Παιδιατρική | Τόμος 67 • Τεύχος 2 • Μάρτιος - Απρίλιος 2004

¶·È‰È·ÙÚÈ΋ 2004;67:75-87

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Paediatriki 2004;67:75-87

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∆Ô Ï›Ô˜ ÙÔ˘ ÛÒÌ·ÙÔ˜: ¤Ó·˜ ÂÓ‰ÔÎÚÈÓ‹˜ ·‰¤Ó·˜ ∫. ¶·ÓÙÛÈÒÙÔ˘

Adipose tissue: an endocrine organ K. Pantsiotou

¶ÂÚ›ÏË„Ë: ∆Ô Ï›Ô˜ ·ÔÙÂÏ› ÙËÓ ·ÔıËÎÂ˘Ì¤ÓË ÂÓ¤ÚÁÂÈ· ÙÔ˘ ÛÒÌ·ÙÔ˜, ÂÓÒ Ë ÌÂÁ·Ï‡ÙÂÚË ÔÛfiÙËÙ· (50%) ‚Ú›ÛÎÂÙ·È ˘Ô‰ÔÚ›ˆ˜. ∏ ·Ó·ÏÔÁ›· ÙÔ˘ ÛÒÌ·ÙÔ˜ Û ϛÔ˜ ·˘Í¿ÓÂÙ·È ÛËÌ·ÓÙÈο ·fi ÙË Á¤ÓÓËÛË ¤ˆ˜ ÙÔ ÚÒÙÔ ¤ÙÔ˜ Ù˘ ËÏÈΛ·˜, ÂÏ·ÙÙÒÓÂÙ·È ¤ˆ˜ ÙÔ 4Ô ¤ÙÔ˜ Î·È ÌÂÙ¿ ·˘Í¿ÓÂÙ·È, ·˘Í·ÓÔÌ¤ÓˆÓ ÙÔ˘ ‚¿ÚÔ˘˜ Î·È Ù˘ ËÏÈΛ·˜, ̤¯ÚÈ ÙËÓ 6Ë-7Ë ‰ÂηÂÙ›· Ù˘ ˙ˆ‹˜ (ÛÙȘ Á˘Ó·›Î˜ ÂÚÈÛÛfiÙÂÚÔ). ∫·Ù¿ ÙËÓ ÂÊ˂›·, ÂÈÙ·¯‡ÓÂÙ·È Ë ·‡ÍËÛË ÙÔ˘ Ï›Ô˘˜ ÛÙȘ ı‹ÏÂȘ Î·È ÂÏ·ÙÙÒÓÂÙ·È ÛÙÔ˘˜ ¿ÚÚÂÓ˜. ∏ ·¯˘Û·ÚΛ· ·ÔÙÂÏ› ÙÔ Û˘¯ÓfiÙÂÚÔ ÔÏ˘ÁÔÓȉȷÎfi ÎÏËÚÔÓÔÌÔ‡ÌÂÓÔ ÓfiÛËÌ·, ÏfiÁˆ ·Ôı‹Î¢Û˘ Î·È ÌË Î·‡Û˘ Ù˘ ÂÈϤÔÓ ÙÚÔÊ‹˜, ·ÏÏ¿ Î·È ÏfiÁˆ ·˘ÍË̤Ó˘ ηٷӿψÛ˘. ∞fi ÙÔ˘˜ ÏÈÌÔ‡˜, ·Ó¿ ÙÔ˘˜ ·ÈÒÓ˜, Â¤˙ËÛ·Ó ¿ÙÔÌ· Ô˘ ·ÍÈÔÔÈÔ‡Û·Ó Î·Ï‡ÙÂÚ· ÙËÓ ÙÚÔÊ‹ ÙÔ˘˜ ‹ ›¯·Ó ÂÚÈÛÛfiÙÂÚ· ·Ôı¤Ì·Ù· ÂÓ¤ÚÁÂÈ·˜. ∂ÓÙÔ‡ÙÔȘ, Û ÂÚÈfi‰Ô˘˜ Ì ·ÊıÔÓ›· ÙÚÔʛ̈Ó, ÔÈ ·fiÁÔÓÔÈ ·˘ÙÒÓ ÙˆÓ ·ÙfiÌˆÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·¯˘Û·ÚΛ·. O ÏÈ҉˘ ÈÛÙfi˜ Û¯ËÌ·Ù›˙ÂÙ·È ÁÈ· ÙËÓ ·Ôı‹Î¢ÛË ÂÓ¤ÚÁÂÈ·˜, Ë ÔÔ›· ÂÍÔÈÎÔÓÔÌÂ›Ù·È fiÙ·Ó ÏÂÔÓ¿˙ÂÈ Ë ÙÚÔÊ‹, ÂÓÒ Î·Ù·Ó·ÏÒÓÂÙ·È fiÙ·Ó ‰ÂÓ ˘¿Ú¯ÂÈ ÙÚÔÊ‹ ÛÙÔ ÂÚÈ‚¿ÏÏÔÓ. ŸÙ·Ó ·ÊıÔÓ› Ë ÙÚÔÊ‹, Û˘ÛÛˆÚ‡ÂÙ·È Ï›Ô˜ ¤Ú·Ó ÙˆÓ ·ÓÒÙÂÚˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÔÚ›ˆÓ, ·ÏÏ¿ Ô ÔÚÁ·ÓÈÛÌfi˜ ·ÓÙÈÛÙ¤ÎÂÙ·È Ì ÙÔ ÌÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ, ÂÓÒ Ë ÈÓÛÔ˘Ï›ÓË Î·È ÔÈ ·˘ÍËÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ (IGF-πs, ·ÁÁÂÈÔÙÂÓÛÈÓÔÁfiÓÔ ππ, TGFs) ·˘Í¿ÓÔ˘Ó ÙË ÏÈÔÁ¤ÓÂÛË ÛÂ Û˘ÓÂÚÁ·Û›· Ì ÙÔ˘˜ ÂÓÂÚÁÔÔÈË̤ÓÔ˘˜ ˘ԉԯ›˜ ÙˆÓ ÔÏÏ·Ï·ÛÈ·ÛÙÒÓ ÙˆÓ ˘ÂÚÔÍ˘ÛˆÌ¿ÙˆÓ (PPARÁs) Î·È ÙÔ˘˜ ÌÂÙ·ÁÚ·ÊÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ (C/EBP, SREP). ∞fi ÙÔ ·˘ÍË̤ÓÔ Ï›Ô˜ ÂÎÎÚ›ÓÂÙ·È ÂÚÈÛÛfiÙÂÚË ÏÂÙ›ÓË, Ô˘ ÏËÚÔÊÔÚ› ÙÔÓ ˘Ôı¿Ï·ÌÔ (ΤÓÙÚÔ ÎÔÚÂÛÌÔ‡) fiÙÈ ˘¿Ú¯ÂÈ Â¿ÚÎÂÈ· ÂÓ¤ÚÁÂÈ·˜ ÁÈ· ‰È·Ù‹ÚËÛË Ù˘ ÔÌÔÈÔÛÙ·Û›·˜ ÙÔ˘ ÛÒÌ·ÙÔ˜ ¯ˆÚ›˜ ÙË Ï‹„Ë ÙÚÔÊ‹˜, ·˘Í¿ÓÔÓÙ·È ÔÈ Î·‡ÛÂȘ, ‰È·ÙËÚÂ›Ù·È Ô ÌËÓÈ·›Ô˜ ·ÎÏÔ˜

Abstract: Adipose tissue is the energy store of the body and about 50% of it is subcutaneous. The proportion of body fat increases from birth to one year, decreases up to the age of 4 years, then increases again as weight is gained, continuing until the 6th-7th decades of life, and a little longer in females. During puberty the adipose tissue increases in girls and decreases in boys. Obesity is the most common polygenetically inherited disease, caused by excess consumption of food and storage of energy. In earlier times when people had to survive famines they made better use of their food and deposited more as fuel. Later, with an excess of food, their descendants started to become obese. Adipose tissue was evolved to cope with limited energy in the environment by storing energy, but it has not evolved further to homeostasis in periods of abundance of food. In the case of increased ingestion of food for a long period, the adipose tissue resists with poor adaptation (metabolic syndrome). When there is plenty of food the insulin and growth factors (IGF1s, angiotensinogen II, TGFs) signal growth in fat, in conjunction with peroxisome proliferator activated receptors (PPARs) and transforming factors (C/EBP, SREBP). In normal circumstances increased fat produces more leptin which informs the centre of satiety in the hypothalamus that there is sufficient energy to preserve homeostasis without food consumption, combustion is increased, puberty is signalled in children, the menstrual cycle is preserved in girls and fat deposition is decreased to low normal. The adipose tissue covers the body and is in touch with environmental stimuli and signals factors that cause apoptosis of affected cells. The adipose tissue resists its own growth by

∂Ó‰ÔÎÚÈÓÔÏfiÁÔ˜

Endocrinologist

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¶·È‰È·ÙÚÈ΋ 2004;67:75-87

Paediatriki 2004;67:75-87

ÛÙȘ ¤Ê˂˜ (‰È¢ÎÔχÓÂÙ·È Ë ÂÊ˂›· ÛÙ· ·È‰È¿) Î·È ÙÔ Ï›Ô˜ Â·Ó¤Ú¯ÂÙ·È ÛÙÔ Î·ÙÒÙÂÚÔ Ê˘ÛÈÔÏÔÁÈÎfi. ªÂ Ï›Ô˜ ηχÙÂÙ·È Ë Â͈ÙÂÚÈ΋ ÂÈÊ¿ÓÂÈ· ÙÔ˘ ÛÒÌ·ÙÔ˜ Ô˘ ¤Ú¯ÂÙ·È Û Â·Ê‹ Ì ÂÚÂı›ÛÌ·Ù· ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ Î·È ÂÎÎÚ›ÓÂÙ·È Ô ·Ú¿ÁÔÓÙ·˜ Ó¤ÎÚˆÛ˘ fiÁÎˆÓ (TNF·) Î·È Ë ÈÓÙÂÚÏ¢ΛÓË (IL-6) Ô˘ ÚÔηÏÔ‡Ó ·fiÙˆÛË ÙˆÓ ÚÔۂ‚ÏËÌ¤ÓˆÓ Î˘ÙÙ¿ÚˆÓ. ∆Ô Ï›Ô˜ ·ÓÙÈÛÙ¤ÎÂÙ·È ÛÙËÓ ·‡ÍËÛ‹ ÙÔ˘ Ì ÙËÓ ¤ÎÎÚÈÛË Î˘ÙÔÎÈÓÒÓ, ÔÈ Ôԛ˜ Â›Ó·È Ô˘Û›Â˜ ÊÏÂÁÌÔÓ‹˜. O TNF· Î·È Ë IL-6 ·˘Í¿ÓÔ˘Ó Ù· ÂχıÂÚ· ÏÈ·Ú¿ Ôͤ· Î·È ÙȘ η‡ÛÂȘ, ‰ËÌÈÔ˘ÚÁÔ‡Ó ÈÓÛÔ˘ÏÈÓÔ·ÓÙ›ÛÙ·ÛË Î·È ÂÌÔ‰›˙Ô˘Ó ÙËÓ ·‡ÍËÛË ÙÔ˘ Ï›Ô˘˜. ∏ Û˘Ó¯‹˜, fï˜, ˘ÂÚηٷӿψÛË ıÂÚÌ›‰ˆÓ ÚÔηÏ› ·‡ÍËÛË ÙÔ˘ Ï›Ô˘˜.

increasing cytokines, which are inflammatory substances; the tumour necrosis factors (TNF·) and interleukin (IL-6) increase the circulating free fatty acids, promote combustion and cause insulin resistance, preventing fat deposition, but in the event of continued consumption of calories fat deposition is increased.

§¤ÍÂȘ ÎÏÂȉȿ: ÏÈ҉˘ ÈÛÙfi˜, ÏÂÙ›ÓË, TNF·, IL-6, PPARÁs, ÈÓÛÔ˘ÏÈÓÔ·ÓÙ›ÛÙ·ÛË.

Key words: adipose tissue, leptin, TNF·, IL-6, PPARÁs, insulin resistance.

∂ÈÛ·ÁˆÁ‹ ∆Ô ÌÂÁ·Ï‡ÙÂÚÔ fiÚÁ·ÓÔ ÙÔ˘ ÛÒÌ·ÙÔ˜ Â›Ó·È Ô ÏÈ҉˘ ÈÛÙfi˜ (15 ÎÈÏ¿ Û ¤Ó·Ó ÂÓ‹ÏÈη) Î·È ¯ÚËÛÈ̇ÂÈ ÛÙË ‰È·ÌfiÚʈÛË ÙÔ˘ Û¯‹Ì·ÙÔ˜ Ù˘ Â͈ÙÂÚÈ΋˜ ÂÈÊ¿ÓÂÈ·˜ ÙÔ˘ ÛÒÌ·ÙÔ˜. ∆Ô ÂÚÈÛÛfiÙÂÚÔ Ï›Ô˜ Â›Ó·È ˘Ô‰fiÚÈÔ Î·È, ˆ˜ ÌÔÓˆÙÈÎfi, ·ÚÂÌÔ‰›˙ÂÈ ÙËÓ ·ÒÏÂÈ· ıÂÚÌfiÙËÙ·˜, ÂÓÒ Ì ϛÔ˜ ηχÙÔÓÙ·È Î·È Ù· ‰È·ÛÙ‹Ì·Ù· ·Ó¿ÌÂÛ· ÛÙÔ˘˜ ÈÛÙÔ‡˜, ÒÛÙ ӷ Û˘ÁÎÚ·ÙÔ‡ÓÙ·È Ù· fiÚÁ·Ó· ÛÙË ı¤ÛË ÙÔ˘˜ (1). ∆Ô Ï›Ô˜, Â›Û˘, ÂÚÈ‚¿ÏÏÂÈ Ù· Ó‡ڷ Î·È ‚ÔËı¿ ÛÙË ÌfiÓˆÛË Î·È ÙË ÁÚ‹ÁÔÚË ÌÂÙ·ÊÔÚ¿ ÙˆÓ ÂÎÔψÙÈÎÒÓ ÂÚÂıÈÛÌ¿ÙˆÓ. §›Ô˜ ˘¿Ú¯ÂÈ Î·È ÛÙË ÌÂÌ‚Ú¿ÓË Î¿ı ΢ÙÙ¿ÚÔ˘ ˆ˜ Û˘ÛÙ·ÙÈÎfi Ù˘ ‰ÔÌ‹˜ Ù˘, ˘fi ÌÔÚÊ‹ ¯ÔÏËÛÙÂÚfiÏ˘ (ıËÏ·ÛÙÈο), ÏÈÔÚˆÙÂ˚ÓÒÓ Î·È ÊˆÛÊÔÏÈȉ›ˆÓ, ¯ÚËÛÈ̇ÔÓÙ·˜ ÛÙÔÓ ¤ÏÂÁ¯Ô Ù˘ ÌÂÙ·ÊÔÚ¿˜ ÓÂÚÔ‡ Î·È ‰È·Ï˘Ì¤ÓˆÓ Ô˘ÛÈÒÓ ·fi ÙÔ Â͈ÙÂÚÈÎfi ÛÙÔ ÂÛˆÙÂÚÈÎfi ÂÚÈ‚¿ÏÏÔÓ ÙÔ˘ ΢ÙÙ¿ÚÔ˘.

O ÏÈ҉˘ ÈÛÙfi˜ ·Ó·Ù‡¯ıËΠÁÈ· Ó· ÂÍÔÈÎÔÓÔÌ› ÂÓ¤ÚÁÂÈ· ·fi ÙÔ ÂÚÈ‚¿ÏÏÔÓ, ÙËÓ ÔÔ›· ¯ÚËÛÈÌÔÔÈ› fiÙ·Ó ˘¿Ú¯ÂÈ ¤ÏÏÂÈ„Ë. ∏ ·Ôı‹Î¢ÛË Ú·ÁÌ·ÙÔÔÈÂ›Ù·È Û ÂÚÈfi‰Ô˘˜ ·ÊıÔÓ›·˜ ÙÚÔÊÒÓ, fiÙ·Ó Ë ÚÔÛÏ·Ì‚·ÓfiÌÂÓË Ì ÙȘ ÙÚÔʤ˜ ÂÓ¤ÚÁÂÈ· ˘ÂÚ‚·›ÓÂÈ ÙȘ ··ÈÙ‹ÛÂȘ ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡. ∏ ÂÈϤÔÓ ÂÓ¤ÚÁÂÈ· ÂÓ·ÔÙ›ıÂÙ·È Ì ÙË ÌÔÚÊ‹ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ ÛÙÔÓ ÏÈÒ‰Ë ÈÛÙfi, Ô˘ ·˘Í¿ÓÂÈ ÙÔÓ ·ÚÈıÌfi Î·È ÙÔ Ì¤ÁÂıÔ˜ ÙˆÓ ÏÈÔ΢ÙÙ¿ÚˆÓ. ∏ ¯ÚËÛÈÌÔÔ›ËÛË Ù˘ ÂÈϤÔÓ ÂÓ¤ÚÁÂÈ·˜ Á›ÓÂÙ·È Û ÂÚÈfi‰Ô˘˜ ÛÙ¤ÚËÛ˘ ÙÚÔÊÒÓ, ÔfiÙ ÂÏ·ÙÙÒÓÂÙ·È ÙÔ Ì¤ÁÂıÔ˜ Î·È Ô ·ÚÈıÌfi˜ ÙˆÓ ÏÈÔ΢ÙÙ¿ÚˆÓ (2). ŸÙ·Ó ÙÔ ‚¿ÚÔ˜ ÙÔ˘ ÛÒÌ·ÙÔ˜ ·˘Í¿ÓÂÙ·È, Ô ÏÈ҉˘ ÈÛÙfi˜ ·˘Í¿ÓÂÙ·È ·Ó·ÏÔÁÈο ÂÚÈÛÛfiÙÂÚÔ Î·È ‰ËÌÈÔ˘ÚÁÂ›Ù·È ·¯˘Û·ÚΛ·, Ë ÔÔ›· ·ÔÙÂÏ› ¯ÚfiÓÈÔ Úfi‚ÏËÌ· ÛÙȘ ·ÓÂÙ˘Á̤Ó˜ ˘ÂÚηٷӷψÙÈΤ˜ ÎÔÈӈӛ˜ Ù˘ ÛËÌÂÚÈÓ‹˜ ÂÔ¯‹˜ (3).

OÈ Î›Ó‰˘ÓÔÈ ·fi ÙȘ ÂÈÏÔΤ˜ ÙÔ˘ ·˘ÍË̤ÓÔ˘ ‚¿ÚÔ˘˜ ·Ú¯›˙Ô˘Ó ·fi ÙËÓ ·È‰È΋ ËÏÈΛ· (4,5). ∂Ó‹ÏÈη ¿ÙÔÌ· Ì ‰Â›ÎÙË ÛˆÌ·ÙÈ΋˜ Ì¿˙·˜ (¢™ª) ÌÂÁ·Ï‡ÙÂÚÔ ·fi 30 ¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚÔ Î›Ó‰˘ÓÔ Ó· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó Î·Ú‰È·ÁÁÂȷο ÓÔÛ‹Ì·Ù· Î·È ÔÚÌÔÓÔ¢·›ÛıËÙÔ Î·ÚΛÓÔ (6). ∏ ÓÔÛËÚfiÙËÙ· Î·È Ë ıÓËÙfiÙËÙ· ÂËÚ¿˙ÔÓÙ·È fi¯È ÌfiÓÔ ·fi ÙÔ Ì¤ÁÂıÔ˜, ·ÏÏ¿ Î·È ·fi ÙÔ Û¯‹Ì· ÙÔ˘ ·¯‡Û·ÚÎÔ˘ ÛÒÌ·ÙÔ˜, ÙÔ ÔÔ›Ô ‰È·ÌÔÚÊÒÓÂÙ·È ·fi ÙËÓ Î·Ù·ÓÔÌ‹ ÙÔ˘ Ï›Ô˘˜. ∆· ¿ÙÔÌ· Ì ·˘ÍË̤ÓË Û˘ÛÛÒÚ¢ÛË Ï›Ô˘˜ ÛÙËÓ ÎÔÈÏÈ¿ ηÈ, Û˘ÓÂÒ˜, ·˘ÍË̤ÓË ÂÚ›ÌÂÙÚÔ Ì¤Û˘ ‹ ·˘ÍË̤ÓË Û¯¤ÛË Ì¤Û˘ ÚÔ˜ ÂÚÈʤÚÂÈ· (>0,8 ÛÙȘ Á˘Ó·›Î˜ Î·È >1,0 ÛÙÔ˘˜ ¿Ó‰Ú˜) ‰È·ÙÚ¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚÔ Î›Ó‰˘ÓÔ ÓfiÛËÛ˘ Î·È ÚfiˆÚÔ˘ ı·Ó¿ÙÔ˘ Û ۇÁÎÚÈÛË Ì ÙÔÓ ÁÂÓÈÎfi ÏËı˘ÛÌfi (7,8). ™ÙË ÛËÌÂÚÈÓ‹ ˘ÂÚηٷӷψÙÈ΋ ÎÔÈÓˆÓ›· ˘¿Ú¯ÂÈ Û˘Ó¯‹˜ Ù¿ÛË ·‡ÍËÛ˘ ÙÔ˘ ÔÛÔÛÙÔ‡ ·¯˘Û·ÚΛ·˜ ÛÙËÓ ·È‰È΋ ËÏÈΛ· (9,10).

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∂›‰Ë ÏÈÒ‰Ô˘˜ ÈÛÙÔ‡ À¿Ú¯Ô˘Ó ‰‡Ô Ù‡ÔÈ ÏÈÒ‰Ô˘˜ ÈÛÙÔ‡: ·) Ô Ï¢Îfi˜, Ô˘ fiÙ·Ó Ù· ·ÙÙ·Ú· ·Ó·Ù˘¯ıÔ‡Ó Ï‹Úˆ˜, ÂÚȤ¯Ô˘Ó ÌfiÓÔ Ì›· ÛÙ·ÁfiÓ· Ï›Ô˘˜ Î·È ‚) Ô Ê·Èfi˜ ‹ Ôχ¯ˆÚÔ˜, Ô˘ Ù· ·ÙÙ·Ú· ÂÚȤ¯Ô˘Ó ÔÏÏ¿ ÛÙ·ÁÔÓ›‰È· Ï›Ô˘˜ ÛÙÔ Î˘ÙÙ·ÚfiÏ·ÛÌ·, ÔÏÏ¿ ÌÈÙÔ¯fiÓ‰ÚÈ· Ì ÙËÓ ·Û‡˙¢ÎÙË ÚˆÙ½ÓË ıÂÚÌÔÁÂÓ›ÓË (UPC1) Î·È Â›Ó·È ÏÔ‡ÛÈ· Û ΢Ùfi¯ÚˆÌ·. ∏ ıÂÚÌÔÁÂÓ›ÓË Â›Ó·È ÚˆÙ½ÓË ÌÂÙ·ÊÔÚ¿˜ ÛÙË ÌÂÌ‚Ú¿ÓË ÙˆÓ ÌÈÙÔ¯ÔÓ‰Ú›ˆÓ Ô˘ ‰È·ÛÎÔÚ›˙ÂÈ Ù· ·ÔıËÎÂ˘Ì¤Ó· ÚˆÙfiÓÈ· ÂÎÙfi˜ ÙˆÓ ÌÈÙÔ¯ÔÓ‰Ú›ˆÓ, ÒÛÙ ӷ ·˘Í¿ÓÔÓÙ·È ÔÈ Î·‡ÛÂȘ, ηıÒ˜ ·Ô‰ÂÛ̇ÔÓÙ·È ·fi ÙËÓ ÔÍÂȉˆÙÈ΋ ʈÛÊÔÚ˘Ï›ˆÛË. ∏ ÂÓ¤ÚÁÂÈ· Ô˘ ÂÎχÂÙ·È ·˘Í¿ÓÂÈ ÙË ıÂÚÌfiÙËÙ· ÛÙÔ ÂÚÈ‚¿ÏÏÔÓ. ∆Ô Ê·Èfi Ï›Ô˜ ‚Ú›ÛÎÂÙ·È Û ·˘ÍË̤ÓË ÔÛfiÙËÙ· ÛÙ· ÓÂÔÁÓ¿ Î·È Û˘Ì‚¿ÏÏÂÈ ÛÙË ÁÚ‹ÁÔÚË ·Ú·ÁˆÁ‹

¶·È‰È·ÙÚÈ΋ 2004;67:75-87

ıÂÚÌfiÙËÙ·˜ (¤ˆ˜ 60% Ù˘ Û˘ÓÔÏÈο ·Ú·ÁfiÌÂÓ˘). ∆Ô Ê·Èfi Ï›Ô˜ ÂÚÈ‚¿ÏÏÂÈ Ù· ÛÏ¿Á¯Ó·, fiˆ˜ ÙÔ˘˜ ÓÂÊÚÔ‡˜, Ù· ÂÈÓÂÊÚ›‰È· Î·È ÙËÓ Î·Ú‰È¿, ·ÏÏ¿ Î·È Ù· ·ÁÁ›· Î·È Ù· Ó‡ڷ ÛÙÔ ÌÂÛÔıˆÚ¿ÎÈÔ Î·È ÙÔÓ Ï·ÈÌfi. ∆· ÓÂÔÁÓ¿ ıËÏ·ÛÙÈÎÒÓ, ÙÔ Ê·Èfi Ï›Ô˜ ÙˆÓ ÔÔ›ˆÓ ·Ê·ÈÚÂ›Ù·È ¯ÂÈÚÔ˘ÚÁÈο, Âı·›ÓÔ˘Ó ·fi ˘ÔıÂÚÌ›·. ™ÙËÓ ÒÚÈÌË ËÏÈΛ·, ÙÔ Ê·Èfi Ï›Ô˜ ˘ÔÛÙÚ¤ÊÂÙ·È. ∏ ÔÚÌfiÓË ÓÔÚ·‰ÚÂÓ·Ï›ÓË Î·È ÔÈ ı˘ÚÂÔÂȉÈΤ˜ ÔÚÌfiÓ˜ ‰ÈÂÁ›ÚÔ˘Ó ÙË ıÂÚÌÔÁ¤ÓÂÛË ÙÔ˘ Ê·ÈÔ‡ Ï›Ô˘˜, ̤ۈ ‚3-·‰ÚÂÓÂÚÁÈÎÒÓ ˘Ô‰Ô¯¤ˆÓ. ªÂÙ·‚ÔÏÈÛÌfi˜ ÙÔ˘ Ï›Ô˘˜ O ÏÈ҉˘ ÈÛÙfi˜ ‚Ú›ÛÎÂÙ·È ÛÂ Û˘Ó¯‹ ·Ó·Ó¤ˆÛË (11). ∆· ÙÚÈÁÏ˘ÎÂÚ›‰È· ÙˆÓ ¯˘ÏÔÌÈÎÚÒÓ Î·È ÙˆÓ Ôχ ¯·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈÔÚˆÙÂ˚ÓÒÓ (VLDL) ˘‰ÚÔχÔÓÙ·È ÛÙ· ·ÈÌÔÊfiÚ· ÙÚȯÔÂȉ‹ ÙÔ˘ ÏÈÒ‰Ô˘˜ ÈÛÙÔ‡ ·fi ÙË ÏÈÔÚˆÙÂ˚ÓÈ΋ ÏÈ¿ÛË (LPL) Ô˘ ÂÎÎÚ›ÓÂÙ·È ·fi Ù· ÏÈÔ·ÙÙ·Ú·, Û ÏÈ·Ú¿ Ôͤ·, Ô˘ ÂÈÛ¤Ú¯ÔÓÙ·È Ì ÈÓÔ·ÙÙˆÛË ÛÙÔ ÏÈÔ·ÙÙ·ÚÔ ÁÈ· Ó· Í·Ó·Û¯ËÌ·Ù›ÛÔ˘Ó ÙÚÈÁÏ˘ÎÂÚ›‰È·.

OÈ Û˘Ì·ıËÙÈΤ˜ ·ÔÏ‹ÍÂȘ ÙˆÓ ÓÂ‡ÚˆÓ (Â›Ó·È ÂÚÈÛÛfiÙÂÚ˜ ÛÙÔ ÛÏ·Á¯ÓÈÎfi ·’ fi,ÙÈ ÛÙÔ ˘Ô‰fiÚÈÔ Ï›Ô˜) ÂÎÏ‡Ô˘Ó ÓÔÚ·‰ÚÂÓ·Ï›ÓË, Ô˘ ÂÓÂÚÁÔÔÈ› ÙËÓ ÔÚÌÔÓÔ¢·›ÛıËÙË ÏÈ¿ÛË Î·È ˘‰ÚÔχÂÈ Ù· ÌfiÚÈ· ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ ÛÙËÓ ÂÈÊ¿ÓÂÈ· ÙˆÓ ÏÈÔÛÙ·ÁÔÓȉ›ˆÓ ÙÔ˘ ΢ÙÙ¿ÚÔ˘. OÈ ÔÚÌfiÓ˜ Ô˘ ÚÔ¿ÁÔ˘Ó ÙË ÏÈfiÏ˘ÛË (ηÙ¯ÔϷ̛Ә, ÁÏ˘Î·ÁfiÓË, ·˘ÍËÙÈ΋ ÔÚÌfiÓË), ‰ÚÔ˘Ó Ì ‰È¤ÁÂÚÛË Ù˘ ·‰ÂÓ˘ÏÈ΋˜ ΢ÎÏ¿Û˘, ÙÔ˘ ÂÓ˙‡ÌÔ˘ Ô˘ ÌÂÙ·ÙÚ¤ÂÈ ÙËÓ ÙÚÈʈÛÊÔÚÈ΋ ·‰ÂÓÔÛ›ÓË (ATP) Û ΢ÎÏÈ΋ ÌÔÓÔʈÛÊÔÚÈ΋ ·‰ÂÓÔÛ›ÓË (cAMP). ∏ ΢ÎÏÈ΋ AMP ·Ô‰ÔÌÂ›Ù·È ·fi ÙÔ ¤Ó˙˘ÌÔ ÊˆÛÊÔ‰ÈÂÛÙÂÚ¿ÛË, Ô˘ ·Ó·ÛÙ¤ÏÏÂÙ·È ·fi ÌÂı˘ÏÔÍ·Óı›Ó˜ (ηʽÓË, ıÂÔÊ˘Ï›ÓË). °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi, fiÏ· Ù· ‰È·ÈÙÔÏfiÁÈ· ·‰˘Ó·Ù›ÛÌ·ÙÔ˜ ÂÚȤ¯Ô˘Ó ηʤ Î·È ÙÛ¿È Ô˘ ·˘Í¿ÓÔ˘Ó ÙËÓ ÂÓ‰Ô΢ÙÙ¿ÚÈ· ÏÈfiÏ˘ÛË. ∆· ÏÈ·Ú¿ Ôͤ· Û˘Ó‰¤ÔÓÙ·È Ì ÏÂ˘ÎˆÌ·Ù›ÓË ÒÛÙ ӷ Â›Ó·È ‰È·Ï˘Ù¿ ÛÙÔ ·›Ì· Î·È ‰È¿ Ù˘ ΢ÎÏÔÊÔÚ›·˜ ÌÂٷʤÚÔÓÙ·È ÛÙÔ ‹·Ú, ÙËÓ Î·Ú‰È¿, ÙÔ˘˜ Ì˘˜, ÙÔ˘˜ Ó‡ÌÔÓ˜, ÙÔ˘˜ fiÚ¯ÂȘ, ÙÔÓ ÂÁΤʷÏÔ Î·È ÙÔÓ ÏÈÒ‰Ë ÈÛÙfi ÁÈ· Ó· Î·Ô‡Ó ‹ Ó· Â·Ó·ÛÙÂÚÔÔÈËıÔ‡Ó (∂ÈÎfiÓ· 1). ∆· ÂχıÂÚ· ÏÈ·Ú¿ Ôͤ· ÛÙÔ ·›Ì· Â›Ó·È ÛÂ Û˘ÁΤÓÙÚˆÛË 0,1-2 mEq/mL ·Ó·ÏfiÁˆ˜ Ù˘ ηٿÛÙ·Û˘ ıÚ¤„˘ Î·È ·ÔÙÂÏÔ‡Ó ÙÔ 25-50% ÙˆÓ ÂÓÂÚÁÂÈ·ÎÒÓ ·Ó·ÁÎÒÓ Û ÓËÛÙ›·. ¢È·ÊÔÚÔÔ›ËÛË ÙÔ˘ ÏÈÒ‰Ô˘˜ ÈÛÙÔ‡ OÈ Ó¤ÔÈ ÏÈÔ‚Ï¿ÛÙ˜ ·Ó·Ù‡ÛÛÔÓÙ·È ·fi ·‰È·ÊÔÚÔÔ›ËÙ· ÌÂÛÂÁ¯˘Ì·ÙÈο ·ÙÙ·Ú·. ∫·Ù¿ ÙË ‰È·ÊÔÚÔÔ›ËÛË, ÙÔ Î‡ÙÙ·ÚÔ ÌÂÙ·‚¿ÏÏÂÙ·È ·fi ·ÛÙÂÚÔÂȉ¤˜ Û ÛÊ·ÈÚÈÎfi, ÂÓÒ ÂÏ·ÙÙÒÓÔÓÙ·È ÔÈ ‚1 ·‰ÚÂÓÂÚÁÈÎÔ› ˘ԉԯ›˜ Î·È ·˘Í¿ÓÔÓÙ·È ÔÈ ‚2 Î·È ‚3 ˘ԉԯ›˜. ∆Ô Ï›Ô˜ ·Ú¯›˙ÂÈ Ó· Û¯ËÌ·Ù›˙ÂÙ·È ÛÙÔÓ

Paediatriki 2004;67:75-87

¿ÓıÚˆÔ ÌÂÙ¿ ÙËÓ 26Ë Â‚‰ÔÌ¿‰· ·ËÛ˘. ∆· ·ÓÒÙÂÚ· fiÚÈ· ÙÔ˘ Ê˘ÛÈÔÏÔÁÈÎÔ‡ Ï›Ô˘˜ ÛÙÔ˘˜ ÂÓ‹ÏÈΘ Â›Ó·È 19% ÙÔ˘ ‚¿ÚÔ˘˜ ÛÒÌ·ÙÔ˜ ÛÙÔ˘˜ ¿Ó‰Ú˜ Î·È 24% ÛÙȘ Á˘Ó·›Î˜. ™Ù· ·È‰È¿ Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜, Ë ·Ó·ÏÔÁ›· ÙÔ˘ ÛÒÌ·ÙÔ˜ Û ϛÔ˜ Â›Ó·È Ôχ ÌÈÎÚfiÙÂÚË, ÂÓÒ ·fi ÙÔ 4Ô ¤ÙÔ˜, ÚÔ˚Ô‡Û˘ Ù˘ ËÏÈΛ·˜ Î·È ÙÔ˘ ‚¿ÚÔ˘˜, ·˘Í¿ÓÂÈ Ë ·Ó·ÏÔÁ›· ÙÔ˘ Ï›Ô˘˜ (¶›Ó·Î·˜ 1). ∞Èٛ˜ ·‡ÍËÛ˘ ÙÔ˘ Ï›Ô˘˜ ÙÔ˘ ÛÒÌ·ÙÔ˜ ∆Ô Î·ÓÔÓÈÎfi ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜ Û ۯ¤ÛË Ì ÙÔ ‡„Ô˜ Â›Ó·È ÂΛÓÔ Ô˘ οÓÂÈ ÙÔ ¿ÙÔÌÔ Ì·ÎÚÔ‚ÈfiÙÂÚÔ Ì ηϋ ÔÈfiÙËÙ· ˙ˆ‹˜, ‰ËÏ·‰‹ ¯ˆÚ›˜ ÓÔÛËÚfiÙËÙ· (14,15). ∫·Ù¿ ÙËÓ ·‡ÍËÛË ÙÔ˘ ‚¿ÚÔ˘˜, ·˘Í¿ÓÂÙ·È Ô Ì˘˚Îfi˜ ÈÛÙfi˜, ·ÏÏ¿ ΢ڛˆ˜ ·˘Í¿ÓÂÙ·È ÙÔ Ï›Ô˜. ∏ ·¯˘Û·ÚΛ· ÔÊ›ÏÂÙ·È Û ·˘ÍË̤ÓË Î·Ù·Ó¿ÏˆÛË ÙÚÔÊÒÓ, ȉȷ›ÙÂÚ· ÂÎÂ›ÓˆÓ Ô˘ ¤¯Ô˘Ó ·˘ÍË̤ÓË ÂÚÈÂÎÙÈÎfiÙËÙ· Û ϛÔ˜ (‚ÈÔÌ˯·ÓÔÔÈË̤ӷ ÙÚfiÊÈÌ·), ÛÙÔÓ Û‡Á¯ÚÔÓÔ ÙÚfiÔ ˙ˆ‹˜, ‰ËÏ·‰‹ ÔÏϤ˜

∂ÈÎfiÓ· 1. ªÂÙ·ÊÔÚ¿ ÙˆÓ ÏÈȉ›ˆÓ ·fi ÙÔÓ ·˘Ïfi ÙÔ˘ ÙÚȯÔÂȉԇ˜ ÛÙÔ ÏÈÔ·ÙÙ·ÚÔ Î·È ·ÓÙ›ÛÙÚÔÊ·. ¶›Ó·Î·˜ 1. ¶ÂÚÈÂÎÙÈÎfiÙËÙ· ÙÔ˘ ÛÒÌ·ÙÔ˜ Û ϛÔ˜ (%) ·Ó¿ÏÔÁ· Ì ÙËÓ ËÏÈΛ· (12,13) ∏ÏÈΛ· (¤ÙË)

∞ÁfiÚÈ·

∫ÔÚ›ÙÛÈ·

°¤ÓÓËÛË 0,25 1,0 2,0 3,0 4,5 5,0 10 14 15 ∂Ó‹ÏÈΘ

11,4 30,2 25,6 25,4 18,3 14,3 16,5 17,6 18,4 11,4 19,0

14,2 31,5 27,6 25,4 14,3 15,4 16,0 27,0 23,3 24,0

77

¶·È‰È·ÙÚÈ΋ 2004;67:75-87

ÂÁÎÂÊ·ÏÈΤ˜ ÂÓ·Û¯ÔÏ‹ÛÂȘ (ÙËÏÂfiÚ·ÛË, ËÏÂÎÙÚÔÓÈÎÔ› ˘ÔÏÔÁÈÛÙ¤˜, Â͈ۯÔÏÈο Ì·ı‹Ì·Ù·), ·˘ÙÔÌ·ÙÔÔ›ËÛË ¯ÂÈÚÔÓ·ÎÙÈÎÒÓ ÂÚÁ·ÛÈÒÓ (Ï˘ÓÙ‹ÚÈ·, ‚ÈÔÌ˯·ÓÈ΋ ·Ú·ÁˆÁ‹ ÂÓ‰˘Ì¿ÙˆÓ Î·È ÙÚÔʛ̈Ó) Î·È ÂÚÈÔÚÈṲ̂ÓË ÛˆÌ·ÙÈ΋ ¿ÛÎËÛË, ·ÏÏ¿ Î·È Û ÎÏËÚÔÓÔÌÈο Î·È ÔÚÌÔÓÈο ·›ÙÈ· (16-18) (¶›Ó·Î·˜ 2) (∂ÈÎfiÓ· 2). ¶ÂÚÈÂÎÙÈÎfiÙËÙ· ÙÔ˘ Ï›Ô˘˜ ÛÙÔ ÛÒÌ· ∏ ̤ÙÚËÛË ÙÔ˘ Ï›Ô˘˜ ÙÔ˘ ÛÒÌ·ÙÔ˜ Â›Ó·È ‰‡ÛÎÔÏË Î·È ÛÙ· ˙Ò· Á›ÓÂÙ·È Î·ÙfiÈÓ ÙÂÌ·¯ÈÛÌÔ‡ ÙÔ˘ ÛÒÌ·ÙÔ˜. ∞Ó·Ù‡¯ıËÎ·Ó ‰È¿ÊÔÚ˜ ̤ıÔ‰ÔÈ ÁÈ· ÙÔÓ Î·Ù¿ ÚÔÛ¤ÁÁÈÛË ˘ÔÏÔÁÈÛÌfi ÙÔ˘ Ï›Ô˘˜. ¶˘ÎÓÔÌÂÙÚ›· £ÂˆÚÂ›Ù·È Ë Î·Ï‡ÙÂÚË Ì¤ıÔ‰Ô˜ ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË ÙÔ˘ Ï›Ô˘˜ ÙÔ˘ ÛÒÌ·ÙÔ˜ Î·È Â›Ó·È Ë ·Ú¯·ÈfiÙÂÚË. ÀÔÏÔÁ›˙ÂÙ·È ÙÔ ÂȉÈÎfi ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜ (‚¿ÚÔ˜/ fiÁÎÔ), fiÔ˘ Ô fiÁÎÔ˜ ÌÂÙÚ¿Ù·È ·fi ÙÔ ÓÂÚfi Ô˘ ÂÎÙÔ›˙ÂÈ ÙÔ ÛÒÌ· fiÙ·Ó ‚˘ıÈÛÙ› ÛÙÔ ÓÂÚfi. À¿Ú¯Ô˘Ó Ù¤ÛÛÂÚȘ Ì·ıËÌ·ÙÈÎÔ› Ù‡ÔÈ ÁÈ· ÙÔÓ ˘ÔÏÔÁÈÛÌfi ÙÔ˘ Ï›Ô˘˜ ·fi ÙÔ ÂȉÈÎfi ‚¿ÚÔ˜ ÙÔ˘ ÛÒÌ·ÙÔ˜, fiˆ˜: %Ï›Ô˜=100[(5,053/Âȉ. ‚¿ÚÔ˜)-4,164] (20). ∏ ·fiÎÏÈÛË ÙÔ˘ ˘ÔÏÔÁÈÛÌÔ‡ ÙÔ˘ Ï›Ô˘˜ ÛÙȘ Ù¤ÛÛÂÚȘ ÂÍÈÛÒÛÂȘ ÁÈ· ÙÔ ÂȉÈÎfi ‚¿ÚÔ˜ ‰ÂÓ ˘ÂÚ‚·›ÓÂÈ ÙÔ 4%. °È· Ó· ¤¯ÂÈ ¿ÌÂÛË Î·È Â‡ÎÔÏË ÂÊ·ÚÌÔÁ‹ Ë ˘ÎÓÔÌÂÙÚ›·, ÂÚÂ˘Ó¿Ù·È Ì¤ıÔ‰Ô˜ ÁÈ· ÙÔÓ ˘ÔÏÔÁÈÛÌfi ÙÔ˘ fiÁÎÔ˘ ÙÔ˘ ÂÎÙÔÈ˙fiÌÂÓÔ˘ ·¤Ú· ·fi ÙÔ ÛÒÌ·. ÕÏϘ ̤ıÔ‰ÔÈ Ì¤ÙÚËÛ˘ ∏ ÂÎÙ›ÌËÛË ÙÔ˘ ÂÓ‰ÔÎÔÈÏÈ·ÎÔ‡ Ï›Ô˘˜ Á›ÓÂÙ·È Ì ÙË Ì¤ÙÚËÛË Ù˘ ÂÚÈ̤ÙÚÔ˘ ̤Û˘, Ë ÔÔ›· ‰ÂÓ

Paediatriki 2004;67:75-87

Ú¤ÂÈ Ó· ÍÂÂÚÓ¿ Ù· 100 cm ÛÙÔ˘˜ ÂÓ‹ÏÈΘ ¿Ó‰Ú˜. ∏ ÂÚ›ÌÂÙÚÔ˜ ̤Û˘ ¤¯ÂÈ Î·Ï‹ Û˘Û¯¤ÙÈÛË Ì ÙÔ ÛÏ·Á¯ÓÈÎfi Ï›Ô˜, fiˆ˜ ÂÎÙÈÌ¿Ù·È ÌÂÙ¿ ·fi Ì·ÁÓËÙÈ΋ ‹ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÎÔÈÏ›·˜ (21,22). ∆Ô Ï›Ô˜ Ù˘ ÎÔÈÏÈ¿˜, ˘Ô‰fiÚÈÔ, ÛÏ·Á¯ÓÈÎfi, ÌÂÛÂÓÙ¤ÚÈÔ Î·È ÔÈÛıÔÂÚÈÙÔÓ·˚Îfi, ·˘Í¿ÓÂÙ·È Ì ÙËÓ ËÏÈΛ· Î·È ÔÈ ¿Ó‰Ú˜ ¤¯Ô˘Ó ‰ÈÏ¿ÛÈ· ÔÛfiÙËÙ· ·fi ÙȘ Á˘Ó·›Î˜. ™Â ÂÓ‹ÏÈΘ Á˘Ó·›Î˜, Ë ÂÈÊ¿ÓÂÈ· ÙÔ˘ Ï›Ô˘˜ ÛÙËÓ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÛÙÔ ‡„Ô˜ ÙˆÓ O4O5 ÛÔÓ‰‡ÏˆÓ Â›Ó·È 28,3 cm2 ÁÈ· Ù· ÛÏ¿Á¯Ó· Î·È 128,4 cm2 ÁÈ· ÙÔ ˘Ô‰fiÚÈÔ. ∏ ̤ÙÚËÛË ÙÔ˘ Ï›Ô˘˜ ÙÔ˘ ÛÒÌ·ÙÔ˜ Á›ÓÂÙ·È Î·È ·fi ÙËÓ ·ÔÚÚfiÊËÛË ÂÓ¤ÚÁÂÈ·˜ Ì ‰ÈÏfi ʈÙfiÓÈÔ (DEXA) (fiˆ˜ ˘ÔÏÔÁ›˙ÂÙ·È Î·È Ë ÔÛÙÈ΋ ˘ÎÓfiÙËÙ·) Î·È ¤¯ÂÈ ‹‰Ë Ú·ÎÙÈ΋ ÂÊ·ÚÌÔÁ‹ (23). ª¤ÙÚËÛË ¿¯Ô˘˜ ‰ÂÚÌ·ÙÈ΋˜ Ù˘¯‹˜ ∏ ̤ÙÚËÛË ÙÔ˘ ˘Ô‰fiÚÈÔ˘ Ï›Ô˘˜ Á›ÓÂÙ·È Û ٤ÛÛÂÚ· ÛÙ·ıÂÚ¿ ÛËÌ›· (‰‡Ô ÛËÌ›· ÛÙÔÓ ‚Ú·¯›ÔÓ·, ¤Ó· ÛÙËÓ ˆÌÔÏ¿ÙË Î·È ¤Ó· ÛÙË ÏÂοÓË), ·ÏÏ¿ ηϋ ÂÎÙ›ÌËÛË Á›ÓÂÙ·È Î·È Ì ÙË Ì¤ÙÚËÛË Û ‰‡Ô ÛËÌ›· (‚Ú·¯›ÔÓ·˜ Î·È ˆÌÔÏ¿ÙË) ‹ Ï·Ì‚¿ÓÔÓÙ·˜ Î·È ¿ÏϘ ·Ú·Ì¤ÙÚÔ˘˜ ıÚ¤„˘ (ÂÚ›ÌÂÙÚÔ˜ ‚Ú·¯›ÔÓ·, ̤Û˘, ÂÚÈʤÚÂÈ·˜). À¿Ú¯Ô˘Ó ÂÍÈÛÒÛÂȘ Ô˘ ˘ÔÏÔÁ›˙Ô˘Ó ÙÔ ÔÏÈÎfi Ï›Ô˜ ÙÔ˘ ÛÒÌ·ÙÔ˜ ·fi ÙÔ ¿¯Ô˜ ‰ÂÚÌ·ÙÈ΋˜ Ù˘¯‹˜, ηıÒ˜ Î·È ‰È·ÁÚ¿ÌÌ·Ù· Ì ÙËÓ Î·Ù·ÓÔÌ‹ ÙÔ˘ ¿¯Ô˘˜ ‰ÂÚÌ·ÙÈ΋˜ Ù˘¯‹˜ ·Ó¿ÏÔÁ· Ì ÙËÓ ËÏÈΛ· Î·È ÙÔ Ê‡ÏÔ (2426). ∆Ô ˘Ô‰fiÚÈÔ Ï›Ô˜ ÙÔ˘ ‚Ú·¯›ÔÓ· ·ÎÔÏÔ˘ı›

¶›Ó·Î·˜ 2. ∞›ÙÈ· ·¯˘Û·ÚΛ·˜ (19) °ÂÓÂÙÈο °ÂÓÂÙÈ΋ ÚԉȿıÂÛË ™‡Ó‰ÚÔÌ· (Prader Willi, Laurence Moon Biedl, Down, „¢‰Ô¸Ô·Ú·ı˘ÚÂÔÂȉÈÛÌfi˜) ÀÔı·Ï·ÌÈο ŸÁÎÔÈ ºÏÂÁÌÔÓ¤˜ ∆Ú·˘Ì·ÙÈÛÌÔ› Î·È ¯ÂÈÚÔ˘ÚÁÈΤ˜ ‚Ï¿‚˜ ∞˘ÍË̤ÓË ÂÓ‰ÔÎÚ¿ÓÈ· ›ÂÛË ¢È·ÙÚÔÊÈο ™˘Ó‹ıÂȘ ‰È·ÙÚÔÊ‹˜ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ∂ÈϤÔÓ Ï‹„Ë ÙÚÔÊ‹˜ ∂Ó˙˘ÌÈΤ˜ ·ÓˆÌ·Ï›Â˜ OÚÌÔÓÈο ÀÂÚ¤ÎÎÚÈÛË ÁÏ˘ÎÔÎÔÚÙÈÎÔÂȉÒÓ (Û‡Ó‰ÚÔÌÔ Cushing) ŒÏÏÂÈ„Ë ı˘ÚÂÔÂȉÈÎÒÓ ÔÚÌÔÓÒÓ (˘Ôı˘ÚÂÔÂȉÈÛÌfi˜) ÀÔÊ˘Ûȷ΋ ·ÓÂ¿ÚÎÂÈ· ¶ÚˆÙÔ·ı‹˜ Î·È ‰Â˘ÙÂÚÔ·ı‹˜ ˘ÔÁÔÓ·‰ÈÛÌfi˜ ÀÂÚÈÓÛÔ˘ÏÈÓ·ÈÌ›· º¿Ú̷η º·ÈÓÔıÂÈ·˙›Ó˜ πÓÛÔ˘Ï›ÓË ∫ÔÚÙÈÎÔÂȉ‹ ∫˘ÚÔÂÙ·‰›ÓË ∆ÚÈ΢ÎÏÈο ·ÓÙÈηٷıÏÈÙÈο

78

∂ÈÎfiÓ· 2. ŒÊË‚Ô˜ ËÏÈΛ·˜ 17 ÂÙÒÓ Ì ‡„Ô˜ 186,7 cm Î·È ‚¿ÚÔ˜ 165 kg (‚¿ÚÔ˜ Á¤ÓÓËÛ˘: 5,5 kg).

¶·È‰È·ÙÚÈ΋ 2004;67:75-87

Paediatriki 2004;67:75-87

¯·Ú·ÎÙËÚÈÛÙÈ΋ ÔÚ›· ÛÙ· ‰‡Ô ʇϷ ·Ó·ÏfiÁˆ˜ Ù˘ ËÏÈΛ·˜ (∂ÈÎfiÓ· 3). ∞Ó·ÏÔÁ›· ‚¿ÚÔ˘˜ ÚÔ˜ ‡„Ô˜ ∆Ô ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜ Û ÎÈÏ¿ ‰È·ÈÚÔ‡ÌÂÓÔ Ì ÙÔ ÙÂÙÚ¿ÁˆÓÔ ÙÔ˘ ‡„Ô˘˜ Û ̤ÙÚ· ·ÔÙÂÏ› ÙÔÓ ‰Â›ÎÙË ÛˆÌ·ÙÈ΋˜ Ì¿˙·˜ (¢™ª). ∏ ÙÈÌ‹ ÙÔ˘ ¢™ª ÂÎÊÚ¿˙ÂÈ Î·Ù¿ ÚÔÛ¤ÁÁÈÛË ÙËÓ ÂÚÈÂÎÙÈÎfiÙËÙ· ÙÔ˘ ÛÒÌ·ÙÔ˜ Û ϛÔ˜ (27). O ‚·ıÌfi˜ Ù˘ ·¯˘Û·ÚΛ·˜ ÛÙÔ˘˜ ÂÓ‹ÏÈΘ ÂÎÙÈÌ¿Ù·È ·fi ÙÔÓ ¢™ª (¶›Ó·Î·˜ 3). O ¢™ª ÛÙ· ·È‰È¿ Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜ ÌÂÙ·‚¿ÏÏÂÙ·È Ì ÙËÓ ËÏÈΛ· Î·È ˘¿Ú¯Ô˘Ó ‰È·ÁÚ¿ÌÌ·Ù· Ô˘ ‰›ÓÔ˘Ó ÙȘ ÂηÙÔÛÙÈ·›Â˜ ı¤ÛÂȘ (28,29). ƒ‡ıÌÈÛË ÙÔ˘ ÈÛÔ˙˘Á›Ô˘ ÂÓ¤ÚÁÂÈ·˜ Î·È ÙÔ˘ ‚¿ÚÔ˘˜ ÛÒÌ·ÙÔ˜ ∆Ô ÎÂÓÙÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ· Ú˘ıÌ›˙ÂÈ ÙË Ï‹„Ë ÙÚÔÊ‹˜, ·Ó¿ÏÔÁ· Ì ÙË ıÚ¤„Ë ÙÔ˘ ÛÒÌ·ÙÔ˜ Î·È Ù· ÂÚÂı›ÛÌ·Ù· ·fi ÙÔ Â͈ÙÂÚÈÎfi ÂÚÈ‚¿ÏÏÔÓ. O ÂÁΤʷÏÔ˜, οı ÛÙÈÁÌ‹, ¤¯ÂÈ ·ÓÙ›ÏË„Ë ÁÈ· ÙËÓ ˘fiÛÙ·ÛË ÙÔ˘ ÛÒÌ·ÙÔ˜ ÛÙÔÓ ¯ÒÚÔ Î·È ÙÔ Û‡Ì·Ó (30). O ÂÁΤʷÏÔ˜ ·Ú·Ï·Ì‚¿ÓÂÈ, ÂÂÍÂÚÁ¿˙ÂÙ·È Î·È ·ÔÛÙ¤ÏÏÂÈ ÌËӇ̷ٷ ÁÈ· ÙË ıÚ¤„Ë ÙÔ˘ ÛÒÌ·ÙÔ˜ ÛÙÔÓ 24

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∂ÈÎfiÓ· 3. ªÂÙ·‚ÔÏ‹ ÙÔ˘ Ï›Ô˘˜ ·Ó¿ÏÔÁ· Ì ÙËÓ ËÏÈΛ·, ·fi ÙÔ ¿¯Ô˜ ‰ÂÚÌ·ÙÈ΋˜ Ù˘¯‹˜ ÙÔ˘ ‚Ú·¯›ÔÓ· Û ‰Â›ÁÌ· ÁÂÓÈÎÔ‡ ÏËı˘ÛÌÔ‡ (n=15.000). ¶›Ó·Î·˜ 3. ∫·Ù¿Ù·ÍË ·¯˘Û·ÚΛ·˜ ÂÓËÏ›ÎˆÓ ·Ó¿ÏÔÁ· Ì ÙÔÓ ¢™ª ¢Â›ÎÙ˘ ۈ̷ÙÈ΋˜ Ì¿˙·˜ <20 20-25 25-30 30-40 >40

∫·ÙËÁÔÚ›· ·¯˘Û·ÚΛ·˜ §ÈfiÛ·ÚÎÔ˜ ∫·ÓÔÓÈÎÔ‡ ‚¿ÚÔ˘˜ À¤Ú‚·ÚÔ˜ ¶·¯‡Û·ÚÎÔ˜ ∫·ÎÔ‹ı˘ ·¯‡Û·ÚÎÔ˜

˘Ôı¿Ï·ÌÔ, Ô ÔÔ›Ô˜ ÚÔÛ·ÚÌfi˙ÂÈ ÙËÓ fiÚÂÍË Î·È ÙËÓ Î·Ù·Ó¿ÏˆÛË ÂÓ¤ÚÁÂÈ·˜. Œ¯Ô˘Ó ‚ÚÂı› 50 Ô˘Û›Â˜ Ô˘ ÂËÚ¿˙Ô˘Ó ·˘Ù¤˜ ÙȘ ÏÂÈÙÔ˘ÚÁ›Â˜ (¶›Ó·Î·˜ 4). O ˘Ôı¿Ï·ÌÔ˜, ÛÂ Û˘ÓÂÚÁ·Û›· Ì ÙÔÓ ‰ÚÂ·ÓÔÂȉ‹ ÊÏÔÈfi (ÌÂٷȯÌÈ·Îfi Û‡ÛÙËÌ· ‹ Limbic system) Î·È ÙÔÓ ‰ÈÎÙ˘ˆÙfi Û¯ËÌ·ÙÈÛÌfi, ÂϤÁ¯ÂÈ ÙË Û˘ÌÂÚÈÊÔÚ¿ Î·È ÙȘ Û˘ÁÎÈÓ‹ÛÂȘ. O ˘Ôı¿Ï·ÌÔ˜ ·ÔÙÂÏ› ÙÔ Î¤ÓÙÚÔ ÙÔ˘ ·˘ÙfiÓÔÌÔ˘ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, ÂÓÒ Ô ‰ÈÎÙ˘ˆÙfi˜ Û¯ËÌ·ÙÈÛÌfi˜ Â›Ó·È Û˘ÛÛˆÚÂ˘Ù‹˜ Î·È ÂÓ·ÚÌÔÓÈÛÙ‹˜ ÂÚÂıÈÛÌ¿ÙˆÓ. O ÂÁΤʷÏÔ˜ ÚÔÛ·ı› Ó· ‰È·ÙËÚ‹ÛÂÈ ÙÔ ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜ ÛÙ·ıÂÚfi, ÎÈÓËÙÔÔÈÒÓÙ·˜ ‰È¿ÊÔÚ˜ ÏÂÈÙÔ˘ÚÁ›Â˜, fiˆ˜ (31,32): ·) ·›ÛıËÌ· ›ӷ˜ ‹ ÎÔÚÂÛÌÔ‡ Î·È ·Ó¿ÏÔÁË Û˘ÌÂÚÈÊÔÚ¿ ÙÔ˘ ·ÙfiÌÔ˘ ÚÔ˜ ·Ó·˙‹ÙËÛË ÙÚÔÊ‹˜, ‚) Ú‡ıÌÈÛË Ù˘ ηٷӿψÛ˘ ÂÓ¤ÚÁÂÈ·˜ ̤ۈ Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘ Û˘Ì·ıËÙÈÎÔ‡-·Ú·Û˘Ì·ıËÙÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Î·È Á) Ú‡ıÌÈÛË Ù˘ ¤ÎÎÚÈÛ˘ ÔÚÌÔÓÒÓ Ô˘ ·ÔıËÎÂ‡Ô˘Ó ‹ η›Ó ÙËÓ ÂÈϤÔÓ ÂÓ¤ÚÁÂÈ·. ∏ Ï‹„Ë Ù˘ ÙÚÔÊ‹˜ ÂËÚ¿˙ÂÙ·È ·fi ‚Ú·¯Â›·˜ ‰È¿ÚÎÂÈ·˜ ÂÚÂı›ÛÌ·Ù· Ô˘ ÚÔ¤Ú¯ÔÓÙ·È ·fi ηÙÒÙÂÚ· ΤÓÙÚ· (¤ÓÙÂÚÔ) ‹ Â͈ÙÂÚÈο ÂÚÂı›ÛÌ·Ù· ·fi ÙȘ ÙÚÔʤ˜ Î·È ÙÔ ÂÚÈ‚¿ÏÏÔÓ (∂ÈÎfiÓ· 4). ∏ fiÚÂÍË Î·È Ë Î·Ù·Ó¿ÏˆÛË ÙÚÔÊ‹˜ ÂËÚ¿˙ÔÓÙ·È ·fi Û˘Ó·ÈÛı‹Ì·Ù· Î·È ·ÓÙÈÏ‹„ÂȘ Ì·ÎÚ¿˜ ‰È¿ÚÎÂÈ·˜ Ô˘ ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙÔÓ ÂÁΤʷÏÔ. ∏ ÏÂÙ›ÓË, ÂÚ¤ıÈÛÌ· Ì·ÎÚ¿˜ ‰È¿ÚÎÂÈ·˜, ÂÎχÂÙ·È ·fi ÙÔÓ ÏÈÒ‰Ë ÈÛÙfi Î·È ÏËÚÔÊÔÚ› ÙÔÓ ÂÁΤʷÏÔ ÁÈ· ÙËÓ ÔÛfiÙËÙ· Ù˘ ·ÔıËÎÂ˘Ì¤Ó˘ ÂÓ¤ÚÁÂÈ·˜ Ì ÙË ÌÔÚÊ‹ Ï›Ô˘˜. O ÂÁΤʷÏÔ˜ Ú˘ıÌ›˙ÂÈ ÙËÓ ÚfiÛÏË„Ë ÙÚÔÊ‹˜, ÒÛÙ ӷ Â›Ó·È Û ÈÛÔ˙‡ÁÈÔ Ì ÙËÓ Î·Ù·Ó¿ÏˆÛË (33). ∫¤ÓÙÚ· ÙÔ˘ ˘Ôı·Ï¿ÌÔ˘ Ô˘ Ú˘ıÌ›˙Ô˘Ó ÙËÓ fiÚÂÍË Î·È ÙÔÓ ÎÔÚÂÛÌfi ∏ ‰È¤ÁÂÚÛË ÙÔ˘ ÌÂÛÔÎÔÈÏÈ·ÎÔ‡ ˘Ú‹Ó· ÛÙÔÓ ˘Ôı¿Ï·ÌÔ (VMH) οÓÂÈ ÙÔ ÂÈÚ·Ì·Ùfi˙ˆÔ Ó· ÌËÓ ÂÈı˘Ì› ÙË Ï‹„Ë ÙÚÔÊ‹˜, ÂÓÒ Ë Î·Ù·ÛÙÚÔÊ‹ ÙÔ˘ ÚÔηÏ› ˘ÂÚÊ·Á›· Î·È ·¯˘Û·ÚΛ·. ™Â ·˘Ùfi ÙÔÓ ˘Ú‹Ó· (ΤÓÙÚÔ ÎÔÚÂÛÌÔ‡) ‰Ú· Ë ÏÂÙ›ÓË, Ë ÔÔ›· ·Ó·ÛÙ¤ÏÏÂÈ ÙË Ï‹„Ë ÙÚÔÊ‹˜, ·˘Í¿ÓÂÈ ÙȘ η‡ÛÂȘ Î·È Û˘ÓÙÂÏ› ÛÙËÓ ·ÒÏÂÈ· ‚¿ÚÔ˘˜ (34). ∏ ‰È¤ÁÂÚÛË ÙÔ˘ Ï¿ÁÈÔ˘ ˘Ú‹Ó· (LHA) οÓÂÈ ÙÔ ÂÈÚ·Ì·Ùfi˙ˆÔ Ó· ·˘Í¿ÓÂÈ ÙË Ï‹„Ë ÙÚÔÊ‹˜, ÂÓÒ Ë Î·Ù·ÛÙÚÔÊ‹ ÙÔ˘ οÓÂÈ ÙÔ ˙ÒÔ Ó· ÌËÓ ÂÈı˘Ì› Ê·ÁËÙfi. ™Â ·˘Ùfi ÙÔÓ ˘Ú‹Ó· (ΤÓÙÚÔ fiÚÂ͢) ‰Ú· ÙÔ Ó¢ÚÔÂÙ›‰ÈÔ À (¡PÀ) Î·È ˘¿Ú¯Ô˘Ó ÔÈ ÙÂÏÈΤ˜ ·ÔÏ‹ÍÂȘ ÙˆÓ Ó¢ÚÒÓˆÓ Ô˘ ÂÎÊÚ¿˙Ô˘Ó ÔÚÂÍÈÔÁfiÓ· ÂÙ›‰È·, fiˆ˜ ÔÈ ÔÚÂ͛Ә (˘ÔÎÚÂÙ›Ó˜) Î·È Ë ÔÚÌfiÓË Ô˘ Û˘ÁÎÂÓÙÚÒÓÂÈ ÌÂÏ·Ó›ÓË (MCH) (35). ∆Ô Ó¢ÚÔÂÙ›‰ÈÔ À (NPY) ‚Ú›ÛÎÂÙ·È ÛÙÔ ÎÂÓÙÚÈÎfi Î·È ÙÔ ÂÚÈÊÂÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ·, ·˘Í¿ÓÂÈ ÙË ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ·Ú·Û˘Ì·ıËÙÈÎÔ‡ Î·È ÙÔ Ï›Ô˜ ÙÔ˘ ÛÒÌ·ÙÔ˜

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¶·È‰È·ÙÚÈ΋ 2004;67:75-87

Paediatriki 2004;67:75-87

¶›Ó·Î·˜ 4. OÚÌfiÓ˜ Ô˘ Ú˘ıÌ›˙Ô˘Ó ÙË Ï‹„Ë ÙÚÔÊ‹˜ ∞. ∞Ó·ÛÙÔÏ‹ Ï‹„˘ ÙÚÔÊ‹˜

µ. ∞‡ÍËÛË Ï‹„˘ ÙÚÔÊ‹˜

¡Â˘ÚÔÌÂÙ·‚È‚·ÛÙ¤˜ ¡ÔÚ·‰ÚÂÓ·Ï›ÓË (‚-˘ԉԯ›˜) ¡ÙÔ·Ì›ÓË ™ÂÚÔÙÔÓ›ÓË ÀÔı·Ï·ÌÈο ÂÙ›‰È· ∂ÎÏ˘ÙÈÎfi˜ ·Ú¿ÁˆÓ Ù˘ ACTH (CRH) ÃÔÏÔ΢ÛÙÔÎÈÓ›ÓË (CCK) ¶ÂÙ›‰ÈÔ ·ÚfiÌÔÈÔ ÙÔ˘ ÁÏ˘Î·ÁfiÓÔ˘ (GLP-1) OÚÌfiÓË Ô˘ ‰ÈÂÁ›ÚÂÈ Ù· ÌÂÏ·ÓÔ·ÙÙ·Ú· (·-MSH) OÚÌfiÓ˜ Ô˘ ÂÎχÔÓÙ·È ·fi ÂÚÈÊÂÚÈÎÔ‡˜ ÈÛÙÔ‡˜ §ÂÙ›ÓË (ÂÚ¤ıÈÛÌ· ÌÂÁ¿Ï˘ ‰È¿ÚÎÂÈ·˜) ÃÔÏÔ΢ÛÙÔÎÈÓ›ÓË (CCK) (ÂÚ¤ıÈÛÌ· Û¯ÂÙÈ˙fiÌÂÓÔ Ì ÙÔ Á‡̷)

OÚÌfiÓ˜ Ô˘ ÂÎχÔÓÙ·È ·fi ÙÔÓ ÂÁΤʷÏÔ ¡ÔÚ·‰ÚÂÓ·Ï›ÓË (·-˘ԉԯ›˜) ¡Â˘ÚÔÂÙ›‰ÈÔ À (NPY) OÚÌfiÓË Ô˘ Û˘ÁÎÂÓÙÚÒÓÂÈ ÌÂÏ·Ó›ÓË (MCH) °·Ï·Ó›ÓË ∂ÎÏ˘ÙÈÎfi˜ ·Ú¿ÁˆÓ Ù˘ ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ (GHRH) OÈÔÂȉ‹ ÂÙ›‰È· OÚÂ͛Ә (˘ÔÎÚÂÙ›Ó˜) °ÏÔ˘Ù·ÌÈÓÈÎfi Ô͇ Á-·ÌÈÓÔ‚Ô˘Ù˘ÚÈÎfi Ô͇ (GABA) ¶ÚˆÙ½ÓË ÙÔ˘ ÁÔÓȉ›Ô˘ Agouti ̤ۈ ÙÔ˘ MC4-R ˘Ô‰Ô¯¤·

ŒÏÂÁ¯Ô˜ À„ËÏfiÙÂÚ· ÂÁÎÂÊ·ÏÈο ˘Ôı·Ï·ÌÈÎÒÓ Û˘Ó·ÈÛı‹Ì·Ù· Ì˯·ÓÈÛÌÒÓ ·ÓÙÈÏ‹„ÂȘ ¶Â›Ó·/ÎÔÚÂÛÌfi˜ AÓ·‚ÔÏÈÎfi ∫·Ù·‚ÔÏÈÎfi NPY CRH ∂͈ÙÂÚÈο ÂÚÂı›ÛÌ·Ù· µÚ·¯Â›·˜ ‰È¿ÚÎÂÈ·˜ ÂÚÂı›ÛÌ·Ù· ∫¡™ ¶Ó¢ÌÔÓÔÁ·ÛÙÚÈÎfi CCK ŒÓÙÂÚÔ ª·ÎÚ¿˜ ‰È¿ÚÎÂÈ·˜ ¶¿ÁÎÚ·˜ ÂÚÂı›ÛÌ·Ù· µ∞∆ §ÂÙ›ÓË

£ÂÚÌfiÙ˘ W∞∆

∆ÚÔʤ˜ & ÔÚÌfiÓ˜ IÓÛÔ˘Ï›ÓË W∞∆

∂ÈÎfiÓ· 4. º˘ÛÈÔÏÔÁÈο Û‹Ì·Ù· Ô˘ Ú˘ıÌ›˙Ô˘Ó ÙÔ ÈÛÔ˙‡ÁÈÔ ÂÓ¤ÚÁÂÈ·˜. NPY: Ó¢ÚÔÂÙ›‰ÈÔ À, CRH: ÂÎÏ˘ÙÈ΋ ÎÔÚÙÈÎÔÙÚfiÊÔ˜ ÔÚÌfiÓË, CCK: ¯ÔÏÔ΢ÛÙÔÎÈÓ›ÓË, SNS: Û˘Ì·ıËÙÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ·, µ∞∆: Ê·Èfi Ï›Ô˜, WAT: Ï¢Îfi Ï›Ô˜.

Î·È ÂÏ·ÙÙÒÓÂÈ ÙË ıÂÚÌÔÁ¤ÓÂÛË ÙÔ˘ Ê·ÈÔ‡ Ï›Ô˘˜. ∆Ô Ó¢ÚÔÂÙ›‰ÈÔ À ‰ÈÂÁ›ÚÂÈ ÙËÓ ¤ÎÎÚÈÛË ÈÓÛÔ˘Ï›Ó˘ Î·È ·˘Í¿ÓÂÈ ÙËÓ ÂÓ·fiıÂÛË ÁÏ˘ÎÔÁfiÓÔ˘ Î·È ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ ÛÙÔ˘˜ ÈÛÙÔ‡˜ (36). ∆· ÂÙ›‰È· ·fi ÙË ‰È¿Û·ÛË Ù˘ ÚÔÔÈÔÌÂÏ·ÓÔÎÔÚÙ›Ó˘ (POMP) (Úfi‰ÚÔÌË Ù˘ ACTH) Î·È Î˘Ú›ˆ˜ Ë ·-ÌÂÏ·ÓÈÓÔÙÚfiÔ˜ ÔÚÌfiÓË (·-MSH), ·Ú¿ÁÔÓÙ·È ÛÙÔ˘˜ Ó¢ÚÒÓ˜ ÙÔ˘ ÙÔÍÔÂȉ‹ ˘Ú‹Ó· ÙÔ˘ ˘Ôı·Ï¿ÌÔ˘ Î·È Ú˘ıÌ›˙Ô˘Ó ÙË Ï‹„Ë ÙÚÔÊ‹˜ Î·È ÙÔ ÛˆÌ·ÙÈÎfi ‚¿ÚÔ˜. ∏ Ê˘ÛÈÔÏÔÁÈ΋ ÏÂÈÙÔ˘ÚÁ›· Ù˘ ·MSH ÛÙÔ ∫¡™ ·Ó·Î·Ï‡ÊıËΠfiÙ·Ó ‚Ú¤ıËÎÂ Ë ÚˆÙ½ÓË Agouti Ô˘ ·ÓÙ·ÁˆÓ›˙ÂÙ·È ÙËÓ ·-MSH ÛÙÔ˘˜ ˘ԉԯ›˜ 4 Ù˘ ÌÂÏ·ÓÔÎÔÚÙ›Ó˘ (MC4-R). ∏ ÌÂÙ¿ÏÏ·ÍË ÂÚÈÔ¯‹˜ ÙÔ˘ DNA Ô˘ Ú˘ıÌ›˙ÂÈ ÙËÓ ¤ÎÊÚ·ÛË ÙÔ˘ ÁÔÓȉ›Ô˘ Agouti, Ô‰ËÁ› Û ¤ÎÙÔË ¤ÎÊÚ·ÛË Ù˘ Ô˘Û›·˜ ÛÙÔ˘˜ ı‡Ï·Î˜ ÙˆÓ ÙÚȯÒÓ, Ô˘ ÂÌÔ‰›˙ÂÈ ÙËÓ ÂÌÊ¿ÓÈÛË Ù˘ Ì·‡Ú˘ ¯ÚˆÛÙÈ΋˜ ÌÂÏ·Ó›Ó˘ ÏfiÁˆ ·-MSH (37). ∆· ÔÓÙ›ÎÈ· Ì ÌÂÙ¿ÏÏ·ÍË ¤¯Ô˘Ó ΛÙÚÈÓÔ ÙÚ›¯ˆÌ·, ÂÓÒ ÔÈ ¿ÓıÚˆÔÈ ÎfiÎÎÈÓÔ ¯ÓÔ‡‰È Î·È Ì·ÏÏÈ¿ Î·È ÛÙÔÓ ˘Ôı¿Ï·ÌÔ Ô ·ÓÙ·ÁˆÓÈÛÌfi˜ ÛÙÔ˘˜ ˘ԉԯ›˜ MC-R Ô‰ËÁ› Û ˘ÂÚÊ·Á›·, ÌÂȈ̤ÓË Î·Ù·Ó¿ÏˆÛË ÂÓ¤ÚÁÂÈ·˜ Î·È ·¯˘Û·ÚΛ·.

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∏ ¤Á¯˘ÛË ÛÂÚÔÙÔÓ›Ó˘ ÛÙÔÓ ˘Ôı¿Ï·ÌÔ Î·Ù·ÛÙ¤ÏÏÂÈ ÙË Ï‹„Ë ÙÚÔÊ‹˜ Î·È Ê¿Ú̷η Ô˘ ‰ÈÂÁ›ÚÔ˘Ó ÙËÓ ¤ÎÏ˘ÛË ÛÂÚÔÙÔÓ›Ó˘ ·fi ÙȘ Ó¢ÚÈΤ˜ ·ÔÏ‹ÍÂȘ (ÊÂÓÊÏÔ˘Ú·Ì›ÓË, ÂÌÔÚÈÎfi fiÓÔÌ· Isomeran, ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·Ó ·Ï·ÈfiÙÂÚ· ÁÈ· ·‰˘Ó¿ÙÈÛÌ·) ‹ ·ÚÂÌÔ‰›˙Ô˘Ó ÙËÓ Â·Ó·ÚfiÛÏË„Ë ÛÂÚÔÙÔÓ›Ó˘ (ÊÏÔ˘ÔÍÂÙ›ÓË, ÂÌÔÚÈÎfi fiÓÔÌ· Ladose), ÂÏ·ÙÙÒÓÔ˘Ó ÙËÓ fiÚÂÍË Î·È ÙÔ ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜. º¿Ú̷η Ì ·ÓÙÈÛÂÚÔÙÔÓÈ΋ ‰Ú¿ÛË, fiˆ˜ ÙÔ ·ÓÙÈ-ÈÛÙ·ÌÈÓÈÎfi ΢ÚÔÂÙ·‰›ÓË (Istam, Kulinet), ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó Î·Ù¿ ‰È·ÛÙ‹Ì·Ù· ˆ˜ ÔÚÂÍÈÔÁfiÓ·.

O ÂÎÏ˘ÙÈÎfi˜ ·Ú¿ÁˆÓ Ù˘ ACTH (CRH) ‰ÈÂÁ›ÚÂÈ ÙÔÓ ¿ÍÔÓ· ˘Ôı¿Ï·ÌÔ˜-˘fiÊ˘ÛË-ÂÈÓÂÊÚ›‰È· Î·È ‰Ú·ÛÙËÚÈÔÔÈ› ÙÔ Û˘Ì·ıËÙÈÎfi. ∏ CRH ÂÏ·ÙÙÒÓÂÈ ÙË Ï‹„Ë ÙÚÔÊ‹˜ Î·È ·ÚÂÌÔ‰›˙ÂÈ ÙËÓ ¤ÎÎÚÈÛË Ù˘ ÈÓÛÔ˘Ï›Ó˘ ·Ú¿ ÙËÓ ˘ÂÚÁÏ˘Î·ÈÌ›·. ∏ ÂÚÈÊÂÚÈ΋ ¯ÔÚ‹ÁËÛË ¯ÔÏÔ΢ÛÙÔÎÈÓ›Ó˘ (CCK) ÂÏ·ÙÙÒÓÂÈ ÙËÓ ÔÛfiÙËÙ· ÙÔ˘ Á‡̷ÙÔ˜ Î·È ÂÚÂı›˙ÂÈ ÙÔ Ó¢ÌÔÓÔÁ·ÛÙÚÈÎfi. ∞‡ÍËÛË ‹ ÂÏ¿ÙÙˆÛË ÙÔ˘ ÏÈÒ‰Ô˘˜ ÈÛÙÔ‡ OÈ ÈÛÙÔ› Î·È Ù· fiÚÁ·Ó·, ÌÂÙ¿ ÙËÓ Ï‹ÚË ·Ó¿Ù˘ÍË, ¤¯Ô˘Ó ÛÙ·ıÂÚfi ̤ÁÂıÔ˜, ·Ú¿ ÙÔ fiÙÈ Û˘Ó¯Ҙ ÌÂÚÈο ·ÙÙ·Ú· ·Ó·ÁÂÓÓÒÓÙ·È Î·È ¿ÏÏ· ηٷÛÙÚ¤ÊÔÓÙ·È. OÈ ·Ú¯¤ÁÔÓÔÈ ÏÈÔ‚Ï¿ÛÙ˜ ›Ù ÂÍÂÏ›ÛÛÔÓÙ·È Û Ӥ· ÏÈÒ‰Ë Î‡ÙÙ·Ú· ›Ù ηٷÛÙÚ¤ÊÔÓÙ·È Ì ÚÔÁÚ·ÌÌ·ÙÈṲ̂ÓÔ Î˘ÙÙ·ÚÈÎfi ı¿Ó·ÙÔ (·fiÙˆÛË) (∂ÈÎfiÓ· 5). ∏ ·‡ÍËÛË ÙˆÓ ÏÈÔ΢ÙÙ¿ÚˆÓ Ú˘ıÌ›˙ÂÙ·È ·fi ÙÔ˘˜ ˘ԉԯ›˜ ÙˆÓ ÔÏÏ·Ï·ÛÈ·ÛÙÒÓ ÙˆÓ ˘ÂÚÔÍ˘ÛˆÌ¿ÙˆÓ (Peroxisome proliferator activated receptor) PPAR·,Á,‰, ÔÈ ÔÔ›ÔÈ - Û˘Ó‰ÂfiÌÂÓÔÈ ÌÂ Ô˘Û›Â˜ - ÂÓÂÚÁÔÔÈÔ‡ÓÙ·È Î·È Û¯ËÌ·Ù›˙Ô˘Ó ÂÙÂÚÔ‰ÈÌÂÚ‹ Ì ÙÔÓ ˘Ô‰Ô¯¤· à ÙÔ˘ ÚÂÙÈÓÔ˚ÎÔ‡ ÔͤԘ (RXR), ΢ڛˆ˜ ÛÙÔ ˘Ô‰fiÚÈÔ Î·È ÏÈÁfiÙÂÚÔ ÛÙÔ ÛÏ·Á¯ÓÈÎfi Ï›Ô˜ (∂ÈÎfiÓ· 6). ∆Ô ÂÙÂÚÔ‰ÈÌÂÚ¤˜ ÂÈÛ¤Ú¯ÂÙ·È ÛÙÔÓ ˘Ú‹Ó·, Û˘Ó‰¤ÂÙ·È Ì ÂÚÈÔ¯‹ ÙÔ˘ DNA Î·È ÂÓÂÚÁÔÔÈ› ÙËÓ ·Ú·ÁˆÁ‹ ÂÓ˙‡ÌˆÓ Ô˘ ‚Ú›ÛÎÔÓÙ·È ÛÙ· ˘ÂÚÔ͢ÛÒÌ·Ù·, ÁÈ· ÙÔÓ ÌÂÙ·‚ÔÏÈÛÌfi ÙˆÓ

¶·È‰È·ÙÚÈ΋ 2004;67:75-87

Paediatriki 2004;67:75-87

ºÈÌÚ¿Ù˜ EÓ¤ÚÁÂÈ·

™˘ÎÒÙÈ

ª‡Â˜

°ÏÈÙ·˙fiÓ˜

9cis-ÚÂÙÈÓÔ˚Îfi Ô͇

Growth

Apoptosis

∂ÈÎÔÛ·ÓÔÂȉ‹ §È҉˘ ÈÛÙfi˜ ¶·Ú·ÎÚÈÓ‹ ÂÚÂı›ÛÌ·Ù·

PPAR· ∞ԉȷÊÔÚÔÔ›ËÛË

¢È·ÊÔÚÔÔ›ËÛË

§ÈfiÏ˘ÛË

§ÈoÁ¤ÓÂÛË

PPARÁ ¶˘Ú‹Ó·˜

RXR

PPAR

RXR

AGGTCA N AGGTCA ∞fiÙˆÛË

°ÔÓ›‰ÈÔ ÛÙfi¯Ô˜

PPRE

∂ÈÎfiÓ· 5. ™¯ËÌ·ÙÈ΋ ·Ú¿ÛÙ·ÛË ·‡ÍËÛ˘ ÙˆÓ ÏÈÔ‚Ï·ÛÙÒÓ Û ÏÈÔ·ÙÙ·Ú· ‹ ÂÏ¿ÙÙˆÛ˘ ÏfiÁˆ ÚÔÁÚ·ÌÌ·ÙÈṲ̂ÓÔ˘ ΢ÙÙ·ÚÈÎÔ‡ ı·Ó¿ÙÔ˘.

∂ÈÎfiÓ· 6. ¶·Ú¿ÁÔÓÙ˜ Ô˘ ÂËÚ¿˙Ô˘Ó ÙË ‰Ú·ÛÙËÚÈfiÙËÙ· ÙˆÓ ˘ÂÚÔÍ˘ÛˆÌ¿ÙˆÓ (PPARs).

ÏÈȉ›ˆÓ Î·È ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ. ∆· ˘ÂÚÔ͢ÛÒÌ·Ù· Â›Ó·È Î˘ÙÙ·ÚÈο ÔÚÁ·Ó›‰È· Ô˘ ÂÚȤ¯Ô˘Ó Ù· ¤Ó˙˘Ì· Ù˘ ‚-ÔÍ›‰ˆÛ˘ ÙˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ. ∞Ô‰ÔÌÔ‡Ó ÙÔ ∏2O2 Ô˘ ‰ËÌÈÔ˘ÚÁÂ›Ù·È ·fi ÙȘ Â͈ÌÈÙÔ¯ÔÓ‰ÚȷΤ˜ ÔÍÂȉÒÛÂȘ. ªÂ ÙË ‚-ÔÍ›‰ˆÛË, ·ÔÎfiÙÔÓÙ·È ·fi Ù· ÏÈ·Ú¿ Ôͤ· ‰È·‰Ô¯Èο ·ÎÂÙ˘Ï-ÔÌ¿‰Â˜ Î·È ÙÔ ·ÎÂÙ˘ÏÔCoA ÂÈÛ¤Ú¯ÂÙ·È ÛÙÔ ÌÈÙÔ¯fiÓ‰ÚÈÔ Î·È Î·›ÁÂÙ·È ÛÙÔÓ Î‡ÎÏÔ ÙÔ˘ Krebs). ∫‡ÙÙ·Ú· Ì ·˘ÍË̤ÓÔ ·ÚÈıÌfi ˘ÂÚÔÍ˘ÛˆÌ¿ÙˆÓ ÂÚÁ¿˙ÔÓÙ·È ÂÓÙÔÓfiÙÂÚ· Î·È ÂÚÈÛÛfiÙÂÚÔÈ ÈÓÔ‚Ï¿ÛÙ˜-ÏÈÔ‚Ï¿ÛÙ˜ ˆÚÈÌ¿˙Ô˘Ó Û ÏÈÔ·ÙÙ·Ú· (38).

OÈ Ô˘Û›Â˜ Ô˘ ÂÓÂÚÁÔÔÈÔ‡Ó ÙÔ˘˜ ˘ԉԯ›˜ (ÏfiÁˆ Û‡Ó‰ÂÛ˘) Â›Ó·È ÂÓ‰ÔÁÂÓ›˜ (ÔÏ˘·ÎfiÚÂÛÙ· ÏÈ·Ú¿ Ôͤ·) ‹ Â͈ÁÂÓ›˜ (ÊÈÌÚ¿Ù˜, ıÂÈ·˙ÔÏÈÓ‰ÈfiÓ˜). ™˘ÓÂÒ˜, ÌÂÚÈο ÏÈ·Ú¿ Ôͤ· ÂËÚ¿˙Ô˘Ó ÙË ÌÂÙ·ÁÚ·Ê‹ ÁÔÓȉ›ˆÓ, fiˆ˜ ÔÈ ÔÚÌfiÓ˜, ‰ËÏ·‰‹ Ú˘ıÌ›˙Ô˘Ó ÙÔÓ ÌÂÙ·‚ÔÏÈÛÌfi ÙÔ˘ ΢ÙÙ¿ÚÔ˘, ÂÎÙfi˜ ·fi ÙËÓ ÂÓ¤ÚÁÂÈ· Ô˘ ·Ú¤¯Ô˘Ó Ì ÙËÓ Î·‡ÛË ÙÔ˘˜. ∞Ó·Ï˘ÙÈÎfiÙÂÚ·, ·fi ÙÔ ·Ú·¯È‰ÔÓÈÎfi Ô͇ Û¯ËÌ·Ù›˙ÔÓÙ·È - ̤ۈ Ù˘ ÏÈÔ-Ô͢ÁÂÓ¿Û˘ - Ï¢ÎÔÙÚȤÓ˜ Î·È ˘‰ÚÔ͢ÂÈÎÔÛ·ÙÂÙÚ·ÓÔ˚Îfi Ô͇ (∏∂∆∂) Î·È - ̤ۈ Ù˘ ΢ÎÏÔ-Ô͢ÁÂÓ¿Û˘ - ÚÔÛÙ·ÁÏ·Ó‰›Ó˜. ∞˘Ù¿ Ù· ÚÔ˚fiÓÙ· Û˘Ó‰¤ÔÓÙ·È Ì ÙÔ˘˜ PPARs Î·È ·˘Í¿ÓÔ˘Ó ÙË ÌÂÙ·ÁÚ·Ê‹ ÁÔÓȉ›ˆÓ, ÔÈ ÚˆÙ½Ó˜ ÙˆÓ ÔÔ›ˆÓ ‚Ú›ÛÎÔÓÙ·È ÛÙ· ˘ÂÚÔ͢ÛÒÌ·Ù·, ·˘Í¿ÓÂÙ·È Ë Î·‡ÛË ÙˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ, ÂÓÒ ÂÏ·ÙÙÒÓÂÙ·È Ë Û˘ÛÛÒÚ¢ÛË Î˘ÙÔÎÈÓÒÓ Î·È Ë ÊÏÂÁÌÔÓ‹. ∏ ‰Ú¿ÛË ÙˆÓ PPARÁs ·Ó·ÛÙ¤ÏÏÂÙ·È fiÙ·Ó ÊˆÛÊÔÚ˘ÏÈÒÓÂÙ·È Ë ÌÈÙÔÁfiÓÔ˜ ÚˆÙÂ˚ÓÈ΋ ÎÈÓ¿ÛË (MAPK) (ÏfiÁˆ ÈÓÛÔ˘Ï›Ó˘ Î·È ÙˆÓ ·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ÛÙÔ˘˜ ˘ԉԯ›˜ Ù˘ ÌÂÌ‚Ú¿Ó˘ ÙÔ˘ ΢ÙÙ¿ÚÔ˘) (39) Î·È Ë ‰È·ÊÔÚÔÔ›ËÛË ÙÔ˘ Ï›Ô˘˜ ÂÏ·ÙÙÒÓÂÙ·È. OÈ ·˘ÍËÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ [·Ú¿ÁÔÓÙ·˜ ·‡ÍËÛ˘ ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ (PDGF), ÂȉÂÚÌÈÎfi˜ ·Ú¿ÁˆÓ ·‡ÍËÛ˘ (EGF), ·˘ÍËÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÙˆÓ ÈÓÔ‚Ï·ÛÙÒÓ (IGF)] ʈÛÊÔÚ˘ÏÈÒÓÔ˘Ó ÙËÓ ÚˆÙÂ˚ÓÈ΋ ÎÈÓ¿ÛË Î·È ÂÏ·ÙÙÒÓÔ˘Ó ÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ PPARÁs Î·È ÙË

ÏÈÔÁ¤ÓÂÛË. ÕÙÔÌ· Ì ÌÂÙ¿ÏÏ·ÍË Ù˘ ÚˆÙ½Ó˘ ÙˆÓ PPARÁs ÛÙË ı¤ÛË 115, fiÔ˘ ·ÓÙÈηı›ÛÙ·Ù·È Ë ÚÔÏ›ÓË ·fi ÁÏÔ˘Ù·Ì›ÓË, ¤¯Ô˘Ó ÂÚÈÛÛfiÙÂÚÔ ÂÓÂÚÁ¿ PPARÁs Î·È Â›Ó·È ÁÂÓÂÙÈο ·¯‡Û·Úη, ÏfiÁˆ ÂÈÙ¿¯˘ÓÛ˘ ÛÙË ‰È·ÊÔÚÔÔ›ËÛË ÙˆÓ ÏÈÔ‚Ï·ÛÙÒÓ Û ÏÈÔ·ÙÙ·Ú· Î·È ÂÌÊ·Ó›˙Ô˘Ó ·ÓÙ›ÛÙ·ÛË ÛÙËÓ ÈÓÛÔ˘Ï›ÓË. ∏ ÌÂÙ¿ÏÏ·ÍË ·˘Ù‹ ‰È·ÈÛÙÒıËΠ۠4 ·fi 121 ·¯‡Û·Úη ¿ÙÔÌ· Ô˘ ÌÂÏÂÙ‹ıËÎÂ Ë Û˘ÁÎÂÎÚÈ̤ÓË ÂÚÈÔ¯‹ ÛÙÔ ÁÔÓȉ›ˆÌ¿ ÙÔ˘˜ (40). ∞ÓÙÈı¤Ùˆ˜, ¿ÙÔÌ· Ì ÌÂÙ¿ÏÏ·ÍË ÙˆÓ PPARÁs ÛÙË ı¤ÛË 12, fiÔ˘ ·ÓÙÈηı›ÛÙ·Ù·È Ë ÚÔÏ›ÓË ·fi ·Ï·Ó›ÓË, ¤¯Ô˘Ó ÏÈÁfiÙÂÚÔ ÂÓÂÚÁ¿ PPARÁs Î·È Â›Ó·È ÁÂÓÂÙÈο ÏÈfiÛ·Úη (41).

OÈ ÊÈÌÚ¿Ù˜ (˘ÔÏÈȉ·ÈÌÈο Ê¿Ú̷η, .¯.

Lipidil) ‰ÂÛ̇ÔÓÙ·È ÂÎÏÂÎÙÈο ·fi ÙÔ˘˜ ·-˘ԉԯ›˜ ÙˆÓ PPAR·s, ÙÔ˘˜ ÔÔ›Ô˘˜ ÂÓÂÚÁÔÔÈÔ‡Ó Î·È, ÂÎÙfi˜ ·fi ÂÏ¿ÙÙˆÛË ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ, ÂÏ·ÙÙÒÓÔ˘Ó Î·È ÙË ÊÏÂÁÌÔÓ‹ (42). OÈ ıÂÈ·˙ÔÏÈÓ‰ÈfiÓ˜ (·ÓÙȉȷ‚ËÙÈο Ê¿Ú̷η, .¯. Avandia, Actos) ‰ÂÛ̇ÔÓÙ·È ·fi ÙÔ˘˜ Á-˘ԉԯ›˜ ÙˆÓ PPARÁs, ·˘Í¿ÓÔ˘Ó ÙËÓ Â˘·ÈÛıËÛ›· ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÛÙËÓ ÈÓÛÔ˘Ï›ÓË Î·È ÂÏ·ÙÙÒÓÔ˘Ó ÙȘ ÙÔÈΤ˜ ΢ÙÔΛÓ˜ ÙÔ˘ Ï›Ô˘˜, fiˆ˜ ÙÔÓ TNF· Ô˘ Â›Ó·È Ì›· ·ÈÙ›· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ·ÓÙ›ÛÙ·Û˘ (ÌÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ) (43). ™ÙËÓ ·‡ÍËÛË ÙÔ˘ Û¯ËÌ·ÙÈÛÌÔ‡ Ï›Ô˘˜ Û˘Ì‚¿ÏÏÂÈ Î·È Ô ÌÂÙ·ÁÚ·ÊÈÎfi˜ ·Ú¿ÁˆÓ ∂µƒ-· (Enhancing binding protein-·), Ô ÔÔ›Ô˜ ÂÓÂÚÁÔÔÈ› ÛÙÔ˘˜ ÏÈÔ‚Ï¿ÛÙ˜ ÙÔ ÁÔÓ›‰ÈÔ Ù˘ ÏÂÙ›Ó˘, ÙÔÓ ˘Ô‰Ô¯¤· Ù˘ ÈÓÛÔ˘Ï›Ó˘ Î·È ÙÔÓ ÌÂÙ·ÊÔÚ¤· 4 Ù˘ ÁÏ˘Îfi˙˘ (GLU-4) Î·È ·˘Í¿ÓÂÈ ÙÔÓ ·ÚÈıÌfi ÙˆÓ ÏÈÔ΢ÙÙ¿ÚˆÓ. ¶ÂÈÚ·Ì·Ùfi˙ˆ· ÛÙ· ÔÔ›· ··Ï›ÊıËÎ·Ó (knock out) Ù· ÁÔÓ›‰È· PPARÁ Î·È C/EBP·, Â›Ó·È ÁÂÓÂÙÈο ÏÈfiÛ·Úη.

O ÌÂÙ·ÁÚ·ÊÈÎfi˜ ·Ú¿ÁˆÓ ADD-1 (Adipocyte determination and differentiation factor-1), ÁÓˆÛÙfi˜ Î·È ˆ˜ SREBP-1c (Steroid regulator binding protein1c), Û˘Ó‰ÂfiÌÂÓÔ˜ Ì ÙȘ ÛÙÂÚÔÂȉ›˜ ÔÚÌfiÓ˜,

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Paediatriki 2004;67:75-87

·˘Í¿ÓÂÈ ÙË ‰Ú·ÛÙËÚÈfiÙËÙ· ÙˆÓ PPARÁs ÛÙÔ˘˜ ÏÈÔ‚Ï¿ÛÙ˜ Î·È ÂÓÂÚÁÔÔÈÔ‡ÓÙ·È ¤Ó˙˘Ì· Ô˘ ÂÎÊÚ¿˙ÔÓÙ·È Û ÒÚÈÌ· ÏÈÔ·ÙÙ·Ú·, fiˆ˜ Ë Û˘ÓıÂÙ¿ÛË ÙˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ Î·È Ë ÏÈÔÚˆÙÂ˚ÓÈ΋ ÏÈ¿ÛË. ∆Ô ·ÁÁÂÈÔÙÂÓÛÈÓÔÁfiÓÔ Ô˘ ·Ú¿ÁÂÙ·È ÙÔÈο ÛÙÔ Ï›Ô˜, ÌÂÙ·ÙÚ¤ÂÙ·È Û ·ÁÁÂÈÔÙÂÓÛ›ÓË ππ Î·È ‰ÈÂÁ›ÚÂÈ ÙË ‰È·ÊÔÚÔÔ›ËÛË ÙˆÓ ÚÔÏÈÔ΢ÙÙ¿ÚˆÓ Û ÏÈÔ·ÙÙ·Ú·.

O ı¿Ó·ÙÔ˜ ÙˆÓ ÏÈÔ΢ÙÙ¿ÚˆÓ (·fiÙˆÛË) ·ÚÂÌÔ‰›˙ÂÙ·È ·fi ÙȘ ·ÓÙÈ·ÔÙˆÙÈΤ˜ ÚˆÙ½Ó˜ [bcl-2 Î·È NAIP (Neuronal apoptosis inhibitor protein)], ÔÈ Ôԛ˜ ·˘Í¿ÓÔÓÙ·È ÛÙËÓ ·ÒÏÂÈ· ‚¿ÚÔ˘˜ ÚÔ˚Ô‡Û˘ Ù˘ ‰›·ÈÙ·˜ ·‰˘Ó·Ù›ÛÌ·ÙÔ˜, fiˆ˜ Î·È Û Â·Ó·Ï·Ì‚·ÓfiÌÂÓ˜ ÚÔÛ¿ıÂȘ ·‰˘Ó·Ù›ÛÌ·ÙÔ˜. ∞fi ÙÔ˘˜ ÏÈÔ‚Ï¿ÛÙ˜ ÂÎÎÚ›ÓÂÙ·È Î·È Ë ÚˆÙ½ÓË Pref-1 (Preadipocyte factor-1), Ë ÔÔ›· ÂÌÔ‰›˙ÂÈ ÙË ÏÈÔÁ¤ÓÂÛË Î·È Â›Ó·È ÚˆÙ½ÓË Ù˘ ΢ÙÙ·ÚÈ΋˜ ÌÂÌ‚Ú¿Ó˘ Ô˘ ·ÔÙÂÏÂ›Ù·È ·fi ¤ÍÈ Â·Ó·Ï‹„ÂȘ ÙÔ˘ EGF (Epidermal growth factor). ¶·¯˘Û·ÚΛ· ÏfiÁˆ ÁÔÓȉȷ΋˜ ‚Ï¿‚˘ ∏ ·¯˘Û·ÚΛ· ÔÊ›ÏÂÙ·È Î·È Û ÁÂÓÂÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ (44). ª·ÎÚÔ¯ÚfiÓȘ ÌÂϤÙ˜ ÔÈÎÔÁÂÓÂÈÒÓ Ì ÂÎÛÂÛËÌ·Ṳ̂ÓË ·¯˘Û·ÚΛ· ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ Ë ·¯˘Û·ÚΛ· ÎÏËÚÔÓÔÌÂ›Ù·È Û ÔÛÔÛÙfi 65-75%, ‰ËÏ·‰‹ ÌÂÁ·Ï‡ÙÂÚÔ ·fi ¿ÏÏ· ÎÏËÚÔÓÔÌÔ‡ÌÂÓ· ÓÔÛ‹Ì·Ù· Ì ÌÂÁ¿ÏË Û˘¯ÓfiÙËÙ· ÛÙÔÓ ÏËı˘ÛÌfi, fiˆ˜ Ë Û¯È˙ÔÊÚ¤ÓÂÈ·, Ô ·ÏÎÔÔÏÈÛÌfi˜ Î·È Ë ·ıËڈ̷ÙÔÛÎÏ‹Ú˘ÓÛË (45). ∏ ·¯˘Û·ÚΛ· Ô˘ ÎÏËÚÔÓÔÌÂ›Ù·È Â›Ó·È ÔÏ˘ÁÔÓȉȷ΋ (46). ¶·¯˘Û·ÚΛ· ÌÔÚ› Ó· ˘Ê›ÛÙ·Ù·È ÏfiÁˆ ÁÂÓÂÙÈ΋˜ ‚Ï¿‚˘ ÂÓfi˜ ÁÔÓȉ›Ô˘, fiˆ˜ ÌÂÙ¿ÏÏ·ÍË ÙÔ˘ ÁÔÓȉ›Ô˘ Ù˘ ÏÂÙ›Ó˘ (47), ÙÔ˘ ˘Ô‰Ô¯¤· Ù˘ ÏÂÙ›Ó˘ (48), Ù˘ ·˘ÍË̤Ó˘ ¤ÎÊÚ·Û˘ Ù˘ ÚˆÙ½Ó˘ Agouti, Ô˘ Â›Ó·È ·ÓÙ·ÁˆÓÈÛÙ‹˜ ÛÙÔÓ ˘Ô‰Ô¯¤· Ù˘ ÌÂÏ·ÓÔÎÔÚÙ›Ó˘ (49), ηıÒ˜ Î·È ÌÂÙ¿ÏÏ·ÍË ÙÔ˘ ‚3 ·‰ÚÂÓÂÚÁÈÎÔ‡ ˘Ô‰Ô¯¤· (50). ∏ ·¯˘Û·ÚΛ· ÌÔÚ› Ó· ÔÊ›ÏÂÙ·È Û ÌÂÙ¿ÏÏ·ÍË ÙÔ˘ ÂÓ˙‡ÌÔ˘ ÏÈÔÚˆÙÂ˚ÓÈ΋ ÏÈ¿ÛË, ÒÛÙ ӷ Â›Ó·È ‰Ú·ÛÙÈÎfiÙÂÚË Î·È Ó· ÂÈÛ¤Ú¯ÔÓÙ·È ÂÚÈÛÛfiÙÂÚ· ÙÚÈÁÏ˘ÎÂÚ›‰È· ÂÓ‰Ô΢ÙÙ¿ÚÈ·, Ù· ÔÔ›· ·˘Í¿ÓÔ˘Ó ÙË Û˘ÛÛÒÚ¢ÛË Ï›Ô˘˜ ‹ Û ÌÂÙ¿ÏÏ·ÍË

ÛÙËÓ ÂÓ‰Ô΢ÙÙ¿ÚÈ· ÏÈ¿ÛË, ÒÛÙ ӷ ÂÎÊÚ¿˙ÂÙ·È ÏÈÁfiÙÂÚÔ ÌÂÙ¿ ·fi ‰È¤ÁÂÚÛË Ì ηÙ¯ÔϷ̛Ә ‹ ÔÚÌfiÓ˜ Î·È Ó· ·Ô‰ÂÛ̇ÔÓÙ·È ÏÈÁfiÙÂÚ· ÙÚÈÁÏ˘ÎÂÚ›‰È· ·fi ÙÔ ÂÓ‰Ô΢ÙÙ¿ÚÈÔ Ï›Ô˜ ÁÈ· Ó· ÂÈÛ¤ÏıÔ˘Ó ÛÙËÓ Î˘ÎÏÔÊÔÚ›·. ∆· ¿ÙÔÌ· Ô˘ Â›Ó·È ·¯‡Û·Úη ¯ˆÚ›˜ Ó· ηٷӷÏÒÓÔ˘Ó ÔÏϤ˜ ıÂÚÌ›‰Â˜, Â›Ó·È Èı·Ófi Ó· ¤¯Ô˘Ó ÌÂÙ¿ÏÏ·ÍË ÛÙÔ ÁÔÓ›‰ÈÔ Ù˘ ·2-˘ÔÔÌ¿‰·˜ Ù˘ ∫-¡a-ATP¿Û˘, ÒÛÙ ӷ ··ÈÙÂ›Ù·È ÏÈÁfiÙÂÚË ÂÓ¤ÚÁÂÈ· ÁÈ· ÙË ‰È·Ù‹ÚËÛË Ù˘ ‰È·ÊÔÚ¿˜ ÙÔ˘ ËÏÂÎÙÚÔ¯ËÌÈÎÔ‡ ‰˘Ó·ÌÈÎÔ‡ ÙÔ˘ ΢ÙÙ¿ÚÔ˘ ·fi ÙÔÓ ÂÍˆÎ˘ÙÙ¿ÚÈÔ ¯ÒÚÔ. ÕÙÔÌ· Ì ÌÔÓÔÁÔÓȉȷΤ˜ ÌÂÙ·ÏÏ¿ÍÂȘ (Â›Ó·È Û¿ÓȘ) ¤¯Ô˘Ó ‚·ÚÈ¿ ·¯˘Û·ÚΛ· ·fi ÙËÓ ·È‰È΋ ËÏÈΛ· Î·È Ì¤¯ÚÈ ÙÒÚ· ‹Ù·Ó ‰‡ÛÎÔÏÔ˜ Ô ÁÂÓÂÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ (¶›Ó·Î·˜ 5). ∞fi ÙÔÓ ¤ÏÂÁ¯Ô ÔÈÎÔÁÂÓÂÈÒÓ Ì ÎÏËÚÔÓÔÌÈ΋ ·¯˘Û·ÚΛ· ‚Ú¤ıËÎ·Ó ÁÂÓÂÙÈΤ˜ ‚Ï¿‚˜ ÛÂ Û˘ÁÎÂÎÚÈ̤ÓÔ˘˜ ÙfiÔ˘˜ ÙÔ˘ ÁÔÓȉÈÒÌ·ÙÔ˜, Û fiÏ· ۯ‰fiÓ Ù· ¯ÚˆÌÔÛÒÌ·Ù·, ÂÎÙfi˜ ÙÔ˘ À. ∆· ÁÔÓ›‰È· Ô˘ ÂÎÊÚ¿˙ÔÓÙ·È Û ·˘ÙÔ‡˜ ÙÔ˘˜ ÙfiÔ˘˜, ÔÈ ÌÂÙ·ÏÏ¿ÍÂȘ ÙÔ˘˜ Î·È Ë Û¯¤ÛË ÙÔ˘˜ Ì ÙËÓ ·¯˘Û·ÚΛ· ‰ÂÓ Â›Ó·È ÁÓˆÛÙ¿.

