Παιδιατρική | Τόμος 70 • Τεύχος 1 • Ιανουάριος - Φεβρουάριος 2007

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∆fiÌÔ˜ 70 ñ ∆‡¯Ô˜ 1 ñ π·ÓÔ˘¿ÚÈÔ˜-ºÂ‚ÚÔ˘¿ÚÈÔ˜ 2007

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37 √ ÚfiÏÔ˜ ÙˆÓ ·Ù‡ˆÓ ‚·ÎÙËÚ›ˆÓ ÛÙÔÓ ¯ÚfiÓÈÔ ‚‹¯· Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ π.ª. µÂÏÈÛÛ·Ú›Ô˘, ¡.°. ¶··‰fiÔ˘ÏÔ˜, M. ∆ÛÔÏÈ¿, ª. °È·ÓÓ¿ÎË, º. ™·ÍÒÓË-¶··ÁˆÚÁ›Ô˘, ¢.∞. ∫·ÊÂÙ˙‹˜ 42 ¶˘ÚÂÙÈÎÔ› Û·ÛÌÔ›: Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈ΋ Ë ‰È·Ï›Ô˘Û· ÚÔʇϷÍË Ì ‰È·˙Â¿ÌË; ∂. ¶·˘Ï›‰Ô˘, ª. ∆˙ËÙËÚ›‰Ô˘, ∂. ∫ÔÓÙfiÔ˘ÏÔ˜, Ã. ¶·ÓÙÂÏÈ¿‰Ë˜

∂¡¢π∞º∂ƒ√À™∂™ ¶∂ƒπ¶∆ø™∂π™ 49 ÀÔ¯ÔÓ‰ÚÔÏ·Û›· Ì ÌÂÙ¿ÏÏ·ÍË ¡540∫ ÛÙÔÓ ˘Ô‰Ô¯¤· 3 ÙÔ˘ ·˘ÍËÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ÙˆÓ ÈÓÔ‚Ï·ÛÙÒÓ - FGFR3. ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ µ. ∞ÁÁÂÏ¿ÎÔ˘, °. ¡ÈˆÙ¿Î˘, ™. ∏Ï›·, ™. ª¿ÎˆÛË, ∂. ∫fiÎÔÚË 54 ™ÈÙÈÔÁÂÓ‹˜ ·ÓÂ¿ÚÎÂÈ· ‚ÈÙ·Ì›Ó˘ µ12 Û ‚Ú¤ÊÔ˜. ∆· ÛÈÙÈÛÙÈο Ï¿ıË ÙˆÓ ¯ÔÚÙÔÊ¿ÁˆÓ µ. ∞ÁÁÂÏ¿ÎÔ˘, ª. √ÚÊ·ÓÔ‡, °. ¡ÈˆÙ¿Î˘, ∂. ∫fiÎÔÚË, π. ÷ڈӛÙË 60 ¢ÈÛÎÔÂȉ‹˜ ·ÙÂÏÂÎÙ·Û›· Û ¤ÊË‚Ô £. ∆·‚Ï·‰¿ÎË, ª. ª·Ï·ıÚ¿ÎË, °. ¢Ú·ÎˆÓ¿Î˘, π. ™·Úȉ¿Î˘, π. ∫·ÙÛ·Ú¿Î˘, ª. ∫Ï·‰›ÙÔ˘, ∞. ∞˘ÁÂÓ¿ÎË, ∞. ¡Â¿Ú¯Ô˘ ¶ƒ∞∫∆π∫A £∂ª∞TA 64 µÚÂÊÈ΋ ÛÔ‚·Ú‹ ·Ú·ÙÂÈÓfiÌÂÓË ‰È¿ÚÚÔÈ· - ¡ÂfiÙÂÚ˜ ·fi„ÂȘ Ã. ∫ÒÛÙ·ÏÔ˜ 70 ∫·Ì‡Ï˜ ۈ̷ÙÈ΋˜ ·Ó¿Ù˘Í˘ ÙˆÓ ·È‰ÈÒÓ Ù˘ ¯ÒÚ·˜ Ì·˜ ∞. ∫·Ê¿ÙÔ˜ 75 ∫§π¡π∫√ ∫√Àπ∑ 76 ¡∂∞ ∞¶√ ∆√ ¢π∞¢π∫∆À√ Pediatric Blogs ¡. ¶··‰fiÔ˘ÏÔ˜

I‰ÈÔÎÙ‹Ù˘ EÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ EÙ·ÈÚ›·© Mȯ·Ï·ÎÔÔ‡ÏÔ˘ 92 Aı‹Ó· 115 28 TËÏ.: 210 7771 140 210 7771 663 Fax: 210 7758 354 e-mail: hps@ath.forthnet.gr EÙ‹ÛÈ· ™˘Ó‰ÚÔÌ‹: 40 € EȉÈ΢fiÌÂÓÔÈ, ºÔÈÙËÙ¤˜: 20 € ∫ˆ‰ÈÎfi˜ ¢È‡ı˘ÓÛ˘ ∂ÔÙ›·˜ ªª∂: 3889

ISSN 0377-2551

80 ∂¶π™∆√§∏ ¶ƒ√™ ∆∏ ™À¡∆∞•∏

Paediatriki Volume 70 ñ Number 1 ñ January-February 2007

Bimonthly Publication of the Greek Paediatric Society President A. Constantopoulos Editorial Board Editor-in-Chief C. Stefanidis Members P. Augoustides-Savvopoulou H. Antonopoulou A. Vazeou-Gerasimidi G. Varlamis M. Kanariou ∂. Katsarou-Pectasides A. Kattamis S. Kitsiou-Tzeli Ch. Costalos N. Papadopoulos ∞. Papadopoulou A. Siamopoulou-Mavridou M. Tsolia Manuscript Editing Greek Editing F. Mavroidi English Editing S. Nakou Publisher K. Griveas Publishing Coordinator SCIENTIFIC PUBLICATIONS Ltd 1a Pierias St. GR - 144 51, Metamorfosi Tel.: +30 210 87 78 810 Fax: +30 210 87 78 822 Owner Greek Paediatric Society© 92 Michalakopoulou str.

GR - 115 28, Athens Tel.: +30 210 7771 140 +30 210 7771 663 Fax: +30 210 7758 354 e-mail: hps@ath.forthnet.gr Annual Subscription All foreign countries: US $ 50

Contents REVIEW ARTICLES 1 Mitochondrial disorders in childhood A. Dinopoulos, A. Papadimitriou 18 High frequency oscillatory ventilation: How it works P. Karagianni, N. Nikolaides ORIGINAL ARTICLES 24 Prevalence of metabolic syndrome in children and adolescents of Crete and its relation to diet M. Linardakis, K. Sarri, G. Bertsias, A. Kafatos, Division of Preventive Medicine and Nutrition 37 The role of mycoplasmal/chlamydial infection in chronic cough in children I.M. Velissariou, N.G. Papadopoulos, M. Giannaki, P. Saxoni-Papageorgiou, D.A. Kafetzis 42 Efficacy of intermittent rectal diazepam prophylaxis for the prevention of febrile seizures E. Pavlidou, M. Tzitiridou, E. Kontopoulos, C. Panteliadis

CASE REPORTS 49 Hypochondroplasia with the mutation N540K of the fibroblast growth factor receptor 3 – FGFR3. A case report V. Aggelakou, G. Niotakis, S. Ilia, A. Bakosi, E. Kokori 54 Nutritional vitamin B12 deficiency in an infant. Dietary errors of a vegan V. Aggelakou, M. Orfanou, G. Niotakis, E. Kokori, I. Charoniti 60 Round atelectasis in adolescent T. Tavladaki, M. Malathraki, G. Drakonakis, I. Saridakis, I. Katsarakis, M. Kladitou, A. Augenaki, A. Nearchou PRACTICAL ISSUES 64 Severe protracted diarrhea of infancy – New aspects C. Costalos 70 Growth curves for Greek children A. Kafatos 75 CLINICAL QUIZ 76 NEWS FROM THE INTERNET Pediatric Blogs ¡. Papadopoulos 80 LETTER TO THE EDITOR

™À¡∆∞∫∆π∫∏ E¶π∆ƒ√¶∏

EDITORIAL BOARD

¢È¢ı˘ÓÙ‹˜ ™‡ÓÙ·Í˘

Editor-in-Chief

∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ™ÙÂÊ·Ó›‰Ë˜, ∞ı‹Ó·

Constantinos Stefanidis, Athens

À‡ı˘ÓÔÈ ™‡ÓÙ·Í˘ ∂ÍÂȉÈ·ۈÓ

Section Editors

∂ϤÓË ∞ÓÙˆÓÔÔ‡ÏÔ˘, ∞ı‹Ó· ∞Ó·Ù˘ÍȷΤ˜ ‰È·Ù·Ú·¯¤˜ - ¶ÚÔ‚Ï‹Ì·Ù· Û˘ÌÂÚÈÊÔÚ¿˜

Eleni Antonopoulou, Athens Developmental and Behavioral Pediatrics

¶ÂÚÛÂÊfiÓË ∞˘ÁÔ˘ÛÙ›‰Ô˘-™·‚‚ÔÔ‡ÏÔ˘, £ÂÛÛ·ÏÔÓ›ÎË KÏËÚÔÓÔÌÈο ÌÂÙ·‚ÔÏÈο ÓÔÛ‹Ì·Ù·

Persefoni Avgoustidou-Savopoulou, Thessaloniki Metabolic Disorders

∞Ó‰ÚÈ·Ó‹ µ·˙·›Ô˘-°ÂÚ·ÛÈÌ›‰Ë, ∞ı‹Ó· ∂Ó‰ÔÎÚÈÓÔÏÔÁ›·

Andriani Vazaiou-Gerasimidi, Athens Endocrinology

°ÂÒÚÁÈÔ˜ µ·ÚÏ¿Ì˘, £ÂÛÛ·ÏÔÓ›ÎË ∫·Ú‰ÈÔÏÔÁ›·

George Varlamis, Thessaloniki Cardiology

ª·Ú›· ∫·Ó¿ÚÈÔ˘, ∞ı‹Ó· ∞ÓÔÛÔÏÔÁ›·

Maria Kanariou, Athens Immunology

∂˘ÛÙ·ı›· ∫·ÙÛ·ÚÔ‡-¶ÂÎÙ·Û›‰Ë, ∞ı‹Ó· ¡Â˘ÚÔÏÔÁ›·

Eustathia Katsarou-Pektasidou, Athens Neurology

∞ÓÙÒÓ˘ ∫·ÙÙ¿Ì˘, ∞ı‹Ó· ∞ÈÌ·ÙÔÏÔÁ›· - OÁÎÔÏÔÁ›·

Antonis Kattamis, Athens Haematology - √ncology

™ÔÊ›· ∫›ÙÛÈÔ˘-∆˙¤ÏË, ∞ı‹Ó· °ÂÓÂÙÈ΋

Sophia Kitsiou-Tzeli, Athens Genetics

ÃÚ‹ÛÙÔ˜ ∫ÒÛÙ·ÏÔ˜, ∞ı‹Ó· ¡ÂÔÁÓÔÏÔÁ›·

Christos Kostalos, Athens Neonatology

∞ÏÂÍ¿Ó‰Ú· ¶··‰ÔÔ‡ÏÔ˘, ∞ı‹Ó· °·ÛÙÚÂÓÙÂÚÔÏÔÁ›· - ∏·ÙÔÏÔÁ›· - ¢È·ÙÚÔÊ‹

Alexandra Papadopoulou, Athens Gastroenterology - Hepatology - Nutrition

¡ÈÎfiÏ·Ô˜ ¶··‰fiÔ˘ÏÔ˜, ∞ı‹Ó· ∞ÏÏÂÚÁÈÔÏÔÁ›· - ¶Ó¢ÌÔÓÔÏÔÁ›·

Nicos Papadopoulos, Athens Allergology - Pneumonology

∞ÓÙÈÁfiÓË ™È·ÌÔÔ‡ÏÔ˘-ª·˘Ú›‰Ô˘, πˆ¿ÓÓÈÓ· ƒÂ˘Ì·ÙÔÏÔÁ›·

Antigoni Siamopoulou-Mavridou, Ioannina Rheumatology

ª·Ú›˙· ∆ÛÔÏÈ¿, ∞ı‹Ó· §ÔÈ̈ÍÈÔÏÔÁ›·

Marisa Tsolia, Athens Infectious Diseases

ª¤ÏË Ù˘ ¢ÈÂıÓÔ‡˜ ™˘ÓÙ·ÎÙÈ΋˜ ∂ÈÙÚÔ‹˜ ñ Members of the International Editorial Board Alexis Arzimanoglou, Paris, France

Peter Hoyer, Essen, Germany

Ellis D. Avner, Milwaukee, USA

Jan Janda, Prague, Czech Republic

Swati Bhave, New Delhi, India

Jan Kimpen, Ultrecht, Netherlands

Alberto Bissot, Panama, Panama

Craig B. Langman, Chicago, USA

David Branski, Jerusalem, Israel

John Manis, Boston, USA

Francesco Chiarelli, Chieti, Italy

Manuel Moya, Alicante, Spain

Chok-Wan Chan, Hong Kong, China

Hugh O'Brodovich, Toronto, Canada

Denis Daneman, Toronto, Canada

Ross Petty, Vancouver, Canada

Jochen Ehrich, Hannover, Germany

Willem Proesmans, Leuven, Belgium

Demetrius Ellis, Pittsburgh, USA

Jose Ramet, Antwerp, Belgium

Yoshikatsu Eto, Tokyo, Japan

Alan Sinaiko, Minneapolis, USA

Richard N. Fine, Stony Brook, USA

Nick J. Spencer, Coventry, UK

Margaret C. Fisher, Philadelphia, USA

Alfred Tenore, Udine, Italy

Raif Geha, Boston, USA

Alkis Togias, Bethesda, USA

Adenike Grange, Lagos, Nigeria

Eva Tsalikian, Iowa City, USA

Judith G. Hall, Vancouver, Canada

Catherine Weil-Olivier, Paris, France

Patricia Hamilton, London, UK

Max Zach Graz, Austria

Enver Hasanoglu, Ankara, Turkey

Johannes Zschocke, Heidelberg, Germany

Christer Holmberg, Helsinki, Finland

v

∂¶π™∆√§∏ ∞¶√ ∆∏ ™À¡∆∞•∏

EDITORIAL

∞Á·ËÙÔ› Û˘Ó¿‰ÂÏÊÔÈ, ™·˜ ¢¯fiÌ·ÛÙÂ Â˘Ù˘¯ÈṲ̂ÓÔ ÙÔÓ Î·ÈÓÔ‡ÚÁÈÔ ¯ÚfiÓÔ Î·È Û·˜ ¢¯·ÚÈÛÙԇ̠ÁÈ· ÙË Û˘Ó¯‹ Û·˜ ˘ÔÛÙ‹ÚÈÍË ÛÙȘ ÚÔÛ¿ıÂȘ ÁÈ· ·Ó·‚¿ıÌÈÛË Ù˘ “¶·È‰È·ÙÚÈ΋˜”. π‰È·›ÙÂÚ· ¢¯·ÚÈÛÙԇ̠ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜, ÙÔ˘˜ ÎÚÈÙ¤˜ ÙˆÓ ÂÚÁ·ÛÈÒÓ Î·È Ù· ̤ÏË Ù˘ ¢ÈÂıÓÔ‡˜ ™˘ÓÙ·ÎÙÈ΋˜ ∂ÈÙÚÔ‹˜. ∏ Û˘ÌÌÂÙÔ¯‹ ÙˆÓ ‰È·ÎÂÎÚÈÌ¤ÓˆÓ ·˘ÙÒÓ Û˘Ó·‰¤ÏÊˆÓ ÛÙËÓ ‰È·‰Èηۛ· ¤Î‰ÔÛ˘ ı· Û˘ÓÙÂϤÛÂÈ ÛÙÔ Ó· ·ÔÎÙ‹ÛÂÈ Ë “¶·È‰È·ÙÚÈ΋” ‰ÈÂıÓ¤˜ ·ÚÔ˜. ™·˜ ˘ÂÓı˘Ì›˙Ô˘Ì fiÙÈ Ë ˘Ô‚ÔÏ‹ ÙˆÓ ÂÚÁ·ÛÈÒÓ Û·˜ ÌÔÚ› Ó· Á›ÓÂÙ·È Î·È ÛÙ· ∞ÁÁÏÈο. ∂›Û˘ ÌËÓ Í¯ӿÙÂ, fiÙÈ ÌÔÚ›Ù ӷ ‚Ú›Ù ÙȘ ‰ËÌÔÛȇÛÂȘ Ù˘ “¶·È‰È·ÙÚÈ΋˜” ÛÙËÓ ÈÛÙÔÛÂÏ›‰· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. ªÂ ıÂṲ́˜ ¢¯¤˜ °È· ÙË ™˘ÓÙ·ÎÙÈ΋ ∂ÈÙÚÔ‹

∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ™ÙÂÊ·Ó›‰Ë˜ ¢È¢ı˘ÓÙ‹˜ ™‡ÓÙ·Í˘

Dear colleagues, We would like to wish you a Happy New Year. On this occasion, we would like to thank all of you for supporting the efforts for improvement of “Paediatriki”.

Especially we would like to thank the authors, the reviewers and the members of the International Editorial Board. We believe that the participation of this distinguished group of colleagues will contribute to our effort for “Paediatriki” to achieve a world-class level. We would like to remind you that papers may be submitted in English. Finally do not forget that you can find past issues of “Paediatriki” at the web page of the journal.

Warm greetings √n behalf of the Editorial Board Constantinos Stefanidis Editor-in-Chief

vii

√¢∏°π∂™ ¶ƒ√™ ∆√À™ ™À°°ƒ∞º∂π™ A. °ÂÓÈΤ˜ ¶ÏËÚÔÊÔڛ˜ ∆Ô ÂÚÈÔ‰ÈÎfi “¶·È‰È·ÙÚÈ΋” Â›Ó·È Ë ÂÈÛÙËÌÔÓÈ΋ ¤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‡ ÂÈÛÙËÌÔÓÈÎÔ‡ ¤ÚÁÔ˘ Î·È ÙË Û˘Ó¯‹ ÂÓË̤ڈÛË ÙˆÓ ¶·È‰È¿ÙÚˆÓ. °È· ÙÔ ÛÎÔfi ·˘Ùfi ‰¤¯ÂÙ·È ÁÈ· ‰ËÌÔÛ›Â˘ÛË ÔÈÎÈÏ›· ¿ÚıÚˆÓ Î·È Û˘ÁÎÂÎÚÈ̤ӷ: 1. ÕÚıÚ· Û‡ÓÙ·Í˘ (ÌÂÙ¿ ·fi ÚfiÛÎÏËÛË Ù˘ ™˘ÓÙ·ÎÙÈ΋˜ EÈÙÚÔ‹˜).

2. ∞Ó·ÛÎÔ‹ÛÂȘ.

3. µÚ·‚Â˘Ì¤Ó˜ ÂÚÁ·Û›Â˜.

4. ∂Ú¢ÓËÙÈΤ˜ ÌÂϤÙ˜.

5. ∫ÏÈÓÈο ∫Ô˘›˙.

6. ∂ÈÏÂÁ̤Ó˜ Û˘˙ËÙ‹ÛÂȘ ÛÙÚÔÁÁ˘ÏÒÓ ÙÚ·Â˙ÒÓ.

7. ∂›Î·ÈÚ· ı¤Ì·Ù·.

8. £¤Ì·Ù· ÂÎ·›‰Â˘Û˘ Î·È ÔÚÁ¿ÓˆÛ˘ ˘Á›·˜.

9. ∂ӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ.

10. ™‡ÓÙÔÌ· Ó¤·.

11. µÚ·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ.

12. ∂ÈÛÙÔϤ˜ ÚÔ˜ ÙË Û‡ÓÙ·ÍË.

13. ¶ÂÚÈÏ‹„ÂȘ Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜.

14. ∞Ó·ÎÔÈÓÒÛÂȘ ÚÔÛ¯ÒÓ Û˘Ó‰ڛˆÓ Î·È ÂÈÛÙËÌÔÓÈÎÒÓ ÂΉËÏÒÛÂˆÓ 15. ∞Ó·ÊÔÚ¤˜ Î·È ÎÚÈÙÈ΋ Ó¤ˆÓ ÂΉfiÛˆÓ, ÂÏÏËÓÈÎÒÓ Î·È Í¤ÓˆÓ, ·È‰È·ÙÚÈÎÔ‡ ÂӉȷʤÚÔÓÙÔ˜.

H ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ‰È·ÙËÚ› ÙÔ ‰Èη›ˆÌ· Ó· ‰ËÌÔÛȇÂÈ ¿ÚıÚ· Ì ȉȷ›ÙÂÚÔ ÂÈÛÙËÌÔÓÈÎfi ÂӉȷʤÚÔÓ, ηıÒ˜ Î·È ¿ÚıÚ· Ì Â›Î·ÈÚ· ı¤Ì·Ù· ¯ˆÚ›˜ Ó· ÙËÚÂ›Ù·È Ë ÛÂÈÚ¿ ˘Ô‚ÔÏ‹˜. ∂›Û˘, ÌÔÚ› Ó· ·ÔÊ·Û›˙ÂÈ ÁÈ· ÙË ‰ËÌÔÛ›Â˘ÛË ÂÚÁ·ÛÈÒÓ Ô˘ ¤¯Ô˘Ó ·ÚÔ˘ÛÈ·ÛÙ› 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 ÂÈÛÙÔÏÒÓ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È Û ‰ËÌÔÛÈÂ˘Ì¤Ó· ÂÈÛÙËÌÔÓÈο ¿ÚıÚ· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. ™ÙȘ ÂÚÁ·Û›Â˜ Ì Â›Î·ÈÚ· 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˘. ŸÏ˜ ÔÈ ÂÚÁ·Û›Â˜ Ú¤ÂÈ Ó· ÌËÓ ¤¯Ô˘Ó ÂÓ Ì¤ÚÂÈ ‹ ÂÍ ÔÏÔÎÏ‹ÚÔ˘ ‰ËÌÔÛÈ¢ı› ‹ ˘Ô‚ÏËı› ÁÈ· ÎÚ›ÛË Û ¿ÏÏÔ ÂÚÈÔ‰ÈÎfi. ∂ÈϤÔÓ, ÛÙËÓ ÂÚÁ·Û›· ı· Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È Ù˘¯fiÓ ÂȉÔÙ‹ÛÂȘ-¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢. ŸÏ˜ ÔÈ ÎÏÈÓÈΤ˜ ¤Ú¢Ó˜ Ú¤ÂÈ Ó· ¤¯Ô˘Ó Á›ÓÂÈ ÌÂÙ¿ ·fi ÏËÚÔÊÔÚË̤ÓË Û˘Ó·›ÓÂÛË ÙˆÓ ÌÂÙ¯fiÓÙˆÓ ‹ ÙˆÓ ÓÔÌ›ÌˆÓ ÂÎÚÔÛÒˆÓ ÙÔ˘˜, Û‡Ìʈӷ Ì ÙȘ ‰È·ÎËÚ‡ÍÂȘ ÙÔ˘ EÏÛ›ÓÎÈ Î·È ÙÔ˘ TfiÎÈÔ. E›Û˘, Ú¤ÂÈ Ó· ¤¯Ô˘Ó ÙËÚËı› ÔÈ Ô‰ËÁ›Â˜ ÁÈ· ÙË ÊÚÔÓÙ›‰· ÂÈÚ·Ì·Ùfi˙ˆˆÓ ÙÔ˘ ∂ıÓÈÎÔ‡ πÓÛÙÈÙÔ‡ÙÔ˘ ÀÁ›·˜ ÙˆÓ ∏¶∞ (DHEW Publication, NIH, 80-23). OÈ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ Ú¤ÂÈ Ó· ¤¯Ô˘Ó ÂÁÎÚÈı› ·fi ÙËÓ ÂÈÙÚÔ‹ ∏ıÈ΋˜ Î·È ¢ÂÔÓÙÔÏÔÁ›·˜ ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ.

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

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·Ó·‰ËÌÔÛ›Â˘Û‹ ÙÔ˘˜ ÂÈÙÚ¤ÂÙ·È ÌfiÓÔ ÌÂÙ¿ ·fi ¤ÁÁÚ·ÊË Û˘ÁηٿıÂÛË ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡.

µ. ™‡ÓÙ·ÍË ÙˆÓ ∂ÚÁ·ÛÈÒÓ ŸÏ˜ ÔÈ ÂÚÁ·Û›Â˜ Ú¤ÂÈ Ó· ·ÎÔÏÔ˘ıÔ‡Ó “∫ÔÈÓ¤˜ ¶ÚԉȷÁڷʤ˜ ÁÈ· ÃÂÈÚfiÁÚ·Ê· Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È Û µÈÔ˚·ÙÚÈο ¶ÂÚÈÔ‰Èο” (Uniform Requirements for Manuscripts Submitted to Biomedical Journals), ÔÈ Ôԛ˜ ÙÚÔÔÔÈ‹ıËÎ·Ó ÚfiÛÊ·Ù· Î·È ‰ËÌÔÛȇÔÓÙ·È ÛÙȘ ‰È¢ı‡ÓÛÂȘ: http://www.icmje.org Î·È http://www.icmje.org/icmje.pdf TÔ Û‡ÓÔÏÔ Ù˘ ÂÚÁ·Û›·˜ (Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ ÙˆÓ ÈÓ¿ÎˆÓ Î·È ÙˆÓ Ù›ÙÏˆÓ ÙˆÓ ÂÈÎfiÓˆÓ) Ú¤ÂÈ Ó· Â›Ó·È Ù˘ˆÌ¤ÓÔ ÛÙË ÌÈ· fi„Ë Ï¢ÎÔ‡ ¯·ÚÙÈÔ‡ ÌÂÁ¤ıÔ˘˜ A4 (21x29,7 cm), Ì ‰ÈÏfi ‰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, ηٿÏÔÁÔ˜ Û˘ÓÙÔÌÔÁÚ·ÊÈÒÓ, ΛÌÂÓÔ, ¢¯·ÚÈÛٛ˜ ηıÒ˜ Î·È ·Ó·ÊÔÚ¿ Û ÂȉÔÙ‹ÛÂȘ-¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢, ‚È‚ÏÈÔÁÚ·Ê›·, ›Ó·Î˜, ÂÈÎfiÓ˜, Ù›ÙÏÔÈ ÂÈÎfiÓˆÓ. 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·: ñ ÙȘ ·Ó·ÛÎÔ‹ÛÂȘ Û 2000-3000 ϤÍÂȘ. ñ ÙȘ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜ Û 1500-2500 ϤÍÂȘ Î·È ÙȘ ÂӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ Û 1000-1500 ϤÍÂȘ. ñ ÙȘ ‚Ú·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ Û 1000-1500 ϤÍÂȘ. ñ ÙȘ ÂÈÛÙÔϤ˜ Û 250-500 ϤÍÂȘ.

™ÂÏ›‰· Ù›ÙÏÔ˘ ¶Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ: ñ ÙÔÓ Ù›ÙÏÔ (<14 ϤÍÂȘ), ηıÒ˜ Î·È ÙÔÓ ‚Ú·¯‡ Ù›ÙÏÔ (<5 ϤÍÂȘ) ÙÔ˘ ¿ÚıÚÔ˘. ¢ÂÓ ÂÈÙÚ¤ÔÓÙ·È Û˘ÓÙÌ‹ÛÂȘ. ñ ÙÔ fiÓÔÌ· Î·È ÙÔ ÂÒÓ˘ÌÔ Î¿ıÂ Û˘ÁÁڷʤ· ÛÙËÓ ÔÓÔÌ·ÛÙÈ΋. ñ ÙÔ ÂÈÛÙËÌÔÓÈÎfi ΤÓÙÚÔ (›‰Ú˘Ì·, ÎÏÈÓÈ΋, ÂÚÁ·ÛÙ‹ÚÈÔ) ·fi fiÔ˘ ÚÔ¤Ú¯ÂÙ·È Ë ÂÚÁ·Û›·. ™Â ÂÚ›ÙˆÛË ¤ÏÏÂȄ˘ Û˘ÓÂÚÁ·Û›·˜ ÌÂ Û˘ÁÎÂÎÚÈ̤ӷ ΤÓÙÚ·, Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÂÙ·È Ë È‰ÈfiÙËÙ· ÙÔ˘/ÙˆÓ Û˘ÁÁڷʤ·/ˆÓ (.¯. ȉÈÒÙ˘ ·È‰›·ÙÚÔ˜) Î·È Ô ÙfiÔ˜ ‰È·ÌÔÓ‹˜ ÙÔ˘/ÙÔ˘˜. ñ ÙËÓ Ï‹ÚË ‰È‡ı˘ÓÛË, e-mail Î·È ÙÔ ÙËϤʈÓÔ ÙÔ˘ Û˘ÁÁڷʤ· Ì ÙÔÓ ÔÔ›Ô Á›ÓÂÙ·È Ë ·ÏÏËÏÔÁÚ·Ê›·.

¶ÂÚÈÏ‹„ÂȘ H ÂÚ›ÏË„Ë Ú¤ÂÈ Ó· ·Ó·ÎÂÊ·Ï·ÈÒÓÂÈ ÙÔ˘˜ ÛÙfi¯Ô˘˜ Ù˘ ÂÚÁ·Û›·˜, ÙË ÌÂıÔ‰ÔÏÔÁ›·, Ù· ΢ÚÈfiÙÂÚ· ·ÔÙÂϤÛÌ·Ù· Î·È Ù· Û˘ÌÂÚ¿ÛÌ·Ù· Ù˘ ÌÂϤÙ˘. ñ £· Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÔ˘Ï¿¯ÈÛÙÔÓ 200 ϤÍÂȘ, fï˜ ‰ÂÓ ı· Ú¤ÂÈ Ó· ˘ÂÚ‚·›ÓÂÈ ÙȘ 250 ϤÍÂȘ. ñ ∏ 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˘ÌÂÚ¿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 ÛÂ: ÂÈÛ·ÁˆÁ‹ (background), ̤ıÔ‰ÔÈ (methods), ·ÔÙÂϤÛÌ·Ù· (results) Î·È Û˘ÌÂÚ¿ÛÌ·Ù· (conclusions). H ÂÚ›ÏË„Ë ÛÙ· ·ÁÁÏÈο ‰ÂÓ Ú¤ÂÈ Ó· ‰È·Ê¤ÚÂÈ ·fi ÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë ÛÙ· ÂÏÏËÓÈο.

xiv

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

K›ÌÂÓÔ OÈ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó: ÂÈÛ·ÁˆÁ‹, ÌÂıfi‰Ô˘˜, ·ÔÙÂϤÛÌ·Ù· Î·È Û˘˙‹ÙËÛË. H 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·ÔÌ¤˜ Î·È ÙÔÓ ÛÎÔfi Ù˘ ÂÚÁ·Û›·˜. H ÂÚÈÁÚ·Ê‹ ÙˆÓ ÌÂıfi‰ˆÓ Ú¤ÂÈ Ó· Â›Ó·È ·ÎÚÈ‚‹˜ Î·È ·ÚÎÂÙ¿ ÏÂÙÔÌÂÚ‹˜, ÒÛÙ ӷ ÂÈÙÚ¤ÂÈ ÙËÓ ·Ó··Ú·ÁˆÁ‹ ÙÔ˘˜ ·fi ¿ÏÏÔ˘˜ ÂÚ¢ÓËÙ¤˜. ∂›Û˘, Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È Ì ÏÂÙÔ̤ÚÂȘ 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˘ÌÂÚ¿ÛÌ·Ù· Ô˘ ÚÔ·ÙÔ˘Ó ·fi ÙËÓ ÂÚÁ·Û›·, ÙË ÛËÌ·Û›· Ô˘ ÌÔÚ› Ó· ¤¯Ô˘Ó Î·È ÙËÓ Èı·Ó‹ Û˘Û¯¤ÙÈÛ‹ ÙÔ˘˜ Ì ·Ú·ÙËÚ‹ÛÂȘ ¿ÏÏˆÓ ÂÚ¢ÓËÙÒÓ.

OÈ ÂӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Û‡ÓÙÔÌË ÂÈÛ·ÁˆÁ‹, ÂÚÈÁÚ·Ê‹ Ù˘ ÂÚ›ÙˆÛ˘ Î·È ‚Ú·¯Â›· Û˘˙‹ÙËÛË, Ì ¤ÌÊ·ÛË ÛÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË.

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

TÈ̤˜ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛÂˆÓ OÈ ÙÈ̤˜ ÙˆÓ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛÂˆÓ Ú¤ÂÈ Ó· ÂÎÊÚ¿˙ÔÓÙ·È ÛÙÔ ¢ÈÂıÓ¤˜ ™‡ÛÙËÌ· MÔÓ¿‰ˆÓ (SI Units) Î·È ÛÙÔ MÂÙÚÈÎfi (Conventional-™˘Ì‚·ÙÈÎfi) ™‡ÛÙËÌ· ̤۷ Û ·Ú¤ÓıÂÛË. ¶›Ó·Î˜ ÌÂÙ·ÙÚÔ‹˜ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÛÙȘ ‰È¢ı‡ÓÛÂȘ: http://www.icmje.org Î·È http://www.icmje.org/icmje.pdf

™˘ÓÙÔÌÔÁڷʛ˜ OÈ Û˘ÓÙÔÌÔÁڷʛ˜ Ô˘ ¤¯Ô˘Ó ÂÈ‚ÏËı› ‰ÈÂıÓÒ˜, ‰ËÌÔÛȇÔÓÙ·È Û οı Ù‡¯Ô˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. ™‡ÓıÂÙÔÈ Î·È Ì·ÎÚÔÛÎÂÏ›˜ fiÚÔÈ Ô˘ Â·Ó·Ï·Ì‚¿ÓÔÓÙ·È Û˘¯Ó¿ ÛÙÔ Î›ÌÂÓÔ ÌÔÚÔ‡Ó Ó· ·ÓÙÈηı›ÛÙ·ÓÙ·È ·fi Û˘ÓÙÔÌÔÁڷʛ˜ Ô˘ ÂÂÍËÁÔ‡ÓÙ·È ·fi ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ Û ÂȉÈÎfi ηٿÏÔÁÔ, Ô ÔÔ›Ô˜ ˘Ô‚¿ÏÏÂÙ·È Ì·˙› Ì ÙËÓ ÂÚÁ·Û›·. OÈ Û˘ÓÙÔÌÔÁڷʛ˜ ·Ó·Ê¤ÚÔÓÙ·È Û ·Ú¤ÓıÂÛË ÌfiÓÔ ÛÙȘ ÂÚÈÏ‹„ÂȘ.

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

H Û‡ÓÙ·ÍË ÙˆÓ ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·ÔÌÒÓ Á›ÓÂÙ·È Û‡Ìʈӷ Ì ÙȘ ÚfiÛÊ·Ù· ÙÚÔÔÔÈË̤Ó˜ ÚԉȷÁڷʤ˜ Ù˘ International Committee of Medical Journal Editors/ Uniform Requirements for Manuscripts Sub-mitted to Biomedical Journals, (http://www.icmje.org Î·È http:// www.icmje.org/icmje.pdf). 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/bsd/uniform_requirements.html)].

¶·Ú·‰Â›ÁÌ·Ù· ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·ÔÌÒÓ I. ¶∂ƒπO¢π∫∞ AÓ ÔÈ Û˘ÁÁÚ·Ê›˜ Â›Ó·È ¤ˆ˜ ¤ÍÈ, ·Ó·ÁÚ¿ÊÔÓÙ·È fiÏÔÈ, ÂÓÒ ·Ó Â›Ó·È ÂÙ¿ ‹ ÂÚÈÛÛfiÙÂÚÔÈ, ·Ó·ÁÚ¿ÊÔÓÙ·È ÔÈ ÚÒÙÔÈ ¤ÍÈ Î·È ÚÔÛÙ›ıÂÙ·È “et al” ‹ “Î·È Û˘Ó”.

T·ÎÙÈ΋ ¤Î‰ÔÛË ÂÚÈÔ‰ÈÎÔ‡: ∞ÓÙˆÓ›Ô˘ ¢, ª¿Ú· Ã, °È·ÓÓ¿ÙÔ˘ Ã. ∂Ì‚fiÏÈ·: Â›‰Ú·ÛË ÛÙËÓ ÂȉËÌÈÔÏÔÁ›· 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. ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜ ÂÚÈÔ‰ÈÎÔ‡: Flyvbjerg A. Role of growth hormone, insulin-like growth factors (IGFs) and IGF-binding proteins in the renal complications of diabetes. Kidney Int 1997;52 (60 Suppl):S12-S19. Èڛ˜ Û˘ÁÁڷʤ·: National Institutes of Health Consensus Development Conference. Neurofibromatosis conference statement. Arch Neurol 1988;45:575-578. ¶ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù‡Ô˘ ¿ÚıÚÔ˘: 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. µπµ§π∞ ∫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‚‹: ¶··‰fiÔ˘ÏÔ˜ Ã. ∏ ıÂÚ·›· ÙÔ˘ ÛÙÚ·‚ÈÛÌÔ‡ [‰È‰·ÎÙÔÚÈ΋ ‰È·ÙÚÈ‚‹]. ∞ı‹Ó·: ¶·ÓÂÈÛÙ‹ÌÈÔ ∞ıËÓÒÓ; 1979.

Kaplan SJ. Post hospital home health care: the elderly’s access and utilization [dissertation]. St. Louis (Mo): Washington Univ.; 1995. πππ. CD-ROM Anderson SC, Poulsen KB. Anderson’s electronic atlas of hematology [CD-ROM]. Philadelphia: Lippincott Williams & Wilkins; 2002.

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IV. ™∆O ¢π∞¢π∫∆ÀO ÕÚıÚÔ Û ÂÚÈÔ‰ÈÎfi: Abood S. Quality improvement initiative in nursing homes: the ANA acts in an advisory role. Am J Nurs [Internet]. 2002 Jun: Webpage: http://www.nursingworld.org/AJN/2002/june/Wawatch.htm ªÔÓÔÁÚ·Ê›·: Foley KM, Gelband H, editors. Improving palliative care for cancer [Monograph, Internet]. Washington: National Academy Press; 2001. Webpage: http://www.nap.edu/books/0309074029/html πÛÙÔÛÂÏ›‰Â˜: Cancer-Pain.org [Webpage, Internet]. New York: Association of Cancer Online Resources, Inc.; 2002: http://www.cancerpain.org/

°. ÀÔ‚ÔÏ‹ Î·È ¢ËÌÔÛ›Â˘ÛË ÙˆÓ ∂ÚÁ·ÛÈÒÓ ŸÏ˜ ÔÈ ÂÚÁ·Û›Â˜ Ú¤ÂÈ Ó· ˘Ô‚¿ÏÏÔÓÙ·È ÂȘ ÙÚÈÏÔ‡Ó Î·È Ó· Û˘Óԉ‡ÔÓÙ·È ·fi ‰ÈÛΤٷ ‹ CD, ηıÒ˜ Î·È ·fi ÂÈÛÙÔÏ‹, Ë ÔÔ›· ı· Û˘Ó˘ÔÁÚ¿ÊÂÙ·È ·fi fiÏÔ˘˜ ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜, ÛÙËÓ ÔÔ›· ı· ‰ËÏÒÓÂÙ·È fiÙÈ Ë ÂÚÁ·Û›· ‰ÂÓ ¤¯ÂÈ ÂÓ Ì¤ÚÂÈ ‹ ÂÍ ÔÏÔÎÏ‹ÚÔ˘ ‰ËÌÔÛÈ¢ı› ‹ ˘Ô‚ÏËı› ÁÈ· ÎÚ›ÛË Û ¿ÏÏÔ ÂÚÈÔ‰ÈÎfi Î·È fiÙÈ ÔÈ Û˘ÁÁÚ·Ê›˜ ÂÁÎÚ›ÓÔ˘Ó ÙË ‰ËÌÔÛ›Â˘Û‹ Ù˘ ÛÙÔ ÂÚÈÔ‰ÈÎfi “¶·È‰È·ÙÚÈ΋”. ∂ÈϤÔÓ, ı· Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È Ù˘¯fiÓ ÂȉÔÙ‹ÛÂȘ-¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢.

EÊfiÛÔÓ Ë ÂÚÁ·Û›· Á›ÓÂÈ ·Ô‰ÂÎÙ‹, ÙÔ ‰ÈÔÚıˆÌ¤ÓÔ Û‡Ìʈӷ Ì ÙȘ ˘ԉ›ÍÂȘ ÙˆÓ ÎÚÈÙÒÓ Î·È ÂÎ Ó¤Ô˘ ‰·ÎÙ˘ÏÔÁÚ·ÊË̤ÓÔ Î›ÌÂÓÔ Ú¤ÂÈ Ó· ˘Ô‚¿ÏÂÙ·È ÛÙË ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹, Û˘Óԉ¢fiÌÂÓÔ ·fi ‰ÈÛΤٷ ‹ CD Ô˘ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ÂÚÁ·Û›· Û ÚfiÁÚ·ÌÌ· Word, ηıÒ˜ Î·È ÂÈÛÙÔÏ‹ fiÔ˘ Ó· ·Ó·Ê¤ÚÔÓÙ·È ·Ó·Ï˘ÙÈο ÔÈ ÙÚÔÔÔÈ‹ÛÂȘ ‹ ÔÈ ·ÓÙÈÚÚ‹ÛÂȘ ÛÙȘ ÚÔÙ¿ÛÂȘ ÙˆÓ ÎÚÈÙÒÓ.

H ηı˘ÛÙ¤ÚËÛË Ù˘ Â·Ó˘Ô‚ÔÏ‹˜ ÙÔ˘ ÙÚÔÔÔÈË̤ÓÔ˘ ÎÂÈ̤ÓÔ˘ ¤Ú·Ó ÙˆÓ 30 ËÌÂÚÒÓ Û˘ÓÂ¿ÁÂÙ·È Ó¤· ˘Ô‚ÔÏ‹.

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 ÂÈÛÙÚ¤ÊÔÓÙ·È. MÔÚ› Ó· ÂÈÛÙÚ·ÊÔ‡Ó, ÂÊfiÛÔÓ ˙ËÙËı› ÂÓÙfi˜ ÂÍ·Ì‹ÓÔ˘, Ù· Û¯‹Ì·Ù· Î·È ÔÈ ÊˆÙÔÁڷʛ˜ Ô˘ Ù· Û˘Óԉ‡ԢÓ.

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 ÙÚÈÏÔ‡Ó ÛÙË ‰È‡ı˘ÓÛË: ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹, EÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ EÙ·ÈÚ›· Mȯ·Ï·ÎÔÔ‡ÏÔ˘ 92, 115 28 Aı‹Ó·

¶›Ó·Î˜ Î·È EÈÎfiÓ˜ AÔÛÙ¤ÏÏÔÓÙ·È ÂȘ ÙÚÈÏÔ‡Ó (¤Ó· ÚˆÙfiÙ˘Ô Î·È ‰‡Ô ʈÙÔ·ÓÙ›ÁÚ·Ê·). ¶Ú¤ÂÈ Ó· ¤¯Ô˘Ó Ï¿ÙÔ˜ ›ÛÔ Ì ÙÔ Ï¿ÙÔ˜ ÙÔ˘ ÌÔÓfiÛÙËÏÔ˘ (7,5 cm) ‹ Ì ÙÔ Ï¿ÙÔ˜ fiÏ˘ Ù˘ ÛÂÏ›‰·˜ (15,5 cm). TÔ Ì¤ÁÈÛÙÔ Ì‹ÎÔ˜ ÙÔ˘˜, Ì·˙› Ì ÙÔ˘˜ Ù›ÙÏÔ˘˜, ‰ÂÓ Ú¤ÂÈ Ó· Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ ·fi 22 cm.

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

¶ÚÈÓ ·ÔÛÙ›ÏÂÙ ÙËÓ ÂÚÁ·Û›· Û·˜, ‚‚·Èˆı›Ù fiÙÈ ÂÚÈÏ·Ì‚¿ÓÂÈ: 1. 3 ·ÓÙ›ÁÚ·Ê· ÙÔ˘ ÎÂÈ̤ÓÔ˘ Ù˘ ÂÚÁ·Û›·˜, Ù˘ˆÌ¤Ó· Û‡Ìʈӷ Ì ÙȘ Ô‰ËÁ›Â˜.

2. ¢ÈÛΤٷ ‹ CD Ì fiÏÔ ÙÔ ˘ÏÈÎfi Ù˘ ÂÚÁ·Û›·˜ (ΛÌÂÓÔ, ›Ó·Î˜, ÂÈÎfiÓ˜).

3. ∂ÈÛÙÔÏ‹ ˘Ô‚ÔÏ‹˜ Î·È ‰‹ÏˆÛË ÌË ÚÔÁÂÓ¤ÛÙÂÚ˘ ‰ËÌÔÛ›Â˘Û˘ Ù˘ ÂÚÁ·Û›·˜.

4. ™ÂÏ›‰· Ù›ÙÏÔ˘ (¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) ÂÚÈÏ·Ì‚¿ÓÂÈ: ·.Ù›ÙÏÔ Î·È ‚Ú·¯‡ Ù›ÙÏÔ ÂÚÁ·Û›·˜ ‚.fiÓÔÌ· Î·È ÂÒÓ˘ÌÔ Û˘ÁÁڷʤˆÓ (ÔÏÔÁڿʈ˜) Á. ÂÈÛÙËÌÔÓÈÎfi/¿ ΤÓÙÚÔ/· fiÔ˘ ¤ÁÈÓÂ Ë ÂÚÁ·Û›· ‰.fiÓÔÌ·, ‰È‡ı˘ÓÛË Î·È ÙËϤʈÓÔ Û˘ÁÁڷʤ· ÁÈ· ·ÏÏËÏÔÁÚ·Ê›·.

5. ¶ÂÚ›ÏË„Ë ÂÏÏËÓÈ΋-·ÁÁÏÈ΋, ‰ÔÌË̤ÓË ÛÙȘ ÂÍ‹˜ ·Ú·ÁÚ¿ÊÔ˘˜: ÂÈÛ·ÁˆÁ‹, ̤ıÔ‰ÔÈ, ·ÔÙÂϤÛÌ·Ù· Î·È Û˘ÌÂÚ¿ÛÌ·Ù·, ηıÒ˜ Î·È Ï¤ÍÂȘ ÎÏÂȉȿ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·).

6. ∫·Ù¿ÏÔÁÔ Û˘ÓÙÔÌÔÁÚ·ÊÈÒÓ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·).

7. ∫›ÌÂÓÔ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·).

8. ∂˘¯·ÚÈÛٛ˜ ‹ ·Ó·ÁÓˆÚ›ÛÂȘ (·Ó·ÊÔÚ¿ Û ÂȉÔÙ‹ÛÂȘ-¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢).

9. µÈ‚ÏÈÔÁÚ·Ê›· (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·).

10. ¶›Ó·Î˜ (Ô Î·ı¤Ó·˜ Û ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) ÂȘ ÙÚÈÏÔ‡Ó.

11. ∂ÈÎfiÓ˜, Ì ‚¤ÏÔ˜ ÛÙÔ ›Ûˆ ̤ÚÔ˜ ÙÔ ÔÔ›Ô Ó· ‰Â›¯ÓÂÈ ÚÔ˜ Ù· Â¿Óˆ, ·ÚÈıÌË̤Ó˜, ÂȘ ÙÚÈÏÔ‡Ó.

12. ∆›ÙÏÔ˘˜ ÂÈÎfiÓˆÓ (‰ÈÏfi ‰È¿ÛÙËÌ· - Ô Î·ı¤Ó·˜ Û ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) ÂȘ ÙÚÈÏÔ‡Ó.

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™À¡∆√ª√°ƒ∞ºπ∂™ o

A cal cm cm2 cm3 o C g h IU kg l m mg min mm mol n NS ‹ ª™ osm p SD SE sec U

ABBREVIATIONS

angstrom ıÂÚÌ›‰· ÂηÙÔÛÙfi ÙÂÙÚ·ÁˆÓÈÎfi ÂηÙÔÛÙfi ΢‚ÈÎfi ÂηÙÔÛÙfi ‚·ıÌfi˜ ∫ÂÏÛ›Ô˘ ÁÚ·ÌÌ¿ÚÈÔ ÒÚ· ‰ÈÂıÓ‹˜ ÌÔÓ¿‰· ¯ÈÏÈfiÁÚ·ÌÌÔ Ï›ÙÚÔ Ì¤ÙÚÔ ¯ÈÏÈfiÁÚ·ÌÌÔ ÏÂÙfi ¯ÈÏÈÔÛÙfiÌÂÙÚÔ ÁÚ·ÌÌÔÌfiÚÈÔ ·ÚÈıÌfi˜ ÌË ÛËÌ·ÓÙÈÎfi ÔÛÌÒÏÈÔ Èı·ÓfiÙËÙ· ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË ÛÙ·ıÂÚfi ÛÊ¿ÏÌ· ‰Â˘ÙÂÚfiÏÂÙÔ ÌÔÓ¿‰·

™˘Ó‰˘·˙fiÌÂÓ· ÚÔı¤Ì·Ù·

Combining prefixes

tera- (1012) giga- (109) mega- (106) kilo- (103) hector- (102) deca- (101) deci- (10-1) centi- (10-2) milli- (10-3) micro- (10-6) nano- (10-9) pico- (10-12) femto- (10-15) atto- (10-18)

T G M k h da d c m Ì n p f a

angstrom calorie centimeter square centimeter cubic centimeter degree Celsius gram hour international unit kilogram liter meter milligram minute millimeter mole number not significant osmole probability standard deviation standard error second unit

INSTRUCTIONS TO AUTHORS A. General Information The Greek Paediatric Society is the owner of “Paediatriki”, its official scientific journal, which is distributed to its members. Its objectives are the publication of paediatric scientific work and the continuing education of paediatricians. For this purpose, it publishes a variety of articles, and in particular: 1. Editorials (upon invitation by the Editorial Board).

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The Editorial Board reserves the right to publish articles of special scientific interest and articles on current issues without observing submission order. In addition it publishes upon decision original papers presented at the Annual Paediatric Conference, presentations of special interest - in whole or in part, and letters - in whole or in part - referring to scientific articles published in the journal.

Regarding papers on current issues, the author’s request for immediate publication should be quoted on the first page. The Editorial Board reserves the right to accept such papers for immediate publication.

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In addition, the US National Institute of Health guide for the care and use of laboratory animals (DHEW Publication, NIH, 80-23) should have been observed. Clinical trials should have been approved by the Ethics Committee of the Hospital.

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should be typed on one side of blank paper format A4 (21x29.7 cm), double line spacing and minimum indent 2.5 cm on both sides.

The paper should have the following structure: title page, short title, abstract in Greek and English, list of abbreviations, text, acknowledgements and quoting of grants, sponsorships or other financial support sources, references, tables, figures, figure legends. Each of these sections should be started on a new page. Pages should be numbered consecutively, beginning with the title page.

Text length shall be: ñ review articles 2000-3000 words; ñ original articles 1500-2500 words and case reports 1000-1500 words; ñ brief reports 1000-1500 words; ñ letters 250-500 words.

The title page should include: ñ the title (<14 words) and the short title (<5 words) of the article. No abbreviations are permitted in the title; ñ the name and surname of all authors; ñ the centre (institution, clinic, laboratory) of origin of the paper. If there is no affiliation with a specific centre, the status of the author(s) should be cited (e.g., private paediatrician) and home address; ñ the complete address, e-mail and telephone number of the author to whom correspondence should be addressed.

Abstracts The abstract should summarize the objectives, methodology, main results and conclusions of the study. ñ It should contain at least 200 words, and not exceed 250 words. ñ It should consist of the following paragraphs: background, methods, results and conclusions.

The English abstract should cite at the beginning the title of the paper and the authors’ names in English. The content of the text should consist of the following paragraphs: background, methods, results and conclusions. The abstract in English should not differ in content from the corresponding Greek abstract.

Beneath the Greek and English abstracts, three to five key words in the respective language should be supplied, to be used in the thematic index.

Text Original articles include: introduction, methods, results and discussion. The introduction includes the latest research data on the subject and the main references and the objectives of the paper. The description of the methods should be precise and detailed so as to enable reproduction by other researchers. In addition, the statistical methods of analysis and evaluation of the results should be described. Results should be presented clearly, together with the appropriate statistical analysis. Discussion should cover the results ensuing from the research, their significance and possible associations with the observations of other researchers.

Case reports comprise a short introduction, case description and brief discussion, with emphasis on differential diagnosis.

The structure of all other articles is free, according to the judgment of the authors.

Thanks or acknowledgements (reference to grants, sponsorships or other sources of financial support) should be quoted at the end of the text, before references.

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Units of measures of laboratory analyses Laboratory analyses should be expressed in the Système International (SI) units and in the metric (Conventional) system in parentheses. See conversion tables on the websites: http://www.icmje.org and http://www.icmje.org/icmje.pdf Abbreviations All issues of the journal contain internationally established abbreviations. Complex or long terms often repeated in the text may be replaced by abbreviations explained by the authors in a list submitted with the paper. Abbreviations are reported in parentheses only in abstracts.

References The reference section contains all references numbered in the order in which they appear in the text. In the text, references are to be indicated by Arabic numerals in parentheses. References should be no more than: ñ 70 in review articles; ñ 30 in original articles; ñ 12 in current issues and case reports; ñ 5 in brief reports and letters.

In listing references follow the recently modified standards of the International Committee of Medical Journal Editors/Uniform Requirements for Manuscripts Submitted to Biomedical Journals, (http://www.icmje.org and http:// www.icmje.org/icmje.pdf). Abbreviated names of journals should conform to the Cumulated Index Medicus [List of Journals Indexed in Index Medicus (http://www.nlm.nih.gov/bsd/uniform_requirements.html)].

Examples of reference style I. JOURNALS All authors are cited if they are six or less; if they are 7 or more, the first six are cited, followed by “et al”.

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

Supplement issue: 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.

No author: National Institutes of Health Consensus Development Conference. Neurofibromatosis conference statement. Arch Neurol 1988;45:575-578.

Article type specification: 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. BOOKS Chapter in book: 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.

Book or monograph: Gorlin RJ, Cohen MM, Levin LS. Syndromes of the head and neck. 3rd ed. New York: Oxford University Press; 1990.

Publication in a volume of proceedings: 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.

Doctoral dissertation: Kaplan SJ. Post hospital home health care: the elderly’s access and utilization [dissertation]. St. Louis (Mo): Washington Univ.; 1995. πππ. CD-ROM Anderson SC, Poulsen KB. Anderson’s electronic atlas of hematology [CD-ROM]. Philadelphia: Lippincott Williams & Wilkins; 2002.

IV. ON THE INTERNET Article in journal Abood S. Quality improvement initiative in nursing homes: the ANA acts in an advisory role. Am J Nurs [Internet]. 2002 Jun: Webpage: http://www.nursingworld.org/ AJN/2002/june/Wawatch.htm Monograph Foley KM, Gelband H, editors. Improving palliative care for cancer [Monograph, Internet]. Washington: National Academy Press; 2001. Webpage: http://www.nap.edu/books/0309074029/html Websites Cancer-Pain.org [Webpage, Internet]. New York: Association of Cancer Online Resources, Inc.; 2002: http://www.cancerpain.org/ Tables and Figures Three copies should be submitted (original plus 2 copies).

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Once the manuscript has been accepted, the corrected version, rewritten according to the reviewers’ recommendations should be submitted to the Editorial Board accompanied by a floppy disk or CD, containing the paper in Word format, along with a covering letter specifying in detail the modifications or objections to the reviewers’ suggestions.

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Manuscripts submitted for review and publication in “Paediatriki” should be sent in three copies to the following address: Editorial Board, Greek Paediatric Society 92, Michalakopoulou Street, 115 28 Athens, Greece Before submitting your paper, make sure it contains: 1. 3 copies of the text of the paper, printed according to instructions.

2. A floppy disk or CD with the entire material of the paper (text, tables, pictures).

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4. The title page (on a separate page), which includes: a. the title and short title of the paper; b. the name and surname (full name)of the author(s); c. the academic centre(s) of origin; d. the corresponding authors’ name, address and telephone number; 5. English and Greek abstracts, with the following structure: background, methods, results and conclusions (double space, separate page) and keywords.

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10. Tables (one per page) in three copies.

11. Figures with an arrow at the back showing the top, numbered, in two copies.

12. Figure titles (double space - on separate pages) in three copies.

“√È ÂÚ›ÔÏÔÈ Ù˘ ÂÈÚ‹Ó˘” Diana Marcela Cortes, 10 ¯ÚÔÓÒÓ, ∫ÔÏÔÌ‚›· ¶·È‰› Ì ÌÂÚÈ΋ fiÚ·ÛË “∆· Ù˘ÊÏ¿ ·È‰È¿ ˙ˆÁÚ·Ê›˙Ô˘Ó”, ÕÓÓ· §·Ô˘Ù¿ÚË°ÎÚÈÙ˙¿Ï·, ∞ı‹Ó· 2006

“The patrol of the Peace”, Diana Marcela Cortes, 10 years old, Colombia Partially blind child “Blind children paint”, Anna Laoutari-Gritzala, Athens 2006

∞¡∞™∫√¶∏™∏

REVIEW ARTICLE

1

ªÈÙÔ¯ÔÓ‰Úȷο ÓÔÛ‹Ì·Ù· Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ ∞. ¡ÙÈÓfiÔ˘ÏÔ˜1, ∞. ¶··‰ËÌËÙÚ›Ô˘2 ¶ÂÚ›ÏË„Ë: ∆· ÌÈÙÔ¯ÔÓ‰Úȷο ÓÔÛ‹Ì·Ù· ·ÔÙÂÏÔ‡Ó ÌÈ· ÔÌ¿‰· ÛÔÚ·‰ÈÎÒÓ ‹ ÎÏËÚÔÓÔÌÔ‡ÌÂÓˆÓ ÓÔÛËÌ¿ÙˆÓ Ù· ÔÔ›· ÚÔηÏÔ‡ÓÙ·È ·fi ÌÂÙ·ÏÏ¿ÍÂȘ ÁÔÓȉ›ˆÓ ÙÔ˘ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ ‹ ˘ÚËÓÈÎÔ‡ DNA Ô˘ Έ‰ÈÎÔÔÈÔ‡Ó ÚˆÙ½Ó˜ ··Ú·›ÙËÙ˜ ÁÈ· ÙË ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ÌÈÙÔ¯ÔÓ‰Ú›Ô˘. ∏ ÈÔ Û˘¯Ó‹ ‰È·Ù·Ú·¯‹ ·ÊÔÚ¿ ÙËÓ ÔÍÂȉˆÙÈ΋ ʈÛÊÔÚ˘Ï›ˆÛË Î·È ÔÊ›ÏÂÙ·È Û ·ÓÂ·Ú΋ ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ Û˘ÌÏÂÁÌ¿ÙˆÓ (I-V) Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ ·Ï˘Û›‰·˜ Ì ·ÔÙ¤ÏÂÛÌ· ÙË ÌÂȈ̤ÓË ÂÓ‰Ô΢ÙÙ·ÚÈ΋ ·Ú·ÁˆÁ‹ ÂÓ¤ÚÁÂÈ·˜. ∂ÈÚÔÛı¤Ùˆ˜ Ë ÚÔÛ‚ÔÏ‹ ¿ÏÏˆÓ ÏÂÈÙÔ˘ÚÁÈÒÓ ÙÔ˘ ÌÈÙÔ¯ÔÓ‰Ú›Ô˘, fiˆ˜ Ù˘ ÚˆÙÂ˚ÓÈ΋˜ Û‡ÓıÂÛ˘, Ù˘ ‰È·ÌÂÌ‚Ú·ÓÈ΋˜ ÌÂÙ·ÊÔÚ¿˜, Ù˘ Û˘Ó·ÚÌÔÏfiÁËÛ˘ ÙˆÓ Û˘ÌÏÂÁÌ¿ÙˆÓ, Ù˘ Û˘ÓÙ‹ÚËÛ˘ ÙÔ˘ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ DNA ÌÔÚ› Ó· ÚÔηϤÛÔ˘Ó ÌÈÙÔ¯ÔÓ‰Úȷ΋ ÓfiÛÔ. ¶ÚfiÎÂÈÙ·È ÁÈ· ÔÏ˘Û˘ÛÙËÌ·ÙÈο ÓÔÛ‹Ì·Ù· Ì ÂΉËÏÒÛÂȘ ·fi ÙÔ ÎÂÓÙÚÈÎfi Ó¢ÚÈÎfi Î·È Ó¢ÚÔÌ˘˚Îfi Û‡ÛÙËÌ·, ÙÔ˘˜ ÔÊı·ÏÌÔ‡˜, ÙËÓ Î·Ú‰È¿, ÙÔ˘˜ ÓÂÊÚÔ‡˜, ÙÔÓ Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ, ÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi Î·È ÂÓ‰ÔÎÚÈÓÈÎfi Û‡ÛÙËÌ·. ∏ ‰È·ÁÓˆÛÙÈ΋ ÚÔÛ¤Ï·ÛË Â›Ó·È ‰‡ÛÎÔÏË ÏfiÁˆ Ù˘ ¿Ù˘˘ ÎÏÈÓÈ΋˜ ÂÈÎfiÓ·˜, ·Ô˘Û›·˜ ·ıÔÁÓˆÌÔÓÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ Î·È ÂÓ‰ÔÁÂÓÒÓ ÂÚÈÔÚÈÛÌÒÓ ÛÙËÓ ·ÍÈÔÏfiÁËÛË ÙˆÓ ‚ÈÔ¯ËÌÈÎÒÓ Î·È ÌÔÚÈ·ÎÒÓ ÂÍÂÙ¿ÛˆÓ. °È· Ù· ·È‰È¿ ¤¯Ô˘Ó ÚÔÙ·ı› ÙÚÔÔÔÈË̤ӷ ‰È·ÁÓˆÛÙÈο ÎÚÈÙ‹ÚÈ· Ù· ÔÔ›· ÂÓۈ̷ÙÒÓÔ˘Ó ÎÏÈÓÈο, ‚ÈÔ¯ËÌÈο, ÂÓ˙˘ÌÈο, ÈÛÙÔ·ıÔÏÔÁÈο Î·È ÌÔÚȷο ‰Â‰Ô̤ӷ. ∏ ÌÔÚȷ΋ ‰È¿ÁÓˆÛË Ú¤ÂÈ Ó· ·ÔÙÂÏ› ÙÔÓ ÙÂÏÈÎfi ÛÙfi¯Ô ÁÈ·Ù› ÌfiÓÔÓ ¤ÙÛÈ ÌÔÚ› Ó· Â›Ó·È ‰˘Ó·Ù‹ Ë ÁÂÓÂÙÈ΋ Û˘Ì‚Ô˘Ï‹ Î·È Î·ıÔ‰‹ÁËÛË. ∞Ó Î·È ·ÈÙÈÔÏÔÁÈ΋ ıÂÚ·›· ÙˆÓ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ ‰ÂÓ ˘¿Ú¯ÂÈ, ÔÏÏ¿ ‰Â˘ÙÂÚÔ·ı‹ ÚÔ‚Ï‹Ì·Ù· ¯Ú‹˙Ô˘Ó ·ÓÙÈÌÂÙÒÈÛ˘. ∏ ·Ó·ÛÎfiËÛË ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ÈÔ ÚfiÛÊ·ÙË ÁÓÒÛË Û¯ÂÙÈο Ì ÙÔ ÁÂÓÂÙÈÎfi ˘fi‚·ıÚÔ, ·ıÔÁÂÓÂÙÈÎÔ‡˜ Ì˯·ÓÈÛÌÔ‡˜, ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ, ‰È·ÁÓˆÛÙÈ΋ ÚÔÛ¤Ï·ÛË Î·È ıÂÚ·¢ÙÈ΋ ÛÙÚ·ÙËÁÈ΋ ÙˆÓ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ.

1 Cincinnati Children’s Hospital Medical Center, Dept of Pediatric Neurology 2 ¶·ÓÂÈÛÙËÌÈ·Îfi ¡ÔÛÔÎÔÌÂ›Ô §¿ÚÈÛ·˜, ∆Ì‹Ì· ¡Â˘ÚÔÏÔÁ›·˜ AÏÏËÏÔÁÚ·Ê›·: ∞ÚÁ‡Ú˘ ¡ÙÈÓfiÔ˘ÏÔ˜ argidino@yahoo.com

§¤ÍÂȘ ÎÏÂȉȿ: ªÈÙÔ¯ÔÓ‰Úȷο ÓÔÛ‹Ì·Ù·, ÁÂÓÂÙÈ΋, ÔÏ˘Û˘ÛÙËÌ·ÙÈο ÓÔÛ‹Ì·Ù·, ÁÂÓÂÙÈ΋ ηıÔ‰‹ÁËÛË.

Mitochondrial disorders in childhood A. Dinopoulos1, A. Papadimitriou2 Abstract: Mitochondrial disorders are caused by mutations, either sporadic or inherited, in nuclear or mitochondrial DNA genes which encode proteins essential for the mitochondrial function. The most common level of dysfunction is primary or secondary compromise of respiratory chain activity, leading to impaired oxygen utilization and reduced intracellular energy production. Other mitochondrial functions can be impaired, such as intergenomic signalling, assembling, transport and mitochondrial motility.

Mitochondrial disorders are usually multisystem disorders involving predominantly tissues or organs with high oxygen and energy demands, such as skeletal muscle, myocardium, brain, eyes, ears, kidneys, intestines and bone marrow. Several mitochondrial syndromes have been described, but many patients and particularly children, who meet the morphological, biochemical and/or molecular criteria for a mitochondrial disorder, do not fall into a syndrome phenotype. During childhood the clinical and genetic heterogeneity and the absence of “gold standards” makes the diagnostic evaluation challenging.

Generally the diagnostic approach has to be individualized and requires an integral approach, incorporating clinical, biochemical, imaging, histological and genetic investigations. Consensus diagnostic criteria have been proposed for respiratory chain defects in infants and children and, despite some limitations, they appear to be sensitive in the paediatric population. The diagnostic efforts should aim at the genetic characterization, because under certain circumstances this may provide the framework for genetic counselling. Although there is no specific therapy and cure for the mitochondrial diseases, many secondary problems require specific treatment. This review summarizes present knowledge about the genetic background, pathogenetic mechanisms, clinical manifestations, diagnostic approach and therapeutic strategies of mitochondriopathies.

1 Cincinnati Children’s Hospital Medical Center, Dept of Pediatric Neurology 2 University Hospital of Larissa, Dept of Neurology Correspondence: Argirios Dinopoulos argidino@yahoo.com

Key words: Mitochondrial disorders, genetics, multisystem disorders, genetic counselling.

¶·È‰È·ÙÚÈ΋ 2007;70:1-17

2

∞. ¡ÙÈÓfiÔ˘ÏÔ˜, ∞. ¶··‰ËÌËÙÚ›Ô˘

Â›Ó·È ÚˆÙÂ˚ÓÈ΋ Î·È Û˘ÌÌÂÙ¤¯ÂÈ ÛÙËÓ ÔÍÂȉˆÙÈ΋ ʈÛÊÔÚ˘Ï›ˆÛË. ∆· ¤Ó˙˘Ì· Ù˘ ·Ó·Ó¢ÛÙÈ΋ ·Ï˘Û›‰·˜, ··Ú·›ÙËÙ· ÁÈ· ÙËÓ ÔÍÂȉˆÙÈ΋ ʈÛÊÔÚ˘Ï›ˆÛË, ‚Ú›ÛÎÔÓÙ·È ÛÙȘ ·ÎÚÔÏÔʛ˜ Ô˘ Û¯ËÌ·Ù›˙ÔÓÙ·È ·fi ·Ó·‰ÈÏÒÛÂȘ Ù˘ ÂÛˆÙÂÚÈ΋˜ ÌÂÌ‚Ú¿Ó˘. ¢˘ÛÏÂÈÙÔ˘ÚÁ›· ÙˆÓ ÌÈÙÔ¯ÔÓ‰Ú›ˆÓ ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ÚÈÓ ·fi 44 ¯ÚfiÓÈ· Ì ÙËÓ ÎÏ·ÛÈ΋ ‰ËÌÔÛ›Â˘ÛË ÙˆÓ Luft et al. Î·È ÙËÓ ÂÚÈÁÚ·Ê‹ ÂÓfi˜ ·ÛıÂÓÔ‡˜ Ì ˘ÂÚÌÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ ÌÈÙÔ¯ÔÓ‰Úȷ΋˜ ·ÈÙÈÔÏÔÁ›·˜ (1). ∏ Û˘¯ÓfiÙËÙ· ‰È·Ù·Ú·¯ÒÓ ÛÙËÓ ·Ó·Ó¢ÛÙÈ΋ ·Ï˘Û›‰· ÛÙËÓ ·È‰È΋ ËÏÈΛ· ˘ÔÏÔÁ›˙ÂÙ·È ÌÂٷ͇ 1/5.000 Î·È 1/11.000 ÁÂÓÓ‹ÛÂȘ (2,3), ÂÓÒ

∂ÈÛ·ÁˆÁ‹ ∆· ÌÈÙÔ¯fiÓ‰ÚÈ· Â›Ó·È ÔÚÁ·Ó›‰È· ÙÔ˘ ΢ÙÙ·ÚÔÏ¿ÛÌ·ÙÔ˜ ˘‡ı˘Ó· ÁÈ· ÙËÓ ÂÓ‰Ô΢ÙÙ¿ÚÈ· ·Ú·ÁˆÁ‹ ÂÓ¤ÚÁÂÈ·˜. ™ÙÔ ÂÛˆÙÂÚÈÎfi ÙÔ˘ ÌÈÙÔ¯ÔÓ‰Ú›Ô˘ ‚Ú›ÛÎÂÙ·È Ë ıÂ̤ÏÈ· Ô˘Û›·, Ô˘ ÂÚȤ¯ÂÈ ¤Ó˙˘Ì· ÁÈ· ‰È¿ÊÔÚ˜ ÌÂÙ·‚ÔÏÈΤ˜ Ô‰Ô‡˜ Î·È ÚˆÙÂ˚ÓÔÛ‡ÓıÂÛË, (∂ÈÎfiÓ· 1) Î·È ÙÔ ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi DNA ÙÔ ÔÔ›Ô Îˆ‰ÈÎÔÔÈ› ÚˆÙ½Ó˜ ÁÈ· ÙË ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘. ∏ ÌÂÌ‚Ú¿ÓË Ô˘ ÂÚÈ‚¿ÏÂÈ Ù· ÌÈÙÔ¯fiÓ‰ÚÈ· Â›Ó·È ‰ÈÏ‹: Ë Â͈ÙÂÚÈ΋ ÌÂÌ‚Ú¿ÓË Â›Ó·È ÏÈȉÈ΋ Î·È Â›Ó·È ˘‡ı˘ÓË ÁÈ· ÙË ÌÂÙ·ÊÔÚ¿ ÙˆÓ Û˘ÛÙ·ÙÈÎÒÓ ·fi ÙÔ Î˘ÙÙ·ÚfiÏ·ÛÌ· ÛÙË ıÂ̤ÏÈ· Ô˘Û›·, ÂÓÒ Ë ÂÛˆÙÂÚÈ΋ ÌÂÌ‚Ú¿ÓË

∞Ï·Ó›ÓË

∂͈ÙÂÚÈ΋ ªÈÙÔ¯ÔÓ‰Úȷ΋ ªÂÌ‚Ú¿ÓË

°·Ï·ÎÙÈÎfi Tim

¶˘ÚÔÛÙ·Ê˘ÏÈÎfi ¶ÚˆÙ½Ó˜ ¶∞

¶∞-º

ºˆÛÊÔÎÚ·ٛÓË ∫Ú·ٛÓË

27,19 ATP ADP

M-CK

NADH ∞ÎÂÙ˘ÏÔCoA

πÛÔÎÈÙÚÈÎfi √Í·ÏÔ·ÎÂÙÈÎfi

NAD+

NAD

∫ÈÙÚÈÎfi

NADH

∂ÛˆÙÂÚÈ΋ ªÈÙÔ¯ÔÓ‰Úȷ΋ ªÂÌ‚Ú¿ÓË

NADH

NADH µ-ÔÍ›‰ˆÛË ÙˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ

NADH

+

2-√∏-ÎÂÙÔÁÏ˘Ù·ÚÈÎfi

ª·ÏÈÎfi

NADH ™Ô˘ÎÈÓ˘ÏÔÛ˘Ó¤Ó˙˘ÌÔ-∞

ºÔ˘Ì·ÚÈÎfi

™Ô˘ÎÈÓÈÎfi ATP

FADH2 FADH2 Û. ππ

ADP H+

Û. π

Û. V

™˘ÓQ Û. πππ

∫˘Ùfi¯Ú. c

Û. IV

√2 H2√

∞ÓÈfiÓÙ· ATP, ADP (ADP-ATP-ÙÚ·ÓÛÏÔοÛË)

∂͈ÙÂÚÈ΋ ªÈÙÔ¯ÔÓ‰Úȷ΋ ªÂÌ‚Ú¿ÓË

H+

∂ÈÎfiÓ· 1. ªÂÙ·‚ÔÏÈΤ˜ Ô‰Ô› ÛÙÔ ÌÈÙÔ¯fiÓ‰ÚÈÔ: ∞Ó·ÁˆÁÈο ÈÛÔ‰‡Ó·Ì· (NADH, FADH2) Û˘ÓÙ›ıÂÓÙ·È ·fi ÙÔ˘˜ ˘‰·Ù¿ÓıڷΘ ̤ۈ ÙÔ˘ ·ÎÏÔ˘ ÙÔ˘ Krebs Î·È ·fi Ù· ÏÈ·Ú¿ Ôͤ· ̤ۈ Ù˘ ‚-ÔÍ›‰ˆÛ˘ Î·È ÂÈÛ¤Ú¯ÔÓÙ·È Ì ÙË ÌÔÚÊ‹ ËÏÂÎÙÚÔÓ›ˆÓ Û ‰È·ÊÔÚÂÙÈο ÛËÌ›· Ù˘ ·Ï˘Û›‰·˜. ∏ÏÂÎÙÚfiÓÈ· ·fi NADH (ÁÏÔ˘Ù·ÌÈÎfi, ˘ÚÔÛÙ·Ê˘ÏÈÎfi, 3√∏-‚Ô˘Ù˘ÚÈÎfi Ô͇ Î·È ÏÈ·Ú¿ Ôͤ·) ÚÔÛ‰›‰ÔÓÙ·È ÛÙÔ Û‡ÌÏÂÁÌ· I, ËÏÂÎÙÚfiÓÈ· ·fi FADH2 (ÛÔ˘ÎÈÓÈÎfi) ÛÙÔ Û‡ÌÏÂÁÌ· II Î·È ËÏÂÎÙÚfiÓÈ· ·fi FADH2 (ÏÈ·Ú¿ Ôͤ·) ·¢ı›·˜ ÛÙÔ Û˘Ó¤Ó˙˘ÌÔ Q. ™ÙË Û˘Ó¤¯ÂÈ· Ì ÙË ‚Ô‹ıÂÈ· ÙÔ˘ Û˘ÓÂÓ˙‡ÌÔ˘ Q Ù· ËÏÂÎÙÚfiÓÈ· ÌÂٷʤÚÔÓÙ·È ·fi Ù· Û˘ÌϤÁÌ·Ù· π Î·È ππ ÛÙÔ Û‡ÌÏÂÁÌ· πππ Î·È ·ÎÔÏÔ‡ıˆ˜, ̤ۈ ÙÔ˘ ΢ÙÔ¯ÚÒÌ·ÙÔ˜ c, ÂÚÓÔ‡Ó ÛÙÔ Û‡ÌÏÂÁÌ· IV. ∏ ÂÓ¤ÚÁÂÈ· Ô˘ ·ÂÏ¢ıÂÚÒÓÂÙ·È ·fi ÙË ÚÔ‹ ÙˆÓ ËÏÂÎÙÚÔÓ›ˆÓ ηٿ Ì‹ÎÔ˜ ÙˆÓ Û˘ÌÏÂÁÌ¿ÙˆÓ π, ππ, πππ, IV ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÁÈ· ÙËÓ ¿ÓÙÏËÛË ÚˆÙÔÓ›ˆÓ ·fi ÙË ıÂ̤ÏÈ· Ô˘Û›· ÛÙÔÓ ‰È·ÌÂÌ‚Ú·ÓÈ·Îfi ¯ÒÚÔ Î·È ÙË ‰ËÌÈÔ˘ÚÁ›· ËÏÂÎÙÚÔ¯ËÌÈ΋˜ ‰È·ÊÔÚ¿˜ ‰˘Ó·ÌÈÎÔ‡ (¢„). ∏ ‰˘Ó·ÌÈ΋ ·˘Ù‹ ÂÓ¤ÚÁÂÈ·, ·ÔıËÎÂ˘Ì¤ÓË ˆ˜ ¢„, ¿ÁÂÈ ÙË Û‡ÓıÂÛË ATP ·fi ADP ̤ۈ ÙÔ˘ Û˘ÌϤÁÌ·ÙÔ˜ V (ATP Û˘ÓıÂÙ¿Û˘), Ì ٷ˘Ùfi¯ÚÔÓË Â·Ó·ÊÔÚ¿ ÙˆÓ ÚˆÙÔÓ›ˆÓ ÛÙË ıÂ̤ÏÈ· Ô˘Û›· (6).

Paediatriki 2007;70:1-17

3

ªÈÙÔ¯ÔÓ‰Úȷο ÓÔÛ‹Ì·Ù· Ù˘ ·È‰È΋˜ ËÏÈΛ·˜

Ë Û˘¯ÓfiÙËÙ· ÌÂÙ·ÏÏ¿ÍÂˆÓ ÙÔ˘ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ DNA ÛÙÔ˘˜ ÂÓ‹ÏÈΘ ÂÎÙÈÌ¿Ù·È 1:8000 (4). ªÈ· Û¯ÂÙÈο ÚfiÛÊ·ÙË ÌÂϤÙË ·fi ÙËÓ ∞˘ÛÙÚ·Ï›·, ‚·ÛÈṲ̂ÓË Û ÎÚÈÙ‹ÚÈ· ÁÈ· ÙË ‰È¿ÁÓˆÛË, ˘ÔÏÔÁ›˙ÂÈ ÙÔÓ ÂÏ¿¯ÈÛÙÔ ÂÈÔÏ·ÛÌfi ÙˆÓ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ ÛÙȘ 1/7634 ÁÂÓÓ‹ÛÂȘ (5). √È ·ÓˆÙ¤Úˆ Û˘¯ÓfiÙËÙ˜ ‰ÂÓ Ê·›ÓÂÙ·È fiÙÈ ·ÓÙ·ÔÎÚ›ÓÔÓÙ·È ÛÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ· ÁÈ·Ù›, ÏfiÁˆ Ù˘ ÂÙÂÚÔÁ¤ÓÂÈ·˜ Ù˘ ÓfiÛÔ˘, ÌfiÓÔÓ ¤Ó· ÔÛÔÛÙfi ·ÛıÂÓÒÓ ·Ú·¤ÌÔÓÙ·È Û ÂȉÈο ΤÓÙÚ· ÁÈ· ÙÂÎÌËÚ›ˆÛË Ù˘ ‰È¿ÁÓˆÛ˘.

¶·ıÔÁ¤ÓÂÛË ÙˆÓ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ ∆Ô ÌÈÙÔ¯fiÓ‰ÚÈÔ ÂÚȤ¯ÂÈ ¤Ó· ΢ÎÏÈÎfi DNA ÁÔÓȉ›ˆÌ· ÙÔ ÔÔ›Ô ·ÔÙÂÏ› ÙËÓ ‚¿ÛË ÙÔ˘ ‰ÈÎÔ‡ ÙÔ˘ ÁÂÓÂÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ∏ Έ‰ÈÎÔÔ›ËÛË ÙˆÓ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÒÓ ÚˆÙÂ˚ÓÒÓ ‚Ú›ÛÎÂÙ·È ˘fi ÙËÓ ÂÈÚÚÔ‹ ‰‡Ô ÁÂÓÂÙÈÎÒÓ Û˘ÛÙËÌ¿ÙˆÓ ÙÔ˘ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ Î·È ÙÔ˘ ˘ÚËÓÈÎÔ‡. ∆Ô ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi DNA Έ‰ÈÎÔÔÈ› 13 ˘ÔÔÌ¿‰Â˜ Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ ·Ï˘Û›‰·˜ Î·È Ù· tRNAs Î·È rRNAs ··Ú·›ÙËÙ· ÁÈ· ÙË ÌÂÙ¿ÊÚ·Û‹ ÙÔ˘˜, ÂÓÒ Ô ÌÂÁ·Ï‡ÙÂÚÔ˜ ·ÚÈıÌfi˜ ˘ÔÔÌ¿‰ˆÓ Î·È ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÒÓ ÚˆÙÂ˚ÓÒÓ Îˆ‰ÈÎÔÔÈÂ›Ù·È ·fi ÙÔ ˘ÚËÓÈÎfi DNA. ∏ ‰ÈÏ‹ ·˘Ù‹ ÁÂÓÂÙÈ΋ ÂÈÚÚÔ‹ Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ ·Ï˘Û›‰·˜ Â›Ó·È ˘‡ı˘ÓË ÁÈ· ÙÔ fiÙÈ ÛÙ· ÌÈÙÔ¯ÔÓ‰Úȷο ÓÔÛ‹Ì·Ù· ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› fiÏÔÈ ÔÈ Ù‡ÔÈ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜. ∏ ÔÌ·Ï‹ ·Ú·ÁˆÁ‹ ÂÓ¤ÚÁÂÈ·˜ ÛÙÔ ÌÈÙÔ¯fiÓ‰ÚÈÔ ··ÈÙ› ÙÔÓ Û˘ÓÙÔÓÈÛÌfi ÔÏÏÒÓ ÏÂÈÙÔ˘ÚÁÈÒÓ. ªÈÙÔ¯ÔÓ‰ÚÈ·Îfi ÓfiÛËÌ· ÚÔ·ÙÂÈ fiÙ·Ó Ë ÎÏËÚÔÓÔÌÔ‡ÌÂÓË ‹ ÛÔÚ·‰È΋ ‚Ï¿‚Ë ÛÙÔ ˘ÚËÓÈÎfi ‹ ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi DNA ÂËÚ¿ÛÂÈ ¤Ó· ·fi Ù· Â›‰· ÏÂÈÙÔ˘ÚÁ›·˜ fiˆ˜ ·Ó·ÁÚ¿ÊÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1 (7). ÷ڷÎÙËÚÈÛÙÈÎfi ÙˆÓ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ Â›Ó·È Ë ÂÙÂÚÔÁ¤ÓÂÈ· ÛÙÔÓ ÎÏÈÓÈÎfi Ê·ÈÓfiÙ˘Ô. °È· ÙËÓ ÂÍ‹ÁËÛË Ù˘ Ê·ÈÓÔÙ˘È΋˜ ÂÙÂÚÔÁ¤ÓÂÈ·˜ Â›Ó·È ÛËÌ·ÓÙÈÎfi Ó· ηٷÓÔËıÔ‡Ó ‰‡Ô ‚·ÛÈΤ˜ ·Ú¯¤˜: Ë ÂÙÂÚÔÏ·ÛÌ›· (heteroplasmy) Î·È Ô Ô˘‰fi˜ Ê·ÈÓÔÙ˘È΋˜ ¤ÎÊÚ·Û˘ (threshold effect). ∫¿ı ·ÙÙ·ÚÔ ÂÚȤ¯ÂÈ ÌÂÁ¿ÏÔ ·ÚÈıÌfi ÌÈÙÔ¯ÔÓ‰Ú›ˆÓ (Î˘Ì·›ÓÂÙ·È ·fi ÌÂÚÈΤ˜ ÂηÙÔÓÙ¿‰Â˜ ̤¯ÚÈ ÌÂÚÈ-

Τ˜ ¯ÈÏÈ¿‰Â˜) Î·È Î¿ı ÌÈÙÔ¯fiÓ‰ÚÈÔ ÂÚȤ¯ÂÈ 2-10 ·ÓÙ›ÁÚ·Ê· ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ DNA. ∫·Ù¿ ÙË ÌÈÙˆÙÈ΋ ‰È·›ÚÂÛË ÙÔ Î‡ÙÙ·ÚÔ ‰›ÓÂÈ ¤Ó·Ó Ù˘¯·›Ô ·ÚÈıÌfi ÌÈÙÔ¯ÔÓ‰Ú›ˆÓ ÛÙ· ı˘Á·ÙÚÈο ·ÙÙ·Ú·, Ê·ÈÓfiÌÂÓÔ Ô˘ ÔÓÔÌ¿˙Ô˘Ì ÌÈÙˆÙÈÎfi ‰È·¯ˆÚÈÛÌfi (mitotic segregation). ªÂÙ¿ÏÏ·ÍË ÙÔ˘ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ DNA ÛÙÔ ÚÔÁÔÓÈÎfi ·ÙÙ·ÚÔ ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙË ‰ËÌÈÔ˘ÚÁ›· ‰‡Ô ÏËı˘ÛÌÒÓ ÌÈÙÔ¯ÔÓ‰Ú›ˆÓ ÛÙ· ı˘Á·ÙÚÈο ·ÙÙ·Ú· (∂ÈÎfiÓ· 2), Ê·ÈÓfiÌÂÓÔ Ô˘ ÔÓÔÌ¿˙ÂÙ·È ÂÙÂÚÔÏ·ÛÌ›· (heteroplasmy). ∫ÏÈÓÈ΋ Û˘Ìو̷ÙÔÏÔÁ›· ÂÌÊ·Ó›˙ÂÙ·È fiÙ·Ó ÙÔ ÔÛÔÛÙfi ÙˆÓ ÌÈÙÔ¯ÔÓ‰Ú›ˆÓ Ô˘ ʤÚÔ˘Ó ÙË ÌÂÙ¿ÏÏ·ÍË ÍÂÂÚ¿ÛÂÈ ¤Ó·Ó Û˘ÁÎÂÎÚÈ̤ÓÔ Ô˘‰fi ÛÙÔ Î‡ÙÙ·ÚÔ (Ô˘‰fi˜ Ê·ÈÓÔÙ˘È΋˜ ¤ÎÊÚ·Û˘/ threshold effect) Î·È Â›Ó·È ÈηÓfi Ó· ÂËÚ¿ÛÂÈ ÙËÓ ÂÓ‰Ô΢ÙÙ¿ÚÈ· ·Ú·ÁˆÁ‹ ÂÓ¤ÚÁÂÈ·˜. √ Ô˘‰fi˜ ÂÍ·ÚÙ¿Ù·È ·fi ÙȘ ÂÓÂÚÁÂȷΤ˜ ·Ó¿ÁΘ ÙÔ˘ ÈÛÙÔ‡ Î·È ·fi ÙÔ Â›‰Ô˜ Ù˘ ÌÂÙ¿ÏÏ·Í˘ (6,8).

∫ÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ & ªÈÙÔ¯ÔÓ‰Úȷο Û‡Ó‰ÚÔÌ· ªÈÙÔ¯ÔÓ‰Úȷο ÓÔÛ‹Ì·Ù· ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› Û fiϘ ÙȘ ËÏÈÎȷΤ˜ ÔÌ¿‰Â˜. ∏ ÓfiÛÔ˜ ·ÎÔÏÔ˘ı› Û˘Ó‹ıˆ˜ ÌÈ· ‚Ú·‰Â›· ÂÍÂÏÈÛÛfiÌÂÓË ÔÚ›· Ì ÂÍ¿ÚÛÂȘ Ù˘ ÓfiÛÔ˘ ˘fi ÙË ÌÔÚÊ‹ ÌÂÙ·‚ÔÏÈÎÒÓ ÎÚ›ÛÂˆÓ Î¿Ùˆ ·fi ηٷÛÙ¿ÛÂȘ stress. ∏ ÂͤÏÈÍË Ù˘ ÓfiÛÔ˘ ÌÔÚ› Ó· Â›Ó·È Ú·Á‰·›· ÛÙË ÓÂÔÁÓÈ΋ ËÏÈΛ·, ÂÓÒ ˘¿Ú¯ÂÈ ÌÈ· Ù¿ÛË ÛÙ·ıÂÚÔÔ›ËÛ˘ ÌÂÙ¿ ÙÔÓ ÚÒÙÔ ¯ÚfiÓÔ Ù˘ ˙ˆ‹˜. °ÂÓÈÎfiÙÂÚ· Ë ÔÚ›· Ù˘ ÓfiÛÔ˘ ÂÍ·ÚÙ¿Ù·È Û ÌÂÁ¿ÏÔ ‚·ıÌfi ·fi ÙÔ Â›‰Ô˜ ÙÔ˘ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ ÓÔÛ‹Ì·ÙÔ˜ Î·È ·fi ÙËÓ ·ÚÔ˘Û›· ‹ fi¯È ÔÏ˘Û˘ÛÙËÌ·ÙÈ΋˜ Û˘ÌÌÂÙÔ¯‹˜. ŸÚÁ·Ó· Î·È ÈÛÙÔ› Ì ·˘ÍË̤Ó˜ ÂÓÂÚÁÂȷΤ˜ ·Ó¿ÁΘ fiˆ˜ ÂÁΤʷÏÔ˜, ̇˜, ·ÌÊÈ‚ÏËÛÙÚÔÂȉ‹˜, ÓÂÊÚÈο ÛˆÏËÓ¿ÚÈ· Â›Ó·È ÈÔ Â˘¿ÏˆÙ· ÛÙË ÌÈÙÔ¯ÔÓ‰Úȷ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Î·È ÚÔÛ‚¿ÏÏÔÓÙ·È ÈÔ Û˘¯Ó¿. ™ÙËÓ ·È‰È΋ ËÏÈΛ· ÔÈ ÌÈÙÔ¯ÔÓ‰ÚÈÔ¿ıÂȘ ÚÔ‚¿ÏÏÔ˘Ó ÛÙËÓ ÏÂÈÔ„ËÊ›· ÙˆÓ ÂÚÈÙÒÛÂˆÓ ˆ˜ ¿Ù˘Ë ÂÁÎÂÊ·ÏÔÌ˘Ô¿ıÂÈ· Ì ‹ ¯ˆÚ›˜ ÙË Û˘ÌÌÂÙÔ¯‹ ¿ÏÏˆÓ Û˘ÛÙËÌ¿ÙˆÓ (¶›Ó·Î·˜ 2). ∆· ÁÓˆÛÙ¿ ÌÈÙÔ¯ÔÓ‰Úȷο Û‡Ó‰ÚÔÌ· Ô˘ ÂÚÈÁÚ¿ÊÔÓÙ·È Î·ÙˆÙ¤Úˆ ··ÓÙÒÓÙ·È ÈÔ

¶›Ó·Î·˜ 1. ¶·ıÔÁÂÓÂÙÈÎÔ› Ì˯·ÓÈÛÌÔ› Ô˘ ÂÓ¤¯ÔÓÙ·È ÛÙËÓ ÚfiÎÏËÛË ÚˆÙÔ·ıÒÓ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ ªÂÙ·ÏÏ¿ÍÂȘ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ DNA

ªÂÙ·ÏÏ¿ÍÂȘ ˘ÚËÓÈÎÔ‡ DNA

i. ªÂÙ·ÏÏ¿ÍÂȘ Ô˘ Έ‰ÈÎÔÔÈÔ‡Ó i. ¢È·Ù·Ú·¯¤˜ Û ‰ÔÌÈο ÁÔÓ›‰È· Ù˘ ÔÍÂȉˆÙÈ΋˜ ˘ÔÔÌ¿‰Â˜ ÙˆÓ Û˘ÌÏÂÁÌ¿ÙˆÓ ÊˆÛÊÔÚ˘Ï›ˆÛ˘ Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ ·Ï˘Û›‰·˜ ii. ¢È·Ù·Ú·¯¤˜ Û ÁÔÓ›‰È· Ô˘ ÂÓ¤¯ÔÓÙ·È ÛÙË Û˘Ó·ÚÌÔÏfiÁËÛË ii. ªÂÙ·ÏÏ¿ÍÂȘ Ô˘ ÂËÚ¿˙Ô˘Ó ÙË (assembly) ÙˆÓ Û˘ÌÏÂÁÌ¿ÙˆÓ ÌÈÙÔ¯ÔÓ‰Úȷ΋ ÚˆÙÂ˚ÓÈ΋ Û‡ÓıÂÛË iii. ¢È·Ù·Ú·¯¤˜ ÛÙË Û˘ÓÙ‹ÚËÛË ÙÔ˘ mtDNA Î·È ÛÙË (tRNA, rRNA) ‰È·ÁÔÓȉȷ΋ Û‹Ì·ÓÛË (intergenomic signalling) ñ ™ÔÚ·‰Èο ÂÏÏ›ÌÌ·Ù· / ·Ó·‰ÈÏ·ÛÈ·ÛÌÔ› iv. ¢È·Ù·Ú·¯¤˜ Û ÁÔÓ›‰È· Ô˘ ÂÓ¤¯ÔÓÙ·È ÛÙËÓ ÔÌÔÈfiÛÙ·ÛË Î·È ñ ™ËÌÂȷΤ˜ ÌÂÙ·ÏÏ¿ÍÂȘ ÂÈÛ·ÁˆÁ‹ (import) Û˘ÛÙ·ÙÈÎÒÓ (ÚˆÙ½Ó˜, ADP) v. ¢È·Ù·Ú·¯¤˜ ÙÔ˘ ÏÈȉÈÎÔ‡ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ Ù˘ ÂÛˆÙÂÚÈ΋˜ ÌÂÌ‚Ú¿Ó˘ vi. ¢È·Ù·Ú·¯¤˜ ÛÙËÓ ÎÈÓËÙÈÎfiÙËÙ· ÙˆÓ ÌÈÙÔ¯ÔÓ‰Ú›ˆÓ ¶·È‰È·ÙÚÈ΋ 2007;70:1-17

4

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¶ÚÔÁÔÓÈÎfi ·ÙÙ·ÚÔ

£˘Á·ÙÚÈο ·ÙÙ·Ú·

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∫ÏÈÓÈ΋ Û˘Ìو̷ÙÔÏÔÁ›·

∂ÈÎfiÓ· 2. ∆Ô Ê·ÈÓfiÌÂÓÔ Ù˘ ÂÙÂÚÔÏ·ÛÌ›·˜ Î·È Ë ·Ú¯‹ ÙÔ˘ Ô˘‰Ô‡ Ê·ÈÓÔÙ˘È΋˜ ¤ÎÊÚ·Û˘: √È Ì·‡ÚÔÈ Î‡ÎÏÔÈ ·ÓÙÈÚÔÛˆÂ‡Ô˘Ó ÌÈÙÔ¯fiÓ‰ÚÈ· Ô˘ ʤÚÔ˘Ó ÙË ÌÂÙ¿ÏÏ·ÍË ÛÙÔ DNA ÙÔ˘˜ (mutant) Î·È ÔÈ Ï¢ÎÔ› ·ÎÏÔÈ Ê˘ÛÈÔÏÔÁÈο ÌÈÙÔ¯fiÓ‰ÚÈ· (wild). ªÂ ÙÔÓ ÌÈÙˆÙÈÎfi ‰È·¯ˆÚÈÛÌfi ÙˆÓ ÌÈÙÔ¯ÔÓ‰Ú›ˆÓ ‰ËÌÈÔ˘ÚÁÂ›Ù·È ÌÈ· ̈۷˚΋ ηٿÛÙ·ÛË ÛÙÔ˘˜ ÈÛÙÔ‡˜, fiÔ˘ ÙÔ ÔÛÔÛÙfi ÙˆÓ ÌÂÙ·ÏÏ·ÁÌ¤ÓˆÓ ÌÈÙÔ¯ÔÓ‰Ú›ˆÓ ‰È·Ê¤ÚÂÈ. ∫ÏÈÓÈÎfi˜ Ê·ÈÓfiÙ˘Ô˜ ÂÌÊ·Ó›˙ÂÙ·È fiÙ·Ó ÙÔ ÔÛÔÛÙfi ÙˆÓ ÌÂÙ·ÏÏ·ÁÌ¤ÓˆÓ ÌÈÙÔ¯ÔÓ‰Ú›ˆÓ Â›Ó·È ÈηÓfi Ó· ÂËÚ¿ÛÂÈ ÙËÓ ÂÓ‰Ô΢ÙÙ¿ÚÈ· ·Ú·ÁˆÁ‹ ÂÓ¤ÚÁÂÈ·˜.

Û˘¯Ó¿ ÛÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹, ÂÓÒ fiÙ·Ó ÂÌÊ·ÓÈÛÙÔ‡Ó ÛÙËÓ ·È‰È΋ ËÏÈΛ· ‰ÂÓ ÂÌÊ·Ó›˙ÔÓÙ·È Ì ÙËÓ ÎÏ·ÛÈ΋ ÙÔ˘˜ Û˘Ìو̷ÙÔÏÔÁ›· (8-14). ÕÏϘ Û˘Ó‰ÚÔÌÈΤ˜ ηٷÛÙ¿ÛÂȘ Ì ÌÈÙÔ¯ÔÓ‰Úȷ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ÂÚÈÁÚ¿ÊÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 3 (15). ¶ÚÔԉ¢ÙÈ΋ Â͈ÙÂÚÈ΋ ÔÊı·ÏÌÔÏËÁ›· & ™‡Ó‰ÚÔÌÔ Kearns-Sayre (Progressive external ophthalmoplegia PEO & Kearns-Sayre syndrome). ¶ÚÔԉ¢ÙÈ΋ ÔÊı·ÏÌÔÏËÁ›· Â›Ó·È ¤Ó· ·fi Ù· ÈÔ Û˘¯Ó¿ Û˘ÌÙÒÌ·Ù· ÛÙ· ÌÈÙÔ¯ÔÓ‰Úȷο ÓÔÛ‹Ì·Ù·. ¶ÙÒÛË ‚ÏÂÊ¿ÚˆÓ Î·È

ÔÊı·ÏÌÔÏËÁ›· ¯ˆÚ›˜ ‰Èψ›· (∂ÈÎfiÓ· 3) Â›Ó·È Ù· ·Ú¯Èο Û˘ÌÙÒÌ·Ù· Ù· ÔÔ›· ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙËÓ fi„ÈÌË ·È‰È΋ ‹ ÂÊË‚È΋ ËÏÈΛ· Î·È ÌÔÚ› Ó· Û˘Ó‰˘¿˙ÔÓÙ·È ÌÂ Ì˘˚΋ ·‰˘Ó·Ì›·, ¯ÚfiÓÈ· ÎfiˆÛË Î·È ‰˘Û·ÓÂÍ›· ÛÙËÓ ¿ÛÎËÛË. ∆Ô Û‡Ó‰ÚÔÌÔ Kearns-Sayre Â›Ó·È ÔÏ˘Û˘ÛÙËÌ·ÙÈÎfi ÓfiÛËÌ·. √ ·ÎÚÈ‚‹˜ ÔÚÈÛÌfi˜ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Â›Ó·È Ë ÂÌÊ¿ÓÈÛË, ÚÈÓ ·fi ÙËÓ ËÏÈΛ· ÙˆÓ 20 ÂÙÒÓ, ÔÊı·ÏÌÔÏËÁ›·˜ Î·È ÌÂÏ·Á¯ÚˆÛÙÈ΋˜ ·ÌÊÈ‚ÏËÛÙÚÔÂȉÔ¿ıÂÈ·˜ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ¤Ó· ·fi Ù· ÂfiÌÂÓ·: ·) ‰È·Ù·Ú·¯‹ Ù˘ ·ÁˆÁÈÌfiÙËÙ·˜ ÛÙÔ Î·Ú‰È·Îfi Ì˘ÔοډÈÔ (conduction block), ‚) ·ÚÂÁÎÂÊ·ÏȉÈ΋ ·Ù·Í›·, Á) ·˘ÍË̤ÓË ÚˆÙ½ÓË ÛÙÔ ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚfi (∂¡À). ÕÏÏ· ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ¯·ÌËÏfi ·Ó¿ÛÙËÌ·, Ó¢ÚÔ·ÈÛıËÙËÚȷ΋ ·ÒÏÂÈ· Ù˘ ·ÎÔ‹˜, ‰È·Ù·Ú·¯‹ ÛÙË ‰È·ÓÔËÙÈ΋ ÏÂÈÙÔ˘ÚÁ›·, ÛˆÏËÓ·Úȷ΋ ÓÂÊÚÔ¿ıÂÈ·. ∏ ÚfiÁÓˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Kearns-Sayre Â›Ó·È Î·Ù¿ Ôχ ‰˘ÛÌÂÓ¤ÛÙÂÚË Ù˘ PEO (14). √È ÂÚÈÛÛfiÙÂÚÔÈ ·ÛıÂÓ›˜ Ì ۇӉÚÔÌÔ KearnsSayre Î·È PEO ¤¯Ô˘Ó ¤Ó· ÌÔÓ‹Ú˜ ¤ÏÏÂÈÌÌ· ÛÙÔ ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi DNA Î·È Ë ÂÌÊ¿ÓÈÛ‹ ÙÔ˘˜ Â›Ó·È ÛÔÚ·‰È΋. ™ËÌÂȷΤ˜ ÌÂÙ·ÏÏ¿ÍÂȘ ÛÙÔ ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi DNA (A3243G) Â›Ó·È ˘‡ı˘Ó˜ ÁÈ· ÙÔ Û‡Ó‰ÚÔÌÔ PEO Ô˘ ÌÂÙ·‚È‚¿˙ÂÙ·È Ì ÙÔÓ ÌËÙÚÈÎfi Ù‡Ô ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜. ªÂÙ·ÏÏ¿ÍÂȘ ˘ÚËÓÈÎÒÓ ÁÔÓȉ›ˆÓ (ANT1, POLG1, Twinkle), Ô˘ Ô‰ËÁÔ‡Ó Û ÔÏÏ·Ï¿ ÂÏÏ›ÌÌ·Ù· ÛÙÔ ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi DNA Â›Ó·È ˘‡ı˘Ó˜ ÁÈ· ÙÔ ÎÏËÚÔÓÔÌÔ‡ÌÂÓÔ PEO (16-19). ™‡Ó‰ÚÔÌÔ Pearson. ¶·ÚÔ˘ÛÈ¿˙ÂÙ·È Î˘Ú›ˆ˜ ÛÙË ‚ÚÂÊÈ΋ ËÏÈΛ· Î·È ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÛȉËÚÔ‚Ï·ÛÙÈ΋

¶›Ó·Î·˜ 2. ∫ÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ ·Ó¿ Û˘ÛÙ‹Ì·Ù· ∫¡™

æ˘¯ÔÎÈÓËÙÈ΋ ηı˘ÛÙ¤ÚËÛË ‹ ˘ÔÛÙÚÔÊ‹, ‰È·ÓÔËÙÈ΋ ηı˘ÛÙ¤ÚËÛË, ÎÂÓÙÚÈ΋ ˘ÔÙÔÓ›· (Û˘Ó‹ıˆ˜ Û˘Ó‰˘·ÛÌfi˜ ˘ÔÙÔÓ›·˜ ÙÔ˘ ÎÔÚÌÔ‡ Î·È ˘ÂÚÙÔÓ›·˜ ÙˆÓ ¿ÎÚˆÓ), ·˘ÙÈÛÌfi˜, ·ÚÂÁÎÂÊ·ÏȉÈ΋ ·Ù·Í›·, ‰˘ÛÙÔÓ›· Î·È ¿ÏϘ ‰˘ÛÎÈÓËۛ˜, ÂÈÏË„›· (Ì˘ÔÎÏÔӛ˜ ‹ ¿ÏÏ· ›‰Ë Û·ÛÌÒÓ), ÔÏ˘Ì˘ÔÎÏÔÓ›· (ÌË ÂÈÏËÙÈ΋˜ ʇÛˆ˜), ¿Ù˘· ÂÁÎÂÊ·ÏÈο ÂÂÈÛfi‰È· (stroke-like events), ˘Ú·ÌȉÈ΋ Û˘Ó‰ÚÔÌ‹ Ì Û·ÛÙÈÎfiÙËÙ·, Â͈˘Ú·ÌȉÈ΋ Û˘Ó‰ÚÔÌ‹, „‡¯ˆÛË, ËÌÈÎÚ·Ó›·, ÎÒÌ·

¡Â˘ÚÔÌ˘˚Îfi

ÀÔÙÔÓ›· (΢ڛˆ˜ ÛÙ· ‚Ú¤ÊË), Ì˘˚΋ ·ÙÚÔÊ›· (ÂÈÎfiÓ· ÓˆÙÈ·›·˜ Ì˘˚΋˜ ·ÙÚÔÊ›·˜), Ì˘Ô¿ıÂÈ· (Û ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿ Î·È ÂÓ‹ÏÈΘ), ‡ÎÔÏË ÎfiˆÛË Î·È ‰˘Û·ÓÂÍ›· ÛÙËÓ ¿ÛÎËÛË, Ì˘˚Τ˜ ÎÚ¿Ì˜ Î·È Ì˘·ÏÁ›Â˜, Ú·‚‰ÔÌ˘fiÏ˘ÛË, ÂÚÈÊÂÚÈ΋ Ó¢ÚÔ¿ıÂÈ· (Û˘Ó‹ıˆ˜ ·ÍÔÓÈ΋ ÌÂ Û˘ÌÌÂÙÔ¯‹ ÙˆÓ ÎÈÓËÙÈÎÒÓ Î·È ·ÈÛıËÙÈÎÒÓ Ó‡ڈÓ)

√Êı·ÏÌÔ›

∫·Ù·ÚÚ¿¯Ù˘, ÌÂÏ·Á¯ÚˆÛÙÈ΋ ·ÌÊÈ‚ÏËÛÙÚÔÂȉÔ¿ıÂÈ·, ÔÙÈ΋ Ó¢ÚÔ¿ıÂÈ·, ·ÙÚÔÊ›· ÔÙÈÎÔ‡ Ó‡ÚÔ˘

∞ÎÔ‹

¡Â˘ÚÔ·ÈÛıËÙËÚȷ΋ ·ÒÏÂÈ· ·ÎÔ‹˜, ˘ÂÚ·ÎÔ˘Û›·

∫·Ú‰È¿

¢È·Ù·Ú·¯¤˜ ·ÁˆÁÈÌfiÙËÙ·˜, ˘ÂÚÙÚÔÊÈ΋ Î·È Û·ÓÈfiÙÂÚ· ‰È·Ù·ÙÈ΋ ηډÈÔÌ˘Ô¿ıÂÈ·

°·ÛÙÚÂÓÙÂÚÈÎfi Û‡ÛÙËÌ·

¶ÚÒÈÌË Ë·ÙÈ΋ ·ÓÂ¿ÚÎÂÈ· (Û˘Ó‹ıˆ˜ Û ‚Ú¤ÊË), ¯ÚfiÓÈ· Ë·ÙÔ¿ıÂÈ·, ÔÍ›· ÎÂÚ·˘ÓÔ‚fiÏÔ˜ Ë·Ù›Ùȉ· Î·È Ó¤ÎÚˆÛË (ÌÂÙ¿ ·fi ¯ÔÚ‹ÁËÛË ‚·ÏÚÔ˚ÎÔ‡ ÔͤԘ Û ۇӉÚÔÌÔ Alper), „¢‰Ô·ÔÊÚ·ÎÙÈÎfi Û‡Ó‰ÚÔÌÔ, ¯ÚfiÓÈÔ ‰È·ÚÚÔ˚Îfi Û‡Ó‰ÚÔÌÔ, ·ÓÂ¿ÚÎÂÈ· Â͈ÎÚÈÓÔ‡˜ ÌÔ›Ú·˜ ÙÔ˘ ·ÁÎÚ¤·ÙÔ˜, ΢ÎÏÈÎÔ› ¤ÌÂÙÔÈ, ‰È·Ù·Ú·¯‹ ·Ó¿Ù˘Í˘ Î·È Î·¯ÂÍ›·

¡ÂÊÚÔ›

™ˆÏËÓ·Úȷ΋ ·ÓÂ¿ÚÎÂÈ·, Û‡Ó‰ÚÔÌÔ DeToni-Debre-Fanconi, ‰È¿ÌÂÛË ÛˆÏËÓ·Úȷ΋ ÓÂÊÚ›Ùȉ·

∂Ó‰ÔÎÚÈÓÔÏÔÁÈÎfi Û‡ÛÙËÌ·

÷ÌËÏfi ·Ó¿ÛÙËÌ·, ÚÒÈÌË ÂÌÊ¿ÓÈÛË Û·Î¯·ÚÒ‰Ô˘˜ ‰È·‚‹ÙË Ù‡Ô˘ 2 (ÂÓËϛΈÓ), ˘Ô·Ú·ı˘ÚÂÔȉÈÛÌfi˜, ÔÛÙÂÔfiÚˆÛË, ˘ÔÊ˘Ûȷ΋ ·ÓÂ¿ÚÎÂÈ·

ª˘ÂÏfi˜ ÙˆÓ ÔÛÙÒÓ ™È‰ËÚÔ‚Ï·ÛÙÈ΋ ·Ó·ÈÌ›·, Ì˘ÂÏÔ‰˘ÛÏ·ÛÙÈÎfi Û‡Ó‰ÚÔÌÔ Paediatriki 2007;70:1-17

5

ªÈÙÔ¯ÔÓ‰Úȷο ÓÔÛ‹Ì·Ù· Ù˘ ·È‰È΋˜ ËÏÈΛ·˜

∂ÈÎfiÓ· 3. ∞ÌÊÔÙÂÚfiÏ¢ÚË ‚ÏÂÊ·ÚfiÙˆÛË Û ·ÛıÂÓ‹ Ì ÂÏ·ÊÚ¿ ·‰˘Ó·Ì›· Î·È Û‡Ó‰ÚÔÌÔ PEO ·fi ¤ÏÏÂÈÌÌ· ÛÙÔ ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi DNA.

