÓˆÛË Ù˘ ˘ÂÚÙÚÔÊÈ΋˜ Ì˘ÔηډÈÔ¿ıÂÈ·˜. ¢È·ÈÛÙÒÓÂÙ·È Ë ‡·ÚÍË Î·È Ë ¤ÎÙ·ÛË Ù˘ ˘ÂÚÙÚÔÊ›·˜ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ Î·È Ë Èı·Ó‹ ·fiÊÚ·ÍË ÙÔ˘ ¯ÒÚÔ˘ ÂÍfi‰Ô˘ ‹ Ë ·Ó¿ÚÎÂÈ· Ù˘ ÌÈÙÚÔÂȉԇ˜ ‚·Ï‚›-
412
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‰·˜. ∂›Û˘, ÂÎÙÈÌ¿Ù·È Ë Û˘ÛÙÔÏÈ΋ Î·È Ë ‰È·ÛÙÔÏÈ΋ ÏÂÈÙÔ˘ÚÁ›· Ù˘ ηډȿ˜ (3,5). O ηډȷÎfi˜ ηıÂÙËÚÈ·ÛÌfi˜ Â›Ó·È ¯Ú‹ÛÈÌÔ˜ ÛÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË Ì ÙË Ï‹„Ë ‚ÈÔ„ÈÒÓ ·fi ÙÔ Ì˘ÔοډÈÔ (60). ∏ 24ˆÚË Î·Ù·ÁÚ·Ê‹ ÙÔ˘ ËÏÂÎÙÚÔηډÈÔÁÚ·Ê‹Ì·ÙÔ˜ Â›Ó·È ··Ú·›ÙËÙË ÁÈ· ÙËÓ ·Ó›¯Ó¢ÛË Ù˘¯fiÓ ·ÚÚ˘ıÌÈÒÓ (34). OÈ ·ÛıÂÓ›˜ Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Û˘ÌÙÒÌ·Ù· ÈÛ¯·ÈÌ›·˜, ı· Ú¤ÂÈ Ó· ˘Ô‚¿ÏÏÔÓÙ·È Û ‰ÔÎÈÌ·Û›· ÎÔÒÛˆ˜ Î·È Û ·ÁÁÂÈÔÁÚ·Ê›· ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ ·ÁÁ›ˆÓ ÁÈ· ÙÔÓ ·ÔÎÏÂÈÛÌfi Ù˘ Û˘Ì›ÂÛ˘ ÙˆÓ ·ÁÁ›ˆÓ Ô˘ ·ÈÌ·ÙÒÓÔ˘Ó ÙÔ ÌÂÛÔÎÔÈÏÈ·Îfi ‰È¿ÊÚ·ÁÌ· ‹ Ù˘ Û˘Ì›ÂÛ˘ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÛÙÂÊ·ÓÈ·›·˜ ·ÚÙËÚ›·˜ (61-63). ™Ù· ÓÂÔÁÓ¿ Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ˘ÂÚÙÚÔÊÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ·, Ú¤ÂÈ Ó· Á›ÓÂÙ·È Ï‹Ú˘ ¤ÏÂÁ¯Ô˜ ÁÈ· ÌÂÙ·‚ÔÏÈο ÓÔÛ‹Ì·Ù· (36). £Âڷ›· ∏ ıÂڷ¢ÙÈ΋ ÛÙÚ·ÙËÁÈ΋ ÂÍ·ÙÔÌÈ·ÂÙ·È ·Ó¿ÏÔÁ· Ì ٷ Û˘ÌÙÒÌ·Ù· ÙÔ˘ ·ÛıÂÓ‹. ∂Âȉ‹ ÛÙËÓ ˘ÂÚÙÚÔÊÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· Ë ·ÚÈÛÙÂÚ‹ ÎÔÈÏ›· ·ÚÔ˘ÛÈ¿˙ÂÈ Û˘Ó‹ıˆ˜ ˘ÂÚÛ˘ÛÙ·ÏÙÈÎfiÙËÙ·, ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÔÈ ‚-·Ó·ÛÙÔÏ›˜ Î·È ÔÈ ·ÓÙ·ÁˆÓÈÛÙ¤˜ ÙˆÓ ‰È·‡ÏˆÓ ·Û‚ÂÛÙ›Ô˘ (3,6,64). OÈ ‚-·Ó·ÛÙÔÏ›˜ (ÚÔÚ·ÓÔÏfiÏË, ·ÙÂÓÔÏfiÏË) Â›Ó·È Û˘Ó‹ıˆ˜ ·ÔÙÂÏÂÛÌ·ÙÈÎÔ›, ηıÒ˜ ÂÏ·ÙÙÒÓÔ˘Ó ÙËÓ Î·Ú‰È·Î‹ Û˘¯ÓfiÙËÙ·, ÙË Û˘ÛÙ·ÏÙÈÎfiÙËÙ· Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ Î·È ÙÔ ÙÔȯˆÌ·ÙÈÎfi stress. OÈ ·Ó·ÛÙÔÏ›˜ ÙˆÓ ‰È·‡ÏˆÓ ·Û‚ÂÛÙ›Ô˘ (ÓÈʉțÓË, ‚ÂÚ··Ì›ÏË, ‰ÈÏÙÈ·˙¤ÌË), ›Û˘, ‚ÂÏÙÈÒÓÔ˘Ó Ù· Û˘ÌÙÒÌ·Ù·, ÌÂÈÒÓÔÓÙ·˜ ÙËÓ Î·Ú‰È·Î‹ Û˘¯ÓfiÙËÙ· Î·È ÙËÓ ·ÚÙËÚȷ΋ ›ÂÛË. Œ¯ÂÈ ¯ÚËÛÈÌÔÔÈËı› Ë ‰ÈÛÔ˘Ú·Ì›‰Ë, Ë ÔÔ›· ¤¯ÂÈ ·ÚÓËÙÈ΋ ÈÓfiÙÚÔË ‰Ú¿ÛË Î·È ‚ÂÏÙÈÒÓÂÈ ÙËÓ ·fiÊÚ·ÍË ÙÔ˘ ¯ÒÚÔ˘ ÂÍfi‰Ô˘ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜, Ì ÌÈÎÚ‹ fï˜ ÂÌÂÈÚ›· ÛÙ· ·È‰È¿ (2,3,6). ªÂϤÙ˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ ÙÔ 1/3 ÙˆÓ ·ÛıÂÓÒÓ ÂˆÊÂÏ‹ıËÎ·Ó ·fi ÙË Ê·Ú̷΢ÙÈ΋ ıÂڷ›· Î·È ‚ÂÏÙÈÒıËÎ·Ó Ù· Û˘ÌÙÒÌ·Ù¿ ÙÔ˘˜. ¢ÂÓ ˘¿Ú¯Ô˘Ó ÌÂϤÙ˜ Ô˘ Ó· ·Ô‰ÂÈÎÓ‡Ô˘Ó fiÙÈ Ë ¯Ú‹ÛË Ê·Ú̷΢ÙÈ΋˜ ıÂڷ›·˜ ÌÔÚ› Ó· ÚÔÏ¿‚ÂÈ ‹ Ó· ηı˘ÛÙÂÚ‹ÛÂÈ ÙËÓ ÂͤÏÈÍË Ù˘ ˘ÂÚÙÚÔÊ›·˜ (3,6,65). ™ÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·ÚÚ˘ı̛˜ ¤¯ÂÈ ¯ÚËÛÈÌÔÔÈËı› Ë ·ÌȈ‰·ÚfiÓË Ì ¢ÓÔ˚ο ·ÔÙÂϤÛÌ·Ù· ÛÙÔ˘˜ ÂÓ‹ÏÈΘ, ·ÏÏ¿ ÛÙ· ·È‰È¿ ‰ÂÓ ¯ÚËÛÈÌÔÔÈÂ›Ù·È Â˘Ú¤ˆ˜ ÏfiÁˆ ÙˆÓ ·ÚÂÓÂÚÁÂÈÒÓ. ™Â ·ÛıÂÓ›˜ Ì ‚Ú·‰˘Î·Ú‰›·, ıÂڷ›· ÂÎÏÔÁ‹˜ Â›Ó·È Ë ÂÌʇÙ¢ÛË ‚ËÌ·ÙÔ‰fiÙË. ¶ÚÔÊ˘Ï·ÎÙÈ΋ ·ÓÙÈ·ÚÚ˘ıÌÈ΋ ıÂڷ›· ı· Ú¤ÂÈ Ó· ¯ÔÚËÁÂ›Ù·È Û ·ÛıÂÓ›˜ Ì ٷ¯˘·ÚÚ˘ı̛˜, ÎÔÈÏȷ΋ Ù·¯˘Î·Ú‰›· Î·È ÈÛÙÔÚÈÎfi ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘. ™Â ÂÚÈÙÒÛÂȘ Ì·˙È΋˜ ˘ÂÚÙÚÔÊ›·˜, ÁÈ· ÙËÓ ÚÔʇϷÍË ·fi ÙÔÓ ·ÈÊÓ›‰ÈÔ ı¿Ó·ÙÔ, ¯ÚËÛÈÌÔÔÈÂ›Ù·È Ë ÂÌʇÙ¢ÛË ·ÈÓȉˆÙ‹ (65). ∏ ÌË ÂȉÈ΋ ıÂڷ›· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ÚÔʇϷÍË ·fi ÙË ‚·ÎÙËÚȉȷ΋ ÂÓ‰Ôηډ›Ùȉ· ηٿ ÙË ‰È¿ÚÎÂÈ· ·ÈÌ·ÙËÚÒÓ ÂÂÌ‚¿ÛÂˆÓ Î·È ÙË ¯Ú‹ÛË ·ÓÙÈËÎÙÈ΋˜ ıÂڷ›·˜ ÌÂÙ¿ ·fi
¶·È‰È·ÙÚÈ΋ 2003;66:405-417
οÔÈÔ ıÚÔÌ‚ÔÂÌ‚ÔÏÈÎfi ÂÂÈÛfi‰ÈÔ. ™Â ·ÛıÂÓ›˜ Ì ÌÂÙ·‚ÔÏÈΤ˜ ·ÓˆÌ·Ï›Â˜, Â›Ó·È Ôχ ÛËÌ·ÓÙÈ΋ Ë ¿ÌÂÛË ·ÔηٿÛÙ·ÛË ÙˆÓ ‚ÈÔ¯ËÌÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ (36). ¶Ú¤ÂÈ Ó· ÙÔÓ›˙ÂÙ·È Ë ·ÔÊ˘Á‹ Ù˘ ¿ÛÎËÛ˘, ÂÎÙfi˜ ·fi ÂÏ·ÊÚ¤˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜. ∞Ó ·ÔÙ‡¯ÂÈ Ë Ê·Ú̷΢ÙÈ΋ ıÂڷ›· ÛÙË ‚ÂÏÙ›ˆÛË ÙˆÓ Û˘Ìو̿وÓ, ¯ÚËÛÈÌÔÔÈÂ›Ù·È ¯ÂÈÚÔ˘ÚÁÈ΋ ·Ú¤Ì‚·ÛË, Ì˘ÔÙÔÌ‹-Ì˘ÂÎÙÔÌ‹ (¤̂·ÛË Morrow) ‹ ¿ÏϘ ¯ÂÈÚÔ˘ÚÁÈΤ˜ Ù¯ÓÈΤ˜, Ì ÛÎÔfi ÙË ‚ÂÏÙ›ˆÛË Ù˘ ·fiÊڷ͢ ÙÔ˘ ¯ÒÚÔ˘ ÂÍfi‰Ô˘ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜. ∆¤ÏÔ˜, Û ·È‰È¿ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘, fiÔ˘ Ë Ê·Ú̷΢ÙÈ΋ ıÂڷ›· ¤¯ÂÈ ·ÔÙ‡¯ÂÈ, ˘¿Ú¯ÂÈ Ë ÂÈÏÔÁ‹ Ù˘ ÌÂÙ·ÌfiÛ¯Â˘Û˘ ηډȿ˜. ¶ÚfiÁÓˆÛË ∏ ˘ÂÚÙÚÔÊÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· Â›Ó·È ÙÔ Û˘¯ÓfiÙÂÚÔ ·›ÙÈÔ ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ Û ӤԢ˜ ÂÓ‹ÏÈΘ Î·È ·ıÏËÙ¤˜, Ì ÔÛÔÛÙfi ÂÙ‹ÛÈ·˜ ıÓËÙfiÙËÙ·˜ 2-4% ÙˆÓ ÓÔÛËÏ¢fiÌÂÓˆÓ ·ÛıÂÓÒÓ (3,63). ∞ÈÊÓ›‰ÈÔ˜ ηډȷÎfi˜ ı¿Ó·ÙÔ˜ Û˘Ì‚·›ÓÂÈ Î˘Ú›ˆ˜ Û ÂÊ‹‚Ô˘˜ Î·È Û Ó·ÚÔ‡˜ ÂÓ‹ÏÈΘ ËÏÈΛ·˜ 15-35 ÂÙÒÓ Ô˘ ‹Ù·Ó ·Û˘Ìو̷ÙÈÎÔ› Î·È Û˘¯Ó¿ ·ÔÙÂÏ› ÙËÓ ÚÒÙË ÂΉ‹ÏˆÛË Ù˘ ÓfiÛÔ˘. ∆· ‚Ú¤ÊË ËÏÈΛ·˜ οو ÙÔ˘ 1 ¤ÙÔ˘˜ ¤¯Ô˘Ó Ôχ η΋ ÚfiÁÓˆÛË. ∞Ó Ë ÚÒÙË ÂΉ‹ÏˆÛË Â›Ó·È Î·Ú‰È·Î‹ ·Ó¿ÚÎÂÈ· ‹ ΢¿ÓˆÛË, ÙfiÙÂ Ô ı¿Ó·ÙÔ˜ Û˘Ì‚·›ÓÂÈ ˆ˜ ÙË Û˘ÌÏ‹ÚˆÛË ÙÔ˘ ÚÒÙÔ˘ ¤ÙÔ˘˜ Ù˘ ˙ˆ‹˜. ∞Ó Ù· ÚÒÙ· Û˘ÌÙÒÌ·Ù· Â›Ó·È ÈÔ ·Ì‚Ï˯ڿ, ÙfiÙ ÙÔ ÔÛÔÛÙfi ÂÈ‚›ˆÛ˘ ¤ˆ˜ ÙÔ ÚÒÙÔ ¤ÙÔ˜ ÊÙ¿ÓÂÈ ÙÔ 50% (3,61). ∏ ˘ÂÚÙÚÔÊÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· Â›Ó·È Ì›· ÂÍÂÏÈÛÛfiÌÂÓË ÓfiÛÔ˜, ΢ڛˆ˜ ηٿ ÙËÓ Ù·¯Â›· ۈ̷ÙÈ΋ ·‡ÍËÛË. ∏ ıÓËÙfiÙËÙ· ÛÙËÓ ·È‰È΋ ËÏÈΛ· Â›Ó·È ‰ÈÏ¿ÛÈ· ·’ fi,ÙÈ ÛÙÔ˘˜ ÂÓ‹ÏÈΘ Î·È Ô Î›Ó‰˘ÓÔ˜ ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ Â›Ó·È ·ÓÂÍ¿ÚÙËÙÔ˜ ·fi ÙËÓ ‡·ÚÍË ‹ fi¯È Û˘ÌÙˆÌ¿ÙˆÓ (3). ™ÙÔ˘˜ ÂÊ‹‚Ô˘˜, Ë ÈÔ Û˘¯Ó‹ ·ÈÙ›· ı·Ó¿ÙÔ˘ Â›Ó·È Ô ·ÈÊÓ›‰ÈÔ˜ ı¿Ó·ÙÔ˜ ηٿ ÙËÓ ¿ÛÎËÛË. ¢˘ÛÌÂÓ›˜ ÚÔÁÓˆÛÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ Û fiϘ ÙȘ ËÏÈÎȷΤ˜ ÔÌ¿‰Â˜ Â›Ó·È Ë ·ÚÔ˘Û›· Û˘ÁÎÔÙÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ, Ë ·ÚÔ˘Û›· ηډȷ΋˜ ·Ó¿ÚÎÂÈ·˜ ÛÙÔ ÚÒÙÔ ¤ÙÔ˜ Ù˘ ˙ˆ‹˜, ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi, ÔÈ Î·Ú‰È·Î¤˜ ‰˘ÛÚ˘ı̛˜, Ë ·ÚÔ˘Û›· ÈÛ¯·ÈÌ›·˜ ÙÔ˘ Ì˘Ôηډ›Ô˘ Î·È Ë ‡·ÚÍË “ηÎÔ‹ıÔ˘˜” ÌÂÙ¿ÏÏ·Í˘ (62). ∂Í·ÈÙ›·˜ ÙÔ˘ ÌÂÁ¿ÏÔ˘ ÔÛÔÛÙÔ‡ Ù˘ ÔÈÎÔÁÂÓÔ‡˜ ÌÔÚÊ‹˜, Û˘ÓÈÛÙ¿Ù·È ¤ÏÂÁ¯Ô˜ ÛÙÔ˘˜ Û˘ÁÁÂÓ›˜ ÚÒÙÔ˘ ‚·ıÌÔ‡ ÙˆÓ ·ÙfiÌˆÓ Ô˘ ¿Û¯Ô˘Ó ·fi ˘ÂÚÙÚÔÊÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ·. ¶ÂÚÈÔÚÈÛÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· ø˜ ÂÚÈÔÚÈÛÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· ÔÚ›˙ÂÙ·È Ë ÓfiÛÔ˜ ÙÔ˘ ηډȷÎÔ‡ Ì˘fi˜ Ô˘ Ô‰ËÁ› Û ÂÏ·Ùو̤ÓË ÎÔÈÏȷ΋ Ï‹ÚˆÛË, ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ‹ ÂÏ·Ùو̤ÓÔ ‰È·ÛÙÔÏÈÎfi fiÁÎÔ Ù˘ Ì›·˜ ‹ Î·È ÙˆÓ ‰‡Ô ÎÔÈÏÈÒÓ. ∏ Û˘ÛÙÔÏÈ΋ ÏÂÈÙÔ˘ÚÁ›· ·Ú·Ì¤ÓÂÈ Ê˘ÛÈÔÏÔÁÈ΋ Î·È ÙÔ ¿¯Ô˜ ÙˆÓ ÙÔȯˆÌ¿ÙˆÓ ÌÔÚ› Ó· Â›Ó·È Ê˘ÛÈÔÏÔÁÈÎfi ‹ ·˘ÍË̤ÓÔ, ·Ó¿ÏÔÁ· Ì ÙÔ ˘ÔΛÌÂÓÔ ·›ÙÈÔ. OÊ›-
Paediatriki 2003;66:405-417
ÏÂÙ·È Û ·˘ÍË̤ÓË ‰˘Ûη̄›· ÙÔ˘ Ì˘Ôηډ›Ô˘, Ô˘ ÚÔηÏ› ·‡ÍËÛË Ù˘ ›ÂÛ˘ ÙˆÓ ÎÔÈÏÈÒÓ ¯ˆÚ›˜ ·‡ÍËÛË ÙÔ˘ fiÁÎÔ˘. ∂›Ó·È Û¿ÓÈ· Î·È ·ÓÙÈÛÙÔȯ› ÛÙÔ 5% ÙˆÓ Ì˘ÔηډÈÔ·ıÂÈÒÓ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜. ∏ ÈÔ Û˘¯Ó‹ ·ÈÙ›· ÛÙȘ ·ÓÂÙ˘Á̤Ó˜ ¯ÒÚ˜ Â›Ó·È Ë ·Ì˘ÏÔ›‰ˆÛË (66). ªÔÚ›, fï˜, Ó· ÔÊ›ÏÂÙ·È Î·È Û ‰È¿ÊÔÚ˜ ¿ÏϘ ·ı‹ÛÂȘ (¶›Ó·Î·˜ 6). ∏ ȉÈÔ·ı‹˜ ÌÔÚÊ‹ Â›Ó·È ÔÏϤ˜ ÊÔÚ¤˜ ÎÏËÚÔÓÔÌÈ΋ Î·È Ê·›ÓÂÙ·È Ó· ¤¯ÂÈ Û¯¤ÛË ÌÂ Ì˘Ô¿ıÂÈ· ÙˆÓ ÛÎÂÏÂÙÈÎÒÓ Ì˘ÒÓ. ™ÙËÓ ·È‰È΋ ËÏÈΛ· Â›Ó·È Û˘¯ÓfiÙÂÚË ÛÙ· ÎÔÚ›ÙÛÈ· Î·È Ë ÚfiÁÓˆÛË Â›Ó·È ¯ÂÈÚfiÙÂÚË ·’ fi,ÙÈ ÛÙÔ˘˜ ÂÓ‹ÏÈΘ (̤ÛÔ˜ ¯ÚfiÓÔ˜ ÂÈ‚›ˆÛ˘: 1,4 ¯ÚfiÓÈ· ·fi ÙË ÛÙÈÁÌ‹ Ù˘ ‰È¿ÁÓˆÛ˘) (66,67). ∂ΉËÏÒÓÂÙ·È ÌÂ Û˘ÌÙÒÌ·Ù· ηډȷ΋˜ ·Ó¿ÚÎÂÈ·˜ ‹ Û˘ÌÈÂÛÙÈ΋˜ ÂÚÈηډ›Ùȉ·˜. ∆Ô 1/3 ÙˆÓ ·ÛıÂÓÒÓ ·ÚÔ˘ÛÈ¿˙ÂÈ ıÚÔÌ‚ÔÂÌ‚ÔÏÈο ÂÂÈÛfi‰È· (66). ∞fi ÙË Ê˘ÛÈ΋ ÂͤٷÛË ÌÔÚ› Ó· ‰È·ÈÛÙˆıÔ‡Ó ‰Ú·ÛÙ‹ÚÈÔ ÚÔοډÈÔ, ÙÚ›ÙÔ˜ Î·È Ù¤Ù·ÚÙÔ˜ ÙfiÓÔ˜ Î·È Ê‡ÛËÌ· ‰È·Ê˘Á‹˜. ªÂ ÙÔ ËÏÂÎÙÚÔηډÈÔÁÚ¿ÊËÌ· ‰È·ÈÛÙÒÓÔÓÙ·È ¯·ÌËÏ¿ ‰˘Ó·ÌÈο (΢ڛˆ˜ ÛÙËÓ ·Ì˘ÏÔ›‰ˆÛË), ·ÚÈÛÙÂÚ‹ ÛÙÚÔÊ‹ ÙÔ˘ ¿ÍÔÓ·, ÎÔÏÈÎfi˜ ÙÂÚ˘ÁÈÛÌfi˜ Î·È ‰È·Ù·Ú·¯¤˜ ·ÁˆÁ‹˜. ™ÙËÓ ·ÎÙÈÓÔÁÚ·Ê›·, Ë Î·Ú‰È¿ ¤¯ÂÈ Ê˘ÛÈÔÏÔÁÈÎfi ̤ÁÂıÔ˜, ·ÏÏ¿ Û˘¯Ó¿ ·Ú·ÙËÚÂ›Ù·È Û˘ÌÊfiÚËÛË ÙˆÓ Ó¢ÌÔÓÈÎÒÓ ·ÁÁ›ˆÓ (67). ªÂ ÙÔ Ë¯ÔηډÈÔÁÚ¿ÊËÌ· ·Ó¢ڛÛÎÂÙ·È Ê˘ÛÈÔÏÔÁÈ΋ ÌÔÚÊÔÏÔÁ›· ÙˆÓ ÎÔÈÏÈÒÓ, ¯ˆÚ›˜ ‰È¿Ù·ÛË ‹ ˘ÂÚÙÚÔÊ›·, Ì ÛËÌ·ÓÙÈο ‰È·ÙÂٷ̤ÓÔ˘˜ ÎfiÏÔ˘˜ (·ÔÙ¤ÏÂÛÌ· ÙˆÓ ·˘ÍËÌ¤ÓˆÓ È¤ÛÂˆÓ Ï‹ÚˆÛ˘). ™Â ¿ÏϘ ÂÚÈÙÒÛÂȘ ‰È·ÈÛÙÒÓÂÙ·È ¿¯˘ÓÛË ÙˆÓ ÙÔȯˆÌ¿ÙˆÓ Î·È ÙˆÓ ‚·Ï‚›‰ˆÓ, ÂȉÈο ÛÙËÓ ·Ì˘ÏÔ›‰ˆÛË. O ηډȷÎfi˜ ηıÂÙËÚÈ·ÛÌfi˜ ÂȂ‚·ÈÒÓÂÈ ÙË ‰È¿ÁÓˆÛË Î·È Ë ‚ÈÔ„›· ÙÔ˘ ηډȷÎÔ‡ Ì˘fi˜ ·ÔηχÙÂÈ ÙÔ ˘ÔΛÌÂÓÔ ·›ÙÈÔ (66). £Âڷ›· ∏ ıÂڷ›· Â›Ó·È ˘ÔÛÙËÚÈÎÙÈ΋ Î·È Û˘Ó›ÛÙ·Ù·È ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Ù˘ Ó¢ÌÔÓÈ΋˜ Î·È ÊÏ‚È΋˜ Û˘ÌÊfiÚËÛ˘. ∂Í·ÈÙ›·˜ Ù˘ η΋˜ ÚfiÁÓˆÛ˘ ÛÙ· ·È‰È¿ Î·È Ù˘ ·ÔÙ˘¯›·˜ Ù˘ Û˘ÓÙËÚËÙÈ΋˜ ıÂڷ›·˜, Ë ÌÂÙ·ÌfiÛ¯Â˘ÛË Î·Ú‰È¿˜ ıˆÚÂ›Ù·È ıÂڷ›· ÂÎÏÔÁ‹˜ (68). ™ÙȘ ÂÚÈÙÒÛÂȘ Ô˘ ¤¯ÂÈ ‰È·ÁÓˆÛÙ› Ë ˘ÔΛÌÂÓË ·ÈÙ›·, ÂÊ·ÚÌfi˙ÔÓÙ·È ·Ó¿ÏÔÁ˜ ıÂڷ¢ÙÈΤ˜ ̤ıÔ‰ÔÈ (66). ∞ÚÚ˘ıÌÈÔÁfiÓÔ˜ ‰˘ÛÏ·Û›· Ù˘ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜ ∏ ·ÚÚ˘ıÌÈÔÁfiÓÔ˜ ‰˘ÛÏ·Û›· Ù˘ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜ (∞¢¢∫) Â›Ó·È Ì›· ¿ıËÛË ÙÔ˘ Ì˘Ôηډ›Ô˘ Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ‚·ıÌÈ·›· ·ÓÙÈηٿÛÙ·ÛË ÙˆÓ Ì˘Ô΢ÙÙ¿ÚˆÓ ·fi ÏÈÒ‰Ë Î·È ÈÓÒ‰Ë ÈÛÙfi. ∂›Ó·È Ì›· ÛËÌ·ÓÙÈ΋ ·ÈÙ›· ı·Ó¿ÙÔ˘ Û ¿ÙÔÌ· ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ 30 ÂÙÒÓ Î·È ÂÓÔ¯ÔÔÈÂ›Ù·È ÁÈ· ÙÔ 20% ÙˆÓ ·ÈÊÓ›‰ÈˆÓ ı·Ó¿ÙˆÓ Ó·ÚÒÓ ÂÓ‹ÏÈÎˆÓ ·ÙfïÓ. ∏ ›وÛË ÛÙÔÓ ÁÂÓÈÎfi ÏËı˘ÛÌfi Â›Ó·È ÂÚ›Ô˘ 1:5000 (6). ∏ ÓfiÛÔ˜ Ù˘Èο ÎÏËÚÔÓÔÌÂ›Ù·È Ì ·˘ÙÔۈ̷ÙÈÎfi
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¶›Ó·Î·˜ 6. ∆·ÍÈÓfiÌËÛË ÙˆÓ Ù‡ˆÓ Ù˘ ÂÚÈÔÚÈÛÙÈ΋˜ Ì˘ÔηډÈÔ¿ıÂÈ·˜ ·Ó¿ÏÔÁ· Ì ÙËÓ ·ÈÙÈÔÏÔÁ›·
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∆ÚÔÔÔÈË̤ÓÔ ·fi: N Engl J Med 1997;336:267-276
ÙÔ˘ Â›Ó·È Ë ÂÈÙ¿¯˘ÓÛË Ù˘ ÎÔÈÏȷ΋˜ Ù·¯˘Î·Ú‰›·˜ Î·È Ë ÂÎÙÚÔ‹ Û ÎÔÈÏȷ΋ Ì·ÚÌ·Ú˘Á‹. ∏ ∞¢¢∫ ¢ı‡ÓÂÙ·È ÁÈ· ÙÔ 3-4% ÙˆÓ ·ÈÊÓ›‰ÈˆÓ ı·Ó¿ÙˆÓ Ô˘ Û˘Ì‚·›ÓÔ˘Ó ÛÙËÓ ¿ÛÎËÛË Û Ó·ÚÔ‡˜ ·ıÏËÙ¤˜ (69). ∏ ‰È¿ÁÓˆÛË Ù›ıÂÙ·È Ì ÙË ‚ÈÔ„›· ÙÔ˘ Ì˘Ôηډ›Ô˘, ÛÙËÓ ÔÔ›· ·Ó¢ڛÛÎÔÓÙ·È ÂÚÈÔ¯¤˜ fiÔ˘ ÙÔ Ì˘ÔοډÈÔ Ù˘ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜ ¤¯ÂÈ ·ÓÙÈηٷÛÙ·ı› ·fi ÈÓÒ‰Ë Î·È ÏÈÒ‰Ë ÈÛÙfi. ∂Âȉ‹ Â›Ó·È ‰‡ÛÎÔÏË Ë ‰ÈÂÓ¤ÚÁÂÈ· ‚ÈÔ„›·˜, ¤¯Ô˘Ó ıÂÛÈÛÙ› ‰È¿ÊÔÚ· ‰È·ÁÓˆÛÙÈο ÎÚÈÙ‹ÚÈ· (69) (¶›Ó·Î·˜ 7), ÂÓÒ ÁÈ· Ó· ÙÂı› Ë ‰È¿ÁÓˆÛË, Ô ·ÛıÂÓ‹˜ Ú¤ÂÈ Ó· ¤¯ÂÈ ‰‡Ô Ì›˙ÔÓ· ÎÚÈÙ‹ÚÈ· ‹ ¤Ó· Ì›˙ÔÓ Î·È ‰‡Ô ÂÏ¿ÛÛÔÓ· ‹ Ù¤ÛÛÂÚ· ÂÏ¿ÛÛÔÓ· ÎÚÈÙ‹ÚÈ·. £Âڷ›· ™Â ·Û˘Ìو̷ÙÈÎÔ‡˜ ·ÛıÂÓ›˜, ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÔÈ ‚-·Ó·ÛÙÔÏ›˜ ÁÈ· Ó· ÂÏ·ÙÙˆı› Ë Èı·ÓfiÙËÙ· ‰ËÌÈÔ˘ÚÁ›·˜ ·ÚÚ˘ıÌ›·˜ ÌÂÙ¿ ·fi ‰È¤ÁÂÚÛË ÙÔ˘ Û˘Ì·ıËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ™ÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ Â›Ó·È ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ·ÈÊÓ›‰ÈÔ ı¿Ó·ÙÔ, ı· Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÂÌʇÙ¢ÛË ·ÈÓȉˆÙ‹ (69). ∂Í·ÈÙ›·˜ Ù˘ ˘„ËÏ‹˜ ıÓËÙfiÙËÙ·˜ ΢ڛˆ˜ Û Ó·ڿ ¿ÙÔÌ·, ı· Ú¤ÂÈ Ó· Û˘ÓÈÛÙ¿Ù·È Ë ·ÔÊ˘Á‹ ÙˆÓ ·ÓÙ·ÁˆÓÈÛÙÈÎÒÓ ·ıÏËÌ¿ÙˆÓ.
ÂÈÎÚ·ÙÔ‡ÓÙ· ¯·Ú·ÎÙ‹Ú·, Ì ÔÈΛÏË ‰ÈÂÈÛ‰˘ÙÈÎfiÙËÙ· Î·È ·ÙÂÏ‹ ¤ÎÊÚ·ÛË. ∆· ÁÔÓ›‰È· Ô˘ Â›Ó·È ˘Â‡ı˘Ó· ÁÈ· ÙËÓ ∞¢¢∫ ‰ÂÓ ¤¯Ô˘Ó ·ÎfiÌË ·Ó·ÁÓˆÚÈÛÙ›, ·ÏÏ¿ ¤¯Ô˘Ó ¯·ÚÙÔÁÚ·ÊËı› 7 ÂÚÈÔ¯¤˜ ÛÙ· ¯ÚˆÌÔÛÒÌ·Ù· 14(14q23-q24 Î·È 14q12-q22), 1(1q42-43), 2(2q32.1-q32.2), 3(3p23) Î·È 10(10p12-p14). ¶ÚfiÛÊ·Ù·, ·Ó·ÁÓˆÚ›ÛÙËÎ·Ó ÌÂÙ·ÏÏ¿ÍÂȘ ÙˆÓ ÁÔÓȉ›ˆÓ Ô˘ Έ‰ÈÎÔÔÈÔ‡Ó ÙȘ ÚˆÙ½Ó˜ Ï·ÎÔÛÊ·ÈÚ›ÓË Î·È ‰ÂÛÌÔϷΛÓË, ÔÈ Ôԛ˜ Â›Ó·È ÚˆÙ½Ó˜ ÙˆÓ Î˘ÙÙ·ÚÈÎÒÓ Û˘Ó‰¤ÛÂˆÓ Î·È Â˘ı‡ÓÔÓÙ·È ÁÈ· ÙËÓ ·˘ÙÔۈ̷ÙÈ΋ ˘ÔÏÂÈfiÌÂÓË ∞¢¢∫ (6,69,70). ∆Ô ÁÔÓ›‰ÈÔ ·Ó·ÁÓˆÚ›ÛÙËΠÛÙË ÓfiÛÔ Ù˘ ¡¿ÍÔ˘, fiÔ˘ ÛÙÔ 90% ÙˆÓ ÂÚÈÙÒÛÂˆÓ Û˘Ó˘¿Ú¯Ô˘Ó ÂΉËÏÒÛÂȘ ·fi ÙÔ ‰¤ÚÌ·, ÛÁÔ˘Ú¿ Ì·ÏÏÈ¿ Î·È ˘ÂÚÎÂÚ¿ÙˆÛË ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ ÙˆÓ ·Ï·ÌÒÓ Î·È ÙˆÓ ÂÏÌ¿ÙˆÓ Î·È ¤¯ÂÈ ÂÚÈÁÚ·Ê› Û ·È‰È¿ ËÏÈΛ·˜ ·fi 7 ÂÙÒÓ. ∂ÎÙfi˜ ·fi ÙË ÁÂÓÂÙÈ΋ ·ÈÙÈÔÏÔÁ›· Ù˘ ÓfiÛÔ˘, ¤¯Ô˘Ó ‰È·Ù˘ˆı› Î·È ¿ÏϘ ıˆڛ˜ Û¯ÂÙÈο Ì ÙËÓ ·ÈÙÈÔÏÔÁ›·, fiˆ˜ Ë ‰˘ÛÔÓÙÔÁ¤ÓÂÛË, Ë ÂÎʇÏÈÛË ÙˆÓ Ì˘ÔηډȷÎÒÓ ÈÓÒÓ ÂÍ·ÈÙ›·˜ οÔÈÔ˘ ÌÂÙ·‚ÔÏÈÎÔ‡ ÓÔÛ‹Ì·ÙÔ˜, Ë ÊÏÂÁÌÔÓ‹ (ÌÂÙ¿ ·fi ÈÔÁÂÓ‹ Ì˘Ôηډ›Ùȉ·) Î·È Ë ·fiÙˆÛË ÙˆÓ Ì˘ÔηډȷÎÒÓ Î˘ÙÙ¿ÚˆÓ (69). ∆˘Èο ÂÌÊ·Ó›˙ÂÙ·È Û Ó·ÚÔ‡˜ ÂÓ‹ÏÈΘ ¿Ó‰Ú˜ Î·È Û ÔÛÔÛÙfi 80% Ë ‰È¿ÁÓˆÛË Á›ÓÂÙ·È ÚÈÓ ÙËÓ ËÏÈΛ· ÙˆÓ 40 ÂÙÒÓ (6,69). ∫ÏÈÓÈο ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Û˘ÁÎÔÙÈο ÂÂÈÛfi‰È·, ÎÔÈÏȷ΋ Ù·¯˘Î·Ú‰›· (Ì ÌÔÚÊÔÏÔÁ›· ·ÔÎÏÂÈÛÌÔ‡ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ÛΤÏÔ˘˜) Î·È Î·Ú‰È·Î‹ ·Ó¿ÚÎÂÈ· ΢ڛˆ˜ ÛÙËÓ 4Ë Î·È 5Ë ‰ÂηÂÙ›· Ù˘ ˙ˆ‹˜. O Ì˯·ÓÈÛÌfi˜ ÙÔ˘ ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿-
ªË Û˘Ì·Á¤˜ Ì˘ÔοډÈÔ ∞Ó‹ÎÂÈ ÛÙȘ ·Ù·ÍÈÓfiÌËÙ˜ Ì˘ÔηډÈÔ¿ıÂȘ (1) Î·È ·ÔÙÂÏ› Ì›· Û¿ÓÈ· ‰È·Ù·Ú·¯‹ Ù˘ ·Ú¯ÈÙÂÎÙÔÓÈ΋˜ ÙÔ˘ Ì˘ÔηډȷÎÔ‡ ÙÔȯÒÌ·ÙÔ˜, Ì ÔÏϷϤ˜ ¢ÌÂÁ¤ıÂȘ ‰ÔÎȉÒÛÂȘ Î·È ‚·ıȤ˜ ÂÓÙÔ̤˜, ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÂÓ‰ÔÌ‹ÙÚÈ·˜ ·Ó·ÛÙÔÏ‹˜ Ù˘ Ì˘Ôηډȷ΋˜ ÌÔÚÊÔÁ¤ÓÂÛ˘, Ì ·Ô˘Û›· ÔÔÈ·Û‰‹ÔÙÂ Û˘Ó˘¿Ú¯Ô˘Û·˜ Û˘ÁÁÂÓÔ‡˜ ηډȷ΋˜ ·ÓˆÌ·Ï›·˜. πÛÙÔÏÔÁÈο ·Ú·ÙËÚÔ‡ÓÙ·È ÔÏϷϤ˜ ‰ÔÎȉÒÛÂȘ Î·È ‚·ıȤ˜ ÂÓÙÔ̤˜ ÌÂٷ͇ ÙÔ˘˜. ∆Ô ÂÓ‰Ôı‹ÏÈÔ Ô˘ ηχÙÂÈ ÙȘ ÂÓÙÔ̤˜ ·ÔÙÂÏ› Û˘Ó¤¯ÂÈ· ÙÔ˘ ÂÓ‰ÔıËÏ›Ô˘ ÙˆÓ ‰ÔÎȉÒÛÂˆÓ Î·È ÙÔ˘ ˘fiÏÔÈÔ˘ ÂÓ‰Ôηډ›Ô˘. ∆Ô Ì˘ÔοډÈÔ Î·È ÔÈ ‰ÔÎȉÒÛÂȘ ·Ú‰Â‡ÔÓÙ·È ·fi ÙÔ ÛÙÂÊ·ÓÈ·›Ô ‰›ÎÙ˘Ô, ÂÓÒ ÔÈ ÂÓÙÔ̤˜ ÏËÚÔ‡ÓÙ·È ·fi ÙÔ ·›Ì· Ù˘ ηډȷ΋˜ ÎÔÈÏfiÙËÙ·˜ (71,72). ∏ ÓfiÛÔ˜ ·ÚÔ˘ÛÈ¿˙ÂÈ ÔÈÎÔÁÂÓ‹ ¯·Ú·ÎÙ‹Ú·, Ì ÌÂÁ¿ÏË ÂÙÂÚÔÁ¤ÓÂÈ· ÛÙÔÓ ÙÚfiÔ ÌÂÙ·‚›‚·Û˘. ªÂÙ·ÏÏ¿ÍÂȘ ÛÙÔ ÁÔÓ›‰ÈÔ G4.5 ÛÙË ¯ÚˆÌ·ÙÔÛˆÌÈ΋ ÂÚÈÔ¯‹ Xq28 Ô˘ Έ‰ÈÎÔÔÈ› ÙËÓ ÚˆÙ½ÓË Ù·Ê·˙›ÓË, ¤¯ÂÈ ‚ÚÂı› fiÙÈ Û˘Ó‰˘¿˙ÔÓÙ·È Ì ÙÔ ÌË Û˘Ì·Á¤˜ Ì˘ÔοډÈÔ Î·È Ê·›ÓÂÙ·È fiÙÈ ·˘Ù‹ Ë ‰È·Ù·Ú·¯‹ Â›Ó·È ·ÏÏËÏfiÌÔÚÊË Ì ÙÔ Û‡Ó‰ÚÔÌÔ Barth Ô˘ ÎÏËÚÔÓÔÌÂ›Ù·È Ì ÙÔÓ Ê˘ÏÔÛ‡Ó‰ÂÙÔ ¯·Ú·ÎÙ‹Ú· (71,73). ∫ÏÈÓÈ΋ ÂÈÎfiÓ· ∂ÓÒ ÙÔ ÌË Û˘Ì·Á¤˜ Ì˘ÔοډÈÔ Â›Ó·È Ì›· ÓfiÛÔ˜ Ô˘ ˘¿Ú¯ÂÈ ·fi ÙË Á¤ÓÓËÛË, Ë ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Ô˘ ÚÔηÏ› ÌÔÚ› Ó· Á›ÓÂÈ ·ÚÁfiÙÂÚ· ÂÌÊ·Ó‹˜, ÛÙË ‚ÚÂÊÈ΋, ·È‰È΋ ‹ ÂÓ‹ÏÈÎË ˙ˆ‹. ∏ ÎÏÈÓÈ΋ ÔÚ›·
ª˘Ôηډȷډȷο ·›ÙÈ· π‰ÈÔ·ı‹˜ Ì˘ÔηډÈÔ¿ıÂÈ· OÈÎÔÁÂÓ‹˜ ÀÂÚÙÚÔÊÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· ™ÎÏËÚfi‰ÂÚÌ· 梉ÔÍ¿ÓıˆÌ· ¢È·‚ËÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· ¢ÈËıËÙÈΤ˜ ∞Ì˘ÏÔ›‰ˆÛË ™·ÚÎÔ›‰ˆÛË ¡. Gaucher ¡. Hurler §È҉˘ ‰È‹ıËÛË ¡fiÛÔÈ ÂÓ·Ôı¤Ûˆ˜ ∞ÈÌԯڈ̿وÛË ¡. Fabry °Ï˘ÎÔÁÔÓÈ¿ÛÂȘ ∂Ó‰ÔÌ˘Ôηډȷο ·›ÙÈ· ∂Ó‰ÔÌ˘Ôηډȷ΋ ›ÓˆÛË ÀÂÚˈÛÈÓÔÊÈÏÈÎfi Û‡Ó‰ÚÔÌÔ ªÂÙ·ÛÙ·ÙÈÎÔ› fiÁÎÔÈ ∞ÎÙÈÓÔ‚ÔÏ›· £Âڷ›· Ì ·Óıڷ΢ÎÏ›ÓË º¿Ú̷η (ÛÂÚÔÙÔÓ›ÓË, ÂÚÁÔÙ·Ì›ÓË)
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¶·È‰È·ÙÚÈ΋ 2003;66:405-417
¶›Ó·Î·˜ 7. ¢È·ÁÓˆÛÙÈο ÎÚÈÙ‹ÚÈ· Ù˘ ∞¢¢∫ ªÂ›˙ÔÓ· ÎÚÈÙ‹ÚÈ· 1. OÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ‰È·ÁÓˆṲ̂Ó˘ ∞¢¢∫ 2. ∫ÔÈÏȷο ÌÂÙ·‰ÈÂÁÂÚÙÈο ·̷ٷ (·̷ٷ ∂) ‹ ‰È‡ڢÓÛË ÙÔ˘ QRS (>110 ms) ÛÙȘ ··ÁˆÁ¤˜ V1-3 3. ™Ô‚·Ú‹ ÙÌËÌ·ÙÈ΋ ‰È¿Ù·ÛË Ù˘ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜ 4. ∆ÔÈο ·Ó¢ڇÛÌ·Ù· Ù˘ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜ 5. πÓÔÏÈ҉˘ ·ÓÙÈηٿÛÙ·ÛË ÙÔ˘ Ì˘Ôηډ›Ô˘ ÛÙË ‚ÈÔ„›· ∂Ï¿ÛÛÔÓ· ÎÚÈÙ‹ÚÈ· 1. OÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ (<35 ÂÙÒÓ) ·fi Èı·Ó‹ ∞¢¢∫ 2. OÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÎÏÈÓÈο ‰È·ÁÓˆṲ̂Ó˘ ∞¢¢∫ 3. ∞ÓÂÛÙÚ·Ì̤ӷ ¿ÚÌ·Ù· ∆ ÛÙȘ ‰ÂÍȤ˜ ÚÔοډȘ ··ÁˆÁ¤˜ 4. ¶·ÚÔ˘Û›· ÌÂÙ·‰˘Ó·ÌÈÎÒÓ ÛÙÔ ∏∫° Û˘Ì„ËÊÈÛÌÔ‡ 5. ∞ÔÎÏÂÈÛÌfi˜ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ÛΤÏÔ˘˜ Î·È ÎÔÈÏȷ΋ Ù·¯˘Î·Ú‰›· 6. ◊È· ÙÌËÌ·ÙÈ΋ ‰È¿Ù·ÛË Ù˘ ¢∫ 7. ∆ÔÈΤ˜ ÂÚÈÔ¯¤˜ ˘ÔÎÈÓËÛ›·˜ Ù˘ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜ ∆ÚÔÔÔÈË̤ÓÔ ·fi J Am Coll Cardiol 2001;38:1777
Ù˘ ÓfiÛÔ˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÚÔԉ¢ÙÈο ÂȉÂÈÓÔ‡ÌÂÓË Û˘ÛÙÔÏÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Î·È ·˘ÍË̤ÓË ÓÔÛËÚfiÙËÙ· Î·È ıÓËÙfiÙËÙ·, ΢ڛˆ˜ ÛÙÔ˘˜ Û˘Ìو̷ÙÈÎÔ‡˜ ·ÛıÂÓ›˜. ∆· Û˘¯ÓfiÙÂÚ· Û˘ÌÙÒÌ·Ù· Â›Ó·È Ë Î·Ú‰È·Î‹ ·Ó¿ÚÎÂÈ· (53%), ÔÈ ÎÔÈÏȷΤ˜ ·ÚÚ˘ı̛˜ (41%), Ù· Û˘ÛÙËÌ·ÙÈο ıÚÔÌ‚ÔÂÌ‚ÔÏÈο ÂÂÈÛfi‰È· (24%) Î·È Ù· Û˘ÁÎÔÙÈο ÂÂÈÛfi‰È· (18%). ™˘¯Ó¿ Û˘Ó‰˘¿˙ÂÙ·È Ì ‰˘ÛÌÔÚʛ˜ ÚÔÛÒÔ˘ ‹ ¿ÏϘ Â͈ηډȷΤ˜ ‰˘ÛÌÔÚʛ˜ (71). ¢È¿ÁÓˆÛË ∏ ‰È¿ÁÓˆÛË Ù›ıÂÙ·È Ì ÙÔ Ë¯ÔηډÈÔÁÚ¿ÊËÌ·, fiÔ˘ ·Ú·ÙËÚÔ‡ÓÙ·È Â·¯˘Ṳ̂ӷ ˘ÔÎÈÓËÙÈο ÙÌ‹Ì·Ù·, Ì ÔÏ˘¿ÚÈı̘ ‰ÔÎȉÒÛÂȘ Î·È ‚·ıȤ˜ ÂÓÙÔ̤˜ ÌÂٷ͇ ·˘ÙÒÓ (71). ™˘Ó‹ıË Â˘Ú‹Ì·Ù· ÛÙÔ ∏∫° ·ÔÙÂÏÔ‡Ó Ë ‰ÂÍÈ¿ ·fiÎÏÈÛË ÙÔ˘ ¿ÍÔÓ·, ·ÓˆÌ·Ï›Â˜ ÙÔ˘ ·̷ÙÔ˜ ƒ, ·ÙÂÏ‹˜ ‹ Ï‹Ú˘ ·ÔÎÏÂÈÛÌfi˜ ÙÔ˘ ‰ÂÍÈÔ‡ ÛΤÏÔ˘˜, ·ÔÎÏÂÈÛÌfi˜ ·ÚÈÛÙÂÚÔ‡ ÛΤÏÔ˘˜, ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ST-T ‰È·ÛÙ‹Ì·ÙÔ˜, ÂÈÎfiÓ· ÎÔÈÏȷ΋˜ ˘ÂÚÙÚÔÊ›·˜, ·ã ‚·ıÌÔ‡ ÎÔÏÔÎÔÈÏÈ·Îfi˜ ·ÔÎÏÂÈÛÌfi˜ ηÈ, Û¿ÓÈ·, WPW (71,72). ∏ ·ÎÙÈÓÔÁÚ·Ê›· ÌÔÚ› Ó· Â›Ó·È Ê˘ÛÈÔÏÔÁÈ΋ Û ·Û˘Ìو̷ÙÈÎÔ‡˜ ·ÛıÂÓ›˜, ÂÓÒ Ë ·ÚÔ˘Û›· ÌÂÁ·ÏÔηډ›·˜ ·Ó¢ڛÛÎÂÙ·È ÛÙÔ 85% ÙˆÓ ·ÛıÂÓÒÓ Ì ÌÂȈ̤ÓË Û˘ÛÙÔÏÈ΋ ÏÂÈÙÔ˘ÚÁ›· ‹ ÂÌÊ·Ó‹ Û˘ÌÙÒÌ·Ù·. ªÂ ÙÔÓ Î·Ú‰È·Îfi ηıÂÙËÚÈ·ÛÌfi ÂÎÙÈÌ¿Ù·È Ë ·ÈÌÔ‰˘Ó·ÌÈ΋ ηٿÛÙ·ÛË Ù˘ ηډȿ˜, Ë ÔÔ›· ÂÍ·ÚÙ¿Ù·È ·fi ÙÔ ÛÙ¿‰ÈÔ Ù˘ ÓfiÛÔ˘. ¢ËÏ·‰‹, ÛÙ· ·Ú¯Èο ÛÙ¿‰È· Ù˘ ÓfiÛÔ˘ Î·È Û ·Û˘Ìو̷ÙÈÎÔ‡˜ ·ÛıÂÓ›˜ ‰È·ÈÛÙÒÓÂÙ·È ÂÚÈÔÚÈÛÙÈ΋ Ê˘ÛÈÔÏÔÁ›·, ÂÓÒ ÛÙÔ˘˜ Û˘Ìو̷ÙÈÎÔ‡˜ ·ÛıÂÓ›˜ ·Ú·ÙËÚÔ‡ÓÙ·È ·ÈÌÔ‰˘Ó·ÌÈο ¯·Ú·ÎÙËÚÈÛÙÈο ·ÚfiÌÔÈ· Ì ·˘Ù¿ Ù˘ ‰È·Ù·ÙÈ΋˜ Ì˘ÔηډÈÔ¿ıÂÈ·˜. £Âڷ›· ∏ ıÂڷ›· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘
Paediatriki 2003;66:405-417
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Genetically modified food: potential effects on allergenicity E. Vassilopoulou, N. G. Papadopoulos, F. Saxoni - Papageorgiou
¶ÂÚ›ÏË„Ë: ŒÓ· ·fi Ù· ÌÂÁ·Ï‡ÙÂÚ· ‰ÈÏ‹ÌÌ·Ù· ÙÔ˘ Û‡Á¯ÚÔÓÔ˘ ÔÏÈÙÈÛÌÔ‡ Â›Ó·È ÙÔ ÛËÌÂ›Ô Ì¤¯ÚÈ ÙÔ ÔÔ›Ô Ú¤ÂÈ Ó· ÂȉÈÒÎÂÙ·È Ô ¤ÏÂÁ¯Ô˜ Ù˘ ʇÛ˘. ∆Ô ı¤Ì· ·˘Ùfi, ¤Ú· ·fi ÙÔÓ ÁÂÓÈÎfiÙÂÚÔ Û‚·ÛÌfi ÚÔ˜ ÙË Ê‡ÛË, ÂÚÈÏ·Ì‚¿ÓÂÈ Î·È ÙË Û¯¤ÛË Ì·˜ Ì ÙËÓ ›‰È· ÙËÓ ÙÚÔÊ‹ Ô˘ ηٷӷÏÒÓÔ˘ÌÂ. ∆· ÂÈÙ‡ÁÌ·Ù· ÛÙÔÓ ÙÔ̤· Ù˘ ‚ÈÔÙ¯ÓÔÏÔÁ›·˜ ·Ú¯Èο Î·È Ù˘ ÁÂÓÂÙÈ΋˜ Ì˯·ÓÈ΋˜ ÛÙË Û˘Ó¤¯ÂÈ·, ¤¯Ô˘Ó ʤÚÂÈ ÚÈ˙ÈΤ˜ ·ÏÏ·Á¤˜ ÛÙË ‰È·ÙÚÔÊ‹, ı¤ÙÔÓÙ·˜ Ù· ·ÎfiÏÔ˘ı· ÂÚˆÙ‹Ì·Ù·: Ú¤ÂÈ Ó· ηٷӷÏÒÓÔÓÙ·È ÁÂÓÂÙÈο ÙÚÔÔÔÈË̤ӷ ÙÚfiÊÈÌ·; À¿Ú¯ÂÈ Ë ‰˘Ó·ÙfiÙËÙ· ÂÓË̤ڈÛ˘ ÁÈ’ ·˘Ù¿ Ù· ÙÚfiÊÈÌ·; ¶ÔÈ· Ú¤ÂÈ Ó· Â›Ó·È Ë ÁÂÓÈÎfiÙÂÚË ı¤ÛË ÙÔ˘ È·ÙÚÈÎÔ‡ ÎfiÛÌÔ˘ Î·È Ò˜ ÌÔÚ› Ó· Û˘Ì‚Ô˘Ï‡ÂÈ ÙÔ˘˜ ·ÛıÂÓ›˜ Û¯ÂÙÈο Ì ·˘Ùfi ÙÔ ı¤Ì·; ™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ·Ó·ÛÎfiËÛ˘ Â›Ó·È Ë ÚÔÛ¿ıÂÈ· ÛÊ·ÈÚÈ΋˜ ÚÔÛ¤ÁÁÈÛ˘ ÙÔ˘ ı¤Ì·ÙÔ˜ ÙˆÓ ÁÂÓÂÙÈο ÙÚÔÔÔÈËÌ¤ÓˆÓ ÙÚÔʛ̈Ó, ÂÚÈÁÚ¿ÊÔÓÙ·˜ ηٿ ÙÔ ‰˘Ó·ÙfiÓ ÏËÚ¤ÛÙÂÚ· Ù· ÏÂÔÓÂÎÙ‹Ì·Ù· Î·È ÙȘ ·‰˘Ó·Ì›Â˜ ÙÔ˘˜. ∞ӷʤÚÔÓÙ·˜ ÙȘ ‰˘ÓËÙÈΤ˜ ÂÈÙÒÛÂȘ Ô˘ ÌÔÚ› Ó· ¤¯Ô˘Ó Ù¤ÙÔȘ ÙÚÔʤ˜ ÛÙËÓ ·ÏÏÂÚÁÈÔÁÔÓÈÎfiÙËÙ·, ÚÔÙ›ÓÔÓÙ·È, ›Û˘, Èı·Ó¤˜ ÚÔÛÂÁÁ›ÛÂȘ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ·Ó·ÊÂÚfiÌÂÓˆÓ ·ÓËÛ˘¯ÈÒÓ Ô˘ ‰ËÌÈÔ˘ÚÁÔ‡Ó.
Abstract: One of the greatest dilemmas of our civilization is the extent to which control of nature should be attempted. This subject, apart from the aspect of a general respect for nature, also includes our relationship with the food we consume. Achievements, first in biotechnology and subsequently in genetic engineering, have brought about radical changes in nutrition and are posing pressing questions: Should genetically modified food be consumed? Is there the possibility of obtaining information on what we eat? What should be the general attitude of the medical community and how can patients be informed on this subject? The intent of this review is to approach the issue of genetically modified foods globally, describing their advantages and weaknesses. By analyzing the potential effects of these foods in terms of allergenicity, approaches to dealing with the concerns they create are suggested.
§¤ÍÂȘ ÎÏÂȉȿ: ·ÏÏÂÚÁ›·, ÙÚfiÊÈÌ·, ÁÂÓÂÙÈ΋ ÙÚÔÔÔ›ËÛË.
Key words: allergy, food, genetic modification.
∂ÈÛ·ÁˆÁ‹ ŒÓ· ·fi Ù· ‚·ÛÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ ·ÓıÚÒÔ˘ Â›Ó·È Ë Ù¿ÛË ÙÔ˘ Ó· ÂÂÌ‚·›ÓÂÈ ÛÙÔ ÂÚÈ‚¿ÏÏÔÓ Ì ÛÎÔfi Ó· ÙÔ ·ÏÏ¿ÍÂÈ. ™·Ó ·ÔÙ¤ÏÂÛÌ· Ù˘ ·ÌÊ›‰ÚÔÌ˘ Û¯¤Û˘ Î·È ·ÏÏËÏ›‰Ú·Û˘ ·Ó¿ÌÂÛ· ÛÙÔ ·ÓıÚÒÈÓÔ Â›‰Ô˜ Î·È ÙÔ ÂÚÈ‚¿ÏÏÔÓ, οı ÌÂÙ·‚ÔÏ‹ Ù˘ Ì›·˜ ·Ú·Ì¤ÙÚÔ˘ ÂËÚ¿˙ÂÈ ¿ÌÂÛ· Î·È ÙËÓ ¿ÏÏË. ªÂ ·˘ÙfiÓ ÙÔÓ ÙÚfiÔ, Ë ÂͤÏÈÍË ÙÔ˘ ·ÓıÚÒ-
ÈÓÔ˘ ›‰Ô˘˜ ÂÍ·ÚÙ¿Ù·È ÙfiÛÔ ·fi ÙË Ê˘ÛÈ΋ ÔÚ›· fiÛÔ Î·È ·fi ÙËÓ Ù¯ÓÔÏÔÁÈ΋ ÚfiÔ‰Ô. µÚÈÛÎfiÌ·ÛÙ ÛÙÔ Ì¤ÛÔ Ì›·˜ ÈÛÙÔÚÈ΋˜ ÌÂÙ¿‚·Û˘ ÚÔ˜ ÙË ‚ÈÔÙ¯ÓÔÏÔÁÈ΋ ÂÔ¯‹. ∏ Û‡Á¯ÚÔÓË Ù¯ÓÔÏÔÁÈ΋ ·ӿÛÙ·ÛË ¤¯ÂÈ ÙÚÂȘ ΢ڛˆ˜ ·ÎÚÔÁˆÓÈ·›Ô˘˜ Ï›ıÔ˘˜: ÙËÓ ÏËÚÔÊÔÚÈ΋, ÙË Ó·ÓÔÙ¯ÓÔÏÔÁ›· Î·È ÙË ÁÂÓÂÙÈ΋ Ì˯·ÓÈ΋. ∆· ̤۷ ·˘Ù¿ ÌÔÚÔ‡Ó Ó· ·ÏÏ¿ÍÔ˘Ó ÙÔÓ ÎfiÛÌÔ Û ÙÂÚ¿ÛÙÈÔ ‚·ıÌfi,
∞ÏÏÂÚÁÈÔÏÔÁÈÎfi ∆Ì‹Ì·, µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó·
Department of Allergology, 2nd Paediatric Clinic of the University of Athens “P. & A. Kyriakou” Children’s Hospital, Athens
418
¶·È‰È·ÙÚÈ΋ 2003;66:418-425
Paediatriki 2003;66:418-425
Ì ·ÔÙ¤ÏÂÛÌ· Ó· ·Ó·Ì¤ÓÂÙ·È ÚÈ˙È΋ Î·È Ë ·ÏÏ·Á‹ ÛÙÔ ·ÓıÚÒÈÓÔ Â›‰Ô˜ (1). ∏ ÈηÓfiÙËÙ· ÙÔ˘ ·ÓıÚÒÔ˘ Ó· ÂÂÌ‚·›ÓÂÈ ÛÙËÓ ÔÚ›· ÂͤÏÈ͢ ÙˆÓ ÂȉÒÓ Î·È Ó· ‰ËÌÈÔ˘ÚÁ› ÙË ‰È΋ ÙÔ˘ “¡¤· °¤ÓÂÛË”, ÂÚÈÔÚÈ˙fiÙ·Ó Ì¤¯ÚÈ ÚfiÛÊ·Ù· ·fi Ù· fiÚÈ· Ô˘ ¤ıÂÙÂ Ë ÌÔÓ·‰ÈÎfiÙËÙ· Î·È Ë ‰È·ÊÔÚÂÙÈÎfiÙËÙ· ÙˆÓ ÂȉÒÓ. OÈ Ó¤Â˜, fï˜, Ù¯ÓÔÏÔÁ›Â˜ ÂÈÙÚ¤Ô˘Ó ÛÙÔ˘˜ ÂÈÛÙ‹ÌÔÓ˜ Ó· ¯ÂÈÚÈÛÙÔ‡Ó ÙÔÓ Ê˘ÛÈÎfi ÎfiÛÌÔ ÛÙÔ Â›Â‰Ô Ô˘ ·ÔÙÂÏ› ÙË ‚¿ÛË Ù˘ ÂͤÏÈ͢: ÙÔ ÁÔÓȉȷÎfi (2). ∏ ÁÂÓÂÙÈ΋ Ì˯·ÓÈ΋ Â›Ó·È Ë ‰È·‰Èηۛ· ηٿ ÙËÓ ÔÔ›· Ù· ÁÔÓ›‰È· ·ÔÌÔÓÒÓÔÓÙ·È, ·Ó·ÁÓˆÚ›˙ÔÓÙ·È, ·Ó·Û˘Ó‰˘¿˙ÔÓÙ·È Î·È ÌÂٷʤÚÔÓÙ·È Ù¯ÓÔÏÔÁÈο ·fi ¤Ó·Ó ÔÚÁ·ÓÈÛÌfi Û ¤Ó·Ó ¿ÏÏÔ. ™‹ÌÂÚ·, Ô ÁÂÓÂÙÈÎfi˜ ÎÒ‰Èη˜ ÂÓfi˜ ÌÂÁ¿ÏÔ˘ ·ÚÈıÌÔ‡ ÂȉÒÓ ¤¯ÂÈ ·ÔÎÚ˘ÙÔÁÚ·ÊËı›. ∏ ÁÂÓÂÙÈ΋ Ì˯·ÓÈ΋ οÓÂÈ ‰˘Ó·Ù‹ ÙËÓ ·ÓÙ·ÏÏ·Á‹ ÁÂÓÂÙÈÎÔ‡ ˘ÏÈÎÔ‡ ÌÂٷ͇ ÔÚÁ·ÓÈÛÌÒÓ Ô˘ ‰ÂÓ ı· ÌÔÚÔ‡Û·Ó Ó· ·Ó··Ú·¯ıÔ‡Ó ÌÂٷ͇ ÙÔ˘˜ Ì ¿ÏÏÔ ÙÚfiÔ. ∆· ÙÂÏÂ˘Ù·›· 20 ¯ÚfiÓÈ· ·ÔÌÔÓÒÓÔÓÙ·È ÁÔÓ›‰È· ·fi οÔÈÔÓ ˙ˆÓÙ·Ófi ÔÚÁ·ÓÈÛÌfi Î·È ÂÈÛ¿ÁÔÓÙ·È Û ¿ÏÏÔÓ Ì ٤ÙÔÈÔ ÙÚfiÔ ÒÛÙ ӷ Â›Ó·È ÏÂÈÙÔ˘ÚÁÈο, Û¿˙ÔÓÙ·˜ ¤ÙÛÈ ÙÔÓ ÊÚ·ÁÌfi ·ÓÙ·ÏÏ·Á‹˜ ÁÂÓÂÙÈÎÔ‡ ˘ÏÈÎÔ‡ ÌÂٷ͇ ‰È·ÊÔÚÂÙÈÎÒÓ ÂȉÒÓ (3). ∂Ô̤ӈ˜, ÚÔ·ÙÔ˘Ó ÔÚÁ·ÓÈÛÌÔ› Ô˘, ÂÎÙfi˜ ·fi ÙȘ ‰ÈΤ˜ ÙÔ˘˜ ÚˆÙ½Ó˜, ÂÎÊÚ¿˙Ô˘Ó Î·È ÂΛӘ ÙÔ˘ ÁÔÓȉ›Ô˘ Ô˘ ÂÈÛ‹¯ıË. ªÂ ÙÔÓ ÙÚfiÔ ·˘Ùfi, ÌÔÚԇ̠ӷ ηٷÓÔ‹ÛÔ˘Ì ÙË ‰Ú¿ÛË ‰È·ÊfiÚˆÓ ÁÔÓȉ›ˆÓ Û ÂÚ¢ÓËÙÈÎfi ›‰Ô, ÂÈÛ¿ÁÔÓÙ·˜ ‹ ·Ê·ÈÚÒÓÙ·˜ ·˘Ù¿ Û ÂÈÚ·Ì·Ùfi˙ˆ·. ∆Ô Â‡ÚÔ˜ ÙˆÓ Ê·Ú̷΢ÙÈÎÒÓ ÂÊ·ÚÌÔÁÒÓ Â›Ó·È ÌÂÁ¿ÏÔ, ·ÊÔ‡ ÔÏÏ¿ Ê¿Ú̷η ‹ ÂÌ‚fiÏÈ·, Ù· ·ÔηÏÔ‡ÌÂÓ· ·Ó·Û˘Ó‰˘·Ṳ̂ӷ, ÚÔ¤Ú¯ÔÓÙ·È ·fi ÁÂÓÂÙÈ΋ ÙÚÔÔÔ›ËÛË ‚·ÎÙËÚ›ˆÓ, ÒÛÙ ӷ ·Ú¿ÁÔ˘Ó Ô˘Û›Â˜ ÁÈ· ·ÓıÚÒÈÓË ¯Ú‹ÛË, fiˆ˜ ÈÓÙÂÚÊÂÚfiÓË, ÈÓÛÔ˘Ï›ÓË ‹ ·˘ÍËÙÈ΋ ÔÚÌfiÓË (3). ¶ÈÔ ¿ÌÂÛ˜ ıÂڷ¢ÙÈΤ˜ ÂÊ·ÚÌÔÁ¤˜ ‚Ú›ÛÎÔ-
ÓÙ·È Û ÂͤÏÈÍË, ¤ÙÔÈ̘ Ó· ‰ÒÛÔ˘Ó Ï‡ÛÂȘ Û ÚÔ‚Ï‹Ì·Ù· Ô˘ ÂϤÁ¯ÔÓÙ·È ÁÔÓȉȷο ̤ۈ Ù˘ ÁÂÓÂÙÈ΋˜ ıÂڷ›·˜. ∆Ô 1984 ·Ó·Ê¤ÚıËΠÁÈ· ÚÒÙË ÊÔÚ¿ Ë ¿ÌÂÛË Î·È ÛÙ·ıÂÚ‹ ÌÂÙ·ÊÔÚ¿ ÁÔÓȉ›ˆÓ ÛÂ Ê˘Ù¿ (4,5). ∆ËÓ ÙÂÏÂ˘Ù·›· ‰ÂηÂÙ›· Ë ·Ó¿Ù˘ÍË ‹Ù·Ó Ú·Á‰·›·, fiÙ·Ó ÔÏϤ˜ ÂÙ·ÈÚ›˜, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÙË ÁÂÓÂÙÈ΋ Ì˯·ÓÈ΋, ηٿÊÂÚ·Ó Ó· ÂÈÛ·Á¿ÁÔ˘Ó Í¤Ó· ÁÔÓ›‰È· Û ηÏÏȤÚÁÂȘ ÛËÌ·ÓÙÈÎÒÓ ÙÚÔʛ̈Ó, fiˆ˜ ÙÔ Î·Ï·ÌfiÎÈ Î·È Ë ÛfiÁÈ· (6). ¶ÚfiÛÊ·Ù·, ÁÂÓÂÙÈο ÙÚÔÔÔÈË̤ӷ ÙÚfiÊÈÌ· ¿Ú¯ÈÛ·Ó Ó· ÂÌÊ·Ó›˙ÔÓÙ·È Û ÔÏÏ¿ ›‰Ë ¢Ú›·˜ ηٷӿψÛ˘, ·ÔÙÂÏÒÓÙ·˜ ϤÔÓ Ì›· Ú·ÁÌ·ÙÈÎfiÙËÙ· Ô˘ ··Û¯ÔÏ› fi¯È ÌfiÓÔ ÙÔ˘˜ ÂÈÛÙ‹ÌÔÓ˜, ·ÏÏ¿ Î·È ÙÔ˘˜ ηٷӷψ٤˜. °ÂÓÂÙÈο ÙÚÔÔÔÈË̤ӷ ÙÚfiÊÈÌ· O fiÚÔ˜ “ÁÂÓÂÙÈο ÙÚÔÔÔÈË̤ӷ ÙÚfiÊÈÌ·” (°∆∆) ·Ó·Ê¤ÚÂÙ·È Û ÙÚfiÊÈÌ· Ô˘ ·Ú·Û΢¿ÛÙËÎ·Ó Ì ÙË ¯Ú‹ÛË ÙˆÓ Ì¤ÛˆÓ Ô˘ ·Ú¤¯ÂÈ Ë ÌÔÚȷ΋ ‚ÈÔÏÔÁ›·, ÁÈ· ÙËÓ Î·Ù·Ó¿ÏˆÛ‹ ÙÔ˘˜ ·fi ·ÓıÚÒÔ˘˜ ‹ ˙Ò·. ¶ÚfiÎÂÈÙ·È ÁÈ· ηÏÏȤÚÁÂȘ Ô˘ ÙÚÔÔÔÈ‹ıËÎ·Ó ÛÙÔ ÂÚÁ·ÛÙ‹ÚÈÔ, Ì ÛÎÔfi Ó· ·Ô‰ÔıÔ‡Ó Û ·˘Ù¤˜ οÔȘ ÂÈı˘ÌËÙ¤˜ ȉÈfiÙËÙ˜, fiˆ˜ ·˘ÍË̤ÓË ıÚÂÙÈ΋ ·Í›· ‹ ·ÓıÂÎÙÈÎfiÙËÙ· Û ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜ (¶›Ó·Î·˜ 1). ∏ ‰È·Ù‹ÚËÛË ÙˆÓ ÂÈı˘ÌËÙÒÓ È‰ÈÔÙ‹ÙˆÓ ·Ú·‰ÔÛȷο ÁÈÓfiÙ·Ó ·fi ÁÂÓÈ¿ Û ÁÂÓÈ¿ ̤ۈ Ù˘ ·Ó··Ú·ÁˆÁ‹˜, Ì›· ‰È·‰Èηۛ· Ô˘ ‰ÂÓ ÌÔÚÔ‡ÛÂ, fï˜, Ó· ÂÁÁ˘Ëı› ÙËÓ ·ÎÚ›‚ÂÈ· Ù˘ ÌÂÙ·‚›‚·Û‹˜ ÙÔ˘˜, ÂÓÒ Ù·˘Ùfi¯ÚÔÓ· ‹Ù·Ó ȉȷ›ÙÂÚ· ¯ÚÔÓÔ‚fiÚ·. ªÂ ÙË ÁÂÓÂÙÈ΋ Ì˯·ÓÈ΋ ÌÔÚÔ‡Ó ‰˘ÓËÙÈο Ó· ·Ú·Û΢·ÛÙÔ‡Ó ÚÔ˚fiÓÙ· ÌÂ Û˘ÁÎÂÎÚÈ̤Ó˜ ȉÈfiÙËÙ˜, ÁÚ‹ÁÔÚ· Î·È Ì ÂÍ·ÈÚÂÙÈ΋ ·ÎÚ›‚ÂÈ·. °È· ·Ú¿‰ÂÈÁÌ·, ¤Ó· ÁÔÓ›‰ÈÔ ˘Â‡ı˘ÓÔ ÁÈ· ÙËÓ ·ÓÔ¯‹ ÂÓfi˜ Ê˘ÙÔ‡ ÛÙËÓ ÍËÚ·Û›· ÌÔÚ› Ó· ÂÈÛ·¯ı› ÛÂ Ê˘Ùfi ‰È·ÊÔÚÂÙÈÎÔ‡ ›‰Ô˘˜, ¤ÙÛÈ
¶›Ó·Î·˜ 1. °ÂÓÂÙÈο ÙÚÔÔÔÈË̤ӷ ÙÚfiÊÈÌ· (ÂÓ‰ÂÈÎÙÈÎfi˜ ›Ó·Î·˜) ∆ÚfiÊÈÌÔ
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∞ÓıÂÎÙÈÎfiÙËÙ· ÛÙÔ ˙È˙¿ÓÈÔ Coleopteran Î·È ÛÙ· ·ÌÈÓÔÁÏ˘ÎÔ˙ȉÈο ·ÓÙÈ‚ÈÔÙÈο ∞ÓıÂÎÙÈÎfiÙËÙ· ÛÂ Û˘ÁÎÂÎÚÈ̤ӷ ÏÂȉfiÙÂÚ·
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Bacillus thuringiensis, Escherichia coli transposon, Tn5 Bacillus thuringiensis, Streptomyces viridochromogenes Agrobacterium sp, ¿Ï˘ÛÔ˜ CP4 Bacillus amyloliquefaciens, streptomyces hygroscopicus Streptomyces hygroscopicus
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S-·‰ÂÓÔÛ˘ÏÌÂıÈÔÓ›ÓË ˘‰ÚÔÏ¿ÛË
E. coli bacteriophage T3
∞ÓÔ¯‹ ÛÙÔ ÁÏ˘ÎÔ˙˘ÏȈ̤ÓÔ ¯ÔÚÙ·Ú›‰ÈÔ ™ÙÂÈÚfiÙËÙ· ·Ó‰Úfi˜ ∞ÓÔ¯‹ ÛÙÔ Herbicide glufosinate ∫·ı˘ÛÙ¤ÚËÛË Ù˘ ·ÔÛ‡ÓıÂÛ˘ ÙÔ˘ ÊÚÔ‡ÙÔ˘ ÏfiÁˆ Ì›ˆÛ˘ Ù˘ Û‡ÓıÂÛ˘ ·Èı˘ÏÂÓ›Ô˘
1507
¡∫603 MS6 LLRICE E06, LLRICE E62 ∞ Î·È µ
419
¶·È‰È·ÙÚÈ΋ 2003;66:418-425
ÒÛÙ ӷ ÌÔÚ› ·˘Ùfi Ó· ηÏÏÈÂÚÁËı› ÛÂ Û˘Óı‹Î˜ ÂÚ‹ÌÔ˘ (7). ∆· °∆∆ ÌÔÚÔ‡Ó Ó· Ù·ÍÈÓÔÌËıÔ‡Ó Û ÙÚÂȘ ηÙËÁÔڛ˜, Ì ‚¿ÛË Ù· ›‰Ë ÌÂٷ͇ ÙˆÓ ÔÔ›ˆÓ Á›ÓÂÙ·È Ë ÌÂÙ·‚›‚·ÛË ÁÔÓȉ›ˆÓ: ·) “¢Ú›·” ÌÂÙ·‚›‚·ÛË ÁÔÓȉ›ˆÓ, ·Ó·ÊÂÚfiÌÂÓË ÛÙË ÌÂÙ·ÊÔÚ¿ ÁÔÓȉ›ˆÓ ÌÂٷ͇ ÔÚÁ·ÓÈÛÌÒÓ ‰È·ÊÔÚÂÙÈÎÒÓ ‚·ÛÈÏ›ˆÓ, ‚) “ÂÚÈÔÚÈṲ̂ÓË” ÌÂÙ·‚›‚·ÛË ÁÔÓȉ›ˆÓ, fiÙ·Ó ·ÊÔÚ¿ ÛÙË ÌÂÙ·ÊÔÚ¿ ÁÔÓȉ›ˆÓ ÌÂٷ͇ ÔÚÁ·ÓÈÛÌÒÓ ÙÔ˘ ›‰ÈÔ˘ ‚·ÛÈÏ›Ԣ Î·È Á) “Û˘ÛÙÚÔÊ‹” (tweaking), fiÙ·Ó Á›ÓÂÙ·È ·Ó·ÊÔÚ¿ ÛÙÔ˘˜ ¯ÂÈÚÈÛÌÔ‡˜ Ô˘ Á›ÓÔÓÙ·È Ì ÛÎÔfi ÙËÓ ·‡ÍËÛË Ù˘ ¤ÎÊÚ·Û˘ ÁÔÓȉ›ˆÓ ÙÔ˘ ›‰ÈÔ˘ ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ (8). OʤÏË Î·È ÚÔÛ‰Ô˘ ·fi Ù· ÁÂÓÂÙÈο ÙÚÔÔÔÈË̤ӷ ÙÚfiÊÈÌ· ∏ ÂÍ·ÛÊ¿ÏÈÛË Â·ÚÎÒÓ ÔÛÔÙ‹ÙˆÓ ÙÚÔÊ›ÌˆÓ ÚfiÎÂÈÙ·È Ó· ·ÔÙÂϤÛÂÈ ÛËÌ·ÓÙÈ΋ ÚfiÎÏËÛË Ù· ¯ÚfiÓÈ· Ô˘ ·ÎÔÏÔ˘ıÔ‡Ó, ÂÓÒ Ù· °∆∆ ·Ó·Ì¤ÓÂÙ·È Ó· ¤¯Ô˘Ó ‚·ÛÈÎfi ÚfiÏÔ Ì ÔÈΛÏÔ˘˜ ÙÚfiÔ˘˜. ∞Ú¯Èο ·Ó·Ì¤ÓÂÙ·È Ó· ÚÔÛ‰ÒÛÔ˘Ó ÛËÌ·ÓÙÈο ÔÈÎÔÓÔÌÈο ÔʤÏË, Û·Ó ·ÔÙ¤ÏÂÛÌ· Ù˘ ·Ó¿Ù˘Í˘ Ó¤ˆÓ ÔÈÎÈÏÈÒÓ Ê˘ÙÒÓ Î·È ˙ÒˆÓ (9). ∏ Û‡Á¯ÚÔÓË ÔÈÎÔÓÔÌ›· ··ÈÙ› ‰È·Ú΋ ·Ó·˙‹ÙËÛË Ó¤ˆÓ ·ÁÔÚÒÓ Ô˘ ı· ·Ó·Ù‡ÛÛÔÓÙ·È Ì ¯·ÌËÏfiÙÂÚÔ ÎfiÛÙÔ˜ ·Ú·ÁˆÁ‹˜, ÒÛÙÂ Î·È Ù· Î¤Ú‰Ë Ó· ·˘Í¿ÓÔ˘Ó. ŒÓ·˜ Ôχ ÛËÌ·ÓÙÈÎfi˜ ·ÎfiÌ· ÏfiÁÔ˜, Ì ¿ÌÂÛË Û¯¤ÛË Ì ÙÔÓ ÚÔ·Ó·ÊÂÚfiÌÂÓÔ, Â›Ó·È Ô ˘ÔÛÈÙÈÛÌfi˜ ÙÔ˘ ÏÂÁfiÌÂÓÔ˘ “ÙÚ›ÙÔ˘ ÎfiÛÌÔ˘”, fiÔ˘ ÂηÙÔÌ̇ÚÈ· ¿ÓıÚˆÔÈ ÛÙËÚ›˙Ô˘Ó ÙË ‰È·ÙÚÔÊ‹ ÙÔ˘˜ ÛÙËÓ Î·ÏÏȤÚÁÂÈ· ÂÓfi˜ ÌfiÓÔ Î·ÚÔ‡, ÙÔ˘ Ú˘˙ÈÔ‡, ÙÔ ÔÔ›Ô ‰ÂÓ Â·ÚΛ ÁÈ· Ó· ηχ„ÂÈ ÙȘ ·Ó¿ÁΘ Û ıÚÂÙÈο Û˘ÛÙ·ÙÈο, ÒÛÙ ӷ ·ÔÙڷ› Ë ˘ÔıÚ„›·. ªÂ ÙË ‚Ô‹ıÂÈ· Ù˘ ÁÂÓÂÙÈ΋˜ Ì˯·ÓÈ΋˜ ÙÔ Ú‡˙È ÌÔÚ› Ó· ÂÌÏÔ˘ÙÈÛÙ› Û ‚Èٷ̛Ә Î·È ÌÂÙ·ÏÏÈο ÛÙÔȯ›·, ÒÛÙ ӷ ·ÔÊ¢¯ıÔ‡Ó ‰È·ÙÚÔÊÈΤ˜ ÂÏÏ›„ÂȘ. °È· ÙÔÓ ÛÎÔfi ·˘Ùfi ¤ÁÈÓ ̛· ÚÒÙË ÚÔÛ¿ıÂÈ· Ì ÙÔ “Golden rice”, Ì›· ÔÈÎÈÏ›· Ú˘˙ÈÔ‡ Ô˘ ÙÚÔÔÔÈ‹ıËΠ·fi ∂Ï‚ÂÙÔ‡˜ ÁÂÓÂÙÈÛÙ¤˜ Ì ٤ÙÔÈÔ ÙÚfiÔ ÒÛÙ ӷ ÂÚȤ¯ÂÈ ÂÍ·ÈÚÂÙÈο ÌÂÁ¿Ï˜ ÔÛfiÙËÙ˜ ‚ÈÙ·Ì›Ó˘ ∞ (10). ∏ ·Ó¿ÚÎÂÈ· ‚ÈÙ·Ì›Ó˘ ∞, Ì ٷ ÁÓˆÛÙ¿ ÎÏÈÓÈο ·ÎfiÏÔ˘ı· (11), Ì·ÛÙ›˙ÂÈ ¿Óˆ ·fi 3.000.000 ·È‰È¿, ΢ڛˆ˜ ÛÙȘ ˘Ô·Ó¿Ù˘ÎÙ˜ ¯ÒÚ˜. ∏ ÚÔÛ¿ıÂÈ· ·˘Ù‹, Ô˘ ·¤Ù˘¯Â ÏfiÁˆ Ì›·˜ ÛÂÈÚ¿˜ Ù¯ÓÈÎÒÓ Î·È ÎÔÈÓˆÓÈÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ (12), ¿ÓÔÈÍ ÙÔ ‰ÚfiÌÔ ÁÈ· ÙËÓ ·Ú·ÁˆÁ‹ ÙÚÔÊ›ÌˆÓ Ô˘ ı· ÌÔÚÔ‡Û·Ó Ó· ηχ„Ô˘Ó Û ÌÂÁ¿ÏÔ ‚·ıÌfi ÙȘ ‰È·ÙÚÔÊÈΤ˜ ÂÏÏ›„ÂȘ ÌË-ÚÔÓÔÌÈÔ‡¯ˆÓ ÎÔÈÓˆÓÈÒÓ. ™Â ¤Ó· ¿ÏÏÔ Â›Â‰Ô, Ô˘ ·ÊÔÚ¿ ÛÙËÓ Î·ÏÏȤÚÁÂÈ· ÚÔ˚fiÓÙˆÓ Â˘Ú›·˜ ηٷӿψÛ˘, οÔÈ· °∆∆ ÌÔÚÔ‡Ó Ó· ʤÚÔ˘Ó Û˘ÁÎÂÎÚÈ̤ӷ ¯·Ú·ÎÙËÚÈÛÙÈο, fiˆ˜ Ù·¯‡ÙÂÚË ·‡ÍËÛË Î·È ÌÂÁ·Ï‡ÙÂÚÔ Ì¤ÁÂıÔ˜ ÙÂÏÈÎÔ‡ ÚÔ˚fiÓÙÔ˜, ÛÙÔ Ï·›ÛÈÔ Ù˘ ·Ó·˙‹ÙËÛ˘ ‰È·ÊfiÚˆÓ ÙÚfiˆÓ ·fi ÙÔ˘˜ ηÏÏÈÂÚÁËÙ¤˜, ÒÛÙ ٷ Ê˘Ù¿
420
Paediatriki 2003;66:418-425
ÙÔ˘˜ Ó· Â›Ó·È ÈÔ ·ÓıÂÎÙÈο, ˘ÁÈ‹ Î·È ·Ô‰ÔÙÈο (13). ∂ÈϤÔÓ, ÔÈ Î·Ù·Ó·ÏˆÙ¤˜ ·ÓÙȉÚÔ‡Ó ÛÙËÓ Î·Ù·Ó¿ÏˆÛË ÙÚÔÊ›ÌˆÓ Ô˘ ¤¯Ô˘Ó ‰Â¯ı› ÙËÓ Â›‰Ú·ÛË ¯ËÌÈÎÒÓ ·Ú·ÛÈÙÔÎÙfiÓˆÓ, ÂÍ·ÈÙ›·˜ ÙˆÓ Èı·ÓÒÓ ‚Ï·‚ÂÚÒÓ ÙÔ˘˜ ÂȉڿÛÂˆÓ ÛÙËÓ ˘Á›·, ·ÏÏ¿ Î·È ÛÙÔ ÂÚÈ‚¿ÏÏÔÓ. OÚÈṲ̂ӷ °∆∆, fiˆ˜ ÙÔ Bacillus thuringiensis (B.t.) ηϷÌfiÎÈ, ‚ÔËıÔ‡Ó ÛÙË Ì›ˆÛË Ù˘ ¯Ú‹Û˘ ¯ËÌÈÎÒÓ Î·È ÙÔ˘ ÎfiÛÙÔ˘˜ ·Ú·ÁˆÁ‹˜ ÙˆÓ ÚÔ˚fiÓÙˆÓ Ô˘ ÊÙ¿ÓÔ˘Ó ÛÙ· ηٷÛÙ‹Ì·Ù· ÙÚÔÊ›ÌˆÓ (14). ™ËÌ·ÓÙÈΤ˜ ÚÔÛ¿ıÂȘ ¤¯Ô˘Ó Á›ÓÂÈ ÛÙÔ ¯ÒÚÔ ÙˆÓ °∆∆, ÒÛÙ ӷ ÙÔ˘˜ ·Ô‰ÔıÔ‡Ó Ê·Ú̷΢ÙÈΤ˜ ȉÈfiÙËÙ˜. ∫¿ÔÈ· ÂÌ‚fiÏÈ· Î·È Ê¿Ú̷η ÎÔÛÙ›˙Ô˘Ó ·ÚÎÂÙ¿ ÁÈ· Ó· ·Ú·¯ıÔ‡Ó Î·È ··ÈÙÔ‡Ó ÂȉÈΤ˜ Û˘Óı‹Î˜ ÁÈ· Ó· Û˘ÓÙËÚËıÔ‡Ó ÛˆÛÙ¿, ηٷÛÙ¿ÛÂȘ Ô˘ ‰ÂÓ Â›Ó·È ¿ÓÙ· ÂÊÈÎÙ¤˜. ŒÙÛÈ ¤¯ÂÈ ·Ú·¯ı› ÁÂÓÂÙÈο ÙÚÔÔÔÈË̤ÓÔ Ú‡˙È Ô˘ ÂÚȤ¯ÂÈ Ê¿ÚÌ·ÎÔ ÁÈ· ÙËÓ Î˘ÛÙÈ΋ ›ÓˆÛË. ∏ Ê·Ú̷΢ÙÈ΋-ıÂڷ¢ÙÈ΋ ‰È¿ÛÙ·ÛË ÙˆÓ °∆∆ ‹Ù·Ó Ë ·ÊÔÚÌ‹ ÁÈ· ÙËÓ ÂÈÛ·ÁˆÁ‹ ·ÓıÚÒÈÓˆÓ ÁÔÓȉ›ˆÓ Û ÙÚfiÊÈÌ· (15). ŒÙÛÈ, η٤ÛÙË ‰˘Ó·Ùfi Ó· ·Ú¿ÁÂÙ·È Û˘Ó¯Ҙ ·ÓıÚÒÈÓË ·Ï‚Ô˘Ì›ÓË ·fi Ê˘Ù›˜ ÁÂÓÂÙÈο ÙÚÔÔÔÈË̤ÓÔ˘ ηԢÙÛԇΠ(16). ¢ÈÂÓÂÚÁÔ‡ÓÙ·È, ›Û˘, ·ÚÎÂÙ¤˜ ÌÂϤÙ˜ ÁÈ· ÙËÓ ·Ú·ÁˆÁ‹ ‚ÚÒÛÈÌˆÓ ÂÌ‚ÔÏ›ˆÓ Û ÓÙÔÌ¿Ù˜ Î·È ·Ù¿Ù˜ (7) Î·È ÂÚ¢ÓÒÓÙ·È ÚˆÙÔÔÚȷΤ˜ ̤ıÔ‰ÔÈ ÌÂÙ·ÊÔÚ¿˜ ·ÓÙÈÁfiÓˆÓ ÈÒÓ ‹ Ú˘ıÌÈÛÙÒÓ ÙÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡ ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ °∆∆ (17). Œ¯Ô˘Ó, Ù¤ÏÔ˜, “ۯ‰ȷÛÙ›” Ì·Ó¿Ó˜ Ô˘ ÂÚȤ¯Ô˘Ó ÙÔ ÂÌ‚fiÏÈÔ Ù˘ ¯ÔϤڷ˜ ‹/Î·È Ù˘ Ë·Ù›Ùȉ·˜ µ. ª›· ‰˘ÓËÙÈ΋ ÂÊ·ÚÌÔÁ‹ Ù˘ ÁÂÓÂÙÈ΋˜ Ì˯·ÓÈ΋˜ Ô˘ ·ÊÔÚ¿ ȉȷ›ÙÂÚ· ÛÙËÓ ·ÏÏÂÚÁÈÔÏÔÁ›·, ·ÔÙÂÏ› Ë ‰˘Ó·ÙfiÙËÙ· Ì›ˆÛ˘ ÙˆÓ ÂȉÈÎÒÓ ·ÏÏÂÚÁÈÔÁÔÓÈÎÒÓ ÚˆÙÂ˚ÓÒÓ ÛÙ· ÙÚfiÊÈÌ·. ∞˘Ùfi ÌÔÚ› Ó· ÂÈÙ¢¯ı› Ì ÙËÓ Î·Ù·ÛÙÔÏ‹ Ù˘ ÁÔÓȉȷ΋˜ ¤ÎÊÚ·Û˘ ̤ۈ Ù˘ ·ÓÙÈÓÔËÌ·ÙÈ΋˜ Ù¯ÓÔÏÔÁ›·˜ (antisense-RNA). ™‡Ìʈӷ Ì ·˘Ù‹ ÙË Ì¤ıÔ‰Ô, ÂÈÛ¿ÁÂÙ·È ¤Ó· ÁÔÓ›‰ÈÔ, ÙÔ mRNA ÙÔ˘ ÔÔ›Ô˘ Â›Ó·È Û˘ÌÏËڈ̷ÙÈÎfi Ì ÙÔ mRNA ÙÔ˘ ÁÔÓȉ›Ô˘ ÙÔ˘ ÔÔ›Ô˘ Ë ¤ÎÊÚ·ÛË ÚfiÎÂÈÙ·È Ó· ηٷÛÙ·Ï›. ŒÙÛÈ, ÙÔ mRNA ÙÔ˘ ÂÈÛ·ÁfiÌÂÓÔ˘ ÁÔÓȉ›Ô˘ ˘‚ÚȉÔÔÈÂ›Ù·È Ì ÙÔ mRNA ÙÔ˘ ÂÓ‰ÔÁÂÓÔ‡˜ ÁÔÓȉ›Ô˘ ÏfiÁˆ Û˘ÌÏËڈ̷ÙÈÎfiÙËÙ·˜. ™ÙËÓ π·ˆÓ›·, ÂÈÛÙ‹ÌÔÓ˜ ηٿÊÂÚ·Ó Ó· ·Ú·Û΢¿ÛÔ˘Ó Ú‡˙È Ì 16% ÏÈÁfiÙÂÚË ÚˆÙ½ÓË 16 kD, Ë ÔÔ›· Â›Ó·È ˘Â‡ı˘ÓË ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ·ÏÏÂÚÁ›·˜ ÛÙÔ Ú‡˙È (18). ™Â Ì›· ·Ó¿ÏÔÁË ÔÚ›· ‚Ú›ÛÎÔÓÙ·È, ›Û˘, Ù· ˘Ô·ÏÏÂÚÁÈο ÊÈÛÙ›ÎÈ· Î·È ÙÔ ·Ï‡ÚÈ ¯ˆÚ›˜ ÁÏÔ˘Ù¤ÓË. ∞ÓÙÈÚÚ‹ÛÂȘ Û¯ÂÙÈο Ì ÙË ¯Ú‹ÛË ÁÂÓÂÙÈο ÙÚÔÔÔÈËÌ¤ÓˆÓ ÙÚÔÊ›ÌˆÓ ™ËÌ·ÓÙÈÎfi ÏfiÁÔ ·ÓÙ›‰Ú·Û˘ ¤Ó·ÓÙÈ ÙˆÓ °∆∆ ·ÔÙÂÏ› Ë ÔÚÈ˙fiÓÙÈ· ÌÂÙ·ÊÔÚ¿ ÁÔÓȉ›ˆÓ, Ë ÔÔ›· Û˘Ì‚·›ÓÂÈ ÌÂٷ͇ ÌË Û˘ÁÁÂÓÒÓ ÂȉÒÓ, ÂËÚ¿˙ÔÓÙ·˜ ¤ÙÛÈ ÙÔ ÂÚÈ‚¿ÏÏÔÓ Ì ·Úfi‚ÏÂÙÔ ÙÚfiÔ,
¶·È‰È·ÙÚÈ΋ 2003;66:418-425
·ÊÔ‡ ÚfiÎÂÈÙ·È ÁÈ· ÂȉڿÛÂȘ Ô˘ Û˘Ì‚·›ÓÔ˘Ó Û ˙ˆÓÙ·ÓÔ‡˜ ÔÚÁ·ÓÈÛÌÔ‡˜. ∆· ÁÔÓ›‰È· ·fi Ù· °∆∆ ÌÔÚÔ‡Ó ıˆÚËÙÈο Ó· ÂÚ¿ÛÔ˘Ó ÛÙÔ˘˜ ·ÓıÚÒÔ˘˜ Ô˘ Ù· ηٷӷÏÒÓÔ˘Ó, ÁÂÁÔÓfi˜ ÙÔ ÔÔ›Ô ˘ÔÛÙËÚ›˙ÂÙ·È Î·È ·fi οÔÈ· ÂÈÚ·Ì·ÙÈο ‰Â‰Ô̤ӷ (3). ∆· ÁÂÓÂÙÈο ÙÚÔÔÔÈË̤ӷ ÚÔ˚fiÓÙ· ·Ó··Ú¿ÁÔÓÙ·È, ÌÂÁ·ÏÒÓÔ˘Ó Î·È ÌÂÙ·Ó·ÛÙ‡ԢÓ. OÈ ÂÈÛÙ‹ÌÔÓ˜, ÁÈ· Ó· ·˘Í‹ÛÔ˘Ó ÙËÓ ·ÓıÂÎÙÈÎfiÙËÙ· ÙˆÓ Î·ÏÏÈÂÚÁÂÈÒÓ ÛÙ· ˙È˙¿ÓÈ· Î·È Ù· ·Ú¿ÛÈÙ·, ‰ËÌÈÔ‡ÚÁËÛ·Ó ÙÚÔÔÔÈË̤Ó˜ ηÏÏȤÚÁÂȘ. ªÂÁ¿ÏË ·ÓËÛ˘¯›· ˘¿Ú¯ÂÈ ÁÈ· ÙË ‰ËÌÈÔ˘ÚÁ›· ÌÂÙ·ÏÏ·ÁÌ¤ÓˆÓ ˙È˙·Ó›ˆÓ, ·ÓıÂÎÙÈÎÒÓ ÛÙ· Ê˘ÙÔÊ¿Ú̷η, ÛÙËÓ ÂÚ›ÙˆÛË Ô˘ Ù· ÁÔÓ›‰È· ·ÓÙÔ¯‹˜ “ÂÚ¿ÛÔ˘Ó” Û ·˘Ù¿, fiÔ˘ ı· ··ÈÙÂ›Ù·È ÂÎÙÂÓ¤ÛÙÂÚË ¯Ú‹ÛË ¯ËÌÈÎÒÓ ÁÈ· ÙËÓ ··ÏÏ·Á‹ ·fi Ù· “ÌÂÙ·ÏÏ·Á̤ӷ” ˙È˙¿ÓÈ·. ∏ “ÚÔ‹ ÁÔÓȉ›ˆÓ” ÌÔÚ› Ó· Ú·ÁÌ·ÙÔÔÈËı› ÌÂٷ͇ ¿ÏÏˆÓ Î·È Ì¤Ûˆ Ù˘ Á‡Ú˘ ÙˆÓ ÙÚÔÔÔÈËÌ¤ÓˆÓ Ê˘ÙÒÓ. ™Â fi,ÙÈ ·ÊÔÚ¿ ÙÔ˘˜ ÈÔ‡˜, Ë ·ÓËÛ˘¯›· Â›Ó·È ¤ÓÙÔÓË Û¯ÂÙÈο Ì ÙË ‰ËÌÈÔ˘ÚÁ›· Ó¤ˆÓ ÌË ·Ó·ÁÓˆÚ›ÛÈÌˆÓ ÈÒÓ, Ì ·Ó·Û˘Ó‰˘·Ṳ̂ÓÔ DNA Î·È ¿ÁÓˆÛÙ˜ ȉÈfiÙËÙ˜ (2). ∏ Èı·ÓfiÙËÙ· ÌÂÙ·ÊÔÚ¿˜ ÁÔÓȉ›ˆÓ, ·ÓıÂÎÙÈÎÒÓ Û ·ÓÙÈ‚ÈÔÙÈο, ·fi ÌÂÙ·ÏÏ·Á̤ӷ Ê˘Ù¿ Û ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜ ̤ۈ ÙÔ˘ ÁÂÓÂÙÈÎÔ‡ ·Ó·Û˘Ó‰˘·ÛÌÔ‡ ÛÙÔÓ ·ÓıÚÒÈÓÔ ‹ ˙ˆÈÎfi ÂÙÈÎfi ۈϋӷ, ·ÔÙÂÏ› ËÁ‹ ·ÓÙÈÚÚ‹ÛÂˆÓ ÁÈ· Ù· °∆∆. ¶ÚfiÛÊ·ÙË ÌÂϤÙË ÛÙÔ Lancet ÂͤٷÛÂ Û˘ÁÎÚÈÙÈο ÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi Û‡ÛÙËÌ· ‰‡Ô ηÙËÁÔÚÈÒÓ ÔÓÙÈÎÈÒÓ: ÂÎÂ›ÓˆÓ Ô˘ Î·Ù·Ó¿ÏˆÓ·Ó ÁÂÓÂÙÈο ÙÚÔÔÔÈË̤Ó˜ ·Ù¿Ù˜ Î·È ÂÎÂ›ÓˆÓ Ô˘ Î·Ù·Ó¿ÏˆÓ·Ó ÌË ÁÂÓÂÙÈο ÙÚÔÔÔÈË̤Ó˜ ·Ù¿Ù˜. OÈ ‰È·ÊÔÚ¤˜ Ô˘ ‰È·ÈÛÙÒıËÎ·Ó ‹Ù·Ó ÛËÌ·ÓÙÈΤ˜, ·Ó Î·È Ë ÌÂϤÙË ıˆڋıËΠ·fi ÔÏÏÔ‡˜ ·Ó·ÚÎÒ˜ ÙÂÎÌËÚȈ̤ÓË (7). OÈ Û˘Ó¤ÂȘ ·ÊÔÚÔ‡Û·Ó Î˘Ú›ˆ˜ ÛÙËÓ ·Ó¿Ù˘ÍË ÙˆÓ ÔÚÁ¿ÓˆÓ ÙÔ˘˜ Î·È ÛÙÔÓ ÌÂÙ·‚ÔÏÈÛÌfi ÙÔ˘˜ (19). ÕÏÏË ÌÂϤÙË, Ô˘ Ú·ÁÌ·ÙÔÔÈ‹ıËΠÁÈ· ÏÔÁ·ÚÈ·ÛÌfi Ù˘ ÂÙ·ÈÚ›·˜ “Monsanto” ÛÙÔ πÓÛÙÈÙÔ‡ÙÔ KOCH Ù˘ °ÂÚÌ·Ó›·˜, ·Ó¤ÊÂÚ ÌÂÙ·‚ÔÏ‹ ÛÙË Û‡ÓıÂÛË ÙÔ˘ Á¿Ï·ÎÙÔ˜ ·ÁÂÏ¿‰ˆÓ Ô˘ ÙÚ¤ÊÔÓÙ·Ó Ì ÌÂÙ·ÏÏ·Á̤ÓË ÛfiÁÈ·, Ì ·‡ÍËÛË ÙˆÓ ÏÈ·ÚÒÓ Û ÔÛÔÛÙfi 8% (19). ∏ ÛÔ‚·ÚfiÙÂÚË, fï˜, ·ÓËÛ˘¯›· ÁÈ· ÙËÓ ˘Á›· ·ÊÔÚ¿ ÛÙËÓ Èı·Ó‹ ·ÏÏÂÚÁÈÔÁÔÓÈÎfiÙËÙ· ÙˆÓ °∆∆, ÁÈ· ÙËÓ ÔÔ›· ı· Á›ÓÂÈ ÂÎÙÂÓ‹˜ ÏfiÁÔ˜ ÛÙË Û˘Ó¤¯ÂÈ·. ∆ÚÔÊÈ΋ ·ÏÏÂÚÁ›· ∏ ÙÚÔÊÈ΋ ·ÏÏÂÚÁ›· ÂÚÈÏ·Ì‚¿ÓÂÈ Î¿ı ·ӷϷ̂·ÓfiÌÂÓË ·ÓÔÛÔÏÔÁÈ΋ ·ÓÙ›‰Ú·ÛË Ô˘ Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ Î·Ù·Ó¿ÏˆÛË ÙÚÔÊ›ÌÔ˘ ‹ ÚfiÛıÂÙÔ˘ ÙÚÔÊÒÓ. ∏ ·ÓÙ›‰Ú·ÛË ÌÔÚ› Ó· ÂΉËψı› ÌÂÙ¿ ·fi ÙËÓ Î·Ù·Ó¿ÏˆÛË ÌÈÎÚ‹˜ ÔÛfiÙËÙ·˜ ·fi ÙË Û˘ÁÎÂÎÚÈ̤ÓË Ô˘Û›· Î·È Ú¤ÂÈ Ó· ‰È·¯ˆÚ›˙ÂÙ·È ·fi
Paediatriki 2003;66:418-425
ÌË ·ÓÔÛÔÏÔÁÈΤ˜, ȉÈÔÛ˘ÛÙ·ÛȷΤ˜, ÙÔÍÈΤ˜ ‹ „˘¯ÔÏÔÁÈΤ˜ ·ÓÙȉڿÛÂȘ (20). °ÂÓÈο, ÂÎÙÈÌ¿Ù·È fiÙÈ ÙÔ 1-2% ÙÔ˘ ÁÂÓÈÎÔ‡ ÏËı˘ÛÌÔ‡ ¿Û¯ÂÈ ·fi ÙÚÔÊÈΤ˜ ·ÏÏÂÚÁ›Â˜, ÂÓÒ ÙÔ 25-30% ÙÔ˘ ·È‰ÈÎÔ‡ ÏËı˘ÛÌÔ‡ ·Ó·Ê¤ÚÂÈ Û οÔÈ· ÛÙÈÁÌ‹ Ù˘ ˙ˆ‹˜ ÙÔ˘ ·ÓÂÈı‡ÌËÙË ·ÓÙ›‰Ú·ÛË Û ÙÚÔÊ‹. ∆Ô ÌÂÁ·Ï‡ÙÂÚÔ Ì¤ÚÔ˜ ·fi ·˘Ù¤˜ ÙȘ ·ÓÙȉڿÛÂȘ ÛÙ· ·È‰È¿ ‰ÂÓ Â›Ó·È Â·Ó·Ï·Ì‚·ÓfiÌÂÓÔ. ŒÙÛÈ, fiÙ·Ó ¤ÁÈÓ·Ó ÚÔÎÏ‹ÛÂȘ, ÙÔ ÔÛÔÛÙfi ÂȂ‚·ÈˆÌ¤Ó˘ ÙÚÔÊÈ΋˜ ·ÏÏÂÚÁ›·˜ Û ·˘Ù¿ ‹Ù·Ó ÏÈÁfiÙÂÚÔ ·fi 10%. ¶·Ú·Ì¤ÓÂÈ, fï˜, ÛËÌ·ÓÙÈÎfi Úfi‚ÏËÌ· ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÔÈ ÙÚÔÊÈΤ˜ ·ÏÏÂÚÁ›Â˜, ÂÎÙfi˜ ·fi Û˘ÌÙÒÌ·Ù· ·fi ÙÔ ‰¤ÚÌ·, ÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi Î·È ÏÈÁfiÙÂÚÔ ·fi ÙÔ ·Ó·Ó¢ÛÙÈÎfi, ÌÔÚÔ‡Ó Ó· ÚÔηϤÛÔ˘Ó Û˘ÛÙËÌ·ÙÈ΋ ·Ó·Ê˘Ï·Í›·, ·ÏÏÂÚÁÈ΋ ηٷÏËÍ›· Î·È ı¿Ó·ÙÔ (21). OÈ Î‡ÚȘ ·ÏÏÂÚÁÈÔÁfiÓ˜ ÙÚÔʤ˜ Â›Ó·È ÙÔ ·‚Áfi, ÙÔ Á¿Ï·, Ù· „¿ÚÈ·, Ù· ÔÛÙÚ·ÎÔÂȉ‹, ÔÈ ÍËÚÔ› ηÚÔ› (΢ڛˆ˜ ÙÔ ·Ú¿ÈÎÔ ÊÈÛÙ›ÎÈ Î·È Ù· ηڇ‰È·) Î·È Ë ÛfiÁÈ·. ∏ ηٷӿψÛË ÙˆÓ ·ÏÏÂÚÁÈÔÁfiÓˆÓ ÙÚÔÊÒÓ ÔÈΛÏÏÂÈ ÛÙ· ‰È¿ÊÔÚ· ̤ÚË ÙÔ˘ ÎfiÛÌÔ˘, ·Ó¿ÏÔÁ· Ì ÙȘ ‰È·ÙÚÔÊÈΤ˜ ÚÔÙÈÌ‹ÛÂȘ (22). OÈ ·ÏÏÂÚÁÈÔÁÔÓÈΤ˜ ÚˆÙ½Ó˜ Â›Ó·È Û˘Ó‹ıˆ˜ fiÍÈÓ˜ ÁÏ˘ÎÔÚˆÙ½Ó˜, ÌÔÚÈ·ÎÔ‡ ‚¿ÚÔ˘˜ 10-40 kD, ÛÙ·ıÂÚ¤˜ ÛÙËÓ ÂÂÍÂÚÁ·Û›· Î·È ÎÔÈÓ¤˜, ¤ÙÛÈ ÒÛÙÂ Ë ¤ÎıÂÛË ÙˆÓ ·ÙfiÌˆÓ Ó· Â›Ó·È ÌÂÁ¿ÏË. ¢˘ÛÙ˘¯Ò˜, fï˜, Ù· ¯·Ú·ÎÙËÚÈÛÙÈο ·˘Ù¿ ‰ÂÓ Â›Ó·È Èηӿ ‹ ·Ó·Áη›· ÁÈ· Ó· ηٷÛÙ‹ÛÔ˘Ó Ì›· ÚˆÙ½ÓË ·ÏÏÂÚÁÈÔÁÔÓÈ΋, Ì ·ÔÙ¤ÏÂÛÌ· Ë ·ÏÏÂÚÁÈÔÁÔÓÈÎfiÙËÙ· Ó· ÌËÓ Â›Ó·È ÚԂϤ„ÈÌË. À¿Ú¯Ô˘Ó, ¿ÏψÛÙÂ, ·Ó·ÊÔÚ¤˜ Û¿ÓÈˆÓ ·ÏÏÂÚÁÈÎÒÓ ·ÓÙȉڿÛÂˆÓ Û ÂÚÈÛÛfiÙÂÚ˜ ·fi 150-200 ÙÚÔʤ˜ (20). °ÂÓÂÙÈο ÙÚÔÔÔÈË̤ӷ ÙÚfiÊÈÌ· Î·È ÙÚÔÊÈ΋ ·ÏÏÂÚÁ›· ŒÓ· ÛËÌ·ÓÙÈÎfi ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÙˆÓ °∆∆ Â›Ó·È Ë ·ÚÔ˘Û›· Ó¤ˆÓ ÚˆÙÂ˚ÓÒÓ Û ·˘Ù¿. µ¤‚·È·, fiˆ˜ ·Ó·Ê¤ÚıËΠ·Ú·¿Óˆ, ÔÈ ·ÏÏÂÚÁÈÔÁÔÓÈΤ˜ ÚˆÙ½Ó˜ Ì ÎÏÈÓÈ΋ ÛËÌ·Û›· Â›Ó·È Û¯ÂÙÈο Ï›Á˜, ·Ó ÛÎÂÊÙ› ηÓ›˜ fiÙÈ Ù· Ê˘ÙÈο ·ÙÙ·Ú· ÌÔÚÔ‡Ó Ó· ÂÎÊÚ¿ÛÔ˘Ó ¿Óˆ ·fi 100.000 ÚˆÙ½Ó˜ (23). °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi, ÔÈ ÁÂÓÂÙÈο ÙÚÔÔÔÈË̤Ó˜ ÚˆÙ½Ó˜ ¤¯Ô˘Ó ÌÈÎÚ‹ Èı·ÓfiÙËÙ· Ó· ÚÔηϤÛÔ˘Ó ·ÏÏÂÚÁ›·, ›Ûˆ˜ fiÛÔ Î·È ¤Ó· ÔÔÈÔ‰‹ÔÙ ÌË ÁÂÓÂÙÈο ÙÚÔÔÔÈË̤ÓÔ ÙÚfiÊÈÌÔ. ∆Ô ÂӉ¯fiÌÂÓÔ ·ÏÏÂÚÁÈ΋˜ ·ÓÙ›‰Ú·Û˘ Û °∆∆ Â›Ó·È Èı·ÓfiÙÂÚÔ fiÙ·Ó Ë ÂÈÛ·¯ı›۷ ÚˆÙ½ÓË Â›Ó·È ÁÓˆÛÙfi ·ÏÏÂÚÁÈÔÁfiÓÔ, fiˆ˜ ÁÈ· ·Ú¿‰ÂÈÁÌ· Ë ÂÈÛ·ÁˆÁ‹ Ù˘ ·ÏÏÂÚÁÈÔÁÔÓÈ΋˜ ‚-η˙½Ó˘ ÙÔ˘ ·ÁÂÏ·‰ÈÓÔ‡ Á¿Ï·ÙÔ˜ Û ηÏÏȤÚÁÂÈ· ÛfiÁÈ·˜, ·ÏÏ¿ Î·È ÙˆÓ ÁÏ˘ÎÈÓÈÓÒÓ Ù˘ ÛfiÁÈ·˜ Û ηÏÏȤÚÁÂÈ· Ú˘˙ÈÔ‡ (24,25). ¶·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ù¤ÙÔÈ· ÚÔ˚fiÓÙ· ‰ÂÓ ¤ÊÙ·Û·Ó (Î·È ›Ûˆ˜ ‰ÂÓ ÊÙ¿ÛÔ˘Ó ÔÙ¤) ÛÙËÓ ·ÁÔÚ¿, Ô Î›Ó‰˘ÓÔ˜ ·Ó¿ÌÂÈ͢ ‹ ‰È¿¯˘Û˘ ÙÔ˘ ÁÂÓÂÙÈÎÔ‡
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¶·È‰È·ÙÚÈ΋ 2003;66:418-425
˘ÏÈÎÔ‡ ˘¿Ú¯ÂÈ ¿ÓÙ·. ŒÙÛÈ, ‰ËÌÈÔ˘ÚÁ‹ıËÎÂ Ë ·Ó¿ÁÎË ÁÈ· ÙË ıÂÛÌÔı¤ÙËÛË ‰È·‰ÈηÛÈÒÓ ÂϤÁ¯Ô˘ Ù˘ Èı·Ó‹˜ ·ÏÏÂÚÁÈÔÁÔÓÈÎfiÙËÙ·˜ ÙˆÓ °∆∆. ¶·Ú’ fiÏ· ·˘Ù¿, ı· Ú¤ÂÈ Ó· Á›ÓÂÈ Û·Ê¤˜ fiÙÈ Ù· ÙÚfiÊÈÌ· ·˘Ù‹˜ Ù˘ ηÙËÁÔÚ›·˜, ·ÓÙÈÎÂÈÌÂÓÈο, ‰ÂÓ Â›Ó·È Î·È, ÂÔ̤ӈ˜, ‰ÂÓ ı· Ú¤ÂÈ Ó· ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÂÎ ÙˆÓ ÚÔÙ¤ÚˆÓ ˆ˜ ÂÈ‚Ï·‚‹ Î·È ÂÈΛӉ˘Ó· ÁÈ· ÙÔÓ Î·Ù·Ó·ÏˆÙ‹ ‹ Û ÌÂÈÔÓÂÎÙÈ΋ ı¤ÛË Û ۯ¤ÛË Ì ·ÓÙ›ÛÙÔȯ· ÌË °∆∆ ‹ ıÚÂÙÈο Û˘ÛÙ·ÙÈο, ÚÔ‚¿ÏÏÔÓÙ·˜ ÙÔ Âȯ›ÚËÌ· fiÙÈ Ë ‰È·ÙÚÔÊÈ΋ ·Í›· ÙÔ˘˜ Â›Ó·È ¯·ÌËÏfiÙÂÚË. ∏ ‰È·‰Èηۛ· ·Ú·ÁˆÁ‹˜ °∆∆ ÂÚÈÏ·Ì‚¿ÓÂÈ, ÁÂÓÈο, ÙÚ›· ÛÙ¿‰È·: ÙËÓ ÂÈÏÔÁ‹ ÙÔ˘ ÁÔÓȉ›Ô˘, ÙËÓ ÂÈÏÔÁ‹ ÙÔ˘ ›‰Ô˘˜ ÙÔ˘ ÙÚÔÊ›ÌÔ˘ Ô˘ ı· ÙÚÔÔÔÈËı› ηÈ, ÙÂÏÈο, ÙËÓ ·Ó¿Ù˘ÍË Î·È ‰È¿ıÂÛ‹ ÙÔ˘ ÛÙËÓ ·ÁÔÚ¿ (26). ∏ ·ÏÏÂÚÁÈÔÁÔÓÈÎfiÙËÙ· ÙÔ˘ ÙÚÔÊ›ÌÔ˘ Ú¤ÂÈ Ó· ÂÎÙÈÌ¿Ù·È ·fi ÙÔ ÚÒÙÔ ÛÙ¿‰ÈÔ. OÈ ··Ú·›ÙËÙ˜ ÏËÚÔÊÔڛ˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó: ·) ÙÔÓ Î·ıÔÚÈÛÌfi ÙÔ˘ Ó¤Ô˘ ÙÚÔÊ›ÌÔ˘, ‚) ÙËÓ Â›‰Ú·ÛË Ù˘ ·Ú·ÁˆÁÈ΋˜ ‰È·‰Èηۛ·˜ ÛÙȘ ȉÈfiÙËÙ˜ ÙÔ˘ ÙÚÔÊ›ÌÔ˘, Á) Ù· ·ÎÚÈ‚‹ ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ Ô˘ ı· ¯ÚËÛÈÌÔÔÈËı› ˆ˜ ÁÔÓȉȷ΋ ËÁ‹ Î·È ‰) ÙȘ ÂȉڿÛÂȘ Ù˘ ÁÂÓÂÙÈ΋˜ ÙÚÔÔÔ›ËÛ˘ ÛÙȘ ȉÈfiÙËÙ˜ Ù˘ “ÌËÙÚÈ΋˜” ηÏÏȤÚÁÂÈ·˜, Ì ηıÔÚÈÛÌfi Î·È ÌÔÚÈ·Îfi ¯·Ú·ÎÙËÚÈÛÌfi Ù˘ ʇÛ˘ Ù˘ ÁÂÓÂÙÈ΋˜ ÙÚÔÔÔ›ËÛ˘, Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ Ù˘ ÁÔÓȉȷ΋˜ ı¤Û˘ ÂÈÛ·ÁˆÁ‹˜, ÙÔ˘ Ï‹ıÔ˘˜ ·ÓÙÈÁÚ¿ÊˆÓ Î·È ÙÔ˘ ÂȤ‰Ô˘ ‚ÈÔ¯ËÌÈ΋˜ ¤ÎÊÚ·Û˘ (27). À¿Ú¯Ô˘Ó ÔÏÏÔ› ÏfiÁÔÈ Ô˘ ηıÈÛÙÔ‡Ó ÛËÌ·ÓÙÈÎfi ÙÔÓ ·ÎÚÈ‚‹ ηıÔÚÈÛÌfi ÙˆÓ Èı·ÓÒÓ ·ÏÏÂÚÁÈÔÁfiÓˆÓ Ô˘ ÂÚȤ¯ÔÓÙ·È Û °∆∆. ∂ÊfiÛÔÓ ÙÂÏÈÎfi ÛÙfi¯Ô ·ÔÙÂÏ› Ë ·ÛÊ·Ï‹˜ ηٷӿψۋ ÙÔ˘˜ ÙfiÛÔ ·fi ÙÔ Û‡ÓÔÏÔ ÙÔ˘ ÏËı˘ÛÌÔ‡ fiÛÔ Î·È ·fi ÙÔÓ ·ÏÏÂÚÁÈÎfi ·ÛıÂÓ‹, Ú¤ÂÈ Ó· ˘¿Ú¯ÂÈ Ë ‰˘Ó·ÙfiÙËÙ· Ù˘ Û·ÊÔ‡˜ ÏËÚÔÊfiÚËÛ˘ ÁÈ· ÙÔ Â›‰Ô˜ Î·È ÙËÓ ·ÎÚÈ‚‹ Û˘ÁΤÓÙÚˆÛË ÙˆÓ Û˘ÛÙ·ÙÈÎÒÓ ÛÙÔ Ó¤Ô ÙÚfiÊÈÌÔ. ∞˘Ùfi ‰ÂÓ ·ÊÔÚ¿ ÌfiÓÔ ÛÙ· ÙÚÔÔÔÈË̤ӷ ÁÔÓ›‰È·, ·ÏÏ¿ ÛÙÔ Û‡ÓÔÏfi ÙÔ˘˜, ·ÊÔ‡ Ë ÁÂÓÂÙÈ΋ ÙÚÔÔÔ›ËÛË ÌÔÚ› Ó· ÂÈʤÚÂÈ ·ÏÏ·Á¤˜ Î·È ÛÙ· ˘fiÏÔÈ· ¯·Ú·ÎÙËÚÈÛÙÈο ¤ÎÊÚ·Û˘ ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ (27). ™Â Ì›· ‹‰Ë ·ÏÏÂÚÁÈÔÁÔÓÈ΋ ÙÚÔÊ‹, Ë ÔÛfiÙËÙ· ¤ÎÊÚ·Û˘ ÙÔ˘ ·ÏÏÂÚÁÈÔÁfiÓÔ˘ ı· ÌÔÚÔ‡Û ӷ ·ÏÏ¿ÍÂÈ, ηıÈÛÙÒÓÙ·˜ ÙËÓ ÂÚÈÛÛfiÙÂÚÔ (‹ ÏÈÁfiÙÂÚÔ) ·ÏÏÂÚÁÈÔÁÔÓÈ΋, ÂÍ·ÈÙ›·˜ Ù˘ ÁÂÓÂÙÈ΋˜ ÙÚÔÔÔ›ËÛ˘ (1). O ηıÔÚÈÛÌfi˜ Ù˘ ·ÏÏÂÚÁÈÔÁÔÓÈÎfiÙËÙ·˜ Á›ÓÂÙ·È Ì ‚ÈÔÏÔÁÈΤ˜ in vivo Î·È in vitro ÌÂıfi‰Ô˘˜, fiˆ˜ ‰ÈÏ‹ Ù˘ÊÏ‹ ÚfiÎÏËÛË, ·ÓÔȯً ÚfiÎÏËÛË Î·È ‰ÂÚÌ·ÙÈΤ˜ ‰ÔÎÈ̷ۛ˜ Ó˘ÁÌÔ‡ Û ·ÓıÚÒÔ˘˜, ·Ó·Ê˘Ï·ÎÙÈ΋ ·¿ÓÙËÛË Û ÂÈÚ·Ì·Ùfi˙ˆ·, ηıÒ˜ Î·È Ì in vitro ̤ÙÚËÛË Ù˘ ¤ÎÏ˘Û˘ ÈÛÙ·Ì›Ó˘ ·fi ‚·ÛÂfiÊÈÏ·, ÚÔÛ‰ÈÔÚÈÛÌfi ÂȉÈ΋˜ IgE Ì ELISA, RAST, RAST-inhibition Î·È PCR, RT-PCR (27).
