COVER May-June 04
19-07-04
18:10
™ÂÏ›‰·1
ISSN 0377-2551
ETO™ 2004
°. ª·ÚÔ‡Ù˘, ª. ¢·ÛÔÔ‡ÏÔ˘
OÈ ‰˘ÛÏÈȉ·È̛˜ ÛÙ· ·È‰È¿ Î·È Ë ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘˜ ∂ȉڿÛÂȘ Ê·Ú̿ΈÓ, ·ÏÎÔfiÏ˘ Î·È Î·Ó›ÛÌ·ÙÔ˜ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÁ΢ÌÔÛ‡Ó˘ ÛÙÔ ¤Ì‚Ú˘Ô Î·È ÙÔ ÓÂÔÁÓfi ∏ ÎÂÊ·Ï·ÏÁ›· Û·Ó Û‡Ìو̷ ÛÙË ÁÂÓÈ΋ ·È‰È·ÙÚÈ΋
160
168
TOMO™ 67
∂. ∫·Ú·ÎˆÓÛÙ·ÓÙ¿ÎË, ∞. ∫·Ê¿ÙÔ˜, ª. §ÈÓ·Ú‰¿Î˘, ™. ªÈ¯ÂÏÔÁÈ¿ÓÓ˘
ªÈÎÚ¿ ·È‰È¿… ÌÂÁ¿ÏÔ˜ ·‰ÂÏÊfi˜
AWARD-WINNING ARTICLE 173
Human metapneumovirus as a cause of acute bronchiolitis in infancy P. Xepapadaki, S. Psarras, A. Bossios, M. Tsolia, D. Kafetzis, N. G. Papadopoulos
ORIGINAL ARTICLES 178
The association of nutrition with developmental and educational abilities of school age children H. Karakonstantaki, A. Kafatos, M. Linardakis, S. Michelogiannis
190
∫. ∆˙È¿ÚÔ˘, ª. ∆·‚Ï·ÓÙ¿, Ã. •˘ÔÏÈ¿, ¶. ∆·‚Ï·ÓÙ¿˜
µ·ıÌfi˜ ÁÓÒÛ˘ ÙˆÓ ÂȤ‰ˆÓ ÏÈȉ›ˆÓ ÙÔ˘ ·›Ì·ÙÔ˜ Û ÊÔÈÙËÙ¤˜ ·ÁÁÂÏÌ¿ÙˆÓ ˘Á›·˜-ÚfiÓÔÈ·˜
Headache as a symptom in the practice of the general paediatrics H. Bazigou-Fotopoulou
∂ƒ∂À¡∏∆π∫∂™ ∂ƒ°∞™π∂™ ∏ Û¯¤ÛË Ù˘ ‰È·ÙÚÔÊ‹˜ Ì ·Ó·Ù˘ÍȷΤ˜ Î·È ÂÎ·È‰Â˘ÙÈΤ˜ ‰ÂÍÈfiÙËÙ˜ ·È‰ÈÒÓ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜
Prenatal drug effects on the foetus and the newborn infant G. Baroutis, M. Dasopoulou
µƒ∞µ∂Àª∂¡∏ ∂ƒ°∞™π∞ O ·ÓıÚÒÈÓÔ˜ ÌÂÙ·Ó¢ÌÔÓÔ˚fi˜ ˆ˜ ·›ÙÈÔ ÔÍ›·˜ ‚ÚÔÁ¯ÈÔÏ›Ùȉ·˜ ÛÙË ‚ÚÂÊÈ΋ ËÏÈΛ·
Dyslipidaemias in children and their management A. Tertipi, V. Petrou, H. Theodoridis
∂. ª·˙›ÁÔ˘-ºˆÙÔÔ‡ÏÔ˘
¶. •Â··‰¿ÎË, ™. æ·ÚÚ¿˜, ∞. ªfiÛÈÔ˜, ª. ∆ÛÔÏÈ¿, ¢. ∫·ÊÂÙ˙‹˜, ¡. °. ¶··‰fiÔ˘ÏÔ˜
¶AI¢IATPIKH
REVIEW ARTICLES 151
∞. ∆ÂÚÙ›Ë, µ. ¶¤ÙÚÔ˘, Ã. £ÂÔ‰ˆÚ›‰Ë˜
●
●
TEYXO™ 3
∞¡∞™∫O¶∏™∂π™
●
ª¿ È Ô ˜ - π Ô ‡ Ó È Ô ˜ 2 0 0 4 ñ ∆ fi Ì Ô ˜ 6 7 ñ ∆  ‡ ¯ Ô ˜ 3
Young children… Big Brother K. Tziarou, M. Tavlanta, C. Xypolia, P. Tavlantas
195
Levels of knowledge of blood lipids levels in health students
™. ∞ÓÙˆÓÈ¿‰Ë˜, ™. ∫˘ÚÈ·ÎÔÔ‡ÏÔ˘, µ. ∞ÚÁ˘ÚÔÔ‡ÏÔ˘, •. ∫Ú›ÎÔ˜
S. Antoniadis, S. Kyriakopoulou, V. Argyropoulou, X. Krikos
∏ Û˘Ó¤¯ÂÈ· ÙˆÓ ÂÚȯÔÌ¤ÓˆÓ ÛÙËÓ ÚÒÙË ÂÛˆÙÂÚÈ΋ ÛÂÏ›‰·
Continuation of table of contents inside title page
Greek Paediatric Society May - June 200 4 ñ V o l u m e 6 7 ñ No 3
May-June 04 chris new
19-07-04
19:23
™ÂÏ›‰·1
M ¿ È Ô ˜ - I Ô ‡ Ó È Ô ˜ 200 4 ñ ∆fiÌÔ˜ 6 7 ñ ∆‡¯Ô˜ 3
™˘Ó¤¯ÂÈ· ÂÚȯÔ̤ӈÓ
Continuation of table of contents
CASE REPORTS
EN¢π∞º∂ƒOÀ™∂™ ¶∂ƒπ¶∆ø™∂π™ ∫ÏËÚÔÓÔÌÈ΋ ·ÈÌÔÚÚ·ÁÈ΋ ÙËÏ·ÁÁÂÈÂÎÙ·Û›· (Û‡Ó‰ÚÔÌÔ Rendu-Osler-Weber). ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ Î·È ·Ó·ÛÎfiËÛË Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜
200
S. Maraka, E. Saridakis, V. Aggelakou, S. Bakosi, G. Vlahaki, E. Kokori
™. ª¿Ú·Î·, ∂. ™·Úȉ¿Î˘, µ. ∞ÁÁÂÏ¿ÎÔ˘, ™. ª¿ÎˆÛË, °. µÏ·¯¿ÎË, ∂. ∫fiÎÔÚË
∞ÈÊÓ›‰ÈÔ Ô›‰ËÌ· fiÛı˘ Î·È ÔÛ¯¤Ô˘ ˆ˜ ·Ú¯È΋ ÂΉ‹ÏˆÛË ÓÂÊÚˆÛÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘
205
208
CURRENT ISSUE
∂¶π∫∞πƒO £∂ª∞ 212
∏ÌÈÎÚ·ÓÈο ÈÛÔ‰‡Ó·Ì· ÛÙ· ·È‰È¿ ™. ¢. ª·ÛÙÚÔÁÈ¿ÓÓË, ∫. µÔ‡‰Ú˘, ∂. ∫·ÙÛ·ÚÔ‡
Hereditary periodic fever syndromes O. Vougiouka
Ÿ. µÔ˘ÁÈԇη
∂π¢π∫O ∞ƒ£ƒO
Hellenic Paediatric Society
Unusual absence of neurological symptoms in a 4 year-old girl with ataxia-telangiectasia (Louis-Bar syndrome) G. Trimis, K. Athanasaki, A. Giannoulia-Karantana, M. Kanariou, X. Krikos, P. Nikolaidou
°. ∆Ú›Ì˘, ∫. ∞ı·Ó·Û¿ÎË, ∞. °È·ÓÓÔ‡ÏÈ·-∫·Ú·ÓÙ·Ó¿, ª. ∫·Ó¿ÚÈÔ˘, •. ∫Ú›ÎÔ˜, ¶. ¡ÈÎÔÏ·˝‰Ô˘
∫ÏËÚÔÓÔÌÔ‡ÌÂÓ· ÂÚÈÔ‰Èο Â̇ÚÂÙ· Û‡Ó‰ÚÔÌ·
Sudden oedema of prepuce and scrotum as initial manifestation of nephrotic syndrome E. Christianakis, G. Vaos, A. Sakelaropoulos, Z. Karakatsani
∂. ÃÚÈÛÙÈ·Ó¿Î˘, °. µ¿Ô˜, ∞. ™·ÎÂÏ·ÚfiÔ˘ÏÔ˜, ∑. ∫·Ú·Î·ÙÛ¿ÓË
AÛ˘Ó‹ı˘ ·Ô˘Û›· Ó¢ÚÔÏÔÁÈ΋˜ Û˘Ó‰ÚÔÌ‹˜ Û ÎÔÚ›ÙÛÈ 4 ÂÙÒÓ Ì ·Ù·Í›·-ÙËÏ·ÁÁÂÈÂÎÙ·Û›· (Û‡Ó‰ÚÔÌÔ Louis-Bar)
Hereditary haemorrhagic telangiectasia (Rendu-Osler-Weber syndrome). Case report and review of the literature
Hellenic Paediatric Society SPECIAL ARTICLE 218
Migraine equivalents in children S. D. Mastrogianni, K. Voudris, E. Katsarou
Greek Paediatric Society ™˘Ó¯›˙ÔÓÙ·È
Continued
Greek Paediatric Society ª a y - J u n e 200 4 ñ V o l u m e 6 7 ñ No 3
May-June 04 chris new
19-07-04
19:23
™ÂÏ›‰·2
M ¿ È Ô ˜ - π Ô ‡ Ó È Ô ˜ 200 4 ñ ∆fiÌÔ˜ 6 7 ñ ∆‡¯Ô˜ 3
™˘Ó¤¯ÂÈ· ÂÚȯÔ̤ӈÓ
Continuation of table of contents
223
NEWS FROM THE INTERNET
¶ÚÔÛ¯‹ ™˘Ó¤‰ÚÈ·
xi
Scheduled Medical Meetings
™˘ÓÙÔÌÔÁڷʛ˜
xiv
Abbreviations
¡∂∞ ∞¶O ∆O ¢π∞¢π∫∆ÀO
Hellenic Paediatric Society
Hellenic Paediatric Society
Greek Paediatric Society
Greek Paediatric Society M a y - J u n e 200 4 ñ V o l u m e 6 7 ñ No 3
May-June 04 chris new
19-07-04
19:24
™ÂÏ›‰·7
M ¿ È Ô ˜ - I Ô ‡ Ó È Ô ˜ 200 4 ñ ∆fiÌÔ˜ 6 7 ñ ∆‡¯Ô˜ 3
¢ÈÌËÓÈ·›· ¤Î‰ÔÛË E›ÛËÌÔ ¶ÂÚÈÔ‰ÈÎfi Ù˘ EÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ EÙ·ÈÚ›·˜
Bimonthly Publication The Official Journal of the Greek Paediatric Society
EΉfiÙ˘ K. °ÚÈ‚¤·˜
Publisher K. Griveas
I‰ÈÔÎÙ‹Ù˘© EÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ EÙ·ÈÚ›· Mȯ·Ï·ÎÔÔ‡ÏÔ˘ 92 Aı‹Ó·È 115 28
Owner© Greek Paediatric Society Michalakopoulou 92 Athens 115 28
TËÏ.: 210 7771 140 / 210 7771 663, Fax: 210 7758 354
Tel.: 210 7771 140 / 210 7771 663, Fax: 210 7758 354
EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ¶Úfi‰ÚÔ˜ : ∞. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜ ¢È¢ı˘ÓÙ‹˜ ™‡ÓÙ·Í˘ : ™. ÷˚‰¿˜ ∞Ó·Ï. ¢È¢ı. ™‡ÓÙ·Í˘ : ∫. ™ÙÂÊ·Ó›‰Ë˜ M¤ÏË : ∂. ∞ÓÙˆÓÔÔ‡ÏÔ˘ A. µ·˙·›Ô˘-°ÂÚ·ÛÈÌ›‰Ë °. µ·ÚÏ¿Ì˘ ∂. ∫·ÙÛ·ÚÔ‡-¶ÂÎÙ·Û›‰Ë Ã. ∫ÒÛÙ·ÏÔ˜ °. ªÚÈ·ÛÔ‡Ï˘ ¡. ¶··‰fiÔ˘ÏÔ˜ ∞. ¶··‰ÔÔ‡ÏÔ˘ ª. ∆ÛÔÏÈ¿-¶·Û·Ú¿ÎË
Scientific Editorial Board President : A. Constantopoulos Editor : S. Haidas Assistant Editor : C. Stefanidis Members : H. Antonopoulou A. Vazeou-Gerasimidi G. Varlamis ∂. Katsarou-Pectasides Greek Paediatric Society Ch. Costalos Greek Paediatric Society G. Briasoulis N. Papadopoulos ∞. Papadopoulou M. Tsolia-Pasparaki
ºÈÏÔÏÔÁÈ΋ EÈ̤ÏÂÈ· ∂È̤ÏÂÈ· ÂÏÏËÓÈÎÒÓ ÎÂÈÌ¤ÓˆÓ I. K·Ú·‚Ú¿ÓÔ˘
Manuscript Editing
EÈ̤ÏÂÈ· ·ÁÁÏÈÎÒÓ ÎÂÈÌ¤ÓˆÓ ™. ¡¿ÎÔ˘
English Editing S. Nakou
∞ÏÏËÏÔÁÚ·Ê›· ∂ÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ ∂Ù·ÈÚ›· ªÈ¯·Ï·ÎÔÔ‡ÏÔ˘ 92 ∞ı‹Ó·È 115 28 ∆ËÏ: 210 7771 140 / 210 7771 663, Fax: 210 7758 354
Correspondence Greek Paediatric Society Michalakopoulou 92 Athens 115 28 Tel: 210 7771 140 / 210 7771 663, Fax: 210 7758 354
™˘ÓÙÔÓÈÛÙ‹˜ ∂ΉfiÛˆ˜
Publishing Coordinator
Hellenic Paediatric Society
Hellenic Paediatric Society
E¶I™THMONIKE™ EK¢O™EI™ E.¶.E. ∞ÚÙ¤ÌȉԘ 3, 151 25 M·ÚÔ‡ÛÈ TËÏ.: 210 87 78 810 Fax: 210 87 78 822
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Greek Editing I. Karavranou
SCIENTIFIC PUBLICATIONS Ltd Artemidos 3, Marousi Hellenic Paediatric Society 151 25 Tel.: 210 87 78 810 Fax: 210 87 78 822
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Greek Paediatric Society M a y - J u n e 200 4 ñ V o l u m e 6 7 ñ No 3
πSSN 0377-2551 i
May-June 04 chris new
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™ÂÏ›‰·11
O‰ËÁ›Â˜ ÚÔ˜ ÙÔ˘˜ ™˘ÁÁÚ·Ê›˜ A. °ÂÓÈΤ˜ ¶ÏËÚÔÊÔڛ˜ ∆Ô ÂÚÈÔ‰ÈÎfi “¶·È‰È·ÙÚÈ΋” Â›Ó·È Ë ÂÈÛÙËÌÔÓÈ΋ ¤Î‰ÔÛË Î·È È‰ÈÔÎÙËÛ›· Ù˘ EÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ EÙ·ÈÚ›·˜, Ô˘ ‰È·Ó¤ÌÂÙ·È ÛÙ· ̤ÏË Ù˘. Œ¯ÂÈ ˆ˜ ‚·ÛÈÎÔ‡˜ ÛÙfi¯Ô˘˜ ÙËÓ ·ÔÙ‡ˆÛË ÙÔ˘ ·È‰È·ÙÚÈÎÔ‡ ÂÈÛÙËÌÔÓÈÎÔ‡ ¤ÚÁÔ˘ Î·È ÙË Û˘Ó¯‹ ÂÓË̤ڈÛË ÙˆÓ ¶·È‰È¿ÙÚˆÓ. °È· ÙÔ ÛÎÔfi ·˘Ùfi ‰¤¯ÂÙ·È ÁÈ· ‰ËÌÔÛ›Â˘ÛË ÔÈÎÈÏ›· ¿ÚıÚˆÓ Î·È Û˘ÁÎÂÎÚÈ̤ӷ: 1. ÕÚıÚ· Û‡ÓÙ·Í˘ (ÌÂÙ¿ ·fi ÚfiÛÎÏËÛË Ù˘ EÈÛÙËÌÔÓÈ΋˜ ™˘ÓÙ·ÎÙÈ΋˜ EÈÙÚÔ‹˜). 2. ∞Ó·ÛÎÔ‹ÛÂȘ. 3. µÚ·‚Â˘Ì¤Ó˜ ÂÚÁ·Û›Â˜. 4. ∂Ú¢ÓËÙÈΤ˜ ÌÂϤÙ˜. 5. ∂ÈÏÂÁ̤Ó˜ Û˘˙ËÙ‹ÛÂȘ ÛÙÚÔÁÁ˘ÏÒÓ ÙÚ·Â˙ÒÓ. 6. ∂›Î·ÈÚ· ı¤Ì·Ù·. 7. £¤Ì·Ù· Âη›‰Â˘Û˘ Î·È ÔÚÁ¿ÓˆÛ˘ ˘Á›·˜. 8. ∫ÏÈÓÈΤ˜ Î·È ·ÂÈÎÔÓÈÛÙÈΤ˜ ÂÚÈÙÒÛÂȘ. 9. ™‡ÓÙÔÌ· Ó¤·. 10. µÚ·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ. 11. ∂ÈÛÙÔϤ˜ ÚÔ˜ ÙË Û‡ÓÙ·ÍË. 12. ¶ÂÚÈÏ‹„ÂȘ Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜. 13. ∞Ó·ÎÔÈÓÒÛÂȘ ÚÔÛ¯ÒÓ Û˘Ó‰ڛˆÓ Î·È ÂÈÛÙËÌÔÓÈÎÒÓ ÂΉËÏÒÛÂˆÓ 14. ∞Ó·ÊÔÚ¤˜ Î·È ÎÚÈÙÈ΋ Ó¤ˆÓ ÂΉfiÛˆÓ, ÂÏÏËÓÈÎÒÓ Î·È Í¤ÓˆÓ, ·È‰È·ÙÚÈÎÔ‡ ÂӉȷʤÚÔÓÙÔ˜. H EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ‰È·ÙËÚ› ÙÔ ‰Èη›ˆÌ· Ó· ‰ËÌÔÛȇÂÈ ¿ÚıÚ· Ì ȉȷ›ÙÂÚÔ ÂÈÛÙËÌÔÓÈÎfi ÂӉȷʤÚÔÓ Î·ıÒ˜ Î·È ¿ÚıÚ· Ì ›ηÈÚ· ı¤Ì·Ù· ¯ˆÚ›˜ Ó· ÙËÚÂ›Ù·È Ë ÛÂÈÚ¿ ˘Ô‚ÔÏ‹˜. ∂›Û˘, ÌÔÚ› Ó· ·ÔÊ·Û›˙ÂÈ ÁÈ· ÙË ‰ËÌÔÛ›Â˘ÛË ÂÚÁ·ÛÈÒÓ Ô˘ ¤¯Ô˘Ó ·ÚÔ˘ÛÈ·Ûı› ÛÙÔ ÂÙ‹ÛÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ, ÙËÓ ÔÏÈ΋ ‹ ÌÂÚÈ΋ ‰ËÌÔÛ›Â˘ÛË ·ÚÔ˘ÛÈ¿ÛÂˆÓ È‰È·›ÙÂÚÔ˘ ÂӉȷʤÚÔÓÙÔ˜ Î·È ÙËÓ ÔÏÈ΋ ‹ ÌÂÚÈ΋ ‰ËÌÔÛ›Â˘ÛË ÂÈÛÙÔÏÒÓ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È Û ‰ËÌÔÛÈÂ˘Ì¤Ó· ÂÈÛÙËÌÔÓÈο ¿ÚıÚ· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. ™ÙȘ ÂÚÁ·Û›Â˜ Ì ›ηÈÚ· ı¤Ì·Ù· Ú¤ÂÈ Ó· ·Ó·ÁÚ¿ÊÂÙ·È ÛÙËÓ ÚÒÙË ÛÂÏ›‰· Ë ÚfiıÂÛË ÙˆÓ Û˘ÁÁڷʤˆÓ ÁÈ· ÙËÓ ·Ó·ÁηÈfiÙËÙ· Ù˘ Ù·¯Â›·˜ ‰ËÌÔÛ›Â˘Û˘. ∏ ∂ÈÙÚÔ‹ ™‡ÓÙ·Í˘ ‰È·ÙËÚ› ÙÔ ‰Èη›ˆÌ· Ù˘ ·Ô‰Ô¯‹˜ Ù˘ Ù·¯Â›·˜ ‰ËÌÔÛ›Â˘Û˘. µ. ÀÔ‚ÔÏ‹ Î·È ¢ËÌÔÛ›Â˘ÛË ÙˆÓ ∂ÚÁ·ÛÈÒÓ OÈ ÂÚÁ·Û›Â˜ Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È ÚÔ˜ ÎÚ›ÛË ÁÈ· ‰ËÌÔÛ›Â˘ÛË ÛÙÔ ÂÚÈÔ‰ÈÎfi “¶·È‰È·ÙÚÈ΋” ·ÔÛÙ¤ÏÏÔÓÙ·È ÂȘ ÙÚÈÏÔ‡Ó ÛÙË ‰È‡ı˘ÓÛË: EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ EÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ EÙ·ÈÚ›· Mȯ·Ï·ÎÔÔ‡ÏÔ˘ 92 115 28 Aı‹Ó· ŸÏ˜ ÔÈ ÂÚÁ·Û›Â˜ Ú¤ÂÈ Ó· Û˘Óԉ‡ÔÓÙ·È ·fi ÂÈÛÙÔÏ‹, Ë ÔÔ›· ı· Û˘Ó˘ÔÁÚ¿ÊÂÙ·È ·fi fiÏÔ˘˜ ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ ÛÙËÓ ÔÔ›· ı· ‰ËÏÒÓÂÙ·È fiÙÈ Ë ÂÚÁ·Û›· ‰ÂÓ ¤¯ÂÈ ÂÓ Ì¤ÚÂÈ ‹ ÂÍ ÔÏÔÎÏ‹ÚÔ˘ ‰ËÌÔÛÈ¢ı› ‹ ˘Ô‚ÏËı› ÁÈ· ÎÚ›ÛË Û ¿ÏÏÔ ÂÚÈÔ‰ÈÎfi Î·È fiÙÈ ÔÈ Û˘ÁÁÚ·Ê›˜ ÂÁÎÚ›ÓÔ˘Ó ÙË ‰ËÌÔÛ›Â˘Û‹ Ù˘ ÛÙÔ ÂÚÈÔ‰ÈÎfi “¶·È‰È·ÙÚÈ΋”. ∂ÈϤÔÓ, ı· Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È Ù˘¯fiÓ ÂȉÔÙ‹ÛÂȘ - ¯ÔÚË-
Á›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢. ŸÏ˜ ÔÈ ÎÏÈÓÈΤ˜ ¤Ú¢Ó˜ Ú¤ÂÈ Ó· Û˘Óԉ‡ÔÓÙ·È ·fi ÁÚ·Ù‹ ‰‹ÏˆÛË ÙˆÓ Û˘ÁÁڷʤˆÓ fiÙÈ ¤ÁÈÓ·Ó ÌÂÙ¿ ·fi ÏËÚÔÊÔÚË̤ÓË Û˘Ó·›ÓÂÛË ÙˆÓ ÌÂÙ¯fiÓÙˆÓ ‹ ÙˆÓ ÓÔÌ›ÌˆÓ ÂÎÚÔÛÒˆÓ ÙÔ˘˜ Û‡Ìʈӷ Ì ÙȘ ‰È·ÎËÚ‡ÍÂȘ ÙÔ˘ EÏÛ›ÓÎÈ Î·È ÙÔ˘ TfiÎÈÔ. ∫·ıÒ˜ Î·È fiÙÈ ÙËÚ‹ıËÎ·Ó ÔÈ Ô‰ËÁ›Â˜ ÁÈ· ÙË ÊÚÔÓÙ›‰· ÂÈÚ·Ì·Ùfi˙ˆˆÓ ÙÔ˘ ∂ıÓÈÎÔ‡ πÓÛÙÈÙÔ‡ÙÔ˘ ÀÁ›·˜ ÙˆÓ ∏¶∞ (DHEW Publication, NIH, 80-23). ™ÙȘ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ ı· Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÂÙ·È fiÙÈ ¤¯Ô˘Ó ÂÁÎÚÈı› ·fi ÙËÓ ÂÈÙÚÔ‹ ∏ıÈ΋˜ Î·È ¢ÂÔÓÙÔÏÔÁ›·˜ ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ. ŸÏ˜ ÔÈ ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ÂÚÁ·Û›Â˜ ıˆÚÔ‡ÓÙ·È È‰ÈÔÎÙËÛ›· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ “¶·È‰È·ÙÚÈ΋” Î·È Ë ÔÏÈ΋ ‹ ÌÂÚÈ΋ ·Ó·‰ËÌÔÛ›Â˘Û‹ ÙÔ˘˜ ÂÈÙÚ¤ÂÙ·È ÌfiÓÔ ÌÂÙ¿ ·fi ¤ÁÁÚ·ÊË Û˘ÁηٿıÂÛË ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. ∏ ¶∞π¢π∞∆ƒπ∫∏ ÚÔÙ›ÓÂÈ Ó· ·ÎÔÏÔ˘ıÔ‡ÓÙ·È ÔÈ “∫ÔÈÓ¤˜ ¶ÚԉȷÁڷʤ˜ ÁÈ· ÃÂÈÚfiÁÚ·Ê· Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È Û µÈÔ˚·ÙÚÈο ¶ÂÚÈÔ‰Èο” (Uniform Requirements for Manuscripts Submitted to Biomedical Journals) Ô˘ ‰ËÌÔÛȇÙËÎ·Ó ÛÙÔ JAMA 1997;277:927-934 http://jama.ama-assn.org/info/auinst_req.html OÈ ·fi„ÂȘ Î·È Ù· Û˘ÌÂÚ¿ÛÌ·Ù· ÙˆÓ Û˘ÁÁڷʤˆÓ Ô˘ ‰È·Ù˘ÒÓÔÓÙ·È ÛÙȘ ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ÂÚÁ·Û›Â˜ ‰ÂÓ ·ÓÙÈηÙÔÙÚ›˙Ô˘Ó ··Ú·›ÙËÙ· ·˘Ù¤˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. H ηٷ¯ÒÚËÛË ‰È·ÊËÌ›ÛÂˆÓ ÛÙÔ ÂÚÈÔ‰ÈÎfi ‰ÂÓ ˘Ô‰ËÏÒÓÂÈ ÔˆÛ‰‹ÔÙ ¤ÁÎÚÈÛË ÙˆÓ ÂÚȯÔÌ¤ÓˆÓ ÙÔ˘˜ ·fi ÙËÓ EÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ EÙ·ÈÚ›·, ÙËÓ EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ‹ ·fi ÙÔÓ EΉfiÙË ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. EÊfiÛÔÓ Ë ÂÚÁ·Û›· Á›ÓÂÈ ·Ô‰ÂÎÙ‹, ÙÔ ‰ÈÔÚıˆÌ¤ÓÔ Û‡Ìʈӷ Ì ÙȘ ˘Ô‰Â›ÍÂȘ ÙˆÓ ÎÚÈÙÒÓ Î·È ÂÎ Ó¤Ô˘ ‰·ÎÙ˘ÏÔÁÚ·ÊË̤ÓÔ Î›ÌÂÓÔ Ú¤ÂÈ Ó· ˘Ô‚¿ÏÏÂÙ·È ÛÙËÓ EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ Û˘Óԉ¢fiÌÂÓÔ ·fi ‰ÈÛΤٷ Ô˘ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ÂÚÁ·Û›· Û ÚfiÁÚ·ÌÌ· Word Î·È ÙÔ˘˜ ›Ó·Î˜, ·Ó Â›Ó·È ‰˘Ó·ÙfiÓ, Û ÚfiÁÚ·ÌÌ· Excel, ηıÒ˜ Î·È ÂÈÛÙÔÏ‹ fiÔ˘ Ó· ·Ó·Ê¤ÚÔÓÙ·È ·Ó·Ï˘ÙÈο ÔÈ ÙÚÔÔÔÈ‹ÛÂȘ ‹ ÔÈ ·ÓÙÈÚÚ‹ÛÂȘ ÛÙȘ ÚÔÙ¿ÛÂȘ ÙˆÓ ÎÚÈÙÒÓ. H ηı˘ÛÙ¤ÚËÛË Ù˘ ·ӢԂÔÏ‹˜ ÙÔ˘ ÙÚÔÔÔÈË̤ÓÔ˘ ÎÂÈ̤ÓÔ˘ ¤Ú·Ó ÙˆÓ 30 ËÌÂÚÒÓ Û˘Ó¿ÁÂÙ·È Ó¤· ˘Ô‚ÔÏ‹. °È· Ó· ÂÈÙ¢¯ı› Ë ¤ÁηÈÚË ‰ËÌÔÛ›Â˘ÛË Ù˘ ÂÚÁ·Û›·˜ Â›Ó·È ··Ú·›ÙËÙÔ Ó· ÂÈÛÙÚ¤ÊÂÙ·È ÙÔ ‰ÈÔÚıˆÌ¤ÓÔ Ù˘ÔÁÚ·ÊÈÎfi ‰ÔΛÌÈÔ ·fi ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ ̤۷ Û ‰‡Ô (2) Ë̤Ú˜. T· ¤ÍÔ‰· ÙˆÓ ÊÈÏÌ Î·È ÙˆÓ ·Ó·Ù‡ˆÓ ‚·Ú‡ÓÔ˘Ó ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ Î·È Ú¤ÂÈ Ó· ÏËÚÒÓÔÓÙ·È Ì ÙËÓ ·ÔÛÙÔÏ‹ ÙÔ˘ ÚÒÙÔ˘ ‰ÔÎÈÌ›Ô˘ ηÙ¢ı›·Ó ÛÙÔÓ Ù˘ÔÁÚ¿ÊÔ. T· ΛÌÂÓ· ÙˆÓ ÂÚÁ·ÛÈÒÓ Ô˘ ‰ÂÓ Á›ÓÔÓÙ·È ·Ô‰ÂÎÙ¤˜ ÁÈ· ‰ËÌÔÛ›Â˘ÛË ‰ÂÓ ÂÈÛÙÚ¤ÊÔÓÙ·È. MÔÚ› Ó· ÂÈÛÙÚ·ÊÔ‡Ó, ÂÊfiÛÔÓ ˙ËÙËı› ÂÓÙfi˜ ÂÍ·Ì‹ÓÔ˘, Ù· Û¯‹Ì·Ù· Î·È ÔÈ ÊˆÙÔÁڷʛ˜ Ô˘ Ù· Û˘Óԉ‡ԢÓ. °. ™‡ÓÙ·ÍË ÙˆÓ ∂ÚÁ·ÛÈÒÓ TÔ Û‡ÓÔÏÔ Ù˘ ÂÚÁ·Û›·˜ (Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ ÙˆÓ ÈÓ¿ÎˆÓ Î·È ÙˆÓ Ù›ÙÏˆÓ ÙˆÓ ÂÈÎfiÓˆÓ) Ú¤ÂÈ Ó· Â›Ó·È ‰·ÎÙ˘ÏÔÁÚ·ÊË̤ÓÔ ÛÙË ÌÈ· fi„Ë Ï¢ÎÔ‡ ¯·ÚÙÈÔ‡ ÌÂÁ¤ıÔ˘˜
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May-June 04 chris new
19-07-04
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A4 (21x29.7 cm) Ì ‰ÈÏfi ‰È¿ÛÙËÌ· ÌÂٷ͇ ÙˆÓ ÁÚ·ÌÌÒÓ Î·È ÂÚÈıÒÚÈ· ÙÔ˘Ï¿¯ÈÛÙÔÓ 2,5 cm ÛÙȘ ‰‡Ô Ï¢ڤ˜. TÔ Î›ÌÂÓÔ Ú¤ÂÈ Ó· ¤¯ÂÈ ÙËÓ ·ÎfiÏÔ˘ıË ‰È¿Ù·ÍË: ÛÂÏ›‰· Ù›ÙÏÔ˘, ‚Ú·¯‡˜ Ù›ÙÏÔ˜, ÂÚ›ÏË„Ë ÛÙ· ÂÏÏËÓÈο Î·È Ù· ·ÁÁÏÈο, ΛÌÂÓÔ, ¢¯·ÚÈÛٛ˜ ηıÒ˜ Î·È ·Ó·ÊÔÚ¿ Û ÂȉÔÙ‹ÛÂȘ-¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢, ‚È‚ÏÈÔÁÚ·Ê›·, ›Ó·Î˜, ÂÈÎfiÓ˜, Ù›ÙÏÔÈ ÂÈÎfiÓˆÓ, ηٿÏÔÁÔ˜ Û˘ÓÙÌ‹ÛˆÓ. K¿ı ¤Ó· ·fi Ù· ·Ú·¿Óˆ ÛÙÔȯ›· Ú¤ÂÈ Ó· ·Ú¯›˙ÂÈ Û ¯ˆÚÈÛÙfi ʇÏÏÔ Î·È ÔÈ ÛÂÏ›‰Â˜ Ó· ·ÚÈıÌÔ‡ÓÙ·È ‰È·‰Ô¯Èο ·Ú¯›˙ÔÓÙ·˜ Ì ÙË ÛÂÏ›‰· Ù›ÙÏÔ˘. H ¤ÎÙ·ÛË ÚÔÛ‰ÈÔÚ›˙ÂÙ·È ÁÈ·: ·. ÙȘ ·Ó·ÛÎÔ‹ÛÂȘ Û 2000-3000 ϤÍÂȘ. ‚. ÙȘ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜ Î·È ÙȘ ÂӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ Û 1500-2500 ϤÍÂȘ. Á. ÙȘ ‚Ú·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ Û 1000-1500 ϤÍÂȘ. ‰. ÙȘ ÂÈÛÙÔϤ˜ Û 250-500 ϤÍÂȘ. ™ÂÏ›‰· Ù›ÙÏÔ˘ ¶Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ: - ÙÔÓ Ù›ÙÏÔ (<14 ϤÍÂȘ) ηıÒ˜ Î·È ÙÔÓ ‚Ú·¯‡ Ù›ÙÏÔ (<5 ϤÍÂȘ) ÙÔ˘ ¿ÚıÚÔ˘. ¢ÂÓ ÂÈÙÚ¤ÔÓÙ·È Û˘ÓÙÌ‹ÛÂȘ, - ÙÔ fiÓÔÌ· Î·È ÙÔ ÂÒÓ˘ÌÔ Î¿ıÂ Û˘ÁÁڷʤ· ÛÙËÓ ÔÓÔÌ·ÛÙÈ΋, - ÙÔ ÂÈÛÙËÌÔÓÈÎfi ΤÓÙÚÔ (›‰Ú˘Ì·, ÎÏÈÓÈ΋, ÂÚÁ·ÛÙ‹ÚÈÔ) ·fi fiÔ˘ ÚÔ¤Ú¯ÂÙ·È Ë ÂÚÁ·Û›·. ™Â ÂÚ›ÙˆÛË ¤ÏÏÂȄ˘ Û˘ÓÂÚÁ·Û›·˜ ÌÂ Û˘ÁÎÂÎÚÈ̤ӷ ΤÓÙÚ·, Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÂÙ·È Ë È‰ÈfiÙËÙ· ÙÔ˘/ÙˆÓ Û˘ÁÁڷʤˆÓ (.¯. ȉÈÒÙ˘ ·È‰›·ÙÚÔ˜) Î·È Ô ÙfiÔ˜ ‰È·ÌÔÓ‹˜ ÙÔ˘/ÙˆÓ, - ÙËÓ Ï‹ÚË ‰È‡ı˘ÓÛË, e-mail Î·È ÙÔ ÙËϤʈÓÔ ÙÔ˘ Û˘ÁÁڷʤ· Ì ÙÔÓ ÔÔ›Ô Á›ÓÂÙ·È Ë ·ÏÏËÏÔÁÚ·Ê›·. ¶ÂÚÈÏ‹„ÂȘ H ÂÚ›ÏË„Ë Ú¤ÂÈ Ó· ·Ó·ÎÂÊ·Ï·ÈÒÓÂÈ ÙÔ˘˜ ÛÙfi¯Ô˘˜ Ù˘ ÂÚÁ·Û›·˜, ÙË ÌÂıÔ‰ÔÏÔÁ›·, Ù· ΢ÚÈfiÙÂÚ· ·ÔÙÂϤÛÌ·Ù· Î·È Ù· Û˘ÌÂÚ¿ÛÌ·Ù· Ù˘ ÌÂϤÙ˘. £· Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÔ˘Ï¿¯ÈÛÙÔÓ 200 ϤÍÂȘ, fï˜ ‰ÂÓ ı· Ú¤ÂÈ Ó· ˘ÂÚ‚·›ÓÂÈ ÙȘ 250 ϤÍÂȘ. ∏ ÂÚ›ÏË„Ë ÙˆÓ ÂÚÁ·ÛÈÒÓ Ú¤ÂÈ Ó· Â›Ó·È ‰ÔÌË̤ÓË ÛÙȘ ÂÍ‹˜ ·Ú·ÁÚ¿ÊÔ˘˜: ÂÈÛ·ÁˆÁ‹, ̤ıÔ‰ÔÈ, ·ÔÙÂϤÛÌ·Ù· Î·È Û˘ÌÂÚ¿ÛÌ·Ù·. ™ÙËÓ ÂÚ›ÏË„Ë ÛÙ· ·ÁÁÏÈο Ú¤ÂÈ Ó· ·Ó·ÁÚ¿ÊÔÓÙ·È ÛÙËÓ ·Ú¯‹ ÙÔ˘ ÎÂÈ̤ÓÔ˘ Ô Ù›ÙÏÔ˜ Ù˘ ÂÚÁ·Û›·˜ Î·È Ù· ÔÓfiÌ·Ù· ÙˆÓ Û˘ÁÁڷʤˆÓ ÛÙ· ·ÁÁÏÈο. TÔ ÂÚȯfiÌÂÓÔ ÙÔ˘ ·ÁÁÏÈÎÔ‡ ÎÂÈ̤ÓÔ˘ Ú¤ÂÈ Ó· Â›Ó·È ‰ÔÌË̤ÓÔ Û ÂÈÛ·ÁˆÁ‹ (background), ̤ıÔ‰ÔÈ (methods), ·ÔÙÂϤÛÌ·Ù· (results) Î·È Û˘ÌÂÚ¿ÛÌ·Ù· (conclusions). H ÂÚ›ÏË„Ë ÛÙ· ·ÁÁÏÈο ‰ÂÓ Ú¤ÂÈ Ó· ‰È·Ê¤ÚÂÈ ·fi ÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë ÛÙ· ÂÏÏËÓÈο. T· ¿ÚıÚ· Û‡ÓÙ·Í˘ Î·È ÔÈ ·ÂÈÎÔÓÈÛÙÈΤ˜ ÂÚÈÙÒÛÂȘ ¤¯Ô˘Ó ÌfiÓÔ ·ÁÁÏÈ΋ ÂÚ›ÏË„Ë. K¿Ùˆ ·fi ÙËÓ ÂÏÏËÓÈ΋ Î·È ÙËÓ ·ÁÁÏÈ΋ ÂÚ›ÏË„Ë ÛËÌÂÈÒÓÔÓÙ·È ÙÚÂȘ ¤ˆ˜ ¤ÓÙ ϤÍÂȘ ÎÏÂȉȿ Ô˘ ı· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó ÁÈ· ÙÔ ıÂÌ·ÙÈÎfi ¢ÚÂÙ‹ÚÈÔ. K›ÌÂÓÔ OÈ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó: ÂÈÛ·ÁˆÁ‹, ÌÂıfi‰Ô˘˜, ·ÔÙÂϤÛÌ·Ù· Î·È Û˘˙‹ÙËÛË. H ÂÈÛ·ÁˆÁ‹ ÂÚÈÏ·Ì‚¿ÓÂÈ Ù· ÙÂÏÂ˘Ù·›· ‰Â‰Ô̤ӷ Ù˘ ¤Ú¢ӷ˜ ÛÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ ı¤Ì· Ì ÙȘ ΢ÚÈfiÙÂÚ˜ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·-
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Ô̤˜ Î·È ÙÔ ÛÎÔfi Ù˘ ÂÚÁ·Û›·˜. H ÂÚÈÁÚ·Ê‹ ÙˆÓ ÌÂıfi‰ˆÓ Ú¤ÂÈ Ó· Â›Ó·È ·ÎÚÈ‚‹˜ Î·È ·ÚÎÂÙ¿ ÏÂÙÔÌÂÚ‹˜ ÒÛÙ ӷ ÂÈÙÚ¤ÂÈ ÙËÓ ·Ó··Ú·ÁˆÁ‹ ÙÔ˘˜ ·fi ¿ÏÏÔ˘˜ ÂÚ¢ÓËÙ¤˜. ∂›Û˘, Ú¤ÂÈ Ì ÏÂÙÔ̤ÚÂȘ Ó· ·Ó·Ê¤ÚÔÓÙ·È ÔÈ ÛÙ·ÙÈÛÙÈΤ˜ ̤ıÔ‰ÔÈ ·Ó¿Ï˘Û˘ Î·È ·ÍÈÔÏfiÁËÛ˘ ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ. T· ·ÔÙÂϤÛÌ·Ù· Ú¤ÂÈ Ó· ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ì ۷ʋÓÂÈ· Î·È Ó· Û˘Óԉ‡ÔÓÙ·È ·fi ÙËÓ ··Ú·›ÙËÙË ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË. H Û˘˙‹ÙËÛË Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ Ù· Û˘ÌÂÚ¿ÛÌ·Ù· Ô˘ ÚÔ·ÙÔ˘Ó ·fi ÙËÓ ÂÚÁ·Û›·, ÙË ÛËÌ·Û›· Ô˘ ÌÔÚ› Ó· ¤¯Ô˘Ó Î·È ÙËÓ Èı·Ó‹ Û˘Û¯¤ÙÈÛ‹ ÙÔ˘˜ Ì ·Ú·ÙËÚ‹ÛÂȘ ¿ÏÏˆÓ ÂÚ¢ÓËÙÒÓ. OÈ ÂӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Û‡ÓÙÔÌË ÂÈÛ·ÁˆÁ‹, ÂÚÈÁÚ·Ê‹ Ù˘ ÂÚ›ÙˆÛ˘ Î·È ‚Ú·¯Â›· Û˘˙‹ÙËÛË. OÈ ·ÂÈÎÔÓÈÛÙÈΤ˜ ÂÚÈÙÒÛÂȘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Û‡ÓÙÔÌË ÂÚÈÁÚ·Ê‹ Ù˘ ÂÚ›ÙˆÛ˘ Î·È ‚Ú·¯Â›· Û˘˙‹ÙËÛË Ì ¤ÌÊ·ÛË ÛÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË. T· ˘fiÏÔÈ· ı¤Ì·Ù· ¤¯Ô˘Ó ÂχıÂÚË ‰ÔÌ‹ ηٿ ÙËÓ ÎÚ›ÛË ÙˆÓ Û˘ÁÁڷʤˆÓ ÙÔ˘˜. ∂˘¯·ÚÈÛٛ˜ ‹ ·Ó·ÁÓˆÚ›ÛÂȘ (·Ó·ÊÔÚ¿ Û ÂȉÔÙ‹ÛÂȘ - ¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢) ı· Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔ Ù¤ÏÔ˜ ÙÔ˘ ÎÂÈ̤ÓÔ˘ Î·È ÚÈÓ ·fi ÙȘ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·Ô̤˜. TÈ̤˜ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛÂˆÓ OÈ ÙÈ̤˜ ÙˆÓ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛÂˆÓ Ú¤ÂÈ Ó· ÂÎÊÚ¿˙ÔÓÙ·È ÛÙÔ ¢ÈÂıÓ¤˜ ™‡ÛÙËÌ· MÔÓ¿‰ˆÓ (SI Units) Î·È ÛÙÔ MÂÙÚÈÎfi (Conventional-™˘Ì‚·ÙÈÎfi) ™‡ÛÙËÌ· ̤۷ Û ·Ú¤ÓıÂÛË. ¶›Ó·Î˜ ÌÂÙ·ÙÚÔ‹˜ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÛÙÔ JAMA 1986;255:2329-2339. ™˘ÓÙÔÌÔÁڷʛ˜ OÈ Û˘ÓÙÔÌÔÁڷʛ˜ Ô˘ ¤¯Ô˘Ó ÂÈ‚ÏËı› ‰ÈÂıÓÒ˜ ‰ËÌÔÛȇÔÓÙ·È Û οı Ù‡¯Ô˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. ™‡ÓıÂÙÔÈ Î·È Ì·ÎÚÔÛÎÂÏ›˜ fiÚÔÈ Ô˘ ·ӷϷ̂¿ÓÔÓÙ·È Û˘¯Ó¿ ÛÙÔ Î›ÌÂÓÔ ÌÔÚÔ‡Ó Ó· ·ÓÙÈηı›ÛÙ·ÓÙ·È ·fi Û˘ÓÙÔÌÔÁڷʛ˜ Ô˘ ÂÂÍËÁÔ‡ÓÙ·È ·fi ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ Û ÂȉÈÎfi ηٿÏÔÁÔ, Ô ÔÔ›Ô˜ ˘Ô‚¿ÏÏÂÙ·È Ì·˙› Ì ÙËÓ ÂÚÁ·Û›·. OÈ Û˘ÓÙÔÌÔÁڷʛ˜ ·Ó·Ê¤ÚÔÓÙ·È Û ·Ú¤ÓıÂÛË ÌfiÓÔ ÛÙȘ ÂÚÈÏ‹„ÂȘ. BÈ‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·Ô̤˜ ™ÙÔ ÙÌ‹Ì· Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜ ηٷ¯ˆÚÔ‡ÓÙ·È fiϘ ÔÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·Ô̤˜ Ì ÙË ÛÂÈÚ¿ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔ Î›ÌÂÓÔ. ™ÙÔ Î›ÌÂÓÔ ÔÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·Ô̤˜ ·Ó·Ê¤ÚÔÓÙ·È Ì ·Ú·‚ÈÎÔ‡˜ ·ÚÈıÌÔ‡˜ Û ·Ú¤ÓıÂÛË. OÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·Ô̤˜ ‰ÂÓ Ú¤ÂÈ Ó· ˘ÂÚ‚·›ÓÔ˘Ó ÙȘ 70 ÛÙȘ ·Ó·ÛÎÔ‹ÛÂȘ, ÙȘ 30 ÛÙȘ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜, ÙȘ 12 ÛÙ· ›ηÈÚ· ı¤Ì·Ù· Î·È ÙȘ ÂӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ, ÙȘ 5 ÛÙȘ ‚Ú·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ Î·È ÛÙȘ ÂÈÛÙÔϤ˜. H Û‡ÓÙ·ÍË ÙˆÓ ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·ÔÌÒÓ Á›ÓÂÙ·È Û‡Ìʈӷ Ì ÙȘ ÚԉȷÁڷʤ˜ Ù˘ International Committee of Medical Journal Editors/Uniform Requirements for Manuscripts Submitted to Biomedical Journals (JAMA 1997;277:927-934), http://jama.amaassn.org/info/auinst_req.html. OÈ Û˘ÓÙÌ‹ÛÂȘ ÙˆÓ Ù›ÙÏˆÓ ÙˆÓ ÂÚÈÔ‰ÈÎÒÓ Á›ÓÔÓÙ·È Ì ‚¿ÛË ÙÔ Cumulated Index Medicus (List of Journals Indexed in Index Medicus, http://www.nlm.nih.gov).
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¶·Ú·‰Â›ÁÌ·Ù· ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·ÔÌÒÓ I. ¶ÂÚÈÔ‰Èο AÓ ÔÈ Û˘ÁÁÚ·Ê›˜ Â›Ó·È ¤ˆ˜ ¤ÍÈ ·Ó·ÁÚ¿ÊÔÓÙ·È fiÏÔÈ, ·Ó Â›Ó·È ÂÙ¿ ‹ ÂÚÈÛÛfiÙÂÚÔÈ ·Ó·ÁÚ¿ÊÔÓÙ·È ÔÈ ÚÒÙÔÈ ¤ÍÈ Î·È ÚÔÛÙ›ıÂÙ·È “et al” ‹ “Î·È Û˘Ó”. T·ÎÙÈ΋ ¤Î‰ÔÛË ÂÚÈÔ‰ÈÎÔ‡: ∞ÓÙˆÓ›Ô˘ ¢, ª¿Ú· Ã, °È·ÓÓ¿ÙÔ˘ Ã. ∂Ì‚fiÏÈ·: ›‰Ú·ÛË ÛÙËÓ ÂȉËÌÈÔÏÔÁ›· ÙˆÓ ÏÔÈ̈‰ÒÓ ÓÔÛËÌ¿ÙˆÓ Î·È ÙËÓ ·È‰È·ÙÚÈ΋ Ú¿ÍË. ¶·È‰È·ÙÚÈ΋ 1999;59:272-279. Proesmans W. Bartter syndrome and its neonatal variant. Eur J Pediatr 1997;156:669-679. ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜ ÂÚÈÔ‰ÈÎÔ‡: Flyvbjerg A. Role of growth hormone, insulin-like growth factors (IGFs) and IGF-binding proteins in the renal complications of diabetes. Kidney Int 1997;52 (60 Suppl):S12-S19. Èڛ˜ Û˘ÁÁڷʤ·: National Institutes of Health Consensus Development Conference. Neurofibromatosis conference statement. Arch Neurol 1988;45:575-578. ¶ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù‡Ô˘ ¿ÚıÚÔ˘: ÷ڷϷ̛‰Ë˜ π, ¶··‰fiÔ˘ÏÔ˜ ∞. ¶·¯˘Û·ÚΛ· Î·È ˘ÂÚÏÈȉ·ÈÌ›· [¶ÂÚ›ÏË„Ë]. 36Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ; 1998 5-7 πÔ˘Ó›Ô˘; ¶¿ÊÔ˜, ∫‡ÚÔ˜; 1998. ÛÂÏ. 199. Schreiner GF, Lange L. Ethanol modulation of macrophage influx in glomerulonephritis [abstract]. J Am Soc Nephrol 1991;2:562. Should antileukotriene therapies be used instead of inhaled corticosteroids in asthma? [Editorial]. Am J Respir Crit Care Med 1998;158:1697-1701. Laux-End R, Inaebnit D, Gerber HA, Bianchetti MG. Vasculitis associated with levamisole and circulating autoantibodies [letter]. Arch Dis Child 1996;75:355-356. II. µÈ‚Ï›· ∫ÂÊ¿Ï·ÈÔ Û ‚È‚Ï›Ô: Clark AG, Barratt TM. Steroid-responsive nephrotic syndrome. In: Barratt TM, Arner ED, Harmon WE, editors. Pediatric Nephrology. 4th ed. Baltimore: Lippincott William Wilkins; 1999. p. 742. ™‡ÁÁÚ·ÌÌ· ‹ ÌÔÓÔÁÚ·Ê›·: Gorlin RJ, Cohen MM, Levin LS. Syndromes of the head and neck. 3rd ed. New York: Oxford University Press; 1990. ¢ËÌÔÛ›Â˘ÛË Û ÙfiÌÔ Ú·ÎÙÈÎÒÓ: Bauer AW. The two definitions of bacterial resistance. In: Smith AJ, Rogers CA, eds. Proceedings of the Third International Congress of Chemotherapy; 1962 May 29-
31; New York: International Society of Chemotherapy; 1963. p. 484-500. ¢È‰·ÎÙÔÚÈ΋ ‰È·ÙÚÈ‚‹: ¶··‰fiÔ˘ÏÔ˜ Ã.. ∏ ıÂڷ›· ÙÔ˘ ÛÙÚ·‚ÈÛÌÔ‡. [‰È‰·ÎÙÔÚÈ΋ ‰È·ÙÚÈ‚‹]. ∞ı‹Ó·: ¶·ÓÂÈÛÙ‹ÌÈÔ ∞ıËÓÒÓ; 1979. Kaplan SJ. Post hospital home health care: the elderly’s access and utilization [dissertation]. St. Louis (Mo): Washington Univ.; 1995. ¶›Ó·Î˜ Î·È EÈÎfiÓ˜ AÔÛÙ¤ÏÏÔÓÙ·È ÂȘ ÙÚÈÏÔ‡Ó (¤Ó· ÚˆÙfiÙ˘Ô+‰‡Ô ʈÙÔ·ÓÙ›ÁÚ·Ê·). ¶Ú¤ÂÈ Ó· ¤¯Ô˘Ó Ï¿ÙÔ˜ ›ÛÔ Ì ÙÔ Ï¿ÙÔ˜ ÙÔ˘ ÌÔÓfiÛÙËÏÔ˘ (8 cm) ‹ Ì ÙÔ Ï¿ÙÔ˜ fiÏ˘ Ù˘ ÛÂÏ›‰·˜ (16,8 cm). TÔ Ì¤ÁÈÛÙÔ Ì‹ÎÔ˜ ÙÔ˘˜, Ì·˙› Ì ÙÔ˘˜ Ù›ÙÏÔ˘˜, ‰ÂÓ Ú¤ÂÈ Ó· Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ ·fi 22 cm. OÈ ›Ó·Î˜ ·ÚÈıÌÔ‡ÓÙ·È Ì ·Ú·‚ÈÎÔ‡˜ ·ÚÈıÌÔ‡˜ Ì ÙË ÛÂÈÚ¿ Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÔ Î›ÌÂÓÔ. ¶ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ‚Ú·¯‡ Ù›ÙÏÔ Î·È ÂÂÍ‹ÁËÛË ÙˆÓ Û˘ÓÙÌ‹ÛÂˆÓ ÛÙÔ Î¿Ùˆ ̤ÚÔ˜. ™ÙÔ˘˜ ›Ó·Î˜ Ú¤ÂÈ Ó· ·ÔʇÁÔÓÙ·È ÔÈ Î¿ıÂÙ˜ ÁÚ·Ì̤˜. ŸÏÔ ÙÔ ·ÂÈÎÔÓÈÛÙÈÎfi ˘ÏÈÎfi (Û¯‹Ì·Ù·, ‰È·ÁÚ¿ÌÌ·Ù·, ʈÙÔÁڷʛ˜, Î.Ï.) ¯·Ú·ÎÙËÚ›˙ÂÙ·È ˆ˜ ÂÈÎfiÓ˜. £· Ú¤ÂÈ Ó· Â›Ó·È ¿ÚÈÛÙ˘ ÔÈfiÙËÙ·˜ Ì ÌÔÚÊ‹ ʈÙÔÁÚ·ÊÈÒÓ ‹ Î·È ÚˆÙÔÙ‡ˆÓ. ™ÙÔ ›Ûˆ ̤ÚÔ˜ ÙˆÓ ÂÈÎfiÓˆÓ Ú¤ÂÈ Ó· ÛËÌÂÈÒÓÂÙ·È Ì ÌÔχ‚È Ô ·ÚÈıÌfi˜ Ù˘ ÂÈÎfiÓ·˜ Î·È ÙÔ fiÓÔÌ· ÙÔ˘ ÚÒÙÔ˘ Û˘ÁÁڷʤ·, ηıÒ˜ Î·È ¤Ó· ‚¤ÏÔ˜ ÙÔ ÔÔ›Ô Ó· ‰Â›¯ÓÂÈ ÙÔ ¿Óˆ ̤ÚÔ˜ Ù˘ ÂÈÎfiÓ·˜. ™ÙȘ ʈÙÔÁڷʛ˜ ·ÛıÂÓÒÓ ‰ÂÓ Ú¤ÂÈ Ó· ·Ó·ÁÓˆÚ›˙ÂÙ·È Ë Ù·˘ÙfiÙËÙ¿ ÙÔ˘˜. OÈ ·ÛıÂÓ›˜ ‰ÂÓ Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È ÔÓÔÌ·ÛÙÈο. ¶ÚÈÓ ·ÔÛÙ›ÏÂÙ ÙËÓ ÂÚÁ·Û›· Û·˜ ‚‚·Èˆı›Ù fiÙÈ ÂÚÈÏ·Ì‚¿ÓÂÈ: 1. ∂ÈÛÙÔÏ‹ ˘Ô‚ÔÏ‹˜. 2. ¢‹ÏˆÛË ÌË ÚÔÁÂÓ¤ÛÙÂÚ˘ ‰ËÌÔÛ›Â˘Û˘ Ù˘ ÂÚÁ·Û›·˜. 3. 3 ·ÓÙ›ÁÚ·Ê· ÙÔ˘ ÎÂÈ̤ÓÔ˘ Ù˘ ÂÚÁ·Û›·˜. 4. ™ÂÏ›‰· Ù›ÙÏÔ˘ (¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) ÂÚÈÏ·Ì‚¿ÓÂÈ: ·. Ù›ÙÏÔ Î·È ‚Ú·¯‡ Ù›ÙÏÔ ÂÚÁ·Û›·˜, ‚. fiÓÔÌ· Î·È ÂÒÓ˘ÌÔ Û˘ÁÁڷʤˆÓ (ÔÏÔÁڿʈ˜), Á. ÂÈÛÙËÌÔÓÈÎfi/¿ ΤÓÙÚÔ/· fiÔ˘ ¤ÁÈÓÂ Ë ÂÚÁ·Û›·, ‰. fiÓÔÌ·, ‰È‡ı˘ÓÛË Î·È ÙËϤʈÓÔ Û˘ÁÁڷʤ· ÁÈ· ·ÏÏËÏÔÁÚ·Ê›·. 5. ¶ÂÚ›ÏË„Ë ÂÏÏËÓÈ΋-·ÁÁÏÈ΋, ϤÍÂȘ ÎÏÂȉȿ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·). 6. ∫·Ù¿ÏÔÁÔ Û˘ÓÙÔÌÔÁÚ·ÊÈÒÓ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·). 7. ∫›ÌÂÓÔ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·). 8. ∂˘¯·ÚÈÛٛ˜ ‹ ·Ó·ÁÓˆÚ›ÛÂȘ (·Ó·ÊÔÚ¿ Û ÂȉÔÙ‹ÛÂȘ-¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢). 9. µÈ‚ÏÈÔÁÚ·Ê›· (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·). 10. ¶›Ó·Î˜ (Ô Î·ı¤Ó·˜ Û ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) ÂȘ ÙÚÈÏÔ‡Ó. 11. ∂ÈÎfiÓ˜, Ì ‚¤ÏÔ˜ ÛÙÔ ›Ûˆ ̤ÚÔ˜ Ó· ‰Â›¯ÓÂÈ ÚÔ˜ Ù· ¿ӈ, ·ÚÈıÌË̤Ó˜, ÂȘ ÙÚÈÏÔ‡Ó. 12. ∆›ÙÏÔÈ ÂÈÎfiÓˆÓ (‰ÈÏfi ‰È¿ÛÙËÌ· - Ô Î·ı¤Ó·˜ Û ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) ÂȘ ÙÚÈÏÔ‡Ó.
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¶·È‰È·ÙÚÈ΋ 2004;67:151-159
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Paediatriki 2004;67:151-159
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OÈ ‰˘ÛÏÈȉ·È̛˜ ÛÙ· ·È‰È¿ Î·È Ë ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘˜ ∞. ∆ÂÚÙ›Ë, µ. ¶¤ÙÚÔ˘, Ã. £ÂÔ‰ˆÚ›‰Ë˜
Dyslipidaemias in children and their management A. Tertipi, V. Petrou, H. Theodoridis
¶ÂÚ›ÏË„Ë: ∏ ·‡ÍËÛË Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘ Î·È Ë Ì›ˆÛË Ù˘ ∏DL-¯ÔÏËÛÙÂÚfiÏ˘ ·ÔÙÂÏÔ‡Ó ·ÓÂÍ¿ÚÙËÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ÚfiÎÏËÛË ÚÒÈÌ˘ ·ıËڈ̿وÛ˘ Î·È ÙËÓ ÂΉ‹ÏˆÛË Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ. ¶·ıÔÏÔÁÔ·Ó·ÙÔÌÈΤ˜ ÌÂϤÙ˜ Û ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ ¤‰ÂÈÍ·Ó fiÙÈ ÔÈ ·ıËڈ̷ÙÈΤ˜ ‚Ï¿‚˜ ÙˆÓ ·ÁÁ›ˆÓ ÂÌÊ·Ó›˙ÔÓÙ·È ‹‰Ë ·fi ÙËÓ ·È‰È΋ ËÏÈΛ·, ÂÓÒ Ë Û‡Á¯ÚÔÓË ·ÓÙ›ÏË„Ë ÁÈ· ÚfiÏË„Ë ÂÈ‚¿ÏÏÂÈ ÙË ‰È·Ù‹ÚËÛË ÙˆÓ ÏÈȉ›ˆÓ ÙÔ˘ ·›Ì·ÙÔ˜ Û ›‰· Ô˘ Ó· ÌËÓ Úԉȷı¤ÙÔ˘Ó ÁÈ· ÚÒÈÌË Î·Ú‰È·ÁÁÂȷ΋ ÓfiÛÔ. ™Ù· ·È‰È¿ ‰ÂÓ ÂΉËÏÒÓÔÓÙ·È Û˘Ó‹ıˆ˜ ηډȷÁÁÂȷο ÓÔÛ‹Ì·Ù·, ·ÏÏ¿ fiÙ·Ó ˘¿Ú¯ÂÈ ÁÂÓÂÙÈ΋ ÚԉȿıÂÛË, ÌÔÚ› Ó· ÂÌÊ·ÓÈÛÙ› ÔÔÈ·‰‹ÔÙ ‰˘ÛÏÈȉ·ÈÌ›·. ∏ ·ıËڈ̿وÛË Â›Ó·È ¤Ó· Ê˘ÛÈÔÏÔÁÈÎfi, ÔÏ˘·Ú·ÁÔÓÙÈ΋˜ ·ÈÙÈÔÏÔÁ›·˜, Ê·ÈÓfiÌÂÓÔ. ∂ÎÙfi˜ ·fi ÙËÓ ·ÚÔ˘Û›· ‰˘ÛÏÈȉ·ÈÌ›·˜, Ôχ ÛËÌ·ÓÙÈÎfi Â›Ó·È ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÚfiˆÚ˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘, ηıÒ˜ ˘Ô‰ÂÈÎÓ‡ÂÈ fiÙÈ ÙÔ ·È‰› ¤¯ÂÈ Èı·ÓfiÓ ÎÏËÚÔÓÔÌ‹ÛÂÈ ÁÓˆÛÙ¿ ‹ ¿ÁÓˆÛÙ· ÁÔÓ›‰È· Ô˘ ÚÔ¿ÁÔ˘Ó ÙËÓ ÚÒÈÌË ·ıËڈ̿وÛË. £Â̤ÏÈÔ˜ Ï›ıÔ˜ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ‰˘ÛÏÈȉ·ÈÌÈÒÓ Â›Ó·È Ë ‰È·ÈÙËÙÈ΋ ·ÁˆÁ‹ Î·È Ë ¿ÛÎËÛË. OÈ Û˘Óı‹Î˜ Ô˘ ÂÈÎÚ·ÙÔ‡Ó ÛÙȘ Û‡Á¯ÚÔÓ˜ ÔÈÎÔÁ¤ÓÂȘ (ÂÚÁ·˙fiÌÂÓ˜ ÌËÙ¤Ú˜ Ì ÂÚÈÔÚÈṲ̂ÓÔ ÂχıÂÚÔ ¯ÚfiÓÔ) Î·È ÔÈ ‰È·ÈÙËÙÈΤ˜ Û˘Ó‹ıÂȘ ÙˆÓ ÂÊ‹‚ˆÓ, Ô˘ Ôχ Û˘¯Ó¿ Û˘Óԉ‡ÔÓÙ·È Î·È ·fi ÙËÓ ·Ô˘Û›· Ê˘ÛÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ (·Ú·ÎÔÏÔ‡ıËÛË ÙËÏÂfiÚ·Û˘ ÛÙÔÓ ÂχıÂÚÔ ¯ÚfiÓÔ, ˘ÂÚ‚ÔÏÈ΋ ··Û¯fiÏËÛË Û ÊÚÔÓÙÈÛÙ‹ÚÈ· Î.Ï.), ¢ÓÔÔ‡Ó ÙË Û˘¯Ó‹ ηٷӿψÛË ¤ÙÔÈÌÔ˘ Ê·ÁËÙÔ‡, ÙÔ ÔÔ›Ô ¤¯ÂÈ ‰˘ÛÌÂÓ‹ ›‰Ú·ÛË ÛÙ· ›‰· ÙˆÓ ÏÈȉ›ˆÓ. O ÁÈ·ÙÚfi˜ Ú¤ÂÈ Ó· ÙÔÓ›˙ÂÈ ÛÙÔ˘˜ ÁÔÓ›˜ fiÙÈ ÌfiÓÔ ÙÔ ‰ÈÎfi ÙÔ˘˜ ·Ú¿‰ÂÈÁÌ· Î·È Ë ÂÈÌÔÓ‹ ÌÔÚ› Ó· ÂÍ·ÛÊ·Ï›ÛÔ˘Ó ÙË Û˘Ó·›ÓÂÛË ÙÔ˘ ·È‰ÈÔ‡ ÛÙÔ˘˜ ‰È¿ÊÔÚÔ˘˜ ‰È·ÈÙËÙÈÎÔ‡˜ ÂÚÈÔÚÈÛÌÔ‡˜.
Abstract: Increased LDL-cholesterol and decreased HDL-cholesterol blood levels are risk factors for premature atheromatosis and cardiovascular disease. Histological studies in children and adolescents have shown that atheromatic vascular lesions start from childhood. The contemporary concept for cardiovascular disease prevention demands the maintenance of serum lipids in children at levels not predisposing to early atheromatosis. Cardiovascular disease is not usually present in children but where there is a genetic predisposition, any dyslipidaemia may appear during childhood. Atherogenesis is a physiological phenomenon of multifactorial aetiology. Apart from dyslipidaemia, a family history of premature cardiovascular disease is an indication that a child may have inherited known or unknown genes predisposing to early atheromatosis. Diet and exercise constitute the cornerstone of the management of dyslipidaemias. The situation of today’s families (working mothers with limited free time) and adolescent eating habits (frequent consumption of fast food), usually accompanied by the absence of physical activity (TV watching, heavy homework load etc.), adversely affect serum lipids. The doctor’s duty to parents is to emphasize that only their attitude and insistence can ensure their children’s compliance with the dietary restrictions recommended for the management of dyslipidaemia, and to stress the need for healthy dietary habits and systematic exercise, not only for children with dyslipidaemia but for all children.
∂Ó‰ÔÎÚÈÓÔÏÔÁÈ΋ ∫ÏÈÓÈ΋, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó·
Department of Endocrinology, “P. & A. Kyriakou” Children’s Hospital, Athens
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¶·È‰È·ÙÚÈ΋ 2004;67:151-159
Paediatriki 2004;67:151-159
∏ ·ÓÙÈÌÂÙÒÈÛË ·˘Ù‹ Ú¤ÂÈ Ó· ·ÊÔÚ¿ Û fiÏ· Ù· ·È‰È¿ Î·È fi¯È ÌfiÓÔ Û ÂΛӷ Ì ‰˘ÛÏÈȉ·ÈÌ›·. §¤ÍÂȘ ÎÏÂȉȿ: ‰˘ÛÏÈȉ·ÈÌ›· Û ·È‰È¿, ‰È¿ÁÓˆÛË, ¤ÏÂÁ¯Ô˜, ıÂڷ›·.
Key words: dyslipidaemia in children, diagnosis, investigation, treatment.
™˘ÓÙÔÌÔÁڷʛ˜
ª·ÎÚÔ¯ÚfiÓȘ ÌÂϤÙ˜ ÁÈ· ÙË Û˘Û¯¤ÙÈÛË ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·˜ Î·È Î·Ú‰È·ÁÁÂȷ΋˜ ÓfiÛÔ˘ Ô‰‹ÁËÛ·Ó ÛÙÔÓ Î·ıÔÚÈÛÌfi ÂÈı˘ÌËÙÒÓ (desirable) Î·È ·Ô‰ÂÎÙÒÓ (acceptable) ÂȤ‰ˆÓ ÁÈ· ÙËÓ ÔÏÈ΋ Î·È Î˘Ú›ˆ˜ ÁÈ· ÙËÓ LDL-¯ÔÏËÛÙÂÚfiÏË, ÙfiÛÔ ÛÙÔ˘˜ ÂÓ‹ÏÈΘ fiÛÔ Î·È ÛÙ· ·È‰È¿ (¶›Ó·Î˜ 1 Î·È 2). ∆· ÂÈı˘ÌËÙ¿ ›‰· ·ÓÙÈÛÙÔÈ¯Ô‡Ó ÂÚ›Ô˘ ÛÙËÓ 75Ë ÂηÙÔÛÙÈ·›· ı¤ÛË ÙˆÓ ÂȤ‰ˆÓ ÙÔ˘ ÁÂÓÈÎÔ‡ ÏËı˘ÛÌÔ‡ Î·È Ù· ·Ô‰ÂÎÙ¿ ÛÙËÓ 90‹ ÂηÙÔÛÙÈ·›· ı¤ÛË. ¶·ıÔÏÔÁÔ·Ó·ÙÔÌÈΤ˜ ÌÂϤÙ˜ Û ·È‰È¿ ¤‰ÂÈÍ·Ó fiÙÈ Ë ·ıËڈ̿وÛË ÙˆÓ ·ÁÁ›ˆÓ ·˘Í¿ÓÂÙ·È ÛËÌ·ÓÙÈο fiÙ·Ó Ù· ›‰· Ù˘ ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ ˘ÂÚ‚·›ÓÔ˘Ó ÙËÓ 90‹ ÂηÙÔÛÙÈ·›· ı¤ÛË (9). ™Â Ì›· ·Ï·ÈfiÙÂÚË ÂÏÏËÓÈ΋ ÌÂϤÙË Û ·ÛÙÈÎfi ÏËı˘ÛÌfi, Ë 75Ë Î·È Ë 90‹ ÂηÙÔÛÙÈ·›· ı¤ÛË ÁÈ· ÙËÓ ÔÏÈ΋ Î·È ÙËÓ LDL¯ÔÏËÛÙÂÚfiÏË Î·È Ù· ÙÚÈÁÏ˘ÎÂÚ›‰È·, fiˆ˜ Î·È Ë 10Ë ÂηÙÔÛÙÈ·›· ı¤ÛË ÁÈ· ÙËÓ ∏DL-¯ÔÏËÛÙÂÚfiÏË, ‹Ù·Ó ·ÚfiÌÔȘ Ì ÂΛӘ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÁÈ· ÙÔ˘˜ ·È‰ÈÎÔ‡˜ ÏËı˘ÛÌÔ‡˜ Í¤ÓˆÓ ¯ˆÚÒÓ (10). ¶ÚfiÛÊ·ÙË, fï˜, ÂÏÏËÓÈ΋ ÌÂϤÙË ¤‰ÂÈÍ ˘„ËÏfiÙÂÚ˜ ÙÈ̤˜ ÔÏÈ΋˜ Î·È LDL-¯ÔÏËÛÙÂÚfiÏ˘ ÁÈ· ÙËÓ 75Ë Î·È ÙËÓ 90‹ ÂηÙÔÛÙÈ·›· ı¤ÛË (11), ‡ÚËÌ· Ô˘ ·ÔÙÂÏ› ¤Ó‰ÂÈÍË ·‡ÍËÛ˘ ÙˆÓ ÂȤ‰ˆÓ ÙˆÓ ÏÈȉ›ˆÓ ÛÙÔÓ ÁÂÓÈÎfi ·È‰ÈÎfi ÏËı˘ÛÌfi. ªÂٷ͇ ·È‰ÈÒÓ ·fi 17 ¯ÒÚ˜, Ù· ∂ÏÏËÓfiÔ˘Ï· ‚Ú›ÛÎÔÓÙ·È ÛÙË ‰Â‡ÙÂÚË ı¤ÛË Ì ٷ ˘„ËÏfiÙÂÚ· ›‰· ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ Î·È ÌÂٷ͇ ·È‰ÈÒÓ ·fi 8 ¯ÒÚ˜, η٤¯Ô˘Ó ÙË ‰Â‡ÙÂÚË ı¤ÛË Ì ٷ ˘„ËÏfiÙÂÚ· ›‰· LDL-¯ÔÏËÛÙÂÚfiÏ˘ (12). ™Ù· ·È‰È¿ ÂÌÊ·Ó›˙ÔÓÙ·È Î·È ¿ÏϘ, Ôχ Û¿ÓȘ, ÌÔÚʤ˜ ‰˘ÛÏÈȉ·ÈÌ›·˜, fiˆ˜ ÙÔ Û‡Ó‰ÚÔÌÔ ¯˘ÏÔÌÈÎÚÔÓ·ÈÌ›·˜, ÙÔ ÔÔ›Ô ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi Ôχ ÌÂÁ¿ÏË ·‡ÍËÛË ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ, ¿ıËÛË Ô˘ ‰ÂÓ ·˘Í¿ÓÂÈ ÙÔÓ Î·Ú‰È·ÁÁÂÈ·Îfi ΛӉ˘ÓÔ, ÌÔÚ› fï˜ Ó· ÚÔηϤÛÂÈ ÔÍ›· ‹ ¯ÚfiÓÈ· ·ÁÎÚ·ٛÙȉ· Î·È ·ÁÎÚ·ÙÈ΋ ·Ó¿ÚÎÂÈ·.
OÃ LDL-¯ ∏DL-¯ ∆° ∫∫
OÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË LDL-¯ÔÏËÛÙÂÚfiÏË ∏DL-¯ÔÏËÛÙÂÚfiÏË ∆ÚÈÁÏ˘ÎÂÚ›‰È· ∫·Ú‰È·ÁÁÂÈ·Îfi˜ ΛӉ˘ÓÔ˜
∂ÈÛ·ÁˆÁ‹ ∏ ·ÚÙËÚÈÔÛÎÏ‹Ú˘ÓÛË Â›Ó·È ÙÔ Û˘¯ÓfiÙÂÚÔ ·›ÙÈÔ ı·Ó¿ÙÔ˘ Î·È ÓÔÛËÚfiÙËÙ·˜ ÛÙÔ˘˜ ÂÓËÏ›ÎÔ˘˜, ÙfiÛÔ ÛÙËÓ ∂ÏÏ¿‰· fiÛÔ Î·È ÛÙÔÓ ˘fiÏÔÈÔ ‰˘ÙÈÎfi ÎfiÛÌÔ. OÈ ·ıËڈ̷ÙÈΤ˜ ‚Ï¿‚˜ ÛÙ· ÛÙÂÊ·ÓÈ·›·, Ù· ÂÁÎÂÊ·ÏÈο Î·È Ù· ÂÚÈÊÂÚÈο ·ÁÁ›· ·Ú¯›˙Ô˘Ó ‹‰Ë ·fi ÙËÓ ·È‰È΋ ËÏÈΛ· ‹ ·ÎfiÌË ·fi ÙËÓ ÂÓ‰ÔÌ‹ÙÚÈ· ˙ˆ‹ (1-3). ∂Ô̤ӈ˜, Ë Ï‹„Ë ÚÔÏËÙÈÎÒÓ ‹ ıÂڷ¢ÙÈÎÒÓ Ì¤ÙÚˆÓ Ú¤ÂÈ Ó· ·Ú¯›˙ÂÈ ÓˆÚ›˜ (4). ªÂ ÙÔÓ fiÚÔ ‰˘ÛÏÈȉ·È̛˜ ·Ó·Ê¤ÚÂÙ·È ÔÔÈ·‰‹ÔÙ ÂÎÙÚÔ‹ ÙˆÓ ÂȤ‰ˆÓ ÙˆÓ ÏÈȉ›ˆÓ ÙÔ˘ ·›Ì·ÙÔ˜ ¿Óˆ ·fi ÙËÓ 90‹ ‹ οو ·fi ÙË 10Ë ÂηÙÔÛÙÈ·›· ı¤ÛË ÙˆÓ ÂȤ‰ˆÓ ÙÔ˘ ÁÂÓÈÎÔ‡ ÏËı˘ÛÌÔ‡. Ÿˆ˜ ¤¯ÂÈ ·Ô‰Âȯı› Ì ÚÔÔÙÈΤ˜ ÌÂϤÙ˜ ÛÙÔ˘˜ ÂÓËÏ›ÎÔ˘˜, Ë ·˘ÍË̤ÓË ¯ÔÏËÛÙÂÚfiÏË Â›Ó·È ·ÓÂÍ¿ÚÙËÙÔ˜ ·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ÚfiˆÚ˘ ·ıËڈ̿وÛ˘, ÂÓÒ ·ÓÙ›ÛÙÔȯ·, Ë Ì›ˆÛ‹ Ù˘ ÂÏ·ÙÙÒÓÂÈ ÙÔÓ Î·Ú‰È·ÁÁÂÈ·Îfi ΛӉ˘ÓÔ (5-8). ™Ù· ·È‰È¿, Ë ÂÎÙ›ÌËÛË ÙÔ˘ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘ Á›ÓÂÙ·È Ì ‚¿ÛË ÙËÓ ·ÍÈÔÏfiÁËÛË ÙˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ Ô˘ ¤¯Ô˘Ó ·Ô‰Âȯı› ÛËÌ·ÓÙÈÎÔ› ÁÈ· ÙÔ˘˜ ÂÓËÏ›ÎÔ˘˜ (9). ∞ÓÂÍ¿ÚÙËÙÔÈ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ÂΉ‹ÏˆÛË Î·Ú‰È·ÁÁÂȷ΋˜ ÓfiÛÔ˘ ∏ ·ÚÔ˘Û›· ÁÂÓÂÙÈÎÒÓ ‹ ÂÚÈ‚·ÏÏÔÓÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ, fiˆ˜ Ë ËÏÈΛ· (>45 ÂÙÒÓ ÁÈ· ÙÔ˘˜ ¿Ó‰Ú˜ Î·È >55 ÂÙÒÓ ÁÈ· ÙȘ Á˘Ó·›Î˜), ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÚÒÈÌ˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘ (¤ÌÊÚ·ÁÌ· Ì˘Ôηډ›Ô˘, ·ÈÊÓ›‰ÈÔ˜ ı¿Ó·ÙÔ˜, ·ÁÁÂÈ·Îfi ÂÁÎÂÊ·ÏÈÎfi ÂÂÈÛfi‰ÈÔ ‹ ÂÚÈÊÂÚÈ΋ ·ÚÙËÚÈÔÛÎÏ‹Ú˘ÓÛË Û ÚÒÙÔ˘ ‚·ıÌÔ‡ Û˘ÁÁÂÓ‹, ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ 55 ÂÙÒÓ ÚÔÎÂÈ̤ÓÔ˘ ÁÈ· ¿Ó‰Ú˜ ‹ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ 65 ÂÙÒÓ ÚÔÎÂÈ̤ÓÔ˘ ÁÈ· Á˘Ó·›Î˜), Ô Û·Î¯·Ú҉˘ ‰È·‚‹Ù˘, Ë ˘¤ÚÙ·ÛË, ÙÔ Î¿ÓÈÛÌ·, Ë ·˘ÍË̤ÓË LDL-¯ÔÏËÛÙÂÚfiÏË Î·È Ë ¯·ÌËÏ‹ HDL-¯ÔÏËÛÙÂÚfiÏË, ıˆÚÔ‡ÓÙ·È ·ÓÂÍ¿ÚÙËÙÔÈ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË Î·Ú‰È·ÁÁÂȷ΋˜ ÓfiÛÔ˘, ηıÒ˜ Ë ·ÚÔ˘Û›· ÂÓfi˜ ¤ÛÙˆ ·fi ·˘ÙÔ‡˜ ·ÚΛ ÁÈ· Ó· ·˘ÍËı› ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο Ë Èı·ÓfiÙËÙ· ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘ (5).
152
µ·ÛÈο ÛÙÔȯ›· ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ OÈ ÏÈÔÚˆÙ½Ó˜ Â›Ó·È ÛˆÌ·Ù›‰È· Ô˘ ·ÔÙÂÏÔ‡ÓÙ·È ·fi ÏÈ›‰È· (ÂχıÂÚË Î·È ÂÛÙÂÚÔÔÈË̤ÓË ¯ÔÏËÛÙÂÚfiÏË, ʈÛÊÔÏÈ›‰È· Î·È ÙÚÈÁÏ˘ÎÂÚ›‰È·) Î·È ·fi ÚˆÙ½Ó˜ (·ÔÏÈÔÚˆÙ½Ó˜). O ÚfiÏÔ˜ ÙÔ˘˜ Â›Ó·È Ë ÌÂÙ·ÊÔÚ¿ ÛÙÔ Ï¿ÛÌ· ÙˆÓ ˘‰ÚfiÊÔ‚ˆÓ ÏÈȉ›ˆÓ, ‰ËÏ·‰‹ ÙˆÓ ÂÛÙ¤ÚˆÓ ¯ÔÏËÛÙÂÚfiÏ˘ Î·È ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ Ô˘ ·ÔÚÚÔÊÔ‡ÓÙ·È ·fi ÙÔ ¤ÓÙÂÚÔ ‹ ·Ú¿ÁÔÓÙ·È ÛÙÔ ‹·Ú. ∏ ÔÓÔÌ·Û›·
May-June 04 chris new
19-07-04
19:24
™ÂÏ›‰·153
¶·È‰È·ÙÚÈ΋ 2004;67:151-159
Paediatriki 2004;67:151-159
¶›Ó·Î·˜ 1. ∂Èı˘ÌËÙ¿ Î·È ·Ô‰ÂÎÙ¿ ›‰· ÏÈȉ›ˆÓ Î·È ÏÈÔÚˆÙÂ˚ÓÒÓ ÔÚÔ‡ ÛÙ· ·È‰È¿
∂Èı˘ÌËÙ¿ ∞Ô‰ÂÎÙ¿ ∞˘ÍË̤ӷ
OÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË (mg%)
LDL¯ÔÏËÛÙÂÚfiÏË (mg%)
HDL¯ÔÏËÛÙÂÚfiÏË (mg%)
∆ÚÈÁÏ˘ÎÂÚ›‰È· (mg%)
Lp(a) (mg%)
≤170 171-200 >200
≤110 111-130 >130
≥45 40-45 >60
≤80 81-100 >100
<30
¶›Ó·Î·˜ 2. ∂Èı˘ÌËÙ¿ ›‰· ·ÔÏÈÔÚˆÙÂ˚ÓÒÓ ÔÚÔ‡ ÛÙ· ·È‰È¿ ·Ô-∞π (mg%) ≥120
·Ô-µ (mg%) ≤90
ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ, ÂÎÙfi˜ ÙˆÓ ¯˘ÏÔÌÈÎÚÒÓ, ηıÔÚ›˙ÂÙ·È ·fi ÙËÓ ˘ÎÓfiÙËÙ¿ ÙÔ˘˜, ÙË Û¯ÂÙÈ΋ ‰ËÏ·‰‹ ÂÚÈÂÎÙÈÎfiÙËÙ· Û ÏÈ›‰È· Î·È ÚˆÙ½Ó˜. OÈ VLDL (very low density lipoproteins) Â›Ó·È ÔÈ ÏÈÔÚˆÙ½Ó˜ Ôχ ¯·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜, ÔÈ IDL (intermediate density lipoproteins) Â›Ó·È ÔÈ ÏÈÔÚˆÙ½Ó˜ ÂӉȿÌÂÛ˘ ˘ÎÓfiÙËÙ·˜, ÔÈ LDL (low density lipoproteins) Â›Ó·È ÔÈ ÏÈÔÚˆÙ½Ó˜ ¯·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜ Î·È ÔÈ HDL (high density lipoproteins) Â›Ó·È ÔÈ ÏÈÔÚˆÙ½Ó˜ ˘„ËÏ‹˜ ˘ÎÓfiÙËÙ·˜. ∏ Lp(a), ‰ËÏ·‰‹ Ë ÏÈÔÚˆÙ½ÓË (a), ¤¯ÂÈ ›‰ÈÔ Ì¤ÁÂıÔ˜ Î·È ˘ÎÓfiÙËÙ· Ì ÙȘ LDL, ·ÏÏ¿ ÂÚȤ¯ÂÈ ÂÈϤÔÓ ÙËÓ ·ÔÏÈÔÚˆÙ½ÓË (a). O ηıÔÚÈÛÌfi˜ Ù˘ ˘ÎÓfiÙËÙ·˜ ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ Á›ÓÂÙ·È Ì ˘ÂÚÊ˘ÁÔΤÓÙÚËÛË (¶›Ó·Î·˜ 3). ∆Ô ÂÚ›‚ÏËÌ· ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ ·ÔÙÂÏÂ›Ù·È ·fi ʈÛÊÔÏÈ›‰È· Î·È ÂχıÂÚË ¯ÔÏËÛÙÂÚfiÏË Î·È Â›Ó·È ˘‰ÚfiÊÈÏÔ. ∆· ÙÚÈÁÏ˘ÎÂÚ›‰È· Î·È ÔÈ ÂÛÙ¤Ú˜ ¯ÔÏËÛÙÂÚfiÏ˘ ‚Ú›ÛÎÔÓÙ·È ÛÙÔ ÂÛˆÙÂÚÈÎfi, ÛÙÔÓ ˘Ú‹Ó· ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ Î·È ÔÈ ·ÔÏÈÔÚˆÙ½Ó˜ ÛÙËÓ ÂÈÊ¿ÓÂÈ·. ∆· ¯˘ÏÔÌÈÎÚ¿ ÂÚȤ¯Ô˘Ó ΢ڛˆ˜ ÙÚÈÁÏ˘ÎÂÚ›‰È· Î·È ·Ú¿ÁÔÓÙ·È ÛÙÔ ¤ÓÙÂÚÔ ·fi Ù· ÏÈ›‰È· Ù˘ ÙÚÔÊ‹˜. OÈ VLDL ÂÚȤ¯Ô˘Ó ΢ڛˆ˜ ÙÚÈÁÏ˘ÎÂÚ›‰È· Î·È ·Ú¿ÁÔÓÙ·È ÛÙÔ ‹·Ú ·fi Ù· ÏÈ›‰È· Ô˘ ·Ú¿ÁÔÓÙ·È ÂÓ‰ÔË·ÙÈο ‹ ÌÂٷʤÚÔÓÙ·È ÂΛ ·fi ÙÔÓ ÏÈÒ‰Ë ÈÛÙfi ‹ ÙËÓ Î˘ÎÏÔÊÔÚ›·. ™ÙËÓ Î˘ÎÏÔÊÔÚ›·, Ì ÙË ‰Ú¿ÛË Ù˘ ÏÈÔÚˆÙÂ˚ÓÈ΋˜ ÏÈ¿Û˘, Ù· ÙÚÈÁÏ˘ÎÂÚ›‰È· ÙˆÓ ¯˘ÏÔÌÈÎÚÒÓ Î·È ÙˆÓ VLDL ·Ô‰›‰Ô˘Ó ÂχıÂÚ· ÏÈ·Ú¿ Ôͤ·, Ô˘ ÂÈÛ¤Ú¯ÔÓÙ·È ÛÙ· ·ÙÙ·Ú· Î·È ÔÍÂȉÒÓÔÓÙ·È ÁÈ· ÙËÓ ·Ú·ÁˆÁ‹ ATP. ∆· ۈ̷ٛ‰È· Ô˘ ·Ô̤ÓÔ˘Ó ÌÂÙ¿ ÙË ‰Ú¿ÛË Ù˘ ÏÈÔÚˆÙÂ˚ÓÈ΋˜ ÏÈ¿Û˘ ÛÙ· ¯˘ÏÔÌÈÎÚ¿ Î·È ÛÙȘ VLDL ϤÁÔÓÙ·È ˘ÔÏ›ÌÌ·Ù· ¯˘ÏÔÌÈÎÚÒÓ Î·È ˘ÔÏ›ÌÌ·Ù· VLDL ‹ IDL, ·ÓÙ›ÛÙÔȯ·. OÈ ÂÛÙ¤Ú˜ ¯ÔÏËÛÙÂÚfiÏ˘ ÂÈÛ¤Ú¯ÔÓÙ·È Ì¤Û· ÛÙ· ·ÙÙ·Ú·, fiÔ˘ ·Ô‰›‰Ô˘Ó ÂχıÂÚË ¯ÔÏËÛÙÂÚfiÏË. ∏ ¯ÔÏËÛÙÂÚfiÏË Â›Ó·È ·Ó·Áη›· ÁÈ· ÙË Û‡ÓıÂÛË ÙˆÓ Î˘ÙÙ·ÚÈÎÒÓ ÌÂÌ‚Ú·ÓÒÓ Û fiÏ· Ù· ·ÙÙ·Ú·, ÁÈ· ÙËÓ ·Ú·ÁˆÁ‹ ÙˆÓ ÛÙÂÚÔÂȉÒÓ ÔÚÌÔÓÒÓ
>30
ÛÙÔ˘˜ ÛÙÂÚÔÂȉԷڷÁˆÁÔ‡˜ ÈÛÙÔ‡˜ (ÂÈÓÂÊÚ›‰È·, ÁÔÓ¿‰Â˜, Ï·ÎÔ‡ÓÙ·˜), Ù˘ ‚ÈÙ·Ì›Ó˘ D ÛÙÔ ‰¤ÚÌ· Î·È ÙˆÓ ¯ÔÏÈÎÒÓ ·Ï¿ÙˆÓ ÛÙÔ ‹·Ú. OÈ IDL (‹ ˘ÔÏ›ÌÌ·Ù· VLDL) ηٿ 50% ÚÔÛÏ·Ì‚¿ÓÔÓÙ·È ·fi ÙÔ˘˜ ÈÛÙÔ‡˜ Î·È Î·Ù¿ 50% ÌÂÙ·ÙÚ¤ÔÓÙ·È ÂÓ‰·ÁÁÂȷο Û LDL, Ô˘ ÂÚȤ¯ÂÈ ·ÔÎÏÂÈÛÙÈο ۯ‰fiÓ ÂÛÙ¤Ú˜ ¯ÔÏËÛÙÂÚfiÏ˘. ∏ ›ÛÔ‰Ô˜ ÙˆÓ LDL ̤۷ ÛÙ· ·ÙÙ·Ú· Á›ÓÂÙ·È Ì¤Ûˆ ÙÔ˘ ÂȉÈÎÔ‡ ˘Ô‰Ô¯¤· Ù˘ LDL ÛÙËÓ ÂÈÊ¿ÓÂÈ· ÙˆÓ Î˘ÙÙ¿ÚˆÓ. O ηٷ‚ÔÏÈÛÌfi˜ ÙˆÓ ˘ÔÏÂÈÌÌ¿ÙˆÓ Á›ÓÂÙ·È Ì¤Ûˆ Ù˘ ÚfiÛÏË„‹˜ ÙÔ˘˜ ·fi ÂȉÈÎÔ‡˜ ΢ÙÙ·ÚÈÎÔ‡˜ ˘Ô‰Ô¯Â›˜, ÙÔ˘˜ ˘Ô‰Ô¯Â›˜ ÙˆÓ ˘ÔÏÂÈÌÌ¿ÙˆÓ. ∏ HDL ·Ú¿ÁÂÙ·È ÛÙÔ ‹·Ú Î·È ÙÔ ¤ÓÙÂÚÔ. ∂›Ó·È ·ÓÙÈ·ıËÚÔÁfiÓÔ˜, ÁÈ·Ù› ÂÈÙÂÏ› ÙË ÏÂÁfiÌÂÓË “·Ó¿ÛÙÚÔÊË ÌÂÙ·ÊÔÚ¿ ¯ÔÏËÛÙÂÚfiÏ˘”, ÙË ÌÂÙ·ÊÔÚ¿ ‰ËÏ·‰‹ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ ·fi ÙÔ˘˜ ÈÛÙÔ‡˜, fiˆ˜ ÙÔ ·ÁÁÂÈ·Îfi ÙÔ›¯ˆÌ·, ÚÔ˜ ÙÔ ‹·Ú, fiÔ˘ ÌÂÙ·‚ÔÏ›˙ÂÙ·È (13-16). OÈ ·ÔÏÈÔÚˆÙ½Ó˜ Â›Ó·È ·Ó·Áη›Â˜ ÁÈ· ÙË Û‡ÓıÂÛË Î·È ÙÔÓ ÌÂÙ·‚ÔÏÈÛÌfi ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ (17). OÈ Î˘ÚÈfiÙÂÚ˜ Â›Ó·È Ë ·Ô-µ, Ô˘ ‚Ú›ÛÎÂÙ·È ÛÙÔ ÛˆÌ·Ù›‰ÈÔ ÙˆÓ ¯˘ÏÔÌÈÎÚÒÓ Î·È ÙˆÓ ˘ÔÏÂÈÌÌ¿ÙˆÓ ÙÔ˘˜, ÙˆÓ VLDL, ÙˆÓ IDL Î·È ÙˆÓ LDL, Ë ·Ô-∞π ÛÙȘ HDL, Ë ·Ô-CII, Ë ·Ô-CIII Î·È Ë ·Ô-∂ ÛÙ· ¯˘ÏÔÌÈÎÚ¿, ÛÙȘ VLDL Î·È Ù· ˘ÔÏ›ÌÌ·Ù¿ ÙÔ˘˜. ∏ ·ÔÏÈÔÚˆÙ½ÓË (a) ‚Ú›ÛÎÂÙ·È ·ÔÎÏÂÈÛÙÈο ÛÙËÓ Lp(a). ∏ ·Ô-µ Â›Ó·È ÙÔ ÚfiÛ‰ÂÌ· ÁÈ· ÙË Û‡Ó‰ÂÛË ÙˆÓ LDL Ì ÙÔÓ ˘Ô‰Ô¯¤· ÙÔ˘˜ Î·È Ë ·Ô-∂ Â›Ó·È ÙÔ ÚfiÛ‰ÂÌ· ÁÈ· ÙË Û‡Ó‰ÂÛË ÙˆÓ ˘ÔÏÂÈÌÌ¿ÙˆÓ Ì ÙÔÓ ˘Ô‰Ô¯¤· ÙÔ˘˜. ∏ ·Ô-∞π Â›Ó·È ·Ó·Áη›· ÁÈ· ÙÔÓ Û¯ËÌ·ÙÈÛÌfi ÙˆÓ HDL. ∏ ·Ô-µ Ô˘ ÚÔÛ‰ÈÔÚ›˙ÂÙ·È ÛÙÔ ·›Ì· ÛÙË ÓËÛÙ›·, Â›Ó·È Î·Ù¿ 90% Ë ·Ô-µ ÙˆÓ LDL Î·È ·˘ÍË̤ӷ ›‰¿ Ù˘ ÛÙÔ ·›Ì· Û˘Ó‰˘¿˙ÔÓÙ·È Û˘Ó‹ıˆ˜ Ì ·˘ÍË̤ÓË LDL-¯ÔÏËÛÙÂÚfiÏË, ÂÓÒ ¯·ÌËÏ¿ ›‰· Ù˘ ·Ô-∞π Ì ¯·ÌËÏ‹ HDL-¯ÔÏËÛÙÂÚfiÏË. ∞ıËÚÔÁfiÓ˜ ȉÈfiÙËÙ˜ ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ ∞ıËÚÔÁfiÓ˜ Â›Ó·È ÔÈ ÌÈÎÚÔ‡ ÌÂÁ¤ıÔ˘˜ ÏÈÔÚˆÙ½Ó˜, fiˆ˜ ÔÈ LDL, Ù· ˘ÔÏ›ÌÌ·Ù· ¯˘ÏÔÌÈÎÚÒÓ, ÔÈ IDL Î·È Ë Lp(a), Ô˘ ÏfiÁˆ ÌÂÁ¤ıÔ˘˜ ÌÔÚÔ‡Ó Ó· ÂÈÛ¤ÏıÔ˘Ó Î·È Ó· ·Ú·Ì›ÓÔ˘Ó ÛÙÔ ·ÁÁÂÈ·Îfi ÙÔ›¯ˆÌ·. ∂ȉÈÎfiÙÂÚ·, ÔÈ LDL Î·È Ë Lp(a) ˘Ê›ÛÙ·ÓÙ·È ÔÍ›‰ˆÛË, ‰ËÏ·‰‹ ÙÚÔÔÔ›ËÛË ÙÔ˘ ÌÔÚ›Ô˘ ÙÔ˘˜, Ô˘ ·˘Í¿ÓÂÈ ÙȘ ·ıËÚÔÁfiÓ˜ ȉÈfiÙËÙ¤˜ ÙÔ˘˜. ∆· ¯˘ÏÔÌÈÎÚ¿ Î·È ÔÈ
153
May-June 04 chris new
19-07-04
19:24
™ÂÏ›‰·154
¶·È‰È·ÙÚÈ΋ 2004;67:151-159
Paediatriki 2004;67:151-159
¶›Ó·Î·˜ 3. ∆· ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ ¶˘ÎÓfiÙËÙ· (g/ml)
ª¤ÁÂıÔ˜ (nm)
∆fiÔ˜ ·Ú·ÁˆÁ‹˜
∫‡ÚÈÔ ÏÈ›‰ÈÔ ÙÔ˘ ˘Ú‹Ó·
Ã˘ÏÔÌÈÎÚ¿
<0,95
75-1200
ŒÓÙÂÚÔ
∆ÚÈÁÏ˘ÎÂÚ›‰È·
ÀÔÏ›ÌÌ·Ù· ¯˘ÏÔÌÈÎÚÒÓ VLDL
<1,006
40-70
∂Ó‰·ÁÁÂȷο
0,95-1,006
30-80
◊·Ú
IDL (˘ÔÏ›ÌÌ·Ù· VLDL) LDL
1,006-1,019
25-35
∂Ó‰·ÁÁÂȷο
1,019-1,063
18-25
∂Ó‰·ÁÁÂȷο
HDL
1,063-1,21
5-12
Lp(a)
1,055-1,085
20-25
◊·Ú, ¤ÓÙÂÚÔ, ÂÓ‰·ÁÁÂȷο ◊·Ú, ÂÓ‰·ÁÁÂȷο (;)
VLDL, ÏfiÁˆ ÙÔ˘ ÌÂÁ¿ÏÔ˘ Û¯ÂÙÈο ÌÂÁ¤ıÔ˘˜ ÙÔ˘˜, ‰ÂÓ ÌÔÚÔ‡Ó Ó· ÂÈÛ¤ÏıÔ˘Ó Â‡ÎÔÏ· ÛÙÔ ·ÁÁÂÈ·Îfi ÙÔ›¯ˆÌ· Î·È ‰ÂÓ Â›Ó·È ·ıËÚÔÁfiÓ˜. ªÂÙ·‚ÔϤ˜ ÙˆÓ ÏÈȉ›ˆÓ ÙÔ˘ ·›Ì·ÙÔ˜ Ì ÙËÓ ËÏÈΛ· ™ÙËÓ ÂÎÙ›ÌËÛË ÙÔ˘ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘ ÛÙ· ·È‰È¿ Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÂÙ·È ˘’ fi„ÈÓ fiÙÈ Ù· ›‰· Ù˘ ÔÏÈ΋˜ Î·È Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘ Î·È ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ ·˘Í¿ÓÔÓÙ·È Ì ÙËÓ ËÏÈΛ· Î·È ÛÙ· ‰‡Ô ʇϷ, ÂÓÒ Ù· ›‰· Ù˘ HDL-¯ÔÏËÛÙÂÚfiÏ˘ ÛÙ· ÎÔÚ›ÙÛÈ· ·Ú·Ì¤ÓÔ˘Ó ÁÂÓÈο ÛÙ·ıÂÚ¿ ‹ ·˘Í¿ÓÔÓÙ·È, ÂÓÒ ÛÙ· ·ÁfiÚÈ· ÌÂÈÒÓÔÓÙ·È Ì ÙËÓ ÂÊ˂›· (18-21). ÕÚ·, Â¿Ó Ù· ›‰· ÙˆÓ ÏÈȉ›ˆÓ Â›Ó·È ‰˘ÛÌÂÓ‹ ·fi ÙËÓ ·È‰È΋ ËÏÈΛ·, ·Ó·Ì¤ÓÂÙ·È Ó· ÂȉÂÈÓˆıÔ‡Ó ÛÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹. ¶ÚˆÙÔ·ı›˜ ‰˘ÛÏÈȉ·È̛˜ ÛÙ· ·È‰È¿ ∏ Û˘¯ÓfiÙÂÚË ÚˆÙÔ·ı‹˜ ‰˘ÛÏÈȉ·ÈÌ›· ÛÙ· ·È‰È¿ Â›Ó·È Ë ÔÈÎÔÁÂÓ‹˜ ÔÏ˘ÁÔÓȉȷ΋ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·, fiˆ˜ Î·È ÛÙÔ˘˜ ÂÓ‹ÏÈΘ (22). O ÂÈÔÏ·ÛÌfi˜ Ù˘, Û ͤÓ˜ ÛÙ·ÙÈÛÙÈΤ˜, ·Ó·Ê¤ÚÂÙ·È ·fi 1/100 ¤ˆ˜ 1/20. OÈ ˘Â‡ı˘Ó˜ ÁÔÓȉȷΤ˜ ‰È·Ù·Ú·¯¤˜ Â›Ó·È ¿ÁÓˆÛÙ˜, ·ÏÏ¿ Ë ÏÔ‡ÛÈ· ‰È·ÙÚÔÊ‹ Û ÏÈ·Ú¿ Î·È Ë ·¯˘Û·ÚΛ· ·˘Í¿ÓÔ˘Ó ÙËÓ Èı·ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ‹˜ Ù˘ (23). ∏ ÔÏÈ΋ Î·È Ë LDL-¯ÔÏËÛÙÂÚfiÏË Â›Ó·È ·˘ÍË̤Ó˜. ™ÙÔ˘˜ ÂÓ‹ÏÈΘ ˘¿Ú¯Ô˘Ó Û˘¯Ó¿ Í·ÓıÂÏ¿ÛÌ·Ù· ÙˆÓ ‚ÏÂÊ¿ÚˆÓ ‹ Î·È ÙfiÍÔ ÎÂÚ·ÙÔÂȉԇ˜ (·ÚfiÌÔÈÔ Ì ÙÔ ÁÂÚÔÓÙfiÙÔÍÔ), fi¯È fï˜ Î·È ÛÙ· ·È‰È¿. ∏ ÂÙÂÚfi˙˘ÁË ÔÈÎÔÁÂÓ‹˜ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· ÔÊ›ÏÂÙ·È Û ÌÂÙ·ÏÏ¿ÍÂȘ ÙÔ˘ ˘Ô‰Ô¯¤· Ù˘ LDL, Ô˘ ÂÌÔ‰›˙Ô˘Ó ÙËÓ Â›ÛÔ‰Ô Ù˘ LDL ÛÙ· ·ÙÙ·Ú· Î·È ÙÔÓ ÌÂÙ·‚ÔÏÈÛÌfi Ù˘ (24,25). ∞ÔÙ¤ÏÂÛÌ· Â›Ó·È Ë Ôχ ÌÂÁ¿ÏË ·‡ÍËÛË Ù˘ ÔÏÈ΋˜ Î·È Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘ ÛÙÔ ·›Ì·. O ÂÈÔÏ·ÛÌfi˜ Ù˘ ÓfiÛÔ˘ Û ‰È¿ÊÔÚ˜ ÂıÓfiÙËÙ˜ ·Ó·Ê¤ÚÂÙ·È ·fi 1/500 ¤ˆ˜ 1/270. ÷ڷÎÙËÚÈÛÙÈÎfi Ù˘ ÓfiÛÔ˘ ÛÙÔ˘˜ ÂÓ‹ÏÈΘ
154
§ÂÈÙÔ˘ÚÁ›·
¶·ÚÔ¯‹ ÏÈ·ÚÒÓ ÔͤˆÓ ÛÙÔ˘˜ ÈÛÙÔ‡˜ ∆ÚÈÁÏ˘ÎÂÚ›‰È· ¶·ÚÔ¯‹ ÏÈ·ÚÒÓ ÔͤˆÓ ÛÙÔ˘˜ ÈÛÙÔ‡˜ ∆ÚÈÁÏ˘ÎÂÚ›‰È· ¶·ÚÔ¯‹ ÏÈ·ÚÒÓ ÔͤˆÓ ÛÙÔ˘˜ ÈÛÙÔ‡˜ ∆ÚÈÁÏ˘ÎÂÚ›‰È·, ÂÛÙ¤Ú˜ ¶·ÚÔ¯‹ ÏÈ·ÚÒÓ ÔͤˆÓ ¯ÔÏËÛÙÂÚfiÏ˘ ÛÙÔ˘˜ ÈÛÙÔ‡˜ ∂ÛÙ¤Ú˜ ¶·ÚÔ¯‹ ¯ÔÏËÛÙÂÚfiÏ˘ ¯ÔÏËÛÙÂÚfiÏ˘ ÛÙÔ˘˜ ÈÛÙÔ‡˜ ∂ÛÙ¤Ú˜ ªÂÙ·ÊÔÚ¿ ¯ÔÏËÛÙÂÚfiÏ˘ ·fi ¯ÔÏËÛÙÂÚfiÏ˘ ÙÔ˘˜ ÈÛÙÔ‡˜ ÚÔ˜ ÙÔ ‹·Ú ∂ÛÙ¤Ú˜ ¶·ÚÔ¯‹ ¯ÔÏËÛÙÂÚfiÏ˘ ¯ÔÏËÛÙÂÚfiÏ˘ ÛÙÔ˘˜ ÈÛÙÔ‡˜ (;)
Â›Ó·È Ù· ÙÂÓfiÓÙÈ· Í·ÓıÒÌ·Ù· ÛÙË Ú·¯È·›· ÂÈÊ¿ÓÂÈ· Ù˘ ·Ï¿Ì˘, ÙÔ˘˜ ·ÁÎÒÓ˜, Ù· ÁfiÓ·Ù· ‹ ÛÙÔ˘˜ ·¯›ÏÏÂÈÔ˘˜ Ù¤ÓÔÓÙ˜. ™˘¯Ó¿ ˘¿Ú¯Ô˘Ó Î·È Â‰Ò Í·ÓıÂÏ¿ÛÌ·Ù· ‚ÏÂÊ¿ÚˆÓ ‹ Î·È ÙfiÍÔ ÎÂÚ·ÙÔÂȉԇ˜. ∏ ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ˜ ÂΉËÏÒÓÂÙ·È ÌÂÙ¿ ÙËÓ ËÏÈΛ· ÙˆÓ 40 ÂÙÒÓ. ™Ù· ·È‰È¿ ‰ÂÓ ÂÌÊ·Ó›˙ÔÓÙ·È ÙÂÓfiÓÙÈ· Í·ÓıÒÌ·Ù· ‹ Í·ÓıÂÏ¿ÛÌ·Ù·, ı· Ú¤ÂÈ, fï˜, Ó· ·Ó·˙ËÙÔ‡ÓÙ·È ÛÙÔ˘˜ ÁÔÓ›˜ ‹ ÙÔ˘˜ ·Ô‡‰Â˜. ∏ ÔÌfi˙˘ÁË ÌÔÚÊ‹ Â›Ó·È Ôχ Û¿ÓÈ· Î·È ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÌÂÁ¿Ï·, Ô˙Ò‰Ë Í·ÓıÒÌ·Ù· Î·È ÂΉ‹ÏˆÛË ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ ·fi ÙËÓ ·È‰È΋ ËÏÈΛ· (26). O ÂÈÔÏ·ÛÌfi˜ Ù˘ Â›Ó·È 1/1.000.000. ∏ ÔÈÎÔÁÂÓ‹˜ ˘Ô-·ÏÊ·-ÏÈÔÚˆÙÂ˚Ó·ÈÌ›· ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ¯·ÌËÏ‹ ÙÈÌ‹ Ù˘ HDL-¯ÔÏËÛÙÂÚfiÏ˘, ‰ËÏ·‰‹ 20-40 mg% (Ë HDL ÔÓÔÌ¿˙ÂÙ·È ·-ÏÈÔÚˆÙ½ÓË ÁÈ·Ù› ÛÙËÓ ËÏÂÎÙÚÔÊfiÚËÛË ÎÈÓÂ›Ù·È ÛÙË ı¤ÛË ÙˆÓ ·-ÛÊ·ÈÚÈÓÒÓ). ∏ ÔÏÈ΋ Î·È Ë LDL-¯ÔÏËÛÙÂÚfiÏË Â›Ó·È Ê˘ÛÈÔÏÔÁÈΤ˜, ·ÏÏ¿ ÌÔÚ› Ó· ˘¿Ú¯ÂÈ ÌÈÎÚ‹ ·‡ÍËÛË ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ. ∏ ÓfiÛÔ˜ Â›Ó·È ÔÏ˘ÁÔÓȉȷ΋˜ Î·È ¿ÁÓˆÛÙ˘ ·ÈÙÈÔÏÔÁ›·˜ (27,28). ∏ ÔÈÎÔÁÂÓ‹˜ Û˘Ó‰˘·Ṳ̂ÓË ˘ÂÚÏÈȉ·ÈÌ›· Â›Ó·È Û¯ÂÙÈο Û˘¯Ó‹ Î·È ·ÚÔ˘ÛÈ¿˙ÂÙ·È Ì ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· ‹/Î·È ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›·, Û˘¯Ó¿ Ì ¯·ÌËÏ‹ HDL-¯ÔÏËÛÙÂÚfiÏË. ∆˘Èο, οÔÈ· ̤ÏË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ¤¯Ô˘Ó ÌfiÓÔ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·, ¿ÏÏ· ÌfiÓÔ ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›· Î·È Î¿ÔÈ· ¿ÏÏ· Î·È ÙȘ ‰‡Ô ‰È·Ù·Ú·¯¤˜. ™˘¯Ó¿, Ë ·Ô-µ Â›Ó·È ·˘ÍË̤ÓË. ¶·È‰È¿ ÔÈÎÔÁÂÓÂÈÒÓ Ì ÙË ÓfiÛÔ ÌÔÚ› Ó· ¤¯Ô˘Ó ÂÏ·ÊÚ¿ ·‡ÍËÛË Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ ‹/Î·È ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ, ¯·ÌËÏ‹ HDL-¯ÔÏËÛÙÂÚfiÏË Î·È ·˘ÍË̤ÓË ·Ô-µ. OÈ ˘Â‡ı˘Ó˜ ÁÔÓȉȷΤ˜ ‚Ï¿‚˜ Â›Ó·È ¿ÁÓˆÛÙ˜, ·ÏÏ¿ Ë ÓfiÛÔ˜ Û˘Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ÈÓÛÔ˘ÏÈÓÔ·ÓÙ›ÛÙ·ÛË Î·È ÙÔ ÌÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ (Û‡Ó‰ÚÔÌÔ Ã) (29,30). ∏ ÔÈÎÔÁÂÓ‹˜ ‰È·Ù·Ú·¯‹ Ù˘ ·Ô-µ ÔÊ›ÏÂÙ·È Û ÌÂÙ·ÏÏ¿ÍÂȘ Ù˘ ·Ô-µ, Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·‰˘Ó·Ì›· Û‡Ó‰ÂÛ˘ Ù˘ LDL Ì ÙÔÓ ˘Ô‰Ô¯¤· Ù˘ Î·È ÙËÓ
May-June 04 chris new
19-07-04
19:24
™ÂÏ›‰·155
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Paediatriki 2004;67:151-159