·Ó·ÈÌ›·, ıÚÔÌ‚ÔÂÓ›· Î·È ·ÓÂ¿ÚÎÂÈ· Ù˘ Â͈ÎÚÈÓÔ‡˜ ÌÔ›Ú·˜ ÙÔ˘ ·ÁÎÚ¤·ÙÔ˜. §ÈÁfiÙÂÚÔ Û˘¯Ó‹ Â›Ó·È Ë ÓÂÊÚÈ΋ ÛˆÏËÓ·Úȷ΋ ÔͤˆÛË (20), Ë·ÙÈ΋ ·ÓÂ¿ÚÎÂÈ· Î·È ‰È·Ù·Ú·¯‹ Ù˘ ÂÓ‰ÔÎÚÈÓÔ‡˜ ÌÔ›Ú·˜ ÙÔ˘ ·ÁÎÚ¤·ÙÔ˜ Ì ÈÓÛÔ˘ÏÈÓÔ-ÂÍ·ÚÙÒÌÂÓÔ Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË (21). √È ÂÚÈÛÛfiÙÂÚÔÈ ·ÛıÂÓ›˜ ˘Ô·ÙÔ˘Ó ÙÔÓ ÚÒÙÔ ¯ÚfiÓÔ Ù˘ ˙ˆ‹˜, ·ÏÏ¿ ÌÂÚÈÎÔ› ·ÛıÂÓ›˜ Ô˘ ¤¯Ô˘Ó ÂÈ˙‹ÛÂÈ ·Ó¤Ù˘Í·Ó ÛÙËÓ ÔÚ›· Û‡Ó‰ÚÔÌÔ Kearns-Sayre. ∂ÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Ì·ÎÚÔ΢ÙÙ·ÚÈ΋ ·Ó·ÈÌ›·, ·‡ÍËÛË Ù˘ ·ÈÌÔÛÊ·ÈÚ›Ó˘ F, ÛȉËÚÔ‚Ï¿ÛÙ˜ ÛÙË Ì˘ÂÏÈ΋ ‚ÈÔ„›·, Á·Ï·ÎÙÈ΋ ÔͤˆÛË, ÌÂı˘ÏÔÁÏÔ˘Ù·ÎÔÓÈ΋ ÔÍÂÔ˘Ú›·, Î·È ·Ó‡ÚÂÛË ÂÚ˘ıÚÒÓ Ú·Îˆ‰ÒÓ ÈÓÒÓ ÛÙËÓ Ì˘˚΋ ‚ÈÔ„›· (22,23). ∆o Û‡Ó‰ÚÔÌÔ Pearson ¤¯ÂÈ ÂÚÈÁÚ·Ê› ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÌÂÁ¿Ï˘ Îϛ̷η˜ ·Ó·Û˘Ó‰˘·ÛÌÔ‡˜ ÙÔ˘ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ DNA (24). ™È‰ËÚÔ‚Ï·ÛÙÈ΋ ·Ó·ÈÌ›· ¤¯ÂÈ ÂÚÈÁÚ·Ê› Â›Û˘ Ì ÙËÓ ÛËÌÂȷ΋ ÌÂÙ¿ÏÏ·ÍË A8344G ηıÒ˜ Î·È Ì ÌÂÙ¿ÏÏ·ÍË ÙÔ˘ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ ÌÂÙ·ÊÔÚ¤· Ûȉ‹ÚÔ˘ (25). ª˘ÔÎÏÔÓÈ΋ ÂÈÏË„›· Ì ÂÚ˘ıÚ¤˜ Ú·ÎÒ‰ÂȘ ›Ó˜ (Myoclonic Epilepsy with Ragged Red Fibbers). ∆Ô Û‡Ó‰ÚÔÌÔ MERRF ··ÓÙ¿Ù·È Û˘Ó‹ıˆ˜ ÛÙÔ˘˜ ÂÓ‹ÏÈΘ ·ÏÏ¿ Ë Û˘Ìو̷ÙÔÏÔÁ›· ÌÔÚ› Ó· ·Ú¯›ÛÂÈ ÛÙËÓ ·È‰È΋ ËÏÈΛ·. ÷ڷÎÙËÚ›˙ÂÙ·È ·fi ÙËÓ ·ÚÔ˘Û›· Ì˘ÔÎÏÔÓÈÎÒÓ Û·ÛÌÒÓ, ÂÈÏË„›·˜, ÂÏ·ÊÚ¿˜ Ì˘˚΋˜ ·‰˘Ó·Ì›·˜ Î·È ·ÚÂÁÎÂÊ·ÏȉÈ΋˜ ·Ù·Í›·˜. ÕÏÏ· ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ¿ÓÔÈ·, ÔÙÈ΋ Ó¢ÚÔ¿ıÂÈ·, Ó¢ÚÔ·ÈÛıËÙËÚȷ΋ ·ÒÏÂÈ· ·ÎÔ‹˜, ÂÚÈÊÂÚÈ΋ Ó¢ÚÔ¿ıÂÈ·, ÔÊı·ÏÌÔÏËÁ›·, ÔÏÏ·Ï¿ ÏÈÒÌ·Ù· Î.Ï. √ Ó¢ÚÔ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ Û˘¯Ó¿ ·Ó·‰ÂÈÎÓ‡ÂÈ ÌË ÂȉÈο ÛËÌ›· fiˆ˜ ÂÁÎÂÊ·ÏÈ΋ Î·È ·ÚÂÁÎÂÊ·ÏȉÈ΋ ·ÙÚÔÊ›·. ∏ ÂÌÊ¿ÓÈÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ÛÙËÓ ·È‰È΋ ËÏÈΛ· Û˘Ó‰˘¿˙ÂÙ·È Ì ‰˘ÛÌÂÓ¤ÛÙÂÚË ÚfiÁÓˆÛË (26). ™ÙË ‚ÈÔ„›· ÛÎÂÏÂÙÈÎÔ‡ Ì˘fi˜ Û˘¯Ó¿ ·Ó¢ڛÛÎÔÓÙ·È ÂÚ˘ıÚ¤˜ Ú·ÎÒ‰ÂȘ ›Ó˜ Î·È ÛÙÔÓ Ì˘˚Îfi ÈÛÙfi Û˘¯Ó‹ Â›Ó·È Ë ·ÓÂ-

¿ÚÎÂÈ· ÙÔ˘ Û˘ÌϤÁÌ·ÙÔ˜ IV. ™ÙÔ 80% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ·ÓȯÓ‡ÂÙ·È Ë ÛËÌÂȷ΋ ÌÂÙ¿ÏÏ·ÍË A8344G (27,28). ªÈÙÔ¯ÔÓ‰Úȷ΋ ÂÁÎÂÊ·ÏÔ¿ıÂÈ·, Á·Ï·ÎÙÈ΋ ÔͤˆÛË Î·È ÂÁÎÂÊ·ÏÈο ÂÂÈÛfi‰È· (Mitochondrial encephalopathy, Lactic acidosis and Stroke). ∫ÚÈÙ‹ÚÈ· ÁÈ· ÙË ‰È¿ÁÓˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ MELAS ÚÔÙ¿ıËÎ·Ó ·fi ÙÔÓ Hirano et al. ÌÂÙ¿ ·fi ·Ó·ÛÎfiËÛË 69 ÂÚÈÙÒÛÂˆÓ (29) Î·È ÂÚÈÏ·Ì‚¿ÓÔ˘Ó: ·) ¿Ù˘Ô ÂÁÎÂÊ·ÏÈÎfi ÂÂÈÛfi‰ÈÔ ÚÈÓ ·fi ÙËÓ ËÏÈΛ· ÙˆÓ 40 ÂÙÒÓ, ‚) ÂÁÎÂÊ·ÏÔ¿ıÂÈ· ¯·Ú·ÎÙËÚÈ˙fiÌÂÓË ·fi Û·ÛÌÔ‡˜ ‹/Î·È ¿ÓÔÈ·, Á) Á·Ï·ÎÙÈ΋ ÔͤˆÛË ‹/Î·È ÂÚ˘ıÚ¤˜ Ú·ÎÒ‰ÂȘ ›Ó˜ ÛÙË Ì˘˚΋ ‚ÈÔ„›·. ™Ù· ·È‰È¿ ·Ú¯Èο ÌÔÚ› Ó· ÚÔ‚¿ÏÂÈ ˆ˜ ¿Ù˘Ë ÂÁÎÂÊ·ÏÔÌ˘Ô¿ıÂÈ·, ‰È·Ù·Ú·¯‹ ÛÙËÓ ·Ó¿Ù˘ÍË Ì ‹ ¯ˆÚ›˜ Á·Ï·ÎÙÈ΋ ÔͤˆÛË, ÂÓÒ Ù· ¯·Ú·ÎÙËÚÈÛÙÈο ÂÁÎÂÊ·ÏÈο ÂÂÈÛfi‰È· ÂÌÊ·Ó›˙ÔÓÙ·È ·ÚÁfiÙÂÚ·. ∆· ÂÁÎÂÊ·ÏÈο ÂÂÈÛfi‰È· ÚÔ‚¿ÏÔ˘Ó Ì ËÌÈ·ÓÔ„›·, ËÌÈÎÚ·Ó›· Î·È Û‡Á¯ÚÔÓË ·ÚÔ˘Û›· ÂÛÙÈ·ÎÒÓ Û·ÛÌÒÓ Î·È fiÙ·Ó ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙËÓ ·È‰È΋ ËÏÈΛ· ˘ÔÙÚÔÈ¿˙Ô˘Ó, Û˘Óԉ‡ÔÓÙ·È ·fi ·ÓıÂÎÙÈ΋ ÂÛÙȷ΋ ÂÈÏË„›· Î·È Ô‰ËÁÔ‡Ó Û ÂÁÎÂÊ·ÏÈ΋ ·ÙÚÔÊ›· Î·È ¿ÓÔÈ· (30). ∞ÂÈÎÔÓÈÛÙÈÎÒ˜ (∂ÈÎfiÓ· 4), Ë ÈÛ¯·ÈÌÈ΋ ÂÚÈÔ¯‹ ‰ÂÓ ¤¯ÂÈ Û˘ÁÎÂÎÚÈ̤ÓË ·ÁÁÂȷ΋ ·Ó·ÙÔÌÈ΋ ηٷÓÔÌ‹, ÂÓÙÔ›˙ÂÙ·È ÛÙË ‚ÚÂÁÌ·ÙÔ˚Óȷ΋ ÂÚÈÔ¯‹ Î·È Ë Ì·ÁÓËÙÈ΋ Ê·ÛÌ·ÙÔÛÎÔ›· ÚˆÙÔÓ›Ô˘ (1HMRS) ‰Â›¯ÓÂÈ ·È¯Ì‹ Á·Ï·ÎÙÈÎÔ‡ (31). ∞˘ÍË̤ÓÔ Á·Ï·ÎÙÈÎfi Â›Ó·È Â‡ÚËÌ· ÈÔ Û˘¯Ófi ÛÙÔ ∂¡À ·Ú¿ ÛÙÔÓ ÔÚfi (32). ∂ÈÚfiÛıÂÙ· ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ÌÔÚ› Ó· Â›Ó·È Ë Ì˘Ô¿ıÂÈ·, Ë Î·Ú‰ÈÔÌ˘Ô¿ıÂÈ·, Ë ÔÙÈ΋ ·ÙÚÔÊ›·, Ë ÂÚÈÊÂÚÈ΋ Ó¢ÚÔ¿ıÂÈ· ·ÍÔÓÈÎÔ‡ Ù‡Ô˘, ÙÔ ¯·ÌËÏfi ·Ó¿ÛÙËÌ·, Ô Û·Î¯·Ú҉˘ ‰È·‚‹Ù˘ Î·È Ë ÔÏ˘ÂÓ‰ÔÎÚÈÓÔ¿ıÂÈ· (33). ∞ÓÂ¿ÚÎÂÈ· ÙÔ˘ Û˘ÌϤÁÌ·ÙÔ˜ I Â›Ó·È Ë ÈÔ Û˘¯Ó‹ ·ÓÂ¿ÚÎÂÈ· Î·È ÛÙÔ 80% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ·Ó¢ڛÛÎÂÙ·È Ë ÛËÌÂȷ΋ ÌÂÙ¿ÏÏ·ÍË A3243G (14). ¡Â˘ÚÔÁÂÓ‹˜ Ì˘˚΋ ·‰˘Ó·Ì›·, ·Ù·Í›·, ÌÂÏ·Á¯ÚˆÛÙÈ΋ ·ÌÊÈ‚ÏËÛÙÚÔÂȉÔ¿ıÂÈ· & ÌËÙÚÈÎÒ˜ ÎÏËÚÔÓÔÌÔ‡ÌÂÓÔ

∂ÈÎfiÓ· 4. ™‡Ó‰ÚÔÌÔ MELAS: ∂ÁοÚÛÈ· ÙÔÌ‹ Flair ·ÎÔÏÔ˘ı›· (10 ÂÙÒÓ). ¶·ıÔÏÔÁÈÎfi Û‹Ì· ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ‚ÚÂÁÌ·ÙÈÎÔ‡ÈÓÈ·ÎÔ‡ ÏÔ‚Ô‡ ηٿ ÙË ‰È¿ÚÎÂÈ· ÂÓfi˜ stroke-like ÂÂÈÛÔ‰›Ô˘. ™ÙËÓ 1HMRS (Ì·ÎÚ¿ ·ÎÔÏÔ˘ı›·) ÌÂÁ¿ÏË ‰›ÎÔÚÊË ·È¯Ì‹ Á·Ï·ÎÙÈÎÔ‡ (‚¤ÏÔ˜). ¶·È‰È·ÙÚÈ΋ 2007;70:1-17

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∞. ¡ÙÈÓfiÔ˘ÏÔ˜, ∞. ¶··‰ËÌËÙÚ›Ô˘

Û‡Ó‰ÚÔÌÔ Leigh (Neurogenic muscle weakness, ∞taxia, and Retinitis Pigmentosa - NARP & Maternal Inherited Leigh syndrome - MILS). ∆Ô Û‡Ó‰ÚÔÌÔ ÂÌÊ·Ó›˙ÂÙ·È Ì ÔÔÈÔÓ‰‹ÔÙÂ Û˘Ó‰˘·ÛÌfi ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÙÔ˘ ·ÎÚˆÓ˘Ì›Ô˘ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ηı˘ÛÙ¤ÚËÛË Ù˘ ·Ó¿Ù˘Í˘, ÂÈÏË„›·, ¿ÓÔÈ· Î·È ·ÈÛıËÙËÚȷ΋ ÂÚÈÊÂÚÈ΋ Ó¢ÚÔ¿ıÂÈ·. ¶·ÚÂÁÎÂÊ·ÏȉÈ΋ ·Ù·Í›· ÎÔÚÌÔ‡ Î·È ¿ÎÚˆÓ Â›Ó·È ÂÌÊ·Ó‹˜, ÂÓÒ Ë Ì˘˚΋ ·‰˘Ó·Ì›· ‰‡ÛÎÔÏ· ·ÓȯÓ‡ÂÙ·È ÏfiÁˆ Ù˘ ·Ù·Í›·˜. ∆· ÙÂÓfiÓÙÈ· ·ÓÙ·Ó·ÎÏ·ÛÙÈο ·Ô˘ÛÈ¿˙Ô˘Ó Î·È ÛÙÔ ËÏÂÎÙÚÔÌ˘ÔÁÚ¿ÊËÌ· ˘¿Ú¯Ô˘Ó Â˘Ú‹Ì·Ù· ·ÍÔÓÈ΋˜ ·ÈÛıËÙËÚȷ΋˜ ÂÚÈÊÂÚÈ΋˜ Ó¢ÚÔ¿ıÂÈ·˜. ∂Ú˘ıÚ¤˜ Ú·ÎÒ‰ÂȘ ›Ó˜ ·Ô˘ÛÈ¿˙Ô˘Ó Î·È Ë ·ÓÙ›‰Ú·ÛË ÔÍÂȉ¿Û˘ ÙÔ˘ ΢ÙÔ¯ÚÒÌ·ÙÔ˜ (COX) Â›Ó·È ıÂÙÈ΋ (14). √È ÈÔ ÔÏÏÔ› ·ÛıÂÓ›˜ ʤÚÔ˘Ó ÙË ÛËÌÂȷ΋ ÌÂÙ¿ÏÏ·ÍË T8993G Ô˘ Έ‰ÈÎÔÔÈ› ÙËÓ ˘ÔÔÌ¿‰· 6 ÙÔ˘ Û˘ÌϤÁÌ·ÙÔ˜ V (ATP Û˘ÓıÂÙ¿ÛË). ∆Ô Û‡Ó‰ÚÔÌÔ ·ÔÙÂÏ› ¤Ó· ¿ÚÈÛÙÔ ·Ú¿‰ÂÈÁÌ· Ê·ÈÓÔÙ˘È΋˜ ÂÙÂÚÔÁ¤ÓÂÈ·˜ ÏfiÁˆ ÂÙÂÚÔÏ·ÛÌ›·˜: ÔÛÔÛÙfi ÌÂÙ·ÏÏ·ÁÌ¤ÓˆÓ ÌÈÙÔ¯ÔÓ‰Ú›ˆÓ ÛÙÔÓ Ì˘˚Îfi ÈÛÙfi ÌÈÎÚfiÙÂÚÔ ·fi 70% Â›Ó·È ·Û˘Ìو̷ÙÈ΋, ÔÛÔÛÙfi 70-90% ÚÔηÏ› ÓfiÛÔ NARP Î·È ÔÛÔÛÙfi ÌÂÁ·Ï‡ÙÂÚÔ ·fi 90% ÚÔηÏ› ÛÔ‚·Úfi Ê·ÈÓfiÙ˘Ô Û˘Ó‰ÚfiÌÔ˘ Leigh (34,35). ™‡Ó‰ÚÔÌÔ Leigh. ∆Ô 1951 Ô Leigh ÂÚȤÁÚ·„ ¤Ó· ·È‰› Ô˘ ˘¤Î˘„ ·fi ˘ÔÍ›· ÛÔ‚·Ú‹ ÂÁÎÂÊ·ÏÔÌ˘Ô¿ıÂÈ· Ì ·ıÔÏÔÁÔ·Ó·ÙÔÌÈΤ˜ ·ÓˆÌ·Ï›Â˜ ΢ڛˆ˜ ÛÙ· ‚·ÛÈο Á¿ÁÁÏÈ·, ÛÙÔÓ ı¿Ï·ÌÔ, ÛÙÔ˘˜ ˘Ôı·Ï¿ÌÈÔ˘˜ ˘Ú‹Ó˜ Î·È ÛÙÔ˘˜ ˘Ú‹Ó˜ ÙÔ˘ ÂÁÎÂÊ·ÏÈÎÔ‡ ÛÙÂϤ¯Ô˘˜ (36). ∏ ¤Ó·ÚÍË Ù˘ ÓfiÛÔ˘ ÂÌÊ·Ó›˙ÂÙ·È Û˘Ó‹ıˆ˜ ÛÙË ‚ÚÂÊÈ΋ ËÏÈΛ·, ·ÏÏ¿ ÌÔÚʤ˜ Ù˘ ÓfiÛÔ˘ ÌÔÚ› Ó· ÚÔ‚¿ÏÔ˘Ó Î·Ù¿ ÙËÓ ÚÒÈÌË Î·È fi„ÈÌË Ó·ÓÈ΋ ËÏÈΛ·. ™˘Ó‰˘¿˙ÂÙ·È Ì ÌÂÁ¿ÏÔ Â‡ÚÔ˜ Ó¢ÚÔÏÔÁÈÎÒÓ ÂΉËÏÒÛÂˆÓ fiˆ˜ „˘¯ÔÎÈÓËÙÈ΋ ηı˘ÛÙ¤ÚËÛË, ÔÙÈ΋ ·ÙÚÔÊ›·, ÔÊı·ÏÌÔÏËÁ›·, ‚ÏÂÊ·ÚfiÙˆÛË, Ó˘ÛÙ·ÁÌÔÂȉ›˜ ÎÈÓ‹ÛÂȘ, ·Ù·Í›·, ÙÚfiÌÔ, ‰˘ÛÙÔÓ›·, ˘Ú·ÌȉÈ΋ Û˘Ó‰ÚÔÌ‹, Ù·¯‡ÓÔÈ· Î·È ¿ÓÔÈ· ÎÂÓÙÚÈ΋˜ ·ÈÙÈÔÏÔÁ›·˜ (37). ™ÙË ‰È¿ÁÓˆÛË ‚ÔËı¿ Ë ·ÂÈÎfiÓÈÛË ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ ΢ڛˆ˜ Ì MRI, Ë ÔÔ›· ¤¯ÂÈ ·ÓÙÈηٷÛÙ‹ÛÂÈ ÙËÓ ·ıÔÏÔÁÔ·Ó·ÙÔÌÈ΋ ‰È¿ÁÓˆÛË. ™ÙËÓ MRI ÂÁÎÂÊ¿ÏÔ˘ ¤¯Ô˘Ì ¯·Ú·ÎÙËÚÈÛÙÈΤ˜ ·ÏÏÔÈÒÛÂȘ ÛÙ· ‚·ÛÈο Á¿ÁÁÏÈ· Î·È ÂÁÎÂÊ·ÏÈÎfi Û٤ϯԘ Î·È ÛÙËÓ 1HMRS ¤¯Ô˘Ì ·È¯Ì‹ Á·Ï·ÎÙÈÎÔ‡ (∂ÈÎfiÓ· 5), ΢ڛˆ˜ ÛÙÔ ·ıÔÏÔÁÈÎfi Û‹Ì· (38-43). ∆Ô Û‡Ó‰ÚÔÌÔ Leigh Â›Ó·È ‚ÈÔ¯ËÌÈο Î·È ÁÂÓÂÙÈο ÂÙÂÚÔÁÂÓ‹˜ ÓfiÛÔ˜ Î·È ÌÔÚ› Ó· ÂÌÊ·ÓÈÛÙ› ÏfiÁˆ ‰È·Ù·Ú·¯‹˜ ‰È·ÊfiÚˆÓ ÂÓ˙˘ÌÈÎÒÓ Û˘ÌÏÂÁÌ¿ÙˆÓ Ô˘ Έ‰ÈÎÔÔÈÔ‡ÓÙ·È Â›Ù ·fi ÙÔ ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi ›Ù ·fi ÙÔ ˘ÚËÓÈÎfi DNA (¶›Ó·Î·˜ 4). ªÈÙÔ¯ÔÓ‰Úȷ΋ Ó¢ÚÔ-Á·ÛÙÚÂÓÙÂÚÈ΋ ÂÁÎÂÊ·ÏÔÌ˘Ô¿ıÂÈ· (Mitochondrial Neuro-Gastro-Intestinal Encephalomyopathy - MNGIE). ∆o Û‡Ó‰ÚÔÌÔ ¯·Ú·Paediatriki 2007;70:1-17

ÎÙËÚ›˙ÂÙ·È ·fi ‰˘ÛÎÈÓËÙÈÎfiÙËÙ· ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Ì „¢‰Ô·ÔÊÚ¿ÍÂȘ, η¯ÂÍ›·, ÚÔԉ¢ÙÈ΋ Â͈ÙÂÚÈ΋ ÔÊı·ÏÌÔÏËÁ›·, ÔÏ˘Ó¢ÚÔ¿ıÂÈ· Î·È Ï¢ÎÔÂÁÎÂÊ·ÏÔ¿ıÂÈ· (44). ™ÙË ‚ÚÂÊÈ΋ ËÏÈΛ· Ë ÓfiÛÔ˜ ÚÔ‚¿ÏÂÈ ÌÂ Û˘ÌÙÒÌ·Ù· ·fi ÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi (Á·ÛÙÚÔ¿ÚÂÛË, ‰˘ÛÊ·Á›·, „¢‰Ô·fiÊÚ·ÍË) (45). ∏ ÎÈÓËÙÈÎÔ-·ÈÛıËÙËÚȷ΋ ÂÚÈÊÂÚÈ΋ Ó¢ÚÔ¿ıÂÈ· Â›Ó·È ÂÏ·ÊÚ¿˜ ÌÔÚÊ‹˜ Î·È ·ÔÌ˘ÂÏÈÓˆÙÈÎÔ‡ ¯·Ú·ÎÙ‹Ú·. ªÂÙ·‚È‚¿˙ÂÙ·È Ì ÙÔÓ ˘ÔÏÂÈfiÌÂÓÔ ÛˆÌ·ÙÈÎfi Ù‡Ô ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜ Î·È ÔÊ›ÏÂÙ·È Û ÌÂÙ¿ÏÏ·ÍË ÙÔ˘ ÁÔÓȉ›Ô˘ Ù˘ ı˘ÌȉÈÓÔʈÛÊˆÚ˘Ï¿Û˘ (thymidine phosphorylase), ÂÓ˙‡ÌÔ˘ ··Ú·›ÙËÙÔ˘ ÁÈ· ÙÔÓ Û¯ËÌ·ÙÈÛÌfi ÓÔ˘ÎÏÂÔÙȉ›ˆÓ. ∏ ‰È·Ù¿Ú·ÍË Ù˘ ÈÛÔÚÚÔ›·˜ ÛÙË ‰ÂÍ·ÌÂÓ‹ ÓÔ˘ÎÏÂÔÙȉ›ˆÓ ÚÔηÏ› ÔÏÏ·Ï¿ ÂÏÏ›ÌÌ·Ù· ÛÙÔ ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi DNA (46). ∫ÏËÚÔÓÔÌÔ‡ÌÂÓË ÔÙÈ΋ Ó¢ڛÙȉ· ÙÔ˘ Leber (Leber’s Hereditary Optic Neuropathy - LHON). ∏ ÔÙÈ΋ Ó¢ڛÙȉ· ÙÔ˘ Leber ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ˘ÔÍ›· ÂÌÊ¿ÓÈÛË ÛÔ‚·Ú‹˜ ·ÌÊÔÙÂÚfiÏ¢Ú˘ ·ÒÏÂÈ·˜ Ù˘ fiÚ·Û˘ Ô˘ ·Ú·ÙËÚÂ›Ù·È Î˘Ú›ˆ˜ ÛÙÔ˘˜ ¿ÚÚÂÓ˜ ËÏÈΛ·˜ 11-30 ÂÙÒÓ. √ ̤ÛÔ˜ ¯ÚfiÓÔ˜ ·Ó¿ÌÂÛ· ÛÙËÓ ÚÔÛ‚ÔÏ‹ ÙˆÓ ‰‡Ô ÔÊı·ÏÌÒÓ Â›Ó·È 8 ‚‰ÔÌ¿‰Â˜ Î·È Ë ÚÔԉ¢ÙÈ΋ Âȉ›ӈÛË Ù˘ fiÚ·Û˘ Á›ÓÂÙ·È Û 1-6 ‚‰ÔÌ¿‰Â˜ (47). √È ·ÛıÂÓ›˜ ·Ú·ÔÓÔ‡ÓÙ·È ÁÈ· “ı¿Ì‚ˆÌ·” Ù˘ fiÚ·Û˘ Ô˘ ÛÙËÓ ÂÚÈÌÂÙÚÈ΋ ̤ÙÚËÛË ÙˆÓ ÔÙÈÎÒÓ ‰›ˆÓ ·ÓÙÈÛÙÔȯ› Û ‰È‡ڢÓÛË ÙÔ˘ Ù˘ÊÏÔ‡ ÛËÌ›Ԣ Î·È ·ÒÏÂÈ· Ù˘ ÎÂÓÙÚÈ΋˜ fiÚ·Û˘. ¶fiÓÔ˜ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÔÊı·ÏÌÈÎÒÓ ÎÈÓ‹ÛÂˆÓ Û¿ÓÈ· ÂÌÊ·Ó›˙ÂÙ·È, ÁÂÁÔÓfi˜ Ô˘ ‚ÔËı¿ ÛÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ·fi ÙËÓ ÂÒ‰˘ÓË ÔÙÈ΋ Ó¢ڛÙȉ· Ô˘ ·Ú·ÙËÚÂ›Ù·È Û ÊÏÂÁÌÔÓÒ‰ÂȘ ηٷÛÙ¿ÛÂȘ. ø¯ÚfiÙËÙ· ÙÔ˘ ÔÙÈÎÔ‡ ‰›ÛÎÔ˘ ÂÌÊ·Ó›˙ÂÙ·È ÌÂÙ¿ ÙËÓ ÂÁηٿÛÙ·ÛË Ù˘ ·ÒÏÂÈ·˜ fiÚ·Û˘. √È ÂÚÈÛÛfiÙÂÚÔÈ ·ÛıÂÓ›˜ ʤÚÔ˘Ó ÔÌÔÈÔÏ·ÛÌÈΤ˜ ÛËÌÂȷΤ˜ ÌÂÙ·ÏÏ¿ÍÂȘ ÙÔ˘ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ DNA Ô˘ Έ‰ÈÎÔÔÈ› ‰ÔÌÈΤ˜ ˘ÔÔÌ¿‰Â˜ ÙÔ˘ Û˘ÌϤÁÌ·ÙÔ˜ I

°·Ï·ÎÙÈÎfi: ‰ÈÎfiÚ˘ÊË ·È¯Ì‹

∂ÈÎfiÓ· 5. ™‡Ó‰ÚÔÌÔ Leigh: ∆2 ·ÎÔÏÔ˘ı›· ÂÁοÚÛÈ· ÙÔÌ‹. √ÌÔÁÂÓ¤˜ ˘„ËÏfi Û‹Ì· ÛÙÔ Ú·‚‰ˆÙfi ÛÒÌ· Ì ÛÙÈÎÙ¤˜ ÂÚÈÔ¯¤˜ ¯·ÌËÏÔ‡ Û‹Ì·ÙÔ˜ Èı·ÓfiÓ ÏfiÁˆ ·˘ÍËÌ¤ÓˆÓ ÂÚÈ·ÁÁÂÈ·ÎÒÓ ¯ÒÚˆÓ. ™ÙË Ì·ÁÓËÙÈ΋ Ê·ÛÌ·ÙÔÛÎÔ›· ·Ú·ÙËÚÂ›Ù·È (1HMRS ‚Ú·¯Â›· ·ÎÔÏÔ˘ı›·) ÌÂÁ¿ÏË ·È¯Ì‹ Á·Ï·ÎÙÈÎÔ‡ (‚¤ÏÔ˜) (6).

7

ªÈÙÔ¯ÔÓ‰Úȷο ÓÔÛ‹Ì·Ù· Ù˘ ·È‰È΋˜ ËÏÈΛ·˜

¶›Ó·Î·˜ 3. ™‡Ó‰ÚÔÌ· Ì ÚˆÙÔ·ı‹ ‹ ‰Â˘ÙÂÚÔ·ı‹ ÌÈÙÔ¯ÔÓ‰Úȷ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ¡fiÛËÌ· / ∫ÏËÚÔÓÔÌÈÎfiÙËÙ·

∫ÏÈÓÈÎÔÂÚÁ·ÛÙËÚÈ·Îfi˜ Ê·ÈÓfiÙ˘Ô˜

°ÂÓÂÙÈ΋ ‚Ï¿‚Ë / ªË¯·ÓÈÛÌfi˜

∞Ù·Í›· ÙÔ˘ Freidreich / À™

∞Ù·Í›·, ·Ô˘Û›· ÙÂÓfiÓÙÈˆÓ ·ÓÙ·Ó·ÎÏ·ÛÙÈÎÒÓ, ÛËÌÂ›Ô Babinski, ηډÈÔÌ˘Ô¿ıÂÈ·, ‰È·‚‹Ù˘, ÔÙÈ΋ ·ÙÚÔÊ›· ∂ÈÏË„›·, „˘¯Ôۈ̷ÙÈ΋ ηı˘ÛÙ¤ÚËÛË, ·ÓˆÌ·Ï›Â˜ ÙÚȯÒÓ ÎÂÊ·Ï‹˜, ÔÛÙÈ΋ ¢ıÚ·˘ÛÙfiÙËÙ·, ÂÁÎÂÊ·ÏÈ΋ ·ÙÚÔÊ›·, AÙ·Í›· ÛȉËÚÔ‚Ï·ÛÙÈ΋ ·Ó·ÈÌ›·

ªÂÙ·ÏÏ¿ÍÂȘ (GAA repeat expansion) ÛÙÔ ÁÔÓ›‰ÈÔ Ù˘ ÊÚ·Ù·Í›Ó˘ (FRDA1)/

™‡Ó‰ÚÔÌÔ Menkes / ºÀ

∞Ù·Í›· ÛȉËÚÔ‚Ï·ÛÙÈ΋ ·Ó·ÈÌ›· / ºÀ ™‡Ó‰ÚÔÌÔ ÎÒʈÛ˘-‰˘ÛÙÔÓ›·˜ (Mohr-Tranebjaerg) / ºÀ ∫ÏËÚÔÓÔÌÔ‡ÌÂÓË Û·ÛÙÈ΋ ·Ú·ÏËÁ›· / À™ ™‡Ó‰ÚÔÌÔ Barth / ºÀ

™‡Ó‰ÚÔÌÔ Alper / À™ - ™ÔÚ·‰È΋

Charcot-Marie-Tooth type 2A

∞ÓÂ¿ÚÎÂÈ· Û˘ÓÂÓ˙‡ÌÔ˘ Q10

ªÂÙ·ÏÏ¿ÍÂȘ ÛÙÔ ÁÔÓ›‰ÈÔ ATP7A Ô˘ Έ‰ÈÎÔÔÈ› ÙÔÓ ATPase ÌÂÙ·ÊÔÚ¤· ¯·ÏÎÔ‡ ªÂÙ·ÏÏ¿ÍÂȘ ÛÙÔ ÁÔÓ›‰ÈÔ ABC7 Ô˘ Έ‰ÈÎÔÔÈ› ÙÔÓ ÌÂÙ·ÊÔÚ¤· Ûȉ‹ÚÔ˘ ÛÙÔ ÌÈÙÔ¯fiÓ‰ÚÈÔ ∫ÒʈÛË, ‰˘ÛÙÔÓ›·, ηٷÚÚ¿ÎÙ˘, ªÂÙ·ÏÏ¿ÍÂȘ ÛÙÔ ÁÔÓ›‰ÈÔ DDP1/ ‰˘ÛÊ·Á›· TIMM8A Ô˘ Έ‰ÈÎÔÔÈ› ÙÔÓ ÚˆÙÂ˚ÓÈÎfi ÌÂÙ·ÊÔÚ¤· ™·ÛÙÈ΋ ·Ú·ÏËÁ›· ªÂÙ·ÏÏ¿ÍÂȘ ÛÙÔ SPG7 ÁÔÓ›‰ÈÔ Ô˘ Έ‰ÈÎÔÔÈ› Ì›· ÌÂÙ·ÏÏÔÚˆÙ¿ÛË Ã·ÌËÏfi ·Ó¿ÛÙËÌ·, ηډÈÔÌ˘Ô¿ıÂÈ·, ªÂÙ·ÏÏ¿ÍÂȘ ÛÙÔ ÁÔÓ›‰ÈÔ Ù˘ Ô˘‰ÂÙÂÚÔÂÓ›· Î·È Ù·Ê·˙›Ó˘ Ô˘ ÚÔηÏ› ‰È·Ù·Ú·¯¤˜ 3-ÌÂı˘ÏÁÏÔ˘Ù·ÎÔÓÈ΋ ÔÍÂÔ˘Ú›· ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ Ù˘ ηډÈÔÏÈ›Ó˘ ÛÙË ÌÈÙÔ¯ÔÓ‰Úȷ΋ ÌÂÌ‚Ú¿ÓË ∞Ù·Í›·, Ì˘ÔÎÏÔÓÈ΋ ÂÈÏË„›·, ªÂÙ·ÏÏ¿ÍÂȘ ÛÙÔ ÁÔÓ›‰ÈÔ POLG1 Ë·ÙÔ¿ıÂÈ· (ÌÔÚ› Ó· ÂÌÊ·ÓÈÛÙ› Â›Ó·È ˘‡ı˘Ó˜ ÁÈ· ÙȘ ÂÚÈÙÒÛÂȘ ÌÂÙ¿ ·fi ¯ÔÚ‹ÁËÛË ‚·ÏÚÔ˚ÎÔ‡ ÔͤԘ). Û˘Ó‰ÚfiÌÔ˘ Alper Ì Ë·ÙÔ¿ıÂÈ· ¶ÚÔԉ¢ÙÈ΋ ÂÁÎÂÊ·ÏÈ΋ ·ÙÚÔÊ›· Î·È Ó¢ÚÔÂÎʇÏÈÛË ∞ÍÔÓÈÎÔ‡ Ù‡Ô˘ ÔÏ˘Ó¢ÚÔ¿ıÂÈ· ªÂÙ·ÏÏ¿ÍÂȘ ÛÙÔ ÁÔÓ›‰ÈÔ MFN2 Ô˘ Έ‰ÈÎÔÔÈ› ÙË ÌÈÙÔÛ˘ÓÙËÍ›ÓË 2, ÚˆÙ½ÓË ··Ú·›ÙËÙË ÁÈ· ÙËÓ ÎÈÓËÙÈÎfiÙËÙ· ÙˆÓ ÌÈÙÔ¯ÔÓ‰Ú›ˆÓ ñ ª˘Ô¿ıÂÈ· (ÂÚ˘ıÚ¤˜ Ú·ÎÒ‰ÂȘ ›Ó˜), ÷ÌËÏ¿ Â›‰· ÔÏÈÎÔ‡ Q10 ÛÙÔ˘˜ Ì˘ÔÛÊ·ÈÚÈÓÔ˘Ú›·, Ì˘˜, Ê˘ÛÈÔÏÔÁÈ΋ ‰Ú·ÛÙÈÎfiÙËÙ· ·ÚÂÁÎÂÊ·ÏȉÈ΋ ·Ù·Í›· Û˘ÌÏÂÁÌ¿ÙˆÓ I, II, III, IV ·ÏÏ¿ ñ ™Ô‚·Ú‹ ÂÁÎÂÊ·ÏÔÌ˘Ô¿ıÂÈ· Î·È ÂÏ·Ùو̤ÓË ‰Ú·ÛÙÈÎfiÙËÙ· ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ· ÙˆÓ I-III Î·È II-III. ÕÁÓˆÛÙË ÁÂÓÂÙÈ΋ ‚Ï¿‚Ë

À™: ÀÔÏÂÈfiÌÂÓÔ ™ˆÌ·ÙÈÎfi, ∂™: ∂ÈÎÚ·ÙÔ‡Ó ™ˆÌ·ÙÈÎfi, ºÀ: º˘ÏÔÛ‡Ó‰ÂÙÔ ÀÔÏÂÈfiÌÂÓÔ

(ND1, ND4, ND6). ∞ÔηٿÛÙ·ÛË Ù˘ fiÚ·Û˘ Â›Ó·È Ôχ Û¿ÓÈ· fiÙ·Ó ÔÈ ·ÛıÂÓ›˜ ʤÚÔ˘Ó ÙË ÌÂÙ¿ÏÏ·ÍË G11778A, ·ÏÏ¿ Û¯ÂÙÈο Û˘¯Ó‹ Û ·ÛıÂÓ›˜ Ì ÙË ÌÂÙ¿ÏÏ·ÍË T14484C (48). ÕÏϘ Ó¢ÚÔÏÔÁÈΤ˜ ÂΉËÏÒÛÂȘ Â›Ó·È Û¿ÓȘ (49). ™‡Ó‰ÚÔÌÔ ÔÛÔÙÈ΋˜ Ì›ˆÛ˘ ÙÔ˘ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ DNA (Mitochondrial DNA depletion syndrome (MDS). ∞ÔÙÂÏÔ‡Ó ·Ûı¤ÓÂȘ Ù˘ ‚ÚÂÊÈ΋˜ ËÏÈΛ·˜ Ô˘ ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÙÔ˘˜ Â›Ó·È ÔÛÔÙÈ΋ ‰È·Ù·Ú·¯‹ ÙÔ˘ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ DNA ÏfiÁÔ˘ ÂÏ¿ÙÙˆÛ˘ Ù˘ ‰ÂÍ·ÌÂÓ‹˜ ÙˆÓ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÒÓ ‰ÂÔ͢ÚÈ‚ÔÓÔ˘ÎÏÂÔÙȉ›ˆÓ (dNTPs) ··Ú·›ÙËÙˆÓ ÁÈ· ÙË Û‡ÓıÂÛË ÙÔ˘ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ DNA. À¿Ú¯Ô˘Ó ‰‡Ô ¤Ó˙˘Ì· Ô˘ ÂϤÁ¯Ô˘Ó ·˘Ù‹ ÙË ‰ÂÍ·ÌÂÓ‹. ∏ ÎÈÓ¿ÛË Ù˘ ‰ÂÔ͢ÁÔ˘·ÓÔÛ›Ó˘ (dGK) ÌÂÙ·ÏÏ¿ÍÂȘ Ù˘ ÔÔ›·˜ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙÔÓ Ë·ÙÔÂÁÎÂÊ·ÏÈÎfi Ù‡Ô Î·È Ë ÎÈÓ¿ÛË Ù˘ ı˘Ìȉ›Ó˘ (TK2) ÌÂÙ·ÏÏ¿ÍÂȘ Ù˘ ÔÔ›·˜ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙÔÓ Ì˘Ô·ıËÙÈÎfi Ù‡Ô (50).

ªËÙÚÈÎÒ˜ ÎÏËÚÔÓÔÌÔ‡ÌÂÓË Ó¢ÚÔ·ÈÛıËÙËÚȷ΋ ·ÒÏÂÈ· ·ÎÔ‹˜ (Maternal Inherited Hearing Loss - MIHL). ∆· ÙÚȯˆÙ¿ ·ÙÙ·Ú· ÙÔ˘ Îԯϛ· Â›Ó·È ·ÚÎÂÙ¿ ¢·›ÛıËÙ· ÛÙË ‰È·Ù·Ú·¯‹ Ù˘ ÌÈÙÔ¯ÔÓ‰Úȷ΋˜ ·Ú·ÁˆÁ‹˜ ÂÓ¤ÚÁÂÈ·˜. ∏ ÛËÌÂȷ΋ ÌÂÙ·ÏÏ¿ÍË, Û˘Ó‹ıˆ˜ Û ÔÌÔÈÔÏ·ÛÌ›·, ÛÙË ı¤ÛË G1555A ÙÔ˘ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ DNA Â›Ó·È Û˘¯Ófi ‡ÚËÌ· Ó¢ÚÔ·ÈÛıËÙËÚȷ΋˜ ·ÒÏÂÈ·˜ ·ÎÔ‹˜. ∂ÈÚÔÛı¤Ùˆ˜, ¿ÙÔÌ· Ô˘ ʤÚÔ˘Ó ÙË ÌÂÙ¿ÏÏ·ÍË C1494T Â›Ó·È Â˘·›ÛıËÙ· ÛÙËÓ ÚfiÎÏËÛË ·ÒÏÂÈ·˜ ·ÎÔ‹˜ ÌÂÙ¿ ·fi ¤ÎıÂÛË ÛÙȘ ·ÌÈÓÔÁÏ˘ÎÔÛ›‰Â˜ (51,52). ªÈÙÔ¯ÔÓ‰Úȷ΋ Ì˘ÔηډÈÔ¿ıÂÈ·. √È ÈÔ Û˘¯Ó¤˜ ηډȷΤ˜ ·ÓˆÌ·Ï›Â˜ Â›Ó·È ÔÈ ‰È·Ù·Ú·¯¤˜ ·ÁˆÁÈÌfiÙËÙ·˜ Ô˘ Â›Ó·È ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Kearns-Sayre Î·È Ë ˘ÂÚÙÚÔÊÈ΋ ηډÈÔÌ˘Ô¿ıÂÈ· (53). ∏ ‰È·Ù·ÙÈ΋ ηډÈÔÌ˘Ô¿ıÂÈ· Â›Ó·È ÏÈÁfiÙÂÚÔ Û˘¯Ó‹. °ÂÓÂÙÈΤ˜ ‚Ï¿‚˜ Ô˘ Û˘Ó‰˘¿˙ÔÓÙ·È Ì ÙËÓ ·ÚÔ˘Û›· ηډÈÔÌ˘Ô¿ıÂÈ·˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó: ¶·È‰È·ÙÚÈ΋ 2007;70:1-17

8

∞. ¡ÙÈÓfiÔ˘ÏÔ˜, ∞. ¶··‰ËÌËÙÚ›Ô˘

¶›Ó·Î·˜ 4. ∂Ó˙˘ÌÈΤ˜ ‰È·Ù·Ú·¯¤˜ Î·È ÌÂÙ·ÏÏ¿ÍÂȘ ÙÔ˘ ˘ÚËÓÈÎÔ‡ ‹ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ DNA Ô˘ Û˘Ó‰˘¿˙ÔÓÙ·È Ì ۇӉÚÔÌÔ Leigh ªÂÙ·ÏÏ¿ÍÂȘ ˘ÚËÓÈÎÔ‡ DNA (˘ÔÏÂÈfiÌÂÓË ÎÏËÚÔÓÔÌÈÎfiÙËÙ·) ñ ªÂÙ·ÏÏ¿ÍÂȘ ÁÔÓȉ›ˆÓ Ô˘ ÂÓ¤¯ÔÓÙ·È ÛÙË Û˘Ó·ÚÌÔÏfiÁËÛË ÙÔ˘ Û˘ÌϤÁÌ·ÙÔ˜ IV (΢ÙÔ¯ÚˆÌÈ΋˜ ÔÍÂȉ¿Û˘ COX) Ô˘ ΢ڛˆ˜ ·ÊÔÚ¿ ÙÔ SURF1 ÁÔÓ›‰ÈÔ Î·È ÈÔ Û¿ÓÈ· ÙÔ SCO2 (ÂÁÎÂÊ·ÏÔ¿ıÂÈ·, ˘ÂÚÙÚÔÊÈ΋ ηډÈÔÌ˘Ô¿ıÂÈ·) Î·È SCO1 ÁÔÓ›‰È· (57,77) ñ ªÂÙ·ÏÏ¿ÍÂȘ ÁÔÓȉ›ˆÓ Ô˘ ·ÊÔÚÔ‡Ó ‰ÔÌÈΤ˜ ˘ÔÔÌ¿‰Â˜ ÙÔ˘ Û˘ÌϤÁÌ·ÙÔ˜ I (NDUFS1, NDUFS8, NDUFS4, NDUFS7, NDUFS2, NDUFV2) (78) ñ ªÂÙ¿ÏÏ·ÍË SDHA ÁÔÓȉ›Ô˘ ÙÔ˘ Û˘ÌϤÁÌ·ÙÔ˜ ππ (79) ñ ªÂÙ¿ÏÏ·ÍË BSC1 ÁÔÓȉ›Ô˘ Ô˘ Û˘ÌÌÂÙ¤¯ÂÈ ÛÙË Û˘Ó·ÚÌÔÏfiÁËÛË (chaperone) ÙÔ˘ Û˘ÌϤÁÌ·ÙÔ˜ πππ (80) ªÂÙ·ÏÏ¿ÍÂȘ ÙÔ˘ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ DNA ñ ªÂÙ·ÏÏ¿ÍÂȘ ÁÔÓȉ›ˆÓ Ù˘ ATP Û˘ÓıÂÙ¿Û˘ (NARP/Leigh) A8344G (tRNALys) G8363A ñ ªÂÙ·ÏÏ¿ÍÂȘ ÛÙ· ÁÔÓ›‰È· ND3 ‹ ND5 Ô˘ Έ‰ÈÎÔÔÈÔ‡Ó ‰ÔÌÈΤ˜ ÌÔÓ¿‰Â˜ ÙÔ˘ Û˘ÌϤÁÌ·ÙÔ˜ π (81,82) ñ ªÂÙ·ÏÏ¿ÍÂȘ ÛÙÔ COXIII ÁÔÓ›‰ÈÔ ÙÔ˘ Û˘ÌϤÁÌ·ÙÔ˜ IV ¶ÔÛÔÙÈ΋ Ì›ˆÛË ÙÔ˘ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ DNA ñ ¶ÔÏÏ·Ï‹ Û˘ÌÏÂÁÌ·ÙÈ΋ ·ÓÂ¿ÚÎÂÈ· (83) ÕÏÏˆÓ ÂÓ˙˘ÌÈÎÒÓ ·ÓÂ·ÚÎÂÈÒÓ ñ ∞ÓÂ¿ÚÎÂÈ· ˘ÚÔÛÙ·Ê˘ÏÈ΋˜ ·Ê˘‰ÚÔÁÔÓ¿Û˘ (E1a, E3, E3BP, ÚÔÛÊ¿Ùˆ˜ E1b) ñ ∞ÓÂ¿ÚÎÂÈ· ‚ÈÔÙÈÓȉ¿Û˘ (ÔÏÏ·Ï‹ ·ÓÂ¿ÚÎÂÈ· ηڂÔÍ˘Ï·ÛÒÓ) (84) ñ ∞ÓÂ¿ÚÎÂÈ· ˘ÚÔÛÙ·Ê˘ÏÈ΋˜ ηڂÔÍ˘Ï¿Û˘

i. ™ËÌÂȷΤ˜ ÌÂÙ·ÏÏ¿ÍÂȘ ÛÙÔ ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi DNA (54) ii. ªÂÙ·ÏÏ¿ÍÂȘ ÙÔ˘ ˘ÚËÓÈÎÔ‡ DNA Ô˘ Έ‰ÈÎÔÔÈÔ‡Ó ‰ÔÌÈΤ˜ ÌÔÓ¿‰Â˜ ÙÔ˘ Û˘ÌϤÁÌ·ÙÔ˜ I (NDUFS2, NDUFV2) (55) iii. ∞ÓÂ¿ÚÎÂÈ· ÙÔ˘ ΢ÙÔ¯ÚÒÌ·ÙÔ˜ b (56) iv. ªÂÙ¿ÏÏ·ÍË ÛÙÔ SCO2 ÁÔÓ›‰ÈÔ Ô˘ Έ‰ÈÎÔÔÈ› ÚˆÙ½ÓË ··Ú·›ÙËÙË ÁÈ· ÙË Û˘Ó·ÚÌÔÏfiÁËÛË ÙÔ˘ Û˘ÌϤÁÌ·ÙÔ˜ IV (57) v. ¶ÔÛÔÙÈ΋ Ì›ˆÛË ÙÔ˘ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ DNA (58). ªÈÙÔ¯ÔÓ‰Úȷ΋ Ì˘Ô¿ıÂÈ· Î·È ‰˘Û·ÓÂÍ›· ÛÙËÓ ¿ÛÎËÛË (Isolated myopathy and exercise intolerance). ¶ÔÏϤ˜ ÊÔÚ¤˜ Ì˘˚΋ ·‰˘Ó·Ì›· ÌÔÚ› Ó· Â›Ó·È ÙÔ ÌfiÓÔ ÎÏÈÓÈÎfi ‡ÚËÌ·. ∏ ÔÚ›· Â›Ó·È ·ÚÁ‹ Î·È ÚÔԉ¢ÙÈ΋ Î·È Û˘Ó‹ıˆ˜ ·ÊÔÚ¿ ÙȘ ÂÁÁ‡˜ Ì˘˚Τ˜ ÔÌ¿‰Â˜. ∏ Û˘Ìو̷ÙÔÏÔÁ›· ÂÚÈÏ·Ì‚¿ÓÂÈ ÌÂȈ̤ÓË ·ÓÙÔ¯‹ ÛÙËÓ ¿ÛÎËÛË, ¯ÚfiÓÈ· ÎfiˆÛË, Ì˘˚ο ¿ÏÁË Î·È Û·Ó›ˆ˜ ÂÂÈÛfi‰È· Ú·‚‰ÔÌ˘fiÏ˘Û˘ (59,60). ∏ ηٿÛÙ·ÛË Â›Ó·È ÁÂÓÂÙÈÎÒ˜ ÂÙÂÚÔÁÂÓ‹˜ Î·È ¤¯ÂÈ Û˘Ó‰˘·ÛÙ› ÌÂ: ·) ÛËÌÂȷΤ˜ ÌÂÙ·ÏÏ¿ÍÂȘ ÙÔ˘ ÁÔÓȉ›Ô˘ Ô˘ Έ‰ÈÎÔÔÈ› ÙÔ Î˘Ùfi¯ÚˆÌ· b, ‚) ¤ÏÏÂÈÌÌ· ÙÔ˘ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ DNA Î·È Á) Ì ÂÚÈÙÒÛÂȘ ÔÛÔÙÈ΋˜ Ì›ˆÛ˘ (depletion) ÙÔ˘ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ DNA (14).

¢È·ÁÓˆÛÙÈ΋ ÚÔÛ¤ÁÁÈÛË Î·È ÎÚÈÙ‹ÚÈ· ∏ ‰˘ÛÎÔÏ›· ÛÙË ‰È·ÁÓˆÛÙÈ΋ ÚÔÛ¤Ï·ÛË ÙˆÓ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ ÔÊ›ÏÂÙ·È ÛÙË ÁÂÓÂÙÈ΋ Î·È Ê·ÈÓÔÙ˘È΋ ÂÙÂÚÔÁ¤ÓÂÈ· Î·È ÛÙËÓ ·Ô˘Û›· ÂȉÈÎÒÓ ‰È·ÁÓˆÛÙÈÎÒÓ Ù¯ÓÈÎÒÓ. ∏ ÎÏËÚÔÓÔÌÈÎfiÙËPaediatriki 2007;70:1-17

Ù· ÔÈΛÏÂÈ Î·È ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi Â›Ó·È ·ÚÓËÙÈÎfi. ™Ù· ·È‰È¿ Ë ‰È¿ÁÓˆÛË Â›Ó·È ·ÎfiÌË ÈÔ ‰‡ÛÎÔÏË ÁÈ·Ù›: ·) Ù· ÎÏÈÓÈο ÌÈÙÔ¯ÔÓ‰Úȷο Û‡Ó‰ÚÔÌ· Â›Ó·È Û¿ÓÈ·, ‚) Ù· Â˘Ú‹Ì·Ù· ·fi ÙË Ì˘˚΋ ‚ÈÔ„›· ÛÙËÓ ÏÂÈÔ„ËÊ›· ÙÔ˘˜ Â›Ó·È ¿Ù˘· Î·È Á) Ô ‚ÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ ‰ÂÓ Â›Ó·È ¿ÓÙ· ·ÔÎ·Ï˘ÙÈÎfi˜ (61). ∏ ÚÔÛ¤ÁÁÈÛË ·ÛıÂÓÔ‡˜ Ì ˘Ô„›· ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ ÓÔÛ‹Ì·ÙÔ˜ Ú¤ÂÈ Ó· ÂÍ·ÙÔÌÈ·ÂÙ·È Î·È ··ÈÙ› ÙËÓ Ù·˘Ùfi¯ÚÔÓË ·ÍÈÔÏfiÁËÛË ÎÏÈÓÈÎÒÓ, Ó¢ÚÔ·ÂÈÎÔÓÈÛÙÈÎÒÓ, ‚ÈÔ¯ËÌÈÎÒÓ, ÈÛÙÔ·ıÔÏÔÁÈÎÒÓ Î·È ÁÂÓÂÙÈÎÒÓ ÏËÚÔÊÔÚÈÒÓ. °È· ÙËÓ Â˘ÎÔÏfiÙÂÚË Î·ÙËÁÔÚÈÔÔ›ËÛË Î·È ‰È¿ÁÓˆÛË ÙˆÓ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ ¤¯Ô˘Ó ÚÔÙ·ı› Î·È ÙÚÔÔÔÈËı› ÁÈ· Ù· ·È‰È¿ ‰È·ÁÓˆÛÙÈο ÎÚÈÙ‹ÚÈ· (¶›Ó·Î·˜ 5) (62). ∆· ‰È·ÁÓˆÛÙÈο ÎÚÈÙ‹ÚÈ· ‚ÔËıÔ‡Ó ÒÛÙ ӷ Ù·ÍÈÓÔÌËı› Ô ·ÛıÂÓ‹˜ ·Ó¿ÏÔÁ· Ì ÙË ‰È·ÁÓˆÛÙÈ΋ ‚‚·ÈfiÙËÙ· (“ÔÚÈÛÙÈ΋”, “Èı·Ó‹”, “‰˘Ó·Ù‹”) Ó· ʤÚÂÈ ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi ÓfiÛËÌ·. µÈÔ¯ËÌÈ΋ ÌÂϤÙË ∏ ·ÓˆÌ·Ï›· Ù˘ ÔÍÂȉˆÙÈ΋˜ ʈÛÊÔÚ˘Ï›ˆÛ˘ ÚÔηÏ› ¿ÌÂÛË Î·È ¤ÌÌÂÛË ‰È·Ù·Ú·¯‹ ‰È·ÊfiÚˆÓ ÌÂÙ·‚ÔÏÈÎÒÓ Ô‰ÒÓ fiˆ˜ Ù˘ ÁÏ˘ÎfiÏ˘Û˘, ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ˘ÚÔÛÙ·Ê˘ÏÈÎÔ‡ ÔͤԘ, ÙÔ˘ ·ÎÏÔ˘ ÙÔ˘ Krebs Î·È ÙÔ˘ ηٷ‚ÔÏÈÛÌÔ‡ ÚˆÙÂ˚ÓÒÓ. ÕÌÂÛË Û˘Ó¤ÂÈ· ÙˆÓ ‰È·Ù·Ú·¯ÒÓ ·˘ÙÒÓ Â›Ó·È Ë ·‡ÍËÛË ÛÙÔÓ ÔÚfi Î·È ∂¡À ÙÔ˘ Á·Ï·ÎÙÈÎÔ‡ Î·È ˘ÚÔÛÙ·Ê˘ÏÈÎÔ‡ (·‡ÍËÛË ÙÔ˘ ÏfiÁÔ˘ Á·Ï·ÎÙÈÎfi/˘ÚÔÛÙ·Ê˘ÏÈÎfi ¿Óˆ ·fi 20) Î·È Ù˘ ·Ï·Ó›Ó˘. ™ÙÔÓ ÔÚfi ¤¯Ô˘Ì Â›Û˘

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ªÈÙÔ¯ÔÓ‰Úȷο ÓÔÛ‹Ì·Ù· Ù˘ ·È‰È΋˜ ËÏÈΛ·˜

·‡ÍËÛË ÙˆÓ ÎÂÙÔÓÔÛˆÌ¿ÙˆÓ È‰È·›ÙÂÚ· ÌÂÙ¿ ÙË Ï‹„Ë ÙÚÔÊ‹˜ (·Ú¿‰ÔÍË ÎÂÙÔÓ·ÈÌ›·). ∏ ʈÛÊÔÎÈÓ¿ÛË Ù˘ ÎÚ·ٛÓ˘ (CPK) Â›Ó·È Û˘Ó‹ıˆ˜ Ê˘ÛÈÔÏÔÁÈ΋ ‹ ÂÏ·ÊÚ¿ ·˘ÍË̤ÓË Û ÌÂÚÈΤ˜ ÌÈÙÔ¯ÔÓ‰ÚȷΤ˜ Ì˘Ô¿ıÂȘ. √ÚÈṲ̂ӷ ÌÈÙÔ¯ÔÓ‰Úȷο ÓÔÛ‹Ì·Ù· ÚÔÛ‚¿ÏÔ˘Ó ÙÔ ‹·Ú Ì ‰È·Ù·Ú·¯‹ ÙˆÓ Ë·ÙÈÎÒÓ ÂÓ˙‡ÌˆÓ Î·È ¿ÏÏ· ÙÔ˘˜ ÓÂÊÚÔ‡˜ Ì ÂÌÊ¿ÓÈÛË ÓÂÊÚÈ΋˜ ÛˆÏËÓ·Úȷ΋˜ ÔͤˆÛ˘ (De-Toni-Fabre-Fanconi). ∏ ·Ó·ÈÌ›· ÌÔÚ› Ó· Â›Ó·È Â›Ù ÚˆÙÔ·ı‹˜ (ÛȉËÚÔ‚Ï·ÛÙÈ΋ ·Ó·ÈÌ›·) ›Ù ‰Â˘ÙÂÚÔ·ı‹˜ ÏfiÁˆ ÓÂÊÚÔ¿ıÂÈ·˜. ¢˘ÛÙ˘¯Ò˜, ÙÔ ‚ÈÔ¯ËÌÈÎfi ÌÂÙ·‚ÔÏÈÎfi screening ‰ÂÓ Â›Ó·È ¿ÓÙ· ·ÔÎ·Ï˘ÙÈÎfi, Î·È Ù· ‰È·ÁÓˆÛÙÈο Ï¿ıË Â›Ó·È Û˘¯Ó¿ (13,63). √ ¶›Ó·Î·˜ 6 ÂÚÈÁÚ¿ÊÂÈ ÙÔÓ ‚ÈÔ¯ËÌÈÎfi ÌÂÙ·‚ÔÏÈÎfi ¤ÏÂÁ¯Ô Ô˘ Û˘ÓÈÛÙ¿Ù·È Â› ˘Ô„›·˜ ÓÔÛ‹Ì·ÙÔ˜ Ì ÌÈÙÔ¯ÔÓ‰Úȷ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·. πÛÙÔ·ıÔÏÔÁ›· Ì˘˚ÎÔ‡ ÈÛÙÔ‡ ∆Ô ÈÛÙÔÏÔÁÈÎfi Û‹Ì· ηٷÙÂı¤Ó ÙˆÓ ÌÈÙÔ¯ÔÓ‰ÚÈÔ·ıÂÈÒÓ Â›Ó·È ÔÈ ÂÚ˘ıÚ¤˜ Ú·ÎÒ‰ÂȘ ›Ó˜ (ragged red fibers) Ô˘ ·ÓȯÓ‡ÔÓÙ·È Ì ÙË ¯ÚÒÛË Gomoritrichrome (∂ÈÎfiÓ· 6·) Î·È ÙË ¯ÚÒÛË ÛÔ˘ÎÈÓÈ΋˜ ·Ê˘‰ÚÔÁÔÓ¿Û˘ (∂ÈÎfiÓ· 6‚). √È ÂÚ˘ıÚ¤˜ Ú·ÎÒ‰ÂȘ ›Ó˜ Û¯ËÌ·Ù›˙ÔÓÙ·È ·fi ÙÔÓ ÔÏÏ·Ï·ÛÈ·ÛÌfi Î·È ÙË Û˘ÁΤÓÙÚˆÛË ˘ÔÛ·ÚÎËÏÂÈÌÌ·ÙÈÎÒÓ ÌÈÙÔ¯ÔÓ‰Ú›ˆÓ Î·È ÙËÓ ÂÎʇÏÈÛË ÙˆÓ Ì˘˚ÎÒÓ ÈÓÒÓ. √È ÈÛÙÔÏÔÁÈΤ˜ ·˘Ù¤˜ ·ÏÏÔÈÒÛÂȘ ·Ú·ÙËÚÔ‡ÓÙ·È Î˘Ú›ˆ˜ ÛÙÔ˘˜ ÂÓ‹ÏÈΘ Î·È Û˘¯ÓfiÙÂÚ· Û ÌÈÙÔ¯ÔÓ‰Úȷο ÓÔÛ‹Ì·Ù· ·fi ÌÂÙ·ÏÏ¿ÍÂȘ ÙÔ˘ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ DNA. ∂Ú˘ıÚ¤˜ Ú·ÎÒ‰ÂȘ ›Ó˜ Û·Ó›ˆ˜ ·ÓȯÓ‡ÔÓÙ·È ÛÙË ‚ÚÂÊÈ΋ Î·È ·È‰È΋ ËÏÈΛ·, ÂÓÒ ÈÔ Û˘¯Ófi ‡ÚËÌ· Â›Ó·È Ë ·ÚÔ˘Û›· ˘ÔÛ·ÚÎËÏÂÈÌÌ·ÙÈÎÒÓ Û˘ÛÛˆÚ‡ÛÂˆÓ (64). ∏ ·ÓÙ›‰Ú·ÛË Ù˘ ÔÍÂȉ¿Û˘ ÙÔ˘ ΢ÙÔ¯ÚÒÌ·ÙÔ˜ (COX) ÔÈΛÏÂÈ. ÕÏϘ ÌË ÂȉÈΤ˜ ÈÛÙÔ·ıÔÏÔÁÈΤ˜ ·ÏÏÔÈÒÛÂȘ Â›Ó·È Û˘¯Ó¤˜ ·ÏÏ¿ ÌË ‰È·ÁÓˆÛÙÈΤ˜ (65). ∏ ·Ó¿Ï˘ÛË Ì ËÏÂÎÙÚÔÓÈÎfi ÌÈÎÚÔÛÎfiÈÔ ÌÔÚ› Ó· ·ÓȯÓ‡ÛÂÈ ‰ÔÌÈΤ˜ ·ÓˆÌ·Ï›Â˜ fiˆ˜ ·Ú·ÎÚ˘ÛÙ·ÏÏÈο ¤ÁÎÏÂÈÛÙ·, ˘ÂÚÌÂÁ¤ıË ÌÈÙÔ¯fiÓ‰ÚÈ·, ÌÈÙÔ¯fiÓ‰ÚÈ· Ì ·ÏÏÔÈÒÛÂȘ ÙˆÓ ·ÎÚÔÏÔÊÈÒÓ, ·˘ÍË̤ÓË ÔÈÎÈÏÔÌÔÚÊ›· ÙˆÓ ÌÈÙÔ¯ÔÓ‰Ú›ˆÓ Î·È ˘ÔÛ·ÚÎÂÈÏËÌÌ·ÙÈΤ˜ Î·È ÂÓ‰ÔÌ˘Ô˚ÓȉȷΤ˜ Û˘ÛÛˆÚ‡ÛÂȘ ÌÈÙÔ¯ÔÓ‰Ú›ˆÓ. ∏ ·ÚÔ˘Û›· ·Ú·ÎÚ˘ÛÙ·ÏÏÈÎÒÓ ¤ÁÎÏÂÈ-

·

ÛÙˆÓ Î·È Û˘ÛÛˆÚ‡ÛÂȘ ·ıÔÏÔÁÈÎÒÓ ÌÈÙÔ¯ÔÓ‰Ú›ˆÓ Â›Ó·È ÂȉÈÎÔ› ‰ÔÌÈÎÔ› ‰Â›ÎÙ˜ ÌÈÙÔ¯ÔÓ‰ÚÈÔ¿ıÂÈ·˜ (∂ÈÎfiÓ· 7 ) ·ÏÏ¿ ‰ÂÓ ·ÓȯÓ‡ÔÓÙ·È ¿ÓÙ·. ∂Ó˙˘Ì·ÙÈ΋ ̤ÙÚËÛË Î·È ÔÍÂȉˆÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÛÙÔ˘˜ ÈÛÙÔ‡˜ ∏ ÂÓ˙˘ÌÈ΋ ·Ó¿Ï˘ÛË ÚÔÙÈÌ¿Ù·È Ó· Á›ÓÂÙ·È Û ÊÚ¤ÛÎÔ Ì˘˚Îfi ÈÛÙfi, ÂÂȉ‹ Ù· ÌÈÙÔ¯fiÓ‰ÚÈ· ·Ú·Ì¤ÓÔ˘Ó ·Î¤Ú·È· Î·È ¤ÙÛÈ ÌÔÚ› Ó· ÌÂÙÚËı› Ô ‚·ıÌfi˜ ÔÍ›‰ˆÛ˘ Î·È Ë ·Ú·ÁˆÁ‹ ATP. ∏ ̤ÙÚËÛË Ù˘ ÔÍÂȉˆÙÈ΋˜ ÈηÓfiÙËÙ·˜ Û ÊÚ¤Ûη Ì˘˚ο ÌÈÙÔ¯fiÓ‰ÚÈ· Á›ÓÂÙ·È Â›Ù Ì ÔÏ·ÚÔÁÚ·ÊÈ΋ ̤ıÔ‰Ô Â›Ù Ì ڷ‰ÈÔ¯ËÌÈ΋ ̤ıÔ‰Ô (6). ∆Ô Úfi‚ÏËÌ· Ì ÙË ‰ÈÂÚ‡ÓËÛË Û ÊÚ¤ÛÎÔ ÈÛÙfi Â›Ó·È fiÙÈ ÙÔ ‰Â›ÁÌ· Ú¤ÂÈ Ó· ÊÙ¿ÛÂÈ ÛÙÔ ÂÚÁ·ÛÙ‹ÚÈÔ Ì¤Û· Û 2-3 ÒÚ˜ ·fi ÙË ‚ÈÔ„›· Î·È Ë ‰ÔÎÈÌ·Û›· Á›ÓÂÙ·È ÌfiÓÔ Û ϛÁ· ÂÍÂȉÈÎÂ˘Ì¤Ó· ÂÚÁ·ÛÙ‹ÚÈ·. ∞Ó Ë ÂͤٷÛË Û ÊÚ¤ÛÎÔ ÈÛÙfi ‰ÂÓ Â›Ó·È ‰˘Ó·Ù‹, ÙÔ ‰Â›ÁÌ· Ú¤ÂÈ Ó· ηٷ„‡¯ÂÙ·È ·Ì¤Ûˆ˜ Û ˘ÁÚfi ¿˙ˆÙÔ, ¯ˆÚ›˜ ̤ÛÔ, Î·È Ó· Ê˘Ï¿ÛÛÂÙ·È ÛÙÔ˘˜ -80ÔC. ªÂÙ·ÊÔÚ¿ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ÛÙÔ ÂÚÁ·ÛÙ‹ÚÈÔ Ú¤ÂÈ Ó· Á›ÓÂÙ·È Ì ÍËÚfi ¿ÁÔ. ™ÙËÓ ÂÚ›ÙˆÛË ·˘Ù‹ Ë Ì¤ÙÚËÛË Ù˘ ‰Ú·ÛÙÈÎfiÙËÙ·˜ ÙˆÓ ·Ó·Ó¢ÛÙÈÎÒÓ ÂÓ˙‡ÌˆÓ Á›ÓÂÙ·È Û ÔÌÔÁÂÓÔÔÈË̤ÓÔ ˘ÏÈÎfi ÙÔ˘ ÈÛÙÔ‡ Ì ÙË Ì¤ıÔ‰Ô Ù˘ Ê·ÛÌ·ÙÔʈÙÔÌÂÙÚ›·˜ (66). ∞ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ∂› ÎÏÈÓÈ΋˜ ÂÁÎÂÊ·ÏÔÌ˘Ô¿ıÂÈ·˜ Ô Ó¢ÚÔ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ Â›Ó·È ··Ú·›ÙËÙÔ˜ ÁÈ·Ù› ÌÔÚ›

‚

∂ÈÎfiÓ· 6. ·) ÃÚÒÛË Gomori Trichrome: ÂÚ˘ıÚ¤˜ Ú·ÎÒ‰ÂȘ ›Ó˜ (Ï¢Îfi ‚¤ÏÔ˜) Î·È ˘ÔÛ·ÚÎËÏÂÈÌÌ·ÙÈΤ˜ Û˘ÛÛˆÚ‡ÛÂȘ ÌÈÙÔ¯ÔÓ‰Ú›ˆÓ (Ì·‡Ú· ‚¤ÏË) ‚) ÃÚÒÛË SDH “΢·Ó¤˜ Ú·ÎÒ‰ÂȘ ›Ó˜” (ÂÚ˘ıÚfi ‚¤ÏÔ˜).

∂ÈÎfiÓ· 7. ¶·Ú·ÎÚ˘ÛÙ·ÏÏÈο ¤ÁÎÏÂÈÛÙ· ÛÙÔÓ ‰È·ÌÂÌ‚Ú·ÓÈÎfi ¯ÒÚÔ ÙˆÓ ÌÈÙÔ¯ÔÓ‰Ú›ˆÓ ˘fi ÙË ÌÔÚÊ‹ “¯ÒÚÔ˘ ÛÙ¿ıÌ¢Û˘ (parking lot)” ‚¤ÏÔ˜. ¶·È‰È·ÙÚÈ΋ 2007;70:1-17

10

∞. ¡ÙÈÓfiÔ˘ÏÔ˜, ∞. ¶··‰ËÌËÙÚ›Ô˘

¶›Ó·Î·˜ 5. ∆ÚÔÔÔÈË̤ӷ ÎÚÈÙ‹ÚÈ· ÂÓËÏ›ÎˆÓ ÁÈ· ÙË ‰È¿ÁÓˆÛË ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ ªÂ›˙ÔÓ· ∫ÚÈÙ‹ÚÈ·

∂Ï¿ÛÛÔÓ· ∫ÚÈÙ‹ÚÈ·

∫ÏÈÓÈ΋ ÂΉ‹ÏˆÛË ¶Ï‹Ú˘ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÌÈÙÔ¯ÔÓ‰Úȷ΋˜ ÂÁÎÂÊ·ÏÔÌ˘Ô¿ıÂÈ·˜* ‹ ÎÏÈÓÈ΋ ÂÈÎfiÓ· Ô˘ ÏËÚÔ› ÙÚÂȘ ÚÔ¸Ôı¤ÛÂȘ: ñ ¶ÔÏ˘Û˘ÛÙËÌ·ÙÈ΋ Û˘Ìو̷ÙÔÏÔÁ›· Ì ÙË Û˘ÌÌÂÙÔ¯‹ ÙÔ˘Ï¿¯ÈÛÙÔÓ ÙÚÈÒÓ ÔÚÁ·ÓÈÎÒÓ Û˘ÛÙËÌ¿ÙˆÓ (∫¡™, Ì˘˚Îfi, ηډȷÁÁÂÈ·Îfi, ÓÂÊÚÈÎfi, Á·ÛÙÚÂÓÙÂÚÈÎfi, Ë·ÙÈÎfi, ÂÓ‰ÔÎÚÈÓÈÎfi, ·ÈÌ·ÙÔÏÔÁÈÎfi) ‹ ÔÚÁ¿ÓˆÓ (·ÎÔ‹, fiÚ·ÛË, ‰˘ÛÌÔÚÊ›·) ñ ¶ÚÔԉ¢ÙÈ΋ ÎÏÈÓÈ΋ ÔÚ›· Ì ÂÍ¿ÚÛÂȘ ‹ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi Ì Èı·Ó‹ ÌÈÙÔ¯ÔÓ‰ÚÈÔ¿ıÂÈ· ñ ∞ÔÎÏÂÈÛÌfi˜ ¿ÏÏˆÓ ÌÂÙ·‚ÔÏÈÎÒÓ ‹ Ó¢ÚÔÂÎÊ˘ÏÈÛÙÈÎÒÓ ÓÔÛËÌ¿ÙˆÓ πÛÙÔ·ıÔÏÔÁ›· >2% ÂÚ˘ıÚÒÓ Ú·Îˆ‰ÒÓ ÈÓÒÓ Û ÛÎÂÏÂÙÈÎfi Ì˘˚Îfi ÈÛÙfi ∂Ó˙˘ÌÔÏÔÁ›·** ñ >2% COX-·ÚÓËÙÈΤ˜ ›Ó˜ (<50 ÂÙÒÓ) ñ >5% COX-·ÚÓËÙÈΤ˜ ›Ó˜ (>50 ÂÙÒÓ) ñ <20% ‰Ú·ÛÙÈÎfiÙËÙ· ÂÓ˙˘ÌÈÎÔ‡ Û˘ÌϤÁÌ·ÙÔ˜ Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ ·Ï˘Û›‰·˜ Û ÈÛÙfi ñ <30% ‰Ú·ÛÙÈÎfiÙËÙ· ÂÓ˙˘ÌÈÎÔ‡ Û˘ÌϤÁÌ·ÙÔ˜ Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ ·Ï˘Û›‰·˜ Û ΢ÙÙ·ÚÈ΋ ÁÚ·ÌÌ‹ ñ <30% ‰Ú·ÛÙÈÎfiÙËÙ· ÂÓ˙˘ÌÈÎÔ‡ Û˘ÌϤÁÌ·ÙÔ˜ Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ ·Ï˘Û›‰·˜ Û ‰‡Ô ÈÛÙÔ‡˜ §ÂÈÙÔ˘ÚÁÈΤ˜ ‰ÔÎÈ̷ۛ˜ ªÂȈ̤ÓË Û˘ÓıÂÙÈ΋ ÈηÓfiÙËÙ· ATP Û ÈÓÔ‚Ï¿ÛÙ˜ (>3 ÛÙ·ıÂÚ¤˜ ·ÔÎÏ›ÛÂȘ Ù˘ ̤Û˘ ÙÈÌ‹˜) ªÔÚȷο Â˘Ú‹Ì·Ù· ∆·˘ÙÔÔ›ËÛË ÌÂÙ¿ÏÏ·Í˘ Û ˘ÚËÓÈÎfi ‹ ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi DNA ·‰È·ÌÊÈÛ‚‹ÙËÙ˘ ·ıÔÁÂÓÂÙÈÎfiÙËÙ·˜

∫ÏÈÓÈ΋ ÂΉ‹ÏˆÛË ∫ÏÈÓÈ΋ Û˘Ìو̷ÙÔÏÔÁ›· Û˘Ì‚·Ù‹ Ì ÌÈÙÔ¯ÔÓ‰Úȷ΋ ÂÁÎÂÊ·ÏÔÌ˘Ô¿ıÂÈ·* πÛÙÔ·ıÔÏÔÁ›· ñ 1-2% ÂÚ˘ıÚÒÓ Ú·Îˆ‰ÒÓ ÈÓÒÓ (ËÏÈΛ· 30-50 ÂÙÒÓ) ñ √ÔÈ·‰‹ÔÙ ·ÚÔ˘Û›· ÂÚ˘ıÚÒÓ Ú·Îˆ‰ÒÓ ÈÓÒÓ (<30 ÂÙÒÓ) ñ >2% ˘ÔÛ·ÚÎÂÈÏËÌ·ÙÈΤ˜ ÌÈÙÔ¯ÔÓ‰ÚȷΤ˜ Û˘ÛÛˆÚ‡ÛÂȘ (<16 ÂÙÒÓ) ñ ∂ÎÙÂٷ̤Ó˜ ÌÈÙÔ¯ÔÓ‰ÚȷΤ˜ ·ÏÏÔÈÒÛÂȘ ÛÙÔ ËÏÂÎÙÚÔÓÈÎfi ÌÈÎÚÔÛÎfiÈÔ ∂Ó˙˘ÌÔÏÔÁ›· ñ 20-30% ‰Ú·ÛÙÈÎfiÙËÙ· ÂÓ˙˘ÌÈÎÔ‡ Û˘ÌϤÁÌ·ÙÔ˜ Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ ·Ï˘Û›‰·˜ Û ÈÛÙfi ñ 30-40% ‰Ú·ÛÙÈÎfiÙËÙ· ÂÓ˙˘ÌÈÎÔ‡ Û˘ÌϤÁÌ·ÙÔ˜ Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ ·Ï˘Û›‰·˜ Û ΢ÙÙ·ÚÈ΋ ÁÚ·ÌÌ‹ ñ 30-40% ‰Ú·ÛÙÈÎfiÙËÙ· ÂÓ˙˘ÌÈÎÔ‡ Û˘ÌϤÁÌ·ÙÔ˜ Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ ·Ï˘Û›‰·˜ Û ‰‡Ô ÈÛÙÔ‡˜ §ÂÈÙÔ˘ÚÁÈΤ˜ ‰ÔÎÈ̷ۛ˜ ñ ªÂȈ̤ÓË Û˘ÓıÂÙÈ΋ ÈηÓfiÙËÙ· ATP Û ÈÓÔ‚Ï¿ÛÙ˜ (2-3 ÛÙ·ıÂÚ¤˜ ·ÔÎÏ›ÛÂȘ ·fi ÙË Ì¤ÛË) ªÔÚȷο Â˘Ú‹Ì·Ù· ∆·˘ÙÔÔ›ËÛË ÌÂÙ¿ÏÏ·Í˘ Û ˘ÚËÓÈÎfi ‹ ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi DNA Èı·Ó‹˜ ·ıÔÁÂÓÂÙÈÎfiÙËÙ·˜ ªÂÙ·‚ÔÏÈΤ˜ ‰È·Ù·Ú·¯¤˜ ŒÓ·˜ ‹ ÂÚÈÛÛfiÙÂÚÔÈ ÌÂÙ·‚ÔÏÈÎÔ› ‰Â›ÎÙ˜ ‰È·Ù·Ú·¯‹˜ Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ ·Ï˘Û›‰·˜

* ∫ÏÈÓÈ΋ ÚÔ‚ÔÏ‹ Ù˘È΋ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ (Leigh, Alper, Pearson’s, Kearns-Sayre, MELAS, MERRF, NARP, MNGIE, LHON) ** ∂Ó˙˘ÌÈ΋ ‰Ú·ÛÙÈÎfiÙËÙ· ·ÓÙÈÚÔÛˆ‡ÂÈ ÔÛÔÛÙÈ·›· ·Ó·ÏÔÁ›· Û ۯ¤ÛË Ì ÙË Ê˘ÛÈÔÏÔÁÈ΋ ̤ÛË ÙÈÌ‹

Ó· ‰ÒÛÂÈ ÏËÚÔÊÔڛ˜ ÔÈ Ôԛ˜ Ó· ηÙ¢ı‡ÓÔ˘Ó ÙË ‰È·ÁÓˆÛÙÈ΋ ÚÔÛ¤ÁÁÈÛË. √ Ì·ÁÓËÙÈÎfi˜ ·ÂÈÎÔÓÈÛÙÈÎfi˜ Û˘ÓÙÔÓÈÛÌfi˜ ÚÔÙÈÌ¿Ù·È, ÂÓÒ Ë ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ ÌÔÚ› Ó· ·ÂÈÎÔÓ›ÛÂÈ Î·Ï‡ÙÂÚ· ÙȘ Èı·Ó¤˜ ·Û‚ÂÛÙÔÔÈ‹ÛÂȘ ÛÙ· ‚·ÛÈο Á¿ÁÁÏÈ· (67). π‰È·›ÙÂÚ· ÛÙȘ ÂÚÈÙÒÛÂȘ Û˘Ó‰ÚfiÌÔ˘ Leigh, Û˘ÌÌÂÙÚÈÎfi ·ıÔÏÔÁÈÎfi Û‹Ì· ·Ó¢ڛÛÎÂÙ·È ÛÙ· ‚·ÛÈο Á¿ÁÁÏÈ· (∂ÈÎfiÓ· 5) ·ÏÏ¿ Î·È ¿ÏÏÔ˘˜ ÂÁÎÂÊ·ÏÈÎÔ‡˜ ˘Ú‹Ó˜ (˘Ôı·Ï¿ÌÈÔ˘˜, ̤ϷÈÓ· Ô˘Û›·, Ê·È¿ Ô˘Û›· ÙÔ˘ ˘‰Ú·ÁˆÁÔ‡ ÙÔ˘ Sylvious Î·È ˘Ú‹Ó˜ ÙÔ˘ ÛÙÂϤ¯Ô˘˜). ÷ڷÎÙËÚÈÛÙÈ΋ ÂÈÎfiÓ· Ï¢ÎÔ‰˘ÛÙÚÔÊ›·˜ ¤¯Ô˘Ì ÛÙÔ Û‡Ó‰ÚÔÌÔ Kearns-Sayre (∂ÈÎfiÓ· 8). ¶ÚÔÛ‚ÔÏ‹ Ù˘ Ï¢΋˜ Ô˘Û›·˜ ¤¯Ô˘Ì Â›Û˘ ÛÙÔ Û‡Ó‰ÚÔÌÔ MNGIE Î·È Û‡Ó‰ÚÔÌÔ Leigh (41,68). ∂ÁÎÂÊ·ÏÈ΋ Î·È ·ÚÂÁÎÂÊ·ÏȉÈ΋ ÊÏÔÈ҉˘ ·ÙÚÔÊ›· Â›Ó·È Û˘¯Ófi ‡ÚËÌ·, ηٿ ηÓfiÓ· ‚Ú›ÛÎÂÙ·È ÛÙÔ Û‡Ó‰ÚÔÌÔ Alper, ÂÓÒ Û·Ó›ˆ˜ ··ÓÙ¿Ù·È ÛÙÔ Û‡Ó‰ÚÔÌÔ Leigh (31,39,41,69).

Paediatriki 2007;70:1-17

* ∆· ÎÚÈÙ‹ÚÈ· ÁÈ· ÂÓ‹ÏÈΘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Û˘ÌÌÂÙÔ¯‹ ÙÔ Ó¢ÚÈÎÔ‡ ‹ Ì˘˚ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ™Ù· ·È‰È¿ Û˘ÌÙÒÌ·Ù· fiˆ˜ ÓÂÔÁÓÈÎfi˜ ı¿Ó·ÙÔ˜, ÓÂÔÁÓÈ΋ ˘ÔÙÔÓ›·, ÛÔ‚·Ú‹ ηı˘ÛÙ¤ÚËÛË ·Ó¿Ù˘Í˘, ÓÂÔÁÓÈ΋ ˘ÂÚÙÔÓ›· ıˆÚÔ‡ÓÙ·È ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ÌÈÙÔ¯ÔÓ‰ÚÈÔ¿ıÂÈ·˜

∂ÈÎfiÓ· 8. ™‡Ó‰ÚÔÌÔ Kearns-Sayre: ∂ÁοÚÛÈ· ÙÔÌ‹ ∆2 ·ÎÔÏÔ˘ı›· (11 ÂÙÒÓ). ∂ÎÙÂٷ̤ÓË Û˘ÌÌÂÙÔ¯‹ Ù˘ ˘ÔÊÏÔÈÒ‰Ô˘˜ Ï¢΋˜ Ô˘Û›·˜ (ÎfiÎÎÈÓÔ ‚¤ÏÔ˜). ¶·ıÔÏÔÁÈÎfi ˘„ËÏfi ∆2 Û‹Ì· ·Ú·ÙËÚÂ›Ù·È ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ Ê·ÎÔÂȉԇ˜ ˘Ú‹Ó· (6).

11

ªÈÙÔ¯ÔÓ‰Úȷο ÓÔÛ‹Ì·Ù· Ù˘ ·È‰È΋˜ ËÏÈΛ·˜

¶›Ó·Î·˜ 6. ¶ÚÔÙÂÈÓfiÌÂÓÔ ÌÂÙ·‚ÔÏÈÎfi ÚÔÊ›Ï Â› ˘Ô„›· ÂÓÂÚÁÂȷ΋˜ ‰È·Ù·Ú·¯‹˜ ¢ÂÈÁÌ·ÙÔÏË„›· ÓËÛÙ›·˜ (8 ÒÚ˜ Û ·È‰È¿, 4-5 ÒÚ˜ Û ‚Ú¤ÊË)

¢ÂÈÁÌ·ÙÔÏË„›· ÌÂÙ¿ Ê·ÁËÙfi (1-2 ÒÚ˜ ÌÂÙ¿ ·fi ηÏfi Á‡̷)

√Úfi˜ °Ï˘Îfi˙Ë, ÓÂÊÚÈ΋/Ë·ÙÈ΋ ÏÂÈÙÔ˘ÚÁ›·, Á·Ï·ÎÙÈÎfi, ˘ÚÔÛÙ·Ê˘ÏÈÎfi, ÎÂÙÔÓÔÛÒÌ·Ù·, ·ÌÈÓÔͤ·, Ô˘ÚÈÎfi Ô͇, ÔÏÈ΋ ηÚÓÈÙ›ÓË, ·ÎÂÙ˘ÏÔηÚÓÈÙ›Ó˜, ÂχıÂÚ· ÏÈ·Ú¿ Ôͤ·, ·Ì̈ӛ·, CPK, ‰Â›ÁÌ· ÚÔ˜ ·Ôı‹Î¢ÛË

√Úfi˜ °Ï˘Îfi˙Ë, Á·Ï·ÎÙÈÎfi, ˘ÚÔÛÙ·Ê˘ÏÈÎfi, ÎÂÙÔÓÔÛÒÌ·Ù·, ·ÌÈÓÔͤ·

√‡Ú· °ÂÓÈ΋ Ô‡ÚˆÓ, ÎÂÙÔÓÔÛÒÌ·Ù·, ÔÚÁ·ÓÈο Ôͤ· Î·È ÔÚÔÙÈÎfi, ·ÌÈÓÔͤ· Ô‡ÚˆÓ, ‰Â›ÁÌ· ÚÔ˜ ·Ôı‹Î¢ÛË

√‡Ú· °ÂÓÈ΋ Ô‡ÚˆÓ, ÎÂÙÔÓÔÛÒÌ·Ù·, ÔÚÁ·ÓÈο Ôͤ· Î·È ÔÚÔÙÈÎfi, ·ÌÈÓÔͤ· Ô‡ÚˆÓ

∂¡À °Ï˘Îfi˙Ë, ÚˆÙ½ÓË, Á·Ï·ÎÙÈÎfi, ˘ÚÔÛÙ·Ê˘ÏÈÎfi, ·ÌÈÓÔͤ·, ‰Â›ÁÌ· ÚÔ˜ ·Ôı‹Î¢ÛË ¶ÂÚÈÔÚÈÛÌÔ› ñ ∂Ó˙˘Ì·ÙÈο Î·È ÁÂÓÂÙÈο ·ԉ‰ÂÈÁ̤Ó˜ ÌÈÙÔ¯ÔÓ‰ÚÈÔ¿ıÂȘ ÌÔÚ› Ó· ¤¯Ô˘Ó Ê˘ÛÈÔÏÔÁÈÎfi Á·Ï·ÎÙÈÎfi Ô͇ Î·È ¿ÏÏÔ˘˜ ‚ÈÔ¯ËÌÈÎÔ‡˜ ‰Â›ÎÙ˜ ÛÙÔÓ ÔÚfi. ñ ™Â ÂÚ›Ô‰Ô ‡ÊÂÛ˘ Î·È ·Ô˘Û›·˜ ÌÂÙ·‚ÔÏÈÎÔ‡ stress, Ô ‚ÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÌÔÚ› Ó· Â›Ó·È Ê˘ÛÈÔÏÔÁÈÎfi˜. ñ ŒÓÙÔÓÔ ÎÏ¿Ì· (ȉȷ›ÙÂÚ· ÛÙ· ·È‰È¿), Ë ÂÊ·ÚÌÔÁ‹ ÂÚ›ÛÊÈ͢ (tourniquet) ÁÈ· ÙË ÊÏ‚ÔΤÓÙËÛË ÌÔÚ› Ê˘ÛÈÔÏÔÁÈο Ó· ÂËÚ¿ÛÔ˘Ó ÙË Û˘ÁΤÓÙÚˆÛË ÙÔ˘ Á·Ï·ÎÙÈÎÔ‡ ÛÙÔÓ ÔÚfi. ∏ ·Ï·Ó›ÓË ÔÚÔ‡ Î·È ÙÔ Á·Ï·ÎÙÈÎfi Ô͇ ÛÙÔ ∂¡À ÂËÚ¿˙ÔÓÙ·È Û ÌÈÎÚfiÙÂÚÔ ‚·ıÌfi. ñ ∂ÁÁ‡˜ ÛˆÏËÓ·Úȷ΋ ‚Ï¿‚Ë ÂÏ·ÙÙÒÓÂÈ ÙË Û˘ÁΤÓÙÚˆÛË Á·Ï·ÎÙÈÎÔ‡ ÛÙÔÓ ÔÚfi ·ÏÏ¿ ÙËÓ ·˘Í¿ÓÂÈ ÛÙ· Ô‡Ú·. ñ ∏ ·ÚÔ˘Û›· ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË ÂÌÔ‰›˙ÂÈ ÙËÓ Â›ÛÔ‰Ô ÙÔ˘ ˘ÚÔÛÙ·Ê˘ÏÈÎÔ‡ ÛÙÔÓ Î‡ÎÏÔ ÙÔ˘ ÎÈÙÚÈÎÔ‡ ÔͤԘ Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·˘ÍË̤ÓË ·Ú·ÁˆÁ‹ Á·Ï·ÎÙÈÎÔ‡. ñ ∏ ̤ÙÚËÛË ÙÔ˘ Á·Ï·ÎÙÈÎÔ‡ ÛÙÔ ∂¡À Â›Ó·È ÈÔ Â˘·›ÛıËÙË Î·È ÂȉÈ΋ ̤ıÔ‰Ô˜ Î·È Û˘ÓÈÛٿٷÈ.

∏ 1HMRS ÌÔÚ› Ó· ‰ÒÛÂÈ ¯Ú‹ÛÈ̘ in vivo ÌÂÙ·‚ÔÏÈΤ˜ ÏËÚÔÊÔڛ˜ Î·È Ë ·ÚÔ˘Û›· ·È¯Ì‹˜ Á·Ï·ÎÙÈÎÔ‡ ÛÙËÓ 1HMRS ÌÔÚ› Ó· ÂÚÈÏ·Ì‚¿ÓÂÙ·È ·˘ÙfiÓÔÌ· ˆ˜ ¤Ï·ÛÛÔÓ ÎÚÈÙ‹ÚÈÔ ÛÙÔ Û¯‹Ì· ÎÚÈÙËÚ›ˆÓ (MAC) (70). ÷ÌËÏ‹ ÙÈÌ‹ ¡∞∞ Â›Ó·È Û˘¯Ófi ‡ÚËÌ· ·ÏÏ¿ ‰ÂÓ ·ÔÙÂÏ› ÂȉÈÎfi ÌÂÙ·‚ÔÏÈÎfi ‰Â›ÎÙË (41). °ÂÓÂÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ∏ ÁÂÓÂÙÈ΋ ÚÔÛ¤Ï·ÛË ÙˆÓ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ Â›Ó·È ‰··ÓËÚ‹ ‰È·‰Èηۛ· Î·È ··ÈÙ› ÂÍÂȉÈÎÂ˘Ì¤ÓÔ ÂÚÁ·ÛÙ‹ÚÈÔ. ŸÙ·Ó ¤¯Ô˘ÌÂ Ù˘ÈÎfi ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi Ê·ÈÓfiÙ˘Ô, ÙfiÙÂ Ô ¤ÏÂÁ¯Ô˜ ÙˆÓ ÎÔÈÓÒÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ ÛÙÔ ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi DNA Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÚÈÓ ÙËÓ ÂÊ·ÚÌÔÁ‹ Ì˘˚΋˜ ‚ÈÔ„›·˜. ∞ÚÓËÙÈÎfi ·ÔÙ¤ÏÂÛÌ· ÌÂÈÒÓÂÈ ÙËÓ Èı·ÓfiÙËÙ· ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ ÓÔÛ‹Ì·ÙÔ˜ ·ÏÏ¿ ‰ÂÓ ÙÔ ·ÔÎÏ›ÂÈ, ÁÈ·Ù› ÌÂÙ·ÏÏ¿ÍÂȘ ÙÔ˘ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ DNA ‰ÂÓ ÂÎÊÚ¿˙ÔÓÙ·È Û fiÏÔ˘˜ ÙÔ˘˜ ÈÛÙÔ‡˜. ∂ÏÏ›ÌÌ·Ù· ÛÙÔ ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi DNA ÂÎÊÚ¿˙ÔÓÙ·È Î·Ï‡ÙÂÚ· ÛÙÔÓ Ì˘˚Îfi ÈÛÙfi ·Ú¿ ÛÙ· Ï¢ÎÔ·ÙÙ·Ú· (ÂÍ·›ÚÂÛË ·ÔÙÂÏ› ÙÔ Û‡Ó‰ÚÔÌÔ Pearson). ŸÙ·Ó ÎÏÈÓÈο, ‚ÈÔ¯ËÌÈο Î·È ÈÛÙÔ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù· Â›Ó·È Û˘Ì‚·Ù¿ Ì ÌÈÙÔ¯ÔÓ‰ÚÈÔ¿ıÂÈ· Î·È ÔÈ ÎÔÈÓ¤˜ ÌÂÙ·ÏÏ¿ÍÂȘ ÛÙÔ ÌÈÙÔ¯fiÓ‰ÚÈ· DNA ·Ô˘ÛÈ¿˙Ô˘Ó, ÙfiÙÂ Ô ÂÚ·ÈÙ¤Úˆ ÁÂÓÂÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ú¤ÂÈ Ó· ÂÍ·ÙÔÌÈ·ÂÙ·È. ∏ ·ÔΈ‰ÈÎÔÔ›ËÛË ÙˆÓ ·ÏÏËÏÔ˘¯ÈÒÓ ÙÔ˘ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ DNA (sequencing) Û˘ÓÈÛÙ¿Ù·È Ì ÛÎÔfi ÙËÓ ·Ó‡ÚÂÛË ÌË ÎÔÈÓÒÓ ‹ ·ÎfiÌË Î·È Ó¤ˆÓ ÌÂ-

Ù·ÏϿ͈Ó. ∏ ·Ó‡ÚÂÛË ÌÈ·˜ Ó¤·˜ ÌÂÙ¿ÏÏ·Í˘ ‰ÂÓ ÛËÌ·›ÓÂÈ fiÙÈ ·˘Ù‹ Â›Ó·È ··Ú·›ÙËÙ· ·ıÔÏÔÁÈ΋ Î·È Ë ÂÚÌËÓ›· ı· Ú¤ÂÈ Ó· Á›ÓÂÙ·È ·fi ÂÍÂȉÈÎÂ˘Ì¤Ó· ΤÓÙÚ·. ™Ù· ·È‰È¿ ÈÛÙ‡ÂÙ·È fiÙÈ Ë ÏÂÈÔ„ËÊ›· ÙˆÓ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ ÚÔηÏÂ›Ù·È ·fi ÌÂÙ·ÏÏ¿ÍÂȘ ÛÙÔ ˘ÚËÓÈÎfi DNA. ∏ ·fiÊ·ÛË ÁÈ· ÙÔ ÔÈ· ÁÂÓÂÙÈ΋ ηÙ‡ı˘ÓÛË ı· ·ÎÔÏÔ˘ı‹ÛÔ˘ÌÂ Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ÚÔÛÂÎÙÈ΋˜ ·Ó¿Ï˘Û˘ ÙÔ˘ ÎÏÈÓÈÎÔ‡ Ê·ÈÓÔÙ‡Ô˘, ÈÛÙÔ·ıÔÏÔÁ›·˜, ÂÓ˙˘ÌÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ Î·È ÙÔ˘ Ó¢ÚÔ·ÂÈÎÔÓÈÛÙÈÎÔ‡ ÂϤÁ¯Ô˘. °È· ·Ú¿‰ÂÈÁÌ·, Û ·ÛıÂÓ‹ Ì ۇӉÚÔÌÔ Leigh Î·È ·ÚÓËÙÈ΋ ·ÓÙ›‰Ú·ÛË COX ÛÙË Ì˘˚΋ ‚ÈÔ„›·, ··Ú·›ÙËÙË Â›Ó·È Ë ·Ó›¯Ó¢ÛË ÌÂÙ·ÏÏ¿ÍÂˆÓ ÛÙÔ ÁÔÓ›‰ÈÔ SURF1. ¶·ÚÔ˘Û›· ΢ÛÙÈ΋˜ Ï¢ÎÔÂÁÎÂÊ·ÏÔ¿ıÂÈ·˜ Û ·ÛıÂÓ‹ Ì ·ÓÂ¿ÚÎÂÈ· ÙÔ˘ Û˘ÌϤÁÌ·ÙÔ˜ π Ì¿˜ ηÙ¢ı‡ÓÂÈ ÚÔ˜ ÌÂÙ·ÏÏ¿ÍÂȘ ÛÙÔ ÁÔÓ›‰ÈÔ NDUFV1. ∞ÛıÂÓ‹˜ Ì ηډÈÔÌ˘Ô¿ıÂÈ· Î·È ·ÚÓËÙÈ΋ ·ÓÙ›‰Ú·ÛË COX Ì¿˜ ηÙ¢ı‡ÓÂÈ ÛÙÔ ÁÔÓ›‰ÈÔ SCO2 Î·È ·ÛıÂÓ‹˜ Ì ÂÁÎÂÊ·ÏÔ¿ıÂÈ·, ÓÂÊÚÈ΋ ÛˆÏËÓ·Úȷ΋ ‚Ï¿‚Ë Î·È ·ÚÓËÙÈ΋ ·ÓÙ›‰Ú·ÛË COX Ì¿˜ ηÙ¢ı‡ÓÂÈ ÛÙÔ ÁÔÓ›‰ÈÔ COX10. √ ηٿÏÔÁÔ˜ ÙˆÓ ˘‡ı˘ÓˆÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ ÁÈ· ÚˆÙÔ·ı‹ ÌÈÙÔ¯ÔÓ‰Úȷ΋ ÓfiÛÔ Û˘Ó¯Ҙ ·˘Í¿ÓÂÙ·È Î·È ÙÔ ¢È·‰›ÎÙ˘Ô ·ÔÙÂÏ› ÙËÓ Î·Ï‡ÙÂÚË ËÁ‹ ÏËÚÔÊfiÚËÛ˘ (mitomap.org). √È ¶›Ó·Î˜ 7 Î·È 8 ÂÚÈÁÚ¿ÊÔ˘Ó ÁÓˆÛÙ¤˜ ·ıÔÏÔÁÈΤ˜ ÌÂÙ·ÏÏ¿ÍÂȘ ÛÙÔ ˘ÚËÓÈÎfi ‹ ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi DNA ·ÓÙÈÛÙÔ›¯ˆ˜ (6,8,14,33,71). ¶·È‰È·ÙÚÈ΋ 2007;70:1-17

12

∞. ¡ÙÈÓfiÔ˘ÏÔ˜, ∞. ¶··‰ËÌËÙÚ›Ô˘

¶›Ó·Î·˜ 7. ªÂÙ·ÏÏ¿ÍÂȘ ÙÔ˘ ˘ÚËÓÈÎÔ‡ DNA ˘‡ı˘Ó˜ ÁÈ· ÚˆÙÔ·ı‹ ÌÈÙÔ¯ÔÓ‰Úȷ΋ ÓfiÛÔ °ÔÓ›‰ÈÔ

ªÈÙÔ¯ÔÓ‰Úȷ΋ ‚Ï¿‚Ë

∫ÏËÚÔÓÔÌÈÎfiÙËÙ· / ∫ÏÈÓÈÎfi˜ Ê·ÈÓfiÙ˘Ô˜

ªÂÙ·ÏÏ¿ÍÂȘ Ô˘ Έ‰ÈÎÔÔÈÔ‡Ó ‰ÔÌÈΤ˜ ÌÔÓ¿‰Â˜ Û˘ÌÏÂÁÌ¿ÙˆÓ NDUFS1 ™‡ÌÏÂÁÌ· π À™ / ÂÁÎÂÊ·ÏÔ¿ıÂÈ· NDUFS2 » NDUFS4 » À™ / ¶ÔÏ˘Û˘ÛÙËÌ·ÙÈ΋ ÓfiÛÔ˜ NDUFS7 » À™ / Leigh NDUFS8 » À™ / Leigh NDUFV1 » À™ / §Â˘ÎÔÂÁÎÂÊ·ÏÔ¿ıÂÈ· / Ì˘ÔÎÏÔÓ›· SDHA ™‡ÌÏÂÁÌ· ππ À™ / Leigh SDHB » ∂™ ‹ ™ÔÚ·‰È΋ / º·ÈÔ¯ÚˆÌÔ·Ùو̷, ÙÚ·¯ËÏÈÎfi ·Ú·Á·ÁÁÏ›ˆÌ· SDHD Î·È SDHC » ∫ÏËÚÔÓÔÌÈÎfi ·Ú·Á·ÁÁÏ›ˆÌ· UQCRB ™‡ÌÏÂÁÌ· πππ ÀÔηÏÈ·ÈÌ›·, Á·Ï·ÎÙÈ΋ ÔͤˆÛË ªÂÙ·ÏÏ¿ÍÂȘ Ô˘ Έ‰ÈÎÔÔÈÔ‡Ó ÚˆÙ½Ó˜ Û˘Ó·ÚÌÔÏfiÁËÛ˘ Û˘ÌÏÂÁÌ¿ÙˆÓ SURF1 ™‡ÌÏÂÁÌ· πV À™ / Leigh SCO1 » À™ / ∏·ÙÔ¿ıÂÈ· SCO2 » À™ / µÚÂÊÈ΋ ηډÈÔÌ˘Ô¿ıÂÈ· COX10 » À™ / §Â˘ÎÔÂÁÎÂÊ·ÏÔ¿ıÂÈ·, ÓÂÊÚÈ΋ ÛˆÏËÓ·Úȷ΋ ‚Ï¿‚Ë COX15 » À™ / ÀÂÚÙÚÔÊÈ΋ ηډÈÔÌ˘Ô¿ıÂÈ· LRPPRC » À™ / Leigh BCS1L ™‡ÌÏÂÁÌ· πII À™ / ∂ÁÎÂÊ·ÏÔÌ˘Ô¿ıÂÈ·, Ë·ÙÈ΋ ·ÓÂ¿ÚÎÂÈ·, ÓÂÊÚÈ΋ ÛˆÏËÓ·Úȷ΋ ‚Ï¿‚Ë ATP12 ™‡ÌÏÂÁÌ· V À™ / ∂ÁÎÂÊ·ÏÔ¿ıÂÈ· ªÂÙ·ÏÏ¿ÍÂȘ Ô˘ Έ‰ÈÎÔÔÈÔ‡Ó ÚˆÙ½Ó˜ ··Ú·›ÙËÙ˜ ÁÈ· ÙË ‰È·Ù‹ÚËÛË ÙÔ˘ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ DNA Twinkle ¶ÔÏÏ·Ï¿ ÂÏÏ›ÌÌ·Ù· À™ ‹ ∂™ / ¶ÚÔԉ¢ÙÈ΋ ÔÊı·ÏÌÔÏËÁ›· (PEO) ÛÙÔ ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi DNA POLG1 À™ / ™‡Ó‰ÚÔÌÔ Alpers Thymidine ¶ÔÏÏ·Ï¿ ÂÏÏ›ÌÌ·Ù· ‹ À™ / ªÈÙÔ¯ÔÓ‰Úȷ΋ Ó¢ÚÔ-Á·ÛÙÚÂÓÙÂÚÈ΋ phosphorylase ÔÛÔÙÈ΋ Ì›ˆÛË ÙÔ˘ ÂÁÎÂÊ·ÏÔÌ˘Ô¿ıÂÈ· (MNGIE) ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ DNA TK2 ¶ÔÛÔÙÈ΋ Ì›ˆÛË ÙÔ˘ µÚÂÊÈ΋ Û˘ÁÁÂÓ‹˜ Ì˘Ô¿ıÂÈ· Ì ‹ ¯ˆÚ›˜ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ DNA Û‡Ó‰ÚÔÌÔ De Toni-Fanconi DGUOK ¶ÔÛÔÙÈ΋ Ì›ˆÛË µÚÂÊÈ΋ Ë·ÙÔ¿ıÂÈ· Î·È ÂÁÎÂÊ·ÏÔÌ˘Ô¿ıÂÈ· ÙÔ˘ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ DNA ªÂÙ·ÏÏ¿ÍÂȘ Ô˘ Έ‰ÈÎÔÔÈÔ‡Ó ÚˆÙ½Ó˜ ÌÂÙ·ÊÔÚ›˜ DDP1/TIMM8A ºÀ / ∫ÒʈÛË ‰˘ÛÙÔÓ›· (Û‡Ó‰ÚÔÌÔ Mohr-Tranebjaerg) ANT1 ¶ÔÏÏ·Ï¿ ÂÏÏ›ÌÌ·Ù· À™ ‹ ∂™ / ¶ÚÔԉ¢ÙÈ΋ ÔÊı·ÏÌÔÏËÁ›· (PEO) ÛÙÔ ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi DNA ÕÏϘ ÌÂÙ·ÏÏ¿ÍÂȘ Tafazzin

ºÀ / ™‡Ó‰ÚÔÌÔ Barth

À™: ÀÔÏÂÈfiÌÂÓÔ ™ˆÌ·ÙÈÎfi, ∂™: ∂ÈÎÚ·ÙÔ‡Ó ™ˆÌ·ÙÈÎfi, ºÀ: º˘ÏÔÛ‡Ó‰ÂÙÔ ÀÔÏÂÈfiÌÂÓÔ

£ÂÚ·›· Î·È ÁÂÓÂÙÈ΋ ηıÔ‰‹ÁËÛË £ÂÚ·›· ¢˘ÛÙ˘¯Ò˜ ·ÔÙÂÏÂÛÌ·ÙÈ΋ ·ÈÙÈÔÏÔÁÈ΋ ıÂÚ·›· ÙˆÓ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ ‰ÂÓ ˘¿Ú¯ÂÈ Î·È Ë ıÂÚ·›· ÂÚÈÔÚ›˙ÂÙ·È ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ Û˘Ìو̿وÓ, ˘ÔÛÙ‹ÚÈÍË ÙˆÓ ÔÚÁ¿ÓˆÓ ‹ Û˘ÛÙËÌ¿ÙˆÓ Ô˘ Û˘ÌÌÂÙ¤¯Ô˘Ó Î·È ·ÔÊ˘Á‹ ÂÈÏÔÎÒÓ ·fi ·Ó·Ëڛ˜ Ù˘ ÓfiÛÔ˘ (72,73). ¢È·ÈÙËÙÈο ̤ÙÚ·. ™˘ÓÈÛÙ¿Ù·È Ë ·ÔÊ˘Á‹ ·Ú·ÙÂٷ̤Ó˘ ÓËÛÙ›·˜ Î·È Ë Î·Ï‹ ÂÓ˘‰¿ÙˆÛË, ȉȷ›ÙÂÚ· fiÙ·Ó ÙÔ ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi ÓfiÛËÌ· Û˘Óԉ‡ÂÙ·È ·fi ˘ÔÁÏ˘Î·ÈÌ›·. ∏ ÎÂÙÔÁÂÓ‹˜ ‰›·ÈÙ· Û˘ÓÈÛÙ¿Ù·È Û ·ÓÂ¿ÚÎÂÈ· Ù˘ ˘ÚÔÛÙ·Ê˘ÏÏÈ΋˜ ·Ê˘‰ÚÔÁÔÓ¿Û˘ Paediatriki 2007;70:1-17

ÂÓÒ ÌÔÚ› Ó· Â›Ó·È ‚ÔËıËÙÈ΋ Û ·ÓÂ¿ÚÎÂÈ· ÙÔ˘ Û˘ÌϤÁÌ·ÙÔ˜ I Ì ·ÓıÂÎÙÈ΋ ÂÈÏË„›·. ™ËÌ·ÓÙÈ΋ Â›Ó·È Ë ‰È·Ù‹ÚËÛË ‰È·ÈÙËÙÈÎÔ‡ ÈÛÔ˙˘Á›Ô˘ Ì ÚfiÛÏË„Ë fiÏˆÓ ÙˆÓ ··Ú·›ÙËÙˆÓ ‚ÈÙ·ÌÈÓÒÓ Î·È È¯ÓÔÛÙÔȯ›ˆÓ ÂÂȉ‹ ÔÈ ·ÛıÂÓ›˜ Ì ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi ÓfiÛËÌ· Â›Ó·È È‰È·›ÙÂÚ· ÂÈÚÚÂ‹˜ Û ·ÓÂ¿ÚÎÂȘ. º˘ÛÈÎÔıÂÚ·›·. ∏ Ê˘ÛÈ΋ ¿ÛÎËÛË Ú¤ÂÈ Ó· ÂÓı·ÚÚ‡ÓÂÙ·È Î·È Î·Ïfi Â›Ó·È Ó· Á›ÓÂÙ·È ÚÔÁÚ·ÌÌ·ÙÈṲ̂ӷ ˘fi ÙËÓ Â›‚ÏÂ„Ë ÙÔ˘ Ê˘ÛÈÎÔıÂÚ·Â˘Ù‹ Î·È ·ÊÔ‡ ¤¯ÂÈ ·ÔÎÏÂÈÛÙ› ˘ÔÎÏÈÓÈ΋ ηډÈÔ¿ıÂÈ·. ∏ Ê˘ÛÈÎÔıÂÚ·›· ‚ÔËı¿ÂÈ ÛÙËÓ ÚfiÏË„Ë ÙˆÓ Û˘Áο̄ˆÓ, ÛÎÔÏ›ˆÛ˘ Î·È ÛÙËÓ ÚfiÏË„Ë Ù˘ ÔÛÙÂÔfiÚˆÛ˘. ∏ ˘ÂÚ‚ÔÏÈ΋ ¿ÛÎËÛË Î·Ïfi Â›Ó·È Ó·

13

ªÈÙÔ¯ÔÓ‰Úȷο ÓÔÛ‹Ì·Ù· Ù˘ ·È‰È΋˜ ËÏÈΛ·˜

¶›Ó·Î·˜ 8. º·ÈÓÔÙ˘È΋ ¤ÎÊÚ·ÛË ·ıÔÁfiÓˆÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ ÙÔ˘ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ DNA (Ì ¤ÓÙÔÓ· ÁÚ¿ÌÌ·Ù· ·Ó·ÁÚ¿ÊÔÓÙ·È ÔÈ ÈÔ Û˘¯Ó¤˜ ÌÂÙ·ÏÏ¿ÍÂȘ) ∫ÏÈÓÈÎfi˜ º·ÈÓfiÙ˘Ô˜ °ÔÓ›‰ÈÔ

ªÂÙ·ÏÏ¿ÍÂȘ

MELAS

ñ {3243, 3252, 3260, 5814}A>G, {1642, 583}G>A, {3271, 3291}T>C ñ ŒÏÏÂÈÌÌ· (deletion) ñ 13513G>A, 13514A>G ñ 14787del4 ñ 9957T>C ñ 3308T>C

MELAS/Ó¤ÎÚˆÛË Ú·‚‰ˆÙÔ‡ ÛÒÌ·ÙÔ˜ MELAS/MERRF MERRF PEO

tRNA

ND5 (Û‡ÌÏÂÁÌ· π) Cyt b (Û‡ÌÏÂÁÌ· IIπ) COX III (Û‡ÌÏÂÁÌ· πV) ND5 (Û‡ÌÏÂÁÌ· π) tRNA

PEO/ÔÏ˘Û˘ÛÙËÌ·ÙÈ΋ ÓfiÛÔ˜ PEO/‰È·‚‹Ù˘, ·Ù·Í›· ª˘Ô¿ıÂÈ· Cyt b (Û‡ÌÏÂÁÌ· III)

ÀÂÚÙÚÔÊÈ΋ ηډÈÔÌ˘Ô¿ıÂÈ· ¡Â˘ÚÔ·ÈÛıËÙËÚȷ΋ ·ÒÏÂÈ· ·ÎÔ‹˜ NARP/MILS

LHON /

tRNA Cyt b (Û‡ÌÏÂÁÌ· IIπ) tRNA rRNA tRNA ATPase 6 (Û‡ÌÏÂÁÌ· V) ND6 (Û‡ÌÏÂÁÌ· π) COX III (Û‡ÌÏÂÁÌ· πV) ND1 (Û‡ÌÏÂÁÌ· π) ND4 (Û‡ÌÏÂÁÌ· π) ND6 (Û‡ÌÏÂÁÌ· π)

LHON / ¢˘ÛÙÔÓ›· ∫™™ / Pearson

tRNA

ñ {8356,7512}T>C ñ 8344A>G, 8363G>A ñ ŒÏÏÂÈÌÌ· (deletion) ñ {3243, 5692, 3251}A>G, {4309, 5703, 12315, 4298, 8342}G>A ñ 3256C>T ñ {3264, 12311}T>C ñ {3288, 3302, 3243, 12320}A>G, 5521G>A, 15990C>T {618, 3250, 4409}T>C ñ {14846, 15059, 15084, 15150, 15168, 15242, 15615, 15723, 15762}G>A, 15197T>C ñ 15498del24 ñ {3243, 3254, 3260, 4269, 4295, 4300, 8296}A>G, {3303, 4320} C>T, 9997T>C, 8363 G>A ñ 15243G>A ñ {3243, 7445}A>G, {7510, 7511, 7512}T>C, 12258G>A ñ 7472-insC ñ delT961Cn, 1095T>C, 1555A>G ñ {1624, 1644}C>T, 8344A>G, 8363G>A, 5537-insT ñ 8993A>G, {8851, 9171}T>C ñ 14459 G>A ñ 9537 insC ñ {3460, 5244, 7444, 9438, 9804, 13708, 15257, 15812}G>A, 4917A>G , {3394, 4160, 4216, 9101}T>C ñ 11778G>A (Ï¢ÎÔÂÁÎÂÊ·ÏÔ¿ıÂÈ·), 10663T>C ñ 14482G>A, 14484T>C, 14495A>G ñ 11696, 14459 (‚Ï¿‚Ë ÛÙ· ‚·ÛÈο Á¿ÁÁÏÈ·), 14596 ñ ∂ÏÏ›ÌÌ·Ù· ñ ∞Ó·‰ÈÏ·ÛÈ·ÛÌÔ›

·ÔʇÁÂÙ·È ÁÈ·Ù› ·ÊÂÓfi˜ ˘¿Ú¯ÂÈ Î›Ó‰˘ÓÔ˜ Ú·‚‰ÔÌ˘fiÏ˘Û˘ Î·È Î›Ó‰˘ÓÔ˜ ηډȷ΋˜ ‚Ï¿‚˘, ·ÊÂÙ¤ÚÔ˘ ÌÔÚ› Ó· ·˘Í‹ÛÂÈ ÙÔ ÔÛÔÛÙfi ÙˆÓ ·ıÔÏÔÁÈÎÒÓ ÌÈÙÔ¯ÔÓ‰Ú›ˆÓ. º·Ú̷΢ÙÈ΋ Î·È ·Ó·ÏËڈ̷ÙÈ΋ ıÂÚ·›·. ∏ ¯ÔÚ‹ÁËÛË Û˘ÓÂÓ˙‡ÌÔ˘ Q10 (4-10 mg/kg/Ë̤ڷ) ‹ ¿ÏÏÔ˘ ·Ó¿ÏÔÁÔ˘ (idebenone 90-200 mg/Ë̤ڷ) Û˘ÓÈÛٿٷÈ, ·Ó Î·È ‰ÂÓ ˘¿Ú¯Ô˘Ó Ù˘¯·ÈÔÔÈË̤Ó˜ ÌÂϤÙ˜ Ô˘ Ó· ·Ô‰ÂÈÎÓ‡Ô˘Ó ÙËÓ Â˘ÂÚÁÂÙÈ΋ ÙÔ˘˜ ‰Ú¿ÛË. ∏ ¯ÔÚ‹ÁËÛË ‚ÈÙ·ÌÈÓÒÓ Â›Ó·È ··Ú·›ÙËÙË fiˆ˜ ‚ÈÙ·Ì›ÓË C (100-1000 mg/Ë̤ڷ), ıÈ·Ì›ÓË (50-200 mg/Ë̤ڷ), ÚÈ‚ÔÊÏ·‚›ÓË (50-200 mg/Ë̤ڷ), ÂÓÒ ¿ÏϘ ‚Èٷ̛Ә (D, E) ¯ÔÚËÁÔ‡ÓÙ·È ·Ó¿ ÂÚ›ÙˆÛË. ∏ ¯ÔÚ‹ÁËÛË L-ηÚÓÈÙ›Ó˘ (25-50 mg/kg/Ë̤ڷ) Â›Ó·È ·ÌÊÈÏÂÁfiÌÂÓË ·ÏÏ¿ ÁÂÓÈÎÒ˜ Û˘ÓÈÛÙ¿Ù·È Û ÂÚÈÙÒÛÂȘ Ô˘ ¤¯Ô˘Ì ·ԉ‰ÂÈÁ-

̤ÓË ·ÓÂ¿ÚÎÂÈ·. ™Â ÂȉÈΤ˜ ÂÚÈÙÒÛÂȘ fiˆ˜ ÛÔ‚·ÚÔ‡˜ Û˘ÁÁÂÓÔ‡˜ Á·Ï·ÎÙÈ΋˜ ÔͤˆÛ˘ ¤¯ÂÈ ¯ÚËÛÈÌÔÔÈËı› ÙÔ ‰È¯ÏˆÚÔ·ÎÂÙÔÙÈÎfi Ô͇ (DCA) Î·È Û ÂÚÈÙÒÛÂȘ ÂÁÎÂÊ·ÏÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ Û ۇӉÚÔÌÔ MELAS Ë L-·ÚÁÈÓ›ÓË (74,75). ∆Ô ‚·ÏÚÔ˚Îfi Ô͇ ηÏfi Â›Ó·È Ó· ·ÔʇÁÂÙ·È ÁÈ·Ù› ȉȷ›ÙÂÚ· ÛÙÔ Û‡Ó‰ÚÔÌÔ Alper ÌÔÚ› Ó· Â¿ÁÂÈ ÎÂÚ·˘ÓÔ‚fiÏÔ Ë·ÙÈ΋ Ó¤ÎÚˆÛË. ∞ÓÙÈÂÈÏËÙÈο fiˆ˜ ÙÔÈÚ·Ì¿ÙË Î·È ˙ÔÓÈÛ·Ì›‰Ë ÌÔÚ› Ó· ÂȉÂÈÓÒÛÔ˘Ó ÙË ÌÂÙ·‚ÔÏÈ΋ ÔͤˆÛË Î·È Ú¤ÂÈ Ó· ¯ÔÚËÁÔ‡ÓÙ·È Ì ÚÔÛÔ¯‹ Î·È ÛÂ Û˘Ó‰˘·ÛÌfi Ì ‰ÈÙÙ·ÓıÚ·ÎÈο. ÕÏÏ· Ê¿Ú̷η ÙÔÍÈο ÁÈ· Ù· ÌÈÙÔ¯fiÓ‰ÚÈ· Â›Ó·È ·ÓÙÈ‚ÈÔÙÈο fiˆ˜ ÔÈ ·ÌÈÓÔÁÏ˘ÎÔÛ›‰Â˜ (ΛӉ˘ÓÔ˜ ·ÒÏÂÈ· ·ÎÔ‹˜) Î·È Ë ¯ÏˆÚ·ÌÊÂÓÈÎfiÏË, ÈÔÛÙ·ÙÈο (AZT) Î·È ·ÓÙÈ·Ú·ÛÈÙÈο fiˆ˜ Ë ÌÂÙÚÔÓȉ·˙fiÏË. ¶·È‰È·ÙÚÈ΋ 2007;70:1-17

14

∞. ¡ÙÈÓfiÔ˘ÏÔ˜, ∞. ¶··‰ËÌËÙÚ›Ô˘

ÀÔÛÙËÚÈÎÙÈ΋ ıÂÚ·›·. i. ∞ÓÙÈÌÂÙÒÈÛË ÙˆÓ Û·ÛÌÒÓ Ì ·ÓÙÈÂÈÏËÙÈ΋ ·ÁˆÁ‹. ¢ÂÓ ˘¿Ú¯ÂÈ Î¿ÔÈÔ ÂȉÈÎfi ·ÓÙÈÂÈÏËÙÈÎfi Ê¿ÚÌ·ÎÔ. ∞fi Ù· ÓÂfiÙÂÚ· ·ÓÙÈÂÈÏËÙÈο Ë Ï·ÌÔÙÚÈÁ›ÓË Î·È Ë Ï‚ÂÙÈÚ·ÎÂÙ¿ÌË ‰ÂÓ ÚÔηÏÔ‡Ó ÌÂÙ·‚ÔÏÈ΋ ‰È·Ù·Ú·¯‹ Î·È Â›Ó·È Î·Ï¿ ·ÓÂÎÙ¿. ii. ∞ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË Î·È ¿ÏÏˆÓ ÂÓ‰ÔÎÚÈÓÔ·ıÂÈÒÓ. iii. ÀÔÛÙËÚÈÎÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË Ù˘ Ì˘ÔηډÈÔ¿ıÂÈ·˜ (ACE ·Ó·ÛÙÔÏ›˜, ‰ÈÔ˘ÚËÙÈο Î.Ï.) Î·È ·ÚÚ˘ıÌÈÒÓ (Ê¿Ú̷η ‹ ‚ËÌ·ÙÔ‰fiÙ˘). iv. ŒÁηÈÚË ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ Û˘ÁÁÂÓÔ‡˜ ηٷÚÚ¿¯ÙË Î·È Ë ‚ÏÂÊ·ÚÔÏ·ÛÙÈ΋ Û˘ÓÈÛÙ¿Ù·È fiÙ·Ó ¤¯Ô˘Ì ÛÔ‚·Ú‹ ‚ÏÂÊ·ÚfiÙˆÛË. v. ∞ÓÙÈÌÂÙÒÈÛË Ù˘ ‚·ÚËÎÔ˝·˜ Ì ·ÎÔ˘ÛÙÈο ‹ ·Ó ¯ÚÂÈ·ÛÙ›, ÎÔ¯Ïȷο ÂÌÊ˘Ù‡̷ٷ. vi. ∞ÓÙÈÌÂÙÒÈÛË ÓÂÊÚÈ΋˜ ÓfiÛÔ˘ Î·È Ù˘ Û˘ÓÔ‰Ô‡ ·Ó·ÈÌ›·˜. ∞ÓÙÈÌÂÙÒÈÛË ÌÂÙ·‚ÔÏÈ΋˜ ÎÚ›Û˘. ∏ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÎÚ›ÛÂˆÓ Â›Ó·È Û˘Ìو̷ÙÈ΋ Î·È ÂÚÈÏ·Ì‚¿ÓÂÈ Î·Ï‹ ÂÓ˘‰¿ÙˆÛË, ‰ÈfiÚıˆÛË Ù˘ ˘ÔÁÏ˘Î·ÈÌ›·˜ Î·È ÛˆÛÙ‹ Ú‡ıÌÈÛË Ù˘ ÔÍÂÔ‚·ÛÈ΋˜ ÈÛÔÚÚÔ›·˜. ™ËÌ·ÓÙÈÎfi˜ Â›Ó·È Ô ¤ÏÂÁ¯Ô˜ Ù˘ Ë·ÙÈ΋˜ Î·È È‰È·›ÙÂÚ· Ù˘ ÓÂÊÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ fiÙ·Ó ¤¯Ô˘ÌÂ Û˘ÓÔ‰fi Ú·‚‰ÔÌ˘fiÏ˘ÛË. ∏ ¯ÔÚ‹ÁËÛË ‰ÈÙÙ·ÓıÚ·ÎÈÎÒÓ Û ÂÚÈÙÒÛÂȘ Á·Ï·ÎÙÈ΋˜ ÔͤˆÛ˘ ÂÈ‚¿ÏÏÂÙ·È. ∞Ó Ë Á·Ï·ÎÙÈ΋ ÔͤˆÛË Â›Ó·È ÛÔ‚·Ú‹, ÙfiÙ ÌÔÚԇ̠ӷ ¯ÔÚËÁ‹ÛÔ˘Ì ‰È¯ÏˆÚÔ·ÎÂÙÔÙÈÎfi Ô͇ DCA (25 mg/kg/day) (76). ∏ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ Û·ÛÌÒÓ Ô˘ ÔÏϤ˜ ÊÔÚ¤˜ ÂÈϤÎÔ˘Ó ÌÈ· ÎÚ›ÛË Á›ÓÂÙ·È Ì ÂÓ‰ÔÊϤ‚È· ‹ ·fi ÙÔ ÔÚıfi ¯ÔÚ‹ÁËÛË ‚ÂÓ˙ԉȷ˙ÂÈÓÒÓ, ÂÓÒ ·fi ÚÔÛˆÈ΋ ÂÌÂÈÚ›·, Ë ¯ÔÚ‹ÁËÛË Ê·ÈÓÔ‚·Ú‚ÈÙ¿Ï˘ ÌÔÚ› Ó· Â›Ó·È ‚ÔËıËÙÈ΋. °ÂÓÂÙÈ΋ ηıÔ‰‹ÁËÛË ™ËÌÂȷΤ˜ ÌÂÙ·ÏÏ¿ÍÂȘ ÛÙÔ ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi DNA. √ ΛӉ˘ÓÔ˜ Ù˘ ÌËÙ¤Ú·˜ Ì ÛËÌÂȷ΋ ÌÂÙ¿ÏÏ·ÍË ÛÙÔ ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi DNA Ó· ÌÂÙ·‚È‚¿ÛÂÈ ÙË ÓfiÛÔ ÛÙ· ·È‰È¿ ÂÍ·ÚÙ¿Ù·È ·fi ÙÔ Â›Â‰Ô Ù˘ ÂÙÂÚÔÏ·ÛÌ›·˜ Ù˘ ÌÂÙ¿ÏÏ·Í˘ ÛÙÔ˘˜ ÈÛÙÔ‡˜. √ ΛӉ˘ÓÔ˜ ·˘Í¿ÓÂÙ·È Ì ÙÔ ÔÛÔÛÙfi ÂÙÂÚÔÏ·ÛÌ›·˜ ÛÙÔ˘˜ ÈÛÙÔ‡˜ Î·È ‰ÂÓ ˘¿Ú¯ÂÈ ¤Ó· ÂÏ¿¯ÈÛÙÔ Â›Â‰Ô ÂÙÂÚÔÏ·ÛÌ›·˜ οو ÙÔ˘ ÔÔ›Ô˘ Ô Î›Ó‰˘ÓÔ˜ ÌÂÙ·‚›‚·Û˘ Ó· ··Ï›ÊÂÙ·È. ÕÚÚÂÓ˜ Ì ÌÂÙ·ÏÏ¿ÍÂȘ ÛÙÔ ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi DNA ÂÍ·ÈÚÂÙÈο Û¿ÓÈ· ÌÔÚ› Ó· ÌÂÙ·‚È‚¿ÛÔ˘Ó ÙË ÓfiÛÔ. ∞Ó·Û˘Ó‰˘·ÛÌÔ› ÛÙÔ ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi DNA. √È ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ Ì ÌÔÓ‹Ú˜ ¤ÏÏÂÈÌÌ· ÛÙÔ ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi DNA Â›Ó·È ÛÔÚ·‰ÈΤ˜ (4). √ ΛӉ˘ÓÔ˜ ÂÌÊ¿ÓÈÛ˘ Ù˘ ÓfiÛÔ˘ ÛÙÔ ·È‰› ‰ÂÓ ·˘Í¿ÓÂÙ·È Ì ÙËÓ ËÏÈΛ· Ù˘ ÌËÙ¤Ú·˜. ªËÙ¤Ú˜ Ì ÌÔÓ‹Ú˜ ¤ÏÏÂÈÌÌ· Î·È Û‡Ó‰ÚÔÌÔ Kearn-Sayre ‹ PEO ¤¯Ô˘Ó ΛӉ˘ÓÔ 4% Ó· ÌÂÙ·‚È‚¿ÛÔ˘Ó ÙË ÓfiÛÔ.

