Παιδιατρική | Τόμος 66 • Τεύχος 6 • Νοέμβριος - Δεκέμβριος 2003

ISSN 0377-2551

∞¡∞™∫O¶∏™∂π™ OÈ Ì˘ÔηډÈÔ¿ıÂȘ ÛÙ· ·È‰È¿

REVIEW ARTICLES 405

∂. ∞ÔÛÙfiÏÔ˘, ∞. ∆ÛÈÏÈÌÈÁοÎË

°ÂÓÂÙÈο ÙÚÔÔÔÈË̤ӷ ÙÚfiÊÈÌ·: Èı·Ó¤˜ ÂÈÙÒÛÂȘ ÛÙËÓ ·ÏÏÂÚÁÈÔÁÔÓÈÎfiÙËÙ·

Cardiomyopathies in children H. Apostolou, A. Tsilimigaki

418

∞. µ·ÛÈÏÔÔ‡ÏÔ˘, ¡. °. ¶··‰fiÔ˘ÏÔ˜, º. ™·ÍÒÓË-¶··ÁˆÚÁ›Ô˘

Genetically modified food: potential effects on allergenicity E. Vassilopoulou, N. G. Papadopoulos, F. Saxoni-Papageorgiou

¶AI¢IATPIKH

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TOMO™ 66

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TEYXO™ 6

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ETO™ 2003

¡Ô¤Ì‚Ú ÈÔ˜ - ¢ÂΤ̂ÚÈ Ô˜ 2003 . ∆fiÌÔ˜ 66 . ∆‡¯Ô˜ 6

OÈÎÔÏÔÁ›·, ÂȉËÌÈÔÏÔÁ›· Î·È ÂÚÁ·ÛÙËÚȷ΋ ‰È¿ÁÓˆÛË Ì˘ÎËÙÈ¿ÛÂˆÓ ÙÔ˘ ÙÚȯˆÙÔ‡ Ù˘ ÎÂÊ·Ï‹˜ Û ·È‰È¿

426

∂. ºÚ·ÁÎÔ‡ÏË

E. Frangoulis

µƒ∞µ∂Àª∂¡∏ ∂ƒ°∞™π∞ ∞ÍÈÔÏfiÁËÛË 10 ÂÙÒÓ ·fi ÙËÓ ¤Ó·ÚÍË ÚÔÁÚ¿ÌÌ·ÙÔ˜ ·ÁˆÁ‹˜ ˘Á›·˜ ÛÙ· Û¯ÔÏ›· Ù˘ ∫Ú‹Ù˘

AWARD-WINNING ARTICLE 436

ª. §ÈÓ·Ú‰¿Î˘, ∫. ™·ÚÚ‹, º. ªÂÚ‚·Ó¿ÎË, ∂. ª¿ÚηÙ˙Ë, Ã. ÷Ù˙‹˜, ™. ºÏÔ˘Ú‹, ∞. ∫·Ê¿ÙÔ˜

ORIGINAL ARTICLES 448

ª. ™¯ÔÈÓ¿, °. ™¯ÔÈÓ¿˜, ∫. ¶·ÙÂÚfiÔ˘ÏÔ˜

¶ÚÔ‚Ï‹Ì·Ù· ˘Á›·˜ ·È‰ÈÒÓ-·Ú·ıÂÚÈÛÙÒÓ Û ÓËÛ› ÙˆÓ ∫˘ÎÏ¿‰ˆÓ

Is there consistency in immunization of children who live in the countryside? Study of the child population of a Rural Health Centre M. Schina, G. Schinas, K. Pateropoulos

452

∂. ¶·Ú·Ûο΢, ª. ∆ÛÈÌÈÓfi˜, ∫. ∫·Ú·Ó¿ÛÈÔ˘, ¡. ª·Î·ÚÒÓ·˜, ∂. °·Ï·Ó¿Î˘

¡Â˘ÚÔÏÔÁÈΤ˜ ÂΉËÏÒÛÂȘ ·È‰ÈÒÓ Ì ·ÈÌÔÏ˘ÙÈÎfi-Ô˘Ú·ÈÌÈÎfi Û‡Ó‰ÚÔÌÔ

Ten-year evaluation of the initiation of a health education program in the schools of Crete M. Linardakis, K. Sarri, F. Bervanaki, I. Markatzi, C. Hatzis, S. Flouri, A. Kafatos

∂ƒ∂À¡∏∆π∫∂™ ∂ƒ°∞™π∂™ À¿Ú¯ÂÈ Û˘Ó¤ÂÈ· ÛÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi ÙˆÓ ·È‰ÈÒÓ ÛÙËÓ Â·Ú¯›·; ŒÚ¢ӷ Û ·È‰ÈÎfi ÏËı˘ÛÌfi ∫¤ÓÙÚÔ˘ ÀÁ›·˜

Ecology, epidemiology and diagnosis of tinea capitis in children

Health problems of child-tourists in a Cycladic island E. Paraskakis, M. Tsimbinos, K. Karanasiou, N. Makaronas, E. Galanakis

456

Neurological complications of children with haemolytic-uraemic syndrome

∫. µÔ‡‰Ú˘, ∫. ™ÙÂÊ·Ó›‰Ë˜, ∞. ™Î·Ú‰Ô‡ÙÛÔ˘, ∂. ∫·ÙÛ·ÚÔ‡, ™. ª·ÛÙÚÔÁÈ¿ÓÓË, ∂. µ·ÁÈ¿ÎÔ˘

K. Voudris, C. Stefanidis, A. Skardoutsou, E. Katsarou, S. Mastroyianni, E. Vagiakou

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

Continuation of table of contents inside title page

Hellenic Paediatric Society November - December 2003 . Volume 66 . No 6

NÔ¤Ì‚Ú ÈÔ˜ - ¢ÂΤ̂ÚÈ Ô˜ 2003 . ∆fiÌÔ˜ 66 . ∆‡¯Ô˜ 6

™˘Ó¤¯ÂÈ· ÂÚȯÔ̤ӈÓ

∫˘ÙÙ·ÚÔÁÂÓÂÙÈο Î·È ÂȉËÌÈÔÏÔÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο 533 ·ÛıÂÓÒÓ Ì ۇӉÚÔÌÔ Down Ù· ¤ÙË 1973-2001

Continuation of table of contents

461

H. Hatzissevastou-Loukidou, P. Kambouridou

Ã. ÷Ù˙ËÛ‚·ÛÙÔ‡-§Ô˘Î›‰Ô˘, ¶. ∫·ÌÔ˘Ú›‰Ô˘

CASE REPORTS

EN¢π∞º∂ƒOÀ™∂™ ¶∂ƒπ¶∆ø™∂π™ ∞ÓÂ¿ÚÎÂÈ· Ù˘ ÔÚÓÈıÈÓÈ΋˜ ÙÚ·ÓÛηڂ·Ì˘Ï¿Û˘ - ˘Ô͇˜ Ù‡Ô˜. ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘

467

Hellenic Paediatric Society

471

Cushing’s disease in a 15ó year-old girl.

A case report E. Kostakioti, C. Theodoridis, E. Kousta, A. Tertipi, C. Hadjiathanasiou, V. Petrou, A. Papathanasiou

∂. ∫ˆÛÙ·ÎÈÒÙË, Ã. £ÂÔ‰ˆÚ›‰Ë˜, ∂. ∫Ô‡ÛÙ·, ∞. ∆ÂÚÙ›Ë, Ã. ÷Ù˙Ë·ı·Ó·Û›Ô˘, µ. ¶¤ÙÚÔ˘, ∞. ¶··ı·Ó·Û›Ô˘

N∂∞ ∞¶O ∆O ¢π∞¢π∫∆ÀO

Late onset ornithine transcarbamylase deficiency.

A case report S. Fessatou, A. Attilakos, H. Tsapra, G. Maropoulos, H. Michelakakis, K. Schulpis

™. ºÂÛÛ¿ÙÔ˘, ∞. ∞ÙÙÈÏ¿ÎÔ˜, ∂. ∆Û¿Ú·, °. ª·ÚfiÔ˘ÏÔ˜, ∂. ªÈ¯ÂϷοÎË, ∫. ™Ô‡ÏË

¡fiÛÔ˜ Cushing Û ÎÔÚ›ÙÛÈ ËÏÈΛ·˜ 15ó ÂÙÒÓ. ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘

Cytogenetic and epidemiological characteristics of 533 patients with Down syndrome between the years 1973-2001

475

NEWS FROM THE INTERNET

Greek Paediatric Society ™˘Ó¯›˙ÔÓÙ·È

Continued

Hellenic Paediatric Society November - December 2003 . Volume 66 . No 6

¡Ô¤Ì‚Ú ÈÔ˜ - ¢ÂΤ̂ÚÈ Ô˜ 2003 . ∆fiÌÔ˜ 66 . ∆‡¯Ô˜ 6

™˘Ó¤¯ÂÈ· ÂÚȯÔ̤ӈÓ

Continuation of table of contents

∫ÚÈÙ¤˜ ÙÔ˘ ÙfiÌÔ˘ 66

478

Reviewers of Manuscripts, Volume 66

∂˘ÚÂÙ‹ÚÈÔ ™˘ÁÁڷʤˆÓ ÙÔ˘ ÙfiÌÔ˘ 66

479

Author Index, Volume 66

§¤ÍÂȘ ÎÏÂȉȿ ÙÔ˘ ÙfiÌÔ˘ 66

482

Subject Index, Volume 66

¶ÚÔÛ¯‹ ™˘Ó¤‰ÚÈ·

xi

Scheduled Medical Meetings

™˘ÓÙÔÌÔÁڷʛ˜

xv

Abbreviations

Hellenic Paediatric Society

Greek Paediatric Society

Hellenic Paediatric Society November - December 2003 .Volume 66 . No 6

¡Ô¤Ì‚Ú ÈÔ˜ - ¢ÂΤ̂ÚÈ Ô˜ 2003

.

∆fiÌÔ˜ 66

. ∆‡¯Ô˜

6

¢ÈÌËÓÈ·›· ¤Î‰ÔÛË E›ÛËÌÔ ¶ÂÚÈÔ‰ÈÎfi Ù˘ EÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ EÙ·ÈÚ›·˜

Bimonthly Publication The Official Journal of the Hellenic Paediatric Society

EΉfiÙ˘ K. °ÚÈ‚¤·˜

Publisher K. Griveas

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

Owner© Hellenic Paediatric Society Michalakopoulou 92 Athens 115 28

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

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

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

Scientific President Editor Members

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

Manuscript Editing

EÈ̤ÏÂÈ· ·ÁÁÏÈÎÒÓ ÎÂÈÌ¤ÓˆÓ ™. ¡¿ÎÔ˘

English Editing S. Nakou

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

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

™˘ÓÙÔÓÈÛÙ‹˜ ∂ΉfiÛˆ˜

Publishing Coordinator

E¶I™THMONIKE™ EK¢O™EI™ E.¶.E. ¶. ∆۷ω¿ÚË 3, 151 22 M·ÚÔ‡ÛÈ TËÏ.: 210-61 41 360-5 Fax: 210-61 41 366

SCIENTIFIC PUBLICATIONS Ltd P. Tsaldari 3, Marousi 151 22 Tel.: 210-61 41 360-5 Fax: 210-61 41 366

Hellenic Paediatric Society

Hellenic Paediatric Society

EÙ‹ÛÈ· ™˘Ó‰ÚÔÌ‹

40

EȉÈ΢fiÌÂÓÔÈ, ºÔÈÙËÙ¤˜:

20

c c

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

Greek Editing I. Karavranou

Annual Subscription All foreign countries: US $ 50

Hellenic Paediatric Society November-December 2003 . Volume 66 . No 6

πSSN 0377-2551 i Greek Paediatric Society

O‰ËÁ›Â˜ ÚÔ˜ ÙÔ˘˜ ™˘ÁÁÚ·Ê›˜ A. °ÂÓÈΤ˜ ¶ÏËÚÔÊÔڛ˜ ∆Ô ÂÚÈÔ‰ÈÎfi “¶·È‰È·ÙÚÈ΋” Â›Ó·È Ë 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˘ EÈÛÙËÌÔÓÈ΋˜ ™˘ÓÙ·ÎÙÈ΋˜ EÈÙÚÔ‹˜).

2. ∞Ó·ÛÎÔ‹ÛÂȘ.

3. µÚ·‚Â˘Ì¤Ó˜ ÂÚÁ·Û›Â˜.

4. ∂Ú¢ÓËÙÈΤ˜ ÌÂϤÙ˜.

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

6. ∂›Î·ÈÚ· ı¤Ì·Ù·.

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

8. ∫ÏÈÓÈΤ˜ Î·È ·ÂÈÎÔÓÈÛÙÈΤ˜ ÂÚÈÙÒÛÂȘ.

9. ™‡ÓÙÔÌ· Ó¤·.

10. µÚ·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ.

11. ∂ÈÛÙÔϤ˜ ÚÔ˜ ÙË Û‡ÓÙ·ÍË.

12. ¶ÂÚÈÏ‹„ÂȘ Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜.

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

H EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ‰È·ÙËÚ› ÙÔ ‰Èη›ˆÌ· Ó· ‰ËÌÔÛȇÂÈ ¿ÚıÚ· Ì ȉȷ›ÙÂÚÔ ÂÈÛÙËÌÔÓÈÎfi ÂӉȷʤÚÔÓ Î·ıÒ˜ 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·Ûı› ÛÙÔ ÂÙ‹ÛÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ, ÙËÓ ÔÏÈ΋ ‹ ÌÂÚÈ΋ ‰ËÌÔÛ›Â˘ÛË ·ÚÔ˘ÛÈ¿ÛÂˆÓ È‰È·›ÙÂÚÔ˘ ÂӉȷʤÚÔÓÙÔ˜ Î·È ÙËÓ ÔÏÈ΋ ‹ ÌÂÚÈ΋ ‰ËÌÔÛ›Â˘ÛË 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˘. µ. ÀÔ‚ÔÏ‹ Î·È ¢ËÌÔÛ›Â˘ÛË ÙˆÓ ∂ÚÁ·ÛÈÒÓ OÈ ÂÚÁ·Û›Â˜ Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È ÚÔ˜ ÎÚ›ÛË ÁÈ· ‰ËÌÔÛ›Â˘ÛË ÛÙÔ ÂÚÈÔ‰ÈÎfi “¶·È‰È·ÙÚÈ΋” ·ÔÛÙ¤ÏÏÔÓÙ·È ÂȘ ÙÚÈÏÔ‡Ó ÛÙË ‰È‡ı˘ÓÛË: EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ EÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ EÙ·ÈÚ›· Mȯ·Ï·ÎÔÔ‡ÏÔ˘ 92 115 28 Aı‹Ó· ŸÏ˜ ÔÈ ÂÚÁ·Û›Â˜ Ú¤ÂÈ Ó· Û˘Óԉ‡ÔÓÙ·È ·fi ÂÈÛÙÔÏ‹, Ë ÔÔ›· ı· Û˘Ó˘ÔÁÚ¿ÊÂÙ·È ·fi fiÏÔ˘˜ ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ ÛÙËÓ ÔÔ›· ı· ‰ËÏÒÓÂÙ·È fiÙÈ Ë ÂÚÁ·Û›· ‰ÂÓ ¤¯ÂÈ ÂÓ Ì¤ÚÂÈ ‹ ÂÍ ÔÏÔÎÏ‹ÚÔ˘ ‰ËÌÔÛÈ¢ı› ‹ ˘Ô‚ÏËı› ÁÈ· ÎÚ›ÛË Û ¿ÏÏÔ ÂÚÈÔ‰ÈÎfi Î·È fiÙÈ ÔÈ Û˘ÁÁÚ·Ê›˜ ÂÁÎÚ›ÓÔ˘Ó ÙË ‰ËÌÔÛ›Â˘Û‹ Ù˘ ÛÙÔ ÂÚÈÔ‰ÈÎfi “¶·È‰È·ÙÚÈ΋”. ∂ÈϤÔÓ, ı· Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È Ù˘¯fiÓ ÂȉÔÙ‹ÛÂȘ - ¯ÔÚË-

Á›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢. ŸÏ˜ ÔÈ ÎÏÈÓÈΤ˜ ¤Ú¢Ó˜ Ú¤ÂÈ Ó· Û˘Óԉ‡ÔÓÙ·È ·fi ÁÚ·Ù‹ ‰‹ÏˆÛË ÙˆÓ Û˘ÁÁڷʤˆÓ fiÙÈ ¤ÁÈÓ·Ó ÌÂÙ¿ ·fi ÏËÚÔÊÔÚË̤ÓË Û˘Ó·›ÓÂÛË ÙˆÓ ÌÂÙ¯fiÓÙˆÓ ‹ ÙˆÓ ÓÔÌ›ÌˆÓ ÂÎÚÔÛÒˆÓ ÙÔ˘˜ Û‡Ìʈӷ Ì ÙȘ ‰È·ÎËÚ‡ÍÂȘ ÙÔ˘ EÏÛ›ÓÎÈ Î·È ÙÔ˘ TfiÎÈÔ. ∫·ıÒ˜ Î·È fiÙÈ ÙËÚ‹ıËÎ·Ó ÔÈ Ô‰ËÁ›Â˜ ÁÈ· ÙË ÊÚÔÓÙ›‰· ÂÈÚ·Ì·Ùfi˙ˆˆÓ ÙÔ˘ ∂ıÓÈÎÔ‡ πÓÛÙÈÙÔ‡ÙÔ˘ ÀÁ›·˜ ÙˆÓ ∏¶∞ (DHEW Publication, NIH, 80-23). ™ÙȘ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ ı· Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÂÙ·È fiÙÈ ¤¯Ô˘Ó ÂÁÎÚÈı› ·fi ÙËÓ ÂÈÙÚÔ‹ ∏ıÈ΋˜ Î·È ¢ÂÔÓÙÔÏÔÁ›·˜ ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ. ŸÏ˜ ÔÈ ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ÂÚÁ·Û›Â˜ ıˆÚÔ‡ÓÙ·È È‰ÈÔÎÙËÛ›· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ “¶·È‰È·ÙÚÈ΋” Î·È Ë ÔÏÈ΋ ‹ ÌÂÚÈ΋ ·Ó·‰ËÌÔÛ›Â˘Û‹ ÙÔ˘˜ ÂÈÙÚ¤ÂÙ·È ÌfiÓÔ ÌÂÙ¿ ·fi ¤ÁÁÚ·ÊË Û˘ÁηٿıÂÛË ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. ∏ ¶∞π¢π∞∆ƒπ∫∏ ÚÔÙ›ÓÂÈ Ó· ·ÎÔÏÔ˘ıÔ‡ÓÙ·È ÔÈ “∫ÔÈÓ¤˜ ¶ÚԉȷÁڷʤ˜ ÁÈ· ÃÂÈÚfiÁÚ·Ê· Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È Û µÈÔ˚·ÙÚÈο ¶ÂÚÈÔ‰Èο” (Uniform Requirements for Manuscripts Submitted to Biomedical Journals) Ô˘ ‰ËÌÔÛȇÙËÎ·Ó ÛÙÔ JAMA 1997;277:927-934 http://jama.ama-assn.org/info/auinst_req.html OÈ ·fi„ÂȘ Î·È Ù· Û˘ÌÂÚ¿ÛÌ·Ù· ÙˆÓ Û˘ÁÁڷʤˆÓ Ô˘ ‰È·Ù˘ÒÓÔÓÙ·È ÛÙȘ ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ÂÚÁ·Û›Â˜ ‰ÂÓ ·ÓÙÈηÙÔÙÚ›˙Ô˘Ó ··Ú·›ÙËÙ· ·˘Ù¤˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. H ηٷ¯ÒÚËÛË ‰È·ÊËÌ›ÛÂˆÓ ÛÙÔ ÂÚÈÔ‰ÈÎfi ‰ÂÓ ˘Ô‰ËÏÒÓÂÈ ÔˆÛ‰‹ÔÙ ¤ÁÎÚÈÛË ÙˆÓ ÂÚȯÔÌ¤ÓˆÓ ÙÔ˘˜ ·fi ÙËÓ EÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ EÙ·ÈÚ›·, ÙËÓ EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ‹ ·fi ÙÔÓ EΉfiÙË ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡.

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

H ηı˘ÛÙ¤ÚËÛË Ù˘ Â·Ó˘Ô‚ÔÏ‹˜ ÙÔ˘ ÙÚÔÔÔÈË̤ÓÔ˘ ÎÂÈ̤ÓÔ˘ ¤Ú·Ó ÙˆÓ 30 ËÌÂÚÒÓ Û˘ÓÂ¿ÁÂÙ·È Ó¤· ˘Ô‚ÔÏ‹. °È· Ó· ÂÈÙ¢¯ı› Ë ¤ÁηÈÚË ‰ËÌÔÛ›Â˘ÛË Ù˘ ÂÚÁ·Û›·˜ Â›Ó·È ··Ú·›ÙËÙÔ Ó· ÂÈÛÙÚ¤ÊÂÙ·È ÙÔ ‰ÈÔÚıˆÌ¤ÓÔ Ù˘ÔÁÚ·ÊÈÎfi ‰ÔΛÌÈÔ ·fi ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ ̤۷ Û ‰‡Ô (2) Ë̤Ú˜.

T· ¤ÍÔ‰· ÙˆÓ 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. °. ™‡ÓÙ·ÍË ÙˆÓ ∂ÚÁ·ÛÈÒÓ TÔ Û‡ÓÔÏÔ Ù˘ ÂÚÁ·Û›·˜ (Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ ÙˆÓ ÈÓ¿ÎˆÓ Î·È ÙˆÓ Ù›ÙÏˆÓ ÙˆÓ ÂÈÎfiÓˆÓ) Ú¤ÂÈ Ó· Â›Ó·È ‰·ÎÙ˘ÏÔÁÚ·ÊË̤ÓÔ ÛÙË ÌÈ· fi„Ë Ï¢ÎÔ‡ ¯·ÚÙÈÔ‡ ÌÂÁ¤ıÔ˘˜

v

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, ΛÌÂÓÔ, ¢¯·ÚÈÛٛ˜ ηıÒ˜ Î·È ·Ó·ÊÔÚ¿ Û ÂȉÔÙ‹ÛÂȘ-¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢, ‚È‚ÏÈÔÁÚ·Ê›·, ›Ó·Î˜, ÂÈÎfiÓ˜, Ù›ÙÏÔÈ ÂÈÎfiÓˆÓ, ηٿÏÔÁÔ˜ Û˘ÓÙÌ‹ÛˆÓ. K¿ı ¤Ó· ·fi Ù· ·Ú·¿Óˆ ÛÙÔȯ›· Ú¤ÂÈ Ó· ·Ú¯›˙ÂÈ Û ¯ˆÚÈÛÙfi ʇÏÏÔ Î·È ÔÈ ÛÂÏ›‰Â˜ Ó· ·ÚÈıÌÔ‡ÓÙ·È ‰È·‰Ô¯Èο ·Ú¯›˙ÔÓÙ·˜ Ì ÙË ÛÂÏ›‰· Ù›ÙÏÔ˘.

H ¤ÎÙ·ÛË ÚÔÛ‰ÈÔÚ›˙ÂÙ·È ÁÈ·: ·. ÙȘ ·Ó·ÛÎÔ‹ÛÂȘ Û 2000-3000 ϤÍÂȘ. ‚. ÙȘ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜ Î·È ÙȘ ÂӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ Û 1500-2500 ϤÍÂȘ. Á. ÙȘ ‚Ú·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ Û 1000-1500 ϤÍÂȘ. ‰. ÙȘ ÂÈÛÙÔϤ˜ Û 250-500 ϤÍÂȘ. ™ÂÏ›‰· Ù›ÙÏÔ˘ ¶Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ: - ÙÔÓ Ù›ÙÏÔ (<14 ϤÍÂȘ) ηıÒ˜ Î·È ÙÔÓ ‚Ú·¯‡ Ù›ÙÏÔ (<5 ϤÍÂȘ) ÙÔ˘ ¿ÚıÚÔ˘. ¢ÂÓ ÂÈÙÚ¤ÔÓÙ·È Û˘ÓÙÌ‹ÛÂȘ, - ÙÔ fiÓÔÌ· Î·È ÙÔ ÂÒÓ˘ÌÔ Î¿ıÂ Û˘ÁÁڷʤ· ÛÙËÓ ÔÓÔÌ·ÛÙÈ΋, - ÙÔ ÂÈÛÙËÌÔÓÈÎfi ΤÓÙÚÔ (›‰Ú˘Ì·, ÎÏÈÓÈ΋, ÂÚÁ·ÛÙ‹ÚÈÔ) ·fi fiÔ˘ ÚÔ¤Ú¯ÂÙ·È Ë ÂÚÁ·Û›·. ™Â ÂÚ›ÙˆÛË ¤ÏÏÂȄ˘ Û˘ÓÂÚÁ·Û›·˜ ÌÂ Û˘ÁÎÂÎÚÈ̤ӷ ΤÓÙÚ·, Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÂÙ·È Ë È‰ÈfiÙËÙ· ÙÔ˘/ÙˆÓ Û˘ÁÁڷʤˆÓ (.¯. ȉÈÒÙ˘ ·È‰›·ÙÚÔ˜) Î·È Ô ÙfiÔ˜ ‰È·ÌÔÓ‹˜ ÙÔ˘/ÙˆÓ, - ÙËÓ Ï‹ÚË ‰È‡ı˘ÓÛË, 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˘. £· Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÔ˘Ï¿¯ÈÛÙÔÓ 200 ϤÍÂȘ, fï˜ ‰ÂÓ ı· Ú¤ÂÈ Ó· ˘ÂÚ‚·›ÓÂÈ ÙȘ 250 ϤÍÂȘ. ∏ ÂÚ›ÏË„Ë ÙˆÓ ÂÚÁ·ÛÈÒÓ Ú¤ÂÈ Ó· Â›Ó·È ‰ÔÌË̤ÓË ÛÙȘ ÂÍ‹˜ ·Ú·ÁÚ¿ÊÔ˘˜: ÂÈÛ·ÁˆÁ‹, ̤ıÔ‰ÔÈ, ·ÔÙÂϤÛÌ·Ù· Î·È Û˘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 Û 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.