OÚÌfiÓ˜ Î·È ÌËӇ̷ٷ ÙÔ˘ ÏÈÒ‰Ô˘˜ ÈÛÙÔ‡ §ÂÙ›ÓË ∏ ÏÂÙ›ÓË Â›Ó·È Ë ÚˆÙ½ÓË ÙÔ˘ ÁÔÓȉ›Ô˘ ob, ÌÂÁ¤ıÔ˘˜ 20 Kb, Ô˘ ‚Ú›ÛÎÂÙ·È ÛÙÔ Ì·ÎÚ‡ ÛΤÏÔ˜ ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ 7 Î·È ÂÎÎÚ›ÓÂÙ·È ·fi Ù· ÏÈÔ·ÙÙ·Ú·. ∏ ÏÂÙ›ÓË ÚÔ¤Ú¯ÂÙ·È ·fi ÙËÓ ÂÏÏËÓÈ΋ ϤÍË “ÏÂÙfi˜”, ‰ËÏ·‰‹ Â›Ó·È ÔÚÌfiÓË Ô˘ “ÏÂÙ·›ÓÂÈ” ÙÔ ¿ÙÔÌÔ, Ì ‰ÔÌ‹ Î·È ‰Ú¿ÛË fiÌÔȘ Ì ÂΛӘ ÙˆÓ Î˘ÙÔÎÈÓÒÓ. ∏ ÏÂÙ›ÓË ·Ó·Î·Ï‡ÊıËΠÙÔÓ ¢ÂΤ̂ÚÈÔ ÙÔ˘ 1994 ·fi ÙËÓ ÔÌ¿‰· ÙÔ˘ Friedman, Ë ÔÔ›· ÌÂϤÙËÛ ÙÔ ·¯‡Û·ÚÎÔ ÔÓÙ›ÎÈ Ì ˘ÂÚÁÏ˘Î·ÈÌ›·, ˘ÂÚÈÓÛÔ˘ÏÈÓ·ÈÌ›· Î·È ·ÓÙ›ÛÙ·ÛË ÛÙËÓ ÈÓÛÔ˘Ï›ÓË ÏfiÁˆ ÌÂÙ¿ÏÏ·Í˘ ÙÔ˘ ÁÔÓȉ›Ô˘ ob/ob. ∏ ¯ÔÚ‹ÁËÛË Â͈ÁÂÓÒ˜ ÏÂÙ›Ó˘ ‰ÈfiÚıˆÛ ÙȘ ÌÂÙ·‚ÔÏÈΤ˜ ·ÓˆÌ·Ï›Â˜ ÚÈÓ ÂÏ·ÙÙˆı› ÙÔ ‚¿ÚÔ˜. ∏ ÏÂÙ›ÓË ÂÎÎÚ›ÓÂÙ·È ·fi Ù· ÏÈÔ·ÙÙ·Ú· ÙÔ˘ ˘Ô‰fiÚÈÔ˘ ΢ڛˆ˜ Ï›Ô˘˜, Ô˘ ¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚÔ Ì¤ÁÂıÔ˜ ·fi ÂΛӷ ÙÔ˘ ÛÏ·Á¯ÓÈÎÔ‡ (ÛÙȘ Á˘Ó·›Î˜) Î·È Ë ¤ÎÎÚÈÛ‹ Ù˘ Ú˘ıÌ›˙ÂÙ·È ·fi ÙËÓ ÂÓ¤ÚÁÂÈ· ÙÔ˘ ÛÒÌ·ÙÔ˜ Î·È ÙȘ ÔÚÌfiÓ˜. ∏ ÏÂÙ›ÓË ‰Ú· ÛÙÔÓ ˘Ôı¿Ï·ÌÔ ÛÙÔ

¶›Ó·Î·˜ 5. ¶·¯˘Û·ÚΛ· ÏfiÁˆ ÌÔÓÔÁÔÓȉȷ΋˜ ‚Ï¿‚˘ °ÔÓ›‰ÈÔ

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¢Ú¿ÛË ¶ÚfiÛÏË„Ë ÙÚÔÊ‹˜, ηٷӿψÛË ÙÚÔÊ‹˜, Ó¢ÚÔÂÎÚÈÓÈ΋ ‰Ú¿ÛË ƒ˘ıÌ›˙ÂÈ Ù· ÌËӇ̷ٷ Ù˘ ÏÂÙ›Ó˘

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ÀÔı¿Ï·ÌÔ˜, ¯ÔÚÈÔÂȉ‹ ϤÁÌ·Ù·, Ó‡ÌÔÓ˜, ÓÂÊÚÔ› ÀÔı¿Ï·ÌÔ˜

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8

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2

Àԉԯ›˜ ÏÂÙ›Ó˘ ¶ÚˆÙ½ÓË ·ÁÓÒÛÙÔ˘ ·ÈÙÈÔÏÔÁ›·˜ ∫·Ú‚Ô͢ÂÙȉ¿ÛË ∂ ¶ÚˆÙ½ÓË Agouti

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µ-·ÙÙ·Ú· ·ÁÎÚ¤·ÙÔ˜, ˘Ôı¿Ï·ÌÔ˜ ¶·ÓÙÔ‡ ÛÙÔ ‰¤ÚÌ·

∂Ï¿ÙÙˆÛË Ù˘ ÌÂÙ·ÊÔÚ¿˜ ÙÔ˘ ÌËӇ̷ÙÔ˜ Ù˘ ÈÓÛÔ˘Ï›Ó˘ fiÙ·Ó Û˘Ó‰¤ÂÙ·È Ì ÙÔÓ ˘Ô‰Ô¯¤· ∂Ï¿ÙÙˆÛË Û‡Ó‰ÂÛ˘ ÈÓÛÔ˘Ï›Ó˘ Î·È ÌÂÙ·ÊÔÚ¿˜ ÌËӇ̷ÙÔ˜ ∞ÓÙ·ÁˆÓÈÛÙ‹˜ ÌÂÏ·ÓÔÎÔÚÙ›Ó˘

¶·È‰È·ÙÚÈ΋ 2004;67:75-87

ΤÓÙÚÔ ÎÔÚÂÛÌÔ‡, ÂÏ·ÙÙÒÓÂÈ ÙËÓ fiÚÂÍË Î·È ÂÌ̤ۈ˜ ˆÚÈÌ¿˙ÂÈ ÙÔ ·Ó··Ú·ÁˆÁÈÎfi Û‡ÛÙËÌ· (51). ∏ ÈÓÛÔ˘Ï›ÓË ‰ÈÂÁ›ÚÂÈ ÙËÓ ·Ú·ÁˆÁ‹ ÏÂÙ›Ó˘, ÂÓÒ Ë ÏÂÙ›ÓË Î·Ù·ÛÙ¤ÏÏÂÈ ÙËÓ ¤ÎÎÚÈÛË ÈÓÛÔ˘Ï›Ó˘ ̤ۈ Û˘Ì·ıËÙÈ΋˜ ‰Ú¿Ûˆ˜, ÂÓÒ Â› Û˘Ì·ıÂÎÙÔÌ‹˜ ‰ÂÓ ÙËÓ ÂËÚ¿˙ÂÈ (52). ∏ ÏÂÙ›ÓË ‰ÈÂÁ›ÚÂÙ·È ·fi ÙÔÓ TNF· Î·È Ù· ÁÏ˘ÎÔÎÔÚÙÈÎÔÂȉ‹, ÂÓÒ ÔÈ ı˘ÚÂÔÂȉÈΤ˜ ÔÚÌfiÓ˜ ηٷÛÙ¤ÏÏÔ˘Ó ÙËÓ ¤ÎÎÚÈÛ‹ Ù˘. ∏ ¤ÎÎÚÈÛË Ù˘ ÏÂÙ›Ó˘ ÂÍ·ÚÙ¿Ù·È ·fi ÙÔÓ ÎÔÚÂÛÌfi ‹ ÙË ÓËÛÙ›·, ÙÔ stress, ÙË ‰È¤ÁÂÚÛË ÙÔ˘ ·ÓÔÛÔÏÔÁÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, ·ÏÏ¿ Î·È ·fi Ù· ·Ó‰ÚÔÁfiÓ· Î·È ÔÈÛÙÚÔÁfiÓ· ÙÔ˘ ÛÒÌ·ÙÔ˜. ∏ ÏÂÙ›ÓË ¤¯ÂÈ ÎÂÓÙÚÈ΋ Î·È ÂÚÈÊÂÚÈ΋ ‰Ú¿ÛË, ÂÓÒ ˘ԉԯ›˜ ˘¿Ú¯Ô˘Ó ÛÙÔÓ ˘Ôı¿Ï·ÌÔ, ÛÙÔÓ ÏÈÒ‰Ë ÈÛÙfi, ÛÙÔ ‹·Ú, ÛÙÔ˘˜ ÛÎÂÏÂÙÈÎÔ‡˜ Ì˘˜ Î·È ÛÙ· ·ÙÙ·Ú· ÙˆÓ ÓËÛȉ›ˆÓ ÙÔ˘ ·ÁÎÚ¤·ÙÔ˜. ∏ ÏÂÙ›ÓË ÂÏ·ÙÙÒÓÂÈ ÙË ‰Ú¿ÛË Ù˘ ÈÓÛÔ˘Ï›Ó˘ ÁÈ· ›ÛÔ‰Ô ÁÏ˘Îfi˙˘ ÛÙÔ Ì˘˚Îfi Î·È ÏÈ҉˜ ·ÙÙ·ÚÔ, ·ÚÂÌÔ‰›˙ÂÈ ÙË ÏÈÔÁ¤ÓÂÛË Î·È ‰ÈÂÁ›ÚÂÈ ÙË ÏÈfiÏ˘ÛË. ∏ ÈÓÛÔ˘ÏÈÓÔ·ÓÙ›ÛÙ·ÛË ÙˆÓ ·¯‡Û·ÚÎˆÓ ÔÊ›ÏÂÙ·È Î·È ÛÙËÓ ·˘ÍË̤ÓË ÏÂÙ›ÓË Ô˘ ¤¯Ô˘Ó. OÈ Á˘Ó·›Î˜ ηٿ ÙËÓ ÂÁ΢ÌÔÛ‡ÓË ¤¯Ô˘Ó ·˘ÍË̤ÓË ÏÂÙ›ÓË, Èı·ÓfiÓ ÏfiÁˆ ·‡ÍËÛ˘ Ù˘ ۈ̷ÙÈ΋˜ Ì¿˙·˜ Î·È ÙÔ˘ Ï›Ô˘˜. ∏ ¤ÎÎÚÈÛË Ù˘ ÏÂÙ›Ó˘ Â›Ó·È ÂÚÈÔ‰È΋ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ 24ÒÚÔ˘ (̤ÁÈÛÙË Ù· ÌÂÛ¿Ó˘ÎÙ· Ô˘ Ë ÎÔÚÙÈ˙fiÏË Â›Ó·È ÛÙÔ ¯·ÌËÏfiÙÂÚÔ Â›Â‰Ô Î·È ÂÏ¿¯ÈÛÙË ÙÔ ÌÂÛË̤ÚÈ). OÈ Á˘Ó·›Î˜ ¤¯Ô˘Ó ÂÚÈÛÛfiÙÂÚË ÏÂÙ›ÓË ·fi ÙÔ˘˜ ¿Ó‰Ú˜ ÏfiÁˆ ÂÚÈÛÛfiÙÂÚÔ˘ Ï›Ô˘˜ Î·È ¿ÏÏˆÓ ·Ú·ÁfiÓÙˆÓ. §ÂÙ›ÓË Î·È ·Ó¿Ù˘ÍË ÂÊ˂›·˜ ∏ ÂÊ˂›· ·Ú¯›˙ÂÈ Ì ·‡ÍËÛË Ù˘ ¤ÎÎÚÈÛ˘ ÙÔ˘ GnRH (ÂÎÏ˘ÙÈÎfi˜ ·Ú¿ÁˆÓ ÁÔÓ·‰ÔÙÚÔÊÈÓÒÓ) Ô˘ ·˘Í¿ÓÂÈ ÙȘ ÁÔÓ·‰ÔÙÚÔʛӘ (FSH, LH), ÂÓÒ ‰ÈÂÁ›ÚÂÙ·È Ë ÛÙÂÚÔÂȉÔÁ¤ÓÂÛË ÙˆÓ ÔÚÌÔÓÒÓ, Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÂÌÊ¿ÓÈÛË ÙˆÓ ‰Â˘ÙÂÚÔÁÂÓÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ÙÔ˘ ʇÏÔ˘, ÙËÓ ˆÚ›Ì·ÓÛË ÙÔ˘ ¿ÍÔÓ· ˘Ôı¿Ï·ÌÔ˜-˘fiÊ˘ÛË-ÁÔÓ¿‰Â˜, ÙËÓ ÂÌÌËÓ·Ú¯‹ ÛÙȘ Á˘Ó·›Î˜ Î·È ÙËÓ ˆÔı˘Ï·ÎÈÔÚÚËÍ›·. ∞fi ÙÔ 1970 Â›Ó·È ÁÓˆÛÙfi fiÙÈ Ù· ÎÔÚ›ÙÛÈ· ¯ÚÂÈ¿˙ÔÓÙ·È ¤Ó· ÂÏ¿¯ÈÛÙÔ ‚¿ÚÔ˜, “Ì›· ÎÚÈÙÈ΋ ÏÈÒ‰Ë Ì¿˙·”, ÁÈ· ÙËÓ ÂÌÌËÓ·Ú¯‹ (53). ∏ ÏÂÙ›ÓË ÏËÚÔÊÔÚ› ÙÔÓ ˘Ôı¿Ï·ÌÔ fiÙÈ Ù· ·Ôı¤Ì·Ù· ÂÓ¤ÚÁÂÈ·˜ (Ï›Ô˘˜) ÙÔ˘ ÛÒÌ·ÙÔ˜ Â·ÚÎÔ‡Ó ÁÈ· ÙËÓ ·Ó··Ú·ÁˆÁ‹. ∏ ÏÂÙ›ÓË ‰È¢ÎÔχÓÂÈ ÙËÓ ¤ÎÏ˘ÛË Ù˘ FSH Î·È LH Î·È ÙËÓ ÂͤÏÈÍË Ù˘ ÂÊ˂›·˜. ∆· ıËÏ˘Î¿ ÔÓÙ›ÎÈ· Ì ··ÏÔÈÊ‹ ÙÔ˘ ÁÔÓȉ›Ô˘ Ù˘ ÏÂÙ›Ó˘ (ob/ob) Â›Ó·È ÛÙ›ڷ, ÂÓÒ fiÙ·Ó ¯ÔÚËÁËı› ÏÂÙ›ÓË ÂÌÊ·Ó›˙Ô˘Ó ˆÔı˘Ï·ÎÈÔÚÚËÍ›·, ·ËÛË Î·È ÙÔÎÂÙfi. ∏ ËÌÂÚ‹ÛÈ· ÂÚÈÔ‰ÈÎfiÙËÙ· Ù˘ ÏÂÙ›Ó˘ ‰ÂÓ ·Ú·ÙËÚÂ›Ù·È Û ¤Ê˂˜ Ì Ó¢ÚÔÁÂÓ‹ ·ÓÔÚÂÍ›· ‹ ‰ÚÔÌ›˜ ÌÂÁ¿ÏˆÓ ·ÔÛÙ¿ÛÂˆÓ Ô˘ ‰ÂÓ ¤¯Ô˘Ó ÌËÓÈ·›Ô ·ÎÏÔ (54,55). ™Ù· ·ÁfiÚÈ·, ÚÔÂÊË‚Èο Î·È Î·Ù¿ ÙËÓ ÂÊ˂›· ¤ˆ˜ ÙÔ ÛÙ¿‰ÈÔ G3 ηٿ Tanner, Ë ÏÂÙ›ÓË ·˘Í¿ÓÂÈ,

Paediatriki 2004;67:75-87

ÂÓÒ fiÙ·Ó ·˘ÍËı› Ë ÙÂÛÙÔÛÙÂÚfiÓË, ÂÏ·ÙÙÒÓÂÙ·È ÙÔ Ï›Ô˜ Î·È Ë ÏÂÙ›ÓË ˘Ô¯ˆÚ› Û ÚÔÂÊË‚Èο Â›‰· (56). ∫·Ù¿ ÙËÓ ÂÊ˂›·, ÛÙ· ÎÔÚ›ÙÛÈ· ·˘Í¿ÓÂÙ·È ÂÚÈÛÛfiÙÂÚÔ Ë ÏÈ҉˘ Ì¿˙· Î·È Ë ÏÂÙ›ÓË (57), ÂÓÒ ÛÙ· ·ÁfiÚÈ· ·˘Í¿ÓÂÙ·È Ë Ì˘˚΋ Ì¿˙· Î·È ÂÏ·ÙÙÒÓÂÙ·È Ë ÏÂÙ›ÓË. §ÂÙ›ÓË Î·È ÂÈÓÂÊÚ›‰È· ∏ ·¯˘Û·ÚΛ· ·˘Í¿ÓÂÈ ÙËÓ ËÌÂÚ‹ÛÈ· ·Ú·ÁˆÁ‹ Ù˘ ÎÔÚÙÈ˙fiÏ˘, ·ÏÏ¿ - ÏfiÁˆ ·˘ÍË̤ÓÔ˘ ηٷ‚ÔÏÈÛÌÔ‡ - ÔÈ ÙÈ̤˜ ÛÙÔ ·›Ì· ‰ÂÓ Â›Ó·È ·˘ÍË̤Ó˜. ∆· ·˘ÍË̤ӷ ÁÏ˘ÎÔÎÔÚÙÈÎÔÂȉ‹ ÂÓ‰Ô΢ÙÙ¿ÚÈ· ·˘Í¿ÓÔ˘Ó ÙËÓ fiÚÂÍË, ÙË Ï‹„Ë ÙÚÔÊ‹˜ Î·È ÙÔ ‚¿ÚÔ˜ ÙÔ˘ ÛÒÌ·ÙÔ˜, ÂÓÒ ‰ÈÂÁ›ÚÂÙ·È ·fi ÙÔ ·Ú·Û˘Ì·ıËÙÈÎfi Ë ¤ÎÎÚÈÛË ÙÔ˘ ·Ó·‚ÔÏÈÎÔ‡ ÂÙȉ›Ô˘ NPY, Ô˘ ·Ó·ÛÙ¤ÏÏÂÈ ÙËÓ Î·Ù·‚ÔÏÈ΋ ‰Ú¿ÛË Ù˘ CRH. ∏ ÏÂÙ›ÓË ·Ó·ÛÙ¤ÏÏÂÈ ¤ÌÌÂÛ· ÙÔÓ ¿ÍÔÓ· ˘Ôı¿Ï·ÌÔ˜-˘fiÊ˘ÛËÂÈÓÂÊÚ›‰È· (HPA) ̤ۈ ‰È¤ÁÂÚÛ˘ ÙÔ˘ NPY. ∆· ÔÓÙ›ÎÈ· ob/ob (¤ÏÏÂÈ„Ë ÏÂÙ›Ó˘ ÏfiÁˆ ÁÂÓÂÙÈ΋˜ ‚Ï¿‚˘) Â›Ó·È ˘ÂÚÎÔÚÙÈ˙ÔÏ·ÈÌÈο, ÂÓÒ Ë ¤ÎÏ˘ÛË Ù˘ ÎÔÚÙÈ˙fiÏ˘ ·Ó·ÛÙ¤ÏÏÂÙ·È fiÙ·Ó ¯ÔÚËÁËı› ÏÂÙ›ÓË (58). ÀÂÚÎÔÚÙÈ˙ÔÏ·ÈÌ›· ¤¯Ô˘Ó Î·È Ù· ÔÓÙ›ÎÈ· db/db (··ÏÔÈÊ‹ ˘Ô‰Ô¯¤· ÏÂÙ›Ó˘), ηıÒ˜ Î·È Ù· fa/fa (··ÏÔÈÊ‹ ÁÔÓȉ›Ô˘ ηڂÔ͢ÂÙȉ¿Û˘ ∂), Ù· ÔÔ›· ÂÌÊ·Ó›˙Ô˘Ó ·ÓÙ›ÛÙ·ÛË ÛÙËÓ ÈÓÛÔ˘Ï›ÓË. §ÂÙ›ÓË Î·È ı˘ÚÂÔÂȉÈΤ˜ ÔÚÌfiÓ˜ O ı˘ÚÂÔÂȉ‹˜ Ú˘ıÌ›˙ÂÈ ÙȘ η‡ÛÂȘ Î·È ‰È·ÙËÚ› ÛÙ·ıÂÚ‹ ÙË ıÂÚÌÔÎÚ·Û›· ÙÔ˘ ÛÒÌ·ÙÔ˜. O ˘ÂÚı˘ÚÂÔÂȉÈÛÌfi˜ ·˘Í¿ÓÂÈ Î·È Ô ˘Ôı˘ÚÂÔÂȉÈÛÌfi˜ ÂÏ·ÙÙÒÓÂÈ ·˘Ù¤˜ ÙȘ ÏÂÈÙÔ˘ÚÁ›Â˜. ∏ ÏÂÙ›ÓË ¤¯ÂÈ fiÌÔÈ· ‰Ú¿ÛË Ì ÙȘ ı˘ÚÂÔÂȉÈΤ˜ ÔÚÌfiÓ˜ ÛÙË ıÂÚÌÔÁ¤ÓÂÛË Î·È ÙËÓ Î·Ù·Ó¿ÏˆÛË ÂÓ¤ÚÁÂÈ·˜, ÏfiÁˆ ‰È¤ÁÂÚÛ˘ ÙÔ˘ Û˘Ì·ıËÙÈÎÔ‡. ™ÙË Ì·ÎÚÔ¯ÚfiÓÈ· ÓËÛÙ›·, Ë ÏÂÙ›ÓË Î·È ÔÈ ı˘ÚÂÔÂȉÈΤ˜ ÔÚÌfiÓ˜ ÂÏ·ÙÙÒÓÔÓÙ·È. ∏ ÏÂÙ›ÓË Â›Ó·È ·˘ÍË̤ÓË Û ÔÓÙ›ÎÈ· Ô˘ ·Ê·ÈÚ¤ıËÎÂ Ô ı˘ÚÂÔÂȉ‹˜, ÂÓÒ ÂÏ·ÙÙÒÓÂÙ·È fiÙ·Ó ¯ÔÚËÁËı› ÙÚÈȈ‰Ôı˘ÚÔÓ›ÓË ‹ ı˘ÚÔÍ›ÓË. ∫·Ù¯ÔϷ̛Ә Î·È ÏÂÙ›ÓË OÈ Î·Ù¯ÔϷ̛Ә (·‰ÚÂÓ·Ï›ÓË, ÓÔÚ·‰ÚÂÓ·Ï›ÓË) Û˘Ó‰¤ÔÓÙ·È Ì ÙÔ˘˜ ‚2 Î·È ‚3 ˘ԉԯ›˜ ÛÙ· ÏÈÔ·ÙÙ·Ú· Î·È Î·Ù·ÛÙ¤ÏÏÔ˘Ó ÙËÓ ·Ú·ÁˆÁ‹ Ù˘ ÏÂÙ›Ó˘. OÈ Î·Ù¯ÔϷ̛Ә [·Ó·ÛÙ¤ÏÏÔÓÙ·È Ì ÚÔÚ·ÓÔÏfiÓË (‚-·‰ÚÂÓÂÚÁÈÎÔ› ·ÓÙ·ÁˆÓÈÛÙ¤˜)] ‰ÈÂÁ›ÚÔÓÙ·È Ì ÈÛÔÚÂÓ·Ï›ÓË (Isuprel, ‚-·‰ÚÂÓÂÚÁÈÎÔ› ·ÁˆÓÈÛÙ¤˜), ÂÓÒ Î·Ù·ÛÙ¤ÏÏÂÙ·È Ë ·Ú·ÁˆÁ‹ ÏÂÙ›Ó˘ Î·È ·˘Í¿ÓÂÙ·È Ë ÏÈfiÏ˘ÛË. πÓÙÂÚÏ¢ΛÓË-6 (IL-6) ∏ IL-6 (∂ÈÎfiÓ· 7) ÂÎÎÚ›ÓÂÙ·È ÂÚÈÛÛfiÙÂÚÔ ·fi ÙÔ ÛÏ·Á¯ÓÈÎfi Ï›Ô˜ (‰ÈÂÁ›ÚÂÙ·È ·fi ÙÔÓ TNF·), ·ÚÂÌÔ‰›˙ÂÈ ÙËÓ ÂÓ·fiıÂÛË Ï›Ô˘˜ (ÏfiÁˆ ·Ó·ÛÙÔÏ‹˜ ‰Ú¿Û˘ Ù˘ LPL), ·ÏÏ¿ ·˘Í¿ÓÂÈ Ù· ÏÈ›‰È· ·›Ì·ÙÔ˜ Î·È ÙË Û‡ÓıÂÛË ÙˆÓ ·Ú·ÁfiÓÙˆÓ ‹Íˆ˜ ÛÙÔ ‹·Ú (59). ∏ IL-6 ÚÔηÏ› ÌÂÁ·Ï‡ÙÂÚË ·ÓÙ›ÛÙ·ÛË ÛÙËÓ ÈÓÛÔ˘Ï›ÓË ·fi ÙÔÓ TNF· Î·È ÙË ÏÂÙ›ÓË

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Paediatriki 2004;67:75-87

∫¡™ & ÎÔÚÂÛÌfi˜ ∂ÁΤʷÏÔ˜ §ÂÙ›ÓË

IL-6 ¡∂FA

IL-6 ¶ÔÏÏ·Ϥ˜ ‰Ú¿ÛÂȘ ™˘ÎÒÙÈ

¡∂FA §È҉˘ ÈÛÙfi˜ §ÂÙ›ÓË TNF· ¡∂FA

§ÂÙ›ÓË TNF· IL-6 §ÂÙ›ÓË IL-6

¶ÚfiÛÏË„Ë ÁÏ˘Îfi˙˘ ™ÎÂÏÂÙÈÎfi˜ Ì˘˜

ŒÎÎÚÈÛË ÈÓÛÔ˘Ï›Ó˘ ¶¿ÁÎÚ·˜

∂ÈÎfiÓ· 7. OÚÌÔÓÈο Î·È ÌÂÙ·‚ÔÏÈο Û‹Ì·Ù· ·fi ÙÔÓ ÏÈÒ‰Ë ÈÛÙfi. ∆Ô Ï¿ÙÔ˜ ÙÔ˘ ‚¤ÏÔ˘˜ ‰Â›¯ÓÂÈ ÙËÓ ¤ÓÙ·ÛË ÙÔ˘ ÌËӇ̷ÙÔ˜. NEFA: ÌË ÂÛÙÂÚÔÔÈË̤ӷ ÏÈ·Ú¿ Ôͤ·.

ÁÈ· ÙËÓ Â›ÛÔ‰Ô ÁÏ˘Îfi˙˘ ÛÙÔ Î‡ÙÙ·ÚÔ. ™Ù· ·¯‡Û·Úη ¿ÙÔÌ·, ÙÔ 25% Ù˘ ΢ÎÏÔÊÔÚÔ‡Û˘ ÈÓÙÂÚÏ¢ΛÓ˘-6 ÚÔ¤Ú¯ÂÙ·È ·fi ÙÔÓ ÏÈÒ‰Ë ÈÛÙfi. ¶·Ú¿ÁˆÓ Ó¤ÎÚˆÛ˘ fiÁÎˆÓ · (TNF·) ∆· ÂÚÂı›ÛÌ·Ù· ·fi ÙÔ ÂÚÈ‚¿ÏÏÔÓ ÚÔÛ‚¿ÏÏÔ˘Ó ÙÔÓ ÏÈÒ‰Ë ÈÛÙfi Ô˘ ηχÙÂÈ ÙËÓ Â͈ÙÂÚÈ΋ ÂÈÊ¿ÓÂÈ· ÙÔ˘ ÛÒÌ·ÙÔ˜. ∂ÎÎÚ›ÓÂÙ·È IL-6 Î·È TNF· Î·È Ù· ÚÔۂ‚ÏË̤ӷ ·ÙÙ·Ú· ηٷÛÙÚ¤ÊÔÓÙ·È Ì ÚÔÁÚ·ÌÌ·ÙÈṲ̂ÓÔ Î˘ÙÙ·ÚÈÎfi ı¿Ó·ÙÔ. ™ÙË Û˘Ó¤¯ÂÈ·, ÂÎÎÚ›ÓÂÙ·È ÙÔÈο Ô ÈÓÛÔ˘ÏÈÓfiÌÔÚÊÔ˜ ·˘ÍËÙÈÎfi˜ ·Ú¿ÁˆÓ (IGF-1), Ô˘ ‰È·ÊÔÚÔÔÈ› ÏÈÔ·ÙÙ·Ú· Î·È ÈÓÔ‚Ï¿ÛÙ˜ ·fi ·‰È·ÊÔÚÔÔ›ËÙ· ÌÂÛÂÁ¯˘Ì·ÙÈο ·ÙÙ·Ú· ηÈ, ¤ÙÛÈ, ‰È·ÙËÚÂ›Ù·È Ë ÔÌÔÈÔÛÙ·Û›· ÙÔ˘ Ï›Ô˘˜. ™ÙÔ ˘Ô‰fiÚÈÔ Ï›Ô˜ (Û Â·Ê‹ Ì ÙÔ Â͈ÙÂÚÈÎfi ÂÚÈ‚¿ÏÏÔÓ) ÂÎÊÚ¿˙ÂÙ·È Ë ÂÓ·ÏÏ·ÎÙÈ΋ Ô‰fi˜ ÙÔ˘ Û˘ÌÏËÚÒÌ·ÙÔ˜ ÁÈ· ÙËÓ ¿Ì˘Ó· ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡. ŸÙ·Ó ÙÔ Û˘Ìϋڈ̷ ÙÔ˘ Û˘ÌϤÁÌ·ÙÔ˜ C3 ‰È·Û·ÛÙ›, ‰ËÌÈÔ˘ÚÁÂ›Ù·È Ë Ô˘Û›· ASP (Acylation stimulated protein) Ô˘ ‰ÈÂÁ›ÚÂÈ ÙËÓ ÚfiÛÏË„Ë, ÂÛÙÂÚÔÔ›ËÛË Î·È ·Ôı‹Î¢ÛË ÙˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ Û ÙÚÈÁÏ˘ÎÂÚ›‰È· ÛÙ· ÏÈÔ·ÙÙ·Ú· (60).

O ÂÎÎÚÈÓfiÌÂÓÔ˜ TNF· ı·Ó·ÙÒÓÂÈ ÏÈÒ‰Ë Î·È Ì˘˚ο ·ÙÙ·Ú· fi¯È ÌfiÓÔ ÛÙË ÊÏÂÁÌÔÓ‹, ·ÏÏ¿ Î·È ÛÙÔÓ Î·ÚΛÓÔ, ÂÓÒ Û ·˘ÙfiÓ ÔÊ›ÏÂÙ·È Ë Î·¯ÂÍ›· ÙˆÓ Î·ÚÎÈÓÔ·ıÒÓ. O TNF· ÂÎχÂÙ·È ·fi ÙÔÓ ÏÈÒ‰Ë ÈÛÙfi fiÙ·Ó ·˘Í¿ÓÂÙ·È ÙÔ Ï›Ô˜ Î·È ÚÔηÏ› ÏÈfiÏ˘ÛË Î·È ·‡ÍËÛË ÙˆÓ Î˘ÎÏÔÊÔÚÔ‡ÓÙˆÓ ÂχıÂÚˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ Ô˘ ·Ó·ÛÙ¤ÏÏÔ˘Ó ·ÎfiÌË ÂÚÈÛÛfiÙÂÚÔ ÙË ÏÈÔÁ¤ÓÂÛË. O TNF· ηٷÛÙ¤ÏÏÂÈ ÙËÓ ¤ÎÊÚ·ÛË ÙˆÓ PPARÁs Î·È ·Ó·ÛÙ¤ÏÏÂÈ ÙË ‰È·ÊÔÚÔÔ›ËÛË ÏÈÔ΢ÙÙ¿ÚˆÓ ·fi ÏÈÔ‚Ï¿ÛÙ˜. ™Ù· ÌÔÓÔ·ÙÙ·Ú· Ì·ÎÚÔÊ¿Á·, Ô TNF· Ú˘ıÌ›˙ÂÈ ÙÔÓ ‚·ıÌfi Ù˘ ÊÏÂÁÌÔÓ‹˜ Î·È Ù˘ ¿Ì˘Ó·˜.

OÈ Î˘ÙÔΛÓ˜ (ÈÓÙÂÚÏ¢ΛÓ˜, TNF·) ηٿ ÙËÓ ·-

84

¯˘Û·ÚΛ· ·Ô‰ÂÛÌÂ‡Ô˘Ó ÂχıÂÚ· ÏÈ·Ú¿ Ôͤ· ·fi ÙÔ Ï›Ô˜, Ù· ÔÔ›· η›ÁÔÓÙ·È Û ηٷÛÙ¿ÛÂȘ stress Î·È ÏÔÈÌÒÍÂȘ. ∆Ô Ï›Ô˜ ·ÔÙÂÏ› ·Ôı‹ÎË ÁÈ· ÙËÓ Î¿Ï˘„Ë Ù˘ ¤ÏÏÂȄ˘ ÙÚÔÊ›ÌˆÓ ÛÙÔ ÂÚÈ‚¿ÏÏÔÓ Î·È ÂÍÂÏÈÎÙÈο ·Ó¤Ù˘Í Ì˯·ÓÈÛÌÔ‡˜ ·ÔÎÏÂÈÛÙÈο ÁÈ· ÂÍÔÈÎÔÓfiÌËÛË Î·È ·Ôı‹Î¢ÛË ÂÓ¤ÚÁÂÈ·˜. O ÏÈ҉˘ ÈÛÙfi˜ ‰ÂÓ ·Ó¤Ù˘Í ηÏÔ‡˜ Ì˯·ÓÈÛÌÔ‡˜ ÁÈ· ÙËÓ Î·‡ÛË Ù˘ ÂÈϤÔÓ ÂÓ¤ÚÁÂÈ·˜, fiÙ·Ó ÏÂÔÓ¿˙Ô˘Ó ÔÈ ÙÚÔʤ˜ ÛÙÔ ÂÚÈ‚¿ÏÏÔÓ ÁÈ· Ì·ÎÚfi ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·, ÒÛÙ ӷ ÂÌÔ‰›˙ÂÙ·È Ë ·‡ÍËÛË Ù˘ ÂÓ·fiıÂÛ˘ Ï›Ô˘˜. O ÏÈ҉˘ ÈÛÙfi˜ ·ÓÙÈÛÙ¤ÎÂÙ·È ÛÙËÓ ·‡ÍËÛË, Ë ÂÈϤÔÓ ÂÓ¤ÚÁÂÈ· Û·Ù·Ï¿Ù·È (¯ˆÚ›˜ Ó· ·ÔıË·ÂÙ·È Û ۈ̷ÙÈ΋ Ì¿˙·), ·ÏÏ¿ ÎÈÓËÙÔÔÈÔ‡ÓÙ·È Ì˯·ÓÈÛÌÔ› Ô˘ ÏÂÈÙÔ˘ÚÁÔ‡Ó Û ηٷÛÙ¿ÛÂȘ stress Î·È ÂÌÊ·Ó›˙ÂÙ·È ÙÔ ÌÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ. ∆ÂÏÈο, ÛÙËÓ ˘ÂÚÚÔÛÊÔÚ¿ ıÚÂÙÈÎÒÓ Ô˘ÛÈÒÓ, ÙÔ ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜ ·˘Í¿ÓÂÈ. ªË ÂÛÙÂÚÔÔÈË̤ӷ ÏÈ·Ú¿ Ôͤ· (NEFAs) ŸÙ·Ó ÔÈ ˘‰·Ù¿ÓıڷΘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·ÓÂ¿ÚÎÂÈ·, η›ÁÔÓÙ·È ÏÈ·Ú¿ Ôͤ·, ÂÓÒ Ë ÁÏ˘Îfi˙Ë (ı· ÌÂÙ·ÙÚ·› Û ÁÏ˘ÎÂÚfiÏË) ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÁÈ· ÂÛÙÂÚÔÔ›ËÛË ÙˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ. ∆· ·˘ÍË̤ӷ NEFAs ÛÙËÓ Î˘ÎÏÔÊÔÚ›· ÂÏ·ÙÙÒÓÔ˘Ó ÙËÓ Â›ÛÔ‰Ô ÁÏ˘Îfi˙˘ Î·È ÙË Û‡ÓıÂÛË ÁÏ˘ÎÔÁfiÓÔ˘ ÛÙÔ˘˜ ÛÎÂÏÂÙÈÎÔ‡˜ Ì˘˜, ÂÓÒ ‰ÈÂÁ›ÚÂÙ·È Ë ÁÏ˘ÎÔÓÂÔÁ¤ÓÂÛË Î·È ·˘Í¿ÓÂÙ·È Ë ¤ÎÎÚÈÛË ÁÏ˘Îfi˙˘ ÛÙÔ ‹·Ú Î·È Ë ¤ÎÎÚÈÛË ÈÓÛÔ˘Ï›Ó˘ ÛÙÔ ¿ÁÎÚ·˜. §fiÁˆ Ù˘ ¤ÏÏÂȄ˘ ÁÏ˘Îfi˙˘ ÂÓ‰Ô΢ÙÙ¿ÚÈ·, ÎÈÓËÙÔÔÈÔ‡ÓÙ·È ÔÈ ÂÓ‰Ô΢ÙÙ¿ÚȘ ·Ôı‹Î˜ ÂÓ¤ÚÁÂÈ·˜, ·˘Í¿ÓÂÙ·È Ë ÏÈfiÏ˘ÛË Î·È ÂÓÂÚÁÔÔÈÂ›Ù·È Ô ¿ÍÔÓ·˜ ˘Ôı¿Ï·ÌÔ˜-˘fiÊ˘ÛËÂÈÓÂÊÚ›‰È·, fiˆ˜ Û ÔÍ›˜ ÊÏÂÁÌÔÓ¤˜. ™ÙÔ Ï›Ô˜, Ù· ·˘ÍË̤ӷ NEFAs ÂÓÂÚÁÔÔÈÔ‡Ó ÙË ıÂÚÌÔÁÂÓ›ÓË Î·È ·˘Í¿ÓÔÓÙ·È ÔÈ Î·‡ÛÂȘ Ô˘ ·Ô‰›‰Ô˘Ó Ï›ÁË ˆÊ¤ÏÈÌË ÂÓ¤ÚÁÂÈ· (ÌÈÎÚ‹ ·‡ÍËÛË ‚¿ÚÔ˘˜). ∆· ·˘ÍË̤ӷ NEFAs ÛÙËÓ Î˘ÎÏÔÊÔÚ›· ÁÈ· Ì·ÎÚfi ‰È¿ÛÙËÌ· ηٷÛÙÚ¤ÊÔ˘Ó Ù· ‚-·ÙÙ·Ú· ÙÔ˘ ·ÁÎÚ¤·ÙÔ˜ Î·È Úԉȷı¤ÙÔ˘Ó ÛÙËÓ ÂÌÊ¿ÓÈÛË ‰È·‚‹ÙË Ù‡Ô˘ ππ. ∆· ¿ÙÔÌ· Ì ·˘ÍË̤ÓÔ Ï›Ô˜ ÛÙËÓ ÎÔÈÏÈ¿ ¤¯Ô˘Ó ÂÚÈÛÛfiÙÂÚ· NEFAs Î·È ÁÈ· ÙÔÓ ÏfiÁÔ ·˘Ùfi ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÌÂÁ·Ï‡ÙÂÚË ·ÓÙ›ÛÙ·ÛË ÛÙËÓ ÈÓÛÔ˘Ï›ÓË ·fi fi,ÙÈ Ù· ¿ÙÔÌ· Ì ÙËÓ ›‰È· ·Ó·ÏÔÁ›· ÛÒÌ·ÙÔ˜ Û ϛÔ˜ Ô˘ ›ӷÈ, fï˜, ηٷÓÂÌË̤ÓÔ Û fiÏÔ ÙÔ ÛÒÌ·. ™ÙËÓ ˘ÂÚÚÔÛÊÔÚ¿ ıÚÂÙÈÎÒÓ Ô˘ÛÈÒÓ ÂÌÊ·Ó›˙ÂÙ·È ˘ÂÚÏÈȉ·ÈÌ›· Ô˘ ÂÏ·ÙÙÒÓÂÈ ÙËÓ Â›ÛÔ‰Ô ÁÏ˘Îfi˙˘ ÛÙÔ Î‡ÙÙ·ÚÔ (ÈÓÛÔ˘ÏÈÓÔ·ÓÙ›ÛÙ·ÛË), ·˘Í¿ÓÔÓÙ·È ÔÈ Î·Ù¯ÔϷ̛Ә, Ë ÎÔÚÙÈ˙fiÏË Î·È Ë IL-6 Ô˘ ·˘Í¿ÓÔ˘Ó ÂÚÈÛÛfiÙÂÚÔ Ù· ÏÈ›‰È· Î·È ‰ËÌÈÔ˘ÚÁÂ›Ù·È ÙÔ Û‡Ó‰ÚÔÌÔ ·ÓÙ›ÛÙ·Û˘ (ÌÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ) (61). ªÂÙ·‚ÔÏÈÛÌfi˜ ÛÙÂÚÔÂȉÈÎÒÓ ÔÚÌÔÓÒÓ (ÎÔÚÙÈ˙fiÏË, ·Ó‰ÚÔÁfiÓ·, ÔÈÛÙÚÔÁfiÓ·) ÛÙÔÓ ÏÈÒ‰Ë ÈÛÙfi ™ÙÔÓ ÏÈÒ‰Ë ÈÛÙfi ·ÔıË·ÔÓÙ·È ·Ó‰ÚÔÁfiÓ· Ô˘ ·ÚˆÌ·ÙÔÔÈÔ‡ÓÙ·È Û ÔÈÛÙÚÔÁfiÓ·, ΢ڛˆ˜ ÛÙÔ Ï›Ô˜ ÙˆÓ ÁÏÔ˘ÙÒÓ Î·È ÙˆÓ ÌËÚÒÓ, ÏfiÁˆ Ù˘

¶·È‰È·ÙÚÈ΋ 2004;67:75-87

¤ÎÊÚ·Û˘ ÂÓ˙‡ÌˆÓ Ô˘ ÌÂÙ·‚ÔÏ›˙Ô˘Ó Úfi‰ÚÔ̘ ÔÚÌfiÓ˜ ÙˆÓ ÛÙÂÚÔÂȉÒÓ ÙÔ˘ ʇÏÔ˘. ™ÙÔ Ï›Ô˜ ÂÎÊÚ¿˙ÔÓÙ·È Î·È ÔÈ ˘ԉԯ›˜ ÙˆÓ ÛÙÂÚÔÂȉÒÓ ÔÚÌÔÓÒÓ. ∏ ÈÓÛÔ˘Ï›ÓË Î·È Ë ÎÔÚÙÈ˙fiÏË ·˘Í¿ÓÔ˘Ó ÙËÓ ·Ú·ÁˆÁ‹ ÔÈÛÙÚÔÁfiÓˆÓ ·fi ÙÔÓ ÏÈÒ‰Ë ÈÛÙfi. ∆Ô ¤Ó˙˘ÌÔ 11‚-HSD Ô˘ ÌÂÙ·‚ÔÏ›˙ÂÈ ÙËÓ ÂÓÂÚÁ‹ ÎÔÚÙÈ˙fiÏË Û ·ÓÂÓÂÚÁ‹ ÎÔÚÙÈ˙fiÓË, ÂÎÊÚ¿˙ÂÙ·È ÛÙÔ Ï›Ô˜ Ù˘ ÎÔÈÏÈ¿˜ Î·È ÙÔ˘ ÛÙ‹ıÔ˘˜ ηÈ, Â› ·¯˘Û·ÚΛ·˜, Û˘ÓÙÂÏ› ÛÙËÓ ÎÂÓÙÚÈ΋ ÂÓ·fiıÂÛË Ï›Ô˘˜. ™ÙÔÓ ÏÈÒ‰Ë ÈÛÙfi, ΢ڛˆ˜ ÛÙÔ ÛÏ·Á¯ÓÈÎfi Ï›Ô˜, ÂÎÊÚ¿˙ÂÙ·È ÙÔ ¤Ó˙˘ÌÔ 17 ‚-˘‰ÚÔ͢ÛÙÂÚÔÂȉÈ΋ ·Ó·ÁˆÁ¿ÛË, ÙÔ ÔÔ›Ô ÌÂÙ·ÙÚ¤ÂÈ ÙËÓ ·Ó‰ÚÔÛÙ·Ó‰ÈfiÓË, Ô˘ Û˘ÓÙ›ıÂÙ·È ÛÙ· ÂÈÓÂÊÚ›‰È· Î·È ·ÔıË·ÂÙ·È ÛÙÔ Ï›Ô˜, Û ÙÂÛÙÔÛÙÂÚfiÓË. ∆Ô ·˘ÍË̤ÓÔ Ï›Ô˜ ·˘Í¿ÓÂÈ ÙËÓ Èı·ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ÔÚÌÔÓÔ¢·›ÛıËÙÔ˘ ηÚΛÓÔ˘ (·¯¤Ô˜ ÂÓÙ¤ÚÔ˘, Ì·ÛÙÔ‡, ÚÔÛÙ¿ÙË, ÂÓ‰ÔÌËÙÚ›Ô˘), ÏfiÁˆ Ù˘ ·ÊıÔÓ›·˜ ıÚÂÙÈÎÒÓ Ô˘ÛÈÒÓ Î·È ÛÙÂÚÔÂȉÒÓ ÔÚÌÔÓÒÓ, Ù· ÔÔ›· Û˘Ì‚¿ÏÏÔ˘Ó ÛÙÔÓ ÔÏÏ·Ï·ÛÈ·ÛÌfi ÙˆÓ Î·ÚÎÈÓÈÎÒÓ Î˘ÙÙ¿ÚˆÓ (62). ∏ ·¯˘Û·ÚΛ· ·˘Í¿ÓÂÈ Ù· ÛÙÂÚÔÂȉ‹ ÙÔ˘ ¿ÏÏÔ˘ ʇÏÔ˘ Î·È ÚÔηÏ› Á˘Ó·ÈÎÔÌ·ÛÙ›· ÛÙÔÓ ¿Ó‰Ú·, ‰·Û˘ÙÚȯÈÛÌfi ÛÙË Á˘Ó·›Î· Î·È ÂÏ¿ÙÙˆÛË Ù˘ ÁÔÓÈÌfiÙËÙ·˜. ªÂÙ¿ ÙËÓ ÂÌÌËÓfi·˘ÛË, Ô ÏÈ҉˘ ÈÛÙfi˜ ·ÔÙÂÏ› ÙËÓ Î‡ÚÈ· ËÁ‹ ·Ó‰ÚÔÁfiÓˆÓ Î·È ÔÈÛÙÚÔÁfiÓˆÓ. OÈ ·¯‡Û·ÚΘ ÌÂÙÂÌÌËÓÔ·˘ÛȷΤ˜ Á˘Ó·›Î˜ ¤¯Ô˘Ó ÂÚÈÛÛfiÙÂÚ· ÔÈÛÙÚÔÁfiÓ· Î·È ·Ó‰ÚÔÁfiÓ· Î·È ÚÔÛٷهÔÓÙ·È ·fi ÙËÓ ¿ÓÔÈ·, ÙË ÓfiÛÔ ÙÔ˘ Alzheimer Î·È ÙËÓ ÔÛÙÂÔfiÚˆÛË. ™˘ÌÂÚ¿ÛÌ·Ù· O ÏÈ҉˘ ÈÛÙfi˜ ÂÎÎÚ›ÓÂÈ ÔÏϤ˜ ‰ÈÂÁÂÚÙÈΤ˜ Ô˘Û›Â˜ Ì ·˘ÙÔÎÚÈÓÈ΋, ·Ú·ÎÚÈÓÈ΋ ‹ ÔÚÌÔÓÈ΋ ‰Ú¿ÛË. ∞fi ÙÔ Ï›Ô˜ ÂÎÎÚ›ÓÂÙ·È Ë ÏÂÙ›ÓË, Ë IL-6, Ô TNF· Î·È ¿ÏϘ ΢ÙÔΛÓ˜ Î·È Î·Ù¯ÔϷ̛Ә. ∆· NEFAs ÂÎχÔÓÙ·È ·fi ÙÔ Ï›Ô˜ Û ηٷÛÙ¿ÛÂȘ stress, ÏÔÈÌÒ͈Ó, ·Ó··Ú·ÁˆÁ‹˜ ‹ ¤ÓÙÔÓ˘ Ê˘ÛÈ΋˜ ¿ÛÎËÛ˘, ÚÔÎÂÈ̤ÓÔ˘ Ó· ηχ„Ô˘Ó ÙȘ ·˘ÍË̤Ó˜ ·Ó¿ÁΘ ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ Û η‡ÛÈÌ· ¯ˆÚ›˜ Ó· ‰È·Ù·Ú¿ÛÛÂÙ·È Ë ÔÌÔÈÔÛÙ·Û›· ÙÔ˘. O ÏÈ҉˘ ÈÛÙfi˜ ¯ÚËÛÈ̇ÂÈ ÛÙËÓ Î¿Ï˘„Ë Ù˘ ¤ÏÏÂȄ˘ ÙÚÔÊÒÓ Û ÂÚÈ‚¿ÏÏÔÓ ÂÓÂÚÁÂȷ΋˜ ÛÙ¤ÚËÛ˘. ™ÙËÓ ˘ÂÚÚÔÛÊÔÚ¿ ÙÚÔʛ̈Ó, ÔÈ ÚÔÛ·ÚÌÔÛÙÈÎÔ› Ì˯·ÓÈÛÌÔ› ÁÈ· Û·Ù¿ÏË Ù˘ ÂÈϤÔÓ ÂÓ¤ÚÁÂÈ·˜, ¯ˆÚ›˜ Ó· ÂÈ‚·Ú‡ÓÂÙ·È Ô ÔÚÁ·ÓÈÛÌfi˜, ‰ÂÓ ÏÂÈÙÔ˘ÚÁÔ‡Ó Ï‹Úˆ˜. ¶ÔÏϤ˜ ·fi ÙȘ ÂÈÏÔΤ˜ Ù˘ ·¯˘Û·ÚΛ·˜ ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙËÓ ·ÓÙ›ÛÙ·ÛË ÙÔ˘ ÏÈÒ‰Ô˘˜ ÈÛÙÔ‡ ÛÙËÓ ·‡ÍËÛË ÙÔ˘ ‚¿ÚÔ˘˜ (63). ∏ ·¯˘Û·ÚΛ·, fiÙ·Ó ÂÁηٷÛÙ·ı›, Â›Ó·È Ôχ ‰‡ÛÎÔÏÔ Ó· ˘Ô¯ˆÚ‹ÛÂÈ, ¤¯ÂÈ ÔϤıÚȘ ÂÈÙÒÛÂȘ Î·È Ôχ ÊÙˆ¯¿ ıÂÚ·¢ÙÈο ·ÔÙÂϤÛÌ·Ù·. ¶ÂÚ›Ô˘ 5 ¤ÙË ÌÂÙ¿ ÙË ıÂÚ·¢ÙÈ΋ ·ÁˆÁ‹, fiÏ· Ù· ¿ÙÔÌ· Â·Ó·ÎÙÔ‡Ó ‹ ·˘Í¿ÓÔ˘Ó ÙÔ ‚¿ÚÔ˜. ¶Ú¤ÂÈ Ó·

Paediatriki 2004;67:75-87

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∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 18-02-2003 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 25-07-2003 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∫˘Ú·ÙÛԇϷ ¶·ÓÙÛÈÒÙÔ˘ ¢ÚfiÛË 11, ∆.∫. 114 74, °Î‡˙Ë

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¶·È‰È·ÙÚÈ΋ 2004;67:88-96

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Paediatriki 2004;67:88-96

REVIEW ARTICLE

¶ÏÂÔÓÂÎÙ‹Ì·Ù· Î·È ÌÂÈÔÓÂÎÙ‹Ì·Ù· ÙˆÓ ·ÓÙÈÂÈÏËÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ ∫. ∞. µÔ‡‰Ú˘, ™. ª·ÛÙÚÔÁÈ¿ÓÓË

Advantages and disadvantages of antiepileptic drugs K. Voudris, S. Mastroyianni

¶ÂÚ›ÏË„Ë: ∞Ó Î·È Ù· ·Ï·ÈfiÙÂÚ· ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η Â›Ó·È Û˘¯Ó¿ ·ÔÙÂÏÂÛÌ·ÙÈο, ÌÂÚÈο ·È‰È¿ Ì ÂÈÏË„›· ‰ÂÓ ÂϤÁ¯ÔÓÙ·È ÈηÓÔÔÈËÙÈο ‹ ÂÌÊ·Ó›˙Ô˘Ó ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ ·fi ÙË ¯ÔÚ‹ÁËÛ‹ ÙÔ˘˜. OÈ ÚÔÛ¿ıÂȘ Ô˘ ¤¯Ô˘Ó Á›ÓÂÈ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ¤¯Ô˘Ó Ô‰ËÁ‹ÛÂÈ ÛÙËÓ ·Ó·Î¿Ï˘„Ë ÓÂfiÙÂÚˆÓ ·ÓÙÈÂÈÏËÙÈÎÒÓ Ê·Ú̿ΈÓ, Ù· ÔÔ›· Ê·›ÓÂÙ·È Ó· Â›Ó·È ÈÔ ·ÛÊ·Ï‹ Î·È Ì ηχÙÂÚ˜ Ê·ÚÌ·ÎÔÎÈÓËÙÈΤ˜ ȉÈfiÙËÙ˜ ·fi Ù· ·Ï·ÈfiÙÂÚ· ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η. ¢ÂÓ ¤¯ÂÈ, fï˜, ·Ô‰Âȯı› Â¿Ó Â›Ó·È ÈÔ ·ÔÙÂÏÂÛÌ·ÙÈο ·fi ·˘Ù¿. OÈ ÚÔÛ¿ıÂȘ Û˘Ó¯›˙ÔÓÙ·È ÁÈ· ÙËÓ ·Ó‡ÚÂÛË ÙÔ˘ ȉÂÒ‰Ô˘˜ ·ÓÙÈÂÈÏËÙÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘, ÙÔ ÔÔ›Ô ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÈηÓÔÔÈËÙÈ΋ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·, ÌÂÁ¿ÏË ·ÛÊ¿ÏÂÈ·, ¢¯ÚËÛÙ›·, ηϤ˜ Ê·ÚÌ·ÎÔÎÈÓËÙÈΤ˜ ȉÈfiÙËÙ˜ Î·È ¯·ÌËÏfi ÎfiÛÙÔ˜. ™Â ·˘Ù‹ ÙËÓ ·Ó·ÛÎfiËÛË ÂÚÈÁÚ¿ÊÔÓÙ·È Ù· ¯·Ú·ÎÙËÚÈÛÙÈο Â˘Ú‹Ì·Ù· ÙÔ˘ ȉÂÒ‰Ô˘˜ ·ÓÙÈÂÈÏËÙÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘ Î·È Ù· ·ÚÈ· ÏÂÔÓÂÎÙ‹Ì·Ù· Î·È ÌÂÈÔÓÂÎÙ‹Ì·Ù· ÙˆÓ ˘·Ú¯fiÓÙˆÓ ·Ï·ÈfiÙÂÚˆÓ Î·È ÓÂfiÙÂÚˆÓ ·ÓÙÈÂÈÏËÙÈÎÒÓ Ê·Ú̿ΈÓ.

Abstract: Although the old antiepileptic drugs are often effective, some children with epilepsy who are using them either continue to have epileptic seizures or to develop side effects. New antiepileptic drugs have been found which are probably safer and have favourable pharmacokinetic properties, but it is not yet known if they are more effective than the old ones. Efforts will be continued to find the ideal antiepileptic drug, which would be characterized by satisfactory effectiveness, a wide margin of safety, ease of use, excellent pharmacokinetic properties and low cost. In this review the characteristics of the ideal antiepileptic drug and the advantages and disadvantages of the old and new antiepileptic drugs in current use are described.

§¤ÍÂȘ ÎÏÂȉȿ: ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η, ȉÂ҉˜ ·ÓÙÈÂÈÏËÙÈÎfi Ê¿ÚÌ·ÎÔ, ·È‰È΋ ÂÈÏË„›·.

Key words: antiepileptic drugs, ideal antiepileptic drug, paediatric epilepsy.

∂ÈÛ·ÁˆÁ‹ ªÔÏÔÓfiÙÈ Ù· ˘¿Ú¯ÔÓÙ· ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η Â›Ó·È Û˘¯Ó¿ ·ÔÙÂÏÂÛÌ·ÙÈο, ÌÂÚÈο ·È‰È¿ Ì ÂÈÏË„›· ‰ÂÓ ÂϤÁ¯ÔÓÙ·È ÈηÓÔÔÈËÙÈο ‹ ÂÌÊ·Ó›˙Ô˘Ó ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ ·fi ÙË ¯ÔÚ‹ÁËÛ‹ ÙÔ˘˜. ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ¤¯Ô˘Ó Á›ÓÂÈ ÌÂÁ¿Ï˜ ÚÔÛ¿ıÂȘ ÁÈ· ÙËÓ ·Ó‡ÚÂÛË ÓÂfiÙÂÚˆÓ ·ÓÙÈÂÈÏËÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ Ì ηχÙÂÚË ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Î·È ÏÈÁfiÙÂÚ˜ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ (1-9). ¶ÚÈÓ Á›ÓÂÈ ·Ó·ÊÔÚ¿ ÛÙ· ÏÂÔÓÂÎÙ‹Ì·Ù· Î·È Ù· ÌÂÈÔÓÂÎÙ‹-

Ì·Ù· ÙˆÓ ˘·Ú¯fiÓÙˆÓ ·ÓÙÈÂÈÏËÙÈÎÒÓ Ê·Ú̿ΈÓ, ı· ÂÚÈÁÚ·ÊÔ‡Ó Ù· ·ÚÈ· ¯·Ú·ÎÙËÚÈÛÙÈο ÁÓˆÚ›ÛÌ·Ù· ÙÔ˘ ȉÂÒ‰Ô˘˜ ·ÓÙÈÂÈÏËÙÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘.

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

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

88

∆Ô È‰Â҉˜ ·ÓÙÈÂÈÏËÙÈÎfi Ê¿ÚÌ·ÎÔ ∆Ô È‰Â҉˜ ·ÓÙÈÂÈÏËÙÈÎfi Ê¿ÚÌ·ÎÔ ı· Ú¤ÂÈ, ÁÂÓÈÎfiÙÂÚ·, Ó· Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈÎfi, ·ÛʷϤ˜, ‡¯ÚËÛÙÔ, ¯ˆÚ›˜ ·ÏÏËÏÂȉڿÛÂȘ Î·È Ì ¯·ÌËÏfi ÎfiÛÙÔ˜. ŸÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·, ÙÔ È‰Â҉˜ ·ÓÙÈÂÈÏËÙÈÎfi Ê¿ÚÌ·ÎÔ ı· Ú¤ÂÈ Ó·

¶·È‰È·ÙÚÈ΋ 2004;67:88-96

·ÚÔ˘ÛÈ¿˙ÂÈ - ÂÎÙfi˜ ·fi ÙËÓ ÈηÓÔÔÈËÙÈ΋ ηٷÛÙ·ÏÙÈ΋ ÁÈ· ÙÔ˘˜ Û·ÛÌÔ‡˜ ‰Ú¿ÛË - Î·È ·ÓÙÈÂÈÏËÙÔÁfiÓÔ ‰Ú¿ÛË (10). ∆· ˘¿Ú¯ÔÓÙ· ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η Ê·›ÓÂÙ·È fiÙÈ Î·Ù·ÛÙ¤ÏÏÔ˘Ó Î˘Ú›ˆ˜ ÙȘ ÂÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ, ¯ˆÚ›˜ fï˜ Ó· ¤¯Ô˘Ó οÔÈ· ·ÓÙÈÂÈÏËÙÔÁfiÓÔ Â›‰Ú·ÛË ÛÙÔÓ ÂÁΤʷÏÔ. ¶·Ú·‰Â›ÁÌ·ÙÔ˜ ¯¿ÚÈÓ, Ù· ·Ï·ÈfiÙÂÚ· ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η ηڂ·Ì·˙Â›ÓË Î·È Ê·ÈÓ˘ÙÔ˝ÓË ‰ÂÓ Ê·›ÓÂÙ·È Ó· ÂÌÊ·Ó›˙Ô˘Ó ·ÓÙÈÂÈÏËÙÔÁfiÓÔ ‰Ú¿ÛË Î·È Ë ¤ÁηÈÚË ¯ÔÚ‹ÁËÛ‹ ÙÔ˘˜ ‰ÂÓ ·ÔÙÚ¤ÂÈ ÙË ÌÂÏÏÔÓÙÈ΋ ÂÌÊ¿ÓÈÛË ÂÈÏË„›·˜ fiÙ·Ó ¯ÔÚËÁÔ‡ÓÙ·È Û ¿ÙÔÌ· Ì ÈÛÙÔÚÈÎfi ÙÚ·‡Ì·ÙÔ˜ Ù˘ ÎÂÊ·Ï‹˜. ∞fi Ù· ÓÂfiÙÂÚ· ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η, Ë ÙÔÈÚ·Ì¿ÙË Ê·›ÓÂÙ·È Ó· ·ÚÔ˘ÛÈ¿˙ÂÈ Î¿ÔÈ· ·ÓÙÈÂÈÏËÙÔÁfiÓÔ ‰Ú¿ÛË, ·ÏÏ¿ ·˘Ùfi ı· Ú¤ÂÈ Ó· ·Ô‰Âȯı› ÂÚ·ÈÙ¤Úˆ Û ÌÂÏÏÔÓÙÈΤ˜ ÌÂϤÙ˜. ∂ÈϤÔÓ, ÙÔ È‰Â҉˜ ·ÓÙÈÂÈÏËÙÈÎfi Ê¿ÚÌ·ÎÔ ı· Ú¤ÂÈ Ó· Â›Ó·È Â˘Ú¤Ô˜ Ê¿ÛÌ·ÙÔ˜ Î·È Ó· Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈÎfi ÙfiÛÔ Û ÂÛÙȷΤ˜ fiÛÔ Î·È Û ÁÂÓÈÎÂ˘Ì¤Ó˜ ÂÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ, ηıÒ˜ fiˆ˜ Â›Ó·È ÁÓˆÛÙfi, ·ÚÎÂÙÔ› ·ÛıÂÓ›˜ Î·È Î˘Ú›ˆ˜ ·È‰È¿ ¤¯Ô˘Ó Û˘¯Ó¿ ÔÏÏ·Ϥ˜ ÂÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ. ∂›Û˘, ÌÂÚÈο ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η ÌÔÚ› Ó· Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈο Û ¤Ó· ›‰Ô˜ ÂÈÏËÙÈÎÒÓ ÎÚ›ÛÂˆÓ (.¯. ÛÙȘ ÂÛÙȷΤ˜) Î·È Ó· ÂȉÂÈÓÒÓÔ˘Ó ˘¿Ú¯Ô˘Û˜ ‹ Ó· ¢ÓÔÔ‡Ó ÙËÓ ÂÌÊ¿ÓÈÛË Ó¤ˆÓ ÁÂÓÈÎÂ˘Ì¤ÓˆÓ ÎÚ›ÛˆÓ, fiˆ˜ Â›Ó·È ÔÈ ·Ê·ÈÚ¤ÛÂȘ Î·È ÔÈ Ì˘ÔÎÏÔÓÈÎÔ› Û·ÛÌÔ›. ∏ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ú¤ÂÈ Ó· Â›Ó·È ÛÙ·ıÂÚ‹ Î·È Ó· ÌËÓ ÌÂÈÒÓÂÙ·È ÌÂÙ¿ ·fi ÌÂÚÈÎÔ‡˜ Ì‹Ó˜ ıÂÚ·›·˜, fiˆ˜ Û˘¯Ó¿ ·Ú·ÙËÚÂ›Ù·È Ì ÙȘ ‚ÂÓ˙ԉȷ˙Â›Ó˜. ∂›Û˘, ‰ÂÓ Ú¤ÂÈ Ó· ÂËÚ¿˙ÂÙ·È ·fi ·ÙÔÌÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ ·ÛıÂÓÔ‡˜ Î·È Ó· ‰È·Ê¤ÚÂÈ ÌÂٷ͇ ÙˆÓ ·ÛıÂÓÒÓ. ∂ÎÙfi˜ ·fi ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·, ÙÔ È‰Â҉˜ ·ÓÙÈÂÈÏËÙÈÎfi Ê¿ÚÌ·ÎÔ ı· Ú¤ÂÈ Ó· Â›Ó·È ·ÛʷϤ˜ Î·È Ó· ÌËÓ ÚÔηÏ› ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ (3,11,12). OÈ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ ÙˆÓ ·ÓÙÈÂÈÏËÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ ÌÔÚ› Ó· Â›Ó·È ‰ÔÛÔÂÍ·ÚÙÒÌÂÓ˜, ȉÈÔÛ˘ÁÎÚ·ÛȷΤ˜ ‹ ·ÏÏÂÚÁÈΤ˜ Î·È Ó· ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ¯ÚfiÓÈ· ÙÔÍÈÎfiÙËÙ· Î·È ÙÂÚ·ÙÔÁ¤ÓÂÛË. ∞Ó Î·È ÔÏϤ˜ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ ‰ÂÓ Â›Ó·È ÛÔ‚·Ú¤˜, Â›Ó·È Û˘¯Ó¿ ÂÓÔ¯ÏËÙÈΤ˜, Ì ·ÔÙ¤ÏÂÛÌ· Ó· ÂÌÔ‰›˙Ô˘Ó ÙÔÓ ·ÛıÂÓ‹ Ó· Ï·Ì‚¿ÓÂÈ ÛˆÛÙ¿ Ù· ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷ο ÙÔ˘. ∞˘Ù¤˜ Â›Ó·È Û˘¯Ó¿ ‰ÔÛÔÂÍ·ÚÙÒÌÂÓ˜, ·ÊÔÚÔ‡Ó Î˘Ú›ˆ˜ ÛÂ Û˘ÌÙÒÌ·Ù· ·fi ÙÔ ÎÂÓÙÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ·, fiˆ˜ ÎÂÊ·Ï·ÏÁ›·, ˘ÓËÏ›·, Â̤ÙÔ˘˜ Î·È ÂÌÊ·Ó›˙ÔÓÙ·È Û˘¯Ó¿ ÙȘ ÚÒÙ˜ Ë̤Ú˜ Ù˘ ıÂÚ·›·˜. ∂ÈϤÔÓ, Ë ÂÌÊ¿ÓÈÛË ·ÓÂÈı‡ÌËÙˆÓ ÂÓÂÚÁÂÈÒÓ ˘Ô¯ÚÂÒÓÂÈ Û ‚Ú·‰Â›· ·‡ÍËÛË Ù˘ ·Ú¯È΋˜ ‰fiÛ˘ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘, Ì ·ÔÙ¤ÏÂÛÌ· Ó· ·ÚÁ› Î·È Ë ¯ÔÚ‹ÁËÛË Ù˘ ·ÔÙÂÏÂÛÌ·ÙÈ΋˜ ‰fiÛ˘ ÙÔ˘.

OÈ ÈÔ ÛÔ‚·Ú¤˜ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ, Ô˘

Paediatriki 2004;67:88-96

ÌÔÚ› Ó· Ô‰ËÁ‹ÛÔ˘Ó ÙÔÓ ·ÛıÂÓ‹ ·ÎfiÌË Î·È ÛÙÔÓ ı¿Ó·ÙÔ, Â›Ó·È ÔÈ È‰ÈÔÛ˘ÁÎÚ·ÛȷΤ˜ ‹ ·ÏÏÂÚÁÈΤ˜, ÔÈ Ôԛ˜ Â›Ó·È Â˘Ù˘¯Ò˜ Û¿ÓȘ, ‰ÂÓ Â›Ó·È ‰ÔÛÔÂÍ·ÚÙÒÌÂÓ˜ Î·È ÂÌÊ·Ó›˙ÔÓÙ·È Û˘¯Ó¿ ÙÔ˘˜ ÚÒÙÔ˘˜ Ì‹Ó˜ Ù˘ ıÂÚ·›·˜. ∂¿Ó ÂÌÊ·ÓÈÛÙÔ‡Ó ·˘Ù¤˜ ÔÈ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ, ··ÈÙÂ›Ù·È ¿ÌÂÛË ‰È·ÎÔ‹ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘. ¶ÚÔÎÂÈ̤ÓÔ˘ Ó· ‰È·ÈÛÙˆıÔ‡Ó, ÏfiÁˆ Ù˘ Û·ÓÈfiÙËÙ¿˜ ÙÔ˘˜, ÙÔ ·ÓÙÈÂÈÏËÙÈÎfi Ê¿ÚÌ·ÎÔ ı· Ú¤ÂÈ Ó· ¤¯ÂÈ ¯ÔÚËÁËı› Û ÌÂÁ¿ÏÔ ·ÚÈıÌfi ·ÛıÂÓÒÓ, fiˆ˜ ·Ú·ÙËÚ‹ıËΠ̠ÙË ¯ÔÚ‹ÁËÛË Ù˘ ÊÂÏÌ·Ì¿Ù˘, fiÔ˘ ‰È·ÈÛÙÒıËÎ·Ó ÛÔ‚·Ú‹ Ë·ÙÈ΋ ‚Ï¿‚Ë Î·È ·Ï·ÛÙÈ΋ ·Ó·ÈÌ›·, Û ÌÂÁ¿ÏÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÌÂÙ¿ ÙËÓ ¤ÁÎÚÈÛË ¯ÔÚ‹ÁËÛ‹˜ Ù˘ Û ÂÈÏËÙÈÎÔ‡˜ ·ÛıÂÓ›˜ (3). ŸÛÔÓ ·ÊÔÚ¿ Û ·˘Ù¤˜ ÙȘ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ, Ù· ·Ï·ÈfiÙÂÚ· ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η ÏÂÔÓÂÎÙÔ‡Ó Û ۯ¤ÛË Ì ٷ ÓÂfiÙÂÚ·, Ù· ÔÔ›· ¤¯Ô˘Ó ¯ÔÚËÁËı› Û ÌÈÎÚfiÙÂÚÔ ·ÚÈıÌfi ·ÛıÂÓÒÓ Î·È ˘¿Ú¯ÂÈ ÌÈÎÚfiÙÂÚË ÂÌÂÈÚ›·, Ì ·ÔÙ¤ÏÂÛÌ· Ó· ÌËÓ ¤¯Ô˘Ó, Èı·ÓfiÓ, ‰È·ÈÛÙˆı› ·ÎfiÌË ÛÔ‚·Ú¤˜ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ. ŸÛÔÓ ·ÊÔÚ¿ ÛÙË ¯ÚfiÓÈ· ÙÔÍÈÎfiÙËÙ·, fiˆ˜ Â›Ó·È ÔÈ ‰È·Ù·Ú·¯¤˜ ÙˆÓ ÓÔËÙÈÎÒÓ ÏÂÈÙÔ˘ÚÁÈÒÓ ‹ ¿ÏÏˆÓ ÔÚÁ¿ÓˆÓ Î·È Û˘ÛÙËÌ¿ÙˆÓ ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡, ÌÔÚ› Ó· ÂÌÊ·ÓÈÛÙ› Â¿Ó ¤Ó· Ê¿ÚÌ·ÎÔ ¯ÔÚËÁÂ›Ù·È ÁÈ· ÌÂÁ¿ÏÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ‹ Û ÌÂÁ¿Ï˜ ‰fiÛÂȘ. ∞fi Ù· ·Ï·È¿ Ê¿Ú̷η, Ë Ê·ÈÓ˘ÙÔ˝ÓË Î˘Ú›ˆ˜ ¤¯ÂÈ ÂÓÔ¯ÔÔÈËı› fiÙÈ ÌÔÚ› Ó· ÚÔηϤÛÂÈ ¯ÚfiÓÈ· ÙÔÍÈÎfiÙËÙ·, Ô˘ ·ÊÔÚ¿ ΢ڛˆ˜ ÛÙȘ ÓÔËÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜. ŸÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÙÂÚ·ÙÔÁ¤ÓÂÛË, fiÏ· Ù· ·Ï·ÈfiÙÂÚ· Ê¿Ú̷η ÌÔÚ› Ó· ÚÔηϤÛÔ˘Ó ‹Ș ‹ ÛÔ‚·Ú¤˜ ‚Ï¿‚˜ ÛÙÔ ¤Ì‚Ú˘Ô, fiˆ˜ Â›Ó·È Ë ‰Èۯȉ‹˜ Ú¿¯Ë, ΢ڛˆ˜ fiÙ·Ó ¯ÔÚËÁÔ‡ÓÙ·È ÛÙÔ ÚÒÙÔ ÙÚ›ÌËÓÔ Ù˘ ÂÁ΢ÌÔÛ‡Ó˘, ÂÓÒ ÁÈ· Ù· ÓÂfiÙÂÚ· Ê¿Ú̷η ‰ÂÓ ˘¿Ú¯Ô˘Ó Â·Ú΋ ‰Â‰Ô̤ӷ Û¯ÂÙÈο Ì ·˘Ùfi ÙÔ ı¤Ì· (14). ∞fi Ù· ·Ï·ÈfiÙÂÚ· ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η, ÙÔ ‚·ÏÚÔ˚Îfi Ó¿ÙÚÈÔ Î·È Ë Ê·ÈÓ˘ÙÔ˝ÓË ÚÔηÏÔ‡Ó Û˘¯ÓfiÙÂÚ· ÛÔ‚·Ú¤˜ ‰˘ÛϷۛ˜ ÛÙÔ ¤Ì‚Ú˘Ô, fiˆ˜ ‰Èۯȉ‹ Ú¿¯Ë (1-3%), ÂÓÒ Ë Î·Ú‚·Ì·˙Â›ÓË, Ë ·ÈıÔÛÔ˘ÍÈÌ›‰Ë Î·È ÔÈ ‚ÂÓ˙ԉȷ˙Â›Ó˜ Û·ÓÈfiÙÂÚ· (0,5-1%). ŒÌ‚Ú˘· ·fi ÂÁ΢ÌÔÓÔ‡Û˜ ÌËÙ¤Ú˜ Ô˘ Ï·Ì‚¿ÓÔ˘Ó ÌÂÁ¿Ï˜ ‰fiÛÂȘ ·ÓÙÈÂÈÏËÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ ‹ ÔÏÏ·Ï‹ ·ÓÙÈÂÈÏËÙÈ΋ Ê·Ú̷΢ÙÈ΋ ıÂÚ·›·, ÎÈÓ‰˘ÓÂ‡Ô˘Ó ÂÚÈÛÛfiÙÂÚÔ Ó· ˘ÔÛÙÔ‡Ó ÛÔ‚·Ú¤˜ ‰˘ÛϷۛ˜. °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi, Ë ÂÁ΢ÌÔÓÔ‡Û· ÌËÙ¤Ú· ı· Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÂÈ ÌÔÓÔıÂÚ·›· Ì ÙË ÌÈÎÚfiÙÂÚË ‰˘Ó·Ù‹ ‰ÔÛÔÏÔÁ›· ηÈ, Ì¿ÏÈÛÙ·, Ë Ï‹„Ë Ù˘ ËÌÂÚ‹ÛÈ·˜ ‰ÔÛÔÏÔÁ›·˜ Ó· Â›Ó·È Î·Ù·ÓÂÌË̤ÓË Û ÔÏϤ˜ ‰fiÛÂȘ, Ô‡Ùˆ˜ ÒÛÙ ӷ ·ÔʇÁÔÓÙ·È Ôχ ·˘ÍË̤ӷ Â›‰· ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ÛÙÔ ·›Ì·. º˘ÏÏÈÎfi Ô͇ ı· Ú¤ÂÈ Ó· ¯ÔÚËÁÂ›Ù·È ÚÈÓ Î·È Î·ı’ fiÏË ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÁ΢ÌÔÛ‡Ó˘ ÛÙȘ ÂÁ΢ÌÔÓÔ‡Û˜ ÌËÙ¤Ú˜ Ô˘ Ï·Ì‚¿ÓÔ˘Ó ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η. ¶ÚÔÁÂÓÓËÙÈ΋ ‰È¿ÁÓˆÛË

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Ì ÙË ‚Ô‹ıÂÈ· ˘ÂÚ‹¯ˆÓ ‹, Û·ÓÈfiÙÂÚ·, Ì ·ÌÓÈÔΤÓÙËÛË ÁÈ· ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi Ù˘ ·-ÊÂÙÔÚˆÙ½Ó˘ ı· Ú¤ÂÈ Ó· ÂÊ·ÚÌfi˙ÂÙ·È Û fiϘ ÂÁ΢ÌÔÓÔ‡Û˜ ÌËÙ¤Ú˜ Ô˘ Ï·Ì‚¿ÓÔ˘Ó ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η, ÁÈ· ÙËÓ ·Ó›¯Ó¢ÛË ÛÔ‚·ÚÒÓ ‰˘ÛÏ·ÛÈÒÓ Î·È È‰È·›ÙÂÚ· Ù˘ ‰Èۯȉԇ˜ Ú¿¯Ë˜. ∏ ¢ÎÔÏ›· ÛÙË ¯Ú‹ÛË Î·È Ë Î·Ï‹ Û˘ÌÌfiÚʈÛË ÙÔ˘ ·ÛıÂÓÔ‡˜ ÛÙË Ï‹„Ë ÙÔ˘ ·ÓÙÈÂÈÏËÙÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘ ÂÍ·ÚÙ¿Ù·È ·fi ÙȘ Ê·ÚÌ·ÎÔÎÈÓËÙÈΤ˜ ȉÈfiÙËÙ¤˜ ÙÔ˘ (13). OÈ ÂÈı˘ÌËÙ¤˜ Ê·ÚÌ·ÎÔÎÈÓËÙÈΤ˜ ȉÈfiÙËÙ˜ ÙˆÓ ·ÓÙÈÂÈÏËÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1. ∆Ô ·ÓÙÈÂÈÏËÙÈÎfi Ê¿ÚÌ·ÎÔ Ú¤ÂÈ Ó· ¤¯ÂÈ Ï‹ÚË ‹ ÛÙ·ıÂÚ‹ ‚ÈԉȷıÂÛÈÌfiÙËÙ·, ‰ËÏ·‰‹ Ë ÔÛfiÙËÙ· ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Ô˘ ÂÈÛ¤Ú¯ÂÙ·È ÛÙÔÓ ÔÚÁ·ÓÈÛÌfi ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛ‹ ÙÔ˘ ·fi ÙÔ ÛÙfiÌ· Ú¤ÂÈ Ó· Â›Ó·È Ï‹Ú˘ ‹ ÛÙ·ıÂÚ‹ Û Â·Ó·Ï·Ì‚·ÓfiÌÂÓ˜ ‰fiÛÂȘ. ∂ÈϤÔÓ, Ë ·ÔÚÚfiÊËÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ·fi ÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi Û‡ÛÙËÌ· ‰ÂÓ Ú¤ÂÈ Ó· ÂËÚ¿˙ÂÙ·È ·fi ÙË Ï‹„Ë ÙÚÔÊ‹˜ ‹ ÙË ¯ÔÚ‹ÁËÛË ¿ÏÏˆÓ Ê·ÚÌ¿ÎˆÓ Î·È Ô˘ÛÈÒÓ. ∆Ô ·ÓÙÈÂÈÏËÙÈÎfi Ê¿ÚÌ·ÎÔ Ú¤ÂÈ Ó· ‰È·Ù›ıÂÙ·È Û ˘ÁÚ‹ ÌÔÚÊ‹, fiˆ˜ Â›Ó·È ÙÔ ÛÈÚfiÈ, ÁÈ·Ù› ¤ÙÛÈ ÙÔ Ê¿ÚÌ·ÎÔ ÌÔÚ› Ó· ¯ÔÚËÁËı› Û ÌÈÎÚ¿ ·È‰È¿ Î·È Û ÂÓ‰ÔÊϤ‚È· ÌÔÚÊ‹, Û ηٷÛÙ¿ÛÂȘ Ô˘ Â›Ó·È ·‰‡Ó·ÙË Ë Ï‹„Ë ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ·fi ÙÔ ÛÙfiÌ· ‹ Û Â›ÁÔ˘Û˜ ηٷÛÙ¿ÛÂȘ, fiˆ˜ Â›Ó·È ÙÔ status epilepticus. ∏ ÛÙ·ıÂÚ‹ ‹ ·ÚÁ‹ ÂÏÂÁ¯fiÌÂÓË ·ÔÚÚfiÊËÛË Ô˘ ÂÈÙ˘Á¯¿ÓÂÙ·È ·fi Û˘ÁÎÂÎÚÈ̤ÓË ÌÔÚÊ‹ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘, fiˆ˜ ˘¿Ú¯ÂÈ Û‹ÌÂÚ· ÁÈ· Ù· ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η ‚·ÏÚÔ˚Îfi Ó¿ÙÚÈÔ Î·È Î·Ú‚·Ì·˙Â›ÓË, ·ÔÙÂÏ› ÏÂÔÓ¤ÎÙËÌ·, ηıÒ˜ ¤ÙÛÈ ·ÔʇÁÔÓÙ·È ÔÈ ÌÂÁ¿Ï˜ ·˘ÍÔÌÂÈÒÛÂȘ ÛÙ· Â›‰· ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ÛÙÔ ·›Ì·.

O ÌÂÙ·‚ÔÏÈÛÌfi˜ ηÈ, ηْ Â¤ÎÙ·ÛË, Ô ¯ÚfiÓÔ˜ ËÌ›ÛÂÈ·˜ ˙ˆ‹˜ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ‰ÂÓ Ú¤ÂÈ Ó· ÂËÚ¿˙ÂÙ·È ·fi ·ÙÔÌÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Î·È ÙËÓ ËÏÈΛ· ¶›Ó·Î·˜ 1. π‰ÂÒ‰ÂȘ Ê·ÚÌ·ÎÔÎÈÓËÙÈΤ˜ ȉÈfiÙËÙ˜ ·ÓÙÈÂÈÏËÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ ñ ¶Ï‹Ú˘ ‹ ÛÙ·ıÂÚ‹ ‚ÈԉȷıÂÛÈÌfiÙËÙ· ñ ⁄·ÚÍË ˘ÁÚ‹˜ Î·È ÂÓ‰ÔÊϤ‚È·˜ ÌÔÚÊ‹˜ ñ ∞ÚÁ‹ ·ÔÚÚfiÊËÛË ‹ ‡·ÚÍË ÌÔÚÊ‹˜ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Û ÌÔÚÊ‹ ‚Ú·‰Â›·˜ ÂÏÂÁ¯fiÌÂÓ˘ ·Ô‰¤ÛÌ¢Û˘ ñ O ÌÂÙ·‚ÔÏÈÛÌfi˜ Ó· ÌËÓ ÂËÚ¿˙ÂÙ·È ·fi ÙËÓ ËÏÈΛ· Î·È ·ÙÔÌÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ñ ∫·Ù¿ÏÏËÏË ËÌ›ÛÂÈ· ˙ˆ‹ Ô˘ Ó· ÂÈÙÚ¤ÂÈ ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ 1-2 ÊÔÚ¤˜ ÙËÓ Ë̤ڷ ñ ªË ·˘ÙÔ-Â·ÁˆÁÈ΋ ‰Ú¿ÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ñ ∞Ô˘Û›· ÂÓÂÚÁÒÓ ÌÂÙ·‚ÔÏÈÙÒÓ ñ °Ú·ÌÌÈ΋ ·ÔÚÚfiÊËÛË Î·È ·Ô‚ÔÏ‹ ñ ∂Ï¿¯ÈÛÙË Î·È ÌË ÎÂÎÔÚÂṲ̂ÓË ‰¤ÛÌ¢ÛË Ì ÙȘ ÚˆÙ½Ó˜ ÙÔ˘ Ï¿ÛÌ·ÙÔ˜ ñ ∂·Ú΋˜ Î·È ÁÚ‹ÁÔÚË Â›ÛÔ‰Ô˜ ÛÙÔÓ ÂÁΤʷÏÔ ñ ∏ Û˘ÁΤÓÙÚˆÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Ó· Â›Ó·È ÈÛfiÙÈÌË Û ‰È¿ÊÔÚÔ˘˜ ÈÛÙÔ‡˜ ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ ñ ªË Ê·ÚÌ·ÎÔÎÈÓËÙÈΤ˜ ·ÏÏËÏÂȉڿÛÂȘ Ì ¿ÏÏ· Ê¿Ú̷η

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Paediatriki 2004;67:88-96

ÙÔ˘ ·ÛıÂÓÔ‡˜. ∞ÚÎÂÙ¿ ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η ¤¯Ô˘Ó ÌÂÁ¿ÏÔ ¯ÚfiÓÔ ËÌ›ÛÂÈ·˜ ˙ˆ‹˜ ÛÙË ÓÂÔÁÓÈ΋ ËÏÈΛ·, Ô ÔÔ›Ô˜ ÌÂÈÒÓÂÙ·È ÛÙË ‚ÚÂÊÈ΋ Î·È ÛÙË ÓËȷ΋ ËÏÈΛ·, ÁÈ· Ó· ·˘ÍËı› ÚÔԉ¢ÙÈο ·ÚÁfiÙÂÚ· ̤¯ÚÈ ÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹. ∂ÈϤÔÓ, Ô ¯ÚfiÓÔ˜ ËÌ›ÛÂÈ·˜ ˙ˆ‹˜ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Ú¤ÂÈ Ó· ÂÈÙÚ¤ÂÈ ÙË ¯ÔÚ‹ÁËÛ‹ ÙÔ˘ Û ̛· ‹, ηχÙÂÚ·, ‰‡Ô ‰fiÛÂȘ ÙËÓ Ë̤ڷ. ∏ ¯ÔÚ‹ÁËÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ‰‡Ô ÊÔÚ¤˜ ÙËÓ Ë̤ڷ Â›Ó·È ÚÔÙÈÌfiÙÂÚË, ÁÈ·Ù› ÛÙËÓ ÂÚ›ÙˆÛË Ô˘ ÙÔ Ê¿ÚÌ·ÎÔ Ï·Ì‚¿ÓÂÙ·È Ì›· ÊÔÚ¿ ÙËÓ Ë̤ڷ Î·È Í¯·ÛÙ›, ÙÔ ·È‰› ·Ú·Ì¤ÓÂÈ ¯ˆÚ›˜ Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ fiÏË ÙËÓ Ë̤ڷ. ∆Ô ·ÓÙÈÂÈÏËÙÈÎfi Ê¿ÚÌ·ÎÔ ‰ÂÓ ı· Ú¤ÂÈ Ó· ÚÔηÏ› Â·ÁˆÁ‹ ÙÔ˘ ‰ÈÎÔ‡ ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡, fiˆ˜ Û˘¯Ó¿ Û˘Ì‚·›ÓÂÈ Ì ÙËÓ Î·Ú‚·Ì·˙Â›ÓË ÛÙÔ˘˜ ÚÒÙÔ˘˜ Ì‹Ó˜ Ù˘ ıÂÚ·›·˜, Ì ·ÔÙ¤ÏÂÛÌ· ÙË Ì›ˆÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ÛÙÔ ·›Ì· Î·È ÙËÓ ·Ó¿ÁÎË ÚÔÛ·ÚÌÔÁ‹˜ Ù˘ ‰fiÛ˘. ∆Ô ·ÓÙÈÂÈÏËÙÈÎfi Ê¿ÚÌ·ÎÔ ‰ÂÓ Ú¤ÂÈ Ó· ÌÂÙ·‚ÔÏ›˙ÂÙ·È Û ÂÓÂÚÁÔ‡˜ ÌÂÙ·‚Ôϛ٘, fiˆ˜ Û˘Ì‚·›ÓÂÈ Û˘¯Ó¿ ÛÙÔ ‹·Ú, ÁÈ·Ù› ÂËÚ¿˙ÂÙ·È Ô ÌÂÙ·‚ÔÏÈÛÌfi˜ ÙÔ˘ ·fi ·ı‹ÛÂȘ ÙÔ˘ ‹·ÙÔ˜ Î·È ÔÈ ·Ú·ÁfiÌÂÓÔÈ ÌÂÙ·‚Ôϛ٘ ÌÔÚ› Ó· ·ÚÂÌ‚·›ÓÔ˘Ó ÛÙËÓ ·ÓÙÈÂÈÏËÙÈ΋ ‰Ú¿ÛË ÙÔ˘, Ó· ÚÔηÏÔ‡Ó ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ ‹ Ó· ·ÏÏËÏÂȉÚÔ‡Ó Ì ¿ÏÏ· Ê¿Ú̷η. ∂›Ó·È ÂÈı˘ÌËÙfi Ó· ·Ô‚¿ÏÏÂÙ·È ÙÔ ·ÓÙÈÂÈÏËÙÈÎfi Ê¿ÚÌ·ÎÔ ·fi ÙÔÓ ÔÚÁ·ÓÈÛÌfi ·fi Ù· ÓÂÊÚ¿, ¯ˆÚ›˜ ÚÔËÁÔ‡ÌÂÓÔ ÌÂÙ·‚ÔÏÈÛÌfi ÙÔ˘ ÛÙÔ ‹·Ú. ∆Ô È‰Â҉˜ ·ÓÙÈÂÈÏËÙÈÎfi Ê¿ÚÌ·ÎÔ ı· Ú¤ÂÈ Ó· ·ÔÚÚÔÊ¿Ù·È Î·È Ó· ·Ô‚¿ÏÏÂÙ·È ·fi ÙÔÓ ÔÚÁ·ÓÈÛÌfi ÁÚ·ÌÌÈο, ¤ÙÛÈ ÒÛÙ ٷ Â›‰· ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ÛÙÔ ·›Ì· Ó· Û¯ÂÙ›˙ÔÓÙ·È Ì ÙË ¯ÔÚËÁÔ‡ÌÂÓË ·fi ÙÔ ÛÙfiÌ· ‰fiÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Î·È Ó· ÌËÓ ·˘Í¿ÓÔÓÙ·È ·fiÙÔÌ·, ÔÏϤ˜ ÊÔÚ¤˜ Û ÙÔÍÈο Â›‰·, ÌÂÙ¿ ·fi Ì›· ÔÚÈṲ̂ÓË ‰fiÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘. ∞˘Ùfi Û˘Ì‚·›ÓÂÈ Ì ÙË ¯ÔÚ‹ÁËÛË Ù˘ Ê·ÈÓ˘ÙÔ˝Ó˘, fiÔ˘ Ì›· ÌÈÎÚ‹ ·‡ÍËÛË Ù˘ ¯ÔÚËÁÔ‡ÌÂÓ˘ ·fi ÙÔ ÛÙfiÌ· ‰fiÛ˘ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û ·fiÙÔÌË ·‡ÍËÛË ÙˆÓ ÂÈ¤‰ˆÓ ÛÙÔ ·›Ì·, Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÂÌÊ¿ÓÈÛË ÙÔÍÈÎfiÙËÙ·˜. ∆Ô ·ÓÙÈÂÈÏËÙÈÎfi Ê¿ÚÌ·ÎÔ ı· Ú¤ÂÈ Ó· Û˘Ó‰¤ÂÙ·È ÂÏ¿¯ÈÛÙ· Ì ٷ Ï¢ÎÒÌ·Ù· ÙÔ˘ ·›Ì·ÙÔ˜ Î·È Ó· ÌËÓ ÎÔÚ¤ÓÓ˘Ù·È Ë Û‡Ó‰ÂÛ‹ ÙÔ˘ ÛÙ· ıÂÚ·¢ÙÈο fiÚÈ· ÙÔ˘ Ê·ÚÌ¿ÎÔ˘, Ô‡Ùˆ˜ ÒÛÙ ӷ ÌËÓ ÂËÚ¿˙ÂÙ·È ÙÔ ÂχıÂÚÔ ÎÏ¿ÛÌ·, ÙÔ ÔÔ›Ô ·ÔÙÂÏ› ÙÔ ‰Ú·ÛÙÈÎfi ̤ÚÔ˜ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘, ·fi ÙËÓ ÔÛfiÙËÙ· ÙˆÓ ÔÏÈÎÒÓ ÏÂ˘ÎˆÌ¿ÙˆÓ ÙÔ˘ Ï¿ÛÌ·ÙÔ˜ ‹ ·fi ¿ÏÏ· Ê¿Ú̷η Ô˘ Û˘Ó‰¤ÔÓÙ·È Î·È ·˘Ù¿ Ì ٷ Ï¢ÎÒÌ·Ù·. ¢‡Ô ·Ï·È¿ ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η, ÙÔ ‚·ÏÚÔ˚Îfi Ó¿ÙÚÈÔ Î·È Ë Ê·ÈÓ˘ÙÔ˝ÓË, Û˘Ó‰¤ÔÓÙ·È Û ÌÂÁ¿ÏÔ ÔÛÔÛÙfi Ì ٷ Ï¢ÎÒÌ·Ù· ÙÔ˘ ·›Ì·ÙÔ˜. ∆Ô ·ÓÙÈÂÈÏËÙÈÎfi Ê¿ÚÌ·ÎÔ ı· Ú¤ÂÈ Ó· ÂÈÛ¤Ú¯ÂÙ·È Â·ÚÎÒ˜ Î·È ÁÚ‹ÁÔÚ· ÛÙÔÓ ÂÁΤʷÏÔ ÁÈ·

¶·È‰È·ÙÚÈ΋ 2004;67:88-96

¿ÌÂÛÔ ·ÔÙ¤ÏÂÛÌ· Û Â›ÁÔ˘Û˜ ηٷÛÙ¿ÛÂȘ, fiˆ˜ Â›Ó·È ÙÔ status epilepticus. ∏ ÔÛfiÙËÙ· ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Ô˘ ÂÈÛ¤Ú¯ÂÙ·È ÛÙÔÓ ÔÚÁ·ÓÈÛÌfi Ú¤ÂÈ Ó· ηٷӤÌÂÙ·È ÈÛfiÙÈÌ· Û ·˘ÙfiÓ, ÁÈ·Ù› ÔÈ ‰È·ÊÔÚ¤˜ Û˘ÁΤÓÙÚˆÛ˘ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Û ‰È¿ÊÔÚÔ˘˜ ÈÛÙÔ‡˜ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÔ˘Ó Û ÁÚ‹ÁÔÚ˜ ÌÂÙ·ÎÈÓ‹ÛÂȘ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘, ÂÏ·ÙÙÒÓÔÓÙ·˜ Ù·¯¤ˆ˜ ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·, fiˆ˜ Û˘Ì‚·›ÓÂÈ Ì ÙË ‰È·˙Â¿ÌË. ∆¤ÏÔ˜, ÙÔ È‰Â҉˜ ·ÓÙÈÂÈÏËÙÈÎfi Ê¿ÚÌ·ÎÔ ‰ÂÓ ı· Ú¤ÂÈ Ó· ¤¯ÂÈ Ê·ÚÌ·ÎÔÎÈÓËÙÈΤ˜ ·ÏÏËÏÂȉڿÛÂȘ Ì ¿ÏÏ· ·ÓÙÈÂÈÏËÙÈο ‹ ÌË Ê¿Ú̷η Î·È Ó· ÌËÓ ÂËÚ¿˙ÂÙ·È Ô ÌÂÙ·‚ÔÏÈÛÌfi˜ ÙÔ˘ ·fi ÓÔÛ‹Ì·Ù· ÙÔ˘ ·ÛıÂÓÔ‡˜, ηıÒ˜ ‡ÎÔÏ· ÚÔηÏÔ‡ÓÙ·È ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ ‹ Ì›ˆÛË Ù˘ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ ÙˆÓ Ê·Ú̿ΈÓ. ÕÏÏ· ¯·Ú·ÎÙËÚÈÛÙÈο ÁÓˆÚ›ÛÌ·Ù· ÙÔ˘ ȉÂÒ‰Ô˘˜ ·ÓÙÈÂÈÏËÙÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘ Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2. ∏ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙÔ˘ ·ÓÙÈÂÈÏËÙÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘ Ú¤ÂÈ Ó· Û¯ÂÙ›˙ÂÙ·È Ì ÙË ‰fiÛË ·fi ÙÔ ÛÙfiÌ· Î·È Ó· ÌËÓ ¯ÚÂÈ¿˙ÂÙ·È ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ·ÓÙÈÂÈÏËÙÈÎÒÓ Ô˘ÛÈÒÓ ÛÙÔ ·›Ì· ÁÈ· ÙËÓ ÂÎÙ›ÌËÛ‹ Ù˘ ‹ ÙËÓ ·Ó›¯Ó¢ÛË ·ÓÂÈı‡ÌËÙˆÓ ÂÓÂÚÁÂÈÒÓ. ∆· ıÂÚ·¢ÙÈο fiÚÈ· Ú¤ÂÈ Ó· Â›Ó·È ÌÂÁ¿Ï· Î·È Ù· ÙÔÍÈο Â›‰· ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Ó· ·¤¯Ô˘Ó ·ÚÎÂÙ¿ ·fi ·˘Ù¿, ÒÛÙ ӷ ·ÔʇÁÔÓÙ·È ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ ·fi Ù˘¯fiÓ ÌÈÎÚ‹ ·‡ÍËÛË Ù˘ ‰fiÛ˘ ÙÔ˘. O ÙÚfiÔ˜ ‰Ú¿Û˘ ÙˆÓ Ê·ÚÌ¿ÎˆÓ ı· Ú¤ÂÈ Ó· Â›Ó·È ÁÓˆÛÙfi˜, ÁÈ·Ù› Û ÌÂÚÈΤ˜ ·ÓıÂÎÙÈΤ˜ ÂÚÈÙÒÛÂȘ Ë ¯ÔÚ‹ÁËÛË Ê·ÚÌ¿ÎˆÓ Ì ·ÏÏËÏÔÛ˘ÌÏËÚÔ‡ÌÂÓÔ˘˜ Ì˯·ÓÈÛÌÔ‡˜ ‰Ú¿Û˘ ÌÔÚ› Ó· ÂÈʤÚÂÈ Ê·ÚÌ·ÎÔ‰˘Ó·ÌÈ΋ Û˘Ó¤ÚÁÂÈ· Ì ηχÙÂÚ· ·ÔÙÂϤÛÌ·Ù·. ¶ÈÛÙ‡ÂÙ·È fiÙÈ Ë Ù·˘Ùfi¯ÚÔÓË ¯ÔÚ‹ÁËÛË ÂÓfi˜ Ê·ÚÌ¿ÎÔ˘ Ì ‰Ú¿ÛË ÛÙÔ˘˜ ‰È·‡ÏÔ˘˜ Ó·ÙÚ›Ô˘ Î·È ÂÓfi˜ ¿ÏÏÔ˘ Ì Â›‰Ú·ÛË ÛÙÔ Á-·ÌÈÓÔ‚Ô˘Ù˘ÚÈÎfi Ô͇ (GABA), ÂÓfi˜ ·Ó·ÛÙ·ÏÙÈÎÔ‡ Ó¢ÚÔÌÂÙ·‚È‚·ÛÙ‹ ÛÙÔ ÎÂÓÙÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ·, ¤¯ÂÈ Î·Ï‡ÙÂÚË ‰Ú¿ÛË ·fi ÙË Û˘Á¯ÔÚ‹ÁËÛË ‰‡Ô ·ÓÙÈÂÈÏËÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ Ì ‰Ú¿ÛË ÛÙÔ˘˜ ‰È·‡ÏÔ˘˜ ÙÔ˘ Ó·ÙÚ›Ô˘. ¶›Ó·Î·˜ 2. ÕÏÏ· ¯·Ú·ÎÙËÚÈÛÙÈο ÁÓˆÚ›ÛÌ·Ù· ÙÔ˘ ȉÂÒ‰Ô˘˜ ·ÓÙÈÂÈÏËÙÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘ ñ ∏ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ó· Û¯ÂÙ›˙ÂÙ·È Ì ÙË ‰fiÛË ·fi ÙÔ ÛÙfiÌ· ñ ¡· ÌËÓ ¯ÚÂÈ¿˙ÂÙ·È ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ ÂÈ¤‰ˆÓ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ÛÙÔ ·›Ì· ñ ∂˘Ú‡ ıÂÚ·¢ÙÈÎfi fiÚÈÔ ñ ∆· ıÂÚ·¢ÙÈο Â›‰· Ó· ·¤¯Ô˘Ó Ôχ ·fi Ù· ÙÔÍÈο Â›‰· ñ ¡· Â›Ó·È ÁÓˆÛÙfi˜ Ô ÙÚfiÔ˜ ‰Ú¿Û˘ ñ ¡· ˘¿Ú¯ÂÈ ÂÌÂÈÚ›· ÛÙ· ·È‰È¿ ñ °Ú‹ÁÔÚË ÙÈÙÏÔÔ›ËÛË Ù˘ ·Ú¯È΋˜ ‰fiÛ˘ ñ ∏ ·fiÙÔÌË ‰È·ÎÔ‹ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Ó· ÌËÓ ÚÔηÏ› Û·ÛÌÔ‡˜ ñ ¡· ÌËÓ ÂÎÎÚ›ÓÂÙ·È ÙÔ Ê¿ÚÌ·ÎÔ ÛÙÔ Á¿Ï· Ù˘ ÌËÙ¤Ú·˜ Ô˘ ıËÏ¿˙ÂÈ

Paediatriki 2004;67:88-96

∂›Ó·È ÛËÌ·ÓÙÈÎfi Ó· ˘¿Ú¯ÂÈ ÂÌÂÈÚ›· ·fi ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ ·ÓÙÈÂÈÏËÙÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘ ÛÙ· ·È‰È¿, ÁÈ·Ù› Û˘¯Ó¿ ˘¿Ú¯ÂÈ ¤Ú¢ӷ Î·È ÂÌÂÈÚ›· ÌfiÓÔ ÛÙÔ˘˜ ÂÓ‹ÏÈΘ, Ë ÔÔ›· ÌÂٷʤÚÂÙ·È ÛÙ· ·È‰È¿. ™˘¯Ó¿, fï˜, Ù· ·È‰È¿ ·ÓÙ·ÔÎÚ›ÓÔÓÙ·È ‰È·ÊÔÚÂÙÈο ·fi ÙÔ˘˜ ÂÓ‹ÏÈΘ ÛÙ· ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η Î·È Ë ·È‰È΋ ÂÈÏË„›· ‰ÂÓ Â›Ó·È Ù·˘ÙfiÛËÌË Ì ÂΛÓË ÙˆÓ ÂÓËϛΈÓ. ∆Ô ·ÓÙÈÂÈÏËÙÈÎfi Ê¿ÚÌ·ÎÔ ı· Ú¤ÂÈ Ó· ÌÔÚ› Ó· ¯ÔÚËÁÂ›Ù·È Û ηÓÔÓÈΤ˜ ‰fiÛÂȘ ·fi ÙËÓ ·Ú¯‹ Ù˘ ıÂÚ·›·˜ Î·È Ó· ÌËÓ ¯ÚÂÈ¿˙ÂÙ·È ÛÙ·‰È·Î‹ ·‡ÍËÛË Ù˘ ·Ú¯È΋˜ ‰fiÛ˘, fiˆ˜ Û˘Ì‚·›ÓÂÈ Ì ٷ ÂÚÈÛÛfiÙÂÚ· ·Ï·ÈfiÙÂÚ· Î·È ÓÂfiÙÂÚ· ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η, ÁÈ·Ù› ¤ÙÛÈ ·ÚÁ› Ë ¯ÔÚ‹ÁËÛË Ù˘ ·ÔÙÂÏÂÛÌ·ÙÈ΋˜ ‰fiÛ˘. ∂›Û˘, Ë ·fiÙÔÌË ‰È·ÎÔ‹ Ù˘ ıÂÚ·›·˜, fiˆ˜ ··ÈÙÂ›Ù·È Û ÂÚÈÙÒÛÂȘ ÂÌÊ¿ÓÈÛ˘ ·ÓÂÈı‡ÌËÙˆÓ ÂÓÂÚÁÂÈÒÓ, ı· Ú¤ÂÈ Ó· ÌËÓ ÚÔηÏ› ‰È¿ÊÔÚ· Û˘ÌÙÒÌ·Ù· Î·È Û·ÛÌÔ‡˜, οÙÈ Ô˘ ·Ú·ÙËÚÂ›Ù·È Ì fiÏ· Ù· ˘¿Ú¯ÔÓÙ· ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η Î·È È‰È·›ÙÂÚ· Ì ÙË Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË Î·È ÙȘ ‚ÂÓ˙ԉȷ˙Â›Ó˜. ∂ÈϤÔÓ, ÙÔ ·ÓÙÈÂÈÏËÙÈÎfi Ê¿ÚÌ·ÎÔ ‰ÂÓ ı· Ú¤ÂÈ Ó· ÂÎÎÚ›ÓÂÙ·È ÛÙÔ Á¿Ï· Ù˘ ÌËÙ¤Ú·˜ Ì ÂÈÏË„›· Ô˘ ıËÏ¿˙ÂÈ Î·È Ï·Ì‚¿ÓÂÈ ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η ‹, Â¿Ó ÂÎÎÚ›ÓÂÙ·È, Ó· ÌËÓ ÚÔηÏ› Û˘ÌÙÒÌ·Ù· ÛÙÔ ıËÏ¿˙ÔÓ ÓÂÔÁÓfi. ∂Âȉ‹ Ù· ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η Û˘¯Ó¿ ¯ÔÚËÁÔ‡ÓÙ·È ÁÈ· ÌÂÁ¿ÏÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·, ÙÔ ÎfiÛÙÔ˜ ¤¯ÂÈ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙË ıÂÚ·›· Ù˘ ÂÈÏË„›·˜, ȉȷ›ÙÂÚ· ÛÙȘ ÊÙˆ¯¤˜ ¯ÒÚ˜, fiÔ˘ Ôχ ·ÛıÂÓ›˜ ·‰˘Ó·ÙÔ‡Ó Ó· Ù· ÚÔÌËı¢ÙÔ‡Ó, Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÂÏÏÈ‹ ıÂÚ·›· ÙÔ˘˜. °ÂÓÈο, Ù· ÓÂfiÙÂÚ· ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η Â›Ó·È ÈÔ ·ÎÚÈ‚¿ ·fi Ù· ·Ï·ÈfiÙÂÚ·. ∂ÓÙÔ‡ÙÔȘ, ÙÔ ÎfiÛÙÔ˜ ‰ÂÓ Ú¤ÂÈ Ó· ˘ÔÏÔÁ›˙ÂÙ·È ÌfiÓÔ ·fi ÙËÓ ÙÈÌ‹ ·ÁÔÚ¿˜ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘, ·ÏÏ¿ Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÔÓÙ·È ˘’ fi„ÈÓ Î·È ¿ÏÏÔÈ ·Ú¿ÁÔÓÙ˜, fiˆ˜ ÙÔ ÎfiÛÙÔ˜ Ô˘ ÚÔ·ÙÂÈ ·fi ÙȘ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ ÙˆÓ Ê·ÚÌ¿ÎˆÓ ‹ ÙÔ ÎfiÛÙÔ˜ ÓÔÛËÏ›·˜ ·fi ÙË ÌË ÈηÓÔÔÈËÙÈ΋ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ¿ ÙÔ˘˜. ™ÙË Û˘Ó¤¯ÂÈ· ·Ó·Ê¤ÚÔÓÙ·È Ù· ‚·ÛÈÎfiÙÂÚ· ÏÂÔÓÂÎÙ‹Ì·Ù· Î·È ÌÂÈÔÓÂÎÙ‹Ì·Ù· ÙˆÓ Î˘ÚÈfiÙÂÚˆÓ ·Ï·ÈfiÙÂÚˆÓ Î·È ÓÂfiÙÂÚˆÓ ·ÓÙÈÂÈÏËÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ (¶›Ó·Î˜ 3, 4). ¶ÏÂÔÓÂÎÙ‹Ì·Ù· Î·È ÌÂÈÔÓÂÎÙ‹Ì·Ù· ·Ï·ÈfiÙÂÚˆÓ ·ÓÙÈÂÈÏËÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ ∆Ô ‚·ÏÚÔ˚Îfi Ó¿ÙÚÈÔ (Depakine) Â›Ó·È ¤Ó· ·fi Ù· ‰‡Ô ·Ï·ÈfiÙÂÚ· ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η Ô˘ ÂÍ·ÎÔÏÔ˘ıÔ‡Ó Ó· ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Û˘¯Ó¿ ηÈ, Ì¿ÏÈÛÙ·, ˆ˜ ·Ú¯È΋ ıÂÚ·›· Ù˘ ÂÈÏË„›·˜ ÛÙ· ·È‰È¿ (14). ∫‡ÚÈÔ ÏÂÔÓ¤ÎÙËÌ· ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Â›Ó·È ÙÔ Â˘Ú‡ Ê¿ÛÌ· Ù˘ ‰Ú¿Û˘ ÙÔ˘, ηıÒ˜ Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈÎfi ÙfiÛÔ Û ÂÛÙȷΤ˜ fiÛÔ Î·È Û ÁÂÓÈÎÂ˘Ì¤Ó˜ ÂÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ, fiˆ˜ Â›Ó·È ÔÈ ÁÂÓÈÎÂ˘Ì¤ÓÔÈ

91

¶·È‰È·ÙÚÈ΋ 2004;67:88-96

Paediatriki 2004;67:88-96

¶›Ó·Î·˜ 3. ÷ڷÎÙËÚÈÛÙÈο ÁÓˆÚ›ÛÌ·Ù· ·Ï·ÈfiÙÂÚˆÓ ·ÓÙÈÂÈÏËÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ Ã·Ú·ÎÙËÚÈÛÙÈο ÁÓˆÚ›ÛÌ·Ù·

µ·ÏÚÔ˚Îfi Ó¿ÙÚÈÔ ∫·Ú‚·Ì·˙Â›ÓË ∞ÈıÔÛÔ˘ÍÈÌ›‰Ë º·ÈÓÔ‚·Ú‚ÈÙ¿ÏË º·ÈÓ˘ÙÔ˝ÓË

∂˘Ú‡ Ê¿ÛÌ· ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ ∂ÌÂÈÚ›· ÛÙ· ·È‰È¿ ¶·È‰È·ÙÚÈ΋ ÌÔÚÊ‹ ∂Ó‰ÔÊϤ‚È· ÌÔÚÊ‹ ¶Ï‹Ú˘ ‹ ÛÙ·ıÂÚ‹ ‚ÈԉȷıÂÛÈÌfiÙËÙ· ÃÚfiÓÔ˜ ËÌ›ÛÂÈ·˜ ˙ˆ‹˜ (ÒÚ˜) °Ú·ÌÌÈ΋ ·ÔÚÚfiÊËÛË Î·È ·Ô‚ÔÏ‹ ¢¤ÛÌ¢ÛË Ì ÚˆÙ½Ó˜ Ï¿ÛÌ·ÙÔ˜ °Ú‹ÁÔÚË ·‡ÍËÛË ·Ú¯È΋˜ ‰fiÛ˘ º·ÚÌ·ÎÔÎÈÓËÙÈΤ˜ ·ÏÏËÏÂȉڿÛÂȘ ¶ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÂÈ¤‰ˆÓ ÔÚÔ‡

¡·È ¡·È ¡·È ¡·È ¡·È 6-18 ¡·È 90% ¡·È ¡·È ¡·È

Ÿ¯È ¡·È ¡·È Ÿ¯È ¡·È 5-12 ¡·È 75% Ÿ¯È ¡·È ¡·È

Ÿ¯È ¡·È ¡·È Ÿ¯È ¡·È 30-40 ¡·È Ÿ¯È §›Á˜ ¡·È

¡·È ¡·È ¡·È ¡·È ¡·È 20-150 ¡·È 50% ¡·È ¡·È ¡·È

Ÿ¯È ¡·È ¡·È ¡·È ¡·È 8-40 Ÿ¯È 90-95% ¡·È ¡·È ¡·È

¶›Ó·Î·˜ 4. ÷ڷÎÙËÚÈÛÙÈο ÁÓˆÚ›ÛÌ·Ù· ÓÂfiÙÂÚˆÓ ·ÓÙÈÂÈÏËÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ Ã·Ú·ÎÙËÚÈÛÙÈο ÁÓˆÚ›ÛÌ·Ù· ∂˘Ú‡ Ê¿ÛÌ· ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ ∂ÌÂÈÚ›· ÛÙ· ·È‰È¿ ¶·È‰È·ÙÚÈ΋ ÌÔÚÊ‹ ∂Ó‰ÔÊϤ‚È· ÌÔÚÊ‹ ¶Ï‹Ú˘ ‹ ÛÙ·ıÂÚ‹ ‚ÈԉȷıÂÛÈÌfiÙËÙ· ÃÚfiÓÔ˜ ËÌ›ÛÂÈ·˜ ˙ˆ‹˜ (ÒÚ˜) °Ú·ÌÌÈ΋ ·ÔÚÚfiÊËÛË Î·È ·Ô‚ÔÏ‹ ¢¤ÛÌ¢ÛË Ì ÚˆÙ½Ó˜ Ï¿ÛÌ·ÙÔ˜ °Ú‹ÁÔÚË ·‡ÍËÛË ·Ú¯È΋˜ ‰fiÛ˘ º·ÚÌ·ÎÔÎÈÓËÙÈΤ˜ ·ÏÏËÏÂȉڿÛÂȘ ¶ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÂÈ¤‰ˆÓ ÔÚÔ‡

§·ÌÔÙÚÈÁ›ÓË ∆ÔÈÚ·Ì¿ÙË OÍηڂ·˙Â›ÓË

∫ÏÔÌ·˙¿ÌË ∆È·ÁηÌ›ÓË °Î·Ì·- §Â‚ÂÙÈÚ·ÂÓÙ›ÓË ÛÂÙ¿ÌË

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15-60

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6-8

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ÙÔÓÈÎÔÎÏÔÓÈÎÔ› Û·ÛÌÔ›, ÔÈ ·Ê·ÈÚ¤ÛÂȘ Î·È ÔÈ Ì˘ÔÎÏÔÓÈÎÔ›, ·ÙÔÓÈÎÔ› Î·È ÙÔÓÈÎÔ› Û·ÛÌÔ›. ÕÏÏ· ÏÂÔÓÂÎÙ‹Ì·Ù· ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Â›Ó·È Ë Û¿ÓÈ· ÂÌÊ¿ÓÈÛË È‰ÈÔÛ˘ÁÎÚ·ÛÈ·ÎÒÓ ·ÓÂÈı‡ÌËÙˆÓ ÂÓÂÚÁÂÈÒÓ, Ë ÌË Â›‰Ú·ÛË ÛÙȘ ÓÔËÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜, Ë ·Ô˘Û›· Â·ÁˆÁ‹˜ ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ¿ÏÏˆÓ Ê·ÚÌ¿ÎˆÓ ÛÙÔ ‹·Ú, Ë ‡·ÚÍË ˘ÁÚ‹˜ Î·È ÂÓ‰ÔÊϤ‚È·˜ ÌÔÚÊ‹˜ ηÈ, ÂÔ̤ӈ˜, Ë ‰˘Ó·ÙfiÙËÙ· Ó· ¯ÔÚËÁËı› Û ÌÈÎÚ¿ ·È‰È¿ Î·È Û Â›ÁÔ˘Û˜ ηٷÛÙ¿ÛÂȘ, Ë ‰˘Ó·ÙfiÙËÙ· ¯ÔÚ‹ÁËÛ˘ Û 1-2 ‰fiÛÂȘ ÙËÓ Ë̤ڷ, ÏfiÁˆ Ù˘ ‡·Ú͢ Ù˘ ÌÔÚÊ‹˜ ‚Ú·‰Â›·˜ Î·È ÂÏÂÁ¯fiÌÂÓ˘ ·Ô‰¤ÛÌ¢Û˘ Î·È ÙÔ Û¯ÂÙÈο ¯·ÌËÏfi ÎfiÛÙÔ˜.