·‡ÍËÛË Ù˘ ÔÏÈ΋˜ Î·È Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘ ÛÙÔ ·›Ì·. ∫ÏÈÓÈο, ÌÔÈ¿˙ÂÈ Ôχ Ì ÙËÓ ÔÈÎÔÁÂÓ‹ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·, ‰ÂÓ Ê·›ÓÂÙ·È fï˜ Ó· ·˘Í¿ÓÂÈ ÛÙÔÓ ›‰ÈÔ ‚·ıÌfi ÙÔÓ Î·Ú‰È·ÁÁÂÈ·Îfi ΛӉ˘ÓÔ. ™Â ͤÓ˜ ÌÂϤÙ˜, Ô ÂÈÔÏ·ÛÌfi˜ Ù˘ ·Ó·Ê¤ÚÂÙ·È ·fi 1/1300 ¤ˆ˜ 1/200 (31). ∏ ÔÈÎÔÁÂÓ‹˜ ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›· ·ÚÔ˘ÛÈ¿˙ÂÈ ·‡ÍËÛË ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ, Û˘¯Ó¿ Ì ¯·ÌËÏ‹ HDL-¯ÔÏËÛÙÂÚfiÏË. ŸÏ· Ù· ¿Û¯ÔÓÙ· ̤ÏË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ¤¯Ô˘Ó ·˘ÍË̤ӷ ÌfiÓÔ Ù· ÙÚÈÁÏ˘ÎÂÚ›‰È·. OÈ ˘Â‡ı˘Ó˜ ÁÔÓȉȷΤ˜ ‰È·Ù·Ú·¯¤˜ Â›Ó·È ¿ÁÓˆÛÙ˜, ÂÓÒ Ë ·‡ÍËÛË ÙÔ˘ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘ ÛÙÔ ÓfiÛËÌ· ·˘Ùfi ‰ÂÓ Â›Ó·È ÙÂÎÌËÚȈ̤ÓË (32). ∆· ‰‡Ô ÙÂÏÂ˘Ù·›· ÓÔÛ‹Ì·Ù·, Ì ÙËÓ Â›‰Ú·ÛË Î¿ÔÈÔ˘ ‰Â˘ÙÂÚÔÁÂÓÔ‡˜ ·Ú¿ÁÔÓÙ· Ô˘ ·˘Í¿ÓÂÈ Â›Û˘ Ù· ÙÚÈÁÏ˘ÎÂÚ›‰È·, fiˆ˜ .¯. Ë Ï‹„Ë ·ÏÎÔfiÏ ‹ Ê·Ú̿ΈÓ, ÌÔÚÔ‡Ó Ó· Ô‰ËÁ‹ÛÔ˘Ó Û ۇӉÚÔÌÔ ¯˘ÏÔÌÈÎÚÔÓ·ÈÌ›·˜. ™ÙÔ Û‡Ó‰ÚÔÌÔ ·˘Ùfi, Ù· ›‰· ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ ÙÔ˘ ·›Ì·ÙÔ˜ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚ· ·fi 1000 mg% Î·È ˘¿Ú¯ÂÈ Î›Ó‰˘ÓÔ˜ ÂÌÊ¿ÓÈÛ˘ ÔÍ›·˜ ·ÁÎÚ·ٛÙȉ·˜ ηÈ, Û ·ÓÂÈÏËÌ̤ӷ ÂÂÈÛfi‰È·, ÂӉ¯fiÌÂÓË ÂΉ‹ÏˆÛË ·ÁÎÚ·ÙÈ΋˜ ·Ó¿ÚÎÂÈ·˜. ∏ ÔÈÎÔÁÂÓ‹˜ ·‡ÍËÛË Ù˘ Lp(a) ÂÌÊ·Ó›˙ÂÈ ·˘ÍË̤ÓË ÙÈÌ‹ Ù˘ Lp(a), ¯ˆÚ›˜ ¿ÏÏË ‰È·Ù·Ú·¯‹ ÙˆÓ ÏÈȉ›ˆÓ. ∂Âȉ‹, fï˜, Ë ·˘ÍË̤ÓË Lp(a) ıˆÚÂ›Ù·È ·ÓÂÍ¿ÚÙËÙÔ˜ ·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘, Ô Î·Ú‰È·ÁÁÂÈ·Îfi˜ ΛӉ˘ÓÔ˜ ·˘Í¿ÓÂÙ·È (33,34). ∏ ÌÂÌÔӈ̤ÓË ·‡ÍËÛË Ù˘ Lp(a) Â›Ó·È Û¯ÂÙÈο Û¿ÓÈ·, ·ÏÏ¿ ·˘ÍË̤ÓË Lp(a) Û˘Ó˘¿Ú¯ÂÈ Û˘¯Ó¿ Ì ¿ÏÏË ‰˘ÛÏÈȉ·ÈÌ›·, fiˆ˜ ·˘ÍË̤ÓË LDL-¯ÔÏËÛÙÂÚfiÏË ‹ ¯·ÌËÏ‹ HDL-¯ÔÏËÛÙÂÚfiÏË. ∏ ÔÈÎÔÁÂÓ‹˜ ‰˘Û-‚ËÙ·-ÏÈÔÚˆÙÂ˚Ó·ÈÌ›· Â›Ó·È Ôχ Û¿ÓÈ·. OÊ›ÏÂÙ·È Û ÌÂÙ·ÏÏ¿ÍÂȘ Ù˘ ·ÔÏÈÔÚˆÙ½Ó˘ ∂, Ô˘ ÌÂÈÒÓÔ˘Ó ÙÔÓ ÌÂÙ·‚ÔÏÈÛÌfi ÙˆÓ ˘ÔÏÂÈÌÌ¿ÙˆÓ ¯˘ÏÔÌÈÎÚÒÓ Î·È ÙˆÓ IDL. ∏ ÔÏÈ-
΋ Î·È Ë LDL-¯ÔÏËÛÙÂÚfiÏË, ηıÒ˜ Î·È Ù· ÙÚÈÁÏ˘ÎÂÚ›‰È· Â›Ó·È Ôχ ·˘ÍË̤ӷ. ¶·ıÔÁÓˆÌÔÓÈÎfi ‡ÚËÌ· Â›Ó·È Ù· ·Ï·ÌÈ·›· Í·ÓıÒÌ·Ù·, Ë ÂÓ·fiıÂÛË, ‰ËÏ·‰‹, ÏÈȉ›ˆÓ ÛÙȘ ÁÚ·ÌÌÒÛÂȘ Ù˘ ·Ï¿Ì˘, ÂÓÒ ˘¿Ú¯Ô˘Ó Î·È Ô˙Ò‰Ë ÙÂÓfiÓÙÈ· Í·ÓıÒÌ·Ù· ÛÙÔ˘˜ ·ÁÎÒÓ˜ Î·È Ù· ÁfiÓ·Ù· (35-37) (¶›Ó·Î·˜ 4). ¶Ú¤ÂÈ Ó· ÙÔÓÈÛÙ› fiÙÈ Ì ‚¿ÛË ÌfiÓÔ ÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ·, Â›Ó·È ·‰‡Ó·ÙÔ, Û˘Ó‹ıˆ˜, Ó· ÙÂÎÌËÚȈı› Ì ‚‚·ÈfiÙËÙ· Ô Ù‡Ô˜ Ù˘ ‰˘ÛÏÈȉ·ÈÌ›·˜. ¢Â˘ÙÂÚÔ·ı›˜ ‰˘ÛÏÈȉ·È̛˜ ™Ù· ·È‰È¿, ÌÔÚ› Ó· ÂÌÊ·ÓÈÛÙÔ‡Ó Î·È ‰Â˘ÙÂÚÔ·ı›˜ ‰˘ÛÏÈȉ·È̛˜, fiˆ˜ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· Û ˘Ôı˘ÚÂÔÂȉÈÛÌfi Î·È ÓÂÊÚˆÛÈÎfi Û‡Ó‰ÚÔÌÔ ‹ ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›· Û ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË Î·È ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ·, ηıÒ˜ Î·È ‰È¿ÊÔÚ˜ ‰È·Ù·Ú·¯¤˜ ·fi Ê¿Ú̷η (38-42) (¶›Ó·Î·˜ 5). ¢˘ÛÏÈȉ·È̛˜ Ì ¯·ÌËÏ¿ ›‰· ¯ÔÏËÛÙÂÚfiÏ˘ ∏ ÔÈÎÔÁÂÓ‹˜ ˘Ô-‚ËÙ·-ÏÈÔÚˆÙÂ˚Ó·ÈÌ›· (43,44) ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ¯·ÌËÏ¿ ›‰· Ù˘ ÔÏÈ΋˜ (90135 mg%) Î·È Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘ (60-85 mg%) Î·È ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ (<40 mg%). OÊ›ÏÂÙ·È Û ÌÂÙ·ÏÏ¿ÍÂȘ ÙÔ˘ ÁÔÓȉ›Ô˘ Ù˘ ·o-µ, Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·Ú·ÁˆÁ‹ Û˘ÁÎÂÎÔÌÌ¤ÓˆÓ ÌÔÚ›ˆÓ Ù˘ ·o-µ100 Î·È Ù˘ ·Ô-µ48 (·o-µ4, ·o-µ9, ·o-µ25, Î.¿.) ‹ ÙËÓ Ï‹ÚË ¤ÏÏÂÈ„Ë ·Ú·ÁˆÁ‹˜ ·Ô-µ. ∏ ¤ÏÏÂÈ„Ë ·Ô-µ Ô‰ËÁ› Û ÌÂȈ̤ÓË ‹ Ï‹ÚË ·‰˘Ó·Ì›· ·Ú·ÁˆÁ‹˜ ÏÈÔÚˆÙÂ˚ÓÒÓ. ∫ÏËÚÔÓÔÌÂ›Ù·È Ì ˘ÔÏÂÈfiÌÂÓÔ ¯·Ú·ÎÙ‹Ú· Î·È ÔÈ ÂÙÂÚÔ˙˘ÁÒÙ˜ Â›Ó·È ·Û˘Ìو̷ÙÈÎÔ›. OÈ ÔÌÔ˙˘ÁÒÙ˜, fï˜, ·ÚÔ˘ÛÈ¿˙Ô˘Ó ‚·ÚÈ¿ ÎÏÈÓÈ΋ ÂÈÎfiÓ·, Ì ۇӉÚÔÌÔ ‰˘Û·ÔÚÚfiÊËÛ˘, Ó¢ÚÔÌ˘˚΋ ÂÎʇÏÈÛË Î.¿. ∏ ÔÈÎÔÁÂÓ‹˜ ·-‚ËÙ·-ÏÈÔÚˆÙÂ˚Ó·ÈÌ›· ÔÊ›ÏÂÙ·È Û ÌÂÙ·ÏÏ¿ÍÂȘ ÙÔ˘ ÂÓ˙‡ÌÔ˘ Ô˘ Û˘Ó‰¤ÂÈ Ù·
¶›Ó·Î·˜ 4. ¶ÚˆÙÔ·ı›˜ ‰˘ÛÏÈȉ·È̛˜. ∂›Â‰· ÏÈȉ›ˆÓ (mg%) Î·È Î·Ú‰È·ÁÁÂÈ·Îfi˜ ΛӉ˘ÓÔ˜ ¢˘ÛÏÈȉ·ÈÌ›· OÈÎÔÁÂÓ‹˜ ÔÏ˘ÁÔÓȉȷ΋ ˘ÂÚ¯ÔÏ/Ì›· ∂ÙÂÚfi˙˘ÁË ÔÈÎÔÁÂÓ‹˜ ˘ÂÚ¯ÔÏ/Ì›· OÈÎÔÁÂÓ‹˜ ˘Ô-·ÏÊ·ÏÈÔÚˆÙ/Ì›· OÈÎÔÁÂÓ‹˜ Û˘Ó‰˘·Ṳ̂ÓË ˘ÂÚÏÈÔÚ/Ì›·* OÈÎÔÁÂÓ‹˜ ‰È·Ù·Ú·¯‹ Ù˘ ·Ô-µ OÈÎÔÁÂÓ‹˜ ˘ÂÚÙÚÈÁÏ/Ì›· OÈÎÔÁÂÓ‹˜ ·‡ÍËÛË Ù˘ Lp(a)
OX
LDL-¯
∏DL-¯
T°
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·Ô-∞π
Lp(a)
∫K
250-350
190-260
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300-600
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ÎÊ
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↑↑
ÎÊ
ÎÊ
<40
ÎÊ (>100)
ÎÊ
<120
ÎÊ
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250-400
160-250
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200-400
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250-580
200-400
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ÎÊ
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ÎÊ
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<40 (ÎÊ)
250-500
ÎÊ
<120 (ÎÊ)
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;
ÎÊ
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ÎÊ
ÎÊ
ÎÊ
>30
↑
* ™ÙËÓ ÔÈÎÔÁÂÓ‹ Û˘Ó‰˘·Ṳ̂ÓË ˘ÂÚÏÈȉ·ÈÌ›· ÌÔÚ› Ó· Â›Ó·È ·ıÔÏÔÁÈΤ˜ ÔÈ ÙÈ̤˜ ÌfiÓÔ ÂÓfi˜ ‹ ‰‡Ô ÏÈȉ›ˆÓ
155
May-June 04 chris new
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¶·È‰È·ÙÚÈ΋ 2004;67:151-159
Paediatriki 2004;67:151-159
¶›Ó·Î·˜ 5. ∞›ÙÈ· ‰Â˘ÙÂÚÔ·ıÒÓ ‰˘ÛÏÈȉ·ÈÌÈÒÓ ¡ÔÛ‹Ì·Ù·
OX
LDL-¯
∏DL-¯
T°
™·Î¯·Ú҉˘ ‰È·‚‹Ù˘ ÀÔı˘ÚÂÔÂȉÈÛÌfi˜ ÀÂÚı˘ÚÂÔÂȉÈÛÌfi˜ º¿Ú̷η ¶ÚÂ˙ÔÏfiÓË º·ÈÓÔ‚·Ú‚ÈÙ¿ÏË ∫·Ú‚·Ì·˙›ÓË ∞Û·Ú·ÁÈÓ¿ÛË πÓÙÂÚÊÂÚfiÓË ∫˘ÎÏÔÛÔÚ›ÓË ƒÂÙÈÓÔÂȉ‹ OÈÛÙÚÔÁfiÓ· ∞Ó‰ÚÔÁfiÓ·
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ÙÚÈÁÏ˘ÎÂÚ›‰È· Ì ÙËÓ ·Ô-µ100 ÁÈ· ÙËÓ ·Ú·ÁˆÁ‹ ÙˆÓ VLDL ÛÙÔ ‹·Ú, ηıÒ˜ Î·È Ì ÙËÓ ·Ô-µ48 ÁÈ· ÙËÓ ·Ú·ÁˆÁ‹ ÙˆÓ ¯˘ÏÔÌÈÎÚÒÓ ÛÙÔ ¤ÓÙÂÚÔ, ·ÓÙ›ÛÙÔȯ·. ∫ÏËÚÔÓÔÌÂ›Ù·È Î·È ·˘Ù‹ Ì ˘ÔÏÂÈfiÌÂÓÔ ¯·Ú·ÎÙ‹Ú· Î·È ÔÈ ÔÌÔ˙˘ÁÒÙ˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ‚·ÚÈ¿ ÎÏÈÓÈ΋ ÂÈÎfiÓ·, ·ÚfiÌÔÈ· Ì Ù˘ ÔÈÎÔÁÂÓÔ‡˜ ˘Ô‚ËÙ·-ÏÈÔÚˆÙÂ˚Ó·ÈÌ›·˜ (36). OÈ ‰˘ÛÏÈȉ·È̛˜ ·˘Ù¤˜ ‰ÂÓ Û¯ÂÙ›˙ÔÓÙ·È Ì ·˘ÍË̤ÓÔ Î·Ú‰È·ÁÁÂÈ·Îfi ΛӉ˘ÓÔ. ¶fiÙ ڤÂÈ Ó· Á›ÓÂÙ·È ¤ÏÂÁ¯Ô˜ ÏÈȉ›ˆÓ ÛÙ· ·È‰È¿ ∆· ·È‰È¿ ËÏÈΛ·˜ ÌÂÁ·Ï‡ÙÂÚ˘ ÙˆÓ 2 ÂÙÒÓ Ú¤ÂÈ Ó· ˘Ô‚¿ÏÏÔÓÙ·È Û ¤ÏÂÁ¯Ô ÏÈȉ›ˆÓ fiÙ·Ó: ·) ¤¯Ô˘Ó ¤Ó·Ó ÁÔÓ¤· ‹ ·Ô‡-ÁÈ·ÁÈ¿ Ì ÈÛÙÔÚÈÎfi ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘, ·ÁÁÂÈ·ÎÔ‡ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘ ‹ ÂÚÈÊÂÚÈ΋˜ ·ÚÙËÚÈÔÛÎÏ‹Ú˘ÓÛ˘ Û ËÏÈΛ· ÌÈÎÚfiÙÂÚË ÙˆÓ 55 ÂÙÒÓ Î·È ‚) ¤¯Ô˘Ó ¤Ó·Ó ÁÔÓ¤· Ì ›‰· ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ ˘„ËÏfiÙÂÚ· ·fi 240 mg% (4). ∆o 1/3 ÙˆÓ ·È‰ÈÒÓ Ô˘ ÂϤÁ¯ÔÓÙ·È ÁÈ· ÙÔ˘˜ ·Ú·¿Óˆ ÏfiÁÔ˘˜, ·ÚÔ˘ÛÈ¿˙ÂÈ Î¿ÔÈ·˜ ÌÔÚÊ‹˜ ‰˘ÛÏÈȉ·ÈÌ›· (4). ™Â ÚfiÛÊ·ÙË, fï˜, ÂÏÏËÓÈ΋ ÌÂϤÙË, Ë ÔÔ›· ÂÚÈÂÏ¿Ì‚·Ó 1118 ·È‰È¿ ËÏÈΛ·˜ 315 ÂÙÒÓ, ‰È·ÈÛÙÒıËΠfiÙÈ Ë ¯ÚËÛÈÌÔÔ›ËÛË ÙˆÓ ·Ú·¿Óˆ ÎÚÈÙËÚ›ˆÓ ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô ÙÔ˘ ·È‰ÈÎÔ‡ ÏËı˘ÛÌÔ‡, ·Ê‹ÓÂÈ ÙÔ 25% ÂÚ›Ô˘ ÙˆÓ ·È‰ÈÒÓ Ì ‰˘ÛÏÈȉ·ÈÌ›· ¯ˆÚ›˜ ‰È¿ÁÓˆÛË, ‡ÚËÌ· Ô˘ ηٿ ÙË ÁÓÒÌË ÙˆÓ Û˘ÁÁڷʤˆÓ Û˘ÓËÁÔÚ› ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô ÙˆÓ ÏÈȉ›ˆÓ Û fiÏ· Ù· ·È‰È¿ ËÏÈΛ·˜ ÌÂÁ·Ï‡ÙÂÚ˘ ÙˆÓ 3 ÂÙÒÓ (45). ø˜ ·Ú¯ÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÚÔÙ›ÓÂÙ·È Ë Ì¤ÙÚËÛË Ù˘ ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ Î·È Â¿Ó ·˘Ù‹ ‚ÚÂı› >170 mg%, ·ӷϷ̂¿ÓÂÙ·È Ë Ì¤ÙÚËÛ‹ Ù˘ ÌÂÙ¿ 3 ‚‰ÔÌ¿‰Â˜ ÙÔ˘Ï¿¯ÈÛÙÔÓ. ∂¿Ó Ô Ì¤ÛÔ˜ fiÚÔ˜ ÙˆÓ ‰‡Ô ÌÂÙÚ‹ÛÂˆÓ Â›Ó·È >170 mg%, ÙfiÙ Á›ÓÂÙ·È Ì¤ÙÚËÛË Î·È ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ Î·È Ù˘ HDL-¯ÔÏËÛÙÂÚfiÏ˘ Î·È ˘ÔÏÔÁÈÛÌfi˜ Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘ (46). OÈ Û˘ÁÁÚ·Ê›˜ ÈÛÙÂ‡Ô˘Ó fiÙÈ ·˘Ù‹ Ë Ù·ÎÙÈ΋
156
Ú¤ÂÈ Ó· ·ÎÔÏÔ˘ıÂ›Ù·È ÁÈ· ÙÔÓ Ì·˙ÈÎfi ¤ÏÂÁ¯Ô ÙÔ˘ ÏËı˘ÛÌÔ‡ ‹ Û ·È‰È¿ ¯ˆÚ›˜ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ‰˘ÛÏÈȉ·ÈÌ›·˜ ‹ ÚfiˆÚ˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘ ¯ˆÚ›˜ ¿ÏÏÔ˘˜ ÂÈ‚·Ú˘ÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜, fiˆ˜ ·¯˘Û·ÚΛ·, ۷ί·Ú҉˘ ‰È·‚‹Ù˘ Î·È ˘¤ÚÙ·ÛË. ∂ÈϤÔÓ, Ù· ·È‰È¿ ¤¯Ô˘Ó Û˘¯Ó¿ ·˘ÍË̤ÓË ÙËÓ HDL-¯ÔÏËÛÙÂÚfiÏË (>60 mg%), Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·‡ÍËÛË Ù˘ ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘. ™Ù· ·È‰È¿ ·˘Ù¿ ‰ÂÓ ¯ÚÂÈ¿˙ÂÙ·È Î·Ì›· ·Ú¤Ì‚·ÛË (21). ∞ıËÚÔÁfiÓÔ˜ Â›Ó·È Ë LDL-¯ÔÏËÛÙÂÚfiÏË Î·È ÙÔ ÂӉ¯fiÌÂÓÔ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·˜ ˘Ê›ÛÙ·Ù·È ÌfiÓÔ fiÙ·Ó Â›Ó·È ·˘ÍË̤ÓË Ë LDL-¯ÔÏËÛÙÂÚfiÏË. ∏ ̤ÙÚËÛË ÙˆÓ ÏÈȉ›ˆÓ Î·È ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÌÂÙ¿ 12ˆÚË ÓËÛÙ›·. ¶ÚÔÛ‰ÈÔÚ›˙ÔÓÙ·È Ë ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË, Ù· ÙÚÈÁÏ˘ÎÂÚ›‰È· Î·È Ë HDL-¯ÔÏËÛÙÂÚfiÏË, ÂÓÒ Ë LDL-¯ÔÏËÛÙÂÚfiÏË ˘ÔÏÔÁ›˙ÂÙ·È ·fi ÙÔÓ Ù‡Ô: ∆° LDL-¯ = Oà - HDL-¯, 5 Ì ÙËÓ ÚÔ¸fiıÂÛË fiÙÈ Ù· ÙÚÈÁÏ˘ÎÂÚ›‰È· Â›Ó·È <400 mg%. ∂¿Ó ‰È·ÈÛÙˆı› ‰˘ÛÏÈȉ·ÈÌ›·, ÌÂÙÚÒÓÙ·È Î·È ÔÈ ·Ô-µ, ·Ô-∞π Î·È Lp(a). ∞˘ÍË̤ÓË ·Ô-µ ‹ Lp(a) ‹ ÌÂȈ̤ÓË ·Ô-∞π ˘Ô‰ËÏÒÓÔ˘Ó ·˘ÍË̤ÓÔ ÌÂÏÏÔÓÙÈÎfi ηډȷÁÁÂÈ·Îfi ΛӉ˘ÓÔ (47-49). °È· ÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË, ı· Ú¤ÂÈ Ó· Á›ÓÔ˘Ó ÌÂÙÚ‹ÛÂȘ ÏÈȉ›ˆÓ Î·È ÛÙÔ˘˜ ÁÔÓ›˜. §·Ì‚¿ÓÂÙ·È ÏÂÙÔÌÂÚ¤˜ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÁÈ· Ù˘¯fiÓ ‡·ÚÍË ‰˘ÛÏÈȉ·ÈÌ›·˜, ÚÒÈÌ˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘ (ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ˜, ·ÈÊÓ›‰ÈÔ˜ ı¿Ó·ÙÔ˜, ÂÁÎÂÊ·ÏÈο ÂÂÈÛfi‰È·, ÂÚÈÊÂÚÈ΋ ·ÁÁÂÈÔ¿ıÂÈ·) Î·È ÁÈ· ÌÂÙ·‚ÔÏÈο ÓÔÛ‹Ì·Ù· (۷ί·Ú҉˘ ‰È·‚‹Ù˘, ˘¤ÚÙ·ÛË, Û‡Ó‰ÚÔÌÔ Ã), ÛÂ Û˘ÁÁÂÓ›˜ ÚÒÙÔ˘ Î·È ‰Â‡ÙÂÚÔ˘ ‚·ıÌÔ‡. °È· ÙÔÓ ·ÔÎÏÂÈÛÌfi ‰Â˘ÙÂÚÔ·ıÔ‡˜ ‰˘ÛÏÈȉ·ÈÌ›·˜, Ú¤ÂÈ Ó· Á›ÓÂÙ·È ¤ÏÂÁ¯Ô˜ Ù˘ Ë·ÙÈ΋˜, ÓÂÊÚÈ΋˜ Î·È ı˘ÚÂÔÂȉÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜. ∞ÓÙÈÌÂÙÒÈÛË ™ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ·È‰ÈÔ‡ Ì ‰˘ÛÏÈȉ·ÈÌ›· ‰ÂÓ ¤¯ÂÈ È‰È·›ÙÂÚË Ú·ÎÙÈ΋ ·Í›· Ë ·ÎÚÈ‚‹˜ ‰È¿ÁÓˆÛË ÙÔ˘ ›‰Ô˘˜ Ù˘ ÁÂÓÂÙÈ΋˜ ‰È·Ù·Ú·¯‹˜, ·ÏÏ¿: ·) Ô ÂÓÙÔÈÛÌfi˜ Ù˘¯fiÓ ‰Â˘ÙÂÚÔ·ıÔ‡˜ ‰˘ÛÏÈȉ·ÈÌ›·˜ Î·È Ë ıÂڷ›· ÙÔ˘ ÚˆÙÔ·ıÔ‡˜ ·ÈÙ›Ô˘ Î·È ‚) Ë Ì›ˆÛË ÙˆÓ ·˘ÍËÌ¤ÓˆÓ ÂȤ‰ˆÓ Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘ ‹ ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ ‹/Î·È Ë ·‡Í‹ÛË ÙˆÓ ¯·ÌËÏÒÓ ÂȤ‰ˆÓ Ù˘ HDL-¯ÔÏËÛÙÂÚfiÏ˘, ¤ÛÙˆ Î·È ·Ó ‰ÂÓ Â›Ó·È ÁÓˆÛÙ‹ Ë ·ÎÚÈ‚‹˜ ·ÈÙ›· ÙÔ˘˜. ¢›·ÈÙ· ™Â ÂÚ›ÙˆÛË ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·˜, ÂÊ·ÚÌfi˙ÔÓÙ·È ‰›·ÈÙ˜ Ì Ì›ˆÛË ÙˆÓ ÎÔÚÂÛÌ¤ÓˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ Ô˘ ·˘Í¿ÓÔ˘Ó ÙËÓ ÔÏÈ΋ Î·È ÙËÓ LDL-¯ÔÏËÛÙÂÚfiÏË Î·È ·‡ÍËÛË ÙˆÓ ÌÔÓÔ·ÎfiÚÂÛÙˆÓ Î˘Ú›ˆ˜
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¶·È‰È·ÙÚÈ΋ 2004;67:151-159
Î·È ÔÏ˘·ÎfiÚÂÛÙˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ Ô˘ ÙȘ ÌÂÈÒÓÔ˘Ó. OÈ ‰›·ÈÙ˜ ·˘Ù¤˜ ¤¯Ô˘Ó ·Ô‰Âȯı› Ì·ÎÚÔ¯ÚfiÓÈ· ·ÛÊ·Ï›˜ ÛÙ· ·È‰È¿, ·Ú¤¯Ô˘Ó fiÏ· Ù· ·Ó·Áη›· Û˘ÛÙ·ÙÈο Î·È ÌÂÈÒÓÔ˘Ó ÙËÓ LDL-¯ÔÏËÛÙÂÚfiÏË Î·Ù¿ 10-15% (55,51). ∆· ‰È·ÈÙÔÏfiÁÈ· ·˘Ù¿ ÂÚȤ¯Ô˘Ó ηٿ 30% ϛԘ, 50-55% ˘‰·Ù¿ÓıڷΘ Î·È 15-20% ÚˆÙ½Ó˜. ∏ ËÌÂÚ‹ÛÈ· ÚfiÛÏË„Ë ¯ÔÏËÛÙÂÚfiÏ˘ Â›Ó·È ÏÈÁfiÙÂÚË ·fi 300 mg, ÌÂÈÒÓÂÙ·È Ë ÔÛfiÙËÙ· ÙˆÓ ÎÔÚÂÛÌ¤ÓˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ (Á¿Ï·, Ù˘Ú›, ‚Ô‰ÈÓfi) Î·È ·ÓÙÈηı›ÛÙ·Ù·È ·fi ÌÔÓÔ·ÎfiÚÂÛÙ· (ÂÏ·ÈfiÏ·‰Ô) Î·È ÔÏ˘·ÎfiÚÂÛÙ· ÏÈ·Ú¿ (Ï·¯·ÓÈο, „¿ÚÈ·). ™Â ÂÚÈÙÒÛÂȘ ·ÓıÂÎÙÈ΋˜ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·˜, Û˘ÓÈÛÙ¿Ù·È ‰›·ÈÙ· Ì ÂÚÈÔÚÈÛÌfi ÙÔ˘ Ï›Ô˘˜ ÛÙÔ 20% ÙˆÓ Û˘ÓÔÏÈÎÒÓ ıÂÚÌ›‰ˆÓ Î·È ËÌÂÚ‹ÛÈ· ÚfiÛÏË„Ë ¯ÔÏËÛÙÂÚfiÏ˘ ÌÈÎÚfiÙÂÚË ·fi 200 mg. ∫·Ïfi Â›Ó·È Ù· ‰È·ÈÙÔÏfiÁÈ· ·˘Ù¿ Ó· ¯ÔÚËÁÔ‡ÓÙ·È ·fi ÂÍÂȉÈÎÂ˘Ì¤ÓÔ˘˜ ‰È·ÈÙÔÏfiÁÔ˘˜, ÒÛÙ ӷ ÂÍ·ÛÊ·Ï›˙ÂÙ·È ÙfiÛÔ Ë Î¿Ï˘„Ë ÙˆÓ ‰È·ÙÚÔÊÈÎÒÓ ·Ó·ÁÎÒÓ ÙˆÓ ·È‰ÈÒÓ fiÛÔ Î·È Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ‰›·ÈÙ·˜. ÕÛÎËÛË ∏ ¿ÛÎËÛË Ú¤ÂÈ Ó· Á›ÓÂÙ·È Û˘ÛÙËÌ·ÙÈο, ÙÔ˘Ï¿¯ÈÛÙÔÓ 3 ÒÚ˜ ÙËÓ Â‚‰ÔÌ¿‰·. ∆Ô ÛËÌ·ÓÙÈÎfiÙÂÚÔ Â›Ó·È Ó· ηıÈÂÚˆı› Î·È Ó· ·Ú·Ì›ÓÂÈ ÌfiÓÈÌË Ë Û˘Ó‹ıÂÈ· Ù˘ Ê˘ÛÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜, Ë ÔÔ›· ¤¯ÂÈ ÌfiÓÔ Â˘ÂÚÁÂÙÈΤ˜ ÂȉڿÛÂȘ. ∏ ¿ÛÎËÛË ÌÂÈÒÓÂÈ ÙÔ ÛˆÌ·ÙÈÎfi ‚¿ÚÔ˜, ÙËÓ ÔÏÈ΋ Î·È ÙËÓ LDL-¯ÔÏËÛÙÂÚfiÏË Î·È Ù· ÙÚÈÁÏ˘ÎÂÚ›‰È·, ÂÓÒ ·˘Í¿ÓÂÈ ÙËÓ ∏DL¯ÔÏËÛÙÂÚfiÏË (52) Î·È ÙËÓ „˘¯È΋ ¢ÂÍ›·. º·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ ™Â ·È‰È¿ ËÏÈΛ·˜ ÌÂÁ·Ï‡ÙÂÚ˘ ÙˆÓ 10 ÂÙÒÓ Ì ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·, ¯ÔÚËÁÂ›Ù·È ¯ÔÏÂÛÙ˘Ú·Ì›ÓË (Questran, Ê¿ÎÂÏÔÈ ÙˆÓ 4 g), Â¿Ó ÌÂÙ¿ 6-12 Ì‹Ó˜ ‰È·ÈÙËÙÈ΋˜ ÚÔÛ¿ıÂÈ·˜ Ë LDL-¯ÔÏËÛÙÂÚfiÏË Â›Ó·È >190 mg% ‹ fiÙ·Ó Â›Ó·È >160 mg% ·ÏÏ¿ Û˘Ó˘¿Ú¯Ô˘Ó ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÚÒÈÌ˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘ ‹ ¿ÏÏÔÈ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘, fiˆ˜ ‰È·‚‹Ù˘ ‹ ˘¤ÚÙ·ÛË. O ÛÙfi¯Ô˜ Â›Ó·È Ó· ÌÂȈıÔ‡Ó Ù· ›‰· Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘ Û <110 mg% ‹ ÙÔ˘Ï¿¯ÈÛÙÔÓ <130 mg%. ∏ ‰fiÛË Ù˘ ¯ÔÏÂÛÙ˘Ú·Ì›Ó˘ Â›Ó·È ¤ˆ˜ 20 g/Ë̤ڷ, ‰È·ÈÚÂ̤ÓË Û 2-3 ‰fiÛÂȘ, ÌÂÙ¿ ÙÔ Ê·ÁËÙfi. ÃÔÚËÁÂ›Ù·È ÛÙ·‰È·Î¿, ÍÂÎÈÓÒÓÙ·˜ ·fi 4-8 g/Ë̤ڷ (53-55). ∏ ¯ÔÚ‹ÁËÛË ¿ÏÏˆÓ ˘Ô¯ÔÏËÛÙÂÚÔÏ·ÈÌÈÎÒÓ Ê·ÚÌ¿ÎˆÓ ÛÙ· ·È‰È¿ ‰ÂÓ ¤¯ÂÈ ·ÎfiÌË Î·ıÈÂÚˆı›. ∏ ‚Ú·¯˘¯ÚfiÓÈ· ¯ÔÚ‹ÁËÛË ·Ó·ÛÙÔϤˆÓ Ù˘ ˘‰ÚÔ͢-ÌÂı˘ÏÔ-ÁÏÔ˘Ù·Ú˘Ï-CoA ·Ó·ÁˆÁ¿Û˘ (‹ ÛÙ·Ù›Ó˜) Û ·È‰È¿ Ì ÂÙÂÚfi˙˘ÁË ÔÈÎÔÁÂÓ‹ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·, fiˆ˜ Ë ÏÔ‚·ÛÙ·Ù›ÓË ‹ Ë Ú·‚·ÛÙ·Ù›ÓË (Û ‰fiÛÂȘ 5-40 mg/Ë̤ڷ) ¤ÊÂÚ ÛËÌ·ÓÙÈ΋ Ì›ˆÛË Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘ ¯ˆÚ›˜ ÛÔ‚·Ú¤˜,
Paediatriki 2004;67:151-159
¿ÌÂÛ˜, ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ (56,57). ∆· ·È‰È¿ Ì ̤ÙÚÈ· ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›· Û˘Ó‹ıˆ˜ ··ÓÙÔ‡Ó Î·Ï¿ ÛÙË ‰È·ÈÙËÙÈ΋ ·ÁˆÁ‹ Î·È ‰ÂÓ ¯ÚÂÈ¿˙ÔÓÙ·È Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹. ∏ HDL-¯ÔÏËÛÙÂÚfiÏË ÌÔÚ› Ó· ·˘ÍËı› Ì ÙËÓ ÂÊ·ÚÌÔÁ‹ ‰›·ÈÙ·˜, Ô˘ ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ·ÓÙÈηٿÛÙ·ÛË ÙˆÓ ÎÔÚÂÛÌ¤ÓˆÓ ÏÈ·ÚÒÓ Î˘Ú›ˆ˜ Ì ÔÏ˘·ÎfiÚÂÛÙ· fiˆ˜ Â›Ó·È ÙÔ ÂÏ·ÈfiÏ·‰Ô Î·È ÙËÓ ¿ÛÎËÛË. ∏ ¿ÛÎËÛË ¤¯ÂÈ ‰È·ÈÛÙˆı› fiÙÈ ·˘Í¿ÓÂÈ Û ÛËÌ·ÓÙÈÎfi ‚·ıÌfi ÙËÓ HDL-¯ÔÏËÛÙÂÚfiÏË. °È· Ù· ·È‰È¿ Ì ·˘ÍË̤ÓË Lp(a) ‰ÂÓ ˘¿Ú¯ÂÈ ÂȉÈ΋ ·ÁˆÁ‹, Ú¤ÂÈ, fï˜, Ó· ‰ÈÔÚıÒÓÔÓÙ·È Ù˘¯fiÓ Û˘Ó˘¿Ú¯Ô˘Û˜ ‰˘ÛÏÈȉ·È̛˜. µÈ‚ÏÈÔÁÚ·Ê›· 1. PDAY Research Group. Relationship of atherosclerosis in young men to serum lipoprotein cholesterol concentrations and smoking. A preliminary report from the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) Research Group. JAMA 1990;264:3018-3024. 2. McGill HC Jr, McMahan CA and the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) Research Group. Determinants of atherosclerosis in the young. Am J Cardiol 1998;82:30T-36T. 3. Napoli C, Glass CK, Witztum JL, Deutsch R, D’-Armiento FP, Palinski W. Influence of maternal hypercholesterolaemia during pregnancy on progression of early atherosclerotic lesions in childhood. Fate of Early Lesions in Children (FELIC) study. Lancet 1999;354:1234-1241. 4. American Academy of Pediatrics. National Cholesterol Education Program. Report of the Expert Panel on Blood Cholesterol Levels in Children and Adolescents. Pediatrics 1992;89 (Suppl):S525-S584. 5. National Cholesterol Education Program. Second Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II). Circulation 1994;89:1329-1440. 6. Castelli WP. Cholesterol and lipids in the risk of coronary artery disease. The Framingham Heart Study. Can J Cardiol 1988;4 (Suppl A):5A-10A. 7. Lipid Research Clinics Program. The Lipid Research Clinics Coronary Primary Prevention Trial Results. II. The relationship of reduction in incidence of coronary heart disease to cholesterol lowering. JAMA 1984;251:365-374. 8. Kwiterovich PO Jr. State-of-the-art update and review: clinical trials of lipid-lowering agents. Am J Cardiol 1998;82 (12A):3U-17U. 9. Gidding SS. The rationale for lowering serum cholesterol levels in American children. Am J Dis Child 1993;147:386-392. 10. ∫·Ê¿ÙÔ˜ ∞°, Christakis G, Hsia SL, Cassady J, ¶·Ó·ÁȈٷÎfiÔ˘ÏÔ˜ °. §È›‰È· ÔÚÔ‡ Û 1010 ·È‰È¿ Ù˘ ∞ı‹Ó·˜ ËÏÈΛ·˜ 10-14 ¯ÚfiÓˆÓ. π·ÙÚÈ΋ 1980;38:283-290. 11. ∫·‚·˙·Ú¿Î˘ ∂, ∆ÛfiÏ·˜ °, ™ÎÔ‡ÚÔ˘-÷Ù˙Ë·ÚÁ˘ÚÔ‡ ¢, ºÔ˘ÛÙÔ‡ÎÔ˘ ª, ¢‹ÌÔ˘ ™, ¢ÂÏËÁÈ¿ÓÓË µ. ∫·Ù·ÓÔÌ‹ ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘, ÏÈÔÚˆÙÂ˚ÓÒÓ Î·È ·ÔÏÈÔÚˆÙÂ˚ÓÒÓ Û ‚Ú¤ÊË Î·È ·È‰È¿. ¶·È‰È·ÙÚÈ΋ 1998;61:148-160. 12. Brotons C, Ribera A, Perich RM, Abrodos D, Magana P,
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∂ȉڿÛÂȘ Ê·Ú̿ΈÓ, ·ÏÎÔfiÏ˘ Î·È Î·Ó›ÛÌ·ÙÔ˜ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÁ΢ÌÔÛ‡Ó˘ ÛÙÔ ¤Ì‚Ú˘Ô Î·È ÙÔ ÓÂÔÁÓfi °. ª·ÚÔ‡Ù˘, ª. ¢·ÛÔÔ‡ÏÔ˘
Prenatal drug effects on the foetus and the newborn infant G. Baroutis, M. Dasopoulou
¶ÂÚ›ÏË„Ë: OÚÈṲ̂ӷ ·fi Ù· Ê¿Ú̷η Ô˘ Û˘ÓÙ·ÁÔÁÚ·ÊÔ‡ÓÙ·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÁ΢ÌÔÛ‡Ó˘, ‰ËÌÈÔ˘ÚÁÔ‡Ó ÂÚˆÙËÌ·ÙÈο Û¯ÂÙÈο Ì ÙÔ˘˜ Èı·ÓÔ‡˜ ÎÈÓ‰‡ÓÔ˘˜ ·fi ÙË ¯ÔÚ‹ÁËÛ‹ ÙÔ˘˜ ÛÙÔ ¤Ì‚Ú˘Ô Î·È ÙÔ ÓÂÔÁÓfi. ¶ÂÚÈÁÚ¿ÊÔÓÙ·È ÔÈ ‰˘ÓËÙÈÎÔ› ΛӉ˘ÓÔÈ ·fi ÙË ¯ÔÚ‹ÁËÛË ÙˆÓ ÈÔ Û˘¯Ó¿ ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓˆÓ Ê·Ú̿ΈÓ, Ù· ÎÏÈÓÈο ·ÔÙÂϤÛÌ·Ù·, ÔÈ ‰È·ÁÓˆÛÙÈΤ˜ ÛΤ„ÂȘ, Ë ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ÂÌ‚Ú‡Ô˘ ‹ ÙÔ˘ ‚Ú¤ÊÔ˘˜ Ô˘ ÂÎÙ¤ıËΠ۠·˘Ù¿ Î·È Ë ÂΉ‹ÏˆÛË ÙˆÓ ¿ÌÂÛˆÓ Î·È Ì·ÎÚÔ¯ÚfiÓÈˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ. ∞ӷʤÚÔÓÙ·È, ›Û˘, ÔÈ ÈÔ Û˘¯Ó¤˜ ·ı‹ÛÂȘ, fiˆ˜ Ë Ó¢ÌÔÓÔ¿ıÂÈ·, ÙÔ Û‡Ó‰ÚÔÌÔ ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ ÙˆÓ ‚ÚÂÊÒÓ Î·È ¿ÏÏ·.
Abstract: Some of the drugs prescribed during pregnancy are of questionable safety regarding the possible risks of their administration for the foetus and the newborn infant. This article indicates the potential risks of commonly used drugs and their clinical effects, makes some diagnostic suggestions, and covers management of the foetus or infant exposed to them, along with the appearance of short and long-term effects. It also refers to the most commonly-encountered drugrelated diseases, including pulmonary disease and SIDS.
§¤ÍÂȘ ÎÏÂȉȿ: Ê¿Ú̷η, ÚÔÁÂÓÓËÙÈ΋ ÂÚ›Ô‰Ô˜, ¤Ì‚Ú˘Ô, ÓÂÔÁÓfi, ÂÁ΢ÌÔÛ‡ÓË, ·ÓÙÈÂÈÏËÙÈο, ÂÌ‚Ú˘˚Îfi Û‡Ó‰ÚÔÌÔ ·fi ÙË Ï‹„Ë ·ÏÎÔfiÏ, ·ÓÙÈËÎÙÈο, Û‡Ó‰ÚÔÌÔ ·fi ÙË Ï‹„Ë ‚·ÚÊ·Ú›Ó˘, Ï›ıÈÔ, οÓÈÛÌ· ÌËÙ¤Ú·˜, ·Ó·ÛÙÔÏ›˜ ÙÔ˘ ÌÂÙ·ÙÚÂÙÈÎÔ‡ ÂÓ˙‡ÌÔ˘ Ù˘ ·ÁÁÂÈÔÙÂÓÛ›Ó˘.
Key words: prenatal drugs, foetus, newborn, pregnancy, anticonvulsants, foetal alcohol syndrome, anticoagulants, warfarin syndrome, lithium, maternal smoking, angiotensin-converting enzyme (ACE) inhibitors.
∂ÈÛ·ÁˆÁ‹ ∏ ·ÏÎÔfiÏË, Ù· ÚÔ˚fiÓÙ· ηÓÔ‡, ηıÒ˜ Î·È Ê¿Ú̷η fiˆ˜ Ù· ·ÓÙÈÂÈÏËÙÈο, Ë ÈÛÔÙÚÂÙÈÓÔ˝ÓË, ÙÔ Ï›ıÈÔ, ÔÈ ·Ó·ÛÙÔÏ›˜ ÙÔ˘ ÌÂÙ·ÙÚÂÙÈÎÔ‡ ÂÓ˙‡ÌÔ˘ Î·È Ù· ·ÓÙÈËÎÙÈο, Ï·Ì‚¿ÓÔÓÙ·È Û˘¯Ó¿ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÁ΢ÌÔÛ‡Ó˘. ∏ Ï‹„Ë ·˘ÙÒÓ ÙˆÓ Ô˘ÛÈÒÓ Î·È Ê·ÚÌ¿ÎˆÓ Â›Ó·È Û˘¯Ó¿ ˘Â‡ı˘ÓË ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ·ÚÂÓÂÚÁÂÈÒÓ ÛÙÔ ¤Ì‚Ú˘Ô Î·È ÙÔ ÓÂÔÁÓfi, fiˆ˜ Ë ÂÌÊ¿ÓÈÛË Û˘Ó‰ÚfïÓ, ÙÂÚ·ÙÔÁ¤ÓÂÛ˘, ¯ÚfiÓÈ·˜ Ó¢ÌÔÓÔ¿ıÂÈ·˜, ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘, ·ÈÌÔÚÚ·ÁÈ΋˜ ÓfiÛÔ˘, Û˘ÁÁÂÓÔ‡˜ ηډÈÔ¿ıÂÈ·˜, ÔÏÈÁ¿ÌÓÈÔ˘ Î·È ÓÂÊÚÈ΋˜ ÓfiÛÔ˘. ∏ ÚÔÛ¯ÙÈ΋ Ï‹„Ë ÙÔ˘ ·ÙÔÌÈÎÔ‡ ÈÛÙÔÚÈÎÔ‡ Ù˘ ÌËÙ¤Ú·˜, ηıÒ˜ Î·È Ë ÁÓÒÛË ÙˆÓ ÎÈÓ‰‡ÓˆÓ ·fi ÙË ¯Ú‹ÛË ÙˆÓ ÚÔ·Ó·-
ÊÂÚı¤ÓÙˆÓ Ê·ÚÌ¿ÎˆÓ Â›Ó·È ··Ú·›ÙËÙ˜ ÚÔ¸Ôı¤ÛÂȘ ÁÈ· ÙË ÛˆÛÙ‹ ÎÏÈÓÈ΋ ÂÎÙ›ÌËÛË ÙÔ˘ ÓÂÔÁÓÔ‡ Î·È ÙËÓ ¤ÁηÈÚË ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ ÙÔ˘ (¶›Ó·Î·˜ 1).
¡ÂÔÁÓÔÏÔÁÈÎfi ∆Ì‹Ì·, °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô “∞ÏÂÍ¿Ó‰Ú·”, ∞ı‹Ó·
Department of Neonatology, “Alexandra” General Hospital, Athens
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∂Ì‚Ú˘˚Îfi Û‡Ó‰ÚÔÌÔ ·fi ÙË Ï‹„Ë ·ÏÎÔfiÏ Î·È Ó¢ÚÔ·Ó·Ù˘ÍȷΤ˜ ‰È·Ù·Ú·¯¤˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙË Ï‹„Ë ·ÏÎÔfiÏ ∆Ô ·ÏÎÔfiÏ Î·È Ù· ÚÔ˚fiÓÙ· ηÓÔ‡ Â›Ó·È ÔÈ Û˘¯ÓfiÙÂÚ˜ Ô˘Û›Â˜ Ô˘ ÌÂٷʤÚÔÓÙ·È ‰È·Ï·ÎÔ˘ÓÙȷο ·fi ÙË ÌËÙ¤Ú· ÛÙÔ ¤Ì‚Ú˘Ô. µÚ¤ıËΠfiÙÈ ÙÔ 10% ÂÚ›Ô˘ ÙˆÓ Á˘Ó·ÈÎÒÓ ÛÙËÓ ·Ó··Ú·ÁˆÁÈ΋ ËÏÈΛ· οÓÂÈ Î·Ù¿¯ÚËÛË ·ÏÎÔfiÏ (ÂÚ›Ô˘ 6-7 ÔÙ¿ ÙËÓ Ë̤ڷ) (1). ∆Ô ÔÛÔÛÙfi ÙˆÓ ÎÔÚÈÙÛÈÒÓ Ô˘
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¶·È‰È·ÙÚÈ΋ 2004;67:160-167
¶›Ó·Î·˜ 1. ¶·Ú¿ÁÔÓÙ˜ Ô˘ ÌÔÚ› Ó· ÂËÚ¿˙Ô˘Ó ÙËÓ Â›‰Ú·ÛË Ê·ÚÌ¿ÎˆÓ ÛÙÔ ¤Ì‚Ú˘Ô Î·È ÙÔ ÓÂÔÁÓfi ñ ∏ ¯ÔÚ‹ÁËÛË ÙˆÓ Ê·ÚÌ¿ÎˆÓ ÛÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÚÒÙÔ˘ ÙÚÈÌ‹ÓÔ˘ ·ËÛ˘ (ÔÚÁ·ÓÔÁ¤ÓÂÛË), .¯. ÎÔ˘Ì·Ú›ÓË, ·ÏÎÔfiÏ ñ ∏ ¯ÚfiÓÈ· ¯Ú‹ÛË ÙˆÓ Ê·ÚÌ¿ÎˆÓ ‹ Ô˘ÛÈÒÓ, .¯. οÓÈÛÌ·, Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË ñ ∏ ‰fiÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘, .¯. ·ÏÎÔfiÏ, οÓÈÛÌ·, ·ÓÙÈÂÈÏËÙÈο, ·Ó·ÛÙÔÏ›˜ ÙÔ˘ ÌÂÙ·ÙÚÂÙÈÎÔ‡ ÂÓ˙‡ÌÔ˘ ñ ∏ Ê·ÚÌ·ÎÔÎÈÓËÙÈ΋ Î·È Ô ÌÂÙ·‚ÔÏÈÛÌfi˜ οı ʷÚÌ¿ÎÔ˘ ñ ∏ ¯Ú‹ÛË Ê·ÚÌ¿ÎˆÓ Î·È Ô˘ÛÈÒÓ ÌÂÙ¿ ÙË Á¤ÓÓËÛË, .¯. Ë Û˘Ó¤¯ÈÛË ÙÔ˘ ÏÈı›Ô˘ ‹ ÙÔ˘ ηӛÛÌ·ÙÔ˜ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡ ñ ∏ ÔÏ˘Ê·Ú̷Λ·, .¯. ÂÚÈÛÛfiÙÂÚ· ÙÔ˘ ÂÓfi˜ ·ÓÙÈÂÈÏËÙÈο ñ ¢È·ÙÚÔÊÈÎÔ› ·Ú¿ÁÔÓÙ˜, .¯. ·ÓÙÈÂÈÏËÙÈο Î·È Ê˘ÏÏÈÎfi Ô͇/ ‚ÈÙ·Ì›ÓË ∫
ηٷӷÏÒÓÔ˘Ó ·ÏÎÔfiÏ ÛÙȘ Â˘Úˆ·˚Τ˜ ¯ÒÚ˜ Î˘Ì·›ÓÂÙ·È ÛÙ· ›‰È· ›‰·, ÂÓÒ ÁÈ· ÙËÓ ∂ÏÏ¿‰· Â›Ó·È ÂÚ›Ô˘ 33% (2). ∆· ·È‰È¿ ÌËÙ¤ÚˆÓ Ì ˘ÂÚηٷӿψÛË ·ÏÎÔfiÏ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÛËÌ›· Î·È Û˘ÌÙÒÌ·Ù· ‰ËÏËÙËÚ›·Û˘ ·fi ‰È¿ÊÔÚ· Û˘ÛÙ‹Ì·Ù· Î·È Î˘Ú›ˆ˜ ·fi ÙÔ ÎÂÓÙÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ·, Ì ÚÔÂÍ¿Ú¯ÔÓÙ· ÙËÓ Î·Ù·ÛÙÔÏ‹ Î·È ÙËÓ ˘ÔÁÏ˘Î·ÈÌ›· (3). ™˘¯Ó¿ ·ÓȯÓ‡ÔÓÙ·È ÙÔÍÈο ›‰· ·ÏÎÔfiÏ ÛÙÔ ·›Ì· ÙÔ˘ ÔÌÊ¿ÏÈÔ˘ ÏÒÚÔ˘. ∆· ÓÂÔÁÓ¿ ÌËÙ¤ÚˆÓ Ì ¯ÚfiÓÈ· ηٿ¯ÚËÛË ·ÏÎÔfiÏ ÂÓ›ÔÙ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Û˘ÌÙÒÌ·Ù· ÂÍ¿ÚÙËÛ˘, fiˆ˜ ÙÚfiÌÔ, ·ÓËÛ˘¯›·, ˘ÂÚ‚ÔÏÈÎfi ÎÏ¿Ì·, ˘ÂÚÙÔÓ›·, ¤ÓÙÔÓÔ ÛËÌÂ›Ô startle (·ÓÙ›‰Ú·ÛË ÛÙÔ ÂÚ¤ıÈÛÌ·) Î·È ÔÈÛıfiÙÔÓÔ (1,3). ∆· Û˘ÌÙÒÌ·Ù· ·˘Ù¿ ÌÔÚ› Ó· ‰È·ÚΤÛÔ˘Ó 72 ÒÚ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË. ∂›Û˘, Û˘¯Ó‹ Â›Ó·È Ë ÙÂÚ·ÙÔÁfiÓÔ˜ ‰Ú¿ÛË ÙÔ˘ ·ÏÎÔfiÏ ÛÙÔ ¤Ì‚Ú˘Ô Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÁ΢ÌÔÛ‡Ó˘, Ô˘ ÚÔηÏ› ÓÔËÙÈ΋ ˘ÛÙ¤ÚËÛË ÛÙË ÌÂÙ¤ÂÈÙ· ˙ˆ‹ (1,3,6). ∆Ô ÂÌ‚Ú˘˚Îfi Û‡Ó‰ÚÔÌÔ ·fi ÙË Ï‹„Ë ·ÏÎÔfiÏ (∂™∞) (foetal alcohol syndrome FAS), ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÚ›· ÎÚÈÙ‹ÚÈ·: ·) ÂÓ‰ÔÌ‹ÙÚÈ· ‹ Î·È ÌÂÙ¿ ÙË Á¤ÓÓËÛË Î·ı˘ÛÙ¤ÚËÛË ÛˆÌ·ÙÈ΋˜ ·Ó¿Ù˘Í˘, ‚) ÚÔÛ‚ÔÏ‹ ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Î·È Á) Ù˘Èο ‰˘ÛÌÔÚÊÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÚÔÛÒÔ˘ (¶›Ó·Î·˜ 2·). ∆· ÂÚÈÛÛfiÙÂÚ· ·È‰È¿ Ô˘ ¤¯Ô˘Ó ÂÎÙÂı› ÂÓ‰ÔÌ‹ÙÚÈ· Û ÙÔÍÈο ›‰· ·ÏÎÔfiÏ, ‰ÂÓ ÂΉËÏÒÓÔ˘Ó Ï‹Úˆ˜ Ù· ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘. ¶·ÚÔ˘ÛÈ¿˙Ô˘Ó, fï˜, ηı˘ÛÙ¤ÚËÛË Ù˘ ·Ó¿Ù˘Í˘, ‰È·Ù·Ú·¯¤˜ Û˘ÌÂÚÈÊÔÚ¿˜, ÎÈÓËÙÈ΋ ηı˘ÛÙ¤ÚËÛË Î·È Î·ı˘ÛÙ¤ÚËÛË ÛÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ ÏfiÁÔ˘. O fiÚÔ˜ “Û˘Ó¤ÂȘ ·fi ÙË Ï‹„Ë ·ÏÎÔfiÏ ÛÙÔ ¤Ì‚Ú˘Ô” ¯ÚËÛÈÌÔÔÈÂ›Ù·È Û ·ÓÙÈηٿÛÙ·ÛË ÙÔ˘ ∂™∞ ÁÈ· Ó· ÂÚÈÁÚ¿„ÂÈ ÙÔ Â‡ÚÔ˜ ÙˆÓ ·Ó·Ù˘ÍÈ·ÎÒÓ ‰È·Ù·Ú·¯ÒÓ ·fi ÙË ¯ÚfiÓÈ· Ï‹„Ë ·ÏÎÔfiÏ (1,3,4) (¶›Ó·Î·˜ 2‚). ¶ÚfiÛÊ·Ù·, ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ô fiÚÔ˜ “Ó¢ÚÔ·Ó·Ù˘ÍȷΤ˜ ‰È·Ù·Ú·¯¤˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙÔ ·ÏÎÔfiÏ” (alcohol-related neurodevelopmental disorders - ARND), Ô ÔÔ›Ô˜ ÂÚÈÏ·Ì‚¿ÓÂÈ ÙȘ ‰È·-
Paediatriki 2004;67:160-167
Ù·Ú·¯¤˜ ÁÓÒÛ˘ ‹ ÙȘ ‰È·Ù·Ú·¯¤˜ Û˘ÌÂÚÈÊÔÚ¿˜, ¯ˆÚ›˜ Ù· ÎÏ·ÛÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ ÚÔÛÒÔ˘ ÙÔ˘ ∂™∞. ªÂ ÙÔÓ fiÚÔ “Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜ Ô˘ Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì ÙË Ï‹„Ë ·ÏÎÔfiÏ” (alcohol-related birth defects - ARBD) ÂÚÈÁÚ¿ÊÔÓÙ·È ·ÓˆÌ·Ï›Â˜ ·fi ÙË Á¤ÓÓËÛË, ¯ˆÚ›˜ Ù· ÎÏ·ÛÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ ÚÔÛÒÔ˘ ÙÔ˘ ∂™∞ (1,3). ∏ ·ÈÙÈÔÏÔÁ›· ÙˆÓ ·Ú·¿Óˆ Û˘Ó‰ÚfiÌˆÓ ‰ÂÓ Â›Ó·È ÙÂÏ›ˆ˜ ÁÓˆÛÙ‹ Î·È ÌÔÚ› Ó· Â›Ó·È ÔÏ˘·Ú·ÁÔÓÙÈ΋. ™˘Û¯ÂÙ›˙ÂÙ·È, fï˜, Ì ÙËÓ Â›‰Ú·ÛË Ù˘ ·ÏÎÔfiÏ˘ ‹ ÙˆÓ ÌÂÙ·‚ÔÏÈÙÒÓ Ù˘ ÛÙË ÌÂÙ·ÊÔÚ¿ ıÚÂÙÈÎÒÓ Ô˘ÛÈÒÓ Î·È Ô͢ÁfiÓÔ˘ ̤ۈ ÙÔ˘ Ï·ÎÔ‡ÓÙ· ‹ ÙËÓ ¿ÌÂÛË Â›‰Ú·ÛË Û ÌÂÙ·‚ÔÏÈΤ˜ ‚ÈÔ¯ËÌÈΤ˜ Ô‰Ô‡˜ ÙÔ˘ ·Ó·Ù˘ÛÛfiÌÂÓÔ˘ ÂÌ‚Ú‡Ô˘ (7). OÈ ¶›Ó·Î·˜ 2·. OÈ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ÙÔ˘ ÂÌ‚Ú˘˚ÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ ·fi ÙË Ï‹„Ë ·ÏÎÔfiÏ ∫Ú·ÓÈÔÚÔÛˆÈΤ˜ ªÈÎÚ¤˜ ‚ÏÂÊ·ÚÈΤ˜ Û¯ÈṲ̂˜ ∂›Â‰Ô ÚfiÛˆÔ ∂›Â‰Ë ÚÈÓÔ¯ÂÈÏÈ΋ ·‡Ï·Î· ∫˘ÚÙfi ¿Óˆ ¯Â›ÏÔ˜ ∫·Ú‰È·Î¤˜ ªÂÛÔÎÔÏÈο ÂÏÏ›ÌÌ·Ù· ªÂÛÔÎÔÈÏȷο ÂÏÏ›ÌÌ·Ù· ∆ÂÙÚ·ÏÔÁ›· Fallot ™ÎÂÏÂÙÈΤ˜ ÀÔÏ·ÛÙÈο Ó‡¯È· ∫ÔÓÙ‹ ¤ÌÙË Ê¿Ï·ÁÁ· ∫ÏÈÓÔ‰·ÎÙ˘Ï›· ™‡Ó‰ÚÔÌÔ Klippel-Feil ™ÎÔÏ›ˆÛË ¡ÂÊÚÈΤ˜ ∞Ï·ÛÙÈÎÔ›/˘ÔÏ·ÛÙÈÎÔ›/‰˘ÛÏ·ÛÙÈÎÔ› ÓÂÊÚÔ› ¶ÂÙ·ÏÔÂȉ‹˜ ÓÂÊÚfi˜ ¢ÈÏ·ÛÈ·ÛÌfi˜ Ô˘ÚËÙ‹Ú· ∞Ó¿Ù˘ÍË ªÈÎÚ¿ ÁÈ· ÙËÓ ËÏÈΛ· ·ËÛ˘ ÓÂÔÁÓ¿ ¢˘Û¯¤ÚÂÈ· Û›ÙÈÛ˘ ¢˘Û·Ó·ÏÔÁ›· ‚¿ÚÔ˘˜-‡„Ô˘˜ ∫ÂÓÙÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ· ªÈÎÚÔÎÂÊ·Ï›· ªÂÚÈ΋ ‹ ÔÏÈ΋ ·Ï·Û›· ÙÔ˘ ÌÂÛÔÏÔ‚›Ô˘ ¶·ÚÂÁÎÂÊ·ÏȉÈ΋ ˘ÔÏ·Û›· ÀÔÏ·Û›· ÙÔ˘ ÔÙÈÎÔ‡ Ó‡ÚÔ˘ ™ÙÚ·‚ÈÛÌfi˜
¶›Ó·Î·˜ 2‚. ¡Â˘ÚÔ·Ó·Ù˘ÍȷΤ˜ ‰È·Ù·Ú·¯¤˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙË Ï‹„Ë ·ÏÎÔfiÏ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÁ΢ÌÔÛ‡Ó˘ ∂ËÚ·Ṳ̂ÓË ÏÂÙ‹ ÎÈÓËÙÈÎfiÙËÙ· ¡Â˘ÚÔ·ÈÛıËÙ‹ÚÈ· ÎÒʈÛË ºÙˆ¯‹ Û˘Ó¤ÚÁÂÈ· ÔÊı·ÏÌÔ‡-¯ÂÚÈÔ‡ ª·ıËÛȷΤ˜ ‰˘ÛÎÔϛ˜ ¶ÚÔ‚Ï‹Ì·Ù· ÌÓ‹Ì˘, ÚÔÛÔ¯‹˜ Î·È ÎÚ›Û˘ ∫·Îfi˜ ¤ÏÂÁ¯Ô˜ ·ÚÔÚÌËÙÈÎfiÙËÙ·˜ ¶ÚÔ‚Ï‹Ì·Ù· ÎÔÈÓˆÓÈ΋˜ ·Ô‰Ô¯‹˜ ÀÂÚÎÈÓËÙÈÎfiÙËÙ· ¶ÚÔ‚Ï‹Ì·Ù· ÂÈÎÔÈÓˆÓ›·˜
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¶·È‰È·ÙÚÈ΋ 2004;67:160-167
Ô‰Ô› ·˘Ù¤˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙË Û‡ÓıÂÛË ÚˆÙÂ˚ÓÒÓ, ÙËÓ ·Ú·ÁˆÁ‹ ÂÓ¤ÚÁÂÈ·˜, ÙËÓ ¤Ó·ÚÍË ‹ ÙÔÓ ÙÂÚÌ·ÙÈÛÌfi ‚ÈÔ¯ËÌÈÎÒÓ ·ÓÙȉڿÛˆÓ, ÙË ÌÂÙ·Ó¿ÛÙ¢ÛË Î˘ÙÙ¿ÚˆÓ, ÙËÓ ·˘ÍË̤ÓË ·fiÙˆÛË Î·È ÙËÓ ·Ú·ÁˆÁ‹ Ó¢Úԉȷ‚È‚·ÛÙÒÓ. ∏ Û˘¯ÓfiÙËÙ· ÙÔ˘ ∂™∞ Â›Ó·È 5 ·Ó¿ 10.000 ˙ÒÓÙ· ÓÂÔÁÓ¿ ÛÙȘ ∏¶∞, ÂÓÒ Â›Ó·È ·ÎfiÌË ˘„ËÏfiÙÂÚË Û ÔÚÈṲ̂Ó˜ ÏËı˘ÛÌȷΤ˜ ˘Ô-ÔÌ¿‰Â˜, fiˆ˜ ÔÈ ÌÂÈÔÓfiÙËÙ˜. ∏ Û˘¯ÓfiÙËÙ·, fï˜, ÙÔ˘ ∂™∞ ηıÒ˜ Î·È ÙˆÓ Û˘ÁÁÂÓÒÓ ·ÓˆÌ·ÏÈÒÓ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙË Ï‹„Ë ·ÏÎÔfiÏ, Â›Ó·È Ôχ ÌÂÁ·Ï‡ÙÂÚË Î·È ÂÎÙÈÌ¿Ù·È ‰‡ÛÎÔÏ· (5). ªÂÚÈÎÔ› ÂÚ¢ÓËÙ¤˜ ˘ÔÏÔÁ›˙Ô˘Ó ÙË Û˘¯ÓfiÙËÙ· ÙˆÓ Û˘Ó‰ÚfiÌˆÓ Û 1 ·Ó¿ 300 ·È‰È¿ (5). ∏ ÂÓ‰ÔÌ‹ÙÚÈ· ¤ÎıÂÛË ÛÙÔ ·ÏÎÔfiÏ Û ÌÈÎÚfiÙÂÚË ËÏÈΛ· ·ËÛ˘ Èı·ÓÒ˜ ÚÔηÏ› ÙÔ ÎÏ·ÛÈÎfi ÂÌ‚Ú˘˚Îfi Û‡Ó‰ÚÔÌÔ ÌÂ Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜, ÂÓÒ Ë ¤ÎıÂÛË Û ÌÂÁ·Ï‡ÙÂÚË ËÏÈΛ· ·ËÛ˘ Â›Ó·È ˘Â‡ı˘ÓË ÁÈ· ‰È·Ù·Ú·¯¤˜ Ó¢ÚÔ·Ó¿Ù˘Í˘ Î·È Û˘ÌÂÚÈÊÔÚ¿˜ (5). ∏ ¤ÎıÂÛË ÛÙËÓ ·ÏÎÔfiÏË ÌÔÚ› Ó· ¢ı‡ÓÂÙ·È ÁÈ· ÙÔ 5% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ Û˘ÁÁÂÓÒÓ ·ÓˆÌ·ÏÈÒÓ (6). ∏ ̤ÛË Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ÙÔ˘ ∂™∞ ÛÙȘ ÌËÙ¤Ú˜ Ô˘ οÓÔ˘Ó ¯Ú‹ÛË ·ÏÎÔfiÏ ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÁ΢ÌÔÛ‡Ó˘ Â›Ó·È 2-3% (5). O ΛӉ˘ÓÔ˜, fï˜, ÂÌÊ¿ÓÈÛ˘ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ·˘Í¿ÓÂÈ Û 85% ÛÙȘ ÌËÙ¤Ú˜ Ì ÚÔÁÂÓÓËÙÈÎÔ‡˜ ÂÈ‚·Ú˘ÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜, fiˆ˜ ÙÔ ˘„ËÏfi ÔÛÔÛÙfi ËÌÂÚÒÓ ¤ÎıÂÛ˘ Û ·ÏÎÔfiÏ, Û ÌËÙ¤Ú˜ Ì ÔÏϷϤ˜ ΢‹ÛÂȘ Î·È Û ÂΛӘ Ô˘ ··ÓÙÔ‡Ó Î·Ù·Ê·ÙÈο ÛÙËÓ ÂÚÒÙËÛË Â¿Ó Î·Ù·Ó¿ÏˆÛ·Ó ·ÏÎÔfiÏ ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ·ËÛ˘ (5). O ΛӉ˘ÓÔ˜ Ó· ÂËÚ·ÛÙ› ÙÔ ¤Ì‚Ú˘Ô Â›Ó·È ÌÂÁ·Ï‡ÙÂÚÔ˜, fiÛÔ ÌÂÁ·Ï‡ÙÂÚË Â›Ó·È Ë ÔÛfiÙËÙ· ÙÔ˘ ·ÏÎÔfiÏ Ô˘ ηٷӷÏÒıËÎÂ. ∏ ÂÚÈÛÙ·Ûȷ΋ ηٷӿψÛË ÌÂÁ¿ÏˆÓ ÔÛÔÙ‹ÙˆÓ ·ÏÎÔfiÏ Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ ÂÈΛӉ˘ÓË ·fi ÙË ¯ÚfiÓÈ· ηٷӿψÛË ÌÈÎÚÒÓ ÔÛÔÙ‹ÙˆÓ (5). ∫ÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ÙÔ˘ ∂™∞ ·Ú·ÙËÚ‹ıËÎ·Ó Û 10% ÙˆÓ ÓÂÔÁÓÒÓ, ÙˆÓ ÔÔ›ˆÓ ÔÈ ÌËÙ¤Ú˜ Î·Ù·Ó¿ÏˆÓ·Ó Î·ıËÌÂÚÈÓ¿ ÂÚ›Ô˘ 30-60 ml ηı·ÚÔ‡ ·ÏÎÔfiÏ. ™‡Ìʈӷ Ì ÙȘ ÌÂϤÙ˜, ˆ˜ ¤Ó· ÔÙfi ÔÚ›˙ÔÓÙ·È 360 ml ̇ڷ˜ ‹ 150 ml ÎÚ·ÛÈÔ‡ ‹ 45 ml ÏÈΤÚ, Ô˘ ·ÓÙÈÛÙÔÈ¯Ô‡Ó Û 15 ml ηı·ÚÔ‡ ·ÏÎÔfiÏ. O ΛӉ˘ÓÔ˜ ·˘Í¿ÓÂÈ Û 40%, fiÙ·Ó Ë Î·Ù·Ó¿ÏˆÛË Î·ı·ÚÔ‡ ·ÏÎÔfiÏ ÍÂÂÚ¿ÛÂÈ Ù· 150 ml ÙËÓ Ë̤ڷ (1). O ΛӉ˘ÓÔ˜ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË Ó¢ÚÔ·Ó·Ù˘Íȷ΋˜ ‰È·Ù·Ú·¯‹˜ Ô˘ Û¯ÂÙ›˙ÂÙ·È Ì ÙË Ï‹„Ë ·ÏÎÔfiÏ Â›Ó·È ·ÎfiÌË ‰˘ÛÎÔÏfiÙÂÚÔ Ó· ˘ÔÏÔÁÈÛÙ› ÂÍ·ÈÙ›·˜ ÙÔ˘ ÌÂÁ¿ÏÔ˘ ‡ÚÔ˘˜ ÙˆÓ ÎÏÈÓÈÎÒÓ ÂΉËÏÒÛÂˆÓ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘. OÈ ÂÚÈÛÛfiÙÂÚÔÈ ÂÚ¢ÓËÙ¤˜ Û˘ÌʈÓÔ‡Ó fiÙÈ Ë Î·Ù·Ó¿ÏˆÛË ÌÂÁ¿ÏˆÓ ÔÛÔÙ‹ÙˆÓ ·ÏÎÔfiÏ Û˘Û¯ÂÙ›˙ÂÙ·È Ì ¯·ÌËÏfi ‰Â›ÎÙË Â˘Ê˘˝·˜ Î·È ‰È·Ù·Ú·¯¤˜ Û˘ÌÂÚÈÊÔÚ¿˜. ¢ÂÓ ¤¯ÂÈ ÚÔÛ‰ÈÔÚÈÛÙ› ̤¯ÚÈ Û‹ÌÂÚ· ¤Ó· ·ÛʷϤ˜ fiÚÈÔ Î·Ù·Ó¿ÏˆÛ˘ ·ÏÎÔfiÏ ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÁ΢ÌÔÛ‡Ó˘ (5).
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Paediatriki 2004;67:160-167
∆Ô ∂™∞, ÔÈ Ó¢ÚÔ·Ó·Ù˘ÍȷΤ˜ ‰È·Ù·Ú·¯¤˜ Î·È ÔÈ Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜ Ô˘ Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì ÙË Ï‹„Ë ·ÏÎÔfiÏ ¤¯Ô˘Ó ÛÔ‚·Ú¤˜ ÎÔÈÓˆÓÈΤ˜ Î·È ÔÈÎÔÓÔÌÈΤ˜ Û˘Ó¤ÂȘ Î·È Ô ÓÂÔÁÓÔÏfiÁÔ˜ ‹ Ô ·È‰›·ÙÚÔ˜ ı· Ú¤ÂÈ Ó· Â›Ó·È Ôχ ÚÔÛÂÎÙÈÎfi˜ ÛÙËÓ ·Ó·ÁÓÒÚÈÛË ÙˆÓ ÎÏÈÓÈÎÒÓ ÂΉËÏÒÛÂˆÓ ÙˆÓ ·Ú·¿Óˆ Û˘Ó‰ÚfïÓ, ȉȷ›ÙÂÚ· fiÙ·Ó ˘¿Ú¯ÂÈ ıÂÙÈÎfi ÈÛÙÔÚÈÎfi ÌÂÁ¿Ï˘ ηٷӿψÛ˘ ·ÏÎÔfiÏ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÁ΢ÌÔÛ‡Ó˘ (1). OÈ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ÂÓ›ÔÙ ‰ÂÓ Â›Ó·È ÂÌÊ·Ó›˜ ·fi ÙË ÓÂÔÁÓÈ΋ ÂÚ›Ô‰Ô Î·È ÔÈ Ó¢ÚÔ·Ó·Ù˘ÍȷΤ˜ ‰È·Ù·Ú·¯¤˜ ÂÌÊ·Ó›˙ÔÓÙ·È ·ÚÁfiÙÂÚ·. ŸÙ·Ó ˘¿Ú¯ÂÈ Ë ˘Ô„›· Ù˘ ‰È¿ÁÓˆÛ˘, ÙÔ ·È‰› ÂÎÙÈÌ¿Ù·È ·fi ÙÔ˘˜ ·È‰Ô·Ó·Ù˘ÍÈÔÏfiÁÔ˘˜, ÒÛÙ ӷ Á›ÓÂÈ ·ÎÚÈ‚‹˜ Ë ‰È¿ÁÓˆÛË. ∫¿ÓÈÛÌ· ÀÔÏÔÁ›˙ÂÙ·È fiÙÈ ÂÚ›Ô˘ 20% ÙˆÓ Á˘Ó·ÈÎÒÓ ÛÙȘ ∏¶∞ ηӛ˙ÂÈ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÁ΢ÌÔÛ‡Ó˘. ∆· ›‰È· ÂÚ›Ô˘ ÔÛÔÛÙ¿ ·ÊÔÚÔ‡Ó Û Á˘Ó·›Î˜ Û ·Ó··Ú·ÁˆÁÈ΋ ËÏÈΛ· ÛÙËÓ ∂˘ÚÒË, ÂÓÒ ÛÙËÓ ∂ÏÏ¿‰· ÙÔ ÔÛÔÛÙfi ÙˆÓ Á˘Ó·ÈÎÒÓ Û ·Ó··Ú·ÁˆÁÈ΋ ËÏÈΛ· Ô˘ ηӛ˙ÂÈ Â›Ó·È 27% (2). ∏ ·ÚÈ· ›وÛË ÙÔ˘ ηӛÛÌ·ÙÔ˜ ÛÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ ÂÌ‚Ú‡Ô˘ Â›Ó·È Ë ÂÏ·Ùو̤ÓË ÚfiÛÏË„Ë ‚¿ÚÔ˘˜ (8). ¶ÔÏÏÔ› ÂÚ¢ÓËÙ¤˜, fï˜, ÂÎÙÈÌÔ‡Ó fiÙÈ ÔÈ Û˘Ó¤ÂȘ ÙÔ˘ ηӛÛÌ·ÙÔ˜ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÁ΢ÌÔÛ‡Ó˘ Â›Ó·È ÔχÏ¢Ú˜, fiˆ˜ ‰È·Ù·Ú·¯¤˜ Û˘ÌÂÚÈÊÔÚ¿˜, ‰È·Ù·Ú·¯¤˜ ÛÙËÓ Î·Ù·ÓfiËÛË Î·È ¤ÎÊÚ·ÛË ÙÔ˘ ÏfiÁÔ˘, ˘ÂÚÎÈÓËÙÈÎfiÙËÙ·, ‰È·Ù·Ú·¯¤˜ ÚÔÛÔ¯‹˜ Î·È ¯·ÌËÏfi ÓÔËÙÈÎfi ËÏ›ÎÔ (¶›Ó·Î·˜ 3). øÛÙfiÛÔ, ÔÈ Ì·ÎÚÔ¯ÚfiÓȘ Û˘Ó¤ÂȘ ÙÔ˘ ηӛÛÌ·ÙÔ˜ ‰ÂÓ ¤¯Ô˘Ó ‰È¢ÎÚÈÓÈÛÙ›. ™Â ÂȉËÌÈÔÏÔÁÈΤ˜ ¤Ú¢Ó˜, ÙÔ Î¿ÓÈÛÌ· ·Ó·ÁÓˆÚ›˙ÂÙ·È Û·Ó ·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙÔ Û‡Ó‰ÚÔÌÔ ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ ÛÙ· ‚Ú¤ÊË (sudden infant death syndrome - SIDS), Ô˘ Èı·Ó¿ ÔÊ›ÏÂÙ·È Û ‰È·Ù·Ú·¯‹ ÛÙÔÓ Ì˯·ÓÈÛÌfi ·Ê‡ÓÈÛ˘ (9). ¶›Ó·Î·˜ 3. ∞ÔÙÂϤÛÌ·Ù· ÙÔ˘ ηӛÛÌ·ÙÔ˜ ηٿ ÙËÓ ÂÁ΢ÌÔÛ‡ÓË ¶ÂÚÈÁÂÓÓËÙÈο ÚÔ‚Ï‹Ì·Ù· ∞˘ÙfiÌ·ÙË ·Ô‚ÔÏ‹ ∂Ó‰ÔÌ‹ÙÚÈ· ηı˘ÛÙ¤ÚËÛË Ù˘ ·Ó¿Ù˘Í˘ ¶ÚfiˆÚË Ú‹ÍË ˘Ì¤ÓˆÓ: ·‡ÍËÛË Û¯ÂÙÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘ ηٿ 3 ¶ÚfiˆÚÔ˜ ÙÔÎÂÙfi˜: ·‡ÍËÛË Û¯ÂÙÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘ ηٿ 2 ∞ÔÎfiÏÏËÛË Ï·ÎÔ‡ÓÙ·: ·‡ÍËÛË Û¯ÂÙÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘ ηٿ 2,5 ∂Ȉ̷ÙÈÎfi˜ Ï·ÎÔ‡ÓÙ·˜: ·‡ÍËÛË Û¯ÂÙÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘ ηٿ 3 ¶ÚÔ‚Ï‹Ì·Ù· ÚÒÙ˘ ‚ÚÂÊÈ΋˜ ËÏÈΛ·˜ ªÈÎÚ‹ ÂÚ›ÌÂÙÚÔ˜ ÎÂÊ·Ï‹˜ ªÂȈ̤ÓË ÏÂÎÙÈ΋ ÈηÓfiÙËÙ· ÷ÌËÏfi ÓÔËÙÈÎfi ËÏ›ÎÔ ∞˘ÍË̤ÓË Â›ÙˆÛË ‚ÚÔÁ¯ÈÎÔ‡ ¿ÛıÌ·ÙÔ˜ ∞˘ÍË̤ÓÔ˜ ΛӉ˘ÓÔ˜ ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ ÙˆÓ ‚ÚÂÊÒÓ
May-June 04 chris new
19-07-04
19:24
™ÂÏ›‰·163
¶·È‰È·ÙÚÈ΋ 2004;67:160-167
OÈ ·ıÔÊ˘ÛÈÔÏÔÁÈÎÔ› Ì˯·ÓÈÛÌÔ› Ô˘ ÂÓÔ¯ÔÔÈÔ‡ÓÙ·È Â›Ó·È Ë ¤ÎıÂÛË ÙfiÛÔ Ù˘ ÌËÙ¤Ú·˜ fiÛÔ Î·È ÙÔ˘ ÂÌ‚Ú‡Ô˘ ÛÙË ÓÈÎÔÙ›ÓË Î·È ÙÔ ÌÔÓÔÍ›‰ÈÔ ÙÔ˘ ¿Óıڷη. ∏ ÓÈÎÔÙ›ÓË ¤¯ÂÈ ·Ô‰Âȯı› fiÙÈ ÚÔηÏ› ÙËÓ ·ÂÏ¢ı¤ÚˆÛË Î·Ù¯ÔÏ·ÌÈÓÒÓ, Ô˘ ÚÔηÏÔ‡Ó ·ÁÁÂÈÔÛ‡Û·ÛË ÙˆÓ ·ÁÁ›ˆÓ Ù˘ Ì‹ÙÚ·˜ Ì ·ÔÙ¤ÏÂÛÌ· ÙË Ì›ˆÛË Ù˘ ÌËÙÚÔÏ·ÎÔ˘ÓÙȷ΋˜ ÚÔ‹˜ ·›Ì·ÙÔ˜ Î·È Ù˘ ÌÂÙ·ÊÔÚ¿˜ ıÚÂÙÈÎÒÓ Ô˘ÛÈÒÓ Î·È Ô͢ÁfiÓÔ˘ ÛÙÔ ¤Ì‚Ú˘Ô (10). Œ¯ÂÈ ˘ÔÏÔÁÈÛÙ› fiÙÈ Ë Û˘ÁΤÓÙÚˆÛË ÓÈÎÔÙ›Ó˘ ÛÙÔ ¤Ì‚Ú˘Ô Â›Ó·È 10-15% ˘„ËÏfiÙÂÚË Û ۯ¤ÛË Ì ٷ ›‰· ÓÈÎÔÙ›Ó˘ Ô˘ ·ÓȯÓ‡ÔÓÙ·È ÛÙË ÌËÙ¤Ú·. ∆Ô ÌÔÓÔÍ›‰ÈÔ ÙÔ˘ ¿Óıڷη, ÚÔ˚fiÓ ÙÔ˘ ηÓÔ‡, ·ÓÙ·ÁˆÓ›˙ÂÙ·È ÙÔ Ô͢ÁfiÓÔ ÛÙË Û‡Ó‰ÂÛ‹ ÙÔ˘ Ì ÙËÓ ·ÈÌÔÛÊ·ÈÚ›ÓË, ÁÈ·Ù› Û˘Ó‰¤ÂÙ·È Ì ·˘Ù‹ Î·È ·Ú¿ÁÂÙ·È Ë Î·Ú‚Ô͢·ÈÌÔÛÊ·ÈÚ›ÓË, Ë ÔÔ›· ÂÌÔ‰›˙ÂÈ ÙË ÌÂÙ·ÊÔÚ¿ Ô͢ÁfiÓÔ˘ ÛÙÔ˘˜ ÈÛÙÔ‡˜. ∏ ÂÌ‚Ú˘˚΋ ·ÈÌÔÛÊ·ÈÚ›ÓË ¤¯ÂÈ ÌÂÁ·Ï‡ÙÂÚË ‰ÂÛÌ¢ÙÈ΋ ÈηÓfiÙËÙ· ÚÔ˜ ÙÔ ÌÔÓÔÍ›‰ÈÔ ÙÔ˘ ¿Óıڷη ·fi ÙÔ Ô͢ÁfiÓÔ, Ì ·ÔÙ¤ÏÂÛÌ· Ó· ÂÚÈÔÚ›˙ÂÙ·È ·ÎfiÌË ÂÚÈÛÛfiÙÂÚÔ Ë ÌÂÙ·ÊÔÚ¿ Ô͢ÁfiÓÔ˘ ÚÔ˜ ÙÔ˘˜ ÈÛÙÔ‡˜. ¶·ıÔÏÔÁÔ·Ó·ÙÔÌÈΤ˜ ÌÂϤÙ˜ Ï·ÎÔ˘ÓÙÈ·ÎÔ‡ ˘ÏÈÎÔ‡ Û ÌËÙ¤Ú˜ ηӛÛÙÚȘ ¤‰ÂÈÍ·Ó ÈÛÙÈΤ˜ ÓÂÎÚˆÙÈΤ˜ ‚Ï¿‚˜, ÌÈÎÚÔ¤ÌÊÚ·ÎÙ·, ‰ËÌÈÔ˘ÚÁ›· ÈÓÒ‰Ô˘˜ Î·È ˙ÒÓ˜ Ì ˘Ô·ÁÁ›ˆÛË Î·È ·ÙÚÔÊÈΤ˜ Ï¿¯Ó˜, Û·Ó ·ÔÙ¤ÏÂÛÌ· ·ÁÁÂÈÔÛ‡Û·Û˘ Î·È ÈÛ¯·ÈÌ›·˜. ∆Ô ·ÔÙ¤ÏÂÛÌ· ÙÔ˘ ηӛÛÌ·ÙÔ˜ Â›Ó·È ‰ÔÛÔÂÍ·ÚÙÒÌÂÓÔ, ·˘Í¿ÓÂÙ·È ‰ËÏ·‰‹ ·Ó¿ÏÔÁ· Ì ÙÔÓ ·ÚÈıÌfi ÙˆÓ ÙÛÈÁ¿ÚˆÓ Ô˘ ηٷӷÏÒÓÔÓÙ·È ËÌÂÚËÛ›ˆ˜. ŸÙ·Ó Ô ·ÚÈıÌfi˜ ÙˆÓ ÙÛÈÁ¿ÚˆÓ Ô˘ ηٷӷÏÒÓÔÓÙ·È Â›Ó·È ÌÈÎÚfiÙÂÚÔ˜ ·fi 10 ËÌÂÚËÛ›ˆ˜, ·Ú·ÙËÚÔ‡ÓÙ·È Ï›Á˜ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ. ∆Ô Î¿ÓÈÛÌ· Ù˘ ÌËÙ¤Ú·˜ Û˘Ó‹ıˆ˜ Û˘Ó¯›˙ÂÙ·È Î·È ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi, Ì ·ÔÙ¤ÏÂÛÌ· ÙÔ ‚Ú¤ÊÔ˜ Ó· ÂÎÙ›ıÂÙ·È ÂÚ·ÈÙ¤Úˆ ÛÙÔ˘˜ ÎÈÓ‰‡ÓÔ˘˜ ·fi ·˘Ùfi. ∏ ¤ÎıÂÛË ÙÔ˘ ‚Ú¤ÊÔ˘˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË ÛÙÔ Î¿ÓÈÛÌ· ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙ› Ì ÙËÓ ·Ó¿Ù˘ÍË ¯ÚfiÓÈ·˜ ·Ó·Ó¢ÛÙÈ΋˜ ÓfiÛÔ˘ Î·È ÙÔ Û‡Ó‰ÚÔÌÔ ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘. ∆Ô ÌËÙÚÈÎfi Á¿Ï· ÙˆÓ ÌËÙ¤ÚˆÓ Ô˘ ηӛ˙Ô˘Ó ÂÚȤ¯ÂÈ ÛËÌ·ÓÙÈΤ˜ ÔÛfiÙËÙ˜ ÓÈÎÔÙ›Ó˘. ∞ÓÙÈÂÈÏËÙÈο ™·ÛÌÔ› ÂÌÊ·Ó›˙ÔÓÙ·È ÂÚ›Ô˘ ÛÙÔ 0,4-0,8% ÙÔ˘ ÏËı˘ÛÌÔ‡, ÂÓÒ ÔÏÏ¿ ·fi Ù· ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η Â›Ó·È ÙÂÚ·ÙÔÁfiÓ· (14,15). ∏ ÂΉ‹ÏˆÛË ÙˆÓ Û˘ÁÁÂÓÒÓ ·ÓˆÌ·ÏÈÒÓ Û ÓÂÔÁÓ¿ ÙˆÓ ÔÔ›ˆÓ ÔÈ ÌËÙ¤Ú˜ ÂÌÊ·Ó›˙Ô˘Ó Û·ÛÌÔ‡˜ Î·È Ï·Ì‚¿ÓÔ˘Ó Î¿ÔÈ· Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ Â›Ó·È 2-3 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚË ·fi fi,ÙÈ ÛÙÔÓ ÁÂÓÈÎfi ÏËı˘ÛÌfi (11-13). OÈ ·ÈÙÈÔÏÔÁÈÎÔ› ·Ú¿ÁÔÓÙ˜ ÂÌÊ¿ÓÈÛ˘ Û˘ÁÁÂÓÒÓ ·ÓˆÌ·ÏÈÒÓ Â›Ó·È Ë ›‰È· Ë ÂÈÏË„›·
Paediatriki 2004;67:160-167
¯ˆÚ›˜ Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹, Ë ÁÂÓÂÙÈ΋ ÚԉȿıÂÛË, Ë ‚·Ú‡ÙËÙ· ÙˆÓ Û·ÛÌÒÓ, ÙÔ Â›‰Ô˜ Ù˘ ·ÓÙÈÂÈÏËÙÈ΋˜ ·ÁˆÁ‹˜, Ù· ›‰· ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Î·È Ë ıÂڷ›· Ì ÂÚÈÛÛfiÙÂÚ· ÙÔ˘ ÂÓfi˜ Ê¿Ú̷η (14,20,21). ™˘¯Ó¿ ·Ú·ÙËÚÂ›Ù·È ·ÏÏËÏÔÂÈÎ¿Ï˘„Ë ÙˆÓ ·ÓˆÌ·ÏÈÒÓ ·Ó¿ÌÂÛ· Û ‰È¿ÊÔÚ· ‰˘ÛÌÔÚÊÈο Û‡Ó‰ÚÔÌ· Ô˘ ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› Î·È Û¯ÂÙ›˙ÔÓÙ·È Ì ÙË Ï‹„Ë ·ÓÙÈÂÈÏËÙÈÎÒÓ Ê·Ú̿ΈÓ, ÂÓÒ ˘ÔÛÙËÚ›˙ÂÙ·È fiÙÈ Ù· Û‡Ó‰ÚÔÌ· ·˘Ù¿ ·ÓÙÈÚÔÛˆÂ‡Ô˘Ó ‰È·ÊÔÚÂÙÈΤ˜ ÌÔÚʤ˜ ÙÔ˘ ›‰ÈÔ˘ ÂÌ‚Ú˘˚ÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ (¶›Ó·Î·˜ 4) (16-18). OÈ Ì˯·ÓÈÛÌÔ› Ô˘ ÂÓÔ¯ÔÔÈÔ‡ÓÙ·È ÁÈ· ÙËÓ ·ıÔÁ¤ÓÂÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ›ӷÈ: ·) Ô ÌÂÙ·‚ÔÏÈÛÌfi˜ ·˘ÙÒÓ ÙˆÓ Ê·ÚÌ¿ÎˆÓ Ô˘ Ô‰ËÁ› ÛÙËÓ ·Ú·ÁˆÁ‹ ÙÔÍÈÎÒÓ ·ÛÙ·ıÒÓ ·Ú·ÁÒÁˆÓ ÙˆÓ ÂÔÍÂȉ›ˆÓ (19). ™Â ÔÚÈṲ̂ӷ ¿ÙÔÌ·, Ë ·Ú·ÁˆÁ‹ ÂÔÍÂȉ›ˆÓ ¢ÓÔÂ›Ù·È ·fi ÙËÓ ‡·ÚÍË ÁÂÓÂÙÈÎÔ‡ ÂÏÏ›ÌÌ·ÙÔ˜ Ô˘ ¶›Ó·Î·˜ 4. ™˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜ Ô˘ Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì ·ÓÙÈÂÈÏËÙÈο º·ÈÓ˘ÓÙÔ˝ÓË ◊È· ¤ˆ˜ ̤ÙÚÈ· ηı˘ÛÙ¤ÚËÛË ·Ó¿Ù˘Í˘ ∂˘Ú›· ÚfiÛıÈ· ËÁ‹ ÀÂÚÙÂÏÔÚÈÛÌfi˜ ∫·ı›˙ËÛË Ù˘ ‚¿Û˘ Ù˘ ÚÈÓfi˜ ∫ÔÓÙ‹ ̇ÙË Ì ΢ÚÙfi ¿Óˆ ¯Â›ÏÔ˜ ∂˘Ú¤· Ê·ÙÓ›· §·Áfi¯ÂÈÏÔ˜ Î·È Ï˘ÎfiÛÙÔÌ· ÀÔÏ·Û›· ÙˆÓ ¿ˆ Ê·Ï¿ÁÁˆÓ ÙˆÓ ‰·ÎÙ‡ÏˆÓ ªÈÎÚ¿ Ó‡¯È· ∫ÔÓÙfi˜ Ï·ÈÌfi˜ ∞ӈ̷ϛ˜ Ï¢ÚÒÓ ÀÂÚÙÚ›¯ˆÛË µ·Ï‚ȉÈ΋ ÛÙ¤ÓˆÛË Ó¢ÌÔÓÈ΋˜ ‹ ·ÔÚÙ‹˜ ªÂÛÔÎÔÈÏȷο ÂÏÏ›ÌÌ·Ù· ÀÔÛ·‰›·˜ µ·ÏÚÔ˚Îfi æËÏfi Ì¤ÙˆÔ ∂›Î·ÓıÔ˜ ∂˘Ú›· ‚¿ÛË Ì‡Ù˘ ÕÓˆ ÊÔÚ¿ ÙˆÓ ÚˆıÒÓˆÓ ª·ÎÚ‡ ÚÈÓÔ¯ÂÈÏÈÎfi ‰È¿ÛÙËÌ· ªÈÎÚfi ÛÙfiÌ· ™¯ÈÛٛ˜ Ì·Ïı·Î‹˜ ˘ÂÚÒ·˜ πÛıÌÈ΋ ÛÙ¤ÓˆÛË Ù˘ ·ÔÚÙ‹˜ ÀÔÏ·ÛÙÈ΋ ·ÚÈÛÙÂÚ‹ ÎÔÈÏ›· µ·Ï‚ȉÈ΋ ÛÙ¤ÓˆÛË ·ÔÚÙ‹˜ ªÂÛÔÎÔÏÈÎfi ¤ÏÏÂÈÌÌ· ªÂÛÔÎÔÈÏȷο ÂÏÏ›ÌÌ·Ù· ª·ÎÚÈ¿ ÏÂÙ¿ ‰¿ÎÙ˘Ï· ∫˘ÚÙ¿ Ó‡¯È· ∂ÏÏ›ÌÌ·Ù· Ó¢ÚÈÎÔ‡ ۈϋӷ ÀÔÛ·‰›·˜ ∫·Ú‚·Ì·˙›ÓË ∫Ú·ÓÈÔÚÔÛˆÈο ÂÏÏ›ÌÌ·Ù· ∂ÏÏ›ÌÌ·Ù· Ó¢ÚÈÎÔ‡ ۈϋӷ º·ÈÓÔ‚·Ú‚ÈÙ¿ÏË §·Áfi¯ÂÈÏÔ˜ Î·È Ï˘ÎfiÛÙÔÌ· ∫·Ú‰È·Î¿ ÂÏÏ›ÌÌ·Ù·
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¶·È‰È·ÙÚÈ΋ 2004;67:160-167
ÂϤÁ¯ÂÈ ÙË ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ˘‰ÚÔÏ¿Û˘ ÙÔ˘ ÂÔÍÂȉ›Ô˘ (14), ‚) Ë ·ÂÏ¢ı¤ÚˆÛË ÙÔÍÈÎÒÓ ÂχıÂÚˆÓ ÚÈ˙ÒÓ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙˆÓ Ê·Ú̿ΈÓ, Á) Ë ·Ó¿ÚÎÂÈ· Ê˘ÏÏÈÎÔ‡ ÔͤԘ ÏfiÁˆ ÌÂȈ̤Ó˘ ·ÔÚÚfiÊËÛ˘ ‹ ·˘ÍË̤ÓÔ˘ Ë·ÙÈÎÔ‡ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙÔ˘ (14) Î·È ‰) Ë ·Ó·ÛÙÔÏ‹ Ù˘ ·Ú·ÁˆÁ‹˜ Ê˘ÏÏÈÎÔ‡ ÔͤԘ ·fi ÙË ‰Ú¿ÛË ÙÔ˘ ‚·ÏÚÔ˚ÎÔ‡ ÔͤԘ (14). ŒÁÎ˘Â˜ Á˘Ó·›Î˜ Ô˘ ¿Û¯Ô˘Ó ·fi ÂÈÏË„›·, Ì ¯·ÌËÏ¿ ›‰· Ê˘ÏÏÈÎÔ‡ ÔͤԘ, ¤¯Ô˘Ó ·˘ÍË̤ÓË Èı·ÓfiÙËÙ· Ó· ÁÂÓÓ‹ÛÔ˘Ó ·È‰È¿ ÌÂ Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜ (23). ∏ ηڂ·Ì·˙›ÓË Î·È ÙÔ ‚·ÏÚÔ˚Îfi Ô͇ ÂÓÔ¯ÔÔÈÔ‡ÓÙ·È ÁÈ· ·ÓˆÌ·Ï›Â˜ ÙÔ˘ Ó¢ÚÈÎÔ‡ ۈϋӷ (1-2%), ÔÈ Ôԛ˜ ÛÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi Â›Ó·È ÔÛÊ˘˚Τ˜ ÌËÓÈÁÁÔÌ˘ÂÏÔ΋Ϙ (14). ∏ Ï‹„Ë Ê˘ÏÏÈÎÔ‡ ÔͤԘ ÚÈÓ ‹ ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË Û‡ÏÏË„Ë, ÌÂÈÒÓÂÈ ·˘ÙfiÓ ÙÔÓ Î›Ó‰˘ÓÔ Î·È Û˘ÓÈÛÙ¿Ù·È Ë ÚÔÏËÙÈ΋ ¯ÔÚ‹ÁËÛË Ê˘ÏÏÈÎÔ‡ ÔͤԘ ÛÙȘ Á˘Ó·›Î˜ Ô˘ ÚfiÎÂÈÙ·È Ó· Ì›ÓÔ˘Ó ¤ÁÎ˘Â˜ Û ‰fiÛË 0,4 mg ËÌÂÚËÛ›ˆ˜. ªÂÚÈÎÔ› Û˘ÓÈÛÙÔ‡Ó ·ÎfiÌË ÌÂÁ·Ï‡ÙÂÚ˜ ‰fiÛÂȘ, fiˆ˜ 4 mg ËÌÂÚËÛ›ˆ˜ (14,23). ∏ ·ÈÌÔÚÚ·ÁÈ΋ ÓfiÛÔ˜ ÙÔ˘ ÓÂÔÁÓÔ‡ ÔÊ›ÏÂÙ·È Û ¤ÏÏÂÈ„Ë ‚ÈÙ·Ì›Ó˘ ∫. º¿Ú̷η fiˆ˜ Ë Ê·ÈÓ˘ÓÙÔ˝ÓË, Ë Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË, Ë ÚÈÌȉfiÓË, Ë Î·Ú‚·Ì·˙›ÓË Î·È Ë ÂıÔÛÔ˘ÍÈÌ›‰Ë, ÌÂÈÒÓÔ˘Ó ÙË ‰È·Ï·ÎÔ˘ÓÙȷ΋ ÌÂÙ·ÊÔÚ¿ ‚ÈÙ·Ì›Ó˘ ∫ Î·È Â˘ı‡ÓÔÓÙ·È ÁÈ· ÙËÓ ·ÈÌÔÚÚ·ÁÈ΋ ÓfiÛÔ ÙˆÓ ÓÂÔÁÓÒÓ (14). ∆· Ê¿Ú̷η ·˘Ù¿ ÌÂÙ¤¯Ô˘Ó ÛÙÔÓ ÌÂÙ·‚ÔÏÈÛÌfi Ù˘ ‚ÈÙ·Ì›Ó˘ D, Ì ·ÔÙ¤ÏÂÛÌ· Ó· ÚÔηÏÔ‡Ó ‰Â˘ÙÂÚÔ·ı‹ ˘·Û‚ÂÛÙÈ·ÈÌ›· ÛÙË ÌËÙ¤Ú· Î·È ÙÔ ÓÂÔÁÓfi (14,22). ¢ÂÓ ¤¯ÂÈ ·Ô‰Âȯı› ·ÎfiÌË Ë ÙÂÚ·ÙÔÁfiÓÔ˜ ‰Ú¿ÛË ÙˆÓ ÓÂfiÙÂÚˆÓ ·ÓÙÈÂÈÏËÙÈÎÒÓ Ê·Ú̿ΈÓ, fiˆ˜ Ë Ï·ÌÔÙÚÈÁ›ÓË, Ë Áη̷ÂÓÙ›ÓË Î·È Ë ÊÂÏ‚·Ì¿ÙË (13). O ¤ÏÂÁ¯Ô˜ ÙˆÓ Û·ÛÌÒÓ Î·Ù¿ ÙËÓ ÂÁ΢ÌÔÛ‡ÓË Â›Ó·È È‰È·›ÙÂÚ· ÛËÌ·ÓÙÈÎfi˜. ∏ ÂÌÊ¿ÓÈÛË Û·ÛÌÒÓ ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÁ΢ÌÔÛ‡Ó˘ ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙ› Ì ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· ÚfiˆÚˆÓ ·Ô‚ÔÏÒÓ, ÚfiˆÚÔ˘ ÙÔÎÂÙÔ‡, ÂÓ‰ÔÎÚ¿ÓÈ·˜ ·ÈÌÔÚÚ·Á›·˜ ÛÙÔ ¤Ì‚Ú˘Ô, ÂÓ‰ÔÌ‹ÙÚÈÔ˘ ı·Ó¿ÙÔ˘ Î·È ‰È·Ù·Ú·¯ÒÓ ÛÙË Ì¿ıËÛË Î·È ·Ó¿Ù˘ÍË (13). ¶Èı·Ó¿ ·›ÙÈ· ıˆÚÔ‡ÓÙ·È ÙÔ ÙÚ·‡Ì· Î·È Ë ˘ÔÍ›·/ÈÛ¯·ÈÌ›· Ô˘ ÔÊ›ÏÂÙ·È Û ÂÏ·Ùو̤ÓË ‰È·Ï·ÎÔ˘ÓÙȷ΋ ÚÔ‹ (13,14). °È· ÙÔ˘˜ ·Ú·¿Óˆ ÏfiÁÔ˘˜ Û˘ÓÈÛÙ¿Ù·È Ë Û˘Ó¤¯ÈÛË Ù˘ ·ÓÙÈÂÈÏËÙÈ΋˜ ·ÁˆÁ‹˜ ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÁ΢ÌÔÛ‡Ó˘. ∏ ¯ÔÚ‹ÁËÛË ‚ÈÙ·Ì›Ó˘ ∫ Â›Ó·È ··Ú·›ÙËÙË ÁÈ· Ù· ÓÂÔÁÓ¿ Ô˘ ¤¯Ô˘Ó ÂÎÙÂı› ÂÓ‰ÔÌËÙÚ›ˆ˜ Û ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η. ∆· ÓÂÔÁÓ¿ ÙˆÓ ÔÔ›ˆÓ ÔÈ ÌËÙ¤Ú˜ ÙÂÏÔ‡Ó ˘fi ·ÁˆÁ‹ Ì ʷÈÓÔ‚·Ú‚ÈÙ¿ÏË ‹ ÚÈÌȉfiÓË, Ú¤ÂÈ Ó· ·Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·È ÁÈ· ÂΉËÏÒÛÂȘ ÛÙÂÚËÙÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘, ¤ˆ˜ Î·È ÙËÓ 7Ë Ë̤ڷ ˙ˆ‹˜.
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Paediatriki 2004;67:160-167
O ÌËÙÚÈÎfi˜ ıËÏ·ÛÌfi˜ ‰ÂÓ ·ÓÙÂӉ›ÎÓ˘Ù·È ÛÙËÓ ÂÚ›ÙˆÛË Ô˘ Ë ÌËÙ¤Ú· Ï·Ì‚¿ÓÂÈ ·ÓÙÈÂÈÏËÙÈ΋ ·ÁˆÁ‹. À¿Ú¯Ô˘Ó, fï˜, ÂӉ›ÍÂȘ ηٷÛÙÔÏ‹˜ Û ıËÏ¿˙ÔÓÙ· ‚Ú¤ÊË ÌËÙ¤ÚˆÓ Ô˘ Ï·Ì‚¿ÓÔ˘Ó Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË ‹ ÚÈÌȉfiÓË (14). πÛÔÙÚÂÙÈÓÔ˝ÓË ∏ ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜ ¯ÔÚ‹ÁËÛË ÈÛÔÙÚÂÙÈÓÔ˝Ó˘ ÁÈ· ÙË ıÂڷ›· Ù˘ ·ÎÌ‹˜ ηٿ ÙÔ ÚÒÙÔ ‰ÂηÂÓı‹ÌÂÚÔ Ù˘ ·ËÛ˘ Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ÂÌÊ¿ÓÈÛË Û˘ÁÁÂÓÒÓ ·ÓˆÌ·ÏÈÒÓ ÛÙÔ ¤Ì‚Ú˘Ô Û ÔÛÔÛÙfi ÂÚ›Ô˘ 35% (¶›Ó·Î·˜ 5) (12). O ·ıÔÊ˘ÛÈÔÏÔÁÈÎfi˜ Ì˯·ÓÈÛÌfi˜ Ì ÙÔÓ ÔÔ›Ô ÚÔηÏÔ‡ÓÙ·È ÔÈ Î˘ÙÙ·ÚÔÙÔÍÈΤ˜ ‚Ï¿‚˜ ÛÙÔ Ú·¯È·›Ô ÙÌ‹Ì· ÙÔ˘ Ó¢ÚÈÎÔ‡ ۈϋӷ, Â›Ó·È Ë ·ÂÏ¢ı¤ÚˆÛË ÙˆÓ ÚÈ˙ÒÓ ˘ÂÚÔÍÂȉ›Ô˘ (12). ∆· ÂÚÈÛÛfiÙÂÚ· ·fi Ù· ÓÂÔÁÓ¿ Ô˘ ¤¯Ô˘Ó ÂÎÙÂı› ÙȘ ÚÒÙ˜ Ë̤Ú˜ ÂÁ΢ÌÔÛ‡Ó˘ ÛÙÔ Ê¿ÚÌ·ÎÔ, ÂÌÊ·Ó›˙Ô˘Ó Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜. ∏ ·Ô˘Û›· Û˘ÁÁÂÓÒÓ ·ÓˆÌ·ÏÈÒÓ ‰ÂÓ ·ÔÎÏ›ÂÈ ÙËÓ ÂÌÊ¿ÓÈÛË ÓÔËÙÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ. °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi, Û˘ÓÈÛÙ¿Ù·È Ë Ó¢ÚÔ·Ó·Ù˘Íȷ΋ ÂÎÙ›ÌËÛË fiÏˆÓ ÙˆÓ ·È‰ÈÒÓ. §›ıÈÔ ∆Ô Ï›ıÈÔ Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈÎfi Ê¿ÚÌ·ÎÔ ÁÈ· ÙË Ì·ÓÈÔηٿıÏÈ„Ë Î·È ÙË Ì·Ó›·. ∆Ô Ê¿ÚÌ·ÎÔ Û˘Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ÂÌÊ¿ÓÈÛË Ù˘ ·ÓˆÌ·Ï›·˜ Ebstein (23,24). ∞˘Ù‹ Ë Û˘ÁÁÂÓ‹˜ ηډÈÔ¿ıÂÈ· ÂΉËÏÒÓÂÙ·È Ì ΢¿ÓˆÛË Ô˘ ÔÊ›ÏÂÙ·È Û ‚·Ï‚ȉÈ΋ ¶›Ó·Î·˜ 5. ∞ӈ̷ϛ˜ Û¯ÂÙÈ˙fiÌÂÓ˜ Ì ÙË Ï‹„Ë ÈÛÔÙÚÂÙÈÓÔ˝Ó˘ ∫Ú·ÓÈÔÚÔÛˆÈΤ˜ ªÈÎÚÔ‰ÔÓÙ›· ‹ ·ÓÔ‰ÔÓÙ›· ™Ù¤ÓˆÛË ÙÔ˘ ¤Íˆ ·ÎÔ˘ÛÙÈÎÔ‡ fiÚÔ˘ ¶·Ú¿Ï˘ÛË ÙÔ˘ ÚÔÛˆÈÎÔ‡ Ó‡ÚÔ˘ ªÈÎÚÔÁÓ·ı›· ∫·ı›˙ËÛË Ù˘ ‚¿Û˘ Ù˘ ÚÈÓfi˜ ÀÂÚÙÂÏÔÚÈÛÌfi˜ ™¯ÈÛٛ˜ Ì·Ïı·Î‹˜ ˘ÂÚÒ·˜ £‡ÌÔ˘ ∂ÎÙÔ›· ÀÔÏ·Û›· ¢˘ÛÏ·Û›· ∫·Ú‰È·Î¤˜ ªÔÓ‹Ú˘ ηډȷÎfi˜ ÎÒÓÔ˜ ∆ÂÙÚ·ÏÔÁ›· Fallot ªÂÙ¿ıÂÛË ÌÂÁ¿ÏˆÓ ·ÁÁ›ˆÓ ªÂÛÔÎÔÈÏȷο ÂÏÏ›ÌÌ·Ù· ∞Û˘Ó¤¯ÂȘ ·ÔÚÙÈÎÔ‡ ÙfiÍÔ˘ ÀÔÏ·ÛÙÈ΋ ·ÚÈÛÙÂÚ‹ ÎÔÈÏ›· ∫ÂÓÙÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ· À‰ÚÔΤʷÏÔ˜ ªÈÎÚÔÎÂÊ·Ï›· ¶·ÚÂÁÎÂÊ·ÏȉÈ΋ ˘ÔÏ·Û›· ¡ÔËÙÈ΋ ηı˘ÛÙ¤ÚËÛË ¢Èۯȉ‹˜ Ú¿¯Ë
May-June 04 chris new
19-07-04
19:24
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¶·È‰È·ÙÚÈ΋ 2004;67:160-167
·Ó¿ÚÎÂÈ· Î·È ˘ÂÚÎÔÈÏȷ΋ Ù·¯˘Î·Ú‰›·. ÕÏϘ ÂȉڿÛÂȘ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Â›Ó·È Ë ÓÂÔÁÓÈ΋ ‚ÚÔÁ¯Ô΋ÏË, Ë ˘ÔÙÔÓ›·, Ô ÎÔÏÈÎfi˜ ÙÂÚ˘ÁÈÛÌfi˜, Ë ·Ó·ÛÙÚÔÊ‹ ÙÔ˘ ∆ ·̷ÙÔ˜ ÛÙÔ ËÏÂÎÙÚÔηډÈÔÁÚ¿ÊËÌ·, Ô ¿ÔÈÔ˜ ‰È·‚‹Ù˘, ÙÔ shock, ÔÈ Û·ÛÌÔ› Î·È Ô ÚfiˆÚÔ˜ ÙÔÎÂÙfi˜ (12,24). ¢ÂÓ Û˘ÓÈÛÙ¿Ù·È Ë ‰È·ÎÔ‹ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ÂÍ·ÈÙ›·˜ Ù˘ ‰˘ÛÎÔÏ›·˜ Ó· ÂÏÂÁ¯ı› Ë Ì·ÓÈÔηٿıÏÈ„Ë, ·ÏÏ¿ ı· Ú¤ÂÈ Ó· ·Ú·ÎÔÏÔ˘ıÂ›Ù·È ËÏÂÎÙÚÔηډÈÔÁÚ·ÊÈο ÙÔ ¤Ì‚Ú˘Ô Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÚÒÙÔ˘ ÙÚÈÌ‹ÓÔ˘ Ù˘ ·ËÛ˘. ∆Ô Ï›ıÈÔ ÂÎÎÚ›ÓÂÙ·È ÛÙÔ ÌËÙÚÈÎfi Á¿Ï·, Û ¤ÁÎ˘Â˜ Á˘Ó·›Î˜ Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È Û ıÂڷ›· Ì ·˘Ùfi. ∆· ›‰· ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ÛÙ· ‚Ú¤ÊË Â›Ó·È 10-15% Ù˘ ÔÛfiÙËÙ·˜ Ô˘ Ï·Ì‚¿ÓÂÈ Ë ÌËÙ¤Ú·. OÈ ÂÈÏÔΤ˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Î˘¿ÓˆÛË, ˘ÔÙÔÓ›· Î·È ËÏÂÎÙÚÔηډÈÔÁÚ·ÊÈΤ˜ ·ÓˆÌ·Ï›Â˜ (12,24). ∞Ó·ÛÙÔÏ›˜ ÙÔ˘ ÌÂÙ·ÙÚÂÙÈÎÔ‡ ÂÓ˙‡ÌÔ˘ Ù˘ ·ÁÁÂÈÔÙÂÓÛ›Ó˘ OÈ ·Ó·ÛÙÔÏ›˜ ÙÔ˘ ÌÂÙ·ÙÚÂÙÈÎÔ‡ ÂÓ˙‡ÌÔ˘ (ACE), fiˆ˜ Ë Î·ÙÔÚ›ÏË, Ë ÂÓ·Ï·Ú›ÏË, Ë Ï˘ÛÈÓÔÚ›ÏË Î·È Ë ÎÈÓ·Ú›ÏË, Â›Ó·È Ôχ ·ÔÙÂÏÂÛÌ·ÙÈο ·ÓÙȸÂÚÙ·ÛÈο Ê¿Ú̷η, ¤¯Ô˘Ó Ï›Á˜ ·ÚÂÓ¤ÚÁÂȘ Î·È ¯ÔÚËÁÔ‡ÓÙ·È Û Á˘Ó·›Î˜ ·Ó··Ú·ÁˆÁÈ΋˜ ËÏÈΛ·˜. ∆Ô ¤Ó˙˘ÌÔ ACE ÌÂÙ·ÙÚ¤ÂÈ ÙËÓ ·ÁÁÂÈÔÙÂÓÛ›ÓË π Û ·ÁÁÂÈÔÙÂÓÛ›ÓË ππ, Ô˘ ¤¯ÂÈ ·ÁÁÂÈÔÛ˘Û·ÛÙÈΤ˜ ȉÈfiÙËÙ˜. ∆Ô Û‡ÛÙËÌ· Ù˘ ·ÁÁÂÈÔÙÂÓÛ›Ó˘ ¤¯ÂÈ ·Ô‰Âȯı› ÛËÌ·ÓÙÈÎfi ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË Î·È ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ÓÂÊÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ηٿ ÙËÓ ÂÌ‚Ú˘˚΋ ÂÚ›Ô‰Ô. ∆· ·ÓÙȸÂÚÙ·ÛÈο Ê¿Ú̷η ACE ‰ÂÓ ÚÔηÏÔ‡Ó Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜ Î·È ÏÂÈÙÔ˘ÚÁÈΤ˜ ‰È·Ù·Ú·¯¤˜ fiÙ·Ó Ï·Ì‚¿ÓÔÓÙ·È Î·Ù¿ ÙÔ 1Ô ÙÚ›ÌËÓÔ Ù˘ ·ËÛ˘. ∞ÓÙ›ıÂÙ·, Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜ Î·È ÏÂÈÙÔ˘ÚÁÈΤ˜ ‰È·Ù·Ú·¯¤˜ ÚÔηÏÔ‡ÓÙ·È ÛÙ· ÓÂÔÁÓ¿ Ô˘ ¤¯Ô˘Ó ÂÎÙÂı› ÛÙÔ Ê¿ÚÌ·ÎÔ Î·Ù¿ ÙÔ 2Ô Î·È 3Ô ÙÚ›ÌËÓÔ Ù˘ ·ËÛ˘. ∆· Ê¿Ú̷η ·˘Ù¿ ÚÔηÏÔ‡Ó ÂÏ·Ùو̤ÓË ÓÂÊÚÈ΋ ÚÔ‹, Ì ·ÔÙ¤ÏÂÛÌ· ÔÏÈÁÔ˘Ú›·, ·ÓÔ˘Ú›·, ÓÂÊÚÈ΋ ÛˆÏËÓ·Úȷ΋ ‰˘ÛÁÂÓÂÛ›· Î·È ÔÏÈÁ¿ÌÓÈÔ (26). ∏ ¯·ÌËÏ‹ ·ÚÙËÚȷ΋ ›ÂÛË Î·È ÙÔ ÔÏÈÁ¿ÌÓÈÔ Â˘ı‡ÓÔÓÙ·È ÁÈ· ÙË ÊÙˆ¯‹ ÂÚÈÊÂÚÈ΋ ÈÛÙÈ΋ ·ÈÌ¿ÙˆÛË Î·È ÙȘ ·˘ÍË̤Ó˜ ȤÛÂȘ ÛÙÔ ÂÌ‚Ú˘˚Îfi ÎÚ·Ó›Ô, Ì ·ÔÙ¤ÏÂÛÌ· ÊÙˆ¯‹ ÔÛÙÂÔÔ›ËÛË ÙˆÓ ÔÛÙÒÓ ÙÔ˘ ÎÚ·Ó›Ô˘. ∆· ÓÂÔÁÓ¿ Ô˘ ¤¯Ô˘Ó ÂÎÙÂı› ÂÓ‰ÔÌËÙÚ›ˆ˜ Û ·˘Ù¿ Ù· Ê¿Ú̷η, ÌÔÚ› Ó· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó ÛÔ‚·Ú‹ ˘fiÙ·ÛË Î·È ·ÓÔ˘Ú›·, Ó¢ÌÔÓÈ΋ ˘ÔÏ·Û›· ÏfiÁˆ ›ÂÛ˘ Î·È ·Ó·ÙÔÌÈΤ˜ ‰˘ÛϷۛ˜ (¶›Ó·Î·˜ 6) (26). ∆· Ê¿Ú̷η ·˘Ù¿ ‰ÂÓ ÚÔηÏÔ‡Ó ÂÓ‰ÔÌ‹ÙÚÈ· ηı˘ÛÙ¤ÚËÛË Ù˘ ·Ó¿Ù˘Í˘. ∏ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË ·˘ÙÒÓ ÙˆÓ ÓÂÔÁÓÒÓ ÌÂÙ¿ ÙË Á¤ÓÓËÛË ÂÚÈÏ·Ì‚¿ÓÂÈ ¤ÏÂÁ¯Ô Ù˘ ·ÚÙË-
Paediatriki 2004;67:160-167
¶›Ó·Î·˜ 6. ∂ȉڿÛÂȘ ÙÔ˘ ÌÂÙ·ÙÚÂÙÈÎÔ‡ ÂÓ˙‡ÌÔ˘ Ù˘ ·ÁÁÂÈÔÙÂÓÛ›Ó˘ §ÂÈÙÔ˘ÚÁÈΤ˜ ∞ÁÁÂÈԉȷÛÙÔÏ‹ ÀfiÙ·ÛË ∞ÓÔ˘Ú›· OÏÈÁÔ˘Ú›· OÏÈÁÔ¸‰Ú¿ÌÓÈÔ ∞Ó·ÙÔÌÈΤ˜ ∞ӈ̷ϛ˜ ¿ÎÚˆÓ ¶Ó¢ÌÔÓÈ΋ ˘ÔÏ·Û›· ∂ÏÏ›ÌÌ·Ù· ÎÚ·ÓÈ·ÎÒÓ ÔÛÙÒÓ
Úȷ΋˜ ›ÂÛ˘ Î·È Ù˘ ‰ÈÔ‡ÚËÛ˘ Î·È ÂͤٷÛË ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡. ∏ Ú‡ıÌÈÛË Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ ··ÈÙ› ÙËÓ ÚÔÛÂÎÙÈ΋ ¯ÔÚ‹ÁËÛË ˘ÁÚÒÓ Î·È ËÏÂÎÙÚÔÏ˘ÙÒÓ Î·È ¤ÏÂÁ¯Ô Ù˘ Ô˘Ú›·˜ Î·È Ù˘ ÎÚ·ÙÈÓ›Ó˘. O ˘ÂÚ˯ÔÁÚ·ÊÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙˆÓ ÓÂÊÚÒÓ Ì Doppler ı· ÚÔÛ‰ÈÔÚ›ÛÂÈ ÙËÓ Î·Ù¿ÛÙ·ÛË Ù˘ ÓÂÊÚÈ΋˜ ÚÔ‹˜ Î·È Ë ·ÎÙÈÓÔÁÚ·Ê›· ÙÔ˘ ÎÚ·Ó›Ô˘ ı· ·Ôηχ„ÂÈ ÂÚÈÔ¯¤˜ ÊÙˆ¯‹˜ ÔÛÙÂÔÔ›ËÛ˘ (26). ∞ÓÙÈËÎÙÈο ∏ ¯ÔÚ‹ÁËÛË ·ÓÙÈËÎÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ ıˆÚÂ›Ù·È È‰È·›ÙÂÚ· ÂÈΛӉ˘ÓË ÁÈ· ÙÔ ¤Ì‚Ú˘Ô, ·ÏÏ¿ Ë ¤Ó‰ÂÈÍË ¯ÔÚ‹ÁËÛ‹˜ ÙÔ˘˜ Û ÌËÙ¤Ú˜ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ıÚÔÌ‚ÔÂÌ‚ÔÏÈο ÂÂÈÛfi‰È· Â›Ó·È ··Ú·›ÙËÙË. ∏ ÎÔ˘Ì·Ú›ÓË ¯ÔÚËÁÂ›Ù·È ÁÈ· ÙËÓ ÚfiÏË„Ë Î·È ıÂڷ›· Ù˘ ıÚÔÌ‚ÔÂÌ‚ÔÏÈ΋˜ ÓfiÛÔ˘. ∞Ó·ÛÙ¤ÏÏÂÈ ÙË Û‡ÓıÂÛË ÙˆÓ ·fi ÙË ‚ÈÙ·Ì›ÓË ∫ ÂÍ·ÚÙÒÌÂÓˆÓ ·Ú·ÁfiÓÙˆÓ ‹Í˘, fiˆ˜ Ô II, VII, IX Î·È X. ∆Ô Ê¿ÚÌ·ÎÔ ÂÚÓ¿ ÛÙËÓ Î˘ÎÏÔÊÔÚ›· ÙÔ˘ ÂÌ‚Ú‡Ô˘ ‰È·Ì¤ÛÔ˘ ÙÔ˘ Ï·ÎÔ‡ÓÙ· Î·È ¤¯ÂÈ ÙÂÚ·ÙÔÁfiÓÔ ‰Ú¿ÛË ÛÙÔ ¤Ì‚Ú˘Ô (12) (¶›Ó·Î·˜ 7). ∏ ¤ÎıÂÛË ÛÙË ‚·ÚÊ·Ú›ÓË ÌÂٷ͇ 6˘ Î·È 12˘ ‚‰ÔÌ¿‰·˜ ·ËÛ˘, ÚÔηÏ› ÙÔ ÁÓˆÛÙfi Û‡Ó‰ÚÔÌÔ Ù˘ ‚·ÚÊ·Ú›Ó˘ ÛÂ Û˘¯ÓfiÙËÙ· 25% (12). ∏ ¤ÎıÂÛË ÛÙÔ Ê¿ÚÌ·ÎÔ ÌÂÙ¿ ÙË 12Ë Â‚‰ÔÌ¿‰· ·ËÛ˘, ÚÔηÏ› Ô˘Ï¤˜ (<5%) Ô˘ ÔÊ›ÏÔÓÙ·È Û ·ÈÌÔÚÚ·Á›· ÛÙÔÓ ÂÌ‚Ú˘˚Îfi ÈÛÙfi. ∂›Û˘, ÂÚÈÁÚ¿ÊÂÙ·È Ô Î›Ó‰˘ÓÔ˜ Ù˘ ·ÈÌÔÚÚ·Á›·˜ ÙÔ˘ ÂÌ‚Ú‡Ô˘ ÛÙÔ ÎÂÓÙÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ·, ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÙÔÎÂÙÔ‡, Â¿Ó Ë ÌËÙ¤Ú· Û˘Ó¯›˙ÂÈ ÙË Ï‹„Ë ÎÔ˘Ì·Ú›Ó˘ (12). ∏ Ë·Ú›ÓË ıˆÚÂ›Ù·È Ê¿ÚÌ·ÎÔ ÂÎÏÔÁ‹˜ ÁÈ· ÙË ıÂڷ›· ıÚÔÌ‚ÔÂÌ‚ÔÏÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ Ù˘ ÂÁ·Ԣ. ∆Ô Ê¿ÚÌ·ÎÔ ‰ÂÓ ÂÚÓ¿ ÛÙËÓ Î˘ÎÏÔÊÔÚ›· ÙÔ˘ ÂÌ‚Ú‡Ô˘ ‰È·Ì¤ÛÔ˘ ÙÔ˘ Ï·ÎÔ‡ÓÙ·, ‰ÂÓ Â›Ó·È ÙÂÚ·ÙÔÁfiÓÔ Î·È ‰ÂÓ ·Ó·Ê¤ÚÔÓÙ·È ¿ÏϘ ·ÚÂÓ¤ÚÁÂȘ ÛÙÔ ¤Ì‚Ú˘Ô Î·È ÙÔ ÓÂÔÁÓfi. π‰È·›ÙÂÚ·, Ë ÌÈÎÚfiÙÂÚÔ˘ ÌÔÚÈ·ÎÔ‡ ‚¿ÚÔ˘˜ Ë·Ú›ÓË ıˆÚÂ›Ù·È ÂÚÈÛÛfiÙÂÚÔ ·ÛÊ·Ï‹˜ ÁÈ· ¯ÔÚ‹ÁËÛË Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÚÒÙÔ˘ ÙÚÈÌ‹ÓÔ˘ Ù˘ ·ËÛ˘.