T· ¿ÚıÚ· Û‡ÓÙ·Í˘ Î·È ÔÈ ·ÂÈÎÔÓÈÛÙÈΤ˜ ÂÚÈÙÒÛÂȘ ¤¯Ô˘Ó ÌfiÓÔ ·ÁÁÏÈ΋ ÂÚ›ÏË„Ë.

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

K›ÌÂÓÔ OÈ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó: ÂÈÛ·ÁˆÁ‹, ÌÂıfi‰Ô˘˜, ·ÔÙÂϤÛÌ·Ù· Î·È Û˘˙‹ÙËÛË. H ÂÈÛ·ÁˆÁ‹ ÂÚÈÏ·Ì‚¿ÓÂÈ Ù· ÙÂÏÂ˘Ù·›· ‰Â‰Ô̤ӷ Ù˘ ¤Ú¢ӷ˜ ÛÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ ı¤Ì· Ì ÙȘ ΢ÚÈfiÙÂÚ˜ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·-

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ÔÌ¤˜ Î·È ÙÔ 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 Ì ÏÂÙÔ̤ÚÂȘ Ó· ·Ó·Ê¤ÚÔÓÙ·È ÔÈ ÛÙ·ÙÈÛÙÈΤ˜ ̤ıÔ‰ÔÈ ·Ó¿Ï˘Û˘ Î·È ·ÍÈÔÏfiÁËÛ˘ ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ. T· ·ÔÙÂϤÛÌ·Ù· Ú¤ÂÈ Ó· ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ì ۷ʋÓÂÈ· Î·È Ó· Û˘Óԉ‡ÔÓÙ·È ·fi ÙËÓ ··Ú·›ÙËÙË ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË. H Û˘˙‹ÙËÛË Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ Ù· Û˘ÌÂÚ¿ÛÌ·Ù· Ô˘ ÚÔ·ÙÔ˘Ó ·fi ÙËÓ ÂÚÁ·Û›·, ÙË ÛËÌ·Û›· Ô˘ ÌÔÚ› Ó· ¤¯Ô˘Ó Î·È ÙËÓ Èı·Ó‹ Û˘Û¯¤ÙÈÛ‹ ÙÔ˘˜ Ì ·Ú·ÙËÚ‹ÛÂȘ ¿ÏÏˆÓ ÂÚ¢ÓËÙÒÓ.

OÈ ÂӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Û‡ÓÙÔÌË ÂÈÛ·ÁˆÁ‹, ÂÚÈÁÚ·Ê‹ Ù˘ ÂÚ›ÙˆÛ˘ Î·È ‚Ú·¯Â›· Û˘˙‹ÙËÛË. OÈ ·ÂÈÎÔÓÈÛÙÈΤ˜ ÂÚÈÙÒÛÂȘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Û‡ÓÙÔÌË ÂÚÈÁÚ·Ê‹ Ù˘ ÂÚ›ÙˆÛ˘ 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 ÛÙÔ JAMA 1986;255:2329-2339. ™˘ÓÙÔÌÔÁڷʛ˜ OÈ Û˘ÓÙÔÌÔÁڷʛ˜ Ô˘ ¤¯Ô˘Ó ÂÈ‚ÏËı› ‰ÈÂıÓÒ˜ ‰ËÌÔÛȇÔÓÙ·È Û οı Ù‡¯Ô˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. ™‡ÓıÂÙÔÈ Î·È Ì·ÎÚÔÛÎÂÏ›˜ fiÚÔÈ Ô˘ Â·Ó·Ï·Ì‚¿ÓÔÓÙ·È Û˘¯Ó¿ ÛÙÔ Î›ÌÂÓÔ ÌÔÚÔ‡Ó Ó· ·ÓÙÈηı›ÛÙ·ÓÙ·È ·fi Û˘ÓÙÔÌÔÁڷʛ˜ Ô˘ ÂÂÍËÁÔ‡ÓÙ·È ·fi ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ Û ÂȉÈÎfi ηٿÏÔÁÔ, Ô ÔÔ›Ô˜ ˘Ô‚¿ÏÏÂÙ·È Ì·˙› Ì ÙËÓ ÂÚÁ·Û›·. OÈ Û˘ÓÙÔÌÔÁڷʛ˜ ·Ó·Ê¤ÚÔÓÙ·È Û ·Ú¤ÓıÂÛË ÌfiÓÔ ÛÙȘ ÂÚÈÏ‹„ÂȘ.

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

H Û‡ÓÙ·ÍË ÙˆÓ ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·ÔÌÒÓ Á›ÓÂÙ·È Û‡Ìʈӷ Ì ÙȘ ÚԉȷÁڷʤ˜ Ù˘ International Committee of Medical Journal Editors/Uniform Requirements for Manuscripts Submitted to Biomedical Journals (JAMA 1997;277:927-934), http://jama.amaassn.org/info/auinst_req.html. OÈ Û˘ÓÙÌ‹ÛÂȘ ÙˆÓ Ù›ÙÏˆÓ ÙˆÓ ÂÚÈÔ‰ÈÎÒÓ Á›ÓÔÓÙ·È Ì ‚¿ÛË ÙÔ Cumulated Index Medicus (List of Journals Indexed in Index Medicus, http://www.nlm.nih.gov).

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

T·ÎÙÈ΋ ¤Î‰ÔÛË ÂÚÈÔ‰ÈÎÔ‡: ∞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˘: ÷ڷϷÌ›‰Ë˜ π, ¶··‰fiÔ˘ÏÔ˜ ∞. ¶·¯˘Û·ÚΛ· Î·È ˘ÂÚÏÈȉ·ÈÌ›· [¶ÂÚ›ÏË„Ë]. 36Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ; 1998 5-7 πÔ˘Ó›Ô˘; ¶¿ÊÔ˜, ∫‡ÚÔ˜; 1998. ÛÂÏ. 199.

Schreiner GF, Lange L. Ethanol modulation of macrophage influx in glomerulonephritis [abstract].

J Am Soc Nephrol 1991;2:562.

Should antileukotriene therapies be used instead of inhaled corticosteroids in asthma? [Editorial]. Am J Respir Crit Care Med 1998;158:1697-1701.

Laux-End R, Inaebnit D, Gerber HA, Bianchetti MG. Vasculitis associated with levamisole and circulating autoantibodies [letter]. Arch Dis Child 1996;75:355-356.

II. µÈ‚Ï›· ∫ÂÊ¿Ï·ÈÔ Û ‚È‚Ï›Ô: Clark AG, Barratt TM. Steroid-responsive nephrotic syndrome. In: Barratt TM, Arner ED, Harmon WE, editors.

Pediatric Nephrology. 4th ed. Baltimore: Lippincott William Wilkins; 1999. p. 742. ™‡ÁÁÚ·ÌÌ· ‹ ÌÔÓÔÁÚ·Ê›·: Gorlin RJ, Cohen MM, Levin LS. Syndromes of the head and neck. 3rd ed. New York: Oxford University Press; 1990. ¢ËÌÔÛ›Â˘ÛË Û ÙfiÌÔ Ú·ÎÙÈÎÒÓ: Bauer AW. The two definitions of bacterial resistance.

In: Smith AJ, Rogers CA, eds. Proceedings of the Third International Congress of Chemotherapy; 1962 May 29-

31; New York: International Society of Chemotherapy; 1963. p. 484-500. ¢È‰·ÎÙÔÚÈ΋ ‰È·ÙÚÈ‚‹: ¶··‰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. ¶›Ó·Î˜ Î·È EÈÎfiÓ˜ AÔÛÙ¤ÏÏÔÓÙ·È ÂȘ ÙÚÈÏÔ‡Ó (¤Ó· ÚˆÙfiÙ˘Ô+‰‡Ô ʈÙÔ·ÓÙ›ÁÚ·Ê·). ¶Ú¤ÂÈ Ó· ¤¯Ô˘Ó Ï¿ÙÔ˜ ›ÛÔ Ì ÙÔ Ï¿ÙÔ˜ ÙÔ˘ ÌÔÓfiÛÙËÏÔ˘ (8 cm) ‹ Ì ÙÔ Ï¿ÙÔ˜ fiÏ˘ Ù˘ ÛÂÏ›‰·˜ (16,8 cm). TÔ Ì¤ÁÈÛÙÔ Ì‹ÎÔ˜ ÙÔ˘˜, Ì·˙› Ì ÙÔ˘˜ Ù›ÙÏÔ˘˜, ‰ÂÓ Ú¤ÂÈ Ó· Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ ·fi 22 cm.

OÈ ›Ó·Î˜ ·ÚÈıÌÔ‡ÓÙ·È Ì ·Ú·‚ÈÎÔ‡˜ ·ÚÈıÌÔ‡˜ Ì ÙË ÛÂÈÚ¿ Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÔ Î›ÌÂÓÔ. ¶ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ‚Ú·¯‡ Ù›ÙÏÔ Î·È ÂÂÍ‹ÁËÛË ÙˆÓ Û˘ÓÙÌ‹ÛÂˆÓ ÛÙÔ Î¿Ùˆ ̤ÚÔ˜. ™ÙÔ˘˜ ›Ó·Î˜ Ú¤ÂÈ Ó· ·ÔʇÁÔÓÙ·È ÔÈ Î¿ıÂÙ˜ ÁÚ·Ì̤˜. ŸÏÔ ÙÔ ·ÂÈÎÔÓÈÛÙÈÎfi ˘ÏÈÎfi (Û¯‹Ì·Ù·, ‰È·ÁÚ¿ÌÌ·Ù·, ʈÙÔÁڷʛ˜, Î.Ï.) ¯·Ú·ÎÙËÚ›˙ÂÙ·È ˆ˜ ÂÈÎfiÓ˜. £· Ú¤ÂÈ Ó· Â›Ó·È ¿ÚÈÛÙ˘ ÔÈfiÙËÙ·˜ Ì ÌÔÚÊ‹ ʈÙÔÁÚ·ÊÈÒÓ ‹ Î·È ÚˆÙÔÙ‡ˆÓ. ™ÙÔ ›Ûˆ ̤ÚÔ˜ ÙˆÓ ÂÈÎfiÓˆÓ Ú¤ÂÈ Ó· ÛËÌÂÈÒÓÂÙ·È Ì ÌÔχ‚È Ô ·ÚÈıÌfi˜ Ù˘ ÂÈÎfiÓ·˜ Î·È ÙÔ fiÓÔÌ· ÙÔ˘ ÚÒÙÔ˘ Û˘ÁÁڷʤ·, ηıÒ˜ Î·È ¤Ó· ‚¤ÏÔ˜ ÙÔ 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. ∂ÈÛÙÔÏ‹ ˘Ô‚ÔÏ‹˜.

2. ¢‹ÏˆÛË ÌË ÚÔÁÂÓ¤ÛÙÂÚ˘ ‰ËÌÔÛ›Â˘Û˘ Ù˘ ÂÚÁ·Û›·˜.

3. 3 ·ÓÙ›ÁÚ·Ê· ÙÔ˘ ÎÂÈ̤ÓÔ˘ Ù˘ ÂÚÁ·Û›·˜.

4. ™ÂÏ›‰· Ù›ÙÏÔ˘ (¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) ÂÚÈÏ·Ì‚¿ÓÂÈ: ·. Ù›ÙÏÔ Î·È ‚Ú·¯‡ Ù›ÙÏÔ ÂÚÁ·Û›·˜, ‚. fiÓÔÌ· Î·È 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΋, ϤÍÂȘ 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˜ Ó· ‰Â›¯ÓÂÈ ÚÔ˜ Ù· Â¿Óˆ, ·ÚÈıÌË̤Ó˜, ÂȘ ÙÚÈÏÔ‡Ó.

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

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OÈ Ì˘ÔηډÈÔ¿ıÂȘ ÛÙ· ·È‰È¿ ∂. ∞ÔÛÙfiÏÔ˘, ∞. ∆ÛÈÏÈÌÈÁοÎË

Cardiomyopathies in children H. Apostolou, A. Tsilimigaki

¶ÂÚ›ÏË„Ë: OÈ Ì˘ÔηډÈÔ¿ıÂȘ ·ÔÙÂÏÔ‡Ó ÛËÌ·ÓÙÈ΋ ·ÈÙ›· ÓÔÛËÚfiÙËÙ·˜ Î·È ıÓËÛÈÌfiÙËÙ·˜ Û fiÏÔ ÙÔÓ ÎfiÛÌÔ, ÙfiÛÔ ÛÙÔ˘˜ ÂÓ‹ÏÈΘ fiÛÔ Î·È ÛÙ· ·È‰È¿. OÈ Ì˘ÔηډÈÔ¿ıÂȘ ·ÔÙÂÏÔ‡Ó ·ı‹ÛÂȘ ÙÔ˘ ηډȷÎÔ‡ Ì˘fi˜ Î·È ¯ˆÚ›˙ÔÓÙ·È ÛÙËÓ ˘ÂÚÙÚÔÊÈ΋, ÙË ‰È·Ù·ÙÈ΋, ÙËÓ ÂÚÈÔÚÈÛÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ·, ÙËÓ ·ÚÚ˘ıÌÈÔÁfiÓÔ ‰˘ÛÏ·Û›· Ù˘ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜, ηıÒ˜ Î·È ÛÙÔ “ÌË Û˘Ì·Á¤˜ Ì˘ÔοډÈÔ” Ô˘ ÂÚÈÁÚ¿ÊËΠÚfiÛÊ·Ù·. OÈ Ú·Á‰·›Â˜ ÂÍÂÏ›ÍÂȘ Ô˘ ÛËÌÂÈÒÓÔÓÙ·È ÛÙË ÌÔÚȷ΋ ÁÂÓÂÙÈ΋, ¤¯Ô˘Ó Û˘Ì‚¿ÏÏÂÈ ÛÙËÓ Î·Ï‡ÙÂÚË Î·Ù·ÓfiËÛË Ù˘ ·ÈÙÈÔÏÔÁ›·˜ ÙˆÓ Ì˘ÔηډÈÔ·ıÂÈÒÓ, Ù˘ ÂͤÏÈ͢, ηıÒ˜ Î·È ÛÙËÓ ÙÚÔÔÔ›ËÛË ˆ˜ ¤Ó· ‚·ıÌfi Ù˘ ıÂÚ·¢ÙÈ΋˜ ÛÙÚ·ÙËÁÈ΋˜.

Abstract: Cardiomyopathies represent a variety of cardiac diseases that are an important cause of morbidity and mortality throughout the world, in both children and adults. They are classified into categories of hypertrophic, dilated and restrictive cardiomyopathy, arrythmiogenic right ventricular dysplasia, and the recently described noncompaction of the left ventricle. The recent advances in molecular genetics have contributed to the better understanding of the aetiology of the cardiomyopathies, the therapeutic interventions and the prognosis.

§¤ÍÂȘ ÎÏÂȉȿ: Ì˘ÔηډÈÔ¿ıÂȘ, ‰È·Ù·ÙÈ΋, ˘ÂÚÙÚÔÊÈ΋, ÂÚÈÔÚÈÛÙÈ΋, ·ÚÚ˘ıÌÈÔÁfiÓÔ˜ ‰˘ÛÏ·Û›· Ù˘ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜, ÌË Û˘Ì·Á¤˜ Ì˘ÔοډÈÔ.

Key words: cardiomyopathies, dilated, hypertrophic, restrictive, arrythmiogenic right ventricular dysplasia, non-compaction of the left ventricle.

∂ÈÛ·ÁˆÁ‹ OÈ Ì˘ÔηډÈÔ¿ıÂȘ ·ÔÙÂÏÔ‡Ó Ì›· ÔÌ¿‰· ÓfiÛˆÓ, ·ÚÈÔ ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÙˆÓ ÔÔ›ˆÓ Â›Ó·È Ë ÚÔÛ‚ÔÏ‹ ÙÔ˘ ›‰ÈÔ˘ ÙÔ˘ ηډȷÎÔ‡ Ì˘fi˜, ÂÓÒ Û˘ÓÈÛÙÔ‡Ó ‰ÔÌÈΤ˜ ‹ ÏÂÈÙÔ˘ÚÁÈΤ˜ ·ÓˆÌ·Ï›Â˜ ÙÔ˘ ηډȷÎÔ‡ Ì˘fi˜ Ô˘ ‰ÂÓ Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ˘¤ÚÙ·Û˘, ‚·Ï‚ȉÔ¿ıÂÈ·˜ ‹ Û˘ÁÁÂÓÔ‡˜ ·ÓˆÌ·Ï›·˜ ÙÔ˘ Ì˘Ôηډ›Ô˘ (1). ∏ ÙÂÏÂ˘Ù·›· Ù·ÍÈÓfiÌËÛË ÙˆÓ Ì˘ÔηډÈÔ·ıÂÈÒÓ ·fi ÙËÓ ¶·ÁÎfiÛÌÈ· OÚÁ¿ÓˆÛË ÀÁ›·˜ Ê·›ÓÂÙ·È ÛÙÔÓ ¶›Ó·Î· 1 (1).

OÈ Ì˘ÔηډÈÔ¿ıÂȘ, Ì ‚¿ÛË ÙË ÏÂÈÙÔ˘ÚÁÈ΋ ÙÔ˘˜ ‰È·Ù·Ú·¯‹, Ù·ÍÈÓÔÌÔ‡ÓÙ·È ÛÂ: ·) ‰È·Ù·ÙÈ΋ ‹ Û˘ÌÊÔÚËÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ·, ÛÙËÓ ÔÔ›· Ë ·ÚÈÛÙÂÚ‹ ‹ Î·È ÔÈ ‰‡Ô ÎÔÈϛ˜ Â›Ó·È ‰È·ÙÂٷ̤Ó˜ Î·È ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÌÂȈ̤ÓË Û˘ÛÙ·ÏÙÈÎfiÙËÙ·, ‚) ˘ÂÚÙÚÔÊÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ·, Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ˘ÂÚÙÚÔÊ›· Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜, Û˘Ó‹ıˆ˜ ·Û‡Ì-

ÌÂÙÚË, Á) ÂÚÈÔÚÈÛÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ·, Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÛËÌ·ÓÙÈο ‰È·ÙÂٷ̤ÓÔ˘˜ ÎfiÏÔ˘˜, ÌÂ Ê˘ÛÈÔÏÔÁÈΤ˜ ‰È·ÛÙ¿ÛÂȘ ÙˆÓ ÎÔÈÏÈÒÓ (3) (¶›Ó·Î·˜ 2), ‰) ·ÚÚ˘ıÌÈÔÁfiÓÔ ‰˘ÛÏ·Û›· Ù˘ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜, ÛÙËÓ ÔÔ›· Ù· ·ÙÙ·Ú· ÙÔ˘ Ì˘Ôηډ›Ô˘ ·ÓÙÈηı›ÛÙ·ÓÙ·È ·fi ÏÈÒ‰Ë Î·È ÈÓÒ‰Ë ÈÛÙfi (4) Î·È Â) ÌË Û˘Ì·Á¤˜ Ì˘ÔοډÈÔ, Ì›· Ì˘ÔηډÈÔ¿ıÂÈ· Ô˘ ÂÚÈÁÚ¿ÊËΠÚfiÛÊ·Ù·. ªÂ ÙË Ú·Á‰·›· ÂͤÏÈÍË ÛÙÔÓ ÙÔ̤· Ù˘ ÌÔÚȷ΋˜ ‚ÈÔÏÔÁ›·˜ Î·È Ì ÙË ‚ÂÏÙ›ˆÛË ÙˆÓ ‰È·ÁÓˆÛÙÈÎÒÓ Ì¤ÛˆÓ, ÔÈ Ì˘ÔηډÈÔ¿ıÂȘ ·Ó·ÁÓˆÚ›˙ÔÓÙ·È ˆ˜ ÛËÌ·ÓÙÈ΋ ·ÈÙ›· ÓÔÛËÚfiÙËÙ·˜ Î·È ıÓËÛÈÌfiÙËÙ·˜, ÙfiÛÔ ÛÙÔ˘˜ ÂÓ‹ÏÈΘ fiÛÔ Î·È ÛÙ· ·È‰È¿.

µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ µÂÓÈ˙¤ÏÂÈÔ˘ ¡ÔÛÔÎÔÌ›Ԣ, ∏Ú¿ÎÏÂÈÔ ∫Ú‹Ù˘

2nd Paediatric Clinic of Venizelion Hospital, Heraklion, Crete

¢È·Ù·ÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· ∏ ‰È·Ù·ÙÈ΋ ‹ Û˘ÌÊÔÚËÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· (¢ª∫) Â›Ó·È Ë ÈÔ Û˘¯Ó‹ ÌÔÚÊ‹ Ì˘ÔηډÈÔ¿ıÂÈ·˜,

405

¶·È‰È·ÙÚÈ΋ 2003;66:405-417

Paediatriki 2003;66:405-417

Ì ÂÙ‹ÛÈ· Â›ÙˆÛË 40-50 ÂÚÈÙÒÛÂȘ ·Ó¿ 100.000 ÏËı˘ÛÌÔ‡ ÛÙȘ ∏.¶.∞. Î·È ÙËÓ ∂˘ÚÒË (5,6). ÷ڷÎÙËÚ›˙ÂÙ·È ·fi ‰È¿Ù·ÛË Î·È ÌÂȈ̤ÓË Û˘ÛÙ·ÏÙÈÎfiÙËÙ· Ù˘ ·ÚÈÛÙÂÚ‹˜ ‹ Î·È ÙˆÓ ‰‡Ô ÎÔÈÏÈÒÓ. ∞ÈÙÈÔÏÔÁ›· ∏ ¢ª∫ ·ÔÙÂÏ› Ì›· ÎÔÈÓ‹ ¤ÎÊÚ·ÛË Ì˘Ôηډȷ΋˜ ‚Ï¿‚˘ Ô˘ ÚÔ‹Ïı ·fi Ì›· ÔÈÎÈÏ›· ÌË Ï‹Úˆ˜ ‰È¢ÎÚÈÓÈÛÌ¤ÓˆÓ ‚Ï·ÙÈÎÒÓ ÂȉڿÛÂˆÓ Â› ÙÔ˘ Ì˘Ôηډ›Ô˘ (¶›Ó·Î·˜ 3). ∏ ¤Ú¢ӷ Û¯ÂÙÈο Ì ÙËÓ ·ıÔÁ¤ÓÂÈ· ¤¯ÂÈ ÂÛÙÈ·ÛÙ› Û 4 ‚·ÛÈÎÔ‡˜ Ì˯·ÓÈÛÌÔ‡˜: ÔÈÎÔÁÂÓ›˜ Î·È ÁÂÓÂÙÈÎÔ› ·Ú¿ÁÔÓÙ˜, ÈÔÁÂÓ‹˜ Ì˘Ôηډ›Ùȉ·, ·ÓÔÛÔÏÔÁÈΤ˜ Î·È ÌÂÙ·‚ÔÏÈΤ˜ ‰È·Ù·Ú·¯¤˜ (7). ∏ ÔÈÎÔÁÂÓ‹˜ ÌÂÙ·‚›‚·ÛË Ù˘ ‰È·Ù·ÙÈ΋˜ Ì˘ÔηډÈÔ¿ıÂÈ·˜ Â›Ó·È Û˘¯ÓfiÙÂÚË ·fi fi,ÙÈ Û˘Ó‹ıˆ˜ ·Ó·ÁÓˆÚ›˙ÂÙ·È. ™Â ÔÛÔÛÙfi 20% ÙˆÓ ·ÛıÂÓÒÓ, ¤Ó·˜ ÚÒÙÔ˘ ‚·ıÌÔ‡ Û˘ÁÁÂÓ‹˜ ÂÌÊ·Ó›˙ÂÈ ÂӉ›ÍÂȘ ¢ª∫

‹ ˘ÔÎÏÈÓÈ΋ ÓfiÛÔ, ÁÂÁÔÓfi˜ Ô˘ ˘Ô‰ÂÈÎÓ‡ÂÈ fiÙÈ Ë ÔÈÎÔÁÂÓ‹˜ ÌÂÙ·‚›‚·ÛË Â›Ó·È Ôχ Û˘¯Ó‹ (8). ªÂ ÏÈÁfiÙÂÚÔ ·˘ÛÙËÚ¿ ÎÚÈÙ‹ÚÈ·, Û ÔÛÔÛÙfi ÂÚ›Ô˘ 3548% ÙˆÓ ·ÛıÂÓÒÓ Ì ¢ª∫, ıˆÚÂ›Ù·È fiÙÈ Â›Ó·È ÔÈÎÔÁÂÓ‹˜ (9,10). ∏ ÈÔ Û˘¯Ó‹ ÌÔÚÊ‹ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜ Â›Ó·È Ì ÙÔÓ ·˘ÙÔۈ̷ÙÈÎfi ÂÈÎÚ·ÙÔ‡ÓÙ· ¯·Ú·ÎÙ‹Ú· (>90%), Ì ÔÈÎÈÏÔÌÔÚÊ›· ÛÙËÓ ¤ÎÊÚ·ÛË ·ÎfiÌ· Î·È Ì¤Û· ÛÙËÓ ›‰È· ÔÈÎÔÁ¤ÓÂÈ· Î·È Ì ‰ÈÂÈÛ‰˘ÙÈÎfiÙËÙ· Ô˘ ÂÍ·ÚÙ¿Ù·È ·fi ÙËÓ ËÏÈΛ· (9-11). ∏ ÓfiÛÔ˜ Â›Ó·È ÁÂÓÂÙÈο ·ÓÔÌÔÈÔÁÂÓ‹˜ Î·È ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ÂÚÈÙÒÛÂȘ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜ Ì ÙÔÓ ·˘ÙÔۈ̷ÙÈÎfi ˘ÔÏÂÈfiÌÂÓÔ, ÌÂ Ê˘ÏÔÛ‡Ó‰ÂÙÔ ¯·Ú·ÎÙ‹Ú·, ·ÏÏ¿ Î·È ÌÂÙ·ÏÏ¿ÍÂȘ ÛÙÔ ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi DNA (12,13). ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ¤¯ÂÈ ÌÂÏÂÙËı› ·ÚÎÂÙ¿ Ë ÁÂÓÂÙÈ΋ ‚¿ÛË Ù˘ ÔÈÎÔÁÂÓÔ‡˜ ‰È·Ù·ÙÈ΋˜ Ì˘ÔηډÈÔ¿ıÂÈ·˜ Î·È ¤¯Ô˘Ó ÂÓÔ¯ÔÔÈËı› 8 ‰È·ÊÔÚÂÙÈο ·˘ÙÔۈ̷ÙÈο ÁÔÓ›‰È· Î·È 8 ÂÈÚfiÛıÂÙ˜ ÂÚÈÔ¯¤˜ ¯ÚˆÌÔۈ̿وÓ