OÈ ÈÔ ÛÔ‚·Ú¤˜, ·ÏÏ¿ Û¿ÓȘ, ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙËÓ ÂÌÊ¿ÓÈÛË ÔÍ›·˜ ·ÁÎÚ·ٛÙȉ·˜ Î·È Ë·ÙÔÙÔÍÈÎfiÙËÙ·˜. ∏·ÙÔÙÔÍÈÎfiÙËÙ· ÂÌÊ·Ó›˙ÂÙ·È Û 1 ·Ó¿ 20.000 ·ÛıÂÓ›˜, ·ÏÏ¿ Â›Ó·È Û˘¯ÓfiÙÂÚË ÛÙ· ·È‰È¿ ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ 2 ÂÙÒÓ Î·È Î˘Ú›ˆ˜ Û ·˘Ù¿ Ô˘ Ï·Ì‚¿ÓÔ˘Ó Ù·˘Ùfi¯ÚÔÓ· Î·È ¿ÏÏ· ·ÓÙÈÂÈÏËÙÈο

92

µÈÁηÌ·ÙÚ›ÓË

Ê¿Ú̷η, ¤¯Ô˘Ó ÓÔËÙÈ΋ ηı˘ÛÙ¤ÚËÛË, ÌÂÙ·‚ÔÏÈÎfi ÓfiÛËÌ·, fiˆ˜ ‰È·Ù·Ú·¯¤˜ Ù˘ ‚-ÔÍ›‰ˆÛ˘ ÙˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ ‹ ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi ÓfiÛËÌ·, ‹ ÚÔ¸¿Ú¯Ô˘Û· ‚Ï¿‚Ë ÙÔ˘ ‹·ÙÔ˜. ™Â ·È‰È¿ ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ 2 ÂÙÒÓ, Ù· ÔÔ›· Ï·Ì‚¿ÓÔ˘Ó ÔÏÏ·Ï‹ ·ÓÙÈÂÈÏËÙÈ΋ ıÂÚ·›·, Ë ÂÌÊ¿ÓÈÛË Ë·ÙÔÙÔÍÈÎfiÙËÙ·˜ ·Ó¤Ú¯ÂÙ·È Û 1 ·Ó¿ 600 ‹ 1 ·Ó¿ 800 ·ÛıÂÓ›˜. ∏ Û˘¯ÓfiÙËÙ·, fï˜, ÌÂÈÒÓÂÙ·È Ì ÙËÓ ·‡ÍËÛË Ù˘ ËÏÈΛ·˜. ¶·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ô ÂÚÈÔ‰ÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙˆÓ Ë·ÙÈÎÒÓ ÂÓ˙‡ÌˆÓ, ΢ڛˆ˜ ÛÙÔ˘˜ 6 ÚÒÙÔ˘˜ Ì‹Ó˜ ıÂÚ·›·˜, ÌÔÚ› Ó· ·ÓȯÓ‡ÛÂÈ Û ÌÂÚÈΤ˜ ÂÚÈÙÒÛÂȘ ¤ÁηÈÚ· ÙËÓ Ë·ÙÈ΋ ‚Ï¿‚Ë, ¯ÚÂÈ¿˙ÂÙ·È ÂÁÚ‹ÁÔÚÛË, ÂÓÒ Ë ÂÌÊ¿ÓÈÛË Û˘ÌÙˆÌ¿ÙˆÓ fiˆ˜ ˘ÓËÏ›·, ·ÓÔÚÂÍ›·, ¤ÌÂÙÔÈ Î·È ·‡ÍËÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÂÈÏËÙÈÎÒÓ ÎÚ›ÛˆÓ, ÌÔÚ› Ó· ÛËÌ·ÙÔ‰ÔÙ› ÙËÓ ÂΉ‹ÏˆÛË Ë·ÙÔÙÔÍÈÎfiÙËÙ·˜. ªÂÈÔÓÂÎÙ‹Ì·Ù· ÙÔ˘ Ê·ÚÌ¿ÎÔ˘, Â›Û˘, ·ÔÙÂÏÔ‡Ó Ë ÈÛ¯˘Ú‹ Û‡Ó‰ÂÛË Ì Ï¢ÎÒÌ·Ù· ÙÔ˘ ·›Ì·ÙÔ˜, Ë ÚfiÎÏËÛË Â›ÌÔÓˆÓ Á·ÛÙÚÂÓÙÂÚÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ,

¶·È‰È·ÙÚÈ΋ 2004;67:88-96

‰È·Ù·Ú·¯ÒÓ ÂÌÌ‹ÓÔ˘ Ú‡Ûˆ˜ Î·È ÔÏ˘Î˘ÛÙÈÎÒÓ ˆÔıËÎÒÓ, Ë ·‡ÍËÛË ÛˆÌ·ÙÈÎÔ‡ ‚¿ÚÔ˘˜, Ë ÚfiÎÏËÛË ÙÂÚ·ÙÔÁ¤ÓÂÛ˘ (‰Èۯȉ‹˜ Ú¿¯Ë) Î·È ÔÈ ·ÏÏËÏÂȉڿÛÂȘ Ì ¿ÏÏ· Ê¿Ú̷η (Û˘¯Ó¿ ·Ó·ÛÙ¤ÏÏÂÈ ÙÔÓ ÌÂÙ·‚ÔÏÈÛÌfi ÙÔ˘˜). ∏ ηڂ·Ì·˙Â›ÓË (Tegretol) Â›Ó·È ÙÔ ‰Â‡ÙÂÚÔ ·fi Ù· ·Ï·ÈfiÙÂÚ· Ê¿Ú̷η Ô˘ Û˘¯Ó¿ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È. ∫‡ÚÈ· ÏÂÔÓÂÎÙ‹Ì·Ù· ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Â›Ó·È Ë ¤ÏÏÂÈ„Ë Î·Ù·ÛÙ·ÏÙÈ΋˜ ‰Ú¿Û˘ Û ıÂÚ·¢ÙÈΤ˜ ‰fiÛÂȘ, Ë ‡·ÚÍË ˘ÁÚ‹˜ ÌÔÚÊ‹˜ ÁÈ· Ï‹„Ë ·fi ÙÔ ÛÙfiÌ·, Ë ‰˘Ó·ÙfiÙËÙ· ¯ÔÚ‹ÁËÛ‹˜ ÙÔ˘ Û ‰‡Ô ‰fiÛÂȘ ÙËÓ Ë̤ڷ ÏfiÁˆ Ù˘ ‡·Ú͢ Ù˘ ÌÔÚÊ‹˜ ‚Ú·‰Â›·˜ Î·È ÂÏÂÁ¯fiÌÂÓ˘ ·Ô‰¤ÛÌ¢Û˘, Ë ÌÈÎÚfiÙÂÚË ÙÂÚ·ÙÔÁfiÓÔ˜ ‰Ú¿ÛË Û ۯ¤ÛË Ì ٷ ¿ÏÏ· ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η Î·È ÙÔ Û¯ÂÙÈο ¯·ÌËÏfi ÎfiÛÙÔ˜. ∫‡ÚÈÔ ÌÂÈÔÓ¤ÎÙËÌ· ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Â›Ó·È ÙÔ ÂÚÈÔÚÈṲ̂ÓÔ Ê¿ÛÌ· ‰Ú·ÛÙÈÎfiÙËÙ·˜, ηıÒ˜ Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈÎfi ÌfiÓÔ Û ÂÛÙȷΤ˜ Î·È ÁÂÓÈÎÂ˘Ì¤Ó˜ ÙÔÓÈÎÔÎÏÔÓÈΤ˜ ÂÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ Î·È ÌÔÚ› Ó· ÂȉÂÈÓÒÛÂÈ ‹ Ó· ÚÔηϤÛÂÈ Ì˘ÔÎÏÔӛ˜ Î·È ·Ê·ÈÚ¤ÛÂȘ. ∏ ηڂ·Ì·˙Â›ÓË ıˆÚÂ›Ù·È ˆ˜ ÚÒÙ˘ ÂÈÏÔÁ‹˜ ·ÓÙÈÂÈÏËÈÎfi Ê¿ÚÌ·ÎÔ ÁÈ· ÙȘ ȉÈÔ·ı›˜ η Û˘Ìو̷ÙÈΤ˜ ÂÛÙȷΤ˜ ÂÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ (6-8). ÕÏÏ· ÌÂÈÔÓÂÎÙ‹Ì·Ù· ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Â›Ó·È Ë Û˘¯Ó‹ ÂÌÊ¿ÓÈÛË È‰ÈÔÛ˘ÁÎÚ·ÛÈ·ÎÒÓ ·ÓÙȉڿÛˆÓ, fiˆ˜ Â›Ó·È Ù· ‰ÂÚÌ·ÙÈο ÂÍ·Óı‹Ì·Ù· (515% ÙˆÓ ·ÛıÂÓÒÓ) Ô˘ Û¿ÓÈ· fï˜ Â›Ó·È ÛÔ‚·Ú¿ (ÂÌÊ·Ó›˙ÔÓÙ·È Î˘Ú›ˆ˜ ηٿ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜ Î·È ˘Ô¯ˆÚÔ‡Ó Ì ÙË ‰È·ÎÔ‹ Ù˘), Ë Û˘¯Ó‹ ÂÌÊ¿ÓÈÛË Ï¢ÎÔÂÓ›·˜ (Ô˘ Â›Ó·È ·Ó·ÛÙÚ¤„ÈÌË), Ë Û¿ÓÈ· ÂÌÊ¿ÓÈÛË ·Ï·ÛÙÈ΋˜ ·Ó·ÈÌ›·˜ Î·È Ë·ÙÔÙÔÍÈÎfiÙËÙ·˜, Ë ÚfiÎÏËÛË Ó¢ÚÔÙÔÍÈÎfiÙËÙ·˜ ΢ڛˆ˜ ηٿ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜, Ë ÌË ‡·ÚÍË ÂÓ‰ÔÊϤ‚È·˜ ÌÔÚÊ‹˜ Î·È Ë Â·ÁˆÁÈ΋ ‰Ú¿ÛË ÙÔ˘ ÛÙ· Ë·ÙÈο ¤Ó˙˘Ì·, Ì ·ÔÙ¤ÏÂÛÌ· ÙË Ì›ˆÛË ÙˆÓ ÂÈ¤‰ˆÓ ÛÙÔ ·›Ì· ÔÏÏÒÓ ·ÓÙÈÂÈÏËÙÈÎÒÓ ‹ ÌË Ê·Ú̿ΈÓ. À¿Ú¯Ô˘Ó ÙÚ›· ·Ï·È¿ Ê¿Ú̷η Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÂÏ¿¯ÈÛÙ· Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, ÁÈ· ͯˆÚÈÛÙÔ‡˜ ÏfiÁÔ˘˜ ÙÔ Î·ı¤Ó·. ∏ ·ÈıÔÛÔ˘ÍÈÌ›‰Ë (Zarontin), ¤Ó· ÊıËÓfi Î·È ‰ÔÎÈÌ·Ṳ̂ÓÔ Ê¿ÚÌ·ÎÔ, ηϿ ·ÓÂÎÙfi, Ì ϛÁ˜ ·ÏÏËÏÂȉڿÛÂȘ Î·È Ì ÌÈÎÚ‹ ÙÂÚ·ÙÔÁfiÓÔ ‰Ú¿ÛË, ·ÔÙÂÏÂÛÌ·ÙÈÎfi Û ·Ê·ÈÚ¤ÛÂȘ ·ÏÏ¿ Î·È ÛÂ Ì˘ÔÎÏÔӛ˜, ¯ÚËÛÈÌÔÔÈÂ›Ù·È Ï›ÁÔ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, ÁÈ·Ù› ¤¯ÂÈ ÛÙÂÓfi Ê¿ÛÌ· ‰Ú¿Û˘ Î·È ‰ÂÓ Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈ΋ Û ÙÔÓÈÎÔÎÏÔÓÈÎÔ‡˜ Û·ÛÌÔ‡˜ Ô˘ Û˘ÓÔ‰Â‡Ô˘Ó Û˘¯Ó¿ Ù· ·È‰È¿ Ì ·Ê·ÈÚ¤ÛÂȘ. ªÔÚ› Ó· ÚÔηϤÛÂÈ Á·ÛÙÚÂÓÙÂÚÈΤ˜ ‰È·Ù·Ú·¯¤˜ ηÈ, Û¿ÓÈ·, ·Ï·ÛÙÈ΋ ·Ó·ÈÌ›·. ∏ Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË (Kaneuron), ÙÔ ·Ú¯·ÈfiÙÂÚÔ ÂÓ ¯Ú‹ÛÂÈ ·ÓÙÈÂÈÏËÙÈÎfi Ê¿ÚÌ·ÎÔ, Â›Ó·È ¤Ó· ÊıËÓfi Î·È Ì ηϤ˜ Ê·ÚÌ·ÎÔÎÈÓËÙÈΤ˜ ȉÈfiÙËÙ˜ ·ÓÙÈÂÈ-

Paediatriki 2004;67:88-96

ÏËÙÈÎfi Ê¿ÚÌ·ÎÔ. ÃÔÚËÁÂ›Ù·È 1-2 ÊÔÚ¤˜ ÙËÓ Ë̤ڷ, ˘¿Ú¯ÂÈ Û ˘ÁÚ‹ Î·È ÂÓ‰ÔÊϤ‚È· ÌÔÚÊ‹ Î·È ¤¯ÂÈ Û¯ÂÙÈο ¢ڇ Ê¿ÛÌ· ‰Ú¿Û˘. §fiÁˆ Ù˘ ÌÂÁ¿Ï˘ ÎÏÈÓÈ΋˜ ÂÌÂÈÚ›·˜, ¯ÔÚËÁÂ›Ù·È Û˘¯Ó¿ Û ÂÈÏË„›Â˜ Ù˘ ÓÂÔÁÓÈ΋˜ Î·È ‚ÚÂÊÈ΋˜ ËÏÈΛ·˜. ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÏÈÁfiÙÂÚÔ Û ÂÈÏËÙÈο ·È‰È¿ ¿ÏÏ˘ ËÏÈΛ·˜, ÁÈ·Ù› ÚÔηÏ› Û˘¯Ó¿ ˘ÓËÏ›·, Ì·ÎÚÔ¯ÚfiÓȘ ‰È·Ù·Ú·¯¤˜ ÙˆÓ ÓÔËÙÈÎÒÓ ÏÂÈÙÔ˘ÚÁÈÒÓ Î·È ‰È·Ù·Ú·¯¤˜ Û˘ÌÂÚÈÊÔÚ¿˜ (6-8). ∂ÈϤÔÓ, ¤¯ÂÈ ÙÂÚ·ÙÔÁfiÓÔ Î·È Â·ÁˆÁÈ΋ ‰Ú¿ÛË Î·È ÌÔÚ› Ó· ÚÔηϤÛÂÈ Û˘ÌÙÒÌ·Ù·, ÏfiÁˆ ‰È·ÎÔ‹˜ ¯ÔÚ‹ÁËÛ‹˜ Ù˘ ηÈ, Û¿ÓÈ·, ‰È·Ù·Ú·¯¤˜ ÙÔ˘ Û˘Ó‰ÂÙÈÎÔ‡ ÈÛÙÔ‡. ∆· ·ÚÈ· ÏÂÔÓÂÎÙ‹Ì·Ù· Ù˘ Ê·ÈÓ˘ÙÔ˝Ó˘ (Epanutin), ÙÔ˘ ÙÚ›ÙÔ˘ ·fi Ù· ·Ï·ÈfiÙÂÚ· ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η Ô˘ ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÏÈÁfiÙÂÚÔ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, ȉȷ›ÙÂÚ· ÛÙËÓ ∂˘ÚÒË, ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙËÓ ¤ÏÏÂÈ„Ë ˘ÓËÏ›·˜ Û ıÂÚ·¢ÙÈΤ˜ ‰fiÛÂȘ, ÙÔÓ ÌÂÁ¿ÏÔ ¯ÚfiÓÔ ËÌ›ÛÂÈ·˜ ˙ˆ‹˜, Ì ·ÔÙ¤ÏÂÛÌ· ÙË ‰˘Ó·ÙfiÙËÙ· ¯ÔÚ‹ÁËÛ‹˜ Ù˘ 1-2 ÊÔÚ¤˜ ÙËÓ Ë̤ڷ, ÙË ‰È¿ıÂÛ‹ Ù˘ Û ˘ÁÚ‹ Î·È ÂÓ‰ÔÊϤ‚È· ÌÔÚÊ‹, ÙË ‰˘Ó·ÙfiÙËÙ· Ó· ¯ÔÚËÁËı› Û ˘„ËϤ˜ ‰fiÛÂȘ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜ Î·È ÙÔ ¯·ÌËÏfi ÎfiÛÙÔ˜. §fiÁˆ ‡·Ú͢ Â·ÚÎÔ‡˜ ÎÏÈÓÈ΋˜ ÂÌÂÈÚ›·˜, Ë ÔÔ›· ‰ÂÓ ˘Ê›ÛÙ·Ù·È ÁÈ· Ù· ÓÂfiÙÂÚ· ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η, Ë Ê·ÈÓ˘ÙÔ˝ÓË, Ì·˙› Ì ٷ ·Ï·È¿ ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË Î·È ‚ÂÓ˙ԉȷ˙Â›Ó˜, ÚÔÙÈÌ¿Ù·È Î˘Ú›ˆ˜ ÁÈ· ÙË ıÂÚ·›· ÙˆÓ ÂÈÏËÙÈÎÒÓ ÎÚ›ÛÂˆÓ ÛÙË ‚ÚÂÊÈ΋ ËÏÈΛ· (6-8). ∫‡ÚÈ· ÌÂÈÔÓÂÎÙ‹Ì·Ù· ÙÔ˘ Ê·ÚÌ¿ÎÔ˘, Ù· ÔÔ›· ¤¯Ô˘Ó Ô‰ËÁ‹ÛÂÈ ÛÙË Û¿ÓÈ· ¯ÔÚ‹ÁËÛ‹ ÙÔ˘ Û ÂÈÏËÙÈο ·È‰È¿ ¿ÏÏˆÓ ËÏÈÎÈÒÓ, Â›Ó·È ÙÔ ÛÙÂÓfi Ê¿ÛÌ· ‰Ú·ÛÙÈÎfiÙËÙ·˜ ηÈ, Û˘ÁÎÂÎÚÈ̤ӷ, Ë ‰Ú¿ÛË ÌfiÓÔ Û ÂÛÙȷΤ˜ Î·È ÁÂÓÈÎÂ˘Ì¤Ó˜ ÙÔÓÈÎÔÎÏÔÓÈΤ˜ ÂÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ, Ë ÚfiÎÏËÛË Ó¢ÚÔÙÔÍÈÎfiÙËÙ·˜, ‰È·Ù·Ú·¯ÒÓ ÙÔ˘ Û˘Ó‰ÂÙÈÎÔ‡ ÈÛÙÔ‡ Î·È ‰˘ÛÌÔÚÊÈÒÓ, Ë Ì·ÎÚÔ¯ÚfiÓÈ· ÙÔÍÈÎfiÙËÙ· Ô˘ ·ÊÔÚ¿ ΢ڛˆ˜ ÛÙȘ ÓÔËÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜, Ë ÈÛ¯˘Ú‹ Û‡Ó‰ÂÛË Ì ٷ Ï¢ÎÒÌ·Ù· ÙÔ˘ ·›Ì·ÙÔ˜, Ë Â·ÁˆÁÈ΋ Î·È ÙÂÚ·ÙÔÁfiÓÔ˜ ‰Ú¿ÛË Î·È Ô ··ÈÙÔ‡ÌÂÓÔ˜ Û˘¯Ófi˜ ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ ÂÈ¤‰ˆÓ ÛÙÔ ·›Ì·, ηıÒ˜ Ë ·¤ÎÎÚÈÛ‹ ÙÔ˘ Â›Ó·È ÌË ÁÚ·ÌÌÈ΋ Î·È ÂӉ¯fiÌÂÓË ÌÈÎÚ‹ ·‡ÍËÛË Ù˘ ‰fiÛ˘ ÚÔηÏ› ÌÂÁ¿ÏË ·‡ÍËÛË ÙˆÓ ÂÈ¤‰ˆÓ ÛÙÔ ·›Ì·, Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÙÔÍÈÎfiÙËÙ·. ¶ÏÂÔÓÂÎÙ‹Ì·Ù· Î·È ÌÂÈÔÓÂÎÙ‹Ì·Ù· ÓÂfiÙÂÚˆÓ ·ÓÙÈÂÈÏËÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ ŸÛÔÓ ·ÊÔÚ¿ ÛÙ· ÓÂfiÙÂÚ· ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η, ÌÂÁ·Ï‡ÙÂÚË ÂÌÂÈÚ›· ·fi ÙË ¯Ú‹ÛË ÙÔ˘˜ ÛÙ· ·È‰È¿ ˘¿Ú¯ÂÈ ÁÈ· ÙË Ï·ÌÔÙÚÈÁ›ÓË, ÙËÓ ÙÔÈÚ·Ì¿ÙË Î·È ÙËÓ ÔÍηڂ·˙Â›ÓË. ∫‡ÚÈÔ ÏÂÔÓÂÎÙ‹Ì· Ù˘ Ï·ÌÔÙÚÈÁ›Ó˘ (Lamictal) Â›Ó·È ÙÔ Â˘Ú‡ Ê¿ÛÌ· ‰Ú¿Û˘

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Ù˘, ηıÒ˜ Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈ΋ ÙfiÛÔ Û ÂÛÙȷΤ˜ fiÛÔ Î·È Û ÁÂÓÈÎÂ˘Ì¤Ó˜ ÂÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ, fiˆ˜ Â›Ó·È ÔÈ ÚˆÙÔ·ı›˜ ÙÔÓÈÎÔÎÏÔÓÈÎÔ› Û·ÛÌÔ›, ÔÈ ·Ê·ÈÚ¤ÛÂȘ, ÔÈ ÙÔÓÈÎÔ› Î·È ÔÈ ·ÙÔÓÈÎÔ› Û·ÛÌÔ› ηÈ, ÏÈÁfiÙÂÚÔ, ÔÈ Ì˘ÔÎÏÔӛ˜. ™Â ÂÈÏËÙÈο ·È‰È¿ ÌÂ Ù˘ÈΤ˜ ·Ê·ÈÚ¤ÛÂȘ Ô˘ ‰ÂÓ ˘Ô¯ˆÚÔ‡Ó ÌÂÙ¿ ·fi ¯ÔÚ‹ÁËÛË ÙÔ˘ ‚·ÏÚÔ˚ÎÔ‡ Ó·ÙÚ›Ô˘ Ì ‹ ¯ˆÚ›˜ Û˘Á¯ÔÚ‹ÁËÛË ·ÈıÔÛÔ˘ÍÈÌ›‰Ë˜, Ë ÚÔÛı‹ÎË Ù˘ Ï·ÌÔÙÚÈÁ›Ó˘ Û˘¯Ó¿ Ô‰ËÁ› Û ˘Ô¯ÒÚËÛË ÙˆÓ ·Ê·ÈÚ¤ÛÂˆÓ (6-8). ÕÏÏ· ÏÂÔÓÂÎÙ‹Ì·Ù· ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Â›Ó·È Ë ‰˘Ó·ÙfiÙËÙ· ¯ÔÚ‹ÁËÛ‹˜ ÙÔ˘ 1-2 ÊÔÚ¤˜ ÙËÓ Ë̤ڷ, Ë ·ÔÙÂÏÂÛÌ·ÙÈ΋ ·ÓÙÈÂÈÏËÙÈ΋ ‰Ú¿ÛË ÙÔ˘ ˆ˜ ÌÔÓÔıÂÚ·›·, Ë ·Ô˘Û›· Â›‰Ú·Û˘ ÛÙȘ ÓÔËÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜, Ë ÌÈÎÚ‹ Èı·ÓÒ˜ ÙÂÚ·ÙÔÁfiÓÔ˜ ‰Ú¿ÛË, Ë ·Ô˘Û›· Â·ÁˆÁÈ΋˜ ‰Ú¿Û˘ Î·È Ë ÌË ·Ó·ÁηÈfiÙËÙ· ÚÔÛ‰ÈÔÚÈÛÌÔ‡ ÙˆÓ ÂÈ¤‰ˆÓ ÙÔ˘ ÛÙÔ ·›Ì· ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ¯ÔÚ‹ÁËÛ‹˜ ÙÔ˘. ∫‡ÚÈÔ ÌÂÈÔÓ¤ÎÙËÌ· Ù˘ Ï·ÌÔÙÚÈÁ›Ó˘ Â›Ó·È Ë ÂÌÊ¿ÓÈÛË ‰ÂÚÌ·ÙÈÎÒÓ ÂÍ·ÓıËÌ¿ÙˆÓ (5-10% ÙˆÓ ·ÛıÂÓÒÓ), Ù· ÔÔ›· Û·ÓÈfiÙÂÚ· Â›Ó·È ÛÔ‚·Ú¿ (1% ÙˆÓ ·ÛıÂÓÒÓ) Î·È ÌÔÚ› Ó· Ô‰ËÁ‹ÛÔ˘Ó ÛÙËÓ ÂÌÊ¿ÓÈÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Stevens-Johnson. ∆· ‰ÂÚÌ·ÙÈο ÂÍ·Óı‹Ì·Ù· ÂÌÊ·Ó›˙ÔÓÙ·È Û˘¯ÓfiÙÂÚ· ÛÙ· ·È‰È¿, ΢ڛˆ˜ ÛÙȘ 8 ÚÒÙ˜ ‚‰ÔÌ¿‰Â˜ Ù˘ ıÂÚ·›·˜ Î·È Û˘¯Ó¿ Û ·ÛıÂÓ›˜ Ô˘ Ï·Ì‚¿ÓÔ˘Ó Ù·˘Ùfi¯ÚÔÓ· ‚·ÏÚÔ˚Îfi Ó¿ÙÚÈÔ. ™Â ÂÚ›ÙˆÛË ÂÌÊ¿ÓÈÛ˘ ·˘ÙÒÓ ÙˆÓ ÂÍ·ÓıËÌ¿ÙˆÓ, ··ÈÙÂ›Ù·È ¿ÌÂÛË ‰È·ÎÔ‹ Ù˘ ¯ÔÚ‹ÁËÛ˘ Ù˘ Ï·ÌÔÙÚÈÁ›Ó˘, ‰ÈfiÙÈ ÎÈÓ‰˘Ó‡ÂÈ Ë ˙ˆ‹ ÙÔ˘ ·ÛıÂÓÔ‡˜. °È· ÙËÓ ·ÔÊ˘Á‹ ÂÌÊ¿ÓÈÛ˘ ‰ÂÚÌ·ÙÈÎÒÓ ÂÍ·ÓıËÌ¿ÙˆÓ, ··ÈÙÂ›Ù·È ‚Ú·‰Â›· ÙÈÙÏÔÔ›ËÛË Ù˘ ·Ú¯È΋˜ ‰fiÛ˘, Ì ·ÔÙ¤ÏÂÛÌ· Ó· ηı˘ÛÙÂÚ› Î·È Ë ¯ÔÚ‹ÁËÛË Ù˘ ·ÔÙÂÏÂÛÌ·ÙÈ΋˜ ‰ÔÛÔÏÔÁ›·˜. ∏ Â›‰Ú·ÛË ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ Ù˘ ·fi ¿ÏÏ· Ê¿Ú̷η, fiˆ˜ ÙÔ ‚·ÏÚÔ˚Îfi Ó¿ÙÚÈÔ, Ô‰ËÁ› ··Ú·Èًو˜ Û ÌÂȈ̤ÓË ‰ÔÛÔÏÔÁ›· Ù˘ fiÙ·Ó Û˘Á¯ÔÚËÁÂ›Ù·È Ì ·˘Ù¿. ÕÏÏ· ÌÂÈÔÓÂÎÙ‹Ì·Ù· ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Â›Ó·È Ë ·Ô˘Û›· ÂÓ‰ÔÊϤ‚È·˜ ÌÔÚÊ‹˜ Î·È ÙÔ Û¯ÂÙÈο ·˘ÍË̤ÓÔ ÎfiÛÙÔ˜ (24,9,12,15). ∏ ÙÔÈÚ·Ì¿ÙË (Topamac) ¤¯ÂÈ ÈÛ¯˘Ú‹ ·ÓÙÈÂÈÏËÙÈ΋ ‰Ú¿ÛË, ¢ڇ Ê¿ÛÌ· ‰Ú¿Û˘ Î·È Î·Ï¤˜ Ê·ÚÌ·ÎÔÎÈÓËÙÈΤ˜ ȉÈfiÙËÙ˜. Œ¯ÂÈ Ï›Á˜ ·ÏÏËÏÂȉڿÛÂȘ Ì ¿ÏÏ· Ê¿Ú̷η, ‰ÂÓ ¤¯ÂÈ Â·ÁˆÁÈ΋ ‰Ú¿ÛË, ¯ÔÚËÁÂ›Ù·È ‰‡Ô ÊÔÚ¤˜ ÙËÓ Ë̤ڷ, ‰È·Ù›ıÂÙ·È Û ·È‰È·ÙÚÈ΋ ÌÔÚÊ‹ Î·È ‰ÂÓ ¯ÚÂÈ¿˙ÂÙ·È ÂÚÈÔ‰ÈÎfi ÚÔÛ‰ÈÔÚÈÛÌfi ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ ÛÙÔ ·›Ì·. ∫‡ÚÈÔ ÌÂÈÔÓ¤ÎÙËÌ· ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Â›Ó·È Ë Û¯ÂÙÈο Û˘¯Ó‹ ÂÌÊ¿ÓÈÛË Ó¢ÚÔÙÔÍÈÎfiÙËÙ·˜, ȉ›ˆ˜ ÛÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜, Ë ÔÔ›· Ô‰ËÁ› Û ·ÚÁ‹ ·‡ÍËÛË Ù˘ ·Ú¯È΋˜ ‰fiÛ˘. ÕÏÏ· ÌÂÈÔÓÂÎÙ‹Ì·Ù· ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Â›Ó·È Ë Ì›ˆÛË ÙÔ˘ ‚¿ÚÔ˘˜ (10% ÙˆÓ ·ÛıÂÓÒÓ), Ë ÔÔ›· Û ÌÂÚÈΤ˜ ÂÚÈÙÒÛÂȘ Â›Ó·È ÛÔ‚·Ú‹, Ë Û¿ÓÈ· ÂÌÊ¿ÓÈÛË Ï›ıˆÓ ÓÂÊÚÔ‡ (1,5% ÙˆÓ

94

Paediatriki 2004;67:88-96

·ÛıÂÓÒÓ), ÔÈ ·Ó·ÊÂÚfiÌÂÓ˜ ‰È·Ù·Ú·¯¤˜ ÛÙȘ ÓÔËÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜, Ë Èı·Ó‹ ÙÂÚ·ÙÔÁfiÓÔ˜ ‰Ú¿ÛË, Ë Â·ÁˆÁÈ΋ ‰Ú¿ÛË ÛÙȘ ·ÓÙÈÛ˘ÏÏËÙÈΤ˜ ÔÚÌfiÓ˜, Ë ·Ô˘Û›· ÂÓ‰ÔÊϤ‚È·˜ ÌÔÚÊ‹˜ Î·È ÙÔ ·˘ÍË̤ÓÔ ÎfiÛÙÔ˜ (2-4,9,12). ∏ ÔÍηڂ·˙Â›ÓË (Trileptal), ·Ú¿ÁˆÁÔ Ù˘ ηڂ·Ì·˙Â›Ó˘ Ì ·ÚfiÌÔÈ· ‰Ú¿ÛË, Ë ÔÔ›· ‰È·Ù›ıÂÙ·È Î·È Û ˘ÁÚ‹ ÌÔÚÊ‹ ÁÈ· Ï‹„Ë ·fi ÙÔ ÛÙfiÌ·, ¤¯ÂÈ ÏÈÁfiÙÂÚ˜ ·ÏÏËÏÂȉڿÛÂȘ ·fi ÙËÓ Î·Ú‚·Ì·˙Â›ÓË, ‰ÂÓ Â¿ÁÂÈ ÙÔÓ ÌÂÙ·‚ÔÏÈÛÌfi Ù˘, ‰ÂÓ ·Ú¿ÁÂÈ ÙÔÓ ÌÂÙ·‚ÔÏ›ÙË 10,11 ÂÔÍ›‰ÈÔ Ù˘ ηڂ·Ì·˙Â›Ó˘ Î·È ¤¯ÂÈ ÏÈÁfiÙÂÚ˜ ·ÏÏÂÚÁÈΤ˜ Î·È ‰ÔÛÔÂÍ·ÚÙÒÌÂÓ˜ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ ·fi ÙËÓ Î·Ú‚·Ì·˙Â›ÓË. ∆Ô Î˘ÚÈfiÙÂÚÔ ÌÂÈÔÓ¤ÎÙËÌ· Ù˘ ÔÍηڂ·˙Â›Ó˘ Û ۇÁÎÚÈÛË Ì ÙËÓ Î·Ú‚·Ì·˙Â›ÓË Â›Ó·È Ë Û˘¯ÓfiÙÂÚË ÂÌÊ¿ÓÈÛË ˘ÔÓ·ÙÚÈ·ÈÌ›·˜ Ô˘ ·Ú·ÙËÚÂ›Ù·È Î˘Ú›ˆ˜ ÛÙÔ˘˜ ÂÓ‹ÏÈΘ Î·È ÙÔ ·˘ÍË̤ÓÔ ÎfiÛÙÔ˜. ∂›Ó·È ¿ÁÓˆÛÙÔ Â¿Ó ¤¯ÂÈ ÙÂÚ·ÙÔÁfiÓÔ ‰Ú¿ÛË (2-5,9,12). ∏ ‚ÈÁηÌ·ÙÚ›ÓË (Sabril) Â›Ó·È ¤Ó· ÈÛ¯˘Úfi ·ÓÙÈÂÈÏËÙÈÎfi Ê¿ÚÌ·ÎÔ, Ì ηϤ˜ Ê·ÚÌ·ÎÔÎÈÓËÙÈΤ˜ ȉÈfiÙËÙ˜ Î·È ÔÏÏ¿ ÏÂÔÓÂÎÙ‹Ì·Ù·. Œ¯ÂÈ ÈÛ¯˘Ú‹ ·ÓÙÈÂÈÏËÙÈ΋ ‰Ú¿ÛË, ÂÏ¿¯ÈÛÙ˜ ·ÏÏËÏÂȉڿÛÂȘ Ì ¿ÏÏ· Ê¿Ú̷η, ‰ÂÓ Ê·›ÓÂÙ·È Ó· ÚÔηÏ› Ì·ÎÚÔ¯ÚfiÓȘ ‰È·Ù·Ú·¯¤˜ ÙˆÓ ÓÔËÙÈÎÒÓ ÏÂÈÙÔ˘ÚÁÈÒÓ, ¯ÔÚËÁÂ›Ù·È 1-2 ÊÔÚ¤˜ ÙËÓ Ë̤ڷ, ¤¯ÂÈ Î·Ï‹ ·Ô‰Ô¯‹ ·fi ÙÔ˘˜ ·ÛıÂÓ›˜, ‰ÂÓ ¤¯ÂÈ Â·ÁˆÁÈ΋ ‰Ú¿ÛË, ‰ÂÓ ¯ÚÂÈ¿˙ÂÙ·È ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ ÛÙÔ ·›Ì·, Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈ΋ Î·È ˆ˜ ÌÔÓÔıÂÚ·›· Î·È ¤¯ÂÈ Èı·ÓÒ˜ ÌÈÎÚ‹ ÙÂÚ·ÙÔÁfiÓÔ ‰Ú¿ÛË. ÃÚËÛÈÌÔÔÈÂ›Ù·È Û·Ó Ê¿ÚÌ·ÎÔ ÚÒÙ˘ ÂÈÏÔÁ‹˜ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ‚ÚÂÊÈÎÒÓ Û·ÛÌÒÓ Î·È ÈÛÙ‡ÂÙ·È fiÙÈ ÌÔÚ› Ó· Â›Ó·È ÈÔ ·ÔÙÂÏÂÛÌ·ÙÈ΋ ·fi Ù· ÎÔÚÙÈÎÔÂȉ‹, ȉȷ›ÙÂÚ· ÛÙÔ˘˜ ‚ÚÂÊÈÎÔ‡˜ Û·ÛÌÔ‡˜ Ô˘ ÔÊ›ÏÔÓÙ·È ÛÙËÓ Ô˙Ò‰Ë ÛÎÏ‹Ú˘ÓÛË (6-8). ∏ ‚ÈÁηÌ·ÙÚ›ÓË, fï˜, ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÂÏ¿¯ÈÛÙ· Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, ΢ڛˆ˜ ÛÙȘ ÌË ÂÏÂÁ¯fiÌÂÓ˜ ·fi ¿ÏÏ· Ê¿Ú̷η ÂÛÙȷΤ˜ ÂÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ Î·È ÛÙÔ˘˜ ‚ÚÂÊÈÎÔ‡˜ Û·ÛÌÔ‡˜, ÏfiÁˆ Ù˘ ÚfiÎÏËÛ˘ ÂÏÏÂÈÌÌ¿ÙˆÓ ÔÙÈÎÔ‡ ‰›Ô˘ (3,4,12,16). Œ¯Ô˘Ó ·Ó·ÊÂÚı› ÂÏÏ›ÌÌ·Ù· ÔÙÈÎÔ‡ ‰›Ô˘ Û ·ÛıÂÓ›˜ Ô˘ Ï·Ì‚¿ÓÔ˘Ó ‚ÈÁηÌ·ÙÚ›ÓË Û ÌÂÁ¿ÏË Û˘¯ÓfiÙËÙ· (ÂÚ›Ô˘ 30% ÙˆÓ ·ÛıÂÓÒÓ). ∞˘Ù‹ Ë ·ÓÂÈı‡ÌËÙË ÂÓ¤ÚÁÂÈ· Ê·›ÓÂÙ·È Ó· Â›Ó·È ÌË ·Ó·ÛÙÚ¤„ÈÌË, ·ÎfiÌ· Î·È ÌÂÙ¿ ÙË ‰È·ÎÔ‹ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘. OÈ ÂÚÈÛÛfiÙÂÚÔÈ ·ÛıÂÓ›˜ Ô˘ ·ÚÔ˘Û›·Û·Ó ¤ÏÏÂÈÌÌ· ÔÙÈÎÔ‡ ‰›Ô˘, ÂȂ‚·ÈˆÌ¤ÓÔ˘ Ì ÂͤٷÛË ÂÚÈÌÂÙÚ›·˜, ‰ÂÓ Â›¯·Ó ÚÔËÁÔ˘Ì¤Óˆ˜ ·Ó·Ê¤ÚÂÈ Û˘ÌÙÒÌ·Ù·. °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi, fiÏÔÈ ÔÈ ·ÛıÂÓ›˜ ı· Ú¤ÂÈ Ó· ÂÍÂÙ¿˙ÔÓÙ·È ·fi ÔÊı·ÏÌ›·ÙÚÔ, Ô ÔÔ›Ô˜ ı· ÙÔ˘˜ ˘Ô‚¿ÏÏÂÈ Û ÂͤٷÛË ÔÙÈÎÒÓ ‰›ˆÓ (ÂÚÈÌÂÙÚ›·), ÙfiÛÔ ÚÈÓ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜ Ì ‚ÈÁηÌ·ÙÚ›ÓË fiÛÔ Î·È ÛÂ

¶·È‰È·ÙÚÈ΋ 2004;67:88-96

Ù·ÎÙ¿ ¯ÚÔÓÈο ‰È·ÛÙ‹Ì·Ù· ÙÔ˘Ï¿¯ÈÛÙÔÓ 6 ÌËÓÒÓ Î·ı’ fiÏË ÙË ‰È¿ÚÎÂÈ· Ù˘ ıÂÚ·›·˜. O ¤ÏÂÁ¯Ô˜ ÙˆÓ ÔÙÈÎÒÓ ‰›ˆÓ, fï˜, Û ·È‰È¿ ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ 9 ÂÙÒÓ ‰ÂÓ Â›Ó·È Û˘Ó‹ıˆ˜ ÂÊÈÎÙfi˜ Î·È ÁÈ’ ·˘Ùfi Ë ¯ÔÚ‹ÁËÛË Ù˘ ‚ÈÁηÌ·ÙÚ›Ó˘ ÛÙȘ ÂȉÈΤ˜ ÂÚÈÙÒÛÂȘ Ô˘ ıˆÚÂ›Ù·È ··Ú·›ÙËÙË, fiˆ˜ Â›Ó·È ÔÈ ‚ÚÂÊÈÎÔ› Û·ÛÌÔ›, ı· Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÁÈ· ÙÔ ÌÈÎÚfiÙÂÚÔ ‰˘Ó·Ùfi ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· Î·È ÛÙË ÌÈÎÚfiÙÂÚË ‰˘Ó·Ù‹ ‰ÔÛÔÏÔÁ›· (6,7). ÕÏÏ· ÌÂÈÔÓÂÎÙ‹Ì·Ù· ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Â›Ó·È Ë ÂÌÊ¿ÓÈÛË „‡¯ˆÛ˘ ‹ ÛÔ‚·Ú‹˜ ηٿıÏȄ˘, Ë Âȉ›ӈÛË ·Ê·ÈÚ¤ÛÂˆÓ Î·È Ì˘ÔÎÏÔÓÈÒÓ, Ë ÌË ‡·ÚÍË ˘ÁÚ‹˜ Î·È ÂÓ‰ÔÊϤ‚È·˜ ÌÔÚÊ‹˜ Î·È ÙÔ ·˘ÍË̤ÓÔ ÎfiÛÙÔ˜. ∞fi ÙȘ ‚ÂÓ˙ԉȷ˙Â›Ó˜, Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÂÚÈÛÛfiÙÂÚÔ Ë ÎÏÔÌ·˙¿ÌË (Frisium), ÁÈ·Ù› ÂÌÊ·Ó›˙ÂÈ ÏÈÁfiÙÂÚ˜ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ. ∏ ÎÏÔÌ·˙¿ÌË ¤¯ÂÈ ·ÚÎÂÙ¿ ÏÂÔÓÂÎÙ‹Ì·Ù·, fiˆ˜ ¢ڇ Ê¿ÛÌ· ‰Ú¿Û˘, ηϋ ·ÓÂÎÙÈÎfiÙËÙ·, ηϤ˜ Ê·ÚÌ·ÎÔÎÈÓËÙÈΤ˜ ȉÈfiÙËÙ˜, ¤ÏÏÂÈ„Ë Ì·ÎÚÔ¯ÚfiÓÈ·˜ ÙÔÍÈÎfiÙËÙ·˜, ÁÚ‹ÁÔÚË ¤Ó·ÚÍË ‰Ú¿Û˘, ‰˘Ó·ÙfiÙËÙ· ¯ÔÚ‹ÁËÛ˘ 1-2 ÊÔÚ¤˜ ÙËÓ Ë̤ڷ, ·Ô˘Û›· Â·ÁˆÁÈ΋˜ ‰Ú¿Û˘ ÛÙ· Ë·ÙÈο ¤Ó˙˘Ì· Î·È Ï›Á˜ ·ÏÏËÏÂȉڿÛÂȘ Ì ¿ÏÏ· Ê¿Ú̷η. ∂ÈϤÔÓ, ‰ÂÓ ¯ÚÂÈ¿˙ÂÙ·È ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ ÛÙÔ ·›Ì·, Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈ΋ Û·Ó ÌÔÓÔıÂÚ·›· Î·È ¤¯ÂÈ ÌÈÎÚ‹ ÙÂÚ·ÙÔÁfiÓÔ ‰Ú¿ÛË Î·È ¯·ÌËÏfi ÎfiÛÙÔ˜. ∂ÓÙÔ‡ÙÔȘ, Ë ÎÏÔÌ·˙¿ÌË ÚÔηÏ› Û˘¯Ó¿ ˘ÓËÏ›· Î·È ‰È·Ù·Ú·¯¤˜ Û˘ÌÂÚÈÊÔÚ¿˜, ÌÔÚ› Ó· ÂȉÂÈÓÒÛÂÈ ÂÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ, Ó· ÚÔηϤÛÂÈ Û˘ÌÙÒÌ·Ù· ηÈ, Û˘¯Ó¿, Û·ÛÌÔ‡˜ ÌÂÙ¿ ·fi ‰È·ÎÔ‹ ¯ÔÚ‹ÁËÛ‹˜ Ù˘, ‰ÂÓ ‰È·Ù›ıÂÙ·È Û ˘ÁÚ‹ Î·È ÂÓ‰ÔÊϤ‚È· ÌÔÚÊ‹ Î·È ÌÔÚ› Ó· ˘¿ÚÍÂÈ ÂÏ¿ÙÙˆÛË ÛÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ¿ Ù˘ Ï›ÁÔ˘˜ Ì‹Ó˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜. ∂›Û˘, Ú¤ÂÈ Ó· ·Ó·ÊÂÚıÔ‡Ó ÙÚ›· ÓÂfiÙÂÚ· ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η, Ë ÙÈ·ÁηÌ›ÓË, Ë ÁηÌ·ÂÓÙ›ÓË Î·È Ë Ï‚ÂÙÈÚ·ÛÂÙ¿ÌË, Ì Ôχ ÂÚÈÔÚÈṲ̂ÓË ÂÌÂÈÚ›· ÛÙ· ·È‰È¿, Ù· ÔÔ›·, fï˜, Ê·›ÓÂÙ·È fiÙÈ Û‡ÓÙÔÌ· ı· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ·È‰È΋˜ ÂÈÏË„›·˜. ∞fi ÙËÓ ÂÌÂÈÚ›· ÛÙÔ˘˜ ÂÓ‹ÏÈΘ, Ë ÙÈ·ÁηÌ›ÓË (Gabitril) ¯ÔÚËÁÂ›Ù·È Î˘Ú›ˆ˜ Û ÂÛÙȷΤ˜ - Ì ‹ ¯ˆÚ›˜ ‰Â˘ÙÂÚÔ·ı‹ ÁÂӛ΢ÛË - ÂÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ, ÂÓÒ ‰ÂÓ ˘¿Ú¯ÂÈ ÂÌÂÈÚ›· ÁÈ· ÙȘ ÁÂÓÈÎÂ˘Ì¤Ó˜ ÂÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ, ¤¯ÂÈ Î·Ï‹ ·ÓÂÎÙÈÎfiÙËÙ·, ‰ÂÓ ‰È·Ù·Ú¿ÛÛÂÈ ÙȘ ÓÔËÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜, ‰ÂÓ ¯ÚÂÈ¿˙ÂÙ·È ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ ÛÙÔ ·›Ì· Î·È ‰ÂÓ ÚÔηÏ› ‰ÂÚÌ·ÙÈο ÂÍ·Óı‹Ì·Ù·. ¢ÂÓ ‰È·Ù›ıÂÙ·È, fï˜, Û ˘ÁÚ‹ ‹ ÂÓ‰ÔÊϤ‚È· ÌÔÚÊ‹, ¯ÚÂÈ¿˙ÂÙ·È ÛÙ·‰È·Î‹ ·‡ÍËÛË Ù˘ ·Ú¯È΋˜ ‰fiÛ˘, ¤¯ÂÈ Û¯ÂÙÈο ÌÈÎÚfi ¯ÚfiÓÈÔ ËÌ›ÛÂÈ·˜ ˙ˆ‹˜ (ȉȷ›ÙÂÚ· Â¿Ó ¯ÔÚËÁÂ›Ù·È Ù·˘Ùfi¯ÚÔÓ· Ì ʿÚ̷η Ô˘ ¤¯Ô˘Ó Â·ÁˆÁÈ΋ ‰Ú¿ÛË ÛÙÔ ‹·Ú, fiˆ˜ Â›Ó·È Ë Î·Ú‚·Ì·˙Â›ÓË, Ì ·ÔÙ¤ÏÂÛÌ·

Paediatriki 2004;67:88-96

Ó· Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÂÙ·È 3-4 ÊÔÚ¤˜ ÙËÓ Ë̤ڷ) Î·È ÌÔÚ› Ó· ÚÔηϤÛÂÈ status epilepticus, ȉȷ›ÙÂÚ· Û ¿ÙÔÌ· Ì ÁÂÓÈÎÂ˘Ì¤Ó˜ ÂÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ ‹ ÁÂÓÈÎÂ˘Ì¤Ó˜ ·ÚÔ͢ÛÌÈΤ˜ ·ÓˆÌ·Ï›Â˜ ÛÙÔ ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ·. ∂ÈϤÔÓ, Ë ÙÈ·ÁηÌ›ÓË ¤¯ÂÈ ·˘ÍË̤ÓÔ ÎfiÛÙÔ˜ Î·È Â›Ó·È ¿ÁÓˆÛÙÔ Â¿Ó ¤¯ÂÈ ÙÂÚ·ÙÔÁfiÓÔ ‰Ú¿ÛË, ÂÓÒ Ë ¯ÔÚ‹ÁËÛ‹ Ù˘ Û ·ÛıÂÓ›˜ Ì Ë·ÙÔ¿ıÂÈ· ¯ÚÂÈ¿˙ÂÙ·È ÚÔÛÔ¯‹ (3,9,12). ∏ ÁηÌ·ÂÓÙ›ÓË (Neurontin) ¤¯ÂÈ Ôχ ηϋ ·ÓÂÎÙÈÎfiÙËÙ· Î·È Ôχ ηϤ˜ Ê·ÚÌ·ÎÔÎÈÓËÙÈΤ˜ ȉÈfiÙËÙ˜, ‰ÂÓ ÌÂÙ·‚ÔÏ›˙ÂÙ·È ÛÙÔÓ ÔÚÁ·ÓÈÛÌfi, ‰ÂÓ ·ÏÏËÏÂȉڿ Ì ¿ÏÏ· Ê¿Ú̷η, ‰ÂÓ ¤¯ÂÈ Ì·ÎÚÔ¯ÚfiÓÈ· ÙÔÍÈÎfiÙËÙ·, ‰ÂÓ ¯ÚÂÈ¿˙ÂÙ·È ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ ÛÙÔ ·›Ì· Î·È ¤¯ÂÈ Èı·Ó¿ ¯·ÌËÏ‹ ÙÂÚ·ÙÔÁfiÓÔ ‰Ú¿ÛË, ÂÓÒ Ë ·Ú¯È΋ Ù˘ ‰fiÛË ÌÔÚ› Ó· ·˘ÍËı› ÁÚ‹ÁÔÚ·. Œ¯ÂÈ, fï˜, ÛÙÂÓfi Ê¿ÛÌ· ‰Ú¿Û˘, ΢ڛˆ˜ Û ÂÛÙȷΤ˜ - Ì ‹ ¯ˆÚ›˜ ‰Â˘ÙÂÚÔ·ı‹ ÁÂӛ΢ÛË - ÂÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ, Ú¤ÂÈ Ó· ¯ÔÚËÁÂ›Ù·È ÙÚÂȘ ÊÔÚ¤˜ ÙËÓ Ë̤ڷ, ¤¯ÂÈ Ì¤ÙÚÈ· ‚ÈԉȷıÂÛÈÌfiÙËÙ· Î·È Ë ·ÔÚÚfiÊËÛË ·fi ÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi Û‡ÛÙËÌ· ÂÍ·ÚÙ¿Ù·È ·fi ÙË ‰fiÛË, ‰ÂÓ ‰È·Ù›ıÂÙ·È Û ˘ÁÚ‹ Î·È ÂÓ‰ÔÊϤ‚È· ÌÔÚÊ‹ Î·È ¤¯ÂÈ ·˘ÍË̤ÓÔ ÎfiÛÙÔ˜ (3,4,9,12). ∞fi ÙËÓ ÂÌÂÈÚ›· ΢ڛˆ˜ ÛÙÔ˘˜ ÂÓ‹ÏÈΘ, Ë Ï‚ÂÙÈÚ·ÛÂÙ¿ÌË (Keppra) ¤¯ÂÈ Î·Ï¤˜ Ê·ÚÌ·ÎÔÎÈÓËÙÈΤ˜ ȉÈfiÙËÙ˜ Î·È Ôχ ηϋ ·ÓÂÎÙÈÎfiÙËÙ·, Ì ‰˘Ó·ÙfiÙËÙ· ÁÚ‹ÁÔÚ˘ ·‡ÍËÛ˘ Ù˘ ·Ú¯È΋˜ ‰fiÛ˘ Î·È ÂӉ¯Ô̤ӈ˜ ¢ڇ Ê¿ÛÌ· ‰Ú¿Û˘, ÙfiÛÔ Û ÂÛÙȷΤ˜ fiÛÔ Î·È Û ÁÂÓÈÎÂ˘Ì¤Ó˜ ÂÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ, ‰ÂÓ ·ÏÏËÏÂȉڿ Ì ¿ÏÏ· Ê¿Ú̷η, ¯ÔÚËÁÂ›Ù·È ‰‡Ô ÊÔÚ¤˜ ËÌÂÚËÛ›ˆ˜ Î·È ‰ÂÓ ¯ÚÂÈ¿˙ÂÙ·È ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ ÛÙÔ ·›Ì·. ∂›Ó·È, fï˜, Ôχ Ó¤Ô Ê¿ÚÌ·ÎÔ Î·È ¯ÚÂÈ¿˙ÔÓÙ·È ÂÚ·ÈÙ¤Úˆ ÌÂϤÙ˜ ÚÔÎÂÈ̤ÓÔ˘ Ó· ηıÔÚÈÛÙ› ÙÔ Ê¿ÛÌ· ‰Ú¿Û˘ ÙÔ˘ Î·È Ó· ·ÓȯÓ¢ıÔ‡Ó Ù˘¯fiÓ ÛÔ‚·Ú¤˜ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ. ∂ÈϤÔÓ, ‰ÂÓ ‰È·Ù›ıÂÙ·È Û ˘ÁÚ‹ Î·È ÂÓ‰ÔÊϤ‚È· ÌÔÚÊ‹ Î·È ¤¯ÂÈ ·˘ÍË̤ÓÔ ÎfiÛÙÔ˜ (1,3,5,9,17,18).

OÈ ÚÔÛ¿ıÂȘ Ô˘ ¤¯Ô˘Ó Á›ÓÂÈ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ¤¯Ô˘Ó Ô‰ËÁ‹ÛÂÈ ÛÙËÓ ·Ó·Î¿Ï˘„Ë ÓÂfiÙÂÚˆÓ ·ÓÙÈÂÈÏËÙÈÎÒÓ Ê·Ú̿ΈÓ, Ù· ÔÔ›· Ê·›ÓÂÙ·È Ó· Â›Ó·È ÈÔ ·ÛÊ·Ï‹ Î·È Ì ηχÙÂÚ˜ Ê·ÚÌ·ÎÔÎÈÓËÙÈΤ˜ ȉÈfiÙËÙ˜ Û ۇÁÎÚÈÛË Ì ٷ ·Ï·ÈfiÙÂÚ·. ¶Ú¤ÂÈ, fï˜, Ó· ÂÚ¢ÓËı› Î·È Ó· ·Ô‰Âȯı› Â¿Ó Â›Ó·È ÈÔ ·ÔÙÂÏÂÛÌ·ÙÈο ·fi ·˘Ù¿. ∂ÈϤÔÓ, Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ‰ÈÂÍ¿ÁÔÓÙ·È ÌÂϤÙ˜ ÚÔÎÂÈ̤ÓÔ˘ Ó· Á›ÓÔ˘Ó ÁÓˆÛÙ¿ ÁÂÓÂÙÈο ÁÓˆÚ›ÛÌ·Ù· Ô˘ ηıÔÚ›˙Ô˘Ó ÔÈÔ Ê¿ÚÌ·ÎÔ Î·È Û ÔȘ ‰fiÛÂȘ ¯ÚÂÈ¿˙ÂÙ·È ÙÔ Î¿ı ¿ÙÔÌÔ Ì ÂÈÏË„›·, ¯ˆÚ›˜ Ó· ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ, ÒÛÙ ӷ ¯ÔÚËÁÂ›Ù·È ÂÎ ÙˆÓ ÚÔÙ¤ÚˆÓ ÙÔ Î·Ù¿ÏÏËÏÔ Ê¿ÚÌ·ÎÔ Î·È Ó· ÌË ıÂÚ·‡ÂÙ·È Ô ·ÛıÂÓ‹˜ ÂÌÂÈÚÈο (10). £· Ú¤ÂÈ Ó· Û˘Ó¯ÈÛÙÔ‡Ó ÔÈ ÚÔÛ¿ıÂȘ ÁÈ· ÙËÓ ·Ó‡ÚÂÛË

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ÙÔ˘ ȉÂÒ‰Ô˘˜ ·ÓÙÈÂÈÏËÙÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘ Ì ٷ ¯·Ú·ÎÙËÚÈÛÙÈο Ô˘ ·Ó·Ê¤ÚıËηÓ, Ù· ÔÔ›· ÛÂ Û˘Ó‰˘·ÛÌfi Ì ¿ÏϘ ıÂÚ·¢ÙÈΤ˜ ·ÚÂÌ‚¿ÛÂȘ, fiˆ˜ Â›Ó·È Ë ¯ÂÈÚÔ˘ÚÁÈ΋ Ù˘ ÂÈÏË„›·˜, ı· Û˘Ì‚¿ÏÏÔ˘Ó ÂÚ·ÈÙ¤Úˆ ÛÙË ‚ÂÏÙ›ˆÛË Ù˘ ˙ˆ‹˜ ÙˆÓ ·È‰ÈÒÓ Ì ÂÈÏË„›·. µÈ‚ÏÈÔÁÚ·Ê›· 1. Willmore LJ. Clinical pharmacology of new antiepileptic drugs. Neurology 2000;55 (Suppl 3):S17-S24.

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∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 04-03-2003 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 02-09-2003 ¢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΋ 2004;67:97-104

µƒ∞µ∂Àª∂¡∏ ∂ƒ°∞™π∞

Paediatriki 2004;67:97-104

AWARD-WINNING ARTICLE

∏ Â›‰Ú·ÛË ÙˆÓ ÈÔÁÂÓÒÓ ÏÔÈÌÒÍÂˆÓ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ ÛÙȘ ÂÍ¿ÚÛÂȘ ÂÔ¯È΋˜ ·Ó·Ó¢ÛÙÈ΋˜ ·ÏÏÂÚÁ›·˜ Û ·È‰È¿* ¡. °. ¶··‰fiÔ˘ÏÔ˜, º. æ·Úfi˜, ∂. ª·ÓÔ˘Û¿Î˘, ª. ÷Ù˙Ë„¿ÏÙË, ∞. ™˘Ú›ÁÔ˘, ∞. ªfiÛÈÔ˜, ¡. ª·˚Ì¿˜, Ã. ª¿ÌÈ·, ¢. °Ô˘ÚÁÈÒÙ˘, º. ™·ÍÒÓË - ¶··ÁˆÚÁ›Ô˘

The contribution of respiratory viral infections to exacerbation of seasonal respiratory allergy in children* N. G. Papadopoulos, F. Psaros, E. Manousakis, M. Hatzipsalti, C. Syrigou, A. Bosios, N. Baibas, C. Bamia, D. Gourgiotis, F. Saxoni - Papageorgiou

¶ÂÚ›ÏË„Ë: ™ÎÔfi Ù˘ ·ÚÔ‡Û·˜ ÚÔÔÙÈ΋˜ ÌÂϤÙ˘ ·ÔÙ¤ÏÂÛÂ Ë Î·Ù·ÁÚ·Ê‹ ηıËÌÂÚÈÓÒÓ Û˘ÌÙˆÌ¿ÙˆÓ Î·È Ë ·Ó·˙‹ÙËÛË Ù˘ ·ÚÔ˘Û›·˜ ÈÒÓ, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ·Ï˘ÛȉˆÙ‹ ·ÓÙ›‰Ú·ÛË ÔÏ˘ÌÂÚ¿Û˘ (PCR) Û ٷÎÙ¿ ¯ÚÔÓÈο ‰È·ÛÙ‹Ì·Ù· Î·È Â› ÎÚ›Ûˆ˜, Û ·È‰È¿ Ì ÂÔ¯ÈÎfi ·ÏÏÂÚÁÈÎfi ¿ÛıÌ·, ·Ú¿ÏÏËÏ· Ì ÌÂÙÚ‹ÛÂȘ ÙˆÓ Á‡ÚÂˆÓ ÛÙËÓ ·ÙÌfiÛÊ·ÈÚ·. ∏ ÌÂϤÙË Û˘ÌÂÚȤϷ‚ 43 ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ ËÏÈΛ·˜ 7-18 ÂÙÒÓ, Ì ·˘ÛÙËÚ¿ ÂÔ¯ÈÎfi ·ÏÏÂÚÁÈÎfi ¿ÛıÌ· ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘Ï¿¯ÈÛÙÔÓ ‰‡Ô ÚÔËÁÔ‡ÌÂÓˆÓ ÂÙÒÓ Î·È Ì ¢·ÈÛıËÙÔÔ›ËÛË ÛÙ· ÎÏÈÓÈο ÛËÌ·ÓÙÈο ·ÏÏÂÚÁÈÔÁfiÓ·, fiˆ˜ Ë ÂÏÈ¿, Ë ·ÚÈÂÙ¿ÚÈ· ‹ Ù· ·ÁÚˆÛÙÒ‰Ë. OÈ ÎÚ›ÛÂȘ Ù˘ ÓfiÛÔ˘ Ì ‚¿ÛË Ù· Û˘ÌÙÒÌ·Ù· ·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ (Ù·ÚÌÔ›, ηٷÚÚÔ‹, Û˘ÌÊfiÚËÛË), ηÙÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ (‚‹¯·˜, ‰‡ÛÓÔÈ·, Û˘ÚÈÁÌfi˜) Î·È Û˘ÓÔÏÈο, ˘ÔÏÔÁ›ÛÙËÎ·Ó ‚¿ÛÂÈ ÂȉÈÎÔ‡ ·ÏÁfiÚÈıÌÔ˘ Ì ËÏÂÎÙÚÔÓÈÎfi ˘ÔÏÔÁÈÛÙ‹. ŒÁÈÓ PCR ÁÈ· ÚÈÓÔ˚Ô‡˜, ·‰ÂÓÔ˚Ô‡˜, ·Ó·Ó¢ÛÙÈÎfi Û˘Á΢ÙÈ·Îfi Èfi, ÈÔ‡˜ ÁÚ›˘, ·Ú·ÁÚ›˘ Î·È ÈÔ‡˜ ÎÔÚfiÓ· Û 151 ÂÈÛΤ„ÂȘ (133 Ù·ÎÙÈΤ˜ Î·È 18 ¤ÎÙ·ÎÙ˜). πÔ› Ù·˘ÙÔÔÈ‹ıËÎ·Ó ÛÙÔ 56% ÙˆÓ ¤ÎÙ·ÎÙˆÓ ÂÈÛΤ„ÂˆÓ Î·È Û 35% ÙˆÓ ÂÂÈÛÔ‰›ˆÓ ·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡, Û 33% ÙˆÓ ÂÂÈÛÔ‰›ˆÓ ηÙÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Î·È Û 36% ÙˆÓ ÂÂÈÛÔ‰›ˆÓ Û˘ÓÔÏÈÎÒÓ Û˘Ìو̿وÓ. ™˘¯ÓfiÙÂÚÔÈ ‹Ù·Ó ÔÈ ÚÈÓÔ˚Ô› Û ÔÛÔÛÙfi 63-74%. ∆· Û¯ÂÙÈ˙fiÌÂÓ· Ì ÈÔ‡˜ ÂÂÈÛfi‰È· ·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ ‹Ù·Ó ÌÈÎÚfiÙÂÚ˘ ‚·Ú‡ÙËÙ·˜ (1,9±0,2 ¤Ó·ÓÙÈ 2,7±0,2, p=0,027). ∞ÓÙ›ıÂÙ·, ÔÈ ÈÔ› ÚÔοÏÂÛ·Ó ÂÚÈÛÛfiÙÂÚ· Û˘ÌÙÒÌ·Ù· ÛÙÔ Î·ÙÒÙÂÚÔ ·Ó·Ó¢ÛÙÈÎfi (3,3±0,3 ¤Ó·ÓÙÈ 3,0±0,3, p=0,07). ∂›Û˘, Ù·

Abstract: In this prospective study, the daily symptoms, pollen counts and presence of respiratory viral infections using polymerase chain reaction (PCR), were assessed in children with seasonal allergic asthma. Forty-three children and adolescents, aged 7-18 years, with strictly seasonal asthma during the previous two years and allergic sensitization to grasses, olive or parietaria pollens were included. Disease exacerbations of both the upper (sneezing, runny nose, blocked nose) and lower (cough, wheeze, shortness of breath) airway were evaluated, using a computer algorithm. PCR for rhinoviruses, coronaviruses, influenza, parainfluenza, respiratory syncytial and adenoviruses was conducted at 151 visits (133 regular and 18 emergency visits). Viruses were detected at 56% of emergency visits and during 35% of upper airway episodes and 33% of lower airway episodes (36% of total symptomatic episodes). Rhinoviruses were the most frequently identified pathogens (63-74%).

Virus-related episodes of upper airway disease were less severe than those where no virus was isolated (1.9±0.2 vs 2.7±0.2, p=0.027). In contrast, viruses were associated with more severe lower respiratory disease episodes (3.3±0.3 vs 3.0±0.3, p=0.07), and virus-related total symptomatic episodes were of longer duration (8.7±1.2 vs 6.0±0.7 days, p=0.019). This evidence suggests that in addition to pollen allergens, respiratory viruses play an important role in the induction of seasonal asthma. However, there were differences

∆Ì‹Ì· ∞ÏÏÂÚÁÈÔÏÔÁ›·˜, µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›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

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

* 1st “Choremio” Award 40th Panhellenic Paediatric Meeting, 2002

97

¶·È‰È·ÙÚÈ΋ 2004;67:97-104

Paediatriki 2004;67:97-104

Û¯ÂÙÈ˙fiÌÂÓ· Ì Èfi ÂÂÈÛfi‰È· ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚ˘ ‰È¿ÚÎÂÈ·˜ ·fi ÂΛӷ ÛÙ· ÔÔ›· ‰ÂÓ ·ÓȯÓ‡ÙËΠÈfi˜ (8,7±1,2 ¤Ó·ÓÙÈ 6,0±0,7 Ë̤Ú˜ ÁÈ· ÂÂÈÛfi‰È· Û˘ÓÔÏÈÎÒÓ Û˘Ìو̿وÓ, p=0,019). ∆· ·Ú·¿Óˆ ‰Â‰Ô̤ӷ ‰Â›¯ÓÔ˘Ó fiÙÈ, ÂÎÙfi˜ ·fi Ù· ·ÏÏÂÚÁÈÔÁfiÓ·, ÔÈ ÈÔ› ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Â›Ó·È ÛËÌ·ÓÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ¤ÎÏ˘Û˘ ÎÚ›ÛÂˆÓ ·ÏÏÂÚÁÈÎÔ‡ ¿ÛıÌ·ÙÔ˜. À¿Ú¯Ô˘Ó ·ÎfiÌË ÛËÌ·ÓÙÈΤ˜ ÂӉ›ÍÂȘ ÁÈ· ‡·ÚÍË ‰È·ÊÔÚÒÓ ÌÂٷ͇ ÙˆÓ ÂÂÈÛÔ‰›ˆÓ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÈÔ‡˜ Î·È ÙˆÓ ˘ÔÏÔ›ˆÓ Ô˘ Ú¤ÂÈ Ó· ·Ô‰ÔıÔ‡Ó ÛÙ· ·ÏÏÂÚÁÈÔÁfiÓ·. ŒÙÛÈ, Ê·›ÓÂÙ·È fiÙÈ ÙÔ “·ÏÏÂÚÁÈÎfi” Î·È ÙÔ “ÌÂÙ·ÏÔÈÌ҉˜” ¿ÛıÌ· ·ÔÙÂÏÔ‡Ó ·ÏÏËÏÔÂÈÎ·Ï˘ÙfiÌÂÓÔ˘˜, ·ÏÏ¿ ‰È·ÊÔÚÂÙÈÎÔ‡˜ Ê·ÈÓÔÙ‡Ô˘˜ Ù˘ ÓfiÛÔ˘.

between virus-related and presumably allergenrelated disease exacerbations, indicating that these represent two overlapping but distinct asthma phenotypes.

§¤ÍÂȘ ÎÏÂȉȿ: ¿ÛıÌ·, ÈÔ› ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡, ·ÓıÚÒÈÓÔ˜ ÚÈÓÔ˚fi˜, Á˘ÚÂÔ·ÏÏÂÚÁ›·, ÂÔ¯È΋ ·ÏÏÂÚÁÈ΋ ÚÈÓ›ÙȘ.

Key words: asthma, respiratory virus, human rhinovirus, pollen allergy, seasonal allergic rhinitis.

∂ÈÛ·ÁˆÁ‹ ∆Ô ¿ÛıÌ· ·ÔÙÂÏ› Ì›· ·fi ÙȘ Û˘¯ÓfiÙÂÚ˜ ÓfiÛÔ˘˜ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜, Â›Ó·È ‰Â Ë Û˘¯ÓfiÙÂÚË ·ÈÙ›· ÂÈÛ·ÁˆÁ‹˜ Û ÓÔÛÔÎÔÌ›Ô, Ì ÙÂÚ¿ÛÙÈ· ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈο Â·ÎfiÏÔ˘ı· (1). ∂ÈϤÔÓ, Û‡Á¯ÚÔÓ˜ ‰ÈÂıÓ›˜ ÌÂϤÙ˜ ‰Â›¯ÓÔ˘Ó Ì›· ·ÓÙÈÎÂÈÌÂÓÈ΋ ·‡ÍËÛË Ù˘ Â›ÙˆÛ˘ ÙÔ˘ ¿ÛıÌ·ÙÔ˜ ·ÁÎÔÛÌ›ˆ˜, Ì ȉȷ›ÙÂÚË ÂÈ‚¿Ú˘ÓÛË ÛÙȘ “‰˘ÙÈΤ˜” ÎÔÈӈӛ˜ (2). ∆Ô Úfi‚ÏËÌ· Â›Ó·È ÂÍ›ÛÔ˘ ÛËÌ·ÓÙÈÎfi Î·È ÛÙËÓ ∂ÏÏ¿‰·, Ô˘ ·Ó Î·È ¤¯ÂÈ ÙËÓ Ù‡¯Ë Ó· ·ÚÔ˘ÛÈ¿˙ÂÈ Û¯ÂÙÈο ¯·ÌËÏ¿ ÔÛÔÛÙ¿ ¿ÛıÌ·ÙÔ˜, ‰ÂÓ Ê·›ÓÂÙ·È Ó· ÂÍ·ÈÚÂ›Ù·È ·fi ÙËÓ ·ÓÔ‰È΋ Â›ÙˆÛË Ù˘ ÓfiÛÔ˘.

OÈ ·˘ÍËÙÈΤ˜ Ù¿ÛÂȘ Ô˘ ‰È·ÈÛÙÒıËÎ·Ó Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÙÂÏÂ˘Ù·›ˆÓ ‰ÂηÂÙÈÒÓ, fiˆ˜ Î·È ÔÈ ÌÂÁ¿Ï˜ ‰È·ÊÔÚ¤˜ ÌÂٷ͇ ÙˆÓ ‰˘ÙÈÎÒÓ Î·È ¿ÏÏˆÓ ÎÔÈÓˆÓÈÒÓ, ˘Ô‰ËÏÒÓÔ˘Ó fiÙÈ ÔÈ ÂÚÈ‚·ÏÏÔÓÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ÂȉÚÔ‡Ó Î·Ù·Ï˘ÙÈο ÛÙËÓ ÂΉ‹ÏˆÛË Ù˘ ÓfiÛÔ˘ (3). ¶ÔÏÏÔ› Ù¤ÙÔÈÔÈ ·Ú¿ÁÔÓÙ˜ ¤¯Ô˘Ó ÂÓÔ¯ÔÔÈËı›, ¯ˆÚ›˜ fï˜ Ó· Â›Ó·È Â‡ÎÔÏÔ Ó· ·Ô‰Ôı› ÌÂÁ·Ï‡ÙÂÚË ‚·Ú‡ÙËÙ· Û οÔÈÔÓ. ŒÙÛÈ, ÔÈ ÈÔÁÂÓ›˜ ÏÔÈÌÒÍÂȘ ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡, Ë Â˘·ÈÛıËÙÔÔ›ËÛË Û ·ÏÏÂÚÁÈÔÁfiÓ· Î·È ÙÔ ·ıËÙÈÎfi οÓÈÛÌ· ·ÔÙÂÏÔ‡Ó ÙÔ˘˜ ÈÛ¯˘ÚfiÙÂÚÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ Ô˘ ¤¯ÂÈ ·Ô‰ÂȯÙ› fiÙÈ Û¯ÂÙ›˙ÔÓÙ·È Ì ÎÚ›ÛÂȘ ¿ÛıÌ·ÙÔ˜ (4). ™‡Ìʈӷ Ì ÙȘ ̤¯ÚÈ Û‹ÌÂÚ· ÁÓÒÛÂȘ, ÔÈ ÈÔÁÂÓ›˜ ÏÔÈÌÒÍÂȘ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ ·ÔÙÂÏÔ‡Ó ÙÔÓ ÈÛ¯˘ÚfiÙÂÚÔ ·Ú¿ÁÔÓÙ· Ô˘ Û˘Ó‰¤ÂÙ·È Ì ÙȘ ÎÚ›ÛÂȘ ¿ÛıÌ·ÙÔ˜. ¶ÚÔÔÙÈΤ˜ ÌÂϤÙ˜ Û ·È‰È¿ ¤‰ÂÈÍ·Ó fiÙÈ ÔÈ ÎÚ›ÛÂȘ ¿ÛıÌ·ÙÔ˜ Â›Ó·È ·ÔÙ¤ÏÂÛÌ· Ù¤ÙÔÈˆÓ ÏÔÈÌÒÍÂˆÓ Û ÔÛÔÛÙfi ¿Óˆ ÙÔ˘ 85% (5,6). ∞fi ÙËÓ ¿ÏÏË ÌÂÚÈ¿, ÙÔ ¿ÛıÌ· ˆ˜ ÓfiÛÔ˜ Û¯ÂÙ›˙ÂÙ·È ÈÛ¯˘Ú¿ Ì ÙËÓ ·ÏÏÂÚÁÈ΋ ¢·ÈÛıËÙÔ-

Ô›ËÛË Û ÎÔÈÓ¿ ÂÚÈ‚·ÏÏÔÓÙÈο ·ÓÙÈÁfiÓ·. ™˘Û¯¤ÙÈÛË ÙˆÓ ·ÏÏÂÚÁÈÔÁfiÓˆÓ Ì ÔÍ›˜ ÎÚ›ÛÂȘ ¿ÛıÌ·ÙÔ˜ ¤¯ÂÈ Á›ÓÂÈ Û ϛÁ˜ ÌfiÓÔ ÂÚÈÙÒÛÂȘ Î·È ıˆÚÂ›Ù·È fiÙÈ ÔÈ Û˘Óı‹Î˜ οو ·fi ÙȘ Ôԛ˜ ¤Ó· ·ÏÏÂÚÁÈÔÁfiÓÔ ÌÔÚ› Ó· ÚÔηϤÛÂÈ ¿ÌÂÛ· ÎÚ›ÛË (fiˆ˜ .¯. Ë ··ÈÙÔ‡ÌÂÓË Û˘ÁΤÓÙÚˆÛË) ‰ÂÓ Â›Ó·È Ô Î·ÓfiÓ·˜ (7). ŸÌˆ˜, ¤Ó· ÔÛÔÛÙfi ·ÛıÂÓÒÓ ÂÌÊ·Ó›˙ÂÈ Û˘ÌÙÒÌ·Ù· Ì ۷ʋ ÂÔ¯È΋ ηٷÓÔÌ‹, Ë ÔÔ›· Ì¿ÏÈÛÙ· Û˘Û¯ÂÙ›˙ÂÙ·È ÛÙÂÓ¿ Ì ÙËÓ ¤Í·ÚÛË ÙˆÓ Á‡ÚÂˆÓ ÛÙȘ Ôԛ˜ Â›Ó·È Â˘·ÈÛıËÙÔÔÈË̤ÓÔÈ ·˘ÙÔ› ÔÈ ·ÛıÂÓ›˜. ÷ڷÎÙËÚÈÛÙÈÎfi ·Ú¿‰ÂÈÁÌ· ·ÔÙÂÏ› Ë ¿ÓÔÈÍË ÛÙËÓ ∂ÏÏ¿‰· Î·È Û ¿ÏϘ ÌÂÛÔÁÂȷΤ˜ ¯ÒÚ˜, Ì ÙȘ ·ÓıÔÊÔڛ˜ ÙˆÓ ·ÁÚˆÛÙˆ‰ÒÓ, ÙˆÓ Ô˘ÚÙÈÎȉÒÓ Î·È Ù˘ ÂÏÈ¿˜. ∞fi Ù· ·Ú·¿Óˆ Ê·›ÓÂÙ·È fiÙÈ ÛÙËÓ Âȉ›ӈÛË Ù˘ ÓfiÛÔ˘ Î·È ÛÙËÓ ÂΉ‹ÏˆÛË ÎÚ›Ûˆ˜ Û˘ÌÌÂÙ¤¯Ô˘Ó Èı·ÓÒ˜ ÂÚÈÛÛfiÙÂÚÔÈ ÙÔ˘ ÂÓfi˜ ·Ú¿ÁÔÓÙ˜. ªÂϤÙ˜ Û¯ÂÙÈΤ˜ Ì ÙË Û˘ÓÂÚÁÈ΋ ‰Ú¿ÛË ÙˆÓ ‰È·ÊfiÚˆÓ ·Ú·ÁfiÓÙˆÓ ‰ÂÓ ˘¿Ú¯Ô˘Ó ‹ Â›Ó·È ÂÚÈÔÚÈṲ̂Ó˜. ∫‡ÚÈ· ·ÈÙ›· ÁÈ· ·˘Ù‹ ÙËÓ ¤ÏÏÂÈ„Ë ·ÔÙÂÏ› Ì¿ÏÏÔÓ Ë ‰˘ÛÎÔÏ›· Ù˘ ÌÂϤÙ˘ ÙÔ˘ ΢ÚÈfiÙÂÚÔ˘ ·Ú¿ÁÔÓÙ·, ‰ËÏ·‰‹ ÙˆÓ ÈÒÓ, ÔÈ ÔÔ›ÔÈ Ì¤¯ÚÈ ÚfiÛÊ·Ù· ‹Ù·Ó ‰‡ÛÎÔÏÔ Ó· ‰È·ÁÓˆÛıÔ‡Ó Ì ¢·ÈÛıËÛ›· Î·È ·ÎÚ›‚ÂÈ·. °È· ·˘ÙÔ‡˜ ÙÔ˘˜ ÏfiÁÔ˘˜ ۯ‰ȿÛÙËÎÂ Ë ·ÚÔ‡Û· ÌÂϤÙË, ÛÙËÓ ÔÔ›· ·Ú·ÎÔÏÔ˘ı‹ıËÎ·Ó ÚÔÔÙÈο ·È‰È¿ Ì ÈÛÙÔÚÈÎfi ÂÔ¯ÈÎÔ‡ ¿ÛıÌ·ÙÔ˜ Î·È ·ԉ‰ÂÈÁ̤ÓË Â˘·ÈÛıËÙÔÔ›ËÛË Û ·ÂÚÔ·ÏÏÂÚÁÈÔÁfiÓ·, ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ¢ڇÙÂÚ˘ ÂÔ¯‹˜ ·ÓıÔÊÔÚ›·˜ (ºÂ‚ÚÔ˘¿ÚÈÔ˜-πÔ‡ÏÈÔ˜), Ì ÛÎÔfi Ó· ηٷÁÚ·ÊÔ‡Ó Î·È Ó· ·Ó·Ï˘ıÔ‡Ó Ù· Û˘ÌÙÒÌ·Ù· ·fi ÙÔ ·Ó·Ó¢ÛÙÈÎfi, ÔÈ ÈÔÁÂÓ›˜ ÙÔ˘˜ ÏÔÈÌÒÍÂȘ Î·È Ë Û¯¤ÛË ·˘ÙÒÓ Ì ٷ Â›‰· ÙˆÓ ·ÂÚÔ·ÏÏÂÚÁÈÔÁfiÓˆÓ ÛÙËÓ ·ÙÌfiÛÊ·ÈÚ·.

98

¶·È‰È·ÙÚÈ΋ 2004;67:97-104

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ™ÙË ÌÂϤÙË ÂÚÈÂÏ‹ÊıËÛ·Ó 43 ·È‰È¿ Î·È ¤ÊË‚ÔÈ (25 ·ÁfiÚÈ·), ̤Û˘ ËÏÈΛ·˜ 12 ÂÙÒÓ (‡ÚÔ˜: 7-18 ¤ÙË), Ô˘ ÂÈϤ¯ıËÎ·Ó ·Ó¿ÌÂÛ· Û ·ÛıÂÓ›˜ Ô˘ ·Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·Ó ÛÙÔ ∞ÏÏÂÚÁÈÔÏÔÁÈÎfi ∆Ì‹Ì· Ù˘ µ’ ¶·È‰È·ÙÚÈ΋˜ ∫ÏÈÓÈ΋˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ÛÙÔ ¡ÔÛÔÎÔÌÂ›Ô “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”. ∆· ÎÚÈÙ‹ÚÈ· ÂÈÛfi‰Ô˘ ÛÙË ÌÂϤÙË ÂÚÈÂÏ¿Ì‚·Ó·Ó: ·) ‰È¿ÁÓˆÛË ¿ÛıÌ·ÙÔ˜, Û‡Ìʈӷ Ì ٷ ÎÚÈÙ‹ÚÈ· Ù˘ ‰ÈÂıÓÔ‡˜ ÔÌÔʈӛ·˜ GINA, ‚) ·˘ÛÙËÚ¿ ÂÔ¯ÈÎfi ¯·Ú·ÎÙ‹Ú·, ‰ËÏ·‰‹ ÂÌÊ¿ÓÈÛË ·ÔÎÏÂÈÛÙÈο Î·È ÌfiÓÔ ÙÔ˘˜ ·ÚÈÓÔ‡˜ Ì‹Ó˜, ÙÔ˘Ï¿¯ÈÛÙÔÓ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ‰‡Ô ÚÔËÁÔ‡ÌÂÓˆÓ ÂÙÒÓ, Á) ·ÏÏÂÚÁÈ΋ ¢·ÈÛıËÙÔÔ›ËÛË ÂȂ‚·ÈˆÌ¤ÓË Ì ‰ÂÚÌ·ÙÈΤ˜ ‰ÔÎÈ̷ۛ˜ Ó˘ÁÌÔ‡ Û ¤Ó· ÙÔ˘Ï¿¯ÈÛÙÔÓ ·fi Ù· ·ÎfiÏÔ˘ı·: Ì›ÁÌ· Á‡ÚÂˆÓ ·ÁÚˆÛÙˆ‰ÒÓ, Á‡ÚË ·ÚÈÂÙ¿ÚÈ·˜ ‹ Á‡ÚË ÂÏÈ¿˜ Î·È ‰) ÂÓ˘fiÁÚ·ÊË Û˘ÁηٿıÂÛË ÁÔÓ¤· Î·È ÚÔÊÔÚÈ΋ Û˘Ìʈӛ· ÙÔ˘ ·È‰ÈÔ‡. ∆· ÎÚÈÙ‹ÚÈ· ·ÔÎÏÂÈÛÌÔ‡ ÂÚÈÂÏ¿Ì‚·Ó·Ó: ·) ıÂÙÈÎfi ÈÛÙÔÚÈÎfi ÛÔ‚·Ú‹˜ ÌÂÙ·‚ÔÏÈ΋˜, ηډÈÔÏÔÁÈ΋˜, ·ÈÌ·ÙÔÏÔÁÈ΋˜, Ë·ÙÈ΋˜, Á·ÛÙÚÂÓÙÂÚÈ΋˜, Ó¢ÚÔÏÔÁÈ΋˜, ·Ó·Ó¢ÛÙÈ΋˜ (ÂÎÙfi˜ ·fi ¿ÛıÌ· ‹ ÚÈÓ›Ùȉ·), ÓÂÊÚÈ΋˜, ·ÓÔÛÔÏÔÁÈ΋˜ ‹ ¿ÏÏ˘ ÓfiÛÔ˘ Î·È ‚) ·‰˘Ó·Ì›· ·ÓÙ·fiÎÚÈÛ˘ ÛÙȘ ··ÈÙ‹ÛÂȘ Ù˘ ÌÂϤÙ˘, Û‡Ìʈӷ Ì ÙËÓ ÎÚ›ÛË ÙˆÓ ÂÚ¢ÓËÙÒÓ. ∏ ÌÂϤÙË ÍÂΛÓËÛ ÙÔÓ ºÂ‚ÚÔ˘¿ÚÈÔ ÙÔ˘ 2000 Î·È ÔÏÔÎÏËÚÒıËΠÙÔÓ πÔ‡ÏÈÔ ÙÔ˘ ›‰ÈÔ˘ ¤ÙÔ˘˜. ™Ù· ·È‰È¿ ‰fiıËÎ·Ó Î¿ÚÙ˜ ηıËÌÂÚÈÓ‹˜ ηٷÁÚ·Ê‹˜ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ·ÓÒÙÂÚÔ˘ (Ù·ÚÌÔ›, ÚÈÓÈ΋ ηٷÚÚÔ‹, ÚÈÓÈ΋ Û˘ÌÊfiÚËÛË, ÎÓËÛÌfi˜) Î·È Î·ÙÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ (‚‹¯·˜, ‰‡ÛÓÔÈ·, Û˘ÚÈÁÌfi˜) Î·È ÚÔfiÌÂÙÚ· ÁÈ· ÙËÓ Î·Ù·ÁÚ·Ê‹ Ù˘ ̤ÁÈÛÙ˘ ÂÎÓ¢ÛÙÈ΋˜ ÚÔ‹˜ (PFR) ‰È˜ ηıËÌÂÚÈÓ¿ (Úˆ› Î·È ‚Ú¿‰˘). ∫·Ù·ÁÚ·ÊfiÙ·Ó, Â›Û˘, Ë ¯Ú‹ÛË ‚ÚÔÁ¯Ô‰È·ÛÙ·ÏÙÈÎÒÓ, ·ÓÙÈÈÛÙ·ÌÈÓÈÎÒÓ ‹ ¿ÏÏˆÓ Ê·Ú̿ΈÓ. ¶ÚÔÁÚ·ÌÌ·Ù›ÛÙËÎ·Ó ÌËÓÈ·›Â˜ Ù·ÎÙÈΤ˜ ÂÈÛΤ„ÂȘ, ηٿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÔÔ›ˆÓ ÁÈÓfiÙ·Ó ·ÍÈÔÏfiÁËÛË Ù˘ ηٷÁÚ·Ê‹˜, Â·Ó¿ÏË„Ë ÙˆÓ Ô‰ËÁÈÒÓ Û˘ÌÏ‹ÚˆÛ˘ ÁÈ· ηχÙÂÚË Û˘ÌÌfiÚʈÛË Î·È Ï·Ì‚·ÓfiÙ·Ó ‰Â›ÁÌ· ÚÈÓÈÎÔ‡ ÂÎχ̷ÙÔ˜ ÁÈ· ·Ó›¯Ó¢ÛË ÈÒÓ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡. ¢fiıËÎÂ, Â›Û˘, Ô‰ËÁ›· ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ó· ÂÈÎÔÈÓˆÓÔ‡Ó Ì ÙÔ˘˜ È·ÙÚÔ‡˜ Ù˘ ÌÂϤÙ˘ Û ÂÚ›ÙˆÛË Ô˘: ·) ÙÔ ¿ıÚÔÈÛÌ· ÙÔ˘ ‰Â›ÎÙË Û˘ÌÙˆÌ¿ÙˆÓ ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚÔ ·fi 4, ‚) Ë PFR ‹Ù·Ó ÌÂȈ̤ÓË Î·Ù¿ 20% ‹ ÂÚÈÛÛfiÙÂÚÔ ·fi ÙÔ ‚¤ÏÙÈÛÙÔ ÙÔ˘ ·ÛıÂÓÔ‡˜ ‹ Á) ÙÔ ›‰ÈÔ ÙÔ ·È‰› ‹ Ô ÁÔÓ¤·˜ ›¯·Ó ÙËÓ ˘ÔÎÂÈÌÂÓÈ΋ ·›ÛıËÛË fiÙÈ Â›ÎÂÈÙ·È Âȉ›ӈÛË-ÎÚ›ÛË Ù˘ ÓfiÛÔ˘. ™ÙËÓ ÂÚ›ÙˆÛË ·˘Ù‹ ÁÈÓfiÙ·Ó ¤ÎÙ·ÎÙË Â›Û΄Ë, ηٿ ÙËÓ ÔÔ›· Ï·Ì‚·ÓfiÙ·Ó Â›Û˘ ÚÈÓÈÎfi ¤ÎÏ˘Ì·. §‹„Ë ÚÈÓÈÎÔ‡ ÂÎχ̷ÙÔ˜ °È· ÙËÓ ·Ó›¯Ó¢ÛË ÈÒÓ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡, ÂÏ‹ÊıË ÚÈÓÈÎfi ¤ÎÏ˘Ì· Ì ÙËÓ ·ÎfiÏÔ˘ıË ‰È·‰Èηۛ·: ∆· ·È‰È¿ ¤Ï·‚·Ó ηıÈÛÙ‹ ı¤ÛË Ì ˘ÂÚ¤ÎÙ·ÛË Ù˘ ÎÂÊ·Ï‹˜. ™ÙË Û˘Ó¤¯ÂÈ·, ÙÔÔıÂÙ‹ıËÎ·Ó 5 ml Ê˘ÛÈÔÏÔÁÈÎÔ‡ ÔÚÔ‡ Û οı ÚÈÓÈ΋ ÎÔÈÏfiÙËÙ· Î·È ·Ì¤Ûˆ˜ ÌÂÙ¿ ·ÎÔÏÔ‡ıËÛ ·Ó·ÚÚfiÊËÛË Ì ¯Ú‹ÛË ·Á›‰ˆÓ ‚ϤÓÓ˘. ∆Ô ·Ó·ÚÚfiÊËÌ· ‰È·Ï‡ıËΠ۠7 ml ˘ÏÈÎÔ‡ ÌÂÙ·ÊÔÚ¿˜ ÈÒÓ (VTM) Ô˘ ·ÔÙÂÏÔ‡ÓÙ·Ó ·fi Hanks BSS, 0,5% BSA, 40 Ìg/ml ciprofloxacin Î·È 2,5 Ìg/ml ·ÌÊÔÙÂÚÈΛÓË µ.

Paediatriki 2004;67:97-104

∆Ô ‰Â›ÁÌ· ÙÔÔıÂÙÔ‡ÓÙ·Ó Û ¿ÁÔ Ì¤¯ÚÈ ÙË ÌÂÙ·ÊÔÚ¿ ÙÔ˘ ÛÙÔ ÂÚÁ·ÛÙ‹ÚÈÔ, fiÔ˘ ÌÔÈÚ·˙fiÙ·Ó Û ۈÏËÓ¿ÚÈ· 1 ml, Ù· ÔÔ›· ηٷ„‡¯ÔÓÙ·Ó ÛÙÔ˘˜ -70oC ̤¯ÚÈ Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó. ∞Ó›¯Ó¢ÛË ÈÒÓ ∏ ·ÚÔ˘Û›· ÈÈÎÔ‡ RNA ÛÙ· ÚÈÓÔÊ·Ú˘ÁÁÈο ÂÎχ̷ٷ ÂÍÂÙ¿ÛÙËΠ̠·Ï˘ÛȉˆÙ‹ ·ÓÙ›‰Ú·ÛË ÔÏ˘ÌÂÚ¿Û˘ Ì ·Ó¿ÛÙÚÔÊË ÌÂÙ·ÁÚ·Ê‹ (RT-PCR). °È· ÙËÓ ÂÍ·ÁˆÁ‹ RNA, ·Ú·ÈÒıËÎ·Ó 10 Ìl ‰Â›ÁÌ·ÙÔ˜ Û ÓÂÚfi ˘ÂÚ˘„ËÏ‹˜ ÔÈfiÙËÙ·˜ (UHQ) Û ·Ó·ÏÔÁ›· 1:10. ™ÙË Û˘Ó¤¯ÂÈ·, ÚÔÛÙ¤ıËΠ›ÛË ÔÛfiÙËÙ· ·ÓÙȉڷÛÙËÚ›Ô˘ Trizol (Gibco) Î·È ¯ÏˆÚÔÊfiÚÌÈÔ 1:5. ∆Ô RNA ˘¤ÛÙË Î·ı›˙ËÛË Ì ÈÛÔÚÔ˘ÏÈ΋ ·ÏÎÔfiÏË, χıËΠ̠80% ·Èı·ÓfiÏË, ·Ê˘ÁÚ¿ÓıËΠ۠ÎÂÓfi Î·È Â·Ó·‰È·Ï‡ıËΠ۠UHQ. ∏ ·ÓÙ›ÛÙÚÔÊË ÌÂÙ·ÁÚ·Ê‹ ¤ÁÈÓ Û Ì›ÁÌ· Ô˘ ÂÚÈÂÏ¿Ì‚·Ó 50 mM Tris-HCl, 75 mM KCl, 3 mM MgCl2 Ú˘ıÌÈÛÙÈÎfi ‰È¿Ï˘Ì·, 10 mM DTT, 0,4 mM dNTPs, 0,5 Ìg ÂÍ·ÌÂÚ›˜ ÂÎÎÈÓËÙ¤˜ Î·È 200 U ·ÓÙ›ÛÙÚÔÊ˘ ÌÂÙ·ÁÚ·Ê¿Û˘ (SuperscriptTM, Gibco). ∆Ô Ì›ÁÌ· Âˆ¿ÛÙËΠÁÈ· 60 ÏÂÙ¿ ÛÙÔ˘˜ 37oC ÁÈ· ÙËÓ ·Ú·ÁˆÁ‹ Û˘ÌÏËڈ̷ÙÈÎÔ‡ DNA (cDNA) Î·È Î·Ù·„‡¯ıËΠÛÙÔ˘˜ -20oC ̤¯ÚÈ ÙÔ ÂfiÌÂÓÔ ‚‹Ì·.

OÈ ·ÓÙȉڿÛÂȘ PCR Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó Ì ÂÎÎÈÓËÙ¤˜ Î·È Û˘Óı‹Î˜ ÂȉÈΤ˜ ÁÈ· ÚÈÓÔ˚fi (8), ·Ó·Ó¢ÛÙÈÎfi Û˘Á΢ÙÈ·Îfi Èfi (9), ·‰ÂÓÔ˚fi (10), ÈÔ‡˜ ÁÚ›˘ ∞ Î·È µ (11), ÈÔ‡˜ ·Ú·ÁÚ›˘ 1, 2 Î·È 3 (12), ÈÔ‡˜ ÎÔÚfiÓ· OC43 Î·È 229∂ (13) Î·È ¯Ï·Ì‡‰È· Ó¢ÌÔÓ›·˜ (14), Û‡Ìʈӷ Ì ٷ ‰ËÌÔÛÈÂ˘Ì¤Ó· ÚˆÙfiÎÔÏÏ·. ∆· ÚÔ˚fiÓÙ· Ù˘ ·ÓÙ›‰Ú·Û˘ ËÏÂÎÙÚÔÊÔÚ‹ıËÎ·Ó Û Á¤ÏË ·Á·Úfi˙˘ 1,5% Î·È ÂÌÊ·Ó›ÛÙËÎ·Ó Ì ‚ÚˆÌÈÔ‡¯Ô ·Èı›‰ÈÔ. ™ÙÂϤ¯Ë ·Ó·ÊÔÚ¿˜ ÙˆÓ ·Ú·¿Óˆ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÒÓ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·Ó Û οı ·ÓÙ›‰Ú·ÛË ˆ˜ ıÂÙÈÎÔ› Ì¿ÚÙ˘Ú˜, fiˆ˜ Î·È ·ÚÎÂÙ¿ ‰Â›ÁÌ·Ù· ‰È·Ï‡ÙË ˆ˜ ·ÚÓËÙÈÎÔ‡ Ì¿ÚÙ˘Ú·. ªÂÙÚ‹ÛÂȘ ·ÂÚÔ·ÏÏÂÚÁÈÔÁfiÓˆÓ ∏ ηٷ̤ÙÚËÛË ÙˆÓ ·ÂÚÔ·ÏÏÂÚÁÈÔÁfiÓˆÓ Î·È, Û˘ÁÎÂÎÚÈ̤ӷ, ÙˆÓ Á˘ÚÂfiÎÔÎÎˆÓ Ù˘ ÂÏÈ¿˜, Ù˘ ·ÚÈÂÙ¿ÚÈ·˜ Î·È ÙˆÓ ·ÁÚˆÛÙˆ‰ÒÓ ÁÈÓfiÙ·Ó Î·ıËÌÂÚÈÓ¿ Ì ÌÈÎÚÔÛÎÔÈ΋ ̤ÙÚËÛË Â› ·ÓÙÈÎÂÈÌÂÓÔÊfiÚÔ˘ Ͽη˜ ÂÈÛÙڈ̤Ó˘ Ì ‚·˙ÂÏ›ÓË, Ë ÔÔ›· ÙÔÔıÂÙÔ‡ÓÙ·Ó Û Á˘ÚÂÔ·Á›‰· Burkard 24ˆÚ˘ ̤ÙÚËÛ˘ Î·È ÛÙË Û˘Ó¤¯ÂÈ· ‚·ÊfiÙ·Ó Ì ÊԢ͛ÓË. ∏ Á˘ÚÂÔ·Á›‰· Â›Ó·È ÙÔÔıÂÙË̤ÓË ÛÙÔ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”. ™Ù·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË °È· ÙËÓ ·ÍÈÔÏfiÁËÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ, Ù· Û˘ÌÙÒÌ·Ù· Ô˘ ηٷÁÚ¿ÊËÎ·Ó ÛÙȘ ËÌÂÚÔÏÔÁȷΤ˜ οÚÙ˜ ηٷ¯ˆÚ‹ıËÎ·Ó Û ËÏÂÎÙÚÔÓÈÎfi ˘ÔÏÔÁÈÛÙ‹ Î·È ÚÔÁÚ·ÌÌ·Ù›ÛÙËΠ·ÏÁfiÚÈıÌÔ˜ ˘ÔÏÔÁÈÛÌÔ‡ ÙˆÓ ÂÍ¿ÚÛÂˆÓ ÚÈÓ›Ùȉ·˜ (Û˘ÌÙÒÌ·Ù· ·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡, ‰ËÏ·‰‹ ÚÈÓÈ΋ ηٷÚÚÔ‹ ‹ Û˘ÌÊfiÚËÛË, Ù·ÚÌÔ›, ÎÓËÛÌfi˜, Î·È ÔÊı·ÏÌÈο Û˘ÌÙÒÌ·Ù·), ¿ÛıÌ·ÙÔ˜ (‚‹¯·˜, Û˘ÚÈÁÌfi˜, ‰‡ÛÓÔÈ·) Î·È ÙˆÓ Û˘ÓÔÏÈÎÒÓ Û˘ÌÙˆÌ¿ÙˆÓ ·Ó·Ó¢ÛÙÈ΋˜ ·ÏÏÂÚÁ›·˜ (¿ıÚÔÈÛÌ· ÙˆÓ ·Ú·¿Óˆ Û˘Ó ÁÂÓÈο Û˘ÌÙÒÌ·Ù·). ø˜ ¤Í·ÚÛË ÔÚ›ÛÙËÎÂ Ë ‡·ÚÍË ‰‡Ô ‹ ÂÚÈÛÛfiÙÂÚˆÓ ËÌÂÚÒÓ Ì ÙÈ̤˜ Û˘ÌÙˆÌ¿ÙˆÓ ·ÓÒÙÂÚ˜ Ù˘ ‰È¿ÌÂÛ˘ ÙÔ˘ Û˘ÁÎÂÎÚÈ̤ÓÔ˘ ·ÙfiÌÔ˘, ÂÓÒ ÚÔËÁÂ›Ù·È Ì›· ÙÔ˘Ï¿¯ÈÛÙÔÓ Ë̤ڷ Ì ÙÈÌ‹ ›ÛË ‹ ÌÈÎÚfiÙÂÚË Ù˘ ‰È¿ÌÂÛ˘ Î·È ¤ÔÓÙ·È 2 ÙÔ˘Ï¿¯ÈÛÙÔÓ Ë̤Ú˜ Ì ÙÈÌ‹ ›ÛË ‹ ÌÈÎÚfiÙÂÚË Ù˘ ‰È¿ÌÂÛ˘. ø˜ ‰È¿ÚÎÂÈ· ÙÔ˘ ÂÂÈÛÔ‰›Ô˘

99

¶·È‰È·ÙÚÈ΋ 2004;67:97-104

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∂ÈÎfiÓ· 1. ÃÚÔÓÈ΋ ηٷÓÔÌ‹ Û˘ÌÙˆÌ¿ÙˆÓ Î·È Â›‰· Á‡ÚÂˆÓ ÛÙËÓ ·ÙÌfiÛÊ·ÈÚ· ÙˆÓ ∞ıËÓÒÓ.

14 12

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ÕÛıÌ· ƒÈÓ›ÙȘ ∞ÁÚˆÛÙÒ‰Ë OÏÈο Û˘ÌÙ.

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25

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9/3/00

0 24/2/00

∞ÔÙÂϤÛÌ·Ù· ∫ÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ∆ÚÈ¿ÓÙ· ÂÓÓ¤· ·fi ÙÔ˘˜ 43 ·ÛıÂÓ›˜ (90,7%) ¤·Û¯·Ó Î·È ·fi ÂÔ¯È΋ ·ÏÏÂÚÁÈ΋ ÚÈÓ›Ùȉ·, ÂÓÒ 32/43 (74,4%) Î·È ·fi ·ÏÏÂÚÁÈ΋ ÂÈÂÊ˘Î›Ùȉ·. ∞fi ÙÔ˘˜ ·ÛıÂÓ›˜, 28 ‹Ù·Ó ¢·›ÛıËÙÔÈ ÛÙË Á‡ÚË Ù˘ ÂÏÈ¿˜, 17 ÛÙËÓ ·ÚÈÂÙ¿ÚÈ· Î·È 25 ÛÙÔ Ì›ÁÌ· ·ÁÚˆÛÙˆ‰ÒÓ. ∂Í ·˘ÙÒÓ, ÔÈ ÌÔÓÔ¢·›ÛıËÙÔÈ ‹Ù·Ó 9 ÛÙËÓ ÂÏÈ¿, 3 ÛÙËÓ ·ÚÈÂÙ¿ÚÈ· Î·È 7 ÛÙ· ·ÁÚˆÛÙÒ‰Ë. ¶¤ÓÙ ·ÛıÂÓ›˜ ‹Ù·Ó ¢·ÈÛıËÙÔÔÈË̤ÓÔÈ Î·È ÛÙȘ ÙÚÂȘ Á‡ÚÂȘ, ÂÓÒ ÔÈ ˘fiÏÔÈÔÈ ·ÚÔ˘Û›·˙·Ó Û˘Ó‰˘·ÛÌÔ‡˜ ·Ó¿ ‰‡Ô. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÔ¯‹˜, ÔÈ ·ÛıÂÓ›˜ ·ÚÔ˘Û›·Û·Ó 180 ÂÍ¿ÚÛÂȘ ·ÏÏÂÚÁÈ΋˜ ÓfiÛÔ˘ (‡ÚÔ˜: 1-8 ÂÂÈÛfi‰È· ηْ ¿ÙÔÌÔ), Û˘ÓÔÏÈ΋˜ ̤Û˘ ‰È¿ÚÎÂÈ·˜ 22,3 ËÌÂÚÒÓ Î·Ù’ ¿ÙÔÌÔ (‡ÚÔ˜: 2-41 Ë̤Ú˜, ̤ÛË ‰È¿ÚÎÂÈ· ÂÂÈÛÔ‰›Ô˘: 6 Ë̤Ú˜). ∞˘Ù¤˜ ÂÚÈÂÏ¿Ì‚·Ó·Ó 115 ÂÍ¿ÚÛÂȘ Û˘ÌÙˆÌ¿ÙˆÓ ¿ÛıÌ·ÙÔ˜ (‡ÚÔ˜: 0-8), ̤Û˘ ‰È¿ÚÎÂÈ·˜ ηْ ¿ÙÔÌÔ 15,3 ËÌÂÚÒÓ (̤ÛË ‰È¿ÚÎÂÈ· ÂÂÈÛÔ‰›Ô˘: 5,9 Ë̤Ú˜) Î·È 176 ÂÂÈÛfi‰È· ÚÈÓ›Ùȉ·˜ (‡ÚÔ˜: 0-8), Ô˘ ÎÚ¿ÙËÛ·Ó Î·Ù¿ ̤ÛÔ fiÚÔ 17,2 Ë̤Ú˜ ηْ ¿ÙÔÌÔ (̤ÛË ‰È¿ÚÎÂÈ· ÂÂÈÛÔ‰›Ô˘: 4,5 Ë̤Ú˜). ™Â οı ·ÛıÂÓ‹ ·ÓȯÓ‡ÙËÎ·Ó Î·Ù¿ ̤ÛÔ fiÚÔ 0,95 ÈÔ› (‡ÚÔ˜: 0-3, ‰È¿ÌÂÛË ÙÈÌ‹: 1). ™˘Û¯¤ÙÈÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Ì Â›‰· Á‡ÚÂˆÓ ™Â ÁÂÓÈΤ˜ ÁÚ·Ì̤˜, Ù· Û˘ÌÙÒÌ·Ù· ÙˆÓ ·ÛıÂÓÒÓ ÍÂΛÓËÛ·Ó ·fi ÙȘ ·Ú¯¤˜ ª·ÚÙ›Ô˘ Î·È Û˘Ó¤¯ÈÛ·Ó Ì¤¯ÚÈ Î·È ÙÔÓ πÔ‡ÓÈÔ. ∂Í¿ÚÛÂȘ ÙˆÓ Û˘ÓÔÏÈÎÒÓ Û˘ÌÙˆÌ¿ÙˆÓ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ ·Ú·ÙËÚ‹ıËÎ·Ó ÛÙȘ 11/3, 18/3, 3/4, 24/4, 12/5. OÈ ÂÍ¿ÚÛÂȘ ·˘Ù¤˜ ÂÚÈÂÏ¿Ì‚·Ó·Ó Û fiϘ ÙȘ ÂÚÈÙÒÛÂȘ ÂÍ¿ÚÛÂȘ Û˘ÌÙˆÌ¿ÙˆÓ ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡, ÂÓÒ ÂÍ¿ÚÛÂȘ Û˘ÌÙˆÌ¿ÙˆÓ ÙÔ˘ ηÙÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ ·Ú·ÙËÚ‹ıËÎ·Ó ÛÙȘ 19/3, 29-31/3, 26/4 Î·È 12/5 (∂ÈÎfiÓ· 1). ∞fi ÙȘ ηٷÓÔ̤˜ ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ Á‡ÚÂˆÓ ÛÙËÓ ·ÙÌfiÛÊ·ÈÚ·, η̛· ‰ÂÓ ÌÔÚÔ‡Û ӷ ‰ÈηÈÔÏÔÁ‹ÛÂÈ ·ÔÎÏÂÈÛÙÈο ÙȘ ÌÂÙ·‚ÔϤ˜ ÙˆÓ Û˘Ìو̿وÓ. ŒÙÛÈ, Ë ¤Í·ÚÛË ÛÙȘ 12/5 Û˘Ó¤ÈÙ Ì ÙËÓ ¤Í·ÚÛË Ù˘ Á˘ÚÂÔÊÔÚ›·˜ Ù˘ ÂÏÈ¿˜. ŸÌˆ˜, ·ÎfiÌ· Î·È ÔÈ ·ÛıÂÓ›˜ Ì ·ÔÎÏÂÈÛÙÈ΋ ¢·ÈÛıËÛ›· ÛÙËÓ ÂÏÈ¿ ·ÚÔ˘Û›·Û·Ó Û˘ÌÙÒÌ·Ù· Î·È ÂÎÙfi˜ ÂÔ¯‹˜, Ì ÂÍ¿ÚÛÂȘ ÛÙȘ 12/3, 21/3 Î·È 31/3 (∂ÈÎfiÓ· 2).

OÏÈο Û˘ÌÙ. ÕÛıÌ· ƒÈÓ›ÙȘ ∞ÁÚˆÛÙÒ‰Ë ∂ÏÈ¿ ¶·ÚÈÂÙ¿ÚÈ·

120

10/2/00

ÔÚ›ÛÙËÎÂ Ô ¯ÚfiÓÔ˜ ·fi ÙËÓ ·Ú¯È΋ Â›Ù·ÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Ì¤¯ÚÈ ÙËÓ ÂÈÛÙÚÔÊ‹ ÛÙË ‰È¿ÌÂÛË ÙÈÌ‹, ÂÓÒ ˆ˜ ‚·Ú‡ÙËÙ· Ë Ì¤ÁÈÛÙË ÙÈÌ‹ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÂÂÈÛÔ‰›Ô˘. £ÂˆÚ‹ıËΠfiÙÈ Ì›· ̤ÙÚËÛË Û˘Û¯ÂÙ›˙ÂÙ·È Ì ÙÔ ÂÂÈÛfi‰ÈÔ, Â¿Ó Û˘Ó¤‚Ë ·fi Ì›· ‚‰ÔÌ¿‰· ÚÈÓ ¤ˆ˜ Î·È ÙË Ï‹ÍË ÙÔ˘ ÂÂÈÛÔ‰›Ô˘ (5). °È· ÙË Û‡ÁÎÚÈÛË ÙˆÓ Ì¤ÛˆÓ ÙÈÌÒÓ ‚·Ú‡ÙËÙ·˜ Î·È ‰È¿ÚÎÂÈ·˜ ÙˆÓ ÂÂÈÛÔ‰›ˆÓ Ô˘ Û¯ÂÙ›ÛÙËÎ·Ó Ì ÈÔ‡˜ Ì ÂΛӷ Ô˘ ‰ÂÓ Û¯ÂÙ›ÛÙËηÓ, ¯ÚËÛÈÌÔÔÈ‹ıËΠÙÔ student’s t-test. ™ËÌ·ÓÙÈÎfi ıˆڋıËΠÙÔ Â›Â‰Ô <5%.