Paediatriki 2007;70:1-17

ªÂÙ·ÏÏ¿ÍÂȘ ÛÙÔ ˘ÚËÓÈÎfi DNA. ∏ ÁÂÓÂÙÈ΋ ÙˆÓ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ ·fi ÌÂÙ¿ÏÏ·ÍË ÛÙÔ ˘ÚËÓÈÎfi DNA ·ÎÔÏÔ˘ı› ÙÔ˘˜ ÌÂÓ‰¤ÏÈÔ˘˜ ηÓfiÓ˜ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜ Î·È Û ·˘Ù¤˜ ÙȘ ÂÚÈÙÒÛÂȘ ÌfiÓÔÓ ·Ó Ù·˘ÙÔÔÈËı› Ë ÌÂÙ¿ÏÏ·ÍË Â›Ó·È ‰˘Ó·Ù‹ Ë ÚÔÁÂÓÂÙÈ΋ ‰È¿ÁÓˆÛË. ¶Ú¤ÂÈ Ó· ÙÔÓ›ÛÔ˘Ì fiÙÈ Ë ·Ó‡ÚÂÛË Ù˘ ˘‡ı˘Ó˘ ÌÂÙ¿ÏÏ·Í˘ ‰ÂÓ Â›Ó·È ¿ÓÙ· ÂÊÈÎÙ‹ Î·È ÔÏϤ˜ ÊÔÚ¤˜ ÌÔÚ› Ó· ÂÚ¿ÛÔ˘Ó Î·È ¯ÚfiÓÈ· ̤¯ÚÈ Ó· ÙË ‚ÚÔ‡ÌÂ. ™˘ÌÏÂÁÌ·ÙÈ΋ ·ÓÂ¿ÚÎÂÈ· Ì ¿ÁÓˆÛÙË ÁÂÓÂÙÈ΋ ‚Ï¿‚Ë. ¶ÚÔÁÂÓÂÙÈ΋ ‰È¿ÁÓˆÛË Û ·ԉ‰ÂÈÁ̤ÓË Û˘ÌÏÂÁÌ·ÙÈ΋ ·ÓÂ¿ÚÎÂÈ· ·ÁÓÒÛÙÔ˘ ÁÂÓÂÙÈ΋˜ ·ÈÙÈÔÏÔÁ›·˜ Â›Ó·È ‰˘Ó·Ù‹ Û ÂÍÂȉÈÎÂ˘Ì¤Ó· ΤÓÙÚ·, ·ÊÔ‡ ÚÒÙ· ·ÔÎÏÂÈÛÙÔ‡Ó ÌÂÙ·ÏÏ¿ÍÂȘ ÛÙÔ ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi DNA (71). ∏ ‰Ú·ÛÙÈÎfiÙËÙ· ÙˆÓ Û˘ÌÏÂÁÌ¿ÙˆÓ ÌÂÙÚ¿Ù·È Û ÙÚÔÊÔ‚Ï¿ÛÙË Î·È ·ÌÓȷο ·ÙÙ·Ú·. ∏ ̤ıÔ‰Ô˜ Â›Ó·È ÈÔ ·ÔÙÂÏÂÛÌ·ÙÈ΋ ÁÈ· ·ÓÂ¿ÚÎÂÈ· Û˘ÌϤÁÌ·ÙÔ˜ π Î·È IV, ·ÏÏ¿ ÂÓ¤¯ÂÈ ÔÏϤ˜ Ù¯ÓÈΤ˜ ‰˘ÛÎÔϛ˜ Î·È Ú¤ÂÈ Ó· Á›ÓÂÙ·È Û ÂÍÂȉÈÎÂ˘Ì¤Ó· ÌÈÙÔ¯ÔÓ‰Úȷο ΤÓÙÚ· Ì ÂÌÂÈÚ›· ÛÙËÓ ÚÔÁÂÓÂÙÈ΋ ‰È¿ÁÓˆÛË.

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¶·È‰È·ÙÚÈ΋ 2007;70:1-17

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¶. ∫·Ú·ÁÈ¿ÓÓË, ¡. ¡ÈÎÔÏ·˝‰Ë˜ ¶ÂÚ›ÏË„Ë: O ˘„›Û˘¯ÓÔ˜ ·ÂÚÈÛÌfi˜ Ì ٷϷÓÙÒÛÂȘ (À∞∆) ·ÔÙÂÏ› ¤Ó·Ó ÂÓ·ÏÏ·ÎÙÈÎfi ÙÚfiÔ Ì˯·ÓÈÎÔ‡ ·ÂÚÈÛÌÔ‡, Ô ÔÔ›Ô˜ ¯ÚËÛÈÌÔÔÈ› ÌÈÎÚÔ‡˜ ·Ó·ÓÂfiÌÂÓÔ˘˜ fiÁÎÔ˘˜ ·¤Ú·, Û˘¯Ó¿ ÌÈÎÚfiÙÂÚÔ˘˜ ·fi ÙÔÓ ·Ó·ÙÔÌÈο ÓÂÎÚfi ¯ÒÚÔ Î·È ÂÍ·ÈÚÂÙÈο ÁÚ‹ÁÔÚÔ˘˜ ·Ó·Ó¢ÛÙÈÎÔ‡˜ Ú˘ıÌÔ‡˜, ¤Ú·Ó ÙÔ˘ Ê˘ÛÈÔÏÔÁÈÎÔ‡, ÁÈ· ÙËÓ ÂÍ·ÛÊ¿ÏÈÛË Ù˘ Ô͢ÁfiÓˆÛ˘ Î·È ÙÔ˘ ·ÂÚÈÛÌÔ‡ ÙˆÓ ÓÂÔÁÓÒÓ. ∞ÚÎÂÙ¤˜ ÂÈÚ·Ì·ÙÈΤ˜ ÌÂϤÙ˜ ¤‰ÂÈÍ·Ó fiÙÈ ÙÔ ÔÁÎfiÙÚ·˘Ì· Ì¿ÏÏÔÓ ·Ú¿ ÙÔ ‚·ÚfiÙÚ·˘Ì· Â›Ó·È Ë ·Ú¯È΋ ·ÈÙ›· Ù˘ ÔÍ›·˜ Ó¢ÌÔÓÈ΋˜ ‚Ï¿‚˘ Ô˘ ÚÔηÏÂ›Ù·È ·fi ÙÔ Û˘Ì‚·ÙÈÎfi ·ÂÚÈÛÌfi (™∞). π‰È·›ÙÂÚ· ÁÈ· ÙËÓ ÚfiÎÏËÛË ·˘Ù‹˜ Ù˘ ‚Ï¿‚˘ ·ԉ›¯ıËΠfiÙÈ ÛËÌ·ÓÙÈÎfiÙÂÚÔ ÚfiÏÔ ‰È·‰Ú·Ì·Ù›˙Ô˘Ó ÔÈ ‰È·Î˘Ì¿ÓÛÂȘ ÙÔ˘ fiÁÎÔ˘ ÙˆÓ Ó¢ÌfiÓˆÓ ÂÍ·ÈÙ›·˜ Ù˘ ÚÔηıÔÚÈṲ̂Ó˘ ÂÚÈÔ‰ÈÎfiÙËÙ·˜ ÙÔ˘ ™∞, ·Ú¿ ÔÈ ÌÂÙ·‚ÔϤ˜ ÛÙȘ ȤÛÂȘ ÙˆÓ ·ÂÚÔÊfiÚˆÓ Ô‰ÒÓ. ∆Ô ÁÂÁÔÓfi˜ fiÙÈ Î·Ù¿ ÙÔÓ À∞∆, Ô fiÁÎÔ˜ ÙˆÓ Ó¢ÌfiÓˆÓ ·Ú·Ì¤ÓÂÈ Û¯ÂÙÈο ÛÙ·ıÂÚfi˜ Ì ÌÈÎÚ¤˜ ÌfiÓÔ ‰È·Î˘Ì¿ÓÛÂȘ, ı· ÌÔÚÔ‡Û ıˆÚËÙÈο Ó· ‰ÈηÈÔÏÔÁ‹ÛÂÈ ÙË ¯Ú‹ÛË ÙÔ˘, ÒÛÙ ӷ ÚÔÛٷ٤„ÂÈ ÙÔÓ ·ÓÒÚÈÌÔ ÓÂÔÁÓÈÎfi Ó‡ÌÔÓ· ·fi ‚Ï¿‚Ë. Œ¯ÂÈ ¯ÚËÛÈÌÔÔÈËı› ΢ڛˆ˜ ˆ˜ ıÂÚ·›· ‰È¿ÛˆÛ˘ Û ÙÂÏÂÈfiÌËÓ· ‹ ÌÂÁ¿Ï· ÚfiˆÚ· Ì ÛÔ‚·Ú‹ ·Ó·Ó¢ÛÙÈ΋ ·ÓÂ¿ÚÎÂÈ· Î·È ·Ú·Ì¤ÓÔ˘Û· Ó¢ÌÔÓÈ΋ ˘¤ÚÙ·ÛË Î·È ˆ˜ ·Ú¯È΋ ıÂÚ·¢ÙÈ΋ ÂÈÏÔÁ‹ Û ÚfiˆÚ· Ì ÛÔ‚·Úfi Û‡Ó‰ÚÔÌÔ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜ Î·È ÛÙ· Û‡Ó‰ÚÔÌ· ‰È·Ê˘Á‹˜ ·¤Ú·. √È ·fi„ÂȘ Û¯ÂÙÈο Ì ÙȘ ÂӉ›ÍÂȘ ÂÊ·ÚÌÔÁ‹˜ ÙÔ˘ Â›Ó·È ·ÎfiÌË ·ÓÙÈÎÚÔ˘fiÌÂÓ˜. ™ÙËÓ ·ÚÔ‡Û· ·Ó·ÛÎfiËÛË ı· ÂÚÈÁÚ·ÊÔ‡Ó ÔÈ ·Ú¯¤˜ ÏÂÈÙÔ˘ÚÁ›·˜, Ë Ê˘ÛÈÔÏÔÁ›· Ù˘ Ô͢ÁfiÓˆÛ˘ Î·È ÙÔ˘ ·ÂÚÈÛÌÔ‡ Î·È ÔÈ Ì˯·ÓÈÛÌÔ› ·ÓÙ·ÏÏ·Á‹˜ ·ÂÚ›ˆÓ Û ·˘Ùfi ÙÔ ÌÔÓÙ¤ÏÔ Ì˯·ÓÈÎÔ‡ ·ÂÚÈÛÌÔ‡. §¤ÍÂȘ ÎÏÂȉȿ: À„›Û˘¯ÓÔ˜ ·ÂÚÈÛÌfi˜ Ì ٷϷÓÙÒÛÂȘ, Ô͢ÁfiÓˆÛË, ·ÂÚÈÛÌfi˜, ·ÓÙ·ÏÏ·Á‹ ·ÂÚ›ˆÓ.

High frequency oscillatory ventilation: How it works 2nd NICU and Neonatology Department of the Aristotle University of Thessaloniki, G.P.N. “Papageorgiou”, Thessaloniki Correspondence: Karagianni Paraskevi karagpar@med.auth.gr 2nd NICU and Neonatology Department of Aristotle University of Thessaloniki.

G.P.N. “Papageorgiou” Ring road Nea Efkarpia, 546 03, Thessaloniki

P. Karagianni, N. Nikolaides Abstract: High frequency oscillatory ventilation (HFOV) is an alternative mode of mechanical ventilation that uses small tidal volumes, usually smaller than the anatomically dead space and extremely rapid respiratory rates, above the normal, in order to achieve the oxygenation and ventilation of neonates. Several experimental studies showed that volutrauma rather than barotrauma is the initial cause of acute pulmonary damage, caused by conventional ventilation (CV). It was proved that the fluctuations of the lung volume due to the time cycled of conventional ventilation and not the pressure changes in the airway tracts play important role for this damage. During the application of HFOV, the lung volume remains relatively constant with only small fluctuations. This could theoretically justify its use in order to protect the immature neonatal lung from damage. It has been used mainly as rescue therapy in full term or near term neonates with serious respiratory insufficiency and persistent pulmonary hypertension and also as an initial therapy in premature neonates with serious respiratory distress and air leak syndromes. Opinions regarding the indication of its application are still controversial. This review describes the operational principles of HFOV and the relevant physiology and mechanisms of gas exchange during this mode of mechanical ventilation.

Key words: High frequency oscillatory ventilation, oxygenation, ventilation, mechanisms of gas exchange.

™˘ÓÙÔÌÔÁڷʛ˜ À∞∆

Y„›Û˘¯ÓÔ˜ ·ÂÚÈÛÌfi˜ Ì ٷϷÓÙÒÛÂȘ (HFOV) ™∞ ™˘Ì‚·ÙÈÎfi˜ ·ÂÚÈÛÌfi˜ Vt ∞Ó·ÓÂfiÌÂÓÔ˜ fiÁÎÔ˜ ·¤Ú· ™∞¢ ™‡Ó‰ÚÔÌÔ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜ Pa-w ª¤ÛË ›ÂÛË ·ÂÚ·ÁˆÁÒÓ ¢ƒ ¢È·ÊÔÚ¿ ›ÂÛ˘ Ù·Ï¿ÓÙˆÛ˘ Amplitude ∂‡ÚÔ˜ Ù·Ï¿ÓÙˆÛ˘ f ™˘¯ÓfiÙËÙ· Paediatriki 2007;70:18-23

√ ˘„›Û˘¯ÓÔ˜ ·ÂÚÈÛÌfi˜ Ì ٷϷÓÙÒÛÂȘ (High frequency oscillatory ventilation, HFOV) ·ÔÙÂÏ› ¤Ó·Ó ÂÓ·ÏÏ·ÎÙÈÎfi ÙÚfiÔ Ì˯·ÓÈÎÔ‡ ·ÂÚÈÛÌÔ‡ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ ÛÙ· ÓÂÔÁÓ¿. ∆Ô Î‡ÚÈÔ ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÙÔ˘ Â›Ó·È fiÙÈ ¯ÚËÛÈÌÔÔÈ› ÌÈÎÚÔ‡˜ ·Ó·ÓÂfiÌÂÓÔ˘˜ fiÁÎÔ˘˜ ·¤Ú· (Vt, tidal volume), Û˘¯Ó¿ ÌÈÎÚfiÙÂÚÔ˘˜ ·fi ÙÔÓ ·Ó·ÙÔÌÈο ÓÂÎÚfi ¯ÒÚÔ Î·È Ôχ ÁÚ‹ÁÔÚÔ˘˜ ·Ó·Ó¢ÛÙÈÎÔ‡˜

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À„›Û˘¯ÓÔ˜ ·ÂÚÈÛÌfi˜ Ì ٷϷÓÙÒÛÂȘ

Ú˘ıÌÔ‡˜ (·fi 2,5 ¤ˆ˜ 30 Hz) ÁÈ· ÙËÓ ÂÍ·ÛÊ¿ÏÈÛË Ù˘ Ô͢ÁfiÓˆÛ˘ Î·È ÙÔ˘ ·ÂÚÈÛÌÔ‡ ÛÙ· ÓÂÔÁÓ¿ (1-3). ∆· ÚÒÙ· ÂÈÚ¿Ì·Ù· Û¯ÂÙÈο Ì ÙȘ ·Ú¯¤˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘ ˘„›Û˘¯ÓÔ˘ ·ÂÚÈÛÌÔ‡ Ì ٷϷÓÙÒÛÂȘ (À∞∆) ÍÂΛÓËÛ·Ó ÙÔ 1915 ·fi ÙÔÓ Henderson (4), ·ÏÏ¿ Ô ÚÒÙÔ˜ ·Ó·Ó¢ÛÙ‹Ú·˜ ˘„ËÏ‹˜ Û˘¯ÓfiÙËÙ·˜ ηٷÛ΢¿ÛÙËΠ·fi ÙÔÓ Emmerson ÙÔ 1959. √È Lunkenheimer Î·È Û˘Ó. ÙÔ 1972, ·¤‰ÂÈÍ·Ó Û ÂÈÚ·Ì·ÙÈ΋ ÌÂϤÙË fiÙÈ Ë Ù·Ï¿ÓÙˆÛË ÌÈÎÚÒÓ fiÁÎˆÓ ·¤Ú· ÛÙÔ˘˜ ·ÂÚ·ÁˆÁÔ‡˜ ÙˆÓ ÂÈÚ·Ì·Ùfi˙ˆˆÓ ‰È·ÙËÚÔ‡Û ÙÔ ·ÚÙËÚÈ·Îfi ‰ÈÔÍ›‰ÈÔ ÙÔ˘ ¿Óıڷη ÛÂ Ê˘ÛÈÔÏÔÁÈο Â›‰· (5). ∞ÚÁfiÙÂÚ· ·ԉ›¯ıËΠfiÙÈ ·Ó ¯ÚËÛÈÌÔÔÈËıÔ‡Ó ·Ó·ÓÂfiÌÂÓÔÈ fiÁÎÔÈ ÌÈÎÚfiÙÂÚÔÈ ·fi ÙÔÓ ·Ó·ÙÔÌÈο ÓÂÎÚfi ¯ÒÚÔ, ÌÔÚ› Ó· ‰È·ÙËÚËı› Ô Î˘„ÂÏȉÈÎfi˜ ·ÂÚÈÛÌfi˜ Û ÈηÓÔÔÈËÙÈο Â›‰· (6,7). ∏ ÚÒÙË ÎÏÈÓÈ΋ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ À∞∆ Û ÓÂÔÁÓ¿ Ú·ÁÌ·ÙÔÔÈ‹ıËΠ·fi ÙÔ˘˜ Marchak Î·È Û˘Ó. (8). √ À∞∆ ¯ÚËÛÈÌÔÔÈ‹ıËΠ·Ú¯Èο Ì ÙËÓ ÂÔ›ıËÛË fiÙÈ ÏfiÁˆ ÙˆÓ È‰È·›ÙÂÚˆÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ÙÔ˘ ÌÔÚ› Ó· ‚ÂÏÙÈÒÛÂÈ ÙËÓ ·ÓÙ·ÏÏ·Á‹ ÙˆÓ ·ÂÚ›ˆÓ Û ÓÂÔÁÓ¿ Ì ÛÔ‚·Ú‹ ·Ó·Ó¢ÛÙÈ΋ ·ÓÂ¿ÚÎÂÈ·, ·ÏÏ¿ Î·È Ó· ÌÂÈÒÛÂÈ ÙȘ ÔÍ›˜ ‹ ¯ÚfiÓȘ ÂÈÏÔΤ˜ Ô˘ ÔÊ›ÏÔÓÙ·È ÛÙËÓ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ Ì˯·ÓÈÎÔ‡ ·ÂÚÈÛÌÔ‡. ∞ÚÎÂÙ¤˜ ÂÈÚ·Ì·ÙÈΤ˜ ÌÂϤÙ˜ ¤‰ÂÈÍ·Ó fiÙÈ ÙÔ ÔÁÎfiÙÚ·˘Ì· Ì¿ÏÏÔÓ ·Ú¿ ÙÔ ‚·ÚfiÙÚ·˘Ì· Â›Ó·È Ë ·Ú¯È΋ ·ÈÙ›· Ù˘ ÔÍ›·˜ Ó¢ÌÔÓÈ΋˜ ‚Ï¿‚˘ Ô˘ ÚÔηÏÂ›Ù·È ·fi ÙÔÓ Û˘Ì‚·ÙÈÎfi ·ÂÚÈÛÌfi (™∞) (9-12). π‰È·›ÙÂÚ· ÁÈ· ÙËÓ ÚfiÎÏËÛË ·˘Ù‹˜ Ù˘ ‚Ï¿‚˘ ·ԉ›¯ıËΠfiÙÈ ÛËÌ·ÓÙÈÎfiÙÂÚÔ ÚfiÏÔ ‰È·‰Ú·Ì·Ù›˙Ô˘Ó ÔÈ ‰È·Î˘Ì¿ÓÛÂȘ ÙÔ˘ fiÁÎÔ˘ ÙˆÓ Ó¢ÌfiÓˆÓ ÂÍ·ÈÙ›·˜ Ù˘ ÚÔηıÔÚÈṲ̂Ó˘ ÂÚÈÔ‰ÈÎfiÙËÙ·˜ (time cycled) ÙÔ˘ ™∞, ·Ú¿ ÔÈ ÌÂÙ·‚ÔϤ˜ ÛÙȘ ȤÛÂȘ ÙˆÓ ·ÂÚÔÊfiÚˆÓ Ô‰ÒÓ. ∆Ô ÁÂÁÔÓfi˜ fiÙÈ Î·Ù¿ ÙÔÓ À∞∆, Ô fiÁÎÔ˜ ÙˆÓ Ó¢ÌfiÓˆÓ ·Ú·Ì¤ÓÂÈ Û¯ÂÙÈο ÛÙ·ıÂÚfi˜ Ì ÌÈÎÚ¤˜ ÌfiÓÔ ‰È·Î˘Ì¿ÓÛÂȘ, ı· ÌÔÚÔ‡Û ıˆÚËÙÈο Ó· ‰ÈηÈÔÏÔÁ‹ÛÂÈ ÙË ¯Ú‹ÛË ÙÔ˘, ÒÛÙ ӷ ÚÔÛٷ٤„ÂÈ ÙÔÓ ·ÓÒÚÈÌÔ ÓÂÔÁÓÈÎfi Ó‡ÌÔÓ· ·fi ‚Ï¿‚Ë (13). ∂ÈϤÔÓ ¤¯ÂÈ ÙÔ ÏÂÔÓ¤ÎÙËÌ·, ÂÊfiÛÔÓ ÂÊ·ÚÌÔÛÙ› Ë Î·Ù¿ÏÏËÏË ÛÙÚ·ÙËÁÈ΋, Ó· ÂÙ‡¯ÂÈ ÈÔ ÔÌÔÈÔÁÂÓ‹ ¤ÎÙ˘ÍË ÙÔ˘ Ó‡ÌÔÓ·, Ì›ˆÛË ÙˆÓ ÂÓ‰ÔÓ¢ÌÔÓÈÎÒÓ ‰È·Ê˘ÁÒÓ, Ù·¯‡ÙÂÚË ‚ÂÏÙ›ˆÛË ÛÙË Û¯¤ÛË ·ÂÚÈÛÌÔ‡-·ÈÌ¿ÙˆÛ˘ Î·È Ù˘ Ô͢ÁfiÓˆÛ˘. ªÂ ÙËÓ Ù·¯‡ÙÂÚË ‚ÂÏÙ›ˆÛË ÛÙËÓ Ô͢ÁfiÓˆÛË ÌÂÈÒÓÂÙ·È Ô ¯ÚfiÓÔ˜ ¯ÔÚ‹ÁËÛ˘ √2, ¿Ú· Î·È Ë ¤ÎıÂÛË ÙÔ˘ Ó‡ÌÔÓ· ÛÙȘ ÂχıÂÚ˜ Ú›˙˜ ÙÔ˘ Ô˘ ÂÓÔ¯ÔÔÈÔ‡ÓÙ·È ÁÈ· ÚfiÎÏËÛË Ó¢ÌÔÓÈ΋˜ ‚Ï¿‚˘ (14).

∞Ú¯¤˜ ÏÂÈÙÔ˘ÚÁ›·˜ - ·Ú¿ÌÂÙÚÔÈ √ ˘„›Û˘¯ÓÔ˜ ·Ó·Ó¢ÛÙ‹Ú·˜ ÏÂÈÙÔ˘ÚÁ› Û·Ó ·ÓÙÏ›· Ì ÈÛÙfiÓÈ (¤Ì‚ÔÏÔ) ‹ Ù·Ï·ÓÙÔ‡ÌÂÓ· ‰È·ÊÚ¿ÁÌ·Ù·, Ù· ÔÔ›· ¿ÏÏÔÓÙ·È ÌÂ Û˘¯ÓfiÙËÙ· 4002400 ·Ó·ÓÔÒÓ ÛÙÔ ÏÂÙfi (15). ∫·Ù¿ ÙË ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ À∞∆ Ë ÂÈÛÓÔ‹ Î·È Ë ÂÎÓÔ‹ Â›Ó·È ÂÓÂÚÁËÙÈΤ˜.

√È Ù·Ï·Óو٤˜ ·Ú¿ÁÔ˘Ó Î·È ‰È·Ó¤ÌÔ˘Ó ÌÂÁ¿ÏÔ˘˜ fiÁÎÔ˘˜ ·¤Ú·. ™˘Ó¯‹˜ Î·È ÚÔηıÔÚÈṲ̂ÓË (Û l/min) ÚÔ‹ ·¤Ú· ‰ÈÔ¯ÂÙ‡ÂÙ·È Ì ٷ¯‡ Ú˘ıÌfi ·fi Ì›· ËÁ‹, Ë ÔÔ›· ·Ú¿ÁÂÈ ‹ ·Ú¤¯ÂÈ ÂÓ¤ÚÁÂÈ· ÛÙȘ Ù·Ï·ÓÙÒÛÂȘ. ŒÓ· ÂÏÂÁ¯fiÌÂÓÔ ÛËÌÂ›Ô ‰È·ÚÚÔ‹˜ ‹ ¯·ÌËÏ‹˜ ‰È¿‚·Û˘ Ê›ÏÙÚÔ ÂÈÙÚ¤ÂÈ ÛÙÔÓ ·¤Ú· Ó· ÂͤگÂÙ·È ·fi ÙÔ Û‡ÛÙËÌ· (16). ¶ÂÚÈÛÛfiÙÂÚÔ ·fi fiÏÔ˘˜ ¤¯ÂÈ ¯ÚËÛÈÌÔÔÈËı› Ô SensorMedics 3100A (SensorMedics, Corp Yorba Linda, CA) (17). √ Û˘ÁÎÂÎÚÈ̤ÓÔ˜ ·Ó·Ó¢ÛÙ‹Ú·˜ ʤÚÂÈ ÛÊÚ·ÁÈṲ̂ÓÔ ¤Ì‚ÔÏÔ Ì ڢıÌÈ˙fiÌÂÓË ÌÂٷΛÓËÛË fiÁÎÔ˘, ÚÔηÏÒÓÙ·˜ Ù·Ï·ÓÙÒÛÂȘ ÛÙȘ ·ÂÚÔÊfiÚÔ˘˜ Ô‰Ô‡˜. ∏ Û˘¯ÓfiÙËÙ· (frequency-f) Ú˘ıÌ›˙ÂÙ·È ÌÂٷ͇ 180-900 ·Ó·ÓÔ¤˜ ÙÔ ÏÂÙfi (315Hz), Ë Ì¤ÛË ›ÂÛË ·ÂÚ·ÁˆÁÒÓ (mean airway pressure - Pa-w) ·fi 3-45 cm H2O Î·È Ô ÂÈÛÓ¢ÛÙÈÎfi˜ ¯ÚfiÓÔ˜ (inspiratory time - π∆) Â›Ó·È ÌÂÙ·‚·ÏÏfiÌÂÓÔ˜ ̤¯ÚÈ ÙÔ 50% ÙÔ˘ Û˘ÓÔÏÈÎÔ‡ ·Ó·Ó¢ÛÙÈÎÔ‡ ·ÎÏÔ˘. ∏ ‰È·ÊÔÚ¿ ›ÂÛ˘ Ù·Ï¿ÓÙˆÛ˘ (¢ƒ) ‹ ‡ÚÔ˜ Ù·Ï¿ÓÙˆÛ˘ (amplitude) ηıÔÚ›˙ÂÈ ÙÔÓ ·Ó·ÓÂfiÌÂÓÔ fiÁÎÔ Î·È Ú˘ıÌ›˙ÂÙ·È ¤ˆ˜ 90 cmH2O. ∏ ÚÔ‹ (flow) Ú˘ıÌ›˙ÂÙ·È ·fi 6-20 lt/min ÁÈ· Ù· ÌÈÎÚfiÙÂÚ· ÙˆÓ 1000 gr Î·È Ù· ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿ ·ÓÙ›ÛÙÔȯ·. ∆Ô ÎÏ¿ÛÌ· ÂÈÛÓÂfiÌÂÓÔ˘ √2 (Fraction of inspired √xygen - Fi√2) Ú˘ıÌ›˙ÂÙ·È fiˆ˜ Î·È Û fiÏÔ˘˜ ÙÔ˘˜ ·Ó·Ó¢ÛÙ‹Ú˜. √ ·Ó·Ó¢ÛÙ‹Ú·˜ SensorMedics 3100A ¯ÚËÛÈÌÔÔÈ› ÙÔ ËÏÂÎÙÚÔÌ·ÁÓËÙÈο ηıÔ‰ËÁÔ‡ÌÂÓÔ ‰È¿ÊÚ·ÁÌ· ÁÈ· ÙËÓ ·Ú·ÁˆÁ‹ ›ÂÛ˘ ËÌÈÙÔÓÔÂȉԇ˜ ÌÔÚÊ‹˜ ̤۷ ÛÙÔ Î‡Îψ̷ ÙÔ˘ ·Ó·Ó¢ÛÙ‹Ú·, Ë ÔÔ›· ÂÊ·ÚÌfi˙ÂÙ·È ÛÙÔÓ ÂÓ‰ÔÙÚ·¯ÂÈ·Îfi ۈϋӷ. ∏ ΛÓËÛË Ù·Ï¿ÓÙˆÛ˘ ÙÔ˘ ‰È·ÊÚ¿ÁÌ·ÙÔ˜ ÚÔηÏ› ÂÓÂÚÁËÙÈΤ˜ ÂÈÛÓ¢ÛÙÈΤ˜ Î·È ÂÎÓ¢ÛÙÈΤ˜ Ê¿ÛÂȘ, ÔÈ Ôԛ˜ ηÙ¢ı‡ÓÔ˘Ó ÙÔ Ì›ÁÌ· ÙˆÓ ·ÂÚ›ˆÓ ÌÂٷ͇ ÙÔ˘ ΢ÎÏÒÌ·ÙÔ˜ ÙÔ˘ ·Ó·Ó¢ÛÙ‹Ú· Î·È ÙˆÓ Ó¢ÌÔÓÈÎÒÓ Î˘„ÂÏ›‰ˆÓ ÙÔ˘ ·ÛıÂÓ‹. ∏ ‰È·ÊÔÚ¿ ›ÂÛ˘ ˘ÔÏÔÁ›˙ÂÙ·È ÛÙËÓ ˘Ô‰Ô¯‹ ÙÔ˘ ÂÓ‰ÔÙÚ·¯ÂÈ·ÎÔ‡ ۈϋӷ ˆ˜ ¢ƒ Î·È Î·ıÔÚ›˙ÂÈ ÙÔÓ ·Ó·ÓÂfiÌÂÓÔ fiÁÎÔ Ô˘ Êı¿ÓÂÈ ÛÙÔÓ ·ÛıÂÓ‹ Û οı ·Ó·ÓÔ‹. ∫¿ı ÌÂÙ·‚ÔÏ‹ ÛÙËÓ ¢ƒ ÂËÚ¿˙ÂÈ Î·È ÙÔÓ ·ÂÚÈÛÌfi ÙÔ˘ ÓÂÔÁÓÔ‡. ∏ ̤ÛË ›ÂÛË ÙˆÓ ·ÂÚÔÊfiÚˆÓ Ô‰ÒÓ ‰È¤ÂÙ·È ·fi ÙÔÓ Ú˘ıÌfi ÚÔ‹˜ ·¤Ú· ̤۷ ÛÙÔ Î‡Îψ̷ Î·È ÙËÓ ·ÓÙ›ÛÙ·ÛË ÚÔ˜ ÙËÓ ÂÎÓ¢ÛÙÈ΋ ÏÂ˘Ú¿ ÙÔ˘ ΢ÎÏÒÌ·ÙÔ˜. ∆Ô Â‡ÚÔ˜ Ù·Ï¿ÓÙˆÛ˘ (amplitude) Ù˘ ‰È·ÊÔÚ¿˜ ›ÂÛ˘ (¢P), Ô˘ ·Ú¿ÁÂÙ·È ·fi ÙÔ ‰È¿ÊÚ·ÁÌ· Î·È Ë Ì¤ÛË ›ÂÛË ÙˆÓ ·ÂÚ·ÁˆÁÒÓ, ÌÔÚÔ‡Ó Ó· Ú˘ıÌÈÛÙÔ‡Ó ·ÓÂÍ¿ÚÙËÙ·. ÕÚ·, ÌÔÚԇ̠ӷ ¤¯Ô˘Ì ÙËÓ ›‰È· ›ÂÛË Ì ‰È·ÊÔÚÂÙÈÎfi ‡ÚÔ˜ Ù·Ï¿ÓÙˆÛ˘ (17).

√͢ÁfiÓˆÛË Î·È ·ÂÚÈÛÌfi˜ ∏ Ê˘ÛÈÔÏÔÁ›· Ù˘ ·ÓÙ·ÏÏ·Á‹˜ ·ÂÚ›ˆÓ Ì ÙÔÓ À∞∆ Û ۇÁÎÚÈÛË Ì ™∞ Â›Ó·È ÂÍ·ÈÚÂÙÈο ÈÔ Û‡ÓıÂÙË. ∏ ¶·È‰È·ÙÚÈ΋ 2007;70:18-23

20

¶. ∫·Ú·ÁÈ¿ÓÓË, ¡. ¡ÈÎÔÏ·˝‰Ë˜

·. √͢ÁfiÓˆÛË ∏ Ô͢ÁfiÓˆÛË ÛÙÔÓ À∞∆ ÂÍ·ÚÙ¿Ù·È ·fi ÙË Ì¤ÛË ›ÂÛË ·ÂÚ·ÁˆÁÒÓ (Pa-w). √È ÂÚÈÛÛfiÙÂÚ˜ ·Ó·Ó¢ÛÙÈΤ˜ ·ı‹ÛÂȘ ÙˆÓ ÓÂÔÁÓÒÓ Â›Ó·È Î˘Ú›ˆ˜ ÂÚÈÔÚÈÛÙÈÎÔ‡ Ù‡Ô˘. ∏ ‚·ÛÈ΋ ·Ú¯‹ Ù˘ ÂÈı˘ÌËÙ‹˜ Ô͢ÁfiÓˆÛ˘ ÛÙÔÓ À∞∆ Â›Ó·È Ë Â›Ù¢ÍË Î·È ‰È·Ù‹ÚËÛË Ù˘ ‚¤ÏÙÈÛÙ˘ ¤ÎÙ˘Í˘ ÙˆÓ Ó¢ÌfiÓˆÓ (optimal lung inflation) Ì ÙËÓ ÂÈÛÙÚ¿Ù¢ÛË ÂÚÈÛÛfiÙÂÚˆÓ Î˘„ÂÏ›‰ˆÓ, ¯ˆÚ›˜ ˘ÂډȿٷÛË ÙˆÓ Ó¢ÌfiÓˆÓ (22). √È ˙ÒÓ˜ Ù˘ ¤ÎÙ˘Í˘ ÙˆÓ Ó¢ÌfiÓˆÓ ÛÙÔÓ À∞∆ ·ÂÈÎÔÓ›˙ÔÓÙ·È ÛÙËÓ ∂ÈÎfiÓ· 1. ™ÙË ˙ÒÓË ∞, Ô Ó‡ÌÔÓ·˜ ˘Ô-ÂÎÙ‡ÛÛÂÙ·È, ÂÓÒ Ë ·‡ÍËÛË ÙÔ˘ ‡ÚÔ˘˜ Ù·Ï·ÓÙÒÛÂˆÓ ÂÈʤÚÂÈ ÌfiÓÔ ÌÈÎÚ¤˜ ·ÏÏ·Á¤˜ ÛÙÔÓ fiÁÎÔ ÙÔ˘. ∫ÏÈÓÈο, ÂÎÊÚ¿˙ÂÙ·È Ì ˘„ËϤ˜ ··ÈÙ‹ÛÂȘ Û Ô͢ÁfiÓÔ Î·È ÂÚÈÔÚÈṲ̂Ó˜ ‰ÔÓ‹ÛÂȘ ÙÔ˘ ıˆÚ·ÎÈÎÔ‡ ÙÔȯÒÌ·ÙÔ˜. ∏ ˙ÒÓË µ ·ÔÙÂÏ› ÙËÓ ÂÚÈÔ¯‹ Ù˘ ‚¤ÏÙÈÛÙ˘ ¤ÎÙ˘Í˘. ∂ÊfiÛÔÓ Ô Ó‡ÌÔÓ·˜ ¤¯ÂÈ ÂÎÙ˘¯ı› Ì ˘„ËÏ‹ Pa-w, Ë Ó¢ÌÔÓÈ΋ ·ÁÁÂȷ΋ ·ÓÙ›ÛÙ·ÛË ÌÂÈÒÓÂÙ·È Î·È ÙfiÙÂ, ÌÈÎÚfiÙÂÚ· ‡ÚË Ù·Ï¿ÓÙˆÛ˘ Ô‰ËÁÔ‡Ó Û ÌÂÁ·Ï‡ÙÂÚ˜ ·ÏÏ·Á¤˜ ÛÙÔÓ fiÁÎÔ. ∫ÏÈÓÈο, ÂÎÊÚ¿˙ÂÙ·È Ì ÙÒÛË ÙˆÓ ··ÈÙ‹ÛÂˆÓ Û Ô͢ÁfiÓÔ Î·È Î·Ï¤˜ ‰ÔÓ‹ÛÂȘ ÙÔ˘ ıˆÚ·ÎÈÎÔ‡ ÙÔȯÒÌ·ÙÔ˜. ∏ ˙ÒÓË ° ·ÓÙ·Ó·ÎÏ¿ ÙËÓ ˘ÂډȿٷÛË ÙÔ˘ Ó‡ÌÔÓ·. ∫·È ÛÙË ˙ÒÓË ·˘Ù‹ ÌÔÚ› Ó· ··ÈÙËı› ÌÂÁ·Ï‡ÙÂÚÔ Â‡ÚÔ˜ Ù·Ï¿ÓÙˆÛ˘ ÁÈ· Ó· ÚÔηϤÛÂÈ ·ÏÏ·Á¤˜ ÛÙÔÓ fiÁÎÔ, ÂÓÒ Ô ˘ÂډȷÙÂٷ̤ÓÔ˜ Ó‡ÌÔÓ·˜ ÌÔÚ› Ó· ÂËÚ¿ÛÂÈ ÙËÓ Î·Ú‰È·Î‹ ·ÚÔ¯‹, ÏfiÁˆ Ì›ˆÛ˘ Ù˘ ÊÏ‚È΋˜ Â·Ó·ÊÔÚ¿˜. ∞˘Ùfi ·ÔÙÂÏ› Î·È ÙÔ ÈÔ ÂÈΛӉ˘ÓÔ ÛËÌÂ›Ô ÛÙË ¯Ú‹ÛË ÙÔ˘. ∂›Ó·È ‰‡ÛÎÔÏÔ Ó· ·Ó·ÁÓˆÚÈÛı› ÎÏÈÓÈο, ÁÈ·Ù› ÔÈ ··ÈÙ‹ÛÂȘ Û Ô͢ÁfiÓÔ ‰È·ÙËÚÔ‡ÓÙ·È ·Ú¯Èο ¯·ÌËϤ˜ Î·È Ë Ì›ˆÛË ÙˆÓ ‰ÔÓ‹ÛÂˆÓ ÌÔÚ› Ó· ÌËÓ ·ÍÈÔÏÔÁËı›. ∏ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ ·Ú·Ì¤ÓÂÈ ÙÔ ·ÛʷϤÛÙÂÚÔ Ì¤ÛÔÓ ÂÎÙ›ÌËÛ˘ Ù˘ ¤ÎÙ˘Í˘. ∏ ˙ÒÓË ¢, Ù¤ÏÔ˜, ·ÓÙÈηÙÔÙÚ›˙ÂÈ ÙÔÓ ‚¤ÏÙÈÛÙÔ fiÁÎÔ ÁÈ· ÙËÓ ·Ô‰¤ÛÌ¢ÛË ·fi ÙÔÓ ·Ó·Ó¢ÛÙ‹Ú·. ™Ùfi¯Ô˜ Â›Ó·È Ë ÌÂÙ¿ÙˆÛË ÙˆÓ Ó¢ÌfiÓˆÓ ·fi ÙÔ ÛËÌÂ›Ô µ ÛÙÔ ÛËÌÂ›Ô ¢, ·ÔʇÁÔÓÙ·˜ ÙË ˙ÒÓË °. ∂ÊfiÛÔÓ ÂÈÙ¢¯ı› Ë ‰È·Ù‹ÚËÛË Ù˘ ‚¤ÏÙÈÛÙ˘ ¤ÎÙ˘Í˘ ÙˆÓ Ó¢ÌfiÓˆÓ Î·È ÙÔ˘ ·ÂÚÈÛÌÔ‡ Ì ÛÙ·‰È·Î¤˜ ÌÂÈÒÛÂȘ Ù˘ Pa-w ÌÔÚԇ̠ӷ ˘ÔÛÙËÚ›ÍÔ˘Ì ÙÔ ÓÂÔÁÓfi Ì ¯·ÌËÏ‹ Pa-w. ∂¿Ó fï˜ Ë Pa-w ÌÂȈı› ¿Ú· Ôχ, ˘¿Ú¯ÂÈ Î›Ó‰˘ÓÔ˜ Ó· ·˘ÍËıÔ‡Ó Î·È ¿ÏÈ ÔÈ ··ÈÙ‹ÛÂȘ Û Ô͢ÁfiÓÔ (∂ÈÎfiÓ· 1). ‚. ∞ÂÚÈÛÌfi˜ ∏ Ô˘ÛÈ·ÛÙÈ΋ ‰È·ÊÔÚ¿ ÛÙËÓ ·Ô‚ÔÏ‹ ‰ÈÔÍÂȉ›Ô˘ ÙÔ˘ ¿Óıڷη ÌÂٷ͇ ™∞ Î·È À∞∆, Â›Ó·È fiÙÈ Ô ™∞ ·Ô‰›‰ÂÈ ·Ó·Óˆ̤ÓÔ ·¤Ú· ÛÙȘ ΢„ÂÏ›‰Â˜ ÌfiÓÔ Ì ÙÔ Ê·ÈÓfiÌÂÓÔ Ù˘ ÔÁÎÒ‰Ô˘˜ ÚÔ‹˜ (bulk flow), ÂÓÒ Ô Paediatriki 2007;70:18-23

§ÀÃ

√°∫√™ (ml)

·ÏÏËÏÂ›‰Ú·ÛË ÙˆÓ ·Ú·ÁfiÓÙˆÓ Ô˘ ÂËÚ¿˙Ô˘Ó ÙËÓ ·ÓÙ·ÏÏ·Á‹ ·ÂÚ›ˆÓ ÛÙÔÓ À∞∆ ¤¯ÂÈ ÌÂÏÂÙËı› ·fi ·ÚÎÂÙÔ‡˜ ÂÚ¢ÓËÙ¤˜ (18-21).

° µ

¢

∞ ¶π∂™∏ (cmH2O) ∂ÈÎfiÓ· 1. ∑ÒÓ˜ Ù˘ ¤ÎÙ˘Í˘ ÙˆÓ Ó¢ÌfiÓˆÓ ÛÙÔÓ À∞∆: ∑ÒÓË ∞: ˘Ô¤ÎÙ˘ÍË. ∑ÒÓË B: ‚¤ÏÙÈÛÙË ¤ÎÙ˘ÍË. ∑ÒÓË °: ˘ÂډȿٷÛË. ∑ÒÓË ¢: ‚¤ÏÙÈÛÙË ¤ÎÙ˘ÍË Î·Ù¿ ÙÔÓ ·ÔÁ·Ï·ÎÙÈÛÌfi. §ÀÃ: §ÂÈÙÔ˘ÚÁÈ΋ ˘ÔÏÂÈfiÌÂÓË ¯ˆÚËÙÈÎfiÙËÙ·, À∞∆: À„›Û˘¯ÓÔ˜ ·ÂÚÈÛÌfi˜ Ì ٷϷÓÙÒÛÂȘ.

À∞∆ ÚÔηÏ› ÙfiÛÔ ÔÁÎÒ‰Ë ÚÔ‹, fiÛÔ Î·È Ì›ÍË. ∞˘Ù‹ Ë ‰˘Ó·ÙfiÙËÙ· ·Ó¿ÌÈ͢ ÙÔ˘ ·¤Ú· ÌÂٷ͇ ÙˆÓ ·ÓÒÙÂÚˆÓ ·ÂÚ·ÁˆÁÒÓ Î·È ÙˆÓ Î˘„ÂÏ›‰ˆÓ οÓÂÈ ÙÔÓ À∞∆ ÂÚÈÛÛfiÙÂÚÔ ·ÔÙÂÏÂÛÌ·ÙÈÎfi. ™ÙÔÓ ™∞ o ·ÂÚÈÛÌfi˜, ‰ËÏ·‰‹ Ë ·ÔÌ¿ÎÚ˘ÓÛË ÙÔ˘ ‰ÈÔÍÂȉ›Ô˘ ÙÔ˘ ¿Óıڷη, Â›Ó·È ·Ó¿ÏÔÁÔ˜ Ù˘ Û˘¯ÓfiÙËÙ·˜ Â› ÙÔÓ ·Ó·ÓÂfiÌÂÓÔ fiÁÎÔ (VECO2 = f x Vt ). ∞ÓÙÈı¤Ùˆ˜ ÛÙÔÓ À∞∆ Ë ·ÔÌ¿ÎÚ˘ÓÛË ÙÔ˘ ‰ÈÔÍÂȉ›Ô˘ ÙÔ˘ ¿Óıڷη ÚÔÛ‰ÈÔÚ›˙ÂÙ·È ·fi ÙËÓ Â͛ۈÛË VECO2 = fa x Vtb ‹ fa x amplitudeb), fiÔ˘ a Î˘Ì·›ÓÂÙ·È ·fi 0,75 ¤ˆ˜ 1,24 Î·È b ·fi 1,5 ¤ˆ˜ 2,2. ª›· ·fi ÙȘ ÂÈÙÒÛÂȘ ·˘Ù‹˜ Ù˘ Û¯¤Û˘ Â›Ó·È fiÙÈ ÛÙÔÓ À∞∆, ÌÈÎÚ¤˜ ·ÏÏ·Á¤˜ ÛÙÔÓ ·Ó·ÓÂfiÌÂÓÔ fiÁÎÔ ¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚË Â›‰Ú·ÛË ÛÙÔÓ ·ÂÚÈÛÌfi ·’ fi,ÙÈ ÔÈ ÌÈÎÚ¤˜ ·ÏÏ·Á¤˜ ÛÙË Û˘¯ÓfiÙËÙ· (17,22). À„ËÏfiÙÂÚ· ‡ÚË Ù·Ï¿ÓÙˆÛ˘ ·˘Í¿ÓÔ˘Ó ÙÔÓ ·Ó·ÓÂfiÌÂÓÔ fiÁÎÔ Î·È, ˆ˜ Â·ÎfiÏÔ˘ıÔ, ÙËÓ ·ÔÌ¿ÎÚ˘ÓÛË ÙÔ˘ CO2. ∞ÓÙÈı¤Ùˆ˜ Ë ·‡ÍËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ Ô‰ËÁ› ÛÙÔ ·Ú¿‰ÔÍÔ Ê·ÈÓfiÌÂÓÔ Ù˘ Ì›ˆÛ˘ Ù˘ ·Ô‚ÔÏ‹˜ ÙÔ˘ CO2 (23) Î·È Û ÛËÌ·ÓÙÈ΋ Ì›ˆÛË ÙÔ˘ Vt. ∆Ô ·Ú·¿Óˆ ÈÛ¯‡ÂÈ ÛÙÔÓ SensorMedics, ·Ó Ë ¢ƒ ·Ú·Ì¤ÓÂÈ ÛÙ·ıÂÚ‹. À¿Ú¯Ô˘Ó HFOV Ô˘ ‰È·ÙËÚÔ‡Ó ÛÙ·ıÂÚfi Vt ·ÓÂÍ¿ÚÙËÙ· ·fi ÙË Û˘¯ÓfiÙËÙ· (Hummingbird). ∞˘Ù‹ Ë Û‡ÓıÂÙË Û¯¤ÛË ÌÂٷ͇ Û˘¯ÓfiÙËÙ·˜ Î·È CO2 ÂÍËÁ› ÁÈ·Ù› Ë Û˘¯ÓfiÙËÙ· ‰ÂÓ Â›Ó·È Ë ÚˆÙ·Ú¯È΋ ·Ú¿ÌÂÙÚÔ˜ fiÙ·Ó ı¤ÏÔ˘Ì ӷ ‚ÂÏÙÈÒÛÔ˘Ì ÙÔÓ ·ÂÚÈÛÌfi ÛÙÔÓ À∞∆ (24).

ªË¯·ÓÈÛÌÔ› ÌÂÙ·ÊÔÚ¿˜ Î·È ·ÓÙ·ÏÏ·Á‹˜ ·ÂÚ›ˆÓ √È Ì˯·ÓÈÛÌÔ› Ì ÙÔ˘˜ ÔÔ›Ô˘˜ Ô À∞∆ ‚ÂÏÙÈÒÓÂÈ ÙËÓ ·Ó¿ÌÈÍË ÙÔ˘ ·¤Ú· ÌÂٷ͇ ÙˆÓ ·ÓÒÙÂÚˆÓ ·ÂÚ·ÁˆÁÒÓ Î·È ÙˆÓ Î˘„ÂÏ›‰ˆÓ Â›Ó·È ÂÍ·ÈÚÂÙÈο Û‡ÓıÂÙÔÈ. §ÂÙÔÌÂÚ‹˜ ·Ó¿Ï˘ÛË ÙˆÓ Ì˯·ÓÈÛÌÒÓ ·˘ÙÒÓ ÂÚÈÁÚ¿ÊÂÙ·È ÛÙËÓ ÎÏ·ÛÈ΋ ÂÚÁ·Û›· ÙÔ˘ Chang (22) Î·È ÈÔ ÚfiÛÊ·Ù· Ù˘ Pillow (25).

21

À„›Û˘¯ÓÔ˜ ·ÂÚÈÛÌfi˜ Ì ٷϷÓÙÒÛÂȘ

·. ªÂÙ·ÊÔÚ¿ (Convection) ªÂÙ¿ ·fi Ï›ÁÔ˘˜ ·Ó·Ó¢ÛÙÈÎÔ‡˜ ·ÎÏÔ˘˜ Ù·Ï¿ÓÙˆÛ˘, Ù· ÌfiÚÈ· ·¤Ú· Ô˘ ·Ú¯Èο ‹Ù·Ó ÛÙÔ Î¤ÓÙÚÔ ÙÔ˘ ·ÂÚ·ÁˆÁÔ‡ ÂÎÙÔ͇ÔÓÙ·È ÚÔ˜ Ù· ÚfiÛˆ, ÛÙÔ Ì¤ÛÔÓ ÙˆÓ ‰‡Ô ÂÚÈÊÂÚÈÎÒÓ ·ÂÚ·ÁˆÁÒÓ Î·È Ù· ÌfiÚÈ·, Ô˘ ‹Ù·Ó ·Ú¯Èο ÛÙËÓ ÂÚÈʤÚÂÈ· ÎÔÓÙ¿ ÛÙȘ Ï¢ڤ˜ ÙÔ˘ ·ÚÈÔ˘ ·ÂÚ·ÁˆÁÔ‡, ÌÂÙ·ÎÈÓÔ‡ÓÙ·È ÚÔ˜ Ù· ›Ûˆ ‹ ·¢ı›·˜ ÛÙËÓ ÙÚ·¯Â›·. Œ¯ÂÈ ˘ÔÏÔÁÈÛÙ› fiÙÈ Û οı ·ÎÏÔ Û˘Ì‚·›ÓÂÈ ·ÓÙ·ÏÏ·Á‹ ·ÂÚ›ˆÓ Ì ÌÂÙ·ÊÔÚ¿ ηٿ 5% (26). ‚. ∂·˘Í·ÓfiÌÂÓË ‰È¿¯˘ÛË (Augmented diffusion) ™ÙÔ˘˜ ·ÂÚ·ÁˆÁÔ‡˜ ‹ ÛÙ· ÛËÌ›· ÙÔ˘ ‰È¯·ÛÌÔ‡, Û˘Ì‚·›ÓÂÈ ‰Â˘ÙÂÚÔ·ı‹˜ ·Ó¿ÌÈÍË ÙÔ˘ ·¤Ú·, Ë ÔÔ›· ·Ê’ ÂÓfi˜ ÌÂÓ Ô‰ËÁ› Û Ï¢ÚÈ΋ ·Ó¿ÌÈÍË ÙˆÓ ·ÂÚ›ˆÓ ·ÏÏ¿, ·Ê’ ÂÙ¤ÚÔ˘ ÂÌÔ‰›˙ÂÈ ÙËÓ Î·Ù¿ Ì‹ÎÔ˜ ÌÂÙ·ÊÔÚ¿ ÙÔ˘˜. ∏ ·ÏÌÈ΋ ΛÓËÛË ÙˆÓ ÙÔȯˆÌ¿ÙˆÓ ÙˆÓ ‚ÚfiÁ¯ˆÓ ÌÔÚ› Ó· ·Ó·ÛÙÚ¤„ÂÈ ÙË ÚÔ‹ ÙÔ˘ ·¤Ú·, ·˘Í¿ÓÔÓÙ·˜ ¤ÙÛÈ ÙË ‰È·ÊÔÚ¿ ÛÙË Û˘ÁΤÓÙÚˆÛË ÌÂٷ͇ ÙˆÓ ‰‡Ô ·ÂÚ›ˆÓ. ∞˘Ùfi ÚÔηÏ› ÌÂÁ·Ï‡ÙÂÚË Î·Ù¿ Ì‹ÎÔ˜ ÌÂٷΛÓËÛË ÙÔ˘ ·¤Ú·. Á. ƒÔ‹ ÌÂÁ¿ÏÔ˘ fiÁÎÔ˘ (Bulk flow) ∂›Ó·È ÁÂÓÈο ·Ô‰ÂÎÙfi fiÙÈ Ô À∞∆ ÏÂÈÙÔ˘ÚÁ› Ì ·Ó·ÓÂfiÌÂÓÔ˘˜ fiÁÎÔ˘˜ ·¤Ú· Ô˘ Â›Ó·È ÂÚ›Ô˘ ÈÛÔ‰‡Ó·ÌÔÈ Ì ÙÔÓ fiÁÎÔ ÙÔ˘ ·Ó·ÙÔÌÈο ÓÂÎÚÔ‡ ¯ÒÚÔ˘. øÛÙfiÛÔ ÛÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ·, ÌÂÚÈΤ˜ ΢„ÂÏ›‰Â˜ ‚Ú›ÛÎÔÓÙ·È ÈÔ ÎÔÓÙ¿, ·’ fiÙÈ Î¿ÔȘ ¿ÏϘ, ÛÙ· ·ÓÒÙÂÚ· ÙÌ‹Ì·Ù· ÙÔ˘ ·ÂÚ·ÁˆÁÔ‡. ŒÙÛÈ, Ô ·ÂÚÈÛÌfi˜ Ì ·Ó·ÓÂfiÌÂÓÔ˘˜ fiÁÎÔ˘˜ ·¤Ú· Ô˘ ÚÔÛÂÁÁ›˙Ô˘Ó ÙÔÓ fiÁÎÔ ÙÔ˘ ÓÂÎÚÔ‡ ¯ÒÚÔ˘, ‰›ÓÂÈ ÛÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ· ÊÚ¤ÛÎÔ ·¤Ú· Û οÔȘ “ÏËÛȤÛÙÂÚ˜” ΢„ÂÏ›‰Â˜. ‰. º·ÈÓfiÌÂÓÔ Pendelluft O ÁÂÚÌ·ÓÈÎfi˜ fiÚÔ˜ Pendelluft ‹ ηٿ ÚÔÛ¤ÁÁÈÛË “·ÈˆÚÔ‡ÌÂÓÔ˜ ·¤Ú·˜”, ‰ËÏÒÓÂÈ ¤Ó·Ó ÛËÌ·ÓÙÈÎfi Ì˯·ÓÈÛÌfi ·ÓÙ·ÏÏ·Á‹˜ ·ÂÚ›ˆÓ ÛÙÔÓ À∞∆. ¶ÚfiÎÂÈÙ·È ÁÈ· ÌÂٷΛÓËÛË ÙÔ˘ ·¤Ú· ÌÂٷ͇ “·Ú·Î›ÌÂÓˆÓ” ÌÔÓ¿‰ˆÓ ÙÔ˘ Ó‡ÌÔÓ· Î·È fi¯È ÌÂٷ͇ ÙˆÓ ·ÓÒÙÂÚˆÓ ·ÂÚ·ÁˆÁÒÓ Î·È ÙˆÓ Î˘„ÂÏ›‰ˆÓ. ∂Âȉ‹ Ë ÛÙ·ıÂÚ¿ ¯ÚfiÓÔ˘ (Tc, time constant) ÈÛÔ‡Ù·È Ì ÙÔ ÁÈÓfiÌÂÓÔ Ù˘ ·ÓÙ›ÛÙ·Û˘ (Resistance) Â› ÙËÓ Â˘ÂÓ‰ÔÙfiÙËÙ· (Compliance), (∆c=RxC) ˘¿Ú¯Ô˘Ó ÌÈÎÚ¤˜ ‰È·ÊÔÚ¤˜ ÛÙȘ ÙÈ̤˜ Û ‰È·ÊÔÚÂÙÈΤ˜ ΢„ÂÏ›‰Â˜. ∫·ıÒ˜ ÔÈ ·Ó·Ó¢ÛÙÈΤ˜ Û˘¯ÓfiÙËÙ˜ ·˘Í¿ÓÔ˘Ó Î·È ÔÈ ¯ÚfiÓÔÈ ÂÈÛÓÔ‹˜ Î·È ÂÎÓÔ‹˜ Á›ÓÔÓÙ·È ÌÈÎÚÔ› Û ۯ¤ÛË Ì ÙËÓ ∆c, ‰ÂÓ ˘¿Ú¯ÂÈ ϤÔÓ Â·Ú΋˜ ¯ÚfiÓÔ˜ ÁÈ· ÙȘ ΢„ÂÏȉÈΤ˜ ȤÛÂȘ Ó· ÂÍÈÛÔÚÚÔËıÔ‡Ó Ì ÙȘ ȤÛÂȘ ÙˆÓ ·ÓÒÙÂÚˆÓ ·ÂÚ·ÁˆÁÒÓ. ∂¿Ó ÔÈ Û˘¯ÓfiÙËÙ˜ ·˘ÍËıÔ‡Ó ·ÎfiÌË ÂÚÈÛÛfiÙÂÚÔ Î·È ·ÓÙ›ÛÙÔȯ· ÌÂȈıÔ‡Ó ÔÈ ¯ÚfiÓÔÈ ÂÎ-

ÓÔ‹˜ Î·È ÂÈÛÓÔ‹˜, ÙfiÙ ÌÔÚ› Ó· ˘¿ÚÍÔ˘Ó ÛÙÈÁ̤˜ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ ·ÎÏÔ˘ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÔÔ›ˆÓ ˘¿Ú¯ÂÈ ÌÈ· ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙËÓ ›ÂÛË (gradient) ÌÂٷ͇ ÙˆÓ ·Ú·Î›ÌÂÓˆÓ Î˘„ÂÏ›‰ˆÓ. ™ÙȘ ¯ÚÔÓÈΤ˜ ·˘Ù¤˜ ÛÙÈÁ̤˜, Ô ·¤Ú·˜ ı· Ú¤ÂÈ Ì¿ÏÏÔÓ ·fi ÙË Ì›· ΢„ÂÏ›‰· ÛÙËÓ ¿ÏÏË, ·Ú¿ ·fi ÙÔÓ ·ÂÚ·ÁˆÁfi ÚÔ˜ ÙȘ ΢„ÂÏ›‰Â˜. ¶Ú·ÁÌ·ÙÈο, Ë Â·Ú΋˜ Û˘ÓÙfiÌ¢ÛË ÙˆÓ ¯ÚfiÓˆÓ ÂÈÛÓÔ‹˜ Î·È ÂÎÓÔ‹˜ ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÔÈ ÁÂÈÙÔÓÈΤ˜ ΢„ÂÏ›‰Â˜ Ó· Ô‰ËÁÔ‡ÓÙ·È ÂÎÙfi˜ Ê¿Û˘, Û ۯ¤ÛË Ì ÙȘ ¿ÏϘ. ŸÙ·Ó ·˘Ùfi Û˘Ì‚·›ÓÂÈ, Ë ‰È·ÓÔÌ‹ Û¯ÂÙÈο ÌÈÎÚÒÓ fiÁÎˆÓ ÚÔ˜ ÙÔ˘˜ ·ÓÒÙÂÚÔ˘˜ ·ÂÚ·ÁˆÁÔ‡˜ Ô‰ËÁ› Û “Ì›ÍË ·¤Ú·” ·Ó¿ÌÂÛ· ÛÙȘ ΢„ÂÏ›‰Â˜ ·˘Ù¤˜. ∞˘Ùfi˜ Â›Ó·È Ô Ì˯·ÓÈÛÌfi˜ ÙÔ˘ “·ÈˆÚÔ‡ÌÂÓÔ˘ ·¤Ú·” Ô˘ ÌÂÙ·ÎÈÓÂ›Ù·È ÌÂٷ͇ ÙˆÓ ·Ú·Î›ÌÂÓˆÓ Î˘„ÂÏ›‰ˆÓ Î·È ÌÔÚ› Ó· Â·˘Í¿ÓÂÈ ÙËÓ ·Ó¿ÌÈÍ‹ ÙÔ˘ ÛÙÔ˘˜ ·ÂÚ·ÁˆÁÔ‡˜ (25,27). Â. ∞Û‡ÌÌÂÙÚ˜ ηٷÙÔ̤˜ Ù·¯˘Ù‹ÙˆÓ (Asymmetric velocity profiles) ŸÙ·Ó ÛÙÔÓ Î˘ÎÏÔÊÔÚÔ‡ÓÙ· ·¤Ú· οÔÈÔ˘ ·ÁˆÁÔ‡ ÂÊ·ÚÌfi˙ÂÙ·È ·fiÙÔÌË ›ÂÛË, Ô ·¤Ú·˜ ‰ÂÓ ÂÈÙ·¯‡ÓÂÈ ÔÌÔÈfiÌÔÚÊ·. √ ·¤Ú·˜ Ô˘ ‚Ú›ÛÎÂÙ·È ÛÙÔ Î¤ÓÙÚÔ ÙÔ˘ ·ÁˆÁÔ‡ ÎÈÓÂ›Ù·È Ì ٷ¯‡ÙËÙ· ÌÂÁ·Ï‡ÙÂÚË ·fi ÂΛÓË ÙÔ˘ ·¤Ú· ÛÙËÓ ÂÚÈʤÚÂÈ· ÙÔ˘ ۈϋӷ. ∏ ‰È·ÊÔÚ¿ ÌÂٷ͇ ÙÔ˘ ·Ó‡ÛÌ·ÙÔ˜ Ù·¯‡ÙËÙ·˜ ÙÔ˘ ·¤Ú· ÛÙÔ Î¤ÓÙÚÔ ÙÔ˘ ·ÁˆÁÔ‡ Î·È Ù˘ Ù·¯‡ÙËÙ·˜ ÛÙËÓ ÂÚÈʤÚÂÈ· ‹ Ë ·Û˘ÌÌÂÙÚ›· ÛÙËÓ Î·Ù·ÓÔÌ‹ ÙˆÓ Ù·¯˘Ù‹ÙˆÓ, ÂÍ·ÚÙ¿Ù·È ·fi ÔÏÏ·ÏÔ‡˜ ·Ú¿ÁÔÓÙ˜, ÛÙÔ˘˜ ÔÔ›Ô˘˜ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È Ë ‰È¿ÌÂÙÚÔ˜ ÙÔ˘ ·ÁˆÁÔ‡ Î·È Ë ÂÊ·ÚÌÔ˙fiÌÂÓË ›ÂÛË. ŸÙ·Ó ÂÊ·ÚÌfi˙ÂÙ·È Í·ÊÓÈο ÛÙÔÓ ·¤Ú· ˘„ËÏ‹ ›ÂÛË ÛÙÔÓ ·ÓÒÙÂÚÔ ·ÂÚ·ÁˆÁfi, Ô ·¤Ú·˜ ÛÙÔ Î¤ÓÙÚÔ ÙÔ˘ Ù·Íȉ‡ÂÈ Ì ÌÂÁ·Ï‡ÙÂÚË Ù·¯‡ÙËÙ· Î·È ÂÔ̤ӈ˜ ‚·ı‡ÙÂÚ· ̤۷ ÛÙÔÓ Ó‡ÌÔÓ·, Û ۇÁÎÚÈÛË Ì ÙËÓ ÂÚ›ÙˆÛË Ô˘ Ë ÂÊ·ÚÌÔÁ‹ Ù˘ ›ÂÛ˘ Á›ÓÂÙ·È ·ÚÁ¿ (fiˆ˜ ÛÙÔÓ ™∞) (28). ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÎÓÔ‹˜, Ô ·¤Ú·˜ ÂÈÙ·¯‡ÓÂÈ ÚÔ˜ ÙÔ Â͈ÙÂÚÈÎfi ÙˆÓ Î˘„ÂÏ›‰ˆÓ Î·È Ë ÔÚ›· ÙÔ˘ ·ÓÙÈÛÙÚ¤ÊÂÙ·È. ∂Âȉ‹, Ë ‰È¿ÌÂÙÚÔ˜ ÙÔ˘ ·ÂÚ·ÁˆÁÔ‡ Â›Ó·È ÌÈÎÚfiÙÂÚË ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÎÓÔ‹˜ ·fi ÂΛÓË Ù˘ ÂÈÛÓÔ‹˜, Ô ‚·ıÌfi˜ ·Û˘ÌÌÂÙÚ›·˜ ÙˆÓ Î·Ù·ÙÔÌÒÓ Ù·¯‡ÙËÙ·˜ Â›Ó·È ÌÈÎÚfiÙÂÚÔ˜ ÛÙËÓ ÂÎÓÔ‹. ŒÙÛÈ ÂÍËÁÂ›Ù·È ÁÈ·Ù› Ù· ‰È·Ó‡ÛÌ·Ù· Ù‹˜ ÚÔ˜ Ù· ÂÌÚfi˜ (ÂÈÛÓ¢ÛÙÈ΋˜) Î·È Ù˘ ·Ó¿ÛÙÚÔÊ˘ (ÂÎÓ¢ÛÙÈ΋˜) Ù·¯‡ÙËÙ·˜ ÂÓfi˜ Ï‹ÚÔ˘˜ ·ÎÏÔ˘ À∞∆ ‰ÂÓ ·ÏÏËÏÔ·Ó·ÈÚÔ‡ÓÙ·È, ÂÈÛÙÚ¤ÊÔÓÙ·˜ fiÏÔ ÙÔÓ ·¤Ú· ÛÙËÓ ·Ú¯È΋ ÙÔ˘ ı¤ÛË. ÛÙ. ¢È·ÛÔÚ¿ Ù‡Ô˘ Taylor (Taylor-type dispersion) ª›· ·fi ÙȘ Û˘Ó¤ÂȘ ÙˆÓ ·Û‡ÌÌÂÙÚˆÓ Î·Ù·ÓÔÌÒÓ Ù·¯‡ÙËÙ·˜ Â›Ó·È fiÙÈ o ·Ó·Óˆ̤ÓÔ˜ ·¤Ú·˜ ÛÙÔ ¶·È‰È·ÙÚÈ΋ 2007;70:18-23

22

¶. ∫·Ú·ÁÈ¿ÓÓË, ¡. ¡ÈÎÔÏ·˝‰Ë˜

ΤÓÙÚÔ ÙˆÓ ·ÂÚ·ÁˆÁÒÓ ÂÚÈ‚¿ÏÏÂÙ·È ·fi ·¤Ú· ÙÔ˘ ÚÔËÁÔ‡ÌÂÓÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ ·ÎÏÔ˘, ÛÙËÓ ÂÚÈʤÚÂÈ·. À¿Ú¯ÂÈ ‰ËÏ·‰‹ ‰È·ÊÔÚ¿ Û˘ÁΤÓÙÚˆÛ˘, ·fi ÙÔ Î¤ÓÙÚÔ ÚÔ˜ ÙËÓ ÂÚÈʤÚÂÈ· ÙfiÛÔ ÁÈ· ÙÔ √2 fiÛÔ Î·È ÁÈ· ÙÔ CO2. ∂Âȉ‹ Ë ·Ó¿ÌÈÍË Û˘Ì‚·›ÓÂÈ Û οı ÂÚ›ÙˆÛË fiÔ˘ ˘¿Ú¯ÂÈ Ë ‰È·ÊÔÚ¿ ÛÙË Û˘ÁΤÓÙÚˆÛË √2 Î·È CO2, ·˘Ùfi Ô‰ËÁ› Û ·ÎÙÈÓˆÙ‹ ‰È¿¯˘ÛË ·fi ÙÔÓ ·ÂÚ·ÁˆÁfi ÚÔ˜ ÙÔ Î¤ÓÙÚÔ Î·È ·fi ÙÔ Î¤ÓÙÚÔ ÚÔ˜ ÙËÓ ÂÚÈʤÚÂÈ·. ∞˘Ù‹ Ë ‰È¿¯˘ÛË, Ô˘ ÚÔηÏÂ›Ù·È ·fi ÙÔÓ Û˘Ó‰˘·ÛÌfi ÙˆÓ ·ÍÔÓÈÎÒÓ ·Û‡ÌÌÂÙÚˆÓ ·Ó˘ÛÌ¿ÙˆÓ Ù·¯‡ÙËÙ·˜ Î·È Ù˘ ·ÎÙÈÓˆÙ‹˜ ÎÏ›Û˘ Û˘ÁΤÓÙÚˆÛ˘, ÔÓÔÌ¿˙ÂÙ·È ‰È·ÛÔÚ¿ Ù‡Ô˘ Taylor.

ıÒ˜ Î·È ·ÍÈÔÏfiÁËÛË Ù˘ Ó¢ÌÔÓÈ΋˜ ·ıÔÊ˘ÛÈÔÏÔÁ›·˜ ÙÔ˘ οı ÓÂÔÁÓÔ‡ ı· ‚ÔËıÔ‡Û ÛÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂÚË ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘. √È ÂÍÂÏ›ÍÂȘ ÛÙÔÓ ÙÔ̤· ÙÔ˘ Ì˯·ÓÈÎÔ‡ ·ÂÚÈÛÌÔ‡ ·ÔÙÂÏÔ‡Ó ÚfiÎÏËÛË ÁÈ· ÙÔ˘˜ ÓÂÔÁÓÔÏfiÁÔ˘˜. ∏ ÛˆÛÙ‹ ÂÈÏÔÁ‹ ÙÔ˘ ÌÔÓÙ¤ÏÔ˘ ı· Ú¤ÂÈ Ó· Â›Ó·È ÂÍ·ÙÔÌÈÎÂ˘Ì¤ÓË ÁÈ· οı ÓÂÔÁÓfi. ∏ ·Ó¿Ù˘ÍË Ù˘ Ù¯ÓÔÏÔÁ›·˜ Û·ÊÒ˜ Â›Ó·È ·ÏÌ·Ù҉˘, ‰ÂÓ ı· Ú¤ÂÈ fï˜ Ó· ·Ú·‚ϤÂÙ·È Ë ÎÏÈÓÈ΋ ÂÎÙ›ÌËÛË Î·È Ë ÂÌÂÈÚ›· ÛÙË ¯Ú‹ÛË ÂÓfi˜ Ì˯·Ó‹Ì·ÙÔ˜, ÁÈ·Ù› ·ÏÔ‡Ûٷٷ ¤Ó· Û‡Á¯ÚÔÓÔ Ì˯¿ÓËÌ· Èı·ÓÒ˜ Ó· Â›Ó·È ÂÈΛӉ˘ÓÔ ÁÈ· ÙÔÓ ·ÛıÂÓ‹, Â¿Ó ‰ÂÓ ¤¯Ô˘Ì ηٷÓÔ‹ÛÂÈ Ï‹Úˆ˜ ÙÔ˘˜ Ì˯·ÓÈÛÌÔ‡˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘.

˙. ÕÏÏÔÈ Ì˯·ÓÈÛÌÔ› ·ÓÙ·ÏÏ·Á‹˜ ·ÂÚ›ˆÓ Ÿˆ˜ ÛÙÔÓ ™∞, ¤ÙÛÈ Î·È ÛÙÔÓ À∞∆, Ë ÌÔÚȷ΋ ‰È¿¯˘ÛË (molecular diffusion) Û˘ÌÌÂÙ¤¯ÂÈ ÛÙËÓ ·Ó¿ÌÈÍË ÙˆÓ ·ÂÚ›ˆÓ, ·ÎÚÈ‚Ò˜ ‰›Ï· ·fi ÙËÓ Î˘„ÂÏȉÈ΋ ÂÈÊ¿ÓÂÈ·. ∂›Û˘, ¤Ó· ÌÈÎÚfi ÙÌ‹Ì· ÙˆÓ ÏËÛȤÛÙÂÚˆÓ ÛÙÔ˘˜ ·ÂÚ·ÁˆÁÔ‡˜ ΢„ÂÏ›‰ˆÓ ·ÂÚ›˙ÂÙ·È ·¢ı›·˜ (direct alveolar ventilation). ŒÙÛÈ, Ë ·ÓÙ·ÏÏ·Á‹ ·ÂÚ›ˆÓ Á›ÓÂÙ·È fiˆ˜ Î·È ÛÙÔÓ ™∞.

µÈ‚ÏÈÔÁÚ·Ê›·

™ÙÚ·ÙËÁÈΤ˜ ·ÂÚÈÛÌÔ‡ ∏ ÚÔÙÂÈÓfiÌÂÓË ÛÙÚ·ÙËÁÈ΋ ¯Ú‹Û˘ ÙÔ˘ À∞∆ ÛÙËÚ›˙ÂÙ·È ÛÙË ‰È·Ù‹ÚËÛË ÙÔ˘ “‚¤ÏÙÈÛÙÔ˘” fiÁÎÔ˘ ÙˆÓ Ó¢ÌfiÓˆÓ Û ÛÙÂÓ¿ Ï·›ÛÈ·, ·Ó¿ÌÂÛ· ÛÙËÓ ·ÔÊ˘Á‹ ·ÙÂÏÂÎÙ·Û›·˜ Î·È ˘ÂډȿٷÛ˘, ÚÔÎÂÈ̤ÓÔ˘ Ó· “·Ô‰ÂÛÌ¢Ù›” Û‡ÓÙÔÌ· ÙÔ ÓÂÔÁÓfi ·fi ÙÔÓ Ì˯·ÓÈÎfi ·ÂÚÈÛÌfi (9,29,30). ÃÚËÛÈÌÔÔÈÒÓÙ·˜ ÙËÓ Ù·ÎÙÈ΋ ÙÔ˘ “˘„ËÏÔ‡ fiÁÎÔ˘ ÙˆÓ Ó¢ÌfiÓˆÓ”, ÂÊ·ÚÌfi˙ÂÙ·È Û˘Ó¯‹˜ ‰È·Ù·ÙÈ΋ ›ÂÛË, ˘„ËÏfiÙÂÚË ·fi ÙËÓ ›ÂÛË ‰È¿ÓÔÈ͢ ÙˆÓ Î˘„ÂÏ›‰ˆÓ, Ì ·ÔÙ¤ÏÂÛÌ· ÙË ÛÙÚ·ÙÔÏfiÁËÛË ÙˆÓ ·ÙÂÏÂÎÙ·ÙÈÎÒÓ Î˘„ÂÏ›‰ˆÓ Î·È ÙËÓ Î·Ï‡ÙÂÚË ¤ÎÙ˘ÍË ÙˆÓ Ó¢ÌfiÓˆÓ (31). ∞˘Ù¤˜ ÔÈ Ô‰ËÁ›Â˜ ·¢ı‡ÓÔÓÙ·È ÛÙÔ ÚfiˆÚÔ ÓÂÔÁÓfi Ô˘ ¿Û¯ÂÈ Î˘Ú›ˆ˜ ·fi ÙËÓ ·ÙÂÏÂÎÙ·ÙÈ΋ ÓfiÛÔ ÙˆÓ Ó¢ÌfiÓˆÓ. √È Ô‰ËÁ›Â˜ fï˜, Ú¤ÂÈ Ó· ÂÍ·ÙÔÌÈ·ÔÓÙ·È Î·È Ó· ‰È·ÊÔÚÔÔÈÔ‡ÓÙ·È ·Ó¿ÏÔÁ· Ì ÙËÓ ÚˆÙÔ·ı‹ Ó¢ÌÔÓÈ΋ ÓfiÛÔ (21,32-34). ∂›Ó·È ÛËÌ·ÓÙÈÎfi Ô ÓÂÔÁÓÔÏfiÁÔ˜ Ó· ·ÍÈÔÏÔÁ› ÚÔÛÂÎÙÈο ÙËÓ Ó¢ÌÔÓÈ΋ ·ıÔÊ˘ÛÈÔÏÔÁ›· οı ·ÛıÂÓ‹ Î·È Ó· ηıÔÚ›˙ÂÈ ÙÔ˘˜ Ì˯·ÓÈÛÌÔ‡˜ Ô˘ ¢ı‡ÓÔÓÙ·È ÁÈ· ÙË ÌË Â·Ú΋ ·ÓÙ·ÏÏ·Á‹ ÙˆÓ ·ÂÚ›ˆÓ. ªfiÓÔ ÙfiÙ ÌÔÚ› Ó· ۯ‰ȷÛÙ› Ë Î·Ï‡ÙÂÚË ÛÙÚ·ÙËÁÈ΋ ·ÂÚÈÛÌÔ‡ Ô˘ ı· Â›Ó·È Ë Î·Ù·ÏÏËÏfiÙÂÚË ÁÈ· οı ÓÂÔÁÓfi. ∏ ÔÚ›· Ù˘ ÓfiÛÔ˘ Ú¤ÂÈ Ó· Â·Ó·ÍÈÔÏÔÁÂ›Ù·È Û˘¯Ó¿ Î·È Ó· ÙÚÔÔÔÈÂ›Ù·È ·Ó·ÏfiÁˆ˜ Ë ÛÙÚ·ÙËÁÈ΋ ÙÔ˘ ·ÂÚÈÛÌÔ‡ (34). ™˘Ì¤Ú·ÛÌ· ∏ ηχÙÂÚË Î·Ù·ÓfiËÛË ÙÔ˘ ÙÚfiÔ˘ Î·È ÙˆÓ Ì˯·ÓÈÛÌÒÓ ÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘ ˘„›Û˘¯ÓÔ˘ ·ÂÚÈÛÌÔ‡ ηPaediatriki 2007;70:18-23

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¶·È‰È·ÙÚÈ΋ 2007;70:18-23

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∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞

ORIGINAL ARTICLE

ªÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ Û ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ Ù˘ ∫Ú‹Ù˘ Û ۯ¤ÛË Ì ÙË ‰È·ÙÚÔÊ‹ ÙÔ˘˜ ¶·ÓÂÈÛÙ‹ÌÈÔ ∫Ú‹Ù˘, ∆Ì‹Ì· π·ÙÚÈ΋˜, ∆Ô̤·˜ ∫ÔÈÓˆÓÈ΋˜ π·ÙÚÈ΋˜, ∫ÏÈÓÈ΋ ¶ÚÔÏËÙÈ΋˜ π·ÙÚÈ΋˜ Î·È ¢È·ÙÚÔÊ‹˜, ∏Ú¿ÎÏÂÈÔ ∫Ú‹Ù˘ AÏÏËÏÔÁÚ·Ê›·: ª·ÓfiÏ˘ §ÈÓ·Ú‰¿Î˘ linman@med.uoc.gr ¢È·ÛÙ·‡ÚˆÛË µÔ‡Ù˜ ™Ù·˘Ú¿ÎÈ· ∆.∫. 710 03, ∆.£.: 2208, ∏Ú¿ÎÏÂÈÔ ∫Ú‹Ù˘

*

Ã. ÷Ù˙‹˜, ™. ºÏÔ˘Ú‹, π. ªÔÛ¯·Ó‰Ú¤·, º. ªÂÚ‚·Ó¿ÎË, ª. ∫˘Úȷο΢, °. ∆ÛÈÌÈÓfi˜, C. Codrington, °. ª·Ì·Ï¿ÎȘ

ª. §ÈÓ·Ú‰¿Î˘, ∫. ™·ÚÚ‹, °. ªÂÚÙÛÈ¿˜, ∞. ∫·Ê¿ÙÔ˜, √Ì¿‰· ∫ÏÈÓÈ΋˜ ¶ÚÔÏËÙÈ΋˜ π·ÙÚÈ΋˜ Î·È ¢È·ÙÚÔÊ‹˜* ¶ÂÚ›ÏË„Ë ∂ÈÛ·ÁˆÁ‹: ™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ Â›Ó·È Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù˘ Û˘¯ÓfiÙËÙ·˜ ÂÌÊ¿ÓÈÛ˘ ÙÔ˘ ªÂÙ·‚ÔÏÈÎÔ‡ ™˘Ó‰ÚfiÌÔ˘ (ªÂÙ™˘Ó) Û ·È‰È¿ & ÂÊ‹‚Ô˘˜ Ù˘ ∫Ú‹Ù˘ Û ۯ¤ÛË Ì ÙË ‰È·ÙÚÔÊ‹ ÙÔ˘˜. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ∂ÈϤ¯ıËÎ·Ó 1209 ·È‰È¿ Î·È ¤ÊË‚ÔÈ. ÀÔÏÔÁ›ÛÙËÎÂ Ë Û˘¯ÓfiÙËÙ· Û˘Ó‡·Ú͢ ÙÚÈÒÓ ‹ ÂÚÈÛÛÔÙ¤ÚˆÓ ·Ú·ÁfiÓÙˆÓ ÙÔ˘ ªÂÙ™˘Ó Î·È Û˘Û¯ÂÙ›ÛÙËΠ̠ÙÔÓ ¢Â›ÎÙË ÀÁÈÂÈÓ‹˜ ¢È·ÙÚÔÊ‹˜ (¢À¢), Ô ÔÔ›Ô˜ ·ÍÈÔÏÔÁ› Î·È Ù·ÍÈÓÔÌ› ÙË ‰È·ÙÚÔÊ‹ οı ·ÙfiÌÔ˘ Û Îϛ̷η ·fi 1-100. ¢È·ÙÚÔÊ‹ Ì ‚·ıÌÔÏÔÁ›· <51 ıˆÚÂ›Ù·È “·ÓÂ·Ú΋˜”, ·fi 51-80 fiÙÈ “¯ÚÂÈ¿˙ÂÙ·È ‚ÂÏÙ›ˆÛË” Î·È ·fi 81-100 “ηϋ”. ∞ÔÙÂϤÛÌ·Ù·: √ ÂÈÔÏ·ÛÌfi˜ ÙÔ˘ ªÂÙ™˘Ó ‚Ú¤ıËΠ3,9% (4,2% ÛÙ· ·ÁfiÚÈ·, 3,6% ÛÙ· ÎÔÚ›ÙÛÈ·). ∏ ̤ÛË ‚·ıÌÔÏÔÁ›· ÙÔ˘ ¢À¢ ‹Ù·Ó 58,7 Ì 58,4 ÛÙ· ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ Ì ªÂÙ™˘Ó ¤Ó·ÓÙÈ 59,8 Û ÂΛӷ ¯ˆÚ›˜ ·Ú¿ÁÔÓÙ˜ ªÂÙ™˘Ó (p>0,05). ∆Ô 36% ÙˆÓ ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ Ì ªÂÙ™˘Ó, ›¯Â ‰È·ÙÚÔÊ‹ “·ÓÂ·Ú΋” Î·È 5% “ηϋ”, ¤Ó·ÓÙÈ 28% Î·È 8% ·ÓÙ›ÛÙÔȯ·, ÂÎÂ›ÓˆÓ ¯ˆÚ›˜ ·Ú¿ÁÔÓÙ˜ ªÂÙ™˘Ó (p=0,026). ∂›Û˘, Ù· ·È‰È¿ - ¤ÊË‚ÔÈ Ì ªÂÙ™˘Ó, ¤Ó·ÓÙÈ ÂÎÂ›ÓˆÓ ¯ˆÚ›˜ ·Ú¿ÁÔÓÙ˜ ªÂÙ™˘Ó, ›¯·Ó ˘„ËÏfiÙÂÚ· ÔÛÔÛÙ¿ Ì ·ÓÂ·Ú΋ Ï‹„Ë Ê˘ÏÈÎÔ‡ ÔͤԘ (55% ¤Ó·ÓÙÈ 53%, p=0,010) Î·È ‚ÈÙ·Ì›Ó˘ ∞ (45% ¤Ó·ÓÙÈ 43%, p=0,023). ™Ù· ·¯‡Û·Úη ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜, Ô Î›Ó‰˘ÓÔ˜ Ó· ·Ó·Ù‡ÍÔ˘Ó ªÂÙ™˘Ó ‚Ú¤ıËΠ85 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚÔ˜ Û ۯ¤ÛË Ì ٷ Ê˘ÛÈÔÏÔÁÈο (95% ¢∂: 33-219, p<0,001). ∆· ·È‰È¿ Î·È ¤ÊË‚ÔÈ Ì ªÂÙ™˘Ó ›¯·Ó Â›Û˘ 30% ¯·ÌËÏfiÙÂÚË Èı·ÓfiÙËÙ· ÁÈ· ηϋ ηډÈÔ·Ó·Ó¢ÛÙÈ΋ ·ÓÙÔ¯‹ Û ۯ¤ÛË Ì ÂΛӷ ¯ˆÚ›˜ ·Ú¿ÁÔÓÙ˜ ªÂÙ™˘Ó (OR=0,70, 95% ¢∂: 0,49-0,99, p=0,042). ™˘ÌÂÚ¿ÛÌ·Ù·: ∞fi Ù· ·ÔÙÂϤÛÌ·Ù· ‰È·ÈÛÙÒÓÂÙ·È fiÙÈ Ë ÚˆÙÔÁÂÓ‹˜ ÚfiÏË„Ë Î·È ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ªÂÙ™˘Ó ÌÔÚ› Ó· ÂÈÙ¢¯ı› ÌfiÓÔ Ì ηٿÏÏËÏË ·ÁˆÁ‹ ˘Á›·˜ ·¢ı˘ÓfiÌÂÓË ÛÙ· ·È‰È¿ Î·È ÛÙȘ ÔÈÎÔÁ¤ÓÂȤ˜ ÙÔ˘˜, ¤ÙÛÈ ÒÛÙ ӷ ÙÔ˘˜ ‰Ôı› Ë ‰˘Ó·ÙfiÙËÙ· Ó· οÓÔ˘Ó Î·Ï‡ÙÂÚ˜ ÂÈÏÔÁ¤˜ ÛÙË ‰È·ÙÚÔÊ‹, ÛÙË ÛˆÌ·ÙÈ΋ ¿ÛÎËÛË Î·È ÁÂÓÈÎfiÙÂÚ· ÛÙÔÓ ÙÚfiÔ ˙ˆ‹˜ ÙÔ˘˜.

§¤ÍÂȘ ÎÏÂȉȿ: ªÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ, ‰È·ÙÚÔÊ‹, ‰Â›ÎÙ˘ ˘ÁÈÂÈÓ‹˜ ‰È·ÙÚÔÊ‹˜, ·¯˘Û·ÚΛ·, ÏÈÔÚˆÙ½Ó˜.

Prevalence of metabolic syndrome in children and adolescents of Crete and its relation to diet University of Crete, Faculty of Medicine, Department of Social Medicine, Division of Preventive Medicine and Nutrition, Heraklion, Crete Correspondence: Manolis Linardakis linman@med.uoc.gr Voutes-Stavrakia Junction, 71 003, Po. Box: 2208, Herakleion, Crete

*

H. Hatzis, S. Flouri, I. Moschandrea, F. Bervanaki, M. Kiriakakis, G. Tsibinos, C. Codrington, G. Mamalakis

M. Linardakis, K. Sarri, G. Bertsias, A. Kafatos, Division of Preventive Medicine and Nutrition* Abstract Background: The aim of this study was to determine the prevalence of the metabolic syndrome (MetSyn) in children and adolescents of Crete, and to explore its association with dietary intake.

Methods: The study included 1209 children and adolescents. The prevalence of MetSyn was examined and associated with the USDA Healthy Eating Index (HEI), which classifies the dietary intake of individuals, providing a score of 1-100. The scores indicate respectively: <51 a “poor” diet, 51-80 a diet that “needs improvement”, and >80 a “good” diet.

Results: The rate of MetSyn in the children and adolescents was 3.9% (4.2% of boys, 3.6% of girls). The overall mean HEI score was 58.7 (58.4 in children and adolescents with MetSyn and 59.8 in risk-free individuals, p>0.05). Of the children and adolescents with MetSyn, 36% had a “poor” diet and only 5% had a “good” diet according to the HEI score, while the respective rates in risk-free individuals were 28% and 8% (p=0.026). Inadequate intakes of folate (55% vs 53%, p=0.010) and vitamin A (45% vs 43%, p=0.023) were also more common in children and adolescents with MetSyn. Compared to their non-obese counterparts, obese children and adolescents had an 85 times higher risk for MetSyn (95% CI: 33-219, p<0.001). The children and adolescents with MetSyn were 30% less likely to have good cardiorespiratory fitness (OR=0.70, 95% CI: 0.49-0.99, p=0.042) than those with no risk factors.

Conclusions: Primary prevention of MetSyn could be achieved when appropriate health and nutrition intervention is initiated early in childhood, aimed at behaviour modification in children, parents and teachers, for better health choices in nutrition and physical activity.

Key words: Metabolic syndrome, nutrition, healthy eating index, obesity, serum lipids.

Paediatriki 2007;70:24-36

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™˘ÓÙÔÌÔÁڷʛ˜ ªÂÙ™˘Ó ¢ª™ HDL-C

ªÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ ¢Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ ÃÔÏËÛÙÂÚfiÏË ÙˆÓ ˘„ËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈÔÚˆÙÂ˚ÓÒÓ LDL-C ÃÔÏËÛÙÂÚfiÏË ÙˆÓ ¯·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈÔÚˆÙÂ˚ÓÒÓ ¢À¢ ¢Â›ÎÙ˘ ˘ÁÈÂÈÓ‹˜ ‰È·ÙÚÔÊ‹˜ USDA United States Department of Agriculture ∏™¶ ∏ÌÂÚ‹ÛÈ· Û˘ÓÈÛÙÒÌÂÓË ÔÛfiÙËÙ· RDA Recommended dietary allowances ª™ ™Ù·ÙÈÛÙÈÎÒ˜ ÌË ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ANCOVA ∞Ó¿Ï˘ÛË Û˘Ó‰È·Î‡Ì·ÓÛ˘ OR Odds ratio NHANES III 3rd National Health and Nutrition Examination Survey

∂ÈÛ·ÁˆÁ‹ ŒÓ· ·fi Ù· ÌÂÁ·Ï‡ÙÂÚ· Û‡Á¯ÚÔÓ· ÚÔ‚Ï‹Ì·Ù· Ù˘ ‰ËÌfiÛÈ·˜ ˘Á›·˜ ·ÔÙÂÏ› ÙÔ ÌÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ (ªÂÙ™˘Ó) ‹ Û‡Ó‰ÚÔÌÔ Ã, ·ÊÔ‡ ηıÔÚ›˙ÂÙ·È ·fi ÙË Û˘ÁΤÓÙÚˆÛË ÙÚÈÒÓ ‹ ÂÚÈÛÛfiÙÂÚˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË Î·Ú‰È·ÁÁÂÈ·ÎÒÓ Î·È ¿ÏÏˆÓ ¯ÚfiÓÈˆÓ ÓÔÛËÌ¿ÙˆÓ (1-3). ™‹ÌÂÚ·, ·Ú¿ ÙÔ˘˜ ‰È·ÊÔÚÂÙÈÎÔ‡˜ ÔÚÈÛÌÔ‡˜ Ô˘ ¤¯Ô˘Ó ‰Ôı›, ¤¯ÂÈ Á›ÓÂÈ ·Ô‰ÂÎÙfi fiÙÈ ªÂÙ™˘Ó ˘Ê›ÛÙ·Ù·È fiÙ·Ó Û˘Ó˘¿Ú¯Ô˘Ó ÙÚÂȘ ‹ ÂÚÈÛÛfiÙÂÚÔÈ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ (2-4), fiˆ˜ ·˘ÍË̤ÓË ÙÈÌ‹ ۷ί¿ÚÔ˘ ÔÚÔ‡ ·›Ì·ÙÔ˜ ˆ˜ ‰Â›ÎÙ˘ ˘ÂÚÁÏ˘Î·ÈÌ›·˜ ‹ ۷ί·ÚÒ‰Ô˘˜ ‰È·‚‹ÙË Ù‡Ô˘ 2, ¯·ÌËÏ‹ HDL ¯ÔÏËÛÙÂÚfiÏË, ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›·, ·˘ÍË̤ÓË Û˘ÛÙÔÏÈ΋ Î·È ‰È·ÛÙÔÏÈ΋ ·ÚÙËÚȷ΋ ›ÂÛË ˆ˜ ‰Â›ÎÙ˜ ˘¤ÚÙ·Û˘ ηÈ, Ù¤ÏÔ˜, ·˘ÍË̤ÓË ÂÚ›ÌÂÙÚÔ˜ ̤Û˘ ˆ˜ ‰Â›ÎÙ˘ ÎÂÓÙÚÈ΋˜ ·¯˘Û·ÚΛ·˜. ∏ Û˘Ó¤ÚÁÂÈ· ÙˆÓ ·Ú·ÁfiÓÙˆÓ ·˘ÙÒÓ Ô‰ËÁ› ÛÙËÓ ·Ó¿Ù˘ÍË ·ıËÚÔÛÎÏËÚˆÙÈÎÒÓ Ï·ÎÒÓ Î·È, ηٿ Û˘Ó¤ÂÈ·, ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ ‹ ÁÂÓÈÎfiÙÂÚ· ηډȷÁÁÂÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ (1-7). ∂ÎÙÈÌ‹ıËΠ‰Â ·fi ÙË ÌÂϤÙË NHANES 1999-2000, fiÙÈ ÂÚ›Ô˘ 47 ÂηÙÔÌ̇ÚÈ· ∞ÌÂÚÈηÓÒÓ ¤¯Ô˘Ó ªÂÙ™˘Ó, ηıÒ˜ Î·È ÂÚÈÛÛfiÙÂÚÔÈ ·fi 2 ÂηÙÔÌ̇ÚÈ· ¤ÊË‚ÔÈ (8-10). ∏ ·ÚÔ˘Û›· ÈÓÒ‰Ô˘˜ Ͽη˜ ÂÍÂÏ›ÛÛÂÙ·È Û ·ıËÚÔÛÎÏ‹ÚˆÛË ·fi ÙËÓ ·È‰È΋ Î·È ÂÊË‚È΋ ·ÎfiÌ· ËÏÈΛ· (11,12). ∞ÔÙÂÏ› Û˘Ó¤ÂÈ· Û˘Ó‰˘·ÛÌÔ‡ Ù˘ η΋˜ ‰È·ÙÚÔÊ‹˜, Ù˘ ·ÓÂ·ÚÎÔ‡˜ ¿ÛÎËÛ˘ Î·È Ù˘ ·¯˘Û·ÚΛ·˜, Ô˘ fiˆ˜ ·Ó·Ê¤ÚÂÙ·È Û ÌÂϤÙË ÛÙȘ ∏¶∞ (13), ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙÔ˘Ï¿¯ÈÛÙÔÓ 300.000 ı·Ó¿ÙÔ˘˜ ÂÙËÛ›ˆ˜ Î·È ÂÚ›Ô˘ 99 ‰ÈÛ. ‰ÔÏ¿ÚÈ· ÂÙ‹ÛÈÔ ÔÈÎÔÓÔÌÈÎfi ÎfiÛÙÔ˜. ∞Ó Î·È Ë ·ıÔÁ¤ÓÂÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ‰ÂÓ ¤¯ÂÈ Ï‹Úˆ˜ ηٷÓÔËı›, Â›Ó·È ÁÓˆÛÙ‹ Ë Û¯¤ÛË ÙÔ˘ Ì ÁÂÓÂÙÈÎÔ‡˜ Î·È ÂÚÈ‚·ÏÏÔÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜, fiˆ˜ Ë Î·ıÈÛÙÈ΋ ˙ˆ‹ Î·È Ë ‰˘ÙÈÎÔ‡ Ù‡Ô˘ ‰È·ÙÚÔÊ‹ (14), ÛÙÔȯ›· Ô˘ ·ÔÙÂÏÔ‡Ó Â›Û˘ ‚·ÛÈÎfi ¿ÍÔÓ· Ù˘ Û˘ÓÔÏÈ΋˜ ·ÓÙÈÌÂÙÒÈÛ‹˜ ÙÔ˘ (15).

™ÙË ¯ÒÚ· Ì·˜ ‰ÂÓ ¤¯ÂÈ ·ÎfiÌË ÌÂÏÂÙËı› Ë Û˘¯ÓfiÙËÙ· ÙÔ˘ ªÂÙ™˘Ó ÛÙÔÓ ·È‰ÈÎfi Î·È ÂÊË‚ÈÎfi ÏËı˘ÛÌfi, ηıÒ˜ Î·È Ë Û¯¤ÛË ÙÔ˘ Ì ÙË ‰È·ÙÚÔÊ‹. ∏ ·ÏÏ·Á‹ ÙˆÓ ‰È·ÈÙËÙÈÎÒÓ Û˘ÓËıÂÈÒÓ ÛÙȘ ÙÂÏÂ˘Ù·›Â˜ ‰ÂηÂٛ˜ Î·È ÁÂÓÈÎfiÙÂÚ· ÙÔ˘ ÙÚfiÔ˘ ˙ˆ‹˜ ÙˆÓ Û‡Á¯ÚÔÓˆÓ ∫ÚËÙÈÎÒÓ (16,17), ÙÔÓ›˙ÂÈ ÙÔ È‰È·›ÙÂÚÔ ÂӉȷʤÚÔÓ Ô˘ ¤¯ÂÈ Ë ÌÂϤÙË Ù˘ ·ÚÔ˘Û›·˜ ÙÔ˘ ªÂÙ™˘Ó Û ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ Ù˘ ∫Ú‹Ù˘ Î·È Ë Û¯¤ÛË ÙÔ˘ Ì ÙË ‰È·ÙÚÔÊ‹ ÙÔ˘˜. ™ÙËÓ ·ÚÔ‡Û· ¤Ú¢ӷ ÌÂÏÂÙ‹ıËÎÂ Ô ÂÈÔÏ·ÛÌfi˜ ÙÔ˘ ªÂÙ™˘Ó Û ‰Â›ÁÌ· ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ Ù˘ ∫Ú‹Ù˘ Î·È Ë Û¯¤ÛË ÙÔ˘ Ì ÙË ‰È·ÙÚÔÊ‹ ÙÔ˘˜, ·ÏÏ¿ Î·È Ì ¿ÏÏÔ˘˜ ·Ú¿ÁÔÓÙ˜ fiˆ˜ Â›Ó·È Ë ÛˆÌ·ÙÈ΋ ¿ÛÎËÛË, Ë Û˘ÓÔÏÈ΋ ÏÈȉ·ÈÌÈ΋ ÂÈÎfiÓ·, ÙÔ Î¿ÓÈÛÌ· (ÛÙÔ˘˜ ÂÊ‹‚Ô˘˜), ηıÒ˜ Î·È Ë Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ÛÙ· ·¯‡Û·Úη ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ∏ ÌÂϤÙË Ú·ÁÌ·ÙÔÔÈ‹ıËΠ۠·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ Ù˘ ∫Ú‹Ù˘ ηٿ Ù· ¤ÙË 2001-2003. ∞Ú¯Èο Û˘ÌÌÂÙ›¯·Ó 1381 ·È‰È¿-¤ÊË‚ÔÈ, ·fi ÙÔ˘˜ ÔÔ›Ô˘˜ 172 ·ÚÓ‹ıËÎ·Ó Ó· Û˘ÌÌÂÙ¿Û¯Ô˘Ó ÛÙȘ ۈ̷ÙÔÌÂÙÚ‹ÛÂȘ ‹ Î·È ÛÙËÓ ·ÈÌÔÏË„›·. ∆ÂÏÈο, 1209 ·È‰È¿-¤ÊË‚ÔÈ (545 ·ÁfiÚÈ· Î·È 677 ÎÔÚ›ÙÛÈ·), ËÏÈΛ·˜ 3 ¤ˆ˜ 17ó ÂÙÒÓ, ›¯·Ó Ï‹ÚË ÛÙÔȯ›· Î·È Û˘ÌÂÚÈÏ‹ÊıËÛ·Ó ÛÙȘ ·Ó·Ï‡ÛÂȘ. ∂›¯·Ó Û˘ÌÌÂÙ¿Û¯ÂÈ Û ÌÂϤÙ˜ Û˘Á¯ÚÔÓÈ΋˜ ‹ Î·È ‰È·¯ÚÔÓÈ΋˜ ·Ú·ÎÔÏÔ‡ıËÛ˘ Ù˘ ∫ÏÈÓÈ΋˜ ¶ÚÔÏËÙÈ΋˜ π·ÙÚÈ΋˜ Î·È ¢È·ÙÚÔÊ‹˜ (¶›Ó·Î·˜ 1) Î·È ÚÔ¤Ú¯ÔÓÙ·È ·fi ¤ÓÙ ‰È·ÊÔÚÂÙÈΤ˜ ÂÚÈÔ¯¤˜ ÙˆÓ ¡ÔÌÒÓ Ã·Ó›ˆÓ Î·È ∏Ú·ÎÏ›Ԣ. ∆ÔÓ π·ÓÔ˘¿ÚÈÔ ÙÔ˘ 2001, Ë ∫ÏÈÓÈ΋ ÍÂΛÓËÛ ÛÙ· Û¯ÔÏ›· Ù˘ ËÌÈÔÚÂÈÓ‹˜ ÂÚÈÔ¯‹˜ ÙÔ˘ ¢‹ÌÔ˘ ƒÔ‡‚· ∏Ú·ÎÏ›Ԣ ¶ÚfiÁÚ·ÌÌ· ¶ÚÔ·ÁˆÁ‹˜ Ù˘ ÀÁ›·˜, ·fi ÙÔ ÔÔ›Ô ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ¤¯Ô˘Ó Û˘ÌÂÚÈÏËÊı› Û˘ÓÔÏÈο 188 Ì·ıËÙ¤˜ (18). ¢Ò‰Âη ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙÔ ÓËÈ·ÁˆÁ›Ô, 108 ·fi Ù· ‰ËÌÔÙÈο Î·È 68 ·fi ÙÔ Á˘ÌÓ¿ÛÈÔ. ∞fi ÙËÓ ÙÂÏÂ˘Ù·›· ·ÍÈÔÏfiÁËÛË (2001-2002) ÂÍ·ÂÙÔ‡˜ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÂÎ·È‰Â˘ÙÈ΋˜ ·Ú¤Ì‚·Û˘, Ô˘ ¿Ú¯ÈÛ ÛÙËÓ ÚÒÙË Ù¿ÍË ÙˆÓ ‰ËÌÔÙÈÎÒÓ Û¯ÔÏ›ˆÓ Ù˘ ∫Ú‹Ù˘ ÙÔ Û¯ÔÏÈÎfi ¤ÙÔ˜ 1992-1993 (19,20), ÂÈϤ¯ıËÎ·Ó 246 Ì·ıËÙ¤˜ ·fi ÙÔ ¡ÔÌfi ÷ӛˆÓ (ÔÌ¿‰· ÂϤÁ¯Ô˘). ∆ËÓ ¿ÓÔÈÍË ÙÔ˘ 2003, Ë ∫ÏÈÓÈ΋ ÛÂ Û˘ÓÂÚÁ·Û›· Ì ÙÔÓ ¢‹ÌÔ ÃÂÚÛÔÓ‹ÛÔ˘ ¿Ú¯ÈÛ ¶ÚfiÁÚ·ÌÌ· ¶ÚÔ·ÁˆÁ‹˜ Ù˘ ÀÁ›·˜ Î·È ∞Ó¿Ù˘Í˘ ÙˆÓ ·È‰ÈÒÓ Û ÂÙ¿ ÓËÈ·ÁˆÁ›·. ∞fi ·˘Ù¿, Ô ‚ÚÂÊÔÓËÈ·Îfi˜ ÛÙ·ıÌfi˜, ÙÔ 1Ô & 2Ô ¡ËÈ·ÁˆÁÂ›Ô Î·È ÙÔ ¡ËÈ·ÁˆÁÂ›Ô ÃÂÚÛÔÓ‹ÛÔ˘ ÚÔ¤Ú¯ÔÓÙ·Ó ·fi ÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ §È̤ӷ ÃÂÚÛÔÓ‹ÛÔ˘, ÂÓÒ Â›Û˘ Û˘ÌÂÚÈÏ‹ÊıËÎ·Ó Ù· ÓËÈ·ÁˆÁ›· ∫Ô˘ÙÔ˘ÏÔ˘Ê·Ú›Ô˘, ∞Ó¿Ï˄˘ Î·È °ˆÓÈÒÓ ¶Â‰È¿‰Ô˜. ø˜ ÚÒÙË Ê¿ÛË ˘ÏÔÔ›ËÛ˘ ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ηıÔÚ›ÛÙËÎÂ Ô ¤ÏÂÁ¯Ô˜ Î·È Ë ÂÎÙ›ÌËÛË ÙÔ˘ ÂÈ¤‰Ô˘ ˘Á›·˜ ÙˆÓ ·È‰ÈÒÓ, ·fi Ù· ÔÔ›· Û˘ÌÌÂÙ›¯·Ó 89 ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË. ¶·ÚfiÌÔÈ·, ÙÔ 2002-2003, ¿Ú¯ÈÛ ¶ÚfiÁÚ·ÌÌ· ÕıÏËÛ˘ Î·È ¢È·ÙÚÔÊ‹˜ Û ۯÔÏ›· Ù˘ ÂÚÈÔ¯‹˜ ¢ÂÈÏÈÓÒÓ ÙÔ˘ ¢‹ÌÔ˘ ∏Ú·ÎÏ›Ԣ, fiÔ˘ Û˘ÌÌÂÙ›¯Â ÙÔ 30fi & 45Ô ¡ËÈ·ÁˆÁ›Ô, ÙÔ 33Ô & 45Ô ¢ËÌÔÙÈÎfi, ÙÔ ∞ıÏËÙÈÎfi 8Ô & 9Ô °˘ÌÓ¿ÛÈÔ Î·È ÙÔ 7Ô & 10Ô §‡ÎÂÈÔ. ∂›Û˘, Û˘ÌÌÂÙ›¯·Ó ÙÔ ¡ËÈ·ÁˆÁ›Ô, ¢ËÌÔÙÈÎfi Î·È °˘ÌÓ¿ÛÈÔ Î·È ÙÔ˘ ¢‹ÌÔ˘ ∆˘Ï›ÛÛÔ˘. ∏ ÚÒÙË Ê¿ÛË ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÔÏÔÎÏËÚÒıËΠÙÔ ‰È¿ÛÙËÌ· ·fi ÙÔÓ ¢ÂΤ̂ÚÈÔ 2002 ¤ˆ˜ ÙÔÓ ∞Ú›ÏÈÔ 2003. ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË Û˘ÌÌÂÙ›¯·Ó Û˘ÓÔÏÈο 686 ·È‰È¿. ¶·È‰È·ÙÚÈ΋ 2007;70:24-36

26

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¶›Ó·Î·˜ 1. ¶ÂÚÈÁÚ·ÊÈο ¯·Ú·ÎÙËÚÈÛÙÈο ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ ÌÂϤÙ˘ ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ √Ì¿‰Â˜ ÌÂϤÙ˘ ª·ıËÙ¤˜ ¢‹ÌÔ˘ ƒÔ‡‚· ª·ıËÙ¤˜ ÷ӛˆÓ ¡‹È· ¢‹ÌÔ˘ ÃÂÚÛÔÓ‹ÛÔ˘ ¡‹È· Î·È Ì·ıËÙ¤˜ ¢ÂÈÏÈÓÒÓ ∏Ú·ÎÏ›Ԣ & ¢‹ÌÔ˘ ∆˘Ï›ÛÛÔ˘ ™‡ÓÔÏÔ

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* ¶·È‰È¿ Ô˘ Û˘ÌÌÂÙ›¯·Ó ÛÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë ÌÂϤÙË Î·È ÔÛÔÛÙfi Û˘ÌÌÂÙÔ¯‹˜ ÙÔ˘˜ (ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ Ì·ıËÙÒÓ ÛÙ· Û¯ÔÏ›· ÙÔ˘˜) ** ¶·È‰È¿ Ô˘ Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË

ªÂÙÚ‹ÛÂȘ √È ÌÂÙÚ‹ÛÂȘ Î·È ÔÈ ÎÏÈÓÈΤ˜ ÂÍÂÙ¿ÛÂȘ ·ÊÔÚÔ‡Ó ÛÙËÓ Î·Ù·ÁÚ·Ê‹ Ù˘ Û˘Ó‹ıÂÈ·˜ ηÓ›ÛÌ·ÙÔ˜ (ÛÙÔ˘˜ ÂÊ‹‚Ô˘˜), ÛÙË Ì¤ÙÚËÛË ÙˆÓ ÛˆÌ·ÙÔÌÂÙÚÈÎÒÓ ÌÂÁÂıÒÓ, Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘, ÙÔ˘ ۷ί¿ÚÔ˘ ÔÚÔ‡ ·›Ì·ÙÔ˜ Î·È ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ, ÛÙËÓ ·ÍÈÔÏfiÁËÛË Ù˘ Ê˘ÛÈ΋˜ ηٿÛÙ·Û˘ Î·È ÛÙË Ï‹„Ë Î·È Î·Ù·ÁÚ·Ê‹ ‰È·ÈÙËÙÈÎÔ‡ ÈÛÙÔÚÈÎÔ‡. °È· ÙË Û˘ÌÌÂÙÔ¯‹, ÔÈ ÁÔÓ›˜ ÙˆÓ ·È‰ÈÒÓ Î·È ÙˆÓ ÂÊ‹‚ˆÓ ˘¤ÁÚ·Ê·Ó Û˘ÌʈÓËÙÈÎfi ·Ô‰Ô¯‹˜, ·ÊÔ‡ ›¯·Ó ÂÓËÌÂÚˆı› ÁÚ·ÙÒ˜ ÁÈ· ÙË ‰È·‰Èηۛ· Î·È ÙÔ Â›‰Ô˜ ÙˆÓ ÌÂÙÚ‹ÛˆÓ. ∏ ÎÏÈÓÈ΋ ÂͤٷÛË ¤ÁÈÓ ÛÙ· ÓËÈ·ÁˆÁ›· Î·È Ù· Û¯ÔÏ›·, ·ÊÔ‡ ÚÔËÁ‹ıËΠۯÂÙÈ΋ ¤ÁÎÚÈÛË ÙˆÓ ¶ÚÔÁÚ·ÌÌ¿ÙˆÓ ∞ÁˆÁ‹˜ Î·È ¶ÚÔ·ÁˆÁ‹˜ Ù˘ ÀÁ›·˜ ·fi ÙÔ ¶·È‰·ÁˆÁÈÎfi πÓÛÙÈÙÔ‡ÙÔ Î·È ÙÔ ÀÔ˘ÚÁÂ›Ô ¶·È‰Â›·˜. °È· fiϘ ÙȘ ÌÂϤÙ˜ ÚÔËÁ‹ıËÎÂ, Â›Û˘, ¤ÁÎÚÈÛË ·fi ÙËÓ ÂÈÙÚÔ‹ ∏ıÈ΋˜ Î·È ¢ÂÔÓÙÔÏÔÁ›·˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘. ∂ÚˆÙËÌ·ÙÔÏfiÁÈÔ °È· ÙË Û˘Ó‹ıÂÈ· ÙÔ˘ ηÓ›ÛÌ·ÙÔ˜ ‰fiıËΠÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ÛÙÔ˘˜ ÂÊ‹‚Ô˘˜, ÙÔ ÔÔ›Ô Û˘ÌÏ‹ÚˆÓ·Ó ÌfiÓÔÈ ÙÔ˘˜, Û‡Ìʈӷ Ì ÙȘ ··Ú·›ÙËÙ˜ Ô‰ËÁ›Â˜. À‹Ú¯·Ó ¤ÓÙ ÂÚˆÙ‹ÛÂȘ, ·ÓÔÈÎÙÔ‡ Î·È ÎÏÂÈÛÙÔ‡ Ù‡Ô˘, ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË Ù˘ ·ÍÈÔÈÛÙ›·˜ ÙˆÓ ··ÓÙ‹ÛÂˆÓ (21). ø˜ ηÓÈÛÙ¤˜ ıˆڋıËÎ·Ó fiÛÔÈ Î¿ÓÈ˙·Ó ÂÚÈÛÛfiÙÂÚÔ ·fi ¤Ó· ÙÛÈÁ¿ÚÔ ÙËÓ Ë̤ڷ, ÁÈ· ‰È¿ÛÙËÌ· ÌÂÁ·Ï‡ÙÂÚÔ ÙˆÓ ÙÚÈÒÓ Û˘Ó¯fiÌÂÓˆÓ ÌËÓÒÓ. ™ˆÌ·ÙÔÌÂÙÚ‹ÛÂȘ ™Â 1209 ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ ÌÂÙÚ‹ıËΠÙÔ ‚¿ÚÔ˜, ÙÔ ‡„Ô˜ (Û ‡ÙÈ· ı¤ÛË ÁÈ· ·È‰È¿ ËÏÈΛ·˜ <6 ÂÙÒÓ) Î·È Ë ÂÚ›ÌÂÙÚÔ˜ ̤Û˘ Î·È ÏÂοÓ˘, ÂÓÒ ÂÎÙÈÌ‹ıËÎ·Ó ÔÈ ‰Â›ÎÙ˜ ÂÚÈ̤ÙÚÔ˘ ̤Û˘ ÚÔ˜ ÏÂοÓË, ÂÚÈ̤ÙÚÔ˘ ̤Û˘ ÚÔ˜ ‡„Ô˜ Î·È Ô ¢Â›ÎÙ˘ ª¿˙·˜ ™ÒÌ·ÙÔ˜ (¢ª™) ˆ˜ ÎÈÏ¿ ÚÔ˜ ÙÔ ‡„Ô˜ Û ̤ÙÚ· ÛÙÔ ÙÂÙÚ¿ÁˆÓÔ (kg/m2). ¶Ï‹Ú˘ ÂÚÈÁÚ·Ê‹ ÙˆÓ ÌÂıfi‰ˆÓ ̤ÙÚËÛ˘ ·Ó·Ê¤ÚÂÙ·È Û ÚÔËÁÔ‡ÌÂÓ˜ ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ÌÂϤÙ˜ (19,22). °È· ÙÔÓ Î·ıÔÚÈÛÌfi ÙˆÓ ˘¤Ú‚·ÚˆÓ Î·È ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ, ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ô ‰È·¯ˆÚÈÛÌfi˜ ÙÔ˘ ¢ª™, Ô˘ ·ÓÙÈÛÙÔȯ› Û fiÚÈ· ≤25 kg/m2, 25,1 kg/m2 ¤ˆ˜ 30 kg/m2 Î·È ≥30 kg/m2 (23). ª¤ÙÚËÛË ·ÚÙËÚȷ΋˜ ›ÂÛ˘ ·›Ì·ÙÔ˜ ∏ ·ÚÙËÚȷ΋ ›ÂÛË ÌÂÙÚ‹ıËΠ۠1209 ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜, Û ηıÈÛÙ‹ ı¤ÛË Î·È ÌÂÙ¿ ·fi ·Ó¿·˘ÛË 5-10 ÏÂÙÒÓ, Ì ˘‰Ú·ÚÁ˘ÚÈÎfi ÛÊ˘ÁÌÔÌ·ÓfiÌÂÙÚÔ Î·Ù¿ÏÏËÏÔ Û ̤ÁÂıÔ˜ ÂÚȯÂÈÚ›‰Ô˜, ηχÙÔÓÙ·˜ ÙÔ 50-75% Ù˘ ÂÚÈ̤ÙÚÔ˘ ÙÔ˘ ‰ÂÍÈÔ‡ ‚Ú·¯›ÔÓ·. O ÚÒÙÔ˜ Î·È ¤ÌÙÔ˜ ÙfiÓÔ˜ Korotkoff Paediatriki 2007;70:24-36

·ÔÙ¤ÏÂÛ·Ó, ·ÓÙÈÛÙÔ›¯ˆ˜, ÙË Û˘ÛÙÔÏÈ΋ Î·È ‰È·ÛÙÔÏÈ΋ ·ÚÙËÚȷ΋ ›ÂÛË, Ô˘ ÌÂÙÚ‹ıËÎ·Ó ÙÚÂȘ ÊÔÚ¤˜ Ì ÌÂÛԉȿÛÙËÌ· 1-2 ÏÂÙÒÓ Î·È ÂÏ‹ÊıË Ô Ì¤ÛÔ˜ fiÚÔ˜ ÙˆÓ ÌÂÙÚ‹ÛÂˆÓ (ÚˆÙfiÎÔÏÏÔ MONICA) (18). §‹„Ë ·›Ì·ÙÔ˜ Î·È ‚ÈÔ¯ËÌÈΤ˜ ·Ó·Ï‡ÛÂȘ ∞ÈÌÔÏË„›· Ú·ÁÌ·ÙÔÔÈ‹ıËΠ۠1209 ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ ÙȘ ÚÒÙ˜ ÚˆÈÓ¤˜ ÒÚ˜, Û ‡ÙÈ· ı¤ÛË, ÌÂÙ¿ ·fi 12ˆÚË ÓËÛÙ›·. ∂Ï‹ÊıËÛ·Ó ‰Â›ÁÌ·Ù· ÙˆÓ 10 ml Û ۈÏËÓ¿ÚÈ· ¯ˆÚ›˜ ·ÓÙÈËÎÙÈÎfi ÁÈ· ÙÔÓ ‰È·¯ˆÚÈÛÌfi ÙÔ˘ ÔÚÔ‡ Î·È ÙÔÔıÂÙ‹ıËÎ·Ó Û ÊÔÚËÙfi „˘ÁÂ›Ô Ì ·ÁÔ·ÛÙ˜, ÒÛÙ ӷ ‰È·ÙËÚËıÔ‡Ó Û ıÂÚÌÔÎÚ·Û›· 3-4ÔC. ªÂٷʤÚıËÎ·Ó ÂÓÙfi˜ 2-4 ˆÚÒÓ ÛÙ· ÂÚÁ·ÛÙ‹ÚÈ· Ù˘ ∫ÏÈÓÈ΋˜ Î·È ·Ì¤Ûˆ˜ Ê˘ÁÔÎÂÓÙÚ‹ıËÎ·Ó Û 4000 rpm ÁÈ· 15 ÏÂÙ¿, ÂÓÒ Û Ï·ÛÙÈο ÛˆÏËÓ¿ÚÈ· Eppendorf ‰È·¯ˆÚ›ÛÙËÎÂ Ô ÔÚfi˜. ¶ÂÚÈÛÛfiÙÂÚ˜ ÏÂÙÔ̤ÚÂȘ ÁÈ· ÙÔÓ ˘ÔÏÔÁÈÛÌfi ÙÔ˘ ۷ί¿ÚÔ˘ Î·È ÙˆÓ ‚ÈÔ¯ËÌÈÎÒÓ ‰ÂÈÎÙÒÓ (ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË, ÙÚÈÁÏ˘ÎÂÚȉ›·, HDL-C, LDL-C) Î·È ÙˆÓ ·ıËڈ̷ÙÈÎÒÓ ‰ÂÈÎÙÒÓ (ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË ÚÔ˜ HDL-C Î·È LDL-C ÚÔ˜ HDL-C) ·Ó·Ê¤ÚÔÓÙ·È Û ¿ÏϘ ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ÌÂϤÙ˜ (18-22). ŒÏÂÁ¯Ô˜ Ê˘ÛÈ΋˜ ηٿÛÙ·Û˘ ∏ Ê˘ÛÈ΋ ηٿÛÙ·ÛË Î·È Ë Î·Ú‰ÈÔ·Ó·Ó¢ÛÙÈ΋ ·ÓÙÔ¯‹ ÂϤÁ¯ıËÎ·Ó Û 433 ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ Ì ÙÔ ·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜ (20). ∆· ·È‰È¿ Î·È ÔÈ ¤ÊË‚ÔÈ Û¯ËÌ¿ÙÈ˙·Ó ÔÌ¿‰Â˜ ÙˆÓ 5 ·ÙfiÌˆÓ Î·È Î·ÏÔ‡ÓÙ·Ó Ó· ‰È·Ó‡ÛÔ˘Ó Ì›· ·fiÛÙ·ÛË 20 ̤ÙÚˆÓ ÌÂٷ͇ ‰‡Ô ÁÚ·ÌÌÒÓ, fiÛÔ ÙÔ ‰˘Ó·ÙfiÓ ÈÔ ÔÏϤ˜ ÊÔÚ¤˜. √ Ú˘ıÌfi˜ ÁÈ· ÙËÓ Ù·¯‡ÙËÙ· ‰ÈÓfiÙ·Ó ·fi ¤Ó· Ì·ÁÓËÙÔʈÓË̤ÓÔ Ë¯ËÙÈÎfi Û‹Ì·, ÙÔ˘ ÔÔ›Ô˘ Ô Ú˘ıÌfi˜ ÛÙ·‰È·Î¿ ·˘Í·ÓfiÙ·Ó. ∏ Û˘ÌÏ‹ÚˆÛË Û˘ÁÎÂÎÚÈ̤ÓÔ˘ ·ÚÈıÌÔ‡ ‰È·‰ÚÔÌÒÓ ·ÓÙÈÛÙÔȯԇÛ Û ¤Ó· ÛÙ¿‰ÈÔ. ø˜ ÙÂÏÈ΋ ‚·ıÌÔÏÔÁ›· ηٷÁÚ¿ÊËÎ·Ó Ù· ÛÙ¿‰È· Ô˘ ηٿÊÂÚ·Ó Ó· ‰È·Ó‡ÛÔ˘Ó Ù· ·È‰È¿-¤ÊË‚ÔÈ Û˘Ó¯fiÌÂÓ· Î·È Ì¤Û· ÛÙÔÓ Ú˘ıÌfi Ô˘ Â¤‚·Ï ÙÔ Ë¯ËÙÈÎfi Û‹Ì·. ¢È·ÈÙËÙÈÎfi ÈÛÙÔÚÈÎfi ∏ Ï‹„Ë ‰È·ÈÙËÙÈÎÔ‡ ÈÛÙÔÚÈÎÔ‡ ÙÂÏÂ˘Ù·›Ô˘ 24ÒÚÔ˘ ¤ÁÈÓ ÌÂ Û˘Ó¤ÓÙ¢ÍË ·fi ‰È·ÈÙÔÏfiÁÔ Û 1124 ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜. ∫·Ù¿ ÙË ‰È·‰Èηۛ· ÙˆÓ Û˘ÓÂÓه͈Ó, ÁÈ· ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi Ù˘ ÔÛfiÙËÙ·˜ ηٷӿψÛ˘ ÙÚÔÊ›ÌˆÓ (Û ÁÚ·ÌÌ¿ÚÈ·), ·ÚÔ˘ÛÈ¿˙ÔÓÙ·Ó ÌÔÓ٤Ϸ ÙÚÔʛ̈Ó, ÂÓÒ ÁÈ· Ù· ·È‰È¿ ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ 8 ÂÙÒÓ, Ë Ï‹„Ë ÙÔ˘ ÈÛÙÔÚÈÎÔ‡ ¤ÁÈÓÂ Î·È Ì ÙË Û˘ÓÂÚÁ·Û›· ÙˆÓ ÁÔÓ¤ˆÓ. ∏ ·Ó¿Ï˘ÛË ÙˆÓ ‰È·ÈÙÔÏÔÁ›ˆÓ ¤ÁÈÓ ·fi ÙËÓ ∏ÏÂÎÙÚÔÓÈ΋ µ¿ÛË ∆ÚÔÊ›ÌˆÓ Ù˘ ∫ÏÈÓÈ΋˜ (24).