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∞Ó ÙÔ ÁÔÓ›‰ÈÔ ¤¯ÂÈ ÎÔÈÓ‹ ·ÏÏËÏÔ˘¯›· Ì ÎÔÈÓ‹ ·ÏÏÂÚÁÈÔÁfiÓÔ ËÁ‹, fiˆ˜ Ù· ÊÈÛÙ›ÎÈ· ‹ ÙÔ „¿ÚÈ, Ú¤ÂÈ Ó· ‰ÈÂÓÂÚÁËıÔ‡Ó ÔÈ Î·Ù¿ÏÏËϘ ‰ÔÎÈ̷ۛ˜ Ô˘ ı· ·ÔÎÏ›ÛÔ˘Ó ÙÔ ÂӉ¯fiÌÂÓÔ ÙÔ Ó¤Ô ÙÚfiÊÈÌÔ Ó· ÚÔηÏ› ·ÏÏÂÚÁ›Â˜ Û ¿ÙÔÌ· ¢·ÈÛıËÙÔÔÈË̤ӷ Û ·˘Ù‹ ÙËÓ ËÁ‹ (26). ™ÙËÓ ÂÚ›ÙˆÛË Ô˘ Ë ÚˆÙ½ÓË ·Ó‹ÎÂÈ Û ٿÍË ÚˆÙÂ˚ÓÒÓ Ô˘ ¤¯Ô˘Ó Û¯ÂÙÈÛÙ› Ì Èı·Ó‹ ·ÏÏÂÚÁÈÔÁÔÓÈÎfiÙËÙ·, Ë Û˘ÁÎÂÎÚÈ̤ÓË Ó¤· ÚˆÙ½ÓË ‰ËÌÈÔ˘ÚÁ› ÚfiÛıÂÙË ·ÓËÛ˘¯›· Î·È Ú¤ÂÈ Ó· ·ÍÈÔÏÔÁËı›. °È· ·Ú¿‰ÂÈÁÌ·, ÔÈ ¯ÈÙÈÓ¿Û˜ ÌÔÚÔ‡Ó Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó ·fi ÙË ÁÂÓÂÙÈ΋ Ì˯·ÓÈ΋ ÁÈ· ÙËÓ ÚÔÛÙ·Û›· ÙˆÓ Ê˘ÙÈÎÒÓ Î·ÏÏÈÂÚÁÂÈÒÓ ·fi ̇ÎËÙ˜. ∂ÓÙÔ‡ÙÔȘ, οÔȘ ¯ÈÙÈÓ¿Û˜ Â›Ó·È ˘Â‡ı˘Ó˜ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ÙÚÔÊÈÎÒÓ ·ÏÏÂÚÁÈÒÓ, Ì ·ÔÙ¤ÏÂÛÌ· Ë ÂÈÛ·ÁˆÁ‹ ÙÔ˘˜ ÛÙÔ Ó¤Ô ÙÚfiÊÈÌÔ Ó· ÂÈ‚¿ÏÏÂÈ ÙËÓ ÂÚ·ÈÙ¤Úˆ ·ÍÈÔÏfiÁËÛ‹ ÙÔ˘ (26). OÈ Èı·ÓfiÙËÙ˜ ‰ËÌÈÔ˘ÚÁ›·˜ ÂÓfi˜ Ó¤Ô˘ ·ÏÏÂÚÁÈÔÁfiÓÔ˘ Â›Ó·È Ì¿ÏÏÔÓ ÌÈÎÚ¤˜. ∏ ·˘ÍË̤ÓË ¤ÎıÂÛË Û οÔÈ· Ô˘Û›·, Ô˘ ̤¯ÚÈ ÚfiÙÈÓÔ˜ ·Ô˘Û›·˙ ·fi ÙÔ ‰È·ÈÙÔÏfiÁÈÔ ‹ ηٷӷψÓfiÙ·Ó Û ÌÈÎÚ¤˜ ÔÛfiÙËÙ˜, ÌÔÚ› ıˆÚËÙÈο Ó· ÚÔηϤÛÂÈ ÙËÓ Â˘·ÈÛıËÙÔÔ›ËÛË Î¿ÔÈˆÓ ·ÙfiÌˆÓ Û ·˘Ù‹. ª›· ÙÂÏÂ˘Ù·›· ÛΤ„Ë, Ë ÔÔ›· fï˜ ‰ÂÓ ¤¯ÂÈ ¤Á΢ÚË ÂÈÛÙËÌÔÓÈ΋ ‚¿ÛË, ·ÊÔÚ¿ ÛÙË ÁÂÓÈÎfiÙÂÚË Â›‰Ú·ÛË Ô˘ ı· ÌÔÚÔ‡Û·Ó Ó· ¤¯Ô˘Ó ÔÈ ÁÂÓÂÙÈο ÙÚÔÔÔÈË̤Ó˜ ÙÚÔʤ˜ ÛÙÔ ·ÓÔÛÔÔÈËÙÈÎfi Û‡ÛÙËÌ·. OÈ Û˘Ó¤ÂȘ Èı·Ófiٷٷ ı· ‹Ù·Ó ·ÓÂͤÏÂÁÎÙ˜, ÁÂÁÔÓfi˜ Ô˘ ÚÔηÏ›, ·ÎfiÌ· Î·È Û ıˆÚËÙÈÎfi ›‰Ô, ¤ÓÙÔÓË ·ÓËÛ˘¯›· (1). ¶Ú¤ÂÈ, ‚¤‚·È·, Ó· ÂÈÛËÌ·Óı› ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ì›· Ù¤ÙÔÈ· Èı·ÓfiÙËÙ·, Â¿Ó ÈÛ¯‡ÂÈ, ı· ·ÊÔÚ¿ ÛÙÔ ÌÂÁ·Ï‡ÙÂÚÔ Ì¤ÚÔ˜ Ù˘ ÙÔÓ ·È‰ÈÎfi ÏËı˘ÛÌfi, ÙfiÛÔ ÏfiÁˆ Ù˘ ÌÂÁ·Ï‡ÙÂÚ˘ ¢·ÈÛıËÛ›·˜ ÙÔ˘ ·Ó·Ù˘ÛÛfiÌÂÓÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ Û ‰È·ÙÚÔÊÈΤ˜ ·ÚÂÌ‚¿ÛÂȘ, fiÛÔ Î·È ÏfiÁˆ Ù˘ ÔÏÏ·Ï¿ Û˘¯ÓfiÙÂÚ˘ ‡·Ú͢ ÙÚÔÊÈ΋˜ ·ÏÏÂÚÁ›·˜ ÛÙ· ·È‰È¿ Û ۯ¤ÛË Ì ÙÔ˘˜ ÂÓ‹ÏÈÎÔ˘˜. ªÂ ·˘Ù¿ Ù· ‰Â‰Ô̤ӷ, ÙfiÛÔ ÛÙËÓ ∞ÌÂÚÈ΋ (Food and Drug Administration - FDA) fiÛÔ Î·È ÛÙËÓ ∂˘ÚÒË, ıÂÛÌÔıÂÙ‹ıËÎ·Ó ‰È·Ù¿ÍÂȘ ÁÈ· ÙÔÓ Î·Ù¿ÏÏËÏÔ ¤ÏÂÁ¯Ô ÙˆÓ ÁÂÓÂÙÈο ÙÚÔÔÔÈËÌ¤ÓˆÓ ÙÚÔʛ̈Ó, ÚÔÛı¤ÙˆÓ Î.Ï., ÚÔÎÂÈ̤ÓÔ˘ Ó· ‰ÈÂÓÂÚÁËı› ÚÔÛÂÎÙÈ΋ ·Ó¿Ï˘ÛË ÚÈÓ Î¿ÔÈÔ °∆∆ ΢ÎÏÔÊÔÚ‹ÛÂÈ ÛÙËÓ ·ÁÔÚ¿ (28,29). ¶·Ú’ fiÙÈ ‰ÂÓ ˘¿Ú¯ÂÈ ‰ÈÂıÓ‹˜ ÎÔÈÓ‹ ÚfiÙ˘Ë ÛÙÚ·ÙËÁÈ΋ ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô Ù˘ ·ÏÏÂÚÁÈÔÁÔÓÈÎfiÙËÙ·˜ ÙˆÓ °∆∆, Ì›· ÁÂÓÈ΋ ÚÔÛ¤ÁÁÈÛË ÂÚÈÏ·Ì‚¿ÓÂÈ ÛÙÔȯ›· fiˆ˜ Ë ·ÍÈÔÏfiÁËÛË Ù˘ ÌÂıfi‰Ô˘ Î·È Ë ÂͤٷÛË Ù˘ ÁÔÓȉȷ΋˜ ËÁ‹˜, Ù˘ ·ÌÈÓÔÍÈ΋˜ ·ÏÏËÏÔ˘¯›·˜ Î·È ÔÌÔÏÔÁ›·˜, Ù˘ ÂȉÈÎfiÙËÙ·˜ Ì ÔÚÔ‡˜ Î·È Ù˘ ·ÓÔ¯‹˜ ÛÙËÓ Â„›ÓË (26). °ÂÓÈο, ¤¯ÂÈ ÔÚÈÛÙ› Ô ·ÎfiÏÔ˘ıÔ˜ ·ÏÁfiÚÈıÌÔ˜, Ô˘ ·ÊÔÚ¿ ÛÙËÓ, ηٿ ÙÔ ‰˘Ó·ÙfiÓ, ‚¤ÏÙÈÛÙË ÚÔÛÙ·Û›· ·fi ·ÏÏÂÚÁ›· ÛÙ· °∆∆ (∂ÈÎfiÓ· 1). ∞Ú¯Èο, ÂÍÂÙ¿˙ÂÙ·È Â¿Ó Ë ËÁ‹ ÙÔ˘ ÁÔÓȉ›Ô˘ ›ӷÈ
¶·È‰È·ÙÚÈ΋ 2003;66:418-425
Paediatriki 2003;66:418-425
∂¿Ó Ë ·ÓÙ›‰Ú·ÛË Â›Ó·È ·ÚÓËÙÈ΋, ÙfiÙ Á›ÓÔÓÙ·È ‰ÂÚÌ·ÙÈΤ˜ ‰ÔÎÈ̷ۛ˜ ‹ ·ÎfiÌ· Î·È ÚÔÎÏ‹ÛÂȘ Û ¢·›ÛıËÙ· ¿ÙÔÌ·. ∞Ó Û ÔÔÈ·‰‹ÔÙ ʿÛË Ù˘ ‰È·‰Èηۛ·˜ ÏËÊıÔ‡Ó ıÂÙÈο ·ÔÙÂϤÛÌ·Ù·, ÚÔÙ›ÓÂÙ·È Ë Û‹Ì·ÓÛË ÙÔ˘ ÂÚȯÔ̤ÓÔ˘ Ù˘ ÙÚÔÊ‹˜ ÚÈÓ ·˘Ù‹ ÚÔˆıËı› ÛÙËÓ ·ÁÔÚ¿. ∆Ô Û˘ÁÎÂÎÚÈ̤ÓÔ ÚˆÙfiÎÔÏÏÔ ·ÎÔÏÔ˘ı‹ıËΠÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô Ù˘ ·ÏÏÂÚÁÈÔÁÔÓÈÎfiÙËÙ·˜ Ù˘ ηÏÏȤÚÁÂÈ·˜ ÛfiÁÈ·˜, ÛÙËÓ ÔÔ›· ¤¯ÂÈ ÚÔÛÙÂı› ÙÔ ÁÔÓ›‰ÈÔ 2S ÙÔ˘ ‚Ú·˙ÈÏÈ¿ÓÈÎÔ˘ ÊÈÛÙÈÎÈÔ‡. ™Â ÌÂϤÙË Ô˘ ‰ËÌÔÛ›Â˘Û ÙÔ “New England Journal of Medicine” ÙÔ 1996, ‰È·ÈÛÙÒıËΠfiÙÈ Ë ·ÏÏÂÚÁÈÔÁÔÓÈÎfiÙËÙ· ÌÂٷʤÚıËΠÛÙËÓ ÙÚÔÔÔÈË̤ÓË ÛfiÁÈ·, ·ÊÔ‡ ÛÙËÓ in vitro ·ÓÙ›‰Ú·ÛË ‚Ú¤ıËÎ·Ó ıÂÙÈο ·ÔÙÂϤÛÌ·Ù· Û 8 ·fi ÙÔ˘˜ 9 ÔÚÔ‡˜ Ô˘ ·Ó‹Î·Ó Û ¢·›ÛıËÙÔ˘˜ ·ÛıÂÓ›˜ (18). ∏ ·Ó·Î¿Ï˘„Ë ·˘Ù‹ ›¯Â Û·Ó ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·Ó·ÛÙÔÏ‹ Ù˘ ÂÌÊ¿ÓÈÛ˘ ÙÔ˘ Û˘ÁÎÂÎÚÈ̤ÓÔ˘ ÚÔ˚fiÓÙÔ˜ ÛÙËÓ ·ÁÔÚ¿ (2,14). ∂Ô̤ӈ˜, Ô Î›Ó‰˘ÓÔ˜ ·ÏÏÂÚÁÈÎÒÓ ·ÓÙȉڿÛÂˆÓ ÌÂÈÒÓÂÙ·È, ·Ó ‰ÂÓ ÂÎÌˉÂÓ›˙ÂÙ·È, Ì ηٿÏÏËÏÔ˘˜ ÂÚÁ·ÛÙËÚÈ·ÎÔ‡˜ ¯ÂÈÚÈÛÌÔ‡˜ Î·È Ì ÙË Û‹Ì·ÓÛË ÙˆÓ °∆∆ Ô˘ ΢ÎÏÔÊÔÚÔ‡Ó ÛÙÔ ÂÌfiÚÈÔ.
·ÏÏÂÚÁÈÔÁfiÓÔ ‹ fi¯È. ™ÙÔ Ï·›ÛÈÔ ·˘Ùfi Ï·Ì‚¿ÓÔÓÙ·È, ›Û˘, ˘’ fi„ÈÓ Ù· ÎÔÈÓ¿ ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ·ÏÏÂÚÁÈÔÁfiÓˆÓ ÚˆÙÂ˚ÓÒÓ, fiˆ˜ ÙÔ ÌÔÚÈ·Îfi ‚¿ÚÔ˜. ™ÙË Û˘Ó¤¯ÂÈ·, Ë ÚˆÙÂ˚ÓÈ΋ ·ÏÏËÏÔ˘¯›· Û˘ÁÎÚ›ÓÂÙ·È Ì ̛· ‚¿ÛË ‰Â‰Ô̤ӈÓ, fiÔ˘ ˘¿Ú¯Ô˘Ó ηٷÁÂÁÚ·Ì̤Ó˜ fiϘ ÔÈ ·ÏÏÂÚÁÈÔÁÔÓÈΤ˜ ·ÏÏËÏÔ˘¯›Â˜, ̤¯ÚÈ ÙÔ Ì‹ÎÔ˜ ÙˆÓ ÔÎÙÒ ·ÌÈÓÔͤˆÓ. ŒÓ· ‰Â‡ÙÂÚÔ, ÛËÌ·ÓÙÈÎfi ÚÔ˜ ÂͤٷÛË, ÛÙÔÈ¯Â›Ô Â›Ó·È Ë ÛÙ·ıÂÚfiÙËÙ· Ù˘ ÚˆÙ½Ó˘ ÛÙËÓ ÂÂÍÂÚÁ·Û›·. OÈ Û˘Ó‹ıÂȘ ·ÏÏÂÚÁÈÔÁfiÓ˜ ÚˆÙ½Ó˜ Â›Ó·È ÛÙ·ıÂÚ¤˜ ÛÙË ıÂÚÌÔÎÚ·Û›· Î·È ÛÂ Û˘Óı‹Î˜ fiÍÈÓÔ˘ pH, Ô˘ ÚÔÛÔÌÔÈ¿˙Ô˘Ó ·˘Ù¤˜ ÙÔ˘ ÛÙÔÌ¿¯Ô˘. ∂¿Ó Ë ÚˆÙ½ÓË ÂÌÊ·ÓÈÛÙ› ·ÛÙ·ı‹˜ Û ·˘Ù¤˜ ÙȘ Û˘Óı‹Î˜, ¤¯ÂÈ ÌÈÎÚfiÙÂÚË Èı·ÓfiÙËÙ· Ó· Â›Ó·È ·ÏÏÂÚÁÈÔÁÔÓÈ΋. ∂ÓÙÔ‡ÙÔȘ, ÛÙËÓ ÂÚ›ÙˆÛË Ô˘, ÂÓÒ ‰ÂÓ ˘¿Ú¯ÂÈ ÔÌÔÏÔÁ›· ·ÏÏËÏÔ˘¯›·˜, Ë ÚˆÙ½ÓË Â›Ó·È ÛÙ·ıÂÚ‹ ÛÙËÓ ÂÂÍÂÚÁ·Û›·, ‰ÂÓ ÌÔÚԇ̠ӷ ·ÔÎÏ›ÛÔ˘Ì ÙÔ ÂӉ¯fiÌÂÓÔ ·ÏÏÂÚÁ›·˜ ηÈ, Ì¿ÏÈÛÙ·, ‰ÂÓ ÌÔÚԇ̠ӷ ÚÔÛ‰ÈÔÚ›ÛÔ˘ÌÂ Î·È ÔÌ¿‰· ·ÙfiÌˆÓ Ô˘ ÌÔÚ› Ó· Â›Ó·È Â˘¿ÏˆÙË ÛÙËÓ Èı·Ó‹ “·ÏÏÂÚÁÈÔÁfiÓÔ” ÚˆÙ½ÓË. ∞ÓÙ›ıÂÙ·, Â¿Ó ˘¿Ú¯ÂÈ ÔÌÔÏÔÁ›· ·ÏÏËÏÔ˘¯›·˜ Ì ÁÓˆÛÙfi ·ÏÏÂÚÁÈÔÁfiÓÔ ‹ ÙÔ ÁÔÓ›‰ÈÔ Ô˘ ÚÔ¤Ú¯ÂÙ·È ·fi ÁÓˆÛÙfi ·ÏÏÂÚÁÈÔÁfiÓÔ, ÌÔÚԇ̠ӷ ÚÔÛ‰ÈÔÚ›ÛÔ˘ÌÂ, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÔÚÔ‡˜ ·ÛıÂÓÒÓ, ηٿ fiÛÔ Ë Ó¤· ÚˆÙ½ÓË ı· ·ÓÙȉڿÛÂÈ Ì ·˘ÙÔ‡˜, Ì ÙȘ Ù¯ÓÈΤ˜ ELISA ‹ RAST inhibition.
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∂ÈÎfiÓ· 1. ŒÏÂÁ¯Ô˜ ·ÛÊ¿ÏÂÈ·˜ Û¯ÂÙÈο Ì ÙËÓ ·ÏÏÂÚÁÈÔÁÔÓÈÎfiÙËÙ· ÁÂÓÂÙÈο ÙÚÔÔÔÈËÌ¤ÓˆÓ ÙÚÔʛ̈Ó.
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·ÁÔÚ¿. ∆Ô 30% ÙÔ˘ ηϷÌÔÎÈÔ‡ Î·È ÙÔ 50% Ù˘ ÛfiÁÈ·˜ Ô˘ ·Ú¿ÁÂÙ·È Î·È Î·Ù·Ó·ÏÒÓÂÙ·È ÛÙȘ ∏.¶.∞. Â›Ó·È ÁÂÓÂÙÈο ÙÚÔÔÔÈË̤ÓÔ, ÂÓÒ ÂÚ›Ô˘ ÙÔ 75% ÙˆÓ ÚÔ˚fiÓÙˆÓ Ô˘ ˘¿Ú¯Ô˘Ó ÛÙ· Ú¿ÊÈ· Ù˘ ·ÌÂÚÈηÓÈ΋˜ ·ÁÔÚ¿˜ ÂÚÈÏ·Ì‚¿ÓÂÈ Î·È ÁÂÓÂÙÈο ÙÚÔÔÔÈË̤Ó˜ ÔÈÎÈϛ˜ (1,26). ™ÙȘ ∏.¶.∞., Ë ·Ô‰Ô¯‹ ÙˆÓ °∆∆ ¤ÁÈÓ ÈÔ Â‡ÎÔÏ· ·’ fiÙÈ ÛÙËÓ ∂˘ÚÒË, fiÔ˘ ÙÔ 1996, fiÙ·Ó ¤ÁÈÓÂ Ë ÚÒÙË Ì·˙È΋ ÂÈÛ·ÁˆÁ‹ ÁÂÓÂÙÈο ÙÚÔÔÔÈË̤Ó˘ ÛfiÁÈ·˜, Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó ÔÚÁ·ÓˆÌ¤Ó˜ ÂÎÛÙÚ·Ù›˜ ÂÓË̤ڈÛ˘ ÙˆÓ Î·Ù·Ó·ÏˆÙÒÓ Î·È È¤ÛÂˆÓ ÚÔ˜ ÙȘ ÔÏÈÙÈΤ˜ ËÁÂۛ˜ (19). ∏ ∂ÏÏ¿‰·, ÙÔ 1999, Ì·˙› Ì ٤ÛÛÂÚȘ ·ÎfiÌ· Â˘Úˆ·˚Τ˜ ¯ÒÚ˜, ÚfiÙÂÈÓ ¤Ó· ‰ÈÂÙ¤˜ ÌÔÚ·ÙfiÚÈÔ˘Ì, Ì ÙÔ ÔÔ›Ô ·ÔÊ·Û›ÛÙËÎÂ Ë ·Ó·ÛÙÔÏ‹ ÙˆÓ ÂÁÎÚ›ÛÂˆÓ Ó¤ˆÓ ÁÂÓÂÙÈο ÙÚÔÔÔÈËÌ¤ÓˆÓ ÚÔ˚fiÓÙˆÓ, ̤¯ÚȘ fiÙÔ˘ ÂÊ·ÚÌÔÛÙ› ÓÔÌÔıÂÛ›· Ô˘ Ó· ÔÚ›˙ÂÈ ··ÈÙ‹ÛÂȘ ÁÈ· ÙË Û‹Ì·ÓÛË ÙˆÓ °∆∆ Î·È ÙË ‰ÈÂÍÔ‰È΋ ¤Ú¢ӷ ÙˆÓ ÚÔ˚fiÓÙˆÓ ·˘ÙÒÓ (30). ∞fi ÙËÓ ÂÈÛÙËÌÔÓÈ΋ ÛÎÔÈ¿, ÔÏÏ¿ ÂÚˆÙ‹Ì·Ù· ·Ú·Ì¤ÓÔ˘Ó ·Ó·¿ÓÙËÙ·. ∆· °∆∆ ÌÔÚ› Ó· ·ÔÙÂϤÛÔ˘Ó ÛˆÙ‹ÚÈ· χÛË ÁÈ· ·ÛıÂÓ›˜ Ì ÙÚÔÊÈ΋ ·ÏÏÂÚÁ›·, ÂÓÒ ÌÔÚ› Ó· ·Ô‰ÂȯıÔ‡Ó ÔϤıÚÈ· ÁÈ· ¿ÏÏÔ˘˜. ∆· ‰Â‰Ô̤ӷ Ô˘ ·Ó·Ê¤ÚıËηÓ, ÂÌÊ·ÓÒ˜ ‰ÂÓ ‰ÈηÈÔÏÔÁÔ‡Ó Û˘Ó·ÈÛıËÌ·ÙÈΤ˜ ·ÓÙȉڿÛÂȘ, ÔÈ Ôԛ˜ Ôχ Û˘¯Ó¿ ·Ú·ÙËÚÔ‡ÓÙ·È ÙfiÛÔ ·fi Ù· ̤۷ Ì·˙È΋˜ ÂÓË̤ڈÛ˘ fiÛÔ Î·È ·fi ÂÈÛÙ‹ÌÔÓ˜. ∏ ÈÛÔÚÚÔË̤ÓË Î·È ¯ˆÚ›˜ ˘ÂÚ‚ÔϤ˜ ÚÔÛ¤ÁÁÈÛË ÙˆÓ ÂȉÈÎÒÓ ÌÔÚ› Ó· ·Ô‚› Ôχ ¯Ú‹ÛÈÌË, ·Ú¤¯ÔÓÙ·˜ ˘Â‡ı˘ÓË Âη›‰Â˘ÛË Î·È ÂÓË̤ڈÛË ÛÙÔ ÎÔÈÓfi. µÈ‚ÏÈÔÁÚ·Ê›· 1. ¶··‰fiÔ˘ÏÔ˜ ¡°. °ÂÓÂÙÈο ÙÚÔÔÔÈË̤Ó˜ ÙÚÔʤ˜: ÂÈÙÒÛÂȘ ÛÙËÓ ·ÏÏÂÚÁÈÔÁÔÓÈÎfiÙËÙ·. ™ÙÔ: ∆Ô ·ÏÏÂÚÁÈÎfi ·È‰› ÛÙËÓ ÎÏÈÓÈ΋ Ú¿ÍË. ¶ÔÏÂÌÈÎfi ªÔ˘ÛÂ›Ô ∞ıËÓÒÓ; 2001. 2. Rifkin J, editor. Playing ecological roulette with mother nature’s designs. The Biotech Century: Harnessing the gene and remaking the world (Tarcher/Putnam). Vol. IX; 1998. 3. Burke D. Why all the fuss about genetically modified food? Much depends on who benefits. BMJ 1998;316:1845-1846. 4. Horsch RB, Fraley RT, Rogers SG, Sanders PR, Lloyd A, Hoffmann N. Inheritance of functional foreign genes in plants. Science 1984;223:496-498. 5. De Block M, Herrera-Estrella L, Van Montagu M, Schell J, Zambryski P. Expression of foreign genes in regenerated plants and their progeny. EMBO J 1984;3:1681-1689. 6. Massey R. Rachel’s environment and health news. In: Biotech: the Basics. Part 1. #716; 2001. 7. Whitman DB. Genetically modified foods: harmful or helpful. Cambridge Scientific Abstracts; 2000. http://www.csa.com/ hottopics/gmfood/oview.html. 8. Tester M. Seeking clarity in the debate over the safety of GM foods. Nature 1999;402:575.
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∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 20-01-2003 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 02-09-2003 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ¡ÈÎfiÏ·Ô˜ °. ¶··‰fiÔ˘ÏÔ˜ µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡” §Â‚·‰Â›·˜ 13, ∆.∫. 115 27, °Ô˘‰› E-mail: ngp@allergy.gr
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OÈÎÔÏÔÁ›·, ÂȉËÌÈÔÏÔÁ›· Î·È ÂÚÁ·ÛÙËÚȷ΋ ‰È¿ÁÓˆÛË Ì˘ÎËÙÈ¿ÛÂˆÓ ÙÔ˘ ÙÚȯˆÙÔ‡ Ù˘ ÎÂÊ·Ï‹˜ Û ·È‰È¿ ∂. ºÚ·ÁÎÔ‡ÏË
Ecology, epidemiology and diagnosis of tinea capitis in children E. Frangoulis
¶ÂÚ›ÏË„Ë: ∏ Ì˘ÎËÙ›·ÛË ÙÔ˘ ÙÚȯˆÙÔ‡ Ù˘ ÎÂÊ·Ï‹˜ Â›Ó·È Ì›· ·fi ÙȘ Û˘Ó‹ıÂȘ ‰ÂÚÌ·ÙÈΤ˜ ÏÔÈÌÒÍÂȘ ÙˆÓ ·È‰ÈÒÓ Î·Ù¿ ÙËÓ ÚÔÛ¯ÔÏÈ΋ Î·È Û¯ÔÏÈ΋ ËÏÈΛ·. ∞ÈÙÈÔÏÔÁÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ·ÔÙÂÏÔ‡Ó ÔÚÈṲ̂ӷ ›‰Ë ‰ÂÚÌ·ÙfiÊ˘ÙˆÓ, ÙÔ˘ Á¤ÓÔ˘˜ Microsporum Î·È Trichophyton. ∆· ›‰Ë ·˘Ù¿, ·Ó¿ÏÔÁ· Ì ÙÔ Ê˘ÛÈÎfi ÙÔ˘˜ ÂÚÈ‚¿ÏÏÔÓ Î·È ÙËÓ ÚÔÙ›ÌËÛ‹ ÙÔ˘˜ ÚÔ˜ ÙÔÓ ÍÂÓÈÛÙ‹, ‰È·ÎÚ›ÓÔÓÙ·È Û ·ÓıÚˆfiÊÈÏ·, ˙ˆfiÊÈÏ· Î·È ÁÂÒÊÈÏ·. ™ÙË ¯ÒÚ· Ì·˜, Ù· ·ÚÈ· ·›ÙÈ· Â›Ó·È ÙÔ ˙ˆfiÊÈÏÔ M. canis Û ÔÛÔÛÙfi 87% Î·È ÙÔ ·ÓıÚˆfiÊÈÏÔ ∆. violaceum Û ÔÛÔÛÙfi 6%. ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ·ÓȯÓ‡ÔÓÙ·È Î·È ÌË ÂÓ‰ËÌÈο ·ÓıÚˆfiÊÈÏ· ›‰Ë, ΢ڛˆ˜ Û ÔÈÎÔÓÔÌÈÎÔ‡˜ ÌÂÙ·Ó¿ÛÙ˜ ·fi ¯ÒÚ˜ Ù˘ ª¤Û˘ ∞Ó·ÙÔÏ‹˜, Ù˘ ∞Û›·˜ Î·È Ù˘ ∞ÊÚÈ΋˜. ¶ËÁ‹ ÌfiÏ˘ÓÛ˘ ÁÈ· ÙȘ ˙ˆÔÊÈÏÈΤ˜ ÏÔÈÌÒÍÂȘ Â›Ó·È Ù· ˙Ò· Ô˘ ÓÔÛÔ‡Ó ‹ fi¯È, ÂȉÈο ‰Â ÁÈ· ÙÔ M. canis Â›Ó·È Ù· ηÙÔÈΛ‰È· Î·È Ù· ·‰¤ÛÔÙ· (Á¿Ù˜, Û·ÏÔÈ). ∏ ÌÂÙ¿‰ÔÛË ÙˆÓ ·ÓıÚˆÔÊÈÏÈÎÒÓ ÏÔÈÌÒÍÂˆÓ Á›ÓÂÙ·È Â›Ù Ì ¿ÌÂÛË Â·Ê‹ Ì ¿Û¯ÔÓÙ˜ ‹ ·Û˘Ìو̷ÙÈÎÔ‡˜ ÊÔÚ›˜ ›Ù Ì ¯Ú‹ÛË ÌÔÏ˘ÛÌ¤ÓˆÓ ·ÓÙÈÎÂÈ̤ӈÓ. OÈ Ì˘ÎËÙÈ¿ÛÂȘ ÙÔ˘ ÙÚȯˆÙÔ‡ Ù˘ ÎÂÊ·Ï‹˜ ˆ˜ › ÙÔ Ï›ÛÙÔÓ Â›Ó·È ÌË ÊÏÂÁÌÔÓÒ‰ÂȘ. OÈ ÊÏÂÁÌÔÓÒ‰ÂȘ ÌÔÚʤ˜ (¤Ì˘Ô˜ ÙÚȯÔÊ˘Ù›·) Û˘Ó‰¤ÔÓÙ·È Î˘Ú›ˆ˜ Ì ˙ˆfiÊÈÏÔ˘˜ Î·È ÁÂÒÊÈÏÔ˘˜ ̇ÎËÙ˜ Î·È Û¿ÓÈ· Ì ·ÓıÚˆfiÊÈÏÔ˘˜. O ¿¯ÔÚ·˜, Û¿ÓÈ· ÌÔÚÊ‹ Ì˘ÎËÙ›·Û˘ ÙÔ˘ ÙÚȯˆÙÔ‡ Ù˘ ÎÂÊ·Ï‹˜, ÚÔηÏÂ›Ù·È ·fi ÙÔ ·ÓıÚˆfiÊÈÏÔ Â›‰Ô˜ T. schoenleinii. ∏ ÂÚÁ·ÛÙËÚȷ΋ ÂͤٷÛË Â›Ó·È ·Ó·Áη›· ÁÈ· ÙËÓ ÂȂ‚·›ˆÛË Ù˘ ÎÏÈÓÈ΋˜ ‰È¿ÁÓˆÛ˘ Î·È ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙÔ˘ ˘Â‡ı˘ÓÔ˘ ›‰Ô˘˜. ¶ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ¿ÌÂÛË ÌÈÎÚÔÛÎÔÈ΋ ÂͤٷÛË ‰Â›ÁÌ·ÙÔ˜ ·fi ÙËÓ ÂÚÈÔ¯‹ Ù˘ Ïԛ̈͢, ηÏÏȤÚÁÂÈ· Î·È Ù·˘ÙÔÔ›ËÛË ÙÔ˘ ̇ÎËÙ· Ì ‚¿ÛË Ù· ÌÈÎÚÔÛÎÔÈο Î·È Ì·ÎÚÔÛÎÔÈο ÌÔÚÊÔÏÔÁÈο ÛÙÔȯ›· Ù˘ ·ÔÈΛ·˜.
Abstract: Tinea capitis is a common scalp infection affecting predominantly children of preschool and school age. It is caused by dermatophytes mostly of the genus Microsporum and Trichophyton. These dermatophytes, depending on their natural habitat and host preference, are classified as geophilic, zoophilic and anthropophilic. The main tinea capitis pathogens in Greece are the zoophilic M. canis (87%) and the anthropophilic T. violaceum (6%). During the last few years a number of dermatophyte species non-endemic in Greece have been isolated from immigrants from the Middle East, Asia and Africa. The main sources of zoophilic infections are infected animals; for M. canis domestic or stray dogs and cats. The transmission mode of anthropophilic infection involves contact with infected persons, asymptomatic carriers or fomites. Tinea capitis is usually not inflammatory. Inflammatory infections (Kerion) involve mostly zoophilic and geophilic dermatophytes and rarely anthropophilic. Favus is a rare scalp infection caused by the anthropophilic T. schoenleinii. Clinical diagnosis should be confirmed by mycological examination which includes direct microscopy of the specimen, culture and identification of the pathogen on the basis of the macro- and microscopic features of the colony. Identification is necessary for the selection of the appropriate antifungal agent. Clinicians should suspect tinea capitis in all scalp infections involving children of prepubertal age.
∂ÚÁ·ÛÙ‹ÚÈÔ µÈÔ·ıÔÏÔÁ›·˜, ¡ÔÛÔÎÔÌÂ›Ô ∞ÊÚÔ‰›ÛÈˆÓ Î·È ¢ÂÚÌ·ÙÈÎÒÓ ¡fiÛˆÓ “∞. ™˘ÁÁÚfi˜”, ∞ı‹Ó·
Laboratory of Biopathology, “Andreas Sygros” Skin and Venereal Disease Hospital, Athens
426
¶·È‰È·ÙÚÈ΋ 2003;66:426-435
Paediatriki 2003;66:426-435
∏ Ù·˘ÙÔÔ›ËÛË Â›Ó·È ··Ú·›ÙËÙË ÁÈ· ÙËÓ ÂÈÏÔÁ‹ Ù˘ ηٿÏÏËÏ˘ ·ÓÙÈÌ˘ÎËÙÈ·ÛÈ΋˜ ·ÁˆÁ‹˜. ŸÏ˜ ÔÈ ÂÚÈÙÒÛÂȘ ·ÏÏÔÈÒÛÂˆÓ ÙÔ˘ ÙÚȯˆÙÔ‡ Ù˘ ÎÂÊ·Ï‹˜ Û ·È‰È¿ ÚÔÂÊË‚È΋˜ ËÏÈΛ·˜ ı· Ú¤ÂÈ Ó· ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È ·fi ÙÔÓ ÎÏÈÓÈÎfi È·ÙÚfi ˆ˜ ‡ÔÙ˜ Ì˘ÎËÙÈ·ÛÈΤ˜ ÏÔÈÌÒÍÂȘ. §¤ÍÂȘ ÎÏÂȉȿ: Ì˘ÎËÙ›·ÛË ÙÚȯˆÙÔ‡ ÎÂÊ·Ï‹˜, ÔÈÎÔÏÔÁ›·, ÂȉËÌÈÔÏÔÁ›·, ÂÚÁ·ÛÙËÚȷ΋ ‰È¿ÁÓˆÛË.
Key words: tinea capitis, ecology, epidemiology, mycological examination.
∂ÈÛ·ÁˆÁ‹ O fiÚÔ˜ tinea ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·Ó ·fi ÙÔ˘˜ ƒˆÌ·›Ô˘˜ ÁÈ· ÙȘ Ì˘ÎËÙÈ·ÛÈΤ˜ Î·È ·Ú·ÛÈÙÈΤ˜ ÏÔÈÌÒÍÂȘ ÙÔ˘ ÙÚȯˆÙÔ‡ Ù˘ ÎÂÊ·Ï‹˜, ηıÒ˜ ıˆÚÔ‡Û·Ó ˆ˜ ˘Â‡ı˘ÓÔ ÙÔÓ ÛÎfiÚÔ ÙˆÓ ÂÓ‰˘Ì¿ÙˆÓ (Ï·ÙÈÓÈο: tinea) (1). O fiÚÔ˜ ·˘Ùfi˜ ‚·ıÌÈ·›· ÂÈÎÚ¿ÙËÛÂ, ÒÛÙ ÛÙ· ̤۷ ÙÔ˘ 16Ô˘ ·ÈÒÓ· Ó· ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÁÈ· fiϘ ÙȘ ·ı‹ÛÂȘ ÙÔ˘ ÙÚȯˆÙÔ‡ Ù˘ ÎÂÊ·Ï‹˜. OÚfiÛËÌÔ ÛÙËÓ È·ÙÚÈ΋ Ì˘ÎËÙÔÏÔÁ›· ·ÔÙÂÏ› Ë ·Ó·Î¿Ï˘„Ë ·fi ÙÔ˘˜ J. Schöenlein Î·È R. Remak, ÛÙȘ ·Ú¯¤˜ ÙÔ˘ 19Ô˘ ·ÈÒÓ·, fiÙÈ Ô Ì‡ÎËÙ·˜ ∞¯fiÚÈÔÓ (ÛËÌÂÚÈÓ‹ ÔÓÔÌ·Û›· Trichophyton schoenleinii) Â›Ó·È Ô ·ÈÙÈÔÏÔÁÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÙÔ˘ ¿¯ÔÚ· (2). ∆· ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο Ù˘ ÓfiÛÔ˘, Ô ÙÚfiÔ˜ ÌÂÙ¿‰ÔÛ˘, ηıÒ˜ Î·È Ô ÙÚfiÔ˜ ·Ú·ÛÈÙÈÛÌÔ‡ ÙÔ˘ ̇ÎËÙ· ÛÙËÓ ÙÚ›¯· ÂÚÈÁÚ¿ÊËÎ·Ó ·fi ÙÔÓ Gruby, Û ̛· ÛÂÈÚ¿ ·fi ÌÂϤÙ˜ ÙÔ˘, ÌÂٷ͇ ÙˆÓ ÂÙÒÓ 1840-1844 (3). O Sabouraud, ÛÙ· Ù¤ÏË ÙÔ˘ 19Ô˘ ·ÈÒÓ·, ÌÂϤÙËÛ ÙË ÌÔÚÊÔÏÔÁ›· ÙˆÓ ‰ÂÚÌ·ÙfiÊ˘ÙˆÓ, ‰È¤ÎÚÈÓ ÙÔ˘˜ ‰È¿ÊÔÚÔ˘˜ Ù‡Ô˘˜ Ì˘ÎËÙÈ¿ÛÂˆÓ (ÌÈÎÚÔÛÔÚ›·, ÙÚȯÔÊ˘Ù›·, ¿¯ÔÚ·˜), ÂÚȤÁÚ·„ ÙËÓ ÎÏÈÓÈ΋ ÙÔ˘˜ ÂÈÎfiÓ· Î·È ·Ú·Ù‹ÚËÛ fiÙÈ Ô ÙÚȯÔÊ˘ÙÈÎfi˜ Ù‡Ô˜ ÌÔÚ› Ó· ÚÔÎÏËı› ·fi ÔÏÏ¿ ›‰Ë ‰ÂÚÌ·ÙfiÊ˘ÙˆÓ (4). ∂›Û˘, Ù·ÍÈÓfiÌËÛ ٷ ‰ÂÚÌ·ÙfiÊ˘Ù· Û ٤ÛÛÂÚ· Á¤ÓË: Trichophyton, Microsporum, Epidermophyton Î·È Achorion. ∆Ô 1934, Ô Emmons, ÌÂÏÂÙÒÓÙ·˜ ÙË ÌÈÎÚÔÛÎÔÈ΋ ÌÔÚÊÔÏÔÁ›· ÙˆÓ ÎÔÓȉ›ˆÓ (ÛÔÚ›ˆÓ) Î·È ÙË ‰ÔÌ‹ ÙˆÓ ˘ÊÒÓ (ÓËÌ·Ù›ˆÓ) ÙˆÓ ‰ÂÚÌ·ÙfiÊ˘ÙˆÓ, ηıfiÚÈÛ ÙÔ Ì¤¯ÚÈ Û‹ÌÂÚ· ·Ô‰ÂÎÙfi Û‡ÛÙËÌ· Ù·ÍÈÓfiÌËÛ‹˜ ÙÔ˘˜ Î·È Ù· η٤ٷÍ Û ÙÚ›· Á¤ÓË: Trichophyton, Microsporum Î·È Epidermophyton (5).
ÚÔÙ›ÌËÛ‹ ÙÔ˘˜ ÚÔ˜ ÙÔÓ ÍÂÓÈÛÙ‹ (¶›Ó·Î·˜ 1). ∆· ÁÂÒÊÈÏ· ›‰Ë ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÌÈÎÚfi ·ÚÈıÌfi ‰ÂÚÌ·ÙfiÊ˘ÙˆÓ, Û·ÚÔÊ˘ÙÔ‡Ó ÛÙÔ ¤‰·ÊÔ˜ Î·È ÚÔηÏÔ‡Ó Ì˘ÎËÙÈ¿ÛÂȘ ÙfiÛÔ ÛÙ· ˙Ò· fiÛÔ Î·È ÛÙÔÓ ¿ÓıÚˆÔ. ∆· ˙ˆfiÊÈÏ· ›‰Ë ÚÔÛ‚¿ÏÏÔ˘Ó Ù· ˙Ò·, ÔÏÏ¿ fï˜ ÛÙÂϤ¯Ë ÙÔ˘˜ ÚÔηÏÔ‡Ó Ì˘ÎËÙÈ¿ÛÂȘ Î·È ÛÙÔÓ ¿ÓıÚˆÔ. ∆· ·ÓıÚˆfiÊÈÏ· ›‰Ë ÚÔÛ‚¿ÏÏÔ˘Ó ·ÔÎÏÂÈÛÙÈο ÙÔÓ ¿ÓıÚˆÔ. ŒÙÛÈ, ÔÚÈṲ̂ӷ ›‰Ë Ì˘Î‹ÙˆÓ fiˆ˜ Ù· ª. gypseum Î·È ª. fulvum Û·ÚÔÊ˘ÙÔ‡Ó ÛÙÔ ¤‰·ÊÔ˜ Î·È ÚÔÛ‚¿ÏÏÔ˘Ó Ù· ˙Ò· Î·È ÙÔÓ ¿ÓıÚˆÔ, Ù· ª. canis Î·È T. mentagrophytes var mentagrophytes ÚÔÛ‚¿ÏÏÔ˘Ó Ù· ˙Ò· Î·È ÙÔÓ ¿ÓıÚˆÔ, ÂÓÒ ¿ÏÏ·, fiˆ˜ Ù· T. rubrum Î·È T. violaceum ·Ú·ÛÈÙÔ‡Ó ·ÔÎÏÂÈÛÙÈο ÛÙËÓ ·ÓıÚÒÈÓË ÎÂÚ·Ù›ÓË ÛÙÈ‚¿‰·. ∞fi Ù· 40 ›‰Ë ‰ÂÚÌ·ÙfiÊ˘ÙˆÓ Ô˘ Â›Ó·È ·ıÔÁfiÓ· ÁÈ· ÙÔÓ ¿ÓıÚˆÔ, ÌfiÓÔ 10-12 ›‰Ë, ·fi Ù· Á¤ÓË Microsporum Î·È Trichophyton Î·È Û·ÓÈfiٷٷ ·fi ÙÔ Á¤ÓÔ˜ Epidermophyton, Û˘Ó‰¤ÔÓÙ·È Ì ‰ÂÚÌ·ÙÔÊ˘Ù›Â˜ ÙÔ˘ ÙÚȯˆÙÔ‡ Ù˘ ÎÂÊ·Ï‹˜.
OÈÎÔÏÔÁ›· ∆· ‰ÂÚÌ·ÙfiÊ˘Ù· ·ÔÙÂÏÔ‡Ó ÔÌ¿‰· ÓËÌ·ÙÔÂȉÒÓ Ì˘Î‹ÙˆÓ Ô˘, Ì ÙË ‚Ô‹ıÂÈ· ÂȉÈÎÒÓ ÚˆÙÂ˚ÓÒÓ Î·È ÂÓ˙‡ÌˆÓ (ÎÂÚ·ÙÈÓ¿Û˜), ·ÔÈÎÔ‰ÔÌÔ‡Ó Î·È ‰ÈÂÈÛ‰‡Ô˘Ó ÛÙËÓ ÎÂÚ¿ÙÈÓË ÛÙÈ‚¿‰·, ÚÔηÏÒÓÙ·˜ ÏÔÈÌÒÍÂȘ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜, ÙˆÓ Ó˘¯ÈÒÓ Î·È ÙˆÓ ÙÚȯÒÓ. ∂ÎÙfi˜ ·fi ÙËÓ Ù·ÍÈÓfiÌËÛ‹ ÙÔ˘˜ Û ÙÚ›· ·Ó¿ÌÔÚÊ· (·ÛÂÍÔ˘·ÏÈο) Á¤ÓË (Trichophyton, Microsporum Î·È ∂pidermophyton), Ù· ‰ÂÚÌ·ÙfiÊ˘Ù· Ù·ÍÈÓÔÌÔ‡ÓÙ·È, ›Û˘, Û ÁÂÒÊÈÏ·, ˙ˆfiÊÈÏ· Î·È ·ÓıÚˆfiÊÈÏ· (6), ·Ó¿ÏÔÁ· Ì ÙÔ Ê˘ÛÈÎfi ÙÔ˘˜ ÂÚÈ‚¿ÏÏÔÓ Î·È ÙËÓ
∂ȉËÌÈÔÏÔÁ›· ∏ Ì˘ÎËÙ›·ÛË ÙÔ˘ ÙÚȯˆÙÔ‡ Ù˘ ÎÂÊ·Ï‹˜ (ª∆∫) Â›Ó·È Ë Û˘ÓËı¤ÛÙÂÚË ‰ÂÚÌ·ÙÈ΋ Ïԛ̈ÍË ÙÔ˘ ÙÚȯˆÙÔ‡ ÎÂÊ·Ï‹˜ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜, ηٿ ÙËÓ ÔÔ›· ÚÔÛ‚¿ÏÏÔÓÙ·È ÔÈ ÙÚ›¯Â˜, ÔÈ ı‡Ï·ÎÔÈ Î·È ÙÔ ÂÚÈ‚¿ÏÏÔÓ ‰¤ÚÌ·. ∂›Ó·È ÌÔÏ˘ÛÌ·ÙÈ΋ ÓfiÛÔ˜, Ë ÔÔ›· ¤¯ÂÈ ˆ˜ ·ÈÙÈÔÏÔÁÈÎfi ·Ú¿ÁÔÓÙ· Ù· ‰ÂÚÌ·ÙfiÊ˘Ù·. ¶ÚÔÛ‚¿ÏÏÂÈ ·È‰È¿ ·fi ÙËÓ ËÏÈΛ· ÙˆÓ 6 ÌËÓÒÓ Ì¤¯ÚÈ ÙËÓ ÂÊ˂›· (7,8). ∂›Ó·È Û¿ÓÈ· ÛÙÔ˘˜ ÂÓ‹ÏÈΘ Î·È ·˘Ùfi ·Ô‰›‰ÂÙ·È ÛÙË Ì˘ÎËÙÔÎÙfiÓÔ ‰Ú¿ÛË ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ ÙÔ˘ ÛÌ‹ÁÌ·ÙÔ˜, Ë ÂÚÈÂÎÙÈÎfiÙËÙ· ÙˆÓ ÔÔ›ˆÓ ·˘Í¿ÓÂÈ ÌÂÙ¿ ÙËÓ ÂÊ˂›· (9,10). ∆· ÁÂÒÊÈÏ· ‰ÂÚÌ·ÙfiÊ˘Ù· Â›Ó·È Â˘Ú¤ˆ˜ ‰È·‰Â‰Ô̤ӷ, ÂÓÒ Ù· ·ÓıÚˆfiÊÈÏ· Î·È ÔÚÈṲ̂ӷ ˙ˆfiÊÈÏ· ›‰Ë Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ¤¯Ô˘Ó ÂÚÈÔÚÈṲ̂ÓË ÁˆÁÚ·ÊÈ΋ ηٷÓÔÌ‹, Ë ÔÔ›· ÂÍ·ÚÙ¿Ù·È ·fi ÙÔÓ ÍÂÓÈÛÙ‹. ∏ ηٷÓÔÌ‹ ·˘Ù‹ ÌÂÙ·‚¿ÏÏÂÙ·È ‰È·¯ÚÔÓÈο ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙˆÓ ‚ÂÏÙÈÒÛÂˆÓ ÛÙȘ Û˘Óı‹Î˜ ‰È·‚›ˆÛ˘ Î·È ˘ÁÈÂÈÓ‹˜, ÙˆÓ ÌÂÙ·ÎÈÓ‹ÛÂˆÓ ÏËı˘ÛÌÒÓ Î·È Ù˘ ·Ó¿Ù˘Í˘ ·ÓÙÈÌ˘ÎËÙÈ·ÛÈÎÒÓ Ê·ÚÌ¿ÎˆÓ (11). ∏ ·Ó·Î¿Ï˘„Ë Ù˘ ÁÎÚÈ˙ÂÔÊÔ˘Ï‚›Ó˘, ÙÔ 1958, ·ÔÙÂÏ› ÔÚfiÛËÌÔ ÁÈ· ÙË ıÂڷ›· ÙˆÓ
427
¶·È‰È·ÙÚÈ΋ 2003;66:426-435
Paediatriki 2003;66:426-435
¶›Ó·Î·˜ 1. ∆· ΢ÚÈfiÙÂÚ· ›‰Ë ÙˆÓ ·ıÔÁfiÓˆÓ ‰ÂÚÌ·ÙfiÊ˘ÙˆÓ ∞ÓıÚˆfiÊÈÏÔÈ Trichophyton spp T. rubrum T. mentagrophytes var interdigitale T. megninii T. violaceum T. tonsurans T. soudanense T. concentricum T. gourvilii T. youndeii T. schoenleinii ∆. raubitschekii Microsporum spp M. audouinii M. audouinii var rivalieri M. ferrugineum
∑ˆfiÊÈÏÔÈ
°ÂÒÊÈÏÔÈ
T. T. T. T. T.
T. terestre
mentagrophytes var mentagrophytes verrucosum equinum mentagrophtes var erinacei simii
M. M. M. M. M. M.
canis var canis canis var distortum equinum gallinae persicolor nanum
M. M. M. M.
gypseum fulvum paecox vanbreuseghemii
Epidermophyton spp ∂. floccosum
Ì˘ÎËÙÈ¿ÛÂˆÓ Î·È Â›¯Â Û·Ó ·ÔÙ¤ÏÂÛÌ· ÙÔÓ ÛËÌ·ÓÙÈÎfi ÂÚÈÔÚÈÛÌfi ÙˆÓ ÂÓ‰ËÌÈÎÒÓ ÏÔÈÌÒÍÂˆÓ (12). ∏ ÁˆÁÚ·ÊÈ΋ ηٷÓÔÌ‹ ÙˆÓ ‰ÂÚÌ·ÙfiÊ˘ÙˆÓ ÔÈΛÏÂÈ. ™ÙË µfiÚÂÈ· Î·È ÙËÓ ∫ÂÓÙÚÈ΋ ∞ÌÂÚÈ΋ ÂÈÎÚ·Ù¤ÛÙÂÚÔ ·›ÙÈÔ ª∆∫ ·ÔÙÂÏ› Ô ·ÓıÚˆfiÊÈÏÔ˜ ̇ÎËÙ·˜ ∆. tonsurans (90%) (13-15). O ̇ÎËÙ·˜ ÚÔÛ‚¿ÏÏÂÈ Î˘Ú›ˆ˜ πÛ·ÓfiʈÓÔ˘˜ Î·È ∞ÊÚÔ·ÌÂÚÈηÓÔ‡˜ (16). ™ÙË ¡fiÙÈ· ∞ÌÂÚÈ΋, ÙËÓ ∞˘ÛÙÚ·Ï›· Î·È ÙË ¡¤· ∑ËÏ·Ó‰›· ÂÈÎÚ·ÙÔ‡Ó Ù· ›‰Ë M. canis Î·È T. tonsurans (7,17). ™ÙË ¢˘ÙÈ΋ Î·È ¡fiÙÈ· ∞Û›· ÙÔ Û˘ÓËı¤ÛÙÂÚÔ Â›‰Ô˜ Â›Ó·È ÙÔ T. violaceum (18), ÂÓÒ ÛÙȘ ¯ÒÚ˜ Ù˘ ª¤Û˘ ∞Ó·ÙÔÏ‹˜ ÂÈÎÚ·ÙÔ‡Ó Ù· ›‰Ë M. canis, T. violaceum Î·È T. mentagrophytes var mentagrophytes (19,20). ™ÙËÓ ∞ÊÚÈ΋, Ì ÂÍ·›ÚÂÛË ÙËÓ ∞›Á˘ÙÔ fiÔ˘ ÚÔÂÍ¿Ú¯ÂÈ ÙÔ M. canis (21), ÂÓ‰ËÌÔ‡Ó Î˘Ú›ˆ˜ ·ÓıÚˆfiÊÈÏ· ›‰Ë, fiˆ˜ Ù· ∆. violaceum, M. audouinii, M. rivalieri, T. soudanense, M. ferrugineum Î·È T. schoenleinii, ∆. yaoundei Î·È T. gourvilii (22,23). ™Â ·ÚÎÂÙ¤˜ ¯ÒÚ˜ Ù˘ ∞ÊÚÈ΋˜ ÙÔ ÔÛÔÛÙfi ÙˆÓ ·ÛıÂÓÒÓ Ì ÂÓÂÚÁ‹ ÓfiÛÔ ·Ó¤Ú¯ÂÙ·È Û 10-30% (21). ™ÙË ¢˘ÙÈ΋ ∂˘ÚÒË, Û‡Ìʈӷ Ì ÚfiÛÊ·ÙË ÂȉËÌÈÔÏÔÁÈ΋ ÌÂϤÙË ÙˆÓ ª∆∫ Û 19 Â˘Úˆ·˚Τ˜ ¯ÒÚ˜, ·Ú·ÙËÚ‹ıËÎÂ, ηٿ ÙËÓ ÙÂÏÂ˘Ù·›· ‰ÂηÂÙ›·, ÌÂÁ¿ÏË ·‡ÍËÛË ÙˆÓ ·ÓıÚˆÔÊÈÏÈÎÒÓ ÏÔÈÌÒÍÂˆÓ È‰È·›ÙÂÚ· ÛÙȘ ·ÛÙÈΤ˜ ÂÚÈÔ¯¤˜, Ì ·ÔÙ¤ÏÂÛÌ· Ó· ˘ÂÚÙÂÚÔ‡Ó ÙˆÓ ˙ˆÔÊÈÏÈÎÒÓ Û ·Ó·ÏÔÁ›· 1:0,8 (24). ∏ ·‡ÍËÛË ·˘Ù‹ Û˘Ó‰¤ÂÙ·È Ì ÙËÓ ÂÈÛÚÔ‹ ÌÂÙ·Ó·ÛÙÒÓ ·fi ¯ÒÚ˜ Ù˘ ∞ÊÚÈ΋˜ Î·È Ù˘ ∞Û›·˜ (25). ¶·Ú¿ Ù·‡Ù·, Ô ˙ˆfiÊÈÏÔ˜ M. canis Â›Ó·È Ô ÂÈÎÚ·Ù¤ÛÙÂÚÔ˜ ̇ÎËÙ·˜, Ì ÌÂÁ·Ï‡ÙÂÚË Â›ÙˆÛË ÛÙȘ ¯ÒÚ˜ Ù˘ ¡fiÙÈ·˜ ∂˘ÚÒ˘ (8,26-28).
428
∆ËÓ ÙÂÏÂ˘Ù·›· ÙÚÈ·ÎÔÓÙ·ÂÙ›· ·Ú·ÙËÚ‹ıËÎ·Ó ÛËÌ·ÓÙÈΤ˜ ·ÏÏ·Á¤˜ ÛÙËÓ ÂȉËÌÈÔÏÔÁ›· ÙˆÓ ‰ÂÚÌ·ÙfiÊ˘ÙˆÓ ÛÙË ¯ÒÚ· Ì·˜. ∆· ·ÓıÚˆfiÊÈÏ· ›‰Ë ∆. schoenleinii Î·È M. audouinii, Ù· ÔÔ›· ÂÈÎÚ·ÙÔ‡Û·Ó ÙȘ ÚÒÙ˜ ‰ÂηÂٛ˜ ÙÔ˘ 20Ô‡ ·ÈÒÓ·, ·ÓÙÈηٷÛÙ¿ıËÎ·Ó ‚·ıÌÈ·›· ·fi ÙÔ T. violaceum (29,30), Ë ·ÚÔ˘Û›· ÙÔ˘ ÔÔ›Ô˘, fï˜, ÌÂÈÒıËΠÛËÌ·ÓÙÈο ÛÙË Û˘Ó¤¯ÂÈ· Î·È ·ÓÙÈηٷÛÙ¿ıËΠ·fi ÙÔ ª. canis, ÙÔ ÔÔ›Ô Û‹ÌÂÚ· Â›Ó·È Ô Î˘ÚÈfiÙÂÚÔ˜ ·ÈÙÈÔÏÔÁÈÎfi˜ ·Ú¿ÁÔÓÙ·˜. ∆· ›‰Ë ∆. schoenleinii Î·È M. audouinii ¤¯Ô˘Ó ۯ‰fiÓ ÂÎÚÈ˙ˆı› ÛÙÔÓ ÁËÁÂÓ‹ ÏËı˘ÛÌfi, ÂÓÒ ÙÔ T. violaceum ÂÚÈÔÚ›˙ÂÙ·È Ï¤ÔÓ Û ·ÁÚÔÙÈΤ˜ ÂÚÈÔ¯¤˜ Ù˘ ¯ÒÚ·˜, fiÔ˘ ˘¿Ú¯ÂÈ Û˘Á¯ÚˆÙÈÛÌfi˜ ·ÙfiÌˆÓ Î·È ÔÈ Û˘Óı‹Î˜ ˘ÁÈÂÈÓ‹˜ Î·È ‰È·‚›ˆÛ˘ Â›Ó·È ‰˘ÛÌÂÓ›˜, ηıÒ˜ ›Û˘ Î·È Û ÔÈÎÔÓÔÌÈÎÔ‡˜ ÌÂÙ·Ó¿ÛÙ˜, ·È‰È¿ Î·È ÂÓ‹ÏÈΘ ·fi ¯ÒÚ˜ Ù˘ µ·ÏηÓÈ΋˜ Î·È Ù˘ ∞Ó·ÙÔÏÈ΋˜ ∂˘ÚÒ˘ (31,32). ∂ȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜ Ô˘ ¤ÁÈÓ·Ó Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÛÙË ¯ÒÚ· Ì·˜ ¤‰ÂÈÍ·Ó fiÙÈ Û ·ÛıÂÓ›˜ Ì ª∆∫ ¤¯ÂÈ ·ÔÌÔÓˆı› ¢ڇ Ê¿ÛÌ· ·ıÔÁfiÓˆÓ Ì˘Î‹ÙˆÓ, fiˆ˜ Ù· ª. canis, T. violaceum, T. mentagrophytes var mentagrophytes, M. gypseum, T. verrucosum, T. tonsurans, M. audouinii, T. soudanense, M. ferrugineum, T. schoenleinii Î·È T. erinacei (¶›Ó·Î·˜ 2). ∆· ÚÒÙ· 6 ›‰Ë ·fi ·˘Ù¿ ¤¯Ô˘Ó ·ÔÌÔÓˆı› ÛÙÔÓ ÁËÁÂÓ‹ ÏËı˘ÛÌfi (28,3336), ÂÓÒ Ù· ˘fiÏÔÈ· ¤¯Ô˘Ó ·ÔÌÔÓˆı› Û ·È‰È¿ ÌÂÙ·Ó·ÛÙÒÓ ·fi ¯ÒÚ˜ Ù˘ ∞ÊÚÈ΋˜ Î·È Ù˘ ∞Û›·˜, fiÔ˘ Ù· ›‰Ë ·˘Ù¿ ÂÓ‰ËÌÔ‡Ó (37,38). ∆Ô T. violaceum ·ÔÌÔÓÒıËÎÂ, ›Û˘, Û ·È‰È¿ ÌÂÙ·Ó·ÛÙÒÓ ·fi ÙËÓ ∞Ï‚·Ó›· Î·È ÙËÓ ∞Ó·ÙÔÏÈ΋ ∂˘ÚÒË (31,32). °È· ÙÔÓ ·ÓıÚˆfiÊÈÏÔ Ì‡ÎËÙ· ∆. rubrum,
¶·È‰È·ÙÚÈ΋ 2003;66:426-435
Paediatriki 2003;66:426-435
Û‡ÓËı˜ ·›ÙÈÔ Ì˘ÎËÙÈ¿ÛÂˆÓ Ó˘¯ÈÒÓ Î·È ‰¤ÚÌ·ÙÔ˜ ÛÙÔ˘˜ ÂÓ‹ÏÈΘ, ˘¿Ú¯Ô˘Ó ÛÔÚ·‰ÈΤ˜ ·Ó·ÊÔÚ¤˜ ª∆∫ Ì ¿Ù˘Ë ÎÏÈÓÈ΋ ÂÈÎfiÓ· (39). ∆Ô ·ÓıÚˆfiÊÈÏÔ Â›‰Ô˜ ∂. floccosum ÂÍ·ÈÚÂÙÈο Û¿ÓÈ· ·ÔÙÂÏ› ·›ÙÈÔ ª∆∫ (40), ÂÓÒ ‰ÂÓ ˘¿Ú¯ÂÈ ·Ó·ÊÔÚ¿ ÁÈ· ÙÔ ·ÓıÚˆfiÊÈÏÔ Â›‰Ô˜ ∆. concentricum (11). ™˘ÌÂÚ·ÛÌ·ÙÈο, ·Ú·ÙËÚ›ٷÈ: ·) ·‡ÍËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ ÙÔ˘ M. canis ÛÙË ¡fiÙÈ· ∞ÌÂÚÈ΋, ÛÙË ¡fiÙÈ· Î·È ∞Ó·ÙÔÏÈ΋ ∂˘ÚÒË Î·È ÛÙË ª¤ÛË ∞Ó·ÙÔÏ‹, ‚) ·‡ÍËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ ÙÔ˘ T. tonsurans ÛÙË µfiÚÂÈ· ∞ÌÂÚÈ΋ Î·È Û ÔÚÈṲ̂Ó˜ ¯ÒÚ˜ Ù˘ ∂˘ÚÒ˘ (∞ÁÁÏ›·, °·ÏÏ›·), Á) ·Ú·ÌÔÓ‹ ÙÔ˘ ∆. violaceum Û ÔÚÈṲ̂Ó˜ ÂÚÈÔ¯¤˜ Ù˘ ∞Ó·ÙÔÏÈ΋˜ ∂˘ÚÒ˘, Ù˘ ∞ÊÚÈ΋˜ Î·È ÛÙËÓ πÓ‰›·, ‰) ·Ú·ÌÔÓ‹ ÂÓ‰ËÌÈÎÒÓ Ì˘Î‹ÙˆÓ ÛÙËÓ ∞ÊÚÈ΋, fiˆ˜ ÙÔ˘ T. soudanense Î·È ÙÔ˘ M. ferrugineum Â) ÂÌÊ¿ÓÈÛË ÛÙËÓ ∂˘ÚÒË ÔÚÈÛÌ¤ÓˆÓ ·ÓıÚˆfiÊÈÏˆÓ Ì˘Î‹ÙˆÓ, fiˆ˜ Ô T. soudanense, Ô M. audouinii Î·È Ô T. Violaceum, Û ÎÔÈÓfiÙËÙ˜ ÌÂÙ·Ó·ÛÙÒÓ ·fi ÙËÓ ∞ÊÚÈ΋, ÙËÓ ∞Û›· Î·È ÙË ¡ÔÙÈÔ·Ó·ÙÔÏÈ΋ ∂˘ÚÒË Î·È ÛÙ) ÂÎÚ›˙ˆÛË ÙÔ˘ ∆. shoenleinii ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ¯ÒÚ˜, ÏËÓ Ù˘ ∞ÊÚÈ΋˜ (41). ∏ ª∆∫ ÚÔÛ‚¿ÏÏÂÈ Î˘Ú›ˆ˜ ·È‰È¿ ÚÔÛ¯ÔÏÈ΋˜ Î·È Û¯ÔÏÈ΋˜ ËÏÈΛ·˜, ÌÂٷ͇ 3-8 ÂÙÒÓ (8,27,28,42). Œ¯ÂÈ, ›Û˘, ·Ú·ÙËÚËı› fiÙÈ Ë Û˘¯ÓfiÙËÙ¿ Ù˘ Â›Ó·È Û˘Ó¿ÚÙËÛË ÙÔ˘ ʇÏÔ˘ Î·È ÙÔ˘ ·ÈÙÈÔÏÔÁÈÎÔ‡ ·Ú¿ÁÔÓÙ· (43). OÈ ÌÈÎÚÔÛÔÚÈÎÔ› ̇ÎËÙ˜ ÚÔÛ‚¿ÏÏÔ˘Ó Î·Ù¿ ÚÔÙ›ÌËÛË ÙÔ ¿ÚÚÂÓ Ê‡ÏÔ, ÂÓÒ ÛÙÔ˘˜ ÙÚȯÔÊ˘ÙÈÎÔ‡˜ Ë Î·Ù·ÓÔÌ‹ ÌÂٷ͇ ÙˆÓ ‰‡Ô Ê‡ÏˆÓ Â›Ó·È ÈÛfiÚÚÔË (28,43). ∆o M. canis ÚÔÛ‚¿ÏÏÂÈ Î·È Ù· ‰‡Ô ʇϷ, ȉȷ›ÙÂÚ· fï˜ Ù· ·ÁfiÚÈ·, ÂÓÒ ÙÔ M. audouinii ·ÚÔ˘ÛÈ¿˙ÂÈ ˘„ËÏ‹ ÂÈÏÂÎÙÈÎfiÙËÙ· (5:1) ÛÙ· ·ÁfiÚÈ· ¤Ó·ÓÙÈ ÙˆÓ ÎÔÚÈÙÛÈÒÓ (44). ™Â ÚfiÛÊ·ÙË ÌÂϤÙË Ô˘ ¤ÁÈÓ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô “∞. ™˘ÁÁÚfi˜”, Ë Û¯¤ÛË ÙˆÓ ·ÁÔÚÈÒÓ ÚÔ˜ Ù· ÎÔÚ›ÙÛÈ· ‹Ù·Ó 6:1 ÁÈ· ÙÔ˘˜ ÌÈÎÚÔÛÔÚÈÎÔ‡˜ ̇ÎËÙ˜ M. audouinii, M.
ferrugineum Î·È ª. gypseum, ÂÓÒ ÁÈ· ÙÔ ª. canis Ë ·Ó·ÏÔÁ›· ‹Ù·Ó ÌfiÓÔ 1,3:1. ¶Èı·ÓÒ˜, Ù· ÎÔÓÙ¿ Ì·ÏÏÈ¿ ÙˆÓ ·ÁÔÚÈÒÓ Ó· ¢ÓÔÔ‡Ó ÙËÓ ÂÌʇÙ¢ÛË ÙˆÓ ÛÔÚ›ˆÓ (16). ∞ÓÙ›ıÂÙ·, Ë Î·Ù·ÓÔÌ‹ ÙÔ˘ T. violaceum ‹Ù·Ó ÂÚ›Ô˘ 1:1 (38). ∆ÚfiÔ˜ ÌfiÏ˘ÓÛ˘ ∏ ÌÂÙ¿‰ÔÛË ÙˆÓ ˙ˆÔÊÈÏÈÎÒÓ ÏÔÈÌÒÍÂˆÓ Á›ÓÂÙ·È Â›Ù Ì ÙËÓ ¿ÌÂÛË Â·Ê‹ Ì ηÙÔÈΛ‰È· ‹ ¿ÁÚÈ· ˙Ò· Ô˘ Â›Ó·È ÌÔÏ˘Ṳ̂ӷ ‹ ÓÔÛÔ‡Ó Â›Ù ¤ÌÌÂÛ·, Ì ÂÓÂÚÁ¿ ÎÔÓ›‰È·, Ù· ÔÔ›· ·Ó¢ڛÛÎÔÓÙ·È Û ÊÚ¿ÎÙ˜, ÛÙ¿‚ÏÔ˘˜ Î.Ï. ∏ ·ÚÈ· ËÁ‹ ÌfiÏ˘ÓÛ˘ ÁÈ· ÙÔ ª. canis Â›Ó·È Ù· ηÙÔÈΛ‰È· ˙Ò· (Á¿Ù˜, Û·ÏÔÈ), ΢ڛˆ˜ Ù· ·‰¤ÛÔÙ· (28,33,36). ∏ ‰ÂÍ·ÌÂÓ‹ ·˘Ù‹ ÌfiÏ˘ÓÛ˘ Â›Ó·È ··Ú·›ÙËÙË, ‰Â‰Ô̤ÓÔ˘ fiÙÈ Ë ÌÔÏ˘ÛÌ·ÙÈ΋ ÈÛ¯‡˜ ÙÔ˘ M. canis ÂÍ·ÛıÂÓ› Û ÌÂÁ¿ÏÔ ‚·ıÌfi ÌÂÙ¿ ·fi Ù¤ÛÛÂÚȘ ‰È·‰Ô¯ÈΤ˜ ÌÂÙ·‚È‚¿ÛÂȘ ·fi ¿ÓıÚˆÔ Û ¿ÓıÚˆÔ (45). ∏ ËÁ‹ ÌfiÏ˘ÓÛ˘ ÁÈ· ÙÔ T. verrucosum Â›Ó·È Ù· ‚ÔÔÂȉ‹ Î·È Ù· ·ÈÁÔÚfi‚·Ù· Ô˘ ÓÔÛÔ‡Ó, ÂÓÒ ÁÈ· ÙÔ ∆. mentagrophytes var mentagrophytes Â›Ó·È oÈ ¯Ô›ÚÔÈ, ÔÈ ÎfiÓÈÎÏÔÈ, Ù· ·ÈÁÔÚfi‚·Ù· Î·È Ù· ÙÚˆÎÙÈο. OÈ ÁÂÒÊÈÏÔÈ Ì‡ÎËÙ˜ Û·ÓÈfiٷٷ ÂÌϤÎÔÓÙ·È ˆ˜ ·ÈÙÈÔÏÔÁÈÎÔ› ·Ú¿ÁÔÓÙ˜ ª∆∫. ¶ËÁ‹ ÌfiÏ˘ÓÛ˘ ÁÈ· ÙȘ ·ÓıÚˆÔÊÈÏÈΤ˜ ÏÔÈÌÒÍÂȘ ·ÔÙÂÏÔ‡Ó ÔÈ ¿Û¯ÔÓÙ˜ Î·È Û ÛËÌ·ÓÙÈÎfi ‚·ıÌfi ÔÈ ·Û˘Ìو̷ÙÈÎÔ› ÊÔÚ›˜ Ù˘ ÓfiÛÔ˘ (46,47). ∏ ÌÂÙ¿‰ÔÛË ÙˆÓ ·ÓıÚˆÔÊÈÏÈÎÒÓ ÏÔÈÌÒÍÂˆÓ Á›ÓÂÙ·È Â›Ù Ì ¿ÌÂÛË Â·Ê‹ Ì ¿Û¯ÔÓÙ· ‹ ·Û˘Ìو̷ÙÈÎfi ÊÔÚ¤· ›Ù ¤ÌÌÂÛ·, Ì ÌÔÏ˘Ṳ̂ӷ ·ÓÙÈΛÌÂÓ·, fiˆ˜ ›‰Ë ÎÔÌ̈ÙÈ΋˜, ÚÔ‡¯·, η¤Ï·, ÂÙÛ¤Ù˜, ÎÏÈÓÔÛοÛÌ·Ù·, ·ÎÔ˘ÛÙÈο ÙËÏÂʈÓÈÎÒÓ Û˘Û΢ÒÓ, ·È¯Ó›‰È· Î.¿. (48,49). ∫ÔÓ›‰È· (ÛfiÚÈ·) Ì˘Î‹ÙˆÓ ¤¯Ô˘Ó ·ÔÌÔÓˆı› fi¯È ÌfiÓÔÓ Û ÙÚ›¯Â˜ ·Û¯fiÓÙˆÓ Ô˘ ¤¯Ô˘Ó ·Ô¤ÛÂÈ, ·ÏÏ¿ Î·È Û ÌÔÏ˘Ṳ̂ӷ ·ÓÙÈΛÌÂÓ· Î·È ¤ÈÏ· ÙÔ˘ ÛÈÙÈÔ‡.