Paediatriki 2004;67:97-104

200 150 100 50 0

∂ÈÎfiÓ· 2. ÃÚÔÓÈ΋ ηٷÓÔÌ‹ Û˘ÌÙˆÌ¿ÙˆÓ Î·È Â›‰· ·ÚÈÂÙ¿ÚÈ·˜, ·ÁÚˆÛÙˆ‰ÒÓ Î·È ÂÏÈ¿˜ Û ·ÛıÂÓ›˜ Ì ÌÔÓÔ¢·ÈÛıËÛ›· ÛÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë Á‡ÚË (Â› 3, 7 Î·È 9 ·ÛıÂÓÒÓ, ·ÓÙ›ÛÙÔȯ·).

∞ÓÙ›ÛÙÔȯ·, Ë ¤Í·ÚÛË ÛÙȘ 11/3 ı· ÌÔÚÔ‡Û ӷ ·Ô‰Ôı› Û ÌÈÎÚ‹ ·‡ÍËÛË ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ Á‡Ú˘ ·ÚÈÂÙ¿ÚÈ·˜. ¶·Ú’ fiÏ· ·˘Ù¿, Ë ÌÂÁ¿ÏË ¤Í·ÚÛË

¶·È‰È·ÙÚÈ΋ 2004;67:97-104

Paediatriki 2004;67:97-104

Ù˘ ·ÚÈÂÙ¿ÚÈ·˜ ÛÙȘ 16/4 ‰ÂÓ Ê¿ÓËΠӷ Û˘Óԉ‡ÂÙ·È ·Ú¿ ·fi ÌÈÎÚ‹ ¤Í·ÚÛË Û˘Ìو̿وÓ, ÌfiÓÔ ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡. ∂ÈϤÔÓ, Ë Â›Ù·ÛË Ô˘ ·ÚÔ˘ÛÈ¿ÛÙËΠÛÙÔ Ù¤ÏÔ˜ ª·ÚÙ›Ô˘ ¤ˆ˜ ÙȘ ·Ú¯¤˜ ∞ÚÈÏ›Ô˘ (29-31/3 ÛÙÔ Î·ÙÒÙÂÚÔ ·Ó·Ó¢ÛÙÈÎfi, 3/4 ÁÈ· Ù· Û˘ÓÔÏÈο Û˘ÌÙÒÌ·Ù·), ·Ó Î·È Û˘Ó‰¤ÂÙ·È ¯·Ï·Ú¿ Ì ÌÈÎÚ¤˜ ·˘Í‹ÛÂȘ ÙˆÓ Á‡ÚÂˆÓ ÙˆÓ ·ÁÚˆÛÙˆ‰ÒÓ Î·È Ù˘ ·ÚÈÂÙ¿ÚÈ·˜, ·Ú·ÙËÚ‹ıËΠÂ›Û˘ Î·È ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ·ÔÎÏÂÈÛÙÈ΋ ¢·ÈÛıËÛ›· ÛÙËÓ ÂÏÈ¿. ∏ ¤Í·ÚÛË ÛÙȘ 24-26/4 Û˘Ó‰¤ÂÙ·È Ì ¤Í·ÚÛË ÙˆÓ Á‡ÚÂˆÓ ÙˆÓ ·ÁÚˆÛÙˆ‰ÒÓ, ·ÎÔÏÔ˘ı› ‰Â ÙȘ ̤ÁÈÛÙ˜ ÙÈ̤˜ ·ÚÈÂÙ¿ÚÈ·˜ Î·È ·ÁÚˆÛÙˆ‰ÒÓ Ô˘ ÂÌÊ·Ó›ÛÙËÎ·Ó ÙËÓ ÚÔËÁÔ‡ÌÂÓË Â‚‰ÔÌ¿‰· ηÈ, ÂÔ̤ӈ˜, ÌÔÚ› Ó· ·Ô‰Ôı› Û ·˘Ù¤˜. ∆¤ÏÔ˜, Ë ¤Í·ÚÛË ÛÙȘ 18-19/3 ‰ÂÓ Ê·›ÓÂÙ·È Ó· Û˘Û¯ÂÙ›˙ÂÙ·È Ì οÔÈ· ÌÂÙ·‚ÔÏ‹ ÙˆÓ ÙÈÌÒÓ ÙˆÓ Á‡ÚÂˆÓ ÛÙËÓ ·ÙÌfiÛÊ·ÈÚ·. ¶Ú¤ÂÈ Ó· ·Ó·ÊÂÚı› fiÙÈ Ô ·ÚÈıÌfi˜ ÂÍ¿ÚÛÂˆÓ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ‹Ù·Ó ›‰ÈÔ˜ ‹ Î·È ÌÂÁ·Ï‡ÙÂÚÔ˜ ÂÎÙfi˜ Ù˘ ÂÔ¯‹˜ Á˘ÚÂÔÊÔÚ›·˜ ·’ fiÙÈ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ¿ Ù˘, ÁÈ· fiÏ· Ù· ¿ÙÔÌ·, ·Û¯¤Ùˆ˜ ÙÔ˘ ·ÏÏÂÚÁÈÔÁfiÓÔ˘ ÛÙÔ ÔÔ›Ô ‹Ù·Ó ¢·ÈÛıËÙÔÔÈË̤ÓÔÈ (Ù· ‰Â‰Ô̤ӷ ‰ÂÓ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È). ™˘Û¯¤ÙÈÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Ì ÈÒÛÂȘ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ ªÂÙÚ‹ÛÂȘ ÈÒÓ Ì PCR ¤ÁÈÓ·Ó Û 151 ÂÈÛΤ„ÂȘ, 133 ÚÔÁÚ·ÌÌ·ÙÈṲ̂Ó˜ Î·È 18 ¤ÎÙ·ÎÙ˜. ∞ÓȯÓ‡ÙËÎ·Ó 42 ÈÔ›, 26 ÂÎ ÙˆÓ ÔÔ›ˆÓ ‹Ù·Ó ÚÈÓÔ˚Ô›, 7 ·‰ÂÓÔ˚Ô›, 5 ÈÔ› ·Ú·ÁÚ›˘, 2 ÈÔ› ÎÔÚfiÓ· Î·È 2 ·Ó·Ó¢ÛÙÈÎÔ› Û˘Á΢ÙÈ·ÎÔ› ÈÔ›. ∏ ÂÔ¯È΋ ηٷÓÔÌ‹ ÙˆÓ ÈÒÓ Ê·›ÓÂÙ·È ÛÙËÓ ∂ÈÎfiÓ· 3. ∂ӉȷʤÚÔÓ ·ÚÔ˘ÛÈ¿˙ÂÈ Ë ÌÂÁ¿ÏË ¤Í·ÚÛË ÙˆÓ ÈÒÛÂˆÓ ÙÔ ÚÒÙÔ 15‹ÌÂÚÔ ÙÔ˘ ª·˝Ô˘, ·Ú¿ÏÏËÏ· Ì ÙËÓ ¤Í·ÚÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Ô˘ ÁÂÓÈο ·Ô‰›‰ÔÓÙ·È ÛÙË Á‡ÚË Ù˘ ÂÏÈ¿˜. ∂›Û˘, ·˘ÍË̤Ó˜ ÈÒÛÂȘ ·Ú·ÙËÚ‹ıËÎ·Ó ÛÙÔ ‰Â‡ÙÂÚÔ 15‹ÌÂÚÔ ÙÔ˘ ª·ÚÙ›Ô˘, ÁÂÁÔÓfi˜ ÙÔ ÔÔ›Ô ı· ÌÔÚÔ‡Û ӷ Û¯ÂÙÈÛÙ› Ì ÙȘ

AÚÈıÌfi˜ ·ÔÌÔÓˆı¤ÓÙˆÓ ÈÒÓ

15

ÂÍ¿ÚÛÂȘ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÛÙȘ 18-19/3 Î·È ÛÙȘ 29/3-3/4, Ù· ÔÔ›·, fiˆ˜ ·Ó·Ê¤ÚıËΠ·Ú·¿Óˆ, ‰ÂÓ ÌÔÚÔ‡Ó Ó· ÂÍËÁËıÔ‡Ó ÈηÓÔÔÈËÙÈο Ì ÙȘ ÌÂÙ·‚ÔϤ˜ ÙˆÓ Á‡ÚˆÓ. ∞fi ÙȘ 151 ÂÈÛΤ„ÂȘ, 67 ‹Ù·Ó Â› ÎÚ›ÛˆÓ, fiˆ˜ ·Ó·ÁÓˆÚ›ÛÙËΠ·fi ÙÔÓ ·ÏÁfiÚÈıÌÔ Ì¤Ûˆ ˘ÔÏÔÁÈÛÙ‹. ™Â 24/67 (36%) Û˘Ó˘‹Ú¯·Ó ÈÔ› (∂ÈÎfiÓ· 4). ∞ÓÙ›ÛÙÔȯ·, fiÙ·Ó ÂÍÂÙ¿ÛÙËÎ·Ó ÔÈ ÎÚ›ÛÂȘ ¿ÛıÌ·ÙÔ˜, ÙÔ ÔÛÔÛÙfi ·Ó‡ÚÂÛ˘ ÈÒÓ ‹Ù·Ó 33%, ÂÓÒ ÛÙȘ ÂÍ¿ÚÛÂȘ ÚÈÓ›Ùȉ·˜ ‹Ù·Ó 35%. ∞fi ÙȘ 18 ¤ÎÙ·ÎÙ˜ ÂÈÛΤ„ÂȘ, Èfi˜ ·ÔÌÔÓÒıËΠÛÙȘ 10 (56%). ™Â fiϘ ÙȘ ÂÚÈÙÒÛÂȘ, ÔÈ ÈÔ› Ô˘ ÚÔÂÍ‹Ú¯·Ó ‹Ù·Ó ÔÈ ÚÈÓÔ˚Ô› (6374%). πÔ› ·ÔÌÔÓÒıËÎ·Ó Î·È Û 18/84 (21%) ÂÚÈÙÒÛÂȘ Ô˘ ¤ÁÈÓ ϋ„Ë ÂÎÙfi˜ ÂÂÈÛÔ‰›Ô˘. ∆Ô ÔÛÔÛÙfi ·˘Ùfi Â›Ó·È ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ÌÈÎÚfiÙÂÚÔ ·fi ÂΛÓÔ Ô˘ ·Ú·ÙËÚ‹ıËΠÂ› ÂÂÈÛÔ‰›Ô˘ (‰ÔÎÈÌ·Û›· ¯2, p=0,05). ™ÙË Û˘Ó¤¯ÂÈ·, Û˘ÁÎÚ›ıËÎ·Ó Ù· ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ÂÂÈÛÔ‰›ˆÓ Ô˘ ·ÔÌÔÓÒıËΠÈfi˜ Ì ÂΛӷ ÛÙ· ÔÔ›· ‰ÂÓ ˘‹Ú¯Â Èfi˜. ∏ ̤ÛË ‚·Ú‡ÙËÙ· ÙˆÓ ÂÂÈÛÔ‰›ˆÓ ÚÈÓ›Ùȉ·˜ ÛÙ· ÔÔ›· ·ÔÌÔÓÒıËΠÈfi˜ ‹Ù·Ó 1,9±0,2, ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ÌÈÎÚfiÙÂÚË ·fi ÂΛÓË ÙˆÓ ÂÂÈÛÔ‰›ˆÓ ÛÙ· ÔÔ›· ‰ÂÓ ˘‹Ú¯Â Èfi˜ (2,7±0,2, p=0,027) (∂ÈÎfiÓ· 5). ∞ÓÙ›ıÂÙ·, Ù· ÂÂÈÛfi‰È· ¿ÛıÌ·ÙÔ˜ Ô˘ Û¯ÂÙ›ÛÙËÎ·Ó Ì Èfi ‹Ù·Ó Û¯ÂÙÈο ‚·Ú‡ÙÂÚ· ·fi ÂΛӷ ÛÙ· ÔÔ›· ‰ÂÓ ˘‹Ú¯Â Èfi˜, ·ÏÏ¿ ·˘Ù‹ Ë ‰È·ÊÔÚ¿ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÔÚȷ΋ (3,3±0,3 Û ۇÁÎÚÈÛË Ì 3,0±0,3, p=0,07). ∆¤ÏÔ˜, Ë ‰È¿ÚÎÂÈ· ÙˆÓ ÂÂÈÛÔ‰›ˆÓ ·Ó·Ó¢ÛÙÈ΋˜ ·ÏÏÂÚÁ›·˜ ÛÙ· ÔÔ›· ·ÔÌÔÓÒıËΠÈfi˜ ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚË ·fi ÂΛӷ ÛÙ· ÔÔ›· ‰ÂÓ ˘‹Ú¯Â Èfi˜ (8,7±1,2 Û ۯ¤ÛË Ì 6,0±0,7 Ë̤Ú˜, p=0,019) (∂ÈÎfiÓ· 6). ™˘˙‹ÙËÛË ∆Ô ¿ÛıÌ· Â›Ó·È ÙÔ Û˘¯ÓfiÙÂÚÔ ¯ÚfiÓÈÔ ÓfiÛËÌ· Ù˘ ·È‰È΋˜ ËÏÈΛ·˜, ÂÓÒ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÙÂÏÂ˘Ù·›ˆÓ ‰‡Ô ‰ÂηÂÙÈÒÓ ·ÚÔ˘ÛÈ¿˙ÂÈ Ù¿ÛË ·‡ÍËÛ˘ ÛÙÔÓ “‰˘ÙÈÎfi” ÎfiÛÌÔ, Ì ·ÔÙ¤ÏÂÛÌ· Ó· ¤¯ÂÈ Ï¿‚ÂÈ Û‹ÌÂÚ· ÚˆÙfiÁÓˆÚ˜, ÂȉËÌÈΤ˜ ‰È·ÛÙ¿ÛÂȘ (2).

10

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∂ÈÎfiÓ· 3. ÃÚÔÓÈ΋ ηٷÓÔÌ‹ ·ÔÌfiÓˆÛ˘ ÈÒÓ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÌÂϤÙ˘. OÈ ÛًϘ ·Ó·Ê¤ÚÔÓÙ·È Û ·ÚÈıÌfi ÈÒÓ Ô˘ ·ÔÌÔÓÒıËÎ·Ó Û οı 15‹ÌÂÚÔ.

∂ÈÎfiÓ· 4. ¶ÔÛÔÛÙfi ÂÂÈÛÔ‰›ˆÓ ·Ó·Ó¢ÛÙÈ΋˜ ·ÏÏÂÚÁ›·˜, ÛÙÔ ÔÔ›Ô ·ÔÌÔÓÒıËÎ·Ó ÈÔ› (36%). ∏ ÌÂÁ¿ÏË ÏÂÈÔÓfiÙËÙ· ÙˆÓ ÈÒÓ ·˘ÙÒÓ (70%) ‹Ù·Ó ·ÓıÚÒÈÓÔÈ ÚÈÓÔ˚Ô› (RV).

101

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∂ÈÎfiÓ· 5. µ·Ú‡ÙËÙ· ÂÂÈÛÔ‰›ˆÓ ÚÈÓ›Ùȉ·˜ (·ÓÒÙÂÚÔ ·Ó·Ó¢ÛÙÈÎfi) Î·È ¿ÛıÌ·ÙÔ˜ (ηÙÒÙÂÚÔ ·Ó·Ó¢ÛÙÈÎfi) Û¯ÂÙÈο Ì ÙÔ Â¿Ó ·ÔÌÔÓÒıËΠ‹ fi¯È Èfi˜ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ (* = p<0,05, # = 0,05<p<0,1).

∂ÈÎfiÓ· 6. ª¤ÛË ‰È¿ÚÎÂÈ· ÂÍ¿ÚÛÂˆÓ ÂÔ¯È΋˜ ·Ó·Ó¢ÛÙÈ΋˜ ·ÏÏÂÚÁ›·˜. ™‡ÁÎÚÈÛË ÌÂٷ͇ ÙˆÓ ÂÂÈÛÔ‰›ˆÓ Ô˘ ·ÔÌÔÓÒıËΠÈfi˜ Î·È ÂÎÂ›ÓˆÓ ÛÙ· ÔÔ›· ‰ÂÓ ‚Ú¤ıËÎÂ. ∏ ‰È·ÊÔÚ¿ Â›Ó·È ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ (p=0,019).

OÈ ·Èٛ˜ ·˘Ù‹˜ Ù˘ ·‡ÍËÛ˘ ‰ÂÓ Â›Ó·È ·fiÏ˘Ù· ηٷÓÔËÙ¤˜. Œ¯ÂÈ Á›ÓÂÈ, fï˜, ۷ʤ˜ fiÙÈ ÙÔ ¿ÛıÌ· ·ÚÔ˘ÛÈ¿˙ÂÙ·È Ì ·ÚÎÂÙÔ‡˜ ‰È·ÊÔÚÂÙÈÎÔ‡˜ Ê·ÈÓÔÙ‡Ô˘˜, ÂÓÒ Ï‹ıÔ˜ ·Ú·ÁfiÓÙˆÓ, ÙfiÛÔ ÁÂÓÂÙÈÎÒÓ fiÛÔ Î·È ÂÚÈ‚·ÏÏÔÓÙÈÎÒÓ, ·›˙ÂÈ ÚfiÏÔ ÛÙËÓ ÂÌÊ¿ÓÈÛË Î·È ÙËÓ ÂΉ‹ÏˆÛ‹ ÙÔ˘, Ì ÂÍ·ÈÚÂÙÈο ÔχÏÔΘ ·ÏÏËÏÂȉڿÛÂȘ (3). ∞Ó¿ÌÂÛ· ÛÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ Ô˘ ¤¯Ô˘Ó ÌÂÏÂÙËı› ÂÚÈÛÛfiÙÂÚÔ ÂÚÈÏ·Ì‚¿ÓÂÙ·È Î·È Ë Â˘·ÈÛıËÙÔÔ›ËÛË Û ÎÔÈÓ¿ ÂÚÈ‚·ÏÏÔÓÙÈο ·ÏÏÂÚÁÈÔÁfiÓ·. ∏ Á˘ÚÂÔ·ÏÏÂÚÁ›· Â›Ó·È ¿ÏψÛÙ ¤Ó· Û‡Ó‰ÚÔÌÔ Ô˘ ÂΉËÏÒÓÂÙ·È ¯·Ú·ÎÙËÚÈÛÙÈο Û·Ó ·ÏÏÂÚÁ›· ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡, ÂÚÈÏ·Ì‚¿ÓÔÓÙ·˜ ÚÈÓ›Ùȉ·, ¿ÛıÌ·, ÂÈÂÊ˘Î›Ùȉ· Î·È ÁÂÓÈο Û˘ÌÙÒÌ·Ù·. ∞Ó Î·È Ô Ì˯·ÓÈÛÌfi˜ Ù˘ ¿ÌÂÛ˘ ˘ÂÚ¢·ÈÛıËÛ›·˜ ¤¯ÂÈ ÌÂÏÂÙËı› ÏÂÙÔÌÂÚÒ˜, ·ÏÏ¿ Î·È ÚÔÎÏ‹ÛÂȘ Ì Á‡ÚÂȘ ˘fi ÂÏÂÁ¯fiÌÂÓ˜ Û˘Óı‹Î˜ ¤¯Ô˘Ó ηٷʤÚÂÈ Ó· Â·Ó·Ï¿‚Ô˘Ó ÙË Û˘Ìو̷ÙÔÏÔÁ›· Ù˘ ÂÔ¯È΋˜ ·ÏÏÂÚÁ›·˜, Ë Û˘Û¯¤ÙÈÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ Á‡ÚÂˆÓ Ì ٷ Û˘ÌÙÒÌ·Ù· ÙÔ˘ ¿ÛıÌ·ÙÔ˜ ‹ Ù˘ ÚÈÓ›Ùȉ·˜ Û Â›Â‰Ô Ê˘ÛÈ΋˜ ÈÛÙÔÚ›·˜ ‰ÂÓ Â›Ó·È ·ÎfiÌË Ï‹Úˆ˜ ηٷÓÔËÙ‹ (15,16). ŒÙÛÈ, ıˆÚÂ›Ù·È fiÙÈ ÔÈ Á‡ÚÂȘ ÌÔÚ› Ó· ‰ÚÔ˘Ó Ì ·ıÚÔÈÛÙÈÎfi Ì˯·ÓÈÛÌfi ‹ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ¿ÏÏÔ˘˜ ·Ú¿ÁÔÓÙ˜. ∞ÓÙ›ıÂÙ·, Ë ÈÛ¯˘ÚfiÙÂÚË Û˘Û¯¤ÙÈÛË ·Ó¿ÌÂÛ· Û ÂÚÈ‚·ÏÏÔÓÙÈÎfi ·Ú¿ÁÔÓÙ· Î·È ÛÙËÓ ¤ÎÏ˘ÛË ÎÚ›Ûˆ˜ ¿ÛıÌ·ÙÔ˜ ÛÙËÓ ÎÔÈÓfiÙËÙ· ˘¿Ú¯ÂÈ Ì ÙȘ ÈÔÁÂÓ›˜ ÏÔÈÌÒÍÂȘ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡. ŒÙÛÈ, ·ÚÎÂÙ¤˜ ÌÂϤÙ˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ ÂÚÈÛÛfiÙÂÚÔ ·fi ÙÔ 80% ÙˆÓ ÎÚ›ÛÂˆÓ ¿ÛıÌ·ÙÔ˜ ·ÎÔÏÔ˘ı› ÈÔÏÔÁÈο Ù·˘ÙÔÔÈË̤ӷ ÎÚ˘ÔÏÔÁ‹Ì·Ù· (5). ™Â ·ÓÙ›ıÂÛË Ì ÙȘ Á‡ÚÂȘ, Ù· ÂÈÚ·Ì·ÙÈο ÎÚ˘ÔÏÔÁ‹Ì·Ù· Û ÂıÂÏÔÓÙ¤˜ Â›Ó·È Û ϛÁ˜ ÌfiÓÔ ÂÚÈÙÒÛÂȘ Èηӿ Ó· ÚÔηϤÛÔ˘Ó ÎÚ›ÛË ¿ÛıÌ·ÙÔ˜, ÔÈ ‰Â Ì˯·ÓÈÛÌÔ› Ô˘ ÚÔηÏÔ‡Ó ÙËÓ ÎÚ›ÛË ‚Ú›ÛÎÔÓÙ·È ·ÎfiÌË ˘fi ‰ÈÂÚ‡ÓËÛË (17,18).

∏ ·ÚÔ‡Û· ÂÚÁ·Û›· Â›Ó·È Ë ÚÒÙË ÂȉËÌÈÔÏÔÁÈ΋ ÌÂϤÙË Ô˘ Û˘Ó˘ÔÏÔÁ›˙ÂÈ ÈÔ‡˜ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Î·È ·ÏÏÂÚÁÈÔÁfiÓ· ÛÙË Ê˘ÛÈ΋ ÈÛÙÔÚ›· ÙÔ˘ ¿ÛıÌ·ÙÔ˜. ∂ÂϤÁË Ó· ÌÂÏÂÙËı› ÙÔ ÂÔ¯ÈÎfi ¿ÛıÌ·, ‰Â‰Ô̤Ó˘ Ù˘ Ôχ ÈÛ¯˘Ú‹˜ Û˘Û¯¤ÙÈÛ‹˜ ÙÔ˘ Ì ÙË Á˘ÚÂÔ·ÏÏÂÚÁ›·, ¤ÙÛÈ ÒÛÙ ӷ ÂÍÂÙ·ÛÙ› Ë ·ÎÚ·›· ÂÚ›ÙˆÛË ÂÓfi˜ Ê¿ÛÌ·ÙÔ˜, fiÔ˘ ÈÔ› Î·È ·ÏÏÂÚÁÈÔÁfiÓ· Û˘ÌÌÂÙ¤¯Ô˘Ó. Ÿˆ˜ Î·È Û ÚÔËÁÔ‡ÌÂÓ˜ ÌÂϤÙ˜, ‰È·ÈÛÙÒıËΠfiÙÈ ÔÈ ÌÂÙ·‚ÔϤ˜ ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ Á‡ÚÂˆÓ ‰ÂÓ ÌÔÚÔ‡Ó ·fi ÌfiÓ˜ ÙÔ˘˜ Ó· ÂÍËÁ‹ÛÔ˘Ó ÙË ÌÂÙ·‚ÏËÙfiÙËÙ· ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ “·ÏÏÂÚÁÈ΋˜ ÂÔ¯‹˜” (15,16). ∞Ó Î·È ·ÚÎÂÙ¤˜ ·fi ÙȘ ÂÍ¿ÚÛÂȘ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Û˘Ó¤ÈÙ·Ó Ì ·‡ÍËÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ Á‡ÚˆÓ, ÙÔ ÁÂÁÔÓfi˜ ·˘Ùfi ‰ÂÓ ÌÔÚÔ‡Û ӷ ÁÂÓÈ΢ٛ. ∂›Û˘, ¿ÙÔÌ· Ì ·ÔÎÏÂÈÛÙÈ΋ ¢·ÈÛıËÛ›· Û ¤Ó· ·ÏÏÂÚÁÈÔÁfiÓÔ ·ÚÔ˘Û›·˙·Ó Û˘ÌÙÒÌ·Ù· Î·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ Á˘ÚÂÔÊÔÚ›·˜ ¿ÏÏˆÓ Ê˘ÙÒÓ. ŒÓ·˜ Èı·Ófi˜ ·Ú¿ÁÔÓÙ·˜ Ô˘ ı· ÌÔÚÔ‡Û ӷ ÂÚÌËÓ‡ÛÂÈ ·˘Ù‹ ÙË ÌÂÙ·‚ÏËÙfiÙËÙ· Â›Ó·È Ë Â˘·ÈÛıËÛ›· Û ¿ÏÏ· ·ÏÏÂÚÁÈÔÁfiÓ·, Ù· ÔÔ›· ‰ÂÓ ÂϤÁ¯ıËÎ·Ó ÛÙË ÌÂϤÙË. ¶Ú¤ÂÈ, fï˜, Ó· ÛËÌÂȈı› fiÙÈ, Ì ÂÍ·›ÚÂÛË ÙÔ Î˘·Ú›ÛÛÈ, ÙÔ˘ ÔÔ›Ô˘ Ë ·ÓıÔÊÔÚ›· ÔÏÔÎÏËÚÒÓÂÙ·È ÚÈÓ ÙËÓ ¿ÓÔÈÍË, ¿ÏϘ Á‡ÚÂȘ ıˆÚÂ›Ù·È fiÙÈ ¤¯Ô˘Ó ÌÈÎÚ‹ ÎÏÈÓÈ΋ ÛËÌ·Û›· ÛÙËÓ ∂ÏÏ¿‰· (19). ª›· ·ÎfiÌË Èı·ÓfiÙËÙ· Â›Ó·È Ë ÌÂÙ·‚ÔÏ‹ Ù˘ ¢·ÈÛıËÙÔÔ›ËÛ˘ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÔ¯‹˜. ¶ÚÔËÁÔ‡ÌÂÓË ÌÂϤÙË ¤‰ÂÈÍ fiÙÈ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÊ˂›·˜ Û˘Ì‚·›ÓÔ˘Ó ÛËÌ·ÓÙÈΤ˜ ÌÂÙ·‚ÔϤ˜ ÛÙËÓ Â˘·ÈÛıËÙÔÔ›ËÛË (20). ∫·È ÛÙËÓ ÂÚ›ÙˆÛË ·˘Ù‹, fï˜, ‰ÂÓ ı· ÌÔÚÔ‡Û ӷ ‰ÈηÈÔÏÔÁËı› ¤Ó· ÌÂÁ¿ÏÔ ÔÛÔÛÙfi ·ÏÏ·Á‹˜. ∂Ô̤ӈ˜, Ë ‡·ÚÍË ¿ÏÏˆÓ ·Ú·ÁfiÓÙˆÓ Ô˘ Â¿ÁÔ˘Ó ÙȘ ÎÚ›ÛÂȘ Ê·›ÓÂÙ·È Ó· ·ÔÙÂÏ› ÙËÓ ÈÔ Â‡ÏÔÁË ÂÚÌËÓ›·.

OÈ ÈÒÛÂȘ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Ê·›ÓÂÙ·È Ó· Û˘ÌÌÂÙ¤¯Ô˘Ó Û ÂÚÈÛÛfiÙÂÚ˜ ·fi ÙÔ ¤Ó· ÙÚ›ÙÔ ÙˆÓ

102

¶·È‰È·ÙÚÈ΋ 2004;67:97-104

ÎÚ›ÛˆÓ. ∆Ô ÔÛÔÛÙfi ·˘Ùfi Â›Ó·È È‰È·›ÙÂÚ· ÛËÌ·ÓÙÈÎfi, ‰Â‰Ô̤ÓÔ˘ fiÙÈ Ô ÏËı˘ÛÌfi˜ ·˘Ùfi˜ ÂÈϤ¯ıËΠ̠ÎÚÈÙ‹ÚÈÔ ÙËÓ ÂȉÈ΋ ¢·ÈÛıËÙÔÔ›ËÛË Û ÂÔ¯Èο ·ÏÏÂÚÁÈÔÁfiÓ·. ∞fi ÙËÓ ¿ÏÏË ÌÂÚÈ¿, ÙÔ ÔÛÔÛÙfi ·˘Ùfi Â›Ó·È Ôχ ÌÈÎÚfiÙÂÚÔ ·fi ÙÔ 80-85% Ô˘ ·Ú·ÙËÚÂ›Ù·È Û ÎÚ›ÛÂȘ Û˘ÚÈÁÌÔ‡ ÛÙËÓ ÎÔÈÓfiÙËÙ·. ∆· ‰‡Ô ·˘Ù¿ ÁÂÁÔÓfiÙ· ÛÙËÚ›˙Ô˘Ó ÙËÓ ¿Ô„Ë fiÙÈ ÈÔ› Î·È ·ÏÏÂÚÁÈÔÁfiÓ· ·ÔÙÂÏÔ‡Ó ·ÓÂÍ¿ÚÙËÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ Âȉ›ӈÛ˘ ÙÔ˘ ¿ÛıÌ·ÙÔ˜, Ì ÛËÌ·ÓÙÈ΋ ÂÈÎ¿Ï˘„Ë Ô˘ ‰È·Ê¤ÚÂÈ ·Ó·ÏfiÁˆ˜ ÙÔ˘ ·ÛıÌ·ÙÈÎÔ‡ Ê·ÈÓÔÙ‡Ô˘. OÈ ‰È·ÊÔÚ¤˜ ÌÂٷ͇ ÙˆÓ ‰‡Ô Ê·ÈÓÔÙ‡ˆÓ ηÙÔ¯˘ÚÒÓÔÓÙ·È ÂÚÈÛÛfiÙÂÚÔ Î·Ù¿ ÙË Û‡ÁÎÚÈÛË ÌÂٷ͇ ÙˆÓ ÂÂÈÛÔ‰›ˆÓ Ô˘ Û¯ÂÙ›ÛÙËÎ·Ó Ì ÈÔ‡˜ Î·È ÂÎÂ›ÓˆÓ ÛÙ· ÔÔ›· ‰ÂÓ ˘‹Ú¯Â Èfi˜. OÈ ÈÔ› ÚÔηÏÔ‡Ó ËÈfiÙÂÚË ÚÈÓ›Ùȉ·, ·ÏÏ¿ ‚·Ú‡ÙÂÚÔ ¿ÛıÌ·, ÂÓÒ Ë ·ÚÔ˘Û›· ÈÔ‡ ηı˘ÛÙÂÚ› ÙËÓ ·Ó¿ÚÚˆÛË. OÈ ·Ú·ÙËÚ‹ÛÂȘ ·˘Ù¤˜ Û˘ÌʈÓÔ‡Ó Ì ÙËÓ È‰¤· ÁÈ· ÙÔ˘˜ ÎÔÈÓÔ‡˜ ·ÂÚ·ÁˆÁÔ‡˜, fiÙÈ ‰ËÏ·‰‹ ÔÈ ÈÔ› ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ ÌÔχÓÔ˘Ó fiÏÔ ÙÔ ‚ÚÔÁ¯ÈÎfi ‰¤ÓÙÚÔ (21). ™Â ·ÓÙ›ıÂÛË, fï˜, Ì ÙË ÚÈÓÈ΋ ÎÔÈÏfiÙËÙ·, fiÔ˘ Ù· ·ÏÏÂÚÁÈÔÁfiÓ· ¤¯Ô˘Ó ¿ÌÂÛË ÚfiÛ‚·ÛË Î·È ÚÔηÏÔ‡Ó ¤ÓÙÔÓ· Û˘ÌÙÒÌ·Ù·, Ë ·ÚÔ˘Û›· ÙˆÓ ÈÒÓ ÂȉÂÈÓÒÓÂÈ ÂÚÈÛÛfiÙÂÚÔ ÙÔ ¿ÛıÌ·.

OÈ Ì˯·ÓÈÛÌÔ›, ÛÙÔ˘˜ ÔÔ›Ô˘˜ ÛÙËÚ›˙ÔÓÙ·È Ù· ·Ú·¿Óˆ, Â›Ó·È ÌfiÓÔ ÙÌËÌ·ÙÈο ÁÓˆÛÙÔ›. ŒÙÛÈ, Â›Ó·È ÁÓˆÛÙfi fiÙÈ ÙÔ ÎÔÈÓfi ÎÚ˘ÔÏfiÁËÌ· ¤¯ÂÈ Û·Ó ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·Ó¿Ù˘ÍË ‚ÚÔÁ¯È΋˜ ˘ÂÚ··ÓÙËÙÈÎfiÙËÙ·˜ ·¤Ó·ÓÙÈ Û ÂȉÈο Î·È ÌË-ÂȉÈο ÂÚÂı›ÛÌ·Ù· (22). ∏ ‰È¿ÚÎÂÈ· ·˘Ù‹˜ Ù˘ ˘ÂÚ··ÓÙËÙÈÎfiÙËÙ·˜ ›ӷÈ, Û‡Ìʈӷ Ì ÙË ‚È‚ÏÈÔÁÚ·Ê›·, ÌÂÁ·Ï‡ÙÂÚË ·fi 6 ‚‰ÔÌ¿‰Â˜, ÂÓÒ ·‰ËÌÔÛ›Â˘Ù· ‰Â‰Ô̤ӷ ÙËÓ ·Ó‚¿˙Ô˘Ó Û ·ÙÔÈο ·È‰È¿ ̤¯ÚÈ Î·È ÛÙÔ˘˜ 6 Ì‹Ó˜. ŒÙÛÈ, ı· ÌÔÚÔ‡Û ӷ ıˆÚËı› fiÙÈ Ë ·ÚÔ˘Û›· ÙÔ˘ ÈÔ‡ “ÚÈÌÔ‰ÔÙ›” ÙÔ ·Ó·Ó¢ÛÙÈÎfi ÁÈ· Ó· ·ÓÙȉڿÛÂÈ Ì ٷ ·ÏÏÂÚÁÈÔÁfiÓ·. ∞fi ÙËÓ ¿ÏÏË ÌÂÚÈ¿, ÚfiÛÊ·ÙË ÌÂϤÙË Û ÂıÂÏÔÓÙ¤˜ ¤‰ÂÈÍ fiÙÈ fiÙ·Ó Ë ·ÏÏÂÚÁÈ΋ ÊÏÂÁÌÔÓ‹ ‚Ú›ÛÎÂÙ·È Û ¤Í·ÚÛË, Ô ·Ó·Ó¢ÛÙÈÎfi˜ ‚ÏÂÓÓÔÁfiÓÔ˜ ÚÔÛٷهÂÙ·È ·fi ÎÚ˘ÔÏfiÁËÌ· (23). OÈ ·Ú·ÙËÚ‹ÛÂȘ ·˘Ù¤˜, ·Ó Î·È Ê·›ÓÔÓÙ·È ·ÓÙÈÊ·ÙÈΤ˜ Ì ̛· ÚÒÙË ÂÎÙ›ÌËÛË, ˘Ô‰ÂÈÎÓ‡Ô˘Ó ÙfiÛÔ ÙËÓ ÔÏ˘ÏÔÎfiÙËÙ· ÙˆÓ ·ÏÏËÏÂȉڿÛˆÓ, fiÛÔ Î·È Î¿ÔȘ ÏÂÙÔ̤ÚÂȘ, fiˆ˜ ÙË ¯ÚÔÓÈ΋ ÛÂÈÚ¿, Û‡Ìʈӷ Ì ÙËÓ ÔÔ›· ·’ fiÙÈ Ê·›ÓÂÙ·È Ô Èfi˜ ÚÔËÁ›ٷÈ, ·ÏÏ¿ Î·È ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Î¿ıÂ Û˘ÓÂÚÁÈ΋ ‰Ú¿ÛË Ï·Ì‚¿ÓÂÈ ¯ÒÚ· ÚÈÓ ÙËÓ ÔÍ›· Ê¿ÛË. ™˘ÌÂÚ·ÛÌ·ÙÈο, Ë ·ÚÔ‡Û· ÌÂϤÙË ‰Â›¯ÓÂÈ fiÙÈ Ë ÎÏÈÓÈ΋ ¤ÎÊÚ·ÛË Ù˘ ÂÔ¯È΋˜ ·ÏÏÂÚÁ›·˜ Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ÙfiÛÔ ÙˆÓ ·ÏÏÂÚÁÈÔÁfiÓˆÓ, fiˆ˜ ÁÂÓÈο Â›Ó·È ·Ô‰ÂÎÙfi, fiÛÔ Î·È ÈÔÁÂÓÒÓ ÏÔÈÌÒÍÂˆÓ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡. OÈ ·Ú¿ÁÔÓÙ˜ ·˘ÙÔ› ‰ÚÔ˘Ó ·ÓÂÍ¿ÚÙËÙ· ÌÂٷ͇ ÙÔ˘˜, ¯ÚÔÓÈο fï˜ Û˘¯Ó¿ Û˘Ì›ÙÔ˘Ó, Ì ·ÔÙ¤ÏÂÛÌ· ·ÏÏËÏÔÎ·Ï˘ÙfiÌÂÓÔ˘˜ Ê·ÈÓÔÙ‡Ô˘˜.

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9. Corne JM, Lau L, Scott SJ, Davies R, Johnston SL, Howarth PH. The relationship between atopic status and IL-10 nasal lavage levels in the acute and persistent inflammatory response to upper respiratory tract infection. Am J Respir Crit Care Med 2001;163:1101-1107.

10. Hierholzer JC, Halonen PE, Dahlen PO, Bingham PG, McDonough MM. Detection of adenovirus in clinical specimens by polymerase chain reaction and liquid-phase hybridization quantitated by time-resolved fluorometry. J Clin Microbiol 1993;31:1886-1891.

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16. Djukanovic R, Feather I, Gratziou C, Walls A, Peroni D, Bradding P et al. Effect of natural allergen exposure during the grass pollen season on airways inflammatory cells and

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asthma symptoms. Thorax 1996;51:575-581.

17. Johnston SL. Bronchial hyperresponsiveness and cytokines in virus-induced asthma exacerbations. Clin Exp Allergy 1997;27:7-9.

18. Papadopoulos N, Johnston S. The rhinovirus. Not such an innocent? QJM 2001;94:1-3.

19. ™˘Ú›ÁÔ˘ ∞ Î·È Û˘Ó. ∂Ô¯È΋ ηٷÁÚ·Ê‹ ÙˆÓ Á˘ÚÂfiÎÔÎÎˆÓ ·ÁÚˆÛÙˆ‰ÒÓ, ÂÏÈ¿˜, ·ÚÈÂÙ¿ÚÈ·˜ Î·È Î˘·ÚÈÛÛÈÔ‡ ÛÙËÓ ÂÚÈÔ¯‹ Ù˘ ∞ı‹Ó·˜ ηٿ Ù· ¤ÙË 1995-1999. ∂ÏÏ ∞ÏÏÂÚÁ ∫ÏÈÓ ∞ÓÔÛÔÏ 1999;7:160-169.

20. ∫·Ï¤ÁÈ·˜ π Î·È Û˘Ó. ŒÎ‚·ÛË ÙÔ˘ ·È‰ÈÎÔ‡ ·ÙÔÈÎÔ‡ ¿ÛıÌ·ÙÔ˜ ÛÙËÓ ÂÊ˂›· Î·È Û˘Û¯¤ÙÈÛË Ì ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘. ∂ÏÏ ∞ÏÏÂÚÁ ∫ÏÈÓ ∞ÓÔÛÔÏ 1999;7:93-103.

21. Papadopoulos N, Johnston S. Viral infections of the nose and lung. Eur Respir Mono 2002;18:79-100.

22. Gern JE, Calhoun W, Swenson C, Shen G, Busse WW.

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Rhinovirus infection preferentially increases lower airway responsiveness in allergic subjects. Am J Respir Crit Care Med 1997;155:1872-1876.

23. Avila PC, Abisheganaden JA, Wong H, Liu J, Yagi S, Schnurr D et al. Effects of allergic inflammation of the nasal mucosa on the severity of rhinovirus 16 cold. J Allergy Clin Immunol 2000;105:923-932.

¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ¡ÈÎfiÏ·Ô˜ °. ¶··‰fiÔ˘ÏÔ˜ ∂Ú¢ÓËÙÈο ∂ÚÁ·ÛÙ‹ÚÈ· µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·Ó/Ì›Ô˘ ∞ıËÓÒÓ §Â‚·‰Â›·˜ 13, ∆.∫. 115 27, ∞ı‹Ó· E-mail: ngp@allergy.gr

¶·È‰È·ÙÚÈ΋ 2004;67:105-114

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Paediatriki 2004;67:105-114

ORIGINAL ARTICLE

°ÓÒÛÂȘ ·ÙfiÌˆÓ Ì ۇӉÚÔÌÔ Down Î·È ÛÙ¿ÛÂȘ ÁÔÓ¤ˆÓ Û¯ÂÙÈο Ì ÙË ÛÂÍÔ˘·ÏÈ΋ Û˘ÌÂÚÈÊÔÚ¿ Ã. §ÂÈ‚·‰ÈÒÙÔ˘1, Ã. ÷Ù˙ËÛ‚·ÛÙÔ‡ - §Ô˘Î›‰Ô˘2, ∞. ™ÙÔÁÈ·ÓÓ›‰Ô˘1

Knowledge of individuals with Down’s syndrome and attitudes of parents concerning their sexual behaviour C. Livadiotou1, H. Hatzisevastou - Loukidou2, A. Stogiannidou1

¶ÂÚ›ÏË„Ë: ∏ ÎÔÈÓˆÓÈ΋ ¤ÓÙ·ÍË ÙˆÓ ·ÙfiÌˆÓ Ì ۇӉÚÔÌÔ Down ·ÔÎ¿Ï˘„ ÙËÓ ·Ó¿ÁÎË Ù˘ ÛÂÍÔ˘·ÏÈ΋˜ ‰È··È‰·ÁÒÁËÛ‹˜ ÙÔ˘˜. ™ÎÔfi Ù˘ ÌÂϤÙ˘ ·ÔÙ¤ÏÂÛÂ Ë ‰ÈÂÚ‡ÓËÛË ÙˆÓ ÁÓÒÛÂÒÓ ÙÔ˘˜ Û¯ÂÙÈο Ì ÙË ÛÂÍÔ˘·ÏÈ΋ ·ÁˆÁ‹, Ù˘ Â›ÁÓˆÛ˘ ÙˆÓ ÁÔÓ¤ˆÓ ÁÈ· ÙȘ ÁÓÒÛÂȘ ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜ Î·È Ù˘ ÛÙ¿Û˘ ÙÔ˘˜ Û¯ÂÙÈο Ì ·˘Ùfi ÙÔ ı¤Ì·. ªÂÏÂÙ‹ıËÎ·Ó 29 ¿ÙÔÌ· Ì ۇӉÚÔÌÔ Down Î·È ÔÈ ÁÔÓ›˜ ÙÔ˘˜. OÈ ÁÔÓ›˜ ˘Ô‚Ï‹ıËÎ·Ó Û 12 ÂÚˆÙ‹ÛÂȘ ÁÈ· ÙË ÛÂÍÔ˘·ÏÈ΋ Û˘ÌÂÚÈÊÔÚ¿ ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜. ∂ȉ›¯ıËÎ·Ó ÛÙ· 29 ¿ÙÔÌ· 11 ÂÈÎfiÓ˜ Ì ÙȘ ›‰È˜ ¤ÓÓÔȘ ÙˆÓ ÂÚˆÙ‹ÛˆÓ. ∂Ú¢ӋıËÎ·Ó ÔÈ ··ÓÙ‹ÛÂȘ ÁÔÓ¤ˆÓ Î·È ·È‰ÈÒÓ Î·È Ë Û‡ÌÙˆÛË ÙˆÓ ÂÓÙ˘ÒÛÂˆÓ ÙˆÓ ÁÔÓ¤ˆÓ Ì ÙȘ ··ÓÙ‹ÛÂȘ ÙˆÓ ‰ÈÎÒÓ ÙÔ˘˜ ·È‰ÈÒÓ. ¢ÂÓ ¤ÁÈÓÂ Û˘Û¯¤ÙÈÛË Ì ÙÔ ÌÔÚʈÙÈÎfi Î·È ÙÔ ÎÔÈÓˆÓÈÎfi ÙÔ˘˜ Â›‰Ô. ¢ÂÓ ˘‹Ú¯Â ÔÌ¿‰· Ì·ÚÙ‡ÚˆÓ. OÈ ÁÔÓ›˜ ‰‹ÏˆÛ·Ó Â¿ÚÎÂÈ· ÙˆÓ ÁÓÒÛÂˆÓ ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜ ÁÈ·: ÙËÓ ·Ó·ÙÔÌ›· ÙˆÓ Ê‡ÏˆÓ 21/29, ÙË ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ ÁÂÓÓËÙÈÎÒÓ ÔÚÁ¿ÓˆÓ 17/29, ÙËÓ ÂÚˆÙÈ΋ Û˘Ó‡ÚÂÛË 17/29, ÙÔÓ ·˘Ó·ÓÈÛÌfi 16/29, ÙÔ ÚÔÊ˘Ï·ÎÙÈÎfi Î·È ÙË ¯Ú‹ÛË ÙÔ˘ 2/29, ÙË ÛÂÍÔ˘·ÏÈ΋ ·ÚÂÓfi¯ÏËÛË 4/29, ÙËÓ ÔÌÔÊ˘ÏÔÊÈÏ›· 2/29, ÙÔ AIDS 5/29 Î·È ÙËÓ ·Ó··Ú·ÁˆÁ‹ 15/29. ªfiÓÔ 3 ›¯·Ó ıÂÙÈ΋ ÛÙ¿ÛË ÛÙË ÛÂÍÔ˘·ÏÈ΋ ˙ˆ‹ ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜. ∞fi Ù· ¿ÙÔÌ· Ì ۇӉÚÔÌÔ Down, ÈηÓÔÔÈËÙÈΤ˜ ÁÓÒÛÂȘ ÁÈ· Ù· ·ÓÙ›ÛÙÔȯ· ı¤Ì·Ù· ›¯·Ó: 25/29, 18/29, 17/25, 10/25, 2/29, 8/29, 2/25, 5/29, 3/29, 15/29. ¢È·ÈÛÙÒıËΠۇÌÙˆÛË ÙˆÓ ıÂÙÈÎÒÓ ÂÓÙ˘ÒÛÂˆÓ ÙˆÓ ÁÔÓ¤ˆÓ Û 21/25, 14/18, 12/17, 9/10, 1/2, 2/8, 1/2, 3/5, 3/3 Î·È 3/15 ··ÓÙ‹ÛÂȘ ÙˆÓ ‰ÈÎÒÓ ÙÔ˘˜ ·È‰ÈÒÓ, ·ÓÙ›ÛÙÔȯ·. OÈ ÁÔÓ›˜ ›¯·Ó Â·Ú΋ Â›ÁÓˆÛË ÙˆÓ ÁÓÒÛÂˆÓ ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜ Î·È ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ ‰ÂÓ ÂÈı˘ÌÔ‡Û·Ó ÙË

Abstract: The social inclusion of persons with Down’s syndrome (DS) has revealed the need for their sexual education. The aim of this study was the exploration of the knowledge of persons with DS concerning their sexual behaviour and their parents’ knowledge and attitudes towards their children’s sexual behaviour. Twenty-nine persons with DS and their parents were investigated. A 12-item questionnaire on the sexual behaviour of their children was given to the parents. Eleven pictures illustrating the subjects of the questionnaire were shown to the persons with DS and their responses were recorded. The answers from the two groups were studied and the degree to which the parents’ impressions coincided with the answers provided by their children was investigated. No correlation was made between the parents’ answers and their educational and social level and there was no control group. The parents believed that their children’s knowledge was sufficient regarding the following: the anatomy of the two sexes 21/29; the function of the genital organs 17/29; sexual intercourse 17/29; masturbation 16/29; the use of condoms 2/29; sexual harassment 4/29; homosexuality 2/29; HIV and AIDS 5/29; reproduction 15/29. According to their responses, the children’s knowledge on the respective subjects was sufficient as follows: 25/29, 18/29, 17/25, 10/25, 2/29, 8/29, 2/25, 5/29, 3/29 and 15/29. The parents’ impressions coincided with the answers provided by their children, on the respective questions, by: 21/25, 14/18, 12/17, 9/10, 1/2, 2/8, 1/2, 3/5, 3/3 and 3/15.

Only 3 of the parents viewed a sexual life for their

1 ∆Ì‹Ì· æ˘¯ÔÏÔÁ›·˜, ∞ÚÈÛÙÔÙ¤ÏÂÈÔ ¶·ÓÂÈÛÙ‹ÌÈÔ £ÂÛÛ·ÏÔӛ΢ 2 ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋, ∞ÚÈÛÙÔÙ¤ÏÂÈÔ ¶·ÓÂÈÛÙ‹ÌÈÔ £ÂÛÛ·ÏÔӛ΢ °.¶.¡. “πÔÎÚ¿ÙÂÈÔ”, £ÂÛÛ·ÏÔÓ›ÎË

1 Department of Psychology, Aristotle University of Thessaloniki 2 1st Paediatric Clinic, Aristotle University of Thessaloniki Ippokration General Hospital, Thessaloniki

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ÛÂÍÔ˘·ÏÈ΋ ÙÔ˘˜ ˙ˆ‹. ∆· ·È‰È¿ ›¯·Ó ‰È·ÊÔÚÂÙÈÎÔ‡ ÂÈ¤‰Ô˘ ÁÓÒÛÂȘ ÛÙ· ÂÈ̤ÚÔ˘˜ ı¤Ì·Ù· Î·È Ù· ÂÚÈÛÛfiÙÂÚ· ÂÈı˘ÌÔ‡Û·Ó Û˘ÌÌÂÙÔ¯‹ ÛÙË ÛÂÍÔ˘·ÏÈ΋ ˙ˆ‹. º·›ÓÂÙ·È Ë ·Ó·ÁηÈfiÙËÙ· Ù˘ ‰È··È‰·ÁÒÁËÛ‹˜ ÙÔ˘˜ Û ı¤Ì·Ù· Ì ·ÓÂ¿ÚÎÂÈ· ÁÓÒÛÂˆÓ ÁÈ· ÙËÓ ·ÛÊ¿ÏÂÈ¿ ÙÔ˘˜ Î·È Ù˘ ÂÎ·›‰Â˘Û˘ ÙˆÓ ÁÔÓ¤ˆÓ fiÛÔÓ ·ÊÔÚ¿ ÛÙÔ ‰Èη›ˆÌ· ÙˆÓ ·È‰ÈÒÓ ÁÈ· ÛÂÍÔ˘·ÏÈ΋ ˙ˆ‹.

children positively. The parents were sufficiently aware of their children’s knowledge and the majority did not desire their children to participate in sexual activities. The persons with DS had various levels of knowledge regarding the diverse themes of sexual behaviour. Most of them wished to have an active sexual life. From the safety aspect there is a need for sexual education of the individuals with DS since their knowledge is limited. There is also a need for educating the parents on their children’s right to have a sexual life.

§¤ÍÂȘ ÎÏÂȉȿ: Û‡Ó‰ÚÔÌÔ Down, ÛÂÍÔ˘·ÏÈ΋ Û˘ÌÂÚÈÊÔÚ¿, ÁÔÓ›˜ ÂÊ‹‚ˆÓ Ì ۇӉÚÔÌÔ Down, ÛÂÍÔ˘·ÏÈ΋ ‰È··È‰·ÁÒÁËÛË.

Key words: Down’s syndrome, sex education, sexuality, adolescence, family.

™˘ÓÙÔÌÔÁڷʛ˜

™ÎÔfi˜ Ù˘ ÂÚÁ·Û›·˜ ‹Ù·Ó Ë ‰ÈÂÚ‡ÓËÛË ÙˆÓ ÁÓÒÛÂˆÓ Î·È ÂÈı˘ÌÈÒÓ ÙˆÓ ·ÙfiÌˆÓ Ì DS Û¯ÂÙÈο Ì ÙË ÛÂÍÔ˘·ÏÈ΋ Û˘ÌÂÚÈÊÔÚ¿ ÙÔ˘˜, Ù˘ Â›ÁÓˆÛ˘ ÙˆÓ ÁÔÓ¤ˆÓ ÁÈ· ÙȘ ÁÓÒÛÂȘ ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜, Ù˘ ÛÙ¿Û˘ ÙÔ˘˜ ÁÈ· ÙÔ ›‰ÈÔ ı¤Ì· Î·È Ù˘ ·Ó·ÁηÈfiÙËÙ·˜ ÂÊ·ÚÌÔÁ‹˜ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÛÂÍÔ˘·ÏÈ΋˜ ‰È··È‰·ÁÒÁËÛ˘.

DS

™‡Ó‰ÚÔÌÔ Down

∂ÈÛ·ÁˆÁ‹ ∆· ·È‰È¿ Ì ۇӉÚÔÌÔ Down (DS) ÂÈÛ¤Ú¯ÔÓÙ·È, fiˆ˜ fiÏ· Ù· ·È‰È¿, ÛÙËÓ ‹‚Ë Î·È ·Ó·Ù‡ÛÛÔ˘Ó Î·È ·˘Ù¿ Ù· ‰Â˘ÙÂÚÔÁÂÓ‹ ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ ʇÏÔ˘. ∂ΉËÏÒÓÔ˘Ó ÙȘ „˘¯ÔÏÔÁÈΤ˜ ·ÏÏ·Á¤˜ Ù˘ ÂÊ˂›·˜ Ô˘ ¤¯Ô˘Ó Û¯¤ÛË Ì ÙË Û˘ÓÂȉËÙÔÔ›ËÛË ÙÔ˘ ۈ̷ÙÈÎÔ‡ “ÂÁÒ” Î·È Ù˘ „˘¯È΋˜ Ù·˘ÙfiÙËÙ·˜ ÙÔ˘ ÂÊ‹‚Ô˘, Ì ÙËÓ ·Ó¿ÁÎË ÁÈ· ·ÓÂÍ·ÚÙËÛ›· Î·È ·˘ÙÔÓÔÌ›·, Ì ÙËÓ ÂÈı˘Ì›· ÁÈ· Û‡Ó·„Ë Û¯¤ÛÂˆÓ ÌÂ Û˘ÓÔÌËÏ›ÎÔ˘˜, ÙfiÛÔ ÙÔ˘ ›‰ÈÔ˘ fiÛÔ Î·È ÙÔ˘ ·ÓÙ›ıÂÙÔ˘ ʇÏÔ˘ (1). ∂›Û˘, fiÏÔ Î·È ÂÚÈÛÛfiÙÂÚÔ ÂȉÈÒÎÂÙ·È Î·È ÂÈÙ˘Á¯¿ÓÂÙ·È ·fi ÙÔ˘˜ ÁÔÓ›˜ Î·È ÙËÓ ÎÔÈÓˆÓ›· Ë ÎÔÈÓˆÓÈ΋ ¤ÓÙ·Í‹ ÙÔ˘˜. ∏ ηٿÛÙ·ÛË ·˘Ù‹ ÂÈ‚¿ÏÏÂÈ ÙË ÛÂÍÔ˘·ÏÈ΋ ‰È··È‰·ÁÒÁËÛ‹ ÙÔ˘˜, ΢ڛˆ˜ ÁÈ· ÙËÓ ·ÙÔÌÈ΋ ÙÔ˘˜ ·ÛÊ¿ÏÂÈ· (2).

OÈ ·Ó·ÊÔÚ¤˜ ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· Û¯ÂÙÈο Ì ÙȘ ÁÓÒÛÂȘ Î·È ÙȘ ÂÈı˘Ì›Â˜ ÁÈ· ÛÂÍÔ˘·ÏÈο ı¤Ì·Ù· ÙˆÓ ·ÙfiÌˆÓ Ì DS, ·ÏÏ¿ Î·È ÁÈ· ÙË ÛÙ¿ÛË ÙˆÓ ÁÔÓ¤ˆÓ ÛÙÔ ›‰ÈÔ ı¤Ì· Â›Ó·È ÂÚÈÔÚÈṲ̂Ó˜. ¶Ôχ ÚfiÛÊ·ÙË ¤Ú¢ӷ ÙˆÓ Castelao Î·È Û˘Ó (3) ·ÔÎ¿Ï˘„ fiÙÈ ÔÈ ÁÔÓ›˜ ÙˆÓ ·È‰ÈÒÓ Ì DS, Ù· ·ÓÙÈÌÂÙˆ›˙Ô˘Ó ÌÔӛ̈˜ Û·Ó ·È‰È¿ Î·È ‰ÂÓ Û˘ÌʈÓÔ‡Ó Ì ÙËÓ ·fiÎÙËÛË ÛÂÍÔ˘·ÏÈ΋˜ ˙ˆ‹˜ ·fi ·˘Ù¿, ÏfiÁˆ Ù˘ Èı·ÓfiÙËÙ·˜ Ì›·˜ ·ÓÂÈı‡ÌËÙ˘ ·ËÛ˘ Î·È ÙÔ˘ ÂÈΛÌÂÓÔ˘ ÎÈÓ‰‡ÓÔ˘ Â·Ó¿Ï˄˘ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘. µÈ‚ÏÈÔÁÚ·ÊÈο, Ë ÛÂÍÔ˘·ÏÈ΋ ·ÁˆÁ‹ ÙˆÓ ·ÙfiÌˆÓ Ì DS ÚÔÙ›ÓÂÙ·È Ó· ÍÂÎÈÓ¿ Ôχ ÓˆÚ›˜ ÛÙËÓ ·È‰È΋ ËÏÈΛ·, ÚÔÛ‰ÈÔÚ›˙ÔÓÙ·˜ ÙÔ ÂÚȯfiÌÂÓfi Ù˘ Û ı¤Ì·Ù· Û¯ÂÙÈο Ì ÙËÓ ¤ÌÌËÓÔ Ú‡ÛË Î·È ÙËÓ ˘ÁÈÂÈÓ‹ Î·È Ó· Û˘Ó¯›˙ÂÈ ÛÙËÓ ÂÊË‚È΋ Î·È Ó·ÓÈ΋ ËÏÈΛ· ÌÂ Û˘˙ËÙ‹ÛÂȘ Û¯ÂÙÈο Ì ÙË ÛÂÍÔ˘·ÏÈÎfiÙËÙ·, ÙȘ ‰È·ÚÔÛˆÈΤ˜ Û¯¤ÛÂȘ, ÙËÓ ·ÓÙÈÛ‡ÏÏË„Ë Î·È ÙËÓ ¤Î‚·ÛË Ì›·˜ Èı·Ó‹˜ ·ËÛ˘ (4,5).

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ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ÀÏÈÎfi Ù˘ ÌÂϤÙ˘ ·ÔÙ¤ÏÂÛ·Ó 29 ¿ÙÔÌ· Ì DS Ô˘ ‰ÂÓ ÓÔÛËχÔÓÙ·Ó Û ›‰Ú˘Ì· Î·È ÔÈ ÁÔÓ›˜ ÙÔ˘˜. ∆· ÂÚÈÛÛfiÙÂÚ· ·fi ·˘Ù¿ ÂÚ¢ӋıËÎ·Ó ¯ÚˆÌÔÛˆÌÈο ÛÙÔ ∂ÚÁ·ÛÙ‹ÚÈÔ ∫˘ÙÙ·ÚÔÁÂÓÂÙÈ΋˜ Ù˘ ∞’ ¶·È‰È·ÙÚÈ΋˜ ∫ÏÈÓÈ΋˜ ÙÔ˘ ∞.¶.£. ¢Âη¤ÓÙ ·fi Ù· 29 ‹Ù·Ó ·ÁfiÚÈ· Î·È Ù· ˘fiÏÔÈ· 14 ‹Ù·Ó ÎÔÚ›ÙÛÈ· (¶›Ó·Î·˜ 1, ·/·: 1-15 Î·È 16-29, ·ÓÙ›ÛÙÔȯ·). ∏ ËÏÈΛ· ÙÔ˘˜ Î˘Ì·ÈÓfiÙ·Ó ÌÂٷ͇ 16 Î·È 27 ÂÙÒÓ. ∏ Û¯¤ÛË ÙÔ˘˜ Ì ÙÔÓ ™‡ÏÏÔÁÔ ™˘Ó‰ÚfiÌÔ˘ Down ∂ÏÏ¿‰Ô˜ ‹Ù·Ó ‰È·ÊÔÚÂÙÈÎÔ‡ ‚·ıÌÔ‡ Î·È Û˘ÁÎÂÎÚÈ̤ӷ: 11/29 ›¯·Ó ηıËÌÂÚÈÓ‹ ÚˆÈÓ‹ ··Û¯fiÏËÛË ÛÙÔ ÙÌ‹Ì· ÚÔ-Â·ÁÁÂÏÌ·ÙÈ΋˜ ηٿÚÙÈÛ˘ Î·È ·˘ÙÔÓÔÌ›·˜ ÙÔ˘ Û˘ÏÏfiÁÔ˘, 13/29 ‰ÂÓ Â›¯·Ó Û˘¯Ó‹ Â·Ê‹, Û˘ÌÌÂÙ›¯·Ó fï˜ Û ÂÈÏÂÁ̤Ó˜ ‰Ú·ÛÙËÚÈfiÙËÙ¤˜ ÙÔ˘ ηÈ, Ù¤ÏÔ˜, 5/29 ‹Ù·Ó ÌfiÓÔ ÂÁÁÂÁÚ·Ì̤ӷ ̤ÏË, Ô˘ ‰¤¯ÙËηÓ, fï˜, Ó· Û˘ÌÌÂÙ¿Û¯Ô˘Ó ÛÙËÓ ·ÚÔ‡Û· ¤Ú¢ӷ. ™ÙËÓ ¤Ú¢ӷ Û˘ÌÌÂÙ›¯·Ó Î·È ÔÈ ÁÔÓ›˜ fiÏˆÓ ÙˆÓ ·ÙfiÌˆÓ Ì DS, Û˘ÁÎÂÎÚÈ̤ӷ 23/29 Û˘ÌÌÂÙ›¯·Ó ÌfiÓÔ ÔÈ ÌËÙ¤Ú˜, 3/29 Î·È ÔÈ ‰‡Ô ÁÔÓ›˜, 2 ÌÔÓ·¯ÈΤ˜ ÌËÙ¤Ú˜ (Ì›· ÏfiÁˆ ÌÔÓÔÁÔÓÂ˚΋˜ ÔÈÎÔÁ¤ÓÂÈ·˜, Ì›· ‹Ù·Ó ¯‹Ú·) ηÈ, Ù¤ÏÔ˜, ¤Ó·˜ ·Ù¤Ú·˜. ™·Ó ÎÚÈÙ‹ÚÈÔ Ù˘ ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈ΋˜ ηٿÛÙ·Û˘ ÙˆÓ ÔÈÎÔÁÂÓÂÈÒÓ, ηٷÁÚ¿ÊËΠÙÔ Â¿ÁÁÂÏÌ· Î·È ÙÔ ÌÔÚʈÙÈÎfi Â›Â‰Ô ÙÔ˘ ·Ù¤Ú·. ∞fi ÙÔ˘˜ ·Ù¤Ú˜, 7/28 ›¯·Ó ·ÓÒÙ·ÙË ÌfiÚʈÛË (ÁÈ·ÙÚÔ›, ‰ÈÎËÁfiÚÔÈ, ηıËÁËÙ¤˜), 17/28 ‰‹ÏˆÛ·Ó ȉȈÙÈÎÔ›-‰ËÌfiÛÈÔÈ ˘¿ÏÏËÏÔÈ ‹ ÌÈÎÚÔÂȯÂÈÚË̷ٛ˜ Î·È Â›¯·Ó ·ÓÒÙÂÚË ÂÎ·›‰Â˘ÛË Î·È 4/28 ‰‹ÏˆÛ·Ó “Ù¯ӛÙ˜-ÂÚÁ¿Ù˜” Î·È Â›¯·Ó ηÙÒÙÂÚË ‹ ̤ÛË ÂÎ·›‰Â˘ÛË. ™ÙË ÌÔÓÔÁÔÓÂ˚΋ ÔÈÎÔÁ¤ÓÂÈ·, Ë ÌËÙ¤Ú· ›¯Â ·ÓÒÙ·ÙË ÂÎ·›‰Â˘ÛË. ∏ ¤Ú¢ӷ ‰ÈÂÍ‹¯ıË ·fi ÙËÓ ›‰È· ÂÚ¢ӋÙÚÈ·, ÙËÓ ÔÔ›·

¶·È‰È·ÙÚÈ΋ 2004;67:105-114

Paediatriki 2004;67:105-114

ÁÓÒÚÈ˙·Ó ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ ·fi ÙÔ˘˜ ÁÔÓ›˜ Î·È Ù· ·È‰È¿ ÙÔ˘˜, ηıÒ˜ ÂÚÁ·˙fiÙ·Ó ÛÙÔÓ Û‡ÏÏÔÁÔ. OÈ ÁÔÓ›˜ ÂÓËÌÂÚÒıËÎ·Ó ÙËÏÂʈÓÈο ÁÈ· ÙÔÓ ÛÎÔfi Ù˘ ¤Ú¢ӷ˜, ÙÔÓ ÙÚfiÔ ‰ÈÂÍ·ÁˆÁ‹˜ Ù˘ Î·È ¤‰ˆÛ·Ó ÙË Û˘ÁηٿıÂÛ‹ ÙÔ˘˜. ∏ ¤Ú¢ӷ ‰ÈÂÓÂÚÁ‹ıËΠ̤ۈ Û˘Ó¤ÓÙ¢Í˘, ‰ÈÂÍ‹¯ıË ÛÙÔ ÔÈÎÂ›Ô ÂÚÈ‚¿ÏÏÔÓ ÙÔ˘ ÛÈÙÈÔ‡ Î·È Ì·ÁÓËÙÔʈӋıËÎÂ. ¶ÂÚÈÂÏ¿Ì‚·Ó ‰‡Ô ÛÙ¿‰È·: ·) Û˘Ó¤ÓÙ¢ÍË Ì ÙÔ˘˜ ÁÔÓ›˜ Î·È ‚) Û˘Ó¤ÓÙ¢ÍË Ì ٷ ·È‰È¿ ÙÔ˘˜. ¶›Ó·Î·˜ 1. º‡ÏÔ, ËÏÈΛ· Î·È Î·Ú˘fiÙ˘Ô˜ ÙˆÓ 29 ·ÙfiÌˆÓ Ì DS ·/·

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47, XY, +21 47, XY, +21 47, XY, +21 47, XY, +21 47, XY, +21 47, XY, +21 47, XY, +21 46, XY, +t (13; 21) 47, XY, +21 47, XY, +21 47, XY, +21 46, XY, +t (21; 21) 47, XY, +21 46, XY, +t (D; G) 47, XY, +21 47, XX, +21 47, XX, +21 47, XX, +21 47, XX, +21 47, ÃÃ, +21 47, XX, +21 47, XX, +21 47, XX, +21 47, XX, +21 47, XX, +21 47, XX, +21 47, XX, +21 47, XX, +21 47, XX, +21

™˘Ó¤ÓÙ¢ÍË Ì ÙÔ˘˜ ÁÔÓ›˜ ∞Ú¯Èο, ÔÈ ÁÔÓ›˜ ˘Ô‚Ï‹ıËÎ·Ó ÛÙȘ 12 ÂÚˆÙ‹ÛÂȘ, ¯ˆÚ›˜ Ó· Â›Ó·È ·ÚfiÓÙ· Ù· ·È‰È¿ ÙÔ˘˜ (¶›Ó·Î·˜ 2). OÈ ÂÚˆÙ‹ÛÂȘ ‰È·ÌÔÚÊÒıËÎ·Ó Ì ÙÚÔÔÔ›ËÛË ·˘ÙÒÓ Ù˘ Shepperdson ·fi ·ÚfiÌÔÈ· ¤Ú¢ӷ (2). OÈ ··ÓÙ‹ÛÂȘ ÙˆÓ ÁÔÓ¤ˆÓ ·ÔÎ¿Ï˘Ù·Ó ÙÔ Â›Â‰Ô Â›ÁÓˆÛ‹˜ ÙÔ˘˜ ÁÈ· ÙËÓ Â¿ÚÎÂÈ· ‹ fi¯È ÙˆÓ ÁÓÒÛÂˆÓ ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘˜ Û¯ÂÙÈο Ì ÙË ÛÂÍÔ˘·ÏÈ΋ Û˘ÌÂÚÈÊÔÚ¿ ÂÓfi˜ ·ÙfiÌÔ˘ Ù˘ ËÏÈΛ·˜ ÙÔ˘ Î·È ÙÔ˘˜ ·ÓÙ›ÛÙÔÈ¯Ô˘˜ ÎÔÈÓˆÓÈÎÔ‡˜ ÂÚÈÔÚÈÛÌÔ‡˜ ·˘Ù‹˜ Ù˘ Û˘ÌÂÚÈÊÔÚ¿˜. °È· ÙËÓ ÙÂÏÈ΋ ·ÍÈÔÏfiÁËÛË ÙˆÓ ··ÓÙ‹ÛÂˆÓ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë ÂÍ‹˜ Έ‰ÈÎÔÔ›ËÛË: “Ó·È” fiÙ·Ó ·ÔÎ¿Ï˘Ù·Ó ÈηÓÔÔÈËÙÈÎfi Â›Â‰Ô Â›ÁÓˆÛ˘ ÙˆÓ ÁÓÒÛÂˆÓ ·˘ÙÒÓ, “fi¯È” ÌË ÈηÓÔÔÈËÙÈÎfi Â›‰Ô, “‰ÂÓ ÁÓˆÚ›˙ˆ” fiÙ·Ó ·ÔÎ¿Ï˘Ù·Ó ¿ÁÓÔÈ· ÙˆÓ ÁÓÒÛÂˆÓ ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘˜. ™ÙÔ Ù¤ÏÔ˜ Ù˘ Û˘Ó¤ÓÙ¢Í˘ ÂȉÂÈÎÓ‡ÔÓÙ·Ó ÛÙÔ˘˜ ÁÔÓ›˜ 11 ¢‰È¿ÎÚÈÙ˜ ÂÈÎfiÓ˜ Û¯ÂÙÈΤ˜ Ì ÙȘ ÂÚˆÙ‹ÛÂȘ Î·È ˙ËÙ‹ıËÎÂ Ë ¤ÁÎÚÈÛ‹ ÙÔ˘˜ ÁÈ· ÙËÓ Â›‰ÂÈÍË ·˘ÙÒÓ ÛÙ· ·È‰È¿ ÙÔ˘˜ (∂ÈÎfiÓ˜ 1-11). ∏ ÂÈı˘Ì›· ÙÔ˘˜ ÁÈ· ÌË Â›‰ÂÈÍË Î¿ÔÈ·˜ ·fi ·˘Ù¤˜ ¤ÁÈÓ ·Ô‰ÂÎÙ‹ ·fi ÙËÓ ÂÚ¢ӋÙÚÈ·. ™˘Ó¤ÓÙ¢ÍË Ì ٷ ·È‰È¿ (Ì DS) ∆ËÓ ›‰È· Ë̤ڷ, ·ÎÔÏÔ˘ıÔ‡ÛÂ Û˘Ó¿ÓÙËÛË Ì ÙÔ˘˜ ÂÊ‹‚Ô˘˜ ‹ Ù· Ó·ڿ ¿ÙÔÌ·, ¯ˆÚ›˜ Ó· Â›Ó·È ·ÚfiÓÙ˜ ÔÈ ÁÔÓ›˜ ÙÔ˘˜. ¶ÚÈÓ ÙË Û˘Ó¤ÓÙ¢ÍË ‰ÈÂÍ·ÁfiÙ·Ó Û‡ÓÙÔÌË Î·È ıÂÚÌ‹ Û˘ÓÔÌÈÏ›· ÁÈ· ÔÈΛ· Î·È ÚÔÛˆÈο ı¤Ì·Ù¿ ÙÔ˘˜, ÏfiÁˆ Ù˘ ÁÓˆÚÈÌ›·˜ Ì ÙËÓ ÂÚ¢ӋÙÚÈ·, Ô˘ ‰ËÌÈÔ˘ÚÁÔ‡Û ¢¯¿ÚÈÛÙË ·ÙÌfiÛÊ·ÈÚ·. ™ÙË Û˘Ó¤¯ÂÈ·, ÙÔ˘˜ ÂȉÂÈÎÓ‡ÔÓÙ·Ó 11 ¢‰È¿ÎÚÈÙ˜ ÂÈÎfiÓ˜, ÔÈ Ôԛ˜ ·ÂÈÎfiÓÈ˙·Ó Ì ·Ï¿ Û¯‹Ì·Ù· ÙȘ ›‰È˜ ¤ÓÓÔȘ ÙˆÓ ·ÓÙ›ÛÙÔȯˆÓ ÂÚˆÙ‹ÛÂˆÓ ÛÙȘ Ôԛ˜ ˘Ô‚Ï‹ıËÎ·Ó ÔÈ ÁÔÓ›˜ (∂ÈÎfiÓ˜ 1-11). OÈ ÂÈÎfiÓ˜ ÂȉÂÈÎÓ‡ÔÓÙ·Ó Û οÚÙ˜ ‰È·ÛÙ¿ÛÂˆÓ 14x21 cm Î·È ÂÈϤ¯ıËÎ·Ó ·fi ÙȘ Ù¤ÛÛÂÚȘ ÂÓfiÙËÙ˜ “Picture Yourself” Ù˘ ÂÙ·ÈÚ›·˜ ÂÔÙÈÎÔ‡ ˘ÏÈÎÔ‡ Learning Development Aids (LDA) ÙÔ˘ ÂΉÔÙÈÎÔ‡ Ô›ÎÔ˘ Joseph Rowntree Foundation (6). ∆Ô˘˜ ˙ËÙ‹ıËΠӷ ÂÚÈÁÚ¿„Ô˘Ó “ÙÈ ‚ϤÔ˘Ó ÛÙËÓ ÂÈÎfiÓ·”. °È· ÙËÓ ·ÍÈÔÏfiÁËÛË ÙˆÓ ··ÓÙ‹ÛÂˆÓ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ô ›‰ÈÔ˜ ÎÒ‰Èη˜: “Ó·È” fiÙ·Ó ¤Î·Ó·Ó Â·Ú΋ ÂÚÈÁÚ·Ê‹ Ù˘ ÂÈÎfiÓ·˜, “fi¯È” fiÙ·Ó ¤Î·Ó·Ó

¶›Ó·Î·˜ 2. OÈ 12 ÂÚˆÙ‹ÛÂȘ Ô˘ ˘Ô‚Ï‹ıËÎ·Ó ÛÙÔ˘˜ ÁÔÓ›˜. ™Â ·Ú¤ÓıÂÛË ·Ó·Ê¤ÚÔÓÙ·È ÔÈ ·‡ÍÔÓÙ˜ ·ÚÈıÌÔ› ÙˆÓ ∂ÈÎfiÓˆÓ 1-11, ÔÈ Ôԛ˜ Âȉ›¯ıËÎ·Ó ÛÙ· ¿ÙÔÌ· Ì DS Î·È ·ÂÈÎÔÓ›˙Ô˘Ó Ì ·Ï¿ Û¯‹Ì·Ù· ÙȘ ›‰È˜ ¤ÓÓÔȘ ÙˆÓ ·ÓÙ›ÛÙÔȯˆÓ ÂÚˆÙ‹ÛÂˆÓ 1. ∆È ÓÔÌ›˙ÂÙ fiÙÈ ÁÓˆÚ›˙ÂÈ ÙÔ ·È‰› Û·˜ Û¯ÂÙÈο Ì ٷ ·Ó·ÙÔÌÈο ¯·Ú·ÎÙËÚÈÛÙÈο ·) ÙˆÓ ‰˘Ô Ê‡ÏˆÓ Î·È ‚) ÙË ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘˜; (∂ÈÎfiÓ˜ 1, 2) 2. ¶ÈÛÙ‡ÂÙ fiÙÈ ÌÔÚ› Ó· ·Ó·ÁÓˆÚ›ÛÂÈ fiÙÈ ‰‡Ô ¿ÙÔÌ· Â›Ó·È ˙¢Á¿ÚÈ Î·È fi¯È Ê›ÏÔÈ; (∂ÈÎfiÓ· 3) 3. ¶Ò˜ ÓÔÌ›˙ÂÙ fiÙÈ ÂÚÈÁÚ¿ÊÂÈ ÙËÓ ÂÈÎfiÓ· ÂÓfi˜ ÂÚˆÙÈÎÔ‡ ÊÈÏÈÔ‡; (∂ÈÎfiÓ· 4) 4. ∞Ó·ÁÓˆÚ›˙ÂÈ ÙËÓ ÂÚˆÙÈ΋ Û˘Ó‡ÚÂÛË Î·È ÙË ‰È·ÎÚ›ÓÂÈ ·fi ÙÔ ·Ïfi ÂÚˆÙÈÎfi ÊÈÏ›; (∂ÈÎfiÓ· 5) 5. ¶ÈÛÙ‡ÂÙ fiÙÈ ¤¯ÂÈ ÙËÓ ÂÌÂÈÚ›· ÙÔ˘ ·˘Ó·ÓÈÛÌÔ‡; ∫·È, ·Ó Ó·È, ÁÓˆÚ›˙ÂÈ Ù· fiÚÈ· Î·È ÙÔ˘˜ ηÓfiÓ˜ ÙÔ˘; (∂ÈÎfiÓ˜ 6, 7) 6. ∆È ÓÔÌ›˙ÂÙ fiÙÈ ÁÓˆÚ›˙ÂÈ ÁÈ· ÙÔ ÚÔÊ˘Ï·ÎÙÈÎfi Î·È ÙË ¯Ú‹ÛË ÙÔ˘; (∂ÈÎfiÓ· 8) 7. ¶ÈÛÙ‡ÂÙ fiÙÈ ÁÓˆÚ›˙ÂÈ ÁÈ· ÙÔÓ ‚È·ÛÌfi ‹ ÙË ÛÂÍÔ˘·ÏÈ΋ ·ÚÂÓfi¯ÏËÛË; (∂ÈÎfiÓ· 9) 8. ∆È ÈÛÙ‡ÂÙ fiÙÈ ÁÓˆÚ›˙ÂÈ ÁÈ· ÙËÓ ·Ó‰ÚÈ΋ Î·È ÙË Á˘Ó·ÈΛ· ÔÌÔÊ˘ÏÔÊÈÏ›·; (∂ÈÎfiÓ˜ 10, 11) 9. Œ¯ÂÈ ·ÎÔ‡ÛÂÈ ÔÙ¤ ÁÈ· ÙȘ ÌÂÙ·‰ÔÙÈΤ˜ ·Ûı¤ÓÂȘ ηÈ, ÈÔ Û˘ÁÎÂÎÚÈ̤ӷ, ÁÈ· ÙÔ AIDS; 10. Œ¯ÂÙÂ Û˘˙ËÙ‹ÛÂÈ ÔÙ¤ ÁÈ· ÙËÓ ·Ó··Ú·ÁˆÁ‹; ∫·È, ·Ó fi¯È, ÙÈ ÈÛÙ‡ÂÙ fiÙÈ ÁÓˆÚ›˙ÂÈ ÙÔ ·È‰› Û·˜; ¢ËÏ·‰‹, Ò˜ Á›ÓÂÙ·È Ë Û‡ÏÏË„Ë, ÔÈÔ˜ ΢ÔÊÔÚ›, Ò˜ ÁÂÓÓÈÔ‡ÓÙ·È Ù· ·È‰È¿; 11. ™·˜ ¤¯ÂÈ ÌÈÏ‹ÛÂÈ ÔÙ¤ ÙÔ ·È‰› Û·˜ ·) ÁÈ· Ù· fiÓÂÈÚ¿ ÙÔ˘ ÛÊ·ÈÚÈο ÁÈ· ÙË ˙ˆ‹; ‚) ¶ÔȘ ÈÛÙ‡ÂÙ fiÙÈ Â›Ó·È ÔÈ ÂÈı˘Ì›Â˜ ÙÔ˘ Û¯ÂÙÈο Ì ÙË ÛÂÍÔ˘·ÏÈ΋ ˙ˆ‹; Á) ¶ÔÈ· Â›Ó·È Ë ¿Ô„‹ Û·˜ ÁÈ· Ù· fiÓÂÈÚ¿ ÙÔ˘; 12. ™˘ÌʈÓ›Ù ÁÈ· ÙËÓ ÔÚÁ¿ÓˆÛË ÂÓfi˜ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÛÂÍÔ˘·ÏÈ΋˜ ‰È··È‰·ÁÒÁËÛ˘; ¶ÔÈ· ÈÛÙ‡ÂÙ fiÙÈ ı· ‹Ù·Ó Ù· ÔʤÏË Î·È Ò˜ ı· ı¤Ï·Ù ӷ Â›Ó·È Ë ÂÊ·ÚÌÔÁ‹ Î·È ÙÔ ÂÚȯfiÌÂÓfi ÙÔ˘; OÈ ÂÚˆÙ‹ÛÂȘ ¤¯Ô˘Ó ‰È·ÌÔÚʈı› Ì ÙÚÔÔÔ›ËÛË ·˘ÙÒÓ Ù˘ ¤Ú¢ӷ˜ Ù˘ Shepperdson (2)

107

¶·È‰È·ÙÚÈ΋ 2004;67:105-114

Paediatriki 2004;67:105-114

·ÓÂ·Ú΋ ÂÚÈÁÚ·Ê‹, “‰ÂÓ ÁÓˆÚ›˙ˆ” fiÙ·Ó ‰ÂÓ ÁÓÒÚÈ˙·Ó Ó· ÂÚÈÁÚ¿„Ô˘Ó ÙËÓ ÂÈÎfiÓ· Î·È “‰ÂÓ ··ÓÙÒ” fiÙ·Ó ‰ÂÓ ‹ıÂÏ·Ó Ó· ÙË Û¯ÔÏÈ¿ÛÔ˘Ó Î·È ‰ÂÓ ¤ÏÂÁ·Ó Ù›ÔÙ·. ∏ ∂ÈÎfiÓ· 6 Âȉ›¯ıËΠÌfiÓÔ Û ·ÁfiÚÈ· Î·È Ë ∂ÈÎfiÓ· 7 ÌfiÓÔ Û ÎÔÚ›ÙÛÈ·. ∆¤ÛÛÂÚȘ ÁÔÓ›˜ ‰ÂÓ Â¤ÙÚ„·Ó ÙËÓ Â›‰ÂÈÍË ÙˆÓ ∂ÈÎfiÓˆÓ 4-7 Î·È 10-11 ÛÙ· ·È‰È¿ ÙÔ˘˜ (Û 1 ·ÁfiÚÈ Î·È 3 ÎÔÚ›ÙÛÈ·). ∞fi ÙȘ ÂÚˆÙ‹ÛÂȘ ÙÔ˘ ¶›Ó·Î· 2, ÔÈ 9-11 ‰ÂÓ ·ÓÙÈÛÙÔÈ¯Ô‡Û·Ó Û ÂÈÎfiÓ· Î·È ¤ÁÈÓÂ Û˘˙‹ÙËÛË Ì ٷ ¿ÙÔÌ· Ì DS Î·È Ë 12 ·¢ı‡ÓıËΠÌfiÓÔ ÛÙÔ˘˜ ÁÔÓ›˜.

OÈ ··ÓÙ‹ÛÂȘ ÙˆÓ ÁÔÓ¤ˆÓ Û˘ÁÎÚ›ıËÎ·Ó Ì ÙȘ ·ÓÙ›ÛÙÔȯ˜ ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜. ∂ÈϤÔÓ, ÂÚ¢ӋıËÎÂ Â¿Ó Û˘Ó¤ÈÙÂ Ë ÂÓÙ‡ˆÛË ÙˆÓ ÁÔÓ¤ˆÓ Ì ÙȘ ··ÓÙ‹ÛÂȘ ÙˆÓ ‰ÈÎÒÓ ÙÔ˘˜ ·È‰ÈÒÓ. ¢ÂÓ ¤ÁÈÓÂ Û˘Û¯¤ÙÈÛË ÙˆÓ ··ÓÙ‹ÛÂˆÓ ÙˆÓ ÁÔÓ¤ˆÓ Ì ÙÔ ÌÔÚʈÙÈÎfi Î·È ÎÔÈÓˆÓÈÎfi ÙÔ˘˜ Â›‰Ô. ∂›Û˘, ‰ÂÓ ˘‹Ú¯Â ÔÌ¿‰· Ì·ÚÙ‡ÚˆÓ ·fi ¿ÏÏË Î·ÙËÁÔÚ›· ·ÙfiÌˆÓ Ì ÂȉÈΤ˜ ·Ó¿ÁΘ Ô˘ ı· Û˘ÁÎÚ›ÓÔÓÙ·Ó Ì ٷ ¿ÙÔÌ· Ì DS. §fiÁˆ ÙÔ˘ ÌÈÎÚÔ‡ ·ÚÈıÌÔ‡ ÙˆÓ Û˘ÌÌÂÙ¯fiÓÙˆÓ, ‰ÂÓ ‰fiıËΠÂ› ÙÔȘ ÂηÙfi (%) ·Ó·ÏÔÁ›· ÙˆÓ Â˘ÚËÌ¿ÙˆÓ Û οı ·¿ÓÙËÛË.

∞ÔÙÂϤÛÌ·Ù· OÈ ÂÚˆÙ‹ÛÂȘ Ô˘ ˘Ô‚Ï‹ıËÎ·Ó ÛÙÔ˘˜ ÁÔÓ›˜ Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2 Î·È ÔÈ ··ÓÙ‹ÛÂȘ ·˘ÙÒÓ Î·È ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜ ÛÙÔÓ ¶›Ó·Î· 3. ™ÙËÓ ÂÚÒÙËÛË 1·, 21/29 ÁÔÓ›˜ ·¿ÓÙËÛ·Ó “Ó·È”, ‰ËÏ·‰‹ ÁÓÒÚÈ˙·Ó fiÙÈ Ù· ·È‰È¿ ÙÔ˘˜ ›¯·Ó Â·ÚΛ˜ ÁÓÒÛÂȘ Û¯ÂÙÈο Ì ٷ ·Ó·ÙÔÌÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ‰˘Ô ʇψÓ, 7/29 ·¿ÓÙËÛ·Ó “fi¯È”, fiÙÈ ‰ËÏ·‰‹ Ù· ·È‰È¿ ÙÔ˘˜ ‰ÂÓ Â›¯·Ó Â·ÚΛ˜ ÁÓÒÛÂȘ ÁÈ· Ù· ·Ó·ÙÔÌÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ‰˘Ô Ê‡ÏˆÓ Î·È, Ù¤ÏÔ˜, ¤Ó·˜ ·¿ÓÙËÛ “‰ÂÓ ÁÓˆÚ›˙ˆ”. ∞fi Ù· ¿ÙÔÌ· Ì DS, 25/29 ÂÚȤÁÚ·„·Ó ÛˆÛÙ¿ ÙȘ

·ÓÙ›ÛÙÔȯ˜ ÂÈÎfiÓ˜ (∂ÈÎfiÓ˜ 1, 2), ‰‡Ô ÙȘ ÂÚȤÁÚ·„·Ó Ï·Óı·Ṳ̂ӷ Î·È ‰‡Ô ‰ÂÓ ·¿ÓÙËÛ·Ó (“‰ÂÓ ··ÓÙÒ”). ∏ ıÂÙÈ΋ ÂÓÙ‡ˆÛË ÙˆÓ 21 ÁÔÓ¤ˆÓ Û˘Ó¤ÈÙ ·fiÏ˘Ù· ÌÂ ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜, ˘‹Ú¯·Ó fï˜ Î·È 4 ¿ÙÔÌ· Ì DS Ù· ÔÔ›· ÂÚȤÁÚ·„·Ó ÛˆÛÙ¿ Ù· ·Ó·ÙÔÌÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ‰‡Ô ʇψÓ, ÂÓÒ ÔÈ ÁÔÓ›˜ ÙÔ˘˜ ·¿ÓÙËÛ·Ó fiÙÈ Ù· ·È‰È¿ ÙÔ˘˜ ‰ÂÓ Ù· ÁÓÒÚÈ˙·Ó. ™ÙËÓ ÂÚÒÙËÛË 1‚ Û¯ÂÙÈο Ì ÙË ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ ÁÂÓÓËÙÈÎÒÓ ÔÚÁ¿ÓˆÓ, 17/29 ÁÔÓ›˜ ·¿ÓÙËÛ·Ó “Ó·È” (fiÙÈ Ù· ·È‰È¿ ÙÔ˘˜ ÁÓÒÚÈ˙·Ó Â·ÚÎÒ˜ ÙË ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘˜), 2/29 “fi¯È” Î·È 10/29 ·¿ÓÙËÛ·Ó “‰ÂÓ ÁÓˆÚ›˙ˆ”. ∞fi Ù· ¿ÙÔÌ· Ì DS, 18/29 ÁÓÒÚÈ˙·Ó ÛˆÛÙ¿ ÙË ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ ÁÂÓÓËÙÈÎÒÓ ÔÚÁ¿ÓˆÓ, 4/29 ‰ÂÓ ÙË ÁÓÒÚÈ˙·Ó ÛˆÛÙ¿ Î·È 7/29 ‰ÂÓ ·¿ÓÙËÛ·Ó (“‰ÂÓ ··ÓÙÒ”). ∏ ıÂÙÈ΋ ·¿ÓÙËÛË 14 ·fi ÙÔ˘˜ 17 ÁÔÓ›˜ Ô˘ ·¿ÓÙËÛ·Ó “Ó·È”, Û˘Ó¤ÈÙ Ì ·˘Ù‹ ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜. ∆ÚÂȘ ÓfiÌÈ˙·Ó fiÙÈ Ù· ·È‰È¿ ÙÔ˘˜ ÁÓÒÚÈ˙·Ó ÙË ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ ÁÂÓÓËÙÈÎÒÓ ÔÚÁ¿ÓˆÓ, ÂÓÒ ÂΛӷ ·¿ÓÙËÛ·Ó “fi¯È”. ∂›Û˘, ˘‹Ú¯·Ó ¿ÏÏ· 4 ¿ÙÔÌ· Ì DS Ô˘ ÁÓÒÚÈ˙·Ó ÙË ÏÂÈÙÔ˘ÚÁ›·, ÂÓÒ ÔÈ ÁÔÓ›˜ ÙÔ˘˜ ·¿ÓÙËÛ·Ó ·ÚÓËÙÈο. ™ÙË 2Ë ÂÚÒÙËÛË, 15/29 ÁÔÓ›˜ ·¿ÓÙËÛ·Ó “Ó·È”, 8/29 “fi¯È” Î·È 6/29 fiÙÈ ‰ÂÓ ÁÓˆÚ›˙Ô˘Ó Â¿Ó Ù· ·È‰È¿ ÙÔ˘˜ ÌÔÚÔ‡Ó Ó· ‰È·ÎÚ›ÓÔ˘Ó ¤Ó· ˙¢Á¿ÚÈ ·fi ‰‡Ô ·ÏÔ‡˜ Ê›ÏÔ˘˜. ŸÏ· Ù· ¿ÙÔÌ· Ì DS ‰ÂÓ ÌfiÚÂÛ·Ó Ó· ÂÚÌËÓ‡ÛÔ˘Ó Ù· ÌËӇ̷ٷ Ù˘ ·ÓÙ›ÛÙÔȯ˘ ÂÈÎfiÓ·˜ (∂ÈÎfiÓ· 3). ™ÙȘ ÂÚˆÙ‹ÛÂȘ 3 Î·È 4, 17/29 ÁÔÓ›˜ ·¿ÓÙËÛ·Ó “Ó·È” (‰ËÏ·‰‹ ÁÓÒÚÈ˙·Ó fiÙÈ Ù· ·È‰È¿ ÙÔ˘˜ ›¯·Ó ÙËÓ ÈηÓfiÙËÙ· Ó· ‰È·ÎÚ›ÓÔ˘Ó ¤Ó· ÊÈÏ› ·fi ÙËÓ ÂÚˆÙÈ΋ Û˘Ó‡ÚÂÛË), 6/29 ·¿ÓÙËÛ·Ó “fi¯È” Î·È 6/29 ‰ÂÓ

¶›Ó·Î·˜ 3. OÈ ··ÓÙ‹ÛÂȘ ÙˆÓ ÁÔÓ¤ˆÓ (n=29) ÛÙȘ 12 ÂÚˆÙ‹ÛÂȘ Î·È ÔÈ ÂÚÌËÓ›˜ ÙˆÓ ·ÙfiÌˆÓ Ì DS (n=29) ÛÙȘ ·ÓÙ›ÛÙÔȯ˜ ÂÈÎfiÓ˜ (∂ÈÎfiÓ˜ 1-11) ∂ÚˆÙ‹ÛÂȘ (∂Ú.)/ ∂ÈÎfiÓ˜ (∂ÈÎ.)

¡·È

°ÔÓ›˜ Ÿ¯È

¢ÂÓ ÁÓˆÚ›˙ˆ

¡·È

∂Ú. ∂Ú. ∂Ú. ∂Ú. ∂Ú. ∂Ú. ∂Ú. ∂Ú. ∂Ú. ∂Ú.

EÚ. ∂Ú. ∂Ú. ∂Ú.

21 17 15 17 16 2 4 2 5 8 6 17 3 20

7 2 8 6 4 21 16 17 16 15 12 2 21 2

1 10 6 6 9 6 9 10 8 6 11 10 5 7

25 18 17 10 2 8 2 5 3 16 14 15 -

1· / ∂ÈÎ. 1, 2 1‚ / ∂ÈÎ. 1, 2 2 / ∂ÈÎ. 3* 3, 4 / ∂ÈÎ. 4**, 5 5 / ∂ÈÎ. 6, 7 6 / ∂ÈÎ. 8 7 / ∂ÈÎ. 9 8 / ∂ÈÎ. 10, 11 9*** / ™˘˙‹ÙËÛË 10 / ™˘˙‹ÙËÛË 11· / ™˘˙‹ÙËÛË 11‚ / ™˘˙‹ÙËÛË 11Á / ™˘˙‹ÙËÛË 12****

ÕÙÔÌ· Ì DS Ÿ¯È ¢ÂÓ ÁÓˆÚ›˙ˆ ¢ÂÓ ··ÓÙÒ 2 4 3 6 15 16 11 19 2 3 3 3 -

0 0 0 0 0 0 4 0 8 2 2 1 -

2 7 5 9 12 5 8 5 16 8 10 10

* ∆· ¿ÙÔÌ· Ì DS ‰˘ÛÎÔχÔÓÙ·Ó Ó· ÂÚÌËÓ‡ÛÔ˘Ó ÙËÓ ¤ÓÓÔÈ· Ù˘ ∂ÈÎfiÓ·˜ 3 ** OÈ ∂ÈÎfiÓ˜ 4-7, 10 Î·È 11 ‰ÂÓ Âȉ›¯ıËÎ·Ó Û 4 ¿ÙÔÌ· Ì DS (1 ·ÁfiÚÈ Î·È 3 ÎÔÚ›ÙÛÈ·, Û‡Ìʈӷ Ì ÙËÓ ÂÈı˘Ì›· ÙˆÓ ÁÔÓ¤ˆÓ ÙÔ˘˜) *** ™ÙȘ ÂÚˆÙ‹ÛÂȘ 9-11 (¶›Ó·Î·˜ 2) ‰ÂÓ ·ÓÙÈÛÙÔÈ¯Ô‡Û·Ó ÂÈÎfiÓ˜ ÁÈ· Ù· ¿ÙÔÌ· Ì DS, ·ÏÏ¿ ¤ÁÈÓÂ Û˘˙‹ÙËÛË **** ∏ ÂÚÒÙËÛË 12 (¶›Ó·Î·˜ 2) ˘Ô‚Ï‹ıËΠÌfiÓÔ ÛÙÔ˘˜ ÁÔÓ›˜

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∂ÈÎfiÓ˜ 1, 2. ∞Ó·ÙÔÌ›· Î·È ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ ÁÂÓÓËÙÈÎÒÓ ÔÚÁ¿ÓˆÓ ÙˆÓ ‰‡Ô ʇψÓ.

∂ÈÎfiÓ· 4. ∂ÚˆÙÈÎfi ÊÈÏ›.

∂ÈÎfiÓ· 3. ŒÓ· ÂÚˆÙÈÎfi ˙¢Á¿ÚÈ.

∂ÈÎfiÓ· 5. EÚˆÙÈ΋ Û˘Ó‡ÚÂÛË.

ÁÓÒÚÈ˙·Ó ÙȘ Û¯ÂÙÈΤ˜ ÁÓÒÛÂȘ ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜.

OÈ ·ÓÙ›ÛÙÔȯ˜ ÂÈÎfiÓ˜ (∂ÈÎfiÓ˜ 4, 5) Âȉ›¯ıËÎ·Ó Û‡Ìʈӷ Ì ÙËÓ ÂÈı˘Ì›· ÙˆÓ ÁÔÓ¤ˆÓ ÌfiÓÔ Û 25 ·È‰È¿. ∞fi ·˘Ù¿, 17/25 ÙȘ ÂÚÌ‹ÓÂ˘Û·Ó ÛˆÛÙ¿, 3/25 ÙȘ ÂÚÌ‹ÓÂ˘Û·Ó Ï·Óı·Ṳ̂ӷ Î·È 5/25 ‰ÂÓ ·¿ÓÙËÛ·Ó (“‰ÂÓ ··ÓÙÒ”). ∏ ıÂÙÈ΋ ÂÓÙ‡ˆÛË 12 ÌfiÓÔ ÁÔÓ¤ˆÓ Û˘Ó¤ÈÙ Ì ÙȘ ÛˆÛÙ¤˜ ··ÓÙ‹ÛÂȘ ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜. ∆· ·È‰È¿ ÙˆÓ ˘fiÏÔÈˆÓ 5 ÁÔÓ¤ˆÓ ¤Î·Ó·Ó Ï·Óı·Ṳ̂ÓË ÂÚÈÁÚ·Ê‹ ÙˆÓ ÂÈÎfiÓˆÓ. ∞fi Ù· 17 ¿ÙÔÌ· Ì DS Ô˘ ÂÚȤÁÚ·„·Ó ÛˆÛÙ¿ ÙȘ ÂÈÎfiÓ˜, ˘‹Ú¯·Ó 5 ÙˆÓ ÔÔ›ˆÓ ÔÈ ÁÔÓ›˜ ·¿ÓÙËÛ·Ó ·ÚÓËÙÈο, ‰ÂÓ ÁÓÒÚÈ˙·Ó ‰ËÏ·‰‹ fiÙÈ Ù· ·È‰È¿ ÙÔ˘˜ ·Ó·ÁÓÒÚÈ˙·Ó ÙËÓ ÂÚˆÙÈ΋ Û˘Ó‡ÚÂÛË Î·È ÙË ‰È¤ÎÚÈÓ·Ó ·fi ÙÔ ·Ïfi ÂÚˆÙÈÎfi ÊÈÏ›. ™ÙËÓ ÂÚÒÙËÛË 5, Ô˘ ·ÊÔÚÔ‡Û ÛÙÔÓ ·˘Ó·ÓÈÛÌfi, ÛÙËÓ ÂÌÂÈÚ›· ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘˜ Î·È ÛÙÔ˘˜ ηÓfiÓ˜ ÁÈ· ÙËÓ Ú¿ÍË, 16/29 ÁÔÓ›˜ ·¿ÓÙËÛ·Ó “Ó·È”, 4/29 ·¿ÓÙËÛ·Ó “fi¯È” (‰ËÏ·‰‹ fiÙÈ ÙÔ ·È‰› ÙÔ˘˜ ‰ÂÓ Â›¯Â ÂÌÂÈÚ›·) Î·È 9/29 ·¿ÓÙËÛ·Ó “‰ÂÓ ÁÓˆÚ›˙ˆ”. OÈ ·ÓÙ›ÛÙÔȯ˜ ÂÈÎfiÓ˜ (∂ÈÎfiÓ˜ 6, 7) ‰ÂÓ Âȉ›¯ıËÎ·Ó Û 4 ·È‰È¿, 1 ·ÁfiÚÈ Î·È 3 ÎÔÚ›ÙÛÈ·, Û‡Ìʈӷ Ì ÙËÓ ÂÈı˘Ì›· ÙˆÓ ÁÔÓ¤ˆÓ. ∏ ∂ÈÎfiÓ· 6 Âȉ›¯ıËΠÌfiÓÔ ÛÙ· ˘fiÏÔÈ· ·ÁfiÚÈ· Î·È Ë ∂ÈÎfi-

Ó· 7 ÌfiÓÔ ÛÙ· ˘fiÏÔÈ· ÎÔÚ›ÙÛÈ·. ∞fi Ù· ¿ÙÔÌ· Ì DS, 10/25 ·¿ÓÙËÛ·Ó ıÂÙÈο (3 ÎÔÚ›ÙÛÈ· Î·È 7 ·ÁfiÚÈ·), 6/25 ·ÚÓËÙÈο Î·È 9/25 ‰ÂÓ ·¿ÓÙËÛ·Ó (“‰ÂÓ ··ÓÙÒ”). ∞fi ÙÔ˘˜ 16 ÁÔÓ›˜ Ì ıÂÙÈ΋ ·¿ÓÙËÛË, ÌfiÓÔ ÙˆÓ 9 Ë ÂÓÙ‡ˆÛË Û˘Ó¤ÈÙ Ì ÙȘ ··ÓÙ‹ÛÂȘ ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜, ÂÓÒ Ù· ·È‰È¿ ÙˆÓ ˘fiÏÔÈˆÓ ·¿ÓÙËÛ·Ó ·ÚÓËÙÈο. ŒÓ· ·fi Ù· 10 ¿ÙÔÌ· Ì DS ÁÓÒÚÈ˙ ÁÈ· ÙÔÓ ·˘Ó·ÓÈÛÌfi, ÔÈ ÁÔÓ›˜ ÙÔ˘ ÔÔ›Ô˘ ·¿ÓÙËÛ·Ó ·ÚÓËÙÈο. ™ÙËÓ ÂÚÒÙËÛË 6 ÁÈ· ÙÔ ÚÔÊ˘Ï·ÎÙÈÎfi, 2/29 ÁÔÓ›˜ ·¿ÓÙËÛ·Ó “Ó·È”, 21/29 “fi¯È” Î·È 6/29 “‰ÂÓ ÁÓˆÚ›˙ˆ”. ∞fi Ù· ¿ÙÔÌ· Ì DS, 2/29 ÂÚȤÁÚ·„·Ó ÔÚı¿ ÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë ÂÈÎfiÓ· (∂ÈÎfiÓ· 8), 15/29 Ï·Óı·Ṳ̂ӷ Î·È 12/29 ‰ÂÓ ·¿ÓÙËÛ·Ó (“‰ÂÓ ··ÓÙÒ”). ∞fi ÙÔ˘˜ 2 ÁÔÓ›˜ Ô˘ ·¿ÓÙËÛ·Ó ıÂÙÈο ÁÈ· ÙÔ ÚÔÊ˘Ï·ÎÙÈÎfi, Ë ·¿ÓÙËÛË ÌfiÓÔ ÙÔ˘ ÂÓfi˜ Û˘Ó¤ÈÙ Ì ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘. ∞fi Ù· 2 ¿ÙÔÌ· Ì DS Ô˘ ·¿ÓÙËÛ·Ó “Ó·È”, ÔÈ ÁÔÓ›˜ ÙÔ˘ ÂÓfi˜ ·¿ÓÙËÛ·Ó “fi¯È” (‰ËÏ·‰‹ ÙÔ ÎÔÚ›ÙÛÈ ÙÔ˘˜ ÁÓÒÚÈ˙ ÙË ¯Ú‹ÛË ÙÔ˘ ÚÔÊ˘Ï·ÎÙÈÎÔ‡, ÂÓÒ ÔÈ ÁÔÓ›˜ ÙÔ˘ ÓfiÌÈ˙·Ó ÙÔ ·ÓÙ›ıÂÙÔ). ∏ ·ÚÓËÙÈ΋ ·¿ÓÙËÛË ÙˆÓ ˘fiÏÔÈˆÓ ·ÙfiÌˆÓ Ì DS Û˘Ó¤ÈÙ Ì ÙËÓ ·ÚÓËÙÈ΋ ÙˆÓ ÁÔÓ¤ˆÓ. ™ÙËÓ ÂÚÒÙËÛË 7 Û¯ÂÙÈο Ì ÙÔÓ ‚È·ÛÌfi Î·È ÙË

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∂ÈÎfiÓ· 6. ∞˘Ó·ÓÈÛÌfi˜ (Âȉ›¯ıËΠÌfiÓÔ Û ·ÁfiÚÈ· ).

∂ÈÎfiÓ· 8. ¶ÚÔÊ˘Ï·ÎÙÈÎfi Î·È Ë ¯Ú‹ÛË ÙÔ˘.

∂ÈÎfiÓ· 7. ∞˘Ó·ÓÈÛÌfi˜ (Âȉ›¯ıËΠÌfiÓÔ Û ÎÔÚ›ÙÛÈ·).

∂ÈÎfiÓ· 9. ™ÂÍÔ˘·ÏÈ΋ ·ÚÂÓfi¯ÏËÛË.