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¶›Ó·Î·˜ 7. ™‡Ó‰ÚÔÌÔ ‚·ÚÊ·Ú›Ó˘ ∂Ì‚Ú˘Ô¿ıÂÈ· ·fi ÙË Ï‹„Ë ‚·ÚÊ·Ú›Ó˘ ÀÔÏ·Û›· ̇Ù˘ ∫·ı›˙ËÛË ‚¿Û˘ Ù˘ ÚÈÓfi˜ ªË ÔÛÙÂÔÔÈË̤Ó˜ ÂÈʇÛÂȘ ‹ ÎÔÎΛˆÛË ÂÈʇÛˆÓ, ȉȷ›ÙÂÚ· ÙÔ˘ ÎÔÚÌÈÎÔ‡ ÛÎÂÏÂÙÔ‡ Î·È ÙÔ˘ ÂÁÁ‡˜ ÌËÚÈ·›Ô˘ ª¤ÙÚÈ· ˘ÔÏ·Û›· Ó˘¯ÈÒÓ Î·È ÎÔÓÙ¿ ‰¿¯Ù˘Ï· ¡ÔËÙÈ΋ ηı˘ÛÙ¤ÚËÛË ™·ÛÌÔ› ÕÏϘ ÂÌ‚Ú˘˚Τ˜/ÓÂÔÁÓÈΤ˜ Û˘Ó¤ÂȘ ∞˘ÙfiÌ·ÙË ¤ÎÙÚˆÛË ∂Ó‰ÔÌ‹ÙÚÈÔ˜ ı¿Ó·ÙÔ˜ ªÈÎÚÔÎÂÊ·Ï›· À‰ÚÔΤʷÏÔ˜ ¢˘ÛÏ·Û›· Dandy-Walker ∞ÁÂÓÂÛ›· ÌÂÛÔÏÔ‚›Ô˘ OÙÈ΋ ·ÙÚÔÊ›· ªÈÎÚÔÊı·ÏÌ›· ∂Ó‰ÔÎÚ¿ÓÈ· ·ÈÌÔÚÚ·Á›·
∆· ÓÂÔÁÓ¿ Ì ¤ÎıÂÛË ÛÙËÓ ÎÔ˘Ì·Ú›ÓË Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÚÒÙÔ˘ ÙÚÈÌ‹ÓÔ˘ ·ËÛ˘ Ú¤ÂÈ Ó· ÂÍÂÙ¿˙ÔÓÙ·È ÚÔÛÂÎÙÈο ÌÂÙ¿ ÙË Á¤ÓÓËÛË, ÚÔÎÂÈ̤ÓÔ˘ Ó· ‰È·ÈÛÙˆı› Ù˘¯fiÓ ÂÌ‚Ú˘Ô¿ıÂÈ·. ∂¿Ó Ë ¤ÎıÂÛË Û˘Ì‚Â› ÛÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‰Â‡ÙÂÚÔ˘ ‹ ÙÚ›ÙÔ˘ ÙÚÈÌ‹ÓÔ˘ ·ËÛ˘, Ë ÂͤٷÛË ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÔ ÎÂÓÙÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ· Î·È ÙÔÓ ¤ÏÂÁ¯Ô Ì ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÂÁÎÂÊ¿ÏÔ˘. ∂¿Ó Ë ÌËÙ¤Ú· Ï¿Ì‚·Ó ÎÔ˘Ì·Ú›ÓË 48-72 ÒÚ˜ ÚÈÓ ·fi ÙÔÓ ÙÔÎÂÙfi, ÙÔ ÓÂÔÁÓfi ı· Ú¤ÂÈ Ó· ÂϤÁ¯ÂÙ·È ÁÈ· ·ÈÌÔÚÚ·ÁÈΤ˜ ÂΉËÏÒÛÂȘ (12). ™˘ÌÂÚ¿ÛÌ·Ù· ªÂ ÂÍ·›ÚÂÛË ÙËÓ ÈÛÔÙÚÂÙÈÓÔ˝ÓË Ô˘ ·ÓÙÂӉ›ÎÓ˘Ù·È ÏfiÁˆ ‰˘ÓËÙÈ΋˜ ÙÂÚ·ÙÔÁ¤ÓÂÛ˘, fiÏ· Ù· ¿ÏÏ· Ê¿Ú̷η ÌÔÚÔ‡Ó Ó· ¯ÔÚËÁËıÔ‡Ó, ÂÊfiÛÔÓ ˘¿Ú¯ÂÈ ·fiÏ˘ÙË ¤Ó‰ÂÈÍË Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÁ΢ÌÔÛ‡Ó˘. O ÓÂÔÁÓÔÏfiÁÔ˜ ‹ Ô ·È‰›·ÙÚÔ˜ ı· Ú¤ÂÈ Ó· ÁÓˆÚ›˙ÂÈ ÙÔ˘˜ ÎÈÓ‰‡ÓÔ˘˜ ·fi ÙËÓ ¤ÎıÂÛË ÙÔ˘ ÂÌ‚Ú‡Ô˘ Û ·˘ÙÔ‡˜ ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ Î·È Ó· Â›Ó·È È‰È·›ÙÂÚ· ÚÔÛÂÎÙÈÎfi˜ ηٿ ÙËÓ ÂÎÙ›ÌËÛË ÙÔ˘ ÓÂÔÁÓÔ‡. µÈ‚ÏÈÔÁÚ·Ê›· 1. American Academy of Pediatrics. Committee on Substance Abuse and Committee on Children with Disabilities. Fetal alcohol syndrome and alcohol-related neurodevelopmental disorders. Pediatrics 2000;106:358-361. 2. Hibell B, Andersson B, Ahlstrom S, Balakireva O, Bjarnason T, Kokkevi A et al. Alcohol and other drug use among students in 30 European countries. The 1999 ESPAD Report. The European School Survey Project on Alcohol and Other Drugs. 1999. p. 88-91. 3. Clarren SK, Smith DW. The fetal alcohol syndrome. N Engl J Med 1978;298:1063-1067. 4. Aase JM, Jones KL, Clarren SK. Do we need the term “FAE”? Pediatrics 1995;95:428-430.
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5. Cordero JF, Floyd RL, Martin ML, Davis M, Hymbaugh K. Tracking the prevalence of FAS. Alcohol Health Res World 1994;18:82-85. 6. Boyle RJ. Effects of certain prenatal drugs on the fetus and the newborn. Pediatr Rev 2002;23:17-24. 7. Charness ME, Simon RP, Greenberg DA. Ethanol and the nervous system. N Engl J Med 1989;321:442-454. 8. Harrison GG, Branson RS, Vaucher YE. Association of maternal smoking with body composition of the newborn. Am J Clin Nutr 1983;38:757-762. 9. Klonoff-Cohen HS, Srinivasan IP, Edelstein SL. Prenatal and intrapartum events and sudden infant death syndrome. Paediatr Perinat Epidemiol 2002;16:82-89. 10. Temesvari P, Boda D, Kecskemeti L, Eck E, Endreffy E. Deleterious effects of smoking during pregnancy: studies on blood oxygen affinity. Acta Paediatr Hung 1984;25:371-376. 11. Eller DP, Patterson CA, Webb GW. Maternal and fetal implications of anticonvulsive therapy during pregnancy. Obstet Gynecol Clin North Am 1997;24:523-534. 12. Koren G, Pastuszak A, Ito S. Drugs in pregnancy. N Engl J Med 1998;338:1128-1137. 13. Malone FD, D’Alton ME. Drugs in pregnancy: anticonvulsants. Semin Perinatol 1997;21:114-123. 14. Zahn CA, Morrell MJ, Collins SD, Labiner DM, Yerby MS. Management issues for women with epilepsy: a review of the literature. Neurology 1998;51:949-956. 15. Hauser WA, Annegers JF, Rocca WA. Descriptive epidemiology of epilepsy: contributions of populationbased studies from Rochester, Minnesota. Mayo Clin Proc 1996;71:576-586. 16. Yerby MS, Leppik I. Epilepsy and the outcome of pregnancy. J Epilepsy 1990;3:193-199. 17. Speidel BD, Meadow SR. Maternal epilepsy and abnormalities of the fetus and newborn. Lancet 1972;2:839-843. 18. Nakane Y, Okuma T, Takahashi R, Sato Y, Wada T, Sato T et al. Multi-institutional study on the teratogenicity and fetal toxicity of antiepileptic drugs: a report of a collaborative study group in Japan. Epilepsia 1980;21:663-680. 19. Lindhout D, Hoppener RJ, Meinardi H. Teratogenicity of antiepileptic drug combinations with special emphasis on epoxidation (of carbamazepine). Epilepsia 1984;25:77-83. 20. Kelly TE, Edwards P, Rein M, Miller JQ, Dreifuss FE. Teratogenicity of anticonvulsant drugs. II: A prospective study. Am J Med Genet 1984;19:435-443. 21. Kaneko S, Otani K, Fukushima Y, Ogawa Y, Nomura Y, Ono T et al. Teratogenicity of antiepileptic drugs: analysis of possible risk factors. Epilepsia 1988;29:459-467. 22. Sheth RD, Wesolowski CA, Jacob JC, Penney S, Hobbs GR, Riggs JE et al. Effect of carbamazepine and valproate on bone mineral density. J Pediatr 1995;127:256-262. 23. MRC Vitamin Study Research Group. Prevention of neural tube defects: results of the Medical Research Council vitamin study. Lancet 1991;338:131-137. 24. Committee on Drugs. American Academy of Pediatrics. Use of psychoactive medication during pregnancy and possible effects on the fetus and newborn. Pediatrics 2000;105:880-887. 25. Cohen LS, Friedman JM, Jefferson JW, Johnson EM,
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∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 28-03-2003 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 09-09-2003 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ª·Ú›· ¢·ÛÔÔ‡ÏÔ˘ ¶··‰È·Ì·ÓÙÔÔ‡ÏÔ˘ 11, ∆.∫. 115 28, πÏ›ÛÈ· E-mail: kpaplos@med.uoa.gr
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¶·È‰È·ÙÚÈ΋ 2004;67:168-172
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Paediatriki 2004;67:168-172
REVIEW ARTICLE
∏ ÎÂÊ·Ï·ÏÁ›· Û·Ó Û‡Ìو̷ ÛÙË ÁÂÓÈ΋ ·È‰È·ÙÚÈ΋ ∂. ª·˙›ÁÔ˘ - ºˆÙÔÔ‡ÏÔ˘
Headache as a symptom in the practice of the general paediatrics H. Bazigou - Fotopoulou
¶ÂÚ›ÏË„Ë: ∏ ÎÂÊ·Ï·ÏÁ›· Â›Ó·È ¤Ó· Ôχ Û˘ÓËıÈṲ̂ÓÔ Û‡Ìو̷ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ ÌÂ Û˘¯ÓfiÙËÙ· Ô˘ ·˘Í¿ÓÂÈ Ì ÙËÓ ¿ÚÔ‰Ô Ù˘ ËÏÈΛ·˜. O ‰È·¯ˆÚÈÛÌfi˜ Ù˘ Û ڈÙÔ·ı‹, Ì ·ÚÈÔ ÂÎÚfiÛˆÔ ÙËÓ ËÌÈÎÚ·Ó›· Î·È Û ‰Â˘ÙÂÚÔ·ı‹ ‹ ÔÚÁ·ÓÈ΋˜ ·ÈÙÈÔÏÔÁ›·˜ ÎÂÊ·Ï·ÏÁ›·, ·ÔÙÂÏ› ÙÔ ÚÒÙÔ ‚‹Ì· ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛ‹ Ù˘. ∆Ô ¿ÚıÚÔ ·˘Ùfi ·Ó·Ê¤ÚÂÙ·È ÛÙË ‰Â˘ÙÂÚÔ·ı‹ ÎÂÊ·Ï·ÏÁ›·, Ì ÔÍ›· ‹ ¯ÚfiÓÈ· ÔÚ›·, ÛÙËÓ ·ÈÙÈÔÏÔÁ›· Ù˘ Î·È ÛÙË ÛÙÚ·ÙËÁÈ΋ fiÛÔÓ ·ÊÔÚ¿ ÛÙË ‰È·ÁÓˆÛÙÈ΋ Ù˘ ÚÔÛ¤ÁÁÈÛË.
Abstract: Headache is a common occurrence in the paediatric population and its prevalence increases with age. Headache disorders are divided into primary (migraine) and secondary categories. In clinical practice it is necessary first to exclude or identify secondary headaches, based on a directed history, physical examination and the use of diagnostic tests. This article considers acute and chronic non-migraine headaches in children, covering differential aetiologies and diagnostic decisions.
§¤ÍÂȘ ÎÏÂȉȿ: ‰Â˘ÙÂÚÔ·ı‹˜ ÎÂÊ·Ï·ÏÁ›·, ÁÂÓÈ΋ ·È‰È·ÙÚÈ΋.
Key words: paediatrics.
∂ÈÛ·ÁˆÁ‹ ∏ ›ӷ Î·È Ë ‰›„· Ì·˙› Ì ÙËÓ ÎÂÊ·Ï·ÏÁ›· ıˆÚÔ‡ÓÙ·È ÔÈ Û˘¯ÓfiÙÂÚ˜ ·Èٛ˜ ·ÓıÚÒÈÓ˘ ηÎÔ˘¯›·˜ Û fiϘ ÙȘ ËÏÈ˘ Î·È Û fiϘ ÙȘ ÂÔ¯¤˜. ∏ ÔÛÊ˘·ÏÁ›· Î·È Ë ÎÂÊ·Ï·ÏÁ›· Â›Ó·È Û˘ÌÙÒÌ·Ù· Ô˘ ·ÓÙÈÚÔÛˆÂ‡Ô˘Ó ¿Ú· ÔÏÏ¿ ÓÔÛ‹Ì·Ù·. ∏ ·ÈÌ·ÙÔ˘Ú›· Î·È Ë ÎÂÊ·Ï·ÏÁ›· Â›Ó·È Î·Ù’ ÂÍÔ¯‹Ó Ù· Û˘ÌÙÒÌ·Ù· Ô˘ ÚÔηÏÔ‡Ó ÙË ÌÂÁ·Ï‡ÙÂÚË ·ÓËÛ˘¯›· ÙˆÓ ·ÛıÂÓÒÓ Î¿ı ËÏÈΛ·˜. ∏ ÎÂÊ·Ï·ÏÁ›· Â›Ó·È ÙÔ Û˘¯ÓfiÙÂÚÔ Û‡Ìو̷ Ô˘ Ô ·ÛıÂÓ‹˜ ÂÈ˙ËÙ¿ Ó¢ÚÔ·ÂÈÎÔÓÈÛÙÈÎfi ¤ÏÂÁ¯Ô. ∂ȉËÌÈÔÏÔÁÈο ÛÙÔȯ›· ¶ÚfiÛÊ·Ù˜ ÌÂϤÙ˜ ·Ô‰ÂÈÎÓ‡Ô˘Ó fiÙÈ Ù· ÙÂÏÂ˘Ù·›· 30 ¯ÚfiÓÈ· ·Ú·ÙËÚ‹ıËΠÛËÌ·ÓÙÈ΋ ·‡ÍËÛË Ù˘ ÎÂÊ·Ï·ÏÁ›·˜ ÛÙÔÓ ÁÂÓÈÎfi ÏËı˘ÛÌfi ÁÈ· ¿ÁÓˆÛÙÔ˘˜ ÏfiÁÔ˘˜. ŸÛÔÓ ·ÊÔÚ¿ ÛÙ· ·È‰È¿, ÙÔ 1974, ÔÛÔÛÙfi 14,4% ÙˆÓ ·È‰ÈÒÓ ËÏÈΛ·˜ 7 ÂÙÒÓ ·ÚÔ˘Û›·˙ ÎÂÊ·Ï·ÏÁ›·, ÂÓÒ ÙÔ 1992, ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ÔÛÔÛÙfi ‹Ù·Ó 51,5%. ∞Ó¿ÏÔÁË ·‡ÍËÛË, ÛÙÔÓ ›‰ÈÔ ÏËı˘ÛÌfi, ·-
ÚÔ˘Û›·ÛÂ Î·È Ô ÂÈÔÏ·ÛÌfi˜ Ù˘ ËÌÈÎÚ·Ó›·˜, Ë ÔÔ›· ·fi 1,9% ÙÔ 1974 ·Ó‹Ïı Û 5,7% ÙÔ 1992 (1). ∏ Û˘¯ÓfiÙËÙ· Ù˘ ÎÂÊ·Ï·ÏÁ›·˜ Î˘Ì·›ÓÂÙ·È ÛÙËÓ ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ· Û ÔÛÔÛÙfi 4-20%, ηٿ ÙËÓ Â›ÛÔ‰Ô ÛÙÔ Û¯ÔÏÂ›Ô Û 38-50% Î·È ÛÙËÓ ÂÊ˂›· Û 50-75% (1,2). ∏ ÎÂÊ·Ï·ÏÁ›·, ÂÍ¿ÏÏÔ˘, ˆ˜ ˘ÔÎÂÈÌÂÓÈÎfi Û‡Ìو̷, ··ÈÙ› ÙË Ì·ÚÙ˘Ú›· ÙÔ˘ ·ÛıÂÓÔ‡˜, Ë ÔÔ›· fï˜ ·Ô˘ÛÈ¿˙ÂÈ Ù· ÙÚ›· ÚÒÙ· ¯ÚfiÓÈ· Ù˘ ˙ˆ‹˜ Ì ·ÔÙ¤ÏÂÛÌ· Ó· ˘ÔÂÎÙÈÌ¿Ù·È Ë Û˘¯ÓfiÙËÙ¿ Ù˘ ÛÙËÓ ËÏÈΛ· ·˘Ù‹ (3). ™Â ÌÂÌÔӈ̤ÓË ÌÂϤÙË ·Ó·Ê¤ÚÂÙ·È fiÙÈ ·È‰È¿ ËÏÈΛ·˜ 3 ÂÙÒÓ Â›¯·Ó ÂÌÂÈÚ›· ÎÂÊ·Ï·ÏÁ›·˜ Û ÔÛÔÛÙfi 15%, ÂÓÒ 3% ›¯Â ˘ÔÙÚÔÈ¿˙ÔÓÙ˜ ÔÓÔÎÂÊ¿ÏÔ˘˜ (4). ∏ ‚·ÛÈ΋ ·ÓËÛ˘¯›· ÛÙËÓ ÚÔÛ¤ÁÁÈÛË Ù˘ ÎÂÊ·Ï·ÏÁ›·˜, ÁÂÓÈο, Â›Ó·È Ô ‰È·¯ˆÚÈÛÌfi˜ Ù˘ ÚˆÙÔ·ıÔ‡˜ ·fi ÙË ‰Â˘ÙÂÚÔ·ı‹ ‹ ÔÚÁ·ÓÈ΋, ÛÙËÓ ÔÔ›· ·Ó·Ê¤ÚÂÙ·È ÙÔ ¿ÚıÚÔ ·˘Ùfi. ∏ ‰Â˘ÙÂÚÔ·ı‹˜ ÎÂÊ·Ï·ÏÁ›· ·ÔÙÂÏ› ÙÔ 10% Ù˘ ·È‰È΋˜ ÎÂÊ·Ï·ÏÁ›·˜ ÛÙÔ Û‡ÓÔÏfi Ù˘. ªÂÙ¿ ÙÔÓ ‰È·¯ˆÚÈÛÌfi ·˘Ùfi, Ë ÚÔÛÔ¯‹ ÂÈÎÂÓÙÚÒÓÂÙ·È ÛÙËÓ ·ÈÙÈÔÏfiÁËÛË Ù˘
¶·È‰ÔÓ¢ÚÔÏÔÁÈ΋ ∫ÏÈÓÈ΋, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ ¶ÂÓÙ¤Ï˘, ∞ı‹Ó·
Department of Paediatric Neurology, Penteli Children’s Hospital, Athens
168
secondary
headache,
general
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¶·È‰È·ÙÚÈ΋ 2004;67:168-172
‰Â˘ÙÂÚÔ·ıÔ‡˜ ϤÔÓ ÎÂÊ·Ï·ÏÁ›·˜, Ì ÛÎÔfi Ó· ·ÔÎÏÂÈÛÙÔ‡Ó ÛÔ‚·Ú¤˜ Ó¢ÚÔÏÔÁÈΤ˜ ·ı‹ÛÂȘ, fiˆ˜ ¯ˆÚÔηٷÎÙËÙÈΤ˜ ÂÂÍÂÚÁ·Û›Â˜ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘, ÊÏÂÁÌÔÓ¤˜ ÙÔ˘ ∫¡™, ÂÓ‰ÔÎÚ·ÓȷΤ˜ ·ÈÌÔÚÚ·Á›Â˜ Î·È ÔÏ˘Û˘ÛÙËÌ·ÙÈο ÓÔÛ‹Ì·Ù·. ∏ ÂÈÛÙ‹ÌË Ù˘ ÛÙ·ÙÈÛÙÈ΋˜ Î·È Ë ÛˆÛÙ‹ È·ÙÚÈ΋ ·ÍÈÔÏfiÁËÛË ÙˆÓ ·ÛıÂÓÒÓ Â›Ó·È ‚·ÛÈο ÛËÌ›·, ÛÙ· ÔÔ›· Ô ÁÈ·ÙÚfi˜ Ú¤ÂÈ Ó· ÛÙËÚȯÙ› ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË Ù˘ ÎÂÊ·Ï·ÏÁ›·˜ Û ÔÔÈ·‰‹ÔÙ ËÏÈΛ·. ™Â Ì›· ÌÂϤÙË Ô˘ ·ÊÔÚÔ‡Û Û 54.000 ·È‰È¿ Ô˘ ÚÔÛÎÔÌ›ÛÙËÎ·Ó ÛÙ· Â͈ÙÂÚÈο È·ÙÚ›· ÙÔ˘ ·È‰È·ÙÚÈÎÔ‡ ÓÔÛÔÎÔÌ›Ԣ ÙÔ˘ Miami ÙÔ 1993, ‚Ú¤ıËΠfiÙÈ ÛÙÔ ‰È¿ÛÙËÌ· ·˘Ùfi 696 ·ÛıÂÓ›˜ (1,3%) ›¯·Ó ˆ˜ ·ÚÈÔ Û‡Ìو̷ ÙËÓ ÎÂÊ·Ï·ÏÁ›· (4). ™ÙËÓ ›‰È· ÌÂϤÙË ‚Ú¤ıËΠfiÙÈ Û 288 ·fi ·˘Ù¿ Ù· ·È‰È¿ Ù· Û˘¯ÓfiÙÂÚ· ·›ÙÈ· Ù˘ ÎÂÊ·Ï·ÏÁ›·˜ ÂÚÈÂÏ¿Ì‚·Ó·Ó (∂ÈÎfiÓ· 1): ÈÔÁÂÓ›˜ ÏÔÈÌÒÍÂȘ (39,2%), ÊÏÂÁÌÔÓ¤˜ ·Ú·ÚÚ›ÓÈˆÓ ÎfiÏˆÓ (16%), ËÌÈÎÚ·Ó›· (15,6%), ÌÂÙ·ÙÚ·˘Ì·ÙÈ΋ ÎÂÊ·Ï·ÏÁ›· (6,6%), ÈÔÁÂÓ‹ ÌËÓÈÁÁ›Ùȉ· (5,2%), ÛÙÚÂÙÔÎÔÎÎÈ΋ Ê·Ú˘ÁÁ›Ùȉ· (5,2%), ÎÂÊ·Ï·ÏÁ›· Ù¿Û˘ (4,5%) Î·È ¿ÏÏ· ·›ÙÈ· (7,7%). ™Â ·ÚfiÌÔȘ ÌÂϤÙ˜ ‰È·ÈÛÙÒÓÂÙ·È fiÙÈ ÙÔ ÔÛÔÛÙfi ÎÂÊ·Ï·ÏÁ›·˜ ÛÙ· ·È‰È·ÙÚÈο Â͈ÙÂÚÈο È·ÙÚ›· Ô˘ ÔÊ›ÏÂÙ·È Û ÛÔ‚·Ú¤˜ Ó¢ÚÔÏÔÁÈΤ˜ ·ı‹ÛÂȘ, ÏËÓ ÙˆÓ ÊÏÂÁÌÔÓÒÓ ÙÔ˘ ∫¡™, Î˘Ì·›ÓÂÙ·È ·fi 0-1% (5,6). ∆‡ÔÈ Î·È ·ÈÙÈÔÏÔÁ›· ÎÂÊ·Ï·ÏÁÈÒÓ O ÙÚfiÔ˜ ÂÈÛ‚ÔÏ‹˜ Ù˘ ÎÂÊ·Ï·ÏÁ›·˜ Î·È Ë Û˘ÓÔÏÈ΋ Ù˘ ‰È¿ÚÎÂÈ· ·Ú¤¯Ô˘Ó ÛËÌ·ÓÙÈΤ˜ ÏËÚÔÊÔڛ˜ ÁÈ· ÙË ‰ÈÂÚ‡ÓËÛ‹ Ù˘. ™‡Ìʈӷ Ì ٷ ÛÙÔȯ›· ·˘Ù¿, Ë ÎÂÊ·Ï·ÏÁ›· ‰È·ÎÚ›ÓÂÙ·È Û ÔÍ›· (ÁÂÓÈÎÂ˘Ì¤ÓË ‹ ÂÓÙÔÈṲ̂ÓË), ÔÍ›· ˘ÔÙÚÔÈ¿˙Ô˘Û· Î·È ¯ÚfiÓÈ· (ÂȉÂÈÓÔ‡ÌÂÓË ‹ ÛÙ·ıÂÚ‹) (∂ÈÎfiÓ· 2). ¶ÔÛÔÛÙfi 70% ÙˆÓ ÎÂÊ·Ï·ÏÁÈÒÓ Â›Ó·È ÔÍ›˜. OÍ›· ÁÂÓÈÎÂ˘Ì¤ÓË ÎÂÊ·Ï·ÏÁ›· ∆· Û˘ÓËı¤ÛÙÂÚ· ·›ÙÈ· Ì›·˜ ÔÍ›·˜ ÁÂÓÈÎÂ˘Ì¤Ó˘ ÎÂÊ·Ï·ÏÁ›·˜ ÛÙ· ·È‰È¿ ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1 (2,6). O ˘ÚÂÙfi˜ ÔÔÈ·Û‰‹ÔÙ ·ÈÙÈÔÏÔÁ›·˜ ıˆÚÂ›Ù·È ÙÔ Û˘¯ÓfiÙÂÚÔ ·›ÙÈÔ. ™˘Ó‹ıˆ˜, Ë ¤Ó·ÚÍË Î·È Ë ‡ÊÂÛË Ù˘ ÎÂÊ·Ï·ÏÁ›·˜ Û˘Ì›ÙÔ˘Ó Ì ÙËÓ ÂÈÛ‚ÔÏ‹ Î·È ÙËÓ ·ÔıÂڷ›· Ù˘ Ïԛ̈͢, ·ÓÙ›ÛÙÔȯ·. ™Â ÂÚ›ÙˆÛË Ïԛ̈͢ ÙÔ˘ ∫¡™, Ë ÂËÚ·Ṳ̂ÓË ÁÂÓÈ΋ ηٿÛÙ·ÛË Ì·˙› Ì ٷ Â˘Ú‹Ì·Ù· ·fi ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË Î·È ÙËÓ ÔÛÊ˘ÔÓˆÙÈ·›· ·Ú·Î¤ÓÙËÛË Û˘Ì‚¿ÏÏÔ˘Ó ÛÙËÓ ·ÍÈÔÏfiÁËÛË Ù˘ ÎÂÊ·Ï·ÏÁ›·˜. ™ÙËÓ ÂÚ›ÙˆÛË Î¿ÎˆÛ˘ Ù˘ ÎÂÊ·Ï‹˜, ı· Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÂÙ·È ˘’ fi„ÈÓ ÙÔ ÂӉ¯fiÌÂÓÔ Î·ÎÔÔ›ËÛ˘ ÙÔ˘ ·ÛıÂÓÔ‡˜. ™ÙËÓ ˘·Ú·¯ÓÔÂȉ‹ ·ÈÌÔÚÚ·Á›·, Ë ·Ô˘Û›· ˘ÚÂÙÔ‡, Ë ‰˘Ûη̄›· Î·È Ë Í·Óıԯڈ̷ÙÈ΋ fi„Ë ÙÔ˘ ∂¡À ı¤ÙÔ˘Ó Â‡ÎÔÏ· ÙË ÛˆÛÙ‹ ‰È¿ÁÓˆÛË. OÍ›· ÂÓÙÔÈṲ̂ÓË ÎÂÊ·Ï·ÏÁ›· ™ÙËÓ ÔÍ›· ÂÓÙÔÈṲ̂ÓË ÎÂÊ·Ï·ÏÁ›· (6), ÔÈ ÔÍ›˜
Paediatriki 2004;67:168-172
∂ÈÎfiÓ· 1. ∫·Ù·ÓÔÌ‹ Ù˘ ÎÂÊ·Ï·ÏÁ›·˜ ‚¿ÛÂÈ ÙÔ˘ ·ÈÙ›Ô˘ (n=288) (Burton LJ et al. Pediatr Emerg Care 1997;13:1-4).
∂ÈÎfiÓ· 2. ªÔÚʤ˜ ÎÂÊ·Ï·ÏÁ›·˜ (Pakalnis A. Adolesc Med 2002;13:433-442). ¶›Ó·Î·˜ 1. ™˘Ó‹ıË ·›ÙÈ· ÔÍ›·˜ ÁÂÓÈÎÂ˘Ì¤Ó˘ ÎÂÊ·Ï·ÏÁ›·˜ ¶˘ÚÂÙfi˜ ÔÔÈ·Û‰‹ÔÙ ·ÈÙÈÔÏÔÁ›·˜ ∫Ú·ÓÈÔÂÁÎÂÊ·ÏÈ΋ οΈÛË §Ô›ÌˆÍË ∫¡™ º˘ÛÈ΋ ηٷfiÓËÛË ¶·Ú·ÙÂٷ̤ÓË ¤ÎıÂÛË ÛÙÔÓ ‹ÏÈÔ ∞ÁÁÂÈ·Îfi ÂÂÈÛfi‰ÈÔ À·Ú·¯ÓÔÂȉ‹˜ ·ÈÌÔÚÚ·Á›· ¢ËÏËÙËÚ›·ÛË Ì ʷÚ̷΢ÙÈΤ˜ Ô˘Û›Â˜
ÊÏÂÁÌÔÓ¤˜ ÙˆÓ ÎfiÏˆÓ ÙÔ˘ ÎÚ·Ó›Ô˘ ·ÔÙÂÏÔ‡Ó ÙÔ Û˘¯ÓfiÙÂÚÔ ·›ÙÈÔ (¶›Ó·Î·˜ 2). ÃÚfiÓȘ ÊÏÂÁÌÔÓ¤˜ ‰ÂÓ ÚÔηÏÔ‡Ó ÎÂÊ·Ï·ÏÁ›·. ™ÙȘ ÔÍ›˜ ÈÁÌÔÚ›Ùȉ˜, ÙÔ ¿ÏÁÔ˜ ÂÓÙÔ›˙ÂÙ·È Î¿Ùˆ ·fi ÙÔ˘˜ ÔÊı·ÏÌÈÎÔ‡˜ ÎfiÁ¯Ô˘˜, ÂÓÒ ÛÙȘ ÊÏÂÁÌÔÓ¤˜ ÙÔ˘ ÛÊËÓÔÂȉԇ˜ ‹ ËıÌÔÂȉԇ˜ ÎfiÏÔ˘ ÂÚÈÔÊı·ÏÌÈο Î·È ·ÓÙ·Ó·ÎÏ¿ Û fiÏÔ ÙÔ ÎÚ·Ó›Ô. ∏ ÎÂÊ·Ï·ÏÁ›· Â›Ó·È Û˘Ó‹ıˆ˜ ÚˆÈÓ‹ Î·È Û˘Óԉ‡ÂÙ·È ·fi Â̤ÙÔ˘˜ ‹ ‚‹¯·. OÈ ·ı‹ÛÂȘ ÙÔ˘ ̤ÛÔ˘ ˆÙfi˜ Î·È Ù· Ô‰ÔÓÙÈο ÚÔ‚Ï‹Ì·Ù· ¢ı‡ÓÔÓÙ·È Û ÌÂÁ¿ÏÔ, ›Û˘, ÔÛÔÛÙfi ÛÙËÓ ÔÍ›· ÂÓÙÔÈṲ̂ÓË ÎÂÊ·Ï·ÏÁ›·. ∏ ·˘ÍË̤ÓË ÚÔÛ¿ıÂÈ· ÙˆÓ ÔÊı·ÏÌÈÎÒÓ Ì˘ÒÓ Ó· ·ÓÙÈÛÙ·ıÌ›ÛÔ˘Ó ÙȘ ˘¿Ú¯Ô˘Û˜ ‰È·ıÏ·ÛÙÈΤ˜ ·ÓˆÌ·Ï›Â˜ ÚÔηÏ› ·ÚÎÂÙ¿
169
May-June 04 chris new
19-07-04
19:24
™ÂÏ›‰·170
¶·È‰È·ÙÚÈ΋ 2004;67:168-172
Û˘¯Ó¿ ÎÂÊ·Ï·ÏÁ›· ÛÙ· ·È‰È¿. ™Â ·˘Ù‹ ÙËÓ ÂÚ›ÙˆÛË, ÙÔ ¿ÏÁÔ˜ ÂÓÙÔ›˙ÂÙ·È ÂÚÈÔÊı·ÏÌÈο, ·ÏÏ¿ Î·È Ì¤Û· ÛÙÔ˘˜ ÔÊı·ÏÌÔ‡˜ Î·È ÂÌÊ·Ó›˙ÂÙ·È Û¯Â‰fiÓ ·ÔÎÏÂÈÛÙÈο ηٿ ÙË ‰È¿ÚÎÂÈ· ÔχˆÚ˘ ÌÂϤÙ˘ ‹ ÌÂϤÙ˘ Ì ηΤ˜ Û˘Óı‹Î˜ ʈÙÈÛÌÔ‡. OÍ›· ˘ÔÙÚÔÈ¿˙Ô˘Û· ÎÂÊ·Ï·ÏÁ›· ™ÙËÓ ÔÍ›· ˘ÔÙÚÔÈ¿˙Ô˘Û· ÎÂÊ·Ï·ÏÁ›·, Ë ËÌÈÎÚ·Ó›· Î·È Ù· ËÌÈÎÚ·ÓÈο ÈÛÔ‰‡Ó·Ì·, Ô˘ ·Ó‹ÎÔ˘Ó ÛÙËÓ ÚˆÙÔ·ı‹ ÎÂÊ·Ï·ÏÁ›·, η٤¯Ô˘Ó ÚˆÙÂ‡Ô˘Û· ı¤ÛË, ÂÓÒ ÏÈÁfiÙÂÚÔ Û˘ÓËıÈṲ̂ӷ ·›ÙÈ· Â›Ó·È ‰˘ÛÏÂÈÙÔ˘ÚÁ›Â˜ ÛÙË ‚·Ï‚›‰· › ˘‰ÚÔÎÂÊ¿ÏÔ˘ (2,6) (¶›Ó·Î·˜ 3). ÃÚfiÓÈ· ÂȉÂÈÓÔ‡ÌÂÓË ÎÂÊ·Ï·ÏÁ›· ∏ ¯ÚfiÓÈ· ÂȉÂÈÓÔ‡ÌÂÓË ÎÂÊ·Ï·ÏÁ›· ··ÈÙ› Û ÌÂÁ·Ï‡ÙÂÚÔ ‚·ıÌfi ÙË Û˘Ó¯‹ ·ÁÚ‡ÓËÛË ÙÔ˘ ·È‰È¿ÙÚÔ˘ Î·È ÙË Û˘ÓÂÚÁ·Û›· Û˘Ó·ÊÒÓ ˘ÔÂȉÈÎÔًوÓ, ηıÒ˜ ÌÔÚ› Ó· ÔÊ›ÏÂÙ·È Û ·ı‹ÛÂȘ ·ÂÈÏËÙÈΤ˜ ÁÈ· ÙË ˙ˆ‹ ÙÔ˘ ·ÛıÂÓÔ‡˜ (2,6). ∏ ηÏÔ‹ı˘ ÂÓ‰ÔÎÚ¿ÓÈ· ˘¤ÚÙ·ÛË Û˘Ó‹ıˆ˜ Û˘Óԉ‡ÂÙ·È ·fi Ô›‰ËÌ· ÙˆÓ ÔÙÈÎÒÓ ıËÏÒÓ Ì ‹ ¯ˆÚ›˜ ‰Èψ›· Î·È ·˘ÍË̤ÓË ›ÂÛË ÛÙÔ ∂¡À (¶›Ó·Î·˜ 4). ∏ ·Ô˘Û›· ¢ÚËÌ¿ÙˆÓ, ÙfiÛÔ Î·Ù¿ ÙË Ó¢ÚÔÏÔÁÈ΋ ÂͤٷÛË fiÛÔ Î·È Î·Ù¿ ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi Î·È Ó¢ÚÔ·ÂÈÎÔÓÈÛÙÈÎfi ¤ÏÂÁ¯Ô, ·ÔÙÂÏ› ÙÔ ‚·ÛÈÎfi ¯·Ú·ÎÙËÚÈÛÙÈÎfi Ù˘. ¶Ú¤ÂÈ Ó· ÙÔÓÈÛÙ›, fï˜, fiÙÈ Ë ·Ô˘Û›· Ôȉ‹Ì·ÙÔ˜ ÙˆÓ ÔÙÈÎÒÓ ıËÏÒÓ ‰ÂÓ ·ÔÎÏ›ÂÈ ÙË ‰È¿ÁÓˆÛË Ù˘ ÂÓ‰ÔÎÚ¿ÓÈ·˜ ˘¤ÚÙ·Û˘ (9,10). OÈ ¯·Ú·ÎÙ‹Ú˜ Ù˘ ÎÂÊ·Ï·ÏÁ›·˜ ÛÙÔ˘˜ fiÁÎÔ˘˜ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ ‰ÂÓ Â›Ó·È ÂȉÈÎÔ›, ÂÓÙÔ‡ÙÔȘ ÙÔ ¿ÏÁÔ˜ ÛÙÔ˘˜ fiÁÎÔ˘˜ Â›Ó·È ‚‡ıÈÔ Û ·ÓÙȉȷÛÙÔÏ‹ Ì ÙÔ ¤ÓÙÔÓÔ ¿ÏÁÔ˜ Ù˘ ËÌÈÎÚ·Ó›·˜. OÈ ¤ÌÂÙÔÈ, Ë Ó·˘Ù›· Î·È ÙÔ Ô›‰ËÌ· ÙˆÓ ÔÙÈÎÒÓ ıËÏÒÓ ¶›Ó·Î·˜ 2. ™˘Ó‹ıË ·›ÙÈ· ÔÍ›·˜ ÂÓÙÔÈṲ̂Ó˘ ÎÂÊ·Ï·ÏÁ›·˜ OÍ›˜ ÊÏÂÁÌÔÓ¤˜ ÙˆÓ ÎfiÏˆÓ ÙÔ˘ ÎÚ·Ó›Ô˘ ¶·ı‹ÛÂȘ ̤ÛÔ˘ ˆÙfi˜ O‰ÔÓÙÈο ÚÔ‚Ï‹Ì·Ù· OÊı·ÏÌÔÏÔÁÈΤ˜ ‰È·Ù·Ú·¯¤˜ ∫Ú·ÓÈÔÂÁÎÂÊ·ÏÈ΋ οΈÛË
¶›Ó·Î·˜ 3. ™˘Ó‹ıË ·›ÙÈ· ÔÍ›·˜ ˘ÔÙÚÔÈ¿˙Ô˘Û·˜ ÎÂÊ·Ï·ÏÁ›·˜ ∫ÔÈÓ‹ ËÌÈÎÚ·Ó›· ∂ÈÂÏÂÁ̤ÓË ËÌÈÎÚ·Ó›· ∏ÌÈÎÚ·ÓÈο ÈÛÔ‰‡Ó·Ì· ¢˘ÛÏÂÈÙÔ˘ÚÁ›· ÛÙË ‚·Ï‚›‰· › ˘‰ÚÔÎÂÊ¿ÏÔ˘
Paediatriki 2004;67:168-172
‰ÂÓ ·ÔÙÂÏÔ‡Ó ÔˆÛ‰‹ÔÙ ÛËÌ›· Ô˘ Û˘ÓÔ‰Â‡Ô˘Ó ÙË ÓfiÛÔ. ™˘ÓËı¤ÛÙÂÚ· Â›Ó·È Ù· ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù· Ô˘ ÚÔ·ÙÔ˘Ó ·fi Ì›· ÏÂÙÔÌÂÚ‹ Ó¢ÚÔÏÔÁÈ΋ ÂͤٷÛË. ∆Ô ˘ÂÚÛÎËÓȉȷÎfi ÎÚ·ÓÈÔÊ·Ú˘ÁÁ›ˆÌ·, ÙÔ ÂÂÓ‰‡ÌˆÌ·, ÙÔ ÚˆÙÔÏ·ÛÌ·ÙÈÎfi ·ÛÙÚÔ·Ùو̷ Î·È ÙÔ ˘ÔÛÎËÓȉȷÎfi ÈÏÔ΢ÙÙ·ÚÈÎfi ·ÛÙÚÔ·Ùو̷ ıˆÚÔ‡ÓÙ·È ÔÈ fiÁÎÔÈ ÂΛÓÔÈ Ô˘ Û˘Óԉ‡ÔÓÙ·È Û ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ·fi ÎÂÊ·Ï·ÏÁ›·. ÕÏÏ· ÏÈÁfiÙÂÚÔ Û˘ÓËıÈṲ̂ӷ ·›ÙÈ·, Â›Ó·È Ô ˘‰ÚÔΤʷÏÔ˜ ÁÂÓÈο, ÔÈ ‰˘ÛÏÂÈÙÔ˘ÚÁ›Â˜ ‚·Ï‚›‰·˜, ÔÈ fiÁÎÔÈ Î·È ÔÈ ‰ÈËıËÙÈΤ˜ ÂÍÂÚÁ·Û›Â˜ ÙÔ˘ ÎÚ·Ó›Ô˘, .¯. ˈÛÈÓfiÊÈÏÔ ÎÔÎΛˆÌ· Î·È ¿ÏÏ·. ÃÚfiÓÈ· ÛÙ·ıÂÚ‹ ÎÂÊ·Ï·ÏÁ›· ∆· Û˘ÓËı¤ÛÙÂÚ· ·›ÙÈ· Ù˘ ¯ÚfiÓÈ·˜ ÛÙ·ıÂÚ‹˜ ÎÂÊ·Ï·ÏÁ›·˜ (2) Â›Ó·È Û˘Ó‹ıˆ˜ Ë ÎÂÊ·Ï·ÏÁ›· Ù¿Ûˆ˜ ÌË ÔÚÁ·ÓÈ΋˜ ·ÈÙÈÔÏÔÁ›·˜, „˘¯È·ÙÚÈο Î·È „˘¯ÔÏÔÁÈο ÚÔ‚Ï‹Ì·Ù·, Ë ÌÂÙ·ÙÚ·˘Ì·ÙÈ΋ ÂÈÏË„›·, Ì ۷ÊÒ˜ ÌÈÎÚfiÙÂÚË Û˘¯ÓfiÙËÙ· ·fi ÂΛÓË ÙˆÓ ÂÓËϛΈÓ, Ë ‰˘ÛÏ·Û›· Arnold-Chiari, ÔÏ˘Û˘ÛÙËÌ·ÙÈο ÓÔÛ‹Ì·Ù·, ‰ËÏËÙËÚ›·ÛË Ì ÙÔÍÈΤ˜ Ô˘Û›Â˜ Î·È ¿ÏÏ· (¶›Ó·Î·˜ 5). ∏ ÂÈÏË„›· ·ÔÙÂÏ› ·ÈÙ›· Ù˘ ¯ÚfiÓÈ·˜ ÛÙ·ıÂÚ‹˜ ÎÂÊ·Ï·ÏÁ›·˜ ΢ڛˆ˜ ÌÂÙ¿ ÙËÓ ÎÚ›ÛË Î·È - Û ÌÈÎÚfiÙÂÚÔ ÔÛÔÛÙfi - ÚÈÓ ‹ ηٿ ÙËÓ ÎÚ›ÛË Ì ¿ÏÏÔÙ ¿ÏÏË ‰È¿ÚÎÂÈ·. ™ÙȘ ÁÂÓÈÎÂ˘Ì¤Ó˜ ÂÈÏË„›Â˜ ¤¯ÂÈ ·Ú·ÙËÚËı› fiÙÈ Ë ÎÂÊ·Ï·ÏÁ›· Â›Ó·È Û˘Ó¯‹˜, ÂÓÒ ÛÙȘ ÂÛÙȷΤ˜ ¤¯ÂÈ ‰È·Ï›ÔÓÙ· ÛÊ˘ÁÌÒ‰Ë ¯·Ú·ÎÙ‹Ú· (11). ¢È·ÁÓˆÛÙÈ΋ ÚÔۤϷÛË ªÂ ‚¿ÛË Ù· ÛÙ·ÙÈÛÙÈο ‰Â‰Ô̤ӷ fiÛÔÓ ·ÊÔÚ¿ ÛÙË Û˘¯ÓfiÙËÙ· ÙˆÓ ·ÈÙ›ˆÓ Ù˘ ÎÂÊ·Ï·ÏÁ›·˜, Ë ÎÏÈÓÈ΋ ·ÍÈÔÏfiÁËÛË ÙˆÓ ·ÛıÂÓÒÓ Â›Ó·È ÙÔ ÂfiÌÂÓÔ ‚‹Ì· ÛÙË ‰ÈÂÚ‡ÓËÛË Ù˘ ÎÂÊ·Ï·ÏÁ›·˜. ∆Ô ÏÂÙÔÌÂÚ¤˜ ·ÙÔÌÈÎfi Î·È ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi, Ë Ê˘ÛÈ΋, Ó¢ÚÔÏÔÁÈ΋, ˆÙÔÚÈÓÔÏ·Ú˘ÁÁÔÏÔÁÈ΋ Î·È ÔÊı·ÏÌÔÏÔÁÈ΋ ÂͤٷÛË Î·È Ô Î·Ù¿ÏÏËÏÔ˜ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ·ÔÙÂÏÔ‡Ó ÛËÌ·ÓÙÈΤ˜ ËÁ¤˜ ÏËÚÔÊÔÚÈÒÓ. ∫·Ù¿ ÙË Ï‹„Ë ÙÔ˘ ÈÛÙÔÚÈÎÔ‡, ÔÚÈṲ̂ӷ ÛÙÔȯ›· Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÔÓÙ·È È‰È·›ÙÂÚ· ˘’ fi„ÈÓ, fiˆ˜ Ô ÙÚfiÔ˜ ÂÈÛ‚ÔÏ‹˜ Ù˘ ÎÂÊ·Ï·ÏÁ›·˜, Ë ‰È¿ÚÎÂÈ· ÙÔ˘ ÂÂÈÛÔ‰›Ô˘, Ë ÂÓÙfiÈÛË, Ë Û˘¯ÓfiÙËÙ· Î·È Ë Û˘ÓÔÏÈ΋ ‰È¿ÚÎÂÈ¿ Ù˘. ™˘ÌÙÒÌ·Ù· Ô˘ Û˘ÓÔ‰Â‡Ô˘Ó ÙËÓ ÎÂÊ·Ï·ÏÁ›·, Èı·ÓÔ› ÂÎÏ˘ÙÈÎÔ› ·Ú¿ÁÔÓÙ˜, Ë Ê˘ÛÈ΋ Î·È „˘¯È΋ ηٿÛÙ·ÛË ÙÔ˘ ·È‰ÈÔ‡ Î·È Ë ËÏÈΛ· ¤Ó·Ú͢ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Ú¤ÂÈ Â›Û˘ Ó· ¶›Ó·Î·˜ 5. ™˘Ó‹ıË ·›ÙÈ· ¯ÚfiÓÈ·˜ ÛÙ·ıÂÚ‹˜ ÎÂÊ·Ï·ÏÁ›·˜
¶›Ó·Î·˜ 4. ™˘Ó‹ıË ·›ÙÈ· ¯ÚfiÓÈ·˜ ÂȉÂÈÓÔ‡ÌÂÓ˘ ÎÂÊ·Ï·ÏÁ›·˜ ∫·ÏÔ‹ı˘ ÂÓ‰ÔÎÚ¿ÓÈ· ˘¤ÚÙ·ÛË ŸÁÎÔÈ ÂÁÎÂÊ¿ÏÔ˘ À‰ÚÔΤʷÏÔ˜ ¢˘ÛÏÂÈÙÔ˘ÚÁ›Â˜ ‚·Ï‚›‰·˜ ŸÁÎÔÈ Î·È ‰ÈËıËÙÈΤ˜ ÂÍÂÚÁ·Û›Â˜ ÙÔ˘ ÎÚ·Ó›Ô˘
170
∫ÂÊ·Ï·ÏÁ›· Ù¿Ûˆ˜ ªÂÙ·ÙÚ·˘Ì·ÙÈ΋ ÂÈÏË„›· æ˘¯È·ÙÚÈο-„˘¯ÔÏÔÁÈο ÓÔÛ‹Ì·Ù· ¢˘ÛÏ·Û›· Arnold-Chiari ¶ÔÏ˘Û˘ÛÙËÌ·ÙÈο ÓÔÛ‹Ì·Ù· ∆ÔÍÈΤ˜ Ô˘Û›Â˜ ∞Ù·ÍÈÓfiÌËÙ˜ ÌÔÚʤ˜
May-June 04 chris new
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¶·È‰È·ÙÚÈ΋ 2004;67:168-172
·ÍÈÔÏÔÁÔ‡ÓÙ·È. ∫·Ù¿ ÙË Ê˘ÛÈ΋ ÂͤٷÛË, ÂÎÙÈÌÒÓÙ·È Ë Ê˘ÛÈ΋ Î·È Û˘Ó·ÈÛıËÌ·ÙÈ΋ ηٿÛÙ·ÛË ÙÔ˘ ·ÛıÂÓÔ‡˜ Î·È ÙÔ Â›Â‰Ô Û˘Ó›‰ËÛ˘. ∂ϤÁ¯ÔÓÙ·È Ë ıÂÚÌÔÎÚ·Û›· ÙÔ˘ ÛÒÌ·ÙÔ˜, Ë ·ÚÙËÚȷ΋ ›ÂÛË Î·È Ë ÂÚ›ÌÂÙÚÔ˜ ÎÂÊ·Ï‹˜. æËÏ·Ê¿Ù·È ÙÔ ÎÚ·Ó›Ô Î·È ·Ó·˙ËÙÔ‡ÓÙ·È È‰È·›ÙÂÚ· ÌÔÚÊÔÏÔÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο ‹ ·ÏÏÔÈÒÛÂȘ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ Ô˘ ÌÔÚ› Ó· Â›Ó·È ÂÓ‰ÂÈÎÙÈο Û˘Ó‰ÚfiÌÔ˘ ‹ ÁÂÓÂÙÈ΋˜ ·ÓˆÌ·Ï›·˜, οΈÛ˘ ‹ ηÎÔÔ›ËÛ˘ Î·È ÂӉ›ÍÂȘ ÌËÓÈÁÁÈÎÔ‡ ÂÚÂıÈÛÌÔ‡ ‹ ·˘ÍË̤Ó˘ ÂÓ‰ÔÎÚ·Óȷ΋˜ ›ÂÛ˘. ∏ Ê˘ÛÈ΋ ÂͤٷÛË Û˘ÌÏËÚÒÓÂÙ·È ·fi Ì›· ÏÂÙÔÌÂÚ‹ Ó¢ÚÔÏÔÁÈ΋ ÂͤٷÛË. ™ÙÔ 90% ÙˆÓ ÂÚÈÙÒÛˆÓ, Ë ‰È¿ÁÓˆÛË Ù›ıÂÙ·È ·fi ÙÔ ÈÛÙÔÚÈÎfi Î·È ÙË Ê˘ÛÈ΋ Î·È Ó¢ÚÔÏÔÁÈ΋ ÂͤٷÛË. ∂¿Ó ÚÔ·„ÂÈ ·ÎfiÌË Î·È ÂÏ¿¯ÈÛÙË ˘Ô„›· ‹ ·Ó Ë ÎÏÈÓÈ΋ ÂͤٷÛË ‰ÂÓ ÌÔÚ› Ó· Â›Ó·È Ï‹Ú˘, ÂÈ‚¿ÏÏÂÙ·È ÂÚ·ÈÙ¤Úˆ ‰ÈÂÚ‡ÓËÛË Ì ·ÈÌ·ÙÔÏÔÁÈÎfi Î·È ‚ÈÔ¯ËÌÈÎfi ¤ÏÂÁ¯Ô, ÔÛÊ˘ÔÓˆÙÈ·›· ·Ú·Î¤ÓÙËÛË, ·ÎÙÈÓÔÁÚ·Ê›· ÎÚ·Ó›Ô˘ Î·È Ó¢ÚÔ·ÂÈÎfiÓÈÛË fiÔ˘ ÎÚ›ÓÂÙ·È ··Ú·›ÙËÙË, ηıÒ˜ ›Û˘ ·Ó·˙ËÙÂ›Ù·È Î·È Ë Û˘ÓÂÚÁ·Û›· ¿ÏÏˆÓ ÂȉÈÎÔًوÓ. ∏ Û˘Ì‚ÔÏ‹ ÙÔ˘ ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·Ê‹Ì·ÙÔ˜ (∏∂°) ÛÙË ‰ÈÂÚ‡ÓËÛË Ù˘ ÎÂÊ·Ï·ÏÁ›·˜ Â›Ó·È ÂÚÈÔÚÈṲ̂ÓË Î·È Û˘ÓÈÛÙ¿Ù·È Û ˘Ô„›· ÂÈÏËÙÈ΋˜ ÎÚ›Û˘ ‹ ÂÁÎÂÊ·Ï›Ùȉ·˜ (7). ™Â ÂÚ›ÙˆÛË ÂÁÎÂÊ·Ï›Ùȉ·˜, ÙÔ ∏∂° Ú¤ÂÈ Ó· Á›ÓÂÙ·È Ì ÙÔÓ ·ÛıÂÓ‹ Û ÂÁÚ‹ÁÔÚÛË Î·È fi¯È ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘. ∂Ӊ›ÍÂȘ Ó¢ÚÔ·ÂÈÎfiÓÈÛ˘ ∏ ·ÍÈÔÏfiÁËÛË Ì›·˜ ‰Â˘ÙÂÚÔ·ıÔ‡˜ ÎÂÊ·Ï·ÏÁ›·˜ ÔÏÔÎÏËÚÒÓÂÙ·È Ì ÙËÓ ÂÈÛ‹Ì·ÓÛË ÙˆÓ ÛËÌ›ˆÓ ÂÈÎÈÓ‰˘ÓfiÙËÙ·˜ Ô˘ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÙË ¯·Ú·ÎÙËÚ›˙Ô˘Ó (¶›Ó·Î·˜ 6) (13). ∏ ÚÔԉ¢ÙÈ΋ Âȉ›ӈÛË Ì›·˜ ÔÍ›·˜ ÎÂÊ·Ï·ÏÁ›·˜ ‹ Ë ·ÏÏ·Á‹ ¯·Ú·ÎÙ‹ÚˆÓ Ì›·˜ ¯ÚfiÓÈ·˜ ÛÙ·ıÂÚ‹˜ ‹ ÔÍ›·˜ ˘ÔÙÚÔÈ¿˙Ô˘Û·˜ (·‡ÍËÛË Ù˘ ¤ÓÙ·Û˘ ‹ Û˘¯ÓfiÙËÙ·˜, ÚÔÛı‹ÎË Û˘ÌÙˆÌ¿ÙˆÓ Î·È ÛËÌ›ˆÓ Ô˘ ÙË Û˘Óԉ‡ԢÓ, ÂÌÊ¿ÓÈÛË Ù˘ ÎÂÊ·Ï·ÏÁ›·˜ ÙË Ó‡¯Ù·, ·ÏÏ·Á‹ Ù˘ Û˘ÌÂÚÈÊÔÚ¿˜ Î.Ï.) ·ÔÙÂÏÔ‡Ó ÂÈ‚·Ú˘ÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÂÈÎÈÓ‰˘ÓfiÙËÙ¿ Ù˘, Ë ÔÔ›· ·˘Í¿ÓÂÈ ÛËÌ·ÓÙÈο fiÙ·Ó Û˘Ó˘¿Ú¯Ô˘Ó Î·È ·ÓÙÈÎÂÈ̶›Ó·Î·˜ 6. ™ËÌ›· Ô˘ ¯·Ú·ÎÙËÚ›˙Ô˘Ó ÙËÓ ÂÈÎÈÓ‰˘ÓfiÙËÙ· Ù˘ ÎÂÊ·Ï·ÏÁ›·˜ ¶ÚÔԉ¢ÙÈ΋ Âȉ›ӈÛË ∞ÏÏ·Á‹ ¯·Ú·ÎÙ‹ÚˆÓ (·‡ÍËÛË Ù˘ ¤ÓÙ·Û˘ Î·È Ù˘ Û˘¯ÓfiÙËÙ·˜) ™˘Ó‡·ÚÍË ÚˆÈÓÒÓ Î˘Ú›ˆ˜ Â̤وÓ, Û‡Á¯˘Û˘ Î·È ‰È·Ù·Ú·¯ÒÓ ÔÌÈÏ›·˜ ∞ÓıÂÎÙÈÎfiÙËÙ· ÛÙË ıÂڷ›· ™·ÛÌÔ› O›‰ËÌ· ÙˆÓ ÔÙÈÎÒÓ ıËÏÒÓ ¶·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù· ÛÙË Ê˘ÛÈ΋ Î·È Ó¢ÚÔÏÔÁÈ΋ ÂͤٷÛË ∫·ı˘ÛÙ¤ÚËÛË ÛˆÌ·ÙÈ΋˜ ·Ó¿Ù˘Í˘ ¢È·Ù·Ú·¯¤˜ Û˘ÌÂÚÈÊÔÚ¿˜ ¶·ÚÔ˘Û›· ÁÓˆÛÙ‹˜ ÔÏ˘Û˘ÛÙËÌ·ÙÈ΋˜ ÓfiÛÔ˘
Paediatriki 2004;67:168-172
∂ÈÎfiÓ· 3. ∞ÏÁfiÚÈıÌÔ˜ ÁÈ· ÙË ‰ÈÂÓ¤ÚÁÂÈ· Ó¢ÚÔ·ÂÈÎfiÓÈÛ˘ ÛÙËÓ ÎÂÊ·Ï·ÏÁ›·.
ÓÈο Â˘Ú‹Ì·Ù· ·fi ÙË Ê˘ÛÈ΋ Î·È Ó¢ÚÔÏÔÁÈ΋ ÂͤٷÛË Î·È Î˘Ú›ˆ˜ Ô›‰ËÌ· ÔÙÈÎÒÓ ıËÏÒÓ. ∏ ·ÚÔ˘Û›· ÙˆÓ ÛËÌ›ˆÓ ÂÈÎÈÓ‰˘ÓfiÙËÙ·˜ ÂÈ‚¿ÏÏÂÈ ÙË ‰ÈÂÓ¤ÚÁÂÈ· Ó¢ÚÔ·ÂÈÎfiÓÈÛ˘ ÁÈ· ÙÔÓ ·ÔÎÏÂÈÛÌfi Ù˘¯fiÓ ¯ˆÚÔηٷÎÙËÙÈ΋˜ ‹ ¿ÏÏ˘ ÂÂÍÂÚÁ·Û›·˜. ∞fi ‰È¿ÊÔÚ˜ ÌÂϤÙ˜ ÚÔ·ÙÂÈ fiÙÈ ÛÙÔ Û‡ÓÔÏÔ Ù˘ ÎÂÊ·Ï·ÏÁ›·˜, Ë ·Ó‡ÚÂÛË ıÂÙÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ ÛÙË Ó¢ÚÔ·ÂÈÎfiÓÈÛË Î˘Ì·›ÓÂÙ·È ·fi 3,7% ¤ˆ˜ 16,6% (12,13). ™ÙËÓ ÏÂÈÔÓfiÙËÙ¿ ÙÔ˘˜, fï˜, Ù· Â˘Ú‹Ì·Ù· ·˘Ù¿ ‰ÂÓ ÂËÚ¿˙Ô˘Ó ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ‹ ÙËÓ ¤Î‚·ÛË Ù˘ ÎÂÊ·Ï·ÏÁ›·˜. ∂¿Ó ˘¿Ú¯Ô˘Ó Ó¢ÚÔ·ÂÈÎÔÓÈÛÙÈο Â˘Ú‹Ì·Ù· ÂÓ‰ÂÈÎÙÈο ÁÈ· ¿ÌÂÛË ·Ú¤Ì‚·ÛË, ·˘Ù¿ ı· Ú¤ÂÈ Ó· Û˘ÓÂÎÙÈÌËıÔ‡Ó Ì ÙÔÓ Ù‡Ô Ù˘ ÎÂÊ·Ï·ÏÁ›·˜, ÙÔÓ Û˘ÓÔÏÈÎfi ¯ÚfiÓÔ ‰È¿ÚÎÂÈ¿˜ Ù˘ Î·È ÙËÓ ·ÚÔ˘Û›· ÂÓfi˜ Ë ÂÚÈÛÛfiÙÂÚˆÓ ÛËÌ›ˆÓ ÂÈÎÈÓ‰˘ÓfiÙËÙ·˜. ªË ËÌÈÎÚ·ÓÈÎÔ‡ Ù‡Ô˘ ÎÂÊ·Ï·ÏÁ›· Ì ¯ÚÔÓÈ΋ ‰È¿ÚÎÂÈ· ÌÈÎÚfiÙÂÚË ÙˆÓ 6 ÌËÓÒÓ Î·È ·ÚÔ˘Û›· ÂÓfi˜ ‹ ÂÚÈÛÛfiÙÂÚˆÓ ÛËÌ›ˆÓ ÂÈÎÈÓ‰˘ÓfiÙËÙ·˜ ¯·Ú·ÎÙËÚ›˙ÂÈ Ù· ¿ÙÔÌ· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘, fiÔ˘ Ë Èı·ÓfiÙËÙ· ·Ó‡ÚÂÛ˘ ÂÓ‰ÔÎÚ·ÓÈ·ÎÔ‡ fiÁÎÔ˘ ·Ó¤Ú¯ÂÙ·È Û 4%. ™Ù· ¿ÙÔÌ· ¯·ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘, Ì ÌË ËÌÈÎÚ·ÓÈÎÔ‡ Ù‡Ô˘ ÎÂÊ·Ï·ÏÁ›· Ì ¯ÚÔÓÈ΋ ‰È¿ÚÎÂÈ· ÌÂÁ·Ï‡ÙÂÚË ÙˆÓ 6 ÌËÓÒÓ Î·È ·Ô˘Û›· ÛËÌ›ˆÓ ÂÈÎÈÓ‰˘ÓfiÙËÙ·˜, ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ÔÛÔÛÙfi Â›Ó·È 0,01%. ™Â ËÌÈÎÚ·ÓÈÎÔ‡ Ù‡Ô˘ ÎÂÊ·Ï·ÏÁ›· ÌÂ Ê˘ÛÈÔÏÔÁÈ΋ Ó¢ÚÔÏÔÁÈ΋ ÂͤٷÛË, ÙÔ ÔÛÔÛÙfi ·Ó‡ÚÂÛ˘ ÂÓ‰ÔÎÚ·Óȷ΋˜ ÂÂÍÂÚÁ·Û›·˜ ·Ó¤Ú¯ÂÙ·È Û 0,04% (13). ∆· ÔÛÔÛÙ¿ ·˘Ù¿ ηıÔÚ›˙Ô˘Ó ÙË ÛÙÚ·ÙËÁÈ΋ Ô˘ Ú¤ÂÈ Ó· ·ÎÔÏÔ˘ıËı› fiÛÔÓ ·ÊÔÚ¿ ÛÙË ‰ÈÂÓ¤ÚÁÂÈ· ·ÂÈÎfiÓÈÛ˘ (∂ÈÎfiÓ· 3). ™Â ·È‰È¿ ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ 6 ÂÙÒÓ, Ë Ó¢ÚÔ·ÂÈÎfiÓÈÛË Á›ÓÂÙ·È Ì ÌÂÁ·Ï‡ÙÂÚË Â˘ÎÔÏ›·. ∏ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ‰Â˘ÙÂÚÔ·ıÔ‡˜ ÎÂÊ·Ï·ÏÁ›·˜ Â›Ó·È ·ÈÙÈÔÏÔÁÈ΋. ™˘ÌÂÚ¿ÛÌ·Ù· ¢ÂÓ ˘¿Ú¯ÂÈ “Ê˘ÛÈÔÏÔÁÈÎfi˜” ÔÓÔΤʷÏÔ˜, ηıÒ˜ Ù· ˘ÁÈ‹ ¿ÙÔÌ· ‰ÂÓ ¿Û¯Ô˘Ó ·fi ÎÂÊ·Ï·ÏÁ›·. ∏ ‰È¿ÁÓˆÛË Ù˘ ÎÂÊ·Ï·ÏÁ›·˜ Ù›ıÂÙ·È Î˘Ú›ˆ˜ ·fi ÙÔ ÈÛÙÔÚÈÎfi, Ë ‰Â ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË Î·ıÔÚ›˙ÂÈ
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ÙËÓ ÂÚ·ÈÙ¤Úˆ ‰ÈÂÚ‡ÓËÛ‹ Ù˘. ∏ ·ÚÔ˘Û›· ÛËÌ›ˆÓ ÂÈÎÈÓ‰˘ÓfiÙËÙ·˜ ÂÈ‚¿ÏÏÂÈ ÙË ‰ÈÂÓ¤ÚÁÂÈ· Ó¢ÚÔ·ÂÈÎfiÓÈÛ˘, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙÔ ÌÈÎÚfi ÔÛÔÛÙfi ÙˆÓ Â˘ÚËÌ¿ÙˆÓ Ô˘ ¯ÚÂÈ¿˙ÔÓÙ·È ·Ú¤Ì‚·ÛË. µÈ‚ÏÈÔÁÚ·Ê›· 1. Sillanpaa M, Anttila P. Increasing prevalence of headache in 7-year-old schoolchildren. Headache 1996;36:466-470. 2. Pakalnis A. Nonmigraine headaches in adolescents. Adolesc Med 2002;13:433-442. 3. Aromaa M, Sillanpaa ML, Rautava P, Helenius H. Childhood headache at school entry: a controlled clinical study. Neurology 1998;50:1729-1736. 4. Burton LJ, Quinn B, Pratt-Cheney JL, Pourani M. Headache etiology in a pediatric emergency department. Pediatr Emerg Care 1997;13:1-4. 5. Kan L, Nagelberg J, Maytal J. Headaches in a pediatric emergency department: etiology, imaging, and treatment. Headache 2000;40:25-29. 6. ∫Ô‡ÙÏ·˜ ∂. ∫ÂÊ·Ï·ÏÁ›· - ª‡ıÔ˜ Î·È Ú·ÁÌ·ÙÈÎfiÙËÙ·. π·ÙÚÈÎfi µ‹Ì· 1991;2:41-46. 7. Lewis DW, Ashwal S, Dahl G, Dorbad D, Hirtz D, Prensky A et al. Practice parameter: evaluation of children and adolescents with recurrent headaches: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology 2002;59:490-498.
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8. Deda G, Caksen H, Ocal A. Headache etiology in children: a retrospective study of 125 cases. Pediatr Int 2000;42: 668-673. 9. Winner P, Bello L. Idiopathic intracranial hypertension in a young child without visual symptoms or signs. Headache 1996;36:574-576. 10. Krishna R, Kosmorsky GS, Wright KW. Pseudotumor cerebri sine papilledema with unilateral sixth nerve palsy. J Neuroophthalmol 1998;18:53-55. 11. Karaali-Savrun F, Goksan B, Yeni SN, Ertan S, Uzun N. Seizure-related headache in patients with epilepsy. Seizure 2002;11:67-69. 12. Lewis DW, Dorbad D. The utility of neuroimaging in the evaluation of children with migraine or chronic daily headache who have normal neurological examinations. Headache 2000;40:629-632. 13. Medina LS, Kuntz KM, Pomeroy S. Children with headache suspected of having a brain tumor: a cost-effectiveness analysis of diagnostic strategies. Pediatrics 2001;108: 255-263.
∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 04-03-2003 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 31-10-2003 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∂ϤÓË ª·˙›ÁÔ˘-ºˆÙÔÔ‡ÏÔ˘ ¶·È‰ÔÓ¢ÚÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ ¶ÂÓÙ¤Ï˘, ∞ı‹Ó·
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AWARD-WINNING ARTICLE
O ·ÓıÚÒÈÓÔ˜ ÌÂÙ·Ó¢ÌÔÓÔ˚fi˜ ˆ˜ ·›ÙÈÔ ÔÍ›·˜ ‚ÚÔÁ¯ÈÔÏ›Ùȉ·˜ ÛÙË ‚ÚÂÊÈ΋ ËÏÈΛ·* ¶. •Â··‰¿ÎË, ™. æ·ÚÚ¿˜, ∞. ªfiÛÈÔ˜, ª. ∆ÛÔÏÈ¿, ¢. ∫·ÊÂÙ˙‹˜, ¡. °. ¶··‰fiÔ˘ÏÔ˜
Human metapneumovirus as a cause of acute bronchiolitis in infancy* P. Xepapadaki, S. Psarras, A. Bossios, M. Tsolia, D. Kafetzis, N. G. Papadopoulos
¶ÂÚ›ÏË„Ë: O ·ÓıÚÒÈÓÔ˜ ÌÂÙ·Ó¢ÌÔÓÔ˚fi˜ ¤¯ÂÈ ·ÔÌÔÓˆı› ÚfiÛÊ·Ù· Û ·È‰È¿ Ì Ïԛ̈ÍË ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Î·È ¤¯ÂÈ Ù·ÍÈÓÔÌËı› ÛÙËÓ ˘Ô-ÔÈÎÔÁ¤ÓÂÈ· ÙˆÓ ÌÂÙ·Ó¢ÌÔÓÔ˚ÒÓ, Ë ÔÔ›· ·Ó‹ÎÂÈ ÛÙËÓ Â˘Ú‡ÙÂÚË ÔÈÎÔÁ¤ÓÂÈ· ÙˆÓ ·Ú·Ì˘ÍÔ˚ÒÓ. ™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‹Ù·Ó Ó· ·ÓȯÓ¢ı› Ô ·ÓıÚÒÈÓÔ˜ ÌÂÙ·Ó¢ÌÔÓÔ˚fi˜ Û ÚÈÓÈο ÂÎχ̷ٷ ·È‰ÈÒÓ Ô˘ ÓÔÛËχÙËÎ·Ó ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô Ì ÔÍ›· ‚ÚÔÁ¯ÈÔÏ›Ùȉ·, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÙËÓ Ù¯ÓÈ΋ Ù˘ ·Ó¿ÛÙÚÔÊ˘ ·ÓÙ›‰Ú·Û˘ ·Ï˘ÛȉˆÙ‹˜ ÔÏ˘ÌÂÚ¿Û˘ Î·È Ó· ‰ÈÂÚ¢ÓËı› Èı·Ó‹ ·ÈÙÈÔÏÔÁÈ΋ Û˘Û¯¤ÙÈÛË ÙÔ˘ ÈÔ‡ Ì ٷ ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο Ù˘ ÓfiÛÔ˘. ∏ ·ÚÔ˘Û›· ÙÔ˘ ÈÔ‡ Ì ÙËÓ Ù¯ÓÈ΋ Ù˘ ·Ó¿ÛÙÚÔÊ˘ ·ÓÙ›‰Ú·Û˘ ·Ï˘ÛȉˆÙ‹˜ ÔÏ˘ÌÂÚ¿Û˘ ÂȂ‚·ÈÒıËΠ۠16% ÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ ‚ÚÔÁ¯ÈÔÏ›Ùȉ·˜ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó Î·È ‹Ù·Ó ‰Â‡ÙÂÚÔ˜ ÛÂ Û˘¯ÓfiÙËÙ· ÌÂÙ¿ ÙÔÓ ·Ó·Ó¢ÛÙÈÎfi Û˘Á΢ÙÈ·Îfi Èfi, Ô ÔÔ›Ô˜ ·ÔÌÔÓÒıËΠ۠67,9% ÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ. O ·ÓıÚÒÈÓÔ˜ ÌÂÙ·Ó¢ÌÔÓÔ˚fi˜ ·Ó·ÁÓˆÚ›ÛÙËΠ›Ù ˆ˜ ÌÔÓ·‰ÈÎfi˜ ·ıÔÁfiÓÔ˜ Èfi˜, ›Ù ˆ˜ Û˘Ó˘¿Ú¯ˆÓ Ì ÙÔÓ ·Ó·Ó¢ÛÙÈÎfi Û˘Á΢ÙÈ·Îfi Èfi, Ì ÙÔÓ ÔÔ›Ô Ê¿ÓËΠӷ ¤¯Ô˘Ó ·ÚfiÌÔÈ· ÂÔ¯È΋ ηٷÓÔÌ‹. ¢ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ‰È·ÊÔÚ¤˜ ÛÙ· ÎÏÈÓÈο ‹ ÂÚÁ·ÛÙËÚȷο ¯·Ú·ÎÙËÚÈÛÙÈο ÌÂٷ͇ ÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ ‚ÚÔÁ¯ÈÔÏ›Ùȉ·˜ ÛÙ· ÔÔ›· ·ÔÌÔÓÒıËÎÂ Ô ·ÓıÚÒÈÓÔ˜ ÌÂÙ·Ó¢ÌÔÓÔ˚fi˜ Î·È ÂÎÂ›ÓˆÓ Ô˘ ÔÊ›ÏÔÓÙ·Ó ÛÙÔÓ ·Ó·Ó¢ÛÙÈÎfi Û˘Á΢ÙÈ·Îfi Èfi ‹ ¿ÏÏÔ ·ıÔÁfiÓÔ Û٤ϯԘ. ∆· Â˘Ú‹Ì·Ù· Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ Û˘ÓËÁÔÚÔ‡Ó fiÙÈ Ô ·ÓıÚÒÈÓÔ˜ ÌÂÙ·Ó¢ÌÔÓÔ˚fi˜ ·ÔÙÂÏ› ÛËÌ·ÓÙÈÎfi ·ÈÙÈÔÏÔÁÈÎfi ·Ú¿ÁÔÓÙ· Û ‚Ú¤ÊË Ì ÔÍ›· ‚ÚÔÁ¯ÈÔÏ›Ùȉ·, ÌÂ
Abstract: Human metapneumovirus has recently been isolated from children with acute respiratory tract infections. It is classified in the Metapneumovirinae subfamily of the Paramyxoviridae family. In this study RT-PCR was used to detect human metapneumovirus in nasal washes from children admitted to hospital for acute bronchiolitis, and possible correlation of the virus with clinical characteristics of the disease was assessed. PCR revealed the presence of human metapneumovirus in 16% of cases of bronchiolitis, rendering it second in frequency to respiratory syncytial virus (67.9%) of the viral pathogens identified in this cohort. Human metapneumovirus was observed either as the sole viral pathogen or co-existent with respiratory syncytial virus, with which it has a similar seasonal distribution. There were no differences in disease characteristics, either clinical or laboratory, between cases of bronchiolitis where human metapneumovirus was present and those caused by respiratory syncytial virus or other pathogens. These findings support the premise that human metapneumovirus is an important causative agent of bronchiolitis in infants, with clinical characteristics similar to those of respiratory syncytial virus bronchiolitis.
∂Ú¢ÓËÙÈο ∂ÚÁ·ÛÙ‹ÚÈ·, µ’ ¶·È‰È·ÙÚÈ΋ ¶·ÓÂÈÛÙËÌȷ΋ ∫ÏÈÓÈ΋, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó·
Research Laboratories, 2nd Paediatric Clinic of the University of Athens, “P. & A. Kyriakou” Children’s Hospital, Athens
* ∞’ ÈڤÌÂÈÔ Œ·ıÏÔ 41Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ, 2003
* 1st “Choremio” Award 41st Panhellenic Paediatric Meeting, 2003
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ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο fiÌÔÈ· Ì ÂΛӷ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘Á΢ÙÈ·ÎÔ‡ ÈÔ‡. §¤ÍÂȘ ÎÏÂȉȿ: ÌÂÙ·Ó¢ÌÔÓÔ˚fi˜, ÔÍ›· ‚ÚÔÁ¯ÈÔÏ›Ùȉ·, ‚Ú¤ÊË.
Key words: Human metapneumovirus, acute bronchiolitis, infants.
™˘ÓÙÔÌÔÁڷʛ˜
¯ÈÔÏ›Ùȉ· Û˘ÌʈÓÔ‡Ó fiÙÈ Û ÌÂÁ¿ÏÔ ÔÛÔÛÙfi Â›Ó·È ·‰‡Ó·ÙË Ë ·Ó·ÁÓÒÚÈÛË ˘Â‡ı˘ÓÔ˘ ·ÈÙÈÔÏÔÁÈÎÔ‡ ·Ú¿ÁÔÓÙ·. ∂ÈÚfiÛıÂÙ·, ÁÓˆÚ›˙ÔÓÙ·˜ ÙȘ ‰ÔÌÈΤ˜ ÔÌÔÈfiÙËÙ˜ ÙÔ˘ hMPV Î·È ÙÔ˘ RSV, ηıÒ˜ Î·È fiÙÈ ·ÔÌÔÓÒıËΠ۠·ÛıÂÓ›˜ Ì ‚ÚÔÁ¯ÈÔÏ›Ùȉ·, ˘Ôı¤Û·Ì fiÙÈ Ô hMPV Èı·Ó¿ Ó· ·ÔÙÂÏ› ÛËÌ·ÓÙÈÎfi ·ıÔÁfiÓÔ Û٤ϯԘ Û ‚Ú¤ÊË Ì ‚ÚÔÁ¯ÈÔÏ›Ùȉ·. ¶ÚfiÛÊ·Ù· ·Ó·ÎÔÈÓÒıËÎ·Ó Ù· ·ÔÙÂϤÛÌ·Ù· ÙÔ˘ ÈÔÏÔÁÈÎÔ‡ ÂϤÁ¯Ô˘ Ì›·˜ ÔÌ¿‰·˜ ‚ÚÂÊÒÓ Ô˘ ÂÈÛ‹¯ıËÛ·Ó ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô ÏfiÁˆ ÔÍ›·˜ ‚ÚÔÁ¯ÈÔÏ›Ùȉ·˜, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÙË Ì¤ıÔ‰Ô Ù˘ ·Ó¿ÛÙÚÔÊ˘ ÌÂÙ·ÁÚ·Ê‹˜ Ù˘ ·ÓÙ›‰Ú·Û˘ ·Ï˘ÛȉˆÙ‹˜ ÔÏ˘ÌÂÚ¿Û˘ (RT-PCR), ÚÔÎÂÈ̤ÓÔ˘ Ó· ·ÓȯÓ¢ıÔ‡Ó ¤ÓÙÂη ·ıÔÁfiÓ· ÛÙÂϤ¯Ë ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ (5). Ÿˆ˜ ·Ó·ÌÂÓfiÙ·Ó, Ô RSV ‹Ù·Ó ÙÔ Î˘ÚÈfiÙÂÚÔ ·ıÔÁfiÓÔ Û٤ϯԘ, ·ÎÔÏÔ˘ıÔ‡ÌÂÓÔ ·fi ÙÔÓ ·ÓıÚÒÈÓÔ ÚÈÓÔ˚fi (RV), Ô ÔÔ›Ô˜ ·Ó·ÁÓˆÚ›ÛÙËΠÛÙÔ ¤Ó· ÙÚ›ÙÔ ÂÚ›Ô˘ ÙˆÓ ÂÚÈÙÒÛˆÓ. ™Â ÌÈÎÚfiÙÂÚÔ ÔÛÔÛÙfi ·Ó¢ڤıËÛ·Ó ·‰ÂÓÔ˚Ô›, Corona ÈÔ›, ηıÒ˜ Î·È ÔÈ ÈÔ› Ù˘ Áڛ˘ Î·È ·Ú·Áڛ˘. ¢ÂÓ ·Ó·ÁÓˆÚ›ÛÙËΠ·ıÔÁfiÓÔ Û٤ϯԘ ÛÙÔ 25% ÂÚ›Ô˘ ÙˆÓ ÂÚÈÙÒÛÂˆÓ (5). ™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‹Ù·Ó Ó· ‰ÈÂÚ¢ÓËı› Ë ·ÚÔ˘Û›· ÙÔ˘ hMPV ÛÙ· ÚÈÓÈο ÂÎχ̷ٷ ·È‰ÈÒÓ Ô˘ ÂÈÛ‹¯ıËÛ·Ó ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô Ì ÔÍ›· ‚ÚÔÁ¯ÈÔÏ›Ùȉ· Î·È Ó· ÂÎÙÈÌËı› Èı·Ó‹ Û¯¤ÛË ÌÂٷ͇ ÙÔ˘ ÈÔ‡ Î·È ÙˆÓ ÎÏÈÓÈÎÒÓ Î·È ÂȉËÌÈÔÏÔÁÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ Ù˘ ÓfiÛÔ˘.
hMPV
∞ÓıÚÒÈÓÔ˜ ÌÂÙ·Ó¢ÌÔÓÔ˚fi˜ (Human metapneumovirus) ∏RSV ∞Ó·Ó¢ÛÙÈÎfi˜ Û˘Á΢ÙÈ·Îfi˜ Èfi˜ RV ∞ÓıÚÒÈÓÔ˜ ÚÈÓÔ˚fi˜ RT-PCR ∞Ó¿ÛÙÚÔÊË ·ÓÙ›‰Ú·ÛË ·Ï˘ÛȉˆÙ‹˜ ÔÏ˘ÌÂÚ¿Û˘
∂ÈÛ·ÁˆÁ‹ ŒÓ·˜ Ó¤Ô˜ ·Ó·Ó¢ÛÙÈÎfi˜ Èfi˜, Ô ·ÓıÚÒÈÓÔ˜ ÌÂÙ·Ó¢ÌÔÓÔ˚fi˜ (Human metapneumovirus hMPV), ·ÔÌÔÓÒıËΠÚfiÛÊ·Ù· Û ÚÈÓÔÊ·Ú˘ÁÁÈο ÂÎχ̷ٷ ·È‰ÈÒÓ ÛÙËÓ OÏÏ·Ó‰›· (1). O hMPV Â›Ó·È ÙÔ ÚÒÙÔ ·ÓıÚÒÈÓÔ ·ıÔÁfiÓÔ Û٤ϯԘ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Ô˘ Ù·ÍÈÓÔÌ‹ıËΠˆ˜ ̤ÏÔ˜ ÙÔ˘ Á¤ÓÔ˘˜ ÙˆÓ ÌÂÙ·Ó¢ÌÔÓÔ˚ÒÓ, ÔÈ ÔÔ›ÔÈ Ì·˙› Ì ÙÔ˘˜ Ó¢ÌÔÓÔ˚Ô‡˜ ··ÚÙ›˙Ô˘Ó ÙËÓ Pneumovirinae ˘Ô-ÔÈÎÔÁ¤ÓÂÈ·, Ë ÔÔ›· ·Ó‹ÎÂÈ ÛÙËÓ Â˘Ú‡ÙÂÚË ÔÈÎÔÁ¤ÓÂÈ· ÙˆÓ ·Ú·Ì˘ÍÔ˚ÒÓ (Paramyxoviridae family), fiÔ˘ ·Ó‹ÎÔ˘Ó ·ÎfiÌË Ô Èfi˜ Ù˘ ·Ú·Áڛ˘ (Parainfluenza) Î·È Ô ·Ó·Ó¢ÛÙÈÎfi˜ Û˘Á΢ÙÈ·Îfi˜ Èfi˜ (respiratory syncytial virus RSV). O ηÈÓÔ‡ÚÁÈÔ˜ Èfi˜ ·ÚÔ˘ÛÈ¿˙ÂÈ ÛÙÔ ËÏÂÎÙÚÔÓÈÎfi ÌÈÎÚÔÛÎfiÈÔ ÏÂÈÔÌÔÚÊÈο ÙÌ‹Ì·Ù· Ì ÌÔÚÊÔÏÔÁ›· ·Ú·Ì˘ÍÔ˚ÒÓ, Â›Ó·È Â˘·›ÛıËÙÔ˜ ÛÙÔ ¯ÏˆÚÔÊfiÚÌÈÔ Î·È ÔÏÏ·Ï·ÛÈ¿˙ÂÙ·È ·ÚÔ˘Û›· ÙÚ˘„›Ó˘ Û tª∫ ·ÙÙ·Ú·. ÷ڷÎÙËÚÈÛÙÈΤ˜ ΢ÙÙ·ÚÔ·ıÔÏÔÁÈΤ˜ ÂȉڿÛÂȘ ÙÔ˘ ÈÔ‡ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Û¯ËÌ·ÙÈÛÌfi Û˘ÁÎ˘Ù›ˆÓ Î·È Ú·Á‰·›· ÂÛˆÙÂÚÈ΋ ‰È¿Û·ÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÌÂ Û˘Ó·ÎfiÏÔ˘ıË ·ÔÎfiÏÏËÛË ·fi ÙÚ˘‚Ï›· ΢ÙÙ·ÚÈÎÒÓ Î·ÏÏÈÂÚÁÂÈÒÓ (1,2). º˘ÏÔÁÂÓÂÙÈΤ˜ ·Ó·Ï‡ÛÂȘ ·¤‰ÂÈÍ·Ó ‰È·ÊÔÚ¤˜ ÛÙËÓ ·ÏÏËÏÔ˘¯›· ÌÂٷ͇ ÙˆÓ ÙÌËÌ¿ÙˆÓ ÙÔ˘ ÈÔ‡ Ô˘ ·ÔÌÔÓÒÓÔÓÙ·Ó, ˘Ô‰ËÏÒÓÔÓÙ·˜ ÙËÓ ‡·ÚÍË Èı·ÓfiÓ ‰‡Ô ‰È·ÊÔÚÂÙÈÎÒÓ ÁÂÓÂÙÈÎÒÓ ÔÌ¿‰ˆÓ (1,2). ∆· ·È‰È¿, ·fi Ù· ÔÔ›· ·ÔÌÔÓÒıËÎÂ Ô Èfi˜ ÛÙËÓ OÏÏ·Ó‰›·, ·ÚÔ˘Û›·˙·Ó ÔÈΛÏË ÎÏÈÓÈ΋ ÂÈÎfiÓ·, Ô˘ Î˘Ì·ÈÓfiÙ·Ó ·fi Û˘ÌÙÒÌ·Ù· ÌfiÓÔ ·fi ÙÔ ·ÓÒÙÂÚÔ ·Ó·Ó¢ÛÙÈÎfi ¤ˆ˜ ÛÔ‚·Ú‹ ‚ÚÔÁ¯ÈÔÏ›Ùȉ· Î·È Ó¢ÌÔÓ›· (1). ªÂÙ¤ÂÈÙ· ÌÂϤÙ˜ Ô˘ Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó Û ‰È¿ÊÔÚ˜ ÂÚÈÔ¯¤˜ ÙÔ˘ Ï·Ó‹ÙË, ·Ó¤‰ÂÈÍ·Ó ÙÔÓ Èı·Ófi ÚfiÏÔ ÙÔ˘ ÈÔ‡ ·ÊÂÓfi˜ Û ·È‰È¿ Ì ÔÍ›· ‚ÚÔÁ¯ÈÔÏ›Ùȉ· (3), ·ÊÂÙ¤ÚÔ˘ Û ÏÔÈÌÒÍÂȘ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û ¿ÙÔÌ· οı ËÏÈΛ·˜ (2,4). ¶·Ú’ fiÏ· ·˘Ù¿, Ù· ÂȉËÌÈÔÏÔÁÈο Î·È ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ÏÔÈÌÒÍÂˆÓ Ô˘ ÚÔηÏÔ‡ÓÙ·È ·fi ÙÔÓ hMPV ¯Ú‹˙Ô˘Ó ÂÚ·ÈÙ¤Úˆ ÌÂϤÙ˘. ¶·Ú¿ ÙË ¯Ú‹ÛË Û‡Á¯ÚÔÓˆÓ ÌÂıfi‰ˆÓ ·Ó›¯Ó¢Û˘ ÈÒÓ, fiϘ ۯ‰fiÓ ÔÈ ÌÂϤÙ˜ ‚ÚÂÊÒÓ Ì ‚ÚÔÁ-
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ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ∏ ÌÂϤÙË ‰ÈÂÓÂÚÁ‹ıËΠÛÙË µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ηٿ ÙÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÌÂٷ͇ 1˘ OÎÙˆ‚Ú›Ô˘ 1999 Î·È 30‹˜ ™ÂÙÂÌ‚Ú›Ô˘ 2000 Î·È ÂÁÎÚ›ıËΠ·fi ÙË ‰ÂÔÓÙÔÏÔÁÈ΋ ÂÈÙÚÔ‹ ÙÔ˘ ÓÔÛÔÎÔÌ›Ԣ. ∫·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹, Ù· ·È‰È¿ ·ÍÈÔÏÔÁ‹ıËÎ·Ó ·fi È·ÙÚÔ‡˜ Ù˘ ÎÏÈÓÈ΋˜, ÙfiÛÔ ÎÏÈÓÈο fiÛÔ Î·È ‚¿ÛÂÈ ÂÓfi˜ Ù˘ÔÔÈË̤ÓÔ˘ ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘. ∆Ô ÈÛÙÔÚÈÎfi ÂÚÈÂÏ¿Ì‚·Ó ÏËÚÔÊÔڛ˜ fiˆ˜ Ë ËÏÈΛ·, ÙÔ Ê‡ÏÔ, ÙÔ ÂÚÈÁÂÓÓËÙÈÎfi ÈÛÙÔÚÈÎfi (‰È¿ÚÎÂÈ· ·ËÛ˘, ‚¿ÚÔ˜ Á¤ÓÓËÛ˘), ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ·ÙÔ›·˜ (Ô˘ ÔÚ›ÛÙËΠˆ˜ ıÂÙÈÎfi ÈÛÙÔÚÈÎfi È·ÙÚÈ΋˜ ‰È¿ÁÓˆÛ˘ ¿ÛıÌ·ÙÔ˜, ·ÏÏÂÚÁÈ΋˜ ÚÈÓ›Ùȉ·˜ ‹ ·Ó·Ê˘Ï·Í›·˜ ÛÂ Û˘ÁÁÂÓ›˜ ÚÒÙÔ˘ ‚·ıÌÔ‡), Ë ¤ÎıÂÛË Û ηÓfi ÙÛÈÁ¿ÚÔ˘ (Ô˘ ÔÚ›ÛÙËΠˆ˜ ıÂÙÈÎfi ÂÊfiÛÔÓ ¤Ó·˜ ·fi ÙÔ˘˜ ‰‡Ô ÁÔÓ›˜ οÓÈ˙ ÔÔÈÔÓ‰‹ÔÙ ·ÚÈıÌfi ÙÛÈÁ¿ÚˆÓ ̤۷ ÛÙÔ Û›ÙÈ), ηıÒ˜ Î·È ÙÔ ÚÔËÁÔ‡ÌÂÓÔ ÈÛÙÔÚÈÎfi ÂÂÈÛÔ‰›ˆÓ Û˘ÚÈÁÌÔ‡ ‹ ¿ÏÏ˘ ¯ÚfiÓÈ·˜ ¿ıËÛ˘ Ì ȷÙÚÈ΋ Áӈ̿Ù¢ÛË. ™ÙË ÌÂϤÙË ÂÚÈÂÏ‹ÊıËÛ·Ó ·È‰È¿ ÌÂ
May-June 04 chris new
19-07-04
19:24
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¶·È‰È·ÙÚÈ΋ 2004;67:173-177
ÔÍ›· ‚ÚÔÁ¯ÈÔÏ›Ùȉ·, ËÏÈΛ·˜ οو ÙˆÓ 18 ÌËÓÒÓ. ø˜ ‚ÚÔÁ¯ÈÔÏ›Ùȉ· ÔÚ›ÛÙËÎÂ Ë ÔÍ›· Ïԛ̈ÍË ÙÔ˘ ηÙÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, ¯·Ú·ÎÙËÚÈ˙fiÌÂÓË ·fi ·˘ÍË̤ÓË ·Ó·Ó¢ÛÙÈ΋ ÚÔÛ¿ıÂÈ· (Ù·¯‡ÓÔÈ· Ì >50 ·Ó·ÓÔ¤˜/min ηÈ/‹ ¯Ú‹ÛË ÂÈÎÔ˘ÚÈÎÒÓ ·Ó·Ó¢ÛÙÈÎÒÓ Ì˘ÒÓ), ÂÎÓ¢ÛÙÈÎfi Û˘ÚÈÁÌfi ηÈ/‹ ˘ÁÚÔ‡˜ ÚfiÁ¯Ô˘˜. ∆· ÎÚÈÙ‹ÚÈ· ·ÔÎÏÂÈÛÌÔ‡ ÂÚÈÂÏ¿Ì‚·Ó·Ó ¯ÚfiÓȘ ·ı‹ÛÂȘ (΢ÛÙÈ΋ ›ÓˆÛË, ‚ÚÔÁ¯ÔÓ¢ÌÔÓÈ΋ ‰˘ÛÏ·Û›·, Û˘ÁÁÂÓ›˜ ηډȷΤ˜ ·ı‹ÛÂȘ, ·ÓÔÛÔ·Ó¿ÚÎÂÈ·) Î·È ˘ÔÙÚÔÈ¿˙ÔÓÙ· ÂÂÈÛfi‰È· Û˘ÚÈÁÌÔ‡. OÚ›ÛÙËΠÎÏÈÓÈ΋ Îϛ̷η ‚·Ú‡ÙËÙ·˜ ÙÔ˘ ÂÂÈÛÔ‰›Ô˘ ‚·ÛÈ˙fiÌÂÓË ÛÙÔÓ Î·Ú‰È·Îfi Î·È ·Ó·Ó¢ÛÙÈÎfi Ú˘ıÌfi, ÙÔÓ Û˘ÚÈÁÌfi, ÙËÓ Î˘¿ÓˆÛË, ÙË ‰˘Û¯¤ÚÂÈ· Ï‹„˘ ÙÚÔÊ‹˜ Î·È ÙÔÓ ÎÔÚÂÛÌfi Ô͢ÁfiÓÔ˘. OÈ ·ÛıÂÓ›˜ ˘Ô‚Ï‹ıËÎ·Ó Û ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜, ·ÈÌÔÏË„›· Î·È Ï‹„Ë ÚÈÓÔÊ·Ú˘ÁÁÈÎÔ‡ ÂÎχ̷ÙÔ˜ Ì 2 ml Ê˘ÛÈÔÏÔÁÈÎÔ‡ ÔÚÔ‡ Û οı ÚÒıˆÓ·, ÙÔ ÔÔ›Ô ‰È·¯ˆÚ›ÛÙËΠ۠ÎÏ¿ÛÌ·Ù· Î·È ‰È·ÙËÚ‹ıËΠÛÙÔ˘˜ -70ÔC. ¡¤Ô ÎÏ¿ÛÌ· ¯ÚËÛÈÌÔÔÈ‹ıËΠÁÈ· ÙËÓ ·Ó›¯Ó¢ÛË ÙÔ˘ hMPV. ∫·Ù’ ·˘ÙfiÓ ÙÔÓ ÙÚfiÔ, ÌÂÏÂÙ‹ıËΠ˘ÏÈÎfi Ô˘ ÚÔÂÚ¯fiÙ·Ó ·fi 56 ·È‰È¿. ∆· ‚Ú¤ÊË ıÂڷ‡ÙËÎ·Ó Û‡Ìʈӷ Ì ÙÔ ÚˆÙfiÎÔÏÏÔ Ù˘ ÎÏÈÓÈ΋˜ Î·È ÂÍ‹Ïı·Ó Û ηϋ ÁÂÓÈ΋ ηٿÛÙ·ÛË. ∂ÈÚfiÛıÂÙ·, ÚÈÓÔÊ·Ú˘ÁÁÈÎfi ¤ÎÏ˘Ì· Ï‹ÊıËΠ·fi 10 ˘ÁÈ‹ ·È‰È¿, ¯ˆÚ›˜ ÛËÌ›· ‹ Û˘ÌÙÒÌ·Ù· Ïԛ̈͢ ·ÓÒÙÂÚÔ˘ ‹ ηÙÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡, Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ˆ˜ Ì¿ÚÙ˘Ú˜. ∞Ó›¯Ó¢ÛË ÙÔ˘ hPMV Ì ÙË Ì¤ıÔ‰Ô Ù˘ PCR ∞ÔÌÔÓÒıËΠÈÈÎfi RNA ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÙË Ê·ÈÓfiÏ/ÁÔ˘·Óȉ›ÓË ÈÛÔıÂÈÔ΢·ÓÈ΋ ̤ıÔ‰Ô (5). ∏ ·Ó¿ÛÙÚÔÊË ÌÂÙ·ÁÚ·Ê‹ ‰ÈÂÓÂÚÁ‹ıËΠÛÙÔ˘˜ 37ÔC Û 50 mM Tris-HCL, 75 mM KCL, 3 mM MgCl2 Ú˘ıÌÈÛÙÈÎfi ‰È¿Ï˘Ì·, Ô˘ ÂÚÈ›¯Â 10 mª DTT, 0,4 mM dNTPs, 0,5 Ìg Ù˘¯·›Ô˘˜ ÂÍ·ÌÂÚ›˜ ÂÎÎÈÓËÙ¤˜ Î·È 200 ÌÔÓ¿‰Â˜ ·Ó¿ÛÙÚÔÊ˘ ÙÚ·ÓÛÎÚÈÙ¿Û˘ (SuperscriptTM, Invitrogen). ∆Ô cDNA ‰È·ÙËÚ‹ıËΠÛÙÔ˘˜ -20ÔC ¤ˆ˜ fiÙÔ˘ Ó· ¯ÚËÛÈÌÔÔÈËı›. OÈ ÂÎÎÈÓËÙ¤˜ (¿Óˆ MPVNF: 5’AGGCCCTCAGCACCAGACA3’, οو MPVNR: 5’TTGACCGGCCCCATAAGC3’) ۯ‰ȿÛÙËÎ·Ó ÁÈ· ÙË ¡ (ÓÔ˘ÎÏÂÔηۛ‰ÈÔ) ÂÚÈÔ¯‹ ÙÔ˘ 00-1 ÙÌ‹Ì·ÙÔ˜ ÙÔ˘ hMPV Ô˘ ·ÔÌÔÓˆÓfiÙ·Ó (Genbank accesion Nr AF 371337.2), ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂÓÈÛ¯˘ı› ıÚ·‡ÛÌ· ·ÔÙÂÏÔ‡ÌÂÓÔ ·fi 318 ‚¿ÛÂȘ, Ô˘ ·ÓÙÈÛÙÔȯ› ÛÙ· ÓÔ˘ÎÏÂÔÙ›‰È· 505-822 ÙÔ˘ ‰ËÌÔÛÈÂ˘Ì¤ÓÔ˘ ÁÂÓÂÙÈÎÔ‡ ÙÌ‹Ì·ÙÔ˜ ÙÔ˘ ÈÔ‡ (1). ∏ ·ÓÙ›‰Ú·ÛË ·Ï˘ÛȉˆÙ‹˜ ÔÏ˘ÌÂÚ¿Û˘ ‰ÈÂÓÂÚÁ‹ıËΠ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ 2,5 mM MgCl2, 400 ÌM dNTPs, 0,25 ̪ ·fi οı hMPV ÂÎÎÈÓËÙ‹ Î·È 2,5 ÌÔÓ¿‰Â˜ Taq ÔÏ˘ÌÂÚ¿ÛË (Invitrogen) ÁÈ· 40 ·ÎÏÔ˘˜ (94ÔC ÁÈ· 40 sec, 55ÔC ÁÈ· 40 sec, 72ÔC ÁÈ· 1 min, οı ·ÎÏÔ˜). ™ÙË Û˘Ó¤¯ÂÈ·, 20% ·fi ÙÔ ÚÔ˚fiÓ Ù˘ PCR ËÏÂÎÙÚÔÊÔÚ‹ıËΠ۠1,8% ‹Îو̷ ·Á·Úfi˙˘ ηÈ, ÂÊfiÛÔÓ Ù· ÂÓÈÛ¯˘Ì¤Ó· ÙÌ‹Ì·Ù· ÙˆÓ 318 ‚¿ÛÂˆÓ ‹Ù·Ó ·ÚfiÓÙ·, ·ÔÎfiËÎ·Ó Î·È Î·ı·Ú›ÛÙËÎ·Ó Ì ÙÔ Concert Rapid Gel Extraction System Kit (GibcoBRL), Û‡Ìʈӷ Ì ÙȘ Ô‰ËÁ›Â˜ ÙÔ˘ ηٷÛ΢·ÛÙ‹. ∂ÈÏÂÁ̤ӷ ‰Â›ÁÌ·Ù· ÍËÚ¿ÓıËÎ·Ó ˘fi ÎÂÓfi Î·È ˘¤ÛÙËÛ·Ó ·Ó¿Ï˘ÛË ·ÏÏËÏÔ˘¯›·˜, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÙȘ ˘ËÚÂۛ˜ Ù˘ MWG AG Biotech (Ebersberg, Germany, ˘ËÚÂÛ›· ·Ó¿Ï˘Û˘ ·ÏÏËÏÔ˘¯ÈÒÓ). ¶Ú·ÁÌ·ÙÔÔÈ‹ıËΠۇÁÎÚÈÛË ÙˆÓ ıÚ·˘ÛÌ¿ÙˆÓ Ô˘ ·Ó·Ï‡ıËÎ·Ó Ì ÙÔ ÁÂÓÂÙÈÎfi ˘ÏÈÎfi
Paediatriki 2004;67:173-177
ÙÔ˘ hMPV, Ì ˘Ô‚ÔÏ‹ ÙˆÓ ·ÏÏËÏÔ˘¯ÈÒÓ ÛÙËÓ Genbank, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÙËÓ ÎÏ·ÛÈ΋ ̤ıÔ‰Ô ·Ó¿Ï˘Û˘ ÓÔ˘ÎÏÂÔÙȉ›ˆÓ BLAST (blastn). ™Ù·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ∏ ÛÙ·ÙÈÛÙÈ΋ ‰ÔÎÈÌ·Û›· ∞nova ¯ÚËÛÈÌÔÔÈ‹ıËΠÁÈ· ÙË Û‡ÁÎÚÈÛË Û˘Ó¯ÒÓ ÌÂÙ·‚ÏËÙÒÓ ÌÂٷ͇ ÙˆÓ ·ÛıÂÓÒÓ Ì hMPV, ¯ˆÚ›˜ hMPV Î·È Ì RSV. ¢ÈÂÓÂÚÁ‹ıËΠ‰ÔÎÈÌ·Û›· ¯2 ÁÈ· ÙËÓ ÂÂÍÂÚÁ·Û›· Ù·ÎÙÈÎÒÓ ‹ ηÙËÁÔÚÈÔÔÈËÌ¤ÓˆÓ ‰Â‰Ô̤ӈÓ. ∆· ·ÔÙÂϤÛÌ·Ù· Û˘Ó¯ÒÓ ‰Â‰ÔÌ¤ÓˆÓ ÂÎÊÚ¿ÛÙËÎ·Ó ˆ˜ ̤ÛÔ ± ÛÙ·ıÂÚfi ÛÊ¿ÏÌ· ̤ÛÔ˘. ™Ù·ÙÈÛÙÈΤ˜ ·Í›Â˜ ÌÈÎÚfiÙÂÚ˜ ·fi 0,05 ıˆڋıËÎ·Ó ˆ˜ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜.
∞ÔÙÂϤÛÌ·Ù· O ·ÓıÚÒÈÓÔ˜ ÌÂÙ·Ó¢ÌÔÓÔ˚fi˜ (hMPV) ‚Ú¤ıËΠ۠9 ·fi Ù· 56 ‰Â›ÁÌ·Ù· Ô˘ ÂÍÂÙ¿ÛÙËÎ·Ó (16,1%), fiˆ˜ Ê¿ÓËΠ·fi ÙÔ ÚÔ˚fiÓ Ù˘ PCR, ·ÔÙÂÏÔ‡ÌÂÓÔ ·fi 318 ‚¿ÛÂȘ ÛÙÔ ‹Îو̷ ËÏÂÎÙÚÔÊfiÚËÛ˘. ∏ ·ÚÔ˘Û›· ÙÔ˘ ÈÔ‡ ÂȂ‚·ÈÒıËΠ·fi ÙËÓ ·Ó¿Ï˘ÛË ·ÏÏËÏÔ˘¯›·˜ Ô˘ ¤ÁÈÓ Û ıÂÙÈο ÚÔ˚fiÓÙ· Ù˘ PCR (6,7). O ·Ó·Ó¢ÛÙÈÎfi˜ Û˘Á΢ÙÈ·Îfi˜ Èfi˜ (RSV) ‹Ù·Ó ÙÔ Î‡ÚÈÔ ·ıÔÁfiÓÔ Û٤ϯԘ, ·ÊÔ‡ ·ÔÌÔÓÒıËΠ۠38 ·fi Ù· 56 ‰Â›ÁÌ·Ù· (67,9%), ÂÓÒ Ô ·ÓıÚÒÈÓÔ˜ ÚÈÓÔ˚fi˜ (RV) ‚Ú¤ıËΠ۠8 ‰Â›ÁÌ·Ù· (14,3%). ÕÏÏÔÈ ÈÔ› Ô˘ ·ÔÌÔÓÒıËÎ·Ó ‹Ù·Ó ·‰ÂÓÔ˚Ô› (4 ÂÚÈÙÒÛÂȘ) Î·È ÈÔ› Corona (3 ÂÚÈÙÒÛÂȘ), ÂÓÒ Û ¤Ó· ‰Â›ÁÌ· ·ÔÌÔÓÒıËΠÈfi˜ Ù˘ ·Ú·Áڛ˘ (5). ¢¤Î· ¤ÍÈ ·ÛıÂÓ›˜ ‚Ú¤ıËÎ·Ó Ù·˘Ùfi¯ÚÔÓ· ıÂÙÈÎÔ› Û 2 ÈÔ‡˜, ÂÓÒ ‰ÂÓ ‚Ú¤ıËΠ·ıÔÁfiÓÔ Û٤ϯԘ Û 9 ÂÚÈÙÒÛÂȘ. ŸÏ· Ù· ÚÈÓÔÊ·Ú˘ÁÁÈο ÂÎχ̷ٷ ·fi ÙÔ˘˜ ˘ÁÈ›˜ Ì¿ÚÙ˘Ú˜ Ô˘ ·Ó·Ï‡ıËÎ·Ó Ì PCR ÁÈ· hMPV ‹Ù·Ó ·ÚÓËÙÈο. ™Â 5 ·fi Ù· ıÂÙÈο ÁÈ· hMPV ‰Â›ÁÌ·Ù·, Ô Èfi˜ ‹Ù·Ó ÙÔ ÌÔÓ·‰ÈÎfi ·ıÔÁfiÓÔ Û٤ϯԘ, ÂÓÒ ÛÙ· ˘fiÏÔÈ· 4 Û˘Ó˘‹Ú¯Â Ì ÙÔÓ RSV. ¢ÂÓ ·Ú·ÙËÚ‹ıËÎÂ Û˘Ó‡·ÚÍË ÙÔ˘ ÈÔ‡ Ì ¿ÏÏÔ˘˜ ÈÔ‡˜ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. OÈ ÂÚÈÛÛfiÙÂÚ˜ ÏÔÈÌÒÍÂȘ Ì ÙÔÓ hMPV Ê·›ÓÂÙ·È Ó· ÚˆÙÔÂÌÊ·Ó›˙ÔÓÙ·È ÙÔÓ ºÂ‚ÚÔ˘¿ÚÈÔ Î·È, ·Ú¿ ÙÔ fiÙÈ ÚÔԉ¢ÙÈο ÂÍ·ÛıÂÓÔ‡Ó, ÂÈ̤ÓÔ˘Ó Ì¤¯ÚÈ ÙÔÓ ∞Ú›ÏÈÔ (∂ÈÎfiÓ· 1). ∏ ·ÓÙ›ÛÙÔÈ¯Ë ÂÚ›Ô‰Ô˜ ÂÌÊ¿ÓÈÛ˘ ÙÔ˘ RSV ÙËÓ ›‰È· ¯ÚÔÓÈ¿ ‹Ù·Ó ·fi ÙÔÓ ¢ÂΤ̂ÚÈÔ ¤ˆ˜ ÙÔÓ ª¿ÚÙÈÔ. ¶·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ô ·ÚÈıÌfi˜ ÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ Â›Ó·È Û¯ÂÙÈο ÌÈÎÚfi˜, Ê·›ÓÂÙ·È fiÙÈ Ô hMPV ·ÚÔ˘ÛÈ¿˙ÂÈ ·ÚfiÌÔÈ·, ·ÏÏ¿ ·Ú’ fiÏ· ·˘Ù¿ - ¢‰È¿ÎÚÈÙË ÂÔ¯È΋ ηٷÓÔÌ‹ Û ۯ¤ÛË Ì ÙÔÓ RSV. ¢ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ‰È·ÊÔÚ¤˜ ÛÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ ‚ÚÔÁ¯ÈÔÏ›Ùȉ·˜ fiÔ˘ ·ÔÌÔÓÒıËÎÂ Ô hMPV, Ô RSV ‹ ¿ÏÏÔ ·ıÔÁfiÓÔ Û٤ϯԘ (¶›Ó·Î·˜ 1). ∂ÈϤÔÓ, ‰ÂÓ ˘‹ÚÍ ‰È·ÊÔÚ¿ ÛÙË ‚·Ú‡ÙËÙ· Ù˘ ÓfiÛÔ˘ ÌÂٷ͇ ÙˆÓ ıÂÙÈÎÒÓ ÁÈ· hMPV Î·È ÙˆÓ ‰ÈÏ¿ ıÂÙÈÎÒÓ ÁÈ· hMPV-RSV ÂÚÈÙÒÛˆÓ
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(‰Â›ÎÙ˘ ‚·Ú‡ÙËÙ·˜: 8,3±0,6 ¤Ó·ÓÙÈ 8,4±0,6). ¢È·ÊÔÚ¤˜ ‰ÂÓ ·Ú·ÙËÚ‹ıËηÓ, ›Û˘, fiÙ·Ó Ù· ÛÙÔȯ›· Ô˘ ηıfiÚÈÛ·Ó ÙË ‚·Ú‡ÙËÙ· Ù˘ ÓfiÛÔ˘ ÂÍÂÙ¿ÛÙËÎ·Ó Í¯ˆÚÈÛÙ¿ (ηډȷÎfi˜ Ú˘ıÌfi˜, ·Ó·Ó¢ÛÙÈÎfi˜ Ú˘ıÌfi˜, Û˘ÚÈÁÌfi˜, ¯ÚÒÌ· ‰¤ÚÌ·ÙÔ˜ Î·È ·ÚÙËÚÈ·Îfi˜ ÎÔÚÂÛÌfi˜ Ô͢ÁfiÓÔ˘). ∆¤ÏÔ˜, Ù· ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· ÌÂٷ͇ ÙˆÓ ·È‰ÈÒÓ Ì ‹ ¯ˆÚ›˜ ÙÔÓ hMPV ‰ÂÓ ·ÚÔ˘Û›·˙·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ (¶›Ó·Î·˜ 2). ™˘˙‹ÙËÛË ¶·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ô ·ÓıÚÒÈÓÔ˜ ·Ó·Ó¢ÛÙÈÎfi˜ Û˘Á΢ÙÈ·Îfi˜ Èfi˜ ·ÔÙÂÏ› ÙÔ ÈÔ Û˘¯Ófi ·›ÙÈÔ ÔÍ›·˜ ‚ÚÔÁ¯ÈÔÏ›Ùȉ·˜ Û ·È‰È¿, ·Ú·Ì¤ÓÂÈ ÛËÌ·ÓÙÈÎfi˜ ·ÚÈıÌfi˜ ÂÚÈÙÒÛÂˆÓ ÛÙȘ Ôԛ˜ ‰ÂÓ ·Ó¢ڛÛÎÂÙ·È ·ÈÙÈÔÏÔÁÈÎfi˜ ·Ú¿ÁÔÓÙ·˜. ÿÛˆ˜, Ô hMPV Ô˘ ·Ó·Î·Ï‡ÊıËΠÚfiÛÊ·Ù·, Ó· ‰ÒÛÂÈ Ì›· ÂÍ‹ÁËÛË Û ÂÚÈÙÒÛÂȘ ÏÔÈÌÒÍÂˆÓ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Ô˘ ‰ÂÓ ¤¯Ô˘Ó ‰È·ÁÓˆÛÙ› ¤ˆ˜ ÙÒÚ· (1). ∏ ·ÚÔ‡Û· ÌÂϤÙË, Ì ÙË ¯ÚËÛÈÌÔÔ›ËÛË Ù˘ ÌÂıfi‰Ô˘ PCR, ·ÔηχÙÂÈ Û˘¯Ó‹ Û˘ÌÌÂÙÔ¯‹ ÙÔ˘ hMPV Û ‚Ú¤ÊË Ì ÔÍ›· ‚ÚÔÁ¯ÈÔÏ›Ùȉ·. ™‡Ìʈӷ Ì ÙËÓ ·Ó¿Ï˘ÛË, Ô hMPV ‚Ú¤ıËΠ۠16% ÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ ‚ÚÔÁ¯ÈÔÏ›Ùȉ·˜, ÔÛÔÛÙfi ÌfiÏȘ ‰Â‡ÙÂÚÔ ÛÂ Û˘¯ÓfiÙËÙ· ÌÂÙ¿ ÙÔÓ RSV (5). O hMPV ‹Ù·Ó ÌÔÓ·‰ÈÎfi ·ıÔÁfiÓÔ Û٤ϯԘ ‹ Û˘Ó˘‹Ú¯Â Ì ÙÔÓ RSV, ·ÚÔ˘ÛÈ¿˙ÔÓÙ·˜ Ì›· ·Ú¿ÏÏËÏË ·ÏÏ¿ ηÈ, 30 ™‡ÓÔÏÔ RSV MPV
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∂ÈÎfiÓ· 1. ∂Ô¯È΋ ηٷÓÔÌ‹ ÙÔ˘ hMPV. OÈ Ì·‡Ú˜ Ú¿‚‰ÔÈ ·ÂÈÎÔÓ›˙Ô˘Ó ÙÔÓ ·ÚÈıÌfi ÙˆÓ ‰ÂÈÁÌ¿ÙˆÓ Ô˘ ‚Ú¤ıËÎ·Ó ıÂÙÈο ÁÈ· hMPV, ÔÈ ÁÎÚÈ ÁÈ· RSV Î·È ÔÈ Ï¢Τ˜ ÁÈ· ÔÔÈÔÓ‰‹ÔÙ ¿ÏÏÔ ·Ó·Ó¢ÛÙÈÎfi Èfi.