¶›Ó·Î·˜ 2. ∂›‰Ë ‰ÂÚÌ·ÙfiÊ˘ÙˆÓ Ô˘ ·ÔÌÔÓÒıËÎ·Ó Û ·È‰È¿ ÌÂ Ì˘ÎËÙ›·ÛË ÙÔ˘ ÙÚȯˆÙÔ‡ Ù˘ ÎÂÊ·Ï‹˜ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô “∞. ™˘ÁÁÚfi˜” ηٿ ÙËÓ ÂÍ·ÂÙ›· 1996-2001 °ËÁÂÓ›˜ ¢ÂÚÌ·ÙfiÊ˘ÙÔ
No
%
A
£
M. canis T. violaceum M. audouinii T. mentagrÔphytes var ment M. ferrugineum M. gypseum T. verrucosum T. soudanense T. rubrum T. schoenleinii T. erinacei ™‡ÓÔÏÔ
454 31 9 6 7 5 2 3 2 1 1 521
87,1 6,0 1,7 1,2 1,3 1,0 0,4 0,6 0,4 0,2 0,2 100,0
233 10 4 4 2 2 255
163 8 1 1 173
ªÂÙ·Ó¿ÛÙ˜ ∞ £ 32 6 8 1 6 2 55
26 7 1 1 1 1 1 38
429
¶·È‰È·ÙÚÈ΋ 2003;66:426-435
∆· ÎÔÓ›‰È· Â›Ó·È ‚ÈÒÛÈÌ· ÁÈ· ÌÂÁ¿ÏÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·, Ë ‰Â ·Ú·ÌÔÓ‹ ÙÔ˘˜ Û ¤ÈÏ· Î·È ·ÓÙÈΛÌÂÓ· ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ ÙÔ˘ ·ÛıÂÓÔ‡˜ ÂÍËÁ› fi¯È ÌfiÓÔÓ ÙË ÌÂÙ¿‰ÔÛË Ù˘ ÓfiÛÔ˘ ÂÓ ·Ô˘Û›· ÍÂÓÈÛÙ‹, ·ÏÏ¿ Î·È ÙËÓ Ù˘¯fiÓ ·ÔÙ˘¯›· Ù˘ ıÂڷ›·˜, ηıÒ˜ ›Û˘ Î·È ÙȘ Û˘¯Ó¤˜ ˘ÔÙÚÔ¤˜ Ù˘ ÓfiÛÔ˘ ÌÂÙ¿ ÙË ıÂڷ›·. ∏ ÌÂÙ¿‰ÔÛË Á›ÓÂÙ·È Â›Ù ÛÙÔ Û›ÙÈ ·fi ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÂÚÈ‚¿ÏÏÔÓ ‹ Û ¿ÏÏÔ˘˜ ÙfiÔ˘˜ Û˘Á¯ÚˆÙÈÛÌÔ‡, fiˆ˜ Ù· ÓËÈ·ÁˆÁ›·, Ù· Û¯ÔÏ›·, Ù· ÓÔÛÔÎÔÌ›·, Ù· ÎÔ˘Ú›· Î.¿. (50,51), ÂÓÒ ‰È¢ÎÔχÓÂÙ·È ·fi ÙÔÓ ÛÙÂÓfi Û˘Á¯ÚˆÙÈÛÌfi Î·È ÙËÓ Î·Î‹ ·ÙÔÌÈ΋ ˘ÁÈÂÈÓ‹. ™ËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙË ÌÂÙ¿‰ÔÛË ·ÏÏ¿ Î·È ÙË Û˘ÓÙ‹ÚËÛË ÙˆÓ ÂȉËÌÈÒÓ Î·Ù¤¯ÂÈ Ë ‡·ÚÍË ·Û˘Ìو̷ÙÈÎÒÓ ÊÔÚ¤ˆÓ. ø˜ ·Û˘Ìو̷ÙÈÎÔ› ÊÔÚ›˜ ÔÚ›˙ÔÓÙ·È Ù· ¿ÙÔÌ· Ô˘ ‰ÂÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÂÌÊ·Ó‹ ÎÏÈÓÈ΋ ÂÈÎfiÓ· Ì˘ÎËÙ›·Û˘, ¤¯Ô˘Ó Û˘¯Ó¿ ·ÚÓËÙÈο ¿ÌÂÛ· ÌÈÎÚÔÛÎÔÈο ·Ú·Û΢¿ÛÌ·Ù·, ·ÏÏ¿ ÔÈ Î·ÏÏȤÚÁÂȘ Â›Ó·È ÙÂÏÈο ıÂÙÈΤ˜ (43,47). ŸÏ˜ ۯ‰fiÓ ÔÈ ·Ó·ÊÔÚ¤˜ Ì ˘„ËÏfi ÔÛÔÛÙfi ·Û˘Ìو̷ÙÈÎÒÓ ÊÔÚ¤ˆÓ ·ÊÔÚÔ‡Ó Û ·ÓıÚˆfiÊÈÏÔ˘˜ ̇ÎËÙ˜, fiˆ˜ ÔÈ T. tonsurans Î·È T. violaceum Î·È Û ‹È·˜ ÌÔÚÊ‹˜ Ïԛ̈ÍË, ÔÌÔÈ¿˙Ô˘Û· Ì ÛÌËÁÌ·ÙÔÚÚÔ˚΋ ‰ÂÚÌ·Ù›Ùȉ· (46). ∆Ô ÔÛÔÛÙfi ÙˆÓ ·Û˘Ìو̷ÙÈÎÒÓ ÊÔÚ¤ˆÓ ÔÈΛÏÏÂÈ ÛËÌ·ÓÙÈο Î·È Û¯ÂÙ›˙ÂÙ·È Ì ÙË Û˘¯ÓfiÙËÙ· ÙˆÓ ª∆∫ ·Ó¿ ¯ÒÚ·. OÚÈṲ̂Ó˜ ÌÂϤÙ˜, ÔÈ Ôԛ˜ ¤ÁÈÓ·Ó Û ۯÔÏ›· Î·È Û ÎÔÈÓfiÙËÙ˜, fiÔ˘ Ë ª∆∫ Â›Ó·È Û˘¯Ó‹, ¤‰ÂÈÍ·Ó fiÙÈ ÙÔ ÔÛÔÛÙfi ÙˆÓ ·Û˘Ìو̷ÙÈÎÒÓ ÊÔÚ¤ˆÓ ·Ó¤Ú¯ÂÙ·È Û 15% ÂÚ›Ô˘ (23,51), ÂÓÒ ·ÓÙ›ıÂÙ·, Û ¢Ú›· ÌÂϤÙË Ì·ıËÙÒÓ Ô˘ ¤ÁÈÓ ÛÙËÓ πÛ·Ó›· Î·È ÙËÓ πÙ·Ï›·, ÙÔ ÔÛÔÛÙfi Â›Ó·È ÂÍ·ÈÚÂÙÈο ¯·ÌËÏfi (0,2% Î·È 0,3%, ·ÓÙ›ÛÙÔȯ·) (52,53). ¶Ôχ ˘„ËÏ¿ ÔÛÔÛÙ¿ ·Û˘Ìو̷ÙÈÎÒÓ ÊÔÚ¤ˆÓ ·Ó·Ê¤ÚÔÓÙ·È ÛÙË ¡fiÙÈ· ∞ÊÚÈ΋, fiÔ˘ ÂÓ‰ËÌ› ÙÔ ∆. violaceum. OÈ Nail Î·È Û˘Ó ·Ó·Ê¤ÚÔ˘Ó fiÙÈ Û ÔÚÈṲ̂ӷ ̤ÚË Ù˘ ∞ÊÚÈ΋˜ ÔÛÔÛÙfi 41% ÙˆÓ ·È‰ÈÒÓ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ Â›Ó·È ÊÔÚ¤·˜ Î·È 30% ÙˆÓ ÌËÙ¤ÚˆÓ ·˘ÙÒÓ ÙˆÓ ·È‰ÈÒÓ Â›¯Â ÂÓÂÚÁ‹ ÓfiÛÔ (54). OÈ Vargo Î·È Cohen, ÂÍÂÙ¿˙ÔÓÙ·˜ ÙfiÛÔ Ù· ÂÓ‹ÏÈη ̤ÏË fiÛÔ Î·È Ù· ·È‰È¿ Ù˘ ›‰È·˜ ÔÈÎÔÁ¤ÓÂÈ·˜, ‚Ú‹Î·Ó fiÙÈ ÙÔ ÔÛÔÛÙfi ÙˆÓ ·Û˘Ìو̷ÙÈÎÒÓ ÂÓ‹ÏÈÎˆÓ ÊÔÚ¤ˆÓ Ì T. tonsurans ‹Ù·Ó 12%, ÂÓÒ ÙˆÓ ·È‰ÈÒÓ 44% (55). ∞Ó¿ÏÔÁË ÌÂϤÙË Ô˘ ¤ÁÈÓ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô “∞. ™˘ÁÁÚfi˜” Û 25 ·È‰È¿ Ì ª∆∫ ·fi T. violaceum ¤‰ÂÈÍ fiÙÈ ‰‡Ô Ó‹È· ÌÔχÓıËÎ·Ó ·fi ·Û˘Ìو̷ÙÈΤ˜ ÔÈÎȷΤ˜ ‚ÔËıÔ‡˜, 18 ·È‰È¿ ·fi ¿Û¯ÔÓÙ˜ Î·È ·Û˘Ìو̷ÙÈÎÔ‡˜ ÊÔÚ›˜ ÙÔ˘ ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÂÚÈ‚¿ÏÏÔÓÙÔ˜, ÂÓÒ ÁÈ· Ù· ˘fiÏÔÈ· 5 ·È‰È¿ ‰ÂÓ ‹Ù·Ó ‰˘Ó·ÙfiÓ Ó· ÂÓÙÔÈÛÙ› Ë ËÁ‹ ÌfiÏ˘ÓÛ˘ (31). OÈ ·Ú·¿Óˆ ÌÂϤÙ˜ ˘Ô‰ÂÈÎÓ‡Ô˘Ó fiÙÈ ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÂÚÈ‚¿ÏÏÔÓ ‹/Î·È ÙÔ Û¯ÔÏÂ›Ô ·ÔÙÂÏÔ‡Ó ÙÔ˘˜ ¯ÒÚÔ˘˜ fiÔ˘ Ë ÓfiÛÔ˜ ÌÂÙ·‰›‰ÂÙ·È ÛÙ· ·È‰È¿.
430
Paediatriki 2003;66:426-435
¶·ıÔÁ¤ÓÂÈ· ª˘ÎËÙ›·ÛË ÙÔ˘ ÙÚȯˆÙÔ‡ Ù˘ ÎÂÊ·Ï‹˜ ÚÔηÏÔ‡Ó ÌfiÓÔ Ù· ‰ÂÚÌ·ÙfiÊ˘Ù·. ∞Ó·ÊÔÚ¤˜ fiÙÈ ¿ÏÏ· ›‰Ë, fiˆ˜ Ù· ÌË ‰ÂÚÌ·ÙfiÊ˘Ù·, ÌÔÚÔ‡Ó Ó· ÚÔηϤÛÔ˘Ó ª∆∫ ‰ÂÓ ¤¯Ô˘Ó ÂȂ‚·Èˆı› ÌÂ Û˘Ì‚·ÙÈΤ˜ ÂÚÁ·ÛÙËÚȷΤ˜ ÌÂıfi‰Ô˘˜ (ÌÈÎÚÔÛÎfiËÛË-ηÏÏȤÚÁÂÈ·). O Ì˯·ÓÈÛÌfi˜ ·Ó¿Ù˘Í˘ ÙˆÓ ‰ÂÚÌ·ÙfiÊ˘ÙˆÓ ÛÙËÓ ÙÚ›¯· ‰ÂÓ Â›Ó·È Ï‹Úˆ˜ ÁÓˆÛÙfi˜. ∏ ‰˘Ó·ÙfiÙËÙ· ÎÂÚ·ÙfiÏ˘Û˘ ‰ÂÓ ·ÔÙÂÏ› ¤Ó‰ÂÈÍË ·ıÔÁfiÓÔ˘ ‰˘Ó·ÌÈÎÔ‡ ÂÓfi˜ ̇ÎËÙ·, ‰Â‰Ô̤ÓÔ˘ fiÙÈ ˘¿Ú¯ÂÈ Ï‹ıÔ˜ Ì˘Î‹ÙˆÓ Ô˘ ·Ó·Ù‡ÛÛÔÓÙ·È ÛÙËÓ ÎÂÚ·Ù›ÓË ÛÙÈ‚¿‰·, ·ÏÏ¿ ‰ÂÓ ÚÔÛ‚¿ÏÏÔ˘Ó ÙËÓ ÙÚ›¯·, fiˆ˜ .¯. ÔÈ Ì‡ÎËÙ˜ T. concentricum, Scytalidium dimidiatum Î·È ∂. floccosum (13). ∏ ÌÂÙ·ÊÔÚ¿ ÎÔÓȉ›ˆÓ ‹ ˘ÊÒÓ ·fi ·ÛıÂÓ‹ ‹ ÌÔÏ˘Ṳ̂ӷ ·ÓÙÈΛÌÂÓ· ÛÙËÓ ÎÂÊ·Ï‹ ˘ÁÈÔ‡˜ ·ÙfiÌÔ˘ ‰ÂÓ Û˘Ó¿ÁÂÙ·È Î·Ù’ ·Ó¿ÁÎËÓ ÙË ÌfiÏ˘ÓÛË. ™‡Ìʈӷ Ì ÙÔÓ Kligman, ÚÔËÁÂ›Ù·È ÚÔÛ‚ÔÏ‹ Ù˘ ÎÂÚ¿ÙÈÓ˘ ÛÙÈ‚¿‰·˜ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ Ù˘ ÎÂÊ·Ï‹˜ Î·È ¤ÂÙ·È Ë ÚÔÛ‚ÔÏ‹ ÙˆÓ ÙÚȯÒÓ (56). ¶Èı·ÓfiÓ Ó· Â›Ó·È ·Ó·Áη›· Ë ‡·ÚÍË ÙÚ·‡Ì·ÙÔ˜, ÙÔ ÔÔ›Ô ‚ÔËı¿ ÛÙÔÓ ÂÓÔÊı·ÏÌÈÛÌfi ÙÔ˘ ̇ÎËÙ·. ∏ Ïԛ̈ÍË ·Ú¯›˙ÂÈ Ì ÙËÓ ÚÔÛÎfiÏÏËÛË ÙˆÓ ÎÔÓȉ›ˆÓ ÛÙËÓ ÂÈÊ¿ÓÂÈ· ÙˆÓ ÎÂÚ·ÙÈÓÔ΢ÙÙ¿ÚˆÓ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜. ∞ÎÔÏÔ˘ı› Â΂ϿÛÙËÛË, ÔÏÏ·Ï·ÛÈ·ÛÌfi˜ Î·È ‰È›ۉ˘ÛË ÙÔ˘ ̇ÎËÙ· Ê˘ÁÔÎÂÓÙÚÈο ÛÙËÓ ÎÂÚ¿ÙÈÓË ÛÙÈ‚¿‰· Ì ÙË ‚Ô‹ıÂÈ· ÚˆÙÂÔÏ˘ÙÈÎÒÓ ÂÓ˙‡ÌˆÓ, ÙȘ ÎÂÚ·ÙÈÓ¿Û˜, Ô˘ ÂÎÎÚ›ÓÂÈ Ô Ì‡ÎËÙ·˜. ∏ ¯ÚÔÓÈ΋ ÂÚ›Ô‰Ô˜ ·fi ÙÔÓ ÂÓÔÊı·ÏÌÈÛÌfi ̤¯ÚÈ ÙËÓ ÚÔÛ‚ÔÏ‹ Ù˘ ÙÚ›¯·˜ Â›Ó·È ÂÚ›Ô˘ ÙÚÂȘ ‚‰ÔÌ¿‰Â˜ (57). ∆· ‰ÂÚÌ·ÙfiÊ˘Ù· ÚÔÛ‚¿ÏÏÔ˘Ó ÌfiÓÔÓ ÙȘ ·Ó·Ù˘ÛÛfiÌÂÓ˜ ÙÚ›¯Â˜ (·Ó·ÁÂÓ‹˜ Ê¿ÛË). ∆Ô Û٤ϯԘ Ù˘ ÙÚ›¯·˜ ÚÔÛ‚¿ÏÏÂÙ·È ÛÙÔ Ì¤ÛÔÓ ÂÚ›Ô˘ ÙÔ˘ ‡„Ô˘˜ ÙÔ˘ ı‡Ï·Î·. OÈ ÂÓÙfi˜ ÙÔ˘ ÛÙÂϤ¯Ô˘˜ ˘Ê¤˜ ·Ó·Ù‡ÛÛÔÓÙ·È ÚÔ˜ Ù· οو, ÚÔ˜ ÙÔÓ ‚ÔÏ‚fi, ·ÏÏ¿ Ë ·Ó¿Ù˘ÍË ÛÙ·Ì·Ù¿ ÛÙÔ ÛËÌÂ›Ô fiÔ˘ Ë ÎÂÚ·ÙÈÓÔÔ›ËÛË Â›Ó·È ·ÙÂÏ‹˜. ™ÙÔ ÛËÌÂ›Ô ·˘Ùfi, ÔÈ ÎÔÚ˘Ê¤˜ ÙˆÓ ˘ÊÒÓ Û¯ËÌ·Ù›˙Ô˘Ó ı‡Û·ÓÔ Ì ÌÔÚÊ‹ § (ı‡Û·ÓÔ˜ Adamson). OÈ ÂÓÙfi˜ ÙÔ˘ ÛÙÂϤ¯Ô˘˜ ˘Ê¤˜ ÌÂٷʤÚÔÓÙ·È, ηıÒ˜ ·Ó·Ù‡ÛÛÂÙ·È Ë ÙÚ›¯·, ÚÔ˜ Ù· ¿ӈ, ‰È·ÙËÚÒÓÙ·˜ fï˜ ÙË Û¯ÂÙÈ΋ ı¤ÛË ÙÔ˘˜ ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ‚ÔÏ‚Ô‡. ™ÙȘ Â͈ÙÚȯÈΤ˜ ÏÔÈÌÒÍÂȘ, ·ÚÈıÌfi˜ Ï¢ÚÈÎÒÓ ·Ï‡ÛÂˆÓ ÙˆÓ ˘ÊÒÓ ‰È·ÂÚÓ¿ ÙÔ Û٤ϯԘ Ù˘ ÙÚ›¯·˜ Î·È ·Ó·Ù‡ÛÛÂÈ ˘ÎÓfi Ì˘Î‹ÏÈÔ ÛÙËÓ ÂÈÊ¿ÓÂÈ¿ ÙÔ˘, ÙÔ ÔÔ›Ô Î·Ù·ÎÂÚÌ·Ù›˙ÂÙ·È Û¯ËÌ·Ù›˙ÔÓÙ·˜ ÔÏ˘¿ÚÈıÌ· ÛfiÚÈ·, Ù· ÔÔ›· ÂÚÈ‚¿ÏÏÔ˘Ó ÙËÓ ÙÚ›¯· Î·È ÚÔηÏÔ‡Ó Î·Ù·ÛÙÚÔÊ‹ ÙÔ˘ ÂÚÈÙÚȯ›Ô˘. ∫·Ù¿ ÙËÓ ·fiÛ·Û‹ Ù˘, Ë ÙÚ›¯· Û¿ÂÈ ÛÙÔ ÈÔ ·‰‡Ó·ÙÔ ÛËÌ›Ô, ·ÎÚÈ‚Ò˜ ¿Óˆ ·fi ÙÔÓ ı‡Û·ÓÔ ÙÔ˘ Adamson. ™ÙȘ ÂÓ‰ÔÙÚȯÈΤ˜ ÏÔÈÌÒÍÂȘ, Ë ·Ó¿Ù˘ÍË ÙˆÓ ÛÔÚ›ˆÓ Á›ÓÂÙ·È Ì¤Û· ÛÙÔ Û٤ϯԘ Ù˘ ÙÚ›¯·˜,
¶·È‰È·ÙÚÈ΋ 2003;66:426-435
ÂÓÒ ÙÔ ÂÚÈÙÚ›¯ÈÔ ·Ú·Ì¤ÓÂÈ ¿ıÈÎÙÔ. ∏ ÙÚ›¯· Á›ÓÂÙ·È Â‡ıÚ·˘ÛÙË Î·È Û¿ÂÈ ÛÙËÓ ÂÈÊ¿ÓÂÈ· ÙÔ˘ ÙÚȯˆÙÔ‡, ·Ê‹ÓÔÓÙ·˜ ÛÙÔ ÛËÌÂ›Ô ÂΛÓÔ ¤Ó· Ì·‡ÚÔ ÛÙ›ÁÌ· (black dot) (7,58). ¢È¿ÁÓˆÛË ∏ ‰È¿ÁÓˆÛË ÙˆÓ ª∆∫ Û˘Ó‹ıˆ˜ ‚·Û›˙ÂÙ·È ÛÙËÓ Ù˘È΋ ÎÏÈÓÈ΋ ÂÈÎfiÓ· Ì ÏÂȉ҉ÂȘ ϿΘ, ·ÔÎÔÌ̤Ó˜ ÙÚ›¯Â˜ Î·È ‰ÈfiÁΈÛË ÙˆÓ ÙÚ·¯ËÏÈÎÒÓ ·‰¤ÓˆÓ. ∏ ÂȂ‚·›ˆÛË Á›ÓÂÙ·È Ì ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô. ∏ ‰È·‰Èηۛ· ·˘Ù‹ ı· Ú¤ÂÈ Ó· ÂÊ·ÚÌfi˙ÂÙ·È Û οı ÌÈÎÚfi ·ÛıÂÓ‹ Ô˘ ·ÚÔ˘ÛÈ¿˙ÂÈ ·fiÙˆÛË ÙˆÓ ÙÚȯÒÓ Î·È ¤ÓÙÔÓË ·ÔϤÈÛË, ¿Û¯ÂÙ· ·fi ÙËÓ ÂÌÊ¿ÓÈÛË Ù˘È΋˜ ‹ ÌË ÎÏÈÓÈ΋˜ ÂÈÎfiÓ·˜ Ì˘ÎËÙ›·Û˘ ÙÔ˘ ÙÚȯˆÙÔ‡ Ù˘ ÎÂÊ·Ï‹˜. ∫ÏÈÓÈ΋ ÂÈÎfiÓ· ∆Ô Î‡ÚÈÔ ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÙˆÓ ª∆∫ Â›Ó·È Ë ·fiÙˆÛË ÙˆÓ ÙÚȯÒÓ Ô˘ Û˘¯Ó¿ Û˘Óԉ‡ÂÙ·È ·fi ÛËÌ›· ÊÏÂÁÌÔÓ‹˜, fiˆ˜ ·ÔϤÈÛË, ı˘Ï·ÎÈο ÊÏ˘ÎÙ·ÈÓ›‰È· Î·È ÎÓËÛÌfi. OÈ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ÔÈΛÏÏÔ˘Ó. O ‚·ıÌfi˜ ‚·Ú‡ÙËÙ·˜ ÙˆÓ ‚Ï·‚ÒÓ ÂÍ·ÚÙ¿Ù·È ·fi ÙÔ Â›‰Ô˜ ÙÔ˘ ˘Â‡ı˘ÓÔ˘ ̇ÎËÙ· Î·È ÙËÓ ·ÓÔÛ›· ÙÔ˘ ÍÂÓÈÛÙ‹. ¢È·ÎÚ›ÓÔÓÙ·È ÔÈ ·ÎfiÏÔ˘ıÔÈ Ù‡ÔÈ: ÌÈÎÚÔÛÔڛ˜, ÙÚȯÔÊ˘Ù›Â˜, ¿¯ÔÚ·˜ Î·È ÎËÚ›Ô. ∂ÎÙfi˜ ·fi ÙËÓ Ù·ÍÈÓfiÌËÛË ·˘Ù‹, ÔÈ ª∆∫ ‰È·ÎÚ›ÓÔÓÙ·È Û ÌË ÊÏÂÁÌÔÓÒ‰ÂȘ Î·È ÊÏÂÁÌÔÓÒ‰ÂȘ ÌÔÚʤ˜ (7,49,59). ·) ªÈÎÚÔÛÔڛ˜: ÷ڷÎÙËÚ›˙ÔÓÙ·È ·fi Ì›· ÌÂÌÔӈ̤ÓË (Û·ÓÈfiÙÂÚ· ‰‡Ô ‹ ÂÚÈÛÛfiÙÂÚ˜) ΢ÎÏÈ΋ ÏÂÈ‰Ò‰Ë Ï¿Î· ‰È·Ì¤ÙÚÔ˘ 2-5 cm, ÂÏ·ÊÚÒ˜ ÂÚ˘ıËÌ·ÙÒ‰Ë, Ë ÂÈÊ¿ÓÂÈ· Ù˘ ÔÔ›·˜ ηχÙÂÙ·È ·fi ÎÔÌ̤Ó˜ ÙÚ›¯Â˜ Û ‡„Ô˜ 2-3 cm ¿Óˆ ·fi ÙËÓ ÂÈÊ¿ÓÂÈ· ÙÔ˘ ‰¤ÚÌ·ÙÔ˜. OÈ ÚÔۂ‚ÏË̤Ó˜ ÙÚ›¯Â˜ Â›Ó·È Ê·È¤˜ Î·È ·Ï·Ì›˜ ÏfiÁˆ Ù˘ ÂÈÎ¿Ï˘„‹˜ ÙÔ˘˜ ·fi Ù· ·ÚıÚÔÎÔÓ›‰È· ÙˆÓ ÂÍÒÙÚȯˆÓ ‰ÂÚÌ·ÙfiÊ˘ÙˆÓ. ø˜ › ÙÔ Ï›ÛÙÔÓ, Â›Ó·È ÌË ÊÏÂÁÌÔÓÒ‰ÂȘ Î·È Û˘Ó‰¤ÔÓÙ·È Ì ÙÔ ˙ˆfiÊÈÏÔ Â›‰Ô˜ M. canis Î·È Û·ÓÈfiÙÂÚ· Ì ٷ ·ÓıÚˆfiÊÈÏ· ›‰Ë M. audouinii Î·È ª. ferrugineum (∂ÈÎfiÓ· 1). ‚) ∆ÚȯÔÊ˘Ù›Â˜: ÷ڷÎÙËÚ›˙ÔÓÙ·È ·fi ÙË ÌÔÚÊ‹ ÌÈÎÚÒÓ ‰È¿Û·ÚÙˆÓ ÔÏ˘ÁˆÓÈÎÒÓ Ï·ÎÒÓ Ì ÈÙ˘ÚÒ‰Ë ·ÔϤÈÛË, Ì ·ÔÎÔÌ̤Ó˜ ÙÚ›¯Â˜ ÛÙÔ ÛËÌÂ›Ô Ù˘ ¤ÎÊ˘Û‹˜ ÙÔ˘˜. ∆Ô ˘fiÏÂÈÌÌ· Ù˘ ÙÚ›¯·˜ ̤۷ ÛÙÔÓ ı‡Ï·Î· ‰›ÓÂÈ ÙËÓ ÂÈÎfiÓ· Ì·‡ÚÔ˘ ÛÙ›ÁÌ·ÙÔ˜ (black dots). O ÌË ÊÏÂÁÌÔÓ҉˘ Ù‡Ô˜ ·ÚÔ˘ÛÈ¿˙ÂÈ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÔÌÔÈ¿˙Ô˘Û· Ì ÙË ÛÌËÁÌ·ÙÔÚÚÔ˚΋ ‰ÂÚÌ·Ù›Ùȉ·. OÈ Ï¿Î˜ Û˘¯Ó¿ Û˘ÚÚ¤Ô˘Ó, Û¯ËÌ·Ù›˙ÔÓÙ·˜ ÌÂÁ·Ï‡ÙÂÚ˜ Ì ·ÔϤÈÛË Î·È ÛËÌ›· ‹È·˜ ÊÏÂÁÌÔÓ‹˜. ªÂٷ͇ ÙˆÓ ÚÔۂ‚ÏËÌ¤ÓˆÓ ÙÚȯÒÓ ˘¿Ú¯Ô˘Ó ˘ÁÈ›˜ ÙÚ›¯Â˜ ‹/Î·È Ì·‡Ú· ÛÙ›ÁÌ·Ù·, Ù· ÔÔ›· Â›Ó·È ÂÍ·ÈÚÂÙÈο ‰˘Û‰È¿ÎÚÈÙ· ÛÙ· ·È‰È¿. ™˘Ó‰¤ÔÓÙ·È Ì ٷ ·ÓıÚˆfiÊÈÏ· ›‰Ë T.
Paediatriki 2003;66:426-435
tonsurans Î·È T. violaceum (∂ÈÎfiÓ˜ 2 Î·È 3). Á) ŒÌ˘Ô˜ ÙÚȯÔÊ˘Ù›·/ÎËÚ›ÔÓ Î¤ÏÛÔ˘: ÷ڷÎÙËÚ›˙ÂÙ·È ·fi ÂÒ‰˘Ó˜ ‚Ï·ÙȉÔÔ˙Ò‰ÂȘ ϿΘ, Ì ÊÏ˘ÎÙ·ÈÓ›‰È· Ô˘ ηχÙÔÓÙ·È ·fi ÌÂÏÈÙfi¯ÚÔ˜ ÂÊÂÏΛ‰Â˜. ∞fi Ù· ÛÙfiÌÈ· ÙˆÓ ÙÚȯÔÛÌËÁÌ·ÙÔÁfiÓˆÓ ı˘Ï¿ÎˆÓ ÂͤگÂÙ·È ‡ÔÓ Î·È ˘¿Ú¯ÂÈ ·fiÙˆÛË ÙˆÓ ÙÚȯÒÓ. ∂›Ó·È ÎÓËÛÌ҉˘ Î·È Û˘¯Ó¿ Û˘Óԉ‡ÂÙ·È ·fi ˘ÚÂÙfi Î·È ÙÚ·¯ËÏÈ΋ ÏÂÌÊ·‰ÂÓ›Ùȉ·. ∏ ÊÏÂÁÌÔÓ҉˘ ·˘Ù‹ ÌÔÚÊ‹ Û˘Ó‰¤ÂÙ·È Ì ˙ˆfiÊÈÏÔ˘˜ ‹ ÁÂÒÊÈÏÔ˘˜ ̇ÎËÙ˜, fiˆ˜ Ù· ª. canis, T. verrucosum, T. mentagrophytes var mentagrophytes, M. nanum, M. gypseum ηÈ, Û·ÓÈfiÙÂÚ·, Ì Ùo ·ÓıÚˆfiÊÈÏo ›‰o˜ ∆. violaceum (∂ÈÎfiÓ· 4). ‰) Õ¯ÔÚ·˜: ¶ÚfiÎÂÈÙ·È ÁÈ· Û·ÓÈfiÙ·ÙË ÓfiÛÔ ÛÙË ¯ÒÚ· Ì·˜. ∂ÌÊ·Ó›˙ÂÈ ¯·Ú·ÎÙËÚÈÛÙÈΤ˜ ‚Ï¿‚˜, Ù· ÛÎ˘Ê›·, ‰ËÏ. ΢ÂÏÏÔÂȉ›˜ Û¯ËÌ·ÙÈÛÌÔ‡˜ Ù˘ ÂȉÂÚÌ›‰·˜, ÛÙÚÔÁÁ˘ÏÔ‡ Û¯‹Ì·ÙÔ˜, ÛÙÔ Î¤ÓÙÚÔ ÙˆÓ ÔÔ›ˆÓ ˘¿Ú¯ÂÈ Û˘Ó‹ıˆ˜ ÌÔÓ‹Ú˘, ÍËÚ‹, ·Ï·Ì‹˜ ÙÚ›¯·. ∆· ÛÎ˘Ê›· ¤¯Ô˘Ó ¯ÚÒÌ· ÎÈÙÚÈÓfiÊ·ÈÔ Î·È ·Ó·‰›‰Ô˘Ó ¯·Ú·ÎÙËÚÈÛÙÈ΋ ‰˘Û¿ÚÂÛÙË ÔÛÌ‹. OÈ ÙÚ›¯Â˜ ‰ÂÓ Â›Ó·È Â‡ıÚ·˘ÛÙ˜ fiˆ˜ ÛÙȘ ¿ÏϘ ÌÔÚʤ˜. ∞ÈÙÈÔÏÔÁÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÙÔ˘ ¿¯ÔÚ· Â›Ó·È ÙÔ ·ÓıÚˆfiÊÈÏÔ Â›‰Ô˜ T. schoenleinii (∂ÈÎfiÓ· 5). ∂ÚÁ·ÛÙËÚȷ΋ ‰È¿ÁÓˆÛË ∏ ÂÚÁ·ÛÙËÚȷ΋ ÌÂıÔ‰ÔÏÔÁ›· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ¿ÌÂÛË ÌÈÎÚÔÛÎÔÈ΋ ÂͤٷÛË ÙˆÓ Ï›ˆÓ, ÙÚȯÒÓ Î·È ı˘Ï¿ÎˆÓ, ÙËÓ Î·ÏÏȤÚÁÂÈ· ÁÈ· ÙËÓ ·ÔÌfiÓˆÛË ÙÔ˘ ˘Â‡ı˘ÓÔ˘ ̇ÎËÙ· Î·È ÙËÓ Ù·˘ÙÔÔ›ËÛË. ∏ ‚ÈÔ„›· Û·Ó›ˆ˜ ÂӉ›ÎÓ˘Ù·È ÁÈ· ÙËÓ ÂÚÁ·ÛÙËÚȷ΋ ‰È¿ÁÓˆÛË ÙˆÓ ª∆∫. ¶ÚˆÙ·Ú¯È΋˜ ÛËÌ·Û›·˜ ÁÈ· ÙȘ ·Ú·¿Óˆ Ì˘ÎËÙÔÏÔÁÈΤ˜ ÂÍÂÙ¿ÛÂȘ Â›Ó·È Ë ÂÈÏÔÁ‹ Î·È Û˘ÏÏÔÁ‹ ÙÔ˘ ηٿÏÏËÏÔ˘ ‰Â›ÁÌ·ÙÔ˜. ∏ ÌË ÛˆÛÙ‹ Ï‹„Ë ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û „¢‰Ò˜ ·ÚÓËÙÈο ·ÔÙÂϤÛÌ·Ù·. ∏ Û˘ÏÏÔÁ‹ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜
∂ÈÎfiÓ· 1. ªÈÎÚÔÛÔÚ›· ·fi ÙÔÓ Ì‡ÎËÙ· Microsporum canis.
431
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ÂÈÙÂÏÂ›Ù·È Ì ̛· ÛÂÈÚ¿ ·ÓÒ‰˘ÓˆÓ Ù¯ÓÈÎÒÓ. ªÂ ÙË ‚Ô‹ıÂÈ· ·ÔÛÙÂÈڈ̤ÓÔ˘ ·È¯ÌËÚÔ‡ ͤÛÙÚÔ˘, ‚Ô‡ÚÙÛ·˜ Ì›·˜ ¯Ú‹Û˘, ÙÚȯÔÏ·‚›‰·˜ ‹/Î·È ‚·Ì‚·ÎÔÊfiÚÔ˘ ÛÙ˘ÏÂÔ‡ Û˘ÏϤÁÔÓÙ·È ·fi ÙËÓ ÂÚÈÔ¯‹ ÙˆÓ ·ÏÏÔÈÒÛÂˆÓ Ï¤È·, ÙÚ›¯Â˜ Î·È ÂÚȯfiÌÂÓ· ı˘Ï¿ÎˆÓ, Ù· ÔÔ›· ʤÚÔÓÙ·È Û ηı·Ú‹ ·ÓÙÈÎÂÈÌÂÓÔÊfiÚÔ Ï¿Î·. OÈ ÚÔۂ‚ÏË̤Ó˜ ÙÚ›¯Â˜ ·ÔÛÒÓÙ·È ¯ˆÚ›˜ ·ÓÙ›ÛÙ·ÛË, ·ÓÒ‰˘Ó·, Ì ͤÛÙÚÔ ‹ Ì ÙÚȯÔÏ·‚›‰·. ∂¿Ó ‰ÂÓ ˘¿Ú¯Ô˘Ó ÂÌÊ·Ó›˜ ‚Ï¿‚˜, Ì›· ¿ÏÏË ÈηÓÔÔÈËÙÈ΋ ̤ıÔ‰Ô˜ Â›Ó·È ÙÔ ‚Ô‡ÚÙÛÈÛÌ· ÙÔ˘ ÙÚȯˆÙÔ‡ Ù˘ ÎÂÊ·Ï‹˜ Ì ԉÔÓÙfi‚Ô˘ÚÙÛ· Ì›·˜ ¯Ú‹Û˘, Ë ÔÔ›·, ÛÙË Û˘Ó¤¯ÂÈ·, ʤÚÂÙ·È Û ·ʋ Ì ÙËÓ ÂÈÊ¿ÓÂÈ· ÙÔ˘ ıÚÂÙÈÎÔ‡ ˘ÔÛÙÚÒÌ·ÙÔ˜. ™Â ÂÒ‰˘Ó˜ ÊÏÂÁÌÔÓÒ‰ÂȘ ·ÏÏÔÈÒÛÂȘ, Ë Ï‹„Ë Ï›ˆÓ Î·È ÙÚȯÒÓ Û˘¯Ó¿ ‰ÂÓ Â›Ó·È ÂÊÈÎÙ‹. ™ÙȘ ÂÚÈÙÒÛÂȘ ·˘Ù¤˜, Û˘ÏϤÁÂÙ·È ‡ÔÓ Ì ‚·Ì‚·ÎÔÊfiÚÔ ÛÙ˘ÏÂfi. ªÂ ÙÔÓ ÙÚfiÔ ·˘Ùfi Â›Ó·È ‰˘Ó·Ù‹ Ë ÌÂÙ·ÊÔÚ¿ ı˘Ï¿ÎˆÓ Î·È ÌÂÁ¿ÏÔ˘ ·ÚÈıÌÔ‡ ÎÔÓȉ›ˆÓ, ÒÛÙ ӷ ·Ó·Ù˘¯ı› Ô Ì‡ÎËÙ·˜ ÛÙËÓ Î·ÏÏȤÚÁÂÈ· (60). ∏ ¯Ú‹ÛË Ù˘ Ï˘¯Ó›·˜ Wood ÚÔÛʤÚÂÈ ÛËÌ·ÓÙÈ΋ ‚Ô‹ıÂÈ· ÛÙÔÓ ÂÓÙÔÈÛÌfi ÙˆÓ Â͈ÙÚȯÈÎÒÓ ·ÏÏÔÈÒÛÂˆÓ Ô˘ ÚÔηÏÔ‡Ó ÔÚÈṲ̂ӷ ›‰Ë ÙÔ˘ Á¤-
∂ÈÎfiÓ· 2. ∆ÚȯÔÊ˘Ù›· ·fi ÙÔÓ Ì‡ÎËÙ· Trichophyton violaceum.
432
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ÓÔ˘˜ Microsporum. ™ÙÔ ˘ÂÚÈ҉˜ ʈ˜ Ù˘ Ï˘¯Ó›·˜ (3650 Å), ÔÈ ÚÔۂ‚ÏË̤Ó˜ ÙÚ›¯Â˜ ÂΤÌÔ˘Ó ¤ÓÙÔÓÔ ÊıÔÚÈÛÌfi. O ÊıÔÚÈÛÌfi˜ ÔÊ›ÏÂÙ·È ÛÙÔÓ ÌÂÙ·‚ÔÏÈÛÌfi Ù˘ ÙÚ˘ÙÔÊ¿Ó˘, Ë ÔÔ›· Û˘ÛÛˆÚ‡ÂÙ·È ÛÙȘ ÚÔۂ‚ÏË̤Ó˜ ÙÚ›¯Â˜, ÔÈ Ôԛ˜ ‰ÈÂÁ›ÚÔÓÙ·È Î·È ÊıÔÚ›˙Ô˘Ó (7). £· Ú¤ÂÈ Ó· ÛËÌÂȈı› fiÙÈ ÙÔÈ΋ ıÂڷ›· ÂÓ‰¤¯ÂÙ·È Ó· ÂËÚ¿ÛÂÈ ÙÔ ·ÔÙ¤ÏÂÛÌ· Ù˘ ÂͤٷÛ˘, ‰›‰ÔÓÙ·˜ ·¯Ófi ÊıÔÚÈÛÌfi ‹ „¢‰Ò˜ ·ÚÓËÙÈÎfi ·ÔÙ¤ÏÂÛÌ·, ÂÚÈÔÚ›˙ÔÓÙ·˜ ¤ÙÛÈ ÙËÓ ÂȉÈÎfiÙËÙ· Ù˘ ÌÂıfi‰Ô˘ (28). ™ÙȘ ÂÓ‰ÔÙÚȯÈΤ˜ ÏÔÈÌÒÍÂȘ ‰ÂÓ ·Ú·ÙËÚÂ›Ù·È ÊıÔÚÈÛÌfi˜, ÂÓÒ ÛÙÔÓ ¿¯ÔÚ· ÔÈ ÚÔۂ‚ÏË̤Ó˜ ÙÚ›¯Â˜ ‰È·ÙËÚÔ‡ÓÙ·È ·Ó¤·Ê˜ Î·È ÂΤÌÔ˘Ó ·¯Ófi ÊıÔÚÈÛÌfi. ∂Âȉ‹ Ô ·ÚÈıÌfi˜ ÙˆÓ ÏÔÈÌÒÍÂˆÓ ·fi ÂÓ‰fiÙÚÈ¯Ô˘˜ ̇ÎËÙ˜ ¤¯ÂÈ ·˘ÍËı› ÛËÌ·ÓÙÈο Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, Ë ¯Ú‹ÛË Ù˘ Ï˘¯Ó›·˜ Wood ¤¯ÂÈ ÌÂÚÈ΋ ‰È·ÁÓˆÛÙÈ΋ ·Í›· ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô ÌÂÁ¿ÏÔ˘ ·ÚÈıÌÔ‡ ·ÙfïÓ, fiˆ˜ ÁÈ· ÂȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜ ÛÙ· Û¯ÔÏ›· Î·È ÁÈ· ÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË Ù˘ ıÂڷ›·˜ ÙÔ˘ ·ÛıÂÓÔ‡˜. ∆Ô ÚÔ˜ ÂͤٷÛË ‰Â›ÁÌ· ʤÚÂÙ·È Û ·ÓÙÈÎÂÈÌÂÓÔÊfiÚÔ Ï¿Î·, ÚÔÛÙ›ıÂÓÙ·È ÌÂÚÈΤ˜ ÛÙ·ÁfiÓ˜
∂ÈÎfiÓ· 3. ∆ÚȯÔÊ˘Ù›· „ˆÚÈ·ÛÈ΋˜ ÌÔÚÊ‹˜ ·fi ÙÔÓ Ì‡ÎËÙ· Trichophyton violaceum.
¶·È‰È·ÙÚÈ΋ 2003;66:426-435
∫O∏ 20% (‰È·˘Á·ÛÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜), ηχÙÂÙ·È ÌÂ Î·Ï˘ÙÚ›‰· Î·È ÌÈÎÚÔÛÎÔÂ›Ù·È Ì ÍËÚfi Ê·Îfi x10 ÁÈ· ÙËÓ ÂÓÙfiÈÛË ÙˆÓ ÌÔÚÊÔÏÔÁÈÎÒÓ ÛÙÔȯ›ˆÓ, ÂÓÒ ÁÈ· ÂȂ‚·›ˆÛË ··ÈÙÂ›Ù·È ·ÓÙÈÎÂÈÌÂÓÈÎfi˜ Ê·Îfi˜ x40. ªÂ ÙËÓ ¿ÌÂÛË ÌÈÎÚÔÛÎÔÈ΋ ÂͤٷÛË ·ÓȯÓ‡ÔÓÙ·È Ù· ΢ÙÙ·ÚÈο ÛÙÔȯ›· Ù˘ ·Ú·ÛÈÙÈ΋˜ ÌÔÚÊ‹˜ ÙÔ˘ ̇ÎËÙ·. ™Ù· Ϥȷ ·Ó·˙ËÙÔ‡ÓÙ·È ÔÈ ˘·ÏÔÂȉ›˜, Û˘¯Ó¿ ‰È·ÎÏ·‰È˙fiÌÂÓ˜, ˘Ê¤˜ (ÓËÌ¿ÙÈ·) Ì ‰È·ÊÚ·ÁÌ¿ÙÈ· Î·È ÔÈ ·Ï‡ÛÂȘ ÙˆÓ ·ÚıÚÔÎÔÓȉ›ˆÓ, ÔÈ Ôԛ˜ ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙÔÓ Î·Ù·ÎÂÚÌ·ÙÈÛÌfi ÙˆÓ ˘ÊÒÓ, ÂÓÒ ÛÙȘ ÙÚ›¯Â˜ Ë ‰È¿Ù·ÍË Î·È ÙÔ Ì¤ÁÂıÔ˜ ÙˆÓ ÎÔÓȉ›ˆÓ, ÌÔÚÊÔÏÔÁÈÎÔ› ¯·Ú·ÎÙ‹Ú˜ Ô˘ ÌÔÚ› Ó· ÚÔÛ‰ÈÔÚ›ÛÔ˘Ó ÙÔ Á¤ÓÔ˜ ÙÔ˘ ˘Â‡ı˘ÓÔ˘ ̇ÎËÙ·. ™Â ·ÛıÂÓ›˜ Ì ÊÏÂÁÌÔÓÒ‰ÂȘ ‚Ï¿‚˜, ÛÙÔȯ›· ÙÔ˘ ̇ÎËÙ· Û¿ÓÈ· ·Ó¢ڛÛÎÔÓÙ·È ÛÙ· ¿ÌÂÛ· ·Ú·Û΢¿ÛÌ·Ù·. OÙÈο ÛÊ¿ÏÌ·Ù· ‰ÂÓ ·ÔÎÏ›ÔÓÙ·È (60). ∏ ¿ÌÂÛË ÌÈÎÚÔÛÎfiËÛË Â›Ó·È Ù·¯Â›· Î·È ·ÍÈfiÈÛÙË ‰È·ÁÓˆÛÙÈ΋ ̤ıÔ‰Ô˜. ∏ ¢·ÈÛıËÛ›· Î·È Ë ÂȉÈÎfiÙËÙ¿ Ù˘, fï˜, ÂÍ·ÚÙÒÓÙ·È ·fi ÙÔÓ ·ÚÈıÌfi ÙˆÓ Ì˘Î‹ÙˆÓ ÛÙÔ ·Ú·Û··ÛÌ·, ·fi Ù˘¯fiÓ ÚÔÁÂÓ¤ÛÙÂÚË ıÂڷ›· Î·È ·fi ÙËÓ ÂÌÂÈÚ›· ÙÔ˘ ÂÚÁ·ÛÙËÚÈ·ÎÔ‡ È·ÙÚÔ‡. ∏ ıÂÙÈ΋ ¿ÌÂÛË ÌÈÎÚÔÛÎÔÈ΋ ÂͤٷÛË ÂȂ‚·ÈÒÓÂÈ ÙËÓ ÎÏÈÓÈ΋ ‰È¿ÁÓˆÛË Î·È ÂÈ-
∂ÈÎfiÓ· 4. ŒÌ˘Ô˜ ‰ÂÚÌ·ÙÔÊ˘Ù›· ·fi ÙÔÓ Ì‡ÎËÙ· Microsporum gypseum.
Paediatriki 2003;66:426-435
ÙÚ¤ÂÈ ÙËÓ ¤Ó·ÚÍË ıÂڷ›·˜. ¶·Ú¿ Ù·‡Ù·, Ë ÌË ·Ó‡ÚÂÛË ÙÔ˘ ̇ÎËÙ· ÛÙ· ¿ÌÂÛ· ·Ú·Û΢¿ÛÌ·Ù· ‰ÂÓ ·ÔÎÏ›ÂÈ ÙË Ì˘ÎËÙÈ·ÛÈ΋ Ïԛ̈ÍË. ∏ ̤ıÔ‰Ô˜ ηıÈÛÙ¿ ‰˘Ó·Ùfi ÙÔÓ Î·ıÔÚÈÛÌfi ÙˆÓ ÙÚÈÒÓ Ù‡ˆÓ ·Ú·ÛÈÙÈÛÌÔ‡ ÙÔ˘ ̇ÎËÙ· ÛÙËÓ ÙÚ›¯·: ÂÍÒÙÚȯÔ, ÂÓ‰fiÙÚÈ¯Ô Î·È ·¯ÔÚÈÎfi. ™ÙËÓ ÂÍÒÙÚÈ¯Ë Ïԛ̈ÍË, ÔÈ ˘Ê¤˜ ηٷÎÂÚÌ·Ù›˙ÔÓÙ·È Û ÌÈÎÚÔ‡ ÌÂÁ¤ıÔ˘˜ ·ÚıÚÔÎÔÓ›‰È· (ÛfiÚÈ·), Ù· ÔÔ›· ηχÙÔ˘Ó ÙËÓ ÂÈÊ¿ÓÂÈ· Î·È ÂÚÈ‚¿ÏÏÔ˘Ó ÙÔ Û٤ϯԘ Ù˘ ÙÚ›¯·˜, ÚÔηÏÒÓÙ·˜ ÔÚÈÛÙÈ΋ ηٷÛÙÚÔÊ‹ ÙÔ˘ ÂÚÈÙÚȯ›Ô˘. ∞ÓÙ›ıÂÙ·, ÛÙËÓ ÂÓ‰ÔÙÚȯÈ΋ Ïԛ̈ÍË, Ù· ·ÚıÚÔÎÔÓ›‰È· Â›Ó·È ÌÂÁ·Ï‡ÙÂÚÔ˘ ÌÂÁ¤ıÔ˘˜, ·Ú·Ì¤ÓÔ˘Ó ÛÙÔ Û٤ϯԘ Ù˘ ÙÚ›¯·˜, ¯ˆÚ›˜ fï˜ Ó· ·Ú·ÙËÚÂ›Ù·È Î·Ù·ÛÙÚÔÊ‹ ÙÔ˘ ÂÚÈÙÚȯ›Ô˘. ™ÙÔÓ ¿¯ÔÚ·, ÔÈ ÙÚ›¯Â˜ ̤ÓÔ˘Ó ·Ó¤·Ê˜ Î·È ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ÙËÓ ·Ó‡ÚÂÛË ÌfiÓÔ ÓËÌ·Ù›ˆÓ ηٿ Ì‹ÎÔ˜ Ù˘ ÙÚ›¯·˜, ÏÈÔÛÊ·ÈÚ›ˆÓ Î·È ÎÂÓÒÓ ·¤ÚÔ˜ (61). °È· ÙËÓ ÂȂ‚·›ˆÛË ÙÔ˘ ·ÔÙÂϤÛÌ·ÙÔ˜ Ù˘ ¿ÌÂÛ˘ ÌÈÎÚÔÛÎÔÈ΋˜ ÂͤٷÛ˘ Î·È ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙÔ˘ ·ÈÙÈÔÏÔÁÈÎÔ‡ ·Ú¿ÁÔÓÙ·, fiÏ· Ù· ÏËÊı¤ÓÙ· ‰Â›ÁÌ·Ù· Ú¤ÂÈ Ó· ηÏÏÈÂÚÁÔ‡ÓÙ·È. ∏ ηÏÏȤÚÁÂÈ· ·ÔÙÂÏ› ‚·ÛÈ΋ ÂͤٷÛË ÁÈ· ÙË ‰È¿ÁÓˆÛË Ù˘ Ì˘ÎËÙÈ·ÛÈ΋˜ Ïԛ̈͢. ∆· ıÚÂÙÈο ˘ÔÛÙÚÒÌ·Ù· Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Û˘Ó‹ıˆ˜ ÁÈ· ÙȘ ÚˆÙÔηÏÏȤÚÁÂȘ ÙˆÓ ‰ÂÚÌ·ÙfiÊ˘ÙˆÓ Â›Ó·È Ù· Sabouraud ‹ potato dextrose ¿Á·Ú ÂÌÏÔ˘ÙÈṲ̂ÓÔ Ì ·ÓÙÈ‚ÈÔÙÈο, fiˆ˜ ¯ÏˆÚ·ÌÊ·ÈÓÈÎfiÏË Î·È Î˘ÎÏÔÂÍ·Ì›‰Ë, Ù· ÔÔ›· ‚ÔËıÔ‡Ó ÛÙËÓ ÂÏ·¯ÈÛÙÔÔ›ËÛË
∂ÈÎfiÓ· 5. Õ¯ÔÚ·˜ ·fi ÙÔÓ Ì‡ÎËÙ· Trichophyton schoenleinii.
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Ù˘ ·Ó¿Ù˘Í˘ ÙˆÓ ‚·ÎÙËÚȉ›ˆÓ Î·È ÙˆÓ Û·ÚÔÊ˘ÙÈÎÒÓ Ì˘Î‹ÙˆÓ. ∆· ÙÂÏÂ˘Ù·›· ·Ó·Ù‡ÛÛÔÓÙ·È Ù·¯‡Ù·Ù·, Ì ·ÔÙ¤ÏÂÛÌ· Ó· ˘ÂÚηχÙÔ˘Ó Ù· ‚Ú·‰¤ˆ˜ ·Ó·Ù˘ÛÛfiÌÂÓ· ‰ÂÚÌ·ÙfiÊ˘Ù·. ∏ ÂÒ·ÛË ÌÔÚ› Ó· Á›ÓÂÈ Û ıÂÚÌÔÎÚ·Û›· ‰ˆÌ·Ù›Ô˘, ·ÏÏ¿ Û˘ÓÈÛÙ¿Ù·È ÎÏ›‚·ÓÔ˜ ÛÙ·ıÂÚ‹˜ ıÂÚÌÔÎÚ·Û›·˜. ∏ ¿ÚÈÛÙË ıÂÚÌÔÎÚ·Û›· ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ÙˆÓ ‰ÂÚÌ·ÙfiÊ˘ÙˆÓ Â›Ó·È 26-28ÔC Î·È Ô ¯ÚfiÓÔ˜ ÂÒ·Û˘ 24 ‚‰ÔÌ¿‰Â˜. OÈ Î·ÏÏȤÚÁÂȘ ı· Ú¤ÂÈ Ó· ÂϤÁ¯ÔÓÙ·È Û˘¯Ó¿ ÁÈ· ÙË ‰È·›ÛÙˆÛË ·Ó¿Ù˘Í˘ ÙÔ˘ ·ıÔÁfiÓÔ˘ ̇ÎËÙ· Î·È Ù˘¯fiÓ ÂÈÌÔχÓÛÂȘ ·fi Û·ÚÔÊ˘ÙÈÎÔ‡˜ ̇ÎËÙ˜ (62). O ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙÔ˘ Á¤ÓÔ˘˜ Î·È ÙÔ˘ ›‰Ô˘˜ ÙÔ˘ ·ıÔÁfiÓÔ˘ ̇ÎËÙ· (Ù·˘ÙÔÔ›ËÛË) Â›Ó·È ··Ú·›ÙËÙÔ˜ ÁÈ· ÙËÓ ÂÈÏÔÁ‹ ÙÔ˘ ηٿÏÏËÏÔ˘ ıÂڷ¢ÙÈÎÔ‡ Û¯‹Ì·ÙÔ˜, ‰Â‰Ô̤Ó˘ Ù˘ ‰È·ÊÔÚÂÙÈ΋˜ ¢·ÈÛıËÛ›·˜ ÔÚÈÛÌ¤ÓˆÓ ‰ÂÚÌ·ÙfiÊ˘ÙˆÓ ÛÙ· Ó¤· ·ÓÙÈÌ˘ÎËÙÈ·ÛÈο Ê¿Ú̷η, ηıÒ˜ Î·È ÁÈ· ÂȉËÌÈÔÏÔÁÈÎÔ‡˜ ÏfiÁÔ˘˜. ∂ÈÙ˘Á¯¿ÓÂÙ·È Ì ÙËÓ ·Ú·Ù‹ÚËÛË Ù˘ Ì·ÎÚÔÛÎÔÈ΋˜ ÌÔÚÊÔÏÔÁ›·˜ ÙˆÓ ·ÔÈÎÈÒÓ ÙÔ˘ ̇ÎËÙ·, ηıÒ˜ Î·È Ì ÙË ÏÂÙÔÌÂÚ‹ ÌÂϤÙË Ù˘ ÌÈÎÚÔÛÎÔÈ΋˜ ÌÔÚÊÔÏÔÁ›·˜ ÙÔ˘, ‰ËÏ. Ù˘ ‰ÔÌ‹˜ ÙˆÓ ÓËÌ·Ù›ˆÓ Î·È Ù˘ ÌÔÚÊÔÏÔÁ›·˜ ÙˆÓ ÎÔÓȉ›ˆÓ (63,64). ™˘ÌÂÚ¿ÛÌ·Ù· ªÂ ‚¿ÛË Ù· ÛÙ·ÙÈÛÙÈο ÛÙÔȯ›· ÙÔ˘ ÓÔÛÔÎÔÌ›Ԣ “∞. ™˘ÁÁÚfi˜” Î·È ÙËÓ ÂÏÏËÓÈ΋ ‚È‚ÏÈÔÁÚ·Ê›·, Û˘Ó¿ÁÂÙ·È fiÙÈ ÙÔ Î‡ÚÈÔ ·›ÙÈÔ ª∆∫ ÛÙË ¯ÒÚ· Ì·˜ Â›Ó·È o ˙ˆfiÊÈÏÔ˜ ̇ÎËÙ·˜ ª. canis Î·È ‰Â˘ÙÂÚ¢fiÓÙˆ˜ Ô ·ÓıÚˆfiÊÈÏÔ˜ T. violaceum. ∏ ·Ú·ÙËÚÔ‡ÌÂÓË, ÚfiÛÊ·Ù·, ·‡ÍËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ ÙÔ˘ ÙÂÏÂ˘Ù·›Ô˘, ηıÒ˜ Î·È Ë ·ÚÔ˘Û›· ÌË ÂÓ‰ËÌÈÎÒÓ ÂȉÒÓ ÛÙË ¯ÒÚ· Ì·˜ Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ÙÔ˘ ÌÂÙ·Ó·ÛÙ¢ÙÈÎÔ‡ ·̷ÙÔ˜ ÙˆÓ ÙÂÏÂ˘Ù·›ˆÓ ÂÙÒÓ ·fi ¯ÒÚ˜ Ù˘ µ·ÏηÓÈ΋˜, Ù˘ ∞Ó·ÙÔÏÈ΋˜ ∂˘ÚÒ˘, Ù˘ ∞Û›·˜ Î·È Ù˘ ∞ÊÚÈ΋˜, fiÔ˘ Ù· ›‰Ë ·˘Ù¿ ÂÓ‰ËÌÔ‡Ó. °È· ÙÔÓ ÂÚÈÔÚÈÛÌfi Ù˘ ÂͿψÛ˘ ÙˆÓ ª∆∫ ÛÙ· ·È‰È¿ ··ÈÙÂ›Ù·È ÛˆÛÙ‹ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ·‰¤ÛÔÙˆÓ ˙ÒˆÓ Ô˘ ÓÔÛÔ‡Ó, ÛˆÛÙ‹ ˘ÁÈÂÈÓ‹ ÙˆÓ Î·ÙÔÈΛ‰ÈˆÓ ˙ÒˆÓ ÁÈ· ÙËÓ ÂÚ›ÙˆÛË Ô˘ Â›Ó·È ˘ÁÈ›˜ ÊÔÚ›˜ Î·È ÌÂÙ·‰›‰Ô˘Ó ÙË ÓfiÛÔ, ηıÒ˜ ›Û˘ ÛˆÛÙ‹ ·ÓÙÈÌÂÙÒÈÛË Î·È ÙˆÓ ·ÛıÂÓÒÓ ‹ ·Û˘Ìو̷ÙÈÎÒÓ ÂÓËÏ›ÎˆÓ ÙÔ˘ ÔÈΛԢ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ ÙÔ˘ ·ÛıÂÓÔ‡˜. OÈ ÎÏÈÓÈÎÔ› È·ÙÚÔ› ı· Ú¤ÂÈ Ó· ·ÓÙÈÌÂÙˆ›˙Ô˘Ó Ì ÚÔÛÔ¯‹ Î·È ˆ˜ Èı·Ó¤˜ ª∆∫ fiϘ ÙȘ ÂÚÈÙÒÛÂȘ ·ÏÏÔÈÒÛÂˆÓ ÙÔ˘ ÙÚȯˆÙÔ‡ Ù˘ ÎÂÊ·Ï‹˜ ·È‰ÈÒÓ ÚÔÂÊË‚È΋˜ ËÏÈΛ·˜, ȉȷ›ÙÂÚ· ÙˆÓ ·È‰ÈÒÓ ÙˆÓ ÌÂÙ·Ó·ÛÙÒÓ. £· Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÂÙ·È Ï‹Ú˜ ÈÛÙÔÚÈÎfi, Ó· Á›ÓÂÙ·È Ï‹Ú˘ Ì˘ÎËÙÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ (¿ÌÂÛË ÌÈÎÚÔÛÎÔÈ΋ ÂͤٷÛË Î·È Î·ÏÏȤÚÁÂÈ·) Û ÂÍÂȉÈÎÂ˘Ì¤Ó· ÂÚÁ·ÛÙ‹ÚÈ· Î·È Ó· ÂϤÁ¯ÂÙ·È ÙÔ ¿ÌÂÛÔ ÂÚÈ‚¿ÏÏÔÓ ÙÔ˘ ÌÈÎÚÔ‡ ·ÛıÂÓÔ‡˜ ÁÈ· Ù˘¯fiÓ ·Û˘Ìو̷ÙÈÎÔ‡˜ ÊÔÚ›˜.
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µÈ‚ÏÈÔÁÚ·Ê›· 1. Sabouraud RJ. Maladies du cruir chevelu. Les maladies desquamatiques: pityriasis et alopécies pelliculaires. Paris: Maison et cie; 1904. 2. Remak R. De morbo scrofulo. Berlin: Von Xaverus Hube; 1837. 3. Gruby D. Recherches sur la nature le siége et la développement du Porrigo declaveus ou Phytoalopécie. Comptes rendus de l’ Académie des Sciences 1843;17:301307. 4. Sabouraud RJ. Les trichophyties humaines. Paris: Rueff et cie; 1894. 5. Emmons CW. Dermatophytes. Natural grouping based on the form of the spores and accessory organs. Arch Dermatol Syph 1934;30:337-362. 6. Ajello L. Geographic distribution and prevalence of the dermatophytes. Ann NY Acad Sci 1960;89:30-38. 7. Gupta AK, Summerbell RC. Tinea capitis. Med Mycol 2000;38:255-287. 8. Romano C. Tinea capitis in Siena, Italy. An 18-year survey. Mycoses 1999;42:559-562. 9. Barlow D, Saxe N. Tinea capitis in adults. Int J Dermatol 1988;27:388-390. 10. Aste N, Pau M, Biggio P. Tinea capitis in adults. Mycoses 1996;39:299-301. 11. Rippon JW. The changing epidemiology and emerging patterns of dermatophyte species. Curr Top Med Mycol 1985;1:208-234. 12. Clayton YM. The changing pattern of tinea capitis in London schoolchildren. Mykosen 1978;1 (Suppl):S104-S107. 13. Lucky A. Tinea capitis: current concepts. Pediatr Dermatol 1985;2:224-237. 14. Hebert AA, Head ES, Macdonald EM. Tinea capitis caused by Trichophyton tonsurans. Pediatr Dermatol 1985;2:219-223. 15. Kemna ME, Elewski BE. Epidemiological survey of superficial fungal diseases. J Am Acad Dermat 1996;135:955-958. 16. Elewski B. Tinea capitis. Dermatol Clin 1996;14:23-31. 17. Rogers M, Muir D, Pritchard R. Increasing importance of Trichophyton tonsurans in childhood tinea in New South Wales. Australas J Dermatol 1993;34:5-8. 18. Hussain I, Aman S, Haroon TS, Jahangir M, Nagi AH. Tinea capitis in Lahore, Pakistan. Int J Dermatol 1994;33:255-257. 19. Ali-Shtayeh MS, Arda HM. A study of tinea capitis in Jordan (West Bank). J Trop Med Hyg 1986;89:137-141. 20. Gargoom AM, Elyazachi MB, Al-Ani SM, Duweb GA. Tinea capitis in Benghazi, Libya. Int J Dermatol 2000;39:263-265. 21. Amer M, Taha M, Tosson Z, El-Garf A. The frequency of causative dermatophytes in Egypt. Int J Dermatol 1981;20:431-434. 22. Verhagen AR. Distribution of dermatophytes causing tinea capitis in Africa. Trop Geogr Med 1974;26:101-120. 23. Figueroa JI, Hawranek T, Abraha A, Hay RJ. Tinea capitis in south-western Ethiopia: a study of risk factors for infection and carriage. Int J Dermatol 1997;36:661-666. 24. Hay RJ, Robles W, Midgley G, Moore MK, European Confederation of Medical Mycology Working Party on Tinea Capitis. Tinea capitis in Europe: new perspective on an old problem. J Eur Acad Dermatol Venereol 2001;15:229-233. 25. Aly R, Hay RJ, Del Palacio A, Galimberti R. Epidemiology of tinea capitis. Med Mycol 2000;38 (Suppl 1):S183-S188. 26. Pereiro Miguens M, Pereiro M, Pereiro M Jr. Review of dermatophytoses in Galicia from 1951 to 1987, and comparison with other areas of Spain. Mycopathologia
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1991;113:65-78. 27. Koussidou-Eremondi T, Devliotou-Panagiotidou D, MourellouTsatsou O, Fotidou D, Minas A. Tinea capitis in children in northern Greece during the period 1981-1995. Mycoses 1999;42:319-322. 28. ∞ı·Ó·ÛÔÔ‡ÏÔ˘ µ, ºÚ·ÁÎÔ‡ÏË ∂, ¶··‰ÔÁˆÚÁ¿ÎË ∂, ∞Ó‰Ú¤Ô˘ ∂, ∫·ÙÛ¿Ì·˜ ∞. ª˘ÎËÙÈ¿ÛÂȘ ÙÚȯˆÙÔ‡ ÎÂÊ·Ï‹˜ Û ·È‰È¿ Î·È ÂÓ‹ÏÈΘ ηٿ ÙËÓ ÂÓÙ·ÂÙ›· 1995-1999. ¢ÂÏÙ›Ô ∂ÏÏ ªÈÎÚ ∂Ù·ÈÚ 2001;46:30-37. 29. ™·ÎÂÏÏ·Ú›Ô˘ °. ∂ȉËÌÈÔÏÔÁÈ΋ ¤Ú¢ӷ ÙˆÓ ÙÚȯԂÚÒÙˆÓ ÙÔ˘ ÙÚȯˆÙÔ‡ Ù˘ ÎÂÊ·Ï‹˜ ÂȘ ÙËÓ µ. ∂ÏÏ¿‰· [‰È‰·ÎÙÔÚÈ΋ ‰È·ÙÚÈ‚‹]. £ÂÛÛ·ÏÔÓ›ÎË: ¶·ÓÂÈÛÙ‹ÌÈÔ £ÂÛÛ·ÏÔӛ΢; 1959. 30. Marcelou-Kinti O. Le epidemiologie des teignes en Grèce. Bull Soc Fr Myc Med 1966;11:20-21. 31. ºÚ·ÁÎÔ‡ÏË ∂, ∞ı·Ó·ÛÔÔ‡ÏÔ˘ µ, ¶··‰ÔÁˆÚÁ¿ÎË ∂, ºÏÂÌÂÙ¿Î˘ ∞, ª¿ÏÎÔ˘ ¶, ∞˘ÁÂÚÈÓÔ‡ ∂. ª˘ÎËÙ›·ÛË ÙÚȯˆÙÔ‡ ÎÂÊ·Ï‹˜ ·fi ÙÔÓ Ì‡ÎËÙ· Trichophyton violaceum. ¢ÂÏÙ›Ô ∂ÏÏ ªÈÎÚ ∂Ù·ÈÚ 1998;43:370-373. 32. ºÚ·ÁÎÔ‡ÏË ∂, ∞ı·Ó·ÛÔÔ‡ÏÔ˘ µ, ¶··‰ÔÁˆÚÁ¿ÎË ∂, ºÏÂÌÂÙ¿Î˘ ∞, ª¿ÏÎÔ˘ ¶, ∞˘ÁÂÚÈÓÔ‡ ∂. ∫ÏÈÓÈÎÔÂÚÁ·ÛÙËÚȷ΋ ÌÂϤÙË Ì˘ÎËÙÈ¿ÛÂˆÓ ÙÚȯˆÙÔ‡ ÎÂÊ·Ï‹˜ ·fi ÙÔÓ Ì‡ÎËÙ· T. violaceum ÛÙËÓ Â˘Ú‡ÙÂÚË ÂÚÈÔ¯‹ ∞ıËÓÒÓ Î·Ù¿ ÙËÓ ÂÓÙ·ÂÙ›· 1995-1999. ∂ÏÏ ∂Èı ¢ÂÚÌ ∞ÊÚ 2000;11:203-206. 33. ∫Ô˘Û›‰Ô˘ £, ¶··Ìȯ·‹Ï ∂, ∞Ϥ͢ π, ºˆÙ›‰Ô˘-∑‹ÎÔ˘ ¢, ¢ÂÏ‚ÈÒÙÔ˘-¶·Ó·ÁȈٛ‰Ô˘ ¢. ª˘ÎËÙÈ¿ÛÂȘ ÙÚȯˆÙÔ‡ Ù˘ ÎÂÊ·Ï‹˜ ηٿ ÙË ‰ÂηÂÙ›· 1981-1990 ÛÙË µ. ∂ÏÏ¿‰· (ª·Î‰ÔÓ›·). ∂ÏÏ ∂Èı ¢ÂÚÌ ∞ÊÚ 1992;3:193-199. 34. ÃÚ˘Û¿ÎË ∞, ƒ·˘ÙÔÔ‡ÏÔ˘ ∞, ∫ˆÙÛÈÁÈ¿ÓË ∞, ¶¿ÁηÏË ∞. Microsporum canis Û ‰ÂÚÌ·ÙÈΤ˜ ‚Ï¿‚˜ ·È‰ÈÒÓ Î·Ù¿ ÙÔ ‰È¿ÛÙËÌ· 1986-91. ∂Ê·ÚÌ ∫ÏÈÓ ªÈÎÚ ∂ÚÁ·ÛÙ ¢È·ÁÓˆÛÙ 1995;10:207-211. 35. ÃÚÈÛÙÔÊ›‰Ô˘ ª, ¶·Ó·ÁȈÙÔÔ‡ÏÔ˘ ∂, π·Îˆ‚›‰Ô˘ ∂, ¢ËÌËÙÚ·ÎfiÔ˘ÏÔ˜ °. ∂›‰Ë ‰ÂÚÌ·ÙfiÊ˘ÙˆÓ Î·È Û˘¯ÓfiÙËÙ· ·ÔÌfiÓˆÛ˘ ·fi ·ÛıÂÓ›˜ Ì ÎÏÈÓÈ΋ ¤Ó‰ÂÈÍË ‰ÂÚÌ·ÙÔÊ˘ÙÒÛˆ˜. ¢ÂÏÙ›Ô ∂ÏÏ ªÈÎÚ ∂Ù·ÈÚ 1996;41:49-53. 36. ª·Ú¿ÎË ™, ∆ÛÂϤÓÙ˘ π. ¢ÂÚÌ·ÙÔÊ˘ÙÒÛÂȘ ÛÙËÓ ∫Ú‹ÙË Î·Ù¿ ÙË ¯ÚÔÓÈ΋ ÂÚ›Ô‰Ô 1992-1995. ¢ÂÏÙ›Ô ∂ÏÏ ªÈÎÚ ∂Ù·ÈÚ 1996;41:452-455. 37. ºÚ·ÁÎÔ‡ÏË E, Aı·Ó·ÛÔÔ‡ÏÔ˘ µ, ºÏÂÌÂÙ¿Î˘ ∞. ™¿ÓÈ· Ì˘ÎËÙ›·ÛË ÙÚȯˆÙÔ‡ Ù˘ ÎÂÊ·Ï‹˜ ·fi ÙÔÓ Ì‡ÎËÙ· Trichophyton soudanense. ∂Ê·ÚÌ ∫ÏÈÓ ªÈÎÚ ∂ÚÁ·ÛÙ ¢È·ÁÓˆÛÙ 2000;5:182-186. 38. ºÚ·ÁÎÔ‡ÏË ∂, ∞ı·Ó·ÛÔÔ‡ÏÔ˘ µ. ª˘ÎËÙÈ¿ÛÂȘ ÙÚȯˆÙÔ‡ ÎÂÊ·Ï‹˜ ·fi Û¿ÓÈ· ›‰Ë ‰ÂÚÌ·ÙfiÊ˘ÙˆÓ Û ·È‰È¿ ÌÂÙ·Ó·ÛÙÒÓ. ∂Ê·ÚÌ ∫ÏÈÓ ªÈÎÚ ∂ÚÁ·ÛÙ ¢È·ÁÓˆÛÙ 2002;7:33-40. 39. Schwinn A, Ebert J, Brocker EB. Frequency of Trichophyton rubrum in tinea capitis. Mycoses 1995;38:1-7. 40. Romano C. Case reports. Four paediatric cases of tinea capitis due to unusual agents. Mycoses 1999;42:421-425. 41. Al Sogair S, Hay RJ. Fungal infection in children: tinea capitis. Clin Dermatol 2000;18:679-685. 42. ∫Ô˘Ì·ÓÙ¿ÎË E, ∫·ÙÔ‡Ï˘ A, ºÚ·ÁÎÔ‡ÏË E. ª˘ÎËÙÈ¿ÛÂȘ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜. ∂ÏÏ ∂Èı ¢ÂÚÌ ∞ÊÚ 1996;7:3:139-143. 43. Elewski BE. Tinea capitis: a current perspective. J Am Acad Dermatol 2000;42:1-20. 44. Elewski BE. In: Demis DJ, editor. Tinea capitis in clinical dermatology. Vol 3, Philadelphia: JB Lippincott; 1999. p. 1-23. 45. Aly R. Ecology, epidemiology and diagnosis of tinea capitis. Pediatr Infect Dis J 1999;18:180-185. 46. Babel DE, Baughman SA. Evaluation of the adult carrier state
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AWARD-WINNING ARTICLE
∞ÍÈÔÏfiÁËÛË 10 ÂÙÒÓ ·fi ÙËÓ ¤Ó·ÚÍË ÚÔÁÚ¿ÌÌ·ÙÔ˜ ·ÁˆÁ‹˜ ˘Á›·˜ ÛÙ· Û¯ÔÏ›· Ù˘ ∫Ú‹Ù˘* ª. §ÈÓ·Ú‰¿Î˘, ∫. ™·ÚÚ‹, º. ªÂÚ‚·Ó¿ÎË, ∂. ª¿ÚηÙ˙Ë, Ã. ÷Ù˙‹˜, ™. ºÏÔ˘Ú‹, ∞. ∫·Ê¿ÙÔ˜
Ten-year evaluation of the initiation of a health education program in the schools of Crete* M. Linardakis, K. Sarri, F. Bervanaki, I. Markatzi, C. Hatzis, S. Flouri, A. Kafatos
¶ÂÚ›ÏË„Ë: ∏ ÚfiÏË„Ë ÙˆÓ ¯ÚfiÓÈˆÓ ÓÔÛËÌ¿ÙˆÓ Ú¤ÂÈ Ó· ·Ú¯›˙ÂÈ ·fi ÙËÓ ·È‰È΋ ËÏÈΛ·, ηıÒ˜ ÔÈ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ·˘Ù¿ ÂÌÊ·Ó›˙ÔÓÙ·È Ôχ ÓˆÚ›˜. ™Ùfi¯Ô˜ Ù˘ ·ÚÔ‡Û·˜ ÂÚÁ·Û›·˜ ‹Ù·Ó Ë ·ÍÈÔÏfiÁËÛË Ù˘ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ Ù˘ ÂÎ·È‰Â˘ÙÈ΋˜ ·Ú¤Ì‚·Û˘ Û ı¤Ì·Ù· ˘Á›·˜ ÛÙË ‰È¿ÚÎÂÈ· Ù˘ Âη›‰Â˘Û˘ ÛÙÔ ‰ËÌÔÙÈÎfi, Û ÔÌ¿‰· ·È‰ÈÒÓ Ô˘ ÂÍÂÙ¿ÛÙËÎ·Ó ÛÙËÓ ¤Ó·ÚÍË Ù˘ ·Ú¤Ì‚·Û˘ Î·È ÙÚ›·, ¤ÍÈ Î·È ‰¤Î· ¯ÚfiÓÈ· ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË. ∆Ô ÚfiÁÚ·ÌÌ·, ‰È¿ÚÎÂÈ·˜ 6 ÂÙÒÓ, ÍÂΛÓËÛ ÙÔ 1992 Û 5681 Ì·ıËÙ¤˜ Ù˘ ∞’ Ù¿Í˘ fiÏˆÓ ÙˆÓ ‰ËÌÔÙÈÎÒÓ Û¯ÔÏ›ˆÓ ·fi ÙÚÂȘ ÓÔÌÔ‡˜ Ù˘ ∫Ú‹Ù˘. ∆· 4171 ·È‰È¿ ·ÔÙÂÏÔ‡Û·Ó ÙËÓ ÔÌ¿‰· ÂÎ·È‰Â˘ÙÈ΋˜ ·Ú¤Ì‚·Û˘ Î·È Ù· ˘fiÏÔÈ· 1510 ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘. ™Â ·ÓÙÈÚÔÛˆÂ˘ÙÈÎfi ‰Â›ÁÌ· 40 Û¯ÔÏ›ˆÓ, 1046 Ì·ıËÙ¤˜ (·Ú¤Ì‚·Û˘: 602, ÂϤÁ¯Ô˘: 444) ˘Ô‚Ï‹ıËÎ·Ó ÛÙȘ ·ÎfiÏÔ˘ı˜ ÂÍÂÙ¿ÛÂȘ: ۈ̷ÙÔÌÂÙÚÈΤ˜ ÌÂÙÚ‹ÛÂȘ, ÏÈÔÚˆÙ½Ó˜ ÔÚÔ‡ Î·È ·ÚÙËÚȷ΋ ›ÂÛË ·›Ì·ÙÔ˜, ÂÓÒ ·Ú¿ÏÏËÏ· ÂÎÙÈÌ‹ıËÎ·Ó Ë Ê˘ÛÈ΋ ηٿÛÙ·ÛË, ÙÔ ‰È·ÈÙËÙÈÎfi ÈÛÙÔÚÈÎfi Î·È ÔÈ Û˘Ó‹ıÂȘ ˘Á›·˜. ¢È·¯ÚÔÓÈο Î·È ‰¤Î· ¯ÚfiÓÈ· ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ·Ú¤Ì‚·Û˘ ‰È·ÈÛÙÒıËΠÛËÌ·ÓÙÈο ÌÈÎÚfiÙÂÚË ·‡ÍËÛË ÛÙÔÓ ‰Â›ÎÙË Ì¿˙·˜ ÛÒÌ·ÙÔ˜ (¢ª™) ÛÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·Û˘ (+3,3 kg/m2) Û ۇÁÎÚÈÛË Ì ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘ (+4,3 kg/m2) (p<0,001). ™ÙÔ ·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜ ÛËÌÂÈÒıËΠÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚË Â›‰ÔÛË ÛÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·Û˘ (p<0,001). ∏ ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË ÌÂÈÒıËΠÛËÌ·ÓÙÈο ÂÚÈÛÛfiÙÂÚÔ ÛÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·Û˘ Û ۯ¤ÛË Ì ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘ (-9% Î·È -0,5% ·ÓÙ›ÛÙÔȯ·, p<0,001), ÂÓÒ Ë LDL-¯ÔÏËÛÙÂÚfiÏË
Abstract: Prevention of chronic diseases should start in childhood since the risk factors related to these diseases make their appearance at early ages. The objective of this study was to assess the long-term effectiveness of a health education intervention program applied to primary school pupils, 10 years after the initiation of the program. The 6-year-long school-based intervention program was applied to all students (5681) who registered in the first grade of primary school in three counties of Crete (intervention group: 4171, control group: 1510) in 1992. A number of biochemical and behavioural parameters (somatometric measurements, serum lipoproteins, blood pressure, physical activity, dietary record, health habits) were measured in 1046 students from 40 schools randomly selected (602 intervention group and 444 control group). Re-evaluation of the intervention program was performed at 3, 6 and 10 years after the initiation of the program. Ten years after the initiation of the program, the results showed that the body mass index (µªπ) had increased significantly less (p<0.001) and performance in the shuttle run test was significantly better (p<0.001) in the intervention group as compared to the control group. The reduction in total cholesterol noted in both groups was significantly greater in the intervention group than in the control group (p<0.001). The LDL decreased significantly in the intervention group, but increased in the control group (p<0.001). The incidence of smoking was also significantly lower in the intervention group
∆Ô̤·˜ ∫ÔÈÓˆÓÈ΋˜ π·ÙÚÈ΋˜ ∫ÏÈÓÈ΋ ¶ÚÔÏËÙÈ΋˜ π·ÙÚÈ΋˜ Î·È ¢È·ÙÚÔÊ‹˜ ∆Ì‹Ì· π·ÙÚÈ΋˜ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘
Department of Social Medicine Preventive Medicine and Nutrition Clinic University of Crete Medical School
*∞’ µÚ·‚Â›Ô ∫ÔÈÓˆÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ 41Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ, 2003
*1st Prize of Social Paediatrics 41st Panhellenic Paediatric Meeting, 2003
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¶·È‰È·ÙÚÈ΋ 2003;66:436-447
Paediatriki 2003;66:436-447
ÌÂÈÒıËΠÛËÌ·ÓÙÈο ÛÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·Û˘ Î·È ·˘Í‹ıËΠÛÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘ (-10% Î·È +5% ·ÓÙ›ÛÙÔȯ·, p<0,001). ∂›Û˘, ÛËÌ·ÓÙÈο ÌÈÎÚfiÙÂÚÔ ÔÛÔÛÙfi ·È‰ÈÒÓ Ù˘ ÔÌ¿‰·˜ ·Ú¤Ì‚·Û˘ οÓÈ˙ ÙÔ 2002 Û ۇÁÎÚÈÛË Ì ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘ (7% Î·È 13% ·ÓÙ›ÛÙÔȯ·, p<0,05). ∏ ÂÎ·È‰Â˘ÙÈ΋ ·Ú¤Ì‚·ÛË Ê·›ÓÂÙ·È fiÙÈ ‚ÂÏÙÈÒÓÂÈ ÙÔ Â›Â‰Ô ˘Á›·˜ ÙˆÓ ·È‰ÈÒÓ Î·È ÂÏ·ÙÙÒÓÂÈ ÛËÌ·ÓÙÈο ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù·. ∂¿Ó ·˘Ù¤˜ ÔÈ ıÂÙÈΤ˜ ÂȉڿÛÂȘ Û˘Ó¯ÈÛÙÔ‡Ó ÙȘ ÂfiÌÂÓ˜ ‰ÂηÂٛ˜, ›Ûˆ˜ Ó· Â›Ó·È ‰˘Ó·Ù‹ Ë Ì›ˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù·.
(intervention group: 7%, control group 13%, p<0.005). This health and nutrition education program appears to improve children’s health and to decrease risk factors for chronic diseases. If these positive effects are maintained in the forthcoming decades, the risk of chronic diseases may well be reduced.
§¤ÍÂȘ ÎÏÂȉȿ: ·È‰È¿, ·ÁˆÁ‹ ˘Á›·˜, ÏÈÔÚˆÙ½Ó˜, ۈ̷ÙÔÌÂÙÚ‹ÛÂȘ, Ê˘ÛÈ΋ ηٿÛÙ·ÛË.
Key words: children, health and nutrition education, lipoproteins, anthropometric measurements, fitness.
™˘ÓÙÔÌÔÁڷʛ˜
ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ
¶ ∂ ¢ª™ HDL-C LDL-C ª™
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∂ÈÛ·ÁˆÁ‹ ∏ Ù·¯Â›· ·‡ÍËÛË ÙˆÓ ‰ÂÈÎÙÒÓ ÓÔÛËÚfiÙËÙ·˜ Î·È ıÓËÛÈÌfiÙËÙ·˜ ÛÙÔÓ ÏËı˘ÛÌfi Ù˘ ¯ÒÚ·˜ Ì·˜ ηٿ ÙȘ ÙÂÏÂ˘Ù·›Â˜ ‰ÂηÂٛ˜ (2,10) ηıÈÛÙ¿ ·Ó·Áη›· ÙËÓ ¤Ó·ÚÍË ÚÔÁÚ·ÌÌ¿ÙˆÓ ÚÔ·ÁˆÁ‹˜ Ù˘ ˘Á›·˜ Î·È ÚfiÏ˄˘ Ôχ ÓˆÚ›˜ ·fi ÙËÓ ·È‰È΋ ËÏÈΛ· (1-3,23-29). ∏ ∫ÏÈÓÈ΋ ¶ÚÔÏËÙÈ΋˜ π·ÙÚÈ΋˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘ ÍÂΛÓËÛ ¤Ó· ÂÍ·ÂÙ¤˜ ÚfiÁÚ·ÌÌ· ÂÎ·È‰Â˘ÙÈ΋˜ ·Ú¤Ì‚·Û˘ ÛÙ· Û¯ÔÏ›· Ù˘ ∫Ú‹Ù˘, ÙÔ Û¯ÔÏÈÎfi ¤ÙÔ˜ 1992-1993. ™ÙÔ ÚfiÁÚ·ÌÌ· ÁÚ¿ÊÙËÎ·Ó fiÏ· Ù· ·È‰È¿ Ù˘ ∞’ Ù¿Í˘ ‰ËÌÔÙÈÎÔ‡, ÂÓÒ ÙÔ ÚfiÁÚ·ÌÌ· ÂÓÙ¿¯ıËΠÛÙËÓ ÂÎ·È‰Â˘ÙÈ΋ ‰È·‰Èηۛ· Û ‰È·Û‡Ó‰ÂÛË Ì ¿ÏÏ· Ì·ı‹Ì·Ù·. ∏ ÂÎ·È‰Â˘ÙÈ΋ ·Ú¤Ì‚·ÛË ÂÛÙÈ¿ÛÙËΠ΢ڛˆ˜ ÛÙË ‰È·ÙÚÔÊ‹, ÙË Ê˘ÛÈ΋ ¿ÛÎËÛË Î·È ÙËÓ ·ÔÊ˘Á‹ ÙÔÍÈÎÒÓ Ô˘ÛÈÒÓ. ∏ ÚÒÙË ·ÍÈÔÏfiÁËÛË ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ¤ÁÈÓ ÛÙ· 3 ¯ÚfiÓÈ· ÂÎ·È‰Â˘ÙÈ΋˜ ·Ú¤Ì‚·Û˘ (4,5) Î·È Ë ‰Â‡ÙÂÚË ¤ÁÈÓ Ì ÙËÓ ÔÏÔÎÏ‹ÚˆÛ‹ ÙÔ˘ ÛÙ· 6 ¯ÚfiÓÈ· (6-9). ∞ÎÔÏÔ‡ıËÛÂ Ë ÙÚ›ÙË ·ÍÈÔÏfiÁËÛË, 4 ¯ÚfiÓÈ· ÌÂÙ¿ ÙÔ Ù¤ÏÔ˜ Ù˘ ·Ú¤Ì‚·Û˘ Î·È ÂÓÒ Ù· ·È‰È¿ ‹Ù·Ó ËÏÈΛ·˜ 14-16 ÂÙÒÓ. ∏ ·ÚÔ‡Û· ¤Ú¢ӷ ÛÙԯ‡ÂÈ ÛÙËÓ ·ÍÈÔÏfiÁËÛË Ù˘ ÂÎ·È‰Â˘ÙÈ΋˜ ·Ú¤Ì‚·Û˘ 10 ¯ÚfiÓÈ· ·fi ÙËÓ ¤Ó·ÚÍ‹ Ù˘ Î·È 4 ¯ÚfiÓÈ· ·fi ÙË ‰È·ÎÔ‹ Ù˘ ·ÁˆÁ‹˜ ˘Á›·˜. °È· ÙËÓ ·ÍÈÔÏfiÁËÛË ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÌÂÏÂÙ‹ıËÎ·Ó Ù· ›‰· ˘Á›·˜, ıÚ¤„˘ Î·È ·Ó¿Ù˘Í˘ ÙˆÓ ·È‰ÈÒÓ Î·È Ë ·ÚÔ˘Û›· ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù·.