27

ªÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ Û ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜

°È· ÙËÓ ·ÍÈÔÏfiÁËÛË Ù˘ ‰È·ÙÚÔÊ‹˜, ˘ÔÏÔÁ›ÛÙËÎ·Ó Ù· ÚÔÛÏ·Ì‚·ÓfiÌÂÓ· ıÚÂÙÈο Û˘ÛÙ·ÙÈο, ηıÒ˜ Î·È 16 ÔÌ¿‰Â˜ ηٷӿψÛ˘ ÙÚÔʛ̈Ó. ∂›Û˘, ÂÎÙÈÌ‹ıËÎ·Ó Ô ¢Â›ÎÙ˘ ÀÁÈÂÈÓ‹˜ ¢È·ÙÚÔÊ‹˜ (¢À¢) (25,26) Î·È Ù· ÔÛÔÛÙ¿ ·ÓÂ·ÚÎÔ‡˜ ıÚ¤„˘ ·fi ÙȘ ËÌÂÚ‹ÛȘ Û˘ÓÈÛÙÒÌÂÓ˜ ÔÛfiÙËÙ˜ (∏™¶) ÚfiÛÏ˄˘ ıÚÂÙÈÎÒÓ Û˘ÛÙ·ÙÈÎÒÓ. √ ¢À¢ (¶›Ó·Î·˜ 2) ·ÔÙÂÏ› ̤ıÔ‰Ô ÔÈÔÙÈ΋˜ ·ÍÈÔÏfiÁËÛ˘ Ù˘ ËÌÂÚ‹ÛÈ·˜ ‰È·ÙÚÔÊ‹˜ ·ÙfiÌˆÓ ËÏÈΛ·˜ ¿Óˆ ÙˆÓ 2 ÂÙÒÓ Î·È ÂÎÙÈÌ¿Ù·È ·fi ‰È·ÈÙÔÏfiÁÈÔ Î·Ù·ÁÚ·Ê‹˜ ÙÂÏÂ˘Ù·›Ô˘ 24ÒÚÔ˘ (25,26). Œ¯ÂÈ Û¯Â‰È·ÛÙ› ·fi ÙÔ USDA Ì ‚¿ÛË ÙȘ ‰È·ÈÙËÙÈΤ˜ Ô‰ËÁ›Â˜ Ô˘ ·¢ı‡ÓÔÓÙ·È ÚÔ˜ ÙÔ˘˜ ∞ÌÂÚÈηÓÔ‡˜ (27), ÂÊ·ÚÌfi˙ÂÙ·È fï˜ Î·È Û ÌÂÛÔÁÂÈ·ÎÔ‡˜ ÏËı˘ÛÌÔ‡˜ (28) Î·È ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙ› Ì ÙÔ˘˜ ‚ÈÔÏÔÁÈÎÔ‡˜ ‰Â›ÎÙ˜ ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ Î·È ÙËÓ ·¯˘Û·ÚΛ· (29,30). √ ¢À¢ ·ÔÙÂÏ› ‰È·‚¿ıÌÈÛË ‚·ıÌÔÏÔÁ›·˜ Û Îϛ̷η Ì ¯Â›ÚÈÛÙË ÙÈÌ‹ 0 Î·È ¿ÚÈÛÙË 100. ∆È̤˜ <51 ·ÍÈÔÏÔÁÔ‡Ó ÙË ‰È·ÙÚÔÊ‹ ˆ˜ “·ÓÂ·Ú΋”, 51-80 ‰ËÏÒÓÔ˘Ó fiÙÈ “¯ÚÂÈ¿˙ÂÙ·È ‚ÂÏÙ›ˆÛË” Î·È ÙÈ̤˜ 81100 ¯·Ú·ÎÙËÚ›˙Ô˘Ó ÙË ‰È·ÙÚÔÊ‹ ˆ˜ “ηϋ”. ∏ ‚·ıÌÔÏÔÁ›· ÚÔ·ÙÂÈ ·fi ÙÔ ¿ıÚÔÈÛÌ· ‰¤Î· Û˘ÓÈÛÙˆÛÒÓ, ÔÈ Ôԛ˜ ¯ˆÚ›˙ÔÓÙ·È Û ÙÚÂȘ ·ÚȘ ÔÌ¿‰Â˜ Î·È ÂÓ¤¯Ô˘Ó ‰È·‚·ıÌÈṲ̂ÓË ‚·ıÌÔÏÔÁ›· Ì ¯Â›ÚÈÛÙË ÙÈÌ‹ 0 Î·È ¿ÚÈÛÙË 10. ∏ ÚÒÙË Î‡ÚÈ· ÔÌ¿‰· ·ÊÔÚ¿ ÛÙËÓ Î·Ù·Ó¿ÏˆÛË ÙÚÔÊ›ÌˆÓ Î·È ÂÚÈÏ·Ì‚¿ÓÂÈ ÙȘ Û˘ÓÈÛÙÒÛ˜: ‰ËÌËÙÚȷο („ˆÌ›, Ú‡˙È, ‰ËÌËÙÚȷο, ˙˘Ì·ÚÈο), Ï·¯·ÓÈο, ÊÚÔ‡Ù·, Á·Ï·ÎÙÔÎÔÌÈο (Á¿Ï·, ÁÈ·Ô‡ÚÙÈ, Ù˘Ú›) Î·È ÎÚ¤·˜ (ÎÚ¤·˜, Ô˘ÏÂÚÈο, ÍËÚ¿ Ê·ÛfiÏÈ·, „¿ÚÈ, ·˘Á¿, ÍËÚÔ› ηÚÔ›). ∏ ‰Â‡ÙÂÚË ·ÊÔÚ¿ ÛÙËÓ ÚfiÛÏË„Ë ıÚÂÙÈÎÒÓ Û˘ÛÙ·ÙÈÎÒÓ Î·È ÂÚÈÏ·Ì‚¿ÓÂÈ ÙȘ Û˘ÓÈÛÙÒÛ˜: ÔÏÈÎfi Î·È ÎÔÚÂṲ̂ÓÔ Ï›Ô˜ ˆ˜ ÔÛÔÛÙ¿ ÂÓ¤ÚÁÂÈ·˜, ¯ÔÏËÛÙÂÚfiÏË ÙÚÔÊ‹˜ Î·È Ó¿ÙÚÈÔ. ∆¤ÏÔ˜, Ë ÙÚ›ÙË ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ Î·Ù·Ó¿ÏˆÛË ÔÈÎÈÏ›·˜ ÙÚÔÊ›ÌˆÓ Î·È ˘ÔÏÔÁ›˙ÂÙ·È ·fi ‰È·ÊÔÚÂÙÈο ˆ˜ ÚÔ˜ ÙÔ Â›‰Ô˜ ÙÔ˘˜ ÙÚfiÊÈÌ·. ∏ ·fi‰ÔÛË ‚·ıÌÔÏÔÁ›·˜ ·fi 0 ¤ˆ˜ 10 ‰È·Ê¤ÚÂÈ Û οı ̛· Û˘ÓÈÛÙÒÛ· Î·È Â›Ó·È ·Ó¿ÏÔÁË ÙˆÓ ÌÂÚ›‰ˆÓ, Ô˘ ˘ÔÏÔÁ›˙ÔÓÙ·È Û ÁÚ·ÌÌ¿ÚÈ·, ÙˆÓ ÔÚ›ˆÓ ÚfiÛÏ˄˘ ıÚÂÙÈÎÒÓ Û˘ÛÙ·ÙÈÎÒÓ Î·È ÙÔ˘ ·ÚÈıÌÔ‡ ηٷӿψÛ˘ ‰È·ÊÔÚÂÙÈÎÒÓ ÙÚÔÊ›ÌˆÓ ÛÙȘ ÙÚÂȘ ·ÚȘ ÔÌ¿‰Â˜, ·ÓÙÈÛÙÔ›¯ˆ˜. ¶ÈÔ Û˘ÁÎÂÎÚÈ̤ӷ, ÛÙËÓ ÚÒÙË Î‡ÚÈ· ÔÌ¿‰·, Ë ¯Â›ÚÈÛÙË ÙÈÌ‹ 0 ·Ô‰›‰ÂÙ·È ÛÙË ÌˉÂÓÈ΋ ηٷӿψÛË ÌÂÚ›‰ˆÓ. ∆Ô ¿ÚÈÛÙ· 10, ·ÓÙÈÛÙÔȯ› Û ηٷӿψÛË 6-11 ÌÂÚ›‰ˆÓ ‰ËÌËÙÚÈ·ÎÒÓ, 3-5 Ï·¯·ÓÈÎÒÓ, 2-4 ÊÚÔ‡ÙˆÓ, 2-3 Á·Ï·ÎÙÔÎÔÌÈÎÒÓ Î·È 2-3 ÎÚ¤·ÙÔ˜. √È ÌÂÚ›‰Â˜ ·˘Ù¤˜ ηıÔÚ›˙ÔÓÙ·È Î·È Â›Ó·È ·Ó¿ÏÔÁ˜ ·fi ÙËÓ Î·Ù¿ ʇÏÔ Î·È ËÏÈΛ· ËÌÂÚ‹ÛÈ· Û˘ÓÈÛÙÒÌÂÓË ÂÓ¤ÚÁÂÈ· Î·È Î·Ù·Ó¿ÏˆÛË ÙÚÔÊ›ÌˆÓ (¶›Ó·Î·˜ 2) (25). ™ÙË ‰Â‡ÙÂÚË Î‡ÚÈ· ÔÌ¿‰·, ¯Â›ÚÈÛÙË ÙÈÌ‹ 0 ·Ô‰›‰ÂÙ·È ÛÙËÓ ÚfiÛÏË„Ë ÔÏÈÎÔ‡ Ï›Ô˘˜ ≥45% Ù˘ ÚÔÛÏ·Ì‚·ÓfiÌÂÓ˘ ÂÓ¤ÚÁÂÈ·˜, ÎÔÚÂṲ̂ÓÔ˘ Ï›Ô˘˜ ≥15%, ¯ÔÏËÛÙÂÚfiÏ˘ ÙÚÔÊ‹˜ ≥450 mg Î·È Ó·ÙÚ›Ô˘ ≥4800 mg. ÕÚÈÛÙ· 10 ·Ô‰›‰ÂÙ·È ÛÙËÓ ÚfiÛÏË„Ë ÔÏÈÎÔ‡ Ï›Ô˘˜ ≤30% Ù˘ ÂÓ¤ÚÁÂÈ·˜, ÎÔÚÂṲ̂ÓÔ˘ Ï›Ô˘˜ <10%, ¯ÔÏËÛÙÂÚfiÏ˘ ÙÚÔÊ‹˜ ≤300 mg Î·È Ó·ÙÚ›Ô˘ ≤2400 mg. ∆¤ÏÔ˜, ÛÙËÓ ÙÚ›ÙË Î‡ÚÈ· ÔÌ¿‰·, ¯Â›ÚÈÛÙË ÙÈÌ‹ 0 ·Ô‰›‰ÂÙ·È fiÙ·Ó Ë Î·Ù·Ó¿ÏˆÛË ‰ÂÓ ˘ÂÚ‚·›ÓÂÈ Ù· ÙÚ›· ‰È·ÊÔÚÂÙÈο ›‰Ë ÙÚÔʛ̈Ó, ÂÓÒ ¿ÚÈÛÙË 10 fiÙ·Ó Ë Î·Ù·Ó¿ÏˆÛË Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË ‹ ›ÛË ÙˆÓ 8 ‰È·ÊÔÚÂÙÈÎÒÓ ÙÚÔʛ̈Ó. ∫·È ÛÙȘ ‰¤Î· Û˘ÓÈÛÙÒÛ˜ ÙÔ˘ ¢À¢, Ë ‚·ıÌÔÏÔÁ›· ÁÈ· ÙȘ ÂӉȿÌÂÛ˜ ÙÈ̤˜ Ù˘ ¯Â›ÚÈÛÙ˘ Î·È Ù˘ ¿ÚÈÛÙ˘ ˘ÔÏÔÁ›˙ÂÙ·È ·Ó·ÏÔÁÈο. ∆¤ÏÔ˜, ·fi ÙȘ ∏™¶ ÚfiÛÏ˄˘ ÙˆÓ ıÚÂÙÈÎÒÓ Û˘ÛÙ·ÙÈÎÒÓ (31), ˘ÔÏÔÁ›ÛÙËηÓ, ·Ó¿ ʇÏÔ Î·È ËÏÈΛ·, Ù· fiÚÈ· ÙÔ˘ 67%, Ô˘ ηıÔÚ›˙Ô˘Ó ÙËÓ ·ÓÂ·Ú΋ ıÚ¤„Ë. ŸÚÈ· ·Ú·ÁfiÓÙˆÓ ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó fiÚÈ· ÙˆÓ ·-

Ú·ÁfiÓÙˆÓ ªÂÙ™˘Ó Ô˘ ηıÔÚ›˙ÔÓÙ·È ·fi ÙÔ Ê‡ÏÔ Î·È ÙËÓ ËÏÈΛ· (2,32). ∆· fiÚÈ· ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ Î·È Ù˘ ÂÚÈ̤ÙÚÔ˘ ̤Û˘ ·ÊÔÚÔ‡Ó ÙËÓ 90‹ ÂηÙÔÛÙÈ·›· ı¤ÛË Î·È ÙË 10Ë ÁÈ· ÙËÓ HDL-C (32). ∂›Û˘, ÂÂȉ‹ Ë Û˘ÛÙÔÏÈ΋ Î·È ‰È·ÛÙÔÏÈ΋ ·ÚÙËÚȷ΋ ›ÂÛË Û˘ÓÂÎÙÈÌÒÓÙ·È ˆ˜ ¤Ó·˜ ÎÔÈÓfi˜ ·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘, ˆ˜ ·ıÔÏÔÁÈ΋ ıˆڋıËÎÂ Ë ˘¤Ú‚·ÛË ÙÔ˘ ÔÚ›Ô˘, ›Ù Ù˘ Û˘ÛÙÔÏÈ΋˜ ›Ù Ù˘ ‰È·ÛÙÔÏÈ΋˜. ∆· fiÚÈ· ·˘Ù¿ ·ÊÔÚÔ‡Û·Ó ÛÙËÓ ÂÈÏÔÁ‹ Ù˘ 90‹˜ ÂηÙÔÛÙÈ·›·˜ ı¤Û˘ Ô˘ ·ÓÙÈÛÙÔȯ› ÛÙËÓ 50‹ ÂηÙÔÛÙÈ·›· ı¤ÛË ÙÔ˘ ·Ó·ÛÙ‹Ì·ÙÔ˜ (2,33). ∆¤ÏÔ˜, ˆ˜ fiÚÈÔ ÁÈ· ÙÔ Û¿Î¯·ÚÔ ÔÚÔ‡ ·›Ì·ÙÔ˜ ηıÔÚ›ÛÙËÎ·Ó Ù· 100 mg/dl (2). ™Ù·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË °È· ÙË ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ¯ÚËÛÈÌÔÔÈ‹ıËΠÙÔ ÚfiÁÚ·ÌÌ· SPSS 12.0. ÃÚËÛÈÌÔÔÈ‹ıËÎ·Ó Ì¤ıÔ‰ÔÈ ·Ó¿Ï˘Û˘ Û ÛÙڈ̷ÙÔÔÈË̤ӷ ‰Â‰Ô̤ӷ, ÂϤÁ¯ÔÓÙ·˜ Î·È ÁÈ· ÙËÓ Â›‰Ú·ÛË Û˘Á¯˘ÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ (34), ηıÒ˜ ÙÔ ‰Â›ÁÌ· ÌÂϤÙ˘ ‰È·¯ˆÚ›ÛÙËΠ۠ÔÌ¿‰Â˜ ËÏÈÎÈÒÓ, fiˆ˜ 3-6, 6ó-10, 10ó-14 Î·È 14ó-17ó ÂÙÒÓ. ªÂ ÙÔÓ ¤ÏÂÁ¯Ô χ2 (Chi-square test) ÂϤÁ¯ıËÎÂ Ë ‡·ÚÍË ‰È·ÊÔÚ¿˜ ÛÙËÓ Î·Ù·ÓÔÌ‹ ÙÔ˘ ·ÚÈıÌÔ‡ Û˘ÁΤÓÙÚˆÛ˘ ·Ú·ÁfiÓÙˆÓ ªÂÙ™˘Ó ˆ˜ ÚÔ˜ ÙÔ Ê‡ÏÔ Î·È ÙȘ ∏™¶ ÚfiÛÏ˄˘ ıÚÂÙÈÎÒÓ Û˘ÛÙ·ÙÈÎÒÓ, ηıÒ˜ Î·È Ë ‡·ÚÍË ÁÚ·ÌÌÈ΋˜ Ù¿Û˘ (linear trend) ˆ˜ ÚÔ˜ ÙȘ ÔÌ¿‰Â˜ ËÏÈÎÈÒÓ Î·È ÙÔÓ ·ÚÈıÌfi Û˘ÁΤÓÙÚˆÛ˘ ·Ú·ÁfiÓÙˆÓ ªÂÙ™˘Ó. ªÂ ÙÔÓ ¤ÏÂÁ¯Ô Student t (equal variances not assumed) ÂϤÁ¯ıËÎÂ Ë ‰È·ÊÔÚÔÔ›ËÛË Ù˘ ‚·ıÌÔÏÔÁ›·˜ ÙˆÓ Û˘ÓÈÛÙˆÛÒÓ Î·È ÙÔ˘ ¢À¢ ÛÙ· ‰‡Ô ʇϷ ÌÂٷ͇ ÙˆÓ ËÏÈÎÈÒÓ 3-6 Î·È 14ó-17ó ÂÙÒÓ. ¶·ÚÔÌÔ›ˆ˜, Ì ÙÔÓ ¤ÏÂÁ¯Ô Mann-Whitney ¤ÁÈÓ ۇÁÎÚÈÛË Ù˘ ηٷӿψÛ˘ ÙÚÔÊ›ÌˆÓ ÌÂٷ͇ ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ ¯ˆÚ›˜ ·Ú¿ÁÔÓÙ˜ ªÂÙ™˘Ó Î·È ÂÎÂ›ÓˆÓ Ì ªÂÙ™˘Ó. ªÂ ÙË Ì¤ıÔ‰Ô ·Ó¿Ï˘Û˘ Û˘Ó‰È·Î‡Ì·ÓÛ˘ (ANCOVA) ÂÎÙÈÌ‹ıËÎÂ Ë ‡·ÚÍË ÁÚ·ÌÌÈ΋˜ Ù¿Û˘ (linear trend) ÛÙËÓ ÚfiÛÏË„Ë ıÚÂÙÈÎÒÓ Û˘ÛÙ·ÙÈÎÒÓ Î·È ÛÙË ‚·ıÌÔÏÔÁ›· ÙÔ˘ ¢À¢ Î·È ÙˆÓ Û˘ÓÈÛÙˆÛÒÓ ÙÔ˘, ˆ˜ ÚÔ˜ ÙÔÓ ·ÚÈıÌfi Û˘ÁΤÓÙÚˆÛ˘ ·Ú·ÁfiÓÙˆÓ ªÂÙ™˘Ó. ø˜ Û˘ÌÌÂÙ·‚ÏËÙ¤˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÙÔ Ê‡ÏÔ, Ë ËÏÈΛ· Î·È Ô ¢ª™, ÂÓÒ Ë ÂÙÂÚÔÁ¤ÓÂÈ· ÂϤÁ¯ıËΠ̠ÙË Ì¤ıÔ‰Ô Levene (Levene’s test). ∆¤ÏÔ˜, ÁÈ· ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ Ì ªÂÙ™˘Ó, ÂÎÙÈÌ‹ıËÎ·Ó Ì ÙË Ì¤ıÔ‰Ô ·Ó¿Ï˘Û˘ ÏÔÁÈÛÙÈ΋˜ ·ÏÈÓ‰ÚfiÌËÛ˘ (Logistic linear regression), ÔÈ ÏfiÁÔÈ Û˘ÌÏËڈ̷ÙÈÎÒÓ Èı·ÓÔÙ‹ÙˆÓ ‹ Û¯ÂÙÈÎÔ› ΛӉ˘ÓÔÈ (Odds Ratio) Î·È Ù· 95% ¢È·ÛÙ‹Ì·Ù· ∂ÌÈÛÙÔÛ‡Ó˘. ∏ ÂÎÙ›ÌËÛË ÔÚ›ÛÙËΠˆ˜ ÚÔ˜ ÂΛӷ Ù· ·È‰È¿ Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜ Ô˘ ‰ÂÓ ¤¯Ô˘Ó ·Ú¿ÁÔÓÙ˜ ªÂÙ™˘Ó, ÂÓÒ ˆ˜ Û˘ÌÌÂÙ·‚ÏËÙ¤˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÙÔ Ê‡ÏÔ Î·È Ë ËÏÈΛ·. ø˜ ÛÙ·ÙÈÛÙÈÎÒ˜ ÌË ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ (ª™) ÔÚ›ÛÙËÎ·Ó Ù· Â›‰· Ì p>0,05.

∞ÔÙÂϤÛÌ·Ù· Ÿˆ˜ Ê·›ÓÂÙ·È ÛÙÔÓ ¶›Ó·Î· 3, ÛÙË Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ·Ú·ÁfiÓÙˆÓ ªÂÙ™˘Ó ‰ÂÓ ‚Ú¤ıËΠÛÙ· ·ÁfiÚÈ· ÛËÌ·ÓÙÈ΋ Ù¿ÛË ·‡ÍËÛ˘ ·Ó¿ÏÔÁ· Ì ÙËÓ ËÏÈΛ·. ªÂ ªÂÙ™˘Ó ‚Ú¤ıËΠÔÛÔÛÙfi 2,5% ÛÙȘ ËÏÈ˘ 3-6 ÂÙÒÓ Î·È 4,6% ÛÙȘ ËÏÈ˘ 14ó-17ó ÂÙÒÓ, ÂÓÒ ÛÙ· ÎÔÚ›ÙÛÈ· ‹Ù·Ó 2,9% Î·È 3%, ·ÓÙ›ÛÙÔȯ·. ™Ù· ÎÔÚ›ÙÛÈ·, ˆÛÙfiÛÔ, ‹Ù·Ó ÛËÌ·ÓÙÈ΋ Ë ‰È·ÊÔÚÔÔ›ËÛË ÛÙËÓ Î·Ù·ÓÔÌ‹ ÙÔ˘˜ ÛÙȘ ÔÌ¿‰Â˜ ËÏÈÎÈÒÓ ˆ˜ ÚÔ˜ ÙË Û˘¯ÓfiÙËÙ· ÙˆÓ ·Ú·ÁfiÓÙˆÓ ªÂÙ™˘Ó (p<0,05). ¶·È‰È·ÙÚÈ΋ 2007;70:24-36

28

ª. §ÈÓ·Ú‰¿Î˘ Î·È Û˘Ó.

¶›Ó·Î·˜ 2. ∫ÚÈÙ‹ÚÈ· Î·È ‚·ıÌÔÏfiÁËÛË Û˘ÓÈÛÙˆÛÒÓ ÙÔ˘ ¢Â›ÎÙË ÀÁÈÂÈÓ‹˜ ¢È·ÙÚÔÊ‹˜ (25) ∫ÚÈÙ‹ÚÈ· ‚·ıÌÔÏfiÁËÛ˘ ∂Ï¿¯ÈÛÙË (Ìˉ¤Ó) ª¤ÁÈÛÙË (‰¤Î·) 1. √Ì¿‰· ‰ËÌËÙÚÈ·ÎÒÓ („ˆÌ›, Ú‡˙È, ‰ËÌËÙÚȷο, ˙˘Ì·ÚÈο) 2. §·¯·ÓÈο 3. ºÚÔ‡Ù· 4. √Ì¿‰· Á·Ï·ÎÙÔÎÔÌÈÎÒÓ (Á¿Ï·, ÁÈ·Ô‡ÚÙÈ, Ù˘Ú›) 5. √Ì¿‰· ÎÚ¤·ÙÔ˜ (ÎÚ¤·˜, Ô˘ÏÂÚÈο, ÍËÚ¿ Ê·ÛfiÏÈ·, „¿ÚÈ, ·˘Á¿, ÍËÚÔ› ηÚÔ›) 6. √ÏÈÎfi Ï›Ô˜ (% ÂÓ¤ÚÁÂÈ·˜) 7. ∫ÔÚÂṲ̂ÓÔ Ï›Ô˜ (% ÂÓ¤ÚÁÂÈ·˜) 8. ÃÔÏËÛÙÂÚfiÏË ÙÚÔÊ‹˜ 9. ¡¿ÙÚÈÔ 10. ¶ÔÈÎÈÏ›· ÙÚÔʛ̈Ó

0 ÌÂÚ›‰Â˜

6-11 ÌÂÚ›‰Â˜

0 ÌÂÚ›‰Â˜ 0 ÌÂÚ›‰Â˜ 0 ÌÂÚ›‰Â˜

3-5 ÌÂÚ›‰Â˜ 2-4 ÌÂÚ›‰Â˜ 2-3 ÌÂÚ›‰Â˜

0 ÌÂÚ›‰Â˜

2-3 ÌÂÚ›‰Â˜

≥45% Ù˘ ÂÓ¤ÚÁÂÈ·˜

≤30% Ù˘ ÂÓ¤ÚÁÂÈ·˜

≥15% Ù˘ ÂÓ¤ÚÁÂÈ·˜

<10% Ù˘ ÂÓ¤ÚÁÂÈ·˜

≥450 mg ≥4800 mg ≤3 ‰È·ÊÔÚÂÙÈο ›‰Ë ÙÚÔʛ̈Ó

≤300 mg ≤2400 mg ≥8 ‰È·ÊÔÚÂÙÈο ›‰Ë ÙÚÔʛ̈Ó

[

™˘ÓÈÛÙÒÌÂÓË ÂÓ¤ÚÁÂÈ· & Û˘ÓÈÛÙÒÌÂÓ˜ ÌÂÚ›‰Â˜ ÙÚÔÊ›ÌˆÓ ·Ó¿ Ë̤ڷ (USDA, 1996) ∏ÏÈΛ·

∂Ó¤ÚÁÂÈ· (kcal)

¢ËÌËÙÚȷο

§·¯·ÓÈο

ºÚÔ‡Ù·

°·Ï·ÎÙÔÎÔÌÈο

∫Ú¤·˜

™˘ÓÈÛÙÒÌÂÓ˜ ÌÂÚ›‰Â˜ ·Ó¿ Ë̤ڷ ¶·È‰È¿

∞ÁfiÚÈ· ∫ÔÚ›ÙÛÈ·

2-3 4-6 7-10 11-14 15-18 11-24

1300 1800 2000 2500 3000 2200

6 7 7,8 9,9 11 9

3 3,3 3,7 4,5 5 4

2 2,3 2,7 3,5 4 3

2 2 2 3 3 3

2 2,1 2,3 2,6 2,8 2,4

[ ÕıÚÔÈÛÌ· 10 Û˘ÓÈÛÙˆÛÒÓ Î·È Ù·ÍÈÓfiÌËÛË ¢Â›ÎÙ˘ ÀÁÈÂÈÓ‹˜ ¢È·ÙÚÔÊ‹˜

<51

51-80

>80

∞ÓÂ·Ú΋˜

ÃÚÂÈ¿˙ÂÙ·È ‚ÂÏÙ›ˆÛË

∫·Ï‹

* √È Û˘ÓÈÛÙÒÛ˜ Î·È Ô ¢Â›ÎÙ˘ ÀÁÈÂÈÓ‹˜ ¢È·ÙÚÔÊ‹˜ ÂÎÙÈÌÒÓÙ·È ·fi ‰È·ÈÙÔÏfiÁÈÔ 24ÒÚÔ˘ ** ∏ ‚·ıÌÔÏfiÁËÛË ÌÂٷ͇ Ù˘ ÂÏ¿¯ÈÛÙ˘ Î·È Ì¤ÁÈÛÙ˘ ÙÈÌ‹˜ (0 ¤ˆ˜ 10) ÂÎÙÈÌ¿Ù·È ·Ó·ÏÔÁÈο

™˘ÓÔÏÈο, Ô ÂÈÔÏ·ÛÌfi˜ ÙÔ˘ ªÂÙ™˘Ó ‹Ù·Ó 3,9% ÛÙ· ·È‰È¿ Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜ (4,2% ÛÙ· ·ÁfiÚÈ· Î·È 3,9% ÛÙ· ÎÔÚ›ÙÛÈ·, ª™). ™‡Ìʈӷ Ì ÙÔÓ ¶›Ó·Î· 4, ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ‚Ú¤ıËÎ·Ó ÛÙ· ‰‡Ô ʇϷ, ÌÂٷ͇ ÙˆÓ ËÏÈÎÈÒÓ 3-6 Î·È 14ó-17ó ÂÙÒÓ, ÛÙË ‚·ıÌÔÏÔÁ›· ÚfiÛÏ˄˘ ÎÔÚÂṲ̂ÓÔ˘ Ï›Ô˘˜ (·ÁfiÚÈ·: 2,0 ¤Ó·ÓÙÈ 3,9, p<0,001, ÎÔÚ›ÙÛÈ·: 2,2 ¤Ó·ÓÙÈ 3,9, p<0,001), Ó·ÙÚ›Ô˘ (·ÁfiÚÈ·: 9,9 ¤Ó·ÓÙÈ 7,8, p<0,001, ÎÔÚ›ÙÛÈ·: 9,8 ¤Ó·ÓÙÈ 9,2, p<0,001) Î·È ÛÙÔÓ ¢À¢ (·ÁfiÚÈ·: 62,8 ¤Ó·ÓÙÈ 57,8, p<0,01, ÎÔÚ›ÙÛÈ·: 61,5 ¤Ó·ÓÙÈ 57,5, p<0,05). ∂›Û˘, ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚË ‚·ıÌÔÏÔÁ›· ‚Ú¤ıËΠÛÙ· ·ÁfiÚÈ· ÌÂٷ͇ ÙˆÓ ËÏÈÎÈÒÓ 3-6 Î·È 14ó-17ó ÂÙÒÓ, ÛÙËÓ Î·Ù·Ó¿ÏˆÛË ÊÚÔ‡ÙˆÓ (5,8 ¤Ó·ÓÙÈ 4,2, p<0,05), Á·Ï·ÎÙÔÎÔÌÈÎÒÓ (9,9 ¤Ó·ÓÙÈ 8,6, p<0,001) Î·È ÔÈÎÈÏ›·˜ ÙÚÔÊ›ÌˆÓ (4,8 ¤Ó·ÓÙÈ 6,2, p<0,01).

Paediatriki 2007;70:24-36

∏ Û˘ÓÔÏÈ΋ ̤ÛË ‚·ıÌÔÏÔÁ›· ÙÔ˘ ¢À¢ ‚Ú¤ıËΠ58,7, Ì ÙË ‰È·ÙÚÔÊ‹ Ù˘ ÏÂÈÔÓfiÙËÙ·˜ ÙˆÓ ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ Ó· Ù·ÍÈÓÔÌÂ›Ù·È ÛÙËÓ Î·ÙËÁÔÚ›· “¯ÚÂÈ¿˙ÂÙ·È ‚ÂÏÙ›ˆÛË”. ¢ÂÓ ‚Ú¤ıËΠÛËÌ·ÓÙÈ΋ Ù¿ÛË ÌÂÙ·‚ÔÏ‹˜ Ì ÙËÓ ·‡ÍËÛË ÙˆÓ ·Ú·ÁfiÓÙˆÓ ÙÔ˘ ªÂÙ™˘Ó ÛÙËÓ ÚfiÛÏË„Ë ıÚÂÙÈÎÒÓ Û˘ÛÙ·ÙÈÎÒÓ, ÛÙËÓ Î·Ù·Ó¿ÏˆÛË ÙÚÔʛ̈Ó, ÛÙÔÓ ¢À¢ Î·È ÛÙȘ Û˘ÓÈÛÙÒÛ˜ ÙÔ˘ (‰Â‰Ô̤ӷ ‰ÂÓ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Û ›Ó·Î·). øÛÙfiÛÔ, Ù· ·È‰È¿ Î·È ÔÈ ¤ÊË‚ÔÈ ¯ˆÚ›˜ ·Ú¿ÁÔÓÙ˜ ªÂÙ™˘Ó, Û ۇÁÎÚÈÛË Ì ÂΛӷ Ì ªÂÙ™˘Ó, ›¯·Ó ÌÈÎÚfiÙÂÚË Ï‹„Ë ÎÔÚÂÛÌ¤ÓˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ (31,9 g ¤Ó·ÓÙÈ 34,8 g, ª™) Î·È Î·Ù·Ó¿ÏˆÛË ÎÚ¤·ÙÔ˜ (115 g ¤Ó·ÓÙÈ 146 g, ª™), ÂÓÒ ‚Ú¤ıËÎ·Ó Ì ÌÂÁ·Ï‡ÙÂÚË Î·Ù·Ó¿ÏˆÛË ÊÚÔ‡ÙˆÓ Î·È Ï·¯·ÓÈÎÒÓ (299 g ¤Ó·ÓÙÈ 244 g, ª™).

29

ªÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ Û ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜

¶›Ó·Î·˜ 3. ¶·È‰È¿ Î·È ¤ÊË‚ÔÈ Ì ‹ ¯ˆÚ›˜ ·Ú¿ÁÔÓÙ˜ ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ Û ۯ¤ÛË Ì ÙÔ Ê‡ÏÔ Î·È ÙËÓ ËÏÈΛ· ∏ÏÈΛ· (¤ÙË) 3-6

6ó-10

10ó-14

14ó-17ó

™‡ÓÔÏÔ

¡ (%) ∞ÁfiÚÈ·

™‡ÓÔÏÔ ¶·Ú¿ÁÔÓÙ˜ 0 1 2 ≥3

∫ÔÚ›ÙÛÈ·*

™‡ÓÔÏÔ ¶·Ú¿ÁÔÓÙ˜ 0 1 2 ≥3

81

113

152

196

542

43 (53,1) 29 (35,8) 7 (8,6) 2 (2,5) 68

42 (37,2) 48 (42,5) 15 (13,3) 8 (7,1) 120

63 (41,4) 65 (42,8) 20 (13,2) 4 (2,6) 215

80 (40,8) 81 (41,3) 26 (13,3) 9 (4,6) 264

228 (42,1) 223 (41,1) 68 (12,5) 23 (4,2) 667

41 (60,3) 19 (27,9) 6 (8,8) 2 (2,9)

49 (40,8) 48 (40,0) 19 (15,8) 4 (3,3)

63 (29,3) 116 (54,0) 26 (12,1) 10 (4,7)

128 (48,5) 106 (40,2) 22 (8,3) 8 (3,0)

281 (42,1) 289 (43,3) 73 (10,9) 24 (3,6)

* ŒÏÂÁ¯Ô˜ χ2 (p<0,05) ** ŒÏÂÁ¯Ô˜ χ2 ÁÈ· ÁÚ·ÌÌÈ΋ Ù¿ÛË (p value for linear trend): p<0,05

¶›Ó·Î·˜ 4. ª¤ÛË ‚·ıÌÔÏÔÁ›· Û˘ÓÈÛÙˆÛÒÓ Î·È ¢Â›ÎÙË ÀÁÈÂÈÓ‹˜ ¢È·ÙÚÔÊ‹˜ ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ ˆ˜ ÚÔ˜ ÙÔ Ê‡ÏÔ Î·È ÙȘ ÔÌ¿‰Â˜ ËÏÈÎÈÒÓ ∏ÏÈΛ· (¤ÙË) 3-6 ™˘ÓÈÛÙÒÛ˜ & ‰Â›ÎÙ˘

º‡ÏÔ

6ó-10

10ó-14

14ó-17ó

™‡ÓÔÏÔ

ª¤ÛË ÙÈÌ‹ ± ∆˘È΋ ·fiÎÏÈÛË

1. √Ì¿‰· ‰ËÌËÙÚÈ·ÎÒÓ („ˆÌ›, Ú‡˙È, ‰ËÌËÙÚȷο, ˙˘Ì·ÚÈο)

∞ÁfiÚÈ· ∫ÔÚ›ÙÛÈ·

6,4±3,6 6,0±3,5

7,3±3,1 6,6±3,2

6,1±3,1 5,4±3,1

5,7±2,8 5,7±3,3

6,2±3,1 5,8±3,3

2. §·¯·ÓÈο

∞ÁfiÚÈ· ∫ÔÚ›ÙÛÈ·

3,4±3,7 3,1±3,6

2,5±3,4 2,9±3,6

2,3±3,1 2,4±3,2

3,0±3,1 2,8±3,3

2,8±3,3 2,7±3,3

3. ºÚÔ‡Ù·

∞ÁfiÚÈ· ∫ÔÚ›ÙÛÈ·

5,8±4,7* 6,0±4,5

4,9±4,6 5,0±4,8

4,2±4,6 5,0±4,8

4,2±4,4 4,3±4,6

4,6±4,6 4,8±4,72

4. √Ì¿‰· Á·Ï·ÎÙÔÎÔÌÈÎÒÓ (Á¿Ï·, ÁÈ·Ô‡ÚÙÈ, Ù˘Ú›)

∞ÁfiÚÈ· ∫ÔÚ›ÙÛÈ·

9,9±0,6*** 9,8±1,4

9,5±2,0 9,2±2,6

8,7±2,7 7,4±3,8

8,6±3,0 7,4±3,9

9,0±2,6 7,9±3,6

5. √Ì¿‰· ÎÚ¤·ÙÔ˜ (ÎÚ¤·˜, Ô˘ÏÂÚÈο, ÍËÚ¿ Ê·ÛfiÏÈ·, „¿ÚÈ, ·˘Á¿, ÍËÚÔ› ηÚÔ›)

∞ÁfiÚÈ· ∫ÔÚ›ÙÛÈ·

8,7±3,2 8,1±3,8

7,8±3,8 8,4±3,4

8,4±3,4 7,7±3,9

8,2±3,5 7,3±4,1

8,2±3,5 7,7±3,9

6. √ÏÈÎfi Ï›Ô˜ (% ÂÓ¤ÚÁÂÈ·˜)

∞ÁfiÚÈ· ∫ÔÚ›ÙÛÈ·

3,0±2,9 3,5±3,0

2,9±3,3 2,8±3,2

3,7±3,6 3,0±3,5

3,2±3,4 3,8±3,8

3,3±3,4 3,4±3,6

7. ∫ÔÚÂṲ̂ÓÔ Ï›Ô˜ (% ÂÓ¤ÚÁÂÈ·˜)

∞ÁfiÚÈ· ∫ÔÚ›ÙÛÈ·

2,0±2,9*** 2,2±3,0***

3,1±3,6 2,2±3,3

3,6±3,7 3,8±3,9

3,9±3,9 3,9±4,0

3,4±3,7 3,4±3,8

8. ÃÔÏËÛÙÂÚfiÏË ÙÚÔÊ‹˜

∞ÁfiÚÈ· ∫ÔÚ›ÙÛÈ·

8,9±2,8*** 8,3±3,3

8,0±3,6 9,1±2,5

7,8±3,8 8,6±3,0

6,9±4,2 8,6±3,2

7,6±3,9 8,6±3,0

9. ¡¿ÙÚÈÔ

∞ÁfiÚÈ· ∫ÔÚ›ÙÛÈ·

9,9±0,2*** 9,8±0,6***

9,6±1,4 9,6±1,3

8,6±2,5 9,6±1,4

7,8±3,0 9,2±2,0

8,7±2,5 9,5±1,6

10. ¶ÔÈÎÈÏ›· ÙÚÔʛ̈Ó

∞ÁfiÚÈ· ∫ÔÚ›ÙÛÈ·

4,8±3,1** 4,6±3,3

4,7±3,1 4,4±3,1

5,6±3,4 4,5±3,1

6,2±3,3 4,3±3,1

5,6±3,3 4,4±3,1

¢Â›ÎÙ˘ ÀÁÈÂÈÓ‹˜ ¢È·ÙÚÔÊ‹˜

∞ÁfiÚÈ· ∫ÔÚ›ÙÛÈ·

62,8±12,7** 61,5±13,5*

60,3±14,3 60,2±12,6

59,0±11,9 57,4±13,0

57,8±12,2 59,3±12,7 57,5±14,7 58,3±13,7

∆· ‰È·ÈÙÔÏfiÁÈ· ·fi Ù· ÔÔ›· ÚÔ¤Ú¯ÔÓÙ·È ÔÈ ·Ú·¿Óˆ ÂÎÙÈÌ‹ÛÂȘ ·Ó¤Ú¯ÔÓÙ·È Û 1124 Û ۇÓÔÏÔ 1209 ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ. ∏ ηٷÓÔÌ‹ ÙÔ˘˜ (¡) ÛÙȘ ·Ú·¿Óˆ ÔÌ¿‰Â˜ ËÏÈÎÈÒÓ Â›Ó·È ·ÓÙ›ÛÙÔȯ· ÛÙ· ·ÁfiÚÈ·: 66, 95,151 Î·È 191 Î·È ÛÙ· ÎÔÚ›ÙÛÈ·: 53, 103, 209 Î·È 256. # ŒÏÂÁ¯Ô˜ Student t test (equal variances not assumed) ÌÂٷ͇ ÙˆÓ ËÏÈÎÈÒÓ 3-6 Î·È 14ó-17ó: * p≤0,05, ** p≤0,01, *** p≤0,001

¶·È‰È·ÙÚÈ΋ 2007;70:24-36

30

ª. §ÈÓ·Ú‰¿Î˘ Î·È Û˘Ó.

ªÂ ÙËÓ ·‡ÍËÛË ÙÔ˘ ·ÚÈıÌÔ‡ ·Ú·ÁfiÓÙˆÓ ªÂÙ™˘Ó (¶›Ó·Î·˜ 5), ·˘Í¿ÓÔÓÙ·È ÛËÌ·ÓÙÈο Ù· ÔÛÔÛÙ¿ ÙˆÓ ·È‰ÈÒÓ Î·È ÙˆÓ ÂÊ‹‚ˆÓ Ì ·ÓÂ·Ú΋ Ï‹„Ë ÚˆÙÂ˚ÓÒÓ (Ï‹„Ë <67% ÙÔ˘ RDA) ·fi 4% Û 11% (p=0,027), Ì·ÁÓËÛ›Ô˘ ·fi 45% Û 61% (p=0,018), Ê˘ÏÈÎÔ‡ ÔͤԘ ·fi 53% Û 55% (p=0,010) Î·È ‚ÈÙ·Ì›Ó˘ ∞ ·fi 43% Û 45% (p=0,023). ∞ÓÙ›ıÂÙ·, ‰ÂÓ ÌÂÙ·‚¿ÏÏÂÙ·È ÛËÌ·ÓÙÈο Ë ‚·ıÌÔÏÔÁ›· ÙÔ˘ ¢À¢ Î·È ÙˆÓ Û˘ÓÈÛÙˆÛÒÓ ÙÔ˘ Ì ÙËÓ ·‡ÍËÛË ÙÔ˘ ·ÚÈıÌÔ‡ ·Ú·ÁfiÓÙˆÓ ªÂÙ™˘Ó (‰Â‰Ô̤ӷ ‰ÂÓ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Û ›Ó·Î·). ¶·È‰È¿ Î·È ¤ÊË‚ÔÈ ¯ˆÚ›˜ ·Ú¿ÁÔÓÙ˜ ªÂÙ™˘Ó, Û ۯ¤ÛË Ì ÂΛӷ Ì ªÂÙ™˘Ó, ‚Ú¤ıËÎ·Ó Ì ˘„ËÏfiÙÂÚË ‚·ıÌÔÏÔÁ›· ÛÙËÓ Î·Ù·Ó¿ÏˆÛË ‰ËÌËÙÚÈ·ÎÒÓ (6,1 ¤Ó·ÓÙÈ 5,6, ª™), ÊÚÔ‡ÙˆÓ (5,1 ¤Ó·ÓÙÈ 4,4, ª™) Î·È ÛÙÔÓ ¢À¢ (59,8 ¤Ó·ÓÙÈ 58,4, ª™). ∏ ηٷÓÔÌ‹ ÙˆÓ ·ÁÔÚÈÒÓ Î·È ÙˆÓ ÎÔÚÈÙÛÈÒÓ ˆ˜ ÚÔ˜ ÙȘ ηÙËÁÔڛ˜ ÙÔ˘ ¢À¢ (¶›Ó·Î·˜ 6) ‰ÂÓ ‰È·ÊÔÚÔÔÈ›ٷÈ, Â›Û˘, ÛËÌ·ÓÙÈο. ¶ÔÛÔÛÙfi ÌfiÏȘ 6% ÙˆÓ ·ÁÔÚÈÒÓ Â›¯Â “ηϋ” ‰È·ÙÚÔÊ‹ Î·È 27% “·ÓÂ·Ú΋”, ÂÓÒ ÛÙ· ÎÔÚ›ÙÛÈ· ÔÛÔÛÙfi 7% ›¯Â “ηϋ” Î·È 32% “·ÓÂ·Ú΋” ‰È·ÙÚÔÊ‹. øÛÙfiÛÔ, ÙÔ ÔÛÔÛÙfi ÙˆÓ ·È‰ÈÒÓ Î·È ÙˆÓ ÂÊ‹‚ˆÓ Ì “ηϋ” ‰È·ÙÚÔÊ‹ ·fi 10% ÛÙȘ ËÏÈ˘ 3-6 ÂÙÒÓ, ÌÂÈÒÓÂÙ·È ÛËÌ·ÓÙÈο Û 7% ÛÙȘ ËÏÈ˘ ÙˆÓ 14ó-17ó ÂÙÒÓ, ÂÓÒ Ì “·ÓÂ·Ú΋” ‰È·ÙÚÔÊ‹ ·˘Í¿ÓÂÙ·È ·fi 24% Û 32% (p=0,019). ∂ÈϤÔÓ, ÙÔ 36% ÙˆÓ ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ Ì ªÂÙ™˘Ó, ›¯Â “·ÓÂ·Ú΋” ‰È·ÙÚÔÊ‹ Î·È ÙÔ 5% “ηϋ”, ¤Ó·ÓÙÈ 28% Î·È 8%, ·ÓÙ›ÛÙÔȯ·, ÂÎÂ›ÓˆÓ ¯ˆÚ›˜ ·Ú¿ÁÔÓÙ˜ ªÂÙ™˘Ó (p=0,026).

√ Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜ (Odds Ratio) (¶›Ó·Î·˜ 7) ÁÈ· ªÂÙ™˘Ó ‚Ú¤ıËΠӷ ·˘Í¿ÓÂÙ·È Î·Ù¿ 3,16 ÊÔÚ¤˜ ÁÈ· Ù· ·È‰È¿ Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜ Ì ·˘ÍË̤ӷ Â›‰· LDL-C (95% ¢∂: 1,59-6,29, p=0,001), ηٿ 71,2 ÊÔÚ¤˜ ÁÈ· fiÛ· ¤¯Ô˘Ó ·˘ÍË̤ӷ Â›‰· ·ıËڈ̷ÙÈÎÔ‡ ‰Â›ÎÙË ÔÏÈ΋˜ ÚÔ˜ ∏DL-C (95% ¢∂: 19,5260,1, p<0,001) Î·È Î·Ù¿ 84,8 ÊÔÚ¤˜ ÁÈ· fiÛ· Â›Ó·È ·¯‡Û·Úη (¢ª™ >30 kg/m2) (95% ¢∂: 32,7-219,4, p<0,001). ∂›Û˘, ·È‰È¿ Î·È ¤ÊË‚ÔÈ Ì ªÂÙ™˘Ó ‚Ú¤ıËÎ·Ó Ó· ¤¯Ô˘Ó ÛËÌ·ÓÙÈο ÌÂȈ̤Ó˜ Èı·ÓfiÙËÙ˜ (ηٿ 30%) ÁÈ· ηϋ ηډÈÔ·Ó·Ó¢ÛÙÈ΋ ·ÓÙÔ¯‹ (95% ¢∂: 0,49-0,99, p<0,042). ∆Ô 85% ÙˆÓ ·È‰ÈÒÓ Î·È ÙˆÓ ÂÊ‹‚ˆÓ Ì ªÂÙ™˘Ó (∂ÈÎfiÓ· 1) ˘ÂÚ‚·›ÓÂÈ Ù· fiÚÈ· Ù˘ 90‹˜ ÂηÙÔÛÙÈ·›·˜ ı¤Û˘ Ù˘ Û˘ÛÙÔÏÈ΋˜ ›ÂÛ˘ οÙÈ Ô˘ ·ÔÙÂÏ› ÙÔÓ ÈÔ Û˘¯Ófi ·Ú¿ÁÔÓÙ· ªÂÙ™˘Ó. ∞ÎÔÏÔ˘ıÔ‡Ó Ù· ·˘ÍË̤ӷ ÙÚÈÁÏ˘ÎÂÚ›‰È· Î·È Ë ¯·ÌËÏ‹ HDL-C. ™Â 243 ÂÊ‹‚Ô˘˜ ËÏÈΛ·˜ 15-17 ÂÙÒÓ, ÔÛÔÛÙfi 12% ‚Ú¤ıËΠӷ Â›Ó·È Î·ÓÈÛÙ¤˜ (‰Â‰Ô̤ӷ ‰ÂÓ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Û ›Ó·Î·) (13% ·ÁfiÚÈ· Î·È 11% ÎÔÚ›ÙÛÈ·, χ2 ¤ÏÂÁ¯Ô˜, ª™). øÛÙfiÛÔ, ‰ÂÓ Û¯ÂÙ›˙ÂÙ·È ÛËÌ·ÓÙÈο ÙÔ Î¿ÓÈÛÌ· Ì ÙÔÓ ÂÈÔÏ·ÛÌfi ÙÔ˘ ªÂÙ™˘Ó. ∆¤ÏÔ˜, Ì ‚¿ÛË ÙÔÓ ¢ª™, ÙÔ 23,2% ÙˆÓ ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ ‚Ú¤ıËΠ̠·˘ÍË̤ÓÔ ‚¿ÚÔ˜ Î·È ÙÔ 9,9% Ì ·¯˘Û·ÚΛ· (‰Â‰Ô̤ӷ ‰ÂÓ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Û ›Ó·Î·). ªÂ ·˘ÍË̤ÓÔ ‚¿ÚÔ˜ ‚Ú¤ıËΠÙÔ 25% ÙˆÓ ·ÁÔÚÈÒÓ Î·È ÙÔ 21% ÙˆÓ ÎÔÚÈÙÛÈÒÓ Î·È Ì ·¯˘Û·ÚΛ· ÔÛÔÛÙfi 12% Î·È 9%, ·ÓÙ›ÛÙÔȯ· (χ2 ¤ÏÂÁ¯Ô˜,

¶›Ó·Î·˜ 5. ¶ÔÛÔÛÙ¿ ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ Ô˘ ÚÔÛÏ·Ì‚¿ÓÔ˘Ó ıÚÂÙÈο Û˘ÛÙ·ÙÈο ÏÈÁfiÙÂÚÔ ·fi 67% Ù˘ ËÌÂÚ‹ÛÈ·˜ Û˘ÓÈÛÙÒÌÂÓ˘ ÔÛfiÙËÙ·˜ (RDA) Û ۯ¤ÛË Ì ÙËÓ ·ÚÔ˘Û›· ·Ú·ÁfiÓÙˆÓ ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ ¶·Ú¿ÁÔÓÙ˜ ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ 0

1

<67% RDA ª·ÎÚÔıÚÂÙÈο

ª¤Ù·ÏÏ· & ȯÓÔÛÙÔȯ›·

µÈٷ̛Ә

≥3

¡ (%) ∂Ó¤ÚÁÂÈ· ¶ÚˆÙ½Ó˜ ÿÓ˜ ∞Û‚¤ÛÙÈÔ ™›‰ËÚÔ˜ ª·ÁÓ‹ÛÈÔ ºÒÛÊÔÚÔ˜ º˘ÏÈÎfi Ô͇ µÈÙ·Ì›ÓË ∞ µÈÙ·Ì›ÓË ∂ µÈÙ·Ì›ÓË C µÈÙ·Ì›ÓË µ1 µÈÙ·Ì›ÓË µ2 µÈÙ·Ì›ÓË µ6 µÈÙ·Ì›ÓË µ12 ¡È·Û›ÓË

106 (22) 19 (4) 362 (77) 239 (51) 103 (22) 208 (45) 140 (31) 252 (53) 202 (43) 304 (64) 96 (20) 20 (4) 17 (4) 58 (12) 103 (22) 66 (14)

* ŒÏÂÁ¯Ô˜ χ2 ÁÈ· ÁÚ·ÌÌÈ΋ Ù¿ÛË (p value for linear trend) Paediatriki 2007;70:24-36

2

127 (26) 26 (5) 382 (80) 253 (53) 108 (23) 238 (51) 166 (36) 310 (65) 232 (48) 308 (64) 125 (26) 22 (5) 16 (3) 68 (14) 102 (21) 82 (17)

p* 35 (27) 9 (7) 109 (83) 67 (51) 30 (23) 66 (51) 45 (35) 86 (66) 74 (56) 87 (67) 38 (29) 9 (7) 5 (4) 22 (17) 33 (25) 28 (22)

14 (32) 5 (11) 34 (77) 25 (57) 12 (27) 27 (61) 19 (44) 24 (55) 20 (45) 27 (61) 7 (16) 0 4 (9) 9 (20) 13 (30) 7 (16)

ª™ 0,027 ª™ ª™ ª™ 0,018 ª™ 0,010 0,023 ª™ ª™ ª™ ª™ ª™ ª™ ª™

31

ªÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ Û ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜

¶›Ó·Î·˜ 6. ∞ÚÈıÌfi˜ Î·È ÔÛÔÛÙ¿ ·È‰ÈÒÓ Ì ‚·ıÌÔÏÔÁ›· ¢À¢ “·ÓÂ·Ú΋”, “¯ÚÂÈ¿˙ÂÙ·È ‚ÂÏÙ›ˆÛË” Î·È “ηϋ” Û ۯ¤ÛË Ì ÙÔ Ê‡ÏÔ, ÙËÓ ËÏÈΛ· Î·È ÙËÓ ·ÚÔ˘Û›· ·Ú·ÁfiÓÙˆÓ ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ ¢Â›ÎÙ˘ ÀÁÈÂÈÓ‹˜ ¢È·ÙÚÔÊ‹˜ ∞ÓÂ·Ú΋˜ ÃÚÂÈ¿˙ÂÙ·È (<51) ‚ÂÏÙ›ˆÛË (51-80)

∫·Ï‹ (>80)

¡ (%)

p*

º‡ÏÔ ∞ÁfiÚÈ· ∫ÔÚ›ÙÛÈ· ™‡ÓÔÏÔ

139 (27) 197 (32) 336 (30)

336 (67) 382 (61) 718 (64)

28 (6) 42 (7) 70 (6)

∏ÏÈΛ· 3-6 6ó-10 10ó-14 14ó-17ó

28 (24) 52 (26) 113 (31) 143 (32)

79 (66) 130 (66) 234 (65) 275 (62)

12 (10) 16 (8) 0,019** 13 (4) 29 (7)

¶·Ú¿ÁÔÓÙ˜ ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ 0 131 (28) 303 (64) 1 144 (30) 311 (65) 2 45 (35) 78 (60) ≥3 16 (36) 26 (59)

38 (8) 23 (5) 0,026** 7 (5) 2 (5)

* **

ª™*

ŒÏÂÁ¯Ô˜ χ2 ŒÏÂÁ¯Ô˜ χ2 ÁÈ· ÁÚ·ÌÌÈ΋ Ù¿ÛË (p value for linear trend)

p=0,024). ∂›Û˘, Ì ·¯˘Û·ÚΛ· ‚Ú¤ıËΠÙÔ 51% ÙˆÓ ·È‰ÈÒÓ Î·È ÙˆÓ ÂÊ‹‚ˆÓ Ì ªÂÙ™˘Ó, ¤Ó·ÓÙÈ 8% ÂÎÂ›ÓˆÓ Ì 0-2 ·Ú¿ÁÔÓÙ˜ ªÂÙ™˘Ó (p<0,001).

∂ÈÔÏ·ÛÌfi˜ ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ §›Á˜ ¤Ú¢Ó˜ ·ÁÎÔÛÌ›ˆ˜ ¤¯Ô˘Ó ÌÂÏÂÙ‹ÛÂÈ ÙÔ ªÂÙ™˘Ó ÛÙËÓ ·È‰È΋ Î·È ÂÊË‚È΋ ËÏÈΛ· (35). √ ÂÈÔÏ·ÛÌfi˜ ÙÔ˘, ˆÛÙfiÛÔ, ÂÎÙÈÌ¿Ù·È ÌÂٷ͇ 4% Î·È 5% (36). ∞fi ÙË ÌÂϤÙË NHANES 1999-2000 ÙˆÓ ∏¶∞, Û ¤ÊË‚Ô˘˜ ËÏÈΛ·˜ 12-19 ÂÙÒÓ (10), ‚Ú¤ıËΠfiÙÈ 6,4% ›¯Â ªÂÙ™˘Ó (9,1% Ù· ·ÁfiÚÈ· Î·È 3,7% Ù· ÎÔÚ›ÙÛÈ·) Î·È fiÙÈ ÂÚÈÛÛfiÙÂÚÔÈ ·fi ‰‡Ô ÂηÙÔÌ̇ÚÈ· ¤ÊË‚ÔÈ

39

™¿Î¯·ÚÔ ¶·Ú¿ÁÔÓÙ˜ ªÂÙ·‚ÔÏÈÎÔ‡ ™˘Ó‰ÚfiÌÔ˘

™˘˙‹ÙËÛË ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, ÔÛÔÛÙfi 3,9% ÙˆÓ ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ Ù˘ ∫Ú‹Ù˘ ‚Ú¤ıËΠ̠ÙÚÂȘ ‹ ÂÚÈÛÛfiÙÂÚÔ˘˜ ·Ú¿ÁÔÓÙ˜ ªÂÙ™˘Ó (4,2% ÛÙ· ·ÁfiÚÈ·, 3,6% ÛÙ· ÎÔÚ›ÙÛÈ·). ∏ ‚·ıÌÔÏÔÁ›· ÙÔ˘ ¢À¢ ‰ÂÓ ‰È¤ÊÂÚ ÛËÌ·ÓÙÈο ·fi ÙË ‚·ıÌÔÏÔÁ›· ÙˆÓ ·È‰ÈÒÓ Î·È ÙˆÓ ÂÊ‹‚ˆÓ Ì ηıfiÏÔ˘ ‹ ÏÈÁfiÙÂÚÔ˘˜ ·Ú¿ÁÔÓÙ˜ ªÂÙ™˘Ó. øÛÙfiÛÔ, Ë ·ÍÈÔÏfiÁËÛË Ù˘ ‰È·ÙÚÔÊ‹˜ ÙÔ˘˜ ¤‰ÂÈÍ fiÙÈ ¤¯Ô˘Ó Û ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi “·ÓÂ·Ú΋” ‰È·ÙÚÔÊ‹ Î·È Û ÌÈÎÚfiÙÂÚÔ “ηϋ”. ∂›Û˘, Û ÔÛÔÛÙfi 64% fiÏˆÓ ÙˆÓ ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ Ù˘ ÌÂϤÙ˘, ·ÓÂÍ·Úًو˜ ‰ËÏ·‰‹ Ù˘ ·ÚÔ˘Û›·˜ ‹ ÌË ·Ú·ÁfiÓÙˆÓ ªÂÙ™˘Ó, ‚Ú¤ıËΠfiÙÈ Ë ‰È·ÙÚÔÊ‹ “¯ÚÂÈ¿˙ÂÙ·È ‚ÂÏÙ›ˆÛË”. ∞ÎfiÌË, Ù· ·È‰È¿ Î·È ÔÈ ¤ÊË‚ÔÈ Ì ÙÚÂȘ ‹ ÂÚÈÛÛfiÙÂÚÔ˘˜ ·Ú¿ÁÔÓÙ˜ ªÂÙ™˘Ó ηٷӷÏÒÓÔ˘Ó ÌÈÎÚfiÙÂÚË ÔÛfiÙËÙ· ÊÚÔ‡ÙˆÓ Î·È Ï·¯·ÓÈÎÒÓ, ÂÓÒ Â›¯·Ó ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚ· ÔÛÔÛÙ¿ ·ÓÂ·ÚÎÔ‡˜ Ï‹„˘ ÚˆÙÂ˚ÓÒÓ, Ê˘ÏÈÎÔ‡ ÔͤԘ Î·È ‚ÈÙ·Ì›Ó˘ ∞.

13 87

™˘ÛÙÔÏÈ΋ ∞¶

83 44 42

¢È·ÛÙÔÏÈ΋ ∞¶

52

∆ÚÈÁÏ˘ÎÂÚ›‰È·

83 57

HDL-C

75 ∞ÁfiÚÈ· ∫ÔÚ›ÙÛÈ·

61 63

¶ÂÚ. ª¤Û˘ 0

10

20

30

40

50

60

70

80

90

100

¶ÔÛÔÛÙfi ·È‰ÈÒÓ / ÂÊ‹‚ˆÓ (%)

∂ÈÎfiÓ· 1. ¶ÔÛÔÛÙ¿ ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ Ì ÌÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ Ô˘ ˘ÂÚ‚·›ÓÔ˘Ó Ù· fiÚÈ· (cut offs) ÙˆÓ ·Ú·ÁfiÓÙˆÓ ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘. ¶·È‰È·ÙÚÈ΋ 2007;70:24-36

32

ª. §ÈÓ·Ú‰¿Î˘ Î·È Û˘Ó.

¶›Ó·Î·˜ 7. ∂ÎÙ›ÌËÛË ‰ÂÈÎÙÒÓ Û¯ÂÙÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘ (Odds Ratio) ‰È·ÊfiÚˆÓ ·Ú·ÁfiÓÙˆÓ Û ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ Ì ÌÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ Û ۯ¤ÛË Ì ·È‰È¿ ¯ˆÚ›˜ ·Ú¿ÁÔÓÙ˜ ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘

√ÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË* LDL ¯ÔÏËÛÙÂÚfiÏË** ∞ıËڈ̷ÙÈÎfi˜ ‰Â›ÎÙ˘ ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ ÚÔ˜ HDL-C*** ∞ıËڈ̷ÙÈÎfi˜ ‰Â›ÎÙ˘ LDL-C ÚÔ˜ HDL-C$ ¢Â›ÎÙ˘ ª¿˙·˜ ™ÒÌ·ÙÔ˜ (kg/m2) ¶·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜ ∫¿ÓÈÛÌ·

¡

OR (95% ‰È¿ÛÙËÌ· ÂÌÈÛÙÔÛ‡Ó˘)

p-value#

556 556 556

1,58 (0,70-3,57) 3,16 (1,59-6,29) 71,2 (19,5-260,1)

ª™ 0,001 <0,001

556

47,4 (9,4-239,5)

<0,001

25-30$$ >30 181 ∫·ÓÈÛÙ¤˜

556 556 0,70 (0,49-0,99) 106

7,32 (3,07-14,47)<0,001 84,8 (32,7-219,4)<0,001 0,042 0,98 (0,11-8,97) ª™

∏ ·Ó¿Ï˘ÛË ·ÊÔÚ¿ ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ Ô˘ ‰ÂÓ ¤¯Ô˘Ó ·Ú¿ÁÔÓÙ˜ ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ (Ìˉ¤Ó ·Ú¿ÁÔÓÙ˜) Û ۯ¤ÛË Ì ÂΛӷ Ì ÌÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ (ÙÚÂȘ ‹ ÂÚÈÛÛfiÙÂÚÔ˘˜ ·Ú¿ÁÔÓÙ˜). # ∞Ó¿Ï˘ÛË ÏÔÁÈÛÙÈ΋˜ ·ÏÈÓ‰ÚfiÌËÛ˘ (logistic linear regression analysis): ˆ˜ Û˘ÌÌÂÙ·‚ÏËÙ¤˜ ÂϤÁ¯Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÙÔ Ê‡ÏÔ Î·È Ë ËÏÈΛ· * √ÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË >200 mg/dl, ** LDL ¯ÔÏËÛÙÂÚfiÏË >130 mg/dl, *** ∞ıËڈ̷ÙÈÎfi˜ ‰Â›ÎÙ˘ ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ ÚÔ˜ HDL >5,00, $ ∞ıËڈ̷ÙÈÎfi˜ ‰Â›ÎÙ˘ LDL ¯ÔÏËÛÙÂÚfiÏ˘ ÚÔ˜ HDL >4,00, $$ ∆· fiÚÈ· ÙÔ˘ ¢ª™ ηıÔÚ›˙ÔÓÙ·È ·fi ÙÔ˘˜ Cole Î·È Û˘Ó, 2000 (23)

¤¯Ô˘Ó ªÂÙ™˘Ó. ™ÙË ÌÂϤÙË NHANES πππ 1988-1992, Ô ÂÈÔÏ·ÛÌfi˜ ‹Ù·Ó ÌÈÎÚfiÙÂÚÔ˜ Î·È ÚÔÛ¤ÁÁÈ˙ ÙÔ 4,2% (10), ÂÓÒ ·fi ÙËÓ Bogalusa Heart Study, Û ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ ËÏÈΛ·˜ 8-17 ÂÙÒÓ, ηٿ ÙÔ ‰È¿ÛÙËÌ· 1978-1996, ‚Ú¤ıËΠ3,6% (37). ™Â ¿ÏÏË ÌÂϤÙË ÛÙȘ ∏¶∞, ÙÔ 1999, Û 439 ·¯‡Û·Úη ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ ‚Ú¤ıËΠÂÈÔÏ·ÛÌfi˜ ªÂÙ™˘Ó 50% (38). ™ÙÔÓ ∫·Ó·‰¿, ÙËÓ ›‰È· ÂÚ›Ô‰Ô, Û ·ÓÙÈÚÔÛˆ¢ÙÈÎfi ‰Â›ÁÌ· 2244 ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ, ËÏÈΛ·˜ 9, 13 Î·È 16 ÂÙÒÓ, Ô ÂÈÔÏ·ÛÌfi˜ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ·ÓÙ›ÛÙ·Û˘ ÛÙËÓ ÈÓÛÔ˘Ï›ÓË ‚Ú¤ıËΠ11,5% (39). ¶·¯˘Û·ÚΛ· ∏ ·¯˘Û·ÚΛ· ·ÔÙÂÏ› ·ÚÈÔ ÁÓÒÚÈÛÌ· ÙÔ˘ ªÂÙ™˘Ó Î·È Û˘Óԉ‡ÂÙ·È Û˘¯Ó¿ ·fi ¿ÏÏÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘, fiˆ˜ Â›Ó·È Ù· ·˘ÍË̤ӷ ÏÈ›‰È· ÔÚÔ‡ ·›Ì·ÙÔ˜, ÙÔ Û¿Î¯·ÚÔ Î·È Ô Û·Î¯·Ú҉˘ ‰È·‚‹Ù˘ Ù‡Ô˘ 2 (40). ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, ÔÛÔÛÙfi 33% fiÏˆÓ ÙˆÓ ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ ‚Ú¤ıËΠӷ Â›Ó·È ˘¤Ú‚·Ú· Î·È ·¯‡Û·Úη Û‡Ìʈӷ Ì ÙÔÓ ¢ª™, ÂÓÒ ÙÔ 51% ÂÎÂ›ÓˆÓ Ì ªÂÙ™˘Ó ‹Ù·Ó ·¯‡Û·Úη. ªÂ ÎÂÓÙÚÈ΋ ·¯˘Û·ÚΛ· ‚Ú¤ıËΠÙÔ 62% ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ Ì ªÂÙ™˘Ó. ∂ÈϤÔÓ, Ù· ·¯‡Û·Úη ·È‰È¿ Î·È ÔÈ ¤ÊË‚ÔÈ ‚Ú¤ıËÎ·Ó Ó· ¤¯Ô˘Ó 85 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚÔ Î›Ó‰˘ÓÔ Ó· ·Ó·Ù‡ÍÔ˘Ó ªÂÙ™˘Ó, Û ۯ¤ÛË Ì ٷ Ê˘ÛÈÔÏÔÁÈο. ∞fi ÙË ÌÂϤÙË NHANES 1999-2000 (10), ÙÔ 32% ÙˆÓ ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ, Û‡Ìʈӷ Ì ÙÔÓ ¢ª™, ‚Ú¤ıËΠӷ ¤¯Ô˘Ó ªÂÙ™˘Ó (36). ™ÙË ‰ÂηÂÙ›· ÙÔ˘ 1990, Ô ÂÈÔÏ·ÛÌfi˜ ˘¤Ú‚·ÚˆÓ Î·È ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ ËÏÈΛ·˜ 5-17 ÂÙÒÓ ÚÔÛÂÁÁ›˙ÂÈ ·ÁÎÔÛÌ›ˆ˜ ÙÔ 10%, Ì ÙËÓ ∞ÌÂÚÈ΋ Î·È ÙËÓ ∂˘ÚÒË Ó· ˘ÂÚ‚·›ÓÔ˘Ó ÙÔ 20% (34). ™ÙËÓ Paediatriki 2007;70:24-36

∂ÏÏ¿‰· ‹Ù·Ó 23% Î·È ÛÙȘ ∏¶∞ 26% (41), ÂÓÒ ÛÙËÓ πÙ·Ï›· ‚Ú¤ıËΠÙÔ ˘„ËÏfiÙÂÚÔ ÔÛÔÛÙfi (36%) (42). ªÂϤÙË ÏËı˘ÛÌȷ΋˜ Ù¿Û˘ Û ·ÁfiÚÈ· Ù˘ ∫Ú‹Ù˘ ËÏÈΛ·˜ 9-16 ÂÙÒÓ, ¤‰ÂÈÍ fiÙÈ Î·Ù¿ ÙÔ ‰È¿ÛÙËÌ· 1982-2002, ·˘Í‹ıËÎ·Ó Ù· ˘¤Ú‚·Ú· Î·È ·¯‡Û·Úη ·fi 20% Û 40% (43). ∏ ÚfiÏË„Ë Ù˘ ·¯˘Û·ÚΛ·˜ ı· Ú¤ÂÈ Ó· ·Ú¯›˙ÂÈ ·fi ÙË ‚ÚÂÊÈ΋ ËÏÈΛ· (40). √ ıËÏ·ÛÌfi˜, Ë ·Ú·‰ÔÛȷ΋ ÂÏÏËÓÈ΋ ‰È·ÙÚÔÊ‹ Î·È Ë ¿ÛÎËÛË Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈο ̤۷ ÚfiÏ˄˘ Î·È ·ÓÙÈÌÂÙÒÈÛ˘ Ù˘ ·¯˘Û·ÚΛ·˜ Î·È ÙÔ˘ ªÂÙ™˘Ó. ªÂ ·˘ÙfiÓ ÙÔÓ ÙÚfiÔ ÌÔÚ› Ó· ÌÂȈı› Ô Î›Ó‰˘ÓÔ˜ ÁÈ· ηډȷο ÓÔÛ‹Ì·Ù· ηٿ 35-55% (40,42,44-46). §ÈÔÚˆÙ½Ó˜ Î·È Û¿Î¯·ÚÔ ÔÚÔ‡ ·›Ì·ÙÔ˜ ™Ù· ·È‰È¿ Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜ Ì ªÂÙ™˘Ó, ÔÛÔÛÙfi 68% ‚Ú¤ıËΠ̠·˘ÍË̤ӷ Â›‰· ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ, 66% Ì ¯·ÌËÏ‹ HDL-C, ÂÓÒ Â›¯·Ó ÂÚ›Ô˘ 3,2 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚÔ Î›Ó‰˘ÓÔ ÁÈ· ·ıÔÏÔÁÈο Â›‰· LDL-C. ∆· ˘„ËÏ¿ Â›‰· ÏÈÔÚˆÙÂ˚ÓÒÓ Î·È Û·Î¯¿ÚÔ˘, fiˆ˜ Î·È Ë ·¯˘Û·ÚΛ·, Û¯ÂÙ›˙ÔÓÙ·È ¿ÌÂÛ· Ì ÙË ‰È·ÙÚÔÊ‹ Î·È ÙË ÛˆÌ·ÙÈ΋ ¿ÛÎËÛË. ∏ ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË ·˘Í¿ÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ÁÈ· ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘ ηٿ 2,4 ÊÔÚ¤˜, ÂÓÒ Ë ÛˆÛÙ‹ ‰È·ÙÚÔÊ‹, ÛÂ Û˘Ó‰˘·ÛÌfi Ì ¿ÏÏÔ˘˜ ·Ú¿ÁÔÓÙ˜, Û˘Ì‚¿ÏÏÂÈ ÛËÌ·ÓÙÈο ÛÙË Ì›ˆÛ‹ Ù˘ (47). ÕÙÔÌ· Ì ˘„ËÏ¿ Â›‰· ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ Î·È ¯·ÌËÏ‹ HDL-C Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÔ˘Ó ÌÈÎÚ¤˜ ÔÛfiÙËÙ˜ ÎÔÚÂÛÌ¤ÓˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ Î·È ¯ÔÏËÛÙÂÚfiÏ˘ ÙÚÔÊ‹˜, Ó· ÂÚÈÔÚ›˙Ô˘Ó ÙËÓ ÂÓ¤ÚÁÂÈ· Ô˘ Ï·Ì‚¿ÓÔ˘Ó ·Ó¿ÏÔÁ· Ì ÙÔ ‚¿ÚÔ˜ ÙÔ˘˜ Î·È Ó· ¤¯Ô˘Ó ηıËÌÂÚÈÓ‹ ۈ̷ÙÈ΋ ¿ÛÎËÛË Ì ̤ÙÚÈÔ ÚÔ˜ ¤ÓÙÔÓÔ Ú˘ıÌfi (47).

33

ªÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ Û ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜

™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, ÙÔ ·˘ÍË̤ÓÔ Û¿Î¯·ÚÔ, ˆ˜ ¤Ó‰ÂÈÍË ‰È·Ù·Ú·¯‹˜ Ù˘ ۷ί·Ú·ÈÌÈ΋˜ ηÌ‡Ï˘, ·ÚÔ˘ÛÈ¿˙ÂÈ ÙË ¯·ÌËÏfiÙÂÚË Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ (26%) Û ۯ¤ÛË Ì ÙÔ˘˜ ˘fiÏÔÈÔ˘˜ Ù¤ÛÛÂÚȘ ·Ú¿ÁÔÓÙ˜. ∏ ηٿÏÏËÏË ‰È·ÙÚÔÊ‹ Î·È Ë ÛˆÌ·ÙÈ΋ ¿ÛÎËÛË Â›Ó·È Ù· ÌÔÓ·‰Èο ̤۷ ÁÈ· ÙËÓ ·‡ÍËÛË Ù˘ ¢·ÈÛıËÛ›·˜ ÛÙË ‰Ú¿ÛË Ù˘ ÈÓÛÔ˘Ï›Ó˘. ŒÙÛÈ ÂÏ·ÙÙÒÓÔÓÙ·È Ù· Â›‰· ۷ί¿ÚÔ˘, ÂÓÒ Ì ÙËÓ ·ÓÙÈηٿÛÙ·ÛË ÙÔ˘ ÎÔÚÂṲ̂ÓÔ˘ Ï›Ô˘˜ Ì ÌÔÓÔ·ÎfiÚÂÛÙÔ ·fi ÂÏ·ÈfiÏ·‰Ô, ·˘Í¿ÓÂÙ·È Ë Â˘·ÈÛıËÛ›· ÙˆÓ ÈÛÙÒÓ ÛÙË ‰Ú¿ÛË Ù˘ ÈÓÛÔ˘Ï›Ó˘, ÌÂ Û˘Ó¤ÂÈ· ÙËÓ ÂÏ¿ÙÙˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË Ù‡Ô˘ 2 (3,15). ∂›Û˘, Ë Î·Ù·Ó¿ÏˆÛË ÙÚÔÊ›ÌˆÓ Ì ˘„ËÏfi ÁÏ˘Î·ÈÌÈÎfi ‰Â›ÎÙË Û¯ÂÙ›˙ÂÙ·È Ì ·‡ÍËÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË Ù‡Ô˘ 2 (48). ™ÙË ÌÂϤÙË Framingham, Û ÂÓ‹ÏÈΘ Ì ªÂÙ™˘Ó ‚Ú¤ıËΠ¯·ÌËÏfiÙÂÚË Î·Ù·Ó¿ÏˆÛË ‰ËÌËÙÚÈ·ÎÒÓ Ì ‰È·ÈÙËÙÈΤ˜ ›Ó˜, Û ۯ¤ÛË Ì ¿ÙÔÌ· ¯ˆÚ›˜ ªÂÙ™˘Ó. √ ÂÈÔÏ·ÛÌfi˜ ÙÔ˘ ªÂÙ™˘Ó Û¯ÂÙÈ˙fiÙ·Ó ıÂÙÈο Ì ÙËÓ ·‡ÍËÛË ÙÔ˘ ÁÏ˘Î·ÈÌÈÎÔ‡ ‰Â›ÎÙË ÙˆÓ ÙÚÔÊ›ÌˆÓ Ô˘ Î·Ù·Ó¿ÏˆÓ·Ó (49). ∞ÚÙËÚȷ΋ ›ÂÛË ·›Ì·ÙÔ˜ ∏ ˘¤ÚÙ·ÛË Â›¯Â ÙË ÌÂÁ·Ï‡ÙÂÚË Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ Ì ÔÛÔÛÙfi 96% ÛÙ· ·È‰È¿ Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜ Ì ªÂÙ™˘Ó. √ ÂÈÔÏ·ÛÌfi˜ Ù˘ ıˆÚÂ›Ù·È ·ÚÎÂÙ¿ ˘„ËÏfi˜ ÛÙȘ ·ÓÂÙ˘Á̤Ó˜ ¯ÒÚ˜ Î·È ÚÔÛÂÁÁ›˙ÂÈ ÙÔ 30% ÙÔ˘ ÂÓ‹ÏÈÎÔ˘ ÏËı˘ÛÌÔ‡, ÂÓÒ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ë ˘¤ÚÙ·ÛË ‰ÈÏ·ÛÈ¿˙ÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ÁÈ· ηډÈÔ¿ıÂÈ· (15) ηٷ‰ÂÈÎÓ‡ÂÈ ÙËÓ ·Ó·ÁηÈfiÙËÙ· ÁÈ· ¤ÁηÈÚË ÌË Ê·Ú̷΢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË, Ì ‚ÂÏÙ›ˆÛË ÙÔ˘ ÙÚfiÔ˘ ˙ˆ‹˜, ‰È·ÙÚÔÊ‹˜ Î·È ¿ıÏËÛ˘ (50,51). ∏ Ì›ˆÛË ÙÔ˘ ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜, Ë ÂÚÈÔÚÈṲ̂ÓË Î·Ù·Ó¿ÏˆÛË ·Ï·ÙÈÔ‡, Ë ¯Ú‹ÛË ÌfiÓÔ ÂÏ·ÈÔÏ¿‰Ô˘, Ë ·˘ÍË̤ÓË Ï‹„Ë Î·Ï›Ô˘ ·fi Ï·¯·ÓÈο, ÊÚÔ‡Ù·, fiÛÚÈ· Î·È ·Ó¿Ï·ÙÔ˘˜ ÍËÚÔ‡˜ ηÚÔ‡˜, ηıÒ˜ Î·È Ë Î·ıËÌÂÚÈÓ‹ ̤ÙÚÈ· ÚÔ˜ ¤ÓÙÔÓË ÛˆÌ·ÙÈ΋ ¿ÛÎËÛË, ·ÔÙÂÏÔ‡Ó Î‡ÚȘ ÌÂıfi‰Ô˘˜ ÌË Ê·Ú̷΢ÙÈ΋˜ ·ÓÙÈÌÂÙÒÈÛ˘ (50). º˘ÛÈ΋ ¿ÛÎËÛË ∏ ¤ÏÏÂÈ„Ë ÛˆÌ·ÙÈ΋˜ ¿ÛÎËÛ˘ Û¯ÂÙ›˙ÂÙ·È ÛÙÂÓ¿ Ì ÙÔ ªÂÙ™˘Ó, ηıÒ˜ ·˘Í¿ÓÂÙ·È Ô Î›Ó‰˘ÓÔ˜ ÁÈ· ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË, ·¯˘Û·ÚΛ·, ˘¤ÚÙ·ÛË Î·È ‰˘ÛÏÈȉ·ÈÌ›· (15). ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, Ù· ·È‰È¿ Î·È ÔÈ ¤ÊË‚ÔÈ Ì ªÂÙ™˘Ó ‚Ú¤ıËÎ·Ó Ì ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚ˜ Èı·ÓfiÙËÙ˜ (ηٿ 30%) Ó· ¤¯Ô˘Ó ηϋ ηډÈÔ·Ó·Ó¢ÛÙÈ΋ ·ÓÙÔ¯‹. √È Ribeiro Î·È Û˘Ó (52) ·Ó·Ê¤ÚÔ˘Ó (·fi ÌÂϤÙË ÛÙËÓ ¶ÔÚÙÔÁ·Ï›·) fiÙÈ ·ÁfiÚÈ· ËÏÈΛ·˜ 815 ÂÙÒÓ, Ì ¯·ÌËÏ¿ Â›‰· ۈ̷ÙÈ΋˜ ¿ÛÎËÛ˘, ›¯·Ó ÂÚÈÛÛfiÙÂÚÔ˘˜ ·Ú¿ÁÔÓÙ˜ ªÂÙ™˘Ó. ∞ÎfiÌË,

·fi ÌÂϤÙË ÂÓËÏ›ÎˆÓ Ù˘ ∞ÙÙÈ΋˜, fiÛÔÈ ‰‹ÏˆÓ·Ó fiÙÈ ·ÛÎÔ‡ÓÙ·Ó Ì ̤ÙÚÈ· ¤ÓÙ·ÛË ‚Ú¤ıËÎ·Ó Ì 25% ¯·ÌËÏfiÙÂÚÔ Î›Ó‰˘ÓÔ ÁÈ· ·Ó¿Ù˘ÍË ªÂÙ™˘Ó (53). ∫¿ÓÈÛÌ· ∆Ô Î¿ÓÈÛÌ·, ·Ó Î·È ‰ÂÓ ÂÚÈÏ·Ì‚¿ÓÂÙ·È ϤÔÓ ÛÙÔ ªÂÙ™˘Ó (5), ·ÔÙÂÏ› ÚˆÙ‡ÔÓÙ· ·ıËÚÔÁfiÓÔ ·Ú¿ÁÔÓÙ· Î·È ‰Ú· ÛÂ Û˘Ó¤ÚÁÂÈ· Ì ÙÔ˘˜ ˘fiÏÔÈÔ˘˜. ¢ÂÓ ‚Ú¤ıËΠÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË Ó· Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ·ÚÔ˘Û›· ªÂÙ™˘Ó, ·Ú’ fiÏÔ Ô˘ ÔÛÔÛÙfi 12% ÙˆÓ ÂÊ‹‚ˆÓ ‰‹ÏˆÓ·Ó ηÓÈÛÙ¤˜. ∆Ô Î¿ÓÈÛÌ· Ô˘ ·Ú¯›˙ÂÈ Û˘Ó‹ıˆ˜ ·fi ÙËÓ ÂÊË‚È΋ ËÏÈΛ·, ·ÔÙÂÏ› ÙÔ ÛÔ‚·ÚfiÙÂÚÔ Úfi‚ÏËÌ· ‰ËÌfiÛÈ·˜ ˘Á›·˜ ·ÁÎÔÛÌ›ˆ˜ (13). ∞˘Í¿ÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ÁÈ· ηډÈÔ¿ıÂÈ· ηٿ 2,5 ÊÔÚ¤˜ (48), ÂÓÒ Â˘ı‡ÓÂÙ·È ÁÈ· ÙÔ 13% fiÏˆÓ ÙˆÓ ı·Ó¿ÙˆÓ Î·È ÁÈ· ÂÚ›Ô˘ 19-23 “¯·Ì¤Ó·” ¯ÚfiÓÈ· ˙ˆ‹˜ (54). ∏ ÛËÌ·Û›· Ù˘ ÂÎ·È‰Â˘ÙÈ΋˜ ·Ú¤Ì‚·Û˘ ÛÙË ‰È·ÎÔ‹ ‹ ÙËÓ ÂÏ¿ÙÙˆÛË ÙÔ˘ ηÓ›ÛÌ·ÙÔ˜ ·Ó·‰Â›¯ÙËΠ·fi Û¯ÂÙÈο ÚÔÁÚ¿ÌÌ·Ù· Ô˘ ÂÊ·ÚÌfiÛÙËÎ·Ó Û ۯÔÏ›· Ù˘ ∫Ú‹Ù˘ (19,55). ¢È·ÙÚÔÊ‹ Î·È ÌÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ ™‡Ìʈӷ Ì ÙÔÓ ¢À¢, Ë ‰È·ÙÚÔÊ‹ ÙˆÓ 2/3 ÙˆÓ ·È‰ÈÒÓ Î·È ÙˆÓ ÂÊ‹‚ˆÓ “¯ÚÂÈ¿˙ÂÙ·È ‚ÂÏÙ›ˆÛË”, ÙÔ 1/3 ¤¯ÂÈ “·ÓÂ·Ú΋” ‰È·ÙÚÔÊ‹ Î·È ÂÏ¿¯ÈÛÙÔ ÔÛÔÛÙfi (6%) ¤¯ÂÈ “ηϋ”. √ ¢À¢, ˆ˜ ̤ıÔ‰Ô˜ ÔÈÔÙÈ΋˜ ·ÍÈÔÏfiÁËÛ˘ Ù˘ ËÌÂÚ‹ÛÈ·˜ ‰È·ÙÚÔÊ‹˜, ˘ÔÏÔÁ›˙ÂÙ·È ·fi ÙÔÓ Û˘Ó‰˘·ÛÌfi Ù˘ Ï‹„˘ ıÚÂÙÈÎÒÓ Û˘ÛÙ·ÙÈÎÒÓ Î·È Î·Ù·Ó¿ÏˆÛ˘ ÙÚÔʛ̈Ó. ∂Ê·ÚÌfi˙ÂÙ·È Û ¯ÒÚ˜ Î·È ÏËı˘ÛÌÔ‡˜ Ì ‰È·ÊÔÚÂÙÈΤ˜ ‰È·ÈÙËÙÈΤ˜ Û˘Ó‹ıÂȘ, fiˆ˜ Ë πÛ·Ó›· (28), ÂÚÈÔ¯‹ Ì ÙËÓ ÔÔ›· Ë ∂ÏÏ¿‰· ¤¯ÂÈ ÎÔÈÓ¿ ¯·Ú·ÎÙËÚÈÛÙÈο ÁÓˆÚ›ÛÌ·Ù·, ÛÙÔ Ï·›ÛÈÔ È‰›ˆ˜ Ù˘ ·Ó·ÊÂÚfiÌÂÓ˘ ÌÂÛÔÁÂȷ΋˜ ‰È·ÙÚÔÊ‹˜. øÛÙfiÛÔ, Ô ¢À¢ Ú¤ÂÈ Ó· ·Ó·ÓÂÒÓÂÙ·È, Ó· ÙÚÔÔÔÈÂ›Ù·È Î·È Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ÂÎÙÈÌ‹ÛÂȘ Î·È ÁÈ· ÙËÓ Î·Ù·Ó¿ÏˆÛË ÌË ˘ÁÈÂÈÓÒÓ ÙÚÔÊ›ÌˆÓ (25,56). ™ÙȘ ∏¶∞, Ù· ·È‰È¿ Î·È ÔÈ ¤ÊË‚ÔÈ Î·Ù¿ Ù· ¤ÙË 1999-2000, ›¯·Ó ‚·ıÌÔÏÔÁ›· ¢À¢ 62,8, Ô˘ Â›Ó·È ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚË ·fi ÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ (¤ÏÂÁ¯Ô˜ Student, 62,8 ¤Ó·ÓÙÈ 58,7, p<0,001), Ì ÔÛÔÛÙfi 16% Ó· ¤¯ÂÈ “·ÓÂ·Ú΋” ‰È·ÙÚÔÊ‹ Î·È 10% “ηϋ” (25). ™ÙËÓ πÛ·Ó›· ÂÎÙÈÌ‹ıËΠfiÙÈ ·È‰È¿ ËÏÈΛ·˜ 6-7 ÂÙÒÓ Â›¯·Ó ‚·ıÌÔÏÔÁ›· 64,6, Ì 3,7% Ó· ¤¯ÂÈ “·ÓÂ·Ú΋” ‰È·ÙÚÔÊ‹ Î·È 1,6% “ηϋ” (28). °È· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Î·È ÙË ıÂÚ·›· ÙÔ˘ ªÂÙ™˘Ó, Ë ‰È·ÙÚÔÊ‹ Ú¤ÂÈ Ó· Â›Ó·È ¯·ÌËÏ‹ Û ÎÔÚÂṲ̂ӷ ÏÈ·Ú¿ Ôͤ· Î·È ÏÔ‡ÛÈ· Û ‰È·ÈÙËÙÈΤ˜ ›Ó˜ - ·fi ÙÚfiÊÈÌ· Ô˘ ¤¯Ô˘Ó ¯·ÌËÏfi ÁÏ˘Î·ÈÌÈÎfi ‰Â›ÎÙË - Î·È ÌÔÓÔ·ÎfiÚÂÛÙ· ÏÈ·Ú¿ Ôͤ· Ô˘ ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙÔ ÂÏ·ÈfiÏ·‰Ô (46). ∏ ÓËÛÙÂȷ΋ ‰›·ÈÙ· ¶·È‰È·ÙÚÈ΋ 2007;70:24-36

34

ª. §ÈÓ·Ú‰¿Î˘ Î·È Û˘Ó.

Ô˘ ηıÔÚ›˙ÂÙ·È ·fi ÙÔ˘˜ ηÓfiÓ˜ Ù˘ √Úıfi‰Ô͢ ∂ÏÏËÓÈ΋˜ ∂ÎÎÏËÛ›·˜ (40,57-59) ‚Ú¤ıËΠӷ ¤¯ÂÈ ÙËÓ ˘„ËÏfiÙÂÚË ÂÚÈÂÎÙÈÎfiÙËÙ· Û ۇÓıÂÙÔ˘˜ ˘‰·Ù¿ÓıڷΘ Ì ¯·ÌËÏfi ÁÏ˘Î·ÈÌÈÎfi ‰Â›ÎÙË, Ú¿ÁÌ· Ô˘ Û˘Ó¿‰ÂÈ Ì ÙȘ ‚·ÛÈΤ˜ Ô‰ËÁ›Â˜ Ô˘ ·ÊÔÚÔ‡Ó ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ªÂÙ™˘Ó (46,60). ∂ÈϤÔÓ, ·fi ÙÔ˘˜ Davy Î·È Melby (60) ÂȂ‚·ÈÒÓÂÙ·È fiÙÈ ‰È·ÙÚÔÊ‹ ˘„ËÏ‹ Û ۇÓıÂÙÔ˘˜ ˘‰·Ù¿ÓıڷΘ Î·È ¯·ÌËÏ‹ Û ÏÈ·Ú¿, ÌÂÈÒÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ÁÈ· ¯ÚfiÓȘ ·Ûı¤ÓÂȘ, ÂÓÒ Ë Ï‹„Ë ‰È·ÈÙËÙÈÎÒÓ ÈÓÒÓ, fiˆ˜ ηıÔÚ›˙ÂÙ·È ·fi ÙÔ American Dietetic Association, Â›Ó·È Â˘ÂÚÁÂÙÈ΋ ÁÈ· ÙËÓ ÚfiÏË„Ë Î·È ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ªÂÙ™˘Ó, ·ÊÔ‡ Ô‰ËÁ› ÛÙË Ì›ˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ıÚÔÌ‚ÔÁ¤ÓÂÛ˘.

™˘ÌÂÚ¿ÛÌ·Ù· ∞Ó Î·È Ë Û˘¯ÓfiÙËÙ· ÙÔ˘ ªÂÙ™˘Ó ‚Ú¤ıËΠ¯·ÌËÏfiÙÂÚË Û ۯ¤ÛË Ì ¿ÏϘ ‰ÈÂıÓ›˜ ÌÂϤÙ˜, Ë ·ÓËÛ˘¯›· ÁÈ· ˘„ËÏ‹ Â›ÙˆÛ‹ ÙÔ˘ ÛÙÔÓ ÎÚËÙÈÎfi ·È‰ÈÎfi Î·È ÂÊË‚ÈÎfi ÏËı˘ÛÌfi ·Ú·Ì¤ÓÂÈ, ·ÊÔ‡ ‚Ú¤ıËÎ·Ó Û ˘„ËÏ‹ Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ÔÚÈṲ̂Ó˜ Û˘ÓÈÛÙÒÛ˜ ÙÔ˘, fiˆ˜ Ë ·˘ÍË̤ÓË ·ÚÙËÚȷ΋ ›ÂÛË Î·È Ë ·¯˘Û·ÚΛ·. ∏ ÏÂÈÔÓfiÙËÙ· ÙˆÓ ·È‰ÈÒÓ Â›¯Â ‰È·ÙÚÔÊ‹ Ô˘ “¯ÚÂÈ¿˙ÂÙ·È ‚ÂÏÙ›ˆÛË”, ÂÓÒ ‹Ù·Ó Ôχ ¯·ÌËÏfi ÙÔ ÔÛÔÛÙfi ÙˆÓ ·È‰ÈÒÓ Î·È ÙˆÓ ÂÊ‹‚ˆÓ Ì “ηϋ” ÔÈÔÙÈÎÒ˜ ‰È·ÙÚÔÊ‹. ∆fiÛÔ Ë “·ÓÂ·Ú΋˜” ‰È·ÙÚÔÊ‹ fiÛÔ Î·È ·˘Ù‹ Ô˘ “¯ÚÂÈ¿˙ÂÙ·È ‚ÂÏÙ›ˆÛË”, ÔÊ›ÏÔÓÙ·È Î˘Ú›ˆ˜ ÛÙË ¯·ÌËÏ‹ ηٷӿψÛË ÊÚÔ‡ÙˆÓ, Ï·¯·ÓÈÎÒÓ Î·È ÔÛÚ›ˆÓ, ÂÓÒ ˘„ËÏ‹ ‹Ù·Ó Ë Ï‹„Ë ÎÔÚÂṲ̂ÓÔ˘ Ï›Ô˘˜ Î·È ÎÚ¤·ÙÔ˜. ∏ ÚˆÙÔÁÂÓ‹˜ ÚfiÏË„Ë Â›Ó·È Ô ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂÚÔ˜ ÙÚfiÔ˜ ÂÏ¿ÙÙˆÛ˘ Ù˘ Û˘¯ÓfiÙËÙ·˜ ÂÌÊ¿ÓÈÛ˘ ÙÔ˘ ªÂÙ™˘Ó (36). ∫·Ù¿ÏÏËÏ· ÂÎ·È‰Â˘ÙÈο ÚÔÁÚ¿ÌÌ·Ù· Ô˘ ¢·ÈÛıËÙÔÔÈÔ‡Ó Ù· ·È‰È¿ Û ı¤Ì·Ù· ˘Á›·˜ Î·È ‰È·ÙÚÔÊ‹˜, ÌÔÚÔ‡Ó Ó· Û˘Ì‚¿ÏÏÔ˘Ó ÒÛÙ ӷ Á›ÓÔÓÙ·È Î·Ï‡ÙÂÚ˜ ÂÈÏÔÁ¤˜ fiÛÔÓ ·ÊÔÚ¿ ÛÙË ‰È·ÙÚÔÊ‹ Î·È ÛÙËÓ ·‡ÍËÛË Ù˘ ۈ̷ÙÈ΋˜ ¿ÛÎËÛ˘. ∂˘¯·ÚÈÛٛ˜ ∂˘¯·ÚÈÛÙԇ̠ıÂÚÌ¿ ÁÈ· ÙË ¯ÚËÌ·ÙÔ‰fiÙËÛË Ù˘ ÌÂϤÙ˘, ÙË °ÂÓÈ΋ °Ú·ÌÌ·Ù›· ∞ıÏËÙÈÛÌÔ‡, ÙÔ ÀÔ˘ÚÁÂ›Ô ¶·È‰Â›·˜ Î·È £ÚËÛÎÂ˘Ì¿ÙˆÓ, ÙËÓ ÂÙ·ÈÚ›· Kellogg’s, ηıÒ˜ Î·È ÙȘ ‰ËÌÔÙÈΤ˜ ·˘ÙÔ‰ÈÔÈ΋ÛÂȘ ÙˆÓ ¢‹ÌˆÓ ƒÔ‡‚· Î·È ÃÂÚÛÔÓ‹ÛÔ˘ ∏Ú·ÎÏ›Ԣ. ∂›Û˘, Û˘Ó¤‚·Ï·Ó ·ÔÙÂÏÂÛÌ·ÙÈο ÔÈ Û˘ÓÂÚÁ¿Ù˜: ª·Ú›· ªÈÙÛÒÚË, πˆ¿ÓÓ· ∞ÔÛÙÔÏ¿ÎË, ∞ÁÁÂÏÈ΋ ¶··‰¿ÎË Î·È ¢ËÌ‹ÙÚ˘ ∞ı·Ó·ÛfiÔ˘ÏÔ˜.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications.

Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 1998;15:539-553.

Paediatriki 2007;70:24-36

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∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞

ORIGINAL ARTICLE

37

√ ÚfiÏÔ˜ ÙˆÓ ¿Ù˘ˆÓ ‚·ÎÙËÚ›ˆÓ ÛÙÔÓ ¯ÚfiÓÈÔ ‚‹¯· Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ π.ª. µÂÏÈÛÛ·Ú›Ô˘, ¡.°. ¶··‰fiÔ˘ÏÔ˜, M. ∆ÛÔÏÈ¿, ª. °È·ÓÓ¿ÎË, º. ™·ÍÒÓË-¶··ÁˆÚÁ›Ô˘, ¢.∞. ∫·ÊÂÙ˙‹˜ ¶ÂÚ›ÏË„Ë: ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ Â›Ó·È Ë ‰ÈÂÚ‡ÓËÛË ÙÔ˘ ÚfiÏÔ˘ ÙÔ˘ Ì˘ÎÔÏ¿ÛÌ·ÙÔ˜ Î·È ÙÔ˘ ¯Ï·Ì˘‰›Ô˘ Ù˘ Ó¢ÌÔÓ›·˜ ÛÙÔÓ ·È‰ÈÎfi ÏËı˘ÛÌfi Ì ¯ÚfiÓÈÔ ‹/Î·È ˘ÔÙÚÔÈ¿˙ÔÓÙ· ‚‹¯· Î·È Ë ·ÍÈÔÏfiÁËÛË Ù˘ ÎÏÈÓÈ΋˜ ·¿ÓÙËÛ˘ ÙˆÓ ·ÛıÂÓÒÓ ·˘ÙÒÓ ÛÙËÓ ·Ó¿ÏÔÁË ıÂÚ·›·. ∂Í‹ÓÙ· ÂÙ¿ ·È‰È¿, ·fi 2,5 ¤ˆ˜ 16 ÂÙÒÓ, Ì ¯ÚfiÓÈÔ ‹ ˘ÔÙÚÔÈ¿˙ÔÓÙ· ‚‹¯· Û˘ÌÂÚÈÂÏ‹ÊıËÛ·Ó ÛÙË ÌÂϤÙË. ∞ÓÙÈÛÒÌ·Ù· ÁÈ· Mycoplasma pneumoniae (M. pneumoniae) Î·È Chlamydia pneumoniae (C. pneumoniae) ·ÓȯÓ‡ıËÎ·Ó Û ‰Â›ÁÌ· ÔÚÔ‡ ÙˆÓ ·ÛıÂÓÒÓ ·˘ÙÒÓ Ì ‰‡Ô ¢ڤˆ˜ ‰È·‰Â‰Ô̤Ó˜ ÌÂıfi‰Ô˘˜, ÙËÓ ELISA (enzyme-linked immunosorbent assay) Î·È ÙÔÓ ¤ÌÌÂÛÔ ·ÓÔÛÔÊıÔÚÈÛÌfi (IFA). √È ·ÛıÂÓ›˜ Ì ıÂÙÈο ·ÓÙÈÛÒÌ·Ù· IgM ÁÈ· M. pneumoniae ‹ C. pneumoniae Î·È ·ÓÂ·Ú΋ ·ÓÙ·fiÎÚÈÛË ÛÙËÓ ·ÓÙÈ·ÛıÌ·ÙÈ΋ ·ÁˆÁ‹, ¤Ï·‚·Ó ÎÏ·ÚÈıÚÔÌ˘Î›ÓË ·fi ÙÔ ÛÙfiÌ·. ∂›ÎÔÛÈ ·ÛıÂÓ›˜ (29,9%) ¤·Û¯·Ó ·fi ÔÍ›· Ì˘ÎÔÏ·ÛÌ·ÙÈ΋ Ïԛ̈ÍË Î·È 4 (6,0%) ·fi ÔÍ›· ¯Ï·Ì˘‰È·Î‹ Ïԛ̈ÍË, ÂÓÒ ¤Ó· ·È‰› ›¯Â Ù·˘Ùfi¯ÚÔÓ· Î·È ÙȘ ‰‡Ô ÏÔÈÌÒÍÂȘ. ∞fi ÙÔ˘˜ 23 ÔÚÔıÂÙÈÎÔ‡˜ ·ÛıÂÓ›˜, ÔÈ 9 (39,1%) ¤·Û¯·Ó ·fi ÔÍ›· Ì˘ÎÔÏ·ÛÌ·ÙÈ΋/¯Ï·Ì˘‰È·Î‹ Ïԛ̈ÍË ÌfiÓÔ, ÂÓÒ ÔÈ ˘fiÏÔÈÔÈ 14 (60,8%) ·fi Û˘Ó‰˘·ÛÌfi ¿ÛıÌ·ÙÔ˜ ‹/Î·È ÚÈÓ›Ùȉ·˜/·Ú·ÚÚÈÓÔÎÔÏ›Ùȉ·˜. ∏ ¯ÔÚ‹ÁËÛË ÎÏ·ÚÈıÚÔÌ˘Î›Ó˘ Ê·›ÓÂÙ·È ˆ˜ ‹Ù·Ó ·ÔÙÂÏÂÛÌ·ÙÈ΋ ÛÙËÓ ÂÍ¿ÏÂÈ„Ë ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÛÙ· 15 ·È‰È¿ (65,2%), ÂÓÒ 8 ·ÛıÂÓ›˜ (34,7%) ‚ÂÏÙÈÒıËÎ·Ó ¯ˆÚ›˜ Ï‹„Ë Ì·ÎÚÔÏȉÒÓ. ∏ ÔÍ›· Ì˘ÎÔÏ·ÛÌ·ÙÈ΋/¯Ï·Ì˘‰È·Î‹ Ïԛ̈ÍË Â›Ó·È Û˘¯Ó‹ ÛÙ· ·È‰È¿ Ì ¯ÚfiÓÈÔ ‹ ˘ÔÙÚÔÈ¿˙ÔÓÙ· ‚‹¯· Î·È Ê·›ÓÂÙ·È fiÙÈ ·ÓÙ·ÔÎÚ›ÓÂÙ·È Î·Ï¿ ÛÙË ¯ÔÚ‹ÁËÛË ÎÏ·ÚÈıÚÔÌ˘Î›Ó˘.

2Ë ¶·ÓÂÈÛÙËÌȷ΋ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞ÁÏ·˝· ∫˘ÚÈ·ÎÔ‡”, £Ë‚ÒÓ Î·È §Â‚·‰Â›·˜, ∞ı‹Ó· AÏÏËÏÔÁÚ·Ê›·: πˆ¿ÓÓ· ª. µÂÏÈÛÛ·Ú›Ô˘, jane_vel@hotmail.com ∞ÌÊÈÙÚ›Ù˘ 3, ¶·Ï·Èfi º¿ÏËÚÔ, ∆.∫. 175 61, ∞ı‹Ó·

§¤ÍÂȘ ÎÏÂȉȿ: ÕÙ˘Ë Ïԛ̈ÍË, Ì˘ÎfiÏ·ÛÌ·, ·È‰È¿, ¯ÚfiÓÈÔ˜ ‚‹¯·˜.

The role of mycoplasmal/chlamydial infection in chronic cough in children I.M. Velissariou, N.G. Papadopoulos, M. Giannaki, P. Saxoni-Papageorgiou, D.A. Kafetzis Abstract Objectives: The aim of this study was to assess the role of recent mycoplasmal/chlamydial infection in children with a chronic cough, and to evaluate the clinical response to treatment with clarithromycin.

Methods: Sixty-seven children, aged 2.5 to 16 years, with chronic or recurrent cough were enrolled in the study. A serum sample from each child was processed for Mycoplasma pneumoniae and Chlamydia pneumoniae antibody status, using two widely approved methods, the enzyme-linked immunosorbent assay (ELISA) and the immunofluorescence assay (IFA). Clarithromycin was prescribed for children with positive IgM M. pneumoniae and/or C. pneumoniae antibodies, according to their response to antiasthmatic treatment.

Results: Twenty patients (29.9%) had evidence of recent mycoplasmal infection and 4 (6.0%) of recent chlamydial infection, with one child having both mycoplasmal and chlamydial infection. Of the 23 positive patients, 9 (39.1%) had recent mycoplasmal/chlamydial infection only, while in 14 (60.8%) the atypical bacterial infection was in addition to asthma or rhino-sinusitis. Clarithromycin treatment was effective in diminishing symptoms in 15 (65.2%) children, while 8 patients (34.7%) improved without it.

Conclusions: Chronic or recurrent cough in children is commonly due to recent mycoplasmal/ chlamydial infection and tends to respond well to clarithromycin.

2nd Pediatric Clinic, University of Athens “P. & A. Kyriakou” Children’s Hospital, Athens Correspondence: Ioanna M. Velissariou, jane_vel@hotmail.com 3, Amphitritis St., 175 61, Athens, Greece

Key words: Atypical respiratory infection, mycoplasma, chronic cough.

∂ÈÛ·ÁˆÁ‹ ∆Ô Ì˘ÎfiÏ·ÛÌ· Î·È ÙÔ ¯Ï·Ì‡‰ÈÔ Ù˘ Ó¢ÌÔÓ›·˜ ·ÔÙÂÏÔ‡Ó ÁÓˆÛÙÔ‡˜ ·ÈÙÈÔÏÔÁÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ¿Ù˘˘ Ó¢ÌÔÓ›·˜ Û ·È‰È¿ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜, ·ÏÏ¿ Î·È Û Ó·ÚÔ‡˜ ÂÓ‹ÏÈΘ

(1,2). ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, ‰ÈÂÍ¿ÁÔÓÙ·È ÌÂϤÙ˜ Ô˘ ÛÙfi¯Ô ¤¯Ô˘Ó Ó· ·ÔÛ·ÊËÓ›ÛÔ˘Ó ÙËÓ Èı·Ó‹ Û¯¤ÛË ÌÂٷ͇ ‚ÚÔÁ¯È΋˜ ˘ÂÚ··ÓÙËÙÈÎfiÙËÙ·˜ Î·È ÈÔÁÂÓÒÓ ‹ Ì˘ÎÔÏ·ÛÌ·ÙÈÎÒÓ ÏÔÈÌÒÍÂˆÓ (1,3,4). ¶·È‰È·ÙÚÈ΋ 2007;70:37-41

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π.ª. µÂÏÈÛÛ·Ú›Ô˘ Î·È Û˘Ó.