¶›Ó·Î·˜ 1. ∞ÈÙÈÔÏÔÁÈ΋ Ù·ÍÈÓfiÌËÛË ÙˆÓ Ì˘ÔηډÈÔ·ıÂÈÒÓ ¢Â˘ÙÂÚÔ·ı›˜ ÀÂÚÙ·ÛÈ΋ µ·Ï‚ȉÈ΋ πÛ¯·ÈÌÈ΋ ™˘ÛÙËÌ·ÙÈ΋˜ ÓfiÛÔ˘ ºÏÂÁÌÔÓ҉˘

¶ÚˆÙÔ·ı›˜

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πÓÔÂÏ¿ÛÙˆÛË ªË Û˘Ì·Á¤˜ Ì˘ÔοډÈÔ ªÈÙÔ¯ÔÓ‰Úȷ΋

∆ÚÔÔÔÈË̤ÓÔ ·fi Circulation 1996;93:341-342 ¶›Ó·Î·˜ 2. ∫ÏÈÓÈο, ·ÈÌÔ‰˘Ó·ÌÈο Î·È ÌÔÚÊÔÏÔÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ Ì˘ÔηډÈÔ·ıÂÈÒÓ

∫ÏÈÓÈο ñ ∫·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ· ñ ∞ÚÚ˘ı̛˜

ñ ∞ÈÊÓ›‰ÈÔ˜ ı¿Ó·ÙÔ˜ ∞ÈÌÔ‰˘Ó·ÌÈο ñ ™˘ÛÙÔÏÈ΋ ÏÂÈÙÔ˘ÚÁ›· ñ ¢È·ÛÙÔÏÈ΋ ÏÂÈÙÔ˘ÚÁ›· ªÔÚÊÔÏÔÁÈο ñ ª¤ÁÂıÔ˜ ÎÔÈÏÔÙ‹ÙˆÓ ∫ÔÈϛ˜ ∫fiÏÔÈ

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¶·È‰È·ÙÚÈ΋ 2003;66:405-417

(6,11). ∏ ÔÈÎÔÁÂÓ‹˜ ‰È·Ù·ÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· ÌÔÚ› Ó· ¯ˆÚÈÛÙ› Û 4 ·ÚȘ ÔÌ¿‰Â˜ Ì ‚¿ÛË ÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ· Î·È ÙÔÓ ˘‡ı˘ÓÔ ·ÈÙÈÔÏÔÁÈÎfi ·Ú¿ÁÔÓÙ·: ·) ‰È·Ù·ÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· Ì ÁÚ‹ÁÔÚË Âȉ›ӈÛË ÛÙÔ˘˜ Ó·ÚÔ‡˜ ¿Ó‰Ú˜, Ô˘ ÔÊ›ÏÂÙ·È Î˘Ú›ˆ˜ Û ÌÂÙ·ÏÏ¿ÍÂȘ ÙˆÓ ÁÔÓȉ›ˆÓ Ô˘ Έ‰ÈÎÔÔÈÔ‡Ó ÙȘ ÚˆÙ½Ó˜ ‰˘ÛÙÚÔÊ›ÓË Î·È Ù·Ê·˙›ÓË, ‚) ‰È·Ù·ÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· Ô˘ ÂΉËÏÒÓÂÙ·È Î˘Ú›ˆ˜ Ì ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜, fiÔ˘ ÔÈ ˘‡ı˘Ó˜ ÚˆÙ½Ó˜ Ô˘ ¤¯Ô˘Ó ˘ÔÛÙ› ÌÂÙ¿ÏÏ·ÍË Â›Ó·È Ë ÙÚÔÔÓ›ÓË ∆, Ë ‰-Û·ÚÎÔÁÏ˘Î¿ÓË, Ë ‚-MHC (‚·ÚÈ¿ ¿Ï˘ÛÔ˜ Ù˘ ‚-Ì˘ÔÛ›Ó˘) Î·È Ë ·ÎÙ›ÓË, Á) ‰È·Ù·ÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· Ì ÚÒÈÌË ‰È·Ù·Ú·¯‹ Ù˘ ·ÁˆÁ‹˜, Ì ‚Ï¿‚Ë ÛÙȘ ÚˆÙ½Ó˜ ÙÔ˘ ˘Ú‹Ó· Ϸ̛Ә A Î·È C Î·È ÛÙË ‰ÂÛÌ›ÓË, ‰) ‰È·Ù·ÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· Ô˘ Û˘Ó˘¿Ú¯ÂÈ Ì Ó¢ÚÔ·ÈÛıËÙ‹ÚÈÔ ‚·ÚËÎÔ˝· Î·È ÔÊ›ÏÂÙ·È Û ÌÂÙ¿ÏÏ·ÍË Ù˘ ı¤Û˘ ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ 6q23-24 (∂ÈÎfiÓ· 1) (4,9). ŒÓ·˜ ·ıÔÁÂÓÂÙÈÎfi˜ Ì˯·ÓÈÛÌfi˜ Ù˘ ‰È·Ù·ÙÈ΋˜ Ì˘ÔηډÈÔ¿ıÂÈ·˜ Â›Ó·È ÔÈ ÌÂÙ·ÏÏ¿ÍÂȘ ÁÔÓȉ›ˆÓ Ô˘ Έ‰ÈÎÔÔÈÔ‡Ó ÚˆÙ½Ó˜ ÙÔ˘ ΢ÙÙ·ÚÔÛÎÂÏÂÙÔ‡, fiˆ˜ Ë ‰˘ÛÙÚÔÊ›ÓË (¯ÚˆÌfiۈ̷ Ãp21), Ë Ù·Ê·˙›ÓË (¯ÚˆÌfiۈ̷ Xq28), Ë ‰-Û·ÚÎÔÁÏ˘Î¿ÓË (¯ÚˆÌfiۈ̷ 5q33-q34) Î·È Ë ‰ÂÛÌ›ÓË (¯ÚˆÌfiۈ̷ 2q35) (14). ¶›Ó·Î·˜ 3. AÈÙÈÔÏÔÁ›· ‰È·Ù·ÙÈ΋˜ Ì˘ÔηډÈÔ¿ıÂÈ·˜ ªÂÙ·‚ÔÏÈο ∂Ó‰ÔÎÚÈÓÔÏÔÁÈο

¡fiÛÔÈ ÂÓ·Ôı¤Ûˆ˜

ÀÔÛÈÙÈÛÌfi˜ ∞ÓÂ¿ÚÎÂÈ· ηÚÓÈÙ›Ó˘ ∞ÓÂ¿ÚÎÂÈ· ‚-ÎÂÙÔÏ¿Û˘ ÀÂÚÙ·˘ÚÈÓÔ˘Ú›· OÈÎÔÁÂÓ‹˜ Ì˘ÔηډÈÔ¿ıÂÈ·

∫ÏËÚÔÓÔÌÈΤ˜ ‰È·Ù·Ú·¯¤˜ ª˘˚Τ˜ ‰˘ÛÙÚÔʛ˜

ªÈÙÔ¯ÔÓ‰ÚȷΤ˜ ‰È·Ù·Ú·¯¤˜ ÕÏÏ·

£˘ÚÂÔÙÔ͛ΈÛË ÀÔı˘ÚÂÔÂȉÈÛÌfi˜ ¢È·‚ËÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· ÀÔÁÏ˘Î·ÈÌ›· º·ÈÔ¯ÚˆÌÔ·Ùو̷ ¡Â˘ÚÔ‚Ï¿Ûو̷ °Ï˘ÎÔÁÔÓÈ¿ÛÂȘ µÏÂÓÓÔÔÏ˘Û·Î¯·ÚȉÒÛÂȘ ™ÊÈÁÁÔÏÈȉÒÛÂȘ Kwashiorkor Beriberi

π‰ÈÔ·ı‹˜ (·˘Ùo ۈ̷ÙÈ΋ ÂÈÎÚ·ÙÔ‡Û·, ˘ÔÏÂÈfiÌÂÓË, Ê˘ÏÔÛ‡Ó‰ÂÙË, ÛÔÚ·‰È΋) º˘ÏÔÛ‡Ó‰ÂÙË Î·Ú‰ÈÔÛÎÂÏÂÙÈ΋ Ì˘Ô¿ıÂÈ· (Û. Barth)

Duchene-Becker Emery-Dreiffus ª˘ÔÙÔÓÈ΋ ‰˘ÛÙÚÔÊ›· ™. Kearns-Sayre ∞ÓÂ¿ÚÎÂÈ· ÙÔ˘ NADH-Co Q ∞ÈÌÔÏ˘ÙÈÎfi-Ô˘Ú·ÈÌÈÎfi Û‡Ó‰ÚÔÌÔ ª˘ÔηډÈÔ¿ıÂÈ· Ù˘ Ïԯ›·˜ ∞ÙÂÏ‹˜ ÔÛÙÂÔÁ¤ÓÂÛË §ÔÈÌ҉˘ Ì˘Ôηډ›Ùȉ·

∆ÚÔÔÔÈË̤ÓÔ ·fi Curr Opin Pediatr 1995;7:587-594

Paediatriki 2003;66:405-417

O Ê·ÈÓfiÙ˘Ô˜ Ù˘ Ê˘ÏÔÛ‡Ó‰ÂÙ˘ ‰È·Ù·ÙÈ΋˜ Ì˘ÔηډÈÔ¿ıÂÈ·˜ Ô˘ ÔÊ›ÏÂÙ·È Û ÌÂÙ·ÏÏ¿ÍÂȘ ÙÔ˘ ÁÔÓȉ›Ô˘ Ô˘ Έ‰ÈÎÔÔÈ› ÙËÓ ÚˆÙ½ÓË ‰˘ÛÙÚÔÊ›ÓË (Ãp21), Û˘Ó‹ıˆ˜ ·Ó·ÁÓˆÚ›˙ÂÙ·È ÛÙËÓ ÂÊ˂›· ‹ Û ӤԢ˜ ¿ÚÚÂÓ˜ Î·È Û˘¯Ó¿ Û˘Ó‰˘¿˙ÂÙ·È Ì ÙË Ì˘˚΋ ‰˘ÛÙÚÔÊ›· Duchenne Î·È Becker, ·Ú’ fiÏÔ Ô˘ ¤¯Ô˘Ó ÂÓÙÔÈÛÙ› ÌÂÙ·ÏÏ¿ÍÂȘ Ô˘ ÚÔηÏÔ‡Ó ‰È·Ù·ÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· ¯ˆÚ›˜ Û˘ÌÌÂÙÔ¯‹ ÙÔ˘ Ì˘ÔÛÎÂÏÂÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ (15-17). ∏ Ê˘ÏÔÛ‡Ó‰ÂÙË Ì˘ÔηډÈÔ¿ıÂÈ· Ô˘ Û˘Ó‰˘¿˙ÂÙ·È Ì ÌÂÙ·ÏÏ¿ÍÂȘ Ù˘ Ù·Ê·˙›Ó˘ (Û‡Ó‰ÚÔÌÔ Barth), ÂÌÊ·Ó›˙ÂÙ·È Ù˘Èο ÛÙË ‚ÚÂÊÈ΋ ËÏÈΛ· Î·È Â›Ó·È ı·Ó·ÙËÊfiÚÔ˜ (17). ªÂÙ·ÏÏ¿ÍÂȘ ÙˆÓ ÁÔÓȉ›ˆÓ Ô˘ Έ‰ÈÎÔÔÈÔ‡Ó ÚˆÙ½Ó˜ ÙÔ˘ Û·ÚÎÔÌÂÚȉ›Ô˘, fiˆ˜ Ë ‰ÂÛÌ›ÓË, Ë ‰-Û·ÚÎÔÁÏ˘Î¿ÓË, Ë ·ÎÙ›ÓË Î·È Ë ÙÈÙ›ÓË, ÌÂÙ·‚È‚¿˙ÔÓÙ·È Ì ÙÔÓ ·˘ÙÔۈ̷ÙÈÎfi ÂÈÎÚ·ÙÔ‡ÓÙ· ¯·Ú·ÎÙ‹Ú· (18-21) (∂ÈÎfiÓ· 1). ∞ӈ̷ϛ˜ ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ·ÁˆÁ‹˜ ¤¯Ô˘Ó ·Ú·ÙËÚËı› ÛÙË Ì˘˚΋ ‰˘ÛÙÚÔÊ›· EmeryDreifus, Ô˘ ÎÏËÚÔÓÔÌÂ›Ù·È Â›Ù ÌÂ Ê˘ÏÔÛ‡Ó‰ÂÙÔ ¯·Ú·ÎÙ‹Ú· Î·È ÔÊ›ÏÂÙ·È Û ÌÂÙ·ÏÏ¿ÍÂȘ ÙÔ˘ ÁÔÓȉ›Ô˘ Ù˘ ÂÌÂÚ›Ó˘, ›Ù Ì ·˘ÙÔۈ̷ÙÈÎfi ÂÈÎÚ·ÙÔ‡ÓÙ· ¯·Ú·ÎÙ‹Ú· Î·È ÔÊ›ÏÂÙ·È Û ÌÂÙ·ÏÏ¿ÍÂȘ ÁÔÓȉ›ˆÓ Ô˘ Έ‰ÈÎÔÔÈÔ‡Ó ÙȘ ÚˆÙ½Ó˜ ÙÔ˘ ˘Ú‹Ó· Ϸ̛Ә A Î·È C (22,23). ∫¿ÔÈ· Û‡Ó‰ÚÔÌ· Û˘Ó‰˘¿˙ÔÓÙ·È Ì ‰È·Ù·ÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· Î·È ‚·ÚËÎÔ˝· Ó¢ÚÔ·ÈÛıËÙËÚÈ·ÎÔ‡ Ù‡Ô˘, fiˆ˜ ÙÔ Û‡Ó‰ÚÔÌÔ Alstrom (24), ÌÂÙ·ÏÏ¿ÍÂȘ ÛÙÔ ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi tRNA Î·È ÌÂÙ·ÏÏ¿ÍÂȘ ÛÙÔ ¯ÚˆÌfiۈ̷ 6q23-24 (25). ¡ÂfiÙÂÚ˜ ÌÂϤÙ˜ ·Ó·Ê¤ÚÔÓÙ·È Û ÌÂÙ·ÏÏ¿ÍÂȘ Î·È ¿ÏÏˆÓ ‰ÔÌÈÎÒÓ ÚˆÙÂ˚ÓÒÓ ÙÔ˘ Û·ÚÎÔÌÂÚȉ›Ô˘, fiˆ˜ Ë ÚˆÙ½ÓË LIM (Lin-11, Isl-1 Î·È Mec-3) (26) Î·È Ë ÌÂÙ·‚ÈÎÔ˘Ï›ÓË (27). ∂›Ó·È Èı·Ófi fiÙÈ ¤Ó· ÂÂÈÛfi‰ÈÔ ˘ÔÎÏÈÓÈ΋˜ ÈÔÁÂÓÔ‡˜ Ì˘Ôηډ›Ùȉ·˜ ÌÔÚ› Ó· ÎÈÓËÙÔÔÈ‹ÛÂÈ ·ÓÔÛÔÏÔÁÈ΋ ·ÓÙ›‰Ú·ÛË, Ô‰ËÁÒÓÙ·˜ ÛÙËÓ ·Ó¿Ù˘ÍË ‰È·Ù·ÙÈ΋˜ Ì˘ÔηډÈÔ¿ıÂÈ·˜ (28,29). ¢È·Ù·Ú·¯¤˜, ÙfiÛÔ Ù˘ ΢ÙÙ·ÚÈ΋˜ fiÛÔ Î·È Ù˘ ¯˘ÌÈ΋˜ ·ÓÔÛ›·˜, ¤¯Ô˘Ó ‚ÚÂı› Û ·ÛıÂÓ›˜ Ì ‰È·Ù·ÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ·. Œ¯ÂÈ ‰È·Ù˘ˆı› Ë ˘fiıÂÛË fiÙÈ ÂȉÈο ·ÓÙÈÁfiÓ· Ù˘ ηÙËÁÔÚ›·˜ HLA Ù¿Í˘ ππ (HLA-DR4 Î·È HLA-DQB1) ÛÙÔ ¯ÚˆÌfiۈ̷ 6, Â›Ó·È ÁÂÓÂÙÈÎÔ› ‰Â›ÎÙ˜ Ù˘ ÚԉȿıÂÛ˘ ÁÈ· ·Ó¿Ù˘ÍË ¢ª∫ (3). ∂›Û˘, ¤¯Ô˘Ó ·ÓȯÓ¢ı› ÌfiÚÈ· ÚÔÛÎfiÏÏËÛ˘ ÙˆÓ Î˘ÙÙ¿ÚˆÓ Û ‚ÈÔ„›Â˜ Ì˘Ôηډ›Ô˘ ·ÛıÂÓÒÓ Ì ¢ª∫, fiˆ˜ ÔÈ ÛÂÏÂÎÙ›Ó˜ CD62E Î·È CD62P, ‚2 ÈÓÙÂÁÎÚ›Ó˜ CD29, ÌfiÚÈ· ÚÔÛÎfiÏÏËÛ˘ ÛÙ· ÙÔȯÒÌ·Ù· ÙˆÓ ·ÁÁ›ˆÓ (VCAM-1) Î·È ÌfiÚÈ· ÚÔÛÎfiÏÏËÛ˘ ÛÙ· ·ÙÙ·Ú· (30). Œ¯Ô˘Ó ‰È·ÈÛÙˆı› ΢ÎÏÔÊÔÚÔ‡ÓÙ· ·ÓÙÈÌ˘Ôηډȷο ·ÓÙÈÛÒÌ·Ù· ÂÓ·ÓÙ›ˆÓ ÔÈÎ›ÏˆÓ ·ÓÙÈÁfiÓˆÓ, fiˆ˜ Ë ‚·ÚÈ¿ ¿Ï˘ÛÔ˜ Ù˘ Ì˘ÔÛ›Ó˘, ÔÈ ‚-·‰ÚÂÓÂÚÁÈÎÔ› ˘ԉԯ›˜, Ô ÌÔ˘ÛηÚÈÓÈÎfi˜ ˘Ô‰Ô¯¤·˜, Ë Ï·Ì›ÓË Î·È Ù· ÌÈÙÔ¯fiÓ‰ÚÈ· (31). ∆· ·ÓÙÈÌ˘Ôηډȷο ·ÓÙÈÛÒÌ·Ù· ·ÓȯÓ‡ÔÓÙ·È Î·È Û ÌË Û˘Ìو̷ÙÈÎÔ‡˜ Û˘ÁÁÂÓ›˜ ·ÛıÂÓÒÓ Ì ‰È·Ù·ÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· Î·È Â›Ó·È ÚÔÁÓˆÛÙÈÎÔ› ‰Â›ÎÙ˜

407

¶·È‰È·ÙÚÈ΋ 2003;66:405-417

Paediatriki 2003;66:405-417

‰-Û·ÚÎÔÁÏ˘Î¿ÓË

Ï·ÌÈÓ›ÓË ·-2 ‰˘ÛÙÚÔÁÏ˘Î¿Ó˜ ÂÌÂÚ›ÓË

ÁÏ˘ÎÔÚˆÙ½Ó˜ Ù˘ ‰˘ÛÙÚÔÊ›Ó˘

ÂÍˆÎ˘ÙÙ¿ÚÈ· Ô˘Û›· ΢ÙÙ·ÚÔÏ·ÛÌ·ÙÈ΋ ÌÂÌ‚Ú¿ÓË Ï·Ì›ÓË A/C

‰˘ÛÙÚÔÊ›ÓË ˘Ú‹Ó·˜ ¯ÚˆÌ·Ù›ÓË ¢π∞∆∞∆π∫∏

‰ÂÛÌ›ÓË

‚·ÚÈ¿ ¿Ï˘ÛÔ˜ ‚-Ì˘ÔÛ›Ó˘

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ÚˆÙ½ÓË C Û‡Ó‰ÂÛ˘ Ù˘ Ì˘ÔÛ›Ó˘ ÂÏ·ÊÚ¤˜ ¿Ï˘ÛÔÈ Ì˘ÔÛ›Ó˘ 1/2

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·-ÙÚÔÔÌ˘ÔÛ›ÓË ·-·ÎÙÈÓ›ÓË ÙÚÔÔÓ›ÓË π ÙÚÔÔÓ›ÓË ∆ ·-ηÙÂÓ›ÓË Ï·ÎÔÛÊ·ÈÚ›ÓË Î˘ÙÙ·ÚfiÏ·ÛÌ· η¯ÂÚ›Ó˜

΢ÙÙ·ÚÔÏ·ÛÌ·ÙÈ΋ ÌÂÌ‚Ú¿ÓË

∂ÈÎfiÓ· 1. ∏ ÌÔÚȷ΋ ·ÏÏËÏÂ›‰Ú·ÛË ÙˆÓ ÚÔۂ‚ÏËÌ¤ÓˆÓ ÚˆÙÂ˚ÓÒÓ ÛÙË ‰È·Ù·ÙÈ΋, ÙËÓ ˘ÂÚÙÚÔÊÈ΋ Î·È ÙËÓ ·ÚÚ˘ıÌÈÔÁfiÓÔ ‰˘ÛÏ·Û›· Ù˘ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜ (∞¢¢∫) (ÙÚÔÔÔÈË̤ÓÔ ·fi Lancet 2001;358:1630). ∫fiÎÎÈÓÔ: ÔÈ ÚÔۂ‚ÏË̤Ó˜ ÚˆÙ½Ó˜ Ô˘ ÚÔηÏÔ‡Ó ‰È·Ù·ÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ·, ∫›ÙÚÈÓÔ: ÔÈ ÚÔۂ‚ÏË̤Ó˜ ÚˆÙ½Ó˜ Ô˘ ÚÔηÏÔ‡Ó ˘ÂÚÙÚÔÊÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· Î·È ¶Ú¿ÛÈÓÔ: ÔÈ ÚÔۂ‚ÏË̤Ó˜ ÚˆÙ½Ó˜ Ô˘ ÚÔηÏÔ‡Ó ∞¢¢∫, ÂÓÒ ªÏÂ: ÔÈ ÚÔۂ‚ÏË̤Ó˜ ÚˆÙ½Ó˜ Ô˘ ÚÔηÏÔ‡Ó ‹ ‰È·Ù·ÙÈ΋ ‹ ˘ÂÚÙÚÔÊÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ·.