ÛÂÍÔ˘·ÏÈ΋ ·ÚÂÓfi¯ÏËÛË, 4/29 ÁÔÓ›˜ ·¿ÓÙËÛ·Ó “Ó·È” (fiÙÈ ‰ËÏ·‰‹ Ù· ·È‰È¿ ÙÔ˘˜ ÁÓÒÚÈ˙·Ó Â·ÚÎÒ˜ ÙÔ ı¤Ì·), 16/29 ·¿ÓÙËÛ·Ó “fi¯È”, ÂÓÒ 9/29 ·¿ÓÙËÛ·Ó “‰ÂÓ ÁÓˆÚ›˙ˆ”. ∞fi Ù· ¿ÙÔÌ· Ì DS, 8/29 ·¿ÓÙËÛ·Ó “Ó·È”, 16/29 “fi¯È” Î·È 5/29 ‰ÂÓ ·¿ÓÙËÛ·Ó (“‰ÂÓ ··ÓÙÒ”) ÌÂÙ¿ ·fi Â›‰ÂÈÍË Ù˘ ∂ÈÎfiÓ·˜ 9. ∏ ıÂÙÈ΋ ·¿ÓÙËÛË ÌfiÓÔ 2 ÁÔÓ¤ˆÓ Û˘Ó¤ÈÙ Ì ÂΛÓË ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜. ∆· ·È‰È¿ ÙˆÓ ¿ÏÏˆÓ ‰‡Ô ÁÔÓ¤ˆÓ ·ÚÔ˘Û›·˙·Ó Û‡Á¯˘ÛË Û¯ÂÙÈο Ì ·˘Ùfi ÙÔ ı¤Ì·. ∞fi Ù· ¿ÙÔÌ· Ì DS, 8 ÁÓÒÚÈ˙·Ó ·ÚÎÂÙ¿ ÛÙÔȯ›· ÁÈ· ÙÔÓ ‚È·ÛÌfi Î·È ÙË ÛÂÍÔ˘·ÏÈ΋ ·ÚÂÓfi¯ÏËÛË, ˆÛÙfiÛÔ ÔÈ ÁÔÓ›˜ ÙˆÓ 6 ÓfiÌÈ˙·Ó fiÙÈ Ù· ·È‰È¿ ÙÔ˘˜ ·ÁÓÔÔ‡Û·Ó ÙÔ ı¤Ì·. ™ÙËÓ ÂÚÒÙËÛË 8 ÁÈ· ÙËÓ ÔÌÔÊ˘ÏÔÊÈÏ›·, 2/29 ÁÔÓ›˜ ·¿ÓÙËÛ·Ó “Ó·È”, 17/29 “fi¯È” Î·È ÔÈ ˘fiÏÔÈÔÈ 10 ·¿ÓÙËÛ·Ó “‰ÂÓ ÁÓˆÚ›˙ˆ”. ∆¤ÛÛÂÚȘ ÁÔÓ›˜ ‰ÂÓ Â¤ÙÚ„·Ó ÙËÓ Â›‰ÂÈÍË ÙˆÓ ·ÓÙ›ÛÙÔȯˆÓ ÂÈÎfiÓˆÓ (∂ÈÎfiÓ˜ 10, 11) ÛÙ· ·È‰È¿ ÙÔ˘˜. ∞fi Ù· ˘fiÏÔÈ· ¿ÙÔÌ· Ì DS, 2/25 ÂÚȤÁÚ·„·Ó ÛˆÛÙ¿ ÙȘ ÂÈÎfiÓ˜ (“Ó·È”), 11/25 Ï·Óı·Ṳ̂ӷ (“fi¯È”), 4/25 ·¿ÓÙËÛ·Ó “‰ÂÓ ÁÓˆÚ›˙ˆ” Î·È 8/25 ‰ÂÓ ·¿ÓÙËÛ·Ó (“‰ÂÓ ··ÓÙÒ”). ∞fi ÙÔ˘˜ ‰‡Ô ÁÔÓ›˜ Ì ıÂÙÈ΋ ·¿ÓÙËÛË, ÌfiÓÔ Ë ÂÓÙ‡ˆÛË ÙÔ˘ ÂÓfi˜ Û˘Ó¤ÈÙ Ì ÙËÓ ·¿ÓÙËÛË Ù˘ ÎfiÚ˘ ÙÔ˘. O ÁÔÓ¤·˜ ÙÔ˘ ÂÓfi˜ ·fi Ù· 2

¿ÙÔÌ· Ì DS Ô˘ ¤‰ˆÛ·Ó ıÂÙÈ΋ ·¿ÓÙËÛË, ÓfiÌÈ˙ fiÙÈ ÙÔ ·È‰› ÙÔ˘ ‰ÂÓ ÁÓÒÚÈ˙ ÁÈ· ÙËÓ ÔÌÔÊ˘ÏÔÊÈÏ›·, ÂÓÒ ÂΛÓÔ ÁÓÒÚÈ˙Â. ™ÙËÓ ÂÚÒÙËÛË 9 ÁÈ· ÙË ÓfiÛÔ ÙÔ˘ AIDS, 5/29 ÁÔÓ›˜ ·¿ÓÙËÛ·Ó “Ó·È” (‹ÍÂÚ·Ó ‰ËÏ·‰‹ fiÙÈ Ù· ·È‰È¿ ÙÔ˘˜ ÁÓÒÚÈ˙·Ó Â·ÚÎÒ˜ ÙÈ ÛËÌ·›ÓÂÈ), 16/29 ·¿ÓÙËÛ·Ó “fi¯È”, ÂÓÒ 8/29 ÁÔÓ›˜ ·¿ÓÙËÛ·Ó “‰ÂÓ ÁÓˆÚ›˙ˆ”. ∞fi Ù· ¿ÙÔÌ· Ì DS, 5/29 ·¿ÓÙËÛ·Ó “Ó·È” ÌÂÙ¿ ·fi Û˘˙‹ÙËÛË, 19/29 ¤‰ˆÛ·Ó Ï·Óı·Ṳ̂Ó˜ ··ÓÙ‹ÛÂȘ (“fi¯È”) ηÈ, Ù¤ÏÔ˜, 5/29 ‰ÂÓ ·¿ÓÙËÛ·Ó (“‰ÂÓ ··ÓÙÒ”). ∏ ÂÓÙ‡ˆÛË ÙÚÈÒÓ ·fi ÙÔ˘˜ 5 ÁÔÓ›˜ Ì ıÂÙÈ΋ ·¿ÓÙËÛË Û˘Ó¤ÈÙ Ì ÙȘ ··ÓÙ‹ÛÂȘ ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜. ¢‡Ô ¿ÙÔÌ· Ì DS ÁÓÒÚÈ˙·Ó ÁÈ· ÙÔ AIDS, ÂÓÒ ÔÈ ÁÔÓ›˜ ÙÔ˘˜ ÙÔ ·ÁÓÔÔ‡Û·Ó. ™ÙËÓ ÂÚÒÙËÛË 10 Û¯ÂÙÈο Ì ÙËÓ ·Ó··Ú·ÁˆÁ‹, 8/29 ÁÔÓ›˜ ·¿ÓÙËÛ·Ó “Ó·È”, 15/29 “fi¯È” Î·È 6/29 “‰ÂÓ ÁÓˆÚ›˙ˆ”. ∞fi Ù· ¿ÙÔÌ· Ì DS, 3/29 ·¿ÓÙËÛ·Ó ÌÂÙ¿ ·fi Û˘˙‹ÙËÛË “Ó·È”, 2/29 ·¿ÓÙËÛ·Ó “fi¯È”, 8/29 “‰ÂÓ ÁÓˆÚ›˙ˆ” Î·È 16/29 ‰ÂÓ ·¿ÓÙËÛ·Ó (“‰ÂÓ ··ÓÙÒ”). ∏ ıÂÙÈ΋ ÂÓÙ‡ˆÛË ÌfiÓÔ 3 ÁÔÓ¤ˆÓ Û˘Ó¤ÈÙ Ì ÙËÓ ·¿ÓÙËÛË ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜. ™ÙËÓ ÂÚÒÙËÛË 11· ÁÈ· Ù· fiÓÂÈÚ¿ ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘˜, 6/29 ÁÔÓ›˜ ·¿ÓÙËÛ·Ó “Ó·È”, 12/29 “fi¯È”

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∂ÈÎfiÓ· 10. OÌÔÊ˘ÏÔÊÈÏ›· Á˘Ó·ÈÎÒÓ.

∂ÈÎfiÓ· 11. OÌÔÊ˘ÏÔÊÈÏ›· ·Ó‰ÚÒÓ.

Î·È 11/29 “‰ÂÓ ÁÓˆÚ›˙ˆ”. ∞fi Ù· ¿ÙÔÌ· Ì DS, 16/29 ·¿ÓÙËÛ·Ó ÌÂÙ¿ ·fi Û˘˙‹ÙËÛË “Ó·È”, 3/29 “fi¯È”, 2/29 “‰ÂÓ ÁÓˆÚ›˙ˆ” ηÈ, Ù¤ÏÔ˜, 8/29 ‰ÂÓ ·¿ÓÙËÛ·Ó (“‰ÂÓ ··ÓÙÒ”). ∏ ıÂÙÈ΋ ÂÓÙ‡ˆÛË ÙˆÓ 6 ÁÔÓ¤ˆÓ Û˘Ó¤ÈÙ Ì ÙȘ ··ÓÙ‹ÛÂȘ ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜, ˘‹Ú¯·Ó fï˜ Î·È ¿ÏÏ· 10 ¿ÙÔÌ· Ì DS Ì ıÂÙÈ΋ ·¿ÓÙËÛË, ÔÈ ÁÔÓ›˜ ÙˆÓ ÔÔ›ˆÓ ·¿ÓÙËÛ·Ó ·ÚÓËÙÈο. ™ÙËÓ ÂÚÒÙËÛË 11‚ Û¯ÂÙÈο Ì ÙȘ ÂÈı˘Ì›Â˜ ÙÔ˘ ·È‰ÈÔ‡ fiÛÔÓ ·ÊÔÚ¿ ÛÙË ÛÂÍÔ˘·ÏÈ΋ ˙ˆ‹, 17/29 ·¿ÓÙËÛ·Ó “Ó·È” (fiÙÈ ‰ËÏ·‰‹ ›¯·Ó ÙȘ ›‰È˜ ÂÈı˘Ì›Â˜ Ì ÙÔ˘˜ Û˘ÓÔÌËÏ›ÎÔ˘˜ ÙÔ˘˜), 2/29 “fi¯È” Î·È 10/29 “‰ÂÓ ÁÓˆÚ›˙ˆ”. ∞fi Ù· ¿ÙÔÌ· Ì DS, 14/29 ·¿ÓÙËÛ·Ó ÌÂÙ¿ ·fi Û˘˙‹ÙËÛË “Ó·È” (fiÙÈ ‰ËÏ·‰‹ ›¯·Ó ÂÈı˘Ì›Â˜ ÁÈ· ÛÂÍÔ˘·ÏÈ΋ ˙ˆ‹), 3/29 “fi¯È”, 2/29 “‰ÂÓ ÁÓˆÚ›˙ˆ” Î·È 10/29 ‰ÂÓ ·¿ÓÙËÛ·Ó (“‰ÂÓ ··ÓÙÒ”). ∏ ıÂÙÈ΋ ÂÓÙ‡ˆÛË ÙˆÓ 14 ·fi ÙÔ˘˜ 17 ÁÔÓ›˜ Û˘Ó¤ÈÙ Ì ÙȘ ıÂÙÈΤ˜ ··ÓÙ‹ÛÂȘ ÙˆÓ 14 ·È‰ÈÒÓ ÙÔ˘˜. OÈ ˘fiÏÔÈÔÈ 3 ÁÔÓ›˜ Ì ıÂÙÈ΋ ·¿ÓÙËÛË ÓfiÌÈ˙·Ó fiÙÈ Ù· ·È‰È¿ ÙÔ˘˜ ¤¯Ô˘Ó ÂÈı˘Ì›Â˜ Û¯ÂÙÈο Ì ÙË ÛÂÍÔ˘·ÏÈ΋ ˙ˆ‹, ÂÓÒ ÂΛӷ ¤‰ˆÛ·Ó ·ÚÓËÙÈ΋ ·¿ÓÙËÛË. ™ÙËÓ ÂÚÒÙËÛË 11Á Û¯ÂÙÈο Ì ÙËÓ ¿Ô„Ë ÙˆÓ

Paediatriki 2004;67:105-114

ÁÔÓ¤ˆÓ ÁÈ· Ù· fiÓÂÈÚ· ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜, 3/29 ·¿ÓÙËÛ·Ó “Ó·È”, 21/29 “fi¯È” Î·È 5/29 “‰ÂÓ ÁÓˆÚ›˙ˆ”. ∞fi Ù· ¿ÙÔÌ· Ì DS, 15/29 ÌÈÏÔ‡Û·Ó Ì ÂÓıÔ˘ÛÈ·ÛÌfi ÁÈ· Ù· fiÓÂÈÚ¿ ÙÔ˘˜, 3/29 ‹Ù·Ó Û˘ÁÎÚ·ÙË̤ӷ (“fi¯È”), 1/29 ·¿ÓÙËÛ “‰ÂÓ ÁÓˆÚ›˙ˆ” Î·È 10/29 ‰ÂÓ ·¿ÓÙËÛ·Ó (“‰ÂÓ ··ÓÙÒ”). ∏ ıÂÙÈ΋ ÂÓÙ‡ˆÛË ÙˆÓ 3 ÁÔÓ¤ˆÓ Û˘Ó¤ÈÙ Ì ÙȘ ··ÓÙ‹ÛÂȘ 3 ÌfiÓÔ ·fi Ù· 15 ¿ÙÔÌ· Ì DS Ì ıÂÙÈ΋ ÛÙ¿ÛË. ∞˘ÙÔ› ÔÈ 3 ‹Ù·Ó ÁÔÓ›˜ ·ÁÔÚÈÒÓ, Ù· ÔÔ›· ‹Ù·Ó fiÏ· ÌÔÓ·¯Ô·›‰È·. ∆¤ÏÔ˜, Ë ÂÚÒÙËÛË 12, ·Ó·ÊÔÚÈο Ì ÙË ‰ËÌÈÔ˘ÚÁ›· ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÛÂÍÔ˘·ÏÈ΋˜ ‰È··È‰·ÁÒÁËÛ˘, ˘Ô‚Ï‹ıËΠÌfiÓÔ ÛÙÔ˘˜ ÁÔÓ›˜. ∂›ÎÔÛÈ ·fi ÙÔ˘˜ 29 ·¿ÓÙËÛ·Ó “Ó·È”, 2/29 “fi¯È” Î·È 7/29 “‰ÂÓ ÁÓˆÚ›˙ˆ”. ™˘˙‹ÙËÛË ∏ Û‡Á¯ÚÔÓË Ù¿ÛË Ù˘ ÎÔÈÓˆÓ›·˜ Û¯ÂÙÈο Ì ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ·ÙfiÌˆÓ Ì ÂȉÈΤ˜ ·Ó¿ÁΘ Ù›ÓÂÈ Ó· ·ÏÏ¿ÍÂÈ (20), ÚÔ˜ ÙËÓ Î·Ù‡ı˘ÓÛË Ù˘ Ï‹ÚÔ˘˜ ¤ÓÙ·Í˘ Î·È ÂÓۈ̿وۋ˜ ÙÔ˘˜ ÛÙȘ ÔÈΛϘ ‰Ú·ÛÙËÚÈfiÙËÙ˜. ∏ ·ÏÏ·Á‹ ·˘Ù‹, fï˜, ·ÔηχÙÂÈ ÂÎÙfi˜ ÙˆÓ ¿ÏÏˆÓ - ÂÓ‰ÔÁÂÓ‹ ËıÈο Î·È Ú·ÎÙÈο ‰ÈÏ‹ÌÌ·Ù· Î·È ÂÛˆÙÂÚÈΤ˜ Û˘ÁÎÚÔ‡ÛÂȘ ÛÙȘ ·ÔÊ¿ÛÂȘ ÙˆÓ ÁÔÓ¤ˆÓ Î·È ÙˆÓ ·Û¯ÔÏÔ‡ÌÂÓˆÓ Ì ·˘Ù¿ Ù· ¿ÙÔÌ· Û¯ÂÙÈο Ì ÙË ÛÂÍÔ˘·ÏÈ΋ ·ÁˆÁ‹ Î·È ÙË ÛÂÍÔ˘·ÏÈ΋ ÙÔ˘˜ ¤ÎÊÚ·ÛË.

OÈ ÁÔÓ›˜ Î·È Ù· ¿ÙÔÌ· Ì DS Ù˘ ·ÚÔ‡Û·˜ ÂÚÁ·Û›·˜ Û˘ÌÌÂÙ›¯·Ó Ì ÚÔı˘Ì›· ÛÙËÓ ¤Ú¢ӷ. ∏ ÚÔı˘Ì›· ·˘Ù‹ ÂÚÌËÓ‡ÙËΠˆ˜ ¤Ó‰ÂÈÍË Ù˘ ·Ó¿Á΢ Ó· “·ÁÁ›ÍÔ˘Ó” ÙÔ ı¤Ì·, ÁÂÓÈο Î·È ÂȉÈο. ŸÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ·ÍÈÔÈÛÙ›· ÙˆÓ ··ÓÙ‹ÛˆÓ, ‰ÂÓ ¤ÁÈÓ ÚfiÛÊ·Ù· ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂÎÙ›ÌËÛË Ù˘ ÓÔËÌÔÛ‡Ó˘ ÙˆÓ ·ÙfiÌˆÓ Ì DS Ù˘ ¤Ú¢ӷ˜ (IQ). ∞ӷʤÚÔÓÙ·È, fï˜, ÔÚÈṲ̂ӷ ¯·Ú·ÎÙËÚÈÛÙÈο ·˘ÙÒÓ: 16/29 ‹Ù·Ó ÎÔÈÓˆÓÈο, ›¯·Ó ÈηÓfiÙËÙ· Ï‹ÚÔ˘˜ ·˘ÙÔÂ͢ËÚ¤ÙËÛ˘, ›¯·Ó Ú¤ÔÓÙ· ÏfiÁÔ, Û˘ÌÌÂÙ›¯·Ó ·˘ıfiÚÌËÙ· ÛÙÔÓ ‰È¿ÏÔÁÔ Î·È Û ÔÌ·‰ÈΤ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜ Î·È 6/29 ‹Ù·Ó ÎÔÈÓˆÓÈο, ÌÔÚÔ‡Û·Ó ÂÓ Ì¤ÚÂÈ Ó· ·˘ÙÔÂ͢ËÚÂÙËıÔ‡Ó, ›¯·Ó Ôχ ÊÙˆ¯fi ÏÂÍÈÏfiÁÈÔ Î·È ‰ÂÓ Û˘ÌÌÂÙ›¯·Ó ·˘ıfiÚÌËÙ· ÛÙÔÓ ‰È¿ÏÔÁÔ Î·È Û ÔÌ·‰ÈΤ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜, ·Ú¿ ÌfiÓÔ ÌÂÙ¿ ·fi ·Ú·Î›ÓËÛË. ∆· ˘fiÏÔÈ· 7 ¿ÙÔÌ· Ì DS ¯·Ú·ÎÙËÚ›˙ÔÓÙ·Ó ·fi ÂӉȿÌÂÛË ÓÔËÙÈ΋ ηٿÛÙ·ÛË. ™ÙËÓ ÂÚÁ·Û›· ‰ÂÓ ˘‹Ú¯Â ÔÌ¿‰· Ì·ÚÙ‡ÚˆÓ Î·È ‰ÂÓ ¤ÁÈÓÂ Û˘Û¯¤ÙÈÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ Ì ÙÔ ÎÔÈÓˆÓÈÎfi Î·È ÌÔÚʈÙÈÎfi Â›Â‰Ô ÙˆÓ ÁÔÓ¤ˆÓ. ∆· ·ÔÙÂϤÛÌ·Ù· ·˘Ù‹˜ Ù˘ ÂÚÁ·Û›·˜ ‰ÂÓ ·ÊÔÚÔ‡Ó Û οı ¿ÙÔÌÔ Ì DS ÛÙËÓ ∂ÏÏ¿‰·, ·ÏÏ¿ ÛÙÔ ‰Â›ÁÌ· ÙˆÓ Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ·ÙfïÓ, Ù· ÔÔ›· ‰ÂÓ ÓÔÛËχÔÓÙ·Ó Û ›‰Ú˘Ì·. ∞fi Ù· 18 Ì ÌÂÚÈ΋ Û¯¤ÛË Ì ÙÔ Û‡ÏÏÔÁÔ, ÌfiÓÔ 2 ¤ÌÂÓ·Ó ÙÔ Úˆ› ÛÙÔ Û›ÙÈ, ÂÓÒ Ù· ˘fiÏÔÈ· 16 ÊÔÈÙÔ‡Û·Ó Û ٤ÛÛÂÚ· ‰È·ÊÔÚÂÙÈο ΤÓÙÚ· ··Û¯fiÏËÛ˘ ·ÙfiÌˆÓ Ì ÂȉÈΤ˜ ·Ó¿ÁΘ Ù˘ £ÂÛÛ·ÏÔӛ΢.

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OÈ ·Ó·ÊÔÚ¤˜ ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· Û¯ÂÙÈο Ì ÙË ÛÂÍÔ˘·ÏÈ΋ ·ÁˆÁ‹ ÂÈÏÂÁ̤ÓÔ˘ ÏËı˘ÛÌÔ‡ ·ÙfiÌˆÓ Ì ۇӉÚÔÌÔ Down Â›Ó·È ÊÙˆ¯¤˜ (3-5), ÂÓÒ ˘¿Ú¯Ô˘Ó ¤Ú¢Ó˜ ÁÈ· ÙȘ ÁÓÒÛÂȘ, ÙȘ ÂÌÂÈڛ˜ Î·È Ù· ÂӉȷʤÚÔÓÙ· ·ÙfiÌˆÓ Ì ÎÈÓËÙÈΤ˜ ·Ó·Ëڛ˜ Î·È ÓÔËÙÈ΋ ˘ÛÙ¤ÚËÛË ÁÂÓÈο ‹ ·˘ÙÈÛÌfi (7,8). ∆· ·È‰È¿ Ì DS ÂÈÛ¤Ú¯ÔÓÙ·È Ê˘ÛÈÔÏÔÁÈο ÛÙËÓ ‹‚Ë. ∆· ÎÔÚ›ÙÛÈ· ÂΉËÏÒÓÔ˘Ó ÂÌÌËÓÔÚÚ˘Û›· Î·È Â›Ó·È ÁfiÓÈÌ·, ÂÓÒ Ù· ·ÁfiÚÈ· ¤¯Ô˘Ó Ï‹ÚË ÛÂÍÔ˘·ÏÈ΋ ÏÂÈÙÔ˘ÚÁ›·, ·ÏÏ¿ ‰ÂÓ Â›Ó·È ÁfiÓÈÌ· (2,4,5,9-11). ™ÙË ‚È‚ÏÈÔÁÚ·Ê›· ·Ó·Ê¤ÚÂÙ·È ÌfiÓÔ ¤Ó·˜ ¿Ó‰Ú·˜ Ì DS Ô˘ ¤ÁÈÓ ·Ù¤Ú·˜ (12). OÈ ÁÔÓ›˜ Ô˘ Û˘ÌÌÂÙ›¯·Ó Û ·˘Ù‹ ÙËÓ ÂÚÁ·Û›· ‹Ù·Ó ÏËÚÔÊÔÚË̤ÓÔÈ ÁÈ· ÙË ÁÔÓÈÌfiÙËÙ· ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜ Î·È ÁÓÒÚÈ˙·Ó fiÙÈ Ù· ÎÔÚ›ÙÛÈ· ÙÔ˘˜ Û ÂÚ›ÙˆÛË Î‡ËÛ˘ ·ÓÙÈÌÂÙˆ›˙Ô˘Ó ÙËÓ Èı·ÓfiÙËÙ· ·Ô‚ÔÏ‹˜ ‹ Á¤ÓÓËÛ˘ ·È‰ÈÔ‡ ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ηڢfiÙ˘Ô ‹ DS. ∏ ÁÓÒÛË ·˘Ù‹ Â·˘Í¿ÓÂÈ ÙȘ ÂÛˆÙÂÚÈΤ˜ ÙÔ˘˜ Û˘ÁÎÚÔ‡ÛÂȘ ηÈ, ÂÓÒ ¤¯Ô˘Ó ‰È¿ıÂÛË Ó· ÚÔÛʤÚÔ˘Ó ·˘ÙÔÓÔÌ›·-·ÓÂÍ·ÚÙËÛ›· ÛÙ· ·È‰È¿ ÙÔ˘˜ Î·È ‰˘Ó·ÙfiÙËÙ˜ Ó· ¯·ÚÔ‡Ó ÙËÓ ÂÓËÏÈΛˆÛ‹ ÙÔ˘˜, Â›Ó·È ÂÈÊ˘Ï·ÎÙÈÎÔ›, ηıÒ˜ Ë ÂÓı¿ÚÚ˘ÓÛ‹ ÙÔ˘˜ ÛÙ·ıÌ›˙ÂÙ·È Ì ·ÓÙ›ÛÙÔÈ¯Ô˘˜ ÎÈÓ‰‡ÓÔ˘˜. ªfiÓÔ 3 ÁÔÓ›˜ ÂÈı˘ÌÔ‡Û·Ó ÙË ÛÂÍÔ˘·ÏÈ΋ ˙ˆ‹ ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜, Ù· ÔÔ›· ‹Ù·Ó ·ÁfiÚÈ· Î·È ÌÔÓ·¯Ô·›‰È·. ∞fi Ù· Â˘Ú‹Ì·Ù¿ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘, ÂӉȷʤÚÔÓ ·ÚÔ˘Û›·˙ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÔÈ ÂÓÙ˘ÒÛÂȘ ÙˆÓ ÁÔÓ¤ˆÓ Û˘Ó¤ÈÙ·Ó ÂÓ Ì¤ÚÂÈ Ì ÙȘ ··ÓÙ‹ÛÂȘ ÙˆÓ ‰ÈÎÒÓ ÙÔ˘˜ ·È‰ÈÒÓ fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ·Ó·ÙÔÌ›·, ÙË ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ ÁÂÓÓËÙÈÎÒÓ ÔÚÁ¿ÓˆÓ Î·È ÙË Û˘Ó‡ÚÂÛË. ∞˘Ùfi ÌÔÚ› Ó· ÂÍËÁËı› ·fi ÙËÓ ÂÓË̤ڈÛË Ô˘ οÓÔ˘Ó ÔÈ ›‰ÈÔÈ ÔÈ ÁÔÓ›˜ ÛÙ· ·È‰È¿ ÙÔ˘˜ Î·È ÙË ÛÙÂÓ‹ ηıËÌÂÚÈÓ‹ Û¯¤ÛË ÁÔÓ¤ˆÓ-·È‰ÈÒÓ, Ë ÔÔ›· ηٷϋÁÂÈ ÛÙËÓ Â›ÁÓˆÛË ÙˆÓ ÁÔÓ¤ˆÓ ÁÈ· ÙȘ ÁÓÒÛÂȘ ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜. ™¯Â‰fiÓ ·fiÏ˘ÙË Ù·‡ÙÈÛË ˘‹Ú¯Â ÛÙÔ ı¤Ì· ÙÔ˘ ·˘Ó·ÓÈÛÌÔ‡ (9/10), ÁÈ·Ù› ·˘Ùfi ·ÔÙÂÏ› Ì›· ‰È·›ÛÙˆÛË ÂÓfi˜ ÁÂÁÔÓfiÙÔ˜. ™ÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë ÂÈÎfiÓ·, Ù· 9 ·È‰È¿ Ô˘ ‰ÂÓ ·¿ÓÙËÛ·Ó (“‰ÂÓ ··ÓÙÒ”), ¤‰ÂÈ¯Ó·Ó Ì ÙË ÁÏÒÛÛ· ÙÔ˘ ÛÒÌ·ÙÔ˜ ÂÚÈÛÛfiÙÂÚÔ ÓÙÚÔ‹ ·Ú¿ ¿ÁÓÔÈ·. ∞ÓÙ›ıÂÙ·, fiÙ·Ó ‰ÂÓ ··ÓÙÔ‡Û·Ó ÛÙȘ ¿ÏϘ ÂÈÎfiÓ˜, Ê·ÈÓfiÙ·Ó fiÙÈ ·ÁÓÔÔ‡Û·Ó ÙÂÏ›ˆ˜ ÙÔ Û¯ÂÙÈÎfi ı¤Ì·. ∆· ¿ÙÔÌ· Ì DS Ê¿ÓËΠfiÙÈ Â›Ó·È Â·ÚÎÒ˜ ÂÓËÌÂڈ̤ӷ ÁÈ· ÙËÓ ·Ó·ÙÔÌ›·, ÙË ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ÁÂÓÓËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Î·È ÙËÓ ÂÚˆÙÈ΋ Û˘Ó‡ÚÂÛË, Â›Ó·È fï˜ ·ÓÂ·ÚÎÒ˜ ÂÓËÌÂڈ̤ӷ ÁÈ· ÔÚÈṲ̂Ó˜ Ù˘¯¤˜ Ù˘ ÛÂÍÔ˘·ÏÈ΋˜ ˙ˆ‹˜ Ô˘ ¿ÙÔÓÙ·È ÙˆÓ ‰È·ÚÔÛˆÈÎÒÓ Û¯¤ÛˆÓ, fiˆ˜ Ë ·Ó·ÁÓÒÚÈÛË ÂÓfi˜ ÂÚˆÙÈÎÔ‡ ˙¢Á·ÚÈÔ‡ ·fi ·ÏÔ‡˜ Ê›ÏÔ˘˜, ÙÔ ÚÔÊ˘Ï·ÎÙÈÎfi Î·È Ë ¯Ú‹ÛË ÙÔ˘, Ë ÛÂÍÔ˘·ÏÈ΋ ·ÚÂÓfi¯ÏËÛË, Ë ÔÌÔÊ˘ÏÔÊÈÏ›·, Ù· ÛÂÍÔ˘·ÏÈο ÌÂÙ·‰È‰fiÌÂÓ· ÓÔÛ‹Ì·Ù· Î·È Ë ·Ó··Ú·ÁˆÁ‹

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(∂ÈÎfiÓ˜ 3, 8-11). ∂ÈϤÔÓ, ÛÙ· ›‰È· ı¤Ì·Ù· ‰ÂÓ ˘‹Ú¯Â Û‡ÌÙˆÛË ÙˆÓ ·fi„ÂˆÓ ÙˆÓ ÁÔÓ¤ˆÓ Ì ÙȘ ··ÓÙ‹ÛÂȘ ÙˆÓ ‰ÈÎÒÓ ÙÔ˘˜ ·È‰ÈÒÓ. ∏ ‰È·›ÛÙˆÛË ·˘Ù‹ ‰ÈηÈÔÏÔÁ› ÙÔ˘˜ Êfi‚Ô˘˜ ÙˆÓ ÁÔÓ¤ˆÓ Î·È ÙËÓ ¿ÚÓËÛ‹ ÙÔ˘˜ ÁÈ· Û˘ÌÌÂÙÔ¯‹ ÙˆÓ ·È‰ÈÒÓ Û ÛÂÍÔ˘·ÏÈΤ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜, ÂÓÒ ·˘Ù‹ Ë ‰È¿ÛÙ·ÛË ·fi„ÂˆÓ ÂÁ΢ÌÔÓ› ÎÈÓ‰‡ÓÔ˘˜ ÁÈ· ÙËÓ ·ÛÊ¿ÏÂÈ¿ ÙÔ˘˜.

OÚÈṲ̂ÓÔÈ ÁÔÓ›˜ ›¯·Ó ÂÈÊ˘Ï¿ÍÂȘ ˆ˜ ÚÔ˜ ÙËÓ ·ÚÔ˘Û›·ÛË ÔÚÈÛÌ¤ÓˆÓ ıÂÌ¿ÙˆÓ ÛÙ· ·È‰È¿ ÙÔ˘˜, .¯. ‰ÂÓ Â¤ÙÚ„·Ó Ó· ÂȉÂȯıÔ‡Ó Û ·˘Ù¿ ÔÈ ∂ÈÎfiÓ˜ 4-7, 10, 11 (ÂÚˆÙÈÎfi ÊÈÏ›, ÂÚˆÙÈ΋ Û˘Ó‡ÚÂÛË, ·˘Ó·ÓÈÛÌfi˜, ÔÌÔÊ˘ÏÔÊÈÏ›·). ∞˘Ù¤˜ ÔÈ ‰È·ÈÛÙÒÛÂȘ ·ÔηχÙÔ˘Ó Ù· ‰ÈÏ‹ÌÌ·Ù· ÙˆÓ ÁÔÓ¤ˆÓ Û¯ÂÙÈο Ì ÙË ÛÂÍÔ˘·ÏÈ΋ ¤ÎÊÚ·ÛË ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜, ηٿÛÙ·ÛË Ô˘ ÙÔÓ›˙ÂÙ·È Î·È ·fi ¿ÏÏÔ˘˜ ÂÚ¢ÓËÙ¤˜ (2). OÈ ÁÔÓ›˜, ȉȷ›ÙÂÚ· ÙˆÓ ÎÔÚÈÙÛÈÒÓ, ¤‰ÂÈ¯Ó·Ó ·Ì˯·Ó›· fiÛÔÓ ·ÊÔÚ¿ ÛÙÔÓ ·˘Ó·ÓÈÛÌfi Î·È ‰ÂÓ ¤‰ÈÓ·Ó Û·Ê›˜ ··ÓÙ‹ÛÂȘ. ∏ ÛÂÍÔ˘·ÏÈ΋ ·ÚÂÓfi¯ÏËÛË ÙÔ‡˜ ÚÔÍÂÓ› ÌÂÁ¿ÏÔ ¿Á¯Ô˜ Î·È fiÏÔÈ ·ÔÎ¿Ï˘„·Ó fiÙÈ Û˘Ì‚Ô˘ÏÂ‡Ô˘Ó Î·ıËÌÂÚÈÓ¿ Ù· ·È‰È¿ ÙÔ˘˜ “Ó· ÌËÓ ·Ê‹ÓÔ˘Ó Î·Ó¤Ó·Ó Ó· Ù· ·ÁÁ›˙ÂÈ ‹ Ó· Ù· ÂÓԯϛ Ì ÔÔÈÔÓ‰‹ÔÙ ÙÚfiÔ”. ∏ ÛÙ¿ÛË ÙˆÓ ÁÔÓ¤ˆÓ ÁÈ· ÙË ÛÂÍÔ˘·ÏÈ΋ ˙ˆ‹ ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘˜ ‹Ù·Ó ·fiÏ˘Ù· ·ÚÓËÙÈ΋. ∏ ȉ¤· ÙÔ˘ Á¿ÌÔ˘ ÙÔ‡˜ Êfi‚È˙Â, ÂÓÒ ÙÔÓ ıˆÚÔ‡Û·Ó ·Ó¤ÊÈÎÙÔ ¤ˆ˜ ·Ú¿ÏÔÁÔ. ∞ÎfiÌË ÂÚÈÛÛfiÙÂÚÔ ÊÔ‚Ô‡ÓÙ·Ó ÙËÓ ÙÂÎÓÔÔ›ËÛË Î·È ÙË ıˆÚÔ‡Û·Ó ·ÎfiÌË ÈÔ ‰‡ÛÎÔÏË ˘fiıÂÛË ·fi ÙÔ Á¿ÌÔ, ·Ú·Ù‹ÚËÛË Ô˘ ·ÔηχÊıËΠ۠ÚfiÛÊ·ÙË Û¯ÂÙÈ΋ ¤Ú¢ӷ ·fi ÙË µÚ·˙ÈÏ›·, ÏfiÁˆ Ù˘ Û˘Ó·ÈÛıËÌ·ÙÈ΋˜ ÊfiÚÙÈÛ˘ ÙfiÛÔ Ù˘ ÌËÙ¤Ú·˜ fiÛÔ Î·È ÙÔ˘ ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ ̤۷ ÛÙÔ ÔÔ›Ô ı· ·Ó·ÙÚ·Ê› ÙÔ ÓÂÔÁÓfi (3).

OÈ ÂÚÈÛÛfiÙÂÚÔÈ ÁÔÓ›˜ (17/29) ÂÈı˘ÌÔ‡Û·Ó ÙËÓ ·˘ÙÔÓÔÌ›· ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜. π‰È·›ÙÂÚÔ ÂӉȷʤÚÔÓ Â›¯Â fiÙÈ ÔÈ ÁÔÓ›˜ Ô˘ ›ÛÙ¢·Ó ÛÙËÓ Ï‹ÚË ·˘ÙÔÓÔÌ›· Î·È ÙË ‰È·‚›ˆÛË ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘˜ ÂÎÙfi˜ ÙÔ˘ ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ ‹Ù·Ó fiÏÔÈ ÁÔÓ›˜ ·ÁÔÚÈÒÓ (7/17). ¢È·ÈÛÙÒÓÂÙ·È fiÙÈ ÔÈ ÁÔÓ›˜ ÙˆÓ ÎÔÚÈÙÛÈÒÓ ‰È·Î·Ù¤¯ÔÓÙ·È ·fi ÙÔ ¿Á¯Ô˜ Ì›·˜ ·ÓÂÈı‡ÌËÙ˘ ÂÁ΢ÌÔÛ‡Ó˘, ÂÓÒ ÔÈ ÁÔÓ›˜ ÙˆÓ ·ÁÔÚÈÒÓ - ··ÏÏ·Á̤ÓÔÈ ·fi ·˘Ù‹ ÙËÓ ·ÁˆÓ›· - Â›Ó·È ÈÔ ÚÔԉ¢ÙÈÎÔ›. OÈ ˘fiÏÔÈÔÈ ·fi ÙÔ˘˜ 17 ÁÔÓ›˜ Ô˘ ˘ÔÛÙ‹ÚÈ˙·Ó ÙËÓ ·˘ÙÔÓÔÌ›·, ÙËÓ ÂÚȤÁÚ·Ê·Ó ÂÚÈÛÛfiÙÂÚÔ Û·Ó ·˘ÙÔÂ͢ËÚ¤ÙËÛË Î·È ·Ú·ÌÔÓ‹ ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜ Û ÂÏÂÁ¯fiÌÂÓÔ ÂÚÈ‚¿ÏÏÔÓ. ∂›ÎÔÛÈ ·fi ÙÔ˘˜ 29 ÁÔÓ›˜ ÂÂÛ‹Ì·Ó·Ó ÙËÓ ·Ó·ÁηÈfiÙËÙ· ÂÓfi˜ ÚÔÁÚ¿ÌÌ·ÙÔ˜, ÂÎ ÙˆÓ ÔÔ›ˆÓ ÌfiÓÔ ÔÈ 13 ÂÚȤÁÚ·„·Ó ÙÔ ÂÚȯfiÌÂÓfi ÙÔ˘, ÙÔÓ›˙ÔÓÙ·˜ ÙÔ˘˜ ÂÍ‹˜ ÙÔÌ›˜: Û˘Ó‡·ÚÍË ÙˆÓ ‰‡Ô ʇψÓ, ÂÍ·ÙÔÌÈÎÂ˘Ì¤ÓË ·ÍÈÔÏfiÁËÛË ÙÔ˘ οıÂ

¶·È‰È·ÙÚÈ΋ 2004;67:105-114

·È‰ÈÔ‡, ÂÓË̤ڈÛË Û ‚·ÛÈο ı¤Ì·Ù· ÛÂÍÔ˘·ÏÈ΋˜ ·ÁˆÁ‹˜, ·ÔÊ˘Á‹ ÂÌ‚¿ı˘ÓÛ˘ Û ÏÂÙÔ̤ÚÂȘ Î·È Û˘Ì‚Ô˘Ï¢ÙÈ΋ Û ı¤Ì·Ù· ÚÔÛÙ·Û›·˜ (‰ËÏ·‰‹ Ò˜ Ó· ·ÔʇÁÔ˘Ó Î¿ÔÈÔÓ Ô˘ Ù· ·ÚÂÓԯϛ ÛÂÍÔ˘·ÏÈο). ¶ÈÛÙÂ‡Ô˘Ó ÛÙË Û˘ÓÂÚÁ·Û›· ÁÔÓ¤ˆÓ Î·È ÂȉÈÎÒÓ Ô˘ ı· ÙÔ˘˜ Û˘Ì‚Ô˘Ï‡ԢÓ. ∆¤ÏÔ˜, ÏfiÁˆ ÙÔ˘ Êfi‚Ô˘ ·ÓÂÈı‡ÌËÙ˘ ÂÁ΢ÌÔÛ‡Ó˘ ÙˆÓ ÎÔÚÈÙÛÈÒÓ, ÂÎÙfi˜ Ù˘ ÛÂÍÔ˘·ÏÈ΋˜ Û¯¤Û˘, ÙÔÓ›˙Ô˘Ó ÙËÓ ·Ó¿ÁÎË ÁÈ· ·Ó¿Ù˘ÍË Û¯¤ÛÂˆÓ Û˘ÓÙÚÔÊÈÎfiÙËÙ·˜. ¶ÚÔÙÂÈÓfiÌÂÓÔ ÚfiÁÚ·ÌÌ· OÈ Evans Î·È Û˘Ó (8) ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ Ë ÛÂÍÔ˘·ÏÈ΋ ·ÁˆÁ‹ Ú¤ÂÈ Ó· ‰È·ÌÔÚÊÒÓÂÙ·È Ï·Ì‚¿ÓÔÓÙ·˜ ˘’ fi„ÈÓ ÙȘ ÁÓÒÛÂȘ ÙÔ˘ οı ·ÙfiÌÔ˘, Û˘ÓÈÛÙÒÓÙ·˜ ̤ÚÔ˜ ÂÓfi˜ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÁÈ· ÙËÓ ÚÔÛˆÈ΋ Î·È ÎÔÈÓˆÓÈ΋ ÙÔ˘ ·Ó¿Ù˘ÍË, Ì ¤ÌÊ·ÛË ÛÙËÓ ÂͤÏÈÍË ÙˆÓ Û¯¤ÛˆÓ. ∆· ¿ÙÔÌ· Ì DS ı· Ú¤ÂÈ Ó· ‰È‰·¯ıÔ‡Ó Ò˜ Ó· ·ÔʇÁÔ˘Ó ÌË ·Ô‰ÂÎÙ¤˜ Û˘ÌÂÚÈÊÔÚ¤˜ Î·È Ò˜ Ó· Û˘ÌÂÚÈʤÚÔÓÙ·È ÎÔÈÓˆÓÈο ·Ó¿ÏÔÁ· Ì ÙȘ ÂÚÈÛÙ¿ÛÂȘ (13). ∏ ÛÂÍÔ˘·ÏÈ΋ ·ÁˆÁ‹ ÙˆÓ ·ÙfiÌˆÓ Ì ‚·ÚÈ¿ ÓÔËÙÈ΋ ˘ÛÙ¤ÚËÛË, Û ‰ÈÂıÓ¤˜ Â›‰Ô, ÂÚÈÔÚ›˙ÂÙ·È ÌfiÓÔ Û ı¤Ì·Ù· È·ÙÚÈÎÔ‡ ÂÚȯÔ̤ÓÔ˘, ÚÔÛˆÈ΋˜ ÊÚÔÓÙ›‰·˜ Î·È ˘ÁÈÂÈÓ‹˜. ∏ ÏÂÈÔ„ËÊ›·, fï˜, ÙˆÓ ·ÙfiÌˆÓ Ì DS ÌÔÚ› Ó· ÂÎ·È‰Â˘Ù› Î·È ¤Ú·Ó ÙˆÓ ‚·ÛÈÎÒÓ ·˘ÙÒÓ ıÂÌ¿ÙˆÓ (11).

OÈ ·fi„ÂȘ ÙˆÓ ÁÔÓ¤ˆÓ Ù˘ ¤Ú¢ӷ˜ ÁÈ· ¤Ó· ÚfiÁÚ·ÌÌ· ÛÂÍÔ˘·ÏÈ΋˜ ·ÁˆÁ‹˜ Û˘ÌʈÓÔ‡Û·Ó ÂÓ Ì¤ÚÂÈ Ì ÛÙÔȯ›· Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜ (2,9). ™ËÌ·Û›· ¤¯ÂÈ Ë ÂÍ·ÙÔÌÈÎÂ˘Ì¤ÓË ÂÎ·›‰Â˘ÛË ÙˆÓ ·ÙfiÌˆÓ Ì DS ÛÙ· ‚·ÛÈο ı¤Ì·Ù·, ÒÛÙ ӷ ·ÔÎÙ‹ÛÔ˘Ó ÙȘ ··Ú·›ÙËÙ˜ ÁÓÒÛÂȘ ÁÈ· ÙËÓ ÂÚ·ÈÙ¤Úˆ ÂÎ·›‰Â˘ÛË, Ï·Ì‚¿ÓÔÓÙ·˜ ˘’ fi„ÈÓ ÙȘ ‰È·ÊÔÚÂÙÈΤ˜ ÁÓÒÛÂȘ ÙÔ˘˜, ÙȘ ‰È·ÊÔÚÂÙÈΤ˜ ÚÔÛˆÈÎfiÙËÙ¤˜ ÙÔ˘˜ Î·È ÙȘ ‰˘Ó·ÙfiÙËÙ¤˜ ÙÔ˘˜ ÁÈ· ÙËÓ Î·Ù·ÓfiËÛË ÙˆÓ ·Ú¯fiÌÂÓˆÓ ÏËÚÔÊÔÚÈÒÓ. µ·ÛÈ΋ ÚÔ¸fiıÂÛË ÁÈ· ÙËÓ Î·Ï‡ÙÂÚË ÏÂÈÙÔ˘ÚÁ›· ÂÓfi˜ Ù¤ÙÔÈÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ Â›Ó·È Ë Î·Ù¿ÚÙÈÛË ÙˆÓ ˘¢ı‡ÓˆÓ Î·È Ë ÂÓË̤ڈÛË Î·È Û˘Ì‚Ô˘Ï¢ÙÈ΋ ÙˆÓ ÁÔÓ¤ˆÓ. ¶ÚÔÙ›ÓÂÙ·È Ë ‰ËÌÈÔ˘ÚÁ›· ÌÈÎÙÒÓ ÔÌ¿‰ˆÓ (·ÁfiÚÈ· Î·È ÎÔÚ›ÙÛÈ·), Ì ÎÚÈÙ‹ÚÈÔ ÙȘ ÈηÓfiÙËÙ¤˜ ÙÔ˘˜. ∆Ô ÂÚȯfiÌÂÓÔ ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ÂÎ·›‰Â˘ÛË Û¯ÂÙÈο ÌÂ: ·) Ù· ‚·ÛÈο ·Ó·ÙÔÌÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ ·ÓıÚÒÔ˘, ÙȘ ‰È·ÊÔÚ¤˜ ÙˆÓ ‰‡Ô Ê‡ÏˆÓ Î·È ÙËÓ ÂÚˆÙÈ΋ Û˘Ó‡ÚÂÛË, ‚) ÙËÓ Î·Ù¿ÏÏËÏË Û˘ÌÂÚÈÊÔÚ¿ Û ÔÌ·‰ÈΤ˜ Î·È ·ÙÔÌÈΤ˜ Û˘Ó·Ó·ÛÙÚÔʤ˜ (Ò˜ ÂÈÎÔÈÓˆÓÒ Ì ÙÔ˘˜ Ê›ÏÔ˘˜ ÌÔ˘, ÔÈ· Û˘ÌÂÚÈÊÔÚ¿ Â›Ó·È ·Ô‰ÂÎÙ‹ Û ‰ËÌfiÛÈÔ ¯ÒÚÔ, ÔȘ Û˘ÌÂÚÈÊÔÚ¤˜ Â›Ó·È ·fiÏ˘Ù· ÚÔÛˆÈΤ˜), Á) ÙË ÛÂÍÔ˘·ÏÈ΋ ·ÚÂÓfi¯ÏËÛË-ηÎÔÔ›ËÛË

Paediatriki 2004;67:105-114

(ÂÎ·›‰Â˘ÛË ‰ÂÍÈÔÙ‹ÙˆÓ ·˘ÙÔÚÔÛÙ·Û›·˜: ÌÔÚÒ Ó· Ϥˆ “fi¯È”) Î·È ‰) ÙÔÓ Á¿ÌÔ, ÙȘ Û¯¤ÛÂȘ (ÂÚˆÙÈΤ˜ Î·È ÊÈÏÈΤ˜), ÙË Û˘ÓÙÚÔÊÈÎfiÙËÙ· ̤۷ ÛÙȘ Û¯¤ÛÂȘ Î·È ÙËÓ ·ÓÙÈÛ‡ÏÏË„Ë. ™ËÌ·ÓÙÈÎfi ·Ú¿ÁÔÓÙ· ÁÈ· ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Î·È ÙËÓ ÂÈÙ˘¯›· ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ·ÔÙÂÏ› ÙfiÛÔ Ë ¯Ú‹ÛË ÂÔÙÈÎÒÓ Ì¤ÛˆÓ, fiˆ˜ ÛΛÙÛ·, ʈÙÔÁڷʛ˜ Î·È ÚÔ‚ÔϤ˜ video fiÛÔ Î·È Ë ‰Ú·Ì·ÙÔÔ›ËÛË ÙˆÓ ‰È·ÊfiÚˆÓ ÂÚÈÛÙ¿ÛÂˆÓ Î·È ÙÔ ·›ÍÈÌÔ ÚfiÏˆÓ (role-playing), Ù· ÔÔ›· ı· ‰È¢ÎÔχÓÔ˘Ó ÙË Û˘ÏÏÔÁÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË, ÙËÓ ÂÓÂÚÁfi Û˘ÌÌÂÙÔ¯‹ Î·È ÙËÓ Â‡ÎÔÏË Î·Ù·ÓfiËÛË. ∂˘¯·ÚÈÛٛ˜ £ÂṲ́˜ ¢¯·ÚÈÛٛ˜ ÛÙ· ¿ÙÔÌ· Ì DS Î·È ÛÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘˜, ÔÈ ÔÔ›ÔÈ Ì ÚÔı˘Ì›· ¤Ï·‚·Ó ̤ÚÔ˜ ÛÙË ‰ÈÂÓ¤ÚÁÂÈ· ·˘Ù‹˜ Ù˘ ¤Ú¢ӷ˜.

µÈ‚ÏÈÔÁÚ·Ê›· 1. ¶·ÈÔÓ›‰Ë˜ ∞. ∞‡ÍËÛË Î·È ·Ó¿Ù˘ÍË. ™ÙÔ: ¶·È‰È·ÙÚÈ΋. ¢∂¶, ∆Ô̤·˜ ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡. ∞ÚÈÛÙÔÙ¤ÏÂÈÔ ¶·ÓÂÈÛÙ‹ÌÈÔ £ÂÛÛ·ÏÔӛ΢. 2Ë ¤Î‰ÔÛË. £ÂÛÛ·ÏÔÓ›ÎË: °È·¯Ô‡‰Ë-°È·Ô‡ÏË O.∂.; 2000. ÛÂÏ. 17-18.

2. Shepperdson B. The control of sexuality in young people with Down’s syndrome. Child Care Health Dev 1995;21: 333-349.

3. Castelao TB, Schiavo MR, Jurberg P. Sexuality in Down syndrome individuals. Rev Saude Publica 2003;37:32-39.

4. American Academy of Pediatrics. Health supervision for children with Down syndrome. Pediatrics 2001;107: 442-449.

5. Van Dyke DC. McBrien DM, Siddiqi SU, Petersen MC. Sexuality and individuals with Down syndrome. In: Rondal J, Perera J, Nadel L, editors. Down syndrome: a review of current knowledge. London: Whurr Publishers Ltd; 1997. p.

33-47.

6. Dixon H, Craft A and Nottinghamshire County Council.

Picture yourself. Learning Development Aids (LDA): Joseph Rowntree Foundation; 1992.

7. Konstantareas MM, Lunsky YJ. Sociosexual knowledge, experience, attitudes, and interests of individuals with autistic disorder and developmental delay. J Autism Dev Disord 1997;27:397-413.

8. Evans AL, McKinlay IA. Sex education and the severely mentally retarded child. Dev Med Child Neurol 1989;31: 98-103.

9. Goldstein H. Menarche, menstruation, sexual relations and contraception of adolescent females with Down syndrome.

Eur J Obstet Gynecol Reprod Biol 1988;27:343-349.

10. Shobha Rani A, Jyothi A, Reddy PP, Reddy OS. Reproduction in Down’s syndrome. Int J Gynaecol Obstet 1990;31:81-86.

11. Elkins TE, McNeeley SG, Punch M, Kope S, Heaton C. Reproductive health concerns in Down syndrome. A report of eight cases. J Reprod Med 1990;35:745-750.

12. Sheridan R, Llerena J Jr, Matkins S, Debenham P, Cawood

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A, Bobrow M. Fertility in a male with trisomy 21. J Med Genet 1989;26:294-298.

13. Pueschel SM, Sustrova M. General health issues and medical care. In: Pueschel SM, Sustrova M, editors.

Adolescents with Down syndrome: toward a more fulfilling life. Baltimore: Brookes Paul Co; 1997. p. 9-15.

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∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 15-09-2003 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 02-03-2004 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: Ã. ÷Ù˙ËÛ‚·ÛÙÔ‡-§Ô˘Î›‰Ô˘ ∂ÚÁ·ÛÙ‹ÚÈÔ ∫˘ÙÙ·ÚÔÁÂÓÂÙÈ΋˜ ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ∞.¶.£. °.¶.¡. “πÔÎÚ¿ÙÂÈÔ” £ÂÛÛ·ÏÔӛ΢ ∫ˆÓÛÙ·ÓÙÈÓÔ˘fiψ˜ 49, ∆.∫. 546 42, £ÂÛÛ·ÏÔÓ›ÎË

¶·È‰È·ÙÚÈ΋ 2004;67:115-119

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Paediatriki 2004;67:115-119

ORIGINAL ARTICLE

ÃÚ‹ÛË ÎÂÓÙÚÈÎÒÓ Î·ıÂÙ‹ÚˆÓ ·fi ÂÚÈÊÂÚÈ΋ ÊϤ‚· Û ÚfiˆÚ· ÓÂÔÁÓ¿. ∆ÚÔÔÔ›ËÛË Ù˘ ÌÂıfi‰Ô˘ - OÈ ÂÈÏÔΤ˜ ∞. °Ô‡Ó·Ú˘, ∫. ∫ˆÓÛÙ·ÓÙÈÓ›‰Ô˘, ∫. ªËÙÛ¿Î˘, ª. £ÂÔ‰ˆÚ¿ÎË, ¶. ¶·Ó·ÁȈÙÔ˘Ó¿ÎÔ˘, ¡. ∞ÏÂ͛Ԣ

Use of central catheters from a peripheral vein in premature newborn infants.

Method modification - The complications A. Gounaris, C. Konstantinidou, K. Mitsakis, M. Theodoraki, P. Panagiotounakou, N. Alexiou

¶ÂÚ›ÏË„Ë: ∏ ‚ÂÏÙ›ˆÛË Ù˘ ÂÈ‚›ˆÛ˘ ÙˆÓ Ôχ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓÒÓ ¤¯ÂÈ ·˘Í‹ÛÂÈ ÙËÓ ·Ó¿ÁÎË ÁÈ· ÂÓ‰ÔÊϤ‚Ș ÁÚ·Ì̤˜ ¯ÔÚ‹ÁËÛ˘ Ù˘ ·ÚÂÓÙÂÚÈ΋˜ ‰È·ÙÚÔÊ‹˜. OÈ ÂÚÈÊÂÚÈΤ˜ ÊϤ‚˜ ‰ÂÓ ‰È·ÙËÚÔ‡ÓÙ·È ·ÚÎÂÙ¿ Î·È ÔÈ Û˘Ó¯›˜ ·ÏÏ·Á¤˜ ÂËÚ¿˙Ô˘Ó ·ÚÓËÙÈο, ȉȷ›ÙÂÚ· Ù· ÂÍ·ÈÚÂÙÈο ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓ¿. ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë Ù¯ÓÈ΋ ÙÔÔı¤ÙËÛ˘ ÙˆÓ ÎÂÓÙÚÈÎÒÓ Î·ıÂÙ‹ÚˆÓ ·fi ÂÚÈÊÂÚÈ΋ ÊϤ‚· Ô˘ ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÛÙÔ ¡ÂÔÁÓÔÏÔÁÈÎfi ∆Ì‹Ì· ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ, Ë ÔÔ›· Â›Ó·È ·Ú·ÏÏ·Á‹ Ù˘ ‚·ÛÈ΋˜, ηıÒ˜ Î·È Ù· ÛËÌ·ÓÙÈÎfiÙÂÚ· ÚÔ‚Ï‹Ì·Ù·. ™Â 61 ÓÂÔÁÓ¿ Ì ̤ÛÔ ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ (SD) 1110 g (350 g) Î·È Ì¤ÛË ËÏÈΛ· ·ËÛ˘ (SD) 28,7 ‚‰ÔÌ¿‰Â˜ (2,5 ‚‰ÔÌ¿‰Â˜), ÙÔÔıÂÙ‹ıËÎ·Ó 74 ÊÔÚ¤˜ ÎÂÓÙÚÈÎÔ› ηıÂÙ‹Ú˜ ·fi ÂÚÈÊÂÚÈ΋ ÊϤ‚·. ∞fi Ù· ÓÂÔÁÓ¿ ·˘Ù¿, 50 ›¯·Ó ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ <1500 g Î·È 26 ›¯·Ó ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ <1000 g. OÈ Î·ıÂÙ‹Ú˜ ·Ú¤ÌÂÈÓ·Ó ÁÈ· ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· 11,2 ËÌÂÚÒÓ (7,5 Ë̤Ú˜) [̤ÛË ÙÈÌ‹ (SD), ·ÎÚ·›Â˜ ÙÈ̤˜: 3-42 Ë̤Ú˜]. O ηıÂÙ‹Ú·˜ ·Ê·ÈÚ¤ıËΠ14 ÊÔÚ¤˜ ÏfiÁˆ ÂÈÏÔÎÒÓ (ÔÛÔÛÙfi 19%). ™Â 5 ·fi ÙȘ 14 ÂÚÈÙÒÛÂȘ ·Ê·ÈÚ¤ıËΠÁÈ·Ù› ıˆڋıËΠ·›ÙÈÔ ÛË„·ÈÌ›·˜, Û 4 ÏfiÁˆ ·fiÊڷ͢, ÂÓÒ ÛÙȘ ˘fiÏÔÈ˜ 5 ·Ê·ÈÚ¤ıËΠÂÂȉ‹ ˘‹ÚÍ ÂÚÂıÈÛÌfi˜ ηٿ ÙËÓ ÔÚ›· ÙÔ˘ ‹ Ô›‰ËÌ·. O ηıÂÙ‹Ú·˜ ÙÔÔıÂÙ‹ıËΠ33 ÊÔÚ¤˜ ÛÙȘ ‚·ÛÈÏÈΤ˜ ÊϤ‚˜, 12 ÊÔÚ¤˜ ÛÙȘ Ì·Û¯·ÏÈ·›Â˜, 8 ÊÔÚ¤˜ ÛÙȘ ÂÏ¿ÛÛÔÓ˜ Û·ÊËÓ›˜, 9 ÛÙȘ Ì›˙ÔÓ˜ Û·ÊËÓ›˜, 10 ÛÙȘ ÊϤ‚˜ ÙÔ˘ ‹¯Âˆ˜ Î·È ·fi Ì›· ÊÔÚ¿ ÛÙËÓ ¤Íˆ ÛÊ·Á›Ùȉ· Î·È ÙËÓ Ô›ÛıÈ· ˆÙÈ·›· ÊϤ‚·. ¢ÂÓ ·ÚÔ˘ÛÈ¿ÛÙËÎ·Ó ÂÈÏÔΤ˜ ÛÙȘ 12 ÊÔÚ¤˜ Ô˘ ÙÔÔıÂÙ‹ıËΠ̷۠ۯ·ÏÈ·›· ÊϤ‚·. O ÎÂÓÙÚÈÎfi˜ ηıÂÙ‹Ú·˜ ·fi ÂÚÈÊÂÚÈ΋ ÊϤ‚· Â›Ó·È ˆÊ¤ÏÈÌÔ˜ Î·È Ú¤ÂÈ Ó· ¯ÚËÛÈÌÔÔÈ›ٷÈ, ȉȷ›ÙÂÚ· ÛÙË ÓÔÛËÏ›· ÙˆÓ

Abstract: The improvement in perinatal mortality rates among very low birth weight (BW) newborn infants has increased the need for intravenous lines for parenteral nutrition. Peripheral veins are not stable enough to be used for more than a few days, and frequent attempts to find a new vein are stressful, particularly for the extremely low BW newborn infants. A technique of long line insertion is described, which is a variation on the usual long line procedure. Long lines were placed a total of 74 times in 61 newborn infants with an average BW of 1110 g (SD 350 g) and an average gestational age of 28.7 weeks (SD 2.5 weeks). Of these infants, 50 had BW <1500 g and 26 had BW <1000 g. The catheters remained in place for an average of 11.2 days (SD 7.5 days, range 3-42 days). The catheter was removed in 14 occasions due to complications (19%); in 5 of these cases because it was a possible cause of septicaemia, in 4 cases because it was occluded and in the remaining 5 because of redness or swelling along the catheter route. The catheter was placed 33 times in the basilic vein, 12 times in the axillary vein, 8 times in the minor saphenous and 9 in the major saphenous veins, 10 times in the veins of the forearm and once each in the external jugular and the posterior auricular veins. In the 12 cases where the catheter was placed in the axillary vein there were no associated complications. A central catheter from a peripheral vein is beneficial and should be used, especially in the care of very low and extremely low BW newborn infants.

¡ÂÔÁÓÔÏÔÁÈÎfi ∆Ì‹Ì·, °.¡. ¡›Î·È·˜ “ÕÁÈÔ˜ ¶·ÓÙÂÏ‹̈Ӕ, ¶ÂÈÚ·È¿˜

Department of Neonatology, “Aghios Panteleimon” General Hospital, Nikaia, Piraeus

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Paediatriki 2004;67:115-119

Ôχ ¯·ÌËÏÔ‡ Î·È ÂÍ·ÈÚÂÙÈο ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓÒÓ. §¤ÍÂȘ ÎÏÂȉȿ: ·ÚÂÓÙÂÚÈ΋ ‰È·ÙÚÔÊ‹, ÎÂÓÙÚÈÎfi˜ ηıÂÙ‹Ú·˜, Ôχ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓfi.

Key words: parenteral nutrition, central catheter, very low birth weight newborn.

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ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ

¶Ãµ° ∂õ° ∫∫¶º µ° ∏∫ ™∞¢ ƒ°∫ ™°∫

¶Ôχ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ∂Í·ÈÚÂÙÈο ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ∫ÂÓÙÚÈÎfi˜ ηıÂÙ‹Ú·˜ ·fi ÂÚÈÊÂÚÈ΋ ÊϤ‚· µ¿ÚÔ˜ Á¤ÓÓËÛ˘ ∏ÏÈΛ· ·ËÛ˘ ™‡Ó‰ÚÔÌÔ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜ ƒÈÓÔÁ·ÛÙÚÈÎfi˜ ηıÂÙ‹Ú·˜ ™ÙÔÌ·ÙÔÁ·ÛÙÚÈÎfi˜ ηıÂÙ‹Ú·˜

∂ÈÛ·ÁˆÁ‹ ∏ ÛËÌ·ÓÙÈ΋ ‚ÂÏÙ›ˆÛË Ù˘ ÂÈ‚›ˆÛ˘ ÙˆÓ ÓÂÔÁÓÒÓ Î·È È‰È·›ÙÂÚ· ÙˆÓ Ôχ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ (¶Ãµ°) (1) Î·È ÛÙË ¯ÒÚ· Ì·˜, ηıÈÛÙ¿ ·Ó·Áη›· ÙËÓ ‡·ÚÍË ÂÓ‰ÔÊϤ‚ÈˆÓ ÁÚ·ÌÌÒÓ ¯ÔÚ‹ÁËÛ˘ ·ÚÂÓÙÂÚÈÎÒÓ ‰È·Ï˘Ì¿ÙˆÓ ÁÈ· Ì·ÎÚfi ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·, ÁÂÁÔÓfi˜ Ô˘ Û˘¯Ó¿ ·ÔÙÂÏ› ÙÔ ÛËÌ·ÓÙÈÎfiÙÂÚÔ Úfi‚ÏËÌ· ÛÙË ÓÔÛËÏ›· ÂÓfi˜ ¿ÚÚˆÛÙÔ˘ ÓÂÔÁÓÔ‡. ∏ ·ÚfiÛÎÔÙË ¯ÔÚ‹ÁËÛË ÂÓ‰ÔÊϤ‚ÈˆÓ ˘ÁÚÒÓ Î·È ÂȉÈο Ù˘ ÔÏÈ΋˜ ·ÚÂÓÙÂÚÈ΋˜ ‰È·ÙÚÔÊ‹˜ Â›Ó·È ··Ú·›ÙËÙË, ÒÛÙ ÙÔ ÓÂÔÁÓfi Ó· ·Ó·Ù˘¯ı› Ì ÙÔ˘˜ ·Ó·Áη›Ô˘˜ (ÂÓ‰ÔÌ‹ÙÚÈÔ˘˜) Ú˘ıÌÔ‡˜ ·Ó¿Ù˘Í˘ (2), ÛÙÔÈ¯Â›Ô Ô˘ Â›Ó·È ÛËÌ·ÓÙÈÎfi Î·È ÌÔÚ› Ó· ÂËÚ¿ÛÂÈ ÙËÓ fi„ÈÌË ÚfiÁÓˆÛË. ∏ ¯Ú‹ÛË Î·ıÂÙ‹ÚˆÓ Broviac ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙ› Ì ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· ÂÈÏÔÎÒÓ (ıÚÔÌ‚ÒÛÂȘ, ÏÔÈÌÒÍÂȘ) (3,4). OÈ Û˘¯Ó¤˜ ÙÔÔıÂÙ‹ÛÂȘ ÊÏ‚ÔηıÂÙ‹ÚˆÓ ‰ËÌÈÔ˘ÚÁÔ‡Ó È·ÙÚÔÁÂÓ¤˜ stress (5) Î·È ·Ó·ÙÚ¤Ô˘Ó ÙËÓ ÔÏÈÙÈ΋ ÂÏ¿¯ÈÛÙ˘ ·ÚÂÓfi¯ÏËÛ˘ Ô˘ Ú¤ÂÈ Ó· ·ÎÔÏÔ˘ı›ٷÈ, ÂȉÈο ÛÙ· ÂÍ·ÈÚÂÙÈο ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓ¿. ∏ ¯Ú‹ÛË ÎÂÓÙÚÈÎÒÓ Î·ıÂÙ‹ÚˆÓ ·fi ÂÚÈÊÂÚÈ΋ ÊϤ‚· (∫∫¶º), Ô˘ ·Ú¯Èο ¯ÚËÛÈÌÔÔÈ‹ıËΠ·fi ÙÔÓ Shaw ÛÙȘ ·Ú¯¤˜ Ù˘ ‰ÂηÂÙ›·˜ ÙÔ˘ ’70 (6), Ê·›ÓÂÙ·È Ó· ÂÏ·ÙÙÒÓÂÈ ÛËÌ·ÓÙÈο ÙȘ ÂÈÏÔΤ˜, Û‡Ìʈӷ Ì ÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›·, Û ۯ¤ÛË Ì ÙÔ˘˜ ¿ÏÏÔ˘˜ ·Ó·ÊÂÚfiÌÂÓÔ˘˜ ÙÚfiÔ˘˜ ¯ÔÚ‹ÁËÛ˘ ·ÚÂÓÙÂÚÈÎÒÓ ‰È·Ï˘Ì¿ÙˆÓ (7). ™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÂÚÁ·Û›·˜ Â›Ó·È Ó· ÂÚÈÁÚ¿„ÂÈ ÙËÓ Ù¯ÓÈ΋ ÙÔÔı¤ÙËÛ˘ ÙÔ˘ ∫∫¶º, Ë ÔÔ›· ·ÔÙÂÏ› Ì›· ·Ú·ÏÏ·Á‹ Ù˘ ÚÔÙÂÈÓfiÌÂÓ˘ ·fi ÙÔ˘˜ ηٷÛ΢·ÛÙ¤˜ ÙˆÓ Î·ıÂÙ‹ÚˆÓ, ηıÒ˜ Î·È ÙȘ ÂÈÏÔΤ˜ Î·È ÙË Û˘¯ÓfiÙËÙ¿ ÙÔ˘˜ ÛÙ· ÓÂÔÁÓ¿ Ù˘ Û˘ÁÎÂÎÚÈ̤Ó˘ ÌÂϤÙ˘ Û ۯ¤ÛË Ì ¿ÏϘ ÂÚÁ·Û›Â˜.

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∫·Ù¿ Ù· ¤ÙË 2000-2001, ÙÔÔıÂÙ‹ıËΠ∫∫¶º Û 61 ÓÂÔÁÓ¿ Ô˘ ÓÔÛËχÙËÎ·Ó ÛÙÔ ¡ÂÔÁÓÔÏÔÁÈÎfi ∆Ì‹Ì· ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ ÁÈ· ‰È¿ÊÔÚ˜ ·Èٛ˜ Î·È Î˘Ú›ˆ˜ ÁÈ· ™∞¢. ∆· ÓÂÔÁÓ¿ ·˘Ù¿ ›¯·Ó ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ (µ°) 1110 g [̤ÛË ÙÈÌ‹ (SD): 350 g] Î·È ËÏÈΛ· ·ËÛ˘ (∏∫) 28,7 ‚‰ÔÌ¿‰Â˜ (SD: 2,5 ‚‰ÔÌ¿‰Â˜). ∞fi ·˘Ù¿, 50 ›¯·Ó µ° <1500 g Î·È 26 ›¯·Ó µ° <1000 g. ™Â 9 ÓÂÔÁÓ¿ ¯ÚÂÈ¿ÛÙËΠӷ ÙÔÔıÂÙËı› Î·È ‰Â‡ÙÂÚË ÊÔÚ¿ ∫∫¶º ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÓÔÛËÏ›·˜ ÙÔ˘˜, ÂÓÒ Û ‰‡Ô ÓÂÔÁÓ¿ ÙÚÂȘ ÊÔÚ¤˜. ŒÙÛÈ, ÛÙ· ÓÂÔÁÓ¿ ÙÔÔıÂÙ‹ıËÎÂ Û˘ÓÔÏÈο 74 ÊÔÚ¤˜ ηıÂÙ‹Ú·˜. ∫ÚÈÙ‹ÚÈÔ ÁÈ· ÙËÓ ÙÔÔı¤ÙËÛË ∫∫¶º ‹Ù·Ó Ë ·Ó¿ÁÎË ÁÈ· ·ÚÂÓÙÂÚÈ΋ ¯ÔÚ‹ÁËÛË ˘ÁÚÒÓ ÁÈ· ÂÚÈÛÛfiÙÂÚÔ ·fi Ì›· ‚‰ÔÌ¿‰·, Ë ·ÔÙ˘¯›· Ù˘ ÙÔÔı¤ÙËÛ˘ ÔÌÊ·ÏÈÎÔ‡ ÊÏ‚ÈÎÔ‡ ηıÂÙ‹Ú· ÛÙËÓ Î¿Ùˆ ÎÔ›ÏË ÊϤ‚· ‹ ÔÈ ÂÚÈÙÒÛÂȘ Ô˘, ÁÈ· ‰È¿ÊÔÚÔ˘˜ ÏfiÁÔ˘˜, ›¯Â ·Ê·ÈÚÂı› Ô ÔÌÊ·ÏÈÎfi˜ ÊÏ‚ÈÎfi˜ ηıÂÙ‹Ú·˜. ∆¯ÓÈ΋ ÙÔÔı¤ÙËÛ˘ ∫·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÂÓfi˜ ÓÂÔÁÓÔ‡, ÙÔ ÔÔ›Ô Â›Ó·È ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙÔÔı¤ÙËÛË ∫∫¶º, ÙÔ ÚÔÛˆÈÎfi ÙÔ˘ ÙÌ‹Ì·ÙÔ˜ Ú¤ÂÈ Ó· ÊÚÔÓÙ›˙ÂÈ Ó· ̤ÓÂÈ ¿ıÈÎÙË Ì›· ÙÔ˘Ï¿¯ÈÛÙÔÓ ÊϤ‚·, ·fi ÊÏ‚ÔΤÓÙËÛË ÁÈ· ·ÈÌÔÏË„›· ‹ ¯ÔÚ‹ÁËÛË ÔÚÔ‡. ™˘Ó‹ıˆ˜ ̤ÓÂÈ ¿ıÈÎÙË Ì›· ·fi ÙȘ ‚·ÛÈÏÈΤ˜ ÊϤ‚˜, Ë ÔÔ›· ÛÙË Û˘Ó¤¯ÂÈ· ı· ¯ÚËÛÈÌÔÔÈËı› ÁÈ· ÙËÓ ÙÔÔı¤ÙËÛË, Ì ÂÚÈÛÛfiÙÂÚ˜ Èı·ÓfiÙËÙ˜ ÂÈÙ˘¯›·˜, ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ ηıÂÙ‹Ú·. ∏ ÙÔÔı¤ÙËÛË ÙÔ˘ ∫∫¶º Á›ÓÂÙ·È Î¿Ùˆ ·fi ¿ÛËÙ˜ Û˘Óı‹Î˜, ÛÙË ıÂÚÌÔÎÔÈÙ›‰· Î·È ÌfiÓÔ ·fi ÙÔ ÂȉÈÎÂ˘Ì¤ÓÔ Ì ÙË Ì¤ıÔ‰Ô È·ÙÚÈÎfi Î·È ÓÔÛËÏ¢ÙÈÎfi ÚÔÛˆÈÎfi. ™ÙÔ ∆Ì‹Ì· Ì·˜ ÁÓˆÚ›˙Ô˘Ó ÙËÓ Ù¯ÓÈ΋ ÙÔÔı¤ÙËÛ˘ ¿ÓÙ· ÂÚÈÛÛfiÙÂÚ· ·fi ¤ÓÙ ¿ÙÔÌ·. ÃÚËÛÈÌÔÔÈÂ›Ù·È Ô ·ÎÙÈÓÔÛÎÈÂÚfi˜ ηıÂÙ‹Ú·˜ Nutriline Ù˘ ÂÙ·ÈÚ›·˜ Vygon Ì ‰È¿ÌÂÙÚÔ 2 F Î·È Ì‹ÎÔ˜ 300 mm Ô˘ ʤÚÂÈ ‰È·ÁÚ¿ÌÌÈÛË ·Ó¿ 50 mm. ™ÙË Û˘Û΢·Û›· ˘¿Ú¯ÂÈ ÂȉÈ΋ ·ÔÛÒÌÂÓË ÂÙ·ÏÔ‡‰· 20 G, Ë ÔÔ›· ϤÔÓ ‰ÂÓ ¯ÚËÛÈÌÔÔÈ›ٷÈ, ηıÒ˜ fiÙ·Ó ·Ú¯Èο ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ, ‰È·ÈÛÙÒıËΠfiÙÈ ÚÔηÏÔ‡Û ¤ÓÙÔÓÔ ÙÚ·˘Ì·ÙÈÛÌfi ÙˆÓ ÈÛÙÒÓ ÙÔÈο Ì ·ÈÌÔÚÚ·Á›· Î·È ‰˘ÛÎÔÏ›· ÛÙËÓ ÙÔÔı¤ÙËÛË. ∏ ‰È·ÊÔÚ¿ Ù˘ ÌÂıfi‰Ô˘ Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È Û ۯ¤ÛË Ì ÙȘ Ô‰ËÁ›Â˜ ÙÔ˘ ηٷÛ΢·ÛÙ‹ Û˘Ó›ÛÙ·Ù·È ÛÙË ¯ÚËÛÈÌÔÔ›ËÛË, ·ÓÙ› Ù˘ ÂȉÈ΋˜ ÂÙ·ÏÔ‡‰·˜, ÎÔÈÓÔ‡ ÊÏ‚ÔηıÂÙ‹Ú· ›‰ÈÔ˘ ÌÂÁ¤ıÔ˘˜ (20 G), Ô ÔÔ›Ô˜ Ú·ÎÙÈο ‰ËÌÈÔ˘ÚÁ› ÏÈÁfiÙÂÚ· ÚÔ‚Ï‹Ì·Ù· ÙÔÈο Î·È ‚ÂÏÙÈÒÓÂÈ ÙÔ ÔÛÔÛÙfi ÂÈÙ˘¯Ô‡˜ ÙÔÔı¤ÙËÛ˘. ∞Ú¯Èο, ÌÂÙÚ¿Ù·È Ë ·fiÛÙ·ÛË ·fi ÙÔ ÛËÌÂ›Ô ÂÈÛfi‰Ô˘ ÙÔ˘ ηıÂÙ‹Ú· ¤ˆ˜ ÙÔÓ ‰ÂÍÈfi ÎfiÏÔ. ∫¿Ùˆ ·fi ¿ÛËÙ˜ Û˘Óı‹Î˜ (‰ËÌÈÔ˘ÚÁ›· ·ÔÛÙÂÈڈ̤ÓÔ˘ ‰›Ô˘ - ηı·ÚÈÛÌfi˜ ‰¤ÚÌ·ÙÔ˜ Ì ‰È¿Ï˘Ì· Betadine Î·È ·ÎÔÏÔ‡ıˆ˜ Ì ÔÈÓfiÓÂ˘Ì·), Á›ÓÂÙ·È ·Ú·Î¤ÓÙËÛË Ù˘ ÂÚÈÊÂÚÈ΋˜ ÊϤ‚·˜ ÌÂ

¶·È‰È·ÙÚÈ΋ 2004;67:115-119

ÙÔÓ ÊÏ‚ÔηıÂÙ‹Ú·. ªÂÙ¿ ·fi ÙËÓ ÂÈÙ˘¯‹ ÊÏ‚ÔΤÓÙËÛË, ·Ê·ÈÚÂ›Ù·È Ë ‚ÂÏfiÓ· ÚÔÛÂÎÙÈο, ÂϤÁ¯ÂÙ·È Ë ‚·ÙfiÙËÙ· Ù˘ ÊϤ‚·˜ Ì Ë·ÚÈÓÈṲ̂ÓÔ ÔÚfi Î·È Îfi‚ÂÙ·È ÚÔÛÂÎÙÈο Ì ¤Ó· Ó˘ÛÙ¤ÚÈ Ô ÛˆÏ‹Ó·˜ ÙÔ˘ ÊÏ‚ÔηıÂÙ‹Ú·, Ô˘ ‚Ú›ÛÎÂÙ·È ¤Íˆ ·fi ÙÔ ‰¤ÚÌ·, ÛÙÔ ‡„Ô˜ ÙÔ˘ ÛÙÔÌ›Ô˘ (Beck). ÃÚËÛÈÌÔÔÈÒÓÙ·˜ ÙÔÓ ÛˆÏ‹Ó· Û·Ó Ô‰ËÁfi, ÚÔˆıÂ›Ù·È Ì ‹Ș ÎÈÓ‹ÛÂȘ Ô ÎÂÓÙÚÈÎfi˜ ηıÂÙ‹Ú·˜ ̤¯ÚÈ ÙÔ ÛËÌÂ›Ô Ô˘ ¤¯ÂÈ ÌÂÙÚËı› (+12 cm). ∞ÊÔ‡ ÙÔÔıÂÙËı› Ô ÎÂÓÙÚÈÎfi˜ ηıÂÙ‹Ú·˜ ÛÙËÓ Î·Ù¿ÏÏËÏË ı¤ÛË, ·ÔÌ·ÎÚ‡ÓÂÙ·È ÚÔÛÂÎÙÈο Ô ÛˆÏ‹Ó·˜ ÙÔ˘ ÊÏ‚ÔηıÂÙ‹Ú· ·fi ÙË ÊϤ‚· ηÈ, ·ÊÔ‡ ηı·ÚÈÛÙ› ¿ÏÈ ÙÔ ÛËÌÂ›Ô Ì Betadine, ηχÙÂÙ·È Ì ‰È·Ê·Ó‹ ÌÂÌ‚Ú¿ÓË (Tegaderm), ÒÛÙ ӷ Â›Ó·È ‰˘Ó·Ù‹ Ë ·Ú·ÎÔÏÔ‡ıËÛË Ù˘ ÂÚÈÔ¯‹˜. ™Â ÂÚ›ÙˆÛË ‰˘ÛÎÔÏ›·˜ ηٿ ÙËÓ ÚÔÒıËÛË, Èı·ÓÔÏÔÁÂ›Ù·È ‚Ï¿‚Ë ÛÙË ÛÙÂÁ·ÓfiÙËÙ· ÙÔ˘ ÊÏ‚ÈÎÔ‡ ÙÔȯÒÌ·ÙÔ˜ Î·È Á›ÓÂÙ·È ÚÔÛ¿ıÂÈ· Û ¿ÏÏË ÊϤ‚·. O ∫∫¶º Û˘Ó‰¤ÂÙ·È Ì ¤Ó· 3-way Î·È Ë·ÚÈÓ›˙ÂÙ·È. ∏ ÛˆÛÙ‹ ı¤ÛË ÙÔ˘ ÂϤÁ¯ÂÙ·È Ì ·ÎÙÈÓÔÁÚ·Ê›·. °›ÓÂÙ·È Î·ıËÌÂÚÈÓfi˜ ¤ÏÂÁ¯Ô˜ ÙÔ˘ ÛËÌ›Ԣ ÂÈÛfi‰Ô˘ Î·È ·ÏÏ·Á‹ ÙˆÓ Û˘Ó‰¤ÛˆÓ, ÂÓÒ Ë ‰È·Ê·Ó‹˜ ÌÂÌ‚Ú¿ÓË ·ÓÙÈηı›ÛÙ·Ù·È ÌfiÓÔ Â¿Ó ÍÂÎÔÏÏ‹ÛÂÈ (Û˘Ó‹ıˆ˜ Ì›· ÊÔÚ¿ ÙËÓ Â‚‰ÔÌ¿‰·). ∏ ηıËÌÂÚÈÓ‹ ·Ú·ÎÔÏÔ‡ıËÛË Ú¤ÂÈ Ó· Á›ÓÂÙ·È ·fi ¤ÌÂÈÚÔ ÁÓÒÛÙË Ù˘ Ù¯ÓÈ΋˜ ÙÔÔı¤ÙËÛ˘.

OÈ Û˘Ó‹ıÂȘ ı¤ÛÂȘ ÙÔÔı¤ÙËÛ˘ ÙÔ˘ ηıÂÙ‹Ú· Â›Ó·È ÔÈ ÊϤ‚˜ ÛÙ· ¿Óˆ ¿ÎÚ· (‚·ÛÈÏÈΤ˜, Ì·Û¯·ÏÈ·›Â˜, ÊϤ‚˜ ÙÔ˘ ‹¯Ë Î.Ï.), Ù· οو ¿ÎÚ· (Ë Ì›˙ˆÓ Û·ÊËÓ‹˜ ÛÙÔ ‡„Ô˜ ÙÔ˘ ¤Ûˆ ÛÊ˘ÚÔ‡, Ë ÂÏ¿ÛÛˆÓ Û·ÊËÓ‹˜ ÛÙÔ ‡„Ô˜ Ù˘ ÈÁÓ‡Ô˜) ηÈ, Û·ÓÈfiÙÂÚ·, Ë ¤Íˆ ÛÊ·Á›Ùȉ· Î·È Ë Ô›ÛıÈ· ˆÙÈ·›·. ∏ ÚÔÙÈÌÒÌÂÓË ı¤ÛË ÙÔ˘ ¿ÎÚÔ˘ ÙÔ˘ ηıÂÙ‹Ú· Â›Ó·È Ë ¿Óˆ Î·È Ë Î¿Ùˆ ÎÔ›ÏË ÊϤ‚· Î·È Ô ‰ÂÍÈfi˜ ÎfiÏÔ˜, ÂÓÒ Â›Ó·È ·ÓÂÎÙ‹ Î·È Ë ÙÔÔı¤ÙËÛË ÛÙÔÓ ıÒڷη ÌÂٷ͇ Ù˘ Ì·Û¯·ÏÈ·›·˜ Î·È Ù˘ ¿Óˆ ÎÔ›Ï˘. ∞fi ÙÔÓ ∫∫¶º ¯ÔÚËÁÂ›Ù·È Ë ·ÚÂÓÙÂÚÈ΋ ‰È·ÙÚÔÊ‹ (·ÌÈÓÔͤ·, Ï›Ô˜, ÁÏ˘Îfi˙Ë) Î·È Ù· Ê¿Ú̷η ˆ˜ ¿ÌÂÛË ¯ÔÚ‹ÁËÛË ‹ Û˘Ó¯‹˜ ¤Á¯˘ÛË. °È· ÙË ¯ÔÚ‹ÁËÛË ·›Ì·ÙÔ˜ ‹ ·Ú·ÁÒÁˆÓ ÙÔ˘ ¯ÚËÛÈÌÔÔÈÂ›Ù·È ¿ÏÏË ÂÚÈÊÂÚÈ΋ ÊϤ‚·. ∫·ÏÏȤÚÁÂȘ ·›Ì·ÙÔ˜ Ï·Ì‚¿ÓÔÓÙ·È Û ٷÎÙÈο ¯ÚÔÓÈο ‰È·ÛÙ‹Ì·Ù·, ÂÓÒ fiÙ·Ó Ô Î·ıÂÙ‹Ú·˜ ·Ê·ÈÚÂı›, Ë ¿ÎÚË ÙÔ˘ ·ÔÛÙ¤ÏÏÂÙ·È ÁÈ· ηÏÏȤÚÁÂÈ·. ∆· ÓÂÔÁÓ¿ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó ÛÙËÓ ·ÚÔ‡Û· ÂÚÁ·Û›· ¿Ú¯È˙·Ó ÂÏ¿¯ÈÛÙË ÂÓÙÂÚÈ΋ Û›ÙÈÛË Ì ƒ°∫ ‹ Ì ™°∫ ̤۷ ÛÙËÓ ÚÒÙË Â‚‰ÔÌ¿‰· ˙ˆ‹˜ Î·È ÌÂÙ¿ ·fi 3-6 Ë̤Ú˜ ÂÏ¿¯ÈÛÙ˘ ‰È·ÙÚÔÊ‹˜, ÙÔ Á¿Ï· ·˘Í·ÓfiÙ·Ó ÚÔԉ¢ÙÈο Û ÔÛfiÙËÙ· ¤ˆ˜ 24 ml/kg/Ë̤ڷ, ÒÛÙ ÌÂÙ¿ ·fi ÂÚ›Ô˘ Ì›· ‚‰ÔÌ¿‰· ÙÔ ÓÂÔÁÓfi Ó· Â›Ó·È Û Ï‹ÚË ÂÓÙÂÚÈ΋ Û›ÙÈÛË.

∞ÔÙÂϤÛÌ·Ù· ™Â 61 ·fi Ù· ÓÂÔÁÓ¿ Ô˘ ÓÔÛËχÙËÎ·Ó ÛÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ ÙÌ‹Ì· ÙÔÔıÂÙ‹ıËÎ·Ó 74 ηıÂÙ‹Ú˜ Û ‰È¿ÊÔÚ˜ ı¤ÛÂȘ. ∏ ̤ÛË ‰È¿ÚÎÂÈ· ·Ú·ÌÔÓ‹˜ (SD) ÙÔ˘ ∫∫¶º ‹Ù·Ó 11,2 (7,5) Ë̤Ú˜ Ì ·ÎÚ·›Â˜ ÙÈ̤˜ 3-42. ™Ù· 26 ÓÂÔÁÓ¿ Ì B° <1000 g Ë Ì¤ÛË ‰È¿ÚÎÂÈ· ·Ú·ÌÔÓ‹˜ (SD) ‹Ù·Ó 12,5 (7,4) Ë̤Ú˜ Ì ·ÎÚ·›Â˜ ÙÈ̤˜ 3-42, ÛÙ· 24 ÓÂÔÁÓ¿ Ì µ° 10001500 g ‹Ù·Ó 10 (7,9) Ë̤Ú˜ Ì ·ÎÚ·›Â˜ ÙÈ̤˜ 3-23, ÂÓÒ ÛÙ· 11 ÓÂÔÁÓ¿ Ì µ° 1500-2000 g ‹Ù·Ó 8,7 (5)

Paediatriki 2004;67:115-119

Ë̤Ú˜ Ì ·ÎÚ·›Â˜ ÙÈ̤˜ 6-14. ∏ ·Ú¯È΋ ÙÔÔı¤ÙËÛË ‹Ù·Ó ÂÈÙ˘¯‹˜ Û 70 ÂÚÈÙÒÛÂȘ (ÔÛÔÛÙfi 94,6%). À‹ÚÍ·Ó 4 ı¿Ó·ÙÔÈ, ·ÏÏ¿ ηӤӷ˜ ‰ÂÓ ‹Ù·Ó ·ÔÙ¤ÏÂÛÌ· ÂÈÏÔÎÒÓ ÙˆÓ Î·ıÂÙ‹ÚˆÓ.

O ηıÂÙ‹Ú·˜ ·Ê·ÈÚ¤ıËΠ14 ÊÔÚ¤˜ ÏfiÁˆ ÂÈÏÔÎÒÓ (19%), ÂÓÒ ÛÙȘ ˘fiÏÔÈ˜ 60 ÂÚÈÙÒÛÂȘ (81%) Ô Î·ıÂÙ‹Ú·˜ ·Ê·ÈÚ¤ıËΠÁÈ·Ù› ‰ÈÂÎfiË Ë ·ÚÂÓÙÂÚÈ΋ ‰È·ÙÚÔÊ‹ ‹ η٤ÏËÍÂ Ô ·ÛıÂÓ‹˜. ™Â 5 ·fi ÙȘ 14 ÂÚÈÙÒÛÂȘ, Ô Î·ıÂÙ‹Ú·˜ ·Ê·ÈÚ¤ıËΠÂÂȉ‹ ıˆڋıËΠfiÙÈ Ë ÛË„·ÈÌ›· Ô˘ ‰È·ÁÓÒÛÙËΠÈı·ÓfiÓ Ó· ÔÊÂÈÏfiÙ·Ó Û ·˘ÙfiÓ. ™Â 4 ÂÚÈÙÒÛÂȘ, Ô Î·ıÂÙ‹Ú·˜ ·Ê·ÈÚ¤ıËΠÏfiÁˆ ·fiÊڷ͢, ÂÓÒ ÛÙȘ ˘fiÏÔÈ˜ 5 ·Ê·ÈÚ¤ıËΠÂÂȉ‹ ˘‹ÚÍ ÙÔÈÎfi˜ ÂÚÂıÈÛÌfi˜ ηٿ ÙËÓ ÔÚ›· ÙÔ˘ ‹ Ô›‰ËÌ· (¶›Ó·Î·˜ 1). ™ÙȘ ıÂÙÈΤ˜ ηÏÏȤÚÁÂȘ ·ÔÌÔÓÒıËÎ·Ó Ù· ·Ú·Î¿Ùˆ ÌÈÎÚfi‚È·: St. Epidermidis, Klebsiella Û ÙÚÂȘ ÂÚÈÙÒÛÂȘ Î·È Acinetobacter. ™ÙȘ ‰‡Ô ÂÚÈÙÒÛÂȘ ıÂÙÈ΋˜ ηÏÏȤÚÁÂÈ·˜ ·fi Klebsiella, ·ÔÌÔÓÒıËΠÙÔ ›‰ÈÔ ÌÈÎÚfi‚ÈÔ Î·È ÛÙËÓ Î·ÏÏȤÚÁÂÈ· ·›Ì·ÙÔ˜. O ηıÂÙ‹Ú·˜ ÙÔÔıÂÙ‹ıËΠ33 ÊÔÚ¤˜ ÛÙȘ ‚·ÛÈÏÈΤ˜ ÊϤ‚˜ (44,5%), 12 ÊÔÚ¤˜ ÛÙȘ Ì·Û¯·ÏÈ·›Â˜ (16,2%), 8 ÊÔÚ¤˜ ÛÙȘ ÂÏ¿ÛÛÔÓ˜ Û·ÊËÓ›˜ (10,8%), 9 ÊÔÚ¤˜ ÛÙȘ Ì›˙ÔÓ˜ Û·ÊËÓ›˜ (12,1%), 10 ÊÔÚ¤˜ ÛÙȘ ÊϤ‚˜ ÙÔ˘ ‹¯Ë (13,5%) Î·È ·fi Ì›· ÊÔÚ¿ ÛÙË ¤Íˆ ÛÊ·Á›Ùȉ· Î·È ÙËÓ Ô›ÛıÈ· ˆÙÈ·›· ÊϤ‚·. ™ÙȘ 12 ÂÚÈÙÒÛÂȘ Ô˘ Ô Î·ıÂÙ‹Ú·˜ ÙÔÔıÂÙ‹ıËΠÛÙË Ì·Û¯·ÏÈ·›· ÊϤ‚·, ‰ÂÓ ·ÚÔ˘ÛÈ¿ÛÙËÎ·Ó ÂÈÏÔΤ˜ Î·È ·Ê·ÈÚ¤ıËΠÌfiÓÔ fiÙ·Ó ‰ÂÓ ‹Ù·Ó È· ·Ó·Áη›Ô˜. ™˘˙‹ÙËÛË O ‰È·‰ÂÚÌÈÎfi˜ ÎÂÓÙÚÈÎfi˜ ηıÂÙ‹Ú·˜ ·fi ÂÚÈÊÂÚÈ΋ ÊϤ‚· Â›Ó·È Ì›· ̤ıÔ‰Ô˜ Ô˘ ¯ÚËÛÈÌÔÔÈÂ›Ù·È ‰ÈÂıÓÒ˜ Â˘Ú‡Ù·Ù· ÛÙ· ¡ÂÔÁÓÔÏÔÁÈο ∆Ì‹Ì·Ù·, ÁÈ· ÂÚÈÛÛfiÙÂÚÔ ·fi 25 ¯ÚfiÓÈ·. ∏ ÚÒÙË ÂÚÈÁÚ·Ê‹ ¤ÁÈÓ ·fi ÙÔÓ Shaw, ÙÔ 1973 (6). ŒÎÙÔÙÂ, ¤¯Ô˘Ó ‰ËÌÔÛÈ¢Ù› ·ÚÎÂÙ¤˜ ÂÚÁ·Û›Â˜ fiÔ˘ Ë ˆÊ¤ÏÂÈ· Ù˘ ÌÂıfi‰Ô˘ Â›Ó·È ÂÌÊ·Ó‹˜ Û ۯ¤ÛË Ì ÙË ¯ÂÈÚÔ˘ÚÁÈ΋ ÙÔÔı¤ÙËÛË Broviac ηıÂÙ‹ÚˆÓ Û ÚfiˆÚ· ÓÂÔÁÓ¿ (2,3). ¶ÚfiÛÊ·Ù˜ ‰ËÌÔÛȇÛÂȘ ¤¯Ô˘Ó ÂȂ‚·ÈÒÛÂÈ ÙËÓ Â˘ÎÔÏfiÙÂÚË ¯ÔÚ‹ÁËÛË Ù˘ ·ÚÂÓÙÂÚÈ΋˜ ‰È·ÙÚÔÊ‹˜ Ì ∫∫¶º Û ۯ¤ÛË Ì ÂÚÈÊÂÚÈÎÔ‡˜ ÊÏ‚ÔηıÂÙ‹Ú˜ (8). ª¿ÏÈÛÙ·, Û ∂õ° ÂÎÙfi˜ ·fi ÙË ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙË Û˘¯ÓfiÙËÙ· ÙˆÓ ÏÔÈÌÒÍÂˆÓ ‚Ú¤ıËΠÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ Î·È ÛÙË ıÓËÛÈÌfiÙËÙ· (9). ™ÙÔ ÙÌ‹Ì· Ô˘ ‰ÈÂÓÂÚÁ‹ıËÎÂ Ë ·ÚÔ‡Û· ÌÂϤÙË, Ë ÂÌÂÈÚ›· ·fi ÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘ ÌÂıfi‰Ô˘ ¶›Ó·Î·˜ 1. ∞›ÙÈ· ·Ê·›ÚÂÛ˘ ηıÂÙ‹Ú· Ÿ¯È ·Ó·Áη›Ô˜ ∂ÈÏÔΤ˜ ∞fiÊÚ·ÍË §Ô›ÌˆÍË ∂Ú˘ıÚfiÙËÙ·-Ô›‰ËÌ·

60 (81%) 14 (19%) 4 (5,4%) 5 (6,7%) 5 (6,7%)

117

¶·È‰È·ÙÚÈ΋ 2004;67:115-119

Â›Ó·È È‰È·›ÙÂÚ· ıÂÙÈ΋. ∏ ¯Ú‹ÛË ÙÔ˘ ∫∫¶º ‚Ô‹ıËÛ ÛÙËÓ ÔÌ·Ï‹ ¯ÔÚ‹ÁËÛË Ù˘ ·ÚÂÓÙÂÚÈ΋˜ ‰È·ÙÚÔÊ‹˜ Î·È Ì›ˆÛ ÛËÌ·ÓÙÈο ÙÔÓ ·ÚÈıÌfi ÙˆÓ ÊÏ‚ÔÎÂÓÙ‹ÛÂˆÓ ÙˆÓ ÓÂÔÁÓÒÓ, ÛÙÔÈ¯Â›Ô Ôχ ÛËÌ·ÓÙÈÎfi ÁÈ· ÙË ÓÔÛËÏ›· ÙˆÓ ÚfiˆÚˆÓ Î·È È‰È·›ÙÂÚ· ÙˆÓ ∂õ° ÓÂÔÁÓÒÓ Ì ٷ ‡ıÚ·˘ÛÙ· ·ÁÁ›· Î·È ‰¤ÚÌ·. ∏ ÙÔÔı¤ÙËÛ‹ ÙÔ˘ ÁÈÓfiÙ·Ó Â‡ÎÔÏ· Î·È ÁÚ‹ÁÔÚ· ÛÙË ıÂÚÌÔÎÔÈÙ›‰· Î·È ÌfiÓÔ Û 4 ÂÚÈÙÒÛÂȘ (5,4%) ¯ÚÂÈ¿ÛÙËΠ‰Â‡ÙÂÚË ÚÔÛ¿ıÂÈ·. ∆· ÓÂÔÁÓ¿ ‰ÂÓ ·ÚÂÓÔ¯ÏÔ‡ÓÙ·Ó, Ô‡Ù ·ÚÂÌÔ‰›˙ÔÓÙ·Ó ÔÈ ÎÈÓ‹ÛÂȘ ÙÔ˘˜, ·ÊÔ‡ Ô Î·ıÂÙ‹Ú·˜ Â›Ó·È ÏÂÙfi˜ Î·È Â‡Î·ÌÙÔ˜ Î·È ‰ÂÓ Â›Ó·È ·Ó·Áη›· Ë ¯Ú‹ÛË Ó¿ÚıËη. ∂ÈϤÔÓ, Ë Â‡ÚÂÛË ÊÏ‚È΋˜ ÁÚ·ÌÌ‹˜ ·‡ÂÈ Ó· ·ÔÙÂÏ› ÙÔ Î‡ÚÈÔ Î·È Î·ıËÌÂÚÈÓfi Úfi‚ÏËÌ· Ù˘ ÌÔÓ¿‰·˜, ÁÂÁÔÓfi˜ Ôχ ÛËÌ·ÓÙÈÎfi fiˆ˜ ÁÓˆÚ›˙Ô˘Ó Î·Ï¿ fiÏÔÈ ÔÈ ÂÚÁ·˙fiÌÂÓÔÈ Û ·˘Ù‹. ∆Ô ÔÛÔÛÙfi ·Ê·›ÚÂÛ˘ ÙÔ˘ ηıÂÙ‹Ú· ÏfiÁˆ ÂÈÏÔÎÒÓ ÛÙ· ÓÂÔÁÓ¿ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‹Ù·Ó ȉȷ›ÙÂÚ· ¯·ÌËÏfi (19%) Û ۯ¤ÛË Ì ·Ï·ÈfiÙÂÚ˜ ‰ËÌÔÛȇÛÂȘ (34-53%) (10-12), ÂÓÒ ‹Ù·Ó ÂÚ›Ô˘ ÙÔ ›‰ÈÔ Ì ¿ÏϘ ÚfiÛÊ·Ù˜ (25%) (9). ∞˘Ùfi Â›Ó·È Èı·Ófi Ó· ÔÊ›ÏÂÙ·È: ·) ÛÙÔÓ ÙÚfiÔ ÙÔÔı¤ÙËÛ˘ ÙÔ˘ ηıÂÙ‹Ú· Î·È ‚) ÛÙÔ ÌÈÎÚfiÙÂÚÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· Ô˘ ¤ÌÂÓ (11,2 Ë̤Ú˜) Û ۯ¤ÛË Ì ÙȘ ·Ï·ÈfiÙÂÚ˜ ÂÚÁ·Û›Â˜ (13-25 Ë̤Ú˜), ÏfiÁˆ Ù˘ Ù·¯‡ÙÂÚ˘ ÔÏÔÎÏ‹ÚˆÛ˘ Ù˘ ÂÓÙÂÚÈ΋˜ ‰È·ÙÚÔÊ‹˜. ™ÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ ¡ÂÔÁÓÔÏÔÁÈÎfi ∆Ì‹Ì·, ÁÈ· ÙË ¯ÔÚ‹ÁËÛË Ù˘ ·ÚÂÓÙÂÚÈ΋˜ ‰È·ÙÚÔÊ‹˜ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ·Ú¯Èο, ·ÚÎÂÙ¿ Û˘¯Ó¿, ÔÌÊ·ÏÈÎÔ› ÊÏ‚ÈÎÔ› ηıÂÙ‹Ú˜ ÙÔÔıÂÙË̤ÓÔÈ ÛÙËÓ Î¿Ùˆ ÎÔ›ÏË ÊϤ‚·.

OÈ ÔÌÊ·ÏÈÎÔ› ÊÏ‚ÈÎÔ› ηıÂÙ‹Ú˜, Û‡Ìʈӷ Ì ÙË ‚È‚ÏÈÔÁÚ·Ê›·, Ê·›ÓÂÙ·È Ó· ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÏÈÁfiÙÂÚ˜ ÂÈÏÔΤ˜ (13). ∂ȉÈÎfiÙÂÚ·, fiÛÔÓ ·ÊÔÚ¿ ÛÙÔ˘˜ ÏfiÁÔ˘˜ Ô˘ ·Ê·ÈÚ¤ıËÎ·Ó ÔÈ Î·ıÂÙ‹Ú˜, ÁÈ· ÙËÓ ·fiÊÚ·ÍË ÙÔ˘ ηıÂÙ‹Ú· ÛÙȘ Û˘ÁÎÂÎÚÈ̤Ó˜ ÂÚÈÙÒÛÂȘ ‰ÂÓ ‚Ú¤ıËΠ·ÈÙ›·, ·Ú’ fiÙÈ Û ̛· ÂÚ›ÙˆÛË ı· ÌÔÚÔ‡Û ӷ ÔÊ›ÏÂÙ·È ÛÙËÓ ÔÛfiÙËÙ· ÙÔ˘ ¯ÔÚËÁÔ‡ÌÂÓÔ˘ Ca (>2 mlo/l/Ë̤ڷ), Ë ÔÔ›· ıˆÚÂ›Ù·È ˆ˜ Èı·Ó‹ ·ÈÙ›· (10). ŸÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ·Ê·›ÚÂÛË ÏfiÁˆ ıÂÙÈ΋˜ ηÏÏȤÚÁÂÈ·˜ ·›Ì·ÙÔ˜, ‰ÂÓ Â›Ó·È ‚¤‚·ÈÔ fiÙÈ Î·È ÛÙȘ 5 ÂÚÈÙÒÛÂȘ ·Ê·ÈÚ¤ıËÎÂ Ô Î·ıÂÙ‹Ú·˜ ÔÚıÒ˜, fiˆ˜ Î·È Â¿Ó ı· ¤ÚÂ ӷ ›¯Â ·Ê·ÈÚÂı› Î·È Û ¿ÏϘ ÂÚÈÙÒÛÂȘ. À¿Ú¯Ô˘Ó ÎÚÈÙ‹ÚÈ· ÁÈ· ÔÚÈṲ̂ÓÔ˘˜ (11), Û¯ÂÙÈο Ì ÙÔ ·Ó Ì›· ıÂÙÈ΋ ηÏÏȤÚÁÂÈ· ·›Ì·ÙÔ˜ ÌÔÚ› Ó· ıˆÚËı› fiÙÈ ÔÊ›ÏÂÙ·È ÛÙÔÓ Î·ıÂÙ‹Ú· ‹ fi¯È. ∆· ÎÚÈÙ‹ÚÈ· ·˘Ù¿ ‰ÂÓ ÌÔÚÔ‡Ó Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó ·fiÏ˘Ù·. ¶ÚÔÙÈÌfiÙÂÚÔ Â›Ó·È ·˘Ùfi Ô˘ ÚÔÙ›ÓÂÙ·È ·fi ÚfiÛÊ·ÙË ÌÂϤÙË, ‰ËÏ·‰‹ Ë ·Ê·›ÚÂÛË ÙÔ˘ ηıÂÙ‹Ú· Ó· Á›ÓÂÙ·È fiÙ·Ó ˘¿Ú¯Ô˘Ó ÙÚÂȘ ηÏÏȤÚÁÂȘ ·›Ì·ÙÔ˜ ıÂÙÈΤ˜ ̠ϢÎfi ÛÙ·Ê˘ÏfiÎÔÎÎÔ, ÂÓÒ Â¿Ó ·ÔÌÔÓˆı› ¿ÏÏÔ ÌÈÎÚfi‚ÈÔ (¯Ú˘Û›˙ˆÓ ÛÙ·Ê˘ÏfiÎ-

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ÎÔÎÔ˜ ‹ ·ÚÓËÙÈÎfi ηٿ Gram), Ó· ·Ê·ÈÚÂ›Ù·È ÌÂÙ¿ ·fi Ì›· Î·È ÌfiÓÔ ıÂÙÈ΋ ηÏÏȤÚÁÂÈ· (14). ™ÙȘ ÂÚÈÙÒÛÂȘ Ô˘ ˘‹Ú¯Â ÂÚ˘ıÚfiÙËÙ· ηٿ Ì‹ÎÔ˜ ÙÔ˘ ηıÂÙ‹Ú· ‹ Ô›‰ËÌ·, Ë ·Ê·›ÚÂÛË ÙÔ˘ ηıÂÙ‹Ú· ‹Ù·Ó ÂȂ‚ÏË̤ÓË. ∏ ÙÔÔı¤ÙËÛË ÙÔ˘ ηıÂÙ‹Ú· Û ÌË ÛˆÛÙ‹ ı¤ÛË Ú¤ÂÈ Ó· ·ÔʇÁÂÙ·È (15), ηıÒ˜ ·˘Í¿ÓÂÈ ÛËÌ·ÓÙÈο Ô Î›Ó‰˘ÓÔ˜ ÂÈÏÔÎÒÓ (16). ŸÛÔÓ ·ÊÔÚ¿ ÛÙȘ Û·ÓÈfiٷ٘ ÂÈÏÔΤ˜ ÙÔ˘ ∫∫¶º Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÛÙË ‚È‚ÏÈÔÁÚ·Ê›·, fiˆ˜ Ô ‰Â˘ÙÂÚÔ·ı‹˜ ˘‰ÚÔΤʷÏÔ˜ ÔÊÂÈÏfiÌÂÓÔ˜ Û ıÚfiÌ‚ˆÛË Ù˘ ¿Óˆ ÎÔ›Ï˘ ÊϤ‚·˜ (17), Ë ·ÚÔ͢ÛÌÈ΋ ˘ÂÚÎÔÈÏȷ΋ Ù·¯˘Î·Ú‰›· Û ÙÔÔı¤ÙËÛË ÙÔ˘ ηıÂÙ‹Ú· ·fi ÙËÓ ¤Íˆ ÛÊ·Á›Ùȉ· ÛÙÔÓ ‰ÂÍÈfi ÎfiÏÔ (18), Ë ÂÙÂÚfiÏ¢ÚË ·Ú¿Ï˘ÛË ÙÔ˘ ‰È·ÊÚ¿ÁÌ·ÙÔ˜ Û ÙÔÔı¤ÙËÛË ÊÏ‚ÈÎÔ‡ ηıÂÙ‹Ú· ‰È·‰ÂÚÌÈο ·fi ÙËÓ ˘ÔÎÏ›‰ÈÔ (19), Ë ÂÓ‰Ôηډ›Ùȉ· Ô˘ ·ÚÔ˘ÛÈ¿ÛÙËΠ۠ÙÚ›· ∂õ° ÓÂÔÁÓ¿ (20) Î·È Ë ÂÚÈηډȷ΋ Û˘ÏÏÔÁ‹ Ô˘ ÌÔÚ› Ó· ÚÔηϤÛÂÈ ·ÎfiÌË Î·È ÙÔÓ ı¿Ó·ÙÔ (21), ‰ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó Û ηӤӷ ·fi Ù· ÓÂÔÁÓ¿ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó ÛÙËÓ ·ÚÔ‡Û· ÂÚÁ·Û›·, ¯ˆÚ›˜ ·˘Ùfi Ó· ·ÔÎÏ›ÂÈ ÙËÓ ÂÌÊ¿ÓÈÛ‹ ÙÔ˘˜. ∂ȉÈÎfiÙÂÚ· ÁÈ· ÙËÓ ÂÚÈηډȷ΋ Û˘ÏÏÔÁ‹, Û ÚfiÛÊ·ÙË ·Ó·‰ÚÔÌÈ΋ ¤Ú¢ӷ Ô˘ ‰ÈÂÍ‹¯ıË ÛÙÔ ∏ӈ̤ÓÔ µ·Û›ÏÂÈÔ Î·È ÂÚÈÂÏ¿Ì‚·Ó fiϘ ÙȘ ÌÔÓ¿‰Â˜ ÂÓÙ·ÙÈ΋˜ ÓÔÛËÏ›·˜ ÓÂÔÁÓÒÓ Ù· ÙÂÏÂ˘Ù·›· 5 ¯ÚfiÓÈ·, ‚Ú¤ıËΠfiÙÈ Ë Èı·ÓfiÙËÙ· Ó· ·ÚÔ˘ÛÈ·ÛÙ› Ë ÂÈÏÔ΋ ‹Ù·Ó 1,8/1000 ÙÔÔıÂÙ‹ÛÂȘ (22). ∏ ·Ô˘Û›· ÂÈÏÔÎÒÓ ÛÙȘ ÙÔÔıÂÙ‹ÛÂȘ ·fi ÙË Ì·Û¯·ÏÈ·›· ÊϤ‚· Ô˘ ‰È·ÈÛÙÒıËΠÛÙËÓ ·ÚÔ‡Û· ÂÚÁ·Û›·, ¤¯ÂÈ ÂȂ‚·Èˆı› Î·È ·fi ¿ÏÏÔ˘˜ ÂÚ¢ÓËÙ¤˜ (9,23), Ì ·ÔÙ¤ÏÂÛÌ· Ó· ·ÔÙÂÏ› ÙËÓ ·ÛʷϤÛÙÂÚË, ›Ûˆ˜, ı¤ÛË. ∏ Û˘ÛÙËÌ·ÙÈ΋ ¯ÔÚ‹ÁËÛË Ë·Ú›Ó˘ ÚÔÎÂÈ̤ÓÔ˘ Ó· ‰È·ÙËÚËı› ÁÈ· ÂÚÈÛÛfiÙÂÚÔ ¯ÚfiÓÔ Ô ÎÂÓÙÚÈÎfi˜ ηıÂÙ‹Ú·˜, ‰ÂÓ Ê·›ÓÂÙ·È Ó· Â›Ó·È ·Ó·Áη›·, fiˆ˜ ·¤‰ÂÈÍ ÚfiÛÊ·ÙË ÌÂÙ·-·Ó¿Ï˘ÛË (24). °È· ÙËÓ ÂÈÙ˘¯‹ ¯Ú‹ÛË Ù˘ ÌÂıfi‰Ô˘, Â›Ó·È ··Ú·›ÙËÙÔ Ó· Á›ÓÂÙ·È ÁÓˆÛÙ‹ Ë Ù¯ÓÈ΋ ÙÔÔı¤ÙËÛ˘ Û ·ÚÎÂÙÔ‡˜ ·fi ÙÔ È·ÙÚÈÎfi Î·È ÓÔÛËÏ¢ÙÈÎfi ÚÔÛˆÈÎfi Î·È Ì¿ÏÈÛÙ· ÛÙÔ˘˜ ÂÌÂÈÚfiÙÂÚÔ˘˜, ÒÛÙ ӷ Â›Ó·È ‰˘Ó·Ù‹ Ë ÙÔÔı¤ÙËÛË ÙÔ˘ ηıÂÙ‹Ú· fiÙ·Ó ¯ÚÂÈ¿˙ÂÙ·È, fiÏÔ ÙÔ 24ˆÚÔ.