√ ¯ÚfiÓÈÔ˜ ‚‹¯·˜ ·ÔÙÂÏ› Û¯ÂÙÈο Û˘¯Ófi Û‡Ìو̷ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜, ÚÔηÏÒÓÙ·˜ ÛËÌ·ÓÙÈÎÔ‡ ‚·ıÌÔ‡ ÂÓfi¯ÏËÛË ÛÙÔÓ ¿Û¯ÔÓÙ·, Ì ·ÔÙ¤ÏÂÛÌ· ·˘ÍË̤ÓË ·ÓËÛ˘¯›· ÙˆÓ ÁÔÓ¤ˆÓ Î·È Û˘¯Ó¤˜ ·Ô˘Û›Â˜ ·fi ÙÔ Û¯ÔÏÂ›Ô (5). ŸÛÔÓ ·ÊÔÚ¿ ÙËÓ ·ÈÙÈÔÏÔÁ›· ÙÔ˘, ϤÁÂÙ·È fiÙÈ ÔÔÈ·‰‹ÔÙ ¿ıËÛË ÙÔ˘ Ó‡ÌÔÓ· ÌÔÚ› Ó· ÚÔηϤÛÂÈ ¯ÚfiÓÈÔ ‹ ˘ÔÙÚÔÈ¿˙ÔÓÙ· ‚‹¯· ÛÙ· ·È‰È¿, ·Ó Î·È ÔÈ Û˘¯ÓfiÙÂÚ˜ ·Èٛ˜ Â›Ó·È ÙÔ ¿ÛıÌ·, Ë ÚÈÓ›Ùȉ·, Ë ·Ú·ÚÚÈÓÔÎÔÏ›Ùȉ·, ÔÈ ÏÔÈÌÒÍÂȘ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Î·È ÔÈ ·Ó·ÙÔÌÈΤ˜ ·ÓˆÌ·Ï›Â˜ ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ (5,6). √ ÔÚÈÛÌfi˜ ÙÔ˘ ¯ÚfiÓÈÔ˘ ‚‹¯·, Â›Û˘, ÔÈΛÏÂÈ, ·Ó Î·È ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ ÂÚ¢ÓËÙ¤˜ ıˆÚÔ‡Ó ¯ÚfiÓÈÔ ÙÔÓ ‚‹¯· Ô˘ ‰È·ÚΛ ÂÚÈÛÛfiÙÂÚÔ ·fi 3 ‚‰ÔÌ¿‰Â˜ (5,6). ∆fiÛÔ ÔÈ Ì˘ÎÔÏ·ÛÌ·ÙÈΤ˜, fiÛÔ Î·È ÔÈ ¯Ï·Ì˘‰È·Î¤˜ ÏÔÈÌÒÍÂȘ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ ÂΉËÏÒÓÔÓÙ·È Ôχ Û˘¯Ó¿ Ì ‚‹¯·. øÛÙfiÛÔ, Ë ÌÂÁ·Ï‡ÙÂÚË ‰˘ÛÎÔÏ›· ÛÙË Û˘Û¯¤ÙÈÛË Ì˘ÎÔÏ·ÛÌ·ÙÈ΋˜/¯Ï·Ì˘‰È·Î‹˜ Ïԛ̈͢ Î·È ¯ÚfiÓÈÔ˘ ‚‹¯· ÛÙ· ·È‰È¿ ¤ÁÎÂÈÙ·È ÛÙ· ÌË ÂȉÈο, Û˘¯Ó¿ Û˘ÌÙÒÌ·Ù· Î·È ÛÙËÓ ÂÚÈÏÔÎfiÙËÙ· Ù˘ ‚·ÎÙËÚÈÔÏÔÁÈ΋˜ ‰È¿ÁÓˆÛ˘ (7-10). √ ÛÎÔfi˜ Ù˘ ÌÂϤÙ˘ ·˘Ù‹˜ ‹Ù·Ó Ó· ηıÔÚÈÛÙ› fiÛÔ Û˘¯Ó¿ Û¯ÂÙ›˙ÔÓÙ·È ÔÈ Ì˘ÎÔÏ·ÛÌ·ÙÈΤ˜/¯Ï·Ì˘‰È·Î¤˜ ÏÔÈÌÒÍÂȘ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Ì ¯ÚfiÓÈÔ ‚‹¯· ÛÙ· ·È‰È¿ Î·È Î·Ù¿ fiÛÔ ·ÓÙ·ÔÎÚ›ÓÔÓÙ·È ÛÙËÓ ·ÈÙÈÔÏÔÁÈ΋ ıÂÚ·›·.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ∞ÛıÂÓ›˜ ∆Ô ¿ÚıÚÔ ·˘Ùfi ·ÔÙÂÏ› ̤ÚÔ˜ Ì›·˜ ÚÔÔÙÈ΋˜ ÌÂϤÙ˘ 67 ·È‰ÈÒÓ Ì ¯ÚfiÓÈÔ ‹ ˘ÔÙÚÔÈ¿˙ÔÓÙ· ‚‹¯·, Ù· ÔÔ›· ·ÚÔ˘ÛÈ¿ÛÙËÎ·Ó ÛÙ· ∂͈ÙÂÚÈο π·ÙÚ›· ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ “∞ÁÏ·˝· ∫˘ÚÈ·ÎÔ‡” ÛÙÔ ‰È¿ÛÙËÌ· ÂÓfi˜ ¤ÙÔ˘˜. √È ·ÛıÂÓ›˜ ·˘ÙÔ› ·ÎÔÏÔ‡ıËÛ·Ó ¤Ó·Ó ‰È·ÁÓˆÛÙÈÎfi Î·È ıÂÚ·¢ÙÈÎfi ·ÏÁfiÚÈıÌÔ, Ô ÔÔ›Ô˜ ÂÚÈÂÏ¿Ì‚·Ó ÂÓ‰Âϯ‹ ¤ÏÂÁ¯Ô Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ (Ù·Ï·ÓÙÔÛÈÌÂÙÚ›· Î·È ÛÈÚÔ̤ÙÚËÛË ÚÈÓ Î·È ÌÂÙ¿ ·fi ‚ÚÔÁ¯Ô‰È·ÛÙÔÏ‹ Î·È ‚ÚÔÁ¯È΋ ÚfiÎÏËÛË ·‰ÂÓÔÛ›Ó˘, fiÔ˘ ¯ÚÂÈ¿ÛÙËÎÂ) Î·È ·ÚÔ˘ÛÈ¿˙ÂÙ·È ·ÏÏÔ‡. ø˜ ¯ÚfiÓÈÔ˜ ‚‹¯·˜ ÔÚ›ÛÙËÎÂ Ô ‚‹¯·˜ Ì ‰È¿ÚÎÂÈ· ¿Óˆ ÙˆÓ 3 Û˘Ó¯ÒÓ Â‚‰ÔÌ¿‰ˆÓ, ÂÓÒ ˆ˜ ˘ÔÙÚÔÈ¿˙ˆÓ, Ô ‚‹¯·˜ ‰È¿ÚÎÂÈ·˜ ÙÔ˘Ï¿¯ÈÛÙÔÓ 2 ‚‰ÔÌ¿‰ˆÓ Ô˘ ·ÚÔ˘ÛÈ¿˙ÂÈ ÙÔ˘Ï¿¯ÈÛÙÔÓ 3 ÂÂÈÛfi‰È· ηı’ ¤ÙÔ˜. ∞ÛıÂÓ›˜ ¿Û¯ÔÓÙ˜ ·fi ÁÓˆÛÙ¤˜ ·ı‹ÛÂȘ Ô˘ ÚÔηÏÔ‡Ó ¯ÚfiÓÈÔ ‚‹¯·, fiˆ˜ Ë ÈÓÔ΢ÛÙÈ΋ ÓfiÛÔ˜, Ë ‚ÚÔÁ¯ÔÓ¢ÌÔÓÈ΋ ‰˘ÛÏ·Û›·, ‚ÚÔÁ¯ÈÂÎٷۛ˜, Î.Ï., ·ÔÎÏ›ÛÙËÎ·Ó ·fi ÙË ÌÂϤÙË, fiˆ˜ Î·È ·È‰È¿ ÌÂ Ù˘ÈÎfi ÈÛÙÔÚÈÎfi Î·È Û˘Ìو̷ÙÔÏÔÁ›· ¿ÛıÌ·ÙÔ˜ (Û˘ÚÈÁÌfi˜, ·Ú¿Ù·ÛË ÂÎÓÔ‹˜), ‹ Ì ·ÎÙÈÓÔÁÚ·ÊÈο Â˘Ú‹Ì·Ù· ÏÔ‚Ò‰Ô˘˜ Ó¢ÌÔÓ›·˜. ∏ ¤Ú¢ӷ ÂÁÎÚ›ıËΠ·fi ÙËÓ ∂ÈÙÚÔ‹ ¢ÂÔÓÙÔÏÔÁ›·˜ ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ, ÂÓÒ ¤ÁÁÚ·ÊË Û˘ÁηٿıÂÛË Û˘ÌÌÂÙÔ¯‹˜ ˙ËÙ‹ıËΠ·fi fiÏÔ˘˜ ÙÔ˘˜ ÎˉÂÌfiÓ˜ ÙˆÓ ·ÛıÂÓÒÓ. ∫·Ù¿ ÙËÓ Â›ÛÔ‰Ô ÛÙË ÌÂϤÙË, fiÏ· Ù· ·È‰È¿ Î·È ÔÈ ÁÔÓ›˜ ÙÔ˘˜ Û˘ÌÏ‹ÚˆÛ·Ó ¤Ó· ÏÂÙÔÌÂÚ¤˜ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ fiÛÔÓ ·ÊÔÚ¿ ÙË ‰È¿ÚÎÂÈ· Î·È ÙËÓ ¤ÓÙ·ÛË ÙˆÓ Û˘Ìو̿وÓ, ÂÓÒ ·ÎÔÏÔ‡ıËÛÂ Ê˘ÛÈ΋ ÂͤٷÛË Î·È Ì¤ÙÚËÛË ÙˆÓ ·ÓıÚˆÔÌÂÙÚÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ. √ ¤ÏÂÁ¯Ô˜ Ù˘ ·ÙÔ›·˜ ÂÚÈÂÏ¿Ì‚·Ó Paediatriki 2007;70:37-41

‰ÂÚÌ·ÙÈΤ˜ ‰ÔÎÈ̷ۛ˜ Ó˘ÁÌÔ‡ Û 8 ÎÔÈÓ¿ ·ÏÏÂÚÁÈÔÁfiÓ· (ÂÏÈ¿, ·ÚÈÂÙ¿ÚÈ·, ·ÏÙÂÚÓ¿ÚÈ·, ÔÈÎȷ΋ ÛÎfiÓË, Ì›ÁÌ· ÁÚ·ÛȉÈÒÓ, Á¿Ù·, Û·ÏÔ˜ Î·È Ì›ÁÌ· ‰¤ÓÙÚˆÓ) (11), ÂÓÒ Ô ¤ÏÂÁ¯Ô˜ ·ÓÙÈÛˆÌ¿ÙˆÓ ÁÈ· M. pneumoniae Î·È C. pneumoniae ¤ÁÈÓ Û ÌÔÓfi ‰Â›ÁÌ· ÔÚÔ‡. ∞Ó›¯Ó¢ÛË ·ÓÙÈÛˆÌ¿ÙˆÓ ÁÈ· M. pneumoniae Î·È C. pneumoniae ™ÙË ÌÂϤÙË ·˘Ù‹ ÂÊ·ÚÌfiÛÙËÎ·Ó ‰‡Ô ¢ڤˆ˜ ‰È·‰Â‰Ô̤Ó˜ ̤ıÔ‰ÔÈ ·Ó›¯Ó¢Û˘ ·ÓÙÈۈ̿وÓ, Ë ELISA Î·È Ô ¤ÌÌÂÛÔ˜ ·ÓÔÛÔÊıÔÚÈÛÌfi˜. ∞Í›˙ÂÈ Ó· ÛËÌÂȈı› fiÙÈ ¤Ó·˜ ÌÂÁ¿ÏÔ˜ ·ÚÈıÌfi˜ ·ÛıÂÓÒÓ Î·ÙÔÈÎÔ‡Û ÂÎÙfi˜ ∞ıËÓÒÓ, Ì ·ÔÙ¤ÏÂÛÌ· Ó· ÌËÓ Â›Ó·È ¿ÓÙ· ÂÊÈÎÙ‹ Ë Ï‹„Ë ‰Â‡ÙÂÚÔ˘ ‰Â›ÁÌ·ÙÔ˜ ÔÚÔ‡, ÔfiÙÂ Ë ·Ó›¯Ó¢ÛË ÙˆÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ÂÚÈÔÚ›ÛÙËΠ۠¤Ó· ÌfiÓÔ ‰Â›ÁÌ·. ¢È¿ÁÓˆÛË ÔÍ›·˜ Ì˘ÎÔÏ·ÛÌ·ÙÈ΋˜ ‹ ¯Ï·Ì˘‰È·Î‹˜ Ïԛ̈͢ Ù¤ıËΠÛÙȘ ÂÚÈÙÒÛÂȘ fiÔ˘ Î·È ÔÈ ‰‡Ô ̤ıÔ‰ÔÈ ¤‰ÈÓ·Ó Û·ÊÒ˜ ıÂÙÈÎfi ·ÔÙ¤ÏÂÛÌ·. £ÂÙÈÎÔ› Ù›ÙÏÔÈ IgM ·ÓÙÈÛˆÌ¿ÙˆÓ ÁÈ· Ì˘ÎfiÏ·ÛÌ· ‹ ¯Ï·Ì‡‰ÈÔ Ù˘ Ó¢ÌÔÓ›·˜ ıˆڋıËÎ·Ó ÂÓ‰ÂÈÎÙÈÎÔ› ÚfiÛÊ·Ù˘ ¿Ù˘˘ Ïԛ̈͢. ÃÚËÛÈÌÔÔÈ‹ıËÎÂ Ë ELISA Ù˘ NovaTec Immunodiagnostica, Dietzenbach, GmBH, Germany (·ÚÈıÌfi˜ ÚÔ˚fiÓÙÔ˜ CHLG0510) ÁÈ· ·ÓÙÈÛÒÌ·Ù· IgG Î·È IgM, ÙfiÛÔ ÙÔ˘ Ì˘ÎÔÏ¿ÛÌ·ÙÔ˜, fiÛÔ Î·È ÙÔ˘ ¯Ï·Ì˘‰›Ô˘ Ù˘ Ó¢ÌÔÓ›·˜, Ì ̤ÙÚÈ· ¢·ÈÛıËÛ›· (<70%) Î·È Î·Ï‹ ÂȉÈÎfiÙËÙ· (70-90%) Î·È ÁÈ· ÙÔ˘˜ ‰‡Ô ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜ (12). ∆· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂıfi‰Ô˘ ·˘Ù‹˜ ÂÎÊÚ¿˙ÔÓÙ·È Û ÌÔÓ¿‰Â˜ NovaTec (NTU), ˆ˜ ÂÍ‹˜: ·ÌÊ›‚ÔÏË ˙ÒÓË: 9-11 ¡∆U, ·ÚÓËÙÈÎfi ·ÔÙ¤ÏÂÛÌ·: <9 NTU, ıÂÙÈÎfi ·ÔÙ¤ÏÂÛÌ·: >11 NTU. ∞Ó¿ÏÔÁË ‰È·ÁÓˆÛÙÈ΋ ·ÎÚ›‚ÂÈ· ÂÈÙ˘Á¯¿ÓÂÙ·È Î·È Ì ÙÔÓ ·ÓÔÛÔÊıÔÚÈÛÌfi Ù˘ Biognost, Zagreb, Croatia (antibody assay E0001), ÁÈ· IgG Î·È IgM Î·È ÙˆÓ ‰‡Ô ÌÈÎÚÔÔÚÁ·ÓÈÛÌÒÓ (13). ∏ ̤ıÔ‰Ô˜ ·˘Ù‹ ÂÊ·ÚÌfiÛÙËΠÂÈÎÔ˘ÚÈο ÚÔ˜ ÙËÓ ELISA, ÁÈ· ÙËÓ ÂȂ‚·›ˆÛË ÙˆÓ ıÂÙÈÎÒÓ Î·È ·ÚÓËÙÈÎÒÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ Î·È ÁÈ· ÙË ‰È·Ï‡ηÓÛË Ù˘ ·ÌÊ›‚ÔÏ˘ ˙ÒÓ˘. ∞Ó Î·È ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ ÂÚ¢ÓËÙ¤˜ ‰ÂÓ ‚·Û›˙Ô˘Ó ÙË ‰È¿ÁÓˆÛË ÛÙÔÓ IFA, ˆÛÙfiÛÔ Ë Ì¤ıÔ‰Ô˜ ·˘Ù‹ ¤¯ÂÈ 70% ¢·ÈÛıËÛ›· Î·È 70-90% ÂȉÈÎfiÙËÙ· Î·È ÁÈ· ÙÔ˘˜ ‰‡Ô ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜ (12,13). ∂Í¿ÏÏÔ˘, ˘¿Ú¯Ô˘Ó ÂÚ¢ÓËÙ¤˜ Ô˘ ıˆÚÔ‡Ó ÙÔÓ ·ÓÔÛÔÊıÔÚÈÛÌfi ˆ˜ ÙË Ì¤ıÔ‰Ô ÂÎÏÔÁ‹˜ ÁÈ· ÙË ‰È¿ÁÓˆÛË ÙÔ˘ C. pneumoniae (14). £ÂÙÈÎfi˜ ıˆÚÂ›Ù·È Ô Ù›ÙÏÔ˜ >1/160 ÁÈ· ÔÔÈ·‰‹ÔÙ ٿÍË ·ÓÔÛÔÛÊ·ÈÚÈÓÒÓ. £ÂÚ·¢ÙÈÎfi ÚˆÙfiÎÔÏÏÔ ∏ ·Ú¯È΋ ıÂÚ·¢ÙÈ΋ ÚÔÛ¤ÁÁÈÛË ÁÈ· fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜, ·ÓÂÍ¿ÚÙËÙ· ·fi Ù· ·ÔÙÂϤÛÌ·Ù· ÙˆÓ ÂÍÂÙ¿ÛˆÓ, Û˘Ó›ÛÙ·Ù·È Û ·ÓÙÈ·ÛıÌ·ÙÈ΋ ·ÁˆÁ‹ ÁÈ· 3 ‚‰ÔÌ¿‰Â˜ (Û˘Ó‰˘·ÛÌfi˜ ÂÈÛÓÂfiÌÂÓÔ˘ ‚2 ‰ÈÂÁ¤ÚÙË Ì·ÎÚ¿˜ ‰È¿ÚÎÂÈ·˜ ‰Ú¿Û˘ Î·È ÛÙÂÚÔÂȉԇ˜ Û ‰fiÛË ·Ó¿ÏÔÁË ÚÔ˜ ÙËÓ ËÏÈΛ·, ÁÈ· ̤ÙÚÈÔ, ÂÈ̤ÓÔÓ ¿ÛıÌ·). ∫·Ù¿ ÙËÓ Â·ÓÂͤٷÛË, ÔÈ ÂÚ¢ÓËÙ¤˜ ·ÍÈÔÏÔÁÔ‡Û·Ó ÙËÓ ÎÏÈÓÈ΋ ·ÓÙ·fiÎÚÈÛË ÛÙË ıÂÚ·›·, ÛÂ Û˘Ó‰˘·ÛÌfi Ì ٷ ·ÔÙÂϤÛÌ·Ù· ÙˆÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ÙˆÓ M. pneumoniae Î·È C. pneumoniae. √È ·ÛıÂÓ›˜ ÂΛÓÔÈ Ô˘ ‰ÂÓ ·Ó¤ÊÂÚ·Ó ÛËÌ·ÓÙÈ΋ ‚ÂÏÙ›ˆÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Ì ÙËÓ ·ÓÙÈ·ÛıÌ·ÙÈ΋ ·ÁˆÁ‹ Î·È ÙˆÓ ÔÔ›ˆÓ Ù· ·ÓÙÈÛÒÌ·Ù· ‹Ù·Ó ÂÓ‰ÂÈÎÙÈο ÔÍ›·˜ Ì˘ÎÔÏ·ÛÌ·ÙÈ΋˜/¯Ï·Ì˘‰È·Î‹˜ Ïԛ̈͢, ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó ÛÙË Û˘Ó¤¯ÂÈ· Ì ¯ÔÚ‹ÁËÛË ÎÏ·ÚÈıÚÔÌ˘Î›Ó˘ ·fi ÙÔ ÛÙfiÌ·, Û ‰fiÛË 15 mg/kg/Ë̤ڷ ÁÈ· 21 Ë̤Ú˜. ∂›Û˘, ÔÈ ·ÛıÂÓ›˜ Ô˘ ›¯·Ó ÛÙÔȯ›· ¿ÛıÌ·ÙÔ˜ ÛÙÔÓ ÏÂÈÙÔ˘ÚÁÈÎfi ¤ÏÂÁ¯Ô Ù˘ ·Ó·ÓÔ‹˜, ηıÒ˜ Î·È ·ÓÙÈÛÒÌ·Ù· ÂÓ‰ÂÈÎÙÈο ÔÍ›·˜ Ì˘ÎÔÏ·ÛÌ·ÙÈ΋˜/¯Ï·Ì˘‰È·Î‹˜ Ïԛ̈͢, ¤Ï·‚·Ó ·ÓÙÈ·ÛıÌ·ÙÈ΋ ·ÁˆÁ‹ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÎÏ·ÚÈıÚÔÌ˘Î›ÓË,

39

ª˘ÎfiÏ·ÛÌ· Î·È ¯ÚfiÓÈÔ˜ ‚‹¯·˜

ÂÓÒ ÂΛÓÔÈ Ô˘ ›¯·Ó Â˘Ú‹Ì·Ù· ÚÈÓ›Ùȉ·˜/·Ú·ÚÚÈÓÔÎÔÏ›Ùȉ·˜ ÛÙËÓ ·ÎÙÈÓÔÁÚ·Ê›· ·Ú·ÚÚÈÓ›ˆÓ ÎfiÏˆÓ Î·È ÔÍ›· Ïԛ̈ÍË ·fi ¿Ù˘· ÌÈÎÚfi‚È·, ¤Ï·‚·Ó ÎÏ·ÚÈıÚÔÌ˘Î›ÓË Î·È ÙÔÈο ÛÙÂÚÔÂȉ‹. ∆ÚÂȘ ‚‰ÔÌ¿‰Â˜ ·ÚÁfiÙÂÚ·, ÔÈ ·ÛıÂÓ›˜ Â·ÓÂÎÙÈÌ‹ıËÎ·Ó Î·È Ë ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘˜ ·ÎÔÏÔ‡ıˆ˜, ÂÍ·ÙÔÌÈ·ÙËÎÂ.

∞ÔÙÂϤÛÌ·Ù· ∂Í‹ÓÙ· ÂÙ¿ ·È‰È¿ Û˘ÌÌÂÙ›¯·Ó ÛÙË ÌÂϤÙË ·˘Ù‹, ·fi 2,5 ¤ˆ˜ 16 ÂÙÒÓ, Ì ̤ÛË ËÏÈΛ· Ù· 7 ¤ÙË. ∆ÚÈ¿ÓÙ· ‰‡Ô (47,8%) ‹Ù·Ó ·ÁfiÚÈ· Î·È 35 (52,2%) ÎÔÚ›ÙÛÈ·. ™·Ú¿ÓÙ· ‰‡Ô ·ÛıÂÓ›˜ (62,7%) ¤·Û¯·Ó ·fi ¯ÚfiÓÈÔ Î·È 25 (37,3%) ·fi ˘ÔÙÚÔÈ¿˙ÔÓÙ· ‚‹¯·. ™·Ú¿ÓÙ· ÙÚ›· ·È‰È¿ (64,2%) ηÙÔÈÎÔ‡Û·Ó ÛÙËÓ ∞ı‹Ó·, 23 (34,3%) Û ËÌÈ·ÛÙÈΤ˜ Î·È ·ÁÚÔÙÈΤ˜ ÂÚÈÔ¯¤˜, ÂÓÒ ¤Ó· (1,5%) ηÙÔÈÎÔ‡Û ÛÙËÓ ∫‡ÚÔ. ŸÏ· ‹Ù·Ó Ï‹Úˆ˜ ÂÌ‚ÔÏÈ·Ṳ̂ӷ ÁÈ· ÙËÓ ËÏÈΛ· ÙÔ˘˜ Î·È Û ηӤӷ ‰ÂÓ ·Ó‚ڤıËÎ·Ó ÛËÌ›· ˘ÔÛÈÙÈÛÌÔ‡. ∏ ‰È¿ÁÓˆÛË Ù˘ ÔÍ›·˜ Ì˘ÎÔÏ·ÛÌ·ÙÈ΋˜ ‹ ¯Ï·Ì˘‰È·Î‹˜ Ïԛ̈͢ ·Ô‰fiıËΠÌfiÓÔ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ıÂÙÈÎfi Ù›ÙÏÔ IgM ·ÓÙÈۈ̿وÓ, ÂÓÒ ÔÈ Ù›ÙÏÔÈ ÙˆÓ IgG ·ÓÔÛÔÛÊ·ÈÚÈÓÒÓ ‰ÂÓ ·Ó¤‰ÂÈÍ·Ó ÂÈÚfiÛıÂÙ˜ ÂÚÈÙÒÛÂȘ ¿Ù˘˘ Ïԛ̈͢. ™ÙÔÓ ¶›Ó·Î· 1, ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ù· Û˘ÁÎÂÓÙÚˆÙÈο ·ÔÙÂϤÛÌ·Ù· ÙˆÓ ·ÓÔÛÔÛÊ·ÈÚÈÓÒÓ ÙˆÓ ·ÛıÂÓÒÓ Î·È ÁÈ· ÙÔ˘˜ ‰‡Ô ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜. ∞fi ÙÔ˘˜ 67 ·ÛıÂÓ›˜ Ù˘ ÌÂϤÙ˘, ÔÈ 20 (29,9%) ¤·Û¯·Ó ·fi ÔÍ›· Ì˘ÎÔÏ·ÛÌ·ÙÈ΋ Ïԛ̈ÍË Î·È ÔÈ 4 (6,0%) ·fi ¯Ï·Ì˘‰È·Î‹ Ïԛ̈ÍË, ÂÓÒ ¤Ó·˜ ·ÛıÂÓ‹˜ ›¯Â Ù·˘Ùfi¯ÚÔÓ·, ÔÍ›· Ì˘ÎÔÏ·ÛÌ·ÙÈ΋ Î·È ¯Ï·Ì˘‰È·Î‹ Ïԛ̈ÍË. ∫·Ó¤Ó·˜ ‰ÂÓ ·ÚÔ˘Û›·˙ ÛÙÔȯ›· ÂÍ·Óı‹Ì·ÙÔ˜, ·ÚıÚ›Ùȉ·˜, ·ÈÌÔÏ˘ÙÈ΋˜ ·Ó·ÈÌ›·˜ ‹ ¿ÏÏˆÓ ÂΉËÏÒÛÂˆÓ Ïԛ̈͢ ·fi ¿Ù˘·. ∆· ·ÔÙÂϤÛÌ·Ù· Ô˘ ·Ú·Ù›ıÂÓÙ·È ÛÙË Û˘Ó¤¯ÂÈ·, ·Ó·Ê¤ÚÔÓÙ·È ÌfiÓÔ ÛÙÔ˘˜ 23 ÔÚÔıÂÙÈÎÔ‡˜ ·ÛıÂÓ›˜ ÁÈ· Ì˘ÎfiÏ·ÛÌ· ‹ ¯Ï·Ì‡‰È·. ∞fi ÙÔ˘˜ 23 ·˘ÙÔ‡˜ ·ÛıÂÓ›˜, ÔÈ 9 (39,1%) ¤·Û¯·Ó ·fi ÔÍ›· Ì˘ÎÔÏ·ÛÌ·ÙÈ΋/ ¯Ï·Ì˘‰È·Î‹ Ïԛ̈ÍË ÌfiÓÔ. ™ÙÔ˘˜ ˘fiÏÔÈÔ˘˜ 14 (60,8%) ·Ó‚ڤıËÎ·Ó ÂÚÈÛÛfiÙÂÚ˜ ·fi Ì›· ·Èٛ˜ ÁÈ· ÙÔÓ ‚‹¯· ÙÔ˘˜. √È 6 ¤·Û¯·Ó Î·È ·fi ¿ÛıÌ· (Ì ‚¿ÛË Ù· ·ÔÙÂϤÛÌ·Ù· ÙˆÓ ÏÂÈÙÔ˘ÚÁÈÎÒÓ ‰ÔÎÈÌ·ÛÈÒÓ Ù˘ ·Ó·ÓÔ‹˜ Î·È ÙËÓ ·ÓÙ·fiÎÚÈÛË ÛÙËÓ ·ÓÙÈ·ÛıÌ·ÙÈ΋ ·ÁˆÁ‹), ÔÈ ¶›Ó·Î·˜ 1. ∞ÔÙÂϤÛÌ·Ù· ·ÓÔÛÔÛÊ·ÈÚÈÓÒÓ ÁÈ· M. pneumoniae / C. pneumoniae ∞ÓÔÛÔÛÊ·ÈÚ›Ó˜ M. pneumoniae IgG M. pneumoniae IgM C. pneumoniae IgG C. pneumoniae IgM

¶ÂÚÈÛÙ·ÙÈο (%) Â› 67 ·ÛıÂÓÒÓ 32 (47,8%) 20 (29,9%) 1 (1,5%) 4 (6,0%)

7 ›¯·Ó Î·È ÚÈÓ›Ùȉ·/ ·Ú·ÚÚÈÓÔÎÔÏ›Ùȉ· (Ì ‚¿ÛË ÙËÓ ‡·ÚÍË ÚÈÓÈ΋˜ Û˘ÌÊfiÚËÛ˘, ÔÓÔÎÂÊ¿ÏÔ˘, ¢·ÈÛıËÛ›·˜ ÛÙËÓ „ËÏ¿ÊËÛË ÙˆÓ ·Ú·ÚÚÈÓ›ˆÓ ÎfiÏˆÓ Î·È ˘ÁÚ·ÂÚÈÎÔ‡ ÂÈ¤‰Ô˘ ÛÙËÓ ·ÎÙÈÓÔÁÚ·Ê›· ·Ú·ÚÚÈÓ›ˆÓ), ÂÓÒ ¤Ó·˜ ÂÌÊ¿ÓÈ˙Â Î·È ˘ÂÚÙÚÔÊ›· ÙˆÓ ·‰ÂÓÔÂȉÒÓ Â΂ϷÛÙ‹ÛÂˆÓ (Ô˘ ‰È·ÈÛÙÒıËΠÌÂÙ¿ ·fi ·Ú·ÔÌ‹ ÙÔ˘ ·ÛıÂÓÔ‡˜ Û ˆÙÔÚÈÓÔÏ·Ú˘ÁÁÔÏfiÁÔ). ∏ ̤ÛË ËÏÈΛ· ÙˆÓ ·È‰ÈÒÓ ‹Ù·Ó 7,3 ¤ÙË (±3,1) Î·È Ë Ì¤ÛË ‰È¿ÚÎÂÈ· ÙÔ˘ ‚‹¯· ÚÈÓ ÙËÓ Â›ÛÔ‰fi ÙÔ˘˜ ÛÙË ÌÂϤÙË, 60,4 Ë̤Ú˜ (±22,5). ™¯Â‰fiÓ fiÏÔÈ ÔÈ ·ÛıÂÓ›˜ (97%) ıˆÚÔ‡Û·Ó ÙÔÓ ‚‹¯· ˆ˜ ÙÔ ÈÔ ÂÓÔ¯ÏËÙÈÎfi Û‡Ìو̷ Ô˘ ÂÌÊ¿ÓÈ˙·Ó. ∞fi Ù· 23 ·È‰È¿, Ù· 10 (43,3%) ›¯·Ó ÙÔ˘Ï¿¯ÈÛÙÔÓ Ì›· ıÂÙÈ΋ ‰ÂÚÌ·ÙÈ΋ ‰ÔÎÈÌ·Û›· Ó˘ÁÌÔ‡, Î·È ˆ˜ ÂÎ ÙÔ‡ÙÔ˘ ıˆڋıËÎ·Ó ·ÙÔÈο. √È ÁÔÓ›˜ ÙˆÓ ·È‰ÈÒÓ ·˘ÙÒÓ ·Ó¤ÊÂÚ·Ó ·ÚfiÌÔÈ· ÂÂÈÛfi‰È· ‚‹¯· Î·È ÛÙÔ ·ÚÂÏıfiÓ, Ù· ÔÔ›· ›¯·Ó ·Ô‰Ôı› Û ‚ÚÔÁ¯›Ùȉ· ‹ Ó¢ÌÔÓ›·, ÂÓÒ 7 ·fi Ù· ·È‰È¿ ·˘Ù¿ ›¯·Ó ¯ÚÂÈ·ÛÙ› ÓÔÛËÏ›· Û ·Ó¿ÏÔÁ˜ ÂÚÈÙÒÛÂȘ. ∞˘Ù¿ Ù· ·È‰È¿, ηıÒ˜ Î·È ¤Ó· ·fi Ù· ˘fiÏÔÈ· (Û‡ÓÔÏÔ 11 ·ÛıÂÓ›˜ - 47,8%) ·Ó¤ÊÂÚ·Ó Âԯȷ΋ ‰È·Î‡Ì·ÓÛË ÛÙÔÓ ‚‹¯· ÙÔ˘˜, Ì ¤Í·ÚÛË ÙÔ˘˜ ¯ÂÈÌÂÚÈÓÔ‡˜ Ì‹Ó˜. Ÿˆ˜ ·Ó·Ê¤ÚıËΠÚÔËÁÔ˘Ì¤Óˆ˜, Î·È ÔÈ 23 ·ÛıÂÓ›˜ ¤Ï·‚·Ó ·ÓÙÈ·ÛıÌ·ÙÈ΋ ·ÁˆÁ‹ ˆ˜ ÚÒÙÔ ‚‹Ì· ·ÓÙÈÌÂÙÒÈÛ˘. ∫·Ù¿ ÙÔÓ Â·Ó¤ÏÂÁ¯Ô, Ô ‚‹¯·˜ ›¯Â ˘Ô¯ˆÚ‹ÛÂÈ ÂÓÙÂÏÒ˜ ÛÙÔ˘˜ 8 ·ÛıÂÓ›˜ (34,7%), ÔfiÙ ‰ÂÓ ¯ÔÚËÁ‹ıËΠÎÏ·ÚÈıÚÔÌ˘Î›ÓË. ∆ÚÂȘ ·fi ·˘ÙÔ‡˜ ›¯·Ó ÛÙÔȯ›· ·fiÊڷ͢ ηٿ ÙȘ ‰ÔÎÈ̷ۛ˜ ÏÂÈÙÔ˘ÚÁÈÎÔ‡ ÂϤÁ¯Ô˘ Ù˘ ·Ó·ÓÔ‹˜, ÔfiÙÂ Û˘Ó¤¯ÈÛ·Ó ÙËÓ ·ÓÙÈ·ÛıÌ·ÙÈ΋ ·ÁˆÁ‹, ÂÓÒ ÔÈ ˘fiÏÔÈÔÈ 5 ›¯·Ó Â˘Ú‹Ì·Ù· ·Ú·ÚÚÈÓÔÎÔÏ›Ùȉ·˜ ÛÙËÓ ·ÎÙÈÓÔÁÚ·Ê›· ·Ú·ÚÚÈÓ›ˆÓ ÎfiÏˆÓ, ÔfiÙÂ Û˘Ó¤¯ÈÛ·Ó ÙËÓ ·ÁˆÁ‹ ÙÔ˘˜ Ì ÙÔÈ΋ ¯Ú‹ÛË ÚÈÓÈÎÔ‡ ÛÙÂÚÔÂȉԇ˜ Î·È ¿ÏÏ˘ ·ÓÙÈ‚›ˆÛ˘ ·fi ÙÔ ÛÙfiÌ·. √È ˘fiÏÔÈÔÈ 15 ·ÛıÂÓ›˜ (65,2%) ‰ÂÓ ‚ÂÏÙÈÒıËÎ·Ó Ì ÙËÓ ·ÓÙÈ·ÛıÌ·ÙÈ΋ ıÂÚ·›·, ÔfiÙ ¤Ï·‚·Ó ÎÏ·ÚÈıÚÔÌ˘Î›ÓË Û ‰Â‡ÙÂÚÔ ¯ÚfiÓÔ. √ÎÙÒ ¤Ï·‚·Ó ÌfiÓÔ ÎÏ·ÚÈıÚÔÌ˘Î›ÓË, ÂÓÒ 5 ›¯·Ó Â˘Ú‹Ì·Ù· ·fiÊڷ͢ ηٿ ÙË Ù·Ï·ÓÙÔÛÈÌÂÙÚ›· Î·È ÙË ÛÈÚÔ̤ÙÚËÛË, ÔfiÙ ¤Ï·‚·Ó ÎÏ·ÚÈıÚÔÌ˘Î›ÓË Î·È ·ÓÙÈ·ÛıÌ·ÙÈο Î·È 2 ›¯·Ó ·ıÔÏÔÁÈ΋ ·ÎÙÈÓÔÁÚ·Ê›· ·Ú·ÚÚÈÓ›ˆÓ, ÔfiÙ ¤Ï·‚·Ó ÎÏ·ÚÈıÚÔÌ˘Î›ÓË Î·È ÙÔÈÎfi ÚÈÓÈÎfi ÛÙÂÚÔÂȉ¤˜. ∫·Ù¿ ÙËÓ Â·ÓÂͤٷÛË, Ô ‚‹¯·˜ ›¯Â ˘Ô¯ˆÚ‹ÛÂÈ Û fiÏ· Ù· ·È‰È¿ ÂÎÙfi˜ ·fi ¤Ó·. ∆Ô ·È‰› ·˘Ùfi ¤·ÈÚÓ ÌfiÓÔ ÎÏ·ÚÈıÚÔÌ˘Î›ÓË, ˆÛÙfiÛÔ Â›¯Â ¤Ó·Ó ˘ÔÏÂÈÌÌ·ÙÈÎfi ‚‹¯· ÛÙȘ 3 ‚‰ÔÌ¿‰Â˜ ıÂÚ·›·˜. °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi, ·ÔÊ·Û›ÛÙËÎÂ Ë Û˘Ó¤¯ÈÛË Ù˘ ·ÁˆÁ‹˜ ÁÈ· ¿ÏϘ 3 ‚‰ÔÌ¿‰Â˜, ÔfiÙÂ Î·È Ô ‚‹¯·˜ ˘Ô¯ÒÚËÛÂ. √ ¶›Ó·Î·˜ 2 ÂÚÈÁÚ¿ÊÂÈ ÙË ıÂÚ·¢ÙÈ΋ ÚÔÛ¤ÁÁÈÛË Î·È ·¿ÓÙËÛË fiÏˆÓ ÙˆÓ ·ÛıÂÓÒÓ Ì ÔÍ›· Ì˘ÎÔÏ·ÛÌ·ÙÈ΋/ ¯Ï·Ì˘‰È·Î‹ Ïԛ̈ÍË. ¶·È‰È·ÙÚÈ΋ 2007;70:37-41

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π.ª. µÂÏÈÛÛ·Ú›Ô˘ Î·È Û˘Ó.

™˘˙‹ÙËÛË ∏ ÌÂϤÙË ·˘Ù‹ Âȯ›ÚËÛ ӷ ·ÍÈÔÏÔÁ‹ÛÂÈ ÙÔÓ ÚfiÏÔ ÙÔ˘ Ì˘ÎÔÏ¿ÛÌ·ÙÔ˜ Î·È ÙÔ˘ ¯Ï·Ì˘‰›Ô˘ Ù˘ Ó¢ÌÔÓ›·˜ ÛÙÔÓ ¯ÚfiÓÈÔ Î·È ˘ÔÙÚÔÈ¿˙ÔÓÙ· ‚‹¯· ÙÔ˘ ·È‰ÈÎÔ‡ ÏËı˘ÛÌÔ‡, ηıÒ˜ Î·È ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ıÂÚ·›·˜ ÙÔ˘˜ Ì ̷ÎÚÔÏ›‰Â˜. ∏ Ì·ÎÚ¿ ‰È¿ÚÎÂÈ· ÙÔ˘ ‚‹¯· (̤ÛË ‰È¿ÚÎÂÈ· 2 Ì‹Ó˜), ·ÎfiÌË Î·È fiÙ·Ó Ë ¤ÓÙ·ÛË ‰ÂÓ ‹Ù·Ó ÌÂÁ¿ÏË, Ê¿ÓËΠӷ ÎÔ˘Ú¿˙ÂÈ ÙÔ˘˜ ·ÛıÂÓ›˜ Î·È ÙÔ˘˜ Û˘ÁÁÂÓ›˜ ÙÔ˘˜. ÕÏψÛÙÂ, ۯ‰fiÓ fiÏÔÈ ÔÈ ÁÔÓ›˜ (97%) ·Ó¤ÊÂÚ·Ó fiÙÈ Ô ‚‹¯·˜ ‹Ù·Ó ÙÔ ÈÔ ÂÓÔ¯ÏËÙÈÎfi Û‡Ìو̷ ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜. √ ÚfiÏÔ˜ Ù˘ ÔÍ›·˜ Ì˘ÎÔÏ·ÛÌ·ÙÈ΋˜/¯Ï·Ì˘‰È·Î‹˜ Ïԛ̈͢ Û ·È‰È¿ Ì ·ÚÔ͇ÓÛÂȘ ¿ÛıÌ·ÙÔ˜ ‰ÈÂÚ¢ӋıËΠÚfiÛÊ·Ù·. √Í›· Ì˘ÎÔÏ·ÛÌ·ÙÈ΋ Ïԛ̈ÍË ·Ó‚ڤıËΠÛÙÔ 20% ÙˆÓ ·ÚÔ͇ÓÛÂˆÓ ¿ÛıÌ·ÙÔ˜, ÂÓÒ ÔÍ›· ¯Ï·Ì˘‰È·Î‹ Ïԛ̈ÍË ÛÙÔ 3,4% ÙˆÓ ÂÚÈÙÒÛˆÓ. ∂ÈϤÔÓ, ÙÔ ÔÛÔÛÙfi ÔÍ›·˜ Ì˘ÎÔÏ·ÛÌ·ÙÈ΋˜ Ïԛ̈͢ ÛÙÔ ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ¿ÛıÌ·ÙÔ˜ Êı¿ÓÂÈ ÙÔ 50% (15). ∏ ÌÂϤÙË ·˘Ù‹ ·Ó¤‰ÂÈÍ ·Ú·Ï‹ÛÈ· ÔÛÔÛÙ¿ ÔÍ›·˜ Ì˘ÎÔÏ·ÛÌ·ÙÈ΋˜/¯Ï·Ì˘‰È·Î‹˜ Ïԛ̈͢ (34,3%) Û ÂÚÈÙÒÛÂȘ ¯ÚfiÓÈÔ˘ ‹ ˘ÔÙÚÔÈ¿˙ÔÓÙÔ˜ ‚‹¯·, ¯ˆÚ›˜ ÚÔËÁËı›۷ ‰È¿ÁÓˆÛË ¿ÛıÌ·ÙÔ˜. ¶Ú¤ÂÈ, ˆÛÙfiÛÔ Ó· ·Ó·ÊÂÚı› fiÙÈ 6 ·È‰È¿ (26%) Ì ıÂÙÈο IgM ·ÓÙÈÛÒÌ·Ù· ÁÈ· M. pneumoniae, ÂÌÊ¿ÓÈÛ·Ó ÛÙË Û˘Ó¤¯ÂÈ· ÛÙÔȯ›· ¿ÛıÌ·ÙÔ˜ ÛÙȘ ‰ÔÎÈ̷ۛ˜ ÏÂÈÙÔ˘ÚÁÈÎÔ‡ ÂϤÁ¯Ô˘ Ù˘ ·Ó·ÓÔ‹˜. ∂›Û˘, ·Í›˙ÂÈ Ó· ÛËÌÂȈı› fiÙÈ ¿ÏϘ ÌÂϤÙ˜ ·È‰ÈÒÓ Ì ¯ÚfiÓÈÔ ‹ ˘ÔÙÚÔÈ¿˙ÔÓÙ· ‚‹¯·, ·Ó¤‰ÂÈÍ·Ó ÌÈÎÚfi-

ÙÂÚÔ ÔÛÔÛÙfi ÏÔÈÌÒÍÂˆÓ ·fi ¿Ù˘· ·’ fi,ÙÈ Ë ‰È΋ Ì·˜ (6,16). ∞ÍÈÔÛËÌ›ˆÙÔ Â›Ó·È ÙÔ ÁÂÁÔÓfi˜ fiÙÈ 10 ·ÛıÂÓ›˜ (43,4%) Ì ÔÍ›· Ì˘ÎÔÏ·ÛÌ·ÙÈ΋ Ïԛ̈ÍË, ·Ó¤ÊÂÚ·Ó ·Ó¿ÏÔÁ· ÂÂÈÛfi‰È· ‚‹¯· ÛÙÔ ·ÚÂÏıfiÓ, ÂÓÒ ÔÈ 7 ·fi ·˘ÙÔ‡˜ (30,4%) ¯ÚÂÈ¿ÛÙËÎ·Ó ÓÔÛËÏ›·. ∆Ô ÁÂÁÔÓfi˜ ·˘Ùfi ˘ÔÛÙËÚ›˙ÂÈ ÙËÓ ¿Ô„Ë fiÙÈ ÙÔ M. pneumoniae ÌÔÚ› Ó· ÏÂÈÙÔ˘ÚÁ› ˆ˜ ÂÎÏ˘ÙÈÎfi ·›ÙÈÔ ˘ÔÙÚÔÈ¿˙ÔÓÙÔ˜ Û˘ÚÈÁÌÔ‡ Î·È ‚‹¯· (15). √È ›‰ÈÔÈ 10 ·ÛıÂÓ›˜ (43,4%) ‹Ù·Ó Î·È ·ÙÔÈÎÔ›. ∞˘Ùfi ÙÔ ÔÛÔÛÙfi ·ÙÔ›·˜ Û ·È‰È¿ Ì ¿Ù˘Ë Ïԛ̈ÍË Â›Ó·È ·Ó¿ÏÔÁÔ ÙÔ˘ ÔÛÔÛÙÔ‡ Ô˘ ·Ó·Ê¤ÚÂÙ·È ·ÏÏÔ‡ (15). Ÿˆ˜ Ê·›ÓÂÙ·È Î·È ÛÙÔÓ ¶›Ó·Î· 1, 32 ·fi Ù· 67 ·È‰È¿ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó (47,8%) ›¯·Ó ıÂÙÈο ·ÓÙÈÛÒÌ·Ù· IgG ÁÈ· M. pneumoniae Î·È ¤Ó· ·È‰› (1,5%) ›¯Â ıÂÙÈο IgG ÁÈ· C. pneumoniae. ŸÏÔÈ ÔÈ ·ÛıÂÓ›˜ Ô˘ ›¯·Ó ıÂÙÈο IgM ·ÓÙÈÛÒÌ·Ù· ÁÈ· Ì˘ÎfiÏ·ÛÌ·, ›¯·Ó Â›Û˘ ıÂÙÈο Î·È IgG ·ÓÙÈÛÒÌ·Ù· ÁÈ· ÙÔÓ ›‰ÈÔ ÌÈÎÚÔÔÚÁ·ÓÈÛÌfi. ∆Ô ˘„ËÏfi ÔÛÔÛÙfi ÙˆÓ ıÂÙÈÎÒÓ IgG ·ÓÙÈÛˆÌ¿ÙˆÓ ÙÔ˘ Ì˘ÎÔÏ¿ÛÌ·ÙÔ˜ (47,8%) ˘Ô‰ÂÈÎÓ‡ÂÈ fiÙÈ Ë Â·Ê‹ ÌÂ Ì˘ÎfiÏ·ÛÌ· Ù˘ Ó¢ÌÔÓ›·˜ Â›Ó·È ·ÚÎÂÙ¿ Û˘¯Ó‹ ÛÙ· ·È‰È¿ Î·È Ú¤ÂÈ Ó· ·Ó·˙ËÙÂ›Ù·È Û fiϘ ÙȘ ÂÚÈÙÒÛÂȘ ·Ú·ÙÂٷ̤Ó˘ Û˘Ìو̷ÙÔÏÔÁ›·˜ ·fi ÙÔ ·Ó·Ó¢ÛÙÈÎfi. ¶Ú¤ÂÈ, Â›Û˘, Ó· ·Ó·ÊÂÚı› fiÙÈ ¤Ó· ÛËÌ·ÓÙÈÎfi ÔÛÔÛÙfi ·È‰ÈÒÓ Ì ÔÍ›· Ì˘ÎÔÏ·ÛÌ·ÙÈ΋/ ¯Ï·Ì˘‰È·Î‹ Ïԛ̈ÍË, ›¯Â Ù·˘Ùfi¯ÚÔÓ· Î·È ¿ÏϘ ·Èٛ˜ ÁÈ· ÙÔÓ ‚‹¯· ÙÔ˘, ΢ڛˆ˜ ¿ÛıÌ· ‹ ÚÈÓ›Ùȉ·/ ·Ú·ÚÚÈÓÔÎÔÏ›Ùȉ·. ∏ Û˘Ó‡·ÚÍË Ì˘ÎÔÏ·ÛÌ·ÙÈ΋˜ Ïԛ̈͢ Î·È ¿ÛıÌ·ÙÔ˜ ÛÙÔÓ ›‰ÈÔ ·ÛıÂÓ‹, ÌÔÚ› Ó·

¶›Ó·Î·˜ 2. ™¯ËÌ·ÙÈ΋ ·ÔÙ‡ˆÛË Ù˘ ıÂÚ·¢ÙÈ΋˜ ÚÔÛ¤ÁÁÈÛ˘ ÙˆÓ ÔͤˆÓ Ì˘ÎÔÏ·ÛÌ·ÙÈÎÒÓ/¯Ï·Ì˘‰È·ÎÒÓ ÏÔÈÌÒÍÂˆÓ 8 ·È‰È¿ (34,7%) ‚ÂÏÙ›ˆÛË

3 ·È‰È¿ (13,0%) ·ÓÙÈ·ÛıÌ·ÙÈο

5 ·È‰È¿ (21,7%) ÚÈÓÈÎfi ÛÙÂÚÔÂȉ¤˜ + ·ÓÙÈ‚›ˆÛË 23 ·È‰È¿ (100,0%) (M. pneumoniae IgM + ‹ C. pneumoniae IgM+) ˘fi ·ÓÙÈ·ÛıÌ·ÙÈ΋ ·ÁˆÁ‹ 8 ·È‰È¿ (34,7%) ÎÏ·ÚÈıÚÔÌ˘Î›ÓË 15 ·È‰È¿ (65,2%) fi¯È ‚ÂÏÙ›ˆÛË 5 ·È‰È¿ (21,7%) ÎÏ·ÚÈıÚÔÌ˘Î›ÓË + ·ÓÙÈ·ÛıÌ·ÙÈο

2 ·È‰È¿ (8,6%) ÎÏ·ÚÈıÚÔÌ˘Î›ÓË + ÚÈÓÈÎfi ÛÙÂÚÔÂȉ¤˜ Paediatriki 2007;70:37-41

41

ª˘ÎfiÏ·ÛÌ· Î·È ¯ÚfiÓÈÔ˜ ‚‹¯·˜

·Ô‰Ôı› ÛÙËÓ È‰ÈfiÙËÙ· ÙÔ˘ M. pneumoniae Ó· ÚÔηÏ› ‚ÚÔÁ¯È΋ ˘ÂÚ··ÓÙËÙÈÎfiÙËÙ· Â› Ì·ÎÚfi ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· (1,3,4). ∏ ¯ÔÚ‹ÁËÛË ÎÏ·ÚÈıÚÔÌ˘Î›Ó˘ ·fi ÙÔ ÛÙfiÌ· ÁÈ· 3 ‚‰ÔÌ¿‰Â˜ Ê·›ÓÂÙ·È Ó· Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈ΋ ÛÙË Ì›ˆÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÙˆÓ ·È‰ÈÒÓ Ì ÔÍ›· Ì˘ÎÔÏ·ÛÌ·ÙÈ΋/ ¯Ï·Ì˘‰È·Î‹ Ïԛ̈ÍË, ·Ó Î·È 8 ·ÛıÂÓ›˜ (34,7%) ‚ÂÏÙÈÒıËÎ·Ó ¯ˆÚ›˜ ÂȉÈ΋ ıÂÚ·›·. ÿÛˆ˜, ÏÔÈfiÓ, Ó· ‹Ù·Ó ÏÔÁÈÎfi Ó· ‰ÔÎÈÌ¿ÛÂÈ Î·Ó›˜ ÙË ¯ÔÚ‹ÁËÛË ÎÏ·ÚÈıÚÔÌ˘Î›Ó˘ Û ·È‰È¿ Ì ¯ÚfiÓÈÔ ‚‹¯· Ô˘ ‰ÂÓ ·ÓÙ·ÔÎÚ›ıËÎ·Ó ÛÙËÓ ·ÓÙÈ·ÛıÌ·ÙÈ΋ ·ÁˆÁ‹. ∆ÔÓ›˙Ô˘ÌÂ, ˆÛÙfiÛÔ, fiÙÈ ··ÈÙÔ‡ÓÙ·È ÌÂÁ·Ï‡ÙÂÚ˜ ÌÂϤÙ˜ ÁÈ· Ó· ÙÂÎÌËÚÈÒÛÔ˘Ó ·˘Ù‹ ÙËÓ ˘fiıÂÛË, ηıÒ˜ Î·È Û‡ÁÎÚÈÛË ·ÛıÂÓÒÓ-Ì·ÚÙ‡ÚˆÓ. ∂›Û˘, ‰ÂÓ ÌÔÚ› Ó· ·ÁÓÔËı› ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ô ¯ÚfiÓÈÔ˜ ‚‹¯·˜ Î·È ÔÈ ÏÔÈÌÒÍÂȘ ·fi ¿Ù˘· Â›Ó·È Û˘¯Ó¿ ·˘ÙÔ-È¿ÛÈ̘ ÛÙËÓ ·È‰È΋ ËÏÈΛ·, ÂÔ̤ӈ˜ Â›Ó·È Ôχ ‰‡ÛÎÔÏÔ Ó· ÂÎÙÈÌËı› Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙˆÓ ıÂÚ·ÂÈÒÓ, ‰Â‰Ô̤ÓÔ˘ fiÙÈ ÔÈ ·ÛıÂÓ›˜ ÌÔÚ› Ó· ‚ÂÏÙȈıÔ‡Ó Ì ÙÔ ¤Ú·ÛÌ· ÙÔ˘ ¯ÚfiÓÔ˘ Î·È ¯ˆÚ›˜ ·ÁˆÁ‹. ™˘ÌÂÚ·ÛÌ·ÙÈο, Ë ÔÍ›· Ì˘ÎÔÏ·ÛÌ·ÙÈ΋/¯Ï·Ì˘‰È·Î‹ Ïԛ̈ÍË Â›Ó·È Û¯ÂÙÈο Û˘¯Ó‹ ÛÙ· ·È‰È¿ Ì ¯ÚfiÓÈÔ ‹ ˘ÔÙÚÔÈ¿˙ÔÓÙ· ‚‹¯· Î·È Ù›ÓÂÈ Ó· ·ÓÙ·ÔÎÚ›ÓÂÙ·È Î·Ï¿ ÛÙË ıÂÚ·›· Ì ÎÏ·ÚÈıÚÔÌ˘Î›ÓË. ∆Ô ˘„ËÏfi ÔÛÔÛÙfi ·ÛıÂÓÒÓ Ì ıÂÙÈο IgM ·ÓÙÈÛÒÌ·Ù· ÁÈ· Ì˘ÎfiÏ·ÛÌ·, ˘ÔÁÚ·ÌÌ›˙ÂÈ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÔÈ ÏÔÈÌÒÍÂȘ ·˘Ù¤˜ Ú¤ÂÈ Ó· ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È ÂÁη›Úˆ˜, ÚÔÎÂÈ̤ÓÔ˘ Ó· ·ÔʇÁÂÙ·È Ë ‚ÚÔÁ¯È΋ ˘ÂÚ··ÓÙËÙÈÎfiÙËÙ· Ô˘ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û ÂÈÌÔÓ‹ ÙÔ˘ ‚‹¯·.

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¶·È‰È·ÙÚÈ΋ 2007;70:37-41

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∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞

ORIGINAL ARTICLE

¶˘ÚÂÙÈÎÔ› Û·ÛÌÔ›: ∂›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈ΋ Ë ‰È·Ï›Ô˘Û· ÚÔʇϷÍË Ì ‰È·˙Â¿ÌË; 1 3Ë ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ πÔÎÚ¿ÙÂÈÔ˘ ¡ÔÛÔÎÔÌ›Ԣ, ∞ÚÈÛÙÔÙ¤ÏÂÈÔ ¶·ÓÂÈÛÙ‹ÌÈÔ £ÂÛÛ·ÏÔӛ΢ 2 1Ë ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ πÔÎÚ¿ÙÂÈÔ˘ ¡ÔÛÔÎÔÌ›Ԣ, ∞ÚÈÛÙÔÙ¤ÏÂÈÔ ¶·ÓÂÈÛÙ‹ÌÈÔ £ÂÛÛ·ÏÔӛ΢ AÏÏËÏÔÁÚ·Ê›·: ÃÚ‹ÛÙÔ˜ ¶. ¶·ÓÙÂÏÈ¿‰Ë˜, cpantel@hol.gr ∫·ıËÁËÙ‹˜ ¶·È‰È·ÙÚÈ΋˜ ∫. ¶·Ï·Ì¿ 4, ∆.∫. 551 33, £ÂÛÛ·ÏÔÓ›ÎË

∂. ¶·˘Ï›‰Ô˘1, ª. ∆˙ËÙËÚ›‰Ô˘1, ∂. ∫ÔÓÙfiÔ˘ÏÔ˜2, Ã. ¶·ÓÙÂÏÈ¿‰Ë˜1 ¶ÂÚ›ÏË„Ë ∂ÈÛ·ÁˆÁ‹: ∂ÎÙÈÌ‹ıËÎÂ Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ‰È·Ï›Ô˘Û·˜ ÚÔʇϷ͢ Ì ‰È·˙Â¿ÌË ·fi ÙÔ ÔÚıfi ÛÙËÓ ÚfiÏË„Ë ÙˆÓ ˘ÚÂÙÈÎÒÓ Û·ÛÌÒÓ (¶™). ª¤ıÔ‰ÔÈ: ¶ÚfiÎÂÈÙ·È ÁÈ· ÚÔÔÙÈ΋ Ù˘¯·ÈÔÔÈË̤ÓË ÌÂϤÙË Û 139 ·È‰È¿ (77 ÎÔÚ›ÙÛÈ· Î·È 62 ·ÁfiÚÈ·), Ô˘ ›¯·Ó ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ¶™. ∆· ·È‰È¿ ¯ˆÚ›ÛÙËÎ·Ó Û ‰‡Ô ÔÌ¿‰Â˜: ÙËÓ ÔÌ¿‰· (∞) Ô˘ ¤Ï·‚ ÚÔʇϷÍË (n=68) Î·È ÙËÓ ÔÌ¿‰· (µ) ¯ˆÚ›˜ ÚÔʇϷÍË (n=71). ∆· ·È‰È¿ Î·È ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ·Ú¤ÌÂÈÓ·Ó Û ·Ú·ÎÔÏÔ‡ıËÛË ÁÈ· 3 ¯ÚfiÓÈ·. ∆· ÎÚÈÙ‹ÚÈ· ÂÈÛ·ÁˆÁ‹˜ ÛÙË ÌÂϤÙË ‹Ù·Ó: ÂχıÂÚÔ ·ÙÔÌÈÎfi ÈÛÙÔÚÈÎfi ·‡ÚÂÙˆÓ Û·ÛÌÒÓ, Ê˘ÛÈÔÏÔÁÈ΋ „˘¯ÔÎÈÓËÙÈ΋ ·Ó¿Ù˘ÍË, Ó· ÌËÓ ¤¯ÂÈ ¯ÔÚËÁËı› ·ÓÙÈÂÈÏËÙÈ΋ ·ÁˆÁ‹ Î·È ËÏÈΛ· ¤Ó·Ú͢ ÌÂٷ͇ 6 ÌËÓÒÓ Î·È 3 ÂÙÒÓ. ∏ οı ÔÌ¿‰· Ù·ÍÈÓÔÌ‹ıËΠ۠ÙÚÂȘ ˘ÔÔÌ¿‰Â˜, ·Ó¿ÏÔÁ· Ì ÙÔÓ ‚·ıÌfi ÎÈÓ‰‡ÓÔ˘ ˘ÔÙÚÔ‹˜. ø˜ ·Ú¿ÁÔÓÙ˜ ÂÈÎÈÓ‰˘ÓfiÙËÙ·˜ ıˆڋıËηÓ: Ë ËÏÈΛ· ¤Ó·Ú͢ ≤15 ÌËÓÒÓ, ÙÔ ÈÛÙÔÚÈÎfi ÂÈÏË„›·˜ ÛÂ Û˘ÁÁÂÓ‹ ·’ ‚·ıÌÔ‡, ÙÔ ÈÛÙÔÚÈÎfi ¶™ ÛÂ Û˘ÁÁÂÓ‹ ·’ ‚·ıÌÔ‡, ÙÔ ÂÈÏÂÁ̤ÓÔ ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ¶™ Î·È ÔÈ Û˘¯Ó¤˜ ÂÌ‡ÚÂÙ˜ ÏÔÈÌÒÍÂȘ. ∆ËÓ ÚÒÙË Ë̤ڷ ÙÔ˘ ˘ÚÂÙÔ‡ ¯ÔÚËÁ‹ıËΠ‰È·˙Â¿ÌË 0,33 mg/kg µ™/8ˆÚÔ Î·È ÙË ‰Â‡ÙÂÚË 0,33 mg/kg µ™/12ˆÚÔ, Î·È ÔÙ¤ ¿Óˆ ·fi 7,5 mg/‰fiÛË. ™Â fiÏ· Ù· ·È‰È¿ ¤ÁÈÓ ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ· ÌfiÏȘ ·˘Ú¤ÙËÛ·Ó, ÌÂÙ¿ ÙÔ ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ¶™. ∞ÔÙÂϤÛÌ·Ù·: ™ÙÔ Ù¤ÏÔ˜ ÙˆÓ 3 ÂÙÒÓ ·Ú·ÎÔÏÔ‡ıËÛ˘, Ë Û˘¯ÓfiÙËÙ· ˘ÔÙÚÔÒÓ ÛÙËÓ ÔÌ¿‰· Ô˘ ‰ÂÓ ¤Ï·‚ ‰È·˙Â¿ÌË ‹Ù·Ó 83% ÁÈ· Ù· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘, 55% ÛÙ· ÂӉȷ̤ÛÔ˘ Î·È 46% ÛÙ· ¯·ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ·È‰È¿. ™Ù· ·È‰È¿ Ì ÚÔʇϷÍË ÔÈ Û˘¯ÓfiÙËÙ˜ ˘ÔÙÚÔ‹˜ ÌÂÈÒıËÎ·Ó Û fiϘ ÙȘ ÔÌ¿‰Â˜ ÎÈÓ‰‡ÓÔ˘: 38%, 35% Î·È 33% ·ÓÙ›ÛÙÔȯ·. ™˘ÌÂÚ¿ÛÌ·Ù·: ∏ ‰È·Ï›Ô˘Û· ÚÔʇϷÍË Ì ‰È·˙Â¿ÌË ·fi ÙÔ ÔÚıfi ÌÂÈÒÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ˘ÔÙÚÔ‹˜ ȉȷ›ÙÂÚ· ÛÙ· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ·È‰È¿, ·ÚΛ Ó· ¯ÔÚËÁÂ›Ù·È ¤ÁηÈÚ· Î·È Â·ÚÎÒ˜.

§¤ÍÂȘ ÎÏÂȉȿ: ¢È·˙Â¿ÌË, ÚÔʇϷÍË ˘ÚÂÙÈÎÒÓ Û·ÛÌÒÓ.

Efficacy of intermittent rectal diazepam prophylaxis for the prevention of febrile seizures 1 3rd Department of Pediatrics, “Ippokration” Hospital, Aristotle University of Thessaloniki 2 1st Department of Pediatrics, “Ippokration” Hospital, Aristotle University of Thessaloniki Correspondence: Christos P. Panteliadis, cpantel@hol.gr Professor of Pediatrics 4, K. Palama St., 551 33, Thessaloniki

E. Pavlidou1, M. Tzitiridou1, E. Kontopoulos2, C. Panteliadis1 Abstract Objectives: The aim of this study was to assess the efficacy of intermittent rectal diazepam prophylaxis for the prevention of febrile seizures (FS).

Methods: This was a prospective randomized trial of 139 children (77 females, 62 males), who had experienced a first episode of FS. The children were allocated to two groups: group (A), which received intermittent rectal diazepam prophylaxis (n=68), and group (B) without prophylaxis (n=71). The children in both groups were monitored for 36 months. The inclusion criteria were: no personal history of afebrile seizures, normal neurodevelopment, no previous anticonvulsant therapy, and age between 6 months and 3 years. The children in each group were stratified into low, intermediate and high risk according to clinical factors: age at onset ≤15 months, epilepsy in first degree relatives, FS in first degree relatives, a first complex FS and increased febrile episodes. Diazepam was administered rectally at a dose of 0.33 mg/kg BW/8 hours on the first day of a febrile illness and 0.33 mg/kgBW/12 hours the second day, maximum 7.5 mg/dose. All children had an EEG recording after the first FS as soon as they were afebrile.

Results: The 36-month recurrence rates for the no prophylaxis group were 83% in high-risk, 55% in intermediate and 46% in low-risk patients. For the prophylaxis group the recurrence rates were lower in all risk groups: 38%, 35% and 33% respectively.

Conclusions: Intermittent rectal diazepam prophylaxis reduces the recurrence rate of FS, especially for high-risk children, provided that adequate doses are given early in the febrile illness.

Key words: Diazepam, febrile seizure prophylaxis.

Paediatriki 2007;70:42-48

43

¶˘ÚÂÙÈÎÔ› Û·ÛÌÔ›

∂ÈÛ·ÁˆÁ‹ ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ‰ËÌÔÛȇıËÎ·Ó ÔÏϤ˜ ÂÚÁ·Û›Â˜ Ô˘ ·ÊÔÚÔ‡Û·Ó ÙË ıÂÚ·›·, ÚÔʇϷÍË Î·È ÚfiÁÓˆÛË ÙˆÓ ˘ÚÂÙÈÎÒÓ Û·ÛÌÒÓ (¶™) (1,2). ∞fi ÙȘ ÌÂϤÙ˜ ·˘Ù¤˜ ÚԤ΢„·Ó ÔÏÏ¿ Ó¤· ÛÙÔȯ›· Û¯ÂÙÈο Ì ÙËÓ ÎÏËÚÔÓÔÌÈ΋ ÂÈ‚¿Ú˘ÓÛË ‹ ÚԉȿıÂÛË ÙˆÓ ¶™ (3,4). ∏ ¿Ô„Ë fiÙÈ ÔÈ ·ÏÔ› ¶™ Â›Ó·È Î·ÏÔ‹ıÂȘ Î·È Û¿ÓÈ· ··ÈÙÔ‡Ó ıÂÚ·›· ÈÛ¯‡ÂÈ Î·È Û‹ÌÂÚ·. øÛÙfiÛÔ, Â›Ó·È Èı·Ófi Û ¤Ó· ÌÈÎÚfi ÔÛÔÛÙfi ·È‰ÈÒÓ Ó· ÚÔÎÏËıÔ‡Ó ÂÈÏËÙÈΤ˜ (΢ڛˆ˜ ÂÛÙȷΤ˜) ÎÚ›ÛÂȘ. ∏ ‰È·Ï›Ô˘Û· ÚÔʇϷÍË Ì ‰È·˙Â¿ÌË ·fi ÙÔ ÛÙfiÌ·, ˘ÔÁÏÒÛÛÈ· ‹ ÙÔ ÔÚıfi (˘ÔÎÏ˘ÛÌfi) ¤¯ÂÈ Á›ÓÂÈ ı¤Ì· ¤Ú¢ӷ˜ ·fi ÔÏÏÔ‡˜ Û˘ÁÁÚ·Ê›˜ Ù· ÙÂÏÂ˘Ù·›· 20 ¯ÚfiÓÈ·. √È ‰È¿ÊÔÚ˜ ÌÂϤÙ˜ ÂÈÎÂÓÙÚÒıËÎ·Ó ÛÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ‰È·Ï›Ô˘Û·˜ ÚÔʇϷ͢ Ì ‰È·˙Â¿ÌË Î·È ÙËÓ Â›‰Ú·Û‹ Ù˘ ÛÙËÓ ˘ÔÙÚÔ‹ ÙˆÓ ¶™, ÂÓÒ ˆ˜ ÌÂÈÔÓ¤ÎÙËÌ· ıˆÚÂ›Ù·È Ë ¯ÔÚ‹ÁËÛË ÂÓfi˜ Ê·ÚÌ¿ÎÔ˘ Û ÌÈÎÚ¿ ·È‰È¿ ÁÈ· ÌÈ· ηÏÔ‹ıË Î·Ù¿ÛÙ·ÛË (5). √È ÌÂϤÙ˜ ·˘Ù¤˜ ¤‰ÂÈÍ·Ó fiÙÈ Ë ‰È·˙Â¿ÌË Ú¤ÂÈ Ó· ¯ÔÚËÁÂ›Ù·È Û ÂÈÏÂÁ̤Ó˜ ÂÚÈÙÒÛÂȘ, fiˆ˜ Û ·È‰È¿ Ì ·Ú·ÙÂٷ̤ÓÔ˘˜ Û·ÛÌÔ‡˜, ÂÛÙȷΤ˜ ÎÚ›ÛÂȘ Î·È Û ·È‰È¿ Ì ·ÚÎÂÙÔ‡˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ (6,7). ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ Ì·˜ Â›Ó·È Ó· ÂÎÙÈÌËı› Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ‰È·Ï›Ô˘Û·˜ ÚÔʇϷ͢ Ì ‰È·˙Â¿ÌË, ÛÂ Û˘Û¯¤ÙÈÛË Ì ÙÔÓ Î›Ó‰˘ÓÔ ˘ÔÙÚÔ‹˜. °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi, ÌÂÏÂÙ‹Û·Ì ¤Ó· ÌÂÁ¿ÏÔ ‰Â›ÁÌ· ·È‰ÈÒÓ Î·È Ë ‰È¿ÚÎÂÈ· ·Ú·ÎÔÏÔ‡ıËÛ˘ ‹Ù·Ó ÙÔ˘Ï¿¯ÈÛÙÔÓ 3 ¯ÚfiÓÈ·. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ∏ ¤Ú¢ӷ ¤ÁÈÓ Û ÔÌ¿‰· 145 ·È‰ÈÒÓ Ì ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ¶™ Î·È Â›Ó·È ÚÔÔÙÈ΋, ÂÏÂÁ¯fiÌÂÓË Î·È Ù˘¯·ÈÔÔÈË̤ÓË. ∞fi ÙË ÌÂϤÙË ·ÔÎÏ›ÛÙËÎ·Ó 6 ·È‰È¿ ÏfiÁˆ ‰˘ÛÎÔÏÈÒÓ ·Ú·ÎÔÏÔ‡ıËÛ˘. ∆· ˘fiÏÔÈ· 139 ·È‰È¿ ·Ú¤ÌÂÈÓ·Ó Û ·Ú·ÎÔÏÔ‡ıËÛË ÁÈ· ‰È¿ÛÙËÌ· 3 ¯ÚfiÓˆÓ. ∆· ·È‰È¿ ¯ˆÚ›ÛÙËÎ·Ó Û ‰‡Ô ÔÌ¿‰Â˜: ÙËÓ ÔÌ¿‰· ∞ Ô˘ ¤Ï·‚ ÚÔʇϷÍË Ì ‰È·˙Â¿ÌË Î·È ÙËÓ ÔÌ¿‰· µ (Ì·ÚÙ‡ÚˆÓ) Ô˘ ‰ÂÓ ¤Ï·‚ ·ÁˆÁ‹. ∫¿ı ·È‰› Ù˘¯·›· ηٷ¯ˆÚ‹ıËΠÛÙËÓ ÔÌ¿‰· ∞ ‹ µ (ÌÔÓ¤˜ Î·È ˙˘Á¤˜ ̤Ú˜ ·ÓÙ›ÛÙÔȯ·) Î·È Ô ˘‡ı˘ÓÔ˜ ÁÈ· ÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË ÁÈ·ÙÚfi˜ ‰ÂÓ ÁÓÒÚÈ˙ ÙËÓ Ù˘¯·ÈÔÔ›ËÛË. √È ‰‡Ô ÔÌ¿‰Â˜ ‹Ù·Ó Û˘ÁÎÚ›ÛÈ̘ fiÛÔÓ ·ÊÔÚ¿ Ù· ‰ËÌÔÁÚ·ÊÈο Î·È ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘˜ (¶›Ó·Î·˜ 1). ∏ ÔÌ¿‰· ∞ (ÔÌ¿‰· ÚÔʇϷ͢) ·ÔÙÂÏÂ›Ù·È ·fi 68 ·È‰È¿ Î·È Ë ÔÌ¿‰· µ (Ì·ÚÙ‡ÚˆÓ, ¯ˆÚ›˜ ÚÔʇϷÍË) ·fi 71 ·È‰È¿. ∆· ÎÚÈÙ‹ÚÈ· ÂÈÛ·ÁˆÁ‹˜ ÛÙË ÌÂϤÙË Â›Ó·È: ÂχıÂÚÔ ·ÙÔÌÈÎfi ÈÛÙÔÚÈÎfi ·‡ÚÂÙˆÓ Û·ÛÌÒÓ, Ê˘ÛÈÔÏÔÁÈ΋ „˘¯ÔÎÈÓËÙÈ΋ ·Ó¿Ù˘ÍË, Ó· ÌËÓ ¤¯ÂÈ ¯ÔÚËÁËı› ·ÓÙÈÂÈÏËÙÈ΋ ·ÁˆÁ‹ Î·È Ë ËÏÈΛ· ¤Ó·Ú͢ Ó· Â›Ó·È ÌÂٷ͇ 6 ÌËÓÒÓ Î·È 3 ÂÙÒÓ. √È ¶™ ÔÚ›ÛÙËÎ·Ó ‚¿ÛÂÈ Ù˘ ÔÌÔʈӛ·˜ ÙÔ˘ National Institutes of Health. ™‡Ìʈӷ Ì ÙËÓ ÔÔ›·, ˆ˜ ¶™ ÔÚ›˙ÔÓÙ·È ÔÈ Û·ÛÌÔ› Ô˘ Û˘Ì‚·›ÓÔ˘Ó Û ‚Ú¤ÊË Î·È ·È‰È¿ ËÏÈΛ·˜ ·fi 3 ÌËÓÒÓ ¤ˆ˜ 5 ÂÙÒÓ, Û¯ÂÙ›˙ÔÓÙ·È Ì ÙÔÓ ˘ÚÂÙfi ·ÏÏ¿ ‰ÂÓ ˘¿Ú¯ÂÈ ¤Ó‰ÂÈÍË ÂÓ‰ÔÎÚ¿ÓÈ·˜ Ïԛ̈͢ ‹ ¿ÏÏ˘ ÔÚÈṲ̂Ó˘ ·ÈÙ›·˜, Ô‡Ù ÈÛÙÔÚÈÎfi ÚÔËÁÔ‡ÌÂÓÔ˘ ÂÂÈÛÔ‰›Ô˘ ·‡ÚÂÙˆÓ Û·ÛÌÒÓ (8).

√È ÁÔÓ›˜ ÙˆÓ ·È‰ÈÒÓ ÂÓËÌÂÚÒıËÎ·Ó ÏÂÙÔÌÂÚÒ˜ Û¯ÂÙÈο Ì ÙË Ê‡ÛË Î·È ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ¶™ Î·È ¤‰ˆÛ·Ó ÙË Û˘ÁηٿıÂÛ‹ ÙÔ˘˜ ÁÈ· ÙË ÌÂϤÙË. ∂ÈϤÔÓ, ÔÈ ÁÔÓ›˜ Ù˘ ÔÌ¿‰·˜ ∞ ‹Ú·Ó ÚÔÊÔÚÈΤ˜ Î·È ÁÚ·Ù¤˜ Ô‰ËÁ›Â˜ Û¯ÂÙÈο Ì ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ÎχÛÌ·ÙÔ˜ ‰È·˙Â¿Ì˘ ·fi ÙÔ ÔÚıfi Î·È ÏËÚÔÊÔÚ‹ıËÎ·Ó ÁÈ· ÙȘ Èı·Ó¤˜ ·ÚÂÓ¤ÚÁÂȘ. ∏ ÚÔʇϷÍË ÂÊ·ÚÌfiÛÙËΠÙȘ ‰‡Ô ÚÒÙ˜ Ë̤Ú˜ ÙÔ˘ ˘ÚÂÙÔ‡ Î·È fiÙ·Ó Ë ıÂÚÌÔÎÚ·Û›· ÛÒÌ·ÙÔ˜ ·fi ÙÔ ÔÚıfi ‹Ù·Ó >38ÔC. ∞Ó¿ÏÔÁ· Ì ÙÔ ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜ ¯ÔÚËÁ‹ıËΠÙËÓ ÚÒÙË Ì¤Ú· ÙÔ˘ ˘ÚÂÙÔ‡ 0,33 mg/kg µ™/8ˆÚÔ Î·È ÙË ‰Â‡ÙÂÚË 0,33 mg/kg µ™/12ˆÚÔ Î·È fi¯È ¿Óˆ ·fi 7,5 mg/‰fiÛË. ¶ÚÔÎÂÈ̤ÓÔ˘ Ó· ·ÔÊ¢¯ı› ·ÓÂÈı‡ÌËÙË Î·Ù·ÛÙÔÏ‹ ·fi ÙË Û˘ÛÛÒÚ¢ÛË Ù˘ ‰È·˙Â¿Ì˘, ‰fiıËÎ·Ó ÙÔ Ì¤ÁÈÛÙÔ 5 Û˘Ó¯›˜ ‰fiÛÂȘ Û οı ÂÌ‡ÚÂÙË Ïԛ̈ÍË, Û‡Ìʈӷ Ì ÙÔ ·Ú·¿Óˆ Û¯‹Ì·. ¶ÚÔÊ›Ï ÎÈÓ‰‡ÓÔ˘ ˘ÔÙÚÔ‹˜ ¤ÁÈÓ Û οı ·È‰› Ù˘ ÌÂϤÙ˘ ÚÈÓ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜ Î·È ÔÈ ÁÔÓ›˜ ÂÓËÌÂÚÒıËÎ·Ó ÁÈ· ÙËÓ ÂӉ¯fiÌÂÓË ˘ÔÙÚÔ‹ ÙˆÓ ¶™ (¯·ÌËÏfi˜, ÂӉȿÌÂÛÔ˜ ‹ ˘„ËÏfi˜ ΛӉ˘ÓÔ˜). ∂Âȉ‹ Ù· ˘„ËÏÔ‡, ÂӉȷ̤ÛÔ˘ ‹ ¯·ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ·È‰È¿ ·ÓÙ·ÔÎÚ›ÓÔÓÙ·È ‰È·ÊÔÚÂÙÈο ÛÙË ‰È·Ï›Ô˘Û· ÚÔʇϷÍË Ì ‰È·˙Â¿ÌË, Ë Î¿ı ÔÌ¿‰· Ù·ÍÈÓÔÌ‹ıËΠ۠ÙÚÂȘ ˘ÔÔÌ¿‰Â˜, ·Ó¿ÏÔÁ· Ì ÙÔÓ ‚·ıÌfi ÎÈÓ‰‡ÓÔ˘ ˘ÔÙÚÔ‹˜. ∆Ô ÚÔÊ›Ï ÂÈÎÈÓ‰˘ÓfiÙËÙ·˜ ηıÔÚ›ÛÙËΠ‚¿ÛÂÈ ÙˆÓ ÎÏÈÓÈÎÒÓ ÎÚÈÙËÚ›ˆÓ ·fi ÙÔ ÈÛÙÔÚÈÎfi. √È ÚÔÁÓˆÛÙÈÎÔ› ‰Â›ÎÙ˜ ˘ÔÙÚÔ‹˜ ÙˆÓ ¶™, Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó Î·È ÛÙË ‰È΋ Ì·˜ ÌÂϤÙË, ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2. ∆· ·È‰È¿ Ô˘ ›¯·Ó ·fi Ìˉ¤Ó ¤ˆ˜ ¤Ó·Ó ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ηٷÓÂÌ‹ıËÎ·Ó ÛÙ· ¯·ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘, ÂΛӷ Ì ‰‡Ô ·Ú¿ÁÔÓÙ˜ ÛÙ· ÂӉȷ̤ÛÔ˘ Î·È ÂΛӷ Ì ÙÚÂȘ ¤ˆ˜ ¤ÓÙ ÛÙ· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘. ∏ ÌÂϤÙË ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜ ¿Ú¯ÈÛ ÌÂÙ¿ ÙÔ ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ¶™ ·fi ÙÔ ÙÌ‹Ì· ¶·È‰È·ÙÚÈ΋˜ ¡Â˘ÚÔÏÔÁ›·˜ (ÎÏÈÓÈ΋ Î·È Â͈ÙÂÚÈο È·ÙÚ›·). ŸÏ· Ù· ·È‰È¿ ›¯·Ó ÂχıÂÚÔ ÚÔÁÂÓÓËÙÈÎfi Î·È ÂÚÈÁÂÓÓËÙÈÎfi ÈÛÙÔÚÈÎfi, Ê˘ÛÈÔÏÔÁÈ΋ „˘¯ÔÎÈÓËÙÈ΋ ·Ó¿Ù˘ÍË Î·È Î·Ó¤Ó· ‰ÂÓ Â›¯Â ÎÏÈÓÈΤ˜ ‹ ÂÚÁ·ÛÙËÚȷΤ˜ ÂӉ›ÍÂȘ ÂÎÊ˘ÏÈÛÙÈÎÔ‡ ÓÔÛ‹Ì·ÙÔ˜ ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ (∫¡™). ™Â fiÏ· ¤ÁÈÓ ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ· (∏∂°), ÌfiÏȘ ·˘Ú¤ÙËÛ·Ó, ÌÂÙ¿ ÙÔ ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ¶™ Î·È ·Ú·ÎÔÏÔ˘ı‹ıËÎ·Ó ÁÈ· ÙÔ˘Ï¿¯ÈÛÙÔÓ 3 ¯ÚfiÓÈ·. ∏ ÙÂÏÈ΋ Â·ÓÂÎÙ›ÌËÛË ¤ÁÈÓ ÛÙËÓ ËÏÈΛ· ÙˆÓ 3-6 ÂÙÒÓ, ̤ÛË ËÏÈΛ· 4,8±1,2 ÂÙÒÓ. ∫¿ı 4 Ì‹Ó˜ ˘‹Ú¯Â Â·Ê‹ Ì ÙÔ˘˜ ÁÔÓ›˜ ÙˆÓ ·È‰ÈÒÓ ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô ÂÊ·ÚÌÔÁ‹˜ ÙÔ˘ ÚˆÙÔÎfiÏÏÔ˘ Î·È ÙËÓ ·ÔÊ˘Á‹ Ï·ıÒÓ. ∂›Û˘, Û οı ÂÌ‡ÚÂÙÔ ÂÂÈÛfi‰ÈÔ ˘‹Ú¯Â ͯˆÚÈÛÙ‹ ÙËÏÂʈÓÈ΋ ÂÈÎÔÈÓˆÓ›· Ì ÙÔ˘˜ ÁÔÓ›˜ ÁÈ· Ó· Û˘ÁÎÂÓÙÚˆıÔ‡Ó fiϘ ÔÈ ··Ú·›ÙËÙ˜ ÏËÚÔÊÔڛ˜ Û¯ÂÙÈο Ì ÙÔÓ ˘ÚÂÙfi, ÙÔ˘˜ Û·ÛÌÔ‡˜ Î·È ÙȘ Èı·Ó¤˜ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ. ™Ù·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ∏ ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ¤ÁÈÓ ۇÌʈӷ Ì ÙÔ Pearson Chi-Square Test (™˘Ó¯‹˜ ¢ÈfiÚıˆÛË Î·Ù¿ Yates). ™Ù·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ıˆڋıËÎ·Ó ÔÈ ÙÈ̤˜ ÙÔ˘ P<0,05.

∞ÔÙÂϤÛÌ·Ù· ∏ ÔÌ¿‰· ÚÔʇϷ͢ (n=68) ·ÔÙÂÏ›ÙÔ ·fi 39 ÎÔÚ›ÙÛÈ· Î·È 29 ·ÁfiÚÈ· Î·È Ë ËÏÈΛ· ¤Ó·Ú͢ Î˘Ì·ÈÓfiÙ·Ó ·fi 6 ¤ˆ˜ 36 Ì‹Ó˜ (̤ÛË ËÏÈΛ·±SD, 15±7). ™˘ÓÔÏÈο 54/68 ÂÌÊ¿ÓÈÛ·Ó ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ·ÏÒÓ ¶™, ÂÓÒ 14/68 ›¯·Ó ·ÚÔ˘ÛÈ¿ÛÂÈ ÛÙÔ ÚÒÙÔ ¶·È‰È·ÙÚÈ΋ 2007;70:42-48

44

∂. ¶·˘Ï›‰Ô˘ Î·È Û˘Ó.

¶›Ó·Î·˜ 1. µ·ÛÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ÔÌ¿‰ˆÓ ∞ Î·È µ ¢ËÌÔÁÚ·ÊÈο ¯·Ú·ÎÙËÚÈÛÙÈο £‹Ï· ∏ÏÈΛ· ¤Ó·Ú͢ a* √ÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ¶™* √ÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÂÈÏË„›·˜* æ˘¯ÔÎÈÓËÙÈ΋ ηı˘ÛÙ¤ÚËÛË ¶·È‰ÈÎfi˜ ÛÙ·ıÌfi˜* ¶Ï‹Ú˘ ÂÌ‚ÔÏÈ·ÛÙÈ΋ Î¿Ï˘„Ëb ÷ڷÎÙËÚÈÛÙÈο ÙÔ˘ ·Ú¯ÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘ ∏ÏÈΛ· ¤Ó·Ú͢ a* >15 ÌËÓÒÓ ≤15 ÌËÓÒÓ ¶™∂c* ∂ÈÏÂÁ̤ÓÔÈ ¶™ (ÂÛÙÈ·ÎÔ›)* ∂ÈÏÂÁ̤ÓÔÈ ¶™ (˘ÔÙÚÔ¤˜ ÛÙÔ ›‰ÈÔ ÂÌ‡ÚÂÙÔ)* ∂ÈÏÂÁ̤ÓÔÈ ¶™ (≥15 ÏÂÙ¿ ‰È¿ÚÎÂÈ·)* £ÂÚÌÔÎÚ·Û›· ÔÚıÔ‡ (ÔC) µ·ıÌfi˜ ÎÈÓ‰‡ÓÔ˘ ˘ÔÙÚÔ‹˜ 0-1 (÷ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘) 2 (ªÂÛ·›Ô˘ ÎÈÓ‰‡ÓÔ˘) 3-5 (À„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘)

√Ì¿‰· A (n=68)

√Ì¿‰· B (n=71)

39 (57%) 15 (6-36) 21 (31%) 6 (9%) ∫·Ó¤Ó· 21 (31%) 56 (82%)

38 (54%) 15 (6-36) 21 (30%) 8 (11%) ∫·Ó¤Ó· 24 (34%) 59 (83%)

15 (6-36) 30 (44%) 38 (56%) 2 (3%) 3 (4%)

15 (6-36) 31 (44%) 40 (56%) 2 (3%) 4 (6%)

12 (18%) 1 (2%) 38,5 (37-40oC)

10 (14%) 1 (2%) 38,8 (37-41oC)

27 (40%) 20 (29%) 21 (31%)

28 (39%) 20 (28%) 23 (32%)

a

™Â Ì‹Ó˜, b ™‡Ìʈӷ Ì ÙÔ ∂ıÓÈÎfi ¶ÚfiÁÚ·ÌÌ· ∂Ì‚ÔÏÈ·ÛÌÔ‡, c ¶˘ÚÂÙÈÎfi status epilepticus (‰È¿ÚÎÂÈ· >30 ÏÂÙ¿), * ¶·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ˘ÔÙÚÔ‹ ÙˆÓ ¶™, fiˆ˜ Û˘˙ËÙ‹ıËÎ·Ó ÛÙÔ “ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ”.

ÂÂÈÛfi‰ÈÔ ÂÈÏÂÁ̤ÓÔ˘˜ ¶™ Î·È ·fi ·˘Ù¿ 3 ÂÌÊ¿ÓÈÛ·Ó ÂÛÙȷ΋ ÛËÌÂÈÔÏÔÁ›·, ÂÓÒ 12 ›¯·Ó ˘ÔÙÚÔ‹ ÛÙÔ ›‰ÈÔ ÂÌ‡ÚÂÙÔ. ∏ ‰È¿ÚÎÂÈ· ÙˆÓ ÎÚ›ÛÂˆÓ ‹Ù·Ó Û 65 ·È‰È¿ ÌÈÎÚfiÙÂÚË ·fi 10 ÏÂÙ¿. ™Â 3 ÂÚÈÙÒÛÂȘ ÔÈ Û·ÛÌÔ› ›¯·Ó ‰È¿ÚÎÂÈ· >15 ÏÂÙ¿, ·fi ÙȘ Ôԛ˜ ‰‡Ô ÂΉËÏÒıËÎ·Ó Ì ÙË ÌÔÚÊ‹ ˘ÚÂÙÈÎÔ‡ status epilepticus (>30 ÏÂÙ¿). ™˘ÓÔÏÈο 30 ·È‰È¿ Ù˘ ÔÌ¿‰·˜ ∞ ›¯·Ó ËÏÈΛ· ¤Ó·Ú͢ ¿Óˆ ÙˆÓ 15 ÌËÓÒÓ, ÂÓÒ 38 ‹Ù·Ó ÌÈÎÚfiÙÂÚ· (¶›Ó·Î·˜ 1). ∏ ÔÌ¿‰· ÙˆÓ Ì·ÚÙ‡ÚˆÓ (n=71) ·ÔÙÂÏ›ÙÔ ·fi 38 ÎÔÚ›ÙÛÈ· Î·È 33 ·ÁfiÚÈ· Î·È Ë ËÏÈΛ· ¤Ó·Ú͢ Î˘Ì·ÈÓfiÙ·Ó ·fi 6 ¤ˆ˜ 36 Ì‹Ó˜ (̤ÛË ËÏÈΛ·±SD, 15±8). ¶ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ·ÏÒÓ ¶™ ÂÌÊ¿ÓÈÛ·Ó 59/71 ·È‰È¿ Î·È 12/71 ›¯·Ó ÂÈÏÂÁ̤ÓÔ. ™·ÛÌÔ› ‰È¿ÚÎÂÈ·˜ 1-5 ÏÂÙ¿ ηٷÁÚ¿ÊËÎ·Ó Û 68/71 ·ÛıÂÓ›˜, ‰‡Ô ›¯·Ó ˘ÚÂÙÈÎfi status epilepticus, ÂÓÒ 10/71 ›¯·Ó Î·È ‰Â‡ÙÂÚÔ ÂÂÈÛfi‰ÈÔ ÛÙÔ ›‰ÈÔ ÂÌ‡ÚÂÙÔ. ∂ÛÙÈ·ÎÔ› ¶™ ·Ú·ÙËÚ‹ıËÎ·Ó Û ٤ÛÛÂÚȘ ·ÛıÂÓ›˜. ∆ÚÈ¿ÓÙ· ¤Ó· ·È‰È¿ ‹Ù·Ó ËÏÈΛ·˜ ÌÂÁ·Ï‡ÙÂÚ· ·fi 15 ÌËÓÒÓ Î·È 40 ÌÈÎÚfiÙÂÚ· (¶›Ó·Î·˜ 1). ¶›Ó·Î·˜ 2. ¶ÚÔÁÓˆÛÙÈÎÔ› ‰Â›ÎÙ˜ ˘ÔÙÚÔ‹˜ ˘ÚÂÙÈÎÒÓ Û·ÛÌÒÓ ñ ∏ÏÈΛ· ¤Ó·Ú͢ ≤15 ÌËÓÒÓ ñ √ÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ¶™ ÛÂ Û˘ÁÁÂÓ‹ ·ã ‚·ıÌÔ‡ ñ √ÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÂÈÏË„›·˜ ÛÂ Û˘ÁÁÂÓ‹ ·ã ‚·ıÌÔ‡ ñ ∂ÈÏÂÁ̤ÓÔ ÙÔ ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ¶™ ñ ™˘¯Ó¤˜ ÂÌ‡ÚÂÙ˜ ÏÔÈÌÒÍÂȘ (·È‰ÈÎfi˜ ÛÙ·ıÌfi˜) Paediatriki 2007;70:42-48

ªÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ‰ÂÓ ˘‹Ú¯·Ó ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ fiÛÔÓ ·ÊÔÚ¿ ÙÔ Ê‡ÏÔ, ÙËÓ ËÏÈΛ· ¤Ó·Ú͢, ÙË ÌÔÚÊ‹ Î·È ÙË ‰È¿ÚÎÂÈ· Û·ÛÌÒÓ. £ÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÂÈÏË„›·˜ ÛÂ Û˘ÁÁÂÓ‹ ·ã ‚·ıÌÔ‡ ˘‹Ú¯Â Û 6 ·ÛıÂÓ›˜ Ù˘ ÔÌ¿‰·˜ ∞ Î·È Û 8 Ù˘ ÔÌ¿‰·˜ µ, ÂÓÒ ÈÛÙÔÚÈÎfi ¶™ ÛÂ Û˘ÁÁÂÓ‹ ·ã ‚·ıÌÔ‡ ›¯·Ó 21/68 ·È‰È¿ Ù˘ ÔÌ¿‰·˜ ∞ Î·È 21/71 Ù˘ ÔÌ¿‰·˜ µ. ∏ Ó¢ÚÔÏÔÁÈ΋ ÂͤٷÛË Î·È Ë „˘¯ÔÎÈÓËÙÈ΋ ·Ó¿Ù˘ÍË ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈΤ˜ Û fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜. ∆· ∏∂° fiÏˆÓ ÙˆÓ ·È‰ÈÒÓ (ÔÌ¿‰· ∞ Î·È µ) ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο, ÂÎÙfi˜ ·fi Ì›· ÂÚ›ÙˆÛË fiÔ˘ ηٷÁÚ¿ÊËÎ·Ó Û·Ê›˜ ·ÚÔ͢ÓÙÈΤ˜ ÂÎÊÔÚÙ›ÛÂȘ ·ÚÈÛÙÂÚ¿ Î·È Ù¿ÛË ÁÂÓ›Î¢Û˘. ∆Ô ·È‰› ·Ó‹Î ÛÙËÓ ÔÌ¿‰· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ¯ˆÚ›˜ ÚÔʇϷÍË Î·È ÂÌÊ¿ÓÈÛÂ Û˘ÓÔÏÈο 6 ˘ÔÙÚÔ¤˜. ŸÏ· Ù· ·È‰È¿ Ù˘ ÌÂϤÙ˘ ›¯·Ó ÙÔ˘Ï¿¯ÈÛÙÔÓ ¤ÍÈ ÂÌ‡ÚÂÙ· ÂÂÈÛfi‰È· ηٿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ 3 ¯ÚfiÓˆÓ ·Ú·ÎÔÏÔ‡ıËÛ˘ Î·È Ô Û˘ÓÔÏÈÎfi˜ ·ÚÈıÌfi˜ ÙˆÓ ÂÌ‡ÚÂÙˆÓ Î·Ù·ÛÙ¿ÛÂˆÓ ‹Ù·Ó 443 ÁÈ· ÙËÓ ÔÌ¿‰· ∞ Î·È 485 ÁÈ· ÙË µ. ∆· ·›ÙÈ· ÙÔ˘ ˘ÚÂÙÔ‡ ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ ‹Ù·Ó ÈÔÁÂÓ›˜ ÏÔÈÌÒÍÂȘ ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡. ∏ ıÂÚÌÔÎÚ·Û›· ÛÙÔ ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ¶™ Î˘Ì·›ÓÔÓÙ·Ó ÛÙ· ·È‰È¿ ˘fi ÚÔʇϷÍË ÌÂٷ͇ 37,5ÔC Î·È 40ÔC (̤ÛË ÙÈÌ‹ 38,5ÔC) Î·È ÛÙËÓ ÔÌ¿‰· ¯ˆÚ›˜ ÚÔʇϷÍË ÌÂٷ͇ 37,6ÔC Î·È 41ÔC (̤ÛË ÙÈÌ‹ 38,8ÔC). øÛÙfiÛÔ, ÛÙȘ ˘ÔÙÚÔ¤˜ Ë ıÂÚÌÔÎÚ·Û›· ›¯Â ‰È·Î‡Ì·ÓÛË ·fi 38ÔC ¤ˆ˜ 39,5ÔC (̤ÛË ÙÈÌ‹ 39ÔC). ∏ ÏÂÈÔÓfiÙËÙ·

45

ÙˆÓ ˘ÔÙÚÔÒÓ ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜ ·ÚÔ˘ÛÈ¿ÛÙËΠÙȘ ÚÒÙ˜ 24 ÒÚ˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË ÙÔ˘ ˘ÚÂÙÔ‡. ™˘ÓÔÏÈο ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ÌÂϤÙ˘ ÛÙËÓ ÔÌ¿‰· ∞ Ô˘ ¤Ï·‚ ‰È·˙Â¿ÌË, ˘‹Ú¯·Ó 38 ˘ÔÙÚÔ¤˜ Î·È 103 ÛÙËÓ ÔÌ¿‰· µ ÙˆÓ Ì·ÚÙ‡ÚˆÓ. ∆Ô˘˜ ÚÒÙÔ˘˜ 6 Ì‹Ó˜ Ù˘ ÌÂϤÙ˘ ‰Âη¤ÓÙ ·ÛıÂÓ›˜ ·fi ÙËÓ ÔÌ¿‰· ∞ (22%) Î·È ÂÈÎÔÛÈÙ¤ÛÛÂÚȘ ·fi ÙËÓ ÔÌ¿‰· µ (34%) ›¯·Ó ÙÔ˘Ï¿¯ÈÛÙÔÓ Ì›· ˘ÔÙÚÔ‹. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÚÒÙÔ˘ ¯ÚfiÓÔ˘ ·Ú·ÎÔÏÔ‡ıËÛ˘ 20/68 ·È‰È¿ Ô˘ ‹Ú·Ó ÚÔʇϷÍË (29%) Î·È 33/71 Ô˘ ‰ÂÓ ‹Ú·Ó ÚÔʇϷÍË (46%) ˘ÔÙÚÔ›·Û·Ó. ∆Ú›· ¯ÚfiÓÈ· ÌÂÙ¿ ÙËÓ Ù˘¯·ÈÔÔ›ËÛË, Ë ·ıÚÔÈÛÙÈ΋ Û˘¯ÓfiÙËÙ· Ù˘ ÚÒÙ˘ ˘ÔÙÚÔ‹˜ ÙˆÓ ¶™ ‹Ù·Ó 60% ÛÙËÓ ÔÌ¿‰· ÙˆÓ Ì·ÚÙ‡ÚˆÓ Î·È 35% ÛÙËÓ ÔÌ¿‰· Ù˘ ‰È·˙Â¿Ì˘. ∞˘Ùfi ‰Â›¯ÓÂÈ fiÙÈ ÛËÌÂÈÒıËΠ̛ˆÛË 25% ÛÙËÓ ÔÌ¿‰· ∞ Ô˘ ¤Ï·‚ ÙËÓ ÚÔʇϷÍË (¶›Ó·Î·˜ 3). ™ÙËÓ ÔÌ¿‰· Ù˘ ‰È·˙Â¿Ì˘ 7/68 ·È‰È¿ ›¯·Ó Û˘ÓÔÏÈο 15 ˘ÔÙÚÔ¤˜, 15/68 Ì›· ˘ÔÙÚÔ‹, ÌfiÓÔ ‰‡Ô ·È‰È¿ Ù¤ÛÛÂÚȘ, ÂÓÒ 44/68 ‰ÂÓ ÂÌÊ¿ÓÈÛ·Ó ˘ÔÙÚÔ‹. ™ÙËÓ ÔÌ¿‰· Ô˘ ‰ÂÓ ¤Ï·‚ ÚÔʇϷÍË, 22/71 ·ÛıÂÓ›˜ ›¯·Ó Û˘ÓÔÏÈο 73 ˘ÔÙÚÔ¤˜, 20/71 Ì›· Î·È 1 ·È‰› ›¯Â 10. ∏ Û˘¯ÓfiÙËÙ· Ù˘ ˘ÔÙÚÔ‹˜ ÌÂȈÓfiÙ·Ó Ì ÙËÓ ·‡ÍËÛË Ù˘ ËÏÈΛ·˜ ÙˆÓ ·È‰ÈÒÓ, ÂȉÈÎfiÙÂÚ· ÌÂÙ¿ ÙÔÓ 2Ô ¯ÚfiÓÔ Ù˘ ˙ˆ‹˜. ™ÙËÓ ÔÌ¿‰· µ, Ë Û˘¯ÓfiÙËÙ· ˘ÔÙÚÔ‹˜ ÛÙÔ Ù¤ÏÔ˜ Ù˘ ·Ú·ÎÔÏÔ‡ıËÛ˘ ÙˆÓ ÙÚÈÒÓ ¯ÚfiÓˆÓ ‹Ù·Ó 46% ÁÈ· Ù· ¯·ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ·È‰È¿, 55% ÁÈ· Ù· ÂӉȷ̤ÛÔ˘ Î·È 83% ÁÈ· Ù· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ (∂ÈÎfiÓ· 1). ∞ÓÙ›ıÂÙ·, ÛÙËÓ ÔÌ¿‰· ∞ Ë Û˘¯ÓfiÙËÙ· Ù˘ ˘ÔÙÚÔ‹˜ ÁÈ· ÙÔ ›‰ÈÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÌÂÈÒıËΠ۠33% ÛÙ· ¯·ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘, 35% ÛÙ· ÂӉȷ̤ÛÔ˘ Î·È 38% ÛÙ· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ·È‰È¿ (∂ÈÎfiÓ· 2). ªÂ ÙË ¯Ú‹ÛË Ù˘ ‰È·˙Â¿Ì˘ ·Ú·ÙËÚ‹ıËΠ̛ˆÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ ˘ÔÙÚÔ‹˜ ηٿ 45% ÛÙ· ·È‰È¿ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ Î·È ÌfiÓÔ 13% Î·È 20% ·ÓÙ›ÛÙÔȯ·, ÛÙ· ¯·ÌËÏÔ‡ Î·È ÂӉȿÌÂÛÔ˘ ÎÈÓ‰‡ÓÔ˘. ∏ ‰È·Ï›Ô˘Û· ÚÔʇϷÍË Ì ‰È·˙Â¿ÌË Ì›ˆÛ ÙË Û˘¯ÓfiÙËÙ· ˘ÔÙÚÔ‹˜ ÛËÌ·ÓÙÈο ÛÙ· ˘„ËÏÔ‡ ÎÈÓ-

™˘¯ÓfiÙËÙ· ˘ÔÙÚÔ‹˜ (%)

¶˘ÚÂÙÈÎÔ› Û·ÛÌÔ›

™˘¯ÓfiÙËÙ· ˘ÔÙÚÔ‹˜ Û ۯ¤ÛË Ì ÙÔÓ ‚·ıÌfi ÎÈÓ‰‡ÓÔ˘ ÛÙËÓ ÔÌ¿‰· µ 100 80 60 40 20 0 0

6

12

18

24

30

36

ª‹Ó˜ ÌÂÙ¿ ÙÔ 1Ô ÂÂÈÛfi‰ÈÔ ¶™ ÷ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ∂Ӊȷ̤ÛÔ˘ ÎÈÓ‰‡ÓÔ˘ À„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ∂ÈÎfiÓ· 1. ™˘¯ÓfiÙËÙ· ˘ÔÙÚÔ‹˜ Û ۯ¤ÛË Ì ÙÔÓ ‚·ıÌfi ÎÈÓ‰‡ÓÔ˘ ÛÙËÓ ÔÌ¿‰· µ.

‰‡ÓÔ˘ ·È‰È¿ (p=0,005, ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿), ÂÓÒ ÛÙ· ¯·ÌËÏÔ‡ (p=0,412, ÛÙ·ÙÈÛÙÈο ÌË ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿) Î·È ÛÙ· ÌÂÛ·›Ô˘ ÎÈÓ‰‡ÓÔ˘ (p=0,341, ÛÙ·ÙÈÛÙÈο ÌË ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿) ›¯Â ¯·ÌËÏ‹ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· (¶›Ó·Î·˜ 3). √È ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ Ô˘ ·Ú·ÙËÚ‹ıËÎ·Ó ÛÙËÓ ÔÌ¿‰· ∞ (14%), fiˆ˜ ˘ÓËÏ›· Î·È Â˘ÂÚÂıÈÛÙfiÙËÙ·, ‹Ù·Ó ‹Ș Î·È ·ÚÔ‰ÈΤ˜, ÂÓÒ Ì·ÎÚÔÚfiıÂÛ̘ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ ‰ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ÛÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÙÚÈÒÓ ¯ÚfiÓˆÓ. ¶ÚÔ‚Ï‹Ì·Ù· ÂÏÏÈÔ‡˜ Û˘ÌÌfiÚʈÛ˘ ‹ ÂÊ·ÚÌÔÁ‹˜ Ù˘ ÌÂϤÙ˘ ‰ÂÓ ÛËÌÂÈÒıËηÓ, ‰ÈfiÙÈ ˘‹Ú¯Â Û˘¯Ó‹ Â·Ê‹ Ì ÙÔ˘˜ ÁÔÓ›˜ ÁÈ· ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙˆÓ Ô‰ËÁÈÒÓ. ™Â 14 ÂÚÈÙÒÛÂȘ Ë ˘ÔÙÚÔ‹ ÙˆÓ ¶™ Û˘Ó¤‚Ë Ì ÙËÓ ¿ÓÔ‰Ô ÙÔ˘ ˘ÚÂÙÔ‡. √È 6 ·fi ·˘Ù¤˜ ·Ó‹Î·Ó Û ·È‰È¿ Ù˘ ÔÌ¿‰·˜ ∞, ÛÙ· ÔÔ›· ÔÈ ÁÔÓ›˜ ‰ÂÓ ÚfiÏ·‚·Ó Ó· ¯ÔÚËÁ‹ÛÔ˘Ó ¤ÁηÈÚ· ÙÔ Ê¿ÚÌ·ÎÔ. ∞fi Ù· ·È‰È¿ ·˘Ù¿ 1 ·Ó‹Î ÛÙËÓ ˘ÔÔÌ¿‰· ˘„ËÏÔ‡

¶›Ó·Î·˜ 3. ™‡ÁÎÚÈÛË ÙˆÓ Û˘¯ÓÔÙ‹ÙˆÓ ˘ÔÙÚÔ‹˜ ÛÙ· ·È‰È¿ ¯·ÌËÏÔ‡, ÌÂÛ·›Ô˘ Î·È ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ˘ÔÙÚÔ‹˜ ÙˆÓ ÔÌ¿‰ˆÓ ∞ Î·È µ (·Ú·ÎÔÏÔ‡ıËÛË 3 ¯ÚfiÓˆÓ) ÷ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘

ªÂÛ·›Ô˘ ÎÈÓ‰‡ÓÔ˘

À„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘

ÀÔÙÚÔ‹

√Ì¿‰· µ

√Ì¿‰· ∞

Exact Sig. (2-sided)

Ÿ¯È ¡·È ™‡ÓÔÏÔ Ÿ¯È ¡·È ™‡ÓÔÏÔ Ÿ¯È ¡·È ™‡ÓÔÏÔ

15 13 28 9 11 20 4 19 23

18 9 27 13 7 20 13 8 21

p=0,412 NS p=0,341 NS p=0,005 S

NS: ªË ™ËÌ·ÓÙÈÎfi, S: ™ËÌ·ÓÙÈÎfi ¶·È‰È·ÙÚÈ΋ 2007;70:42-48

46

™˘¯ÓfiÙËÙ· ˘ÔÙÚÔ‹˜ (%)

∂. ¶·˘Ï›‰Ô˘ Î·È Û˘Ó.

™˘¯ÓfiÙËÙ· ˘ÔÙÚÔ‹˜ Û ۯ¤ÛË Ì ÙÔÓ ‚·ıÌfi ÎÈÓ‰‡ÓÔ˘ ÛÙËÓ ÔÌ¿‰· ∞ 100 80 60 40 20 0 0

6 12 18 24 30 ª‹Ó˜ ÌÂÙ¿ ÙÔ 1Ô ÂÂÈÛfi‰ÈÔ ¶™

36

÷ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ∂Ӊȷ̤ÛÔ˘ ÎÈÓ‰‡ÓÔ˘ À„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘

∂ÈÎfiÓ· 2. ™˘¯ÓfiÙËÙ· ˘ÔÙÚÔ‹˜ Û ۯ¤ÛË Ì ÙÔÓ ‚·ıÌfi ÎÈÓ‰‡ÓÔ˘ ÛÙËÓ ÔÌ¿‰· ∞.

ÎÈÓ‰‡ÓÔ˘, 3 ÛÙËÓ ÂӉȷ̤ÛÔ˘ Î·È 2 ÛÙË ¯·ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘. °È· ÙË ÛˆÛÙfiÙÂÚË ·Ó¿Ï˘ÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ Ù˘ ÌÂϤÙ˘, ÔÈ Û˘ÁÎÂÎÚÈ̤Ó˜ ˘ÔÙÚÔ¤˜ ‰ÂÓ Î·Ù·ÌÂÙÚ‹ıËηÓ. ªÂÙ¿ ÙËÓ ˘ÔÙÚÔ‹ ÔÈ ÁÔÓ›˜ ¤Ï·‚·Ó Ô‰ËÁ›Â˜ Ó· Û˘Ó¯›ÛÔ˘Ó Î·ÓÔÓÈο ÙÔ ÚˆÙfiÎÔÏÏÔ Ù˘ ÚÔʇϷ͢.

™˘˙‹ÙËÛË ∏ ‰È·Ï›Ô˘Û· ÚÔʇϷÍË Ì ‰È·˙Â¿ÌË ÂÊ·ÚÌfiÛÙËΠٷ ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ·fi ÔÏÏÔ‡˜ ÂÚ¢ÓËÙ¤˜ ÛÙËÓ ∂˘ÚÒË Î·È ÙËÓ π·ˆÓ›· (6,9). ∏ ‰È·˙Â¿ÌË ÌÔÚ› Ó· ¯ÔÚËÁËı› ·fi ÙÔ ÛÙfiÌ·, ˘ÔÁÏÒÛÛÈ· Î·È ·fi ÙÔ ÔÚıfi (10,11). ∏ ÚÈÓÈ΋ ¯ÔÚ‹ÁËÛË ‰È·˙Â¿Ì˘ ‰ÂÓ ¤¯ÂÈ ¯ÚËÛÈÌÔÔÈËı› ·ÎfiÌË ÁÈ· ÙË ‰È·Ï›Ô˘Û· ÚÔʇϷÍË ÙˆÓ ¶™ (12). ™ÙË ÌÂϤÙË Ì·˜ ÂÈϤͷÌ ÙË ‰È·˙Â¿ÌË ·fi ÙÔ ÔÚıfi, ÁÈ·Ù› Â›Ó·È Â‡ÎÔÏË Ë ¯Ú‹ÛË Ù˘, ÊÙ¿ÓÂÈ ÁÚ‹ÁÔÚ· Û ˘„ËÏ¿ ıÂÚ·¢ÙÈο Â›‰· ÛÙÔÓ ÔÚfi (<10 ÏÂÙ¿) Î·È Ë Ì¤ÁÈÛÙË Û˘ÁΤÓÙÚˆÛ‹ Ù˘ ÂÈÙ˘Á¯¿ÓÂÙ·È Û 30 ̤¯ÚÈ 60 ÏÂÙ¿ (10). √È Minagawa Î·È Û˘Ó. ÌÂϤÙËÛ·Ó ÙË Ê·ÚÌ·ÎÔÎÈÓËÙÈ΋ Ù˘ ‰È·˙Â¿Ì˘ ·fi ÙÔ ÔÚıfi Û Â·Ó·Ï·Ì‚·ÓfiÌÂÓ˜ ‰fiÛÂȘ. ™Â 6 ‚Ú¤ÊË Ì ÂÌ‡ÚÂÙË Ïԛ̈ÍË ¯ÔÚ‹ÁËÛ·Ó ‰È·˙Â¿ÌË Û ‰‡Ô ‰fiÛÂȘ ÙˆÓ 0,5 mg/kg ·fi ÙÔ ÔÚıfi, Ì ÌÂÛԉȿÛÙËÌ· 8 ˆÚÒÓ Î·È ¤‰ÂÈÍ·Ó fiÙÈ ÂÈÙ‡¯ıËÎ·Ó ıÂÚ·¢ÙÈο Â›‰· ÛÙÔ Ï¿ÛÌ· Û 30 ÏÂÙ¿ ·fi ÙË ¯ÔÚ‹ÁËÛË Î·È ‰È·ÙËÚ‹ıËÎ·Ó ÁÈ· 24 ÒÚ˜ (13). ∏ ËÏÈΛ· ¤Ó·Ú͢ Ù˘ ÌÂϤÙ˘ Ì·˜, Û‡Ìʈӷ Ì ٷ ÎÚÈÙ‹ÚÈ·, Î˘Ì·ÈÓfiÙ·Ó ·fi 6 Ì‹Ó˜ ¤ˆ˜ 3 ¯ÚfiÓÈ· ÎÈ ·˘Ùfi ÁÈ·Ù› ÙÔ 90% ÂÚ›Ô˘ ÙˆÓ ·È‰ÈÒÓ Ô˘ ÂÌÊ·Ó›˙Ô˘Ó ¶™ Â›Ó·È Î¿Ùˆ ÙˆÓ 3 ÂÙÒÓ. ∞˘Ùfi ÛËÌ·›ÓÂÈ fiÙÈ ·È‰È¿ Ô˘ ¤¯Ô˘Ó ÙÔ ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ¶™ Û ÌÈÎÚ‹ ËÏÈΛ·, ¤¯Ô˘Ó ÂÚÈÛÛfiÙÂÚÔ ¯ÚfiÓÔ ÁÈ· Ó· ÂÌÊ·Paediatriki 2007;70:42-48

Ó›ÛÔ˘Ó ˘ÔÙÚÔ‹ Û ۯ¤ÛË Ì ٷ ÌÂÁ·Ï‡ÙÂÚ˘ ËÏÈΛ·˜. √È Offringa Î·È Û˘Ó. (1994) Û ÌÈ· ÌÂÙ·-·Ó¿Ï˘ÛË 5 ÌÂÏÂÙÒÓ ·Û¯ÔÏ‹ıËÎ·Ó Ì ÙÔÓ Î›Ó‰˘ÓÔ ˘ÔÙÚÔ‹˜ Û ۯ¤ÛË Ì ÙËÓ ËÏÈΛ· ¤Ó·Ú͢ Î·È ‚Ú‹Î·Ó ˆ˜ ÔÈ ¶™ ÂÏ·ÙÙÒÓÔÓÙ·Ó Û˘Ó¯Ҙ Ì ÙËÓ ¿ÚÔ‰Ô Ù˘ ËÏÈΛ·˜ ·fi 12 ¤ˆ˜ 42 ÌËÓÒÓ (14). ∞fi ÙË ‚È‚ÏÈÔÁÚ·Ê›· ÁÓˆÚ›˙Ô˘ÌÂ, fiÙÈ Ô Î›Ó‰˘ÓÔ˜ ÂÌÊ¿ÓÈÛ˘ ˘ÔÙÚÔ‹˜ ÙˆÓ ¶™ ÙÔÓ ÚÒÙÔ ¯ÚfiÓÔ Î˘Ì·›ÓÂÙ·È ÌÂٷ͇ 29 Î·È 42,5%, ηٿ ̤ÛÔÓ fiÚÔ 35% (15). ∏ ‰È΋ Ì·˜ ÌÂϤÙË ¤‰ÂÈÍ ˆ˜ Ë Û˘ÓÔÏÈ΋ Û˘¯ÓfiÙËÙ· ˘ÔÙÚÔÒÓ ÛÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÙÚÈÒÓ ¯ÚfiÓˆÓ ‹Ù·Ó 60% ÛÙËÓ ÔÌ¿‰· Ô˘ ‰ÂÓ ¯ÔÚËÁ‹ıËΠ‰È·˙Â¿ÌË Î·È 35% ÛÙËÓ ÔÌ¿‰· Ô˘ ¤Ï·‚ ÙÔ Ê¿ÚÌ·ÎÔ. ∫·Ù¿ ÙË ÁÓÒÌË Ì·˜ ÔÈ ˘„ËÏÔ› ·ÚÈıÌÔ› ˘ÔÙÚÔ‹˜ Ô˘ ‚ڋηÌÂ Î·È ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜ ÔÊ›ÏÔÓÙ·È Û ‰‡Ô ÏfiÁÔ˘˜: ·) ÛÙË ÌÂÁ¿ÏË ‰È¿ÚÎÂÈ· ·Ú·ÎÔÏÔ‡ıËÛ˘ (3 ¯ÚfiÓÈ·) Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·‡ÍËÛË Ù˘ Èı·ÓfiÙËÙ·˜ ÂÌÊ¿ÓÈÛ˘ ˘ÔÙÚÔÒÓ Î·È ‚) ÛÙË ÌÈÎÚ‹ ËÏÈΛ· ¤Ó·Ú͢ ÙˆÓ ¶™ (<15 ÌËÓÒÓ) ÛÙÔ 60% ÂÚ›Ô˘ ÙˆÓ ·È‰ÈÒÓ Û οı ÔÌ¿‰·. ™ÙȘ ¿ÏϘ ÌÂϤÙ˜ Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜ ÙÔ ÔÛÔÛÙfi ÙˆÓ ·È‰ÈÒÓ Ì ËÏÈΛ· οو ÙˆÓ 15 ÌËÓÒÓ ‰ÂÓ ‹Ù·Ó Û η̛· ÂÚ›ÙˆÛË ÙfiÛÔ ˘„ËÏfi (11,12,14). √È ÂÚÈÛÛfiÙÂÚ˜ ÌÂϤÙ˜, Û˘ÌÂÚÈÏ·Ì‚·ÓÔ̤Ó˘ Î·È Ù˘ ‰È΋˜ Ì·˜, Û˘ÌʈÓÔ‡Ó fiÙÈ Ë ÌÈÎÚ‹ ËÏÈΛ· ¤Ó·Ú͢ Â›Ó·È Ô ÈÔ ÛËÌ·ÓÙÈÎfi˜ ÚÔÁÓˆÛÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ˘ÔÙÚÔÒÓ (16-18). °È· Ó· ÂÎÙÈÌ‹ÛÔ˘Ì ÙÔÓ Î›Ó‰˘ÓÔ ˘ÔÙÚÔ‹˜ ηχÙÂÚ·, ˘ÈÔıÂÙ‹Û·Ì ¤Ó·Ó ÚÔÁÓˆÛÙÈÎfi ‰Â›ÎÙË ‚·ÛÈṲ̂ÓÔ Û ¤ÓÙ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘. °È· Ú·ÎÙÈÎÔ‡˜ ÏfiÁÔ˘˜ fiÏÔÈ ÔÈ ·Ú¿ÁÔÓÙ˜ ıˆڋıËÎ·Ó ˆ˜ ¤¯Ô˘Ó ÙËÓ ›‰È· ÚÔÁÓˆÛÙÈ΋ ·Í›·. ∞ÏÏ¿ Î·È ÁÂÓÂÙÈÎÔ› Î·È ÎÔÈÓˆÓÈÎÔ-ÔÈÎÔÓÔÌÈÎÔ› ·Ú¿ÁÔÓÙ˜ ÌÔÚÔ‡Ó Â›Û˘ Ó· ÂËÚ¿ÛÔ˘Ó ÙÔÓ Ù‡Ô, ÙÔÓ ·ÚÈıÌfi, ÙËÓ ·ÏÏËÏÂ›‰Ú·ÛË Î·È ÙËÓ ÈÛ¯‡ ÙˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘. ∏ ÌÂϤÙË Ì·˜ ‰Â›¯ÓÂÈ fiÙÈ Ë ÚÔʇϷÍË Ì ‰È·˙Â¿ÌË Â› ˘ÚÂÙÔ‡ ÚÔÛʤÚÂÈ ÈηÓÔÔÈËÙÈÎfi ¤ÏÂÁ¯Ô ÙˆÓ ˘ÔÙÚÔÒÓ ÛÙ· ·È‰È¿ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ Î·È fi¯È ÛÙ· ·È‰È¿ Ì ¯·ÌËÏfi ‹ ÌÂÛ·›Ô ΛӉ˘ÓÔ ˘ÔÙÚÔ‹˜. ∆· ·ÔÙÂϤÛÌ·Ù¿ Ì·˜ ÂȂ‚·ÈÒÓÔ˘Ó ÙË ÌÂϤÙË ÙÔ˘ Knudsen (1985b), Ô ÔÔ›Ô˜ Ì ÙÔ ›‰ÈÔ ÚÔÊ›Ï ÂÈÎÈÓ‰˘ÓfiÙËÙ·˜, ˘ÔÏfiÁÈÛ ÙË Û˘¯ÓfiÙËÙ· ˘ÔÙÚÔ‹˜ ÙˆÓ ¶™ Û ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· 18 ÌËÓÒÓ. ÃÔÚ‹ÁËÛ ‰È·˙Â¿ÌË ·fi ÙÔ ÔÚıfi 0,5 mg/kg Û ‰‡Ô ‰fiÛÂȘ ÛÙË ‰È¿ÚÎÂÈ· ÂÌ˘Ú¤ÙÔ˘ ÓÔÛ‹Ì·ÙÔ˜, ̤¯ÚÈ Ô ˘ÚÂÙfi˜ Ó· ¤ÛÂÈ Î¿Ùˆ ·fi 38,5ÔC. ∆· Û˘ÌÂÚ¿ÛÌ·Ù· Ù˘ ÌÂϤÙ˘ ¤‰ÂÈÍ·Ó fiÙÈ Ë ‰È·Ï›Ô˘Û· ¯ÔÚ‹ÁËÛË ‰È·˙Â¿Ì˘ Â›Ó·È ·Ó·ÔÙÂÏÂÛÌ·ÙÈ΋ ÛÙ· Ôχ ¯·ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ·È‰È¿ (ηӤӷ˜ ·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘), ¤¯ÂÈ Ì¤ÙÚÈ· ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÛÙ· ÌÂÛ·›Ô˘ ÎÈÓ‰‡ÓÔ˘ Î·È Â›Ó·È ÂÍ·ÈÚÂÙÈο ·ÔÙÂÏÂÛÌ·ÙÈ΋ ÛÙ· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘. ™˘ÁÎÂÎÚÈ̤ӷ, ÛÙËÓ ÔÌ¿‰· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ‚ڋΠfiÙÈ Ë Û˘¯ÓfiÙËÙ· ˘ÔÙÚÔ‹˜ ÌÂÈÒıËΠ·fi 75-100% Û 10-15% Ì ÙËÓ ÚÔʇϷÍË (17).