∆Ô ÚfiÁÚ·ÌÌ· ÂÎ·È‰Â˘ÙÈ΋˜ ·Ú¤Ì‚·Û˘ Û ۯÔÏ›· Ù˘ ∫Ú‹Ù˘ ¿Ú¯ÈÛ Ì fiÏ· Ù· ·È‰È¿ Ô˘ ÁÚ¿ÊÙËÎ·Ó ÛÙËÓ ∞’ Ù¿ÍË ‰ËÌÔÙÈÎÔ‡ ÙÔ 1992-1993 Û ÙÚÂȘ ÓÔÌÔ‡˜ Ù˘ ∫Ú‹Ù˘. ∞fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ ‰ËÌÔÙÈÎÒÓ Û¯ÔÏ›ˆÓ ÛÙÔ˘˜ ÓÔÌÔ‡˜ ∏Ú·ÎÏ›Ԣ, ƒÂı‡ÌÓÔ˘ Î·È Ã·Ó›ˆÓ Î·È ÙˆÓ 5681 Ì·ıËÙÒÓ Ô˘ ÁÚ¿ÊÙËÎ·Ó ÛÙËÓ ∞’ Ù¿ÍË, ÂÂϤÁË ·ÓÙÈÚÔÛˆÂ˘ÙÈÎfi ‰Â›ÁÌ· 40 Û¯ÔÏ›ˆÓ Ì 1046 Ì·ıËÙ¤˜ ËÏÈΛ·˜ 5,5-7 ÂÙÒÓ, ÔÈ ÔÔ›ÔÈ ˘Ô‚Ï‹ıËÎ·Ó Û ϋÚË ¤ÏÂÁ¯Ô Ù˘ ˘Á›·˜ ÙÔ˘˜. ∞fi Ù· 40 Û¯ÔÏ›·, Ù· 24 ‹Ù·Ó ·fi ÙÔ˘˜ ÓÔÌÔ‡˜ ∏Ú·ÎÏ›Ԣ Î·È ƒÂı‡ÌÓÔ˘ Ì 602 Ì·ıËÙ¤˜ [ÔÌ¿‰· ·Ú¤Ì‚·Û˘ (¶)] Î·È Ù· 16 ·fi ÙÔÓ ÓÔÌfi ÷ӛˆÓ Ì 444 Ì·ıËÙ¤˜ [ÔÌ¿‰· ÂϤÁ¯Ô˘ (∂)]. ∏ ÌÂıÔ‰ÔÏÔÁ›· Ù˘ ¤Ú¢ӷ˜, Ë ÂÎ·È‰Â˘ÙÈ΋ ‰È·‰Èηۛ· Î·È ÔÈ ÂÚÈÔ‰ÈΤ˜ ·ÍÈÔÏÔÁ‹ÛÂȘ Ô˘ ¤ÁÈÓ·Ó Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ¤ÍÈ ÂÙÒÓ ÂÊ·ÚÌÔÁ‹˜ Ù˘ ÂÎ·È‰Â˘ÙÈ΋˜ ·Ú¤Ì‚·Û˘ (1992-1998), ÂÚÈÁÚ¿ÊÔÓÙ·È Ï‹Úˆ˜ Û ÚÔËÁÔ‡ÌÂÓ˜ ÂÚÁ·Û›Â˜ (4-9). ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ Û¯ÔÏÈÎÔ‡ ¤ÙÔ˘˜ 2001-2002, Ù· ·È‰È¿ Ô˘ ›¯·Ó Û˘ÌÌÂÙ¿Û¯ÂÈ ÛÙÔ ÚfiÁÚ·ÌÌ· ÙÔ 1992 ÂÓÙÔ›ÛÙËÎ·Ó Û 63 Û¯ÔÏ›· ÛÙÔ˘˜ ÙÚÂȘ ÓÔÌÔ‡˜ Ù˘ ∫Ú‹Ù˘. OÈ ÁÔÓ›˜ ÙˆÓ ·È‰ÈÒÓ ÂÓËÌÂÚÒıËÎ·Ó ÁÚ·ÙÒ˜ ÁÈ· ÙȘ ÂÍÂÙ¿ÛÂȘ Ù˘ ·ӷÍÈÔÏfiÁËÛ˘ Î·È ˘¤ÁÚ·„·Ó ˘Â‡ı˘ÓË ‰‹ÏˆÛË ÁÈ· ÙË Û˘ÌÌÂÙÔ¯‹ ‹ ÌË ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜. ∞fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ Ì·ıËÙÒÓ Ô˘ ÂÍÂÙ¿ÛÙËÎ·Ó ·fi ÙÔ 1992 ¤ˆ˜ ÙÔ 1998, ÙÔ 2002 ·¿ÓÙËÛ·Ó 728 ·È‰È¿ (70%), Ù· 49 ÂÎ ÙˆÓ ÔÔ›ˆÓ ›¯·Ó ‰È·Îfi„ÂÈ ÙË ÊÔ›ÙËÛ‹ ÙÔ˘˜. ∂‚‰ÔÌ‹ÓÙ· ÂÙ¿ ·È‰È¿ ·ÚÓ‹ıËÎ·Ó ÙË Û˘ÌÌÂÙÔ¯‹ ÙÔ˘˜, ÂÓÒ 651 ‰¤¯ÙËηÓ. ™ÙËÓ È·ÙÚÈ΋ ÂͤٷÛË ÚÔÛ‹Ïı·Ó, ÙÂÏÈο, 634 ·È‰È¿ (61%) (¶: 331, ∂: 303), ÂÓÒ ÌfiÏȘ 7 ·fi Ù· 49 ·È‰È¿ Ô˘ ›¯·Ó ‰È·Îfi„ÂÈ ÙË ÊÔ›ÙËÛ‹ ÙÔ˘˜ ÚÔÛ‹Ïı·Ó ÛÙȘ ÂÍÂÙ¿ÛÂȘ. OÈ ÂÍÂÙ¿ÛÂȘ Ô˘ Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó ÙÔ 2002 ·fi ÙËÓ ÂÚ¢ÓËÙÈ΋ ÔÌ¿‰· Ù˘ ∫ÏÈÓÈ΋˜ ¶ÚÔÏËÙÈ΋˜ π·ÙÚÈ΋˜ Î·È ¢È·ÙÚÔÊ‹˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘, ·ÊÔÚÔ‡Û·Ó Û ۈ̷ÙÔÌÂÙÚÈΤ˜ ÌÂÙÚ‹ÛÂȘ, ·ÚÙËÚȷ΋ ›ÂÛË ·›Ì·ÙÔ˜, ·ÈÌÔÏË„›· ÁÈ· ÏÈÔÚˆÙ½Ó˜, ·ÍÈÔÏfiÁËÛË Ù˘ Ê˘ÛÈ΋˜ ηٿÛÙ·Û˘ Ì ·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜ (¶∆∞), Ï‹„Ë ‰È·ÈÙÔÏÔÁ›Ô˘ ÚÔËÁÔ‡ÌÂÓÔ˘ 24ÒÚÔ˘ Î·È ˙˘ÁÈṲ̂ÓÔ˘ Ê·ÁËÙÔ‡ 3 ËÌÂÚÒÓ Î·È
437
¶·È‰È·ÙÚÈ΋ 2003;66:436-447
ηٷÁÚ·Ê‹ ÙˆÓ ÁÓÒÛÂˆÓ Î·È ÙˆÓ Û˘ÓËıÂÈÒÓ ˘Á›·˜, ηıÒ˜ Î·È ÙÔ˘ ÙÚfiÔ˘ ˙ˆ‹˜. °È· ÙȘ Û˘Ó‹ıÂȘ Î·È ÙȘ ÁÓÒÛÂȘ ˘Á›·˜ ¯ÚËÛÈÌÔÔÈ‹ıËΠÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Ô˘ ·Ó·ÊÂÚfiÙ·Ó ÛÙÔ Î¿ÓÈÛÌ·, ÛÙËÓ Î·Ù·Ó¿ÏˆÛË ÔÈÓÔÓ‡̷ÙÔ˜ Î·È Î·Ê¤, ÛÙËÓ Î·Ù·ÁÚ·Ê‹ ‰Ú·ÛÙËÚÈÔÙ‹ÙˆÓ Î·È ÛÙȘ ÁÓÒÛÂȘ Û ı¤Ì·Ù· ‰È·ÙÚÔÊ‹˜ Î·È ˘Á›·˜. ∏ ·Ó¿Ï˘ÛË ÙÔ˘ ‰È·ÈÙÔÏÔÁ›Ô˘ ¤ÁÈÓ ·fi ËÏÂÎÙÚÔÓÈ΋ ‚¿ÛË ‰Â‰ÔÌ¤ÓˆÓ ÙÚÔʛ̈Ó, ‚·ÛÈṲ̂ÓË ÙfiÛÔ ÛÙË ‚¿ÛË ÙÔ˘ ÀÔ˘ÚÁ›Ԣ °ÂˆÚÁ›·˜ ÙˆÓ ∏ÓˆÌ¤ÓˆÓ ¶ÔÏÈÙÂÈÒÓ (United States Department of Agriculture - USDA) fiÛÔ Î·È ÛÙË ¯ËÌÈ΋ ·Ó¿Ï˘ÛË 120 ÂÏÏËÓÈÎÒÓ ÙÚÔÊ›ÌˆÓ Ô˘ ¤ÁÈÓ ÛÙÔ TNO Nutrition Institute ÛÙËÓ OÏÏ·Ó‰›· ÛÙÔ Ï·›ÛÈÔ ÙÔ˘ Â˘Úˆ·˚ÎÔ‡ ÚÔÁÚ¿ÌÌ·ÙÔ˜ Transfair, ÂÓÒ 20 ÙÚfiÊÈÌ· ·Ó·Ï‡ıËÎ·Ó ¯ËÌÈο ÛÙÔ Wegeningen Agricultural University. ∞fi Ù· 634 ·È‰È¿ Ô˘ ÂÍÂÙ¿ÛÙËÎ·Ó ÙÔ 2002, Ù· 617 Û˘ÌÏ‹ÚˆÛ·Ó ‰È·ÈÙËÙÈÎfi ÈÛÙÔÚÈÎfi ÙÂÏÂ˘Ù·›Ô˘ 24ÒÚÔ˘ (¶: 329, ∂: 288), ÂÓÒ 107 ·È‰È¿ Û˘ÌÏ‹ÚˆÛ·Ó Î·È Â¤ÛÙÚ„·Ó ‰È·ÈÙÔÏfiÁÈÔ ˙˘ÁÈṲ̂ÓÔ˘ Ê·ÁËÙÔ‡ 3 ËÌÂÚÒÓ (¶: 77, ∂: 30). ∆Ô ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜ ÌÂÙÚ‹ıËΠ̠ËÏÂÎÙÚÔÓÈÎfi ˙˘Áfi Ù‡Ô˘ Seca Alpha ·ÎÚȂ›·˜ ±100 g Î·È Ë ˙‡ÁÈÛË ¤ÁÈÓ Ì ÂÛÒÚÔ˘¯·, ¯ˆÚ›˜ ·Ô‡ÙÛÈ·. ∆Ô ‡„Ô˜ ÌÂÙÚ‹ıËΠ̠·Ó·ÛÙËÌfiÌÂÙÚÔ ·ÎÚȂ›·˜ <0,5 cm, Û fiÚıÈ· ı¤ÛË, ¯ˆÚ›˜ ·Ô‡ÙÛÈ·, Ì ¯·Ï·ÚÔ‡˜ ÒÌÔ˘˜ Î·È Ù· ¯¤ÚÈ· ÙÔÔıÂÙË̤ӷ ÛÙÔ Ï¿È. O ‰Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ (¢ª™) ˘ÔÏÔÁ›ÛÙËΠ·fi ÙË Û¯¤ÛË ÙÔ˘ ‚¿ÚÔ˘˜ Û ÎÈÏ¿ ÚÔ˜ ÙÔ ‡„Ô˜ Û ̤ÙÚ· ÛÙÔ ÙÂÙÚ¿ÁˆÓÔ 2 (kg/m ). ªÂ ‚¿ÛË ÙÔÓ ‰Â›ÎÙË Ì¿˙·˜ ÛÒÌ·ÙÔ˜ ˘ÔÏÔÁ›ÛÙËÎÂ Î·È ÙÔ ÔÛÔÛÙfi ÙˆÓ ·È‰ÈÒÓ Ì ˘ÂÚ‚ÔÏÈÎfi ‚¿ÚÔ˜ Î·È ·¯˘Û·ÚΛ· (22). OÈ ‰ÂÚÌ·ÙÈΤ˜ Ù˘¯¤˜ ‰ÈΤʷÏÔ˘, ÙÚÈΤʷÏÔ˘, Ï·ÁÔÓ›Ô˘ Î·È ˆÌÔÏ¿Ù˘ ÌÂÙÚ‹ıËÎ·Ó Ì fiÚÁ·ÓÔ Ù‡Ô˘ Lange. ∆Ô ÔÛÔÛÙfi Ï›Ô˘˜ ÛÒÌ·ÙÔ˜ ˘ÔÏÔÁ›ÛÙËΠ̠‚¿ÛË ÙÔÓ ¢ª™, ÙÔ Ê‡ÏÔ Î·È ÙËÓ ËÏÈΛ· (21). ∏ ÂÚ›ÌÂÙÚÔ˜ Ù˘ ̤Û˘ ÌÂÙÚ‹ıËΠ̠ϷÛÙÈ΋ ÌÂÙÚÈ΋ Ù·ÈÓ›· ÛÙÔ ‡„Ô˜ ÙÔ˘ ÔÌÊ·ÏÔ‡ Î·È Î¿ÙˆıÂÓ ÙÔ˘ Ï¢ÚÈÎÔ‡ ÙfiÍÔ˘ (ÛÙÔ Ì¤ÛÔ Ù˘ ·fiÛÙ·Û˘ ÌÂٷ͇ Ï¢ÚÈÎÔ‡ ÙfiÍÔ˘ Î·È Ï·ÁÔÓ›Ô˘ ·ÎÚÔÏÔÊ›·˜) Î·È Ë ÂÚ›ÌÂÙÚÔ˜ ÏÂοÓ˘ ÛÙÔ ‡„Ô˜ ÙˆÓ Î·Ù’ ÈÛ¯›ˆÓ ·ÚıÚÒÛÂˆÓ Î·È ¿ÓˆıÂÓ ÙÔ˘ ÂÊË‚·›Ô˘. OÈ Û¯¤ÛÂȘ Ù˘ ÂÚÈ̤ÙÚÔ˘ ̤Û˘ ÚÔ˜ ÏÂοÓË Î·È ÚÔ˜ ‡„Ô˜ ˘ÔÏÔÁ›ÛÙËÎ·Ó ·fi ÙȘ ·Ú·¿Óˆ ÌÂÙÚ‹ÛÂȘ (11). ™ÙË Ì¤ÙÚËÛË ÙˆÓ ÛˆÌ·ÙÔÌÂÙÚÈÎÒÓ ÌÂÁÂıÒÓ Û˘ÌÌÂÙ›¯·Ó 617 ·È‰È¿. ∏ Û˘ÛÙÔÏÈ΋ Î·È ‰È·ÛÙÔÏÈ΋ ·ÚÙËÚȷ΋ ›ÂÛË ÌÂÙÚ‹ıËΠ۠622 ·È‰È¿ Ì ˘‰Ú·ÚÁ˘ÚÈÎfi Ì·ÓfiÌÂÙÚÔ ÙÚÂȘ ÊÔÚ¤˜, Ì ÌÂÛԉȿÛÙËÌ· 1-2 min (12). ∫¿ı ·È‰› ‚ÚÈÛÎfiÙ·Ó Û ηıÈÛÙ‹ ı¤ÛË Ì ÙËÓ Ï¿ÙË Î·È Ù· ¯¤ÚÈ· ÛÙËÚÈÁ̤ӷ ÛÙ· ÁfiÓ·Ù· Î·È Û ηٿÛÙ·ÛË ËÚÂÌ›·˜ ÚÈÓ ·fi ÙË Ì¤ÙÚËÛË ÁÈ· ÙÔ˘Ï¿¯ÈÛÙÔÓ 5 min. ∞fi ÙȘ ÙÚÂȘ ·˘Ù¤˜ ÌÂÙÚ‹ÛÂȘ ÂÏ‹ÊıË Ô Ì¤ÛÔ˜ fiÚÔ˜. ∏ ·ÚÙËÚȷ΋ ›ÂÛË Â›¯Â ÌÂÙÚËı› Î·È Î·Ù·ÁÚ·Ê› ηٿ ÙËÓ ¤Ó·ÚÍË ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÙÔ 1992 Û 932 ·È‰È¿. ¢Â›ÁÌ·Ù· ·›Ì·ÙÔ˜ ÂÏ‹ÊıËÛ·Ó ·fi 556 ·È‰È¿ ÙȘ ÚˆÈÓ¤˜ ÒÚ˜ ÌÂÙ¿ ·fi 12ˆÚË ÓËÛÙ›· Î·È ÌÂÙÚ‹ıËÎ·Ó Ë ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË (TC), Ù· ÙÚÈÁÏ˘ÎÂÚ›‰È· (Trigl) Î·È Ë HDL-¯ÔÏËÛÙÂÚfiÏË. ∏ LDL-¯ÔÏËÛÙÂÚfiÏË ˘ÔÏÔÁ›ÛÙËΠ·fi ÙÔÓ Ù‡Ô LDL=TC-(Trigl/5+HDL), ÂÓÒ Ô ·ıËڈ̷ÙÈÎfi˜ ‰Â›ÎÙ˘ ˘ÔÏÔÁ›ÛÙËΠ·fi ÙÔ ËÏ›ÎÔ Ù˘ ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ ÚÔ˜ ÙËÓ HDL-¯ÔÏËÛÙÂÚfiÏË (4).
438
Paediatriki 2003;66:436-447
∆¤ÏÔ˜, Ë ÂÎÙ›ÌËÛË Ù˘ Ê˘ÛÈ΋˜ ηٿÛÙ·Û˘ Ì ÙÔ ·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜ ¤ÁÈÓ Û 421 ·È‰È¿ (4-6). ∏ ¤ÁÎÚÈÛË ÂÊ·ÚÌÔÁ‹˜ ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ Î·È ÙˆÓ ÂÚÈÔ‰ÈÎÒÓ ·ÍÈÔÏÔÁ‹ÛÂˆÓ ÙˆÓ Ì·ıËÙÒÓ ÂÏ‹ÊıË ·fi ÙÔ ÀÔ˘ÚÁÂ›Ô ¶·È‰Â›·˜ Î·È ÙÔ ¶·È‰·ÁˆÁÈÎfi πÓÛÙÈÙÔ‡ÙÔ, ÂÓÒ fiÏÔÈ ÔÈ ÁÔÓ›˜ ¤‰ˆÛ·Ó ÂÓ˘fiÁÚ·ÊË ÏËÚÔÊÔÚË̤ÓË Û˘Ó·›ÓÂÛË ÁÈ· ÙËÓ ÂͤٷÛË ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘˜. ™Ù·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË OÈ ÛˆÌ·ÙÔÌÂÙÚÈΤ˜ ÌÂÙÚ‹ÛÂȘ, ÔÈ ÏÈÔÚˆÙ½Ó˜, Ë ·ÚÙËÚȷ΋ ›ÂÛË ·›Ì·ÙÔ˜, Ë ‰ÔÎÈÌ·Û›· ·ÓÙÔ¯‹˜ Î·È Ë ÚfiÛÏË„Ë ‰È·ÈÙËÙÈÎÒÓ ÛÙÔȯ›ˆÓ Û˘ÁÎÚ›ıËÎ·Ó ÁÈ· ÙȘ ‰‡Ô ÔÌ¿‰Â˜ (·Ú¤Ì‚·Û˘ Î·È ÂϤÁ¯Ô˘) ÁÈ· ÙȘ ÂÚÈfi‰Ô˘˜ ·ÍÈÔÏfiÁËÛ˘ 1995, 1998 Î·È 2002 Û ۯ¤ÛË Ì ÙËÓ ·Ú¯È΋ ÂͤٷÛË ÙÔ 1992. ªÂ ÙË ¯Ú‹ÛË ÁÂÓÈÎÂ˘Ì¤ÓÔ˘ ÁÚ·ÌÌÈÎÔ‡ ÌÔÓÙ¤ÏÔ˘ ·Ó¿Ï˘Û˘ Û˘Ó‰È·Î‡Ì·ÓÛ˘ (ANCOVA) Î·È Û˘ÌÌÂÙ·‚ÏËÙÒÓ Ê‡ÏÔ˘ Î·È ¢ª™, ÂϤÁ¯ıËÎÂ Ë ‡·ÚÍË ‹ ÌË ‰È·ÊÔÚ¿˜ ÌÂÙ¿ 10 ¯ÚfiÓÈ· ·fi ÙËÓ ¤Ó·ÚÍË ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜. ¶·Ú¿ÏÏËÏ· Ì ÙË ¯Ú‹ÛË ÁÂÓÈÎÂ˘Ì¤ÓÔ˘ ÌÔÓÙ¤ÏÔ˘ ·Ó¿Ï˘Û˘ Û˘Ó‰È·Î‡Ì·ÓÛ˘ ·ӷϷ̂·ÓfiÌÂÓˆÓ ÌÂÙÚ‹ÛÂˆÓ (GLM-Repeated measures analysis) Î·È Û˘ÌÌÂÙ·‚ÏËÙÒÓ Ê‡ÏÔ˘ Î·È Ì¤Û˘ ‰È·ÊÔÚ¿˜ ¢ª™ ·fi ÙËÓ ·Ú¯È΋ ÂͤٷÛË, ÂϤÁ¯ıËÎÂ Ë ‰È·ÊÔÚÔÔ›ËÛË ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ ·Ú¤Ì‚·Û˘ Î·È ÂϤÁ¯Ô˘ Û fiϘ ÙȘ ÂÚÈfi‰Ô˘˜ ·ÍÈÔÏfiÁËÛ˘. OÈ ¤ÏÂÁ¯ÔÈ ¤ÁÈÓ·Ó ÛÙȘ ‰È·ÊÔÚ¤˜ ÙˆÓ ÙÈÌÒÓ ·fi ÙËÓ ·Ú¯È΋ ÂͤٷÛË ÙÔ˘ 1992 Ì ÙËÓ Î¿ı ÂÚ›Ô‰Ô ·ÍÈÔÏfiÁËÛ˘. °È· ÙÔÓ ¤ÏÂÁ¯Ô ˙¢ÁÒÓ ·Ú·ÙËÚ‹ÛÂˆÓ (Student paired samples t-test) Û˘ÁÎÚ›ıËÎ·Ó Ù· 107 ‰È·ÈÙÔÏfiÁÈ· 3 ËÌÂÚÒÓ Ì ٷ ·ÓÙ›ÛÙÔȯ· ‰È·ÈÙÔÏfiÁÈ· ÙÔ˘ 24ÒÚÔ˘ ηٿ ÙËÓ ÙÚ›ÙË ·ÍÈÔÏfiÁËÛË ÙÔ 2002. ¶·Ú¿ÏÏËÏ· Ì ÙË ¯Ú‹ÛË ÂϤÁ¯Ô˘ ·Ó¿Ï˘Û˘ Û˘Ó‰È·Î‡Ì·ÓÛ˘ (ANCOVA) Î·È Û˘ÌÌÂÙ·‚ÏËÙÒÓ Ê‡ÏÔ˘, ¢ª™, ËÏÈΛ·˜ Î·È ÂÎ·È‰Â˘ÙÈ΋˜ ·Ú¤Ì‚·Û˘, ¤ÁÈÓ ۇÁÎÚÈÛË ÙˆÓ ÛˆÌ·ÙÔÌÂÙÚ‹ÛˆÓ, Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ ·›Ì·ÙÔ˜, ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ Î·È ÙÔ˘ ·Ï›Ó‰ÚÔÌÔ˘ ÙÚÂ̷͛ÙÔ˜ ·ÓÙÔ¯‹˜ ÙˆÓ ·È‰ÈÒÓ ÂÎÂ›ÓˆÓ Ô˘ ¤ÛÙÚ„·Ó Ù· 107 ‰È·ÈÙÔÏfiÁÈ· ˙˘ÁÈṲ̂ÓÔ˘ Ê·ÁËÙÔ‡ 3 ËÌÂÚÒÓ, Ì ٷ ˘fiÏÔÈ· 498 ·È‰È¿ ÛÙ· ÔÔ›· ÂÏ‹ÊıË ‰È·ÈÙÔÏfiÁÈÔ ÙÂÏÂ˘Ù·›Ô˘ 24ÒÚÔ˘. 2 O ¯ ¤ÏÂÁ¯Ô˜ (Chi-square test) ¯ÚËÛÈÌÔÔÈ‹ıËΠÁÈ· ÙË ‰È·ÊÔÚ¿ Û˘¯ÓÔÙ‹ÙˆÓ ÛÙÔ Î¿ÓÈÛÌ· ÙˆÓ ·È‰ÈÒÓ Î·È ÙˆÓ ÁÔÓ¤ˆÓ ÙÔ˘˜, ÂÓÒ Ô ÌË ·Ú·ÌÂÙÚÈÎfi˜ ¤ÏÂÁ¯Ô˜ Mann-Whitney ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô Ù˘ ‰È¿ÚÎÂÈ·˜ Î·È Ù˘ ÔÛfiÙËÙ·˜ ÙÔ˘ ηӛÛÌ·ÙÔ˜ ÙˆÓ ·È‰ÈÒÓ ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜.
∞ÔÙÂϤÛÌ·Ù· ™ÙÔÓ ¶›Ó·Î· 1 ·ÚÔ˘ÛÈ¿˙ÂÙ·È Ô Û¯Â‰È·ÛÌfi˜ ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜, fiˆ˜ ‰ÈÂÓÂÚÁ‹ıËΠÛÙ· 10 ¯ÚfiÓÈ· ·fi ÙËÓ ¤Ó·ÚÍ‹ ÙÔ˘. ∏ ÂÎ·È‰Â˘ÙÈ΋ ·Ú¤Ì‚·ÛË ‰È¿ÚÎÂÈ·˜ 6 ÂÙÒÓ ÔÏÔÎÏËÚÒıËΠÙÔ 1998 Î·È ·ÎÔÏÔ‡ıËÛÂ Ë ÙÚ›ÙË ·ÍÈÔÏfiÁËÛË ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÙÔ 2002. ∞fi Ù· 1046 ·È‰È¿ Ô˘ ÂÍÂÙ¿ÛÙËÎ·Ó ÛÙËÓ ·Ú¯È΋ ÂͤٷÛË ÙÔ 1992, 471 ·È‰È¿ Û˘ÌÌÂÙ›¯·Ó ÙÔ 1995 ÛÙËÓ 1Ë ·ÍÈÔÏfiÁËÛË (45% ÙÔ˘ ·Ú¯ÈÎÔ‡ ‰Â›ÁÌ·ÙÔ˜), 831 ·È‰È¿ (79%) Û˘ÌÌÂÙ›¯·Ó ÛÙË 2Ë ·ÍÈÔÏfiÁËÛË ÙÔ 1998 ηÈ, Ù¤ÏÔ˜, 634 ·È‰È¿ (61%) Û˘ÌÌÂÙ›¯·Ó ÛÙËÓ 3Ë ·ÍÈÔÏfiÁËÛË ÙÔ 2002.
¶·È‰È·ÙÚÈ΋ 2003;66:436-447
Paediatriki 2003;66:436-447
™ÙÔÓ ¶›Ó·Î· 2 ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ù· ›‰· ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ Î·È Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ ÙˆÓ ·È‰ÈÒÓ Ô˘ ÂÍÂÙ¿ÛÙËÎ·Ó ÙÔ 1992 Î·È ÙÔ 2002. ∏ ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË ÌÂÈÒıËΠ۠ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚÔ ‚·ıÌfi ÛÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·Û˘ Û ۇÁÎÚÈÛË Ì ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘ (¶: -24,0±1,7 mg/dL, E: -10,1±1,8 mg/dL, p<0,001), fiˆ˜ Î·È Ë LDL-¯ÔÏËÛÙÂÚfiÏË (¶: -18,5±1,4 mg/dL, E: -3,1±1,6 mg/dL, p<0,001). O ·ıËڈ̷ÙÈÎfi˜ ‰Â›ÎÙ˘ ·˘Í‹ıËΠÛËÌ·-
ÓÙÈο ÏÈÁfiÙÂÚÔ ÛÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·Û˘ (¶: 0,06±0,05, E: 0,29±0,05, p<0,01), ÂÓÒ ‰ÂÓ ˘‹ÚÍ ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙËÓ ·ÚÙËÚȷ΋ ›ÂÛË ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ. O ¶›Ó·Î·˜ 3 ÂÚÈÏ·Ì‚¿ÓÂÈ ÙȘ ÌÂÙ·‚ÔϤ˜ ÛÙȘ ۈ̷ÙÔÌÂÙÚÈΤ˜ ÌÂÙÚ‹ÛÂȘ Î·È ÛÙË ‰ÔÎÈÌ·Û›· ·ÓÙÔ¯‹˜ ÙˆÓ ·È‰ÈÒÓ ÙÔ 1992 Î·È ÙÔ 2002. ∆Ô ‚¿ÚÔ˜ Î·È Ô ¢ª™ ·˘Í‹ıËÎ·Ó ÛËÌ·ÓÙÈο ÂÚÈÛÛfiÙÂÚÔ ÛÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘ Û ۇÁÎÚÈÛË Ì ÙËÓ ÔÌ¿‰·
¶›Ó·Î·˜ 1. ÷ڷÎÙËÚÈÛÙÈο ÚÔÁÚ¿ÌÌ·ÙÔ˜ ·ÁˆÁ‹˜ ˘Á›·˜ ÛÙ· Û¯ÔÏ›· Ù˘ ∫Ú‹Ù˘
°’ ¢ËÌÔÙÈÎÔ‡
6,3±0,4*
8,6±0,3*
11,6±0,3*
15,1±0,5*
4171 602** 24
288** 12
457** 24
331** 37
1510 444** 16
183** 9
374* 16
303** 26
1046 545 501 40
471 242 229 21
831 427 404 42
634 302 332 63
ñ ∏ÏÈΛ· (¤ÙË) ñ OÌ¿‰· ·Ú¤Ì‚·Û˘ ª·ıËÙ¤˜ ∞’ Ù¿Í˘ ‰ËÌÔÙÈÎÒÓ Û¯ÔÏ›ˆÓ Ù˘ ∫Ú‹Ù˘ ª·ıËÙ¤˜ Ô˘ ÂÍÂÙ¿ÛÙËÎ·Ó ™¯ÔÏ›· ñ OÌ¿‰· ÂϤÁ¯Ô˘ ª·ıËÙ¤˜ ∞’ Ù¿Í˘ ‰ËÌÔÙÈÎÒÓ Û¯ÔÏ›ˆÓ Ù˘ ∫Ú‹Ù˘ ª·ıËÙ¤˜ Ô˘ ÂÍÂÙ¿ÛÙËÎ·Ó ™¯ÔÏ›· ñ ™‡ÓÔÏÔ ª·ıËÙ¤˜ Ô˘ ÂÍÂÙ¿ÛÙËÎ·Ó ∞ÁfiÚÈ· ∫ÔÚ›ÙÛÈ· ™¯ÔÏ›·
1Ë: 1995
∞•πO§O°∏™∏ 2Ë: 1998 3Ë: 2002 (∆∂§O™ ¶∞ƒ∂ªµ∞™∏™) °’ °˘ÌÓ·Û›Ô˘ & ™∆’ ¢ËÌÔÙÈÎÔ‡ ∞’ §˘Î›Ԣ
1992 (∞ƒÃ∏ ¶∞ƒ∂ªµ∞™∏™) ∞’ ¢ËÌÔÙÈÎÔ‡
* ª¤ÛÔ˜ fiÚÔ˜ ± Ù˘È΋ ·fiÎÏÈÛË ** ∂ÈÏÂÁ̤ÓÔ Ù˘¯·›Ô ‰Â›ÁÌ· ·fi ÙÔ˘˜ Ì·ıËÙ¤˜ Ô˘ ÁÚ¿ÊÙËÎ·Ó ÛÙËÓ ∞’ Ù¿ÍË ‰ËÌÔÙÈÎÔ‡ ¶›Ó·Î·˜ 2. ªÂÙ·‚ÔϤ˜ ÙˆÓ ÂȤ‰ˆÓ ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ Î·È Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ ÙˆÓ ÔÌ¿‰ˆÓ ·Ú¤Ì‚·Û˘ Î·È ÂϤÁ¯Ô˘ Û ‰È¿ÛÙËÌ· 10 ÂÙÒÓ ∞ƒÃ∏ 1992
3Ë ·ÍÈÔÏfiÁËÛË 2002 ª¤ÛÔ˜ ± ∆™
ªÂÙ·‚ÔÏ‹
p** <0,001
¡ OÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË (mg/dL) ∆ÚÈÁÏ˘ÎÂÚ›‰È· (mg/dL) HDL-C (mg/dL) LDL-C (mg/dL) ∞ıËڈ̷ÙÈÎfi˜ ‰Â›ÎÙ˘: ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË/HDL-C ™˘ÛÙÔÏÈ΋ ›ÂÛË ·›Ì·ÙÔ˜ (mm Hg) ¢È·ÛÙÔÏÈ΋ ›ÂÛË ·›Ì·ÙÔ˜ (mm Hg)
¶* ∂* ¶ ∂ ¶ ∂ ¶ ∂
255 214 255 214 255 214 255 214
188,1±1,9 176,0±2,1 52,9±1,3 52,9±1,4 60,5±0,9 59,7±0,9 117,2±1,8 105,7±1,9
164,1±1,8 165,9±1,9 66,9±1,7 64,8±1,8 51,9±0,7 50,3±0,7 98,7±1,5 102,6±1,6
-24,0±1,7 -10,1±1,8 13,9±1,8 11,9±1,9 -8,5±0,8 -9,3±0,9 -18,5±1,4 -3,1±1,6
¶ ∂ ¶ ∂ ¶ ∂
255 214 274 244 274 244
3,22±0,05 3,11±0,06 100,4±0,6 104,4±0,7 58,6±0,5 60,0±0,5
3,28±0,05 3,40±0,05 117,6±0,7 120,8±0,7 71,5±0,6 74,9±0,6
0,06±0,05 0,29±0,05 17,2±0,8 16,5±0,8 12,9±0,7 14,9±0,8
ª™*** ª™ <0,001
0,001 ª™ ª™
* ¶: ÔÌ¿‰· ·Ú¤Ì‚·Û˘, ∂: ÔÌ¿‰· ÂϤÁ¯Ô˘ ** ∞Ó¿Ï˘ÛË Û˘Ó‰È·Î‡Ì·ÓÛ˘ (ANCOVA): Ô ¤ÏÂÁ¯Ô˜ ¤ÁÈÓ ÛÙË ‰È·ÊÔÚ¿ Ù˘ 3˘ ·ÍÈÔÏfiÁËÛ˘ ·fi ÙËÓ ·Ú¯È΋ ÂͤٷÛË (∞ƒÃ∏) Î·È ˆ˜ Û˘ÌÌÂÙ·‚ÏËÙ¤˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÙÔ Ê‡ÏÔ Î·È Ë ‰È·ÊÔÚ¿ ÙÔ˘ ¢ª™ ·fi ÙËÓ ·Ú¯È΋ ÂͤٷÛË (1992) *** ª™: ÛÙ·ÙÈÛÙÈÎÒ˜ ÌË ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿
439
¶·È‰È·ÙÚÈ΋ 2003;66:436-447
Paediatriki 2003;66:436-447
¶›Ó·Î·˜ 3. ªÂÙ·‚ÔϤ˜ ÙˆÓ ÂȤ‰ˆÓ ÙˆÓ ÛˆÌ·ÙÔÌÂÙÚ‹ÛÂˆÓ Î·È Ù˘ Ê˘ÛÈ΋˜ ηٿÛÙ·Û˘ ÙˆÓ ÔÌ¿‰ˆÓ ·Ú¤Ì‚·Û˘ Î·È ÂϤÁ¯Ô˘ Û ‰È¿ÛÙËÌ· 10 ÂÙÒÓ ∞ƒÃ∏ 1992
3Ë ·ÍÈÔÏfiÁËÛË 2002 ª¤ÛÔ˜ ± ∆™
22,8±0,3 24,3±0,3 118,4±0,3 121,5±0,3 16,2±0,1 16,3±0,1 54,2±0,3 55,7±0,3 0,86±0,003 0,85±0,003 0,46±0,002 0,46±0,002 29,6±0,9 31,6±1,0 19,7±0,2 19,9±0,2 1,7±0,1 1,8±0,1
61,1±0,8 66,6±0,9 165,7±0,4 169,1±0,5 22,1±0,2 23,1±0,3 74,3±0,6 76,5±0,6 0,78±0,004 0,79±0,005 0,45±0,003 0,45±0,003 60,5±1,7 60,1±1,8 22,2±0,3 22,1±0,4 4,0±0,1 3,9±0,1
¡ µ¿ÚÔ˜ (kg) ⁄„Ô˜ (cm) ¢Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ ¶ÂÚ›ÌÂÙÚÔ˜ ̤Û˘ (cm) ¢Â›ÎÙ˘ ÂÚÈ̤ÙÚÔ˘ ̤Û˘/ÏÂοÓ˘ ¢Â›ÎÙ˘ ÂÚÈ̤ÙÚÔ˘ ̤Û˘/‡„Ô˜ ÕıÚÔÈÛÌ· ÙÂÛÛ¿ÚˆÓ ‰ÂÚÌ·ÙÈÎÒÓ Ù˘¯ÒÓ (mm) ¶ÔÛÔÛÙfi Ï›Ô˘˜ ÛÒÌ·ÙÔ˜ (%) ¶·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜ (ÛÙ¿‰È·)
¶* ∂* ¶ ∂ ¶ ∂ ¶ ∂ ¶ ∂ ¶ ∂ ¶ ∂ ¶ ∂ ¶ ∂
291 265 291 265 298 265 288 265 287 265 287 265 275 247 291 265 133 169
ªÂÙ·‚ÔÏ‹
p**
38,4±0,8 <0,001 42,5±0,7 47,3±0,3 ª™*** 47,6±0,3 5,9±0,2 0,001 6,9±0,2 20,1±0,5 ª™ 20,8±0,5 -0,07±0,005 ª™ -0,06±0,005 -0,01±0,003 ª™ -0,01±0,003 30,9±1,3 ª™ 28,6±1,4 2,5±0,3 ª™ 2,2±0,3 2,3±0,1 ª™ 2,1±0,1
* ¶: ÔÌ¿‰· ·Ú¤Ì‚·Û˘, ∂: ÔÌ¿‰· ÂϤÁ¯Ô˘ ** ∞Ó¿Ï˘ÛË Û˘Ó‰È·Î‡Ì·ÓÛ˘ (ANCOVA): Ô ¤ÏÂÁ¯Ô˜ ¤ÁÈÓ ÛÙË ‰È·ÊÔÚ¿ Ù˘ 3˘ ·ÍÈÔÏfiÁËÛ˘ ·fi ÙËÓ ·Ú¯È΋ ÂͤٷÛË (∞ƒÃ∏) Î·È ˆ˜ Û˘ÌÌÂÙ·‚ÏËÙ¤˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÙÔ Ê‡ÏÔ Î·È Ë ‰È·ÊÔÚ¿ ÙÔ˘ ¢ª™ ·fi ÙËÓ ·Ú¯È΋ ÂͤٷÛË (Ô ¢ª™ ¯ÚËÛÈÌÔÔÈ‹ıËΠÌfiÓÔ ÛÙÔ ·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜) *** ª™: ÛÙ·ÙÈÛÙÈÎÒ˜ ÌË ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿
·Ú¤Ì‚·Û˘ (¶: 38,4±0,8 kg, ∂: 42,5±0,7 kg, p<0,001 Î·È ¶: 5,9±0,2 kg/m2, ∂: 6,9±0,2 kg/m2, p<0,01, ·ÓÙ›ÛÙÔȯ·). OÈ ÌÂÙ·‚ÔϤ˜ ÛÙËÓ ÂÚ›ÌÂÙÚÔ Ì¤Û˘ (¶: 20,1±0,5 cm, ∂: 20,8±0,5 cm) Î·È ÛÙÔ ·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜ (¶: 2,3±0,1 ÛÙ¿‰È·, ∂: 2,1±0,1 ÛÙ¿‰È·) ‰ÂÓ ‰È¤ÊÂÚ·Ó ÛËÌ·ÓÙÈο ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ. ™ÙÔÓ ¶›Ó·Î· 4 ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ù· ›‰· ÚfiÛÏ˄˘ ÙˆÓ ‰È·ÈÙËÙÈÎÒÓ Û˘ÛÙ·ÙÈÎÒÓ. §fiÁˆ ÙÔ˘ ÌÈÎÚÔ‡ ·ÚÈıÌÔ‡ ÙˆÓ ‰È·ÈÙÔÏÔÁ›ˆÓ Ì ˙˘ÁÈṲ̂ÓÔ Ê·ÁËÙfi 3 ËÌÂÚÒÓ (Ó=107) Ô˘ ÂÈÛÙÚ¿ÊËÎ·Ó ÙÔ 2002, ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÁÈ· ÙȘ ·Ú·Î¿Ùˆ Û˘Û¯ÂÙ›ÛÂȘ Ù· ‰Â‰Ô̤ӷ ·fi ÙÔ ‰È·ÈÙÔÏfiÁÈÔ ÙÔ˘ ÙÂÏÂ˘Ù·›Ô˘ 24ÒÚÔ˘ (Ó=617). °È· ÙÔÓ ¤ÏÂÁ¯Ô Ù˘ ·ÍÈÔÈÛÙ›·˜ ÙÔ˘ ‰È·ÈÙÔÏÔÁ›Ô˘ ÙÔ˘ ÙÂÏÂ˘Ù·›Ô˘ 24ÒÚÔ˘, ¤ÁÈÓ ۇÁÎÚÈÛË ˙¢ÁÒÓ ‰È·ÈÙÔÏÔÁ›ˆÓ ÛÙ· ›‰È· ·È‰È¿ (Student paired samples t-test) ÌÂٷ͇ ÙˆÓ 107 ‰È·ÈÙÔÏÔÁ›ˆÓ 3 ËÌÂÚÒÓ Î·È ÙˆÓ ·ÓÙ›ÛÙÔȯˆÓ 107 ÙÔ˘ ÙÂÏÂ˘Ù·›Ô˘ 24ÒÚÔ˘. O ¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍ fiÙÈ ÛÙËÓ ÙÚ›ÙË ·ÍÈÔÏfiÁËÛË (2002) ‰ÂÓ ˘‹Ú¯·Ó ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÌÂٷ͇ ÙˆÓ ‰‡Ô Ù‡ˆÓ ‰È·ÈÙÔÏÔÁ›ˆÓ, ·Ú¿ ÌfiÓÔ ÛÙËÓ ÚfiÛÏË„Ë ÓÈ·Û›Ó˘ (24ˆÚÔ: 19,1±1,0 mg, 3 ËÌÂÚÒÓ: 17,0±0,7 mg, p<0,05), ÌÔÓÔ·ÎfiÚÂÛÙˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ ˆ˜ ÔÛÔÛÙÔ‡ ÂÓ¤ÚÁÂÈ·˜ (24ˆÚÔ: 16,2±0,5%, 3 ËÌÂÚÒÓ: 17,9±0,4%, p<0,01) Î·È ÔÏ˘·ÎfiÚÂÛÙˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ, ›Û˘ ˆ˜ ÔÛÔÛÙÔ‡ ÂÓ¤ÚÁÂÈ·˜ (24ˆÚÔ: 4,7±0,2%, 3 ËÌÂÚÒÓ: 5,2±0,2%, p<0,05). ∏ Û‡-
440
ÁÎÚÈÛË ÙˆÓ ÌÂÙÚ‹ÛÂˆÓ (ۈ̷ÙÔÌÂÙÚ‹ÛÂȘ, ·ÚÙËÚȷ΋ ›ÂÛË, ÏÈÔÚˆÙ½Ó˜ Î·È ·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜) ÙˆÓ 107 ·È‰ÈÒÓ Ô˘ ¤ÛÙÚ„·Ó ‰È·ÈÙÔÏfiÁÈ· ˙˘ÁÈṲ̂ÓÔ˘ Ê·ÁËÙÔ‡ 3 ËÌÂÚÒÓ Ì ÂΛӘ ÙˆÓ 510 ·È‰ÈÒÓ ·fi Ù· ÔÔ›· ÂÏ‹ÊıË ‰È·ÈÙËÙÈÎfi ÈÛÙÔÚÈÎfi ÙÂÏÂ˘Ù·›Ô˘ 24ÒÚÔ˘, ¤‰ÂÈÍ fiÙÈ ˘‹ÚÍ ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÌfiÓÔ ÛÙÔ ‡„Ô˜ (·È‰È¿ Ì ‰È·ÈÙÔÏfiÁÈÔ 3 ËÌÂÚÒÓ: 165,9±0,7 cm, ·È‰È¿ Ì ‰È·ÈÙÔÏfiÁÈÔ 24ÒÚÔ˘: 167,5±0,3 cm, p<0,05) Î·È ÛÙËÓ HDL-¯ÔÏËÛÙÂÚfiÏË (·È‰È¿ Ì ‰È·ÈÙÔÏfiÁÈÔ 3 ËÌÂÚÒÓ: 54,0±1,1 mg/dl, ·È‰È¿ Ì ‰È·ÈÙÔÏfiÁÈÔ 24ÒÚÔ˘: 50,5±0,5 mg/dl, p<0,01). ∆· 107 ‰È·ÈÙÔÏfiÁÈ· 3 ËÌÂÚÒÓ ÚÔ¤Ú¯ÔÓÙ·È Û ÔÛÔÛÙfi 17% ·fi ·ÁÚÔÙÈΤ˜ ÂÚÈÔ¯¤˜ Î·È Û ÔÛÔÛÙfi 83% ·fi ·ÛÙÈΤ˜-ËÌÈ·ÛÙÈΤ˜, Û ·ÓÙ›ıÂÛË Ì ٷ 510 ÙÂÏÂ˘Ù·›Ô˘ 24ÒÚÔ˘, Ù· ÔÔ›· ÚÔ¤Ú¯ÔÓÙ·È Û ÔÛÔÛÙfi 30% ·fi ·ÁÚÔÙÈΤ˜ Î·È Î·Ù¿ 70% ·fi ·ÛÙÈΤ˜-ËÌÈ·ÛÙÈ2 Τ˜ ÂÚÈÔ¯¤˜ (¯ , p<0,01). ™ÙÔÓ ¶›Ó·Î· 4 Ê·›ÓÂÙ·È fiÙÈ Ë ÔÌ¿‰· ·Ú¤Ì‚·Û˘ ·ÚÔ˘ÛÈ¿˙ÂÈ ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚË ·‡ÍËÛË ÛÙËÓ ÚfiÛÏË„Ë ˘‰·Ù·ÓıڿΈÓ, ÌÔÓÔ·ÎfiÚÂÛÙˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ, Ê˘ÏÏÈÎÔ‡ ÔͤԘ, ‚ÈÙ·Ì›Ó˘ C Î·È ‚ÈÙ·Ì›Ó˘ µ2, ÂÓÒ Ë ÔÌ¿‰· ÂϤÁ¯Ô˘ ·ÚÔ˘ÛÈ¿˙ÂÈ ¯·ÌËÏfiÙÂÚË ÚfiÛÏË„Ë ÔÏÈ΋˜ ÂÓ¤ÚÁÂÈ·˜ Î·È trans ÏÈ·ÚÒÓ ÔͤˆÓ. ™ÙÔ˘˜ ¶›Ó·Î˜ 5 Î·È 6 ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÔÈ ÌÂÙÚ‹ÛÂȘ ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ, ÙˆÓ ÛˆÌ·ÙÔÌÂÙÚ‹ÛÂˆÓ Î·È ÙÔ˘ ·Ï›Ó‰ÚÔÌÔ˘ ÙÚÂ̷͛ÙÔ˜ ·ÓÙÔ¯‹˜ ÙˆÓ
¶·È‰È·ÙÚÈ΋ 2003;66:436-447
Paediatriki 2003;66:436-447
¶›Ó·Î·˜ 4. ªÂÙ·‚ÔϤ˜ ÛÙËÓ ÚfiÛÏË„Ë ‰È·ÈÙËÙÈÎÒÓ ÛÙÔȯ›ˆÓ ÙˆÓ ÔÌ¿‰ˆÓ ·Ú¤Ì‚·Û˘ Î·È ÂϤÁ¯Ô˘ Û ‰È¿ÛÙËÌ· 10 ÂÙÒÓ
∂Ó¤ÚÁÂÈ· (kcal) ¶ÚˆÙ½Ó˜ (g) À‰·Ù¿ÓıڷΘ (g) OÏÈÎfi ϛԘ (g) ∫ÔÚÂṲ̂ӷ ÏÈ·Ú¿ Ôͤ· (g) ªÔÓÔ·ÎfiÚÂÛÙ· ÏÈ·Ú¿ Ôͤ· (g) ¶ÔÏ˘·ÎfiÚÂÛÙ· ÏÈ·Ú¿ Ôͤ· (g) Trans ÏÈ·Ú¿ Ôͤ· (g) º˘ÙÈΤ˜ ›Ó˜ (g) º˘ÏÏÈÎfi Ô͇ (Ìg) ∞Û‚¤ÛÙÈÔ (mg) ™›‰ËÚÔ˜ (mg) µÈÙ·Ì›ÓË C (mg) µÈÙ·Ì›ÓË µ2 (mg)
¶* ∂* ¶ ∂ ¶ ∂ ¶ ∂ ¶ ∂ ¶ ∂ ¶ ∂ ¶ ∂ ¶ ∂ ¶ ∂ ¶ ∂ ¶ ∂ ¶ ∂ ¶ ∂
∞ƒÃ∏ 1992
3Ë ·ÍÈÔÏfiÁËÛË 2002 ª¤ÛÔ˜ ± ∆™
ªÂÙ·‚ÔÏ‹
p**
1845±49 1843±45 61,7±2,1 64,2±1,9 208,4±6,5 201,3±6,0 86,1±2,6 86,9±2,4 30,6±37,4 30,7±0,9 35,9±1,3 36,8±1,2 9,6±0,4 9,6±0,3 1,5±0,1 1,6±0,1 14,4±0,6 14,0±0,5 183,5±14,2 248,6±13,1 846,1±36,7 899,4±33,9 10,6±0,7 11,8±0,7 93,1±6,4 116,9±5,9 1,7±0,1 2,0±0,1
2386±89 2066±82 78,6±3,7 70,8±3,4 274,9±10,8 232,9±9,9 109,8±4,9 95,7±4,5 37,5±0,9 32,9±1,7 45,7±2,2 39,3±2,0 13,3±1,0 11,9±0,9 2,9±0,1 2,2±0,2 17,7±0,9 15,3±0,9 240,3±14,9 211,9±13,7 865,6±55,7 913,9±51,5 13,9±0,7 13,0±0,7 149,9±13,9 123,7±12,9 2,0±0,1 1,9±0,1
541±103 222±96 16,8±4,3 6,6±4,0 66,6±12,8 31,7±11,9 23,7±5,7 8,8±5,3 6,9±2,1 2,2±1,9 9,7±2,5 2,4±2,3 3,7±1,0 2,3±0,9 1,4±0,2 0,6±0,2 3,3±1,1 1,3±1,0 56,7±20,4 -36,7±18,9 19,4±64,8 14,4±59,9 3,1±1,0 1,9±0,9 56,8±15,2 6,8±14,2 0,26±0,14 0,21±0,13
0,027 ª™*** 0,050 ª™ ª™ 0,036 ª™ 0,022 ª™ 0,001 ª™ ª™ 0,019 0,015
* ¶: ÔÌ¿‰· ·Ú¤Ì‚·Û˘ (¡=80), ∂: ÔÌ¿‰· ÂϤÁ¯Ô˘ (¡=93) ** ∞Ó¿Ï˘ÛË Û˘Ó‰È·Î‡Ì·ÓÛ˘ (ANCOVA): Ô ¤ÏÂÁ¯Ô˜ ¤ÁÈÓ ÛÙË ‰È·ÊÔÚ¿ Ù˘ 3˘ ·ÍÈÔÏfiÁËÛ˘ ·fi ÙËÓ ·Ú¯È΋ ÂͤٷÛË (∞ƒÃ∏) Î·È ˆ˜ Û˘ÌÌÂÙ·‚ÏËÙ¤˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÙÔ Ê‡ÏÔ Î·È Ë ‰È·ÊÔÚ¿ ÙÔ˘ ¢ª™ ·fi ÙËÓ ·Ú¯È΋ ÂͤٷÛË *** ª™: ÛÙ·ÙÈÛÙÈÎÒ˜ ÌË ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿
·È‰ÈÒÓ Ô˘ Û˘ÌÌÂÙ›¯·Ó ÛÙȘ ÌÂÙÚ‹ÛÂȘ Ù˘ ·Ú¯È΋˜ ÂͤٷÛ˘ ÙÔ 1992 Î·È ÙˆÓ ÂfiÌÂÓˆÓ ÙÚÈÒÓ ·ÍÈÔÏÔÁ‹ÛˆÓ. ∞fi ÙÔÓ ¶›Ó·Î· 5 ‰È·ÈÛÙÒÓÂÙ·È fiÙÈ Ë ÔÌ¿‰· ·Ú¤Ì‚·Û˘ ¤¯ÂÈ ÛËÌ·ÓÙÈ΋ Ì›ˆÛË ÙˆÓ ÂȤ‰ˆÓ ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ Î·È LDL-¯ÔÏËÛÙÂÚfiÏ˘, ¤Ó·ÓÙÈ ·‡ÍËÛ˘ ÛÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘. ∂›Û˘, Ë ÔÌ¿‰· ·Ú¤Ì‚·Û˘ ¤¯ÂÈ ÛËÌ·ÓÙÈο ÌÈÎÚfiÙÂÚË ·‡ÍËÛË ÛÙÔÓ ·ıËڈ̷ÙÈÎfi ‰Â›ÎÙË (ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË ÚÔ˜ HDL-¯ÔÏËÛÙÂÚfiÏË), ÂÓÒ ÔÈ ‰‡Ô ÔÌ¿‰Â˜ ‰ÂÓ ‰È·Ê¤ÚÔ˘Ó ÛËÌ·ÓÙÈο ÛÙ· ÙÚÈÁÏ˘ÎÂÚ›‰È· Î·È ÛÙËÓ HDL-¯ÔÏËÛÙÂÚfiÏË. ™ÙÔÓ ¶›Ó·Î· 6 Ê·›ÓÂÙ·È fiÙÈ Ë ÔÌ¿‰· ÂϤÁ¯Ô˘ ·ÚÔ˘ÛÈ¿˙ÂÈ ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚË ·‡ÍËÛË ÛÙÔ ‚¿ÚÔ˜, ÛÙÔÓ ¢ª™, ÛÙÔÓ ‰Â›ÎÙË ÂÚÈ̤ÙÚÔ˘ ̤Û˘ ÚÔ˜ ‡„Ô˜ Î·È ÛÙÔ ÔÛÔÛÙfi Ï›Ô˘˜ ÛÒÌ·ÙÔ˜, ÂÓÒ ·ÓÙ›ıÂÙ· ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚË ·‡ÍËÛË ·ÚÔ˘ÛÈ¿˙ÂÈ Ë ÔÌ¿‰· ·Ú¤Ì‚·Û˘ ÛÙÔ ‡„Ô˜ Î·È ÛÙÔ ·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜. ¢ÂÓ ÛËÌÂÈÒÓÔÓÙ·È ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ÛÙËÓ ÂÚ›ÌÂÙÚÔ Ì¤Û˘, ÛÙÔÓ ‰Â›ÎÙË ÂÚÈ̤ÙÚÔ˘ ̤Û˘
ÚÔ˜ ÏÂοÓË Î·È ÛÙÔ ¿ıÚÔÈÛÌ· ÙˆÓ ‰ÂÚÌ·ÙÈÎÒÓ Ù˘¯ÒÓ. ™ÙËÓ ∂ÈÎfiÓ· 1 ·ÂÈÎÔÓ›˙ÔÓÙ·È ‰È·¯ÚÔÓÈο ÔÈ ÌÂÙ·‚ÔϤ˜ ÛÙËÓ ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË, ÛÙÔÓ ¢ª™ Î·È ÛÙÔ ·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜ ÙˆÓ ‰È·ÊfiÚˆÓ ÂÚÈfi‰ˆÓ ·ÍÈÔÏfiÁËÛ˘ Û ۯ¤ÛË Ì ÙËÓ ·Ú¯È΋ ÙÔ 1992. ∞fi ÙÔ ÌÂÙ·‚·ÏÏfiÌÂÓÔ ‰Â›ÁÌ· ÙˆÓ ·È‰ÈÒÓ Ô˘ ÂÍÂÙ¿ÛÙËÎ·Ó Û οı ÂÚ›Ô‰Ô, fiˆ˜ ·˘Ùfi Ê·›ÓÂÙ·È ÛÙÔÓ ¶›Ó·Î· 1, ‚Ú¤ıËΠfiÙÈ ÙÔ 20,5% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ·È‰ÈÒÓ Â›¯Â ·˘ÍË̤ÓÔ ‚¿ÚÔ˜ (¯2 ¤ÏÂÁ¯Ô˜, ¶: 19,2%, E: 21,9%, ª™) Î·È ÙÔ 8,3% ›¯Â ·¯˘Û·ÚΛ· 2 (¯ ¤ÏÂÁ¯Ô˜, ¶: 6,9%, ∂: 9,7%, ª™). ™ÙÔÓ ¶›Ó·Î· 7 ηٷÁÚ¿ÊÔÓÙ·È ÔÈ Û˘Ó‹ıÂȘ ηӛÛÌ·ÙÔ˜ ÙˆÓ ·È‰ÈÒÓ ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜, ηıÒ˜ Î·È ÙˆÓ ÁÔÓ¤ˆÓ ÙÔ˘˜ ÛÙÔ Û›ÙÈ, fiˆ˜ ÚԤ΢„·Ó ηٿ ÙËÓ ÙÂÏÂ˘Ù·›· ·ÍÈÔÏfiÁËÛË ÙÔ 2002. ∆Ô 7% ÙˆÓ ·È‰ÈÒÓ Ù˘ ÔÌ¿‰·˜ ·Ú¤Ì‚·Û˘ ‹Ù·Ó ηÓÈÛÙ¤˜ ¤Ó·ÓÙÈ 13% ÙˆÓ ·È‰ÈÒÓ Ù˘ ÔÌ¿‰·˜ ÂϤÁ¯Ô˘ (p<0,05). ¢ÂÓ ‰È·ÈÛÙÒıËΠÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙ· ·È‰È¿ ÙˆÓ ÔÌ¿‰ˆÓ ·Ú¤Ì‚·Û˘ Î·È ÂϤÁ¯Ô˘
441
¶·È‰È·ÙÚÈ΋ 2003;66:436-447
Paediatriki 2003;66:436-447
¶›Ó·Î·˜ 5. ∂›Â‰· ÏÈÔÚˆÙÂ˚ÓÒÓ ÙˆÓ ·È‰ÈÒÓ Ù˘ ∫Ú‹Ù˘ ηٿ ÙË ‰È·¯ÚÔÓÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË 10 ÂÙÒÓ ∞ƒÃ∏ 1992
1Ë: 1995
186,9±2,6 174,2±3,1 51,3±1,7 50,9±1,9 60,6±1,3 62,8±1,5 115,9±2,5 101,2±3,0 3,21±0,07 2,92±0,09
173,9±2,5 185,1±2,9 44,3±1,9 40,1±2,3 54,3±1,3 58,2±1,5 110,5±2,2 118,9±2,6 3,49±0,09 3,34±0,10
¡ OÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË (mg/dL) ∆ÚÈÁÏ˘ÎÂÚ›‰È· (mg/dL) HDL-C (mg/dL) LDL-C (mg/dL) ∞ıËڈ̷ÙÈÎfi˜ ‰Â›ÎÙ˘: ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË/HDL-C
¶* ∂* ¶ ∂ ¶ ∂ ¶ ∂ ¶ ∂
139 101 139 101 137 101 139 101 137 101
∞•πO§O°∏™∏ 2Ë: 1998 3Ë: 2002 ª¤ÛÔ˜ ± ∆™ 173,8±2,6 172,3±3,1 65,6±2,0 67,6±2,4 58,7±1,3 57,8±1,5 102,7±2,3 101,0±2,7 3,12±0,07 3,15±0,08
164,4±2,4 162,6±2,8 64,7±2,2 62,9±2,6 52,7±1,0 50,9±1,2 98,6±2,1 99,1±2,4 3,27±0,07 3,31±0,08
™‡ÓÔÏÔ
ªÂÙ·‚ÔÏ‹
p**
174,7±2,2 -16,2±1,8 <0,001 173,6±2,6 -0,9±2,0 56,5±1,4 6,9±1,8 ª™*** 55,3±1,7 6,0±2,1 56,6±1,0 -5,3±1,0 ª™ 57,4±1,2 -7,2±1,1 106,9±2,0 -12,0±1,6 <0,001 105,1±2,4 5,1±1,9 3,27±0,06 0,08±0,05 0,002 3,18±0,07 0,34±0,06
* ¶: ÔÌ¿‰· ·Ú¤Ì‚·Û˘, ∂: ÔÌ¿‰· ÂϤÁ¯Ô˘ ** ∞Ó¿Ï˘ÛË Û˘Ó‰È·Î‡Ì·ÓÛ˘ ·ӷϷ̂·ÓfiÌÂÓˆÓ ÌÂÙÚ‹ÛÂˆÓ (GLM: repeated measures analysis): Ô ¤ÏÂÁ¯Ô˜ ¤ÁÈÓ ÛÙȘ ‰È·ÊÔÚ¤˜ οı ·ÍÈÔÏfiÁËÛ˘ ·fi ÙËÓ ·Ú¯È΋ ÂͤٷÛË (∞ƒÃ∏) Î·È ˆ˜ Û˘ÌÌÂÙ·‚ÏËÙ¤˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÙÔ Ê‡ÏÔ Î·È Ë Ì¤ÛË ‰È·ÊÔÚ¿ ÙÔ˘ ¢ª™ fiÏˆÓ ÙˆÓ ÌÂÙÚ‹ÛÂˆÓ ·fi ÙËÓ ·Ú¯È΋ ÂͤٷÛË (∞ƒÃ∏) ***ª™: ÛÙ·ÙÈÛÙÈÎÒ˜ ÌË ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿
fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÔÛfiÙËÙ· ηӛÛÌ·ÙÔ˜ (¶: 8,4±1,9 ÙÛÈÁ¿Ú·/Ë̤ڷ, E: 11,0±1,3 ÙÛÈÁ¿Ú·/ Ë̤ڷ) Î·È ÛÙÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· Ô˘ ηӛ˙Ô˘Ó (¶: 15,6±2,3 Ì‹Ó˜, E: 22,5±3,2 Ì‹Ó˜). ŸÛÔÓ ·ÊÔÚ¿ ÛÙÔ˘˜ ÁÔÓ›˜, ÙÔ 38% ÙˆÓ ÌËÙ¤ÚˆÓ Â›Ó·È Î·Ó›ÛÙÚȘ, ¤Ó·ÓÙÈ ÙÔ˘ 55% ÙˆÓ ·Ù¤ÚˆÓ (p<0,001). ∞fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ 614 ˙¢Á·ÚÈÒÓ-ÁÔÓ¤ˆÓ, ÙÔ 25% Â›Ó·È Î·È ÔÈ ‰‡Ô ηÓÈÛÙ¤˜, ÂÓÒ ÙÔ 33% Â›Ó·È Î·È ÔÈ ‰‡Ô ÌË Î·ÓÈÛÙ¤˜ (p<0,001). ™¯ÂÙÈο Ì ÙÔ˘˜ ÁÔÓ›˜-ηÓÈÛÙ¤˜ ÚÔ·ÙÂÈ fiÙÈ ÙÔ 92% ÙˆÓ ÌËÙ¤ÚˆÓ Î·Ó›˙Ô˘Ó ÛÙËÓ ÔÈΛ· ÙÔ˘˜, ¤Ó·ÓÙÈ ÙÔ˘ 84% ÙˆÓ ·Ù¤ÚˆÓ (p<0,05). ™˘˙‹ÙËÛË ∏ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙÔ˘ ÂÎ·È‰Â˘ÙÈÎÔ‡ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ·Ú¤Ì‚·Û˘ Û ı¤Ì·Ù· ˘Á›·˜, ‰È·ÙÚÔÊ‹˜ Î·È ¿ıÏËÛ˘ Û ̷ıËÙ¤˜ Ù˘ ∫Ú‹Ù˘ ·ÍÈÔÏÔÁ‹ıËΠηٿ Ù· 6 ¯ÚfiÓÈ· ÂÊ·ÚÌÔÁ‹˜ ÙÔ˘ Û ÚÔËÁÔ‡ÌÂÓ˜ ÂÚÁ·Û›Â˜ (4-9). ∏ Û˘Ó¯È˙fiÌÂÓË, fï˜, ıÂÙÈ΋ ›‰Ú·ÛË ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÛÙÔ˘˜ ‰Â›ÎÙ˜ ˘Á›·˜ 4 ¯ÚfiÓÈ· ·fi ÙË ‰È·ÎÔ‹ ÙÔ˘ Î·È 10 ¯ÚfiÓÈ· ·fi ÙËÓ ¤Ó·ÚÍ‹ ÙÔ˘, ·ÔÙÂÏ› ÂÍ·ÈÚÂÙÈο ÂÏȉÔÊfiÚÔ Â‡ÚËÌ·. º·›ÓÂÙ·È fiÙÈ Ë ÂȉËÌ›· ÙˆÓ ¯ÚfiÓÈˆÓ ÓÔÛËÌ¿ÙˆÓ Ì ÙËÓ ·ÚÔ˘Û›· ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ·fi ÙËÓ ·È‰È΋ ËÏÈΛ· Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÂÚÈÛÙ·Ï›. ¢È·¯ÚÔÓÈο, ·fi ÙÔ 1992 ¤ˆ˜ ÙÔ 2002, ÙÔ ‚¿ÚÔ˜ ÙˆÓ ·È‰ÈÒÓ ¯ˆÚ›˜ ·Ú¤Ì‚·ÛË (ÔÌ¿‰· ÂϤÁ¯Ô˘) ·˘Í‹ıËΠηٿ 2,3 kg ÂÚÈÛÛfiÙÂÚÔ Û ۇÁÎÚÈÛË Ì ÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·Û˘ (p<0,01), fiˆ˜ ›Û˘ Î·È o ¢ª™ ·˘Í‹ıËΠηٿ 1 kg/m2 (p<0,01), ÂÓÒ ÙÔ ‡„Ô˜ ÛÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·Û˘ ·˘Í‹ıËΠÛËÌ·ÓÙÈο ÂÚÈÛÛfiÙÂÚÔ Î·Ù¿ 2,1 cm (p<0,001). ¶·ÚfiÌÔÈ·, Ë ÔÌ¿‰· ·Ú¤Ì‚·Û˘ ›¯Â ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚË Ì›ˆÛË ÛÙËÓ ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË Î·Ù¿ 15,3
442
mg/dl (p<0,001), ÛÙËÓ LDL-¯ÔÏËÛÙÂÚfiÏË Î·Ù¿ 6,9 mg/dl (p<0,001), ÂÓÒ ÛËÌ·ÓÙÈο ÌÈÎÚfiÙÂÚË ‹Ù·Ó Ë ·‡ÍËÛË Ô˘ ·ÚÔ˘Û›·Û ÛÙÔÓ ·ıËڈ̷ÙÈÎfi ‰Â›ÎÙË, ηٿ 0,26 ÌÔÓ¿‰Â˜ (p<0,01). ∆· ·ÔÙÂϤÛÌ·Ù· ·˘Ù¿ ·Ú¤¯Ô˘Ó Ì›· ÂÏ›‰· fiÙÈ Ë ÂȉËÌ›· Ù˘ ·¯˘Û·ÚΛ·˜ Î·È Ù˘ ·ıËڈ̿وÛ˘ ı· ÌÔÚÔ‡Û ӷ ÙÂı› ˘fi ¤ÏÂÁ¯Ô Ì ÙË ‰ÈÂÓ¤ÚÁÂÈ· ·ÚfiÌÔÈˆÓ ·ÓÂÏÏ‹ÓÈˆÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ Âη›‰Â˘Û˘ Û ı¤Ì·Ù· ˘Á›·˜, ‰È·ÙÚÔÊ‹˜ Î·È ¿ıÏËÛ˘. ∏ ‰È·›ÛÙˆÛË fiÙÈ Ë ÂÌÊ¿ÓÈÛË ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ηډȷÁÁÂȷο Î·È ¿ÏÏ· ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù· ÛÙËÓ ·È‰È΋ ËÏÈΛ· Ô‰ËÁ› ÛÙË ‰È·Ù‹ÚËÛË Î·È Â·‡ÍËÛË ·˘ÙÒÓ Î·È ÛÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹ (19-20), ÒıËÛ ÙÔ˘˜ ÂÚ¢ÓËÙ¤˜ Ó· ÚÔÛ·ı‹ÛÔ˘Ó Ì¤Ûˆ ÚÔÁÚ·ÌÌ¿ÙˆÓ ·Ú¤Ì‚·Û˘ Ó· ÌÂÈÒÛÔ˘Ó Ù· ›‰· ‹ ·ÎfiÌ· Î·È Ó· ÂÍ·Ï›„Ô˘Ó ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ ·˘ÙÔ‡˜ ηٿ ÙËÓ ·È‰È΋ ËÏÈΛ· (1,3,23-29). ¶·ÚfiÌÔÈ· Ì ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, Ì›· ¿ÏÏË ÌÔÓÔÂÙÔ‡˜ ÂÎ·È‰Â˘ÙÈ΋˜ ·Ú¤Ì‚·Û˘ Ô˘ ÂÊ·ÚÌfiÛÙËΠ۠171 Ì·ıËÙ¤˜ Ù˘ ∫Ú‹Ù˘ ËÏÈΛ·˜ 13 Î·È 14 ÂÙÒÓ, ¤‰ÂÈÍ fiÙÈ Ë ÔÌ¿‰· ·Ú¤Ì‚·Û˘ ›¯Â ÌÈÎÚfiÙÂÚË ·‡ÍËÛË ÛÙËÓ ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË, ÛÙÔÓ ¢ª™, ÛÙËÓ LDL-¯ÔÏËÛÙÂÚfiÏË Î·È ÛÙÔÓ ·ıËڈ̷ÙÈÎfi ‰Â›ÎÙË ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ ÚÔ˜ HDL-¯ÔÏËÛÙÂÚfiÏË Û ۇÁÎÚÈÛË Ì ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘ (1). ÕÏÏË ¤Ú¢ӷ ÛÙȘ ∏ӈ̤Ó˜ ¶ÔÏÈÙ›˜ (24) ¤‰ÂÈÍ fiÙÈ ÌÂÙ¿ ·fi ¤Ó· ¯ÚfiÓÔ ÂÎ·È‰Â˘ÙÈ΋˜ ·Ú¤Ì‚·Û˘, Ë ÔÌ¿‰· ·Ú¤Ì‚·Û˘ ›¯Â ÌÈÎÚfiÙÂÚË ·‡ÍËÛË Ù˘ Û˘ÛÙÔÏÈ΋˜ ›ÂÛ˘, ÌÂÁ·Ï‡ÙÂÚË Ì›ˆÛË Ù˘ ‰È·ÛÙÔÏÈ΋˜ ›ÂÛ˘, Ì›ˆÛË Ù˘ ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ Î·È ÙÔ˘ ·ıËڈ̷ÙÈÎÔ‡ ‰Â›ÎÙË ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ ÚÔ˜ HDL-¯ÔÏËÛÙÂÚfiÏË Û ۯ¤ÛË Ì ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘. ªÂȈ̤ÓË ·ÚÙËÚȷ΋ ›ÂÛË Î·È ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË ·ÚÔ˘Û›·ÛÂ Ë ÔÌ¿‰· ·Ú¤Ì‚·Û˘ ÌÂÙ¿ ·fi ÙÚ›· ¯ÚfiÓÈ· ·Ú¤Ì‚·Û˘ ηÈ
¶·È‰È·ÙÚÈ΋ 2003;66:436-447
Paediatriki 2003;66:436-447
¶›Ó·Î·˜ 6. ∂›Â‰· ۈ̷ÙÔÌÂÙÚ‹ÛÂˆÓ Î·È Ê˘ÛÈ΋˜ ηٿÛÙ·Û˘ ÙˆÓ ·È‰ÈÒÓ Ù˘ ∫Ú‹Ù˘ ηٿ ÙË ‰È·¯ÚÔÓÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË 10 ÂÙÒÓ ∞ƒÃ∏ 1992 ¡ µ¿ÚÔ˜ (kg) ⁄„Ô˜ (cm) ¢Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ ¶ÂÚ›ÌÂÙÚÔ˜ ̤Û˘ (cm) ¢Â›ÎÙ˘ ÂÚÈ̤ÙÚÔ˘ ̤Û˘/ÏÂοÓ˘ ¢Â›ÎÙ˘ ÂÚÈ̤ÙÚÔ˘ ̤Û˘/‡„Ô˜ ÕıÚÔÈÛÌ· ÙÂÛÛ¿ÚˆÓ ‰ÂÚÌ·ÙÈÎÒÓ Ù˘¯ÒÓ (mm) ¶ÔÛÔÛÙfi Ï›Ô˘˜ ÛÒÌ·ÙÔ˜ (%) ¶·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜ (ÛÙ¿‰È·)
¶* ∂* ¶ ∂ ¶ ∂ ¶ ∂ ¶ ∂ ¶ ∂ ¶ ∂ ¶ ∂ ¶ ∂
167 120 167 120 167 120 163 120 162 120 163 120 155 116 167 120 77 85
22,7±0,3 24,9±0,4 118,0±0,4 122,5±0,5 16,2±0,2 16,5±0,2 54,3±0,4 56,3±0,5 0,86±0,003 0,85±0,004 0,46±0,003 0,46±0,004 28,6±1,3 32,4±1,5 19,6±0,3 20,0±0,3 1,7±0,1 1,9±0,1
∞•πO§O°∏™∏ 1Ë: 1995 2Ë: 1998 3Ë: 2002 ª¤ÛÔ˜ ± ∆™ 30,1±0,5 33,2±0,6 133,5±0,5 134,6±0,6 16,9±0,2 18,2±0,3 59,5±0,6 61,8±0,7 0,83±0,004 0,82±0,004 0,45±0,004 0,46±0,004 31,4±1,2 35,1±1,4 19,0±0,3 20,9±0,4 3,4±0,2 3,3±0,3
43,9±0,9 47,4±1,0 149,0±0,6 150,3±0,7 19,5±0,3 20,8±0,3 68,6±0,8 73,1±0,9 0,86±0,005 0,86±0,006 0,46±0,005 0,49±0,006 55,8±2,3 62,7±2,7 20,1±0,4 22,9±0,5 4,8±0,2 3,1±0,2
60,8±1,1 68,2±1,3 165,5±0,6 169,8±0,7 22,0±0,3 23,6±0,4 74,2±0,8 77,2±0,9 0,79±0,007 0,79±0,008 0,45±0,004 0,46±0,005 58,1±2,2 60,5±2,5 21,8±0,5 22,3±0,5 4,2±0,2 4,0±0,2
™‡ÓÔÏÔ
ªÂÙ·‚ÔÏ‹
p**
39,4±0,7 22,4±0,5 0,004 43,4±0,8 24,7±0,6 141,5±0,5 31,3±0,2 <0,001 144,3±0,6 29,1±0,3 18,7±0,2 3,3±0,2 <0,001 19,8±0,3 4,3±0,2 64,2±0,6 13,1±0,4 ª™*** 67,1±0,7 14,3±0,5 0,83±0,003 -0,03±0,01 ª™ 0,83±0,003 -0,03±0,01 0,45±0,003 -0,009±0,003 <0,001 0,47±0,004 0,006±0,003 43,5±1,6 19,8±1,1 ª™ 47,7±1,8 20,3±1,3 20,3±0,3 1,0±0,2 0,001 21,7±0,5 2,2±0,3 3,5±0,1 2,4±0,1 <0,001 3,1±0,1 1,5±0,1
* ¶: ÔÌ¿‰· ·Ú¤Ì‚·Û˘, ∂: ÔÌ¿‰· ÂϤÁ¯Ô˘ ** ∞Ó¿Ï˘ÛË Û˘Ó‰È·Î‡Ì·ÓÛ˘ ·ӷϷ̂·ÓfiÌÂÓˆÓ ÌÂÙÚ‹ÛÂˆÓ (GLM: repeated measures analysis): Ô ¤ÏÂÁ¯Ô˜ ¤ÁÈÓ ÛÙȘ ‰È·ÊÔÚ¤˜ οı ·ÍÈÔÏfiÁËÛ˘ ·fi ÙËÓ ·Ú¯È΋ ÂͤٷÛË (∞ƒÃ∏) Î·È ˆ˜ Û˘ÌÌÂÙ·‚ÏËÙ¤˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÙÔ Ê‡ÏÔ Î·È Ë Ì¤ÛË ‰È·ÊÔÚ¿ ÙÔ˘ ¢ª™ fiÏˆÓ ÙˆÓ ÌÂÙÚ‹ÛÂˆÓ ·fi ÙËÓ ·Ú¯È΋ ÂͤٷÛË (Ô ¢ª™ ¯ÚËÛÈÌÔÔÈ‹ıËΠÌfiÓÔ ÛÙÔ ·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜) *** ª™: ÛÙ·ÙÈÛÙÈÎÒ˜ ÌË ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿
ÛÙËÓ ¤Ú¢ӷ KNOW YOUR BODY (25). ™ÙȘ ¤Ú¢Ó˜ CHIC II (27), Ô˘ Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó ÛÙË µfiÚÂÈ· ∫·ÚÔϛӷ, ¤ÁÈÓ ÂÎ·È‰Â˘ÙÈ΋ ·Ú¤Ì‚·ÛË ÁÈ· 8 ‚‰ÔÌ¿‰Â˜ ÌfiÓÔ ÌÂ Ê˘ÛÈ΋ ¿ÛÎËÛË, ÌfiÓÔ Ì Âη›‰Â˘ÛË ‹ ÌÂ Û˘Ó‰˘·ÛÌfi ÙÔ˘˜. ¢È·ÈÛÙÒıËΠfiÙÈ Ë ÙÂÏÂ˘Ù·›· ÔÌ¿‰· Ô˘ Û˘Ó‰‡·˙ ÙȘ ‰‡Ô ÌÔÚʤ˜ ·Ú¤Ì‚·Û˘ (Ê˘ÛÈ΋˜ ¿ÛÎËÛ˘ Î·È Âη›‰Â˘Û˘) Ì›ˆÛ ٷ ›‰· ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ Î·È ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ‰ÂÚÌ·ÙÈÎÒÓ Ù˘¯ÒÓ, ηıÒ˜ ›Û˘ ·‡ÍËÛ ÛËÌ·ÓÙÈο ÙËÓ ·ÂÚfi‚È· ÈηÓfiÙËÙ¿ Ù˘. ¶·ÚfiÌÔÈ· ‹Ù·Ó Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘ CHIC, Ë ÔÔ›· Ú·ÁÌ·ÙÔÔÈ‹ıËΠÛÙËÓ ›‰È· ÂÚÈÔ¯‹ Î·È ‰È‹ÚÎÂÛ 12 Ì‹Ó˜ (29). OÈ ·Ú·¿Óˆ ÌÂϤÙ˜, ·Ó Î·È ÂȂ‚·ÈÒÓÔ˘Ó ÙË ıÂÙÈ΋ ›‰Ú·ÛË Ù˘ ÂÎ·È‰Â˘ÙÈ΋˜ ·Ú¤Ì‚·Û˘ ÛÙË Ì›ˆÛË ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÈÎÒÓ ÂȤ‰ˆÓ, ηıÒ˜ Î·È ÙˆÓ ‰ÂÈÎÙÒÓ ·¯˘Û·ÚΛ·˜, ¤¯Ô˘Ó Û˘ÁÎÚÈÙÈο Ôχ ÌÈÎÚfiÙÂÚË ‰È¿ÚÎÂÈ· ·Ú¤Ì‚·Û˘ Û ۯ¤ÛË Ì ÙËÓ ·ÚÔ‡Û· ¤Ú¢ӷ. ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, ·Ú¿ ÙË ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙË ÌÂÙ·‚ÔÏ‹ ÙˆÓ ÂȤ‰ˆÓ ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ ÙˆÓ ·È‰ÈÒÓ ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜, ˘‹Ú¯Â ÔÛÔÛÙfi 18,5% ÙˆÓ ·È‰ÈÒÓ ÛÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·Û˘ Î·È 21,5% ÛÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘ Ì LDL-¯ÔÏËÛÙÂÚfiÏË >130 mg/dl. ¶·Ú¿ÏÏËÏ·, ÙÔ ÔÛÔÛÙfi ÙˆÓ ·È‰ÈÒÓ Ì ˘ÂÚ‚ÔÏÈÎfi ‚¿ÚÔ˜ Î·È ·¯˘Û·ÚΛ· ·ÔÙÂ-
Ï› ¤Ó‰ÂÈÍË ÙˆÓ ‰È·ÛÙ¿ÛÂˆÓ Ô˘ ¤¯ÂÈ Ï¿‚ÂÈ ÛÙË ¯ÒÚ· Ì·˜ Ë ·¯˘Û·ÚΛ·. ∆Ô 28,8% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ·È‰ÈÒÓ Â›¯Â ·˘ÍË̤ÓÔ ‹ ˘ÂÚ‚ÔÏÈο ·˘ÍË̤ÓÔ ‚¿ÚÔ˜/·¯˘Û·ÚΛ·, ÂÓÒ Û ÌË ‰È·¯ÚÔÓÈ΋ ÌÂϤÙË ·È‰ÈÒÓ ËÏÈΛ·˜ 6-17 ÂÙÒÓ ÛÙËÓ ÂÚÈÔ¯‹ Ù˘ £ÂÛÛ·ÏÔӛ΢ ÙÔ 2000-2001 (13) Î·È ¯ˆÚ›˜ ÙËÓ ÂÊ·ÚÌÔÁ‹ ÂÎ·È‰Â˘ÙÈ΋˜ ·Ú¤Ì‚·Û˘, ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ÔÛÔÛÙfi ‹Ù·Ó 26,3% (22,2% ›¯Â ˘ÂÚ‚ÔÏÈÎfi ‚¿ÚÔ˜ Î·È 4,1% ·¯˘Û·ÚΛ·). ™ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù·, ÂÎÙfi˜ ·fi ÙË Ê˘ÛÈ΋ ¿ÛÎËÛË, ÛÔ˘‰·›Ô˜ Â›Ó·È Ô ÚfiÏÔ˜ Ù˘ ‰È·ÙÚÔÊ‹˜. ∏ “‰˘ÙÈÎÔÔ›ËÛË” Ù˘ Û‡Á¯ÚÔÓ˘ ‰È·ÙÚÔÊ‹˜ ÙˆÓ ∫ÚËÙÒÓ Ù· ÙÂÏÂ˘Ù·›· Û·Ú¿ÓÙ· ¯ÚfiÓÈ·, Ô˘ ·Ú·ÙËÚÂ›Ù·È Î·È ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ ∂ÏÏ‹ÓˆÓ, ηıÒ˜ Î·È Ë ·ÔÌ¿ÎÚ˘ÓÛ‹ ÙÔ˘˜ ·fi ÙËÓ ·Ú·‰ÔÛȷ΋ ÎÚËÙÈ΋ ‰È·ÙÚÔÊ‹ (30), ÙÔ˘˜ Ô‰ËÁÔ‡Ó Û ‰È·ÚÎÒ˜ ·˘Í·ÓfiÌÂÓÔ˘˜ ‰Â›ÎÙ˜ ıÓËÛÈÌfiÙËÙ·˜ ·fi ηډȷÁÁÂȷο Î·È ¿ÏÏ· ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù·, ÂÓÒ Û ¿ÏϘ ÚÔËÁ̤Ó˜ ¯ÒÚ˜ ÔÈ ‰Â›ÎÙ˜ ·˘ÙÔ› ÂÏ·ÙÙÒÓÔÓÙ·È ·ÔÙÂÏÂÛÌ·ÙÈο ÙȘ ÙÂÏÂ˘Ù·›Â˜ ‰ÂηÂٛ˜ (10). ∏ ÂÏ¿ÙÙˆÛË Ù˘ ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ Î·È Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘ ‰ÂÓ ÂÍËÁÂ›Ù·È ·fi Ù· ‰È·ÈÙËÙÈο ‰Â‰Ô̤ӷ, ηı’ fiÙÈ ‰ÂÓ ‰È·ÈÛÙÒıËΠÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙË Ï‹„Ë ÎÔÚÂṲ̂ÓÔ˘ Ï›Ô˘˜ ÛÙË ‰È·ÙÚÔÊ‹ ÙˆÓ ·È‰ÈÒÓ ÙˆÓ ÔÌ¿‰ˆÓ ·Ú¤Ì‚·Û˘ ηÈ
443
¶·È‰È·ÙÚÈ΋ 2003;66:436-447
Paediatriki 2003;66:436-447
OÏÈ΋ xÔÏËÛÙÂÚfiÏË (mg/dL)
15,0
OÌ¿‰· ·Ú¤Ì‚·Û˘ (¡=139)
10,0 ª¤ÛË ‰È·ÊÔÚ¿ (mg/dL)
OÌ¿‰· ÂϤÁ¯Ô˘ (¡=101) 5,0 0,0
1994
1998
2002
-5,0 -10,0 -15,0 -20,0 -25,0
ŒÙÔ˜ ·ÍÈÔÏfiÁËÛ˘ (·ÓÂͤٷÛË) ¢Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ (kg/m2)
8,0
ª¤ÛË ‰È·ÊÔÚ¿ (kg/m2)
7,0 6,0
OÌ¿‰· ·Ú¤Ì‚·Û˘ (¡=167) OÌ¿‰· ÂϤÁ¯Ô˘ (¡=120)
5,0 4,0 3,0 2,0 1,0 0,0 1994
1998 ŒÙÔ˜ ·ÍÈÔÏfiÁËÛ˘ (·ÓÂͤٷÛË)
2002
¶·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜ (ÛÙ¿‰È·)
4,0
OÌ¿‰· ¶·Ú¤Ì‚·Û˘ (¡=77) ª¤ÛË ‰È·ÊÔÚ¿ (ÛÙ¿‰È·)
3,5
OÌ¿‰· ∂ϤÁ¯Ô˘ (¡=85)
3,0 2,5 2,0 1,5 1,0
1994
1998
2002
ŒÙÔ˜ ·ÍÈÔÏfiÁËÛ˘ (·ÓÂͤٷÛË) ∂ÈÎfiÓ· 1. ¢È·ÊÔÚ¤˜ ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘, ¢ª™ Î·È ·Ï›Ó‰ÚÔÌÔ˘ ÙÚÂ̷͛ÙÔ˜ ·ÓÙÔ¯‹˜ ÙˆÓ ÂÚÈfi‰ˆÓ ·ÍÈÔÏfiÁËÛ˘ (1994, 1998 Î·È 2002) ·fi ÙËÓ ·Ú¯È΋ ÂͤٷÛË (1992).
444
¶·È‰È·ÙÚÈ΋ 2003;66:436-447
Paediatriki 2003;66:436-447
¶›Ó·Î·˜ 7. ™˘Ó‹ıÂȘ ηӛÛÌ·ÙÔ˜ ·È‰ÈÒÓ Î·È ÁÔÓ¤ˆÓ ñ ¶·È‰È¿ OÌ¿‰· ·Ú¤Ì‚·Û˘ OÌ¿‰· ÂϤÁ¯Ô˘ ñ °ÔÓ›˜ ªËÙ¤Ú· ¶·Ù¤Ú·˜ ™˘Ó‰˘·ÛÌfi˜ ÁÔÓ¤ˆÓ ηÓÈÛÙÒÓ ‹ ÌË
∫·ÓÈÛÙ¤˜
ªË ηÓÈÛÙ¤˜
p-value**
7 (23)* 13 (37)
93 (303) 87 (260)
0,016
38 (236) 55 (337)
62 (386) 45 (277)
<0,001
¶·Ù¤Ú·˜ ∫·ÓÈÛÙ‹˜
ñ ªËÙ¤Ú· ∫·Ó›ÛÙÚÈ· ªË ηӛÛÙÚÈ·
ªËÙ¤Ú· ¶·Ù¤Ú·˜
ªË ηÓÈÛÙ‹˜
25 (156) 13 (76) 29 (180) 33 (202) ∫¿ÓÈÛÌ· ÛÙÔ Û›ÙÈ ¡·È Ÿ¯È 92 (213) 8 (19) 84 (280) 16 (84)
<0,001
0,010
* OÈ ÙÈ̤˜ ‰›ÓÔÓÙ·È ˆ˜ % (¡) 2 ** ŒÏÂÁ¯Ô˜ ¯
ÂϤÁ¯Ô˘. ∏ ÚfiÛÏË„Ë ÂÓ¤ÚÁÂÈ·˜ ·fi Ù· ·È‰È¿ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ÁÈÓfiÙ·Ó Î·Ù¿ 41% ·fi ÔÏÈÎfi ϛԘ, 14% ·fi ÙÔ ÔÔ›Ô ‹Ù·Ó ÎÔÚÂṲ̂ÓÔ. ∆Ô ÔÛÔÛÙfi ÂÓ¤ÚÁÂÈ·˜ ·fi ÎÔÚÂṲ̂ÓÔ Ï›Ô˜ ‹Ù·Ó ÌfiÏȘ 7% fiÙ·Ó ¿Ú¯ÈÛÂ Ë ÌÂϤÙË ÙˆÓ ∂Ù¿ ÈÚÒÓ ÙÔ 1960. ∆· ıÂÙÈο ·ÔÙÂϤÛÌ·Ù· fiÛÔÓ ·ÊÔÚ¿ ÛÙȘ ÏÈÔÚˆÙ½Ó˜ Èı·ÓfiÓ Ó· Û¯ÂÙ›˙ÔÓÙ·È Ì ÙÔÓ ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚÔ ¢ª™ Î·È ÙË ÛËÌ·ÓÙÈο ηχÙÂÚË ·ıÏËÙÈ΋ ›‰ÔÛË ÙˆÓ ·È‰ÈÒÓ Ù˘ ÔÌ¿‰·˜ ·Ú¤Ì‚·Û˘ Û ۇÁÎÚÈÛË Ì ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘. ∞ÓÙ›ıÂÙ·, ÛÙËÓ ¤Ú¢ӷ CATCH (26) ÛËÌÂÈÒıËÎ·Ó ÛËÌ·ÓÙÈΤ˜ ÌÂÙ·‚ÔϤ˜ ÛÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·Û˘ ·fi ÙËÓ °’ ÛÙËÓ ∂’ Ù¿ÍË ‰ËÌÔÙÈÎÔ‡, Ì Ì›ˆÛË ÛÙËÓ ÚfiÛÏË„Ë ÂÓ¤ÚÁÂÈ·˜ Î·È ÛÙ· ÔÛÔÛÙ¿ ÂÓ¤ÚÁÂÈ·˜ ·fi ÔÏÈÎfi, ÎÔÚÂṲ̂ÓÔ Î·È ÌÔÓÔ·ÎfiÚÂÛÙÔ Ï›Ô˜. ™Â ¿ÏÏË ¤Ú¢ӷ ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ Leeds (28), ÌÂÙ¿ ·fi 12 Ì‹Ó˜ ÂÎ·È‰Â˘ÙÈ΋˜ ÂÈÌfiÚʈÛ˘ Î·È ÂÓË̤ڈÛ˘, ·Ú·ÙËÚ‹ıËΠfiÙÈ Ë ÔÌ¿‰· ·Ú¤Ì‚·Û˘ ηٷӿψÓ ÂÚÈÛÛfiÙÂÚ· Ï·¯·ÓÈο. ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, Ë ÔÌ¿‰· ·Ú¤Ì‚·Û˘ ›¯Â ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚË Ï‹„Ë Ê˘ÏÏÈÎÔ‡ Î·È ·ÛÎÔÚ‚ÈÎÔ‡ ÔͤԘ, ‰ËÏ·‰‹ ˘„ËÏfiÙÂÚË Ï‹„Ë ÊÚÔ‡ÙˆÓ Î·È Ï·¯·ÓÈÎÒÓ. ªÂϤÙË Ô˘ Ú·ÁÌ·ÙÔÔÈ‹ıËΠ۠·È‰È¿ Ù˘ µfiÚÂÈ·˜ ∂ÏÏ¿‰·˜ ËÏÈΛ·˜ 11,616,6 ÂÙÒÓ, ¯ˆÚ›˜ ÙËÓ ÂÊ·ÚÌÔÁ‹ ÂÎ·È‰Â˘ÙÈ΋˜ ·Ú¤Ì‚·Û˘, ¤‰ÂÈÍ fiÙÈ ÙÔ 45% Ù˘ ÚÔÛÏ·Ì‚·ÓfiÌÂÓ˘ ÂÓ¤ÚÁÂÈ·˜ ÚÔ¤Ú¯ÂÙ·È ·fi ˘‰·Ù¿ÓıڷΘ, ÂÓÒ ÙÔ 42% ÚÔ¤Ú¯ÂÙ·È ·fi ÔÏÈÎfi ϛԘ, ·fi ÙÔ ÔÔ›Ô ÔÛÔÛÙfi 12% Â›Ó·È ÎÔÚÂṲ̂ÓÔ (18). ÕÏÏÔÓ ÚˆÙ‡ÔÓÙ· ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ·ÔÙÂÏ› ÙÔ Î¿ÓÈÛÌ· Ô˘ ·Ú¯›˙ÂÈ Û˘Ó‹ıˆ˜ ÛÙËÓ ÂÊË‚È΋ ËÏÈΛ· (14,17). ∆Ô Î¿ÓÈÛÌ· ·ÔÙÂÏ› ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ Úfi‚ÏËÌ· ‰ËÌfiÛÈ·˜ ˘Á›·˜ ÙfiÛÔ ÛÙË ¯ÒÚ· Ì·˜ fiÛÔ Î·È ·ÁÎÔÛÌ›ˆ˜, ÂÓÒ ÔÈ ‚ÈÔÌ˯·Ó›Â˜ ηÓÔ‡ ¤¯Ô˘Ó ÛÙÚ¤„ÂÈ ÙȘ ‰È·ÊËÌÈÛÙÈΤ˜ ÙÔ˘˜ ÚÔÛ¿ıÂȘ ÚÔ˜ Ù· ·È‰È¿, ÙÔ˘˜ ÂÊ‹‚Ô˘˜ Î·È ÙȘ Á˘-
Ó·›Î˜. ™ÙȘ ·Ú¯¤˜ Ù˘ ‰ÂηÂÙ›·˜ ÙÔ˘ ’80, Û ̛· ÂıÓÈ΋ ÚÔÛ¿ıÂÈ· ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ηӛÛÌ·ÙÔ˜ (17), ÙÔ ÀÔ˘ÚÁÂ›Ô ÀÁ›·˜ ÍÂΛÓËÛ ÙË ÌÂÙ¿‰ÔÛË ·ÓÙÈηÓÈÛÙÈÎÒÓ ÌËÓ˘Ì¿ÙˆÓ Ì¤Ûˆ Ù˘ ÙËÏÂfiÚ·Û˘ Î·È ÙÔ˘ Ú·‰ÈÔÊÒÓÔ˘. O Ú˘ıÌfi˜ Ù˘ ÂÙ‹ÛÈ·˜ ·‡ÍËÛ˘ ηٷӿψÛ˘ ηÓÔ‡ ÌÂÈÒıËΠÛËÌ·ÓÙÈο Ù· ¤ÙË 1979 Î·È 1980, ‰ËÏ·‰‹ ÛÙ· ‰‡Ô ¯ÚfiÓÈ· Ù˘ ÌÂÙ¿‰ÔÛ˘ ÙˆÓ ÌËÓ˘Ì¿ÙˆÓ, Ë ÔÔ›· ÚÔÛ¤ÁÁÈÛ ÙÔ 0%. ¶·Ú¿ÏÏËÏ·, ÛÙÔ ‰È¿ÛÙËÌ· ·˘Ùfi ‰È·ÈÛÙÒıËΠfiÙÈ ÙÔ 10,5% ‰Â›ÁÌ·ÙÔ˜ 1500 ·ÙfiÌˆÓ ËÏÈΛ·˜ 15-64 ÂÙÒÓ ‰È¤ÎÔ„Â ÌfiÓÈÌ· ÙÔ Î¿ÓÈÛÌ·, ÂÓÒ fiÙ·Ó ÛÙ·Ì¿ÙËÛ·Ó Ù· ·ÓÙÈηÓÈÛÙÈο ÌËӇ̷ٷ, ÔÈ Ú˘ıÌÔ› ·‡ÍËÛ˘ Ù˘ ηٷӿψÛ˘ ηÓÔ‡ ·ӋÏı·Ó ÛÙ· ·Ú¯Èο ›‰·. ™Â ¤Ú¢ӷ Ô˘ ¤ÁÈÓ ÛÙËÓ ∫Ú‹ÙË (1) ÌÂÙ¿ ·fi ¤Ó·Ó ¯ÚfiÓÔ ÂÎ·È‰Â˘ÙÈ΋˜ ·Ú¤Ì‚·Û˘, ‚Ú¤ıËΠӷ ηӛ˙ÂÈ ÙÔ 6% Ù˘ ÔÌ¿‰·˜ ·Ú¤Ì‚·Û˘ Î·È ÙÔ 20% Ù˘ ÔÌ¿‰·˜ ÂϤÁ¯Ô˘, Û ۯ¤ÛË Ì ٷ ·ÓÙ›ÛÙÔȯ· ÔÛÔÛÙ¿ 7% Î·È 13% Ù˘ ·ÚÔ‡Û·˜ ¤Ú¢ӷ˜. ™Â ¿ÏÏË ¤Ú¢ӷ Û ÂÊ‹‚Ô˘˜ Î·È Ó·ÚÔ‡˜ ÂÓ‹ÏÈΘ ÛÙËÓ ∫·ÏÈÊfiÚÓÈ·, Ô˘ ‰ÈÂÍ‹¯ıË ·fi ÙÔ 1979 ¤ˆ˜ ÙÔ 1990 (16), ·Ú·ÙËÚ‹ıËΠfiÙÈ Î·Ù¿ ÙÔ 1979 ÙÔ 28,7% ÙˆÓ ‰ÂÈÁÌ¿ÙˆÓ ·Ú¤Ì‚·Û˘ Î·È ÙÔ 21,7% ÙˆÓ ‰ÂÈÁÌ¿ÙˆÓ ÂϤÁ¯Ô˘ ‹Ù·Ó ηÓÈÛÙ¤˜, ÂÓÒ ÙÔ 1990 Ù· ÔÛÔÛÙ¿ ·˘Ù¿ ÌÂÈÒıËÎ·Ó Û 15,2% Î·È 15,8%, ·ÓÙ›ÛÙÔȯ·. ¶·Ú¿ÏÏËÏ·, ¯ˆÚ›˜ ÙËÓ ÂÊ·ÚÌÔÁ‹ ÚÔÁÚ·ÌÌ¿ÙˆÓ ·Ú¤Ì‚·Û˘, Û ‰È·¯ÚÔÓÈ΋ ÌÂϤÙË ‰È·ÊfiÚˆÓ ÂÚÈÔ¯ÒÓ Ù˘ ∂ÏÏ¿‰·˜ (14) ÛÙ· Ù¤ÏË Ù˘ ‰ÂηÂÙ›·˜ ÙÔ˘ ’80 Î·È Û ‰Â›ÁÌ· 4268 Ì·ıËÙÒÓ §˘Î›Ԣ ‚Ú¤ıËΠfiÙÈ ÙÔ 29,7% ‹Ù·Ó ηÓÈÛÙ¤˜, ÂÓÒ ÛÙ· ̤۷ Ù˘ ›‰È·˜ ‰ÂηÂÙ›·˜ ÙÔ ÔÛÔÛÙfi ›¯Â ÊÙ¿ÛÂÈ ÙÔ 43,4%. ∫·Ù¿ ÙËÓ ›‰È· ¯ÚÔÓÈ΋ ÂÚ›Ô‰Ô, ¤Ú¢ӷ ÛÙËÓ ∞ı‹Ó· (15) ¤‰ÂÈÍ fiÙÈ Û ‰Â›ÁÌ· 11.058 Ì·ıËÙÒÓ ËÏÈΛ·˜ 14-18 ÂÙÒÓ, ÙÔ ÔÛÔÛÙfi ÙˆÓ Î·ÓÈÛÙÒÓ ‹Ù·Ó 22,3%.