ÂͤÏÈ͢ Ù˘ ÓfiÛÔ˘ (32). ∞ӈ̷ϛ˜ ˘ÔÏËı˘ÛÌÒÓ ∆ ΢ÙÙ¿ÚˆÓ, ÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ ÙˆÓ Î˘ÙÙ·ÚÔÙÔÍÈÎÒÓ ∆ ΢ÙÙ¿ÚˆÓ, ÙˆÓ Î·Ù·ÛÙ·ÏÙÈÎÒÓ ∆ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Î·È ÙˆÓ Ê˘ÛÈÎÒÓ Î˘ÙÙ¿ÚˆÓ-ÊÔÓ¤ˆÓ, ¤¯Ô˘Ó ‚ÚÂı› Û ÌÂÚÈΤ˜ ÌÂϤÙ˜ (33). Œ¯ÂÈ ˘ÔÛÙËÚȯı› fiÙÈ ·˘Ù¤˜ ÔÈ ·ÓÔÛÔÏÔÁÈΤ˜ ‰È·Ù·Ú·¯¤˜ ÌÔÚ› Ó· Â›Ó·È Û˘Ó¤ÂÈ· ÈÔÁÂÓÔ‡˜ Ì˘Ôηډ›Ùȉ·˜. £ÂˆÚÂ›Ù·È fiÙÈ Û˘ÛÙ·ÙÈο ÙˆÓ ÈÒÓ ÌÔÚ› Ó· ¤¯Ô˘Ó ÂÓۈ̷وı› ÛÙÔ Û·ÚΛÏËÌ· ÙˆÓ Ì˘ÔηډȷÎÒÓ Î˘ÙÙ¿ÚˆÓ Î·È ‰ÚÔ˘Ó ˆ˜ ·ÓÙÈÁÔÓÈ΋ ËÁ‹ Ô˘ ηÙ¢ı‡ÓÂÈ ÙËÓ ·ÓÔÛÔÏÔÁÈ΋ ·¿ÓÙËÛË ÚÔ˜ ÙÔ Ì˘ÔοډÈÔ. ¶·ıÔÊ˘ÛÈÔÏÔÁ›· ™ÙË ‰È·Ù·ÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ·, Ë ·ÚÈÛÙÂÚ‹ ‹ Î·È ÔÈ ‰‡Ô ÎÔÈϛ˜ Â›Ó·È ‰È·ÙÂٷ̤Ó˜ Î·È ·ÚÔ˘ÛÈ¿˙Ô˘Ó ˘ÔÛ˘ÛÙ·ÏÙÈÎfiÙËÙ·. ª·ÎÚÔÛÎÔÈο, Ë Î‡ÚÈ· ÌÔÚÊÔÏÔÁÈ΋ ·ÓˆÌ·Ï›· Â›Ó·È Ë ‰È¿Ù·ÛË ÙˆÓ ‰‡Ô ÎÔÈÏÈÒÓ, ηıÒ˜ Î·È Ë ‰È¿Ù·ÛË ÙˆÓ ÎfiÏˆÓ. ∏ ηډȿ ¤¯ÂÈ ÛÊ·ÈÚÈ΋ ÂÌÊ¿ÓÈÛË Î·È ÙÔ Ì˘ÔοډÈÔ Â›Ó·È ˆ¯Úfi ηÈ, ÌÂÚÈΤ˜ ÊÔÚ¤˜, ‰È¿ÛÙÈÎÙÔ. ∆Ô ÂÓ‰ÔοډÈÔ Â›Ó·È ÏÂÙfi Î·È ‰È¿Ê·ÓÔ, Ì ÛËÌ›· ÙÔÈ΋˜ ÛÎÏ‹Ú˘ÓÛ˘. πÛÙÔÏÔÁÈο ·Ú·ÙËÚÂ›Ù·È ˘ÂÚÙÚÔÊ›· ÙˆÓ Ì˘ÔηډȷÎÒÓ Î˘ÙÙ¿ÚˆÓ Î·È ÂÎʇÏÈÛË, ·ÏÏ¿ ·Ó¢ڛÛÎÂÙ·È Î·È ‰È¿ÌÂÛË ›ÓˆÛË (2,3,5). ∏ ÂÏ¿ÙÙˆÛË Ù˘ Û˘ÛÙ·ÏÙÈÎfiÙËÙ·˜ ÙÔ˘ Ì˘Ôηډ›-

408

Ô˘ Ô‰ËÁ› Û ÂÏ·Ùو̤ÓÔ ÎÏ¿ÛÌ· ‚Ú¿¯˘ÓÛ˘, ÎÏ¿ÛÌ· ÂÍÒıËÛ˘ Î·È Î·Ú‰È·Î‹ ·ÚÔ¯‹, Ô˘ Ô‰ËÁÔ‡Ó Û ϛÌÓ·ÛË ·›Ì·ÙÔ˜ ÛÙȘ ÎÔÈÏfiÙËÙ˜ Î·È Û ‰Â˘ÙÂÚÔ·ı‹ ·‡ÍËÛË ÙÔ˘ ÙÂÏԉȷÛÙÔÏÈÎÔ‡ fiÁÎÔ˘ Î·È ›ÂÛ˘, ηıÒ˜ Î·È Ù˘ ›ÂÛ˘ Ï‹ÚˆÛ˘ ÙˆÓ ÎÔÈÏÈÒÓ. °È· Ó· ‰È·ÙËÚËı› Â·Ú΋˜ ηډȷ΋ ·ÚÔ¯‹, ÔÈ ÎÔÈϛ˜ ‰È·Ù›ÓÔÓÙ·È Î·È ÙÔ Ì˘ÔοډÈÔ ˘ÂÚÙÚ¤ÊÂÙ·È Û οÔÈÔ ‚·ıÌfi. ∏ ‰È¿Ù·ÛË ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·‡ÍËÛË Ù˘ ÙÔȯˆÌ·ÙÈ΋˜ Ù¿Û˘ Î·È ÙËÓ ·‡ÍËÛË ÙˆÓ ·Ó·ÁÎÒÓ ÙÔ˘ Ì˘Ôηډ›Ô˘ Û Ô͢ÁfiÓÔ. ∫·ıÒ˜ ÂÏ·ÙÙÒÓÂÙ·È Ë Î·Ú‰È·Î‹ ·ÚÔ¯‹, ÂÏ·ÙÙÒÓÂÙ·È Î·È Ë ·ÈÌ¿ÙˆÛË ÙˆÓ ÓÂÊÚÒÓ. ¶·Ú·ÙËÚÂ›Ù·È ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ Ó¢ÚÔÔÚÌÔÓÈÎÒÓ Ì˯·ÓÈÛÌÒÓ, ΢ڛˆ˜ ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ÚÂÓ›Ó˘-·ÁÁÂÈÔÙÂÓÛ›Ó˘-·Ï‰ÔÛÙÂÚfiÓ˘ Î·È ÙÔ˘ Û˘Ì·ıËÙÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ∆˘Èο, ·˘Ù¤˜ ÔÈ ·ÏÏ·Á¤˜ Á›ÓÔÓÙ·È ·ÚÁ¿ Î·È Ô‰ËÁÔ‡Ó ÛÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ· Ù˘ ηډȷ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ Î·È Ù˘ Ó¢ÌÔÓÈ΋˜ ˘¤ÚÙ·Û˘, ÂÓÒ Ë ›ÓˆÛË ÙÔ˘ ÎÔÈÏÈ·ÎÔ‡ Ì˘Ôηډ›Ô˘ ‰ËÌÈÔ˘ÚÁ› ÂÛٛ˜ ÎÔÈÏÈ·ÎÒÓ ·ÚÚ˘ıÌÈÒÓ (3,6). ∫ÏÈÓÈ΋ ÂÈÎfiÓ· ŸÙ·Ó ‰ÂÓ Â›Ó·È ‰˘Ó·Ù‹ Ë ‰È·Ù‹ÚËÛË Â·ÚÎÔ‡˜ ηډȷ΋˜ ·ÚÔ¯‹˜, ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛËÌ›· Î·È Û˘ÌÙÒÌ·Ù· ηډȷ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ (2,3,6). ∞Ú¯Èο, Ù· Û˘ÌÙÒÌ·Ù· ÌÔÚ› Ó· Â›Ó·È ˘ÔÎÏÈÓÈο Î·È Ó·

¶·È‰È·ÙÚÈ΋ 2003;66:405-417

·ÚÔ˘ÛÈ·ÛÙÔ‡Ó Û ηٷÛÙ¿ÛÂȘ ·˘ÍË̤ÓÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡, .¯. Û ÏÔÈÌÒÍÂȘ, fiÙ·Ó Ë Î·Ú‰È·Î‹ ·ÚÔ¯‹ ‰ÂÓ Â·ÚΛ ÁÈ· Ó· ηχ„ÂÈ ÙȘ ·Ó¿ÁΘ ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡. ªÂÁ·Ï‡ÙÂÚ· ·È‰È¿ ‹ ¤ÊË‚ÔÈ ÌÔÚ› Ó· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó ÂÏ·Ùو̤ÓË ·ÓÔ¯‹ ÛÙËÓ ¿ÛÎËÛË ‹ ‰‡ÛÓÔÈ· ÛÙËÓ ÚÔÛ¿ıÂÈ·. ∆· ‚Ú¤ÊË ÌÔÚ› Ó· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó Ù·¯‡ÓÔÈ·, ·ÓÂ·Ú΋ ÚfiÛÏË„Ë ‚¿ÚÔ˘˜ Î·È ÛËÌ›· ηډȷ΋˜ ·ÓÂ¿ÚÎÂÈ·˜. ™Â ÔÛÔÛÙfi 13% ÙˆÓ ·È‰ÈÒÓ ÂÌÊ·Ó›˙ÔÓÙ·È Û˘ÁÎÔÙÈο ÂÂÈÛfi‰È· Î·È ·›ÛıËÌ· ·ÏÌÒÓ (3). º˘ÛÈ΋ ÂͤٷÛË ∆· Â˘Ú‹Ì·Ù· Ù˘ Ê˘ÛÈ΋˜ ÂͤٷÛ˘ ÌÔÚ› Ó· ÔÈΛÏÏÔ˘Ó, ·Ó¿ÏÔÁ· Ì ÙÔ ÛÙ¿‰ÈÔ Ù˘ ÓfiÛÔ˘. ∆Ô 7080% ÙˆÓ ·ÙfiÌˆÓ Ô˘ ¿Û¯Ô˘Ó ·fi ‰È·Ù·ÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ·, ·ÚÔ˘ÛÈ¿˙ÂÈ ÛËÌ›· ηډȷ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ (3,5). ∆· ¿ÙÔÌ· ·˘Ù¿ Û˘Ó‹ıˆ˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ù·¯‡ÓÔÈ·, Ù·¯˘Î·Ú‰›· Î·È ˆ¯ÚfiÙËÙ·. ∞fi ÙËÓ ·ÎÚfi·ÛË ÙˆÓ Ó¢ÌfiÓˆÓ ÌÔÚ› Ó· ˘¿Ú¯Ô˘Ó ˘ÁÚÔ› ÚfiÁ¯ÔÈ ‹ Ì›ˆÛË ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ „Èı˘Ú›ÛÌ·ÙÔ˜ ÏfiÁˆ ·ÙÂÏÂÎÙ·Û›·˜ ÙÔ˘ Ó‡ÌÔÓ· ·fi ÙËÓ ˘ÂÚÌÂÁ¤ıË Î·Ú‰È¿. ∏ ·ÎÚfi·ÛË Ù˘ ηډȿ˜ ·ÔηχÙÂÈ Û˘Ó‹ıˆ˜ ηÏ·ÛÙÈÎfi Ú˘ıÌfi ηÈ, Û¿ÓÈ·, Û˘ÛÙÔÏÈÎfi ʇÛËÌ· ·ÓÂ¿ÚÎÂÈ·˜ ÌÈÙÚÔÂȉԇ˜. OÈ ÂÚÈÊÂÚÈΤ˜ ÛʇÍÂȘ Â›Ó·È ·ÛıÂÓ›˜. ∆Ô ‹·Ú Î·È Ô ÛÏ‹Ó·˜ Â›Ó·È „ËÏ·ÊËÙ¿ fiÙ·Ó ˘¿Ú¯ÂÈ Û˘ÌÊfiÚËÛË ÙˆÓ Û˘ÛÙËÌ·ÙÈÎÒÓ ÊÏ‚ÒÓ. ¢È¿ÁÓˆÛË ™ÙËÓ ·ÎÙÈÓÔÁÚ·Ê›· ·Ú·ÙËÚÂ›Ù·È ·‡ÍËÛË Ù˘ ηډȷ΋˜ ÛÎÈ¿˜ ÂÍ·ÈÙ›·˜ Ù˘ ‰È·ÙÂٷ̤Ó˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ Î·È ÙÔ˘ ÎfiÏÔ˘. ªÔÚ›, Â›Û˘, Ó· ˘¿Ú¯Ô˘Ó ÂÚÈÔ¯¤˜ Ì ·ÙÂÏÂÎÙ·Û›· ÛÙÔÓ ·ÚÈÛÙÂÚfi Ó‡ÌÔÓ· ÂÍ·ÈÙ›·˜ Ù˘ Û˘Ì›ÂÛ˘ ÙˆÓ ‚ÚfiÁ¯ˆÓ ·fi ÙÔÓ ‰È·ÙÂٷ̤ÓÔ ·ÚÈÛÙÂÚfi ÎfiÏÔ Î·È ÙË ‰È·ÙÂٷ̤ÓË ·ÚÈÛÙÂÚ‹ Ó¢ÌÔÓÈ΋ ·ÚÙËÚ›·. ™ËÌ›· Ó¢ÌÔÓÈ΋˜ ˘¤ÚÙ·Û˘ Î·È Ó¢ÌÔÓÈÎÔ‡ Ôȉ‹Ì·ÙÔ˜ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Û ηډȷ΋ Î¿Ì„Ë (3). ∆Ô ËÏÂÎÙÚÔηډÈÔÁÚ¿ÊËÌ· ·ÔηχÙÂÈ ÊÏ‚ÔÎÔÌ‚È΋ Ù·¯˘Î·Ú‰›·, ˘ÂÚÙÚÔÊ›· Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜, ¯·ÌËÏ¿ ‰˘Ó·ÌÈο ÛÙȘ ÚÔοډȘ ··ÁˆÁ¤˜, ηıÒ˜ Î·È ÌË ÂȉÈΤ˜ ·ÏÏÔÈÒÛÂȘ ÙÔ˘ ST Î·È T. ∞ӷʤÚÂÙ·È fiÙÈ ÂÚ›Ô˘ ÙÔ 46% ÙˆÓ ·È‰ÈÒÓ Ì ‰È·Ù·ÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· ·ÚÔ˘ÛÈ¿˙ÂÈ ·ÚÚ˘ı̛˜ ÛÙËÓ 24ˆÚË Î·Ù·ÁÚ·Ê‹ ÙÔ˘ ∏∫°, ÙfiÛÔ ˘ÂÚÎÔÈÏȷΤ˜ fiÛÔ Î·È ÎÔÈÏȷΤ˜, ÔÈ Ôԛ˜ ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙÔÈΤ˜ ÂÛٛ˜ ÛÙÔ ˘ÂÓ‰ÔοډÈÔ ‹ ÛÙȘ ˘ÔÂÈηډȷΤ˜ ÛÙÈ‚¿‰Â˜ (34,35).

O ·ÎÚÔÁˆÓÈ·›Ô˜ Ï›ıÔ˜ Ù˘ ‰È¿ÁÓˆÛ˘ Ù˘ ‰È·Ù·ÙÈ΋˜ Ì˘ÔηډÈÔ¿ıÂÈ·˜ Â›Ó·È ÙÔ Ë¯ÔηډÈÔÁÚ¿ÊËÌ·, Ì ÙÔ ÔÔ›Ô ‰È·ÈÛÙÒÓÂÙ·È ‰È¿Ù·ÛË Î·È ˘ÔÛ˘ÛÙ·ÏÙÈÎfiÙËÙ· ÙˆÓ ÎÔÈÏÈÒÓ, ΢ڛˆ˜ Ù˘ ·ÚÈÛÙÂÚ‹˜ (‰È·ÛÙ¿ÛÂȘ ηٿ ÙË ‰È·ÛÙÔÏ‹ >95Ë ∂£ ÁÈ· ÙËÓ ÂÈÊ¿ÓÂÈ· ÛÒÌ·ÙÔ˜ Î·È ÎÏ¿ÛÌ· ÂÍÒıËÛ˘ <50%). ∂›Û˘, ‰È·ÈÛÙÒÓÂÙ·È Î·È ‰È¿ÊÔÚÔ˘ ‚·ıÌÔ‡ ·ÓÂ¿ÚÎÂÈ· ÌÈÙÚÔÂȉԇ˜, Ô˘ Â›Ó·È ·ÔÙ¤ÏÂÛÌ· Ù˘ ‰È¿Ù·-

Paediatriki 2003;66:405-417

Û˘ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ Î·È Ù˘ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·˜ ÙˆÓ ıËÏÔÂȉÒÓ Ì˘ÒÓ (3,6). ∂Ӊ›ÍÂȘ ÁÈ· ηıÂÙËÚÈ·ÛÌfi Î·È ·ÁÁÂÈÔÁÚ·Ê›· ·ÔÙÂÏÔ‡Ó Ë Ï‹„Ë ‚ÈÔ„›·˜ ·fi ÙÔÓ Î·Ú‰È·Îfi Ì˘ Î·È Ë ÛÎÈ·ÁÚ¿ÊËÛË ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ ·ÁÁ›ˆÓ. ∞Ó¿ÏÔÁ· Ì ÙËÓ ËÏÈΛ· ÂÌÊ¿ÓÈÛ˘ Ù˘ ÓfiÛÔ˘, Â›Ó·È ¯Ú‹ÛÈ̘ ‰È¿ÊÔÚ˜ ÂÚÁ·ÛÙËÚȷΤ˜ ÂÍÂÙ¿ÛÂȘ, fiˆ˜ Ô Ï‹Ú˘ ¤ÏÂÁ¯Ô˜ ÁÈ· ÌÂÙ·‚ÔÏÈο ÓÔÛ‹Ì·Ù· (36), ÂÓÒ ‰È·ÁÓˆÛÙÈ΋ ÌÔÚ› Ó· Â›Ó·È Ë ·Ó¿Ï˘ÛË DNA ÁÈ· ÙËÓ ·Ó·ÁÓÒÚÈÛË ÙˆÓ ˘‡ı˘ÓˆÓ ÌÂÙ·ÏϿ͈Ó. ∏ ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË (¶›Ó·Î·˜ 4) ı· Û˘ÓÙÂϤÛÂÈ ÛÙËÓ ·Ó·ÁÓÒÚÈÛË Èı·Ó¿ È¿ÛÈÌˆÓ ·ÈÙ›ˆÓ. £ÂÚ·›· ∞Ó ‰ÂÓ ·Ó·ÁÓˆÚÈÛÙ› οÔÈÔ È¿ÛÈÌÔ ·›ÙÈÔ, Ë ıÂÚ·›· Â›Ó·È Û˘Ìو̷ÙÈ΋ Î·È Û˘Ó›ÛÙ·Ù·È ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ Û˘ÌÊÔÚËÙÈ΋˜ ηډȷ΋˜ ·ÓÂ¿ÚÎÂÈ·˜, ÙˆÓ ·ÚÚ˘ıÌÈÒÓ Î·È ÙˆÓ ıÚÔÌ‚ÔÂÌ‚ÔÏÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ. ∆· ÂÓ‰ÔÊϤ‚È· ÈÓfiÙÚÔ· (ÓÙÔ·Ì›ÓË, ÓÙÔÌÔ˘Ù·Ì›ÓË), ÔÈ ·Ó·ÛÙÔÏ›˜ Ù˘ ʈÛÊÔ‰ÈÂÛÙÂÚ¿Û˘ (·ÌÚÈÓfiÓË, ÌÈÏÚÈÓÏfiÓË), Ù· ‰ÈÔ˘ÚËÙÈο, ÔÈ ·Ó·ÛÙÔÏ›˜ ÙÔ˘ ÌÂÙ·ÙÚÂÙÈÎÔ‡ ÂÓ˙‡ÌÔ˘ Î·È Ë ‰ÈÁÔÍ›ÓË ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÔÍ›·˜ ηډȷ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ (3,6). ∏ ¯Ú‹ÛË ÙˆÓ ‚·‰ÚÂÓÂÚÁÈÎÒÓ ·ÔÎÏÂÈÛÙÒÓ ¤¯ÂÈ, Â›Û˘, ÂÓı·ÚÚ˘ÓÙÈο ·ÔÙÂϤÛÌ·Ù· (37). °È· ÙË ıÂÚ·›· ÙˆÓ ·ÚÚ˘ıÌÈÒÓ, Ô˘ Â›Ó·È ·ÚÎÂÙ¿ Û˘¯Ó¤˜ ÛÙ· ·È‰È¿, ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ·ÓÙÈ·ÚÚ˘ıÌÈο Ê¿Ú̷η. ∂› ·ÚÔ˘Û›·˜ ıÚÔÌ‚ÔÂÌ‚ÔÏÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ, ı· Ú¤ÂÈ Ó· ¯ÚËÛÈÌÔÔÈÂ›Ù·È ·ÓÙÈËÎÙÈ΋ ıÂÚ·›·. ∆ÂÏÂ˘Ù·›·, ¤¯ÂÈ ¯ÚËÛÈÌÔÔÈËı› ¯ˆÚ›˜ ÂÈÙ˘¯›· Ë ·ÓÔÛÔıÂÚ·›· Ì ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹, ·˙·ıÂÈÔÚ›ÓË ‹ ΢ÎÏÔÛÔÚ›ÓË, ΢ڛˆ˜ Û ·ÛıÂÓ›˜ Ì ÏÂÌÊÔ΢ÙÙ·ÚÈ΋ ‰È‹ıËÛË ÙÔ˘ Ì˘Ôηډ›Ô˘. ™ÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ Ë ‰È·Ù·ÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ÌÂÙ·‚ÔÏÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ, ··ÈÙÂ›Ù·È Ë ¿ÌÂÛË ·ÔηٿÛÙ·ÛË ÙˆÓ ‚ÈÔ¯ËÌÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ. ∂¿Ó ‰ÂÓ ˘¿ÚÍÂÈ ·ÓÙ·fiÎÚÈÛË ÛÙË Ê·Ú̷΢ÙÈ΋ ıÂÚ·›·, ÙfiÙ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÂÂÌ‚·ÙÈΤ˜ ̤ıÔ‰ÔÈ, fiˆ˜ ÔÈ Û˘Û΢¤˜ ˘ÔÛÙ‹ÚÈ͢ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜, Ë ÂÓ‰Ô·ÔÚÙÈ΋ ·ÓÙÏ›· Î·È Ë Û˘Û΢‹ Â͈ۈ̷ÙÈ΋˜ ΢ÎÏÔÊÔÚ›·˜. ™ÙȘ Ôχ ÛÔ‚·Ú¤˜ ÂÚÈÙÒÛÂȘ ··ÈÙÂ›Ù·È ÌÂÙ·ÌfiÛ¯Â˘ÛË Î·Ú‰È¿˜ (2,3,6). ¶ÚfiÁÓˆÛË ∏ ÚfiÁÓˆÛË Ù˘ ‰È·Ù·ÙÈ΋˜ Ì˘ÔηډÈÔ¿ıÂÈ·˜ ÛÙ· ·È‰È¿ ÔÈΛÏÏÂÈ Î·È ·ÓÙ·Ó·ÎÏ¿ ÙËÓ ÂÙÂÚÔÁÂÓ‹ ·ÈÙÈÔÏÔÁ›· Ù˘ ÓfiÛÔ˘. ∞ӷʤÚÂÙ·È 5ÂÙ‹˜ ıÓËÙfiÙËÙ· ¤ˆ˜ 80% ÛÙ· ·È‰È¿ (38). ø˜ ‰Â›ÎÙ˜ η΋˜ ÚfiÁÓˆÛ˘ ¤¯Ô˘Ó ·Ó·ÊÂÚı› Ë ÂÎÛÂÛËÌ·Ṳ̂ÓË ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ ηٿ ÙË ÛÙÈÁÌ‹ Ù˘ ‰È¿ÁÓˆÛ˘ ‹ ÛÙËÓ Â·ÓÂͤٷÛË, ÂÈ̤ÓÔÓÙ· Û˘ÌÙÒÌ·Ù· ηډȷ΋˜ ·ÓÂ¿ÚÎÂÈ·˜, ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi Ì˘ÔηډÈÔ¿ıÂÈ·˜, Ù· ÈÛÙÔÏÔÁÈο Â˘Ú‹Ì·Ù· ÂÓ‰Ôηډȷ΋˜ ÈÓÔÂÏ¿ÛÙˆÛ˘ Î·È Ë ·Ó¿ÁÎË ·ÓÙÈËÎÙÈ΋˜ ıÂÚ·›·˜ (38).

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¶·È‰È·ÙÚÈ΋ 2003;66:405-417

Paediatriki 2003;66:405-417

¶›Ó·Î·˜ 4. ¢È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË Ù˘ ‰È·Ù·ÙÈ΋˜ Ì˘ÔηډÈÔ¿ıÂÈ·˜ ÛÙ· ·È‰È¿ ¶ÚÔÛ¤ÁÁÈÛË

∞ӈ̷ϛ·

¶Èı·Ó‹ ‰È¿ÁÓˆÛË

ñ ∫ÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ

∂ÁÎÂÊ·ÏÔ¿ıÂÈ· ª˘Ô¿ıÂÈ· ¢˘ÛÌÔÚÊÔÏÔÁÈΤ˜ ·ÏÏÔÈÒÛÂȘ ∏·ÙÔÛÏËÓÔÌÂÁ·Ï›· ∞˘ÍË̤ÓË ∆∫∂, CRP ∞˘ÍË̤ӷ ηډȷο ¤Ó˙˘Ì· £ÂÙÈÎfi˜ ÈÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÀÔÁÏ˘Î·ÈÌ›· Ì ÔͤˆÛË ÀÔÁÏ˘Î·ÈÌ›· ¯ˆÚ›˜ ÔͤˆÛË

ªÂÙ·‚ÔÏÈÎfi ÓfiÛËÌ· ‹ ÓfiÛÔ˜ ÂÓ·fiıÂÛ˘

ñ ∂ÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜

ñ ∏ÏÂÎÙÚÔηډÈÔÁÚ¿ÊËÌ·

ñ ∏¯ÔηډÈÔÁÚ¿ÊËÌ·, ηډȷÎfi˜ ηıÂÙËÚÈ·ÛÌfi˜ ñ µÈÔ„›· ÙÔ˘ Ì˘Ôηډ›Ô˘

ÀÂÚÎÔÈÏȷ΋ Ù·¯˘Î·Ú‰›· ∂ÈÎfiÓ· Ô˘Ï‹˜ ÛÙÔ ÚfiÛıÈÔ ‰È·ÊÚ·ÁÌ·ÙÈÎfi ÙÔ›¯ˆÌ· ™˘ÁÁÂÓ‹˜ ηډÈÔ¿ıÂÈ· ºÏÂÁÌÔÓ‹ Ì ӤÎÚˆÛË, ıÂÙÈο ·ÓÙÈÁfiÓ· ÈÒÓ

πÔÁÂÓ‹˜ Ì˘Ôηډ›Ùȉ·

°Ï˘ÎÔÁÔÓ›·ÛË, ÔÚÁ·ÓÈ΋ Ô͢·ÈÌ›· ¢È·Ù·Ú·¯¤˜ Ù˘ ÔÍ›‰ˆÛ˘ ÙˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ, ·ÓÂ¿ÚÎÂÈ· ηÚÓÈÙ›Ó˘ ¢È·Ù·ÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· ÌÂÙ¿ ·fi ·ÚÚ˘ıÌ›· ∞ӈ̷ϛ· Ù˘ ¤ÎÊ˘Û˘ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÛÙÂÊ·ÓÈ·›·˜ ·ÚÙËÚ›·˜ ·fi ÙËÓ Ó¢ÌÔÓÈ΋ ·ÚÙËÚ›·

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∆ÚÔÔÔÈË̤ÓÔ ·fi Eur J Pediatr 2000;159:803-810