47

¶˘ÚÂÙÈÎÔ› Û·ÛÌÔ›

∏ ‰È΋ Ì·˜ ÌÂϤÙË ¤¯ÂÈ ÌÂÁ·Ï‡ÙÂÚÔ ¯ÚfiÓÔ ·Ú·ÎÔÏÔ‡ıËÛ˘ (36 Ì‹Ó˜ ·ÓÙ› 18) Î·È ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ ·Ú·ÙËÚ‹ıËÎ·Ó Û ÌÈÎÚfiÙÂÚÔ ÔÛÔÛÙfi, ÏfiÁˆ Ù˘ ¯ÔÚ‹ÁËÛ˘ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ÌfiÓÔ ÁÈ· ‰‡Ô Ë̤Ú˜ (3 ‰fiÛÂȘ ÙËÓ ÚÒÙË Ë̤ڷ Î·È 2 ÙË ‰Â‡ÙÂÚË) ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÌ‡ÚÂÙ˘ Ïԛ̈͢. ™ÙÔ ›‰ÈÔ Û˘Ì¤Ú·ÛÌ· Ô‰ËÁ‹ıËÎ·Ó Î·È ÔÈ Û˘ÁÁÚ·Ê›˜ Ù˘ ·Ú·¿Óˆ ÌÂϤÙ˘ (Knudsen, 1985b), ÔÈ ÔÔ›ÔÈ ¿ÏÏ·Í·Ó ÙÔ Û¯‹Ì· ÚÔʇϷ͢ Û ٤ÛÛÂÚȘ ‰fiÛÂȘ. ∞fi ÙËÓ ¿ÏÏË ÌÂÚÈ¿, ·ÓÙÈÎÚÔ˘fiÌÂÓ· ·ÔÙÂϤÛÌ·Ù· ÚÔ·ÙÔ˘Ó ·fi ÙȘ ÌÂϤÙ˜ ÙˆÓ Uhari Î·È Û˘Ó. (1995) Î·È ÙˆÓ Autret Î·È Û˘Ó. (1990), ÙˆÓ ÔÔ›ˆÓ ÔÈ ¤Ú¢Ó˜ ¤‰ÂÈÍ·Ó ˆ˜ ‰ÂÓ ÂÈÙ‡¯ıËΠÛËÌ·ÓÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙˆÓ ÎÚ›ÛÂˆÓ (11,19). ŸÌˆ˜, ÛÙË ÌÂϤÙË ÙˆÓ Uhari Î·È Û˘Ó. (1995) Ê·›ÓÂÙ·È fiÙÈ Ë ¯·ÌËÏ‹ ‰fiÛË Ù˘ ‰È·˙Â¿Ì˘, ·Ú¯Èο ·fi ÙÔ ÔÚıfi Î·È ·ÎÔÏÔ‡ıˆ˜ ·fi ÙÔ ÛÙfiÌ· (0,2 mg/kg ÙÚÂȘ ÊÔÚ¤˜/Ë̤ڷ) ‹Ù·Ó ˘‡ı˘ÓË ÁÈ· ÙËÓ ¤ÏÏÂÈ„Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜. ∏ ÌÂϤÙË ÙˆÓ Autret Î·È Û˘Ó. (1990) ·ÚÔ˘Û›·˙ ÛÔ‚·Ú¿ ÚÔ‚Ï‹Ì·Ù· Û˘ÌÌfiÚʈÛ˘ ÛÙÔ Û¯‹Ì· ÚÔʇϷ͢, ·ÊÔ‡ ÌfiÓÔ ¤Ó· ÛÙ· 15 ·È‰È¿ Ì ˘ÔÙÚÔ‹ ¤Ï·‚·Ó ÙË ‰È·˙Â¿ÌË Û‡Ìʈӷ Ì ÙȘ Ô‰ËÁ›Â˜. ™Â ÌÈ· ÚfiÛÊ·ÙË ÌÂϤÙË ÙˆÓ Okumura Î·È Û˘Ó. (2004) ‰ÈÂÚ¢ӋıËÎÂ Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ÚÔÊ˘Ï·ÎÙÈ΋˜ ·ÁˆÁ‹˜ Û ·È‰È¿ Ì ¶™, ÛÙ· ÔÔ›· ÙÔ ∏∂° η٤ÁÚ·„ ÂÈÏËÙÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ·. ∆· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘ ÙÔ˘˜ ¤‰ÂÈÍ·Ó ˆ˜ Ë ‰È·Ï›Ô˘Û· ÚÔʇϷÍË Ì ‰È·˙Â¿ÌË ‰ÂÓ Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈ΋ ÛÙË Ì›ˆÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ ˘ÔÙÚÔÒÓ ÙˆÓ ¶™. øÛÙfiÛÔ, Ô ·ÚÈıÌfi˜ ÙˆÓ ·È‰ÈÒÓ Ô˘ ÌÂϤÙËÛ·Ó ‰ÂÓ ‹Ù·Ó ÈηÓÔÔÈËÙÈο ÌÂÁ¿ÏÔ˜ (10/43 ¤Ï·‚·Ó ‰È·Ï›Ô˘Û· ÚÔʇϷÍË ‰È·˙Â¿Ì˘), Ô‡Ù ·Ó·Ê¤ÚÔ˘Ó ÙÔ Û¯‹Ì· ¯ÔÚ‹ÁËÛ˘ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ (20). ™Â ¿ÏϘ ÌÂϤÙ˜ Ê¿ÓËΠfiÙÈ Ë ‰È·Ï›Ô˘Û· ¯ÔÚ‹ÁËÛË ‰È·˙Â¿Ì˘ ·fi ÙÔ ÛÙfiÌ· ÌÂÈÒÓÂÈ ÛËÌ·ÓÙÈο ÙÔ ÔÛÔÛÙfi ˘ÔÙÚÔÒÓ (21,22). ™ÙȘ ÌÂϤÙ˜ ·˘Ù¤˜ ηٷÁÚ¿ÊËÎ·Ó ÔÈ ›‰È˜ ·ÚÂÓ¤ÚÁÂȘ, fiˆ˜ ÛÙÔ˘˜ ‰ÈÎÔ‡˜ Ì·˜ ·ÛıÂÓ›˜, ·ÏÏ¿ Û ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi. ∞˘Ùfi ÌÔÚ› Ó· ÔÊ›ÏÂÙ·È ÛÙË ÌÂÁ·Ï‡ÙÂÚË ‰È¿ÚÎÂÈ· ¯ÔÚ‹ÁËÛ˘ ‰È·˙Â¿Ì˘. √È ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ ÛÙË ‰È΋ Ì·˜ ¤Ú¢ӷ ‹Ù·Ó ‹Ș, ·ÚÔ‰ÈΤ˜ Î·È Û η̛· ÂÚ›ÙˆÛË ‰ÂÓ ‹Ù·Ó ÛÔ‚·Ú¤˜. ÕÏÏÔÈ Û˘ÁÁÚ·Ê›˜ ÚÔ‚ÏËÌ·Ù›˙ÔÓÙ·È Ì ÙËÓ ÚÔÊ˘Ï·ÎÙÈ΋ ¯ÔÚ‹ÁËÛË ‰È·˙Â¿Ì˘, ÂÂȉ‹ ÊÔ‚Ô‡ÓÙ·È Ì‹ˆ˜ ÙÔ˘˜ ‰È·Ê‡ÁÂÈ Ë ‰È¿ÁÓˆÛË ÛÔ‚·Ú‹˜ ˘ÔΛÌÂÓ˘ ÓfiÛÔ˘ (.¯. ÌËÓÈÁÁ›Ùȉ·˜ ‹ ÂÁÎÂÊ·Ï›Ùȉ·˜) (5,23). ŸÛÔÓ ·ÊÔÚ¿ fï˜, ÛÙ· ·È‰È¿ ËÏÈΛ·˜ οو ÙˆÓ 18 ÌËÓÒÓ Ì ¶™, ÛÙË ‰È·ÁÓˆÛÙÈ΋ Ì·˜ ÛΤ„Ë Ì·›ÓÂÈ ·˘ÙÔÌ¿Ùˆ˜ Î·È Ë Èı·Ó‹ Ïԛ̈ÍË ÙÔ˘ ∫¡™. ™Â ‡ÔÙ˜ ÂÚÈÙÒÛÂȘ Á›ÓÂÙ·È Î·Ù¿ ηÓfiÓ· ÔÛÊ˘ÔÓˆÙÈ·›· ·Ú·Î¤ÓÙËÛË (√¡¶). ™ÙË ÌÂϤÙË Ì·˜ ¤ÁÈÓ √¡¶ Û ‰¤Î· ·È‰È¿ ÁÈ· ‰È·ÁÓˆÛÙÈÎÔ‡˜ ÏfiÁÔ˘˜ Î·È ‹Ù·Ó fiϘ ·ÚÓËÙÈΤ˜.

∆· ·ÚÈ· ÂÚˆÙ‹Ì·Ù· Ô˘ ÚÔ‚ÏËÌ·Ù›˙Ô˘Ó ÙÔ˘˜ ÂÚÈÛÛfiÙÂÚÔ˘˜ ÂÚ¢ÓËÙ¤˜ Â›Ó·È Î·Ù¿ fiÛÔÓ ÔÈ ¶™ ÌÔÚÔ‡Ó Ó· ‚Ï¿„Ô˘Ó ÙÔÓ ÂÁΤʷÏÔ, Î·È È‰›ˆ˜ ÙÔÓ ·ÓÒÚÈÌÔ, ‹ ·ÎfiÌË Î·È Ó· ÚÔηϤÛÔ˘Ó ı¿Ó·ÙÔ ÙˆÓ Ó¢ÚÈÎÒÓ Î˘ÙÙ¿ÚˆÓ Î·È ˆ˜ ÂÎ ÙÔ‡ÙÔ˘ ÂÈ‚¿ÏÏÂÙ·È Ë ÚfiÏË„‹ ÙÔ˘˜ (24,25). ∞ÓÙ›ıÂÙ˜ ÚÔ˜ ·˘Ù‹Ó ÙËÓ ¿Ô„Ë Â›Ó·È ÔÈ ÌÂϤÙ˜ ÙˆÓ Verity Î·È Û˘Ó. (1991, 1998) (26,27). √È Morell Î·È Û˘Ó. Û ÂÈÚ·Ì·ÙÈÎfi ÌÔÓÙ¤ÏÔ ¤‰ÂÈÍ·Ó ˆ˜ ÔÈ Û·ÛÌÔ› (οو ·fi Û˘Óı‹Î˜ ˘ÚÂÙÔ‡) Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÚÔηϤÛÔ˘Ó ·˘ÍË̤ÓË Â˘·ÈÛıËÛ›· ÛÙË Á¤ÓÂÛË ÙˆÓ Û·ÛÌÒÓ ÂÓÂÚÁÔÔÈÒÓÙ·˜ Ì˯·ÓÈÛÌÔ‡˜ ÛÙÔÓ ÂÁΤʷÏÔ (28). ªÂϤÙ˜ ·Ó·Ê¤ÚÔ˘Ó fiÙÈ ÔÈ ˘ÔÙÚÔÈ¿˙ÔÓÙ˜ Û·ÛÌÔ› Û¯ÂÙ›˙ÔÓÙ·È Ì ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ Â·ÎfiÏÔ˘ı˘ ÂÈÏË„›·˜ (24,25). ∞ÓÙ›ıÂÙ· ÔÈ Berg Î·È Shinnar (1994a) ¤‰ÂÈÍ·Ó ˆ˜ Ô Î›Ó‰˘ÓÔ˜ ηٿÏË͢ Û ÂÈÏË„›· Û ·È‰È¿ ÌÂÙ¿ ·fi ¶™ Â›Ó·È ¯·ÌËÏfi˜ (29). ÕÏÏÔÈ ¿ÏÈ ·Ó·Ê¤ÚÔÓÙ·È Û ÌÂÁ·Ï‡ÙÂÚ· ÔÛÔÛÙ¿ ÂÌÊ¿ÓÈÛ˘ ÂÈÏË„›·˜ Û ·È‰È¿ Ì ˘„ËÏfi ΛӉ˘ÓÔ ˘ÔÙÚÔ‹˜ ÙˆÓ ¶™. ¶ÈÔ ·Ó·Ï˘ÙÈο ÙÔÓ›˙Ô˘Ó ˆ˜ Ù· ˘ÔÙÚÔÈ¿˙ÔÓÙ· ÂÂÈÛfi‰È· ¶™ ·ÔÙÂÏÔ‡Ó ÛËÌ·ÓÙÈÎfi ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ Â·ÎfiÏÔ˘ıË ÂÌÊ¿ÓÈÛË ÂÈÏË„›·˜. ∏ Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ÂÈÏË„›·˜ ÛÙ· ·È‰È¿ Ì ¤Ó· ·Ïfi ÂÂÈÛfi‰ÈÔ ¶™ Î·È ¯ˆÚ›˜ Î·Ó¤Ó·Ó ¿ÏÏÔ ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ˘ÔÏÔÁ›ÛÙËΠÂÚ›Ô˘ Û 1%, ÂÓÒ ÛÙ· ·È‰È¿ Ì ٤ÛÛÂÚ· ‹ ÂÚÈÛÛfiÙÂÚ· ÂÂÈÛfi‰È· ¶™ ÛÙÔ ÈÛÙÔÚÈÎfi ÙÔ˘˜ Ô Î›Ó‰˘ÓÔ˜ ·˘Ùfi˜ ·Ó¤Ú¯ÂÙ·È Û 4% (19,25,30,31). °ÂÓÈο, ÔÈ ÁÈ·ÙÚÔ› ı· Ú¤ÂÈ Ó· ηıËÛ˘¯¿˙Ô˘Ó ÙÔ˘˜ ÁÔÓ›˜ Î·È Ó· ÙÔ˘˜ ‰È·‚‚·ÈÒÓÔ˘Ó ÁÈ· ÙËÓ Î·Ï‹ ÔÚ›· ÙˆÓ ¶™. ™‡Ìʈӷ Ì ÌÈ· ÚfiÛÊ·ÙË ¤Ú¢ӷ, Ë ÛˆÛÙ‹ ÂÓË̤ڈÛË ÙˆÓ ÁÔÓÈÒÓ ÙÔ‡˜ ÂÌ„˘¯ÒÓÂÈ Î·È ÌÂÈÒÓÂÈ ÙÔ ¿Á¯Ô˜ ÙÔ˘˜ (32). ∫·Ù¿ ÙËÓ ¿Ô„‹ Ì·˜, Ë Î·Ù·ÏÏËÏfiÙÂÚË ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ¶™ ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ÚfiÏË„Ë ÙˆÓ ˘ÔÙÚÔÒÓ ÌfiÓÔ ÛÙÔ˘˜ ÏËı˘ÛÌÔ‡˜ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘. ∞˘Ùfi ÌÔÚ› Ó· Á›ÓÂÈ ·ÔÙÂÏÂÛÌ·ÙÈο Ì ÙË ‰È·Ï›Ô˘Û· ¯ÔÚ‹ÁËÛË ‰È·˙Â¿Ì˘ ·fi ÙÔ ÔÚıfi, ·ÚΛ Ó· ‰›ÓÂÙ·È ¤ÁηÈÚ· Î·È ÛˆÛÙ¿ ÛÙËÓ ¤Ó·ÚÍË ÙÔ˘ ˘ÚÂÙÔ‡.

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CASE REPORT

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ÀÔ¯ÔÓ‰ÚÔÏ·Û›· Ì ÌÂÙ¿ÏÏ·ÍË ¡540∫ ÛÙÔÓ ˘Ô‰Ô¯¤· 3 ÙÔ˘ ·˘ÍËÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ÙˆÓ ÈÓÔ‚Ï·ÛÙÒÓ - FGFR3. ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ µ. ∞ÁÁÂÏ¿ÎÔ˘, °. ¡ÈˆÙ¿Î˘, ™. ∏Ï›·, ™. ª¿ÎˆÛË, ∂. ∫fiÎÔÚË ¶ÂÚ›ÏË„Ë: ∏ ˘Ô¯ÔÓ‰ÚÔÏ·Û›· (ªπª 146000) Â›Ó·È ·˘ÙÔۈ̷ÙÈ΋ ÂÈÎÚ·ÙËÙÈ΋ ÛÎÂÏÂÙÈ΋ ‰˘ÛÏ·Û›· ÌÂ Û˘¯ÓfiÙËÙ· 1:30.000 ÛÙÔÓ ÁÂÓÈÎfi ÏËı˘ÛÌfi. ™˘¯Ó¿, ÔÏϤ˜ ÂÚÈÙÒÛÂȘ ‰È·Ê‡ÁÔ˘Ó Ù˘ ‰È¿ÁÓˆÛ˘ ‹ ıˆÚÔ‡ÓÙ·È Ï·Óı·Ṳ̂ӷ ˆ˜ ÂÚÈÙÒÛÂȘ ÔÈÎÔÁÂÓÔ‡˜ ‚Ú·¯˘ÛˆÌ›·˜, ÂÂȉ‹ ÔÈ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ Â›Ó·È ‹Ș. ∏ ‰È¿ÁÓˆÛË ÌÔÚ› Ó· Á›ÓÂÈ Î·ı˘ÛÙÂÚË̤ӷ (ÛÙ· 2-4 ¯ÚfiÓÈ·), fiÙ·Ó ‰È·ÈÛÙÒÓÂÙ·È fiÙÈ ÙÔ ·È‰› ÛÙ·ıÂÚ¿ ‚Ú›ÛÎÂÙ·È Î¿Ùˆ ·fi ÙËÓ 3Ë ∂.£., ÂÓÒ Ë ÚÔÛÂÎÙÈ΋ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË ·ÔηχÙÂÈ ÙË ÚÈ˙ÔÌÂÏÈ΋ ‚Ú¿¯˘ÓÛË ÙˆÓ ¿ÎÚˆÓ. ™Ù· ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ‹È· ‚Ú·¯˘ÛˆÌ›·, ÎÔÓÙ¿ ¿ÎÚ·, ÏfiÚ‰ˆÛË Ù˘ ÔÛÊ˘˚΋˜ ÌÔ›Ú·˜ Ù˘ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘, ÎÔÓÙ¤˜ Î·È Ï·ÙÂȤ˜ ·Ï¿Ì˜ Î·È ¤ÏÌ·Ù·, ÚÔ¤¯ÔÓ Ì¤ÙˆÔ Î·È ·Ô‡Û· ‹ ‹È· Ì·ÎÚÔÎÂÊ·Ï›·. ¶ÚfiÛÊ·Ù· ‚Ú¤ıËΠfiÙÈ ÛÙÔ 70% ÂÚ›Ô˘ ÙˆÓ ·ÛıÂÓÒÓ Ì ˘Ô¯ÔÓ‰ÚÔÏ·Û›· ˘¿Ú¯ÂÈ ÌÂÙ¿ÏÏ·ÍË ÛÙÔ ÁÔÓ›‰ÈÔ ÙÔ˘ ˘Ô‰Ô¯¤· 3 ÙÔ˘ ·˘ÍËÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ÙˆÓ ÈÓÔ‚Ï·ÛÙÒÓ (FGFR3), Ô˘ ‚Ú›ÛÎÂÙ·È ÛÙÔ ¯ÚˆÌfiۈ̷ 4p16.3. ¶ÂÚÈÁÚ¿ÊÔ˘Ì ÎÔÚ›ÙÛÈ ËÏÈΛ·˜ 7ó ÂÙÒÓ, Ì ‰˘Û·Ó¿ÏÔÁÔ ÎÔÓÙfi ·Ó¿ÛÙËÌ·, Î·È Ì ÎÏÈÓÈο Î·È ·ÎÙÈÓÔÏÔÁÈο Â˘Ú‹Ì·Ù· Û˘Ì‚·Ù¿ Ì ÙË ‰È¿ÁÓˆÛË Ù˘ ˘Ô¯ÔÓ‰ÚÔÏ·Û›·˜. ∏ ÌÔÚȷ΋ ÁÂÓÂÙÈ΋ ·Ó¿Ï˘ÛË ¤‰ÂÈÍ fiÙÈ Ë ·ÛıÂÓ‹˜ Â›Ó·È ÂÙÂÚÔ˙˘ÁÒÙ˘ ÁÈ· ÙË ÌÂÙ¿ÏÏ·ÍË C1620A ÛÙÔ ¯ÚˆÌfiۈ̷ 4p16.3, Ô˘ Ô‰ËÁ› ÛÙËÓ ·ÓÙÈηٿÛÙ·ÛË ¡540∫ ÛÙÔÓ FGFR3 Î·È ·ÓÙÈÚÔÛˆ‡ÂÈ ÙËÓ ÈÔ Û˘¯Ó‹ ÌÂÙ¿ÏÏ·ÍË ÛÙËÓ ˘Ô¯ÔÓ‰ÚÔÏ·Û›·.

∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ µÂÓÈ˙¤ÏÂÈÔ˘ ¡ÔÛÔÎÔÌ›Ԣ, ∏Ú¿ÎÏÂÈÔ ∫Ú‹Ù˘ AÏÏËÏÔÁÚ·Ê›·: µ·ÛÈÏÈ΋ ∞ÁÁÂÏ¿ÎÔ˘ vaagge3@yahoo.gr °Ô‡ÚÓ˜ ∆Â̤ÓÔ˘˜ ∆.∫. 71 500 ∏Ú¿ÎÏÂÈÔ ∫Ú‹Ù˘

§¤ÍÂȘ ÎÏÂȉȿ: ÀÔ¯ÔÓ‰ÚÔÏ·Û›·, ÛÎÂÏÂÙÈ΋ ‰˘ÛÏ·Û›·, FGFR3, ‰˘Û·Ó¿ÏÔÁÔ ÎÔÓÙfi ·Ó¿ÛÙËÌ·, ·˘ÍËÙÈ΋ ÔÚÌfiÓË.

Hypochondroplasia with the mutation N540K of the fibroblast growth factor receptor 3 - FGFR3. A case report V. Aggelakou, G. Niotakis, S. Ilia, S. Bakosi, E. Kokori

1st Pediatric Clinic, Venizeleio Hospital, Herakleion, Crete

Abstract: Hypochondroplasia (MIM 146000) is an autosomal dominant skeletal dysplasia affecting 1 in 30,000 individuals. It is not uncommon for many cases to be overlooked or misdiagnosed as being familial short stature, since the clinical manifestations may be mild, and the diagnosis is often delayed (2-4 years). Suspicions arise when the child is noted to “fall off the growth curve”, and a careful examination reveals the rhizomelic shortening. Clinical features of hypochondroplasia include mild short stature, micromelia, lumbar lordosis, short broad hands and feet, a large forehead and absent or mild macrocephaly. Recently, it has been reported that almost 70% of patients with hypochondroplasia carry a gene mutation encoding for the receptor 3 of the fibroblast growth factor (FGFR3) on chromosome 4q16.3. The case is described of a 7ó year-old girl who presented with disproportional short stature and clinical and radiological findings consistent with hypochondroplasia. Molecular genetic analysis confirmed that the patient was heterozygous for the C1620A mutation resulting in N540K substitution in FGFR3, the most common mutation in hypochondroplasia.

Correspondence: Vassiliki Aggelakou vaagge3@yahoo.gr Gournes Temenous 71 500, Herakleion, Crete

Key words: Hypochondroplasia, skeletal dysplasia, FGFR3, disproportional short stature, growth hormone.

∂ÈÛ·ÁˆÁ‹ ∏ ˘Ô¯ÔÓ‰ÚÔÏ·Û›· (ÀÃ) ·Ó‹ÎÂÈ ÛÙËÓ ÔÌ¿‰· Ù˘ ·¯ÔÓ‰ÚÔÏ·Û›·˜ Ì ‚¿ÛË ÌÈ· Ó¤· ·Ó·ıˆÚË̤ÓË ‰ÈÂıÓ‹ ÔÓÔÌ·ÙÔÏÔÁ›· Î·È Ù·ÍÈÓfiÌËÛË (1), Ì·˙› Ì ÙËÓ ·¯ÔÓ‰ÚÔÏ·Û›· Î·È ÙË ı·Ó·ÙÔÙÚÔÊÈ΋ ‰˘ÛÏ·Û›· Î·È ÌÂÙ·‚È‚¿˙ÂÙ·È Ì ÙÔÓ ·˘ÙÔۈ̷ÙÈÎfi ÂÈÎÚ·ÙËÙÈÎfi ¯·Ú·ÎÙ‹Ú·. ∏ ÁÂÓÂÙÈ΋ ‰È·Ù·Ú·¯‹ ·ÊÔÚ¿ ÌÂÙ·ÏÏ¿ÍÂȘ ÛÙÔ ÁÔÓ›‰ÈÔ ÙÔ˘ ˘Ô‰Ô¯¤· 3 ÙÔ˘ ·˘ÍËÙÈÎÔ‡ ·Ú¿ÁÔÓÙ·

ÙˆÓ ÈÓÔ‚Ï·ÛÙÒÓ (FGFR 3) (∂ÈÎfiÓ· 1), Ô˘ ‚Ú›ÛÎÂÙ·È ÛÙÔ ¯ÚˆÌfiۈ̷ 4p16.3 (2). √È ÂÚÈÛÛfiÙÂÚ˜ ÌÂÙ·ÏÏ¿ÍÂȘ Â›Ó·È Ù˘¯·›Â˜ (de novo), ÂÓÒ ˘¿Ú¯ÂÈ ÌÂÁ¿ÏË Ê·ÈÓÔÙ˘È΋ ÔÈÎÈÏÔÌÔÚÊ›· Ù˘ Àà ÏfiÁˆ ÙÔ˘ ›‰Ô˘˜ ÙˆÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ (2). ∏ Û˘¯ÓfiÙËÙ· ˘ÔÏÔÁ›˙ÂÙ·È Û 1:30.000 ÛÙÔÓ ÁÂÓÈÎfi ÏËı˘ÛÌfi. ∫ÏÈÓÈο ·Ú·ÙËÚÂ›Ù·È ‹È· ‚Ú·¯˘ÛˆÌ›· (‡„Ô˜ 145-165 cm ÛÙ· ·ÁfiÚÈ· Î·È 133-150 cm ÛÙ· ÎÔÚ›ÙÛÈ·), ÎÔÓÙ¿ ¿ÎÚ·, ÚÔ¤¯ÔÓ Ì¤ÙˆÔ, ¶·È‰È·ÙÚÈ΋ 2007;70:49-53

50

µ. ∞ÁÁÂÏ¿ÎÔ˘ Î·È Û˘Ó.

S

Ig I

A

Ig II

Ig III

TM

TK1

TK2

NH2

COOH

TD I

ACH

HCH

TD II

TD I

∂ÈÎfiÓ· 1. ™¯ËÌ·ÙÈ΋ ·Ú¿ÛÙ·ÛË Ù˘ ÚˆÙÂ˚ÓÈ΋˜ ‰ÔÌ‹˜ ÙÔ˘ FGFR-3 Î·È Ù˘ ı¤Û˘ ÙˆÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ Ô˘ ÚÔηÏÔ‡Ó ÙÚÂȘ ÛÎÂÏÂÙÈΤ˜ ‰˘ÛϷۛ˜: ·¯ÔÓ‰ÚÔÏ·Û›· (ACH), ˘Ô¯ÔÓ‰ÚÔÏ·Û›· (HCH) Î·È ı·Ó·ÙÔÙÚÔÊÈ΋ ¯ÔÓ‰ÚÔ‰˘ÛÏ·Û›· Ù‡Ô˘ π Î·È ππ (TD I, TD II).

TM: ‰È·ÌÂÌ‚Ú·ÓÈÎfi ÙÌ‹Ì·. ∆∫1, ∆∫2: ÙÌ‹Ì·Ù· ÎÈÓ¿ÛË Ù˘ÚÔÛ›Ó˘ 1 Î·È 2. Ig π, Ig II, Ig III: ÙÌ‹Ì·Ù· Ô˘ ÌÔÈ¿˙Ô˘Ó Ì ·ÓÔÛÔÛÊ·ÈÚ›ÓË.

·Ô‡Û· ‹ ‹È· Ì·ÎÚÔÎÂÊ·Ï›·, ÏfiÚ‰ˆÛË Ù˘ ÔÛÊ˘˚΋˜ ÌÔ›Ú·˜ Ù˘ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘ Î·È ÎÔÓÙ¿ Î·È Ï·ÙÈ¿ ÌÂٷοÚÈ· Î·È Ê¿Ï·ÁÁ˜ (3). ∆· ·ÎÙÈÓÔÏÔÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÌÂȈ̤ÓË ‰È·˘¯ÂÓÈ΋ ·fiÛÙ·ÛË ÛÙÔ˘˜ ηÙÒÙÂÚÔ˘˜ ÔÛÊ˘˚ÎÔ‡˜ ÛÔÓ‰‡ÏÔ˘˜, ¢ڤ· Î·È ÎÔÓÙ¿ Ì·ÎÚ¿ ÔÛÙ¿, ÌÂٷοÚÈ· Î·È Ê¿Ï·ÁÁ˜, ηıÒ˜ Î·È Â˘Ú‡ Î·È ÎÔÓÙfi ·˘¯¤Ó· ÙÔ˘ ÌËÚÈ·›Ô˘, ÂÓÒ ÙÔ Ì‹ÎÔ˜ Ù˘ ÂÚfiÓ˘ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚÔ Ù˘ ÎÓ‹Ì˘ (4). ¶·ÚÔ˘ÛÈ¿˙Ô˘Ì ÂÚ›ÙˆÛË ˘Ô¯ÔÓ‰ÚÔÏ·Û›·˜ Ì ÌÂÙ¿ÏÏ·ÍË ¡540∫ ÛÙÔÓ FGFR 3, ÛÙËÓ ÔÔ›· Ë ‰È¿ÁÓˆÛË Ù¤ıËΠηı˘ÛÙÂÚË̤ӷ Û ËÏÈΛ· 7,5 ÂÙÒÓ, Ì ÛÎÔfi Ó· ¢·ÈÛıËÙÔÔÈ‹ÛÔ˘Ì ÙÔ˘˜ Û˘Ó·‰¤ÏÊÔ˘˜ ·È‰È¿ÙÚÔ˘˜, ÒÛÙ ӷ ·Ó·ÁÓˆÚ›˙Ô˘Ó ¤ÁηÈÚ· ÙË ÓfiÛÔ Î·È Ó· ÌÔÚÔ‡Ó Ó· ˙ËÙ‹ÛÔ˘Ó ÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë ÁÂÓÂÙÈ΋ ÙÂÎÌËÚ›ˆÛË. ∏ ÂÚ›ÙˆÛË Â›Ó·È Ë ÚÒÙË Ô˘ ‰ËÌÔÛȇÂÙ·È ÛÙËÓ ÚÔÛÈÙ‹ ÂÏÏËÓÈ΋ ‚È‚ÏÈÔÁÚ·Ê›·.

¶ÂÚÈÁÚ·Ê‹ ÂÚÈÛÙ·ÙÈÎÔ‡ ¶ÚfiÎÂÈÙ·È ÁÈ· ÎÔÚ›ÙÛÈ ËÏÈΛ·˜ 7ó ÂÙÒÓ Ô˘ Ó ÔÛËχıËΠÁÈ· Ïԛ̈ÍË ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡. ™ÙÔ ·ÙÔÌÈÎfi ·Ó·ÌÓËÛÙÈÎfi Ù˘ ·Ó·Ê¤ÚÂÙ·È fiÙÈ ÁÂÓÓ‹ıËΠÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ÙÔÎÂÙfi, ÌÂÙ¿ ·fi ÙÂÏÂÈfiÌËÓË Î‡ËÛË Ì ‚¿ÚÔ˜ 2.930 g (25Ë ∂.£.), Ì‹ÎÔ˜ 46 cm (3Ë ∂.£.) Î·È ÂÚ›ÌÂÙÚÔ ÎÂÊ·Ï‹˜ 34 cm (50‹ ∂.£.). ™Â ËÏÈΛ· 3 ÂÙÒÓ ÙÔ ‡„Ô˜ ‹Ù·Ó 81 cm (-4 SD ·fi 50‹ ∂.£.), ÙÔ ‚¿ÚÔ˜ 11,5 kg (-2 SD ·fi 50‹ ∂.£.) Î·È Ë ÂÚ›ÌÂÙÚÔ˜ ÎÂÊ·Ï‹˜ 48 cm (-2 SD ·fi 50 ‹ ∂.£.), ÂÓÒ ‰ÂÓ ˘¿Ú¯Ô˘Ó ¿ÏϘ ηٷÁÂÁÚ·Ì̤Ó˜ ÌÂÙÚ‹ÛÂȘ. §fiÁˆ Ù˘ ÌÂÁ¿Ï˘ ·fiÎÏÈÛ˘ ÙÔ˘ ‡„Ô˘˜ ·fi ÙË Ì¤ÛË ÙÈÌ‹ ÁÈ· ÙËÓ ËÏÈΛ· Ù˘, ¤ÁÈÓ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ Ô˘ ·¤ÎÏÂÈÛ ٷ ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù· Î·È ÙËÓ ¤ÏÏÂÈ„Ë ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘, ÂÓÒ Èı·ÓÔÏÔÁ‹ıËΠοÔÈ· ÌÔÚÊ‹ ÛÎÂÏÂÙÈ΋˜ ‰˘ÛÏ·Û›·˜, ¯ˆÚ›˜ fï˜ Ó· Á›ÓÂÈ ÂÚ·ÈÙ¤Úˆ ¤ÏÂÁ¯Ô˜. ∏ „˘¯ÔÎÈÓËÙÈ΋ ÂͤÏÈÍË Ù˘ ·ÛıÂÓÔ‡˜ ‹Ù·Ó ÔÌ·Ï‹, Ì ηϋ Û¯ÔÏÈ΋ Â›‰ÔÛË. √È ÁÔÓ›˜ Î·È Ô ·‰ÂÏÊfi˜ Ù˘ ¤¯Ô˘Ó Ê˘ÛÈÔÏÔÁÈÎfi ‚¿ÚÔ˜, ‡„Ô˜ Î·È ÂÚ›ÌÂÙÚÔ ÎÂÊ·Ï‹˜, ¯ˆÚ›˜ ‰˘Û·Ó·ÏÔÁ›· ÎÔÚÌÔ‡-¿ÎÚˆÓ.

Paediatriki 2007;70:49-53

∏ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ Ù˘ ÛÙËÓ ÎÏÈÓÈ΋ ·ÔÎ¿Ï˘„ ˘ÔÏÂÈfiÌÂÓË ÛˆÌ·ÙÈ΋ ·Ó¿Ù˘ÍË Î·È ‰˘Û·Ó¿ÏÔÁÔ ÎÔÓÙfi ·Ó¿ÛÙËÌ· Ì ÎÔÓÙ¿ ¿Óˆ Î·È Î¿Ùˆ ¿ÎÚ· [‡„Ô˜: 102,5 cm (-6 SD ·fi 50‹ ∂.£.), ‚¿ÚÔ˜: 18 kg (-2,5 SD ·fi 50‹ ∂.£.), ÂÚ›ÌÂÙÚÔ˜ ÎÂÊ·Ï‹˜: 50 cm (-2 SD ·fi 50‹ ∂.£.), ηıÈÛÙfi ‡„Ô˜: 59 cm, ¿ÓÔÈÁÌ· ¯ÂÚÈÒÓ: 96 cm, ·Ó·ÏÔÁ›· ¿Óˆ/οو ÙÌ‹Ì·ÙÔ˜ ÙÔ˘ ÛÒÌ·ÙÔ˜: 1,35 (Ê.Ù. ÁÈ· ÙËÓ ËÏÈΛ·: 1,06), ‰È·ÊÔÚ¿ ·ÓÔ›ÁÌ·ÙÔ˜ ¯ÂÚÈÒÓ - ‡„Ô˜: 0,65 (Ê.Ù.: -2) Î·È ÏfiÁÔ˜ ηıÈÛÙÔ‡ ‡„Ô˘˜ / Û˘ÓÔÏÈÎfi ‡„Ô˜: 0,575 (+3 SD ·fi 50‹ ∂.£.)]. ∆· ‰¿ÎÙ˘Ï¿ Ù˘ ‹Ù·Ó ÎÔÓÙ¿ Î·È Ï·ÙÈ¿, ÂÓÒ ·Ú·ÙËÚ‹ıËΠ‹È· ÏfiÚ‰ˆÛË Ù˘ ÔÛÊ˘˚΋˜ ÌÔ›Ú·˜ Ù˘ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘. ¢ÂÓ ÂÌÊ¿ÓÈ˙ ‰˘ÛÌÔÚÊÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÛÙÔ ÚfiÛˆÔ Î·È ÛÙÔ ÎÚ·Ó›Ô (∂ÈÎfiÓ· 2). ∏ ÔÛÙÈ΋ ËÏÈΛ· ‹Ù·Ó Û˘Ì‚·Ù‹ Ì ÙË ¯ÚÔÓÔÏÔÁÈ΋. ∆· ·ÎÙÈÓÔÏÔÁÈο Â˘Ú‹Ì·Ù· ·ÊÔÚÔ‡Û·Ó ÎÔÓÙ¿ Î·È Ê·Ú‰È¿ ÌÂٷοÚÈ· Î·È Ê¿Ï·ÁÁ˜ ¿Óˆ ¿ÎÚˆÓ, Ì›ˆÛË Ù˘ ‰È·˘¯ÂÓÈ΋˜ ·fiÛÙ·Û˘ ·fi ÙÔÓ √1 ¤ˆ˜ ÙÔÓ √5 ÛfiÓ‰˘ÏÔ, ÎÔÓÙfi Î·È Â˘Ú‡ ·˘¯¤Ó· ÌËÚÈ·›Ô˘ ÔÛÙÔ‡, ‹È· ÂÏ·Ù˘Ṳ̂ӷ Î·È ÎÔÓÙ¿ Ï·ÁfiÓÈ· ÔÛÙ¿ Ì ÂÈ¤‰ˆÛË Ù˘ ÔÚÔÊ‹˜ Ù˘ ÎÔÙ‡Ï˘, ÂÚfiÓË ÌÂÁ·Ï‡ÙÂÚË Ù˘ ÎÓ‹Ì˘ Î·È Ù¤ÏÔ˜, ÎÔÓÙ¿ Î·È Ê·Ú‰È¿ Ì·ÎÚ¿ ÔÛÙ¿ ÙˆÓ Î¿Ùˆ ¿ÎÚˆÓ (∂ÈÎfiÓ· 3). √ ˘fiÏÔÈÔ˜ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜ fiˆ˜ Î·È Ô ¤ÏÂÁ¯Ô˜ ı˘ÚÂÔÂȉԇ˜ Î·È ·Ú·ı˘ÚÂÔÂȉÒÓ ·‰¤ÓˆÓ [·Ú·ıÔÚÌfiÓË: 31 pg/ml (Ê.Ù. 1-43), TSH: 1,90 IU/ml (Ê.Ù. 0,4-4), FT3: 5,4 pmol/L (Ê.Ù. 2,2-6,2), FT4 18,2 pmol/L (Ê.Ù. 10,224,4)], Ë ¤ÎÎÚÈÛË ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ Ì ‰ÔÎÈ̷ۛ˜ ‡ÓÔ˘ Î·È ¿ÛÎËÛ˘, ηıÒ˜ Î·È ÔÈ ÙÈ̤˜ ÙÔ˘ ·˘ÍËÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· IGF-1 Î·È Ù˘ ÚˆÙ½Ó˘ IGF-BP3. ªÂ ‚¿ÛË Ù· ·ÓˆÙ¤Úˆ ÎÏÈÓÈÎÔÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· Ô˘ Û˘ÓËÁÔÚÔ‡Û·Ó ˘¤Ú Ù˘ ÀÃ, ‰Â›ÁÌ· ·›Ì·ÙÔ˜ ÂÛÙ¿ÏË ÁÈ· ÌÔÚÈ·Îfi ÁÔÓȉȷÎfi ¤ÏÂÁ¯Ô ÛÙÔ ∂˘Úˆ·˚Îfi ¢›ÎÙ˘Ô ™ÎÂÏÂÙÈÎÒÓ ¢˘ÛÏ·ÛÈÒÓ (European Skeletal Dysplasia Network: www.esdn.org) Î·È ‰È·ÈÛÙÒıËΠfiÙÈ Ë ·ÛıÂÓ‹˜ Â›Ó·È ÂÙÂÚÔ˙˘ÁÒÙ˘ ÁÈ· ÙË

51

ÀÔ¯ÔÓ‰ÚÔÏ·Û›· ÌÂ ÌÂÙ¿ÏÏ·ÍË ¡540∫ ÛÙÔÓ FGFR3

∞

°

∂ÈÎfiÓ· 2. ∏ ·ÛıÂÓ‹˜ Û ËÏÈΛ· 10 ÂÙÒÓ.

ÌÂÙ¿ÏÏ·ÍË C1620A ÛÙÔ ÁÔÓ›‰ÈÔ ÙÔ˘ FGFR3. ∏ ÌÂÙ¿ÏÏ·ÍË ·˘Ù‹ Ô˘ Ô‰ËÁ› ÛÙËÓ ·ÓÙÈηٿÛÙ·ÛË ¡540∫ ÛÙÔÓ FGFR3 ·ÔÙÂÏ› ÙËÓ ÈÔ Û˘¯Ó‹ Î·È ÛÔ‚·Ú‹ ÌÂÙ¿ÏÏ·ÍË Û ·ÛıÂÓ›˜ Ì ˘Ô¯ÔÓ‰ÚÔÏ·Û›·. √ ÁÔÓȉȷÎfi˜ ¤ÏÂÁ¯Ô˜ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ‹Ù·Ó ·ÚÓËÙÈÎfi˜ ÁÈ· ÙË ÌÂÙ¿ÏÏ·ÍË.

™˘˙‹ÙËÛË ∏ ÀÃ Â›Ó·È Ë ËÈfiÙÂÚË ÌÔÚÊ‹ ÛÎÂÏÂÙÈ΋˜ ‰˘ÛÏ·Û›·˜ ÛÙËÓ ÔÌ¿‰· Ù˘ ·¯ÔÓ‰ÚÔÏ·Û›·˜ (5,6), Î·È ÔÊ›ÏÂÙ·È Û˘Ó‹ıˆ˜ Û ÌÂÙ·ÏÏ¿ÍÂȘ ÛÙÔÓ FGFR3 (6,7). √ FGFR3 Â›Ó·È ÌÈ· ÁÏ˘ÎÔÚˆÙ½ÓË Ô˘ ·Ó‹ÎÂÈ ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ· ÙˆÓ ˘Ô‰Ô¯¤ˆÓ Ù˘ Ù˘ÚÔÛÈÓÈ΋˜ ÎÈÓ¿Û˘ (∆∫). ∏ ·¯ÔÓ‰ÚÔÏ·Û›· ÚÔηÏÂ›Ù·È ·fi ÛËÌÂȷΤ˜ ÌÂÙ·ÏÏ¿ÍÂȘ ÛÙÔ ‰È·ÌÂÌ‚Ú·ÓÈÎfi ÙÌ‹Ì· ÙÔ˘ FGFR3, ÂÓÒ Ë ÀÃ, fiˆ˜ Î·È Ë ı·Ó·ÙÔÙÚÔÊÈ΋ ‰˘ÛÏ·Û›·, ·fi ÌÂÙ·ÏÏ¿ÍÂȘ ÛÙË ‰ÔÌ‹ Ù˘ ∆∫1, TK2 ·ÏÏ¿ Î·È ¿ÏÏˆÓ ÙÌËÌ¿ÙˆÓ ÙÔ˘ FGFR3 (∂ÈÎfiÓ· 1) (7). ∏ ÌÂÁ¿ÏË ÎÏÈÓÈ΋ ÂÙÂÚÔÁ¤ÓÂÈ· ÙˆÓ ÚÔ·Ó·ÊÂÚı¤ÓÙˆÓ ÓÔÛËÌ¿ÙˆÓ ÔÊ›ÏÂÙ·È ÛÙË ‰È·ÊÔÚÂÙÈ΋˜ ‚·Ú‡ÙËÙ·˜ ‰È·Ù·Ú·¯‹ Ù˘ ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ·˜ ÙÔ˘ FGFR3 Ô˘ ÚÔηÏÔ‡Ó ÔÈ ‰È¿ÊÔÚ˜ ÌÂÙ·ÏÏ¿ÍÂȘ (7). ™ÙÔ 70% ÙˆÓ ÂÚÈÙÒÛÂˆÓ Àà ¤¯Ô˘Ó Ù·˘ÙÔÔÈËı› ÂÓÓ¤· ÌÂÙ·ÏÏ¿ÍÂȘ ÁÈ· ÙËÓ ∆∫1 ÛÙÔ ÁÔÓ›‰ÈÔ ÙÔ˘ FGFR3, ÔÈ Ôԛ˜ ÚÔηÏÔ‡Ó ÂÙ¿ ‰È·ÊÔÚÂÙÈΤ˜ ·ÓÙÈηٷÛÙ¿ÛÂȘ ·ÌÈÓÔͤˆÓ (2,8), Ì ÈÔ Û˘¯Ó‹ ÌÂÙ¿ÏÏ·ÍË ÙË ¡540∫ Ô˘ ·ÓÙÈÚÔÛˆ‡ÂÈ ÂÚ›Ô˘ ÙÔ 50% fiÏˆÓ ÙˆÓ ÌÂÙ·ÏÏ¿ÍÂ-

µ

¢

∂ÈÎfiÓ· 3. ∞ÎÙÈÓÔÁÚ·ÊÈο Â˘Ú‹Ì·Ù·: ∞. ∫ÔÓÙ‹ Î·È Ï·ÙÈ¿ ÎÓ‹ÌË Î·È ÂÚfiÓË Ì·ÎÚ‡ÙÂÚË Ù˘ ÎÓ‹Ì˘. µ. ¢È·˘¯ÂÓÈ΋ ·fiÛÙ·ÛË ÛÙÔ˘˜ ηÙÒÙÂÚÔ˘˜ ÔÛÊ˘˚ÎÔ‡˜ ÛÔÓ‰‡ÏÔ˘˜ ÌÈÎÚfiÙÂÚË ·fi ÙÔ˘˜ ·ÓÒÙÂÚÔ˘˜. °. µÚ·¯¤· Î·È Ï·ÙÈ¿ ÌÂٷοÚÈ· Î·È Ê¿Ï·ÁÁ˜. ¢. ∫ÔÓÙfi˜ Î·È Ï·Ù‡˜ ·˘¯¤Ó·˜ ÌËÚÈ·›Ô˘, ÎÔÓÙ¿ Î·È Ï·ÙÈ¿ Ï·ÁfiÓÈ·.

ˆÓ ÙÔ˘ FGFR3 ÛÙËÓ YX (2). ™ÙÔ ˘fiÏÔÈÔ 30% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÀÃ, ‰ÂÓ ¤¯ÂÈ ‚ÚÂı› Ë ÁÔÓȉȷ΋ ‰È·Ù·Ú·¯‹. ™Â ÔÏϤ˜ ÌÂϤÙ˜ ¤¯ÂÈ Á›ÓÂÈ ÚÔÛ¿ıÂÈ· Ê·ÈÓÔÙ˘È΋˜-ÁÔÓÔÙ˘È΋˜ Û˘Û¯¤ÙÈÛ˘ (2,4,9,10) (¶›Ó·Î·˜ 1). √È ·ÛıÂÓ›˜ Ì ÙËÓ ¡540∫ ÌÂÙ¿ÏÏ·ÍË Ù›ÓÔ˘Ó Ó· ¤¯Ô˘Ó Ôχ ÎÔÓÙfi ·Ó¿ÛÙËÌ· Î·È ÌÂÁ·Ï‡ÙÂÚË ‰˘Û·Ó·ÏÔÁ›· ÎÔÚÌÔ‡-¿ÎÚˆÓ Û ۯ¤ÛË Ì ¿ÏϘ ÌÂÙ·ÏÏ¿ÍÂȘ, ÂÓÒ Ë Ì·ÎÚÔÎÂÊ·Ï›· ÌÔÈ¿˙ÂÈ Ó· Â›Ó·È ÛÔ‚·ÚfiÙÂÚË Û ·ÛıÂÓ›˜ Ì ÙËÓ ∫650¡ Î·È ∫650Q ÌÂÙ¿ÏÏ·ÍË (4,9,10). ∆ÂÏÂ˘Ù·›· ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ÙÚÂȘ ÂÚÈÙÒÛÂȘ ÔÈÎÔÁÂÓÂÈÒÓ ÙˆÓ ÔÔ›ˆÓ Ù· ̤ÏË Â›¯·Ó ‡„Ô˜ ÂÓÙfi˜ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÔÚ›ˆÓ, ·ÏÏ¿ Ì ̤ÙÚÈ· ‰˘Û·Ó·ÏÔÁ›· ÎÔÚÌÔ‡ Î·È ¿ÎÚˆÓ, Ì·ÎÚÔÎÂÊ·Ï›·, ÚÔ¤¯ÔÓ Ì¤ÙˆÔ, ηı›˙ËÛË Ù˘ Ú›˙·˜ Ù˘ ̇Ù˘, ¢ڇ ıÒڷη Î·È ÏfiÚ‰ˆÛË Ù˘ ÔÛÊ˘˚΋˜ ÌÔ›Ú·˜ Ù˘ ™™, ·ÎÙÈÓÔÏÔÁÈο Â˘Ú‹Ì·Ù· Û˘Ì‚·Ù¿ Ì ÀÃ, ÂÓÒ Î·È ÛÙȘ ÙÚÂȘ ÔÈÎÔÁ¤ÓÂȘ ·ÓȯÓ‡ÙËÎÂ Ë ÌÂÙ¿ÏÏ·ÍË ¡540S (2,8). ∂›Û˘, ‹È· Ê·ÈÓÔÙ˘Èο ¯·Ú·ÎÙËÚÈÛÙÈο Àà ·ÚÔ˘ÛÈ¿˙Ô˘Ó ¿ÙÔÌ· Ì ÙË ÌÂÙ¿ÏÏ·ÍË I538V (11), ÛÙ· ÔÔ›· ÙÔ ‡„Ô˜ Î·È Ë ÂÚ›ÌÂÙÚÔ˜ ÎÂÊ·Ï‹˜ Â›Ó·È ÂÓÙfi˜ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÔÚ›ˆÓ, ÂÓÒ Ë ·Ó·ÏÔÁ›· ηıÈÛÙfi ‡„Ô˜/Û˘ÓÔÏÈÎfi ‡„Ô˜ Â›Ó·È ·ıÔÏÔÁÈ΋. ∫·Ù¿ Û˘Ó¤ÂÈ·, ¿ÙÔÌ· Ì ÙȘ ÌÂÙ·ÏÏ¿ÍÂȘ ¡540S Î·È I538V ÌÔÚ› Ó· ‰È·Ê‡ÁÔ˘Ó Ù˘ ‰È¿ÁÓˆÛ˘. ∂ÎÙfi˜ ·fi ÙȘ ÌÂÙ·ÏÏ¿ÍÂȘ ÛÙËÓ ∆∫1, ÚfiÛÊ·Ù· ‰ËÌÔÛȇıËΠÂÚ›ÙˆÛË Àà ¶·È‰È·ÙÚÈ΋ 2007;70:49-53

52

µ. ∞ÁÁÂÏ¿ÎÔ˘ Î·È Û˘Ó.

¶›Ó·Î·˜ 1. ™˘Û¯¤ÙÈÛË ÙˆÓ ‰È·ÊfiÚˆÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ ÛÙÔÓ FGFR-3 Ì ÙÔ ‡„Ô˜ Î·È ÙËÓ ÂÚ›ÌÂÙÚÔ ÎÂÊ·Ï‹˜ Û ·ÛıÂÓ›˜ Ì ˘Ô¯ÔÓ‰ÚÔÏ·Û›· N328I N540K N540T N540S I538V K650N, K650Q

ª¤ÛÔ ‡„Ô˜

¶ÂÚ›ÌÂÙÚÔ˜ ÎÂÊ·Ï‹˜

µÈ‚ÏÈÔÁÚ·Ê›·

-2,5 SD -3,25 ±1 SD -2,5 SD -1,5 SD -1,8 SD 1,87 SD ± 0,99 SD

+2 SD +1,72 ± 1,1 SD +2,5 SD +0,5 ¤ˆ˜ 3 SD +0,81 SD +2,48 ± 1,65 SD

Winterpacht et al, 2000 Matsui et al, 1998 Deutz-Terlow et al, 1998 Mortier et al, 2000 Grigelioniene et al, 1997 Bellus et al, 2000

Ì ÙË ÛËÌÂȷ΋ ÌÂÙ¿ÏÏ·ÍË ¡328π ÛÙÔ ÂÍˆÎ˘ÙÙ¿ÚÈÔ ·ÓÔÛÔÛÊ·ÈÚÈÓÈÎfi ÌfiÚÈÔ Ig III ÙÔ˘ FGFR3. ∏ ÌÂÙ¿ÏÏ·ÍË ·˘Ù‹ ¤¯ÂÈ ˆ˜ Û˘Ó¤ÂÈ· ÙË ‰È·Ù·Ú·¯‹ Ù˘ ÁÏ˘ÎÔ˙˘Ï›ˆÛ˘ Î·È Ê·›ÓÂÙ·È Ó· ·›˙ÂÈ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙË Ê˘ÛÈÔÏÔÁÈ΋ ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ˘Ô‰Ô¯¤· (12). ∆· Ê·ÈÓÔÙ˘Èο ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ ·ÛıÂÓÔ‡˜ ‹Ù·Ó Ù· ÎÏ·ÛÈο Ù˘ ÀÃ. ¶ÔÏÏÔ› ·ÛıÂÓ›˜ Ì Àà ÂÌÊ·Ó›˙Ô˘Ó „˘¯ÔÎÔÈÓˆÓÈο ÚÔ‚Ï‹Ì·Ù· ÏfiÁˆ Ù˘ ÌÂȈ̤Ó˘ ·˘ÙÔÂÎÙ›ÌËÛ‹˜ ÙÔ˘˜, ·ÏÏ¿ Î·È ÙÔ˘ ÎÔÈÓˆÓÈÎÔ‡ ·ÔÎÏÂÈÛÌÔ‡ Ô˘ Û˘¯Ó¿ Û˘Ì‚·›ÓÂÈ Û ¿ÙÔÌ· Ì ۈ̷ÙÈο ÂÏÏ›ÌÌ·Ù·. °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi ¤¯ÂÈ ÂȯÂÈÚËı› Ë ·‡ÍËÛË ÙÔ˘ ‡„Ô˘˜ ÙˆÓ ·ÛıÂÓÒÓ Ì ÙË ¯ÔÚ‹ÁËÛË ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ Î·È ÙË ¯ÂÈÚÔ˘ÚÁÈ΋ ÂÈÌ‹Î˘ÓÛË ÙˆÓ ÔÛÙÒÓ ÌÂÙ¿ ÙËÓ Û‡ÁÎÏÂÈÛË ÙˆÓ ÂÈʇÛÂˆÓ (1315). √È ÌÂϤÙ˜ fï˜ ¯ÔÚ‹ÁËÛ˘ ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ Â›Ó·È ÂÚÈÔÚÈṲ̂Ó˜ Û ÌÈÎÚfi ·ÚÈıÌfi ·ÛıÂÓÒÓ Î·È ÁÈ· Û‡ÓÙÔÌÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ·Ú·ÎÔÏÔ‡ıËÛ˘. √È ÂÚÈÛÛfiÙÂÚÔÈ Û˘ÁÁÚ·Ê›˜ Û˘ÌʈÓÔ‡Ó fiÙÈ Ù· ·ÔÙÂϤÛÌ·Ù· Â›Ó·È Î·Ï‡ÙÂÚ· fiÙ·Ó Ë ·˘ÍËÙÈ΋ ÔÚÌfiÓË ¯ÔÚËÁËı› ÛÙËÓ ‹‚Ë, ÂÂȉ‹ ÔÈ ·ÛıÂÓ›˜ Ì Àà ‰ÂÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÙËÓ Ù˘È΋ Ù·¯Â›· ·Ó¿Ù˘ÍË Ù˘ ‹‚˘ (pubertal growth spurt) Ô˘ ·Ú·ÙËÚÂ›Ù·È ÛÙ· Ê˘ÛÈÔÏÔÁÈο ·È‰È¿, Û˘ÓÂÒ˜ Ë ·˘ÍËÙÈ΋ ÔÚÌfiÓË Û ‰fiÛË ˘„ËÏfiÙÂÚË ·fi ÙË Û˘Ó‹ıË Ô˘ ‰›‰ÂÙ·È Û ·ÛıÂÓ›˜ Ì ·ÓÂ¿ÚÎÂÈ· Ù˘ ˘fiÊ˘Û˘, ÌÔÚ› Ó· ‰Ú¿ÛÂÈ ·Ó·ÏËÚÒÓÔÓÙ·˜ ·˘Ùfi ÙÔ ¤ÏÏÂÈÌÌ· (3,13). (3). ∞Ó Î·È ÁÂÓÈο ‰ÂÓ ¤¯Ô˘Ó ·Ú·ÙËÚËı› ·ÓÂÈı‡ÌËÙ˜ ‰Ú¿ÛÂȘ ÛÙ· ÔÛÙ¿, fiˆ˜ ÂÈÙ¿¯˘ÓÛË Ù˘ ÔÛÙÈ΋˜ ËÏÈΛ·˜ ‹ Âȉ›ӈÛË Ù˘ ‰˘Û·Ó·ÏÔÁ›·˜ ÎÔÚÌÔ‡-¿ÎÚˆÓ (3,13), ˆÛÙfiÛÔ, Â›Ó·È ··Ú·›ÙËÙ˜ ÂÚ·ÈÙ¤Úˆ ÌÂϤÙ˜. ŸÛÔÓ ·ÊÔÚ¿ ÙË ¯ÂÈÚÔ˘ÚÁÈ΋ ÂÈÌ‹Î˘ÓÛË ÙˆÓ ÔÛÙÒÓ, Ô˘ ·ÔÙÂÏ› ÌÈ· ÂÂÌ‚·ÙÈ΋, ÂÈΛӉ˘ÓË, ÂÚ›ÏÔÎË Î·È Ì·ÎÚÔ¯ÚfiÓÈ· ‰È·‰Èηۛ·, Ë ÂÈÏÔÁ‹ Ù˘ ı· Ú¤ÂÈ Ó· ·ÔÊ·Û›˙ÂÙ·È Ì ÌÂÁ¿ÏË ÂÚ›Û΄Ë. ™Â ÚfiÛÊ·ÙË ÌÂϤÙË 20 ·ÛıÂÓÒÓ Ì Àà Ô˘ ˘Ô‚Ï‹ıËÎ·Ó Û ÂÈÌ‹Î˘ÓÛË ÔÛÙÒÓ, ÌÂÙ¿ ÙËÓ ÂÈÌ‹Î˘ÓÛË ÙÔ˘ ÌËÚÈ·›Ô˘ Î·È Ù˘ ÎÓ‹Ì˘, ÛÙÔ Û‡ÓÔÏfi ÙÔ˘˜ ÍÂ¤Ú·Û·Ó Ù· 150 cm Î·È ·Ú¿ ÙÔ fiÙÈ ÂÌÊ·Ó›ÛıËÎ·Ó ‰È¿ÊÔÚ˜ ÂÈÏÔΤ˜ ÛÙÔ 46% ÙˆÓ ·ÛıÂÓÒÓ, ‰ÂÓ ·Ú¤ÌÂÈÓ·Ó ÌfiÓÈ̘ ‚Ï¿‚˜ (15). ∂ÈÛËÌ·›ÓÂÙ·È ·fi ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ fiÙÈ Ë ıÂÙÈ΋ Â›‰Ú·ÛË Ù˘ ·‡ÍËÛ˘ ÙÔ˘ ‡„Ô˘˜ ÛÙËÓ ÔÈfiPaediatriki 2007;70:49-53

ÙËÙ· ˙ˆ‹˜ ÙˆÓ ·ÛıÂÓÒÓ, Ô˘ ·ÊÔÚÔ‡Û ÙËÓ ·ÓÂÍ·ÚÙËÛ›· ÙÔ˘˜, ÙËÓ ·˘ÙÔÂÎÙ›ÌËÛ‹ ÙÔ˘˜ Î·È ÙË ‚ÂÏÙ›ˆÛË ÙˆÓ ÎÔÈÓˆÓÈÎÒÓ ÙÔ˘˜ Û¯¤ÛˆÓ, ÍÂ¤Ú·Û ηٿ Ôχ ÙÔ ÎfiÛÙÔ˜ Û ¯Ú‹Ì·Ù· Î·È ¯ÚfiÓÔ Ô˘ ··ÈÙ‹ıËΠ(15). ∏ ÚÔÁÂÓÓËÙÈ΋ ‰È¿ÁÓˆÛË Ù˘ Àà Ì ÙË ¯Ú‹ÛË ˘ÂÚ‹¯ˆÓ ÌÔÚ› ‡ÎÔÏ· Ó· ‰È·Ê‡ÁÂÈ Û ÂÚÈÙÒÛÂȘ ·Ô˘Û›·˜ ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÈÛÙÔÚÈÎÔ‡. √È ·Ó·ÊÔÚ¤˜ ÚÔÁÂÓÓËÙÈ΋˜ ‰È¿ÁÓˆÛ˘ Ù˘ Àà ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· Â›Ó·È Ï›Á˜ (5,16,17). ™ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ Ë ˘ÂÚ˯ÔÁÚ·ÊÈ΋ ‰È¿ÁÓˆÛË ¤ÁÈÓ ÛÙÔ ‰Â‡ÙÂÚÔ ÙÚ›ÌËÓÔ Ù˘ ·ËÛ˘, ÌÂٷ͇ 23˘-26˘ ‚‰ÔÌ¿‰·˜ ·ËÛ˘, Ì ÛÙ·ıÂÚfi ‡ÚËÌ· ÙÔ ÌÈÎÚfi Ì‹ÎÔ˜ ÙÔ˘ ÌËÚÈ·›Ô˘ ÔÛÙÔ‡ Û ۯ¤ÛË Ì ÙËÓ ·ÌÊÈ‚ÚÂÁÌ·ÙÈ΋ ‰È¿ÌÂÙÚÔ, ÙËÓ ÂÚ›ÌÂÙÚÔ Ù˘ ÎÔÈÏ›·˜ Î·È ÙÔ Ì‹ÎÔ˜ ÙÔ˘ ¿ÎÚÔ˘ Ô‰fi˜, ÂÓÒ ·Ô˘Û›·˙·Ó ¿ÏÏ· ÛÔ‚·Ú¿ ·ıÔÏÔÁÈο ˘ÂÚ˯ÔÁÚ·ÊÈο Â˘Ú‹Ì·Ù· (5,16). ™ÙȘ ÂÚÈÙÒÛÂȘ ·˘Ù¤˜ Ô ÚÔÁÂÓÓËÙÈÎfi˜ ÁÔÓȉȷÎfi˜ ¤ÏÂÁ¯Ô˜ ÌÔÚ› Ó· Û˘Ì‚¿ÏÂÈ ÛÙË ‰È¿ÁÓˆÛË. ŸÌˆ˜, ÏfiÁˆ ÙˆÓ Èı·ÓÒÓ ÎÈÓ‰‡ÓˆÓ Ù˘ ·ÌÓÈÔ·Ú·Î¤ÓÙËÛ˘ Î·È ÂÂȉ‹ Ë Àà ‰ÂÓ Â›Ó·È ı·Ó·ÙËÊfiÚÔ˜ ·Ûı¤ÓÂÈ·, ÚÔÙ›ÓÂÙ·È Ë ·ÌÓÈÔ·Ú·Î¤ÓÙËÛË Ó· Á›ÓÂÙ·È ÌfiÓÔ fiÙ·Ó Ë ÀÃ Â›Ó·È ‰È·ÁÓˆṲ̂ÓË ÛÙÔÓ ¤Ó· ‹ Î·È ÛÙÔ˘˜ ‰‡Ô ÁÔÓ›˜ (16). ™˘ÌÂÚ·ÛÌ·ÙÈο, Ë ÀÃ Â›Ó·È ÌÈ· ÓfiÛÔ˜ Ô˘ ÌÔÚ› Ó· ‰È·Ê‡ÁÂÈ Ù˘ ‰È¿ÁÓˆÛ˘, ·Ó ‰ÂÓ ˘¿Ú¯ÂÈ ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi. °È· ÙËÓ ¤ÁηÈÚË ‰È¿ÁÓˆÛË ··ÈÙÂ›Ù·È ÏÂÙÔÌÂÚ‹˜ ÎÏÈÓÈ΋ ÂͤٷÛË Î·È ÁÓÒÛË ÙˆÓ ÎÏÈÓÈÎÒÓ Î·È ·ÎÙÈÓÔÏÔÁÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ Ô˘ Û˘ÓÔ‰Â‡Ô˘Ó ÙË ÓÔÛÔÏÔÁÈ΋ ·˘Ù‹ ÔÓÙfiÙËÙ·, ÚÔ¸Ôı¤ÛÂȘ Ô˘ ··ÈÙÔ‡ÓÙ·È ÁÈ· ÙËÓ ·Ó·˙‹ÙËÛË Ù˘ Û˘ÁÎÂÎÚÈ̤Ó˘ ÁÔÓȉȷ΋˜ ‰È·Ù·Ú·¯‹˜. ∏ ÚÔÁÂÓÓËÙÈ΋ ‰È¿ÁÓˆÛË Â›Ó·È ‰˘Ó·Ù‹ Ì ÙË ¯Ú‹ÛË ˘ÂÚ‹¯ˆÓ Î·È ÁÔÓȉȷÎfi ¤ÏÂÁ¯Ô. ™Â ÂÚÈÙÒÛÂȘ Ì ÛÔ‚·Ú‹ ‚Ú·¯˘ÛˆÌ›· Â›Ó·È ‰˘Ó·Ù‹ ÙfiÛÔ Ë ¯Ú‹ÛË ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ ÛÙËÓ ÂÊ˂›·, fiÛÔ Î·È Ë ¯ÂÈÚÔ˘ÚÁÈ΋ ÂÈÌ‹Î˘ÓÛË ÙˆÓ ÔÛÙÒÓ ÌÂÙ¿ ÙËÓ Û‡ÁÎÏÂÈÛË ÙˆÓ ÂÈʇÛˆÓ.

∂˘¯·ÚÈÛٛ˜ ∂˘¯·ÚÈÛÙԇ̠ÙËÓ ÔÌ¿‰· ÂȉÈÎÒÓ ÙÔ˘ ∂˘Úˆ·˚ÎÔ‡ ¢ÈÎÙ‡Ô˘ ™ÎÂÏÂÙÈÎÒÓ ¢˘ÛÏ·ÛÈÒÓ Ô˘ Ì·˜ ‚Ô‹ıËÛ ÛÙËÓ ÎÏÈÓÈ΋ Î·È ÁÂÓÂÙÈ΋ ‰È¿ÁÓˆÛË. ∂›Û˘, ¢¯·ÚÈÛÙԇ̠ÙÔ ∂Ó‰ÔÎÚÈÓÔÏÔÁÈÎfi ∆Ì‹Ì· Î·È ÙÔ ∞ÎÙÈÓÔÏÔÁÈÎfi ∂ÚÁ·ÛÙ‹ÚÈÔ ÙÔ˘ µÂÓÈ˙¤ÏÂÈÔ˘ ¡ÔÛÔÎÔÌ›Ԣ ÁÈ· ÙË Û˘Ì‚ÔÏ‹ ÙÔ˘˜ ÛÙË ‰È¿ÁÓˆÛË.

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ÀÔ¯ÔÓ‰ÚÔÏ·Û›· ÌÂ ÌÂÙ¿ÏÏ·ÍË ¡540∫ ÛÙÔÓ FGFR3

µÈ‚ÏÈÔÁÚ·Ê›· 1. International Working Group on Constitutional Diseases of Bone. International nomenclature and classification of the osteochondrodysplasias (1997). Am J Med Genet 1998;79:376-382.

2. Thauvin-Robinet C, Faivre L, Lewin P, De Monleon JV, Francois C, Huet F, et al. Hypochondroplasia and stature within normal limits: another family with an Asn540Ser mutation in the fibroblast growth factor receptor 3 gene.

Am J Med Genet A 2003;119:81-84.

3. Kanaka-Gantenbein C. Present status of the use of growth hormone in short children with bone diseases (diseases of the skeleton). J Pediatr Endocrinol Metab 2001;14:17-26.

4. Prinster C, Del Maschio M, Beluffi G, Maghnie M, Weber G, Del Maschio A, et al. Diagnosis of hypochondroplasia: the role of radiological interpretation. Italian Study Group of Hypochondroplasia. Pediatr Radiol 2001;31:203-208.

5. Kataoka S, Sawai H, Yamada H, Kanazawa N, Koyama K, Nishimura G, et al. Radiographic and genetic diagnosis of sporadic hypochondroplasia early in the neonatal period.

Prenat Diagn 2004;24:45-49.

6. Hecht JT, Herrera CA, Greenhaw GA, Francomano CA, Bellus GA, Blanton SH. Confirmatory linkage of hypochondroplasia to chromosome arm 4p. Am J Med Genet 1995;57:505-506.

7. Bonaventure J, Rousseau F, Legeai-Mallet L, Le Merrer M, Munnich A, Maroteaux P. Common mutations in the fibroblast growth factor receptor 3 (FGFR 3) gene account for achondroplasia, hypochondroplasia and thanatophoric dwarfism. Am J Med Genet 1996;63:148-154.

8. Riepe FG, Krone N, Sippell WG. Disproportionate stature but normal height in hypochondroplasia. Eur J Pediatr 2005;164:397-399.

9. Prinster C, Carrera P, Del Maschio M, Weber G, Maghnie M, Vigone MC, et al. Comparison of clinical-radiological and molecular findings in hypochondroplasia. Am J Med Genet 1998;75:109-112.

10. Ramaswami U, Rumsby G, Hindmarsh PC, Brook CG. Genotype and phenotype in hypochondroplasia. J Pediatr 1998;133:99-102.

11. Grigelioniene G, Hagenas L, Eklof O, Neumeyer L, Haereid PE, Anvret M. A novel missense mutation Ile538Val in the fibroblast growth factor receptor 3 in hypochondroplasia.

Mutations in brief no. 122. Hum Mutat 1998;11:333.

12. Winterpacht A, Hilbert K, Stelzer C, Schweikardt T, Decker H, Segerer H, et al. A novel mutation in FGFR 3 disrupts a putative N-glycosylation site and results in hypochondroplasia. Physiol Genomics 2000;2:9-12.

13. Tanaka N, Katsumata N, Horikawa R, Tanaka T. The comparison of the effects of short-term growth hormone treatment in patients with achondroplasia and with hypochondroplasia. Endocr J 2003;50:69-75.

14. Kanazawa H, Tanaka H, Inoue M, Yamanaka Y, Namba N, Seino Y. Efficacy of growth hormone therapy for patients with skeletal dysplasia. J Bone Miner Metab 2003;21: 307-310.

15. Aldegheri R, Dall’Oca C. Limb lengthening in short stature patients. J Pediatr Orthop B 2001;10:238-247.

16. Huggins MJ, Mernagh JR, Steele L, Smith JR, Nowaczyk MJ. Prenatal sonographic diagnosis of hypochondroplasia in a high-risk fetus. Am J Med Genet 1999;87:226-229.

17. Karadimas C, Sifakis S, Valsamopoulos P, Makatsoris C, Velissariou V, Petersen MB, et al. Prenatal diagnosis of hypochondroplasia: report of two cases. Am J Med Genet A 2006;140:998-1003.

¶·È‰È·ÙÚÈ΋ 2007;70:49-53

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CASE REPORT

™ÈÙÈÔÁÂÓ‹˜ ·ÓÂ¿ÚÎÂÈ· ‚ÈÙ·Ì›Ó˘ µ12 Û ‚Ú¤ÊÔ˜. ∆· ÛÈÙÈÛÙÈο Ï¿ıË ÙˆÓ ¯ÔÚÙÔÊ¿ÁˆÓ ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋, µÂÓÈ˙¤ÏÂÈÔ ¡ÔÛÔÎÔÌÂ›Ô ∏Ú·ÎÏ›Ԣ, ∫Ú‹ÙË AÏÏËÏÔÁÚ·Ê›·: ∞ÁÁÂÏ¿ÎÔ˘ µ·ÛÈÏÈ΋ vaagge3@yahoo.gr °Ô‡ÚÓ˜ ∆Â̤ÓÔ˘˜ ∆.∫. 715 00, ∏Ú¿ÎÏÂÈÔ ∫Ú‹Ù˘

µ. ∞ÁÁÂÏ¿ÎÔ˘, ª. OÚÊ·ÓÔ‡, °. ¡ÈˆÙ¿Î˘, ∂. ∫fiÎÔÚË, π. ÷ڈӛÙË ¶ÂÚ›ÏË„Ë: ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ·ÓÂ¿ÚÎÂÈ·˜ ‚ÈÙ·Ì›Ó˘ µ12 Û ı‹Ï˘ ‚Ú¤ÊÔ˜ ËÏÈΛ·˜ 12 ÌËÓÒÓ, Ô˘ ÁÂÓÓ‹ıËÎÂ Î·È ı‹Ï·Û ·fi ÌËÙ¤Ú· ·ÔÎÏÂÈÛÙÈο ¯ÔÚÙÔÊ¿ÁÔ. ∆· Û˘ÌÙÒÌ·Ù· ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ‹Ù·Ó ·ÓÔÚÂÍ›·, ·ÓÂ·Ú΋˜ ÚfiÛÏË„Ë ‚¿ÚÔ˘˜, ¤ÌÂÙÔÈ, ·¿ıÂÈ· Î·È Ì˘˚΋ ˘ÔÙÔÓ›·. ∆Ô ‚Ú¤ÊÔ˜ ı‹Ï·˙ ·ÔÎÏÂÈÛÙÈο ̤¯ÚÈ ÙËÓ ËÏÈΛ· ÙˆÓ 8,5 ÌËÓÒÓ, fiÙ·Ó ¿Ú¯ÈÛ·Ó Ó· ÚÔÛÙ›ıÂÓÙ·È ÛÙË ‰È·ÙÚÔÊ‹ ÙÔ˘ ÌÈÎÚ¤˜ ÔÛfiÙËÙ˜ ·fi Á¿Ï· ÛfiÁÈ·˜, ÊÚÔ‡Ù· Î·È Ï·¯·ÓÈο. ∏ ·ÓÔÚÂÍ›· ‹Ù·Ó ÙÔ ÚÒÙÔ Û‡Ìو̷ Ô˘ ÂÌÊ·Ó›ÛÙËΠ۠ËÏÈΛ· 6 ÌËÓÒÓ. ™ÙËÓ ËÏÈΛ· ÙˆÓ 9 ÌËÓÒÓ ÚÔÛÙ¤ıËÎ·Ó ¤ÌÂÙÔÈ Î·È ·ÒÏÂÈ· ‚¿ÚÔ˘˜. ∏ „˘¯ÔÎÈÓËÙÈ΋ ÂͤÏÈÍË ÙÔ˘ ‚Ú¤ÊÔ˘˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋ ηٿ ÙÔ˘˜ ÚÒÙÔ˘˜ Ì‹Ó˜ Ù˘ ˙ˆ‹˜. ™ÙËÓ ËÏÈΛ· ÙˆÓ 10 ÌËÓÒÓ ÂÌÊ·Ó›ÛÙËÎ·Ó ÛËÌ›· „˘¯ÔÎÈÓËÙÈ΋˜ ηı˘ÛÙ¤ÚËÛ˘ Î·È Ë ÌËÙ¤Ú· ÂÚÈÁÚ¿ÊÂÈ ÙÔ ‚Ú¤ÊÔ˜ Û·Ó ÏÈÁfiÙÂÚÔ ˙ˆËÚfi Î·È Ì ÛÙ·‰È·Î¿ ·˘Í·ÓfiÌÂÓË ·¿ıÂÈ·. ∆· ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· ¤‰ÂÈÍ·Ó ÛÔ‚·Ú‹ ÌÂÁ·ÏÔ‚Ï·ÛÙÈ΋ ·Ó·ÈÌ›·. ∆· Â›‰· ‚ÈÙ·Ì›Ó˘ µ12 ÛÙÔÓ ÔÚfi ÙÔ˘ ‚Ú¤ÊÔ˘˜ Î·È Ù˘ ÌËÙ¤Ú·˜ ‹Ù·Ó ¯·ÌËÏ¿. ∆Ô ‚Ú¤ÊÔ˜ ·ÓÙ·ÔÎÚ›ıËΠηϿ ÛÙË ¯ÔÚ‹ÁËÛË ‚ÈÙ·Ì›Ó˘ µ12 fiÛÔÓ ·ÊÔÚ¿ ÛÙ· ÁÂÓÈο Û˘ÌÙÒÌ·Ù·, ÙȘ ·ÈÌ·ÙÔÏÔÁÈΤ˜ ‰È·Ù·Ú·¯¤˜, ÙËÓ ˘ÔÙÔÓ›· Î·È ÙËÓ „˘¯ÔÎÈÓËÙÈ΋ ÂͤÏÈÍË. §¤ÍÂȘ ÎÏÂȉȿ: ÃÔÚÙÔÊ·Á›·, ·ÔÎÏÂÈÛÙÈο ¯ÔÚÙÔÊ¿ÁÔÈ, ·ÓÂ¿ÚÎÂÈ· ‚ÈÙ·Ì›Ó˘ µ12, ‰È·ÙÚÔÊ‹, ‚Ú¤ÊË.

1st Paediatric Clinic, Venizelion General Hospital of Heraklion, Crete Correspondence: V. Aggelakou vaagge3@yahoo.gr Gournes Temenous 715 00, Heraklion, Crete

Nutritional vitamin B12 deficiency in an infant. Dietary errors of a vegan V. Aggelakou, M. Orfanou, G. Niotakis, H. Kokori, I. Charoniti Abstract: The case is reported of vitamin B12 deficiency in a twelve month-old female infant born to and breastfed by a strictly vegan mother. The infant presented with anorexia, failure to thrive, vomiting, apathy and muscular hypotonia. She had been exclusively breast fed up to the age of 8.5 months, when small amounts of soya milk, vegetables and fruits were added to her diet. The first symptom was reduced appetite, which presented at the age of 6 months, followed by vomiting and weight loss at the age of 9 months. The psychomotor development was normal during the first months of life, but around 10 months of age signs of psychomotor delay were noted and the mother described the baby as being less active and increasingly apathetic. Laboratory tests revealed severe megaloblastic anaemia. Low levels of serum vitamin B12 were found in both the infant and her mother. The infant responded well to vitamin B12 administration, with improvement in the general symptoms and in the haematologic manifestations, muscular hypotonia and psychomotor development.

Key words: Vegetarianism, vegan, vitamin B12 deficiency, infant, nutrition.

∂ÈÛ·ÁˆÁ‹ ∆· ·ÚÈ· ·›ÙÈ· ·ÓÂ¿ÚÎÂÈ·˜ ‚ÈÙ·Ì›Ó˘ µ12 (∞µµ12) ÛÙ· ·È‰È¿ ‰È·ÈÚÔ‡ÓÙ·È Û ÙÚÂȘ ηÙËÁÔڛ˜: ÌÂȈ̤ÓË ÚfiÛÏË„Ë, ·ÓÒÌ·ÏË ·ÔÚÚfiÊËÛË Î·È ÂÓ‰ÔÁÂÓ›˜ ‰È·Ù·Ú·¯¤˜ Ù˘ ÌÂÙ·ÊÔÚ¿˜ Î·È ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ Ù˘ ‚ÈÙ·Ì›Ó˘ µ12 (µµ12 ) (¶›Ó·Î·˜ 1, ∂ÈÎfiÓ· 1) (1). ∞Ó Î·È Ë ∞µµ12 ÛÙ· ·È‰È¿ ÛÙȘ ·ÓÂÙ˘Á̤Ó˜ ¯ÒÚ˜ ÌÔÚ› Ó· ÔÊ›ÏÂÙ·È Û ÂȉÈΤ˜ ‰›·ÈÙ˜ (.¯. ·ÛıÂÓ›˜ Ì ʷÈÓ˘ÏÎÂÙÔÓÔ˘Ú›· ‹ ÁÏ˘ÎÔÁÔÓ›·ÛË Ib) ‹ Û ÂËÚ·Ṳ̂ÓË ·ÔÚÚfiÊËÛË (.¯. ÎÔÈÏÈÔοÎË ‹ ¯ÂÈÚÔ˘ÚÁÈΤ˜ ÂÂÌ‚¿ÛÂȘ ÛÙÔ ÛÙÔÌ¿¯È ‹ ÙÔ ¤ÓÙÂÚÔ), ÔÈ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒPaediatriki 2007;70:54-59

ÛÂȘ ∞µµ12 Ô˘ ÂÚÈÁÚ¿ÊÔÓÙ·È ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· ·ÊÔÚÔ‡Ó Û ıËÏ¿˙ÔÓÙ· ‚Ú¤ÊË ÌËÙ¤ÚˆÓ Ì ∞µµ12 (2). ∏ ∞µµ12 ÙˆÓ ıËÏ·˙Ô˘ÛÒÓ ÌËÙ¤ÚˆÓ Û˘Ó‹ıˆ˜ ÔÊ›ÏÂÙ·È Û ·˘ÛÙËÚ‹ ¯ÔÚÙÔÊ·Á›· (veganism), Ë ÔÔ›· ·ÔÎÏ›ÂÈ Ï‹Úˆ˜ Ù· ÙÚfiÊÈÌ· ˙ˆÈ΋˜ ÚÔ¤Ï¢Û˘ (ÎÚ¤·˜, „¿ÚÈ, ·˘Á¿, Á¿Ï· Î·È ¿ÏÏ· ˙ˆÈο ÚÔ˚fiÓÙ·) ·fi ÙË ‰È·ÙÚÔÊ‹ (2). ∏ ¯ÔÚÙÔÊ·Á›· (vegetarianism) Â›Ó·È ÛÈÙÈÛÙÈ΋ Ú·ÎÙÈ΋ Û ÔÏϤ˜ ÂÚÈÔ¯¤˜ ÙÔ˘ Ï·Ó‹ÙË, fiˆ˜ Ë πÓ‰›·, ÙÔ ªÂÍÈÎfi, Ë ∫ÂÓÙÚÈ΋ Î·È ¡fiÙÈ· ∞ÌÂÚÈ΋ Î·È ÔÚÈṲ̂Ó˜ ÂÚÈÔ¯¤˜ Ù˘ ∞ÊÚÈ΋˜ (3). √ ÊÈÏfiÛÔÊÔ˜ ¶˘ı·ÁfiÚ·˜ ‹Ù·Ó ·fi ÙÔ˘˜ ÚÒÙÔ˘˜ ˘ÔÛÙËÚÈÎÙ¤˜ Ù˘

55

™ÈÙÈÔÁÂÓ‹˜ ·ÓÂ¿ÚÎÂÈ· ‚ÈÙ·Ì›Ó˘ µ12 Û ‚Ú¤ÊÔ˜

¶›Ó·Î·˜ 1. ∞›ÙÈ· ·ÓÂ¿ÚÎÂÈ·˜ ‚ÈÙ·Ì›Ó˘ µ12 ÛÙ· ·È‰È¿ ªÂȈ̤ÓË ÚfiÛÏË„Ë ñ ÃÔÚÙÔÊ·ÁÈ΋ ‰›·ÈÙ· ñ £ËÏ¿˙ÔÓÙ· ‚Ú¤ÊË ·fi ÌËÙ¤Ú˜ Ì ·ÓÂ¿ÚÎÂÈ· µµ12 ÏfiÁˆ ηÎÔ‹ıÔ˘˜ ·Ó·ÈÌ›·˜, ¯ÔÚÙÔÊ·ÁÈ΋˜ ‰›·ÈÙ·˜, ÂÁ¯Â›ÚËÛ˘ ·Ú¿Î·Ì„˘ ÙÔ˘ ÛÙÔÌ¿¯Ô˘, Ï‹„˘ ·Ó·ÛÙÔϤˆÓ Ù˘ ·ÓÙÏ›·˜ ÚˆÙÔÓ›ˆÓ ñ ÕÏϘ ‰›·ÈÙ˜, .¯. ÌË ÛˆÛÙ‹ ‰›·ÈÙ· Û ʷÈÓ˘ÏÎÂÙÔÓÔ˘Ú›· ∞ÓÒÌ·ÏË ·ÔÚÚfiÊËÛË ñ ∞Ô˘Û›·/‰˘ÛÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ÂÓ‰ÔÁÂÓ‹ ·Ú¿ÁÔÓÙ· Ô˘ ·Ú¿ÁÂÙ·È ·fi Ù· ÙÔȯˆÌ·ÙÈο ·ÙÙ·Ú· ÙÔ˘ ÛÙÔÌ¿¯Ô˘, ÏfiÁˆ: - ∞Ê·›ÚÂÛ˘ ÙÔ˘ ÛÙÔÌ¿¯Ô˘ - ∞˘ÙÔ¿ÓÔÛ˘ ηÎÔ‹ıÔ˘˜ ·Ó·ÈÌ›·˜ ñ ªÂȈ̤ÓË ÔÛfiÙËÙ· Á·ÛÙÚÈÎÔ‡ ÔͤԘ - ¶·Ú·ÙÂٷ̤ÓË ıÂÚ·›· Ì ·Ó·ÛÙÔÏ›˜ Ù˘ ·ÓÙÏ›·˜ ÚˆÙÔÓ›ˆÓ ñ ¶·ÁÎÚ·ÙÈ΋ ·ÓÂ¿ÚÎÂÈ· ñ ∞ÓÙ·ÁˆÓÈÛÌfi˜ ÁÈ· µµ12 ÛÙÔ ¤ÓÙÂÚÔ - ¶·Ú·ÛÈÙÈΤ˜ ÏÔÈÌÒÍÂȘ - ÀÂÚ·Ó¿Ù˘ÍË ‚·ÎÙËÚȉ›ˆÓ ñ ¢È·Ù·Ú·¯‹ Ù˘ ·ÔÚÚfiÊËÛ˘ ηٿ Ì‹ÎÔ˜ ÙÔ˘ ÂÈÏÂÔ‡ - ¡fiÛÔ˜ Crohn - ∫ÔÈÏÈÔοÎË - ÃÂÈÚÔ˘ÚÁÈΤ˜ ÂÂÌ‚¿ÛÂȘ ÛÙÔÓ ÂÈÏÂfi - ∞ӈ̷ϛ· ÙÔ˘ ˘Ô‰Ô¯¤· ÛÙÔÓ ÂÈÏÂfi (ÓfiÛÔ˜ Imerslund-Grasbeck) ∂Ó‰ÔÁÂÓ›˜ ‰È·Ù·Ú·¯¤˜ Ù˘ ÌÂÙ·ÊÔÚ¿˜ Î·È ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ Ù˘ µµ12 ñ ¢È·Ù·Ú·¯‹ ÛÙË ÌÂÙ·ÊÔÚ¿ - ∞ÓÂ¿ÚÎÂÈ· ÙÚ·ÓÛÎÔ‚·Ï·Ì›Ó˘ ππ - ∞ÓÂ¿ÚÎÂÈ· ÙˆÓ R-binder ÚˆÙÂ˚ÓÒÓ ñ ¢È·Ù·Ú·¯‹ ÌÂÙ·‚ÔÏÈÛÌÔ‡ - ∞ÓÂ¿ÚÎÂÈ· ·‰ÂÓÔÛ˘ÏÎÔ‚·Ï·Ì›Ó˘: ÓfiÛÔ˜ cblA Î·È cblµ - ∞ÓÂ¿ÚÎÂÈ· ÌÂı˘ÏÎÔ‚·Ï·Ì›Ó˘: ÓfiÛÔ˜ cblE Î·È cblG - ™˘Ó‰˘·Ṳ̂ÓË ·ÓÂ¿ÚÎÂÈ· ·‰ÂÓÔÛ˘ÏÎÔ‚·Ï·Ì›Ó˘ Î·È ÌÂı˘ÏÎÔ‚·Ï·Ì›Ó˘: cblC, cblD Î·È cblF

¯ÔÚÙÔÊ·Á›·˜ ÛÙË ¢‡ÛË (4). ™ÙȘ ‰ÂηÂٛ˜ ÙÔ˘ 1960 Î·È 1970 ¿Ú¯ÈÛ ӷ ·˘Í¿ÓÂÙ·È ÙÔ ÔÛÔÛÙfi ÙˆÓ ¯ÔÚÙÔÊ¿ÁˆÓ ÛÙËÓ ∂˘ÚÒË Î·È ÙȘ ∏¶∞ ÏfiÁˆ ıÚËÛ΢ÙÈÎÒÓ, ÊÈÏÔÛÔÊÈÎÒÓ Î·È ÔÈÎÔÏÔÁÈÎÒÓ ÂÔÈı‹ÛˆÓ, ·ÏÏ¿ Î·È ÁÈ· ÏfiÁÔ˘˜ ‚ÂÏÙ›ˆÛ˘ Ù˘ ˘Á›·˜ (4). ¶·Ú¿ÏÏËÏ·, Ê·›ÓÂÙ·È Ó· ·˘Í¿ÓÂÈ Î·È ÙÔ ÔÛÔÛÙfi ÙˆÓ ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ Ô˘ ·ÎÔÏÔ˘ıÔ‡Ó ¯ÔÚÙÔÊ·ÁÈ΋ ‰È·ÙÚÔÊ‹, Û˘Ó‹ıˆ˜ ÏfiÁˆ ¯ÔÚÙÔÊ·Á›·˜ ÙˆÓ ÁÔÓ¤ˆÓ (5). ∏ ÌË ÈÛÔÚÚÔË̤ÓË ¯ÔÚÙÔÊ·ÁÈ΋ ‰È·ÙÚÔÊ‹ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û ÌÂȈ̤ÓË ÚfiÛÏË„Ë ÂÓ¤ÚÁÂÈ·˜, ÚˆÙÂ˚ÓÒÓ, ‚ÈÙ·ÌÈÓÒÓ (΢ڛˆ˜ µ12 Î·È D) Î·È È¯ÓÔÛÙÔȯ›ˆÓ fiˆ˜ Fe, Ca Î·È Zn (4). ∏ ∞µµ12 Â›Ó·È Û˘¯Ó‹ ÛÙÔ˘˜ ·˘ÛÙËÚ¿ ¯ÔÚÙÔÊ¿ÁÔ˘˜ (vegan) (3). ∏ ‰È¿ÁÓˆÛ‹ Ù˘ ÌÔÚ› Ó· ‰È·Ê‡ÁÂÈ ‹ Ó· ηı˘ÛÙÂÚ‹ÛÂÈ ÂÂȉ‹ Ù· Û˘ÌÙÒÌ·Ù¿ Ù˘ ‰ÂÓ Â›Ó·È ÂȉÈο. √È Û˘ÓËı¤ÛÙÂÚ˜ ÂΉËÏÒÛÂȘ Ù˘ ∞µµ12 ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Á·ÛÙÚÂÓÙÂÚÈΤ˜ ‰È·Ù·Ú·¯¤˜ Î·È Ó¢ÚÔÏÔÁÈο

™ÙfiÌ· ∂χıÂÚË µ12 ÌÔÚ› Ó· ·ÔÚÚÔÊËı› ˘ÔÁÏÒÛÛÈ·

◊·Ú ∏ µ12 ·ÔıË·ÂÙ·È Î·È ÂÎÎÚ›ÓÂÙ·È ÛÙÔ ¤ÓÙÂÚÔ Ì ÙË ¯ÔÏ‹ ·fi fiÔ˘ Î·È Â·Ó·ÚÚÔÊ¿Ù·È

∞›Ì· ∏ ÙÚ·ÓÛÎÔ‚·Ï·Ì›ÓË ππ ÌÂٷʤÚÂÈ ÙË µ12 ÛÙÔ˘˜ ÈÛÙÔ‡˜ fiÔ˘ ¯ÚËÛÈÌÔÔÈÂ›Ù·È Î·È ÛÙÔ ‹·Ú fiÔ˘ ·ÔıË·ÂÙ·È ÛÙËÓ ÙÚ·ÓÛÎÔ‚·Ï·Ì›ÓË πππ

™ÙÔÌ¿¯È ñ ŒÓ˙˘Ì· Î·È Ôͤ· ·ÔÛ˘Ó‰¤Ô˘Ó ÙË µ12 ·fi ÙȘ ÚˆÙ½Ó˜ ñ R-ÚˆÙ½Ó˜ ‰ÂÛÌÂ‡Ô˘Ó ÙË µ12 ñ ŒÎÎÚÈÛË ÙÔ˘ ÂÓ‰ÔÁÂÓ‹ ·Ú¿ÁÔÓÙ· (IF)

∞ÓÒÙÂÚÔ ÏÂÙfi ¤ÓÙÂÚÔ ñ R-ÚˆÙ½Ó˜ ·Ô‰ÂÛÌÂ‡Ô˘Ó ÙË µ12 ñ IF ‰ÂÛ̇ÂÈ ÙË µ12

∫·ÙÒÙÂÚÔ ÏÂÙfi ¤ÓÙÂÚÔ ∆Ô Û‡ÌÏÂÁÌ· IF- µ12 Û˘Ó‰¤ÂÙ·È ÛÙÔÓ IF- µ12 ˘Ô‰Ô¯¤· ÛÙ· ÂÓÙÂÚÈο ·ÙÙ·Ú·

∂ÓÙÂÚÈο ·ÙÙ·Ú· ∏ µ12 Û˘Ó‰¤ÂÙ·È ÛÙËÓ ÙÚ·ÓÛÎÔ‚·Ï·Ì›ÓË ππ

∂ÈÎfiÓ· 1. ∞ÔÚÚfiÊËÛË Î·È ÌÂÙ·‚ÔÏÈÛÌfi˜ Ù˘ ‚ÈÙ·Ì›Ó˘ µ12.

Û˘ÌÙÒÌ·Ù·, Ù· ÔÔ›· ÌÔÚ› Ó· Â›Ó·È ·ÚÔ‰Èο ‹ ÌfiÓÈÌ· (6-9).

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ £‹Ï˘ ‚Ú¤ÊÔ˜, ËÏÈΛ·˜ 12 ÌËÓÒÓ, ÚÔÛÎÔÌ›ÛÙËΠÛÙËÓ ÎÏÈÓÈ΋ ÏfiÁˆ ·ÓÔÚÂÍ›·˜, ÓˆıÚfiÙËÙ·˜, Â̤وÓ, ˆ¯ÚÔΛÙÚÈÓ˘ ¯ÚÔÈ¿˜ ‰¤ÚÌ·ÙÔ˜ Î·È ·ÒÏÂÈ·˜ ‚¿ÚÔ˘˜. √È ÁÔÓ›˜ ÙÔ˘ Â›Ó·È ·˘ÛÙËÚÒ˜ ¯ÔÚÙÔÊ¿ÁÔÈ ·fi 20ÂÙ›·˜ ÏfiÁˆ ıÚËÛ΢ÙÈÎÒÓ ÂÔÈı‹ÛˆÓ. ∆Ô ‚Ú¤ÊÔ˜ Â›Ó·È ÙÔ ÚÒÙÔ ·È‰› Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜. °ÂÓÓ‹ıËΠÌÂÙ¿ ·fi Ê˘ÛÈÔÏÔÁÈ΋ ÙÂÏÂÈfiÌËÓË Î‡ËÛË, ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ÙÔÎÂÙfi Î·È Ì ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ 3820 g. ∆Ô ‚Ú¤ÊÔ˜ ÙÚÂÊfiÙ·Ó ·ÔÎÏÂÈÛÙÈο Ì ÌËÙÚÈÎfi ıËÏ·ÛÌfi ¤ˆ˜ ÙËÓ ËÏÈΛ· ÙˆÓ 8,5 ÌËÓÒÓ, ÂÓÒ ÛÙË Û˘Ó¤¯ÂÈ· ÚÔÛÙ¤ıËÎ·Ó ÛÙË ‰È·ÙÚÔÊ‹ ÙÔ˘ Á¿Ï· ÛfiÁÈ·˜, Ê˘ÙÈΤ˜ ÙÚÔʤ˜ Î·È ÊÚÔ‡Ù·, ·fi Ù· ÔÔ›· ÂÏ¿Ì‚·Ó ÂÏ¿¯ÈÛÙ˜ ÔÛfiÙËÙ˜. ∆Ô ‚Ú¤ÊÔ˜ ›¯Â Ê˘ÛÈÔÏÔÁÈ΋ ۈ̷ÙÈ΋ ·Ó¿Ù˘ÍË Ì¤¯ÚÈ ÙËÓ ËÏÈΛ· ÙˆÓ 6 ÌËÓÒÓ. ∞fi ·˘Ù‹ ÙËÓ ËÏÈΛ· ·ÚÔ˘Û›·Û ÌÂȈ̤ÓË fiÚÂÍË, ÂÓÒ ·fi ÙÔÓ ¤Ó·ÙÔ Ì‹Ó· ηıËÌÂÚÈÓÔ‡˜ Â̤ÙÔ˘˜ (12 ËÌÂÚËÛ›ˆ˜) Î·È ·ÒÏÂÈ· ‚¿ÚÔ˘˜. ™‡Ìʈӷ Ì ÙȘ ÏËÚÔÊÔڛ˜ ÙˆÓ ÁÔÓ¤ˆÓ, ηٿ ÙÔ˘˜ ÚÒÙÔ˘˜ Ì‹Ó˜ Ù˘ ˙ˆ‹˜ ÙÔ ‚Ú¤ÊÔ˜ ›¯Â ÔÌ·Ï‹ „˘¯ÔÎÈÓËÙÈ΋ ÂͤÏÈÍË. ™Â ËÏÈΛ· 10 ÌËÓÒÓ, ÙÔ ‚Ú¤ÊÔ˜ ÌÔÚÔ‡Û ӷ οıÂÙ·È ÛÙ·ıÂÚ¿ Î·È Ó· ÛÙ¤ÎÂÙ·È fiÚıÈÔ ÎÚ·ÙÒÓÙ·˜ ¤ÈÏ·, Ó· È¿ÓÂÈ ·ÓÙÈΛÌÂÓÔ Ì ‰Â›ÎÙË-·ÓÙ›¯ÂÈÚ·, Ó· Û˘Ó‰˘¿˙ÂÈ ‰‡Ô Û˘ÏÏ·‚¤˜, ÂÓÒ Ë ·ÓÙ›ÏË„Ë Î·È Ë ¶·È‰È·ÙÚÈ΋ 2007;70:54-59

56

µ. ∞ÁÁÂÏ¿ÎÔ˘ Î·È Û˘Ó.

ÎÔÈÓˆÓÈÎfiÙËÙ· ‹Ù·Ó Û˘Ì‚·Ù¤˜ Ì ÙËÓ ËÏÈΛ· ÙÔ˘. ∞fi ÙËÓ ËÏÈΛ· ÙˆÓ 10 ÌËÓÒÓ, Ë Î·Ù¿ÛÙ·ÛË ÙÔ˘ ‚Ú¤ÊÔ˘˜ ·ÚÔ˘Û›·Û ÛÙ·‰È·Î‹ Âȉ›ӈÛË Ì ӈıÚfiÙËÙ·, ÌÂȈ̤ÓË ÎÈÓËÙÈÎfiÙËÙ·, ·‰˘Ó·Ì›· Ó· ÛÙ¤ÎÂÙ·È ÁÈ· ·ÚÎÂÙ‹ ÒÚ· fiÚıÈÔ, ÂÓÒ ·Ú¿ÏÏËÏ· ÙÔ ·È‰› ÛÙ·Ì¿ÙËÛ ӷ ¯·ÌÔÁÂÏ¿ Î·È ·ÚÔ˘Û›·Û ¤ÓÙÔÓË ˆ¯ÚÔΛÙÚÈÓË ¯ÚÔÈ¿ ‰¤ÚÌ·ÙÔ˜, ÛÙÔÌ·Ù›Ùȉ· Î·È ‰˘ÛÎÔÏ›· ÛÙË Û›ÙÈÛË. ∫·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô ÙÔ ‚Ú¤ÊÔ˜ ‹Ù·Ó Û ÂËÚ·Ṳ̂ÓË ÁÂÓÈ΋ ηٿÛÙ·ÛË, ÓˆıÚfi Î·È Â›¯Â ÌÂȈ̤ÓË ıÚ¤„Ë. ∆Ô ‚¿ÚÔ˜ ‹Ù·Ó 7300 g (<3Ë ∂.£.), ÂÓÒ ÙÔ Ì‹ÎÔ˜ Î·È Ë ÂÚ›ÌÂÙÚÔ˜ ÎÂÊ·Ï‹˜ ‹Ù·Ó ÛÙËÓ 50‹ ∂.£. Î·È ÌÂٷ͇ 25˘-50‹˜ ∂.£., ·ÓÙ›ÛÙÔȯ·. ∂›¯Â ˆ¯ÚÔΛÙÚÈÓË ¯ÚÔÈ¿ ‰¤ÚÌ·ÙÔ˜, Ë ·ÚÙËÚȷ΋ ›ÂÛË ‹Ù·Ó 95/51 mmHg Î·È Ë Î·Ú‰È·Î‹ Û˘¯ÓfiÙËÙ· 163 ÛʇÍÂȘ/min. ∞fi ÙËÓ ·‰Ú‹ Ó¢ÚÔÏÔÁÈ΋ ÂÎÙ›ÌËÛË ·ÚÔ˘Û›·˙ ÁÂÓÈÎÂ˘Ì¤ÓË Ì˘˚΋ ˘ÔÙÔÓ›·, ÂÓÒ ·fi Ù· ˘fiÏÔÈ· Û˘ÛÙ‹Ì·Ù· ‰ÂÓ Â›¯Â ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·. ∞fi ÙË ÁÂÓÈ΋ ÂͤٷÛË ·›Ì·ÙÔ˜ ‰È·ÈÛÙÒıËΠÛÔ‚·Ú‹ ·Ó·ÈÌ›· Ì Hb: 5,2 g/dl, Ht: 15,2%, ̤ÛÔ fiÁÎÔ ÂÚ˘ıÚÒÓ (MCV): 109 fl, ̤ÛË ÔÛfiÙËÙ· ·ÈÌÔÛÊ·ÈÚ›Ó˘ (MCH): 37,6 pg, ÏÂ˘Î¿ ·ÈÌÔÛÊ·›ÚÈ·: 6,72 K/Ìl, ·ÈÌÔÂÙ¿ÏÈ·: 207 K/Ìl Î·È ‰ÈÎÙ˘ÔÂÚ˘ıÚÔ·ÙÙ·Ú·: 4,3%. ∏ ÌÔÚÊÔÏÔÁ›· ÙˆÓ ÂÚ˘ıÚÒÓ ¤‰ÂÈÍ ·ÓÈÛÔ΢ÙÙ¿ÚˆÛË, ÔÈÎÈÏÔ΢ÙÙ¿ÚˆÛË, Ì·ÎÚÔ΢ÙÙ¿ÚˆÛË, ‚·ÛÂfiÊÈÏË ÛÙ›ÍË Î·È ‰·ÎÚ˘Ô·ÙÙ·Ú·, ÛÙÔȯ›· Ô˘ Û˘ÓËÁÔÚÔ‡Ó ˘¤Ú ÌÂÁ·ÏÔ‚Ï·ÛÙÈ΋˜ ·Ó·ÈÌ›·˜. √ ˘fiÏÔÈÔ˜ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍÂ: ÁÏ˘Îfi˙Ë: 83 mg/dl, Ô˘Ú›·: 19 mg/dl, ÎÚ·ÙÈÓ›ÓË: 0,3 mg/dl, Na: 142 mEq/L, K: 4,4 mEq/L, Cl: 102 mEq/L, Ca: 8,9 mg/dl, Ph: 4,6 mg/dl, Mg: 2,4 mg/dl, ÔÏÈο Ï¢ÎÒÌ·Ù· ÔÚÔ‡: 5,6 g/dl, ·Ï‚Ô˘Ì›ÓË: 3,7 g/dl, oÏÈ΋ ¯ÔÏÂÚ˘ıÚ›ÓË: 2,7 mg/dl, ¿ÌÂÛË ¯ÔÏÂÚ˘ıÚ›ÓË: 0,7 mg/dl, SGOT: 44U/L, SGPT: 14U/L, Û›‰ËÚÔ˜ ÔÚÔ‡: 156 Ìg/dl, ÊÂÚÚÈÙ›ÓË ÔÚÔ‡: 116 ng /ml, ‰ÔÎÈÌ·Û›· ‰ÚÂ¿ÓˆÛ˘ ·ÚÓËÙÈ΋, ¿ÌÂÛË Coombs ·ÚÓËÙÈ΋, Â¿ÚÎÂÈ· ÙÔ˘ ÂÓ˙‡ÌÔ˘ G6PD, Â›‰· ÙÔ˘ ‰È·Ï˘ÙÔ‡ ˘Ô‰Ô¯¤· Ù˘ ÙÚ·ÓÛÊÂÚ›Ó˘ (sTfR): 2,32 mg/l (Ê.Ù.: 0,83-1,76 mg/l), Ê˘ÏÏÈÎfi Ô͇: 17 ng /ml (Ê.Ù.: 5-17,5 ng/ml), ‚ÈÙ·Ì›ÓË µ12 ÔÚÔ‡: 102 pg/ml (Ê.Ù.: 120-970 pg/ml), LDH: 1460 πU/L, Ï‹ÚË ¤ÏÂÁ¯Ô ËÎÙÈÎfiÙËÙ·˜ Ê˘ÛÈÔÏÔÁÈÎfi. ŒÁÈÓ ‚·ÚÈÔ‡¯Ô Á‡̷, Ô˘ ¤‰ÂÈÍÂ Ê˘ÛÈÔÏÔÁÈÎfi ÛÙfiÌ·¯Ô Î·È ‰ˆ‰Âη‰¿ÎÙ˘ÏÔ. ∏ ÌËÙ¤Ú· ÙÔ˘ ‚Ú¤ÊÔ˘˜ ›¯Â: ∏b: 12,6 g/dl, Ht: 37,9%, MCV: 87,9 fl, MCH: 29,3 pg, ÏÂ˘Î¿ ·ÈÌÔÛÊ·›ÚÈ·: 6,80 K/Ìl Î·È PLT: 287 K/Ìl, ‚ÈÙ·Ì›ÓË µ12: 112 pg/ml. ∆o ‚Ú¤ÊÔ˜ ÌÂÙ·ÁÁ›ÛÙËΠ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ Ì 90 ml Û˘Ì˘ÎÓˆÌ¤ÓˆÓ ÂÚ˘ıÚÒÓ. §fiÁˆ Ù˘ ¿ÚÓËÛ˘ Ï‹„˘ ÙÚÔÊ‹˜ ÂÙ¤ıË ÚÈÓÔÁ·ÛÙÚÈÎfi˜ ηıÂÙ‹Ú·˜ Î·È ÛÈÙÈ˙fiÙ·Ó Ì ÌÂÚÈÎÒ˜ ˘‰ÚÔÏ˘Ì¤ÓÔ Á¿Ï·. ÃÔÚËÁ‹ıËΠÂÓ‰ÔÌ˘˚ÎÒ˜ ˘‰ÚÔ͢ÎÔ‚·Ï·Ì›ÓË Û ‰fiÛË 250 Ìg οı 2 Ë̤Ú˜ Â› 2 ‚‰ÔÌ¿‰Â˜ Î·È ÛÙË Û˘Ó¤¯ÂÈ· Paediatriki 2007;70:54-59

250 Ìg ·Ó¿ ‚‰ÔÌ¿‰·. ∂›Û˘, ¯ÔÚËÁ‹ıËΠۛ‰ËÚÔ˜ per os Û ‰fiÛË 3 mg/kg/24 h. ∞fi ÙȘ ÚÒÙ˜ Ë̤Ú˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜, ÙÔ ‚Ú¤ÊÔ˜ ·ÚÔ˘Û›·Û ‚ÂÏÙ›ˆÛË ÙÔ˘ Ì˘˚ÎÔ‡ ÙfiÓÔ˘ Î·È Ù˘ ÎÈÓËÙÈÎfiÙËÙ¿˜ ÙÔ˘. ÕÚ¯ÈÛ ӷ ¯·ÌÔÁÂÏ¿ Î·È Ó· ·›˙ÂÈ Ì ÙÔ˘˜ ÔÈΛԢ˜ ÙÔ˘. √ ÚÈÓÔÁ·ÛÙÚÈÎfi˜ ηıÂÙ‹Ú·˜ ·Ê·ÈÚ¤ıËÎÂ Î·È ÙÔ ·È‰› ¿Ú¯ÈÛ ӷ ÛÈÙ›˙ÂÙ·È ·fi ÙÔ ÛÙfiÌ·, Ì ÛÙ·‰È·Î‹ ‚ÂÏÙ›ˆÛË Ù˘ fiÚÂÍ‹˜ ÙÔ˘ Î·È Ù˘ ÚfiÛÏ˄˘ ‚¿ÚÔ˘˜. ¶¤ÓÙ ‚‰ÔÌ¿‰Â˜ ÂÚ›Ô˘ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜ Ì ˘‰ÚÔ͢ÎÔ‚·Ï·Ì›ÓË, Ë ÁÂÓÈ΋ ÂͤٷÛË ·›Ì·ÙÔ˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋ Î·È ÔÈ ÙÈ̤˜ Ù˘ µµ12 ÛÙÔÓ ÔÚfi ‹Ù·Ó >1000 pg/ml. ∆Ô ·È‰› ¿Ú¯ÈÛ ӷ ÛÈÙ›˙ÂÙ·È Ì ‰È·ÙÚÔÊ‹ Ô˘ ÂÚÈÂÏ¿Ì‚·Ó Á·Ï·ÎÙÔÎÔÌÈο ÚÔ˚fiÓÙ·, ·ÏÏ¿ fi¯È „¿ÚÈ Î·È ÎÚ¤·˜ (ÏfiÁˆ ¿ÚÓËÛ˘ ÙˆÓ ÁÔÓ¤ˆÓ). ∆Ô ‚¿ÚÔ˜ Â·Ó‹Ïı Û Â›‰· ¿Óˆ Ù˘ 50‹˜ ∂.£. ÁÈ· ÙËÓ ËÏÈΛ· ÙÔ˘ ·È‰ÈÔ‡. ™Â ËÏÈΛ· 14 ÌËÓÒÓ ÂÚ·ÙÔ‡Û ηÓÔÓÈο Î·È ¿Ú¯ÈÛ ӷ ϤÂÈ 2-3 ϤÍÂȘ Ì ¤ÓÓÔÈ·. ∏ ·ÓÙ›ÏË„Ë Î·È Ë ÎÔÈÓˆÓÈÎfiÙËÙ¿ ÙÔ˘ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈΤ˜. ∏ ·Ú·ÎÔÏÔ‡ıËÛË ÙÔ˘ ·È‰ÈÔ‡ Û˘Ó¯›ÛÙËΠ̤¯ÚÈ ÙËÓ ËÏÈΛ· ÙˆÓ 16 ÌËÓÒÓ, ÔfiÙÂ Ë ÔÈÎÔÁ¤ÓÂÈ· ÌÂÙ·ÎfiÌÈÛ ÛÙÔ Â͈ÙÂÚÈÎfi.