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ÙËÓ Kellogg’s. ∂›Û˘, Û˘Ó¤‚·Ï·Ó ·ÔÙÂÏÂÛÌ·ÙÈο ÔÈ Û˘ÓÂÚÁ¿Ù˜ Î.Î. ªÈ¯¿Ï˘ ∫˘Úȷο΢, ª·Ú›· ªÈÙÛÒÚË, πˆ¿ÓÓ· ∞ÔÛÙÔÏ¿ÎË, ∞ÁÁÂÏÈ΋ ¶··‰¿ÎË, ¢ËÌ‹ÙÚ˘ ∞ı·Ó·ÛfiÔ˘ÏÔ˜, ∂‡· ªÔ‡Î·, πˆ¿ÓÓ· ªÔÛ¯·Ó‰Ú¤·, ∫·ÚÔÏ¿ÈÓ ∫fi‰ÚÈÁÎÙÔÓ Î·È °È¿ÓÓ˘ ª·ÓÈfi˜.
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25. Resnicow K, Cohn L, Reinhardt J, Cross D, Futterman R, Kirschner E et al. A three-year evaluation of the know your body program in inner-city schoolchildren. Health Educ Q 1992;19:463-480. 26. Lytle LA, Stone EJ, Nichaman MZ, Perry CL, Montgomery DH, Nicklas TA et al. Changes in nutrient intakes of elementary school children following a school-based intervention: results from the CATCH Study. Prev Med 1996;25:465-477. 27. McMurray RG, Harrell JS, Bangdiwala SI, Bradley CB, Deng S, Levine A. A school-based intervention can reduce body fat and blood pressure in young adolescents. J Adolesc Health 2002;31:125-132. 28. Sahota P, Rudolf MC, Dixey R, Hill AJ, Barth JH, Cade J. Randomised controlled trial of primary school based intervention to reduce risk factors for obesity. BMJ 2001;323:1029-1032. 29. Harrell JS, McMurray RG, Bangdiwala SI, Frauman AC, Gansky SA, Bradley CB. Effects of a school-based intervention to reduce cardiovascular disease risk factors in elementary-school children: the Cardiovascular Health in Children (CHIC) study. J Pediatr 1996;128:797-805. 30. Kafatos A, Mamalakis G. Changing patterns of fat intake in Crete. Eur J Clin Nutr 1993;47 (Suppl 1):S21-S24.
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ORIGINAL ARTICLE
À¿Ú¯ÂÈ Û˘Ó¤ÂÈ· ÛÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi ÙˆÓ ·È‰ÈÒÓ ÛÙËÓ Â·Ú¯›·; ŒÚ¢ӷ Û ·È‰ÈÎfi ÏËı˘ÛÌfi ∫¤ÓÙÚÔ˘ ÀÁ›·˜ ª. ™¯ÔÈÓ¿, °. ™¯ÔÈÓ¿˜, ∫. ¶·ÙÂÚfiÔ˘ÏÔ˜
Is there consistency in immunization of children who live in the countryside? Study of the child population of a Rural Health Centre M. Schina, G. Schinas, K. Pateropoulos
¶ÂÚ›ÏË„Ë: ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ë ‰ÈÂÚ‡ÓËÛË Î·È Î·Ù·ÁÚ·Ê‹ Ù˘ ÂÌ‚ÔÏÈ·ÛÙÈ΋˜ Î¿Ï˘„˘ ÙˆÓ ·È‰ÈÒÓ Ô˘ ηÙÔÈÎÔ‡Ó ÛÙËÓ ÂÚÈÔ¯‹ ¢ı‡Ó˘ ÙÔ˘ ∫¤ÓÙÚÔ˘ ÀÁ›·˜ π¿ÛÌÔ˘ ÙÔ˘ ¡ÔÌÔ‡ ƒÔ‰fi˘, ηıÒ˜ Î·È Ë Û‡ÁÎÚÈÛË ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ Ù˘ ÂÚÈÔ¯‹˜ Ì ÙÔ˘˜ ÛÙfi¯Ô˘˜ Ô˘ ÚԂϤÔÓÙ·È ·fi ÙËÓ ¶·ÁÎfiÛÌÈ· OÚÁ¿ÓˆÛË ÀÁ›·˜ Î·È Ì ·Ó¿ÏÔÁ· ÛÙÔȯ›· ¿ÏÏˆÓ ÌÂÏÂÙÒÓ. ∞ÓÙÈΛÌÂÓÔ Ù˘ ÌÂϤÙ˘ ·ÔÙ¤ÏÂÛ·Ó 230 ·È‰È¿ Ù˘ ÂÚÈÔ¯‹˜, ËÏÈΛ·˜ 6-14 ÂÙÒÓ, Ô˘ ÂÈÛΤÊıËÎ·Ó ÙÔ ∫¤ÓÙÚÔ ÀÁ›·˜ ÁÈ· ÏfiÁÔ˘˜ ˘Á›·˜ ‹ ÁÈ· ÚÔÏËÙÈ΋ ÂͤٷÛË Î·Ù¿ Ù· ¤ÙË 2000-2001, ÙˆÓ ÔÔ›ˆÓ Ù· ‚È‚ÏÈ¿ÚÈ· ÌÂÏÂÙ‹ıËÎ·Ó Î·È Î·Ù·ÁÚ¿ÊËÎÂ Ë ÂÌ‚ÔÏÈ·ÛÙÈ΋ ÙÔ˘˜ ΛÓËÛË. O ·ÚÈıÌfi˜ ÙˆÓ ‰fiÛÂˆÓ ÌÂÏÂÙ‹ıËΠ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ˆ˜ ËÏÈ˘ ÔÚfiÛËÌÔ ÙÔ 1Ô Î·È 2Ô ¤ÙÔ˜, ηıÒ˜ Î·È Û˘ÓÔÏÈο ÛÙÔ Î¿ı ·È‰› ·ÓÂÍ·Úًو˜ ËÏÈΛ·˜. ™‡Ìʈӷ Ì ٷ ·ÔÙÂϤÛÌ·Ù· ÁÈ· ÙË ‰ÈÊıÂÚ›Ùȉ·, ÙÔÓ Ù¤Ù·ÓÔ, ÙÔÓ ÎÔηÙË Î·È ÙËÓ ÔÏÈÔÌ˘ÂÏ›Ùȉ·, ÙÔ 63%, 63%, 62,2% Î·È ÙÔ 63,5% ÙˆÓ ·È‰ÈÒÓ ·ÓÙÈÛÙÔ›¯ˆ˜ ‹Ù·Ó ÂÌ‚ÔÏÈ·Ṳ̂ÓÔ Ì 3 ‰fiÛÂȘ Û ËÏÈΛ· ÌÈÎÚfiÙÂÚË ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜, ÙÔ 51%, 51%, 49,1% Î·È 49,6% ·ÓÙ›ÛÙÔȯ· ‹Ù·Ó ÂÌ‚ÔÏÈ·Ṳ̂ÓÔ Ì 4 ‰fiÛÂȘ Û ËÏÈΛ· οو ÙˆÓ 2 ÂÙÒÓ Î·È ÙÔ 83,9%, 83,9%, 64,8% Î·È 82,2% ·ÓÙÈÛÙÔ›¯ˆ˜ ›¯Â 5 ‰fiÛÂȘ Û˘ÓÔÏÈο, ·ÓÂÍ·Úًو˜ ËÏÈΛ·˜, ÁÈ· ÙËÓ Î¿ı ÓfiÛÔ. °È· ÙËÓ ÈÏ·Ú¿, ÙËÓ ÂÚ˘ıÚ¿ Î·È ÙËÓ ·ÚˆÙ›Ùȉ·, Ì›· ‰fiÛË Û ËÏÈΛ· ÌÈÎÚfiÙÂÚË ÙˆÓ ‰‡Ô ÂÙÒÓ Â›¯Â Ï¿‚ÂÈ ÙÔ 4,8% ÙˆÓ ·È‰ÈÒÓ, ‰‡Ô ‰fiÛÂȘ ·ÓÂÍ·Úًو˜ ËÏÈΛ·˜ ÙÔ 53,9%, ÂÓÒ ÙÔ 8,7% ·Ú¤ÌÂÓ ·ÓÂÌ‚ÔÏ›·ÛÙÔ. ∫·Ù¿ ÙË Û‡ÁÎÚÈÛË ÙˆÓ ÛÙÔȯ›ˆÓ ·˘ÙÒÓ, ‰È·ÈÛÙÒÓÂÙ·È ÛËÌ·ÓÙÈ΋ ·fiÎÏÈÛË ·fi ÙÔ˘˜ ÛÙfi¯Ô˘˜ Ù˘ ¶·ÁÎfiÛÌÈ·˜ OÚÁ¿ÓˆÛ˘ ÀÁ›·˜, fiÔ˘ ÂÓ‰ÂÈÎÙÈο ·Ó·Ê¤ÚÂÙ·È fiÙÈ ··ÈÙÂ›Ù·È ÂÌ‚ÔÏÈ·ÛÙÈ΋ Î¿Ï˘„Ë ≥90% ÁÈ· ÙË ‰ÈÊıÂÚ›Ùȉ· Î·È ÙÔÓ Ù¤Ù·ÓÔ Û ·È‰È¿ ËÏÈΛ·˜ <1 ¤ÙÔ˘˜, ·ÏÏ¿ Î·È ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ Ì ¿ÏϘ ÂÚÈÔ¯¤˜ Ù˘ ∂ÏÏ¿‰·˜. ∞ÔÙÂÏ›,
Abstract: The aim of this study was to examine and record the degree of sufficiency of immunization of the children living in the area covered by the Iasmos Health Care Centre and to compare the findings with the standards set by the World Health Organization (WHO) and results from similar studies. The subjects of the study were 230 children aged 6-14 years, living in the area, who had visited the Health Care Centre for preventive examination or acute disease in the years 20002001. Their health booklets were examined and their immunizations were recorded, specifically the number of doses which had been administered in the 1st and 2nd years of life, and the total number of doses given to each child independent of age. It was found that for diphtheria, tetanus, pertussis and poliomyelitis vaccines, three doses had been given before the end of the first year to respectively 63%, 63%, 62.2% and 63.5% of the children, four doses by the end of the second year to respectively 51%, 51%, 49.1% and 49.6%, and a total of five doses, irrespective of age, had been given to respectively 83.9%, 83.9%, 64.8% and 82.2% of the children. Regarding the vaccine for measles, mumps and rubella, 4.8% of the children had received one dose before the end of the second year and 53.9% had received two doses irrespective of age, while 8.7% were unimmunized. The study revealed significant deviation from the targets set by the WHO, whereby 90% cover of children for diphtheria and tetanus is demanded for children in the first year of life. There was also less effective coverage in comparison to studies conducted in other parts of Greece. It is necessary for similar studies to be conducted at a local level in order for effective planning of immunization promotion programmes to be carried out.
∫¤ÓÙÚÔ ÀÁ›·˜ ™Ô˘ÊÏ›Ô˘, ¡ÔÌfi˜ Œ‚ÚÔ˘
Health Care Centre of Soufli, Prefecture of Evros
448
¶·È‰È·ÙÚÈ΋ 2003;66:448-451
Paediatriki 2003;66:448-451
ÏÔÈfiÓ, ·Ó·ÁηÈfiÙËÙ· Ë ‰ÈÂÓ¤ÚÁÂÈ· ÌÂϤÙ˘ Ù˘ ηٿÛÙ·Û˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Û ÙÔÈÎfi Â›Â‰Ô Î·È Ë ÚÔÒıËÛË ÙÔÈÎÔ‡ ۯ‰ȷÛÌÔ‡ ‰Ú·ÛÙËÚÈÔÙ‹ÙˆÓ ÚÔ·ÁˆÁ‹˜ ÙˆÓ ÂÌ‚ÔÏÈ·ÛÌÒÓ. §¤ÍÂȘ ÎÏÂȉȿ: ÂÌ‚ÔÏÈ·ÛÌÔ›, ·È‰È¿, ∫¤ÓÙÚÔ ÀÁ›·˜, £Ú¿ÎË.
Key words: immunization, children, Health Care Centre, Thrace.
™˘ÓÙÔÌÔÁڷʛ˜
Ù·ÁÚ¿ÊËÎÂ Ë ÂÌ‚ÔÏÈ·ÛÙÈ΋ ÙÔ˘˜ ηٿÛÙ·ÛË. ∞Í›˙ÂÈ Ó· ÛËÌÂȈı› fiÙÈ ÙÔ 80% ÙˆÓ ·È‰ÈÒÓ ‹Ù·Ó ªÔ˘ÛÔ˘ÏÌ¿ÓÔÈ ÂÏÏËÓÈ΋˜ ηٷÁˆÁ‹˜. ∏ ÂÌ‚ÔÏÈ·ÛÙÈ΋ ÙÔ˘˜ Î¿Ï˘„Ë ÌÂÏÂÙ‹ıËÎÂ: ·) ÁÈ· ÙË ‰ÈÊıÂÚ›Ùȉ·, ÙÔÓ Ù¤Ù·ÓÔ, ÙÔÓ ÎÔηÙË Î·È ÙËÓ ÔÏÈÔÌ˘ÂÏ›Ùȉ· ˆ˜ ÚÔ˜ ÙÔÓ ·ÚÈıÌfi ÙˆÓ ‰fiÛÂˆÓ Ô˘ ¯ÔÚËÁ‹ıËÎ·Ó Û ËÏÈΛ· ÌÈÎÚfiÙÂÚË ÙÔ˘ 1Ô˘ Î·È ÙÔ˘ 2Ô˘ ¤ÙÔ˘˜ Î·È ˆ˜ ÚÔ˜ ÙÔÓ ·ÚÈıÌfi ÙˆÓ ‰fiÛÂˆÓ Ô˘ ¯ÔÚËÁ‹ıËÎ·Ó Û˘ÓÔÏÈο, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙËÓ ËÏÈΛ·, ‚) ÁÈ· ÙËÓ ÈÏ·Ú¿, ÙËÓ ÂÚ˘ıÚ¿ Î·È ÙËÓ ·ÚˆÙ›Ùȉ·, ˆ˜ ÚÔ˜ ÙÔÓ ·ÚÈıÌfi ÙˆÓ ‰fiÛÂˆÓ Ô˘ ¯ÔÚËÁ‹ıËÎ·Ó Û ËÏÈΛ· ÌÈÎÚfiÙÂÚË ÙÔ˘ 2Ô˘ ¤ÙÔ˘˜ Î·È ˆ˜ ÚÔ˜ ÙÔÓ ·ÚÈıÌfi ÙˆÓ ‰fiÛÂˆÓ ·ÓÂÍ¿ÚÙËÙ· ·fi ÙËÓ ËÏÈΛ· ¯ÔÚ‹ÁËÛ˘. ™ËÌÂÈÒÓÂÙ·È fiÙÈ Û fiÏ· ۯ‰fiÓ Ù· ·È‰È¿ ›¯Â ¯ÔÚËÁËı› ÙÔ ÙÚÈÏfi ÂÌ‚fiÏÈÔ MMR Î·È ‰ÂÓ Â›¯·Ó Á›ÓÂÈ Í¯ˆÚÈÛÙÔ› ÂÌ‚ÔÏÈ·ÛÌÔ› ÁÈ· οı ÓfiÛÔ, Á) ÁÈ· ÙËÓ Ë·Ù›Ùȉ· µ, ˆ˜ ÚÔ˜ ÙÔÓ ·ÚÈıÌfi ÙˆÓ ·È‰ÈÒÓ Ô˘ ›¯·Ó Ï¿‚ÂÈ ÙÔ ÚÔ‚ÏÂfiÌÂÓÔ Û¯‹Ì· ÙˆÓ 3 ‰fiÛˆÓ, ‰) ÁÈ· ÙÔÓ ·ÈÌfiÊÈÏÔ Ù˘ ÈÓÊÏÔ˘¤ÓÙÛ·˜, ˆ˜ ÚÔ˜ ÙÔÓ ·ÚÈıÌfi ÙˆÓ ·È‰ÈÒÓ Ô˘ ›¯·Ó Ï¿‚ÂÈ ÙÔ Ï‹Ú˜ Û¯‹Ì· ÙˆÓ ‰fiÛˆÓ, fiˆ˜ ÚԂϤÂÙ·È Û‡Ìʈӷ Ì ÙËÓ ËÏÈΛ·, Â) ÁÈ· ÙËÓ Ë·Ù›Ùȉ· ∞: ‰‡Ô ‰fiÛÂȘ ·ÓÂÍ¿ÚÙËÙ· ·fi ÙËÓ ËÏÈΛ· ÂÌ‚ÔÏÈ·ÛÌÔ‡ ηÈ, Ù¤ÏÔ˜, ÛÙ) Ë Î¿Ï˘„‹ ÙÔ˘˜ Ì ÙÔ BCG. ™¯ÂÙÈο Ì ÙÔ Ó¤Ô ÂÌ‚fiÏÈÔ ÙÔ˘ ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘ ÔÌ¿‰·˜ C, ·Ó·Ê¤ÚÂÙ·È fiÙÈ Î·Ó¤Ó· ·È‰› ‰ÂÓ ‹Ù·Ó ÂÌ‚ÔÏÈ·Ṳ̂ÓÔ. ¶ÚfiÙ˘Ô ÁÈ· ÙË ÌÂϤÙË ·ÔÙ¤ÏÂÛ ÌÂıÔ‰ÔÏÔÁ›· ·Ó¿ÏÔÁË Ù˘ ·ÓÂÏÏ·‰È΋˜ ÌÂϤÙ˘ Ô˘ ¤Ï·‚ ¯ÒÚ· ÙÔ 1996-1997 Î·È ‰ÈÔÚÁ·ÓÒıËΠ·fi ÙÔ πÓÛÙÈÙÔ‡ÙÔ ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡ (πÀ¶).
∫À ¶OÀ πÀ¶
∫¤ÓÙÚÔ ÀÁ›·˜ ¶·ÁÎfiÛÌÈ· OÚÁ¿ÓˆÛË ÀÁ›·˜ πÓÛÙÈÙÔ‡ÙÔ ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡
∂ÈÛ·ÁˆÁ‹ ∏ ·ÓÙ›ÏË„Ë fiÙÈ Ë ÚfiÏË„Ë ÙˆÓ ·ÛıÂÓÂÈÒÓ ·ÔÙÂÏ› ÙËÓ Î·Ï‡ÙÂÚË Ì¤ıÔ‰Ô ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘˜ Â›Ó·È ·Ô‰ÂÎÙ‹ ·fi ·Ú¯·ÈÔÙ¿ÙˆÓ ¯ÚfiÓˆÓ. ∞˘Ùfi ÂȂ‚·ÈÒÓÂÙ·È ·fi ÙËÓ ÂÊ·ÚÌÔÁ‹ ÌÂıfi‰ˆÓ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÚÈÓ ·ÎfiÌË ·fi ÙË Á¤ÓÓËÛË ÙÔ˘ ÃÚÈÛÙÔ‡, ·Ú¯Èο Ì ÛÔ‚·Ú¤˜ ·ÚÂÓ¤ÚÁÂȘ Î·È ÎÈÓ‰‡ÓÔ˘˜ ÁÈ· ÙËÓ ˘Á›· ÙÔ˘ ÂÌ‚ÔÏÈ·˙fiÌÂÓÔ˘. ™‹ÌÂÚ·, Ë ÂͤÏÈÍË Ù˘ ÌÔÚȷ΋˜ Î·È Î˘ÙÙ·ÚÈ΋˜ ‚ÈÔÏÔÁ›·˜ ¤¯ÂÈ Ê¤ÚÂÈ Â·Ó¿ÛÙ·ÛË ÛÙËÓ ·Ú·Û΢‹ ·ÔÙÂÏÂÛÌ·ÙÈÎÒÓ Î·È ·Î›Ó‰˘ÓˆÓ ÂÌ‚ÔÏ›ˆÓ, Ì ÙȘ ÏÈÁfiÙÂÚ˜ ‰˘Ó·Ù¤˜ ·ÚÂÓ¤ÚÁÂȘ ÁÈ· ÙÔÓ ÂÌ‚ÔÏÈ·˙fiÌÂÓÔ. O ·ÒÙÂÚÔ˜ ÛÙfi¯Ô˜ Ù˘ ÂÓÂÚÁËÙÈ΋˜ ·ÓÔÛÔÔ›ËÛ˘ Â›Ó·È Ë ÂÍ¿ÏÂÈ„Ë Ù˘ ÓfiÛÔ˘. O ÂӉȿÌÂÛÔ˜ ÛÙfi¯Ô˜ Â›Ó·È Ó· ·ÔÙڷ› Ë ÂΉ‹ÏˆÛË Ù˘ ÓfiÛÔ˘ Û ¿ÙÔÌ· ‹ ÔÌ¿‰Â˜ ·ÙfïÓ. °È· Ó· ÂÈÙ¢¯ıÔ‡Ó ·˘ÙÔ› ÔÈ ÛÙfi¯ÔÈ, ÔÈ ÁÈ·ÙÚÔ› Ú¤ÂÈ Ó· ÙËÚÔ‡Ó ÛÙ·ıÂÚfi ÚfiÁÚ·ÌÌ· ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÙˆÓ ‚ÚÂÊÒÓ, ÙˆÓ ·È‰ÈÒÓ, ÙˆÓ ÂÊ‹‚ˆÓ Î·È ÙˆÓ ÂÓËϛΈÓ, ‰Â‰Ô̤ÓÔ˘ fiÙÈ ·˘Ùfi ·ÔÙÂÏ› Ú¿ÍË Ì¤ÁÈÛÙ˘ ÛÔ˘‰·ÈfiÙËÙ·˜. ∞fi‰ÂÈÍË ·˘ÙÔ‡ ·ÔÙÂÏ› Ë Ï‹Ú˘ ÂÍ¿ÏÂÈ„Ë Ù˘ ¢ÏÔÁÈ¿˜ ÙÔ 1979 Î·È Ô ÛËÌ·ÓÙÈÎfi˜ ÂÚÈÔÚÈÛÌfi˜ Ù˘ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜, ·ÏÏ¿ Î·È ¿ÏÏˆÓ ÓÔÛËÌ¿ÙˆÓ Ô˘ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÛÙÔ ‚·ÛÈÎfi ÚfiÁÚ·ÌÌ· ÂÌ‚ÔÏÈ·ÛÌÒÓ. ™ÎÔfi Ù˘ ÌÂϤÙ˘ ·˘Ù‹˜ ·ÔÙÂÏ› Ë ‰ÈÂÚ‡ÓËÛË Î·È Î·Ù·ÁÚ·Ê‹ Ù˘ ÂÌ‚ÔÏÈ·ÛÙÈ΋˜ Î¿Ï˘„˘ ÙˆÓ ·È‰ÈÒÓ Ô˘ ηÙÔÈÎÔ‡Ó ÛÙËÓ ÂÚÈÔ¯‹ ¢ı‡Ó˘ ÙÔ˘ ∫¤ÓÙÚÔ˘ ÀÁ›·˜ π¿ÛÌÔ˘ ÙÔ˘ ÓÔÌÔ‡ ƒÔ‰fi˘, Ì›·˜ ÔÚÂÈÓ‹˜ ÂÚÈÔ¯‹˜ Ì ÏËı˘ÛÌȷΤ˜ ȉȷÈÙÂÚfiÙËÙ˜, ηıÒ˜ Î·È Ë Û‡ÁÎÚÈÛË ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ Ù˘ ÂÚÈÔ¯‹˜ Ì ÙÔ˘˜ ÛÙfi¯Ô˘˜ Ù˘ ¶·ÁÎfiÛÌÈ·˜ OÚÁ¿ÓˆÛ˘ ÀÁ›·˜ (¶OÀ) Î·È Ì ÛÙÔȯ›· ¿ÏÏˆÓ ·Ó¿ÏÔÁˆÓ ÌÂÏÂÙÒÓ. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ∞ÓÙÈΛÌÂÓÔ Ù˘ ÌÂϤÙ˘ ·ÔÙ¤ÏÂÛ·Ó 230 ·È‰È¿ Ù˘ ÂÚÈÔ¯‹˜, ËÏÈΛ·˜ 6-14 ÂÙÒÓ, Ù· ÔÔ›· ÂÈÛΤÊıËÎ·Ó ÙÔ ∫À ÁÈ· ÏfiÁÔ˘˜ ÔÍ›·˜ ÓfiÛËÛ˘ ‹ ÁÈ· ÚÔÏËÙÈ΋ ÂͤٷÛË Î·È Û˘ÌÏ‹ÚˆÛË ÙÔ˘ ·ÙÔÌÈÎÔ‡ ‰ÂÏÙ›Ô˘ ˘Á›·˜, ηٿ Ù· ¤ÙË 20002001. ªÂÏÂÙ‹ıËÎ·Ó Ù· ‚È‚ÏÈ¿ÚÈ· ·˘ÙÒÓ ÙˆÓ ·È‰ÈÒÓ Î·È Î·-
∞ÔÙÂϤÛÌ·Ù· ∏ Î¿Ï˘„Ë ÙˆÓ ·È‰ÈÒÓ ÁÈ· ÙË ‰ÈÊıÂÚ›Ùȉ·, ÙÔÓ Ù¤Ù·ÓÔ, ÙÔÓ ÎÔηÙË Î·È ÙËÓ ÔÏÈÔÌ˘ÂÏ›Ùȉ· Ê·›ÓÂÙ·È ÛÙÔÓ ¶›Ó·Î· 1. °›ÓÂÙ·È, ÏÔÈfiÓ, ·ÓÙÈÏËÙfi fiÙÈ ÌfiÏȘ ÙÔ 51% ÙˆÓ ·È‰ÈÒÓ Â›Ó·È ÂÌ‚ÔÏÈ·Ṳ̂ÓÔ Ì 4 ‰fiÛÂȘ ÁÈ· ‰ÈÊıÂÚ›Ùȉ· Î·È Ù¤Ù·ÓÔ Û ËÏÈΛ· ÌÈÎÚfiÙÂÚË ÙˆÓ 2 ÂÙÒÓ, ÂÓÒ ÙÂÏÈο, ÛÙȘ ÌÂÁ·Ï‡ÙÂÚ˜ ËÏÈ˘, ÙÔ ÔÛÔÛÙfi Î¿Ï˘„˘ Ì 5 ‰fiÛÂȘ ÊÙ¿ÓÂÈ ÙÔ 83,9% (ÔÛÔÛÙfi Ô˘ Â›Ó·È Û ·ÓÙÈÛÙÔȯ›· Ì ٷ ÛÙÔȯ›· ·fi ÙËÓ ·ÓÂÏÏ·‰È΋ ÌÂϤÙË) (¶›Ó·Î·˜ 2) Î·È ¿ÏϘ ·ÓÙ›ÛÙÔȯ˜ ÌÂϤÙ˜. ∂ȉÈο ÁÈ· ÙÔÓ ÎÔηÙË, ÂÎÙfi˜ ·fi ÙËÓ Î·ı˘ÛÙ¤ÚËÛË ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡, ·Ú·ÙËÚÂ›Ù·È Î·È ·ÚÎÂÙ¿ ¯·ÌËÏfiÙÂÚÔ ÔÛÔÛÙfi ·È‰ÈÒÓ ÂÌ‚ÔÏÈ·ÛÌ¤ÓˆÓ Ì 5 ‰fiÛÂȘ ÏfiÁˆ ¯ÔÚ‹ÁËÛ˘ ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ DT ÛÙËÓ 5Ë ‰fiÛË, ·ÏÏ¿ Ù· ÔÛÔÛÙ¿ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚ·
449
¶·È‰È·ÙÚÈ΋ 2003;66:448-451
Paediatriki 2003;66:448-451
¶›Ó·Î·˜ 1. ¢Â›ÎÙ˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÁÈ· ÙË ‰ÈÊıÂÚ›Ùȉ·, ÙÔÓ Ù¤Ù·ÓÔ Î·È ÙÔÓ ÎÔηÙË
¢ÈÊıÂÚ›Ùȉ·* ∫ÔÎ·Ù˘ Sabin
3 ‰fiÛÂȘ <1 ¤ÙÔ˘˜
4 ‰fiÛÂȘ <2 ÂÙÒÓ
5 ‰fiÛÂȘ ·ÓÂÍ·Úًو˜ ËÏÈΛ·˜
<3 ‰fiÛÂȘ
∞ÓÂÌ‚ÔÏ›·ÛÙ·
63% 62,2% 63,5%
51% 49,6% 49,6%
83,9% 64,8% 82,2%
3,9% 10,4% 4%
3%
* ∏ Î¿Ï˘„Ë ÙˆÓ ·È‰ÈÒÓ ÁÈ· ٤ٷÓÔ Â›Ó·È Ë ›‰È· Ì Ù˘ ‰ÈÊıÂÚ›Ùȉ·˜, ÁÈ’ ·˘Ùfi Î·È ‰ÂÓ ÌÂÏÂÙÒÓÙ·È ¯ˆÚÈÛÙ¿ ¶›Ó·Î·˜ 3. ¢Â›ÎÙ˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÁÈ· ÙËÓ ÈÏ·Ú¿, ÙËÓ ÂÚ˘ıÚ¿ Î·È ÙËÓ ·ÚˆÙ›Ùȉ·
¶›Ó·Î·˜ 2. ™ÙÔȯ›· ·ÓÂÏÏ·‰È΋˜ ÌÂϤÙ˘
¢ÈÊıÂÚ›Ùȉ· ∫ÔÎ·Ù˘ ¶ÔÏÈÔÌ˘ÂÏ›Ùȉ·
3 ‰fiÛÂȘ <1 ¤ÙÔ˘˜
4 ‰fiÛÂȘ <2 ÂÙÒÓ
5 ‰fiÛÂȘ ·ÓÂÍ·Úًو˜ ËÏÈΛ·˜
84,1% 82,4% 81,2%
69% 65% 65,6%
80,8% 46,3% 80,3%
·fi Ù· ·Ó¿ÏÔÁ· Ù˘ ·ÓÂÏÏ·‰È΋˜ ÌÂϤÙ˘, Êı¿ÓÔÓÙ·˜ ÙÔ 64,8%, ÂÓÒ ÂÈÛËÌ·›ÓÂÙ·È Î·È ÙÔ 3% ÙˆÓ ·ÓÂÌ‚ÔÏ›·ÛÙˆÓ ·È‰ÈÒÓ. ™¯ÔÏÈ¿˙ÔÓÙ·˜ Ù· ÛÙÔȯ›· ÁÈ· ÙËÓ ÈÏ·Ú¿, ÙËÓ ÂÚ˘ıÚ¿ Î·È ÙËÓ ·ÚˆÙ›Ùȉ· (¶›Ó·Î·˜ 3), ȉȷ›ÙÂÚË ÂÓÙ‡ˆÛË ÚÔηÏ› ÙÔ ¯·ÌËÏfi ÔÛÔÛÙfi ÂÌ‚ÔÏÈ·ÛÌÔ‡ Û ËÏÈ˘ οو ÙˆÓ 2 ÂÙÒÓ (4,8% ÁÈ· ÙËÓ ÈÏ·Ú¿), fiÙ·Ó Ô ÛÙfi¯Ô˜ Ù˘ ¶OÀ (¶›Ó·Î·˜ 4) Â›Ó·È Ó· ÂÌ‚ÔÏÈ·ÛÙ› Ì ÙÔ˘Ï¿¯ÈÛÙÔÓ Ì›· ‰fiÛË ÙÔ 90% ÙˆÓ ·È‰ÈÒÓ ËÏÈΛ·˜ οو ÙˆÓ 2 ÂÙÒÓ. ∞Ó¿ÏÔÁ· Â›Ó·È Î·È Ù· ÛÙÔȯ›· ÁÈ· ÙËÓ ÂÚ˘ıÚ¿ Î·È ÙËÓ ·ÚˆÙ›Ùȉ·, ÁÂÁÔÓfi˜ Ô˘ ηıÈÛÙ¿ ÂÍ·ÈÚÂÙÈο ‰‡ÛÎÔÏÔ ÛÙfi¯Ô ÙËÓ ÂÎÚ›˙ˆÛË ÙˆÓ ÓfiÛˆÓ ·˘ÙÒÓ ÛÙ· ·Ì¤Ûˆ˜ ÂfiÌÂÓ· ¯ÚfiÓÈ·. OÈ ÔÌÔÈfiÙËÙ˜ ÛÙ· ÔÛÔÛÙ¿ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÁÈ· ÙȘ ÙÚÂȘ ÓfiÛÔ˘˜ ÔÊ›ÏÔÓÙ·È ÛÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ ÙÚÈÏÔ‡ ÂÌ‚ÔÏ›Ô˘ MMR Û fiÏ· ۯ‰fiÓ Ù· ·È‰È¿. ™Â ·Ó¿ÏÔÁË ÌÂϤÙË Ô˘ ¤Ï·‚ ¯ÒÚ· ÛÙÔÓ ÓÔÌfi ¶ÈÂÚ›·˜ ÙÔ 2000 (8), Ù· ÔÛÔÛÙ¿ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÁÈ· ÙȘ ÙÚÂȘ ÓfiÛÔ˘˜ ‹Ù·Ó 34,4% ÁÈ· Ù· ·È‰È¿ ÙÔ˘ §˘Î›Ԣ Î·È 34,8% ÁÈ· Ù· ·È‰È¿ ÙÔ˘ °˘ÌÓ·Û›Ô˘. ∆· ÔÛÔÛÙ¿ ·˘Ù¿ Â›Ó·È ‚¤‚·È· ˘„ËÏfiÙÂÚ· ·fi ÙÔ 26,1% Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ (¶›Ó·Î·˜ 3), ·ÏÏ¿ ÙÔÓ›˙ÂÙ·È ÁÈ· ¿ÏÏË Ì›· ÊÔÚ¿ Ë ÛËÌ·ÓÙÈ΋ ·fiÎÏÈÛË ·fi ÙÔ˘˜ ÛÙfi¯Ô˘˜ Ù˘ ¶OÀ. ™Â ÌÂϤÙË Ô˘ ‰ÈÂÓÂÚÁ‹ıËΠ·fi ÙËÓ ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ÙÔ 1995, Û ÓÔÛÔÎÔÌÂÈ·Îfi ÏËı˘ÛÌfi (3), Ù· ÔÛÔÛÙ¿ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ›¯·Ó ÌÈÎÚ¤˜ ‰È·ÊÔÚ¤˜ ÁÈ· ÙË ‰ÈÊıÂÚ›Ùȉ·, ÙÔÓ ÎÔηÙË Î·È ÙËÓ ÔÏÈÔÌ˘ÂÏ›Ùȉ·, ÂÓÒ ·Ú·ÙËÚ‹ıËΠÌÂÁ¿ÏË ‰È·ÊÔÚ¿ ÁÈ· ÙËÓ ÈÏ·Ú¿, ÙËÓ ÂÚ˘ıÚ¿ Î·È ÙËÓ ·ÚˆÙ›Ùȉ·, fiÔ˘ Ù· ÔÛÔÛÙ¿ ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ‹Ù·Ó 89%, 76% Î·È 82%, ·ÓÙ›ÛÙÔȯ·, ÂÓÒ Ù· ÔÛÔÛÙ¿ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ Êı¿ÓÔ˘Ó ÌfiÏȘ ÙÔ 26,1% ÁÈ· ÙËÓ ÈÏ·Ú¿, ÙÔ 25,2% ÁÈ· ÙËÓ ÂÚ˘ıÚ¿ Î·È ÙÔ 26,1% ÁÈ· ÙËÓ ·ÚˆÙ›Ùȉ·. ∞ÎfiÌË, ÂÈÛËÌ·›ÓÂÙ·È ÙÔ ¯·ÌËÏfi ÔÛÔÛÙfi ÂÌ‚Ô-
450
ñ 0 ‰fiÛÂȘ ñ 1 ‰fiÛË (<2ÂÙÒÓ) ñ 1 ‰fiÛË ñ 2 ‰fiÛÂȘ (·ÓÂÍ·Úًو˜ ËÏÈΛ·˜) ñ 2 ‰fiÛÂȘ (<6 ÂÙÒÓ)
πÏ·Ú¿
∂Ú˘ıÚ¿
¶·ÚˆÙ›Ùȉ·
8,7% 4,8%
8,7% 4,8%
8,7% 4,8%
26,1% 53,9%
25,2% 54,3%
26,1% 53,9%
6,5%
6,9%
6,5%
¶›Ó·Î·˜ 4. ™Ùfi¯ÔÈ Ù˘ ¶·ÁÎfiÛÌÈ·˜ OÚÁ·ÓˆÛ˘ ÀÁ›·˜ (¶OÀ) ™Ùfi¯ÔÈ Ù˘ ¶OÀ ñ ¢ÈÊıÂÚ›Ùȉ·/٤ٷÓÔ˜ (3 ¤Á΢Ú˜ ‰fiÛÂȘ ¤ˆ˜ 1 ¤ÙÔ˘˜) ñ ∫ÔÎ·Ù˘ (3 ¤Á΢Ú˜ ‰fiÛÂȘ ¤ˆ˜ 1 ¤ÙÔ˘˜) ñ ¶ÔÏÈÔÌ˘ÂÏ›Ùȉ· (3 ¤Á΢Ú˜ ‰fiÛÂȘ ¤ˆ˜ 1 ¤ÙÔ˘˜) ñ πÏ·Ú¿, ÂÚ˘ıÚ¿, ·ÚˆÙ›Ùȉ· (1 ¤Á΢ÚË ‰fiÛË ¤ˆ˜ 2 ÂÙÒÓ)
≥90% ≥90% ≥90% ≥90%
¶›Ó·Î·˜ 5. ¢Â›ÎÙ˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÁÈ· ÙËÓ Ë·Ù›Ùȉ· µ, ÙËÓ Ë·Ù›Ùȉ· ∞, ÙÔÓ ·ÈÌfiÊÈÏÔ Î·È ÙË Ê˘Ì·Ù›ˆÛË ñ ∏·Ù›Ùȉ· µ (3 ‰fiÛÂȘ ·ÓÂÍ·Úًو˜ ËÏÈΛ·˜) ñ ∏·Ù›Ùȉ· ∞ (3 ‰fiÛÂȘ ·ÓÂÍ·Úًو˜ ËÏÈΛ·˜) ñ ∞ÈÌfiÊÈÏÔ˜ (Ï‹Ú˘ ÂÌ‚ÔÏÈ·ÛÌfi˜) ñ BCG
80,4% 1,7% 11,7% 32,6%
ÏÈ·ÛÌÔ‡ ÁÈ· ÙÔÓ ·ÈÌfiÊÈÏÔ Ù˘ ÈÓÊÏÔ˘¤ÓÙÛ·˜ (ÌfiÏȘ 11,7%) (¶›Ó·Î·˜ 5) Î·È ÙÔ ˘„ËÏfi ÔÛÔÛÙfi ÂÌ‚ÔÏÈ·ÛÌÔ‡ Ù˘ Ë·Ù›Ùȉ·˜ µ ¯¿ÚË ÛÙȘ ÚÔÛ¿ıÂȘ ÙÔ˘ ÚÔÛˆÈÎÔ‡ ÙÔ˘ ∫¤ÓÙÚÔ˘ ÀÁ›·˜ Ô˘ ¤ÌÂÓ ÛÙȘ ÂÈÛΤ„ÂȘ Î·È Î·ıfiÚÈ˙ ۷ʤ˜ ¯ÚÔÓԉȿÁÚ·ÌÌ· ÂÌ‚ÔÏÈ·ÛÌÒÓ ÛÙ· ·È‰È¿ Ù˘ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ Ô˘ ÂÈÛΤÙÔÓÙ·Ó ÙÔ ∫À ÁÈ· ÚÔÏËÙÈÎfi ¤ÏÂÁ¯Ô (¶›Ó·Î·˜ 5). ™˘˙‹ÙËÛË ∞fi Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘ Á›ÓÂÙ·È ·ÓÙÈÏËÙ‹ Ë ÛËÌ·ÓÙÈ΋ ηı˘ÛÙ¤ÚËÛË ÛÙË ‰ÈÂÓ¤ÚÁÂÈ·
¶·È‰È·ÙÚÈ΋ 2003;66:448-451
¶ÔÛÔÛÙfi ÂÌ‚ÔÏÈ·ÛÌÔ‡
30
Paediatriki 2003;66:448-451
ηٿÛÙ·ÛË ÙˆÓ ·ÙfiÌˆÓ Ù˘ οı ÂÚÈÔ¯‹˜ Î·È Ó· ÂÊ·ÚÌfi˙ÔÓÙ·È Û˘ÁÎÂÎÚÈ̤ӷ ÚÔÁÚ¿ÌÌ·Ù· ÁÈ· Ó· ÂÈÙ¢¯ıÔ‡Ó, ÙÂÏÈο, ÔÈ ÛÙfi¯ÔÈ Ô˘ Ù›ıÂÓÙ·È ·fi ÙËÓ ¶·ÁÎfiÛÌÈ· OÚÁ¿ÓˆÛË ÀÁ›·˜.
20
µÈ‚ÏÈÔÁÚ·Ê›· 10
0 1 3 5 7 9 11 13 15 19 24 27 30 36 48 72 85 110 ∏ÏÈΛ· Û ̋Ó˜ ∂ÈÎfiÓ· 1. ∏ÏÈÎȷ΋ ηٷÓÔÌ‹ ÙˆÓ ·È‰ÈÒÓ Î·Ù¿ ÙËÓ ¤Ó·ÚÍË ÙˆÓ ÂÌ‚ÔÏÈ·ÛÌÒÓ.
ÙˆÓ ˘Ô¯ÚˆÙÈÎÒÓ ÂÌ‚ÔÏÈ·ÛÌÒÓ ÛÙËÓ ÂÚÈÔ¯‹ Ù˘ ÌÂϤÙ˘. ∞˘Ùfi ÔÊ›ÏÂÙ·È ·ÊÂÓfi˜ ÛÙËÓ ÂÏÏÈ‹ ÏËÚÔÊfiÚËÛË Î·È ·ÊÂÙ¤ÚÔ˘ ÛÙÔ ˘„ËÏfi ÔÛÔÛÙfi ·Ó·ÏÊ·‚ËÙÈÛÌÔ‡. ∏ ‰˘ÛÎÔÏ›· Ù˘ ÂÓË̤ڈÛ˘ ÂÈÙ›ÓÂÙ·È ·ÎfiÌË ÂÚÈÛÛfiÙÂÚÔ ·fi ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ¤Ó· ÌÂÁ¿ÏÔ ÔÛÔÛÙfi ÙˆÓ Î·ÙÔ›ÎˆÓ ·Ó‹ÎÂÈ ÛÙË ÌÔ˘ÛÔ˘ÏÌ·ÓÈ΋ ÌÂÈÔÓfiÙËÙ· Î·È ÂÌÊ·Ó›˙ÂÈ Úfi‚ÏËÌ· ÂÈÎÔÈÓˆÓ›·˜ ÌË Î·Ù·ÓÔÒÓÙ·˜ ·ÚÎÒ˜ ÙË ÁÏÒÛÛ·, ȉ›ˆ˜ ÔÈ ÌËÙ¤Ú˜ Ô˘ Û˘Ó‹ıˆ˜ ÊÚÔÓÙ›˙Ô˘Ó ÁÈ· ÙËÓ Ù‹ÚËÛË ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÂÌ‚ÔÏÈ·ÛÌÒÓ Î·È ¤¯Ô˘Ó ηٿ ·ÚÈÔ ÏfiÁÔ ÙËÓ ÂÈ̤ÏÂÈ· ÙˆÓ ·È‰ÈÒÓ. ŒÙÛÈ ‰È·ÈÛÙÒÓÂÙ·È fiÙÈ ÙÔ ÚfiÁÚ·ÌÌ· ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÌÂٷʤÚÂÙ·È Û ÌÂÁ·Ï‡ÙÂÚ˜ ËÏÈ˘, fiÙ·Ó ‰ËÏ. ÂÈ‚¿ÏÏÂÙ·È Ë ÂͤٷÛË ÙˆÓ ·È‰ÈÒÓ ·fi ·È‰›·ÙÚÔ ÁÈ· ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ ‰ÂÏÙ›Ô˘ ˘Á›·˜ ÙÔ˘ ·È‰ÈÔ‡. µÚ¤ıËΠÏÔÈfiÓ fiÙÈ ÌfiÓÔ ÙÔ 75% ÙˆÓ ·È‰ÈÒÓ ·Ú¯›˙ÂÈ ÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi ÙÔ˘ Û ËÏÈ˘ <7 ÌËÓÒÓ, ÂÓÒ ¤Ó· 20% ÙˆÓ ·È‰ÈÒÓ ·Ú¯›˙ÂÈ Ó· ÂÌ‚ÔÏÈ¿˙ÂÙ·È ÌÂÙ¿ ÙËÓ ËÏÈΛ· ÙˆÓ 2 ÂÙÒÓ (∂ÈÎfiÓ· 1). ∆ÔÓ›˙ÂÙ·È, Ù¤ÏÔ˜, Ë ÌÂÁ¿ÏË ÛËÌ·Û›· Ù˘ ÂÊ·ÚÌÔÁ‹˜ ÙˆÓ ‰‡Ô ‰fiÛÂˆÓ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÁÈ· ÙËÓ ÈÏ·Ú¿, ÙËÓ ÂÚ˘ıÚ¿ Î·È ÙËÓ ·ÚˆÙ›Ùȉ·, ÚÔÎÂÈ̤ÓÔ˘ Ó· ·ÔÊ¢¯ıÔ‡Ó ÂȉË̛˜ fiˆ˜ ·˘Ù‹ Ù˘ ÈÏ·Ú¿˜ ÙÔ 1996 Î·È Ù˘ Û˘ÁÁÂÓÔ‡˜ ÂÚ˘ıÚ¿˜ ÙÔ 1993. §·Ì‚¿ÓÔÓÙ·˜, ÏÔÈfiÓ, ˘’ fi„ÈÓ Ù· ¯·ÌËÏ¿ ÔÛÔÛÙ¿ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Ù˘ ÂÚÈÔ¯‹˜ ‰È·ÈÛÙÒÓÂÙ·È fiÙÈ Â›Ó·È ··Ú·›ÙËÙ· ÙfiÛÔ Ë ÂÎfiÓËÛË Û¯Â‰›Ô˘ ÂÊ·ÚÌÔÁ‹˜ ÙˆÓ ÂÌ‚ÔÏÈ·ÛÌÒÓ fiÛÔ Î·È Ô Û·Ê‹˜ ηıÔÚÈÛÌfi˜ ÙˆÓ ÛÙfi¯ˆÓ ÛÙÔ˘˜ ·ÓıÚÒÔ˘˜ Ô˘ ·Û¯ÔÏÔ‡ÓÙ·È Ì ÙÔ˘˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡˜ ÁÈ· ÙË ¯¿Ú·ÍË ÎÔÈÓ‹˜ ÛÙÚ·ÙËÁÈ΋˜, ·ÏÏ¿ Î·È ÁÈ· ÙËÓ ÂÓË̤ڈÛË ÙÔ˘ ÏËı˘ÛÌÔ‡, ηıÒ˜ Î·È Ô ¤ÏÂÁ¯Ô˜ ˆ˜ ÚÔ˜ ÙËÓ ·ÓÙ·fiÎÚÈÛË ‹ fi¯È ÛÙȘ ÚԉȷÁڷʤ˜ ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜. ªÂÁ¿Ï˘, ›Û˘, ÛÔ˘‰·ÈfiÙËÙ·˜ Â›Ó·È Ë ÌÂϤÙË Ù˘ ηٿÛÙ·Û˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Û ÙÔÈÎfi ›‰Ô, ¤ÙÛÈ ÒÛÙ ӷ Á›ÓÂÙ·È ÁÓˆÛÙ‹ Ë ÂÌ‚ÔÏÈ·ÛÙÈ΋
1. ¶·Ó·ÁȈÙfiÔ˘ÏÔ˜ ∆, µ·Ï¿ÛÛË-∞‰¿Ì ∂. ŒÎıÂÛË. ¶·ÓÂÏÏ·‰È΋ ÌÂϤÙË Î·Ù¿ÛÙ·Û˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡. ∞ı‹Ó·: πÓÛÙÈÙÔ‡ÙÔ ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡; 1998. 2. ¶·Ó·ÁȈÙfiÔ˘ÏÔ˜ T. ªÂıÔ‰ÔÏÔÁÈο ÚÔ‚Ï‹Ì·Ù· ÛÙËÓ ¤Ú¢ӷ ÁÈ· ÙËÓ Î·Ù¿ÛÙ·ÛË ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÛÙËÓ ∂ÏÏ¿‰·: Û˘ÛÙËÌ·ÙÈ΋ ·Ó·ÛÎfiËÛË ÌÂÏÂÙÒÓ, 1970-1995. ¶·È‰È·ÙÚÈ΋ 1999;62:116-130. 3. µ·Ï¿ÛÛË-∞‰¿Ì ∂. ∞ÔÙ‡ˆÛË Î·Ù¿ÛÙ·Û˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Û ÓÔÛÔÎÔÌÂÈ·Îfi ÏËı˘ÛÌfi. ¢ÂÏÙ›Ô ∞’ ¶·È‰È·ÙÚÈ΋˜ ∫ÏÈÓÈ΋˜ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ 1995;42:82-86. 4. ºˆÙ›Ô˘ ∫, ¶··‰¿ÎË ∂. O ÂÌ‚ÔÏÈ·ÛÌfi˜ ÁÈ· ÙËÓ Ë·Ù›Ùȉ· µ ÛÙËÓ ·È‰È΋ ËÏÈΛ·. ¶·È‰È·ÙÚÈο ÃÚÔÓÈο 1995;22:63-68. 5. °ÂˆÚÁ¿ÙÔ˜ ¢, ∫·Ú·Î·˚‰fi˜ ¢, ªÔÛ¯ÔÓ¿ ¢, ™·ÍÈÒÓË ∂, ∆˙ÈÔ˘‚¿Ú· Ã, ƒËÁ¿ÙÔ˘ ∂ Î·È Û˘Ó. ∫·Ù¿ÛÙ·ÛË ÂÌ‚ÔÏÈ·ÛÌÔ‡ ·È‰ÈÎÔ‡ ÏËı˘ÛÌÔ‡ ∫ÂÊ·ÏÔÓÈ¿˜ [¶ÂÚ›ÏË„Ë]. 35Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ; 1997 13-15 πÔ˘Ó›Ô˘; ∫Ú‹ÙË; 1997. ÛÂÏ. 69. #62µ∞. 6. American Academy of Pediatrics (Active and Passive Immunization). In: Pickering LK, editor. 2000 Red Book: Report of the Committee on Infectious Diseases. 25th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2000. p. 1. 7. ª·ÏˆÌ¤ÓÔ˜ ∫, ¶··‰ËÌËÙÚ›Ô˘ ∂, °Ú‡ÏÏ˘ ™, ∫ÔÏ˘¤Ú·˜ ¢, ∞ÁÔÚ›ÙÛ· ™. ªÂϤÙË Î·Ù¿ÛÙ·Û˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Ì·ıËÙÒÓ §˘Î›Ԣ ÛÙÔ ¡ÔÌfi ∆ÚÈÎ¿ÏˆÓ [¶ÂÚ›ÏË„Ë]. 38Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ; 2000 16-18 πÔ˘Ó›Ô˘; ∫ˆ˜; 2000. ÛÂÏ. 289. #568. 8. ºÈ‰¿ÓË §, ¢¿Ú‰· ∞, ∞ÎÙÛ¤ÏË ∫, ªfi˙ÔÁÏÔ˘ ª, ºÈÏÈ›‰Ë˜ ™, µ·Ï·‚¿ÓË Ã Î·È Û˘Ó. ∫·Ù¿ÛÙ·ÛË ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÁÈ· ÈÏ·Ú¿, ÂÚ˘ıÚ¿ Î·È ·ÚˆÙ›Ùȉ· ÛÙÔÓ ¡ÔÌfi ¶ÈÂÚ›·˜ [¶ÂÚ›ÏË„Ë]. 38Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ; 2000 16-18 πÔ˘Ó›Ô˘; ∫ˆ˜; 2000. ÛÂÏ. 5. #002. 9. ∆˙Ô˘‚ÂϤ΢ °, ¡¿Ó·˜ Ã, ÷Ù˙ËÛÙ˘ÏÈ·ÓÔ‡ ª, ∫·ÙÚÈÔ‡ ¢. ∫·Ù¿ÛÙ·ÛË ÂÌ‚ÔÏÈ·ÛÌÒÓ ÙˆÓ Ì·ıËÙÒÓ ËÏÈΛ·˜ 7-15 ÂÙÒÓ ÙÔ˘ ¡. ∫ÈÏΛ˜ [¶ÂÚ›ÏË„Ë]. 38Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ; 2000 16-18 πÔ˘Ó›Ô˘; ∫ˆ˜; 2000. ÛÂÏ. 289. #569. 10. ¶ÂÙÚÔÔ‡ÏÔ˘ º, ªÂÚ›‰Ë˜ £, ∆Û¿ÌÈÚ· ¶, ¶·Ó·ÁȈÙfiÔ˘ÏÔ˜ ∆. ∂ȉËÌÈÔÏÔÁÈ΋ ÌÂϤÙË Ù˘ ηٿÛÙ·Û˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÙÔ˘ ·È‰ÈÎÔ‡ ÏËı˘ÛÌÔ‡ ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ¢‹ÌÔ˘ µfiÏÔ˘ [¶ÂÚ›ÏË„Ë]. 36Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ; 1998 5-7 πÔ˘Ó›Ô˘; ¶¿ÊÔ˜, ∫‡ÚÔ˜; 1998. ÛÂÏ. 161. #306∞∞.
∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 10-01-2003 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 09-09-2003 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ª·Ú›· ™¯ÔÈÓ¿ ∞Ó. £Ú¿Î˘ 23, ∆.∫. 681 00 ∞ÏÂÍ·Ó‰ÚÔ‡ÔÏË, ¡. Œ‚ÚÔ˘
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¶·È‰È·ÙÚÈ΋ 2003;66:452-455
∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞
Paediatriki 2003;66:452-455
ORIGINAL ARTICLE
¶ÚÔ‚Ï‹Ì·Ù· ˘Á›·˜ ·È‰ÈÒÓ-·Ú·ıÂÚÈÛÙÒÓ Û ÓËÛ› ÙˆÓ ∫˘ÎÏ¿‰ˆÓ ∂. ¶·Ú·Ûο΢1, ª. ∆ÛÈÌÈÓfi˜1, ∫. ∫·Ú·Ó¿ÛÈÔ˘1, ¡. ª·Î·ÚÒÓ·˜1, ∂. °·Ï·Ó¿Î˘2
Health problems of child-tourists in a Cycladic island E. Paraskakis1, M. Tsimbinos1, K. Karanasiou1, N. Makaronas1, E. Galanakis2
¶ÂÚ›ÏË„Ë: ∏ ÁÓÒÛË ÙˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ ˘Á›·˜ ÙˆÓ ·È‰ÈÒÓ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù·ÍȉÈÒÓ Î·È ‰È·ÎÔÒÓ ÌÔÚ› Ó· Û˘Ì‚¿ÏÂÈ ÛÙËÓ ÚfiÏË„Ë Î·È ÙË ÛˆÛÙ‹ ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘˜ ÛÙÔ˘˜ ÙfiÔ˘˜ ˘Ô‰Ô¯‹˜. ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ë Î·Ù·ÁÚ·Ê‹ ·˘ÙÒÓ ÙˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ Û ·È‰È¿ Ô˘ ‹Ù·Ó ıÂÚÈÓÔ› ÂÈÛΤÙ˜ ÛÙÔ ÓËÛ› Ù˘ ™›ÊÓÔ˘. ªÂÏÂÙ‹ıËÎ·Ó 311 ·È‰È¿-·Ú·ıÂÚÈÛÙ¤˜, Ù· ÔÔ›· ÂÍÂÙ¿ÛÙËÎ·Ó ÛÙÔ ÔÏ˘‰‡Ó·ÌÔ ÂÚÈÊÂÚÂÈ·Îfi È·ÙÚÂ›Ô ™›ÊÓÔ˘ ηٿ ÙÔ˘˜ ıÂÚÈÓÔ‡˜ Ì‹Ó˜ Ù˘ ‰ÈÂÙ›·˜ 2001-2002 Î·È Û˘ÁÎÚ›ıËÎ·Ó Ì 311 ·È‰È¿-ÌfiÓÈÌÔ˘˜ οÙÔÈÎÔ˘˜, Ù· ÔÔ›· ·ÔÙ¤ÏÂÛ·Ó ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘. ™˘¯ÓfiÙÂÚË ·ÈÙ›· ÚÔÛ¤Ï¢Û˘ ÙˆÓ ·È‰ÈÒÓ-·Ú·ıÂÚÈÛÙÒÓ ÛÙÔ È·ÙÚÂ›Ô ‹Ù·Ó Ù· ·Ù˘¯‹Ì·Ù· (16%) Î·È ·ÎÔÏÔ˘ıÔ‡Û·Ó ÔÈ ˆÙ›Ùȉ˜ (13%), ÔÈ ‰ÂÚÌ·Ù›Ùȉ˜ (13%), ÔÈ ÏÔÈÌÒÍÂȘ ηÙÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ (12%) Î·È Ë Á·ÛÙÚÂÓÙÂÚ›Ùȉ· (10%). ∆· ·È‰È¿-ÌfiÓÈÌÔÈ Î¿ÙÔÈÎÔÈ ·ÚÔ˘Û›·˙·Ó ‰È·ÊÔÚÂÙÈο ÔÛÔÛÙ¿ ÛÙȘ ·Èٛ˜ ÚÔÛ¤Ï¢Û˘ (ÏÔÈÌÒÍÂȘ ηÙÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ 16%, ‰ÂÚÌ·Ù›Ùȉ˜ 12%, ÏÔÈÌÒÍÂȘ ·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ 7%, ¿ÛıÌ· 6%, ˆÙ›Ùȉ˜ 5%). ∆· ·È‰È¿-·Ú·ıÂÚÈÛÙ¤˜ ·ÚÔ˘Û›·Û·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ·˘ÍË̤ÓË ÓÔÛËÚfiÙËÙ· ·fi Á·ÛÙÚÂÓÙÂÚ›Ùȉ˜, ˆÙ›Ùȉ˜ Î·È ·Ù˘¯‹Ì·Ù· (p=0,0002, p=0,0012 Î·È p=0,011, ·ÓÙ›ÛÙÔȯ·). ™˘ÌÂÚ·ÛÌ·ÙÈο, Ù· ·È‰È¿ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ıÂÚÈÓÒÓ ‰È·ÎÔÒÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÓÔÛ‹Ì·Ù· ‰È·ÊÔÚÂÙÈο ·fi ÂΛӷ ÙˆÓ ·È‰ÈÒÓ-ÌfiÓÈÌˆÓ Î·ÙԛΈÓ. ∏ ηٿÏÏËÏË ÚfiÏË„Ë Î·È ·Ú¤Ì‚·ÛË ÌÔÚ› Ó· Û˘Ì‚¿ÏÂÈ ÛÙËÓ ÂÍ·ÛÊ¿ÏÈÛË ‰È·ÎÔÒÓ Ì ٷ ÏÈÁfiÙÂÚ· ηٿ ÙÔ ‰˘Ó·ÙfiÓ ÚÔ‚Ï‹Ì·Ù· ˘Á›·˜.
Abstract: Information about children’s health problems on holiday is essential for their appropriate prevention and management. The aim of this study was to investigate the health problems of child-tourists on the island of Sifnos during the summer. All 311 child-tourists who visited the Health Centre of Sifnos during the summers of the years 2001-2002 were included and compared with 311 children-residents of the island, who were used as the control group. Child-tourists presented with (in descending order of frequency) accidents (16%), otitis (13%), dermatitis (13%), lower respiratory tract infection (12%) and gastroenteritis (10%). In contrast, the resident children presented more frequently with lower respiratory tract infection (16%), dermatitis (12)%, upper respiratory tract infection (7%), asthma (6%) and otitis (5%). Childtourists compared to their age matched residents of the island presented more often with gastroenteritis, otitis and accidents (p=0.0002, p=0.0012 and p=0.011, respectively). In conclusion, children on holiday appear to have health problems in a distribution quite different from that observed in the resident children. Appropriate prevention and intervention may lead to children’s holidays free from severe health problems.
§¤ÍÂȘ ÎÏÂȉȿ: ÚÔ‚Ï‹Ì·Ù· ˘Á›·˜, ·È‰È¿-·Ú·ıÂÚÈÛÙ¤˜, ∫˘ÎÏ¿‰Â˜.
Key words: health problems, child-tourists, Cyclades.
1 ¶ÔÏ˘‰‡Ó·ÌÔ ¶ÂÚÈÊÂÚÂÈ·Îfi π·ÙÚÂ›Ô ™›ÊÓÔ˘ 2 ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘
1 Health Centre of Sifnos 2 Paediatric Clinic of University of Crete
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∂ÈÛ·ÁˆÁ‹ ∆· Ù·Í›‰È· ·Ó·„˘¯‹˜, ÙfiÛÔ ÛÙÔ Â͈ÙÂÚÈÎfi fiÛÔ Î·È ÂÓÙfi˜ ∂ÏÏ¿‰·˜, ·ÔÙÂÏÔ‡Ó Ï¤ÔÓ Ì›· ηıÈÂڈ̤ÓË Û˘Ó‹ıÂÈ· Ù˘ ÂÏÏËÓÈ΋˜ ÔÈÎÔÁ¤ÓÂÈ·˜. ∫·ıÒ˜ ÔÈ ·Ú¯fiÌÂÓ˜ ˘ËÚÂۛ˜ ÛÙÔ˘˜ ÙÔ˘ÚÈÛÙÈÎÔ‡˜ ÚÔÔÚÈÛÌÔ‡˜ Ù˘ ∂ÏÏ¿‰·˜ Â›Ó·È Î·Ù¿ ηÓfiÓ· ˘„ËÏÔ‡ ÂȤ‰Ô˘, ÔÈ ÁÔÓ›˜ ·ÈÛı¿ÓÔÓÙ·È ·ÛÊ¿ÏÂÈ· Î·È Î¿ÓÔ˘Ó ‰È·ÎÔ¤˜ Ì·˙› Ì ٷ ·È‰È¿ ÙÔ˘˜. ŒÙÛÈ, Ô ·È‰ÈÎfi˜ ÏËı˘ÛÌfi˜ ·ÔÙÂÏ› ¤Ó· ÛËÌ·ÓÙÈÎfi ̤ÚÔ˜ ÙˆÓ ·Ú·ıÂÚÈÛÙÒÓ. ∂›Ó·È ÁÓˆÛÙfi fiÙÈ Ù· ÚÔ‚Ï‹Ì·Ù· ˘Á›·˜ Û ٷÍȉÈÒÙ˜ Â›Ó·È Û˘¯Ó¿, ÙfiÛÔ Î·Ù¿ ÙËÓ ÂÚ›Ô‰Ô ÙˆÓ ‰È·ÎÔÒÓ fiÛÔ Î·È ÌÂÙ¿ ÙËÓ ÂÈÛÙÚÔÊ‹ ÙÔ˘˜. øÛÙfiÛÔ, ÔÈ ÌÂϤÙ˜ Ô˘ ¤¯Ô˘Ó ‰ÈÂÍ·¯ı› ·Ó·Ê¤ÚÔÓÙ·È Î˘Ú›ˆ˜ Û ·Ú·ıÂÚÈÛÙ¤˜ Ô˘ ‚Ú›ÛÎÔÓÙ·È ‹ ÂÈÛÙÚ¤ÊÔ˘Ó ·fi ÌÂÁ¿Ï· Ù·Í›‰È· ÛÙÔ Â͈ÙÂÚÈÎfi, ÂÓÒ ÂÏ¿¯ÈÛÙ˜ ·Û¯ÔÏÔ‡ÓÙ·È Ì ٷ ÚÔ‚Ï‹Ì·Ù· ˘Á›·˜ Ô˘ ·ÓÙÈÌÂÙˆ›˙Ô˘Ó ÔÈ ·Ú·ıÂÚÈÛÙ¤˜ Û ÌÈÎÚfiÙÂÚ· Ù·Í›‰È· ÛÙÔ ÂÛˆÙÂÚÈÎfi Ù˘ ¯ÒÚ·˜ (1-4). ∞ÎfiÌË, fï˜ Î·È ÛÙȘ ÂÚÈÙÒÛÂȘ Ô˘ ÙÔ Â›Â‰Ô ÙˆÓ Û˘ÓıËÎÒÓ ‰È·‚›ˆÛ˘ Â›Ó·È ÙÔ Î·Ï‡ÙÂÚÔ, Ë ·ÏÏ·Á‹ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ Î·È ÔÈ Û˘Óı‹Î˜ „˘¯·ÁˆÁ›·˜ Ô˘ Û˘ÓÔ‰Â‡Ô˘Ó ÙÔ Î¿ı ٷ͛‰È, Â›Ó·È ·Ó·ÌÂÓfiÌÂÓÔ Ó· ÌÂÙ·‚¿ÏÏÔ˘Ó Ù· Û˘Ó‹ıË ·›ÙÈ· ÓÔÛËÚfiÙËÙ·˜ ÛÙËÓ ÂÚ›Ô‰Ô ÙˆÓ ‰È·ÎÔÒÓ. ∏ ÁÓÒÛË ÙˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ ˘Á›·˜ ÛÙ· ·È‰È¿ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ‰È·ÎÔÒÓ ÙÔ˘˜ Â›Ó·È ÚÔ¸fiıÂÛË ÁÈ· ÙË ÛˆÛÙ‹ ·ÓÙÈÌÂÙÒÈÛË Î·È ÚfiÏË„‹ ÙÔ˘˜. ∆Ô ÓËÛ› Ù˘ ™›ÊÓÔ˘ ·ÔÙÂÏ› ÚÔÛÊÈϤ˜ ı¤ÚÂÙÚÔ, ΢ڛˆ˜ ∂ÏÏ‹ÓˆÓ ·Ú·ıÂÚÈÛÙÒÓ. ™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ Â›Ó·È Ë Î·Ù·ÁÚ·Ê‹ ÙˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ ˘Á›·˜ Ô˘ ·Ú·ÙËÚ‹ıËÎ·Ó Û ·È‰È¿ ËÏÈΛ·˜ ¤ˆ˜ 14 ÂÙÒÓ Î·Ù¿ ÙȘ ıÂÚÈÓ¤˜ ‰È·ÎÔ¤˜ ÙÔ˘˜ ÛÙÔ ÓËÛ› Î·È Ë Û‡ÁÎÚÈÛ‹ ÙÔ˘˜ Ì ·˘Ù¿ ÙˆÓ ·È‰ÈÒÓ Ô˘ Â›Ó·È ÌfiÓÈÌÔÈ Î¿ÙÔÈÎÔÈ ÙÔ˘ ÓËÛÈÔ‡, ÙËÓ ›‰È· ÂÚ›Ô‰Ô. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ∏ ˘ÁÂÈÔÓÔÌÈ΋ Î¿Ï˘„Ë fiÏˆÓ ÙˆÓ ÂÈÛÎÂÙÒÓ, ηıÒ˜ Î·È ÙˆÓ ÌfiÓÈÌˆÓ Î·ÙÔ›ÎˆÓ Ù˘ ™›ÊÓÔ˘ Á›ÓÂÙ·È ·fi ÙÔ ÔÏ˘‰‡Ó·ÌÔ ÂÚÈÊÂÚÂÈ·Îfi È·ÙÚÂ›Ô ÙÔ˘ ÓËÛÈÔ‡, ÙÔ ÔÔ›Ô ÛÙÂϯÒÓÂÙ·È ·fi ·ıÔÏfiÁÔ˘˜, ·È‰›·ÙÚÔ Î·È È·ÙÚÔ‡˜ ˘fi¯ÚÂÔ˘˜ ˘ËÚÂÛ›·˜ ˘·›ıÚÔ˘ Î·È ‰È·ı¤ÙÂÈ ÌÈÎÚÔ‚ÈÔÏÔÁÈÎfi Î·È ·ÎÙÈÓÔÏÔÁÈÎfi ÂÚÁ·ÛÙ‹ÚÈÔ. ∆Ô È·ÙÚÂ›Ô ·ÓÙÈÌÂÙˆ›˙ÂÈ ÙÔ Û‡ÓÔÏÔ ÙˆÓ ·ÛıÂÓÒÓ, ·ÊÔ‡ ÛÙÔ ÓËÛ› ‰ÂÓ ˘¿Ú¯Ô˘Ó ȉȈÙÈο È·ÙÚ›· ‹ È·ÙÚÈο ΤÓÙÚ·. ªÂÏÂÙ‹ıËÎ·Ó 311 ·È‰È¿-·Ú·ıÂÚÈÛÙ¤˜, ËÏÈΛ·˜ 1 ÌËÓfi˜ ¤ˆ˜ 14 ÂÙÒÓ (̤ÛË ËÏÈΛ·±SD: 6,3±4 ¤ÙË) Î·È 311 ·È‰È¿-ÌfiÓÈÌÔÈ Î¿ÙÔÈÎÔÈ ™›ÊÓÔ˘ (̤ÛË ËÏÈΛ·±SD: 6,4±3,8 ¤ÙË). ∆· ·È‰È¿ ·˘Ù¿ ÂÍÂÙ¿ÛÙËÎ·Ó Î·Ù¿ ÙÔ˘˜ ıÂÚÈÓÔ‡˜ Ì‹Ó˜ (πÔ‡ÓÈÔ˜, πÔ‡ÏÈÔ˜, ∞‡ÁÔ˘ÛÙÔ˜) Ù˘ ‰ÈÂÙ›·˜ 2001-2002. °È· οı ·È‰›·Ú·ıÂÚÈÛÙ‹ ηٷÁÚ¿ÊËΠÙÔ ·Ì¤Ûˆ˜ ÂfiÌÂÓÔ ·È‰›-ÌfiÓÈÌÔ˜ οÙÔÈÎÔ˜ Ô˘ ÂÍÂÙ¿ÛÙËÎÂ. ∆· 311 ·È‰È¿-ÌfiÓÈÌÔÈ Î¿ÙÔÈÎÔÈ Ô˘ ÂÍÂÙ¿ÛÙËÎ·Ó ÌÂÙ¿ Ù· ·È‰È¿-·Ú·ıÂÚÈÛÙ¤˜, ·ÔÙ¤-
Paediatriki 2003;66:452-455
ÏÂÛ·Ó ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘. OÈ ·Èٛ˜ ÚÔÛ¤Ï¢Û˘ Ù·ÍÈÓÔÌ‹ıËÎ·Ó Ì ‚¿ÛË ÙË ¢ÈÂıÓ‹ ∆·ÍÈÓfiÌËÛË ¡ÔÛËÌ¿ÙˆÓ (5). °È· ÙÔ˘˜ ÛÎÔÔ‡˜ Ù˘ ·Ó·‰ÚÔÌÈ΋˜ ·˘Ù‹˜ ÌÂϤÙ˘, ÛÙËÓ ÔÌ¿‰· ÙˆÓ ·Ù˘¯ËÌ¿ÙˆÓ Û˘ÌÂÚÈÏ‹ÊıËÎ·Ó Î·ÎÒÛÂȘ, ͤӷ ÛÒÌ·Ù·, ‰‹ÁÌ·Ù· ÂÓÙfiÌˆÓ Î·È Ê·Ú̷΢ÙÈΤ˜ ‰ËÏËÙËÚÈ¿ÛÂȘ. ™ÙËÓ ÔÌ¿‰· ÙˆÓ ˆÙ›ÙȉˆÓ Û˘ÌÂÚÈÏ‹ÊıËÎ·Ó Ë ÔÍ›· ̤ÛË Î·È Ë Â͈ÙÂÚÈ΋ ˆÙ›Ùȉ·. ∞fi ÙȘ ÏÔÈÌÒÍÂȘ ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ ηٷÁÚ¿ÊËÎ·Ó ¯ˆÚÈÛÙ¿ ÂΛӘ Ô˘ ›¯·Ó Û·Ê‹ ÂÓÙfiÈÛË (.¯. ˆÙ›Ùȉ˜, Ê·Ú˘ÁÁÔ·Ì˘Á‰·Ï›Ùȉ˜) Î·È ÂΛӘ Ô˘ ‰ÂÓ Â›¯·Ó. OÈ ÏÔÈÌÒÍÂȘ ÙÔ˘ ηÙÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ ÌÂÏÂÙ‹ıËÎ·Ó ˆ˜ ÎÔÈÓ‹ ÔÌ¿‰·. °È· ÙË ÛÙ·ÙÈÛÙÈ΋ ÂÂÍÂÚÁ·Û›· ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÔÈ ‰ÔÎÈ̷ۛ˜ ¯2 Î·È Ô ˘ÔÏÔÁÈÛÌfi˜ ÙˆÓ Û¯ÂÙÈÎÒÓ ÎÈÓ‰‡ÓˆÓ Ì 95% ‰È·ÛÙ‹Ì·Ù· ÂÌÈÛÙÔÛ‡Ó˘. ™Ù·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ıˆڋıËÎ·Ó ÔÈ ‰È·ÊÔÚ¤˜ Ì p<0,05.
∞ÔÙÂϤÛÌ·Ù· OÈ Û˘¯ÓfiÙÂÚ˜ ·Èٛ˜ ÚÔÛ¤Ï¢Û˘ ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜ ·È‰ÈÒÓ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1. ∆· ·È‰È¿-·Ú·ıÂÚÈÛÙ¤˜ ·ÚÔ˘Û›·Û·Ó ÛËÌ·ÓÙÈο ·˘ÍË̤ÓË ÓÔÛËÚfiÙËÙ· ÛÙ· ÓÔÛ‹Ì·Ù· Ô˘ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2. OÈ ÂÈÛΤ„ÂȘ ÙˆÓ ·È‰ÈÒÓ·Ú·ıÂÚÈÛÙÒÓ ·Ó¿ ¤ÙÔ˜ ‹Ù·Ó ÂÚ›Ô˘ ÔÈ ›‰È˜ ÛÙ· ¤ÙË 2001 Î·È 2002 (153 Î·È 158, ·ÓÙ›ÛÙÔȯ·). ∞˘ÍË̤ÓË ÚÔۤϢÛË Î·Ù·ÁÚ¿ÊËΠηٿ ÙÔÓ Ì‹Ó· ∞‡ÁÔ˘ÛÙÔ (50% ÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ, ¤Ó·ÓÙÈ 29% ÙÔÓ πÔ‡ÏÈÔ Î·È 21% ÙÔÓ πÔ‡ÓÈÔ). ¢ÂÓ ‰È·ÈÛÙÒıËÎ·Ó ‰È·ÊÔÚ¤˜ fiÛÔÓ ·ÊÔÚ¿ ÛÙÔ Ê‡ÏÔ ·Ó¿ÌÂÛ· ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜ (56% ·ÁfiÚÈ· Î·È 44% ÎÔÚ›ÙÛÈ·). ™˘˙‹ÙËÛË ∏ ·ÚÔ‡Û· ÌÂϤÙË ÂȂ‚·ÈÒÓÂÈ Ù· Â˘Ú‹Ì·Ù· ÚÔËÁÔ‡ÌÂÓˆÓ ÌÂÏÂÙÒÓ, ÛÙȘ Ôԛ˜ ¤¯ÂÈ ·Ó·ÊÂÚı› ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· ÓÔÛËÌ¿ÙˆÓ fiˆ˜ Ù· ·Ù˘¯‹Ì·Ù·, Ë ˆÙ›Ùȉ·, Ù· ‰ÂÚÌ·ÙÈο ÓÔÛ‹Ì·Ù· Î·È Ë Á·ÛÙÚÂÓÙÂÚ›Ùȉ·, ηٿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ‰È·ÎÔÒÓ (1-4). ∂›Ó·È ÁÓˆÛÙfi fiÙÈ Û ÙÚÔÈΤ˜ ‹ ·Ó·Ù˘ÛÛfiÌÂÓ˜ ¯ÒÚ˜ ¤Ó·˜ ÛËÌ·ÓÙÈÎfi˜ ÏfiÁÔ˜ ·˘ÍË̤Ó˘ ÓÔÛËÚfiÙËÙ·˜ ÙˆÓ ·Ú·ıÂÚÈÛÙÒÓ Â›Ó·È ÔÈ Î·Î¤˜ Û˘Óı‹Î˜ ˘ÁÈÂÈÓ‹˜ (1,2). ∞˘Ùfi ÈÛ¯‡ÂÈ ·ÎfiÌ· ÂÚÈÛÛfiÙÂÚÔ ÁÈ· Ù· ·È‰È¿, Ù· ÔÔ›· Â›Ó·È Û ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ Û ۯ¤ÛË Ì ÙȘ ÌÂÁ·Ï‡ÙÂÚ˜ ËÏÈ˘ (6). øÛÙfiÛÔ, ·ÎfiÌ· Î·È ÛÙȘ ÈÔ ·Ó·Ù˘Á̤Ó˜ ¯ÒÚ˜ Î·È ÛÙȘ ÂÚÈÔ¯¤˜ Ì ÂÍ·ÈÚÂÙÈΤ˜ Û˘Óı‹Î˜ ˘ÁÈÂÈÓ‹˜, fiˆ˜ Â›Ó·È Ù· ÂÏÏËÓÈο ı¤ÚÂÙÚ·, ÔÈ ‰È·ÊÔÚ¤˜ ÛÙȘ Û˘Óı‹Î˜ ‰È·‚›ˆÛ˘, Ë ·˘ÍË̤ÓË ‰Ú·ÛÙËÚÈfiÙËÙ· ÙˆÓ ·È‰ÈÒÓ, Ë Â·Ê‹ Ì ÙË ı¿Ï·ÛÛ· Î·È ÙÔÓ ‹ÏÈÔ, ηıÒ˜ Î·È Ë ·fiÙÔÌË ·ÏÏ·Á‹ ÛÙȘ ‰È·ÙÚÔÊÈΤ˜ Û˘Ó‹ıÂȘ Ô‰ËÁÔ‡Ó Û ·˘ÍË̤ÓË ÓÔÛËÚfiÙËÙ· ÛÂ Û˘ÁÎÂÎÚÈ̤ӷ ÓÔÛ‹Ì·Ù· (2,3). ∆· Â˘Ú‹Ì·Ù· ·˘Ù¿ ÂȂ‚·ÈÒıËÎ·Ó Î·È ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, fiÔ˘ ·Ú·ÙËÚ‹ıËΠ·‡ÍËÛË ÂÎÂ›ÓˆÓ ÙˆÓ ÓÔÛËÌ¿ÙˆÓ Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È Û ÙÔ˘Ú›ÛÙ˜ Ì ÌÂÁ¿Ï·
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Paediatriki 2003;66:452-455
¶›Ó·Î·˜ 1. ∞Èٛ˜ ÚÔÛ¤Ï¢Û˘ Û ·È‰È¿-·Ú·ıÂÚÈÛÙ¤˜ Î·È Û ·È‰È¿-ÌfiÓÈÌÔ˘˜ ηÙÔ›ÎÔ˘˜ Ù˘ ™›ÊÓÔ˘
∞Ù˘¯‹Ì·Ù· øÙ›Ùȉ˜ ∫Ó›‰ˆÛË, ‰ÂÚÌ·Ù›Ùȉ· §ÔÈÌÒÍÂȘ ηÙÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ °·ÛÙÚÂÓÙÂÚ›Ùȉ· §ÔÈÌÒÍÂȘ ·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡* ÕÛıÌ· º·Ú˘ÁÁÔ·Ì˘Á‰·Ï›Ùȉ· ƒÈÓ›Ùȉ· ∂ÈÂÊ˘Î›Ùȉ· ∞ÓÂÌÔ‚ÏÔÁÈ¿ πÁÌÔÚ›Ùȉ· §ÔÈ¿ ÓÔÛ‹Ì·Ù·
¶·È‰È¿-·Ú·ıÂÚÈÛÙ¤˜ ¡ (%)
¶·È‰È¿-ÌfiÓÈÌÔÈ Î¿ÙÔÈÎÔÈ ¡ (%)
50 (16%) 40 (12,9%) 40 (12,9%) 39 (12,5%) 31 (10%) 27 (8,7%) 15 (4,8%) 10 (3,2%) 6 (2%) 3 (1%) 2 (0,6%) 1 (0,3%) 47 (15,1%)
29 (9,3%) 16 (5%) 36 (11,6%) 50 (16%) 7 (2,3%) 23 (7,4%) 18 (5,9%) 12 (3,9%) 2 (0,6%) 12 (3,9%) 11 (3,5%) 3 (1%) 92 (29,6%)
* ÕÏϘ ÔÍ›˜ ÏÔÈÌÒÍÂȘ ·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Ì ÔÏÏ·Ï‹ ÂÓÙfiÈÛË ¶›Ó·Î·˜ 2. ¶ÚÔ‚Ï‹Ì·Ù· ˘Á›·˜ Ô˘ ·ÚÔ˘ÛÈ¿ÛÙËÎ·Ó Û ·È‰È¿-·Ú·ıÂÚÈÛÙ¤˜ Ì ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ Û ۇÁÎÚÈÛË Ì ٷ ·È‰È¿-ÌfiÓÈÌÔ˘˜ ηÙÔ›ÎÔ˘˜ ¶Úfi‚ÏËÌ· ˘Á›·˜ °·ÛÙÚÂÓÙÂÚ›Ùȉ· øÙ›Ùȉ˜ ∞Ù˘¯‹Ì·Ù·
¶·È‰È¿-·Ú·ıÂÚÈÛÙ¤˜
¶·È‰È¿-ÌfiÓÈÌÔÈ Î¿ÙÔÈÎÔÈ
™¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜ (95% CI)
p 2 (ÌÂ ¯ )
31 40 50
7 16 29
4,43 (1,98-9,91) 2,50 (1,43-4,37) 1,72 (1,12-2,65)
0,0002 0,0012 0,0111
Ù·Í›‰È· ÛÙÔ Â͈ÙÂÚÈÎfi (1,7), ·Ó Î·È ÔÈ Û˘Óı‹Î˜ ‰È·‚›ˆÛ˘ Ô˘ ·Ú¤¯ÔÓÙ·È ÛÙÔ ÓËÛ› Ù˘ ™›ÊÓÔ˘ Â›Ó·È ˘„ËÏÔ‡ ÂȤ‰Ô˘ Î·È ·Ó¿ÏÔÁ˜ ÂÎÂ›ÓˆÓ ÙÔ˘ ÌfiÓÈÌÔ˘ ÙfiÔ˘ ηÙÔÈΛ·˜. ¶Ú¤ÂÈ Ó· ÛËÌÂȈı› fiÙÈ Ù· ·È‰È¿-·Ú·ıÂÚÈÛÙ¤˜ ÛÙË ™›ÊÓÔ ÚÔ¤Ú¯ÔÓÙ·È Û¯Â‰fiÓ ·ÔÎÏÂÈÛÙÈο ·fi ÙËÓ ˘fiÏÔÈË ∂ÏÏ¿‰·, Ì ·ÔÙ¤ÏÂÛÌ· ÔÈ Û˘Óı‹Î˜ ‰È·‚›ˆÛ˘ ÛÙË ÌfiÓÈÌË Î·ÙÔÈΛ· ÙÔ˘˜ Ó· ÌËÓ ‰È·Ê¤ÚÔ˘Ó Û ÌÂÁ¿ÏÔ ‚·ıÌfi ·fi ÂΛӘ ÙˆÓ ‰È·ÎÔÒÓ ÙÔ˘˜. º·›ÓÂÙ·È, ÏÔÈfiÓ, fiÙÈ Ë ·fiÙÔÌË ÌÂٷΛÓËÛË Î·È Ë ÌÈÎÚ‹, ¤ÛÙˆ, ·ÏÏ·Á‹ ÙˆÓ Û˘ÓıËÎÒÓ ‰È·‚›ˆÛ˘ Î·È „˘¯·ÁˆÁ›·˜ ·ÚÎÔ‡Ó ÁÈ· ÙË Û˘¯Ó‹ ÂΉ‹ÏˆÛË ÔÚÈÛÌ¤ÓˆÓ ÓÔÛËÌ¿ÙˆÓ Î·Ù¿ ÙËÓ ÂÚ›Ô‰Ô ÙˆÓ ‰È·ÎÔÒÓ (8). ∏ ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· ·Ù˘¯ËÌ¿ÙˆÓ ÛÙ· ·È‰È¿-ÙÔ˘Ú›ÛÙ˜ Â›Ó·È ·Ó·ÌÂÓfiÌÂÓË, ΢ڛˆ˜ ÏfiÁˆ Ù˘ ·˘ÍË̤Ó˘ Ê˘ÛÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ¿˜ ÙÔ˘˜ ·˘Ù‹ ÙËÓ ÂÚ›Ô‰Ô Î·È Ù˘ ‰˘ÛÎÔÏ›·˜ ÂÈÙ‹ÚËÛ‹˜ ÙÔ˘˜ ÂΠ̤ÚÔ˘˜ ÙˆÓ ÁÔÓ¤ˆÓ. ∏ Û˘¯Ó‹ Î·È ·Ú·ÙÂٷ̤Ó˘ ‰È¿ÚÎÂÈ·˜ ·ʋ ÙˆÓ ·È‰ÈÒÓ Ì ÙÔ ı·Ï·ÛÛÈÓfi ÓÂÚfi Î·È ÙÔÓ ˙ÂÛÙfi ·¤Ú· ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙË ÌÈÎÚ‹ ËÏÈΛ· ·ÔÙÂÏÔ‡Ó ÁÓˆÛÙÔ‡˜ ·Ú¿ÁÔÓÙ˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ·˘ÍË̤ÓË Â›ÙˆÛË Ù˘ Â͈ÙÂÚÈ΋˜ ˆÙ›Ùȉ·˜ (“swimmer’s ear”, fiˆ˜ ¯·Ú·ÎÙËÚÈÛÙÈο ÔÓÔÌ¿˙ÂÙ·È ‰ÈÂıÓÒ˜) (9-14). øÛÙfiÛÔ, ¤¯ÂÈ ˘ÔÛÙËÚȯı› fiÙÈ Î·È Ë Ì¤ÛË ˆÙ›Ùȉ· Â›Ó·È ÈÔ Û˘¯Ó‹ ÛÙ· ·È‰È¿-·Ú·ıÂÚÈÛÙ¤˜ (7). ∏ ·‡ÍËÛË ÙˆÓ ‰ÂÚÌ·Ù›ÙȉˆÓ, Ù˘ ÎÓ›‰ˆÛ˘ Î·È ÙˆÓ ÏÔÈÌÒÍÂˆÓ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ Â›Ó·È ·Ó·ÌÂÓfiÌÂÓË ÙËÓ ÂÚ›Ô‰Ô ÙˆÓ ‰È·ÎÔÒÓ Û ıÂÚÌ¿ Î·È Ì ·˘ÍË-
454
̤ÓË ËÏÈÔÊ¿ÓÂÈ· ̤ÚË, ȉȷ›ÙÂÚ· fiÙ·Ó Ë ¤ÓÙÔÓË ‰Ú·ÛÙËÚÈfiÙËÙ· Ô‰ËÁ› Û˘¯Ó¿ Û ηٷfiÓËÛË ÙÔ˘ ‰¤ÚÌ·ÙÔ˜. OÈ ‰È·Ù·Ú·¯¤˜ ·fi ÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi, ·Ó Î·È Û˘¯ÓfiÙÂÚ˜ ÛÙ· ·È‰È¿-·Ú·ıÂÚÈÛÙ¤˜ Û ۯ¤ÛË Ì ٷ ·È‰È¿-ÌfiÓÈÌÔ˘˜ ηÙÔ›ÎÔ˘˜, ‰ÂÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÙËÓ ˘„ËÏ‹ Û˘¯ÓfiÙËÙ· Ô˘ ·Ó·ÌÂÓfiÙ·Ó ÛÙ· ·È‰È¿ Ô˘ ·ÏÏ¿˙Ô˘Ó ·fiÙÔÌ· ÙË ‰È·ÙÚÔÊ‹ ÙÔ˘˜ Î·È ÙËÓ Î·ıËÌÂÚÈÓ‹ ˘ÁÈÂÈÓ‹ ÙÔ˘˜. ∞˘Ùfi ÌÔÚ› Ó· ·Ô‰Ôı› ÛÙȘ ηϤ˜ Û˘Óı‹Î˜ ‰È·‚›ˆÛ˘, Û ·ÓÙ›ıÂÛË Ì ¿ÏÏÔ˘˜ ÚÔÔÚÈÛÌÔ‡˜ Ì η΋ ˘ÁÈÂÈÓ‹, fiÔ˘ Ë Á·ÛÙÚÂÓÙÂÚ›Ùȉ· ·ÔÙÂÏ› ÙÔ ÚÒÙÔ ÛÂ Û˘¯ÓfiÙËÙ· ÓfiÛËÌ· (1,2). ™˘ÌÂÚ·ÛÌ·ÙÈο, Ù· ·È‰È¿ Ô˘ ·Ú·ıÂÚ›˙Ô˘Ó ÛÙË ¯ÒÚ· ÙÔ˘˜ ¤¯Ô˘Ó ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ Ó· ÂÌÊ·Ó›ÛÔ˘Ó Û˘ÁÎÂÎÚÈ̤ӷ ÚÔ‚Ï‹Ì·Ù· ˘Á›·˜. ∆Ô ÓÔÛÔÏÔÁÈÎfi Ê¿ÛÌ· ÚÔÛÔÌÔÈ¿˙ÂÈ Ì ÂΛÓÔ Ô˘ ·Ú·ÙËÚÂ›Ù·È ÛÙ· ÌÂÁ¿Ï· Ù·Í›‰È· ÛÙÔ Â͈ÙÂÚÈÎfi, ‰È·ÙËÚÒÓÙ·˜ fï˜ οÔȘ ȉÈÔÌÔÚʛ˜. ªÂϤÙ˜ Ì ÌÂÁ·Ï‡ÙÂÚ· ‰Â›ÁÌ·Ù· Î·È Û ¿ÏϘ ÁˆÁÚ·ÊÈΤ˜ ÂÚÈÔ¯¤˜ Ù˘ ¯ÒÚ·˜ ı· ‚ÔËıÔ‡Û·Ó ÛÙËÓ Î·Ï‡ÙÂÚË Î·Ù·ÁÚ·Ê‹ ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜ Î·È ÛÙË ‰È¿ÚıÚˆÛË Î·Ù¿ÏÏËÏ˘ ÛÙÚ·ÙËÁÈ΋˜ ÚfiÏ˄˘ Î·È ·ÓÙÈÌÂÙÒÈÛ˘ ÛÙÔ˘˜ ÙfiÔ˘˜ ˘Ô‰Ô¯‹˜. µÈ‚ÏÈÔÁÚ·Ê›· 1. Hill DR. Health problems in a large cohort of Americans traveling to developing countries. J Travel Med 2000;7:259266. 2. Reinthaler FF, Feierl G, Stunzner D, Marth E. Diarrhea in
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returning Austrian tourists: epidemiology, etiology, and cost-analyses. J Travel Med 1998;5:65-72. Prazuck T, Semaille C, Halioua B, Burcombe A, Papon B, Espinoza P et al. Health hazards in international tourists visiting Paris in August: a five-year retrospective epidemiologic survey. J Travel Med 1998;5:178-183. Zuckerman JN. Recent developments: travel medicine. BMJ 2002;325:260-264. World Health Organization. Manual of the international statistical classification of diseases, injuries and causes of death. Geneva, Switzerland: World Health Organization, Office of Publications; 1977. Looke DF, Robson JM. Infections in the returned traveler. Med J Aust 2002;177:212-219. °·Ï·Ó¿Î˘ ∂, ¶·Ú·Ûο΢ ∂, ªÈÎÔ˘‚·Ú¿Î˘ ™, ∫·Ù˙ËÏ¿Î˘ ¡, ™Ì˘Ú¿ÎȘ ™. ¶ÚÔ‚Ï‹Ì·Ù· ˘Á›·˜ Û ·È‰È¿ ·fi ÙËÓ ∂˘ÚÒË Ô˘ ·Ú·ıÂÚ›˙Ô˘Ó ÛÙËÓ ∫Ú‹ÙË. ¶·È‰È·ÙÚÈ΋ µÔÚ›Ԣ ∂ÏÏ¿‰Ô˜ 1999;11:28-31. Falkenbach A, Sedlmeyer A. Travel to sunny countries is associated with changes in immunological parameters. Photodermatol Photoimmunol Photomed 1997;13:139-142. Russell JD, Donnelly M, McShane DP, Alun-Jones T, Walsh
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∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 07-02-2003 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 22-07-2003 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∂ÌÌ·ÓÔ˘‹Ï ¡. ¶·Ú·Ûο΢ ™·ÊÔ‡˜ 4, ∆.∫. 712 02, ∏Ú¿ÎÏÂÈÔ ∫Ú‹Ù˘
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¶·È‰È·ÙÚÈ΋ 2003;66:456-460
∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞
Paediatriki 2003;66:456-460
ORIGINAL ARTICLE
¡Â˘ÚÔÏÔÁÈΤ˜ ÂΉËÏÒÛÂȘ ·È‰ÈÒÓ Ì ·ÈÌÔÏ˘ÙÈÎfi-Ô˘Ú·ÈÌÈÎfi Û‡Ó‰ÚÔÌÔ ∫. µÔ‡‰Ú˘1, ∫. ™ÙÂÊ·Ó›‰Ë˜2, ∞. ™Î·Ú‰Ô‡ÙÛÔ˘3, ∂. ∫·ÙÛ·ÚÔ‡1, ™. ª·ÛÙÚÔÁÈ¿ÓÓË1, ∂. µ·ÁÈ¿ÎÔ˘4
Neurological complications of children with haemolytic-uraemic syndrome K. Voudris1, C. Stefanidis2, A. Skardoutsou3, E. Katsarou1, S. Mastroyianni1, E. Vagiakou4
¶ÂÚ›ÏË„Ë: ∞Ó Î·È ÂÌÊ·Ó›˙ÔÓÙ·È Û˘¯Ó¿ Ó¢ÚÔÏÔÁÈΤ˜ ÂΉËÏÒÛÂȘ Û ·ÛıÂÓ›˜ Ì ·ÈÌÔÏ˘ÙÈÎfi-Ô˘Ú·ÈÌÈÎfi Û‡Ó‰ÚÔÌÔ (∞O™), ˘¿Ú¯Ô˘Ó ÂÏ¿¯ÈÛÙ˜ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜ Ô˘ ‰ÈÂÚ¢ÓÔ‡Ó ÙËÓ ÂӉ¯fiÌÂÓË Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÙˆÓ Ó¢ÚÔÏÔÁÈÎÒÓ ÂΉËÏÒÛÂˆÓ Î·Ù¿ ÙËÓ ÔÍ›· Ê¿ÛË Ù˘ ÓfiÛÔ˘ Î·È ÙË Ì·ÎÚÔ¯ÚfiÓÈ· ÚfiÁÓˆÛË. ∂›Û˘, Ù· ·ÔÙÂϤÛÌ·Ù· ·˘ÙÒÓ ÙˆÓ ÌÂÏÂÙÒÓ Â›Ó·È ·ÓÙÈÊ·ÙÈο. ¶ÂÚÈÁÚ¿ÊÔÓÙ·È 5 ·È‰È¿ Ì ∞O™ Ô˘ ·ÚÔ˘Û›·Û·Ó Ó¢ÚÔÏÔÁÈο Û˘ÌÙÒÌ·Ù· Î·È Î·ı˘ÛÙÂÚË̤ÓË ÂÈÛ·ÁˆÁ‹ ÛÙÔ ¡ÔÛÔÎÔÌ›Ô. ™Â fiÏ· Ù· ·È‰È¿ ¤ÁÈÓ ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Ì ̷ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ηٿ ÙËÓ ÔÍ›· Ê¿ÛË Ù˘ ÓfiÛÔ˘, ÂÓÒ Û 3 ·È‰È¿ ¤ÁÈÓ ·ӤÏÂÁ¯Ô˜ ÙÚÂȘ Ì‹Ó˜ ·ÚÁfiÙÂÚ·. ŸÏ· Ù· ·È‰È¿ ·ÚÔ˘Û›·Û·Ó ÌÂÙ·‚ÔÏ‹ ÙÔ˘ ÂȤ‰Ô˘ Û˘Ó›‰ËÛ˘ Î·È 4 ·È‰È¿ ·ÚÔ˘Û›·Û·Ó ÌÈÎÚ‹˜ ‰È¿ÚÎÂÈ·˜ ÁÂÓÈÎÂ˘Ì¤ÓÔ˘˜ ÙÔÓÈÎÔÎÏÔÓÈÎÔ‡˜ Û·ÛÌÔ‡˜, Ô˘ ·ÔÙ¤ÏÂÛ·Ó ÙËÓ ·ÈÙ›· ÂÈÛ·ÁˆÁ‹˜ ÙÔ˘˜. ™Â fiÏ· Ù· ·È‰È¿ ›¯Â ÚÔËÁËı› Á·ÛÙÚÂÓÙÂÚ›Ùȉ· Ì ·ÈÌÔÚÚ·ÁÈΤ˜ ÎÂÓÒÛÂȘ Î·È ÔÈ Û·ÛÌÔ› ÂÌÊ·Ó›ÛÙËÎ·Ó ÛÙ· ·Ú¯Èο ÛÙ¿‰È· Ù˘ ÓfiÛÔ˘, ÔÈ ÔÔ›ÔÈ Èı·Ófiٷٷ ÔÊ›ÏÔÓÙ·Ó Û ˘ÔÓ·ÙÚÈ·ÈÌ›·. ™Â ¤Ó·Ó ·ÛıÂÓ‹ ‚Ú¤ıËÎ·Ó ·ÌÊÔÙÂÚfiÏ¢Ú˜ ÂÛٛ˜ ÛÙÔÓ ÂÁΤʷÏÔ, ΢ڛˆ˜ ÛÙËÓ ˘ÔÊÏÔÈÒ‰Ë Ï¢΋ Ô˘Û›· ÙˆÓ ÌÂوȷ›ˆÓ Î·È ‚ÚÂÁÌ·ÙÈÎÒÓ ÏÔ‚ÒÓ, ÔÈ Ôԛ˜ ÂÍ·ÎÔÏÔ˘ıÔ‡Û·Ó Ó· ˘¿Ú¯Ô˘Ó ÛÙÔÓ Â·Ó¤ÏÂÁ¯Ô Î·È Èı·Ófiٷٷ ÔÊ›ÏÔÓÙ·Ó Û ÌÈÎÚ¿ ·ÁÁÂȷο ¤ÌÊÚ·ÎÙ·. ŸÏ· Ù· ·È‰È¿ ›¯·Ó Ï‹ÚË Ó¢ÚÔÏÔÁÈ΋ Î·È ÓÂÊÚÈ΋ ·ÔηٿÛÙ·ÛË Î·È ÔÈ Û·ÛÌÔ› ‰ÂÓ Â·Ó·Ï‹ÊıËηÓ. ∆· Â˘Ú‹Ì·Ù· Ù˘ ÌÂϤÙ˘ ‰Â›¯ÓÔ˘Ó fiÙÈ Ù· Ó¢ÚÔÏÔÁÈο Û˘ÌÙÒÌ·Ù· Î·È È‰È·›ÙÂÚ· ÔÈ Û·ÛÌÔ› ÛÙ· ·Ú¯Èο 1 ¡Â˘ÚÔÏÔÁÈÎfi ∆Ì‹Ì·, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó· 2 ¡ÂÊÚÔÏÔÁÈÎfi ∆Ì‹Ì·, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó· 3 µ’ ¶·ÓÂÈÛÙËÌȷ΋ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó· 4 ªÈÎÚÔ‚ÈÔÏÔÁÈÎfi ∆Ì‹Ì·, ¶ÂÚÈÊÂÚÂÈ·Îfi ¡ÔÛÔÎÔÌÂ›Ô “°. °ÂÓÓËÌ·Ù¿˜”, ∞ı‹Ó·
456
Abstract: Although neurological complications often occur in children with haemolytic-uraemic syndrome (HUS), there are few reports describing the presence of neurological symptoms and the long-term neurological prognosis, and their findings are variable. Five children with HUS and neurological symptoms, with late referral, are described. Brain magnetic resonance imaging (MRI) was performed in all five children in the acute phase, and repeated in three children three months later. Lethargy was observed in all children and brief, generalized tonic-clonic seizures in four, leading to hospitalization. All of the patients had prodromal gastrointestinal symptoms and the seizures which occurred early in the illness were probably due to hyponatraemia. Distinctive subcortical white matter lesions in the frontal and parietal lobes bilaterally, which remained unchanged three months later, were found on brain MRI in one child and were probably due to microinfarctions. All patients had a full recovery free from neurological deficits or recurrent seizures. The findings of this study suggest that the presence of neurological manifestations and particularly of seizures in children with HUS does not usually imply an unfavourable prognosis. These neurological manifestations are probably related to metabolic abnormalities. Earlier diagnosis and better fluid and electrolyte management might prevent these complications.