ŸÙ·Ó ÙÂı› Ë ‰È¿ÁÓˆÛË Ù˘ ‰È·Ù·ÙÈ΋˜ Ì˘ÔηډÈÔ¿ıÂÈ·˜, Ú¤ÂÈ Ó· ÏËÊı› ¤Ó· ÏÂÙÔÌÂÚ¤˜ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÙˆÓ Û˘ÁÁÂÓÒÓ ÚÒÙÔ˘ Î·È ‰Â‡ÙÂÚÔ˘ ‚·ıÌÔ‡ (ηډȷ΋˜ ·ÓÂ¿ÚÎÂÈ·˜, ‰È·Ù·ÙÈ΋˜ Ì˘ÔηډÈÔ¿ıÂÈ·˜, ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘, ·ÚÚ˘ıÌÈÒÓ Î.Ï.) ÁÈ· Ó· ‰ÈÂÚ¢ÓËı› Ë Èı·ÓfiÙËÙ· ÔÈÎÔÁÂÓÔ‡˜ Ì˘ÔηډÈÔ¿ıÂÈ·˜. ∆Ô ÈÛÙÔÚÈÎfi, ‚¤‚·È·, ‰ÂÓ ¤¯ÂÈ ÙfiÛÔ ÌÂÁ¿ÏË Â˘·ÈÛıËÛ›· fiÛÔ ÙÔ Ë¯ÔηډÈÔÁÚ¿ÊËÌ· fiÛÔÓ ·ÊÔÚ¿ ÛÙË ‰ÈÂÚ‡ÓËÛË ÙˆÓ Û˘ÁÁÂÓÒÓ Î·È Î·ıÒ˜ Ë ÔÈÎÔÁÂÓ‹˜ ‰È·Ù·ÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· ÌÂÙ·‚È‚¿˙ÂÙ·È Û˘¯ÓfiÙÂÚ· Ì ÙÔÓ ·˘ÙÔۈ̷ÙÈÎfi ÂÈÎÚ·ÙÔ‡ÓÙ· ¯·Ú·ÎÙ‹Ú·, ÚÔÙ›ÓÂÙ·È Ë ÎÏÈÓÈ΋ ÂÎÙ›ÌËÛË ÙˆÓ Û˘ÁÁÂÓÒÓ ÚÒÙÔ˘ ‚·ıÌÔ‡ (ÁÔÓ›˜, ·‰¤ÚÊÈ·, ·È‰È¿) Ó· Á›ÓÂÙ·È Ì ηϋ Ï‹„Ë ÈÛÙÔÚÈÎÔ‡, ÎÏÈÓÈ΋ ÂͤٷÛË, ËÏÂÎÙÚÔηډÈÔÁÚ¿ÊËÌ· Î·È Ë¯ÔηډÈÔÁÚ¿ÊËÌ· (8-11). ∂Âȉ‹ ÙfiÛÔ Ë ËÏÈΛ· ¤Ó·Ú͢ fiÛÔ Î·È Ë ÎÏÈÓÈ΋ ÂÌÊ¿ÓÈÛË Ù˘ ÔÈÎÔÁÂÓÔ‡˜ ‰È·Ù·ÙÈ΋˜ Ì˘ÔηډÈÔ¿ıÂÈ·˜ Â›Ó·È ·ÛÙ·ı‹ ·ÎfiÌ· Î·È Ì¤Û· ÛÙËÓ ›‰È· ÔÈÎÔÁ¤ÓÂÈ·, Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÂÚÈÔ‰ÈÎfi˜ Â·Ó¤ÏÂÁ¯Ô˜ ÛÙÔ˘˜ Û˘ÁÁÂÓ›˜ οı 3-5 ¯ÚfiÓÈ· (11). ÀÂÚÙÚÔÊÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· ∏ ˘ÂÚÙÚÔÊÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· (Àª∫) Â›Ó·È Ë ‰Â‡ÙÂÚË ÛÂ Û˘¯ÓfiÙËÙ· Ì˘ÔηډÈÔ¿ıÂÈ· ÛÙ· ·È‰È¿ Î·È ·ÔÙÂÏ› ÙÔ 20-30% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ Ì˘ÔηډÈÔ·ıÂÈÒÓ (3). ∏ Â›ÙˆÛ‹ Ù˘ ÛÙÔÓ ÁÂÓÈÎfi ÏËı˘ÛÌfi Â›Ó·È ÂÚ›Ô˘ 1/5000 ¤ˆ˜ 1/500 Ó·ÚÔ‡˜ ÂÓ‹ÏÈΘ, Ì ÌÂÁ¿ÏË ÂÙÂÚÔÁ¤ÓÂÈ· ÛÙËÓ ÎÏÈÓÈ΋ ÂÌÊ¿ÓÈÛË Î·È ‰ÈÂÈÛ‰˘ÙÈÎfiÙËÙ· (6,40,41). ŒÓ·˜ ÌÂÁ¿ÏÔ˜ ·ÚÈıÌfi˜ ·ı‹ÛÂˆÓ Â˘ı‡ÓÂÙ·È ÁÈ· ÙË ‰Â˘ÙÂÚÔ·ı‹ ˘ÂÚÙÚÔÊ›· ÙÔ˘ Ì˘Ôηډ›Ô˘ ÛÙ· ·È‰È¿, fiˆ˜ Ù· ÌÂÙ·‚ÔÏÈο ÓÔÛ‹Ì·Ù·, ‰È¿ÊÔÚ· Û‡Ó‰ÚÔÌ· Î·È Ó¢ÚÔÌ˘˚Τ˜ ‰È·Ù·Ú·¯¤˜ (5) (¶›Ó·Î·˜ 5), ÂÓÒ ÛÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi Ë ·ÈÙÈÔÏÔÁ›· Â›Ó·È ¿ÁÓˆÛÙË. ∏ ÔÈÎÔÁÂÓ‹˜ ÌÔÚÊ‹ ·ÔÙÂÏ› ÙÔ 50% ÙˆÓ ·ÈÙ›ˆÓ

410

Ù˘ ÓfiÛÔ˘ Î·È ÎÏËÚÔÓÔÌÂ›Ù·È Ì ÙÔÓ ·˘ÙfiÛˆÌÔ ÂÈÎÚ·ÙÔ‡ÓÙ· ¯·Ú·ÎÙ‹Ú· (6). OÈ ·ÛıÂÓ›˜ Ô˘ ‰ÂÓ ¤¯Ô˘Ó οÔÈÔÓ ¿Û¯ÔÓÙ· Û˘ÁÁÂÓ‹, ¤¯Ô˘Ó Èı·Ó¿ ÛÔÚ·‰ÈΤ˜ ÌÂÙ·ÏÏ¿ÍÂȘ Ù˘ ÓfiÛÔ˘ Ô˘ ‰‡ÛÎÔÏ· ·ÓȯÓ‡ÔÓÙ·È Î·È Ù·ÍÈÓÔÌÔ‡ÓÙ·È (6). ∞ÎfiÌ· Î·È Ì¤Û· ÛÙËÓ ›‰È· ÔÈÎÔÁ¤ÓÂÈ·, Ë ÓfiÛÔ˜ ·ÚÔ˘ÛÈ¿˙ÂÈ ÌÂÁ¿ÏË ÔÈÎÈÏ›· ÂΉËÏÒÛˆÓ. ¶ÈÛÙ‡ÂÙ·È fiÙÈ ¤¯ÂÈ ·ÙÂÏ‹ ‰ÈÂÈÛ‰˘ÙÈÎfiÙËÙ· ÛÙËÓ ·È‰È΋ Î·È ÂÊË‚È΋ ËÏÈΛ·, ÂÓÒ ÛÙÔ˘˜ ÂÓ‹ÏÈΘ ¤¯ÂÈ Ï‹ÚË ‰ÈÂÈÛ‰˘ÙÈÎfiÙËÙ· (3). ∏ ÁÂÓÂÙÈ΋ ·Ó¿Ï˘ÛË ¤¯ÂÈ ·ÔΈ‰ÈÎÔÔÈ‹ÛÂÈ 9 ‰È·ÊÔÚÂÙÈΤ˜ ÂÚÈÔ¯¤˜ ¯ÚˆÌ·ÙÔÛˆÌ¿ÙˆÓ ˆ˜ ·ÈÙÈÔÏÔÁÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Ù˘ ÔÈÎÔÁÂÓÔ‡˜ ˘ÂÚÙÚÔÊÈ΋˜ Ì˘ÔηډÈÔ¿ıÂÈ·˜, ÔÈ Ôԛ˜ Έ‰ÈÎÔÔÈÔ‡Ó ÚˆÙ½Ó˜ ÙÔ˘ Û·ÚÎÔÌÂÚȉ›Ô˘ (6,41). ŸÏ˜ ·˘Ù¤˜ ÔÈ ÚˆÙ½Ó˜ ¤¯Ô˘Ó ‰È·ÊÔÚÂÙÈÎÔ‡˜ ÚfiÏÔ˘˜ ÛÙÔÓ Î‡ÎÏÔ Û˘ÛÙÔÏ‹˜-¯¿Ï·Û˘ Î·È Û˘ÓÂÈÛʤÚÔ˘Ó ÛÙËÓ ÔÌÔÈfiÛÙ·ÛË Ù˘ ηډȿ˜ (6). ∏ ‚·ÚÈ¿ ¿Ï˘ÛÔ˜ Ù˘ ·-Ì˘ÔÛ›Ó˘ Î·È Ë ‚·ÚÈ¿ ¿Ï˘ÛÔ˜ Ù˘ ‚-Ì˘ÔÛ›Ó˘ ·ÏÏËÏÂȉÚÔ‡Ó Ì ÙËÓ ·ÎÙ›ÓË ÁÈ· ÙËÓ ·Ú·ÁˆÁ‹ Ì˯·ÓÈ΋˜ ÂÓ¤ÚÁÂÈ·˜, Ë ÙÚÔÔÓ›ÓË ∆, Ë ÙÚÔÔÓ›ÓË π, Ë ·-ÙÚÔÔÌ˘ÔÛ›ÓË Î·È Ë ÂÏ·ÊÚ¿ ¿Ï˘ÛÔ˜ Ù˘ Ì˘ÔÛ›Ó˘ ¤¯Ô˘Ó Ú˘ıÌÈÛÙÈÎfi ÚfiÏÔ, ÂÓÒ Ë ÚˆÙ½ÓË C Ô˘ Û˘Ó‰¤ÂÙ·È Ì ÙË Ì˘ÔÛ›ÓË Î·È Ë ÙÈÙ›ÓË ‚ÔËıÔ‡Ó ÛÙË ÌÂÙ·ÊÔÚ¿ ÂÓ¤ÚÁÂÈ·˜ (∂ÈÎfiÓ· 1) (42-50). ¶ÂÚÈÁÚ¿ÊÔÓÙ·È ÂÚÈÛÛfiÙÂÚ˜ ·fi 150 ÌÂÙ·ÏÏ¿ÍÂȘ ÁÔÓȉ›ˆÓ Ô˘ Έ‰ÈÎÔÔÈÔ‡Ó ÚˆÙ½Ó˜ ÙÔ˘ Û·ÚÎÔÌÂÚȉ›Ô˘ Ô˘ Â›Ó·È ˘‡ı˘Ó˜ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ˘ÂÚÙÚÔÊÈ΋˜ Ì˘ÔηډÈÔ¿ıÂÈ·˜ (41). ∆Ô ÂӉȷʤÚÔÓ ¤¯ÂÈ ÛÙÚ·Ê› ÛÙË ‰ÈÂÚ‡ÓËÛË Èı·Ó‹˜ Û˘Û¯¤ÙÈÛ˘ ÌÂٷ͇ ÙÔ˘ ÁÔÓfiÙ˘Ô˘ Î·È ÙÔ˘ Ê·ÈÓfiÙ˘Ô˘ ÙˆÓ ‰È·ÊfiÚˆÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ (41-43). OÈ ÌÂÙ·ÏÏ¿ÍÂȘ ÙÔ˘ ÁÔÓȉ›Ô˘ Ù˘ ‚·ÚÈ¿˜ ·Ï‡ÛÔ˘ Ù˘ ‚-Ì˘ÔÛ›Ó˘ (¯ÚˆÌfiۈ̷ 14q11.212) Â›Ó·È ÔÈ Û˘¯ÓfiÙÂÚ˜ Î·È ·ÓÙÈÛÙÔÈ¯Ô‡Ó ÛÙÔ 35-50% fiÏˆÓ ÙˆÓ ÂÚÈÙÒÛÂˆÓ (41). ∫¿ÔȘ ·fi ·˘Ù¤˜ ÙȘ ÌÂÙ·ÏÏ¿ÍÂȘ Û¯ÂÙ›˙ÔÓÙ·È Ì ‹È· ÎÏÈÓÈ΋ ÔÚ›· ηÈ

¶·È‰È·ÙÚÈ΋ 2003;66:405-417

¶›Ó·Î·˜ 5. ∞ÈÙÈÔÏÔÁ›· ˘ÂÚÙÚÔÊÈ΋˜ Ì˘ÔηډÈÔ¿ıÂÈ·˜ ñ ∞ӈ̷ϛ˜ Û˘ÛÙ·ÏÙÒÓ ÚˆÙÂ˚ÓÒÓ ñ MÂÙ·‚ÔÏÈο

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OÈÎÔÁÂÓ‹˜ ˘ÂÚÙÚÔÊÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· ∞ÓÂ¿ÚÎÂÈ· ηÚÓÈÙ›Ó˘ °Ï˘ÎÔÁÔÓ›·ÛË Ù‡Ô˘ π Î·È ππ ∞ÓÂ¿ÚÎÂÈ· ÛÂÏËÓ›Ô˘ §ÈÔ‰˘ÛÙÚÔʛ˜ ™. Hurler ¡fiÛÔ˜ ÙÔ˘ Fabry ª·ÓÓÔÛ›‰ˆÛË ¡ÂÔÁÓfi ‰È·‚ËÙÈ΋˜ ÌËÙ¤Ú·˜ ™. Noonan ™. Leopard ™. Friedreich’s ™. Beckwith-Wiedermann ªÈÙÔ¯ÔÓ‰Úȷ΋ Ì˘Ô¿ıÂÈ· À¤ÚÙ·ÛË ™. Swyer-James

∆ÚÔÔÔÈË̤ÓÔ ·fi Curr Opin Pediatr 1995;7:587-594

·˘ÍË̤ÓÔ ÚÔÛ‰fiÎÈÌÔ ÂÈ‚›ˆÛ˘, ÂÓÒ ¿ÏϘ ηÎÔ‹ıÂȘ ÌÂÙ·ÏÏ¿ÍÂȘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÂÎÛÂÛËÌ·Ṳ̂ÓË ÎÔÈÏȷ΋ ˘ÂÚÙÚÔÊ›· Î·È Ì›ˆÛË Î·Ù¿ 50% ÙÔ˘ ÚÔÛ‰fiÎÈÌÔ˘ ÂÈ‚›ˆÛ˘ (6,43-46). OÈ ÌÂÙ·ÏÏ¿ÍÂȘ ÙÔ˘ ÁÔÓȉ›Ô˘ Ù˘ ηډȷ΋˜ ÙÚÔÔÓ›Ó˘ ∆ (¯ÚˆÌfiۈ̷ 1q3) ¢ı‡ÓÔÓÙ·È ÁÈ· ÙÔ 15% ÙˆÓ ÂÚÈÙÒÛˆÓ, ÚÔηÏÔ‡Ó ‹È· ˘ÂÚÙÚÔÊ›· Î·È ¤¯Ô˘Ó η΋ ÚfiÁÓˆÛË (47,48). OÈ ÌÂÙ·ÏÏ¿ÍÂȘ ÙÔ˘ ÁÔÓȉ›Ô˘ Ù˘ Û˘Ó‰ÂfiÌÂÓ˘ Ì ÙËÓ Î·Ú‰È·Î‹ Ì˘ÔÛ›ÓË ÚˆÙ½Ó˘ C (¯ÚˆÌfiۈ̷ 11p11.2) ¢ı‡ÓÔÓÙ·È ÁÈ· ÙÔ 20% ÙˆÓ ÂÚÈÙÒÛˆÓ, Û¯ÂÙ›˙ÔÓÙ·È Ì ÈÔ ‹È· ÎÏÈÓÈ΋ ÔÚ›· Î·È Ì ÚÔԉ¢ÙÈ΋ ÂÌÊ¿ÓÈÛË Ù˘ ˘ÂÚÙÚÔÊ›·˜ ΢ڛˆ˜ Û ÌÂÁ¿ÏË ËÏÈΛ· (49-51), ÂÓÒ ÔÈ ÌÂÙ·ÏÏ¿ÍÂȘ Ù˘ ·-ÙÚÔÔÌ˘ÔÛ›Ó˘ (¯ÚˆÌfiۈ̷ 15q22) ¢ı‡ÓÔÓÙ·È ÁÈ· ÏÈÁfiÙÂÚÔ ·fi ÙÔ 3% ÙˆÓ ÂÚÈÙÒÛÂˆÓ (52). ÕÏϘ ÂÚÈÔ¯¤˜ ¯ÚˆÌÔÛˆÌ¿ÙˆÓ Ô˘ ¢ı‡ÓÔÓÙ·È ÁÈ· ÙËÓ Àª∫ ›ӷÈ: ÙÔ 19q13.4 Ô˘ Έ‰ÈÎÔÔÈ› ÙËÓ ÙÚÔÔÌ˘ÔÛ›ÓË π Î·È Ù· 3p21 Î·È 12q23-24.3 ÁÈ· ÙËÓ ÂÏ·ÊÚ¿ ¿Ï˘ÛÔ Ù˘ Ì˘ÔÛ›Ó˘ 1 Î·È 2, ·ÓÙ›ÛÙÔȯ· (6). ¶ÚfiÛÊ·Ù· ·Ó·Î·Ï‡ÊıËΠÌÂÙ¿ÏÏ·ÍË ÙÔ˘ ÁÔÓȉ›Ô˘ Ô˘ Έ‰ÈÎÔÔÈ› ÙË Á2 ˘ÔÔÌ¿‰· Ù˘ ∞ªƒ ÚˆÙÂ˚ÓÈ΋˜ ÎÈÓ¿Û˘, Ë ÔÔ›· Û˘Ó‰˘¿˙ÂÙ·È Ì ÙÔ Û‡Ó‰ÚÔÌÔ Wolf-Parkinson-White (6). ∂›Û˘, ˘¿Ú¯Ô˘Ó ÓÂfiÙÂÚ˜ ÌÂϤÙ˜ Ô˘ ‰Â›¯ÓÔ˘Ó ÙËÓ ‡·ÚÍË ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜ Î·È Ì ÙÔÓ ·˘ÙÔۈ̷ÙÈÎfi ˘ÔÏÂÈfiÌÂÓÔ ¯·Ú·ÎÙ‹Ú· (54). ¶·Ú’ fiÏÔ Ô˘ Ô Ù‡Ô˜ Ù˘ ÌÂÙ¿ÏÏ·Í˘ Ê·›ÓÂÙ·È Ó· ¢ı‡ÓÂÙ·È ÁÈ· Û˘ÁÎÂÎÚÈ̤ÓÔ Ê·ÈÓfiÙ˘Ô Ù˘ ÓfiÛÔ˘, ·Ú·ÙËÚÔ‡ÓÙ·È ‰È·ÊÔÚ¤˜ ÛÙËÓ ÂΉ‹ÏˆÛË Ù˘ ÓfiÛÔ˘ ÌÂٷ͇ ÌÂÏÒÓ Ù˘ ›‰È·˜ ÔÈÎÔÁ¤ÓÂÈ·˜ Ô˘ ʤÚÔ˘Ó ÙËÓ ›‰È· ÌÂÙ¿ÏÏ·ÍË. Œ¯Ô˘Ó ÂÓÔ¯ÔÔÈËı› ÁÈ’ ·˘Ùfi ÂÚÈ‚·ÏÏÔÓÙÈÎÔ› ·Ú¿ÁÔÓÙ˜, fiˆ˜ Ë ¿ÛÎËÛË Î·È Î·Ú‰È·ÁÁÂȷΤ˜ ·ÓˆÌ·Ï›Â˜, fiˆ˜ Ë ˘¤ÚÙ·ÛË (6). ∂›Û˘, ÙÔ ÁÂÓÂÙÈÎfi ˘fiÛÙڈ̷ οı ·ÙfiÌÔ˘ ·Ô‰ÂÈÎÓ‡ÂÙ·È ÛËÌ·ÓÙÈÎfi ηÈ, Û˘ÁÎÂÎÚÈ̤ӷ, Ù· Ú˘ıÌÈÛÙÈο ÁÔÓ›‰È· Ô˘ Έ‰ÈÎÔÔÈÔ‡Ó ÙÔ Û‡ÛÙËÌ· ÚÂÓ›Ó˘-·ÁÁÂÈÔÙÂÓÛ›Ó˘-·Ï‰Ô-

Paediatriki 2003;66:405-417

ÛÙÂÚfiÓ˘. ªÂϤÙ˜ ‰Â›¯ÓÔ˘Ó fiÙÈ ÔÏÏ·ÏÔ› ÔÏ˘ÌÔÚÊÈÛÌÔ› ÙÔ˘ ÌÂÙ·ÙÚÂÙÈÎÔ‡ ÂÓ˙‡ÌÔ˘ ÂËÚ¿˙Ô˘Ó ÙËÓ ˘ÂÚÙÚÔÊ›· ÙÔ˘ Ì˘Ôηډ›Ô˘ ÛÙËÓ ˘ÂÚÙÚÔÊÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· Î·È Û¯ÂÙ›˙ÔÓÙ·È Ì ÂÎÛÂÛËÌ·Ṳ̂ÓË Î·Ú‰È·Î‹ ˘ÂÚÙÚÔÊ›· Î·È Î›Ó‰˘ÓÔ ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ (54). ∞˘Ùfi ÈÛ¯‡ÂÈ Î·È ÁÈ· ÙÔ ¤Ó˙˘ÌÔ Î·Ú‰È·Î‹ ¯˘Ì¿ÛË Ô˘ Ú˘ıÌ›˙ÂÈ ÙËÓ ·ÁÁÂÈÔÙÂÓÛ›ÓË ππ ÛÙÔ Ì˘ÔοډÈÔ, ηıÒ˜ Î·È ÁÈ· ÁÔÓ›‰È· ÙÔ˘ ·ÁÁÂÈÔÙÂÓÛÈÓÔÁfiÓÔ˘ Î·È ÙˆÓ ˘Ô‰Ô¯¤ˆÓ Ù˘ ·ÁÁÂÈÔÙÂÓÛ›Ó˘ ππ (55,56). O ÚfiÏÔ˜ ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ÚÂÓ›Ó˘-·ÁÁÂÈÔÙÂÓÛ›Ó˘-·Ï‰ÔÛÙÂÚfiÓ˘ ÛÙËÓ ÙÚÔÔÔ›ËÛË ÙÔ˘ Ê·ÈÓfiÙ˘Ô˘ Ù˘ ˘ÂÚÙÚÔÊÈ΋˜ Ì˘ÔηډÈÔ¿ıÂÈ·˜ ·Ú·Ì¤ÓÂÈ ·ÌÊÈÏÂÁfiÌÂÓÔ˜ (55). ¶·Ú¿ÁÔÓÙ˜ fiˆ˜ Ë ÂÓ‰ÔıËÏ›ÓË-1 Î·È Ô ·Ú¿ÁÔÓÙ·˜ Ó¤ÎÚˆÛ˘ ÙˆÓ fiÁÎˆÓ ÂȉÚÔ‡Ó, Â›Û˘, ÛÙËÓ ˘ÂÚÙÚÔÊ›· ÙÔ˘ Ì˘Ôηډ›Ô˘ (57). ∏ ˘ÂÚÙÚÔÊÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· ÌÔÚ›, Â›Û˘, Ó· ·ÔÙÂÏ› ÌÈÙÔ¯ÔÓ‰Úȷ΋ ‰È·Ù·Ú·¯‹ Ô˘ ÎÏËÚÔÓÔÌÂ›Ù·È ·fi ÙË ÌËÙ¤Ú·, ÂÂȉ‹ ÙÔ ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi DNA Ù˘ ÌËÙ¤Ú·˜ ÌÂٷʤÚÂÙ·È Û fiÏ· Ù· ·È‰È¿ (·ÁfiÚÈ· Î·È ÎÔÚ›ÙÛÈ·) (58). ¶·ıÔÏÔÁÔ·Ó·ÙÔÌ›· ∏ ÈÔ ¯·Ú·ÎÙËÚÈÛÙÈ΋ ÌÔÚÊÔÏÔÁÈ΋ ·ÓˆÌ·Ï›· Ù˘ ηډȿ˜ ÙˆÓ ·ÛıÂÓÒÓ Ì ˘ÂÚÙÚÔÊÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· Â›Ó·È Ë ˘ÂÚÙÚÔÊ›· Î·È fi¯È Ë ‰È¿Ù·ÛË Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜, Ù˘Èο ·Û‡ÌÌÂÙÚË. ™ÙËÓ ÏÂÈÔ„ËÊ›· ÙˆÓ ·ÛıÂÓÒÓ (55-60%) ˘¿Ú¯ÂÈ ˘ÂÚÙÚÔÊ›· ÙÔ˘ ÌÂÛÔÎÔÈÏÈ·ÎÔ‡ ‰È·ÊÚ¿ÁÌ·ÙÔ˜ Î·È ÙÔ˘ Ô›ÛıÈÔ˘ ÂχıÂÚÔ˘ ÙÔȯÒÌ·ÙÔ˜ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜. ∞ӈ̷ϛ˜ ÙˆÓ ÂÓ‰ÔÙÔȯˆÌ·ÙÈÎÒÓ ÛÙÂÊ·ÓÈ·›ˆÓ ·ÚÙËÚÈÒÓ Ì ÂÏ¿ÙÙˆÛË ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙÔ˘ ·˘ÏÔ‡ Î·È ¿¯˘ÓÛË ÙÔ˘ ÙÔȯÒÌ·ÙÔ˜, ··ÓÙÒÓÙ·È Û ÂÚÈÛÛfiÙÂÚÔ ·fi ÙÔ 80% ÙˆÓ ·ÛıÂÓÒÓ, Û˘¯ÓfiÙÂÚ· ÛÙÔ ÌÂÛÔÎÔÈÏÈ·Îfi ‰È¿ÊÚ·ÁÌ· (2,3,6). ∏ ˘ÂÚÙÚÔÊ›· Â›Ó·È Û˘¯Ó¿ ·ÚÔ‡Û· ÛÙÔ ÙÔ›¯ˆÌ· ÙˆÓ ÌÈÎÚÒÓ ÂÓ‰ÔÙÔȯˆÌ·ÙÈÎÒÓ ÛÙÂÊ·ÓÈ·›ˆÓ ·ÁÁ›ˆÓ, Ô‰ËÁÒÓÙ·˜ Û ÈÛ¯·ÈÌ›· Î·È Û˘Ì›ÂÛË ÙˆÓ ÎÏ¿‰ˆÓ Ô˘ ·ÈÌ·ÙÒÓÔ˘Ó ÙÔ ÌÂÛÔÎÔÈÏÈ·Îfi ‰È¿ÊÚ·ÁÌ·. O ‚·ıÌfi˜ Î·È Ë ı¤ÛË Ù˘ ˘ÂÚÙÚÔÊ›·˜ ÌÔÚ› Ó· ÔÈΛÏÏÔ˘Ó (2,3,5). πÛÙÔÏÔÁÈο ·Ú·ÙËÚÂ›Ù·È ·Ô‰ÈÔÚÁ¿ÓˆÛË ÙˆÓ Î·Ú‰È·ÎÒÓ Î˘ÙÙ¿ÚˆÓ, ·ÓÙÈηٿÛÙ·Û‹ ÙÔ˘˜ ·fi ÈÓÒ‰Ë ÈÛÙfi, ˘ÂÚÙÚÔÊ›· ÙˆÓ Ì˘ÔηډȷÎÒÓ Î˘ÙÙ¿ÚˆÓ Ì ÔÈÎÈÏ›· ÛÙÔ Ì¤ÁÂıÔ˜ Î·È ÙÔ Û¯‹Ì· Î·È ·ÓˆÌ·Ï›Â˜ ÛÙ· ÂÓ‰ÔÙÔȯˆÌ·ÙÈο ÛÙÂÊ·ÓÈ·›· ·ÁÁ›· (58). ™Â ÌÈÎÚ¿ ·È‰È¿ Ì ˘ÂÚÙÚÔÊÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· Ô˘ ÔÊ›ÏÂÙ·È Û ÌÂÙ·‚ÔÏÈο ·›ÙÈ· ‹ ÌÈÙÔ¯ÔÓ‰ÚȷΤ˜ ‰È·Ù·Ú·¯¤˜, ·Ú·ÙËÚÂ›Ù·È ‰È‹ıËÛË ÙÔ˘ Ì˘Ôηډ›Ô˘ Ì ÁÏ˘ÎÔÁfiÓÔ. ∏ ·ÚÈ· ‰È·Ù·Ú·¯‹ Ù˘ ηډȷ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ Â›Ó·È Ë ‰È·ÛÙÔÏÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Î·È Ë ÂÏ·Ùو̤ÓË ÂÓ‰ÔÙÈÎfiÙËÙ· ÙˆÓ ÎÔÈÏÈÒÓ. ∂›Û˘, ·Ú·ÙËÚÂ›Ù·È Û˘ÛÙÔÏÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Ì ·‡ÍËÛË ÙÔ˘ ÎÏ¿ÛÌ·ÙÔ˜ ÂÍÒıËÛ˘ (~75%) Î·È ˘ÔÎÈÓËÛ›· ÙÔ˘ ÌÂÛÔÎÔÈÏÈ·ÎÔ‡ ‰È·ÊÚ¿ÁÌ·ÙÔ˜. ™Â ÌÂÚÈÎÔ‡˜ ·ÛıÂÓ›˜ ·Ú·ÙËÚÂ›Ù·È ·fiÊÚ·ÍË ÙÔ˘ ¯ÒÚÔ˘ ÂÍfi‰Ô˘ Ù˘ ·ÚÈÛÙÂÚ‹˜