™˘˙‹ÙËÛË ∏ µµ12 ‰ÂÓ ·Ú¿ÁÂÙ·È ÛÙÔÓ ·ÓıÚÒÈÓÔ ÔÚÁ·ÓÈÛÌfi Î·È ËÁ¤˜ Ù˘ Â›Ó·È ·ÔÎÏÂÈÛÙÈο ÔÈ ˙ˆÈΤ˜ ÙÚÔʤ˜, fiˆ˜ ÙÔ ÎÚ¤·˜, ÙÔ „¿ÚÈ, Ù· ·˘Á¿ Î·È Ù· Á·Ï·ÎÙÔÎÔÌÈο ÚÔ˚fiÓÙ·. √È ËÌÂÚ‹ÛȘ ·Ó¿ÁΘ Û µµ12 ÛÙ· ‚Ú¤ÊË ˘ÔÏÔÁ›˙ÔÓÙ·È Û 0,4 Ìg, ÛÙ· ·È‰È¿ ËÏÈΛ·˜ 1-8 ÂÙÒÓ Û 1,1 Ìg, ÛÙ· ·È‰È¿ ËÏÈΛ·˜ 9-13 ÂÙÒÓ Û 1,8 Ìg, ÛÙÔ˘˜ ÂÊ‹‚Ô˘˜ Î·È ÂÓ‹ÏÈΘ Û 2,4 Ìg, ÂÓÒ ÛÙȘ ÂÁ·Ԣ˜ Î·È ıËÏ¿˙Ô˘Û˜ Á˘Ó·›Î˜ ÔÈ ·Ó¿ÁΘ ·˘Í¿ÓÔÓÙ·È Û 2,8 Ìg (3). ∆· Ë·ÙÈο ·Ôı¤Ì·Ù· ÙˆÓ ÂÓËÏ›ÎˆÓ Ô˘ ηٷӷÏÒÓÔ˘Ó ˙ˆÈΤ˜ ÙÚÔʤ˜ Â›Ó·È ÂÚ›Ô˘ 3-5 mg µ12 , ÂÓÒ Î·Ù¿ ÙË Á¤ÓÓËÛË ˘¿Ú¯Ô˘Ó ÌÈÎÚ¿ ·Ôı¤Ì·Ù·, ÂÚ›Ô˘ 25Ìg. ∆· ·Ôı¤Ì·Ù· ·˘Ù¿ Â›Ó·È ÌÈÎÚfiÙÂÚ· Â¿Ó Ë ÌËÙ¤Ú· ÙÔ˘ ÓÂÔÁÓÔ‡ ¤¯ÂÈ ∞µµ12 ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ·ËÛ˘ (7). ∂¿Ó ÏËÊıÔ‡Ó ˘’ fi„ÈÓ ÔÈ ËÌÂÚ‹ÛȘ ·Ó¿ÁΘ ÙˆÓ ÂÓËÏ›ÎˆÓ Û µµ12 Û ۯ¤ÛË Ì ٷ ·Ôı¤Ì·Ù¿ ÙÔ˘˜, ÌÔÚ› Ó· Á›ÓÂÈ Î·Ù·ÓÔËÙfi ÁÈ·Ù› ·˘ÛÙËÚÒ˜ ¯ÔÚÙÔÊ¿ÁÔÈ ÂÓ‹ÏÈΘ ηı˘ÛÙÂÚÔ‡Ó ÔÏÏ¿ ¯ÚfiÓÈ· Ó· ÂÌÊ·Ó›ÛÔ˘Ó Û˘ÌÙÒÌ·Ù· ∞µµ12 ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË ¯ÔÚÙÔÊ·ÁÈ΋˜ ‰›·ÈÙ·˜. ∆· ÓÂÔÁÓ¿, ·ÓÙ›ıÂÙ·, ÏfiÁˆ ÙˆÓ ÌÈÎÚÒÓ ·ÔıÂÌ¿ÙˆÓ ÙÔ˘˜ Û µµ12 , ÂÌÊ·Ó›˙Ô˘Ó Û˘ÌÙÒÌ·Ù· ·ÓÂ¿ÚÎÂÈ·˜ ̤۷ Û ϛÁÔ˘˜ Ì‹Ó˜, ÛÙËÓ ÂÚ›ÙˆÛË Ô˘ Ë ÚfiÛÏË„Ë ‰ÂÓ Î·Ï‡ÙÂÈ ÙȘ ËÌÂÚ‹ÛȘ ·Ó¿ÁΘ Û µµ12 (7). ™˘Ó‹ıˆ˜, ∞µµ12 ÂÌÊ·Ó›˙Ô˘Ó Ù· ‚Ú¤ÊË Ô˘ ıËÏ¿˙Ô˘Ó ·ÔÎÏÂÈÛÙÈο ÁÈ· ÌÂÁ¿ÏÔ ‰È¿ÛÙËÌ· ·fi ·˘ÛÙËÚÒ˜ ¯ÔÚÙÔÊ¿ÁÔ˘˜ ÌËÙ¤Ú˜, ÛÙȘ Ôԛ˜ ‰ÂÓ ¯ÔÚËÁÂ›Ù·È Û˘ÌÏËڈ̷ÙÈο µµ12. ∆· Â›‰· µµ12 ÛÙÔ ÌËÙÚÈÎfi Á¿Ï· ¤¯Ô˘Ó ÁÚ·ÌÌÈ΋ Û˘Û¯¤ÙÈÛË Ì ·˘Ù¿ ÙÔ˘ Ï¿ÛÌ·ÙÔ˜ ηÈ

57

™ÈÙÈÔÁÂÓ‹˜ ·ÓÂ¿ÚÎÂÈ· ‚ÈÙ·Ì›Ó˘ µ12 Û ‚Ú¤ÊÔ˜

ÛÙȘ ·˘ÛÙËÚÒ˜ ¯ÔÚÙÔÊ¿ÁÔ˘˜ ÌËÙ¤Ú˜ ·˘Ù¿ ·Ó¢ڛÛÎÔÓÙ·È Ôχ ¯·ÌËÏ¿ (1,2). ∆· ·ÚÈ· ÎÏÈÓÈο Û˘ÌÙÒÌ·Ù· Ù˘ Aµµ12 ÂÍËÁÔ‡ÓÙ·È ÏfiÁˆ Ù˘ ÂÌÏÔ΋˜ Ù˘ µµ12 Û ÛËÌ·ÓÙÈΤ˜ ÌÂÙ·‚ÔÏÈΤ˜ ·ÓÙȉڿÛÂȘ (1) (∂ÈÎfiÓ· 1). ∏ µµ12 Â›Ó·È Û˘Ó¤Ó˙˘ÌÔ ·Ó·Áη›Ô ÁÈ· ÙË ÌÂı˘Ï›ˆÛË Ù˘ ÔÌÔ΢ÛÙ½Ó˘ Û ÌÂıÂÈÔÓ›ÓË, ÙË ÌÂÙ·ÙÚÔ‹ ÙÔ˘ ÌÂı˘ÏÌ·ÏÔÓ˘Ï-Û˘ÓÂÓ˙‡ÌÔ˘ ∞ Û ÛÔ˘ÎÈÓ˘Ï-Û˘Ó¤Ó˙˘ÌÔ ∞ Î·È ÁÈ· ÙË Û‡ÓıÂÛË ÙÔ˘ ÙÂÙÚ·¸‰ÚÔÊ˘ÏÏÈÎÔ‡ ÔͤԘ ·fi ÙÔ ÌÂı˘ÏÙÂÙÚ·¸‰ÚÔÊ˘ÏÏÈÎfi Ô͇. ™Â ·ÛıÂÓ›˜ Ì Aµµ12 ·ıÚÔ›˙ÔÓÙ·È Úfi‰ÚÔ̘ Ô˘Û›Â˜, fiˆ˜ ÔÌÔ΢ÛÙ½ÓË Î·È ÌÂı˘ÏÌ·ÏÔÓÈÎfi Ô͇, ÔÈ Ôԛ˜ ÌÔÚ› Ó· ÚÔÛ‰ÈÔÚÈÛÙÔ‡Ó ÛÙÔÓ ÔÚfi Î·È ·ÔÙÂÏÔ‡Ó ÚÒÈÌÔ˘˜ Î·È ·ÍÈfiÈÛÙÔ˘˜ ‰Â›ÎÙ˜ Aµµ12 (1). ∏ ÌÂıÂÈÔÓ›ÓË Î·È ÙÔ ÙÂÙÚ·¸‰ÚÔÊ˘ÏÏÈÎfi Â›Ó·È ··Ú·›ÙËÙ˜ Ô˘Û›Â˜ ÁÈ· ÙË Û‡ÓıÂÛË DNA Î·È Ë ·ÓÂ¿ÚÎÂÈ¿ ÙÔ˘˜ Ô‰ËÁ› Û ‰È·Ù·Ú·¯¤˜ Û fiÏ· Ù· Ù·¯¤ˆ˜ ‰È·ÈÚÔ‡ÌÂÓ· ·ÙÙ·Ú·, fiˆ˜ Â›Ó·È Ù· ·ÈÌÔÔÈËÙÈο Î·È Ù· ·ÙÙ·Ú· ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ ‚ÏÂÓÓÔÁfiÓÔ˘. ªÂÁ·ÏÔ‚Ï·ÛÙÈ΋ ·Ó·ÈÌ›·, ÁψÛÛ›Ùȉ· Î·È ÌÂÚÈ΋ ·ÙÚÔÊ›· ÙˆÓ Ï·¯ÓÒÓ Â›Ó·È Û˘¯Ó¤˜ ÂΉËÏÒÛÂȘ Ù˘ ∞µµ12 (9). ÕÏÏË ÌÂÙ·‚ÔÏÈ΋ ·ÓÙ›‰Ú·ÛË Ô˘ ÂÍ·ÚÙ¿Ù·È ·fi ÙË µµ12 Â›Ó·È Ë ÌÂÙ·ÙÚÔ‹ ÙÔ˘ ÌÂı˘ÏÌ·ÏÔÓÈÎÔ‡-CoA Û ÛÔ˘ÎÈÓ˘ÏCoA. ∏ ·ÓÂ·Ú΋˜ ÌÂÙ·ÙÚÔ‹ ÙÔ˘ ÌÂı˘ÏÌ·ÏÔÓÈÎÔ‡-CoA Ô‰ËÁ› Û ·‡ÍËÛË Ù˘ Úfi‰ÚÔÌ˘ Ô˘Û›·˜ ÚÔÈÔÓ˘Ï-CoA. ∏ ¿ıÚÔÈÛË ÌÂı˘ÏÌ·ÏÔÓÈÎÔ‡-CoA Î·È ÚÔÈÔÓ˘Ï-CoA Ô‰ËÁ› Û ۇÓıÂÛË ·ÓÒÌ·ÏˆÓ ·Ï˘Û›‰ˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ, ÔÈ Ôԛ˜ Ô‰ËÁÔ‡Ó Û ÂÓۈ̿وÛË ÌÂÁ¿ÏˆÓ ÔÛÔÙ‹ÙˆÓ ·Û˘Ó‹ıÈÛÙˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ C15 Î·È C17 ÛÙÔ ÙÔ›¯ˆÌ· ÙˆÓ Ó‡ڈÓ. ∆Ô ·ÔÙ¤ÏÂÛÌ· Â›Ó·È ·ÔÌ˘ÂϛӈÛË, ·ÍÔÓÈ΋ ÂÎʇÏÈÛË Î·È ı¿Ó·ÙÔ˜ Ó¢ÚÒÓˆÓ (7,8). ∆· Ó¢ÚÔÏÔÁÈο Â˘Ú‹Ì·Ù· ÛÙÔ˘˜ ÂÓ‹ÏÈΘ ·ÊÔÚÔ‡Ó Î˘Ú›ˆ˜ ÛÙÔ ÂÚÈÊÂÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ·, ÂÓÒ ÛÙ· ‚Ú¤ÊË ÛÙÔ ÎÂÓÙÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ· Î·È ·Ô‰›‰ÔÓÙ·È Î˘Ú›ˆ˜ ÛÙȘ ·ÓˆÙ¤Úˆ ÌÂÙ·‚ÔÏÈΤ˜ ‰È·Ù·Ú·¯¤˜ (1), ¯ˆÚ›˜ fï˜ Ó· ·ÔÎÏ›ÔÓÙ·È Î·È ¿ÏÏÔÈ Ì˯·ÓÈÛÌÔ› (7,9). ∏ ·‡ÍËÛË Ù˘ ÔÌÔ΢ÛÙ½Ó˘ ıˆÚÂ›Ù·È ·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ·ÔÊÚ·ÎÙÈ΋ ·ÁÁÂÈÔ¿ıÂÈ·, Û˘ÁÁÂÓ‹ ηډÈÔ¿ıÂÈ·, ÓfiÛÔ Alzheimer Î·È „˘¯ÒÛÂȘ (2,3). ∏ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÛÙ· ‚Ú¤ÊË Ì ∞µµ12 Ô˘ ÂÚÈÁÚ¿ÊÔÓÙ·È ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· ·ÎÔÏÔ˘ı› ¤Ó· ÛÙ·ıÂÚfi ÌÔÓÙ¤ÏÔ. ∏ ÂÌÊ¿ÓÈÛË Û˘ÌÙˆÌ¿ÙˆÓ ·Ú¯›˙ÂÈ Û˘Ó‹ıˆ˜ ÛÙËÓ ËÏÈΛ· ÙˆÓ 4-15 ÌËÓÒÓ, ÌÂÙ¿ ·fi Ì›· ÂÚ›Ô‰Ô Ê˘ÛÈÔÏÔÁÈ΋˜ ·Ó¿Ù˘Í˘. ∆· ÚÒÙ· Û˘ÌÙÒÌ·Ù· Â›Ó·È ·ÓÔÚÂÍ›·, ¢ÂÚÂıÈÛÙfiÙËÙ·, ·¿ıÂÈ·, ¤ÌÂÙÔÈ, ·‰‡Ó·ÌÔ ÎÏ¿Ì· Î·È Î·ı˘ÛÙ¤ÚËÛË ‹ ·ÏÈÓ‰ÚfiÌËÛË ÛÙËÓ „˘¯ÔÎÈÓËÙÈ΋ ·Ó¿Ù˘ÍË. ∏ ۈ̷ÙÈ΋ ·Ó¿Ù˘ÍË ·Ú¯›˙ÂÈ Ó· ˘ÔÏ›ÂÙ·È, ÂÚÈÏ·Ì‚·ÓÔ̤Ó˘ Î·È Ù˘ ÂÚÈ̤ÙÚÔ˘ ÎÂÊ·Ï‹˜, Û˘¯Ó¿ ˘¿Ú¯ÂÈ ˆ¯ÚfiÙËÙ· ‰¤ÚÌ·ÙÔ˜ Î·È ÁψÛÛ›Ùȉ·, ÂÓÒ ÌÔÚ› Ó· ÂÌÊ·ÓÈÛÙÔ‡Ó Ó¢ÚÔÏÔÁÈο Û˘ÌÙÒÌ·Ù·, fiˆ˜ ˘ÔÙÔÓ›·, ÌÂȈ̤ӷ ÙÂÓfiÓÙÈ· ·ÓÙ·Ó·ÎÏ·ÛÙÈο

Î·È ¯ÔÚÈÔ·ıÂÙˆÛÈΤ˜ ÎÈÓ‹ÛÂȘ ηÈ, Û ÌÂÚÈΤ˜ ÂÚÈÙÒÛÂȘ, ÎÒÌ· Ë ·Ó·Ó¢ÛÙÈ΋ ·ÓÂ¿ÚÎÂÈ· (9). √È ÏÔÈ¤˜ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ Ù˘ ∞µµ12 ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2 (1). ∏ ÁÂÓÈ΋ ÂͤٷÛË ·›Ì·ÙÔ˜ ÛÙ· ·È‰È¿ Û˘Ó‹ıˆ˜ ·ÔηχÙÂÈ ·‡ÍËÛË ÙÔ˘ MCV Î·È MCH, ÂÓÒ Ù· Â›‰· Ù˘ Hb ÔÈΛÏÏÔ˘Ó. ÕÏÏÔ Û˘¯Ófi ‡ÚËÌ· ÛÙË ÁÂÓÈ΋ ·›Ì·ÙÔ˜ Â›Ó·È Ë ˘ÂÚηٿÙÌËÛË ÙÔ˘ ˘Ú‹Ó· ÙˆÓ Ô˘‰ÂÙÂÚÔʛψÓ. √È ÌËÙ¤Ú˜ ÙˆÓ ·Û¯fiÓÙˆÓ ‚ÚÂÊÒÓ Û˘Ó‹ıˆ˜ ‰ÂÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ì·ÎÚÔ΢ÙÙ·ÚÈ΋ ·Ó·ÈÌ›· Î·È Ù· Â›‰· Ù˘ µµ12 Â›Ó·È ÛÙ· ηÙÒÙÂÚ· Ê˘ÛÈÔÏÔÁÈο Â›‰·. °ÂÓÈο, ÔÈ ·˘ÛÙËÚÒ˜ ¯ÔÚÙÔÊ¿ÁÔÈ ÂÓ‹ÏÈΘ Û¿ÓÈ· ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÌÂÁ·ÏÔ‚Ï·ÛÙÈ΋ ·Ó·ÈÌ›·. ∆Ô ·Ú·¿Óˆ Û˘Ì‚·›ÓÂÈ ÏfiÁˆ ÙˆÓ ˘„ËÏÒÓ ·ÔıÂÌ¿ÙˆÓ ÙÔ˘˜ ÛÂ Ê˘ÏÏÈÎfi Ô͇, Ô˘ ÔÊ›ÏÂÙ·È ÛÙËÓ Â·Ú΋ ÚfiÛÏË„Ë Ê˘ÙÈÎÒÓ ÙÚÔÊÒÓ, ·ÏÏ¿ Î·È ÛÙËÓ ¿ıÚÔÈÛË Ê˘ÏÏÈÎÔ‡ ÔͤԘ ÛÙÔ˘˜ ÈÛÙÔ‡˜ ÏfiÁˆ Ù˘ ÌË ÌÂÙ·ÙÚÔ‹˜ ÙÔ˘ Û ÙÂÙÚ·¸‰ÚÔÊ˘ÏÏÈÎfi Ô͇ (∂ÈÎfiÓ· 2). ∫·Ù’ ·˘ÙfiÓ ÙÔÓ ÙÚfiÔ Û˘ÁηχÙÂÙ·È Ë Ì·ÎÚÔ΢ÙÙ¿ÚˆÛË Ô˘ ·Ú·ÙËÚÂ›Ù·È ÛÙËÓ ∞µµ12. ∏ ÛȉËÚÔÂÓ›·, Ô˘ Â›Ó·È Û˘¯Ó‹ Û fiϘ ÙȘ ÌÔÚʤ˜ ¯ÔÚÙÔÊ·ÁÈ΋˜ ‰›·ÈÙ·˜, Â›Ó·È ¤Ó·˜ ¿ÏÏÔ˜ ÏfiÁÔ˜ Ô˘ Û˘¯Ó¿ Û˘ÁηχÙÂÈ ÙË Ì·ÎÚÔ΢ÙÙ¿ÚˆÛË, Ô‰ËÁÒÓÙ·˜ ÌÂÚÈΤ˜ ÊÔÚ¤˜ Ì¿ÏÈÛÙ· Û ÌÈÎÚÔ΢ÙÙ¿ÚˆÛË (10,11). ™ÙȘ ÂÚÈÙÒÛÂȘ ·˘Ù¤˜, Ë Ì¤ÙÚËÛË ÙÔ˘ ªª∞ ı¤ÙÂÈ ÙË ‰È¿ÁÓˆÛË Ù˘ ∞µµ12. ™˘¯Ó¿ ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· Ù˘ ∞µµ12 ÛÙ· ·È‰È¿ Â›Ó·È Ë ·‡ÍËÛË Ù˘ ¤ÌÌÂÛ˘ ¯ÔÏÂÚ˘ıÚ›Ó˘ Î·È Ù˘ Á·Ï·ÎÙÈ΋˜ ‰Â¸‰ÚÔÁÂÓ¿Û˘ (LDH) ÛÙÔÓ ÔÚfi, Ô˘ ·ÓÙ·Ó·ÎÏÔ‡Ó ÙË ÌË ·Ô‰ÔÙÈ΋ ÂÚ˘ıÚÔÔ›ËÛË Î·È Î·Ù·ÛÙÚÔÊ‹ ÙˆÓ Úfi‰ÚÔÌˆÓ ÌÔÚÊÒÓ ÙˆÓ ÂÚ˘ıÚÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ ÛÙÔÓ Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ. ™ÙËÓ ·ÂÈÎfiÓÈÛË ÙÔ˘ ∫¡™ Ì ̷ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· (MRI), ·Ó¢ڛÛÎÂÙ·È Û˘¯Ó¿ ÂÁÎÂÊ·ÏÈ΋ ·ÙÚÔÊ›· Î·È Î·ı˘ÛÙ¤ÚËÛË ÛÙË Ì˘ÂϛӈÛË (1,7,9). ∆Ô ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ· (HE°) ÌÔÚ› Ó· ‰Â›ÍÂÈ ‰È¿¯˘ÙË ÂÈ‚Ú¿‰˘ÓÛË ‹ ·Ô˘Û›· ÙÔ˘ ‚·ÛÈÎÔ‡ Ú˘ıÌÔ‡ (1,7,9). ∏ ‰È¿ÁÓˆÛË Ù˘ ∞µµ12 ÌÔÚ› Ó· ηı˘ÛÙÂÚ‹ÛÂÈ ‹ Ó· ‰È·Ê‡ÁÂÈ ÏfiÁˆ ¤ÏÏÂȄ˘ ÂȉÈÎÒÓ Û˘Ìو̿وÓ. ∏ ̤ÙÚËÛË Ù˘ µµ12 ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙˆÓ ÂÈ¤‰ˆÓ ÙÔ˘ ªª∞ Î·È Ù˘ ÔÏÈ΋˜ ÔÌÔ΢ÛÙ½Ó˘ ÛÙÔÓ ÔÚfi ıˆÚÂ›Ù·È fiÙÈ ·ÔÙÂÏÔ‡Ó ··Ú·›ÙËÙ˜ ÂÍÂÙ¿ÛÂȘ Ô˘ ı¤ÙÔ˘Ó ÙË ‰È¿ÁÓˆÛË fiÙ·Ó ˘¿Ú¯Ô˘Ó Û˘ÌÙÒÌ·Ù· Ù· ÔÔ›· ÂÚÈÁÚ¿ÊÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2, ·ÏÏ¿ Î·È Î·Ù·ÛÙ¿ÛÂȘ Ô˘ Û˘Óԉ‡ÔÓÙ·È ·fi ∞µµ12 , fiˆ˜ Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1 (1,12). ∏ ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ÌÂٷ͇ Ù˘ ÛÈÙÈÔÁÂÓÔ‡˜ ¤ÏÏÂȄ˘ µµ12 Î·È ÙˆÓ ÂÓ‰ÔÁÂÓÒÓ ‰È·Ù·Ú·¯ÒÓ ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ Ù˘ µµ12 Â›Ó·È ÛËÌ·ÓÙÈ΋, ȉȷ›ÙÂÚ· ÛÙË ‚ÚÂÊÈ΋ ËÏÈΛ·. ∆Ô ÈÛÙÔÚÈÎfi Â·ÚÎÔ‡˜ ÚfiÛÏ˄˘ µµ12 ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ Ê˘ÛÈÔÏÔÁÈο ‹ Î·È ·˘ÍË̤ӷ Â›‰· µµ12 Î·È ªª∞ ÛÙÔÓ ÔÚfi ÙÔ˘ ‚Ú¤ÊÔ˘˜ Ô˘ ·ÚÔ˘ÛÈ¿˙ÂÈ ÎÏÈÓÈΤ˜ ¶·È‰È·ÙÚÈ΋ 2007;70:54-59

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µ. ∞ÁÁÂÏ¿ÎÔ˘ Î·È Û˘Ó.

¶›Ó·Î·˜ 2. ∫ÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ·ÓÂ¿ÚÎÂÈ·˜ ‚ÈÙ·Ì›Ó˘ µ12 ÛÙ· ·È‰È¿ °ÂÓÈο Û˘ÌÙÒÌ·Ù· ∞‰˘Ó·Ì›· ∂‡ÎÔÏË ÎfiˆÛË ∞ÓÔÚÂÍ›· ∞ÓÂ·Ú΋˜ ·‡ÍËÛË ∂˘ÂÚÂıÈÛÙfiÙËÙ· ¡Â˘ÚÔÏÔÁÈο/„˘¯È·ÙÚÈο Û˘ÌÙÒÌ·Ù· ∞Ó·Ù˘Íȷ΋ ηı˘ÛÙ¤ÚËÛË ‹ ·ÏÈÓ‰ÚfiÌËÛË ¶·Ú·ÈÛıËۛ˜ ÀÔÙÔÓ›· ÃÔÚÈÔ·ıÂÙˆÛÈΤ˜ ÎÈÓ‹ÛÂȘ ™·ÛÌÔ› ∞Ù·Í›· ∫ÒÌ· ∞ÒÏÂÈ· ÌÓ‹Ì˘ ∞ÏÏ·Á‹ Ù˘ ÚÔÛˆÈÎfiÙËÙ·˜ ªÂ›ˆÛË ÙˆÓ Û¯ÔÏÈÎÒÓ ÂȉfiÛÂˆÓ ∫·Ù¿ıÏÈ„Ë ∞ÈÌ·ÙÔÏÔÁÈΤ˜ ÂΉËÏÒÛÂȘ ª·ÎÚÔ΢ÙÙ¿ÚˆÛË ∞Ó·ÈÌ›· ÀÂÚηٿÙÌËÛË ÙÔ˘ ˘Ú‹Ó· ÙˆÓ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ §Â˘ÎÔÂÓ›· £ÚÔÌ‚ÔÂÓ›· ¶·Ó΢ÙÙ·ÚÔÂÓ›· ÕÏϘ ÂΉËÏÒÛÂȘ °ÏˆÛÛ›Ùȉ· À¤Ú¯ÚˆÛË ‰¤ÚÌ·ÙÔ˜ ŒÌÂÙÔÈ›/‰È¿ÚÚÔÈ· ÿÎÙÂÚÔ˜ ∫·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ·

ÂΉËÏÒÛÂȘ Û˘Ì‚·Ù¤˜ Ì ∞µµ12 , Û˘ÓËÁÔÚÔ‡Ó ˘¤Ú ÂÓ‰ÔÁÂÓÔ‡˜ ‰È·Ù·Ú·¯‹˜ ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ Ù˘ µµ12 (1).

∏ ÎÏÈÓÈ΋ ·ÓÙ·fiÎÚÈÛË Û¯Â‰fiÓ fiÏˆÓ ÙˆÓ ‚ÚÂÊÒÓ Ì ÛÈÙÈÔÁÂÓ‹ ¤ÏÏÂÈ„Ë µµ12 ÛÙË ¯ÔÚ‹ÁËÛË µµ12 Â›Ó·È ı·̷ÙÈ΋ Û fi,ÙÈ ·ÊÔÚ¿ ÛÙ· ÁÂÓÈο Û˘ÌÙÒÌ·Ù·, ÛÙȘ Á·ÛÙÚÂÓÙÂÚÈΤ˜ Î·È ·ÈÌ·ÙÔÏÔÁÈΤ˜ ‰È·Ù·Ú·¯¤˜, ÛÙË ÛˆÌ·ÙÈ΋ ·Ó¿Ù˘ÍË, ·ÏÏ¿ Î·È Û ÔÚÈṲ̂ӷ Ó¢ÚÔÏÔÁÈο Û˘ÌÙÒÌ·Ù·, fiˆ˜ Ë ˘ÔÙÔÓ›· (1,6-9). ∆· Â˘Ú‹Ì·Ù· ÛÙËÓ MRI Î·È ÙÔ ∏∂° Û˘Ó‹ıˆ˜ ·Ôηı›ÛÙ·ÓÙ·È (1,7,9), ¯ˆÚ›˜ ˆÛÙfiÛÔ Ó· ÌÔÚ› Ó· ·ÔÎÏÂÈÛÙ› Ë ·Ú·ÌÔÓ‹ Ó¢ÚÔ·Ó·Ù˘ÍÈ·ÎÒÓ ·ıÔÏÔÁÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ. ∆¤ÙÔÈ· Â˘Ú‹Ì·Ù· Â›Ó·È Ë ÓÔËÙÈ΋ ˘ÛÙ¤ÚËÛË, ÔÈ ‰È·Ù·Ú·¯¤˜ ‚¿‰ÈÛ˘ ‹ Ë ÂÈÏË„›· (10). √ ΛӉ˘ÓÔ˜ ·Ú·ÌÔÓ‹˜ ÌfiÓÈÌˆÓ Ó¢ÚÔÏÔÁÈÎÒÓ ÂΉËÏÒÛÂˆÓ Û˘Û¯ÂÙ›˙ÂÙ·È Ì ÙË ÛÔ‚·ÚfiÙËÙ· ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Î·Ù¿ ÙË ‰È¿ÁÓˆÛË, ·ÏÏ¿ Î·È Ì ÙËÓ Î·ı˘ÛÙ¤ÚËÛË Ù˘ ‰È¿ÁÓˆÛ˘ Î·È Ù˘ ¤Ó·Ú͢ ıÂÚ·›·˜ (1,7,10). ªÂϤÙË Û ÂÊ‹‚Ô˘˜ Ô˘ ÛÙË ‚ÚÂÊÈ΋ Î·È ÚÒÙË ·È‰È΋ ËÏÈΛ· ÛÈÙ›ÛÙËÎ·Ó Ì ·ÌÈÁÒ˜ ¯ÔÚÙÔÊ·ÁÈ΋ ‰›·ÈÙ· Î·È ÛÙË Û˘Ó¤¯ÂÈ· ¿Ú¯ÈÛ·Ó Ó· ηٷӷÏÒÓÔ˘Ó ˙ˆ˚Τ˜ ÙÚÔʤ˜, ·Ú¤¯ÂÈ Ôχ ÛËÌ·ÓÙÈΤ˜ ÏËÚÔÊÔڛ˜ (13). ™ÙË ÌÂϤÙË ·˘Ù‹ Ê·›ÓÂÙ·È fiÙÈ ÔÈ ·ÓÂÈı‡ÌËÙ˜ ÂȉڿÛÂȘ Ù˘ ∞µµ12 ÛÙÔ˘˜ ¯ÔÚÙÔÊ¿ÁÔ˘˜ ÌÔÚ› Ó· ÌËÓ ÂÚÈÔÚ›˙ÔÓÙ·È ÌfiÓÔ ÛÙË ‚ÚÂÊÈ΋ ËÏÈΛ·, ·ÏÏ¿ Ó· ÂÂÎÙ›ÓÔÓÙ·È Î·È ÛÙËÓ ÂÊË‚È΋ ËÏÈΛ·. ∏ ·ÏÏ·Á‹ Ù˘ ‰È·ÙÚÔÊ‹˜ ·fi ·ÌÈÁÒ˜ ¯ÔÚÙÔÊ·ÁÈ΋ Û ‰›·ÈÙ· Ô˘ ÂÚȤ¯ÂÈ ·˘Á¿, Á·Ï·ÎÙÔÎÔÌÈο ‹ Î·È ÎÚ¤·˜ ‰ÂÓ Â›Ó·È ÈηӋ ÁÈ· ÙË ‰È·Ù‹ÚËÛË Ù˘ Â¿ÚÎÂÈ·˜ µµ12 Â¿Ó Î·Ù·Ó·ÏÒÓÔÓÙ·È Ì¤ÙÚȘ ÔÛfiÙËÙ˜ ˙ˆ˚ÎÒÓ ÙÚÔÊÒÓ Î·È ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û ÁÓˆÛÙÈΤ˜ Î·È „˘¯ÔÎÈÓËÙÈΤ˜ ‰È·Ù·Ú·¯¤˜. ™˘ÌÂÚ·ÛÌ·ÙÈο, ˘¿Ú¯Ô˘Ó ÔÏϤ˜ ÂӉ›ÍÂȘ fiÙÈ Ë ∞µµ12 Â›Ó·È ·ÈÙ›· ÛËÌ·ÓÙÈ΋˜ ÓÔÛËÚfiÙËÙ·˜ ÛÙËÓ ÔÌ¿‰· ÙˆÓ ·˘ÛÙËÚÒ˜ ¯ÔÚÙÔÊ¿ÁˆÓ ·ÙfiÌˆÓ Î·È ·ÊÔÚ¿ Û fiϘ ÙȘ ËÏÈ˘, Ì ÌÂÁ¿ÏË Èı·ÓfiÙËÙ·

ªÂı˘ÏÙÂÙÚ·¸‰ÚÔÊ˘ÏÏÈÎfi

∆ÂÙÚ·¸‰ÚÔÊ˘ÏÏÈÎfi

ªÂı˘ÏÙÚ·ÓÛÊÂÚ¿ÛË √ÌÔ΢ÛÙ½ÓË

ªÂıÂÈÔÓ›ÓË ªÂı˘ÏÎÔ‚·Ï·Ì›ÓË

µÈÙ·Ì›ÓË µ12 (ÎÔ‚·Ï·Ì›ÓË)

5ã-∞‰ÂÓÔÛ˘ÏÎÔ‚·Ï·Ì›ÓË L-ªÂı˘ÏÌ·ÏÔÓ˘Ï-CoA

™Ô˘ÎÈÓ˘Ï-CoA ªÂı˘ÏÌ·ÏÔÓ˘Ï-CoA ÌÔ˘Ù¿ÛË

∂ÈÎfiÓ· 2. ∏ ‚ÈÙ·Ì›ÓË µ12 Â›Ó·È Û˘Ó¤Ó˙˘ÌÔ ÁÈ· ÙË ÌÂı˘Ï›ˆÛË Ù˘ ÔÌÔ΢ÛÙ½Ó˘ Û ÌÂıÂÈÔÓ›ÓË, ÙË ÌÂÙ·ÙÚÔ‹ ÙÔ˘ ÌÂı˘ÏÌ·ÏÔÓ˘ÏÛ˘ÓÂÓ˙‡ÌÔ˘ ∞ Û ÛÔ˘ÎÈÓ˘Ï-Û˘Ó¤Ó˙˘ÌÔ ∞ Î·È ÙË ÌÂÙ·ÙÚÔ‹ ÙÔ˘ ÌÂı˘ÏÙÂÙÚ·¸‰ÚÔÊ˘ÏÏÈÎÔ‡ ÔͤԘ Û ÙÂÙÚ·¸‰ÚÔÊ˘ÏÏÈÎfi Ô͇.

Paediatriki 2007;70:54-59

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™ÈÙÈÔÁÂÓ‹˜ ·ÓÂ¿ÚÎÂÈ· ‚ÈÙ·Ì›Ó˘ µ12 Û ‚Ú¤ÊÔ˜

Ó· Ô‰ËÁ‹ÛÂÈ Û ÌfiÓÈ̘ ·ıÔÏÔÁÈΤ˜ Ó¢ÚÔÏÔÁÈΤ˜ Î·È ·Ó·Ù˘ÍȷΤ˜ ÂΉËÏÒÛÂȘ. √È Ê˘ÛÈÔÏÔÁÈΤ˜ ÙÈ̤˜ µµ12 Î·È Ë ·Ô˘Û›· ·Ó·ÈÌ›·˜ ‰ÂÓ ·ÔÎÏÂ›Ô˘Ó ÙËÓ ·ÓÂ¿ÚÎÂÈ· Ù˘ µµ12. √È ·˘ÛÙËÚÒ˜ ¯ÔÚÙÔÊ¿ÁÔÈ ÌËÙ¤Ú˜ Ú¤ÂÈ Ó· Â›Ó·È ÂÓËÌÂڈ̤Ó˜ ÁÈ· ÙË ÛËÌ·Û›· Ù˘ Â·ÚÎÔ‡˜ ÚfiÛÏ˄˘ µµ12 ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÁ΢ÌÔÛ‡Ó˘ Î·È ÙÔ˘ ıËÏ·ÛÌÔ‡. ™Â ‚Ú¤ÊË ·˘ÛÙËÚÒ˜ ¯ÔÚÙÔÊ¿ÁˆÓ ÌËÙ¤ÚˆÓ Ô˘ ÙÚ¤ÊÔÓÙ·È ·ÔÎÏÂÈÛÙÈο Ì ÌËÙÚÈÎfi Á¿Ï·, Ú¤ÂÈ Ó· ¯ÔÚËÁÂ›Ù·È Û˘Ìϋڈ̷ µµ12. ŸÙ·Ó ˘¿Ú¯ÂÈ ˘Ô„›· ∞µµ12 Û ‚Ú¤ÊÔ˜, Ë Ï‹„Ë ÏÂÙÔÌÂÚÔ‡˜ ‰È·ÙÚÔÊÈÎÔ‡ ÈÛÙÔÚÈÎÔ‡ ÂΠ̤ÚÔ˘˜ Ù˘ ÌËÙ¤Ú·˜ Î·È ÙÔ˘ ‚Ú¤ÊÔ˘˜, ·ÏÏ¿ Î·È Ô ¤ÏÂÁ¯Ô˜ ÁÈ· ηÎÔ‹ıË ·Ó·ÈÌ›· Ù˘ ÌËÙ¤Ú·˜ ıˆÚÔ‡ÓÙ·È ··Ú·›ÙËÙ·. ∏ ¤ÁηÈÚË ‰È¿ÁÓˆÛË Î·È ıÂÚ·›· Ù˘ ∞µµ12 ÛÙ· ‚Ú¤ÊË Â›Ó·È ··Ú·›ÙËÙË ÁÈ· ÙËÓ ·ÔÙÚÔ‹ ÌfiÓÈÌˆÓ Ó¢ÚÔÏÔÁÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ.

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µÈ‚ÏÈÔÁÚ·Ê›· 1. Rasmussen SA, Fernhoff PM, Scanlon KS. Vitamin B12 deficiency in children and adolescents. J Pediatr 2001;138:10-17.

2. Asok A. Vegetarianism and vitamin B12 (cobalamin) deficiency. Am J Clin Nutr 2003;78:3-6.

3. Stabler SP, Allen RH. Vitamin B12 deficiency as a worldwide problem. Annu Rev Nutr 2004;24:299-326.

4. Sanders TA. Vegetarian diets and children. Pediatr Clin North Am 1995;42:955-965.

5. Hebbelinck M, Clarys P, De Malsche A. Growth, develop-

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ment, and physical fitness of Flemish vegetarian children, adolescents, and young adults. Am J Clin Nutr 1999;70 (3 Suppl):S579-S585.

Centers for Disease Control and Prevention (CDC). Neurologic impairment in children associated with maternal dietary deficiency of cobalamin - Georgia, 2001. MMWR 2003;52:61-64. von Schenck U, Bender-Gotze C, Koletzko B. Persistence of neurological damage induced by dietary vitamin B12 deficiency in infancy. Arch Dis Child 1997;77:137-139.

Graham SM, Arvela OM, Wise GA. Long-term neurologic consequences of nutritional vitamin B12 deficiency in infants. J Pediatr 1992;121:710-714.

Codazzi D, Sala F, Parini R, Langer M. Coma and respiratory failure in a child with severe vitamin B(12) deficiency. Pediatr Crit Care Med 2005;6:483-485.

Weiss R, Fogelman Y, Bennett M. Severe vitamin B12 deficiency in an infant associated with a maternal deficiency and a strict vegetarian diet. J Pediatr Hematol Oncol 2004; 26:270-271.

Obeid R, Geisel J, Schorr H, Hubner U, Herrmann W. The impact of vegetarianism on some haematological parameters. Eur J Haematol 2002;69:275-279.

Roschitz B, Plecko B, Huemer M, Biebl A, Foerster H, Sperl W. Nutritional infantile vitamin B12 deficiency: pathobiochemical considerations in seven patients. Arch Dis Child Fetal Neonatal Ed 2005;90:F281-F282. van Dusseldorp M, Schneede J, Refsum H, Ueland PM, Thomas CM, de Boer E et al. Risk of persistent cobalamin deficiency in adolescents fed a macrobiotic diet in early life. Am J Clin Nutr 1999;69:664-671.

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∂¡¢π∞º∂ƒ√À™∞ ¶∂ƒπ¶∆ø™∏

CASE REPORT

¢ÈÛÎÔÂȉ‹˜ ·ÙÂÏÂÎÙ·Û›· Û ¤ÊË‚Ô 1 ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋, °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ™ËÙ›·˜, ∫Ú‹ÙË 2 ¶Ó¢ÌÔÓÔÏÔÁÈ΋ ∫ÏÈÓÈ΋, °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ™ËÙ›·˜, ∫Ú‹ÙË 3 ∞ÎÙÈÓÔÏÔÁÈÎfi ∆Ì‹Ì·, °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ™ËÙ›·˜, ∫Ú‹ÙË AÏÏËÏÔÁÚ·Ê›·: £ÂÔÓ‡ÌÊË ∆·‚Ï·‰¿ÎË efi.tavladaki@mail.gr ∂ıÓÈ΋˜ ∞ÓÙ›ÛÙ·Û˘ 9 ∆.∫. 724 00, ¡Â¿ÔÏË §·ÛÈı›Ô˘ ∫Ú‹Ù˘

£. ∆·‚Ï·‰¿ÎË1, ª. ª·Ï·ıÚ¿ÎË1, °. ¢Ú·ÎˆÓ¿Î˘2, π. ™·Úȉ¿Î˘3, π. ∫·ÙÛ·Ú¿Î˘1, ª. ∫Ï·‰›ÙÔ˘1, ∞. ∞˘ÁÂÓ¿ÎË1, ∞. ¡Â¿Ú¯Ô˘1 ¶ÂÚ›ÏË„Ë: ∏ ‰ÈÛÎÔÂȉ‹˜ ·ÙÂÏÂÎÙ·Û›· Â›Ó·È ¤Ó· ȉȷ›ÙÂÚÔ Â›‰Ô˜ ÂÚÈÊÂÚÈ΋˜ Ó¢ÌÔÓÈ΋˜ Û‡ÌÙ˘Í˘, Ë ÔÔ›· ÌÈÌÂ›Ù·È ÓÂfiÏ·ÛÌ· ÛÙËÓ ÂÚÈʤÚÂÈ· ÙÔ˘ Ó‡ÌÔÓ· ‹ ÌÂÛÔıËÏ›ˆÌ·. ∞Ó·Ù‡ÛÛÂÙ·È ˆ˜ ·ÔÙ¤ÏÂÛÌ· ·ıÔÏÔÁÈ΋˜ ηٿÛÙ·Û˘ ÙÔ˘ ˘Â˙ˆÎfiÙ·. ™˘Ó·ÓÙ¿Ù·È Ù˘¯·›· Î·È Û¿ÓÈ· Û ·Û˘Ìو̷ÙÈÎfi ÂÓ‹ÏÈη Î·È ·ÎfiÌ· ÈÔ Û¿ÓÈ· Û ·È‰È¿. ¶·ÚfiÌÔȘ ÂÚÈÙÒÛÂȘ ‰ÂÓ ¤¯Ô˘Ó ·Ó·ÊÂÚı› ÛÙË ‚È‚ÏÈÔÁÚ·Ê›·. ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ÂÊ‹‚Ô˘, ËÏÈΛ·˜ ‰ÂηÙÚÈÒÓ ÂÙÒÓ, Ì ‰ÂηÙÈ΋ ˘ÚÂÙÈ΋ ΛÓËÛË, Ï¢ÚÈÙÈ΋ Û˘ÏÏÔÁ‹, ‰ÈÛÎÔÂȉ‹ ·ÙÂÏÂÎÙ·Û›· Î·È ÔÚȷο ‰ÈÔÁΈ̤ÓÔ ÂÚÈ‚ÚÔÁ¯ÈÎfi ÏÂÌÊ·‰¤Ó· ÛÙËÓ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ıÒÚ·ÎÔ˜. √ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ÁÈ· Ê˘Ì·Ù›ˆÛË ‹Ù·Ó ·ÚÓËÙÈÎfi˜ ÁÈ· ÙÔÓ ›‰ÈÔ Î·È ÙÔ ÂÚÈ‚¿ÏÏÔÓ ÙÔ˘, ÂÓÒ Ô Ù›ÙÏÔ˜ ·ÓÙÈÛˆÌ¿ÙˆÓ ÁÈ· Ì˘ÎfiÏ·ÛÌ· (‰‡Ô ‰Â›ÁÌ·Ù·), ‹Ù·Ó Û˘Ì‚·Ùfi˜ Ì Ïԛ̈ÍË ·fi Ì˘ÎfiÏ·ÛÌ·. ∏ ‰ÈÛÎÔÂȉ‹˜ ·ÙÂÏÂÎÙ·Û›· ÙÔ˘ ·ÛıÂÓÔ‡˜ ·Ô‰fiıËΠ۠Ï¢ÚÈÙÈ΋ Û˘ÏÏÔÁ‹ Î·È ·˘Ù‹ ÛÂ Ì˘ÎÔÏ·ÛÌ·ÙÈ΋ Ó¢ÌÔÓ›·. §¤ÍÂȘ ÎÏÂȉȿ: ¢ÈÛÎÔÂȉ‹˜ ·ÙÂÏÂÎÙ·Û›·, Ì˘ÎÔÏ·ÛÌ·ÙÈ΋ Ó¢ÌÔÓ›·, ¤ÊË‚Ô˜.

Round atelectasis in adolescent 1 Paediatric Clinic, General Hospital of Sitia, Crete 2 Pneumonology Clinic, General Hospital of Sitia, Crete 3 Department of Radiology, General Hospital of Sitia, Crete Correspondence: Theonymfi Tavladaki efi.tavladaki@mail.gr 9, Ethnikis Antistasis St. 724 00 Neapoli, Lasithi, Crete

T. Tavladaki1, M. Malathraki1, G. Drakonakis2, I. Saridakis3, I. Katsarakis1, M. Kladitou1, A. Augenaki1, A. Nearchou1 Abstract: Round atelectasis is a special type of peripheral lung collapse that can mimic a peripheral lung tumour or a mesothelioma. It develops as a result of pleural disease. It is a rare incidental finding in asymptomatic adults and even rarer in children, for whom there are no published reports. The case of a thirteen year-old adolescent male is described, who presented with a low grade fever and the findings of pleural effusion, round atelectasis and a slightly enlarged peribronchial lymph node on thoracic computed tomography. The laboratory investigation for tuberculosis was negative for the patient and his environment; however antibody titers for mycoplasma (two samples) were positive.

The round atelectasis was therefore attributed to pleural effusion due to mycoplasma pneumonia.

Key words: Round atelectasis, mycoplasma pneumonia, adolescent.

∂ÈÛ·ÁˆÁ‹ ∏ ‰ÈÛÎÔÂȉ‹˜ ·ÙÂÏÂÎÙ·Û›· (folded lung ‹ atelectatic pseudotumor ‹ Blesousky’s syndrome) Â›Ó·È ÌÈ· ·Û˘Ó‹ıÈÛÙË ÌÔÚÊ‹ ÂÚÈÊÂÚÈ΋˜ ·ÙÂÏÂÎÙ·Û›·˜. ∞Ó·ÊÔÚÈο Ì ÙËÓ ·ıÔÁ¤ÓÂÛ‹ Ù˘ ¤¯Ô˘Ó ·Ó·Ù˘¯ı› ‰‡Ô ‚·ÛÈΤ˜ ıˆڛ˜ (2,3). ™‡Ìʈӷ Ì ÙËÓ ÚÒÙË, Ë Â·ÓÂÈÏËÌ̤ÓË ¤ÎıÂÛË Û ·Ì›·ÓÙÔ ÚÔηÏ› ÌÈ· ÚÔԉ¢ÙÈ΋ ÈÓÒ‰Ë ·ÓÙ›‰Ú·ÛË ÙÔ˘ ˘Â˙ˆÎfiÙ·. ªÂ ÙËÓ ˆÚ›Ì·ÓÛË Ù˘ ·ÓÙ›‰Ú·Û˘ ·˘Ù‹˜, Ô ÈÓ҉˘ ÈÛÙfi˜ Û˘ÚÚÈÎÓÒÓÂÙ·È Î·È ˆı› ÙÌ‹Ì·Ù· ÙÔ˘ ˘ÔΛÌÂÓÔ˘ Ó‡ÌÔÓ· Û ۇÌÙ˘ÍË (2,3). ∏ ‰Â‡ÙÂÚË ıˆڛ· ÂÎÙÈÌ¿ fiÙÈ Ë ‰ÈÛÎÔÂȉ‹˜ ·ÙÂÏÂÎÙ·Û›· ÌÔÚ› Ó· ·Ó·Ù˘¯ı› ÌÂÙ¿ ·fi ›ÂÛË Û ÌÈ· ÂÚÈÊÂÚÈ΋ ı¤ÛË ÙÔ˘ Ó‡ÌÔÓ· ÏfiÁˆ οÔÈ·˜ Ï¢ÚÈÙÈ΋˜ Û˘ÏÏÔÁ‹˜, Ì ·ÔÙ¤ÏÂÛÌ· ÙÔ Ó¢ÌÔÓÈÎfi ·Ú¤Á¯˘Ì· Ó· Û˘ÌÙ‡ÛÛÂÙ·È Î·È Ó· ÂÁÎψ‚›˙ÂÙ·È Ì¤Û· ÛÙË Û˘ÏÏÔÁ‹. ªÔÚ› Ó· ·Ú·Ì¤ÓÂÈ ÂÁÎψ‚ÈṲ̂ÓÔ, ÏfiPaediatriki 2007;70:60-63

Áˆ Ù˘ ·Ó¿Ù˘Í˘ Û˘ÌʇÛˆÓ, ÌÂÙ¿ ÙËÓ ˘Ô¯ÒÚËÛ‹ Ù˘ (1-3,7,8). ™˘Ó‹ıˆ˜ ÂÓÙÔ›˙ÂÙ·È ÛÙ· Ô›ÛıÈ· ÙÌ‹Ì·Ù· ÙˆÓ Î¿Ùˆ ÏÔ‚ÒÓ, ·ÏÏ¿ ÌÔÚ› Ó· ÂÓÙÔÈÛÙ› Î·È Û ¿ÏϘ ı¤ÛÂȘ ÙˆÓ Ó¢ÌfiÓˆÓ. ™˘¯ÓfiÙÂÚË Â›Ó·È Ë ÂÙÂÚfiÏ¢ÚË ÂÓÙfiÈÛË, ·Ó Î·È ¤¯Ô˘Ó ·Ó·ÊÂÚı› ·ÌÊÔÙÂÚfiÏ¢Ú˜ ÂÓÙÔ›ÛÂȘ (1,2,7). ™ÙËÓ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ Ê·›ÓÂÙ·È ÛÙÚÔÁÁ˘Ï‹ ‹ ÛÊËÓÔÂȉ‹˜ ÛΛ·ÛË, ‰È·Ì¤ÙÚÔ˘ 47 cm, Ô˘ Û¯ËÌ·Ù›˙ÂÈ ÔÍ›˜ ÁˆÓ›Â˜ Ì ÙÔÓ ˘Â˙ˆÎfiÙ·. ™˘¯Ó¿ Û˘Ó˘¿Ú¯Ô˘Ó ˘Â˙ˆÎÔÙÈ΋ ¿¯˘ÓÛË Î·È Ï¢ÚÈÙÈ΋ Û˘ÏÏÔÁ‹ (3,6). ™ÙËÓ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ ‰È·ÎÚ›ÓÂÙ·È: ·) ÛÙÚÔÁÁ˘Ï‹ ‹ ÛÊËÓÔÂȉ‹˜ ‹ ÂÏÏÂÈ„ÔÂȉ‹˜ Ì¿˙· Ô˘ Û˘Ó¤¯ÂÙ·È Ì ÌÈ· ‰È¿¯˘ÙË ˘Â˙ˆÎÔÙÈ΋ ¿¯˘ÓÛË Ì ‹ ¯ˆÚ›˜ Û˘ÓÔ‰¤˜ Â·Û‚ÂÛÙÒÛÂȘ, ‚) ‚ÚÔÁ¯Ô·ÁÁÂȷ΋ ‰ÔÌ‹ Ô˘ ÂÈÛ¤Ú¯ÂÙ·È ÛÙ· fiÚÈ· Ù˘ Ì¿˙·˜, ·Ó·Ê¤ÚÂÙ·È ˆ˜

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¢ÈÛÎÔÂȉ‹˜ ·ÙÂÏÂÎÙ·Û›· Û ¤ÊË‚Ô

“ÛËÌÂ›Ô Ô˘Ú¿˜ ÎÔÌ‹ÙË” Î·È ·ÔÙÂÏ› ¯·Ú·ÎÙËÚÈÛÙÈÎfi ‡ÚËÌ·, Á) ·ÂÚÔ‚ÚÔÁ¯fiÁÚ·ÌÌ· ‹ ·ÎÙÈÓԉȷʷÓ›˜ ÎÂÓÙÚÈΤ˜ ÂÚÈÔ¯¤˜ Ô˘ Èı·ÓfiÓ ÂÚȤ¯ÔÓÙ·È Ì¤Û· ÛÙË Ì¿˙·, ÏfiÁˆ ˘ÔÏÂÈÌÌ·ÙÈÎÔ‡ ·ÂÚÈÛÌÔ‡ ÙÔ˘ ·ÙÂÏÂÎÙ·ÙÈÎÔ‡ Ó¢ÌÔÓÈÎÔ‡ ÈÛÙÔ‡ Î·È ‰) ·Ó·ÏËڈ̷ÙÈÎfi˜ ˘ÂÚ·ÂÚÈÛÌfi˜ ÙÔ˘ ·Ú·Î›ÌÂÓÔ˘ Ó¢ÌÔÓÈÎÔ‡ ÈÛÙÔ‡ (4-6). À¿Ú¯ÂÈ ÏËıÒÚ· ·ÎÙÈÓÔÏÔÁÈÎÒÓ ·Ú·ÏÏ·ÁÒÓ fiÛÔÓ ·ÊÔÚ¿ ÛÙÔ Ì¤ÁÂıÔ˜, ÙÔ Û¯‹Ì·, ÙË ı¤ÛË Î·È ÙË ÌÔÚÊÔÏÔÁ›·. ™˘Ó‹ıˆ˜ ·Ú·Ì¤ÓÂÈ ÛÙ¿ÛÈÌË, ·ÏÏ¿ ÌÔÚ› Ó· ˘ÔÛÙÚ·Ê› ‹ Î·È Ó· ÂÍ·ÏÂÈÊı› Ï‹Úˆ˜. ∏ ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÔ ÌÂÛÔıËÏ›ˆÌ· Î·È ÙÔ ‚ÚÔÁ¯ÔÁÂÓ¤˜ ηÚΛӈ̷. ∏ ‰È¿ÁÓˆÛË ı· ÛÙËÚȯı› ÛÙÔ˘˜ ȉȷ›ÙÂÚÔ˘˜ ·ÎÙÈÓÔÏÔÁÈÎÔ‡˜ ¯·Ú·ÎÙ‹Ú˜ Ù˘ ‰ÈÛÎÔÂȉԇ˜ ·ÙÂÏÂÎÙ·Û›·˜, ÛÙË Û˘ÓÔÏÈ΋ ÎÏÈÓÈÎÔÂÚÁ·ÛÙËÚȷ΋ ÂÈÎfiÓ· Î·È ÛÙËÓ Â·ÓÂÎÙ›ÌËÛË. ™Â ·ÌÊ›‚ÔϘ ÂÚÈÙÒÛÂȘ ÌÔÚ› Ó· ··ÈÙËı› Î·È ‚ÈÔ„›·.

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ÂÊ‹‚Ô˘ ËÏÈΛ·˜ 13 ÂÙÒÓ, Ô ÔÔ›Ô˜ - 30 Ë̤Ú˜ ÚÈÓ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ·ÚÔ˘Û›·Û ‰‡Ô ÂÂÈÛfi‰È· ÔͤԘ ¿ÏÁÔ˘˜ ÛÙÔ ÚfiÛıÈÔ Î·È Ô›ÛıÈÔ ·ÚÈÛÙÂÚfi ËÌÈıˆÚ¿ÎÈÔ Î·È ¤Ó· ˘ÚÂÙÈÎfi ·̷ ¤ˆ˜ 38ÔC. ∆· Û˘ÌÙÒÌ·Ù· ·Ô‰fiıËÎ·Ó Û ÈÔÁÂÓ‹ Ïԛ̈ÍË. ∂›ÎÔÛÈ Ë̤Ú˜ ·ÚÁfiÙÂÚ· ·ÚÔ˘Û›·Û ‰ÂηÙÈ΋ ˘ÚÂÙÈ΋ ΛÓËÛË Î·Ù¿ ÙȘ ·ÔÁÂ˘Ì·ÙÈÓ¤˜ Î·È ‚Ú·‰ÈÓ¤˜ ÒÚ˜. ∞fi ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË ÙˆÓ Û˘ÛÙËÌ¿ÙˆÓ ·ÚÔ˘Û›·Û Ì›ˆÛË ·Ó·Ó¢ÛÙÈÎÔ‡ „Èı˘Ú›ÛÌ·ÙÔ˜ ÛÙÔ ·ÚÈÛÙÂÚfi ̤ÛÔ Ó¢ÌÔÓÈÎfi ‰›Ô. ∞fi ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ·Ó·Ê¤ÚÂÙ·È ‚ÚÔÁ¯ÈÎfi ¿ÛıÌ· ·fi ÙË ÌËÙÚÈ΋ ÁÈ·ÁÈ¿, ÂÓÒ ·fi ÙÔ ·ÙÔÌÈÎfi ÈÛÙÔÚÈÎfi ·Ó·Ê¤ÚÂÙ·È ÚÔˆÚfiÙËÙ· (34 ‚‰ÔÌ¿‰ˆÓ ·ËÛË, 1900 g ‚¿ÚÔ˜ Á¤ÓÓËÛ˘) Î·È ÁÈ· ÙÔÓ ÏfiÁÔ ·˘Ùfi ÓÔÛËχÙËΠ۠ÙÌ‹Ì· ÚÔÒÚˆÓ. ™Â ‚ÚÂÊÈ΋ ËÏÈΛ· ÓÔÛËχÙËΠÁÈ· ‚ÚÔÁ¯ÈÔÏ›Ùȉ· Î·È ÛÙË Û˘Ó¤¯ÂÈ· ›¯Â ‹Ș ÎÚ›ÛÂȘ ‚ÚÔÁ¯ÈÎÔ‡ ¿ÛıÌ·ÙÔ˜. ∆· Â˘Ú‹Ì·Ù· ·fi ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ‹Ù·Ó Ù· ·ÎfiÏÔ˘ı·: ™ÙËÓ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ ·Ú·ÙËÚ‹ıËΠÏ¢ÚÈÙÈ΋ Û˘ÏÏÔÁ‹ ·ÚÈÛÙÂÚÔ‡ οو ÏÔ‚Ô‡ (∂ÈÎfiÓ· 1). °ÂÓÈ΋ ·›Ì·ÙÔ˜: §Â˘Î¿: 10.000 Îί (¶: 27%, §ÂÌÊ: 62%, ª: 7%), Ht: 40%, Hb: 13,2 g%, Plt: 366.000. µÈÔ¯ËÌÈο: O˘Ú›·: 32 mg%, ∫Ú·ÙÈÓ›ÓË: 1 mg%, SGOT: 29, SGPT: 14, ALP: 454, LDH: 375, ™¿Î¯·ÚÔ: 97 mg%. ∏ ∆∫∂ ‹Ù·Ó 55 mm/1 h. CRP: 45 mg/l. WIDAL: (-), WRIGHT: (-). Mantoux: 15 mm (ÂÌ‚ÔÏÈ·ÛÌfi˜ Ì µCG ÚÔ 18Ì‹ÓÔ˘). ∆· Â˘Ú‹Ì·Ù· ·fi ÙË ÁÂÓÈ΋ Ô‡ÚˆÓ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο Î·È Ë Î·ÏÏȤÚÁÂÈ· Ô‡ÚˆÓ ÁÈ· µ. Koch (3 ‰Â›ÁÌ·Ù·) ‹Ù·Ó ·ÚÓËÙÈ΋. °·ÛÙÚÈÎfi ˘ÁÚfi (¿ÌÂÛÔ Î·È Î·ÏÏÈÂÚÁÂÈ·, 3 ‰Â›ÁÌ·Ù·): ·ÚÓËÙÈ΋. ∆Ô ˘ÁÚfi ·Ú·Î¤ÓÙËÛ˘ ıÒÚ·ÎÔ˜ ‹Ù·Ó ÔÚÔ·ÈÌ·-

∂ÈÎfiÓ· 1. ∞ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹. ¶Ï¢ÚÈÙÈ΋ Û˘ÏÏÔÁ‹ ·ÚÈÛÙÂÚ¿.

ÙËÚfi, Ì ÔÚÚÒ‰Ë ¯ÚÔÈ¿ Î·È ‰È·˘Á‹ fi„Ë Ì ›˙ËÌ·. ∞fi ÙË ÁÂÓÈ΋ ÂͤٷÛË: ∫‡ÙÙ·Ú·: WBC: 7400/Îί (¶: 50%, §: 47%, ª: 3%), RBC: 15000, ™¿Î¯·ÚÔ: 115 mg/dl, §Â‡ÎˆÌ·: 4,9 g/dl, LDH: 1605 IU/L, ∞Ì˘Ï¿ÛË: 29 u/l. ∏ ηÏÏȤÚÁÂÈ· ÁÈ· ÎÔÈÓ¿ ÌÈÎÚfi‚È· ‹Ù·Ó ÛÙ›ڷ. ∞fi ÙËÓ Î˘ÙÙ·ÚÔÏÔÁÈ΋ ÂͤٷÛË ‰ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ÓÂÔÏ·ÛÌ·ÙÈο ·ÙÙ·Ú·, Ô‡ÙÂ Ê˘Ì¿ÙÈ·, ÂÓÒ ÛËÌÂÈÒÓÂÙ·È Ë ·ÚÔ˘Û›· ˈÛÈÓÔÊ›ÏˆÓ ÛÙÔ Â›¯ÚÈÛÌ·. ∆Ô U/S ηډȿ˜ ¤‰ÂÈÍ ÂχıÂÚÔ ÂÚÈοډÈÔ. ∏ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ ¤‰ÂÈÍ ˘fi˘ÎÓË ˘Â˙ˆÎÔÙÈ΋ Û˘ÏÏÔÁ‹ ˘ÁÚÔ‡ ηٿ ÙË Ú·¯È·›· ·Ú·ÛÔÓ‰˘ÏÈ΋ Î·È ¤Íˆ Ï¿ÁÈ· ÂÈÊ¿ÓÂÈ· ÙÔ˘ ηÙÒÙÂÚÔ˘ ·ÚÈÛÙÂÚÔ‡ ËÌÈıˆÚ·Î›Ô˘ ÌÂ Û˘ÌÌÂÙÔ¯‹ ÙÔ˘ ηÙÒÙÂÚÔ˘ ÙÌ‹Ì·ÙÔ˜ Ù˘ Û‡ÛÙÔÈ¯Ô˘ Ì›˙ÔÓÔ˜ ÌÂÛÔÏÔ‚›Ô˘ Û¯ÈÛÌ‹˜. ™ÙÔ ¤Íˆ ‚·ÛÈÎfi ÙÌ‹Ì· ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ οو Ó¢ÌÔÓÈÎÔ‡ ÏÔ‚Ô‡ ·Ó·‰ÂÈÎÓ‡ÂÙ·È ÛÊËÓÔÂȉԇ˜ Û¯‹Ì·ÙÔ˜ ÌÈÎÚ‹ ·ÚÂÁ¯˘Ì·ÙÈ΋ ‚Ï¿‚Ë, Ë ÔÔ›· ÏËÚÔ› ÔÏÏ¿ ÂÎ ÙˆÓ ·ÂÈÎÔÓÈÛÙÈÎÒÓ ÎÚÈÙËÚ›ˆÓ ÌÈÎÚ‹˜ ‰ÈÛÎÔÂȉԇ˜ ·ÙÂÏÂÎÙ·Û›·˜, ÂÓÙfi˜ ÙˆÓ ÔÚ›ˆÓ Ù˘ ÔÔ›·˜ ·Ó·‰ÂÈÎÓ‡ÔÓÙ·È ÌfiÏȘ ˘ÔÛËÌ·ÈÓfiÌÂÓ˜ ÛˆÏËÓÔÂȉ›˜ ‰Ô̤˜ Ì ·¤Ú· Ô˘ ·ÓÙÈÚÔÛˆÂ‡Ô˘Ó ÔÚȷο ‰È·ÙÂٷ̤ÓÔ˘˜ ‚ÚfiÁ¯Ô˘˜ (∂ÈÎfiÓ˜ 2 Î·È 3). ∂Î ÙÔ˘ ÏÔÈÔ‡ ÂϤÁ¯Ô˘ ·Ó·Ê¤ÚÂÙ·È Ë ·ÚÔ˘Û›· ÌÈÎÚÔ‡ ˘ÔÛÙÚfiÁÁ˘ÏÔ˘ ÌÔÚÊÒÌ·ÙÔ˜ ‰È·Ì¤ÙÚÔ˘ 1,2 cm ÛÙÔ ·ÚÈÛÙÂÚfi ¯Â›ÏÔ˜ ÙÔ˘ Ô›ÛıÈÔ˘ ÌÂÛÔıˆÚ·Î›Ô˘ ‰›Ï· ·fi ÙÔÓ ÔÈÛÔÊ¿ÁÔ. ∂›Û˘, ‰›‰ÂÙ·È Ë ÂÓÙ‡ˆÛË ÔÚȷ΋˜ ·ÔÛÙÚÔÁÁ‡ÏˆÛ˘ Ù˘ ·ÚÈÛÙÂÚ‹˜ Ó¢ÌÔÓÈ΋˜ ‡Ï˘, ÛÙÔ ‡„Ô˜ Ù˘ ·ÚÈÛÙÂÚ‹˜ Ó¢ÌÔÓÈ΋˜ ·ÚÙËÚ›·˜. ∆· ÙÂÏÂ˘Ù·›· Â˘Ú‹Ì·Ù· ¤ıÂÛ·Ó ÙËÓ ˘fiÓÔÈ· ÌÈÎÚÔ‡ ÌÂÛÔıˆÚ·ÎÈÎÔ‡ Î·È Èı·ÓÒ˜ ÔÚȷο ‰ÈÔÁΈ̤ÓÔ˘ ·ÚÈÛÙÂÚÔ‡ ÂÚÈ‚ÚÔÁ¯ÈÎÔ‡ ÏÂÌÊ·‰¤Ó·. √˘‰¤Ó ·ıÔÏÔÁÈÎfi ·Ó¢ڤıË ·fi ÙÔÓ ¤ÏÂÁ¯Ô ÙˆÓ ˘fiÏÔÈˆÓ Ó¢ÌÔÓÈÎÒÓ ‰›ˆÓ. ¶·È‰È·ÙÚÈ΋ 2007;70:60-63

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∂ÈÎfiÓ· 2. ∞ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹. ™ÊËÓÔÂȉԇ˜ Û¯‹Ì·ÙÔ˜ ‰ÈÛÎÔÂȉ‹˜ ·ÙÂÏÂÎÙ·Û›·. ™˘Ó¯È˙fiÌÂÓË Ì ÙÔÓ ˘Â˙ˆÎfiÙ·, Û˘Ó˘¿Ú¯ÂÈ ˘Â˙ˆÎÔÙÈ΋ ¿¯˘ÓÛË Î·È Ï¢ÚÈÙÈ΋ Û˘ÏÏÔÁ‹.

√ ·ÛıÂÓ‹˜ ·ÓÙÈÌÂÙˆ›ÛÙËΠ̠ÎÔÚÙÈ˙fiÓË Î·È ·ÓÙÈÊ˘Ì·ÙÈ΋ ·ÁˆÁ‹ ̤¯ÚÈ Ó· ÔÏÔÎÏËÚˆı› Ô ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ÁÈ· ÙÔÓ ›‰ÈÔ Î·È ÙÔ ÂÚÈ‚¿ÏÏÔÓ ÙÔ˘ Î·È ÛÙË Û˘Ó¤¯ÂÈ· ¤Ï·‚ ̷ÎÚÔÏ›‰Ë (15 mg/kg/24h) Û ‰‡Ô ‰fiÛÂȘ ÁÈ· 15 Ë̤Ú˜. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÓÔÛËÏ›·˜ ÙÔ˘ ·Ú¤ÌÂÈÓ Û ¿ÚÈÛÙË ÁÂÓÈ΋ ηٿÛÙ·ÛË, Û˘Ó¤¯È˙ fï˜ ‰ÂηÙÈ΋ ˘ÚÂÙÈ΋ ΛÓËÛË ÁÈ· ¤ÓÙ Ë̤Ú˜ ηٿ ÙȘ ·ÔÁÂ˘Ì·ÙÈÓ¤˜ ÒÚ˜. ªÂÙ¿ ÙËÓ ¤Ó·ÚÍË ıÂÚ·›·˜, ˘‹ÚÍ ·ÎÚÔ·ÛÙÈÎÒ˜ ÚÔԉ¢ÙÈ΋ ‚ÂÏÙ›ˆÛË ÙˆÓ Â˘ÚËÌ¿ÙˆÓ ·fi ÙÔÓ ıÒڷη, ÂÓÒ ·ÔηٿÛÙ·ÛË ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ „Èı˘Ú›ÛÌ·ÙÔ˜ ˘‹ÚÍ ÌÂÙ¿ ÙË ‰¤Î·ÙË Ë̤ڷ Ù˘ ÓÔÛËÏ›·˜ ÙÔ˘. √ ¤ÏÂÁ¯Ô˜ ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ ÙÔ˘ ÂÊ‹‚Ô˘ ÁÈ· Ê˘Ì·Ù›ˆÛË ‹Ù·Ó ·ÚÓËÙÈÎfi˜, ÂÓÒ ÙÔ ÚÒÙÔ ‰Â›ÁÌ· ÈÔÏÔÁÈÎÔ‡ ÂϤÁ¯Ô˘ Ê·›ÓÂÙ·È ÛÙÔÓ ¶›Ó·Î· 1. √ ¤ÊË‚Ô˜ Û˘Ó¤¯ÈÛ ӷ ·Ú·ÎÔÏÔ˘ıÂ›Ù·È ÎÏÈÓÈο Î·È ÂÚÁ·ÛÙËÚȷο ÛÙ· Â͈ÙÂÚÈο È·ÙÚ›· Ù˘ ÎÏÈÓÈ΋˜. ŒÏ·‚ ·ÓÙÈÊ˘Ì·ÙÈ΋ ·ÁˆÁ‹ ÁÈ· Û˘ÓÔÏÈÎfi ‰È¿ÛÙËÌ· 20 ËÌÂÚÒÓ. ∏ ÂÍ·Ê¿ÓÈÛË Ù˘ ·ÙÂÏÂÎÙ·Û›·˜ ‰È·ÈÛÙÒıËΠ·ÎÙÈÓÔÏÔÁÈο ‰‡Ô Ì‹Ó˜ ÌÂÙ¿ ÙË ‰È¿ÁÓˆÛ‹ Ù˘ Î·È ¤ÎÙÔÙÂ Ô ¤ÊË‚Ô˜ ·Ú·Ì¤ÓÂÈ Û ¿ÚÈÛÙË ÁÂÓÈ΋ ηٿÛÙ·ÛË. ∏ Ï¢ÚÈÙÈ΋ Û˘ÏÏÔÁ‹ ·Ô-

∂ÈÎfiÓ· 3. ∞ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹. ™Ù· fiÚÈ· Ù˘ ·ÏÏÔ›ˆÛ˘ ·Ó·‰ÂÈÎÓ‡ÔÓÙ·È ÔÚȷο ‰È·ÙÂٷ̤ÓÔÈ ‚ÚfiÁ¯ÔÈ. ¢È·Ê·›ÓÂÙ·È Ë ¯·Ú·ÎÙËÚÈÛÙÈ΋ “Ô˘Ú¿ ÎÔÌ‹ÙË”.

‰fiıËΠ۠Ó¢ÌÔÓ›· ·fi Ì˘ÎfiÏ·ÛÌ· Î·È Ë ‰ÈÛÎÔÂȉ‹˜ ·ÙÂÏÂÎÙ·Û›· ÛÙËÓ ‡·ÚÍË ÂÍȉÚÒÌ·ÙÔ˜.

™˘˙‹ÙËÛË ∏ ‰ÈÛÎÔÂȉ‹˜ ·ÙÂÏÂÎÙ·Û›· Â›Ó·È Ì›· ·Û˘Ó‹ıÈÛÙË ÌÔÚÊ‹ ÂÚÈÊÂÚÈ΋˜ ·ÙÂÏÂÎÙ·Û›·˜. ∞Ó·Ù‡ÛÛÂÙ·È ˆ˜ ·ÔÙ¤ÏÂÛÌ· ·ıÔÏÔÁÈ΋˜ ηٿÛÙ·Û˘ ÙÔ˘ ˘Â˙ˆÎfiÙ·. √È ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ ¤¯Ô˘Ó ·Ô‰Ôı› Û ÂÈÛÓÔ‹ ·ÌÈ¿ÓÙÔ˘, ·ÏÏ¿ ¤¯Ô˘Ó ·Ó·ÊÂÚı› Î·È ÔÏϤ˜ ¿ÏϘ ·Èٛ˜, fiˆ˜ Ó¢ÌÔÓÈ΋ Û˘ÏÏÔÁ‹ (ÂÍ›‰ÚˆÌ· ‹ ‰È›‰ÚˆÌ·) Î·È ÙÚ·‡Ì·. ∏ ‰ÈÛÎÔÂȉ‹˜ ·ÙÂÏÂÎÙ·Û›· ÌÔÚ› Ó· ‰È·ÁÓˆÛÙ› ·fi ÏËıÒÚ· ·ÎÙÈÓÔÏÔÁÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ. ™ÙËÓ ÂÚ›ÙˆÛË ÙÔ˘ ·ÛıÂÓÔ‡˜ Ô˘ ·ÚÔ˘ÛÈ¿˙ÂÙ·È, ˘¿Ú¯Ô˘Ó ÔÏÏ¿ ·fi Ù· ÎÚÈÙ‹ÚÈ· Ù˘ ‰ÈÛÎÔÂȉԇ˜ ·ÙÂÏÂÎÙ·Û›·˜, fiÛÔÓ ·ÊÔÚ¿: ·) ÛÙËÓ ÂÓÙfiÈÛË: Â›Ó·È Û˘Ó‹ıˆ˜ ÂÙÂÚfiÏ¢ÚË Î·È Î·Ù·Ï·Ì‚¿ÓÂÈ Ù· Ô›ÛıÈ· ÙÌ‹Ì·Ù· ÙˆÓ Î¿Ùˆ ÏÔ‚ÒÓ, ‚) ÛÙËÓ ·ÈÙÈÔÏÔÁ›·: Ï¢ÚÈÙÈ΋ Û˘ÏÏÔÁ‹, fiˆ˜ Ê·›ÓÂÙ·È ÛÙËÓ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ ·ÚÈÛÙÂÚ¿ Î·È Á) ÛÙÔ Û¯‹Ì·: ÛÊËÓÔÂȉ‹˜ Ì¿˙·, fiˆ˜ Ê·›ÓÂÙ·È ÛÙËÓ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· Ô˘ Û˘Ó¤¯ÂÙ·È Ì ÌÈ· ‰È¿¯˘ÙË ˘Â˙ˆÎÔÙÈ΋ ¿¯˘ÓÛË.

¶›Ó·Î·˜ 1. ¶ÚÒÙÔ ‰Â›ÁÌ· ÈÔÏÔÁÈÎÔ‡ ÂϤÁ¯Ô˘ Echo (1Ô ‰Â›ÁÌ·) Coxsakie Mycoplasm (1Ô ‰Â›ÁÌ·) Chlamydia Mycoplasm (2Ô ‰Â›ÁÌ·-2 ‚‰ÔÌ¿‰Â˜ ·ÚÁfiÙÂÚ·) Echo (2Ô ‰Â›ÁÌ·) Paediatriki 2007;70:60-63

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∂›Û˘, ÛÙËÓ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ·ÂÈÎÔÓ›˙ÂÙ·È Ë ‚ÚÔÁ¯Ô·ÁÁÂȷ΋ ‰ÔÌ‹ Ô˘ ÂÈÛ¤Ú¯ÂÙ·È ÛÙ· fiÚÈ· Ù˘ Ì¿˙·˜ Î·È ·Ó·Ê¤ÚÂÙ·È ˆ˜ “ÛËÌÂ›Ô Ô˘Ú¿˜ ÎÔÌ‹ÙË”, ÙÔ ÔÔ›Ô ·ÔÙÂÏ› ¯·Ú·ÎÙËÚÈÛÙÈÎfi ‡ÚËÌ· Ù˘ ‰ÈÛÎÔÂȉԇ˜ ·ÙÂÏÂÎÙ·Û›·˜. ∆· Ì˘ÎÔÏ¿ÛÌ·Ù· Â›Ó·È ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ›, ÔÚÈṲ̂ӷ ›‰Ë ÂÎ ÙˆÓ ÔÔ›ˆÓ Â›Ó·È ·ıÔÁfiÓ· ÁÈ· ÙÔÓ ¿ÓıÚˆÔ. ∫ÏÈÓÈο Û˘Ó‹ıˆ˜ ÚÔ‚¿ÏÏÔ˘Ó ˆ˜ Ïԛ̈ÍË ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ‹ ˆ˜ Ó¢ÌÔÓ›·. ∏ Ó¢ÌÔÓ›· ÂÌÊ·Ó›˙ÂÙ·È Î˘Ú›ˆ˜ Û ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜. ∏ Ï¢ÚÈÙÈ΋ Û˘ÏÏÔÁ‹ Î·È Ë ·ıÔÏÔÁÈ΋ ηٿÛÙ·ÛË ÙÔ˘ ˘Â˙ˆÎfiÙ· ›¯Â ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·Ó¿Ù˘ÍË ‰ÈÛÎÔÂȉԇ˜ ·ÙÂÏÂÎÙ·Û›·˜, fiˆ˜ Ê·›ÓÂÙ·È ÛÙËÓ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ıÒÚ·ÎÔ˜.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Szydlowski GW, Cohn HE, Steiner RM, Edie RN. Rounded atelectasis: a pulmonary pseudotumor. Ann Thorac Surg 1992;53:817-821.

2. Hanke R, Kretzschmar R. Round atelectasis. Semin Roentgenol 1980;15:174-182.

3. Fraser R, Muller N, Colman N, Pare P. Fraser and Pare’s diagnosis of diseases of the chest. 4th edition. Philadelphia, PA: WB Saunders Company; 1999. p. 513-522.

4. Doyle TC, Lawler GA. CT features of rounded atelectasis of the lung. Am J Roentgenol 1984;143:225-228.

5. McHugh K, Blaquiere RM. CT features of rounded atelectasis. Am J Roentgenol 1989;153:257-260.

6. Roach HD, Davies GJ, Attanoos R, Crane M, Adams H, Phillips S. Asbestos: when the dust settles an imaging review of asbestos-related disease. Radiographics 2002;22: 167-184.

7. Medford ARL, Darby M, Maskell NA. Rounded atelectasis mimicking a lung cancer. J R Col Physicians Edinb 2005;35: 123-125.

8. Woodring Jh. Pleural effusion is a cause of round atelectasis of the lung. J Ky Med Assoc 2000;98:527-532.

¶·È‰È·ÙÚÈ΋ 2007;70:60-63

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¶ÂÚ›ÏË„Ë: ø˜ ÛÔ‚·Ú‹ ·Ú·ÙÂÈÓfiÌÂÓË ‰È¿ÚÚÔÈ· ıˆÚԇ̠οı ‰È·ÚÚÔ˚Îfi ÂÂÈÛfi‰ÈÔ ÙÔ ÔÔ›Ô ‰È·ÚΛ ÂÚÈÛÛfiÙÂÚÔ ·fi 15 Ë̤Ú˜ Î·È Â›Ó·È ·ÚÎÔ‡ÓÙˆ˜ ÛÔ‚·Úfi ÒÛÙ ӷ ··ÈÙ› ıÂÚ·›· Ì ·ÚÂÓÙÂÚÈ΋ ‰È·ÙÚÔÊ‹. ¶ÚfiÎÂÈÙ·È ÁÈ· ‚·ÚÈ¿ ¿ıËÛË Ù˘ ÔÔ›·˜ Ë ıÓËÙfiÙËÙ· Î˘Ì·›ÓÂÙ·È ÌÂٷ͇ 5-47%. §ÔÈÌÒ‰ÂȘ ·Ú¿ÁÔÓÙ˜ Î·È ÙÚÔÊÈΤ˜ ·ÏÏÂÚÁ›Â˜ ·ÔÙÂÏÔ‡Ó ÙȘ ÈÔ Û˘¯Ó¤˜ ·Èٛ˜ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘. ¶ÚÔÁÓˆÛÙÈο ÛËÌ›· Ô˘ ÚԉȷÁÚ¿ÊÔ˘Ó Î·Î‹ ¤Î‚·ÛË, ·ÔÙÂÏÔ‡Ó Ù· ·ÎfiÏÔ˘ı·: ¯·ÌËÏfi ‚¿ÚÔ˜ Á¤ÓÓËÛ˘, ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi, ÚÒÈÌË ¤Ó·ÚÍË, ÎÔÈÓˆÓÈ΋ Ù¿ÍË, Î·È ÌË Ï‹„Ë ÌËÙÚÈÎÔ‡ Á¿Ï·ÎÙÔ˜. ∏ ÂÈÛ·ÁˆÁ‹ Ó¤ˆÓ ‰È·ÁÓˆÛÙÈÎÒÓ ÌÂıfi‰ˆÓ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· Â¤ÙÚ„ ÙË ‰È¿ÁÓˆÛË Ó¤ˆÓ ·ı‹ÛÂˆÓ ÔÈ Ôԛ˜ ÚÔηÏÔ‡Ó ·Ú·ÙÂÈÓfiÌÂÓË ‰È¿ÚÚÔÈ·, fiˆ˜ Â›Ó·È Ë Û˘ÁÁÂÓ‹˜ „¢‰Ô·fiÊÚ·ÍË, Ë ÓfiÛÔ˜ ÙˆÓ ÌÈÎÚÔÏ·¯ÓÈ·ÎÒÓ ÂÁÎÏ›ÛÙˆÓ, Ë ÂÓÙÂÚÔ¿ıÂÈ· Ì ı˘Û¿ÓÔ˘˜, Ë ·˘ÙÔ¿ÓÔÛË ÂÓÙÂÚÔ¿ıÂÈ·, ÙÔ Û‡Ó‰ÚÔÌÔ ·ÓÔÛÔÏÔÁÈ΋˜ ‰˘ÛÚ˘ıÌ›·˜, ÔÏ˘ÂÓ‰ÔÎÚÈÓÔ¿ıÂÈ·˜, ÂÓÙÂÚÔ¿ıÂÈ·˜ Î·È Ê˘ÏÔÛ‡Ó‰ÂÙ˘ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜ (IPEX), Ë ÂÈ̤ÓÔ˘Û· ÂÏÎ҉˘ ÎÔÏ›Ùȉ·, ÔÈ ‰È·Ù·Ú·¯¤˜ ÁÏ˘ÎÔ˙˘Ï›ˆÛ˘, ηıÒ˜ Î·È ÂÓÙÂÚÔ¿ıÂȘ ·fi Ó¤· ÏÔÈÌÒ‰Ë ·›ÙÈ·. √È Ó¤Â˜ ·˘Ù¤˜ ·ı‹ÛÂȘ ·ÔÙÂÏÔ‡Ó ÙÔ ·ÓÙÈΛÌÂÓÔ Ù˘ ·ÚÔ‡Û·˜ ·Ó·ÛÎfiËÛ˘. ∞Ó Î·È ÁÈ· ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ·fi ·˘Ù¤˜, ÂÎÙfi˜ ·fi ÙȘ ÏÔÈÌÒ‰ÂȘ, ‰ÂÓ ˘¿Ú¯ÂÈ ÂȉÈ΋ ıÂÚ·›·, Ë ÚÒÈÌË ‰È¿ÁÓˆÛË Ô‰ËÁ› Û ηχÙÂÚË ÂÎÙ›ÌËÛË Ù˘ ÚfiÁÓˆÛ˘ Î·È ‰›ÓÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· ÁÈ· ÙËÓ ·ÚÔ¯‹ ÁÂÓÂÙÈÎÒÓ Û˘Ì‚Ô˘ÏÒÓ ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ·. Àfi ‰ÔÎÈÌ‹ ‚Ú›ÛÎÔÓÙ·È Û‹ÌÂÚ· Ó¤· ıÂÚ·¢ÙÈο ̤۷ ˘fi ÌÔÚÊ‹ ·˘ÍËÙÈÎÒÓ, ‚ÈÔÏÔÁÈÎÒÓ Î·È ·ÓÙÈÊÏÂÁÌÔÓˆ‰ÒÓ ·Ú·ÁfiÓÙˆÓ Î·ıÒ˜ Î·È ıÚÂÙÈÎÒÓ Ô˘ÛÈÒÓ.

§¤ÍÂȘ ÎÏÂȉȿ: ÃÚfiÓÈ· ‰È¿ÚÚÔÈ·, ÂÓÙÂÚÔ¿ıÂÈ·, ÓÂÔÁÓfi.

Severe protracted diarrhÔea of infancy - New aspects Department of Neonatal Medicine, Alexandra Regional General Hospital, Athens, Greece Correspondence: C. Costalos ccostalos@yahoo.gr 130, Artemidos St., 175 62 P. Faliro, Athens, Greece

C. Costalos Abstract: Severe protracted diarrhoea of infancy is defined as diarrhoea lasting for more than 15 days, severe enough to necessitate parenteral nutrition. It is a serious disease with a mortality rate ranging from 5 to 47%. Infectious agents and trophic allergies account for most of the cases. Poor prognostic factors include low birth weight, positive family history, early onset, atopy, low social class and absence of breast feeding. The availability of novel diagnostic tools in recent years has expanded understanding of the aetiology and pathophysiology of protracted diarrhoea, resulting in the identification of a number of new diarrhoeal disease entities, which are discussed in this review. These include congenital pseudoobstruction, familial microvillus inclusion disease, tufting enteropathy, autoimmune enteropathy, immune dysregulation, polyendocrinopathy, enteropathy, X-linked syndrome (IPEX) and persistent ulcerative colitis, as well as disorders of glucoprotein glycosylation. New infective enteropathogens have also been identified. Although definitive treatment for severe protracted diarrhoea is available only in the case of infectious agents, early identification of these diseases permits improved counseling of parents about the long-term prognosis and therapeutic options, and allows better assessment of the potential risk for subsequent affected siblings. New forms of management are currently under way, with the use of enteral growth factors, biologic and anti-inflammatory agents and nutrients.

Key words: Enteropathies, chronic intractable diarrhoea, newborn infant.

∂ÈÛ·ÁˆÁ‹ ø˜ ·Ú·ÙÂÈÓfiÌÂÓË ÛÔ‚·Ú‹ ‰È¿ÚÚÔÈ· (¶™¢) ÔÚ›˙ÂÙ·È Ë ‰È¿ÚÚÔÈ· Ë ÔÔ›· ·Ú·Ù›ÓÂÙ·È ¤Ú·Ó ÙˆÓ 15 ËÌÂÚÒÓ Î·È Â›Ó·È ·ÚÎÔ‡ÓÙˆ˜ ÛÔ‚·Ú‹ ÒÛÙ ӷ ··ÈÙ› ÂȉÈ΋ ‰È·ÈÙËÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË Î·È Û˘¯Ó¿ ·ÚÂÓÙÂÚÈ΋ ‰È·ÙÚÔÊ‹ (1). ∆Ô ı¤Ì· ¤¯ÂÈ ··Û¯ÔÏ‹ÛÂÈ ÙÔ˘˜ ÂȉÈÎÔ‡˜ ·fi ·ÏÈ¿. √È ÛËÌ·ÓÙÈΤ˜ ÚfiÔ‰ÔÈ Ô˘ ¤ÁÈÓ·Ó Ù· ÙÂÏÂ˘Ù·›· Paediatriki 2007;70:64-69

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Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ˆ˜ ÚÔ˜ ÙËÓ ÚfiÁÓˆÛË Ù˘ ÓfiÛÔ˘ Î·È ÙÔÓ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛ‹˜ Ù˘ Û ÌÂÙ·ÁÂÓ¤ÛÙÂÚË Î‡ËÛË. ∞Ó Î·È Ë Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ¶™¢ ‰ÂÓ ÍÂÂÚÓ¿ÂÈ ÙË 1 ÂÚ›ÙˆÛË/100.000 ÁÂÓÓ‹ÛÂȘ (2), Ë ıÓËÙfiÙËÙ¿ Ù˘ Â›Ó·È Ôχ ˘„ËÏ‹ (5-47%) (1) Î·È Ë ÔÈÎÔÓÔÌÈ΋ ÂÈ‚¿Ú˘ÓÛË ÙÂÚ¿ÛÙÈ·. §fiÁˆ ÙÔ˘ ÌÂÁ¿ÏÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ·ı‹ÛÂˆÓ ÔÈ Ôԛ˜ ÚÔηÏÔ‡Ó ¶™¢, Ë ·Ó·ÛÎfiËÛË ı· ·Ó·ÊÂÚı› ·Ó·Ï˘ÙÈÎfiÙÂÚ· ÌfiÓÔ ÛÙȘ ÚfiÛÊ·Ù· ÂÚÈÁڷʛۘ ÎÏÈÓÈΤ˜ ÔÓÙfiÙËÙ˜ ηıÒ˜ Î·È Û ӤԢ˜ ÏÔÈÌÔÁfiÓÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÔÈ ÔÔ›ÔÈ ÚÔηÏÔ‡Ó ¶™¢. ∆· ΢ÚÈfiÙÂÚ· ·›ÙÈ· ¶™¢ ÂÚÈÁÚ¿ÊÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1 (3). ø˜ ÂÈ‚·Ú˘ÓÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ÁÈ· ¶™¢ ·Ó·Ê¤ÚÔÓÙ·È ÔÈ ÂÍ‹˜: ¯·ÌËÏfi ‚¿ÚÔ˜ Á¤ÓÓËÛ˘, ÌË Ï‹„Ë ÌËÙÚÈÎÔ‡ Á¿Ï·ÎÙÔ˜, ·ÙÔÈ΋ ÚԉȿıÂÛË, ÚÒÈÌË ¤Ó·ÚÍË Ù˘ ÓfiÛÔ˘ (ÓˆÚ›ÙÂÚ· ·fi ÙÔÓ 1Ô Ì‹Ó· ˙ˆ‹˜), ¯·ÌËÏ‹ ÎÔÈÓˆÓÈ΋ Ù¿ÍË, Î·È ÚÔÛ‚ÔÏ‹ Î·È ¿ÏÏÔ˘ ̤ÏÔ˘˜ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ·fi ¶™¢ (3). ∞. ™˘ÁÁÂÓ‹˜ „¢‰Ô·fiÊÚ·ÍË ∂ÌÊ·Ó›˙ÂÙ·È Î·Ù¿ ÙË ÓÂÔÁÓÈ΋ ÂÚ›Ô‰Ô Ì ÛËÌ›· ÂÓÙÂÚÈ΋˜ ·fiÊڷ͢: ¤ÌÂÙÔ, ‰È¿Ù·ÛË ÎÔÈÏÈ¿˜, ·Ô˘Û›· ÎÂÓÒÛˆÓ, ¯ˆÚ›˜ fï˜ ·Ó·ÙÔÌÈÎfi ÎÒÏ˘Ì· (4). ™˘Ó‹ıˆ˜ ÂÌÊ·Ó›˙ÂÙ·È ÛÔÚ·‰Èο, ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› fï˜ ÂÚÈÙÒÛÂȘ ÔÈ Ôԛ˜ ÎÏËÚÔÓÔÌÔ‡ÓÙ·È Ì ÂÈÎÚ·ÙÔ‡ÓÙ· ‹ ˘ÔÏÂÈfiÌÂÓÔ ¯·Ú·ÎÙ‹Ú·. √Ê›ÏÂÙ·È Û˘Ó‹ıˆ˜ Û ·ÓÒÌ·ÏË ·Ó¿Ù˘ÍË ÙÔ˘ Ï›Ԣ Ì˘˚ÎÔ‡ ¯ÈÙÒÓ· ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ÙÔȯÒÌ·ÙÔ˜ ‹ Û ·ÙÂÏ‹ ·Ó¿Ù˘ÍË ÙÔ˘ ·˘ÙfiÓÔÌÔ˘ Ó¢ÚÈÎÔ‡ ϤÁÌ·ÙÔ˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘ (4). ∂› ÚÔÛ‚ÔÏ‹˜ ÙÔ˘ Ì˘˚ÎÔ‡ ¯ÈÙÒÓ· ·Ú·ÙËÚÂ›Ù·È ·ÓÙÈηٿÛÙ·ÛË ÙÔ˘ ÂÈÌ‹ÎÔ˘˜ Ì˘˚ÎÔ‡ ¯ÈÙÒÓ· Ì ÈÓÒ‰Ë ÈÛÙfi. ™Â Ó¢ÚÔÏÔÁÈ΋ ‚Ï¿‚Ë ·Ú·ÙËÚÂ›Ù·È Ì›ˆÛË ÙˆÓ Á·ÁÁÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ. ™Â ÌÂÚÈΤ˜ ÂÚÈÙÒÛÂȘ ·Ó·Ê¤ÚÔÓÙ·È ·ÓˆÌ·Ï›Â˜ ÛÙ· ·ÙÙ·Ú· ÙÔ˘ Cajal, ÂÓÒ Û ¿ÏϘ ÂÚÈÙÒÛÂȘ, ·ÓˆÌ·Ï›Â˜ ÛÙ· ÌÈÙÔ¯fiÓ‰ÚÈ· ÙˆÓ ÂÓÙÂÚÈÎÒÓ Î˘ÙÙ¿ÚˆÓ (5). ™ÙÔ 50% ÙˆÓ ÚÔۂ‚ÏËÌ¤ÓˆÓ ·È‰ÈÒÓ Ù· Û˘ÌÙÒÌ·Ù· ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÔ˘˜ ÙÚÂȘ ÚÒÙÔ˘˜ Ì‹Ó˜ ˙ˆ‹˜. ∆· 2/3 ÙˆÓ ÂÚÈÙÒÛÂˆÓ ·ÊÔÚÔ‡Ó Û ÚfiˆÚ· ‚Ú¤ÊË. ™ÙÔ 40% ÙˆÓ ÂÚÈÙÒÛÂˆÓ Û˘Ó˘¿Ú¯ÂÈ ·ÓÒÌ·ÏË ÂÚÈÛÙÚÔÊ‹ ÙÔ˘ ÂÓÙ¤ÚÔ˘. ∏ ‰˘ÛÎÔÈÏÈfiÙËÙ· ·ÔÙÂÏ› ÙËÓ ÈÔ Û˘¯Ó‹ ÂΉ‹ÏˆÛË, ÂÓÒ Ë ‰È¿ÚÚÔÈ· ÂÌÊ·Ó›˙ÂÙ·È ÛÙÔ 30-40% ÙˆÓ ÂÚÈÙÒÛˆÓ. ™˘ÌÌÂÙÔ¯‹ ÙÔ˘ Ô˘ÚÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ·Ú·ÙËÚÂ›Ù·È Û˘¯Ó¿ Î·È ÂΉËÏÒÓÂÙ·È ÌÂ Û˘¯Ó¤˜ Ô˘ÚÔÏÔÈÌÒÍÂȘ. ∏ ‰È¿ÁÓˆÛË Ù›ıÂÙ·È Ì ̷ÓÔÌÂÙÚÈÎfi ¤ÏÂÁ¯Ô Ù˘ ÎÈÓËÙÈÎfiÙËÙ·˜ ÙÔ˘ ÂÙÈÎÔ‡, ÂÓÒ ÙÂÏÂ˘Ù·›· ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Î·È ÛÈÓıËÚÔÁÚ·ÊÈΤ˜ ̤ıÔ‰ÔÈ Ì ڷ‰ÈÔ˚ÛfiÙÔ·. (6). ∏ ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ı· Á›ÓÂÈ ·fi ÙË ÓfiÛÔ ÙÔ˘ Hirschprung. ™Â ·ÓÙ›ıÂÛË fï˜, Ì ÙÔ Û˘ÁÁÂÓ¤˜ ÌÂÁ¿ÎÔÏÔ, Ë ÎÈÓËÙÈÎfiÙËÙ· ÙÔ˘ ÔÚıÔ‡ Î·È ÙÔ˘ ÚˆÎÙÔ‡ Â›Ó·È Ê˘ÛÈÔÏÔÁÈ΋. ∏ ÙÂÏÈ΋ ‰È¿ÁÓˆÛË Á›ÓÂÙ·È

¶›Ó·Î·˜ 1. ™˘¯ÓfiÙÂÚ· ·›ÙÈ· ÛÔ‚·Ú‹˜ ·Ú·ÙÂÈÓfiÌÂÓ˘ ‰È¿ÚÚÔÈ·˜ Û 38 ‚Ú¤ÊË (3) ∂ÓÙÂÚÈ΋ Ïԛ̈ÍË ∆ÚÔÊÈ΋ ·ÏÏÂÚÁ›· ∞˘ÙÔ¿ÓÔÛË ÂÓÙÂÚÔ¿ıÂÈ· ¡fiÛÔ˜ ÌÈÎÚÔÏ·¯ÓÈ·ÎÒÓ ÂÁÎÏ›ÛÙˆÓ ∫ÔÈÏÈÔοÎË HˆÛÈÓÔÊÈÏÈ΋ ÂÓÙÂÚÔ¿ıÂÈ· §ÂÌÊ·ÁÁÈÂÎÙ·Û›· 梉ԷfiÊÚ·ÍË ¡Â˘ÚÔ‰˘ÛÏ·Û›· ÕÁÓˆÛÙ· ·›ÙÈ·

18 8 2 2 1 1 1 1 1 3

Ì ÈÛÙÔÏÔÁÈ΋ ÂͤٷÛË ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ‚ÏÂÓÓÔÁfiÓÔ˘ ÌÂÙ¿ ·fi ‚ÈÔ„›·. ∏ ıÂÚ·›· Û˘Ó›ÛÙ·Ù·È Û ¯ÔÚ‹ÁËÛË ÚÔÎÈÓËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ .¯. ·ÓÙ·ÁˆÓÈÛÙÒÓ Ù˘ 5-˘‰ÚÔ͢ÙÚ˘Ù·Ì›Ó˘ (ÛÈÛ·Ú›‰Ë), ‹ Ì ٷ ÓÂfiÙÂÚ· Ê¿Ú̷η alosetron (·ÓÙ·ÁˆÓÈÛÙ‹˜ ÙˆÓ ˘Ô‰Ô¯¤ˆÓ Ù˘ 5-∏∆3) ‹ tegaserod (Û˘Ó·ÁˆÓÈÛÙ‹˜ ÙˆÓ ˘Ô‰Ô¯¤ˆÓ Ù˘ 5-∏∆4). ™Â ÛÔ‚·Ú¤˜ ÂÚÈÙÒÛÂȘ Á›ÓÂÙ·È ÎÔÏÂÎÙÔÌ‹ ‹ ÂÈÏÂÔÛÙÔÌ›· (7,8). µ. ¡fiÛÔ˜ ÌÈÎÚÔÏ·¯ÓÈ·ÎÒÓ ÂÁÎÏ›ÛÙˆÓ ¶ÚfiÎÂÈÙ·È ÁÈ· ÛÔ‚·Ú‹ ‰È·ÚÚÔ˚΋ Û˘Ó‰ÚÔÌ‹ Ì ˘‰·Ú›˜ ÎÂÓÒÛÂȘ Î·È ÙÂÚ¿ÛÙȘ ·ÒÏÂȘ ËÏÂÎÙÚÔÏ˘ÙÒÓ ÛÙ· ÎfiÚ·Ó·, Ë ÔÔ›· ÂÌÊ·Ó›˙ÂÙ·È ·fi ÙȘ ÚÒÙ˜ Ë̤Ú˜ ˙ˆ‹˜ Î·È ·ÔÙÂÏ› ÙË Û˘¯ÓfiÙÂÚË ·ÈÙ›· ¶™¢ Ù˘ ÓÂÔÁÓÈ΋˜ ÂÚÈfi‰Ô˘ ÌÂÙ¿ ÙË ÏÔÈÌÒ‰Ë ·ÈÙÈÔÏÔÁ›· (9,10). ∂›Ó·È ·ÁÓÒÛÙÔ˘ ·ÈÙÈÔÏÔÁ›·˜ Î·È Èı·ÓfiÓ ÎÏËÚÔÓÔÌÂ›Ù·È Ì ۈ̷ÙÈο ˘ÔÏÂÈfiÌÂÓÔ ¯·Ú·ÎÙ‹Ú·. ∏ ‰È¿ÁÓˆÛË Ù›ıÂÙ·È Ì ‚ÈÔ„›· ÙÔ˘ ÂÓÙ¤ÚÔ˘, Ë ÔÔ›· ‰Â›¯ÓÂÈ ·ÙÚÔÊ›· ÙˆÓ Ï·¯ÓÒÓ. ™ÙÔ ËÏÂÎÙÚÔÓÈÎfi ÌÈÎÚÔÛÎfiÈÔ, Ù· ·ÙÙ·Ú· ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ‚ÏÂÓÓÔÁfiÓÔ˘ Û˘ÁÎÂÓÙÚÒÓÔÓÙ·È Î·Ù¿ ÛˆÚÔ‡˜ Î·È ‰Â›¯ÓÔ˘Ó ÎÂÓÔÙfiÈ· ÙÔ˘ ΢ÙÙ·ÚÔÏ¿ÛÌ·ÙÔ˜. ∏ „˘ÎÙÚÔÂȉ‹˜ ·Ú˘Ê‹ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ¤¯ÂÈ ·Û·Ê‹ fiÚÈ· (11). ∞ÓÔÛԯڈ̷ÙÈÛÌfi˜ ÁÈ· “‚ÈÏÏ›ÓË”, ¤Ó· ÌÈÎÚÔÓËÌ·Ù҉˜ Û˘ÛÙ·ÙÈÎfi ÙˆÓ ÌÈÎÚÔÏ·¯ÓÒÓ ·ÔηχÙÂÈ ÙËÓ ·ÚÔ˘Û›· ΢ÙÙ·ÚÈÎÒÓ ÂÁÎÏ›ÛÙˆÓ ·ÔÙÂÏÔ‡ÌÂÓˆÓ ·fi ·ÓÒ̷Ϙ ÌÈÎÚÔÏ¿¯Ó˜ ÔÈ Ôԛ˜ ʤÚÔ˘Ó „˘ÎÙÚÔÂȉ‹ ·Ú˘Ê‹, ÌÂÌ‚Ú¿ÓË, ÌÈÎÚÔÓËÌ¿ÙÈ·, ÓËÌ·ÙÈ҉˜ ÂÚ›‚ÏËÌ· (12). ∆· ¤ÁÎÏÂÈÛÙ· ·˘Ù¿ ·Ó¢ڛÛÎÔÓÙ·È Î·È Û ¿ÏÏ· ÂÈıËÏȷο ·ÙÙ·Ú· ÙfiÛÔ ÙÔ˘ ÂÙÈÎÔ‡ (ÛÙÔÌ¿¯È, ¯ÔÏˉfi¯Ô˜ ·ÛÙË, ÎfiÏÔÓ), fiÛÔ Î·È ÛÙ· ÓÂÊÚÈο ÛˆÏËÓ¿ÚÈ· (11). ∂›Û˘ ·ÓȯÓ‡ÔÓÙ·È Ê˘Û·ÏÈ‰Ò‰Ë ÛˆÌ¿ÙÈ· Ù· ÔÔ›· ÂÚȤ¯Ô˘Ó ÎÔÎÎÈ҉˜ ˘ÏÈÎfi ¿ÁÓˆÛÙ˘ ÚÔ¤Ï¢Û˘. ∏ ·ÈÙÈÔÏÔÁ›· Ù˘ ÓfiÛÔ˘ Â›Ó·È ¿ÁÓˆÛÙË. ¶Èı·ÓÔÏÔÁÂ›Ù·È ‰È·Ù·Ú·¯‹ ÛÙË ÌÂÙ·ÊÔÚ¿ ÚˆÙÂ˚ÓÒÓ ··Ú·›ÙËÙˆÓ ÁÈ· ÙË ‰ÔÌ‹ ÙÔ˘ ΢ÙÙ·ÚÔÏ¿ÛÌ·ÙÔ˜ ÙˆÓ ÂÓÙÂÚÈÎÒÓ Î˘ÙÙ¿ÚˆÓ. ªÂ ‚¿ÛË ÙË ıˆڛ· ·˘Ù‹, ÔÈ Ê˘Û·Ï›‰Â˜ ÔÈ Ôԛ˜ ·Ú·ÙËÚÔ‡ÓÙ·È ÛÙÔ ËÏÂÎÙÚÔÓÈÎfi ÌÈÎÚÔÛÎfiÈÔ ÚÔ¤Ú¯ÔÓÙ·È ·fi Ù· ۈ̿ÙÈ· ÙÔ˘ ¶·È‰È·ÙÚÈ΋ 2007;70:64-69

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Golgi ·’ fiÔ˘ ÌÂÙ·Ó·ÛÙÂ‡Ô˘Ó ÚÔ˜ ÙËÓ ÂÈÊ¿ÓÂÈ· ÙÔ˘ ΢ÙÙ¿ÚÔ˘ ÌÂٷʤÚÔÓÙ·˜ Û˘ÛÙ·ÙÈο ··Ú·›ÙËÙ· ÁÈ· ÙË ‰fiÌËÛË Ù˘ „˘ÎÙÚÔÂȉԇ˜ ·Ú˘Ê‹˜. ™ÙËÓ ¿ıËÛË ·˘Ù‹ Ë ÔÚ›· ÙˆÓ Ê˘Û·Ï›‰ˆÓ ·Ó·ÎfiÙÂÙ·È Î·È ÔÈ Ê˘Û·Ï›‰Â˜ ηٷÎÚ·ÙÔ‡ÓÙ·È ÛÙÔ Î˘ÙÙ·ÚfiÏ·ÛÌ· ÙÔ˘ ΢ÙÙ¿ÚÔ˘ fiÔ˘ Î·È ‰ËÌÈÔ˘ÚÁÔ‡Ó ·ıÔÏÔÁÈο ÌÈÎÚÔÏ·¯ÓÒ‰Ë ¤ÁÎÏÂÈÛÙ· (9,13). ŒÓ· ¿ÏÏÔ ¯·Ú·ÎÙËÚÈÛÙÈÎfi Ù˘ ¿ıËÛ˘ Â›Ó·È Ë ·ÚÔ˘Û›· ·ÓÙÈÛˆÌ¿ÙˆÓ Î·Ù¿ ÙÔ˘ ηÚÎÈÓÔÂÌ‚Ú˘˚ÎÔ‡ (CEA) Î·È ÙÔ˘ Ï¢¯·ÈÌÈÎÔ‡ (CD10) ·ÓÙÈÁfiÓÔ˘ (12). ¢ÂÓ ˘¿Ú¯ÂÈ ÂȉÈ΋ ıÂÚ·›· ÁÈ· ÙË ÓfiÛÔ. ÃÚËÛÈÌÔÔÈÔ‡ÓÙ·È ‰È¿ÊÔÚ· ·ÓÙÈÂÎÎÚÈÙÈο Ê¿Ú̷η .¯. ·ÓıÚ·ÎÈÎfi Ï›ıÈÔ (14) Î·È ÛˆÌ·ÙÔÛÙ·Ù›ÓË (15). ∏ Û›ÙÈÛË Á›ÓÂÙ·È ·ÚÂÓÙÂÚÈο ̤¯ÚȘ fiÙÔ˘ ‚ÚÂı› ÙÔ Î·Ù¿ÏÏËÏÔ ÌfiÛ¯Â˘Ì· ÂÓÙ¤ÚÔ˘ ÁÈ· ÌÂÙ·ÌfiÛ¯Â˘ÛË. °. ∂ÓÙÂÚÔ¿ıÂÈ· Ì ı˘Û¿ÓÔ˘˜ ∂ÌÊ·Ó›˙ÂÙ·È Î·Ù¿ ÙÔ˘˜ ÚÒÙÔ˘˜ Ì‹Ó˜ ˙ˆ‹˜ Ì ¯ÚfiÓÈ· ˘‰·Ú‹ ‰È¿ÚÚÔÈ· Î·È Î·ı˘ÛÙ¤ÚËÛË ÛÙË ÛˆÌ·ÙÈ΋ ·Ó¿Ù˘ÍË. √ÚÈṲ̂ӷ ‚Ú¤ÊË ÂÌÊ·Ó›˙Ô˘Ó Î·È ‰˘ÛÌÔÚÊÈÎfi ÚfiÛˆÔ. ¶·Ú·ÙËÚÂ›Ù·È Û˘¯ÓfiÙÂÚ· Û ¿ÙÔÌ· Ì·ÏÙ¤˙È΢ ηٷÁˆÁ‹˜ (16). º·›ÓÂÙ·È fiÙÈ ÔÊ›ÏÂÙ·È Û ·ÓˆÌ·Ï›Â˜ ÛÙËÓ ¤ÎÊÚ·ÛË Î˘ÙÙ·ÚÈÎÒÓ ÌÔÚ›ˆÓ ÚÔÛÎfiÏÏËÛ˘. ∞ӷʤÚÔÓÙ·È ‰È·Ù·Ú·¯¤˜ ÛÙËÓ Î·Ù·ÓÔÌ‹ Ù˘ ¿ÏÊ·2/‚‹Ù·1 ÈÓÙÂÁÎÚ›Ó˘ Î·È ‰ÔÌÈΤ˜ ÌÂÙ·‚ÔϤ˜ ÛÙ· ‰ÂÛÌÔۈ̿ÙÈ· ÙÔ˘ ÂÓÙ¤ÚÔ˘ (17,18). ™Â ÔÓÙ›ÎÈ· ¿Û¯ÔÓÙ· ·fi ÙË ÓfiÛÔ ‚Ú¤ıËÎ·Ó Â›Û˘ ÌÂȈ̤ӷ Â›‰· ÙÔ˘ ˘Ô‰Ô¯¤· Ù‡Ô˘ 2 ÙÔ˘ ÌÂÙ·ÙÚÂÙÈÎÔ‡ ·˘ÍËÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ‚. √È ·ÓˆÌ·Ï›Â˜ ·˘Ù¤˜ Ô‰ËÁÔ‡Ó Û ‰È·Ù·Ú·¯¤˜ ˆ˜ ÚÔ˜ ÙË Û‡ÛÙ·ÛË Ù˘ ‚·ÛÈ΋˜ ÌÂÌ‚Ú¿Ó˘ Î·È Î˘Ú›ˆ˜ Ù˘ Ï·ÌÈÓ›Ó˘ Î·È Ù˘ ÚˆÙÂÔÁÏ˘Î¿Ó˘ ÙˆÓ ÂÈıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ ÙÔ˘ ÂÓÙ¤ÚÔ˘, ÌÂ Û˘Ó¤ÂÈ· Ó· ˘Ê›ÛÙ·ÓÙ·È ·fiÙˆÛË (19). ∏ ‚ÈÔ„›· ÙÔ˘ ÂÓÙ¤ÚÔ˘ ‰Â›¯ÓÂÈ ÔÏÈ΋ ‹ ÌÂÚÈ΋ ·ÙÚÔÊ›· ÙˆÓ Ï·¯ÓÒÓ, ˘ÂÚÏ·Û›· ÎÚ˘ÙÒÓ Î·È ·‡ÍËÛË ÙˆÓ ÊÏÂÁÌÔÓˆ‰ÒÓ Î˘ÙÙ¿ÚˆÓ ÛÙÔ ¯fiÚÈÔ. ÷ڷÎÙËÚÈÛÙÈÎfi ‡ÚËÌ· ·ÔÙÂÏ› Ë ·Û‡ÓÙ·ÎÙË Û˘ÛÛÒÚ¢ÛË ÂÈıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ Ì ‰ËÌÈÔ˘ÚÁ›· “ı˘Û¿ÓˆÓ” ÏfiÁˆ ÙÔ˘ fiÙÈ Ë Î˘ÙÙ·ÚÈ΋ ÙÔ˘˜ ÌÂÌ‚Ú¿ÓË Â›Ó·È ÛÙÚÔÁÁ˘ÏÂ̤ÓË ÛÙËÓ ÎÔÚ˘Ê‹, ÒÛÙ ÙÔ ÂÈıËÏÈ·Îfi ·ÙÙ·ÚÔ Ó· ÚÔÛÔÌÔÈ¿˙ÂÈ Ì ÛÙ·ÁfiÓ· ‰·ÎÚ‡Ô˘ (16). ¢ÂÓ ˘¿Ú¯ÂÈ ÂȉÈ΋ ıÂÚ·›· Î·È Ë ÌfiÓË ‰È¤ÍÔ‰Ô˜ ÛÙËÓ ÂÚ›ÙˆÛË ·˘Ù‹ Â›Ó·È Ë ÌÂÙ·ÌfiÛ¯Â˘ÛË ÂÓÙ¤ÚÔ˘. ¢. ∞˘ÙÔ¿ÓÔÛË ÂÓÙÂÚÔ¿ıÂÈ· √Ê›ÏÂÙ·È ÛÙËÓ ‡·ÚÍË ·ÓÙÈÛˆÌ¿ÙˆÓ Î·Ù¿ ·ÓÙÈÁfiÓˆÓ ÙˆÓ ÂÓÙÂÚÔ΢ÙÙ¿ÚˆÓ. ∆Ô ·˘ÙÔ·ÓÙÈÁfiÓÔ ÙÔ ÔÔ›Ô ÚÔηÏ› ÙËÓ ·ÓÔÛÔÏÔÁÈ΋ ·¿ÓÙËÛË ÔÓÔÌ¿˙ÂÙ·È MCC2 Î·È Î·ıÔÚ›˙ÂÙ·È ·fi ÁÔÓ›‰ÈÔ ÛÙÔ ¯ÚˆÌfiۈ̷ 19p13. ∏ ÓfiÛÔ˜ Û˘¯Ó¿ Û˘Óԉ‡ÂÙ·È ·fi Â͈-ÂÓÙÂÚÈΤ˜ ÂΉËÏÒÛÂȘ ·˘ÙÔ·ÓÔÛ›·˜ (9). ∏ ‚ÈÔ„›· ÂÓÙ¤ÚÔ˘ ‰Â›¯ÓÂÈ ·ÙÚÔÊ›· ÙˆÓ Ï·¯ÓÒÓ Î·È ‰È‹ıËPaediatriki 2007;70:64-69

ÛË ÙÔ˘ ¯ÔÚ›Ô˘ Ì ∆ ÏÂÌÊÔ·ÙÙ·Ú·, ηıÒ˜ Î·È ˘ÂÚÏ·Û›· ÙˆÓ ÎÚ˘ÙÒÓ. ∂›Û˘ ·Ú·ÙËÚÂ›Ù·È ‰ÂηÏ¿ÛÈ· ·‡ÍËÛË CD-3 ıÂÙÈÎÒÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ÛÙÔ ÂÈı‹ÏÈÔ Î·È ÛÙÔ ¯fiÚÈÔ ÙÔ˘ ÏÂÙÔ‡ Î·È ÙÔ˘ ·¯¤Ô˜ ÂÓÙ¤ÚÔ˘ (21,22). ∏ ıÂÚ·›· Û˘Ó›ÛÙ·Ù·È ÛÙË ¯ÔÚ‹ÁËÛË ·ÓÔÛÔηٷÛÙ·ÏÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ .¯. ÎÔÚÙÈÎÔÛÙÂÚÔÂȉÒÓ, ΢ÎÏÔÛÔÚ›Ó˘, ΢ÎÏÔʈÛÊ·Ì›‰Ë˜, tacrolimus, Î·È ÙÔ˘ Ó¤Ô˘ ·Ú¿ÁÔÓÙ· infliximab ÙÔ ÔÔ›Ô ·Ó·ÛÙ¤ÏÏÂÈ ÙË ‰Ú¿ÛË ÙÔ˘ ∆¡F (23). ∂. ™‡Ó‰ÚÔÌÔ ·ÓÔÛÔÏÔÁÈ΋˜ ‰˘ÛÚ˘ıÌ›·˜, ÔÏ˘ÂÓ‰ÔÎÚÈÓÔ¿ıÂÈ·˜, ÂÓÙÂÚÔ¿ıÂÈ·˜ Î·È Ê˘ÏÔÛ‡Ó‰ÂÙ˘ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜ (IPEX) ∏ ÔÓÔÌ·Û›· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ÚÔ¤Ú¯ÂÙ·È ·fi ÙÔ ·ÎÚˆÓ‡ÌÈÔ ÙˆÓ ‰È·Ù·Ú·¯ÒÓ ÙȘ Ôԛ˜ ÚÔηÏ› (Immune dysregulation, Polyendocrino-pathy, Enteropathy, X-linked syndrome) ‰ËÏ·‰‹ ·ÓÔÛÔÏÔÁÈ΋ ‰˘ÛÚ˘ıÌ›·, ÔÏ˘ÂÓ‰ÔÎÚÈÓÔ¿ıÂÈ·, ÂÓÙÂÚÔ¿ıÂÈ· Î·È Ê˘ÏÔÛ‡Ó‰ÂÙË ÎÏËÚÔÓÔÌÈÎfiÙËÙ· (24,25). ÷ڷÎÙËÚ›˙ÂÙ·È ·fi ‰È‹ıËÛË ÙÔ˘ ¯ÔÚ›Ô˘ Ì ÂÓÂÚÁÔÔÈË̤ӷ ∆ ÏÂÌÊÔ·ÙÙ·Ú· ηıÒ˜ Î·È ·fi ·ÙÚÔÊ›· ÙˆÓ Ï·¯ÓÒÓ. ¶ÚÔηÏÂ›Ù·È ·fi ÌÂÙ¿ÏÏ·ÍË ÙÔ˘ ÁÔÓȉ›Ô˘ FOXP3 (ÛηÚÊ›ÓË) Ë ÔÔ›· Û¯ÂÙ›˙ÂÙ·È Ì ÙÔÓ ÔÏÏ·Ï·ÛÈ·ÛÌfi ÙˆÓ CD4+ T ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ (26). ∂ÎÙfi˜ ·fi ‰È·ÚÚÔ˚Îfi Û‡Ó‰ÚÔÌÔ, Ù· ¿Û¯ÔÓÙ· ¿ÙÔÌ· ÂÌÊ·Ó›˙Ô˘Ó Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË, ı˘ÚÂÔÂȉÔ¿ıÂÈ·, ȯı‡ˆÛË, ·ÈÌÔÏ˘ÙÈ΋ ·Ó·ÈÌ›·. ∏ ÓfiÛÔ˜ ·ÓÙÈÌÂÙˆ›˙ÂÙ·È Ì ΢ÙÙ·ÚÔÛÙ·ÙÈο. ™Ù. ∂È̤ÓÔ˘Û· ÂÏÎ҉˘ ÎÔÏ›Ùȉ· ¶ÚfiÎÂÈÙ·È ÁÈ· Ôχ Û¿ÓÈ· ÓÔÛÔÏÔÁÈ΋ ÔÓÙfiÙËÙ· Ë ÔÔ›· Èı·ÓfiÓ ÎÏËÚÔÓÔÌÂ›Ù·È Ì ÙÔÓ ˘ÔÏÂÈfiÌÂÓÔ ¯·Ú·ÎÙ‹Ú·. ∆· ÎÚÈÙ‹ÚÈ· ‰È¿ÁÓˆÛ˘ ›ӷÈ: Û˘ÁÁÂÓÈ΋ Û¯¤ÛË ÙˆÓ ÁÔÓ¤ˆÓ, Î·È ÂΉËÏÒÛÂȘ ·fi ÙÔ ÛÙfiÌ· Î·È ÙËÓ ÂÚÈÚˆÎÙÈ΋ ÂÚÈÔ¯‹ (ÂÍÂÏÎÒÛÂȘ, ÊÏÂÁÌÔÓ‹, Û˘Ú›ÁÁÈ·) (27,28). ∂ÎÙfi˜ ·fi ÙË ‰È¿ÚÚÔÈ·, Ë ¿ıËÛË Û˘Óԉ‡ÂÙ·È ·fi ‚ÏÂÓÓÔ·ÈÌÔÚÚ·ÁÈΤ˜ ÎÂÓÒÛÂȘ. ∫·Ù¿ ÙËÓ ÂÓ‰ÔÛÎfiËÛË ‹ ÙË ‚ÈÔ„›· ·Ú·ÙËÚÂ›Ù·È ÂÈÎfiÓ· ÎÔÏ›Ùȉ·˜ Ì ‰È·ÙÔȯˆÌ·ÙÈο ¤ÏÎË Û ۯ‹Ì· ÊÏ·ÛÎÈÔ‡ Ì ÂÈÎÚÂÌ¿ÌÂÓ· ¯Â›ÏË, ηıÒ˜ Î·È ·ÔÛÙËÌ¿ÙÈ· ÎÚ˘ÙÒÓ. ∏ ÈÛÙÔÏÔÁÈ΋ ÂÈÎfiÓ· ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ‰È‹ıËÛË ÙÔ˘ ¯ÔÚ›Ô˘ ·fi ÊÏÂÁÌÔÓÒ‰Ë Î‡ÙÙ·Ú·. ™Â ÛÔ‚·Ú¤˜ ÌÔÚʤ˜ ˘¿Ú¯ÂÈ ÂÎÙÂٷ̤ÓË ·Ó¿Ù˘ÍË ÎÔÎÎÈÒ‰Ô˘˜ ÈÛÙÔ‡ Î·È Û¯ËÌ·ÙÈÛÌfi˜ „¢‰ÔÔÏ˘fi‰ˆÓ. ∂ÎÙfi˜ ·fi ÙÔ ÎfiÏÔÓ ·Ú·ÙËÚÂ›Ù·È Û˘ÌÌÂÙÔ¯‹ Î·È ÙÔ˘ ÏÂÙÔ‡ ÂÓÙ¤ÚÔ˘ Ì Ì›ˆÛË Ù˘ Û¯¤Û˘ Ï·¯ÓÒÓ/ÎÚ˘ÙÒÓ. ∂ÎÙfi˜ ·fi ÙËÓ ÂÓ‰ÔÛÎfiËÛË Î·È ÙË ‚ÈÔ„›·, Ë ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘ Î·È ÁÂÓÈο ÙˆÓ ÊÏÂÁÌÔÓˆ‰ÒÓ ·ı‹ÛÂˆÓ ÙÔ˘ ÂÓÙ¤ÚÔ˘ ·fi ÙȘ ÂÎÎÚÈÙÈÎÔ‡ Ù‡Ô˘ ÂÓÙÂÚÔ¿ıÂȘ ÌÔÚ› Ó· Á›ÓÂÈ Ì ÂͤٷÛË ÛÙ· ÎfiÚ·Ó· ÁÈ· ÙËÓ ·Ó›¯Ó¢ÛË Ù˘ Ô˘Û›·˜

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µÚÂÊÈ΋ ·Ú·ÙÂÈÓfiÌÂÓË ‰È¿ÚÚÔÈ·

ηÏÚÔÙÂÎÙ›Ó˘. ¶ÚfiÎÂÈÙ·È ÁÈ· ÚˆÙ½ÓË Ô˘ ‰ÂÛ̇ÂÈ ÙÔ ·Û‚¤ÛÙÈÔ Î·È ÙÔÓ „¢‰¿ÚÁ˘ÚÔ ÛÙ· Ô˘‰ÂÙÂÚfiÊÈÏ· ÔÏ˘ÌÔÚÊÔ‡ÚËÓ· ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ÙÔȯÒÌ·ÙÔ˜. ∏ ÚˆÙ½ÓË ·˘Ù‹ ·Ú·Ì¤ÓÂÈ ¿ıÈÎÙË ÛÙ· ÎfiÚ·Ó· ̤¯ÚÈ Î·È 7 Ë̤Ú˜ ÌÂÙ¿ ÙËÓ ·Ô‚ÔÏ‹ Ù˘ (29). ∏ ·ÚÔ˘Û›· Ù˘ ˘Ô‰ËÏÒÓÂÈ ÊÏÂÁÌÔÓ‹ ÙÔ˘ ÂÓÙ¤ÚÔ˘. ÕÏÏÔÈ ‰Â›ÎÙ˜ ÊÏÂÁÌÔÓ‹˜ Â›Ó·È Ë ·ÚÔ˘Û›· ÙÔ˘ ·Ú¿ÁÔÓÙ· ÊÏÂÁÌÔÓ‹˜ TNF, Ë ÂÎÙ›ÌËÛË ÙÔ˘ ·Ô‚·ÏÏfiÌÂÓÔ˘ ÛÙ· ÎfiÚ·Ó· ÌÔÓÔÍÂȉ›Ô˘ ÙÔ˘ ·˙ÒÙÔ˘ (30) Î·È Ì¤ÙÚËÛË ÙÔ˘ ÂÓ˙‡ÌÔ˘ ÂÏ·ÛÙ¿ÛË ÛÙ· ÎfiÚ·Ó· (31). ∏ ıÂÚ·›· Û˘Ó›ÛÙ·Ù·È Û ˘ÊÔÏÈ΋ ÎÔÏÂÎÙÔÌ‹ Î·È Û ¯ÔÚ‹ÁËÛË Î˘ÙÙ·ÚÔÛÙ·ÙÈÎÒÓ. ¶·Ú·ÙËÚÂ›Ù·È fï˜ Û˘¯Ó¿, ·Ó¿Ù˘ÍË ÏÂÌÊˆÌ¿ÙˆÓ (32). ¶ÚfiÛÊ·Ù· ‰ÔÎÈÌ¿ÛÙËÎ·Ó Ì ÂÈÙ˘¯›·, Û ÂÓ‹ÏÈΘ fï˜, ÔÚÈṲ̂ӷ Ó¤· Ê¿Ú̷η .¯. Ô ·ÓÙ·ÁˆÓÈÛÙ‹˜ ÙÔ˘ ∆¡F infliximab Î·È ÔÈ ·ÓÙ·ÁˆÓÈÛÙ¤˜ ÙˆÓ ˘Ô‰Ô¯¤ˆÓ Ù˘ IL-2 daclizumab, basiliximab, visilizumab (33). ∑. ¢È·Ù·Ú·¯¤˜ ÁÏ˘ÎÔ˙˘Ï›ˆÛ˘ ÙˆÓ ¡-ÁÏ˘ÎÔÚˆÙÂ˚ÓÒÓ ∆· ‚Ú¤ÊË Ì ÙËÓ ¿ıËÛË ·˘Ù‹ ÂÌÊ·Ó›˙Ô˘Ó ÂÎÙfi˜ ·fi Â›ÌÔÓË ‰È¿ÚÚÔÈ· Î·È ‰˘ÛÌÔÚÊÈο ¯·Ú·ÎÙËÚÈÛÙÈο (ÌÈÎÚÔÁÓ·ı›·, ·ÓÒÌ·ÏË Î·Ù·ÓÔÌ‹ ÙÔ˘ ˘Ô‰fiÚÈÔ˘ Ï›Ô˘˜, ÌÈÎÚÔÛÙÔÌ›·), Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›·, Ë·ÙÔ¿ıÂÈ·, ıÚÔÌ‚ÔÂÓ›·, ˘ÂÚÛÏËÓÈÛÌfi, ηٷÚÚ¿ÎÙË, ÌÂÏ·Á¯ÚˆÌ·ÙÈ΋ ·ÌÊÈ‚ÏËÛÙÚÔÂȉÔ¿ıÂÈ·, ηıÒ˜ Î·È ¯·ÌËÏ¿ Â›‰· ÁÏ˘ÎÔÚˆÙÂ˚ÓÒÓ .¯. ·ÙÔÛÊ·ÈÚ›Ó˘, ÙÚ·ÓÛÊÂÚ›Ó˘, ı˘ÚÂÔÙÚfiÔ˘ ÔÚÌfiÓ˘. ∏ ‰È¿ÁÓˆÛË Ù›ıÂÙ·È Ì ËÏÂÎÙÚÔÊfiÚËÛË Ù˘ ÙÚ·ÓÛÊÂÚÚ›Ó˘. ¢ÂÓ ˘¿Ú¯ÂÈ ÂȉÈ΋ ıÂÚ·›· ÁÈ· ÙË Û˘ÁÎÂÎÚÈ̤ÓË ¿ıËÛË. ™Â ÔÚÈṲ̂Ó˜ ÌÔÚʤ˜ ¤¯ÂÈ ‰ÔÎÈÌ·ÛÙ› Ë ¯ÔÚ‹ÁËÛË Ì·ÓÓfi˙˘ ·fi ÙÔ ÛÙfiÌ· (34). ∏. §ÔÈÌÒ‰Ë ·›ÙÈ· ∂ÎÙfi˜ ·fi Ù· ÁÓˆÛÙ¿ ÏÔÈÌÒ‰Ë ·›ÙÈ· Ù· ÔÔ›· ÚÔηÏÔ‡Ó ·Ú·ÙÂÈÓfiÌÂÓË ‰È¿ÚÚÔÈ·, Ë ÚfiÔ‰Ô˜ Ë ÔÔ›· ¤¯ÂÈ Û˘ÓÙÂÏÂÛÙ› Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÛÙË ÌÈÎÚÔ‚ÈÔÏÔÁ›· Î·È Ë ¯ÚËÛÈÌÔÔ›ËÛË Ù˘ ·Ï˘ÛȉˆÙ‹˜ ·ÓÙ›‰Ú·Û˘ Ù˘ ÔÏ˘ÌÂÚ¿Û˘ (PCR) Î·È ÙÔ˘ ËÏÂÎÙÚÔÓÈÎÔ‡ ÌÈÎÚÔÛÎÔ›Ô˘, η٤ÛÙËÛ ‰˘Ó·Ù‹ ÙËÓ ·Ó›¯Ó¢ÛË Ó¤ˆÓ ÏÔÈÌÔÁfiÓˆÓ ·Ú·ÁfiÓÙˆÓ ÔÈ ÔÔ›ÔÈ ÚÔηÏÔ‡Ó ÂÓÙÂÚÈΤ˜ ÏÔÈÌÒÍÂȘ ÂȉÈο Û ·ÓÔÛÔηٷÛÙ·Ï̤ӷ ¿ÙÔÌ· ηıÒ˜ Î·È Û ÚfiˆÚ· ‹ ‰˘ÛÙÚÔÊÈο ‚Ú¤ÊË. ªÈ· Ó¤· ÔÌ¿‰· ÎÔÏÔ‚·ÎÙËÚȉ›ˆÓ (enteroaggregative E. coli) ¤¯ÂÈ ·Ó·‰Âȯı› ˆ˜ ‚·ÛÈÎfi ·›ÙÈÔ ¶™¢, fiˆ˜ Î·È ÈÔ› (ÌÂÁ·ÏÔ΢ÙÙ·ÚÔ˚fi˜, Î·È Ô Èfi˜ ∏πV) (35,36). √ Ì˯·ÓÈÛÌfi˜ Ì ÙÔÓ ÔÔ›Ô Ô HIV ÚÔηÏ› ÂÓÙÂÚÔ¿ıÂÈ· Â›Ó·È Ì¤Ûˆ ‰Â˘ÙÂÚÔÁÂÓÒÓ ÏÔÈÌÒÍÂˆÓ Ì ‚·ÎÙËÚ›‰È·, ÚˆÙfi˙ˆ·, Î·È ·Ú¿ÛÈÙ· ÏfiÁˆ Ù˘ ·ÓÔÛÔÏÔÁÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜. ∏ ¤ÎÏ˘ÛË ÊÏÂÁÌÔÓˆ‰ÒÓ ÌÂÛÔÏ·‚ËÙÒÓ Î·È Ë Î·¯ÂÍ›· Ë ÔÔ›· Û˘Ó‹ıˆ˜ Û˘Óԉ‡ÂÙ·È ·fi ¤ÏÏÂÈ„Ë ··Ú·›ÙËÙˆÓ

ȯÓÔÛÙÔȯ›ˆÓ .¯. ÙÔ˘ „¢‰·ÚÁ‡ÚÔ˘, Û˘Ì‚¿ÏÏÔ˘Ó Â›Û˘ ÛËÌ·ÓÙÈο ÛÙË ‰È·ÈÒÓÈÛË Ù˘ ÂÓÙÂÚÈ΋˜ ‚Ï¿‚˘ (37). ∂ÎÙfi˜ ·fi ÙÔ˘˜ ·Ú·¿Óˆ ÏÔÈÌÔÁfiÓÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÙˆÓ ÔÔ›ˆÓ Ô ÚfiÏÔ˜ ÛÙËÓ ÚfiÎÏËÛË ¶™¢ Â›Ó·È ·ԉ‰ÂÈÁ̤ÓÔ˜, Ë ÂÊ·ÚÌÔÁ‹ Û‡Á¯ÚÔÓˆÓ ÌÂıfi‰ˆÓ ·ÔÎ¿Ï˘„ ÙËÓ ·ÚÔ˘Û›· Î·È Ï‹ıÔ˘˜ Ó¤ˆÓ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÒÓ ÛÙÔÓ ÂÙÈÎfi ۈϋӷ fiˆ˜ ÈÒÓ (astrovirus, calicivirus, torovirus, coronavirus) (38), ηıÒ˜ Î·È ·Ú·Û›ÙˆÓ (ÎÚ˘ÙÔÛÔÚ›‰È·, ΢ÎÏfiÛÔÚ·, ÈÛfiÛÔÚ·) (39). O ÚfiÏÔ˜ fiÏˆÓ ·˘ÙÒÓ ÙˆÓ ·Ú·ÁfiÓÙˆÓ ÛÙËÓ ÚfiÎÏËÛË ¶™¢ ̤ÓÂÈ Ó· ‰È¢ÎÚÈÓÈÛı›. ∏ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÂÓÙÂÚÈÎÒÓ ÏÔÈÌÒÍÂˆÓ Á›ÓÂÙ·È Ì ÙË ¯Ú‹ÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ, ·ÓÙÈ-ÈÈÎÒÓ Î·È ·ÓÙÈ·Ú·ÛÈÙÈÎÒÓ Ê·Ú̿ΈÓ. ªÂÁ¿ÏÔ ÂӉȷʤÚÔÓ ·ÚÔ˘ÛÈ¿˙ÂÈ Î·È Ë ÚÔÛ¿ıÂÈ· ÁÈ· ÙË ‰ËÌÈÔ˘ÚÁ›· ÂÌ‚ÔÏ›ˆÓ ηٿ ÔÏÏÒÓ ÂÓÙÂÚÈÎÒÓ ·ıÔÁfiÓˆÓ (40,41). ∂ȉÈ΋ ıÂÚ·›· ÁÈ· ÙȘ ·Ú·¿Óˆ ·ı‹ÛÂȘ, ÏËÓ ·˘ÙÒÓ ÔÈ Ôԛ˜ ÔÊ›ÏÔÓÙ·È Û ÏÔÈÌÒ‰Ë ·›ÙÈ·, ‰ÂÓ ˘¿Ú¯ÂÈ. µÚ›ÛÎÔÓÙ·È, fï˜, Û ÂͤÏÈÍË ‰È¿ÊÔÚ˜ Ӥ˜ ÌÔÚʤ˜ ıÂÚ·›·˜ .¯. ·˘ÍËÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ -ÂȉÂÚÌÈÎfi˜ ·˘ÍËÙÈÎfi˜ ·Ú¿ÁˆÓ (4244), ÂÚ˘ıÚÔÔÈËÙ›ÓË (45), ÈÓÛÔ˘Ï›ÓË (46)- ÔÈ Ôԛ˜ ÚÔ¿ÁÔ˘Ó ÙËÓ ·Ó¿Ï·ÛË ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ÂÈıËÏ›Ô˘ Î·È Èı·ÓÒ˜ ÛÙÔ Ì¤ÏÏÔÓ ı· Û˘ÓÙÂϤÛÔ˘Ó ÛÙËÓ ϤÔÓ ·ÔÙÂÏÂÛÌ·ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ¶™¢. ªÂÁ¿ÏÔ ÂӉȷʤÚÔÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Î·È ‚ÈÔÏÔÁÈÎÔ› ·Ú¿ÁÔÓÙ˜ (ÚÔ‚ÈÔÙÈο, Ú‚ÈÔÙÈο) ÔÈ ÔÔ›ÔÈ Â˘Ô‰ÒÓÔ˘Ó ÙËÓ ·Ó¿Ù˘ÍË Ê˘ÛÈÔÏÔÁÈ΋˜ ¯ÏˆÚ›‰·˜ ÛÙÔ ¤ÓÙÂÚÔ ·ÏÏ¿ ¤¯Ô˘Ó Î·È ·ÓÙÈÊÏÂÁÌÔÓÒ‰ÂȘ ȉÈfiÙËÙ˜ (47-49). ∂›Û˘ ÂÚÂ˘Ó¿Ù·È Î·È Ô ÚfiÏÔ˜ ıÚÂÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ÔÈ ÔÔ›ÔÈ Â›Ó·È ··Ú·›ÙËÙÔÈ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ‚ÏÂÓÓÔÁfiÓÔ˘. ∂‰Ò ˘¿ÁÔÓÙ·È Ù· ÓÔ˘ÎÏÂÔÙ›‰È·, Ù· ÔÏ˘·ÎfiÚÂÛÙ· ÏÈ·Ú¿ Ôͤ·, Ë ÁÏÔ˘Ù·Ì›ÓË, Ë ·ÚÁÈÓ›ÓË Î.¿. (50-52). ¢È¿ÊÔÚ· ȯÓÔÛÙÔȯ›· ¤¯Ô˘Ó Â›Û˘ ÎÚÈı› ··Ú·›ÙËÙ· ÁÈ· ÙË ÛˆÛÙ‹ ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ‚ÏÂÓÓÔÁfiÓÔ˘, fiˆ˜ Ô „¢‰¿ÚÁ˘ÚÔ˜. ∏ ¤ÏÏÂÈ„Ë Ûȉ‹ÚÔ˘ ¤¯ÂÈ ‚ÚÂı› fiÙÈ ·˘Í¿ÓÂÈ ÙË ‰È·ÂÚ·ÙfiÙËÙ· ÙÔ˘ ÂÓÙ¤ÚÔ˘ Û ·ıÔÁfiÓÔ˘˜ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜ Î·È Ô‰ËÁ› Û ¶™¢ (41). ™Â οı ÂÚ›ÙˆÛË, Ô ÌËÙÚÈÎfi˜ ıËÏ·ÛÌfi˜ ·ÔÙÂÏ› ÛËÌ·ÓÙÈÎfi ̤ÛÔ ÚfiÏ˄˘ Î·È ıÂÚ·›·˜ Ù˘ ¶™¢ ÏfiÁˆ ÙˆÓ ·ÓÙÈÌÈÎÚÔ‚È·ÎÒÓ Î·È ·ÓÙÈÊÏÂÁÌÔÓˆ‰ÒÓ È‰ÈÔÙ‹ÙˆÓ ÙÔ˘ Á˘Ó·ÈΛԢ Á¿Ï·ÎÙÔ˜ ηıÒ˜ Î·È ÙˆÓ ·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ÙÔ˘˜ ÔÔ›Ô˘˜ ÂÚȤ¯ÂÈ (53).