1 Department of Neurology, “P. & A. Kyriakou” Children’s Hospital, Athens 2 Department of Nephrology, “P. & A. Kyriakou” Children’s Hospital, Athens 3 2nd Paediatric Clinic of the University of Athens, “P. & A. Kyriakou” Children’s Hospital, Athens 4 Department of Microbiology, “G. Gennimatas” General Hospital, Athens
¶·È‰È·ÙÚÈ΋ 2003;66:456-460
Paediatriki 2003;66:456-460
ÛÙ¿‰È· ÙÔ˘ ∞O™ ‰ÂÓ ÛËÌ·ÙÔ‰ÔÙÔ‡Ó Î·Ù’ ·Ó¿ÁÎËÓ Î·Î‹ ÚfiÁÓˆÛË. A˘Ù¤˜ ÔÈ Ó¢ÚÔÏÔÁÈΤ˜ ÂΉËÏÒÛÂȘ Â›Ó·È Û˘Ó‹ıˆ˜ ·ÔÙ¤ÏÂÛÌ· ÌÂÙ·‚ÔÏÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ, ÙˆÓ ÔÔ›ˆÓ Ë ¤ÁηÈÚË ·ÓÙÈÌÂÙÒÈÛË ÂӉ¯fiÌÂÓ· ı· ·ÔÙÚ¤„ÂÈ ÙËÓ ÂÌÊ¿ÓÈÛ‹ ÙÔ˘˜. §¤ÍÂȘ ÎÏÂȉȿ: ·ÈÌÔÏ˘ÙÈÎfi-Ô˘Ú·ÈÌÈÎfi Û‡Ó‰ÚÔÌÔ, Ó¢ÚÔÏÔÁÈΤ˜ ÂΉËÏÒÛÂȘ, Û·ÛÌÔ›, ˘ÔÓ·ÙÚÈ·ÈÌ›·, ¤ÌÊÚ·ÎÙ· ÂÁÎÂÊ¿ÏÔ˘, Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›·, ·È‰È¿.
Key words: haemolytic-uraemic syndrome, neurological complications, seizures, hyponatraemia, microinfarctions, magnetic resonance imaging, children.
™˘ÓÙÔÌÔÁڷʛ˜
¤Ó· ·È‰› Ì ‹È· „˘¯ÔÎÈÓËÙÈ΋ ηı˘ÛÙ¤ÚËÛË, fiÏ· Ù· ¿ÏÏ· ·È‰È¿ ›¯·Ó ηϋ „˘¯ÔÎÈÓËÙÈ΋ ÂͤÏÈÍË Î·È ÂχıÂÚÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi. ¶ÚÈÓ ÂÈÛ·¯ıÔ‡Ó ÛÙÔ ¡ÔÛÔÎÔÌ›Ô, fiÏ· Ù· ·È‰È¿ ›¯·Ó Á·ÛÙÚÂÓÙÂÚ›Ùȉ· Ì ·ÈÌÔÚÚ·ÁÈΤ˜ ÎÂÓÒÛÂȘ. ∆Ú›· ·fi ·˘Ù¿ ›¯·Ó Ï¿‚ÂÈ ·ÓÙÈ‚›ˆÛË Î·È 4 ·È‰È¿ ›¯·Ó ·ÚÔ˘ÛÈ¿ÛÂÈ ÂÂÈÛfi‰È· ÁÂÓÈÎÂ˘Ì¤ÓˆÓ ÙÔÓÈÎÔÎÏÔÓÈÎÒÓ Û·ÛÌÒÓ ‚Ú·¯Â›·˜ ‰È¿ÚÎÂÈ·˜ (4-6 Ë̤Ú˜ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ Á·ÛÙÚÂÓÙÂÚ›Ùȉ·˜). ∫·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘˜ ÛÙÔ ¡ÔÛÔÎÔÌ›Ô, fiÏ· ‹Ù·Ó ·‡ÚÂÙ· Î·È Â›¯·Ó ˘ÓËÏ›·, ÂÙ¤¯ÂȘ ÛÙÔ ‰¤ÚÌ·, Ôȉ‹Ì·Ù·, ÔÏÈÁÔ˘Ú›·, ˆ¯ÚfiÙËÙ· Î·È Ê˘ÛÈÔÏÔÁÈ΋ ·ÚÙËÚȷ΋ ›ÂÛË. ∂›Û˘, ηٿ ÙË Ó¢ÚÔÏÔÁÈ΋ ÂͤٷÛË, ηӤӷ ·È‰› ‰ÂÓ Â›¯Â ÂÛÙȷο Ó¢ÚÔÏÔÁÈο Â˘Ú‹Ì·Ù· Î·È ÛÙË ‚˘ıÔÛÎfiËÛË ‰ÂÓ ‰È·ÈÛÙÒıËÎ·Ó ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·. O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ Û fiÏ· Ù· ·È‰È¿ ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ¤‰ÂÈ͠ϢÎÔ΢ÙÙ¿ÚˆÛË, ¯·ÌËÏ¿ ›‰· ·ÈÌÔÛÊ·ÈÚ›Ó˘ Î·È ÌÂȈ̤ÓÔ ·ÚÈıÌfi ·ÈÌÔÂÙ·Ï›ˆÓ, ηٷÎÂÚÌ·ÙÈṲ̂ӷ ÂÚ˘ıÚ¿, ‰ÈÎÙ˘ÔÂÚ˘ıÚÔ΢ÙÙ¿ÚˆÛË, ·˘ÍË̤ӷ ›‰· Ô˘Ú›·˜, ÎÚ·ÙÈÓ›Ó˘, ÙÚ·ÓÛ·ÌÈÓ·ÛÒÓ, ¯ÔÏËÛÙÂÚfiÏ˘, ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ Î·È Ô˘ÚÈÎÔ‡ ÔͤԘ ÛÙÔÓ ÔÚfi ·›Ì·ÙÔ˜, ·ÈÌ·ÙÔ˘Ú›· Î·È ÚˆÙÂ˚ÓÔ˘Ú›·, ÂÓÒ ¤‰ÂÈÍÂ Î·È ˘ÔÓ·ÙÚÈ·ÈÌ›· ÛÙ· 4 ·È‰È¿ Ì ÙÔ˘˜ ÚÔËÁËı¤ÓÙ˜ Û·ÛÌÔ‡˜ (¶›Ó·Î·˜ 1). OÈ Î·ÏÏȤÚÁÂȘ ÎÔÚ¿ÓˆÓ ‹Ù·Ó ·ÚÓËÙÈΤ˜ Û 4 ·È‰È¿, ÂÓÒ Û 1 ·ÔÌÔÓÒıËΠÙÔ ÂÓÙÂÚÔ·ıÔÁfiÓÔ Û٤ϯԘ Escherichia coli O157:H7. O ¤ÏÂÁ¯Ô˜ Ì ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ¤‰ÂÈÍ ·‡ÍËÛË ÙˆÓ ‰È·ÛÙ¿ÛÂˆÓ ÙˆÓ ÓÂÊÚÒÓ Ì ·˘ÍË̤ÓË Ë¯ÔÁ¤ÓÂÈ· ÛÙÔ ÓÂÊÚÈÎfi ÊÏÔÈfi, ÂÓÒ ÛÙÔ ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ· ‰È·ÈÛÙÒıËΠ‚Ú·‰˘ÚÚ˘ıÌ›· Û fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜. O ¤ÏÂÁ¯Ô˜ Ì ÙË Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ηٿ ÙËÓ ÔÍ›· Ê¿ÛË Î·È ÛÙÔÓ Â·Ó¤ÏÂÁ¯Ô ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜ Û 4 ·È‰È¿, ÂÓÒ Û ¤Ó· ·È‰› ¤‰ÂÈÍ ·ÌÊÔÙÂÚfiÏ¢Ú˜, ˘„ËÏÔ‡ Û‹Ì·ÙÔ˜ ÛÙȘ ∆2 ÂÈÎfiÓ˜, ÌÈÎÚ¤˜ ÂÛٛ˜ ÛÙËÓ ˘ÔÊÏÔÈÒ‰Ë ÌÔ›Ú· Ù˘ Ï¢΋˜ Ô˘Û›·˜ ÙˆÓ ÌÂوȷ›ˆÓ Î·È ‚ÚÂÁÌ·ÙÈÎÒÓ ÏÔ‚ÒÓ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Î·È Ì›· ÌÂÁ·Ï‡ÙÂÚË ·ÚfiÌÔÈ· ÂÛÙ›· ÎÔÓÙ¿ ÛÙÔ ÌÂوȷ›Ô Τڷ˜ Ù˘ ·ÚÈÛÙÂÚ‹˜ Ï¿ÁÈ·˜ ÎÔÈÏ›·˜ (∂ÈÎfiÓ· 1). OÈ ·ÓˆÌ·Ï›Â˜ ·˘Ù¤˜ ¤ÌÂÓ·Ó Î·È ÛÙÔÓ Â·Ó¤ÏÂÁ¯Ô 3 Ì‹Ó˜ ·ÚÁfiÙÂÚ·.
∞O™ HUS MRI
∞ÈÌÔÏ˘ÙÈÎfi-Ô˘Ú·ÈÌÈÎfi Û‡Ó‰ÚÔÌÔ Haemolytic-uraemic syndrome Magnetic resonance imaging
∂ÈÛ·ÁˆÁ‹ ∆Ô ∞O™ Â›Ó·È ¤Ó· ÔÏ˘Û˘ÛÙËÌ·ÙÈÎfi ÓfiÛËÌ· Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÌÈÎÚÔ·ÁÁÂÈÔ·ıËÙÈ΋ ·ÈÌÔÏ˘ÙÈ΋ ·Ó·ÈÌ›·, ıÚÔÌ‚ÔÂÓ›· Î·È ÔÍ›· ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ·. ∆Ô Ê¿ÛÌ· Ù˘ ÓfiÛÔ˘ Â›Ó·È Â˘Ú‡, ÂÓÒ ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ‹È˜ ˘ÔÎÏÈÓÈΤ˜ ̤¯ÚÈ ·ÂÈÏËÙÈΤ˜ ÁÈ· ÙË ˙ˆ‹ ÙˆÓ ·ÛıÂÓÒÓ ÂÚÈÙÒÛÂȘ. ∆Ô ∞O™ ÂÌÊ·Ó›˙ÂÙ·È Î˘Ú›ˆ˜ Û ‚Ú¤ÊË Î·È ·È‰È¿ ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ 5 ÂÙÒÓ Î·È ·ÔÙÂÏ› ÙËÓ ÈÔ Û˘¯Ó‹ ·ÈÙ›· ÔÍ›·˜ ÓÂÊÚÈ΋˜ ·Ó¿ÚÎÂÈ·˜ Û ·˘Ù¿. ™¯ÂÙ›˙ÂÙ·È Ì ÚÔËÁËı›Û˜ ÏÔÈÌÒÍÂȘ ‹ Ï‹„Ë Ê·ÚÌ¿ÎˆÓ Î·È Û˘¯Ó¿ ÚÔËÁÂ›Ù·È Á·ÛÙÚÂÓÙÂÚ›Ùȉ· ‹ Ïԛ̈ÍË ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ¡Â˘ÚÔÏÔÁÈΤ˜ ÂΉËÏÒÛÂȘ ÂÌÊ·Ó›˙ÔÓÙ·È Û˘¯Ó¿ Û ·ÛıÂÓ›˜ Ì ∞O™ Î·È ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ÔÈΛϷ ·ÂÈÎÔÓÈÛÙÈο Â˘Ú‹Ì·Ù· ÛÙËÓ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ (1-11), ÂÓÒ Û¿ÓÈ· ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ÂÚÈÙÒÛÂȘ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó Ì ̷ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ (7-11). ∏ ·ÚÔ˘Û›· Ó¢ÚÔÏÔÁÈÎÒÓ ÂΉËÏÒÛÂˆÓ Î·È È‰È·›ÙÂÚ· Û·ÛÌÒÓ Î·Ù¿ ÙËÓ ÔÍ›· Ê¿ÛË Ù˘ ÓfiÛÔ˘ ¤¯ÂÈ ÂÓÔ¯ÔÔÈËı› fiÙÈ Û¯ÂÙ›˙ÂÙ·È Ì η΋ ÚfiÁÓˆÛË Ù˘ ÓfiÛÔ˘, ·ÏÏ¿ Ù· ·ÔÙÂϤÛÌ·Ù· ÙˆÓ ÂÏ¿¯ÈÛÙˆÓ ÌÂÏÂÙÒÓ Ô˘ ¤¯Ô˘Ó Á›ÓÂÈ Â›Ó·È ·ÓÙÈÊ·ÙÈο (10,12-14). ™Â ·˘Ù‹ ÙË ÌÂϤÙË ÂÚÈÁÚ¿ÊÔÓÙ·È 5 ·È‰È¿ Ì ∞O™ Î·È Ó¢ÚÔÏÔÁÈΤ˜ ÂΉËÏÒÛÂȘ, 4 ·fi Ù· ÔÔ›· ›¯·Ó ÚÒÈÌË ÂÌÊ¿ÓÈÛË Û·ÛÌÒÓ, ÔÈ ÔÔ›ÔÈ Èı·Ó¿ ÔÊ›ÏÔÓÙ·Ó Û ˘ÔÓ·ÙÚÈ·ÈÌ›·. ™Â fiÏ· Ù· ·È‰È¿ ¤ÁÈÓ ̷ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ ηٿ ÙËÓ ÔÍ›· Ê¿ÛË Ù˘ ÓfiÛÔ˘, ÂÓÒ Û 3 ·È‰È¿ ·ӷϋÊıËΠÙÚÂȘ Ì‹Ó˜ ·ÚÁfiÙÂÚ·. ŸÏ· Ù· ·È‰È¿ ›¯·Ó ηϋ ÂͤÏÈÍË, ¯ˆÚ›˜ Ó¢ÚÔÏÔÁÈο ÚÔ‚Ï‹Ì·Ù·, ÂÓÒ ÔÈ Û·ÛÌÔ› ‰ÂÓ Â·Ó·Ï‹ÊıËηÓ. ¶ÂÚÈÁÚ·Ê‹ ÂÚÈÙÒÛÂˆÓ ¶ÂÚÈÁÚ¿ÊÔÓÙ·È 5 ·È‰È¿ (3 ·ÁfiÚÈ· Î·È 2 ÎÔÚ›ÙÛÈ·) Ì ∞O™, ÙˆÓ ÔÔ›ˆÓ Ë ËÏÈΛ· Î˘Ì·ÈÓfiÙ·Ó ·fi 1 ¤ˆ˜ 5 ¤ÙË (‰È¿ÌÂÛË ËÏÈΛ·: 2,5 ¤ÙË). ∂ÎÙfi˜ ·fi
457
¶·È‰È·ÙÚÈ΋ 2003;66:456-460
Paediatriki 2003;66:456-460
¶›Ó·Î·˜ 1. ∂ÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· ÙˆÓ ·ÛıÂÓÒÓ Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ·/·
1 2 3 4 5
∞ÛıÂÓ›˜
§Â˘Î¿ ·ÈÌÔÛÊ·›ÚÈ· ·›Ì·ÙÔ˜ (/mm3)
Hb (g/dl)
¢∂∫ (%)
AMT 3 (/mm )
O˘Ú›· (mg/dl)
Cr (mg/dl)
¡¿ÙÚÈÔ (mEq/l)
∞ÁfiÚÈ 2,5 ÂÙÒÓ ∞ÁfiÚÈ 5 ÂÙÒÓ ∞ÁfiÚÈ 3 ÂÙÒÓ ∫ÔÚ›ÙÛÈ 1 ¤ÙÔ˘˜ ∫ÔÚ›ÙÛÈ 1 ¤ÙÔ˘˜
18.600 15.400 21.300 21.500 22.900
5,4 5,5 7,5 7,1 6,2
2,8 2,6 2,9 2,9 4,2
80.000 22.000 62.000 22.000 21.000
209 369 411 199 175
6,8 7,8 11,2 4,8 3,8
105 129 118 115 119
Hb: ∞ÈÌÔÛÊ·ÈÚ›ÓË Ï¿ÛÌ·ÙÔ˜ ¢∂∫: ¢ÈÎÙ˘ÔÂÚ˘ıÚÔ·ÙÙ·Ú· ·›Ì·ÙÔ˜ ∞ª∆: ∞ÈÌÔÂÙ¿ÏÈ· ·›Ì·ÙÔ˜ Cr: ∫Ú·ÙÈÓ›ÓË ÔÚÔ‡
OÈ Û·ÛÌÔ› ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó Â‡ÎÔÏ· Ì ÂÓ‰ÔÊϤ‚È· ¯ÔÚ‹ÁËÛË ·ÓÙÈÂÈÏËÙÈ΋˜ ·ÁˆÁ‹˜ (Ìȉ·˙ÔÏ¿ÌË Î·È Ê·ÈÓ˘ÙÔ˝ÓË) Î·È ‰ÈfiÚıˆÛË Ù˘ ˘ÔÓ·ÙÚÈ·ÈÌ›·˜. ŒÁÈÓ·Ó ÌÂÙ·ÁÁ›ÛÂȘ Û˘Ì˘ÎÓˆÌ¤ÓˆÓ ÂÚ˘ıÚÒÓ. ∆Ú›· ·È‰È¿ ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó Ì ·ÈÌÔοı·ÚÛË Î·È 1 Ì ÂÚÈÙÔÓ·˚΋ οı·ÚÛË. ∏ ηٿÛÙ·ÛË ÙˆÓ ·È‰ÈÒÓ ÛÙ·‰È·Î¿ ‚ÂÏÙÈÒıËÎÂ, ÙÔ Â›Â‰Ô Û˘Ó›‰ËÛ˘ ÛÙ·‰È·Î¿ ·ÔηٷÛÙ¿ıËÎÂ Î·È ÔÈ Û·ÛÌÔ› ‰ÂÓ Â·Ó·Ï‹ÊıËηÓ. ™ÙÔÓ Â·Ó¤ÏÂÁ¯Ô, 34 ¯ÚfiÓÈ· ÌÂÙ¿ ÙËÓ ÔÍ›· ÓfiÛËÛË, fiÏ· Ù· ·È‰È¿ ›¯·Ó ηϋ ÂͤÏÈÍË, ¯ˆÚ›˜ Ó¢ÚÔÏÔÁÈο ‹ ÓÂÊÚÈο ÚÔ‚Ï‹Ì·Ù·. ™˘˙‹ÙËÛË ¡Â˘ÚÔÏÔÁÈΤ˜ ÂÈÏÔΤ˜, ‹È˜ ‹ ÛÔ‚·Ú¤˜ Î·È ÌfiÓÈ̘ ‹ ·ÚÔ‰ÈΤ˜, ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÔ 20-50% ÙˆÓ ·ÛıÂÓÒÓ Ì ∞O™. Œ¯ÂÈ ÂÚÈÁÚ·Ê› ¤Ó· ¢ڇ Ê¿ÛÌ· Ó¢ÚÔÏÔÁÈÎÒÓ ÂÈÏÔÎÒÓ, fiˆ˜ ÂÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ, ‰˘ÛÙÔÓ›·, ·Ù·Í›·, ÌÂÙ·‚ÔÏ‹ ÙÔ˘ ÂȤ‰Ô˘ Û˘Ó›‰ËÛ˘, ÎÒÌ·, ÊÏÔÈ҉˘ Ù‡ÊψÛË, Â͈˘Ú·ÌȉÈο Û˘ÌÙÒÌ·Ù· ‹ ÂÛÙȷο Â˘Ú‹Ì·Ù·, fiˆ˜ ËÌÈ¿ÚÂÛË. ∞˘Ù¤˜ ÔÈ ÂΉËÏÒÛÂȘ ÂÌÊ·Ó›˙ÔÓÙ·È Û˘¯Ó¿ ÛÙËÓ Úfi‰ÚÔÌË Ê¿ÛË Ù˘ ÓfiÛÔ˘ Î·È ÛÙÔ 15% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ·ÔÙÂÏÔ‡Ó ÙËÓ ·ÈÙ›· ÂÈÛfi‰Ô˘ ÙˆÓ ·ÛıÂÓÒÓ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô (1,3,6,12). ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, ÙÔ Ù˘ÈÎfi ÈÛÙÔÚÈÎfi, Ë ÎÏÈÓÈ΋ ÂÈÎfiÓ· Î·È Ù· ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· ÂȂ‚·›ˆÛ·Ó ÙË ‰È¿ÁÓˆÛË ÙÔ˘ ∞O™ Ì Ó¢ÚÔÏÔÁÈΤ˜ ÂÈÏÔΤ˜ Û fiϘ ÙȘ ÂÚÈÙÒÛÂȘ. ∫·Ó¤Ó·˜ ·ÛıÂÓ‹˜ ‰ÂÓ Â›¯Â ÂÛÙȷο Ó¢ÚÔÏÔÁÈο Â˘Ú‹Ì·Ù· Î·È ÔÈ Ó¢ÚÔÏÔÁÈΤ˜ ÂΉËÏÒÛÂȘ - Î·È Û˘ÁÎÂÎÚÈ̤ӷ Ë ÌÂÙ·‚ÔÏ‹ ÙÔ˘ ÂȤ‰Ô˘ Û˘Ó›‰ËÛ˘ Î·È ÔÈ ÂÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ - ·ÚÔ˘ÛÈ¿ÛÙËÎ·Ó ÙȘ ÚÒÙ˜ Ë̤Ú˜ Ù˘ ÓfiÛÔ˘ Û fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜. OÈ ÂÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ Î·È ÛÙÔ˘˜ 4 ·ÛıÂÓ›˜ ‹Ù·Ó ‚Ú·¯Â›·˜ ‰È¿ÚÎÂÈ·˜ ÁÂÓÈÎÂ˘Ì¤ÓÔÈ ÙÔÓÈÎÔÎÏÔÓÈÎÔ› Û·ÛÌÔ› Î·È Èı·Ó¿ Û¯ÂÙ›˙ÔÓÙ·Ó Ì ÙËÓ ˘ÔÓ·ÙÚÈ·ÈÌ›· Ô˘ ‰È·ÈÛÙÒıËΠÌÂÙ¿ ÙËÓ Â›ÛÔ‰Ô ÛÙÔ ÓÔÛÔÎÔÌ›Ô. ∏ ·ıÔÁ¤ÓÂÈ· ÙˆÓ ÂΉËÏÒÛÂˆÓ ·fi ÙÔ ÎÂÓÙÚÈÎfi
458
Ó¢ÚÈÎfi Û‡ÛÙËÌ· ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ∞O™ ÔÈΛÏÏÂÈ Î·È Èı·ÓÒ˜ Â›Ó·È ÔÏ˘·Ú·ÁÔÓÙÈ΋. OÈ Ó¢ÚÔÏÔÁÈΤ˜ ÂΉËÏÒÛÂȘ ¤¯Ô˘Ó ·Ô‰Ôı› Û ¤ÌÊÚ·ÎÙ· ÙˆÓ ÌÈÎÚÒÓ Î·È ÙˆÓ ÌÂÁ¿ÏˆÓ ·ÁÁ›ˆÓ, ÂÁÎÂÊ·ÏÈ΋ ·ÈÌÔÚÚ·Á›·, ÌÂÙ·‚ÔÏÈΤ˜ Î·È ËÏÂÎÙÚÔÏ˘ÙÈΤ˜ ‰È·Ù·Ú·¯¤˜, ˘ÔÍ›·, ÂÁÎÂÊ·ÏÈÎfi Ô›‰ËÌ· Î·È ˘¤ÚÙ·ÛË (1-3,5,6). ™Â ·ıÔÏÔÁÔ·Ó·ÙÔÌÈΤ˜ ÌÂϤÙ˜ ¤¯Ô˘Ó ‚ÚÂı› ıÚfiÌ‚ÔÈ Û ÌÈÎÚ¿, ·ÏÏ¿ Î·È Û ÌÂÁ¿Ï· ·ÁÁ›· ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘, ·ÚÂÁ¯˘Ì·ÙÈΤ˜ ·ÈÌÔÚÚ·Á›Â˜, ÌË ÂȉÈΤ˜ ÈÛ¯·ÈÌÈΤ˜ Î·È ·ÓÔÍÈΤ˜ ·ÏÏÔÈÒÛÂȘ Î·È ÂÁÎÂÊ·ÏÈÎfi Ô›‰ËÌ· (1-3,5,6). ∏ÏÂÎÙÚÔÏ˘ÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ Î·È ˘¤ÚÙ·ÛË Ô˘ Û˘¯Ó¿ Û˘ÓÔ‰Â‡Ô˘Ó ÙÔ˘˜ ·ÛıÂÓ›˜ Ì ∞O™ ¤¯Ô˘Ó ›Û˘ ÂÓÔ¯ÔÔÈËı› ÁÈ· ÙȘ ÔÈΛϘ Ó¢ÚÔÏÔÁÈΤ˜ ÂΉËÏÒÛÂȘ. ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, Ë ˘¤ÚÙ·ÛË ‰ÂÓ ¤·ÈÍ ηӤӷ ÚfiÏÔ, ηıÒ˜ ηӤӷ˜ ·ÛıÂÓ‹˜ ‰ÂÓ Â›¯Â ·ÚÔ˘ÛÈ¿ÛÂÈ ˘¤ÚÙ·ÛË, ÂÓÒ Ë Ô˘Ú·ÈÌ›· Î·È Ë ˘ÔÓ·ÙÚÈ·ÈÌ›· ÚÔÊ·ÓÒ˜ Û˘Ó¤‚·Ï·Ó ÛÙËÓ ÚfiÎÏËÛË ÙˆÓ Ó¢ÚÔÏÔÁÈÎÒÓ ÂΉËÏÒÛˆÓ. ™ÙÔÓ ·ÛıÂÓ‹ Ì ÙȘ ·ÏÏÔÈÒÛÂȘ ÛÙË Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘, ÔÈ ÈÛ¯·ÈÌÈΤ˜ ·ÏÏÔÈÒÛÂȘ ÙˆÓ ÌÈÎÚÒÓ ·ÁÁ›ˆÓ Èı·Ó¿ Û˘Ó¤‚·Ï·Ó ÛÙËÓ ÂΉ‹ÏˆÛË ÙˆÓ Ó¢ÚÔÏÔÁÈÎÒÓ ÂΉËÏÒÛˆÓ. ∏ ‚ÂÚÔÙÔÍ›ÓË, Ë ÔÔ›· ÂÏ¢ıÂÚÒÓÂÙ·È ·fi ÙÔ ÂÓÙÂÚÔ·ıÔÁfiÓÔ Û٤ϯԘ Escherichia coli O157:H7, ÌÔÚ› Ó· ¢ı‡ÓÂÙ·È ÁÈ· ÙȘ Ó¢ÚÔÏÔÁÈΤ˜ ÂΉËÏÒÛÂȘ (16). ŸÌˆ˜, Ë ‚ÂÚÔÙÔÍ›ÓË ‰ÂÓ ÚÔÛ‰ÈÔÚ›ÛÙËΠÛÙȘ ÂÚÈÙÒÛÂȘ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ Î·È ÔÈ Î·ÏÏȤÚÁÂȘ ÎÔÚ¿ÓˆÓ ÁÈ· Escherichia coli O157:H7 ‹Ù·Ó ıÂÙÈΤ˜ ÌfiÓÔ Û ̛· ÂÚ›ÙˆÛË. £· Ú¤ÂÈ Ó· ÛËÌÂȈı›, fï˜, fiÙÈ 3 ·fi ÙÔ˘˜ ·ÛıÂÓ›˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ›¯·Ó Ï¿‚ÂÈ ·ÓÙÈ‚ÈÔÙÈ΋ ·ÁˆÁ‹ ÚÈÓ ÂÈÛ·¯ıÔ‡Ó ÛÙÔ ÓÔÛÔÎÔÌ›Ô. ¶ÔÏϤ˜ ÂÚÈÙÒÛÂȘ ∞O™ Ì Ó¢ÚÔÏÔÁÈΤ˜ ÂÈÏÔΤ˜ ¤¯Ô˘Ó ÂÏÂÁ¯ı› Ì ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· Î·È ÔÈΛϷ Â˘Ú‹Ì·Ù· ¤¯Ô˘Ó ÂÚÈÁÚ·Ê›, fiˆ˜ Ô›‰ËÌ· ÂÁÎÂÊ¿ÏÔ˘, ¤ÌÊÚ·ÎÙ· ÔÈΛÏÔ˘ ÌÂÁ¤ıÔ˘˜ Î·È ÂÓ‰ÔÎÚ·ÓȷΤ˜ ·ÈÌÔÚÚ·Á›Â˜ (4-6). ¶ÈÛÙ‡ÂÙ·È fiÙÈ Ë ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ ÌÔÚ› Ó· ÌËÓ Â›Ó·È ·ÚÎÂÙ¿ ¢·›ÛıËÙË ÛÙËÓ ·Ó¿‰ÂÈÍË ÌÈÎÚÒÓ
¶·È‰È·ÙÚÈ΋ 2003;66:456-460
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Paediatriki 2003;66:456-460
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∂ÈÎfiÓ· 1. ª·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘, Û ∆2 ÂÈÎfiÓ˜, ÙÔ˘ ‰Â‡ÙÂÚÔ˘ ·ÛıÂÓÔ‡˜ ηٿ ÙËÓ ÔÍ›· Ê¿ÛË Ù˘ ÓfiÛÔ˘. ¢Â›¯ÓÂÈ ·˘ÍË̤ÓÔ˘ Û‹Ì·ÙÔ˜ ·ÌÊÔÙÂÚfiÏ¢Ú˜ ÂÛٛ˜ ÂÓÙÔÈ˙fiÌÂÓ˜ ÛÙËÓ ˘ÔÊÏÔÈÒ‰Ë Ï¢΋ Ô˘Û›· ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘, ΢ڛˆ˜ ÛÙÔ˘˜ ÌÂوȷ›Ô˘˜ Î·È ‚ÚÂÁÌ·ÙÈÎÔ‡˜ ÏÔ‚Ô‡˜ (·) Î·È Ì›· ·ÚfiÌÔÈ· ÌÂÁ·Ï‡ÙÂÚË ÂÛÙ›· (‚) ÎÔÓÙ¿ ÛÙÔ ÌÂوȷ›Ô Τڷ˜ Ù˘ ·ÚÈÛÙÂÚ‹˜ Ï¿ÁÈ·˜ ÎÔÈÏ›·˜ (‚¤ÏË).
·ÓˆÌ·ÏÈÒÓ Û ·ÛıÂÓ›˜ Ì ∞O™, Û ·ÓÙ›ıÂÛË Ì ÙË Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ Ô˘ Â›Ó·È ÈÔ Â˘·›ÛıËÙË ÛÙËÓ ·Ó¿‰ÂÈÍË ·˘ÙÒÓ ÙˆÓ ·ÓˆÌ·ÏÈÒÓ, ·ÎfiÌË Î·È ÛÙ· ·Ú¯Èο ÛÙ¿‰È· Ù˘ ÓfiÛÔ˘ (10). ŒÏÂÁ¯Ô˜ Ì ̷ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ ¤¯ÂÈ ·Ó·ÊÂÚı› ÌfiÓÔ Û ϛÁ˜ ÚÔËÁÔ‡ÌÂÓ˜ ÂÚÈÙÒÛÂȘ ∞O™ Î·È Ù· ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù· Â›Ó·È Î˘Ú›ˆ˜ ¤ÌÊÚ·ÎÙ· ‹ ·ÈÌÔÚÚ·Á›Â˜ ÛÙËÓ ÂÚÈÔ¯‹ ÙˆÓ ‚·ÛÈÎÒÓ Á·ÁÁÏ›ˆÓ (7-11). ŒÌÊÚ·ÎÙ· ÛÙË Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ ·ÚfiÌÔÈ· Ì ÂΛӷ Ù˘ ·ÚÔ‡Û·˜ ÂÚ›ÙˆÛ˘, ·ÏÏ¿ ÂÓÙÔÈ˙fiÌÂÓ· ΢ڛˆ˜ ÛÙË ÂÚÈÔ¯‹ ÙˆÓ ‚·ÛÈÎÒÓ Á·ÁÁÏ›ˆÓ Î·È ÛÙËÓ ÂÓ Ùˆ ‚¿ıÂÈ Ï¢΋ Ô˘Û›·, ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› Û ÚÔËÁÔ‡ÌÂÓÔ ·ÛıÂÓ‹ Ì ∞O™ Î·È ÔÊı·ÏÌÈ΋ Û˘ÌÌÂÙÔ¯‹ (17). ¶ÈÛÙ‡ÂÙ·È, fï˜, fiÙÈ Ù· Â˘Ú‹Ì·Ù· ÛÙË Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ‰ÂÓ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ÚfiÁÓˆÛË (10), fiˆ˜ ‰È·ÈÛÙÒıËÎÂ Î·È ÛÙÔÓ ·ÛıÂÓ‹ ·˘Ù‹˜ Ù˘ ÌÂϤÙ˘, fiÔ˘ ÂÓÒ ÔÈ ·ÓˆÌ·Ï›Â˜ ÛÙË Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ·Ú¤ÌÂÈÓ·Ó ÛÙÔÓ Â·Ó¤ÏÂÁ¯Ô, ÙÔ ·È‰› ‰ÂÓ ·ÚÔ˘Û›·˙ Ó¢ÚÔÏÔÁÈο ÚÔ‚Ï‹Ì·Ù·. ∞Ó Î·È Ë ˘ÔÛÙËÚÈÎÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË, Ë ·ÈÌÔοı·ÚÛË Î·È Ë ÂÚÈÙÔÓ·˚΋ οı·ÚÛË ¤¯Ô˘Ó ÌÂÈÒÛÂÈ ÙË ıÓËÛÈÌfiÙËÙ· Û ·ÛıÂÓ›˜ Ì ∞O™, ÔÈ Ì·ÎÚÔ¯ÚfiÓȘ Û˘Ó¤ÂȘ, ÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ ÙˆÓ Ó¢ÚÔÏÔÁÈÎÒÓ ÂÈÏÔÎÒÓ, Ù˘ ¯ÚfiÓÈ·˜ ÓÂÊÚÈ΋˜ ·Ó¿ÚÎÂÈ·˜
Î·È Ù˘ ˘¤ÚÙ·Û˘, ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÔ 10-20% ÙˆÓ ·ÛıÂÓÒÓ (1,6). Œ¯ÂÈ ·Ó·ÊÂÚı› fiÙÈ Ë ÚfiÁÓˆÛË Û¯ÂÙ›˙ÂÙ·È Ì ÙË ÛÔ‚·ÚfiÙËÙ· ÙˆÓ Ó¢ÚÔÏÔÁÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ Î·Ù¿ ÙËÓ ÔÍ›· Ê¿ÛË Ù˘ ÓfiÛÔ˘. ™˘ÁÎÂÎÚÈ̤ӷ, Ë ‡·ÚÍË ÎÒÌ·ÙÔ˜ Û¯ÂÙ›˙ÂÙ·È Ì η΋ ÚfiÁÓˆÛË. ∞ÓÙ›ıÂÙ·, οÔÈÔÈ ÂÚ¢ÓËÙ¤˜ ÈÛÙÂ‡Ô˘Ó fiÙÈ Ù· Ó¢ÚÔÏÔÁÈο Û˘ÌÙÒÌ·Ù· ˘Ô¯ˆÚÔ‡Ó ÁÚ‹ÁÔÚ· Î·È ‰ÂÓ ÛËÌ·ÙÔ‰ÔÙÔ‡Ó Î·Î‹ ÚfiÁÓˆÛË (10). ∂›Û˘, ¤¯ÂÈ ·Ó·ÊÂÚı› fiÙÈ Ë ·ÚÔ˘Û›· Û·ÛÌÒÓ Î·Ù¿ ÙËÓ ÔÍ›· Ê¿ÛË Ù˘ ÓfiÛÔ˘ Û¯ÂÙ›˙ÂÙ·È Ì ÌÂÁ¿ÏË ıÓËÛÈÌfiÙËÙ· ‹ Ì·ÎÚÔ¯ÚfiÓȘ Ó¢ÚÔÏÔÁÈΤ˜ ÂÈÏÔΤ˜ (12), ¿Ô„Ë Ô˘ ¤¯ÂÈ, fï˜, ·ÌÊÈÛ‚ËÙËı› ·fi ¿ÏÏÔ˘˜ ÂÚ¢ÓËÙ¤˜ (13). ∂›Ó·È Èı·Ófi Ë ·ÚÔ˘Û›· ÂÛÙÈ·ÎÒÓ Û·ÛÌÒÓ Ô˘ ·Ú·ÙËÚÔ‡ÓÙ·È Î˘Ú›ˆ˜ Û ¿Û¯ÔÓÙ˜ Ì ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù· ÛÙÔÓ ·ÂÈÎÔÓÈÛÙÈÎfi ¤ÏÂÁ¯Ô ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Î·È Ô˘ ˘Ô‰ËÏÒÓÔ˘Ó ‚·Ú‡ÙÂÚË ÂÁÎÂÊ·ÏÈ΋ ‚Ï¿‚Ë, Ó· ÛËÌ·ÙÔ‰ÔÙ› η΋ ÚfiÁÓˆÛË Ù˘ ÓfiÛÔ˘ (14), ÂÓÒ ÔÈ ÁÂÓÈÎÂ˘Ì¤ÓÔÈ, ‚Ú·¯Â›˜ Û·ÛÌÔ›, Ô˘ ÔÊ›ÏÔÓÙ·È Î˘Ú›ˆ˜ Û ÌÂÙ·‚ÔÏÈΤ˜ ‰È·Ù·Ú·¯¤˜, Ó· ¤¯Ô˘Ó ηϋ ÚfiÁÓˆÛË (13,14), fiˆ˜ ·Ú·ÙËÚ‹ıËÎÂ Î·È ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË. ™˘ÌÂÚ·ÛÌ·ÙÈο, Û ·ÛıÂÓ›˜ Ì ∞O™ Î·È Ó¢ÚÔÏÔÁÈΤ˜ ÂΉËÏÒÛÂȘ, Ë ·ÚÔ˘Û›· ‚Ú·¯Â›·˜ ‰È¿ÚÎÂÈ·˜ ÁÂÓÈÎÂ˘Ì¤ÓˆÓ Û·ÛÌÒÓ Èı·Ó¿ ÔÊ›ÏÂÙ·È ÛÂ
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ÌÂÙ·‚ÔÏÈΤ˜ ‰È·Ù·Ú·¯¤˜ Î·È ‰ÂÓ Û˘Óԉ‡ÂÙ·È ·fi ·ÓˆÌ·Ï›Â˜ ÛÙÔÓ ·ÂÈÎÔÓÈÛÙÈÎfi ¤ÏÂÁ¯Ô ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘. ∞˘ÙÔ› ÔÈ Û·ÛÌÔ› ÂϤÁ¯ÔÓÙ·È Â‡ÎÔÏ· Î·È ÁÚ‹ÁÔÚ· Î·È ‰ÂÓ Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì η΋ ÚfiÁÓˆÛË. ∏ ¤ÁηÈÚË ·Ó·ÁÓÒÚÈÛË Î·È Ë Î·Ù¿ÏÏËÏË ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÌÂÙ·‚ÔÏÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ Èı·ÓÒ˜ ı· ·ÔÙÚ¤„ÂÈ ÙËÓ ÂÌÊ¿ÓÈÛË ÙˆÓ Û·ÛÌÒÓ.
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Hemolytic uremic syndrome: MR findings of CNS complications. Pediatr Radiol 1994;24:585-586. Barnett ND, Kaplan AM, Bernes SM, Cohen ML. Hemolytic uremic syndrome with particular involvement of basal ganglia and favorable outcome. Pediatr Neurol 1995;12:155-158. Ogura H, Takaoka M, Kishi M, Kimoto M, Shimazu T, Yoshioka T et al. Reversible MR findings of hemolytic uremic syndrome with mild encephalopathy. Am J Neuroradiol 1998;19:1144-1145. Eriksson KJ, Boyd SG, Tasker RC. Acute neurology and neurophysiology of haemolytic-uraemic syndrome. Arch Dis Child 2001;84:434-435. Bale JF Jr, Brasher C, Siegler RL. CNS manifestations of the hemolytic-uremic syndrome. Relationship to metabolic alterations and prognosis. Am J Dis Child 1980;134:869-872. Dhuna A, Pascual-Leone A, Talwar D, Torres F. EEG and seizures in children with hemolytic-uremic syndrome. Epilepsia 1992;33:482-486. Sheth KJ, Swick HM, Haworth N. Neurological involvement in the haemolytic-uremic syndrome. Ann Neurol 1986;19:90-93. Cimolai N, Morrison BJ, Carter JE. Risk factors for the central nervous system manifestations of gastroenteritisassociated hemolytic uremic syndrome. Am J Dis Child 1980;134:869-872. Siegler RL, Brewer ED, Swartz M. Ocular involvement in hemolytic-uremic syndrome. J Pediatr 1988;112:594-597.
HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 11-04-2003 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 27-06-2003 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ∞. µÔ‡‰Ú˘ ¡Â˘ÚÔÏÔÁÈÎfi ∆Ì‹Ì·, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. &∞. ∫˘ÚÈ·ÎÔ‡” £Ë‚ÒÓ & §Â‚·‰Â›·˜, ∆.∫. 115 27, ∞ı‹Ó· E-mail: kvoudris@otenet.gr
¶·È‰È·ÙÚÈ΋ 2003;66:461-466
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Paediatriki 2003;66:461-466
ORIGINAL ARTICLE
∫˘ÙÙ·ÚÔÁÂÓÂÙÈο Î·È ÂȉËÌÈÔÏÔÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο 533 ·ÛıÂÓÒÓ Ì ۇӉÚÔÌÔ Down Ù· ¤ÙË 1973-2001 Ã. ÷Ù˙ËÛ‚·ÛÙÔ‡ - §Ô˘Î›‰Ô˘, ¶. ∫·ÌÔ˘Ú›‰Ô˘
Cytogenetic and epidemiological characteristics of 533 patients with Down syndrome between the years 1973-2001 H. Hatzissevastou - Loukidou, P. Kambouridou
¶ÂÚ›ÏË„Ë: ∏ ¯ÚˆÌÔÛˆÌÈ΋ Û‡ÓıÂÛË ÙˆÓ ÂÚÈÛÛfiÙÂÚˆÓ ·ÙfiÌˆÓ Ì ۇӉÚÔÌÔ Down Â›Ó·È Ë ÂχıÂÚË ÙÚÈۈ̛· 21, ÂÓÒ ¤Ó·˜ ÂÚÈÔÚÈṲ̂ÓÔ˜ ·ÚÈıÌfi˜ ¤¯ÂÈ ÌÂÙ¿ıÂÛË ÎÂÓÙÚÈ΋˜ Û‡ÓÙË͢ (Robertsonian translocation). ™ÎÔfi˜ Ù˘ ÂÚÁ·Û›·˜ ‹Ù·Ó: ·) Ë ÌÂϤÙË ÙˆÓ Î˘ÙÙ·ÚÔÁÂÓÂÙÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ·ÛıÂÓÒÓ Ì ۇӉÚÔÌÔ Down, ‚) Ë ÂÎÙ›ÌËÛË ÙˆÓ Û˘Ó‹ıˆÓ ·Ú·Ì¤ÙÚˆÓ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ÚfiÏË„Ë Á¤ÓÓËÛ‹˜ ÙÔ˘˜ Î·È Á) Ë ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘˜. ∞Ó·ÛÎÔ‹ıËÎ·Ó ·Ó·‰ÚÔÌÈο ÔÈ Ê¿ÎÂÏÔÈ 533 ·ÛıÂÓÒÓ Ì ۇӉÚÔÌÔ Down, ÔÈ ÔÔ›ÔÈ ÂÚ¢ӋıËÎ·Ó ÂÈÙ˘¯Ò˜ ¯ÚˆÌÔÛˆÌÈο Ù· ¤ÙË 1973-2001, ÂÓÒ ÂÚ¢ӋıËÎ·Ó ÂÈÏÂÎÙÈο Î·È ÔÈ Ê¿ÎÂÏÔÈ ÔÚÈÛÌ¤ÓˆÓ ÔÈÎÔÁÂÓÂÈÒÓ ÂÍ ·˘ÙÒÓ ÁÈ· ·ÔÎÏÂÈÛÌfi Ù˘ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜. ∫·Ù·ÁÚ¿ÊËηÓ: ·) ÙÔ Ê‡ÏÔ, ‚) Ë ËÏÈΛ· ηٿ ÙË ‰È¿ÁÓˆÛË, Á) ÔÈ Î·Ú˘fiÙ˘ÔÈ, ‰) ÔÈ ÌÔÓ‹ÚÂȘ ‹ ‰›‰˘Ì˜ ΢‹ÛÂȘ, Â) Ë ËÏÈΛ· ÙˆÓ ÁÔÓ¤ˆÓ ηٿ ÙÔÓ ÙÔÎÂÙfi, ÛÙ) Ô ÙfiÔ˜ ηÙÔÈΛ·˜ ηÈ, Ù¤ÏÔ˜, Û˘ÁÎÚ›ıËÎ·Ó Ù· Â˘Ú‹Ì·Ù· Ì ÂΛӷ ¿ÏÏˆÓ ÂÚ¢ÓËÙÒÓ. ∆Ô ÔÛÔÛÙfi ÙˆÓ ·ÁÔÚÈÒÓ ‹Ù·Ó 56% Î·È ÙˆÓ ÎÔÚÈÙÛÈÒÓ 44%. ∞ÌÈÁ‹ ÂχıÂÚË ÙÚÈۈ̛· ›¯Â ÙÔ 90%, ̈۷˚ÎÈÛÌfi ÙÔ 5,5%, ÌÂÙ¿ıÂÛË ÎÂÓÙÚÈ΋˜ Û‡ÓÙË͢ ÙÔ 4,5%, ÂÓÒ ·fi ·˘ÙÔ‡˜ ÌfiÓÔ ÙÔ 1% ›¯Â ÎÏËÚÔÓÔÌÈÎfiÙËÙ·. ∏ ̤ÛË ËÏÈΛ· ÙˆÓ ÌËÙ¤ÚˆÓ Î·Ù¿ ÙÔÓ ÙÔÎÂÙfi ‹Ù·Ó Ù· 30,5 ¤ÙË Î·È ÙˆÓ ·Ù¤ÚˆÓ Ù· 34 ¤ÙË. ∏ ËÏÈΛ· ÙˆÓ ·ÛıÂÓÒÓ Î·Ù¿ ÙË ‰È¿ÁÓˆÛË ‰È·ÌÔÚʈÓfiÙ·Ó ˆ˜ ÂÍ‹˜: 4 ‹Ù·Ó ¤Ì‚Ú˘· ·fi ‰È·ÎÔ‹ Ù˘ ·ËÛ˘ ÏfiÁˆ ÚÔÁÂÓÓËÙÈÎÔ‡ ÂϤÁ¯Ô˘, 56% ‹Ù·Ó ÓÂÔÁÓ¿, 27% ‹Ù·Ó ‚Ú¤ÊË Î·È 11% ›¯Â ËÏÈΛ· ÌÂÁ·Ï‡ÙÂÚË ÙÔ˘ 1 ¤ÙÔ˘˜. ∞fi ÙËÓ Â·Ú¯›· ·Ú·¤ÌÊıËÎÂ Û˘ÓÔÏÈο ÙÔ 56% ÙˆÓ ·ÛıÂÓÒÓ Î·È ·fi ÙËÓ fiÏË Ù˘ £ÂÛÛ·ÏÔӛ΢ ÙÔ 38%. ∆· Â˘Ú‹Ì·Ù· Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ Û˘ÌʈÓÔ‡Ó Ì ·˘Ù¿ Ù˘ ‰ÈÂıÓÔ‡˜ ‚È‚ÏÈÔÁÚ·Ê›·˜. ∆· ÚÒÙ· 12 ¯ÚfiÓÈ·, ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ ·ÛıÂÓ›˜ ·Ú·¤ÌÊıËÎ·Ó ÛÙË
Abstract: In most patients with Down syndrome, the condition derives from non-familial trisomy 21 and in a few of them the extra chromosomal material is the result of Robertsonian translocation. The aim of this study was: a) investigation of the cytogenetic characteristics of the patients with Down syndrome, b) evaluation of the usual characteristics relevant to their birth control, c) evaluation of the most prevalent medical problems and their management. The files were reviewed of 533 patients with Down syndrome who had been successfully examined chromosomically between 1973 and 2001. Selectively, some of the families had been examined in order to estimate the prevalence of heredity. For each patient, record was made of the: a) sex, b) age at diagnosis, c) karyotype, d) occurrence of single or twin pregnancy, e) parents’ age at delivery, and f) residential area, and the findings were compared to those of other researchers. Girls comprised 44% and boys 56% of the group. Chromosomal examination revealed free trisomy 21 in 90%, mosaicism in 5.5% and Robertsonian translocation in 4.5%, and among these only 1% showed heredity. The average age of the mothers was 30.5 years and of the fathers 34 years. Regarding the patients’ age at diagnosis, 4 were fetuses derived from termination of pregnancy due to prenatal diagnosis, 56% were neonates, 27% were infants and 11% were aged over 12 months. The residence of 56% of the patients was in the provinces and 38% lived in the city of Thessaloniki. The findings of this study are similar to those reported in the international bibliography. Most of the mothers were younger than 35 years. In the first 12 years most of the patients were referred by the attending physicians in the neonatal age (47%) and 23% of the patients were neonates from the
∂ÚÁ·ÛÙ‹ÚÈÔ ∫˘ÙÙ·ÚÔÁÂÓÂÙÈ΋˜, ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ∞.¶.£. °¶¡ “πÔÎÚ¿ÙÂÈÔ” £ÂÛÛ·ÏÔӛ΢
Cytogenetic Laboratory, 1st Paediatric Clinic of Aristotle University of Thessaloniki “Ippokration” General Hospital, Thessaloniki
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¶·È‰È·ÙÚÈ΋ 2003;66:461-466
Paediatriki 2003;66:461-466
ÓÂÔÁÓÈ΋ ËÏÈΛ· (47%) Î·È ÙÔ 23% ‹Ù·Ó ÓÂÔÁÓ¿ ·fi ÙËÓ Â·Ú¯›·. ∆· ÔÛÔÛÙ¿ ·˘Ù¿ ÂÓÈÛ¯‡ıËÎ·Ó ÛËÌ·ÓÙÈο ÌÂÙ¿ ÙÔ 1985 (65% Î·È 39%, ·ÓÙ›ÛÙÔȯ·). ∞ÔηχÊıËΠÎÏËÚÔÓÔÌÈÎfiÙËÙ· Û 6 ÔÈÎÔÁ¤ÓÂȘ Î·È ‰fiıËΠηٿÏÏËÏË ÁÂÓÂÙÈ΋ ηıÔ‰‹ÁËÛË Û fiÏ· Ù· ˙¢Á¿ÚÈ·. OÈ 139/533 ·ÛıÂÓ›˜ Ù¤ıËÎ·Ó ÛÂ Û˘ÛÙËÌ·ÙÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË ÛÙÔ Â͈ÙÂÚÈÎfi È·ÙÚ›Ô.
provinces. These percentages rose markedly after 1985. Heredity was discovered in 6 families and appropriate genetic counseling was provided to all of them. Of the group, 139/533 children have been under systematic follow-up in outpatient department.
§¤ÍÂȘ ÎÏÂȉȿ: Û‡Ó‰ÚÔÌÔ Down, Û˘¯ÓfiÙËÙ·, ηڢfiÙ˘Ô˜, ÚÔÁÂÓÓËÙÈ΋ ‰È¿ÁÓˆÛË, ÂȉËÌÈÔÏÔÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο.
Key words: Down syndrome, prevalence, karyotype, prenatal diagnosis, epidemiological characteristics.
™˘ÓÙÔÌÔÁڷʛ˜
Î·Ó ÔÈ Ê¿ÎÂÏÔÈ ÔÚÈÛÌ¤ÓˆÓ ÔÈÎÔÁÂÓÂÈÒÓ ÂÍ ·˘ÙÒÓ, ÔÈ Ôԛ˜ ÂÚ¢ӋıËÎ·Ó ¯ÚˆÌÔÛˆÌÈο ÁÈ· Ó· ·ÔÎÏÂÈÛÙ› Ë ÎÏËÚÔÓÔÌÈÎfiÙËÙ·. ∫·Ù·ÁÚ¿ÊËηÓ: ·) ÙÔ Ê‡ÏÔ, ‚) Ë ËÏÈΛ· ÙˆÓ ·ÛıÂÓÒÓ Î·Ù¿ ÙË ‰È¿ÁÓˆÛË, Á) ÔÈ Î·Ú˘fiÙ˘ÔÈ: ÂχıÂÚË ÙÚÈۈ̛· (·ÌÈÁ‹˜ ÌÔÚÊ‹ ‹ ̈۷˚ÎÈÛÌfi˜), ÌÂÙ¿ıÂÛË ÎÂÓÙÚÈ΋˜ Û‡ÓÙË͢ (de novo ‹ ÎÏËÚÔÓÔÌÈ΋), ‰) ÔÈ ÌÔÓ‹ÚÂȘ ‹ ‰›‰˘Ì˜ ΢‹ÛÂȘ, Â) Ô ÙfiÔ˜ ηÙÔÈΛ·˜ (·گ›· ‹ fiÏË Ù˘ £ÂÛÛ·ÏÔӛ΢) Î·È ÛÙ) ÔÈ ËÏÈ˘ ÙˆÓ ÁÔÓ¤ˆÓ ηٿ ÙÔÓ ÙÔÎÂÙfi. ∆Ô 1985 ÂÊ·ÚÌfiÛÙËΠÁÈ· ÚÒÙË ÊÔÚ¿ Ë ÚÔÁÂÓÓËÙÈ΋ ‰È¿ÁÓˆÛË ¯ÚˆÌÔÛˆÌÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ ÙÔ˘ ÂÌ‚Ú‡Ô˘ ÛÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ ÂÚÁ·ÛÙ‹ÚÈÔ, ÛÂ Û˘ÓÂÚÁ·Û›· Ì fiϘ ÙȘ ¶·ÓÂÈÛÙËÌȷΤ˜ Ì·È¢ÙÈΤ˜ ÎÏÈÓÈΤ˜ ÙÔ˘ “πÔÎÚ¿ÙÂÈÔ˘” ¡ÔÛÔÎÔÌ›Ԣ £ÂÛÛ·ÏÔӛ΢. ∆Ô ¤ÙÔ˜ ·˘Ùfi ¯ÚËÛÈÌÔÔÈ‹ıËΠˆ˜ ÔÚfiÛËÌÔ ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË Ù˘¯fiÓ ÌÂÙ·‚ÔÏÒÓ ÙˆÓ ·Ú·¿Óˆ ·Ú·Ì¤ÙÚˆÓ. ŒÁÈÓ ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ÙˆÓ Â˘ÚËÌ¿ÙˆÓ Ì ÙË ‰ÔÎÈÌ·Û›· ¯2. £ÂˆÚ‹ıËÎ·Ó ÛËÌ·ÓÙÈΤ˜ ÔÈ ‰È·ÊÔÚ¤˜ Ô˘ ›¯·Ó ÛÙ¿ıÌË ÛËÌ·ÓÙÈÎfiÙËÙ·˜ Ì p<0,05. ∆· Â˘Ú‹Ì·Ù· Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ Û˘ÁÎÚ›ıËÎ·Ó Ì ·˘Ù¿ ¿ÏÏˆÓ ÂÚ¢ÓËÙÒÓ. ∫˘ÙÙ·ÚÔÁÂÓÂÙÈ΋ ÌÂϤÙË ·) ¶ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜: ŒÁÈÓ ηڢfiÙ˘Ô˜ ÌÂÙ¿ ·fi ηÏÏȤÚÁÂÈ· ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ (ÌÂÏÂÙ‹ıËÎ·Ó 20-30 ÌÂÙ·Ê¿ÛÂȘ ÁÈ· οı ·ÛıÂÓ‹). ∏ Û‹Ì·ÓÛË ¤ÁÈÓ Ì G Î·È Q-banding. ‚) ∞ÌÓÈ·ÎÔ‡ ˘ÁÚÔ‡: ŒÁÈÓ ·Ó¿Ï˘ÛË 20-30 ÌÂÙ·Ê¿ÛÂˆÓ ·fi 2-3 ηÏÏȤÚÁÂȘ ·ÌÓÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ ÛÙ· 4 ¤Ì‚Ú˘· Ô˘ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÛÙËÓ ·ÚÔ‡Û· ÂÚÁ·Û›·. ∏ Û‹Ì·ÓÛË ¤ÁÈÓ Ì G Î·È Q-banding.
DS ª∫™ ∂∆
™‡Ó‰ÚÔÌÔ Down ªÂÙ¿ıÂÛË ÎÂÓÙÚÈ΋˜ Û‡ÓÙË͢ ∂χıÂÚË ÙÚÈۈ̛·
∂ÈÛ·ÁˆÁ‹ ∆Ô Û‡Ó‰ÚÔÌÔ Down (DS) Â›Ó·È Ë ÈÔ Û˘¯Ó‹ ¯ÚˆÌÔÛˆÌÈ΋ ·ÓˆÌ·Ï›· ÛÙ· ·È‰È¿ Î·È Ë ÈÔ Û˘¯Ó‹ ÁÂÓÂÙÈ΋ ·ÈÙ›· ÓÔËÙÈ΋˜ ˘ÛÙ¤ÚËÛ˘ (1-3). ™Â fiÏÔ ÙÔÓ ÎfiÛÌÔ, Ë Û˘¯ÓfiÙËÙ· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Â›Ó·È 1/800 ¤ˆ˜ 1/1000 ÁÂÓÓ‹ÛÂȘ (2). ∆· ·ÁfiÚÈ· Â›Ó·È ÂÚÈÛÛfiÙÂÚ· ·fi Ù· ÎÔÚ›ÙÛÈ· Ì ·Ó·ÏÔÁ›· 1,3/1 (3). ¶·Ï·ÈfiÙÂÚ·, Ë ÁÔÓÂ˚΋ ÚԤϢÛË ÙÔ˘ ˘ÂÚ¿ÚÈıÌÔ˘ ¯ÚˆÌ·ÙÔÛÒÌ·ÙÔ˜ 21 ÛÙËÚÈ˙fiÙ·Ó Û ΢ÙÙ·ÚÔÁÂÓÂÙÈÎÔ‡˜ ÂÙÂÚÔÌÔÚÊÈÛÌÔ‡˜ Î·È Ì ‚¿ÛË ÂΛӘ ÙȘ ÌÂϤÙ˜, ÔÛÔÛÙfi 80% ‹Ù·Ó ÌËÙÚÈ΋˜ Î·È 20% ·ÙÚÈ΋˜ ÚÔ¤Ï¢Û˘. ™‹ÌÂÚ·, fï˜, Ì ÙÔ˘˜ ÔÏ˘ÌÔÚÊÈÛÌÔ‡˜ ÙÔ˘ DNA ‚Ú¤ıËΠfiÙÈ ÔÛÔÛÙfi 95% Â›Ó·È ÌËÙÚÈ΋˜ ÚÔ¤Ï¢Û˘ Î·È ÌfiÓÔÓ 5% ·ÙÚÈ΋˜ (1,410). O ΛӉ˘ÓÔ˜ Ô˘ ·ÓÙÈÌÂÙˆ›˙ÂÈ Ì›· Á˘Ó·›Î· ËÏÈΛ·˜ 35-39 ÂÙÒÓ Ó· ·ÔÎÙ‹ÛÂÈ ·È‰› Ì ÙÚÈۈ̛· 21 Â›Ó·È 6,5 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚÔ˜ ·fi ·˘ÙfiÓ Ì›·˜ ¿ÏÏ˘ ËÏÈΛ·˜ 20-24 ÂÙÒÓ. ∞˘Ù‹ Ë ·Ó·ÏÔÁ›· Êı¿ÓÂÈ ÛÙÔ 20,5 ÁÈ· Á˘Ó·›Î˜ ËÏÈΛ·˜ 40-44 ÂÙÒÓ. ∞ÔÙ¤ÏÂÛÌ· Â›Ó·È fiÙÈ ÔÈ Á˘Ó·›Î˜ ËÏÈΛ·˜ ÌÂÁ·Ï‡ÙÂÚ˘ ÙˆÓ 35 ¯ÚfiÓˆÓ Î˘ÔÊÔÚÔ‡Ó ÙÔ 20-25% ÙˆÓ ÂÌ‚Ú‡ˆÓ Ì DS, fï˜ ÛÙËÓ ËÏÈΛ· ·˘Ù‹ ·Ó·ÏÔÁ› ÌfiÓÔ ÙÔ 7% ÙˆÓ Î˘‹ÛÂˆÓ (2,11-14). ™ÎÔfi˜ Ù˘ ÂÚÁ·Û›·˜ ‹Ù·Ó Ó· ‰ÈÂÚ¢ӋÛÂÈ Ù· ΢ÙÙ·ÚÔÁÂÓÂÙÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ·ÛıÂÓÒÓ, ÙËÓ ËÏÈΛ· ÎÏÈÓÈ΋˜ ‰È¿ÁÓˆÛ˘ Î·È ·Ú·ÔÌ‹˜ Û ۯ¤ÛË Ì ÙËÓ ÚfiÔ‰Ô ÙˆÓ ÂÙÒÓ Î·È ÙÔÓ ÙfiÔ Î·ÙÔÈΛ·˜, ÙËÓ ËÏÈΛ· ÙˆÓ ÁÔÓ¤ˆÓ ηٿ ÙÔÓ ÙÔÎÂÙfi ηÈ, Ù¤ÏÔ˜, Ó· Û˘Ì‚¿ÏÂÈ: ·) ÛÙËÓ ÚfiÏË„Ë Á¤ÓÓËÛ˘ ·È‰ÈÒÓ Ì DS Î·È ‚) ÛÙËÓ ÚÒÈÌË ·Ú¤Ì‚·ÛË ÛÂ Â›Â‰Ô ÚˆÙÔ‚¿ıÌÈ·˜ ÂÚ›ı·Ï„˘. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ∞Ó·ÛÎÔ‹ıËÎ·Ó ÔÈ Ê¿ÎÂÏÔÈ 533 ·ÛıÂÓÒÓ Ì DS (¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ˆ˜ “·ÛıÂÓ›˜”, ηıÒ˜ Ë ËÏÈÎȷ΋ ÙÔ˘˜ ηٷÓÔÌ‹ Â›Ó·È ·fi 0-50 ÂÙÒÓ) Ô˘ ÂÚ¢ӋıËÎ·Ó ÂÈÙ˘¯Ò˜ ¯ÚˆÌÔÛˆÌÈο ÛÙÔ ÂÚÁ·ÛÙ‹ÚÈÔ Ù· ¤ÙË 1973-2001. ∂›Û˘, ·Ó·ÛÎÔ‹ıË-
462
∞ÔÙÂϤÛÌ·Ù· ∞fi ÙÔ˘˜ 533 ·ÛıÂÓ›˜, 292 (56%) ‹Ù·Ó ·ÁfiÚÈ· Î·È 235 (44%) ‹Ù·Ó ÎÔÚ›ÙÛÈ·. ∏ Û¯¤ÛË ·ÁfiÚÈ·/ÎÔÚ›ÙÛÈ· ‹Ù·Ó 1,3/1 (∂ÈÎfiÓ· 1). ∞ÌÈÁ‹ ÂχıÂÚË ÙÚÈۈ̛· ›¯·Ó 478/533 (90%), ̈۷˚ÎÈÛÌfi 30/533 (5,5%), ª∫™ 25/533 (4,5%) ηÈ, ÌÂÙ¿ ÙÔÓ ¤ÏÂÁ¯Ô ÙˆÓ ÁÔÓ¤ˆÓ ÙÔ˘˜, Ê¿ÓËΠfiÙÈ ÎÏËÚÔÓÔÌÈÎfiÙËÙ· ˘‹Ú¯Â ÌfiÓÔ Û 6/25 (1%) (∂ÈÎfiÓ· 2). ¢ÈÏ‹ ¯ÚˆÌÔÛˆÌÈ΋ ·Ù˘›· ›¯·Ó 2 ·ÛıÂÓ›˜: 48,ÃÃÃ,+21 Î·È 46,ÃÀ,-13,-14,+t(13;14),+21. ¢›‰˘Ì˜ ΢‹ÛÂȘ ‹Ù·Ó 8, ÂÓÒ ÌfiÓÔ Û ̛· ›¯·Ó Î·È Ù· ‰‡Ô ·È‰È¿ DS. ª›· ÔÈÎÔÁ¤ÓÂÈ· ·¤ÎÙËÛ 2 ·È‰È¿ Ì ÂχıÂÚË ÙÚÈۈ̛· Û ‰‡Ô ‰È·ÊÔÚÂÙÈΤ˜ ΢‹ÛÂȘ Î·È ÔÈ ÁÔÓ›˜ ›¯·Ó Ê˘ÛÈÔÏÔÁÈÎfi ηڢfiÙ˘Ô ÛÙÔ ÂÚÈÊÂÚÈÎfi ·›Ì·, Û ·ÓÂÈÏËÌ̤Ó˜ ηÏÏȤÚÁÂȘ
¶·È‰È·ÙÚÈ΋ 2003;66:461-466
Paediatriki 2003;66:461-466
ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Î·È ÌÂÁ¿ÏÔ ·ÚÈıÌfi ÌÂÙ·Ê¿ÛˆÓ. ŸÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ËÏÈΛ· ÙˆÓ ·ÛıÂÓÒÓ Î·Ù¿ ÙË ‰È¿ÁÓˆÛË, 4 ‹Ù·Ó ¤Ì‚Ú˘· ·fi ‰È·ÎÔ‹ ·ËÛ˘ ÌÂÙ¿ ·fi ·ÌÓÈÔΤÓÙËÛË (Û ÚÔÁÂÓÓËÙÈÎfi ¤ÏÂÁ¯Ô ÏfiÁˆ ÚÔ¯ˆÚË̤Ó˘ ËÏÈΛ·˜ Ù˘ ÌËÙ¤Ú·˜ ‹ ÌËÙ¤Ú·˜ ÊÔÚ¤· ÌÂÙ¿ıÂÛ˘), 298/533 (56%) ‹Ù·Ó ÓÂÔÁÓ¿, 144/533 (27%) ‹Ù·Ó ‚Ú¤ÊË Î·È 58/533 (11%) ‹Ù·Ó ·ÛıÂÓ›˜ ËÏÈΛ·˜ ÌÂÁ·Ï‡ÙÂÚ˘ ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜ (150 ÂÙÒÓ). ™Â 33/533 (6%) ·ÛıÂÓ›˜, Ë ËÏÈΛ· ‰ÂÓ ‹Ù·Ó ηٷÁÂÁÚ·Ì̤ÓË (∂ÈÎfiÓ· 3). ∞fi ÙËÓ Â·Ú¯›· ·Ú·¤ÌÊıËÎ·Ó 289/533 ·ÛıÂÓ›˜ (54%) Î·È ·fi ÙËÓ fiÏË Ù˘ £ÂÛÛ·ÏÔӛ΢ 202/533 (38%). °È· 42/533 (8%) ‰ÂÓ ‹Ù·Ó ηٷÁÂÁÚ·Ì̤ÓÔ˜ Ô ÙfiÔ˜ ηÙÔÈΛ·˜. ™Â Û¯¤ÛË Ì ÙËÓ ËÏÈΛ· ÙÔ˘˜, ·fi ÙËÓ Â·Ú¯›· ·Ú·¤ÌÊıËÎ·Ó 160 ÓÂÔÁÓ¿ (30%), 98 ‚Ú¤ÊË (18%) Î·È 31 ·È‰È¿ ËÏÈΛ·˜ ÌÂÁ·Ï‡ÙÂÚ˘ ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜ (6%), ÂÓÒ ·fi
ÙËÓ fiÏË Ù˘ £ÂÛÛ·ÏÔӛ΢ 125 ÓÂÔÁÓ¿ (23%), 51 ‚Ú¤ÊË (10%) Î·È 26 ·È‰È¿ ËÏÈΛ·˜ ÌÂÁ·Ï‡ÙÂÚ˘ ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜ (5%) (∂ÈÎfiÓ· 4). ¶ÚÈÓ ·fi ÙÔ 1985 ·Ú·¤ÌÊıËÎ·Ó ÁÈ· ¤ÏÂÁ¯Ô 220 ·ÛıÂÓ›˜, 103 ·fi ÙÔ˘˜ ÔÔ›Ô˘˜ ‹Ù·Ó ÓÂÔÁÓ¿ (47%), 87 ‹Ù·Ó ‚Ú¤ÊË (37%) Î·È 25 ‹Ù·Ó ·È‰È¿ ËÏÈΛ·˜ ÌÂÁ·Ï‡ÙÂÚ˘ ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜ (11%). ªÂÙ¿ ÙÔ 1986 ·Ú·¤ÌÊıËÎ·Ó 281 ·ÛıÂÓ›˜, 182 ·fi ÙÔ˘˜ ÔÔ›Ô˘˜ ‹Ù·Ó ÓÂÔÁÓ¿ (65%), 67 ‹Ù·Ó ÌÈÎÚ¿ ‚Ú¤ÊË (24%) Î·È 32 ‹Ù·Ó ·È‰È¿ ËÏÈΛ·˜ ÌÂÁ·Ï‡ÙÂÚ˘ ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜ (11%) (∂ÈÎfiÓ· 5). ¶ÚÈÓ ·fi ÙÔ 1985 ·Ú·¤ÌÊıËÎ·Ó ·fi ÙËÓ Â·Ú¯›· 110/220 ·ÛıÂÓ›˜ (55%) Î·È ÌÂÙ¿ ÙÔ 1986 179/281 (63%), ÂÓÒ ·fi ÙËÓ fiÏË Ù˘ £ÂÛÛ·ÏÔӛ΢ ·Ú·¤ÌÊıËÎ·Ó 100/220 (45%) Î·È 102/281 (36%), ·ÓÙ›ÛÙÔȯ· (∂ÈÎfiÓ· 6). 40%
∂·Ú¯›· £ÂÛÛ·ÏÔÓ›ÎË
35% 30%
∞ÁfiÚÈ· 44%
30%
56% ∫ÔÚ›ÙÛÈ·
25%
23%
20%
18%
∂ÈÎfiÓ· 1. ™¯¤ÛË ÙˆÓ ·ÁÔÚÈÒÓ ÚÔ˜ Ù· ÎÔÚ›ÙÛÈ·. 15% 10% 10% 6%
∂∆ - ·ÌÈÁ‹˜ ÌÔÚÊ‹
1%
5%
5% ∂∆ - ̈۷˚ÎÈÛÌfi˜
3,5%
0% ¡ÂÔÁÓ¿
ª∫™ de novo 5,5%
90%
µÚ¤ÊË
¶·È‰È¿
∂ÈÎfiÓ· 4. ∏ÏÈÎȷ΋ ηٷÓÔÌ‹ ηٿ ÙË ‰È¿ÁÓˆÛË Û ۯ¤ÛË Ì ÙÔÓ ÙfiÔ ‰È·ÌÔÓ‹˜.
ª∫™ ÎÏËÚÔÓÔÌÈ΋ 80% 70% ∂ÈÎfiÓ· 2. ÃÚˆÌÔÛˆÌÈο ¯·Ú·ÎÙËÚÈÛÙÈο (∂∆: ÂχıÂÚË ÙÚÈۈ̛·, ª∫™: ÌÂÙ¿ıÂÛË ÎÂÓÙÚÈ΋˜ Û‡ÓÙË͢).
60% 50% 40%
6%
30%
11%
¡ÂÔÁÓ¿ µÚ¤ÊË
27%
¶·È‰È¿ ÕÁÓˆÛÙ· 56%
∂ÈÎfiÓ· 3. ∫·Ù·ÓÔÌ‹ ηٿ ËÏÈ˘ ÛÙË ‰È¿ÁÓˆÛË.
65% 47% 37%
20%
11%
10% 0%
24% 11%
Ë È¿ Ó¿ ÔÁ µÚ¤Ê ¶·È‰ ¡Â 1973-1985
Ë È¿ Ó¿ ÔÁ µÚ¤Ê ¶·È‰ ¡Â 1986-2001
∂ÈÎfiÓ· 5. ∞ÏÏ·Á¤˜ ÛÙËÓ ËÏÈÎȷ΋ ηٷÓÔÌ‹ ηٿ ÙË ‰È¿ÁÓˆÛË Ì ÙËÓ ÚfiÔ‰Ô ÙˆÓ ÂÙÒÓ (ÓÂÔÁÓ¿: p=0,001, ‚Ú¤ÊË: p<0,005).
463
¶·È‰È·ÙÚÈ΋ 2003;66:461-466
Paediatriki 2003;66:461-466
∞ӷχÔÓÙ·˜ ÂÚ·ÈÙ¤Úˆ ÙËÓ ËÏÈΛ· ·Ú·ÔÌ‹˜ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙÔÓ ÙfiÔ Î·ÙÔÈΛ·˜ ‰È·ÈÛÙÒıËΠfiÙÈ ÚÈÓ ·fi ÙÔ 1985 ·fi ÙËÓ Â·Ú¯›· ‹Ù·Ó 50/220 ÓÂÔÁÓ¿ (23%), 50/220 ‚Ú¤ÊË (23%) Î·È 10/220 ·È‰È¿ ËÏÈΛ·˜ ÌÂÁ·Ï‡ÙÂÚ˘ ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜ (5%), ÂÓÒ ÌÂÙ¿ ÙÔ 1986 ÓÂÔÁÓ¿ ‹Ù·Ó 110/281 (39%), ‚Ú¤ÊË 48/281 (17%) Î·È ·È‰È¿ ËÏÈΛ·˜ ÌÂÁ·Ï‡ÙÂÚ˘ ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜ ‹Ù·Ó 21/281 (7%). ∞fi ÙËÓ fiÏË Ù˘ £ÂÛÛ·ÏÔӛ΢ ÚÈÓ ·fi ÙÔ 1985 ‹Ù·Ó 53/220 ÓÂÔÁÓ¿ (24%), 32/220 ‚Ú¤ÊË (15%) Î·È 15/220 ·È‰È¿ ËÏÈΛ·˜ ÌÂÁ·Ï‡ÙÂÚ˘ ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜ (7%), ÂÓÒ ÌÂÙ¿ ÙÔ 1986 ÓÂÔÁÓ¿ ‹Ù·Ó 72/281 (26%), ‚Ú¤ÊË 19/281 (7%) Î·È ·È‰È¿ ËÏÈΛ·˜ ÌÂÁ·Ï‡ÙÂÚ˘ ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜ ‹Ù·Ó 11/281 (4%) (∂ÈÎfiÓ· 7). ∞Ó·ÊÔÚÈο Ì ÙËÓ ËÏÈΛ· ÙˆÓ ÌËÙ¤ÚˆÓ Î·Ù¿ ÙÔÓ ÙÔÎÂÙfi, ÏËÚÔÊÔڛ˜ ˘‹Ú¯·Ó ÁÈ· 460/533. OÈ 105/460 ‹Ù·Ó ÌÈÎÚfiÙÂÚ˜ ÙˆÓ 25 ÂÙÒÓ (23%), 146/460 ‹Ù·Ó 25-30 ÂÙÒÓ (32%), 104/460 ‹Ù·Ó 30-35 ÂÙÒÓ (23%) Î·È 104/560 ›¯·Ó ËÏÈΛ· ÌÂÁ·Ï‡ÙÂÚË ÙˆÓ 35 ÂÙÒÓ (22%) (∂ÈÎfiÓ· 8). ŒÁÈÓ ·Ó¿Ï˘ÛË Ù˘ ËÏÈΛ·˜ ÙˆÓ ÌËÙ¤ÚˆÓ ÚÈÓ Î·È ÌÂÙ¿ ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ÚÔÁÂÓÓËÙÈÎÔ‡ ÂϤÁ¯Ô˘ Î·È ‰È·ÈÛÙÒıËΠfiÙÈ ÚÈÓ ·fi ÙÔ 1985 55/193 ‹Ù·Ó ÌÈÎÚfiÙÂÚ˜ ÙˆÓ 25 ÂÙÒÓ (28%), 47/193 ‹Ù·Ó 25-30 ÂÙÒÓ (24%), 39/193 ‹Ù·Ó 30-35 ÂÙÒÓ (20%) Î·È 52/193 ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚ˜ ÙˆÓ 35 ÂÙÒÓ (27%). ªÂÙ¿ ÙÔ 1986, 50/267 ‹Ù·Ó ÌÈÎÚfiÙÂÚ˜ ÙˆÓ 25 ÂÙÒÓ (19%), 98/267 ‹Ù·Ó 25-30 ÂÙÒÓ (37%), 65/267 ‹Ù·Ó 30-35 ÂÙÒÓ (24%) Î·È 54/267 ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚ˜ ÙˆÓ 35 ÂÙÒÓ (20%) (∂ÈÎfiÓ· 9). ™˘˙‹ÙËÛË ™ÙË ‚È‚ÏÈÔÁÚ·Ê›· ·Ó·Ê¤ÚÂÙ·È fiÙÈ ·fi ÙÔ˘˜ ·ÛıÂÓ›˜ Ì ۇӉÚÔÌÔ Down, 95% ¤¯ÂÈ ÂχıÂÚË 0,85
∂·Ú¯›·
0,75
£ÂÛÛ·ÏÔÓ›ÎË
0,65
ÙÚÈۈ̛·, 1% ̈۷˚ÎÈÛÌfi Î·È 3-4% ÌË ÈÛÔ˙˘ÁÈṲ̂ÓË ÌÂÙ¿ıÂÛË ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ 21 Î·È ÂÓfi˜ ·ÎÚÔÎÂÓÙÚÈÎÔ‡ ¯ÚˆÌÔÛÒÌ·ÙÔ˜, Û˘Ó‹ıˆ˜ ÙÔ˘ 14. ªfiÓÔ ÙÔ Å/4 ÙˆÓ ÌÂÙ·ı¤ÛÂˆÓ Â›Ó·È ÎÏËÚÔÓÔÌÈΤ˜ Î·È ÔÈ ˘fiÏÔȘ Â›Ó·È de novo (3,15-17). ∆· ΢ÙÙ·ÚÔÁÂÓÂÙÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ·ÛıÂÓÒÓ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ Û˘ÌʈÓÔ‡Ó Ì ·˘Ù¿ Ù˘ ‰ÈÂıÓÔ‡˜ ‚È‚ÏÈÔÁÚ·Ê›·˜: 95,5% ›¯Â ÂχıÂÚË ÙÚÈۈ̛·, 4,5% ›¯Â ª∫™ ηÈ, ·fi ·˘ÙÔ‡˜, ÎÏËÚÔÓÔÌÈ΋ ÌÂÙ¿ıÂÛË Â›¯·Ó ÌfiÓÔ 6/533 ·ÛıÂÓ›˜ (1%) (∂ÈÎfiÓ· 2). OÈ ÔÈÎÔÁ¤ÓÂȘ ÙˆÓ ·ÛıÂÓÒÓ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‰¤¯ıËÎ·Ó Î·Ù¿ÏÏËÏË ÁÂÓÂÙÈ΋ ηıÔ‰‹ÁËÛË, ÂÓÒ ‰ÈÂÚ¢ӋıËÎ·Ó Î˘ÙÙ·ÚÔÁÂÓÂÙÈο Ù· ̤ÏË ÙˆÓ ÔÈÎÔÁÂÓÂÈÒÓ ÙˆÓ ·ÛıÂÓÒÓ ÛÙÔ˘˜ ÔÔ›Ô˘˜ ‰È·ÈÛÙÒıËΠÎÏËÚÔÓÔÌÈÎfiÙËÙ·. ªÂ ·˘ÙfiÓ ÙÔÓ ÙÚfiÔ ÂÓËÌÂÚÒıËÎ·Ó ÔÈ Û˘ÁÁÂÓ›˜ ÊÔÚ›˜ ÁÈ· ÙË ÛˆÛÙ‹ ·ÓÙÈÌÂÙÒÈÛË Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ·Ó··Ú·ÁˆÁ‹˜, ‰ËÏ·‰‹ ÙËÓ ·Ó·ÁηÈfiÙËÙ· Ù˘ ‰ÈÂÓ¤ÚÁÂÈ·˜ ÚÔÁÂÓÓËÙÈ΋˜ ‰È¿ÁÓˆÛ˘ ÛÙÔ Î‡ËÌ¿ ÙÔ˘˜ (18). ∏ ËÏÈΛ· Ù˘ ‰È¿ÁÓˆÛ˘, ·ÓÂÍ·Úًو˜ ¿ÏÏˆÓ ·Ú·Ì¤ÙÚˆÓ, ‹Ù·Ó ΢ڛˆ˜ Ë ÓÂÔÁÓÈ΋. ¶ÂÚÈÛÛfiÙÂÚÔÈ ·fi ÙÔ˘˜ ÌÈÛÔ‡˜ ·ÛıÂÓ›˜ ·Ú·¤ÌÊıËÎ·Ó ÁÈ· ¤ÏÂÁ¯Ô ÛÙË ÓÂÔÁÓÈ΋ ËÏÈΛ· (56%), Ï›ÁÔÈ ÛÙË ‚ÚÂÊÈ΋ (27%) Î·È ·ÎfiÌË ÏÈÁfiÙÂÚÔÈ (11%) ÌÂÙ¿ ÙËÓ ËÏÈΛ· ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜ (1-50 ÂÙÒÓ) (∂ÈÎfiÓ· 3). ŸÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ËÏÈΛ·, Ë Î·Ù·ÓÔÌ‹ ÙˆÓ ·ÛıÂÓÒÓ ‰ÂÓ ÙÚÔÔÔÈ‹ıËΠ۠ۯ¤ÛË Ì ÙÔÓ ÙfiÔ Î·ÙÔÈΛ·˜ ηٿ Ù· ¤ÙË 1973-2001. ¢ËÏ·‰‹, ÙfiÛÔ ·fi ÙËÓ Â·Ú¯›· fiÛÔ Î·È ·fi ÙËÓ fiÏË Ù˘ £ÂÛÛ·ÏÔӛ΢, ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ ·ÛıÂÓ›˜ ‹Ù·Ó ÓÂÔÁÓ¿ Î·È ÔÈ ÏÈÁfiÙÂÚÔÈ ‹Ù·Ó ·È‰È¿ ËÏÈΛ·˜ ÌÂÁ·Ï‡ÙÂÚ˘ ÙÔ˘ 1 ¤ÙÔ˘˜ (∂ÈÎfiÓ· 4). ™ÙËÓ ·ÚÔ‡Û· ÂÚÁ·Û›· ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Û·Ó ÔÚfiÛËÌÔ ÙÔ ¤ÙÔ˜ 1985, ηٿ ÙÔ ÔÔ›Ô ¿Ú¯ÈÛÂ Ë ÂÊ·ÚÌÔÁ‹ Ù˘ ÚÔÁÂÓÓËÙÈ΋˜ ‰È¿ÁÓˆÛ˘ ¯ÚˆÌÔÛˆÌÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ ÙÔ˘ ÂÌ‚Ú‡Ô˘ ÛÙÔ ÓÔÛÔÎÔÌ›Ô. ∆Ô ¤ÙÔ˜ ·˘Ùfi ·ÔÙ¤ÏÂÛ ÛÙ·ıÌfi ·ÏÏ·Á‹˜ ÛÙËÓ Î·ıËÌÂÚÈÓ‹ Ú·ÎÙÈ΋ ·ÓÙÈÌÂÙÒÈÛ˘ ÙˆÓ ÂÁ·ˆÓ
0,55
50%
0,45
40%
63% 0,35
30%
55% 45% 36%
0,15
15% 5% 7%
10% 0%
0,05
¡ÂÔÁÓ¿
µÚ¤ÊË
1973-1985
-0,05 1973-1985
1986-2001
∂ÈÎfiÓ· 6. ∞ÏÏ·Á¤˜ ÛÙÔÓ ·ÚÈıÌfi ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ·Ú·¤ÌÊıËÎ·Ó Û ۯ¤ÛË Ì ÙÔÓ ÙfiÔ ‰È·ÌÔÓ‹˜ ÚÈÓ Î·È ÌÂÙ¿ ÙÔ 1985 (·گ›·: p<0,05, £ÂÛÛ·ÏÔÓ›ÎË: p<0,05).
39%
24% 23% 23%
20%
0,25
464
∂·Ú¯›· £ÂÛÛ·ÏÔÓ›ÎË
26% 17% 7%
¶·È‰È¿ ¡ÂÔÁÓ¿ µÚ¤ÊË
7%4% ¶·È‰È¿
1986-2001
∂ÈÎfiÓ· 7. ∞ÏÏ·Á¤˜ ÛÙÔÓ ·ÚÈıÌfi ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ·Ú·¤ÌÊıËÎ·Ó Û ۯ¤ÛË Ì ÙËÓ ËÏÈΛ· Î·È ÙÔÓ ÙfiÔ ‰È·ÌÔÓ‹˜ ÚÈÓ Î·È ÌÂÙ¿ ÙÔ 1985 (ÓÂÔÁÓ¿ ·fi ÙËÓ Â·Ú¯›·: p<0,001, ‚Ú¤ÊË ·fi ÙË £ÂÛÛ·ÏÔÓ›ÎË: p<0,005).