Ù·˘Ùfi¯ÚÔÓ·, ‰È·ÎÚÈÙ‹ ÂÔ¯È΋ ηٷÓÔÌ‹ Û ۯ¤ÛË Ì ÙÔÓ RSV. ¶·ÚfiÌÔÈ· ÂÔ¯È΋ ηٷÓÔÌ‹ ·Ó·Ê¤ÚÂÙ·È Î·È ÛÙË ÌÂϤÙË ÙˆÓ Jartti Î·È Û˘Ó Û ·ÛıÂÓ›˜ Ì ·ÈÊÓ›‰ÈÔ Û˘ÚÈÁÌfi (3). ∏ ·ÚÔ˘Û›· ÙÔ˘ hMPV ÛÙËÓ ÂÚÈÔ¯‹ Ù˘ ªÂÛÔÁ›Ԣ ·ÔÙÂÏ› Ì›· ÂÈϤÔÓ ¤Ó‰ÂÈÍË ˘¤Ú Ù˘ ·ÁÎfiÛÌÈ·˜ ηٷÓÔÌ‹˜ ÙÔ˘ ÈÔ‡, Û˘ÌÏËÚÒÓÔÓÙ·˜ ÙȘ ˘¿Ú¯Ô˘Û˜ ÌÂϤÙ˜ Ô˘ ·ÊÔÚÔ‡Ó ÛÙË µfiÚÂÈ· ∂˘ÚÒË, ÙË µfiÚÂÈ· ∞ÌÂÚÈ΋ Î·È ÙËÓ ∞˘ÛÙÚ·Ï›· (1,3,4,7-9). ∂ÍÂÙ¿˙ÔÓÙ·˜ ‰È¿ÊÔÚ· ÛÙÔȯ›· ÙfiÛÔ ·fi ÙÔ ÈÛÙÔÚÈÎfi, fiˆ˜ ËÏÈΛ·, ʇÏÔ, ‚¿ÚÔ˜ Á¤ÓÓËÛ˘, ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ·ÙÔ›·˜ Î·È ¤ÎıÂÛË Û ηÓfi ÙÛÈÁ¿ÚÔ˘, fiÛÔ Î·È ·fi Ù· ÂÂÈÛfi‰È· ‚ÚÔÁ¯ÈÔÏ›Ùȉ·˜, fiˆ˜ ¯ÚfiÓÔ˜ ¤Ó·Ú͢ Ù˘ ÓfiÛÔ˘ ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹, ‰È¿ÚÎÂÈ· ÓÔÛËÏ›·˜ Î·È ·ÚÔ˘Û›· ˘ÚÂÙÔ‡, ‰ÂÓ ‚Ú¤ıËÎ·Ó ‰È·ÊÔÚ¤˜ ÌÂٷ͇ ÙˆÓ ÂÚÈÙÒÛÂˆÓ fiÔ˘ ·ÔÌÔÓÒıËÎÂ Ô hMPV, Ô RSV ‹ ¿ÏÏÔ ·ıÔÁfiÓÔ Û٤ϯԘ. ¢ÂÓ ·Ú·ÙËÚ‹ıËηÓ, ÂÈÚfiÛıÂÙ·, ‰È·ÊÔÚ¤˜ ÛÙË ‚·Ú‡ÙËÙ· Ù˘ ÓfiÛÔ˘ ÌÂٷ͇ ÙˆÓ hMPV Î·È ÙˆÓ ‰ÈÏ¿ ıÂÙÈÎÒÓ hMPV-RSV ÂÚÈÙÒÛˆÓ. ¶·ÚfiÌÔÈ·, ‰ÂÓ ˘‹ÚÍ·Ó ‰È·ÊÔÚ¤˜ ÛÙ· ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù·. ŸÏ· Ù· ·Ú·¿Óˆ Ê·›ÓÂÙ·È Ó· ˘ÔÛÙËÚ›˙Ô˘Ó ÙËÓ ·ÓÙ›ÏË„Ë fiÙÈ Ô hMPV ÌÔÚ› Ó· ÚÔηϤÛÂÈ ÂÂÈÛfi‰ÈÔ ‚ÚÔÁ¯ÈÔÏ›Ùȉ·˜ Ô˘ ÎÏÈÓÈο ÔÌÔÈ¿˙ÂÈ Ì ·˘Ùfi Ô˘ ÚÔηÏÂ›Ù·È ·fi ÙÔÓ RSV, η٤¯ÔÓÙ·˜ ÙË ‰Â‡ÙÂÚË ı¤ÛË Û ÛÂÈÚ¿ Û˘¯ÓfiÙËÙ·˜. ∞fi ÌÂϤÙ˜ Ê·›ÓÂÙ·È fiÙÈ Ô hMPV ÌÔÚ› Ó· ÚÔηϤÛÂÈ ÎÏÈÓÈ΋ ÓfiÛÔ Û fiϘ ÙȘ ËÏÈÎȷΤ˜ ÔÌ¿‰Â˜, ÂÓÒ ıˆÚÂ›Ù·È ·ıÔÁfiÓÔ Û٤ϯԘ ÙfiÛÔ ÙÔ˘ ·ÓÒÙÂÚÔ˘ fiÛÔ Î·È ÙÔ˘ ηÙÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ (1-4). ¶·Ú’ fiÏ· ·˘Ù¿, ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÌÂϤÙ˜ ¤ˆ˜ ÙÒÚ· Û˘ÏϤÁÔÓÙ·È ÏËÚÔÊÔڛ˜ ·fi ·ÓfiÌÔȘ ÏËı˘ÛÌȷΤ˜ ÔÌ¿‰Â˜, Ì ÔÈΛÏË ·Ó·Ó¢ÛÙÈ΋ Û˘Ìو̷ÙÔÏÔÁ›·, fiÔ˘ ‰ÂÓ Ê·›ÓÂÙ·È Ó· ·Ó·Ï‡ÂÙ·È Â·ÚÎÒ˜ Ì›· ηϿ ¯·Ú·ÎÙËÚÈṲ̂ÓË, fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ·, ÔÌ¿‰· (3). ¶ÚfiÛÊ·Ù˜ ÌÂϤÙ˜ ·Ô‰ÂÈÎÓ‡Ô˘Ó fiÙÈ Ô hMPV Èı·ÓfiÓ Ó· Â›Ó·È ˘Â‡ı˘ÓÔ˜ ÁÈ· ¤Ó· ÌÂÁ¿ÏÔ ÔÛÔÛÙfi ÂÚÈÛÙ·ÙÈÎÒÓ, ÛÙ· ÔÔ›· ‰ÂÓ ·Ó¢ÚÈÛÎfiÙ·Ó
¶›Ó·Î·˜ 1. ÷ڷÎÙËÚÈÛÙÈο Ù˘ ÓfiÛÔ˘ Û ·ÛıÂÓ›˜ Ô˘ ·ÓȯÓ‡ıËΠ‹ fi¯È Ô hMPV Û ۇÁÎÚÈÛË Ì ÙÔ˘˜ ·ÛıÂÓ›˜ fiÔ˘ ·ÔÌÔÓÒıËÎÂ Ô RSV ªÂÙ·‚ÏËÙ‹ º‡ÏÔ (¿ÚÚÂÓ) ∏ÏÈΛ· (Ì‹Ó˜) µ¿ÚÔ˜ Á¤ÓÓËÛ˘ (g) ŒÎıÂÛË Û ηÓfi OÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ·ÙÔ›·˜ ∏̤ڷ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ÓfiÛÔ˘ ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ¢È¿ÚÎÂÈ· ÓÔÛËÏ›·˜ (Ë̤Ú˜) ¶˘ÚÂÙfi˜ µ·ıÌÔÏÔÁ›· ÛÔ‚·ÚfiÙËÙ·˜ ÓfiÛÔ˘
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MPV (+) (n=9)
MPV (-) (n=47)
RSV (n=38)
67% 5,3±1,1 3118±150 44% 33% 2,6±0,4 5,3±0,9 44% 8,3±0,4
70% 5,4±0,5 3150±71 74% 24% 3,3±0,3 4,8±0,4 35% 8,3±0,2
71% 5,0±0,5 3103±86 65% 19% 3,0±0,3 5,1±0,5 34% 8,3±0,2
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¶›Ó·Î·˜ 2. ∂ÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· ÙˆÓ ·ÛıÂÓÒÓ, ÛÙÔ˘˜ ÔÔ›Ô˘˜ ·ÔÌÔÓÒıËΠ‹ fi¯È Ô Èfi˜. ¢ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ªÂÙ·‚ÏËÙ‹
hMPV (n=9) Èڛ˜ hMPV (n=47)
§Â˘ÎÔ·ÙÙ·Ú· (n) (/mm3) 12,5±0,45 ¶ÔÏ˘ÌÔÚÊÔ‡ÚËÓ· (%) 31,7±5,7 §ÂÌÊÔ·ÙÙ·Ú· (%) 41,2±8,8 ªÔÓÔ·ÙÙ·Ú· (%) 10,1±2,3 ∏ˆÛÈÓfiÊÈÏ· (%) 2,5±0,4 ∆∫∂ (mm/h) 41,1±12,5 CRP (mg/l) 11,6±3,7 IgE (U/l) 389,5±88,3
12,7±0,45 31,7±2,8 47,9±2,9 9,6±1,7 2,4±0,4 31,2±4,2 15,0±3,0 363,4±39,3
¤ˆ˜ ÙÒÚ· ·ÈÙÈÔÏÔÁÈÎfi˜ ·Ú¿ÁÔÓÙ·˜. £· Ú¤ÂÈ Ó· ‰ÈÂÍ·¯ıÔ‡Ó ÂÚ·ÈÙ¤Úˆ ÌÂϤÙ˜, ÚÔÎÂÈ̤ÓÔ˘ Ó· ‰È¢ÎÚÈÓÈÛÙ› Ô ÚfiÏÔ˜ ÙÔ˘ hMPV Û ‰È¿ÊÔÚ˜ ÓfiÛÔ˘˜ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÛÙÔÓ ¿ÓıÚˆÔ, ·Ú¤¯ÔÓÙ·˜ Ì ·˘ÙfiÓ ÙÔÓ ÙÚfiÔ ÛËÌ·ÓÙÈΤ˜ ÏËÚÔÊÔڛ˜ ÁÈ· ÙÔÓ ÌÂÏÏÔÓÙÈÎfi ۯ‰ȷÛÌfi ÂȉÈÎÒÓ ·ÓÙÈ-ÈÈÎÒÓ ıÂÚ·ÂÈÒÓ Î·È ÂÌ‚ÔÏ›ˆÓ.
3. Jartti T, van den Hoogen B, Garofalo RP, Osterhaus AD, Ruuskanen O. Metapneumovirus and acute wheezing in children. Lancet 2002;360:1393-1394. 4. Stockton J, Stephenson I, Fleming D, Zambon M. Human metapneumovirus as a cause of community-acquired respiratory illness. Emerg Infect Dis 2002;8:897-901. 5. Papadopoulos NG, Moustaki M, Tsolia M, Bossios A, Astra E, Prezerakou A et al. Association of rhinovirus infection with increased disease severity in acute bronchiolitis. Am J Respir Crit Care Med 2002;165:1285-1289. 6. van den Hoogen BG, Bestebroer TM, Osterhaus AD, Fouchier RA. Analysis of the genomic sequence of a human metapneumovirus. Virology 2002;295:119-132. 7. Peret TC, Boivin G, Li Y, Couillard M, Humphrey C, Osterhaus AD et al. Characterization of human metapneumoviruses isolated from patients in North America. J Infect Dis 2002;185:1660-1663. 8. Nissen MD, Siebert DJ, Mackay IM, Sloots TP, Withers SJ. Evidence of human metapneumovirus in Australian children. Med J Aust 2002;176:188. 9. Howe M. Australian find suggests worldwide reach for metapneumovirus. Lancet Infect Dis 2002;2:202.
µÈ‚ÏÈÔÁÚ·Ê›· 1. van den Hoogen BG, de Jong JC, Groen J, Kuiken T, de Groot R, Fouchier RA et al. A newly discovered human pneumovirus isolated from young children with respiratory tract disease. Nat Med 2001;7:719-724. 2. Boivin G, Abed Y, Pelletier G, Ruel L, Moisan D, Cote S et al. Virological features and clinical manifestations associated with human metapneumovirus: a new paramyxovirus responsible for acute respiratory-tract infections in all age groups. J Infect Dis 2002;186:1330-1334.
¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ¶·Ú·Û΢‹ •Â··‰¿ÎË ∂Ú¢ÓËÙÈο ∂ÚÁ·ÛÙ‹ÚÈ·, µ’ ¶·È‰È·ÙÚÈ΋ ¶·ÓÂÈÛÙËÌȷ΋ ∫ÏÈÓÈ΋ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡” ∆.∫. 115 27, °Ô˘‰›, ∞ı‹Ó· ∂-mail: panvik@hol.gr
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Paediatriki 2004;67:178-189
ORIGINAL ARTICLE
∏ Û¯¤ÛË Ù˘ ‰È·ÙÚÔÊ‹˜ Ì ·Ó·Ù˘ÍȷΤ˜ Î·È ÂÎ·È‰Â˘ÙÈΤ˜ ‰ÂÍÈfiÙËÙ˜ ·È‰ÈÒÓ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ ∂. ∫·Ú·ÎˆÓÛÙ·ÓÙ¿ÎË, ∞. ∫·Ê¿ÙÔ˜, ª. §ÈÓ·Ú‰¿Î˘, ™. ªÈ¯ÂÏÔÁÈ¿ÓÓ˘
The association of nutrition with developmental and educational abilities of school age children H. Karakonstantaki, A. Kafatos, M. Linardakis, S. Michelogiannis
¶ÂÚ›ÏË„Ë: ¶·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ë Û¯¤ÛË Ù˘ ‰È·ÙÚÔÊ‹˜ Ì ÙË ÛˆÌ·ÙÈ΋ ˘Á›· ·ÔÙÂÏ› ·ÓÙÈΛÌÂÓÔ Û˘ÛÙËÌ·ÙÈ΋˜ ‰ÈÂÚ‡ÓËÛ˘, Ë Û¯¤ÛË Ù˘ Ì ÙË ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ ·Ú·Ì¤ÓÂÈ Û¯ÂÙÈο ¿ÁÓˆÛÙË. ∏ ÌÂϤÙË Ù˘ Û¯¤Û˘ Ù˘ ÔÈfiÙËÙ·˜ ‰È·ÙÚÔÊ‹˜ Ì ÙÔ ÁÓˆÛÙÈÎfi Î·È Û˘Ó·ÈÛıËÌ·ÙÈÎfi ÙÌ‹Ì· Ù˘ ·ÓıÚÒÈÓ˘ Û˘ÌÂÚÈÊÔÚ¿˜ ·ÚÔ˘ÛÈ¿˙ÂÈ, ·Ó·ÌÊ›‚ÔÏ·, ÌÂÁ¿ÏÔ ÂӉȷʤÚÔÓ. ∏ ·ÚÔ‡Û· ¤Ú¢ӷ ÂȯÂÈÚ› Ì›· ÚÔÛ¤ÁÁÈÛË ·˘ÙÔ‡ ÙÔ˘ ı¤Ì·ÙÔ˜. ™Â ‰Â›ÁÌ· Ô˘ Û˘ÌÌÂÙ›¯Â ÛÙÔ ¶ÚfiÁÚ·ÌÌ· ∂Î·È‰Â˘ÙÈ΋˜ ¶·Ú¤Ì‚·Û˘ “∞ÁˆÁ‹ ÀÁ›·˜”, ¤ÁÈÓ ÂÎÙ›ÌËÛË ÙˆÓ ·Ó·Ù˘ÍÈ·ÎÒÓ Î·È ÂÎ·È‰Â˘ÙÈÎÒÓ ÈηÓÔÙ‹ÙˆÓ Ì ÙË ¯Ú‹ÛË ÂȉÈ΋˜ Îϛ̷η˜ Ì·ıËÛȷ΋˜ ÈηÓfiÙËÙ·˜ ·fi ÙÔ˘˜ ÂÎ·È‰Â˘ÙÈÎÔ‡˜. ŒÁÈÓÂ Û˘Û¯¤ÙÈÛË ÙˆÓ ‰ÂÈÎÙÒÓ Ì·ıËÛȷ΋˜ ›‰ÔÛ˘ Î·È ÙˆÓ Û¯ÔÏÈÎÒÓ ‚·ıÌÒÓ Ì ÙÔ˘˜ ·ÈÌ·ÙÔÏÔÁÈÎÔ‡˜ ‰Â›ÎÙ˜, ÙÔ˘˜ ‰È·ÙÚÔÊÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜, Ù· ‰Â‰Ô̤ӷ ÙˆÓ ÛˆÌ·ÙÔÌÂÙÚ‹ÛÂˆÓ Î·È ÙËÓ Â›‰ÔÛË Û ̛· ‰ÔÎÈÌ·Û›· Ê˘ÛÈ΋˜ ηٿÛÙ·Û˘, ÙÔ ·Ï›Ó‰ÚÔÌÔ ÙÂÛÙ ·ÓÙÔ¯‹˜. µÚ¤ıËΠfiÙÈ Ë Î·Ù·Ó¿ÏˆÛË Á·Ï·ÎÙÔÎÔÌÈÎÒÓ, Ï·¯·ÓÈÎÒÓ Î·È ÊÚÔ‡ÙˆÓ ‚ÂÏÙÈÒÓÂÈ Î¿ÔȘ ÈηÓfiÙËÙ˜. ™Â ·˘Ùfi Ê·›ÓÂÙ·È Ó· ¤¯Ô˘Ó οÔÈÔ ÚfiÏÔ ÔÈ ‚Èٷ̛Ә µ12 Î·È ∞, ÙÔ ·Û‚¤ÛÙÈÔ Î·È ÔÈ ÚˆÙ½Ó˜. π‰È·›ÙÂÚÔ ÂӉȷʤÚÔÓ ·ÚÔ˘ÛÈ¿˙ÂÈ ÙÔ Â‡ÚËÌ· Û‡Ìʈӷ Ì ÙÔ ÔÔ›Ô Ë Ê˘ÛÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· Û¯ÂÙ›˙ÂÙ·È Ì ˘„ËÏ‹ ‚·ıÌÔÏÔÁ›· ÛÙËÓ Îϛ̷η Ì·ıËÛȷ΋˜ ›‰ÔÛ˘. ™ÙÔ ‰Â›ÁÌ· Ô˘ ÂÍÂÙ¿ÛÙËÎÂ, Ù· ÎÔÚ›ÙÛÈ· ·ÚÔ˘Û›·Û·Ó ηχÙÂÚË Â›‰ÔÛË Û ·˘Ù‹ ÙËÓ Îϛ̷η Û ۯ¤ÛË Ì ٷ ·ÁfiÚÈ·. OÈ Ì·ıËÙ¤˜ Ì ˘„ËÏfiÙÂÚË Â›‰ÔÛË ÛÙËÓ Îϛ̷η ›¯·Ó ÌÂÁ·Ï‡ÙÂÚÔ ‚¿ÚÔ˜, ·˘ÍË̤ÓË Î·Ù·Ó¿ÏˆÛË Ï·¯·ÓÈÎÒÓ Î·È ÊÚÔ‡ÙˆÓ Î·È ÚfiÛÏË„Ë ‚ÈÙ·Ì›Ó˘ µ12 Û ۯ¤ÛË Ì ÙÔ˘˜ Ì·ıËÙ¤˜ Ô˘ ·ÚÔ˘Û›·Û·Ó ¯·ÌËÏfiÙÂÚË Â›‰ÔÛË. ∆· Â˘Ú‹Ì·Ù· Ù˘ ¤Ú¢ӷ˜ Â›Ó·È Û‡Ìʈӷ Ì ·˘Ù¿ ¿ÏÏˆÓ ÂÚ¢ÓÒÓ Î·È Û˘ÓËÁÔÚÔ‡Ó ˘¤Ú Ù˘ ¿Ô„˘ fiÙÈ Ë ÔÈfiÙËÙ· Ù˘ ‰È·ÙÚÔÊ‹˜ Û˘Û¯ÂÙ›˙ÂÙ·È fi¯È ÌfiÓÔ ÌÂ
Abstract: While the relationship between nutrition and physical well-being is well established, that between nutrition and brain function still remains uncertain. This study attempts an approach to the investigation of the association between the quality of nutrition and the cognitive and emotional aspects of human behaviour. The developmental and educational skills of students who had participated in a health education intervention programme were evaluated. The evaluation was carried out by their teachers, using an academic performance scale. Performance scores and school grades were correlated with haematological and anthropometric indices, dietary intake and performance on a physical fitness scale. The findings indicated that consumption of dairy products, vegetables and fruits was associated with improvements in some cognitive abilities. Vitamins B12 and A, and calcium and proteins appear to play a role. The association observed between physical activity and high scores on the academic performance scale is of special interest. Girls scored higher than boys on this scale, and pupils with higher scores in the scale had greater body weight and recorded higher intakes of vegetables, fruits and vitamin B12 than pupils with lower scores. These findings are in accordance with those of other studies and suggest that the quality of nutrition correlates not just with physical wellbeing but also with cognitive performance. This association should be further investigated. In view of the possible negative consequences of malnutrition and reduced physical activity on the general performance of children, prevention and intervention programmes are indicated.
π·ÙÚÈ΋ ™¯ÔÏ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘, ∏Ú¿ÎÏÂÈÔ
Medical School, University of Crete, Heraklion
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ÙË ÛˆÌ·ÙÈ΋ ˘Á›·, ·ÏÏ¿ Î·È Ì ÙË ÁÓˆÛÙÈ΋ ÏÂÈÙÔ˘ÚÁ›·. ∏ Û¯¤ÛË ·˘Ù‹ ¯Ú‹˙ÂÈ Û˘ÛÙËÌ·ÙÈ΋˜ ‰ÈÂÚ‡ÓËÛ˘. §fiÁˆ ÙˆÓ Èı·ÓÒÓ ·ÚÓËÙÈÎÒÓ Û˘ÓÂÂÈÒÓ Ù˘ η΋˜ ‰È·ÙÚÔÊ‹˜ Î·È Ù˘ ÌÂȈ̤Ó˘ Ê˘ÛÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÛÙË ÁÂÓÈ΋ ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ· ÙˆÓ ·ÙfïÓ, ÎÚ›ÓÂÙ·È ··Ú·›ÙËÙË Ë ÂÊ·ÚÌÔÁ‹ ÚÔÁÚ·ÌÌ¿ÙˆÓ ÚfiÏ˄˘ Î·È ·Ú¤Ì‚·Û˘ ·fi ÙË Û¯ÔÏÈ΋ ËÏÈΛ·. §¤ÍÂȘ ÎÏÂȉȿ: ‰È·ÙÚÔÊ‹, ÁÓˆÛÙÈ΋ ›‰ÔÛË, Ê˘ÛÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ·, ‚Èٷ̛Ә, Û¯ÔÏÈ΋ ËÏÈΛ·.
Key words: nutrition, cognitive performance, physical activity, vitamins, school age.
™˘ÓÙÔÌÔÁڷʛ˜
η΋ ‰È·ÙÚÔÊ‹ Û˘Ó›ÛÙ·Ù·È ÙfiÛÔ ÛÙËÓ ÂÏÏÈ‹ ÔÛfiÙËÙ· fiÛÔ Î·È ÛÙËÓ Î·Î‹ ÔÈfiÙËÙ· ÙÚÔÊ‹˜. ªÔÚ›, ÏÔÈfiÓ, Ó· ÔÊ›ÏÂÙ·È ÛÙËÓ ¤ÏÏÂÈ„Ë ÙÚÔÊ‹˜ ÏfiÁˆ ¤Ó‰ÂÈ·˜, Û ·Ûı¤ÓÂȘ ‹ Û ‰È¿ÊÔÚÔ˘˜ ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜, fiˆ˜ ÙÔ ÌÔÚʈÙÈÎfi Â›Â‰Ô ÙˆÓ ÁÔÓ¤ˆÓ ‹ Ë ··Û¯fiÏËÛË Ù˘ ÌËÙ¤Ú·˜ (8). O ·ÎÚÈ‚‹˜ Ì˯·ÓÈÛÌfi˜ Ù˘ ›‰Ú·Û˘ Ù˘ ‰È·ÙÚÔÊ‹˜ ÛÙË ÁÓˆÛÙÈ΋ ÈηÓfiÙËÙ· ‰ÂÓ Â›Ó·È ÁÓˆÛÙfi˜ Î·È Â›Ó·È ‰‡ÛÎÔÏÔ Ó· ÌÂÏÂÙËı›. À¿Ú¯ÂÈ, ˆÛÙfiÛÔ, ·ÚÎÂÙ‹ ÁÓÒÛË ÒÛÙ ӷ ˘ÔÛÙËÚȯı› ·ÚÎÒ˜ Ì›· Ù¤ÙÔÈ· ıˆڛ·. ∏ η΋ ‰È·ÙÚÔÊ‹ ÌÔÚ› Ó· Âȉڿ ÛÙÔ ∫¡™ ›Ù ¤ÌÌÂÛ·, ÚÔηÏÒÓÙ·˜ ·‰˘Ó·Ì›· Î·È ÌÂȈ̤ÓË ‰È¿ıÂÛË ÁÈ· ÂÍÂÚ‡ÓËÛË ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ ηÈ, ÂÔ̤ӈ˜, ı¤ÙÔÓÙ·˜ ÂÚÈÔÚÈÛÌÔ‡˜ ÛÙÔÓ ÁÓˆÛÙÈÎfi, ÎÈÓËÙÈÎfi Î·È Û˘Ó·ÈÛıËÌ·ÙÈÎfi ÙÔ̤· Ù˘ ·Ó¿Ù˘Í˘ (8,10), ›Ù ¿ÌÂÛ·, ‰È·Ù·Ú¿ÛÛÔÓÙ·˜ ÙË Ó¢ÚÔ¯ËÌÈ΋ ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Î·È ÂËÚ¿˙ÔÓÙ·˜ ÙË Û‡ÓıÂÛË Î·È ‰Ú¿ÛË ÙˆÓ Ó¢Úԉȷ‚È‚·ÛÙÒÓ, Ô˘ - ˆ˜ ÁÓˆÛÙfiÓ - ÂϤÁ¯Ô˘Ó ÙËÓ ÂΉ‹ÏˆÛË ÙfiÛÔ ÙˆÓ Û˘Ó·ÈÛıËÌ·ÙÈÎÒÓ Î·È ÁÓˆÛÙÈÎÒÓ ·ÓÙȉڿÛÂˆÓ fiÛÔ Î·È ·˘ÙÒÓ Ù˘ Û˘ÌÂÚÈÊÔÚ¿˜ (9). OÈ ÂÚ¢ÓËÙ¤˜ Strupp Î·È Levitsky ηٷϋÁÔ˘Ó ÛÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ ÔÈ ÁÓˆÛÙÈΤ˜ ‚Ï¿‚˜ Ô˘ ÚÔηÏÔ‡ÓÙ·È ·fi ÙËÓ Î·Î‹ ‰È·ÙÚÔÊ‹ Â›Ó·È Ôχ ÏÂÙ¤˜, ‰È·ÌÂÛÔÏ·‚Ô‡ÓÙ·È ·fi ¤Ó·Ó Ó¢ÚÔ¯ËÌÈÎfi Ì˯·ÓÈÛÌfi Î·È Èı·Ó¿ ·ÊÔÚÔ‡Ó Û ÂÍÂȉÈÎÂ˘Ì¤Ó˜ ‰ÂÍÈfiÙËÙ˜, fiˆ˜ ÛÙȘ ÂÎÙÂÏÂÛÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜ ۯ‰ȷÛÌfi Û˘ÌÂÚÈÊÔÚ¿˜, ÛÙÔÓ ¤ÏÂÁ¯Ô ÚÔÛÔ¯‹˜, ÛÙËÓ ·Ó·ÛÙÔÏ‹ ·ÓÙȉڿÛÂˆÓ (ÚÔÌÂوȷ›Ô˜ ÊÏÔÈfi˜), ÛÙË Ì·ÎÚfi¯ÚÔÓË ÌÓ‹ÌË ÁÂÁÔÓfiÙˆÓ (ÈfiηÌÔ˜), ÛÙËÓ ÔÚÁ¿ÓˆÛË ÙˆÓ ÎÈÓ‹ÛÂˆÓ Î·È ÛÙË ‰È·‰ÈηÛÙÈ΋ Ì¿ıËÛË, .¯. ηٿ ÙËÓ Âη›‰Â˘ÛË ÛÙË ÁÚ·Ê‹ ‹ ÙËÓ ·Ó¿ÁÓˆÛË (·ÚÂÁÎÂÊ·Ï›‰·) (11). ∂ÈϤÔÓ, ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ Ô ˘ÔÛÈÙÈÛÌfi˜ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ·ËÛ˘ ‹ ÙÔ˘ ıËÏ·ÛÌÔ‡ ÂËÚ¿˙ÂÈ ·ÚÓËÙÈο Ù· ΛÓËÙÚ· Î·È ÙË Û˘Ó·ÈÛıËÌ·ÙÈ΋ ·ÓÙ›‰Ú·ÛË Î·È ÚÔÛ·ÚÌÔÛÙÈÎfiÙËÙ·, ‰È·Ì¤ÛÔ˘ Ì›·˜ ÓÔÚ·‰ÚÂÓÂÚÁÈ΋˜ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·˜. ∂ȯÂÈÚÔ‡Ó, ‰ËÏ·‰‹, ¤Ó·Ó Û˘Û¯ÂÙÈÛÌfi Ì ÙÔÓ Ì˯·ÓÈÛÌfi ·Ó¿Ù˘Í˘ ÙˆÓ Û˘Ó·ÈÛıËÌ·ÙÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ Î·È ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ
HDL-C
ÃÔÏËÛÙÂÚfiÏË ÙˆÓ ˘„ËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈÔÚˆÙÂ˚ÓÒÓ LDL-C ÃÔÏËÛÙÂÚfiÏË ÙˆÓ ¯·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈÔÚˆÙÂ˚ÓÒÓ TC/HDL ∞ıËڈ̷ÙÈÎfi˜ ‰Â›ÎÙ˘ ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ ÚÔ˜ ˘„ËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈÔÚˆÙ½ÓË ¶∆∞ ¶·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜ ¢ª™ ¢Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜
∂ÈÛ·ÁˆÁ‹ ∏ ¤Ú¢ӷ Û¯ÂÙÈο Ì ÙËÓ Â›‰Ú·ÛË Ù˘ ‰È·ÙÚÔÊ‹˜ ÛÙËÓ ˘Á›· ‰ÂÓ Â›Ó·È ÚfiÛÊ·ÙË. §fiÁˆ ÙÔ˘ ÙÚfiÔ˘ ˙ˆ‹˜ ÛÙȘ Û‡Á¯ÚÔÓ˜ ‚ÈÔÌ˯·ÓÈΤ˜ ÎÔÈӈӛ˜, Ë ÌÂϤÙË ÙˆÓ ‰È·ÙÚÔÊÈÎÒÓ Û˘ÓËıÂÈÒÓ Î·È ÙˆÓ Û˘ÓÂÂÈÒÓ ÙÔ˘˜ ÛÙË Ê˘ÛÈ΋ ηٿÛÙ·ÛË ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡, ¯·›ÚÂÈ Â˘Ú›·˜ ·Ô‰Ô¯‹˜ (1). øÛÙfiÛÔ, ÌfiÏȘ Ù· ÙÂÏÂ˘Ù·›· ÙÚÈ¿ÓÙ· ¯ÚfiÓÈ·, Ë ·ÁÎfiÛÌÈ· ÂÈÛÙËÌÔÓÈ΋ ÎÔÈÓfiÙËÙ· ¤ÛÙÚ„ ÙÔ ÂӉȷʤÚÔÓ Ù˘ ÛÙË ÌÂϤÙË ÙˆÓ ÂȉڿÛÂˆÓ Ù˘ ‰È·ÙÚÔÊ‹˜ ÛÙÔ ÎÂÓÙÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ· (∫¡™). ŒÌÊ·ÛË ¤¯ÂÈ ‰Ôı› ÛÙËÓ ·ÚÓËÙÈ΋ ›‰Ú·ÛË Ù˘ η΋˜ ‰È·ÙÚÔÊ‹˜ ÛÙÔÓ ÁÓˆÛÙÈÎfi ÙÔ̤· Î·È ÙË Û˘ÌÂÚÈÊÔÚ¿, ÂÓÒ ÏÈÁfiÙÂÚÔ ¤¯Ô˘Ó ÌÂÏÂÙËı› Ô Û˘Ó·ÈÛıËÌ·ÙÈÎfi˜ Î·È ÎÈÓËÙÈÎfi˜ ÙÔ̤·˜ ·Ó¿Ù˘Í˘ (2). ™ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ, ¤¯ÂÈ ÌÂÏÂÙËı› Ë Â›‰Ú·ÛË Ù˘ ‰È·ÙÚÔÊ‹˜ ÛÙË ÁÓˆÛÙÈ΋ ÈηÓfiÙËÙ· ¢·ıÒÓ ÔÌ¿‰ˆÓ ‹ ¤¯ÂÈ ‰ÈÂÚ¢ÓËı› Ô ÙÚfiÔ˜ Ô˘ Ë ‰È·ÙÚÔÊ‹ ÙˆÓ ‚ÚÂÊÒÓ ÂËÚ¿˙ÂÈ ÙË ÌÂÙ¤ÂÈÙ· ÂͤÏÈÍ‹ ÙÔ˘˜ (3-5). ™Â ¿ÏϘ ÂÚÈÙÒÛÂȘ, ÂȯÂÈÚ‹ıËÎÂ Ë Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ηٷӿψÛ˘ ÚˆÈÓÔ‡ Á‡̷ÙÔ˜ Î·È Û¯ÔÏÈÎÒÓ ‚·ıÌÒÓ (6,7). ∞’ fiÛÔ Â›Ó·È ÁÓˆÛÙfi, ‰ÂÓ ¤¯Ô˘Ó Á›ÓÂÈ ¤Ú¢Ó˜ Ô˘ Ó· Û˘Û¯ÂÙ›˙Ô˘Ó Û˘ÁÎÂÎÚÈ̤ӷ ‰È·ÙÚÔÊÈο ÛÙÔȯ›· ÌÂ Û˘ÁÎÂÎÚÈ̤Ó˜ ÂȉfiÛÂȘ ÛÙÔÓ ÁÓˆÛÙÈÎfi ÙÔ̤· ηٿ ÙË Û¯ÔÏÈ΋ ËÏÈΛ·. ø˜ η΋ ‰È·ÙÚÔÊ‹ ÔÚ›˙ÂÙ·È Ë Î·ÙÒÙÂÚË ÙÔ˘ ÚÔ‚ÏÂfiÌÂÓÔ˘ ËÌÂÚ‹ÛÈÔ˘ ÔÚ›Ô˘ ÚfiÛÏË„Ë ÂÓ¤ÚÁÂÈ·˜ Î·È ıÚÂÙÈÎÒÓ Û˘ÛÙ·ÙÈÎÒÓ (.¯. ‚ÈÙ·ÌÈÓÒÓ, ÌÂÙ¿ÏψÓ), Ô˘ ÌÔÚ› Ó· Ï¿‚ÂÈ ¯ÒÚ· ›Ù ηٿ ÙËÓ ÚÔÁÂÓÓËÙÈ΋ ÂÚ›Ô‰Ô, ÂËÚ¿˙ÔÓÙ·˜ ÙÔÓ ·Ó·Ù˘ÛÛfiÌÂÓÔ ÂÁΤʷÏÔ, ›Ù ηٿ ÙË ÌÂÙ·ÁÂÓÓËÙÈ΋ ÂÚ›Ô‰Ô (8,9). ∏
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Ë Û¯¤ÛË ‰È·ÙÚÔÊ‹˜-Û˘Ó·ÈÛı‹Ì·ÙÔ˜ ¯Ú‹˙ÂÈ Û˘ÛÙËÌ·ÙÈ΋˜ ‰ÈÂÚ‡ÓËÛ˘ (11,12). ¶ÂÈÚ¿Ì·Ù· Û ˙Ò·, ·ÏÏ¿ Î·È ÌÂϤÙ˜ ÌÂ Û˘ÌÏËÚÒÌ·Ù· ‰È·ÙÚÔÊ‹˜ Û ·ÓıÚÒÔ˘˜, ‰ÈÂÚ¢ÓÔ‡Ó Ù˘¯fiÓ Ê˘ÛÈÔÏÔÁÈΤ˜, Û˘ÌÂÚÈÊÔÚÈΤ˜ Î·È ÁÓˆÛÙÈΤ˜ ‰È·Ù·Ú·¯¤˜. ∞ӷʤÚÂÙ·È fiÙÈ Ë ÛȉËÚÔÂÓÈ΋ ·Ó·ÈÌ›· Û ‚Ú¤ÊË ÚÔηÏ› ηı˘ÛÙ¤ÚËÛË ÛÙËÓ ÎÈÓËÙÈ΋ Î·È ÓÔËÙÈ΋ ·Ó¿Ù˘ÍË (13) ‹ ÌÂȈ̤ÓË Â›‰ÔÛË ÛÙËÓ ·ÚÈıÌËÙÈ΋ Î·È ·Ó¿ÁÓˆÛË ÛÙËÓ ËÏÈΛ· ÙˆÓ 12 ÂÙÒÓ (14). ™Â ¤Ú¢ӷ Ô˘ ÂͤٷÛ ·Ó Ë Ï‹„Ë Û˘ÌÏËÚˆÌ¿ÙˆÓ ÌÈÎÚÔıÚÂÙÈÎÒÓ Ô˘ÛÈÒÓ ÂËÚ¿˙ÂÈ ÙË ÓÔËÌÔÛ‡ÓË ÂÊ‹‚ˆÓ, ·Ú·ÙËÚ‹ıËΠÛËÌ·ÓÙÈ΋ ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÙˆÓ ÂȤ‰ˆÓ ÙÔ˘ ·ÛÎÔÚ‚ÈÎÔ‡ ÔͤԘ Î·È ÙÔ˘ ·Ú¯ÈÎÔ‡ ‰Â›ÎÙË ÌË ÏÂÎÙÈ΋˜ ÓÔËÌÔÛ‡Ó˘ Û ·ÁfiÚÈ·. ¢ÂÓ ÂȂ‚·ÈÒıËÎÂ, fï˜, Ë ˘fiıÂÛË fiÙÈ Ë Ï‹„Ë Û˘ÌÏËÚˆÌ¿ÙˆÓ Ô‰ËÁ› Û ·‡ÍËÛË ÙÔ˘ ‰Â›ÎÙË ÓÔËÌÔÛ‡Ó˘ (15). øÛÙfiÛÔ, Ì›· ÚfiÛÊ·ÙË ·Ó·ÛÎfiËÛË Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜ η٤‰ÂÈÍ ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ Ù˘ Ï‹„˘ Û˘ÌÏËÚˆÌ¿ÙˆÓ ÌÈÎÚÔıÚÂÙÈÎÒÓ Ô˘ÛÈÒÓ Î·È Ù˘ ÌË ÏÂÎÙÈ΋˜ ÓÔËÌÔÛ‡Ó˘, ÂȉÈο Û ·È‰È¿ ÙˆÓ ÔÔ›ˆÓ Ë ‰È·ÙÚÔÊ‹ ‹Ù·Ó ÊÙˆ¯‹ Û ÌÈÎÚÔıÚÂÙÈΤ˜ Ô˘Û›Â˜ (16). ŒÚ¢ӷ Ô˘ Ú·ÁÌ·ÙÔÔÈ‹ıËΠ۠ÚfiˆÚ· ‚Ú¤ÊË ¤‰ÂÈÍ fiÙÈ Ù· ··Ú·›ÙËÙ· ÏÈ·Ú¿ Ôͤ· Ô˘ ‰ÂÓ ÌÔÚ› Ó· Û˘Óı¤ÛÂÈ Ô ·ÓıÚÒÈÓÔ˜ ÔÚÁ·ÓÈÛÌfi˜, Â›Ó·È ‚·ÛÈο ‰ÔÌÈο Û˘ÛÙ·ÙÈο ÙˆÓ ÂÁÎÂÊ·ÏÈÎÒÓ Î˘ÙÙ¿ÚˆÓ Î·È Ë ¤ÏÏÂÈ„‹ ÙÔ˘˜ ÂËÚ¿˙ÂÈ ·ÚÓËÙÈο ÙËÓ ÔÙÈ΋ ÏÂÈÙÔ˘ÚÁ›· (13). °ÂÓÈο, ‰È·ÈÛÙÒıËΠfiÙÈ Ë Î·Î‹ ‰È·ÙÚÔÊ‹ ÚÔηÏ› ·‰ÂÍÈfiÙËÙ·, ‰È¿Û·ÛË ÚÔÛÔ¯‹˜, ÊÙˆ¯¤˜ Û¯¤ÛÂȘ Ì ÙÔ˘˜ Û˘ÓÔÌËÏ›ÎÔ˘˜ Î·È ¯·ÌËϤ˜ ÂȉfiÛÂȘ ÛÙÔ Û¯ÔÏÂ›Ô (10). OÈ ·ÚÓËÙÈΤ˜ Û˘Ó¤ÂȘ Ù˘ η΋˜ ‰È·ÙÚÔÊ‹˜ ÌÂÙÚÈ¿˙ÔÓÙ·È Ì ηٿÏÏËÏË ÂÚÈ‚·ÏÏÔÓÙÈ΋ ·Ú¤Ì‚·ÛË (2). ∏ ·ÚÔ‡Û· ¤Ú¢ӷ ÌÂÏÂÙ¿ ÙȘ ‰È·ÙÚÔÊÈΤ˜ Û˘Ó‹ıÂȘ Î·È ÙË Û¯ÔÏÈ΋ ›‰ÔÛË Ì·ıËÙÒÓ Ì ÛÎÔfi ÙËÓ ·Ó›¯Ó¢ÛË ·ÚÓËÙÈÎÒÓ ÂȉڿÛÂˆÓ Î·È ÙÔÓ ÂÓÙÔÈÛÌfi ·Ó·ÁÎÒÓ ÁÈ· ÔÚÁ¿ÓˆÛË Î·Ù¿ÏÏËÏˆÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ Âη›‰Â˘Û˘ ÁÈ· ÙË ÛˆÛÙ‹ ‰È·ÙÚÔÊ‹. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ∏ ¤Ú¢ӷ ‰ÈÂÍ‹¯ıË Û ۯÔÏ›· Ù˘ ∫Ú‹Ù˘, ηٿ Ù· ¤ÙË 1999-2000, ÛÙÔ Ï·›ÛÈÔ ÙÔ˘ ¶ÚÔÁÚ¿ÌÌ·ÙÔ˜ ∂Î·È‰Â˘ÙÈ΋˜ ¶·Ú¤Ì‚·Û˘ “∞ÁˆÁ‹ ÀÁ›·˜”, ÙÔ ÔÔ›Ô ÔÚÁ·ÓÒıËΠ·fi ÙËÓ ∫ÏÈÓÈ΋ ¶ÚÔÏËÙÈ΋˜ π·ÙÚÈ΋˜ Î·È ¢È·ÙÚÔÊ‹˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘ (17). ∞fi ÙÔ ·Ú¯ÈÎfi ‰Â›ÁÌ· ÙˆÓ 583 Ì·ıËÙÒÓ ËÏÈΛ·˜ 9-12 ÂÙÒÓ, Û˘ÁÎÂÓÙÚÒıËÎ·Ó Ï‹ÚË ÛÙÔȯ›· ÁÈ· 166 Ì·ıËÙ¤˜. ŸÏÔÈ ÊÔÈÙÔ‡Û·Ó ÛÙËÓ ∂’ ¢ËÌÔÙÈÎÔ‡, ‹Ù·Ó ËÏÈΛ·˜ 11-12 ÂÙÒÓ Î·È ÚÔ¤Ú¯ÔÓÙ·Ó ·fi ¤ÍÈ Û¯ÔÏ›· ·ÛÙÈÎÒÓ, ËÌÈ·ÛÙÈÎÒÓ Î·È ·ÁÚÔÙÈÎÒÓ ÂÚÈÔ¯ÒÓ ÙÔ˘ ∏Ú·ÎÏ›Ԣ, ÙÔ˘ ƒÂı‡ÌÓÔ˘ Î·È ÙÔ˘ ∞Á›Ô˘ ¡ÈÎÔÏ¿Ô˘. OÈ ÂÍÂÙ¿ÛÂȘ Ô˘ Ú·ÁÌ·-
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ÙÔÔÈ‹ıËÎ·Ó ·ÊÔÚÔ‡Û·Ó ÛÙË Ï‹„Ë ÈÛÙÔÚÈÎÔ‡ ‰È·ÈÙÔÏÔÁ›Ô˘ ÙÔ˘ ÚÔËÁÔ‡ÌÂÓÔ˘ 24ÒÚÔ˘, Û ۈ̷ÙÔÌÂÙÚÈΤ˜ ÌÂÙÚ‹ÛÂȘ, ÛÙË Ì¤ÙÚËÛË ‚ÈÔ¯ËÌÈÎÒÓ Î·È ·ÈÌ·ÙÔÏÔÁÈÎÒÓ ‰ÂÈÎÙÒÓ, ÛÙËÓ ·ÍÈÔÏfiÁËÛË Ù˘ Ê˘ÛÈ΋˜ ηٿÛÙ·Û˘ Ì ·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜ (¶∆∞) Î·È Û ÂÎÙ›ÌËÛË Ù˘ Ì·ıËÛȷ΋˜ ›‰ÔÛ˘. OÈ ÁÔÓ›˜ ÙˆÓ ·È‰ÈÒÓ ÂÓËÌÂÚÒıËÎ·Ó ÁÚ·ÙÒ˜ ÁÈ· ÙȘ ÂÍÂÙ¿ÛÂȘ Î·È ˘¤ÁÚ·„·Ó ˘Â‡ı˘ÓË ‰‹ÏˆÛË ÁÈ· ÙË Û˘ÌÌÂÙÔ¯‹ ‹ ÌË ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜. ∏ Û˘ÏÏÔÁ‹ ÙˆÓ ÛÙÔȯ›ˆÓ ÁÈ· ÙË ‰È·ÙÚÔÊ‹ ÙˆÓ Ì·ıËÙÒÓ ¤ÁÈÓ Ì ÙË Ì¤ıÔ‰Ô Ù˘ ηٷÁÚ·Ê‹˜ ‰È·ÈÙÔÏÔÁ›Ô˘ ÙÔ˘ ÚÔËÁÔ‡ÌÂÓÔ˘ 24ÒÚÔ˘ Î·È ·ÊÔÚÔ‡Û ÛÙËÓ Ï‹ÚË Î·È ·Ó·Ï˘ÙÈ΋ ηٷÁÚ·Ê‹ ·fi ‰È·ÈÙÔÏfiÁÔ - ̤ۈ ÚÔÛˆÈ΋˜ Û˘Ó¤ÓÙ¢Í˘ - ÙˆÓ ÙÚÔÊ›ÌˆÓ Î·È ÙˆÓ ÔÛÔÙ‹ÙˆÓ Ô˘ Î·Ù·Ó¿ÏˆÛ·Ó ÙÔ ÚÔËÁÔ‡ÌÂÓÔ 24ˆÚÔ (17,18). ™ÙË Û˘Ó¤¯ÂÈ·, Ù· ÙÚfiÊÈÌ· ‰È·¯ˆÚ›ÛÙËÎ·Ó Û ‚·ÛÈΤ˜ ÔÌ¿‰Â˜, fiˆ˜ Á·Ï·ÎÙÔÎÔÌÈο ÚÔ˚fiÓÙ·, ÎÚ¤·˜-·˘Á¿, „¿ÚÈ·, fiÛÚÈ·, ‰ËÌËÙÚȷο, Ï·¯·ÓÈο, ÊÚÔ‡Ù·, ·Ó·„˘ÎÙÈο Î·È Ù˘ÔÔÈË̤ӷ ÚÔ˚fiÓÙ· (snacks). ∏ ·Ó¿Ï˘ÛË ÙÔ˘ ‰È·ÈÙÔÏÔÁ›Ô˘ ¤ÁÈÓ ·fi ËÏÂÎÙÚÔÓÈ΋ ‚¿ÛË ‰Â‰ÔÌ¤ÓˆÓ ÙÚÔʛ̈Ó, ‚·ÛÈṲ̂ÓË ÙfiÛÔ ÛÙË ‚¿ÛË ÙÔ˘ ÀÔ˘ÚÁ›Ԣ °ÂˆÚÁ›·˜ ÙˆÓ ∏ÓˆÌ¤ÓˆÓ ¶ÔÏÈÙÂÈÒÓ (United States Department of Agriculture - USDA) fiÛÔ Î·È ÛÙË ¯ËÌÈ΋ ·Ó¿Ï˘ÛË 120 ÂÏÏËÓÈÎÒÓ ÙÚÔÊ›ÌˆÓ Ô˘ ¤ÁÈÓ ÛÙÔ TNO Nutrition Institute ÛÙËÓ OÏÏ·Ó‰›· ÛÙÔ Ï·›ÛÈÔ ÙÔ˘ Â˘Úˆ·˚ÎÔ‡ ÚÔÁÚ¿ÌÌ·ÙÔ˜ Transfair, ÂÓÒ 20 ÙÚfiÊÈÌ· ·Ó·Ï‡ıËÎ·Ó ¯ËÌÈο ÛÙÔ Wegeningen Agricultural University (17,18). ∞fi ÙË ‚¿ÛË ‰Â‰ÔÌ¤ÓˆÓ ÙÚÔʛ̈Ó, ÂÎÙÈÌ‹ıËÎÂ Ë ËÌÂÚ‹ÛÈ· ÚfiÛÏË„Ë ÂÓ¤ÚÁÂÈ·˜, ÙˆÓ ‚ÈÙ·ÌÈÓÒÓ A, C, E, B1, µ2, B6, B12 Î·È Ù˘ ÓÈ·Û›Ó˘. ∆Ô ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜ ÌÂÙÚ‹ıËΠ̠ËÏÂÎÙÚÔÓÈÎfi ˙˘Áfi Ù‡Ô˘ Seca Alpha ·ÎÚȂ›·˜ ±100 g Î·È Ë ˙‡ÁÈÛË ¤ÁÈÓ ÌfiÓÔ Ì ÂÛÒÚÔ˘¯·, ¯ˆÚ›˜ ·Ô‡ÙÛÈ·. ∆Ô ‡„Ô˜ ÌÂÙÚ‹ıËΠ̠·Ó·ÛÙËÌfiÌÂÙÚÔ ·ÎÚȂ›·˜ <0,5 cm, Û fiÚıÈ· ı¤ÛË, ¯ˆÚ›˜ ·Ô‡ÙÛÈ·, Ì ¯·Ï·ÚÔ‡˜ ÒÌÔ˘˜ Î·È Ù· ¯¤ÚÈ· ÙÔÔıÂÙË̤ӷ ÛÙÔ Ï¿È. O ‰Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ (¢ª™) ˘ÔÏÔÁ›ÛÙËΠ·fi ÙË Û¯¤ÛË ‚¿ÚÔ˘˜ Û ÎÈÏ¿ ÚÔ˜ ÙÔ ‡„Ô˜ Û ̤ÙÚ· ÛÙÔ ÙÂÙÚ¿ÁˆÓÔ (kg/m2). ∏ ÂÚ›ÌÂÙÚÔ˜ ̤Û˘ ÌÂÙÚ‹ıËΠ̠ϷÛÙÈ΋ ÌÂÙÚÈ΋ Ù·ÈÓ›· ÛÙÔ ‡„Ô˜ ÙÔ˘ ÔÌÊ·ÏÔ‡ Î·È Î¿ÙˆıÂÓ ÙÔ˘ Ï¢ÚÈÎÔ‡ ÙfiÍÔ˘ (ÛÙÔ Ì¤ÛÔ Ù˘ ·fiÛÙ·Û˘ ÌÂٷ͇ Ï¢ÚÈÎÔ‡ ÙfiÍÔ˘ Î·È Ï·ÁÔÓ›Ô˘ ·ÎÚÔÏÔÊ›·˜) Î·È Ë ÂÚ›ÌÂÙÚÔ˜ ÏÂοÓ˘ ÛÙÔ ‡„Ô˜ ÙˆÓ Î·Ù’ ÈÛ¯›ˆÓ ·ÚıÚÒÛÂˆÓ Î·È ¿ÓˆıÂÓ ÙÔ˘ ÂÊË‚·›Ô˘ (18). ∆· ·È‰È¿ ˘Ô‚Ï‹ıËηÓ, ›Û˘, Û ‚ÈÔ¯ËÌÈΤ˜ Î·È ·ÈÌ·ÙÔÏÔÁÈΤ˜ ÂÍÂÙ¿ÛÂȘ. ¢Â›ÁÌ·Ù· ·›Ì·ÙÔ˜ ÂÏ‹ÊıËÛ·Ó ÙȘ ÚˆÈÓ¤˜ ÒÚ˜ ÌÂÙ¿ ·fi 12ˆÚË ÓËÛÙ›· Î·È ÌÂÙÚ‹ıËÎ·Ó Ë ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË (TC), Ù· ÙÚÈÁÏ˘ÎÂÚ›‰È· (Trigl), Ë HDL-¯ÔÏËÛÙÂÚfiÏË, Ë LDL-¯ÔÏËÛÙÂÚfiÏË (˘ÔÏÔÁ›ÛÙËΠ·fi ÙÔÓ Ù‡Ô LDL = TC - (Trigl/5+HDL), Ô ·ıËڈ̷ÙÈÎfi˜ ‰Â›ÎÙ˘ (˘ÔÏÔÁ›ÛÙËΠ·fi ÙÔ ËÏ›ÎÔ Ù˘ ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ ÚÔ˜ HDL-¯ÔÏËÛÙÂÚfiÏË), Ë ·ÈÌÔÛÊ·ÈÚ›ÓË, Ô ·ÈÌ·ÙÔÎÚ›Ù˘ Î·È Ô Ì¤ÛÔ˜ fiÁÎÔ˜ ÂÚ˘ıÚÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ (17,18). ∏ ÂÎÙ›ÌËÛË Ù˘ Ê˘ÛÈ΋˜ ηٿÛÙ·Û˘ ÙˆÓ ·È‰ÈÒÓ ¤ÁÈÓ Ì ÙÔ ·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜ (endurance shuttle run test) (18,19). ∞fi Ù· 583 ·È‰È¿ ËÏÈΛ·˜ 9-12 ÂÙÒÓ Ô˘ ·ÔÙÂÏÔ‡Û·Ó ÙÔ ·Ú¯ÈÎfi ‰Â›ÁÌ· (17), ÂÈϤ¯ıËÎ·Ó fiÛ· ÊÔÈÙÔ‡Û·Ó ÛÙËÓ ∂’
May-June 04 chris new
19-07-04
19:24
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¶·È‰È·ÙÚÈ΋ 2004;67:178-189
¢ËÌÔÙÈÎÔ‡, ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂÎÙÈÌËıÔ‡Ó ÔÈ Û¯ÔÏÈΤ˜ ÈηÓfiÙËÙ¤˜ ÙÔ˘˜ Ì ÂȉÈÎfi ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Ô˘ Û˘ÌÏËÚˆÓfiÙ·Ó ·fi ÙÔÓ ÂÎ·È‰Â˘ÙÈÎfi. OÈ Ì·ıËÙ¤˜ ÙˆÓ ÌÈÎÚfiÙÂÚˆÓ Ù¿ÍÂˆÓ ·ÔÎÏ›ÛÙËÎ·Ó ·fi ·˘Ù‹ ÙËÓ ÂÎÙ›ÌËÛË, ÁÈ·Ù› ÎÚ›ıËΠfiÙÈ ÔÈ ÈηÓfiÙËÙ˜ Ô˘ ÂÚÈÁÚ¿ÊÔÓÙ·Ó ÛÙÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ÌÔÚÔ‡Ó Ó· ÌÂÏÂÙËıÔ‡Ó Â˘ÎÔÏfiÙÂÚ· ÛÙ· ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿. ∫·ıÒ˜ Ù· ·È‰È¿ Ù˘ ∂’ ¢ËÌÔÙÈÎÔ‡ ‹Ù·Ó ÂÚÈÛÛfiÙÂÚ· ·fi Ù· ·È‰È¿ Ù˘ ™Ù’ ¢ËÌÔÙÈÎÔ‡, ıˆڋıËΠfiÙÈ ı· ·ÔÙÂÏÔ‡Û·Ó ÈÔ ·ÓÙÈÚÔÛˆÂ˘ÙÈÎfi ‰Â›ÁÌ·. °È· ÙËÓ ÂÎÙ›ÌËÛË Ù˘ Ì·ıËÛȷ΋˜ ›‰ÔÛ˘, ¯ÔÚËÁ‹ıËΠÛÙÔ˘˜ ÂÎ·È‰Â˘ÙÈÎÔ‡˜ ÂȉÈ΋ Îϛ̷η, fiˆ˜ ÚÔÙ›ÓÂÙ·È ·fi ÙË J. Lerner (20). ¶ÚfiÎÂÈÙ·È ÁÈ· ÌË ÛÙ·ıÌÈṲ̂ÓÔ ÛÙ· ÂÏÏËÓÈο ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ, ÙÔ ÔÔ›Ô fï˜ ¤¯ÂÈ ÙÚÔÔÔÈËı› Î·È ¤¯ÂÈ ¯ÚËÛÈÌÔÔÈËı› Ì ÂÈÙ˘¯›· Û ÚÔËÁÔ‡ÌÂÓ˜ ¤Ú¢Ó˜ (21). ∏ Îϛ̷η ·˘Ù‹ ÂÎÙÈÌ¿ ‰È¿ÊÔÚ˜ ·Ú·Ì¤ÙÚÔ˘˜ Ù˘ Ì¿ıËÛ˘ Î·È Û˘ÁÎÂÎÚÈ̤ӷ ÙËÓ ·ÎÔ˘ÛÙÈ΋ ·ÓÙ›ÏË„Ë, ÙÔÓ ÚÔÊÔÚÈÎfi ÏfiÁÔ, ÙÔÓ ÚÔÛ·Ó·ÙÔÏÈÛÌfi, ÙË Û˘ÌÂÚÈÊÔÚ¿, ÙËÓ ÎÈÓËÙÈ΋ ÈηÓfiÙËÙ·, ÙË ÁψÛÛÈ΋ ›‰ÔÛË, Ù˘¯fiÓ ‰È¿Û·ÛË ÚÔÛÔ¯‹˜, ÔÙÈÎÔÎÈÓËÙÈΤ˜ ‰È·Ù·Ú·¯¤˜, ‰˘ÛÎÔϛ˜ ÛÙËÓ ·ÎÔ˘ÛÙÈ΋ ÂÂÍÂÚÁ·Û›· Î·È ·‰˘Ó·Ì›Â˜ ÌÓ‹Ì˘. ∞ÔÙÂÏÂ›Ù·È ·fi 50 ÂÚˆÙ‹ÛÂȘ Ô˘ ÂÚÈÁÚ¿ÊÔ˘Ó Î¿ÔȘ ÈηÓfiÙËÙ˜ ‹ ·‰˘Ó·Ì›Â˜ ÛÙÔ˘˜ ·Ú·¿Óˆ Ì·ıËÛÈ·ÎÔ‡˜ ÙÔÌ›˜ (‚Ï. ¶·Ú¿ÚÙËÌ·). °È· ÙȘ ·Ó¿ÁΘ Ù˘ ¤Ú¢ӷ˜, ÔÈ ÂÚˆÙ‹ÛÂȘ ÔÌ·‰ÔÔÈ‹ıËÎ·Ó Û ¤ÍÈ ÙÔÌ›˜ Ì·ıËÛȷ΋˜ ›‰ÔÛ˘: 1) ÁÏÒÛÛ·, 2) ÌÓ‹ÌË, 3) ÚÔÛÔ¯‹, 4) ÔÙÈÎÔÎÈÓËÙÈ΋ ··ÚÙ›ˆÛË, 5) ÎÈÓËÙÈ΋ ÈηÓfiÙËÙ· Î·È 6) Û˘ÌÂÚÈÊÔÚ¿. ªÂÙ¿ ·fi Ì›· ÂÓË̤ڈÛË ÙˆÓ ÂÎ·È‰Â˘ÙÈÎÒÓ ·fi ¤ÌÂÈÚÔ „˘¯ÔÏfiÁÔ, ÙÔ˘˜ ˙ËÙ‹ıËΠӷ ·Ú·ÙËÚ‹ÛÔ˘Ó Î·È Ó· ·ÍÈÔÏÔÁ‹ÛÔ˘Ó ÙÔ˘˜ Ì·ıËÙ¤˜ ÙÔ˘˜ ÛÙÔ˘˜ Û˘ÁÎÂÎÚÈ̤ÓÔ˘˜ ÙÔÌ›˜, Û ̛· Îϛ̷η ·fi 0-3, fiÔ˘ ÙÔ 0 ·ÓÙÈÚÔۈ‡ÂÈ ÙËÓ ¿ÚÈÛÙË Â›‰ÔÛË, ÂÓÒ ÙÔ 3 ‰ËÏÒÓÂÈ ÙËÓ ‡·ÚÍË ¤ÓÙÔÓˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ. ∞ÎfiÌË, ˙ËÙ‹ıËΠӷ ηٷÁÚ·ÊÔ‡Ó Î·È ÔÈ ‚·ıÌÔ› ÙˆÓ Û˘ÌÌÂÙ¯fiÓÙˆÓ ÛÙ· ª·ıËÌ·ÙÈο, ÙË °ÏÒÛÛ·, ÙËÓ πÛÙÔÚ›·, ÙË º˘ÛÈ΋ Î·È ÙËÓ ∞ÈÛıËÙÈ΋ ∞ÁˆÁ‹ Î·È ˘ÔÏÔÁ›ÛÙËÎÂ Ô Ì¤ÛÔ˜ fiÚÔ˜ ÙÔ˘˜. ŒÁÈÓÂ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ Ù˘ ηٷӿψÛ˘ ÙˆÓ ÙÚÔʛ̈Ó, ÙˆÓ ÂȤ‰ˆÓ ÙˆÓ ·ÈÌ·ÙÔÏÔÁÈÎÒÓ Î·È ‚ÈÔ¯ËÌÈÎÒÓ ·Ú·ÁfiÓÙˆÓ Î·È ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ ÙˆÓ ÛˆÌ·ÙÔÌÂÙÚ‹ÛÂˆÓ Ì ÙȘ ‚·ıÌÔÏÔÁ›Â˜ ÛÙÔ˘˜ ¤ÍÈ ÙÔÌ›˜ Ì·ıËÛȷ΋˜ ›‰ÔÛ˘, ·ÏÏ¿ Î·È Ì ÙË Û˘ÓÔÏÈ΋ ‚·ıÌÔÏÔÁ›· ÛÙËÓ Îϛ̷η Ì·ıËÛȷ΋˜ ›‰ÔÛ˘. ∞ÎfiÌË, Û˘Û¯ÂÙ›ÛÙËÎ·Ó ÔÈ ‚·ıÌÔÏÔÁ›Â˜ ÛÙÔ˘˜ ÙÔÌ›˜ Ì·ıËÛȷ΋˜ ›‰ÔÛ˘, Ë Û˘ÓÔÏÈ΋ ‚·ıÌÔÏÔÁ›· Ù˘ Îϛ̷η˜ Î·È Ô Ì¤ÛÔ˜ fiÚÔ˜ ÙˆÓ Û¯ÔÏÈÎÒÓ ‚·ıÌÒÓ Ì ٷ ‰È·ÙÚÔÊÈο ÛÙÔȯ›·. ∞Ó·˙ËÙ‹ıËÎ·Ó Ù˘¯fiÓ ÂȉڿÛÂȘ ÙÔ˘ ʇÏÔ˘, Ù˘ ËÏÈΛ·˜, ÙÔ˘ ‰Â›ÎÙË Ì¿˙·˜ ÛÒÌ·ÙÔ˜, Ù˘ ›‰ÔÛ˘ ÛÙÔ ·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜, ÙˆÓ ıÂÚÌ›‰ˆÓ Î·È Ù˘ TC/HDL. ∆¤ÏÔ˜, ÂÓÙÔ›ÛÙËÎ·Ó ÔÈ ‰‡Ô ÔÚȷΤ˜ ÔÌ¿‰Â˜ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜, ‰ËÏ·‰‹ ÔÈ Ì·ıËÙ¤˜ Ì Ôχ ˘„ËÏ‹ ›‰ÔÛË ÛÙËÓ Îϛ̷η (>75%) Î·È ÔÈ Ì·ıËÙ¤˜ Ì Ôχ ¯·ÌËÏ‹ ›‰ÔÛË (<25%), ÂÓÒ ¤ÁÈÓ ۇÁÎÚÈÛË ÙˆÓ ÛˆÌ·ÙÔÌÂÙÚÈÎÒÓ ÌÂÁÂıÒÓ ÙÔ˘˜, ÙˆÓ ·ÈÌ·ÙÔÏÔÁÈÎÒÓ Î·È ‚ÈÔ¯ËÌÈÎÒÓ ‰ÂÈÎÙÒÓ, ÙˆÓ ‰È·ÈÙËÙÈÎÒÓ ÛÙÔȯ›ˆÓ Î·È ÙÔ˘ ‰Â›ÎÙË Ê˘ÛÈ΋˜ ηٿÛÙ·Û˘. ∏ ·Ó¿Ï˘ÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ¤ÁÈÓ Ì ÙÔ ÛÙ·ÙÈÛÙÈÎfi ÚfiÁÚ·ÌÌ· STATISTICA. OÈ Û˘Û¯ÂÙ›ÛÂȘ ÂϤÁ¯ıËÎ·Ó ÌÂ
Paediatriki 2004;67:178-189
Pearson correlation test (partial correlation coefficient) Î·È Ì ÙȘ ÌÂıfi‰Ô˘˜ Ù˘ ÁÚ·ÌÌÈ΋˜ ·Ó¿Ï˘Û˘ ·ÏÈÓ‰ÚfiÌËÛ˘ Î·È Ù˘ ·Ó¿Ï˘Û˘ Û˘Ó‰È·Î‡Ì·ÓÛ˘, ÂϤÁ¯ÔÓÙ·˜ ÁÈ· Ù˘¯fiÓ ÂȉڿÛÂȘ ÙÔ˘ ʇÏÔ˘, Ù˘ ËÏÈΛ·˜ Î·È ÙÔ˘ ‰Â›ÎÙË Ì¿˙·˜ ÛÒÌ·ÙÔ˜.
∞ÔÙÂϤÛÌ·Ù· ™ÙËÓ ¤Ú¢ӷ Û˘ÌÌÂÙ›¯·Ó 166 Ì·ıËÙ¤˜ Ù˘ ∂’ ¢ËÌÔÙÈÎÔ‡, ËÏÈΛ·˜ 11-12 ÂÙÒÓ, Ô˘ ÊÔÈÙÔ‡Û·Ó Û ¤ÍÈ Û¯ÔÏ›· Ù˘ ¢ڇÙÂÚ˘ ÂÚÈÔ¯‹˜ ÙÔ˘ ∏Ú·ÎÏ›Ԣ, ÙÔ˘ ƒÂı‡ÌÓÔ˘ Î·È ÙÔ˘ ∞Á›Ô˘ ¡ÈÎÔÏ¿Ô˘. ∞fi ·˘ÙÔ‡˜, ÔÈ 92 ‹Ù·Ó ·ÁfiÚÈ· Î·È ÔÈ 74 ‹Ù·Ó ÎÔÚ›ÙÛÈ· (¶›Ó·Î˜ 1 Î·È 2). OÈ ·Ó·Ï‡ÛÂȘ ¤‰ÂÈÍ·Ó fiÙÈ ˘¿Ú¯ÂÈ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ Ù˘ ηٷӿψÛ˘ Á·Ï·ÎÙÔÎÔÌÈÎÒÓ ÚÔ˚fiÓÙˆÓ Î·È ÙˆÓ ÙÔ̤ˆÓ ÁÏÒÛÛ·˜ Î·È ÌÓ‹Ì˘, ηıÒ˜ Î·È Ù˘ Û˘ÓÔÏÈ΋˜ ‚·ıÌÔÏÔÁ›·˜ ÛÙËÓ Îϛ̷η Ì·ıËÛȷ΋˜ ›‰ÔÛ˘. ∞ÎfiÌË, ·Ú·ÙËÚ‹ıËÎÂ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ Ù˘ ηٷӿψÛ˘ Ï·¯·ÓÈÎÒÓ Î·È Ù˘ ÚÔÛÔ¯‹˜, ηıÒ˜ Î·È ÌÂٷ͇ Ù˘ ηٷӿψÛ˘ ÊÚÔ‡ÙˆÓ Î·È ÙÔ˘ ÙÔ̤· Ù˘ ÁÏÒÛÛ·˜. ŸÏ˜ ÔÈ Û˘Û¯ÂÙ›ÛÂȘ ‹Ù·Ó ıÂÙÈΤ˜, ˘Ô‰ËÏÒÓÔÓÙ·˜ ¤ÙÛÈ fiÙÈ Ë ·‡ÍËÛË Ù˘ ηٷӿψÛ˘ Á·Ï·ÎÙÔÎÔÌÈÎÒÓ, Ï·¯·ÓÈÎÒÓ Î·È ÊÚÔ‡ÙˆÓ Û˘Óԉ‡ÂÙ·È ·fi ·‡ÍËÛË ÙˆÓ ÂȉfiÛÂˆÓ ÛÙÔ˘˜ ‰È¿ÊÔÚÔ˘˜ ÙÔÌ›˜ Ù˘ Îϛ̷η˜ (¶›Ó·Î·˜ 3). OÈ ·ÈÌ·ÙÔÏÔÁÈΤ˜ ·Ú¿ÌÂÙÚÔÈ ·ÚÔ˘Û›·Û·Ó, ›Û˘, ıÂÙÈΤ˜ Û˘Û¯ÂÙ›ÛÂȘ Ì ÙÔ˘˜ Ì·ıËÛÈ·ÎÔ‡˜ ÙÔÌ›˜, ηٷ‰ÂÈÎÓ‡ÔÓÙ·˜ fiÙÈ Ù· ·˘ÍË̤ӷ ›‰· ·ÈÌÔÛÊ·ÈÚ›Ó˘ Î·È ·ÈÌ·ÙÔÎÚ›ÙË Û˘Óԉ‡ÔÓÙ·È ·fi ˘„ËϤ˜ ÂȉfiÛÂȘ ÛÙÔ˘˜ ÙÔÌ›˜ ·˘ÙÔ‡˜ (¶›Ó·Î·˜ 4). ™˘ÁÎÂÎÚÈ̤ӷ, Ë ·ÈÌÔÛÊ·ÈÚ›ÓË Û˘Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ Â›‰ÔÛË ÛÙÔ˘˜ ÙÔÌ›˜ ÁÏÒÛÛ·˜, ÌÓ‹Ì˘ Î·È Û˘ÌÂÚÈÊÔÚ¿˜, Ì ÙË Û˘ÓÔÏÈ΋ ‚·ıÌÔÏÔÁ›· ÛÙËÓ Îϛ̷η Ì·ıËÛȷ΋˜ ›‰ÔÛ˘ Î·È Ì ÙÔÓ Ì¤ÛÔ fiÚÔ ÙˆÓ Û¯ÔÏÈÎÒÓ ‚·ıÌÒÓ. ∂›Û˘, Ô ·ÈÌ·ÙÔÎÚ›Ù˘ ·ÚÔ˘ÛÈ¿˙ÂÈ Û˘Û¯¤ÙÈÛË Ì fiÏÔ˘˜ ÙÔ˘˜ Ì·ıËÛÈ·ÎÔ‡˜ ÙÔÌ›˜, ÏËÓ Ù˘ ÔÙÈÎÔÎÈÓËÙÈ΋˜ ··ÚÙ›ˆÛ˘. OÈ Û˘Û¯ÂÙ›ÛÂȘ ÙˆÓ ‚·ıÌÒÓ ÛÙÔ˘˜ Ì·ıËÛÈ·ÎÔ‡˜ ÙÔÌ›˜ Ì ٷ ÛÙÔȯ›· ‰È·ÙÚÔÊ‹˜ η٤‰ÂÈÍ·Ó ÙÔÓ ÚfiÏÔ ÙˆÓ ‚ÈÙ·ÌÈÓÒÓ, ÙÔ˘ ·Û‚ÂÛÙ›Ô˘ Î·È ÙˆÓ ÚˆÙÂ˚ÓÒÓ ÛÙË Ì·ıËÛȷ΋ ›‰ÔÛË (¶›Ó·Î·˜ 5). ™˘ÁÎÂÎÚÈ̤ӷ, Ë ‚ÈÙ·Ì›ÓË µ12 ·ÚÔ˘Û›·Û ıÂÙÈΤ˜ Û˘Û¯ÂÙ›ÛÂȘ Ì ÙÔ˘˜ ÙÔÌ›˜ Û˘ÌÂÚÈÊÔÚ¿˜, ÁÏÒÛÛ·˜, ÌÓ‹Ì˘ Î·È Ì ÙË Û˘ÓÔÏÈ΋ ‚·ıÌÔÏÔÁ›· ÛÙËÓ Îϛ̷η Ì·ıËÛȷ΋˜ ›‰ÔÛ˘. ¶·ÚÔÌÔ›ˆ˜, Ë ‚ÈÙ·Ì›ÓË ∞ ·ÚÔ˘Û›·Û ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË Ì ÙÔ˘˜ ÙÔÌ›˜ Û˘ÌÂÚÈÊÔÚ¿˜ Î·È ÚÔÛÔ¯‹˜. ∞ÓÙ›ıÂÙ· ·fi ÙȘ ‚Èٷ̛Ә µ12 Î·È ∞, ÔÈ Ôԛ˜ - fiˆ˜ Ê·›ÓÂÙ·È - Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì ‚ÂÏÙ›ˆÛË ÙˆÓ ÂȉfiÛÂˆÓ ÛÙÔ Û¯ÔÏ›Ô, ÔÈ ‚Èٷ̛Ә µ1 Î·È ÓÈ·Û›ÓË Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì ÊÙˆ¯¤˜ ÂȉfiÛÂȘ, fiˆ˜ Ì·ÚÙ˘ÚÔ‡Ó ÔÈ ·ÚÓËÙÈΤ˜ Û˘Û¯ÂÙ›ÛÂȘ Ô˘ ·ÚÔ˘Û›·Û·Ó Ì ÙÔ˘˜ Ì·ıËÛÈ·ÎÔ‡˜
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¶·È‰È·ÙÚÈ΋ 2004;67:178-189
Paediatriki 2004;67:178-189
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¶›Ó·Î·˜ 2. ∫·Ù·ÓÔÌ‹ Ì·ıËÙÒÓ ·Ó¿ ÓÔÌfi ¡ÔÌfi˜ ∏Ú¿ÎÏÂÈÔ ƒ¤ı˘ÌÓÔ §·Û›ıÈ ™‡ÓÔÏÔ
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ÙÔÌ›˜. ™˘ÁÎÂÎÚÈ̤ӷ, Ë ‚ÈÙ·Ì›ÓË µ1 ·ÚÔ˘Û›·Û ·ÚÓËÙÈ΋ Û˘Û¯¤ÙÈÛË Ì ÙË Û˘ÌÂÚÈÊÔÚ¿, ÙË ÁÏÒÛÛ·, ÙË ÌÓ‹ÌË Î·È ÙÔÓ Û¯ÔÏÈÎfi ‚·ıÌfi, ÂÓÒ Ë ÓÈ·Û›ÓË ·ÚÔ˘Û›·Û ·ÚÓËÙÈ΋ Û˘Û¯¤ÙÈÛË Ì ÙÔÓ ÙÔ̤· Ù˘ ΛÓËÛ˘. ∆Ô ·Û‚¤ÛÙÈÔ ÂÌÊ¿ÓÈÛ ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË Ì ÙÔ˘˜ ÙÔÌ›˜ ÁÏÒÛÛ·˜ Î·È ÌÓ‹Ì˘, Ì ÙË Û˘ÓÔÏÈ΋ ‚·ıÌÔÏÔÁ›· ÛÙËÓ Îϛ̷η Î·È Ì ÙÔÓ Û¯ÔÏÈÎfi ‚·ıÌfi. ∏ ÚfiÛÏË„Ë ÂÓ¤ÚÁÂÈ·˜ ·fi ÚˆÙ½Ó˜ ÂÌÊ¿ÓÈÛ ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË Ì ÙÔÓ Û¯ÔÏÈÎfi ‚·ıÌfi, Ì ÙË Û˘ÓÔÏÈ΋ ‚·ıÌÔÏÔÁ›· ÛÙËÓ Îϛ̷η Î·È Ì ηı¤Ó·Ó ·fi ÙÔ˘˜ Ì·ıËÛÈ·ÎÔ‡˜ ÙÔÌ›˜, ÏËÓ Ù˘ ΛÓËÛ˘ Î·È Ù˘ ÔÙÈÎÔÎÈÓËÙÈ΋˜ ··ÚÙ›ˆÛ˘. ∏ ÂÓ¤ÚÁÂÈ· ·fi ÔÏ˘·ÎfiÚÂÛÙ· Ï›Ë Â›¯Â ıÂÙÈ΋ Û¯¤ÛË Ì ÙËÓ ÚÔÛÔ¯‹. ∏ ·Ó¿Ï˘ÛË ·ÏÈÓ‰ÚfiÌËÛ˘ ‰ÂÓ ÂÓÙfiÈÛ οÔÈÔ ÚfiÏÔ ÙˆÓ ıÂÚÌ›‰ˆÓ Û fi,ÙÈ ·ÊÔÚ¿ ÙËÓ Â›‰ÔÛË ÙˆÓ Ì·ıËÙÒÓ ÛÙËÓ Îϛ̷η (¶›Ó·Î·˜ 6). ∞ÓÙ›ıÂÙ·, ¤‰ÂÈÍ fiÙÈ ÔÈ ‚·ıÌÔÏÔÁ›Â˜ Û οı ̷ıËÛÈ·Îfi ÙÔ̤·, ·ÏÏ¿ Î·È Ë Û˘ÓÔÏÈ΋ ‚·ıÌÔÏÔÁ›· fiÏˆÓ ÙˆÓ ÙÔ̤ˆÓ, ηıÒ˜ Î·È ÔÈ Û¯ÔÏÈÎÔ› ‚·ıÌÔ›, ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ Û˘Û¯¤ÙÈÛË Ì ÙËÓ ËÏÈΛ· ÙˆÓ ·È‰ÈÒÓ. ™˘ÁÎÂÎÚÈ̤ӷ, fiÛÔ ·˘Í¿ÓÂÈ Ë ËÏÈΛ· ÙˆÓ Ì·ıËÙÒÓ, ÌÂÈÒÓÂÙ·È Ë Û¯ÔÏÈ΋ ‚·ıÌÔÏÔÁ›· Î·È Ë Â›‰ÔÛ‹ ÙÔ˘˜ ÛÙÔ˘˜ ˘fi ÂͤٷÛË Ì·ıËÛÈ·ÎÔ‡˜ ÙÔÌ›˜. ∆· ÎÔÚ›ÙÛÈ· ‚Ú¤ıËΠfiÙÈ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ˘„ËÏfiÙÂÚÔ˘˜ ‚·ıÌÔ‡˜ ·fi Ù· ·ÁfiÚÈ· Î·È ˘„ËÏfiÙÂÚË Â›‰ÔÛË ÛÙËÓ Îϛ̷η ÁÂÓÈο, ·ÏÏ¿ Î·È ÂȉÈÎfiÙÂÚ· ÛÙÔ˘˜ ÙÔÌ›˜ ÁÏÒÛÛ·˜, Û˘ÌÂÚÈÊÔÚ¿˜, ΛÓËÛ˘ Î·È ÚÔÛÔ¯‹˜. O ‰Â›ÎÙ˘ Ê˘ÛÈ΋˜ ηٿÛÙ·Û˘ ·ÚÔ˘ÛÈ¿˙ÂÈ ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË Ì ÙË Û˘ÓÔÏÈ΋ ‚·ıÌÔÏÔÁ›· fiÏˆÓ ÙˆÓ Ì·ıËÛÈ·ÎÒÓ ÙÔ̤ˆÓ Î·È Ì ÙË ‚·ıÌÔÏÔÁ›· Û οı ¤Ó·Ó ·fi ÙÔ˘˜ ÙÔÌ›˜ ÁÏÒÛÛ·˜, ÔÙÈÎÔÎÈÓËÙÈ΋˜ ··ÚÙ›ˆÛ˘, Û˘ÌÂÚÈÊÔÚ¿˜, ΛÓËÛ˘ Î·È ÌÓ‹Ì˘. ∞˘Ùfi ÛËÌ·›ÓÂÈ fiÙÈ Ë Ê˘ÛÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ Î·Ï‹ ›‰ÔÛË Û ·˘ÙÔ‡˜ ÙÔ˘˜ ÁÓˆÛÙÈÎÔ‡˜ ÙÔÌ›˜ Î·È ÛÙËÓ Îϛ̷η Ì·ıËÛȷ΋˜ ›‰ÔÛ˘, ÁÂÓÈÎfiÙÂÚ·.
182
O ÏfiÁÔ˜ ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ ÚÔ˜ HDL-¯ÔÏËÛÙÂÚfiÏË Û˘Û¯ÂÙ›˙ÂÙ·È ıÂÙÈο Ì ÙÔÓ Û¯ÔÏÈÎfi ‚·ıÌfi Î·È ÙËÓ Â›‰ÔÛË ÛÙÔ˘˜ ÙÔÌ›˜ ÁÏÒÛÛ·˜, Û˘ÌÂÚÈÊÔÚ¿˜ Î·È Î›ÓËÛ˘. O ‰Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ ·ÚÔ˘ÛÈ¿˙ÂÈ ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË Ì ÙË Ì·ıËÛȷ΋ ›‰ÔÛË ÁÂÓÈο ηÈ, ÂȉÈÎfiÙÂÚ·, Ì ÙÔÓ ÙÔ̤· Ù˘ ÌÓ‹Ì˘. ∏ ·Ó¿Ï˘ÛË Û˘Ó‰È·Î‡Ì·ÓÛ˘ ¤‰ÂÈÍ fiÙÈ ÔÈ Ì·ıËÙ¤˜ Ì ÙËÓ ˘„ËÏfiÙÂÚË ‚·ıÌÔÏÔÁ›· ÛÙËÓ Îϛ̷η ›¯·Ó ÌÂÁ·Ï‡ÙÂÚÔ ‚¿ÚÔ˜, ηχÙÂÚË Ê˘ÛÈ΋ ηٿÛÙ·ÛË Î·È Û¯Â‰fiÓ ‰ÈÏ¿ÛÈ· ηٷӿψÛË Ï·¯·ÓÈÎÒÓ Î·È ÊÚÔ‡ÙˆÓ Î·È ÚfiÛÏË„Ë ‚ÈÙ·Ì›Ó˘ µ12 Û ۯ¤ÛË Ì ÙÔ˘˜ Ì·ıËÙ¤˜ Ô˘ ÂÌÊ¿ÓÈÛ·Ó ÙË ¯·ÌËÏfiÙÂÚË Â›‰ÔÛË (¶›Ó·Î·˜ 7). ™˘˙‹ÙËÛË ∏ ·ÚÔ‡Û· ¤Ú¢ӷ Û˘ÓËÁÔÚ› ˘¤Ú Ù˘ ‡·Ú͢ ıÂÙÈ΋˜ Û˘Û¯¤ÙÈÛ˘ ÌÂٷ͇ Ù˘ ·ÈÌÔÛÊ·ÈÚ›Ó˘, ÙÔ˘ Ûȉ‹ÚÔ˘, ÙÔ˘ ·Û‚ÂÛÙ›Ô˘, ÙˆÓ ‚ÈÙ·ÌÈÓÒÓ ∞ Î·È µ12, ÙÔ˘ ÔÏ˘·ÎfiÚÂÛÙÔ˘ Ï›Ô˘˜ Ù˘ ÙÚÔÊ‹˜, Ù˘ ÂÓ¤ÚÁÂÈ·˜ ·fi ÚˆÙ½Ó˜, Ù˘ ηٷӿψÛ˘ Á·Ï·ÎÙÔÎÔÌÈÎÒÓ, Ï·¯·ÓÈÎÒÓ Î·È ÊÚÔ‡ÙˆÓ, ÙÔ˘ ·ıËڈ̷ÙÈÎÔ‡ ‰Â›ÎÙË (ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË ÚÔ˜ HDL) Î·È Ù˘ Ê˘ÛÈ΋˜ ηٿÛÙ·Û˘ Ì ‰È¿ÊÔÚÔ˘˜ ÁÓˆÛÙÈÎÔ‡˜ ÙÔÌ›˜. ∏ ÚfiÛÏË„Ë ‚ÈÙ·ÌÈÓÒÓ µ1 Î·È ÓÈ·Û›Ó˘ ·ÚÔ˘ÛÈ¿˙ÂÈ ·ÚÓËÙÈ΋ Û˘Û¯¤ÙÈÛË Ì ÙË Ì·ıËÛȷ΋ ›‰ÔÛË. ∏ ÚfiÛÏË„Ë ıÂÚÌ›‰ˆÓ ‰ÂÓ Ê·›ÓÂÙ·È Ó· ÂËÚ¿˙ÂÈ ÙË Ì·ıËÛȷ΋ ›‰ÔÛË, ˆÛÙfiÛÔ, Ô ‰Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ ·›˙ÂÈ Î¿ÔÈÔ ÚfiÏÔ, ηıÒ˜ ÔÈ Î·Ï‡ÙÂÚÔÈ Ì·ıËÙ¤˜ ¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚÔ ‚¿ÚÔ˜. ∆· ÎÔÚ›ÙÛÈ· ¤¯Ô˘Ó, ÁÂÓÈο, ηχÙÂÚ˜ ÂȉfiÛÂȘ ·fi Ù· ·ÁfiÚÈ·. ŸÛÔ ·˘Í¿ÓÂÈ Ë ËÏÈΛ·, ÔÈ Û¯ÔÏÈÎÔ› ‚·ıÌÔ› Á›ÓÔÓÙ·È ¯·ÌËÏfiÙÂÚÔÈ Î·È ÌÂÈÒÓÂÙ·È Ë Ì·ıËÛȷ΋ ›‰ÔÛË. ™˘ÁÎÂÎÚÈ̤ӷ, ÛÙÔ ‰Â›ÁÌ· Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ·Ú·ÙËÚ‹ıËΠfiÙÈ Ë ·‡ÍËÛË ÙˆÓ ÂȤ‰ˆÓ ·ÈÌÔÛÊ·ÈÚ›Ó˘ Î·È ·ÈÌ·ÙÔÎÚ›ÙË Û˘Û¯ÂÙ›˙ÂÙ·È Ì ‚ÂÏÙ›ˆÛË Ù˘ ›‰ÔÛ˘ ÛÙȘ ˘ÔÎϛ̷Θ Ù˘ ÁÏÒÛÛ·˜, Ù˘ ÌÓ‹Ì˘ Î·È Ù˘ ÚÔÛÔ¯‹˜. ∏ Û¯¤ÛË Ù˘ ·ÈÌÔÛÊ·ÈÚ›Ó˘ Î·È ÙÔ˘ ·ÈÌ·ÙÔÎÚ›ÙË Ì ÙË Ì·ıËÛȷ΋ ›‰ÔÛË Â·ÏËı‡ÂÙ·È ·fi Ï‹ıÔ˜ ÂÚ¢ÓÒÓ. ∞ӷʤÚÂÙ·È ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· fiÙÈ Ë ¯ÔÚ‹ÁËÛË Ûȉ‹ÚÔ˘ Û ¤Ê˂˜ Ì ¤ÏÏÂÈ„‹ ÙÔ˘ ›¯Â ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙË ‚ÂÏÙ›ˆÛË Ù˘ ÏÂÎÙÈ΋˜ Ì¿ıËÛ˘ Î·È Ù˘ ÌÓ‹Ì˘ (22). ∞ÎfiÌË ·Ó·Ê¤ÚÂÙ·È fiÙÈ Ë ¯·ÌËÏ‹ ·ÈÌÔÛÊ·ÈÚ›ÓË ˆ˜ ÙËÓ ËÏÈΛ· ÙˆÓ 2 ÂÙÒÓ Û˘Û¯ÂÙ›˙ÂÙ·È Ì ¤ÎÙˆÛË ÛÙË ÓÔËÙÈ΋ ·Ó¿Ù˘ÍË, Ë
May-June 04 chris new
19-07-04
19:24
™ÂÏ›‰·183
¶·È‰È·ÙÚÈ΋ 2004;67:178-189
Paediatriki 2004;67:178-189
¶›Ó·Î·˜ 3. ™¯¤ÛË ÁÓˆÛÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ Ì ÙÚfiÊÈÌ· ∆ÚfiÊÈÌ·
™˘ÓÔÏÈÎfi˜ ‚·ıÌfi˜ Îϛ̷η˜
°ÏÒÛÛ·
ªÓ‹ÌË
0,177 (0,023)
0,169 (0,031)
0,154 (0,050)
°·Ï·ÎÙÔÎÔÌÈο §·¯·ÓÈο ºÚÔ‡Ù·
¶ÚÔÛÔ¯‹ 0,158 (0,044)
0,155 (0,048)
™˘ÓÙÂÏÂÛÙ¤˜ ÌÂÚÈ΋˜ Û˘Û¯¤ÙÈÛ˘ r-Pearson (p-value): ÂϤÁ¯ÔÓÙ·È Ù˘¯fiÓ ÂȉڿÛÂȘ ÙÔ˘ ʇÏÔ˘, Ù˘ ËÏÈΛ·˜ Î·È ÙÔ˘ ¢ª™
¶›Ó·Î·˜ 4. ™¯¤ÛË ÁÓˆÛÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ Ì ·ÈÌ·ÙÔÏÔÁÈÎÔ‡˜ ‰Â›ÎÙ˜ ™˘ÓÔÏÈÎfi˜ ‚·ıÌfi˜ Îϛ̷η˜
°ÏÒÛÛ·
ªÓ‹ÌË
¶ÚÔÛÔ¯‹
∫›ÓËÛË
™˘ÌÂÚÈÊÔÚ¿
™¯ÔÏÈÎfi˜ ‚·ıÌfi˜
∞ÈÌ·ÙÔÏÔÁÈÎÔ› ‰Â›ÎÙ˜ ∞ÈÌÔÛÊ·ÈÚ›ÓË 0,180 (0,021) 0,183 (0,019) 0,197 (0,012) 0,171 (0,029) 0,200 (0,011) ∞ÈÌ·ÙÔÎÚ›Ù˘ 0,238 (0,002) 0,240 (0,002) 0,246 (0,002) 0,185 (0,018) 0,200 (0,010) 0,242 (0,002) 0,218 (0,005) ™˘ÓÙÂÏÂÛÙ¤˜ ÌÂÚÈ΋˜ Û˘Û¯¤ÙÈÛ˘ r-Pearson (p-value): ÂϤÁ¯ÔÓÙ·È Ù˘¯fiÓ ÂȉڿÛÂȘ ÙÔ˘ ʇÏÔ˘, Ù˘ ËÏÈΛ·˜ Î·È ÙÔ˘ ¢ª™
¶›Ó·Î·˜ 5. ™¯¤ÛË ·Ú·ÁfiÓÙˆÓ Ì·ıËÛȷ΋˜ ·ÍÈÔÏfiÁËÛ˘ ·È‰ÈÒÓ Ù˘ ∫Ú‹Ù˘ Ì ÛÙÔȯ›· Ù˘ ‰È·ÙÚÔÊ‹˜ ÙÔ˘˜ ¶·Ú¿ÁÔÓÙ˜ ·ÍÈÔÏfiÁËÛ˘ ™˘ÓÔÏÈÎfi˜ ‚·ıÌfi˜ Îϛ̷η˜
™¯ÔÏÈÎfi˜ ‚·ıÌfi˜ (ª.O.)
™˘ÌÂÚÈÊÔÚ¿
°ÏÒÛÛ·
∫›ÓËÛË ¶ÚÔÛÔ¯‹
ªÓ‹ÌË
™ÙÔȯ›· ‰È·ÙÚÔÊ‹˜
r-Pearson*
p-value
∞Û‚¤ÛÙÈÔ µÈÙ·Ì›ÓË µ12 ¶ÚˆÙ½Ó˜ (% ÂÓÂÚÁ.) ∞Û‚¤ÛÙÈÔ µÈÙ·Ì›ÓË µ1 ¶ÚˆÙ½Ó˜ (% ÂÓÂÚÁ.) µÈÙ·Ì›ÓË A µÈÙ·Ì›ÓË µ1 µÈÙ·Ì›ÓË µ12 ¶ÚˆÙ½Ó˜ (% ÂÓÂÚÁ.) ∞Û‚¤ÛÙÈÔ µÈÙ·Ì›ÓË µ1 µÈÙ·Ì›ÓË µ12 ¶ÚˆÙ½Ó˜ (% ÂÓÂÚÁ.) ¡È·Û›ÓË µÈÙ·Ì›ÓË A ¶ÚˆÙ½Ó˜ (% ÂÓÂÚÁ.) ¶ÔÏ˘·ÎfiÚÂÛÙÔ Ï›Ô˜ (% ÂÓÂÚÁ.) ∞Û‚¤ÛÙÈÔ µÈÙ·Ì›ÓË µ1 µÈÙ·Ì›ÓË µ12 ¶ÚˆÙ½Ó˜ (% ÂÓÂÚÁ.)
0,161 0,172 0,215 0,159 -0,180 0,265 0,177 -0,156 0,167 0,219 0,152 -0,195 0,204 0,247 -0,163 0,185 0,184 0,183 0,160 -0,155 0,185 0,214
0,040 0,028 0,006 0,045 0,024 0,001 0,024 0,047 0,033 0,005 0,050 0,013 0,009 0,001 0,039 0,018 0,019 0,020 0,041 0,048 0,018 0,006
* ™˘ÓÙÂÏÂÛÙ¤˜ ÌÂÚÈ΋˜ Û˘Û¯¤ÙÈÛ˘ r-Pearson: ÂϤÁ¯ÔÓÙ·È Ù˘¯fiÓ ÂȉڿÛÂȘ ÙÔ˘ ʇÏÔ˘, Ù˘ ËÏÈΛ·˜ Î·È ÙÔ˘ ¢ª™
ÔÔ›· Â›Ó·È È‰È·›ÙÂÚ· ¤ÓÙÔÓË ÛÙÔ˘˜ 18 Ì‹Ó˜ (8). ™‡ÌʈÓË Â›Ó·È Î·È Ë ÁÓÒÌË ÙˆÓ Lozoff Î·È Û˘Ó (14), ÔÈ ÔÔ›ÔÈ ‚Ú‹Î·Ó fiÙÈ Ù· ¯·ÌËÏ¿ ›‰· ·ÈÌÔÛÊ·ÈÚ›Ó˘ ÛÙË ‚ÚÂÊÈ΋ ËÏÈΛ· ·˘Í¿ÓÔ˘Ó ÙÔÓ Î›Ó‰˘ÓÔ ÓÔËÙÈ΋˜ ˘ÛÙ¤ÚËÛ˘ ÛÙËÓ ËÏÈΛ· ÙˆÓ 10 ÂÙÒÓ. ∂›Û˘, ‚Ú‹Î·Ó fiÙÈ ·È‰È¿ Ì ÛÔ‚·Ú‹, ¯ÚfiÓÈ· ¤ÏÏÂÈ„Ë Ûȉ‹ÚÔ˘ ·ÚÔ˘Û›·Û·Ó ÛÙËÓ ËÏÈΛ· ÙˆÓ 12 ÂÙÒÓ Î·Î‹ ›‰ÔÛË ÛÙËÓ ·ÚÈıÌËÙÈ΋ Î·È ÙË ÁÚ·Ù‹ ¤ÎÊÚ·ÛË, ÊÙˆ¯‹ ÎÈÓËÙÈ΋ ÈηÓfiÙËÙ· Î·È ·‰˘Ó·Ì›Â˜ Û ‰È¿ÊÔÚ˜ ÁÓˆÛÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜ (¯ˆÚÈ΋ ÌÓ‹ÌË, ÂÈÏÂÎÙÈ΋ ·Ó¿ÎÏËÛË). ¶ÔÏÏ¿ ·È‰È¿ ·ӤϷ‚·Ó οÔÈ· Ù¿ÍË ‹ ·Ú·¤ÌÊıËηÓ
ÁÈ· ÂÓÈÛ¯˘ÙÈ΋ ‰È‰·Ûηϛ·. ∂›Û˘, Û˘¯Ó¿ ·ÚÔ˘Û›·˙·Ó ÚÔ‚Ï‹Ì·Ù· ÛÙÔ Û˘Ó·›ÛıËÌ· Î·È ÙË Û˘ÌÂÚÈÊÔÚ¿ (¿Á¯Ô˜, ηٿıÏÈ„Ë, ‰È·Ù·Ú·Á̤ÓË ÎÔÈÓˆÓÈÎfiÙËÙ·, ÚÔ‚Ï‹Ì·Ù· ÚÔÛÔ¯‹˜). ∞ӷʤÚÔ˘Ó, ·ÎfiÌË, fiÙÈ ¤Ú¢Ó˜ Û ˙Ò· ‰Â›¯ÓÔ˘Ó fiÙÈ Ë ¤ÏÏÂÈ„Ë Ûȉ‹ÚÔ˘ ÂËÚ¿˙ÂÈ ÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ÈfiηÌÔ˘, ÁÂÁÔÓfi˜ Ô˘ ÂÍËÁ› Î·È ÙÔ Â‡ÚËÌ· Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ÁÈ· ÙË Û¯¤ÛË ·ÈÌÔÛÊ·ÈÚ›Ó˘-·ÈÌ·ÙÔÎÚ›ÙË Ì ÙË ÌÓ‹ÌË. OÈ ›‰ÈÔÈ ÂÚ¢ÓËÙ¤˜ ·Ó·Ê¤ÚÔ˘Ó fiÙÈ ÌÂÁ·Ï‡ÙÂÚ˜ Û˘ÁÎÂÓÙÚÒÛÂȘ Ûȉ‹ÚÔ˘ ˘¿Ú¯Ô˘Ó Û ÂÚÈÔ¯¤˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ Î›ÓËÛË Î·È ÙÔÓ ÚÔÛ·Ó·ÙÔÏÈÛÌfi, ˆÛÙfiÛÔ, ÛÙËÓ ·ÚÔ‡Û· ¤Ú¢ӷ
183
May-June 04 chris new
19-07-04
19:24
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¶·È‰È·ÙÚÈ΋ 2004;67:178-189
Paediatriki 2004;67:178-189
¶›Ó·Î·˜ 6. ™¯¤ÛË ÁÓˆÛÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ Ì ÙËÓ ËÏÈΛ·, ÙÔ ¶∆∞, ÙÔ Ê‡ÏÔ, ÙÔÓ ¢ª™, ÙÔÓ ·ıËڈ̷ÙÈÎfi ‰Â›ÎÙË TC/HDL Î·È ÙËÓ ÚfiÛÏË„Ë ÂÓ¤ÚÁÂÈ·˜
™˘ÓÔÏÈÎfi˜ ‚·ıÌfi˜ Îϛ̷η˜
™¯ÔÏÈÎfi˜ ‚·ıÌfi˜ (ª.O.)
°ÏÒÛÛ·
OÙÈÎÔÎÈÓËÙÈ΋ ··ÚÙ›ˆÛË ™˘ÌÂÚÈÊÔÚ¿
∫›ÓËÛË
¶ÚÔÛÔ¯‹ ªÓ‹ÌË
¶·Ú¿ÁÔÓÙ˜
Beta
t
p-value
∏ÏÈΛ· ¶∆∞ º‡ÏÔ ¢ª™ ∏ÏÈΛ· TC/HDL º‡ÏÔ ∏ÏÈΛ· ¶∆∞ º‡ÏÔ TC/HDL ∏ÏÈΛ· ¶∆∞ ∏ÏÈΛ· ¶∆∞ º‡ÏÔ TC/HDL ∏ÏÈΛ· º‡ÏÔ ¶∆∞ TC/HDL ∏ÏÈΛ· º‡ÏÔ ∏ÏÈΛ· ¶∆∞ ¢ª™
-0,386 0,305 0,206 0,170 -0,323 0,231 0,199 -0,466 0,217 0,180 0,149 -0,355 0,186 -0,423 0,250 0,208 0,138 -0,379 0,286 0,234 0,152 -0,381 0,181 -0,349 0,341 0,204
-5,56 3,87 2,78 2,27 -4,50 3,22 2,80 -6,80 3,00 2,52 2,16 -4,90 2,56 -6,09 3,42 2,87 1,98 -5,43 3,93 3,18 2,16 -5,37 2,55 -5,02 4,60 2,76
<0,001 <0,001 0,006 0,024 <0,001 0,002 0,006 <0,001 0,003 0,013 0,033 <0,001 0,011 <0,001 0,001 0,005 0,050 <0,001 <0,001 0,002 0,032 <0,001 0,012 <0,001 <0,001 0,006
∞Ó¿Ï˘ÛË ‚ËÌ·ÙÈ΋˜ ÁÚ·ÌÌÈ΋˜ ·ÏÈÓ‰ÚfiÌËÛ˘ (Stepwise Linear Regression)
‰ÂÓ ‚Ú¤ıËÎÂ Û˘Û¯¤ÙÈÛË Ì ÙÔÓ ·Ú¿ÁÔÓÙ· ÔÙÈÎÔÎÈÓËÙÈ΋˜ ··ÚÙ›ˆÛ˘. ∆Ô ·Û‚¤ÛÙÈÔ Î·È Ë ‚ÈÙ·Ì›ÓË µ12 ‚Ú¤ıËΠfiÙÈ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË Ì ÙÔ˘˜ ÙÔÌ›˜ ÁψÛÛÈ΋˜ ÈηÓfiÙËÙ·˜, ÌÓ‹Ì˘ Î·È Ì ÙÔ Û‡ÓÔÏÔ Ù˘ ‚·ıÌÔÏÔÁ›·˜ ÛÙËÓ Îϛ̷η Ì·ıËÛȷ΋˜ ›‰ÔÛ˘. ∞ÎfiÌ·, ÙÔ ·Û‚¤ÛÙÈÔ ·ÚÔ˘ÛÈ¿˙ÂÈ ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË Ì ÙÔÓ Û¯ÔÏÈÎfi ‚·ıÌfi Î·È Ë ‚ÈÙ·Ì›ÓË µ12 ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË Ì ÙÔÓ ÙÔ̤· Û˘ÌÂÚÈÊÔÚ¿˜. ∞ӷʤÚÂÙ·È ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· fiÙÈ ÙÔ ·Û‚¤ÛÙÈÔ Î·È Ë ‚ÈÙ·Ì›ÓË µ12 Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ÈηÓfiÙËÙ· ÁÈ· Û˘Ì‚ÔÏÈÎfi ·È¯Ó›‰È (8), Ë ÔÔ›· - fiˆ˜ Î·È Ë ÁψÛÛÈ΋ ÈηÓfiÙËÙ· - ·ÔÙÂÏ› ·ÓÒÙÂÚË ÁÓˆÛÙÈ΋ ÏÂÈÙÔ˘ÚÁ›·. ∂ÈϤÔÓ, ˘ÔÛÙËÚ›˙ÂÙ·È fiÙÈ Ë ıÂڷ›· Ì µ12 ‚ÂÏÙÈÒÓÂÈ ÙË ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ÌÂوȷ›Ô˘ ÏÔ‚Ô‡ Î·È ÙË ÁψÛÛÈ΋ ÈηÓfiÙËÙ· (23). O ÚfiÏÔ˜ Ù˘ ·˘Ù‹˜ Ù˘ ‚ÈÙ·Ì›Ó˘ ÛÙËÓ ·Ó¿Ù˘ÍË Ó¢ÚÔÏÔÁÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ ¤¯ÂÈ ·Ô‰Âȯı› (24). ∏ ‚ÈÙ·Ì›ÓË µ1 ·ÚÔ˘Û›·Û ·ÚÓËÙÈΤ˜ Û˘Û¯ÂÙ›ÛÂȘ Ì ÙÔ˘˜ ÙÔÌ›˜ Û˘ÌÂÚÈÊÔÚ¿˜, ÁψÛÛÈ΋˜ ÈηÓfiÙËÙ·˜ Î·È ÌÓ‹Ì˘, ηıÒ˜ Î·È Ì ÙÔÓ Û¯ÔÏÈÎfi ‚·ıÌfi. ∏ ÓÈ·Û›ÓË ·ÚÔ˘Û›·Û ·ÚÓËÙÈ΋ Û˘Û¯¤ÙÈÛË Ì ÙËÓ ÎÈÓËÙÈ΋ ÈηÓfiÙËÙ·. ™ÙË ‚È‚ÏÈÔÁÚ·Ê›· ‰ÂÓ ·Ó·Ê¤ÚÔÓÙ·È Ù¤ÙÔȘ Û˘Û¯ÂÙ›ÛÂȘ. ∞ÓÙ›ıÂÙ·, Â›Ó·È ÁÓˆÛÙfi fiÙÈ Ë ¤ÏÏÂÈ„Ë ‚ÈÙ·Ì›Ó˘ µ1 ÌÔÚ› Ó· ÚÔηϤ-
184
ÛÂÈ ÂÁÎÂÊ·ÏÔ¿ıÂÈ· Wernicke, ¯·Ú·ÎÙËÚÈÛÙÈο Û˘ÌÙÒÌ·Ù· Ù˘ ÔÔ›·˜ Â›Ó·È Ë ·Ù·Í›·, Ë ÔÊı·ÏÌÔÏËÁ›· Î·È Ë ÓÔËÙÈ΋ Û‡Á¯˘ÛË. ŒÏÏÂÈ„Ë ÓÈ·Û›Ó˘ Ô‰ËÁ› ÛÙËÓ ÂΉ‹ÏˆÛË Ó¢ÚÔÏÔÁÈÎÒÓ Û˘Ìو̿وÓ, fiˆ˜ ÎfiˆÛË, Ï‹ı·ÚÁÔ˜, ·‰˘Ó·Ì›· Û˘ÁΤÓÙÚˆÛ˘, ηٿıÏÈ„Ë Î·È ·Ú·ÈÛı‹ÛÂȘ (24). ∏ ‚ÈÙ·Ì›ÓË ∞ ·ÚÔ˘Û›·Û ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË Ì ÙÔ˘˜ ÙÔÌ›˜ Û˘ÌÂÚÈÊÔÚ¿˜ Î·È ÚÔÛÔ¯‹˜. OÈ La Rue Î·È Û˘Ó (25) ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ Ô˘Û›Â˜ Ì ·ÓÙÈÔÍÂȉˆÙÈΤ˜ ȉÈfiÙËÙ˜, fiˆ˜ Ë ‚ÈÙ·Ì›ÓË ∞, ηı˘ÛÙÂÚÔ‡Ó ÙËÓ „˘¯ÔÎÈÓËÙÈ΋ ÂÈ‚Ú¿‰˘ÓÛË, ÙËÓ ¤ÎÙˆÛË Ù˘ ÌÓËÌÔÓÈ΋˜ ÈηÓfiÙËÙ·˜ Î·È ÙË Ì›ˆÛË Ù˘ ¢ÂÏÈÍ›·˜ ÛÙË ÛΤ„Ë, Ô˘ ÚÔηÏÔ‡ÓÙ·È ·fi ÙËÓ ·‡ÍËÛË Ù˘ ÌÔÓÔ·ÌÈÓÔÍÂȉ¿Û˘ µ, ηٿ ÙË Á‹Ú·ÓÛË. ∂ÚÂ˘Ó¿Ù·È Ô ıÂڷ¢ÙÈÎfi˜ ÚfiÏÔ˜ ÙˆÓ ·ÓÙÈÔÍÂȉˆÙÈÎÒÓ Û ÓfiÛÔ˘˜ ÙÔ˘ ∫¡™ (26) ηÈ, ȉȷ›ÙÂÚ·, Ë Â›‰Ú·Û‹ ÙÔ˘˜ ÛÙË ÌÓËÌÔÓÈ΋ ÈηÓfiÙËÙ· (27). ª›· ÚfiÛÊ·ÙË ¤Ú¢ӷ ·Ó·Ê¤ÚÂÈ fiÙÈ ÙÚÔʤ˜ fiˆ˜ ÙÔ Û·Ó¿ÎÈ Î·È ÔÈ ÊÚ¿Ô˘Ï˜, ÔÈ Ôԛ˜ Â›Ó·È ÏÔ‡ÛȘ Û ·ÓÙÈÔÍÂȉˆÙÈΤ˜ Ô˘Û›Â˜, Û˘ÓÙÂÏÔ‡Ó ÛÙËÓ ÂÈ‚Ú¿‰˘ÓÛË Ù˘ ÏÂÈÙÔ˘ÚÁÈ΋˜ ¤ÎÙˆÛ˘ ÙÔ˘ ∫¡™ Î·È ÂӉ¯Ô̤ӈ˜ ¤¯Ô˘Ó οÔÈ· ıÂÙÈ΋ ›‰Ú·ÛË Û Ó¢ÚÔÂÎÊ˘ÏÈÛÙÈΤ˜ ÓfiÛÔ˘˜ (28). ∏ ÂÚÈÂÎÙÈÎfiÙËÙ· ÙˆÓ Ï·¯·ÓÈÎÒÓ Û ‚Èٷ̛Ә Ô˘ ¤¯Ô˘Ó ·ÓÙÈÔÍÂȉˆÙÈΤ˜ ȉÈfiÙËÙ˜,
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Paediatriki 2004;67:178-189
¶›Ó·Î·˜ 7. ™‡ÁÎÚÈÛË ÛˆÌ·ÙÔÌÂÙÚÈÎÒÓ, ·ÈÌ·ÙÔÏÔÁÈÎÒÓ, ‚ÈÔ¯ËÌÈÎÒÓ Î·È ‰È·ÙÚÔÊÈÎÒÓ ÛÙÔȯ›ˆÓ, ηıÒ˜ Î·È ÙÔ˘ ‰Â›ÎÙË Ê˘ÛÈ΋˜ ηٿÛÙ·Û˘ ÌÂٷ͇ Ì·ıËÙÒÓ Ì ¯·ÌËÏ‹ Î·È ˘„ËÏ‹ ‚·ıÌÔÏÔÁ›· ÛÙËÓ Îϛ̷η ÁÓˆÛÙÈ΋˜ ›‰ÔÛ˘ ÷ÌËÏ‹ ‚·ıÌÔÏÔÁ›· (≤25%) À„ËÏ‹ ‚·ıÌÔÏÔÁ›· (≥75%) p-value (n = 42) (n = 42) ª¤ÛÔ˜ fiÚÔ˜ ± Ù˘È΋ ·fiÎÏÈÛË ™¢ª™ (kg/m2) µ¿ÚÔ˜ (kg) ¶ÂÚ›ÌÂÙÚÔ˜ ̤Û˘ (cm) ¶∆∞ (ÛÙ¿‰È·) OÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË (mg/dl) ∆ÚÈÁÏ˘ÎÂÚ›‰È· (mg/dl) HDL-C (mg/dl) LDL-C (mg/dl) ∞ıËڈ̷ÙÈÎfi˜ ‰Â›ÎÙ˘ ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ ÚÔ˜ HDL ∞ÈÌÔÛÊ·ÈÚ›ÓË (g/dl) ∞ÈÌ·ÙÔÎÚ›Ù˘ (%) ª¤ÛÔ˜ fiÁÎÔ˜ ÂÚ˘ıÚÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ (fL) ∂Ó¤ÚÁÂÈ· (kcal) ∞Û‚¤ÛÙÈÔ (mg) µÈÙ·Ì›ÓË B1 (mg) µÈÙ·Ì›ÓË B12 (Ìg) °·Ï·ÎÙÔÎÔÌÈο (ÌÂÚ›‰Â˜/Ë̤ڷ) §·¯·ÓÈο Î·È ÊÚÔ‡Ù· (ÌÂÚ›‰Â˜/Ë̤ڷ)** ∫Ú¤·˜, ·˘Á¿ (ÌÂÚ›‰Â˜/Ë̤ڷ)** ¢ËÌËÙÚȷο (ÌÂÚ›‰Â˜/Ë̤ڷ)**
18,6 ± 0,6 37,1 ± 1,5 68,4 ± 1,7 2,5 ± 0,2 173,5 ± 5,2 66,0 ± 4,5 51,1 ± 2,2 109,2 ± 4,9 3,5 ± 0,3 13,2 ± 0,2 39,3 ± 0,4 81,0 ± 1,0 1603 ± 98 644 ± 69 2,9 ± 0,5 1,8 ± 0,4 1,8 ± 0,2 1,6 ± 0,4 2,4 ± 0,4 7,9 ± 0,8
19,9 ± 0,6 41,9 ± 1,5 71,7 ± 1,7 3,5 ± 0,3 176,2 ± 5,2 60,8 ± 4,5 49,3 ± 2,3 114,8 ± 4,9 4,1 ± 0,3 13,5 ± 0,2 40,3 ± 0,4 83,2 ± 1,0 1500 ± 98 826 ± 69 2,0 ± 0,5 3,1 ± 0,4 2,4 ± 0,2 3,0 ± 0,4 2,3 ± 0,4 7,6 ± 0,8
ª™* 0,029 ª™ 0,008 ª™ ª™ ª™ ª™ ª™ ª™ ª™ ª™ ª™ ª™ ª™ 0,026 ª™ 0,026 ª™ ª™
∞Ó¿Ï˘ÛË Û˘Ó‰È·Î‡Ì·ÓÛ˘ (∞¡COVA): ˆ˜ Û˘ÌÌÂÙ·‚ÏËÙ¤˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÙÔ Ê‡ÏÔ, Ë ËÏÈΛ· Î·È Ô ¢ª™ * ª™: ÛÙ·ÙÈÛÙÈÎÒ˜ ÌË ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ** 1 ÌÂÚ›‰· ÈÛÔ‰˘Ó·Ì›: Á·Ï·ÎÙÔÎÔÌÈο: 30 g Ù˘Ú› ‹ 245 g ÁÈ·Ô‡ÚÙÈ ‹ Á¿Ï· Ï·¯·ÓÈο: 100 g Ï·¯·ÓÈÎÒÓ ÊÚÔ‡Ù·: 100 g ÔÚÙÔοÏÈ ‹ 80 g Ì‹ÏÔ ‹ 120 g ‚ÂÚ›ÎÔÎÔ ‹ 200 g ÂfiÓÈ ‹ ηÚÔ‡˙È ‹ 60 g Ì·Ó¿Ó· ‹ ۇη ‹ 15 g ÍËÚ¿ ۇη ‹ ÛÙ·Ê›‰Â˜ ‰ËÌËÙÚȷο: 25 g „ˆÌ› ‹ 20 g ‰ËÌËÙÚȷο ÁÈ· ÚˆÈÓfi ‹ 50 g ̷ηÚfiÓÈ· Ì·ÁÂÈÚÂ̤ӷ ‹ 100 g ·Ú·Î¿˜ ‹ 100 g ·Ù¿Ù· ‹ 50 g ηϷÌfiÎÈ ÎÚ¤·˜-·˘Á¿: 30 g ÎÚ¤·˜ ‹ 50 g ·˘Á¿
‰ÈηÈÔÏÔÁ› ÙÔ Â‡ÚËÌ· Ù˘ ·ÚÔ‡Û·˜ ¤Ú¢ӷ˜ ÁÈ· ÙË Û˘Û¯¤ÙÈÛË Ù˘ ηٷӿψÛ˘ Ï·¯·ÓÈÎÒÓ Ì ÙËÓ Î·Ï‹ ›‰ÔÛË ÛÂ Û˘ÁÎÂÎÚÈ̤ÓÔ˘˜ Ì·ıËÛÈ·ÎÔ‡˜ ÙÔÌ›˜. ∆Ô ÔÏ˘·ÎfiÚÂÛÙÔ Ï›Ô˜ ·ÚÔ˘Û›·Û ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË Ì ÙÔÓ ÙÔ̤· Ù˘ ÚÔÛÔ¯‹˜. ™ÙÔ ·ÚÂÏıfiÓ ¤¯ÂÈ ÂÚÈÁÚ·Ê› Ë Û¯¤ÛË ÙˆÓ ÔÏ˘·ÎfiÚÂÛÙˆÓ ÏÈÒÓ Ì ÙËÓ ˆÚ›Ì·ÓÛË ÙÔ˘ ∫¡™ Û ‚Ú¤ÊË. ™Ù· ÔÏ˘·ÎfiÚÂÛÙ· ÏÈ·Ú¿ Ôͤ· ÙÔ˘ ÌËÙÚÈÎÔ‡ Á¿Ï·ÙÔ˜ ·Ô‰›‰ÂÙ·È Ë Â˘ÂÚÁÂÙÈ΋ ›‰Ú·ÛË ÙÔ˘ ıËÏ·ÛÌÔ‡ ÛÙË Ó¢ÚÔÏÔÁÈ΋ (4) Î·È ÁÓˆÛÙÈ΋ (5) ·Ó¿Ù˘ÍË ÙˆÓ ·È‰ÈÒÓ. µÚ¤ıËΠfiÙÈ ÚfiˆÚ· ‚Ú¤ÊË Ô˘ ÙÚ¿ÊËÎ·Ó ÁÈ· ¤Ó· Ì‹Ó· Ì Á¿Ï· ÂÌÏÔ˘ÙÈṲ̂ÓÔ Ì ÔÏ˘·ÎfiÚÂÛÙ· ÏÈ·Ú¿ Ôͤ·, ÛÙÔ Ù¤ÏÔ˜ ÙÔ˘ Ì‹Ó·, ‰ÂÓ ·ÚÔ˘Û›·Û·Ó ‰È·ÊÔÚ¿ ˆ˜ ÚÔ˜ ÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ ∫¡™, Û˘ÁÎÚÈÙÈο Ì ‚Ú¤ÊË Ô˘ ı‹Ï·Û·Ó (29). ∏ ÚfiÛÏË„Ë ÂÓ¤ÚÁÂÈ·˜ ·fi ÙËÓ Î·Ù·Ó¿ÏˆÛË ÚˆÙÂ˚ÓÒÓ ·ÚÔ˘Û›·Û ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË Ì fiÏÔ˘˜ ÙÔ˘˜ ÁÓˆÛÙÈÎÔ‡˜ ÙÔÌ›˜, ÏËÓ Ù˘ ÎÈÓËÙÈ΋˜ ÈηÓfiÙËÙ·˜ Î·È Ù˘ ÔÙÈÎÔÎÈÓËÙÈ΋˜ ··ÚÙ›ˆÛ˘. ™Â fi,ÙÈ ·ÊÔÚ¿ ÙȘ ÔÌ¿‰Â˜ ÙÚÔʛ̈Ó, ‚Ú¤ıËÎÂ
fiÙÈ Ë Î·Ù·Ó¿ÏˆÛË Á·Ï·ÎÙÔÎÔÌÈÎÒÓ Û˘Û¯ÂÙ›˙ÂÙ·È Ì ηϋ ÁÂÓÈ΋ ›‰ÔÛË ÛÙËÓ Îϛ̷η ηÈ, Û˘ÁÎÂÎÚÈ̤ӷ, ÛÙÔ˘˜ ÙÔÌ›˜ ÁÏÒÛÛ·˜ Î·È ÌÓ‹Ì˘. ∫·ıÒ˜ Ù· Á·Ï·ÎÙÔÎÔÌÈο ÚÔ˚fiÓÙ· Â›Ó·È ÏÔ‡ÛÈ· Û ·Û‚¤ÛÙÈÔ Î·È ‚ÈÙ·Ì›ÓË µ12, Ô˘Û›Â˜ Ô˘ - fiˆ˜ ÚԷӷʤÚıËΠ- ÂÓ‰¤¯ÂÙ·È Ó· ¤¯Ô˘Ó Û¯¤ÛË Ì ÙȘ ·ÓÒÙÂÚ˜ ÁÓˆÛÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜, Ë Û˘Û¯¤ÙÈÛË Ô˘ ·Ú·ÙËÚ‹ıËΠ‹Ù·Ó ·Ó·ÌÂÓfiÌÂÓË. ∏ ηٷӿψÛË Ï·¯·ÓÈÎÒÓ ‚Ú¤ıËΠfiÙÈ ·ÚÔ˘ÛÈ¿˙ÂÈ Û˘Û¯¤ÙÈÛË Ì ÙËÓ Î·Ï‹ ›‰ÔÛË ÛÙÔÓ ÙÔ̤· Ù˘ ÚÔÛÔ¯‹˜, fiˆ˜ ÂÍ¿ÏÏÔ˘ Î·È Ë ‚ÈÙ·Ì›ÓË ∞ Ô˘ ÂÚȤ¯ÂÙ·È Û ·˘Ù¿. ª¿ÏÈÛÙ·, ·Ú·ÙËÚ‹ıËΠfiÙÈ ÔÈ Ì·ıËÙ¤˜ Ì ÙËÓ ˘„ËÏfiÙÂÚË Â›‰ÔÛË Î·Ù·Ó·ÏÒÓÔ˘Ó ÌÂÁ·Ï‡ÙÂÚ˜ ÔÛfiÙËÙ˜ Ï·¯·ÓÈÎÒÓ. O Û¯ÔÏÈÎfi˜ ‚·ıÌfi˜ ·ÚÔ˘Û›·Û ıÂÙÈΤ˜ Û˘Û¯ÂÙ›ÛÂȘ Ì ٷ ›‰· ÙˆÓ ·ÈÌ·ÙÔÏÔÁÈÎÒÓ ‰ÂÈÎÙÒÓ, ÙÔ˘ ·Û‚ÂÛÙ›Ô˘, ÙˆÓ ÚˆÙÂ˚ÓÒÓ Î·È Ì ÙÔÓ ·ıËڈ̷ÙÈÎfi ‰Â›ÎÙË (ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË ÚÔ˜ HDL), ηٷ‰ÂÈÎÓ‡ÔÓÙ·˜ fiÙÈ ÔÈ ·ÈÌ·ÙÔÏÔÁÈÎÔ› Î·È ‰È·ÙÚÔÊÈÎÔ› ·Ú¿ÁÔÓÙ˜ ÂËÚ¿˙Ô˘Ó ÙË ‚·ıÌÔÏÔÁ›·. ¶ÚfiÛÊ·ÙÔ ¿ÚıÚÔ ·Ó·Ê¤ÚÂÈ fiÙÈ ÔÈ Û¯ÔÏÈÎÔ› ‚·ıÌÔ› ÙˆÓ Ì·ıËÙÒÓ Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì ÙȘ ‰È·ÙÚÔÊÈΤ˜
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Û˘Ó‹ıÂȘ Î·È Î˘Ú›ˆ˜ Ì ÙËÓ Ù·ÎÙÈ΋ ηٷӿψÛË ÙÚÈÒÓ ÁÂ˘Ì¿ÙˆÓ ËÌÂÚËÛ›ˆ˜ (30). ÕÏϘ ¤Ú¢Ó˜ Û˘Û¯ÂÙ›˙Ô˘Ó ÙËÓ Î·Ù·Ó¿ÏˆÛË ÚˆÈÓÔ‡ Á‡̷ÙÔ˜ Ì ÙÔÓ Û¯ÔÏÈÎfi ‚·ıÌfi. ∞ÚÓËÙÈ΋ Û˘Û¯¤ÙÈÛË ÂÓÙÔ›ÛÙËΠÌÂٷ͇ Ù˘ ‚ÈÙ·Ì›Ó˘ µ1 Î·È ÙÔ˘ Û¯ÔÏÈÎÔ‡ ‚·ıÌÔ‡. ¶·Ú·ÙËÚ‹ıËÎÂ, ·ÎfiÌË, fiÙÈ Ù· ÎÔÚ›ÙÛÈ· ÂÌÊ·Ó›˙Ô˘Ó ˘„ËÏfiÙÂÚË ‚·ıÌÔÏÔÁ›· ·fi Ù· ·ÁfiÚÈ·, ÂÓÒ ÔÈ ‚·ıÌÔ› ÌÂÈÒÓÔÓÙ·È Î·ıÒ˜ ·˘Í¿ÓÂÈ Ë ËÏÈΛ·. ∞˘Ùfi, ÛÙËÓ ·ÚÔ‡Û· ¤Ú¢ӷ, Èı·ÓfiÓ ÔÊ›ÏÂÙ·È ÛÙÔ ÌÈÎÚfi Ê¿ÛÌ· ËÏÈÎÈÒÓ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜. O ‰Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ Ê·›ÓÂÙ·È Ó· Âȉڿ ÛÙË Û˘ÓÔÏÈ΋ ‚·ıÌÔÏÔÁ›· Ù˘ Îϛ̷η˜ Î·È ÛÙÔÓ ÙÔ̤· Ù˘ ÌÓ‹Ì˘. øÛÙfiÛÔ, Ë ·Ó¿Ï˘ÛË Û˘Ó‰È·Î‡Ì·ÓÛ˘ ¤‰ÂÈÍ fiÙÈ ÔÈ Ì·ıËÙ¤˜ Ì ˘„ËÏ‹ ‚·ıÌÔÏÔÁ›· ÛÙËÓ Îϛ̷η ‰ÂÓ ‰È¤ÊÂÚ·Ó ·fi ·˘ÙÔ‡˜ Ì ¯·ÌËÏ‹ ‚·ıÌÔÏÔÁ›· ˆ˜ ÚÔ˜ ÙÔÓ ‰Â›ÎÙË Ì¿˙·˜ ÛÒÌ·ÙÔ˜. ∞ÓÙ›ıÂÙ·, ÔÈ ÚÒÙÔÈ, ›¯·Ó ÌÂÁ·Ï‡ÙÂÚÔ ‚¿ÚÔ˜ ·fi ÙÔ˘˜ ‰Â‡ÙÂÚÔ˘˜, ‡ÚËÌ· Ô˘ ·ÚÔ˘ÛÈ¿˙ÂÈ ÂӉȷʤÚÔÓ Î·È ¯ÚÂÈ¿˙ÂÙ·È ‰ÈÂÚ‡ÓËÛË. ∂ӉȷʤÚÔÓ ·ÚÔ˘ÛÈ¿˙ÂÈ ÙÔ Â‡ÚËÌ·, Û‡Ìʈӷ Ì ÙÔ ÔÔ›Ô Ë Ê˘ÛÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· Û˘Û¯ÂÙ›˙ÂÙ·È Ì ÙË ÁÏÒÛÛ·, ÙËÓ ÔÙÈÎÔÎÈÓËÙÈ΋ ··ÚÙ›ˆÛË, ÙË Û˘ÌÂÚÈÊÔÚ¿, ÙË ÌÓ‹ÌË, ·ÏÏ¿ Î·È Û˘ÓÔÏÈο Ì ÙË Ì·ıËÛȷ΋ ›‰ÔÛË, fiˆ˜ ·˘Ù‹ ÂÎÙÈÌ¿Ù·È ·fi ÙËÓ Îϛ̷η Ì·ıËÛȷ΋˜ ›‰ÔÛ˘. ∆Ô Â‡ÚËÌ· ·˘Ùfi Û˘ÌʈÓ› Ì ÚfiÛÊ·ÙË ¤Ú¢ӷ Ô˘ ‰ÈÂÍ‹¯ıË ÛÙÔÓ ∫·Ó·‰¿, Ì ÛÎÔfi ÙË ‰ÈÂÚ‡ÓËÛË Ù˘ Û¯¤Û˘ Ù˘ ΛÓËÛ˘ Ì ÙËÓ „˘¯ÔÏÔÁÈ΋ ·Ó¿Ù˘ÍË. OÈ Û˘ÁÁÚ·Ê›˜ ·Ú·ÙËÚÔ‡Ó fiÙÈ Ë ÎÔڇʈÛË Ù˘ ÎÈÓËÙÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÛÙËÓ ËÏÈΛ· ÙˆÓ 7-9 ÂÙÒÓ, ‰ËÏ·‰‹ ÛÙËÓ ÂÚ›Ô‰Ô Ù˘ Û˘ÁÎÂÎÚÈ̤Ó˘ ÛΤ„˘, ηٿ ÙÔÓ Piaget. ÀÔÛÙËÚ›˙Ô˘Ó, ÏÔÈfiÓ, fiÙÈ Ù· ·È‰È¿ ¯ÚËÛÈÌÔÔÈÔ‡Ó ÙËÓ Î›ÓËÛË ÁÈ· ÙËÓ ·fiÎÙËÛË ÁÓˆÛÙÈÎÒÓ ÂÌÂÈÚÈÒÓ, ÙË Ú‡ıÌÈÛË ÙÔ˘ ÂȤ‰Ô˘ ‰È¤ÁÂÚÛ‹˜ ÙÔ˘˜ Î·È ÙËÓ ¤ÎÊÚ·ÛË ÙˆÓ Û˘Ó·ÈÛıËÌ¿ÙˆÓ ÙÔ˘˜, fiÛÔ Â›Ó·È ·ÓÒÚÈÌ· ÁÓˆÛÙÈο. ∏ ÎÈÓËÙÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· ÌÂÈÒÓÂÙ·È Î·Ù¿ ÙËÓ ÂÊ˂›·, ÛËÌ·ÙÔ‰ÔÙÒÓÙ·˜ Ì›· ÛÙÚÔÊ‹ ÚÔ˜ ÙËÓ ·ÊËÚË̤ÓË ÛΤ„Ë, ÙË Ú‡ıÌÈÛË ÙÔ˘ ÂȤ‰Ô˘ ‰È¤ÁÂÚÛ˘ ̤۷ ·fi Û˘Ì‚ÔÏÈΤ˜ ‰È·‰Èηۛ˜ Î·È ÙË ÁÓˆÛÙÈ΋ ¤ÎÊÚ·ÛË ÙÔ˘ Û˘Ó·ÈÛı‹Ì·ÙÔ˜ ̤۷ ·fi ÙÔÓ ÏfiÁÔ. ∞ÎfiÌË, ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ Ë Î›ÓËÛË ‚ÂÏÙÈÒÓÂÈ ÙË Û¯ÔÏÈ΋ ›‰ÔÛË Î·È ÚÔÙ›ÓÔ˘Ó ÙËÓ ÂÓۈ̿وۋ Ù˘ ÛÙÔ ÚfiÁÚ·ÌÌ· ‰È‰·Ûηϛ·˜, ÙfiÛÔ ÛÙ· ÚÒÙ· fiÛÔ Î·È ÛÙ· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· Ù˘ ÊÔ›ÙËÛ˘ ÛÙÔ ¢ËÌÔÙÈÎfi. ™Â fi,ÙÈ ·ÊÔÚ¿ ÙË Û¯¤ÛË Î›ÓËÛ˘-Û˘ÌÂÚÈÊÔÚ¿˜, ÔÈ Û˘ÁÁÚ·Ê›˜ ÂÈÛËÌ·›ÓÔ˘Ó fiÙÈ, ·fi ÙË ‚ÚÂÊÈ΋ ËÏÈΛ· ˆ˜ ÙËÓ ÂÓËÏÈΛˆÛË, Ë ÎÔÈÓˆÓÈ΋ Û˘ÌÂÚÈÊÔÚ¿ ‰È·ÌÔÚÊÒÓÂÙ·È Û ÌÂÁ¿ÏÔ ‚·ıÌfi ·fi ÙÔ Â›Â‰Ô ÎÈÓËÙÈÎfiÙËÙ·˜ ÙˆÓ ·ÙfïÓ, ηıÒ˜ ̤۷ ·fi ÙËÓ Î›ÓËÛË ÂÍÂÚ¢ÓÔ‡Ó ÙÔ ÂÚÈ‚¿ÏÏÔÓ ÙÔ˘˜ Î·È ÂÌϤÎÔÓÙ·È Û ÎÔÈÓˆÓÈΤ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜, fiˆ˜ ÙÔ ·È¯Ó›‰È.