O ‰È·‰ÂÚÌÈÎfi˜ ÎÂÓÙÚÈÎfi˜ ÊÏ‚ÈÎfi˜ ηıÂÙ‹Ú·˜ Â›Ó·È ˆÊ¤ÏÈÌÔ˜ Î·È Ú¤ÂÈ Ó· ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÛÙË ÓÔÛËÏ›· ÙˆÓ ¶Ãµ° Î·È È‰È·›ÙÂÚ· ÙˆÓ ∂õ° ÓÂÔÁÓÒÓ, ÁÈ· Ù· ÔÔ›· Û ·ÚÎÂÙ¤˜ ÂÚÈÙÒÛÂȘ ·ÔÙÂÏ› ÁÚ·ÌÌ‹ ˙ˆ‹˜ (25). ∏ ·Ú·ÏÏ·Á‹ Ù˘ ÌÂıfi‰Ô˘ ÙÔÔı¤ÙËÛ˘ Ô˘ ÚÔÙ›ÓÂÙ·È Â›Ó·È ¯Ú‹ÛÈÌË Î·È Ë Ù·¯Â›· Î·È ÂÈÙ˘¯‹˜ ÔÏÔÎÏ‹ÚˆÛË Ù˘ ÂÓÙÂÚÈ΋˜ Û›ÙÈÛ˘ ı· ÌÂÈÒÛÂÈ ·ÎfiÌË ÂÚÈÛÛfiÙÂÚÔ ÙÔÓ ¯ÚfiÓÔ ·Ú·ÌÔÓ‹˜ ÙÔ˘ ηıÂÙ‹Ú· Î·È ÙÔÓ Î›Ó‰˘ÓÔ ÂÈÏÔÎÒÓ.

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BÈ‚ÏÈÔÁÚ·Ê›· 1. ∆˙Ô˘Ì¿Î·-ª·ÎԇϷ Ã, §ÂΤ· µ, ∫·‚‚·‰›· °, ª·ÎÚ‹ ∞, ∫Ô˘ÙÛÔ‚›ÙË ¶, ª·ÙÛ·ÓÈÒÙ˘ ¡. ¶ÂÚÈÁÂÓÓËÙÈ΋ ÊÚÔÓÙ›‰· ÛÙËÓ ∂ÏÏ¿‰· Ù· ÙÂÏÂ˘Ù·›· 15 ¯ÚfiÓÈ·. ∆fiÌÔ˜ 75. ∞ı‹Ó·: ¶Ú·ÎÙÈο ∞η‰ËÌ›·˜ ∞ıËÓÒÓ; 2000.

2. Ziegler EE, Thyreen PJ, Carlson SJ. Aggressive nutrition of the very low birth weight infant. Clin Perinatol 2002;29: 225-244.

3. Sadiq F, Devaskar S, Weber T, Keenan W. Life threatening complications of Broviac catheterization [abstract]. Pediatr Res 1985;19:361A. 4. Loeff DS, Matlak ME, Black RE, Overall JC, Dolcourt JL, Johnson DG. Insertion of a small central venous catheter in neonates and young infants. J Pediatr Surg 1982;17: 944-948.

5. Peabody JL, Lewis K. Consequences of newborn intensive care. In: Gottfried AW, Gaiter JL, editors. Infant stress under intensive care: environmental neonatology. Baltimore: University Park Press; 1985. p. 206-208.

6. Shaw JC. Parenteral nutrition in the management of sick low birth weight infants. Pediatr Clin North Am 1973;20:333-358.

7. Ogata ES, Schulman S, Raffensperger J, Luck S, Rusnak M. Caval catheterization in the intensive care nursery: a useful means for providing parenteral nutrition to the extremely low birth-weight infant. J Pediatr Surg 1984;19:258-262.

8. Ainsworth SB, Furness J, Fenton AC. Randomized comparative trial between percutaneous longlines and peripheral cannulae in the delivery of neonatal parenteral nutrition. Acta Paediatr 2001;90:1016-1020.

9. Liossis G, Bardin C, Papageorgiou A. Comparison of risks from percutaneous central venous catheters and peripheral lines in infants of extremely low birth weight: a cohort controlled study of infants <1000 g. J Matern Fetal Neonatal Med 2003;13:171-174.

10. Durand M, Ramanathan R, Martinelli B, Tolentino M. Prospective evaluation of percutaneous central venous silastic catheters in newborn infants with birth weights of 510 to 3920 grams. Pediatrics 1986;78:245-250.

11. Chathas MK, Paton JB, Fisher DE. Percutaneous central venous catheterization. Three years’ experience in a neonatal intensive care unit. Am J Dis Child 1990;144: 1246-1250.

12. Cairns PA, Wilson DC, McClure BG, Halliday HL, McReid M. Percutaneous central venous catheter use in the very low birth weight neonate. Eur J Pediatr 1995;154:145-147.

13. Chien LY, Macnab Y, Aziz K, Andrews W, McMillan DD, Lee SK et al. Variations in central venous catheter-related infection risks among Canadian neonatal intensive care units. Pediatr Infect Dis J 2002;21:505-511.

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14. Benjamin DK Jr, Miller W, Garges H, Benjamin DK, McKinney RE Jr, Cotton M et al. Bacteremia, central catheters, and neonates: when to pull the line. Pediatrics 2001;107:1272-1276.

15. Lussky RC, Trower N, Fisher D, Engel R, Cifuentes R. Unusual misplacement sites of percutaneous central venous lines in the very low birth weight neonate. Am J Perinatol 1997;14:63-67.

16. Chen C, Tsao N, Yau L. Paraplegia: complication of percutaneous central venous line malposition. Pediatr Neurol 2001;24:65-68.

17. Mactier H, Alroomi LG, Young DG, Raine PA. Central venous catheterisation in very low birthweight infants. Arch Dis Child 1986;61:449-453.

18. Daniels SR, Hannon DW, Meyer RA, Kaplan S. Paroxysmal supraventricular tachycardia: a complication of jugular central venous catheters in neonates. Am J Dis Child 1984;138:474-475.

19. D’Netto MA, Bender J, Brown RT, Herson VC. Unilateral diaphragmatic palsy in association with a subclavian vein thrombus in a very-low-birth-weight infant. Am J Perinatol 2001;18:459-464.

20. Armstrong D, Battin MR, Knight D, Skinner J. Staphylococcus aureus endocarditis in preterm neonates.

Am J Perinatol 2002;19:247-251.

21. Kabra NS, Kluckow MR. Survival after an acute pericardial tamponade as a result of percutaneously inserted central venous catheter in a preterm neonate. Indian J Pediatr 2001;68:677-680.

22. Beardsall K, White DK, Pinto EM, Kelsall AW. Pericardial effusion and cardiac tamponade as complications of neonatal long lines: are they really a problem? Arch Dis Child Fetal Neonatal Ed 2003;88:F292-F295.

23. Messeri A, Calamandrei M. Percutaneous central venous catheterization in small infants: axillary vein can facilitate the insertion rate. Paediatr Anaesth 2000;10:527-530.

24. Shah P, Shah V. Continuous heparin infusion to prevent thrombosis and catheter occlusion in neonates with peripherally placed percutaneous central venous catheters. Cochrane Database Syst Rev 2001;CD002772.

25. Menon G. Neonatal long lines. Arch Dis Child Fetal Neonatal Ed 2003;88:F260-F262.

∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 03-10-2003 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 02-03-2004 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∞ÓÙÒÓ˘ °Ô‡Ó·Ú˘ ºÚ‡Ó˘ 5, ∆.∫. 116 34, ¶·ÁÎÚ¿ÙÈ

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ORIGINAL ARTICLE

∫·Ù¿ÛÙ·ÛË ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÙˆÓ Ì·ıËÙÒÓ ÛÙÔ ÕÚÁÔ˜ OÚÂÛÙÈÎfi ηٿ ÙÔ Û¯ÔÏÈÎfi ¤ÙÔ˜ 2002-2003 ∞. ∏. ™¤ÚÌ˘

Vaccination coverage of pupils in the town of Argos Orestiko for the school year 2002-2003 A. I. Serbis

¶ÂÚ›ÏË„Ë: ™Ùfi¯Ô˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‹Ù·Ó Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ ÔÛÔÛÙÒÓ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÙˆÓ Ì·ıËÙÒÓ ËÏÈΛ·˜ 4-18 ÂÙÒÓ ÛÙÔ ÕÚÁÔ˜ OÚÂÛÙÈÎfi ÙÔ˘ ÓÔÌÔ‡ ∫·ÛÙÔÚÈ¿˜, ηٿ ÙÔ Û¯ÔÏÈÎfi ¤ÙÔ˜ 20022003 Î·È Ë Û‡ÁÎÚÈÛ‹ ÙÔ˘˜ Ì ÂΛӷ ¿ÏÏˆÓ ÂÚÈÔ¯ÒÓ Ù˘ ∂ÏÏ¿‰·˜. ∂›Û˘, ÛÎÔfi Ù˘ ÌÂϤÙ˘ ·ÔÙ¤ÏÂÛÂ Î·È Ë ‰ËÌÈÔ˘ÚÁ›· Ì›·˜ ‚¿Û˘ ‰Â‰ÔÌ¤ÓˆÓ ÁÈ· Ì›· Èı·Ó‹ Û˘ÁÎÚÈÙÈ΋ ÌÂϤÙË ÛÙÔ Ì¤ÏÏÔÓ, ηıÒ˜ Î·È Ë ÂÎÙ›ÌËÛË Ù˘ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ Ù˘ ÔÌ¿‰·˜ ÂÌ‚ÔÏÈ·ÛÌÒÓ ÙÔ˘ ∫¤ÓÙÚÔ˘ ÀÁ›·˜ Ù˘ fiÏ˘. ∞fi Û‡ÓÔÏÔ 1291 Ì·ıËÙÒÓ, 1149 Û˘ÌÌÂÙ›¯·Ó ÛÙËÓ ¤Ú¢ӷ. ÈڛÛÙËÎ·Ó Û ÙÚÂȘ ËÏÈÎȷΤ˜ ÔÌ¿‰Â˜ Î·È ÂϤÁ¯ıËΠ·fi Ù· ‚È‚ÏÈ¿ÚÈ· ˘Á›·˜ ÙÔ˘˜ ηٿ fiÛÔ ‹Ù·Ó ÂÌ‚ÔÏÈ·Ṳ̂ÓÔÈ ‚¿ÛÂÈ ÙÔ˘ ∂ıÓÈÎÔ‡ ¶ÚÔÁÚ¿ÌÌ·ÙÔ˜ ∂Ì‚ÔÏÈ·ÛÌÒÓ. ∆· ÔÛÔÛÙ¿ Î¿Ï˘„˘ Ô˘ ‚Ú¤ıËÎ·Ó ‹Ù·Ó ÈηÓÔÔÈËÙÈο ÁÈ· ÙÔ˘˜ Ì·ıËÙ¤˜ ÌÈÎÚfiÙÂÚˆÓ ËÏÈÎÈÒÓ, ·ÏÏ¿ ÌÂÈÒÓÔÓÙ·Ó ÛÙȘ ÌÂÁ·Ï‡ÙÂÚ˜ ËÏÈ˘, ÏfiÁˆ ·Ú¿ÏÂȄ˘ Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ÂÌ‚ÔÏ›ˆÓ. ŒÙÛÈ, ·fi ÙËÓ ÚÒÙË ËÏÈÎȷ΋ ÔÌ¿‰· (4-6 ÂÙÒÓ) Ï‹Úˆ˜ ÂÌ‚ÔÏÈ·Ṳ̂ÓÔ ‹Ù·Ó ÙÔ 95,5%, ·fi ÙË ‰Â‡ÙÂÚË ÔÌ¿‰· (7-16 ÂÙÒÓ) ÙÔ 64,6%, ÂÓÒ ·fi ÙËÓ ÙÚ›ÙË ÔÌ¿‰· (17-18 ÂÙÒÓ) ÌfiÓÔ ÙÔ 15,9%. °È· ÔÚÈṲ̂Ó˜ ·Ûı¤ÓÂȘ, Ù· ÔÛÔÛÙ¿ Î¿Ï˘„˘ ‹Ù·Ó Ôχ ˘„ËÏ¿, Ôχ ÎÔÓÙ¿ ÛÙÔ˘˜ ÛÙfi¯Ô˘˜ Ù˘ ¶·ÁÎfiÛÌÈ·˜ OÚÁ¿ÓˆÛ˘ ÀÁ›·˜, fiˆ˜ ÁÈ· ÙËÓ ÔÏÈÔÌ˘ÂÏ›Ùȉ· Î·È ÙË Ê˘Ì·Ù›ˆÛË Û fiϘ ÙȘ ËÏÈ˘, ·ÏÏ¿ Î·È ÁÈ· ÙË ‰ÈÊıÂÚ›Ùȉ·, ÙÔÓ Ù¤Ù·ÓÔ Î·È ÙËÓ Ë·Ù›Ùȉ· µ ÛÙÔ˘˜ Ó·ÚfiÙÂÚÔ˘˜ Ì·ıËÙ¤˜. ∞ÓÙ›ıÂÙ·, ·ÚÎÂÙ¿ ¯·ÌËÏ‹ ‹Ù·Ó Ë ÂÌ‚ÔÏÈ·ÛÙÈ΋ Î¿Ï˘„Ë ÙˆÓ Ì·ıËÙÒÓ Ù˘ ÙÚ›Ù˘ ËÏÈÎȷ΋˜ ÔÌ¿‰·˜ (17-18 ÂÙÒÓ) ÁÈ· ÙËÓ ÂÚ˘ıÚ¿ Î·È ÙÔÓ ÎÔηÙË Î·È Ì¤ÙÚÈ· ÁÈ· ÙË ‰ÈÊıÂÚ›Ùȉ· Î·È ÙÔÓ Ù¤Ù·ÓÔ. À¿Ú¯ÂÈ ÌÂÁ¿ÏË ·Ó¿ÁÎË ¯¿Ú·Í˘ Û˘ÁÎÂÎÚÈ̤Ó˘ ÔÏÈÙÈ΋˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÛÙËÓ ∂ÏÏ¿‰· ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ˘·Ú¯fiÓÙˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ Î·È ÂÏÏ›„ˆÓ,

Abstract: The aim of this study was to determine the vaccination status of pupils aged 4-18 years in the town of Argos Orestiko for the school year 20022003 and to compare the results with vaccination percentages from other areas around Greece. The objective was to create a body of valid and comparable data for future reference, and to assess the effectiveness of the vaccination team. Of a total of 1291 pupils in the school system, 1149 participated in this study. They were separated into three age groups and their health booklets were checked in order to determine whether the students had been vaccinated according to the National Vaccination Programme. The vaccination percentages were satisfactory for the younger pupils, but declined with age, due to omission of specific vaccines: 95.5% of the pupils in the 4-6 years age group, 64.6% of those in the 7-16 years group, and only 15.9% of those in the 17-18 years group were fully vaccinated. For certain diseases, the percent coverage was very high, reaching the targets of the WHO. This was the case for poliomyelitis and tuberculosis for all age groups, as well as for diphtheria, tetanus and hepatitis B for younger students. On the contrary, the coverage of the 17-18 years group was low for rubella and pertussis and moderate for diphtheria and tetanus. There is a great need for a comprehensive vaccination policy in Greece to face the existing problems, as well as for introduction of measures to implement this policy, such as Health Centre vaccination teams.

∫¤ÓÙÚÔ ÀÁ›·˜ ÕÚÁÔ˘˜ OÚÂÛÙÈÎÔ‡, ∫·ÛÙÔÚÈ¿

Health Center of Argos Orestiko, Kastoria

120

¶·È‰È·ÙÚÈ΋ 2004;67:120-125

Paediatriki 2004;67:120-125

·ÏÏ¿ Î·È ·Ó¿ÁÎË ı¤ÛÈÛ˘ ̤ÙÚˆÓ ÁÈ· ÙËÓ Â·Ú΋ ÂÊ·ÚÌÔÁ‹ ·˘Ù‹˜ Ù˘ ÔÏÈÙÈ΋˜, fiˆ˜ Â›Ó·È ÔÈ ÔÌ¿‰Â˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÙˆÓ ∫¤ÓÙÚˆÓ ÀÁ›·˜. §¤ÍÂȘ ÎÏÂȉȿ: ÂÌ‚fiÏÈ·, ÂÌ‚ÔÏÈ·ÛÙÈ΋ Î¿Ï˘„Ë, ·ÓÔÛÔÔ›ËÛË, ÂȉËÌÈÔÏÔÁ›·.

Key words: vaccines, vaccination coverage, immunization, epidemiology.

∂ÈÛ·ÁˆÁ‹ ∞fi ÙȘ ·Ú¯¤˜ ÙÔ˘ ÂÚ·Ṳ̂ÓÔ˘ ·ÈÒÓ· ˘‹ÚÍ ̛· Û˘Ó¯‹˜ ÚÔÛ¿ıÂÈ· ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË Ó¤ˆÓ ÂÌ‚ÔÏ›ˆÓ Î·È ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙÔ˘˜ ÛÙËÓ Î·ıËÌÂÚÈÓ‹ È·ÙÚÈ΋ Ú¿ÍË, ηıÒ˜ ‹Ù·Ó Ê·ÓÂÚfi fiÙÈ ¿ÌÂÛ· ÚÔÏ·Ì‚¿ÓÔ˘Ó Ì›· ÓfiÛÔ, ÂÓÒ Ì·ÎÚÔÚfiıÂÛÌ· ÌÔÚÔ‡Ó Ó· ÙËÓ ÂÍ·Ê·Ó›ÛÔ˘Ó. ŒÙÛÈ, ÌÂÙ¿ ·fi Û˘ÓÙÔÓÈṲ̂ÓË ÂÊ·ÚÌÔÁ‹ ÚÔÁÚ·ÌÌ¿ÙˆÓ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Û ·ÁÎfiÛÌÈ· Îϛ̷η, ÂÈÙ‡¯ıËÎÂ Ë ÂÎÚ›˙ˆÛË Ù˘ ¢ÏÔÁÈ¿˜ ·fi ÙÔÓ Ï·Ó‹ÙË, ·ÏÏ¿ Î·È Ù˘ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜ ·fi ÙËÓ ·ÌÂÚÈηÓÈ΋ ‹ÂÈÚÔ. ™ÙËÓ ∂ÏÏ¿‰·, Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, ÌˉÂÓ›ÛÙËÎ·Ó Ù· ÎÚÔ‡ÛÌ·Ù· Ù˘ ‰ÈÊıÂÚ›Ùȉ·˜ Î·È ÙÔ˘ ÓÂÔÁÓÈÎÔ‡ ÙÂÙ¿ÓÔ˘ Î·È ÂÏ·ÙÙÒıËÎ·Ó ÛËÌ·ÓÙÈο Ù· ÎÚÔ‡ÛÌ·Ù· Ù˘ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜ ηÈ, ÏÈÁfiÙÂÚÔ, ÙÔ˘ ÎÔηÙË (1). øÛÙfiÛÔ, Ë ÌÂٷΛÓËÛË ÏËı˘ÛÌÒÓ ·Ó¿ ÙÔÓ ÎfiÛÌÔ, Ë ÂÏÏÈ‹˜ ÂÊ·ÚÌÔÁ‹ ÙˆÓ ‰È·ÊfiÚˆÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÙˆÓ ¯ˆÚÒÓ Î·È Ë ÂÍ¿ψÛË Ù˘ HIV Ïԛ̈͢ (AIDS) ›¯·Ó Û·Ó ·ÔÙ¤ÏÂÛÌ· ÙËÓ Â·ÓÂÌÊ¿ÓÈÛË ÔÏÏÒÓ ÓfiÛˆÓ Ì ‰È·ÊÔÚÔÔÈË̤ӷ ÂȉËÌÈÔÏÔÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο. ∏ Û‡ÓıÂÙË ·˘Ù‹ ÂÈÎfiÓ· ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙË Û‡Á¯˘ÛË ·fi ÙÔÓ Û˘Ó¯Ҙ ·˘Í·ÓfiÌÂÓÔ ·ÚÈıÌfi Ó¤ˆÓ ÂÌ‚ÔÏ›ˆÓ Ô˘ Á›ÓÔÓÙ·È ÚÔÛÈÙ¿ ÁÈ· Ì·˙È΋ ¯Ú‹ÛË, ηıÈÛÙÔ‡Ó ··Ú·›ÙËÙË Û‹ÌÂÚ· ÙË ¯¿Ú·ÍË Û˘ÁÎÂÎÚÈ̤Ó˘ ÔÏÈÙÈ΋˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÛÙË ¯ÒÚ· Ì·˜. ∫·ıÈÛÙÔ‡Ó, Â›Û˘, ··Ú·›ÙËÙÔ ÙÔÓ Û˘Ó¯‹ ¤ÏÂÁ¯Ô ÙÔ˘ ÂÈ¤‰Ô˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÙÔ˘ ÂÏÏËÓÈÎÔ‡ ·È‰ÈÎÔ‡ ÏËı˘ÛÌÔ‡, ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂÈÙ¢¯ı› Ë ÛˆÛÙ‹ ÂÊ·ÚÌÔÁ‹ Ù˘ ÂıÓÈ΋˜ ÔÏÈÙÈ΋˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡. ™ÙÔ Ï·›ÛÈÔ ·˘Ùfi, ¤ÁÈÓ ÚÔÛ¿ıÂÈ· ηٷÁÚ·Ê‹˜ Ù˘ ηٿÛÙ·Û˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÙˆÓ Ì·ıËÙÒÓ ÙÔ˘ ÕÚÁÔ˘˜ OÚÂÛÙÈÎÔ‡ ÙÔ˘ ÓÔÌÔ‡ ∫·ÛÙÔÚÈ¿˜, ÂÚÈÔ¯‹˜ fiÔ˘ ‰ÂÓ ¤¯ÂÈ Í·Ó·Á›ÓÂÈ ·ÚfiÌÔÈ· ¤Ú¢ӷ (2). ™ÎÔfi˜ ‹Ù·Ó Ó· Û˘ÁÎÚÈıÔ‡Ó Ù· ÔÛÔÛÙ¿ Î¿Ï˘„˘ ÁÈ· Ù· ‰È¿ÊÔÚ· ÏÔÈÌÒ‰Ë ÓÔÛ‹Ì·Ù· ÛÙ· ·È‰È¿ ·˘Ù¿, Ì ÂΛӷ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· ÁÈ· ¿ÏϘ ÂÚÈÔ¯¤˜ Ù˘ ∂ÏÏ¿‰·˜ Î·È Ó· ÂÓËÌÂÚˆıÔ‡Ó Ù· ·È‰È¿ Ô˘ ˘ÔÏ›ÔÓÙ·È Î¿ÔÈÔ˘ ÂÌ‚ÔÏ›Ô˘ ÁÈ· ÙËÓ ¿ÌÂÛË ‰ÈÂÓ¤ÚÁÂÈ¿ ÙÔ˘. ∂›Û˘, Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó Ù· ÔÛÔÛÙ¿ ·˘Ù¿ ˆ˜ Û˘ÁÎÚÈÙÈο ÛÙÔȯ›· ÁÈ· Ì›· Èı·Ó‹ ·ÚfiÌÔÈ· ÌÂϤÙË ÛÙÔ Ì¤ÏÏÔÓ, ηıÒ˜ Î·È Ó· ÂÍÂÙ·ÛÙ› Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙˆÓ ‰Ú·ÛÙËÚÈÔÙ‹ÙˆÓ Ù˘ ÔÌ¿‰·˜ ÂÌ‚ÔÏÈ·ÛÌÒÓ ÙÔ˘ ∫¤ÓÙÚÔ˘ ÀÁ›·˜ (∫À).

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ OÈ Ì·ıËÙ¤˜ ÙˆÓ Û¯ÔÏÈÎÒÓ ÌÔÓ¿‰ˆÓ ÙÔ˘ ÕÚÁÔ˘˜ OÚÂÛÙÈÎÔ‡ ·ÔÙ¤ÏÂÛ·Ó ÙÔÓ ÏËı˘ÛÌfi ÌÂϤÙ˘ (study/survey population) ÁÈ· ÙË Û˘ÁÎÂÎÚÈ̤ÓË ÂȉËÌÈÔÏÔÁÈ΋ ¤Ú¢ӷ, ηٿ ÙÔ ÚÒÙÔ ÙÚ›ÌËÓÔ ÙÔ˘ Û¯ÔÏÈÎÔ‡ ¤ÙÔ˘˜ 2002-2003. ªÂ ÙË ‚Ô‹ıÂÈ· ÙfiÛÔ ÙˆÓ ÂÈÛÎÂÙÚÈÒÓ ˘Á›·˜ ÙÔ˘ ∫À ÕÚÁÔ˘˜ OÚÂÛÙÈÎÔ‡ fiÛÔ Î·È ÙˆÓ ÓËÈ·ÁˆÁÒÓ, ‰·ÛÎ¿ÏˆÓ Î·È Î·ıËÁËÙÒÓ, ¤ÁÈÓÂ Û˘ÏÏÔÁ‹ ηٿ ÙÔ ‰˘Ó·ÙfiÓ ÂÚÈÛÛfiÙÂÚˆÓ ‚È‚ÏÈ·Ú›ˆÓ ˘Á›·˜ ÙˆÓ ·È‰ÈÒÓ. ™˘ÁÎÂÓÙÚÒıËÎ·Ó Û˘ÓÔÏÈο 1149 ‚È‚ÏÈ¿ÚÈ· ˘Á›·˜ ·fi Ù· 1291 ·È‰È¿ Ô˘ ÊÔÈÙÔ‡Ó ÛÙȘ ‰È¿ÊÔÚ˜ Û¯ÔÏÈΤ˜ ‚·ıÌ›‰Â˜ Ù˘ fiÏ˘ [Û˘ÓÔÏÈÎfi ÔÛÔÛÙfi Û˘ÌÌÂÙÔ¯‹˜ ÛÙË ÌÂϤÙË (response rate) 89%]. ¶ÈÔ Û˘ÁÎÂÎÚÈ̤ӷ, ·fi Ù· 4 ÓËÈ·ÁˆÁ›· ÌÂ Û˘ÓÔÏÈο 126 ·È‰È¿, ËÏÈΛ·˜ 4-5 ÂÙÒÓ, Û˘ÁÎÂÓÙÚÒıËÎ·Ó 106 ‚È‚ÏÈ¿ÚÈ· (ÔÛÔÛÙfi Û˘ÌÌÂÙÔ¯‹˜ 84,1%), ·fi Ù· 4 ‰ËÌÔÙÈο Û¯ÔÏ›· Ì ۇÓÔÏÔ ·È‰ÈÒÓ 528, ËÏÈΛ·˜ 6-12 ÂÙÒÓ, Û˘ÁÎÂÓÙÚÒıËÎ·Ó 483 ‚È‚ÏÈ¿ÚÈ· (ÔÛÔÛÙfi Û˘ÌÌÂÙÔ¯‹˜ 91,5%), ·fi Ù· 2 Á˘ÌÓ¿ÛÈ· Ì ۇÓÔÏÔ ·È‰ÈÒÓ 340, ËÏÈΛ·˜ 13-15 ÂÙÒÓ, Û˘ÁÎÂÓÙÚÒıËÎ·Ó 320 ‚È‚ÏÈ¿ÚÈ· (ÔÛÔÛÙfi Û˘ÌÌÂÙÔ¯‹˜ 94,1%) Î·È ·fi ÙÔ 1 χÎÂÈÔ Ù˘ ÂÚÈÔ¯‹˜ Ì ۇÓÔÏÔ ·È‰ÈÒÓ 297, ËÏÈΛ·˜ 16-18 ÂÙÒÓ, Û˘ÁÎÂÓÙÚÒıËÎ·Ó 240 ‚È‚ÏÈ¿ÚÈ· (ÔÛÔÛÙfi Û˘ÌÌÂÙÔ¯‹˜ 80,8%). ∆· ·È‰È¿ ¯ˆÚ›ÛÙËÎ·Ó Û ÙÚÂȘ ËÏÈÎȷΤ˜ ÔÌ¿‰Â˜, Û‡Ìʈӷ Ì ÔÚÈṲ̂ÓÔ˘˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡˜-“ÔÚfiÛËÌ·”, fiˆ˜ ·Ó·Ï‡ÂÙ·È ÛÙË Û˘Ó¤¯ÂÈ·. ŒÙÛÈ, ÙËÓ ÚÒÙË ÔÌ¿‰· ·ÔÙ¤ÏÂÛ·Ó Ì·ıËÙ¤˜ ËÏÈΛ·˜ 4-6 ÂÙÒÓ, ÙË ‰Â‡ÙÂÚË Ì·ıËÙ¤˜ ËÏÈΛ·˜ 7-16 ÂÙÒÓ Î·È ÙËÓ ÙÚ›ÙË Ì·ıËÙ¤˜ ËÏÈΛ·˜ 17-18 ÂÙÒÓ. ™ÙË Û˘Ó¤¯ÂÈ·, ÁÈ· οı ¤Ó·Ó ·fi ÙÔ˘˜ Ì·ıËÙ¤˜ ¤ÁÈÓ ηٷÁÚ·Ê‹ ÙÔ˘ ʇÏÔ˘, Ù˘ ËÏÈΛ·˜, Ù˘ ÂıÓÈÎfiÙËÙ·˜ ηÈ, ‚¤‚·È·, Ù˘ Â¿ÚÎÂÈ·˜ ‹ ÌË ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÁÈ· ÙË ‰ÈÊıÂÚ›Ùȉ·, ÙÔÓ Ù¤Ù·ÓÔ, ÙÔÓ ÎÔηÙË, ÙËÓ ÔÏÈÔÌ˘ÂÏ›Ùȉ·, ÙË Ê˘Ì·Ù›ˆÛË, ÙËÓ ÈÏ·Ú¿, ÙËÓ ÂÚ˘ıÚ¿, ÙËÓ ·ÚˆÙ›Ùȉ· Î·È ÙËÓ Ë·Ù›Ùȉ· µ, ·ÏÏ¿ Î·È ÁÈ· ÙÔÓ ·ÈÌfiÊÈÏÔ ÈÓÊÏÔ˘¤ÓÙÛ·˜ Ù‡Ô˘ b, ÙÔÓ ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ Î·È ÙËÓ Ë·Ù›Ùȉ· ∞. ∞Í›˙ÂÈ Ó· ÛËÌÂȈı› fiÙÈ ÌÂٷ͇ ÙˆÓ 1149 Ì·ıËÙÒÓ Ô˘ Û˘ÌÌÂÙ›¯·Ó ÛÙËÓ ¤Ú¢ӷ, 58 Ì·ıËÙ¤˜ (5%) ‹Ù·Ó ·È‰È¿ Ô˘ ·Ó‹Î·Ó Û ÔÈÎÔÁ¤ÓÂȘ ÌÂÙ·Ó·ÛÙÒÓ ‹ Â·Ó··ÙÚÈÛı¤ÓÙˆÓ ·fi ¿ÏϘ ¯ÒÚ˜. ¶ÈÔ Û˘ÁÎÂÎÚÈ̤ӷ, 47 Ì·ıËÙ¤˜ (4,1% Â› ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ Ì·ıËÙÒÓ) ÚÔ¤Ú¯ÔÓÙ·Ó ·fi ÙËÓ ∞Ï‚·Ó›·, 4 ·fi ÙË ƒˆÛ›·, 4 ·fi ÙË °ÂÚÌ·Ó›·, 2 ·fi ÙË ™ÂÚ‚›· Î·È ¤Ó·˜ ·fi ÙËÓ ∫‡ÚÔ. OÈ ÂÚÈÛÛfiÙÂÚÔÈ ·fi ·˘ÙÔ‡˜ ÙÔ˘˜ Ì·ıËÙ¤˜ (40 Ì·ıËÙ¤˜) ÊÔÈÙÔ‡Û·Ó Û ٿÍÂȘ ÙÔ˘ ‰ËÌÔÙÈÎÔ‡ Û¯ÔÏ›Ԣ. ™ÙËÓ ÚÒÙË ÔÌ¿‰·, Ï‹Úˆ˜ ÂÌ‚ÔÏÈ·Ṳ̂ӷ ıˆڋıËÎ·Ó Ù· ·È‰È¿ Ô˘ ›¯·Ó οÓÂÈ Ù¤ÛÛÂÚȘ ‰fiÛÂȘ ÙÔ˘ ÙÚÈÏÔ‡ ÂÌ‚ÔÏ›Ô˘ ‰ÈÊıÂÚ›Ùȉ·˜-ÙÂÙ¿ÓÔ˘-ÎÔηÙË (DTP), Ù¤ÛÛÂÚȘ ‰fiÛÂȘ ÙÔ˘ fiÛÈÌÔ˘ ÂÌ‚ÔÏ›Ô˘ ηٿ Ù˘ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜ (OPV), ÙÚÂȘ ‰fiÛÂȘ ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ ηٿ Ù˘ Ë·Ù›Ùȉ·˜ µ (HepB) Î·È Ì›· ‰fiÛË ÙÚȉ‡Ó·ÌÔ˘ ÂÌ‚ÔÏ›Ô˘ ÈÏ·Ú¿˜-ÂÚ˘ıÚ¿˜-·ÚˆÙ›Ùȉ·˜

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¶·È‰È·ÙÚÈ΋ 2004;67:120-125

(MMR) ‹ Ì›· ‰fiÛË ·fi ÙÔ Î¿ı ÌÔÓÔ‰‡Ó·ÌÔ ÂÌ‚fiÏÈÔ. ™¯ÂÙÈο Ì ÙȘ ÓfiÛÔ˘˜ ÈÏ·Ú¿, ÂÚ˘ıÚ¿ Î·È ·ÚˆÙ›Ùȉ·, Ï‹Úˆ˜ ÂÌ‚ÔÏÈ·Ṳ̂ӷ ıˆڋıËÎ·Ó Î·È Ù· ·È‰È¿ ÛÙÔ ‚È‚ÏÈ¿ÚÈÔ ÙˆÓ ÔÔ›ˆÓ ·Ó·ÊÂÚfiÙ·Ó ÓfiÛËÛË ·fi οÔÈ· ·fi ·˘Ù¤˜ ÙȘ ·Ûı¤ÓÂȘ Î·È Â›¯·Ó οÓÂÈ Ì›· ‰fiÛË ·fi Ù· ÌÔÓÔ‰‡Ó·Ì· ÂÌ‚fiÏÈ· Ô˘ ·ÓÙ›ÛÙÔȯ· ˘ÔÏ›ÔÓÙ·Ó ‹ Ì›· ‰fiÛË ÙÚȉ‡Ó·ÌÔ˘. ™¯ÂÙÈο Ì ÙÔ ÂÌ‚fiÏÈÔ Î·Ù¿ Ù˘ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜, Ï‹Úˆ˜ ÂÌ‚ÔÏÈ·Ṳ̂ӷ ıˆڋıËÎ·Ó Î·È fiÛ· ·fi Ù· ·È‰È¿ ›¯·Ó οÓÂÈ ÙËÓ ÚÒÙË ‹ ÙȘ ‰‡Ô ÚÒÙ˜ ‰fiÛÂȘ Ì ÙË ÌÔÚÊ‹ ÙÔ˘ ·‰Ú·ÓÔÔÈË̤ÓÔ˘ ÂÌ‚ÔÏ›Ô˘ (IPV) Î·È ·ÎÔÏÔ‡ıËÛ·Ó ÙÚÂȘ ‹ ‰‡Ô ‰fiÛÂȘ ÙÔ˘ OPV, ·ÓÙ›ÛÙÔȯ·. ™¯ÂÙÈο Ì ÙÔ ÂÌ‚fiÏÈÔ Î·Ù¿ Ù˘ Ê˘Ì·Ù›ˆÛ˘ (BCG), ηı’ fiÙÈ ‹Ù·Ó ·Ú¯‹ ÙÔ˘ Û¯ÔÏÈÎÔ‡ ¤ÙÔ˘˜, ÔÈ Ì·ıËÙ¤˜ Ù˘ ∞’ ¢ËÌÔÙÈÎÔ‡ ‰ÂÓ Â›¯·Ó ·ÎfiÌË ÂÌ‚ÔÏÈ·ÛÙ›, ÔfiÙÂ Û˘ÌÂÚÈÂÏ‹ÊıËÛ·Ó Û ·˘Ù‹ ÙËÓ ÚÒÙË ÔÌ¿‰·. ™ÙË ‰Â‡ÙÂÚË ÔÌ¿‰·, Ï‹Úˆ˜ ÂÌ‚ÔÏÈ·Ṳ̂ӷ ıˆڋıËÎ·Ó Ù· ·È‰È¿ Ô˘ ›¯·Ó οÓÂÈ ¤ÓÙ ‰fiÛÂȘ ÙÔ˘ DTP, ¤ÓÙ ‰fiÛÂȘ ÙÔ˘ OPV, ÙÚÂȘ ‰fiÛÂȘ ÙÔ˘ HepB, ‰‡Ô ‰fiÛÂȘ ÙÔ˘ MMR ‹ ‰‡Ô ‰fiÛÂȘ ·fi ÙÔ Î¿ı ÌÔÓÔ‰‡Ó·ÌÔ ÂÌ‚fiÏÈÔ Î·È, Â›Û˘, Ì›· ‰fiÛË ÙÔ˘ BCG. µ¤‚·È·, Î·È ·˘Ù¿ Ù· ·È‰È¿ ıˆڋıËÎ·Ó ÂÌ‚ÔÏÈ·Ṳ̂ӷ ˆ˜ ÚÔ˜ ÙȘ ·Ûı¤ÓÂȘ ÈÏ·Ú¿, ÂÚ˘ıÚ¿, ·ÚˆÙ›Ùȉ·, ÂÊfiÛÔÓ ·Ó¤ÊÂÚ·Ó ÓfiÛËÛË ·fi οÔÈ· ·fi ·˘Ù¤˜ ÙȘ ·Ûı¤ÓÂȘ Î·È Â›¯·Ó οÓÂÈ ‰‡Ô ‰fiÛÂȘ ·fi Ù· ÌÔÓÔ‰‡Ó·Ì· ÂÌ‚fiÏÈ· Ô˘ ·ÓÙ›ÛÙÔȯ· ˘ÔÏ›ÔÓÙ·Ó ‹ ‰‡Ô ‰fiÛÂȘ ÙÚȉ‡Ó·ÌÔ˘. ∂›Û˘, ÁÈ· ÙËÓ ÔÏÈÔÌ˘ÂÏ›Ùȉ·, Â¿Ó Â›¯·Ó Á›ÓÂÈ Ë ÚÒÙË ‹ ÔÈ ‰‡Ô ÚÒÙ˜ ‰fiÛÂȘ Ì IPV Î·È ·ÎÔÏÔ‡ıËÛ·Ó Ù¤ÛÛÂÚȘ ‹ ÙÚÂȘ ‰fiÛÂȘ OPV ·ÓÙ›ÛÙÔȯ·, ÙÔ ·È‰› ıˆڋıËΠÏ‹Úˆ˜ ÂÌ‚ÔÏÈ·Ṳ̂ÓÔ. ™ÙËÓ ÙÚ›ÙË ÔÌ¿‰·, Ù¤ÏÔ˜, Ï‹Úˆ˜ ÂÌ‚ÔÏÈ·Ṳ̂ӷ ıˆڋıËÎ·Ó Ù· ·È‰È¿ Ô˘ ›¯·Ó οÓÂÈ fiÏ· Ù· ÂÌ‚fiÏÈ· Ô˘ ·ÊÔÚÔ‡Û·Ó ÛÙË ‰Â‡ÙÂÚË ÔÌ¿‰· ηÈ, ÂÈϤÔÓ, Ì›· ‰fiÛË ‰ÈÏÔ‡ ÂÌ‚ÔÏ›Ô˘ ‰ÈÊıÂÚ›Ùȉ·˜-ÙÂÙ¿ÓÔ˘, ·ÏÔ‡ (DT) ‹ Ù‡Ô˘ ÂÓËÏ›ÎÔ˘ (Td). ∆Ô ÂÌ‚fiÏÈÔ ·˘Ùfi Û˘ÓÈÛÙ¿Ù·È Ó· Á›ÓÂÙ·È ÌÂٷ͇ 14 Î·È 16 ÂÙÒÓ. °È· ·˘ÙfiÓ ÙÔÓ ÏfiÁÔ, Ë ÙÚ›ÙË ÔÌ¿‰· ÔÚ›ÛÙËΠӷ ÂÚÈÏ·Ì‚¿ÓÂÈ ¿ÙÔÌ· ËÏÈΛ·˜ 17-18 ÂÙÒÓ, Ù· ÔÔ›· ı· Ú¤ÂÈ Ó· ¤¯Ô˘Ó οÓÂÈ Ì›· ‰fiÛË Td ‹ DT. ∂›Ó·È, ‚¤‚·È·, ÁÓˆÛÙfi fiÙÈ ÛÙË ¯ÒÚ· Ì·˜ Ù· ÌÔÓÔ‰‡Ó·Ì· ÂÌ‚fiÏÈ· ηٿ Ù˘ ÈÏ·Ú¿˜, Ù˘ ÂÚ˘ıÚ¿˜ Î·È Ù˘ ·ÚˆÙ›Ùȉ·˜ ¤¯Ô˘Ó ·ÓÙÈηٷÛÙ·ı› Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ·fi ÙÔ ÙÚȉ‡Ó·ÌÔ MMR. øÛÙfiÛÔ, ·Ó·Ê¤ÚÔÓÙ·È ·Ú·¿Óˆ ˆ˜ Èı·Ófi˜ ÙÚfiÔ˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Î·È ÁÈ· ÙȘ ÙÚÂȘ ËÏÈÎȷΤ˜ ÔÌ¿‰Â˜, ηıÒ˜ fiˆ˜ ·Ó·Ê¤ÚıËÎÂ, ÛÙË ÌÂϤÙË Û˘ÌÌÂÙ›¯·Ó Î·È Ì·ıËÙ¤˜ Ô˘ ÂÌ‚ÔÏÈ¿ÛÙËÎ·Ó ·Ú¯Èο Û ¿ÏϘ ¯ÒÚ˜, fiÔ˘ Ù· ÌÔÓÔ‰‡Ó·Ì· ÂÌ‚fiÏÈ· ÂÍ·ÎÔÏÔ˘ıÔ‡Ó Ó· ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È (fiˆ˜, ÁÈ· ·Ú¿‰ÂÈÁÌ·, Ë ∞Ï‚·Ó›· Î·È Ë ƒˆÛ›·). ∂Í¿ÏÏÔ˘, ÌÔÓÔ‰‡Ó·Ì· ÂÌ‚fiÏÈ· ·Ú·ÙËÚ‹ıËÎ·Ó Î·È ÛÙ· ‚È‚ÏÈ¿ÚÈ· ÔÏÏÒÓ Ì·ıËÙÒÓ ÙÔ˘ Ï˘Î›Ԣ, ηıÒ˜ Ù· ·È‰È¿ ·˘Ù¿ ›¯·Ó ÂÌ‚ÔÏÈ·ÛÙ› ·ÚÎÂÙ¿ ¯ÚfiÓÈ· ÚÈÓ, fiÙ·Ó Î·È ÛÙËÓ ∂ÏÏ¿‰· ÁÈÓfiÙ·Ó Â˘Ú›· ¯Ú‹ÛË ÙˆÓ ÌÔÓÔ‰‡Ó·ÌˆÓ Î·È fi¯È ÙÔ˘ ÙÚȉ‡Ó·ÌÔ˘ ÂÌ‚ÔÏ›Ô˘.

O ÂÌ‚ÔÏÈ·ÛÌfi˜ ÂÓ¿ÓÙÈ· ÛÙÔÓ ·ÈÌfiÊÈÏÔ ÈÓÊÏÔ˘¤ÓÙÛ·˜ Ù‡Ô˘ b (Hib) ‰ÂÓ ıˆڋıËΠÎÚÈÙ‹ÚÈÔ ÁÈ· Ó· ¯·Ú·ÎÙËÚÈÛÙ› οÔÈÔ ·È‰› ˆ˜ Ï‹Úˆ˜ ÂÌ‚ÔÏÈ·Ṳ̂ÓÔ, ηıÒ˜ ÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ ÂÌ‚fiÏÈÔ Û˘ÌÂÚÈÂÏ‹ÊıË ÛÙÔ ∂ıÓÈÎfi ¶ÚfiÁÚ·ÌÌ· ∂Ì‚ÔÏÈ·ÛÌÒÓ ÌfiÏȘ ÛÙÔ Ù¤ÏÔ˜ ÙÔ˘ 2001, ÔfiÙÂ Ô ˘Ô¯ÚˆÙÈÎfi˜

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ÂÌ‚ÔÏÈ·ÛÌfi˜ ·ÊÔÚ¿ ·ÎfiÌË Û ·È‰È¿ ÌÈÎÚfiÙÂÚ· ÙˆÓ 4 ÂÙÒÓ Ô˘ ‰ÂÓ Û˘ÌÌÂÙ›¯·Ó ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË. ™ÙË Û˘Ó¤¯ÂÈ·, ¤ÁÈÓ ¤ÏÂÁ¯Ô˜ ÁÈ· Ó· ‰È·ÈÛÙˆı› ÙÔ ÔÛÔÛÙfi ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÙˆÓ ·È‰ÈÒÓ ˆ˜ ÚÔ˜ ÙȘ ÚÔ·Ó·ÊÂÚı›Û˜ ÓfiÛÔ˘˜, ÙfiÛÔ Û˘ÓÔÏÈο fiÛÔ Î·È ÁÈ· οı ÔÌ¿‰· ¯ˆÚÈÛÙ¿.

∞ÔÙÂϤÛÌ·Ù· ∆Ô Û‡ÓÔÏÔ ÙˆÓ ·È‰ÈÒÓ, ÛÙ· ‚È‚ÏÈ¿ÚÈ· ÙˆÓ ÔÔ›ˆÓ ¤ÁÈÓ ¤ÏÂÁ¯Ô˜, ‹Ù·Ó 1149 (544 ·ÁfiÚÈ· Î·È 605 ÎÔÚ›ÙÛÈ·). ∆ËÓ ÚÒÙË ÔÌ¿‰· ·ÔÙ¤ÏÂÛ·Ó 199 ·È‰È¿ ËÏÈΛ·˜ 4-6 ÂÙÒÓ, ÙË ‰Â‡ÙÂÚË ÔÌ¿‰· (Ô˘ ·ÔÙ¤ÏÂÛÂ Î·È ÙÔÓ Î‡ÚÈÔ fiÁÎÔ ÙÔ˘ ÏËı˘ÛÌÔ‡ Ù˘ ÌÂϤÙ˘) 799 ·È‰È¿ ËÏÈΛ·˜ 7-16 ÂÙÒÓ Î·È ÙËÓ ÙÚ›ÙË ÔÌ¿‰· 151 ·È‰È¿ ËÏÈΛ·˜ 17-18 ÂÙÒÓ. ¶Ï‹Úˆ˜ ÂÌ‚ÔÏÈ·Ṳ̂ÓÔÈ ‚Ú¤ıËÎ·Ó ÛÙËÓ ÚÒÙË ÔÌ¿‰· 190 Ì·ıËÙ¤˜ (95,5%), ÛÙË ‰Â‡ÙÂÚË 516 (64,6%) Î·È ÛÙËÓ ÙÚ›ÙË 24 (15,9%). ™ÙÔ Û‡ÓÔÏÔ ÙˆÓ Ì·ıËÙÒÓ, 730 ‹Ù·Ó Ï‹Úˆ˜ ÂÌ‚ÔÏÈ·Ṳ̂ÓÔÈ (ÔÛÔÛÙfi 63,5%).

O ¤ÏÂÁ¯Ô˜ ͯˆÚÈÛÙ¿ ÁÈ· ÙËÓ Î¿ı ÓfiÛÔ ¤‰ˆÛ ٷ ·ÎfiÏÔ˘ı· ·ÔÙÂϤÛÌ·Ù· (¶›Ó·Î·˜ 1): ¢ÈÊıÂÚ›Ùȉ· Î·È Ù¤Ù·ÓÔ˜: ™ÙËÓ ÚÒÙË ÔÌ¿‰· ‚Ú¤ıËÎ·Ó 199 ·È‰È¿ Ï‹Úˆ˜ ÂÌ‚ÔÏÈ·Ṳ̂ӷ (100%), ÛÙË ‰Â‡ÙÂÚË 791 (99%) Î·È ÛÙËÓ ÙÚ›ÙË 105 (69,5%). ™˘ÓÔÏÈο, 1095 Ì·ıËÙ¤˜ (95,3%) ‹Ù·Ó Ï‹Úˆ˜ ÂÌ‚ÔÏÈ·Ṳ̂ÓÔÈ ÁÈ· ‰ÈÊıÂÚ›Ùȉ· Î·È Ù¤Ù·ÓÔ. ∫ÔÎ·Ù˘: ™ÙËÓ ÚÒÙË ÔÌ¿‰· ‚Ú¤ıËÎ·Ó 199 ·È‰È¿ Ï‹Úˆ˜ ÂÌ‚ÔÏÈ·Ṳ̂ӷ (100%), ÛÙË ‰Â‡ÙÂÚË 653 (81,7%) Î·È ÛÙËÓ ÙÚ›ÙË 80 (53%). ™˘ÓÔÏÈο, 932 Ì·ıËÙ¤˜ (81,1%) ‹Ù·Ó Ï‹Úˆ˜ ÂÌ‚ÔÏÈ·Ṳ̂ÓÔÈ ÁÈ· ÎÔηÙË. ¶ÔÏÈÔÌ˘ÂÏ›Ùȉ·: ™ÙËÓ ÚÒÙË ÔÌ¿‰· ‚Ú¤ıËÎ·Ó 199 ·È‰È¿ Ï‹Úˆ˜ ÂÌ‚ÔÏÈ·Ṳ̂ӷ (100%), ÛÙË ‰Â‡ÙÂÚË 791 (99%) Î·È ÛÙËÓ ÙÚ›ÙË 151 (100%). ™˘ÓÔÏÈο, 1141 Ì·ıËÙ¤˜ (99,3%) ‹Ù·Ó Ï‹Úˆ˜ ÂÌ‚ÔÏÈ·Ṳ̂ÓÔÈ ÁÈ· ÔÏÈÔÌ˘ÂÏ›Ùȉ·. πÏ·Ú¿: ™ÙËÓ ÚÒÙË ÔÌ¿‰· ‚Ú¤ıËÎ·Ó 197 ·È‰È¿ Ï‹Úˆ˜ ÂÌ‚ÔÏÈ·Ṳ̂ӷ (99%), ÛÙË ‰Â‡ÙÂÚË 692 (86,6%) Î·È ÛÙËÓ ÙÚ›ÙË 128 (84,8%). ™˘ÓÔÏÈο, 1017 Ì·ıËÙ¤˜ (88,5%) ‹Ù·Ó Ï‹Úˆ˜ ÂÌ‚ÔÏÈ·Ṳ̂ÓÔÈ ÁÈ· ÈÏ·Ú¿. ∂Ú˘ıÚ¿: ™ÙËÓ ÚÒÙË ÔÌ¿‰· ‚Ú¤ıËÎ·Ó 196 ¶›Ó·Î·˜ 1. ¶ÔÛÔÛÙ¿ ÂÌ‚ÔÏÈ·ÛÌ¤ÓˆÓ ·È‰ÈÒÓ ÁÈ· οı ÓfiÛÔ, ͯˆÚÈÛÙ¿ Î·È Û˘ÓÔÏÈο, ηٿ ËÏÈÎȷΤ˜ ÔÌ¿‰Â˜ 4-6 ÂÙÒÓ 7-16 ÂÙÒÓ 17-18 ÂÙÒÓ ™‡ÓÔÏÔ ¢ÈÊıÂÚ›Ùȉ· ∆¤Ù·ÓÔ˜ ∫ÔÎ·Ù˘ ¶ÔÏÈÔÌ˘ÂÏ›Ùȉ· πÏ·Ú¿ ∂Ú˘ıÚ¿ ¶·ÚˆÙ›Ùȉ· º˘Ì·Ù›ˆÛË ∏·Ù›Ùȉ· µ

100% 100% 100% 100% 99% 98,5% 98,5% 96,5%

99% 99% 81,7% 99% 86,6% 83,6% 84,7% 94% 91,4%

69,5% 69,5% 53% 100% 84,8% 44,4% 75,5% 94,7% 84,1%

95,3% 95,3% 81,1% 99,3% 88,5% 81% 85,9% 94,1% 91,3%

¶·È‰È·ÙÚÈ΋ 2004;67:120-125

·È‰È¿ Ï‹Úˆ˜ ÂÌ‚ÔÏÈ·Ṳ̂ӷ (98,5%), ÛÙË ‰Â‡ÙÂÚË 668 (83,6%) Î·È ÛÙËÓ ÙÚ›ÙË 67 (44,4%). ™˘ÓÔÏÈο, 931 Ì·ıËÙ¤˜ (81%) ‹Ù·Ó Ï‹Úˆ˜ ÂÌ‚ÔÏÈ·Ṳ̂ÓÔÈ ÁÈ· ÂÚ˘ıÚ¿. ¶·ÚˆÙ›Ùȉ·: ™ÙËÓ ÚÒÙË ÔÌ¿‰· ‚Ú¤ıËÎ·Ó 196 ·È‰È¿ Ï‹Úˆ˜ ÂÌ‚ÔÏÈ·Ṳ̂ӷ (98,5%), ÛÙË ‰Â‡ÙÂÚË 677 (84,7%) Î·È ÛÙËÓ ÙÚ›ÙË 114 (75,5%). ™˘ÓÔÏÈο, 987 Ì·ıËÙ¤˜ (85,9%) ‹Ù·Ó Ï‹Úˆ˜ ÂÌ‚ÔÏÈ·Ṳ̂ÓÔÈ ÁÈ· ·ÚˆÙ›Ùȉ·. º˘Ì·Ù›ˆÛË: ∆· ·È‰È¿ Ù˘ ÚÒÙ˘ ÔÌ¿‰·˜, ÏfiÁˆ ËÏÈΛ·˜, ‰ÂÓ Â›¯·Ó ·ÎfiÌ· ÂÌ‚ÔÏÈ·ÛÙ› Ì BCG. ™ÙË ‰Â‡ÙÂÚË ÔÌ¿‰· ‚Ú¤ıËÎ·Ó 751 ·È‰È¿ Ï‹Úˆ˜ ÂÌ‚ÔÏÈ·Ṳ̂ӷ (94%), ÂÓÒ ÛÙËÓ ÙÚ›ÙË 143 (94,7%). ™˘ÓÔÏÈο, ·fi ÙË ‰Â‡ÙÂÚË Î·È ÙËÓ ÙÚ›ÙË ÔÌ¿‰·, 894 Ì·ıËÙ¤˜ (94,1%) ‹Ù·Ó Ï‹Úˆ˜ ÂÌ‚ÔÏÈ·Ṳ̂ÓÔÈ ÁÈ· Ê˘Ì·Ù›ˆÛË. ∏·Ù›Ùȉ· µ: ™ÙËÓ ÚÒÙË ÔÌ¿‰· ‚Ú¤ıËÎ·Ó 192 ·È‰È¿ Ï‹Úˆ˜ ÂÌ‚ÔÏÈ·Ṳ̂ӷ (96,5%), ÛÙË ‰Â‡ÙÂÚË 730 (91,4%) Î·È ÛÙËÓ ÙÚ›ÙË 127 (84,1%). ™˘ÓÔÏÈο, 1049 Ì·ıËÙ¤˜ (91,3%) ‹Ù·Ó Ï‹Úˆ˜ ÂÌ‚ÔÏÈ·Ṳ̂ÓÔÈ ÁÈ· Ë·Ù›Ùȉ· µ. ™˘˙‹ÙËÛË ∫¿ı ¯ÚfiÓÔ ÛÙȘ ·Ó·Ù˘ÛÛfiÌÂÓ˜ ¯ÒÚ˜ Âı·›ÓÔ˘Ó ÂÚ›Ô˘ 5.000.000 ‚Ú¤ÊË ·fi ÏÔÈÌÒ‰Ë ÓÔÛ‹Ì·Ù· Ô˘ ı· ÌÔÚÔ‡Û·Ó Ó· ÚÔÏËÊıÔ‡Ó Ì ÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi. ∂Í¿ÏÏÔ˘, ÛÙȘ ·ÓÂÙ˘Á̤Ó˜ ¯ÒÚ˜, Ë Ì›ˆÛË ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ÓfiÛˆÓ Î·ÙfiÈÓ Û˘ÛÙËÌ·ÙÈÎÔ‡ ÂÌ‚ÔÏÈ·ÛÌÔ‡, ›¯Â Û·Ó ·ÔÙ¤ÏÂÛÌ· Ó· ÌÂȈıÔ‡Ó Û ÌÂÚÈΤ˜ ·fi ·˘Ù¤˜ ÔÈ ‰Â›ÎÙ˜ ÂÊ·ÚÌÔÁ‹˜ ÙˆÓ ÂÌ‚ÔÏÈ·ÛÌÒÓ (3). ∏ ∂ÏÏ¿‰· ‰È·ı¤ÙÂÈ ÙËÓ ˘ÁÂÈÔÓÔÌÈ΋ ˘Ô‰ÔÌ‹ ÁÈ· Ï‹ÚË ·ÓÔÛÔÔ›ËÛË ÙÔ˘ ÏËı˘ÛÌÔ‡ Ù˘ ηٿ ÙˆÓ ÓfiÛˆÓ ÁÈ· ÙȘ Ôԛ˜ ˘¿Ú¯Ô˘Ó ÂÌ‚fiÏÈ· (4). °È· ÙËÓ Â›Ù¢ÍË ÙÔ˘ ÛÙfi¯Ô˘ ·˘ÙÔ‡, ˆÛÙfiÛÔ, ··ÈÙÂ›Ù·È Û˘Ó¯‹˜ ÚÔÛ¿ıÂÈ· Î·È ·ÎÚÈ‚‹˜ ·ÔÙ‡ˆÛË Ù˘ ηٿÛÙ·Û˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÙˆÓ Ó¤ˆÓ Ù˘ ¯ÒÚ·˜ Ì·˜. ∆· ÛÙÔȯ›· Ô˘ ÚԤ΢„·Ó ηٿ ÙÔÓ ¤ÏÂÁ¯Ô ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÙˆÓ Ì·ıËÙÒÓ ÙÔ˘ ÕÚÁÔ˘˜ OÚÂÛÙÈÎÔ‡ Â›Ó·È Ì¿ÏÏÔÓ ÂÓı·ÚÚ˘ÓÙÈο, ȉȷ›ÙÂÚ· fiÛÔÓ ·ÊÔÚ¿ ÛÙ· ¿ÙÔÌ· ÌÈÎÚfiÙÂÚ˘ ËÏÈΛ·˜. ™˘ÓÔÏÈο, ÔÛÔÛÙfi 63,5% ÙˆÓ Ì·ıËÙÒÓ ‹Ù·Ó Ï‹Úˆ˜ ÂÌ‚ÔÏÈ·Ṳ̂ÓÔ. ¶ÈÔ Û˘ÁÎÂÎÚÈ̤ӷ: ∆· ÔÛÔÛÙ¿ Î¿Ï˘„˘ ÁÈ· ÙË ‰ÈÊıÂÚ›Ùȉ· Î·È ÙÔÓ Ù¤Ù·ÓÔ ‹Ù·Ó ȉȷ›ÙÂÚ· ÈηÓÔÔÈËÙÈο ÁÈ· ÙËÓ ÚÒÙË (100%) Î·È ÙË ‰Â‡ÙÂÚË (99%) ËÏÈÎȷ΋ ÔÌ¿‰·. °È· Ù· ·È‰È¿ Ù˘ ÙÚ›Ù˘ ÔÌ¿‰·˜, ÙÔ ÔÛÔÛÙfi ‹Ù·Ó 69,5%. ∏ Ì›ˆÛË ·˘Ù‹ ÔÊ›ÏÂÙ·È ÛÙËÓ ¤ÏÏÂÈ„Ë Ù˘ ¤ÎÙ˘ Â·Ó·ÏËÙÈ΋˜ ‰fiÛ˘ ÙÔ˘ Td Û ÔÚÈṲ̂ӷ ·fi Ù· ·È‰È¿ ÙÔ˘ Ï˘Î›Ԣ. ∆Ô ÔÛÔÛÙfi Î¿Ï˘„˘ Â›Ó·È ˘„ËÏfiÙÂÚÔ ·fi ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô Û ·ÓÂÏÏ·‰ÈÎfi Â›Â‰Ô (55% ÙˆÓ ÂÊ‹‚ˆÓ Â›Ó·È Î·Ï˘Ì̤ÓÔ ¤Ó·ÓÙÈ ÙÔ˘ ÙÂÙ¿ÓÔ˘ Î·È 41,5% ¤Ó·ÓÙÈ Ù˘ ‰ÈÊıÂÚ›Ùȉ·˜) (1).

Paediatriki 2004;67:120-125

£· Ú¤ÂÈ, ˆÛÙfiÛÔ, Ó· ÂÓÙ·ı› Ë ÚÔÛ¿ıÂÈ· Î¿Ï˘„˘ ÙˆÓ ÂÊ‹‚ˆÓ, ηıÒ˜ ˘¿Ú¯ÂÈ Î›Ó‰˘ÓÔ˜ ÂȉËÌ›·˜ ‰ÈÊıÂÚ›Ùȉ·˜ ·fi ÂÈÛ·ÁˆÁ‹ ÎÚÔ˘ÛÌ¿ÙˆÓ ·fi ÙËÓ ∆Ô˘ÚΛ· Î·È ÙȘ ¯ÒÚ˜ Ù˘ ÚÒËÓ ™Ô‚ÈÂÙÈ΋˜ ŒÓˆÛ˘ (ȉȷ›ÙÂÚ· ÙË ƒˆÛ›· Î·È ÙËÓ O˘ÎÚ·Ó›·), fiÔ˘ Ë ÂȉËÌ›· ‰ÈÊıÂÚ›Ùȉ·˜ ¤¯ÂÈ Ï¿‚ÂÈ ·ÚÔÛ‰fiÎËÙ˜ ‰È·ÛÙ¿ÛÂȘ (5). ™¯ÂÙÈο Ì ٷ Â›‰· Î¿Ï˘„˘ ÂÓ¿ÓÙÈ· ÛÙÔÓ ÎÔηÙË, Ù· ·È‰È¿ Ù˘ ÚÒÙ˘ ÔÌ¿‰·˜ ‹Ù·Ó fiÏ· ÂÌ‚ÔÏÈ·Ṳ̂ӷ (100%), ÔÛÔÛÙfi 81,7% ÙˆÓ ·È‰ÈÒÓ Ù˘ ‰Â‡ÙÂÚ˘, ÂÓÒ ÌfiÓÔ ÙÔ 53% Ù˘ ÙÚ›Ù˘ ÔÌ¿‰·˜ ‹Ù·Ó Ï‹Úˆ˜ ÂÌ‚ÔÏÈ·Ṳ̂ÓÔ. ∆Ô ¯·ÌËÏfi ÔÛÔÛÙfi Î¿Ï˘„˘ ηٿ ÙÔ˘ ÎÔηÙË ÛÙȘ ÌÂÁ·Ï‡ÙÂÚ˜ ËÏÈ˘ ÔÊ›ÏÂÙ·È Î˘Ú›ˆ˜ ÛÙËÓ ÂÛÊ·Ï̤ÓË ·ÓÙ›ÏË„Ë ÌÈÎÚÔ‡ ·ÚÈıÌÔ‡ ÁÔÓ¤ˆÓ Î·È ıÂÚ·fiÓÙˆÓ Û¯ÂÙÈο Ì ÙËÓ ·ÛÊ¿ÏÂÈ· ÙÔ˘ ·ÓÙÈÎÔÎ΢ÙÈÎÔ‡ ÂÌ‚ÔÏ›Ô˘. ∞ÔÙ¤ÏÂÛÌ· ‹Ù·Ó Ó· ÌËÓ ˘¿Ú¯ÂÈ ÂÓÈ·›Ô Û¯‹Ì· ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÁÈ· ÙÔ˘˜ Ì·ıËÙ¤˜ (ÌfiÓÔ DT ÂÍ·Ú¯‹˜ ‹ ·ÏÏ·Á‹ ÙÔ˘ DTP Û DT ÌÂÙ¿ ÙËÓ ÚÒÙË, ‰Â‡ÙÂÚË, ÙÚ›ÙË ‹, ΢ڛˆ˜, ٤ٷÚÙË ‰fiÛË), ‡ÚËÌ· ›‰ÈÔ Ì ÂΛÓÔ ·ÚfiÌÔÈˆÓ ÌÂÏÂÙÒÓ (6-8). ªÂ ÙÔÓ ÌÂȈ̤ÓÔ ·ÚÈıÌfi ‰fiÛÂˆÓ ÙÔ˘ ÂÌ‚ÔÏ›Ô˘, fï˜, ÔÈ ÂÌ‚ÔÏÈ·˙fiÌÂÓÔÈ Â›Ù ‰ÂÓ ·ÔÎÙÔ‡Ó Î·Ì›· ·ÓÔÛ›·, ›Ù ·˘Ù‹ Ô˘ ·ÔÎÙÔ‡Ó Â›Ó·È ‚Ú·¯‡‚È·. ŒÙÛÈ, Î·È ÔÈ ›‰ÈÔÈ Ì¤ÓÔ˘Ó ·Î¿Ï˘ÙÔÈ ·¤Ó·ÓÙÈ ÛÙË ÓfiÛÔ, ·ÏÏ¿ Î·È ÂÈÙÚ¤ÂÙ·È Ë ‰È·ÛÔÚ¿ ÙÔ˘ ÌÈÎÚÔ‚›Ô˘ ÛÙÔ ÂÚÈ‚¿ÏÏÔÓ ÙÔ˘˜ (9). ∆· ÔÛÔÛÙ¿ Î¿Ï˘„˘ ÂÓ¿ÓÙÈ· ÛÙËÓ ÔÏÈÔÌ˘ÂÏ›Ùȉ· ‹Ù·Ó ȉȷ›ÙÂÚ· ÈηÓÔÔÈËÙÈο (99,3% ÛÙÔ Û‡ÓÔÏÔ ÙÔ˘ Û¯ÔÏÈÎÔ‡ ÏËı˘ÛÌÔ‡). ¢ÂÓ ı· Ú¤ÂÈ, fï˜, ÔÈ ÊÔÚ›˜ ˘Á›·˜ Ó· ÂÊËÛ˘¯¿˙Ô˘Ó, ηıÒ˜ ÙfiÛÔ Û ÁÂÈÙÔÓÈΤ˜ ¯ÒÚ˜ fiÛÔ Î·È Û ÌÂÈÔÓÔÙÈΤ˜ ÔÌ¿‰Â˜ Ù˘ ¯ÒÚ·˜ Ì·˜, Ë ÓfiÛÔ˜ Û˘Ó¯›˙ÂÈ Ó· ·ÔÙÂÏ› Úfi‚ÏËÌ·. ÷ڷÎÙËÚÈÛÙÈο, ÙÔ 1996 ÛÙË ÁÂÈÙÔÓÈ΋ ∞Ï‚·Ó›·, ÂΉËÏÒıËΠÌÂÁ¿ÏË ÂȉËÌ›· ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜ Ì 16 ı·Ó¿ÙÔ˘˜ (10), ÔfiÙ ηٷÁÚ¿ÊËÎ·Ó 5 ÎÚÔ‡ÛÌ·Ù· Î·È ÛÙËÓ ∂ÏÏ¿‰·, fiÏ· Û ÏËı˘ÛÌÔ‡˜ ·ıÈÁÁ¿ÓˆÓ (11). ∆Ô ÔÛÔÛÙfi ÂÌ‚ÔÏÈ·ÛÙÈ΋˜ Î¿Ï˘„˘ ηٿ Ù˘ ÈÏ·Ú¿˜ ‹Ù·Ó Ôχ ˘„ËÏfi ÁÈ· ÙËÓ ÚÒÙË ËÏÈÎȷ΋ ÔÌ¿‰· (99%), ÂÓÒ ÛÙȘ ÌÂÁ·Ï‡ÙÂÚ˜ ËÏÈ˘ ‹Ù·Ó ÂÚ›Ô˘ 85%. ∫·ıÒ˜, ÚÔÎÂÈ̤ÓÔ˘ Ó· ‰È·ÎÔ› Ë Î˘ÎÏÔÊÔÚ›· ÙÔ˘ ÈÔ‡ Î·È Ó· ÂÍ·Ê·ÓÈÛÙÔ‡Ó ÔÈ ÂȉË̛˜, ÙÔ ÔÛÔÛÙfi ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÛÙ· ·È‰È¿ ËÏÈΛ·˜ 1-14 ÂÙÒÓ Ú¤ÂÈ Ó· Â›Ó·È ÂÚ› ÙÔ 95% (12), Á›ÓÂÙ·È Ê·ÓÂÚ‹ Ë ·Ó¿ÁÎË ÁÈ· ÂÚ·ÈÙ¤Úˆ ‚ÂÏÙ›ˆÛË ÙˆÓ ·Ú·¿Óˆ ÔÛÔÛÙÒÓ. ∂›Ó·È ··Ú·›ÙËÙË, Â›Û˘, Ë ÂÓ›Û¯˘ÛË ÙˆÓ ÚÔÛ·ıÂÈÒÓ Â·ÚÎÔ‡˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÙˆÓ ·ÙfiÌˆÓ ÌÂÁ·Ï‡ÙÂÚ˘ ËÏÈΛ·˜, ηıÒ˜ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÛÙË ¯ÒÚ· Ì·˜ ·Ú·ÙËÚ‹ıËΠ̛· ·Ó·ÌÂÓfiÌÂÓË ·‡ÍËÛË Ù˘ ËÏÈΛ·˜ ÓfiÛËÛ˘ ·fi ÈÏ·Ú¿. ∫·Ù¿ ÙËÓ ÙÂÏÂ˘Ù·›· ÛËÌ·ÓÙÈ΋ ÂȉËÌ›· ÈÏ·Ú¿˜, ÙÔ 1996, ÓfiÛËÛ·Ó ÓÂÔÁÓ¿, ‚Ú¤ÊË, ·È‰È¿, ¤ÊË‚ÔÈ Î·È ÂÓ‹ÏÈΘ (13), ÌÂٷ͇ ÙˆÓ ÔÔ›ˆÓ Î·È ·ÚÎÂÙÔ›

123

¶·È‰È·ÙÚÈ΋ 2004;67:120-125

ÛÙÚ·ÙÈÒÙ˜ (14). ∆¤ÏÔ˜, ··Ú·›ÙËÙÔ˜ Â›Ó·È Ô ¤ÏÂÁ¯Ô˜ Î·È ÂÌ‚ÔÏÈ·ÛÌfi˜ ÔÈÎÔÓÔÌÈÎÒÓ ÌÂÙ·Ó·ÛÙÒÓ ·fi ÙË ÁÂÈÙÔÓÈ΋ ∞Ï‚·Ó›·, fiÔ˘ Ë ·Ô˘Û›· ˘Ô¯ÚˆÙÈ΋˜ ‰Â‡ÙÂÚ˘ ‰fiÛ˘ ÂÌ‚ÔÏ›Ô˘ ÂÓ¿ÓÙÈ· ÛÙËÓ ÈÏ·Ú¿ (ÛÙÔÈ¯Â›Ô Ô˘ ‰È·ÈÛÙÒıËÎÂ Î·È ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË) ηıÈÛÙ¿ ·ÌÊ›‚ÔÏË ÙËÓ Â·Ú΋ ·ÓÔÛÔÔ›ËÛË ÙˆÓ ·ÙfiÌˆÓ ·˘ÙÒÓ (15). ∆· ÔÛÔÛÙ¿ Î¿Ï˘„˘ ÁÈ· ÙËÓ ÂÚ˘ıÚ¿, ÂÓÒ ‹Ù·Ó ÈηÓÔÔÈËÙÈο ÁÈ· Ù· ¿ÙÔÌ· ÌÈÎÚ‹˜ ËÏÈΛ·˜, ÌÂÈÒÓÔÓÙ·Ó ÛËÌ·ÓÙÈο ÛÙȘ ÌÂÁ·Ï‡ÙÂÚ˜ ËÏÈ˘, ηıÒ˜ ÌfiÓÔ ÙÔ 44,4% ÙˆÓ ·ÙfiÌˆÓ ËÏÈΛ·˜ 17-18 ÂÙÒÓ ‹Ù·Ó Î·Ï˘Ì̤ÓÔ. ∞ÚÎÂÙÔ› Ì·ıËÙ¤˜ ‰ÂÓ Â›¯·Ó ÂÌ‚ÔÏÈ·ÛÙ› Ì ÙË ‰Â‡ÙÂÚË ‰fiÛË ÙÔ˘ MMR ‹ ›¯·Ó ·Ú·Ï›„ÂÈ ÂÍ ÔÏÔÎÏ‹ÚÔ˘ ÙȘ ‰‡Ô ‰fiÛÂȘ ÙÔ˘ ÌÔÓÔ‰‡Ó·ÌÔ˘ ÂÌ‚ÔÏ›Ô˘ ηٿ Ù˘ ÂÚ˘ıÚ¿˜. ∂›Ó·È ÁÓˆÛÙfi fiÙÈ Ô ÚˆÙÔÊ·Ó‹˜ ·ÚÈıÌfi˜ ÎÚÔ˘ÛÌ¿ÙˆÓ Û˘ÁÁÂÓÔ‡˜ ÂÚ˘ıÚ¿˜ ÛÙË ¯ÒÚ· Ì·˜ ÌÂÙ¿ ÙËÓ ÂȉËÌ›· ÂÚ˘ıÚ¿˜ ÙÔ 1993, ÔÊÂÈÏfiÙ·Ó ÛÙËÓ ·‡ÍËÛË Ù˘ ̤Û˘ ËÏÈΛ·˜ ÓfiÛËÛ˘ ÛÙÔÓ ÁÂÓÈÎfi ÏËı˘ÛÌfi, Ô˘ Ô‰‹ÁËÛ ÛÙËÓ ·‡ÍËÛË ÙÔ˘ ·fiÏ˘ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ Â›ÓÔÛˆÓ Á˘Ó·ÈÎÒÓ ·Ó··Ú·ÁˆÁÈ΋˜ ËÏÈΛ·˜ (1). ¡¤· ÂȉËÌ›· ÂÚ˘ıÚ¿˜ ÌÂٷ͇ ÂÓËÏ›ÎˆÓ ÛËÌÂÈÒıËΠÙËÓ ¿ÓÔÈÍË ÙÔ˘ 1999 (9).

O ΛӉ˘ÓÔ˜ ÁÈ· Ì›· ÌÂÏÏÔÓÙÈ΋ ·ÚfiÌÔÈ· ÂȉËÌ›· ‰ÂÓ ÚfiÎÂÈÙ·È Ó· ÂÎÏ›„ÂÈ, ·Ó ‰ÂÓ ÏËÊıÔ‡Ó Ì¤ÙÚ· Â·ÚÎÔ‡˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÙˆÓ ·ÙfiÌˆÓ (΢ڛˆ˜ ÎÔÚÈÙÛÈÒÓ) ÂÊË‚È΋˜ ËÏÈΛ·˜ Î·È ÙˆÓ Á˘Ó·ÈÎÒÓ ·Ó··Ú·ÁˆÁÈ΋˜ ËÏÈΛ·˜, ·ÏÏ¿ Î·È ÙÔ˘ Û˘ÓfiÏÔ˘ ÙÔ˘ ·È‰ÈÎÔ‡ ÏËı˘ÛÌÔ‡, Ì ÛÙfi¯Ô ÙË ‰È·ÎÔ‹ ΢ÎÏÔÊÔÚ›·˜ ÙÔ˘ ÈÔ‡. ∆· ÔÛÔÛÙ¿ Î¿Ï˘„˘ ÁÈ· ÙËÓ ·ÚˆÙ›Ùȉ· ·ÎÔÏÔ˘ıÔ‡Ó ·˘Ù¿ Ù˘ ÈÏ·Ú¿˜, ·ÏÏ¿ ÌÂÈÒÓÔÓÙ·È Û οÔÈÔ ‚·ıÌfi ÛÙËÓ ÙÚ›ÙË ËÏÈÎȷ΋ ÔÌ¿‰·, ÏfiÁˆ ·ÒÏÂÈ·˜ Ù˘ ‰Â‡ÙÂÚ˘ ‰fiÛ˘ ÙÔ˘ ·ÓÙ›ÛÙÔÈ¯Ô˘ ÌÔÓÔ‰‡Ó·ÌÔ˘ ÂÌ‚ÔÏ›Ô˘ (ÙÔ ÔÔ›Ô ‹Ù·Ó ·ÎfiÌË Û ¯Ú‹ÛË fiÙ·Ó ÂÌ‚ÔÏÈ¿ÛÙËÎ·Ó Ù· ·È‰È¿ ·˘Ù¿). µ¤‚·È·, ÙÔ ÛÙÔÈ¯Â›Ô ·˘Ùfi ÛÙ·‰È·Î¿ ı· ÂÎÏ›„ÂÈ ÏfiÁˆ Ù˘ ¯Ú‹Û˘ ϤÔÓ ÙÔ˘ ÙÚȉ‡Ó·ÌÔ˘ MMR, ÂÊfiÛÔÓ ÂÍ·ÛÊ·Ï›˙ÂÙ·È Ô ÂÌ‚ÔÏÈ·ÛÌfi˜ Ì ÙȘ ‰‡Ô ··ÈÙÔ‡ÌÂÓ˜ ‰fiÛÂȘ. ™¯ÂÙÈο Ì ÙË Ê˘Ì·Ù›ˆÛË, ÙÔ ÔÛÔÛÙfi ÂÌ‚ÔÏÈ·ÛÌÔ‡ Ì BCG ÁÈ· ÙÔ Û‡ÓÔÏÔ ÙˆÓ Ì·ıËÙÒÓ ‹Ù·Ó 94,1%, Ôχ ˘„ËÏfiÙÂÚÔ ·fi ÂΛÓÔ Ô˘ ‚Ú¤ıËΠ۠·ÓÂÏÏ·‰È΋ ¤Ú¢ӷ (39% ÁÈ· Ù· ·È‰È¿ Ù˘ ∞’ ¢ËÌÔÙÈÎÔ‡ Î·È 68% ÁÈ· Ù· ·È‰È¿ Ù˘ °’ °˘ÌÓ·Û›Ô˘) (8). µ¤‚·È·, Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙÔ˘ Û˘ÁÎÂÎÚÈ̤ÓÔ˘ ÂÌ‚ÔÏ›Ô˘ ÂÓ¿ÓÙÈ· ÛÙËÓ Ó¢ÌÔÓÈ΋ Ê˘Ì·Ù›ˆÛË ·ÌÊÈÛ‚ËÙÂ›Ù·È Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· (16). O ÂÌ‚ÔÏÈ·ÛÌfi˜ Ì BCG ı· Ú¤ÂÈ Ó· ·ÔÙÂÏ› ÙÌ‹Ì· ÂÓfi˜ ÔÏÔÎÏËڈ̤ÓÔ˘ ·ÓÙÈÊ˘Ì·ÙÈÎÔ‡ ÚÔÁÚ¿ÌÌ·ÙÔ˜, ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂÏÂÁ¯ı› Ë Ó¤· ·ÁÎfiÛÌÈ· ¤Í·ÚÛË Ù˘ ÓfiÛÔ˘ (17). ŸÛÔÓ ·ÊÔÚ¿ ÛÙËÓ Ë·Ù›Ùȉ· µ, Ù· ÔÛÔÛÙ¿ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ‹Ù·Ó ȉȷ›ÙÂÚ· ÈηÓÔÔÈËÙÈο, ·Ó Î·È ÌÂÈ-

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ÒÓÔÓÙ·Ó ÂÏ·ÊÚ¿ Ì ÙËÓ ·‡ÍËÛË Ù˘ ËÏÈΛ·˜. ™ÙÔ Û‡ÓÔÏÔ, ÙÔ 91,3% ÙˆÓ ·È‰ÈÒÓ Â›Ó·È ÂÌ‚ÔÏÈ·Ṳ̂ÓÔ, Û ۇÁÎÚÈÛË Ì ÙÔ 58% ÙˆÓ Ì·ıËÙÒÓ Ù˘ ∞’ ¢ËÌÔÙÈÎÔ‡ Î·È ÙÔ 46% ÙˆÓ Ì·ıËÙÒÓ Ù˘ °’ °˘ÌÓ·Û›Ô˘ Û ·ÓÂÏÏ·‰ÈÎfi Â›Â‰Ô (8). ∂¿Ó ÏËÊı› ˘’ fi„ÈÓ fiÙÈ ÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ ÂÌ‚fiÏÈÔ ÂÓÙ¿¯ıËΠÛÙÔ ∂ıÓÈÎfi ¶ÚfiÁÚ·ÌÌ· ∂Ì‚ÔÏÈ·ÛÌÒÓ ÙÔ ÊıÈÓfiˆÚÔ ÙÔ˘ 1997 ÁÈ· fiÏ· Ù· ‚Ú¤ÊË Î·È Ù· ‰ˆ‰Âο¯ÚÔÓ· ·È‰È¿, Ù· ˘„ËÏ¿ ÔÛÔÛÙ¿ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‰Â›¯ÓÔ˘Ó fiÙÈ Ì›· ‰Ú·ÛÙ‹ÚÈ· ÔÌ¿‰· ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÌÔÚ› Û ÌÈÎÚfi ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· Ó· ¤¯ÂÈ ÈηÓÔÔÈËÙÈο ·ÔÙÂϤÛÌ·Ù·.

O ÂÌ‚ÔÏÈ·ÛÌfi˜ ÂÓ¿ÓÙÈ· ÛÙÔÓ ·ÈÌfiÊÈÏÔ ÈÓÊÏÔ˘¤ÓÙÛ·˜ Ù‡Ô˘ b ›¯Â ·Ú¯›ÛÂÈ, ¯ˆÚ›˜ Û˘ÛÙËÌ·ÙÈÎfiÙËÙ·, ·fi ÙÔ 1994 Î·È ÌfiÏȘ ÛÙÔ Ù¤ÏÔ˜ ÙÔ˘ 2001 Û˘ÌÂÚÈÂÏ‹ÊıË ˆ˜ ˘Ô¯ÚˆÙÈÎfi˜ ÛÙÔ ∂ıÓÈÎfi ¶ÚfiÁÚ·ÌÌ· ∂Ì‚ÔÏÈ·ÛÌÒÓ (ÚÔÛˆÈ΋ ÂÈÎÔÈÓˆÓ›·, πÓÛÙÈÙÔ‡ÙÔ ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡). ∂›Ó·È ÏÔÁÈÎfi, ÂÔ̤ӈ˜, Ó· ˘¿Ú¯ÂÈ ·ÓÔÌÔÈÔÁ¤ÓÂÈ· ÛÙ· ÔÛÔÛÙ¿ Î¿Ï˘„˘ ÁÈ· ÙȘ ‰È¿ÊÔÚ˜ ËÏÈÎȷΤ˜ ÔÌ¿‰Â˜. ŒÙÛÈ, 146 ·fi Ù· 199 ·È‰È¿ ËÏÈΛ·˜ ¤ˆ˜ 6 ÂÙÒÓ (73,4%) ‚Ú¤ıËÎ·Ó ÂÌ‚ÔÏÈ·Ṳ̂ӷ [ÔÛÔÛÙfi Ôχ ˘„ËÏfi Û ۯ¤ÛË Ì ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ·ÓÂÏÏ·‰ÈÎfi Ô˘ Ê·›ÓÂÙ·È Ó· Î˘Ì·›ÓÂÙ·È ·fi 15% (8) ¤ˆ˜ 26,5% (18)], ÂÓÒ ·fi Ù· ·È‰È¿ ËÏÈΛ·˜ 7-16 ÂÙÒÓ, ÙÔ 30,2% (241 ·fi Ù· 799) ›¯Â ÂÌ‚ÔÏÈ·ÛÙ›. ∆¤ÏÔ˜, ¤Ó· ÌÈÎÚfi ÔÛÔÛÙfi Ì·ıËÙÒÓ Â›¯Â ÂÌ‚ÔÏÈ·ÛÙ› ÂÓ¿ÓÙÈ· ÛÙÔÓ ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ (19,7% Û˘ÓÔÏÈο) Î·È ¤Ó· ÂÏ¿¯ÈÛÙÔ ÔÛÔÛÙfi ÂÓ¿ÓÙÈ· ÛÙËÓ Ë·Ù›Ùȉ· ∞ (3,5%). ∆· ÂÌ‚fiÏÈ· ·˘Ù¿ ‰ÂÓ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÛÙÔ ∂ıÓÈÎfi ¶ÚfiÁÚ·ÌÌ· ∂Ì‚ÔÏÈ·ÛÌÒÓ, Ô‡ÙÂ Û˘ÓÈÛÙÒÓÙ·È ÁÈ· ÂÌ‚ÔÏÈ·ÛÌfi ÚÔ˘Ù›Ó·˜ ÙˆÓ ·È‰ÈÒÓ (9). øÛÙfiÛÔ, ‰ÈηÈÔÏÔÁÂ›Ù·È Ë ‰ÈÂÓ¤ÚÁÂÈ¿ ÙÔ˘˜ Û ·È‰È¿ ·˘ÍË̤ÓÔ˘ ÎÈÓ‰‡ÓÔ˘, ·ÚΛ Ó· ÌË Á›ÓÔÓÙ·È Û ‚¿ÚÔ˜ ÙˆÓ ˘Ô¯ÚˆÙÈÎÒÓ ÂÌ‚ÔÏ›ˆÓ. ™¯ÂÙÈο Ì ٷ ·È‰È¿ Ô˘ ·Ó‹Î·Ó Û ÔÈÎÔÁ¤ÓÂȘ ÌÂÙ·Ó·ÛÙÒÓ ‹ Â·Ó··ÙÚÈÛı¤ÓÙˆÓ ·fi ÙËÓ ∞Ï‚·Ó›·, ·ÍÈÔÛËÌ›ˆÙË ‹Ù·Ó Ë Û¯Â‰fiÓ Ï‹Ú˘ ·Ô˘Û›· ÂÌ‚ÔÏÈ·ÛÌÔ‡ ηٿ Ù˘ Ë·Ù›Ùȉ·˜ µ, Ù˘ ÈÏ·Ú¿˜, Ù˘ ÂÚ˘ıÚ¿˜ Î·È Ù˘ ·ÚˆÙ›Ùȉ·˜. OÈ ÂÚÈÛÛfiÙÂÚÔÈ ·fi ·˘ÙÔ‡˜ ÙÔ˘˜ Ì·ıËÙ¤˜ ›¯·Ó ‰Â¯Ù› Ì›· ÌfiÓÔ ‰fiÛË ÙÔ˘ ÌÔÓÔ‰‡Ó·ÌÔ˘ ÂÌ‚ÔÏ›Ô˘ ηٿ Ù˘ ÈÏ·Ú¿˜. øÛÙfiÛÔ, ÌÂÙ¿ ÙËÓ ÂÁÁÚ·Ê‹ ÙÔ˘˜ ÛÙ· ÂÏÏËÓÈο Û¯ÔÏ›·, ÂÓÙ¿¯ıËÎ·Ó ÛÂ Û˘ÁÎÂÎÚÈ̤ÓÔ Û¯‹Ì· ÂÌ‚ÔÏÈ·ÛÌÒÓ, ÔfiÙ 27 ·fi ÙÔ˘˜ 47 (57,4%) ‹Ù·Ó Ï‹Úˆ˜ ÂÌ‚ÔÏÈ·Ṳ̂ÓÔÈ fiÙ·Ó ¤ÁÈÓÂ Ë ÌÂϤÙË. ∏ ¯Ú‹ÛË ÙˆÓ ÌÔÓÔ‰‡Ó·ÌˆÓ ÂÌ‚ÔÏ›ˆÓ ‰È·ÈÛÙÒıËÎÂ Î·È ÛÙ· ‚È‚ÏÈ¿ÚÈ· ÙˆÓ Ì·ıËÙÒÓ ·fi ÙË ƒˆÛ›·. ¢‡Ô ·fi ·˘ÙÔ‡˜ ‹Ù·Ó Ï‹Úˆ˜ ÂÌ‚ÔÏÈ·Ṳ̂ÓÔÈ, ÂÓÒ ÔÈ ¿ÏÏÔÈ ‰‡Ô ›¯·Ó ÂÓÙ·¯ı› ÛÂ Û˘ÁÎÂÎÚÈ̤ÓÔ Û¯‹Ì· ÂÌ‚ÔÏÈ·ÛÌÒÓ ÛÙËÓ ∂ÏÏ¿‰·. ∆¤ÏÔ˜, ÔÈ Ì·ıËÙ¤˜ ·fi ÙË °ÂÚÌ·Ó›·, ÙËÓ ∫‡ÚÔ Î·È ÙË ™ÂÚ‚›· ‹Ù·Ó Ï‹Úˆ˜ ÂÌ‚ÔÏÈ·Ṳ̂ÓÔÈ.

¶·È‰È·ÙÚÈ΋ 2004;67:120-125

¢È·ÈÛÙÒÓÂÙ·È fiÙÈ Â›Ó·È ·Ó·Áη›· Ë ÚÔۋψÛË ÙˆÓ ÊÔÚ¤ˆÓ ˘Á›·˜ ÛÙÔ ∂ıÓÈÎfi ¶ÚfiÁÚ·ÌÌ· ∂Ì‚ÔÏÈ·ÛÌÒÓ Î·È Ë ÂÓË̤ڈÛË ÙˆÓ ÁÔÓ¤ˆÓ Û¯ÂÙÈο Ì ÙËÓ ·ÛÊ¿ÏÂÈ· ÙˆÓ ÂÌ‚ÔÏ›ˆÓ Î·È ÙËÓ ·Ó·ÁηÈfiÙËÙ· ‰ÈÂÓ¤ÚÁÂÈ¿˜ ÙÔ˘˜. ∂›Ó·È, Â›Û˘, ·Ó·Áη›· Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂÚË ·ÓÔÛÔÔ›ËÛË ÙˆÓ ÂÊ‹‚ˆÓ Ô˘ ˘ÔÏ›ÔÓÙ·È Û ·ÚÎÂÙ¿ ÂÌ‚fiÏÈ·, ›Ù ÏfiÁˆ Ù˘ ·Ó·ÔÙÂÏÂÛÌ·ÙÈ΋˜ ÔÏÈÙÈ΋˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÙˆÓ ÂÚ·ÛÌ¤ÓˆÓ ÂÙÒÓ, ›Ù ÏfiÁˆ Ì›·˜ Èı·Ó‹˜ “·‰È·ÊÔÚ›·˜” ·¤Ó·ÓÙÈ ÛÙÔ˘˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡˜ ÙÔ˘ ·È‰ÈÔ‡ Ô˘ ÌÂÁ·ÏÒÓÂÈ. ∫¿ÙÈ Ù¤ÙÔÈÔ ı· ÌÔÚÔ‡Û ӷ ÂÈÙ¢¯ı› Ì ÔÌ¿‰Â˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡, ÔÈ Ôԛ˜ ı· ‰Ú·ÛÙËÚÈÔÔÈÔ‡ÓÙ·È ÛÙ· Á˘ÌÓ¿ÛÈ· Î·È Ù· χÎÂÈ· Ù˘ ¯ÒÚ·˜. ∂›Ó·È, Ù¤ÏÔ˜, ··Ú·›ÙËÙÔ Ó· ˘¿ÚÍÔ˘Ó ÂȉÈο ÚÔÁÚ¿ÌÌ·Ù· ÁÈ· ÌÂÈÔÓfiÙËÙ˜ (·ı›ÁÁ·ÓÔÈ, ÔÈÎÔÓÔÌÈÎÔ› ÌÂÙ·Ó¿ÛÙ˜). ªÂ Ù· ·Ú·¿Óˆ ̤ÙÚ· ı· ÂÈÙ¢¯ı› ¿ÚÈÛÙÔ Â›Â‰Ô ·ÓÔÛ›·˜ ÛÙË ¯ÒÚ· Ì·˜ Î·È ı· ÂÍ·ÏÂÈÊı› Ô Î›Ó‰˘ÓÔ˜ ÌÂÏÏÔÓÙÈÎÒÓ ÂȉËÌÈÒÓ. ∂˘¯·ÚÈÛٛ˜ £· ‹ıÂÏ· Ó· ¢¯·ÚÈÛÙ‹Ûˆ ıÂÚÌ¿ ÙȘ ÂÈÛΤÙÚȘ ˘Á›·˜ ÙÔ˘ ∫¤ÓÙÚÔ˘ ÀÁ›·˜ ÕÚÁÔ˘˜ OÚÂÛÙÈÎÔ‡ η. µ. ∫·ÚηڤÙÛÔ˘ Î·È Î·. ∂. ¶ÂÙÚ›‰Ô˘, ηıÒ˜ Î·È ÙÔ˘˜ ‰È¢ı˘ÓÙ¤˜ fiÏˆÓ ÙˆÓ Û¯ÔÏÈÎÒÓ ‚·ıÌ›‰ˆÓ Ù˘ fiÏ˘ ÁÈ· ÙË ‚Ô‹ıÂÈ¿ ÙÔ˘˜ ÛÙË Û˘ÏÏÔÁ‹ ÙˆÓ ‚È‚ÏÈ·Ú›ˆÓ ˘Á›·˜ ÙˆÓ Ì·ıËÙÒÓ. ∂›Û˘, ÙËÓ ·È‰›·ÙÚÔ Î·. £. ª¿ÓÙ˙ÈÔ˘-°ÂÚÌ·ÓÔÔ‡ÏÔ˘ ÁÈ· ÙÔÓ ¯ÚfiÓÔ Ô˘ ÌÔ˘ ‰È¤ıÂÛÂ Î·È ÙËÓ ÔχÙÈÌË ÂÈÛÙËÌÔÓÈ΋ ‚Ô‹ıÂÈ· Ô˘ ÌÔ˘ ·Ú›¯Â.

µÈ‚ÏÈÔÁÚ·Ê›· 1. £ˆÌ·˝‰Ë˜ £, §¿ÁÁ·˜ ¢. ∂ȉËÌÈÔÏÔÁÈο ‰Â‰Ô̤ӷ ÙˆÓ ÂÌ‚ÔÏÈ·ÛÌÒÓ ÛÙËÓ ∂ÏÏ¿‰·. ™ÙÔ: ∆· ÂÌ‚fiÏÈ· ÛÙËÓ ∂ÏÏ¿‰·. ∂ÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ ∂Ù·ÈÚ›·. ∞ı‹Ó·; 2000. ÛÂÏ. 23-43.

2. ¶·Ó·ÁȈÙfiÔ˘ÏÔ˜ ∆. ªÂıÔ‰ÔÏÔÁÈο ÚÔ‚Ï‹Ì·Ù· ÛÙËÓ ¤Ú¢ӷ ÁÈ· ÙËÓ Î·Ù¿ÛÙ·ÛË ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÛÙËÓ ∂ÏÏ¿‰·: Û˘ÛÙËÌ·ÙÈ΋ ·Ó·ÛÎfiËÛË ÌÂÏÂÙÒÓ, 1970-1995. ¶·È‰È·ÙÚÈ΋ 1999;62:116-130.

3. Guerin N, Roure C. Immunization coverage in the European Union. Euro Surveill 1997;2:2-4.

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17. ™˘Ú›‰Ë˜ ¶. ∞ÓÙÈÌÂÙÒÈÛË Ù˘ Ê˘Ì·Ù›ˆÛ˘ Ì ÂÌ‚ÔÏÈ·ÛÌfi. ™ÙÔ: ™ÈÓ·ÓÈÒÙ˘ ∫, ª˘ÚÈÔÎÂÊ·ÏÈÙ¿Î˘ ¡. §ÔÈÌÒÍÂȘ Î·È ÂÌ‚ÔÏÈ·ÛÌÔ› ÛÙËÓ ·È‰È΋ ËÏÈΛ·. ∂Ù·ÈÚ›· ™˘Ó¯È˙fiÌÂÓ˘ ∂Î·›‰Â˘Û˘ ÛÙËÓ ¶·È‰È·ÙÚÈ΋. ªÂÙÂÎ·È‰Â˘ÙÈο ™ÂÌÈÓ¿ÚÈ· ¶·È‰È·ÙÚÈ΋˜. ∞ı‹Ó·; 1997. ÛÂÏ. 207-218.

18. ™˘ÚÈÔÔ‡ÏÔ˘ µ, ¶·˘ÏÔÔ‡ÏÔ˘ π, ªÈ¯ÂϤÙÔ˘ ª, ∆Û›ÊÙ˘ °, ªËÏ›ÁÎÔ˜ µ, £ÂÔ‰ˆÚ›‰Ô˘ ª. ∂Ì‚ÔÏÈ·ÛÌÔ› Ì ٷ ÓÂfiÙÂÚ· Î·È ·Ï·È¿ ÂÌ‚fiÏÈ· Û ‰Â›ÁÌ·Ù· ·È‰ÈÎÔ‡ ÏËı˘ÛÌÔ‡ Ù˘ ∞ı‹Ó·˜. ¢ÂÏÙ ∞’ ¶·È‰È·ÙÚ ∫ÏÈÓ ¶·ÓÂ ∞ıËÓÒÓ 1996;43: 114-118.

∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 14-10-2003 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 02-03-2004 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∞Ó·ÛÙ¿ÛÈÔ˜ ∏. ™¤ÚÌ˘ Ã. ¡ÈÔ˘‚fiÏ· 9, ∆.∫. 454 45, πˆ¿ÓÓÈÓ·

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ORIGINAL ARTICLE

∂˘Ú‹Ì·Ù· ÛÙÔÓ ·ÂÈÎÔÓÈÛÙÈÎfi ¤ÏÂÁ¯Ô Û ‚Ú¤ÊË Ì ÚÒÙÔ ÂÂÈÛfi‰ÈÔ Ô˘ÚÔÏԛ̈͢ Î·È Î˘ÛÙÂÔÔ˘ÚËÙËÚÈ΋ ·ÏÈÓ‰ÚfiÌËÛË º. ¶··¯Ú‹ÛÙÔ˘1, ¡. ¶Ú›ÓÙ˙·1, ª. ª·ÓÙÔ˘Ú¿ÎË2

Imaging findings in infants with first urinary tract infection and primary vesicoureteric reflux F. Papachristou1, N. Printza1, M. Badouraki2

¶ÂÚ›ÏË„Ë: ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ë Î·Ù·ÁÚ·Ê‹ Î·È ·ÍÈÔÏfiÁËÛË ÙˆÓ Â˘ÚËÌ¿ÙˆÓ ÛÙÔÓ ˘ÂÚ˯ÔÁÚ·ÊÈÎfi ¤ÏÂÁ¯Ô ÙÔ˘ Ô˘ÚÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Î·È ÛÙÔ ÛÙ·ÙÈÎfi ÛÈÓıËÚÔÁÚ¿ÊËÌ· ÓÂÊÚÒÓ Ì 99m-Tc DMSA Û ‚Ú¤ÊË ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙÔ˘ 1 ¤ÙÔ˘˜ Ì ÚÒÙÔ ÂÂÈÛfi‰ÈÔ Ô˘ÚÔÏԛ̈͢ Î·È Î˘ÛÙÂÔÔ˘ÚËÙËÚÈ΋ ·ÏÈÓ‰ÚfiÌËÛË. ªÂÏÂÙ‹ıËÎ·Ó 152 ·È‰È¿, ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙÔ˘ 1 ¤ÙÔ˘˜ (84 ·ÁfiÚÈ·, 68 ÎÔÚ›ÙÛÈ·), Ì ԢÚÔÏԛ̈ÍË Î·È ·ÏÈÓ‰ÚfiÌËÛË Ô˘ ›¯Â ‰È·ÁÓˆÛÙ› Ì ΢ÛÙÂÔÁÚ·Ê›·. ∆Ô ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ¤ÁÈÓ 48 ÒÚ˜ ·fi ÙË ‰È¿ÁÓˆÛË Ù˘ Ô˘ÚÔÏԛ̈͢ Î·È ÙÔ DMSA ̤۷ Û ‰È¿ÛÙËÌ· ÂÓfi˜ Ì‹Ó·. ™Â ·ıÔÏÔÁÈÎfi ÛÈÓıËÚÔÁÚ¿ÊËÌ·, Ë ÂͤٷÛË Â·Ó·Ï‹ÊıËΠ6 ¤ˆ˜ 12 Ì‹Ó˜ ·ÚÁfiÙÂÚ·. ¶·ıÔÏÔÁÈÎfi ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ›¯·Ó 47 ‚Ú¤ÊË (31%). ∫‡ÚÈ· Â˘Ú‹Ì·Ù· ‹Ù·Ó ‰È¿Ù·ÛË ˘¤ÏÔ˘ ‹ Ô˘ÚËÙ‹ÚˆÓ, ÂÛÙȷ΋ ϤÙ˘ÓÛË ÙÔ˘ ÊÏÔÈÔ‡, ˘ÔÏ·Û›· ÓÂÊÚÔ‡, ‰ÈÏfi ˘ÂÏÔÎ·Ï˘ÎÈÎfi Û‡ÛÙËÌ· Î·È ÌÔÓ‹Ú˘, ¤ÎÙÔÔ˜ Î·È ÂÙ·ÏÔÂȉ‹˜ ÓÂÊÚfi˜. ™·Ú¿ÓÙ· ¤Ó· ·fi Ù· 47 ‚Ú¤ÊË Î·È ÂȉÈÎfiÙÂÚ· 16/94 ÓÂÊÚÈΤ˜ ÌÔÓ¿‰Â˜ Ì III ‚·ıÌÔ‡ ·ÏÈÓ‰ÚfiÌËÛË, 20/25 Ì IV ‚·ıÌÔ‡ Î·È fiϘ Ì V ‚·ıÌÔ‡, ·ÚÔ˘Û›·˙·Ó ÛÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ‰È¿Ù·ÛË ˘¤ÏÔ˘ ‹ Ô˘ÚËÙ‹ÚˆÓ. ∞fi ·˘Ù¿, ·ıÔÏÔÁÈÎfi DMSA ›¯·Ó 12, 13 Î·È 4 ‚Ú¤ÊË Ì III, IV Î·È V ‚·ıÌÔ‡ ·ÏÈÓ‰ÚfiÌËÛË, ·ÓÙ›ÛÙÔȯ·. ∂ÈÎfiÓ· ÂÓ‰ÂÈÎÙÈ΋ Ô˘Ï‹˜ ·ÚÔ˘Û›·˙·Ó 24 ‚Ú¤ÊË (16%). ∆Ô ÔÛÔÛÙfi Ô˘ÏÒÓ ·˘Í·ÓfiÙ·Ó Ì ÙÔÓ ‚·ıÌfi Ù˘ ·ÏÈÓ‰ÚfiÌËÛ˘ Î·È ‹Ù·Ó 0%, 4%, 12%, 28% Î·È 40% ÁÈ· I, II, III, IV Î·È V ‚·ıÌÔ‡, ·ÓÙ›ÛÙÔȯ·. ∆· ˘ÂÚ˯ÔÁÚ·ÊÈο Â˘Ú‹Ì·Ù· ‰ÂÓ Â›Ó·È Â˘·›ÛıËÙÔ˜ ‰Â›ÎÙ˘ ÁÈ· ·ÏÈÓ‰ÚfiÌËÛË. ∂Ô̤ӈ˜, Ë Î˘ÛÙÂÔÁÚ·Ê›· ‰ÂÓ ı· Ú¤ÂÈ Ó· ·Ó·‚¿ÏÏÂÙ·È. ∂› ·ıÔÏÔÁÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ, Ë ‰ÈÂÚ‡ÓËÛË Î·È Ë ıÂÚ·¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÌÔÚ› Ó· ¯ÚÂÈ·ÛÙ› Ó·

Abstract: The aim of this study was to evaluate the findings on renal ultrasonogram (US) and renal scanning with technetium-99m-labeled dimercaptosuccinic acid (DMSA) in infants with their first urinary tract infection (UTI) and findings of primary vesicoureteric reflux (VUR). The study included 152 infants under the age of 1 year, 84 males and 68 females. Diagnosis of UTI and VUR was based on positive urine culture and contrast voiding cystourethrography (VCUG) respectively. US was performed at the time of acute illness and DMSA within one month. In the case of abnormal findings the latter was repeated after 6 to 12 months.

Abnormal US was observed in 47 infants (31%), the main findings being dilated pelvis, dilated ureter, focal reduced cortical echogenicity, renal hypoplasia, double collecting system, and single, displaced or horseshoe kidney. Dilated ureters or pelvis were found in 41/47 infants and specifically in 16/94 ureteric units with grade III reflux, in 20/25 with grade IV and all with grade V reflux. Of these, abnormal DMSA was observed in respectively 12, 13 and 4 infants with grades III, IV and V reflux.

Renal scars were detected in 24 infants (16%). The rate of scarring increased with the grade Ôf VUR and was respectively 0%, 4%, 12%, 28% and 40% for grades I, II, III, IV and V. US findings were not predictive of VUR and VCUG is necessary. In the case of abnormal findings, management needs to be individually adjusted. DMSA is valid for documenting renal scars. These children are at high risk for long-term complications and should be monitored.

1 ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ∞.¶.£., πÔÎÚ¿ÙÂÈÔ ¡ÔÛÔÎÔÌ›Ô, £ÂÛÛ·ÏÔÓ›ÎË 2 ¶·È‰Ô·ÎÙÈÓÔÏÔÁÈÎfi ∆Ì‹Ì·, πÔÎÚ¿ÙÂÈÔ ¡ÔÛÔÎÔÌ›Ô, £ÂÛÛ·ÏÔÓ›ÎË

1 1st Paediatric Department, Aristotle University, Ippokration General Hospital, Thessaloniki 2 Department of Paediatric Radiology, Ippokration General Hospital, Thessaloniki

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ÙÚÔÔÔÈËıÔ‡Ó ·Ó¿ÏÔÁ·. ∆Ô DMSA Â›Ó·È Ë ÂͤٷÛË Ì ÙË ÌÂÁ·Ï‡ÙÂÚË Â˘·ÈÛıËÛ›· ÛÙËÓ ·Ó›¯Ó¢ÛË ÓÂÊÚÈÎÒÓ Ô˘ÏÒÓ. ∆· ·È‰È¿ ·˘Ù¿ ¯ÚÂÈ¿˙ÔÓÙ·È Ì·ÎÚÔ¯ÚfiÓÈ· ·Ú·ÎÔÏÔ‡ıËÛË ÁÈ· ÂÌÊ¿ÓÈÛË ·ÒÙÂÚˆÓ ÂÈÏÔÎÒÓ. §¤ÍÂȘ ÎÏÂȉȿ: ΢ÛÙÂÔÔ˘ÚËÙËÚÈ΋ ·ÏÈÓ‰ÚfiÌËÛË, ‚Ú¤ÊË, ·ÂÈÎÔÓÈÛÙÈο Â˘Ú‹Ì·Ù·, Ô˘ÚÔÏԛ̈ÍË.

Key words: vesicoureteric reflux, infants, imaging findings, urinary tract infection.

™˘ÓÙÔÌÔÁڷʛ˜

ÏÔÁ‹ıËÎ·Ó Ù· Â˘Ú‹Ì·Ù· ÛÙÔÓ ˘ÂÚ˯ÔÁÚ·ÊÈÎfi ¤ÏÂÁ¯Ô ÙÔ˘ Ô˘ÚÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Î·È ÛÙÔ ÛÙ·ÙÈÎfi ÛÈÓıËÚÔÁÚ¿ÊËÌ· ÓÂÊÚÒÓ Ì 99m-Tc DMSA Û ‚Ú¤ÊË ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙÔ˘ 1 ¤ÙÔ˘˜ Ì ÚÒÙÔ ÂÂÈÛfi‰ÈÔ Ô˘ÚÔÏԛ̈͢ Î·È ∫O¶.