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ÎÔÈÏ›·˜ Î·È ·ÓÂ¿ÚÎÂÈ· ÌÈÙÚÔÂȉԇ˜ ‚·Ï‚›‰·˜. ™·ÓÈfiÙÂÚ·, οÔÈ· ·È‰È¿ ¤¯Ô˘Ó ÌÂÁ¿Ï˜ Î·È Ì ÌÂȈ̤ÓË ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ· ·ÚÈÛÙÂÚ¤˜ ÎÔÈÏfiÙËÙ˜, ÔÈ Ôԛ˜ ÛÙËÓ ÔÚ›· Ù˘ ÓfiÛÔ˘ ‰È·Ù›ÓÔÓÙ·È ÂÚ·ÈÙ¤Úˆ (2,3). ∫ÏÈÓÈο Â˘Ú‹Ì·Ù· ∆· ÛËÌ›· Î·È Ù· Û˘ÌÙÒÌ·Ù· Ù˘ ˘ÂÚÙÚÔÊÈ΋˜ Ì˘ÔηډÈÔ¿ıÂÈ·˜ Â›Ó·È ÔÈΛϷ Î·È ÂÍ·ÚÙÒÓÙ·È ·fi ÙËÓ ËÏÈΛ·. °ÂÓÈο, Ù· ‚Ú¤ÊË Ì ˘ÂÚÙÚÔÊÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· ·ÚÔ˘ÛÈ¿˙Ô˘Ó Û˘ÌÊÔÚËÙÈ΋ ηډȷ΋ ·ÓÂ¿ÚÎÂÈ· Î·È ÔÏÏ¿ ηٷϋÁÔ˘Ó ÛÙÔ ÚÒÙÔ ¤ÙÔ˜ Ù˘ ˙ˆ‹˜ ÙÔ˘˜. ∆Ô 35% ÙˆÓ ‚ÚÂÊÒÓ Â›Ó·È ·Û˘Ìو̷ÙÈÎfi, ÂÓÒ ÙÔ 25% ÂÚ›Ô˘ ·ÚÔ˘ÛÈ¿˙ÂÈ Î·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ·. ∞ÓÙ›ıÂÙ·, Ù· ·È‰È¿ Â›Ó·È Û˘¯Ó¿ ·Û˘Ìو̷ÙÈο. ∆Ô 40% ÙˆÓ ·È‰ÈÒÓ ·ÚÔ˘ÛÈ¿˙ÂÈ ‹È· Û˘ÌÙÒÌ·Ù·, ·ÏÏ¿ ÌfiÓÔ ÙÔ 6% ¤¯ÂÈ ÛËÌ·ÓÙÈÎfi ÂÚÈÔÚÈÛÌfi Ù˘ Ê˘ÛÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ηٿ ÙË ‰È¿ÁÓˆÛË. ™Â ¤Ó·Ó ¿ÁÓˆÛÙÔ ·ÚÈıÌfi ·È‰ÈÒÓ, Ë ÚÒÙË ÂΉ‹ÏˆÛË Ù˘ ÓfiÛÔ˘ Â›Ó·È Ô ·ÈÊÓ›‰ÈÔ˜ ı¿Ó·ÙÔ˜ (3,5). ∆· Û˘ÌÙÒÌ·Ù· Ô˘ ÌÔÚ› Ó· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó Ù· ·È‰È¿ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ‰‡ÛÓÔÈ·, ‡ÎÔÏË ÎfiˆÛË È‰›ˆ˜ ÛÙËÓ ¿ÛÎËÛË, ıˆÚ·ÎÈÎfi ¿ÏÁÔ˜, ÚÔÛ˘ÁÎÔ‹, Û˘ÁÎÔ‹ Î·È ·›ÛıËÌ· ·ÏÌÒÓ. ∫·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ· Û˘Ì‚·›ÓÂÈ Û ÏÈÁfiÙÂÚÔ ·fi 4% ÙˆÓ ·È‰ÈÒÓ ËÏÈΛ·˜ ÌÂÁ·Ï‡ÙÂÚ˘ ÙÔ˘ 1 ¤ÙÔ˘˜ (3). ∫·Ù¿ ÙË Ê˘ÛÈ΋ ÂͤٷÛË, fiÙ·Ó ˘¿Ú¯ÂÈ ·fiÊÚ·ÍË ÙÔ˘ ¯ÒÚÔ˘ ÂÍfi‰Ô˘ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜, ‰È·ÈÛÙÒÓÂÙ·È ¤ÓÙÔÓÔ ÔÏÔÛ˘ÛÙÔÏÈÎfi ʇÛËÌ· ÂÍÒıËÛ˘, ÙÔ ÔÔ›Ô Á›ÓÂÙ·È ÂÓÙÔÓfiÙÂÚÔ ÛÙËÓ ¿ÛÎËÛË, Ì ÙË ‰ÔÎÈÌ·Û›· Valsava. O ‰Â‡ÙÂÚÔ˜ ÙfiÓÔ˜ Â›Ó·È ‰È¯·Ṳ̂ÓÔ˜ Î·È ÌÔÚ› Ó· ·ÎÔ˘ÛÙ› ÙÚ›ÙÔ˜ Î·È Ù¤Ù·ÚÙÔ˜ ÙfiÓÔ˜. ¢È¿ÁÓˆÛË ªÂ ÙËÓ ·ÎÙÈÓÔÁÚ·Ê›· ‰È·ÈÛÙÒÓÂÙ·È ÌÂÁ·ÏÔηډ›·. ¶·Ú’ fiÏÔ Ô˘ ÙÔ ËÏÂÎÙÚÔηډÈÔÁÚ¿ÊËÌ· Â›Ó·È Û˘Ó‹ıˆ˜ ·ıÔÏÔÁÈÎfi ÙfiÛÔ ÛÙ· ‚Ú¤ÊË fiÛÔ Î·È Û ÂÚÈÛÛfiÙÂÚÔ ·fi 90% ÙˆÓ ·È‰ÈÒÓ, Ù· Â˘Ú‹Ì·Ù· ‰ÂÓ Â›Ó·È ÂȉÈο. ™Ù· ‚Ú¤ÊË ·Ú·ÙËÚÔ‡ÓÙ·È ˘ÂÚÙÚÔÊ›· Ù˘ ·ÚÈÛÙÂÚ‹˜ ‹ Î·È Ù˘ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜ Î·È ÌË ÂȉÈΤ˜ ·ÏÏÔÈÒÛÂȘ ÙÔ˘ ST Î·È ∆. ™Ù· ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿ ·Ó¢ڛÛÎÔÓÙ·È ˘ÂÚÙÚÔÊ›· Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜, ·ÏÏ·Á¤˜ ÛÙ· ST Â¿ÚÌ·Ù· Î·È ÛÙÔ Î‡Ì· ∆ Î·È ·ÓÒÌ·Ï· ·̷ٷ Q, ηıÒ˜ Î·È ·Ú¿Ù·ÛË ÙÔ˘ ‰È·ÛÙ‹Ì·ÙÔ˜ QT. ™Ù· ÌÂÁ¿Ï· ·È‰È¿ Î·È ÙÔ˘˜ ÂÓ‹ÏÈΘ ÙÔ ∏∫° ·ÔÙÂÏ› Ì›· ÈηÓÔÔÈËÙÈ΋ ̤ıÔ‰Ô ·Ú·ÎÔÏÔ‡ıËÛ˘. ÕÏÏ· Â˘Ú‹Ì·Ù· Ô˘ ÌÔÚ› Ó· ˘¿Ú¯Ô˘Ó Â›Ó·È ·ÚÚ˘ı̛˜, fiˆ˜ ÊÏ‚ÔÎÔÌ‚È΋ ‚Ú·‰˘Î·Ú‰›·, ˘ÂÚÎÔÈÏȷ΋ Ù·¯˘Î·Ú‰›·, ÚÒÈ̘ ¤ÎÙ·ÎÙ˜ ÎÔÈÏȷΤ˜ Û˘ÛÙÔϤ˜ Î·È ÎÔÏÔÎÔÈÏÈ·Îfi˜ ·ÔÎÏÂÈÛÌfi˜ (59). ªÂ ÙÔ Ë¯ÔηډÈÔÁÚ¿ÊËÌ· Ù›ıÂÙ·È Î·È Ë ‰È¿ÁÓˆÛË Ù˘ ˘ÂÚÙÚÔÊÈ΋˜ Ì˘ÔηډÈÔ¿ıÂÈ·˜. ¢È·ÈÛÙÒÓÂÙ·È Ë ‡·ÚÍË Î·È Ë ¤ÎÙ·ÛË Ù˘ ˘ÂÚÙÚÔÊ›·˜ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ Î·È Ë Èı·Ó‹ ·fiÊÚ·ÍË ÙÔ˘ ¯ÒÚÔ˘ ÂÍfi‰Ô˘ ‹ Ë ·ÓÂ¿ÚÎÂÈ· Ù˘ ÌÈÙÚÔÂȉԇ˜ ‚·Ï‚›-

412

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‰·˜. ∂›Û˘, ÂÎÙÈÌ¿Ù·È Ë Û˘ÛÙÔÏÈ΋ Î·È Ë ‰È·ÛÙÔÏÈ΋ ÏÂÈÙÔ˘ÚÁ›· Ù˘ ηډȿ˜ (3,5).

O ηډȷÎfi˜ ηıÂÙËÚÈ·ÛÌfi˜ Â›Ó·È ¯Ú‹ÛÈÌÔ˜ ÛÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË Ì ÙË Ï‹„Ë ‚ÈÔ„ÈÒÓ ·fi ÙÔ Ì˘ÔοډÈÔ (60). ∏ 24ˆÚË Î·Ù·ÁÚ·Ê‹ ÙÔ˘ ËÏÂÎÙÚÔηډÈÔÁÚ·Ê‹Ì·ÙÔ˜ Â›Ó·È ··Ú·›ÙËÙË ÁÈ· ÙËÓ ·Ó›¯Ó¢ÛË Ù˘¯fiÓ ·ÚÚ˘ıÌÈÒÓ (34). OÈ ·ÛıÂÓ›˜ Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Û˘ÌÙÒÌ·Ù· ÈÛ¯·ÈÌ›·˜, ı· Ú¤ÂÈ Ó· ˘Ô‚¿ÏÏÔÓÙ·È Û ‰ÔÎÈÌ·Û›· ÎÔÒÛˆ˜ Î·È Û ·ÁÁÂÈÔÁÚ·Ê›· ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ ·ÁÁ›ˆÓ ÁÈ· ÙÔÓ ·ÔÎÏÂÈÛÌfi Ù˘ Û˘Ì›ÂÛ˘ ÙˆÓ ·ÁÁ›ˆÓ Ô˘ ·ÈÌ·ÙÒÓÔ˘Ó ÙÔ ÌÂÛÔÎÔÈÏÈ·Îfi ‰È¿ÊÚ·ÁÌ· ‹ Ù˘ Û˘Ì›ÂÛ˘ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÛÙÂÊ·ÓÈ·›·˜ ·ÚÙËÚ›·˜ (61-63). ™Ù· ÓÂÔÁÓ¿ Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ˘ÂÚÙÚÔÊÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ·, Ú¤ÂÈ Ó· Á›ÓÂÙ·È Ï‹Ú˘ ¤ÏÂÁ¯Ô˜ ÁÈ· ÌÂÙ·‚ÔÏÈο ÓÔÛ‹Ì·Ù· (36). £ÂÚ·›· ∏ ıÂÚ·¢ÙÈ΋ ÛÙÚ·ÙËÁÈ΋ ÂÍ·ÙÔÌÈ·ÂÙ·È ·Ó¿ÏÔÁ· Ì ٷ Û˘ÌÙÒÌ·Ù· ÙÔ˘ ·ÛıÂÓ‹. ∂Âȉ‹ ÛÙËÓ ˘ÂÚÙÚÔÊÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· Ë ·ÚÈÛÙÂÚ‹ ÎÔÈÏ›· ·ÚÔ˘ÛÈ¿˙ÂÈ Û˘Ó‹ıˆ˜ ˘ÂÚÛ˘ÛÙ·ÏÙÈÎfiÙËÙ·, ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÔÈ ‚-·Ó·ÛÙÔÏ›˜ Î·È ÔÈ ·ÓÙ·ÁˆÓÈÛÙ¤˜ ÙˆÓ ‰È·‡ÏˆÓ ·Û‚ÂÛÙ›Ô˘ (3,6,64). OÈ ‚-·Ó·ÛÙÔÏ›˜ (ÚÔÚ·ÓÔÏfiÏË, ·ÙÂÓÔÏfiÏË) Â›Ó·È Û˘Ó‹ıˆ˜ ·ÔÙÂÏÂÛÌ·ÙÈÎÔ›, ηıÒ˜ ÂÏ·ÙÙÒÓÔ˘Ó ÙËÓ Î·Ú‰È·Î‹ Û˘¯ÓfiÙËÙ·, ÙË Û˘ÛÙ·ÏÙÈÎfiÙËÙ· Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ Î·È ÙÔ ÙÔȯˆÌ·ÙÈÎfi stress. OÈ ·Ó·ÛÙÔÏ›˜ ÙˆÓ ‰È·‡ÏˆÓ ·Û‚ÂÛÙ›Ô˘ (ÓÈʉÈ›ÓË, ‚ÂÚ··Ì›ÏË, ‰ÈÏÙÈ·˙¤ÌË), Â›Û˘, ‚ÂÏÙÈÒÓÔ˘Ó Ù· Û˘ÌÙÒÌ·Ù·, ÌÂÈÒÓÔÓÙ·˜ ÙËÓ Î·Ú‰È·Î‹ Û˘¯ÓfiÙËÙ· Î·È ÙËÓ ·ÚÙËÚȷ΋ ›ÂÛË. Œ¯ÂÈ ¯ÚËÛÈÌÔÔÈËı› Ë ‰ÈÛÔ˘Ú·Ì›‰Ë, Ë ÔÔ›· ¤¯ÂÈ ·ÚÓËÙÈ΋ ÈÓfiÙÚÔË ‰Ú¿ÛË Î·È ‚ÂÏÙÈÒÓÂÈ ÙËÓ ·fiÊÚ·ÍË ÙÔ˘ ¯ÒÚÔ˘ ÂÍfi‰Ô˘ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜, Ì ÌÈÎÚ‹ fï˜ ÂÌÂÈÚ›· ÛÙ· ·È‰È¿ (2,3,6). ªÂϤÙ˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ ÙÔ 1/3 ÙˆÓ ·ÛıÂÓÒÓ ÂˆÊÂÏ‹ıËÎ·Ó ·fi ÙË Ê·Ú̷΢ÙÈ΋ ıÂÚ·›· Î·È ‚ÂÏÙÈÒıËÎ·Ó Ù· Û˘ÌÙÒÌ·Ù¿ ÙÔ˘˜. ¢ÂÓ ˘¿Ú¯Ô˘Ó ÌÂϤÙ˜ Ô˘ Ó· ·Ô‰ÂÈÎÓ‡Ô˘Ó fiÙÈ Ë ¯Ú‹ÛË Ê·Ú̷΢ÙÈ΋˜ ıÂÚ·›·˜ ÌÔÚ› Ó· ÚÔÏ¿‚ÂÈ ‹ Ó· ηı˘ÛÙÂÚ‹ÛÂÈ ÙËÓ ÂͤÏÈÍË Ù˘ ˘ÂÚÙÚÔÊ›·˜ (3,6,65). ™ÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·ÚÚ˘ı̛˜ ¤¯ÂÈ ¯ÚËÛÈÌÔÔÈËı› Ë ·ÌȈ‰·ÚfiÓË Ì ¢ÓÔ˚ο ·ÔÙÂϤÛÌ·Ù· ÛÙÔ˘˜ ÂÓ‹ÏÈΘ, ·ÏÏ¿ ÛÙ· ·È‰È¿ ‰ÂÓ ¯ÚËÛÈÌÔÔÈÂ›Ù·È Â˘Ú¤ˆ˜ ÏfiÁˆ ÙˆÓ ·ÚÂÓÂÚÁÂÈÒÓ. ™Â ·ÛıÂÓ›˜ Ì ‚Ú·‰˘Î·Ú‰›·, ıÂÚ·›· ÂÎÏÔÁ‹˜ Â›Ó·È Ë ÂÌʇÙ¢ÛË ‚ËÌ·ÙÔ‰fiÙË. ¶ÚÔÊ˘Ï·ÎÙÈ΋ ·ÓÙÈ·ÚÚ˘ıÌÈ΋ ıÂÚ·›· ı· Ú¤ÂÈ Ó· ¯ÔÚËÁÂ›Ù·È Û ·ÛıÂÓ›˜ Ì ٷ¯˘·ÚÚ˘ı̛˜, ÎÔÈÏȷ΋ Ù·¯˘Î·Ú‰›· Î·È ÈÛÙÔÚÈÎfi ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘. ™Â ÂÚÈÙÒÛÂȘ Ì·˙È΋˜ ˘ÂÚÙÚÔÊ›·˜, ÁÈ· ÙËÓ ÚÔʇϷÍË ·fi ÙÔÓ ·ÈÊÓ›‰ÈÔ ı¿Ó·ÙÔ, ¯ÚËÛÈÌÔÔÈÂ›Ù·È Ë ÂÌʇÙ¢ÛË ·ÈÓȉˆÙ‹ (65). ∏ ÌË ÂȉÈ΋ ıÂÚ·›· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ÚÔʇϷÍË ·fi ÙË ‚·ÎÙËÚȉȷ΋ ÂÓ‰Ôηډ›Ùȉ· ηٿ ÙË ‰È¿ÚÎÂÈ· ·ÈÌ·ÙËÚÒÓ ÂÂÌ‚¿ÛÂˆÓ Î·È ÙË ¯Ú‹ÛË ·ÓÙÈËÎÙÈ΋˜ ıÂÚ·›·˜ ÌÂÙ¿ ·fi

¶·È‰È·ÙÚÈ΋ 2003;66:405-417

οÔÈÔ ıÚÔÌ‚ÔÂÌ‚ÔÏÈÎfi ÂÂÈÛfi‰ÈÔ. ™Â ·ÛıÂÓ›˜ Ì ÌÂÙ·‚ÔÏÈΤ˜ ·ÓˆÌ·Ï›Â˜, Â›Ó·È Ôχ ÛËÌ·ÓÙÈ΋ Ë ¿ÌÂÛË ·ÔηٿÛÙ·ÛË ÙˆÓ ‚ÈÔ¯ËÌÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ (36). ¶Ú¤ÂÈ Ó· ÙÔÓ›˙ÂÙ·È Ë ·ÔÊ˘Á‹ Ù˘ ¿ÛÎËÛ˘, ÂÎÙfi˜ ·fi ÂÏ·ÊÚ¤˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜. ∞Ó ·ÔÙ‡¯ÂÈ Ë Ê·Ú̷΢ÙÈ΋ ıÂÚ·›· ÛÙË ‚ÂÏÙ›ˆÛË ÙˆÓ Û˘Ìو̿وÓ, ¯ÚËÛÈÌÔÔÈÂ›Ù·È ¯ÂÈÚÔ˘ÚÁÈ΋ ·Ú¤Ì‚·ÛË, Ì˘ÔÙÔÌ‹-Ì˘ÂÎÙÔÌ‹ (Â¤Ì‚·ÛË Morrow) ‹ ¿ÏϘ ¯ÂÈÚÔ˘ÚÁÈΤ˜ Ù¯ÓÈΤ˜, Ì ÛÎÔfi ÙË ‚ÂÏÙ›ˆÛË Ù˘ ·fiÊڷ͢ ÙÔ˘ ¯ÒÚÔ˘ ÂÍfi‰Ô˘ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜. ∆¤ÏÔ˜, Û ·È‰È¿ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘, fiÔ˘ Ë Ê·Ú̷΢ÙÈ΋ ıÂÚ·›· ¤¯ÂÈ ·ÔÙ‡¯ÂÈ, ˘¿Ú¯ÂÈ Ë ÂÈÏÔÁ‹ Ù˘ ÌÂÙ·ÌfiÛ¯Â˘Û˘ ηډȿ˜. ¶ÚfiÁÓˆÛË ∏ ˘ÂÚÙÚÔÊÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· Â›Ó·È ÙÔ Û˘¯ÓfiÙÂÚÔ ·›ÙÈÔ ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ Û ӤԢ˜ ÂÓ‹ÏÈΘ Î·È ·ıÏËÙ¤˜, Ì ÔÛÔÛÙfi ÂÙ‹ÛÈ·˜ ıÓËÙfiÙËÙ·˜ 2-4% ÙˆÓ ÓÔÛËÏ¢fiÌÂÓˆÓ ·ÛıÂÓÒÓ (3,63). ∞ÈÊÓ›‰ÈÔ˜ ηډȷÎfi˜ ı¿Ó·ÙÔ˜ Û˘Ì‚·›ÓÂÈ Î˘Ú›ˆ˜ Û ÂÊ‹‚Ô˘˜ Î·È Û Ó·ÚÔ‡˜ ÂÓ‹ÏÈΘ ËÏÈΛ·˜ 15-35 ÂÙÒÓ Ô˘ ‹Ù·Ó ·Û˘Ìو̷ÙÈÎÔ› Î·È Û˘¯Ó¿ ·ÔÙÂÏ› ÙËÓ ÚÒÙË ÂΉ‹ÏˆÛË Ù˘ ÓfiÛÔ˘. ∆· ‚Ú¤ÊË ËÏÈΛ·˜ οو ÙÔ˘ 1 ¤ÙÔ˘˜ ¤¯Ô˘Ó Ôχ η΋ ÚfiÁÓˆÛË. ∞Ó Ë ÚÒÙË ÂΉ‹ÏˆÛË Â›Ó·È Î·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ· ‹ ΢¿ÓˆÛË, ÙfiÙÂ Ô ı¿Ó·ÙÔ˜ Û˘Ì‚·›ÓÂÈ ˆ˜ ÙË Û˘ÌÏ‹ÚˆÛË ÙÔ˘ ÚÒÙÔ˘ ¤ÙÔ˘˜ Ù˘ ˙ˆ‹˜. ∞Ó Ù· ÚÒÙ· Û˘ÌÙÒÌ·Ù· Â›Ó·È ÈÔ ·Ì‚Ï˯ڿ, ÙfiÙ ÙÔ ÔÛÔÛÙfi ÂÈ‚›ˆÛ˘ ¤ˆ˜ ÙÔ ÚÒÙÔ ¤ÙÔ˜ ÊÙ¿ÓÂÈ ÙÔ 50% (3,61). ∏ ˘ÂÚÙÚÔÊÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· Â›Ó·È Ì›· ÂÍÂÏÈÛÛfiÌÂÓË ÓfiÛÔ˜, ΢ڛˆ˜ ηٿ ÙËÓ Ù·¯Â›· ۈ̷ÙÈ΋ ·‡ÍËÛË. ∏ ıÓËÙfiÙËÙ· ÛÙËÓ ·È‰È΋ ËÏÈΛ· Â›Ó·È ‰ÈÏ¿ÛÈ· ·’ fi,ÙÈ ÛÙÔ˘˜ ÂÓ‹ÏÈΘ Î·È Ô Î›Ó‰˘ÓÔ˜ ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ Â›Ó·È ·ÓÂÍ¿ÚÙËÙÔ˜ ·fi ÙËÓ ‡·ÚÍË ‹ fi¯È Û˘ÌÙˆÌ¿ÙˆÓ (3). ™ÙÔ˘˜ ÂÊ‹‚Ô˘˜, Ë ÈÔ Û˘¯Ó‹ ·ÈÙ›· ı·Ó¿ÙÔ˘ Â›Ó·È Ô ·ÈÊÓ›‰ÈÔ˜ ı¿Ó·ÙÔ˜ ηٿ ÙËÓ ¿ÛÎËÛË. ¢˘ÛÌÂÓ›˜ ÚÔÁÓˆÛÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ Û fiϘ ÙȘ ËÏÈÎȷΤ˜ ÔÌ¿‰Â˜ Â›Ó·È Ë ·ÚÔ˘Û›· Û˘ÁÎÔÙÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ, Ë ·ÚÔ˘Û›· ηډȷ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ ÛÙÔ ÚÒÙÔ ¤ÙÔ˜ Ù˘ ˙ˆ‹˜, ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi, ÔÈ Î·Ú‰È·Î¤˜ ‰˘ÛÚ˘ı̛˜, Ë ·ÚÔ˘Û›· ÈÛ¯·ÈÌ›·˜ ÙÔ˘ Ì˘Ôηډ›Ô˘ Î·È Ë ‡·ÚÍË “ηÎÔ‹ıÔ˘˜” ÌÂÙ¿ÏÏ·Í˘ (62). ∂Í·ÈÙ›·˜ ÙÔ˘ ÌÂÁ¿ÏÔ˘ ÔÛÔÛÙÔ‡ Ù˘ ÔÈÎÔÁÂÓÔ‡˜ ÌÔÚÊ‹˜, Û˘ÓÈÛÙ¿Ù·È ¤ÏÂÁ¯Ô˜ ÛÙÔ˘˜ Û˘ÁÁÂÓ›˜ ÚÒÙÔ˘ ‚·ıÌÔ‡ ÙˆÓ ·ÙfiÌˆÓ Ô˘ ¿Û¯Ô˘Ó ·fi ˘ÂÚÙÚÔÊÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ·. ¶ÂÚÈÔÚÈÛÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· ø˜ ÂÚÈÔÚÈÛÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· ÔÚ›˙ÂÙ·È Ë ÓfiÛÔ˜ ÙÔ˘ ηډȷÎÔ‡ Ì˘fi˜ Ô˘ Ô‰ËÁ› Û ÂÏ·Ùو̤ÓË ÎÔÈÏȷ΋ Ï‹ÚˆÛË, ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ‹ ÂÏ·Ùو̤ÓÔ ‰È·ÛÙÔÏÈÎfi fiÁÎÔ Ù˘ Ì›·˜ ‹ Î·È ÙˆÓ ‰‡Ô ÎÔÈÏÈÒÓ. ∏ Û˘ÛÙÔÏÈ΋ ÏÂÈÙÔ˘ÚÁ›· ·Ú·Ì¤ÓÂÈ Ê˘ÛÈÔÏÔÁÈ΋ Î·È ÙÔ ¿¯Ô˜ ÙˆÓ ÙÔȯˆÌ¿ÙˆÓ ÌÔÚ› Ó· Â›Ó·È Ê˘ÛÈÔÏÔÁÈÎfi ‹ ·˘ÍË̤ÓÔ, ·Ó¿ÏÔÁ· Ì ÙÔ ˘ÔΛÌÂÓÔ ·›ÙÈÔ. OÊ›-