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π‰È·›ÙÂÚ· ÂӉȷʤÚÔ˘Û· Â›Ó·È Ë ¿Ô„‹ ÙÔ˘˜ ÁÈ· ÙË Û¯¤ÛË Ù˘ ΛÓËÛ˘ Ì ÙËÓ ÚÔÛÔ¯‹, Û¯¤ÛË Ô˘ ÛÙËÓ ·ÚÔ‡Û· ¤Ú¢ӷ ‰ÂÓ ÂÓÙÔ›ÛÙËÎÂ. ÀÔÛÙËÚ›˙Ô˘Ó fiÙÈ Û ÂÚÈÙÒÛÂȘ ¤ÓÙÔÓ˘ ÎÈÓËÙÈÎfiÙËÙ·˜, fiˆ˜ Â›Ó·È ÔÈ ·ıÏËÙÈΤ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜, ÙÔ ¿ÙÔÌÔ ·Ó·Áο˙ÂÙ·È Ó· ·ÊÈÂÚÒÓÂÈ ÌÈÎÚ‹˜ ‰È¿ÚÎÂÈ·˜ ÚÔÛÔ¯‹ Û ÔÏÏ¿ ÂÚÂı›ÛÌ·Ù· Ù·˘Ùfi¯ÚÔÓ·. ∏ Û˘ÌÂÚÈÊÔÚ¿ ·˘Ù‹ ¯·Ú·ÎÙËÚ›˙ÂÈ Î·È Ù· ·È‰È¿ ÙËÓ ÂÚ›Ô‰Ô Ô˘ Ë ÎÈÓËÙÈÎfiÙËÙ¿ ÙÔ˘˜ ·˘Í¿ÓÂÈ, ‰›ÓÔÓÙ·˜ Û ¤Ó·Ó ÂÓ‹ÏÈÎÔ ÙËÓ ÂÓÙ‡ˆÛË fiÙÈ Â›Ó·È ·ÚfiÛ¯ٷ (31). ¶·Ú¿ ÙȘ ÔÏϷϤ˜ Û˘Û¯ÂÙ›ÛÂȘ Ô˘ ÂÓÙÔ›ÛÙËηÓ, ÌfiÓÔ ÙÚÂȘ ·Ú¿ÁÔÓÙ˜ ‚Ú¤ıËΠfiÙÈ ÌÔÚÔ‡Ó Ó· ‰È·ÎÚ›ÓÔ˘Ó ÙÔ ‰Â›ÁÌ· Û ˘Ô-ÔÌ¿‰Â˜ Ì ‚¿ÛË Ù· ·ÔÙÂϤÛÌ·Ù· ÛÙËÓ Îϛ̷η ›‰ÔÛ˘: ÙÔ ‚¿ÚÔ˜, Ë ÚfiÛÏË„Ë ‚ÈÙ·Ì›Ó˘ µ12 Î·È Ë Î·Ù·Ó¿ÏˆÛË Ï·¯·ÓÈÎÒÓ Î·È ÊÚÔ‡ÙˆÓ. ∂›Ó·È ۷ʤ˜ fiÙÈ ÔÈ ·Ó·Ù˘ÍȷΤ˜ ‰ÂÍÈfiÙËÙ˜ ÛÙÔÓ ¿ÓıÚˆÔ ‰ÂÓ Â›Ó·È ·ÓÂÍ¿ÚÙËÙ˜ ·fi ÙÔ ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎfi ÂÚÈ‚¿ÏÏÔÓ (2,8,10,11,32). ¶·Ú’ fiÏÔ, ÏÔÈfiÓ, Ô˘ ÔÈ ‚Ï¿‚˜ ÏfiÁˆ Ù˘ η΋˜ ‰È·ÙÚÔÊ‹˜ - fiÙ·Ó Ï·Ì‚¿ÓÔ˘Ó ¯ÒÚ· ηٿ ÙȘ ÎÚ›ÛÈ̘ ÂÚÈfi‰Ô˘˜ Ù˘ ÂͤÏÈ͢ - Ô‰ËÁÔ‡Ó Û ·Ó·Ù˘ÍȷΤ˜ ηı˘ÛÙÂÚ‹ÛÂȘ, ÁÂÓÈο Â›Ó·È ·Ó·ÛÙÚ¤„È̘, ÂÊfiÛÔÓ ÂÍ·ÛÊ·ÏÈÛÙ› ¤Ó· ¢ÓÔ˚Îfi ÂÚÈ‚¿ÏÏÔÓ Î·È Û¯Â‰È·ÛÙ› Ë Î·Ù¿ÏÏËÏË ·Ú¤Ì‚·ÛË (11). ™‡Ìʈӷ Ì ÚfiÛÊ·ÙÔ ¿ÚıÚÔ, Û ÏËı˘ÛÌÔ‡˜ Ô˘ ‚Ú›ÛÎÔÓÙ·È Û ‰˘ÛÌÂÓ›˜ ÎÔÈÓˆÓÈΤ˜ Û˘Óı‹Î˜, ··ÈÙÂ›Ù·È ·Ú¤Ì‚·ÛË ÛÙËÓ ËÏÈΛ· ÙˆÓ 18-24 ÌËÓÒÓ, ÂÓÒ ÌÂÙ¿ ÙÔ˘˜ 24 Ì‹Ó˜ Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ¿ Ù˘ ÂÍ·ÚÙ¿Ù·È ·fi ÙÔ Â›‰Ô˜ (‰È·ÙÚÔÊÈ΋, È·ÙÚÈ΋, ÂÎ·È‰Â˘ÙÈ΋) Î·È ÙË ‰È¿ÚÎÂÈ¿ Ù˘ (2). ™˘Ó‹ıˆ˜, Ë ·Ú¤Ì‚·ÛË ÂÚÈÏ·Ì‚¿ÓÂÈ ¤Ó· ‰È·ÈÙÔÏfiÁÈÔ ÚÔÛ·ÚÌÔṲ̂ÓÔ ÛÙȘ ·Ó¿ÁΘ ÙÔ˘ ·ÙfiÌÔ˘, ÛˆÛÙ‹ È·ÙÚÈ΋ ÂÚ›ı·Ï„Ë Î·È, Ù·˘Ùfi¯ÚÔÓ·, Û˘ÌÌÂÙÔ¯‹ Û ÚÔÁÚ¿ÌÌ·Ù· Âη›‰Â˘Û˘ ÁÔÓ¤ˆÓ Î·È ·È‰ÈÒÓ (2). ŒÚ¢ӷ Ô˘ ÌÂϤÙËÛ ÙȘ ÛÙ¿ÛÂȘ Ì·ıËÙÒÓ ËÏÈΛ·˜ 7-17 ÂÙÒÓ ˆ˜ ÚÔ˜ ÙË ‰È·ÙÚÔÊ‹, ·ÔÎ¿Ï˘„ fiÙÈ ÔÈ ›‰ÈÔÈ ÔÈ Ì·ıËÙ¤˜ ·Ó·ÁÓˆÚ›˙Ô˘Ó fiÙÈ Ë ˘ÁÈÂÈÓ‹ ‰È·ÙÚÔÊ‹ Î·È Ë Ê˘ÛÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· Ô‰ËÁÔ‡Ó Û ‚ÂÏÙ›ˆÛË ÙˆÓ ·Ó·Ù˘ÍÈ·ÎÒÓ ÈηÓÔÙ‹ÙˆÓ Î·È Ù˘ Ê˘ÛÈ΋˜ ηٿÛÙ·Û˘, ηıÒ˜ Î·È Û „˘¯ÔÏÔÁÈο Î·È ÎÔÈÓˆÓÈο ÔʤÏË. ¶ÈÛÙÂ‡Ô˘Ó fiÙÈ ÁÈ· Ó· ÂÈÙ‡¯Ô˘Ó ÛˆÛÙ‹ ‰È·ÙÚÔÊ‹ Î·È ¿ÛÎËÛË ¯ÚÂÈ¿˙ÔÓÙ·È, ÌÂٷ͇ ¿ÏψÓ, ˘ÔÛÙ‹ÚÈÍË ·fi ÁÔÓ›˜ Î·È ÂÎ·È‰Â˘ÙÈÎÔ‡˜ Î·È ÂÓË̤ڈÛË (33). ∫·ıÒ˜ Ë Î·Î‹ ‰È·ÙÚÔÊ‹ Ì·ÎÚÔ¯ÚfiÓÈ· Âȉڿ ÛÙËÓ ÂÎ·È‰Â˘ÙÈ΋ Î·È Â·ÁÁÂÏÌ·ÙÈ΋ ÔÚ›·, ÙËÓ „˘¯È΋ ˘Á›· Î·È ÙȘ ÎÔÈÓˆÓÈΤ˜ Û¯¤ÛÂȘ ÙÔ˘ ·ÙfiÌÔ˘, Ô Û¯Â‰È·ÛÌfi˜ ÙfiÛÔ ÚÔÁÚ·ÌÌ¿ÙˆÓ ÚfiÏ˄˘ fiÛÔ Î·È ÚÔÁÚ·ÌÌ¿ÙˆÓ ·Ú¤Ì‚·Û˘ ÁÈ· ·È‰È¿ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜, ηı›ÛÙ·Ù·È ··Ú·›ÙËÙÔ˜.
May-June 04 chris new
19-07-04
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¶·È‰È·ÙÚÈ΋ 2004;67:178-189
Paediatriki 2004;67:178-189
¶·Ú¿ÚÙËÌ·. ∫ϛ̷η Ì·ıËÛȷ΋˜ ›‰ÔÛ˘ ∞Á·ËÙ¤ ‰¿ÛηÏÂ/‰·ÛοϷ. ∑ËÙ¿Ì ӷ ÂÓÙÔ›ÛÔ˘Ì ·È‰È¿ Ô˘ ¤¯Ô˘Ó ‰˘ÛÎÔϛ˜ ÛÙÔ Û¯ÔÏ›Ô, ·ÓÂÍ¿ÚÙËÙ· ÙÔ˘ Â¿Ó ¤¯Ô˘Ó Î·È È‰È·›ÙÂÚ· ÚÔÛfiÓÙ·. £· ‚ÔËıËıԇ̠ÛÙÔ Ó· ÂÓÙÔ›ÛÔ˘Ì ·Èٛ˜ Î·È ·˘Ùfi ı· ‚ÔËı‹ÛÂÈ ÔÏÏ¿ ·È‰È¿. ∞˘Ùfi˜ Â›Ó·È Ô ÛÎÔfi˜ ÙˆÓ ÂÚˆÙ‹ÛÂˆÓ Ô˘ ·ÎÔÏÔ˘ıÔ‡Ó. ™¯ÔÏ›Ô: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ∆¿ÍË: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ∆ËϤʈÓÔ: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OÓÔÌ·ÙÂÒÓ˘ÌÔ Ì·ıËÙ‹: . . . . . . . . . . . . . . . . . . . . . . . . . . µ·ıÌÔ› (1-10): ª·ıËÌ·ÙÈο: . . . . . . . . . . . . . . . . . . . . . . . . °ÏÒÛÛ·: . . . . . . . . . . . . . . . . .πÛÙÔÚ›·: . . . . . . . . . . . . . . . Œ¯ÂÈ È‰È·›ÙÂÚ· ηϋ ›‰ÔÛË Û οÔÈÔ Ì¿ıËÌ·; ™Â ÔÈÔ; . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (µ·ıÌÔÏÔÁ‹ÛÙ ÛËÌÂÈÒÓÔÓÙ·˜ à ÛÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë ı¤ÛË ˆ˜ ÂÍ‹˜: 3=Ôχ ηÎfi, 2=ÏÈÁfiÙÂÚÔ Î·Îfi, 1=‡ÔÙÔ, 0=ηÏfi) ∞ÎÔ˘ÛÙÈ΋ ·ÓÙ›ÏË„Ë 0 1. Œ¯ÂÈ ÙËÓ ÈηÓfiÙËÙ· Ó· ·ÎÔÏÔ˘ı‹ÛÂÈ ÚÔÊÔÚÈΤ˜ Ô‰ËÁ›Â˜; 2. ∞ÓÙÈÏ·Ì‚¿ÓÂÙ·È ÙË Û˘˙‹ÙËÛË ÛÙË Û¯ÔÏÈ΋ Ù¿ÍË; 3. Œ¯ÂÈ ÙËÓ ÈηÓfiÙËÙ· Ó· Û˘ÁÎÚ·Ù‹ÛÂÈ fiÙÈ ·ÎÔ‡ÂÈ ÛÙÔ Ì¿ıËÌ·; 4. ∞ÓÙÈÏ·Ì‚¿ÓÂÙ·È ÙË ÛËÌ·Û›· ÙˆÓ Ï¤ÍˆÓ; ¶ÚÔÊÔÚÈÎfi˜ ÏfiÁÔ˜ 0 5. ∏ ¤ÎÊÚ·Û‹ ÙÔ˘/Ù˘ Â›Ó·È Ï‹Ú˘ Î·È ·ÎÚÈ‚‹˜; 6. ÃÚËÛÈÌÔÔÈ› ÏÔ‡ÛÈÔ ÏÂÍÈÏfiÁÈÔ; 7. Œ¯ÂÈ ÙËÓ ÈηÓfiÙËÙ· Ó· ı˘Ì¿Ù·È ϤÍÂȘ; 8. Œ¯ÂÈ ÙËÓ ÈηÓfiÙËÙ· Ó· Û˘Û¯ÂÙ›˙ÂÈ ÂÌÂÈڛ˜; 9. Œ¯ÂÈ ÙËÓ ÈηÓfiÙËÙ· Ó· ‰È·ÌÔÚÊÒÓÂÈ È‰¤Â˜; ¶ÚÔÛ·Ó·ÙÔÏÈÛÌfi˜ 0 10. ¶ÚÔÛ·Ó·ÙÔÏ›˙ÂÙ·È ÁÚ‹ÁÔÚ·; 11. ¶ÚÔÛ·Ó·ÙÔÏ›˙ÂÙ·È Â‡ÎÔÏ· ÛÙÔÓ ¯ÒÚÔ; 12. ∂ÎÙÈÌ¿ ‡ÎÔÏ· ‰È¿ÊÔÚ· ÌÂÁ¤ıË, .¯. ·fiÛÙ·ÛË; 13. ª·ı·›ÓÂÈ Â‡ÎÔÏ· ηÙ¢ı‡ÓÛÂȘ; ™˘ÌÂÚÈÊÔÚ¿: ÙÔÓ/ÙË ‰È·ÎÚ›ÓÂÈ 0 14. ™˘ÓÂÚÁ·Û›· 15. ¶ÚÔÛÔ¯‹ 16. πηÓfiÙËÙ· ÁÈ· ÔÚÁ¿ÓˆÛË 17. πηÓfiÙËÙ· Ó· ·ÓÙÂÂͤگÂÙ·È Û Ӥ˜ ηٷÛÙ¿ÛÂȘ 18. ∫ÔÈÓˆÓÈ΋ ·Ô‰Ô¯‹ (.¯. ·fi ÙÔ˘˜ Û˘ÌÌ·ıËÙ¤˜ ÙÔ˘/Ù˘) 19. ∞Ó·Ï·Ì‚¿ÓÂÈ Ì ˘Â˘ı˘ÓfiÙËÙ· ˘Ô¯ÚÂÒÛÂȘ; 20. ∂ÎÙÂÏ› fiÙÈ ÙÔ˘/Ù˘ ·Ó·Ù›ıÂÙ·È; 21. §ÂÙfiÙËÙ· ÛÙË Û˘ÌÂÚÈÊÔÚ¿ ∫ÈÓËÙÈ΋ Û˘ÌÂÚÈÊÔÚ¿ 0 22. OÈ ÎÈÓ‹ÛÂȘ ÙÔ˘/Ù˘ Â›Ó·È Û˘ÓÙÔÓÈṲ̂Ó˜; 23. ∆ÔÓ/ÙË ‰È·ÎÚ›ÓÂÈ ÈÛÔÚÚÔ›· ÛÙÔ ‚¿‰ÈÛÌ· Î·È ÙÔ ÙÚ¤ÍÈÌÔ; 24. ∆ÔÓ/ÙË ‰È·ÎÚ›ÓÂÈ ‰ÂÍÈÔÙ¯ӛ·; 25. Œ¯ÂÈ ‰˘ÛÎÔÏ›· ÛÙË ÁÚ·Ê‹ ÁÚ·ÌÌ¿ÙˆÓ Î·È ·ÚÈıÌÒÓ, ·Ú·ÙËÚÂ›Ù·È Î·ÎÔÁÚ·Ê›·;
1 2 3
1 2 3
1 2 3
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26. ¢˘ÛÎÔχÂÙ·È ÛÙË ˙ˆÁÚ·ÊÈ΋; 27. ∂›Ó·È “¿ÙÛ·ÏÔ˜/Ë”, ‰˘ÛÎÔχÂÙ·È Ó· Ù·ÎÙÔÔÈ‹ÛÂÈ Ù· Ú¿ÁÌ·Ù¿ ÙÔ˘/Ù˘; 28. ∆Ô˘/Ù˘ ¤ÊÙÔ˘Ó Û˘¯Ó¿ Ú¿ÁÌ·Ù·; 29. ¢ÂÓ ÌÔÚ› Ó· ÁÚ¿„ÂÈ Ù· ÁÚ¿ÌÌ·Ù· ‹ ÙÔ˘˜ ·ÚÈıÌÔ‡˜ Û ÂÚÈÔÚÈṲ̂ÓÔ ¯ÒÚÔ (ÁÚ¿ÊÂÈ ¿ÓÙ· ÌÂÁ¿ÏÔ˘˜ ·ÚÈıÌÔ‡˜); °ÏˆÛÛÈο 0 30. ¢È·‚¿˙ÂÈ Ì ¢¯¤ÚÂÈ·, ¯ˆÚ›˜ Ï¿ıË; 31. ™ÙËÓ ÚÔÊÔÚÈ΋ ¤ÎÊÚ·ÛË, ¯ÚËÛÈÌÔÔÈ› ÔÏÔÎÏËڈ̤Ó˜ ÚÔÙ¿ÛÂȘ ¯ˆÚ›˜ Ï¿ıË; 32. ∂›‰ÔÛË ÛÙËÓ ¤ÎıÂÛË 33. •Â¯ˆÚ›˙ÂÈ ˘ÔΛÌÂÓÔ, Ú‹Ì·, ·ÓÙÈΛÌÂÓÔ; 34. •Â¯ˆÚ›˙ÂÈ ÎÏÈÙ¿ Î·È ¿ÎÏÈÙ· ̤ÚË ÙÔ˘ ÏfiÁÔ˘; 35. ∫¿ÓÂÈ ÔÚıÔÁÚ·ÊÈο Ï¿ıË ÛÙȘ ηٷϋÍÂȘ ÙˆÓ Ï¤ÍˆÓ; ¢È¿Û·ÛË ÚÔÛÔ¯‹˜ 0 36. ¢˘ÛÎÔχÂÙ·È ÛÙË ‰È·Ù‹ÚËÛË Ù˘ ÚÔÛÔ¯‹˜ ÙÔ˘/Ù˘ ÛÙ· Ì·ı‹Ì·Ù· ‹ Û ‰È¿ÊÔÚ· ÛÙ¿‰È· Â›Ï˘Û˘ ÚÔ‚ÏËÌ¿ÙˆÓ; 37. ¢˘ÛÎÔχÂÙ·È ÛÙË ‰È·Ù‹ÚËÛË Ù˘ ÚÔÛÔ¯‹˜ Û ÛÔ‚·Ú¤˜ ¯ÚÔÓÈΤ˜ ÛÙÈÁ̤˜ (fiÙ·Ó Ô ‰¿ÛηÏÔ˜ ‰›ÓÂÈ Ô‰ËÁ›Â˜ ÁÈ· ÙÔ Ì¿ıËÌ· ‹ ÁÈ· ÙËÓ Â›Ï˘ÛË ÚÔ‚Ï‹Ì·ÙÔ˜); ¢È·Ù·Ú·¯¤˜ ÔÙÈÎÔÎÈÓËÙÈΤ˜ 0 38. ¢˘ÛÎÔχÂÙ·È, ¯ˆÚÔÙ·ÍÈο, ÛÙÔ Ê‡ÏÏÔ ¯·ÚÙÈÔ‡ Ô˘ ÂÚÁ¿˙ÂÙ·È; 39. ¢˘ÛÎÔχÂÙ·È ÛÂ Û˘ÌÌÂÙڛ˜ ‹ ·Ó·ÛÙÚÔʤ˜ (‰È¿ÎÚÈÛË ÌÂٷ͇ 6 Î·È 9, 2 Î·È 5, 17 Î·È 71, Â Î·È 3, Ú Î·È 9 Î.Ï.); 40. Œ¯ÂÈ ‰˘ÛÎÔϛ˜ Ì ٷ ÓÔÌ›ÛÌ·Ù·, Ù· ۇ̂ÔÏ· ڿ͈Ó, ÙÔ˘˜ ‰Â›ÎÙ˜ ÚÔÏÔÁÈÔ‡; 41. ¢˘ÛÎÔχÂÙ·È Ó· ÁÚ¿„ÂÈ ÛÙÔ ¯·ÚÙ›, Û ¢ı›· ÁÚ·ÌÌ‹; 42. ¢˘ÛÎÔχÂÙ·È Ôχ Û ̷ıËÌ·ÙÈο ÚÔ‚Ï‹Ì·Ù·, fiÔ˘ Ú¤ÂÈ Ó· ÂÚÁ·ÛÙ› ÛÙÔÓ ¯ÒÚÔ, .¯. ÚÔ‚Ï‹Ì·Ù· Ô˘ ··ÈÙÔ‡Ó Û˘Û¯¤ÙÈÛË ÙˆÓ: ¿Óˆ-οو Î·È ·ÚÈÛÙÂÚ¿-‰ÂÍÈ¿ (fiˆ˜ οıÂÙË ÚfiÛıÂÛË), Ù·ÎÙÔÔ›ËÛË ·ÚÈıÌÒÓ Û ÔÌ¿‰Â˜, ÛÙÔȯÂÈÔı¤ÙËÛË ·˘ÙÒÓ; 43. ¢˘ÛÎÔχÂÙ·È Ó· ÁÚ¿„ÂÈ ¤Ó·Ó Ì·ÎÚ‡ ·ÚÈıÌfi ‹ Ì›· ÌÂÁ¿ÏË Ï¤ÍË Û ¢ı›· ÁÚ·ÌÌ‹; ¢˘ÛÎÔϛ˜ ÛÙËÓ ·ÎÔ˘ÛÙÈ΋ ÂÂÍÂÚÁ·Û›· 0 44. ¢˘ÛÎÔχÂÙ·È ÛÙÔ Ó· οÓÂÈ ÚÔÊÔÚÈΤ˜ ·Û΋ÛÂȘ; 45. ¢ÂÓ ÌÔÚ› Ó· Û˘Ó¯›ÛÂÈ ÙÔ Ì¤ÙÚËÌ· Û ̛· ·ÎÔÏÔ˘ı›·; ∞‰˘Ó·Ì›Â˜ ÌÓ‹Ì˘ 0 46. ¢ÂÓ ÌÔÚ› Ó· Û˘ÁÎÚ·Ù‹ÛÂÈ Ó¤· ÏËÚÔÊÔÚ›· ‹, ȉȷ›ÙÂÚ·, Ì·ıËÌ·ÙÈο ÓÔ‡ÌÂÚ·; 47. •Â¯Ó¿ ÛÙ¿‰È· Û ̷ıËÌ·ÙÈΤ˜ Ú¿ÍÂȘ; 48. ∏ ·fi‰ÔÛ‹ ÙÔ˘/Ù˘ Â›Ó·È ÊÙˆ¯‹ ÛÙËÓ Â·Ó¿ÏË„Ë Ì·ıËÌ¿ÙˆÓ ‹ ÙËÓ ·ÓÙ›ÏË„Ë ÌÈÎÙÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ; 49. ¢˘ÛÎÔχÂÙ·È Ó· ÂÈ ÙËÓ ÒÚ·; 50. ¢˘ÛÎÔχÂÙ·È Ó· χÛÂÈ ÚÔÊÔÚÈο ÚÔ‚Ï‹Ì·Ù· Ô˘ ¤¯Ô˘Ó ÔÏÏ¿ ÛÙ¿‰È·;
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∂˘¯·ÚÈÛٛ˜ ∏ ÌÂϤÙË ¯ÚËÌ·ÙÔ‰ÔÙ‹ıËΠ·fi ÙËÓ ÂÙ·ÈÚ›· Kellog’s Î·È ÙÔ ÀÔ˘ÚÁÂ›Ô ∂ıÓÈ΋˜ ¶·È‰Â›·˜ Î·È £ÚËÛÎÂ˘Ì¿ÙˆÓ. ∂˘¯·ÚÈÛÙԇ̠ıÂÚÌ¿ ÙËÓ ÂÚ¢ÓËÙÈ΋ ÔÌ¿‰· Ù˘ ∫ÏÈÓÈ΋˜ ¶ÚÔÏËÙÈ΋˜ π·ÙÚÈ΋˜ Î·È ¢È·ÙÚÔÊ‹˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘ ÁÈ· ÙË Û˘ÓÂÚÁ·Û›· Î·È ÙËÓ ÔχÙÈÌË ‚Ô‹ıÂÈ¿ Ù˘: ºÚfiÛˆ ªÂÚ‚·Ó¿ÎË, ƒ¤Ó· ª¿ÚηÙ˙Ë, ™ÔÊ›· ºÏÔ˘Ú‹, ª˘ÚˆÓ›· §·ÓÙ˙Ô˘Ú¿ÎË, ∂ϤÓË §ÔÁÔı¤ÙË, °ÂˆÚÁ›· ¶ÂÚ‚ÔÏ·Ú¿ÎË, ∫·ÙÂÚ›Ó· ™·ÚÚ‹, ∂ÈÚ‹ÓË ™ËÊ¿ÎË, πˆ¿ÓÓ· ∞ÔÛÙÔÏ¿ÎË, ÃÚ‹ÛÙÔ Ã·Ù˙‹ Î·È °È¿ÓÓË ª·ÓÈfi.
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15. Southon S, Wright AJ, Finglas PM, Bailey AL, Loughridge JM, Walker AD. Dietary intake and micronutrient status of adolescents: effect of vitamin and trace element supplementation on indices of status and performance in tests of verbal and non-verbal intelligence. Br J Nutr 1994;71:897-918. 16. Benton D. Micro-nutrient supplementation and the intelligence of children. Neurosci Biobehav Rev 2001;25:297-309. 17. Moschandreas JA, Kafatos A. Calcium intake in relation to diet and health indicators in Cretan primary and high school pupils, Greece. Int J Vitam Nutr Res 2002;72:264277. 18. ∫·Ê¿ÙÔ˜ ∞, ª·ÓÈfi˜ °, ÷Ù˙‹˜ Ã, ªÔÛ¯·Ó‰Ú¤· π, ª·ÏˆÌÂÓ¿ÎË ∂, ∞ı·Ó·ÛfiÔ˘ÏÔ˜ ¢ Î·È Û˘Ó. ∞ÍÈÔÏfiÁËÛË ÚÔÁÚ¿ÌÌ·ÙÔ˜ “∞ÁˆÁ‹ ÀÁ›·˜” ÌÂÙ¿ ·fi ÙÚ›· ¯ÚfiÓÈ· ÂÎ·È‰Â˘ÙÈ΋˜ ·Ú¤Ì‚·Û˘ ÛÙ· ‰ËÌÔÙÈο Û¯ÔÏ›· Ù˘ ∫Ú‹Ù˘. ¶·È‰È·ÙÚÈ΋ 1998;61:483-497. 19. Mamalakis G, Kafatos A, Manios Y, Anagnostopoulou T, Apostolaki I. Obesity indices in a cohort of primary school children in Crete: a six year prospective study. Int J Obes Relat Metab Disord 2000;24:765-771. 20. Lerner JW. Learning disabilities: theories, diagnosis and teaching strategies. Boston, USA: Houghton Mifflin Company; 1993. 21. ∆˙ÂÓ¿ÎË ª, ∫·Ú·ÎˆÓÛÙ·ÓÙ¿ÎË ∂, §ÈÓ·Ú‰¿Î˘ ª, ªÈ¯ÂÏÔÁÈ¿ÓÓ˘ ™. O ÚfiÏÔ˜ ÙÔ˘ ·È‰È¿ÙÚÔ˘ ÛÙËÓ ·Ó›¯Ó¢ÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ÂÏÏÂÈÌÌ·ÙÈ΋˜ ÚÔÛÔ¯‹˜ Ì ˘ÂÚÎÈÓËÙÈÎfiÙËÙ·. ¶·È‰È·ÙÚÈ΋ 2002;65:452-462. 22. Sandstead HH. Causes of iron and zinc deficiencies and their effects on brain. J Nutr 2000;130 (2 Suppl):S347S349. 23. Eastley R, Wilcock GK, Bucks RS. Vitamin B12 deficiency in dementia and cognitive impairment: the effects of treatment on neuropsychological function. Int J Geriatr Psychiatry 2000;15:226-233. 24. Jeffery DR. Nutrition and diseases of the nervous system. In: Shils ME, Olson JA, Shike M, Ross AC, editors. Modern nutrition in health and disease. 9th ed. Baltimore: Lippincott William & Wilkins; 1999. p. 1544-1548. 25. La Rue A, Koehler KM, Wayne SJ, Chiulli SJ, Haaland KY, Garry PJ. Nutritional status and cognitive functioning in a normally aging sample: a 6-y reassessment. Am J Clin Nutr 1997;65:20-29. 26. Vatassery GT, Bauer T, Dysken M. High doses of vitamin E in the treatment of disorders of the central nervous system in the aged. Am J Clin Nutr 1999;70:793-801. 27. Perkins AJ, Hendrie HC, Callahan CM, Gao S, Unverzagt FW, Xu Y et al. Association of antioxidants with memory in a multiethnic elderly sample using the Third National Health and Nutrition Examination Survey. Am J Epidemiol 1999;150:37-44. 28. Joseph JA, Shukitt-Hale B, Denisova NA, Prior RL, Cao G, Martin A et al. Long-term dietary strawberry, spinach, or vitamin E supplementation retards the onset of age-related neuronal signal-transduction and cognitive behavioral deficits. J Neurosci 1998;18:8047-8055. 29. Bougle D, Denise P, Vimard F, Nouvelot A, Penneillo MJ, Guillois B. Early neurological and neuropsychological development of the preterm infant and polyunsaturated
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fatty acids supply. Clin Neurophysiol 1999;110:1363-1370. 30. Kim HY, Frongillo EA, Han SS, Oh SY, Kim WK, Jang YA et al. Academic performance of Korean children is associated with dietary behaviours and physical status. Asia Pac J Clin Nutr 2003;12:186-192. 31. Eaton WO, McKeen NA, Campbell DW. The waxing and waning of movement: implications for psychological development. Dev Rev 2001;21:205-223. 32. Mendez MA, Adair LS. Severity and timing of stunting in the first two years of life affect performance on cognitive tests in late childhood. J Nutr 1999;129:1555-1562.
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33. O’dea JA. Why do kids eat healthful food? Perceived benefits of and barriers to healthful eating and physical activity among children and adolescents. J Am Diet Assoc 2003;103:497-501.
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ORIGINAL ARTICLE
ªÈÎÚ¿ ·È‰È¿… ÌÂÁ¿ÏÔ˜ ·‰ÂÏÊfi˜ ∫. ∆˙È¿ÚÔ˘1, ª. ∆·‚Ï·ÓÙ¿1, Ã. •˘ÔÏÈ¿2, ¶. ∆·‚Ï·ÓÙ¿˜1
Young children… Big Brother K. Tziarou1, M. Tavlanta1, C. Xypolia2, P. Tavlantas1
¶ÂÚ›ÏË„Ë: ∏ ÙËÏÂfiÚ·ÛË ·ÔÙÂÏ› Ì›· ·Î·Ù·Ó›ÎËÙË ‰‡Ó·ÌË, ηıÒ˜ - Ì ٷ ‰ÔÚ˘ÊÔÚÈο ÚÔÁÚ¿ÌÌ·Ù· - ¤Û·Û ٷ Û‡ÓÔÚ· ÙˆÓ Ï·ÒÓ Î·È Î·ıȤڈÛ Ӥ· ‹ıË. ∏ ›‰Ú·Û‹ Ù˘ ÛÙ· ·È‰È¿ Â›Ó·È ·Ó·ÌÊÈÛ‚‹ÙËÙ· ÌÂÁ¿ÏË, ÁÈ·Ù› οÔÈÔÈ ·Ì˘ÓÙÈÎÔ› Ì˯·ÓÈÛÌÔ› ÙÔ˘˜ Â›Ó·È ·ÓÒÚÈÌÔÈ Î·È ·ÓÂͤÏÂÁÎÙÔÈ, ‰ËÌÈÔ˘ÚÁÒÓÙ·˜ ‡ÎÔÏ· Ì ·˘ÙfiÓ ÙÔÓ ÙÚfiÔ ÚfiÙ˘· Î·È ÙÚfiÔ˘˜ Û˘ÌÂÚÈÊÔÚ¿˜. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÌÂÙ¿‰ÔÛ˘ Ù˘ ÂÎÔÌ‹˜ “Big Brother” ·fi ÙËÓ ÙËÏÂfiÚ·ÛË, ÂÂȉ‹ ‰¤¯ÙËΠÛÎÏËÚ‹ Î·È ·ÚÓËÙÈ΋ ÎÚÈÙÈ΋ ÙfiÛÔ ÛÙËÓ ∂ÏÏ¿‰· fiÛÔ Î·È ÛÙÔÓ ˘fiÏÔÈÔ ÎfiÛÌÔ, ÍÂΛÓËÛÂ Ë Î·Ù·ÁÚ·Ê‹ ÙˆÓ ·fi„ÂˆÓ ÙˆÓ ÁÔÓ¤ˆÓ Î·È ÙˆÓ ÌÈÎÚÒÓ ·È‰ÈÒÓ ÁÈ· ÙËÓ Â›‰Ú·ÛË Ô˘ ·ÛΛ Ë ÙËÏÂfiÚ·ÛË Î·È È‰È·›ÙÂÚ· Ë Û˘ÁÎÂÎÚÈ̤ÓË ÂÎÔÌ‹ ÛÙÔÓ ÙÚfiÔ Û˘ÌÂÚÈÊÔÚ¿˜ Î·È ÛÙË ‰È·ÌfiÚʈÛË ÙÔ˘ ¯·Ú·ÎÙ‹Ú· ÙˆÓ ·È‰ÈÒÓ. ∞fi ÙË ÌÂϤÙË ‰È·ÈÛÙÒıËΠfiÙÈ, ÛÙËÓ Â·Ú¯›·, Ë ÙËÏÂfiÚ·ÛË ·ÔÙÂÏ› ÙÔ ÌÔÓ·‰ÈÎfi ̤ÛÔ „˘¯·ÁˆÁ›·˜ Î·È ÂÓË̤ڈÛ˘. ∆· ·È‰È¿ ·Ú·ÎÔÏÔ˘ıÔ‡Ó ÙËÏÂfiÚ·ÛË ·ÓÂͤÏÂÁÎÙ·, ÔÏϤ˜ ÒÚ˜ ÙËÓ Ë̤ڷ, Ì fiÏ· Ù· ·ÎfiÏÔ˘ı·. ∆· ·È‰È¿ ÛÙËÓ ÏÂÈÔ„ËÊ›· ÙÔ˘˜ ‰ÂÓ ÁÓÒÚÈ˙·Ó ÙËÓ ÚˆÙÂ‡Ô˘Û· ÙÔ˘ ÓÔÌÔ‡, ÙÔÓ ¶Úfi‰ÚÔ Ù˘ ¢ËÌÔÎÚ·Ù›·˜ Î·È Ù˘ ∫˘‚¤ÚÓËÛ˘, ·ÏÏ¿ ÁÓÒÚÈ˙·Ó ·ÎÚÈ‚Ò˜ ÙËÓ ÒÚ· ÌÂÙ¿‰ÔÛ˘ Ù˘ ÂÎÔÌ‹˜, Ù· ÔÓfiÌ·Ù· ÙˆÓ ·È¯ÙÒÓ Î·È ÙÈ ·ÎÚÈ‚Ò˜ ÁÈÓfiÙ·Ó ÛÙÔ Û›ÙÈ ÙÔ˘ “ªÂÁ¿ÏÔ˘ ∞‰ÂÏÊÔ‡”.
Abstract: Nowadays television is considered to have an unbeatable power, which, along with its satellite programmes, breaks national borders and establishes new sets of morals. The effects of television on children’s behaviour are particularly serious because a part of their defensive mechanism is weak, immature and uncontrollable. For this reason television can easily shape models and ways of behaving. The strong, negative criticism that “Big Brother” received, not only in Greece but also all over the world, led to a study of what parents and youngsters in the rural area of Argolida believe, based on their written accounts. Most of the points that were raised concerned the effects on the attitudes of teenagers, and the possibility that the development of their character may be influenced by television and more specifically by the reality show. From the research that was undertaken, it was found that television is the most common form of entertainment in the district. Children watch television many hours a day, facing at the end, all of its consequences. However, one finding of the study was that the majority of the children did not know basic facts like the capital of the region, or name of the President of Democracy, or the party in Government, but a surprisingly large percentage happened to know the exact time of transmission of the show, the name of each player, as well as exactly what was going on in the house of “Big Brother”.
§¤ÍÂȘ ÎÏÂȉȿ: ·È‰È¿, ÙËÏÂfiÚ·ÛË, ÔÈÎÔÁ¤ÓÂÈ·, ÙËÏ·ȯӛ‰È·.
Key words: children, television, family, reality shows.
∂ÈÛ·ÁˆÁ‹ ∏ ÙËÏÂfiÚ·ÛË ÂÌÊ·Ó›ÛÙËΠÛÙȘ ∏.¶.∞. ÁÈ· ÚÒÙË ÊÔÚ¿ ÙÔ 1939, ·fi ÙÔ ‰›ÎÙ˘Ô N.B.C. Î·È ÙÔ 1941
ÌÂÙ¤‰ˆÛ ÙËÓ ÚÒÙË ÂÓÙ¿ÏÂÙË ‰È·Ê‹ÌÈÛË (1,2). OÚÈṲ̂ÓÔÈ Û˘ÁÁÚ·Ê›˜, ·fi Ù· ÚÒÙ· ¯ÚfiÓÈ·, ¤‰ÈÓ·Ó ÙË ‰È΋ ÙÔ˘˜ ıÂÙÈ΋ ÂÚÌËÓ›· fiÛÔÓ ·ÊÔÚ¿ ÛÙË
1 ∫¤ÓÙÚÔ ÀÁ›·˜ §˘ÁÔ˘ÚÈÔ‡, ¡. ∞ÚÁÔÏ›‰·˜ 2 ¢ËÌÔÙÈÎfi ™¯ÔÏÂ›Ô ∞ÛÎÏËÈ›Ԣ, ¡. ∞ÚÁÔÏ›‰·˜
1 Health Centre of Lygourio, Prefecture of Argolida 2 Primary School of Asklipieio, Prefecture of Argolida
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¶·È‰È·ÙÚÈ΋ 2004;67:190-194
ÌÂÙ·‰ÔÙÈ΋ ›‰Ú·Û‹ Ù˘ ÛÙËÓ ÎÔÈÓˆÓ›· ÁÂÓÈÎfiÙÂÚ·, ˘ÔÛÙËÚ›˙ÔÓÙ·˜ fiÙÈ Ù· ÌËӇ̷ٿ Ù˘ ·ÔÙÂÏÔ‡Ó ¤Ó· ÔÙÈÎÔ·ÎÔ˘ÛÙÈÎfi ̤ÛÔ ÂÈÎÔÈÓˆÓ›·˜ Î·È Ì›· ÈηÓfiÙËÙ· ÂÚÌËÓ›·˜ Ù˘ ‰ÈۉȿÛÙ·Ù˘ ·ÚÔ˘Û›·Û˘ Ù˘ ΛÓËÛ˘ Î·È ÙÔ˘ ¯ÒÚÔ˘ (3). ™ÙËÓ ∂ÏÏ¿‰·, Ë ÙËÏÂfiÚ·ÛË ¿Ú¯ÈÛ ӷ ÂΤÌÂÈ ÙÔ 1966 Û·Ó ÎÚ·ÙÈÎfi˜ ÊÔÚ¤·˜. ∞ÔÙÂÏ› ÙÔ ‰ËÌÔÊÈϤÛÙÂÚÔ Ì¤ÛÔ ÂÈÎÔÈÓˆÓ›·˜ Î·È ‰È·ÛΤ‰·Û˘. ∂›Ó·È Ì›· ·Î·Ù·Ó›ÎËÙË ‰‡Ó·ÌË, Ë ÔÔ›·, Ì ٷ ‰ÔÚ˘ÊÔÚÈο ÚÔÁÚ¿ÌÌ·Ù·, ¤Û·Û ٷ Û‡ÓÔÚ· ÙˆÓ Ï·ÒÓ Î·È Î·ıȤڈÛ Ӥ· ‹ıË. ∏ ›‰Ú·Û‹ Ù˘, ˆÛÙfiÛÔ, ÛÙ· ·È‰È¿ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË, ÁÈ·Ù› οÔÈÔÈ ·Ì˘ÓÙÈÎÔ› Ì˯·ÓÈÛÌÔ› ÙÔ˘˜ Â›Ó·È ·ÓÒÚÈÌÔÈ Î·È ·ÓÂͤÏÂÁÎÙÔÈ Î·È Â‡ÎÔÏ· ‰ËÌÈÔ˘ÚÁÔ‡Ó ÚfiÙ˘· Î·È ÙÚfiÔ˘˜ Û˘ÌÂÚÈÊÔÚ¿˜ (4-6). ª¤Û· ÛÙÔ Ï‹ıÔ˜ ÙˆÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ Ô˘ ηٷÎχ˙Ô˘Ó Û ηıËÌÂÚÈÓ‹ ‚¿ÛË ÙËÓ ÙËÏÂfiÚ·ÛË, ÂÌÊ·Ó›ÛÙËÎÂ Î·È ÙÔ ÙËÏ·ȯӛ‰È “Big Brother”, ‚·ÛÈṲ̂ÓÔ ÛÙËÓ È‰¤· fiÙÈ Ù· ¿ÓÙ· ÛÙË ˙ˆ‹ ÙÔ˘ ·ÓıÚÒÔ˘ ı· “ηٷÁÚ¿ÊÔÓÙ·È-ÂϤÁ¯ÔÓÙ·È” ·fi ¤Ó· ·fiÚ·ÙÔ Ì¿ÙÈ, ÙÔÓ “ªÂÁ¿ÏÔ ∞‰ÂÏÊfi”. ∏ ȉ¤· ÚÔ‹Ïı ·fi ÙÔ ‚È‚Ï›Ô ÙÔ˘ George Orwell (1984) “O ªÂÁ¿ÏÔ˜ ∞‰ÂÏÊfi˜” (7). ŸÛÔÈ ¤¯Ô˘Ó ·Ú·ÎÔÏÔ˘ı‹ÛÂÈ Û˘ÛÙËÌ·ÙÈο ‹ ÂÚÈÛÙ·Ûȷο Ù· Û˘ÁÎÂÎÚÈ̤ӷ ÙËÏ·ȯӛ‰È· ÛÙËÓ ÂÏÏËÓÈ΋ ÙÔ˘˜ ÂΉԯ‹ ÁÓˆÚ›˙Ô˘Ó fiÙÈ ·˘Ù¿ Û˘Ó›ÛÙ·ÓÙ·È ÛÙË ‰È·ÌÔÓ‹ οÔÈˆÓ ·ÙfiÌˆÓ - Î·È ÙˆÓ ‰‡Ô Ê‡ÏˆÓ - Û ¤Ó·Ó ÎÏÂÈÛÙfi ¯ÒÚÔ, ¤Ó· “Û›ÙÈ”, fiÔ˘ ˙Ô˘Ó ÁÈ· ÔÚÈṲ̂ÓÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·, Ì·ÎÚÈ¿ ·fi ÙȘ ÔÈÎÔÁ¤ÓÂȤ˜ ÙÔ˘˜ Î·È ÙÔ˘˜ Ê›ÏÔ˘˜ ÙÔ˘˜, ÂÓÒ Ë ˙ˆ‹ ÙÔ˘˜ ·Ú·ÎÔÏÔ˘ıÂ›Ù·È fiÏÔ ÙÔ 24ˆÚÔ. ŸÏÔÈ ÔÈ Û˘ÌÌÂÙ¤¯ÔÓÙ˜ Á›ÓÔÓÙ·È ÁÓˆÛÙÔ› ÛÙÔ Â˘Ú‡ ÎÔÈÓfi - ¤Ó· ›‰Ô˜ ÂÊ‹ÌÂÚˆÓ ÛÙ·Ú - ›Ù Ì ÙÔ fiÓÔÌ¿ ÙÔ˘˜ ›Ù Ì ÙË Ê˘ÛÈÔÁӈ̛· ÙÔ˘˜. ŒÙÛÈ Á›ÓÔÓÙ·È ·Ó·ÁÓˆÚ›ÛÈÌÔÈ, ÂÓÒ ·˘Ù‹ Ë ÚÔÛˆÚÈÓ‹ ‰È·ÛËÌfiÙËÙ· ÌÔÚ› ÂӉ¯Ô̤ӈ˜ Ó· ‚ÔËı‹ÛÂÈ ÛÙËÓ Â·ÁÁÂÏÌ·ÙÈ΋ ÙÔ˘˜ ηÚȤڷ. ¶ÚfiÎÂÈÙ·È ÁÈ· Ì›· ÛÙË̤ÓË ÚfiÎÏËÛË ÛÙËÓ ·ÓıÚÒÈÓË Ê‡ÛË Î·ı·˘Ù‹, ÛÙËÓ ·ÓıÚÒÈÓË Ô˘Û›·, ÛÙËÓ Î·Ú‰È¿ ÙÔ˘ „˘¯ÈÎÔ‡ ÎfiÛÌÔ˘, ÛÙËÓ È‰È·ÈÙÂÚfiÙËÙ· ÙÔ˘ ηıÂÓfi˜, ηıÒ˜ ·˘Ù‹ Ë È‰È·ÈÙÂÚfiÙËÙ· ÌÂÙ·ÙÚ¤ÂÙ·È Û ÙËÏÂÔÙÈÎfi ·ÓÙÈΛÌÂÓÔ. ∆Ô ÂÚȯfiÌÂÓÔ Ù˘ ÂÎÔÌ‹˜ “Big Brother”, Û·Ó ı¤Ì· Ù˘ ÙËÏÂfiÚ·Û˘, ·ÔÙÂÏ› ¤Ó· ‰›Ô ·Ó¿Ù˘Í˘-‰Ú¿Û˘-ÚÔ‚ÏËÌ·ÙÈÛÌÔ‡ Ù˘ ÂÈÚ·Ì·ÙÈ΋˜ „˘¯ÔÏÔÁ›·˜, fiÔ˘ ÂÈÎÚ·Ù› Ë „˘¯ÔÏÔÁ›· ÙÔ˘ “˙‡ÁÔ˘˜”: ÚfiıÂÛË-·fiÚÚÈ„Ë, ‰È¤ÁÂÚÛË-·Ó·ÛÙÔÏ‹, ·Ú·ÌÔÓ‹-·fi‰Ú·ÛË, ÛÂÍÔ˘·ÏÈ΋ ·ʋ-·ÔÊ˘Á‹, ËıÔÔÈ›·-ÂÍ¢ÙÂÏÈÛÌfi˜. ∆Ô Û˘ÁÎÂÎÚÈ̤ÓÔ ÙËÏ·ȯӛ‰È, ÙÔ ÔÔ›Ô ·ÚÔ˘ÛÈ¿ÛÙËÎÂ Î·È Û ¿ÏϘ ¯ÒÚ˜, ‰¤¯ÙËΠÛÎÏËÚ‹ ·ÚÓËÙÈ΋ ÎÚÈÙÈ΋ ÂÍ·ÈÙ›·˜ ÙÔ˘ ÂÚȯÔ̤ÓÔ˘ Î·È ÙÔ˘ ÙÚfiÔ˘ ‰ÈÂÍ·ÁˆÁ‹˜ ÙÔ˘. ∆Ô ›‰ÈÔ Û˘Ó¤‚Ë Î·È ÛÙËÓ ∂ÏÏ¿‰·. ªÂ ·˘Ù‹ ÙËÓ ·ÊÔÚÌ‹, ÍÂΛÓËÛÂ Ë Î·Ù·ÁÚ·Ê‹ Ù˘ ›‰Ú·Û˘ Ô˘ ·ÛΛ Ë ÙËÏÂfiÚ·ÛË ÛÙËÓ
Paediatriki 2004;67:190-194
ÂÏÏËÓÈ΋ ÔÈÎÔÁ¤ÓÂÈ·, ηıÒ˜ Î·È Ù˘ Ù˘¯fiÓ ‰È·ÊÔÚÔÔ›ËÛ˘ ÛÙË Û˘ÌÂÚÈÊÔÚ¿ ÙˆÓ ·È‰ÈÒÓ Î·È ÛÙË ‰ËÌÈÔ˘ÚÁ›· ÚÔÙ‡ˆÓ Ô˘ ÂÈ‚¿ÏÏÂÈ ÙÔ “Big Brother” ÛÙË ˙ˆ‹ ÙÔ˘˜. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ∏ ¤Ú¢ӷ ·˘Ù‹ ‰ÈÂÓÂÚÁ‹ıËΠ۠·ÁÚÔÙÈ΋ ÂÚÈÔ¯‹ ÙÔ˘ ÓÔÌÔ‡ ∞ÚÁÔÏ›‰·˜, ·fi ÙÔÓ ™Â٤̂ÚÈÔ ÙÔ˘ 2001 ¤ˆ˜ Î·È ÙÔÓ π·ÓÔ˘¿ÚÈÔ ÙÔ˘ 2002, Ù·˘Ùfi¯ÚÔÓ· Ì ÙË ÌÂÙ¿‰ÔÛË ÙÔ˘ ÙËÏ·ȯÓȉÈÔ‡ “Big Brother”. ¢È·ÓÂÌ‹ıËÎ·Ó 200 ·ÓÒÓ˘Ì· ÂÚˆÙËÌ·ÙÔÏfiÁÈ· Û ÈÛ¿ÚÈıÌÔ˘˜ ŒÏÏËÓ˜, Ô˘ ‹Ù·Ó ÁÔÓ›˜ ·È‰ÈÒÓ ËÏÈΛ·˜ 6-14 ÂÙÒÓ Î·È Î·Ù·ÁÚ¿ÊËÎ·Ó ÔÈ ·fi„ÂȘ ÙÔ˘˜ ÁÈ· ÙËÓ Â›‰Ú·ÛË Ô˘ ·ÛΛ Ë ÙËÏÂfiÚ·ÛË ÛÙËÓ ÔÈÎÔÁÂÓÂȷ΋ ÙÔ˘˜ ˙ˆ‹. ∂Ï‹ÊıË ÚÔÊÔÚÈ΋ Û˘Ó¤ÓÙ¢ÍË ·fi 106 ·È‰È¿, ËÏÈΛ·˜ 10-14 ÂÙÒÓ Î·È ·ÔÙ˘ÒıËÎ·Ó ÔÈ ·fi„ÂȘ ÙÔ˘˜ ÁÈ· ÙÔ ›‰ÈÔ ı¤Ì·. ∆· ÂÚˆÙËÌ·ÙÔÏfiÁÈ· ‰È·ÓÂÌ‹ıËÎ·Ó ÛÙÔ˘˜ ÁÔÓ›˜ Î·È Û˘ÌÏËÚÒıËÎ·Ó Î·Ù¿ ÙȘ ÂÈÛΤ„ÂȘ ÙÔ˘˜ ÛÙÔ ∫¤ÓÙÚÔ ÀÁ›·˜ ¯ˆÚ›˜ ÙËÓ ·ÚÔ˘Û›· ¿ÏÏˆÓ - Î·È ÂÈÛÙÚ¿ÊËÎ·Ó ÚÔ Ù˘ ·Ô¯ÒÚËÛ‹˜ ÙÔ˘˜ ·fi ·˘Ùfi. ¢ÂÓ ˘‹ÚÍ·Ó ÌË Û˘ÌÏËڈ̤ӷ ÂÚˆÙËÌ·ÙÔÏfiÁÈ·. ∏ ÚÔÊÔÚÈ΋ Û˘Ó¤ÓÙ¢ÍË ÛÙ· ·È‰È¿ ‹Ù·Ó ·ÙÔÌÈ΋, ¤ÁÈÓ ηٿ ÙÔ ›‰ÈÔ ‰È¿ÛÙËÌ· ÌÂÙ¿ ·fi Û˘ÁηٿıÂÛË ÙˆÓ ÁÔÓ¤ˆÓ ÙÔ˘˜ Î·È ¯ˆÚ›˜ Ó· Â›Ó·È ·ÚfiÓÙ˜ ÛÙËÓ ·›ıÔ˘Û·, ÛÙÔ ›‰ÈÔ Ì¤ÚÔ˜, ÙËÚÒÓÙ·˜ ÙËÓ È‰ÈˆÙÈÎfiÙËÙ· ÙˆÓ ·È‰ÈÒÓ Î·È Ì ÙÚfiÔ ÒÛÙ ÔÈ ··ÓÙ‹ÛÂȘ ÙÔ˘˜ Ó· ÌË ıˆÚËıÔ‡Ó ˘Ô‚fiÏÈ̘ ·fi ÙÔÓ ¿ÓıÚˆÔ Ô˘ ‰ÈÂÓÂÚÁÔ‡Û ÙË Û˘Ó¤ÓÙ¢ÍË. ∆Ô ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ, ÛÙÔ ÔÔ›Ô ·¿ÓÙËÛ·Ó ÔÈ ÁÔÓ›˜, ‹Ù·Ó ÙÔ ÂÍ‹˜: i) ¶fiÛ˜ ÙËÏÂÔÚ¿ÛÂȘ ¤¯ÂÙ ÛÙÔ Û›ÙÈ Û·˜; ii) Œ¯Ô˘Ó ÙËÏÂfiÚ·ÛË Ù· ·È‰È¿ ÛÙÔ ‰ˆÌ¿ÙÈfi ÙÔ˘˜; ii) µÏ¤ÂÈ ÙÔ ·È‰› fi,ÙÈ ı¤ÏÂÈ ÛÙËÓ ÙËÏÂfiÚ·ÛË; iv) À¿Ú¯Ô˘Ó ÚÔÁÚ¿ÌÌ·Ù· Ô˘ ÙÔ˘ ÂÈÙÚ¤ÂÙ ‹ ÙÔ˘ ··ÁÔÚ‡ÂÙ ӷ ·Ú·ÎÔÏÔ˘ı‹ÛÂÈ; v) ÃÚËÛÈÌÔÔț٠ÙËÓ ÙËÏÂfiÚ·ÛË Û·Ó ÂÓË̤ڈÛË, „˘¯·ÁˆÁ›·, ÌfiÚʈÛË; vi) ∏ ÙËÏÂfiÚ·ÛË ¤¯ÂÈ ÂÏ·ÙÙÒÛÂÈ, ÁÂÓÈο, ÙȘ ‰Ú·ÛÙËÚÈfiÙËÙ¤˜ Û·˜ Û·Ó ÔÈÎÔÁ¤ÓÂÈ·; vii) ¶ÈÛÙ‡ÂÙ fiÙÈ Ë ÙËÏÂfiÚ·ÛË ‰ËÌÈÔ˘ÚÁ› ÚfiÙ˘· Î·È ÂÈ‚¿ÏÏÂÈ ‰ÈÎÔ‡˜ Ù˘ ÙÚfiÔ˘˜ Û˘ÌÂÚÈÊÔÚ¿˜; viii) ªÈÌÔ‡ÓÙ·È Ù· ·È‰È¿ Û·˜ ‹ÚˆÂ˜ ÙËÏÂÔÙÈÎÒÓ ÂÎÔÌÒÓ; ix) ¢È·ÊÔÚÔÔÈÔ‡Ó ÙÔÓ ¯·Ú·ÎÙ‹Ú· Î·È ÙË Û˘ÌÂÚÈÊÔÚ¿ ÙˆÓ ·È‰ÈÒÓ ÔÚÈṲ̂Ó˜ ÙËÏÂÔÙÈΤ˜ ÂÎÔ̤˜; x) ¶fiÛ˜ ÒÚ˜ ÙËÓ Ë̤ڷ ·Ú·ÎÔÏÔ˘ı›Ù ÙËÏÂÔÙÈο ÚÔÁÚ¿ÌÌ·Ù·; xi) ¶fiÛ˜ ÒÚ˜ ÙËÓ Ë̤ڷ ·Ú·ÎÔÏÔ˘ıÔ‡Ó Ù· ·È‰È¿ Û·˜ ÙËÏÂfiÚ·ÛË; xii) ¶ÈÛÙ‡ÂÙ fiÙÈ ˘¿Ú¯ÂÈ Ô˘ÛÈ·ÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙˆÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ Ô˘ ÚÔ‚¿ÏÏÔÓÙ·È ·fi ÙËÓ ÙËÏÂfiÚ·ÛË; xiii) ∞Ó Û·˜ ¤ÏÂÁ·Ó Ó· ÎÏ›ÛÂÙ ÙËÓ ÙËÏÂfiÚ·ÛË ÁÈ· ¤Ó· Ì‹Ó·, ÙÈ ı· οӷÙÂ; xiv) Œ¯ÂÙÂ Û˘Ó‰ÚÔÌËÙÈ΋ Û‡Ó‰ÂÛË ÙËÏÂfiÚ·Û˘; xv) ÃÚËÛÈÌÔÔț٠ÙËÓ ÙËÏÂfiÚ·ÛË ÁÈ· Ó· ··Û¯Ôϛ٠ٷ ·È‰È¿ Û·˜ ‹/Î·È ÁÈ· ¿ÏÏÔ˘˜ ÏfiÁÔ˘˜ Î·È ÔÈÔ˘˜;
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¶·È‰È·ÙÚÈ΋ 2004;67:190-194
Paediatriki 2004;67:190-194
xvi) ∞Ó ÙÔ ·È‰› ı¤ÏÂÈ Ó· ‚ϤÂÈ Î·È ¿ÏÏ· ÚÔÁÚ¿ÌÌ·Ù· ÂÎÙfi˜ ÙˆÓ ·È‰ÈÎÒÓ Ì ٷ ÔÔ›· ‰È·ÊˆÓ›ÙÂ, Ò˜ ·ÓÙȉڿÙÂ; xvii) ∞ÁÔÚ¿˙ÂÙ ÚÔ˚fiÓÙ· Ô˘ ‰È·ÊËÌ›˙ÂÈ Ë ÙËÏÂfiÚ·ÛË; xviii) ¶·Ú·ÎÔÏÔ˘ı›Ù ÙÔ “Big Brother”; ∆· ·È‰È¿ ·¿ÓÙËÛ·Ó ÛÙȘ ÂÍ‹˜ ÂÚˆÙ‹ÛÂȘ: i) ¶fiÛ˜ ÙËÏÂÔÚ¿ÛÂȘ ¤¯ÂÙ ۛÙÈ; ii) Œ¯ÂÙ ÙËÏÂfiÚ·ÛË ÛÙÔ ‰ˆÌ¿ÙÈfi Û·˜; iii) ¶fiÛ˜ ÒÚ˜ ÙËÓ Ë̤ڷ ‚ϤÂÙ ÙËÏÂfiÚ·ÛË; ™·˜ ··ÁÔÚÂ‡Ô˘Ó ÔÈ ÁÔÓ›˜ Û·˜ Ó· ‚ϤÂÙ fi,ÙÈ ı¤ÏÂÙÂ; iv) ∑Ëٿ٠·fi ÙÔ˘˜ ÁÔÓ›˜ Û·˜ Ó· Û·˜ ·ÁÔÚ¿ÛÔ˘Ó ÚÔ˚fiÓÙ· Ô˘ ‰È·ÊËÌ›˙ÂÈ Ë ÙËÏÂfiÚ·ÛË; v) ™·˜ ·Ú¤ÛÔ˘Ó ÔÈ ‹ÚˆÂ˜ ÙˆÓ ÙËÏÂÔÙÈÎÒÓ ÂÎÔÌÒÓ Î·È, ·Ó Ó·È, ÔÈÔÈ; Œ¯ÂÙ ‰ÂÈ ÙÔ ÙËÏ·ȯӛ‰È “Big Brother”; °ÓˆÚ›˙ÂÙ ÔÈ· ÒÚ· ÌÂÙ·‰›‰ÂÙ·È Î·È ·fi ÔÈÔ ÙËÏÂÔÙÈÎfi ÛÙ·ıÌfi; ∆È ı˘Ì¿ÛÙ ·fi ÙÔ ·È¯Ó›‰È; vi) ¶ÔÈ· Â›Ó·È Ë ÚˆÙÂ‡Ô˘Û· ÙÔ˘ ÓÔÌÔ‡ ∞ÚÁÔÏ›‰·˜ Î·È ÔÈ· Ù˘ ∂ÏÏ¿‰·˜; vii) ¶ÔÈÔ˜ Â›Ó·È Ô ¶Úfi‰ÚÔ˜ Ù˘ ¢ËÌÔÎÚ·Ù›·˜ Î·È ÔÈÔ˜ Ô ¶Úˆı˘Ô˘ÚÁfi˜ Ù˘ ∂ÏÏ¿‰·˜;
‡·ÚÍË ‰Â‡ÙÂÚ˘ Û˘Û΢‹˜ ÛÙÔ Û›ÙÈ. ™ÙËÓ ÏÂÈÔ„ËÊ›· ÙÔ˘˜ (76%) ·Ú·ÎÔÏÔ˘ıÔ‡Ó ÙËÏÂfiÚ·ÛË ÔÏϤ˜ ÒÚ˜ ÙËÓ Ë̤ڷ (ηٿ ̤ÛÔ fiÚÔ 28 ÒÚ˜ ÙËÓ Â‚‰ÔÌ¿‰·) Î·È Ì¿ÏÈÛÙ· ·ÓÂͤÏÂÁÎÙ·, ÂÓÒ ÔÈ ÁÔÓ›˜ ÈÛ¯˘Ú›˙ÔÓÙ·È ÙÔ ·ÓÙ›ıÂÙÔ. ∞ÚÎÂÙ¿ ·È‰È¿ (47%) ·Ó·Áο˙Ô˘Ó ÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘˜ Ó· ÙÔ˘˜ ·ÁÔÚ¿˙Ô˘Ó ÚÔ˚fiÓÙ· Ô˘ ‰È·ÊËÌ›˙ÂÈ Ë ÙËÏÂfiÚ·ÛË. ŸÏ·, ·ÓÂÍ·ÈÚ¤Ùˆ˜, Ù· ·È‰È¿ ÁÓÒÚÈ˙·Ó ÙËÓ ÒÚ· ÌÂÙ¿‰ÔÛ˘ Ù˘ ÂÎÔÌ‹˜ “Big Brother”, Ù· ÌÈÎÚ¿ ÔÓfiÌ·Ù· ÙˆÓ ·ÈÎÙÒÓ, ηıÒ˜ Î·È fi,ÙÈ ÁÈÓfiÙ·Ó Ì¤Û· ÛÙÔ Û›ÙÈ ÙÔ˘ “ªÂÁ¿ÏÔ˘ ∞‰ÂÏÊÔ‡”. ÃÚËÛÈÌÔÔÈÔ‡Ó ·Ù¿Î˜ ÙˆÓ ·ÈÎÙÒÓ, fiˆ˜ “οÙÛ’ οو, ˆ! ηÏfi, ˆ! ηÎfi, ÎÔ˘Ì¿ÚÂ, Î.Ï.” Î·È ı¤ÏÔ˘Ó Ó· ÌÈÌËıÔ‡Ó Ù· ÂӉȷʤÚÔÓÙ¿ ÙÔ˘˜, .¯. Ó· Ì¿ıÔ˘Ó Ó· ·›˙Ô˘Ó ÙÔ˘ÌÂÚϤÎÈ. ¶ÔÛÔÛÙfi ÌfiÏȘ 68% ·¿ÓÙËÛ ۈÛÙ¿ ÛÙȘ ÂÚˆÙ‹ÛÂȘ ÁÈ· ÙËÓ ÚˆÙÂ‡Ô˘Û· ÙÔ˘ ÓÔÌÔ‡, 37% ÁÈ· ÙÔÓ ¶Úfi‰ÚÔ Ù˘ ¢ËÌÔÎÚ·Ù›·˜ Î·È 41% ÁÈ· ÙÔÓ ¶Úˆı˘Ô˘ÚÁfi Ù˘ ¯ÒÚ·˜.
∞ÔÙÂϤÛÌ·Ù· ∆· ·ÔÙÂϤÛÌ·Ù· ·fi Ù· ÂÚˆÙËÌ·ÙÔÏfiÁÈ· Ô˘ ‰fiıËÎ·Ó ÛÙÔ˘˜ ÁÔÓ›˜ Û˘ÓÔ„›˙ÔÓÙ·È ÛÙ· ·ÎfiÏÔ˘ı·. ∏ ÂÏÏËÓÈ΋ ÔÈÎÔÁ¤ÓÂÈ· ·Á·¿, ÁÂÓÈο, ÙËÓ ÙËÏÂfiÚ·ÛË. OÈ ÂÚÈÛÛfiÙÂÚÔÈ ÁÔÓ›˜ (87%) ÙËÓ ÂÈϤÁÔ˘Ó Û·Ó Ì¤ÛÔ ÂÓË̤ڈÛ˘ Î·È ‰È·ÛΤ‰·Û˘, ·ÏÏ¿ ÔÛÔÛÙfi 42% ‰ÂÓ ı· ÌÔÚÔ‡Û ӷ ÙË ÛÙÂÚËı›. ¢È·ı¤ÙÔ˘Ó ¯Ú‹Ì·Ù· ÁÈ· ‰Â‡ÙÂÚË ÙËÏÂfiÚ·ÛË (33%) ‹ ÁÈ· ÙÚ›ÙË (8%). ŒÓ· Ôχ ÌÈÎÚfi ÔÛÔÛÙfi ÙˆÓ ÁÔÓ¤ˆÓ (9%) ‰È·ı¤ÙÂÈ Û˘Ó‰ÚÔÌËÙÈ΋ Û‡Ó‰ÂÛË. ¶ÔÛÔÛÙfi 11% ÙˆÓ ·È‰ÈÒÓ ¤¯ÂÈ ÙËÏÂfiÚ·ÛË ÛÙÔ ‰ˆÌ¿ÙÈfi ÙÔ˘. ∆Ô 72% ÙˆÓ ÁÔÓ¤ˆÓ ·Ó·Ê¤ÚÂÈ fiÙÈ ÂϤÁ¯ÂÈ Ù· ÚÔÁÚ¿ÌÌ·Ù· Ô˘ ·Ú·ÎÔÏÔ˘ıÔ‡Ó Ù· ·È‰È¿. ∆· ·È‰È¿ ·Ú·ÎÔÏÔ˘ıÔ‡Ó ÙËÏÂfiÚ·ÛË Î·Ù¿ ̤ÛÔ fiÚÔ 19 ÒÚ˜, ÂÓÒ ÔÈ ÁÔÓ›˜ ηٿ ̤ÛÔ fiÚÔ 13 ÒÚ˜ ‚‰ÔÌ·‰È·›ˆ˜. ¶ÔÛÔÛÙfi 51% ÙˆÓ ÁÔÓ¤ˆÓ ıˆÚ› fiÙÈ Ë Ì›ÌËÛË ÙˆÓ ËÚÒˆÓ Ù˘ ÙËÏÂfiÚ·Û˘ Â›Ó·È ·Ó·fiÊ¢ÎÙË, Ì fiÏ· Ù· ·ÎfiÏÔ˘ı·. ∆Ô 68% ¯ÚËÛÈÌÔÔÈ› ÙËÓ ÙËÏÂfiÚ·ÛË ÁÈ· Ó· ··Û¯ÔÏ› Ù· ·È‰È¿ ÛÙÔ Û›ÙÈ, ÂÓÒ ÔÛÔÛÙfi 22% ÙË ¯ÚËÛÈÌÔÔÈ› ÁÈ· Ó· ‰È¢ÎÔÏ˘Óı› Ô ‡ÓÔ˜. ∆Ô 85% ÈÛÙ‡ÂÈ fiÙÈ Ë ÙËÏÂfiÚ·ÛË Ú¤ÂÈ Ó· ÂϤÁ¯ÂÙ·È ·fi Û˘Ì‚Ô‡ÏÈÔ ÔÏÈÙÈÛÙÈÎÒÓ ÊÔÚ¤ˆÓ. OÈ ÂÚÈÛÛfiÙÂÚÔÈ ÁÔÓ›˜ (43%) ÂËÚ¿˙ÔÓÙ·È ·fi ÙË ‰È·Ê‹ÌÈÛË ÚÔ˚fiÓÙˆÓ Î·È ·ÚÎÂÙ¤˜ ÊÔÚ¤˜ ÂÈϤÁÔ˘Ó Ó· ·ÁÔÚ¿ÛÔ˘Ó Î¿ÔÈ· ·fi ·˘Ù¿. ™ÙËÓ ÏÂÈÔ„ËÊ›· ÙÔ˘˜ (79%) ·Ú·‰¤¯ÔÓÙ·È fiÙÈ ÌÂÈÒÓÂÙ·È Ë Û¯ÔÏÈ΋ ›‰ÔÛË ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜ fiÙ·Ó ·Ú·ÎÔÏÔ˘ıÔ‡Ó ÔÏϤ˜ ÒÚ˜ ÙËÏÂfiÚ·ÛË, ÂÓÒ ÙÔ 39% ÙˆÓ ÁÔÓ¤ˆÓ ·Ó·Ê¤ÚÂÈ fiÙÈ ·Ú·ÎÔÏÔ˘ı› ÙÔ ÙËÏ·ȯӛ‰È “Big Brother” ·fi ÂÚȤÚÁÂÈ·. ™ÙËÓ ÚÔÊÔÚÈ΋ Û˘Ó¤ÓÙ¢ÍË, Ô˘ ÂÏ‹ÊıË ·fi ·È‰È¿ ËÏÈΛ·˜ 10-14 ÂÙÒÓ, ·ÔÙ˘ÒıËÎ·Ó ÔÈ ·ÎfiÏÔ˘ı˜ ·fi„ÂȘ. ¶Ôχ Ï›Á· ·È‰È¿ (7%) ¤¯Ô˘Ó ÙËÏÂfiÚ·ÛË ÛÙÔ ‰ˆÌ¿ÙÈfi ÙÔ˘˜, ÂÓÒ ÙÔ 21% ·Ó·Ê¤ÚÂÈ
™˘˙‹ÙËÛË ∏ ÙËÏÂfiÚ·ÛË Â›Ó·È Ì›· Ú·ÁÌ·ÙÈÎfiÙËÙ· ÛÙË ˙ˆ‹ Ù˘ ÂÏÏËÓÈ΋˜ ÔÈÎÔÁ¤ÓÂÈ·˜. À¿Ú¯Ô˘Ó Ù¤ÛÛÂÚ· ÂηÙÔÌ̇ÚÈ· ÙËÏÂÔÙÈΤ˜ Û˘Û΢¤˜ ÛÙËÓ ∂ÏÏ¿‰·. OÈ ·ÓËÛ˘¯›Â˜ ÁÈ· ÙËÓ Â›‰Ú·Û‹ Ù˘ ÛÙ· ·È‰È¿ ¤¯Ô˘Ó ›ÎÂÓÙÚÔ, ۯ‰fiÓ ¿ÓÙÔÙÂ, ÙÔ ÂÚȯfiÌÂÓÔ ÙˆÓ ÂÎÔÌÒÓ Ô˘ ·˘Ù¿ ·Ú·ÎÔÏÔ˘ıÔ‡Ó. ∏ ÙËÏÂfiÚ·ÛË, ÛÙËÓ Â·Ú¯›·, ÂÈϤÁÂÙ·È Û·Ó Ì¤ÛÔ ÂÓË̤ڈÛ˘ Î·È ‰È·ÛΤ‰·Û˘. ∏ ÏÂÈÔ„ËÊ›· ÙˆÓ ÁÔÓ¤ˆÓ ÈÛ¯˘Ú›˙ÂÙ·È fiÙÈ ÂϤÁ¯ÂÈ Ù· ÚÔÁÚ¿ÌÌ·Ù· Ô˘ ·Ú·ÎÔÏÔ˘ıÔ‡Ó Ù· ·È‰È¿. ∂›Ó·È, fï˜, ·˘Ùfi ‰˘Ó·Ùfi ÂÊfiÛÔÓ ˘¿Ú¯Ô˘Ó ÔÏϤ˜ Û˘Û΢¤˜ ÛÙÔ Û›ÙÈ Î·È Ì¿ÏÈÛÙ· ÛÙ· ‰ˆÌ¿ÙÈ· ÙˆÓ ·È‰ÈÒÓ; ∏ ÙËÏÂfiÚ·ÛË ¯ÚËÛÈÌÔÔÈ›ٷÈ, Û˘¯Ó¿, ÁÈ· Ó· ··Û¯ÔÏËıÔ‡Ó Ù· ·È‰È¿ - ÚfiÏÔ˜ “baby-sitter” (8). ™¯Â‰fiÓ ÛÙÔ Û‡ÓÔÏfi ÙÔ˘˜, ÔÈ ÁÔÓ›˜ ÈÛÙÂ‡Ô˘Ó fiÙÈ Ë ÙËÏÂfiÚ·ÛË Ú¤ÂÈ Ó· ÂϤÁ¯ÂÙ·È Ô˘ÛÈ·ÛÙÈο ·fi Û˘Ì‚Ô‡ÏÈÔ ÔÏÈÙÈÛÙÈÎÒÓ ÊÔÚ¤ˆÓ. ∂›Û˘, ·Ó·ÁÓˆÚ›˙Ô˘Ó fiÙÈ ÔÈ ÔÏϤ˜ ÒÚ˜ ·Ú·ÎÔÏÔ‡ıËÛ˘ ÌÂÈÒÓÔ˘Ó ÙË Û¯ÔÏÈ΋ ›‰ÔÛË ÙˆÓ ·È‰ÈÒÓ, Ë ÔÔ›· ‰È·ÌÔÚÊÒÓÂÈ ¯·Ú·ÎÙ‹Ú˜ Î·È Û˘ÌÂÚÈÊÔÚ¤˜ (9). ™‡Ìʈӷ Ì ÙÔ˘˜ ÁÔÓ›˜, Ù· ·È‰È¿ ·Ú·ÎÔÏÔ˘ıÔ‡Ó ÙËÏÂfiÚ·ÛË Î·Ù¿ ̤ÛÔ fiÚÔ 19 ÒÚ˜ ÙËÓ Â‚‰ÔÌ¿‰·, ÂÓÒ Û‡Ìʈӷ Ì ٷ ·È‰È¿ ÔÈ ÒÚ˜ Â›Ó·È Ôχ ÂÚÈÛÛfiÙÂÚ˜ (ηٿ ̤ÛÔ fiÚÔ 28), ÌÂÈÒÓÔÓÙ·˜ ¤ÙÛÈ ÙÔÓ ¯ÚfiÓÔ Ô˘ ‰È·Ù›ıÂÙ·È ÛÙÔ ‰È¿‚·ÛÌ· Î·È Û ¿ÏϘ ‰Ú·ÛÙËÚÈfiÙËÙ˜ (10-12). ∆fiÛÔ Ë Ì›ÌËÛË ÙˆÓ ËÚÒˆÓ Ù˘ ÙËÏÂfiÚ·Û˘ fiÛÔ Î·È Ë ‰È·ÊÔÚÔÔ›ËÛË ÛÙÔÓ ¯·Ú·ÎÙ‹Ú· Î·È ÙË Û˘ÌÂÚÈÊÔÚ¿ ÙˆÓ ·È‰ÈÒÓ Â›Ó·È ·Ó·fiÊ¢ÎÙ˜, Ì fiÏ· Ù· ·ÎfiÏÔ˘ı· ÚÔ‚Ï‹Ì·Ù·. ª›· ÂÎÔÌ‹ Ì ·Ó¿ÏÔÁ˜ ÂÈÙÒÛÂȘ Â›Ó·È Î·È ÙÔ ÙËÏ·ȯӛ‰È “Big Brother”. ¶ÔÏÏÔ› ÂÚ¢ÓËÙ¤˜ ÚÔÛ·ıÔ‡Ó Ó· ‰È·ÈÛÙÒÛÔ˘Ó
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¶·È‰È·ÙÚÈ΋ 2004;67:190-194
·Ó Ù· ÚÔÁÚ¿ÌÌ·Ù· ‚›·˜ οÓÔ˘Ó Ù· ·È‰È¿ ÈÔ ÂÈıÂÙÈο Î·È ·Ó Ù· ÂÔÈÎÔ‰ÔÌËÙÈο ÚÔÁÚ¿ÌÌ·Ù· Ù· ÂÓı·ÚÚ‡ÓÔ˘Ó ÛÙË ‰È·ÌfiÚʈÛË ÛˆÛÙ‹˜ Û˘ÌÂÚÈÊÔÚ¿˜. ∂ȯÂÈÚÔ‡Ó, ‰ËÏ·‰‹, Ó· ·Ó·Î·Ï‡„Ô˘Ó ·Ó Ù· ÚfiÙ˘· Ô˘ ‰›ÓÂÈ Ë ÙËÏÂfiÚ·ÛË ÂËÚ¿˙Ô˘Ó ÙË ÛΤ„Ë ÙˆÓ ·È‰ÈÒÓ, ·ÓÔ›ÁÔÓÙ·˜ Ó¤Ô˘˜ ÔÚ›˙ÔÓÙ˜ ‹ ÂÚÈÔÚ›˙ÔÓÙ¿˜ Ù·. O ‰È·ÚÎÒ˜ ÂÓ·ÏÏ·ÛÛfiÌÂÓÔ˜ ηٷÈÁÈÛÌfi˜ ÂÈÎfiÓˆÓ Î·È ‹¯ˆÓ Ô˘ ‚ÔÌ‚·Ú‰›˙ÂÈ Ù· Ì¿ÙÈ· Î·È Ù· ·˘ÙÈ¿, ‰ËÌÈÔ˘ÚÁ› ÙËÓ ·˘Ù·¿ÙË Ì›·˜ ÔÏ˘Ô›ÎÈÏ˘ ÂÌÂÈÚ›·˜ ÁÈ· ÙÔÓ ı·ً. ŸÔÈ· Î·È ·Ó Â›Ó·È Ë ÂÎÔÌ‹, ˘¿Ú¯ÂÈ Ì›· ÔÌÔÈfiÙËÙ· ‚ÈˆÌ¿ÙˆÓ Û οı ÙËÏÂÔÙÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË. ¶ÚfiÎÂÈÙ·È ÁÈ· Ì›· ‰È·‰Èηۛ· ÌÔÓ‹˜ ηÙ‡ı˘ÓÛ˘ Ô˘ ··ÈÙ› ·fi ÙȘ ·ÈÛı‹ÛÂȘ Ó· ·ÊÔÌÔÈÒÛÔ˘Ó ¤Ó· Û˘ÁÎÂÎÚÈ̤ÓÔ ˘ÏÈÎfi Ì ¤Ó·Ó ȉȷ›ÙÂÚÔ ÙÚfiÔ, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙÔ ÂÚȯfiÌÂÓfi ÙÔ˘ (12). ¶Ú·ÁÌ·ÙÈο, ÛÙË ˙ˆ‹ ÙÔ˘ ·È‰ÈÔ‡ ‰ÂÓ ˘¿Ú¯ÂÈ Î·Ì›· ¿ÏÏË ÂÌÂÈÚ›·, ηٿ ÙËÓ ÔÔ›· ÙÔ ·È‰› Ó· Ï·Ì‚¿ÓÂÈ ÙfiÛÔ ÔÏÏ¿ ηÈ, fï˜, Ó· ·ÔÎÔÌ›˙ÂÈ ÙfiÛÔ Ï›Á·. ∞fi Ù· ÚÒÙ· ¯ÚfiÓÈ· ÏÂÈÙÔ˘ÚÁ›·˜ Ù˘ ÙËÏÂfiÚ·Û˘, ÔÈ ÎÚÈÙÈÎÔ› ÙËÓ ·ÚÔ˘Û›·˙·Ó Û·Ó ¤Ó· ‡Ô˘ÏÔ Ó·ÚΈÙÈÎfi ÁÈ· ÙÔ˘˜ ÁÔÓ›˜ ηÈ, ηْ ¤ÎÙ·ÛË, ÁÈ· Ù· ·È‰È¿. ∞ӷʤÚÂÙ·È fiÙÈ Ô ÂÚÈÔÚÈÛÌfi˜ ÙÔ˘ ¯ÚÔÓÈÎÔ‡ ‰È·ÛÙ‹Ì·ÙÔ˜ ÙËÏÂı¤·Û˘ ÛÙ· ·È‰È¿ ËÏÈΛ·˜ 6 ÂÙÒÓ, ÌÂÙ¤ÙÚ„ ÙÔÓ ÓÂ˘Ì·ÙÈÎfi ÙÔ˘˜ ÎfiÛÌÔ ·fi ·˘ıfiÚÌËÙÔ Û ÂÚÈÛÛfiÙÂÚÔ ÛÙÔ¯·ÛÙÈÎfi Î·È ÚÔοÏÂÛ ‚·ıÌÔÏÔÁÈÎfi ÂӉȷʤÚÔÓ ÛÙÔÓ ‰Â›ÎÙË ÓÔËÌÔÛ‡Ó˘ ÙÔ˘˜ (13). £ÂˆÚÂ›Ù·È fiÙÈ Ë ÙËÏÂfiÚ·ÛË ·ÔÙÂÏ› Ì›· ˙ˆÓÙ·Ó‹ Ú·ÁÌ·ÙÈÎfiÙËÙ· ηÈ, ›Ûˆ˜, ÙÔ ÈÔ Û·ÁËÓ¢ÙÈÎfi ̤ÛÔ ÌÂÙ·ÊÔÚ¿˜ Ù˘ Ê·ÓÙ·Û›·˜ ÛÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ·. OÈ ÂȉڿÛÂȘ Ù˘ ÙËÏÂfiÚ·Û˘ Â›Ó·È Ì›· Û˘Ó¿ÚÙËÛË fi¯È ÌfiÓÔ ÙˆÓ ÂÈÙÒÛÂˆÓ Ô˘ ÚÔηÏÔ‡ÓÙ·È ÛÙÔ ·È‰› ·fi ·˘Ù‹, ·ÏÏ¿ Î·È ÙˆÓ ÂÎÔÌÒÓ Ô˘ ·Ú·ÎÔÏÔ˘ı› (14,15). ∆· ÚÔÁÚ¿ÌÌ·Ù· ÔÊ›ÏÔ˘Ó Ó· Â›Ó·È ÚÔÛ·ÚÌÔṲ̂ӷ ÛÙȘ Ú·ÁÌ·ÙÈΤ˜ ·Ó¿ÁΘ ÙˆÓ ·È‰ÈÒÓ (15,16). ¢È·ÈÛÙÒıËΠfiÙÈ Ë ·Ú·ÎÔÏÔ‡ıËÛË Ù˘ ÂÎÔÌ‹˜ “Big Brother” ·fi ÙÔ˘˜ ÁÔÓ›˜ Î·È Ù· ·È‰È¿ ÂÚÈÂÏ¿Ì‚·Ó Ôχ ÌÂÁ¿ÏÔ ÔÛÔÛÙfi. OÈ ÙËÏÂı·٤˜ (ÁÔÓ›˜ Î·È ·È‰È¿) ·Ú·ÎÔÏÔ˘ıÔ‡Ó ·ıËÙÈο ÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ ÙËÏ·ȯӛ‰È, ÁÈ·Ù›: ·) ¤ÏÎÔÓÙ·È Î·È Î·ıËÏÒÓÔÓÙ·È ·fi ÙÔ ¿ÁÓˆÛÙÔ Î·È ·ÚfiÛÌÂÓÔ ÛÂÓ¿ÚÈÔ Ô˘ ÂÍÂÏ›ÛÛÂÙ·È ·fi ÙÔ˘˜ ·›ÎÙ˜, ÙÔ ÔÔ›Ô ÌÔÈ¿˙ÂÈ Ì ηÏÂȉÔÛÎfiÈÔ ·fi ·ÓıÚÒÈÓ˜ ÂÈÎfiÓ˜, ÊÈÁÔ‡Ú˜ Î·È Û˘ÌϤÁÌ·Ù· Û˘ÌÂÚÈÊÔÚ¿˜, ·ÚÈÔ ¤ÚÁÔ ÙˆÓ ÔÔ›ˆÓ Â›Ó·È ÙÔ ¿ÁÓˆÛÙÔ, ‚) Ú·ÁÌ·ÙÔÔÈÂ›Ù·È ÌÔÈÚ·›· Ù·‡ÙÈÛ‹ ÙÔ˘˜ Ì ÙÔ˘˜ ·›ÎÙ˜ οı ÛÙÈÁÌ‹ Î·È Á) ‰È·ÙËÚÂ›Ù·È ÙÔ ÂӉȷʤÚÔÓ ÙÔ˘˜ ·fi ÙÔ ›‰ÈÔ ÙÔ ı¤·Ì·, Û·Ó ÁÂÁÔÓfi˜, Û·Ó Û‡ÌÏÂÁÌ·, Û·Ó ‰Ú¿ÛË, Û·Ó ‰Ú¿Ì· ‹ Έ̈‰›·, ηıÒ˜ ÍÂʇÁÂÈ ·fi ÙÔ ÁÓˆÛÙfi, ÙÔ Î·ıËÌÂÚÈÓfi, ÙÔ Ù˘ÔÔÈ-
Paediatriki 2004;67:190-194
Ë̤ÓÔ, ÙÔ Û˘ÓËıÈṲ̂ÓÔ Î·È ÙÔ Î·ıÈÂڈ̤ÓÔ. ∆· ·È‰È¿ ·Ú·ÎÔÏÔ˘ıÔ‡Ó fiÏ· ·˘Ù¿, Ì ÙȘ ÂÈÙÒÛÂȘ Ô˘ Û˘Ó¿ÁÔÓÙ·È ÛÙÔÓ ¯·Ú·ÎÙ‹Ú· Î·È ÙË Û˘ÌÂÚÈÊÔÚ¿ ÙÔ˘˜, ηıÒ˜, Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, Ë ÙËÏÂfiÚ·ÛË ·ÓÙÈη٤ÛÙËÛ ÙȘ ·Ú·‰fiÛÂȘ Î·È Ù· ·Ú·Ì‡ıÈ·, ÙÔ˘˜ ÁÚ›ÊÔ˘˜ Î·È Ù· ·ÈÓ›ÁÌ·Ù·, ÙȘ ÈÛÙÔڛ˜ Î·È ÙȘ ·ÚÔÈ̛˜, Ì ٷ ÔÔ›· Ë ÁÈ·ÁÈ¿ Á·ÏÔ˘¯Ô‡ÛÂ Î·È Î·ıÔ‰ËÁÔ‡Û ÙË Ó¤· ÁÂÓÈ¿ ‰›Ï· ÛÙÔ Ù˙¿ÎÈ. ∏ ÙËÏÂfiÚ·ÛË, fï˜, ·ÓÙ› Ó· Û˘Ó¯›ÛÂÈ ÙÔÓ ÚfiÏÔ Ù˘ ÁÈ·ÁÈ¿˜, ·ÓÙ¤ÁÚ·„ ͤÓ˜ ·Ú·‰fiÛÂȘ Î·È ‹ÚˆÂ˜, Ì ·ÔÙ¤ÏÂÛÌ· Ë Ó¤· ÁÂÓÈ¿ - ÂËÚ·Ṳ̂ÓË Î·È ·fi ‰È¿ÊÔÚ˜ ¿ÏϘ ·Ú·Ì¤ÙÚÔ˘˜ - Ó· ÎÈÓ‰˘Ó‡ÂÈ Ó· ¯¿ÛÂÈ ÙËÓ Ù·˘ÙfiÙËÙ¿ Ù˘ (17). ∞Í›˙ÂÈ, ›Û˘, Ó· ·Ó·ÊÂÚı› fiÙÈ Î·Ù·Ó·ÏÒıËÎ·Ó ÂηÙÔÓÙ¿‰Â˜ ÒÚ˜ ÙËÏÂÔÙÈÎÒÓ ÂÎÔÌÒÓ, Ì ·Ú¿ı˘Ú· Î·È ÌË, ·ÊÈÂڈ̤Ó˜ Û ÙËÏÂ-·›ÁÓÈ· Î·È ÙËÏÂ-‹ıË, Û ·›ÎÙ˜ Î·È Û ÙËÏÂ-fiÚ·ÛË ÁÂÓÈÎfiÙÂÚ·. ∂›Ó·È ‰˘Û¿ÚÂÛÙÔ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÙÔ ·Ú¯ÈÎfi “ÎÈÓÔ‡Ó ·›ÙÈÔ” ·˘Ù‹˜ Ù˘ ·Ó·Î˘ÎÏÔ‡ÌÂÓ˘ “ÌÂÁ·ÏÔ·‰ÂÏÊÈ΋˜ ÊÏ˘·Ú›·˜” ‰ÂÓ Â›Ó·È Ì›· - ¤ÛÙˆ Û˘ÓÙËÚËÙÈÎÒÓ ·ÓÙ·Ó·ÎÏ·ÛÙÈÎÒÓ - ËıÈ΋ ÂͤÁÂÚÛË, ·ÏÏ¿ ¤Ó·˜ ÔÓËÚfi˜ ˘ÔÏÔÁÈÛÌfi˜, ÌÂÚ›‰ÈÔ ÛÙ· ÔÛÔÛÙ¿ ÙËÏÂı¤·Û˘ ÙˆÓ Î·Ù·ÁÁÂÏÏÔ̤ӈÓ. ∆Ô ¯ÂÈÚfiÙÂÚÔ, fï˜, Â›Ó·È fiÙÈ ·˘Ù‹ Ë ÊÏ˘·Ú›· ÌÂÙ·ı¤ÙÂÈ Î·È Â˘ÙÂÏ›˙ÂÈ ÙÔ ı¤Ì· Ì›·˜ ·Ó·Áη›·˜ Î·È ÎÚ›ÛÈÌ˘ Û˘˙‹ÙËÛ˘ Î·È Ì›·˜ ›Û˘ ·Ó·Áη›·˜, ÎÚ›ÛÈÌ˘ Î·È ÂÍ·ÈÚÂÙÈο ηı˘ÛÙÂÚË̤Ó˘, ÂÎÛ˘Á¯ÚÔÓÈÛÙÈ΋˜ Î·È ÂÎÏÔÁÈ΢ÙÈ΋˜ ·Ú¤Ì‚·Û˘ ÛÙÔ Â‰›Ô Ù˘ ÙËÏÂÔÙÈ΋˜ ·ÁÔÚ¿˜ (18). µÈ‚ÏÈÔÁÚ·Ê›· 1. ºÚ·Ù˙ÂÛο΢ °. ∂ÊËÌÂÚ›‰· ∫·ıËÌÂÚÈÓ‹. ¶ÂÚÈÔ‰ÈÎfi View: ∞ı‹Ó·; 2002. 2. ∂Á΢ÎÏÔ·›‰ÂÈ· Grand Larousse. ∂ÓfiÙËÙ· 1. ∞ı‹Ó·; 2002. ÛÂÏ. 289. 3. Greenfield MP. ª¤Û· ÂÓË̤ڈÛ˘ Î·È ·È‰›. ∞ı‹Ó·: ∂ΉfiÛÂȘ ∫Ô˘ÙÛÔ˘Ìfi˜; 1988. ÛÂÏ. 185. 4. Ferguson ES. The mind’s eye: nonverbal thought in technology. Science 1977;197:827-836. 5. Bronfenbrenner U. Who cares for American’s children? Address presented at the Conference of the National Association for the Education of Young Children; 1970. 6. Nielsen Television Index. S Report on Television Usage (A.C. Nielsen Co., Hachensack, N.J.). 7. ŸÚÁÔ˘ÂÏ ∆. O ªÂÁ¿ÏÔ˜ ∞‰ÂÏÊfi˜. ∞ı‹Ó·: ∂ΉfiÛÂȘ ∫¿ÎÙÔ˜; 1984. 8. Gadberry S. Television as baby-sitter: a field comparison of preschooler’s behavior during playtime and during television viewing. Child Dev 1974;45:1132-1136. 9. LoSciuto LA. A national inventory of television viewing behavior. In: Rubinstein EA, Comstock GA, Murray JP, editors. Television and social behavior. Vol. 4. Television in day to day life: patterns of use. Government Printing Office: Washington, DC; 1971. 10. ∞ÁÔÚ›ÙÛ· ™, ∫ˆÛÙ·Ú›‰Ô˘ ™, ™ˆÙËÚÔÔ‡ÏÔ˘ º, ª·ÓÈ¿ ¢, ∞Ó·ÛÙ·Û¤·-µÏ¿¯Ô˘ ∫. ∂›Ó·È Î·È Ù· ·È‰È¿ Ù˘ ·گ›·˜
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Ê·Ó·ÙÈÎÔ› ÙËÏÂı·٤˜; ¶·È‰È·ÙÚÈ΋ 1997;60:703-708. 11. ºÚ˘Û›Ú·-∫·ÓÈÔ‡Ú· ∂, ∞Ó·ÛÙ·Û¤·-µÏ¿¯Ô˘ ∫, ¶··ı·Ó·Û›Ô˘-∫ÏÒÓÙ˙· ¢, •˘ÔÏ˘Ù¿-∑·¯·ÚÈ¿‰Ë ∞, ª·ÙÛ·ÓÈÒÙ˘ ¡. ∏ ›‰Ú·ÛË Ù˘ ÙËÏÂfiÚ·Û˘ ÛÙ· ∂ÏÏËÓfiÔ˘Ï·, ÛÙÔ Ù¤ÏÔ˜ ÙÔ˘ 20Ô‡ ·ÈÒÓ· Î·È Ô ¶·È‰›·ÙÚÔ˜. ¶·È‰È·ÙÚÈ΋ 1993;56:300-316. 12. American Academy of Pediatrics Committee on Communications. The commercialization of children’s television. Pediatrics 1992;89:343-344. 13. Strasburger VC. Does television affect learning and school performance? Pediatrician 1986;13:141-147. 14. Winn Miller M. ∆ËÏÂfiÚ·ÛË: ¤Ó·˜ ͤÓÔ˜ ÛÙÔ Û›ÙÈ. ∞ı‹Ó·: ∂ΉfiÛÂȘ ∞ÎÚ›Ù·˜; 1996. ÛÂÏ. 19. 15. Kelly H, Gardner H. Viewing children through television. San Fransisco: Jossey-Bass; 1981.
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∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 26-08-2003 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 23-04-2004 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ¶ÚÔÎfiÈÔ˜ ∆·‚Ï·ÓÙ¿˜ §˘ÁÔ˘ÚÈfi ∞ÚÁÔÏ›‰·˜, ∆.∫. 210 52 E-mail: tziarou@otenet.gr
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ORIGINAL ARTICLE
µ·ıÌfi˜ ÁÓÒÛ˘ ÙˆÓ ÂȤ‰ˆÓ ÏÈȉ›ˆÓ ÙÔ˘ ·›Ì·ÙÔ˜ Û ÊÔÈÙËÙ¤˜ ·ÁÁÂÏÌ¿ÙˆÓ ˘Á›·˜-ÚfiÓÔÈ·˜ ™. ∞ÓÙˆÓÈ¿‰Ë˜, ™. ∫˘ÚÈ·ÎÔÔ‡ÏÔ˘, µ. ∞ÚÁ˘ÚÔÔ‡ÏÔ˘, •. ∫Ú›ÎÔ˜
Levels of knowledge of blood lipids levels in health students S. Antoniadis, S. Kyriakopoulou, V. Argyropoulou, X. Krikos
¶ÂÚ›ÏË„Ë: OÈ ˘ÔÏÔÁÈÛÌÔ› Ù˘ ¶·ÁÎfiÛÌÈ·˜ OÚÁ¿ÓˆÛ˘ ÀÁ›·˜ Û fi,ÙÈ ·ÊÔÚ¿ Ù· ÔÛÔÛÙ¿ ı·Ó¿ÙˆÓ ·fi ηډȷÁÁÂȷο ÓÔÛ‹Ì·Ù· ‰ÂÓ Â›Ó·È Î·ıfiÏÔ˘ ÂÓı·ÚÚ˘ÓÙÈÎÔ›. ¶ÚԂϤÂÙ·È fiÙÈ, ÙÔ ¤ÙÔ˜ 2020, Ù· ı·Ó·ÙËÊfiÚ· ÂÂÈÛfi‰È· ı· ÊÙ¿ÛÔ˘Ó Ù· 25.000.000. ™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‹Ù·Ó Ó· ‰ÈÂÚ¢ÓËı› Ô ‚·ıÌfi˜ ÁÓÒÛ˘ ÙˆÓ ÂȤ‰ˆÓ ÙˆÓ ÏÈȉ›ˆÓ ÙÔ˘ ·›Ì·ÙÔ˜ Û ÊÔÈÙËÙ¤˜ ·ÁÁÂÏÌ¿ÙˆÓ ˘Á›·˜-ÚfiÓÔÈ·˜, ÏfiÁˆ Ù˘ ÌÂÁ¿Ï˘ ÛËÌ·Û›·˜ ÙˆÓ ÏËÚÔÊÔÚÈÒÓ Û fi,ÙÈ ·ÊÔÚ¿ ÙËÓ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·, ηıÒ˜ Î·È ÙÔÓ ÙÚfiÔ ˙ˆ‹˜ ÙˆÓ ÔÈÎÔÁÂÓÂÈÒÓ Û ۯ¤ÛË Ì ٷ ·È‰È¿. ™ÙÔ ‰È¿ÛÙËÌ· ÙˆÓ 8 ÌËÓÒÓ Ô˘ ‰È‹ÚÎÂÛ ·˘Ù‹ Ë ÂÚÁ·Û›·, ˘Ô‚Ï‹ıËΠÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Û 1282 ÊÔÈÙËÙ¤˜. ™‡Ìʈӷ Ì ٷ ·ÔÙÂϤÛÌ·Ù·, 375 ÊÔÈÙËÙ¤˜ (29,2%) ›¯·Ó ÂϤÁÍÂÈ Ù· ›‰· ÙˆÓ ÏÈȉ›ˆÓ ÙÔ˘ ·›Ì·ÙÔ˜, ÂÓÒ 907 (70,8%) ‰ÂÓ Â›¯·Ó ÂÏÂÁ¯ı› ÔÙ¤, ·Ú’ fiÏÔ Ô˘ 503 ·fi ·˘ÙÔ‡˜ (55,4%) ÙÔ Â›¯·Ó ÛÎÂÊÙ›. ∞˘ÍË̤ӷ ÏÈ›‰È· ·›Ì·ÙÔ˜ ‚Ú¤ıËÎ·Ó Û 11 ÊÔÈÙËÙ¤˜ (2,9%). ™Â fi,ÙÈ ·ÊÔÚ¿ ÙÔÓ ÙÚfiÔ ˙ˆ‹˜ ÙÔ˘˜, 1080 (84,2%) ·ÎÔÏÔ˘ıÔ‡Û·Ó ÂχıÂÚÔ ‰È·ÈÙÔÏfiÁÈÔ, 801 (62,4%) Î·Ù·Ó¿ÏˆÓ·Ó ÎÚ¤·˜ 1-3 ÊÔÚ¤˜ ÙËÓ Â‚‰ÔÌ¿‰· Î·È 481 (37,5%) 4-7 ÊÔÚ¤˜. °·Ï·ÎÙÔÎÔÌÈο ÚÔ˚fiÓÙ·, fiˆ˜ ‚Ô‡Ù˘ÚÔ, ·¯È¿ Ù˘ÚÈ¿ Î·È Ï‹Ú˜ Á¿Ï·, ηıÒ˜ Î·È ·˘Á¿ Î·Ù·Ó¿ÏˆÓ·Ó ÂχıÂÚ· 474 ÊÔÈÙËÙ¤˜ (36,9%). ™‡Ìʈӷ Ì ÙȘ ··ÓÙ‹ÛÂȘ, 1153 (89,9%) ıˆÚÔ‡Û·Ó ··Ú·›ÙËÙÔ ÙÔÓ ¤ÏÂÁ¯Ô Ù˘ ‰È·ÙÚÔÊ‹˜ ·fi ÙËÓ ËÏÈΛ· ÙˆÓ 3-5 ÂÙÒÓ. ∫·ÓÈÛÙ¤˜ ‹Ù·Ó 419 ÊÔÈÙËÙ¤˜ (32,6%), 633 (49,3%) Á˘ÌÓ¿˙ÔÓÙ·Ó, ÂÓÒ 213 (16,6%) ‹Ù·Ó ·ıÏËÙ¤˜. °È· fiÏ· Ù· ·Ú·¿Óˆ, ÔÈ Û˘Ó‹ıÂȘ ÙˆÓ ÁÔÓ¤ˆÓ ‹Ù·Ó ·ÔÁÔËÙ¢ÙÈΤ˜. ™Â fi,ÙÈ ·ÊÔÚ¿ ÙÔ ÎÏËÚÔÓÔÌÈÎfi ÙÔ˘˜ ÈÛÙÔÚÈÎfi, ‚Ú¤ıËΠfiÙÈ ÌfiÓÔ 1 ÛÙÔ˘˜ 3 ‹ÍÂÚÂ Â¿Ó Â›¯·Ó ÂÏÂÁ¯ı› ÔÈ ÁÔÓ›˜ ÙÔ˘ ÁÈ· Ù· ›‰· ÏÈȉ›ˆÓ ÙÔ˘ ·›Ì·ÙÔ˜, ·fi ÙÔ˘˜ ÔÔ›Ô˘˜ ÙÔ 1/3 ÙˆÓ ·Ù¤ÚˆÓ ›¯Â ·ıÔÏÔÁÈΤ˜ ÙÈ̤˜, ÂÓÒ ÁÈ· fiÛÔ˘˜ ‰ÂÓ Â›¯·Ó ÂÏÂÁ¯ı› Î·È Â›¯·Ó
Abstract: The estimations of the WHO of deaths due to cardiovascular problems are discouraging. It is foreseen that by the year 2020, fatal episodes will rich the figure of 25,000,000. The objective of this study was to determine the level of knowledge in health students concerning their own blood lipid levels. The survey lasted 8 months, during which time 1282 students provided answers to a questionnaire. It was found that 375 (29.2%) had already had a check-up for their blood lipids and 907 (70.8%) had never been checked, although 503 (55.4%) were thinking of doing it some time. Increased lipid levels had been found in 11 (2.9%). In questions related to their diet and lifestyle, 1080 (84.2%) had not been taking any care about their dietary habits, and 801 (62.4%) reported eating meat 1-3 times, and 481 (37.5%) 4-7 times a week. Dairy products and eggs were consumed freely by 474 (37%). Concerning attitudes, 1153 (89.9%) answered that it is necessary to be careful about diet from the early ages of 3 and 5 years. Concerning lifestyle, 419 (32.6%) were cigarette smokers, 633 (49.3%) took part in athletic activities and 213 in competitive sports. The relevant family history and parental habits were not particularly encouraging. About 1 in 3 had knowledge of the family history. Of those, 1 in 3 of the fathers had increased lipid levels, some of whom had never had a check-up but were examined because of symptoms, in which case the consequences were rather bad. Their knowledge about their grandparents was limited; 80% knew nothing. In conclusion, although the efforts of doctors and other health authorities, as well as of the media, in disseminating information concerning the importance of prevention are not at a bad level, it is
∆Ì‹Ì· µÚÂÊÔÓËÈÔÎÔÌ›·˜ ∞ÓÒÙ·ÙÔ˘ ™.∂.À.¶. ∆.∂.π. ∞ı‹Ó·˜ ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ
Pre-School Education Department, S.E.I.P. T.E.I. of Athens 1st Department of Paediatrics, University of Athens
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¶·È‰È·ÙÚÈ΋ 2004;67:195-199
Paediatriki 2004;67:195-199
ÁÈ· ÚÒÙË ÊÔÚ¿ ÂÍÂÙ·ÛÙ› ÏfiÁˆ Û˘Ìو̿وÓ, Ù· ·ÎfiÏÔ˘ı· ‹Ù·Ó Ôχ ÛÔ‚·Ú¿. ™Â fi,ÙÈ ·ÊÔÚ¿ ÙÔ˘˜ ÁÔÓ›˜ ÙˆÓ ÁÔÓ¤ˆÓ ÙÔ˘˜, ÙÔ ÔÛÔÛÙfi ·˘ÙÒÓ Ô˘ ‰ÂÓ ÁÓÒÚÈ˙·Ó ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚÔ ·fi 80%. ™˘ÌÂÚ·ÛÌ·ÙÈο, Ê·›ÓÂÙ·È fiÙÈ ÔÈ ÚÔÛ¿ıÂȘ ÁÈ· ÂÓË̤ڈÛË ·fi ÙÔ˘˜ ÁÈ·ÙÚÔ‡˜, ÙÔ˘˜ ‰È¿ÊÔÚÔ˘˜ ˘ÁÂÈÔÓÔÌÈÎÔ‡˜ ÊÔÚ›˜, ηıÒ˜ Î·È Ù· ªª∂ Û fi,ÙÈ ·ÊÔÚ¿ ÙË ÛËÌ·Û›· Ù˘ ÚfiÏ˄˘, ¤¯Ô˘Ó ˆ˜ ¤Ó· ‚·ıÌfi ·Ô‰ÒÛÂÈ. ÃÚÂÈ¿˙ÂÙ·È, fï˜, ·ÎfiÌË ÂÚÈÛÛfiÙÂÚË ÚÔÛ¿ıÂÈ·, ÂÈÎÂÓÙÚÒÓÔÓÙ·˜ ÛÙȘ ÌÈÎÚ¤˜ ËÏÈ˘, ÛÙÔ˘˜ ·È‰È¿ÙÚÔ˘˜, ·ÏÏ¿ Î·È ÛÙÔ˘˜ ÊÔÈÙËÙ¤˜ (ÌÂÏÏÔÓÙÈÎÔ‡˜ ·ÁÁÂÏ̷ٛ˜ ˘Á›·˜), Ô‡Ùˆ˜ ÒÛÙ ӷ Á›ÓÂÈ ÁÓˆÛÙ‹ Î·È Ú·ÎÙÈο ÂÊ·ÚÌfiÛÈÌË Ë ÛËÌ·Û›· Ù˘ ¤ÁηÈÚ˘ ‰È¿ÁÓˆÛ˘ Ù˘ ˘ÂÚÏÈȉ·ÈÌ›·˜ Û fiÛÔ ÙÔ ‰˘Ó·ÙfiÓ ÌÂÁ·Ï‡ÙÂÚÔ ·ÚÈıÌfi ·ÙfïÓ.
obvious that there is need for greater promotion. This should focus on early diagnosis. Paediatricians and health workers need to be prepared in order to inform greater numbers of people to make a practice of paying attention to early diagnosis of a condition which is a major cause of death in adults, which is hereditary, and which starts from the early childhood ages of 3-5 years.