O˘ÚÔÏԛ̈ÍË ∫˘ÛÙÂÔÔ˘ÚËÙËÚÈ΋ ·ÏÈÓ‰ÚfiÌËÛË ƒ·‰ÈÔ˚ÛÔÙÔÈ΋ ΢ÛÙÂÔÁÚ·Ê›· ™Ù·ÙÈÎfi ÛÈÓıËÚÔÁÚ¿ÊËÌ· ÓÂÊÚÒÓ Ì 99m-Tc DMSA

OÀƒ§ ∫O¶ ƒπ∫ DMSA

∂ÈÛ·ÁˆÁ‹ ∆o Ô˘ÚÔÔÈËÙÈÎfi Û‡ÛÙËÌ· ·ÔÙÂÏ› Û¯ÂÙÈο Û˘¯Ó‹ ÂÓÙfiÈÛË ÏÔÈÌÒÍÂˆÓ ÛÙ· ·È‰È¿. ∂ȉÈÎfiÙÂÚ· ÛÙ· ‚Ú¤ÊË ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜, Ë Û˘¯ÓfiÙËÙ· Ô˘ÚÔÏÔÈÌÒÍÂˆÓ (OÀƒ§) ÂÎÙÈÌ¿Ù·È fiÙÈ ·Ó¤Ú¯ÂÙ·È Û ÔÛÔÛÙfi 6,5% ÛÙ· ÎÔÚ›ÙÛÈ· Î·È 3,3% ÛÙ· ·ÁfiÚÈ· (1). ∏ ΢ÛÙÂÔÔ˘ÚËÙËÚÈ΋ ·ÏÈÓ‰ÚfiÌËÛË (∫O¶) ¤¯ÂÈ ·Ó·ÁÓˆÚÈÛÙ› ˆ˜ ¤Ó·˜ ·fi ÙÔ˘˜ ·ÚÈÔ˘˜ ÚԉȷıÂÛÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ÛÙËÓ ÂÌÊ¿ÓÈÛË OÀƒ§, ÂÓÒ ·fi ÔÚÈṲ̂ÓÔ˘˜ Û˘ÁÁÚ·Ê›˜ ·Ó·Ê¤ÚÂÙ·È fiÙÈ Ë Û˘¯ÓfiÙËÙ¿ Ù˘ Û ‚Ú¤ÊË ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙÔ˘ 1 ¤ÙÔ˘˜ Ì ÚÒÙÔ ÂÂÈÛfi‰ÈÔ Ô˘ÚÔÏԛ̈͢ ·Ó¤Ú¯ÂÙ·È Û ÔÛÔÛÙfi ¤ˆ˜ 50% (1). °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi, ·fi ÙËÓ ∞ÌÂÚÈηÓÈ΋ ¶·È‰È·ÙÚÈ΋ ∞η‰ËÌ›· Û˘ÓÈÛٿٷÈ, ÛÙÔ ÚÒÙÔ ÂÂÈÛfi‰ÈÔ OÀƒ§ Û ‚Ú¤ÊË Î·È ÌÈÎÚ¿ ·È‰È¿ ËÏÈΛ·˜ 2 ÌËÓÒÓ ¤ˆ˜ Î·È 2 ÂÙÒÓ, Ë ‰ÈÂÓ¤ÚÁÂÈ· ·ÂÈÎÔÓÈÛÙÈÎÔ‡ ÂϤÁ¯Ô˘ ÙÔ˘ Ô˘ÚÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Ì ˘ÂÚ˯ÔÁÚ¿ÊËÌ·, Û˘Ì‚·ÙÈ΋ ‹ Ú·‰ÈÔ˚ÛÔÙÔÈ΋ ΢ÛÙÂÔÁÚ·Ê›· (ƒπ∫) Î·È ÛÙ·ÙÈÎfi ÛÈÓıËÚÔÁÚ¿ÊËÌ· ÓÂÊÚÒÓ Ì 99m-Tc DMSA (1). ™ÎÔfi˜ ÙˆÓ ·ÂÈÎÔÓÈÛÙÈÎÒÓ ÂÍÂÙ¿ÛÂˆÓ Â›Ó·È Ë ·Ó‡ÚÂÛË Èı·ÓÒÓ ·Ó·ÙÔÌÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ ÙÔ˘ Ô˘ÚÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, ·ÏÈÓ‰ÚfiÌËÛ˘ Î·È Ë ‰È·›ÛÙˆÛË Èı·ÓÒÓ ˘ÂÏÔÓÂÊÚÈÙȉÈÎÒÓ ·ÏÏÔÈÒÛˆÓ. ™ÙËÓ ËÏÈΛ· ·˘Ù‹, Ë ÛÔ‚·Ú‹ ·ÏÈÓ‰ÚfiÌËÛË, IV Î·È V ‚·ıÌÔ‡, Â›Ó·È Û˘¯ÓfiÙÂÚË ÛÙ· ¿ÚÚÂÓ· ·fi fi,ÙÈ ÛÙ· ı‹Ï· ‚Ú¤ÊË, Û ·Ó·ÏÔÁ›· 3:1 ¤ˆ˜ 5:1 (2). ÀÂÚÔ¯‹ ÛÙ· ¿ÚÚÂÓ· ‚Ú¤ÊË ·Ó·Ê¤ÚÂÙ·È ÙfiÛÔ ÛÙȘ ÂÚÈÙÒÛÂȘ ÚÔÁÂÓÓËÙÈ΋˜ ‰È¿ÁÓˆÛ˘ Ù˘ ∫O¶ Ì ÙË ÌÔÚÊ‹ ˘‰ÚÔÓ¤ÊÚˆÛ˘ (3) fiÛÔ Î·È Û ·˘Ù¤˜ fiÔ˘ Ë ∫O¶ ‰È·ÈÛÙÒıËΠÌÂÙ¿ ·fi ÂÂÈÛfi‰ÈÔ OÀƒ§ (4). ™ÙËÓ ·ıÔÁ¤ÓÂÈ· Ù˘ ÛÔ‚·Ú‹˜ ·˘Ù‹˜ ·ÏÈÓ‰ÚfiÌËÛ˘ Èı·ÓÔÏÔÁÂ›Ù·È fiÙÈ, ÂÎÙfi˜ Ù˘ ·ÓÂ¿ÚÎÂÈ·˜ ÙÔ˘ ‚·Ï‚ȉÈÎÔ‡ Ì˯·ÓÈÛÌÔ‡ ÛÙËÓ Î˘ÛÙÂÔÔ˘ÚËÙËÚÈ΋ Û˘Ì‚ÔÏ‹, Û˘ÌÌÂÙ¤¯ÂÈ Î·È Ë ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Ù˘ Ô˘ÚÔ‰fi¯Ô˘ ·ÛÙ˘ (5). ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË Î·Ù·ÁÚ¿ÊËÎ·Ó Î·È ·ÍÈÔ-

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ÂÍÂÙ¿ÛÙËÎ·Ó ·Ó·‰ÚÔÌÈο ÔÈ Ê¿ÎÂÏÔÈ 152 ·È‰ÈÒÓ ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙÔ˘ 1 ¤ÙÔ˘˜, 84 ·ÁÔÚÈÒÓ Î·È 68 ÎÔÚÈÙÛÈÒÓ, Ì ∫O¶ Ô˘ ›¯Â ‰È·ÁÓˆÛÙ› ηٿ ÙË ‰ÈÂÚ‡ÓËÛË ÙÔ˘ ÚÒÙÔ˘ ÂÂÈÛÔ‰›Ô˘ Ô˘ÚÔÏԛ̈͢. O Û˘ÓÔÏÈÎfi˜ ·ÚÈıÌfi˜ ·ÏÈÓ‰ÚÔÌÔ‡ÓÙˆÓ Ô˘ÚËÙ‹ÚˆÓ ‹Ù·Ó 245. ∞ÌÊoÙÂÚfiÏ¢ÚË ∫O¶ ηٿ ÙË ‰È¿ÁÓˆÛË Â›¯·Ó 93 ‚Ú¤ÊË (61%) Î·È ÂÙÂÚfiÏ¢ÚË 59 (39%).

KÚÈÙ‹ÚÈÔ OÀƒ§ ıˆڋıËÎÂ Ë ıÂÙÈ΋ ηÏÏȤÚÁÂÈ· Ô‡ÚˆÓ. ∏ ÂÚÌËÓ›· ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ÙˆÓ Ô˘ÚÔηÏÏÈÂÚÁÂÈÒÓ ÂÍ·ÚÙ‹ıËΠ·fi ÙË Ì¤ıÔ‰Ô Û˘ÏÏÔÁ‹˜ Ô‡ÚˆÓ. ™Â ‰Â›ÁÌ· Ô˘ ÂÏ‹ÊıË Ì ˘ÂÚË‚È΋ ·Ú·Î¤ÓÙËÛË, Ë ·Ó¿Ù˘ÍË ÔÔÈÔ˘‰‹ÔÙ ·ÚÈıÌÔ‡ ÌÈÎÚÔ‚›ˆÓ ‹Ù·Ó ÂÓ‰ÂÈÎÙÈ΋ Ïԛ̈͢ (6). ™Â Û˘ÏÏÔÁ‹ Ô‡ÚˆÓ Ì Ï·ÛÙÈÎfi Ô˘ÚÔÛ˘ÏϤÎÙË ‹ Ì ԢÚÔηıÂÙ‹Ú·, ıÂÙÈ΋ ıˆڋıËÎÂ, Û‡Ìʈӷ Ì ÙÔ ÎÚÈÙ‹ÚÈÔ ÙÔ˘ Kass, Ë Î·ÏÏȤÚÁÂÈ· Ì ·Ó¿Ù˘ÍË 105 ‹ ÂÚÈÛÛfiÙÂÚˆÓ ·ÔÈÎÈÒÓ ÂÓfi˜ ÌÈÎÚÔ‚›Ô˘ ·Ó¿ ml Ô‡ÚˆÓ (7). ÀÂÚ˯ÔÁÚ·ÊÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙÔ˘ Ô˘ÚÔÔÈËÙÈÎÔ‡ Ú·ÁÌ·ÙÔÔÈ‹ıËΠηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÓÔÛËÏ›·˜ ÙˆÓ ‚ÚÂÊÒÓ, Û˘Ó‹ıˆ˜ ÂÓÙfi˜ 48 ˆÚÒÓ ·fi ÙË ‰È¿ÁÓˆÛË Ù˘ OÀƒ§, Ì ÛÎÔfi ÙËÓ ·Ó‡ÚÂÛË Èı·ÓÒÓ ·Ó·ÙÔÌÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ. ∏ ÂͤٷÛË ¤ÁÈÓ Ì ˘ÂÚ˯ÔÙÔÌÔÁÚ¿ÊÔ Philips Ù‡Ô˘ ƒ700 Ì ÎÂʷϤ˜ 7.5 Î·È 5 ª∏∑, ·Ó¿ÏÔÁ· Ì ÙËÓ ËÏÈΛ· ÙÔ˘ ·È‰ÈÔ‡. ™ÙËÓ ÂͤٷÛË, ‡ÚËÌ· ÂÓ‰ÂÈÎÙÈÎfi ∫O¶ ıˆڋıËÎÂ Ë ‰È¿Ù·ÛË ÙÔ˘ ˘ÂÏÔÎ·Ï˘ÎÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ‹ ÙˆÓ Ô˘ÚËÙ‹ÚˆÓ. ¶ÚÔÛ‰ÈÔÚ›ÛÙËÎÂ, Â›Û˘, Ë Â˘·ÈÛıËÛ›· ÙÔ˘ ˘ÂÚ˯ÔÁÚ·Ê‹Ì·ÙÔ˜ ÛÙË ‰È¿ÁÓˆÛË Ù˘ ∫O¶. Œ¯ÔÓÙ·˜ ˆ˜ ‰Â‰Ô̤ÓÔ Ù· Â˘Ú‹Ì·Ù· ÛÙËÓ Î˘ÛÙÂÔÁÚ·Ê›·, ˆ˜ ¢·ÈÛıËÛ›· Ù˘ ÌÂıfi‰Ô˘ ÔÚ›ÛÙËΠÙÔ ÔÛÔÛÙfi ÙˆÓ ‚ÚÂÊÒÓ Ì ∫O¶ Ô˘ ›¯Â Î·È ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÂÓ‰ÂÈÎÙÈÎfi ÁÈ· ·ÏÈÓ‰ÚfiÌËÛË. ∞ÓÈÔ‡Û· ·ÎÙÈÓÔÁÚ·ÊÈ΋ ΢ÛÙÂÔÁÚ·Ê›· ¤ÁÈÓ Û fiÏ· Ù· ‚Ú¤ÊË ÂÚ›Ô˘ ¤Ó· Ì‹Ó· ÌÂÙ¿ ÙË ‰È¿ÁÓˆÛË Ù˘ OÀƒ§. ∏ ·Ó·ÁÓÒÚÈÛË Î·È Ù·ÍÈÓfiÌËÛË Ù˘ ∫O¶ Û ‚·ıÌÔ‡˜ ‚·Û›ÛÙËΠÛÙ· Â˘Ú‹Ì·Ù· Ù˘ ΢ÛÙÂÔÁÚ·Ê›·˜ Û ʿÛË Ï‹ÚˆÛ˘ Ù˘ Ô˘ÚÔ‰fi¯Ô˘ ·ÛÙ˘ Î·È Û ʿÛË Ô‡ÚËÛ˘. ∏ ∫O¶ Ù·ÍÈÓÔÌ‹ıËΠ۠‚·ıÌÔ‡˜ ·fi I ¤ˆ˜ V Û‡Ìʈӷ Ì ٷ ‰ÈÂıÓ‹ ÎÚÈÙ‹ÚÈ· (8). ™ÈÓıËÚÔÁÚ¿ÊËÌ· ÓÂÊÚÒÓ ÛÙ· ‚Ú¤ÊË Ì 99m-Tc DMSA ¤ÁÈÓ ̤۷ Û ‰È¿ÛÙËÌ· ÂÓfi˜ Ì‹Ó· ÂÚ›Ô˘ ·fi ÙË ‰È¿ÁÓˆÛË

127

¶·È‰È·ÙÚÈ΋ 2004;67:126-131

Paediatriki 2004;67:126-131

Ù˘ OÀƒ§. ¶·ıÔÏÔÁÈ΋ ıˆڋıËÎÂ Ë ÂͤٷÛË Ì ÛËÌ·ÓÙÈ΋ ÂÏ¿ÙÙˆÛË Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘ ÂÓfi˜ ÓÂÊÚÔ‡, Ì ·ÚÔ˘Û›· Ì›·˜ ‹ ÂÚÈÛÛfiÙÂÚˆÓ ÂÚÈÔ¯ÒÓ ÌÂȈ̤Ó˘ ÚfiÛÏ˄˘ ÙÔ˘ Ú·‰ÈÔÊ·ÚÌ¿ÎÔ˘ Î·È Ì ÌÈÎÚÔ‡˜ ‹ ·Ú·ÌÔÚʈ̤ÓÔ˘˜ ÓÂÊÚÔ‡˜ (9). ¶ÂÚÈÔ¯‹ ÂÏ·Ùو̤Ó˘ ÚfiÛÏ˄˘ Ô˘ Â¤ÌÂÓÂ Î·È ÌÂÙ¿ ·fi ¤ÍÈ Ì‹Ó˜ ·fi ÙÔ ÂÂÈÛfi‰ÈÔ OÀƒ§, Ì ϤÙ˘ÓÛË ÙÔ˘ ÊÏÔÈÔ‡, ıˆڋıËÎÂ Ô˘Ï‹. ŸÏ· Ù· ‚Ú¤ÊË Ù¤ıËÎ·Ó Û ¯ËÌÂÈÔÚÔʇϷÍË Ì ·ÌÔ͢ÎÈÏÏ›ÓË ‹ Ì›· ÎÂÊ·ÏÔÛÔÚ›ÓË ‹ ÎÔÙÚÈÌÔÍ·˙fiÏË Û ̛· ¯·ÌËÏ‹ ‰fiÛË ÙÔ ‚Ú¿‰˘. ¢Â›ÁÌ·Ù· Ô‡ÚˆÓ Ï·Ì‚¿ÓÔÓÙ·Ó ÁÈ· ηÏÏȤÚÁÂÈ· Ì›· ÊÔÚ¿ ÙÔ Ì‹Ó·, ηıÒ˜ Î·È Û ÂÚ›ÙˆÛË ˘ÚÂÙÔ‡ ‹ ¿ÏÏ˘ Û˘Ìو̷ÙÔÏÔÁ›·˜ ‡ÔÙ˘ ÁÈ· OÀƒ§. ∏ ·Ú·ÎÔÏÔ‡ıËÛË ÂÚÈÂÏ¿Ì‚·ÓÂ, Â›Û˘, ̤ÙÚËÛË Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘, ‚ÈÔ¯ËÌÈΤ˜ ÂÍÂÙ¿ÛÂȘ ·›Ì·ÙÔ˜, Ú·‰ÈÔ˚ÛÔÙÔÈ΋ ΢ÛÙÂÔÁÚ·Ê›· Î·È ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÓÂÊÚÒÓ Î¿ı ¯ÚfiÓÔ (10). O ¯ÚfiÓÔ˜ Â·Ó¿Ï˄˘ ÙÔ˘ DMSA ÂÍ·ÙÔÌÈ΢fiÙ·Ó. ∫ÚÈÙ‹ÚÈÔ ÂÍ·Ê¿ÓÈÛ˘ Ù˘ ∫O¶ ıˆڋıËÎ·Ó ‰‡Ô ‰È·‰Ô¯ÈΤ˜ Ê˘ÛÈÔÏÔÁÈΤ˜ ΢ÛÙÂÔÁڷʛ˜ Ì ÌÂÛԉȿÛÙËÌ· 6 ÌËÓÒÓ. ø˜ ¯ÚfiÓÔ˜ ›·Û˘ ıˆڋıËΠ·˘Ùfi˜ Ù˘ ÚÒÙ˘ ƒπ∫ (3).

∞ÔÙÂϤÛÌ·Ù· ªÂÏÂÙ‹ıËÎ·Ó ÔÈ Ê¿ÎÂÏÔÈ 152 ‚ÚÂÊÒÓ, 84 ·ÁÔÚÈÒÓ (55%) Î·È 68 ÎÔÚÈÙÛÈÒÓ (45%), ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙÔ˘ 1 ¤ÙÔ˘˜, Ì ‰È¿ÁÓˆÛË ∫O¶ ÌÂÙ¿ ÙÔ ÚÒÙÔ ÂÂÈÛfi‰ÈÔ OÀƒ§. ∆· Û˘ÓËı¤ÛÙÂÚ· Û˘ÌÙÒÌ·Ù·, Ì ٷ ÔÔ›· ÚÔÛ‹Ïı·Ó Ù· ‚Ú¤ÊË, ‹Ù·Ó ˘ÚÂÙfi˜ (67%), ·ÓÔÚÂÍ›· (49%), ·ÓËÛ˘¯›· (16%), ÁÔÁÁ˘ÛÌfi˜ (12%), ¤ÌÂÙÔÈ (11%) Î·È ·ÈÌ·ÙÔ˘Ú›· (1,5%). ∆· ÌÈÎÚfi‚È· Ô˘ ·ÔÌÔÓÒıËÎ·Ó ‹Ù·Ó ΢ڛˆ˜ E. coli (93%), Û ÌÈÎÚfiÙÂÚ· ÔÛÔÛÙ¿ Proteus Î·È Clebsiella Î·È Û ¤Ó· ‚Ú¤ÊÔ˜ Enterobacter cloacae. ∏ ̤ÛË ËÏÈΛ· ‰È¿ÁÓˆÛ˘ Ù˘ ∫O¶ ‹Ù·Ó 5,92 Ì‹Ó˜. ∞fi ÙÔ˘˜ 245 Û˘ÓÔÏÈο ·ÏÈÓ‰ÚÔÌÔ‡ÓÙ˜ Ô˘ÚËÙ‹Ú˜, 3, 118, 94, 25 Î·È 5 ›¯·Ó I, Iπ III, IV Î·È V ‚·ıÌÔ‡ ·ÏÈÓ‰ÚfiÌËÛË, ·ÓÙ›ÛÙÔȯ·. ∆Ș ÚÒÙ˜ 48 ÒÚ˜ ·fi ÙË ‰È¿ÁÓˆÛË Ù˘ OÀƒ§ Û fiÏ· Ù· ‚Ú¤ÊË ¤ÁÈÓ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÓÂÊÚÒÓ, ·ÛÙ˘ Î·È Ô˘ÚËÙ‹ÚˆÓ. ¶·ıÔÏÔÁÈÎfi ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ›¯·Ó 47 ‚Ú¤ÊË (31%). ™Â 41 ·fi Ù· 47 ‚Ú¤ÊË Î·È ÂȉÈÎfiÙÂÚ· Û 16 ·fi ÙȘ 94 ÓÂÊÚÈΤ˜ ÌÔÓ¿‰Â˜ Ì ∫O¶ ‚·ıÌÔ‡ III, Û 20 ·fi ÙȘ 25 Ì ‚·ıÌÔ‡ IV Î·È Û fiϘ Ì V ‚·ıÌÔ‡, ÂÚÈÁÚ¿ÊËΠ‰È¿Ù·ÛË ÙˆÓ Ô˘ÚËÙ‹ÚˆÓ ‹ Ù˘ ˘¤ÏÔ˘. ¶·ÚfiÌÔÈ· Â˘Ú‹Ì·Ù· ÂÓ‰ÂÈÎÙÈο ·ÏÈÓ‰ÚfiÌËÛ˘ ‰ÂÓ ‰È·ÈÛÙÒıËÎ·Ó Û ηӤӷ ‚Ú¤ÊÔ˜ Ì ‚·ıÌfi I ‹ II ·ÏÈÓ‰ÚfiÌËÛ˘. ™ÙÔÓ ¶›Ó·Î· 1 ÛËÌÂÈÒÓÔÓÙ·È Ù· ÂÓ‰ÂÈÎÙÈο ÁÈ· ·ÏÈÓ‰ÚfiÌËÛË ·Ô-

ÙÂϤÛÌ·Ù· ÙÔ˘ ˘ÂÚ˯ÔÁÚ·Ê‹Ì·ÙÔ˜, ·Ó¿ ‚·ıÌfi ∫O¶. ∂Ô̤ӈ˜, Ë Â˘·ÈÛıËÛ›· ÙÔ˘ ˘ÂÚ˯ÔÁÚ·Ê‹Ì·ÙÔ˜ ÛÙË ‰È¿ÁÓˆÛË ‹Ù·Ó 17%, 80% Î·È 100% ÁÈ· ∫O¶ III, IV Î·È V ‚·ıÌÔ‡, ·ÓÙ›ÛÙÔȯ·. ÕÏÏ· Â˘Ú‹Ì·Ù· ÛÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ‹Ù·Ó Ë ÂÛÙȷ΋ ϤÙ˘ÓÛË ÙÔ˘ ÊÏÔÈÔ‡, Ë ˘ÔÏ·Û›· ÓÂÊÚÔ‡, ÙÔ ‰ÈÏfi ˘ÂÏÔÎ·Ï˘ÎÈÎfi Û‡ÛÙËÌ· Î·È Ô ÌÔÓ‹Ú˘, Ô ¤ÎÙÔÔ˜ Î·È Ô ÂÙ·ÏÔÂȉ‹˜ ÓÂÊÚfi˜. ∆· Â˘Ú‹Ì·Ù· ·˘Ù¿ ηٷÁÚ¿ÊÔÓÙ·È ·Ó·Ï˘ÙÈÎfiÙÂÚ· ÛÙÔÓ ¶›Ó·Î· 2. ™Â ‰‡Ô ‚Ú¤ÊË Ì ‰ÈÏfi ˘ÂÏÔÎ·Ï˘ÎÈÎfi Û‡ÛÙËÌ·, ÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi. ∏ ‰È¿ÁÓˆÛË Û ·˘Ù¿ ¤ÁÈÓ Ì ÂÓ‰ÔÊϤ‚È· ˘ÂÏÔÁÚ·Ê›·. ¶·ıÔÏÔÁÈÎfi ÛÈÓıËÚÔÁÚ¿ÊËÌ· ÓÂÊÚÒÓ Ì 99mTc DMSA ̤۷ ÛÙÔÓ ÚÒÙÔ Ì‹Ó· ·fi ÙË ‰È¿ÁÓˆÛË Ù˘ OÀƒ§ ›¯·Ó Ù· 50 (32%) ·fi Ù· 152 ‚Ú¤ÊË, ÛÙ· ÔÔ›· Ë ÂͤٷÛË Â·Ó·Ï‹ÊıËΠ6 Ì‹Ó˜ ¤ˆ˜ 1 ¯ÚfiÓÔ ·ÚÁfiÙÂÚ·. ∂ÈÎfiÓ· ÂÓ‰ÂÈÎÙÈ΋ Ô˘Ï‹˜ ·ÚÔ˘Û›·˙·Ó Ù· 24 ‚Ú¤ÊË (16%). ∆Ô ÔÛÔÛÙfi Ô˘ÏÒÓ ·˘Í·ÓfiÙ·Ó Ì ÙÔÓ ‚·ıÌfi Ù˘ ∫O¶ Î·È ‹Ù·Ó 0%, 4%, 12%, 28% Î·È 40% ÁÈ· I, II, III, IV Î·È V ‚·ıÌÔ‡ ·ÏÈÓ‰ÚfiÌËÛË, ·ÓÙ›ÛÙÔȯ·. ™Â ¤Ó· ·fi ·˘Ù¿ Ì ·ÌÊoÙÂÚfiÏ¢ÚË ·ÏÈÓ‰ÚfiÌËÛË IV Î·È V ‚·ıÌÔ‡, ÔÈ Ô˘Ï¤˜ ÂÓÙÔ›˙ÔÓÙ·Ó Â›Û˘ ·ÌÊoÙÂÚfiÏ¢ڷ. ∞fi ·˘Ù¿ Ô˘ ·ÚÔ˘Û›·˙·Ó ÛÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ‰È¿Ù·ÛË ˘¤ÏÔ˘ ‹ Ô˘ÚËÙ‹ÚˆÓ, ·ıÔÏÔÁÈÎfi DMSA ›¯·Ó 12, 13 Î·È 4 ‚Ú¤ÊË Ì III, IV Î·È V ‚·ıÌÔ‡ ·ÏÈÓ‰ÚfiÌËÛË, ·ÓÙ›ÛÙÔȯ·. ™Â 25 ‚Ú¤ÊË, Ë Û¯ÂÙÈ΋ Û˘ÌÌÂÙÔ¯‹ ÙÔ˘ ÂÓfi˜ ÓÂÊÚÔ‡ ÛÙË Û˘ÓÔÏÈ΋ ÓÂÊÚÈ΋ ÏÂÈÙÔ˘ÚÁ›· ‹Ù·Ó ÌÈÎÚfiÙÂÚË ÙÔ˘ 45%. ∏ ·ÎÚÈ‚‹˜ Û˘¯ÓfiÙËÙ· ÔÍ›·˜ ˘ÂÏÔÓÂÊÚ›Ùȉ·˜ ÛÈÓıËÚÔÁÚ·ÊÈο ÙÂÎÌËÚȈ̤Ó˘, ‰ÂÓ ‹Ù·Ó ‰˘Ó·Ùfi Ó· ηıÔÚÈÛÙ›, ‰ÈfiÙÈ ÙÔ DMSA Û ·ÚÎÂÙ¤˜ ÂÚÈÙÒÛÂȘ ¤ÁÈÓ ̤¯ÚÈ Î·È ¤Ó· Ì‹Ó· ÌÂÙ¿ ÙÔ ÂÂÈÛfi‰ÈÔ Ù˘ ÔÍ›·˜ Ïԛ̈͢. ™˘˙‹ÙËÛË ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ·ÚÔ˘ÛÈ¿ÛÙËÎ·Ó Ù· ·ÂÈÎÔÓÈÛÙÈο Â˘Ú‹Ì·Ù· Û ‚Ú¤ÊË ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙÔ˘ 1 ¤ÙÔ˘˜, Ì ÚÒÙÔ ÂÂÈÛfi‰ÈÔ OÀƒ§ Î·È ∫O¶. ∆Ô ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÓÂÊÚÒÓ ·ÔÙÂÏ› ·ÛÊ·Ï‹, ÌË ÂÂÌ‚·ÙÈ΋ ̤ıÔ‰Ô Î·È ¤¯ÂÈ ·ÓÙÈηٷÛÙ‹ÛÂÈ Û ÌÂÁ¿ÏÔ ‚·ıÌfi ÙËÓ ÂÓ‰ÔÊϤ‚È· ˘ÂÏÔÁÚ·Ê›· ÛÙËÓ ·Ó·˙‹ÙËÛË ·Ó·ÙÔÌÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ ÙÔ˘ Ô˘ÚÔÔÈËÙÈÎÔ‡. ¢ÈÂÓÂÚÁÂ›Ù·È ˆ˜ ÂͤٷÛË ÚÔ˘Ù›Ó·˜ ÌÂÙ¿ ÙË ‰È¿ÁÓˆÛË ÙÔ˘ ÚÒÙÔ˘ ÂÂÈÛÔ‰›Ô˘ Ô˘ÚÔÏԛ̈͢ Î·È ÌÔÚ› Ó· ·Ú¿Û¯ÂÈ ÏËÚÔÊÔڛ˜ ÁÈ· ÙÔ Ì¤ÁÂıÔ˜ Î·È ÙÔ Û¯‹Ì· ÙˆÓ ÓÂÊÚÒÓ, ÙËÓ

¶›Ó·Î·˜ 1. ÀÂÚ˯ÔÁÚ·ÊÈο Â˘Ú‹Ì·Ù· ÂÓ‰ÂÈÎÙÈο ÁÈ· ·ÏÈÓ‰ÚfiÌËÛË, ·Ó¿ ‚·ıÌfi ∫O¶ µ·ıÌfi˜ ∫O¶ ÛÙËÓ Î˘ÛÙÂÔÁÚ·Ê›· I II III IV V

128

ÀÂÚ˯ÔÁÚ¿ÊËÌ· (+)

ÀÂÚ˯ÔÁÚ¿ÊËÌ· (-)

™‡ÓÔÏÔ

0 0 16 20 5

3 118 78 5 0

3 118 94 25 5

¶·È‰È·ÙÚÈ΋ 2004;67:126-131

Paediatriki 2004;67:126-131

¶›Ó·Î·˜ 2. ∂˘Ú‹Ì·Ù· ÛÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÓÂÊÚÒÓ, ·ÛÙ˘ Î·È Ô˘ÚËÙ‹ÚˆÓ ÛÙ· 152 ‚Ú¤ÊË Ì ‰È¿ÁÓˆÛË ∫O¶ ÌÂÙ¿ ÙÔ ÚÒÙÔ ÂÂÈÛfi‰ÈÔ OÀƒ§* ∂‡ÚËÌ· º˘ÛÈÔÏÔÁÈο ¢È¿Ù·ÛË ˘¤ÏÔ˘ ¢È¿Ù·ÛË Ô˘ÚËÙ‹Ú· §¤Ù˘ÓÛË ÙÔ˘ ÊÏÔÈÔ‡ ÀÔÏ·Û›· ÓÂÊÚÔ‡ ¢ÈÏfi ˘ÂÏÔÎ·Ï˘ÎÈÎfi Û‡ÛÙËÌ· ªÔÓ‹Ú˘ ÓÂÊÚfi˜ ŒÎÙÔÔ˜ ÓÂÊÚfi˜ ¶ÂÙ·ÏÔÂȉ‹˜ ÓÂÊÚfi˜

∞ÚÈıÌfi˜ ‚ÚÂÊÒÓ (%) 105 (69%) 34 (22%) 10 (6,5%) 11 (7%) 7 (4,5%) 5 (3%) 2 (1,3%) 1 (0,6%) 1 (0,6%)

* ªÂÚÈο ·È‰È¿ ›¯·Ó ÂÚÈÛÛfiÙÂÚ˜ ·fi Ì›· ·ÓˆÌ·Ï›Â˜

‡·ÚÍË ‰ÈÏ·ÛÈ·ÛÌÔ‡ Î·È ÙË ‰È¿Ù·ÛË ÙˆÓ Ô˘ÚËÙ‹ÚˆÓ, ÙȘ Ô˘ÚËÙËÚÔ΋Ϙ Î·È ÙȘ Ì›˙ÔÓ˜ ·Ó·ÙÔÌÈΤ˜ ·ÓˆÌ·Ï›Â˜, fiˆ˜ Ô ÂÙ·ÏÔÂȉ‹˜ ÓÂÊÚfi˜ (1). ∂›Û˘, ÛÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÌÔÚ› Ó· ˘¿Ú¯Ô˘Ó ÂӉ›ÍÂȘ ÔÍ›·˜ ˘ÂÏÔÓÂÊÚ›Ùȉ·˜ ‹ ÂÁηÙÂÛÙËÌ¤ÓˆÓ ÓÂÊÚÈÎÒÓ Ô˘ÏÒÓ, ¯ˆÚ›˜ fï˜ ·˘Ùfi Ó· ¤¯ÂÈ ÙËÓ Â˘·ÈÛıËÛ›· ¿ÏÏˆÓ ·ÂÈÎÔÓÈÛÙÈÎÒÓ Ù¯ÓÈÎÒÓ. ¡ÂfiÙÂÚ˜ ÌÂϤÙ˜ ·ÌÊÈÛ‚ËÙÔ‡Ó ÙËÓ ·Ó·ÁηÈfiÙËÙ· ˘ÂÚ˯ÔÁÚ·ÊÈÎÔ‡ ÂϤÁ¯Ô˘ ÛÙ· ‚Ú¤ÊË Ì ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ÂÌ‡ÚÂÙ˘ OÀƒ§, ÛÙ· ÔÔ›· ›¯Â Á›ÓÂÈ ÚÔÁÂÓÓËÙÈÎfi˜ ˘ÂÚ˯ÔÁÚ·ÊÈÎfi˜ ¤ÏÂÁ¯Ô˜ Û ÂÍÂȉÈÎÂ˘Ì¤ÓÔ Î¤ÓÙÚÔ ÌÂÙ¿ ÙËÓ 30‹-32Ë Â‚‰ÔÌ¿‰· ·ËÛ˘ (11). £ÂˆÚÂ›Ù·È fiÙÈ Ë ·ÂÈÎfiÓÈÛË ÙÔ˘ Ô˘ÚÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Û ·˘Ù‹ ÙËÓ ËÏÈΛ· ·ËÛ˘ Â›Ó·È ·ÎÚÈ‚‹˜ Î·È ‰ÂÓ ·Ó·Ì¤ÓÔÓÙ·È ÚfiÛıÂÙ· Â˘Ú‹Ì·Ù· Ô˘ Èı·ÓÒ˜ ı· ÙÚÔÔÔÈ‹ÛÔ˘Ó ÙË ıÂÚ·¢ÙÈ΋ ·ÁˆÁ‹ (11). ™ÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ ∆Ì‹Ì·, Û fiÏ· Ù· ·È‰È¿ Ì ԢÚÔÏԛ̈ÍË ‰ÈÂÓÂÚÁÂ›Ù·È ‚¿ÛÂÈ ÚˆÙÔÎfiÏÏÔ˘, fiˆ˜ Û˘ÛÙ‹ÓÂÙ·È Î·È ·fi ÙËÓ ∞ÌÂÚÈηÓÈ΋ ¶·È‰È·ÙÚÈ΋ ∞η‰ËÌ›·, ˘ÂÚ˯ÔÁÚ·ÊÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙÔ˘ Ô˘ÚÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ∆· Â˘Ú‹Ì·Ù·, ·ÎfiÌ· Î·È fiÙ·Ó ‰ÂÓ Â›Ó·È ÂÓ‰ÂÈÎÙÈο ·ÏÈÓ‰ÚfiÌËÛ˘, ÌÔÚÔ‡Ó Ó· ·Ú¿Û¯Ô˘Ó ÏËÚÔÊÔڛ˜ Ô˘ ı· ηÙ¢ı‡ÓÔ˘Ó ÙËÓ ÂÚ·ÈÙ¤Úˆ ‰ÈÂÚ‡ÓËÛË Î·È ·ÓÙÈÌÂÙÒÈÛË. ∆Ô ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ‰ÂÓ ıˆÚÂ›Ù·È ·ÚÎÂÙ¿ ¢·›ÛıËÙÔ ˆ˜ ̤ıÔ‰Ô˜ ÛÙËÓ ·Ó·Î¿Ï˘„Ë ÔÍ›·˜ ˘ÂÏÔÓÂÊÚ›Ùȉ·˜ Î·È ÓÂÊÚÈÎÒÓ Ô˘ÏÒÓ (12,13). π‰È·›ÙÂÚ· ˆ˜ ÚÔ˜ ÙË ‰È¿ÁÓˆÛË Ù˘ ∫O¶, Ô˘ Â›Ó·È ¤Ó· ‰˘Ó·ÌÈÎfi Ê·ÈÓfiÌÂÓÔ, Ë ‰È·ÁÓˆÛÙÈ΋ ÙÔ˘ ·Í›· ıˆÚÂ›Ù·È Ôχ ÂÚÈÔÚÈṲ̂ÓË (11). ™˘ÁÎÂÎÚÈ̤ӷ, oÈ Mahant Î·È Û˘Ó ÚÔÛ‰ÈÔÚ›˙Ô˘Ó ÙËÓ Â˘·ÈÛıËÛ›· Î·È ÙËÓ ÂȉÈÎfiÙËÙ· Ù˘ ÌÂıfi‰Ô˘ ÛÙË ‰È¿ÁÓˆÛË Ù˘ ∫O¶ Û 40% Î·È 76%, ·ÓÙ›ÛÙÔȯ· (14). Ÿˆ˜ Ê¿ÓËÎÂ Î·È ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, Ù· ˘ÂÚ˯ÔÁÚ·ÊÈο Â˘Ú‹Ì·Ù· ÌÔÚ› Ó· ÌËÓ Â›Ó·È ÂÓ‰ÂÈÎÙÈο ∫O¶, ·ÎfiÌË Î·È Û ÌÂÁ¿ÏÔ˘ ‚·ıÌÔ‡ ·ÏÈÓ‰ÚfiÌËÛË. °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi ÙÔÓ›˙ÂÙ·È Ë ·Ó¿ÁÎË ‰ÈÂÓ¤ÚÁÂÈ·˜ ΢ÛÙÂÔÁÚ·Ê›·˜ ÚÔÎÂÈ̤ÓÔ˘ Ó· ·ÔÎÏÂÈÛÙ› Ë ·ÏÈÓ-

‰ÚfiÌËÛË, ·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ô ÂÂÌ‚·ÙÈÎfi˜ ¯·Ú·ÎÙ‹Ú·˜ Ù˘ ÌÂıfi‰Ô˘ Î·È Ù· Ê˘ÛÈÔÏÔÁÈο Â˘Ú‹Ì·Ù· ÛÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÌÂÈÒÓÔ˘Ó Û˘¯Ó¿ ÙË Û˘ÌÌfiÚʈÛË ÙˆÓ ÁÔÓ¤ˆÓ Û ·˘Ù‹ ÙËÓ Ô‰ËÁ›·. ∏ Û˘ÓÂÈÛÊÔÚ¿ ÙˆÓ ˘ÂÚ‹¯ˆÓ ÛÙË ‰È¿ÁÓˆÛË Ù˘ ∫O¶ ¿Ú¯ÈÛ ÛÙ· ̤۷ Ù˘ ‰ÂηÂÙ›·˜ ÙÔ˘ 1990 Ì ÙË ¯Ú‹ÛË Ù˘ ˘ÂÚ˯ÔÁÚ·ÊÈ΋˜ ΢ÛÙÂÔÁÚ·Ê›·˜ (15). À¿Ú¯Ô˘Ó ·ÚÎÂÙ¤˜ ÌÂϤÙ˜ Ô˘ Û˘ÁÎÚ›ÓÔ˘Ó ÙËÓ ·ÎÚ›‚ÂÈ·, ÛÙË ‰È¿ÁÓˆÛË Ù˘ ∫O¶, ÌÂٷ͇ Ù˘ ˘ÂÚ˯ÔÁÚ·ÊÈ΋˜ ΢ÛÙÂÔÁÚ·Ê›·˜ (voiding urosonography using ultrasonography contrast medium agents) Î·È ÙˆÓ ¿ÏÏˆÓ ·ÂÈÎÔÓÈÛÙÈÎÒÓ ‰È·ÁÓˆÛÙÈÎÒÓ ÌÂıfi‰ˆÓ (·ÎÙÈÓÔÏÔÁÈ΋˜ ΢ÛÙÂÔÁÚ·Ê›·˜ Û ‰‡Ô Ê¿ÛÂȘ Î·È Ù˘ ƒπ∫) (16,17). ™ÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ ∆Ì‹Ì· ‰ÂÓ ˘¿Ú¯ÂÈ ÂÌÂÈÚ›· ·fi ÙË ¯Ú‹ÛË ·˘Ù‹˜ Ù˘ ÌÂıfi‰Ô˘. ∆Ô ÛÈÓıËÚÔÁÚ¿ÊËÌ· ÓÂÊÚÒÓ Ì 99m-Tc DMSA ıˆÚÂ›Ù·È ÔχÙÈÌË Î·È ·ÎÚÈ‚‹˜ ̤ıÔ‰Ô˜ ÛÙË ‰È¿ÁÓˆÛË Ù˘ ÔÍ›·˜ ˘ÂÏÔÓÂÊÚ›Ùȉ·˜ Î·È ÛÙËÓ ·Ó›¯Ó¢ÛË ÙˆÓ ÓÂÊÚÈÎÒÓ Ô˘ÏÒÓ Î·È Ù˘ ÓÂÊÚÈ΋˜ ‰˘ÛÏ·Û›·˜ (13). ∂ȉÈÎfiÙÂÚ·, Ë Â˘·ÈÛıËÛ›· Ù˘ ÌÂıfi‰Ô˘ ÛÙË ‰È¿ÁÓˆÛË Ù˘ ÔÍ›·˜ ˘ÂÏÔÓÂÊÚ›Ùȉ·˜ ·Ó¤Ú¯ÂÙ·È ÛÙÔ 96%, fiÙ·Ó ÙÔ ÛÈÓıËÚÔÁÚ¿ÊËÌ· Á›ÓÂÙ·È Ì¤Û· ÛÙËÓ ÚÒÙË Â‚‰ÔÌ¿‰· Ù˘ Ïԛ̈͢ (13), ÂÓÒ ÙÔ ÔÛÔÛÙfi ·˘Ùfi ÂÏ·ÙÙÒÓÂÙ·È ÛËÌ·ÓÙÈο Ì ÙËÓ ¿ÚÔ‰Ô ·ÚÎÂÙÔ‡ ¯ÚÔÓÈÎÔ‡ ‰È·ÛÙ‹Ì·ÙÔ˜ ·fi ÙÔ ÂÂÈÛfi‰ÈÔ OÀƒ§ Î·È Ì ÙËÓ ¤Ó·ÚÍË Ù˘ ·ÓÙÈ‚ÈÔÙÈ΋˜ ·ÁˆÁ‹˜ (18). ™ÙÔ˘˜ ·ÛıÂÓ›˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘, fiÔ˘ Ë ÂͤٷÛË ¤ÁÈÓ ̤¯ÚÈ Î·È ¤Ó· Ì‹Ó· ÌÂÙ¿ ÙÔ ÂÂÈÛfi‰ÈÔ Ù˘ OÀƒ§, Ù· Â˘Ú‹Ì·Ù· ‰ÂÓ ÌÔÚÔ‡Ó Ó· ·ÍÈÔÏÔÁËıÔ‡Ó ˆ˜ ÚÔ˜ ÙË ‰È¿ÁÓˆÛË Ù˘ ÔÍ›·˜ ˘ÂÏÔÓÂÊÚ›Ùȉ·˜. OÈ ÂÛÙȷΤ˜ ‚Ï¿‚˜ Û˘Ó¯›˙Ô˘Ó Ó· ˘Ô¯ˆÚÔ‡Ó ¤ˆ˜ Î·È 5 Ì‹Ó˜ ÌÂÙ¿ ÙÔ ÂÂÈÛfi‰ÈÔ Ù˘ ÔÍ›·˜ Ïԛ̈͢ (19). µ¤‚·È·, Ë ÂÊ·ÚÌÔÁ‹ Ù˘ ÌÂıfi‰Ô˘ ÛÙËÓ ÔÍ›· Ê¿ÛË Ù˘ OÀƒ§ ‰ÂÓ Ê·›ÓÂÙ·È Ó· ·ÏÏ¿˙ÂÈ ÙË ıÂÚ·¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÛÙËÓ ÏÂÈÔ„ËÊ›· ÙˆÓ ÂÚÈÙÒÛˆÓ. ∞Ó Î·È ÔÚÈṲ̂ÓÔÈ Û˘ÁÁÚ·Ê›˜ ÚÔÙ›ÓÔ˘Ó ÙË ¯ÔÚ‹ÁËÛË ¯ËÌÂÈÔÚÔʇϷ͢ ÁÈ· ¤Ó· ¯ÚfiÓÔ Û fiÏ· Ù· ·È‰È¿ ÛÙ· ÔÔ›· ÙÔ ÛÈÓıËÚÔÁÚ¿ÊËÌ· ¤‰ÂÈÍ ÛÙÔȯ›· ÔÍ›·˜ ˘ÂÏÔÓÂÊÚ›Ùȉ·˜, Ù· ·ÔÙÂϤÛÌ·Ù· ·˘Ù‹˜ Ù˘ ÛÙÚ·ÙËÁÈ΋˜ ‰ÂÓ ¤¯Ô˘Ó ·ÎfiÌË ·ÍÈÔÏÔÁËı› (1,11). ¶ÚÔËÁÔ‡ÌÂÓ˜ ÌÂϤÙ˜ ¤‰ÂÈÍ·Ó fiÙÈ ÛÙÔ 60-65% ÙˆÓ ·È‰ÈÒÓ ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ 2 ÂÙÒÓ Ì ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ÂÌ‡ÚÂÙ˘ OÀƒ§, ÙÔ ÛÈÓıËÚÔÁÚ¿ÊËÌ· ÓÂÊÚÒÓ ‹Ù·Ó ·ıÔÏÔÁÈÎfi (11). §·Ì‚¿ÓÔÓÙ·˜ ˘’ fi„ÈÓ fiÙÈ Ë Â˘·ÈÛıËÛ›· Ù˘ ÌÂıfi‰Ô˘ ÛÙË ‰È¿ÁÓˆÛË Ù˘ ˘ÂÏÔÓÂÊÚ›Ùȉ·˜ Î˘Ì·›ÓÂÙ·È ÌÂٷ͇ 85% Î·È 90%, Á›ÓÂÙ·È ·ÓÙÈÏËÙfi fiÙÈ ÙÔ 75% ÂÚ›Ô˘ ÙˆÓ ÌÈÎÚÒÓ ·È‰ÈÒÓ Î·È ‚ÚÂÊÒÓ Ì ˘ÚÂÙfi Î·È ÛËÌ·ÓÙÈ΋ ÌÈÎÚÔ‚ÈÔ˘Ú›· ¤¯ÂÈ ÔÍ›· ˘ÂÏÔÓÂÊÚ›Ùȉ· (11). ∂Ô̤ӈ˜, ۯ‰fiÓ fiÏ· ·˘Ù¿ Ù· ·È‰È¿ ı· Ú¤ÂÈ Ó· ıˆÚÂ›Ù·È fiÙÈ ¤¯Ô˘Ó ÔÍ›· ˘ÂÏÔÓÂÊÚ›Ùȉ· Î·È Ó·

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·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È ¿ÌÂÛ· Î·È ÂÈıÂÙÈο. °ÓˆÚ›˙ÔÓÙ·˜, Â›Û˘, fiÙÈ ÙÔ ÛÈÓıËÚÔÁÚ¿ÊËÌ· ÓÂÊÚÒÓ ‰ÂÓ Â›Ó·È ¿ÓÙ· ¿ÌÂÛ· ÚÔÛÈÙfi Û fiÏ· Ù· ıÂÚ·¢ÙÈο ΤÓÙÚ·, Â›Ó·È ›Ûˆ˜ ÈÔ Ú·ÎÙÈÎfi Û ‚Ú¤ÊË Î·È ÌÈÎÚ¿ ·È‰È¿ Ó· ·ÍÈÔÏÔÁÂ›Ù·È Î·È Ó· ‰ÈÂÚÂ˘Ó¿Ù·È ÂÁη›Úˆ˜ Ô ˘ÚÂÙfi˜ Ì ÁÂÓÈ΋ ÂͤٷÛË Î·È Î·ÏÏȤÚÁÂÈ· Ô‡ÚˆÓ, ÒÛÙ ӷ ·Ó·ÁÓˆÚ›˙ÔÓÙ·È ÓˆÚ›˜ ÔÈ OÀƒ§. ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, ÏfiÁˆ Î·È Ù˘ ÌÈÎÚ‹˜ ËÏÈΛ·˜ ÙˆÓ ·È‰ÈÒÓ, Ë Ê·Ú̷΢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË Û fiÏ· Ù· ·È‰È¿ ‹Ù·Ó ÂΛÓË Ù˘ ˘ÂÏÔÓÂÊÚ›Ùȉ·˜. ∏ ·Ó‡ÚÂÛË ÙˆÓ Ô˘ÏÒÓ ‚·Û›ÛÙËΠ΢ڛˆ˜ ÛÙÔ Â·Ó·ÏËÙÈÎfi ÛÈÓıËÚÔÁÚ¿ÊËÌ·, ÙÔ ÔÔ›Ô ¤ÁÈÓ ÙÔ˘Ï¿¯ÈÛÙÔÓ 6 Ì‹Ó˜ ÌÂÙ¿ ÙÔ ÚÒÙÔ ·ıÔÏÔÁÈÎfi. ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, ÙÔ ÔÛÔÛÙfi ÓÂÊÚÈÎÒÓ Ô˘ÏÒÓ ÛÙË ‰È¿ÁÓˆÛË ‹Ù·Ó 16%, ¯·ÌËÏfiÙÂÚÔ ·fi ÙÔ 20-30% Ô˘ ·Ó·Ê¤ÚÂÙ·È Û ÚÔËÁÔ‡ÌÂÓ˜ ÌÂϤÙ˜ (20,21). ∞˘Ùfi ÔÊ›ÏÂÙ·È Èı·ÓÒ˜ ÛÙËÓ ¤ÁηÈÚË ‰È·ÁÓˆÛÙÈ΋ Î·È ıÂÚ·¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÁÈ· Ù· ‚Ú¤ÊË ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙÔ˘ 1 ¤ÙÔ˘˜ Ì ˘ÚÂÙfi Ô˘ ÂÊ·ÚÌfi˙ÂÙ·È ÛÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ ∆Ì‹Ì·. ∆· ÔÛÔÛÙ¿ Ô˘ÏÒÓ ‹Ù·Ó ˘„ËÏfiÙÂÚ· Û ÌÂÁ¿ÏÔ˘ ‚·ıÌÔ‡ ∫O¶, ÁÂÁÔÓfi˜ Ô˘ Û˘ÌʈÓ› Î·È Ì ٷ Â˘Ú‹Ì·Ù· ¿ÏÏˆÓ Û˘ÁÁڷʤˆÓ (22). µ¤‚·È·, ˘¿Ú¯Ô˘Ó ·ÓÙÈÎÚÔ˘fiÌÂÓ˜ ·fi„ÂȘ Û¯ÂÙÈο Ì ÙÔÓ ÚfiÏÔ ÙÔ˘ ‚·ıÌÔ‡ Ù˘ ∫O¶ ÛÙËÓ ÂÌÊ¿ÓÈÛË ÙˆÓ Ô˘ÏÒÓ. OÈ Rushton Î·È Û˘Ó ¤‰ÂÈÍ·Ó fiÙÈ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ÙˆÓ Ô˘ÏÒÓ Â˘ı‡ÓÂÙ·È Î˘Ú›ˆ˜ Ë OÀƒ§, ·Ú¿ Ë ‡·ÚÍË ‹ fi¯È ∫O¶ (23). À¿Ú¯Ô˘Ó ÔÏϤ˜ ·fi„ÂȘ Û¯ÂÙÈο Ì ÙÔÓ ¯ÚfiÓÔ Î·È ÙË ¯ÚËÛÈÌfiÙËÙ· ÙˆÓ ·ÂÈÎÔÓÈÛÙÈÎÒÓ ÂÍÂÙ¿ÛÂˆÓ ÌÂÙ¿ ÙËÓ ÚÒÙË OÀƒ§. ∏ ÂÌÂÈÚ›· ÛÙ· ‚Ú¤ÊË ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜ ‰Â›¯ÓÂÈ fiÙÈ ÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÓÂÊÚÒÓ ı· Ú¤ÂÈ Ó· Á›ÓÂÙ·È Ì ÙË ‰È¿ÁÓˆÛË Ù˘ OÀƒ§. ™Â Ê˘ÛÈÔÏÔÁÈο Â˘Ú‹Ì·Ù· ‰ÂÓ ı· Ú¤ÂÈ Ó· ·Ó·‚¿ÏÏÂÙ·È Ë Î˘ÛÙÂÔÁÚ·Ê›·, ÂÓÒ Â› ·ıÔÏÔÁÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ Ë ‰ÈÂÚ‡ÓËÛË Î·È Ë ıÂÚ·¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÌÔÚ› Ó· ¯ÚÂÈ·ÛÙ› ·Ó·ÏfiÁˆ˜ Ó· ÙÚÔÔÔÈËıÔ‡Ó. ∆Ô ÛÈÓıËÚÔÁÚ¿ÊËÌ· ÓÂÊÚÒÓ Ì DMSA ı· Ú¤ÂÈ Ó· ‰ÈÂÓÂÚÁÂ›Ù·È Û fiϘ ÙȘ ÂÚÈÙÒÛÂȘ ÂÌ‡ÚÂÙ˘ OÀƒ§ Û ‚Ú¤ÊË ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙÔ˘ 1 ¤ÙÔ˘˜, ÁÈ· ÙËÓ ·Ó·˙‹ÙËÛË ÔÍ›·˜ ˘ÂÏÔÓÂÊÚ›Ùȉ·˜ Î·È ÙËÓ ·Ó›¯Ó¢ÛË ÓÂÊÚÈÎÒÓ Ô˘ÏÒÓ Î·È ÓÂÊÚÈ΋˜ ‰˘ÛÏ·Û›·˜. ∆· ·È‰È¿ ÌÂ Ô˘Ï¤˜ Î·È ‰˘ÛÏ·Û›· ¯ÚÂÈ¿˙ÔÓÙ·È ÈÔ ÛÙÂÓ‹ ·Ú·ÎÔÏÔ‡ıËÛË ÁÈ· Èı·Ó‹ ÂÌÊ¿ÓÈÛË ·ÒÙÂÚˆÓ ÂÈÏÔÎÒÓ, fiˆ˜ ˘¤ÚÙ·ÛË Î·È ¯ÚfiÓÈ· ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ·.

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3. Goldraich NP, Goldraich IH. Follow-up of conservatively treated children with high and low grade vesicoureteral reflux: a prospective study. J Urol 1992;148:1688-1692.

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The Netherlands: Kluwer; 1997.

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17. Uhi M. Simultaneous performance of voiding cystourethrography and contrast-enhanced voiding urosonography: comparison for reflux diagnosis (abstract).

Proceedings of the 8th Heidelberg Workshop on Sonographic Diagnosis of Vesicoureteral reflux; 2000.

Abstract A7.

18. Stokland E, Hellstrom M, Jacobsson B, Jodal U, Lundgren P, Sixt R. Early 99mTc dimercaptosuccinic acid (DMSA)

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scintigraphy in symptomatic first-time urinary tract infection. Acta Paediatr 1996;85:430-436.

19. Jakobsson B, Svensson L. Transient pyelonephritic changes on 99mTechnetium-dimercaptosuccinic acid scan for at least five months after infection. Acta Paediatr 1997;86:803-807.

20. Olbing H, Claesson I, Ebel KD, Seppanen U, Smellie JM, Tamminen-Mobius T et al. Renal scars and parenchymal thinning in children with vesicoureteral reflux: a 5-year report of the International Reflux Study in Children (European branch). J Urol 1992;148:1653-1656.

21. Smellie J, Edwards D, Hunter N, Normand IC, Prescod N. Vesico-ureteric reflux and renal scarring. Kidney Int 1975;4 (Suppl):S65-S72.

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22. Castello Girona F, Callis Bracons L, Gosalbez Jorda R. Vesicoureteral reflux in the first year of life. An Esp Pediatr 1982;16:9-15.

23. Rushton HG. The evaluation of acute pyelonephritis and renal scarring with technetium 99m-dimercaptosuccinic acid renal scintigraphy: evolving concepts and future directions. Pediatr Nephrol 1997;11:108-120. ∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 29-07-2003 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 23-03-2004 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: º. ¶··¯Ú‹ÛÙÔ˘ ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ∞.¶.£., πÔÎÚ¿ÙÂÈÔ ¡ÔÛÔÎÔÌÂ›Ô ∫ˆÓÛÙ·ÓÙÈÓÔ˘fiψ˜ 49, ∆.∫. 546 42, £ÂÛÛ·ÏÔÓ›ÎË

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∂¡¢π∞º∂ƒOÀ™∞ ¶∂ƒπ¶∆ø™∏

Paediatriki 2004;67:132-134

CASE REPORT

¡fiÛÔ˜ Alexander Û ·ÁfiÚÈ ËÏÈΛ·˜ 14 ÌËÓÒÓ. ¶ÂÚÈÁÚ·Ê‹ Ì›·˜ Ó¤·˜ ÌÂÙ¿ÏÏ·Í˘ §. ∫fiÛÛ˘‚·, ¢. §·˙ÔÔ‡ÏÔ˘, ™. °ÈÔ˘ÚÔ‡ÎÔ˜

Alexander disease in a 14 month-old boy. A new mutation L. Kossiva, D. Lazopoulou, S. Youroukos

¶ÂÚ›ÏË„Ë: ∏ ÓfiÛÔ˜ Alexander Â›Ó·È Ì›· Û¿ÓÈ·, ÂÍÂÏÈÛÛfiÌÂÓË, ı·Ó·ÙËÊfiÚ· Ï¢ÎÔ‰˘ÛÙÚÔÊ›·, Ë ÔÔ›· Û˘Ó‹ıˆ˜ ÚÔÛ‚¿ÏÏÂÈ Ù· ‚Ú¤ÊË. ÷ڷÎÙËÚ›˙ÂÙ·È ·fi ‰È·Ù·Ú·¯‹ ÛÙË Ì˘ÂϛӈÛË ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Î·È ¿ıÚÔÈÛË ÈÓÒÓ Rosenthal ÂÓÙfi˜ ÙˆÓ ·ÛÙÚÔ΢ÙÙ¿ÚˆÓ. ∫ÏËÚÔÓÔÌÂ›Ù·È Ì ÙÔÓ ˘ÔÏÂÈfiÌÂÓÔ ·˘ÙÔۈ̷ÙÈÎfi ¯·Ú·ÎÙ‹Ú·, ÂÓÒ ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› Î·È ÂÚÈÙÒÛÂȘ ·˘ÙfiÌ·ÙˆÓ Ó¤ˆÓ ÌÂÙ·ÏϿ͈Ó. ¶·ÚÔ˘ÛÈ¿˙ÂÙ·È Ë ÂÚ›ÙˆÛË ·ÁÔÚÈÔ‡ ËÏÈΛ·˜ 14 ÌËÓÒÓ, ÙÔ ÔÔ›Ô ÂÈÛ‹¯ıË ÛÙËÓ ÎÏÈÓÈ΋ ÁÈ· ‰ÈÂÚ‡ÓËÛË ÂÂÈÛÔ‰›ˆÓ Û·ÛÌÒÓ, Ì·ÎÚÔÎÂÊ·Ï›·˜ Î·È „˘¯ÔÎÈÓËÙÈ΋˜ ·ÏÈÓ‰ÚfiÌËÛ˘. ¶ÚfiÎÂÈÙ·È ÁÈ· ÙÔ ÌÔÓ·‰ÈÎfi ·È‰› Ê·ÈÓÔÙ˘Èο ˘ÁÈÒÓ ÁÔÓ¤ˆÓ. ∆· ÚÒÙ· ÛËÌ›· Ù˘ ÓfiÛÔ˘ ·ÚÔ˘ÛÈ¿ÛÙËÎ·Ó Û ËÏÈΛ· 5 ÌËÓÒÓ. ∏ ÎÏÈÓÈ΋ ÂÈÎfiÓ· Î·È Ô ÂÚÁ·ÛÙËÚÈ·Îfi˜ Î·È ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ¤ıÂÛ·Ó ÈÛ¯˘Ú¿ ÙËÓ ˘Ô„›· ÓfiÛÔ˘ Alexander. ∏ ‰È¿ÁÓˆÛË ÂȂ‚·ÈÒıËΠ̠ÙË ¯Ú‹ÛË ÌÔÚÈ·ÎÒÓ Ù¯ÓÈÎÒÓ. O ·ÛıÂÓ‹˜ ‚Ú¤ıËΠÂÙÂÚÔ˙˘ÁÒÙ˘ ÁÈ· ÛËÌÂȷ΋ ÌÂÙ¿ÏÏ·ÍË ÙÔ˘ GFAP ÁÔÓȉ›Ô˘, ÔÈ ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ÔÔ›Ô˘ ¢ı‡ÓÔÓÙ·È ÁÈ· ÙË ÓfiÛÔ. ∏ ÌÂÙ¿ÏÏ·ÍË ·˘Ù‹ ÂÚÈÁÚ¿ÊÂÙ·È ÁÈ· ÚÒÙË ÊÔÚ¿ ÛÙË ‚È‚ÏÈÔÁÚ·Ê›·. ∏ Û˘ÁÎÂÎÚÈ̤ÓË ÂÚ›ÙˆÛË ·ÊÔÚ¿ Û Ӥ· ·ÚÂÚÌËÓ‡ÛÈÌË (missense) ÌÂÙ¿ÏÏ·ÍË, ‰Â‰Ô̤ÓÔ˘ ÙÔ˘ ·ÚÓËÙÈÎÔ‡ ÁÔÓȉȷÎÔ‡ ÂϤÁ¯Ô˘ ÙˆÓ ÁÔÓ¤ˆÓ.

Abstract: Alexander disease is a rare, progressive, lethal leukodystrophy, usually affecting infants.

It is characterized by progressive failure of central myelination and accumulation of Rosenthal fibers in the astrocytes. An autosomal recessive mode of inheritance is presumed, but new spontaneous mutations have also been described. The case is presented of a 14 month-old boy who was admitted because of seizures, megalencephaly and neurodevelopmental retardation. The first signs of the disease appeared at the age of 5 months. The clinical, laboratory and imaging findings were highly suggestive of Alexander’s disease. He was the only child of phenotypically healthy parents. Diagnosis was confirmed by gene sequencing, which showed a missense mutation in the GFAP gene (disturbances of this gene are causative of the disease).

This mutation is described here for the first time. It was presumed to be a de novo mutation because analysis of the parents’ DNA was negative.

§¤ÍÂȘ ÎÏÂȉȿ: ÓfiÛÔ˜ Alexander, Ó¤· ·ÚÂÚÌËÓ‡ÛÈÌË ÌÂÙ¿ÏÏ·ÍË, GFAP ÁÔÓ›‰ÈÔ.

Key words: Alexander disease, new missense mutation, GFAP gene.

∂ÈÛ·ÁˆÁ‹ OÈ Ï¢ÎÔ‰˘ÛÙÚÔʛ˜ ·ÔÙÂÏÔ‡Ó Ì›· ÔÌ¿‰· ‰È·ÊÔÚÂÙÈÎÒÓ ÓÔÛËÌ¿ÙˆÓ, ÎÔÈÓfi ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÙˆÓ ÔÔ›ˆÓ Â›Ó·È Ë ÂÎʇÏÈÛË Ù˘ Ï¢΋˜ Ô˘Û›·˜ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘. OÈ ·ÛıÂÓ›˜ Ô˘ ¿Û¯Ô˘Ó ·fi ÓÔÛ‹Ì·Ù· ·˘Ù‹˜ Ù˘ ÔÌ¿‰·˜, ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÚÔԉ¢ÙÈο

·ÏÈÓ‰ÚfiÌËÛË Û ÔÏϤ˜ Ó¢ÚÔÏÔÁÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜, Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·ÒÏÂÈ· ÏfiÁÔ˘, fiÚ·Û˘, ·ÎÔ‹˜ ‹ ÎÈÓËÙÈÎfiÙËÙ·˜. ∏ Ó¢ÚÔÏÔÁÈ΋ ·ÏÈÓ‰ÚfiÌËÛË Û˘¯Ó¿ Û˘Ó‰˘¿˙ÂÙ·È Ì ÂÂÈÛfi‰È· ÂÈÏË„›·˜, ‰˘ÛÎÔÏ›· Û›ÙÈÛ˘ Î·È ÓÔËÙÈ΋ ˘ÛÙ¤ÚËÛË. ™Â ·˘Ù‹ ÙËÓ ÔÌ¿‰· ÙˆÓ Ó¢ÚÔÂÎÊ˘ÏÈÛÙÈÎÒÓ ÓÔÛËÌ¿ÙˆÓ

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

1st Department of Paediatrics, Athens University “Aghia Sophia” Children’s Hospital, Athens

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ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÔÈ ÛÊÈÁÁÔÏÈȉÒÛÂȘ, ÔÈ ÏÈÔÊÔ˘ÛÎÈÓÒÛÂȘ, Ë ·‰ÚÂÓÔÏ¢ÎÔ‰˘ÛÙÚÔÊ›·, Ë ÛÈ·Ï›‰ˆÛË Î·È ÔÈΛϷ ÂÎÊ˘ÏÈÛÙÈο ÓÔÛ‹Ì·Ù·, fiˆ˜ Ë ·ÔÌ˘ÂÏÈÓˆÙÈ΋ ÛÎÏ‹Ú˘ÓÛË, Ë ÓfiÛÔ˜ PelizaeusMerzbacher, Ë ÓfiÛÔ˜ Canavan, ÙÔ Û‡Ó‰ÚÔÌÔ Rett Î·È Ë ÓfiÛÔ˜ Alexander (1). ∏ ÂÚ›ÙˆÛË Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È ·ÊÔÚ¿ ÛÙË ÓfiÛÔ Alexander Û ӋÈÔ 14 ÌËÓÒÓ Î·È ·ÚÔ˘ÛÈ¿˙ÂÈ È‰È·›ÙÂÚÔ ÂӉȷʤÚÔÓ, ηıÒ˜ Ì ÙË ÌÔÚȷ΋ Ù¯ÓÈ΋ Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËΠÁÈ· ÙËÓ ÂȂ‚·›ˆÛË Ù˘ ‰È¿ÁÓˆÛ˘ ‚Ú¤ıËΠÌÂÙ¿ÏÏ·ÍË Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È ÁÈ· ÚÒÙË ÊÔÚ¿ ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· (2). ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ∞ÁfiÚÈ ËÏÈΛ·˜ 14 ÌËÓÒÓ ÂÈÛ‹¯ıË ÛÙËÓ ÎÏÈÓÈ΋ ÁÈ· ‰ÈÂÚ‡ÓËÛË „˘¯ÔÎÈÓËÙÈ΋˜ ·ÏÈÓ‰ÚfiÌËÛ˘. ¶ÚfiÎÂÈÙ·È ÁÈ· ÙÔ ÚÒÙÔ ·È‰› Ê·ÈÓÔÙ˘Èο ˘ÁÈÒÓ ÁÔÓ¤ˆÓ, ÙÔ ÔÔ›Ô ÁÂÓÓ‹ıËΠÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ÙÔÎÂÙfi ÌÂÙ¿ ·fi ÙÂÏÂÈfiÌËÓË Î‡ËÛË. ∏ ÂÚÈÁÂÓÓËÙÈ΋ ÂÚ›Ô‰Ô˜ ·Ó·Ê¤ÚÂÙ·È ÂχıÂÚË Î·È Ë „˘¯ÔÎÈÓËÙÈ΋ ÂͤÏÈÍË ÙÔ˘ ·È‰ÈÔ‡ ¤ˆ˜ ÙËÓ ËÏÈΛ· ÙˆÓ 4 ÌËÓÒÓ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋. ™Â ËÏÈΛ· 5 ÌËÓÒÓ ‰È·ÈÛÙÒıËΠ˘ÔÙÔÓ›· Î·È ÙÔ ‚Ú¤ÊÔ˜ ÛÙ·Ì¿ÙËÛ ӷ ÎÏ·›ÂÈ Î·È Ó· ÁÂÏ¿, ÂÓÒ ÙÔ ÂӉȷʤÚÔÓ ÙÔ˘ ÁÈ· ÚfiÛˆ· ‹ ·ÓÙÈΛÌÂÓ· ‹Ù·Ó ÌÂȈ̤ÓÔ. ™Â ËÏÈΛ· 6 ÌËÓÒÓ ‰È·ÈÛÙÒıËΠ̷ÎÚÔÎÂÊ·Ï›· Î·È Ô ˘ÂÚ˯ÔÁÚ·ÊÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ ¤‰ÂÈÍ ‰È¿Ù·ÛË ÙÔ˘ ÎÔÈÏÈ·ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ¶·Ú¿ÏÏËÏ·, ÙÔ ‚Ú¤ÊÔ˜ ÂÌÊ¿ÓÈÛ ¯ÔÚÂÈÔ·ıÂÙˆÛÈΤ˜ ÎÈÓ‹ÛÂȘ Î·È Û·ÛÙÈÎfiÙËÙ· ÙˆÓ ¿ÎÚˆÓ. ™Â ËÏÈΛ· 9 ÌËÓÒÓ ·ÚÔ˘Û›·Û ÙÔ ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ÂÛÙÈ·ÎÒÓ Û·ÛÌÒÓ. §fiÁˆ ˘ÔÙÚÔÈ·˙fiÓÙˆÓ ÂÂÈÛÔ‰›ˆÓ, ÙÔ ·È‰› Ù¤ıËΠ·Ú¯Èο Û ·ÁˆÁ‹ Ì ηڂ·Ì·˙Â›ÓË. ∏ Â·Ó¿ÏË„Ë ÙÔ˘ ˘ÂÚ˯ÔÁÚ·ÊÈÎÔ‡ ÂϤÁ¯Ô˘ ¤‰ÂÈÍ ·‡ÍËÛË ÙÔ˘ ‚·ıÌÔ‡ ‰È¿Ù·Û˘ ÙˆÓ Ï¿ÁÈˆÓ ÎÔÈÏÈÒÓ Î·È Û ËÏÈΛ· 10 ÌËÓÒÓ ÙÔÔıÂÙ‹ıËΠ‚·Ï‚›‰· ÎÔÈÏÈÔÂÚÈÙÔÓ·˚΋˜ ·ÚÔ¯¤Ù¢Û˘. §fiÁˆ ÂÈÌÔÓ‹˜ ÙˆÓ Û·ÛÌÒÓ, Ë ·ÓÙÈÂÈÏËÙÈ΋ ·ÁˆÁ‹ ÙÚÔÔÔÈ‹ıËÎÂ, Ì ·ÓÙÈηٿÛÙ·ÛË Ù˘ ηڂ·Ì·˙Â›Ó˘ ·fi ‚·ÏÚÔ˚Îfi Ó¿ÙÚÈÔ, Ô˘ ›¯Â ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÛËÌ·ÓÙÈ΋ ·ÓÙ·fiÎÚÈÛË ÙfiÛÔ ˆ˜ ÚÔ˜ ÙËÓ ¤ÓÙ·ÛË fiÛÔ Î·È ˆ˜ ÚÔ˜ ÙË Û˘¯ÓfiÙËÙ· ÙˆÓ ÂÈÏËÙÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ. ∞fi ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô, Ë ÁÂÓÈ΋ ÂͤٷÛË ·›Ì·ÙÔ˜ Î·È Ë ÂͤٷÛË ÂȯڛÛÌ·ÙÔ˜ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο. O ·‰Úfi˜ ‚ÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ (ۿί·ÚÔ, ËÏÂÎÙÚÔχÙ˜, ‰Â›ÎÙ˜ ÓÂÊÚÈ΋˜ Î·È Ë·ÙÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜) ‰ÂÓ ¤‰ˆÛ ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·. ∆· Â›‰· ¯·ÏÎÔ‡ Î·È ÛÂÚÔ˘ÏÔÏ·ÛÌ›Ó˘ ÔÚÔ‡, fiˆ˜ Â›Û˘ Î·È Ù· Â›‰· Á·Ï·ÎÙÈÎÔ‡ ÔͤԘ, Î˘Ì·›ÓÔÓÙ·Ó ÂÓÙfi˜ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÔÚ›ˆÓ, Û ·ÓÙ›ıÂÛË Ì ٷ Â›‰· ˘ÚÔÛÙ·Ê˘ÏÈÎÔ‡ ÔͤԘ Ô˘ ‚Ú¤ıËÎ·Ó ·˘ÍË̤ӷ (1,3 mg/dl, Ê.Ù.: 0,3-0,7 mg/dl). ∏ ÁÂÓÈ΋ ÂͤٷÛË ÙÔ˘ ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô˘ ˘ÁÚÔ‡

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¤‰ÂÈÍÂ: ·ÙÙ·Ú· 7 Î.Ô.., χΈ̷ 79 mg/dl, ÁÏ˘Îfi˙Ë 40 mg/dl Î·È Á·Ï·ÎÙÈÎfi Ô͇ 19,5 mg/dl (Ê.Ù.: 10,818,9 mg/dl). ∆· Â›‰· ‚ÏÂÓÓÔÔÏ˘Û·Î¯·ÚÈÙÒÓ Î·È ÔÚÁ·ÓÈÎÒÓ ÔͤˆÓ Ô‡ÚˆÓ, ηıÒ˜ Î·È Ù· ÏÈ·Ú¿ Ôͤ· Ôχ Ì·ÎÚ¿˜ ·Ï‡ÛÔ˘ ÛÙÔÓ ÔÚfi, ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο. ∞fi ÙÔÓ ¤ÏÂÁ¯Ô ÙˆÓ ı˘ÚÂÔÂȉÈÎÒÓ ÔÚÌÔÓÒÓ ‰ÂÓ ÚԤ΢„·Ó ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·. O ¤ÏÂÁ¯Ô˜ ÁÈ· CMV Ïԛ̈ÍË ‹Ù·Ó ·ÚÓËÙÈÎfi˜. ∞˘ÙÔ·ÓÙÈÛÒÌ·Ù· (·ÓÙÈ˘ÚËÓÈο Î·È anti-DNA) ‰ÂÓ ·Ó¢ڤıËÛ·Ó. ∆Ô ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ· ‹Ù·Ó ‚Ú·‰˘ÚÚ˘ıÌÈÎfi Ì ÔÏ˘ÂÛÙÈ·ÎÔ‡ Ù‡Ô˘ ·ÚÔ͢ÛÌÈΤ˜ ÂÎÊÔÚÙ›ÛÂȘ.

O ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜, Ì ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ Ì ̷ÁÓËÙÈÎfi Û˘ÓÙÔÓÈÛÌfi (MRI), ·Ó¤‰ÂÈÍ ‰È¿Ù·ÛË ÙÔ˘ Ï¿ÁÈÔ˘ ÎÔÈÏÈ·ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Î·È Ù˘ ÙÚ›Ù˘ ÎÔÈÏ›·˜. ™ÙË Ï¢΋ Ô˘Û›·, fiÈÛıÂÓ ÙÔ˘ ‰ÂÍÈÔ‡ ÈÓÈ·ÎÔ‡ ΤڷÙÔ˜, ·ÂÈÎÔÓ›ÛÙËΠÂÛÙ›· ˘„ËÏÔ‡ Û‹Ì·ÙÔ˜ ÛÙËÓ ∆2 ·ÎÔÏÔ˘ı›· Î·È ÂӉȿÌÂÛÔ˘ Û‹Ì·ÙÔ˜ ÛÙËÓ ∆1 ·ÎÔÏÔ˘ı›·. ∂›Û˘, ‰È·ÈÛÙÒıËΠ̛ˆÛË Ù˘ ÂÚÈÎÔÈÏȷ΋˜ Ï¢΋˜ Ô˘Û›·˜, Ë ÔÔ›· ·ÂÈÎÔÓÈ˙fiÙ·Ó Ì ·ıÔÏÔÁÈÎfi Û‹Ì· ÌÂÙˆÔ‚ÚÂÁÌ·ÙÈο, ηıÒ˜ Î·È Ï¤Ù˘ÓÛË ÙÔ˘ ÂÁÎÂÊ·ÏÈÎÔ‡ ÊÏÔÈÔ‡, ·ÏÏ¿ Î·È ÙÔ˘ ÌÂÛÔÏÔ‚›Ô˘.

O ÂÚÁ·ÛÙËÚÈ·Îfi˜ Î·È ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ¤ÛÙÚ„ ÙË ‰È·ÁÓˆÛÙÈ΋ ÛΤ„Ë ÚÔ˜ ÙËÓ ÔÌ¿‰· ÙˆÓ Ï¢ÎÔ‰˘ÛÙÚÔÊÈÒÓ, ÂÓÒ ·Ú¿ÏÏËÏ· ·ÔÎÏ›ÛÙËÎ·Ó ¿ÏϘ ηÙËÁÔڛ˜ ÓÔÛËÌ¿ÙˆÓ (Ï˘ÛÔÛˆÌȷο ÓÔÛ‹Ì·Ù·, ˘ÂÚÔÍÂȉÔÛˆÌÈο ÓÔÛ‹Ì·Ù·). ∆· ·ÓˆÙ¤Úˆ Â˘Ú‹Ì·Ù·, ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÙÔ˘ ·È‰ÈÔ‡, ¤ıÂÙ·Ó ÈÛ¯˘Ú¿ ÙËÓ ˘Ô„›· ÓfiÛÔ˘ Alexander, ‰Â‰Ô̤ÓÔ˘ fiÙÈ Ë Û˘ÁÎÂÎÚÈ̤ÓË Ï¢ÎÔ‰˘ÛÙÚÔÊ›· ¤¯ÂÈ ¯·Ú·ÎÙËÚÈÛÙÈο ·ÂÈÎÔÓÈÛÙÈο Â˘Ú‹Ì·Ù·. ∏ ‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘ ÂȂ‚·ÈÒıËΠ̠ÌÔÚÈ·Îfi ¤ÏÂÁ¯Ô Ô˘ ¤ÁÈÓ Û ÂȉÈÎfi ΤÓÙÚÔ Ù˘ OÏÏ·Ó‰›·˜, fiÔ˘ ‚Ú¤ıËΠfiÙÈ ÙÔ ·È‰› ʤÚÂÈ ¯·Ú·ÎÙËÚÈÛÙÈ΋ ÁÈ· ÙË ÓfiÛÔ ÌÂÙ¿ÏÏ·ÍË ÛÙÔ ÁÔÓ›‰ÈÔ GFAP. ∆Ô ·È‰›, Û‹ÌÂÚ·, ·ÎÔÏÔ˘ı› ÚfiÁÚ·ÌÌ· Ê˘ÛÈÎÔıÂÚ·›·˜, ¯ˆÚ›˜ ȉȷ›ÙÂÚË ‚ÂÏÙ›ˆÛË. ¢ÂÓ Î¿ıÂÙ·È, ÂÓÒ ÛÙËÚ›˙ÂÈ ÙÔ ÎÂÊ¿ÏÈ Î·È ÌÔÚ› Ó· Á˘Ú›˙ÂÈ ·fi ÙËÓ ÚËÓ‹ ÛÙËÓ ‡ÙÈ· ı¤ÛË Î·È ·ÓÙ›ÛÙÚÔÊ·, ·ÚÔ˘ÛÈ¿˙ÔÓÙ·˜ Û˘¯Ó¿ ¯ÔÚÂÈÔ·ıÂÙˆÛÈΤ˜ ÎÈÓ‹ÛÂȘ. ∂Í·ÎÔÏÔ˘ı› Ó· ÌË ÁÂÏ¿ ‹ Ó· ÎÏ·›ÂÈ, ÂÓÒ ÂÌÊ·Ó›˙ÂÈ ¯·ÔÙÈΤ˜ ÎÈÓ‹ÛÂȘ ÔÊı·ÏÌÒÓ. §·Ì‚¿ÓÂÈ ¯ÚfiÓÈ· ·ÁˆÁ‹ Ì ‚·ÏÚÔ˚Îfi Ó¿ÙÚÈÔ Î·È, Ú·ÎÙÈο, Â›Ó·È ÂχıÂÚÔ ÎÚ›ÛˆÓ. ™˘˙‹ÙËÛË ∏ ÓfiÛÔ˜ Alexander Â›Ó·È Û¿ÓÈÔ ÓfiÛËÌ· Î·È ˘¿ÁÂÙ·È ÛÙËÓ ÔÌ¿‰· ÙˆÓ Ï¢ÎÔ‰˘ÛÙÚÔÊÈÒÓ. ¶ÂÚÈÁÚ¿ÊËΠÁÈ· ÚÒÙË ÊÔÚ¿ ÙÔ 1949 ·fi ÙÔÓ Alexander (1). ¶ÚfiÎÂÈÙ·È ÁÈ· Û¿ÓÈ·, ı·Ó·ÙËÊfiÚ· ¤ˆ˜ ÙËÓ ËÏÈΛ· ÙˆÓ 5 ÂÙÒÓ, ‰È·Ù·Ú·¯‹, Ë ÔÔ›· ÂΉËÏÒÓÂÙ·È Ì ÚÔԉ¢ÙÈ΋ Ì·ÎÚÔÎÂÊ·Ï›·, Û˘Ó‹ıˆ˜ ηٿ ÙË

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‰È¿ÚÎÂÈ· ÙÔ˘ 1Ô˘ ¤ÙÔ˘˜ ˙ˆ‹˜, ÌÂ Û˘ÓÔ‰fi ¿ÓÔÈ·, Û·ÛÌÔ‡˜ Î·È Û·ÛÙÈÎfiÙËÙ· (1). ∏ ÎÏÈÓÈ΋ ÚÔ‚ÔÏ‹ Â›Ó·È ¯·Ú·ÎÙËÚÈÛÙÈ΋ Ó¢ÚÔÂÎÊ˘ÏÈÛÙÈÎÔ‡ ÓÔÛ‹Ì·ÙÔ˜, ¯ˆÚ›˜ fï˜ Ó· Â›Ó·È ÂȉÈ΋ ÁÈ· ÙË ÓfiÛÔ. Œ¯Ô˘Ó ÂÚÈÁÚ·Ê› ·ÎfiÌË Î·È ÂÚÈÙÒÛÂȘ ÂÓËϛΈÓ, ·Ó Î·È ‰ÂÓ ¤¯ÂÈ ‰È¢ÎÚÈÓÈÛÙ› Â¿Ó ÚfiÎÂÈÙ·È ÁÈ· ÙËÓ ›‰È· ÓfiÛÔ (2). πÛÙÔÏÔÁÈο ·Ú·ÙËÚÂ›Ù·È ‰È¿¯˘ÙË ·ÔÌ˘ÂϛӈÛË Î·È ·Ú·›ˆÛË Ù˘ Ï¢΋˜ Ô˘Û›·˜, Ì ·ÚÔ˘Û›· ÈÓÒÓ Rosenthal (ÂÚȤ¯Ô˘Ó ÙËÓ fiÍÈÓË ÈÓȉȷ΋ ÚˆÙ½ÓË Ù˘ ÁÏÔ›·˜ - glial fibrillary acidic protein, GFAP) ÂÓÙfi˜ ÙˆÓ ·ÛÙÚÔ΢ÙÙ¿ÚˆÓ (1,2). ∆· ·ÛÙÚÔ·ÙÙ·Ú· Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÙË ‰È·‰Èηۛ· Ì˘ÂϛӈÛ˘ ηÈ, ˆ˜ ÂÎ ÙÔ‡ÙÔ˘, Ë ‰È·Ù·Ú·¯‹ Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘˜ Û˘ÓÂ¿ÁÂÙ·È Î·È ‰È·Ù·Ú·¯‹ Ù˘ Ì˘ÂϛӈÛ˘ (3). ¶ÚfiÛÊ·Ù· ·‰›¯ıË fiÙÈ Ë ÓfiÛÔ˜ ÔÊ›ÏÂÙ·È Û ÌÂÙ·ÏÏ¿ÍÂȘ ÙÔ˘ ÁÔÓȉ›Ô˘ GFAP, Û˘Ó‹ıˆ˜ ÛÔÚ·‰ÈΤ˜, ÔÈ Ôԛ˜ ·ÊÔÚÔ‡Ó Û ·ÏÏ·Á¤˜ ÂÓfi˜ ·ÌÈÓÔͤԘ ÛÙÔ ÙÂÏÈÎfi ÚˆÙÂ˚ÓÈÎfi ÚÔ˚fiÓ (4). ∏ ÓfiÛÔ˜ ¤¯ÂÈ ¯·Ú·ÎÙËÚÈÛÙÈο ·ÂÈÎÔÓÈÛÙÈο Â˘Ú‹Ì·Ù· ÛÙËÓ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ Ì ̷ÁÓËÙÈÎfi Û˘ÓÙÔÓÈÛÌfi (Magnetic Resonance Imaging - MRI), fiÔ˘ ÔÈ ·ÏÏÔÈÒÛÂȘ Ù˘ Ï¢΋˜ Ô˘Û›·˜ ·ÊÔÚÔ‡Ó Î˘Ú›ˆ˜ ÛÙÔ˘˜ ÌÂÙˆÈ·›Ô˘˜ ÏÔ‚Ô‡˜, Ì ٷ˘Ùfi¯ÚÔÓË ‰È¿Ù·ÛË ÙˆÓ Ï¿ÁÈˆÓ ÎÔÈÏÈÒÓ Î·È ÙˆÓ ÌÂÙˆÈ·›ˆÓ ÎÂÚ¿ÙˆÓ (5). ∆· ·ÂÈÎÔÓÈÛÙÈο, fï˜, Â˘Ú‹Ì·Ù· ‰ÂÓ ÌÔÚÔ‡Ó Û η̛· ÂÚ›ÙˆÛË Ó· ıˆÚËıÔ‡Ó ·ıÔÁÓˆÌÔÓÈο. °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi, ̤¯ÚÈ ÚÔ 2ÂÙ›·˜, Ë ‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘ ‚·ÛÈ˙fiÙ·Ó Û ‚ÈÔ„›· ÂÁÎÂÊ·ÏÈÎÔ‡ ÈÛÙÔ‡, fiÔ˘ ·Ó¢ڛÛÎÔÓÙ·Ó ÔÈ ¯·Ú·ÎÙËÚÈÛÙÈΤ˜ ›Ó˜ Rosenthal. ∂›Ó·È ÚÔÊ·Ó¤˜ fiÙÈ Ë ‚ÈÔ„›· ÂÁÎÂÊ¿ÏÔ˘ ·ÚÔ˘ÛÈ¿˙ÂÈ ‰˘ÛÎÔϛ˜ ÛÙËÓ ÂÎÙ¤ÏÂÛ‹ Ù˘ ηÈ, ˆ˜ ÂÎ ÙÔ‡ÙÔ˘, Ë ¿ÚÓËÛË ÙˆÓ ÁÔÓ¤ˆÓ ‹Ù·Ó ·Ó·ÌÂÓfiÌÂÓË. °È· ÙÔÓ ›‰ÈÔ ÏfiÁÔ, ÛÙÔ ·ÚÂÏıfiÓ, Ë ‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘ Alexander ‰ÂÓ ‹Ù·Ó ‡ÎÔÏÔ Ó· ÂȂ‚·Èˆı›. ∆· ÙÂÏÂ˘Ù·›· ‰‡Ô ¯ÚfiÓÈ· ˘¿Ú¯ÂÈ Ë ‰˘Ó·ÙfiÙËÙ· ÁÔÓȉȷÎÔ‡ ÂϤÁ¯Ô˘ ·fi ‰Â›ÁÌ· ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜ ÙÔ˘ ·ÛıÂÓÔ‡˜. ™ÙËÓ ·ÚÔ‡Û· ÂÚ›ÙˆÛË ¤ÁÈÓ ÌÔÚȷ΋ ·Ó¿Ï˘ÛË DNA ÛÙÔ ·È‰› Î·È ÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘. ∏ ÂͤٷÛË ¤ÁÈÓ Û ÂȉÈÎfi ΤÓÙÚÔ Ù˘ OÏÏ·Ó‰›·˜, fiÔ˘ ‚Ú¤ıËΠfiÙÈ ÙÔ ·È‰› ʤÚÂÈ ¯·Ú·ÎÙËÚÈÛÙÈ΋ ÁÈ· ÙË ÓfiÛÔ ÌÂÙ¿ÏÏ·ÍË. ™˘ÁÎÂÎÚÈ̤ӷ, ‚Ú¤ıËΠfiÙÈ ÙÔ ·ÌÈÓÔ͇ ÌÂıÂÈÔÓ›ÓË ÛÙË ı¤ÛË 73 ÛÙÔ ÚˆÙÂ˚ÓÈÎfi ·Ú¿ÁˆÁÔ ÙÔ˘ ÁÔÓȉ›Ô˘ GFAP ¤¯ÂÈ ·ÓÙÈηٷÛÙ·ı› ·fi ıÚÂÔÓ›ÓË, ˆ˜ ·ÔÙ¤ÏÂÛÌ· Ó¤·˜ (de novo) ÌÂÙ¿ÏÏ·Í˘ ÛÙÔ ÂÍfiÓÈÔ 1 (ª73∆) ÙÔ˘ ÁÔÓȉ›Ô˘. ∞ÓÙ›ÛÙÔȯԘ ¤ÏÂÁ¯Ô˜ ÛÙÔ˘˜ ÁÔÓ›˜ ¤‰ÂÈÍ fiÙÈ ‰ÂÓ Â›Ó·È ÊÔÚ›˜ (6). ¶ÚÔÁÂÓÓËÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ô˘ Ú·ÁÌ·ÙÔÔÈ‹ıËΠÛÙËÓ ÂfiÌÂÓË ÂÁ΢ÌÔÛ‡ÓË Ì ϋ„Ë ·ÌÓÈ·ÎÔ‡ ˘ÁÚÔ‡ ÙË 12Ë Â‚‰ÔÌ¿‰· ·ËÛ˘, ‹Ù·Ó ·ÚÓËÙÈÎfi˜ ÁÈ· ÓfiÛÔ Alexander. ∏ Û˘ÁÎÂÎÚÈ̤ÓË ÌÂÙ¿ÏÏ·ÍË ÂÚÈÁÚ¿ÊÂÙ·È ÁÈ· ÚÒÙË ÊÔÚ¿ ÛÙË ‚È‚ÏÈÔÁÚ·Ê›·. ∏ ÓfiÛÔ˜, Û‡Ìʈӷ Ì ٷ ‚È‚ÏÈÔÁÚ·ÊÈο ‰Â‰Ô̤ӷ, ÎÏËÚÔÓÔÌÂ›Ù·È Ì ·˘-

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ÙÔۈ̷ÙÈÎfi ˘ÔÏÂÈfiÌÂÓÔ ¯·Ú·ÎÙ‹Ú·, ÂÎÙfi˜ ÙˆÓ ÂÚÈÙÒÛÂˆÓ ·˘ÙfiÌ·Ù˘ Ó¤·˜ ÌÂÙ¿ÏÏ·Í˘, Ô˘ Â›Ó·È Î·È ÔÈ ÂÚÈÛÛfiÙÂÚ˜ (3). ∏ Û˘ÁÎÂÎÚÈ̤ÓË ÂÚ›ÙˆÛË Ì ٷ ¯·Ú·ÎÙËÚÈÛÙÈο ÎÏÈÓÈο Î·È ·ÂÈÎÔÓÈÛÙÈο Â˘Ú‹Ì·Ù· Ù˘ ÓfiÛÔ˘ Alexander, ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÁÈ· Ó· ÙÔÓ›ÛÂÈ ÙË ¯ÚËÛÈÌfiÙËÙ· Ù˘ ÌÔÚȷ΋˜ ·Ó¿Ï˘Û˘ DNA ÛÙËÓ ÂȂ‚·›ˆÛË Ù˘ ‰È¿ÁÓˆÛ˘ Î·È Ó· ‰Â›ÍÂÈ fiÙÈ Ë ·ÚÂÚÌËÓ‡ÛÈÌË ÌÂÙ¿ÏÏ·ÍË Ô˘ ·ÓȯÓ‡ıËΠÛÙÔÓ ·ÛıÂÓ‹ ÂÚÈÁÚ¿ÊÂÙ·È ÁÈ· ÚÒÙË ÊÔÚ¿ ÛÙË ‚È‚ÏÈÔÁÚ·Ê›·. ∂Ô̤ӈ˜, ‰‡Ó·Ù·È Ó· ÂÓÙ·¯ı› ÛÙËÓ ÔÌ¿‰· ÙˆÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙË ÓfiÛÔ (Database Mutation).

O ·ÛıÂÓ‹˜, Û‹ÌÂÚ·, Â›Ó·È ÛÙËÓ ›‰È· ηٿÛÙ·ÛË Ó¢ÚÔÏÔÁÈο Î·È ˘Ô‚¿ÏÏÂÙ·È ÛÂ Ê˘ÛÈÎÔıÂÚ·›·, ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂÍ·ÛÊ·ÏÈÛÙ› fiÛÔ ÙÔ ‰˘Ó·ÙfiÓ Î·Ï‡ÙÂÚË ÔÈfiÙËÙ· ˙ˆ‹˜, ·Ú¿ ÙÔÓ ÂÍÂÏÈÎÙÈÎfi ¯·Ú·ÎÙ‹Ú· Ù˘ ÓfiÛÔ˘ Î·È ÙËÓ Î·Î‹ ÚfiÁÓˆÛË. ∂˘¯·ÚÈÛٛ˜ π‰È·›ÙÂÚ˜ ¢¯·ÚÈÛٛ˜ ÂÎÊÚ¿˙ÔÓÙ·È ÛÙÔ˘˜ Û˘Ó·‰¤ÏÊÔ˘˜ Marjo S. van Knaap (Department of Child Neurology, Free University of Child Neurology, Amsterdam), Cornelis Jakobs (Metabolic Unit, University Hospital VU, Amsterdam) Î·È ÛÙË ªÔÚȷ΋ µÈÔÏfiÁÔ Gajja S. Salomons (University Hospital VU, Amsterdam).

µÈ‚ÏÈÔÁÚ·Ê›· 1. Brett EM, Lake BD. Progressive neurometabolic brain diseases. In: Brett EM, editor. Paediatric Neurology. 2nd ed.

London: Churchill Livingstone; 1991. p. 141-200.

2. Johnson AB. Alexander disease: a review and the gene. Int J Dev Neurosci 2002;20:391-394.

3. Reichard EA, Ball WS Jr, Bove KE. Alexander disease: a case report and review of the literature. Pediatr Pathol Lab Med 1996;16:327-343.

4. Gorospe JR, Naidu S, Johnson AB, Puri V, Raymond GV, Jenkins SD et al. Molecular findings in symptomatic and pre-symptomatic Alexander disease patients. Neurology 2002;58:1494-1500.

5. Kingsley DPE. Imaging in child neurology. In: Brett EM, editor. Paediatric Neurology. 2nd ed. London: Churchill Livingstone; 1991. p. 831-877.

6. Messing A, Goldman JE, Johnson AB, Brenner M. Alexander disease: new insights from genetics. J Neuropathol Exp Neurol 2001;60:563-573.

∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 25-07-2003 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 16-01-2004 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: §˘‰›· ∫fiÛÛ˘‚· ∫ÔÙ˘·›Ô˘ 12, ∆.∫. 115 21, ∞ı‹Ó· E-mail: lydiakossiva@hotmail.com

¶·È‰È·ÙÚÈ΋ 2004;67:135-139

∂¡¢π∞º∂ƒOÀ™∞ ¶∂ƒπ¶∆ø™∏

Paediatriki 2004;67:135-139

CASE REPORT

™‡Ó‰ÚÔÌÔ Gitelman. ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ÎÔÚÈÙÛÈÔ‡ ËÏÈΛ·˜ 6 ÂÙÒÓ ™. ¡ÙÂÏ›ÎÔ˘1, º. ª·Ú·ÁÎÔ‡1, ∫. °·˙‹1, º. ÷ÏÈÒÙ˘1, ∂. °ÂˆÚÁ¿ÎË2, ™. ∞˘ÏˆÓ›Ù˘1

Gitelman syndrome. Case report of a 6 year-old girl S. Delicou1, F. Maragou1, K. Gazi1, F. Haliotis1, E. Georgaki2, S. Avlonitis1

¶ÂÚ›ÏË„Ë: ∆Ô Û‡Ó‰ÚÔÌÔ Gitelman ·Ú·ÙËÚÂ›Ù·È Û ·È‰È¿ ÌÂÁ·Ï‡ÙÂÚ˘ ËÏÈΛ·˜ Î·È ÂÓ‹ÏÈΘ Î·È ·ÚÔ˘ÛÈ¿˙ÂÙ·È Ì ÂÚÈÔ‰Èο ÂÂÈÛfi‰È· Ì˘˚΋˜ ·‰˘Ó·Ì›·˜, ÙÂÙ·Ó›·˜, ˘ÔηÏÈ·ÈÌ›·˜ Î·È ˘ÔÌ·ÁÓËÛÈ·ÈÌ›·˜. OÊ›ÏÂÙ·È Û ÌÂÙ·ÏÏ¿ÍÂȘ ÛÙÔ ÁÔÓ›‰ÈÔ Ô˘ Έ‰ÈÎÔÔÈ› ÙÔÓ Â˘·›ÛıËÙÔ ÛÙȘ ıÂÈ·˙›‰Â˜ Û˘ÌÌÂÙ·ÊÔÚ¤· NaCl, ÔÈ Ôԛ˜ ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ÛÙËÓ ÏÂÈÔ„ËÊ›· ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ¤¯Ô˘Ó ÌÂÏÂÙËı›. ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ÎÔÚÈÙÛÈÔ‡ ËÏÈΛ·˜ 6 ÂÙÒÓ Ì ˘ÔÌ·ÁÓËÛÈ·ÈÌ›·, ˘ÔηÏÈ·ÈÌÈ΋ ÌÂÙ·‚ÔÏÈ΋ ·ÏοψÛË, ˘ÂÚÌ·ÁÓËÛÈÔ˘Ú›· Î·È ˘·Û‚ÂÛÙÈ·ÈÌ›·, ηıÒ˜ Î·È Ë ‰È¿ÁÓˆÛË ·˘Ù‹˜ Ù˘ Û¿ÓÈ·˜ ¿ıËÛ˘ Î·È Ë ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ·fi ÙÔ Û‡Ó‰ÚÔÌÔ Bartter Ô˘ ÌÔÚ› Ó· ÚÔ‚¿ÏÏÂÈ Ì ÔÏÏ¿ ÎÔÈÓ¿ ÎÏÈÓÈÎÔÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù·.

Abstract: Gitelman syndrome is observed in older children and adults, presenting with intermittent episodes of muscle weakness and tetany, hypokalaemia and hypomagnesaemia.

Mutations of the gene encoding the thiazide sensitive sodium chloride cotransporter have been identified in the majority of the patients studied. The case of a 6 year-old girl with hypomagnesaemia, hypokalaemic metabolic alkalosis, hypermagnesuria and hypocalciuria is described, and the diagnosis and differential diagnosis between Gitelman and Bartter syndromes are discussed.

§¤ÍÂȘ ÎÏÂȉȿ: Û‡Ó‰ÚÔÌÔ Gitelman, ˘ÔηÏÈ·ÈÌ›·, ˘ÔÌ·ÁÓËÛÈ·ÈÌ›·, ·ÏοψÛË.

Key words: Gitelman syndrome, hypokalemia, magnesium deficiency, alkalosis.

∂ÈÛ·ÁˆÁ‹ ∆Ô Û‡Ó‰ÚÔÌÔ Gitelman ·Ó‹ÎÂÈ ÛÙȘ ·ı‹ÛÂȘ ÙÔ˘ Ô˘ÚÔÊfiÚÔ˘ ÛˆÏËÓ·Ú›Ô˘. ÷ڷÎÙËÚ›˙ÂÙ·È ·fi ÌÂÁ¿ÏË ÂÙÂÚÔÁ¤ÓÂÈ· ˆ˜ ÚÔ˜ ÙËÓ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·, ÙËÓ ÂȉËÌÈÔÏÔÁ›· Î·È ÙȘ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ÙÔ˘. ∏ ·fiÏ˘ÙË Û˘¯ÓfiÙËÙ· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ‰ÂÓ Â›Ó·È ÁÓˆÛÙ‹ ÏfiÁˆ ÛÔÚ·‰ÈÎfiÙËÙ·˜. ∫ÏËÚÔÓÔÌÂ›Ù·È Î˘Ú›ˆ˜ Ì ÙÔÓ ·˘ÙÔۈ̷ÙÈÎfi ˘ÔÏÂÈfiÌÂÓÔ ¯·Ú·ÎÙ‹Ú·, ˆÛÙfiÛÔ ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ÂÚÈÙÒÛÂȘ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜ Ì ÙÔÓ ·˘ÙfiÛˆÌÔ ÂÈÎÚ·Ùo‡ÓÙ·.

OÈ Î‡ÚȘ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Â̤ÙÔ˘˜, ÔÏ˘Ô˘Ú›·, ÔÏ˘‰È„›·, ·Ê˘‰¿ÙˆÛË, Ì˘˚΋ ·‰˘Ó·Ì›·, Û·ÛÌÔ‡˜ Î·È ÙÂÙ·Ó›·. ∆· ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· Û˘Ó›ÛÙ·ÓÙ·È ÛÂ

˘ÔηÏÈ·ÈÌ›·, ˘ÔÌ·ÁÓËÛÈ·ÈÌ›·, ˘·Û‚ÂÛÙÈÔ˘Ú›·, ÌÂÙ·‚ÔÏÈ΋ ·ÏοψÛË Î·È ˘ÂÚÚÂÓÈÓ·ÈÌ›·. ∏ ‰È¿ÁÓˆÛË Ù›ıÂÙ·È ·fi ÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ· Î·È Ù· ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù·.