¶·È‰È·ÙÚÈ΋ 2003;66:461-466
Paediatriki 2003;66:461-466
Á˘Ó·ÈÎÒÓ Ì ˘„ËÏfi ΛӉ˘ÓÔ ÁÈ· ¯ÚˆÌÔÛˆÌÈÎfi Úfi‚ÏËÌ· ÛÙË µfiÚÂÈ· ∂ÏÏ¿‰·. ∆Ô Û˘ÁÎÂÎÚÈ̤ÓÔ ÂÚÁ·ÛÙ‹ÚÈÔ Û˘ÛÙÂÁ¿˙ÂÙ·È ÛÙÔ ›‰ÈÔ ÓÔÛÔÎÔÌÂ›Ô Ì fiϘ ÙȘ Ì·È¢ÙÈΤ˜ ÎÏÈÓÈΤ˜ ÙÔ˘ ∞.¶.£. Î·È ·fi fi,ÙÈ ‹Ù·Ó ÁÓˆÛÙfi ‰ÂÓ ˘‹Ú¯Â ·ÔÛÙÔÏ‹ ‰ÂÈÁÌ¿ÙˆÓ ·ÌÓÈ·ÎÔ‡ ˘ÏÈÎÔ‡ Û ȉȈÙÈο ÂÚÁ·ÛÙ‹ÚÈ· ÂÓÙfi˜ Î·È ÂÎÙfi˜ ∂ÏÏ¿‰·˜ ÙËÓ ›‰È· ÂÚ›Ô‰Ô. ªÂ ·˘Ù¿ Ù· ‰Â‰Ô̤ӷ ÂÎÙÈÌ‹ıËÎÂ Ë Û˘Ì‚ÔÏ‹ Ù˘ ÌÂϤÙ˘ ÛÙÔÓ ‚ÔÚÂÈÔÂÏÏ·‰ÈÎfi ¯ÒÚÔ, fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ Âη›‰Â˘ÛË ÙˆÓ ·È‰È¿ÙÚˆÓ Î·È ÙˆÓ Ì·ÈÂ˘Ù‹ÚˆÓ. ¶ÚÈÓ ·fi ÙÔ 1985, ÏÈÁfiÙÂÚ· ·fi Ù· ÌÈÛ¿ ·È‰È¿ Ô˘ ·Ú·¤ÌÊıËÎ·Ó ‹Ù·Ó ÓÂÔÁÓ¿ (47%), 37% ‹Ù·Ó ‚Ú¤ÊË Î·È ÌfiÓÔÓ 11% ‹Ù·Ó ËÏÈΛ·˜ ÌÂÁ·Ï‡ÙÂÚ˘ ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜. ªÂÙ¿ ÙÔ 1986, fï˜, Ù· ÓÂÔÁÓ¿ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ÂÚÈÛÛfiÙÂÚ· (65%, p=0,001), Ù· ‚Ú¤ÊË ÛËÌ·ÓÙÈο ÏÈÁfiÙÂÚ· (24%, p<0,005), ÂÓÒ ÙÔ ÔÛÔÛÙfi ÙˆÓ ·È‰ÈÒÓ Ô˘ ‹Ù·Ó ËÏÈΛ·˜ ÌÂÁ·Ï‡ÙÂÚ˘ ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜ ‰ÂÓ ÌÂÙ·‚Ï‹ıËΠ(11%) (∂ÈÎfiÓ· 5). ªÂÙ¿ ÙÔ 1986 ·Ú·ÙËÚ‹ıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ·Ú·¤ÌÊıËÎ·Ó ·fi ÙËÓ Â·Ú¯›· (·fi 55% Û 63%, p<0,05), ÂÓÒ ·ÓÙ›ıÂÙ· ·Ú·ÙËÚ‹ıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ Ì›ˆÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ·Ú·¤ÌÊıËÎ·Ó ·fi ÙËÓ fiÏË Ù˘ £ÂÛÛ·ÏÔӛ΢ (·fi 45% Û 36%, p<0,05) (∂ÈÎfiÓ· 6). ™ÙËÓ ∂ÈÎfiÓ· 7 Ê·›ÓÂÙ·È, ·ÎfiÌË, fiÙÈ ÌÂÙ¿ ÙÔ 1986 ˘‹Ú¯Â ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË ÙˆÓ ÓÂÔÁÓÒÓ Ô˘ ·Ú·¤ÌÊıËÎ·Ó ·fi ÙËÓ Â·Ú¯›· (·fi 23% Û 39%, p<0,001) Î·È ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ Ì›ˆÛË ÙˆÓ ‚ÚÂÊÒÓ Ô˘ ·Ú·¤ÌÊıËÎ·Ó ·fi ÙËÓ fiÏË Ù˘ £ÂÛÛ·ÏÔӛ΢ (·fi 15% Û 7%, p<0,005). OÈ ·ÛıÂÓ›˜ ÙˆÓ ¿ÏÏˆÓ ËÏÈÎÈÒÓ ‰ÂÓ Â›¯·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿. ∆· Â˘Ú‹Ì·Ù· Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ÂÚÌËÓ‡ıËÎ·Ó Ì ‚¿ÛË ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ì ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ÚÔÁÂÓÓËÙÈÎÔ‡ ÂϤÁ¯Ô˘ ÛÙÔ ÓÔÛÔÎÔÌ›Ô, ÔÈ ÁÈ·ÙÚÔ› Ô˘ ÂȉÈ·ÔÓÙ·È ÛÙȘ ¶·ÓÂÈÛÙËÌȷΤ˜ ÎÏÈÓÈΤ˜
¢·ÈÛıËÙÔÔÈ‹ıËÎ·Ó ÛÙËÓ ÚÒÈÌË ‰È¿ÁÓˆÛË ÙÔ˘ DS. ªÂ ÙËÓ ÚfiÔ‰Ô ÙˆÓ ÂÙÒÓ ÛÙÂϤ¯ˆÛ·Ó ÙËÓ Â·Ú¯›·, ÒÛÙ ӷ ·Ú·¤ÌÔÓÙ·È ¤ÁηÈÚ· Ù· ·È‰È¿. ∏ ‰È·›ÛÙˆÛË ·˘Ù‹ Û˘ÌʈÓ› Ì ÚÔËÁÔ‡ÌÂÓ˜ ‰ËÌÔÁÚ·ÊÈΤ˜ ÌÂϤÙ˜ ÛÙÔÓ ÂÏÏËÓÈÎfi ¯ÒÚÔ (19,20). ªÂÙ¿ ÙË ‰È¿ÁÓˆÛË, 139/533 ·ÛıÂÓ›˜ ÂÓÙ¿¯ıËÎ·Ó ÛÙÔ ÚfiÁÚ·ÌÌ· ÚˆÙÔ‚¿ıÌÈ·˜ ·Ú·ÎÔÏÔ‡ıËÛ˘ ·È‰ÈÒÓ Ì DS ÛÙ· ÂȉÈο Â͈ÙÂÚÈο È·ÙÚ›·. ∞ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó ÔÚÁ·ÓÈο ÚÔ‚Ï‹Ì·Ù· ηٿ ÙË ÓÂÔÁÓÈ΋ ÂÚ›Ô‰Ô (Û˘ÁÁÂÓ›˜ ηډÈÔ¿ıÂȘ, Û˘ÁÁÂÓ‹˜ ηٷÚÚ¿ÎÙ˘, ·ÙÚËÛ›· ‰ˆ‰Âη‰·ÎÙ‡ÏÔ˘, Û˘ÁÁÂÓ‹˜ ˘Ôı˘ÚÂÔÂȉÈÛÌfi˜), ÂÓËÌÂÚÒıËÎ·Ó ÔÈ ÁÔÓ›˜ ÁÈ· ÙȘ ‰È·Ù·Ú·¯¤˜ Ô˘ Â›Ó·È Û˘¯ÓfiÙÂÚ˜ ÛÙ· ·È‰È¿ Ì DS Î·È ÙÔ˘˜ ‰fiıËÎ·Ó Ô‰ËÁ›Â˜ ÁÈ· ÙËÓ ¤ÓÙ·ÍË ÙˆÓ ·È‰ÈÒÓ Û ÂȉÈο ÚÔÁÚ¿ÌÌ·Ù· Âη›‰Â˘Û˘ (3,15-16). ∏ÏÈÎȷο, ÔÈ ÂÚÈÛÛfiÙÂÚ˜ ÌËÙ¤Ú˜ ‹Ù·Ó Ӥ˜. ∏ ̤ÛË ËÏÈΛ· ÙˆÓ ÌËÙ¤ÚˆÓ ‹Ù·Ó Ù· 30,5 ¤ÙË Î·È ÙˆÓ ·Ù¤ÚˆÓ Ù· 34 ¤ÙË. ∆Ô 78% ÙˆÓ ÌËÙ¤ÚˆÓ ÛÙË ‰È¿ÚÎÂÈ· fiÏˆÓ ÙˆÓ ÂÙÒÓ Û˘ÓÔÏÈο ›¯Â ËÏÈΛ· ÌÈÎÚfiÙÂÚË ÙˆÓ 35 ÂÙÒÓ Î·È ÌfiÓÔ ÙÔ 22% ›¯Â ËÏÈΛ· ÌÂÁ·Ï‡ÙÂÚË ÙˆÓ 35 ÂÙÒÓ (∂ÈÎfiÓ· 8). ∆· ÔÛÔÛÙ¿ ‰ÂÓ ÌÂÙ·‚Ï‹ıËÎ·Ó ÌÂÙ¿ ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ÚÔÁÂÓÓËÙÈÎÔ‡ ÂϤÁ¯Ô˘, ‰ËÏ·‰‹ ÚÈÓ ·fi ÙÔ 1985 ÙÔ 72% ÙˆÓ ÌËÙ¤ÚˆÓ ‹Ù·Ó ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ 35 ÂÙÒÓ Î·È ÌÂÙ¿ ÙÔ 1986 ÙÔ 80% ÙˆÓ ÌËÙ¤ÚˆÓ ‹Ù·Ó ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ 35 ÂÙÒÓ. ∆Ô ÔÛÔÛÙfi ÙˆÓ ÌËÙ¤ÚˆÓ ËÏÈΛ·˜ ÌÂÁ·Ï‡ÙÂÚ˘ ÙˆÓ 35 ÂÙÒÓ ‹Ù·Ó 27% Î·È ¤ÁÈÓ 20%, ·ÓÙ›ÛÙÔȯ· (‰È·ÊÔÚ¿ ÌË ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋). ™Ù·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË ˘‹ÚÍ ÌfiÓÔ ÛÙÔÓ ·ÚÈıÌfi ÙˆÓ ÌËÙ¤ÚˆÓ ËÏÈΛ·˜ 2530 ÂÙÒÓ (·fi 24% Û 37%, p=0,006) (∂ÈÎfiÓ· 9). ∞˘Ù‹ Ë ·Ú·Ù‹ÚËÛË ÂȂ‚·ÈÒÓÂÈ ÙË ÁÓÒÛË fiÙÈ Ù· ÂÚÈÛÛfiÙÂÚ· ·È‰È¿ Ì DS ÁÂÓÓÈÔ‡ÓÙ·È ·fi Á˘Ó·›Î˜ Ó¤ˆÓ ËÏÈÎÈÒÓ (<35 ÂÙÒÓ), ÛÙȘ Ôԛ˜ ‰ÂÓ ˘¿Ú¯ÂÈ ¤Ó‰ÂÈÍË ÂÂÌ‚·ÙÈ΋˜ ÌÂıfi‰Ô˘ ÚÔÁÂÓÓËÙÈ΋˜ ‰È¿ÁÓˆÛ˘ (·ÌÓÈԷڷΤÓÙËÛ˘ ‹ Ï¿¯Ó˘), ·Ú¿ ÌfiÓÔ Ù· screening tests ÙÔ˘ 1Ô˘ Î·È 2Ô˘ ÙÚÈÌ‹ÓÔ˘ (˘ÂÚ˯ÔÁÚ·ÊÈο Î·È ÔÚÔÏÔÁÈο), Ù· ÔÔ›·
40% 35%
32%
30% 25%
23%
23%
22%
20% 15% 10% 5% 0% <25
25-30
31-35
>35
∂ÈÎfiÓ· 8. ∏ÏÈÎȷ΋ ηٷÓÔÌ‹ ÙˆÓ ÌËÙ¤ÚˆÓ Î·Ù¿ ÙÔÓ ÙÔÎÂÙfi.
45% 40% 35% 30% 25% 20% 15% 10% 5% 0%
<25 25-30 31-35 >35 37% 28% 24%
19% 20% 27%
24% 20%
1973-1985 1986-2001 ∂ÈÎfiÓ· 9. ∞ÏÏ·Á‹ ÛÙËÓ ËÏÈÎȷ΋ ηٷÓÔÌ‹ ÙˆÓ ÌËÙ¤ÚˆÓ Î·Ù¿ ÙÔÓ ÙÔÎÂÙfi ÚÈÓ Î·È ÌÂÙ¿ ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ÚÔÁÂÓÓËÙÈÎÔ‡ ÂϤÁ¯Ô˘ (ÌËÙ¤Ú˜ <25 ÂÙÒÓ: ¡S, ÌËÙ¤Ú˜ 31-35 ÂÙÒÓ: NS, ÌËÙ¤Ú˜ 25-30 ÂÙÒÓ: p=0,006, ÌËÙ¤Ú˜ >35 ÂÙÒÓ: NS).
465
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Paediatriki 2003;66:461-466
ˆ˜ ÁÓˆÛÙfiÓ ‰ÂÓ Â›Ó·È ‰È·ÁÓˆÛÙÈο ·ÛÊ·Ï‹ (12-14). ™˘ÌÂÚ·›ÓÂÙ·È, ÏÔÈfiÓ, fiÙÈ ı· Ú¤ÂÈ Ó· ·Ó·˙ËÙËıÔ‡Ó Î·È Ó· ÂÊ·ÚÌÔÛÙÔ‡Ó ·ÍÈfiÈÛÙ˜ ÌË ÂÂÌ‚·ÙÈΤ˜ ̤ıÔ‰ÔÈ Ì ÌÈÎÚfi ÔÛÔÛÙfi „¢‰Ò˜ ıÂÙÈÎÔ‡ ·ÔÙÂϤÛÌ·ÙÔ˜, ÔÈ Ôԛ˜ ı· ÂÈϤÁÔ˘Ó ÙȘ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ Ó·ڤ˜ ¤ÁÎ˘Â˜, ÒÛÙ ·˘Ù¤˜ ÂÎÏÂÎÙÈο Ó· ˘Ô‚¿ÏÏÔÓÙ·È Û ÂÂÌ‚·ÙÈΤ˜ ÌÂıfi‰Ô˘˜ ÚÔÁÂÓÓËÙÈ΋˜ ‰È¿ÁÓˆÛ˘ (12-14,21-23).
13.
∂˘¯·ÚÈÛٛ˜
14.
£ÂṲ́˜ ¢¯·ÚÈÛٛ˜ ÛÙȘ ·Ú·Û΢¿ÛÙÚȘ Î.Î. ¢. ∑·ÁηڤÙÔ˘ Î·È ∑. OÓÔ˘ÊÚÈ¿‰Ô˘ ÁÈ· ÙË Û˘Ì‚ÔÏ‹ ÙÔ˘˜ ÛÙÔ Ù¯ÓÈÎfi ̤ÚÔ˜ Ù˘ ÂÚÁ·Û›·˜.
µÈ‚ÏÈÔÁÚ·Ê›· 1. Antonarakis SE, Down Syndrome Collaborative Group. Parental origin of the extra chromosome in trisomy 21 as indicated by analysis of DNA polymorphisms. N Engl J Med 1991;324:872-876. 2. Baird PA, Sadovnick AD. Life tables for Down syndrome. Hum Genet 1989;82:291-292. 3. Hayes A, Batshaw ML. Down syndrome. Clin Pediatr 1993;40:699-715. 4. Hassold TJ, Jacobs PA. Trisomy in man. Annu Rev Genet 1984;18:69-97. 5. Antonarakis SE, Adelsberger PA, Petersen MB, Binkert F, Schinzel AA. Analysis of DNA polymorphisms suggests that most de novo dup(21q) chromosomes in patients with Down syndrome are isochromosomes and not translocations. Am J Hum Genet 1990;47:968-972. 6. Petersen MB, Adelsberger PA, Schinzel AA, Binkert F, Hinkel GK, Antonarakis SE. Down syndrome due to de novo Robertsonian translocation t(14q;21q): DNA polymorphism analysis suggests that the origin of the extra 21q is maternal. Am J Hum Genet 1991;49:529-536. 7. Davies KE, Harper K, Bonthron D, Krumlauf R, Polkey A, Pembrey ME et al. Use of a chromosome 21 cloned DNA probe for the analysis of non-disjunction in Down syndrome. Hum Genet 1984;66:54-56. 8. Antonarakis SE, Kittur SD, Metaxotou C, Watkins PC, Patel AS. Analysis of DNA haplotypes suggests a genetic predisposition to trisomy 21 associated with DNA sequences on chromosome 21. Proc Natl Acad Sci USA 1985;82:3360-3364. 9. Gardiner K, Horisberger M, Kraus J, Tantravahi U, Korenberg J, Rao V et al. Analysis of human chromosome 21: correlation of physical and cytogenetic maps; gene and CpG island distributions. Embo J 1990;9:25-34. 10. Petersen MB, Slaugenhaupt SA, Lewis JD, Warren AC, Chakravarti A, Antonarakis SE. A genetic linkage map of 27 markers on human chromosome 21. Genomics 1991;9:407419. 11. Carothers AD. Down syndrome and maternal age: the effect of erroneous assignment of parental origin. Am J Hum Genet 1987;40:147-150. 12. ¶··ÓÙˆÓ›Ô˘ ¡, ¢·ÛηϿ΢ °, µfiÁÁ·˜ ∂, ªÂÛÔÁ›Ù˘ ™,
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23.
∫Ô‡ÙÚ· ¶, ÃÚÈÛÙÔÊÔÚ¿ÎË ª Î·È Û˘Ó. ¶ÚÔÁÂÓÓËÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÁÈ· Û‡Ó‰ÚÔÌÔ Down Ì ÙË ¯Ú‹ÛË ‚ÈÔ¯ËÌÈÎÒÓ ‰ÂÈÎÙÒÓ. ∏ ÂÌÂÈÚ›· ·fi Ì›· ÌÂÁ¿ÏË Ì·È¢ÙÈ΋ ÌÔÓ¿‰·. ∂ÊË‚ °˘Ó ∞Ó· ∂ÌÌËÓ 2001;13:299-303. ∞ÓÙˆÓÈ¿‰Ë˜ ™, ¶·ÏÈÔ‡ÚË ∫, ¶··‰¿ÎÔ˘ ∞, ª›Ù˙ÈÔ˘ °, ∫·Ú‚ÂÏ¿ ∞, ¶¿ÁηÏÔ˜ ∫ Î·È Û˘Ó. O ÚfiÏÔ˜ ÙÔ˘ a-test (‚ÈÔ¯ËÌÈÎÔ› ‰Â›ÎÙ˜: AFP, HCG, UE3 ÛÙÔÓ ÌËÙÚÈÎfi ÔÚfi) ÛÙËÓ ·Ó›¯Ó¢ÛË Û˘ÁÁÂÓÒÓ ·ÓˆÌ·ÏÈÒÓ ÙÔ˘ ÂÌ‚Ú‡Ô˘ [¶ÂÚ›ÏË„Ë]. 37Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ; 1999 28-30 ª·˝Ô˘; £ÂÛÛ·ÏÔÓ›ÎË; 1999. ÛÂÏ. 148. #285∞∞. µÔÁÈ·˙·Ófi˜ ª, ∞ÚÁ˘Ú›Ô˘ ∞, ∫fiÏÔÎÔ˜ °, °·‚ÚÈ‹Ï ™, ∆ÈÁÁÈÚ›‰Ô˘ ª. µÈÔ¯ËÌÈÎfi ·ÓȯÓ¢ÙÈÎfi ÚfiÁÚ·ÌÌ· ÁÈ· ÙÔ Û‡Ó‰ÚÔÌÔ Down ·fi ÙÔ Î¤ÓÙÚÔ ÚfiÏ˄˘ ÓÂ˘Ì·ÙÈ΋˜ ηı˘ÛÙ¤ÚËÛ˘ [¶ÂÚ›ÏË„Ë]. 36Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ; 1998 5-7 πÔ˘Ó›Ô˘; ¶¿ÊÔ˜; 1998. ÛÂÏ. 76. #136∂∞. Saenz RB. Primary care of infants and young children with Down syndrome. Am Fam Physician 1999;59:381-390, 392, 395-396. American Academy of Pediatrics, Committee on Genetics. Health supervision for children with Down syndrome. Pediatrics 2001;107:442-449. Kovaleva NV, Butomo IV, Verlinskaia DK, Il’iashenko TN, Pantova IG, Prozorova MV et al. Karyological characteristics of Down’s syndrome: clinical and theoretical aspects. Tsitologiia 1999;41:1014-1021. ¶¿ÁηÏÔ˜ ∫. ¡¤· ‰Â‰Ô̤ӷ ÛÙË ÁÂÓÂÙÈ΋ ηıÔ‰‹ÁËÛË ÔÈÎÔÁÂÓÂÈÒÓ Ì ÙÚÈۈ̛· 21 (Û‡Ó‰ÚÔÌÔ Down) ·fi ÌÂϤÙ˜ ÌÔÚȷ΋˜ ÁÂÓÂÙÈ΋˜ [¶ÂÚ›ÏË„Ë]. 31Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ; 1993 4-6 πÔ˘Ó›Ô˘; ∫·ÛÛ¿Ó‰Ú·, ÷ÏÎȉÈ΋; 1993. #195∞. Mavrou A, Metaxotou C, Trichopoulos D. Awareness and use of prenatal diagnosis among Greek women: a national survey. Prenat Diagn 1998;18:349-355. ª·Ú·ÁÎfi˜ Ã, µ·Ï¿ÛÛË-∞‰¿Ì ∂. ¶ÚÔÁÂÓÓËÙÈÎfi˜ Î·È ÚÔÛ˘Ìو̷ÙÈÎfi˜ ÁÂÓÂÙÈÎfi˜ ¤ÏÂÁ¯Ô˜: ·fi„ÂȘ ·È‰È¿ÙÚˆÓ. ¶·È‰È·ÙÚÈ΋ 1999;62:490-498. ∫ÔÏȷϤÍË ∞, ª·ÎԇϷ˜ µ, ¶·Ó·ÁȈÙÔÔ‡ÏÔ˘ ¶, ¢·Ê¤ÚÌÔ˘ ∂, ª·‡ÚÔ˘ ∞, ªÂٷ͈ÙÔ‡ ∞. In situ ˘‚ÚȉÈÛÌfi˜ ·ÌÓÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ [¶ÂÚ›ÏË„Ë]. 34Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ; 1996 31 ª·˝Ô˘ & 1-2 πÔ˘Ó›Ô˘; ƒfi‰Ô˜; 1996. #307∞. ª·‡ÚÔ˘ ∞, ∫ÔÏȷϤÍË ∞, ∆Û¿ÁηÚ˘ °, ∞ÓÙÛ·ÎÏ‹˜ ∞, ¢·Ê¤ÚÌÔ˘ ∂, ∆ÛÂÁ΋ Ã Î·È Û˘Ó. ∞ÔÌfiÓˆÛË ÂÌ‚Ú˘˚ÎÒÓ Î˘ÙÙ¿ÚˆÓ ·fi ÙË ÌËÙÚÈ΋ ΢ÎÏÔÊÔÚ›· Ì ̷ÁÓËÙÈÎfi ‰È·¯ˆÚÈÛÌfi, ·ÓÔÛÔÊ·ÈÓÔÙ˘È΋ ¯ÚÒÛË Î·È FISH. °ÂÓÂÙÈ΋ ÙÔ˘ ∞ÓıÚÒÔ˘ 1999;1:40-46. ∫·ÌÔ˘Ú¿Î˘ °, ∫ÔÓÙÔÁÈ¿ÓÓË ∂. ¶ÚÔÂÌÊ˘Ù¢ÙÈ΋ ‰È¿ÁÓˆÛË ÙˆÓ ÁÂÓÂÙÈÎÒÓ ÓÔÛËÌ¿ÙˆÓ: ÂÈÙ‡ÁÌ·Ù· Î·È ÌÂÏÏÔÓÙÈΤ˜ ÚÔÔÙÈΤ˜. ∂ÊË‚ °˘Ó ∞Ó· ∂ÌÌËÓ 2000;12:46-54.
HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 24-01-2003 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 31-10-2003 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ÷ڛÎÏÂÈ· ÷Ù˙ËÛ‚·ÛÙÔ‡-§Ô˘Î›‰Ô˘ ∂ÚÁ·ÛÙ‹ÚÈÔ ∫˘ÙÙ·ÚÔÁÂÓÂÙÈ΋˜, ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ∞.¶.£. °¶¡ “πÔÎÚ¿ÙÂÈÔ” £ÂÛÛ·ÏÔӛ΢ ∫ˆÓÛÙ·ÓÙÈÓÔ˘fiψ˜ 49, ∆.∫. 544 62, £ÂÛÛ·ÏÔÓ›ÎË
¶·È‰È·ÙÚÈ΋ 2003;66:467-470
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Paediatriki 2003;66:467-470
CASE REPORT
∞Ó¿ÚÎÂÈ· Ù˘ ÔÚÓÈıÈÓÈ΋˜ ÙÚ·ÓÛηڂ·Ì˘Ï¿Û˘ - ˘Ô͇˜ Ù‡Ô˜. ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ™. ºÂÛÛ¿ÙÔ˘1, ∞. ∞ÙÙÈÏ¿ÎÔ˜1, ∂. ∆Û¿Ú·1, °. ª·ÚfiÔ˘ÏÔ˜2, ∂. ªÈ¯ÂϷοÎË3, ∫. ™Ô‡ÏË4
Late onset ornithine transcarbamylase deficiency. A case report S. Fessatou1, A. Attilakos1, H. Tsapra1, G. Maropoulos2, H. Michelakakis3, K. Schulpis4
¶ÂÚ›ÏË„Ë: ∏ ·Ó¿ÚÎÂÈ· Ù˘ ÔÚÓÈıÈÓÈ΋˜ ÙÚ·ÓÛηڂ·Ì˘Ï¿Û˘, Ì›· Ê˘ÏÔÛ‡Ó‰ÂÙË ‰È·Ù·Ú·¯‹, Â›Ó·È Ë ÈÔ Û˘¯Ó‹ ÎÏËÚÔÓÔÌÔ‡ÌÂÓË ÌÂÙ·‚ÔÏÈ΋ ‰È·Ù·Ú·¯‹ ÙÔ˘ ·ÎÏÔ˘ Ù˘ Ô˘Ú›·˜. ªÂϤÙ˜ ¤¯Ô˘Ó ÂÚÈÁÚ¿„ÂÈ ÙËÓ ‡·ÚÍË ·ÚÎÂÙÒÓ ‰È·ÊÔÚÂÙÈÎÒÓ ÌÂÙ·ÏϿ͈Ó, ÔÈ Ôԛ˜ ÂÓ Ì¤ÚÂÈ ÌÔÚÔ‡Ó Ó· ÂÍËÁ‹ÛÔ˘Ó ÙË Ê·ÈÓÔÙ˘È΋ ÔÈÎÈÏ›· ÛÙËÓ ¤ÎÊÚ·ÛË Ù˘ ÓfiÛÔ˘. ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÚÒÙË ÂÚ›ÙˆÛË ·ÁÔÚÈÔ‡ Ì ÌÂÙ¿ÏÏ·ÍË ∆343∫, ÙËÓ ÔÔ›· ÎÏËÚÔÓfiÌËÛ ·fi ÙË ÌËÙ¤Ú· ÙÔ˘. ÀÔÁÚ·ÌÌ›˙ÂÙ·È Ô ·Ú¯ÈÎfi˜ ‰È·ÁÓˆÛÙÈÎfi˜ ·ÔÚÔÛ·Ó·ÙÔÏÈÛÌfi˜ ÛÙËÓ ·Ú¯È΋ ÂΉ‹ÏˆÛË ÙˆÓ Û˘Ìو̿وÓ, ‰ÈfiÙÈ Ù· ÚÒÙ· Û˘ÌÙÒÌ·Ù· ÂÌÊ·Ó›ÛÙËÎ·Ó ÌÂÙ¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙˆÓ ÊÚÔ‡ÙˆÓ ÛÙË ‰È·ÙÚÔÊ‹ ÙÔ˘ ·È‰ÈÔ‡.
Abstract: Ornithine transcarbamylase deficiency, an X-linked metabolic disorder, is the most common inherited urea cycle defect. Previous reports have documented the existence of several different mutations that can explain, at least in part, the phenotypic variability of the disorder. The case is described of a male infant with T343K mutation, also present in his mother, which is described for the first time. The disorientation of the clinicians at the time of presentation of symptoms is underlined, because the patient started vomiting after fruits were added to his diet.
§¤ÍÂȘ ÎÏÂȉȿ: ·Ó¿ÚÎÂÈ· Ù˘ ÔÚÓÈıÈÓÈ΋˜ ÙÚ·ÓÛηڂ·Ì˘Ï¿Û˘, ·ÎÏÔ˜ Ù˘ Ô˘Ú›·˜, ˘ÂÚ·Ì̈ÓÈ·ÈÌ›·.
Key words: ornithine transcarbamylase deficiency, urea cycle, hyperammonaemia.
™˘ÓÙÔÌÔÁڷʛ˜
∂ÈÛ·ÁˆÁ‹ ∏ ·Ó¿ÚÎÂÈ· Ù˘ ÔÚÓÈıÈÓÈ΋˜ ÙÚ·ÓÛηڂ·Ì˘Ï¿Û˘ (O∆C) Â›Ó·È Ë ÈÔ Û˘¯Ó‹ ÎÏËÚÔÓÔÌÔ‡ÌÂÓË ‰È·Ù·Ú·¯‹ ÙÔ˘ ·ÎÏÔ˘ Ù˘ Ô˘Ú›·˜. ∫ÏËÚÔÓÔÌÂ›Ù·È Ì ÂÈÎÚ·ÙËÙÈÎfi Ê˘ÏÔÛ‡Ó‰ÂÙÔ Ù‡Ô Î·È, fiˆ˜ Î·È ÔÈ ¿ÏϘ ·Ó¿ÚÎÂȘ ÂÓ˙‡ÌˆÓ ÙÔ˘ ·ÎÏÔ˘ Ù˘ Ô˘Ú›·˜, ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÎÏÈÓÈο ÛËÌ›· Î·È Û˘-
ÌÙÒÌ·Ù· Ô˘ Â›Ó·È ·ÔÙ¤ÏÂÛÌ· Ù˘ ¿ıÚÔÈÛ˘ ÌÂÙ·‚ÔÏÈÙÒÓ Ù˘ Ô˘Ú›·˜, ΢ڛˆ˜ ·Ì̈ӛ·˜ Î·È ÁÏÔ˘Ù·Ì›Ó˘. ∏ ÛÔ‚·ÚfiÙÂÚË ÎÏÈÓÈ΋ ÂΉ‹ÏˆÛË Ù˘ ÓfiÛÔ˘ Û˘Ì‚·›ÓÂÈ Û ¿Û¯ÔÓÙ· ¿ÚÚÂÓ· ÓÂÔÁÓ¿ Î·È ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÔ ˘ÂÚ·Ì̈ÓÈ·ÈÌÈÎfi ÎÒÌ· Î·È ÙÔÓ ı¿Ó·ÙÔ. O ˘Ô͇˜ Ù‡Ô˜ (late onset) ÂΉËÏÒÓÂÙ·È Û ¿ÚÚÂÓ˜ Ì ÌÂÚÈ΋ ÂÓ˙˘ÌÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· Î·È Û ı‹Ï· Ô˘ Â›Ó·È ÂÙÂÚÔ˙˘ÁÒÙ˜ Ù˘ ÓfiÛÔ˘ (1,2). O ÎÏÈÓÈÎfi˜ Î·È Ô ‚ÈÔ¯ËÌÈÎfi˜ Ê·ÈÓfiÙ˘Ô˜ ¤¯ÂÈ ÌÂÁ¿ÏÔ Â‡ÚÔ˜ ÂΉËÏÒÛÂˆÓ Î·È ÌÔÚ› ÌfiÓÔ ÌÂÚÈÎÒ˜ Ó· ÂÍËÁËı› ·fi ÙÔÓ ÁÔÓfiÙ˘Ô (3).
1 µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó· 2 µÈÔ¯ËÌÈÎfi ∆Ì‹Ì·, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó· 3 ∆Ì‹Ì· ∂Ó˙˘ÌÔÏÔÁ›·˜, πÓÛÙÈÙÔ‡ÙÔ ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “AÁ. ™ÔÊ›·”, ∞ı‹Ó· 4 ∆Ì‹Ì· ªÂÙ·‚ÔÏÈÎÒÓ ¡ÔÛËÌ¿ÙˆÓ, πÓÛÙÈÙÔ‡ÙÔ ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “AÁ. ™ÔÊ›·”, ∞ı‹Ó·
1 2nd Paediatric Clinic, “P. & A. Kyriakou” Children’s Hospital, Athens 2 Department of Biochemistry, “P. & A. Kyriakou” Children’s Hospital, Athens 3 Department of Enzymology, Institute of Child Health, “Aghia Sophia” Children’s Hospital, Athens 4 Department of Metabolic Diseases, Institute of Child Health, “Aghia Sophia” Children’s Hospital, Athens
OTC °O¶
OÚÓÈıÈÓÈ΋ ÙÚ·ÓÛηڂ·Ì˘Ï¿ÛË °·ÛÙÚÔÔÈÛÔÊ·ÁÈ΋ ·ÏÈÓ‰ÚfiÌËÛË
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¶·È‰È·ÙÚÈ΋ 2003;66:467-470
∆Ô ÁÔÓ›‰ÈÔ Ù˘ OTC ¤¯ÂÈ ‚ÚÂı› ÛÙÔ ‚Ú·¯‡ ÛΤÏÔ˜ ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ Ã, ÛÙË ı¤ÛË p21.1 Î·È ¤¯ÂÈ ÌÂÏÂÙËı› ·fi ÙÔ˘˜ Horwich Î·È Û˘Ó Î·È ÙÔ˘˜ Hata Î·È Û˘Ó. ¶ÚfiÎÂÈÙ·È ÁÈ· ¤Ó· ÙÚÈÌÂÚ¤˜ Ô˘ ·ÔÙÂÏÂ›Ù·È ·fi 322 ·ÌÈÓÔͤ· Î·È ¤¯ÂÈ ÌÔÚÈ·Îfi ‚¿ÚÔ˜ ÂÚ›Ô˘ 36000 Daltons ·Ó¿ ÔÏ˘ÂÙȉÈ΋ ·Ï˘Û›‰· (4,5). ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ¿ÚÚÂÓÔ˜ ‚Ú¤ÊÔ˘˜ Ì ·Ó¿ÚÎÂÈ· OTC, Ô˘ ÂΉËÏÒıËΠ۠ËÏÈΛ· 6 ÌËÓÒÓ, Û˘Á¯ÚfiÓˆ˜ Ì ÙËÓ ÂÈÛ·ÁˆÁ‹ ÊÚÔ‡ÙˆÓ ÛÙË ‰È·ÙÚÔÊ‹ ÙÔ˘. ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ¶ÚfiÎÂÈÙ·È ÁÈ· ¤Ó· ·ÁfiÚÈ Ô˘ ÁÂÓÓ‹ıËΠÌÂÙ¿ ·fi Ê˘ÛÈÔÏÔÁÈ΋ ·ËÛË Î·È ÙÔÎÂÙfi, Ì ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ 3350 g. ∏ ÂÚÈÁÂÓÓËÙÈ΋ ÂÚ›Ô‰Ô˜ ‹Ù·Ó ¯ˆÚ›˜ ÚÔ‚Ï‹Ì·Ù· Î·È Ë ·Ó¿Ù˘Í‹ ÙÔ˘ Ôχ ηϋ ̤¯ÚÈ ÙËÓ ËÏÈΛ· ÙˆÓ 6 ÌËÓÒÓ. ™Â ·˘Ù‹ ÙËÓ ËÏÈΛ· ÚÔÛÙ¤ıËÎ·Ó ÊÚÔ‡Ù· ÛÙË ‰È·ÙÚÔÊ‹ ÙÔ˘ Î·È ¿Ú¯ÈÛ ӷ ÂÌÊ·Ó›˙ÂÈ Â̤ÙÔ˘˜. ŒÁÈÓ ¤ÏÂÁ¯Ô˜ Ì ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÔÈÛÔÊ¿ÁÔ˘-ÛÙÔÌ¿¯Ô˘ ÁÈ· Èı·Ó‹ Á·ÛÙÚÔÔÈÛÔÊ·ÁÈ΋ ·ÏÈÓ‰ÚfiÌËÛË (°O¶) Î·È Ë ÂͤٷÛË ¤‰ÂÈÍ ¢Ú›· °O¶. ∂Ù¤ıË ·ÁˆÁ‹ ÁÈ· ÙË °O¶ Ì ÛÈ˙·Ú›‰Ë Î·È ÔÈ ¤ÌÂÙÔÈ ‚ÂÏÙÈÒıËηÓ. ™Â ËÏÈΛ· 7 ÌËÓÒÓ ÂÌÊ¿ÓÈÛ ·ÈÊÓ›‰È· ÂÂÈÛfi‰È· ÌÂ Û˘Ó¯fiÌÂÓÔ˘˜ Â̤ÙÔ˘˜, ηٿÛÙ·ÛË Ô˘ Ô‰‹ÁËÛ ÙÔ˘˜ ÁÔÓ›˜ Ó· ʤÚÔ˘Ó ÙÔ ·È‰› ÛÙÔ ÓÔÛÔÎÔÌ›Ô. ∫·Ù¿ ÙËÓ ÎÏÈÓÈ΋ ÂͤٷÛË ‰ÂÓ ‰È·ÈÛÙÒıËΠοÙÈ ÙÔ ·ıÔÏÔÁÈÎfi, ÏËÓ ·ÒÏÂÈ·˜ ‚¿ÚÔ˘˜ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÙÂÏÂ˘Ù·›ˆÓ ‰‡Ô ‚‰ÔÌ¿‰ˆÓ. O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍ ·˘ÍË̤ÓË ·Ì̈ӛ· (250 Ìg/dl), ·ıÔÏÔÁÈΤ˜ ÂÍÂÙ¿ÛÂȘ ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ·˜ ‹·ÙÔ˜ (SGOT: 835 U/L, SGPT: 1490 U/L, PT: 39,9 sec, PTTK: 62,6 sec, INR: 4,09) Î·È ·˘ÍË̤ӷ ›‰· ÛÙ· Ô‡Ú· ÔÚÔÙÈÎÔ‡ ÔͤԘ (>1900 Ìmol/mmol creatinine, Ê.Ù.: <13) Î·È Ô˘Ú·Î›Ï˘. ™ÙÔ ·ÌÈÓfiÁÚ·ÌÌ· ·›Ì·ÙÔ˜ ·ÚÔ˘Û›·˙ ·˘ÍË̤ӷ ›‰· ÁÏÔ˘Ù·Ì›Ó˘ (35,64 mg/dl, Ê.Ù.: 8,4-10,8), Ï˘Û›Ó˘ (7,14 mg/dl, Ê.Ù.: 1,65-3,05), ·Û·ÚÙÈÎÔ‡ (1,57 mg/dl, Ê.Ù.: 0,29-0,51) Î·È ÌÂıÂÈÔÓ›Ó˘ (2,97 mg/dl, Ê.Ù.: 0,17-0,43) Î·È ÂÏ·Ùو̤ӷ ›‰· ÎÈÙÚÔ˘ÏÏ›Ó˘ Î·È ·ÚÁÈÓ›Ó˘. O ¤ÏÂÁ¯Ô˜ ÁÈ· ‰È·Ù·Ú·¯‹ ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ Ù˘ ÊÚÔ˘ÎÙfi˙˘ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÓÔÛËÏ›·˜ ÙÔ˘, ÙÔ ·È‰› ÂÌÊ¿ÓÈÛ ÂÚ·ÈÙ¤Úˆ ·‡ÍËÛË Ù˘ ·Ì̈ӛ·˜ (700 Ìg/dl) Î·È ÙˆÓ ÙÚ·ÓÛ·ÌÈÓ·ÛÒÓ (SGOT: 2500 U/L, SGPT: 2200 U/L). ªÂÙ¿ ·fi ·˘Ù¿ Ù· Â˘Ú‹Ì·Ù·, Ë ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ÚÔÛ·Ó·ÙÔÏ›ÛÙËΠ۠‰È·Ù·Ú·¯¤˜ ÙÔ˘ ·ÎÏÔ˘ Ù˘ Ô˘Ú›·˜. ŒÁÈÓ ‚ÈÔ„›· ‹·ÙÔ˜ ‰È¿ ‚ÂÏfiÓ˘ ·Ì¤Ûˆ˜ ÌfiÏȘ ‚ÂÏÙÈÒıËÎÂ Ë Ë·ÙÈ΋ ÏÂÈÙÔ˘ÚÁ›·, fiÔ˘ ÂȂ‚·ÈÒıËÎÂ Ë ÌÂȈ̤ÓË ÂÓ˙˘ÌÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ OTC: i) ‰Ú·ÛÙËÚÈfiÙËÙ· OTC: 1,1 Ìmol/mg/h (Ê.Ù.: 13-43) Î·È ii) ‰Ú·ÛÙËÚÈfiÙËÙ· ηڂ·Ì˘ÏÔʈÛÊÔÚÈ΋˜ Û˘ÓıÂÙ¿Û˘ (CPS): 4,61 Ìmol/mg/h (Ê.Ù.: 0,65,5). ∏ Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘
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Paediatriki 2003;66:467-470
(MRI) ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋. £Âڷ¢ÙÈο, ÛÙËÓ ÎÚ›ÛË Ù˘ ˘ÂÚ·Ì̈ÓÈ·ÈÌ›·˜ ¯ÔÚËÁ‹ıËÎ·Ó ÂÓ‰ÔÊÏ‚›ˆ˜ ˘ÁÚ¿, ıÂÚÌȉÈ΋ Î¿Ï˘„Ë Ì ۷ί·ÚÔ‡¯· ˘ÁÚ¿, ÊÚ¤ÛÎÔ Î·Ù„˘Á̤ÓÔ Ï¿ÛÌ·, ‚ÂÓ˙Ô˚Îfi Ó¿ÙÚÈÔ, L-·ÚÁÈÓ›ÓË Î·È L-ηÚÓÈÙ›ÓË Î·È ¤ÁÈÓ ÛÙ¤ÚËÛË ÚˆÙÂ˚ÓÒÓ. ∆· ›‰· Ù˘ ·Ì̈ӛ·˜ ÛÙÔ Ï¿ÛÌ· ¤ÊÙ·Û·Ó ÛÙ· Ê˘ÛÈÔÏÔÁÈο ›‰· ÌÂÙ¿ ·fi 7 Ë̤Ú˜ Î·È Ë Ë·ÙÈ΋ ÏÂÈÙÔ˘ÚÁ›· ·ÔηٷÛÙ¿ıËΠÌÂÙ¿ ·fi 20 Ë̤Ú˜. ∞fi ÙfiÙÂ, ÙÔ ·È‰› ‚Ú›ÛÎÂÙ·È Û ‰›·ÈÙ· Ì ¯·ÌËÏ‹ ÚfiÛÏË„Ë ÚˆÙ½Ó˘ (~2 g/kg/24ˆÚÔ). ÃÔÚËÁÔ‡ÓÙ·È Ù· ··Ú·›ÙËÙ· ·ÌÈÓÔͤ·, ‚Èٷ̛Ә, ¿Ï·Ù· Î·È È¯ÓÔÛÙÔȯ›· Ì ÙË ÌÔÚÊ‹ ȉÈÔÛ΢·ÛÌ¿ÙˆÓ (UCD), Û˘Ìϋڈ̷ ıÂÚÌ›‰ˆÓ Ì caloreen Î·È ‚ÂÓ˙Ô˚Îfi Ó¿ÙÚÈÔ. ∆Ô ·È‰› ‚Ú›ÛÎÂÙ·È Û Ôχ ηϋ ÁÂÓÈ΋ ηٿÛÙ·ÛË Î·È Ë „˘¯ÔÎÈÓËÙÈ΋ ÙÔ˘ ÂͤÏÈÍË Â›Ó·È Ì¤¯ÚÈ ÙÒÚ· Û¯ÂÙÈο ηϋ (˘¿Ú¯ÂÈ Ì›· Û¯ÂÙÈ΋ ηı˘ÛÙ¤ÚËÛË Î·Ù¿ 6 ÂÚ›Ô˘ Ì‹Ó˜). ∏ ÁÂÓÂÙÈ΋ ·Ó¿Ï˘ÛË ÙÔ˘ ·ÛıÂÓÔ‡˜ ¤‰ÂÈÍ ÌÂÙ¿ÏÏ·ÍË c a ÛÙÔ ÂÍfiÓÈÔ 10 ÙÔ˘ ÁÔÓȉ›Ô˘ Ù˘ OTC. ∞˘Ù‹ Ë ·ÏÏ·Á‹ Â›Ó·È ·ÔÙ¤ÏÂÛÌ· Ù˘ ·ÓÙÈηٿÛÙ·Û˘ Ù˘ ıÚÂÔÓ›Ó˘ ·fi Ï˘Û›ÓË ÛÙË ı¤ÛË 343 (∆343∫). ∏ ÁÂÓÂÙÈ΋ ·Ó¿Ï˘ÛË Ô˘ ¤ÁÈÓ ÛÙË ÌËÙ¤Ú· ¤‰ÂÈÍ fiÙÈ ‹Ù·Ó ÂÙÂÚÔ˙˘ÁÒÙ˘ ÛÙÔ ÂÍfiÓÈÔ 10 ÁÈ· ÙËÓ ∆343∫ ÌÂÙ¿ÏÏ·ÍË. ∏ ÌËÙ¤Ú· ·Ó¤ÊÂÚ fiÙÈ ‹Ù·Ó Ê˘ÙÔÊ¿ÁÔ˜, ‰ÈfiÙÈ Î¿ı ÊÔÚ¿ Ô˘ ¤·ÈÚÓ Á‡̷ Ì ˘„ËÏ‹ ÂÚÈÂÎÙÈÎfiÙËÙ· Û ڈÙ½Ó˜ ÂÌÊ¿ÓÈ˙ ÎÂÊ·Ï·ÏÁ›· Î·È Ó·˘Ù›· (Û˘ÌÙÒÌ·Ù· Ô˘ ÂÚÈÁÚ¿ÊÔÓÙ·È ÛÙÔ˘˜ ÊÔÚ›˜ Ù˘ ÓfiÛÔ˘). ™˘˙‹ÙËÛË ∏ OTC Â›Ó·È ¤Ó· ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi ¤Ó˙˘ÌÔ Ô˘ ηٷχÂÈ ÙÔ Î·Ú‚·Ì˘ÏÔʈÛÊÔÚÈÎfi Ô͇ Û ÎÈÙÚÔ˘ÏÏ›ÓË ÛÙÔÓ Î‡ÎÏÔ Ù˘ Ô˘Ú›·˜. ∆Ô ÁÔÓ›‰ÈÔ Ù˘ OTC ‚Ú›ÛÎÂÙ·È ÛÙÔ ‚Ú·¯‡ ¿ÎÚÔ ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ à (Ãp21.1). ¶ÂÚȤ¯ÂÈ 10 ÂÍfiÓÈ· Ô˘ Έ‰ÈÎÔÔÈÔ‡Ó Ì›· ÚÔ-ÚˆÙ½ÓË, Ë ÔÔ›· ·ÔÙÂÏÂ›Ù·È ·fi 354 ·ÌÈÓÔͤ·. ∏ ·ÚÈ· ÚˆÙ½ÓË ·ÔÙÂÏÂ›Ù·È ·fi 32 ·ÌÈÓÔͤ· Î·È ·ÂÏ¢ıÂÚÒÓÂÙ·È ÌÂÙ¿ ÙË ÌÂÙ·ÊÔÚ¿ Ù˘ ̤۷ ÛÙ· ÌÈÙÔ¯fiÓ‰ÚÈ· (3). OÈ Tuchman Î·È Û˘Ó ¯ÚËÛÈÌÔÔ›ËÛ·Ó ÂȉÈΤ˜ ·Ó·Ï‡ÛÂȘ ÙˆÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ ÁÈ· Ó· ˘ÔÏÔÁ›ÛÔ˘Ó ÙËÓ ·Ó·ÏÔÁ›· ·ÚÚ¤ÓˆÓ Î·È ıËϤˆÓ, ÙˆÓ ÔÔ›ˆÓ ÔÈ ÌÂÙ·ÏÏ¿ÍÂȘ ¤¯Ô˘Ó Û˘Ì‚Â› ÛÙ· ÁÂÓÓËÙÈο ·ÙÙ·Ú· ÂÓfi˜ ·fi ÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘˜. ∞fi Ù· 28 ·ÁfiÚÈ· Ì ·Ó¿ÚÎÂÈ· OTC, ÌfiÓÔ 2 (7%) ›¯·Ó ÛÔÚ·‰ÈΤ˜ ÌÂÙ·ÏÏ¿ÍÂȘ, ÂÓÒ ·fi Ù· 15 ÎÔÚ›ÙÛÈ· Ì ·Ó¿ÚÎÂÈ· OTC, 12 (80%) ›¯·Ó ÛÔÚ·‰ÈΤ˜ ÌÂÙ·ÏÏ¿ÍÂȘ. ∞fi ·˘Ù¤˜ ÙȘ ÌÔÚȷΤ˜ ‰ÔÎÈ̷ۛ˜ Ê·›ÓÂÙ·È fiÙÈ Ô Î›Ó‰˘ÓÔ˜ ÁÈ· Ì›· ÌËÙ¤Ú· ·ÁÔÚÈÔ‡ Ô˘ ÓÔÛ› Ó· Â›Ó·È ÂÙÂÚÔ˙˘ÁÒÙ˘ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚÔ˜ ·fi fi,ÙÈ ·Ó·ÌÂÓfiÙ·Ó (2/3) Î·È ÏËÛÈ¿˙ÂÈ ÙÔ 9/10. ∞ÓÙÈÛÙÚfiʈ˜, Ì›· ÌËÙ¤Ú· ¿Û¯ÔÓÙÔ˜ ı‹ÏÂÔ˜ ¤¯ÂÈ Ôχ ÌÈÎÚfiÙÂÚË Èı·ÓfiÙËÙ· Ó· Â›Ó·È ÂÙÂÚÔ˙˘ÁÒÙ˘ (6).
¶·È‰È·ÙÚÈ΋ 2003;66:467-470
ª¤¯ÚÈ Û‹ÌÂÚ· ¤¯Ô˘Ó ÌÂÏÂÙËı› 230 ÌÂÙ·ÏÏ¿ÍÂȘ Î·È 13 ÔÏ˘ÌÔÚÊÈÛÌÔ› ÙÔ˘ ÁÔÓȉ›Ô˘ Ù˘ OTC. O ·ÛıÂÓ‹˜ Ù˘ ·ÚÔ‡Û·˜ ÂÚ›ÙˆÛ˘ Â›Ó·È ÙÔ ÌÔÓ·‰ÈÎfi ·ÁfiÚÈ Ì ÙË ÌÂÙ¿ÏÏ·ÍË ∆343∫, ÛÙËÓ ÔÔ›· Ë ÌËÙ¤Ú· ÙÔ˘ Â›Ó·È ÂÙÂÚÔ˙˘ÁÒÙ˘. OÈ ¿ÏÏÔÈ ‰‡Ô ·ÛıÂÓ›˜ Ì ÙËÓ ›‰È· ÌÂÙ¿ÏÏ·ÍË Â›Ó·È ¤Ó· ÎÔÚ›ÙÛÈ ËÏÈΛ·˜ 8 ÂÙÒÓ Ô˘ ÂÚÈÁÚ¿ÊËΠ·fi ÙÔ˘˜ Tuchman Î·È Û˘Ó ÙÔ 1995 (7) Î·È ¤Ó· ·ÁfiÚÈ ËÏÈΛ·˜ 7 ÂÙÒÓ Ô˘ ÂÚÈÁÚ¿ÊËΠ·fi ÙÔ˘˜ Leibundgut Î·È Û˘Ó ÙÔ 1996, ÔÈ ÔÔ›ÔÈ ‰ÂÓ ¤¯Ô˘Ó ÎÏËÚÔÓÔÌÈ΋ ÌÂÙ¿ÏÏ·ÍË (8). ∏ OTC ˘¿Ú¯ÂÈ ÛÙÔ ‹·Ú Î·È ÛÙÔÓ ‚ÏÂÓÓÔÁfiÓÔ ÙÔ˘ ÏÂÙÔ‡ ÂÓÙ¤ÚÔ˘. ∆Ô ¤Ó˙˘ÌÔ ÚÔ¤Ú¯ÂÙ·È ·fi ÙÔ ›‰ÈÔ ÁÔÓ›‰ÈÔ Î·È ÛÙ· ‰‡Ô fiÚÁ·Ó·. OÈ Hamano Î·È Û˘Ó ¤¯Ô˘Ó ÚÔÛ‰ÈÔÚ›ÛÂÈ ÂÙÂÚÔ˙˘ÁÒÙË Ù˘ OTC Ì ·ÓÔÛÔ΢ÙÙ·ÚÔ¯ËÌÈ΋ ÌÂϤÙË ‚ÈÔ„›·˜ ·fi ÙÔÓ ‚ÏÂÓÓÔÁfiÓÔ ÙÔ˘ ‰ˆ‰Âη‰·ÎÙ‡ÏÔ˘ (9). O Ê·ÈÓfiÙ˘Ô˜ ÙˆÓ ·ÁÔÚÈÒÓ Ô˘ ÓÔÛÔ‡Ó Î·È ÙˆÓ ÂÙÂÚÔ˙˘ÁˆÙÒÓ ÎÔÚÈÙÛÈÒÓ ¤¯ÂÈ ÌÂÁ¿ÏÔ Â‡ÚÔ˜, ·fi ÙÔ ÛÔ‚·ÚfiÙ·ÙÔ ÓÂÔÁÓÈÎfi ˘ÂÚ·Ì̈ÓÈ·ÈÌÈÎfi ÎÒÌ· ̤¯ÚÈ ÙÔÓ ·Û˘Ìو̷ÙÈÎfi ÂÓ‹ÏÈη (3). ∆· ·Ú¯Èο Û˘ÌÙÒÌ·Ù· Ù˘ ˘ÂÚ·Ì̈ÓÈ·ÈÌ›·˜ Î˘Ì·›ÓÔÓÙ·È Â›Û˘ Î·È ÌÔÚ› Ó· Â›Ó·È ÌfiÓÔ ‹È· Û˘Á¯˘ÙÈο ÂÂÈÛfi‰È·, ¢ÂÚÂıÈÛÙfiÙËÙ· ‹ ‰È·Ù·Ú·¯¤˜ Û˘ÌÂÚÈÊÔÚ¿˜, Ù· ÔÔ›· ÌÔÚÔ‡Ó Ó· ÂÎÏËÊıÔ‡Ó ÏfiÁˆ Ï¿ıÔ˘˜ ˆ˜ „˘¯È·ÙÚÈο ÚÔ‚Ï‹Ì·Ù·, ¯Ú‹ÛË “Ô˘ÛÈÒÓ” ‹ ÙÚÔÊÈ΋ ·ÏÏÂÚÁ›·. øÛÙfiÛÔ, ÙÔ Î‡ÚÈÔ Û‡Ìو̷ ÌÔÚ› Ó· Â›Ó·È ÔÈ ¤ÌÂÙÔÈ, ȉ›ˆ˜ Û ÂÚÈÙÒÛÂȘ Ì ÌÂÙ·‚ÔÏÈÎfi ÛÙÚ˜, fiˆ˜ ÔÈ ÏÔÈÌÒÍÂȘ Î·È Ó· ÂÛÙÈ·ÛÙ› Ë ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË Û ÚÔ‚Ï‹Ì·Ù· ·fi ÙÔ ÂÙÈÎfi Û‡ÛÙËÌ·. OÈ ¤ÌÂÙÔÈ Â›Ó·È Û˘¯ÓÔ› ΢ڛˆ˜ ÛÙË ‚ÚÂÊÈ΋ ËÏÈΛ· Î·È Û˘Ó‰˘¿˙ÔÓÙ·È Ì ηı˘ÛÙ¤ÚËÛË Ù˘ ۈ̷ÙÈ΋˜ ·Ó¿Ù˘Í˘. O ·‰Úfi˜ ‚ÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ ·ÔηχÙÂÈ ·˘ÍË̤Ó˜ ÙÚ·ÓÛ·ÌÈÓ¿Û˜ Î·È ·Ú·¤ÌÂÈ Û ˷ٛÙȉ· (10). ™ÙÔÓ ·ÛıÂÓ‹ Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È, Ë ¤Ó·ÚÍË ÙˆÓ ÂÌ¤ÙˆÓ Û˘Ó¤ÂÛ Ì ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙˆÓ ÊÚÔ‡ÙˆÓ ÛÙË ‰È·ÙÚÔÊ‹ ÙÔ˘ Î·È Ë ·Ó‡ÚÂÛË Â˘Ú›·˜ °O¶ Ì ÙÔÓ ˘ÂÚ˯ÔÁÚ·ÊÈÎfi ¤ÏÂÁ¯Ô ‹Ù·Ó ÔÈ ÏfiÁÔÈ Ô˘ “ηı˘ÛÙ¤ÚËÛ·Ó” ÙËÓ ·Ú·ÔÌ‹ ÙÔ˘ ·È‰ÈÔ‡ ÁÈ· ¤ÏÂÁ¯Ô. ∂›Ó·È Ôχ ÛËÌ·ÓÙÈÎfi ÁÈ· ÙÔÓ ·ÛıÂÓ‹ Ì ‰È·Ù·Ú·¯‹ ÛÙÔÓ Î‡ÎÏÔ Ù˘ Ô˘Ú›·˜ Ô˘ ÂÌÊ·Ó›˙ÂÈ ˘ÂÚ·Ì̈ÓÈ·ÈÌ›· Ó· ·Ú¯›ÛÂÈ fiÛÔ ÙÔ ‰˘Ó·ÙfiÓ ÓˆÚ›ÙÂÚ· ıÂڷ›·. °ÓˆÚ›˙ÔÓÙ·˜ fiÙÈ ÔÈ ¤ÌÂÙÔÈ ‹/Î·È Ô Ï‹ı·ÚÁÔ˜ ·ÔÙÂÏÔ‡Ó ÚÒÈÌ· ÛËÌ›· ˘ÂÚ·Ì̈ÓÈ·ÈÌ›·˜, Ú¤ÂÈ ·Ì¤Ûˆ˜ Ó· ÚÔÛ‰ÈÔÚ›˙ÔÓÙ·È Ù· ›‰· Ù˘ ·Ì̈ӛ·˜ ÛÙÔ Ï¿ÛÌ·. ∂¿Ó Ù· ›‰· Â›Ó·È ÙÚÈÏ¿ÛÈ· ·fi ÙÔ Ê˘ÛÈÔÏÔÁÈÎfi ‹ ·ÓÒÙÂÚ· ·fi 120 uM, Ï·Ì‚¿ÓÂÙ·È Ó¤Ô ‰Â›ÁÌ· ÁÈ· ·ϋı¢ÛË ÙÔ˘ ·ÔÙÂϤÛÌ·ÙÔ˜, ·¤ÚÈ· ·›Ì·ÙÔ˜, ÈÔÓÙfiÁÚ·ÌÌ· Î·È ÔÈÔÙÈÎfi ·ÌÈÓfiÁÚ·ÌÌ· Î·È Ú¤ÂÈ Ó· ·Ú¯›ÛÂÈ ¿ÌÂÛ· Ë ıÂڷ›·, ¯ˆÚ›˜ Ó· ·Ó·Ì¤ÓÔÓÙ·È ÔÈ ··ÓÙ‹ÛÂȘ ÙÔ˘ ‰Â‡ÙÂÚÔ˘ ‰Â›ÁÌ·ÙÔ˜ (11). ∆Ô Î‡ÚÈÔ Ì¤ÏËÌ· ÛÙËÓ Î·ıËÌÂÚÈÓ‹ ·ÁˆÁ‹ Â›Ó·È Ë ‰›·ÈÙ· Ì ¯·ÌËÏ‹ ÂÚÈÂÎÙÈÎfiÙËÙ· Û ڈÙ½Ó˜,
Paediatriki 2003;66:467-470
·Ó Î·È ÔÈ ·ÛıÂÓ›˜ Ì ÙÔÓ ˘Ô͇ Ù‡Ô (late onset) ¯ÚÂÈ¿˙ÔÓÙ·È Ì¤ÙÚÈÔ ÂÚÈÔÚÈÛÌfi ÙÔ˘ Ï¢ÎÒÌ·ÙÔ˜ (1,5-2,2 g/kg/Ë̤ڷ). ªÂÚÈÎÔ› ·ÛıÂÓ›˜ ÌÔÚ› Ó· ·Ó¯ÙÔ‡Ó ·ÎfiÌ· Î·È Î·ÓÔÓÈ΋ ‰›·ÈÙ·, ¯ˆÚ›˜ ÂÚÈÔÚÈÛÌfi Ï¢ÎÒÌ·ÙÔ˜. ÕÏÏÔÈ ·ÛıÂÓ›˜ ÚÔÙÈÌÔ‡Ó Ó· ¤¯Ô˘Ó ÂχıÂÚË ‰›·ÈÙ· Î·È Ó· Ï·Ì‚¿ÓÔ˘Ó ‚ÂÓ˙Ô˚Îfi Ó¿ÙÚÈÔ ·ÓÙ› Ó· ÂÚÈÔÚ›˙Ô˘Ó ÙÔ Ï‡Έ̷ ÛÙË ‰È·ÙÚÔÊ‹ ÙÔ˘˜ (10). ∏ ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜ ·ÔÙÂÏ› ıÂڷ›· Ô˘ ·Ó Â›Ó·È ÂÈÙ˘¯Ë̤ÓË, ‰›ÓÂÈ Ï‡ÛË ÛÙÔ Úfi‚ÏËÌ· ·˘ÙÒÓ ÙˆÓ ·ÛıÂÓÒÓ. ÃÚÂÈ¿˙ÂÙ·È Ôχ ηϋ ÂÓË̤ڈÛË ÙˆÓ ÁÔÓ¤ˆÓ ÁÈ· ÙÔ˘˜ ÎÈÓ‰‡ÓÔ˘˜ Ù˘ ÌÂÁ¿Ï˘ ·˘Ù‹˜ ¤̂·Û˘. ªÂ ÙË Û˘ÓÙËÚËÙÈ΋ ·ÁˆÁ‹ ÔÈ ·ÛıÂÓ›˜ ÍÂÂÚÓÔ‡Ó Ù· ÚÒÙ· ‰‡Ô ¯ÚfiÓÈ· ˙ˆ‹˜ Î·È ·ÔÎÙÔ‡Ó Ù¤ÙÔȘ ۈ̷ÙÈΤ˜ ‰È·ÛÙ¿ÛÂȘ, ÒÛÙ ӷ ÌÔÚÔ‡Ó Ó· ˘ÔÛÙÔ‡Ó ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË Î·È Ó· ÌÂȈıÔ‡Ó Û οÔÈÔ ‚·ıÌfi ÔÈ Î›Ó‰˘ÓÔÈ ·fi ÙËÓ Â¤Ì‚·ÛË (12). OÈ Morsy Î·È Û˘Ó Î·Ù¿ÊÂÚ·Ó Ó· ‚ÂÏÙÈÒÛÔ˘Ó ÙË ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ OTC Û ÂÈÚ·Ì·ÙÈÎfi ÌÔÓÙ¤ÏÔ Ì ÔÓÙ›ÎÈ·, οÓÔÓÙ·˜ ÌÂÙ·ÊÔÚ¿ ÙÔ˘ ÁÔÓȉ›Ô˘ Ù˘ ·ÓıÚÒÈÓ˘ OTC Ì ÌÂÙ·ÊÔÚ¤· ·‰ÂÓÔ˚fi. ∏ Ì›ˆÛË Ù˘ ÔÚÔÙÈÎÔ˘Ú›·˜ ·Ú·ÙËÚ‹ıËΠÂÓÙfi˜ 24 ˆÚÒÓ ·fi ÙË ÌÂÙ·ÊÔÚ¿ ÙÔ˘ ÁÔÓȉ›Ô˘. ∏ ‰ÈfiÚıˆÛË Ù˘ ÌÂÙ·‚ÔÏÈ΋˜ ‰È·Ù·Ú·¯‹˜ ›¯Â Û·Ó ·ÔÙ¤ÏÂÛÌ· ÙË ‚ÂÏÙ›ˆÛË ÙÔ˘ Ê·ÈÓfiÙ˘Ô˘ Î·È ÙË Ì¤ÙÚÈ· ·‡ÍËÛË Ù˘ ÂÓ˙˘ÌÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ (13). ∏ ηٷÁÚ·Ê‹ ÙˆÓ ÛˆÌ·ÙÔÌÂÙÚÈÎÒÓ ÛÙÔȯ›ˆÓ ÙˆÓ ·Û¯fiÓÙˆÓ ·fi ·Ó¿ÚÎÂÈ· OTC ‰Â›¯ÓÂÈ fiÙÈ ÔÈ ÌÂÙÚ‹ÛÂȘ Â›Ó·È Î¿Ùˆ ·fi ÙÔÓ Ì¤ÛÔ fiÚÔ ÁÈ· ÙËÓ ËÏÈΛ· ÙÔ˘˜, Èı·Ó¿ ÏfiÁˆ Ù˘ ÌÂȈ̤Ó˘ Ï‹„˘ ÚˆÙ½Ó˘ ÛÙË ‰È·ÙÚÔÊ‹ ÙÔ˘˜ (12). OÈ Msall Î·È Û˘Ó ÂÚȤÁÚ·„·Ó ÙË Ó¢ÚÔÏÔÁÈ΋ ÂͤÏÈÍË 26 ·È‰ÈÒÓ Ì ‰È·Ù·Ú·¯¤˜ ÛÙÔÓ Î‡ÎÏÔ Ù˘ Ô˘Ú›·˜. ∆Ô 79% ›¯Â Ì›· ‹ ÂÚÈÛÛfiÙÂÚ˜ Ó¢ÚÔÏÔÁÈΤ˜ ‰È·Ù·Ú·¯¤˜ Î·È Ì¤ÛÔ fiÚÔ IQ 43±6. £ÂˆÚÂ›Ù·È fiÙÈ Ë ÚfiÏË„Ë ‹ Ë ÚÒÈÌË ·Ú¤Ì‚·ÛË ÛÙË ÓÂÔÁÓÈ΋ ˘ÂÚ·Ì̈ÓÈ·ÈÌ›· ÌÔÚ› Ó· ·ÔÙÚ¤„ÂÈ ÛÔ‚·Ú¤˜ Ó¢ÚÔÏÔÁÈΤ˜ ‰È·Ù·Ú·¯¤˜ Ô˘ ¯·Ú·ÎÙËÚ›˙Ô˘Ó ·˘Ù‹ ÙËÓ ÔÌ¿‰· ÓÔÛËÌ¿ÙˆÓ (14). OÈ Maestri Î·È Û˘Ó ÛËÌÂÈÒÓÔ˘Ó fiÙÈ ÔÈ ·ÛıÂÓ›˜ Ô˘ Ù¤ıËÎ·Ó Û ıÂڷ›· ·fi ÙËÓ ·Ú¯‹, ¤¯Ô˘Ó ηχÙÂÚË Ó¢ÚÔÏÔÁÈ΋ ·Ó¿Ù˘ÍË ·fi ÙÔ˘˜ ÂΛÓÔ˘˜ Ô˘ ¤˙ËÛ·Ó ·fi ¤Ó· ÓÂÔÁÓÈÎfi ˘ÂÚ·Ì̈ÓÈ·ÈÌÈÎfi ÎÒÌ·. ∏ ·ÔÊ˘Á‹ ÙÔ˘ ÓÂÔÁÓÈÎÔ‡ ˘ÂÚ·Ì̈ÓÈ·ÈÌÈÎÔ‡ ÎÒÌ·ÙÔ˜ ÌÔÚ› Ó· Â›Ó·È Ô Î‡ÚÈÔ˜ ÏfiÁÔ˜ ÁÈ· ·˘Ù¤˜ ÙȘ ·Ú·ÙËÚÔ‡ÌÂÓ˜ ‰È·ÊÔÚ¤˜ ÛÙË Ó¢ÚÔÏÔÁÈ΋ ·Ó¿Ù˘ÍË (12). ¶·Ú¿ ÙË Û·ÓÈfiÙËÙ¿ Ù˘ Î·È ÙËÓ ¿Ù˘Ë ÎÏÈÓÈ΋ Ù˘ ·ÚÔ˘Û›·ÛË, Ë ÓfiÛÔ˜ ‰ÂÓ ı· Ú¤ÂÈ Ó· ·ÁÓÔÂ›Ù·È ÛÙËÓ ÎÏÈÓÈ΋ Ú¿ÍË. µÈ‚ÏÈÔÁÚ·Ê›· 1. Walser M. Urea cycle disorders and other hereditary hyperammonemic syndromes. In: Stanbury JB, Wyngaarden
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JB, Fredrickson DS, Goldstein JL, Brown MS, editors. The metabolic basis of inherited disease. 5th ed. New York: McGraw-Hill; 1983. p. 403. Soulpis C, Markosoglou D, Papadelis F, Caraboula A, Giouroukos S, Skarpalezou A et al. Ornithine transcarbamylase deficiency: findings and treatment in a symptomatic female heterozygote. J Inherit Metab Dis 1991;14:107-108. Tuchman M, McCullough BA, Yudkoff M. The molecular basis of ornithine transcarbamylase definciency. Eur J Pediatr 2000;159 (Suppl 3):S196-S198. Horwich AL, Fenton WA, Williams KR, Kalousek F, Kraus JP, Doolittle RF et al. Structure and expression of a complementary DNA for the nuclear coded precursor of human mitochondrial ornithine transcarbamylase. Science 1984;224:1068-1074. Hata A, Tsuzuki T, Shimada K, Takiguchi M, Mori M, Matsuda I. Structure of the human ornithine transcarbamylase gene. J Biochem 1988;103:302-308. Tuchman M, Matsuda I, Munnich A, Malcolm S, Strautnieks S, Briede T. Proportions of spontaneous mutations in males and females with ornithine transcarbamylase deficiency. Am J Med Genet 1995;55:67-70. Tuchman M, Plante RJ. Mutations and polymorphisms in the human ornithine transcarbamylase gene: mutation update addendum. Hum Mutat 1995;5:293-295. Oppliger Leibundgut EO, Wermuth B, Colombo JP, LiechtiGallati S. Ornithine transcarbamylase deficiency: characterization of gene mutations and polymorphisms. Hum Mutat 1996;8:333-339. Hamano Y, Kodama H, Fujikawa Y, Tanaka Y, Nishimura K,
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Yanagisawa M. Use of immunocytochemical analysis of a duodenal biopsy specimen to identify a carrier of ornithine transcarbamylase deficiency. N Engl J Med 1988;318:15211523. Drogari E, Leonard JV. Late onset ornithine carbamoyl transferase deficiency in males. Arch Dis Child 1988;63: 1363-1367. Brusilow SW. Protocol for treatment of intercurrent hyperammonemia in patients with urea cycle defects. http://divis17.pedgen.uiowa.edu/genetics/HyperAmmonem iaTx.html. Maestri NE, Hauser ER, Bartholomew D, Brusilow SW. Prospective treatment of urea cycle disorders. J Pediatr 1991;119:923-928. Morsy MA, Zhao JZ, Ngo TT, Warman AW, O’Brien WE, Graham FL et al. Patient selection may affect gene therapy success. Dominant negative effects observed for ornithine transcarbamylase in mouse and human hepatocytes. J Clin Invest 1996;97:826-832. Msall M, Batshaw ML, Suss R, Brusilow SW, Mellits ED. Neurologic outcome in children with inborn errors of urea synthesis. Outcome of urea-cycle enzymopathies. N Engl J Med 1984;310:1500-1505.
HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 03-01-2003 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 09-09-2003 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ™Ì·Ú·Á‰‹ ºÂÛÛ¿ÙÔ˘ ¶·ÙÚ. °ÚËÁÔÚ›Ô˘ 16, ∆.∫. 143 42 ¡. ºÈÏ·‰¤ÏÊÂÈ·, ∞ı‹Ó·
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CASE REPORT
¡fiÛÔ˜ Cushing Û ÎÔÚ›ÙÛÈ ËÏÈΛ·˜ 15ó ÂÙÒÓ. ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ∂. ∫ˆÛÙ·ÎÈÒÙË, Ã. £ÂÔ‰ˆÚ›‰Ë˜, ∂. ∫Ô‡ÛÙ·, ∞. ∆ÂÚÙ›Ë, Ã. ÷Ù˙Ë·ı·Ó·Û›Ô˘, µ. ¶¤ÙÚÔ˘, ∞. ¶··ı·Ó·Û›Ô˘
Cushing’s disease in a 15ó year-old girl. A case report E. Kostakioti, C. Theodoridis, E. Kousta, A. Tertipi, C. Hadjiathanasiou, V. Petrou, A. Papathanasiou
¶ÂÚ›ÏË„Ë: ∏ ÓfiÛÔ˜ Cushing Â›Ó·È Û¿ÓÈ· ·Ûı¤ÓÂÈ· Ù˘ ·È‰È΋˜ ËÏÈΛ·˜, Ô˘ ÔÊ›ÏÂÙ·È Û ÎÔÚÙÈÎÔÙÚfiÊÔ ·‰¤ÓˆÌ· Ù˘ ˘fiÊ˘Û˘. ∏ ˘ÂÚÎÔÚÙÈ˙ÔÏ·ÈÌ›· Ù˘ ÓfiÛÔ˘ Ô‰ËÁ› Û ηٷÛÙÔÏ‹ ÙˆÓ ÂÚÈÛÛfiÙÂÚˆÓ ÔÚÌÔÓÒÓ Ù˘ ÚfiÛıÈ·˜ ˘fiÊ˘Û˘, fiˆ˜ ÙˆÓ FSH, LH, PRL, TSH Î·È GH. ¶ÂÚÈÁÚ¿ÊÂÙ·È ÓfiÛÔ˜ Cushing Û ÎÔÚ›ÙÛÈ ËÏÈΛ·˜ 15ó ÂÙÒÓ, Ô˘ ÚÔ¤‚·ÏÏ Ì ·ÓÛÂÏËÓÔÂȉ¤˜ ÚÔۈ›Ô, ηı˘ÛÙ¤ÚËÛË ÛˆÌ·ÙÈ΋˜ ·Ó¿Ù˘Í˘, ·¯˘Û·ÚΛ·, ·ÎÌ‹, ˘ÂÚÙÚ›¯ˆÛË Î·È ˘¤ÚÙ·ÛË. O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍ ˘ÂÚÎÔÚÙÈ˙ÔÏ·ÈÌ›· Î·È Ë Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÌÈÎÚÔ·‰¤ÓˆÌ· Ù˘ ˘fiÊ˘Û˘. ∏ ·ÛıÂÓ‹˜ ¯ÂÈÚÔ˘ÚÁ‹ıËΠÂÈÙ˘¯Ò˜ Î·È ÙÔ ·‰¤ÓˆÌ· Ù˘ ˘fiÊ˘Û˘ ·Ê·ÈÚ¤ıËΠ̠‰È·ÛÊËÓÔÂȉ‹ ÚÔۤϷÛË. ™˘˙ËÙÂ›Ù·È Ë ÎÏÈÓÈ΋ ÚÔ‚ÔÏ‹, Ù· ÔÚÌÔÓÔÏÔÁÈο Î·È ·ÂÈÎÔÓÈÛÙÈο Â˘Ú‹Ì·Ù·, ηıÒ˜ Î·È Ë ıÂڷ›· Ù˘ ÓfiÛÔ˘ Cushing.
Abstract: Cushing’s disease refers specifically to an ACTH-producing pituitary adenoma that stimulates excess cortisol production and it is very rare in children and adolescents. Hypercortisolism leads to suppression of most of the anterior pituitary hormones: FSH, LH, PRL, TSH and GH. The case is described of a 15ó year-old girl with Cushing’s disease who presented with the characteristic moon face, short stature, obesity, acne, hirsutism and hypertension. Hypercortisolism was detected during the laboratory examination and MRI of the pituitary revealed a microadenoma. She was successfully treated surgically by transsphenoidal removal of the pituitary adenoma. The clinical features at presentation, the diagnosis, hormonal changes and imaging findings, as well as the treatment of Cushing’s disease are discussed.
§¤ÍÂȘ ÎÏÂȉȿ: ·‰¤ÓˆÌ· ˘fiÊ˘Û˘, Û‡Ó‰ÚÔÌÔ Cushing, ˘ÂÚÎÔÚÙÈ˙ÔÏ·ÈÌ›·, ÎÔÓÙfi ·Ó¿ÛÙËÌ·, ‰È·ÛÊËÓÔÂȉ‹˜ ¯ÂÈÚÔ˘ÚÁÈ΋ ·ÓÙÈÌÂÙÒÈÛË.
Key words: pituitary adenoma, Cushing’s syndrome, hypercortisolism, short stature, transsphenoidal surgical treatment.
™˘ÓÙÔÌÔÁڷʛ˜
∂ÈÛ·ÁˆÁ‹ ∏ ÓfiÛÔ˜ Cushing ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ˘ÂÚ¤ÎÎÚÈÛË Ù˘ ÊÏÔÈÔÂÈÓÂÊÚȉÈÔÙÚfiÔ˘ ÔÚÌfiÓ˘ ACTH, ÔÊÂÈÏfiÌÂÓË Û ÎÔÚÙÈÎÔÙÚfiÊÔ ·‰¤ÓˆÌ· Ù˘ ˘fiÊ˘Û˘ (1,2), Ë ÔÔ›· Ô‰ËÁ› Û ˘ÂÚ·Ú·ÁˆÁ‹ ÎÔÚÙÈ˙fiÏ˘ ·fi ÙÔÓ ÊÏÔÈfi ÙˆÓ ÂÈÓÂÊÚȉ›ˆÓ, ÂÓÒ ÙÔ Û‡Ó‰ÚÔÌÔ Cushing ·ÊÔÚ¿ Û οı ˘ÂÚÎÔÚÙÈ˙ÔÏ·ÈÌ›· ·ÓÂÍ·ÚÙ‹ÙÔ˘ ·ÈÙÈÔÏÔÁ›·˜ (ÂÓ‰ÔÁÂÓ‹˜ ‹ Â͈ÁÂÓ‹˜) (2,3). ∏ Û˘¯ÓfiÙÂÚË ·ÈÙ›· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Cushing Â›Ó·È Ë È·ÙÚÔÁÂÓ‹˜, Ë ÔÔ›· ·Ú·ÙËÚÂ›Ù·È ÌÂÙ¿ ·fi Ì·ÎÚÔ¯ÚfiÓÈ· ¯ÔÚ‹ÁËÛË ÎÔÚÙÈ˙fiÓ˘, Û˘ÛÙËÌ·ÙÈ΋˜ ‹ Î·È ÙÔÈ΋˜ (4,5). ∆· ÂÓ‰ÔÁÂÓ‹ ·›ÙÈ· ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙÔ ·‰¤ÓˆÌ· ÙˆÓ ÂÈÓÂÊÚȉ›ˆÓ (3,5), ÙÔ Î·ÚΛӈ̷ (6), ÙÔ ·‰¤ÓˆÌ· Ù˘ ˘fiÊ˘Û˘
ACTH FSH LH E2 DHEA’S 17-OHÚÔÁÂÛÙÂÚfiÓË TSH T4 FT4 T3 FT3 DXM GH U/S MRI
ºÏÔÈÔÂÈÓÂÊÚȉÈÔÙÚfiÔ˜ ÔÚÌfiÓË £˘Ï·ÎÈÔÙÚfiÔ˜ ÔÚÌfiÓË ø¯ÚÈÓÔÙÚfiÔ˜ ÔÚÌfiÓË OÈÛÙÚ·‰ÈfiÏË £ÂÈ˚΋ ‰Â¸‰ÚÔÂÈ·Ó‰ÚÔÛÙÂÚfiÓË 17-˘‰ÚÔ͢-ÚÔÁÂÛÙÂÚfiÓË £˘ÚÂÔÂȉÔÙÚfiÔ˜ ÔÚÌfiÓË £˘ÚÔÍ›ÓË ∂χıÂÚË ı˘ÚÔÍ›ÓË ∆ÚÈȈ‰Ôı˘ÚÔÓ›ÓË ∂χıÂÚË ÙÚÈȈ‰Ôı˘ÚÔÓ›ÓË ¢ÂÍ·ÌÂı·˙fiÓË ∞˘ÍËÙÈ΋ ÔÚÌfiÓË ÀÂÚ˯ÔÁÚ¿ÊËÌ· ª·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›·
∂Ó‰ÔÎÚÈÓÔÏÔÁÈÎfi ∆Ì‹Ì·, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó·
Department of Endocrinology, “P. & A. Kyriakou” Children’s Hospital, Athens
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(1), ÙË ‰È¿¯˘ÙË ÔÏ˘Ô˙Ò‰Ë ˘ÂÚÏ·Û›· ÙˆÓ ÂÈÓÂÊÚȉ›ˆÓ (3,7,8) ηÈ, Ôχ Û¿ÓÈ·, ÙËÓ ¤ÎÙÔË ·Ú·ÁˆÁ‹ ACTH (7). ∏ ÓfiÛÔ˜ Cushing ÚÔÛ‚¿ÏÏÂÈ ·È‰È¿ fiÏˆÓ ÙˆÓ ËÏÈÎÈÒÓ, ·ÏÏ¿ Â›Ó·È Û˘¯ÓfiÙÂÚË Û ËÏÈ˘ ÌÂÁ·Ï‡ÙÂÚ˜ ÙˆÓ 7 ÂÙÒÓ (7). ∏ Û˘¯ÓfiÙËÙ¿ Ù˘ Â›Ó·È ›‰È· ÛÙ· ‰‡Ô ʇϷ (2), Û ·ÓÙ›ıÂÛË Ì ÙÔ˘˜ fiÁÎÔ˘˜ ÙˆÓ ÂÈÓÂÊÚȉ›ˆÓ, ÔÈ ÔÔ›ÔÈ ˘ÂÚÙÂÚÔ‡Ó ÛÙ· ÎÔÚ›ÙÛÈ· (3:1) (7). ∏ ›وÛË Ù˘ ÓfiÛÔ˘ Cushing ÛÙÔÓ ÁÂÓÈÎfi ÏËı˘ÛÌfi Â›Ó·È 5-10 ÂÚÈÙÒÛÂȘ/¤ÙÔ˜, ·Ó¿ 1.000.000 ÏËı˘ÛÌÔ‡ (9). ∏ ÓfiÛÔ˜ Cushing Â›Ó·È ·ÎfiÌË ÈÔ Û¿ÓÈ· ÛÙËÓ ·È‰È΋ ËÏÈΛ· (1,8,10). ∏ ˘ÂÚÎÔÚÙÈ˙ÔÏ·ÈÌ›· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Cushing Ô‰ËÁ› Û ηٷÛÙÔÏ‹ ÙˆÓ ÂÚÈÛÛfiÙÂÚˆÓ ÔÚÌÔÓÒÓ Ù˘ ÚfiÛıÈ·˜ ˘fiÊ˘Û˘ (10). ™˘¯Ó¿, Ë ÎÏÈÓÈ΋ ‰È·Ù·Ú·¯‹ ‰ÂÓ ·Ó·ÁÓˆÚ›˙ÂÙ·È, ÙfiÛÔ ·fi ÙÔ˘˜ ÁÔÓ›˜ fiÛÔ Î·È ·fi ÙÔ˘˜ ÁÈ·ÙÚÔ‡˜, ÁÈ· ÌÂÁ¿ÏË ¯ÚÔÓÈ΋ ÂÚ›Ô‰Ô (1,2). ∏ ¤ÁηÈÚË ‰È¿ÁÓˆÛË ÛÙËÓ ·È‰È΋ ËÏÈΛ· ÂÍ·ÛÊ·Ï›˙ÂÈ Ê˘ÛÈÔÏÔÁÈ΋ ÂÊ˂›· Î·È ‚ÂÏÙȈ̤ÓÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· (2,10). ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ∫ÔÚ›ÙÛÈ ËÏÈΛ·˜ 15ó ÂÙÒÓ ÚÔÛ‹Ïı ÛÙÔ ÂÓ‰ÔÎÚÈÓÔÏÔÁÈÎfi È·ÙÚÂ›Ô Ì ηı˘ÛÙ¤ÚËÛË ÛˆÌ·ÙÈ΋˜ ·Ó¿Ù˘Í˘ Î·È ·¯˘Û·ÚΛ·. °ÂÓÓ‹ıËΠÌÂÙ¿ ·fi Ê˘ÛÈÔÏÔÁÈ΋ ÙÂÏÂÈfiÌËÓË Î‡ËÛË Î·È ÙÔÎÂÙfi, Ì µ° 1500 g. ∏ ÂÚÈÁÂÓÓËÙÈ΋ ÂÚ›Ô‰Ô˜, ÙÔ ·ÙÔÌÈÎfi Î·È ÎÏËÚÔÓÔÌÈÎfi ÈÛÙÔÚÈÎfi ‹Ù·Ó ÂχıÂÚ·. ∏ „˘¯ÔÎÈÓËÙÈ΋ ÂͤÏÈÍË ÙÔ˘ ·È‰ÈÔ‡ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋. ∞fi ‰ÈÂÙ›·˜, ÔÈ ÁÔÓ›˜ ·Ú·Ù‹ÚËÛ·Ó È‰È·›ÙÂÚË ·‡ÍËÛË ÙÔ˘ ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜, Ì ·Ó·Î·Ù·ÓÔÌ‹ ÙÔ˘ Ï›Ô˘˜ ÛÙËÓ ÎÔÈÏÈ¿ Î·È ÙÔÓ ıÒڷη, ÂÈ‚Ú¿‰˘ÓÛË ÙÔ˘ Ú˘ıÌÔ‡ ۈ̷ÙÈ΋˜ ·Ó¿Ù˘Í˘ Î·È ‹È˜ ÎÂÊ·Ï·ÏÁ›Â˜ Ô˘ ˘Ô¯ˆÚÔ‡Û·Ó ¯ˆÚ›˜ ·ÁˆÁ‹. ∫·Ù¿ ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË ‰È·ÈÛÙÒıËΠ¯·ÌËÏfi ·Ó¿ÛÙËÌ· (<3Ë ∂£), ·ÓÛÂÏËÓÔÂȉ¤˜ ÚÔÛˆÂ›Ô Ì ÂͤڢıÚ˜ ·ÚÂȤ˜, ÎÂÓÙÚÈÎÔ‡ Ù‡Ô˘ ·¯˘Û·ÚΛ·, ȉȷ›ÙÂÚ· ¤Î‰ËÏË ÛÙÔÓ ÎÔÚÌfi, Ì ¯·Ú·ÎÙËÚÈÛÙÈÎfi ‡‚Ô ÛÙÔÓ ·˘¯¤Ó·, Û¯ÂÙÈο ·‰‡Ó·Ù· ¿ÎÚ·, ¯ÓÔÒ‰Ë ÙÚ›¯ˆÛË ÚÔÛÒÔ˘, ¿ÎÚˆÓ, ÎÔÚÌÔ‡ Î·È Ú¿¯Ë˜. ∆Ô ‡„Ô˜ Ù˘ ·ÛıÂÓÔ‡˜ ‹Ù·Ó 137,3 cm (<3Ë ∂£, -4,1 SDS) Ì ‡„Ô˜-ÛÙfi¯Ô 160,7 cm, ÙÔ ‚¿ÚÔ˜ 43,1 kg (3Ë ∂£, -1,3 SDS) Î·È Ô ‰Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ 22,9 kg/m2 (0,9 SDS). ∆· ÛËÌ›· ÂÓ‹‚ˆÛ˘ ηٿ Tanner ‹Ù·Ó: ÙÚ›¯ˆÛË ÂÊË‚·›Ô˘ ÛÙ¿‰ÈÔ πππ, ÙÚ›¯ˆÛË Ì·Û¯¿Ï˘ ÛÙ¿‰ÈÔ ππ Î·È ·Ó¿Ù˘ÍË Ì·ÛÙÒÓ ÛÙ¿‰ÈÔ ππ ÚÔ˜ πππ. ∆· ¤Íˆ ÁÂÓÓËÙÈο fiÚÁ·Ó· ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο. ∏ ·ÛıÂÓ‹˜ ·ÚÔ˘Û›·˙ ڈÙÔ·ı‹ ·ÌËÓfiÚÚÔÈ·. ∏ ·ÚÙËÚȷ΋ ›ÂÛË Û fiϘ ÙȘ ÌÂÙÚ‹ÛÂȘ ‹Ù·Ó >140/90 mmHg. ∏ ÂͤٷÛË ·fi Ù· ÏÔÈ¿ Û˘ÛÙ‹Ì·Ù· ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋. O ÔÚÌÔÓÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍÂ: ÎÔÚÙÈ˙fiÏË (Úˆ›): 64,3 Ìg/dl (Ê.Ù.: 7-25), ÎÔÚÙÈ˙fiÏË (‚Ú¿‰˘): 42,6 Ìg/dl (Ê.Ù.: 2-9), ÂχıÂÚË ÎÔÚÙÈ˙fiÏË Ô‡ÚˆÓ
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24ÒÚÔ˘: 750 Ìg/24ˆÚÔ (Ê.Ù.: 6,5-90 Ìg/ 24ˆÚÔ), ACTH (Úˆ›): 118 pg/ml (Ê.Ù.: 9-52), FSH: 0,53 mIU/ml, LH <0,1 mIU/ml, E2 <10 pg/ml, ÙÂÛÙÔÛÙÂÚfiÓË: 0,9 ng/ml (Ê.Ù.: 0,7-3,9), DHEA’S: 6,3 Ìg/ml (Ê.Ù.: 0,4-1,4), 17-OH-ÚÔÁÂÛÙÂÚfiÓË: 5,7 ng/ml (Ê.Ù.: 0,25-1,9), ¢4-·Ó‰ÚÔÛÙÂÓ‰ÈfiÓË: 5,8 ng/ml (Ê.Ù.: 0,55-2,5), TSH: 0,5 mIU/ml (Ê.Ù.: 0,4-5), T4: 5,8 Ìg/dl (Ê.Ù.: 5,6-13,9), FT4: 1,0 ng/dl (Ê.Ù.: 0,9-2), ∆3: 0,7 ng/dl (Ê.Ù.: 0,9-2) Î·È FT3: 1,5 pg/dl (Ê.Ù.: 2,4-5). ∏ ÚˆÈÓ‹ ÎÔÚÙÈ˙fiÏË Î·È Ë ACTH ·›Ì·ÙÔ˜ ÌÂÙ¿ ·fi ¯ÔÚ‹ÁËÛË ÌÂÁ¿ÏˆÓ ‰fiÛÂˆÓ ‰ÂÍ·ÌÂı·˙fiÓ˘ (DXM) (8 mg ËÌÂÚËÛ›ˆ˜: 2 mg DXM ·Ó¿ ÂÍ¿ˆÚÔ Â› ‰‡Ô Ë̤Ú˜) ηÙÂÛÙ¿ÏËÛ·Ó ·fi 64,3 Ìg/dl Î·È 118 pg/ml Û 31,82 Ìg/dl Î·È 45 pg/ml, ·ÓÙ›ÛÙÔȯ·. OÈ ‰ÔÎÈ̷ۛ˜ ‰È¤ÁÂÚÛ˘ ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ (GH) ÌÂÙ¿ ·fi ¯ÔÚ‹ÁËÛË L-DOPA Î·È ÎÏÔÓȉ›Ó˘ ¤‰ÂÈÍ·Ó ·Ó·Ú΋ ¤ÎÎÚÈÛË ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ (̤ÁÈÛÙË ·ÓÙ·fiÎÚÈÛË 0,57 Î·È 3,32 ÌIU/ml, ·ÓÙ›ÛÙÔȯ·). O ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù˘ ÎÔÚÙÈ˙fiÏ˘, ÙˆÓ TSH, T3, T4, FSH, LH, E2, Ù˘ ÙÂÛÙÔÛÙÂÚfiÓ˘, Ù˘ DHEA’S, Ù˘ 17-OH-ÚÔÁÂÛÙÂÚfiÓ˘ Î·È Ù˘ ¢4-·Ó‰ÚÔÛÙÂÓ‰ÈfiÓ˘ ¤ÁÈÓ Ì ÙË Ì¤ıÔ‰Ô Ù˘ ËÏÂÎÙÚÔ¯ËÌÂÈÔʈٷ‡ÁÂÈ·˜ (¯ÚËÛÈÌÔÔÈÒÓÙ·˜ Ù· kits Ù˘ ROCHE). ∏ ACTH Î·È Ë GH ÚÔÛ‰ÈÔÚ›ÛÙËÎ·Ó Ì ÙË Ì¤ıÔ‰Ô Ù˘ ¯ËÌÂÈÔʈٷ‡ÁÂÈ·˜ (kit: Nichols Advantaged) Î·È Ë ÂχıÂÚË ÎÔÚÙÈ˙fiÏË Ô‡ÚˆÓ 24ÒÚÔ˘ Ì ÙË Ì¤ıÔ‰Ô RIA (̤ıÔ‰Ô˜ Ú·‰ÈÔ·ÓÔÛÔÌÂÙÚ›·˜, kit: DSL). ∏ ÔÛÙÈ΋ ËÏÈΛ· Ù˘ ·ÛıÂÓÔ‡˜ ‹Ù·Ó 12,5 ÂÙÒÓ, ÂÓÒ Ë ¯ÚÔÓÔÏÔÁÈ΋ 15ó. ∆Ô U/S ÂÈÓÂÊÚȉ›ˆÓ ¤‰ÂÈÍ ·ÌÊÔÙÂÚfiÏ¢ÚË ‰ÈfiÁΈÛË ÙˆÓ ÂÈÓÂÊÚȉ›ˆÓ (ÙÔ ‰ÂÍ›: 2,4 x 1,1 cm Î·È ÙÔ ·ÚÈÛÙÂÚfi: 2,06 x 0,98 cm). ™ÙÔ U/S Ì‹ÙÚ·˜-ˆÔıËÎÒÓ, Ë Ì‹ÙÚ· ›¯Â ‰È·ÛÙ¿ÛÂȘ 4,37 x 1,18 cm, Ì ·Ó·ÏÔÁ›· ÛÒÌ·ÙÔ˜ Ì‹ÙÚ·˜-ÙÚ·¯‹ÏÔ˘ 2/1, ÂÓÒ ÔÈ ˆÔı‹Î˜ ‹Ù·Ó ÌÈÎÚ¤˜ (fiÁÎÔ˜ ‰ÂÍÈ¿˜ ˆÔı‹Î˘: 0,83 cc Î·È ·ÚÈÛÙÂÚ‹˜: 1,11 cc). ™ÙËÓ MRI ˘fiÊ˘Û˘ ·ÂÈÎÔÓÈ˙fiÙ·Ó ÌÈÎÚÔ·‰¤ÓˆÌ· ‰È·Ì¤ÙÚÔ˘ <1 cm, ÛÙÔ ·ÚÈÛÙÂÚfi Ï¿ÁÈÔ ÙÔ˘ ·‰¤Ó· Ù˘ ˘fiÊ˘Û˘, Ì ·ÚÔ˘Û›· ·ÈÌÔÚÚ·ÁÈ΋˜ ÂÛÙ›·˜, ÂÓÒ Ô Ì›Û¯Ô˜ ÚÔ¤‚·ÏÏ ÚÔ˜ Ù· ‰ÂÍÈ¿. ∫·Ù¿ ÙËÓ ÔÊı·ÏÌÔÏÔÁÈ΋ ÂͤٷÛË, Ô ‚˘ıfi˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜. ™ÙÔ U/S ηډȿ˜ ‰È·ÈÛÙÒıËΠÔÚȷ΋ ˘ÂÚÙÚÔÊ›· ÙÔ˘ ÌÂÛÔÎÔÈÏÈ·ÎÔ‡ ‰È·ÊÚ¿ÁÌ·ÙÔ˜. ∏ ·ÛıÂÓ‹˜, ÏfiÁˆ Ù˘ ˘¤ÚÙ·Û˘, ¤Ï·‚ ·ÓÙÈ˘ÂÚÙ·ÛÈ΋ ·ÁˆÁ‹ Ì ‚-·Ó·ÛÙÔÏ›˜ (ÚÔÚ·ÓÔÏfiÏË, 20 mg ËÌÂÚËÛ›ˆ˜). ∆Ô ÌÈÎÚÔ·‰¤ÓˆÌ· ·Ê·ÈÚ¤ıËΠÂÈÙ˘¯Ò˜ Ì ‰È·ÛÊËÓÔÂȉ‹ ÚÔۤϷÛË. ª›· ‚‰ÔÌ¿‰· ÌÂÙÂÁ¯ÂÈÚËÙÈο, ÔÈ ÙÈ̤˜ Ù˘ ÚˆÈÓ‹˜ ÎÔÚÙÈ˙fiÏ˘ ÂÏ·ÙÙÒıËÎ·Ó ·fi 64,3 Ìg/dl Û 0,04 Ìg/dl Î·È Ù˘ ACTH ·fi 118 pg/ml Û 10 pg/ml, fiˆ˜ ›Û˘ Î·È ÔÈ ÙÈ̤˜ Ù˘ ÂχıÂÚ˘ ÎÔÚÙÈ˙fiÏ˘ Ô‡ÚˆÓ 24ÒÚÔ˘ ·fi 750 Ìg/24ˆÚÔ Û 5 Ìg/24ˆÚÔ. ∏ ·ÛıÂÓ‹˜ Ï·Ì‚¿ÓÂÈ ·ÁˆÁ‹ ˘ÔηٿÛÙ·Û˘ Ì ˘‰ÚÔÎÔÚÙÈ˙fiÓË. ªÂÙÂÁ¯ÂÈÚËÙÈο ‰ÂÓ ·ÚÔ˘Û›·Û ¿ÔÈÔ ‰È·‚‹ÙË.