§¤ÍÂȘ ÎÏÂȉȿ: ÏÈ›‰È· ·›Ì·ÙÔ˜, ÎÏËÚÔÓÔÌÈÎfiÙËÙ·, ÁÓÒÛË, ÚfiÏË„Ë.
Key words: blood lipids, heredity, information, prevention.
∂ÈÛ·ÁˆÁ‹ ™‡Ìʈӷ Ì ÚfiÛÊ·Ù· ·ÔÙÂϤÛÌ·Ù· ÛÙ·ÙÈÛÙÈÎÒÓ Ù˘ ¶·ÁÎfiÛÌÈ·˜ OÚÁ¿ÓˆÛ˘ ÀÁ›·˜, οı 4 ‰Â˘ÙÂÚfiÏÂÙ· Û˘Ì‚·›ÓÂÈ Ì›· ηډȷ΋ ÚÔÛ‚ÔÏ‹ Î·È Î¿ı 5 ‰Â˘ÙÂÚfiÏÂÙ· ¤Ó· ÂÁÎÂÊ·ÏÈÎfi ÂÂÈÛfi‰ÈÔ. ªÂ ÙÔ˘˜ ÈÔ ÌÂÙÚÈÔ·ı›˜ Ì·ıËÌ·ÙÈÎÔ‡˜ ˘ÔÏÔÁÈÛÌÔ‡˜, Â¿Ó ‰ÂÓ ÏËÊıÔ‡Ó Ù· ηٿÏÏËÏ· ̤ÙÚ· Û fi,ÙÈ ·ÊÔÚ¿ ÙËÓ ÂÓË̤ڈÛË Î·È ÙËÓ ÚfiÏË„Ë ÁÈ· fiÛÔ ÙÔ ‰˘Ó·Ùfi ¢ڇÙÂÚ˜ ÔÌ¿‰Â˜ ÏËı˘ÛÌÔ‡, ÔÈ 17.000.000 ı¿Ó·ÙÔÈ Ô˘ ÛËÌÂÈÒıËÎ·Ó ·fi Ù· ηډȷÁÁÂȷο ÓÔÛ‹Ì·Ù· ÙÔ 1999, ı· ÊÙ¿ÛÔ˘Ó Ù· 25.000.000 ÙÔ 2020 (1,2). ™‹ÌÂÚ· Â›Ó·È ·fiÏ˘Ù· ÙÂÎÌËÚȈ̤ÓÔ fiÙÈ Ë ‰È·‰Èηۛ· Ù˘ ·ıËڈ̷ÙÔÛÎÏ‹Ú˘ÓÛ˘, Ù˘ ÛÙÂÊ·ÓÈ·›·˜ ·Ó¿ÚÎÂÈ·˜, Ù˘ ÛÙËı¿Á¯Ë˜ Î·È ÙÔ˘ ÂÌÊÚ¿ÁÌ·ÙÔ˜, Ô˘ ÚÔηÏ› ÛÔ‚·Ú¿ ÚÔ‚Ï‹Ì·Ù· Ì ηٿÏËÍË ÙËÓ ÂÂÌ‚·ÙÈ΋ ηډÈÔÏÔÁ›· (Ì·ÏÔÓ¿ÎÈ), ÙË ¯ÂÈÚÔ˘ÚÁÈ΋ ¤̂·ÛË (bypass) ‹ ·ÎfiÌË Î·È ÙÔÓ ı¿Ó·ÙÔ, ¤¯ÂÈ ÙËÓ ·Ú¯‹ Ù˘ ÛÙËÓ ·È‰È΋ ËÏÈΛ· (3,4). ¶ÚÈÓ ·fi ÂÚ›Ô˘ 10 ¯ÚfiÓÈ·, Û‡Ìʈӷ Ì ٷ Â˘Ú‹Ì·Ù· ·ıÔÏÔÁÔ·Ó·ÙÔÌÈÎÒÓ Î˘Ú›ˆ˜ ÌÂÏÂÙÒÓ, Ê¿ÓËΠfiÙÈ ÔÈ ÚÒÙ˜ ÂÓ·Ôı¤ÛÂȘ Ï›Ô˘˜ ÛÙËÓ ·ÔÚÙ‹ Â›Ó·È ÂÌÊ·Ó›˜ ·fi ÙËÓ ËÏÈΛ· ÙˆÓ 3 ÂÙÒÓ, ÂÓÒ ÛÙ· ÛÙÂÊ·ÓÈ·›· ÛÙËÓ ËÏÈΛ· ÙˆÓ 12-14 ÂÙÒÓ, Ì›· ‰È·‰Èηۛ· Ô˘ ÚÔԉ¢ÙÈο ı· ÂȉÂÈÓˆı› ÛÙȘ ÂfiÌÂÓ˜ 3-5 ‰ÂηÂٛ˜, ÁÈ· Ó· ηٷϋÍÂÈ - Û ¿ÏÏÔÙ ¿ÏÏÔ ¯ÚfiÓÔ - ÛÙË ‰ËÌÈÔ˘ÚÁ›· ÛÔ‚·ÚÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ (5). §·Ì‚¿ÓÔÓÙ·˜ ˘’ fi„ÈÓ Ù· ·Ú·¿Óˆ ÛÙÔȯ›·, Ê·›ÓÂÙ·È Î·ı·Ú¿ ÙÔ Ì¤ÁÂıÔ˜ ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ Î·È Ë ÌÂÁ¿ÏË ÛËÌ·Û›· Ù˘ ÏËÚÔÊfiÚËÛ˘ ÁÈ· ÙË Ï‹„Ë ÙˆÓ Î·Ù¿ÏÏËÏˆÓ Ì¤ÙÚˆÓ. ∂›Ó·È ÁÓˆÛÙfi fiÙÈ ÙÔ 50% ÙˆÓ Î·ÙÔ›ÎˆÓ ÙˆÓ ∏.¶.∞. Ì ˘„ËÏfi ÌÔÚʈÙÈÎfi Â›Â‰Ô ‰ÂÓ ÁÓˆÚ›˙ÂÈ ÙÔ ÏÈȉ·ÈÌÈÎfi ÙÔ˘ ÚÔÊ›Ï. ∂ÈÚfi-
ÛıÂÙ·, ¤¯ÂÈ Á›ÓÂÈ Ï¤ÔÓ ÎÔÈÓ‹ ÂÔ›ıËÛË fiÙÈ Â›Ó·È ·fiÏ˘Ù· ··Ú·›ÙËÙÔ˜ Ô ¤ÏÂÁ¯Ô˜ Û οı ·È‰› Ì ‚‚·ÚË̤ÓÔ ÎÏËÚÔÓÔÌÈÎfi ÈÛÙÔÚÈÎfi ηÈ, Ì¿ÏÈÛÙ·, fiÛÔ ÙÔ ‰˘Ó·Ùfi ÓˆÚ›ÙÂÚ·, ·fi ÙËÓ ËÏÈΛ· ÙˆÓ 3 ÂÙÒÓ. ™Ù· ·È‰È¿ Ô˘ ‰ÂÓ ˘¿Ú¯ÂÈ ÁÓˆÛÙ‹ ÎÏËÚÔÓÔÌÈ΋ ÂÈ‚¿Ú˘ÓÛË, Â›Ó·È Ôχ ¯Ú‹ÛÈÌÔ Ó· Á›ÓÂÙ·È Ô ¤ÏÂÁ¯Ô˜ Ì ÙËÓ Â˘Î·ÈÚ›· ·ÈÌÔÏË„›·˜ ÁÈ· οÔÈ· ¿ÏÏË ·ÈÙ›·. ∏ ¯ÚËÛÈÌfiÙËÙ· ÙÔ˘ ÂϤÁ¯Ô˘, Û fiÏ· ·ÓÂÍ·ÈÚ¤Ùˆ˜ Ù· ·È‰È¿, ‰ÂÓ ¤¯ÂÈ ‰È¢ÎÚÈÓÈÛÙ› ·fiÏ˘Ù· ̤¯ÚÈ ÙÒÚ·, ηıÒ˜ οÔÈÔÈ ıˆÚÔ‡Ó fiÙÈ ›Ûˆ˜ ‰ÂÓ Â›Ó·È ··Ú·›ÙËÙÔ˜, ÂÓÒ ˘¿Ú¯Ô˘Ó Î·È ·ÓÙ›ıÂÙ˜ ·fi„ÂȘ Ô˘ ÙÔ ˘ÔÛÙËÚ›˙Ô˘Ó (5). ™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÂÚÁ·Û›·˜ ‹Ù·Ó Ó· ‰ÈÂÚ¢ÓËı› Ô ‚·ıÌfi˜ ÁÓÒÛ˘ ÙˆÓ ÂȤ‰ˆÓ ÙˆÓ ÏÈȉ›ˆÓ ÙÔ˘ ·›Ì·ÙÔ˜ Û Ó·ÚÔ‡˜ ÊÔÈÙËÙ¤˜ ·ÁÁÂÏÌ¿ÙˆÓ ˘Á›·˜-ÚfiÓÔÈ·˜.
196
ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ™ÙË ÌÂϤÙË, Ë ÔÔ›· ‰È‹ÚÎÂÛ 8 Ì‹Ó˜ (01/04/2003 01/12/2003), ¤Ï·‚·Ó ̤ÚÔ˜ 1282 ÊÔÈÙËÙ¤˜ Ù˘ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ Î·È ÙÔ˘ ∆Ì‹Ì·ÙÔ˜ ÙˆÓ ∞ÓÒÙ·ÙˆÓ ™¯ÔÏÒÓ ∂·ÁÁÂÏÌ¿ÙˆÓ ÀÁ›·˜-¶ÚfiÓÔÈ·˜ ÙÔ˘ ∆.∂.π. ∞ı‹Ó·˜, ‰ËÏ·‰‹ ÊÔÈÙËÙ¤˜ ª·È¢ÙÈ΋˜, ¡ÔÛËÏ¢ÙÈ΋˜ º˘ÛÈÔıÂڷ›·˜, ∂ÚÁÔıÂڷ›·˜, µÚÂÊÔÓËÈÔÎÔÌ›·˜, ∫ÔÈÓˆÓÈ΋˜ EÚÁ·Û›·˜ Î·È π·ÙÚÈÎÒÓ ∂ÚÁ·ÛÙËÚ›ˆÓ, ËÏÈΛ·˜ 18-25 ÂÙÒÓ. ∏ ÌÂϤÙË Ú·ÁÌ·ÙÔÔÈ‹ıËΠ‚¿ÛÂÈ ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘, ÙÔ ÔÔ›Ô ‰È·ÓÂÌ‹ıËΠÛÙÔ˘˜ ÊÔÈÙËÙ¤˜ Î·È Û˘ÌÏËÚÒıËΠ·fi ·˘ÙÔ‡˜, ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ ¯ˆÚ›˜ η̛· ·Ú¤Ì‚·ÛË ÙˆÓ ÂÚ¢ÓËÙÒÓ, Û ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· 15-30 ÏÂÙÒÓ, ̤۷ ÛÙȘ ·›ıÔ˘Û˜ ‰È‰·Ûηϛ·˜ (·ÌÊÈı¤·ÙÚ·). ∆· ¤ÙË ÊÔ›ÙËÛ˘ Ô›ÎÈÏ·Ó, ÂÎÙfi˜ ·fi ÙÔ˘˜ ÊÔÈÙËÙ¤˜ Ù˘ π·ÙÚÈ΋˜, ÔÈ ÔÔ›ÔÈ ÊÔÈÙÔ‡Û·Ó ÛÙ· “ÙÚ›ÌËÓ·” ÙÔ˘ 6Ô˘ ¤ÙÔ˘˜. ¶ÔÛÔÛÙfi 95,5% ÙˆÓ Û˘ÌÌÂÙ¯fiÓÙˆÓ ‹Ù·Ó ŒÏÏËÓ˜ Î·È 4,5% ·ÏÏÔ‰·Ô›. ¢ÂÓ ˘‹ÚÍ ηӤӷ Úfi‚ÏËÌ· ˆ˜ ÚÔ˜ ÙËÓ ÚÔı˘Ì›·
May-June 04 chris new
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¶·È‰È·ÙÚÈ΋ 2004;67:195-199
ÁÈ· Û˘ÌÌÂÙÔ¯‹. ∆· ·ÔÙÂϤÛÌ·Ù· Ù˘ ¤Ú¢ӷ˜ ÚԤ΢„·Ó ̤ۈ ·Ó¿Ï˘Û˘ ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ ÙˆÓ ÂÚˆÙËÌ·ÙÔÏÔÁ›ˆÓ Û ˘ÔÏÔÁÈÛÙ‹ Ì ÙË ‚Ô‹ıÂÈ· ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ SPSS. º˘ÛÈÔÏÔÁÈΤ˜ ıˆڋıËÎ·Ó ÔÈ ÙÈ̤˜ 200 mg% ÁÈ· ÙËÓ ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË, <180 mg% ÁÈ· Ù· ÙÚÈÁÏ˘ÎÂÚ›‰È·, >45 mg% ÁÈ· ÙËÓ HDL Î·È <160 mg% ÁÈ· ÙËÓ LDL.
∞ÔÙÂϤÛÌ·Ù· ™‡Ìʈӷ Ì ٷ ·ÔÙÂϤÛÌ·Ù·, 375 ÊÔÈÙËÙ¤˜ (29,2%) ›¯·Ó ÂϤÁÍÂÈ Ù· ›‰· ÙˆÓ ÏÈȉ›ˆÓ ÙÔ˘˜ Ì›· ÊÔÚ¿, ÂÓÒ ÔÈ ˘fiÏÔÈÔÈ 907 (70,8%) ‰ÂÓ Â›¯·Ó ÂÏÂÁ¯ı› ÔÙ¤, ·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ 503 ·fi ·˘ÙÔ‡˜ (55,4%) ÙÔ Â›¯·Ó ÛÎÂÊÙ›, ÂÓÒ ÔÈ ˘fiÏÔÈÔÈ 404 (44,6%) ‰‹ÏˆÛ·Ó fiÙÈ ‰ÂÓ ÙÔ Â›¯·Ó ÛÎÂÊÙ› ÔÙ¤ Î·È ¤‰ÂÈÍ·Ó ·‰È·ÊÔÚ›·. ∞fi ÙÔ˘˜ 375 ÊÔÈÙËÙ¤˜ Ô˘ ›¯·Ó οÓÂÈ ÂÚÁ·ÛÙËÚȷΤ˜ ÂÍÂÙ¿ÛÂȘ, 11 (2,9%) ‚Ú¤ıËΠӷ ¤¯Ô˘Ó ·˘ÍË̤ӷ ›‰· ¯ÔÏËÛÙÂÚfiÏ˘ ·›Ì·ÙÔ˜, 6 (1,6%) ›¯·Ó, ›Û˘, ·˘ÍË̤ӷ ÙÚÈÁÏ˘ÎÂÚ›‰È·, ÂÓÒ 3 (0,8%) ›¯·Ó Î·È ·˘ÍË̤Ó˜ ÙÈ̤˜ ¯ÔÏËÛÙÂÚfiÏ˘ ¯·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜ (LDL). ∆· ›‰· Ù˘ ˘„ËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ¯ÔÏËÛÙÂÚfiÏ˘ (HDL) ‹Ù·Ó Û fiÏÔ˘˜ ̤۷ ÛÙ· Ê˘ÛÈÔÏÔÁÈο fiÚÈ·. ™Â fi,ÙÈ ·ÊÔÚ¿ ÙÔÓ ÙÚfiÔ ˙ˆ‹˜ Î·È ÙȘ ηıËÌÂÚÈÓ¤˜ ÙÔ˘˜ Û˘Ó‹ıÂȘ, ‚Ú¤ıËΠfiÙÈ 419 ÊÔÈÙËÙ¤˜ (32,6%) ‹Ù·Ó ηÓÈÛÙ¤˜, 633 (49,3%) Á˘ÌÓ¿˙ÔÓÙ·Ó Â›Ù Û Á˘ÌÓ·ÛÙ‹ÚÈÔ ‹ ‚·‰›˙ÔÓÙ·˜ Î·È Î¿ÓÔÓÙ·˜ Ù˙fiÁÎÈÓÁÎ, ÂÓÒ 213 (16,6%) ·ıÏÔ‡ÓÙ·Ó Û˘ÛÙËÌ·ÙÈο. ∞Ó·ÊÔÚÈο Ì ÙÔ ‰È·ÈÙÔÏfiÁÈÔ Ô˘ ·ÎÔÏÔ˘ıÔ‡Û·Ó, 801 (62,4%) ¤ÙÚˆÁ·Ó ÎÚ¤·˜ 1-3 ÊÔÚ¤˜ ÙËÓ Â‚‰ÔÌ¿‰·, ÂÓÒ 481 (37,6%) 4-7 ÊÔÚ¤˜. °·Ï·ÎÙÔÎÔÌÈο ÚÔ˚fiÓÙ·, fiˆ˜ Ï‹Ú˜ Á¿Ï·, ‚Ô‡Ù˘ÚÔ Î·È ·¯È¿ Ù˘ÚÈ¿, Î·Ù·Ó¿ÏˆÓ·Ó Î·ıËÌÂÚÈÓ¿ 474 ÊÔÈÙËÙ¤˜ (37%). ∞fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ ÂÚˆÙËı¤ÓÙˆÓ, 1080 (84%) ·ÎÔÏÔ˘ıÔ‡Û·Ó ÂχıÂÚÔ ‰È·ÈÙÔÏfiÁÈÔ, Û ·ÓÙ›ıÂÛË Ì 202 (15,8%) Ô˘ ‰‹ÏˆÛ·Ó fiÙÈ ÚfiÛ¯·Ó ÙË ‰È·ÙÚÔÊ‹ ÙÔ˘˜. ¶ÔÛÔÛÙfi 89,9% (1153 ÊÔÈÙËÙ¤˜) ıˆÚÔ‡Û ··Ú·›ÙËÙÔ Ó· ÂϤÁ¯ÂÙ·È Ë ‰È·ÙÚÔÊ‹ ·fi ÙËÓ ËÏÈΛ· ÙˆÓ 3-5 ÂÙÒÓ. OÈ ÏËÚÔÊÔڛ˜ Û¯ÂÙÈο Ì ÙÔ ÔÈÎÔÁÂÓÂÈ·ÎfiÎÏËÚÔÓÔÌÈÎfi ÈÛÙÔÚÈÎfi, fiÛÔÓ ·ÊÔÚ¿ ÛÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘˜, ÂÚÈÂÏ¿Ì‚·Ó·Ó Ù· ·ÎfiÏÔ˘ı·: ÔÛÔÛÙfi 35,4% (455 ÊÔÈÙËÙ¤˜) ‹ÍÂÚ fiÙÈ Ô ·Ù¤Ú·˜ ›¯Â ÂϤÁÍÂÈ Ù· ÏÈ›‰È¿ ÙÔ˘, 22,6% (290 ÊÔÈÙËÙ¤˜) ÁÓÒÚÈ˙ fiÙÈ ‰ÂÓ Ù· ›¯Â ÂϤÁÍÂÈ, ÂÓÒ 41,8% (537 ÊÔÈÙËÙ¤˜) ‰ÂÓ ÁÓÒÚÈ˙ ÔÙȉ‹ÔÙ ۯÂÙÈÎfi. ™Â fi,ÙÈ ·ÊÔÚ¿ ÙȘ ·ÓÙ›ÛÙÔȯ˜ ÁÓÒÛÂȘ ÁÈ· ÙË ÌËÙ¤Ú·, 409 ÊÔÈÙËÙ¤˜ (31,9%) ·¿ÓÙËÛ·Ó fiÙÈ ÁÓÒÚÈ˙·Ó fiÙÈ Ù· ›‰· ÙˆÓ ÏÈȉ›ˆÓ ›¯·Ó ÂÏÂÁ¯ı›, 288 (22,4%) fiÙÈ ‰ÂÓ Â›¯·Ó ÂÏÂÁ¯ı›, ÂÓÒ 585 (45,6%) ‰ÂÓ ÁÓÒÚÈ˙·Ó οÙÈ. ø˜ ÚÔ˜ ÙÔ ‰È·ÈÙÔÏfiÁÈÔ Ô˘ ·ÎÔÏÔ˘ıÔ‡Û·Ó ÔÈ ÁÔÓ›˜ Ê¿ÓËΠfiÙÈ 881 (68,7%) ›¯·Ó ÂÈϤÍÂÈ ÙÔ ÂχıÂÚÔ, ÂÓÒ 401 (31,3%) ÚfiÛ¯·Ó ÙË ‰È·ÙÚÔÊ‹ ÙÔ˘˜. ∫·ÓÈÛÙ¤˜ ‹Ù·Ó 579 (45,1%) ·fi ÙÔ˘˜ ·Ù¤Ú˜ Î·È 395 (30,8%) ·fi ÙȘ ÌËÙ¤Ú˜.
Paediatriki 2004;67:195-199
∞fi ÙÔ˘˜ 455 ·Ù¤Ú˜ Ô˘ ›¯·Ó ÂÏÂÁ¯ı› ˆ˜ ÚÔ˜ Ù· ›‰· ÙˆÓ ÏÈȉ›ˆÓ ÙÔ˘˜, ÔÈ 139 (30,5%) ›¯·Ó ‚ÚÂı› Ì ·ıÔÏÔÁÈΤ˜ ÙÈ̤˜ ¯ÔÏËÛÙÂÚfiÏ˘, ÔÈ 96 (21%) ›¯·Ó Ù·˘Ùfi¯ÚÔÓ· Î·È ˘„ËϤ˜ ÙÈ̤˜ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ, ÂÓÒ Ë LDL ‹Ù·Ó ·ıÔÏÔÁÈ΋ Û 46 (10%). ª›· ¿ÏÏË ÔÌ¿‰· ·ÔÙÂÏÔ‡Û·Ó ÔÈ 664 ·Ù¤Ú˜ Ô˘ ›¯·Ó ÂÍÂÙ·ÛÙ› ÁÈ· Èı·Ófi ηډÈÔÏÔÁÈÎfi Úfi‚ÏËÌ·, ¯ˆÚ›˜ ··Ú·›ÙËÙ· Ó· ¤¯ÂÈ ÚÔËÁËı› ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜. ™Â 41 ·fi ·˘ÙÔ‡˜ (6,1%) ›¯Â ‰È·ÁÓˆÛÙ› ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ˜, Û 50 (7,5%) ¤ÌÊÚ·ÁÌ·, ÂÓÒ 20 (3%) ›¯·Ó ˘Ô‚ÏËı› Û ¯ÂÈÚÔ˘ÚÁÈ΋ ¤̂·ÛË (bypass) Î·È 19 (2,8%), › ÙÔ˘ Û˘ÓfiÏÔ˘, ›¯·Ó ·Ô‚ÈÒÛÂÈ (¯ˆÚ›˜ ·ÓÙÈÌÂÙÒÈÛË ‹ ÌÂÙ¿ ·fi ·ÓÙÈÌÂÙÒÈÛË Ì ÂÂÌ‚·ÙÈ΋-¯ÂÈÚÔ˘ÚÁÈ΋ ̤ıÔ‰Ô). ™Â fi,ÙÈ ·ÊÔÚ¿ ÙȘ ÌËÙ¤Ú˜, Ù· ÔÛÔÛÙ¿ ÁÓÒÛ˘ ÁÈ· ¤ÏÂÁ¯Ô ‹Ù·Ó ÂÚ›Ô˘ ›‰È· Ì ÂΛӷ ÙˆÓ ·Ù¤ÚˆÓ, ˆÛÙfiÛÔ, Û fiϘ ÙȘ ˘fiÏÔȘ ·Ú·Ì¤ÙÚÔ˘˜ ˘‹Ú¯·Ó Ôχ ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜. ¶ÈÔ Û˘ÁÎÂÎÚÈ̤ӷ, 75 (18,3%) ·fi ÙȘ 409 ÌËÙ¤Ú˜ Ô˘ ›¯·Ó ÂϤÁÍÂÈ Ù· ÏÈ›‰È· ÙÔ˘ ·›Ì·Ùfi˜ ÙÔ˘˜ ›¯·Ó ·ıÔÏÔÁÈο ›‰· ¯ÔÏËÛÙÂÚfiÏ˘, 28 (6,8%) ›¯·Ó, ›Û˘, ˘„ËϤ˜ ÙÈ̤˜ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ, ÂÓÒ Ë LDL ‹Ù·Ó ·ıÔÏÔÁÈ΋ Û 23 (5,6%). ∞fi ÙȘ 581 ÌËÙ¤Ú˜ Ô˘ ›¯·Ó ÂÍÂÙ·ÛÙ› ÁÈ· Èı·Ófi ηډÈÔÏÔÁÈÎfi Úfi‚ÏËÌ·, 3 (0,5%) ¤·Û¯·Ó ·fi ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ Î·È 5 (0,8%) ›¯·Ó ·ÚÔ˘ÛÈ¿ÛÂÈ ¤ÌÊÚ·ÁÌ·. ª›· ÌËÙ¤Ú· (0,1%) ›¯Â ¯ÂÈÚÔ˘ÚÁËı› (bypass), ÂÓÒ 4 (0,6%) ›¯·Ó ·Ô‚ÈÒÛÂÈ. ∆¤ÏÔ˜, Û fi,ÙÈ ·ÊÔÚ¿ ÙÔ˘˜ ÁÔÓ›˜ ÙˆÓ ÁÔÓ¤ˆÓ ÙÔ˘˜, 252 ÊÔÈÙËÙ¤˜ (19,6%) ·¿ÓÙËÛ·Ó fiÙÈ ÁÓÒÚÈ˙·Ó Â¿Ó Î¿ÔÈÔ˜ ·Ô‡˜ ÙÔ˘˜ ·ÚÔ˘Û›·˙ ˘ÂÚÏÈȉ·ÈÌ›· ‹ ¤·Û¯Â ·fi ηډÈÔÏÔÁÈÎfi ÓfiÛËÌ·, ÂÓÒ ÁÈ· ÙȘ ÁÈ·ÁÈ¿‰Â˜ ÁÓÒÚÈ˙·Ó ÌfiÓÔ 176 (13,7%). ™˘˙‹ÙËÛË ∆Ô ÁÂÁÔÓfi˜ fiÙÈ ÙÔ 1/3 ÙˆÓ ÊÔÈÙËÙÒÓ Â›¯Â ÂϤÁÍÂÈ Ù· ›‰· ÙˆÓ ÏÈȉ›ˆÓ Â›Ó·È Ôχ ÛËÌ·ÓÙÈÎfi, ÂÓÒ ÂÓı·ÚÚ˘ÓÙÈÎfi Â›Ó·È Î·È ÙÔ fiÙÈ ÔÈ ÌÈÛÔ› ÂÚ›Ô˘ ·fi ÙÔ˘˜ ˘fiÏÔÈÔ˘˜ ›¯·Ó ÛÎÂÊÙ› fiÙÈ Ú¤ÂÈ Î¿ÔÈ· ÛÙÈÁÌ‹ Ó· ÂÏÂÁ¯ıÔ‡Ó. ¶·Ú’ fiÏ· ·˘Ù¿, Ê·›ÓÂÙ·È fiÙÈ ÂÚ›Ô˘ ÙÔ 1/3 ÙˆÓ Ó¤ˆÓ Ô˘ ÛÙÔ Ì¤ÏÏÔÓ ı· ·ÔÙÂϤÛÔ˘Ó ÙÔ˘˜ ·ÁÁÂÏ̷ٛ˜ ˘Á›·˜, ·ÚÔ˘ÛÈ¿˙ÂÈ Ï‹ÚË ·‰È·ÊÔÚ›· (6). ™Â ·˘Ùfi, Â›Ó·È Èı·Ófi Ó· Û˘Ì‚¿ÏÂÈ Î·È Ë ÌÈÎÚ‹ ËÏÈΛ· (7). µ¤‚·È·, ÔÈ 11 ÂÚÈÙÒÛÂȘ (2,6%) Ì ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù· ‰ÂÓ ·ÔÙÂÏÔ‡Ó ·ÓËÛ˘¯ËÙÈÎfi ÛÙÔȯ›Ô, ηıÒ˜ ÙÔ ÂӉȷʤÚÔÓ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‰ÂÓ ÂÛÙÈ·˙fiÙ·Ó ÛÙ· ÔÛÔÛÙ¿ ÙˆÓ ·ıÔÏÔÁÈÎÒÓ ÂÚÈÙÒÛÂˆÓ Û ·˘Ù¤˜ ÙȘ ËÏÈ˘, ·ÏÏ¿ ÛÙËÓ Â˘·ÈÛıËÙÔÔ›ËÛË ÙfiÛÔ ÙˆÓ Û˘ÌÌÂÙ¯fiÓÙˆÓ fiÛÔ Î·È ÙÔ˘ ÛÙÂÓÔ‡ ‹ ¢ڇÙÂÚÔ˘ ÂÚÈ‚¿ÏÏÔÓÙfi˜ ÙÔ˘˜ fiÛÔÓ ·ÊÔÚ¿ ÛÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ Úfi‚ÏËÌ· (8-10).
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¶·È‰È·ÙÚÈ΋ 2004;67:195-199
∂›Ó·È ÂÓı·ÚÚ˘ÓÙÈÎfi ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÌfiÓÔ 32,6% ‹Ù·Ó ηÓÈÛÙ¤˜, ηıÒ˜ ‰Â›¯ÓÂÈ fiÙÈ ÙÔ Û‡ÓÔÏÔ Ù˘ ·ÓÙÈηÓÈÛÙÈ΋˜ ÂÎÛÙÚ·Ù›·˜ Ô˘ Ú·ÁÌ·ÙÔÔÈÂ›Ù·È ·fi ÙÔ ÎÚ¿ÙÔ˜, ÙÔ˘˜ ÁÈ·ÙÚÔ‡˜ ‹ ¿ÏÏÔ˘˜ ˘ÁÂÈÔÓÔÌÈÎÔ‡˜ ÊÔÚ›˜ ¤¯ÂÈ Û ÌÂÁ¿ÏÔ ‚·ıÌfi ıÂÙÈο ·ÔÙÂϤÛÌ·Ù· (11). OÈ ÌÈÛÔ› ÊÔÈÙËÙ¤˜ ÂÚ›Ô˘ ‰‹ÏˆÛ·Ó fiÙÈ Á˘ÌÓ¿˙ÔÓÙ·È, ÂÓÒ ÙÔ 16,6% fiÙÈ ·ıÏÂ›Ù·È Û˘ÛÙËÌ·ÙÈο. ∫·È ÛÙȘ ‰‡Ô ÂÚÈÙÒÛÂȘ, ÔÈ ·ÚÈıÌÔ› ‰Â›¯ÓÔ˘Ó fiÙÈ Ë ·Ó·ÁηÈfiÙËÙ· Ù˘ ¿ÛÎËÛ˘ ÙÔ˘ ÛÒÌ·ÙÔ˜ ·fi οı ¿Ô„Ë ¤¯ÂÈ Á›ÓÂÈ ÎÔÈÓ‹ ÂÔ›ıËÛË (12,13). ™Â fi,ÙÈ ·ÊÔÚ¿ ÙÔ ‰È·ÈÙÔÏfiÁÈÔ, Ê·›ÓÂÙ·È fiÙÈ ˘¿Ú¯Ô˘Ó ÌÂÁ¿Ï˜ ‰È·ÊÔÚ¤˜ ÌÂٷ͇ ıˆڛ·˜ Î·È Ú¿Í˘. ŒÙÛÈ, ÂÓÒ ÙÔ 90% ÂÚ›Ô˘ ıˆÚ› fiÙÈ Â›Ó·È ··Ú·›ÙËÙÔ Ó· Â›Ó·È ÚÔÛÂÁ̤ÓË Ë ‰È·ÙÚÔÊ‹ ηÈ, Ì¿ÏÈÛÙ·, ·fi ÙËÓ ËÏÈΛ· ÙˆÓ 3-5 ÂÙÒÓ, ÌfiÓÔ ÙÔ 15,8% ÙÔ ÙËÚÔ‡ÛÂ. ∆· ÔÛÔÛÙ¿ ·˘ÙÒÓ Ô˘ Î·Ù·Ó¿ÏˆÓ·Ó Î·ıËÌÂÚÈÓ¿ ‚Ô‡Ù˘ÚÔ, ·¯È¿ Ù˘ÚÈ¿, Ï‹Ú˜ Á¿Ï·, ·˘Á¿ Î.Ï. (37%), ηıÒ˜ Î·È fiÛˆÓ ¤ÙÚˆÁ·Ó ηıËÌÂÚÈÓ¿ ÎÚ¤·˜ (37,6%) ‰ÂÓ Â›Ó·È ·ÌÂÏËÙ¤· (14-18). ∞Ó·ÊÔÚÈο Ì ÙȘ ··ÓÙ‹ÛÂȘ ÁÈ· ÙȘ Û˘Ó‹ıÂȘ ÙˆÓ ÁÔÓ¤ˆÓ ÙÔ˘˜, ‰È·ÈÛÙÒıËΠfiÙÈ ÂÚ›Ô˘ 2 ÛÙÔ˘˜ 3 ‰ÂÓ ‹ÍÂÚ·Ó Â¿Ó Â›¯Â ÂÏÂÁ¯ı› Ô ·Ù¤Ú·˜ ‹ Ë ÌËÙ¤Ú· ÙÔ˘˜ ÁÈ· Ù· ›‰· ÙˆÓ ÏÈȉ›ˆÓ ÙÔ˘ ·›Ì·ÙÔ˜, Ì ·ÔÙ¤ÏÂÛÌ· Ó· ÌËÓ ÁÓˆÚ›˙Ô˘Ó ÙÔ ÎÏËÚÔÓÔÌÈÎfi ÙÔ˘˜ ÈÛÙÔÚÈÎfi (19-21). ™Â fi,ÙÈ ¤¯ÂÈ Û¯¤ÛË Ì ÙË ‰È·ÙÚÔÊ‹, ·Ú’ fiÏÔ Ô˘ ÔÈ ÁÔÓ›˜ - Û ‰ÈÏ¿ÛÈÔ ÔÛÔÛÙfi ·fi Ù· ·È‰È¿ ÙÔ˘˜ - ÚfiÛ¯·Ó ÙÔ ‰È·ÈÙÔÏfiÁÈfi ÙÔ˘˜, Ù· ·ÔÙÂϤÛÌ·Ù· ‰ÂÓ Â›Ó·È Î·ıfiÏÔ˘ ÈηÓÔÔÈËÙÈο, Â¿Ó ÏËÊı› ˘’ fi„ÈÓ Ë ‰È·ÊÔÚ¿ ËÏÈΛ·˜ (22,23). ∆Ô ÔÛÔÛÙfi ÙˆÓ ÁÔÓ¤ˆÓ-ηÓÈÛÙÒÓ (·Ù¤Ú˜ 45,1% Î·È ÌËÙ¤Ú˜ 38,8%) ˘Ô‰ËÏÒÓÂÈ fiÙÈ, ÂÎÙfi˜ ÙˆÓ ‚Ï·‚ÒÓ Ô˘ ˘Ê›ÛÙ·ÓÙ·È ·fi ÙÔ Î¿ÓÈÛÌ·, ·ÔÙÂÏÔ‡Ó Î·Îfi ·Ú¿‰ÂÈÁÌ· ÁÈ· Ù· ·È‰È¿ ÙÔ˘˜. ∆Ô ÁÂÁÔÓfi˜ fiÙÈ ÛÙËÓ ÔÌ¿‰· ÙˆÓ ÁÔÓ¤ˆÓ Ô˘ ÂϤÁ¯ıËηÓ, 1 ÛÙÔ˘˜ 3 ·Ù¤Ú˜ ‚Ú¤ıËΠӷ ¤¯ÂÈ ˘„ËÏ¿ ›‰· ¯ÔÏËÛÙÂÚfiÏ˘ ·›Ì·ÙÔ˜, Ì fi¯È ·ÌÂÏËÙ¤·, ·ÓÙ›ÛÙÔȯ·, ÔÛÔÛÙ¿ ÛÙȘ ÌËÙ¤Ú˜, Ê·ÓÂÚÒÓÂÈ ÙËÓ ÙÂÚ¿ÛÙÈ· ÛËÌ·Û›· ÙÔ˘ ÚÔÏËÙÈÎÔ‡ ÂϤÁ¯Ô˘. ∂ÈϤÔÓ, Ë ·Í›· Ù˘ ÚfiÏ˄˘ ·˘Í¿ÓÂÙ·È ·ÎfiÌ· ÂÚÈÛÛfiÙÂÚÔ ·fi Ù· Ôχ ˘„ËÏ¿ ·ıÔÏÔÁÈο ÔÛÔÛÙ¿ ÛÙËÓ ÔÌ¿‰· ÙÔ˘ ηډÈÔÏÔÁÈÎÔ‡ ÂϤÁ¯Ô˘ Ô˘ Á›ÓÂÙ·È ÁÈ· ÚÒÙË ÊÔÚ¿ ÌÂÙ¿ ÙËÓ ÂÌÊ¿ÓÈÛË Û˘ÌÙˆÌ¿ÙˆÓ (24-27). ∆¤ÏÔ˜, ÂÚÈÛÛfiÙÂÚÔÈ ·fi ÙÔ 80% ÙˆÓ Û˘ÌÌÂÙ¯fiÓÙˆÓ ÛÙËÓ ¤Ú¢ӷ ‰ÂÓ ÁÓÒÚÈ˙·Ó Ù›ÔÙ· Û¯ÂÙÈÎfi ÁÈ· ÙÔ˘˜ ÁÔÓ›˜ ÙˆÓ ÁÔÓ¤ˆÓ ÙÔ˘˜, ÁÂÁÔÓfi˜ ·fiÏ˘Ù· ÏÔÁÈÎfi Â¿Ó ÏËÊı› ˘’ fi„ÈÓ fiÙÈ Ù· 2/3 ‰ÂÓ ‹ÍÂÚ·Ó Ô‡Ù ÁÈ· ÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘˜ (28-30). ¢È·ÈÛÙÒÓÂÙ·È, ÂÔ̤ӈ˜, fiÙÈ ·Ú’ fiÏÔ Ô˘ ÔÈ ÚÔÛ¿ıÂȘ ÂÓË̤ڈÛ˘ ÁÈ· ÙË ÛËÌ·Û›· ÙÔ˘ ÚÔ-
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ÏËÙÈÎÔ‡ ÂϤÁ¯Ô˘, ÙËÓ Ù‹ÚËÛË ˘ÁÈÂÈÓÔ‡ ‰È·ÈÙÔÏÔÁ›Ô˘, ÙË ‰È·ÎÔ‹ ÙÔ˘ ηӛÛÌ·ÙÔ˜, ÙË ÛËÌ·Û›· Ù˘ ¿ÛÎËÛ˘, ÙË ÁÓÒÛË Ù˘ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜ Î·È Î˘Ú›ˆ˜ ÙËÓ ÂÊ·ÚÌÔÁ‹ fiÏˆÓ ·˘ÙÒÓ ·fi Ôχ ÌÈÎÚ‹ ËÏÈΛ· ¤¯Ô˘Ó ˆ˜ ¤Ó·Ó ‚·ıÌfi ÂÈÙ‡¯ÂÈ, ˘¿Ú¯Ô˘Ó ·ÎfiÌ· ·ÚÎÂÙ¿ ÂÚÈıÒÚÈ· ‚ÂÏÙ›ˆÛ˘. ∂›Ó·È ÛËÌ·ÓÙÈÎfi Ó· Û˘Ó¯ÈÛÙ› Ë ÚÔÛ¿ıÂÈ· ·fi Ù· ªª∂, ÙÔ˘˜ ·ÁÁÂÏ̷ٛ˜ ˘Á›·˜-ÚfiÓÔÈ·˜, ÙÔ˘˜ ÁÔÓ›˜, ÙÔ˘˜ ÂÎ·È‰Â˘ÙÈÎÔ‡˜, ηıÒ˜ Î·È ÙÔ˘˜ ˘fiÏÔÈÔ˘˜ ˘ÁÂÈÔÓÔÌÈÎÔ‡˜ ÊÔÚ›˜ Î·È Ó· ÂÓÙ·ı›, ÂÈÎÂÓÙÚÒÓÔÓÙ·˜ ȉȷ›ÙÂÚ· ÛÙ· ·È‰È¿, ÍÂÎÈÓÒÓÙ·˜ ·fi ÙËÓ ËÏÈΛ· ÙˆÓ 3 ÂÙÒÓ. ªÂÁ·Ï‡ÙÂÚË ÛËÌ·Û›·, ˆÛÙfiÛÔ, ¤¯ÂÈ Ë ÚÔÂÙÔÈÌ·Û›· Î·È Ë ÂÓË̤ڈÛË ÙˆÓ ÊÔÈÙËÙÒÓ Ô˘ ı· ·ÔÙÂϤÛÔ˘Ó ÙÔ˘˜ ÌÂÏÏÔÓÙÈÎÔ‡˜ ·ÁÁÂÏ̷ٛ˜ ˘Á›·˜, ηıÒ˜ - ÂÊ·ÚÌfi˙ÔÓÙ·˜ ÙËÓ Ù·ÎÙÈ΋ Ù˘ ÚfiÏ˄˘ ÁÈ· ÙÔÓ Â·˘Ùfi ÙÔ˘˜ - ÌÔÚÔ‡Ó Ó· ÌÂÙ·‰ÒÛÔ˘Ó ÙË ÁÓÒÛË Î·È ÙȘ Û˘Ó‹ıÂȤ˜ ÙÔ˘˜, ÙfiÛÔ ÛÙÔ ¿ÌÂÛÔ fiÛÔ Î·È ÛÙÔ Â˘Ú‡ÙÂÚÔ ÎÔÈÓˆÓÈÎfi ÙÔ˘˜ ÂÚÈ‚¿ÏÏÔÓ. µÈ‚ÏÈÔÁÚ·Ê›· 1. ∞ÓÙˆÓ·ÎÔ‡‰Ë˜ Ã. ¶ÚfiÏË„Ë ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘: ÙÔ ÌÂÁ¿ÏÔ ÊÈ¿ÛÎÔ ÙˆÓ Î·Ú‰ÈÔÏfiÁˆÓ. ∫·È, fï˜, Ë ÚfiÏË„Ë Â›Ó·È Ë ÌfiÓË Ï‡ÛË. ∂ÏÏ ÿ‰Ú ∫·Ú‰ÈÔÏÔÁ›·˜ 2003;12:5-6. 2. Fruchart JC. Handbook of dyslipidemia and atherosclerosis. Paris: Excerpta Medica Publications; 2002. 3. Celermayer DS, Sorensen KA, Deanfield JE. Atherosclerosis a disease that begins in childhood [editorial]. Cardiol Young 1994;4:224-227. 4. Palinski W, Napoli C. The fetal origins of atherosclerosis: maternal hypercholesterolemia, and cholesterol-lowering or antioxidant treatment during pregnancy influence in utero programming and postnatal susceptibility to atherogenesis. FASEB J 2002;16:1348-1360. 5. Newburger JW. Dyslipidemia in childhood and adolescence. In: Fyler DC, editor. Nadas’ Pediatric cardiology. Philadelphia: Hanley & Belfus Inc; 1992. p. 285. 6. Muhonen LA, Burns TL, Nelson RP, Lauer RM. Coronary risk factors in adolescents related to their knowledge of familial coronary heart disease and hypercholesterolemia: the Muscatine study. Pediatrics 1994;93:444-451. 7. Tershakovec AM, Jawad AF, Stallings VA, Cortner JA, Zemel BS, Shannon BM. Age-related changes in cardiovascular disease risk factors of hypercholesterolemic children. J Pediatr 1998;132:414-420. 8. Harrell JS, McMurray RG, Bangdiwala SI, Frauman AC, Gansky SA, Bradley CB. Effects of a school-based intervention to reduce cardiovascular disease risk factors in elementary-school children: the Cardiovascular Health in Children (CHIC) study. J Pediatr 1996;128:797-805. 9. Bonow RO. Primary prevention of cardiovascular disease: a call to action. Circulation 2002;106:3140-3141. 10. Tuzcu EM, Kapadia SR, Tutar E, Ziada KM, Hobbs RE, McCarthy PM et al. High prevalence of coronary atherosclerosis in asymptomatic teenagers and young adults: evidence from intravascular ultrasound. Circulation 2001;103:2705-2710.
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11. Berenson GS, Srinivasan SR, Bao W, Newman WP 3rd, Tracy RE, Wattigney WA. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. N Engl J Med 1998;338:1650-1656. 12. Gaziano JM. When should heart disease prevention begin? N Engl J Med 1998;338:1690-1692. 13. LaRosa JC. Prevention and treatment of coronary heart disease: who benefits? Circulation 2001;104:1688-1692. 14. Freedman DS, Khan LK, Dietz WH, Srinivasan SR, Berenson GS. Relationship of childhood obesity to coronary heart disease risk factors in adulthood. The Bogalusa Heart Study. Pediatrics 2001;108:712-718. 15. Teixeira PJ, Sardinha LB, Going SB, Lohman TG. Total and regional fat and serum cardiovascular disease risk factors in lean and obese children and adolescents. Obes Res 2001;9:432-442. 16. Ball EJ, O’Connor J, Abbott R, Steinbeck KS, Davies PS, Wishart C et al. Total energy expenditure, body fatness, and physical activity in children aged 6-9 y. Am J Clin Nutr 2001;74:524-528. 17. Freedman DS, Srinivasan SR, Valdez RA, Williamson DF, Berenson GS. Secular increases in relative weight and adiposity among children over two decades. The Bogalusa Heart Study. Pediatrics 1997;99:420-426. 18. Muratova VN, Islam SS, Spangler EC, Demerath EW, Neal WA. Cholesterol screening in children and family history of coronary heart disease [poster presentation abstract]. Circulation 2001;103:1369. 19. Resnicow K, Cross D. Are parents’ self-reported total cholesterol levels useful in identifying children with hyperlipidemia? An examination of current guidelines. Pediatrics 1993;92:347-353. 20. Griffin TC, Christoffel KK, Binns HJ, McGuire PA. Family history evaluation as a predictive screen for childhood hypercholesterolemia. Pediatric Practice Research Group. Pediatrics 1989;84:365-373. 21. Ketomaki A, Gylling H, Siimes MA, Vuorio A, Miettinen TA. Squalene and noncholesterol sterols in serum and lipoproteins of children with and without familial hypercholesterolemia. Pediatr Res 2003;53:648-653.
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22. Raman RP. Obesity and health risks. J Am Coll Nutr 2002;21:S134-S139. 23. Nicklas TA, Baranowski T, Cullen KW, Berenson G. Eating patterns, dietary quality and obesity. J Am Coll Nutr 2001;20:599-608. 24. Wadowski SJ, Karp RJ, Murray-Bachmann R, Senft C. Family history of coronary artery disease and cholesterol: screening children in a disadvantaged inner-city population. Pediatrics 1994;93:109-113. 25. Tonstad S, Refsum H, Sivertsen M, Christophersen B, Ose L, Ueland PM. Relation of total homocysteine and lipid levels in children to premature cardiovascular death in male relatives. Pediatr Res 1996;40:47-52. 26. Arashiro R, Katsuren K, Maung KK, Fukuyama S, Ohta T. Effect of a common mutation (D442G) of the cholesteryl ester transfer protein gene on lipids and lipoproteins in children. Pediatr Res 2001;50:455-459. 27. Gidding SS. The aging of the cardiovascular system: when should children be treated like adults? J Pediatr 2002;141:159-161. 28. Humphries SE, Mailly F, Gudnason V, Talmud P. The molecular genetics of pediatric lipid disorders: recent progress and future research directions. Pediatr Res 1993;34:403-415. 29. Greenland P, Gidding SS, Tracy RP. Commentary: lifelong prevention of atherosclerosis: the critical importance of major risk factor exposures. Int J Epidemiol 2002;31:1129-1134. 30. Tonstad S, Novik TS, Vandvik IH. Psychosocial function during treatment for familial hypercholesterolemia. Pediatrics 1996;98:249-255.
∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 25-10-2003 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 15-03-2004 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ™Ù¤ÏÈÔ˜ ∞ÓÙˆÓÈ¿‰Ë˜ ∏Ú·ÎÏ›ÙÔ˘ 4, ∆.∫. 106 73, ∫ÔψӿÎÈ
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Paediatriki 2004;67:200-204
CASE REPORT
∫ÏËÚÔÓÔÌÈ΋ ·ÈÌÔÚÚ·ÁÈ΋ ÙËÏ·ÁÁÂÈÂÎÙ·Û›· (Û‡Ó‰ÚÔÌÔ Rendu-Osler-Weber). ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ Î·È ·Ó·ÛÎfiËÛË Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜ ™. ª¿Ú·Î·, ∂. ™·Úȉ¿Î˘, µ. ∞ÁÁÂÏ¿ÎÔ˘, ™. ª¿ÎˆÛË, °. µÏ·¯¿ÎË, ∂. ∫fiÎÔÚË
Hereditary haemorrhagic telangiectasia (Rendu-Osler-Weber syndrome). Case report and review of the literature S. Maraka, E. Saridakis, V. Aggelakou, S. Bakosi, G. Vlahaki, E. Kokori
¶ÂÚ›ÏË„Ë: ∏ ÎÏËÚÔÓÔÌÈ΋ ·ÈÌÔÚÚ·ÁÈ΋ ÙËÏ·ÁÁÂÈÂÎÙ·Û›·, ÁÓˆÛÙ‹ Î·È ˆ˜ Û‡Ó‰ÚÔÌÔ Rendu-OslerWeber, ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÙËÓ Ù˘È΋ ÎÏÈÓÈ΋ ÙÚÈ¿‰·: ÔÏϷϤ˜ ÙËÏ·ÁÁÂÈÂÎٷۛ˜, ˘ÔÙÚÔÈ¿˙ÔÓÙ· ÂÂÈÛfi‰È· ›ÛÙ·Í˘ Î·È ıÂÙÈÎfi ÎÏËÚÔÓÔÌÈÎfi ÈÛÙÔÚÈÎfi. ∫ÏËÚÔÓÔÌÂ›Ù·È Ì ÙÔÓ ·˘ÙÔۈ̷ÙÈÎfi ÂÈÎÚ·ÙÔ‡ÓÙ· Ù‡Ô ÌÂÙ·‚›‚·Û˘. ∏ ·ÚÔ˘Û›· ·ÚÙËÚÈÔÊÏ‚ÈÎÒÓ ‰˘ÛÏ·ÛÈÒÓ Û ‰È¿ÊÔÚ· fiÚÁ·Ó· Î·È Ë ·ÈÌÔÚÚ·Á›· Ô˘ ÌÔÚ› Ó· ÚÔÎÏËı›, ·ÔÙÂÏÔ‡Ó ÙËÓ Î‡ÚÈ· ·ÈÙ›· ÓÔÛËÚfiÙËÙ·˜ Î·È ıÓËÙfiÙËÙ·˜. ∏ ÚÈÓÔÚÚ·Á›· ·ÔÙÂÏ› ÙËÓ ÚÒÙË ÂΉ‹ÏˆÛË Ù˘ ÓfiÛÔ˘ ÛÙÔ 80% ÙˆÓ ÂÚÈÙÒÛˆÓ. ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ÎÔÚÈÙÛÈÔ‡ ËÏÈΛ·˜ 15 ÌËÓÒÓ Ì ·ÈÌfiÙ˘ÛË Î·È Â›ÛÙ·ÍË Ô˘ ÏËÚÔ‡Û ٷ ÎÚÈÙ‹ÚÈ· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Rendu-Osler-Weber Î·È Á›ÓÂÙ·È ·Ó·ÛÎfiËÛË Ù˘ ÚfiÛÊ·Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜.
Abstract: Hereditary haemorrhagic telangiectasia, also known as the Rendu-Osler-Weber syndrome, is an autosomal dominant disorder, typically identified by the triad of multiple telangiectasias, recurrent epistaxis and familial occurrence. The major cause of morbidity and mortality due to this disorder lies in the presence of multiorgan arteriovenous malformations and the associated haemorrhages. Nasal bleeding is the first manifestation of the disease in about 80% of cases. The case of a 15 month-old female is reported, who presented with haemoptysis and epistaxis and had all the diagnostic criteria of RenduOsler-Weber syndrome. A review of the recent bibliography on Rendu-Osler-Weber syndrome is presented.
§¤ÍÂȘ ÎÏÂȉȿ: ÎÏËÚÔÓÔÌÈ΋ ·ÈÌÔÚÚ·ÁÈ΋ ÙËÏ·ÁÁÂÈÂÎÙ·Û›·, Û‡Ó‰ÚÔÌÔ Rendu-Osler-Weber, ÚÈÓÔÚÚ·Á›·, ›ÛÙ·ÍË, ·ÚÙËÚÈÔÊÏ‚҉ÂȘ ‰˘ÛϷۛ˜.
Key words: hereditary haemorrhagic telangiectasia, Rendu-Osler-Weber disease, nasal bleeding, epistaxis, arteriovenous malformations.
∂ÈÛ·ÁˆÁ‹ ∏ ÎÏËÚÔÓÔÌÈ΋ ·ÈÌÔÚÚ·ÁÈ΋ ÙËÏ·ÁÁÂÈÂÎÙ·Û›· Â›Ó·È Ì›· Û¿ÓÈ· ÓfiÛÔ˜, Ô˘ Û˘¯ÓfiÙÂÚ· ÂÌÊ·Ó›˙ÂÙ·È Ì ·ÈÌÔÚÚ·Á›· Î·È ·Ó·ÈÌ›·. O Rendu ÙÔ 1896, Ô Osler ÙÔ 1901 Î·È Ô Weber ÙÔ 1907, ‰È·‰Ô¯Èο, ÂÚȤÁÚ·„·Ó ·˘Ù‹ ÙË ÓfiÛÔ, ÁÓˆÛÙ‹ Î·È ˆ˜ Û‡Ó‰ÚÔÌÔ Rendu-Osler-Weber (1). ∫ÏËÚÔÓÔÌÂ›Ù·È Ì ·˘ÙÔۈ̷ÙÈÎfi ÂÈÎÚ·ÙÔ‡ÓÙ· Ù‡Ô Î·È ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÙËÓ Ù˘È΋ ÎÏÈÓÈ΋ ÙÚÈ¿‰·: ÔÏϷϤ˜ ÙËÏ·ÁÁÂÈÂÎٷۛ˜, ˘ÔÙÚÔÈ¿˙ÔÓÙ· ÂÂÈÛfi‰È· ›ÛÙ·Í˘ Î·È ıÂÙÈÎfi ÎÏËÚÔÓÔÌÈÎfi ÈÛÙÔÚÈÎfi (1-3). ∏ ›وÛË Ù˘ ÓfiÛÔ˘ ˘ÔÏÔÁ›˙ÂÙ·È Û 1-2 ÂÚÈÙÒÛÂȘ ·Ó¿ 100.000 ¿ÙÔÌ· (1,2). Œ¯Ô˘Ó ÌÂÏÂÙËı› ‰‡Ô Ù‡ÔÈ Ù˘ ÓfiÛÔ˘, Ô˘ ıˆÚÂ›Ù·È fiÙÈ ÔÊ›ÏÔÓÙ·È Û ÌÂÙ·Ï-
Ï¿ÍÂȘ ÛÙ· ÁÔÓ›‰È· Ù˘ ÂÓ‰ÔÁÏ›Ó˘ Î·È Ù˘ ALK-1 (activin receptor-like kinase 1) (3,4). ∏ ÚÈÓÔÚÚ·Á›· ·ÔÙÂÏ› ÙËÓ ÚÒÙË ÂΉ‹ÏˆÛË Ù˘ ÓfiÛÔ˘ ÛÙÔ 80% ÙˆÓ ÂÚÈÙÒÛÂˆÓ (2). ™ÙÔ 15-20% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ·Ú·ÙËÚÔ‡ÓÙ·È ÌÈÎÚ¤˜ ‹ ÌÂÁ¿Ï˜ Ó¢ÌÔÓÈΤ˜ ·ÚÙËÚÈÔÊÏ‚҉ÂȘ ‰˘ÛϷۛ˜, Ô˘ ÌÔÚ› Ó· ÂΉËψıÔ‡Ó Ì ·ÈÌfiÙ˘ÛË ‹ Î·È ˘ÔÍ·ÈÌ›· (5,6). OÈ ·ÛıÂÓ›˜ Ì ÎÏËÚÔÓÔÌÈ΋ ·ÈÌÔÚÚ·ÁÈ΋ ÙËÏ·ÁÁÂÈÂÎÙ·Û›· ¤¯Ô˘Ó Ê˘ÛÈÔÏÔÁÈ΋ ÏÂÈÙÔ˘ÚÁ›· ·ÈÌÔÂÙ·Ï›ˆÓ Î·È ËÎÙÈÎfiÙËÙ· ·›Ì·ÙÔ˜ (2). ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ÎÔÚÈÙÛÈÔ‡ ËÏÈΛ·˜ 15 ÌËÓÒÓ, Ô˘ ÂÌÊ¿ÓÈÛ ‰‡Ô ÂÂÈÛfi‰È· ·ÈÌfiÙ˘Û˘, ÂÓÒ ÛÙÔ ·ÙÔÌÈÎfi ·Ó·ÌÓËÛÙÈÎfi ÙÔ˘ ·Ó·Ê¤ÚÂÙ·È ¤Ó· ÂÂÈÛfi‰ÈÔ Â›ÛÙ·Í˘. ∆Ô ÎÔÚ›ÙÛÈ ÏËÚÔ‡Û ٷ
∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋, µÂÓÈ˙¤ÏÂÈÔ ¡ÔÛÔÎÔÌÂ›Ô ∏Ú·ÎÏ›Ԣ ∫Ú‹Ù˘
1st Paediatric Clinic, Venizelion General Hospital of Heraklion, Crete
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¶·È‰È·ÙÚÈ΋ 2004;67:200-204
Paediatriki 2004;67:200-204
ÎÏÈÓÈο ‰È·ÁÓˆÛÙÈο ÎÚÈÙ‹ÚÈ· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Rendu-Osler-Weber. ™˘˙ËÙÔ‡ÓÙ·È Ë ÌÔÚȷ΋ ‚¿ÛË, ÔÈ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ, Ë ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË, Ù· ‰È·ÁÓˆÛÙÈο ÎÚÈÙ‹ÚÈ·, ηıÒ˜ Î·È Ë ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘. ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ∫ÔÚ›ÙÛÈ ËÏÈΛ·˜ 15 ÌËÓÒÓ ÚÔÛ‹Ïı ÛÙËÓ ÎÏÈÓÈ΋ ÏfiÁˆ ·Ô‚ÔÏ‹˜ ÌÂÁ¿Ï˘ ÔÛfiÙËÙ·˜ ·›Ì·ÙÔ˜, ˙ˆËÚÔ‡ ÎfiÎÎÈÓÔ˘ ¯ÚÒÌ·ÙÔ˜, ·fi ÙÔ ÛÙfiÌ·. ∞fi ÙÔ ·ÙÔÌÈÎfi ·Ó·ÌÓËÛÙÈÎfi ·Ó·Ê¤ÚÂÙ·È fiÙÈ ÁÂÓÓ‹ıËΠÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ÙÔÎÂÙfi Î·È ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ 3,45 kg, ÌÂÙ¿ ·fi ÙÂÏÂÈfiÌËÓË - ¯ˆÚ›˜ ȉȷ›ÙÂÚ· ÚÔ‚Ï‹Ì·Ù· - ·ËÛË Î·È Â›¯Â Ê˘ÛÈÔÏÔÁÈ΋ ÂÚÈÁÂÓÓËÙÈ΋ ÂÚ›Ô‰Ô. ™Â ËÏÈΛ· 2 ÌËÓÒÓ ÂÌÊ¿ÓÈÛ ÌÈÎÚ¤˜ ÂÚ˘ıÚ¤˜ ÎËÏ›‰Â˜, ·Ú¯Èο ÛÙÔ ÚfiÛˆÔ Î·È ÛÙË Û˘Ó¤¯ÂÈ· ÛÙÔÓ ÙÚ¿¯ËÏÔ Î·È Ù· ¿ÎÚ·. ™Â ËÏÈΛ· 11 ÌËÓÒÓ ¤ÁÈÓ ‚ÈÔ„›· ‰¤ÚÌ·ÙÔ˜ Î·È ıˆڋıËΠÈı·Ó‹ Ë ‰È¿ÁÓˆÛË Ù˘ Ì·ÛÙÔ΢ÙÙ¿ÚˆÛ˘. ª›· ‚‰ÔÌ¿‰· ÚÔ Ù˘ ÂÈÛ·ÁˆÁ‹˜ ·Ó·Ê¤ÚÂÙ·È ¤Ó· ÂÂÈÛfi‰ÈÔ ·ÈÌfiÙ˘Û˘ Î·È ÚÈÓÔÚÚ·Á›·˜, ÙÔ ÔÔ›Ô ·Ô‰fiıËΠ۠Èı·Ó‹ οΈÛË Ù˘ ÎÂÊ·Ï‹˜, ÌÂÙ¿ ·fi ÙÒÛË ÛÙÔ ¤‰·ÊÔ˜. ∆fiÙÂ, ÂÎÙfi˜ ·fi ·ÎÙÈÓÔÁÚ·Ê›· ÎÚ·Ó›Ô˘, ‰ÂÓ ¤ÁÈÓ ÂÚ·ÈÙ¤Úˆ ¤ÏÂÁ¯Ô˜. ∞fi ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ·Ó·ÌÓËÛÙÈÎfi ·Ó·Ê¤ÚÂÙ·È fiÙÈ Ë ÌËÙ¤Ú· ÂÌÊ·Ó›˙ÂÈ ‰‡Ô ÙËÏ·ÁÁÂÈÂÎÙ·ÛÈΤ˜ ‚Ï¿‚˜ ÛÙȘ ¿ÎÚ˜ ¯Â›Ú˜ Î·È Û˘¯Ó¿ ÂÂÈÛfi‰È· ÚÈÓÈÎÒÓ ÂÈÛٿ͈Ó, ÂÓÒ Ë ÁÈ·ÁÈ¿ (·fi ÙË ÌËÙ¤Ú·) Ì›· ÙËÏ·ÁÁÂÈÂÎÙ·ÛÈ΋ ‚Ï¿‚Ë ÛÙËÓ ÂÚÈÔ¯‹ Ù˘ ÚÈÓfi˜. ∏ ÂͤٷÛË Î·Ù¿ Û˘ÛÙ‹Ì·Ù· ‰ÂÓ ¤‰ÂÈÍ ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·, ÏËÓ ‰È¿Û·ÚÙˆÓ ÂÚ˘ıÚÒÓ ÎËÏ›‰ˆÓ ÌÈÎÚ‹˜ ‰È·Ì¤ÙÚÔ˘ ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ÚÔÛÒÔ˘ Î·È ÙˆÓ ¿Óˆ Î·È Î¿Ùˆ ¿ÎÚˆÓ. ∏ ·ÚÙËÚȷ΋ ›ÂÛË ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋ Î·È Ô ‰È·‰ÂÚÌÈÎfi˜ ÎÔÚÂÛÌfi˜ O2 (SatO2) ‹Ù·Ó 98%. ∆Ô ·È‰› ÂÍÂÙ¿ÛÙËΠ·fi ˆÙÔÚÈÓÔÏ·Ú˘ÁÁÔÏfiÁÔ, ·ÏÏ¿ ‰ÂÓ ‚Ú¤ıËΠÂÛÙ›· ·ÈÌÔÚÚ·Á›·˜. ∞fi ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô, Ô˘ ¤ÁÈÓ ÙËÓ Ë̤ڷ Ù˘ ÂÈÛ·ÁˆÁ‹˜ ÙÔ˘ ·È‰ÈÔ‡ ÛÙËÓ ÎÏÈÓÈ΋, ‰È·ÈÛÙÒıËηÓ: ·ÈÌÔÛÊ·ÈÚ›ÓË: 12,1 g/dl, ·ÈÌ·ÙÔÎÚ›Ù˘: 34%, ·ÈÌÔÂÙ¿ÏÈ·: 578.000/mm3 Î·È ∆∫∂: 10 mm/1Ë ÒÚ·. ∞fi ÙÔÓ ¤ÏÂÁ¯Ô ËÎÙÈÎfiÙËÙ·˜ ÙÔ˘ ·›Ì·ÙÔ˜, ‰È·ÈÛÙÒıËÎÂ: PT: 12,6”, INR: 1,16, APTT: 32,6” Î·È ÈÓˆ‰ÔÁfiÓÔ: 203 mg/dl. ™ÙËÓ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ ‰È·ÈÛÙÒıËΠ›ٷÛË ÙˆÓ Î˘„ÂÏȉÈÎÒÓ ÛÙÔȯ›ˆÓ ÛÙÔÓ ‰ÂÍÈfi Ó‡ÌÔÓ· (∂ÈÎfiÓ· 1). §›Á˜ ÒÚ˜ ÌÂÙ¿ ÙËÓ Â›ÛÔ‰fi ÙÔ˘ ÛÙÔ ÓÔÛÔÎÔÌ›Ô, ÙÔ ÎÔÚ›ÙÛÈ ·ÚÔ˘Û›·ÛÂ Ó¤Ô ÂÂÈÛfi‰ÈÔ ·Ô‚ÔÏ‹˜ ·›Ì·ÙÔ˜ ·fi ÙÔ ÛÙfiÌ·, ‰È¿ÚÎÂÈ·˜ 2-3 min, ÌÂ Û˘ÓÔ‰fi ¤ÓÙÔÓË ·ÓËÛ˘¯›· Î·È ˘ÁÚÔ‡˜ ÚfiÁ¯Ô˘˜ ·fi ÙËÓ ·ÎÚfi·ÛË ÙÔ˘ ıÒڷη. ∏ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ıÒڷη ·Ó¤‰ÂÈÍ ÂÚÈÔ¯‹ ‡ÎÓˆÛ˘ ÛÙÔ Ô›ÛıÈÔ Î·È ¤Íˆ ÙÌ‹Ì· ÙÔ˘ ‰ÂÍÈÔ‡ οو ÏÔ‚Ô‡, ÂÓÙfi˜ Ù˘
∂ÈÎfiÓ· 1. ∞ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜: ›ٷÛË ÙˆÓ Î˘„ÂÏȉÈÎÒÓ ÛÙÔȯ›ˆÓ ÛÙÔÓ ‰ÂÍÈfi Ó‡ÌÔÓ·.
ÔÔ›·˜ ‰ÈÓfiÙ·Ó Ë ÂÓÙ‡ˆÛË ·ÚÔ˘Û›·˜ ‰È·ÙÂٷ̤ÓÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ·ÁÁÂÈ·ÎÔ‡ ÎÏ¿‰Ô˘ (∂ÈÎfiÓ· 2). ªÂ ÙËÓ ˘Ô„›· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Ù˘ ÎÏËÚÔÓÔÌÈ΋˜ ·ÈÌÔÚÚ·ÁÈ΋˜ ÙËÏ·ÁÁÂÈÂÎÙ·Û›·˜, ÙÔ ·È‰› ÌÂٷʤÚıËÎÂ, ÙÔ 3Ô 24ˆÚÔ Ù˘ ÓÔÛËÏ›·˜ ÙÔ˘, Û ÓÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ ÙˆÓ ∞ıËÓÒÓ, ÁÈ· ÂÚ·ÈÙ¤Úˆ ¤ÏÂÁ¯Ô Î·È ·ÓÙÈÌÂÙÒÈÛË Èı·ÓÔ‡ ÂÂÈÛÔ‰›Ô˘ ·ÈÌÔÚÚ·Á›·˜. ŒÁÈÓ ÈÛÙÔÏÔÁÈ΋ ÂͤٷÛË ‰ÂÚÌ·ÙÈ΋˜ ‚Ï¿‚˘, Ë ÔÔ›· ¤‰ÂÈÍ ÂÈÎfiÓ· ÙËÏ·ÁÁÂÈÂÎÙ·Û›·˜. ™ÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜ Î·È Î·Ú‰È¿˜, Ù· Â˘Ú‹Ì·Ù· ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο. OÈ ÁÔÓ›˜ ·ÚÓ‹ıËÎ·Ó Ó· Û˘Ó¯ÈÛÙ› Ô ¤ÏÂÁ¯Ô˜ Ì ̷ÁÓËÙÈ΋ ·ÁÁÂÈÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ Î·È ÂÎÏÂÎÙÈ΋ ·ÁÁÂÈÔÁÚ·Ê›· Ó¢ÌfiÓˆÓ, fiˆ˜ Û˘ÓÂÛÙ‹ıË. ∆Ô ·È‰› ·Ú¤ÌÂÈÓ Û ηϋ ÁÂÓÈ΋ ηٿÛÙ·ÛË Î·ı’ fiÏË ÙË ‰È¿ÚÎÂÈ· Ù˘ ÓÔÛËÏ›·˜ ÙÔ˘ Î·È ‹Ù·Ó ˙ˆËÚfi ÌÂٷ͇ ÙˆÓ ÂÂÈÛÔ‰›ˆÓ, ¯ˆÚ›˜ Â˘Ú‹Ì·Ù· ·fi ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË. ∆Ô ·È‰› ·Ú·ÎÔÏÔ˘ıÂ›Ù·È Û ٷÎÙÈο ¯ÚÔÓÈο ‰È·ÛÙ‹Ì·Ù·, ÎÏÈÓÈο Î·È ÂÚÁ·ÛÙËÚȷο, ÁÈ· Ù˘¯fiÓ ÂÌÊ¿ÓÈÛË Ó¤ˆÓ Û˘Ìو̿وÓ. ™˘˙‹ÙËÛË ∏ ÎÏËÚÔÓÔÌÈ΋ ·ÈÌÔÚÚ·ÁÈ΋ ÙËÏ·ÁÁÂÈÂÎÙ·Û›· ‹ Û‡Ó‰ÚÔÌÔ Rendu-Osler-Weber ·ÔÙÂÏ› ¤Ó· Û¿ÓÈÔ ÎÏËÚÔÓÔÌÈÎfi ÓfiÛËÌ·, Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÙËÓ ·ÚÔ˘Û›· ÔÏÏ·ÏÒÓ ·ÚÙËÚÈÔÊÏ‚ÈÎÒÓ ‰˘ÛÏ·ÛÈÒÓ, ÔÈ Ôԛ˜ ÌÔÚ› Ó· ·ÊÔÚÔ‡Ó ÛÙÔ ‰¤ÚÌ·, ÛÙÔ˘˜ ‚ÏÂÓÓÔÁfiÓÔ˘˜, ÛÙ· ÛÏ¿¯Ó· Î·È ÛÙÔÓ ÂÁΤʷÏÔ. ∏ ÛÔ‚·ÚfiÙËÙ· Ù˘ ÓfiÛÔ˘ ÂÍ·ÚÙ¿Ù·È ·fi ÙÔ fiÚÁ·ÓÔ Ô˘ ÚÔÛ‚¿ÏÏÂÙ·È. ŒÙÛÈ, Ë ÎÏÈÓÈ΋ ¤ÎÊÚ·ÛË Ù˘ ÓfiÛÔ˘ ÔÈΛÏÏÂÈ ·fi ÙËÏ·ÁÁÂÈÂÎٷۛ˜ ÛÙÔ ‰¤ÚÌ· Î·È ÙÔ˘˜ ‚ÏÂÓÓÔÁfiÓÔ˘˜, ̤¯ÚÈ ÌÂÁ¿Ï˜ ·ÚÙËÚÈÔÊÏ‚҉ÂȘ ‰˘ÛϷۛ˜ Î·È ÛÔ‚·Ú‹ ·˘ÙfiÌ·ÙË ·ÈÌÔÚÚ·Á›· (1-3). ∏ ÓfiÛÔ˜ ÎÏËÚÔÓÔÌÂ›Ù·È Ì ÙÔÓ ·˘ÙÔۈ̷ÙÈÎfi ÂÈÎÚ·ÙÔ‡ÓÙ· Ù‡Ô ÌÂÙ·‚›‚·Û˘, ·ÏÏ¿ ÛÙÔ 20%
201
May-June 04 chris new
19-07-04
19:24
™ÂÏ›‰·202
¶·È‰È·ÙÚÈ΋ 2004;67:200-204
∂ÈÎfiÓ· 2. ∞ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ıÒڷη: ÂÚÈÔ¯‹ ‡ÎÓˆÛ˘ ÛÙÔ Ô›ÛıÈÔ Î·È ¤Íˆ ÙÌ‹Ì· ÙÔ˘ ‰ÂÍÈÔ‡ οو ÏÔ‚Ô‡, ÂÓÙfi˜ Ù˘ ÔÔ›·˜ ‰›ÓÂÙ·È Ë ÂÓÙ‡ˆÛË ·ÚÔ˘Û›·˜ ‰È·ÙÂٷ̤ÓÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ·ÁÁÂÈ·ÎÔ‡ ÎÏ¿‰Ô˘.
ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi Â›Ó·È ·ÚÓËÙÈÎfi (1-3). ∏ ÂÌÊ¿ÓÈÛË Ù˘ ÓfiÛÔ˘ Û ·ÛıÂÓ›˜ Ì ·ÚÓËÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÌÔÚ› Ó· ÔÊ›ÏÂÙ·È Û Ӥ˜ ÌÂÙ·ÏÏ¿ÍÂȘ ‹ Û ‰È·ÊÔÚ¤˜ ÛÙËÓ ÎÏÈÓÈ΋ ¤ÎÊÚ·ÛË Ù˘ ÓfiÛÔ˘ (1,2). ∏ ‰ÈÂÈÛ‰˘ÙÈÎfiÙËÙ· Ù˘ ÓfiÛÔ˘ Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ËÏÈΛ· Î·È ÚÔÛÂÁÁ›˙ÂÈ ÙÔ 100% ÙˆÓ ·ÛıÂÓÒÓ ÛÙËÓ ËÏÈΛ· ÙˆÓ 40 ÂÙÒÓ (2,5). ∏ ÓfiÛÔ˜ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÁÂÓÂÙÈ΋ ÂÙÂÚÔÁ¤ÓÂÈ· (1-4). Œ¯Ô˘Ó ÌÂÏÂÙËı› ‰‡Ô ÁÔÓȉȷΤ˜ ı¤ÛÂȘ, Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ‰‡Ô Ù‡Ô˘˜ Ù˘ ÓfiÛÔ˘. ∆Ô ÁÔÓ›‰ÈÔ OWR1 ÛÙË ı¤ÛË 9q33-34, Ô˘ Έ‰ÈÎÔÔÈ› ÁÈ· ÙËÓ ÂÓ‰ÔÁÏ›ÓË, Ì›· ÚˆÙ½ÓË Û‡Ó‰ÂÛ˘ ÙÔ˘ TGF-‚ (Transforming growth factor-‚), ÂÓ¤¯ÂÙ·È ÛÙÔÓ Ù‡Ô I Ù˘ ÓfiÛÔ˘. ∏ ÂÓ‰ÔÁÏ›ÓË Â›Ó·È Ì›· ÁÏ˘ÎÔÚˆÙ½ÓË Ù˘ ÌÂÌ‚Ú¿Ó˘ ÙˆÓ ÂÓ‰ÔıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ ÙˆÓ ÊÏ‚ȉ›ˆÓ, ·ÚÙËÚȉ›ˆÓ Î·È ÙÚȯÔÂȉÒÓ ·ÁÁ›ˆÓ Î·È ‚Ú¤ıËΠӷ ÂÎÊÚ¿˙ÂÙ·È Û ˘„ËÏ¿ ›‰· Û fiÏÔ˘˜ ÙÔ˘˜ ÈÛÙÔ‡˜ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ÙÔÓ Ù‡Ô I Ù˘ ÓfiÛÔ˘. ∏ ÁÔÓȉȷ΋ ı¤ÛË ÁÈ· ÙÔÓ Ù‡Ô II
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Paediatriki 2004;67:200-204
Ù˘ ÓfiÛÔ˘ ‚Ú¤ıËΠÛÙÔ ¯ÚˆÌfiۈ̷ 12 (12q13) Î·È Îˆ‰ÈÎÔÔÈ› ÁÈ· ÙËÓ ALK-1 (activin receptor-like kinase 1), Ì›· ¿ÏÏË ÚˆÙ½ÓË Û‡Ó‰ÂÛ˘ ÙÔ˘ TGF-‚ (1-4). ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÌÂÏÂÙ¿Ù·È Î·È Ì›· ÙÚ›ÙË ÁÔÓȉȷ΋ ı¤ÛË ÛÙÔ ¯ÚˆÌfiۈ̷ 3 (3p22), Ô˘ Èı·ÓfiÓ Û¯ÂÙ›˙ÂÙ·È Ì ÙË ÓfiÛÔ (2,4). À¿Ú¯ÂÈ Û˘Û¯¤ÙÈÛË ÙÔ˘ Ê·ÈÓÔÙ‡Ô˘ Ì ÙÔÓ ÁÔÓfiÙ˘Ô Ù˘ ÓfiÛÔ˘, fiˆ˜ Ê·›ÓÂÙ·È ·fi ÙËÓ ·Ô˘Û›· Ó¢ÌÔÓÈÎÒÓ ·ÚÙËÚÈÔÊÏ‚ÈÎÒÓ ‰˘ÛÏ·ÛÈÒÓ Û ¿ÙÔÌ· ¯ˆÚ›˜ ÌÂÙ¿ÏÏ·ÍË ÛÙË ı¤ÛË 9q (1-5). ∏ ÈÔ Û˘¯Ó‹ ÎÏÈÓÈ΋ ÂΉ‹ÏˆÛË Ù˘ ÓfiÛÔ˘ Â›Ó·È Ë ˘ÔÙÚÔÈ¿˙Ô˘Û· ›ÛÙ·ÍË, Ô˘ ··ÓÙ¿Ù·È ÛÙÔ 8090% ÙˆÓ ÂÚÈÙÒÛˆÓ, Ì ̤ÛË ËÏÈΛ· ÂÌÊ¿ÓÈÛ˘ Ù· 12 ¤ÙË (1,2). OÈ ÙËÏ·ÁÁÂÈÂÎٷۛ˜ ÛÙÔ ‰¤ÚÌ· Î·È ÙÔ˘˜ ‚ÏÂÓÓÔÁfiÓÔ˘˜ ·ÔÙÂÏÔ‡Ó ÙËÓ ÂfiÌÂÓË ÈÔ Û˘¯Ó‹ ÂΉ‹ÏˆÛË, ·ÏÏ¿ Ù˘Èο ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ 2˘-3˘ ‰ÂηÂÙ›·˜ Ù˘ ˙ˆ‹˜ (3,7). OÈ ·ÛıÂÓ›˜ ÌÔÚ› Ó· ÂÌÊ·Ó›˙Ô˘Ó ˆ¯ÚfiÙËÙ· ÏfiÁˆ ·Ó·ÈÌ›·˜. ™ÙÔ 15-20% ÙˆÓ ·ÛıÂÓÒÓ ·Ú·ÙËÚÔ‡ÓÙ·È ÌÈÎÚ¤˜ ‹ ÌÂÁ¿Ï˜ Ó¢ÌÔÓÈΤ˜ ·ÚÙËÚÈÔÊÏ‚҉ÂȘ ‰˘ÛϷۛ˜, Ô˘ ÌÔÚ› Ó· ÚÔηϤÛÔ˘Ó ·ÈÌfiÙ˘ÛË ‹ Î·È ·ÈÌÔıÒڷη. ™Ô‚·Ú‹ ˘ÔÍ·ÈÌ›·, ‰‡ÛÓÔÈ·, ΢¿ÓˆÛË, ÏËÎÙÚÔ‰·ÎÙ˘Ï›· Î·È ÔÏ˘Î˘ÙÙ·Ú·ÈÌ›· ÌÔÚ› Ó· ÂÌÊ·ÓÈÛÙÔ‡Ó Â› ÛËÌ·ÓÙÈ΋˜ ‰È·Ê˘Á‹˜ ·›Ì·ÙÔ˜ ·fi ‰ÂÍÈ¿ ÚÔ˜ Ù· ·ÚÈÛÙÂÚ¿. ∏ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ıÒڷη ·ÔηχÙÂÈ Û˘Ì·Á‹ Ì¿˙· ‹ Î·È ÙËÓ ÂÈÎÔÈÓˆÓ›·, Û˘ÓËı¤ÛÙÂÚ· ÛÙÔ˘˜ οو ÏÔ‚Ô‡˜ ÙˆÓ Ó¢ÌfiÓˆÓ, ÂÓÒ Ë ÂÎÏÂÎÙÈ΋ ·ÁÁÂÈÔÁÚ·Ê›· ÌÔÚ› Ó· Û˘Ó‰˘·ÛÙ› Ì ıÂڷ¢ÙÈ΋ ·ÔηٿÛÙ·ÛË Ì¤Ûˆ ÂÏ·ÛÙÈÎÔ‡ ÛÂÈÚ¿Ì·ÙÔ˜ (4-6). ∂ΉËÏÒÛÂȘ ·fi ÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi Û‡ÛÙËÌ· ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔ 10-40% ÙˆÓ ·ÛıÂÓÒÓ, Û˘Ó‹ıˆ˜ ÌÂÙ¿ ÙËÓ 5Ë ‰ÂηÂÙ›· Ù˘ ˙ˆ‹˜. OÈ ·ÛıÂÓ›˜ ÌÔÚ› Ó· ÂÌÊ·Ó›ÛÔ˘Ó ˘ÔÙÚÔÈ¿˙ÔÓÙ· ÂÂÈÛfi‰È· ·ÈÌÔÚÚ·Á›·˜ ·fi ÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi, ÎÔÈÏÈ·Îfi ¿ÏÁÔ˜ ÏfiÁˆ ıÚÔÌ‚ÒÛÂˆÓ ‹ Î·È Û˘ÌÊÔÚËÙÈ΋ ηډȷ΋ ·Ó¿ÚÎÂÈ· Î·È ›ÎÙÂÚÔ, fiÙ·Ó ˘¿Ú¯Ô˘Ó ‰È¿¯˘Ù˜ Ë·ÙÈΤ˜ ·ÚÙËÚÈÔÊÏ‚҉ÂȘ ‰˘ÛϷۛ˜ (3,8). OÈ ·ÛıÂÓ›˜ Ì ÎÏËÚÔÓÔÌÈ΋ ·ÈÌÔÚÚ·ÁÈ΋ ÙËÏ·ÁÁÂÈÂÎÙ·Û›· ¤¯Ô˘Ó ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÁÈ· ÂÓ‰ÔÎÚ¿ÓÈ· ·ÈÌÔÚÚ·Á›·, ·ÊÔ‡ ÂÚ›Ô˘ ÙÔ 5-11% ÙˆÓ ÂÓËÏ›ÎˆÓ ÂÌÊ·Ó›˙ÂÈ ·ÚÙËÚÈÔÊÏ‚҉ÂȘ ‰˘ÛϷۛ˜ ÛÙÔÓ ÂÁΤʷÏÔ. ¡Â˘ÚÔÏÔÁÈο ÛËÌ›· Î·È Û˘ÌÙÒÌ·Ù·, fiˆ˜ ÎÂÊ·Ï·ÏÁ›· ‹ ÔÙÈΤ˜, ÎÈÓËÙÈΤ˜ Î·È ·ÈÛıËÙÈΤ˜ ‰È·Ù·Ú·¯¤˜, Ú¤ÂÈ Ó· ÂÁ›ÚÔ˘Ó ÙËÓ ˘Ô„›· ÁÈ· Èı·Ófi ÂÁÎÂÊ·ÏÈÎfi ·ÁÁÂÈ·Îfi ÂÂÈÛfi‰ÈÔ ‹ ÂÁÎÂÊ·ÏÈÎfi ·fiÛÙËÌ· (2,3,7). ∏ ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ÂÚÈÏ·Ì‚¿ÓÂÈ ·ı‹ÛÂȘ Ô˘ ÂΉËÏÒÓÔÓÙ·È Ì ·ÈÌÔÚÚ·Á›· Î·È ÙËÏ·ÁÁÂÈÂÎÙ·ÛÈΤ˜ ‚Ï¿‚˜. OÈ ÙËÏ·ÁÁÂÈÂÎٷۛ˜ Î·È Ë Â›ÛÙ·ÍË ·ÔÙÂÏÔ‡Ó Û¯ÂÙÈο Û˘¯Ó¿ Â˘Ú‹Ì·Ù· Û ˘ÁÈ‹ - ηٿ Ù· ¿ÏÏ· - ¿ÙÔÌ·. ∏ ˘ÔÙÚÔÈ¿˙Ô˘Û· ›ÛÙ·ÍË ÌÔÚ› Ó· Â›Ó·È ÂΉ‹ÏˆÛË ÓfiÛÔ˘ Ì ·ÈÌÔÚÚ·ÁÈ΋ ‰È¿ıÂÛË, fiˆ˜ Ë ÓfiÛÔ˜ von
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¶·È‰È·ÙÚÈ΋ 2004;67:200-204
Willebrand. ∞ÍÈÔÛËÌ›ˆÙÔ Â›Ó·È ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÙÔ Û‡Ó‰ÚÔÌÔ Rendu-Osler-Weber ÌÔÚ› Ó· Û˘Ó˘¿Ú¯ÂÈ ÌÂ Û˘ÛÙËÌ·ÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ Ô˘ ÚÔηÏÔ‡Ó ·ÈÌÔÚÚ·ÁÈ΋ ‰È¿ıÂÛË, ȉȷ›ÙÂÚ· Ì ÙË ÓfiÛÔ von Willebrand. ∆ËÏ·ÁÁÂÈÂÎٷۛ˜ ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÔ Û‡Ó‰ÚÔÌÔ Ù˘ ηÏÔ‹ıÔ˘˜ ÎÏËÚÔÓÔÌÈ΋˜ ÙËÏ·ÁÁÂÈÂÎÙ·Û›·˜, ÛÙÔ ÔÔ›Ô, fï˜, ÔÈ ‚Ï¿‚˜ ·fi ÙÔ ‰¤ÚÌ· Â›Ó·È Û˘Ó‹ıˆ˜ ÂÚÈÛÛfiÙÂÚÔ ‰È¿Û·ÚÙ˜ Î·È ·ÊÔÚÔ‡Ó Î˘Ú›ˆ˜ ÛÙÔ ÚfiÛˆÔ, ÛÙ· ¿Óˆ ¿ÎÚ· Î·È ÛÙÔ ¿Óˆ ̤ÚÔ˜ ÙÔ˘ ıÒڷη, ηıÒ˜ Î·È ÛÙÔ Û‡Ó‰ÚÔÌÔ Ù˘ ȉÈÔ·ıÔ‡˜ ÙËÏ·ÁÁÂÈÂÎÙ·Û›·˜, fiÔ˘ ÂÌÊ·Ó›˙ÔÓÙ·È Û˘Ó‹ıˆ˜ Û ÌÂÁ·Ï‡ÙÂÚË ËÏÈΛ·. ™ÙÔ Û‡Ó‰ÚÔÌÔ ·Ù·Í›·˜-ÙËÏ·ÁÁÂÈÂÎÙ·Û›·˜ Û˘Ó˘¿Ú¯Ô˘Ó Ì ÂÁÎÂÊ·ÏÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·, ÂÓÒ ÛÙÔ Û‡Ó‰ÚÔÌÔ CREST (Calcinosis, Raynaud’s phenomenon, esophageal motor dysfunction, sclerodactyly and telangiectasia) ÂÎÙfi˜ ·fi ÙȘ ÙËÏ·ÁÁÂÈÂÎٷۛ˜, ÂÌÊ·Ó›˙ÔÓÙ·È Î·È Ù· ¿ÏÏ· ¯·Ú·ÎÙËÚÈÛÙÈο ÛËÌ›· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘. ∆ËÏ·ÁÁÂÈÂÎٷۛ˜ ·Ú·ÙËÚÔ‡ÓÙ·È Î·È Û ‰È¿ÊÔÚ˜ ¿ÏϘ ηٷÛÙ¿ÛÂȘ, fiˆ˜ Ë Î‡ËÛË Î·È Ë ¯ÚfiÓÈ· Ë·ÙÈ΋ ÓfiÛÔ˜. ∞ÚÙËÚÈÔÊÏ‚҉ÂȘ ‰˘ÛϷۛ˜ ÛÙÔÓ Ó‡ÌÔÓ· ‹ ÙÔÓ ÂÁΤʷÏÔ ÌÔÚ› Ó· ·Ó¢ÚÂıÔ‡Ó ÌÂÌÔӈ̤ӷ, ·ÏÏ¿ Î·È Û ·˘Ù‹ ÙËÓ ÂÚ›ÙˆÛË ÔÈ ·ÛıÂÓ›˜ ı· Ú¤ÂÈ Ó· ‰ÈÂÚ¢ÓÒÓÙ·È Î·È ÁÈ· ¿ÏϘ ÂΉËÏÒÛÂȘ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Rendu-Osler-Weber. ∏ ‰È¿ÁÓˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Ù›ıÂÙ·È ÛÙÔ 30-60% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ·ÛıÂÓÒÓ Ì Ó¢ÌÔÓÈΤ˜ ·ÚÙËÚÈÔÊÏ‚҉ÂȘ ‰˘ÛϷۛ˜ (1,4). ∂›ÎÙËÙ˜ Ó¢ÌÔÓÈΤ˜ ·ÚÙËÚÈÔÊÏ‚҉ÂȘ ‰˘ÛϷۛ˜ ÌÔÚ› Ó· ‰È·ÈÛÙˆıÔ‡Ó Û ηٷÛÙ¿ÛÂȘ fiˆ˜ Ë Ë·ÙÈ΋ ΛÚÚˆÛË Î·È ÏÈÁfiÙÂÚÔ Û˘¯Ó¿ Û ۯÈÛÙÔۈ̛·ÛË, ÛÙ¤ÓˆÛË ÌÈÙÚÔÂȉԇ˜, ÙÚ·‡Ì·, ·ÎÙÈÓÔ̇ΈÛË Î·È ÛÙÔ Û‡Ó‰ÚÔÌÔ Fanconi (1-3,5). ∆· ‰È·ÁÓˆÛÙÈο ÎÚÈÙ‹ÚÈ· Ù˘ ÓfiÛÔ˘ ›ӷÈ: ·) Ë ÚÈÓÔÚÚ·Á›·-›ÛÙ·ÍË, Ô˘ Â›Ó·È ˘ÔÙÚÔÈ¿˙Ô˘Û·, ·˘ÙfiÌ·ÙË Î·È Û˘Ó‹ıˆ˜ Û˘Ì‚·›ÓÂÈ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ Ó‡¯Ù·˜, ‚) ÔÈ ÙËÏ·ÁÁÂÈÂÎٷۛ˜, Ô˘ Â›Ó·È ÌÈÎÚ¤˜ ÎfiÎÎÈÓ˜ ÎËÏ›‰Â˜, Ì ¯·Ú·ÎÙËÚÈÛÙÈ΋ ÂÓÙfiÈÛË ÛÙË Ì‡ÙË, Ù· ¯Â›ÏË, ÙË ÁÏÒÛÛ·, ÙÔÓ ÛÙÔÌ·ÙÈÎfi ‚ÏÂÓÓÔÁfiÓÔ, Ù· ·˘ÙÈ¿, ÙÔ ÚfiÛˆÔ, ÙȘ ·Ï¿Ì˜ Î·È ÙȘ ÎÔ›Ù˜ ÙˆÓ Ó˘¯ÈÒÓ, Á) ÔÈ ÛÏ·¯ÓÈΤ˜ ·ÚÙËÚÈÔÊÏ‚ÈΤ˜ ‰˘ÛϷۛ˜, Ì ¿ÌÂÛË ÂÈÎÔÈÓˆÓ›· ÌÂٷ͇ ·ÚÙËÚÈÒÓ Î·È ÊÏ‚ÒÓ Î·È ÂÓÙfiÈÛË Î˘Ú›ˆ˜ ÛÙÔ˘˜ Ó‡ÌÔÓ˜, ÙÔ ‹·Ú, ÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi Î·È ÙÔÓ ÂÁΤʷÏÔ Î·È ‰) ÙÔ ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi, ‰ËÏ·‰‹ Ë ‡·ÚÍË ·’ ‚·ıÌÔ‡ Û˘ÁÁÂÓ‹ Ô˘ ÏËÚÔ› Ù· ÎÚÈÙ‹ÚÈ· Ù˘ ÓfiÛÔ˘. ∏ ‰È¿ÁÓˆÛË Â›Ó·È ÔÚÈÛÙÈ΋ › ·ÚÔ˘Û›·˜ ÙÔ˘Ï¿¯ÈÛÙÔÓ 3 ÎÚÈÙËÚ›ˆÓ, Èı·Ó‹ › ·ÚÔ˘Û›·˜ 2 ÎÚÈÙËÚ›ˆÓ, ÂÓÒ ‰ÂÓ ıˆÚÂ›Ù·È Èı·Ó‹ Â¿Ó ˘¿Ú¯Ô˘Ó ÏÈÁfiÙÂÚ· ·fi 2 ÎÚÈÙ‹ÚÈ· (3,6,8) (¶›Ó·Î·˜ 1). ∆Ô ÎÔÚ›ÙÛÈ ÏËÚÔ‡Û ÙÔ˘Ï¿¯ÈÛÙÔÓ 3 ·fi Ù· 4
Paediatriki 2004;67:200-204
‰È·ÁÓˆÛÙÈο ÎÚÈÙ‹ÚÈ· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ RenduOsler-Weber. ∆· ÂÂÈÛfi‰È· ·ÈÌfiÙ˘Û˘ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ٷ Â˘Ú‹Ì·Ù· ·fi ÙËÓ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ıÒÚ·ÎÔ˜, Û˘ÓËÁÔÚÔ‡Û·Ó ÁÈ· ÙËÓ ·ÚÔ˘Û›· Ó¢ÌÔÓÈ΋˜ ·ÚÙËÚÈÔÊÏ‚È΋˜ ‰˘ÛÏ·Û›·˜. ∆Ô ÎÔÚ›ÙÛÈ ·Ú·ÎÔÏÔ˘ıÂ›Ù·È Ù·ÎÙÈο ÛÙËÓ ÎÏÈÓÈ΋ Î·È ‰ÂÓ ¤¯ÂÈ ÂÌÊ·Ó›ÛÂÈ, ¤Ó· ¯ÚfiÓÔ ÌÂÙ¿, Ó¤Ô ÂÂÈÛfi‰ÈÔ ·ÈÌÔÚÚ·Á›·˜ ·fi ÙÔ ·Ó·Ó¢ÛÙÈÎfi. ∏ ıÂڷ›· Ù˘ ÓfiÛÔ˘ Â›Ó·È ÁÂÓÈο ˘ÔÛÙËÚÈÎÙÈ΋ Î·È ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ÚfiÏË„Ë Î·È ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÂÂÈÛÔ‰›ˆÓ ·ÈÌÔÚÚ·Á›·˜. OÈ ·ÚÙËÚÈÔÊÏ‚ÈΤ˜ ‰˘ÛϷۛ˜ ÂÓÙÔ›˙ÔÓÙ·È Ì¤Ûˆ ·ÁÁÂÈÔÁÚ·Ê›·˜ Î·È ÛÙË Û˘Ó¤¯ÂÈ· Ù· ‰È·ÙÂٷ̤ӷ ·ÁÁ›· ÂÌ‚ÔÏ›˙ÔÓÙ·È Ì¤Ûˆ ηıÂÙ‹Ú· Ì ÙË ¯Ú‹ÛË ÂÏ·ÛÙÈÎÔ‡ ÛÂÈÚ¿Ì·ÙÔ˜ ‹ ÌÈÎÚÔ‡ Ì·ÏÔÓÈÔ‡. ™ÙËÓ ÂÚ›ÙˆÛË ÌÂÁ¿ÏˆÓ ·ÚÙËÚÈÔÊÏ‚ÈÎÒÓ ‰˘ÛÏ·ÛÈÒÓ, ÌÔÚ› Ó· ¯ÚÂÈ·ÛÙ› Ï··ÚÔÛÎÔÈ΋ ‹ ·ÓÔÈÎÙ‹ ¯ÂÈÚÔ˘ÚÁÈ΋ ÂÍ·›ÚÂÛË Ù˘ ¿Û¯Ô˘Û·˜ ÂÚÈÔ¯‹˜. OÈ ÚÈÓÔÚÚ·Á›Â˜ ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È Ì ÂȈ̷ÙÈÛÌfi, ·Ï›„ÂȘ ‚·˙ÂÏ›Ó˘, ÙÔÈο ·ÈÌÔÛÙ·ÙÈο Ê¿Ú̷η (c-·ÌÈÓÔηÚÔ˚Îfi Ô͇), ‰È·ÊÚ·ÁÌ·ÙÈ΋ ‰ÂÚÌÔÏ·ÛÙÈ΋, ¯ÔÚ‹ÁËÛË Û˘Ó‰˘·ÛÌÔ‡ ÚÔÁÂÛÙÂÚfiÓ˘ Î·È ÔÈÛÙÚÔÁfiÓˆÓ ‹ laser Ì CO2 ‹ Argon (1-3,5,6,9-11). OÈ ·ÛıÂÓ›˜ Ì ÎÏËÚÔÓÔÌÈ΋ ·ÈÌÔÚÚ·ÁÈ΋ ÙËÏ·ÁÁÂÈÂÎÙ·Û›· ¯Ú‹˙Ô˘Ó Ù·ÎÙÈ΋˜ ·Ú·ÎÔÏÔ‡ıËÛ˘, ÙÔ˘Ï¿¯ÈÛÙÔÓ ·Ó¿ ¤ÙÔ˜, ÁÈ· Èı·Ó‹ ÂÌÊ¿ÓÈÛË Ó¤ˆÓ ÎÏÈÓÈÎÒÓ ÂΉËÏÒÛˆÓ. ∂›Ó·È ··Ú·›ÙËÙÔ Ó· Á›ÓÂÙ·È Ù·ÎÙÈ΋ Ó¢ÌÔÓÔÏÔÁÈ΋ Î·È Ó¢ÚÔÏÔÁÈ΋ ÂÎÙ›ÌËÛË, fiˆ˜ Î·È ÔÊı·ÏÌÔÏÔÁÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË ÁÈ· ·Ó›¯Ó¢ÛË ÙËÏ·ÁÁÂÈÂÎÙ·Û›·˜ ÛÙÔÓ ·ÌÊÈ‚ÏËÛÙÚÔÂȉ‹, Ô˘ ÌÔÚ› Ó· ÚÔηϤÛÂÈ ÛÔ‚·Ú‹ ·ÈÌÔÚÚ·Á›·. ∂›Û˘, ÔÈ ·ÛıÂÓ›˜ Ú¤ÂÈ Ó· ·Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·È Î·È ÂÚÁ·ÛÙËÚȷο Û ٷÎÙ¿ ¯ÚÔÓÈο ‰È·ÛÙ‹Ì·Ù·. OÈ Û˘ÁÁÂÓ›˜ ·’ ‚·ıÌÔ‡ Ú¤ÂÈ Ó· ÂϤÁ¯ÔÓÙ·È ÁÈ· Èı·Ó‹ ‡·ÚÍË Ù˘ ÓfiÛÔ˘. ∂›Ó·È ÛËÌ·ÓÙÈÎfi Ó· Ù›ıÂÙ·È ¤ÁηÈÚ· Ë ‰È¿ÁÓˆÛË, ¤ÙÛÈ ÒÛÙ ӷ ÚÔÏ·Ì‚¿ÓÔÓÙ·È Ù· ÂÂÈÛfi‰È· ·ÈÌÔÚÚ·Á›·˜ Î·È Ó· ·Ó·ÁÓˆÚ›˙ÔÓÙ·È ÔÈ Ó¤Â˜ ÂÚÈÙÒÛÂȘ Ù˘ ÓfiÛÔ˘ ÛÙËÓ ›‰È· ÔÈÎÔÁ¤ÓÂÈ·. §ÈÁfiÙÂÚÔ ·fi ÙÔ 10% ÙˆÓ ·ÛıÂÓÒÓ Î·Ù·Ï‹ÁÂÈ ·fi ÙȘ ÂÈÏÔΤ˜ Ù˘ ÓfiÛÔ˘ (3). ∏ ηٷÓfiËÛË Ù˘ ÌÔÚȷ΋˜ ‚¿Û˘ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ı· ÂÈÙÚ¤„ÂÈ ÙË ÁÂÓÂÙÈ΋ ηıÔ‰‹ÁËÛË Î·È ÙËÓ ·Ó·ÁÓÒÚÈÛË ÙˆÓ Ó¤ˆÓ ÂÚÈÙÒÛÂˆÓ ÛÙËÓ ›‰È· ÔÈÎÔÁ¤ÓÂÈ·. ¶›Ó·Î·˜ 1. ¢È·ÁÓˆÛÙÈο ÎÚÈÙ‹ÚÈ· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ RenduOsler-Weber ƒÈÓÔÚÚ·Á›·-›ÛÙ·ÍË ∆ËÏ·ÁÁÂÈÂÎٷۛ˜ ™Ï·¯ÓÈΤ˜ ·ÚÙËÚÈÔÊÏ‚҉ÂȘ ‰˘ÛϷۛ˜ £ÂÙÈÎfi ÎÏËÚÔÓÔÌÈÎfi ÈÛÙÔÚÈÎfi ∏ ‰È¿ÁÓˆÛË ıˆÚÂ›Ù·È ÔÚÈÛÙÈ΋ Â¿Ó ˘¿Ú¯Ô˘Ó 3 ‹ ÂÚÈÛÛfiÙÂÚ· ÎÚÈÙ‹ÚÈ·, Èı·Ó‹ Â¿Ó ˘¿Ú¯Ô˘Ó 2 ÎÚÈÙ‹ÚÈ· Î·È ÌË Èı·Ó‹ Â¿Ó ˘¿Ú¯Ô˘Ó ÏÈÁfiÙÂÚ· ·fi 2 ÎÚÈÙ‹ÚÈ·
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µÈ‚ÏÈÔÁÚ·Ê›· 1. Cooper B. William Osler on telangiectatic syndromes. BUMC Proceedings 1999;12:238-240. 2. Bergler W, Gotte K. Hereditary hemorrhagic telangiectasias: a challenge for the clinician. Eur Arch Otorhinolaryngol 1999;256:10-15. 3. Guttmacher AE, McDonald J. Hereditary hemorrhagic telangiectasia. (electronic article). GENE Reviews (www.genetests.org); 2000. 4. Wallace GM, Shovlin CL. A hereditary haemorrhagic telangiectasia family with pulmonary involvement is unlinked to the known HHT genes, endoglin and ALK-1. Thorax 2000;55:685-690. 5. Tong AK, La Hei ER, Currie B. Congenital pulmonary arteriovenous malformations. Pediatr Surg Int 2002;18:168-170. 6. Pick A, Deschamps C, Stanson AW. Pulmonary arteriovenous fistula: presentation, diagnosis, and treatment. World J Surg 1999;23:1118-1122. 7. Morgan T, McDonald J, Anderson C, Ismail M, Miller F, Mao R et al. Intracranial hemorrhage in infants and children with hereditary hemorrhagic telangiectasia (Osler-WeberRendu syndrome). Pediatrics 2002;109:E12. 8. Chen L, Lang S, Hu T, Zhong L, Li J. Hereditary hemorrhagic telangiectasia: a rare cause of long-lasting
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abdominal distension in an 8-year-old boy. Chin Med J 2002;115:620-621. 9. Bennhagen RG, Holje G, Laurin S, Pesonen E. Coil embolization of a neonatal pulmonary arteriovenous malformation. Pediatr Cardiol 2002;23:235-238. 10. Stockx L, Raat H, Caerts B, Van Cutsem E, Wilms G, Marchal G. Transcatheter embolization of hepatic arteriovenous fistulas in Rendu-Osler-Weber disease: a case report and review of the literature. Eur Radiol 1999;9:1434-1437. 11. Perez-Encinas M, Rabunal Martinez MJ, Bello Lopez JL. Is thalidomide effective for the treatment of gastroinstestinal bleeding in hereditary hemorrhagic telangiectasia? Haematologica 2002;87:(08)ELT34.
∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 01-09-2003 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 24-02-2004 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∂ϤÓË ∫fiÎÔÚË ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ µÂÓÈ˙¤ÏÂÈÔ˘ ¡ÔÛÔÎÔÌ›Ԣ ∏Ú·ÎÏ›Ԣ §ÂˆÊfiÚÔ˜ ∫ÓˆÛÛÔ‡, ∆.∫. 711 10, ∏Ú¿ÎÏÂÈÔ ∫Ú‹Ù˘ E-mail: vaagge3@yahoo.gr
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∂¡¢π∞º∂ƒOÀ™∞ ¶∂ƒπ¶∆ø™∏
Paediatriki 2004;67:205-207
CASE REPORT
∞ÈÊÓ›‰ÈÔ Ô›‰ËÌ· fiÛı˘ Î·È ÔÛ¯¤Ô˘ ˆ˜ ·Ú¯È΋ ÂΉ‹ÏˆÛË ÓÂÊÚˆÛÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ ∂. ÃÚÈÛÙÈ·Ó¿Î˘1, °. µ¿Ô˜1, ∞. ™·ÎÂÏ·ÚfiÔ˘ÏÔ˜2, ∑. ∫·Ú·Î·ÙÛ¿ÓË3
Sudden oedema of prepuce and scrotum as initial manifestation of nephrotic syndrome E. Christianakis1, G. Vaos1, A. Sakelaropoulos2, Z. Karakatsani3
¶ÂÚ›ÏË„Ë: ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË Ôȉ‹Ì·ÙÔ˜ fiÛı˘ Î·È ÔÛ¯¤Ô˘ ˆ˜ ·Ú¯È΋ ÂΉ‹ÏˆÛË ÓÂÊÚˆÛÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ Û ·È‰› ËÏÈΛ·˜ 2 ÂÙÒÓ. ∆· ÎÏÈÓÈο Î·È ˘ÂÚ˯ÔÁÚ·ÊÈο Â˘Ú‹Ì·Ù· ‰È·ÊÔÚÔÔÈÔ‡Ó Ì ·ÛÊ¿ÏÂÈ· ÙÔ ÚÒÈÌÔ ÓÂÊÚˆÛÈÎfi Û‡Ó‰ÚÔÌÔ ·fi ÙËÓ ˘‰ÚÔ΋ÏË ‹ ¿ÏϘ ηٷÛÙ¿ÛÂȘ ÔͤԘ ÔÛ¯¤Ô˘, ·ÔÙÚ¤ÔÓÙ·˜ ÌË ·Ó·Áη›Â˜ ¯ÂÈÚÔ˘ÚÁÈΤ˜ ÂÂÌ‚¿ÛÂȘ
Abstract: The case is presented of a two year-old child with oedema of the prepuce and scrotum as the initial manifestation of nephrotic syndrome. Clinical and ultrasound findings will safely differentiate early nephrotic syndrome from hydrocoeles or other acute scrotal conditions, avoiding unnecessary surgical exploration.
§¤ÍÂȘ ÎÏÂȉȿ: Ô›‰ËÌ· ÔÛ¯¤Ô˘, Ô›‰ËÌ· fiÛı˘, ÓÂÊÚˆÛÈÎfi Û‡Ó‰ÚÔÌÔ, ·È‰›.
Key words: scrotal swelling, prepuce swelling, nephrotic syndrome, child.
∂ÈÛ·ÁˆÁ‹ ∆Ô ÓÂÊÚˆÛÈÎfi Û‡Ó‰ÚÔÌÔ ÛÙÔ 90% ÙˆÓ ·È‰ÈÒÓ Â›Ó·È È‰ÈÔ·ıÔ‡˜ ÌÔÚÊ‹˜ Î·È ·ÁÓÒÛÙÔ˘ ·ÈÙÈÔÏÔÁ›·˜. ∂›Ó·È Û˘¯ÓfiÙÂÚÔ ÛÙ· ·ÁfiÚÈ· Û ۯ¤ÛË Ì ٷ ÎÔÚ›ÙÛÈ· (2:1), ÂÓÒ Û˘¯ÓfiÙÂÚ· ÚÔÛ‚¿ÏÏÔÓÙ·È ·È‰È¿ ËÏÈΛ·˜ 2-6 ÂÙÒÓ. ∆Ô Î‡ÚÈÔ ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÎÏÈÓÈÎfi ‡ÚËÌ· Â›Ó·È ÙÔ Ô›‰ËÌ·, Ô˘ Û˘Ó‹ıˆ˜ ·Ú·ÙËÚÂ›Ù·È ÛÙȘ ÂÚÈÎÔÁ¯ÈΤ˜ ÂÚÈÔ¯¤˜ Î·È ÛÙ· οو ¿ÎÚ· Î·È ·Ê‹ÓÂÈ ÂÓÙ‡ˆÌ· ÛÙËÓ ›ÂÛË. ¶·ÚÔ˘ÛÈ¿˙ÂÙ·È Ë ÂÚ›ÙˆÛË ·ÁÔÚÈÔ‡ Ô˘ ÂÌÊ¿ÓÈÛ ԛ‰ËÌ· Ù˘ fiÛı˘ Î·È ÙÔ˘ ÔÛ¯¤Ô˘ ÚÈÓ ÙÔ ÁÂÓÈÎÂ˘Ì¤ÓÔ Ô›‰ËÌ· ÙÔ˘ ÓÂÊÚˆÛÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘. ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ∞ÁfiÚÈ ËÏÈΛ·˜ ‰‡Ô ÂÙÒÓ ÂÌÊ¿ÓÈÛ ·ÈÊÓ›‰È· ·ÓÒ‰˘ÓÔ Î·È „˘¯Úfi, ˘fi Ù¿ÛË Ô›‰ËÌ· fiÛı˘ Î·È ÔÛ¯¤Ô˘ (∂ÈÎfiÓ· 1). OÎÙÒ Ë̤Ú˜ ÚÈÓ Â›¯Â ÚÔËÁËı› χÛË ‚·Ï·ÓÔÔÛıÈÎÒÓ Û˘ÌʇÛÂˆÓ ˘fi ÙÔÈ΋ ·Ó·ÏÁËÛ›· Ì Îڤ̷ EMLA® Î·È Û˘ÓÂÛÙ‹ıË Ë ÙÔÈ-
΋ ¯Ú‹ÛË ÎÔÚÙÈ˙ÔÓÔ‡¯Ô˘ Îڤ̷˜. ∂ÈϤÔÓ, Û˘Ó˘‹Ú¯Â Ïԛ̈ÍË ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ 4 Ë̤Ú˜ ÚÈÓ ÙËÓ ÂÌÊ¿ÓÈÛË ÙÔ˘ Ôȉ‹Ì·ÙÔ˜. OÈ ÁÔÓ›˜ ‰ÂÓ ·Ú·Ù‹ÚËÛ·Ó, ÙÔ ÙÂÏÂ˘Ù·›Ô ‰È¿ÛÙËÌ·, ·ÚÔ˘Û›· ÚˆÈÓÔ‡ ÂÚÈÎÔÁ¯ÈÎÔ‡ Ôȉ‹Ì·ÙÔ˜, Ô‡Ù ¤‚ÏÂ·Ó ÙÔ ·È‰› ÙÔ˘˜ ÈÔ “·¯Ô˘Ïfi”. ∆Ô Ô›‰ËÌ· ÚÔηÏÔ‡Û ¤Î‰ËÏ· ‰˘ÛÔ˘ÚÈο ÂÓԯϋ̷ٷ Î·È ‰˘Û¯¤ÚÂÈ· ‚·‰›Ûˆ˜ (Ó‹ÛÛÂÈÔ ‚¿‰ÈÛÌ·) Î·È Ô ·ÛıÂÓ‹˜ ÂÈÛ‹¯ıË ÛÙÔ ¶·È‰Ô¯ÂÈÚÔ˘ÚÁÈÎfi ∆Ì‹Ì· ÁÈ· ÂÚ·ÈÙ¤Úˆ ‰ÈÂÚ‡ÓËÛË. ∫·Ù¿ ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË, ÔÈ fiÚ¯ÂȘ ‹Ù·Ó ·„ËÏ¿ÊËÙÔÈ, ÙÔ fiÛ¯ÂÔ ÔȉËÌ·Ù҉˜ Î·È ·ÓÒ‰˘ÓÔ ÛÙËÓ „ËÏ¿ÊËÛË Î·È ÙËÓ ›ÂÛË, ¯ˆÚ›˜ ÂÚ˘ıÚfiÙËÙ· Î·È Ì ¢¯¤ÚÂÈ· ‰È·Ê·ÓÔÛÎfiËÛ˘. ∂ÈÛÎÔÈο, ‰ÈÓfiÙ·Ó Ë ÂÓÙ‡ˆÛË ‡·Ú͢ ˘ÁÚÔ‡, ˆ˜ › ˘‰ÚÔ΋Ï˘, ·ÏÏ¿ - Ì ÙËÓ ·Ê‹ Ë ıÂÚÌÔÎÚ·Û›· Ù˘ ÔȉËÌ·ÙÒ‰Ô˘˜ ÂÚÈÔ¯‹˜ ‹Ù·Ó ¯·ÌËÏ‹. ∆Ô ‰¤ÚÌ· ÙÔ˘ ÔÛ¯¤Ô˘ Î·È Ù˘ fiÛı˘ ‹Ù·Ó ˘fi Ù¿ÛË, ‰È·Ê·Ó¤˜, ÏÂ˘Îˆfi Î·È Ì ÙËÓ ·›ÛıËÛË ÏËÚfiÙËÙ·˜ ·fi ÔÚfi.
1 ¶·È‰Ô¯ÂÈÚÔ˘ÚÁÈÎfi ∆Ì‹Ì·, °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ ¶ÂÓÙ¤Ï˘, ∞ı‹Ó· 2 ∞ÎÙÈÓÔÏÔÁÈÎfi ∆Ì‹Ì·, °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ ¶ÂÓÙ¤Ï˘, ∞ı‹Ó· 3 µ’ ¶·È‰È·ÙÚÈÎfi ∆Ì‹Ì·, °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ ¶ÂÓÙ¤Ï˘, ∞ı‹Ó·
1 Department of Paediatric Surgery, Penteli Children’s Hospital, Athens 2 Department of Radiology, Penteli Children’s Hospital, Athens 3 2nd Paediatric Clinic, Penteli Children’s Hospital, Athens
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∂ÈÎfiÓ· 1. OÛ¯ÂÔÔÛıÈÎfi Ô›‰ËÌ· ˘fi Ù¿ÛË.