Paediatriki 2003;66:405-417

ÏÂÙ·È Û ·˘ÍË̤ÓË ‰˘Ûη̄›· ÙÔ˘ Ì˘Ôηډ›Ô˘, Ô˘ ÚÔηÏ› ·‡ÍËÛË Ù˘ ›ÂÛ˘ ÙˆÓ ÎÔÈÏÈÒÓ ¯ˆÚ›˜ ·‡ÍËÛË ÙÔ˘ fiÁÎÔ˘. ∂›Ó·È Û¿ÓÈ· Î·È ·ÓÙÈÛÙÔȯ› ÛÙÔ 5% ÙˆÓ Ì˘ÔηډÈÔ·ıÂÈÒÓ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜. ∏ ÈÔ Û˘¯Ó‹ ·ÈÙ›· ÛÙȘ ·ÓÂÙ˘Á̤Ó˜ ¯ÒÚ˜ Â›Ó·È Ë ·Ì˘ÏÔ›‰ˆÛË (66). ªÔÚ›, fï˜, Ó· ÔÊ›ÏÂÙ·È Î·È Û ‰È¿ÊÔÚ˜ ¿ÏϘ ·ı‹ÛÂȘ (¶›Ó·Î·˜ 6). ∏ ȉÈÔ·ı‹˜ ÌÔÚÊ‹ Â›Ó·È ÔÏϤ˜ ÊÔÚ¤˜ ÎÏËÚÔÓÔÌÈ΋ Î·È Ê·›ÓÂÙ·È Ó· ¤¯ÂÈ Û¯¤ÛË ÌÂ Ì˘Ô¿ıÂÈ· ÙˆÓ ÛÎÂÏÂÙÈÎÒÓ Ì˘ÒÓ. ™ÙËÓ ·È‰È΋ ËÏÈΛ· Â›Ó·È Û˘¯ÓfiÙÂÚË ÛÙ· ÎÔÚ›ÙÛÈ· Î·È Ë ÚfiÁÓˆÛË Â›Ó·È ¯ÂÈÚfiÙÂÚË ·’ fi,ÙÈ ÛÙÔ˘˜ ÂÓ‹ÏÈΘ (̤ÛÔ˜ ¯ÚfiÓÔ˜ ÂÈ‚›ˆÛ˘: 1,4 ¯ÚfiÓÈ· ·fi ÙË ÛÙÈÁÌ‹ Ù˘ ‰È¿ÁÓˆÛ˘) (66,67). ∂ΉËÏÒÓÂÙ·È ÌÂ Û˘ÌÙÒÌ·Ù· ηډȷ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ ‹ Û˘ÌÈÂÛÙÈ΋˜ ÂÚÈηډ›Ùȉ·˜. ∆Ô 1/3 ÙˆÓ ·ÛıÂÓÒÓ ·ÚÔ˘ÛÈ¿˙ÂÈ ıÚÔÌ‚ÔÂÌ‚ÔÏÈο ÂÂÈÛfi‰È· (66). ∞fi ÙË Ê˘ÛÈ΋ ÂͤٷÛË ÌÔÚ› Ó· ‰È·ÈÛÙˆıÔ‡Ó ‰Ú·ÛÙ‹ÚÈÔ ÚÔοډÈÔ, ÙÚ›ÙÔ˜ Î·È Ù¤Ù·ÚÙÔ˜ ÙfiÓÔ˜ Î·È Ê‡ÛËÌ· ‰È·Ê˘Á‹˜. ªÂ ÙÔ ËÏÂÎÙÚÔηډÈÔÁÚ¿ÊËÌ· ‰È·ÈÛÙÒÓÔÓÙ·È ¯·ÌËÏ¿ ‰˘Ó·ÌÈο (΢ڛˆ˜ ÛÙËÓ ·Ì˘ÏÔ›‰ˆÛË), ·ÚÈÛÙÂÚ‹ ÛÙÚÔÊ‹ ÙÔ˘ ¿ÍÔÓ·, ÎÔÏÈÎfi˜ ÙÂÚ˘ÁÈÛÌfi˜ Î·È ‰È·Ù·Ú·¯¤˜ ·ÁˆÁ‹˜. ™ÙËÓ ·ÎÙÈÓÔÁÚ·Ê›·, Ë Î·Ú‰È¿ ¤¯ÂÈ Ê˘ÛÈÔÏÔÁÈÎfi ̤ÁÂıÔ˜, ·ÏÏ¿ Û˘¯Ó¿ ·Ú·ÙËÚÂ›Ù·È Û˘ÌÊfiÚËÛË ÙˆÓ Ó¢ÌÔÓÈÎÒÓ ·ÁÁ›ˆÓ (67). ªÂ ÙÔ Ë¯ÔηډÈÔÁÚ¿ÊËÌ· ·Ó¢ڛÛÎÂÙ·È Ê˘ÛÈÔÏÔÁÈ΋ ÌÔÚÊÔÏÔÁ›· ÙˆÓ ÎÔÈÏÈÒÓ, ¯ˆÚ›˜ ‰È¿Ù·ÛË ‹ ˘ÂÚÙÚÔÊ›·, Ì ÛËÌ·ÓÙÈο ‰È·ÙÂٷ̤ÓÔ˘˜ ÎfiÏÔ˘˜ (·ÔÙ¤ÏÂÛÌ· ÙˆÓ ·˘ÍËÌ¤ÓˆÓ ȤÛÂˆÓ Ï‹ÚˆÛ˘). ™Â ¿ÏϘ ÂÚÈÙÒÛÂȘ ‰È·ÈÛÙÒÓÂÙ·È ¿¯˘ÓÛË ÙˆÓ ÙÔȯˆÌ¿ÙˆÓ Î·È ÙˆÓ ‚·Ï‚›‰ˆÓ, ÂȉÈο ÛÙËÓ ·Ì˘ÏÔ›‰ˆÛË. O ηډȷÎfi˜ ηıÂÙËÚÈ·ÛÌfi˜ ÂȂ‚·ÈÒÓÂÈ ÙË ‰È¿ÁÓˆÛË Î·È Ë ‚ÈÔ„›· ÙÔ˘ ηډȷÎÔ‡ Ì˘fi˜ ·ÔηχÙÂÈ ÙÔ ˘ÔΛÌÂÓÔ ·›ÙÈÔ (66). £ÂÚ·›· ∏ ıÂÚ·›· Â›Ó·È ˘ÔÛÙËÚÈÎÙÈ΋ Î·È Û˘Ó›ÛÙ·Ù·È ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Ù˘ Ó¢ÌÔÓÈ΋˜ Î·È ÊÏ‚È΋˜ Û˘ÌÊfiÚËÛ˘. ∂Í·ÈÙ›·˜ Ù˘ η΋˜ ÚfiÁÓˆÛ˘ ÛÙ· ·È‰È¿ Î·È Ù˘ ·ÔÙ˘¯›·˜ Ù˘ Û˘ÓÙËÚËÙÈ΋˜ ıÂÚ·›·˜, Ë ÌÂÙ·ÌfiÛ¯Â˘ÛË Î·Ú‰È¿˜ ıˆÚÂ›Ù·È ıÂÚ·›· ÂÎÏÔÁ‹˜ (68). ™ÙȘ ÂÚÈÙÒÛÂȘ Ô˘ ¤¯ÂÈ ‰È·ÁÓˆÛÙ› Ë ˘ÔΛÌÂÓË ·ÈÙ›·, ÂÊ·ÚÌfi˙ÔÓÙ·È ·Ó¿ÏÔÁ˜ ıÂÚ·¢ÙÈΤ˜ ̤ıÔ‰ÔÈ (66). ∞ÚÚ˘ıÌÈÔÁfiÓÔ˜ ‰˘ÛÏ·Û›· Ù˘ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜ ∏ ·ÚÚ˘ıÌÈÔÁfiÓÔ˜ ‰˘ÛÏ·Û›· Ù˘ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜ (∞¢¢∫) Â›Ó·È Ì›· ¿ıËÛË ÙÔ˘ Ì˘Ôηډ›Ô˘ Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ‚·ıÌÈ·›· ·ÓÙÈηٿÛÙ·ÛË ÙˆÓ Ì˘Ô΢ÙÙ¿ÚˆÓ ·fi ÏÈÒ‰Ë Î·È ÈÓÒ‰Ë ÈÛÙfi. ∂›Ó·È Ì›· ÛËÌ·ÓÙÈ΋ ·ÈÙ›· ı·Ó¿ÙÔ˘ Û ¿ÙÔÌ· ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ 30 ÂÙÒÓ Î·È ÂÓÔ¯ÔÔÈÂ›Ù·È ÁÈ· ÙÔ 20% ÙˆÓ ·ÈÊÓ›‰ÈˆÓ ı·Ó¿ÙˆÓ Ó·ÚÒÓ ÂÓ‹ÏÈÎˆÓ ·ÙfïÓ. ∏ Â›ÙˆÛË ÛÙÔÓ ÁÂÓÈÎfi ÏËı˘ÛÌfi Â›Ó·È ÂÚ›Ô˘ 1:5000 (6). ∏ ÓfiÛÔ˜ Ù˘Èο ÎÏËÚÔÓÔÌÂ›Ù·È Ì ·˘ÙÔۈ̷ÙÈÎfi

413

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¶›Ó·Î·˜ 6. ∆·ÍÈÓfiÌËÛË ÙˆÓ Ù‡ˆÓ Ù˘ ÂÚÈÔÚÈÛÙÈ΋˜ Ì˘ÔηډÈÔ¿ıÂÈ·˜ ·Ó¿ÏÔÁ· Ì ÙËÓ ·ÈÙÈÔÏÔÁ›·

Paediatriki 2003;66:405-417

∆ÚÔÔÔÈË̤ÓÔ ·fi: N Engl J Med 1997;336:267-276

ÙÔ˘ Â›Ó·È Ë ÂÈÙ¿¯˘ÓÛË Ù˘ ÎÔÈÏȷ΋˜ Ù·¯˘Î·Ú‰›·˜ Î·È Ë ÂÎÙÚÔ‹ Û ÎÔÈÏȷ΋ Ì·ÚÌ·Ú˘Á‹. ∏ ∞¢¢∫ ¢ı‡ÓÂÙ·È ÁÈ· ÙÔ 3-4% ÙˆÓ ·ÈÊÓ›‰ÈˆÓ ı·Ó¿ÙˆÓ Ô˘ Û˘Ì‚·›ÓÔ˘Ó ÛÙËÓ ¿ÛÎËÛË Û Ó·ÚÔ‡˜ ·ıÏËÙ¤˜ (69). ∏ ‰È¿ÁÓˆÛË Ù›ıÂÙ·È Ì ÙË ‚ÈÔ„›· ÙÔ˘ Ì˘Ôηډ›Ô˘, ÛÙËÓ ÔÔ›· ·Ó¢ڛÛÎÔÓÙ·È ÂÚÈÔ¯¤˜ fiÔ˘ ÙÔ Ì˘ÔοډÈÔ Ù˘ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜ ¤¯ÂÈ ·ÓÙÈηٷÛÙ·ı› ·fi ÈÓÒ‰Ë Î·È ÏÈÒ‰Ë ÈÛÙfi. ∂Âȉ‹ Â›Ó·È ‰‡ÛÎÔÏË Ë ‰ÈÂÓ¤ÚÁÂÈ· ‚ÈÔ„›·˜, ¤¯Ô˘Ó ıÂÛÈÛÙ› ‰È¿ÊÔÚ· ‰È·ÁÓˆÛÙÈο ÎÚÈÙ‹ÚÈ· (69) (¶›Ó·Î·˜ 7), ÂÓÒ ÁÈ· Ó· ÙÂı› Ë ‰È¿ÁÓˆÛË, Ô ·ÛıÂÓ‹˜ Ú¤ÂÈ Ó· ¤¯ÂÈ ‰‡Ô Ì›˙ÔÓ· ÎÚÈÙ‹ÚÈ· ‹ ¤Ó· Ì›˙ÔÓ Î·È ‰‡Ô ÂÏ¿ÛÛÔÓ· ‹ Ù¤ÛÛÂÚ· ÂÏ¿ÛÛÔÓ· ÎÚÈÙ‹ÚÈ·. £ÂÚ·›· ™Â ·Û˘Ìو̷ÙÈÎÔ‡˜ ·ÛıÂÓ›˜, ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÔÈ ‚-·Ó·ÛÙÔÏ›˜ ÁÈ· Ó· ÂÏ·ÙÙˆı› Ë Èı·ÓfiÙËÙ· ‰ËÌÈÔ˘ÚÁ›·˜ ·ÚÚ˘ıÌ›·˜ ÌÂÙ¿ ·fi ‰È¤ÁÂÚÛË ÙÔ˘ Û˘Ì·ıËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ™ÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ Â›Ó·È ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ·ÈÊÓ›‰ÈÔ ı¿Ó·ÙÔ, ı· Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÂÌʇÙ¢ÛË ·ÈÓȉˆÙ‹ (69). ∂Í·ÈÙ›·˜ Ù˘ ˘„ËÏ‹˜ ıÓËÙfiÙËÙ·˜ ΢ڛˆ˜ Û Ó·ڿ ¿ÙÔÌ·, ı· Ú¤ÂÈ Ó· Û˘ÓÈÛÙ¿Ù·È Ë ·ÔÊ˘Á‹ ÙˆÓ ·ÓÙ·ÁˆÓÈÛÙÈÎÒÓ ·ıÏËÌ¿ÙˆÓ.

ÂÈÎÚ·ÙÔ‡ÓÙ· ¯·Ú·ÎÙ‹Ú·, Ì ÔÈΛÏË ‰ÈÂÈÛ‰˘ÙÈÎfiÙËÙ· Î·È ·ÙÂÏ‹ ¤ÎÊÚ·ÛË. ∆· ÁÔÓ›‰È· Ô˘ Â›Ó·È ˘‡ı˘Ó· ÁÈ· ÙËÓ ∞¢¢∫ ‰ÂÓ ¤¯Ô˘Ó ·ÎfiÌË ·Ó·ÁÓˆÚÈÛÙ›, ·ÏÏ¿ ¤¯Ô˘Ó ¯·ÚÙÔÁÚ·ÊËı› 7 ÂÚÈÔ¯¤˜ ÛÙ· ¯ÚˆÌÔÛÒÌ·Ù· 14(14q23-q24 Î·È 14q12-q22), 1(1q42-43), 2(2q32.1-q32.2), 3(3p23) Î·È 10(10p12-p14). ¶ÚfiÛÊ·Ù·, ·Ó·ÁÓˆÚ›ÛÙËÎ·Ó ÌÂÙ·ÏÏ¿ÍÂȘ ÙˆÓ ÁÔÓȉ›ˆÓ Ô˘ Έ‰ÈÎÔÔÈÔ‡Ó ÙȘ ÚˆÙ½Ó˜ Ï·ÎÔÛÊ·ÈÚ›ÓË Î·È ‰ÂÛÌÔϷΛÓË, ÔÈ Ôԛ˜ Â›Ó·È ÚˆÙ½Ó˜ ÙˆÓ Î˘ÙÙ·ÚÈÎÒÓ Û˘Ó‰¤ÛÂˆÓ Î·È Â˘ı‡ÓÔÓÙ·È ÁÈ· ÙËÓ ·˘ÙÔۈ̷ÙÈ΋ ˘ÔÏÂÈfiÌÂÓË ∞¢¢∫ (6,69,70). ∆Ô ÁÔÓ›‰ÈÔ ·Ó·ÁÓˆÚ›ÛÙËΠÛÙË ÓfiÛÔ Ù˘ ¡¿ÍÔ˘, fiÔ˘ ÛÙÔ 90% ÙˆÓ ÂÚÈÙÒÛÂˆÓ Û˘Ó˘¿Ú¯Ô˘Ó ÂΉËÏÒÛÂȘ ·fi ÙÔ ‰¤ÚÌ·, ÛÁÔ˘Ú¿ Ì·ÏÏÈ¿ Î·È ˘ÂÚÎÂÚ¿ÙˆÛË ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ ÙˆÓ ·Ï·ÌÒÓ Î·È ÙˆÓ ÂÏÌ¿ÙˆÓ Î·È ¤¯ÂÈ ÂÚÈÁÚ·Ê› Û ·È‰È¿ ËÏÈΛ·˜ ·fi 7 ÂÙÒÓ. ∂ÎÙfi˜ ·fi ÙË ÁÂÓÂÙÈ΋ ·ÈÙÈÔÏÔÁ›· Ù˘ ÓfiÛÔ˘, ¤¯Ô˘Ó ‰È·Ù˘ˆı› Î·È ¿ÏϘ ıˆڛ˜ Û¯ÂÙÈο Ì ÙËÓ ·ÈÙÈÔÏÔÁ›·, fiˆ˜ Ë ‰˘ÛÔÓÙÔÁ¤ÓÂÛË, Ë ÂÎʇÏÈÛË ÙˆÓ Ì˘ÔηډȷÎÒÓ ÈÓÒÓ ÂÍ·ÈÙ›·˜ οÔÈÔ˘ ÌÂÙ·‚ÔÏÈÎÔ‡ ÓÔÛ‹Ì·ÙÔ˜, Ë ÊÏÂÁÌÔÓ‹ (ÌÂÙ¿ ·fi ÈÔÁÂÓ‹ Ì˘Ôηډ›Ùȉ·) Î·È Ë ·fiÙˆÛË ÙˆÓ Ì˘ÔηډȷÎÒÓ Î˘ÙÙ¿ÚˆÓ (69). ∆˘Èο ÂÌÊ·Ó›˙ÂÙ·È Û Ó·ÚÔ‡˜ ÂÓ‹ÏÈΘ ¿Ó‰Ú˜ Î·È Û ÔÛÔÛÙfi 80% Ë ‰È¿ÁÓˆÛË Á›ÓÂÙ·È ÚÈÓ ÙËÓ ËÏÈΛ· ÙˆÓ 40 ÂÙÒÓ (6,69). ∫ÏÈÓÈο ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Û˘ÁÎÔÙÈο ÂÂÈÛfi‰È·, ÎÔÈÏȷ΋ Ù·¯˘Î·Ú‰›· (Ì ÌÔÚÊÔÏÔÁ›· ·ÔÎÏÂÈÛÌÔ‡ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ÛΤÏÔ˘˜) Î·È Î·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ· ΢ڛˆ˜ ÛÙËÓ 4Ë Î·È 5Ë ‰ÂηÂÙ›· Ù˘ ˙ˆ‹˜. O Ì˯·ÓÈÛÌfi˜ ÙÔ˘ ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿-

ªË Û˘Ì·Á¤˜ Ì˘ÔοډÈÔ ∞Ó‹ÎÂÈ ÛÙȘ ·Ù·ÍÈÓfiÌËÙ˜ Ì˘ÔηډÈÔ¿ıÂȘ (1) Î·È ·ÔÙÂÏ› Ì›· Û¿ÓÈ· ‰È·Ù·Ú·¯‹ Ù˘ ·Ú¯ÈÙÂÎÙÔÓÈ΋˜ ÙÔ˘ Ì˘ÔηډȷÎÔ‡ ÙÔȯÒÌ·ÙÔ˜, Ì ÔÏÏ·Ϥ˜ ¢ÌÂÁ¤ıÂȘ ‰ÔÎȉÒÛÂȘ Î·È ‚·ıȤ˜ ÂÓÙÔ̤˜, ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÂÓ‰ÔÌ‹ÙÚÈ·˜ ·Ó·ÛÙÔÏ‹˜ Ù˘ Ì˘Ôηډȷ΋˜ ÌÔÚÊÔÁ¤ÓÂÛ˘, Ì ·Ô˘Û›· ÔÔÈ·Û‰‹ÔÙÂ Û˘Ó˘¿Ú¯Ô˘Û·˜ Û˘ÁÁÂÓÔ‡˜ ηډȷ΋˜ ·ÓˆÌ·Ï›·˜. πÛÙÔÏÔÁÈο ·Ú·ÙËÚÔ‡ÓÙ·È ÔÏÏ·Ϥ˜ ‰ÔÎȉÒÛÂȘ Î·È ‚·ıȤ˜ ÂÓÙÔ̤˜ ÌÂٷ͇ ÙÔ˘˜. ∆Ô ÂÓ‰Ôı‹ÏÈÔ Ô˘ ηχÙÂÈ ÙȘ ÂÓÙÔ̤˜ ·ÔÙÂÏ› Û˘Ó¤¯ÂÈ· ÙÔ˘ ÂÓ‰ÔıËÏ›Ô˘ ÙˆÓ ‰ÔÎȉÒÛÂˆÓ Î·È ÙÔ˘ ˘fiÏÔÈÔ˘ ÂÓ‰Ôηډ›Ô˘. ∆Ô Ì˘ÔοډÈÔ Î·È ÔÈ ‰ÔÎȉÒÛÂȘ ·Ú‰Â‡ÔÓÙ·È ·fi ÙÔ ÛÙÂÊ·ÓÈ·›Ô ‰›ÎÙ˘Ô, ÂÓÒ ÔÈ ÂÓÙÔ̤˜ ÏËÚÔ‡ÓÙ·È ·fi ÙÔ ·›Ì· Ù˘ ηډȷ΋˜ ÎÔÈÏfiÙËÙ·˜ (71,72). ∏ ÓfiÛÔ˜ ·ÚÔ˘ÛÈ¿˙ÂÈ ÔÈÎÔÁÂÓ‹ ¯·Ú·ÎÙ‹Ú·, Ì ÌÂÁ¿ÏË ÂÙÂÚÔÁ¤ÓÂÈ· ÛÙÔÓ ÙÚfiÔ ÌÂÙ·‚›‚·Û˘. ªÂÙ·ÏÏ¿ÍÂȘ ÛÙÔ ÁÔÓ›‰ÈÔ G4.5 ÛÙË ¯ÚˆÌ·ÙÔÛˆÌÈ΋ ÂÚÈÔ¯‹ Xq28 Ô˘ Έ‰ÈÎÔÔÈ› ÙËÓ ÚˆÙ½ÓË Ù·Ê·˙›ÓË, ¤¯ÂÈ ‚ÚÂı› fiÙÈ Û˘Ó‰˘¿˙ÔÓÙ·È Ì ÙÔ ÌË Û˘Ì·Á¤˜ Ì˘ÔοډÈÔ Î·È Ê·›ÓÂÙ·È fiÙÈ ·˘Ù‹ Ë ‰È·Ù·Ú·¯‹ Â›Ó·È ·ÏÏËÏfiÌÔÚÊË Ì ÙÔ Û‡Ó‰ÚÔÌÔ Barth Ô˘ ÎÏËÚÔÓÔÌÂ›Ù·È Ì ÙÔÓ Ê˘ÏÔÛ‡Ó‰ÂÙÔ ¯·Ú·ÎÙ‹Ú· (71,73). ∫ÏÈÓÈ΋ ÂÈÎfiÓ· ∂ÓÒ ÙÔ ÌË Û˘Ì·Á¤˜ Ì˘ÔοډÈÔ Â›Ó·È Ì›· ÓfiÛÔ˜ Ô˘ ˘¿Ú¯ÂÈ ·fi ÙË Á¤ÓÓËÛË, Ë ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Ô˘ ÚÔηÏ› ÌÔÚ› Ó· Á›ÓÂÈ ·ÚÁfiÙÂÚ· ÂÌÊ·Ó‹˜, ÛÙË ‚ÚÂÊÈ΋, ·È‰È΋ ‹ ÂÓ‹ÏÈÎË ˙ˆ‹. ∏ ÎÏÈÓÈ΋ ÔÚ›·