¶·È‰È·ÙÚÈ΋ 2003;66:471-474
¶¤ÓÙ ̋Ó˜ ÌÂÙ¿ ÙËÓ Â¤Ì‚·ÛË Â›¯Â ÂÌÌËÓ·Ú¯‹ Î·È ÔÈ ÙÈ̤˜ ÙˆÓ FSH, LH, E2, TSH, T3 Î·È T4 ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈΤ˜. O Ú˘ıÌfi˜ ·Ó¿Ù˘Í˘ Ù˘ ·ÛıÂÓÔ‡˜ ‚ÂÏÙÈÒıËÎÂ Î·È ‰Ò‰Âη Ì‹Ó˜ ÌÂÙ¿ ÙËÓ ÂÁ¯Â›ÚËÛË ÙÔ ‡„Ô˜ Ù˘ Â›Ó·È 143 cm, ÙÔ ‚¿ÚÔ˜ 38,5 kg, Ë ÂÌÊ¿ÓÈÛ‹ Ù˘ ¤¯ÂÈ ‚ÂÏÙȈı› ÛËÌ·ÓÙÈο Î·È Ù· ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο Ù˘ ÓfiÛÔ˘ Cushing ¤¯Ô˘Ó ˘Ô¯ˆÚ‹ÛÂÈ. ∏ ·ÚÙËÚȷ΋ Ù˘ ›ÂÛË Â›Ó·È Ê˘ÛÈÔÏÔÁÈ΋ ¯ˆÚ›˜ ıÂڷ›·. ™˘˙‹ÙËÛË ∆· ·È‰È¿ Î·È ÔÈ ¤ÊË‚ÔÈ Ì ÓfiÛÔ Cushing ·ÚÔ˘ÛÈ¿˙Ô˘Ó Û˘Ìو̷ÙÔÏÔÁ›· Ô˘ ‰È·Ê¤ÚÂÈ ·fi ÂΛÓË ÙˆÓ ÂÓËÏ›ÎˆÓ (1,2). O ÈÔ Â˘·›ÛıËÙÔ˜ ‰Â›ÎÙ˘ ˘ÂÚÎÔÚÙÈ˙ÔÏ·ÈÌ›·˜ ÛÙ· ·È‰È¿ Â›Ó·È Ë Î·ı˘ÛÙ¤ÚËÛË Ù˘ ۈ̷ÙÈ΋˜ ·Ó¿Ù˘Í˘, Ë ÔÔ›· Û˘Ó‹ıˆ˜ ÚÔËÁÂ›Ù·È ÙˆÓ ¿ÏÏˆÓ ÂΉËÏÒÛÂˆÓ (2,10), ÂÓÒ Ë ·¯˘Û·ÚΛ· ÛÙ· ·È‰È¿ Ì ۇӉÚÔÌÔ Cushing Â›Ó·È ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÊÔÚ¤˜ ÁÂÓÈÎÂ˘Ì¤ÓË, ·Ú¿ ÎÂÓÙÚÈÎÔ‡ Ù‡Ô˘ (2). ∏ ˘ÂÚÎÔÚÙÈ˙ÔÏ·ÈÌ›· ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙËÓ Î·Ù¿ÚÁËÛË ÙÔ˘ ËÌÂÚ‹ÛÈÔ˘ Ú˘ıÌÔ‡ ¤ÎÎÚÈÛ˘ Ù˘ ÎÔÚÙÈ˙fiÏ˘ Î·È Ë Î·Ù·ÛÙÔÏ‹ Ù˘ ÌÂÙ¿ ·fi ¯ÔÚ‹ÁËÛË ˘„ËÏÒÓ ‰fiÛÂˆÓ DXM, ·ÏÏ¿ fi¯È ÌÂÙ¿ ·fi ¯ÔÚ‹ÁËÛË ÌÈÎÚÒÓ ‰fiÛˆÓ, Â›Ó·È ·fi Ù· ¯·Ú·ÎÙËÚÈÛÙÈο ·ıÔÁÓˆÌÔÓÈο Â˘Ú‹Ì·Ù· Ù˘ ÓfiÛÔ˘ Cushing (1,2). ∏ ·ÛıÂÓ‹˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ›¯Â fiÏ· Ù· ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Cushing: ηı˘ÛÙ¤ÚËÛË ·‡ÍËÛ˘ Î·È ÂÓ‹‚ˆÛ˘, ÎÂÓÙÚÈÎÔ‡ Ù‡Ô˘ ·¯˘Û·ÚΛ·, ·ÓÛÂÏËÓÔÂȉ¤˜ ÚÔÛˆÂ›Ô Î·È ‡‚Ô ÛÙÔÓ ·˘¯¤Ó·, ˘¤ÚÙ·ÛË Î·È ˘ÂÚÙÚ›¯ˆÛË. ∏ ÂχıÂÚË ÎÔÚÙÈ˙fiÏË Ô‡ÚˆÓ 24ÒÚÔ˘ ‹Ù·Ó Ôχ ·˘ÍË̤ÓË, ηıÒ˜ Î·È Ë ACTH. OÈ È‰È·›ÙÂÚ· ·˘ÍË̤Ó˜ ÙÈ̤˜ Ù˘ ÎÔÚÙÈ˙fiÏ˘ Û˘Óԉ‡ÔÓÙ·Ó ·fi ·‡ÍËÛË fiÏˆÓ ÙˆÓ ÛÙÂÚÔÂȉÈÎÒÓ ·Ú·ÁÒÁˆÓ ÙˆÓ ÂÈÓÂÊÚȉ›ˆÓ (17-O∏-ÚÔÁÂÛÙÂÚfiÓË, ·Ó‰ÚÔÁfiÓ·), ÂÓÒ Â›¯Â ηٷÚÁËı› Ë ËÌÂÚ‹ÛÈ· ‰È·Î‡Ì·ÓÛË Ù˘ ÎÔÚÙÈ˙fiÏ˘. ∏ ¯ÔÚ‹ÁËÛË ÌÂÁ¿ÏˆÓ ‰fiÛÂˆÓ DXM η٤ÛÙÂÈÏ ÙËÓ ÎÔÚÙÈ˙fiÏË Î·È ÙËÓ ACTH Û ÔÛÔÛÙfi >50%. ∏ ·˘ÍË̤ÓË ACTH Î·È Ë Î·Ù·ÛÙÔÏ‹ Ù˘ ÎÔÚÙÈ˙fiÏ˘ Î·È Ù˘ ACTH ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË ÌÂÁ¿ÏˆÓ ‰fiÛÂˆÓ DXM, Û˘ÓËÁÔÚÔ‡Û·Ó ˘¤Ú Ù˘ ÓfiÛÔ˘ Cushing Î·È ·˘Ùfi ÂȂ‚·ÈÒıËΠ·ÂÈÎÔÓÈÛÙÈο Ì MRI ˘fiÊ˘Û˘ Î·È U/S ÂÈÓÂÊÚȉ›ˆÓ. ∏ ˘ÂÚÎÔÚÙÈ˙ÔÏ·ÈÌ›· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Cushing Ô‰ËÁ› Û ηٷÛÙÔÏ‹ ÙˆÓ ÂÚÈÛÛfiÙÂÚˆÓ ÔÚÌÔÓÒÓ Ù˘ ÚfiÛıÈ·˜ ˘fiÊ˘Û˘ (FSH, LH, PRL, TSH Î·È GH) (10). O Ú˘ıÌfi˜ Ù˘ ۈ̷ÙÈ΋˜ ·Ó¿Ù˘Í˘ ÂÈ‚Ú·‰‡ÓÂÙ·È Ì¤¯ÚÈ ÌˉÂÓÈÛÌÔ‡ (11). ∏ ·Ó·ÛÙÔÏ‹ Ù˘ ·Ó¿Ù˘Í˘ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙËÓ ÂÌÊ¿ÓÈÛË ·¯˘Û·ÚΛ·˜ ÛÙ· ·È‰È¿, ı¤ÙÂÈ ÙËÓ ˘Ô„›· Û˘Ó‰ÚfiÌÔ˘ Cushing (10), ·ÊÔ‡ Â›Ó·È ÁÓˆÛÙfi fiÙÈ Ë ·‡ÍËÛË ÙÔ˘ ‚¿ÚÔ˘˜ ÛÙËÓ ·È‰È΋ ËÏÈΛ· Û˘Óԉ‡ÂÙ·È ·fi Ù·¯‡ÙÂÚÔ Ú˘ıÌfi ·Ó¿Ù˘Í˘. ∏ ·ÓÙ·fiÎÚÈÛË Ù˘
Paediatriki 2003;66:471-474
·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ ÛÙȘ ‰ÔÎÈ̷ۛ˜ ‰È¤ÁÂÚÛ˘ ÌÔÚ› Ó· Â›Ó·È Ê˘ÛÈÔÏÔÁÈ΋ ‹ ÂÏ·Ùو̤ÓË (2,10,11). ™ÙËÓ ·ÛıÂÓ‹ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‹Ù·Ó ÂÏ·Ùو̤ÓË. ∆Ô ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· ÙˆÓ ·ÛıÂÓÒÓ Â›Ó·È Û˘Ó‹ıˆ˜ ¯·ÌËÏfiÙÂÚÔ ·fi ÙÔ ÚÔ‚ÏÂfiÌÂÓÔ (2). ∆Ô ÚÔ‚ÏÂfiÌÂÓÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· Ù˘ Û˘ÁÎÂÎÚÈ̤Ó˘ ·ÛıÂÓÔ‡˜, ‚¿ÛË Ù˘ ÔÛÙÈ΋˜ ËÏÈΛ·˜, ‹Ù·Ó 144,7 cm, ÙÔ ÔÔ›Ô ˘ÔÏ›ÂÙ·È ÛËÌ·ÓÙÈο ÙÔ˘ ‡„Ô˘˜-ÛÙfi¯Ô˘ (160,7 cm). O ˘ÔÁÔÓ·‰ÔÙÚÔÊÈÎfi˜ ˘ÔÁÔÓ·‰ÈÛÌfi˜ Û˘Óԉ‡ÂÈ Ù· ·È‰È¿ Ô˘ ÂÌÊ·Ó›˙Ô˘Ó Û‡Ó‰ÚÔÌÔ Cushing ÛÙËÓ ·Ú¯‹ Ù˘ ÂÊ˂›·˜ (8,10). ∏ ·ÛıÂÓ‹˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ·ÚÔ˘Û›·Û ›Û˘ ˘ÔÁÔÓ·‰ÔÙÚÔÊÈÎfi ˘ÔÁÔÓ·‰ÈÛÌfi (¯·ÌËϤ˜ ÙÈ̤˜ FSH, LH Î·È ∂2 Î·È ÛÙÔ U/S ¤Ûˆ ÁÂÓÓËÙÈÎÒÓ ÔÚÁ¿ÓˆÓ ÌÈÎÚ¤˜ ˆÔı‹Î˜). ªÂÙ¿ ÙËÓ ·Ê·›ÚÂÛË ÙÔ˘ ·‰ÂÓÒÌ·ÙÔ˜, Ë ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ ÁÔÓ¿‰ˆÓ Û˘Ó‹ıˆ˜ ·Ôηı›ÛÙ·Ù·È Î·È ÔÈ ·ÛıÂÓ›˜ Ù˘ ÂÊË‚È΋˜ ËÏÈΛ·˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ê˘ÛÈÔÏÔÁÈ΋ ÂÊË‚È΋ ÂͤÏÈÍË, Ê˘ÛÈÔÏÔÁÈÎÔ‡˜ ·ÎÏÔ˘˜ ÂÌÌËÓÔÚÚ˘Û›·˜ Î·È Ê˘ÛÈÔÏÔÁÈο ›‰· ÛÙÂÚÔÂȉÒÓ ÙÔ˘ ʇÏÔ˘ (10), fiˆ˜ Û˘Ó¤‚Ë Î·È Ì ÙË Û˘ÁÎÂÎÚÈ̤ÓË ·ÛıÂÓ‹. ¶ÔÏÏÔ› ·ÛıÂÓ›˜ Ì ۇӉÚÔÌÔ Cushing ÂÌÊ·Ó›˙Ô˘Ó ¯·ÌËÏ‹ TSH, T3 Î·È FT3 (10). ∏ Û˘ÁΤÓÙÚˆÛË Ù˘ TSH Â›Ó·È ÌÂȈ̤ÓË ˆ˜ ·ÔÙ¤ÏÂÛÌ· Ù˘ ‰Ú¿Û˘ ÙˆÓ ÁÏ˘ÎÔÎÔÚÙÈÎÔÂȉÒÓ, ÙfiÛÔ ÛÂ Â›Â‰Ô ˘Ôı·Ï¿ÌÔ˘ fiÛÔ Î·È ˘fiÊ˘Û˘ (10). ∏ T3 Â›Ó·È Â›Û˘ ÌÂȈ̤ÓË, ·ÊÔ‡ Ë ˘ÂÚÎÔÚÙÈ˙ÔÏ·ÈÌ›· ÂÌÔ‰›˙ÂÈ ÙËÓ ÂÚÈÊÂÚÈ΋ ÌÂÙ·ÙÚÔ‹ Ù˘ ·fi ÙËÓ T4. ∫ÏÈÓÈο, Ë ı˘ÚÂÔÂȉÈ΋ ÏÂÈÙÔ˘ÚÁ›· Â›Ó·È Ê˘ÛÈÔÏÔÁÈ΋. ªÂÙÂÁ¯ÂÈÚËÙÈο, ÔÈ ÙÈ̤˜ ÙˆÓ ı˘ÚÂÔÂȉÈÎÒÓ ÔÚÌÔÓÒÓ TSH, T3 Î·È FT3 ·Ôηı›ÛÙ·ÓÙ·È ÛÙ· Ê˘ÛÈÔÏÔÁÈο, fiˆ˜ ·Ú·ÙËÚ‹ıËÎÂ Î·È ÛÙËÓ ·ÛıÂÓ‹ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘. ∏ ıÂڷ›· ÂÈÏÔÁ‹˜ ÛÙË ÓfiÛÔ Cushing Â›Ó·È Ë ‰È·ÛÊËÓÔÂȉ‹˜ ·Ê·›ÚÂÛË ÙÔ˘ ˘ÔÊ˘ÛÈ·ÎÔ‡ ·‰ÂÓÒÌ·ÙÔ˜ (2,8). ∏ ÂÈÙ˘¯‹˜ ·Ê·›ÚÂÛË fiÏÔ˘ ÙÔ˘ ·‰ÂÓÒÌ·ÙÔ˜ ¤¯ÂÈ Û·Ó ·ÔÙ¤ÏÂÛÌ· Ù· Ôχ ¯·ÌËÏ¿ ›‰· ÎÔÚÙÈ˙fiÏ˘ ÌÂÙÂÁ¯ÂÈÚËÙÈο (12). ∞˘Ùfi Û˘Ì‚·›ÓÂÈ ÁÈ·Ù› Ù· ·˘ÍË̤ӷ ›‰· ÎÔÚÙÈ˙fiÏ˘ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÓfiÛÔ˘ Ô‰ËÁÔ‡Ó Û ηٷÛÙÔÏ‹ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÎÔÚÙÈÎÔÙÚfiÊˆÓ Î˘ÙÙ¿ÚˆÓ Ù˘ ˘fiÊ˘Û˘, Ô˘ ‚Ú›ÛÎÔÓÙ·È Á‡Úˆ ·fi ÙÔÓ fiÁÎÔ Ù˘ ˘fiÊ˘Û˘ (12). ªÂÙ¿ ÙËÓ ·Ê·›ÚÂÛË ÙÔ˘ ·‰ÂÓÒÌ·ÙÔ˜, Ë ACTH Î·È Ë ·Ú·ÁˆÁ‹ Ù˘ ÎÔÚÙÈ˙fiÏ˘ ·Ó·ÛÙ¤ÏÏÔÓÙ·È ÁÈ· ·ÚÎÂÙfi ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·. ∏ ·ÔηٿÛÙ·ÛË Ù˘ ÎÔÚÙÈ˙fiÏ˘ ÛÂ Ê˘ÛÈÔÏÔÁÈο ›‰· Û˘Ó‹ıˆ˜ ÂÈÙ˘Á¯¿ÓÂÙ·È Û ‰È¿ÛÙËÌ· 6 ¤ˆ˜ 45 ÌËÓÒÓ (12). ∏ Û˘ÁÎÂÎÚÈ̤ÓË ·ÛıÂÓ‹˜ ·ÚÔ˘Û›·Û ÂÏ¿ÙÙˆÛË Ù˘ ÎÔÚÙÈ˙fiÏ˘ Î·È Ù˘ ACTH ÌÂÙÂÁ¯ÂÈÚËÙÈο Î·È ¯ÚÂÈ¿ÛÙËΠ·ÁˆÁ‹ Ì ˘‰ÚÔÎÔÚÙÈ˙fiÓË. ∂› ·ÔÙ˘¯›·˜ Ù˘ ‰È·ÛÊËÓÔÂȉԇ˜ ¯ÂÈÚÔ˘ÚÁÈ΋˜ ÚÔۤϷÛ˘, Û˘ÓÈÛÙ¿Ù·È Â·Ó¿ÏË„Ë (2). ∂› Ó¤·˜ ·ÔÙ˘¯›·˜, Û˘ÓÈÛÙ¿Ù·È ·ÎÙÈÓÔıÂڷ›· Ù˘
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¶·È‰È·ÙÚÈ΋ 2003;66:471-474
˘fiÊ˘Û˘ (8). ™ÙÔ˘˜ ÂÓ‹ÏÈΘ, ÂÎÙfi˜ ·fi ÙË ‰È·ÛÊËÓÔÂȉ‹ ÚÔۤϷÛË, ÌÔÚ› Ó· ¯ÚËÛÈÌÔÔÈËı› Î·È Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ (fiˆ˜ Ë ÌÂÙ˘Ú·fiÓË Î·È Ë ÌÈÙÔÙ¿ÓË, Ô˘ ·Ó·ÛÙ¤ÏÏÔ˘Ó ÙËÓ ·Ú·ÁˆÁ‹ ÎÔÚÙÈ˙fiÏ˘ ·fi Ù· ÂÈÓÂÊÚ›‰È·). ™Ù· ·È‰È¿ ‰ÂÓ Û˘ÓÈÛÙ¿Ù·È ÏfiÁˆ ÙˆÓ ·ÚÂÓÂÚÁÂÈÒÓ (8). ∏ ‰È·ÛÊËÓÔÂȉ‹˜ ¯ÂÈÚÔ˘ÚÁÈ΋ ÚÔۤϷÛË ÛÙËÓ ·ÛıÂÓ‹ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ¤‰ˆÛ ÈηÓÔÔÈËÙÈο ·ÔÙÂϤÛÌ·Ù·. ∆Ô ÔÚÌÔÓÔÏÔÁÈÎfi Ù˘ ÚÔÊ›Ï ‚ÂÏÙÈÒıËÎÂ Î·È Â›Ó·È ˘fi ·ÁˆÁ‹ Ì ˘‰ÚÔÎÔÚÙÈ˙fiÓË. ¢Ò‰Âη Ì‹Ó˜ ÌÂÙ¿, Ë ·ÛıÂÓ‹˜ Â›Ó·È ˘ÁÈ‹˜ Î·È ‰ÂÓ ¤¯ÂÈ ·ÚÔ˘ÛÈ¿ÛÂÈ ÛËÌ›· ˘ÔÙÚÔ‹˜. µÈ‚ÏÈÔÁÚ·Ê›· 1. Savage MO, Lienhardt A, Lebrethon MC, Johnston LB, Huebner A, Grossman AB et al. Cushing’s disease in childhood: presentation, investigation, treatment and longterm outcome. Horm Res 2001;55 (Suppl 1):S24-S30. 2. Devoe DJ, Miller WL, Conte FA, Kaplan SL, Grumbach MM, Rosenthal SM et al. Long-term outcome in children and adolescents after transsphenoidal surgery for Cushing’s disease. J Clin Endocrinol Metab 1997;82:3196-3202. 3. ∫·˚Ì¿Ú·-¶··ı·Ó·Û›Ô˘ ∞, ÷Ù˙Ë·ı·Ó·Û›Ô˘ Ã, §··ÙÛ¿Ó˘ ¶, ªÔ˘ÙÛÔ‡Ú˘ Ã, ¶··ıÂÔ‰ÒÚÔ˘ ∞, £ÂÔ‰ˆÚ›‰Ë˜ Ã. ™‡Ó‰ÚÔÌÔ Cushing ·fi ·‰¤ÓˆÌ· ÊÏÔÈÔ‡ ÙˆÓ ÂÈÓÂÊÚȉ›ˆÓ Û ÎÔÚ›ÙÛÈ ËÏÈΛ·˜ 12 ÂÙÒÓ. ¶·È‰È·ÙÚÈ΋ 1991;54:300-306. 4. ª›ÙÛË ª, £ÂÔ‰ˆÚ›‰Ë˜ Ã, ™˘ÚÈÔÔ‡ÏÔ˘ µ, ∫·ÙÂÚ¤ÏÔ˜ Ã, ª·ÙÛ·ÓÈÒÙ˘ ¡. ™‡Ó‰ÚÔÌÔ Cushing ·fi Ì·ÎÚÔ¯ÚfiÓÈ· ÙÔÈ΋ ¯Ú‹ÛË ÎÔÚÙÈ˙ÔÓÔ‡¯Ô˘ ·ÏÔÈÊ‹˜ Clobetasol propionate. ¢ÂÏÙ›Ô ∞’ ∫ÏÈÓÈ΋˜ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ 1982;29:135-145. 5. £ÂÔ‰ˆÚ›‰Ë˜ Ã, ªÚÈ·ÛÔ‡Ï˘ °, ∆ÛÈ‚ÈÙ·Ó›‰Ô˘ ∆, ªÔ˘Û¿ÙÔ˜ °, ∆˙ˆÚÙ˙¿ÙÔ˘ º, ∫·ÙÂÚ¤ÏÔ˜ Ã. ™‡Ó‰ÚÔÌÔ Cushing ·fi ·‰¤ÓˆÌ· ÙÔ˘ ÊÏÔÈÔ‡ ÙˆÓ ÂÈÓÂÊÚȉ›ˆÓ Û ÎÔÚ›ÙÛÈ ËÏÈΛ·˜
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5ó ÌËÓÒÓ. ¶·È‰È·ÙÚÈ΋ 1983;46:57-62. 6. £ÂÔ‰ˆÚ›‰Ë˜ Ã, ªÔ˘ÚÏÔÁÈ¿ÓÓ˘ Ã, ∫·Ú¿ıÈÔ˜ £, µÏ¿¯Ô˘ ¶, ∫·ÙÙ¿Ì˘ Ã. ∞‰ÂÓÔηÚΛӈ̷ ÙÔ˘ ÊÏÔÈÔ‡ ÙˆÓ ÂÈÓÂÊÚȉ›ˆÓ. ¶·È‰È·ÙÚÈ΋ 1979;42:295-301. 7. McArthur RG, Cloutier MD, Hayles AB, Sprague RG. Cushing’s disease in children. Findings in 13 cases. Mayo Clin Proc 1972;47:318-326. 8. Magiakou MA, Mastorakos G, Oldfield EH, Gomez MT, Doppman JL, Cutler GB et al. Cushing’s syndrome in children and adolescents. Presentation, diagnosis, and therapy. N Engl J Med 1994;331:629-636. 9. Stewart PM. The adrenal cortex. In: Larsen PR, Kronenberg HM, Melmed S, Polonsky KS, editors. Williams Textbook of Endocrinology. 10th edition. Philadelphia: WB Saunders Company; 2003. p. 509. 10. Styne DM, Grumbach MM, Kaplan SL, Wilson CB, Conte FA. Treatment of Cushing’s disease in childhood and adolescence by transsphenoidal microadenomectomy. N Engl J Med 1984;310:889-893. 11. Magiakou MA, Mastorakos G, Gomez MT, Rose SR, Chrousos GP. Suppressed spontaneous and stimulated growth hormone secretion in patients with Cushing’s disease before and after surgical cure. J Clin Endocrinol Metab 1994;78:131-137. 12. Trainer PJ, Lawrie HS, Verhelst J, Howlett TA, Lowe DG, Grossman AB et al. Transsphenoidal resection in Cushing’s disease: undetectable serum cortisol as the definition of successful treatment. Clin Endocrinol 1993;38:73-78.
HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 11-04-2003 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 17-11-2003 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∂ϤÓË ¢. ∫ˆÛÙ·ÎÈÒÙË ¶˘ÚÁȈٛÛÛ˘ 25, ∆.∫. 121 36, ∞ı‹Ó· E-mail: lenakostakioti@hotmail.com
¶·È‰È·ÙÚÈ΋ 2003;66:475-477
Paediatriki 2003;66:475-477
¡∂∞ ∞¶O ∆O ¢π∞¢π∫∆ÀO
¡∂∞ ∏ ıÂڷ›· Ù˘ ÔÍ›·˜ ̤Û˘ ˆÙ›Ùȉ·˜ Û˘Ó‰˘·Ṳ̂ÓË Ì ·ÓÙÈÈÛÙ·ÌÈÓÈο ‹ Î·È ÎÔÚÙÈ˙fiÓË ‰ÂÓ ‚ÂÏÙÈÒÓÂÈ ÙÔ ÙÂÏÈÎfi ·ÔÙ¤ÏÂÛÌ· ∫ÔÚ›Ó· ¶ÚÔ‡ÓÙ˙Ô˘ - ∫·ÛÛÈÔ‡, ¶·È‰›·ÙÚÔ˜
™‡Ìʈӷ Ì ·˘Ù‹ ÙË ÌÂϤÙË, ÔÈ Chonmaitree Î·È Û˘Ó ·fi ÙÔ Galveston Ù˘ ÔÏÈÙ›·˜ ÙÔ˘ Texas (∏¶∞) ÂÚ‡ÓËÛ·Ó ÙËÓ ˘fiıÂÛË fiÙÈ ÚfiÛıÂÙË ıÂڷ›·, ÂÎÙfi˜ ÙˆÓ ·ÓÙÈ‚ÈÔÙÈÎÒÓ, Ì ·ÓÙÈÈÛÙ·ÌÈÓÈο ‹ Î·È ÎÔÚÙÈ˙fiÓË ı· ÌÔÚÔ‡Û ӷ ÂÏ·ÙÙÒÛÂÈ ÙË ‚·Ú‡ÙËÙ· Ù˘ ÊÏÂÁÌÔÓ‹˜ ηÈ, ηٿ Û˘Ó¤ÂÈ·, Ó· ‚ÂÏÙÈÒÛÂÈ ÙËÓ ¿ÌÂÛË ‹ Ì·ÎÚÔÚfiıÂÛÌË ¤Î‚·ÛË Ù˘ Oªø. ∫·Ù¤ÓÂÈÌ·Ó Ù˘¯·›· Û ̛· ‰ÈÏ‹-Ù˘ÊÏ‹, Ì ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ, ÌÂϤÙË 179 ·È‰È¿ ËÏÈΛ·˜ 3 ÌËÓÒÓ ¤ˆ˜ 6 ÂÙÒÓ Û ÙÚÂȘ ÔÌ¿‰Â˜, ·ÊÔ‡ fiÏ· ¤Ï·‚·Ó Ì›· ¤ÓÂÛË ÎÂÊÙÚÈ·ÍfiÓ˘: Ë ÚÒÙË ÔÌ¿‰· ¤Ï·‚ ÚfiÛıÂÙ· ¯ÏˆÚÔÊÂÓÈÚ·Ì›ÓË 0,35 mg/kg ÙËÓ Ë̤ڷ, Ë ‰Â‡ÙÂÚË Ú‰ÓÈ˙ÔÏfiÓË 2 mg/kg ÙËÓ Ë̤ڷ, Ë ÙÚ›ÙË ÔÌ¿‰· ¤Ï·‚ ¯ÏˆÚÔÊÂÓÈÚ·Ì›ÓË Î·È Ú‰ÓÈ˙fiÓË ÛÙȘ ·ÓˆÙ¤Úˆ ‰fiÛÂȘ Î·È Ë Ù¤Ù·ÚÙË ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ ÁÈ· 5 Ë̤Ú˜. ¢ÂÓ ˘‹ÚÍ ‰È·ÊÔÚ¿ ÌÂٷ͇ ÙˆÓ ÙÚÈÒÓ ÔÌ¿‰ˆÓ ÛÙËÓ ÂÏ¿ÙÙˆÛË ÙˆÓ Û˘Ìو̿وÓ, Û‡Ìʈӷ Ì ÙË ‚·ıÌÔÏÔÁ›· ‚·Ú‡ÙËÙ·˜, ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂڷ›·˜ Î·È Î·Ù¿ ÙËÓ ÂͤٷÛË ÙËÓ 5Ë Î·È 14Ë Ë̤ڷ. ¢ÂÓ ˘‹ÚÍÂ, ›Û˘, ‰È·ÊÔÚ¿ ÛÙÔÓ ·ÚÈıÌfi ÙˆÓ ˘ÔÙÚÔÒÓ Î·È ÁÈ· 6 Ì‹Ó˜ ÌÂÙ¿. ªË ·Ó·ÌÂÓfiÌÂÓË ‹Ù·Ó Ë ·Ú·Ù‹ÚËÛË fiÙÈ ÛÙ· ·È‰È¿ Ô˘ ¯ÔÚËÁ‹ıËΠ·ÓÙÈÈÛÙ·ÌÈÓÈÎfi, ·Ú·Ù¿ıËÎÂ Ë Û˘ÏÏÔÁ‹ ˘ÁÚÔ‡ ÛÙÔ Ì¤ÛÔ Ô˘˜ (̤ÛË ‰È¿ÚÎÂÈ· 73 Ë̤Ú˜ Û ۯ¤ÛË Ì ÙȘ ¿ÏϘ 3 ÔÌ¿‰Â˜ fiÔ˘ Ë Ì¤ÛË ‰È¿ÚÎÂÈ· ‹Ù·Ó 23-36 Ë̤Ú˜). ¢ÂÓ Â›Ó·È ÍÂοı·ÚÔ˜ Ô Ì˯·ÓÈÛÌfi˜ Ì ‚¿ÛË ÙÔÓ ÔÔ›Ô Ù· ·È‰È¿ Ô˘ ¤Ï·‚·Ó ·ÓÙÈÈÛÙ·ÌÈÓÈÎfi ›¯·Ó ·Ú·ÌÔÓ‹ ÙÔ˘ ˘ÁÚÔ‡ ÛÙÔ Ì¤ÛÔ Ô˘˜ ÁÈ· ÌÂÁ·Ï‡ÙÂÚÔ ‰È¿ÛÙËÌ·. OÈ Û˘ÁÁÚ·Ê›˜ Èı·ÓÔÏÔÁÔ‡Ó fiÙÈ Ù· ·ÓÙÈÈÛÙ·ÌÈÓÈο ·˘Í¿ÓÔ˘Ó ÙË ÁÏÔÈfiÙËÙ· ÙÔ˘ ˘ÁÚÔ‡ Î·È ¤ÙÛÈ ·ÚÂÌ‚·›ÓÔ˘Ó ÛÙËÓ ·ÔÚÚfiÊËÛË Î·È ÙËÓ ·ÚÔ¯¤ÙÂ˘Û‹ ÙÔ˘. ∫·Ù·Ï‹ÁÔ˘Ó, ÏÔÈfiÓ, fiÙÈ Ë ¯Ú‹ÛË ·ÓÙÈÈÛÙ·ÌÈÓÈÎÒÓ ÛÙËÓ Oªø Ú¤ÂÈ Ó· ·ÔʇÁÂÙ·È. ¢ÂÓ Â›Ó·È Û·Ê¤˜, ·fi ·˘Ù‹ ÙË ÌÂϤÙË, Â¿Ó Ë ¯Ú‹ÛË ÎÔÚÙÈÎÔÂȉÒÓ ˆÊÂÏ› ‹ ‚Ï¿ÙÂÈ. J Pediatr 2003;143:377-385 ∏ ÛȉËÚÔÂÓ›· ÌÔÚ› Ó· ·ÔÙÂÏ› ÚԉȷıÂÛÈÎfi ·Ú¿ÁÔÓÙ· ÁÈ· ÙË ‰ËÏËÙËÚ›·ÛË ·fi ÌfiÏ˘‚‰Ô ÛÙ· ·È‰È¿ ∫ÔÚ›Ó· ¶ÚÔ‡ÓÙ˙Ô˘ - ∫·ÛÛÈÔ‡, ¶·È‰›·ÙÚÔ˜
∞˘Ùfi Â›Ó·È ÙÔ Û˘Ì¤Ú·ÛÌ· Ì›·˜ ÌÂϤÙ˘ ÙˆÓ Choi J Î·È Kim S ·fi ÙË ¡fiÙÈ· ∫ÔÚ¤·. ∏ ÛȉËÚÔÂÓ›· ηÙËÁÔÚÈÔÔÈÂ›Ù·È Û 3 ÛÙ¿‰È·: ÛÙ¿‰ÈÔ π (ÂÍ¿ÓÙÏËÛË ÙˆÓ ·ÔıÂÌ¿ÙˆÓ Ûȉ‹ÚÔ˘) Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÙËÓ ·Ô˘Û›· ·Ó·ÈÌ›·˜, Ê˘ÛÈÔÏÔÁÈο ›‰· Ûȉ‹ÚÔ˘ ÛÙÔ ·›Ì· (>50 mcg/dL) Î·È ÂÏ·Ùو̤ÓË ÊÂÚÚÈÙ›ÓË (<12 mcg/L), ÛÙ¿‰ÈÔ ππ (Ê¿ÛË ÛȉËÚÔÂÓÈ΋˜ ÂÚ˘ıÚÔÔ›ËÛ˘) Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ¯·ÌËÏ‹ ÊÂÚÚÈÙ›ÓË ÔÚÔ‡ <12 mcg/L Î·È Û›‰ËÚÔ ÔÚÔ‡ <50 mcg/dL ¯ˆÚ›˜ ÚÔÊ·Ó‹ ·Ó·ÈÌ›· Î·È ÛÙ¿‰ÈÔ πππ (ÛȉËÚÔÂÓÈ΋ ·Ó·ÈÌ›·) Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ¯·ÌËÏfi Û›‰ËÚÔ ÔÚÔ‡, ¯·ÌËÏ‹ ÊÂÚÚÈÙ›ÓË ÔÚÔ‡ Î·È ·ÈÌÔÛÊ·ÈÚ›ÓË <12 g/dL. ∞fi ÚÔËÁÔ‡ÌÂÓ˜ ÌÂϤÙ˜ Â›Ó·È ÁÓˆÛÙfi fiÙÈ Ù· ·È‰È¿ Ì ÛȉËÚÔÂÓ›· ¤¯Ô˘Ó ˘„ËÏfiÙÂÚ· ›‰· ÌÔχ‚‰Ô˘ ÛÙÔ ·›Ì·. OÈ ÂÚ¢ÓËÙ¤˜ ÚÔÛ‰ÈfiÚÈÛ·Ó Ù· ›‰· ÌÔχ‚‰Ô˘ ÛÙÔ ·›Ì· Û οı ¤Ó· ·fi Ù· 3 ÛÙ¿‰È· Ù˘ ÛȉËÚÔÂÓÈ΋˜ ·Ó·ÈÌ›·˜, ηıÒ˜ ›Û˘ Î·È Ù· ›‰· ÌÔχ‚‰Ô˘ ÛÙÔ ·›Ì· ÌÂÙ¿ ·fi
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¡∂∞ ∞¶O ∆O ¢π∞¢π∫∆ÀO
ÛȉËÚÔıÂڷ›·. ¶ÚÔÛ‰ÈfiÚÈÛ·Ó ÙËÓ ·ÈÌÔÛÊ·ÈÚ›ÓË, ÙÔÓ Û›‰ËÚÔ ÔÚÔ‡, ÙË ÊÂÚÚÈÙ›ÓË ÔÚÔ‡ Î·È Ù· ›‰· ÌÔχ‚‰Ô˘ ÛÙÔ ·›Ì· Û 279 ·È‰È¿ (ËÏÈΛ·˜ 10-15 ÂÙÒÓ) Ô˘ ‰È¤ÌÂÓ·Ó Û ÂÚÈ‚¿ÏÏÔÓ ÂÚÁÔÛÙ·Ûȷ΋˜ ÌfiÏ˘ÓÛ˘. ∆· ·È‰È¿ ¯ˆÚ›ÛÙËÎ·Ó Û 4 ÔÌ¿‰Â˜ (ÛÙ¿‰È· π, ππ, πππ Î·È ˘ÁÈ›˜ Ì¿ÚÙ˘Ú˜). ŸÏ· Ù· ·È‰È¿ Ì ÛȉËÚÔÂÓ›· ›¯·Ó ÂÏ·Ùو̤ÓË ÊÂÚÚÈÙ›ÓË ÔÚÔ‡, ·ÏÏ¿ ÌfiÓÔ Ù· ·È‰È¿ ÛÙ· ÛÙ¿‰È· ππ Î·È πππ ‚Ú¤ıËÎ·Ó Ó· ¤¯Ô˘Ó ·˘ÍË̤ӷ ›‰· ÌÔχ‚‰Ô˘. OÈ Û˘ÁÁÚ·Ê›˜ ηٷϋÁÔ˘Ó fiÙÈ Ë ÂÏ·Ùو̤ÓË ÊÂÚÚÈÙ›ÓË ÔÚÔ‡ ‰ÂÓ ÂËÚ¿˙ÂÈ Ù· ›‰· ÌÔχ‚‰Ô˘, ÂÓÒ Ù· ¯·ÌËÏ¿ ›‰· Ûȉ‹ÚÔ˘ ÛÙÔÓ ÔÚfi (ÛÙ¿‰È· ππ Î·È πππ) ·˘Í¿ÓÔ˘Ó Ù· ›‰· ÌÔχ‚‰Ô˘ ÛÙÔ ·›Ì·. ∆· ›‰· ÌÔχ‚‰Ô˘ ÛÙÔ ·›Ì· ÙˆÓ ·Ó·ÈÌÈÎÒÓ ·È‰ÈÒÓ ‚Ú¤ıËÎ·Ó ·˘ÍË̤ӷ 1,6 ÊÔÚ¤˜ Û ۇÁÎÚÈÛË Ì ÙÔ˘˜ Ì¿ÚÙ˘Ú˜. ∆ÚÈ¿ÓÙ· Ù¤ÛÛÂÚ· ·È‰È¿ Ì ·Ó·ÈÌ›· ıÂڷ‡ÙËÎ·Ó Ì Û··ÛÌ· ıÂÈÈÎÔ‡ Ûȉ‹ÚÔ˘ (3-6 mg ÛÙÔȯÂÈ·ÎÔ‡ Ûȉ‹ÚÔ˘ ·Ó¿ kg µ™ ÙËÓ Ë̤ڷ) Î·È ÌÂÙ¿ ¤Ó· Ì‹Ó· Ù· ›‰· ÌÔχ‚‰Ô˘ ›¯·Ó ÌÂȈı› ÛËÌ·ÓÙÈο (·fi 6,8 ± 1,7 Û 2,7 ± 1,2 mcg/dL, p<0,01). µ·ÛÈ˙fiÌÂÓÔÈ Û ·˘Ù¿ Ù· Â˘Ú‹Ì·Ù·, ÔÈ ÂÚ¢ÓËÙ¤˜ ηٷϋÁÔ˘Ó fiÙÈ Ë ÛȉËÚÔÂÓ›· Â›Ó·È Èı·ÓfiÓ Ó· ·ÔÙÂÏ› ÚԉȷıÂÛÈÎfi ·Ú¿ÁÔÓÙ· ÁÈ· ‰ËÏËÙËÚ›·ÛË ·fi ÌfiÏ˘‚‰Ô, ÂÓÒ ‚ÂÏÙÈÒÓÔÓÙ·˜ ÙË ÛȉËÚÔÂÓ›·, ÌÔÚ› Ó· ÂÏ·ÙÙˆıÔ‡Ó Î·È Ù· ›‰· ÌÔχ‚‰Ô˘ ÛÙÔ ·›Ì·. ™¯fiÏÈÔ: ™ÙËÓ ∂ÏÏ¿‰·, Ë ‰ËÏËÙËÚ›·ÛË ·fi ÌfiÏ˘‚‰Ô Û·Ó›ˆ˜ ıˆÚÂ›Ù·È ˆ˜ Èı·ÓfiÙËÙ·. ÿÛˆ˜, Û‡Ìʈӷ Ì ٷ ·ÓˆÙ¤Úˆ Â˘Ú‹Ì·Ù·, ı· Ú¤ÂÈ Ó· ‰ÈÂÚÂ˘Ó¿Ù·È Û˘ÛÙËÌ·ÙÈο Ë ‰È·ÁÓˆÛÙÈ΋ ·˘Ù‹ Èı·ÓfiÙËÙ· Û ‚ÈÔÌ˯·ÓÈΤ˜ ÂÚÈÔ¯¤˜ Î·È Û ·È‰È¿ Ì ÛȉËÚÔÂÓ›·. ∏ ‰ËÏËÙËÚ›·ÛË ·fi ÌfiÏ˘‚‰Ô Â›Ó·È ‡Ô˘ÏË Î·È ¤¯ÂÈ ÚˆÙÂ˚Τ˜ ÂΉËÏÒÛÂȘ, Â›Ó·È fï˜ ÛÔ‚·Ú‹ Î·È Ú¤ÂÈ Ó· ‰È·ÁÈÁÓÒÛÎÂÙ·È ¤ÁηÈÚ· ÁÈ· Ó· ·ÔÊ¢¯ıÔ‡Ó ÛÔ‚·Ú¤˜ Î·È Ì·ÎÚÔ¯ÚfiÓȘ ÂÈÏÔΤ˜. Arch Dis Child 2003;88:791-792
∏§∂∫∆ƒO¡π∫∂™ ¢π∂À£À¡™∂π™ §·ÌÚfi ª¤ÏÏÔÓ!! http://www.brightfutures.org/ ∆Ô ¶·ÓÂÈÛÙ‹ÌÈÔ Ù˘ Georgetown Î·È ÙÔ ∂ıÓÈÎfi ∫¤ÓÙÚÔ ∂η›‰Â˘Û˘ Û¯ÂÙÈο Ì ÙËÓ ÀÁ›· ªËÙ¤Ú·˜ Î·È ¶·È‰ÈÔ‡ ÙˆÓ ∏.¶.∞. ¤¯Ô˘Ó ۯ‰ȿÛÂÈ ¤Ó·Ó ÎÔÌ„fiÙ·ÙÔ ‰È·‰ÈÎÙ˘·Îfi ÙfiÔ Ô˘ ÂÚȤ¯ÂÈ Ï‹ıÔ˜ Ú·ÎÙÈÎÒÓ Ô‰ËÁÈÒÓ. ¶ÔÏÏ¿ ·fi Ù· ÂÁ¯ÂÈÚ›‰È· Ô˘ ÂΉ›‰ÂÈ Ë ÔÚÁ¿ÓˆÛË ·˘Ù‹ ·Ú¤¯ÔÓÙ·È ‰ˆÚ¿Ó, Ì ÙË ÌÔÚÊ‹ ·Ú¯Â›ˆÓ .pdf. ∏ ÂÈÎÔÓÔÁÚ¿ÊËÛË Â›Ó·È Î·ı·Ú‹ Î·È ¿„ÔÁË, Ù·ÈÚÈ¿˙ÔÓÙ·˜ ·fiÏ˘Ù· Ì ÙÔ ÏÈÙfi ΛÌÂÓÔ, ÙÔ ÔÔ›Ô Â›Ó·È ÚÔÛ·ÚÌÔṲ̂ÓÔ ÛÙȘ ·Ó¿ÁΘ ÙÔ˘ ÔÏ˘¿Û¯ÔÏÔ˘ ·ÁÁÂÏÌ·Ù›· ˘Á›·˜, ηٷʤÚÓÔÓÙ·˜ Ó· ·ÚÔ˘ÛÈ¿˙ÂÈ ÂÚ›ÏÔη ı¤Ì·Ù· Ì ÙÚfiÔ Î·Ù·ÓÔËÙfi, ¯ˆÚ›˜ Ó· ¯¿ÓÂÈ ÙËÓ Ô˘Û›· ÙÔ˘˜. ™˘ÛÙ‹ÓÂÙ·È ·ÓÂÈʇϷÎÙ·, ·ÊÔ‡ ¿ÏψÛÙ ¤¯ÂÈ Î·Ù·ÎÙ‹ÛÂÈ ÔÏÏ¿ Û¯ÂÙÈο ‚Ú·‚›·.
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Paediatriki 2003;66:475-477
¡∂∞ ∞¶O ∆O ¢π∞¢π∫∆ÀO
∞Ó¿Ï˘ÛË ‚È‚ÏÈÔÁÚ·Ê›·˜: ÚÈÓ ·fi ÂÛ¿˜... ÁÈ· ÂÛ¿˜! http://pediatrics.jwatch.org/ ¢Â‰Ô̤ÓÔ˘ fiÙÈ Ë ÔÛfiÙËÙ· Ù˘ ÎÏÈÓÈ΋˜ ¤Ú¢ӷ˜ ÛÙȘ ̤Ú˜ Ì·˜ fiÏÔ Î·È ·˘Í¿ÓÂÈ, ¤Ó·˜ ÛËÌ·ÓÙÈÎfi˜ ·ÚÈıÌfi˜ ÔÚÁ·ÓÒÛÂˆÓ ·Ó·Ï·Ì‚¿ÓÂÈ ÙËÓ ·Ô‰ÂÏÙ›ˆÛË ÙˆÓ Û¯ÂÙÈÎÒÓ ·È‰È·ÙÚÈÎÒÓ ÂÚÈÔ‰ÈÎÒÓ, ÙË Û‡ÓÔ„Ë Î·È ÙÔÓ Û¯ÔÏÈ·ÛÌfi ÙÔ˘˜. OÈ ÚˆÙÔ‚Ô˘Ï›Â˜ ·˘Ù¤˜ ‰ÂÓ Â›Ó·È ¿ÓÙ· ÂÈÙ˘¯Ë̤Ó˜, ·ÊÔ‡ Ú¤ÂÈ Ó· ÈÛÔÚÚÔ‹ÛÔ˘Ó ÌÂٷ͇ Ù˘ ÈÛÔ¤‰ˆÛ˘ ÙÔ˘ ‚¿ıÔ˘˜ Î·È Ù˘ ÎÔ‡Ú·Û˘ Ù˘ ÏÂÙÔ̤ÚÂÈ·˜. ŸÙ·Ó, fï˜, ÙÔ ÂÁ¯Â›ÚËÌ· ÚÔ¤Ú¯ÂÙ·È ·fi ÙÔ˘˜ ÂΉfiÙ˜ ÙÔ˘ New England Journal of Medicine, ÔÈ ÂÁÁ˘‹ÛÂȘ Â›Ó·È ˘„ËϤ˜. ∆Ô Journal Watch Pediatrics and Adolescent Medicine, ÂÌÊ·Ó›˙ÂÙ·È ‰‡Ô ÊÔÚ¤˜ ÙËÓ Â‚‰ÔÌ¿‰· ÛÙÔ ‰›ÎÙ˘Ô, ÂÓÒ Ë ¤ÓÙ˘Ë ¤Î‰ÔÛË Î˘ÎÏÔÊÔÚ› ÌËÓÈ·›·. ∞Ó¿ÌÂÛ· ÛÙ· 28 ÂȉÈο ÂÚÈÔ‰Èο Ô˘ ·Ô‰ÂÏÙÈÒÓÂÈ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È Ù· ÛËÌ·ÓÙÈÎfiÙÂÚ· Ù˘ ÂȉÈÎfiÙËÙ·˜, ·ÏÏ¿ Î·È ÁÂÓÈο ÂÚÈÔ‰Èο ˘„ËÏÔ‡ impact, fiˆ˜ ÙÔ Lancet, ÙÔ NEJM Î.¿. ∏ ¯Ú‹ÛË fiÏˆÓ ÙˆÓ ‰˘Ó·ÙÔÙ‹ÙˆÓ ÙÔ˘ ‰ÈÎÙ˘·ÎÔ‡ ÙfiÔ˘ ··ÈÙ› ÂÙ‹ÛÈ· Û˘Ó‰ÚÔÌ‹, Ë ÔÔ›· ÁÈ· ÙËÓ ∂ÏÏ¿‰· ·Ó¤Ú¯ÂÙ·È Û 115 £ ÁÈ· ÙÔ˘˜ ÂȉÈÎÂ˘Ì¤ÓÔ˘˜ Î·È Û 66 £ ÁÈ· ÙÔ˘˜ ÂȉÈ΢fiÌÂÓÔ˘˜.
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¶·È‰È·ÙÚÈ΋ 2003;66:478
Paediatriki 2003;66:478
∂˘¯·ÚÈÛٛ˜ ÚÔ˜ ÙÔ˘˜ ∫ÚÈÙ¤˜ Ù˘ “¶·È‰È·ÙÚÈ΋˜” ∏ ¢È‡ı˘ÓÛË Î·È Ù· ª¤ÏË Ù˘ ∂ÈÛÙËÌÔÓÈ΋˜ ™˘ÓÙ·ÎÙÈ΋˜ ∂ÈÙÚÔ‹˜ ¢¯·ÚÈÛÙÔ‡Ó ıÂÚÌ¿ ÙÔ˘˜ ÎÚÈÙ¤˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ “¶·È‰È·ÙÚÈ΋” Ô˘ ÚÔÛ¤ÊÂÚ·Ó ÙËÓ Â›Ú· Î·È ÙÔÓ ¯ÚfiÓÔ ÙÔ˘˜ ÁÈ· Ó· ÂÍ·ÛÊ·Ï›ÛÔ˘ÌÂ Û˘ÛÙËÌ·ÙÈΤ˜, ÙÂÎÌËÚȈ̤Ó˜ Î·È ·ÓÙÈÎÂÈÌÂÓÈΤ˜ ·ÍÈÔÏÔÁ‹ÛÂȘ ÁÈ· ÙȘ ÂÈÛÙËÌÔÓÈΤ˜ ÂÚÁ·Û›Â˜ Ô˘ ‰ËÌÔÛȇıËÎ·Ó Î·Ù¿ ÙÔ ¤ÙÔ˜ 2003.
∫ÚÈÙ¤˜ ÙˆÓ ÂÚÁ·ÛÈÒÓ Ô˘ ‰ËÌÔÛȇıËÎ·Ó ÛÙÔÓ ÙfiÌÔ 66 ÙÔ˘ ¤ÙÔ˘˜ 2003 ∞˚‚¿˙˘ µ›ÎÙˆÚ·˜ ∞Ó·ÁÓˆÛÙ¿Î˘ ¢ËÌ‹ÙÚÈÔ˜ ∞Ó·ÁÓˆÛÙ¿Î˘ πˆÛ‹Ê ∞Ó·ÛÙ·Û¤·-µÏ¿¯Ô˘ ∫·ÏÏÈfiË ∞Ó‰Ú¤Ô˘ ∞ϤͷӉÚÔ˜ ∞Ó‰ÚÔÓ›ÎÔ˘ ™Ù˘ÏÈ·Ó‹ ∞Ó‰ÚÔ˘Ï·Î¿Î˘ ª·ÓÒÏ˘ ∞Ó‰ÚÔ˘Ï·Î¿Î˘ º›ÏÈÔ˜ ∞Ó‰ÚÔ˘Ï¿Î˘ πˆ¿ÓÓ˘ ∞ÓıÚ·ÎfiÔ˘ÏÔ˜ ªÈ¯¿Ï˘ ∞ÓÙˆÓÈ¿‰Ë˜ ™Ù˘ÏÈ·Ófi˜ ∞ÚÒÓË-µÔ˘ÚÓ¿ ™ÔÊ›· µ·Ú‚·Ú‹ÁÔ˘-ºÚ›Ì· ∞Ó·ÛÙ·Û›· µ·ÚÏ¿Ì˘ °ÂÒÚÁÈÔ˜ °·ÚÔ‡ÊË-∫Ô‡ÙÛ· ∞Ó·ÛÙ·Û›· °ÂˆÚÁ¿ÎË-∞ÁÁÂÏ¿ÎË ∂ϤÓË °ÈÔ˘ÚÔ‡ÎÔ˜ ™ˆÙ‹Ú˘ °ÎÈÒÓ˘ ¢ËÌ‹ÙÚÈÔ˜ °Ú·Ê¿ÎÔ˜ ™Ù¤ÏÈÔ˜ ¢·‚¿Î˘ ªÈ¯·‹Ï ¢¿ÎÔ˘-µÔ˘ÙÂÙ¿ÎË ∞ÈηÙÂÚ›ÓË ¢È·Ì·ÓÙ‹ ∂ÏÈÛ¿‚ÂÙ ∑ÂÚ‚fi˜ °ÂÚ¿ÛÈÌÔ˜ ∏Ï›· ª·Ú›· £ÂÔ‰ˆÚ›‰Ë˜ ÷ڿϷÌÔ˜ £ÂÔ‰ÒÚÔ˘ ™Ù·Ì¿Ù˘ πÔÚ‰·Ó›‰Ô˘ ∞ÓÙÈÁfiÓË ∫·ÏÔÁÈ¿ÓÓ˘ ¡ÈÎfiÏ·Ô˜ ∫·Ó·ÎÔ‡‰Ë-∆۷ηϛ‰Ô˘ ºÏˆÚÂÓÙ›· ∫·Ó¿ÚÈÔ˘ ª·Ú›· ∫·Ú·Ó›Î·˜ ∏Ï›·˜ ∫·Ú‹˜ ÃÚ›ÛÙÔ˜ ∫·ÙÚÈÔ‡-¡ÈÎÔϷοÎË ¢ˆÚÔı¤· ∫·ÙÛ·Ú‰‹˜ ÷ڿϷÌÔ˜ ∫·ÙÛ·ÚÔ‡-¶ÂÎÙ·Û›‰Ë ∂˘ÛÙ·ı›· ∫·ÙÙ¿Ì˘ ∞ÓÙÒÓÈÔ˜ ∫·Ê¿ÙÔ˜ ∞ÓÙÒÓÈÔ˜ ∫·ÊÂÙ˙‹˜ ¢ËÌ‹ÙÚÈÔ˜ ∫›ÙÛÈÔ˘-∆˙¤ÏË ™ÔÊ›· ∫Ô‚¿Ó˘ ∞ı·Ó¿ÛÈÔ˜ ∫ÔÏÏÈfi˜ ∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ∫Ô˘Ú¿Î˘ °ÂÒÚÁÈÔ˜
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Paediatriki 2003;66:479-481
∂˘ÚÂÙ‹ÚÈÔ ™˘ÁÁڷʤˆÓ ÙÔ˘ ∆fiÌÔ˘ 66 Wevers R.A.
133
∞ ∞ÁÁÂÏ¿ÎÔ˘ µ. ∞ÁÁÂÏfiÔ˘ÏÔ˜ ¢. ∞˙·ÚÈ¿‰Ë˜ ¶. ∞ı·Ó·ÛÈ¿‰Ô˘ º. ∞ı·Ó·Û›Ô˘-ªÂÙ·Í¿ ª. ∞˚‚¿˙˘ µ. ∞ÏÂÍ¿Ó‰ÚÔ˘ ∂. ∞ϤÍ ¡.ª. ∞ÏÂ͛Ԣ ¡. ∞ÏÂÍfiÔ˘ÏÔ˜ ∂. ∞̤ÓÙ· ™. ∞Ó·ÛÙ·ÛÈ¿‰Ë˜ °. ∞Ó·ÛÙ·ÛÈ¿‰Ô˘-∫·Ú·ÁˆÚÁÔÔ‡ÏÔ˘ ∂. ∞Ó·ÛÙ·Û›Ô˘ ∞. ∞Ó‰Ú¤Ô˘ ∞. ∞ÓÙˆÓÔÁÂÒÚÁÔ˜ °. ∞ÔÛÙfiÏÔ˘ ∂. ∞ÚÁ˘ÚÔ‡ ™. ÕÚÛÔ˜ °. ∞ÚÒÓË ™. ∞ÙÙÈÏ¿ÎÔ˜ ∞. ∞˘ÁÔ˘ÛÙ›‰Ô˘-™·‚‚ÔÔ‡ÏÔ˘ ¶. µ µ·ÁÈ¿ÎÔ˘ ∂.∞. µ·ÚÏ¿Ì˘ °. µ·ÛÈÏÂÈ¿‰Ô˘ ∂. µ·ÛÈÏfiÔ˘ÏÔ˜ ∞. µ·ÛÈÏÔÔ‡ÏÔ˘ ∞. µÔÚÁÈ¿ ¶. µÔ‡‰Ú˘ ∫.∞. ° °·‚Ú›ÏË ™. °·Ï·Ó¿Î˘ ∂. °È·ÓÓ·ÎÔÔ‡ÏÔ˘ Ã. °È·ÓÓÔ‡ÏÈ· ∞. °ÈÔ˘ÚÔ‡ÎÔ˜ ™. °ÎÈÒÓ˘ ¢. °ÎÔ˘ÁÎÔ‡‰Ë ∂. °Ô˘‰ÂÛ›‰Ô˘ ª.∑. °Ô‡Ó·Ú˘ ∞. °Ô˘ÚÁÔ˘ÏÈ¿Ó˘ ∫. ¢ ¢·›ÎÔ˜ °. ¢ÂÌÂÚÙ˙›‰Ô˘ µ. ¢ÂÛ‡Ú˘ ¡. ¢‹ÌÔ˘ ™. ¢ÚÔÁοÚË ∂.
392 316 381 195,284 52,55,128 55,211 188 20 278 208 215 316 304 364 304 155 405 145 296 387 467 118
202,456 128 145 97 418 133 118,202,387,456
344 452 58,255 185 215 37 145 140 278 208
188 296 364 202 118
¢ÚfiÛÔ˘-∞Á·Î›‰Ô˘ µ.
29,148
∂ ∂˘·ÁÁÂÏ›Ô˘ ∞.
133
∑ ∑·‚ÈÙÛ¿ÓÔ˜ •. ∑·ÊÂÈÚ›Ô˘ ¢. ∑‹‚·-¶ÂÙÚÔÔ‡ÏÔ˘ ª.
364 211 239
£ £ÂÔ‰ˆÚ›‰Ë˜ Ã. £ÂÔ‰ˆÚ›‰Ô˘ ª.
471 188
π πÁÓ·ÙÈ¿‰Ë˜ π.π.
140
∫ ∫·‰›Ù˘ ∞. ∫·Ï·‚ÚÔ˘˙ÈÒÙ˘ °. ∫·Ï·ÓÙ˙‹˜ ∞. ∫·Ï¤ÁÈ·˜ π. ∫·ÏÔÁÂÚÔÔ‡ÏÔ˘ Ã.¶. ∫·ÏÔ‡ÙÛË µ. ∫·Ì¿˜ ¡. ∫·ÌÔ˘Ú›‰Ô˘ ¶. ∫·Ó¿ÚÈÔ˘ ª. ∫·ÓÈÙÛ¿Î˘ ∞. ∫·Ú·ÁÈ¿ÓÓË ¶. ∫·Ú·Ì¤Ú˘ ™. ∫·Ú·ÌÂÚfiÔ˘ÏÔ˜ ¢. ∫·Ú·Ó¿ÛÈÔ˘ ∫. ∫·Ú·Ó›Î·˜ ∏. ∫·Ú·ÓÙ·Ó¿ ∂. ∫·Ú·Ù˙¿ ∞.∞. ∫·Ú·Ù˙¿ ∂. ∫·Ú·Ù˙¿˜ ¡. ∫·Ú›Î·˜ °.∞. ∫·Úη‚›ÙÛ·˜ ¡. ∫·Ù˙ËÏ¿Î˘ ¡. ∫·ÙÚÈÔ‡ ¢. ∫·ÙÛ·ÚÔ‡ ∂. ∫·ÙÛÈ·Ú‰¿Ó˘ ∫. ∫·Ê¿ÙÔ˜ ∞. ∫¤ÎÔ˘ ∫. ∫ÂÚ·Ì›‰·˜ ¢. ∫fiÎÔÚË ∂. ∫ԇϷÏË ∂. ∫Ô˘ÓÂÓÔ‡ ∫. ∫Ô˘ÚÙ¤Û˘ ∞. ∫Ô‡ÚÙË ª. ∫Ô‡ÛÙ· ∂. ∫ÚÂÌÂÓfiÔ˘ÏÔ˜ °.
208 381 185 278,344 311 195 247 461 47 133 29 128 232 452 47 185 311 296 296 113 264 133 195,284 456 364 264,436 215 145 12,133,223 304 357 381 284 471 29,148
479
¶·È‰È·ÙÚÈ΋ 2003;66:479-481
∫˘Úȷο΢ ª. ∫˘ÚȷΛ‰Ë˜ °. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜ ∞. ∫ˆÛÙ·‰‹Ì· ∂. ∫ˆÛÙ·ÎÈÒÙË ∂. ∫ÒÛÙ·ÏÔ˜ Ã. ∫ˆÛÙ·ÓÙ¤ÏÏÔ˘ ∂. ∫ˆÛÙ·Ú›‰Ô˘ ™.
Paediatriki 2003;66:479-481
264 148 42 208 471 278,344 278 185
§ §··ÙÛ¿Ó˘ ¶.¢. §·Ú›Ô˘ ª.™. §¿ÛηÚË Ã. §ÂÈ‚·‰›ÙË ∂. §ÈıÔÍÔÔ‡ÏÔ˘ ª. §ÈÓ·Ú‰¿Î˘ ª. §ÈÔÓ‹˜ Ã.
82 89 316 145 55 264,436 133
ª ª·Î·ÚÒÓ·˜ ¡. ª·ÌÌ¿˜ π. ª·ÌÔ˘Ï¿Î˘ ¢. ª·ÓÈ·‰¿ÎË ∏. ª¿ÓÔ˜ ¡. ª·ÓÔ˘Ú¿ ∞. ª·ÓÙ¿ ¶. ª·ÓÙ·Áfi˜ ™.¶. ª·ÚÁȈڋ˜ ∞. ª¿ÚηÙ˙Ë ∂. ª¿ÚÎÔ˘ °.¡. ª·ÚfiÔ˘ÏÔ˜ °. ª¿ÛÙÔÚ· ™. ª·ÛÙÚÔÁÈ¿ÓÓË ™. ª·˘ÚfiΈÛÙ· ª. ªÂÁÚ¤Ì˘ ™. ªÂٷ͈ÙÔ‡ ∞. ªËÙÛÈ¿ÎÔ˜ °. ªÈÎÚ¿ÎË µ. ªÈ¯·ËÏ›‰Ô˘ ∂. ªÈ¯ÂϷοÎË ∂. ªÔÛ¯·Ó‰Ú¤· π. ªÔÛ¯fi‚Ë ª. ªÔ‡ÛÎÔ˘ ™. ªÔ˘ÛÙ¿ÎË ª. ª·ÛÈ¿ÎÔ˜ Ã. ª¿ÛÙ· ∂. ª¤ÓÔ˜ ∞. ªÂÚ‚·Ó¿ÎË º. ªÂÚÙÛÈ¿˜ °. ªfiÓÔ˘ ¶.
452 264 334 133 304 58 215 311 264 436 311 118,467 118 456 12,223 352 215 148 208 133 113,467 264 47 211 176 304 381 284 436 264 37
¡ ¡ÈÎËÙ¿Î˘ ¶. ¡ÈÎÔÏ¿Ô˘ ™.
480
133 145
• •˘ÓÈ¿˜ π.
296
O OÈÎÔÓÔÌ›‰Ô˘ O. OÈÎÔÓfiÌÔ˘ ª.
344 52
¶ ¶¿ÁηÏË ∞. ¶·Ó·ÁȈٷÎfiÔ˘ÏÔ˜ °. ¶·Ó·ÁÈÒÙÔ˘ π.¶. ¶·ÓÙÂÏÈ¿‰Ë˜ Ã. ¶··‚·ÛÈÏ›Ԣ ∂. ¶··ÁˆÚÁ›Ô˘ £. ¶··‰¿ÙÔ˜ π. ¶··‰ËÌËÙÚ›Ô˘ ª.¡. ¶··‰fiÔ˘ÏÔ˜ °. ¶··‰fiÔ˘ÏÔ˜ ¡.°. ¶··‰fiÔ˘ÏÔ˜ º. ¶··‰ÔÔ‡ÏÔ˘ ∞.§. ¶··‰ÔÔ‡ÏÔ˘ ∂. ¶··‰ÔÔ‡ÏÔ˘-∫Ô˘ÏÔ˘Ì‹ ∑. ¶··‰ÔÔ‡ÏÔ˘-§ÂÁ̤ÏÔ˘ ∫. ¶·¿˙ÔÁÏÔ˘ ∫. ¶··ı·Ó·Û›Ô˘ ∞. ¶··ıˆÌ¿ ∂. ¶··Ó‰Ú¤Ô˘ ∂. ¶·Ú·Ûο΢ ∂. ¶·Ú‰·Ïfi˜ °. ¶·ÛÈ¿˜ π. ¶·Û·Ï¿ÎË ¶. ¶·ÙÂÚfiÔ˘ÏÔ˜ ∫. ¶·˘ÏÔÔ‡ÏÔ˘ π. ¶·‡ÏÔ˘ µ.¡. ¶·Ê›Ù˘ Ã. ¶ÂÙÚ›‰Ô˘ ∂. ¶ÂÙÚÔÔ‡ÏÔ˘ Ã. ¶¤ÙÚÔ˘ µ. ¶Ï·ÎԇϷ µ. ¶ÔÏ˘¯ÚÔÓ¿ÎË ª. ¶ÔÏ˘¯ÚÔÓÔÔ‡ÏÔ˘-∞Ó‰ÚÔ˘Ï·Î¿ÎË ™. ¶ÚÔ‡ÓÙ˙Ô˘-∫·ÛÛÈÔ‡ ∫. ¶ÚˆÙ·ÁfiÚ·-§È·ÓÔ‡ ¡. ƒ ƒ·ÊÙÔÔ‡ÏÔ˘ ∞. ™ ™·ÍÒÓË-¶··ÁˆÚÁ›Ô˘ º. ™·Ú·Ê›‰Ë˜ ∫. ™·ÚÚ‹ ∫. ™Â‚·ÛÙÈ¿‰Ô˘ ™. ™ÂÚ‚ÈÙ˙fiÁÏÔ˘ ª. ™ËÊ¿Î˘ ™.
188 316 65 296 247 195,284 37,387 2 381 418 20 140 133,334 104 128 387 471 344 145 452 211 104 133 448 188 311 381 20,188 344 471 316 392 65 316 167
47
418 29,148 436 278 202 334
¶·È‰È·ÙÚÈ΋ 2003;66:479-481
™È·ÌÔÔ‡ÏÔ˘-ª·˘Ú›‰Ô˘ ∞. ™È‰ÂÚ‹ °. ™ÈÒÌÔ˘ ∞. ™Î·Ú‰Ô‡ÙÛÔ˘ ∞. ™ÎÂÓÙ¤Ú˘ ¡. ™Ì˘Ú¿ÎȘ ™. ™Ô‡ÏË ∫.∂. ™ËÏÈÒÙË ª. ™˘Ú¿ÎÔ˜ ™. ™‡ÚÔÁÏÔ˘ ∫. ™Ù·ÌÔÁÈ¿ÓÓÔ˘ §. ™Ù¿ÌÔ˘ ª. ™ÙÂÊ·Ó¿ÎË ∫. ™ÙÂÊ·Ó¿ÎË ™. ™ÙÂÊ·Ó›‰Ë˜ ∫. ™˘ÚÈÔÔ‡ÏÔ˘ µ. ™¯ÔÈÓ¿ ª. ™¯ÔÈÓ¿ÎË ∞. ™¯ÔÈÓ¿˜ °.
Paediatriki 2003;66:479-481
104 97,387 104 202,387,456 208 133 113,118,467 133 145 296 89 195,284 65 352 456 188 448 352 448
∆ ∆ÂÚÙ›Ë ∞. ∆˙·ÌÔ˘Ú¿ÓË π. ∆˙Ô‡ÊË ª. ∆˙ˆÚÙ˙¿ÙÔ˘-™Ù·ıÔÔ‡ÏÔ˘ º. ∆˙ÒÚÙ˙Ë ¶. ∆Ú·ÁÈ·ÓÓ›‰Ë˜ £. ∆Ú›Ì˘ °. ∆ÚȯfiÔ˘ÏÔ˜ ¢. ∆ÚÔ˘Ì¤Ù·˜ §. ∆۷ηϛ‰Ë˜ Ã. ∆۷ΛÚ˘ ™. ∆Û·Ì·ÚÏ‹-∫ÈÙÛ·Ú¿ ∞. ∆Û·¿ÎË Œ. ∆Û¿Ú· ∂. ∆Û¿ÙÚ· π. ∆ÛÂÎÔ˘Ú¿ £. ∆ÛÈÏÈÌÈÁοÎË ∞. ∆ÛÈÌÈÓfi˜ ª. ∆Û›ÙÛÈη˜ ∫. ∆ÛÔÏÈ¿ ª. ∆ÛÔ˘Ì¿Î·˜ ∫. ∆ÛÔ˘ÚÔ˘Ó¿Î˘ ¡. ∆ÛÔ‡ÙÛÔ˘ ∞. ∆ÛÒÙ· ∂.π. ∆˘ÏÈÁ¿‰· ∞.
471 113 104 47 65 195 47 20 37 55 113 357 133 467 52 352 352,405 452 65 387 140 352 37 311 155
º º·Ú̷ο΢ £. ºÂÛÛ¿ÙÔ˘ ™. ºÏÔ˘Ú‹ ™. ºÚ·ÁÎÔ‡ÏË ∂. ºÚ˘Û›Ú· ∂.
364 327,467 436 426 215
à ÷˚‰¿˜ ™. ÷ڛÛË ª. ÷ڈӛÙË π. ÷Ù˙‹ §. ÷Ù˙Ë·ı·Ó·Û›Ô˘ Ã. ÷Ù˙ˉ¿ÎË ∂. ÷Ù˙‹˜ Ã. ÷Ù˙ËÛ‚·ÛÙÔ‡-§Ô˘Î›‰Ô˘ Ã. ÷Ù˙ËÛÙ·Ì·Ù›Ô˘ ∑. ÷Ù˙ËÛÙ˘ÏÈ·ÓÔ‡ ª. ÷Ù˙Ë„¿ÏÙË ª.
65 104 12,223,392 264 471 255 264,436 461 278,344 195,284 239
481
¶·È‰È·ÙÚÈ΋ 2003;66:482-484
Paediatriki 2003;66:482-484
∂˘ÚÂÙ‹ÚÈÔ Ï¤ÍˆÓ-ÎÏÂȉÈÒÓ ÙÔ˘ ∆fiÌÔ˘ 66 APAAP Bartonella henselae Henoch-Schonlein ÔÚʇڷ LHX3 Nail-Patella Pit-1 Power Doppler Prop-1 P-ÁÏ˘ÎÔÚˆÙ½ÓË Screening (ÚÔÛ˘Ìو̷ÙÈÎfi˜ ¤ÏÂÁ¯Ô˜) Turner-Kieser
65 55 327 89 140 89 352 89 65 296 140
∞ ∞ÁÁÂÈ›Ùȉ· 185,327 ∞ÁÁÂÈÔÂÓÂÚÁfi ÂÓÙÂÚÈÎfi ÂÙ›‰ÈÔ 278 ∞ÁˆÁ‹ ˘Á›·˜ 436 ∞‰ÂÓÔÂȉÂÎÙÔÌ‹ 208 ∞‰¤ÓˆÌ· ˘fiÊ˘Û˘ 471 ∞‰Âӈ̷Ù҉˘ ‰˘ÛÏ·Û›· Ó‡ÌÔÓ· 148 ∞¤ÚÈ· ¯ÚˆÌ·ÙÔÁÚ·Ê›·-Ê·ÛÌ·ÙÔÁÚ·Ê›· Ì·˙ÒÓ 118 ∞ÈÌÔÏ˘ÙÈÎfi-Ô˘Ú·ÈÌÈÎfi Û‡Ó‰ÚÔÌÔ 456 ∞ÎÂÙ˘Ï¯ÔÏÈÓÂÛÙÂÚ¿ÛË 113 ∞Ï·Ó›ÓË 113 ·-ÏÈÓÔÏÂÓÈÎfi Ô͇ 12 ∞ÏÏÂÚÁ›· 418 ∞ÏÏÂÚÁÈ΋ ÔÚʇڷ 327 ∞Ì˘Á‰·ÏÂÎÙÔÌ‹ 208 ∞Ì˘Á‰·Ï›Ùȉ· 42 ∞ÌÊÈ‚ÏËÛÙÚÔÂȉԿıÂÈ· Ù˘ ÚÔˆÚfiÙËÙ·˜ 304 ∞Ó·ÏÁËÛ›· 29 ∞Ó¿ÚÎÂÈ· ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ 89 ∞Ó¿ÚÎÂÈ· Ù˘ ÔÚÓÈıÈÓÈ΋˜ ÙÚ·ÓÛηڂ·Ì˘Ï¿Û˘ 467 ∞ÓıÂÎÙÈΤ˜ ÛÙ· Ê¿Ú̷η ÂÈÏË„›Â˜ 104 ∞ÓÔÛÔ˚ÛÙÔ¯ËÌ›· 65 ∞ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η 202 ∞ÓÙÈÌÂÙÒÈÛË 304 ∞ÓÙÈËÎÙÈÎfi ÙÔ˘ χÎÔ˘ 55 ∞ÓÙÈ„˘¯ˆÛÈΤ˜ Ô˘Û›Â˜ 247 ∞ÓÒÌ·ÏË Ó¢ÌÔÓÈ΋ ·ÚÙËÚ›· 381 ∞ÔÏÈÔÚˆÙ½Ó˜ 202 ∞ÔÛȉ‹ÚˆÛË 128 ∞ÔÊÚ·ÎÙÈ΋ ¿ÓÔÈ· ÙÔ˘ ‡ÓÔ˘ 208 ∞Ú·¯È‰ÔÓÈÎfi Ô͇ 12 ∞ÚıÚ›Ùȉ· 185 ∞ÚÚ˘ıÌÈÔÁfiÓÔ˜ ‰˘ÛÏ·Û›· Ù˘ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜ 405 ∞Ù‡¯ËÌ· 20,364 µ µ·ÚËÎÔ˝· µÏÂÊ·ÚfiÙˆÛË
482
215 211
µÚÔÁ¯ÔÓ¢ÌÔÓÈ΋ ‰˘ÛÏ·Û›·
344
° °·ÛÙÚÂÓÙÂÚÈΤ˜ ÔÚÌfiÓ˜ °·ÛÙÚ›ÓË °·ÛÙÚÔÔÈÛÔÊ·ÁÈ΋ ·ÏÈÓ‰ÚfiÌËÛË °ÂÓÂÙÈ΋ ÙÚÔÔÔ›ËÛË °Ï˘ÎÔ˙˘ÏȈ̤ÓË ·ÈÌÔÛÊ·ÈÚ›ÓË HbA1c °ÔÓ›‰ÈÔ GH °ÔÓÈÎfiÙËÙ·
278 278 296 418 264 89 357
¢ ¢Â›ÎÙ˜ ∏Oª∞ ¢ËÌfiÛÈ· ˘Á›· ¢È¿ÁÓˆÛË ¢È·ÛÊËÓÔÂȉ‹˜ ¯ÂÈÚÔ˘ÚÁÈ΋ ·ÓÙÈÌÂÙÒÈÛË ¢È·Ù·Ú·¯¤˜ Ù˘ ·Ó·ÓÔ‹˜ ÛÙÔÓ ‡ÓÔ ¢È·Ù·ÙÈ΋ ¢È¿¯˘ÛË CO
264 82 239 471 208 405 176
∂ ∂ÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË ∂ÈÚ‹ÓË ∂ÎÓÂfiÌÂÓÔ NO ∂Ì‚ÔÏÈ·ÛÌÔ› ŒÌÌÂÛË ˘ÂÚ¯ÔÏÂÚ˘ıÚÈÓ·ÈÌ›· ŒÌÊÚ·ÎÙ· ÂÁÎÂÊ¿ÏÔ˘ ∂Ó‰ÔÁÂÓ‹ ÌÂÙ·‚ÔÏÈο ÓÔÛ‹Ì·Ù· ∂Ó‰ÔÎÔÈÏȷ΋ ∂Í¿ÓıËÌ· ∂͈ۈ̷ÙÈ΋ ÁÔÓÈÌÔÔ›ËÛË ∂È‚›ˆÛË ÂχıÂÚË ÓfiÛÔ˘ ∂ȉËÌÈÔÏÔÁ›· ∂ȉËÌÈÔÏÔÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο ∂ÈÏË„›· ∂ÚÁ·ÛÙËÚȷ΋ ‰È¿ÁÓˆÛË
296 82 176 448 52 456 118,133 316 185 58 195 426 461 255 426
∏ ∏ÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ·
2
£ £Âڷ›· £ÂÚÌ·ÓÙÈÎfi ÛÒÌ· £ËÏ·ÛÌfi˜ £Ú¿ÎË £ÚÔÌ‚ÔÂÌ‚ÔÏÈο ÂÂÈÛfi‰È· £ÚÔÌ‚ÔÊÈÏ›· £ÚfiÌ‚ˆÛË
42 20 247 448 387 387 387
π πÓÛÔ˘Ï›ÓË πÓÛÔ˘ÏÈÓÔÂÍ·ÚÙÒÌÂÓÔ˜ ۷ί·Ú҉˘
264
¶·È‰È·ÙÚÈ΋ 2003;66:482-484
Paediatriki 2003;66:482-484
‰È·‚‹Ù˘ 1 πÓÛÔ˘ÏÈÓÔÂÍ·ÚÙÒÌÂÓÔ˜ ۷ί·Ú҉˘ ‰È·‚‹Ù˘ 12 πÓÛÔ˘ÏÈÓÔÂÍ·ÚÙÒÌÂÓÔ˜ ۷ί·Ú҉˘ ‰È·‚‹Ù˘ 2
334 334
55 12 113 208
O OÈÎÔÏÔÁ›· OÌfi˙˘ÁË ‚-ª∞ OÓ˘¯Ô‰˘ÛÏ·Û›· OÍ›· Ï¢¯·ÈÌ›· OÍ›· ˘ÂÏÔÓÂÊÚ›Ùȉ· OÚÁ·ÓÈΤ˜ ÔÍ˘Ô˘Ú›Â˜ OÚÁ·ÓÈ΋ „˘¯È·ÙÚÈ΋ ‰È·Ù·Ú·¯‹ OÛÙÂÔÌ˘ÂÏ›ÙȘ O˘ÚÔÏÔÈÌÒÍÂȘ
426 128 140 65 352 118 167 47 352
334
∫ ∫·ÏÔÚÈÊ¤Ú ∫·Ú˘fiÙ˘Ô˜ ∫·Ù·ÛÙÔÏ‹ ∫¤ÓÙÚÔ ÀÁ›·˜ ∫ÂÊÚÔ˙›ÏË ∫ÏËÚÔÓÔÌÈ΋ ÛÊ·ÈÚÔ΢ÙÙ¿ÚˆÛË ∫ÔÓÙfi ·Ó¿ÛÙËÌ· ∫Ú·ÓÈÔÂÁÎÂÊ·ÏÈ΋ οΈÛË ∫‡ËÛË ∫˘ÎÏ¿‰Â˜ ∫‡ÎÏÔ˜ Ù˘ Ô˘Ú›·˜
20 461 29 448 42 52 471 37 247,255 452 467
§ §··ÚÔÛÎÔÈ΋ ¯ÂÈÚÔ˘ÚÁÈ΋ §ÂÌÊ·‰ÂÓ›Ùȉ· §Â˘ÎÔÙÚȤÓÈ· §ÈÓÔÏÂ˚Îfi Ô͇ §È›‰È· §ÈÔÚˆÙ½Ó˜ §Ô›ÌˆÍË
145 55 155 12 202 202,264,436 42
ª ª·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ ª·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ªÂÙ·‚ÔÏÈ΋ ÂÁÎÂÊ·ÏÔ¿ıÂÈ· ªÂÙ·ÏÏ·Á̤ÓÔ˜ ·Ú¿ÁÔÓÙ·˜ FV Leiden ªÂÙ·ÊÔÚ¿ ‚·Ú¤ˆ˜ ·Û¯fiÓÙˆÓ ·È‰ÈÒÓ ªË Hodgkin ϤÌʈ̷ ªË Û˘Ì·Á¤˜ Ì˘ÔοډÈÔ ªÔÚȷ΋ ‰È¿ÁÓˆÛË ªÔÙÈÏ›ÓË ª˘ÂÏ›Ùȉ· ª˘ÎËÙ›·ÛË ÙÚȯˆÙÔ‡ ÎÂÊ·Ï‹˜ ª˘ÎfiÏ·ÛÌ· Ù˘ Ó¢ÌÔÓ›·˜ ª˘ÔηډÈÔ¿ıÂȘ ¡ ¡ÂÔÁÓ¿ ‰È·‚ËÙÈÎÒÓ ÌËÙ¤ÚˆÓ ¡ÂÔÁÓfi ¡ÂÔÂÏÏËÓÈÎfi˜ ¢È·ÊˆÙÈÛÌfi˜ ¡Â˘ÚÔÂÎÊ˘ÏÈÛÙÈο ¡Â˘ÚÔÏÔÁÈΤ˜ ÂΉËÏÒÛÂȘ ¡Â˘ÚÔ„˘¯È·ÙÚÈ΋ ¡ÔËÙÈ΋ ˘ÛÙ¤ÚËÛË ¡fiÛÔ˜ Gilbert ¡fiÛÔ˜ Hodgkin ¡fiÛÔ˜ Kawasaki
¡fiÛÔ˜ ·fi ·Ì˘¯‹ Ó˘¯ÈÒÓ Á¿Ù·˜ ¡ÙÔÎÔÛ·ÂÍ·ÓÔ˚Îfi Ô͇ ¡ÙÔ·Ì›ÓË ¡˘ÎÙÂÚÈÓ‹ ÂÓÔ‡ÚËÛË
2 456 167 387 37 195 405 215 278 185 426 185 405
278 2,29,145,311 232 167 456 167 215 52 195 392
¶ ¶·È‰› / ¶·È‰È¿ 20,42,188,316,436,448,456 ¶·È‰È¿-·Ú·ıÂÚÈÛÙ¤˜ 452 ¶·È‰È΋ ÂÈÏË„›· 202 ¶·È‰È΋ ËÏÈΛ· 65,104,195 ¶·È‰È΋ ÔÍ›· ÏÂÌÊÔ‚Ï·ÛÙÈ΋ Ï¢¯·ÈÌ›· 284 ¶·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ 188,264,344,364 ¶·Ú·ÚÚÈÓÔÎÔÏ›Ùȉ· 211 ¶·Ú¤Ì‚·ÛË 364 ¶¿ÚÂÛË ·ÓÂÏÎÙ‹Ú· Ì˘fi˜ ¿Óˆ ‚ÏÂÊ¿ÚÔ˘ 211 ¶·¯˘Û·ÚΛ· 264 ¶ÂÚÈÔÚÈÛÙÈ΋ 405 ¶Ó¢ÌÔÓÈΤ˜ ‰ÔÎÈ̷ۛ˜ 176 ¶Ó¢ÌÔÓÈ΋ ˘¤ÚÙ·ÛË 381 ¶Ó¢ÌÔÓÈÎÔ› fiÁÎÔÈ 176 ¶ÔÏÏ·Ï‹ Ê·ÚÌ·ÎÔ·ÓÙÔ¯‹ 65 ¶Ôχ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓ¿ 344 ¶ÔÏ˘·ÎfiÚÂÛÙ· ÏÈ·Ú¿ Ôͤ· Ì·ÎÚ¿˜ ·Ï‡ÛÔ˘ 12 ¶Ôχ‰˘ÌË Î‡ËÛË 58 ¶ÔÏ˘ÙÚ·˘Ì·Ù›·˜ 37 ¶fiÓÔ˜ 29 ¶Ú‚ÈÔÙÈο 223 ¶ÚÔ‚ÈÔÙÈο 223 ¶ÚÔ‚Ï‹Ì·Ù· ˘Á›·˜ 452 ¶ÚÔÁÂÓÓËÙÈ΋ ‰È¿ÁÓˆÛË 461 ¶ÚÔÁÓˆÛÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ 284 ¶ÚÔÎÏËÙ¿ ‰˘Ó·ÌÈο 2 ¶ÚfiÏË„Ë 364 ¶ÚÔÛˆÔ-ˆÌÔ-‚Ú·¯ÈfiÓÈÔ˜ Ì˘˚΋ ‰˘ÛÙÚÔÊ›· 215 ¶ÚÔˆÚfiÙËÙ· 311 ¶ÚˆÙÔ‚¿ıÌÈ· ÊÚÔÓÙ›‰· ˘Á›·˜ 133 ¶ÚˆÙfiÎÔÏÏÔ BFM-90 284 ™ ™·Î¯·Ú҉˘ ‰È·‚‹Ù˘ Ù‡Ô˘ 1 ™·Î¯·Ú҉˘ ‰È·‚‹Ù˘ ™·ÛÌÔ› ™ÈÚÔ̤ÙÚËÛË
334,357 47,232 456 176
483
¶·È‰È·ÙÚÈ΋ 2003;66:482-484
™ÔÓ‰˘ÏÈ΋ ÛÙ‹ÏË ™Ù·Ê˘ÏÔÎÔÎÎÈÎfi ÙÔÍÈÎfi Û‡Ó‰ÚÔÌÔ ™ÙÚÂÙÔÎÔÎÎÈÎfi ÙÔÍÈÎfi Û‡Ó‰ÚÔÌÔ ™ÙÚÂÙfiÎÔÎÎÔ˜ ™˘ÁÁÂÓ›˜ ηډÈÔ¿ıÂȘ ™˘ÁÁÂÓ›˜ ·ÛÙÂȘ ™˘ÁÁÂÓ¤˜ ÌÂÁ¿ÎÔÏÔ ™‡ÁÎ·Ì„Ë ·ÁÎÒÓˆÓ ™˘Ì‚ÈÔÙÈο ™˘ÌÌfiÚʈÛË ÛÙËÓ ·ÔÛȉ‹ÚˆÛË ™‡Ó‰ÚÔÌ· ÙÔÍÈ΋˜ ηٷÏËÍ›·˜ ™‡Ó‰ÚÔÌÔ Cushing ™‡Ó‰ÚÔÌÔ Down ™˘¯ÓfiÙËÙ· ™ˆÌ·ÙÔÌÂÙÚ‹ÛÂȘ
Paediatriki 2003;66:482-484
47 97 97 42 381 148 145 140 223 128 97 471 461 304,461 436
∆ ∆ÔÍ›ÓË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Ù˘ ÙÔÍÈ΋˜ ηٷÏËÍ›·˜ ∆ÔÈÚ·Ì¿ÙË ∆Ú·˘Ì·ÙÈÛÌÔ› ÂÊ‹‚ˆÓ ∆Ú·˘Ì·ÙÈÛÌÔ› ·È‰ÈÒÓ ∆Ú·˘Ì·ÙÈÛÌfi˜ ∆ÚÔÌÔÎÚ·Ù›· ∆ÚÔÔÔÈËÙ¤˜ ∆ÚÔÊÈ΋ ·ÏÏÂÚÁ›· ∆ÚÔÊÈ΋ ÚfiÎÏËÛË ∆ÚfiÊÈÌ· ∆‡Ô˘ ÂÓËÏ›ÎÔ˘
97 104 364 364 20 82 155 239 239 418 316
À ÀÂÚ·Ì̈ÓÈ·ÈÌ›· ÀÂÚ·ÓÙÈÁfiÓ· ÀÂÚ˯ÔÁÚ¿ÊËÌ· ÂÁÎÂÊ¿ÏÔ˘ ÀÂÚÎÔÚÙÈ˙ÔÏ·ÈÌ›· ÀÂÚÙÚÔÊÈ΋ ÀÔ‰fiÚÈÔ Ï›Ô˜ Àԉԯ›˜ ÀÔÓ·ÙÚÈ·ÈÌ›·
467 392 2 471 405 264 155 456
º º·ÈÓ˘Ï·Ï·Ó›ÓË º¿Ú̷η ºÔÚ›· ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘ º˘Ì·Ù›ˆÛË º˘ÛÈ΋ ηٿÛÙ·ÛË ºˆÛÊfiÚÔ˜
113 247 188 316 436 232
à ÃÔÏÔÏÈı›·ÛË ÃÚfiÓÈ· ·ÈÌfiÏ˘ÛË ÃÚfiÓÔ˜ ÂÓÂÚÁÔÔÈË̤Ó˘ ÌÂÚÈ΋˜ ıÚÔÌ‚ÔÏ·ÛÙ›Ó˘
484
52,311 52 55
æ “æ˘¯Ôۈ̷ÙÈ΋ ÔÈÎÔÁ¤ÓÂÈ·” ø ˆ-3 ÏÈ·Ú¿ Ôͤ· ˆ-6 ÏÈ·Ú¿ Ôͤ·
357
12 12
¶PO™EXH ™YNE¢PIA 9-12 ºÂ‚ÚÔ˘·Ú›Ô˘ 2004
15th International Congress on anti-Cancer Treatment ¶ÏËÚÔÊÔڛ˜: T.C.O. Tel.: (33-1) 42 94 87 32 Fax: (33-1) 42 94 87 33 Website: www.icact.com E-mail: info@icact.com
Paris, France
28 ºÂ‚ÚÔ˘·Ú›Ô˘2 ª·ÚÙ›Ô˘ 2004
6th International Congress on Pediatric Pulmonology ¶ÏËÚÔÊÔڛ˜: Annie Bidart Tel.: 33-0-497-038-597 Fax: 33-0-497-038-598
Lisbon, Portugal
13-14 ª·ÚÙ›Ô˘ 2004
3Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ ÀÔÂȉÈÎÔÙ‹ÙˆÓ Ù˘ ¶·È‰È·ÙÚÈ΋˜ •ÂÓÔ‰Ô¯Â›Ô Divani Caravel ∂ÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ ∂Ù·ÈÚ›· ¶ÏËÚÔÊÔڛ˜: C&C International ∆ËÏ.: 210-68 89 100 Fax: 210-68 44 777 E-mail: ped-subspec2004@cnc.gr Website: www.ped-subspec2004.gr
∞ı‹Ó·
28-31 ª·ÚÙ›Ô˘ 2004
30th Annual Meeting of the European Group for Blood and Marrow Transplantation ¶ÏËÚÔÊÔڛ˜: ISAM-EBMT AKM Congress Service Tel.: +41 61 686 77 11 Fax: +41 61 686 77 88 Website: www.akm.ch/ebmt2004 E-mail: ebmt@akm.ch
Barcelona, Spain
23-25 ∞ÚÈÏ›Ô˘ 2004
16Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ ∂ÏÏËÓÈ΋˜ ∂Ù·ÈÚ›·˜ ∫ÔÈÓˆÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ Î·È ¶ÚÔ·ÁˆÁ‹˜ Ù˘ ÀÁ›·˜ “¶·È‰› Î·È ∞ıÏËÙÈÛÌfi˜” ∂ÚÁ·ÛÙ‹ÚÈÔ ÀÁÈÂÈÓ‹˜ Î·È ∂ȉËÌÈÔÏÔÁ›·˜ π·ÙÚÈ΋ ™¯ÔÏ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ¶ÏËÚÔÊÔڛ˜: ∂‡Ë ∞Ù˙¤ÌË, ÃÚ‡Û· ª·˘Ú›‰Ô˘ Tel.: 22410-99101 Website: www.socped.gr
ƒfi‰Ô˜
27 ∞ÚÈÏ›Ô˘1 ª·˝Ô˘ 2004
30Ô ∂Ù‹ÛÈÔ ¶·ÓÂÏÏ‹ÓÈÔ π·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ •ÂÓÔ‰Ô¯Â›Ô Hilton ¶ÏËÚÔÊÔڛ˜: π·ÙÚÈ΋ ∂Ù·ÈÚ›· ∞ıËÓÒÓ ∆ËÏ.: 210-72 11 845 Fax: 210-72 15 082 E-mail: iea@mednet.gr
∞ı‹Ó·
6-8 ª·˝Ô˘ 2004
2nd International Congress on Adult Consequences of Childhood Endocrine Diseases ¶ÏËÚÔÊÔڛ˜: ÕÓÓ· °È·Ï·ÓÙ˙‹ Tel.: (0030) 2310-447.444 Fax: (0030) 2310-447.444 & 2310-282476 E-mail: info@ghsociety.gr Website: www.ghsociety.gr
∞ı‹Ó·
xi
¶PO™EXH ™YNE¢PIA 13-16 ª·˝Ô˘ 2004
3Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ ∫˘ÙÙ·ÚÔÌÂÙÚ›·˜ Ì ¢ÈÂıÓ‹ ™˘ÌÌÂÙÔ¯‹ •ÂÓÔ‰Ô¯Â›Ô Royal Myconian & Spa ∂ÏÏËÓÈ΋ ∂Ù·ÈÚ›· ∫˘ÙÙ·ÚÔÌÂÙÚ›·˜ ¶ÏËÚÔÊÔڛ˜: ∑π∆∞ Congress & Travel ∆ËÏ.: +30 210-66 41 190 Fax: +30 210-66 42 116 E-mail: info@zita-congress.gr
ª‡ÎÔÓÔ˜
28-30 ª·˝Ô˘ 2004
42Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ •ÂÓÔ‰Ô¯Â›Ô Creta Maris ∂ÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ ∂Ù·ÈÚ›· ¶ÏËÚÔÊÔڛ˜: C&C International ∆ËÏ.: 210-68 89 100 Fax: 210-68 44 777 E-mail: pediatric2004@cnc.gr Website: www.pediatric2004.gr
∫Ú‹ÙË
6-9 πÔ˘Ó›Ô˘ 2004
7Ô ¶·ÁÎfiÛÌÈÔ ™˘Ó¤‰ÚÈÔ ÁÈ· ÙËÓ ¶ÚfiÏË„Ë ∞Ù˘¯ËÌ¿ÙˆÓ Î·È ÙËÓ ¶ÚÔ·ÁˆÁ‹ ÀÁ›·˜/∞ÛÊ¿ÏÂÈ·˜ ¶ÏËÚÔÊÔڛ˜: ∫∂¶¶∞ ∆ËÏ.: 210-74 62 187 & 74 62 201 Fax: 210-74 62 105 Website: www.safety2004.info
Vienna, Austria
10-13 πÔ˘Ó›Ô˘ 2004
9th Congress of the European Hematology Association ¶ÏËÚÔÊÔڛ˜: Eurocongres Conference Management ∆el.: +31 20 679 3411 Fax: +31 20 673 7306 E-mail: eha2004@eurocongres.com Website: www.eurocongres.com/eha2004
Geneva, Switzerland
16-19 πÔ˘Ó›Ô˘ 2004
Advances in Neuroblastoma Research 2004 ¶ÏËÚÔÊÔڛ˜: ANR 2004 Secretariat Italian Neuroblastoma Association Tel.: +39 010 60 18 938 Fax: +39 010 60 18 961 Website: www.anr2004.org E-mail: anr2004@neuroblastoma.org
Genoa, Italy
28-31 ∞˘ÁÔ‡ÛÙÔ˘ 2004
6th Balkan Meeting on Human Genetics (BMHG 2004) ¶ÏËÚÔÊÔڛ˜: TOPLINE Travel and Tourism Tel.: +30 2310-538 001 Fax: +30 2310-566 713 E-mail: info@toplinetravel.gr
£ÂÛÛ·ÏÔÓ›ÎË
26 ™ÂÙÂÌ‚Ú›Ô˘1 OÎÙˆ‚Ú›Ô˘ 2004
XII Meeting of the European Association for Haematopathology ¶ÏËÚÔÊÔڛ˜: Triaena Tours & Congress ∆ËÏ.: +30 2310-25 61 94-5 Fax: +30 2310-25 61 96 E-mail: salonica@triaenatours.gr
£ÂÛÛ·ÏÔÓ›ÎË
xii
™YNTOMO°PAºIE™
ABBREVIATIONS
™˘ÓÙÔÌÔÁڷʛ˜
EÏÏËÓÈÎÔ› fiÚÔÈ
AÁÁÏÈÎÔ› fiÚÔÈ
AIDS
Û‡Ó‰ÚÔÌÔ Â›ÎÙËÙ˘ ·ÓÔÛÔ·Ó¿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˘ ·ÓÔÛÔÚÔÛÚfiÊËÛ˘ 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΋˜ ıÂڷ›·˜ ‰ÈÂıÓ‹˜ ÌÔÓ¿‰· ÂÓ‰ÔÌ˘˚ο ÂÓ‰ÔÂÚÈÙÔÓ·˚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 ÏÂÙfi ·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
xv
™˘ÓÙÔÌÔÁڷʛ˜
EÏÏËÓÈÎÔ› fiÚÔÈ
AÁÁÏÈÎÔ› fiÚÔÈ
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˘ÙÂÚfiÏÂÙÔ ˘Ô‰fiÚÈ· ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË ÛÙ·ıÂÚfi ÛÊ¿ÏÌ· ÌÔÓ¿‰·
by mouth radioimmunoassay ribonucleic acid respiratory distress syndrome second subcutaneous standard deviation standard error unit
™˘Ó‰˘·˙fiÌÂÓ· ÚÔı¤Ì·Ù· 12
tera- (10 ) giga- (10 ) mega-(10 ) kilo- (10 ) hecto(10 ) deca (10 ) deci (10 ) centi- (10 ) milli(10 ) micro (10 ) nano (10 ) pico (10 ) femto (10 ) atto (10 ) 9
6
3
2
1
-1
-2
-3
-6
-9
-12
-15
-18
xvi
Combining prefixes T G M k h da d c m Ì n p f a