™‡Ìʈӷ Ì ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô, Ë ÁÂÓÈ΋ ·›Ì·ÙÔ˜ ‹Ù·Ó ÂÓÙfi˜ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÔÚ›ˆÓ (∆∫∂: 125 mm, APTT: 43,5”, Ï¢ÎÒÌ·Ù· ÔÚÔ‡ ÔÏÈο: 4,5 g/dl, ·Ï‚Ô˘Ì›ÓË: 2,3 g/dl, ¯ÔÏËÛÙÂÚ›ÓË: 375 g/dl, ÙÚÈÁÏ˘ÎÂÚ›‰È·: 99 g/dl, IgM: 146 g/dl, IgG: 250 g/dl). O ˘ÂÚ˯ÔÁÚ·ÊÈÎfi˜ ¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍ ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÔÛ¯ÂÔÔÛıÈÎfi Ô›‰ËÌ· Ì ›ÂÛË Ù˘ Ô˘Ú‹ıÚ·˜ (∂ÈÎfiÓ· 2) Î·È ·ÒıËÛË ÙˆÓ fiÚ¯ÂˆÓ ÛÙ· ¤Íˆ ‚Ô˘‚ˆÓÈο ÛÙfiÌÈ· (∂ÈÎfiÓ· 3), ÂÓÒ ‰ÂÓ ‚Ú¤ıËΠϢÚÈÙÈÎfi ‹ ·ÛÎÈÙÈÎfi ˘ÁÚfi. ∞ÂÈÎÔÓÈ˙fiÙ·Ó ¯·Ú·ÎÙËÚÈÛÙÈο Ë ·‡ÍËÛË ÙÔ˘ ¿¯Ô˘˜ ÙˆÓ Ì·Ï·ÎÒÓ ÌÔÚ›ˆÓ ÙÔ˘ ÔÛ¯¤Ô˘ Ì ·ÓÔÌÔÈÔÁÂÓ‹ ˘Ê‹, fiÔ˘ ÔÈ ˘fi˯˜ ÂÚÈÔ¯¤˜ ·ÓÙÈÚÔÛÒ¢·Ó ÙËÓ Î·Ù·ÎÚ¿ÙËÛË ÌÂÛÔ΢ÙÙ¿ÚÈÔ˘ ˘ÁÚÔ‡, ÂÓÒ ÔÈ Ë¯ÔÁÂÓ›˜ ÂÚÈÔ¯¤˜ ·ÓÙÈÚÔÛÒ¢·Ó ÙËÓ ·Ó·ÙÔÌÈ΋ ‰ÔÌ‹ ÙÔ˘ ÔÛ¯¤Ô˘. ™ÙËÓ fiÛıË ·ÂÈÎÔÓÈ˙fiÙ·Ó ¿¯˘ÓÛË ÙÔ˘ ÙÔȯÒÌ·ÙÔ˜ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜, Ì ·ÓÔÌÔÈÔÁÂÓ‹ ˘Ê‹ ÏfiÁˆ ηٷÎÚ¿ÙËÛ˘ ÌÂÛÔ΢ÙÙ¿ÚÈÔ˘ ˘ÁÚÔ‡ ÛÙÔÓ ‰·ÚÙfi. ¢ÂÓ ··ÈÙ‹ıËΠÙÔÔı¤ÙËÛË Ô˘ÚÔηıÂÙ‹Ú·. ¢‡Ô Ë̤Ú˜ ·ÚÁfiÙÂÚ· ÂÌÊ·Ó›ÛÙËΠ“Ô›‰ËÌ· ·Ó¿ Û¿Úη” ÙÔ˘ ηÙÒÙÂÚÔ˘ ÎÔÚÌÔ‡ Î·È ÙˆÓ Î¿Ùˆ ¿ÎÚˆÓ, Ô˘ ÂÂÎÙ¿ıËΠÚÔԉ¢ÙÈο Î·È ÛÙÔ ˘fiÏÔÈÔ ÛÒÌ·. ∆Ô Ô›‰ËÌ·, ÏfiÁˆ Ù˘ ›ÂÛ˘, ÚÔοÏÂÛ ‰‡Ô Ú‹ÍÂȘ ÛÙÔ ‰¤ÚÌ· Ù˘ fiÛı˘. O ÂÚ·ÈÙ¤Úˆ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ Û˘ÌÏ‹ÚˆÛ ÙËÓ ·ıÔÁÓˆÌÔÓÈ΋ ÙÂÙÚ¿‰· ÙÔ˘ ÓÂÊÚˆÛÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ Ì ڈÙÂ˚ÓÔ˘Ú›· (χΈ̷ Ô‡ÚˆÓ: 291 mg/dl Û 350 ml Û˘ÏÏÔÁ‹˜ Ô‡ÚˆÓ 24ÒÚÔ˘). Àfi Û˘ÛÙËÌ·ÙÈ΋ Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ (Ú‰ÓÈ˙ÔÏfiÓË, ÊÔ˘ÚÔÛÂÌ›‰Ë Î·È ·Ï‚Ô˘Ì›ÓË), Ù· Ôȉ‹Ì·Ù· ÌÂÈÒıËÎ·Ó ÛÙ·‰È·Î¿ Î·È Ô ÌÈÎÚfi˜ ·ÛıÂÓ‹˜ ÂÍ‹Ïı Û ηϋ ÁÂÓÈ΋ ηٿÛÙ·ÛË, ÌÂÙ¿ ·fi ÓÔÛËÏ›· 24 ËÌÂÚÒÓ. ∏ ‰È·¯ÚÔÓÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË ÁÈ· Ù· ÂfiÌÂÓ· ‰‡Ô ¯ÚfiÓÈ· ‰ÂÓ ¤‰ÂÈÍ οÙÈ ·ıÔÏÔÁÈÎfi. ™˘˙‹ÙËÛË ∂›Ó·È ÁÓˆÛÙfi fiÙÈ ÛÙÔ ÓÂÊÚˆÛÈÎfi Û‡Ó‰ÚÔÌÔ ÌÔÚ› Ó· ÂÌÊ·ÓÈÛÙ› Ô›‰ËÌ· ÔÛ¯¤Ô˘, Ô˘ Û ۿÓȘ ÂÚÈÙÒÛÂȘ ·ÔÙÂÏ› Î·È ÙËÓ ·Ú¯È΋ ÂΉ‹ÏˆÛË
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∂ÈÎfiÓ· 2. ÀÂÚ˯ÔÁÚ¿ÊËÌ· ÔÛ¯¤Ô˘: ¯·Ú·ÎÙËÚÈÛÙÈÎfi Ô›‰ËÌ· ÔÛ¯¤Ô˘, ÙÔ ÔÔ›Ô ‰ÂÓ ÂÚȤ¯ÂÈ fiÚ¯ÂȘ.
ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ (1,2). ∂›Ó·È, fï˜, ÚÒÙË ÊÔÚ¿, Û‡Ìʈӷ Ì ÙËÓ ÚÔÛÈÙ‹ ·ÁÁÏÈ΋ ‚È‚ÏÈÔÁÚ·Ê›·, Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È Ôȉ‹Ì·Ù· fiÛı˘ Î·È ÔÛ¯¤Ô˘ ˆ˜ ·Ú¯È΋ ÂΉ‹ÏˆÛË ÓÂÊÚˆÛÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘. ∆Ô ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ¤¯ÂÈ ·Ô‰Âȯı› ¯Ú‹ÛÈÌÔ ‰È·ÁÓˆÛÙÈÎfi ̤ÛÔ ÁÈ· ÙȘ ·ı‹ÛÂȘ ÙÔ˘ ÔÛ¯¤Ô˘ ÛÙ· ·È‰È¿. µÔËı¿ ÛËÌ·ÓÙÈο ÛÙË ‰È·ÊÔÚԉȿÁÓˆÛË ·ÚfiÌÔÈˆÓ ÔȉËÌ¿ÙˆÓ Î·È ‰ÈÔÁÎÒÛÂˆÓ ÙÔ˘ ÔÛ¯¤Ô˘, Ô˘ ÌÔÚ› Ó· Â›Ó·È Î˘Ú›ˆ˜ ÙÔ È‰ÈÔ·ı¤˜ Ô›‰ËÌ· ÙÔ˘ ÔÛ¯¤Ô˘, Ë ÔÍ›· ˘‰ÚÔ΋ÏË, ΢ÛÙÈΤ˜ ‚Ï¿‚˜ Î·È Î·Ù·ÛÙ¿ÛÂȘ ÔͤԘ ÔÛ¯¤Ô˘. ∆Ô ÓÂÊÚˆÛÈÎfi Û‡Ó‰ÚÔÌÔ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÚˆÙÂ˚ÓÔ˘Ú›·, ˘ÔÏÂ˘ÎˆÌ·ÙÈÓ·ÈÌ›·, Ô›‰ËÌ· Î·È ˘ÂÚÏÈȉ·ÈÌ›·. ∏ ·ıÔÏÔÁÈ΋ ·˘Ù‹ ÙÂÙÚ¿‰· ‰ÂÓ ÂÌÊ·Ó›˙ÂÙ·È ¿ÓÙÔÙÂ, ȉȷ›ÙÂÚ· ÛÙȘ ˘ÔÙÚÔ¤˜. ∆Ô ·Ú¯ÈÎfi ÎÏÈÓÈÎfi ‡ÚËÌ· Â›Ó·È Û˘Ó‹ıˆ˜ Ù· ÂÚÈÎÔÁ¯Èο Ôȉ‹Ì·Ù· (3). ∆Ô Ô›‰ËÌ· Â›Ó·È Û˘Ó‹ıˆ˜ ÁÂÓÈÎÂ˘Ì¤ÓÔ Î·È Î·Ù·Ó¤ÌÂÙ·È ÛÙÔ ÚfiÛˆÔ, ȉȷ›ÙÂÚ· ÛÙȘ ÂÚÈÎÔÁ¯ÈΤ˜ ÂÚÈÔ¯¤˜, Ô˘ Â›Ó·È ‰ÈÔÁΈ̤Ó˜ ÙÔ Úˆ› Î·È Ù›ÓÔ˘Ó Ó· ˘Ô¯ˆÚÔ‡Ó Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ Ë̤ڷ˜, ÔfiÙÂ Î·È ÂÌÊ·Ó›˙ÂÙ·È Ô›‰ËÌ· ÛÙËÓ ÎÔÈÏÈ¿, ÛÙÔ ÂÚ›ÓÂÔ, ÛÙÔ˘˜ ÌËÚÔ‡˜ Î·È ÛÙ· οو ¿ÎÚ·. ∆· Ôȉ‹Ì·Ù· ·˘Ù¿ ÌÔÚ› Ó· Û˘Óԉ‡ÔÓÙ·È ·fi ·‡ÍËÛË ÙÔ˘ ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜ Î·È ·Ê‹ÓÔ˘Ó ÂÓÙ˘ÒÌ·Ù· ÛÙËÓ ›ÂÛË. ∆Ô Ô›‰ËÌ· ÙÔ˘ ÔÛ¯¤Ô˘ Û¿ÓÈ· ·ÚÔ˘ÛÈ¿˙ÂÈ ÛËÌ·ÓÙÈο ÚÔ‚Ï‹Ì·Ù·, fiˆ˜ Ë ·˘ÙfiÌ·ÙË Ú‹ÍË ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ (2). ™Ù· Ôχ ÌÈÎÚ¿ ·È‰È¿ Î·È Ù· ‚Ú¤ÊË, ÂÂȉ‹ ÔÈ ÈÛÙÔ› Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ ·ÓıÂÎÙÈÎÔ› ÛÙË ‰ËÌÈÔ˘ÚÁ›· Ôȉ‹Ì·ÙÔ˜ ÛÙÔÓ ‰È¿ÌÂÛÔ ¯ÒÚÔ, ‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È Û˘Ó‹ıˆ˜ ÂÍȉÚÒÌ·Ù·, fiˆ˜ ÙÔ Ï¢ÚÈÙÈÎfi Î·È ÙÔ ·ÛÎÈÙÈÎfi, ¯ˆÚ›˜ ¤ÓÙÔÓÔ ÁÂÓÈÎÂ˘Ì¤ÓÔ Ô›‰ËÌ·. Èڛ˜ ıÂڷ›·, ÙÔ Ô›‰ËÌ· ÁÂÓÈ·ÂÙ·È Î·È ÂÓÙÔ›˙ÂÙ·È ÛÙËÓ ÔÛ¯Â˚΋ Î·È ·È‰ÔÈÈ΋ ÂÚÈÔ¯‹, ÛÙ· ·ÁfiÚÈ· Î·È Ù· ÎÔÚ›ÙÛÈ· ·ÓÙ›ÛÙÔȯ·. ™ÙËÓ ·ÚÔ‡Û· ÂÚ›ÙˆÛË, ÙÔ ÓÂÊÚˆÛÈÎfi Û‡Ó‰ÚÔÌÔ ÂΉËÏÒıËΠ·Ú¯Èο Ì ÔÛ¯ÂÔÔÛıÈÎfi Ô›‰ËÌ·. ∂›¯Â ÚÔËÁËı› ÙÚ·˘Ì·ÙÈÛÌfi˜ ·fi ÙËÓ
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∂ÈÎfiÓ· 3. ÀÂÚ˯ÔÁÚ¿ÊËÌ· ÔÛ¯¤Ô˘-‚Ô˘‚ˆÓÈÎÒÓ fiÚˆÓ: ·ÚÂÎÙÔÈṲ̂ÓÔÈ fiÚ¯ÂȘ ÛÙ· ¤Íˆ ‚Ô˘‚ˆÓÈο ÛÙfiÌÈ· ÏfiÁˆ Ôȉ‹Ì·ÙÔ˜ ÔÛ¯¤Ô˘.
·ÔÎfiÏÏËÛË Ù˘ ·ÎÚÔÔÛı›·˜ ÏfiÁˆ ‚·Ï·ÓÔÔÛıÈÎÒÓ Û˘ÌʇÛÂˆÓ Î·È Ë Ïԛ̈ÍË ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡. OÈ ÁÔÓ›˜ ‰ÂÓ ·ÓÙÈÏ‹ÊıËÎ·Ó ÙËÓ ·ÚÔ˘Û›· ÚˆÈÓÔ‡ ÂÚÈÎÔÁ¯ÈÎÔ‡ Ôȉ‹Ì·ÙÔ˜ ‹ ¿¯˘ÓÛË ÙÔ˘ ·È‰ÈÔ‡ ÙÔ ÙÂÏÂ˘Ù·›Ô ‰È¿ÛÙËÌ·. ™ÙËÓ ÔÚ›·, ÙÔ Ô›‰ËÌ· ÂÂÎÙ¿ıËΠÛÙÔÓ Î·ÙÒÙÂÚÔ ÎÔÚÌfi, ÛÙ· οو ¿ÎÚ· ηÈ, ·ÎÔÏÔ‡ıˆ˜, η٤Ϸ‚ ÙÔ ˘fiÏÔÈÔ ÛÒÌ·. £ÂˆÚËÙÈο, ÌÔÚ› Ó· ÚÔ¸‹Ú¯Â ÙÔ Û‡Ó‰ÚÔÌÔ Î·È, ÏfiÁˆ Ù˘ ÌÈÎÚ‹˜ ËÏÈΛ·˜, ÙÔ ÁÂÓÈÎÂ˘Ì¤ÓÔ Ô›‰ËÌ· Ó· ÌËÓ ˘¤ÂÛ ÛÙËÓ ·ÓÙ›ÏË„Ë ÙˆÓ ÁÔÓ¤ˆÓ ‹ ÙˆÓ ÁÈ·ÙÚÒÓ. ∂›Û˘, Ô ÙÔÈÎfi˜ ÙÚ·˘Ì·ÙÈÛÌfi˜ ·fi ÙË Ï‡ÛË ÙˆÓ Û˘ÌʇÛÂˆÓ ı· ÌÔÚÔ‡Û ӷ ÚÔηϤÛÂÈ ÂÎÛÂÛËÌ·Ṳ̂ÓÔ Ô›‰ËÌ· Ù˘ fiÛı˘. ∂ÎÙfi˜ ·fi ÙËÓ ÂÏ¿ÙÙˆÛË ÙÔ˘ ÂÓ‰·ÁÁÂÈ·ÎÔ‡ ¯ÒÚÔ˘ ÏfiÁˆ ˘ÔÏÂ˘ÎˆÌ·ÙÈÓ·ÈÌ›·˜, Ô˘ ÂÓÂÚÁÔÔÈ› ÙË ‰ËÌÈÔ˘ÚÁ›· Ôȉ‹Ì·ÙÔ˜, ¤¯Ô˘Ó ‰È·Ù˘ˆı› ˘Ôı¤ÛÂȘ fiÙÈ ÙÔ Ô›‰ËÌ· ÌÔÚ› Ó· ÔÊ›ÏÂÙ·È ÛÙËÓ ·ÚÔ˘Û›· οÔÈÔ˘ ·Ú¿ÁÔÓÙ· ÛÙËÓ Î˘ÎÏÔÊÔÚ›·, Ô ÔÔ›Ô˜ ·˘Í¿ÓÂÈ ÙË ‰È·ÂÚ·ÙfiÙËÙ· ÙÔ˘ ÙÔȯÒÌ·ÙÔ˜ ÙˆÓ ÙÚȯÔÂȉÒÓ Û fiÏÔ˘˜ ÙÔ˘˜ ÈÛÙÔ‡˜, Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ Î·È ÙˆÓ ÓÂÊÚÒÓ (4). O ·Ú¿ÁÔÓÙ·˜ ·˘Ùfi˜ Â›Ó·È Èı·Ófi Ó· ¤‰Ú·Û ÙÔÈο ÛÙÔ˘˜ ¯·Ï·ÚÔ‡˜ ÈÛÙÔ‡˜ ÙÔ˘ ÔÛ¯¤Ô˘, Ì ·ÔÙ¤ÏÂÛÌ· ÙÔ Ô›‰ËÌ¿ ÙÔ˘ Ó· Â›Ó·È ÂÌÊ·Ó¤˜ Î·È Ó· ÚÔËÁÂ›Ù·È ÙˆÓ ÁÂÓÈÎÂ˘Ì¤ÓˆÓ ÔȉËÌ¿ÙˆÓ, ÛÙÔÓ Û¯ËÌ·ÙÈÛÌfi ÙˆÓ
Paediatriki 2004;67:205-207
ÔÔ›ˆÓ ÙÔ ·ÁfiÚÈ ‹Ù·Ó ·ÓıÂÎÙÈÎfi ÏfiÁˆ Ù˘ ÌÈÎÚ‹˜ ËÏÈΛ·˜. ∫·È ÛÙȘ ‰‡Ô ÂÚÈÙÒÛÂȘ, ˆÛÙfiÛÔ, ÙÔ Ô͇ ÔÛ¯ÂÔÔÛıÈÎfi Ô›‰ËÌ· ‹Ù·Ó ·˘Ùfi Ô˘ Ô‰‹ÁËÛ ÙÔÓ ·ÛıÂÓ‹ ÛÙÔÓ ÁÈ·ÙÚfi. ∂›Û˘, Ë ‰È¿ÎÚÈÛË ·˘ÙÔ‡ ÙÔ˘ ¯·Ú·ÎÙËÚÈÛÙÈÎÔ‡ Ôȉ‹Ì·ÙÔ˜ ·fi ¿ÏÏ˘ ·ÈÙÈÔÏÔÁ›·˜ ·ÚÂÌÊÂÚ‹ Ôͤ· Ôȉ‹Ì·Ù· ¤¯ÂÈ È‰È·›ÙÂÚË ÛËÌ·Û›·. ∆· ÎÏÈÓÈο Î·È Ù· ˘ÂÚ˯ÔÁÚ·ÊÈο Â˘Ú‹Ì·Ù· ÌÔÚ› Ó· Â›Ó·È ·ıÔÁÓˆÌÔÓÈο, fiˆ˜ ÛÙËÓ ·ÚÔ‡Û· ÂÚ›ÙˆÛË, ÒÛÙ ӷ Û˘Ì‚¿ÏÔ˘Ó ÛÙËÓ ¤ÁηÈÚË ‰È·ÊÔÚԉȿÁÓˆÛË ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜ Î·È Ó· ·ÎÔÏÔ˘ıËı› Ë ÂӉ‰ÂÈÁ̤ÓË ıÂڷ¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË. ∆Ô ·ÈÊÓ›‰ÈÔ ÔÛ¯ÂÔÔÛıÈÎfi Ô›‰ËÌ· ÌÔÚ› Ó· ·ÔÙÂÏ› ÙËÓ ÚÒÙË ÂΉ‹ÏˆÛË ÓÂÊÚˆÛÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘. ∆Ô „˘¯Úfi, ·ÓÒ‰˘ÓÔ, ‰È·˘Á¤˜ Î·È ˘‰·Ú¤˜ ˘fi Ù¿ÛË fiÛ¯ÂÔ, Ô˘ ·Ú·Ì¤ÓÂÈ ¤Ú·Ó ÙÔ˘ 24ÒÚÔ˘, ı¤ÙÂÈ ÙË ‚¿ÛÈÌË ˘Ô„›· ‡·Ú͢ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ·˘ÙÔ‡. ∏ ˘ÂÚ˯ÔÁÚ·ÊÈ΋ ÂÈÎfiÓ· Â›Ó·È ¯·Ú·ÎÙËÚÈÛÙÈ΋. ∏ ¤ÁηÈÚË ‰È¿ÁÓˆÛË Î·È Ë Î·Ù¿ÏÏËÏË ıÂڷ›· ·ÔÙÚ¤Ô˘Ó ÌË ·Ó·Áη›Â˜ ¯ÂÈÚÔ˘ÚÁÈΤ˜ ÂÂÌ‚¿ÛÂȘ. µÈ‚ÏÈÔÁÚ·Ê›· 1. Frank RG, Friedman SC, Wise GJ, Gerard PS. Scrotal wall edema presenting as the initial manifestation of nephrotic syndrome. N Y State J Med 1991;91:462-463. 2. Welch TR, Gianis J, Sheldon CA. Perforation of the scrotum complicating nephrotic syndrome. J Pediatr 1988;113: 336-337. 3. Bergstein GM. Nephrotic syndrome. In: Nelson WE, Behrman RE, Kliegman RM, Arvin AM, editors. Nelson Textbook of Pediatrics. 16th ed. London: WB Saunders Co; 2000. p. 1592-1595. 4. Humphreys MH. Mechanisms and management of nephrotic edema. Kidney Int 1994;45:266-281.
∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 20-06-2003 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 30-03-2004 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∂˘ÛÙÚ¿ÙÈÔ˜ ÃÚÈÛÙÈ·Ó¿Î˘ ¶·È‰Ô¯ÂÈÚÔ˘ÚÁÈÎfi ∆Ì‹Ì· °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ ¶ÂÓÙ¤Ï˘ πÔÎÚ¿ÙÔ˘˜ 6, ∆.∫. 152 36, ¶. ¶ÂÓÙ¤ÏË
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Paediatriki 2004;67:208-211
CASE REPORT
AÛ˘Ó‹ı˘ ·Ô˘Û›· Ó¢ÚÔÏÔÁÈ΋˜ Û˘Ó‰ÚÔÌ‹˜ Û ÎÔÚ›ÙÛÈ 4 ÂÙÒÓ Ì ·Ù·Í›·-ÙËÏ·ÁÁÂÈÂÎÙ·Û›· (Û‡Ó‰ÚÔÌÔ Louis-Bar) °. ∆Ú›Ì˘1, ∫. ∞ı·Ó·Û¿ÎË1, ∞. °È·ÓÓÔ‡ÏÈ· - ∫·Ú·ÓÙ·Ó¿1, ª. ∫·Ó¿ÚÈÔ˘2, •. ∫Ú›ÎÔ˜1, ¶. ¡ÈÎÔÏ·˝‰Ô˘1
Unusual absence of neurological symptoms in a 4 year-old girl with ataxia-telangiectasia (Louis-Bar syndrome) G. Trimis1, K. Athanasaki1, A. Giannoulia - Karantana1, M. Kanariou2, X. Krikos1, P. Nikolaidou1
¶ÂÚ›ÏË„Ë: ∏ ·Ù·Í›·-ÙËÏ·ÁÁÂÈÂÎÙ·Û›· (Û‡Ó‰ÚÔÌÔ Louis-Bar) Â›Ó·È Ì›· Û¿ÓÈ· ÔÏ˘Û˘ÛÙËÌ·ÙÈ΋, Ó¢ÚÔÂÎÊ˘ÏÈÛÙÈ΋ ÁÂÓÂÙÈ΋ ‰È·Ù·Ú·¯‹. ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ÎÔÚÈÙÛÈÔ‡ ËÏÈΛ·˜ 4 ÂÙÒÓ Ì ÈÛÙÔÚÈÎfi ˘ÔÙÚÔÈ·˙Ô˘ÛÒÓ ÏÔÈÌÒÍÂˆÓ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡, ÛÙÔ ÔÔ›Ô ·Ó¢ڤıËÛ·Ó ÔÊı·ÏÌÔÏÔÁÈο Î·È ·ÓÔÛÔÏÔÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο Ù˘ ÓfiÛÔ˘. ∏ ·Ô˘Û›· Ó¢ÚÔÏÔÁÈ΋˜ Û˘Ó‰ÚÔÌ‹˜, ÁÂÁÔÓfi˜ ·Û˘Ó‹ıÈÛÙÔ ÁÈ· ·ÛıÂÓ‹ ·˘Ù‹˜ Ù˘ ËÏÈΛ·˜, ‰˘Û¯¤Ú·Ó ÙË ‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘. ∂Ȃ‚·ÈÒÓÂÙ·È fiÙÈ ˘¿Ú¯Ô˘Ó ÔÚÈṲ̂Ó˜ ÌÂÙ·ÏÏ¿ÍÂȘ ÙÔ˘ ˘Â‡ı˘ÓÔ˘ ÁÔÓȉ›Ô˘ Ô˘ Úԉȷı¤ÙÔ˘Ó Û ‚Ú·‰‡ÙÂÚË Ó¢ÚÔÏÔÁÈ΋ ¤ÎÙˆÛË.
Abstract: Ataxia-telangiectasia is a rare multisystem, neurodegenerative genetic disorder. The case is described of a 4 year-old girl with a history of frequent respiratory infections, who presented the ocular and immunologic features of this syndrome. The absence of neurological symptoms, which is very unusual for a patient of this age, raised many difficulties in the diagnosis of the disease. It is confirmed that some mutations of the gene responsible for the disease predispose to slower neurological deterioration.
§¤ÍÂȘ ÎÏÂȉȿ: ·Ù·Í›·-ÙËÏ·ÁÁÂÈÂÎÙ·Û›·, ·ÓÔÛÔ·Ó¿ÚÎÂÈ·, Ó¢ÚÔÏÔÁÈ΋ Û˘Ó‰ÚÔÌ‹.
Key words: ataxia-telangiectasia, immunodeficiency, neurological symptoms.
∂ÈÛ·ÁˆÁ‹ ∏ ·Ù·Í›·-ÙËÏ·ÁÁÂÈÂÎÙ·Û›· (Û‡Ó‰ÚÔÌÔ LouisBar) Â›Ó·È Ì›· Û¿ÓÈ·, ÔÏ˘Û˘ÛÙËÌ·ÙÈ΋, ÁÂÓÂÙÈ΋ ÓfiÛÔ˜, Ì ·ÚȘ ÚÔ‚¿ÏÏÔ˘Û˜ ÂΉËÏÒÛÂȘ ÙËÓ ·ÓÔÛÔ·Ó¿ÚÎÂÈ· Î·È ÙË Ó¢ÚÔÏÔÁÈ΋ Û˘Ó‰ÚÔÌ‹. ∂ΉËÏÒÓÂÙ·È Û˘Ó‹ıˆ˜ ÎÏÈÓÈο ·fi ÙÔ ‰Â‡ÙÂÚÔ ¤ÙÔ˜ Ù˘ ˙ˆ‹˜ Î·È ÂȉÂÈÓÒÓÂÙ·È Ì ÙËÓ ¿ÚÔ‰Ô ÙÔ˘ ¯ÚfiÓÔ˘ (1). ∫ÏËÚÔÓÔÌÂ›Ù·È Ì ·˘ÙfiÛˆÌÔ ˘ÔÏÂÈfiÌÂÓÔ Ù‡Ô Î·È ÙÔ ˘Â‡ı˘ÓÔ ÁÔÓ›‰ÈÔ (∞∆ª) ‰ڿ˙ÂÙ·È ÛÙÔ Ì·ÎÚ‡ ÛΤÏÔ˜ ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ 11 (11q22-23) (2). ∏ Û˘¯ÓfiÙËÙ¿ Ù˘ Î˘Ì·›ÓÂÙ·È ÌÂٷ͇ 1/40.000 Î·È 1/100.000 ¿ÙÔÌ·, ÂΉËÏÒÓÂÙ·È ¿ÓÙ· ÛÙËÓ ·È‰È΋ ËÏÈΛ·, ÂÓÒ ÙÔ ÔÛÔÛÙfi ÙˆÓ ÊÔÚ¤ˆÓ ÙÔ˘ ·ıÔÏÔÁÈÎÔ‡ ÁÔÓȉ›Ô˘ ÛÙÔÓ ÁÂÓÈÎfi ÏËı˘ÛÌfi ˘ÔÏÔÁ›˙ÂÙ·È Û 1%. ∆· ·ÚÈ· ÛÙÔȯ›· Ù˘ ÎÏÈÓÈ΋˜ ÚÔ‚ÔÏ‹˜ Â›Ó·È Ë ÚÔԉ¢ÙÈο ÂȉÂÈÓÔ‡ÌÂÓË ·ÚÂÁÎÂÊ·ÏȉÈ΋ ·Ù·-
Í›·, ÔÈ ÙËÏ·ÁÁÂÈÂÎٷۛ˜ ÛÙÔ˘˜ ÂÈÂÊ˘ÎfiÙ˜ Î·È ÛÙÔ ‰¤ÚÌ· Î·È ÔÈ ¯ÚfiÓȘ ÏÔÈÌÒÍÂȘ ÙˆÓ ·Ú·ÚÚ›ÓÈˆÓ ÎfiÏˆÓ Î·È ÙˆÓ Ó¢ÌfiÓˆÓ. ∏ ÓfiÛÔ˜ Û˘Ó‰˘¿˙ÂÙ·È Ì ÔÈΛÏÔ˘ ‚·ıÌÔ‡ ÌÈÎÙ‹ ·ÓÔÛÔ·Ó¿ÚÎÂÈ·, ÂÈÏÂÎÙÈ΋ ·Ô˘Û›· Ù˘ ·ÓÔÛÔÛÊ·ÈÚ›Ó˘ IgA ÛÙÔÓ ÔÚfi Î·È ˘„ËÏ‹ ÙÈÌ‹ ·-ÊÂÙÔÚˆÙ½Ó˘ (1). ∏ ÚÔÁÂÓÓËÙÈ΋ ‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘ Â›Ó·È ‰˘Ó·Ù‹ (3). Œ¯ÂÈ ·Ú·ÙËÚËı› ·˘ÍË̤ÓË Â›ÙˆÛË Î·ÎÔËıÂÈÒÓ, ÙfiÛÔ ÛÙÔ˘˜ ·ÛıÂÓ›˜ fiÛÔ Î·È ÛÙÔ˘˜ Û˘ÁÁÂÓ›˜ Ô˘ ‰ÂÓ ¤¯Ô˘Ó ÚÔÛ‚ÏËı› ·fi ÙË ÓfiÛÔ (4). ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ÎÔÚÈÙÛÈÔ‡ ËÏÈΛ·˜ 4 ÂÙÒÓ Ô˘ ÚÔÛ‹Ïı ÁÈ· ‰ÈÂÚ‡ÓËÛË ÏfiÁˆ ·Ú·ÙÂٷ̤ÓÔ˘ ÂÂÈÛÔ‰›Ô˘ ‚ÚÔÁ¯›Ùȉ·˜. ∏ ·ÛıÂÓ‹˜ ·ÚÔ˘Û›·˙ ÔÏÏ¿ ÛÙÔȯ›· Ù˘ ÎÏÈÓÈÎÔÂÚÁ·ÛÙËÚȷ΋˜ ÂÈÎfiÓ·˜ Ù˘ ·Ù·Í›·˜-ÙËÏ·ÁÁÂÈÂÎÙ·Û›·˜, ÏËÓ fï˜ ·Ô˘Û›·˙ ÔÔÈ·‰‹ÔÙ ·ıÔÏÔÁÈ΋
1 ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó· 2 ∞ÓÔÛÔÏÔÁÈÎfi ∆Ì‹Ì·, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó·
1 1st Paediatric Clinic of the University of Athens, “Aghia Sophia” Children’s Hospital, Athens 2 Department of Immunology, “Aghia Sophia” Children’s Hospital, Athens
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¶·È‰È·ÙÚÈ΋ 2004;67:208-211
Ó¢ÚÔÏÔÁÈ΋ ÛËÌÂÈÔÏÔÁ›·. ∆Ô ÂÚÈÛÙ·ÙÈÎfi ·ÚÔ˘ÛÈ¿˙ÂÈ ÂӉȷʤÚÔÓ ÏfiÁˆ Ù˘ ·Û˘Ó‹ıÔ˘˜ ÎÏÈÓÈ΋˜ ÚÔ‚ÔÏ‹˜, ηıÒ˜ Â›Ó·È Ôχ Û¿ÓÈ· Ë ¤ÏÏÂÈ„Ë Ó¢ÚÔÏÔÁÈ΋˜ ¤ÎÙˆÛ˘ Û ·ÛıÂÓ‹ ·˘Ù‹˜ Ù˘ ËÏÈΛ·˜. ∆Ô ÁÂÁÔÓfi˜ ·˘Ùfi η٤ÛÙËÛ ȉȷ›ÙÂÚ· ‰˘Û¯ÂÚ‹ ÙË ‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘, ·ÏÏ¿ Ù·˘Ùfi¯ÚÔÓ· ÂȂ‚·›ˆÛ ÙËÓ ÂÙÂÚÔÁ¤ÓÂÈ· ÙÔ˘ ÎÏÈÓÈÎÔ‡ Ê·ÈÓÔÙ‡Ô˘ Î·È ÙË Û˘Û¯¤ÙÈÛ‹ ÙÔ˘ Ì ÙȘ ˘¿Ú¯Ô˘Û˜ ÌÂÙ·ÏÏ¿ÍÂȘ ÙÔ˘ ∞∆ª ÁÔÓȉ›Ô˘. ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ∫ÔÚ›ÙÛÈ ËÏÈΛ·˜ 4 ÂÙÒÓ ·Ú·¤ÌÊıËΠÛÙËÓ ∫ÏÈÓÈ΋ ÏfiÁˆ ·ÛıÌ·ÙÈ΋˜ ‚ÚÔÁ¯›Ùȉ·˜ ·fi ÌËÓfi˜, Ë ÔÔ›· ‰ÂÓ ·ÓÙ·ÔÎÚ›ıËΠÛÙË ıÂڷ›· Ì ‚ÚÔÁ¯Ô‰È·ÛÙ·ÏÙÈο Î·È ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜ ·ÓÙÈÌÈÎÚԂȷ΋ ·ÁˆÁ‹. ™ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ·Ó·ÌÓËÛÙÈÎfi ·Ó·Ê¤ÚıËΠfiÙÈ Ô ÌËÙÚÈÎfi˜ ·Ô‡˜ Î·È Ë ·ÙÚÈ΋ ÁÈ·ÁÈ¿ ·Â‚›ˆÛ·Ó Û ËÏÈΛ· 51 Î·È 32 ÂÙÒÓ, ·ÓÙ›ÛÙÔȯ·, ·fi ηÚΛÓÔ ·ÁÎÚ¤·ÙÔ˜, ÂÓÒ Ë ÌËÙÚÈ΋ ÁÈ·ÁÈ¿ ÚÔÛ‚Ï‹ıËΠ·fi ηÚΛÓÔ Ì·ÛÙÔ‡ ÛÙËÓ ËÏÈΛ· ÙˆÓ 49 ÂÙÒÓ. ∏ ·ÛıÂÓ‹˜ ÁÂÓÓ‹ıËΠÌÂÙ¿ ·fi ÙÂÏÂÈfiÌËÓË Î‡ËÛË ¯ˆÚ›˜ ÂÈÏÔΤ˜. ∆· ۈ̷ÙÔÌÂÙÚÈο ÌÂÁ¤ıË ÛÙË Á¤ÓÓËÛË ‹Ù·Ó ÌÂٷ͇ 25˘ Î·È 50‹˜ ı¤Û˘ (µ™: 2850 g, ª™: 50 cm, ¶∫: 33 cm). ∏ ÂÚÈÁÂÓÓËÙÈ΋ ÂÚ›Ô‰Ô˜ ‹Ù·Ó ÔÌ·Ï‹. ∏ ÚÒÈÌË ÎÈÓËÙÈ΋ ·Ó¿Ù˘ÍË ÙÔ˘ ·È‰ÈÔ‡ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋. ∫¿ıÈÛ Û ËÏÈΛ· 6 ÌËÓÒÓ Î·È ÂÚ¿ÙËÛ Û ËÏÈΛ· 1 ¤ÙÔ˘˜. ∏ ·ÛıÂÓ‹˜ ·ÚÔ˘Û›·˙ ٷ ÙÂÏÂ˘Ù·›· 2 ¯ÚfiÓÈ· Û˘¯Ó¤˜ ÏÔÈÌÒÍÂȘ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Ì ·Ú·ÁˆÁÈÎfi ‚‹¯· Î·È ‚ÏÂÓÓÔ˘Ò‰Ë ¤ÎÎÚÈÛË, Ô˘ ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·Ó ÂÈÙ˘¯Ò˜ Ì ·ÓÙÈÌÈÎÚԂȷ΋ ·ÁˆÁ‹, ¯ˆÚ›˜ ÔÙ¤ Ó· ¯ÚÂÈ·ÛÙ› ÓÔÛËÏ›·. ∞ӷʤÚıËηÓ, ›Û˘, Û˘¯Ó¤˜ Ì˘ÎËÙÈ¿ÛÂȘ ÛÙfiÌ·ÙÔ˜ Ô˘ ˘Ô¯ˆÚÔ‡Û·Ó Ì ÙÔÈ΋ ·ÁˆÁ‹ ηÈ, ÌÂÚÈΤ˜ ÊÔÚ¤˜, ‹È· ÂÂÈÛfi‰È· ‚‹¯· ηٿ ÙË Û›ÙÈÛË Ì ˘‰·Ú›˜, ΢ڛˆ˜, ÙÚÔʤ˜. ∆Ô ·È‰› ‹Ù·Ó Û ηϋ ÁÂÓÈ΋ ηٿÛÙ·ÛË Î·È ·fiÏ˘Ù· Û˘ÓÂÚÁ¿ÛÈÌÔ. ¢ÂÓ ·ÚÔ˘Û›·˙ ٷ¯‡ÓÔÈ·, ΢¿ÓˆÛË, ÏËÎÙÚÔ‰·ÎÙ˘Ï›· ‹ Ô›‰ËÌ· (SaO2: 97%). ∏ ۈ̷ÙÈ΋ ÙÔ˘ ·Ó¿Ù˘ÍË ˘ÔÏÂÈfiÙ·Ó ÁÈ· ÙËÓ ËÏÈΛ· ÙÔ˘ (µ™: <3Ë ∂£, ª™ Î·È ¶∫ ÛÙË 10Ë ∂£). ∂ÈÛÎÔÈο, ÚÔηÏÔ‡Û ÂÓÙ‡ˆÛË Ë ·ÚÔ˘Û›· ÙËÏ·ÁÁÂÈÂÎÙ·ÛÈÒÓ ÛÙÔ˘˜ ‚ÔÏ‚ÈÎÔ‡˜ ÂÈÂÊ˘ÎfiÙ˜ ·ÌÊÔÙÂÚfiÏ¢ڷ. ¢ÂÓ „ËÏ·Ê›˙ÔÓÙ·Ó Ô˘ıÂÓ¿ ÏÂÌÊ·‰¤Ó˜, Ë ÎÔÈÏÈ¿ ‹Ù·Ó ̷Ϸ΋, ¢›ÂÛÙË ¯ˆÚ›˜ ÔÚÁ·ÓÔÌÂÁ·Ï›· Î·È Ù· ¤Íˆ ÁÂÓÓËÙÈο fiÚÁ·Ó· ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎÔ‡ ı‹ÏÂÔ˜. ∏ ·ÛıÂÓ‹˜ ·ÚÔ˘Û›·˙ ÂͤڢıÚ· ·Ú›ÛıÌÈ· Ì ÔÈÛıÔÚÚÈÓÈ΋ ˘Ò‰Ë Ú‡ÛË Î·È ÌË ÌÔ˘ÛÈÎÔ‡˜ ÚfiÁ¯Ô˘˜ Û fiÏÔ ÙÔ Â‡ÚÔ˜ Ù˘ ·Ó·ÓÔ‹˜. ∞fi ÙËÓ ·ÎÚfi·ÛË Ù˘ ηډȿ˜ ‰ÂÓ ÚԤ΢Ù ٛÔÙ· ·ıÔÏÔÁÈÎfi. ∏ Ó¢ÚÔÏÔÁÈ΋ ÂͤٷÛË ‰ÂÓ ÂÓÙfiÈÛ ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·. OÈ ÔÊı·ÏÌÈΤ˜ ÎÈÓ‹ÛÂȘ ‹Ù·Ó Û˘ÌÌÂÙÚÈΤ˜ Î·È Ê˘ÛÈÔÏÔÁÈΤ˜, ÂÓÒ Ô ¤ÏÂÁ¯Ô˜ ÙˆÓ ÂÁÎÂÊ·ÏÈÎÒÓ Û˘˙˘ÁÈÒÓ ‰ÂÓ ÂÓÙfiÈÛ ٛÔÙ· ·ıÔÏÔÁÈÎfi. O Ì˘˚Îfi˜ ÙfiÓÔ˜ Î·È Ù· ÂÓ Ùˆ ‚¿ıÂÈ ÙÂÓfi-
Paediatriki 2004;67:208-211
ÓÙÈ· ·ÓÙ·Ó·ÎÏ·ÛÙÈο ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο Î·È ÔÈ ·ÚÂÁÎÂÊ·ÏȉÈΤ˜ ‰ÔÎÈ̷ۛ˜ ÂÎÙÂϤÛÙËÎ·Ó ÈηÓÔÔÈËÙÈο. ∆Ô ‚¿‰ÈÛÌ· ‹Ù·Ó ·ÚÁfi, ·ÏÏ¿ ÛÙ·ıÂÚfi. ∞fi ÙÔÓ ·‰Úfi ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô ‰È·ÈÛÙÒıËΠϢÎÔÂÓ›· Î·È ÏÂÌÊÔÂÓ›·: Ht: 40%, Hb: 12,7 g/dl, WBC: 3000/Ìl (¶: 71%, §: 24%, ª: 5%), PLT: 386.000/Ìl. OÈ ‰Â›ÎÙ˜ ÊÏÂÁÌÔÓ‹˜ ‹Ù·Ó ¯·ÌËÏÔ› (∆∫∂: 24 mm, CRP: 4 mg/L) Î·È Ô ‚ÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ê˘ÛÈÔÏÔÁÈÎfi˜. ∏ ·Ï‹ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ ¤‰ÂÈÍ ÚÔÛ‚ÔÏ‹ ‰È¿ÌÂÛÔ˘ ÈÛÙÔ‡, ÂÓÒ Ë ‰ÂÚÌÔ·ÓÙ›‰Ú·ÛË Mantoux ‹Ù·Ó ·ÚÓËÙÈ΋. ™ÙȘ ηÏÏȤÚÁÂȘ ÚÈÓÈÎÒÓ ÂÎÎÚÈÌ¿ÙˆÓ Î·È Ù˘¤ÏˆÓ ÁÈ· ÎÔÈÓ¿ ‚·ÎÙ‹ÚÈ· ·Ó·Ù‡¯ıËΠ·ÈÌfiÊÈÏÔ˜ ÈÓÊÏÔ˘¤ÓÙÛ·˜ ·ÓıÂÎÙÈÎfi˜ ÛÙËÓ ÎÏ·ÚÈıÚÔÌ˘Î›ÓË, Ô˘ ¯ÔÚËÁÔ‡ÓÙ·Ó ÚÈÓ ÙËÓ ÂÈÛ·ÁˆÁ‹. ªÂ Ù· Â˘Ú‹Ì·Ù· ·˘Ù¿ ·ÔÊ·Û›ÛÙËÎÂ Ë ¤Ó·ÚÍË ·ÁˆÁ‹˜ ÌÂ Û˘Ó‰˘·ÛÌfi ·ÌÔÍÈÎÈÏÏ›Ó˘ Î·È ÎÏ·‚Ô˘Ï·ÓÈÎÔ‡ ÔͤԘ ÂÓ‰ÔÊÏ‚›ˆ˜. ÃÔÚËÁ‹ıËηÓ, ›Û˘, Û·Ï‚Ô˘Ù·ÌfiÏË Î·È ‚ÚˆÌÈÔ‡¯Ô ÈÚ·ÙÚfiÈÔ Ì ÓÂÊÂÏÔÔÈËÙ‹, Ù· ÔÔ›· ‰È·ÎfiËÎ·Ó ÏfiÁˆ ÌË ·ÓÙ·fiÎÚÈÛ˘ Ù˘ ·ÛıÂÓÔ‡˜. §fiÁˆ Ù˘ ‚Ú·‰Â›·˜ ·ÓÙ·fiÎÚÈÛ˘ ÛÙË ıÂڷ¢ÙÈ΋ ·ÁˆÁ‹ Î·È ÙÔ˘ ÂÈ‚·Ú˘Ì¤ÓÔ˘ ÌÂ Û˘¯Ó¤˜ ÏÔÈÌÒÍÂȘ ·ÙÔÌÈÎÔ‡ ·Ó·ÌÓËÛÙÈÎÔ‡, Ô ¤ÏÂÁ¯Ô˜ ÂÂÎÙ¿ıËÎÂ. ŒÁÈÓ ÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÁÈ· HIV, EBV, CMV, ·‰ÂÓÔ˚Ô‡˜, ÈÔ‡˜ Áڛ˘ Î·È ·Ú·Áڛ˘, ¯Ï·Ì‡‰ÈÔ Î·È Ì˘ÎfiÏ·ÛÌ· Ù˘ Ó¢ÌÔÓ›·˜, ηıÒ˜ Î·È ·ÓÔÛÔÊıÔÚÈÛÌfi˜ Û ÚÈÓÈÎfi ¤ÎÏ˘Ì· ÁÈ· ·Ó›¯Ó¢ÛË ÙÔ˘ ·ÓÙÈÁfiÓÔ˘ ÙÔ˘ RSV. ¶ÚÔÛ‰ÈÔÚ›ÛÙËΠÙÔ Û˘Ìϋڈ̷ Î·È Ë ·1 ·ÓÙÈıÚ˘„›ÓË ÛÙÔÓ ÔÚfi, Ù· Rast Û ÙÚÔÊÈο Î·È ÂÈÛÓÂfiÌÂÓ· ·ÏÏÂÚÁÈÔÁfiÓ· Î·È ¤ÁÈÓ ‰ÔÎÈÌ·Û›· ȉÚÒÙ·. ∆¤ÏÔ˜, ÌÂÙÚ‹ıËÎÂ Ë ÛˆÌ·ÙỔ›ÓË, Ë ÈÓÛÔ˘Ï›ÓË Î·È ÔÈ ÁÂÓÓËÙÈΤ˜ ÔÚÌfiÓ˜ Î·È ¤ÁÈÓ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ Î·È Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘. ∞fi fiϘ ÙȘ ÚÔËÁÔ‡ÌÂÓ˜ ÂÍÂÙ¿ÛÂȘ ‰ÂÓ ÚԤ΢„ ٛÔÙ· ·ıÔÏÔÁÈÎfi. O ¤ÏÂÁ¯Ô˜ Ù˘ ¯˘ÌÈ΋˜ Î·È Î˘ÙÙ·ÚÈ΋˜ ·ÓÔÛ›·˜ ‹Ù·Ó ·˘Ùfi˜ Ô˘ ηÙˇı˘Ó ÙË ‰È¿ÁÓˆÛË. ∂Ȃ‚·ÈÒıËÎÂ Ë ÏÂÌÊÔÂÓ›· (ÏÂÌÊÔ·ÙÙ·Ú·: 850/Ìl) Î·È Ë Ï¢ÎÔÂÓ›· (WBC: 3300/Ìl), ÂÓÒ Ë ·ÛıÂÓ‹˜ ·ÚÔ˘Û›·˙Â, ›Û˘, ¯·ÌËÏ¿ ›‰· Ù˘ Ig∞ (<7 mg/dl) Î·È Ù˘ Ig∂ (<2 IU/ml), Ê˘ÛÈÔÏÔÁÈ΋ IgG (551 mg/dl) Ì ÌÂȈ̤Ó˜, fï˜, ÙÈ̤˜ ÙˆÓ ˘ÔÙ¿ÍÂˆÓ IgG2 (11 mg/dl) Î·È IgG4 (<2 mg/dl), ηıÒ˜ Î·È ˘„ËÏ‹ ÙÈÌ‹ Ù˘ Igª (319 mg/dl). O ·fiÏ˘ÙÔ˜ ·ÚÈıÌfi˜ ÙÔ˘ ÏËı˘ÛÌÔ‡ ÙˆÓ CD4 ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ‹Ù·Ó Ôχ ¯·ÌËÏfi˜ (180/Ìl) Î·È Ë ÙÈÌ‹ Ù˘ ·-ÊÂÙÔÚˆÙ½Ó˘ Ôχ ˘„ËÏ‹ (294 ng/ml, ÊÙ: 0-20 ng/ml). ªÂ ÙË ‰È¿ÁÓˆÛË Ù˘ ·ÓÔÛÔ·Ó¿ÚÎÂÈ·˜, ÙÔ ·È‰› Ù¤ıËΠÛÂ Û˘ÛÙËÌ·ÙÈ΋ ¯ÔÚ‹ÁËÛË Á-ÛÊ·ÈÚ›Ó˘ ÂÓ‰ÔÊÏ‚›ˆ˜ Û ‰fiÛË 400 mg/kg ·Ó¿ 3 ‚‰ÔÌ¿‰Â˜, ÚÔÊ˘Ï·ÎÙÈ΋ ¯ÔÚ‹ÁËÛË ÎÂÊ·ÎÏfiÚ˘ ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜ Û ‰fiÛË 20 mg/kg ËÌÂÚËÛ›ˆ˜ Î·È 50 mcg ÂÈÛÓÔ‹ ÊÏÔ˘ÙÈη˙fiÓ˘ ¿·Í ËÌÂÚËÛ›ˆ˜. ŒÁÈÓÂ
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¶·È‰È·ÙÚÈ΋ 2004;67:208-211
¤ÏÂÁ¯Ô˜ ÈÛÙÔÛ˘Ì‚·ÙfiÙËÙ·˜ ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ·, ÚÔÎÂÈ̤ÓÔ˘ Ó· ‰ÈÂÚ¢ÓËı› Ë Èı·ÓfiÙËÙ· ÌÂÙ·ÌfiÛ¯Â˘Û˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ ÛÙÔ Ì¤ÏÏÔÓ, fiÔ˘ ‰È·ÈÛÙÒıËΠHLA-Ù·˘ÙfiÙËÙ· ÌÂٷ͇ Ù˘ ·ÛıÂÓÔ‡˜ Î·È Ù˘ ·‰ÂÚÊ‹˜ Ù˘. ∏ ηÏÏȤÚÁÂÈ· ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Ù˘ ·ÛıÂÓÔ‡˜ ÂÎÙÈı¤ÌÂÓˆÓ Û ·ÎÙÈÓÔ‚ÔÏ›· ·Ó¤‰ÂÈÍ ·ıÔÏÔÁÈο ·˘ÍË̤ÓÔ ÔÛÔÛÙfi ıÚ·˘ÛÌ¿ÙˆÓ ¯ÚˆÌÔÛˆÌ¿ÙˆÓ (6%) Î·È Ôχ ÌÈÎÚ‹ ÈηÓfiÙËÙ· ÂȉÈfiÚıˆÛ˘ (<5%). ∆Ô Â‡ÚËÌ· ·˘Ùfi Û˘ÓËÁÔÚÔ‡Û ˘¤Ú Ù˘ ‰È¿ÁÓˆÛ˘ Ù˘ ·Ù·Í›·˜-ÙËÏ·ÁÁÂÈÂÎÙ·Û›·˜. ∞ÎÔÏÔ‡ıˆ˜, ÚÔÁÚ·ÌÌ·Ù›ÛÙËΠÁÂÓÂÙÈÎfi˜ ¤ÏÂÁ¯Ô˜, fiÔ˘ ·ÓȯÓ‡ıËΠÙÚÔÔÔ›ËÛË ÛÙË ı¤ÛË 8850 (G>T) ÙÔ˘ ÁÔÓȉ›Ô˘ ATM, ÛÙÔÈ¯Â›Ô Ô˘ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙÔÓ ÎÏÈÓÈÎfi Ê·ÈÓfiÙ˘Ô ÂȂ‚·›ˆÛ ÙËÓ ·Ú·¿Óˆ ‰È¿ÁÓˆÛË. ¢‡Ô ¯ÚfiÓÈ· ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ·Ú·ÎÔÏÔ‡ıËÛ‹˜ Ù˘, Ë ·ÛıÂÓ‹˜ ÚÔÛ‚Ï‹ıËΠ‰‡Ô ÊÔÚ¤˜ ·fi ÏÔÈÌÒÍÂȘ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡, ÔÈ Ôԛ˜ ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó ÂÈÙ˘¯Ò˜ Ì ÂÓ‰ÔÊϤ‚È· ·ÓÙÈÌÈÎÚԂȷ΋ ·ÁˆÁ‹. ™˘Ó¯›˙ÂÙ·È Ë ·ÁˆÁ‹ Ì Á-ÛÊ·ÈÚ›ÓË, ÎÂÊ·ÎÏfiÚË, ÊÏÔ˘ÙÈη˙fiÓË Î·È ·ÎÔÏÔ˘ıÔ‡ÓÙ·È ‰È·ÈÙËÙÈΤ˜ Ô‰ËÁ›Â˜ (Û˘¯Ó¿ Î·È ÌÈÎÚ¿ Á‡̷ٷ Ì ÙÚÔʤ˜ ˘„ËÏ‹˜ ‰È·ÙÚÔÊÈ΋˜ ·Í›·˜ Ô˘ ‰ÂÓ ¯ÚÂÈ¿˙ÔÓÙ·È È‰È·›ÙÂÚË Ì¿ÛËÛË), ÏfiÁˆ Ù˘ ·Û˘Ó¤ÚÁÂÈ·˜ ÙˆÓ Ì˘ÒÓ Ù˘ ηٿÔÛ˘ Ô˘ ‰È·ÈÛÙÒıËΠÌÂÙ¿ ·fi ‚·ÚÈÔ‡¯Ô Á‡̷. ∏ ·ÛıÂÓ‹˜ ‰ÂÓ ¤¯ÂÈ ·ÚÔ˘ÛÈ¿ÛÂÈ Î·Ì›· ÂΉ‹ÏˆÛË ÂÓ‰ÂÈÎÙÈ΋ ÚÔÛ‚ÔÏ‹˜ ÙÔ˘ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ¢È·ÙËÚ› ÙËÓ ÈηÓfiÙËÙ· Ó· ÓÙ‡ÓÂÙ·È Î·È Ó· Á‰‡ÓÂÙ·È, Ó· ÙÚÒÂÈ Ì ÈÚÔ‡ÓÈ Î·È ÎÔ˘Ù¿ÏÈ, ¤ÛÙˆ Î·È Ì οÔÈ· ‰˘ÛÎÔÏ›·, Ó· ÁÚ¿ÊÂÈ Î·ı·Ú¿ ÙÔ fiÓÔÌ¿ Ù˘ Î·È Ó· ÔÌÈÏ› ηı·Ú¿ Ì ÚÔÙ¿ÛÂȘ ÔÏÏÒÓ Ï¤ÍˆÓ. ™˘˙‹ÙËÛË ∏ ‰È¿ÁÓˆÛË Ù˘ ·Ù·Í›·˜-ÙËÏ·ÁÁÂÈÂÎÙ·Û›·˜ Ù›ıÂÙ·È Û ·È‰È¿ ËÏÈΛ·˜ ¿Óˆ ÙÔ˘ 1 ¤ÙÔ˘˜ Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·Ù·Í›· ‹ ÛËÌ·ÓÙÈ΋ ·Û˘Ó¤ÚÁÂÈ· ÎÈÓ‹ÛÂˆÓ Î·È ÙÈÌ‹ ·-ÊÂÙÔÚˆÙ½Ó˘ ÛÙÔÓ ÔÚfi ÌÂÁ·Ï‡ÙÂÚË ·fi ÙÔ ‰ÈÏ¿ÛÈÔ Ù˘ ·ÓÒÙÂÚ˘ Ê˘ÛÈÔÏÔÁÈ΋˜. OÈ ·ÛıÂÓ›˜ Ú¤ÂÈ, ÂÈϤÔÓ, Ó· ÏËÚÔ‡Ó 3 ·fi Ù· ·ÎfiÏÔ˘ı· 4 ‰È·ÁÓˆÛÙÈο ÎÚÈÙ‹ÚÈ·: ·) ·Û˘Ó¤ÚÁÂÈ· ÎÂÊ·Ï‹˜ Î·È ÔÊı·ÏÌÒÓ, ȉ›ˆ˜ ÛÙËÓ Ï¿ÁÈ· ·fiÎÏÈÛË ÙÔ˘ ‚ϤÌÌ·ÙÔ˜, ‚) ÙËÏ·ÁÁÂÈÂÎٷۛ˜ ÚÈÓ ÙÔ ¤ÌÙÔ ¤ÙÔ˜ ˙ˆ‹˜, ·Ú¯Èο ÛÙÔ˘˜ ÂÈÂÊ˘ÎfiÙ˜ Î·È ÌÂÙ¿ ÛÙÔ ‰¤ÚÌ·, Á) ·ÛÙ¿ıÂÈ· ‚¿‰ÈÛ˘ Î·È ‰) ÏÂÌÊÔÂÓ›· Î·È ·Ó¿ÚÎÂÈ· Ù˘ IgA. ™Â ·ÛıÂÓ›˜ Ô˘ ÏËÚÔ‡Ó ÏÈÁfiÙÂÚ· ·fi 3 ÙˆÓ ·ÓˆÙ¤Úˆ ÎÚÈÙËÚ›ˆÓ, Ë ‰È¿ÁÓˆÛË ÂȂ‚·ÈÒÓÂÙ·È Ì ÙËÓ ·Ó‡ÚÂÛË ·ıÔÏÔÁÈο ·˘ÍË̤ÓÔ˘ ÔÛÔÛÙÔ‡ ¢ıÚ·ÛÙfiÙËÙ·˜ ÙˆÓ ¯ÚˆÌÔÛˆÌ¿ÙˆÓ ÙˆÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ÌÂÙ¿ ·fi ¤ÎıÂÛË Û ·ÎÙÈÓÔ‚ÔÏ›· Î·È Ôχ ÌÈÎÚ‹˜ ÈηÓfiÙËÙ·˜ ÂȉÈfiÚıˆÛ˘ ÙˆÓ ‚Ï·‚ÒÓ. ∏ ÌÔÚȷ΋ ÌÂϤÙË ÙÔ˘ ˘Â‡ı˘ÓÔ˘ ÁÔÓȉ›Ô˘ ∞∆ª ÛÙÔ ¯ÚˆÌfiۈ̷ 11 ÔÏÔÎÏËÚÒÓÂÈ ÙË ‰ÈÂÚ‡ÓËÛË (5). ∆Ô ÁÔÓ›‰ÈÔ ÎψÓÔÔÈ‹-
210
Paediatriki 2004;67:208-211
ıËΠÙÔ 1995 Î·È ¤ÎÙÔÙ ¤¯Ô˘Ó Á›ÓÂÈ ÁÓˆÛÙ¤˜ ÂÚ›Ô˘ 60 ÌÂÙ·ÏÏ¿ÍÂȘ ÙÔ˘, Ï›Á˜ ÂÎ ÙˆÓ ÔÔ›ˆÓ (5-10) Û˘Ó‰¤ÔÓÙ·È Ì ‚Ú·‰‡ÙÂÚË Ó¢ÚÔÏÔÁÈ΋ ¤ÎÙˆÛË (6). ∏ ÚˆÙ½ÓË, ÙËÓ ·Ú·ÁˆÁ‹ Ù˘ ÔÔ›·˜ ÂϤÁ¯ÂÈ ÙÔ ÁÔÓ›‰ÈÔ ∞∆ª, Ú˘ıÌ›˙ÂÈ ÙÔÓ Î˘ÙÙ·ÚÈÎfi ·ÎÏÔ Î·È ·ÚÂÌÔ‰›˙ÂÈ ÙËÓ ·Ó··Ú·ÁˆÁ‹ ÙÔ˘ ‰ÔÌÈο ‰È·Ù·Ú·Á̤ÓÔ˘ DNA (7). ™Â ÔÛÔÛÙfi 25-30% ÙˆÓ ·ÛıÂÓÒÓ Ì ÙÔÓ ÎÏÈÓÈÎfi Ê·ÈÓfiÙ˘Ô Ù˘ ·Ù·Í›·˜-ÙËÏ·ÁÁÂÈÂÎÙ·Û›·˜ ›Ù ‰ÂÓ ·ÓȯÓ‡ÂÙ·È Î¿ÔÈ· ÌÂÙ¿ÏÏ·ÍË ÛÙÔ ˘Â‡ı˘ÓÔ ÁÔÓ›‰ÈÔ Â›Ù ÂÓÙÔ›˙ÂÙ·È Ì›· Ó¤·, fiˆ˜ ·˘Ù‹ Ô˘ ·Ó¢ڤıËΠÛÙË Û˘ÁÎÂÎÚÈ̤ÓË ·ÛıÂÓ‹ (2). ∏ ·ÛıÂÓ‹˜ Ù˘ ·ÚÔ‡Û·˜ ÂÚ›ÙˆÛ˘ ÏËÚÔ‡Û ٷ ÚÔ·Ó·ÊÂÚfiÌÂÓ· ÎÚÈÙ‹ÚÈ·, ÏfiÁˆ fï˜ Ù˘ ·Ô˘Û›·˜ Ó¢ÚÔÏÔÁÈÎÒÓ ÂΉËÏÒÛˆÓ, Ë ‰È¿ÁÓˆÛË ‰È¤Ï·ı ˆ˜ ÙËÓ ËÏÈΛ· ÙˆÓ 4 ÂÙÒÓ. ™˘Ó‹ıˆ˜, Ë ÓfiÛÔ˜ ÚÔ‚¿ÏÏÂÈ ÚÈÓ ÙÔ Ù¤ÏÔ˜ ÙÔ˘ ‰Â‡ÙÂÚÔ˘ ¤ÙÔ˘˜ ˙ˆ‹˜ Ì ÚÔԉ¢ÙÈο ÂȉÂÈÓÔ‡ÌÂÓË ·ÚÂÁÎÂÊ·ÏȉÈ΋ ·Ù·Í›·. ∏ ÔÌÈÏ›· ·ÚÔ˘ÛÈ¿˙ÂÈ ‰˘Û·ÚıÚ›·, ÔÈ ÎÈÓ‹ÛÂȘ ÂÎÙÂÏÔ‡ÓÙ·È Ì ‰˘ÛÎÔÏ›· Î·È Û˘¯Ó¿ ·Ú·ÙËÚÂ›Ù·È ÚÔԉ¢ÙÈ΋ ÓÂ˘Ì·ÙÈ΋ ¤ÎÙˆÛË (1,5). ∏ Û˘ÁÎÂÎÚÈ̤ÓË ·ÛıÂÓ‹˜ ›¯Â Ê˘ÛÈÔÏÔÁÈΤ˜ ÎÈÓËÙÈΤ˜ Î·È ÓÔËÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜, fï˜ Ì›· ·Û˘Ó‹ıÈÛÙ· ·Ú·ÙÂٷ̤ÓË Î·È ·ÓıÂÎÙÈ΋ ÛÙË ¯ÔÚËÁËı›۷ ·ÁˆÁ‹ Ïԛ̈ÍË ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ ÙËÓ Ô‰‹ÁËÛ Û ÙÚÈÙÔ‚¿ıÌÈÔ Î¤ÓÙÚÔ, fiÔ˘ Ì ÙË ‚Ô‹ıÂÈ· ÙÔ˘ ·Ú·ÎÏÈÓÈÎÔ‡ ÂϤÁ¯Ô˘ Ù¤ıËÎÂ Ë ‰È¿ÁÓˆÛË. ∂›Ó·È ÁÓˆÛÙfi fiÙÈ Ù· ·ÓÔÛÔÏÔÁÈο Â˘Ú‹Ì·Ù· Ù˘ ·Ù·Í›·˜-ÙËÏ·ÁÁÂÈÂÎÙ·Û›·˜ ÔÈΛÏÏÔ˘Ó. ™˘Ó‹ıˆ˜, fiˆ˜ Î·È ÛÙËÓ ·ÛıÂÓ‹ Ù˘ ·ÚÔ‡Û·˜ ÂÚ›ÙˆÛ˘, ·Ú·ÙËÚÂ›Ù·È ¯·ÌËÏ‹ ÙÈÌ‹ Ù˘ Ig∞ Î·È ÔÚÈÛÌ¤ÓˆÓ ˘ÔÙ¿ÍÂˆÓ Ù˘ IgG. ∏ ˘ÔÁ·ÌÌ·ÛÊ·ÈÚÈÓ·ÈÌ›· Úԉȷı¤ÙÂÈ ÛÙËÓ ·Ó¿Ù˘ÍË ÏÔÈÌÒÍÂˆÓ ÙˆÓ ·Ú·ÚÚ›ÓÈˆÓ ÎfiÏˆÓ Î·È ÙˆÓ Ó¢ÌfiÓˆÓ. ™˘¯Ó¿ ηٷÁÚ¿ÊÂÙ·È ÂÏ¿ÙÙˆÛË ÙˆÓ CD4 Î·È CD8 ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ, ·‡ÍËÛË ÙˆÓ Ê˘ÛÈÎÒÓ Î˘ÙÙ·ÚÔÎÙfiÓˆÓ (¡∫) ΢ÙÙ¿ÚˆÓ Î·È ÌË ıÂÙÈÎÔÔ›ËÛË ÙˆÓ ·ÓÙȉڿÛÂˆÓ ÂÈ‚Ú·‰˘ÓfiÌÂÓ˘ ˘ÂÚ¢·ÈÛıËÛ›·˜ (8). ¶·Ú’ fiÏ· ·˘Ù¿, ÏÔÈÌÒÍÂȘ ·fi ¢ηÈÚȷο ·ıÔÁfiÓ· Â›Ó·È ÂÍ·ÈÚÂÙÈο Û¿ÓȘ, ÁÈ’ ·˘Ùfi ‰ÂÓ Û˘ÛÙ‹ÓÂÙ·È ÚÔÊ˘Ï·ÎÙÈ΋ ·ÁˆÁ‹ Ì ÙÚÈÌÂıÔÚ›ÌË-ÛÔ˘ÏÊÔÌÂıÔÍ·˙fiÏË (9). ∏ ¤ÎÙˆÛË Ù˘ ·ÓÔÛ›·˜, Û ·ÓÙ›ıÂÛË Ì ÙË Ó¢ÚÔÏÔÁÈ΋ Û˘Ó‰ÚÔÌ‹, ‰ÂÓ Â›Ó·È Û˘Ó‹ıˆ˜ ÚÔԉ¢ÙÈ΋ Î·È ¤ÙÛÈ ‰ÂÓ ··ÈÙÂ›Ù·È ÂÚÈÔ‰ÈÎfi˜ ¤ÏÂÁ¯fi˜ Ù˘, ·Ú¿ ÌfiÓÔ ·Ó ·Ú·ÙËÚËı› ·‡ÍËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ ÏÔÈÌÒÍÂˆÓ (1,8). ŒÓ·˜ ÂÈϤÔÓ ·Ú¿ÁÔÓÙ·˜, ÏËÓ Ù˘ ·ÓÔÛÔ·Ó¿ÚÎÂÈ·˜, Ô˘ ¢ı‡ÓÂÙ·È ÁÈ· ÙȘ ›ÌÔÓ˜ ÏÔÈÌÒÍÂȘ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ ÛÙËÓ ·Ù·Í›·-ÙËÏ·ÁÁÂÈÂÎÙ·Û›· Â›Ó·È Ë ·Û˘Ó¤ÚÁÂÈ· ÙˆÓ Ì˘ÒÓ Ù˘ ηٿÔÛ˘ Ô˘ ÚÔηÏ› ÌÈÎÚÔÂÈÛÚÔÊ‹ÛÂȘ, fiˆ˜ Û˘Ó¤‚Ë Î·È ÛÙËÓ ·ÛıÂÓ‹ Ù˘ ·ÚÔ‡Û·˜ ÂÚ›ÙˆÛ˘ (10). ∏ ¢¿ıÂÈ· Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ù· ¯ÚˆÌÔÛÒÌ·Ù· ÙˆÓ ·ÛıÂÓÒÓ ÛÙËÓ ¤ÎıÂÛË Û ·ÎÙÈÓÔ‚ÔÏ›·,
May-June 04 chris new
19-07-04
19:24
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¶·È‰È·ÙÚÈ΋ 2004;67:208-211
·Ó·Áο˙ÂÈ ÙÔÓ ıÂÚ¿ÔÓÙ· È·ÙÚfi Ó· Â›Ó·È ÂÍ·ÈÚÂÙÈο ÊÂȉˆÏfi˜ ÛÙË ‰ÈÂÓ¤ÚÁÂÈ· ·ÎÙÈÓÔÏÔÁÈÎÒÓ ÂÍÂÙ¿ÛˆÓ. ™ËÌÂÈÒÓÂÙ·È È‰È·ÈÙ¤Úˆ˜ fiÙÈ Ë ·ÏfiÁÈÛÙË ¤ÎıÂÛË Û ·ÎÙÈÓÔ‚ÔÏ›· ÌÔÚ› Ó· ÂÈÙ›ÓÂÈ ÙËÓ ÚԉȿıÂÛË ÛÙËÓ ·Ó¿Ù˘ÍË Ì›·˜ ÓÂÔÏ·Û›·˜ ÙÔ˘ ÏÂÌÊÈÎÔ‡ ‹ ÂÈıËÏÈ·ÎÔ‡ ÈÛÙÔ‡ Û ·˘ÙÔ‡˜ ÙÔ˘˜ ·ÛıÂÓ›˜ (11). ÀÔÁÚ·ÌÌ›˙ÂÙ·È fiÙÈ ·˘Ù‹ Ë ÚԉȿıÂÛË ¤¯ÂÈ ÂÓÙÔÈÛÙ› Î·È ÛÙÔ˘˜ ÂÙÂÚÔ˙˘ÁÒÙ˜, ‰Â‰Ô̤ÓÔ Ô˘ Èı·ÓfiÓ ı· ÌÔÚÔ‡Û ӷ ÂÚÌËÓ‡ÛÂÈ ÙËÓ ·Û˘Ó‹ıÈÛÙË Û˘ÛÛÒÚ¢ÛË ÂÚÈÛÙ·ÙÈÎÒÓ ÓÂÔÏ·Û›·˜ ÛÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÂÚÈ‚¿ÏÏÔÓ Ù˘ ·ÛıÂÓÔ‡˜. §fiÁˆ ÙˆÓ ·ÓˆÙ¤Úˆ, Û˘ÓÈÛÙ¿Ù·È ¤ÏÂÁ¯Ô˜ ÁÈ· ÙÔÓ ÂÓÙÔÈÛÌfi ÙÔ˘ ·ıÔÏÔÁÈÎÔ‡ ÁÔÓȉ›Ô˘ ∞∆ª ÛÙÔ˘˜ Û˘ÁÁÂÓ›˜ ÙˆÓ ·ÛıÂÓÒÓ Ì ·Ù·Í›·-ÙËÏ·ÁÁÂÈÂÎÙ·Û›·, ÚÔÎÂÈ̤ÓÔ˘ - Û fiÛÔ˘˜ ·ÓȯÓ‡ÂÙ·È ‡ÔÙË ÌÂÙ¿ÏÏ·ÍË Ó· Á›ÓÂÙ·È Û˘ÛÙËÌ·ÙÈÎfi˜ ÚÔÏËÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÁÈ· ÚÒÈÌË ÂÓÙfiÈÛË Èı·Ó‹˜ ηÎÔ‹ıÂÈ·˜ (3,11). ¶·Ú¿ ÙËÓ ‹È· ÔÚ›· Ô˘ ·ÚÔ˘ÛÈ¿˙ÂÈ ÚÔ˜ ÙÔ ·ÚfiÓ Ë ÓfiÛÔ˜ ÛÙËÓ ·ÛıÂÓ‹ Ù˘ ·ÚÔ‡Û·˜ ÂÚ›ÙˆÛ˘, Ë ÚfiÁÓˆÛË Â›Ó·È ·ÌÊ›‚ÔÏË. ∂›Ó·È ÁÓˆÛÙfi fiÙÈ Ë ÏÂÈÔÓfiÙËÙ· ÙˆÓ ·ÛıÂÓÒÓ Î·ıËÏÒÓÂÙ·È Û ·Ó·ËÚÈÎfi ηÚÔÙÛ¿ÎÈ ÌÂٷ͇ 8 Î·È 12 ÂÙÒÓ Î·È ‰ÂÓ ÌÔÚ› Ó· ÂÎÙÂϤÛÂÈ ·˘ÙfiÓÔÌ· Ô‡Ù ÙȘ ÛÙÔȯÂÈÒ‰ÂȘ ÏÂÈÙÔ˘ÚÁ›Â˜ (5,12). ∏ ·Ó·Ó¢ÛÙÈ΋ ·Ó¿ÚÎÂÈ·, ̤ۈ ÚfiÎÏËÛ˘ ÂÎÙÂÙ·Ì¤ÓˆÓ ‚ÚÔÁ¯ÈÂÎÙ·ÛÈÒÓ ·fi ÙȘ ·ӷϷ̂·ÓfiÌÂÓ˜ ÏÔÈÌÒÍÂȘ, ·ÔÙÂÏ› ÙË Û˘¯ÓfiÙÂÚË ·ÈÙ›· ı·Ó¿ÙÔ˘ Î·È ·ÎÔÏÔ˘ı› Ë ÚÔÛ‚ÔÏ‹ ·fi ÓÂÔÏ·Û›· (13). OÈ ÂÚÈÛÛfiÙÂÚÔÈ Î·Ù·Ï‹ÁÔ˘Ó ÚÈÓ ÙÔ ¤Ú·˜ Ù˘ ÙÚ›Ù˘ ‰ÂηÂÙ›·˜ ˙ˆ‹˜, ·Ó Î·È ¤¯ÂÈ ÂÚÈÁÚ·Ê› ÂÓ ˙ˆ‹ ·ÛıÂÓ‹˜ ËÏÈΛ·˜ 60 ÂÙÒÓ (5). °ÂÓÈο, Ë ıÂڷ›· Ù˘ ÓfiÛÔ˘ Â›Ó·È ÌfiÓÔ Û˘Ìو̷ÙÈ΋ Î·È ÂÚÈÏ·Ì‚¿ÓÂÈ ¯ËÌÂÈÔÚÔʇϷÍË Ô˘ Ó· ÚÔÊ˘Ï¿ÛÛÂÈ ·fi Ù· ÎÔÈÓ¿ ·ıÔÁfiÓ·, fiˆ˜ Ë ÎÂÊ·ÎÏfiÚË, ÂÈÛÓÂfiÌÂÓ· ‚ÚÔÁ¯Ô‰È·ÛÙ·ÏÙÈο, Ù·ÎÙÈ΋ ıÂڷ›· ˘ÔηٿÛÙ·Û˘ Ì Û··ÛÌ· Á-ÛÊ·ÈÚ›Ó˘, Ê˘ÛÈÔıÂڷ›· Î·È ÂÚÁÔıÂڷ›· ÁÈ· ÙËÓ ˘Ô‚Ô‹ıËÛË Ù˘ ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ·˜ ÙÔ˘ Ì˘ÔÛÎÂÏÂÙÈÎÔ‡ Î·È ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ (1). ∏ ·Ô˘Û›· Ù˘ Ig∞ ·˘Í¿ÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ·ÏÏÂÚÁÈÎÒÓ ·ÓÙȉڿÛÂˆÓ Û ÌÂÙ·ÁÁ›ÛÂȘ, ÁÈ’ ·˘Ùfi Û˘ÓÈÛÙ¿Ù·È Ë ¯ÔÚ‹ÁËÛË Û΢¿ÛÌ·ÙÔ˜ Á-ÛÊ·ÈÚ›Ó˘ Ô˘ ‰ÂÓ ÂÚȤ¯ÂÈ Ig∞ Î·È Ï˘Ì¤ÓˆÓ Î·È ·ÎÙÈÓÔ‚ÔÏËÌ¤ÓˆÓ ÂÚ˘ıÚÔ΢ÙÙ¿ÚˆÓ ‹ ·ÈÌÔÂÙ·Ï›ˆÓ ·Ó ˘¿ÚÍÂÈ ¤Ó‰ÂÈÍË (9). ¢ÂÓ ¤¯ÂÈ ·Ó·ÊÂÚı› ÂÈÙ˘¯‹˜ ÌÂÙ·ÌfiÛ¯Â˘ÛË Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ. ™˘ÌÂÚ·ÛÌ·ÙÈο, Ë ·Ù·Í›·-ÙËÏ·ÁÁÂÈÂÎÙ·Û›· Â›Ó·È Ì›· ÔÏ˘Û˘ÛÙËÌ·ÙÈ΋ ÁÂÓÂÙÈ΋ ÓfiÛÔ˜, ¯ˆÚ›˜ ·ÈÙÈÔÏÔÁÈ΋ ıÂڷ›· Î·È Ôχ η΋ ÚfiÁÓˆÛË, Ô˘ ÚÔÛ‚¿ÏÂÈ Î˘Ú›ˆ˜ ÙÔ Ó¢ÚÈÎfi Î·È ÙÔ ·ÓÔÛÔÏÔÁÈÎfi Û‡ÛÙËÌ·. ∆Ô ÂÚÈÛÙ·ÙÈÎfi Ô˘ ÂÚÈÁÚ¿ÊËΠÂÈÛËÌ·›ÓÂÈ ÙËÓ ÂÙÂÚÔÁ¤ÓÂÈ· ÙÔ˘ ÎÏÈÓÈÎÔ‡ Ê·ÈÓÔÙ‡Ô˘, ȉ›ˆ˜ fiÛÔÓ ·ÊÔÚ¿ ÛÙÔ Ó¢ÚÈÎfi Û‡ÛÙËÌ· Î·È ˘Ô‰ÂÈÎÓ‡ÂÈ ÙËÓ ‡·ÚÍË Î¿ÔÈˆÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ ÙÔ˘ ˘Â‡ı˘ÓÔ˘ ÁÔÓȉ›Ô˘ Ô˘ Úԉȷı¤ÙÔ˘Ó Û ‚Ú·‰‡-
Paediatriki 2004;67:208-211
ÙÂÚË Ó¢ÚÔÏÔÁÈ΋ ¤ÎÙˆÛË, ¯ˆÚ›˜ fï˜ ·˘Ùfi Ó· Û˘Ó¿ÁÂÙ·È Â˘ÓÔ˚ÎfiÙÂÚË Û˘ÓÔÏÈ΋ ÚfiÁÓˆÛË. µÈ‚ÏÈÔÁÚ·Ê›· 1. Huang KY, Shyur SD, Wang CY, Shen EY, Liang DC. Ataxia telangiectasia: report of two cases. J Microbiol Immunol Infect 2001;34:71-75. 2. Li A, Swift M. Mutations at the ataxia-telangiectasia locus and clinical phenotypes of A-T patients. Am J Med Genet 2000;92:170-177. 3. Fanos JH, Mackintosh MA. Never again joy without sorrow: the effect on parents of a child with ataxiatelangiectasia. Am J Med Genet 1999;87:413-419. 4. Geoffroy-Perez B, Janin N, Ossian K, Lauge A, Croquette MF, Griscelli C et al. Cancer risk in heterozygotes for ataxia-telangiectasia. Int J Cancer 2001;93:288-293. 5. Crawford TO, Mandir AS, Lefton-Greif MA, Goodman SN, Goodman BK, Sengul H et al. Quantitative neurologic assessment of ataxia-telangiectasia. Neurology 2000;54:1505-1509. 6. Perlman S, Becker-Catania S, Gatti RA. Ataxiatelangiectasia: diagnosis and treatment. Semin Pediatr Neurol 2003;10:173-182. 7. Heinloth AN, Shackelford RE, Innes CL, Bennett L, Li L, Amin RP et al. ATM-dependent and -independent gene expression changes in response to oxidative stress, gamma irradiation, and UV irradiation. Radiat Res 2003;160:273-290. 8. Schubert R, Reichenbach J, Zielen S. Deficiencies in CD4+ and CD8+ T cell subsets in ataxia telangiectasia. Clin Exp Immunol 2002;129:125-132. 9. Kutluk MT, Yalcin B, Buyukpamukcu M. Ataxia telangiectasia and Hodgkin disease. Med Pediatr Oncol 2000;34:62-64. 10. Lefton-Greif MA, Crawford TO, Winkelstein JA, Loughlin GM, Koerner CB, Zahurak M et al. Oropharyngeal dysphagia and aspiration in patients with ataxiatelangiectasia. J Pediatr 2000;136:225-231. 11. Neubauer S, Arutyunyan R, Stumm M, Dork T, Bendix R, Bremer M et al. Radiosensitivity of ataxia telangiectasia and Nijmegen breakage syndrome homozygotes and heterozygotes as determined by three-color FISH chromosome painting. Radiat Res 2002;157:312-321. 12. Mostofsky SH, Kunze JC, Cutting LE, Lederman HM, Denckla MB. Judgment of duration in individuals with ataxia-telangiectasia. Dev Neuropsychol 2000;17:63-74. 1 3. Irsfeld H, Korholz D, Janssen G, Wahn V, Schroten H. Fatal outcome in two girls with Hodgkin disease complicating ataxia-telangiectasia (Louis-Bar syndrome) despite favorable response to modified-dose chemotherapy. Med Pediatr Oncol 2000;34:62-64.
∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 06-05-2003 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 24-03-2004 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: °ÈÒÚÁÔ˜ ∆Ú›Ì˘ ∏Ï›· ∑ÂÚ‚Ô‡ 72, ∆.∫. 111 44, ¶·Ù‹ÛÈ· E-mail: gtrim@compulink.gr
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Paediatriki 2004;67:212-217
CURRENT ISSUE
∫ÏËÚÔÓÔÌÔ‡ÌÂÓ· ÂÚÈÔ‰Èο Â̇ÚÂÙ· Û‡Ó‰ÚÔÌ· Ÿ. µÔ˘ÁÈԇη
Hereditary periodic fever syndromes O. Vougiouka
¶ÂÚ›ÏË„Ë: ∆· ÎÏËÚÔÓÔÌÔ‡ÌÂÓ· ÂÚÈÔ‰Èο Â̇ÚÂÙ· Û‡Ó‰ÚÔÌ· ÌÂÙ·‚È‚¿˙ÔÓÙ·È Û‡Ìʈӷ Ì ÙÔ˘˜ ηÓfiÓ˜ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜ ÙÔ˘ Mendel Î·È ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ˘ÔÙÚÔÈ¿˙ÔÓÙ· ÂÂÈÛfi‰È· ˘ÚÂÙÔ‡ Î·È ÂÓÙÔÈṲ̂ӷ Ê·ÈÓfiÌÂÓ· ÊÏÂÁÌÔÓ‹˜, Ù· ÔÔ›· Û˘Ó‹ıˆ˜ ·ÊÔÚÔ‡Ó ÛÙÔ˘˜ ÔÚÔÁfiÓÔ˘˜, ÛÙÔ˘˜ ·ÚıÚÈÎÔ‡˜ ˘Ì¤Ó˜ Î·È ÛÙÔ ‰¤ÚÌ·. ∆· ÂÂÈÛfi‰È· Û˘Óԉ‡ÔÓÙ·È ·fi ·‡ÍËÛË ÙˆÓ ‰ÂÈÎÙÒÓ ÊÏÂÁÌÔÓ‹˜, fi¯È fï˜ Î·È ·fi ‰È¤ÁÂÚÛË ·Ú·ÁˆÁ‹˜ ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ ‹ ÂȉÈÎÒÓ ∆-ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ. O ÁÔÓȉȷÎfi˜ ÙÔ˘˜ ÚÔÛ‰ÈÔÚÈÛÌfi˜ ·ÔÙÂÏ› ÚfiÛÊ·ÙÔ ÂÈÛÙËÌÔÓÈÎfi ›Ù¢ÁÌ· Î·È ·ÓÔ›ÁÂÈ ‰ÚfiÌÔ˘˜ ÁÈ· ÙË ÌÂϤÙË ÙˆÓ ÔχÏÔÎˆÓ Ì˯·ÓÈÛÌÒÓ Ù˘ ÊÏÂÁÌÔÓ‹˜, ηıÒ˜ Î·È ÁÈ· ÂӉ¯fiÌÂÓ˜ ıÂڷ¢ÙÈΤ˜ ÚÔÛÂÁÁ›ÛÂȘ. ∂› ÙÔ˘ ·ÚfiÓÙÔ˜, ¤¯Ô˘Ó Û·ÊÒ˜ ÂÚÈÁÚ·Ê› Ù· ÂÍ‹˜ Û‡Ó‰ÚÔÌ·: ·fi Ù· ÌÂÙ·‚È‚·˙fiÌÂÓ· Ì ˘ÔÏÂÈfiÌÂÓÔ ·˘ÙÔۈ̷ÙÈÎfi ¯·Ú·ÎÙ‹Ú·: ·) Ô ÔÈÎÔÁÂÓ‹˜ ÌÂÛÔÁÂÈ·Îfi˜ ˘ÚÂÙfi˜ Î·È ‚) ÙÔ Û‡Ó‰ÚÔÌÔ ˘ÂÚÁ·Ì·ÛÊ·ÈÚÈÓ·ÈÌ›·˜ D Î·È ·fi Ù· ÎÏËÚÔÓÔÌÔ‡ÌÂÓ· Ì ÂÈÎÚ·ÙËÙÈÎfi ·˘ÙÔۈ̷ÙÈÎfi ¯·Ú·ÎÙ‹Ú·: ·) ÙÔ Û‡Ó‰ÚÔÌÔ ÙÔ˘ ˘Ô‰Ô¯¤· ÙÔ˘ ·Ú¿ÁÔÓÙ· Ó¤ÎÚˆÛ˘ ÙÔ˘ fiÁÎÔ˘, ‚) ÙÔ ÔÈÎÔÁÂÓ¤˜ ·˘ÙÔÊÏÂÁÌÔÓ҉˜ ÂÍ·ÓıËÌ·ÙÈÎfi Û‡Ó‰ÚÔÌÔ ÌÂÙ¿ ÁÂÓÈÎÂ˘Ì¤ÓË ¤ÎıÂÛË ÛÙÔ ÎÚ‡Ô Î·È Á) ÙÔ Û‡Ó‰ÚÔÌÔ Muckle-Wells.
Abstract: The hereditary periodic fever syndromes are a group of inherited disorders characterized by unprovoked episodes of fever and localized inflammation, most typically involving the serosa, synovium or skin. They are sometimes included in the broader spectrum of autoinflammatory syndromes, because of their lack of autoantibody production and antigen-specific Tcells. The best-described hereditary periodic fever syndromes to date are the recessively inherited familial mediterranean fever and hyperimmunoglobulinaemia-D, and the dominantly inherited TNF receptor associated periodic fever syndrome, familial cold induced autoinflammatory syndrome and Muckle-Wells’ syndrome.
§¤ÍÂȘ ÎÏÂȉȿ: ÎÏËÚÔÓÔÌÔ‡ÌÂÓ· ÂÚÈÔ‰Èο Û‡Ó‰ÚÔÌ·, ÔÈÎÔÁÂÓ‹˜ ÌÂÛÔÁÂÈ·Îfi˜ ˘ÚÂÙfi˜, ˘ÂÚÁ·Ì·ÛÊ·ÈÚÈÓ·ÈÌ›· D, ÂÚÈÔ‰ÈÎfi Û‡Ó‰ÚÔÌÔ ÙÔ˘ ˘Ô‰Ô¯¤· ÙÔ˘ ·Ú¿ÁÔÓÙ· Ó¤ÎÚˆÛ˘ ÙÔ˘ fiÁÎÔ˘, ÔÈÎÔÁÂÓ¤˜ ·˘ÙÔÊÏÂÁÌÔÓ҉˜ Û‡Ó‰ÚÔÌÔ ÌÂÙ¿ ¤ÎıÂÛË ÛÙÔ ÎÚ‡Ô, Û‡Ó‰ÚÔÌÔ Muckle-Wells.
Key words: hereditary periodic fever syndromes, familial mediterranean fever, hyperimmunoglobulinemia D, TNF receptor associated periodic fever syndrome, familial autoinflammmatory cold induced syndrome, Muckle-Wells’ syndrome.
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2nd Paediatric Clinic of University of Athens, “P. & A. Kyriakou” Children’s Hospital, Athens
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FACS
·Ú¿ÁÔÓÙ· Ó¤ÎÚˆÛ˘ ÙÔ˘ fiÁÎÔ˘ OÈÎÔÁÂÓ¤˜ ·˘ÙÔÊÏÂÁÌÔÓ҉˜ Û‡Ó‰ÚÔÌÔ ÌÂÙ¿ ¤ÎıÂÛË ÛÙÔ ÎÚ‡Ô
∂ÈÛ·ÁˆÁ‹ ∆· ÎÏËÚÔÓÔÌÔ‡ÌÂÓ· ÂÚÈÔ‰Èο Â̇ÚÂÙ· Û‡Ó‰ÚÔÌ· ·ÔÙÂÏÔ‡Ó Ì›· ÔÌ¿‰· ÎÏËÚÔÓÔÌÈÎÒÓ Û˘Ó‰ÚfiÌˆÓ Ô˘ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ˘ÔÙÚÔÈ¿˙ÔÓÙ· ÂÂÈÛfi‰È· ˘ÚÂÙÔ‡ Î·È ÂΉËÏÒÛÂȘ ÂÓÙÔÈṲ̂Ó˘ ÊÏÂÁÌÔÓ‹˜ Ô˘ ·ÊÔÚ¿ ÛÙÔ˘˜ ÔÚÔÁfiÓÔ˘˜ ˘Ì¤Ó˜, ÛÙÔÓ ·ÚıÚÈÎfi ˘Ì¤Ó· Î·È ÛÙÔ ‰¤ÚÌ· (1). ∆· ÂÂÈÛfi‰È· ¤گÔÓÙ·È ·˘ÙfiÌ·Ù·, ¯ˆÚ›˜ ÙËÓ ÚfiÎÏËÛË ÂÌÊ·ÓÔ‡˜ Â͈ÁÂÓÔ‡˜ ·ÈÙ›Ô˘, fiˆ˜ ›Û˘ ·˘ÙÔ˚ÒÓÙ·È. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ‰Ú·ÛÙËÚÈfiÙËÙ¿˜ ÙÔ˘˜, Û˘Óԉ‡ÔÓÙ·È ·fi ·‡ÍËÛË ÙˆÓ ‰ÂÈÎÙÒÓ ÊÏÂÁÌÔÓ‹˜, fi¯È fï˜ Î·È ·fi ·Ó›¯Ó¢ÛË ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ ‹ ‰È¤ÁÂÚÛË ÂȉÈÎÒÓ ¤Ó·ÓÙÈ ·ÓÙÈÁfiÓˆÓ ∆-ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ, ÁÈ’ ·˘Ùfi Î·È ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È Û·Ó ·˘ÙÔÊÏÂÁÌÔÓÒ‰Ë ÓÔÛ‹Ì·Ù·. ¶·Ú’ fiÏÔ Ô˘ ÛÙËÓ ÔÓÔÌ·Û›· ÙÔ˘˜ ‰ÈÂıÓÒ˜ ¤¯ÂÈ ÂÚÈÏËÊı› Ë ¤ÓÓÔÈ· Ù˘ ÂÚÈÔ‰ÈÎfiÙËÙ·˜, ÂÓÙÔ‡ÙÔȘ ‰ÂÓ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi Û·Ê‹ ÂÚÈÔ‰ÈÎfiÙËÙ· Î·È Ë Â·Ó·ÏË„ÈÌfiÙËÙ¿ ÙÔ˘˜ ·Ô‰›‰ÂÙ·È ÔÚÔÏÔÁÈο ÛˆÛÙfiÙÂÚ· ˆ˜ ˘ÔÙÚÔ‹. ∏ ·Ó·ÁÓÒÚÈÛ‹ ÙÔ˘˜ Û·Ó Í¯ˆÚÈÛÙ¤˜ ÎÏÈÓÈΤ˜ ÔÓÙfiÙËÙ˜, ·Ú¿ Ù· ıÔÚ˘‚Ò‰Ë Û˘ÌÙÒÌ·Ù¿ ÙÔ˘˜, ˘‹ÚÍ ηı˘ÛÙÂÚË̤ÓË, ÂÓÒ Ô ÁÂÓÂÙÈÎfi˜ ÙÔ˘˜ ÚÔÛ‰ÈÔÚÈÛÌfi˜ Â›Ó·È Â›Ù¢ÁÌ· Ù˘ ÙÂÏÂ˘Ù·›·˜ ÂÓÙ·ÂÙ›·˜, Ì Èı·Ófi ‰È·¯ˆÚÈÛÌfi Î·È ¿ÏÏˆÓ ·ÚÂÌÊÂÚÒÓ ÎÏÈÓÈÎÒÓ Û˘Ó‰ÚÔÌÒÓ (2). ∆· Û‡Ó‰ÚÔÌ· Ô˘ ¤¯Ô˘Ó ·Ó·ÁÓˆÚÈÛÙ› ̤¯ÚÈ ÙÒÚ· ‰È·ÎÚ›ÓÔÓÙ·È Û ÎÏËÚÔÓÔÌÔ‡ÌÂÓ· Ì ˘ÔÏÂÈfiÌÂÓÔ ·˘ÙÔۈ̷ÙÈÎfi ¯·Ú·ÎÙ‹Ú·, Ô˘ Â›Ó·È Ô ÔÈÎÔÁÂÓ‹˜ ÌÂÛÔÁÂÈ·Îfi˜ ˘ÚÂÙfi˜ Î·È ÙÔ Û‡Ó‰ÚÔÌÔ ˘ÂÚÁ·Ì·ÛÊ·ÈÚÈÓ·ÈÌ›·˜ D Î·È Û ÎÏËÚÔÓÔÌÔ‡ÌÂÓ· Ì ÂÈÎÚ·ÙËÙÈÎfi ·˘ÙÔۈ̷ÙÈÎfi ¯·Ú·ÎÙ‹Ú· Ô˘ Â›Ó·È ÙÔ ÂÚÈÔ‰ÈÎfi Û‡Ó‰ÚÔÌÔ ÙÔ˘ ˘Ô‰Ô¯¤· ÙÔ˘ ·Ú¿ÁÔÓÙ· Ó¤ÎÚˆÛ˘ ÙÔ˘ fiÁÎÔ˘ Û‡Ó‰ÚÔÌÔ (TNF receptor associated periodic syndrome - TRAPS), ÙÔ Û‡Ó‰ÚÔÌÔ MuckleWells Î·È ÙÔ ÔÈÎÔÁÂÓ¤˜ ·˘ÙÔÊÏÂÁÌÔÓ҉˜ ÂÍ·ÓıËÌ·ÙÈÎfi Û‡Ó‰ÚÔÌÔ ÌÂÙ¿ ÁÂÓÈÎÂ˘Ì¤ÓË ¤ÎıÂÛË ÛÙÔ ÎÚ‡Ô (Familial cold autoinflammatory syndrome FCAS) (¶›Ó·Î·˜ 1). OÈÎÔÁÂÓ‹˜ ÌÂÛÔÁÂÈ·Îfi˜ ˘ÚÂÙfi˜ O ÔÈÎÔÁÂÓ‹˜ ÌÂÛÔÁÂÈ·Îfi˜ ˘ÚÂÙfi˜ (Oª¶) (¶›Ó·Î·˜ 2) ÂÚÈÁÚ¿ÊËÎÂ Û·Ó Í¯ˆÚÈÛÙ‹ ÎÏÈÓÈ΋ ÔÓÙfi¶›Ó·Î·˜ 1. ∫ÏËÚÔÓÔÌÔ‡ÌÂÓ· ÂÚÈÔ‰Èο Â̇ÚÂÙ· Û‡Ó‰ÚÔÌ· ÀÔÏÂÈfiÌÂÓÔ˜ ·˘ÙÔۈ̷ÙÈÎfi˜ ¯·Ú·ÎÙ‹Ú·˜ OÈÎÔÁÂÓ‹˜ ÌÂÛÔÁÂÈ·Îfi˜ ˘ÚÂÙfi˜ ™‡Ó‰ÚÔÌÔ ˘ÂÚÁ·Ì·ÛÊ·ÈÚÈÓ·ÈÌ›·˜ D ∂ÈÎÚ·ÙËÙÈÎfi˜ ·˘ÙÔۈ̷ÙÈÎfi˜ ¯·Ú·ÎÙ‹Ú·˜ ™‡Ó‰ÚÔÌÔ TRAPS ™‡Ó‰ÚÔÌÔ Muckle-Wells ™‡Ó‰ÚÔÌÔ FCAS
Paediatriki 2004;67:212-217
ÙËÙ· ÙÔ 1945 (3). ∞fi ÙÔ 1972, Ë ‰Â‡ÙÂÚË ÁÂÓÈ¿ ÂÚ¢ÓËÙÒÓ ÌÂϤÙËÛ ٷ ÔʤÏË Ù˘ ıÂڷ›·˜ Ì ÎÔϯÈΛÓË ÛÙËÓ ÚfiÏË„Ë ÙˆÓ ˘ÔÙÚÔÒÓ Î·È Ù˘ ÂÓ·fiıÂÛ˘ ·Ì˘ÏÔÂȉԇ˜ (4). ∞fi ÙÔ 1997 ·Ó·Ù‡¯ıËÎÂ Î·È ÂÍÂÏ›¯ıËÎÂ Ó¤Ô Â‰›Ô ‰Ú¿Û˘ Ì ÙÔÓ Î·ıÔÚÈÛÌfi ÙˆÓ ˘Â‡ı˘ÓˆÓ ÁÔÓȉ›ˆÓ Ù˘ ÓfiÛÔ˘ (5,6). ∂›Ó·È ÁÓˆÛÙfi fiÙÈ Ë ÓfiÛÔ˜ ¤¯ÂÈ ÂıÓÔÏÔÁÈÎfi ¯·Ú·ÎÙ‹Ú·. ∞·ÓÙ¿Ù·È ·ÎfiÌ· Î·È ÛÂ Û˘¯ÓfiÙËÙ· 1/2501/1000 Û ÔÚÈṲ̂ÓÔ˘˜ Ï·Ô‡˜ Ù˘ ·Ó·ÙÔÏÈ΋˜ ªÂÛÔÁ›Ԣ Î·È Û˘ÁÎÂÎÚÈ̤ӷ ÛÙÔ˘˜ ∂‚Ú·›Ô˘˜ Ù˘ µ. ∞ÊÚÈ΋˜, ÛÙÔ˘˜ ∞Ṳ́ÓÈÔ˘˜ ÙÔ˘ §È‚¿ÓÔ˘, ÛÙÔ˘˜ ∆Ô‡ÚÎÔ˘˜ Ù˘ ∫ÂÓÙÚÈ΋˜ ∞Ó·ÙÔÏ›·˜ Î·È ÛÙÔ˘˜ ÕÚ·‚˜ ÙÔ˘ πÚ¿Î. ∂›Ó·È ÓfiÛÔ˜ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜, ‰Â‰Ô̤ÓÔ˘ fiÙÈ ÛÙÔ 60% ÙˆÓ ·ÛıÂÓÒÓ ·Ú¯›˙ÂÈ Û ËÏÈΛ· ÌÈÎÚfiÙÂÚË ÙˆÓ 10 ÂÙÒÓ Î·È ÛÙÔ 90% Û ËÏÈΛ· ÌÈÎÚfiÙÂÚË ÙˆÓ 20 ¯ÚfiÓˆÓ (¶›Ó·Î·˜ 3). ∆· ¯·Ú·ÎÙËÚÈÛÙÈο, ·ӷϷ̂·ÓfiÌÂÓ· Û ¿ÏÏÔÙ ¿ÏÏÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·, Â›Ó·È Û‡ÓÙÔÌ˘ ‰È¿ÚÎÂÈ·˜ (12 ˆÚÒÓ ¤ˆ˜ 4 ËÌÂÚÒÓ) ÂÂÈÛfi‰È· ÂÒ‰˘Ó˘ Â̇ÚÂÙ˘ ÔÚÔÁÔÓ›Ùȉ·˜, Ì ÂΉËÏÒÛÂȘ ·fi ÙÔ ÂÚÈÙfiÓ·ÈÔ, ÙÔÓ ˘Â˙ˆÎfiÙ·, ÙÔÓ ·ÚıÚÈÎfi ˘Ì¤Ó·, ÙÔ ‰¤ÚÌ· Î·È ÚÔԉ¢ÙÈ΋ ·Ó¿Ù˘ÍË ·Ì˘ÏÔ›‰ˆÛ˘, ÂÓÒ ÂÌÏÔ˘Ù›˙ÔÓÙ·È Î·È Ì ¿ÏϘ ÂΉËÏÒÛÂȘ ÏÈÁfiÙÂÚÔ Û˘¯Ó¤˜ (∂ÈÎfiÓ· 1). ∏ ‰È¿ ‚›Ô˘ ¯ÔÚ‹ÁËÛË ÎÔϯÈΛÓ˘ ·ÔÙÚ¤ÂÈ ÙËÓ ÂÌÊ¿ÓÈÛË ÂÂÈÛÔ‰›ˆÓ ÛÙÔ 65% ÙˆÓ ·ÛıÂÓÒÓ, ÂÈʤÚÂÈ ‚ÂÏÙ›ˆÛË ÛÙÔ 20-30% Î·È ÚÔÏ·Ì‚¿ÓÂÈ ÙËÓ ·Ì˘ÏÔ›‰ˆÛË ÛÙÔ 95%. ∞fi ÙÔ 1992 ¯·ÚÙÔÁÚ·Ê‹ıËΠÙÔ ‚Ú·¯‡ ÛΤÏÔ˜ ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ 16 ÁÈ· ÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ÌÂÛÔÁÂÈ·ÎÔ‡ ˘ÚÂÙÔ‡. ∆ÔÓ ™Â٤̂ÚÈÔ ÙÔ˘ 1997 Ù˘ÔÔÈ‹ıËΠÙÔ ÁÔÓ›‰ÈÔ MEFV ·fi ‰‡Ô ·ÓÂÍ¿ÚÙËÙ˜ ÂÚ¢ÓËÙÈΤ˜ ÔÌ¿‰Â˜, ÙË Á·ÏÏÈ΋ Î·È ÙË ‰ÈÂıÓ‹. ∆Ô ÁÔÓ›‰ÈÔ Îˆ‰ÈÎÔÔÈ› ÁÈ· ÙË Û‡ÓıÂÛË Ì›·˜ ÚˆÙ½Ó˘ Ù˘ ˘Ú›Ó˘ ‹ Ì·ÚÂÓÔÛÙÚ›Ó˘, Ë ÔÔ›· ·ÔÙÂÏÂ›Ù·È ·fi 781 ·ÌÈÓÔͤ· Î·È Î·ıÔÚ›˙ÂÈ ÙË Ú‡ıÌÈÛË Ù˘ ÊÏÂÁÌÔÓ‹˜ Î·È ÙËÓ ·ÚÂÌfi‰ÈÛË Ì·˙È΋˜ ÂÈÛÚÔ‹˜ ÔÏ˘ÌÔÚÊÔ‡ÚËÓˆÓ ÛÙÔ˘˜ ÔÚÔÁfiÓÔ˘˜ ηٿ ÙȘ ÎÚ›ÛÂȘ. ª¤¯ÚÈ ÙÒÚ· ¤¯Ô˘Ó ηٷÁÚ·Ê› 29 ÌÂÙ·ÏÏ¿ÍÂȘ. ∞fi ·˘Ù¤˜, Ë ª694V ‚Ú›ÛÎÂÙ·È ÛÙÔ 80% ÙˆÓ ¯ÚˆÌÔÛˆÌ¿ÙˆÓ ÙˆÓ ·ÛıÂÓÒÓ Ì Oª¶ Î·È Û˘Ó‰¤ÂÙ·È Ì ‚·Ú‡ÙÂÚË ÚfiÁÓˆÛË. °ÂÓÂÙÈ΋ ‰È¿ÁÓˆÛË ÙÔ˘ Oª¶ ÂÈÙ˘Á¯¿ÓÂÙ·È ÛÙÔ 60-90% ÙˆÓ ·ÛıÂÓÒÓ, ·Ó¿ÏÔÁ· Ì ÙËÓ ÂıÓÔÏÔÁÈ΋ ÚÔ¤ÏÂ˘Û‹ ÙÔ˘˜ (7). ∆· ¯·ÌËÏfiÙÂÚ· ÔÛÔÛÙ¿ ·ÊÔÚÔ‡Ó Û ¯ÒÚ˜ fiÔ˘ Ô ÌÂÛÔÁÂÈ·Îfi˜ ˘ÚÂÙfi˜ ‰ÂÓ Â›Ó·È Û˘¯Ófi˜, ÂÓÒ ˘„ËÏfiÙÂÚ· ÔÛÔÛÙ¿ ÚÔÛ‰ÈÔÚÈÛÌÔ‡ Ù˘ ÓfiÛÔ˘ ÂÈÙ˘Á¯¿ÓÔÓÙ·È Û ¯ÒÚ˜ fiÔ˘ Ë ÓfiÛÔ˜ Â›Ó·È Û˘¯Ó‹, fiˆ˜ ÙÔ πÛÚ·‹Ï Î·È Ë ∆Ô˘ÚΛ·. ¶›Ó·Î·˜ 2. OÈÎÔÁÂÓ‹˜ ÌÂÛÔÁÂÈ·Îfi˜ ˘ÚÂÙfi˜ 1945: ∞Ó·ÁÓÒÚÈÛË ÎÏÈÓÈ΋˜ ÔÓÙfiÙËÙ·˜ 1972: ∫ÔϯÈΛÓË - ¶ÚfiÏË„Ë ·Ì˘ÏÔ›‰ˆÛ˘ 1997: °ÂÓÂÙÈÎfi˜ ÚÔÛ‰ÈÔÚÈÛÌfi˜
213
May-June 04 chris new
19-07-04
19:24
™ÂÏ›‰·214
¶·È‰È·ÙÚÈ΋ 2004;67:212-217
Paediatriki 2004;67:212-217
¶›Ó·Î·˜ 3. ∫ÏËÚÔÓÔÌÔ‡ÌÂÓ· ÂÚÈÔ‰Èο Â̇ÚÂÙ· Û‡Ó‰ÚÔÌ· ™‡Ó‰ÚÔÌÔ
∏ÏÈΛ· ¤Ó·Ú͢ (¤ÙË)
¢È¿ÚÎÂÈ· ÂÂÈÛÔ‰›Ô˘ (Ë̤Ú˜)
Oª¶
90% <20
0,5-3
ÀÂÚ-IgD
68% <1
3-7
TRAPS
80% <20
>7
FCAS
95% <1/2
flÚ˜
MWS
80% <20
2-3
∫ÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο
OÚÔÁÔÓ›Ùȉ·, ÌÔÓ·ÚıÚ›Ùȉ·, ·Ì˘ÏÔ›‰ˆÛË §ÂÌÊ·‰ÂÓ›Ùȉ·, ÔÏ˘·ÚıÚ·ÏÁ›·, ÎÔÈÏÈ·Îfi ¿ÏÁÔ˜ ∫ÔÈÏȷο ¿ÏÁË, Ì˘·ÏÁ›·, ·ÚıÚ·ÏÁ›·, ÂÈÂÊ˘Î›Ùȉ·, ÂÚÈÎÔÁ¯ÈÎfi Ô›‰ËÌ·, ·Ì˘ÏÔ›‰ˆÛË °ÂÓÈÎÂ˘Ì¤ÓË ¤ÎıÂÛË ÛÙÔ ÎÚ‡Ô: ÂÍ¿ÓıËÌ·, ÔÏ˘·ÚıÚ·ÏÁ›·, ÂÈÂÊ˘Î›Ùȉ· ¶ÔÏ˘·ÚıÚ·ÏÁ›·, Ó¢ÚÔ·ÈÛıËÙ‹ÚÈ· ‚·ÚËÎÔ˝·, ·Ì˘ÏÔ›‰ˆÛË
™ÙËÓ ∂ÏÏ¿‰·, Ë ÓfiÛÔ˜ ·Ó·˙ËÙ‹ıËΠÁÈ· ÚÒÙË ÊÔÚ¿ ÙÔ 1999 Û 8 ·ÛıÂÓ›˜ ËÏÈΛ·˜ 5-26 ÂÙÒÓ, ÔÈ ÔÔ›ÔÈ ÏËÚÔ‡Û·Ó Ù· ÎÏÈÓÈο ‰È·ÁÓˆÛÙÈο ÎÚÈÙ‹ÚÈ· ÙÔ˘ Oª¶ (¶›Ó·Î·˜ 4). ªÂÏÂÙ‹ıËÎ·Ó ÔÈ - ÁÓˆÛÙ¤˜ Û·Ó ÎÏ·ÛÈΤ˜ - ÌÂÙ·ÏÏ¿ÍÂȘ M694V, M694I, M680I, E148Q Î·È ¿ÏϘ Û·ÓÈfiÙÂÚ˜ ÛÙÔ ÂÍfiÓÈÔ 10 Î·È 2. °ÂÓÂÙÈο Oª¶ ÂȂ‚·ÈÒıËΠ۠3 ·ÛıÂÓ›˜: ¤Ó·˜ ÔÌÔ˙˘ÁÒÙ˘ E148Q, ¤Ó·˜ ‰ÈÏfi˜ ÂÙÂÚÔ˙˘ÁÒÙ˘ M694V M680π Î·È ¤Ó·˜ M694V E148Q. ª›· ÌÂÙ¿ÏÏ·ÍË, Ë M694V, ‚Ú¤ıËΠ۠2 ·ÛıÂÓ›˜ (¶›Ó·Î·˜ 5) (8). ™‡Ó‰ÚÔÌÔ ˘ÂÚÁ·Ì·ÛÊ·ÈÚÈÓ·ÈÌ›·˜ D ∆Ô Û‡Ó‰ÚÔÌÔ ˘ÂÚÁ·Ì·ÛÊ·ÈÚÈÓ·ÈÌ›·˜ D ÂÚÈÁÚ¿ÊËΠÁÈ· ÚÒÙË ÊÔÚ¿ ÙÔ 1984 ÛÙËÓ OÏÏ·Ó‰›·, ˆ˜ ÔÈÎÔÁÂÓ‹˜ ÔÏÏ·Ó‰ÈÎfi˜ ˘ÚÂÙfi˜ (9). ∞fi ÙfiÙÂ, ¤¯Ô˘Ó ·Ó·ÊÂÚı› ÂÚ›Ô˘ 150 ·ÛıÂÓ›˜, ÌÂٷ͇ ÙˆÓ ÔÔ›ˆÓ Û ÌÈÎÚfiÙÂÚÔ ·ÚÈıÌfi °¿ÏÏÔÈ, πÙ·ÏÔ›, πÛ·ÓÔ›, ∆Ô‡ÚÎÔÈ Î·È ¿ÏÏÔÈ, ÁÂÁÔÓfi˜ Ô˘ ÂӉ¯Ô̤ӈ˜ ‰ËÏÒÓÂÈ ·Ó·Ú΋ ·Ó·ÊÔÚ¿ ÛÙË ÓfiÛÔ. ∏ ÓfiÛÔ˜ ÍÂÎÈÓ¿ Û ÌÈÎÚ‹ ËÏÈΛ· (68% ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜, 96% οو ÙˆÓ 10 ÂÙÒÓ) (¶›Ó·Î·˜ 3). ∏ Û˘¯ÓfiÙËÙ· Î·È Ë ‰È¿ÚÎÂÈ· ÙˆÓ ÂÂÈÛÔ‰›ˆÓ ÔÈΛÏÏÂÈ. ∏ ‰È¿ÚÎÂÈ· Â›Ó·È Ï›ÁÔ ÌÂÁ·Ï‡ÙÂÚË ·fi ÂΛÓË ÙÔ˘ ÌÂÛÔÁÂÈ·ÎÔ‡ ˘ÚÂÙÔ‡ (3-7 Ë̤Ú˜). ™ÙÔ Û‡Ó‰ÚÔÌÔ ˘ÂÚÁ·Ì·ÛÊ·ÈÚÈÓ·ÈÌ›·˜ D ·Ô‰›‰ÔÓÙ·È ‰È¿ÊÔÚ· Û˘ÌÙÒÌ·Ù· Î·È Â˘Ú‹Ì·Ù· (¶›Ó·Î·˜ 6). ÷ڷÎÙËÚÈÛÙÈΤ˜ ›ӷÈ, fï˜, ÔÈ ÎÔÈÏȷΤ˜ ÂΉËÏÒÛÂȘ, ÁÈ· ÙȘ Ôԛ˜ ‰ÂÓ Â˘ı‡ÓÂÙ·È Ë ÔÚÔÁÔÓ›Ùȉ· Î·È È‰È·›ÙÂÚ· ‰È¿ÚÚÔȘ. ∂›Û˘, ÔÈ ÂΉËÏÒÛÂȘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÏÂÌÊ·‰ÂÓ›Ùȉ·, ÛÏËÓÔÌÂÁ·Ï›· Î·È ÔÈÎÈÏfiÌÔÚÊÔ ÂÍ¿ÓıËÌ· (¶›Ó·Î·˜ 7), ÂÓÒ ÛÙÔÓ Oª¶ ÙÔ ÂÍ¿ÓıËÌ· ÌÔÈ¿˙ÂÈ Ì ÂÚ˘Û›ÂÏ·˜ ÛÙÔÓ ¿ÎÚÔ fi‰· Û˘Ó‹ıˆ˜ ‹ ÛÙÔ Î¿Ùˆ ¿ÎÚÔ, ·fi ÙÔ
214
∫ÏËÚÔÓÔÌÈÎfiÙËÙ·
ÃÚˆÌfiۈ̷ °ÔÓ›‰ÈÔ
£Âڷ›·
ÀÔÏÂÈfiÌÂÓÔ˜ Û. ¯.
16p13
MEFV
∫ÔϯÈΛÓË
ÀÔÏÂÈfiÌÂÓÔ˜ Û. ¯.
12q24
MVK
ª™∞
∂ÈÎÚ·ÙËÙÈÎfi˜ Û. ¯.
12p13
TNFRF1
∫ÔÚÙÈÎÔÛÙÂÚÈÓÔÂȉ‹ Etanercept
∂ÈÎÚ·ÙËÙÈÎfi˜ Û. ¯.
1q44
CIAS1
∂ÈÎÚ·ÙËÙÈÎfi˜ Û. ¯.