1 µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó· 2 ¶·È‰ÔÓÂÊÚÔÏÔÁÈÎfi ∆Ì‹Ì·, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó·

1 2nd Paediatric Clinic, “Aghia Sophia” Children’s Hospital, Athens 2 Department of Nephrology, “Aghia Sophia” Children’s Hospital, Athens

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ÎÔÚÈÙÛÈÔ‡ ËÏÈΛ·˜ 6 ÂÙÒÓ Ì ÂχıÂÚÔ ÂÚÈÁÂÓÓËÙÈÎfi Î·È ·ÙÔÌÈÎfi ·Ó·ÌÓËÛÙÈÎfi. ∏ ۈ̷ÙÈ΋ ·Ó¿Ù˘ÍË (‡„Ô˜: 90‹ ∂.£., ‚¿ÚÔ˜: 60‹ ∂.£.) Î·È Ë „˘¯ÔÎÈÓËÙÈ΋ ÂͤÏÈÍË ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈΤ˜ ÁÈ· ÙËÓ ËÏÈΛ· Ù˘. OÈ ÁÔÓ›˜ ‹Ù·Ó Ê·ÈÓÔÙ˘Èο ˘ÁÈ›˜, Ì ÂχıÂÚÔ ÈÛÙÔÚÈÎfi. ∆Ô ·È‰› ·ÚÔ˘Û›·Û Ӣ¯ÙÂÚÈÓ‹ ·Ê‡ÓÈÛË Ì ӷ˘Ù›·, ÎÔÈÏÈ·Îfi ¿ÏÁÔ˜ Î·È Â̤ÙÔ˘˜. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ Ë̤ڷ˜, ÔÈ ¤ÌÂÙÔÈ Û˘Ó¯›ÛÙËÎ·Ó Î·È ÙÔ

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·È‰› ·ÚÔ˘Û›·ÛÂ Ì˘˚΋ ·‰˘Ó·Ì›·, ·ÛÙ¿ıÂÈ· ‚¿‰ÈÛ˘, ÂÓÒ Ë ‰È¿ıÂÛ‹ ÙÔ˘ ‹Ù·Ó ÂËÚ·Ṳ̂ÓË. ªÂٷʤÚıËΠÛÙÔ ÓÔÛÔÎÔÌ›Ô, fiÔ˘ ηٿ ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË ÂÈÛ·ÁˆÁ‹˜ ‰È·ÈÛÙÒıËΠıÂÚÌÔÎÚ·Û›· 36,5ÔC, ·ÚÙËÚȷ΋ ›ÂÛË 108/68 mmHg, ÛʇÍÂȘ 107/min, ·Ó·ÓÔ¤˜ 45/min, ÍËÚfiÙËÙ· ‰¤ÚÌ·ÙÔ˜ Î·È ‚ÏÂÓÓÔÁfiÓˆÓ Î·È ÂÈÛ¤¯ÔÓÙ˜ ÔÊı·ÏÌÔ›, ÂÓÒ ÙfiÛÔ ÛÙÔ ˆÙÔÚÈÓÔÏ·Ú˘ÁÁÔÏÔÁÈÎfi fiÛÔ Î·È ÛÙÔ ·Ó·Ó¢ÛÙÈÎfi Î·È Î˘ÎÏÔÊÔÚÈÎfi Û‡ÛÙËÌ· ‰ÂÓ ˘‹Ú¯·Ó ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·. ∏ ÎÔÈÏ›· ‹Ù·Ó Ì·Ïı·Î‹, ¢›ÂÛÙË Î·È ·ÓÒ‰˘ÓË Î·È Ù· ˘Ô¯fiÓ‰ÚÈ· ÂχıÂÚ·. ∞fi ÙË Ó¢ÚÔÏÔÁÈ΋ ÂͤٷÛË, Ù· ÙÂÓfiÓÙÈ· ·ÓÙ·Ó·ÎÏ·ÛÙÈο ÂÎχÔÓÙÔ Ê˘ÛÈÔÏÔÁÈο Û˘ÌÌÂÙÚÈο Î·È ÔÈ ÂÁÎÂÊ·ÏÈΤ˜ Û˘˙˘Á›Â˜ ‹Ù·Ó ηٿ ʇÛË. OÈ ÏÔÈ¤˜ ‰ÔÎÈ̷ۛ˜ ‰ÂÓ ¤‰ÂÈÍ·Ó ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·, ÂÓÒ ·Ú·ÙËÚ‹ıËÎÂ Ì˘˚΋ ·‰˘Ó·Ì›· οو ¿ÎÚˆÓ. ∞fi ÙÔÓ ·Ú¯ÈÎfi ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô ÚԤ΢„·Ó Ù· ·ÎfiÏÔ˘ı·: Hb: 12,5 g/dl, Ht: 37%, WBC: 5820/mm3 (¶: 48,5%, §: 41%, ª: 5,8%, ∏: 1,4%, µ: 0,5%), PLT: 354.000/mm3, pH ·ÚÙËÚÈ·ÎÔ‡ ·›Ì·ÙÔ˜: 7,37, HCO3- ·ÚÙËÚÈ·ÎÔ‡ ·›Ì·ÙÔ˜: 32 mmol/l, Ô˘Ú›·: 27 mg/dl, ÎÚ·ÙÈÓ›ÓË: 0,6 mg/dl, ÁÏ˘Îfi˙Ë: 96 mg/dl, ∫+ ÔÚÔ‡: 2,3 mmol/l, Cl- ÔÚÔ‡: 91 mmol/l, Mg++ ÔÚÔ‡: 1,5 mmol/l, Ca++ ÔÚÔ‡: 9,7 mg/dl, ÁÂÓÈ΋ Ô‡ÚˆÓ: ∂.µ.: 1020, pH: 8,0, ¯ˆÚ›˜ ¿ÏÏ· ·ıÔÏÔÁÈο ÛÙÔȯ›·, ηÏÏȤÚÁÂÈ· Ô‡ÚˆÓ: ÛÙ›ڷ, ∏∫°: ·Ú¿Ù·ÛË Q∆, ˘„ËÏ¿ p, ¯·ÌËÏ¿ T, ·̷ u. ŒÁÈÓ ÂÓ˘‰¿ÙˆÛË ÙÔ˘ ·È‰ÈÔ‡ Û‡Ìʈӷ Ì ÙȘ ·Ó¿ÁΘ ÙÔ˘ Î·È ·ÔηٿÛÙ·ÛË ÙˆÓ ËÏÂÎÙÚÔÏ˘ÙÒÓ ·Ó·ÏfiÁˆ˜ ÙˆÓ ÂÏÏÂÈÌÌ¿ÙˆÓ. ªÂ ÙËÓ ˘fiÓÔÈ· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Bartter, ¤ÁÈÓ ̤ÙÚËÛË ÚÂÓ›Ó˘ ÔÚÔ‡ (341 Ìu/ml, Ê.Ù.: 7-76 Ìu/ml) Î·È ÂÓÂÚÁÔ‡ ÎÏ¿ÛÌ·ÙÔ˜ ÚÂÓ›Ó˘ Ï¿ÛÌ·ÙÔ˜ PRA (25 ng/ml, Ê.Ù.: 2,47±2) Ô˘ ‹Ù·Ó ·˘ÍË̤ӷ, ÂÓÒ Ë ·Ï‰ÔÛÙÂÚfiÓË Ï¿ÛÌ·ÙÔ˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋ (14 ng/dl, Ê.Ù.: 4-76 ng/dl). ∏ ·ÚÙËÚȷ΋ ›ÂÛË ÙÔ˘ ·È‰ÈÔ‡ Û fiÚıÈ· Î·È ‡ÙÈ· ı¤ÛË ‹Ù·Ó ÂÓÙfi˜ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÔÚ›ˆÓ ÁÈ· ÙËÓ ËÏÈΛ· ÙÔ˘, ÂÓÒ ·fi ÙÔÓ ·ÂÈÎÔÓÈÛÙÈÎfi ¤ÏÂÁ¯Ô ÙÔ˘ Ô˘ÚÔÔÈËÙÈÎÔ‡ Ì ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ‰ÂÓ ÚԤ΢„ ·Ó·ÙÔÌÈ΋ ·ÓˆÌ·Ï›· ‹ ÂÈÎfiÓ· ÓÂÊÚ·Û‚¤ÛÙˆÛ˘. ¶·Ú¿ ÙË ‰È·ÎÔ‹ ÙˆÓ Â̤وÓ, ÙËÓ ÂÓ˘‰¿ÙˆÛË Î·È ÙËÓ ·ÔηٿÛÙ·ÛË ÙˆÓ ËÏÂÎÙÚÔÏ˘ÙÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ, ÙÔ ∫+ ÔÚÔ‡ ÂÍ·ÎÔÏÔ˘ıÔ‡Û ӷ ·Ú·Ì¤ÓÂÈ ¯·ÌËÏfi (2,8-3,3 mmol/l), ÙÔ Cl- ÔÚÔ‡ ÔÚȷο ¯·ÌËÏfi (98-100 mmol/l), ÂÓÒ ÂÍ·ÎÔÏÔ˘ıÔ‡Û ӷ ·Ô‚¿ÏÏÂÈ ·fi Ù· Ô‡Ú· ÛËÌ·ÓÙÈΤ˜ ÔÛfiÙËÙ˜ ∫+ (5,5 mmol/24 h/kg, Ê.Ù.: 1,6-2,2) Î·È Mg++ (4,9 mg/24 h/kg, Ê.Ù.: 2,5±1). ∏ ·Ô‚ÔÏ‹ Ca++ ·Ú¤ÌÂÈÓ ¯·ÌËÏ‹ (0,73 mg/24 h/kg, Ê.Ù.: <5) Î·È Ô ÏfiÁÔ˜ UCa/UCr ÛÂ Ù˘¯·›Ô ‰Â›ÁÌ· Ô‡ÚˆÓ ‹Ù·Ó 0,08 (Ê.Ù.: 0,20-0,25). T· HCO3- ·ÚÙËÚÈ·ÎÔ‡ ·›Ì·ÙÔ˜ Î˘Ì·›ÓÔÓÙ·Ó ·fi 29-35 mmol/l. ∆· Â›‰· Ca++ ÛÙ· Ô‡Ú·

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Paediatriki 2004;67:135-139

Î·È Ë Û¯¤ÛË Ca++ Ô‡ÚˆÓ ÚÔ˜ ÎÚ·ÙÈÓ›ÓË Ô‡ÚˆÓ (32) ¤¯Ô˘Ó ¯ÚËÛÈÌÔÔÈËı› ÁÈ· ÙÔÓ ‰È·¯ˆÚÈÛÌfi ÙÔ˘ ÎÏ·ÛÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ Bartter Î·È ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Gitelman. ∆Ô ÎÏ·ÛÈÎfi Û‡Ó‰ÚÔÌÔ Bartter Â›Ó·È ÚˆÙÔ·ı‹˜ ÓÂÊÚÈ΋ ÛˆÏËÓ·Úȷ΋ ˘ÔηÏÈ·ÈÌÈ΋ ÌÂÙ·‚ÔÏÈ΋ ·ÏοψÛË ÌÂ Ê˘ÛÈÔÏÔÁÈο ‹ ·˘ÍË̤ӷ Â›‰· Ca++ ÛÙ· Ô‡Ú· Î·È Û¯¤ÛË Ca/Cr Ô‡ÚˆÓ >0,20, ÂÓÒ ÙÔ Û‡Ó‰ÚÔÌÔ Gitelman Â›Ó·È ÚˆÙÔ·ı‹˜ ÓÂÊÚÈ΋ ˘ÔηÏÈ·ÈÌÈ΋ ÌÂÙ·‚ÔÏÈ΋ ·ÏοψÛË, ˘ÔÌ·ÁÓËÛÈ·ÈÌ›·, ˘·Û‚ÂÛÙÈÔ˘Ú›· Î·È Û¯¤ÛË Ca/Cr Ô‡ÚˆÓ <0,20. ªÂ ‚¿ÛË ÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÙÔ˘ ·È‰ÈÔ‡ Î·È Ù· ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù·, Ù¤ıËÎÂ Ë ‰È¿ÁÓˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Gitelman Î·È ·ÔÎÏ›ÛÙËΠÙÔ Û‡Ó‰ÚÔÌÔ Bartter. ŒÁÈÓ ‰È·ÎÔ‹ ÙÔ˘ ¯ÔÚËÁÔ‡ÌÂÓÔ˘ ∫+ Î·È Â·Ó¿ÏË„Ë ÙÔ˘ ÂÚÁ·ÛÙËÚÈ·ÎÔ‡ ÂϤÁ¯Ô˘, Ô ÔÔ›Ô˜ ·Ó¤‰ÂÈÍ ˘ÔηÏÈ·ÈÌ›·, ˘ÔÌ·ÁÓËÛÈ·ÈÌ›·, ˘·Û‚ÂÛÙÈÔ˘Ú›· Î·È ˘ԯψÚÈ·ÈÌÈ΋ ÌÂÙ·‚ÔÏÈ΋ ·ÏοψÛË. ∆Ô ·È‰› Ù¤ıËΠÛÂ Û˘ÓÙËÚËÙÈ΋ ·ÁˆÁ‹ Ì Û΢¿ÛÌ·Ù· Î·Ï›Ô˘ Î·È Ì·ÁÓËÛ›Ô˘ ·fi ÙÔ ÛÙfiÌ·. ∏ ÎÏÈÓÈÎÔÂÚÁ·ÛÙËÚȷ΋ ·Ú·ÎÔÏÔ‡ıËÛË ‰Â›¯ÓÂÈ Ê˘ÛÈÔÏÔÁÈ΋ ·Ó¿Ù˘ÍË Î·È Î·Ï‹ ·ÓÙ·fiÎÚÈÛË ÙÔ˘ ·È‰ÈÔ‡. ™˘˙‹ÙËÛË OÈ ÎÏËÚÔÓÔÌÔ‡ÌÂÓ˜ ÛˆÏËÓ·ÚÈÔ¿ıÂȘ Ù·ÍÈÓÔÌÔ‡ÓÙ·È Û 3 ÎÏÈÓÈÎÔ‡˜ Ù‡Ô˘˜: ·) ÙÔ ÎÏ·ÛÈÎfi Û‡Ó‰ÚÔÌÔ Bartter (1), ‚) ÙÔ Û‡Ó‰ÚÔÌÔ ˘ÂÚ¤ÎÎÚÈÛ˘ ÚÔÛÙ·ÁÏ·Ó‰›Ó˘ ∂ (ÂÌ‚Ú˘˚Îfi˜ Ù‡Ô˜ Û˘Ó‰ÚfiÌÔ˘ Bartter (1) Î·È Á) ÙÔ Û‡Ó‰ÚÔÌÔ Gitelman. ∫ÔÈÓfi ¯·Ú·ÎÙËÚÈÛÙÈÎfi Î·È ÙˆÓ ÙÚÈÒÓ ·˘ÙÒÓ Ù‡ˆÓ Â›Ó·È Ë ˘ÔηÏÈ·ÈÌÈ΋ ÌÂÙ·‚ÔÏÈ΋ ·ÏοψÛË Î·È Ë ·ÒÏÂÈ· ËÏÂÎÙÚÔÏ˘ÙÒÓ Ì ٷ Ô‡Ú·. ∆Ô Û‡Ó‰ÚÔÌÔ Gitelman (2) ·Ó·Ê¤ÚÂÙ·È Î·È ˆ˜ ÔÈÎÈÏ›· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Bartter Î·È ¯·Ú·ÎÙËÚ›˙ÂÙ·È, ÂÎÙfi˜ ·fi ÙËÓ ˘ÔηÏÈ·ÈÌÈ΋ ÌÂÙ·‚ÔÏÈ΋ ·ÏοψÛË, ·fi ˘ÔÌ·ÁÓËÛÈ·ÈÌ›· Î·È ˘·Û‚ÂÛÙÈÔ˘Ú›·. ∫ÏËÚÔÓÔÌÂ›Ù·È Ì ÙÔÓ ·˘ÙfiÛˆÌÔ ˘ÔÏÂÈfiÌÂÓÔ ¯·Ú·ÎÙ‹Ú·, ·Ó Î·È ÔÈ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ Ô˘ ¤¯Ô˘Ó ÂÍÂÙ·ÛÙ› ¤¯Ô˘Ó ÛÔÚ·‰ÈÎfi ¯·Ú·ÎÙ‹Ú· (3-5). ™Â Ì›· ÌÂϤÙË ÙÔ˘ 1988 ˘ÔÏÔÁ›ÛÙËΠfiÙÈ Ë Û˘¯ÓfiÙËÙ· ·Ó¤Ú¯ÂÙ·È Û 1-2 ÂÚÈÙÒÛÂȘ ·Ó¿ ÂηÙÔÌ̇ÚÈÔ ÁÂÓÈÎÔ‡ ÏËı˘ÛÌÔ‡. ∆Ô Û‡Ó‰ÚÔÌÔ ·˘Ùfi ÂΉËÏÒÓÂÙ·È Û ·È‰È¿ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜, ÂÊ‹‚Ô˘˜ ‹ ·ÎfiÌ· Î·È ÂÓ‹ÏÈΘ, ÂÓÒ ˘¿Ú¯Ô˘Ó ÂÚÈÙÒÛÂȘ Ô˘ ÂÍÂÏ›ÛÛÔÓÙ·È ·Û˘Ìو̷ÙÈο Î·È ·ÔηχÙÔÓÙ·È ÛÂ Ù˘¯·›Ô ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô (4). ™ÙÔ ·ÙÔÌÈÎfi Î·È ÂÚÈÁÂÓÓËÙÈÎfi ÈÛÙÔÚÈÎfi ·˘ÙÒÓ ÙˆÓ ·È‰ÈÒÓ ‰ÂÓ ·Ó·Ê¤ÚÔÓÙ·È ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·, Û ·ÓÙ›ıÂÛË Ì ÙÔ Û‡Ó‰ÚÔÌÔ Bartter, ÙÔ ÔÔ›Ô ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÚÔˆÚfiÙËÙ· Î·È ÔÏ˘‰Ú¿ÌÓÈÔ (6). OÈ Î‡ÚȘ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ÔÊ›ÏÔÓÙ·È ÛÙËÓ ˘ÔηÏÈ·ÈÌ›· Î·È ÙËÓ ˘ÔÌ·ÁÓËÛÈ·ÈÌ›· Î·È Û˘Ó›ÛÙ·ÓÙ·È Û ÎfiˆÛË, Ì˘˚΋ ·‰˘Ó·Ì›· Î·È ÎÚ¿Ì˜ Ô˘ ÌÔÚ› Ó· Êı¿ÛÔ˘Ó ÛÂ

¶·È‰È·ÙÚÈ΋ 2004;67:135-139

Û·ÛÌÔ‡˜ ‹ ÙÂÙ·Ó›·. ™ÙÔ ÈÛÙÔÚÈÎfi ÙÔ˘˜, ·˘Ù¿ Ù· ·È‰È¿ ¤¯Ô˘Ó ÂÂÈÛfi‰È· ÔÏ˘Ô˘Ú›·˜, ‰˘ÛÎÔÈÏÈfiÙËÙ·˜ ‹ ·ÓÂÍ‹ÁËÙˆÓ ÂÌ¤ÙˆÓ Î·È ·Ê˘‰¿ÙˆÛ˘ (7-9). ™·ÓÈfiÙÂÚ·, ÂÌÊ·Ó›˙Ô˘Ó ·ÚıÚ·ÏÁ›Â˜. ∏ ıÚ¤„Ë ÙÔ˘˜ Â›Ó·È Û˘Ó‹ıˆ˜ Ê˘ÛÈÔÏÔÁÈ΋ (Û ·ÓÙ›ıÂÛË Ì ٷ ·È‰È¿ Ô˘ ¿Û¯Ô˘Ó ·fi Û‡Ó‰ÚÔÌÔ Bartter, Ù· ÔÔ›· ¤¯Ô˘Ó ·ÓÂ·Ú΋ ıÚ¤„Ë), fiˆ˜ Î·È Ë ÓÔËÙÈ΋ ÙÔ˘˜ ·Ó¿Ù˘ÍË (10). ∏ ·ÚÙËÚȷ΋ ›ÂÛË Â›Ó·È Ê˘ÛÈÔÏÔÁÈ΋ ‹ οو ·fi Ù· Ê˘ÛÈÔÏÔÁÈο fiÚÈ·, ·ÏÏ¿ ÔÙ¤ ·˘ÍË̤ÓË. ∞fi ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô, ·ÚÈ· Â˘Ú‹Ì·Ù· Â›Ó·È Ë ˘ÔηÏÈ·ÈÌ›· Ô˘ Û˘Óԉ‡ÂÙ·È Û˘¯Ó¿ ·fi ËÏÂÎÙÚÔηډÈÔÁÚ·ÊÈΤ˜ ‰È·Ù·Ú·¯¤˜, Ë ˘ÔÌ·ÁÓËÛÈ·ÈÌ›·, Ë ÌÂÙ·‚ÔÏÈ΋ ·ÏοψÛË, Ë ˘ԯψÚÈ·ÈÌ›·, ÂÓÒ ·fi Ù· Ô‡Ú· ·Ô‚¿ÏÏÔÓÙ·È ÌÂÁ¿Ï˜ ÔÛfiÙËÙ˜ Î·Ï›Ô˘ Î·È ¯ÏˆÚ›Ô˘. ÷ڷÎÙËÚÈÛÙÈ΋ Â›Ó·È Ë ˘·Û‚ÂÛÙÈÔ˘Ú›· ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ·Û‚¤ÛÙÈÔ ÔÚÔ‡ (11,12). ∏ ÚÂÓ›ÓË ÔÚÔ‡ Î·È ÙÔ ÂÓÂÚÁfi ÎÏ¿ÛÌ· ÚÂÓ›Ó˘ Ï¿ÛÌ·ÙÔ˜ Â›Ó·È ·˘ÍË̤ӷ, ÂÓÒ Ë ·Ï‰ÔÛÙÂÚfiÓË Â›Ó·È Û˘Ó‹ıˆ˜ Ê˘ÛÈÔÏÔÁÈ΋ Î·È Û·Ó›ˆ˜ ·˘ÍË̤ÓË (13). ∏ ·ıÔÊ˘ÛÈÔÏÔÁÈ΋ ‚Ï¿‚Ë ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Gitelman (14-17) ÂÓÙÔ›˙ÂÙ·È ÛÙ· ¿ˆ ÂÛÂÈڷ̤ӷ ÛˆÏËÓ¿ÚÈ· Î·È ·Ô‰›‰ÂÙ·È Û ·ÒÏÂȘ Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘ Û˘ÌÌÂÙ·ÊÔÚ¤· Na+-Cl- Î·È ÙˆÓ ·ÓÙÈÌÂÙ·ÊÔÚ¤ˆÓ Na+-Ca++ Î·È Na+-Mg++. ∏ ·ÒÏÂÈ· Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ ·˘Ù‹˜ ÌÂÈÒÓÂÈ ÙËÓ Â·Ó·ÚÚfiÊËÛË ÙÔ˘ NaCl ÛÙÔ ¿ˆ ÂÛÂÈڷ̤ÓÔ ÛˆÏËÓ¿ÚÈÔ (fiÔ˘ Ê˘ÛÈÔÏÔÁÈο Â·Ó·ÚÚÔÊ¿Ù·È ÙÔ 7% ÙÔ˘ ‰ÈËıÔ‡ÌÂÓÔ˘ NaCl). ∆Ô ÔÛfi ÙÔ˘ NaCl Ô˘ ‰ÂÓ Â·Ó·ÚÚÔÊ¿Ù·È, ÌÂٷʤÚÂÙ·È ÛÙÔ ·ıÚÔÈÛÙÈÎfi ÛˆÏËÓ¿ÚÈÔ, Ì ·ÔÙ¤ÏÂÛÌ· ÙË Ì›ˆÛË ÙÔ˘ ÂÍˆÎ˘ÙÙ¿ÚÈÔ˘ fiÁÎÔ˘ Î·È ÙËÓ ¤ÎÎÚÈÛË ·Ï‰ÔÛÙÂÚfiÓ˘, Ë ÔÔ›· Ì ÙË ÛÂÈÚ¿ Ù˘ ‰ÈÂÁ›ÚÂÈ ÙËÓ ·¤ÎÎÚÈÛË ∫+ Î·È ∏+ Î·È Ô‰ËÁ› Û ˘ÔηÏÈ·ÈÌÈ΋ ÌÂÙ·‚ÔÏÈ΋ ·ÏοψÛË. ∏ ·Ó·ÛÙÔÏ‹ Ù˘ Â·Ó·ÚÚfiÊËÛ˘ NaCl ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·‡ÍËÛË Ù˘ Â·Ó·ÚÚfiÊËÛ˘ ÙÔ˘ Ca++ Î·È ÙË Ì›ˆÛË Ù˘ ÛÙ¿ıÌ˘ ÙÔ˘ ÛÙ· Ô‡Ú· (˘·Û‚ÂÛÙÈÔ˘Ú›·) (17). ∏ ÌÂÙ·ÊÔÚ¿ ÙÔ˘ Mg++ ÛÙ· ¿ˆ ÂÛÂÈڷ̤ӷ ÛˆÏËÓ¿ÚÈ· ·˘Í¿ÓÂÙ·È Û ÌÂÙ·‚ÔÏÈ΋ ·ÏοψÛË Î·È ˘Ô-ÔÁηÈÌ›·, Ì ÙËÓ ¤ÎÎÚÈÛË Ù˘ ·Ï‰ÔÛÙÂÚfiÓ˘ Î·È Ù˘ ADH. OÈ ‰Ú¿ÛÂȘ ·˘ÙÒÓ ÙˆÓ ÔÚÌÔÓÒÓ ÂÚÈÔÚ›˙ÔÓÙ·È ·fi ÙËÓ ˘ÔηÏÈ·ÈÌ›·, Ë ÔÔ›· ·Ó·ÛÙ¤ÏÏÂÈ ÙË Ó·ÙÚÈÔ-ÂÍ·ÚÙÒÌÂÓË Â·Ó·ÚÚfiÊËÛË ªg++ ÛÙ· ¿ˆ ÂÛÂÈڷ̤ӷ ÛˆÏËÓ¿ÚÈ·, Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ˘ÂÚÌ·ÁÓËÛÈÔ˘Ú›· (15,18). ¶·ÚfiÌÔÈÔ˜ Ì˯·ÓÈÛÌfi˜ ·Ú·ÙËÚÂ›Ù·È Î·È ÛÙË ¯ÚfiÓÈ· ‰Ú¿ÛË ıÂÈ·˙ȉÈÎÒÓ ‰ÈÔ˘ÚËÙÈÎÒÓ (19,20,26,27). OÈ ıÂÈ·˙›‰Â˜ Î·È Ù· ‰ÈÔ˘ÚËÙÈο Ì ·ÚfiÌÔÈ· ‰Ú¿ÛË (¯ÏˆÚÔı·ÏȉfiÓË) ‰ÚÔ˘Ó ÛÙÔ ·ÓÈfiÓ ÛΤÏÔ˜ Ù˘ ·Á·Ï˘ ÙÔ˘ Henle Î·È ÛÙ· ¿ˆ ÂÛÂÈڷ̤ӷ ÛˆÏËÓ¿ÚÈ· Î·È ÚÔηÏÔ‡Ó ·˘ÍË̤ÓË ·¤ÎÎÚÈÛË Ó·ÙÚ›Ô˘ Î·È ‡‰·ÙÔ˜. ∂›Ó·È ‰ÈÔ˘ÚËÙÈο Ì ̤ÙÚÈ· ÈÛ¯‡ Î·È ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÁÈ· ÙËÓ Î·Ù·ÔϤÌËÛË ‹ÈˆÓ ÔȉËÌ¿ÙˆÓ. ∏ ‰Ú¿ÛË ÙÔ˘˜ ÍÂÎÈÓ¿ 1-2

Paediatriki 2004;67:135-139

ÒÚ˜ ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛ‹ ÙÔ˘˜ ·fi ÙÔ ÛÙfiÌ· Î·È - ÁÈ· Ù· ÂÚÈÛÛfiÙÂÚ· ·fi ·˘Ù¿ - ‰È·ÚΛ 12-24 ÒÚ˜. ∏ ˘ÔηÏÈ·ÈÌ›·, Û ¯ÚfiÓÈ· ¯ÔÚ‹ÁËÛË, Â›Ó·È Û˘¯Ó‹. ÕÙ˘˜ ËÏÂÎÙÚÔηډÈÔÁÚ·ÊÈΤ˜ ·ÏÏÔÈÒÛÂȘ ˘ÔηÏÈ·ÈÌ›·˜ ÌÔÚ› Ó· ·Ú·ÙËÚËıÔ‡Ó Û ¿ÙÔÌ· Ô˘ Ï·Ì‚¿ÓÔ˘Ó ¯ÚÔÓ›ˆ˜ ıÂÈ·˙›‰Â˜, ¤ÛÙˆ Î·È ·Ó ÙÔ Î¿ÏÈÔ ÙÔ˘ ÔÚÔ‡ ‰ÂÓ Â›Ó·È Û·ÊÒ˜ ÏÈÁfiÙÂÚÔ ·fi Ù· ηÙÒÙÂÚ· Ê˘ÛÈÔÏÔÁÈο fiÚÈ·. O ÌÂÙ·‚ÔÏÈÛÌfi˜ ÙÔ˘ Ì·ÁÓËÛ›Ô˘ ÂËÚ¿˙ÂÙ·È, Â›Û˘, ·fi Ù· ÚÔ·Ó·ÊÂÚfiÌÂÓ· ‰ÈÔ˘ÚËÙÈο. O ‚·ıÌfi˜ Â·Ó·ÚÚfiÊËÛ˘ ÙÔ˘ NaCl Âȉڿ ÛÙË ÌÂÙ·ÊÔÚ¿ ÙÔ˘ Ì·ÁÓËÛ›Ô˘ ÛÙËÓ ·Á·ÏË ÙÔ˘ Henle Î·È - ·Ó Î·È ·Û‹Ì·ÓÙË ÛÙÔ˘˜ ˘ÁÈ›˜ - Ë ¯ÔÚ‹ÁËÛË ıÂÈ·˙ȉÒÓ, Ë ÔÔ›· ÚÔηÏ› ÂÏ·Ùو̤ÓË Â·Ó·ÚÚfiÊËÛË NaCl, ÌÔÚ› Â›Û˘ Ó· Â¿ÁÂÈ ÙËÓ ·ÒÏÂÈ· Ì·ÁÓËÛ›Ô˘. ™ÙÔ Û‡Ó‰ÚÔÌÔ Gitelman ·Ô˘ÛÈ¿˙ÂÈ Ë ·‡ÍËÛË Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ (21,22), ˆ˜ ·ÔÙ¤ÏÂÛÌ· Ù˘ ÚˆÙÔ·ıÔ‡˜ ˘ÂÚ·Ú·ÁˆÁ‹˜ ÚÔÛÙ·ÁÏ·Ó‰ÈÓÒÓ ∂2 (23-25) (ÓÂÊÚÈ΋˜ ÚÔ¤Ï¢Û˘), Ë ÔÔ›· ı· ÌÔÚÔ‡Û ӷ ÂÚÌËÓ‡ÛÂÈ ÙfiÛÔ ÙËÓ ˘ÔηÏÈ·ÈÌ›· ̤ۈ Ù˘ ÌÂȈ̤Ó˘ Â·Ó·ÚÚfiÊËÛ˘ NaCl ÛÙÔ ·ÓÈfiÓ ·¯‡ ÛΤÏÔ˜ Ù˘ ·Á·Ï˘ ÙÔ˘ Henle Î·È ÙÔ ÂÁÁ‡˜ Ô˘ÚÔÊfiÚÔ ÛˆÏËÓ¿ÚÈÔ, ÌÂ Û˘Ó¤ÂÈ· ÌÂÁ¿Ï· ÔÛ¿ Na+ Ó· ‰È·Ù›ıÂÓÙ·È ˆ˜ ·ÓÙ·ÏÏ¿ÍÈÌ· Ì ÙÔ ∫+ ÛÙÔÓ ¿ˆ ÓÂÊÚÒÓ· - fiÛÔ Î·È ÙÔ ¯ÚfiÓÈÔ ÂÚ¤ıÈÛÌ· Ù˘ ˘ÂÚ¤ÎÎÚÈÛ˘ ÚÂÓ›Ó˘ Î·È ·ÁÁÂÈÔÙÂÓÛ›Ó˘ II, ÙËÓ ·ÁÁÂÈÔÛ˘ÛÙ·ÏÙÈ΋ ‰Ú¿ÛË Ù˘ ÔÔ›·˜ ·ÓÙ·ÁˆÓ›˙ÔÓÙ·È ÔÈ ·ÁÁÂÈԉȷÛÙ·ÏÙÈΤ˜ ȉÈfiÙËÙ˜ ÙˆÓ ÚÔÛÙ·ÁÏ·Ó‰ÈÓÒÓ Î·ÏÏÈÎÚ½Ó˘ Î·È ÎÈÓ›Ó˘. ªÂ ·˘ÙfiÓ ÙÔÓ ÙÚfiÔ ÂÚÌËÓ‡ÂÙ·È Ë ·Ô˘Û›· Ù˘ ˘ÂÚÙ·ÛÈ΋˜ ‰Ú¿Û˘ Ù˘ ·ÁÁÂÈÔÙÂÓÛ›Ó˘ II, ÂÓÒ Ë ·¤ÎÎÚÈÛË Û ·˘ÍË̤ӷ ÔÛ¿ Ù˘ 6-ÎÂÙÔÚÔÛÙ·ÁÏ·Ó‰›Ó˘ F Û˘Ó‰¤ÂÙ·È ¿ÌÂÛ· Ì ÙË ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ Ô˘ ÂÌÊ·Ó›˙Ô˘Ó ÔÈ ¿Û¯ÔÓÙ˜ ·fi Û‡Ó‰ÚÔÌÔ Bartter, ¯ˆÚ›˜ fï˜ Ó· ÂÌÊ·Ó›˙Ô˘Ó Î·È ·ÓÙ›ÛÙÔÈ¯Ë ÎÏÈÓÈ΋ ÂÈÎfiÓ· (16,23). ∏ ·ÒÏÂÈ· Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘ Û˘ÌÌÂÙ·ÊÔÚ¤· Na+-Cl- ÛÙ· ¿ˆ ÂÛÂÈڷ̤ӷ ÛˆÏËÓ¿ÚÈ· ¤¯ÂÈ ·Ô‰Ôı› Û ÌÂÙ¿ÏÏ·ÍË ÙÔ˘ ÁÔÓȉ›Ô˘ NCCT (Thiazidesensitive Na-Cl cotransporter), ÙÔ ÔÔ›Ô ÂÓÙÔ›˙ÂÙ·È ÛÙÔ Ì·ÎÚ‡ ÛΤÏÔ˜ ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ 16q13 Î·È Û˘Ì‚ÔÏ›˙ÂÙ·È ˆ˜ SLC12A3. °ÂÓÂÙÈΤ˜ ·Ó·Ï‡ÛÂȘ Û ÔÈÎÔÁ¤ÓÂȘ Î·È Û ÛÔÚ·‰ÈΤ˜ ÂÚÈÙÒÛÂȘ ·Û¯fiÓÙˆÓ ¤¯Ô˘Ó ‰Â›ÍÂÈ Û˘Û¯¤ÙÈÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Gitelman Ì ÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ ÁÔÓ›‰ÈÔ (27,28). ∏ ‰È·ÊÔÚԉȿÁÓˆÛË Î·È Ë ‰È¿ÁÓˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Gitelman Û ۯ¤ÛË Ì ÙÔ Û‡Ó‰ÚÔÌÔ Bartter Ù›ıÂÙ·È ·fi Ù· ·ÎfiÏÔ˘ı· ÎÚÈÙ‹ÚÈ·: ·) ∏ ËÏÈΛ·, ηıÒ˜ ÙÔ Û‡Ó‰ÚÔÌÔ Gitelman ÂΉËÏÒÓÂÙ·È Û˘Ó‹ıˆ˜ ÛÙËÓ ·È‰È΋, ÂÊË‚È΋ ‹ Î·È ÂÓ‹ÏÈÎË ˙ˆ‹, ÂÓÒ ÙÔ Û‡Ó‰ÚÔÌÔ Bartter ÂΉËÏÒÓÂÙ·È Î·Ù¿ ÙË ÓÂÔÁÓÈ΋-‚ÚÂÊÈ΋ ËÏÈΛ·. ‚) ∏ ÚÔˆÚfiÙËÙ· Î·È ÙÔ ÔÏ˘‰Ú¿ÌÓÈÔ Â›Ó·È

137

¶·È‰È·ÙÚÈ΋ 2004;67:135-139

Paediatriki 2004;67:135-139

¶›Ó·Î·˜ 1. ¢È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË Û˘Ó‰ÚfiÌÔ˘ Gitelman ·fi ÙÔ Û‡Ó‰ÚÔÌÔ Bartter ™‡Ìو̷ ¶ÔÏ˘‰Ú¿ÌÓÈÔ ¶ÚÔˆÚfiÙËÙ· ∂ÌÊ¿ÓÈÛË ÛÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹ ¶ÔÏ˘Ô˘Ú›·, ÔÏ˘‰È„›· ÀÂÚÚÂÓÈÓ·ÈÌ›·, ˘ÂڷωÔÛÙÂÚÔÓÈÛÌfi˜ ∞˘ÍË̤ӷ Â›‰· ÚÔÛÙ·ÁÏ·Ó‰ÈÓÒÓ ÀÔηÏÈ·ÈÌ›· ªÂÙ·‚ÔÏÈ΋ ·ÏοψÛË ÀÂÚ·Û‚ÂÛÙÈÔ˘Ú›· À·Û‚ÂÛÙÈÔ˘Ú›· ¡ÂÊÚ·Û‚¤ÛÙˆÛË ÀÔÌ·ÁÓËÛÈ·ÈÌ›· ∞Ó·Ù˘Íȷ΋ ηı˘ÛÙ¤ÚËÛË

¡ÂÔÁÓÈÎfi Bartter

∫Ï·ÛÈÎfi Bartter

™‡Ó‰ÚÔÌÔ Gitelman

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

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

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

¶›Ó·Î·˜ 2. ™˘ÓÙËÚËÙÈ΋ ıÂÚ·›· Û˘Ó‰ÚfiÌÔ˘ Gitelman ™Î‡·ÛÌ·

¢fiÛË i.v.

¢fiÛË per os

£ÂÈÈÎfi Ì·ÁÓ‹ÛÈÔ (MgSO4-7H2O)

ºfiÚÙÈÛË ÌÂ: 25-50 mg/kg, 4-6 ÊÔÚ¤˜/Ë̤ڷ ™˘ÓÙ‹ÚËÛË ÌÂ: 3-6 mg/kg, 4 ÊÔÚ¤˜/Ë̤ڷ 2-4 mEq/kg/24 h

100-200 mg/kg, 4 ÊÔÚ¤˜/Ë̤ڷ

ÃψÚÈÔ‡¯Ô οÏÈÔ ™ÈÚÔÓÔÏ·ÎÙfiÓË

¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ ÂÚÈÁÂÓÓËÙÈÎÔ‡ ÈÛÙÔÚÈÎÔ‡ ÙˆÓ ·ÛıÂÓÒÓ Ì ۇӉÚÔÌÔ Bartter, Û ·ÓÙ›ıÂÛË Ì ÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ¿Û¯Ô˘Ó ·fi Û‡Ó‰ÚÔÌÔ Gitelman. Á) ∏ ηϋ ıÚ¤„Ë Î·È ·Ó¿Ù˘ÍË ÙˆÓ ·Û¯fiÓÙˆÓ ·fi Û‡Ó‰ÚÔÌÔ Gitelman. ‰) H Ê˘ÛÈÔÏÔÁÈ΋ ÓÔËÙÈ΋ ·Ó¿Ù˘ÍË ÙˆÓ ·ÛıÂÓÒÓ Ì ۇӉÚÔÌÔ Gitelman, Û ·ÓÙ›ıÂÛË Ì ÙÔ˘˜ ·ÛıÂÓ›˜ Ì ۇӉÚÔÌÔ Bartter, ÔÈ ÔÔ›ÔÈ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Û ÌÂÁ¿ÏÔ ÔÛÔÛÙfi - ‰È·ÓÔËÙÈ΋ ηı˘ÛÙ¤ÚËÛË. Â) ∏ ˘ÔÌ·ÁÓËÛÈ·ÈÌ›· Î·È ˘·Û‚ÂÛÙÈÔ˘Ú›· Ô˘ Â›Ó·È ¯·Ú·ÎÙËÚÈÛÙÈΤ˜ ÛÙÔ Û‡Ó‰ÚÔÌÔ Gitelman. ÛÙ) ∏ ˘ÂÚÚÂÓÈÓ·ÈÌ›· ÌÂ Ê˘ÛÈÔÏÔÁÈ΋ ·Ï‰ÔÛÙÂÚfiÓË Î·È ·ÚÙËÚȷ΋ ›ÂÛË Ô˘ ·Ó¢ڛÛÎÂÙ·È ÛÙÔ Û‡Ó‰ÚÔÌÔ Gitelman, Û ·ÓÙ›ıÂÛË Ì ÙÔ Û‡Ó‰ÚÔÌÔ Bartter fiÔ˘ Ë ·Ï‰ÔÛÙÂÚfiÓË Â›Ó·È ·˘ÍË̤ÓË. ˙) ∏ Ê˘ÛÈÔÏÔÁÈ΋ ÚÔÛÙ·ÁÏ·Ó‰›ÓË ∂2 ÛÙ· Ô‡Ú· ÛÙÔ Û‡Ó‰ÚÔÌÔ Gitelman, Û ·ÓÙ›ıÂÛË Ì ÙÔ Û‡Ó‰ÚÔÌÔ Bartter fiÔ˘ ˘¿Ú¯ÂÈ ˘ÂÚÚÔÛÙ·ÁÏ·Ó‰ÈÓÔ˘Ú›· (¶›Ó·Î·˜ 1). ∫·È Ù· ‰‡Ô Û‡Ó‰ÚÔÌ· ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È Û˘ÓÙËÚËÙÈο, ¯ˆÚ›˜ Ó· ıÂÚ·‡ÔÓÙ·È. °È· ÙÔ Û‡Ó‰ÚÔÌÔ Gitelman ¤¯Ô˘Ó ÚÔÙ·ı› Ù· ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜ Û΢¿ÛÌ·Ù· ·Ï¿ÙˆÓ Î·Ï›Ô˘ Î·È Ì·ÁÓËÛ›Ô˘ (29) (¶›Ó·Î·˜ 2) Î·È Ê¿Ú̷η Ô˘ ·ÓÙ·ÁˆÓ›˙ÔÓÙ·È ÙËÓ ·Ï‰ÔÛÙÂÚfiÓË, fiˆ˜ Â›Ó·È Ë ÛÈÚÔÓÔÏ·ÎÙfiÓË Î·È Ë ·ÌÈÏÔÚ›‰Ë (30). ∏ ·Ú·ÎÔÏÔ‡ıËÛË ·˘ÙÒÓ ÙˆÓ ·ÙfiÌˆÓ ¤¯ÂÈ ‰Â›ÍÂÈ fiÙÈ Ì ÙËÓ Î·Ù¿ÏÏËÏË ıÂÚ·›· ·ÔηٿÛÙ·Û˘ ¤¯Ô˘Ó ηϋ ÚfiÁÓˆÛË ˆ˜ ÚÔ˜ ÙËÓ ·Ó¿Ù˘ÍË Î·È ÙËÓ Î·Ï‹ ÓÂÊÚÈ΋ ÏÂÈÙÔ˘ÚÁ›· (31).

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2-4 mEq/kg/24 h 1-3 mg/kg/24 h

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26. Simon DB, Nelson-Williams C, Bia MJ, Ellison D, Karet FE, Molina AM et al. Gitelman’s variant of Bartter’s syndrome, inherited hypokalaemic alkalosis, is caused by mutations in the thiazide-sensitive Na-Cl cotransporter. Nat Genet 1996;12:24-30.

27. Obermuller N, Bernstein P, Velazquez H, Reilly R, Moser D, Ellison DH et al. Expression of the thiazide-sensitive Na-Cl cotransporter in rat and human kidney. Am J Physiol 1995;269:F900-F910.

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31. Bettinelli A, Bianchetti MG, Girardin E, Caringella A, Cecconi M, Appiani AC et al. Use of calcium excretion values to distinguish two forms of primary renal tubular hypokalemic alkalosis: Bartter and Gitelman syndromes. J Pediatr 1992;120:38-43.

∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 09-05-2003 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 02-02-2004 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ™ÔÊ›· ¡ÙÂÏ›ÎÔ˘ µ·ÚÓ¿‚· 7, ∆.∫. 116 36, ¶·ÁÎÚ¿ÙÈ

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Paediatriki 2004;67:145-148

SPECIAL ARTICLE

¶ÚÔÊ˘Ï·ÎÙÈ΋ ıÂÚ·›· ÌÂ Û˘Ì˘Îӈ̤ÓÔ˘˜ ·Ú¿ÁÔÓÙ˜ Û ·È‰È¿ Ì ·ÈÌÔÚÚÔÊÈÏ›· ∂. ¶Ï·ÙÔÎÔ‡ÎË - ∫ÔÌÈÙÔÔ‡ÏÔ˘

Prophylactic therapy with factor concentrates in children with haemophilia H. Platokouki - Komitopoulou

¶ÂÚ›ÏË„Ë: ∏ ·ÈÌÔÚÚÔÊÈÏ›· Â›Ó·È ÎÏËÚÔÓÔÌÈ΋ ‰È·Ù·Ú·¯‹ Ù˘ ·ÈÌfiÛÙ·Û˘ Ô˘ ÔÊ›ÏÂÙ·È Û ·ÓÂ¿ÚÎÂÈ· ÙÔ˘ ·Ú¿ÁÔÓÙ· VIII (·ÈÌÔÚÚÔÊÈÏ›· ∞) ‹ πà (·ÈÌÔÚÚÔÊÈÏ›· µ) Ù˘ ‹Í˘. ∂›‰· ·Ú¿ÁÔÓÙ· <1 u/dl ¯·Ú·ÎÙËÚ›˙Ô˘Ó ÙË ‚·ÚÈ¿ ÌÔÚÊ‹ Ù˘ ÓfiÛÔ˘, Ë ÔÔ›· ÂΉËÏÒÓÂÙ·È Î·Ù¿ ηÓfiÓ· ÚÔ˜ ÙÔ Ù¤ÏÔ˜ ÙÔ˘ ÚÒÙÔ˘ ¯ÚfiÓÔ˘ ˙ˆ‹˜, Ì ·˘ÙfiÌ·Ù· ‹ ÌÂÙ·ÙÚ·˘Ì·ÙÈο ·›Ì·ÚıÚ· ‹ ·ÈÌ·ÙÒÌ·Ù·. ∂·Ó·Ï·Ì‚·ÓfiÌÂÓ· ·›Ì·ÚıÚ· Ô‰ËÁÔ‡Ó ÛÙË ¯ÚfiÓÈ· ·ÈÌÔÚÚÔÊÈÏÈ΋ ·ÚıÚÔ¿ıÂÈ·. ∏ ¤Á¯˘ÛË Û˘Ì˘ÎÓˆÌ¤ÓˆÓ ·Ú·ÁfiÓÙˆÓ ÚÔÏËÙÈο ·ÔÙÂÏ› ÙË ıÂÚ·›· ÚÔʇϷ͢ (ÚˆÙÔ·ı‹˜ ‹ ‰Â˘ÙÂÚÔ·ı‹˜), ÂÓÒ Ë ¤Á¯˘ÛË ·Ú·ÁfiÓÙˆÓ ÌÂÙ¿ ·fi ÙËÓ ÂÌÊ¿ÓÈÛË ·ÈÌÔÚÚ·ÁÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ ·ÔÙÂÏ› ÙË ÏÂÁfiÌÂÓË ıÂÚ·›· Â› ·Ó¿Á΢. ∏ ÂÊ·ÚÌÔÁ‹ Û¯ËÌ¿ÙˆÓ ÚÔʇϷ͢ ·ÔÙÂÏ› ıÂÚ·›· ÂÎÏÔÁ‹˜ ÁÈ· Ù· ·È‰È¿ Ì ‚·ÚÈ¿ ·ÈÌÔÚÚÔÊÈÏ›· ÛÙȘ ·ÓÂÙ˘Á̤Ó˜ ¯ÒÚ˜, ‰Â‰Ô̤ÓÔ˘ fiÙÈ ıˆÚÂ›Ù·È fiÙÈ ÚÔÏ·Ì‚¿ÓÂÈ ÙËÓ ·ÈÌÔÚÚÔÊÈÏÈ΋ ·ÚıÚÔ¿ıÂÈ·, ηıÒ˜ ÂÏ·¯ÈÛÙÔÔÈ› ÙȘ ·ÈÌÔÚÚ·Á›Â˜ Û ·ÚıÚÒÛÂȘ. ∏ ‚¤ÏÙÈÛÙË ËÏÈΛ· ¤Ó·Ú͢ Ù˘ ıÂÚ·›·˜ ÚÔʇϷ͢, Ô ÙÚfiÔ˜ Î·È Ë Û˘¯ÓfiÙËÙ· ¤Á¯˘Û˘ ÙÔ˘ Û˘Ì˘Îӈ̤ÓÔ˘ ·Ú¿ÁÔÓÙ·, ÙÔ ÔÈÎÔÓÔÌÈÎfi ÎfiÛÙÔ˜ Î·È Ô ‚·ıÌfi˜ Ù˘ Û˘ÌÌfiÚʈÛ˘ ÙˆÓ ·ÈÌÔÚÚÔÊÈÏÈÎÒÓ ·È‰ÈÒÓ Û ·˘ÙfiÓ ÙÔÓ ÙÚfiÔ ıÂÚ·›·˜ ·Ó·Ï‡ÔÓÙ·È ÛÙÔ ¿ÚıÚÔ ·˘Ùfi.

Abstract: Haemophilia is an inherited coagulation disorder due to deficiency of factor VIII (haemophilia A) or IX (haemophilia B). Patients with severe haemophilia, (corresponding to plasma factor levels of less than 1 u/dl) bleed spontaneously or after trivial trauma, particularly into joints and muscles, starting by the end of the first year of life. Haemophilic arthropathy is the end result of repeated joint haemorrhage. Prophylactic treatment (primary or secondary prophylaxis) constitutes the infusion of factor concentrates in order to prevent rather than to treat haemorrhage (on demand therapy). Prompt prophylaxis is considered the treatment of choice for the avoidance of arthropathy of severely affected children with haemophilia in developed countries. The best age for initiation of prophylaxis, the route and the rate of factor infusion, the economic burden of high concentrate consumption and the barriers to compliance with prophylactic therapy in haemophilia are reviewed in this paper.

§¤ÍÂȘ ÎÏÂȉȿ: ·ÈÌÔÚÚÔÊÈÏ›·, ·È‰È¿, ÚÔÊ˘Ï·ÎÙÈ΋ ıÂÚ·›·.

Key words: haemophilia, children, prophylaxis.

∏ ·ÈÌÔÚÚÔÊÈÏ›·, ÎÏËÚÔÓÔÌÈ΋ ‰È·Ù·Ú·¯‹ Ù˘ ·ÈÌfiÛÙ·Û˘ Ô˘ ÌÂٷʤÚÂÙ·È ÌÂ Ê˘ÏÔÛ‡Ó‰ÂÙÔ ¯ÚˆÌfiۈ̷, ÔÊ›ÏÂÙ·È Û ·ÓÂ¿ÚÎÂÈ· ÙÔ˘ ·Ú¿ÁÔÓÙ· VIII (·ÈÌÔÚÚÔÊÈÏ›· ∞) ‹ IX (·ÈÌÔÚÚÔÊÈÏ›· µ) Ù˘ ‹Í˘. ∂›‰· ·Ú¿ÁÔÓÙ· <1 u/dl, 2-5 u/dl Î·È >5 u/dl ¯·Ú·ÎÙËÚ›˙Ô˘Ó ÙË ‚·ÚÈ¿, ̤Û˘ ‚·Ú‡ÙËÙ·˜ ηÈ

‹È· ÌÔÚÊ‹ Ù˘ ÓfiÛÔ˘, ·ÓÙÈÛÙÔ›¯ˆ˜. ∏ ‚·ÚÈ¿ ·ÈÌÔÚÚÔÊÈÏ›· ÂΉËÏÒÓÂÙ·È ÚÔ˜ ÙÔ Ù¤ÏÔ˜ ÙÔ˘ ÚÒÙÔ˘ ¯ÚfiÓÔ˘ ˙ˆ‹˜. ∫‡ÚÈ· ÎÏÈÓÈ΋ ÂÈÎfiÓ· ·ÔÙÂÏÔ‡Ó ÔÈ ·˘ÙfiÌ·Ù˜ ‹ ÌÂÙ·ÙÚ·˘Ì·ÙÈΤ˜ ·ÈÌÔÚÚ·Á›Â˜ ·fi ÙȘ ·ÚıÚÒÛÂȘ (·›Ì·ÚıÚ·) Î·È ÙÔ˘˜ Ì˘˜ (·ÈÌ·ÙÒÌ·Ù·), ·Ó Î·È ÌÔÚ› Ó· Û˘Ì‚Â› ·ÈÌÔÚÚ·Á›· ·fi

ªÔÓ¿‰· ∞ÈÌfiÛÙ·Û˘ Î·È ∞ÈÌÔÚÚÔÊÈÏ›·˜, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó·

Haemophilia and Haemostasis Unit, “Aghia Sophia” Children’s Hospital, Athens

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ÔÔÈÔ‰‹ÔÙ ۇÛÙËÌ·. ∂·Ó·Ï·Ì‚·ÓfiÌÂÓ· ·›Ì·ÚıÚ· Ô‰ËÁÔ‡Ó ÛÙË ¯ÚfiÓÈ· ·ÈÌÔÚÚÔÊÈÏÈ΋ ·ÚıÚÔ¿ıÂÈ· Î·È Û ·Ó·ËÚ›·. ∏ ıÂÚ·¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ·ÈÌÔÚÚ·ÁÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ ÙˆÓ ·ÈÌÔÚÚÔÊÈÏÈÎÒÓ (ıÂÚ·›· Â› ·Ó¿Á΢ - on demand treatment) Ì ÙÔ˘˜ Û˘Ì˘Îӈ̤ÓÔ˘˜ ·Ú¿ÁÔÓÙ˜ ˆ˜ ıÂÚ·›· ˘ÔηٿÛÙ·Û˘ ÙÔ˘ ·ÓÂ·ÚÎÔ‡˜ ·Ú¿ÁÔÓÙ· ÛÙȘ ·Ú¯¤˜ Ù˘ ‰ÂηÂÙ›·˜ ÙÔ˘ ’70 Î·È Ù· ÚÔÁÚ¿ÌÌ·Ù· Ù˘ ηْ Ô›ÎÔÓ ıÂÚ·›·˜ (home therapy) ıˆڋıËΠfiÙÈ ¤Ï˘Û·Ó Ù· ÚÔ‚Ï‹Ì·Ù· ÙˆÓ ·ÈÌÔÚÚÔÊÈÏÈÎÒÓ ·ÛıÂÓÒÓ, ÂÊ’ fiÛÔÓ ÂÙ‡¯·ÈÓ·Ó ¤ÁηÈÚË ‰È·ÎÔ‹ Ù˘ ·ÈÌÔÚÚ·Á›·˜ ηÈ, ηْ Â¤ÎÙ·ÛË, ÂÚÈÔÚÈÛÌfi Ù˘ ·ÚıÚÔ¿ıÂÈ·˜ (1). ∏ ÂÚÈÔÚÈṲ̂ÓË ‰È·ıÂÛÈÌfiÙËÙ· ÙˆÓ Û΢·ÛÌ¿ÙˆÓ, ÙÔ ·˘ÍË̤ÓÔ ÎfiÛÙÔ˜ ıÂÚ·›·˜ ηÈ, ΢ڛˆ˜, Ë Ï·›Ï·· ÙÔ˘ AIDS Î·È Ù˘ HIV ÔÚÔıÂÙÈÎfiÙËÙ·˜, ηıÒ˜ Î·È Ë Û˘ÓÂȉËÙÔÔ›ËÛË Ù˘ Ë·Ù›Ùȉ·˜ C ÛÙȘ ·Ú¯¤˜ Ù˘ ‰ÂηÂÙ›·˜ ÙÔ˘ ’80 Î·È ÙÔ˘ ’90, ‰ÂÓ Â¤ÙÚ„·Ó ÛÙËÓ ÂÈÛÙËÌÔÓÈ΋ ÎÔÈÓfiÙËÙ· Ó· ˘ÈÔıÂÙ‹ÛÂÈ Ù· ÚÔÁÚ¿ÌÌ·Ù· ÚÔÊ˘Ï·ÎÙÈ΋˜ ¯ÔÚ‹ÁËÛ˘ Û˘Ì˘ÎÓˆÌ¤ÓˆÓ ·Ú·ÁfiÓÙˆÓ Ô˘ ÂÊ·ÚÌfi˙ÔÓÙ·Ó ÛÙËÓ OÏÏ·Ó‰›· (2) Î·È ÙË ™Ô˘Ë‰›· (3), Ì ÛÙfi¯Ô ÙËÓ ÚfiÏË„Ë Î·È fi¯È ·ÏÒ˜ ÙÔÓ ÂÚÈÔÚÈÛÌfi Ù˘ ·ÈÌÔÚÚÔÊÈÏÈ΋˜ ·ÚıÚÔ¿ıÂÈ·˜. ∏ ÛËÌ·ÓÙÈ΋ ÚfiÔ‰Ô˜ Ô˘ ÂÂÙ‡¯ıË Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÛÙËÓ ·ÛÊ¿ÏÂÈ· Î·È ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙˆÓ Û˘Ì˘ÎÓˆÌ¤ÓˆÓ ·Ú·ÁfiÓÙˆÓ, ·ÏÏ¿ Î·È ÔÈ Â˘Ô›ˆÓ˜ ÚÔÔÙÈΤ˜ ÁÈ· ÙËÓ ÂÊ·ÚÌÔÁ‹ ÁÔÓȉȷ΋˜ ıÂÚ·›·˜ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÓfiÛÔ˘, ¤‰ˆÛ·Ó ÙË ‰˘Ó·ÙfiÙËÙ· Ó· ·Ó·Ù˘¯ıÔ‡Ó Û ·ÈÌÔÚÚÔÊÈÏÈο ·È‰È¿ Û¯‹Ì·Ù· ıÂÚ·›·˜ Ô˘ ‰ÂÓ ÂÚÈÔÚ›˙ÔÓÙ·Ó ·ÏÒ˜ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ·ÈÌÔÚÚ·ÁÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘, ·ÏÏ¿ ÂÂÎÙ›ÓÔÓÙ·Ó Î·È ÛÙËÓ ·ÔÊ˘Á‹ ηٿ ÙÔ ‰˘Ó·ÙfiÓ Î¿ı ·ÈÌÔÚÚ·Á›·˜ Û ·ÚıÚÒÛÂȘ, ÒÛÙ ӷ ‰È·ÙËÚËı› ·Î¤Ú·È· Ë ·Ú¯ÈÙÂÎÙÔÓÈ΋ ÙÔ˘˜ ¤ˆ˜ fiÙÔ˘ ·ÔÙÂÏÂÛÌ·ÙÈ΋ ıÂÚ·›· ÂÈÙÚ¤„ÂÈ ÙËÓ ›·ÛË (4). ∂Í¿ÏÏÔ˘, Ë ¤ÓÓÔÈ· Ù˘ ÚfiÏ˄˘ Â›Ó·È Û˘Ó˘Ê·Ṳ̂ÓË Ì ÙËÓ ¶·È‰È·ÙÚÈ΋ ÂÈÛÙ‹ÌË Î·È Ë ÛΤ„Ë Ù˘ ˘ÔηٿÛÙ·Û˘ Ì›·˜ Ô˘Û›·˜ Ô˘ Ï›ÂÈ ÒÛÙ ӷ ÏÂÈÙÔ˘ÚÁ› Ô ÔÚÁ·ÓÈÛÌfi˜ Û·Ó Ó· ÙËÓ ¤¯ÂÈ, Â›Ó·È Ôχ ‰ÂÏ·ÛÙÈ΋ Î·È ‹‰Ë ÂÊ·ÚÌfi˙ÂÙ·È Û ¿ÏÏ· ÓÔÛ‹Ì·Ù·. ™˘ÓÂÒ˜, Ë ·Ô‰Ô¯‹ ÚÔÁÚ·ÌÌ¿ÙˆÓ ÚÔÊ˘Ï·ÎÙÈ΋˜ ¯ÔÚ‹ÁËÛ˘ ·Ú¿ÁÔÓÙ· VIII ‹ IX ·Ó¿ Ù·ÎÙ¿ ¯ÚÔÓÈο ‰È·ÛÙ‹Ì·Ù· ÁÈ· Ó· ÚÔÏËÊı› (Î·È fi¯È ÁÈ· Ó· ˘Ô¯ˆÚ‹ÛÂÈ) Ì›· ·ÈÌÔÚÚ·Á›·, ‚ڋΠÔÏÏÔ‡˜ ˘ÔÛÙËÚÈÎÙ¤˜ ·Ó¿ÌÂÛ· ÛÙÔ˘˜ ·È‰È¿ÙÚÔ˘˜-·ÈÌ·ÙÔÏfiÁÔ˘˜, ·ÏÏ¿ Î·È ·ÚÎÂÙÔ‡˜ ÛÎÂÙÈÎÈÛÙ¤˜ (5). ¢Â‰Ô̤ÓÔ˘ fiÙÈ ÙfiÛÔ Ô ¶·ÁÎfiÛÌÈÔ˜ OÚÁ·ÓÈÛÌfi˜ ÀÁ›·˜ (6) fiÛÔ Î·È Ë MASAC (π·ÙÚÈ΋ Î·È ∂ÈÛÙËÌÔÓÈ΋ ™˘Ì‚Ô˘Ï¢ÙÈ΋ ∂ÈÙÚÔ‹ - Medical and Scientific Advisory Committee) ÙÔ˘ National Haemophilia Foundation ÙˆÓ ∏.¶.∞. (7) Û˘ÓÈÛÙÔ‡Ó ÙËÓ ÚÔÊ˘Ï·ÎÙÈ΋ ıÂÚ·›· ˆ˜ ıÂÚ·›· ÂÎÏÔÁ‹˜

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ÁÈ· Ù· ·È‰È¿ Ì ‚·ÚÈ¿ ·ÈÌÔÚÚÔÊÈÏ›· (‰ËÏ·‰‹ ÙË ÌÂÙ·ÙÚÔ‹ Ù˘ ‚·ÚÈ¿˜ ·ÓÂ¿ÚÎÂÈ·˜ Û ‹È·), ÙÔ ÂÚÒÙËÌ· Ô˘ Ù›ıÂÙ·È ‰ÂÓ ·ÊÔÚ¿ ÛÙÔ ·Ó ı· ÌÂÈ ¤Ó· ·È‰› Û ÚÔʇϷÍË, ·ÏÏ¿ ÛÙÔ fiÙÂ Î·È ÙÔ Ò˜ (811). ∆Ô ∂˘Úˆ·˚Îfi ¢›ÎÙ˘Ô ÁÈ· ÙËÓ ∞ÓÙÈÌÂÙÒÈÛË Ù˘ ∞ÈÌÔÚÚÔÊÈÏ›·˜ ÛÙ· ¶·È‰È¿ (European Network for Paediatric Haemophilia Management), ÛÙÔ ÔÔ›Ô Û˘ÌÌÂÙ¤¯Ô˘Ó 20 ΤÓÙÚ· (ÌÂٷ͇ ÙˆÓ ÔÔ›ˆÓ Î·È Ë ªÔÓ¿‰· ∞ÈÌfiÛÙ·Û˘-∞ÈÌÔÚÚÔÊÈÏ›·˜ ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”) ·fi 16 ¯ÒÚ˜, ıÂÒÚËÛ ·Ó·Áη›Ô Ó· ÚÔÛ‰ÈÔÚ›ÛÂÈ Ù· ‰È·ÊÔÚÂÙÈο ıÂÚ·¢ÙÈο Û¯‹Ì·Ù·, ÒÛÙ ÂÎÙfi˜ ·fi ÙËÓ ÎÔÈÓ‹ ÁÏÒÛÛ· Û˘ÓÂÓÓfiËÛ˘, Ó· ˘¿ÚÍÔ˘Ó Î·È Û˘ÁÎÚ›ÛÈÌ· ·ÔÙÂϤÛÌ·Ù· (5,12). ø˜ ÚˆÙÔ·ı‹˜/ÚˆÙÔÁÂÓ‹˜ ÚÔʇϷÍË (primary prophylaxis) ÔÚ›˙ÂÙ·È Ë ÛÙ·ıÂÚ‹, Û˘Ó¯‹˜ ıÂÚ·›· Ô˘ ·Ú¯›˙ÂÈ ÚÈÓ ·fi ÙËÓ ËÏÈΛ· ÙˆÓ 2 ÂÙÒÓ ‹ ÌÂÙ¿ ÙËÓ ÚÒÙË ·ÈÌÔÚÚ·Á›· Û ¿ÚıÚˆÛË. ø˜ ‰Â˘ÙÂÚÔ·ı‹˜ ÚÔʇϷÍË (secondary prophylaxis) ÔÚ›˙ÂÙ·È Ë ÛÙ·ıÂÚ‹, Û˘Ó¯‹˜ (Ì·ÎÚfi¯ÚÔÓË) ıÂÚ·›· Ô˘ ·Ú¯›˙ÂÈ Û ËÏÈΛ· ¿Óˆ ÙˆÓ 2 ÂÙÒÓ ‹ ÌÂÙ¿ ·fi ‰‡Ô ‹ ÂÚÈÛÛfiÙÂÚ· ÂÂÈÛfi‰È· ·ÈÌÔÚÚ·Á›·˜ Û ¿ÚıÚˆÛË (ÚÒÈÌË ‰Â˘ÙÂÚÔ·ı‹˜ ÚÔʇϷÍË early secondary prophylaxis), ÂÓÒ ‚Ú·¯˘¯ÚfiÓÈ· Û¯‹Ì·Ù· ıÂÚ·›·˜ Ô˘ ¯ÔÚËÁÔ‡ÓÙ·È ÂÚÈÔ‰Èο ıˆÚÔ‡ÓÙ·È ÌÂÓ ˆ˜ ‰Â˘ÙÂÚÔ·ı‹˜, ·ÏÏ¿ fi„ÈÌË ÚÔʇϷÍË (late secondary prophylaxis) (5). ∆· ·ÔÙÂϤÛÌ·Ù· Ù˘ Â˘Úˆ·˚΋˜ ÔÏ˘ÎÂÓÙÚÈ΋˜ ÌÂϤÙ˘ ¤‰ÂÈÍ·Ó fiÙÈ ÙÔ 79% ÙˆÓ ·ÈÌÔÚÚÔÊÈÏÈÎÒÓ ·È‰ÈÒÓ ·ÓÙÈÌÂÙˆ›˙ÂÙ·È ıÂÚ·¢ÙÈο Ì οÔÈÔ˘ Ù‡Ô˘ ÚÔʇϷÍË (39% ‚Ú›ÛÎÂÙ·È Û ÚˆÙÔ·ı‹ Î·È 31% Û ÚÒÈÌË ‰Â˘ÙÂÚÔ·ı‹ ÚÔʇϷÍË) Î·È ÌfiÓÔ ÙÔ 19% ·ÓÙÈÌÂÙˆ›˙ÂÙ·È Ì ıÂÚ·›· Â› ·Ó¿Á΢ (5). ™Â ÚfiÛÊ·Ù· ‰ËÌÔÛÈÂ˘Ì¤ÓË ÌÂϤÙË ·Ó·Ê¤ÚÂÙ·È fiÙÈ Ù· ·È‰È¿ Ô˘ ¿Ú¯ÈÛ·Ó ÚÔʇϷÍË Û ËÏÈΛ· ÌÈÎÚfiÙÂÚË ÙˆÓ 3 ÂÙÒÓ ¤¯Ô˘Ó ÛÙËÓ ÔÚ›· ηχÙÂÚÔ ÎÏÈÓÈÎfi Î·È ·ÎÙÈÓÔÏÔÁÈÎfi (ηٿ Pettersson) score, Û ۯ¤ÛË Ì ٷ ·È‰È¿ Ô˘ ¿Ú¯ÈÛ·Ó ÚÔʇϷÍË Û ÌÂÁ·Ï‡ÙÂÚË ËÏÈΛ· (11). ÕÚ·, ÛÙÔ ÂÚÒÙËÌ· fiÙ ·Ú¯›˙ÂÈ Î·Ó›˜ ÚÔʇϷÍË, Ë ·¿ÓÙËÛË Û˘ÓÔ„›˙ÂÙ·È ÛÙÔ “fiÛÔ ÓˆÚ›ÙÂÚ·, ÙfiÛÔ Î·Ï‡ÙÂÚ·” (13,14), Ï·Ì‚¿ÓÔÓÙ·˜ ˘’ fi„ÈÓ fiÙÈ Ë Û˘¯ÓfiÙËÙ· Ù˘ ·ÚıÚÔ¿ıÂÈ·˜ ·˘Í¿ÓÂÙ·È Î·Ù¿ 8% ÁÈ· οı ¤ÙÔ˜ Ô˘ ηı˘ÛÙÂÚ› Ë ¤Ó·ÚÍË ÚÔʇϷ͢ ÌÂÙ¿ ÙÔ ÚÒÙÔ ·›Ì·ÚıÚÔ (9). ¶ÔÏÏÔ›, ¿ÓÙˆ˜, Û˘ÁÎÏ›ÓÔ˘Ó ÛÙËÓ ¿Ô„Ë fiÙÈ Ë ·fiÊ·ÛË ı· Ú¤ÂÈ Ó· ÂÍ·ÙÔÌÈ·ÂÙ·È, ·Ó¿ÏÔÁ· Ì ÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÙÔ˘ οı ·È‰ÈÔ‡ (15). ¶ÚÔ˜ ÙÔ ·ÚfiÓ, ıˆÚÂ›Ù·È fiÙÈ Ë Î·ı˘ÛÙÂÚË̤ÓË ¤Ó·ÚÍË Ù˘ ÚÔʇϷ͢ ÌÂÈÒÓÂÈ, ·ÏÏ¿ ‰ÂÓ ÂÍ·Ê·Ó›˙ÂÈ ÙËÓ Èı·ÓfiÙËÙ· ηٷÛÙÚÔÊ‹˜ Ù˘ ¿ÚıÚˆÛ˘, ·Ó Î·È ¤¯ÂÈ ·Ô‰Âȯı› fiÙÈ Ë ¤Ó·ÚÍË Ù˘ ÚÔʇϷ͢ ÚÈÓ ·fi ÙËÓ ÙÚ›ÙË ·ÈÌÔÚÚ·Á›· Û ¿ÚıÚˆÛË ÚÔÛٷهÂÈ ·Ôχو˜ ·fi ÙËÓ ·ÚıÚÔ¿ıÂÈ· (9).

¶·È‰È·ÙÚÈ΋ 2004;67:145-148

∆Ô Û¯‹Ì· Ù˘ ÚÔʇϷ͢ Ô˘ ı· ÂÈÏÂÁ›, ‰ËÏ·‰‹ Ë ‰fiÛË Î·È Ë Û˘¯ÓfiÙËÙ· ¤Á¯˘Û˘ ÙÔ˘ ·Ú¿ÁÔÓÙ· ·Ó¿ ‚‰ÔÌ¿‰·, Â›Ó·È ÛÙÂÓ¿ Û˘Ó‰Â‰Â̤ÓÔ Ì ÙËÓ ·fiÊ·ÛË ÁÈ· ÙÔÓ ¯ÚfiÓÔ ¤Ó·Ú͢ Ù˘ ÚÔÊ˘Ï·ÎÙÈ΋˜ ·ÁˆÁ‹˜ Û ¤Ó· ·È‰›. ∆Ô ‰ÔÛÔÏÔÁÈÎfi Û¯‹Ì· Ô˘ ÂÈÎÚ·Ù› ÁÈ· ÙËÓ ·ÈÌÔÚÚÔÊÈÏ›· ∞ Â›Ó·È ¤Á¯˘ÛË 20-40 U/Kg FVIII ÙÚÂȘ ÊÔÚ¤˜ ÙËÓ Â‚‰ÔÌ¿‰· ‹ οı ‰Â‡ÙÂÚË Ë̤ڷ, ÂÓÒ ÁÈ· ÙËÓ ·ÈÌÔÚÚÔÊÈÏ›· µ ¤Á¯˘ÛË 20-40 U/Kg FIX ‰‡Ô ÊÔÚ¤˜ ÙËÓ Â‚‰ÔÌ¿‰· ‹ οı ÙÚ›ÙË Ë̤ڷ (5), ‰Â‰Ô̤ÓÔ˘ ÙÔ˘ ‰È·ÊÔÚÂÙÈÎÔ‡ ¯ÚfiÓÔ˘ ËÌ›ÛÂÈ·˜ ˙ˆ‹˜ οı ·Ú¿ÁÔÓÙ·. Œ¯Ô˘Ó ÂÊ·ÚÌÔÛÙ› ÔÏϤ˜ ÙÚÔÔÔÈ‹ÛÂȘ ÙÔ˘ ·ÓˆÙ¤Úˆ Û¯‹Ì·ÙÔ˜. ∆Ô ÛԢˉÈÎfi ÌÔÓÙ¤ÏÔ (3,10), ÙÔ ÔÔ›Ô ÛÙԯ‡ÂÈ Û Â›‰· ·Ú¿ÁÔÓÙ· ÛÙÔ Ï¿ÛÌ· ÚÔ Ù˘ ÂfiÌÂÓ˘ ¤Á¯˘Û˘ >1 u/dl, ÚÔÙ›ÓÂÈ ·˘ÍË̤Ó˜ ‰fiÛÂȘ, ÂÓÒ ¿ÏÏÔÈ (4,9,12-14) ıˆÚÔ‡Ó fiÙÈ ÌÂÈÒÓÔÓÙ·˜ Ù· ÌÂÛԉȷÛÙ‹Ì·Ù· ÙˆÓ ‰fiÛÂˆÓ Î·È ·Ú·ÎÔÏÔ˘ıÒÓÙ·˜ ÙËÓ ÔÚ›· ÙÔ˘ ·ÛıÂÓÔ‡˜, ÌÔÚ› Ó· Á›ÓÂÈ ÛÙ·‰È·Î‹ ·‡ÍËÛË ÙˆÓ ‰fiÛˆÓ, Â¿Ó ·˘Ù¤˜ ‰ÂÓ Â·ÚÎÔ‡Ó, ÒÛÙ ӷ ·ÓÙÈÌÂÙˆÈÛÙÔ‡Ó ÂÈÙ˘¯Ò˜ Ù· Â·Ó·Ï·Ì‚·ÓfiÌÂÓ· ·ÈÌÔÚÚ·ÁÈο ÂÂÈÛfi‰È· Û ·ÚıÚÒÛÂȘ-ÛÙfi¯Ô˘˜ Î·È Ó· ÚÔÏËÊı› Ë ·ÈÌÔÚÚÔÊÈÏÈ΋ ·ÚıÚÔ¿ıÂÈ· (ÂÍ·ÙÔÌÈÎÂ˘Ì¤ÓË, ÛÙ·‰È·Î‹ ‹ ÚÔԉ¢ÙÈ΋ ÚÔʇϷÍË). ÀÔÛÙËÚ›˙ÂÙ·È, ¿ÓÙˆ˜, fiÙÈ Ë ‰fiÛË ÙÔ˘ ÂÁ¯ÂfiÌÂÓÔ˘ ·Ú¿ÁÔÓÙ· Î·È ÙÔ ÌÂÛԉȿÛÙËÌ· Ù˘ ıÂÚ·›·˜ ‰ÂÓ ·ÔÙÂÏÔ‡Ó ·ÓÂÍ¿ÚÙËÙ˜ ÌÂÙ·‚ÏËÙ¤˜ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ·ÚıÚÔ¿ıÂÈ·˜, Û ·ÓÙ›ıÂÛË Ì ÙËÓ ËÏÈΛ· ¤Ó·Ú͢ Ù˘ ÚÔʇϷ͢ (13-15). ∆ÂÏÂ˘Ù·›·, ÚÔÙ›ÓÂÙ·È ¤Á¯˘ÛË ÙÔ˘ ·Ú¿ÁÔÓÙ· Ì›· ÊÔÚ¿ ÙËÓ Â‚‰ÔÌ¿‰· ηٿ ÙËÓ ¤Ó·ÚÍË Î·È ÚÔԉ¢ÙÈÎÒ˜ Û˘¯ÓfiÙÂÚ· (12). ◊‰Ë ¤¯Ô˘Ó ‰ËÌÔÛÈ¢ı› ÌÂϤÙ˜ Ô˘ ‰ÂÓ ‰Â›¯ÓÔ˘Ó Ó· ˘¿Ú¯ÂÈ ‰È·ÊÔÚ¿ ÛÙËÓ Î·Ù¿ÛÙ·ÛË ÙˆÓ ·ÚıÚÒÛÂˆÓ ÌÂٷ͇ ·È‰ÈÒÓ Ô˘ ÍÂΛÓËÛ·Ó ÚÔʇϷÍË Ì ¤Á¯˘ÛË ·Ú¿ÁÔÓÙ· Ì›· ÊÔÚ¿ Û ۯ¤ÛË Ì ÂÚÈÛÛfiÙÂÚ˜ ÊÔÚ¤˜ ·Ó¿ ‚‰ÔÌ¿‰· (11,12). ∏ Û˘˙‹ÙËÛË ÁÈ· ÙËÓ ËÏÈΛ· ¤Ó·Ú͢ Ù˘ ÚÔʇϷ͢ Î·È ÁÈ· Ù· ÔÈΛϷ ‰ÔÛÔÏÔÁÈο Û¯‹Ì·Ù· Á›ÓÂÙ·È ÁÈ· ‰‡Ô ÏfiÁÔ˘˜: ·) ÙË ‰˘ÛÎÔÏ›· ÙˆÓ Û˘¯ÓÒÓ ÊÏ‚ÔÎÂÓÙ‹ÛÂˆÓ Û ӋÈ· ÌÈÎÚ‹˜ ËÏÈΛ·˜, ·ÎfiÌË Î·È ·fi ÙÔ˘˜ Â·ÁÁÂÏ̷ٛ˜ Ù˘ ˘Á›·˜, Ôχ ‰Â ÂÚÈÛÛfiÙÂÚÔ ·fi ÙÔ˘˜ ÁÔÓ›˜ Û ÚÔÁÚ¿ÌÌ·Ù· ηْ Ô›ÎÔÓ ıÂÚ·›·˜ Î·È ‚) ÙË ÌÂÁ¿ÏË Î·Ù·Ó¿ÏˆÛË ·Ú·ÁfiÓÙˆÓ (ÔÈÎÔÓÔÌÈÎfi ÎfiÛÙÔ˜, ÂÚÈÔÚÈṲ̂ÓË Â¿ÚÎÂÈ· ·Ú·ÁfiÓÙˆÓ) ·fi ·È‰È¿ Ì ·ÈÌÔÚÚÔÊÈÏ›· Ô˘ ÂӉ¯Ô̤ӈ˜ ηı˘ÛÙÂÚÔ‡Ó Ó· ÂÌÊ·Ó›ÛÔ˘Ó ·›Ì·ÚıÚÔ Î·È Ôχ ÂÚÈÛÛfiÙÂÚÔ Â·Ó·Ï·Ì‚·ÓfiÌÂÓ˜ ·ÈÌÔÚÚ·Á›Â˜ ÛÙËÓ ›‰È· ¿ÚıÚˆÛË (¿ÚıÚˆÛËÛÙfi¯Ô˜). ™Â ·È‰È¿ ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ 6 ÂÙÒÓ, Ë ÙÔÔı¤ÙËÛË ÎÂÓÙÚÈÎÔ‡ ÊÏ‚ÈÎÔ‡ ηıÂÙ‹Ú· ÌÔÚ› Ó· ·Ô‰Âȯı› ÌÔÓfi‰ÚÔÌÔ˜ ÁÈ· ÙË Û˘Ó¤¯ÈÛË Ù˘ ÚÔÊ˘Ï·ÎÙÈ΋˜ ·ÁˆÁ‹˜, ÂÊ’ fiÛÔÓ ˘¿Ú¯ÂÈ ·‰˘Ó·Ì›·

Paediatriki 2004;67:145-148

ηϋ˜ ÊÏ‚ÔΤÓÙËÛ˘. OÈ ÛÔ‚·Úfiٷ٘ ÂÈÏÔΤ˜ (ÏÔÈÌÒÍÂȘ, ÛË„·ÈÌ›·, ıÚÔÌ‚ÒÛÂȘ) οÓÔ˘Ó ‰ÈÛÙ·ÎÙÈÎÔ‡˜ ÔÏÏÔ‡˜ È·ÙÚÔ‡˜, ·ÏÏ¿ Î·È ÁÔÓ›˜, fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ·Ô‰Ô¯‹ ÙÔÔı¤ÙËÛ˘ ÎÂÓÙÚÈÎÔ‡ ÊÏ‚ÈÎÔ‡ ηıÂÙ‹Ú·. ™‡Ìʈӷ Ì ٷ ·ÔÙÂϤÛÌ·Ù· Ù˘ Â˘Úˆ·˚΋˜ ÔÏ˘ÎÂÓÙÚÈ΋˜ ÌÂϤÙ˘, ÌfiÓÔ Û 3 ·fi Ù· 20 ΤÓÙÚ· ›¯Â ÙÔÔıÂÙËı› ÎÂÓÙÚÈ΋ ÁÚ·ÌÌ‹ (Port-A-Cath) ÛÙÔ 80-100% Î·È ÛÙÔ 5-20% ÙˆÓ ·ÈÌÔÚÚÔÊÈÏÈÎÒÓ ·ÁÔÚÈÒÓ ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ‹ ÌÂÁ·Ï‡ÙÂÚ˘ ÙˆÓ 6 ÂÙÒÓ, ·ÓÙ›ÛÙÔȯ· (5).

OÈ ÌÂÁ·Ï‡ÙÂÚ˜ ·ÓÙÈÚÚ‹ÛÂȘ ÁÈ· ÙË ıÂÚ·›· ÚÔʇϷ͢ ‰ÂÓ ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙËÓ ·ÌÊÈÛ‚‹ÙËÛË Ù˘ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ ·˘ÙÔ‡ ÙÔ˘ Ù‡Ô˘ ıÂÚ·›·˜ Û ۯ¤ÛË Ì ÙË ıÂÚ·›· Â› ·Ó¿Á΢ ÁÈ· Ù· ·È‰È¿ Ì ‚·ÚÈ¿ ·ÈÌÔÚÚÔÊÈÏ›·, ·ÏÏ¿ ·fi ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÙÔ ÎfiÛÙÔ˜ ÙˆÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ ÚÔʇϷ͢ Â›Ó·È ÛËÌ·ÓÙÈο ÔÏÏ·Ï¿ÛÈÔ (3000 u/kg/¤ÙÔ˜ ¤Ó·ÓÙÈ 1000 u/kg/¤ÙÔ˜) (7,13). ∆Ô ÁÂÁÔÓfi˜, ¿ÓÙˆ˜, fiÙÈ ·ÊÂÓfi˜ Ë ‰ÔÛÔÏÔÁ›· ÙˆÓ ·Ú·ÁfiÓÙˆÓ ·˘Í¿ÓÂÙ·È ÂÏ¿¯ÈÛÙ· ‹ ηıfiÏÔ˘ ÚÔ˚Ô‡Û˘ Ù˘ ËÏÈΛ·˜ Î·È ÂÈϤÔÓ ÌÂÈÒÓÂÙ·È Î·Ù¿ ÙËÓ ÂÓËÏÈΛˆÛË (2000 u/kg/¤ÙÔ˜ ¤Ó·ÓÙÈ 3599 u/kg/¤ÙÔ˜ Û ·ÛıÂÓ›˜ Ô˘ ‚Ú›ÛÎÔÓÙ·È Û ıÂÚ·›· Â› ·Ó¿Á΢) (16) Î·È ·ÊÂÙ¤ÚÔ˘ Ë ‰È·Ù‹ÚËÛË Î·Ï‡ÙÂÚˆÓ ·ÚıÚÒÛÂˆÓ ·Ú¿ ÙË ÛÔÚ·‰È΋ ÂÌÊ¿ÓÈÛË ·ÈÌÔÚÚ·ÁÈÒÓ, ηıÈÛÙ¿ ‰˘ÓËÙÈο ÙËÓ ÚÔʇϷÍË Î·È ÔÈÎÔÓÔÌÈÎfiÙÂÚÔ ÙÚfiÔ ıÂÚ·›·˜ (4,8,13,14). ∂ÈϤÔÓ, ·Ó Û˘ÓÂÎÙÈÌ‹ÛÂÈ Î·Ó›˜ Î·È ÙÔ ÁÂÓÈÎfiÙÂÚÔ ·›ÛıËÌ· ¢ÂÍ›·˜ ÙÔ˘ ·ÈÌÔÚÚÔÊÈÏÈÎÔ‡, ÙË ÌÂÁ·Ï‡ÙÂÚË ‰˘Ó·ÙfiÙËÙ· ÎÔÈÓˆÓÈÎÔÔ›ËÛ˘, ÙË Û˘ÌÌÂÙÔ¯‹ Û ·ıÏËÙÈΤ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜, ÙËÓ Â›Ù¢ÍË ·Î·‰ËÌ·˚ÎÒÓ ÛÙfi¯ˆÓ ÁÈ· ÔÏÏÔ‡˜ ·fi ·˘ÙÔ‡˜, ηıÒ˜ Î·È ÙËÓ Î·Ï‡ÙÂÚË ÔÈfiÙËÙ· ˙ˆ‹˜ Ê·›ÓÂÙ·È fiÙÈ ÙÔ ÙÂÏÈÎfi fiÊÂÏÔ˜ ˘ÂÚÙÂÚ› ÙÔ˘ ÎfiÛÙÔ˘˜ (17). ¶¿ÓÙˆ˜, ȉȷ›ÙÂÚ· ÛÙȘ ·Ó·Ù˘ÛÛfiÌÂÓ˜ ¯ÒÚ˜, ·Ú·Ì¤ÓÂÈ ‰˘ÛÚfiÛÈÙË ıÂÚ·›· ÁÈ· ÌÂÁ¿Ï· ÙÌ‹Ì·Ù· ÙÔ˘ ÏËı˘ÛÌÔ‡ ÙˆÓ ·ÈÌÔÚÚÔÊÈÏÈÎÒÓ (1,4). ∏ ÚÔÊ˘Ï·ÎÙÈ΋ ·ÁˆÁ‹, ÂÎÙfi˜ ·fi ‰··ÓËÚ‹, Â›Ó·È Î·È ¯ÚÔÓÔ‚fiÚ·, ÂÓÒ ÁÈ· ÙËÓ ÂÈÙ˘¯‹ ÂÊ·ÚÌÔÁ‹ Ù˘ Â›Ó·È ··Ú·›ÙËÙË Ë Û˘ÓÂÚÁ·Û›· ÙÔ˘ ÌÈÎÚÔ‡ ‹ Î·È ÌÂÁ·Ï‡ÙÂÚÔ˘ ·È‰ÈÔ‡. ∆Ô ‚·ÛÈÎfi, fï˜, ÎÚÈÙ‹ÚÈÔ ÁÈ· ÙË Û˘ÌÌfiÚʈÛË (compliance) ÚÔ˜ ÙȘ ıÂÚ·¢ÙÈΤ˜ Ô‰ËÁ›Â˜ Â› Ì·ÎÚfi ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ·ÔÙÂÏ› Ë Ï‹Ú˘ ηٷÓfiËÛË ÙˆÓ ÏÂÔÓÂÎÙËÌ¿ÙˆÓ Ù˘ ÚÔʇϷ͢ ÁÈ· ÙÔ ·È‰› ηÈ, ‰Â˘ÙÂÚ¢fiÓÙˆ˜, ÙÔ fiÊÂÏÔ˜ ÁÈ· fiÏË ÙËÓ ÔÈÎÔÁ¤ÓÂÈ· (18). ™ËÌ·ÓÙÈ΋ ‚Ô‹ıÂÈ· ÚÔÛʤÚÂÈ Ë ˘ÔÛÙ‹ÚÈÍË ·fi ÙÔ ∫¤ÓÙÚÔ ∞ÈÌÔÚÚÔÊÈÏ›·˜ Î·È ·fi ÙÔÓ Â˘Ú‡ÙÂÚÔ Î‡ÎÏÔ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ (18). O ‚·ıÌfi˜ Û˘ÌÌfiÚʈÛ˘ ÚÔ˜ ÙËÓ ÚÔʇϷÍË ·Ó·Ê¤ÚÂÙ·È Û ÔÛÔÛÙfi 58,8% Û ·ÈÌÔÚÚÔÊÈÏÈο ·È‰È¿ Û ·ÌÂÚÈηÓÈ΋ ÌÂϤÙË (18) Î·È Û 77% Û ·È‰È¿ Ô˘ ‚Ú›ÛÎÔÓÙ·Ó ·ÔÎÏÂÈÛÙÈο Û ηْ Ô›ÎÔÓ ıÂÚ·›· Û ÔÏÏ·Ó‰È΋

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ÌÂϤÙË (4), ÂÓÒ Û ¿ÏÏ· ÛÔ‚·Ú¿ ÓÔÛ‹Ì·Ù· Î·È Î·Ù·ÛÙ¿ÛÂȘ Î˘Ì·›ÓÂÙ·È ÛËÌ·ÓÙÈο (25-54% Û ·È‰È¿ ˘fi ·ÓÙÈÂÈÏËÙÈ΋ ·ÁˆÁ‹, 40-60% Û ÌÂÙ·ÌÔÛ¯Â˘Ì¤ÓÔ˘˜ ·ÛıÂÓ›˜ Î·È 81% Û ÂÊ‹‚Ô˘˜ Ì ‰È·‚‹ÙË) (18). ∆Ô Â‡ÏÔÁÔ ÂÚÒÙËÌ· Ô˘ Ù›ıÂÙ·È Â›Ó·È Ì¤¯ÚÈ fiÙÂ Û˘Ó¯›˙ÂÙ·È Ë ÚÔʇϷÍË Î·È ·Ó Ë ‰È·ÎÔ‹ ÂÁ΢ÌÔÓ› ÎÈÓ‰‡ÓÔ˘˜. ∞ÔÙÂϤÛÌ·Ù· ÌÂϤÙ˘ ·Ô‰ÂÈÎÓ‡Ô˘Ó fiÙÈ ÔÈ ·ÛıÂÓ›˜ Ô˘ ‰ÂÓ ‰È¤ÎÔ„·Ó ÙËÓ ÚÔʇϷÍË ¤¯Ô˘Ó ÌÈÎÚfiÙÂÚÔ˘ ‚·ıÌÔ‡ ·ÚıÚÔ¿ıÂÈ· ·fi ¿ÏÏÔ˘˜ Ô˘ ÛÙ·Ì¿ÙËÛ·Ó (8). ∞fi ÂÈÚ¿Ì·Ù· Û Û·ÏÔ˘˜, fï˜, ¤¯ÂÈ ‚ÚÂı› fiÙÈ ÔÈ ¯fiÓ‰ÚÔÈ Û ÂÓ‹ÏÈΘ ˘Ê›ÛÙ·ÓÙ·È ÌÈÎÚfiÙÂÚË Î·Ù·ÛÙÚÔÊ‹ ·fi ÙÔ ·›Ì· Ô˘ Û˘ÛÛˆÚ‡ÂÙ·È ÛÙËÓ ¿ÚıÚˆÛË, Û ۯ¤ÛË Ì ÙËÓ ÂÚ›Ô‰Ô Ù˘ ·Ó¿Ù˘Í˘ (19). ™˘ÓÂÒ˜, οÔȘ ·ÈÌÔÚÚ·Á›Â˜ Û ·ÚıÚÒÛÂȘ ÂÓËÏ›ÎˆÓ ·ÈÌÔÚÚÔÊÈÏÈÎÒÓ ‰ÂÓ Ô‰ËÁÔ‡Ó ˘Ô¯ÚˆÙÈÎÒ˜ ÛÙËÓ ·Ó¿Ù˘ÍË ·ÚıÚÔ¿ıÂÈ·˜. ∂Ӊ¯Ô̤ӈ˜, οÔÈ· ÎÚÈÙ‹ÚÈ· ı· ÌÔÚÔ‡Û·Ó Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó ÁÈ· Ó· ÂÈÏÂÁÔ‡Ó ÔÈ Î·Ù¿ÏÏËÏÔÈ ÁÈ· ‰È·ÎÔ‹ Ù˘ ÚÔʇϷ͢ ˘Ô„‹ÊÈÔÈ. º·›ÓÂÙ·È, ÏÔÈfiÓ, fiÙÈ ÔÈ ·ÛıÂÓ›˜ Ô˘ ¯ÚÂÈ¿ÛÙËÎ·Ó ·ÚÁfiÙÂÚ· ÚÔʇϷÍË, ıÂÚ·‡ÔÓÙ·Ó Ì ÌÈÎÚfiÙÂÚË Â‚‰ÔÌ·‰È·›· ‰fiÛË Î·È Â›¯·Ó ÏÈÁfiÙÂÚ· ·ÈÌÔÚÚ·ÁÈο ÂÂÈÛfi‰È· ηٿ ÙÔ ‰È¿ÛÙËÌ· Ô˘ ‚Ú›ÛÎÔÓÙ·Ó ˘fi ÚÔʇϷÍË, ı· ÌÔÚÔ‡Û·Ó Ó· ‰È·Îfi„Ô˘Ó ÛÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹ Ì ۯÂÙÈ΋ ·ÛÊ¿ÏÂÈ· (8). ∞ÓÙÈı¤Ùˆ˜, ··ÈÙÂ›Ù·È ÌÂÁ·Ï‡ÙÂÚË ÂÈʇϷÍË Û ·ÛıÂÓ›˜ Ì ‚·Ú‡ÙÂÚË ÎÏÈÓÈ΋ ÂÈÎfiÓ·. ™˘ÌÂÚ·ÛÌ·ÙÈο, Ë ÚÔʇϷÍË, ·Ó Î·È ‰··ÓËÚ‹ ÂÈÏÔÁ‹, Ê·›ÓÂÙ·È Ó· ·ÔÙÂÏ› ·Ó·Áη›Ô Î·È ·ÔÙÂÏÂÛÌ·ÙÈÎfi ÙÚfiÔ ıÂÚ·¢ÙÈ΋˜ ·ÓÙÈÌÂÙÒÈÛ˘ ÙˆÓ ·È‰ÈÒÓ Ì ‚·ÚÈ¿ ·ÈÌÔÚÚÔÊÈÏ›·, ÂÊ’ fiÛÔÓ ‰›‰ÂÙ·È ÂÁη›Úˆ˜ Î·È ÂÍ·ÙÔÌÈÎÂ˘Ì¤Ó·. µÈ‚ÏÈÔÁÚ·Ê›· 1. Mannucci PM. Hemophilia and related bleeding disorders: a story of dismay and success. Hematology 2002;8:1-9.

2. Van Creveld S. Prophylaxis of joint hemorrhages in hemophilia. Acta Haematol 1971;45:120-127.

3. Nilsson IM, Hedner U, Ahlberg A. Haemophilia prophylaxis in Sweden. Acta Paediatr Scand 1976;65:129-135.

4. Tusell J, Perez-Bianco R. Prophylaxis in developed and in emerging countries. Haemophilia 2002;8:183-188.

5. Ljung R, Aronis-Vournas S, Kurnik-Auberger K, van den Berg M, Chambost H, Claeyssens S et al. Treatment of children with haemophilia in Europe: a survey of 20 centres in 16 countries. Haemophilia 2000;6:619-624.

6. Berntorp E, Boulyjenkov V, Brettler D, Chandy M, Jones P, Lee C et al. Modern treatment of haemophilia. Bull World Health Organ 1995;73:691-701.

7. Medical and Scientific Advisory Council (MASAC) of the National Hemophilia Foundation. MASAC Recommendations Concerning Prophylaxis. In: Medical Bulletin 193 (chapter advisory 197); 1994.

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8. Fischer K, van der Bom JG, Prejs R, Mauser-Bunschoten EP, Roosendaal G, Grobbee DE et al. Discontinuation of prophylactic therapy in severe haemophilia: incidence and effects on outcome. Haemophilia 2001;7:544-550.

9. Fischer K, van der Bom JG, Mauser-Bunschoten EP, Roosendaal G, Prejs R, de Kleijn P et al. The effects of postponing prophylactic treatment on long-term outcome in patients with severe hemophilia. Blood 2002;99:2337-2341.

10. Ljung RC. Aspects of haemophilia prophylaxis in Sweden.

Haemophilia 2002;8 (Suppl 2):S34-S37.

11. Van den Berg HM, Fischer K, van der Bom JG, Roosendaal G, Mauser-Bunschoten EP. Effects of prophylactic treatment regimens in children with severe haemophilia: a comparison of different strategies. Haemophilia 2002;8 (Suppl 2):S43-S46.

12. Petrini P. What factors should influence the dosage and interval of prophylactic treatment in patients with severe haemophilia A and B? Haemophilia 2001;7:99-102.

13. Fischer K, van der Bom JG, Molho P, Negrier C, MauserBunschoten EP, Roosendaal G et al. Prophylactic versus ondemand treatment strategies for severe haemophilia: a comparison of costs and long-term outcome. Haemophilia 2002;8:745-752.

14. Fischer K, van der Bom JG, Mauser-Bunschoten EP, Roosendaal G, Prejs R, Grobbee DE et al. Changes in treatment strategies for severe haemophilia over the last 3 decades: effects on clotting factor consumption and arthropathy. Haemophilia 2001;7:446-452.

15. Astermark J, Petrini P, Tengborn L, Schulman S, Ljung R, Berntorp E. Primary prophylaxis in severe haemophilia should be started at an early age but can be individualized.

Br J Haematol 1999;105:1109-1113.

16. Szucs TD, Offner A, Kroner B, Giangrande P, Berntorp E, Schramm W. Resource utilisation in haemophiliacs treated in Europe: results from the European Study on Socioeconomic Aspects of Haemophilia Care. The European Socioeconomic Study Group. Haemophilia 1998;4:498-501.

17. Shapiro AD, Donfield SM, Lynn HS, Cool VA, Stehbens JA, Hunsberger SL et al. Defining the impact of hemophilia: the Academic Achievement in Children with Hemophilia Study.

Pediatrics 2001;108:E105-111.

18. Hacker MR, Geraghty S, Manco-Johnson M. Barriers to compliance with prophylaxis therapy in haemophilia.

Haemophilia 2001;7:392-396.

19. Roosendaal G, Tekoppele JM, Vianen ME, van den Berg HM, Lafeber FP, Bijlsma JW. Articular cartilage is more susceptible to blood induced damage at young than at old age. J Rheumatol 2000;27:1740-1744.

∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 04-03-2003 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 25-06-2003 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∂ϤÓË ¶Ï·ÙÔÎÔ‡ÎË-∫ÔÌÈÙÔÔ‡ÏÔ˘ ªÔÓ¿‰· ∞ÈÌfiÛÙ·Û˘-∞ÈÌÔÚÚÔÊÈÏ›·˜ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·” E-mail: theokom@otenet.gr

¶·È‰È·ÙÚÈ΋ 2004;67:149

Paediatriki 2004;67:149

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OBITUARY

°È¿ÓÓ˘ ªÂÛÛ·ÚÈÙ¿Î˘ ∫·ıËÁËÙ‹˜ ¶·È‰È·ÙÚÈ΋˜ (1995) O °È¿ÓÓ˘ ªÂÛÛ·ÚÈÙ¿Î˘ ÍÂΛÓËÛ ·fi ÙÔ ¶·ÁÎÚ¿ÙÈ Î·È ·fi ÙÔ ¶·ÁÎÚ¿ÙÈ Ê‡ÁÂÈ. ∏ ·Ï‹ıÂÈ· Â›Ó·È fiÙÈ Ê‡ÁÂÈ Î·È ·fi ÙËÓ ∞ı‹Ó·, ʇÁÂÈ Î·È ·fi ÙËÓ ∂ÏÏ¿‰· Ô˘ ÙfiÛÔ Ôχ ·Á·Ô‡ÛÂ Î·È Ì ·ÊÔÛ›ˆÛË ˘ËÚ¤ÙËÛ ˆ˜ ÛÙÚ·ÙÈÒÙ˘, ˆ˜ ·È‰›·ÙÚÔ˜, ˆ˜ ·ÓÂÈÛÙËÌÈ·Îfi˜ ‰¿ÛηÏÔ˜ Î·È ˆ˜ ËÁÂÙÈ΋ È·ÙÚÈ΋ Ê˘ÛÈÔÁӈ̛·.

OÈ ÌÂÁ¿Ï˜ ÛÙÈÁ̤˜ Ù˘ ÔÈÎÔÁÂÓÂȷ΋˜ ÙÔ˘ ˙ˆ‹˜ ‰È·‰Ú·Ì·Ù›ÛÙËÎ·Ó Û ·˘Ù‹ ÙËÓ ÂÎÎÏËÛ›·. ∂‰Ò Â˘Ù‡¯ËÛ ӷ ·ÓÙÚ¢Ù› ÙË Û‡ÓÙÚÔÊÔ Ù˘ ˙ˆ‹˜ ÙÔ˘, Ì›· ÛÔ˘‰·›· Û‡ÓÙÚÔÊÔ Ô˘ ÂÌ„˘¯ˆÙÈο ÙÔ˘ ·Ú·ÛÙ¿ıËΠ۠οı ‚‹Ì· ÙÔ˘, ȉȷ›ÙÂÚ· ÛÙÔ˘˜ ‰‡ÛÎÔÏÔ˘˜ ÙÂÏÂ˘Ù·›Ô˘˜ ηÈÚÔ‡˜. ∂‰Ò ¿ÓÙÚÂ„Â Î·È ‚¿ÙÈÛ ·È‰È¿ Î·È ÂÁÁfiÓÈ·. ∏ ˙ˆ‹ ÙÔ˘ ‹Ù·Ó ÌÂÛÙ‹ ·fi ÎÔÈÓ¤˜ ·ÓıÚÒÈÓ˜ ¯·Ú¤˜.

O °È¿ÓÓ˘ ‹Ù·Ó Ì›· ÙÂÚ¿ÛÙÈ· ·ÁηÏÈ¿. •Â¯Â›ÏÈ˙ ·fi ·Á¿Ë ÁÈ· ÙÔ˘˜ ‰ÈÎÔ‡˜ ÙÔ˘. ∫·È ÙÔ ¤‰ÂȯÓ Û οı ÂÚ›ÙˆÛË. ◊Ù·Ó ˘ÂÚ‹Ê·ÓÔ˜ ÁÈ· ÙËÓ ÚÔÎÔ‹ ÙˆÓ ·È‰ÈÒÓ ÙÔ˘ Î·È Î¿ı ηÙfiÚıˆÌ· ÙˆÓ ÂÁÁÔÓÈÒÓ ÙÔ˘ ¤ÓȈı ÙËÓ ·Ó¿ÁÎË Ó· ÙÔ ÌÔÈÚ·ÛÙ› Ì ÙÔ˘˜ ·ÓıÚÒÔ˘˜ Ô˘ ·Á·Ô‡ÛÂ. ∆ÔÓ Ï‚ÂÓÙfiÎÔÚÌÔ Ó¤Ô Ô˘ ¿Ú¯ÈÛ ӷ ÂȉÈ·ÂÙ·È ÛÙËÓ ·È‰È·ÙÚÈ΋, ÙˆÓ ÁÓÒÚÈÛ· ÛÙËÓ ·Ú¯‹ Ù˘ ·ÓÂÈÛÙËÌȷ΋˜ ÌÔ˘ ˙ˆ‹˜ ˆ˜ ∂ÈÌÂÏËÙ‹˜ Ù˘ ¶·È‰È·ÙÚÈ΋˜ ∫ÏÈÓÈ΋˜, ÙÔ 1958. ™Ù· 46 ¯ÚfiÓÈ· Ô˘ ·ÎÔÏÔ‡ıËÛ·Ó Â˘Ù‡¯ËÛ· Ó· ·Ú·ÎÔÏÔ˘ı‹Ûˆ ‚‹Ì· ÚÔ˜ ‚‹Ì· ÙËÓ ÂÈÛÙËÌÔÓÈ΋ ÙÔ˘ ÂͤÏÈÍË. §·ÌÚfi˜ ÂÛˆÙÂÚÈÎfi˜ ‚ÔËıfi˜, ·ÚÈÛÙÔ‡¯Ô˜ ¢È‰¿ÎÙˆÚ, ÌÂÙÂÎ·È‰Â‡ÙËΠÁÈ· 3 ¯ÚfiÓÈ· ÛÙË ªÂÁ¿ÏË µÚÂÙ·Ó›·, fiÔ˘ ·ÓÂÏ›¯ıËΠ۠Â›Â‰Ô ∂ÈÌÂÏËÙÔ‡. ªÂÙ¿ ÙËÓ ÂÈÛÙÚÔÊ‹ ÙÔ˘, ˘‹ÚÍ ¤Ó·˜ ·fi ÙÔ˘˜ ÈÔ ÛÙÂÓÔ‡˜ Û˘ÓÂÚÁ¿Ù˜ ÌÔ˘. ÀÊËÁËÙ‹˜ ÙÔ 1973, ∂ÓÙÂÙ·Ï̤ÓÔ˜ ÀÊËÁËÙ‹˜ ÙÔ 1978, ∞Ó·ÏËÚˆÙ‹˜ ∫·ıËÁËÙ‹˜ ÙÔ 1987, ∫·ıËÁËÙ‹˜ 1˘ ‚·ıÌ›‰·˜ Î·È ¢È¢ı˘ÓÙ‹˜ Ù˘ µ’ ¶·È‰È·ÙÚÈ΋˜ ∫ÏÈÓÈ΋˜ Ù· ÙÂÏÂ˘Ù·›· 3 ¯ÚfiÓÈ· Ù˘ ·ÓÂÈÛÙËÌȷ΋˜ ÙÔ˘ ÛÙ·‰ÈÔ‰ÚÔÌ›·˜. ¢ÂÓ Â›Ó·È Ë ÛÙÈÁÌ‹ Ú¤Ô˘Û· ÁÈ· Ó· ·Ó·ÊÂÚıÒ ÛÙÔ ÂÍ·ÈÚÂÙÈÎfi ÂÈÛÙËÌÔÓÈÎfi ÙÔ˘ ¤ÚÁÔ. ¢ÂÓ ÌÔÚÒ, fï˜, Ó· ·Ú·Ï›„ˆ ÔÚÈṲ̂ӷ ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ ·ÓıÚÒÔ˘ Î·È ÙÔ˘ ÁÈ·ÙÚÔ‡. ∆· ·ÁÓ¿ Î·È ·Á·ı¿ ·ÈÛı‹Ì·Ù· Ô˘ ÙÔÓ ¯·Ú·ÎÙ‹ÚÈ˙·Ó ‹Ù·Ó Ê˘ÛÈÎfi Ó· ÙÔÓ Î¿ÓÔ˘Ó ·Á·ËÙfi ÛÙÔ˘˜ Û˘Ó·‰¤ÏÊÔ˘˜ ÙÔ˘, ÛÙÔ˘˜ Û˘ÓÂÚÁ¿Ù˜ ÙÔ˘, ÛÙÔ˘˜ Ì·ıËÙ¤˜ ÙÔ˘, ÙÔ˘˜ ÁÔÓ›˜ Ô˘ ›¯·Ó ÙËÓ Ù‡¯Ë Ó· ·Ú·ÎÔÏÔ˘ı› Ù· ·È‰È¿ ÙÔ˘˜, ·ÏÏ¿ Î·È ÛÙ· ›‰È· Ù· ·È‰È¿. ∏ ÏËıˆÚÈ΋ ÚÔÛˆÈÎfiÙËÙ¿ ÙÔ˘ ÛÊÚ·ÁÈ˙fiÙ·Ó ÌfiÓÈÌ· ·fi ¤Ó· ηÏÔοÁ·ıÔ ¯·ÌfiÁÂÏÔ. ◊Ù·Ó È‰·ÓÈÎfi˜ ÎÏÈÓÈÎfi˜ ·È‰›·ÙÚÔ˜. ¢›Ï· ÛÙÔ ¿ÚÚˆÛÙÔ ·È‰› ÈÂÚÔ˘ÚÁÔ‡Û ÂÍÂÙ¿˙ÔÓÙ¿˜ ÙÔ. ¶ÔÏÏÔ› ÛËÌÂÚÈÓÔ› ηıËÁËÙ¤˜ È·ÙÚÈÎÒÓ Û¯ÔÏÒÓ Î·È Ï‹ıÔ˜ ÁÈ·ÙÚÒÓ ·Ó·ı˘ÌÔ‡ÓÙ·È ·fi Ù· ÊÔÈÙËÙÈο ÙÔ˘˜ ¯ÚfiÓÈ· Ì ı·˘Ì·ÛÌfi, ÙËÓ ÚfiÙ˘Ë, ÙËÓ ¤ÍÔ¯Ë ÎÏÈÓÈ΋ ÂͤٷÛË ÙÔ˘ ·ÚÚÒÛÙÔ˘ ·fi ÙÔÓ ‰¿ÛηÏÔ ªÂÛÛ·ÚÈÙ¿ÎË. O °È¿ÓÓ˘ ‰ÂÓ Â›¯Â ˆÚ¿ÚÈÔ. ◊Ù·Ó ¿ÓÙÔÙ ÚÔÛÈÙfi˜ Û fiÔÈÔÓ ÙÔÓ ¯ÚÂÈ·˙fiÙ·Ó. ŸÏÔ ÙÔ 24ˆÚÔ. ªÔ¯ıÔ‡Û ηıËÌÂÚÈÓ¿, ÙÔÓ ÍÂÎÔ‡Ú·˙Â Ë ÚÔÛÊÔÚ¿ ÙÔ˘.

O ÏfiÁÔ˜ ÙÔ˘ ÚÔ˜ ÙÔ˘˜ ÁÔÓ›˜ Î·È ÙÔ ·È‰› ‹Ù·Ó ÊÈÏÈÎfi˜, ¢ÚÔÛ‹ÁÔÚÔ˜, ·ÈÛÈfi‰ÔÍÔ˜, ¯ˆÚ›˜ ÔÙ¤ Ó· ÎÚ‡‚ÂÈ ‹ Ó· ·Ú·ÔÈ› ÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ·. ◊Ù·Ó ¤ÓÙÈÌÔ˜ ÏfiÁÔ˜, ‰ÈfiÙÈ Î·È Ô ›‰ÈÔ˜ ‹Ù·Ó ηı·Úfi·ÈÌ· ¤ÓÙÈÌÔ˜ Î·È ·ÓȉÈÔÙÂÏ‹˜. ÿÛÈÔ˜ ¿ÓıÚˆÔ˜. O Û‚·ÛÌfi˜ ÚÔ˜ ÙÔ˘˜ ÌÂÁ·Ï‡ÙÂÚÔ‡˜ ÙÔ˘ ÈÂÚ·Ú¯Èο, ·ÏÏ¿ Î·È ËÏÈÎȷο, ‹Ù·Ó ÁÓ‹ÛÈÔ˜ Î·È ‚·ı‡˜. §¿ÙÚ¢ ÙËÓ ·ÍÈÔÎÚ·Ù›· Î·È ıÏÈ‚fiÙ·Ó ÁÈ· ÙËÓ Î·Ù¿ÛÙ·ÛË Ô˘ ÂÈÎÚ¿ÙËÛ ٷ ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·. ∏ ÎÚ›ÛË ÙÔ˘ ‹Ù·Ó ·Î¤Ú·ÈË. ™¿ÓÈ· Ï¿ı¢Â. ∞·ÈÙËÙÈÎfi˜ Î·È ·˘ÛÙËÚfi˜, ÚÒÙ· ÛÙÔÓ Â·˘Ùfi ÙÔ˘ Î·È ‡ÛÙÂÚ· ÛÙÔ˘˜ Û˘ÓÂÚÁ¿Ù˜ Î·È ÊÔÈÙËÙ¤˜ ÙÔ˘. ™˘Ó‰‡·˙ ÂÍ·›ÚÂÙ· ÙËÓ ·˘ÛÙËÚfiÙËÙ· Ì ÙËÓ ÂÈ›ÎÂÈ·, Ô˘ η٤ÏËÁ Û ‰›Î·ÈË ÎÚ›ÛË. °ÓÒÚÈ˙ ¿ÚÈÛÙ· ÙË ÁÏÒÛÛ· Ì·˜. ∆Ë ÌÈÏÔ‡ÛÂ Î·È ÙËÓ ¤ÁÚ·Ê ¿„ÔÁ·. ∏ ‰È‰·Ûηϛ· ÙÔ˘ ‹Ù·Ó ˘Ô‰ÂÈÁÌ·ÙÈ΋. ∏ ·Ó¿‰ÂÈÍ‹ ÙÔ˘ Û ∫·ıËÁËÙ‹ ÚÒÙ˘ ‚·ıÌ›‰·˜ Î·È ¢È¢ı˘ÓÙ‹ ¶·ÓÂÈÛÙËÌȷ΋˜ ∫ÏÈÓÈ΋˜, Û ¶Úfi‰ÚÔ Ù˘ ∂ÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ ∂Ù·ÈÚ›·˜, Û Ï‹ıÔ˜ ¿ÏÏˆÓ ·ÍÈˆÌ¿ÙˆÓ ÛÙÔÓ ¯ÒÚÔ Ù˘ ‰ËÌfiÛÈ·˜ ˘Á›·˜, ÙÔ Ï‹ıÔ˜ ÙˆÓ Ê›ÏˆÓ, Û˘ÓÂÚÁ·ÙÒÓ ÊÔÈÙËÙÒÓ, ÔÈÎÔÁÂÓÂÈÒÓ Î·È ·È‰ÈÒÓ Ô˘ ÙÔ˘˜ Û˘Ì·Ú·ÛÙ¿ıËΠȷÙÚÈο Î·È ·ÓıÚÒÈÓ· ÔÏÔÎÏËÚÒÓÔ˘Ó ÙËÓ ·‰Ú‹ ÛÎÈ·ÁÚ¿ÊËÛË ÙÔ˘ ÂÎÏÂÎÙÔ‡ Ê›ÏÔ˘ Î·È Û˘Ó·‰¤ÏÊÔ˘ Ô˘ ¯¿Û·ÌÂ Î·È Ô˘ Ë ·Ó¿ÌÓËÛ‹ ÙÔ˘ ı· Ì·˜ Û˘Óԉ‡ÂÈ ÈÛfi‚È·.

OÌÈÏ›· ηٿ ÙËÓ ÂÍfi‰ÈÔ ·ÎÔÏÔ˘ı›· ·fi ÙÔÓ Î. ¡. ™. ª·ÙÛ·ÓÈÒÙË OÌfiÙÈÌÔ ∫·ıËÁËÙ‹ ¶·È‰È·ÙÚÈ΋˜ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ∞η‰ËÌ·˚Îfi

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¶∞π¢π∞∆ƒπ∫∏ ∂¡∏ª∂ƒø™∏

Paediatriki 2004;67:150

PEDIATRIC NEWS

∞Ó¿Ï˘ÛË ‚¿‰ÈÛ˘ - Gait analysis “∞Ó¿Ï˘ÛË ‚¿‰ÈÛ˘ Â›Ó·È Ë Û˘ÛÙËÌ·ÙÈ΋ ̤ÙÚËÛË, ÂÚÈÁÚ·Ê‹ Î·È ÂͤٷÛË ÙˆÓ ÔÛÔÙÈÎÒÓ ÛÙÔȯ›ˆÓ Ô˘ ¯·Ú·ÎÙËÚ›˙Ô˘Ó ÙËÓ ·ÓıÚÒÈÓË ‚¿‰ÈÛË”. Cage JR, Deluca ƒ∞, Renshaw ∆, 1995. ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, Ë ÂÌ‚ÈÔÌ˯·ÓÈ΋ ÂÈÛÙ‹ÌË ·Ó¤Ù˘Í ÙË ÌÂıÔ‰ÔÏÔÁ›· ÁÈ· ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ΋ ·ÍÈÔÏfiÁËÛË Ù˘ ·ÓıÚÒÈÓ˘ ΛÓËÛ˘, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ Ù· ϤÔÓ Û‡Á¯ÚÔÓ· ̤۷. ªÂ ÙÔÓ ·ÓÙÈÎÂÈÌÂÓÈÎfi ÚÔÛ‰ÈÔÚÈÛÌfi ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ Ù˘ ‚¿‰ÈÛ˘, ¤ÁÈÓ ‰˘Ó·Ùfi˜ Ô ÂÓÙÔÈÛÌfi˜ ÙˆÓ ·ıÔÏÔÁÈÎÒÓ ÌÔÚÊÒÓ ‚¿‰ÈÛ˘. ∏ ‚È‚ÏÈÔÁÚ·Ê›· Î·È Ë Ù¯ÓÔÁÓˆÛ›· Ô˘ Û˘Ó¯Ҙ Û˘ÛÛˆÚ‡ÔÓÙ·È, ηıÒ˜ Î·È Ë ÎÏÈÓÈ΋ Ú·ÎÙÈ΋, ηٷϋÁÔ˘Ó ÛÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ Ë ∞Ó¿Ï˘ÛË µ¿‰ÈÛ˘ Â›Ó·È ¤Ó· ·ÓÂÎÙ›ÌËÙÔ ÂÚÁ·ÏÂ›Ô ÛÙË Ï‹„Ë ·ÔÊ¿ÛÂˆÓ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÂÚÈÛÙ·ÙÈÎÒÓ Ì ۇÓıÂÙ· ÚÔ‚Ï‹Ì·Ù· ‚¿‰ÈÛ˘. ªÂÚÈΤ˜ ·fi ÙȘ ÂÚÈÙÒÛÂȘ ÛÙȘ Ôԛ˜ Ë ∞Ó¿Ï˘ÛË µ¿‰ÈÛ˘ ‚ÔËı¿ ›ӷÈ: ñ ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË, ñ ÂÁÎÂÊ·ÏÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·, ñ Û‡Ó‰ÚÔÌ· Û˘Óԉ¢fiÌÂÓ· ·fi ÎÈÓËÙÈο ÚÔ‚Ï‹Ì·Ù·, ñ Ì˘ÂÏÔ‰˘ÛÏ·Û›· – Ì˘ÂÏÔÌËÓÈÁÁÔ΋ÏË, ñ ÎÚ·ÓÈÔÂÁÎÂÊ·ÏÈΤ˜ ηÎÒÛÂȘ, ñ ηÎÒÛÂȘ ¡.ª. Î·È ÂÚÈÊÂÚÈÎÒÓ Ó‡ڈÓ, ñ Ì˘Ô¿ıÂȘ, ñ ¿ÚÎÈÓÛÔÓ, ñ ·ÓÈÛÔÛÎÂϛ˜ ·fi ‰È¿ÊÔÚ· ·›ÙÈ·, ñ ÛÙÚÔÊÈΤ˜ ·Ú·ÌÔÚÊÒÛÂȘ οو ¿ÎÚˆÓ Î·È ñ ·ÍÈÔÏfiÁËÛË ÔÚıˆÙÈÎÒÓ Ì¤ÛˆÓ. ™ÎÔfi˜ Ù˘ ÂÊ·ÚÌÔÁ‹˜ Ù˘ ∞Ó¿Ï˘Û˘ µ¿‰ÈÛ˘ Â›Ó·È Ô ÂÓÙÔÈÛÌfi˜ Î·È Ë ÙÂÎÌËÚ›ˆÛË ÙˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ ‚¿‰ÈÛ˘, Ë ·ÍÈÔÏfiÁËÛË Ù˘ Û˘ÓÙËÚËÙÈ΋˜ ·ÁˆÁ‹˜ Î·È Ù˘ ¯ÂÈÚÔ˘ÚÁÈ΋˜ ıÂÚ·›·˜, Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ¯Ú‹Û˘ Ê·Ú̷΢ÙÈÎÒÓ Ô˘ÛÈÒÓ, Ë ·ÍÈÔÏfiÁËÛË ÔÚıˆÙÈÎÒÓ Ì˯·ÓËÌ¿ÙˆÓ Î.Ï. ™‹ÌÂÚ·, ‰ÂÓ Â›Ó·È ·Ó·Áη›· Ë ÌÂÙ¿‚·ÛË ÙˆÓ ∂ÏÏ‹ÓˆÓ ·ÛıÂÓÒÓ ÛÙÔ Â͈ÙÂÚÈÎfi ÁÈ· ÙËÓ ÂͤٷÛË ·˘Ù‹, ÁÈ·Ù› ÛÙÔ ∫¤ÓÙÚÔ ∞Ó¿Ï˘Û˘ µ¿‰ÈÛ˘ Ù˘ ∂§.∂.¶.∞.¶. ÚÔÛʤÚÔÓÙ·È ÔÈ ·Ú·¿Óˆ ˘ËÚÂۛ˜. ∂ÏÏËÓÈ΋ ∂Ù·ÈÚ›· ¶ÚÔÛÙ·Û›·˜ & ∞ÔηٿÛÙ·Û˘ ∞Ó·‹ÚˆÓ ¶·›‰ˆÓ ∫¤ÓÙÚÔ ∞Ó¿Ï˘Û˘ µ¿‰ÈÛ˘ ∫fiÓˆÓÔ˜ 16, ¶·ÁÎÚ¿ÙÈ, ∆.∫. 116 34, ∞ı‹Ó· ∆ËÏ.: 210 7215 303, 210 7230 142, 210 7233 860, 210 7228 360 Fax: 210 7228 380 Website: www.elepap.gr E-mail: gait_lab@elepap.gr

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