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70

¶ƒ∞∫∆π∫√ £∂ª∞

PRACTICAL ISSUE

∫·Ì‡Ï˜ ۈ̷ÙÈ΋˜ ·Ó¿Ù˘Í˘ ÙˆÓ ·È‰ÈÒÓ Ù˘ ¯ÒÚ·˜ Ì·˜ ¶·ÓÂÈÛÙ‹ÌÈÔ ∫Ú‹Ù˘, ∆Ì‹Ì· π·ÙÚÈ΋˜, ∆Ô̤·˜ ∫ÔÈÓˆÓÈ΋˜ π·ÙÚÈ΋˜, ∫ÏÈÓÈ΋ ¶ÚÔÏËÙÈ΋˜ π·ÙÚÈ΋˜ Î·È ¢È·ÙÚÔÊ‹˜ AÏÏËÏÔÁÚ·Ê›·: ∞ÓÙÒÓ˘ ∫·Ê¿ÙÔ˜ kafatos@med.uoc.gr ¢È·ÛÙ·‡ÚˆÛË µÔ‡Ù˜ ™Ù·˘Ú¿ÎÈ·, ∆.∫. 71 003, ∆.£.: 2208, ∏Ú¿ÎÏÂÈÔ ∫Ú‹Ù˘

∞. ∫·Ê¿ÙÔ˜ ¶ÂÚ›ÏË„Ë: ∞·Ú·›ÙËÙÔ ÂÚÁ·ÏÂ›Ô Î¿ı ·È‰›·ÙÚÔ˘ Î·È ÁÔÓÈÔ‡ Â›Ó·È ÔÈ Î·Ì‡Ï˜ ·Ó¿Ù˘Í˘ ÁÈ· ÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË Ù˘ ۈ̷ÙÈ΋˜ ·Ó¿Ù˘Í˘ ÙÔ˘ ·È‰ÈÔ‡ ·fi ÙË Á¤ÓÓËÛË ¤ˆ˜ Î·È ÙËÓ ÔÏÔÎÏ‹ÚˆÛ‹ Ù˘. ™ÙÔ ‚È‚ÏÈ¿ÚÈÔ ˘Á›·˜ ÙÔ˘ ·È‰ÈÔ‡ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÁÈ· ÔÏÏ¿ ¯ÚfiÓÈ· ·fi ÙÔ ÀÔ˘ÚÁÂ›Ô ÀÁ›·˜, ÔÈ Î·Ì‡Ï˜ ·Ó¿Ù˘Í˘ ÙÔ˘ πÓÛÙÈÙÔ‡ÙÔ˘ ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡ (πÀ¶) ÁÈ· ·È‰È¿ 6-18 ÂÙÒÓ Î·È ÂΛӘ ÙˆÓ ∏¶∞ ÁÈ· ·È‰È¿ ÚÔÛ¯ÔÏÈ΋˜ ËÏÈΛ·˜. ∆Ô 2003 Ӥ˜ ηÌ‡Ï˜ ·Ó¿Ù˘Í˘ ÂÌÊ·Ó›ÛıËÎ·Ó ÛÙ· ‚È‚ÏÈ¿ÚÈ· ˘Á›·˜ Ô˘ ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙËÓ ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ ∞Á›· ™ÔÊ›· (∞’ ¶∫¶∞). ™¯ÂÙÈ΋ ‰ËÌÔÛ›Â˘ÛË ·Ó¤ÊÂÚ fiÙÈ ÙÔ ‰Â›ÁÌ· ÚÔÂÚ¯fiÙ·Ó ·fi ÙËÓ ÂÚÈÔ¯‹ ∞ıËÓÒÓ ¯ˆÚ›˜ Ó· ‰›‰ÔÓÙ·È ÏËÚÔÊÔڛ˜ ·Ó ÚfiÎÂÈÙ·È ÁÈ· ηÓÔÓÈο, ÌÈÎÚ¿ ‹ ÌÂÁ¿Ï· ÁÈ· ÙËÓ ËÏÈΛ· Ù˘ ΢‹Ûˆ˜ ‚Ú¤ÊË, ıËÏ¿˙ÔÓÙ· ‹ ÌË Î·ıÒ˜ Î·È ÁÈ· ÙȘ ÌÂıfi‰Ô˘˜ Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËηÓ. √ ¶·ÁÎfiÛÌÈÔ˜ √ÚÁ·ÓÈÛÌfi˜ ÀÁ›·˜ (WHO) ¯ÚËÛÈÌÔÔ›ËÛ ÙȘ ηÌ‡Ï˜ ·Ó¿Ù˘Í˘ ÙˆÓ ∏¶∞ (CDC 2000) Ô˘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ‰Â‰Ô̤ӷ ·fi Ù¤ÛÛÂÚȘ ÂıÓÈΤ˜ ‰ÂÈÁÌ·ÙÔÏË„›Â˜ ·È‰ÈÒÓ ÌÂٷ͇ 1963 Î·È 1990 Î·È ÙȘ ÚÔÛ¿ÚÌÔÛ ÁÈ· ¯Ú‹ÛË ·fi ¯ÒÚ˜ ÔÈ Ôԛ˜ ‰ÂÓ ‰È·ı¤ÙÔ˘Ó Î·Ì‡Ï˜ ·Ó¿Ù˘Í˘. ¢ÂÓ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë ÂıÓÈ΋ ÌÂϤÙË ÙÔ˘ 1994 ÁÈ· ·È‰È¿ ¿Óˆ ÙˆÓ 6 ÂÙÒÓ ÏfiÁˆ ¤Í·ÚÛ˘ Ù˘ ·¯˘Û·ÚΛ·˜. ∏ Û‡ÁÎÚÈÛË ÙˆÓ Î·Ì˘ÏÒÓ ÙÔ˘ CDC-WHO Î·È Ù˘ ∞’ ¶∫¶∞ ·ÔηχÙÂÈ fiÙÈ ÔÈ ÂÏÏËÓÈΤ˜ ηÌ‡Ï˜ ·Ó¿Ù˘Í˘ ‚Ú›ÛÎÔÓÙ·È Ôχ ˘„ËÏfiÙÂÚ· ÁÈ· fiϘ ÙȘ ÌÂÙÚ‹ÛÂȘ. ø˜ ·ÔÙ¤ÏÂÛÌ·, ÔÏÏ¿ ·È‰È¿ ‚Ú›ÛÎÔÓÙ·È Ó· ¤¯Ô˘Ó ·ÓÂ·Ú΋ ·Ó¿Ù˘ÍË Û‡Ìʈӷ Ì ÙȘ ηÌ‡Ï˜ Ù˘ ∞’ ¶∫¶∞, ÂÓÒ Â›Ó·È ÛÙ· Ê˘ÛÈÔÏÔÁÈο fiÚÈ· Ì ‚¿ÛË ÂΛӘ ÙÔ˘ CDC. ∞ÓÙ›ıÂÙ·, Á›ÓÂÙ·È ˘ÔÂÎÙ›ÌËÛË ÙˆÓ ˘¤Ú‚·ÚˆÓ Î·È ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ. √È Î·Ì‡Ï˜ Ù˘ ∞’ ¶∫¶∞ Ô˘ ‚Ú›ÛÎÔÓÙ·È Û‹ÌÂÚ· ÛÙ· ‚È‚ÏÈ¿ÚÈ· ˘Á›·˜ ı· Ú¤ÂÈ ¿ÌÂÛ· Ó· ·ÓÙÈηٷÛÙ·ıÔ‡Ó ·fi ÙȘ ηÌ‡Ï˜ ÙÔ˘ πÀ¶. °È· ·È‰È¿ ÚÔÛ¯ÔÏÈ΋˜ ËÏÈΛ·˜ ˘¿Ú¯Ô˘Ó Û‹ÌÂÚ· ÌÂÙÚ‹ÛÂȘ ·’ fiÏË ÙË ¯ÒÚ· Ô˘ ÂÈÙÚ¤Ô˘Ó ÙË ‰ËÌÈÔ˘ÚÁ›· ηχÙÂÚˆÓ Î·Ì˘ÏÒÓ ·Ó¿Ù˘Í˘. §¤ÍÂȘ ÎÏÂȉȿ: ∫·Ì‡Ï˜ ·Ó¿Ù˘Í˘, ·È‰È¿, ·¯˘Û·ÚΛ·, ˘ÔıÚ„›·, ·ÓÙÈÚÔÛˆ¢ÙÈÎfi ÂıÓÈÎfi ‰Â›ÁÌ·.

Growth curves for Greek children University of Crete, Medical School, Department of Social Medicine, Clinic of Preventive Medicine and Nutrition Correspondence: Antonis Kafatos kafatos@med.uoc.gr Voutes-Stavrakia Junction, 71 003, Po. Box: 2208, Herakleion, Crete

A. Kafatos Abstract: Physical growth curves enable paediatricians and parents to monitor the pattern of child growth from birth onwards. Growth curves should be derived from large, nationally representative samples. In 1981, the Institute of Child Health (ICH) in Athens conducted a national study and created growth curves for children aged 6-17 years in Greece. Up until the end of 2003 the Greek children’s health booklet contained US Centers for Disease Control (CDC) curves for preschool children and the ICH growth curves for children over the age of 6 years. In 2003, the Greek Ministry of Health replaced these with curves constructed by the A’ Paediatric Clinic of the University of Athens (APCUA), which are based on children living in Athens, but for which very little information about sampling procedures is available. For preschool children it is stated that children were measured in private clinics and health centres, without details of birth weight, the presence of illness or the number of measurements taken on each child. Comparing the APCUA growth curves with CDC-WHO curves for international use and with the ICH curves, the APCUA curves overestimate the proportion of children with stunted growth at every age while underestimating the proportions of overweight and obese children. From the above observations, it is apparent that the growth curves presently in use by the Ministry of Health should be replaced by the original ICH curves for children over the age of 6 years. The ICH growth curves are the most appropriate, since the children in the representative national sample were measured in 1981, before the present epidemic of obesity started. For preschool children, other data are available for more appropriate growth curves.

Key words: Growth curves, children, overweight, obese, underweight, national representative sample.

∂ÈÛ·ÁˆÁ‹ ∞·Ú·›ÙËÙÔ ÂÚÁ·ÏÂ›Ô ÁÈ· οı ·È‰›·ÙÚÔ Î·È ÁÔÓÈfi ÁÈ· ÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË Ù˘ ÔÚ›Paediatriki 2007;70:70-74

·˜ Ù˘ ۈ̷ÙÈ΋˜ ·Ó¿Ù˘Í˘ ÙÔ˘ ·È‰ÈÔ‡ ·fi ÙË Á¤ÓÓËÛË ¤ˆ˜ Î·È ÙËÓ ÔÏÔÎÏ‹ÚˆÛ‹ Ù˘ Â›Ó·È ÔÈ Î·Ì‡Ï˜ ·Ó¿Ù˘Í˘.

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¢ÂÓ ˘¿Ú¯ÂÈ ·ÌÊÈ‚ÔÏ›· fiÙÈ ÔÈ Î·Ì‡Ï˜ ·Ó¿Ù˘Í˘ Ú¤ÂÈ Ó· Â›Ó·È Î·Ù¿ÏÏËÏ· ۯ‰ȷṲ̂Ó˜ Î·È Ó· ‚·Û›˙ÔÓÙ·È Û ÌÂÙÚ‹ÛÂȘ ·ÓÙÈÚÔÛˆ¢ÙÈÎÔ‡ ÂıÓÈÎÔ‡ ‰Â›ÁÌ·ÙÔ˜ ˘ÁÈÒÓ ·È‰ÈÒÓ. √È ∏¶∞ ‹Ù·Ó Ë ÚÒÙË ¯ÒÚ· Ô˘ ‰ËÌÈÔ‡ÚÁËÛ ηÌ‡Ï˜ ·Ó¿Ù˘Í˘ Ì ÂıÓÈΤ˜ ‰ÂÈÁÌ·ÙÔÏË„›Â˜ (¶›Ó·Î·˜ 1) Î·È ·ÎÔÏÔ‡ıËÛ·Ó ÔÈ µÚÂÙ·ÓÔ› (¶›Ó·Î·˜ 2). √ ¶·ÁÎfiÛÌÈÔ˜ √ÚÁ·ÓÈÛÌfi˜ ÀÁ›·˜ (WHO) ¯ÚËÛÈÌÔÔ›ËÛ ÙȘ ·ÌÂÚÈηÓÈΤ˜ ηÌ‡Ï˜ ·Ó¿Ù˘Í˘ Ô˘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ‰Â‰Ô̤ӷ ·fi Ù¤ÛÛÂÚȘ ÂıÓÈΤ˜ ‰ÂÈÁÌ·ÙÔÏË„›Â˜ ·È‰ÈÒÓ ÛÙȘ ∏¶∞ (fiϘ ÔÈ ÂıÓÈÎfiÙËÙ˜) ÌÂٷ͇ 1963 Î·È 1990 Î·È ¤ÓÙÂ Û˘ÌÏËڈ̷ÙÈΤ˜ ÌÂϤÙ˜ Î·È ÙȘ ÚÔÛ¿ÚÌÔÛ ÁÈ· ¯Ú‹ÛË ·fi ¯ÒÚ˜ ÔÈ Ôԛ˜ ‰ÂÓ ‰È·ı¤ÙÔ˘Ó ‰ÈΤ˜ ÙÔ˘˜ ηÌ‡Ï˜ ·Ó¿Ù˘Í˘ (CDC 2000) (¢ÂÓ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë ÂıÓÈ΋ ÌÂϤÙË ÙˆÓ ∏¶∞ ÙÔ˘ 1994 ÁÈ· ·È‰È¿ ¿Óˆ ÙˆÓ 6 ÂÙÒÓ ÏfiÁˆ ÂȉËÌÈ΋˜ ¤Í·ÚÛ˘ Ù˘ ·¯˘Û·ÚΛ·˜). ∏ ¯ÒÚ· Ì·˜ ¯ÚËÛÈÌÔÔ›ËÛ ̤¯ÚÈ ÙÔ 2003 ÙȘ ηÌ‡Ï˜ ·Ó¿Ù˘Í˘ ÙˆÓ ∏¶∞ (CDC) ÁÈ· ·È‰È¿ ÚÔÛ¯ÔÏÈ΋˜ ËÏÈΛ·˜ Î·È ÁÈ· ÙȘ ËÏÈ˘ 6-18 ÂÙÒÓ ÙȘ ηÌ‡Ï˜ ·Ó¿Ù˘Í˘ ÙÔ˘ πÓÛÙÈÙÔ‡ÙÔ˘ ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡. ∏ ϤÔÓ ÛÔ‚·Ú‹ ÚÔÛ¿ıÂÈ· ‰ËÌÈÔ˘ÚÁ›·˜ ηÌ˘ÏÒÓ ·Ó¿Ù˘Í˘ ÁÈ· ·È‰È¿ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ ‹Ù·Ó ÂΛÓË ÙÔ˘ πÓÛÙÈÙÔ‡ÙÔ˘ ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡ ÙÔ 1981 (7). √È Î·Ì‡Ï˜ ÙÔ˘ πÀ¶ ¤ÁÈÓ·Ó Û Ú¿ÁÌ·ÙÈ ·ÓÙÈÚÔÛˆ¢ÙÈÎfi ‰Â›ÁÌ· 27.000 ·È‰ÈÒÓ ËÏÈΛ·˜ 6-18 ÂÙÒÓ ·’ fiÏË ÙË ¯ÒÚ· ÙÔ 1981. ∞˘Ù‹ ‹Ù·Ó Ë ϤÔÓ Î·Ù¿ÏÏËÏË ¯ÚÔÓÈ΋ ÂÚ›Ô‰Ô˜ Ó· Á›ÓÔ˘Ó Î·Ì‡Ï˜ ·Ó¿Ù˘Í˘ ÁÈ·Ù› ‰ÂÓ Â›¯Â ·Ú¯›ÛÂÈ ·ÎfiÌ· Ë ÂȉËÌ›· Ù˘ ·¯˘Û·ÚΛ·˜. ∞Í›˙ÂÈ Û˘Á¯·ÚËÙ‹ÚÈ· ÙÔ πÀ¶ Ì ÙÔÓ ÙfiÙ Úfi‰ÚÔ ÙÔ˘ ™‡ÚÔ ¢ÔÍÈ¿‰Ë ÁÈ· ÙËÓ ÙÂÚ¿ÛÙÈ·˜ ÛËÌ·Û›·˜ ÚÔÛÊÔÚ¿ ÙÔ˘, fiˆ˜ ·Ô‰ÂÈÎÓ‡ÂÙ·È Û‹ÌÂÚ·. ™Â ÚfiÛÊ·ÙË ‰ËÌÔÛ›Â˘ÛË (9) Ê·›ÓÂÙ·È Ë ÌÂÁ¿ÏË ·‡ÍËÛË ÙÔ˘ ‚¿ÚÔ˘˜ ÙˆÓ ·È‰ÈÒÓ ·fi ÙÔ 1982 ̤¯ÚÈ ÙÔ 2002 Û ۇÁÎÚÈÛË Ì ÙËÓ Ôχ ÌÈÎÚ‹ ·‡ÍËÛË ÙÔ˘ ·Ó·ÛÙ‹Ì·ÙÔ˜ ηٿ ÙËÓ ›‰È· ¯ÚÔÓÈ΋ ÂÚ›Ô‰Ô (¶›Ó·Î·˜ 3). √ ¶›Ó·Î·˜ 4 Û˘ÓÔ„›˙ÂÈ ÙȘ ÌÂϤÙ˜ Ô˘ ¤ÁÈÓ·Ó ÛÙË ¯ÒÚ· Ì·˜ ÁÈ· ‰ËÌÈÔ˘ÚÁ›· ηÌ˘ÏÒÓ ·Ó¿Ù˘Í˘ ÙˆÓ ·È‰ÈÒÓ (7,11,12,14).

¶›Ó·Î·˜ 2. µÚÂÙ·ÓÈΤ˜ ηÌ‡Ï˜ ·Ó¿Ù˘Í˘ (5,6) ñ ∫·Ì‡Ï˜ Tanner-Whitehouse 1966 ñ ∞ËÚ¯·ÈˆÌ¤Ó˜ ÏfiÁˆ Ù˘ ·‡ÍËÛ˘ ‡„Ô˘˜ ÙȘ ÙÂÏÂ˘Ù·›Â˜ ‰ÂηÂٛ˜ ñ ∫·Ì‡Ï˜ Buckler-Tanner ÚÔÛ·ÚÌfiÛÙËÎ·Ó ÙÔ 1999 Î·È ¤Ï·‚·Ó ˘’ fi„ÈÓ ÙËÓ ·‡ÍËÛË ‚¿ÚÔ˘˜ - ‡„Ô˘˜ ñ ∫·Ì‡Ï˜ UK 90 - ÚԤ΢„·Ó ·fi ÙȘ ÚÔËÁËı›Û˜ ÌÂϤÙ˜. Œ¯Ô˘Ó ÌÂÁ¿ÏË ·ÍÈÔÈÛÙ›· Û˘ÁÎÚÈÓfiÌÂÓ˜ Ì ÙȘ ·Ï·ÈfiÙÂÚ˜ (ËÏÈ˘ 2-20 ¤ÙË). ™ÙËÓ ÂÊ˂›· ‰È·ÛÙ·˘ÚÒÓÔÓÙ·È Û˘Ó‹ıˆ˜ ÔÈ ÂηÙÔÛÙÈ·›Â˜ ı¤ÛÂȘ ÏfiÁˆ ÌÂÁ¿ÏˆÓ ‰È·ÊÔÚÒÓ ÛÙËÓ ËÏÈΛ· ¤Ó·Ú͢ Ù˘ ÂÚÈfi‰Ô˘ Ù·¯Â›·˜ ·Ó¿Ù˘Í˘ (growth spurt). ÃÚËÛÈÌÔÔÈ‹ıËÎ·Ó ‰Â‰Ô̤ӷ ̤¯ÚÈ ÙÔ 1990 ÏfiÁˆ Ù˘ ÂȉËÌ›·˜ ·¯˘Û·ÚΛ·˜ ÙËÓ ÙÂÏÂ˘Ù·›· ‰ÂηÂÙ›· ñ √È ‚ÚÂÙ·ÓÈΤ˜ ηÌ‡Ï˜ ·Ó·ÊÔÚ¿˜ [UK 90] ÁÈ· ¢ª™ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ‰ÈÂıÓÒ˜ ÁÈ· ÂÎÙ›ÌËÛË ÙˆÓ ˘¤Ú‚·ÚˆÓ Î·È ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ (IOTF)

∆Ô 2003 ÂÌÊ·Ó›ÛÙËÎ·Ó Ó¤Â˜ ηÌ‡Ï˜ ·Ó¿Ù˘Í˘ ÛÙ· ‚È‚ÏÈ¿ÚÈ· ˘Á›·˜ ÙÔ˘ ÀÔ˘ÚÁ›Ԣ ÀÁ›·˜ Ô˘ ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙËÓ ∞ã ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ ∞Á›· ™ÔÊ›·. ∞ÚÁfiÙÂÚ· ÙÔ 2004, Û¯ÂÙÈ΋ ‰ËÌÔÛ›Â˘ÛË ·Ó¤ÊÂÚ fiÙÈ ÙÔ ‰Â›ÁÌ· ÚÔ¤Ú¯ÔÓÙ·Ó ·fi ÙËÓ ÂÚÈÔ¯‹ ∞ıËÓÒÓ, ·ÏÏ¿ ¯ˆÚ›˜ Ó· ‰›‰ÔÓÙ·È ÏËÚÔÊÔڛ˜ ·Ó ÚfiÎÂÈÙ·È ÁÈ· ·È‰È¿ ÌÈÎÚ¿ ‹ ÌÂÁ¿Ï· ÁÈ· ÙËÓ ËÏÈΛ· ΢‹Ûˆ˜, ıËÏ¿˙ÔÓÙ· ‹ ÌË Î·ıÒ˜ Î·È ÁÈ· ÙȘ ÌÂıfi‰Ô˘˜ Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó (1-3). ™ÙË ÌÂϤÙË ·˘Ù‹ Ù· 10.000 ÂÚ›Ô˘ ·È‰È¿ Î·È ¤ÊË‚ÔÈ Ô˘ ÌÂÙÚ‹ıËηÓ, Èı·ÓfiÓ Ó· ÌËÓ ·ÓÙÈÚÔÛˆÂ‡Ô˘Ó Î·Ó Ù· ·È‰È¿ Ù˘ ÂÚÈÔ¯‹˜ ∞ıËÓÒÓ ÁÈ·Ù› ‰ÂÓ ÂÚÈÁÚ¿ÊÂÙ·È Ë ÌÂıÔ‰ÔÏÔÁ›· ÂÈÏÔÁ‹˜ ‰Â›ÁÌ·ÙÔ˜ ÛÙȘ ‰‡Ô ‰ËÌÔÛȇÛÂȘ Ù˘ ›‰È·˜ ∫ÏÈÓÈ΋˜ (13). √‡Ù ÂÚÈÁÚ¿ÊÂÙ·È ÙÔ ‰Â›ÁÌ· ÚÔÛ¯ÔÏÈ΋˜ ËÏÈΛ·˜ Ô˘ Ï‹ÊıËΠ·fi ȉȈÙÈΤ˜ ÎÏÈÓÈΤ˜, ȉȈÙÈο È·ÙÚ›· Î·È Î¤ÓÙÚ· ˘Á›·˜. ¶Ò˜ ÂÂϤÁËÛ·Ó; ∞ÔÎÏ›ÛÙËÎ·Ó Ù· ¿ÚÚˆÛÙ· ·È‰È¿; ¢ÂÓ ·Ó·Ê¤ÚÔÓÙ·È Ù· ÎÚÈÙ‹ÚÈ· ÂÈÏÔÁ‹˜ ÙˆÓ ·È‰ÈÒÓ, Ô‡Ù ·Ó·Ê¤ÚÂÙ·È Ô˘ ‚Ú›ÛÎÔÓÙ·È Ù· È·ÙÚ›· Î·È Î¤ÓÙÚ· ˘Á›·˜ Î·È fiÛ· ·fi ·˘Ù¿ Û˘ÌÌÂÙ›¯·Ó ÛÙË ÌÂϤÙË. ¢ÂÓ ·Ó·Ê¤ÚÂÙ·È Â›Û˘, ·Ó οı ·È‰› ÌÂÙÚ‹ıËΠ̛· ÊÔÚ¿ ‹ ·Ó οı ÊÔÚ¿ Ô˘ ÂÈÛÎÂÙfiÙ·Ó ÙÔ È·ÙÚÂ›Ô ‹ ΤÓÙÚÔ ˘Á›·˜ ηٷÁÚ·ÊfiÙ·Ó ˆ˜ ηÈÓÔ‡ÚÁÈÔ ·È‰›. ∞Ó ‰ÂÓ Û˘Ó¤‚·ÈÓ ·˘Ùfi, fiÛ· ·È‰È¿ ÂÍÂÙ¿ÛıËÎ·Ó Â·ÓÂÈÏËÌ̤ӷ - ‰È·¯ÚÔÓÈο;

¶›Ó·Î·˜ 1. ªÂϤÙ˜ ÙˆÓ ∏¶∞ ÁÈ· ηÌ‡Ï˜ ·Ó¿Ù˘Í˘ (4) ŒÙÔ˜ 1963-65 1966-70 1971-74 1976-80 1988-94 1960-94

ªÂϤÙË

∏ÏÈΛ·

NHES II ∂ıÓÈ΋ 6-11 ÂÙÒÓ NHES III -//12-17 ÂÙÒÓ NHANES I -//1-18 ÂÙÒÓ NHANES II -//6 ÌËÓÒÓ-18 ÂÙÒÓ NHANES III -//2 ÌËÓÒÓ-18 ÂÙÒÓ ¶¤ÓÙÂ Û˘ÌÏËڈ̷ÙÈΤ˜ ÌÂϤÙ˜ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ‚ÚÂÊÒÓ

¶·È‰È¿ 3632 3223 3659 3921 3698 >23000 ¶·È‰È·ÙÚÈ΋ 2007;70:70-74

72

∞. ∫·Ê¿ÙÔ˜

¶›Ó·Î·˜ 3. ™ˆÌ·ÙÔÌÂÙÚ‹ÛÂȘ Î·È ÔÛÔÛÙ¿ ˘¤Ú‚·ÚˆÓ Î·È ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ Ù˘ ∫Ú‹Ù˘, ËÏÈΛ·˜ 9 Ì 17 ÂÙÒÓ ÙÔ 1982 Î·È 2002 (9) 1982 (¡=528)

2002 (¡=620)

∞ÏÏ·Á‹

ª¤ÛË ∆ÈÌ‹ µ¿ÚÔ˜ (kg) ⁄„Ô˜ (cm) ¢ª™ (kg/m2) º˘ÛÈÔÏÔÁÈο À¤Ú‚·Ú· ¶·¯‡Û·Úη À¤Ú‚·Ú· & ¶·¯‡Û·Úη

45,8 150,8 19,4 % 79 16,5 4,2 20,6

50,2 152,5 21,0

% 9,6 1,1 8,2

60 27 12,7 39,7

™ÙÔ ›‰ÈÔ ¿ÚıÚÔ ÂÈÛËÌ·›ÓÂÙ·È Ë ÌÂÁ¿ÏË ·‡ÍËÛË ÙÔ˘ ‚¿ÚÔ˘˜ ·ÁÔÚÈÒÓ Î·È ÎÔÚÈÙÛÈÒÓ Ù· ÙÂÏÂ˘Ù·›· 20 ¯ÚfiÓÈ·. Ÿˆ˜ Ê·›ÓÂÙ·È ÛÙȘ ∂ÈÎfiÓ˜ 1 & 2 ÔÈ Î·Ì‡Ï˜ ·˘Ù¤˜ ÙȘ ∞’ ¶·È‰È·ÙÚÈ΋˜ ∫ÏÈÓÈ΋˜ ˘ÔÙÈÌÔ‡Ó Ù· ̤ÁÈÛÙ· ÙÔÓ ·ÚÈıÌfi ÙˆÓ ·È‰ÈÒÓ Ì ·˘ÍË̤ÓÔ ‚¿ÚÔ˜ Î·È ·¯˘Û·ÚΛ· Î·È ˘ÂÚÂÎÙÈÌÔ‡Ó ÙÔÓ ·ÚÈıÌfi ÙˆÓ ·È‰ÈÒÓ Ì ·ÓÂ·Ú΋ ·Ó¿Ù˘ÍË. √ ‰Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ (¢ª™) ÙfiÛÔ ÛÙ· ·ÁfiÚÈ· fiÛÔ Î·È ÛÙ· ÎÔÚ›ÙÛÈ· Ù˘ 3˘ ∂.£. Ù˘ ∞’ ¶·È‰È·ÙÚÈ΋˜ ∫ÏÈÓÈ΋˜ ·ÓÙÈÛÙÔȯ› ÛÙË 10Ë ÙÔ˘ CDC ÂÓÒ Ë 97Ë ∂.£. Â›Ó·È Ôχ ÈÔ ¿Óˆ ·fi ÙËÓ 97Ë ÙˆÓ Î·Ì˘ÏÒÓ ÙÔ˘ CDC ÛÙȘ ∏¶∞. ∆Ô ›‰ÈÔ ·Ú·ÙËÚÂ›Ù·È Î·È ÛÙËÓ 50‹ ∂.£.. °È’ ·˘ÙfiÓ ·ÎÚÈ‚Ò˜ ÙÔÓ ÏfiÁÔ ˘ÔÙÈÌ¿Ù·È ÙÔ ÔÛÔÛÙfi ·¯˘Û·ÚΛ·˜ Ì ‚¿ÛË ÙȘ ηÌ‡Ï˜ Ù˘ ∞’ ¶·È‰È·ÙÚÈ΋˜ ∫ÏÈÓÈ΋˜, ÂÓÒ ˘ÂÚÂÎÙÈÌ¿Ù·È ÙÔ ÔÛÔÛÙfi ÙˆÓ ·È‰ÈÒÓ Ì ·ÓÂ·Ú΋ ·Ó¿Ù˘ÍË Î·È ˘ÔıÚ„›·. ™ÙË ‰ËÌÔÛ›Â˘ÛË Ù˘ ∞’ ¶·È‰È·ÙÚÈ΋˜ ∫ÏÈÓÈ΋˜ ÙÔÓ›˙ÂÙ·È fiÙÈ ·ıÔÏÔÁÈο ·˘ÍË̤ÓÔ ¢ª™ Î·È ·¯˘Û·ÚΛ· ¤¯Ô˘Ó fiÛ· ·ÁfiÚÈ· Â›Ó·È ¿Óˆ ·fi ÙËÓ

50‹ ∂.£. ÙˆÓ Î·Ì˘ÏÒÓ ÙÔ˘˜ (∂ÈÎfiÓ· 3) ‹ ¿Óˆ ·fi ÙËÓ 75Ë ∂.£. ÁÈ· Ù· ÎÔÚ›ÙÛÈ·, Û‡Ìʈӷ Ì ٷ ÎÚÈÙ‹ÚÈ· ÙÔ˘ IOTF (International Obesity Task Force) (8). √È Î·Ì‡Ï˜ fï˜, Ù˘ ∞’ ¶·È‰È·ÙÚÈ΋˜ ∫ÏÈÓÈ΋˜ ‰ËÌÈÔ˘ÚÁÔ‡Ó Û‡Á¯˘ÛË ÛÙÔ˘˜ ·È‰›·ÙÚÔ˘˜ Î·È ÁÔÓ›˜ ÁÈ·Ù› Ê˘ÛÈÔÏÔÁÈο ıˆÚÔ‡ÓÙ·È Ù· ·ÁfiÚÈ· Ô˘ Â›Ó·È Î¿Ùˆ Ù˘ 50‹˜ ∂.£. Î·È Î¿Ùˆ Ù˘ 75˘ ÁÈ· Ù· ÎÔÚ›ÙÛÈ·. ∞ÓÙ›ıÂÙ· ÔÈ Î·Ì‡Ï˜ ·Ó¿Ù˘Í˘ ÙÔ˘ πÀ¶ Ô˘ ¤ÁÈÓ·Ó Û ·ÓÙÈÚÔÛˆ¢ÙÈÎfi ‰Â›ÁÌ· ÂÏÏËÓÈÎÔ‡ ÏËı˘ÛÌÔ‡ ËÏÈΛ·˜ 6-18 ÂÙÒÓ Î·È Û ηٿÏÏËÏË ¯ÚÔÓÈ΋ ÛÙÈÁÌ‹ (1981), ÚÈÓ ‰ËÏ·‰‹ ÙËÓ ¤Ó·ÚÍË Ù˘ ÂȉËÌ›·˜ Ù˘ ·¯˘Û·ÚΛ·˜, ·ÓÙÈÛÙÔÈ¯Ô‡Ó Ï‹Úˆ˜ ÛÙȘ ·ÓÙ›ÛÙÔȯ˜ ÂηÙÔÛÙÈ·›Â˜ ı¤ÛÂȘ ÙˆÓ Î·Ì˘ÏÒÓ ÙÔ˘ CDC (ÔÈ ÙÈ̤˜ ÙˆÓ ÂηÙÔÛÙÈ·›ˆÓ ı¤ÛÂˆÓ ÙÔ˘ ‚¿ÚÔ˘˜ Î·È ÙÔ˘ ·Ó·ÛÙ‹Ì·ÙÔ˜ ÙˆÓ ·È‰ÈÒÓ ÛÙȘ ‰È¿ÊÔÚ˜ ËÏÈ˘ ‰ÂÓ ‰È¤ÊÂÚ·Ó ÛËÌ·ÓÙÈο - ANOVA, p>0,05). ŸÛÔÓ ·ÊÔÚ¿ ÙȘ ηÌ‡Ï˜ ·Ó¿Ù˘Í˘ ηٿ ÙË ‚ÚÂÊÈ΋ ËÏÈΛ·, Ë ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¯ÚËÛÈÌÔÔ›ËÛ 139 ·ÁfiÚÈ· Î·È ·ÚfiÌÔÈÔ ·ÚÈıÌfi ÎÔÚÈÙÛÈÒÓ. ∞Ó ÌÂÙÚ‹ıËÎ·Ó ÌfiÓÔ Ì›· ÊÔÚ¿ (‰Â›ÁÌ· ÙÔÌ‹˜), Â›Ó·È ÂÍ·ÈÚÂÙÈο ÌÈÎÚfi ‰Â›ÁÌ· ÁÈ· Ó· ·ÚÔ˘ÛÈ·Ûı› ˆ˜ ·ÓÙÈÚÔÛˆ¢ÙÈÎfi ÁÈ· ÂıÓÈΤ˜ ηÌ‡Ï˜. ∏ ÂÚÈÁÂÓÓËÙÈ΋ ÌÂϤÙË ∫Ú‹Ù˘ Ì 1.200 ÂÚ›Ô˘ ˘ÁÈ‹ ·È‰È¿ ‰È·¯ÚÔÓÈ΋˜ ·Ú·ÎÔÏÔ‡ıËÛ˘ ÁÈ· 6 ¯ÚfiÓÈ· (11), Â›Ó·È Ôχ ÈÔ ÏÔÁÈÎfi ‰Â›ÁÌ·, ÂÓÙÔ‡ÙÔȘ ‰ÂÓ ÈÛ¯˘ÚÈ˙fiÌ·ÛÙ ˆ˜ ÌÔÚ› Ó· ¯ÚËÛÈÌÔÔÈËı› ÁÈ· ÂıÓÈΤ˜ ηÌ‡Ï˜ ·Ó¿Ù˘Í˘.

™˘ÌÂÚ¿ÛÌ·Ù· ∆Ô ÂÍ·ÈÚÂÙÈο ÛÔ‚·Úfi Úfi‚ÏËÌ· Ù˘ ·¯˘Û·ÚΛ·˜ Ô˘ ¤¯ÂÈ ¿ÚÂÈ ÂȉËÌÈΤ˜ ‰È·ÛÙ¿ÛÂȘ ˘ÔÙÈÌ¿Ù·È ·fi ÙȘ ˘¿Ú¯Ô˘Û˜ Û‹ÌÂÚ· ηÌ‡Ï˜ ·Ó¿Ù˘Í˘ ÛÙ· ‚È‚ÏÈ¿ÚÈ· ˘Á›·˜ ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘

¶›Ó·Î·˜ 4. ªÂϤÙ˜ ÛÙËÓ ∂ÏÏ¿‰· ÁÈ· ηÌ‡Ï˜ ·Ó¿Ù˘Í˘ πÓÛÙÈÙÔ‡ÙÔ ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡

∂ıÓÈο ÚfiÙ˘· ·Ó¿Ù˘Í˘ ¶·È‰È·ÙÚÈ΋ 1986;49:1-15 ∂ıÓÈ΋ ‰ÂÈÁÌ·ÙÔÏË„›· Û 230 Û¯ÔÏ›· - ÕÓÔÈÍË 1981 ∏ÏÈΛ· 6-18 ÂÙÒÓ, 27.000 ·È‰È¿

¶·ÓÂÈÛÙ‹ÌÈÔ £ÂÛÛ·ÏÔӛ΢ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋

∆Ô Ê˘ÛÈÔÏÔÁÈÎfi ·È‰›. ¶ÚfiÙ˘· ÛÙÔȯ›· ·Ó¿Ù˘Í˘ £ÂÛÛ·ÏÔÓ›ÎË, 1990 1148 ¡ÂÔÁÓ¿ 0-30 ÌËÓÒÓ, ∞ı‹Ó·, 1984-1985 3419 ·È‰È¿ 3-6 ÂÙÒÓ, µÚÂÊÔÓËÈ·ÎÔ›-¶·È‰ÈÎÔ› ÛÙ·ıÌÔ› 7926 ·È‰È¿ 6-17 ÂÙÒÓ, ‰Â›ÁÌ· 38 Û¯ÔÏ›ˆÓ ∫·Ì‡Ï˜ ۈ̷ÙÈ΋˜ ·Ó¿Ù˘Í˘ ·È‰ÈÒÓ ‚ÚÂÊÈ΋˜ Î·È ÚÔÛ¯ÔÏÈ΋˜ ËÏÈΛ·˜ Ô˘ ÚԤ΢„·Ó ·fi ‰È·¯ÚÔÓÈ΋ ·Ú·ÎÔÏÔ‡ıËÛ‹ ÙÔ˘˜ ¶·È‰È·ÙÚÈ΋ 2000;63:391-407 1142 ·È‰È¿ 0-6 ÂÙÒÓ, ∫Ú‹ÙË, 1988-1995, ‰È¿ÚÎÂÈ· 7 ¯ÚfiÓÈ· ÀÁ›·, ‰È·ÙÚÔÊ‹ & ·Ó¿Ù˘ÍË ·È‰ÈÒÓ ÚÔÛ¯ÔÏÈ΋˜ ËÏÈΛ·˜ ÷ÓÈ¿, 2004 6663 ·È‰È¿ ËÏÈΛ·˜ 5 ¤ˆ˜ 17,5 ÂÙÒÓ, 1987-2004

¶·ÓÂÈÛÙ‹ÌÈÔ ∫Ú‹Ù˘ ∫ÏÈÓÈ΋ ¶ÚÔÏËÙÈ΋˜ π·ÙÚÈ΋˜ & ¢È·ÙÚÔÊ‹˜

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™¯ËÌ·ÙÈ΋ Û‡ÁÎÚÈÛË. ª™ ηÌ˘ÏÒÓ ·Ó¿Ù˘Í˘ CDC Î·È ∞’ ¶·È‰È·ÙÚÈ΋˜ ∫ÏÈÓÈ΋˜ ∞ıËÓÒÓ

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∂ÈÎfiÓ· 1. ∫·Ì‡Ï˜ ¢ª™ ÎÔÚÈÙÛÈÒÓ ·fi CDC Î·È ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ∞ıËÓÒÓ.

∂ÈÎfiÓ· 2. ∫·Ì‡Ï˜ ¢ª™ ·ÁÔÚÈÒÓ ·fi CDC Î·È ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ∞ıËÓÒÓ.

ÀÔ˘ÚÁ›Ԣ ÀÁ›·˜. √È Î·Ì‡Ï˜ ·˘Ù¤˜ ‰ÂÓ ¤ÁÈÓ·Ó Û ηٿÏÏËÏÔ ÏËı˘ÛÌÈ·Îfi ‰Â›ÁÌ· Ô‡Ù ÙËÓ Î·Ù¿ÏÏËÏË ¯ÚÔÓÈ΋ ÂÚ›Ô‰Ô. ∆Ô πÀ¶ ¤Î·Ó ÂÍ·ÈÚÂÙÈο ÛÔ˘‰·›Ô ¤ÚÁÔ ÙÔ 1981 Ì ÙË ‰ËÌÈÔ˘ÚÁ›· ηÌ˘ÏÒÓ ·Ó¿Ù˘Í˘ ·fi ·ÓÙÈÚÔÛˆ¢ÙÈÎfi ‰Â›ÁÌ· 27.000 ·È‰ÈÒÓ ËÏÈΛ·˜ 6-18 ¯ÚfiÓˆÓ ·’ fiÏË ÙË ¯ÒÚ·. √È Î·Ì‡Ï˜ ·˘Ù¤˜ ‹Ù·Ó ÛÙ· ‚È‚ÏÈ¿ÚÈ· ˘Á›·˜ ÙÔ˘ ·È‰ÈÔ‡ ̤¯ÚÈ ÙÔ Ù¤ÏÔ˜ ÙÔ˘ 2003. √È Î·Ì‡Ï˜ ·˘Ù¤˜ ı· Ú¤ÂÈ Ó· Â·Ó¤ÏıÔ˘Ó ¿ÌÂÛ·, ·ÊÔ‡ ÂÈÛ·¯ıÔ‡Ó Ù· ‰Â‰Ô̤ӷ ÙˆÓ 27.000 ·È‰ÈÒÓ ÛÙÔ˘˜ ˘ÔÏÔÁÈÛÙ¤˜ Î·È Ì ۇÁ¯ÚÔÓ˜ ÌÂıfi‰Ô˘˜ ‚ÈÔÛÙ·ÙÈÛÙÈ΋˜ Á›ÓÔ˘Ó Í·Ó¿ ÔÈ Î·Ì‡Ï˜ ·Ó¿Ù˘Í˘. ¶ÚÈÓ ·fi 25 ¯ÚfiÓÈ· ‰ÂÓ Ú·ÁÌ·ÙÔÔÈ›ÙÔ Ë Ì¤ÙÚËÛË Ù˘ ÂÚÈ̤ÙÚÔ˘ ̤Û˘. ™‹ÌÂÚ· fï˜, ıˆÚÂ›Ù·È ÂÍ·ÈÚÂÙÈο ÛÔ˘‰·›· ̤ÙÚËÛË ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË Ù˘ ÎÂÓÙÚÈ΋˜ ·¯˘Û·ÚΛ·˜. ∏ ¤Î‰ÔÛË ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘ “ÀÁ›·, ‰È·ÙÚÔÊ‹ Î·È ·Ó¿Ù˘ÍË ·È‰ÈÒÓ ÚÔÛ¯ÔÏÈ΋˜ ËÏÈΛ·˜” ÙÔ 2004 (14), ÂÚÈÏ·Ì‚¿ÓÂÈ Î·Ì‡Ï˜ ÂÚÈ̤ÙÚÔ˘ ̤Û˘, fiˆ˜ Î·È ÔÈ ‰ËÌÔÛȇÛÂȘ ÙˆÓ ™¿‚‚· Î·È Û˘Ó. (13), Û ·ÓÙÈÚÔÛˆ¢ÙÈÎfi ‰Â›ÁÌ· ·È‰ÈÒÓ Ù˘ ∫‡ÚÔ˘. ¶ÏËı˘ÛÌȷΤ˜ ÔÌ¿‰Â˜ ·È‰ÈÒÓ ·ÎfiÌ· ·fi ÙËÓ ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ·, ‚Ú¤ıËÎ·Ó Ó· ¤¯Ô˘Ó ‰ÈÏ¿ÛÈ· Â›‰· ÈÓÛÔ˘Ï›Ó˘ Û ÂΛӷ Ô˘ ›¯·Ó ÂÚ›ÌÂÙÚÔ Ì¤Û˘ ¿Óˆ ·fi ÙËÓ 85Ë ∂.£. Û ۇÁÎÚÈÛË Ì’ ·˘Ù¿ Ô˘ ‹Ù·Ó οو ·fi ÙËÓ 15Ë ∂.£. (10). °È’ ·˘Ùfi ÌÂ

Ó¤· ÂıÓÈ΋ ‰ÂÈÁÌ·ÙÔÏË„›· ·È‰ÈÒÓ fiÏ˘ Ù˘ ¯ÒÚ·˜ Ô˘ ı· ÛÙԯ‡ÂÈ ÛÙËÓ ÂÎÙ›ÌËÛË ÙÔ˘ ÂÈ¤‰Ô˘ ˘Á›·˜, ıÚ¤„˘ Î·È ·Ó¿Ù˘Í˘, Ë ÂÚ›ÌÂÙÚÔ˜ ̤Û˘ Ú¤ÂÈ ™¯ËÌ·ÙÈ΋ Û‡ÁÎÚÈÛË. ª™ ηÌ˘ÏÒÓ ·Ó¿Ù˘Í˘ ∞’ ¶∫¶∞ Î·È ÔÚ›ˆÓ ˘¤Ú‚·ÚˆÓ Î·È ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ ‚¿ÛË ÙÔ˘ IOTF

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∂ÈÎfiÓ· 3. ™¯ËÌ·ÙÈ΋ Û‡ÁÎÚÈÛË Î·Ì˘ÏÒÓ ¢ª™ ·ÁÔÚÈÒÓ ·fi CDC Î·È ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ∞ıËÓÒÓ. ¶·È‰È·ÙÚÈ΋ 2007;70:70-74

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Ó· ÂÚÈÏ·Ì‚¿ÓÂÙ·È ÛÙȘ ÌÂÙÚ‹ÛÂȘ. √È Î·Ì‡Ï˜ ÂÚÈ̤ÙÚÔ˘ ̤Û˘ Ú¤ÂÈ Ó· ÌÔ˘Ó ÛÙ· ‚È‚ÏÈ¿ÚÈ· ˘Á›·˜ ÙÔ˘ ·È‰ÈÔ‡ ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË ÙÔ˘ ‚·ıÌÔ‡ ÎÂÓÙÚÈ΋˜ ·¯˘Û·ÚΛ·˜.

µÈ‚ÏÈÔÁÚ·Ê›· 1. ÃÈÒÙ˘ ¢, ∆Û›ÊÙ˘ °, ÷Ù˙ËÛ˘ÌÂÒÓ ª, ª·ÓÈ¿ÙË-ÃÚËÛÙ›‰Ë ª, ∫Ú›ÎÔ˜ •, ¢¿ÎÔ˘-µÔ˘ÙÂÙ¿ÎË ∞. ∞Ó¿ÛÙËÌ· Î·È ÛˆÌ·ÙÈÎfi ‚¿ÚÔ˜ ÂÏÏËÓÔ·›‰ˆÓ ËÏÈΛ·˜ 0-18 ÂÙÒÓ (20002001): Û‡ÁÎÚÈÛË Ì ‰Â‰Ô̤ӷ ÌÂϤÙ˘ 1978-1979. ¢ÂÏÙ›Ô ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋˜ 2003;50:136-156.

2. ÃÈÒÙ˘ ¢, ∫Ú›ÎÔ˜ •, ∆Û›ÊÙ˘ °, ÷Ù˙ËÛ˘ÌÂÒÓ ª, ª·ÓÈ¿ÙË-ÃÚËÛÙ›‰Ë ª, ¢¿ÎÔ˘-µÔ˘ÙÂÙ¿ÎË ∞. ¢Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ (BMI) Î·È ÔÛÔÛÙfi ·¯˘Û·ÚΛ·˜ Û ¿ÙÔÌ· Ù˘ ¢ڇÙÂÚ˘ ÂÚÈÔ¯‹˜ ∞ıËÓÒÓ, ËÏÈΛ·˜ 0-18 ÂÙÒÓ. ¢ÂÏÙ›Ô Õ ¶·È‰È·ÙÚÈ΋˜ ∫ÏÈÓÈ΋˜ 2004;51:139-154.

3. ÃÚÔ‡ÛÔ˜ °¶. ¶·È‰È΋ ·¯˘Û·ÚΛ· ÛÙËÓ ∂ÏÏ¿‰·. ¶·È‰È·ÙÚÈ΋ £ÂÚ·¢ÙÈ΋ ∂ÓË̤ڈÛË 2003; 225-234.

4. National Center for Health Statistics. [Webpage, Internet].

Growth Charts for the United States: Methods and Development, CDC 2000:http://www.cdc.gov/growthcharts 5. Cole TJ, Freeman JV, Preece MA. Body mass index reference curves for the UK, 1990. Arch Dis Child 1995;73(1):25-29.

6. Cameron N. British growth charts for height and weight with recommendations concerning their use in axiological assessment. Ann Hum Biol 2002; 29(1):1-10.

“√ÓÂÈÚ‡ÔÌ·È ÙËÓ ∂ÈÚ‹ÓË”, Lina Maria Ocampo, 12 ¯ÚÔÓÒÓ, ∫ÔÏÔÌ‚›· ¶·È‰› Ì ÌÂÚÈ΋ fiÚ·ÛË “∆· Ù˘ÊÏ¿ ·È‰È¿ ˙ˆÁÚ·Ê›˙Ô˘Ó”, ÕÓÓ· §·Ô˘Ù¿ÚË°ÎÚÈÙ˙¿Ï·, ∞ı‹Ó· 2006

“Dreaming with the Peace”, Lina Maria Ocampo, 12 years old, Colombia Partially blind child “Blind children paint”, Anna Laoutari-Gritzala, Athens 2006

Paediatriki 2007;70:70-74

7. ª·Ù˙·ÁÚÈÒÙË-ªÂ˚ÌÂÚ›‰Ë ª, ¶·ÓÙ·˙›‰Ë˜ ¡, ¢ÔÍÈ¿‰Ë˜ ™, ƒ·Ê·‹Ï ª. ∂ıÓÈο ÚfiÙ˘· ·Ó¿Ù˘Í˘: µ¿ÚÔ˜ Î·È ‡„Ô˜ ·È‰ÈÎÔ‡ ÏËı˘ÛÌÔ‡ ÛÙËÓ ∂ÏÏ¿‰·. ¶·È‰È·ÙÚÈ΋ 1986; 49:1-15.

8. Lobstein T, Baur L, Uauy R; IASO International Obesity TaskForce. Obesity in children and young people: a crisis in public health. Report to the WHO. Obes Rev 2004; 5(1 Suppl):S4-S104.

9. Magkos F, Manios Y, Christakis G, Kafatos AG. Secular trends in cardiovascular risk factors among school-aged boys from Crete, Greece, 1982-2002. Eur J Clin Nutr 2005; 59:1-7.

10. ªÔÛ¯·Ó‰Ú¤· I, ÷Ù˙‹˜ X, ª·ÌÌ¿˜ I, ªÂÚÙÛÈ¿˜ °, §ÈÓ·Ú‰¿Î˘ ª, ∫˘Úȷο΢ ª, et al. ¢Â›ÎÙ˜ ·¯˘Û·ÚΛ·˜ Î·È ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ Û ·È‰È¿ ·ÁÚÔÙÈ΋˜ ÔÚÂÈÓ‹˜ ÂÚÈÔ¯‹˜ Ù˘ ∫Ú‹Ù˘. ¶·È‰È·ÙÚÈ΋ 2003;66:264-277.

11. §ÈÓ·Ú‰¿Î˘ ª, ªÔÛ¯·Ó‰Ú¤· I, ∫·Ê¿ÙÔ˜ ∞. ∫·Ì‡Ï˜ ۈ̷ÙÈ΋˜ ·Ó¿Ù˘Í˘ ·È‰ÈÒÓ ‚ÚÂÊÈ΋˜ Î·È ÚÔÛ¯ÔÏÈ΋˜ ËÏÈΛ·˜ Ù˘ ∫Ú‹Ù˘ Ô˘ ÚԤ΢„·Ó ·fi ‰È·¯ÚÔÓÈ΋ ·Ú·ÎÔÏÔ‡ıËÛ‹ ÙÔ˘˜. ¶·È‰È·ÙÚÈ΋ 2000;63:391-407.

12. ∞˚‚¿˙˘ µ. ∆Ô Ê˘ÛÈÔÏÔÁÈÎfi ·È‰› - ¶ÚfiÙ˘· ÛÙÔȯ›· ·Ó¿Ù˘Í˘. £ÂÛÛ·ÏÔÓ›ÎË 1990.

13. Savva SC, Kourides Y, Tornaritis M, Epiphaniou-Savva M, Tafouna P, Kafatos A. Reference growth curves for Cypriot children 6 to 17 years of age. Obes Res 2001;9:754-762.

14. ∫·Ê¿ÙÔ˜ ∞. ÀÁ›·, ¢È·ÙÚÔÊ‹ Î·È ·Ó¿Ù˘ÍË ·È‰ÈÒÓ ÚÔÛ¯ÔÏÈ΋˜ ËÏÈΛ·˜. ¡Ô̷گȷ΋ ∞˘ÙÔ‰ÈÔ›ÎËÛË Ã·Ó›ˆÓ ¶·ÓÂÈÛÙ‹ÌÈÔ ∫Ú‹Ù˘, ÂΉfiÙ˜. ÷ÓÈ¿: 2004.

∫§π¡π∫√ ∫√Àπ∑

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¡ÂÊÚÔÏÔÁÈÎfi ∆Ì‹Ì·, ¡ÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ “¶. Î·È ∞. ∫˘ÚÈ·ÎÔ‡”

K. ™ÙÂÊ·Ó›‰Ë˜, µ. ∞ÛÎËÙ‹

∞ÁfiÚÈ ËÏÈΛ·˜ 8 ÂÙÒÓ ·ÚÔ˘Û›·Û ̷ÎÚÔÛÎÔÈ΋ ·ÈÌ·ÙÔ˘Ú›·, ‰È·ÚΛ·˜ ‰‡Ô ËÌÂÚÒÓ Î·È ÛÙË Û˘Ó¤¯ÂÈ· ÂÈ̤ÓÔ˘Û· ÌÈÎÚÔÛÎÔÈ΋ ·ÈÌ·ÙÔ˘Ú›·. ∆Ô ·ÙÔÌÈÎfi ÈÛÙÔÚÈÎfi ‹Ù·Ó ÂχıÂÚÔ. ¢ÂÓ ·Ó·Ê¤ÚıËΠÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÓÂÊÚÔ¿ıÂÈ·˜ ‹ ¿ÏÏÔ˘ ¯ÚfiÓÈÔ˘ ÓÔÛ‹Ì·ÙÔ˜. ∞fi ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË ‰È·ÈÛÙÒıËΠ‡„Ô˜ Î·È ‚¿ÚÔ˜ ÛÙËÓ 50‹ ÂηÙÔÛÙÈ·›· ı¤ÛË, Ê˘ÛÈÔÏÔÁÈ΋ ·ÚÙËÚȷ΋ ›ÂÛË Î·È Î·Ù¿ Û˘ÛÙ‹Ì·Ù· ÂͤٷÛË ¯ˆÚ›˜ ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·, ÂÎÙfi˜ ·fi ÙËÓ ‡·ÚÍË ÎÈÚÛÔ΋Ï˘ ·ÚÈÛÙÂÚ¿. ∏ ÁÂÓÈ΋ ·›Ì·ÙÔ˜ Î·È Ô ‚ÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ (Ô˘Ú›·, ÎÚ·ÙÈÓ›ÓË, Ô˘ÚÈÎfi Ô͇, ÁÏ˘Îfi˙Ë, ·Û‚¤ÛÙÈÔ, οÏÈÔ, Ó¿ÙÚÈÔ, pH Î·È ‰ÈÙÙ·ÓıÚ·ÎÈο) ‰ÂÓ ¤‰ÂÈÍ·Ó ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·. √ ¤ÏÂÁ¯Ô˜ ËÎÙÈÎfiÙËÙ·˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜. ∆· Â˘Ú‹Ì·Ù· ·fi ÙË ÁÂÓÈ΋ Ô‡ÚˆÓ ‹Ù·Ó: ÂȉÈÎfi ‚¿ÚÔ˜ 1020, χΈ̷ ·ÚÓËÙÈÎfi, ·ÈÌÔ-

ÛÊ·ÈÚ›ÓË +++ Î·È ÂÚ˘ıÚÔ·ÙÙ·Ú· 15-20/ÔÙÈÎfi ‰›Ô. ¢ÂÓ ‰È·ÈÛÙÒıËÎ·Ó ‰‡ÛÌÔÚÊ· ÂÚ˘ıÚÔ·ÙÙ·Ú· ÛÙËÓ ÂͤٷÛË ÙÔ˘ È˙‹Ì·ÙÔ˜ ÙˆÓ Ô‡ÚˆÓ Ì ÌÈÎÚÔÛÎfiÈÔ ·ÓÙÈı¤ÙˆÓ Ê¿ÛˆÓ. √ ÏfiÁÔ˜ ·Û‚ÂÛÙ›Ô˘ Ô‡ÚˆÓ/ÎÚ·ÙÈÓ›ÓË Ô‡ÚˆÓ, Ô˘ÚÈÎfi Ô͇ Ô‡ÚˆÓ/ÎÚ·ÙÈÓ›ÓË Ô‡ÚˆÓ Î·È ÔÍ·ÏÈÎfi Ô͇ Ô‡ÚˆÓ/ÎÚ·ÙÈÓ›ÓË Ô‡ÚˆÓ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜. ∆Ô ˘ÂÚ˯ÔÁÚ¿ÊËÌ· Ô˘ÚÔÔÈËÙÈÎÔ‡ ¤‰ÂÈÍÂ Ê˘ÛÈÔÏÔÁÈÎfi ̤ÁÂıÔ˜ Î·È Ë¯ÔÁ¤ÓÂÈ· ÓÂÊÚÒÓ ¯ˆÚ›˜ ‰È¿Ù·ÛË ÙÔ˘ ˘ÂÏÔÎ·Ï˘ÎÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ‹ Î·È ÙˆÓ Ô˘ÚËÙ‹ÚˆÓ. ™Â ËÏÈΛ· 9 ÂÙÒÓ ÙÔ ·È‰› ·ÚÔ˘Û›·Û 2Ë ÊÔÚ¿ Ì·ÎÚÔÛÎÔÈ΋ ·ÈÌ·ÙÔ˘Ú›·. ™ÙËÓ Î˘ÛÙÂÔÛÎfiËÛË ‰È·ÈÛÙÒıËΠ·ÈÌ·ÙÔ˘Ú›· ÌfiÓÔ ·fi ÙÔÓ ·ÚÈÛÙÂÚfi Ô˘ÚËÙ‹Ú·. ™ÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜ ‰È·ÈÛÙÒıËΠÛËÌ·ÓÙÈ΋ ‰È¿Ù·ÛË Ù˘ ·ÚÈÛÙÂÚ¿˜ ÓÂÊÚÈ΋˜ ÊϤ‚·˜ (∂ÈÎfiÓ· 1).

AÏÏËÏÔÁÚ·Ê›·: K. ™ÙÂÊ·Ó›‰Ë˜ stefanid@hol.gr ¡ÂÊÚÔÏÔÁÈÎfi ∆Ì‹Ì·, ¡ÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ “¶. Î·È ∞. ∫˘ÚÈ·ÎÔ‡”

¶Èı·Ó¤˜ ‰È·ÁÓÒÛÂȘ: 1. IgA ÓÂÊÚÔ¿ıÂÈ· 2. ¡ÂfiÏ·ÛÌ· ÓÂÊÚÔ‡ 3. ¡ÂÊÚÔÏÈı›·ÛË 4. ™‡Ó‰ÚÔÌÔ Î·Ú˘ÔıÚ·‡ÛÙË

∂ÈÎfiÓ· 1. ∂ÁοÚÛÈ· ÙÔÌ‹ ˘ÂÚ˯ÔÁÚ·Ê‹Ì·ÙÔ˜ ÎÔÈÏ›·˜ (1: ¿Óˆ ÌÂÛÂÓÙ¤ÚÈÔ˜ ·ÚÙËÚ›·, 2: ·ÔÚÙ‹, 3: ÓÂÊÚÈ΋ ÊϤ‚·).

∏ ·¿ÓÙËÛË ·ÎÔÏÔ˘ı› ÛÙË ÛÂÏ›‰· 78 ¶·È‰È·ÙÚÈ΋ 2006;69:75,78-79

76

¡∂∞ ∞¶√ ∆√ ¢π∞¢π∫∆À√

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

¡›ÎÔ˜ ¶··‰fiÔ˘ÏÔ˜, ¶·È‰›·ÙÚÔ˜, ∞ÏÏÂÚÁÈÔÏfiÁÔ˜

AÏÏËÏÔÁÚ·Ê›·: ¡›ÎÔ˜ ¶··‰fiÔ˘ÏÔ˜ E-mail: ngp@allergy.gr

T· ÙÂÏÂ˘Ù·›· ‰‡Ô ¯ÚfiÓÈ· ¤Ó· Ó¤Ô Ê·ÈÓfiÌÂÓÔ ÂÌÊ·Ó›ÛÙËÎÂ Î·È ‹Ú ÛËÌ·ÓÙÈΤ˜ ‰È·ÛÙ¿ÛÂȘ ÛÙÔ ‰È·‰›ÎÙ˘Ô: Ù· blogs (Û‡ÓÙÌËÛË ÙÔ˘ web-logs) ·ÔÙÂÏÔ‡Ó ‰È·‰ÈÎÙ˘·Î¿ ËÌÂÚÔÏfiÁÈ·-ÛËÌÂȈ̷ٿÚÈ·, Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÁÈ· ÙËÓ Î·Ù·ÁÚ·Ê‹ Î·È ÙËÓ Ù·ÍÈÓfiÌËÛË ÙˆÓ ÛΤ„ÂˆÓ ÙÔ˘ Û˘ÓÙ¿ÎÙË, Ì ‚¿ÛË ÙËÓ ËÌÂÚÔÌËÓ›· Î·È ÙËÓ ÒÚ· Ô˘ ηٷ¯ˆÚÔ‡ÓÙ·È. ™ËÌ·ÓÙÈ΋ ÒıËÛË ÛÙËÓ ÂÍ¿ψÛË ÙÔ˘˜ ·ÔÙ¤ÏÂÛ·Ó Ù· ÁÂÁÔÓfiÙ· Ù˘ 11˘ ™ÂÙÂÌ‚Ú›Ô˘ 2001, fiÙ·Ó ÔÏÏÔ› ·ÏÔ› ¯Ú‹ÛÙ˜ ¤ÓÈˆÛ·Ó ÙËÓ ·Ó¿ÁÎË Ó· ÌÔ˘Ó ÛÙÔ ‰È·‰›ÎÙ˘Ô ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂÓËÌÂÚˆıÔ‡Ó, Ó· ÌÔÈÚ·ÛÙÔ‡Ó ÙȘ ÛΤ„ÂȘ Î·È Ù· Û˘Ó·ÈÛı‹Ì·Ù¿ ÙÔ˘˜, ηıÒ˜ Î·È Ó· ÚÔ‚Ô‡Ó ÛÙÔÓ Û¯ÔÏÈ·ÛÌfi ÙˆÓ ÁÂÁÔÓfiÙˆÓ. ™‹ÌÂÚ· Ù· weblogs ˘¿Ú¯Ô˘Ó Û ‰È¿ÊÔÚ˜ ·Ú·ÏÏ·Á¤˜. °È· ¤Ó·Ó ·Ïfi ¯Ú‹ÛÙË, ÙÔ weblog ÌÔÚ› Ó· Â›Ó·È ¤Ó·˜ ÙÚfiÔ˜ ÁÈ· Ó· ÂÎÊÚ¿ÛÂÈ ÙȘ ÚÔÛˆÈΤ˜ ÙÔ˘ ·fi„ÂȘ Û¯ÂÙÈο Ì ÙËÓ ÂÈηÈÚfiÙËÙ·, Ì ı¤Ì·Ù· Â·ÁÁÂÏÌ·ÙÈο ‹ ÚÔÛˆÈο, ÂÓÒ ÁÈ· ÌÈ· ÂÙ·ÈÚ›· ÌÔÚ› Ó· Â›Ó·È ¤Ó· ̤ÛÔ Û˘ÏÏÔÁÈ΋˜ ηٷÁÚ·Ê‹˜ ÛΤ„ˆÓ, ˘ԉ›ÍÂˆÓ Î·È ÂÈÛËÌ¿ÓÛˆÓ, ÂÍ·Ï›ÙÔÓÙ·˜ ¤ÙÛÈ ÙËÓ ·Ó¿ÁÎË ·ÔÛÙÔÏ‹˜ e-mail. ∞Ó ı¤ÏÂÙ ÌÔÚ›Ù ÎÈ ÂÛ›˜, ¯ˆÚ›˜ ȉȷ›ÙÂÚ˜ Ù¯ÓÈΤ˜ ÁÓÒÛÂȘ Ó· ÍÂÎÈÓ‹ÛÂÙ ӷ ÁÚ¿ÊÂÙ ¤Ó· blog. ∂ÈÛÎÂÊı›Ù ÙÔ www.blogger.com, fiÔ˘ ˘¿Ú¯Ô˘Ó ÙfiÛÔ Ù· ̤۷ fiÛÔ Î·È ÔÈ ··Ú·›ÙËÙ˜ ÏËÚÔÊÔڛ˜ Û¯ÂÙÈο Ì ÙË ÊÈÏÔÛÔÊ›· ÙˆÓ blogs. ∞Ó ¿ÏÈ, ı¤ÏÂÙ ӷ ‰È·‚¿ÛÂÙ ‹ Ó· ÌÔÈÚ·ÛÙ›Ù ÛΤ„ÂȘ ¿ÏÏˆÓ Û˘Ó·‰¤ÏÊˆÓ ‹ ·ÛıÂÓÒÓ, ˘¿Ú¯ÂÈ ÙÂÚ¿ÛÙÈ· ÔÈÎÈÏ›·, ÌÔÚ›Ù fï˜ Ó· ÍÂÎÈÓ‹ÛÂÙ ·fi Ù· ·Ú·Î¿Ùˆ:

Pediatric Blogs

Medicine World - http://medicineworld.org/news/pediatric-news.html ™ÙËÓ ÈÛÙÔÛÂÏ›‰· Medicine World Ô ÂÈÛΤÙ˘ ¤¯ÂÈ ÚfiÛ‚·ÛË Û ÏËıÒÚ· ¿ÚıÚˆÓ ÛÙÔÓ ÙÔ̤· ÙˆÓ Pediatric News, Ù· ÔÔ›· ηٷٿÛÛÔÓÙ·È Ì ¯ÚÔÓÔÏÔÁÈ΋ ÛÂÈÚ¿. ∂ÈÚfiÛıÂÙ· ÙÔ site ÚÔÛʤÚÂÈ ÛÙÔÓ ÂÈÛΤÙË ÙË ‰˘Ó·ÙfiÙËÙ· Ó· ·Ó·ÁÓÒÛÂÈ ÔÏϤ˜ ÂÚÈÙÒÛÂȘ Û¯ÂÙÈΤ˜ Ì ÎÔÈÓ¿ ÚÔ‚Ï‹Ì·Ù· Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ Ù· ÔÔ›· ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ì ¤Ó·Ó ȉȷ›ÙÂÚ· ÁÏ·Ê˘Úfi ÂÚÈÁÚ·ÊÈÎfi ÙÚfiÔ. ÕÚıÚ· fiˆ˜ “¡¤· ∂Ï›‰· ÁÈ· Ù· ·È‰È¿ Ô˘ ¿Û¯Ô˘Ó ·fi §Â˘¯·ÈÌ›·”, fiÔ˘ ·Ó·ÎÔÈÓÒÓÂÙ·È Ë ÂÊ·ÚÌÔÁ‹ Ó¤ˆÓ ‚ÂÏÙÈˆÌ¤ÓˆÓ Ù¯ÓÈÎÒÓ ÁÈ· ÌÂÙ·ÌÔۯ‡ÛÂȘ ÚÔÁÔÓÈÎÒÓ Î˘ÙÙ¿ÚˆÓ Û ·È‰È¿, ‹ ¿ÚıÚ· Ô˘ ·ÊÔÚÔ‡Ó ÂÚÈÛÛfiÙÂÚÔ ˙ËÙ‹Ì·Ù· „˘¯ÔÏÔÁÈ΋˜ ʇÛˆ˜ fiˆ˜ “∞ÓÙÈÌÂÙˆ›˙ÔÓÙ·˜ Ù· ·È‰È¿ Ì ÂÓÔ‡ÚËÛË” Â›Ó·È ÌÂÚÈο ÌfiÓÔ ·fi ·˘Ù¿ Ô˘ ÌÔÚ› ηÓ›˜ Ó· ÂÓÙÔ›ÛÂÈ ÛÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ blog. ∆Ô site ‰›ÓÂÈ ÙËÓ Â˘Î·ÈÚ›· Û οı ·È‰›·ÙÚÔ Ó· ÂÁÁÚ·Ê› ˆ˜ ̤ÏÔ˜ Î·È Ó· ‰ËÌÔÛȇÛÂÈ ÙÔ ¿ÚıÚÔ ÙÔ˘ ·ÏÏ¿ Ù·˘Ùfi¯ÚÔÓ· ·Ó·Ê¤ÚÂÈ fiÙÈ Ù· ¿ÚıÚ· Ú¤ÂÈ Ó· ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ˆ˜ ËÁ‹ ÚÔÛˆÈ΋˜ ÏËÚÔÊfiÚËÛ˘ Î·È fi¯È ˆ˜ ‚¿ÛË È·ÙÚÈÎÒÓ ÂÊ·ÚÌÔÁÒÓ.

Paediatriki 2007;70:76-77

NEWS FROM THE INTERNET

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WebMD - http://blogs.webmd.com/healthy-children/ ∆ËÓ ÂÍ¿ψÛË ÙˆÓ blogs ¤¯Ô˘Ó ·Ó·Î·Ï‡„ÂÈ Î·È ¯ÚËÛÈÌÔÔÈÔ‡Ó Î·È ÌÂÁ¿Ï·, ÔÚÁ·ÓˆÌ¤Ó· sites, fiˆ˜ .¯. ÙÔ webMD, ÛÙÔ ÔÔ›Ô ÔÈ ÛΤ„ÂȘ /ÛËÌÂÈÒÛÂȘ ÚÔ¤Ú¯ÔÓÙ·È ·fi ÂȉÈÎÔ‡˜. ∞Ó Î·È Ë ÚÔÛ¤ÁÁÈÛË ·˘Ù‹ ÌÂÈÒÓÂÈ ÙÔÓ ·˘ıÔÚÌËÙÈÛÌfi ÙˆÓ blogs, ˘¿Ú¯ÂÈ ÌÂÁ·Ï‡ÙÂÚË ÛÈÁÔ˘ÚÈ¿ Û¯ÂÙÈο Ì ÙË ÌË-·˘ı·ÈÚÂÛ›· Ù˘ ÏËÚÔÊÔÚ›·˜

Your Child’s Health - http://yourchildshealth.blogspot.com/2006_12_01_archive.html ∫·È ¤Ó· ·Ú¿‰ÂÈÁÌ· blog ·fi ·È‰›·ÙÚÔ: ηÏÔÛÙË̤ÓË, ¢¯¿ÚÈÛÙË Î·È ‰ËÌÈÔ˘ÚÁÈ΋, Ë ÚÔÛˆÈ΋ ÈÛÙÔÛÂÏ›‰· Ù˘ Dr Gwenn ÔÓÔÌ¿˙ÂÙ·È “Your Child’s Health” Î·È ·ÔÙÂÏ› ¤Ó· blog ÁÈ· ÙȘ Û‡Á¯ÚÔÓ˜ ÔÈÎÔÁ¤ÓÂȘ Ì ÂӉȷʤÚÔÓÙ· Ó¤·, Û¯ÔÏÈ·ÛÌÔ‡˜ Î·È ÛΤ„ÂȘ. ∏ ·È‰›·ÙÚÔ˜ ÂÎı¤ÙÂÈ Ù˘ ȉ¤Â˜ Ù˘ Î·È ÌÔÈÚ¿˙ÂÙ·È ÙȘ ÂÌÂÈڛ˜ Ù˘ Ì ÙÔ˘˜ ÁÔÓ›˜ Â͢ËÚÂÙÒÓÙ·˜ Ù·˘Ùfi¯ÚÔÓ· ¤Ó·Ó ‰È·‰Ú·ÛÙÈÎfi ÛÎÔfi. ∆›ÙÏÔÈ ¿ÚıÚˆÓ fiˆ˜ “¢È·ÙÚÔÊÈΤ˜ ·ÏÏÂÚÁ›Â˜”, “£¤Ì·Ù· Û¯ÂÙÈο Ì ٷ Ó‹È·”, “¢È·ÛΤ‰·ÛË Î·È ·ÛÊ¿ÏÂÈ· ÛÙȘ ‰Ú·ÛÙËÚÈfiÙËÙ˜ ÂÎÙfi˜ ÛÈÙÈÔ‡” ‹ “∏ ˘Á›· ÙˆÓ ÂÊ‹‚ˆÓ”, οÓÔ˘Ó ÙËÓ ¤Ú¢ӷ ÈÔ Â‡ÎÔÏË Î·È Ú·ÎÙÈ΋. ∆Ô site ¤¯ÂÈ ·ÎfiÌË Û ÛÙ‹ÏË ·Ú¯ÂÈÔıÂÙË̤ӷ Ù· ÚÔËÁÔ‡ÌÂÓ· blogs ·ÏÏ¿ Î·È Ï›ÛÙ· Ì links ¿ÏÏˆÓ ¯Ú‹ÛÈÌˆÓ ÈÛÙÔÛÂÏ›‰ˆÓ (∞ÌÂÚÈηÓÈ΋ ∞η‰ËÌ›· ¶·È‰È¿ÙÚˆÓ, ™‡Á¯ÚÔÓË ¶·È‰È·ÙÚÈ΋ Î.¿). ∏ Û˘ÁÎÂÎÚÈ̤ÓË ÈÛÙÔÛÂÏ›‰· ÚÔÛʤÚÂÈ ÌÈ· ¢¯¿ÚÈÛÙË ·Ó¿ÁÓˆÛË ‰È·ÓıÈṲ̂ÓË Ì ÂÈÎfiÓ˜ Î·È ÏÔ‡ÛÈ· ÁÚ·ÊÈο, ÂÓÒ ·Ú¿ÏÏËÏ· ˘¿Ú¯ÂÈ ‰˘Ó·ÙfiÙËÙ· ÂÈÎÔÈÓˆÓ›·˜, ·Ú¿ıÂÛ˘ Û¯ÔÏ›ˆÓ ‹ Î·È ÂÓÂÚÁÔ‡ Û˘ÌÌÂÙÔ¯‹˜ ÛÙËÓ ·ÚıÚÔÁÚ·Ê›·.

∞˜ ÛËÌÂȈı› fiÙÈ Ë ·ÍÈÔÈÛÙ›· ÙˆÓ ÏËÚÔÊÔÚÈÒÓ ÛÙ· blogs ‰ÂÓ ÂϤÁ¯ÂÙ·È ·fi Î·Ó¤Ó·Ó ÎÈ ¤ÙÛÈ, ÂÓÒ ÌÔÚ› Ó· ·ÔÙÂϤÛÔ˘Ó Â˘¯¿ÚÈÛÙÔ ·Ó¿ÁÓˆÛÌ·, ı· Ú¤ÂÈ Ó· Á›ÓÂÙ·È Û·Ê¤˜ fiÙÈ ‰ÂÓ ¤¯Ô˘Ó Û η̛· ÂÚ›ÙˆÛË ÚfiÏÔ È·ÙÚÈ΋˜ ÁÓÒÌ˘ ‹ Û˘Ì‚Ô˘Ï‹˜!

¶·È‰È·ÙÚÈ΋ 2007;70:76-77

78

CLINICAL QUIZ

∫ÏÈÓÈÎfi QUIZ ∞¶∞¡∆∏™∏

∏ ‰È¿ÁÓˆÛË ‹Ù·Ó Û‡Ó‰ÚÔÌÔ ÙÔ˘ ηڢÔıÚ·‡ÛÙË (nutcracker), Ë ÔÔ›· ‚·Û›ÛıËΠÛÙ· Ù˘Èο Â˘Ú‹Ì·Ù· Ù˘ ˘ÔÙÚÔÈ¿˙Ô˘Û·˜ Ì·ÎÚÔÛÎÔÈ΋˜ ·ÈÌ·ÙÔ˘Ú›·˜ ÌfiÓÔ ·fi ÙÔÓ ·ÚÈÛÙÂÚfi Ô˘ÚËÙ‹Ú·, ÌÈÎÚÔÛÎÔÈ΋˜ ·ÈÌ·ÙÔ˘Ú›·˜ Ì ÈÛÔÌÔÚÊÈο ÂÚ˘ıÚÔ·ÙÙ·Ú· ÛÙËÓ ÂͤٷÛË ÙÔ˘ È˙‹Ì·ÙÔ˜ Ô‡ÚˆÓ Ì ÌÈÎÚÔÛÎfiÈÔ ·ÓÙÈı¤ÙˆÓ Ê¿ÛˆÓ, ÛÙËÓ ÎÈÚÛÔ΋ÏË Î·È ÂȂ‚·ÈÒıËΠ̠ÙÔ ¯·Ú·ÎÙËÚÈÛÙÈÎfi ‡ÚËÌ· ‰È¿Ù·ÛË Ù˘ ·ÚÈÛÙÂÚ‹˜ ÓÂÊÚÈ΋˜ ÊϤ‚·˜ ÛÙËÓ ÂÁοÚÛÈ· ÙÔÌ‹ ÙÔ˘ ˘ÂÚ˯ÔÁÚ·Ê‹Ì·ÙÔ˜ ÎÔÈÏ›·˜ (∂ÈÎfiÓ· 2). ∆Ô Û‡Ó‰ÚÔÌÔ ÙÔ˘ ηڢÔıÚ·‡ÛÙË Â›Ó·È ·ÔÙ¤ÏÂÛÌ· Û˘Ì›ÂÛ˘ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÓÂÊÚÈ΋˜ ÊϤ‚·˜ ·fi ÙËÓ ·ÔÚÙ‹ Î·È ÙËÓ ¿Óˆ ÌÂÛÂÓÙ¤ÚÈ· ·ÚÙËÚ›·, Ô˘ ÏÂÈÙÔ˘ÚÁÔ‡Ó Û·Ó Ù· ‰‡Ô ÛΤÏË ÂÓfi˜ ηڢÔıÚ·‡ÛÙË (1). ∆Ô Û‡Ó‰ÚÔÌÔ ·˘Ùfi ÔÊ›ÏÂÙ·È Û ·ÓÒÌ·ÏË ‰È·ÎÏ¿‰ˆÛË Ù˘ ¿Óˆ ÌÂÛÂÓÙ¤ÚÈ·˜ ·ÚÙËÚ›·˜ ·fi ÙËÓ ·ÔÚÙ‹ ‹ ÛÙËÓ ÂÏ¿ÙÙˆÛË Ù˘ ÁˆÓ›·˜ Ô˘ Û¯ËÌ·Ù›˙ÂÙ·È ·fi ÙȘ ‰‡Ô ·˘Ù¤˜ ·ÚÙËڛ˜ (1,2) (∂ÈÎfiÓ· 3). ∏ ÁˆÓ›· ·˘Ù‹ ÂÏ·ÙÙÒÓÂÙ·È ·ÎfiÌË ÂÚÈÛÛfiÙÂÚÔ ÛÙËÓ fiÚıÈ· ı¤ÛË Î·È ¤ÙÛÈ ÌÔÚ› Ó· ÂÍËÁËı› Î·È Ë ÂÌÊ¿ÓÈÛË ÔÚıÔÛÙ·ÙÈ΋˜ ÏÂ˘ÎˆÌ·ÙÔ˘Ú›·˜ Û ·ÛıÂÓ›˜ Ì ÙÔ Û‡Ó‰ÚÔÌÔ ·˘Ùfi (3) ‹ Ë ÂÌÊ¿ÓÈÛË ÙˆÓ ÂÂÈÛÔ‰›ˆÓ Ì·ÎÚÔÛÎÔÈ΋˜ ·ÈÌ·ÙÔ˘Ú›·˜ ÌÂÙ¿ ·fi ¿ÛÎËÛË. ∏ ·‡ÍËÛË Ù˘ ›ÂÛ˘ ÛÙËÓ ·ÚÈÛÙÂÚ‹ ÓÂÊÚÈ΋ ÊϤ‚· ‰ËÌÈÔ˘ÚÁ› ·Ú¿Ï¢ÚË ÊÏ‚È΋ ΢ÎÏÔÊÔÚ›· Î·È ÚÔηÏ› ·ÏÈÓ‰ÚfiÌËÛË ·›Ì·ÙÔ˜ ÛÙËÓ ¤Ûˆ ÛÂÚÌ·ÙÈ΋ ÊϤ‚· Î·È ÂÌÊ¿ÓÈÛË ÎÈÚÛÔ΋Ï˘, ηıÒ˜ Î·È ÌÈÎÚÔÚ‹ÍÂȘ ÙˆÓ ÊÏ‚ÒÓ Ì ÏÂÙfi ÙÔ›¯ˆÌ· ÙÔ˘ ÕÓˆ ÌÂÛÂÓÙ¤ÚÈ· ·ÚÙËÚ›· ŒÛˆ ÛÂÚÌ·ÙÈ΋ ÊϤ‚·

¡ÂÊÚÈ΋ ÊϤ‚· ∞ÔÚÙ‹

∞ÚÈÛÙÂÚfi˜ ÓÂÊÚfi˜

∂ÈÎfiÓ· 2. ªË¯·ÓÈÛÌfi˜ ÚfiÎÏËÛ˘ ‚Ï¿‚˘ ÛÙÔ Û‡Ó‰ÚÔÌÔ ÙÔ˘ ηڢÔıÚ·‡ÛÙË.

Paediatriki 2007;70:75,78-79

ÕÓˆ ÌÂÛÂÓÙ¤ÚÈ· ·ÚÙËÚ›·

∞ÚÈÛÙÂÚfi˜ ÓÂÊÚfi˜

¡ÂÊÚÈ΋ ÊϤ‚· ∞ÔÚÙ‹

ŒÛˆ ÛÂÚÌ·ÙÈ΋ ÊϤ‚·

∂ÈÎfiÓ· 3. ∏ ÔÚ›· Ù˘ ÓÂÊÚÈ΋˜ ÊϤ‚·˜ ÌÂٷ͇ ¿Óˆ ÌÂÛÂÓÙÂÚ›Ô˘ ·ÚÙËÚ›·˜ Î·È ·ÔÚÙ‹˜.

·Ô¯ÂÙ¢ÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ŒÙÛÈ ÂÍËÁÂ›Ù·È Î·È Ë ÂÌÊ¿ÓÈÛË ·ÈÌ·ÙÔ˘Ú›·˜ Ì ÂÚ˘ıÚÔ·ÙÙ·Ú· Ì ÌÔÚÊÔÏÔÁ›· ·Ó¿ÏÔÁË ÂÎÂ›ÓˆÓ ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜ (ÈÛÔÌÔÚÊÈο) (4). ∆· Ù˘Èο Â˘Ú‹Ì·Ù· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Â›Ó·È Ë ·Û˘Ìو̷ÙÈ΋ ÌÈÎÚÔÛÎÔÈ΋, ÌË ÛÂÈÚ·Ì·ÙÈ΋ ·ÈÌ·ÙÔ˘Ú›· Ì ‹ ¯ˆÚ›˜ ÔÚıÔÛÙ·ÙÈ΋ ÏÂ˘ÎˆÌ·ÙÔ˘Ú›· Î·È Ë ·ÈÊÓ›‰È· ÂÌÊ¿ÓÈÛË ÂÂÈÛÔ‰›ˆÓ Ì·ÎÚÔÛÎÔÈ΋˜ ·ÈÌ·ÙÔ˘Ú›·˜ Û˘Ó‹ıˆ˜ ÌÈÎÚ‹˜ ‰È¿ÚÎÂÈ·˜, Ù· ÔÔ›· ‰ÂÓ Û¯ÂÙ›˙ÔÓÙ·È Ì ÏÔÈÌÒÍÂȘ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡, Û ·ÓÙ›ıÂÛË Ì ÙËÓ IgA ÓÂÊÚÔ¿ıÂÈ·. ∞ÎfiÌË ÌÂÚÈÎÔ› ·ÛıÂÓ›˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÎÔÈÏȷο ¿ÏÁË ‹ ¿ÏÁË ÛÙËÓ ÔÛÊ˘˚΋ ¯ÒÚ·, fï˜ Û˘Ó‹ıˆ˜ ‰ÂÓ ‰È·ÈÛÙÒÓÔÓÙ·È ÛÔ‚·Ú¤˜ ‰È·Ù·Ú·¯¤˜. ∆Ô Û‡Ó‰ÚÔÌÔ ‰ÂÓ ·ÔÙÂÏ› ÌÈ· ÎÏËÚÔÓÔÌÈ΋ ÓfiÛÔ Î·È Ë ÂÌÊ¿ÓÈÛ‹ ÙÔ˘ Û ̤ÏË Ù˘ ›‰È·˜ ÔÈÎÔÁ¤ÓÂÈ·˜ Â›Ó·È Û¿ÓÈ·. ¶ÚfiÛÊ·Ù· ¤¯ÂÈ ÂÚÈÁÚ·Ê› Û ‰‡Ô ·‰¤ÏÊÈ· (5). ∆Ô Û‡Ó‰ÚÔÌÔ ÙÔ˘ ηڢÔıÚ·‡ÛÙË Ú¤ÂÈ Ó· ‰È·ÎÚ›ÓÂÙ·È ·fi ÙÔ Ê·ÈÓfiÌÂÓÔ ÙÔ˘ ηڢÔıÚ·‡ÛÙË, ‰ËÏ·‰‹ ÙËÓ ·Û˘Ìو̷ÙÈ΋ ‰È¿Ù·ÛË Ù˘ ÓÂÊÚÈ΋˜ ÊϤ‚·˜, Ô˘ Û˘Ó‹ıˆ˜ Â›Ó·È Ù˘¯·›Ô ‡ÚËÌ· (6). ∏ ÚÒÙË ÂÚÈÁÚ·Ê‹ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ¤ÁÈÓ ÙÔ 1972 ·fi ÙÔÓ De Schepper Û ‰‡Ô ·ÛıÂÓ›˜ Ì ÂÈ̤ÓÔ˘Û· “ȉÈÔ·ı‹” ·ÈÌ·ÙÔ˘Ú›· Î·È ‰È¿Ù·ÛË Ù˘ ·ÚÈÛÙÂÚ‹˜ ÓÂÊÚÈ΋˜ ÊϤ‚·˜ (7). ∆· ÂfiÌÂÓ· ¯ÚfiÓÈ· ÂÚÈÁÚ¿ÊËÎ·Ó ÔÏÏÔ› ·ÛıÂÓ›˜ Ì ÙÔ Û‡Ó‰ÚÔÌÔ ·˘Ùfi, ÔÈ ÔÔ›ÔÈ Û˘Ó‹ıˆ˜ ›¯·Ó ηÏÔ‹ıË ÔÚ›· Î·È Ê¿ÓËΠfiÙÈ ÙÔ Û‡Ó‰ÚÔÌÔ ·˘Ùfi ‹Ù·Ó Ôχ ÈÔ Û˘¯Ófi ·’ fi,ÙÈ ·Ú¯Èο ıˆÚÔ‡ÓÙ·Ó. ŒÙÛÈ Û ÌÈ· ÂȉËÌÈÔÏÔÁÈ΋

CLINICAL QUIZ ÌÂϤÙË ·fi ÙËÓ ∫ÔÚ¤· Û 1044 ·È‰È¿ Ì ·ÈÌ·ÙÔ˘Ú›· ‹/Î·È ÏÂ˘ÎˆÌ·ÙÔ˘Ú›·, ÙÔ Û‡Ó‰ÚÔÌÔ ·˘Ùfi ‰È·ÁÓÒÛÙËΠ۠65 ·È‰È¿, ·ÓÙÈÚÔÛˆ‡ÔÓÙ·˜ ÙÔ Û˘¯ÓfiÙÂÚÔ ·ıÔÏÔÁÈÎfi ‡ÚËÌ· ÛÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÓÂÊÚÒÓ Ì ‹ ¯ˆÚ›˜ Doppler (8). ™Â ¿ÏÏË ÌÂϤÙË Û 52 ·È‰È¿ Ì ÌÈÎÚÔÛÎÔÈ΋ ·ÈÌ·ÙÔ˘Ú›· ‰È·ÈÛÙÒıËÎ·Ó ÛÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÓÂÊÚÒÓ Ì Doppler Â˘Ú‹Ì·Ù· Ô˘ ÏËÚÔ‡Û·Ó Ù· ‰È·ÁÓˆÛÙÈο ÎÚÈÙ‹ÚÈ· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ÛÙÔ 33% ÙˆÓ ·ÛıÂÓÒÓ (9). øÛÙfiÛÔ, ‰ÂÓ ˘¿Ú¯ÂÈ ÔÌÔʈӛ· ÁÈ· ÙÔ Ò˜ Ú¤ÂÈ Ó· Á›ÓÂÙ·È Ì ·ÍÈÔÈÛÙ›· Ë ‰È¿ÁÓˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘. ∏ ÓÂÊÚÈ΋ ÊÏ‚ÔÁÚ·Ê›·, Ì ٷ˘Ùfi¯ÚÔÓË Ì¤ÙÚËÛË ÙˆÓ ȤÛÂˆÓ ÛÙËÓ Î¿Ùˆ ÎÔ›ÏË Î·È ÙË ÓÂÊÚÈ΋ ÊϤ‚· ıˆÚÂ›Ù·È Ë ÈÔ ·ÍÈfiÈÛÙË Ì¤ıÔ‰Ô˜. ŸÌˆ˜ Ë Ù¯ÓÈ΋ ·˘Ù‹ Â›Ó·È ·ÚÂÌ‚·ÙÈ΋ Î·È Ë ÂÊ·ÚÌÔÁ‹ Ù˘ ÛÙ· ·È‰È¿ ‰˘Û¯ÂÚ‹˜. ∏ ‰È¿ÁÓˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘, ·ÎfiÌ· Î·È ÛÙ· ·Ú¯Èο ÛÙ¿‰È·, ÌÔÚ› Ó· Á›ÓÂÈ Î·È Ì ·Ïfi ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ‹ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· Doppler, Ì ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ‹ Ì ̷ÁÓËÙÈ΋ ·ÁÁÂÈÔÁÚ·Ê›· (10). ∆· Â˘Ú‹Ì·Ù· ÛÙËÓ ÂͤٷÛË ÙÔ˘ È˙‹Ì·ÙÔ˜ Ô‡ÚˆÓ Ì ÌÈÎÚÔÛÎfiÈÔ ·ÓÙÈı¤ÙˆÓ Ê¿ÛÂˆÓ ‰ÂÓ Â›Ó·È ¿ÓÙÔÙ ·ÍÈfiÈÛÙ· ÁÈ· ÙË ‰È¿ÎÚÈÛË Ù˘ ÛÂÈÚ·Ì·ÙÈ΋˜, ·fi ÙË ÌË ÛÂÈÚ·Ì·ÙÈ΋ ·ÈÌ·ÙÔ˘Ú›·. ∂›Ó·È ÂӉȷʤÚÔÓ fiÙÈ ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ·ÛıÂÓ›˜ Ì ÌÈÎÚÔÛÎÔÈ΋ ·ÈÌ·ÙÔ˘Ú›· Î·È Ù˘Èο ˘ÂÚ˯ÔÁÚ·ÊÈο Â˘Ú‹Ì·Ù· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘, Ô˘ ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ·Ú·ÎÔÏÔ‡ıËÛ‹˜ ÙÔ˘˜ ‰È·ÁÓÒÛıËΠIgA ÓÂÊÚÔ¿ıÂÈ· (11). ∞Û˘Ìʈӛ· ˘¿Ú¯ÂÈ Î·È ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘. ∂Ӊ›ÍÂȘ ÁÈ· ¯ÂÈÚÔ˘ÚÁÈ΋ ·ÓÙÈÌÂÙÒÈÛË Â›Ó·È Ë ÛÔ‚·Ú‹ ·ÈÌ·ÙÔ˘Ú›· Ô˘ ÚÔηÏ› ·Ó·ÈÌ›·, ÛÔ‚·Ú¿ ÎÔÈÏȷο ¿ÏÁË ‹ ¿ÏÁË ÛÙËÓ ÔÛÊ˘˚΋ ¯ÒÚ· (10,12). ŸÌˆ˜ ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ ·ÛıÂÓ›˜ ÌÔÚÔ‡Ó Ó· ·ÓÙÈÌÂÙˆÈÛıÔ‡Ó Ì ̷ÎÚÔ¯ÚfiÓÈ· ·Ú·ÎÔÏÔ‡ıËÛË, ‰Â‰Ô̤ÓÔ˘ fiÙÈ Ë ÚfiÁÓˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Û˘Ó‹ıˆ˜ Â›Ó·È Î·Ï‹. ™Â ÚfiÛÊ·ÙË ‰ËÌÔÛ›Â˘ÛË ·Ó·Ê¤ÚÂÙ·È fiÙÈ ÌfiÓÔ 15 ·fi Ù· 20 ·È‰È¿ Ì ۇӉÚÔÌÔ ÙÔ˘ ηڢÔıÚ·‡ÛÙË Û˘Ó¤¯È˙·Ó Ó· ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·ÈÌ·ÙÔ˘Ú›· ÌÂÙ¿ ·fi 0,5-3,5 ¯ÚfiÓÈ· (10). ŒÙÛÈ Û‹ÌÂÚ· Â›Ó·È ÁÂÓÈο ·Ô‰ÂÎÙfi fiÙÈ Ë ¤ÁηÈÚË

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‰È¿ÁÓˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Â›Ó·È Ôχ ÛËÌ·ÓÙÈ΋ ÁÈ· Ó· ·ÔʇÁÔÓÙ·È ÔÈ ÂÚÈÙÙ¤˜ ÂÍÂÙ¿ÛÂȘ.

µÈ‚ÏÈoÁÚ·Ê›· 1. Chang CT, Hung CC, Hg KK, Yen TH. Nutcracker syndrome and left unilateral haematuria. Nephrol Dial Transplant 2005;20:460-461.

2. Ahmed K, Sampath R, Khan MS. Current trends in the diagnosis and management of renal nutcracker syndrome: a review. Eur J Vasc Endovasc Surg 2006;31:410-416.

3. Ekim M, Ozcakar ZB, Fitoz S, Soygur T, Yuksel S, Acar B, Yalcinkaya F, Arikan N. The “nutcracker phenomenon” with orthostatic proteinuria: case reports. Clin Nephrol 2006;65:280-283.

4. Wolfish NM, McLaine PN, Martin D. Renal vein entrapment syndrome: frequency and diagnosis. A lesson in conservatism. Clin Nephrol 1986;26:96-100.

5. Matsukura H, Arai M, Miyawaki T. Nutcracker phenomenon in two siblings of a Japanese family. Pediatr Nephrol 2005;20:237-238.

6. Liebl R. Nutcracker phenomenon or nutcracker syndrome?

Nephrol Dial Transplant 2005;20:2009.

7. de Schepper A. “Nutcracker” phenomenon of the renal vein and venous pathology of the left kidney. J Belge Radiol 1972; 55:507-511.

8. Park YH, Choi JY, Chung HS, Koo JW, Kim SY, Namgoong MK, et al. Hematuria and proteinuria in a mass school urine screening test. Pediatr Nephrol 2005;20:1126-1130.

9. Park SJ, Lim JW, Cho BS, Yoon TY, Oh JH. Nutcracker syndrome in children with orthostatic proteinuria: diagnosis on the basis of Doppler sonography. J Ultrasound Med 2002; 21:39-45.

10. Shin JI, Park JM, Lee SM, Shin YH, Kim JH, Lee JS, et al.

Factors affecting spontaneous resolution of hematuria in childhood nutcracker syndrome. Pediatr Nephrol 2005;20: 609-613.

11. Ozono Y, Harada T, Namie S, Ichinose H, Shimamine R, Nishimawa Y, et al. The “nutcracker” phenomenon in combination with IgA nephropathy. J Int Med Res 1995;23: 126-131.

12. Chen W, Chu J, Yang JY, Li HP, Zhuang WQ, Huang YH, et al. Endovascular stent placement for the treatment of nutcracker phenomenon in three pediatric patients. J Vasc Interv Radiol 2005;16:1529-1533.

¶·È‰È·ÙÚÈ΋ 2007;70:75,78-79

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∂¶π™∆√§H ¶ƒ√™ ∆∏ ™À¡∆∞•∏

LETTER TO THE EDITOR

∞Á·ËÙÔ› ·ÚÈÔÈ, ªÂ ¯·Ú¿ Û·˜ ·Ó·ÎÔÈÓÒÓÔ˘Ì fiÙÈ ÙÔ Ó¤Ô ÙÌ‹Ì· Ù˘ µã ¶·È‰È·ÙÚÈ΋˜ ∫ÏÈÓÈ΋˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ªÔÓ¿‰· ∂ÊË‚È΋˜ ÀÁ›·˜ (ª.∂.À.) “∞§§∞∑ø”, ¿Ú¯ÈÛ ӷ ÏÂÈÙÔ˘ÚÁ› ·fi 15-10-2006, ÛÙÔ ¶·Ú¿ÚÙËÌ· ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ “¶·Ó. & ∞ÁÏ·˝· ∫˘ÚÈ·ÎÔ‡”, ªÂÛÔÁ›ˆÓ 24 ÛÙÔÓ 6Ô fiÚÔÊÔ (¶Ù¤Ú˘Á· ∂ϤÓ˘ ¢·Ï·ÎÔ‡Ú·). ∆Ô ∆Ì‹Ì· ÂÈÛΤÙÔÓÙ·È ¤ÊË‚ÔÈ ËÏÈΛ·˜ 11-19 ÂÙÒÓ Î·È Ë ÔÈÎÔÁ¤ÓÂÈ¿ ÙÔ˘˜, ÁÈ· Û˘˙‹ÙËÛË Î·È Â›Ï˘ÛË ıÂÌ¿ÙˆÓ Ô˘ ÙÔ˘˜ ··Û¯ÔÏÔ‡Ó: ñ ∂Ó‰ÔÎÚÈÓÔÏÔÁÈο ñ µ¿ÚÔ˘˜ ÛÒÌ·ÙÔ˜ ñ ¢È·ÙÚÔÊ‹˜ ñ ÕÛÎËÛ˘ ñ ¢ÂÚÌ·ÙÔÏÔÁÈο ñ °˘Ó·ÈÎÔÏÔÁÈο ñ æ˘¯ÔÏÔÁÈο ñ £¤Ì·Ù· Û¯ÔÏÈ΋˜ Â›‰ÔÛ˘ ñ ¢˘ÛÏÂÈÙÔ˘ÚÁ›· ÔÈÎÔÁ¤ÓÂÈ·˜, Û˘Ì‚Ô˘Ï¢ÙÈ΋ Î.Ï. √È ˘ËÚÂۛ˜ ·Ú¤¯ÔÓÙ·È ·fi ÂȉÈÎÔ‡˜ Û ı¤Ì·Ù· ÂÊË‚È΋˜ ˘Á›·˜, ¯ˆÚ›˜ ÔÈÎÔÓÔÌÈ΋ ÂÈ‚¿Ú˘ÓÛË, Î·È Û ÒÚ˜ Ô˘ Â͢ËÚÂÙÔ‡Ó ¿ÓÙ· ÙÔ ÚfiÁÚ·ÌÌ· ÙˆÓ ÂӉȷÊÂÚÔÌ¤ÓˆÓ (·ÔÁ‡̷ٷ). Ÿˆ˜ fiÏÔÈ ÁÓˆÚ›˙Ô˘ÌÂ, Ë ÂÊ˂›· Â›Ó·È ÌÈ· “ȉȷ›ÙÂÚË” ËÏÈΛ·. ∞ÔÙÂÏ› ÌÈ· ÌÂÙ·‚·ÙÈ΋ ÂÚ›Ô‰Ô, ÌÂٷ͇ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ Î·È Ù˘ ÂÓËÏÈΛˆÛ˘. √ ¤ÊË‚Ô˜ ‰ÂÓ Â›Ó·È Ô‡Ù ·È‰›, Ô‡Ù ÂÓ‹ÏÈη˜ Î·È ·ÚÔ˘ÛÈ¿˙ÂÈ È‰È·ÈÙÂÚfiÙËÙ˜ Î·È Û˘ÁÎÂÎÚÈ̤Ó˜ ·Ó¿ÁΘ. ∏ ËÏÈΛ· ·˘Ù‹ Â›Ó·È ÁÂÌ¿ÙË ÚˆÙfiÁÓˆÚ˜ Î·È Û˘Ó·Ú·ÛÙÈΤ˜ ÂÌÂÈڛ˜, ·ÏÏ¿ Î·È ‰˘ÛÎÔϛ˜, ¿Á¯Ô˜ Î·È ÔÚÈṲ̂Ó˜ ÊÔÚ¤˜ ΛӉ˘ÓÔ. §fiÁˆ Ù˘ ۈ̷ÙÈ΋˜ Î·È „˘¯ÔÏÔÁÈ΋˜ ·ÛÙ¿ıÂÈ·˜ Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÈ ÙÔÓ ¤ÊË‚Ô, ÌÔÚ› Ó· ·Ó·‰˘ıÔ‡Ó ‰È¿ÊÔÚ· ÚÔ‚Ï‹Ì·Ù· ‹ Ó· ÂȉÂÈÓˆıÔ‡Ó Ù· ‹‰Ë ˘¿Ú¯ÔÓÙ·. ∂ÈϤÔÓ, Ë ÔÈÎÔÁ¤ÓÂÈ· ÌÔÈ¿˙ÂÈ Û˘¯Ó¿ ·Ì‹¯·ÓË, ÁÂÌ¿ÙË ‰¤Ô˜ ÌÚÔÛÙ¿ Û ·˘Ùfi ÙÔÓ Î·Ù·ÈÁÈÛÌfi ۈ̷ÙÈÎÒÓ Î·È „˘¯ÔÏÔÁÈÎÒÓ ÌÂÙ·‚ÔÏÒÓ. √ ¤ÊË‚Ô˜ Î·È Ë ÔÈÎÔÁ¤ÓÂÈ¿ ÙÔ˘ ¤¯Ô˘Ó ·Ó¿ÁÎË ·fi “Ê¿ÚÔ˘˜” ÛÙȘ Û‡Á¯ÚÔÓ˜ ÎÔÈӈӛ˜. ™ÙËÓ ∂ÏÏ¿‰· ‰ÂÓ ˘¿Ú¯Ô˘Ó ·ÚÎÂÙ¤˜ ‰Ô̤˜ ÁÈ· ÙËÓ ÂÊË‚È΋ ËÏÈΛ·, Ì ·ÔÙ¤ÏÂÛÌ· ÔÈ ¤ÊË‚ÔÈ Ó· ·Ú·ÌÂÏÔ‡ÓÙ·È Î·È Ó· ÂÎÙ›ıÂÓÙ·È Û ÎÈÓ‰‡ÓÔ˘˜. ∏ ·Ó¿ÁÎË ‰ËÌÈÔ˘ÚÁ›·˜ ÌÈ·˜ Ó¤·˜ ‰ÔÌ‹˜ ÁÈ· ÙËÓ ÂÊË‚È΋ ËÏÈΛ· ˘·ÁÔÚ‡ÂÙ·È ·fi ÙË ÁÂÓÈÎfiÙÂÚË ¤ÏÏÂÈ„Ë ‰ÔÌÒÓ ÁÈ· ÙË ÊÚÔÓÙ›‰· ÙˆÓ ∂ÏÏ‹ÓˆÓ ÂÊ‹‚ˆÓ, ηıÒ˜ Î·È ·fi ÙËÓ ·ÓÂ·Ú΋ ηٷÁÚ·Ê‹ Î·È ÌÂϤÙË ÙˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ Ù˘ ËÏÈΛ·˜ ·˘Ù‹˜. °È· ÂÚÈÛÛfiÙÂÚ˜ ÏËÚÔÊÔڛ˜ Î·È Ú·ÓÙ‚ԇ ÔÈ ÂӉȷÊÂÚfiÌÂÓÔÈ ÌÔÚÔ‡Ó Ó· ·¢ı‡ÓÔÓÙ·È ÛÙË ªÔÓ¿‰· ∂ÊË‚È΋˜ ÀÁ›·˜ (ª.∂.À.) ηıËÌÂÚÈÓ¿ 10:00-14:00, ÛÙÔ ÙËϤʈÓÔ 210-7710824.

ªÂ ÙÈÌ‹, √ ¢È¢ı˘ÓÙ‹˜ ∞Ó‰Ú¤·˜ ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜ ∫·ıËÁËÙ‹˜ - ¢È¢ı˘ÓÙ‹˜ µ’ ¶·È‰È·ÙÚÈ΋˜ ∫ÏÈÓÈ΋˜ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ

Paediatriki 2007;70:80

∏ ∂ÈÛÙËÌÔÓÈ΋ À‡ı˘ÓË ÕÚÙÂÌȘ ∆Û›ÙÛÈη ¶·È‰›·ÙÚÔ˜ - ∂ÊË‚È΋ π·ÙÚÈ΋ ¢È‰¿ÎÙˆÚ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ

¶ƒ√™∂Ã∏ ™À¡∂¢ƒπ∞

xxiii

10-11 ºÂ‚ÚÔ˘·Ú›Ô˘ 2007

™ÂÌÈÓ¿ÚÈÔ ¢È·Ù·Ú·¯‹ ∂ÏÏÂÈÌÌ·ÙÈ΋˜ ¶ÚÔÛÔ¯‹˜ – ÀÂÚÎÈÓËÙÈÎfiÙËÙ· MÔ˘ÛÂ›Ô ∞ıÏËÙÈÛÌÔ‡ £ÂÛÛ·ÏÔӛ΢ ¶ÏËÚÔÊÔڛ˜: Diaskepsis - ª·Ù›Ó· ∆Û¿ÌË ∆ËÏ./Fax: 2310 230 459 ∂-mail: mtsami@otenet.gr Website: www.diaskepsis.gr

£ÂÛÛ·ÏÔÓ›ÎË

17 ºÂ‚ÚÔ˘·Ú›Ô˘ 2007

3Ë ∂ÈÛÙËÌÔÓÈ΋ ∏ÌÂÚ›‰· °¡¶∞ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡” “¶·È‰ÈÎfi ∞Ù‡¯ËÌ·” ¢ÈÔÚÁ¿ÓˆÛË: ∂ÈÛÙËÌÔÓÈÎfi ™˘Ì‚Ô‡ÏÈÔ ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ AÌÊÈı¤·ÙÚÔ “∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ¶··‰¿ÙÔ˜” NÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡” £Ë‚ÒÓ & §Â‚·‰Â›·˜, ∞ÌÂÏfiÎËÔÈ ∆ËÏ.: 210 7726000

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28 ºÂ‚ÚÔ˘·Ú›Ô˘ 2 ª·ÚÙ›Ô˘ 2007

Current Concepts in Paediatric Orthopaedics Royal Institute of British Architects Contact: Deborah Eastwood Tel.: 020 8909 5758 Fax: 020 8954 4566 E-mail: Gloria.Richter@rnoh.nhs.uk Website: http://www.bscos.com

London, United Kingdom

8-11 ª·ÚÙ›Ô˘ 2007

Pediatric Anesthesiology 2007 Contact: Society for Pediatric Anesthesia Tel.: 804-282-9780 Fax: 804-282-0090 E-mail: spa@societyhq.com

Phoenix, AZ, United States

31 ª·ÚÙ›Ô˘ 2007

5Ë ∂ÈÛÙËÌÔÓÈ΋ ∏ÌÂÚ›‰· ∂˘ÚˆÎÏÈÓÈ΋˜ ¶·›‰ˆÓ ∞›ıÔ˘Û· Olympia •ÂÓÔ‰Ô¯Â›Ô Royal Olympic ¶ÏËÚÔÊÔڛ˜: FIRSTEVENT ∂¶∂ ∆ËÏ.: 210 8228950 Fax: 210 8228901 E-mail: info@firstevent.gr

∞ı‹Ó·

16-18 ∞ÚÈÏ›Ô˘ 2007

The 7th Annual International Neonatology Symposium Contact: Saleh Al-Alaiyan, MD Tel.: 00-96-614-427-762 Fax: 00-96-614-427-784 E-mail: alaiyan@kfshrc.edu.sa

Riyadh, Saudi Arabia

25-28 ∞ÚÈÏ›Ô˘ 2007

18th Annual Congress of the European Society for Paediatric Urology (ESPU) HALL Ambassadeur, Oud-Sint Jan, Zonnekemeers Website: www.espu2007.com/

Brugge, Belgium

xxiv

2-4 ª·˝Ô˘ 2007

25th European Congress for Pediatric Infectious Diseases ~es Centro de Congressos e Exposiço Contact: Kenes International / ESPID 2007 17, Rue du Cendrier, PO Box 1726 CH-1211 Geneva 1, Switzerland Tel: +41 22 908 0488 Fax: +41 22 732 2850 E-mail: espid@kenes.com Website: www.kenes.com/espid/

Porto, Portugal

2-5 ª·˝Ô˘ 2007

15th TRANSMED: 15th European / Mediterranean Congress about Mother & Child Health Contact: Kamel BARGAOUI Tel.: 33-607-686-118 Fax: 33-143-839-985 E-mail: kamel@medicom-international.com

Cairo, Egypt

9-12 ª·˝Ô˘ 2007

40th Annual meeting of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Catalunya Congress Palace Contact: ESPGHAN 2007 C/o Colloquium 12, rue de la Croix Faubin 75557 Paris Cedex 11 - France Tel.: 33 (0) 1 44 64 15 15 Fax: 33 (0) 1 44 64 15 16 E-mail: espghan2007@colloquium.fr

Barcelona, Spain

25-27 ª·˝Ô˘ 2007

45Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ ™˘Ó‰ÚÈ·Îfi ∫¤ÓÙÚÔ Porto Carras “Olympic” ¶ÏËÚÔÊÔڛ˜: AC&C International S.A. ∆ËÏ.: 210 6889 100 Fax: 210 6844 777 ∂-mail: pediatric2007@acnc.gr Website: www.pediatric2007.gr

™ÈıˆÓ›·, ÷ÏÎȉÈ΋˜

3-7 πÔ˘Ó›Ô˘ 2007

44th Annual Meeting of the European Society of Pediatric Radiology Contact: Viajes Iberia Congresos Fontanella 21-23, 4o1a 08010 Barcelona, Spain Tel.: +34 93 510 1005 Fax: +34 93 510 1009 E-mail: espr2007.meeting@viajesiberia.com Website: www.espr2007.info/

Barcelona, Spain

25-30 ∞˘ÁÔ‡ÛÙÔ˘ 2007

25th International Congress of Pediatrics ª¤Á·ÚÔ ªÔ˘ÛÈ΋˜ ∞ıËÓÒÓ ∞C&C International, PCO Tel: 210 68 89 100 Fax: 210 68 44 777 E-mail: icp2007@acnc.gr Website: www.icp2007.gr

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