1q44
CIAS1
ª™∞
ÁfiÓ·ÙÔ Î·È Î¿Ùˆ. OÈ ÂΉËÏÒÛÂȘ ·fi ÙÔ Ì˘ÔÛÎÂÏÂÙÈÎfi Â›Ó·È Î˘Ú›ˆ˜ ÔÏ˘·ÚıÚ·ÏÁ›Â˜, ÂÓÒ ÛÙÔÓ Oª¶ Â›Ó·È ·ÚÔ‰È΋ Û˘Ó‹ıˆ˜ ÌÔÓ·ÚıÚ›ÙȘ ÈÛ¯›Ô˘, ÁfiÓ·ÙÔ˜ ‹ Ô‰ÔÎÓËÌÈ΋˜ (10). ∂› ÙÔ˘ ·ÚfiÓÙÔ˜, ‰ÂÓ ¤¯ÂÈ ·Ó·ÊÂÚı› ·ÓÙȉڷÛÙÈ΋ ·Ì˘ÏÔ›‰ˆÛË. OÈ ÎÚ›ÛÂȘ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ‰ÂÓ ˘·ÎÔ‡Ô˘Ó ÛÙË ¯ÔÚ‹ÁËÛË ÎÔϯÈΛÓ˘. ™˘Ó‹ıˆ˜ ¯ÔÚËÁÔ‡ÓÙ·È ª™∞ Ê¿Ú̷η. ∞˘ÍË̤ÓË Î·È ÛÙ· ÂӉȿÌÂÛ· ÙˆÓ ÎÚ›ÛÂˆÓ (>100 iu/ml) ‚Ú›ÛÎÂÙ·È Ë ·ÓÔÛÔÛÊ·ÈÚ›ÓË D. Œ¯Ô˘Ó ·Ó·ÊÂÚı› ÂÚÈÙÒÛÂȘ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ¯ˆÚ›˜ ·‡ÍËÛË Ù˘ ·ÓÔÛÔÛÊ·ÈÚ›Ó˘ D, ÂÓÒ ·‡ÍËÛË Ù˘ ÛÊ·ÈÚ›Ó˘ ·˘Ù‹˜ ·Ú·ÙËÚÂ›Ù·È Î·È Û ¿ÏϘ ·ıÔÏÔÁÈΤ˜ ηٷÛÙ¿ÛÂȘ, fiˆ˜ ϤÌʈ̷ Hodgkin, Û·ÚÎÔ›‰ˆÛË, Ê˘Ì·Ù›ˆÛË, ·ÛÂÚÁ›ÏψÛË, ·Ù·Í›·-ÙËÏ·ÁÁÂÈÂÎÙ·Û›· Î·È ÛÙÔ Û‡Ó‰ÚÔÌÔ Â›ÎÙËÙ˘ ·ÓÔÛÔÏÔÁÈ΋˜ ·Ó¿ÚÎÂÈ·˜. ∆Ô 1999 Ù˘ÔÔÈ‹ıËΠÙÔ ÁÔÓ›‰ÈÔ MVK Ù˘ ˘ÂÚÁ·Ì·ÛÊ·ÈÚÈÓ·ÈÌ›·˜ D ÛÙÔ Ì·ÎÚfi ÛΤÏÔ˜ ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ 12 (12q 24) (11). To ÁÔÓ›‰ÈÔ Îˆ‰ÈÎÔÔÈ› ÁÈ· ÙË Û‡ÓıÂÛË Ù˘ Ì‚·ÏÔÓÈ΋˜ ÎÈÓ¿Û˘, ¤Ó˙˘ÌÔ ÙÔ ÔÔ›Ô Î·Ù·Ï‡ÂÈ ÙË ÊˆÛÊÔÚ˘Ï›ˆÛË ÙÔ˘ Ì‚·ÏÔÓÈÎÔ‡ ÔͤԘ Û ÚÒÈÌÔ ÛÙ¿‰ÈÔ ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ (12). ∂› ÙÔ˘ ·ÚfiÓÙÔ˜, ¤¯Ô˘Ó ηٷÁÚ·Ê› 5 ÌÂÙ·ÏÏ¿ÍÂȘ, ÔÈ ‰‡Ô ÂÎ ÙˆÓ ÔÔ›ˆÓ (59A C, 803T C) ‰ÂÓ Â›Ó·È ÁÓˆÛÙfi fiÙÈ Ô‰ËÁÔ‡Ó Û ·Ú·ÁˆÁ‹ ÏÂÈÙÔ˘ÚÁÈο ÂÓÂÚÁ‹˜ ÚˆÙ½Ó˘. ™˘¯ÓfiÙÂÚË Â›Ó·È Ë V377I (·ÓÙÈηٿÛÙ·ÛË Ù˘ ÈÛÔÏ¢ΛÓ˘ ·fi ‚·Ï›ÓË ÛÙË ı¤ÛË 377). OÈ ¿Û¯ÔÓÙ˜ Â›Ó·È ‰ÈÏÔ› ÂÙÂÚÔ˙˘ÁÒÙ˜. ™Ô‚·Ú¤˜ ÌÂÙ·ÏÏ¿ÍÂȘ Ô‰ËÁÔ‡Ó Û ۯ‰fiÓ Ï‹ÚË ¤ÏÏÂÈ„Ë Ù˘ Ì‚·ÏÔÓÈ΋˜ ÎÈÓ¿Û˘ (<0,2%), ¤¯Ô˘Ó Û·Ó ÂΉ‹ÏˆÛË ÙÔÓ Ê·ÈÓfiÙ˘Ô Ù˘ Ì‚·ÏÔÓÈ΋˜ ·ÌÈÓÔ͢Ԣڛ·˜, Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ‰˘ÛÌÔÚÊ›·, ηٷÚÚ¿ÎÙË,
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∫·Ù¿ ÙËÓ ÎÚ›ÛË ∆∫∂ §Â˘ÎÒÓ πÓˆ‰ÔÁfiÓÔ˘ (+) ÌÈÎÚÔÛÎÔÈ΋ ·ÈÌ·ÙÔ˘Ú›·/ ÏÂ˘ÎˆÌ·ÙÔ˘Ú›·
% Û ÁÂÓÂÙÈο ÙÂÎÌËÚȈ̤ÓÔ˘˜ ·ÛıÂÓ›˜ (47) 96% ˘ÚÂÙfi˜ 56% Ï¢ڛÙȉ· 2% ·Ì˘ÏÔ›‰ˆÛË 91% ¿ÛËÙË ÂÚÈÙÔÓ›Ùȉ·
45% ·ÚıÚ›Ùȉ·/ ·ÚıÚ·ÏÁ›·
Paediatriki 2004;67:212-217
¶›Ó·Î·˜ 4. ¢È·ÁÓˆÛÙÈο ÎÚÈÙ‹ÚÈ· Oª¶
E¶π∫OÀƒπ∫∞ ∫ÂÊ·Ï·ÏÁ›· ÕÛËÙË ÌËÓÈÁÁ›Ùȉ· ¶ÂÚÈηډ›Ùȉ· ™ÏËÓÔÌÂÁ·Ï›· O˙҉˘ ÔÏ˘·ÚÙËÚ›Ùȉ· ™ÂÈÚ·Ì·ÙÔÓÂÊÚ›Ùȉ·
¶ÔÚʇڷ Henoch-Schonlein O›‰ËÌ· ÔÛ¯¤Ô˘ ∂̇ÚÂÙË Ì˘·ÏÁ›·
§Â˘ÎˆÌ·ÙÔ˘Ú›· 13% ÂÍ¿ÓıËÌ· Û·Ó ÂÚ˘Û›ÂÏ·˜
¶ÔÚÊ˘ÚÈÎfi ÂÍ¿ÓıËÌ·
∂ÈÎfiÓ· 1. OÈÎÔÁÂÓ‹˜ ÌÂÛÔÁÂÈ·Îfi˜ ˘ÚÂÙfi˜: ÛËÌ›· Î·È Û˘ÌÙÒÌ·Ù· (·fi: Kastner DL. Williams and Wilkins. Baltimore. Arthritis and allied conditions. 1279-1306).
Ì˘ÔÙÔÓ›·, ˘ÔÙÔÓ›·, ·Ù·Í›·, ۈ̷ÙÈ΋ Î·È „˘¯ÔÎÈÓËÙÈ΋ ηı˘ÛÙ¤ÚËÛË, ¯ˆÚ›˜ ·‡ÍËÛË Ù˘ ÛÊ·ÈÚ›Ó˘ D. ¶·Ú·ÌÔÓ‹ Ì‚·ÏÔÓÈ΋˜ ÎÈÓ¿Û˘ 0,8-3,6% Ô‰ËÁ› ÛÙÔ Û‡Ó‰ÚÔÌÔ ˘ÂÚÁ·Ì·ÛÊ·ÈÚÈÓ·ÈÌ›·˜ D. ∏ ·Ô‚ÔÏ‹ Ì‚·ÏÔÓÈÎÔ‡ ÔͤԘ Â›Ó·È ·˘ÍË̤ÓË ÌfiÓÔ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÂÂÈÛÔ‰›ˆÓ ÛÙÔ˘˜ ¿Û¯ÔÓÙ˜ ·fi ˘ÂÚÁ·Ì·ÛÊ·ÈÚÈÓ·ÈÌ›· D. À¿Ú¯Ô˘Ó Î·È ·ÛıÂÓ›˜ ˘ÂÚÁ·Ì·ÛÊ·ÈÚÈÓ·ÈÌ›·˜ D ÌÂ Ê˘ÛÈÔÏÔÁÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· Ì‚·ÏÔÓÈ΋˜ ÎÈÓ¿Û˘, ÁÂÁÔÓfi˜ Ô˘ ‰ËÏÒÓÂÈ ÙËÓ ÂÙÂÚÔÁ¤ÓÂÈ· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘. ∂› ÙÔ˘ ·ÚfiÓÙÔ˜, Ô ˘ÔΛÌÂÓÔ˜ Ì˯·ÓÈÛÌfi˜ ‰ÂÓ ¤¯ÂÈ ·ÔÛ·ÊËÓÈÛÙ›. ∂ÓÔ¯ÔÔÈÔ‡ÓÙ·È Ë ‰È·Ù·Ú·¯‹ Ù˘ Û‡ÓıÂÛ˘ ÈÛÔÚÂÓÔÂȉÒÓ, ÎÔÚÙÈÎÔÛÙÂÚÈÓÔÂȉÒÓ, ¯ÔÏËÛÙÂÚfiÏ˘ Î·È ¿ÏÏˆÓ ÛÙÔȯ›ˆÓ, Ù· ÔÔ›· ÌÂÙ¤¯Ô˘Ó ÛÙË Û‡ÓıÂÛË Ù˘ ΢ÙÙ·ÚÈ΋˜ ÌÂÌ‚Ú¿Ó˘ ‹ Û˘Ì‚¿ÏÏÔ˘Ó Û ΢ÙÙ·ÚÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜. ¶ÂÚÈÔ‰ÈÎfi Û‡Ó‰ÚÔÌÔ ÙÔ˘ ˘Ô‰Ô¯¤· ÙÔ˘ ·Ú¿ÁÔÓÙ· Ó¤ÎÚˆÛ˘ ÙÔ˘ fiÁÎÔ˘ ∆Ô ÂÚÈÔ‰ÈÎfi Û‡Ó‰ÚÔÌÔ ÙÔ˘ ˘Ô‰Ô¯¤· ÙÔ˘ ·Ú¿ÁÔÓÙ· Ó¤ÎÚˆÛ˘ ÙÔ˘ fiÁÎÔ˘ (TRAPS) ÌÂÙ·‚È‚¿˙ÂÙ·È Ì ÂÈÎÚ·ÙËÙÈÎfi ·˘ÙÔۈ̷ÙÈÎfi ¯·Ú·ÎÙ‹Ú·, ÙÔ ÔÔ›Ô ·Ú¯Èο ÂÚÈÁÚ¿ÊËΠ۠ÔÈÎÔÁ¤ÓÂȘ ÈÚÏ·Ó‰È΋˜ ηٷÁˆÁ‹˜ ˆ˜ ÈÚÏ·Ó‰ÈÎfi˜ ÔÈÎÔÁÂÓ‹˜ ˘ÚÂÙfi˜
ªÂ›˙ÔÓ· ∆˘Èο ÂÂÈÛfi‰È·: i) ˘ÚÂÙÔ‡, ii) Ï¢ڛÙȉ·˜-ÂÚÈηډ›Ùȉ·˜, ii) ÌÔÓ·ÚıÚ›Ùȉ·˜ (ηْ ÈÛ¯›Ô, ηٿ ÁfiÓ˘, Ô‰ÔÎÓËÌÈ΋), iv) ÂÚÈÙÔÓ›Ùȉ·˜ ∂Ï¿ÛÛÔÓ· ÕÙ˘· ÂÂÈÛfi‰È· ·fi: i) ÎÔÈÏȷ΋ ¯ÒÚ·, ii) ıÒڷη, ii) ·ÚıÚÒÛÂȘ, iv) ¿ÏÁË ¿ÎÚˆÓ ÌÂÙ¿ ÎfiˆÛË, v) ·ÓÙ·fiÎÚÈÛË ÛÙËÓ ÎÔϯÈΛÓË ∂ÈÎÔ˘ÚÈο i) OÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ii) ∂ıÓÈÎfiÙËÙ· iii) ∏ÏÈΛ· ¤Ó·Ú͢: <20 ÂÙÒÓ iv-vii) ÷ڷÎÙËÚÈÛÙÈο ÂÂÈÛÔ‰›ˆÓ (¤ÓÙ·ÛË, ·˘ÙfiÌ·ÙË ˘Ô¯ÒÚËÛË, ÂχıÂÚ· ÌÂÛԉȷÛÙ‹Ì·Ù·, ‰Â›ÎÙ˜ ÊÏÂÁÌÔÓ‹˜) viii) ¶·ÚÔ‰È΋ ·ÈÌ·ÙÔ˘Ú›· ix) ∞Ù˘¯‹˜ ÛΈÏËÎÔÂȉÂÎÙÔÌ‹ x) ™˘ÁÁ¤ÓÂÈ· ÁÔÓ¤ˆÓ ¢È¿ÁÓˆÛË 1 ·ÚÈÔ ‹ 2 ‰Â˘ÙÂÚ‡ÔÓÙ· ‹ 1 ‰Â˘ÙÂÚ‡ÔÓ Î·È 5 ÂÈÎÔ˘ÚÈο ‹ 1 ‰Â˘ÙÂÚ‡ÔÓ Î·È 4 ·fi Ù· 5 ÚÒÙ· ÂÈÎÔ˘ÚÈο
¶›Ó·Î·˜ 5. °ÂÓÂÙÈ΋ ·Ó¿Ï˘ÛË ∂ÏÏËÓÔ·›‰ˆÓ Ì Oª¶ ∫ˆ‰ÈÎfiÓÈÔ º˘ÛÈÔÏ. ªÂÙ¿ÏÏ·ÍË ÁÔÓ. 694 694 726 680 148
MM MM VV MM EE
VM IM AV IM QQ
∞ÛıÂÓ‹˜
∂ÙÂÚÔ˙˘ÁÒÙ˘
M694V/M680I:1 M694V:2 M694V/E148Q:1
E148Q/E148Q:1
(Familial hibernian fever) (13). ™Ù·‰È·Î¿, fï˜, ÚÔÛÙ¤ıËÎ·Ó ÔÈÎÔÁ¤ÓÂȘ ·fi ‰È¿ÊÔÚ· ¤ıÓË. ∆· Â̇ÚÂÙ· ÂÂÈÛfi‰È· ‰È·Ê¤ÚÔ˘Ó ·fi ÂΛӷ ÙfiÛÔ ÙÔ˘ Oª¶ fiÛÔ Î·È Ù˘ ˘ÂÚÁ·Ì·ÛÊ·ÈÚÈÓ·ÈÌ›·˜ D fiÛÔÓ ·ÊÔÚ¿ ÛÙË ‰È¿ÚÎÂÈ¿ ÙÔ˘˜, Ë ÔÔ›· Â›Ó·È Û·ÊÒ˜ ÌÂÁ·Ï‡ÙÂÚË Î·ıÒ˜ ‰È·ÚÎÔ‡Ó ÂÚÈÛÛfiÙÂÚÔ ·fi Ì›· ‚‰ÔÌ¿‰· Î·È ·ÚÎÂÙ¿ Û˘¯Ó¿ ¿Óˆ ·fi ¤Ó· Ì‹Ó·, ÂÓÒ ÌÂÚÈÎÔ› ·ÛıÂÓ›˜ ‚Ú›ÛÎÔÓÙ·È ÛÂ Û˘Ó¯‹ ÊÏÂÁÌÔÓÒ‰Ë ‰ÈÂÚÁ·Û›· (¶›Ó·Î·˜ 3). ¶ÚÔ¤¯ÔÓÙ· ÛËÌ›· Â›Ó·È Ë ÂÈÂÊ˘Î›Ùȉ· ηÈ/‹ ÙÔ ÂÙÂÚfiÏ¢ÚÔ ÂÚÈÎÔÁ¯ÈÎfi Ô›‰ËÌ·, Ë ÂÓÙÔÈṲ̂ÓË ÈÛ¯˘Ú‹ Ì˘·ÏÁ›· Î·È ÙÔ ÂÚÈÔÚÈṲ̂ÓÔ ÂÒ‰˘ÓÔ ÂÚ‡ıËÌ· ‰¤ÚÌ·ÙÔ˜ ÂÓÙÔÈ˙fiÌÂÓÔ ÔÔ˘‰‹ÔÙÂ, Û˘Ó‹ıˆ˜ fï˜ ÛÙ· ¿ÎÚ·, fiÔ˘ ÍÂÎÈÓ¿ÂÈ ÎÂÓÙÚÈο Î·È ÌÂÙ·Ó·ÛÙ‡ÂÈ ÂÚÈÊÂÚÈο (¶›Ó·Î·˜ 8). ∞Ì˘ÏÔ›‰ˆÛË ¤¯ÂÈ ·Ó·ÊÂÚı› ÛÙÔ 25% ÙˆÓ ·ÛıÂÓÒÓ (14). ∆Ô ÁÔÓ›‰ÈÔ ÙÔ˘ TRAPS (TNFR F1) ·ÔΈ‰ÈÎÔÔÈ‹ıËΠÙÔ 1998 ÛÙÔ ·ÔÌ·ÎÚ˘Ṳ̂ÓÔ ÙÌ‹Ì· ÙÔ˘ ‚Ú·¯¤Ô˜ ÛΤÏÔ˘˜ ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ 12p13 (15). ∂› ÙÔ˘ ·ÚfiÓÙÔ˜, ¤¯Ô˘Ó ·ÔÎÚ˘ÙÔÁÚ·ÊËı› 16 ÌÂÙ·ÏÏ¿ÍÂȘ, ÔÈ ÂÚÈÛÛfiÙÂÚ˜ ·fi ÙȘ Ôԛ˜ ·ÊÔÚÔ‡Ó ÛÙËÓ ÂÍˆÎ˘ÙÙ¿ÚÈ· - ÏÔ‡ÛÈ· Û ΢ÛÙ½ÓË - ÂÚÈÔ¯‹ ÙÔ˘ 55Kd ÙÔ˘ ˘Ô‰Ô¯¤· ÙÔ˘ TNF Î·È ¤¯Ô˘Ó ۯ‰fiÓ Ï‹ÚË ‰ÈÂÈÛ‰˘ÙÈÎfiÙËÙ· Î·È ˘„ËÏ‹ Û˘¯ÓfiÙËÙ·
215
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·ÓÙȉڷÛÙÈ΋˜ ·Ì˘ÏÔ›‰ˆÛ˘. ∏ ‰È·Ù·Ú·¯‹ ·Ô‰fiÌËÛ˘ ÙÔ˘ TNFrc Ô‰ËÁ› ÛÂ Û˘Ó¯‹ Û‹Ì·ÓÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ, ηٿÛÙ·ÛË ˘ÂÚÊÏÂÁÌÔÓ‹˜ Î·È ¯·ÌËÏ¿ ›‰· ÙÔ˘ ‰È·Ï˘ÙÔ‡ ˘Ô‰Ô¯¤· ÛÙÔÓ ÔÚfi. ∆· Û˘ÌÙÒÌ·Ù· Ù˘ ÓfiÛÔ˘ ‰ÂÓ ˘·ÎÔ‡Ô˘Ó ÛÙË ¯ÔÚ‹ÁËÛË ÎÔϯÈΛÓ˘, ˘Ê›ÂÓÙ·È Ì ÙË ¯ÔÚ‹ÁËÛË ÎÔÚÙÈÎÔÛÙÂÚÈÓÔÂȉÒÓ, ·ÏÏ¿ ¯ÚÂÈ¿˙ÔÓÙ·È fiÏÔ Î·È ÌÂÁ·Ï‡ÙÂÚ˜ ‰fiÛÂȘ. ∂Óı·ÚÚ˘ÓÙÈο Â›Ó·È Ù· ·ÔÙÂϤÛÌ·Ù· ıÂڷ›·˜ Ì Etanercept Ô˘ Â›Ó·È 75Kd ·ÓÙÈ-TNFrc. OÈÎÔÁÂÓ¤˜ ·˘ÙÔÊÏÂÁÌÔÓ҉˜ ÂÍ·ÓıËÌ·ÙÈÎfi Û‡Ó‰ÚÔÌÔ ÌÂÙ¿ ÁÂÓÈÎÂ˘Ì¤ÓË ¤ÎıÂÛË ÛÙÔ ÎÚ‡Ô Î·È Û‡Ó‰ÚÔÌÔ Muckle-Wells ¢‡Ô ¿ÏϘ ·ıÔÏÔÁÈΤ˜ ÔÓÙfiÙËÙ˜, ÔÈ Ôԛ˜ Â›Ó·È ÁÓˆÛÙ¤˜ ·fi ÙÔ 1940 Î·È 1962 ·ÓÙ›ÛÙÔȯ·, Â›Ó·È ÙÔ ÔÈÎÔÁÂÓ¤˜ ·˘ÙÔÊÏÂÁÌÔÓ҉˜ ÂÍ·ÓıËÌ·ÙÈÎfi Û‡Ó‰ÚÔÌÔ ÌÂÙ¿ ÁÂÓÈÎÂ˘Ì¤ÓË ¤ÎıÂÛË ÛÙÔ ÎÚ‡Ô (FC∞S) Î·È ÙÔ Û‡Ó‰ÚÔÌÔ Muckle-Wells (16,17). ∫·È Ù· ‰‡Ô Û‡Ó‰ÚÔÌ· ÌÂÙ·‚È‚¿˙ÔÓÙ·È Î·Ù¿ ÙÔÓ ÂÈÎÚ·ÙËÙÈÎfi ۈ̷ÙÈÎfi ¯·Ú·ÎÙ‹Ú· (¶›Ó·Î·˜ 3). ∆Ô Û‡Ó‰ÚÔÌÔ FC∞S ÚÔηÏ› ‰È·Ï›ÔÓÙ· ÂÂÈÛfi‰È· ˘ÚÂÙÔ‡, ÂÍ·Óı‹Ì·ÙÔ˜, ·ÚıÚ·ÏÁÈÒÓ Î·È ÂÈÂÊ˘Î›Ùȉ·˜ ÌÂÙ¿ ÁÂÓÈÎÂ˘Ì¤ÓË ¤ÎıÂÛË ÛÙÔ ÎÚ‡Ô, Û˘ÌÙÒÌ·Ù· Ù· ÔÔ›· ÂÌÊ·Ó›˙ÔÓÙ·È ·fi ÙÔ˘˜ ÚÒÙÔ˘˜ 6 Ì‹Ó˜ Ù˘ ˙ˆ‹˜ ÛÙÔ 95% ÙˆÓ ·Û¯fiÓÙˆÓ. ∏ ̤ÛË ¯ÚÔÓÈ΋ ·fiÛÙ·ÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ·fi ÙËÓ ¤ÎıÂÛË ÛÙÔ ÎÚ‡Ô Â›Ó·È 2-5 ÒÚ˜, ÂÓÒ Ë Ì¤ÛË ‰È¿ÚÎÂÈ· οı ÂÂÈÛÔ‰›Ô˘ Â›Ó·È 12 ÒÚ˜ (¶›Ó·Î·˜ 9). ∞Ì˘ÏÔ›‰ˆÛË ‰ÂÓ Â›Ó·È Û˘¯Ó‹, fï˜ ¤¯ÂÈ ·Ó·ÊÂÚı› Û 2% ÙˆÓ ·ÛıÂÓÒÓ. ¶›Ó·Î·˜ 6. ∫ÚÈÙ‹ÚÈ· ˘ÂÚÁ·Ì·ÛÊ·ÈÚÈÓ·ÈÌ›·˜ D °ÂÓÈο ÀÔÙÚÔ¤˜ ↑ IgD (>100 u/100 ml), 2 ÌÂÙÚ‹ÛÂȘ, 1 Ì‹Ó·˜ ·fiÛÙ·ÛË ↑ IgA ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÎÚ›Û˘ ↑ ∆∫∂ Î·È Ï¢ÎÒÓ ∞ÈÊÓ›‰È· ¤Ó·ÚÍË ˘ÚÂÙÔ‡ §ÂÌÊ·‰ÂÓ›Ùȉ· (ÙÚ·¯ËÏÈ΋) ∫ÔÈÏȷο ¿ÏÁË, ¤ÌÂÙÔÈ, ‰È¿ÚÚÔȘ ∂Í¿ÓıËÌ· ∞ÚıÚ·ÏÁ›·/·ÚıÚ›Ùȉ· ™ÏËÓÔÌÂÁ·Ï›·
∆Ô Û‡Ó‰ÚÔÌÔ Muckle-Wells ¤¯ÂÈ ·ÚfiÌÔÈ· Û˘Ìو̷ÙÔÏÔÁ›·, ÂÎÙfi˜ ·fi ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ù· Û˘ÌÙÒÌ·Ù· ÂÌÊ·Ó›˙ÔÓÙ·È ·˘ÙfiÌ·Ù·, ¯ˆÚ›˜ ÚÔËÁÔ‡ÌÂÓË ¤ÎıÂÛË ÛÙÔ ÎÚ‡Ô, ·Ó·Ù‡ÛÛÂÙ·È ·ÒÏÂÈ· ·ÎÔ‹˜ Ó¢ÚÔ·ÈÛıËÙËÚÈ·ÎÔ‡ Ù‡Ô˘ Î·È Û˘¯ÓfiÙÂÚ· ·Ì˘ÏÔ›‰ˆÛË. ∆Ô ˘Â‡ı˘ÓÔ ÁÔÓ›‰ÈÔ ÙˆÓ ‰‡Ô Û˘Ó‰ÚfiÌˆÓ ÂÓÙÔ›ÛÙËΠÙÔ 2001 ÛÙÔ ¯ÚˆÌfiۈ̷ 1q44 Î·È ¤¯Ô˘Ó ηٷÁÚ·Ê› 4 ÌÂÙ·ÏÏ¿ÍÂȘ (18). ∆Ô ÁÔÓ›‰ÈÔ ·˘Ùfi Έ‰ÈÎÔÔÈ› ÙË ‰ËÌÈÔ˘ÚÁ›· Ì›·˜ ÎÚ˘Ô˘Ú›Ó˘, Ù˘ CIAS 1, Ô˘ ÂÈο˙ÂÙ·È fiÙÈ ÌÂÙ¤¯ÂÈ ÛÙÔ˘˜ Ì˯·ÓÈÛÌÔ‡˜ ·fiÙˆÛ˘ ηٿ ÙËÓ ·ÓÙ›‰Ú·ÛË Ù˘ ÊÏÂÁÌÔÓ‹˜. ª¿ÏÈÛÙ·, Ë Â˘ı‡ÓË ÙÔ˘ ÁÔÓȉ›Ô˘ ·˘ÙÔ‡ ‰ÂÓ Ê·›ÓÂÙ·È Ó· ÛÙ·Ì·Ù¿ÂÈ ÛÙ· ‰‡Ô ÚÔËÁÔ‡ÌÂÓ· Û‡Ó‰ÚÔÌ·, ·ÊÔ‡ ÙÔÓ πÔ‡ÏÈÔ ÙÔ˘ 2002 ·Ó·ÎÔÈÓÒıËΠfiÙÈ ·ÚÔ˘ÛÈ¿˙ÂÈ ˘„ËÏ‹ ¤ÎÊÚ·ÛË Û 7 - ÌË Û˘ÁÁÂÓ›˜ ÌÂٷ͇ ÙÔ˘˜ - ·ÛıÂÓ›˜ ¿Û¯ÔÓÙ˜ ·fi ¯ÚfiÓÈÔ ÊÏÂÁÌÔÓ҉˜ Û‡Ó‰ÚÔÌÔ ·ÚıÚÔ¿ıÂÈ·˜ Î·È ‰ÂÚÌ·ÙÔ¿ıÂÈ·˜ (Chronic inflammatory cutaneus and arthropathy syndrome - CINCA) ‹ IOMID (Infantile-onset multisystem disease) (¶›Ó·Î·˜ 10), ÙÔ ÔÔ›Ô ·Ú¯›˙ÂÈ ÛÙË ÓÂÔÁÓÈ΋ ËÏÈΛ·, ·ÚÔ˘ÛÈ¿˙ÂÈ ¶›Ó·Î·˜ 8. ∫ÏÈÓÈο ÎÚÈÙ‹ÚÈ· TRAPS ªÂ›˙ÔÓ· ÀÔÙÚÔÈ¿˙ˆÓ ˘ÚÂÙfi˜ ÀÔÙÚÔÈ¿˙ÔÓÙ· ÎÔÈÏȷο ¿ÏÁË ‹ ÂÓÙÔÈṲ̂ÓË Ì˘·ÏÁ›· ∞ÔÎÏÂÈÛÌfi˜ ¿ÏÏˆÓ ÓÔÛËÌ¿ÙˆÓ ∂Ï¿ÛÛÔÓ· ŒÓÂÛË ÂÈÂÊ˘ÎfiÙˆÓ ∂Ò‰˘ÓÔ ÂÓÙÔÈṲ̂ÓÔ ÂÚ‡ıËÌ· ‰¤ÚÌ·ÙÔ˜ ¶ÂÚÈÎÔÁ¯ÈÎfi Ô›‰ËÌ· OÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ⁄ÊÂÛË Û˘ÌÙˆÌ¿ÙˆÓ Ì ÎÔÚÙÈÎÔÛÙÂÚÈÓÔÂȉ‹ ¢È¿ÁÓˆÛË 3 Ì›˙ÔÓ· Î·È 1 ¤Ï·ÛÛÔÓ ¶›Ó·Î·˜ 9. ¢È·ÁÓˆÛÙÈο ÎÚÈÙ‹ÚÈ· FC∞S ÀÔÙÚÔÈ¿˙ˆÓ ˘ÚÂÙfi˜ Î·È ÂÍ¿ÓıËÌ· ÌÂÙ¿ ÁÂÓÈÎÂ˘Ì¤ÓË ¤ÎıÂÛË ÛÙÔ ÎÚ‡Ô ∫ÏËÚÔÓÔÌÈÎfiÙËÙ·: ÂÈÎÚ·ÙËÙÈÎfi˜ ·˘ÙÔۈ̷ÙÈÎfi˜ ¯·Ú·ÎÙ‹Ú·˜ ∏ÏÈΛ· ¤Ó·Ú͢: <6 ÌËÓÒÓ ¢È¿ÚÎÂÈ· Û˘Ìو̿وÓ: <24 ÒÚ˜ ∂ÈÂÊ˘Î›Ùȉ· ∞Ô˘Û›· ‚·ÚËÎÔ˝·˜, ÂÚÈÎÔÁ¯ÈÎÔ‡ Ôȉ‹Ì·ÙÔ˜, ÏÂÌÊ·‰ÂÓ›Ùȉ·˜, ÔÚÔÁÔÓ›Ùȉ·˜
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¶›Ó·Î·˜ 10. CINCA / IOMID
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‰ÂÚÌ·ÙÈΤ˜ ÂΉËÏÒÛÂȘ, ¯ÚfiÓÈ· ÌË ÌÈÎÚԂȷ΋ ˘ÔÙÚÔÈ¿˙Ô˘Û· ÌËÓÈÁÁ›Ùȉ·, ÛÔ‚·Ú‹ ·ÚıÚ›Ùȉ· Ì ˘ÔÏ·Û›· ÙÔ˘ ¯fiÓ‰ÚÔ˘ Î·È Î·Ù·ÛÙÚÔÊ‹ ÙÔ˘ ÔÛÙÔ‡, ÚÒÈÌË Û‡ÁÎÏÂÈÛË ÂÈʇÛÂˆÓ Ô˘ Ô‰ËÁÔ‡Ó Û ۈ̷ÙÈ΋ ηı˘ÛÙ¤ÚËÛË Î·È ·Ô‰›‰ÂÈ Û ÌË Û˘ÁÁÂÓ›˜ ÌÂٷ͇ ÙÔ˘˜ ·ÛıÂÓ›˜ ÎÔÈÓ¿ ÌÔÚÊÔÏÔÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο (19). ∆· ÓÔÛ‹Ì·Ù· Ô˘ ·Ó·Ê¤ÚıËÎ·Ó ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÛÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ˘ÔÙÚÔÈ·˙fiÓÙˆÓ Â̇ÚÂÙˆÓ ÓÔÛËÌ¿ÙˆÓ. ∏ ÁÂÓÂÙÈ΋ ÙÔ˘˜ ·Ó¿Ï˘ÛË ·ÊÂÓfi˜ ÌÂÓ ˘ÔÛÙËÚ›˙ÂÈ ÙËÓ ÎÏÈÓÈ΋ ÙÔ˘˜ ‰È¿ÁÓˆÛË, ·ÊÂÙ¤ÚÔ˘ ÌÔÚ› Ó· Û˘Ì‚¿ÏÂÈ ÛÙË ‰ÈÂÚ‡ÓËÛË Ù˘ ÌÔÚȷ΋˜ ‚¿Û˘ Ù˘ ·ÓÙ›‰Ú·Û˘ ÊÏÂÁÌÔÓ‹˜ Î·È ÛÙËÓ ·Ó‡ÚÂÛË ÔÚıÔÏÔÁÈÎfiÙÂÚ˘ ıÂڷ›·˜, fiˆ˜ .¯. ·ÁˆÁ‹ Ù˘ ‰Ú¿Û˘ Ù˘ ˘Ú›Ó˘ ‹ ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ Èı·ÓÔÏÔÁÔ‡ÌÂÓ˘ ÌÂÙ·ÏÏ·Á̤Ó˘ ˘Ú›Ó˘. µÈ‚ÏÈÔÁÚ·Ê›· 1. Grateau G, Drenth JP, Delpech M. Hereditary fevers. Curr Opin Rheumatol 1999;11:75-78. 2. Drenth JP, van der Meer JW. Periodic fevers enter the era of molecular diagnosis. BMJ 2000;320:1091-1092. 3. Eliakim M, Levy M, Ehrenfeld M. Recurrent polyserositis (familial Mediterranean fever). Amsterdam: Elsevier/North Holland Biomedical Press; 1981. 4. Goldfinger SE. Colchicine for familial Mediterranean fever. N Engl J Med 1972;287:1302. 5. The International FMF Consortium. Ancient missense mutations in a new member of the RoRet gene family are likely to cause familial Mediterranean fever. Cell 1997;90:797-807. 6. The French FMF Consortium. A candidate gene for familial Mediterranean fever. Nat Genet 1997;17:25-31. 7. Cazeneuve C, Sarkisian T, Pecheux C, Dervichian M, Nedelec B, Reinert P et al. MEFV-Gene analysis in armenian patients with Familial Mediterranean fever: diagnostic value and unfavorable renal prognosis of the M694V homozygous genotype-genetic and therapeutic implications. Am J Hum Genet 1999;65:88-97. 8. µÔ˘ÁÈԇη Ÿ, ª·ÚÎÔ‡ÚË ª, Touitou I, ∫·Ú¿ıÈÔ˜ £. °ÂÓÂÙÈ΋ ·Ó¿Ï˘ÛË ∂ÏÏËÓÔ·›‰ˆÓ Ì ÔÈÎÔÁÂÓ‹ ÌÂÛÔÁÂÈ·Îfi ˘ÚÂÙfi. 39Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ; 2001. Abstract No EA075.
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9. Van der Meer JW, Vossen JM, Radl J, van Nieuwkoop JA, Meyer CJ, Lobatto S et al. Hyperimmunoglobulinaemia D and periodic fever: a new syndrome. Lancet 1984;1: 1087-1090. 10. Drenth JP, Haagsma CJ, van der Meer JW. Hyperimmunoglobulinemia D and periodic fever syndrome. The clinical spectrum in a series of 50 patients. International Hyper-IgD Study Group. Medicine 1994;73:133-144. 11. Drenth JP, Cuisset L, Grateau G, Vasseur C, van de VeldeVisser SD, de Jong JG et al. Mutations in the gene encoding mevalonate kinase cause hyper-IgD and periodic fever syndrome. International Hyper-IgD Study Group. Nat Genet 1999;22:178-181. 12. Goldstein JL, Brown MS. Regulation of the mevalonate pathway. Nature 1990;343:425-430. 13. Williamson LM, Hull D, Mehta R, Reeves WG, Robinson BH, Toghill PJ. Familial Hibernian fever. Q J Med 1982;51: 469-480. 14. McDermott EM, Smillie DM, Powell RJ. Clinical spectrum of familial Hibernian fever: a 14-year follow-up study of the index case and extended family. Mayo Clin Proc 1997;72:806-817. 15. McDermott MF, Ogunkolade BW, McDermott EM, Jones LC, Wan Y, Quane KA et al. Linkage of familial Hibernian fever to chromosome 12p13. Am J Hum Genet 1998;62;1446-1451. 16. Kile RL, Rusk HA. A case of cold urticaria with unusual family history. JAMA 1940;114:1067-1068. 17. Muckle TJ, Wells M. Urticaria, deafness, and amyloidosis: a new heredo-familial syndrome. Q J Med 1962;31:235-248. 18. Hoffman HM, Mueller JL, Broide DH, Wanderer AA, Kolodner RD. Mutation of a new gene encoding a putative pyrin-like protein causes familial cold autoinflammatory syndrome and Muckle-Wells syndrome. Nat Genet 2001;29:301-305. 19. Feldmann J, Prieur AM, Quartier P, Berquin P, Certain S, Cortis E, et al. Chronic infantile neurological cutaneous and articular syndrome is caused by mutations in CIAS1, a gene highly expressed in polymorphonuclear cells and chondrocytes. Am J Hum Genet 2002;71:198-203. ∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 20-03-2003 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 02-09-2003 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ŸÏÁ· ∂. µÔ˘ÁÈԇη µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡” £Ë‚ÒÓ & §Â‚·‰Â›·˜, ∆.∫. 115 27, °Ô˘‰›
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Paediatriki 2004;67:218-222
SPECIAL ARTICLE
∏ÌÈÎÚ·ÓÈο ÈÛÔ‰‡Ó·Ì· ÛÙ· ·È‰È¿ ™. ¢. ª·ÛÙÚÔÁÈ¿ÓÓË, ∫. µÔ‡‰Ú˘, ∂. ∫·ÙÛ·ÚÔ‡
Migraine equivalents in children S. D. Mastrogianni, K. Voudris, E. Katsarou
¶ÂÚ›ÏË„Ë: ∆· “ËÌÈÎÚ·ÓÈο ÈÛÔ‰‡Ó·Ì·” Â›Ó·È ÎÏÈÓÈΤ˜ ÔÓÙfiÙËÙ˜ Ì ÂÚÈÔ‰ÈÎfi ·ÚÔ͢ÛÌÈÎfi ¯·Ú·ÎÙ‹Ú·, ηÏÔ‹ıË ÚfiÁÓˆÛË Î·È ·ÈÙÈÔÏÔÁÈ΋ Û˘Û¯¤ÙÈÛË Ì ÙËÓ ËÌÈÎÚ·Ó›·, Ë ÔÔ›· ‚·Û›˙ÂÙ·È Î˘Ú›ˆ˜ ÛÙÔ ÈÛ¯˘Úfi ÔÈÎÔÁÂÓÂÈ·Îfi ‹/Î·È ·ÙÔÌÈÎfi ÈÛÙÔÚÈÎfi ËÌÈÎÚ·Ó›·˜. ¶¤ÓÙ ٤ÙÔȘ ηٷÛÙ¿ÛÂȘ ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› Ì ۷ʋÓÂÈ· ÛÙ· ·È‰È¿: ÙÔ Î·ÏfiËı˜ ·ÚÔ͢ÛÌÈÎfi Ú·È‚fiÎÚ·ÓÔ ÛÙ· ‚Ú¤ÊË, Ô Î·ÏÔ‹ı˘ ·ÚÔ͢ÛÌÈÎfi˜ ›ÏÈÁÁÔ˜, ÔÈ Î˘ÎÏÈÎÔ› ¤ÌÂÙÔÈ/ ÎÔÈÏȷ΋ ËÌÈÎÚ·Ó›· Û Ӌȷ Î·È ÌÈÎÚ¿ ·È‰È¿, Ë ·ÎÂÊ·ÏÁÈ΋ ËÌÈÎÚ·Ó›· Î·È Ë ÔÍ›· Û˘Á¯˘ÙÈ΋ ËÌÈÎÚ·Ó›· Û ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜. ∏ ËÏÈÎȷ΋ ηٷÓÔÌ‹ ÙˆÓ ‰È·ÊfiÚˆÓ ËÌÈÎÚ·ÓÈÎÒÓ ÈÛÔ‰‡Ó·ÌˆÓ Â›Ó·È ¯·Ú·ÎÙËÚÈÛÙÈ΋ Î·È Ê·›ÓÂÙ·È Ó· ÂÎÊÚ¿˙ÂÈ ÙËÓ Â›‰Ú·ÛË Ù˘ ·Ó¿Ù˘Í˘ ÛÙË ÁÂÓÂÙÈ΋ ¤ÎÊÚ·ÛË Ù˘ ÚԉȿıÂÛ˘ ÁÈ· ËÌÈÎÚ·Ó›·. ¶·Ú¿ ÙËÓ ÂÓÙ˘ˆÛȷ΋ Î·È ¯·Ú·ÎÙËÚÈÛÙÈ΋ ÙÔ˘˜ Û˘Ìو̷ÙÔÏÔÁ›·, Ù· ËÌÈÎÚ·ÓÈο ÈÛÔ‰‡Ó·Ì· Ê·›ÓÂÙ·È fiÙÈ ˘Ô‰È·ÁÈÁÓÒÛÎÔÓÙ·È. ™˘Ó‹ıˆ˜ ÚÔËÁÂ›Ù·È Ï‹ıÔ˜ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛÂˆÓ ÁÈ· ÙÔÓ ·ÔÎÏÂÈÛÌfi ¿ÏÏˆÓ ÛÔ‚·ÚÒÓ Î·Ù·ÛÙ¿ÛÂˆÓ Î·È Ë Û˘Û¯¤ÙÈÛË Ì ÙËÓ ËÌÈÎÚ·Ó›· ‰ÂÓ ·Ó·ÁÓˆÚ›˙ÂÙ·È ÙÂÏÈο. ™‡Ìʈӷ Ì ÚfiÛÊ·Ù· ‰Â‰Ô̤ӷ, Ë Û˘¯ÓfiÙËÙ· ÙˆÓ ËÌÈÎÚ·ÓÈÎÒÓ ÈÛÔ‰‡Ó·ÌˆÓ ·Ó¤Ú¯ÂÙ·È ÛÙÔ 1,8% ÙÔ˘ ÁÂÓÈÎÔ‡ ·È‰ÈÎÔ‡ ÏËı˘ÛÌÔ‡ Î·È ÛÙÔ 10% ÙˆÓ ·È‰ÈÒÓ Ì ËÌÈÎÚ·Ó›·. °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi, ıˆÚÂ›Ù·È ÛÎfiÈÌË Ë ÂÓË̤ڈÛË ÙˆÓ ·È‰È¿ÙÚˆÓ ÁÈ· ÙËÓ ·Ó·ÁÓÒÚÈÛË ·˘Ù‹˜ Ù˘ Û¯ÂÙÈο Û˘¯Ó‹˜ ·Ú·ÏÏ·Á‹˜ Ù˘ ËÌÈÎÚ·Ó›·˜, Ì ÛÎÔfi fi¯È ÌfiÓÔ ÙÔÓ ÂÚÈÔÚÈÛÌfi ÙˆÓ ÂÍÂÙ¿ÛˆÓ, ·ÏÏ¿ Î·È ÙËÓ ·ÔÊ˘Á‹ ÂÚÈÙÙÔ‡ ¿Á¯Ô˘˜ Î·È ·ÓËÛ˘¯›·˜ ÛÙ· ›‰È· Ù· ·È‰È¿ Î·È ÙȘ ÔÈÎÔÁ¤ÓÂȤ˜ ÙÔ˘˜.
Abstract: Migraine equivalents are clinical conditions with a periodic paroxysmal character, a benign prognosis and an aetiological relationship to migraine based on a strong positive family and/or past medical history of migraine. Five such equivalents are presently recognized: benign paroxysmal vertigo in infancy, benign paroxysmal vertigo and cyclical vomiting/ abdominal migraine in toddlers and young children and acephalgic and acute confusional migraine in late childhood to adolescence. The age distribution of migraine equivalents is characteristic and seems to reflect the influence of the developmental process on the expression of an inherited migrainous predisposition. Despite the impressive and distinctive clinical symptomatology, the diagnosis is usually missed. In most cases an extensive diagnostic work-up for the exclusion of other serious conditions has been conducted, but the relationship with migraine is not always recognized. According to recent data the observed incidence of migraine equivalents is up to 1.8% of the total paediatric population and 10% of migraine sufferers. It is therefore important for paediatricians to be aware of these relative common migraine subtypes not only for limiting the number of tests but also for avoiding unnecessary anxiety in children and their families.
§¤ÍÂȘ ÎÏÂȉȿ: ËÌÈÎÚ·ÓÈο ÈÛÔ‰‡Ó·Ì·, Úfi‰ÚÔÌ· ËÌÈÎÚ·Ó›·˜, ËÌÈÎÚ·Ó›· ÛÙ· ·È‰È¿.
Key words: migraine equivalents, precursors, migraine and children.
¡Â˘ÚÔÏÔÁÈÎfi ∆Ì‹Ì·, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó·
Department of Neurology, “P. & A. Kyriakou” Children’s Hospital, Athens
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∂ÈÛ·ÁˆÁ‹ ªÂ ÙÔÓ fiÚÔ “ËÌÈÎÚ·ÓÈο ÈÛÔ‰‡Ó·Ì·” ÂÚÈÁÚ¿ÊÔÓÙ·È ÂÚÈÔ‰Èο ·ÚÔ͢ÛÌÈο Û‡Ó‰ÚÔÌ· ¯ˆÚ›˜ ¤ÓÙÔÓË Û˘ÓÔ‰fi ÎÂÊ·Ï·ÏÁ›·, Ù· ÔÔ›· ÂÌÊ·Ó›˙Ô˘Ó ·ÈÙÈÔÏÔÁÈ΋ Û¯¤ÛË Ì ÙËÓ ËÌÈÎÚ·Ó›·. ÕÏÏÔÈ fiÚÔÈ ÁÈ· ·˘Ù¤˜ ÙȘ ·ÙÂÏÒ˜ ÚÔÛ‰ÈÔÚÈÛı›Û˜ ‰È·Ù·Ú·¯¤˜ Â›Ó·È “Úfi‰ÚÔÌ· ËÌÈÎÚ·Ó›·˜” ‹ “ÂÚÈÔ‰Èο Û‡Ó‰ÚÔÌ· Ù˘ ·È‰È΋˜ ËÏÈΛ·˜” (1,2). ¶¤ÓÙ ٤ÙÔÈ· Û‡Ó‰ÚÔÌ· ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› Ì ۯÂÙÈ΋ Û·Ê‹ÓÂÈ· ÛÙËÓ ·È‰È΋ ËÏÈΛ·: ÙÔ Î·ÏfiËı˜ ·ÚÔ͢ÛÌÈÎfi Ú·È‚fiÎÚ·ÓÔ (3,4), Ô Î·ÏÔ‹ı˘ ·ÚÔ͢ÛÌÈÎfi˜ ›ÏÈÁÁÔ˜ (5-7), Ë ÎÔÈÏȷ΋ ËÌÈÎÚ·Ó›·/ ΢ÎÏÈÎÔ› ¤ÌÂÙÔÈ (8-12), Ë ÔÍ›· Û˘Á¯˘ÙÈ΋ ËÌÈÎÚ·Ó›· (13-15) Î·È Ë ·ÎÂÊ·ÏÁÈ΋ ËÌÈÎÚ·Ó›· (16,17). ¶ÚfiÎÂÈÙ·È ÁÈ· ÎÏÈÓÈΤ˜ ÔÓÙfiÙËÙ˜ Ì ÂÓÙ˘ˆÛȷ΋ Û˘Ìو̷ÙÔÏÔÁ›·, ÔÈ Ôԛ˜ ¤¯Ô˘Ó ·Ó·ÁÓˆÚÈÛÙ› ÚÔ ‰ÂηÂÙÈÒÓ Î·È ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ηχÙÂÚ· Û ÚfiÛÊ·Ù˜ ÌÂϤÙ˜. ∏ ·ÈÙÈÔÏÔÁÈ΋-·ıÔÁÂÓÂÙÈ΋ Û¯¤ÛË ·˘ÙÒÓ ÙˆÓ ÂÚÈÔ‰ÈÎÒÓ ÎÏÈÓÈÎÒÓ Û˘Ó‰ÚfiÌˆÓ Ì ÙËÓ ËÌÈÎÚ·Ó›· ÛÙËÚ›¯ıËΠÛÙÔÓ ·ÚÔ͢ÛÌÈÎfi ÙÔ˘˜ ¯·Ú·ÎÙ‹Ú·, ÛÙËÓ ·Ô˘Û›· ˘ÔÏÂÈÌÌ·ÙÈÎÒÓ ‚Ï·‚ÒÓ, ÛÙÔ ÈÛ¯˘Úfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ËÌÈÎÚ·Ó›·˜, ÛÙËÓ ÂÌÊ¿ÓÈÛË Û ·ÒÙÂÚÔ ¯ÚfiÓÔ Ù˘È΋˜ ËÌÈÎÚ·Ó›·˜ Î·È ÛÙȘ ÔÌÔÈfiÙËÙ˜ Ì ·ÓÙ›ÛÙÔȯ· ËÌÈÎÚ·ÓÈο Û‡Ó‰ÚÔÌ· ÙˆÓ ÂÓËÏ›ÎˆÓ (1,2). ÷ڷÎÙËÚÈÛÙÈ΋ Â›Ó·È Ë ÂΉ‹ÏˆÛË ÙˆÓ ÂÈ̤ÚÔ˘˜ Û˘Ó‰ÚfiÌˆÓ ÛÂ Û˘ÁÎÂÎÚÈ̤Ó˜ ËÏÈÎȷΤ˜ ÔÌ¿‰Â˜ (ÙÔ Î·ÏfiËı˜ ·ÚÔ͢ÛÌÈÎfi Ú·È‚fiÎÚ·ÓÔ ÛÙ· ‚Ú¤ÊË, Ô Î·ÏÔ‹ı˘ ·ÚÔ͢ÛÌÈÎfi˜ ›ÏÈÁÁÔ˜ Î·È Ë ÎÔÈÏȷ΋ ËÌÈÎÚ·Ó›·/ ΢ÎÏÈÎÔ› ¤ÌÂÙÔÈ ÛÙË ÓËȷ΋ Î·È ÚÒÙË ·È‰È΋ ËÏÈΛ· Î·È Ë ·ÎÂÊ·ÏÁÈ΋ Î·È ÔÍ›· Û˘Á¯˘ÙÈ΋ ËÌÈÎÚ·Ó›· ÛÙË ‰Â‡ÙÂÚË ·È‰È΋ Î·È ÚÔÂÊË‚È΋ ËÏÈΛ·), Ë ÔÔ›· ·ÓÙÈηÙÔÙÚ›˙ÂÈ Èı·ÓfiÓ ÙËÓ Â›‰Ú·ÛË Ù˘ ·Ó·Ù˘Íȷ΋˜ ‰È·‰Èηۛ·˜ ÛÙËÓ ¤ÎÊÚ·ÛË Ù˘ ÁÂÓÂÙÈ΋˜ ÚԉȿıÂÛ˘ ÁÈ· ËÌÈÎÚ·Ó›· (2). ¶ÂÚÈÁÚ·Ê‹ ËÌÈÎÚ·ÓÈÎÒÓ ÈÛÔ‰‡Ó·ÌˆÓ ∫·ÏfiËı˜ ·ÚÔ͢ÛÌÈÎfi Ú·È‚fiÎÚ·ÓÔ Ù˘ ‚ÚÂÊÈ΋˜ ËÏÈΛ·˜ ∆Ô Î·ÏfiËı˜ ·ÚÔ͢ÛÌÈÎfi Ú·È‚fiÎÚ·ÓÔ (benign paroxysmal torticollis) ÂÌÊ·Ó›˙ÂÙ·È Û˘Ó‹ıˆ˜ ÛÙÔ Ù¤ÏÔ˜ ÙÔ˘ ÚÒÙÔ˘ ¯ÚfiÓÔ˘ ˙ˆ‹˜, Ì ÔÚȷ΋ ËÏÈΛ· 2 ÌËÓÒÓ ¤ˆ˜ 3 ÂÙÒÓ (2,4). ¶·ÚÔ˘ÛÈ¿˙ÂÙ·È Ì ÎÏ›ÛË Ù˘ ÎÂÊ·Ï‹˜ ÚÔ˜ ÙËÓ ›‰È· ‹ ÙËÓ ·ÓÙ›ıÂÙË ÏÂ˘Ú¿, Ô˘ ·Ô‰›‰ÂÙ·È Û ‰˘ÛÙÔÓ›· ÙÔ˘ ·˘¯¤Ó· (18) Î·È ÌÔÚ› Ó· Û˘Óԉ‡ÂÙ·È ·fi ˆ¯ÚfiÙËÙ·, ¤ÌÂÙÔ ‹ ‰È·Ù·Ú·¯¤˜ Û˘ÌÂÚÈÊÔÚ¿˜. OÈ ÎÚ›ÛÂȘ ‰È·ÚÎÔ‡Ó ·fi Ï›Á˜ ÒÚ˜ ¤ˆ˜ 4 Ë̤Ú˜ Î·È ˘Ô¯ˆÚÔ‡Ó ÌfiÓÔ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘. ∏ Û˘¯ÓfiÙËÙ· ÙˆÓ ÂÂÈÛÔ‰›ˆÓ ÂÏ·ÙÙÒÓÂÙ·È ÚÔԉ¢ÙÈο, ÂÓÒ ÛÙ·Ì·ÙÔ‡Ó Ì¤¯ÚÈ ÙËÓ ËÏÈΛ· ÙˆÓ 5 ÂÙÒÓ, ÁÈ· Ó· ·ÓÙÈηٷÛÙ·ıÔ‡Ó Èı·ÓfiÓ ·fi ÂÂÈÛfi‰È·
Paediatriki 2004;67:218-222
·ÚÔ͢ÛÌÈÎÔ‡ ÈÏ›ÁÁÔ˘ ‹ ËÌÈÎÚ·Ó›·˜ (4,19). O ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Â›Ó·È ··Ú·›ÙËÙÔ˜ ÁÈ· Ó· ·ÔÎÏÂÈÛÙ› ¯ˆÚÔηٷÎÙËÙÈ΋ ÂÍÂÚÁ·Û›· ÙÔ˘ Ô›ÛıÈÔ˘ ÎÚ·ÓÈ·ÎÔ‡ ‚fiıÚÔ˘ (19). ∏ ıÂڷ›· Â›Ó·È Û˘Ìو̷ÙÈ΋ Î·È ·ÊÔÚ¿ ÛÙËÓ Î·Ù·ÛÙÔÏ‹ ÙÔ˘ ÈÔ ¤ÓÙÔÓÔ˘ ÂÓԯϋ̷ÙÔ˜. ¢ÂÓ ˘¿Ú¯Ô˘Ó ·Ó·ÊÔÚ¤˜ ÁÈ· ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ÚÔÊ˘Ï·ÎÙÈ΋˜ ·ÁˆÁ‹˜, Ì ÂÍ·›ÚÂÛË ¤Ó· ÌÂÌÔӈ̤ÓÔ ÂÚÈÛÙ·ÙÈÎfi, ÛÙÔ ÔÔ›Ô ¯ÔÚËÁ‹ıËΠÈ˙ÔÙÈÊ·›ÓÈÔ (Mosegor), ·ÎÂÙ·˙ÔÏ·Ì›‰Ë Î·È ÊÏÔ˘Ó·ÚÈ˙›ÓË (Sibelium) ¯ˆÚ›˜ ·ÓÙ·fiÎÚÈÛË (19). ∫·ÏÔ‹ı˘ ·ÚÔ͢ÛÌÈÎfi˜ ›ÏÈÁÁÔ˜ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ O ηÏÔ‹ı˘ ·ÚÔ͢ÛÌÈÎfi˜ ›ÏÈÁÁÔ˜ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ (benign paroxysmal vertigo) ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ‚Ú·¯Â›·˜ ‰È¿ÚÎÂÈ·˜ ÂÂÈÛfi‰È· ÈÏ›ÁÁÔ˘ Û ˘ÁÈ‹ ·È‰È¿. ∂ΉËÏÒÓÂÙ·È ÛÙËÓ ËÏÈΛ· ÙˆÓ 2-5 ÂÙÒÓ. ∆· ÂÂÈÛfi‰È· ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ·ÛÙ¿ıÂÈ·, ˆ¯ÚfiÙËÙ· Î·È Êfi‚Ô, ‰È·ÚÎÔ‡Ó 1-5 ÏÂÙ¿ Î·È ÛÙȘ Ù˘ÈΤ˜ ÂÚÈÙÒÛÂȘ ˘Ô¯ˆÚÔ‡Ó ‰‡Ô ¯ÚfiÓÈ· ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍ‹ ÙÔ˘˜ (6,7). ∞Ó¿ÏÔÁË ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÛÙÔ˘˜ ÂÓ‹ÏÈΘ ·Ó·Ê¤ÚÂÙ·È ˆ˜ “ÔÈÎÔÁÂÓ‹˜ ηÏÔ‹ı˘ ˘ÔÙÚÔÈ¿˙ˆÓ ›ÏÈÁÁÔ˜” (familial benign recurrent vertigo) Î·È ıˆÚÂ›Ù·È fiÙÈ ÔÊ›ÏÂÙ·È Û ÁÂÓÂÙÈ΋ ‰È·Ù·Ú·¯‹ Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ ÙˆÓ ‰È·‡ÏˆÓ Ca++ (20). O ›ÏÈÁÁÔ˜ ·Ú·ÙËÚÂ›Ù·È ÛÙÔ 25% ÙˆÓ ÂÓËÏ›ÎˆÓ ·ÛıÂÓÒÓ Ì ËÌÈÎÚ·Ó›· (21). ∏ ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ·fi ÔÚÁ·ÓÈο ·›ÙÈ· ÂÚÈÊÂÚÈÎÔ‡ Î·È ÎÂÓÙÚÈÎÔ‡ Ù‡Ô˘ ÈÏ›ÁÁÔ˘, fiˆ˜ Ì·ÛÙÔÂȉ›Ùȉ·, ˆÙ›Ùȉ·, Ó¢ڛÙȉ· ÙÔ˘ ·ÈıÔ˘Û·›Ô˘, οΈÛË Ï·‚˘Ú›ÓıÔ˘, ¤ÌÊÚ·ÎÙÔ ÙÔ˘ ÚÔÌ‹ÎÔ˘˜ ‹ Ù˘ ·ÚÂÁÎÂÊ·Ï›‰·˜ Î·È ·Ó¿ÚÎÂÈ· Ù˘ ÛÔÓ‰˘ÏÔ‚·ÛÈ΋˜ Â›Ó·È ··Ú·›ÙËÙË. °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi, ÂӉ›ÎÓ˘Ù·È ¤ÏÂÁ¯Ô˜ Ì ·ÎÔfiÁÚ·ÌÌ·, ËÏÂÎÙÚÔÓ˘ÛÙ·ÁÌÔÁÚ·Ê›· Î·È - Û οÔȘ ÂÚÈÙÒÛÂȘ - Ì MRI ÂÁÎÂÊ¿ÏÔ˘ (21,22). ∏ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ·Ú·ÙÂÙ·Ì¤ÓˆÓ ÎÚ›ÛÂˆÓ Â›Ó·È Û˘Ìو̷ÙÈ΋ Ì ¯ÔÚ‹ÁËÛË ·ÓÙÈÂÌÂÙÈÎÒÓ [ÌÂÙÔÎÏÔÚ·Ì›‰Ë (Primperan) ‹ ‰ÔÌÂÚȉfiÓË (Cilroton)] Î·È ·ÓÙÈ-ÈÏÈÁÁÈÎÒÓ Ê·ÚÌ¿ÎˆÓ [‰ÈÌÂÓ˘‰ÚÈÓ¿ÙË (Vomex) ‹ ‰ÈÊ·ÈÓ˘‰Ú·Ì›ÓË (Benadryl)], ÂÓÒ fiÙ·Ó ÔÈ ÎÚ›ÛÂȘ Â›Ó·È Û˘¯Ó¤˜ ÂӉ›ÎÓ˘Ù·È Ë ‰ÔÎÈÌ·ÛÙÈ΋ ¯ÔÚ‹ÁËÛË ÚÔÊ˘Ï·ÎÙÈ΋˜ ·ÁˆÁ‹˜ Ì ʿÚ̷η fiˆ˜ ÙÔ È˙ÔÙÈÊ·›ÓÈÔ Î·È Ë ÚÔÚ·ÓÔÏfiÏË (1,22). ∫ÔÈÏȷ΋ ËÌÈÎÚ·Ó›· - ΢ÎÏÈÎÔ› ¤ÌÂÙÔÈ ∏ ÎÔÈÏȷ΋ ËÌÈÎÚ·Ó›· (abdominal migraine) Î·È ÔÈ Î˘ÎÏÈÎÔ› ¤ÌÂÙÔÈ (cyclical vomiting) ÂΉËÏÒÓÔÓÙ·È Û ËÏÈΛ· 4-10 ÂÙÒÓ. OÈ Î˘ÎÏÈÎÔ› ¤ÌÂÙÔÈ ÂÌÊ·Ó›˙ÔÓÙ·È Û˘Ó‹ıˆ˜ Û ÌÈÎÚfiÙÂÚË ËÏÈΛ· (5 ÂÙÒÓ) Û ۯ¤ÛË Ì ÙËÓ ÎÔÈÏȷ΋ ËÌÈÎÚ·Ó›· (7 ÂÙÒÓ) (10,11). ™˘Ó‹ıˆ˜ ˘¿Ú¯ÂÈ ·ÏÏËÏÔÂÈÎ¿Ï˘„Ë ÙˆÓ ‰‡Ô Û˘Ó‰ÚfiÌˆÓ Î·È ÁÈ· ÙÔÓ ÏfiÁÔ ·˘Ùfi ˘¿Ú¯ÂÈ Ë Ù¿ÛË Ó·
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¶·È‰È·ÙÚÈ΋ 2004;67:218-222
Paediatriki 2004;67:218-222
ÂÚÈÁÚ¿ÊÔÓÙ·È Ì·˙› ÛÙËÓ ÚfiÛÊ·ÙË ‚È‚ÏÈÔÁÚ·Ê›· (12). ÷ڷÎÙËÚ›˙ÔÓÙ·È ·fi ÂÚÈÔÌÊ·ÏÈÎfi ¿ÏÁÔ˜, Ó·˘Ù›·, Û˘¯ÓÔ‡˜ Â̤ÙÔ˘˜, ˆ¯ÚfiÙËÙ· Î·È ÂËÚ·Ṳ̂ÓË ÁÂÓÈ΋ ηٿÛÙ·ÛË, ÂÓÒ Ë ÎÂÊ·Ï·ÏÁ›· Ì ÙËÓ ÚfiÔ‰Ô Ù˘ ËÏÈΛ·˜ ηı›ÛÙ·Ù·È ‚·ÛÈÎfi Û‡Ìو̷ Î·È Ë ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÌÔÈ¿˙ÂÈ ÂÚÈÛÛfiÙÂÚÔ ÌÂ Ù˘È΋ ËÌÈÎÚ·Ó›· (12). ∏ ‰È¿ÚÎÂÈ· ÙˆÓ ÂÂÈÛÔ‰›ˆÓ Â›Ó·È ·ÚÎÂÙ¤˜ ÒÚ˜ ‹ Î·È Ë̤Ú˜, ·ÏÏ¿ Ë ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ı· Ú¤ÂÈ Ó· Â›Ó·È Ôχ ÚÔÛÂÎÙÈ΋, ÂÓÒ È‰È·›ÙÂÚË ÛËÌ·Û›· ¤¯ÂÈ Ô ·ÔÎÏÂÈÛÌfi˜ ÌÂÙ·‚ÔÏÈÎÒÓ, ¯ÂÈÚÔ˘ÚÁÈÎÒÓ ‹ ¿ÏÏˆÓ ·ÈÙ›ˆÓ ˘ÔÙÚÔÈ·˙fiÓÙˆÓ ÂÌ¤ÙˆÓ ‹ ÎÔÈÏÈ·ÎÔ‡ ¿ÏÁÔ˘˜ (23). π‰È·›ÙÂÚË ÛËÌ·Û›· ¤¯ÂÈ Ë ‰È·Ù‹ÚËÛË ÙÔ˘ ÈÛÔ˙˘Á›Ô˘ ˘ÁÚÒÓ Î·È ËÏÂÎÙÚÔÏ˘ÙÒÓ Ì ÙËÓ ·ÚÂÓÙÂÚÈ΋ ¯ÔÚ‹ÁËÛË ˘ÁÚÒÓ ÛÙ· ÛÔ‚·Ú¿ ÂÂÈÛfi‰È·. ∏ ¯ÔÚ‹ÁËÛË ·ÓÙÈÂÌÂÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ ·Ó·ÎÔ˘Ê›˙ÂÈ ÙÔ ·È‰› ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÎÚ›Û˘, ÂÓÒ fiÙ·Ó Ù· ÂÂÈÛfi‰È· Â›Ó·È Û˘¯Ó¿ ÂӉ›ÎÓ˘Ù·È Ë ‰ÔÎÈÌ·ÛÙÈ΋ ¯ÔÚ‹ÁËÛË ÚÔÊ˘Ï·ÎÙÈ΋˜ ·ÁˆÁ‹˜ (1,12,23). OÍ›· Û˘Á¯˘ÙÈ΋ ËÌÈÎÚ·Ó›· ∏ ÔÍ›· Û˘Á¯˘ÙÈ΋ ËÌÈÎÚ·Ó›· (acute confusional migraine) Â›Ó·È Ì›· ÂÓÙ˘ˆÛȷ΋ ÎÏÈÓÈ΋ ÔÓÙfiÙËÙ·. ∂ÌÊ·Ó›˙ÂÙ·È Û ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿ (6,5-15 ÂÙÒÓ) Î·È Â›Ó·È Û˘¯ÓfiÙÂÚË ÛÙ· ·ÁfiÚÈ·. ∏ Û˘¯ÓfiÙËÙ· ÙˆÓ ÎÚ›ÛÂˆÓ Â›Ó·È ¯·ÌËÏ‹ Î·È Û˘Ó‹ıˆ˜ ·ÔÙÂÏ› ÙËÓ ·Ú¯È΋ ÂΉ‹ÏˆÛË Ù˘ ÚԉȿıÂÛ˘ ÁÈ· ËÌÈÎÚ·Ó›· ÛÙÔ ·È‰›, ÁÂÁÔÓfi˜ Ô˘ ηıÈÛÙ¿ ‰‡ÛÎÔÏË ÙËÓ ÚÒÈÌË ‰È¿ÁÓˆÛ‹ Ù˘. ™˘¯Ó¿ ·Ó·Ê¤ÚÂÙ·È ÚfiÛÊ·ÙÔ (Ï›Á˜ ÒÚ˜ ¤ˆ˜ 4 Ë̤Ú˜), ‹ÈÔ ÙÚ·‡Ì· ÎÂÊ·Ï‹˜. ∆Ô ·È‰› ÂÌÊ·Ó›˙ÂÙ·È Û˘Á¯˘ÙÈÎfi, ·Ó‹Û˘¯Ô Î·È ¤¯ÂÈ ¤ÓÙÔÓ˜ ‰È·Ù·Ú·¯¤˜ ÌÓ‹Ì˘. ∏ ÎÂÊ·Ï·ÏÁ›·, ·Ó ˘¿Ú¯ÂÈ, Û¿ÓÈ· ·Ó·ÁÓˆÚ›˙ÂÙ·È ˆ˜ ‚·ÛÈÎfi Û‡Ìو̷ Î·È Û˘Ó‹ıˆ˜ ÚÔËÁÂ›Ù·È Ù˘ Û˘Á¯˘ÙÈ΋˜ Ê¿Û˘. ∆· ÂÂÈÛfi‰È· ‰È·ÚÎÔ‡Ó Û˘Ó‹ıˆ˜ ·fi Ï›Á˜ ÒÚ˜ ¤ˆ˜ Î·È ¤Ó· 24ˆÚÔ. ∆Ô ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ËÌÈÎÚ·Ó›·˜ Â›Ó·È ˘„ËÏfi Î·È Û˘Ó‹ıˆ˜ ·fi ÙËÓ ÏÂ˘Ú¿ Ù˘ ÌËÙ¤Ú·˜. ∏ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÎÚ›ÛÂˆÓ Â›Ó·È Û˘Ìو̷ÙÈ΋, ·ÏÏ¿ ÚÔ¤¯ÂÈ Ë ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ·fi ¿ÏÏ· ·›ÙÈ· Ô˘ ··ÈÙÔ‡Ó ¿ÌÂÛË Î·È ÂȉÈ΋ ·ÓÙÈÌÂÙÒÈÛË, fiˆ˜ Ë ‰ËÏËÙËÚ›·ÛË ·fi Ê¿Ú̷η Î·È ÙÔÍÈΤ˜ Ô˘Û›Â˜, ÔÈ ÌÂÙ·‚ÔÏÈΤ˜ Î·È ÈÔÁÂÓ›˜ ÂÁÎÂÊ·ÏÔ¿ıÂȘ, ·ÏÏ¿ Î·È ÔÈ ÎÚ›ÛÂȘ ÈÓȷ΋˜ Î·È ÎÚÔÙ·ÊÈ΋˜ ÂÈÏË„›·˜ Î·È ÔÈ „˘¯ÔÁÂÓ›˜ ηٷÛÙ¿ÛÂȘ (14,15).
AÎÂÊ·ÏÁÈ΋ ËÌÈÎÚ·Ó›· ∏ ·ÎÂÊ·ÏÁÈ΋ ËÌÈÎÚ·Ó›· (acephalgic migraine) ·Ú·ÙËÚÂ›Ù·È Û ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿ ËÏÈΛ·˜ 5-12 ÂÙÒÓ. ÷ڷÎÙËÚ›˙ÂÙ·È ·fi Ù˘ÈΤ˜ ËÌÈÎÚ·ÓÈΤ˜ ·‡Ú˜ ¯ˆÚ›˜ ÎÂÊ·Ï·ÏÁ›·. ∂›Ó·È Û¯ÂÙÈο Û˘¯Ó‹ ÌÔÚÊ‹ ËÌÈÎÚ·ÓÈÎÒÓ ÈÛÔ‰‡Ó·ÌˆÓ Ô˘ ·Ó¤Ú¯ÂÙ·È ÛÙÔ 2% ÙˆÓ ËÌÈÎÚ·ÓÈÎÒÓ ·È‰ÈÒÓ. OÈ ·ÛıÂÓ›˜ ·Ó·Ê¤ÚÔ˘Ó ‰È·Ù·Ú·¯¤˜ Ù˘ ÔÙÈ΋˜ ·ÓÙ›Ï˄˘, ·Ú·ÌÔÚÊÒÛÂȘ Ù˘ ÂÈÎfiÓ·˜ ÙÔ˘ ÛÒÌ·Ùfi˜ ÙÔ˘˜, ·›ÛıËÌ· ÏÈÏÈÔ‡ÙÂÈÔ˘ Á›Á·ÓÙ·, ÎÈÓËÌ·ÙÔÁÚ·ÊÈ΋ fiÚ·ÛË Ô˘ Û˘Ó›ÛÙ·Ù·È Û ·›ÛıËÌ· ÂÈÙ¿¯˘ÓÛ˘ ‹ ¿ÁˆÌ· Ù˘ ÂÈÎfiÓ·˜, ˘ÂÚ·ÎÔ˘Û›· Î.¿. (17). ∏ ·ÎÂÊ·ÏÁÈ΋ ËÌÈÎÚ·Ó›· ·Ó·Ê¤ÚÂÙ·È Î·È ˆ˜ “Û‡Ó‰ÚÔÌÔ ∞Ï›Î˘ ÛÙË ¯ÒÚ· ÙˆÓ ı·˘Ì¿ÙˆÓ” ·fi ÙÔ ÁÓˆÛÙfi ·È‰ÈÎfi Ì˘ıÈÛÙfiÚËÌ· ÙÔ˘ Lewis Carroll, ÙÔ˘ ÔÔ›Ô˘ ÔÈ ÂÚÈÁڷʤ˜ ·Ô‰›‰ÔÓÙ·È ÛÙËÓ ÚÔÛˆÈ΋ ÙÔ˘ ÂÌÂÈÚ›· ·fi ËÌÈÎÚ·ÓÈΤ˜ ÎÚ›ÛÂȘ (16). ∆· ÂÂÈÛfi‰È· ‰È·ÚÎÔ‡Ó Û˘Ó‹ıˆ˜ ¤ˆ˜ 10 ÏÂÙ¿, ÂÓÒ ‰ÂÓ ¤¯ÂÈ ·Ó·ÊÂÚı› ‰È¿ÚÎÂÈ· ÌÂÁ·Ï‡ÙÂÚË ·fi 1 ÒÚ·. ∏ ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ÂÚÈÏ·Ì‚¿ÓÂÈ ÙȘ ›‰È˜ ηٷÛÙ¿ÛÂȘ Ô˘ ·Ó·Ê¤ÚıËÎ·Ó ÛÙËÓ ÔÍ›· Û˘Á¯˘ÙÈ΋ ËÌÈÎÚ·Ó›·. ∏ ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ·fi ÙËÓ ÔÍ›· Û˘Á¯˘ÙÈ΋ ËÌÈÎÚ·Ó›· ‚·Û›˙ÂÙ·È ÛÙËÓ ·Ô˘Û›· Ù˘ ÎÂÊ·Ï·ÏÁ›·˜ ÛÙËÓ ·ÎÂÊ·ÏÁÈ΋ ËÌÈÎÚ·Ó›·, ÛÙË ‰È¿ÚÎÂÈ· Î·È ÙË Û˘¯ÓfiÙËÙ· ÙˆÓ ÎÚ›ÛÂˆÓ (17). ™˘˙‹ÙËÛË À¿Ú¯Ô˘Ó ÂӉ›ÍÂȘ fiÙÈ Ù· ËÌÈÎÚ·ÓÈο ÈÛÔ‰‡Ó·Ì· ·ÔÙÂÏÔ‡Ó ¤Ó· Û˘¯Ófi Úfi‚ÏËÌ· ÛÙ· ·È‰È¿ Î·È Èı·ÓfiÓ ˘Ô‰È·ÁÈÁÓÒÛÎÔÓÙ·È. Œˆ˜ ÙËÓ ÚfiÛÊ·ÙË ·Ó·ÛÎÔÈ΋ ÌÂϤÙË ÙˆÓ Al-Twaijri Î·È Shevell (2), ‰ÂÓ ˘‹Ú¯·Ó ÛÙÔȯ›· ÁÈ· ÙË Û˘¯ÓfiÙËÙ· ÙˆÓ ËÌÈÎÚ·ÓÈÎÒÓ ÈÛÔ‰‡Ó·ÌˆÓ ÛÙÔÓ ·È‰ÈÎfi ÏËı˘ÛÌfi. ™Â ¤Ó· ‰Â›ÁÌ· 5848 ·ÛıÂÓÒÓ Ô˘ ÂÈÛΤÊıËÎ·Ó ∂͈ÙÂÚÈÎfi ¶·È‰ÔÓ¢ÚÔÏÔÁÈÎfi π·ÙÚ›Ô, ÂÎ ÙˆÓ ÔÔ›ˆÓ 1106 Ì ËÌÈÎÚ·Ó›·, ‚Ú¤ıËÎ·Ó 108 ·È‰È¿ Ì ٷ ÚÔ·Ó·ÊÂÚı¤ÓÙ· ¤ÓÙ ËÌÈÎÚ·ÓÈο Û‡Ó‰ÚÔÌ·, ·ÚÈıÌfi˜ Ô˘ ·ÓÙÈÛÙÔȯ› Û 1,8% ÙÔ˘ Û˘ÓfiÏÔ˘ ‹ 9,8% ÙˆÓ ËÌÈÎÚ·ÓÈÎÒÓ ·È‰ÈÒÓ (2). ™ÙËÓ ›‰È· ÌÂϤÙË, Ô Î·ÏÔ‹ı˘ ·ÚÔ͢ÛÌÈÎfi˜ ›ÏÈÁÁÔ˜ Î·È Ë ·ÎÂÊ·ÏÁÈ΋ ËÌÈÎÚ·Ó›· ·ÓÙÈÚÔÛÒ¢·Ó Ù· 2/3 ÙˆÓ ËÌÈÎÚ·ÓÈÎÒÓ ÈÛÔ‰‡Ó·ÌˆÓ, ÂÓÒ ÙÔ ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ËÌÈÎÚ·Ó›·˜ Î˘Ì·ÈÓfiÙ·Ó ·fi 65%
¶›Ó·Î·˜ 1. ∫ÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ËÌÈÎÚ·ÓÈÎÒÓ ÈÛÔ‰‡Ó·ÌˆÓ ∆‡Ô˜ ËÌÈÎÚ·ÓÈÎÔ‡ ÈÛÔ‰‡Ó·ÌÔ˘ ∫·ÏÔ‹ı˘ ·ÚÔ͢ÛÌÈÎfi˜ ›ÏÈÁÁÔ˜ ∞ÎÂÊ·ÏÁÈ΋ ËÌÈÎÚ·Ó›· ∫ÔÈÏȷ΋ ËÌÈÎÚ·Ó›·/ ΢ÎÏÈÎÔ› ¤ÌÂÙÔÈ ∫·ÏfiËı˜ ·ÚÔ͢ÛÌÈÎfi Ú·È‚fiÎÚ·ÓÔ OÍ›· Û˘Á¯˘ÙÈ΋ ËÌÈÎÚ·Ó›·
220
™˘¯ÓfiÙËÙ· (¡=108)
∏ÏÈΛ· ÂΉ‹ÏˆÛ˘
OÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ËÌÈÎÚ·Ó›·˜
™˘Ó˘¿Ú¯Ô˘Û· Ù˘È΋ ËÌÈÎÚ·Ó›·
38% 28,7% 18,5% 10,2% 4,6%
5 ¤ÙË (1-13 ÂÙÒÓ) 6,8 ¤ÙË (5-14 ÂÙÒÓ) 6,5 ¤ÙË (9 ÌËÓÒÓ-13 ÂÙÒÓ) 1,17 ¤ÙË (2 ÌËÓÒÓ-3 ÂÙÒÓ) 10,9 ¤ÙË (6,5-15 ÂÙÒÓ)
68% 70% 65% 73% 100%
10% 48% 70% 18% 20%
May-June 04 chris new
19-07-04
19:24
™ÂÏ›‰·221
¶·È‰È·ÙÚÈ΋ 2004;67:218-222
ÁÈ· ÙËÓ ÎÔÈÏȷ΋ ËÌÈÎÚ·Ó›·/ ΢ÎÏÈÎÔ‡˜ Â̤ÙÔ˘˜, ¤ˆ˜ 100% ÁÈ· ÙË Û˘Á¯˘ÙÈ΋ ËÌÈÎÚ·Ó›· (¶›Ó·Î·˜ 1). ¢Â‰Ô̤Ó˘ Ù˘ Û¯ÂÙÈο ˘„ËÏ‹˜ Û˘¯ÓfiÙËÙ·˜ ÛÙÔÓ ÁÂÓÈÎfi ·È‰È·ÙÚÈÎfi ÏËı˘ÛÌfi, Â›Ó·È ÛÎfiÈÌË Ë Â˘·ÈÛıËÙÔÔ›ËÛË ÙˆÓ ·È‰È¿ÙÚˆÓ ÁÈ· ÙË ‰È¿ÁÓˆÛË ·˘ÙÒÓ ÙˆÓ Î·Ù·ÛÙ¿ÛˆÓ. ™˘Ó‹ıˆ˜ ÚÔËÁÂ›Ù·È ¤Ó· Ï‹ıÔ˜ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛÂˆÓ ÏfiÁˆ ÙˆÓ ÂÓÙ˘ˆÛÈ·ÎÒÓ Û˘ÌÙˆÌ¿ÙˆÓ Î·È ÙÔ˘ ÁÂÁÔÓfiÙÔ˜ fiÙÈ Ë ËÌÈÎÚ·Ó›· Â›Ó·È ‰È¿ÁÓˆÛË Ô˘ Ù›ıÂÙ·È “ÂÍ ·ÔÎÏÂÈÛÌÔ‡” ¿ÏÏˆÓ ÛÔ‚·ÚfiÙÂÚˆÓ Î·Ù·ÛÙ¿ÛˆÓ. ∏ ·Ó·ÁÓÒÚÈÛË ÙÔ˘ ËÌÈÎÚ·ÓÈÎÔ‡ ˘ÔÛÙÚÒÌ·ÙÔ˜ ‰ÂÓ Á›ÓÂÙ·È ¿ÓÙ· ·ÓÙÈÏËÙ‹ Î·È Ë ‰È¿ÁÓˆÛË ÙÔ˘ ËÌÈÎÚ·ÓÈÎÔ‡ ÈÛÔ‰‡Ó·ÌÔ˘ ‰ÂÓ Ù›ıÂÙ·È, Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÚfiÎÏËÛË ¿ÛÎÔÔ˘ ¿Á¯Ô˘˜ ÙfiÛÔ ÛÙ· ·È‰È¿ Ô˘ ‚ÈÒÓÔ˘Ó ÂÚ›ÂÚÁ· Û˘ÌÙÒÌ·Ù· fiÛÔ Î·È ÛÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘˜. ∏ ·ıÔÁ¤ÓÂÈ· ÙˆÓ ËÌÈÎÚ·ÓÈÎÒÓ ÈÛÔ‰‡Ó·ÌˆÓ ÛÙ· ·È‰È¿ ‰ÂÓ ¤¯ÂÈ ÌÂÏÂÙËı› Î·È ı· Ú¤ÂÈ Ì¿ÏÏÔÓ Ó· ·Ó·˙ËÙËı› ÛÙËÓ ·ıÔÁ¤ÓÂÈ· ·Ó¿ÏÔÁˆÓ ËÌÈÎÚ·ÓÈÎÒÓ Û˘Ó‰ÚfiÌˆÓ ÙˆÓ ÂÓËϛΈÓ. ™ÙËÓ ÚfiÛÊ·ÙË ‚È‚ÏÈÔÁÚ·Ê›· ·Ó·Ê¤ÚÔÓÙ·È ÚÔÛ¿ıÂȘ ÁÂÓÂÙÈ΋˜ ÌÂϤÙ˘ Û ÔÈÎÔÁÂÓ‹ ËÌÈÎÚ·ÓÈο Û‡Ó‰ÚÔÌ·. À¿Ú¯Ô˘Ó ÛÔ‚·Ú¤˜ ÂӉ›ÍÂȘ fiÙÈ ÙÔ ·ÚÔ͢ÛÌÈÎfi Ú·È‚fiÎÚ·ÓÔ, Ô ·ÚÔ͢ÛÌÈÎfi˜ ›ÏÈÁÁÔ˜ Î·È Î¿ÔȘ ÌÔÚʤ˜ ËÌÈÎÚ·Ó›·˜ Â›Ó·È ÔÈÎÔÁÂÓ‹ ËÌÈÎÚ·ÓÈο Û‡Ó‰ÚÔÌ·, Ù· ÔÔ›· Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì ‰È·Ù·Ú·¯¤˜ Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ ÙˆÓ ‰È·‡ÏˆÓ ·Û‚ÂÛÙ›Ô˘ (Ca channelopathy) (19-21,24). ªÂÙ·ÏÏ¿ÍÂȘ ÛÙÔ ÁÔÓ›‰ÈÔ ÙˆÓ ‰È·‡ÏˆÓ Ca++, CACNA1A, Ô˘ ‰ڿ˙ÂÙ·È ÛÙÔ ¯ÚˆÌfiۈ̷ 19, ¤¯Ô˘Ó ‚ÚÂı› Û ·ÛıÂÓ›˜ Ì ÔÈÎÔÁÂÓ‹ ËÌÈÏËÁÈ΋ ËÌÈÎÚ·Ó›·, ÂÂÈÛԉȷ΋ ·Ù·Í›· Ù‡Ô˘ 2 (24) Î·È ÚfiÛÊ·Ù· ÛÙÔ Î·ÏfiËı˜ ·ÚÔ͢ÛÌÈÎfi Ú·È‚fiÎÚ·ÓÔ (19). º·›ÓÂÙ·È fiÙÈ Ì›· ‰Â‰Ô̤ÓË ÌÂÙ¿ÏÏ·ÍË ÌÔÚ› Ó· ·Ú¿ÁÂÈ ‰È·ÊÔÚÂÙÈΤ˜ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ Û ‰È·ÊÔÚÂÙÈΤ˜ ËÏÈ˘, ÏfiÁˆ ÙÚÔÔÔ›ËÛ˘ Ù˘ ¤ÎÊÚ·Û˘ ÂÓfi˜ ÁÔÓȉ›Ô˘ ·fi ¿ÏÏ· ÁÔÓ›‰È·, ‚ÈÔ¯ËÌÈΤ˜ ‹ Î·È ÔÚÌÔÓÈΤ˜ ·ÏÏ·Á¤˜, fiˆ˜ Ë ÂÌÌËÓ·Ú¯‹. ∏ ÂΉ‹ÏˆÛË ÙˆÓ ÂÈ̤ÚÔ˘˜ Û˘Ó‰ÚfiÌˆÓ ÛÂ Û˘ÁÎÂÎÚÈ̤Ó˜ ËÏÈ˘ Èı·ÓfiÓ ·ÓÙÈηÙÔÙÚ›˙ÂÈ ÙËÓ Â›‰Ú·ÛË Ù˘ ·Ó·Ù˘Íȷ΋˜ ‰È·‰Èηۛ·˜ ÛÙËÓ ¤ÎÊÚ·ÛË Ù˘ ÁÂÓÂÙÈ΋˜ ÚԉȿıÂÛ˘ ÁÈ· ËÌÈÎÚ·Ó›· (2). ∏ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÂÂÈÛÔ‰›ˆÓ Â›Ó·È Û˘Ìو̷ÙÈ΋, ΢ڛˆ˜ ÂÓ·ÓÙ›ÔÓ ÙÔ˘ ÚÔ¤¯ÔÓÙÔ˜ ÂÓԯϋ̷ÙÔ˜ (¤ÌÂÙÔ˜, ›ÏÈÁÁÔ˜, ÎÂÊ·Ï·ÏÁ›·). °È· ÙË ıÂڷ›· ÙˆÓ ËÌÈÎÚ·ÓÈÎÒÓ ÈÛÔ‰‡Ó·ÌˆÓ ‰ÂÓ ˘¿Ú¯Ô˘Ó ÂÎÙÂÓ›˜ ·Ó·ÊÔÚ¤˜ Î·È Û·Ê›˜ Û˘ÛÙ¿ÛÂȘ ÛÙË ‚È‚ÏÈÔÁÚ·Ê›·, Ì ÂÍ·›ÚÂÛË ›Ûˆ˜ ÙÔÓ ·ÚÔ͢ÛÌÈÎfi ›ÏÈÁÁÔ, ÙËÓ ÎÔÈÏȷ΋ ËÌÈÎÚ·Ó›· Î·È ÙÔ˘˜ ΢ÎÏÈÎÔ‡˜ Â̤ÙÔ˘˜. ªfiÓÔ ÁÈ· ÙȘ ÂÚÈÙÒÛÂȘ ›ÌÔÓÔ˘ ÛÔ‚·ÚÔ‡ ·ÚÔ͢ÛÌÈÎÔ‡ ÈÏ›ÁÁÔ˘ Î·È Î˘ÎÏÈÎÒÓ ÂÌ¤ÙˆÓ Û˘ÓÈÛÙ¿Ù·È Ë ‰ÔÎÈÌ·ÛÙÈ΋ ¯ÔÚ‹ÁËÛË Ê·Ú̿ΈÓ
Paediatriki 2004;67:218-222
ηٿ Ù˘ ËÌÈÎÚ·Ó›·˜, fiˆ˜ ÙÔ È˙ÔÙÈÊ·›ÓÈÔ (Mosegor 0,5-1,5 mg/∏, Û 1-2 ‰fiÛÂȘ) Î·È Ë ÚÔÚ·ÓÔÏfiÏË (Inderal 10 mg, 2-3 ÊÔÚ¤˜ ËÌÂÚËÛ›ˆ˜ ÁÈ· ·È‰È¿ ËÏÈΛ·˜ 8-12 ÂÙÒÓ) Ì ıÂڷ¢ÙÈÎfi, ·ÏÏ¿ Î·È ‰È·ÁÓˆÛÙÈÎfi ¯·Ú·ÎÙ‹Ú· (1,12,22,23). µÈ‚ÏÈÔÁÚ·Ê›· 1. ∫ÔÓÙfiÔ˘ÏÔ˜ ∂. ∏ÌÈÎÚ·Ó›· - ∫ÂÊ·Ï·ÏÁ›· ÛÙËÓ ·È‰È΋ ËÏÈΛ·. £ÂÛÛ·ÏÔÓ›ÎË; 1994. 2. Al-Twaijri WA, Shevell MI. Pediatric migraine equivalents: occurrence and clinical features in practice. Pediatr Neurol 2002;26:365-368. 3. Snyder CH. Paroxysmal torticollis in infancy. A possible form of labyrinthitis. Am J Dis Child 1969;117:458-460. 4. Deonna T, Martin D. Benign paroxysmal torticollis in infancy. Arch Dis Child 1981;56:956-959. 5. Basser LS. Benign paroxysmal vertigo of childhood: a variety of vestibular neuronitis. Brain 1964;87:141-152. 6. Lanzi G, Balottin U, Fazzi E, Tagliasacchi M, Manfrin M, Mira E. Benign paroxysmal vertigo of childhood: a long-term follow-up. Cephalalgia 1994;14:458-460. 7. Drigo P, Carli G, Laverda AM. Benign paroxysmal vertigo of childhood. Brain Dev 2001;23:38-41. 8. Buchanan JA. The abdominal crises of migraine. J Nervous Ment Dis 1921;54:406-412. 9. Gee S. On fitful or recurrent vomiting. St Bartholomew’s Hosp Rep 1882;18:1-6. 10. Symon DN, Russell G. Abdominal migraine: a childhood syndrome defined. Cephalalgia 1986;6:223-228. 11. Fleisher DR, Matar M. The cyclic vomiting syndrome: a report of 71 cases and literature review. J Pediatr Gastroenterol Nutr 1993;17:361-369. 12. Symon DN, Russell G. The relationship between cyclic vomiting syndrome and abdominal migraine. J Pediatr Gastroenterol Nutr 1995;21 (Suppl 1):S42-S43. 13. Gascon G, Barlow C. Juvenile migraine, presenting as an acute confusional state. Pediatrics 1970;45:628-635. 14. Sheth RD, Riggs JE, Bodensteiner JB. Acute confusional migraine: variant of transient global amnesia. Pediatr Neurol 1995;12:129-131. 15. Shaabat A. Confusional migraine in childhood. Pediatr Neurol 1996;15:23-25. 16. Golden GS. The Alice in Wonderland syndrome in juvenile migraine. Pediatrics 1979;63:517-519. 17. Shevell MI. Acephalgic migraines of childhood. Pediatr Neurol 1996;14:211-215. 18. Kimura S, Nezu A. Electromyographic study in an infant with benign paroxysmal torticollis. Pediatr Neurol 1998;19:236-238. 19. Giffin NJ, Benton S, Goadsby PJ. Benign paroxysmal torticollis of infancy: four new cases and linkage to CACNA1A mutation. Dev Med Child Neurol 2002;44:490-493. 20. Oh AK, Lee H, Jen JC, Corona S, Jacobson KM, Baloh RW. Familial benign recurrent vertigo. Am J Med Genet 2001;100:287-291. 21. Baloh RW. Episodic vertigo: central nervous system causes. Curr Opin Neurol 2002;15:17-21. 22. Weisleder P, Fife TD. Dizziness and headache: a common
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association in children and adolescents. J Child Neurol 2001;16:727-730. 23. Olson AD, Li BU. The diagnostic evaluation of children with cyclic vomiting: a cost-effectiveness assessment. J Pediatr 2002;141:724-728. 24. Ophoff RA, Terwindt GM, Vergouwe MN, van Eijk R, Oefner PJ, Hoffman SM et al. Familial hemiplegic migraine and episodic ataxia type-2 are caused by mutations in the Ca++ channel gene CACNL1A4. Cell 1996;87:543-552.
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∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 14-03-2003 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 18-07-2003 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ™ˆÙËÚ›· ª·ÛÙÚÔÁÈ¿ÓÓË ¡Â˘ÚÔÏÔÁÈÎfi ∆Ì‹Ì·, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡” E-mail: smastr@otenet.gr
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∏ “¶∞π¢π∞∆ƒπ∫∏” ™∆O INTERNET - http://www.e-child.gr/ Ÿˆ˜ ÁÓˆÚ›˙ÂÙÂ, Ô ‰È·‰ÈÎÙ˘·Îfi˜ ÙfiÔ˜ e-child.gr Ù˘ ∂ÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ ∂Ù·ÈÚ›·˜ ‚Ú›ÛÎÂÙ·È ‹‰Ë Û ÏÂÈÙÔ˘ÚÁ›·. ª¤Û· ·fi ÙȘ ÛÂÏ›‰Â˜ ÙÔ˘ ÌÔÚ›Ù ӷ ¤¯ÂÙ ÚfiÛ‚·ÛË ÛÙÔ Ï‹Ú˜ ÂÚȯfiÌÂÓÔ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ “¶·È‰È·ÙÚÈ΋”, ÌÂÙ¿ ·fi ‰ˆÚÂ¿Ó ÂÁÁÚ·Ê‹, ·fi ÙÔ ¤ÙÔ˜ 2000 (ÙfiÌÔ˜ 63), ÛÙË ‰È‡ı˘ÓÛË: http://www.e-child.gr/PeriodikoPaidiatrikiList.asp
∏§∂∫∆ƒO¡π∫∂™ ¢π∂À£À¡™∂π™ ¡›ÎÔ˜ ¶··‰fiÔ˘ÏÔ˜, ¶·È‰›·ÙÚÔ˜ - ∞ÏÏÂÚÁÈÔÏfiÁÔ˜ “™˘Ó¯È˙fiÌÂÓË π·ÙÚÈ΋ ∂η›‰Â˘ÛË” on-line! http://www.pedialink.org/pedialink/tour/aboutpedialink.cfm/ ¶·Ú·ÎÏ¿‰È Ù˘ ∞ÌÂÚÈηÓÈ΋˜ ∞η‰ËÌ›·˜ Ù˘ ¶·È‰È·ÙÚÈ΋˜ (∞∞P), Ô ‰ÈÎÙ˘·Îfi˜ ÙfiÔ˜ Pedialink ÚÔÛʤÚÂÈ ¤Ó· ËÏÂÎÙÚÔÓÈÎfi Û‡ÛÙËÌ· ÂÎÌ¿ıËÛ˘ ÛÙË ™˘Ó¯È˙fiÌÂÓË π·ÙÚÈ΋ ∂η›‰Â˘ÛË ÛÙËÓ ¶·È‰È·ÙÚÈ΋, οو ·fi Ì›· Ó¤· Î·È ÚˆÙÔÔÚȷ΋ ÚÔÛ¤ÁÁÈÛË. ∞¢ı‡ÓÂÙ·È ÛÙÔÓ Û‡Á¯ÚÔÓÔ ÂÈÛÙ‹ÌÔÓ·, Ô ÔÔ›Ô˜ - ·Ó Î·È ÔÏ˘¿Û¯ÔÏÔ˜ - ÂӉȷʤÚÂÙ·È ÁÈ· ÙË Û˘Ó¯‹ ‚ÂÏÙ›ˆÛË ÙÔ˘ ·ÁÁÂÏÌ·ÙÈÎÔ‡ ÙÔ˘ ÚÔÊ›Ï Ì¤Û· ·fi ÙËÓ ËÏÂÎÙÚÔÓÈ΋ Âη›‰Â˘ÛË Î·È ÂÓË̤ڈÛË. ∏ ηÈÓÔÙÔÌ›· Ù˘ Pedialink ¤ÁÎÂÈÙ·È ÛÙȘ ¯Ú‹ÛÈ̘ Ô‰ËÁ›Â˜ Î·È Û˘Ì‚Ô˘Ï¤˜ ÁÈ· ÙËÓ Î·Ï‡ÙÂÚË ‰˘Ó·Ù‹ ™˘Ó¯È˙fiÌÂÓË π·ÙÚÈ΋ ∂η›‰Â˘ÛË Ì¤Û· ·fi ÙÔ ‰È·‰›ÎÙ˘Ô. ∆Ô ∏ÏÂÎÙÚÔÓÈÎfi ªÔÓÙ¤ÏÔ ∂η›‰Â˘Û˘ Ô˘ ÚÔÛʤÚÂÈ, ‚·Û›˙ÂÙ·È Û 4 ‚·ÛÈο ÂÚÁ·Ï›·: ·) ·ÔÙ‡ˆÛË ÙÔ˘ ÚÔÊ›Ï ÙÔ˘ ¯Ú‹ÛÙË, ‚) ¯¿Ú·ÍË ÂÓfi˜ ÁÂÓÈÎÔ‡ Ï¿ÓÔ˘ ‰Ú¿Û˘, Á) ·ÓÙ·ÏÏ·Á‹ Î·È ‰È¿‰ÔÛË ÙÔ˘ ÂÎ·È‰Â˘ÙÈÎÔ‡ ˘ÏÈÎÔ‡ Î·È ‰) ‰È·Û‡Ó‰ÂÛË Ì ¿ÏϘ ËÏÂÎÙÚÔÓÈΤ˜ ËÁ¤˜ ÂÎÌ¿ıËÛ˘. ŒÓ· ÚˆÙfiÙ˘Ô website Ì ÙÔ Î‡ÚÔ˜ Î·È ÙËÓ ·ÚÙÈfiÙËÙ· Ù˘ ∞ÌÂÚÈηÓÈ΋˜ ∞η‰ËÌ›·˜ Ù˘ ¶·È‰È·ÙÚÈ΋˜, ÙÔ ÔÔ›Ô ÚÔÛʤÚÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· ÛÙÔÓ ¯Ú‹ÛÙË-ÂÈÛÙ‹ÌÔÓ· Ó· ‚ÂÏÙÈÒÛÂÈ ÙȘ ÁÓÒÛÂȘ ÛÙÔ ÂÈÛÙËÌÔÓÈÎfi ÙÔ˘ ‰›Ô Î·È Ó· ÙȘ ÂÊ·ÚÌfiÛÂÈ ÛÙËÓ Ú¿ÍË.
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¡∂∞ ∞¶O ∆O ¢π∞¢π∫∆ÀO
™‡Á¯ÚÔÓË Î·È ¤Á΢ÚË È·ÙÚÈ΋ ÂÓË̤ڈÛË ÁÈ· ÙÚÂȘ! - http://www.kidshealth.org/ ªÔÓÙ¤ÚÓÔ˜ Î·È Ó·ÓÈÎfi˜ ÛÙÔÓ Û¯Â‰È·ÛÌfi ÙÔ˘, Ô ‰ÈÎÙ˘·Îfi˜ ÙfiÔ˜ Kids Health, Ì ηı·Ú¿ ÂÎ·È‰Â˘ÙÈÎfi ÂÚȯfiÌÂÓÔ, Â›Ó·È Ô ÌÂÁ·Ï‡ÙÂÚÔ˜ Û ÂÈÛ΄ÈÌfiÙËÙ· ÛÙËÓ ∞ÌÂÚÈ΋, ·fi ÙÔ˘˜ ÂȉÈÎÔ‡˜ ÙÔ˘ Nemours Foundation’s Center for Children’s Health Media. ∞¢ı‡ÓÂÙ·È Û ÁÔÓ›˜, ÂÊ‹‚Ô˘˜ Î·È ·È‰È¿, ̤۷ ·fi ÙÚÂȘ ‰È·ÊÔÚÂÙÈΤ˜ ÈÛÙÔÛÂÏ›‰Â˜ ̠ͯˆÚÈÛÙfi ۯ‰ȷÛÌfi, ‡ÊÔ˜ Î·È ÂÚȯfiÌÂÓÔ ·Ó¿ÏÔÁ· Ì ÙËÓ Î·ÙËÁÔÚ›· - Î·È ÂÚÈÏ·Ì‚¿ÓÂÈ Ï‹ıÔ˜ ÏËÚÔÊÔÚÈÒÓ ÁÈ· ÁÂÓÈο Î·È ÂȉÈο ı¤Ì·Ù· ˘Á›·˜ Û ·Ï‹ Î·È Î·Ù·ÓÔËÙ‹ ÁÏÒÛÛ·. ∂ÎÙfi˜ ·fi Ô‰ËÁ›Â˜ ÁÈ· ÚfiÏË„Ë Î·È ¤ÁηÈÚË ·ÓÙÈÌÂÙÒÈÛË Û ȷÙÚÈο ı¤Ì·Ù·, ÙÔ Kids Health ÚÔÛʤÚÂÈ Î·È ¯Ú‹ÛÈ̘ Û˘Ì‚Ô˘Ï¤˜ fiÛÔÓ ·ÊÔÚ¿ ÛÂ Û˘Ó·ÈÛıËÌ·ÙÈο Î·È „˘¯ÔÏÔÁÈο ˙ËÙ‹Ì·Ù·, ı¤Ì·Ù· ‰È·ÙÚÔÊ‹˜ Î·È ·Ó¿Ù˘Í˘. ∏ ÈÛÙÔÛÂÏ›‰· ªfiÓÔ ÁÈ· ¶·È‰È¿ ÚÔÛÂÁÁ›˙ÂÈ Ù· È·ÙÚÈο ı¤Ì·Ù· Ì ÂÏ΢ÛÙÈÎfi Î·È ¯·ÚÔ‡ÌÂÓÔ ÙÚfiÔ, ÚÔÛʤÚÔÓÙ·˜ - Ù·˘Ùfi¯ÚÔÓ· Ì ÙËÓ ÂÓË̤ڈÛË - Î·È „˘¯·ÁˆÁ›· ̤۷ ·fi ·È¯Ó›‰È·, ·ÈÓ›ÁÌ·Ù· Î·È ÙÂÛÙ. ∏ ÈÛÙÔÛÂÏ›‰· Kids Health ÂÓËÌÂÚÒÓÂÙ·È Ù·ÎÙÈο Î·È ¤¯ÂÈ ÎÂÚ‰›ÛÂÈ ÔÏÏ¿ ‚Ú·‚›· ÁÈ· ÙÔÓ ÂÎ·È‰Â˘ÙÈÎfi ÚfiÏÔ Ù˘, fiˆ˜ ÙÔ “2004 Webby Award for Best Health Website”, ÙÔ “2004 Parents’ Choice Gold Award” Î·È ¿ÏÏ·. ™˘ÛÙ‹ÓÂÙ·È ·ÓÂÈʇϷÎÙ·.
∂‡¯ÚËÛÙÔ˜ ËÏÂÎÙÚÔÓÈÎfi˜ Ô‰ËÁfi˜ ÁÂÓÈ΋˜ ·È‰È·ÙÚÈ΋˜ - http://www.generalpediatrics.com/ ∆Ô General Pediatrics Â›Ó·È Ì›· ‰È·‰ÈÎÙ˘·Î‹ ‡ÏË (portal) Ô˘ ·Â˘ı‡ÓÂÙ·È Í¯ˆÚÈÛÙ¿ Û ·ÁÁÂÏ̷ٛ˜ ·È‰È¿ÙÚÔ˘˜ Î·È ÁÔÓ›˜, ηχÙÔÓÙ·˜ Ì›· ¢Ú›· Áο̷ È·ÙÚÈÎÒÓ ıÂÌ¿ÙˆÓ ÁÈ· ·È‰È¿, ·fi Û¯ÂÙÈÎÔ‡˜ ·È‰È·ÙÚÈÎÔ‡˜ ‰ÈÎÙ˘·ÎÔ‡˜ ÙfiÔ˘˜. ∂ÎÙfi˜ ·fi Ù· ÌÂÌÔӈ̤ӷ ¿ÚıÚ·, ÂÚÈÏ·Ì‚¿ÓÂÈ, ›Û˘, Ì˯·Ó‹ ¢ÚÂÙËÚ›·Û˘ Î·È ÏÔ‹ÁËÛ˘ ÛÙÔ ‰È·‰›ÎÙ˘Ô Û ÈÛÙÔÛÂÏ›‰Â˜ Ì ·ÓÙÈΛÌÂÓÔ ÙË °ÂÓÈ΋ ¶·È‰È·ÙÚÈ΋. ∞Ó Î·È Ô Û¯Â‰È·ÛÌfi˜ ÙÔ˘ Â›Ó·È ·Ïfi˜ Î·È Ì¿ÏÏÔÓ ·‰È¿ÊÔÚÔ˜, ÙÔ General Pediatrics Â›Ó·È ¯Ú‹ÛÈÌÔ ÚˆÙ›ÛÙˆ˜ ˆ˜ ¤Ó·˜ ËÏÂÎÙÚÔÓÈÎfi˜ Ô‰ËÁfi˜ ·È‰È·ÙÚÈ΋˜ ÛÙÔ ‰È·‰›ÎÙ˘Ô.
π·ÙÚÂ›Ô º˘Ì·Ù›ˆÛ˘ Ù˘ ¶·È‰È΋˜ ∏ÏÈΛ·˜ - http://www.pedtb.gr/ ¶ÚfiÎÂÈÙ·È ÁÈ· ÙËÓ Â›ÛËÌË ÈÛÙÔÛÂÏ›‰· ÙÔ˘ π·ÙÚ›Ԣ º˘Ì·Ù›ˆÛ˘ Ù˘ ¶·È‰È΋˜ ∏ÏÈΛ·˜ Ô˘ ‰ËÌÈÔ˘ÚÁ‹ıËΠ·fi ÙË µ’ ¶·È‰È·ÙÚÈ΋ ¶·ÓÂÈÛÙËÌȷ΋ ∫ÏÈÓÈ΋ ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”. ¶ÂÚÈÏ·Ì‚¿ÓÂÈ ¯Ú‹ÛÈ̘ ÏËÚÔÊÔڛ˜ ÁÈ· ÙËÓ ·Ó·ÁÓÒÚÈÛË Î·È ·ÓÙÈÌÂÙÒÈÛË Ù˘ Ê˘Ì·Ù›ˆÛ˘, ηıÒ˜ Î·È ÂÓËÌÂÚˆÙÈο Ê˘ÏÏ¿‰È· Û ͤÓ˜ ÁÏÒÛÛ˜. ™ÙȘ ÛÂÏ›‰Â˜ ·˘ÙÔ‡ ÙÔ˘ ‰È·‰ÈÎÙ˘·ÎÔ‡ ÙfiÔ˘ ˘¿Ú¯Ô˘Ó, ›Û˘, ¯Ú‹ÛÈÌ· ÛÙÔȯ›· ÁÈ· ÙË ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ È·ÙÚ›Ԣ.
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¶PO™EXH ™YNE¢PIA 15-20 ∞˘ÁÔ‡ÛÙÔ˘ 2004
24th International Congress of Pediatrics ¶ÏËÚÔÊÔڛ˜: Congress Organiser ∆ËÏ.: 525 554 491 500 Fax: 525 554 491 555 E-mail: info@icp2004.com Website: www.icp2004com
Cancun, Mexico
29 ∞˘ÁÔ‡ÛÙÔ˘2 ™ÂÙÂÌ‚Ú›Ô˘ 2004
13th Congress of the International Paediatric Nephrology Association hosted by the Australian and New Zealand Paediatric Nephrology Association ¶ÏËÚÔÊÔڛ˜: Hartley Management Group Pty Ltd ∆ËÏ.: 61 883 634 399 Fax: 61 883 634 577 E-mail: ipna2004@hartleymgt.com.au
Adelaide, Australia
24-28 ™ÂÙÂÌ‚Ú›Ô˘ 2004
XXXth World Congress of the International Society of Hematology (ISH) ¶ÏËÚÔÊÔڛ˜: Alper Sahinoglu ∆ËÏ.: 90 3 124 383 721 Fax: 90 3 124 383 723 E-mail: ish2004@ish2004.org
Istanbul, Turkey
26 ™ÂÙÂÌ‚Ú›Ô˘1 OÎÙˆ‚Ú›Ô˘ 2004
XII Meeting of the European Association for Haematopathology ¶ÏËÚÔÊÔڛ˜: Triaena Tours & Congress ∆ËÏ.: +30 2310 25 61 94-5 Fax: +30 2310 25 61 96 E-mail: salonica@triaenatours.gr
£ÂÛÛ·ÏÔÓ›ÎË
13-16 OÎÙˆ‚Ú›Ô˘ 2004
XIX European Congress of Perinatal Medicine •ÂÓÔ‰Ô¯Â›Ô Athens Hilton ¶ÏËÚÔÊÔڛ˜: C&C International S.A. ∆ËÏ.: +30 210 68 89 100 Fax: +30 210 68 44 777 E-mail: perinatal2004@cnc.gr Website: www.perinatal2004.gr
∞ı‹Ó·
11-14 ¡ÔÂÌ‚Ú›Ô˘ 2004
14Ô ¢È··ÓÂÈÛÙËÌÈ·Îfi ™˘Ó¤‰ÚÈÔ ∞ÎÙÈÓÔÏÔÁ›·˜ ∂ÚÁ·ÛÙ‹ÚÈÔ ∞ÎÙÈÓÔÏÔÁ›·˜ Î·È π·ÙÚÈ΋˜ ∞ÂÈÎfiÓÈÛ˘ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘ ∞ÌÊÈı¤·ÙÚÔ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘ ¶ÏËÚÔÊÔڛ˜: PRC Congress & Travel ∆ËÏ.: +30 210 77 11 673 Fax: +30 210 77 11 289 E-mail: info@prctravel.gr
∏Ú¿ÎÏÂÈÔ ∫Ú‹Ù˘
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¶PO™EXH ™YNE¢PIA 27 ¡ÔÂÌ‚Ú›Ô˘ 2004
3Ë ∏ÌÂÚ›‰· ∂ÏÏËÓÈ΋˜ ∂Ù·ÈÚ›·˜ ¶·È‰È·ÙÚÈ΋˜ ¢ÂÚÌ·ÙÔÏÔÁ›·˜ ∞ÌÊÈı¤·ÙÚÔ ¶ÔÏÂÌÈÎÔ‡ ªÔ˘Û›Ԣ ¶ÏËÚÔÊÔڛ˜: ∆ÛÈ‚ÈÙ·Ó›‰Ô˘-∫¿ÎÔ˘ÚÔ˘ ∆¿ÏÈ· ∆ËÏ.: +30 210 67 55 437 Fax: +30 210 67 45 117 E-mail: kakst@otenet.gr
∞ı‹Ó·
8-11 ¢ÂÎÂÌ‚Ú›Ô˘ 2004
6Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ ∞ÓÔÛÔÏÔÁ›·˜ ∂ÏÏËÓÈ΋ ∂Ù·ÈÚ›· ∞ÓÔÛÔÏÔÁ›·˜ •ÂÓÔ‰Ô¯Â›Ô Electra Palace ¶ÏËÚÔÊÔڛ˜: ¢π∞™∆∞™∏ Travel ∆ËÏ.: +30 2310 88 92 44-45 Fax: +30 2310 88 92 46 E-mail: diastasi@diastasitravel.gr
£ÂÛÛ·ÏÔÓ›ÎË
5-7 ª·˝Ô˘ 2005
8th Congress of the European Society of Paediatric Dermatology Hilton Budapest Congress Center ¶ÏËÚÔÊÔڛ˜: Convention Budapest Ltd ∆ËÏ.: (361) 2990 184-6 Fax: (361) 2990 187 E-mail: zspapp@convention.hu kbagdi@convention.hu Website: www.convention.hu
Budapest, Hungary
4-9 ™ÂÙÂÌ‚Ú›Ô˘ 2005
ESPGHAN Summer School on Nutrition “Research Challenges in Clinical Nutrition” European Society for Paediatric Gastroenterology, Hepatology and Nutrition Eden Beach Hotel Club ¶ÏËÚÔÊÔڛ˜: ∞ÏÂÍ¿Ó‰Ú· ¶··‰ÔÔ‡ÏÔ˘ ∆ËÏ.: +30 210 77 26 355, 6945 29 30 71 E-mail: papadop5@otenet.gr
∞Ó¿‚˘ÛÛÔ˜
11-15 ™ÂÙÂÌ‚Ú›Ô˘ 2005
29th UMEMPS - Union of Middle Eastern and Mediterranean Pediatric Societies Congress ¶ÏËÚÔÊÔڛ˜: Pynar Aytac ∆ËÏ.: 90 2 163 473 535 Fax: 90 2 163 477 850 E-mail: paytac@symcon.com.tr
Istanbul, Turkey
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™YNTOMO°PAºIE™
ABBREVIATIONS
™˘ÓÙÔÌÔÁڷʛ˜
EÏÏËÓÈÎÔ› fiÚÔÈ
AÁÁÏÈÎÔ› fiÚÔÈ
AIDS
Û‡Ó‰ÚÔÌÔ Â›ÎÙËÙ˘ ·ÓÔÛÔ·Ó¿ÚÎÂÈ·˜
AMP, ADP, ATP
ÌÔÓÔ-, ‰È-, ÙÚÈʈÛÊÔÚÈ΋ ·‰ÂÓÔÛ›ÓË
ATPase cal CSF ‹ ENY CNS ‹ ∫¡™ cm CoA cmÑ cm2 cAMP ÆC CRP DNA ECG ‹ ∏∫° EEG ‹ ∏∂° ELISA ESR ‹ ∆∫∂ EDTA g Hct Hb HLA
ÙÚÈʈÛÊ·Ù¿ÛË Ù˘ ·‰ÂÓÔÛ›Ó˘ ıÂÚÌ›‰· ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚfi ÎÂÓÙÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ· ÂηÙÔÛÙfi Û˘Ó¤Ó˙˘ÌÔ ∞ ΢‚ÈÎfi ÂηÙÔÛÙfi ÙÂÙÚ·ÁˆÓÈÎfi ÂηÙÔÛÙfi ΢ÎÏÈÎfi AMP ‚·ıÌfi˜ KÂÏÛ›Ô˘ C-·ÓÙȉÚÒÛ· ÚˆÙ½ÓË ‰ÂÔ͢ÚÈ‚Ô˙ÔÓÔ˘ÎÏÂ˚ÓÈÎfi Ô͇ ËÏÂÎÙÚÔηډÈÔÁÚ¿ÊËÌ· ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ· ¤Ó˙˘ÌÔ-Û˘Ó‰¤Ù˘ ·ÓÔÛÔÚÔÛÚfiÊËÛ˘ ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù·¯‡ÙËÙ· ηıÈ˙‹Ûˆ˜ ÂÚ˘ıÚÒÓ Âı˘ÏÂÓԉȷÌÈÓÔÙÂÙÚ·ÔÍÂ˚Îfi Ô͇ ÁÚ·ÌÌ¿ÚÈo ·ÈÌ·ÙÔÎÚ›Ù˘ ·ÈÌÔÛÊ·ÈÚ›ÓË ·ÓÙÈÁfiÓÔ ÈÛÙÔÛ˘Ì‚·ÙfiÙËÙ·˜
Ig ICU ‹ ª∂£ IU i.m. ‹ ∂.ª. i.p. ‹ ∂.¶. i.v. ‹ ∂.º. L log mol ªW ‹ MB MCH MCV mRNA m min n N NS ‹ ª™ Ôsm % PCR pH PCO2 PO2 p
·ÓÔÛÔÛÊ·ÈÚ›ÓË ÌÔÓ¿‰· ÂÓÙ·ÙÈ΋˜ ıÂڷ›·˜ ‰ÈÂıÓ‹˜ ÌÔÓ¿‰· ÂÓ‰ÔÌ˘˚ο ÂÓ‰ÔÂÚÈÙÔÓ·˚ο ÂÓ‰ÔÊϤ‚È· Ï›ÙÚÔ(·) ÏÔÁ¿ÚÈıÌÔ˜ ÁÚ·ÌÌÔÌfiÚÈÔ ÌÔÚÈ·Îfi ‚¿ÚÔ˜ ̤ÛË ·ÈÌÔÛÊ·ÈÚ›ÓË ÂÚ˘ıÚÒÓ Ì¤ÛÔ˜ fiÁÎÔ˜ ÂÚ˘ıÚÒÓ ·ÁÁÂÏÈÔÊfiÚÔ˜ RNA ̤ÙÚÔ ÏÂÙfi ·ÚÈıÌfi˜ Ó¢ÙÒÓÈÔ ÌË ÛËÌ·ÓÙÈÎfi ÔÛÌÒÏÈÔ Â› ÙÔȘ ÂηÙfi ·Ï˘ÛȉˆÙ‹ ·ÓÙ›‰Ú·ÛË ÔÏ˘ÌÂÚ¿Û˘ Û˘ÁΤÓÙÚˆÛË ÈfiÓÙˆÓ ˘‰ÚÔÁfiÓÔ˘ ÌÂÚÈ΋ Ù¿ÛË CO2 ÌÂÚÈ΋ Ù¿ÛË Ô͢ÁfiÓÔ˘ Èı·ÓfiÙËÙ·
acquired immunodeficiency syndrome adenosine 5mono-, di-, triphosphate adenosine triphosphatase calorie cerebrospinal fluid central nervous system centimeter coenzyme A cubic centimeter square centimeter cyclic AMP degree(s) Celsius C-reactive protein deoxyribonucleic acid electrocardiogram electroencephalogram enzyme-linked immunoabsorbent assay erythrocyte sedimentation rate ethylenediaminetetracetate gram haematocrit haemoglobin (human) histocompatibility leucocyte antigen immunoglobulin intensive care unit international Unit intramuscular intraperitoneal intravenous liter logarithm mole molecular weight mean corpuscular haemoglobin mean corpuscular volume messenger RNA meter minute number newton not significant osmole percent polymerase chain reaction potentia hydrogenii carbon dioxide pressure oxygen pressure probability
xiv
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™˘ÓÙÔÌÔÁڷʛ˜
EÏÏËÓÈÎÔ› fiÚÔÈ
AÁÁÏÈÎÔ› fiÚÔÈ
p.o. RIA RNA RDS sec s.c. ‹ À.¢. SD SE U
·fi ÙÔ ÛÙfiÌ· Ú·‰ÈÔ·ÓÔÛÔ·ÔÚÚÔÊËÙÈ΋ ‰ÔÎÈÌ·Û›· ÚÈ‚ÔÓÔ˘ÎÏÂ˚ÓÈÎfi Ô͇ Û‡Ó‰ÚÔÌÔ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÈ·˜ ‰Â˘ÙÂÚfiÏÂÙÔ ˘Ô‰fiÚÈ· ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË ÛÙ·ıÂÚfi ÛÊ¿ÏÌ· ÌÔÓ¿‰·
by mouth radioimmunoassay ribonucleic acid respiratory distress syndrome second subcutaneous standard deviation standard error unit
™˘Ó‰˘·˙fiÌÂÓ· ÚÔı¤Ì·Ù· 12
tera- (10 ) giga- (10 ) mega-(10 ) kilo- (10 ) hecto(10 ) deca (10 ) deci (10 ) centi- (10 ) milli(10 ) micro (10 ) nano (10 ) pico (10 ) femto (10 ) atto (10 ) 9
6
3
2
1
-1
-2
-3
-6
-9
-12
-15
-18
Combining prefixes T G M k h da d c m Ì n p f a
xv