ª˘Ôηډȷډȷο ·›ÙÈ· π‰ÈÔ·ı‹˜ Ì˘ÔηډÈÔ¿ıÂÈ· OÈÎÔÁÂÓ‹˜ ÀÂÚÙÚÔÊÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· ™ÎÏËÚfi‰ÂÚÌ· 梉ÔÍ¿ÓıˆÌ· ¢È·‚ËÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· ¢ÈËıËÙÈΤ˜ ∞Ì˘ÏÔ›‰ˆÛË ™·ÚÎÔ›‰ˆÛË ¡. Gaucher ¡. Hurler §È҉˘ ‰È‹ıËÛË ¡fiÛÔÈ ÂÓ·Ôı¤Ûˆ˜ ∞ÈÌԯڈ̿وÛË ¡. Fabry °Ï˘ÎÔÁÔÓÈ¿ÛÂȘ ∂Ó‰ÔÌ˘Ôηډȷο ·›ÙÈ· ∂Ó‰ÔÌ˘Ôηډȷ΋ ›ÓˆÛË ÀÂÚˈÛÈÓÔÊÈÏÈÎfi Û‡Ó‰ÚÔÌÔ ªÂÙ·ÛÙ·ÙÈÎÔ› fiÁÎÔÈ ∞ÎÙÈÓÔ‚ÔÏ›· £ÂÚ·›· Ì ·Óıڷ΢ÎÏ›ÓË º¿Ú̷η (ÛÂÚÔÙÔÓ›ÓË, ÂÚÁÔÙ·Ì›ÓË)

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¶·È‰È·ÙÚÈ΋ 2003;66:405-417

¶›Ó·Î·˜ 7. ¢È·ÁÓˆÛÙÈο ÎÚÈÙ‹ÚÈ· Ù˘ ∞¢¢∫ ªÂ›˙ÔÓ· ÎÚÈÙ‹ÚÈ· 1. OÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ‰È·ÁÓˆṲ̂Ó˘ ∞¢¢∫ 2. ∫ÔÈÏȷο ÌÂÙ·‰ÈÂÁÂÚÙÈο ·̷ٷ (·̷ٷ ∂) ‹ ‰È‡ڢÓÛË ÙÔ˘ QRS (>110 ms) ÛÙȘ ··ÁˆÁ¤˜ V1-3 3. ™Ô‚·Ú‹ ÙÌËÌ·ÙÈ΋ ‰È¿Ù·ÛË Ù˘ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜ 4. ∆ÔÈο ·Ó¢ڇÛÌ·Ù· Ù˘ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜ 5. πÓÔÏÈ҉˘ ·ÓÙÈηٿÛÙ·ÛË ÙÔ˘ Ì˘Ôηډ›Ô˘ ÛÙË ‚ÈÔ„›· ∂Ï¿ÛÛÔÓ· ÎÚÈÙ‹ÚÈ· 1. OÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ (<35 ÂÙÒÓ) ·fi Èı·Ó‹ ∞¢¢∫ 2. OÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÎÏÈÓÈο ‰È·ÁÓˆṲ̂Ó˘ ∞¢¢∫ 3. ∞ÓÂÛÙÚ·Ì̤ӷ Â¿ÚÌ·Ù· ∆ ÛÙȘ ‰ÂÍȤ˜ ÚÔοډȘ ··ÁˆÁ¤˜ 4. ¶·ÚÔ˘Û›· ÌÂÙ·‰˘Ó·ÌÈÎÒÓ ÛÙÔ ∏∫° Û˘Ì„ËÊÈÛÌÔ‡ 5. ∞ÔÎÏÂÈÛÌfi˜ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ÛΤÏÔ˘˜ Î·È ÎÔÈÏȷ΋ Ù·¯˘Î·Ú‰›· 6. ◊È· ÙÌËÌ·ÙÈ΋ ‰È¿Ù·ÛË Ù˘ ¢∫ 7. ∆ÔÈΤ˜ ÂÚÈÔ¯¤˜ ˘ÔÎÈÓËÛ›·˜ Ù˘ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜ ∆ÚÔÔÔÈË̤ÓÔ ·fi J Am Coll Cardiol 2001;38:1777

Ù˘ ÓfiÛÔ˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÚÔԉ¢ÙÈο ÂȉÂÈÓÔ‡ÌÂÓË Û˘ÛÙÔÏÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Î·È ·˘ÍË̤ÓË ÓÔÛËÚfiÙËÙ· Î·È ıÓËÙfiÙËÙ·, ΢ڛˆ˜ ÛÙÔ˘˜ Û˘Ìو̷ÙÈÎÔ‡˜ ·ÛıÂÓ›˜. ∆· Û˘¯ÓfiÙÂÚ· Û˘ÌÙÒÌ·Ù· Â›Ó·È Ë Î·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ· (53%), ÔÈ ÎÔÈÏȷΤ˜ ·ÚÚ˘ı̛˜ (41%), Ù· Û˘ÛÙËÌ·ÙÈο ıÚÔÌ‚ÔÂÌ‚ÔÏÈο ÂÂÈÛfi‰È· (24%) Î·È Ù· Û˘ÁÎÔÙÈο ÂÂÈÛfi‰È· (18%). ™˘¯Ó¿ Û˘Ó‰˘¿˙ÂÙ·È Ì ‰˘ÛÌÔÚʛ˜ ÚÔÛÒÔ˘ ‹ ¿ÏϘ Â͈ηډȷΤ˜ ‰˘ÛÌÔÚʛ˜ (71). ¢È¿ÁÓˆÛË ∏ ‰È¿ÁÓˆÛË Ù›ıÂÙ·È Ì ÙÔ Ë¯ÔηډÈÔÁÚ¿ÊËÌ·, fiÔ˘ ·Ú·ÙËÚÔ‡ÓÙ·È Â·¯˘Ṳ̂ӷ ˘ÔÎÈÓËÙÈο ÙÌ‹Ì·Ù·, Ì ÔÏ˘¿ÚÈı̘ ‰ÔÎȉÒÛÂȘ Î·È ‚·ıȤ˜ ÂÓÙÔ̤˜ ÌÂٷ͇ ·˘ÙÒÓ (71). ™˘Ó‹ıË Â˘Ú‹Ì·Ù· ÛÙÔ ∏∫° ·ÔÙÂÏÔ‡Ó Ë ‰ÂÍÈ¿ ·fiÎÏÈÛË ÙÔ˘ ¿ÍÔÓ·, ·ÓˆÌ·Ï›Â˜ ÙÔ˘ ·̷ÙÔ˜ ƒ, ·ÙÂÏ‹˜ ‹ Ï‹Ú˘ ·ÔÎÏÂÈÛÌfi˜ ÙÔ˘ ‰ÂÍÈÔ‡ ÛΤÏÔ˘˜, ·ÔÎÏÂÈÛÌfi˜ ·ÚÈÛÙÂÚÔ‡ ÛΤÏÔ˘˜, ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ST-T ‰È·ÛÙ‹Ì·ÙÔ˜, ÂÈÎfiÓ· ÎÔÈÏȷ΋˜ ˘ÂÚÙÚÔÊ›·˜, ·ã ‚·ıÌÔ‡ ÎÔÏÔÎÔÈÏÈ·Îfi˜ ·ÔÎÏÂÈÛÌfi˜ ηÈ, Û¿ÓÈ·, WPW (71,72). ∏ ·ÎÙÈÓÔÁÚ·Ê›· ÌÔÚ› Ó· Â›Ó·È Ê˘ÛÈÔÏÔÁÈ΋ Û ·Û˘Ìو̷ÙÈÎÔ‡˜ ·ÛıÂÓ›˜, ÂÓÒ Ë ·ÚÔ˘Û›· ÌÂÁ·ÏÔηډ›·˜ ·Ó¢ڛÛÎÂÙ·È ÛÙÔ 85% ÙˆÓ ·ÛıÂÓÒÓ Ì ÌÂȈ̤ÓË Û˘ÛÙÔÏÈ΋ ÏÂÈÙÔ˘ÚÁ›· ‹ ÂÌÊ·Ó‹ Û˘ÌÙÒÌ·Ù·. ªÂ ÙÔÓ Î·Ú‰È·Îfi ηıÂÙËÚÈ·ÛÌfi ÂÎÙÈÌ¿Ù·È Ë ·ÈÌÔ‰˘Ó·ÌÈ΋ ηٿÛÙ·ÛË Ù˘ ηډȿ˜, Ë ÔÔ›· ÂÍ·ÚÙ¿Ù·È ·fi ÙÔ ÛÙ¿‰ÈÔ Ù˘ ÓfiÛÔ˘. ¢ËÏ·‰‹, ÛÙ· ·Ú¯Èο ÛÙ¿‰È· Ù˘ ÓfiÛÔ˘ Î·È Û ·Û˘Ìو̷ÙÈÎÔ‡˜ ·ÛıÂÓ›˜ ‰È·ÈÛÙÒÓÂÙ·È ÂÚÈÔÚÈÛÙÈ΋ Ê˘ÛÈÔÏÔÁ›·, ÂÓÒ ÛÙÔ˘˜ Û˘Ìو̷ÙÈÎÔ‡˜ ·ÛıÂÓ›˜ ·Ú·ÙËÚÔ‡ÓÙ·È ·ÈÌÔ‰˘Ó·ÌÈο ¯·Ú·ÎÙËÚÈÛÙÈο ·ÚfiÌÔÈ· Ì ·˘Ù¿ Ù˘ ‰È·Ù·ÙÈ΋˜ Ì˘ÔηډÈÔ¿ıÂÈ·˜. £ÂÚ·›· ∏ ıÂÚ·›· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘

Paediatriki 2003;66:405-417

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°ÂÓÂÙÈο ÙÚÔÔÔÈË̤ӷ ÙÚfiÊÈÌ·: Èı·Ó¤˜ ÂÈÙÒÛÂȘ ÛÙËÓ ·ÏÏÂÚÁÈÔÁÔÓÈÎfiÙËÙ· ∞. µ·ÛÈÏÔÔ‡ÏÔ˘, ¡. °. ¶··‰fiÔ˘ÏÔ˜, º. ™·ÍÒÓË - ¶··ÁˆÚÁ›Ô˘

Genetically modified food: potential effects on allergenicity E. Vassilopoulou, N. G. Papadopoulos, F. Saxoni - Papageorgiou

¶ÂÚ›ÏË„Ë: ŒÓ· ·fi Ù· ÌÂÁ·Ï‡ÙÂÚ· ‰ÈÏ‹ÌÌ·Ù· ÙÔ˘ Û‡Á¯ÚÔÓÔ˘ ÔÏÈÙÈÛÌÔ‡ Â›Ó·È ÙÔ ÛËÌÂ›Ô Ì¤¯ÚÈ ÙÔ ÔÔ›Ô Ú¤ÂÈ Ó· ÂȉÈÒÎÂÙ·È Ô ¤ÏÂÁ¯Ô˜ Ù˘ ʇÛ˘. ∆Ô ı¤Ì· ·˘Ùfi, ¤Ú· ·fi ÙÔÓ ÁÂÓÈÎfiÙÂÚÔ Û‚·ÛÌfi ÚÔ˜ ÙË Ê‡ÛË, ÂÚÈÏ·Ì‚¿ÓÂÈ Î·È ÙË Û¯¤ÛË Ì·˜ Ì ÙËÓ ›‰È· ÙËÓ ÙÚÔÊ‹ Ô˘ ηٷӷÏÒÓÔ˘ÌÂ. ∆· ÂÈÙ‡ÁÌ·Ù· ÛÙÔÓ ÙÔ̤· Ù˘ ‚ÈÔÙ¯ÓÔÏÔÁ›·˜ ·Ú¯Èο Î·È Ù˘ ÁÂÓÂÙÈ΋˜ Ì˯·ÓÈ΋˜ ÛÙË Û˘Ó¤¯ÂÈ·, ¤¯Ô˘Ó ʤÚÂÈ ÚÈ˙ÈΤ˜ ·ÏÏ·Á¤˜ ÛÙË ‰È·ÙÚÔÊ‹, ı¤ÙÔÓÙ·˜ Ù· ·ÎfiÏÔ˘ı· ÂÚˆÙ‹Ì·Ù·: Ú¤ÂÈ Ó· ηٷӷÏÒÓÔÓÙ·È ÁÂÓÂÙÈο ÙÚÔÔÔÈË̤ӷ ÙÚfiÊÈÌ·; À¿Ú¯ÂÈ Ë ‰˘Ó·ÙfiÙËÙ· ÂÓË̤ڈÛ˘ ÁÈ’ ·˘Ù¿ Ù· ÙÚfiÊÈÌ·; ¶ÔÈ· Ú¤ÂÈ Ó· Â›Ó·È Ë ÁÂÓÈÎfiÙÂÚË ı¤ÛË ÙÔ˘ È·ÙÚÈÎÔ‡ ÎfiÛÌÔ˘ Î·È Ò˜ ÌÔÚ› Ó· Û˘Ì‚Ô˘Ï‡ÂÈ ÙÔ˘˜ ·ÛıÂÓ›˜ Û¯ÂÙÈο Ì ·˘Ùfi ÙÔ ı¤Ì·; ™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ·Ó·ÛÎfiËÛ˘ Â›Ó·È Ë ÚÔÛ¿ıÂÈ· ÛÊ·ÈÚÈ΋˜ ÚÔÛ¤ÁÁÈÛ˘ ÙÔ˘ ı¤Ì·ÙÔ˜ ÙˆÓ ÁÂÓÂÙÈο ÙÚÔÔÔÈËÌ¤ÓˆÓ ÙÚÔʛ̈Ó, ÂÚÈÁÚ¿ÊÔÓÙ·˜ ηٿ ÙÔ ‰˘Ó·ÙfiÓ ÏËÚ¤ÛÙÂÚ· Ù· ÏÂÔÓÂÎÙ‹Ì·Ù· Î·È ÙȘ ·‰˘Ó·Ì›Â˜ ÙÔ˘˜. ∞ӷʤÚÔÓÙ·˜ ÙȘ ‰˘ÓËÙÈΤ˜ ÂÈÙÒÛÂȘ Ô˘ ÌÔÚ› Ó· ¤¯Ô˘Ó Ù¤ÙÔȘ ÙÚÔʤ˜ ÛÙËÓ ·ÏÏÂÚÁÈÔÁÔÓÈÎfiÙËÙ·, ÚÔÙ›ÓÔÓÙ·È, Â›Û˘, Èı·Ó¤˜ ÚÔÛÂÁÁ›ÛÂȘ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ·Ó·ÊÂÚfiÌÂÓˆÓ ·ÓËÛ˘¯ÈÒÓ Ô˘ ‰ËÌÈÔ˘ÚÁÔ‡Ó.

Abstract: One of the greatest dilemmas of our civilization is the extent to which control of nature should be attempted. This subject, apart from the aspect of a general respect for nature, also includes our relationship with the food we consume.

Achievements, first in biotechnology and subsequently in genetic engineering, have brought about radical changes in nutrition and are posing pressing questions: Should genetically modified food be consumed? Is there the possibility of obtaining information on what we eat? What should be the general attitude of the medical community and how can patients be informed on this subject?

The intent of this review is to approach the issue of genetically modified foods globally, describing their advantages and weaknesses. By analyzing the potential effects of these foods in terms of allergenicity, approaches to dealing with the concerns they create are suggested.

§¤ÍÂȘ ÎÏÂȉȿ: ·ÏÏÂÚÁ›·, ÙÚfiÊÈÌ·, ÁÂÓÂÙÈ΋ ÙÚÔÔÔ›ËÛË.

Key words: allergy, food, genetic modification.

∂ÈÛ·ÁˆÁ‹ ŒÓ· ·fi Ù· ‚·ÛÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ ·ÓıÚÒÔ˘ Â›Ó·È Ë Ù¿ÛË ÙÔ˘ Ó· ÂÂÌ‚·›ÓÂÈ ÛÙÔ ÂÚÈ‚¿ÏÏÔÓ Ì ÛÎÔfi Ó· ÙÔ ·ÏÏ¿ÍÂÈ. ™·Ó ·ÔÙ¤ÏÂÛÌ· Ù˘ ·ÌÊ›‰ÚÔÌ˘ Û¯¤Û˘ Î·È ·ÏÏËÏÂ›‰Ú·Û˘ ·Ó¿ÌÂÛ· ÛÙÔ ·ÓıÚÒÈÓÔ Â›‰Ô˜ Î·È ÙÔ ÂÚÈ‚¿ÏÏÔÓ, οı ÌÂÙ·‚ÔÏ‹ Ù˘ Ì›·˜ ·Ú·Ì¤ÙÚÔ˘ ÂËÚ¿˙ÂÈ ¿ÌÂÛ· Î·È ÙËÓ ¿ÏÏË. ªÂ ·˘ÙfiÓ ÙÔÓ ÙÚfiÔ, Ë ÂͤÏÈÍË ÙÔ˘ ·ÓıÚÒ-

ÈÓÔ˘ ›‰Ô˘˜ ÂÍ·ÚÙ¿Ù·È ÙfiÛÔ ·fi ÙË Ê˘ÛÈ΋ ÔÚ›· fiÛÔ Î·È ·fi ÙËÓ Ù¯ÓÔÏÔÁÈ΋ ÚfiÔ‰Ô. µÚÈÛÎfiÌ·ÛÙ ÛÙÔ Ì¤ÛÔ Ì›·˜ ÈÛÙÔÚÈ΋˜ ÌÂÙ¿‚·Û˘ ÚÔ˜ ÙË ‚ÈÔÙ¯ÓÔÏÔÁÈ΋ ÂÔ¯‹. ∏ Û‡Á¯ÚÔÓË Ù¯ÓÔÏÔÁÈ΋ Â·Ó¿ÛÙ·ÛË ¤¯ÂÈ ÙÚÂȘ ΢ڛˆ˜ ·ÎÚÔÁˆÓÈ·›Ô˘˜ Ï›ıÔ˘˜: ÙËÓ ÏËÚÔÊÔÚÈ΋, ÙË Ó·ÓÔÙ¯ÓÔÏÔÁ›· Î·È ÙË ÁÂÓÂÙÈ΋ Ì˯·ÓÈ΋. ∆· ̤۷ ·˘Ù¿ ÌÔÚÔ‡Ó Ó· ·ÏÏ¿ÍÔ˘Ó ÙÔÓ ÎfiÛÌÔ Û ÙÂÚ¿ÛÙÈÔ ‚·ıÌfi,

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

Department of Allergology, 2nd Paediatric Clinic of the University of Athens “P. & A. Kyriakou” Children’s Hospital, Athens

418

¶·È‰È·ÙÚÈ΋ 2003;66:418-425

Paediatriki 2003;66:418-425

Ì ·ÔÙ¤ÏÂÛÌ· Ó· ·Ó·Ì¤ÓÂÙ·È ÚÈ˙È΋ Î·È Ë ·ÏÏ·Á‹ ÛÙÔ ·ÓıÚÒÈÓÔ Â›‰Ô˜ (1). ∏ ÈηÓfiÙËÙ· ÙÔ˘ ·ÓıÚÒÔ˘ Ó· ÂÂÌ‚·›ÓÂÈ ÛÙËÓ ÔÚ›· ÂͤÏÈ͢ ÙˆÓ ÂȉÒÓ Î·È Ó· ‰ËÌÈÔ˘ÚÁ› ÙË ‰È΋ ÙÔ˘ “¡¤· °¤ÓÂÛË”, ÂÚÈÔÚÈ˙fiÙ·Ó Ì¤¯ÚÈ ÚfiÛÊ·Ù· ·fi Ù· fiÚÈ· Ô˘ ¤ıÂÙÂ Ë ÌÔÓ·‰ÈÎfiÙËÙ· Î·È Ë ‰È·ÊÔÚÂÙÈÎfiÙËÙ· ÙˆÓ ÂȉÒÓ. OÈ Ó¤Â˜, fï˜, Ù¯ÓÔÏÔÁ›Â˜ ÂÈÙÚ¤Ô˘Ó ÛÙÔ˘˜ ÂÈÛÙ‹ÌÔÓ˜ Ó· ¯ÂÈÚÈÛÙÔ‡Ó ÙÔÓ Ê˘ÛÈÎfi ÎfiÛÌÔ ÛÙÔ Â›Â‰Ô Ô˘ ·ÔÙÂÏ› ÙË ‚¿ÛË Ù˘ ÂͤÏÈ͢: ÙÔ ÁÔÓȉȷÎfi (2). ∏ ÁÂÓÂÙÈ΋ Ì˯·ÓÈ΋ Â›Ó·È Ë ‰È·‰Èηۛ· ηٿ ÙËÓ ÔÔ›· Ù· ÁÔÓ›‰È· ·ÔÌÔÓÒÓÔÓÙ·È, ·Ó·ÁÓˆÚ›˙ÔÓÙ·È, ·Ó·Û˘Ó‰˘¿˙ÔÓÙ·È Î·È ÌÂٷʤÚÔÓÙ·È Ù¯ÓÔÏÔÁÈο ·fi ¤Ó·Ó ÔÚÁ·ÓÈÛÌfi Û ¤Ó·Ó ¿ÏÏÔ. ™‹ÌÂÚ·, Ô ÁÂÓÂÙÈÎfi˜ ÎÒ‰Èη˜ ÂÓfi˜ ÌÂÁ¿ÏÔ˘ ·ÚÈıÌÔ‡ ÂȉÒÓ ¤¯ÂÈ ·ÔÎÚ˘ÙÔÁÚ·ÊËı›. ∏ ÁÂÓÂÙÈ΋ Ì˯·ÓÈ΋ οÓÂÈ ‰˘Ó·Ù‹ ÙËÓ ·ÓÙ·ÏÏ·Á‹ ÁÂÓÂÙÈÎÔ‡ ˘ÏÈÎÔ‡ ÌÂٷ͇ ÔÚÁ·ÓÈÛÌÒÓ Ô˘ ‰ÂÓ ı· ÌÔÚÔ‡Û·Ó Ó· ·Ó··Ú·¯ıÔ‡Ó ÌÂٷ͇ ÙÔ˘˜ Ì ¿ÏÏÔ ÙÚfiÔ. ∆· ÙÂÏÂ˘Ù·›· 20 ¯ÚfiÓÈ· ·ÔÌÔÓÒÓÔÓÙ·È ÁÔÓ›‰È· ·fi οÔÈÔÓ ˙ˆÓÙ·Ófi ÔÚÁ·ÓÈÛÌfi Î·È ÂÈÛ¿ÁÔÓÙ·È Û ¿ÏÏÔÓ Ì ٤ÙÔÈÔ ÙÚfiÔ ÒÛÙ ӷ Â›Ó·È ÏÂÈÙÔ˘ÚÁÈο, Û¿˙ÔÓÙ·˜ ¤ÙÛÈ ÙÔÓ ÊÚ·ÁÌfi ·ÓÙ·ÏÏ·Á‹˜ ÁÂÓÂÙÈÎÔ‡ ˘ÏÈÎÔ‡ ÌÂٷ͇ ‰È·ÊÔÚÂÙÈÎÒÓ ÂȉÒÓ (3). ∂Ô̤ӈ˜, ÚÔ·ÙÔ˘Ó ÔÚÁ·ÓÈÛÌÔ› Ô˘, ÂÎÙfi˜ ·fi ÙȘ ‰ÈΤ˜ ÙÔ˘˜ ÚˆÙ½Ó˜, ÂÎÊÚ¿˙Ô˘Ó Î·È ÂΛӘ ÙÔ˘ ÁÔÓȉ›Ô˘ Ô˘ ÂÈÛ‹¯ıË. ªÂ ÙÔÓ ÙÚfiÔ ·˘Ùfi, ÌÔÚԇ̠ӷ ηٷÓÔ‹ÛÔ˘Ì ÙË ‰Ú¿ÛË ‰È·ÊfiÚˆÓ ÁÔÓȉ›ˆÓ Û ÂÚ¢ÓËÙÈÎfi Â›‰Ô, ÂÈÛ¿ÁÔÓÙ·˜ ‹ ·Ê·ÈÚÒÓÙ·˜ ·˘Ù¿ Û ÂÈÚ·Ì·Ùfi˙ˆ·. ∆Ô Â‡ÚÔ˜ ÙˆÓ Ê·Ú̷΢ÙÈÎÒÓ ÂÊ·ÚÌÔÁÒÓ Â›Ó·È ÌÂÁ¿ÏÔ, ·ÊÔ‡ ÔÏÏ¿ Ê¿Ú̷η ‹ ÂÌ‚fiÏÈ·, Ù· ·ÔηÏÔ‡ÌÂÓ· ·Ó·Û˘Ó‰˘·Ṳ̂ӷ, ÚÔ¤Ú¯ÔÓÙ·È ·fi ÁÂÓÂÙÈ΋ ÙÚÔÔÔ›ËÛË ‚·ÎÙËÚ›ˆÓ, ÒÛÙ ӷ ·Ú¿ÁÔ˘Ó Ô˘Û›Â˜ ÁÈ· ·ÓıÚÒÈÓË ¯Ú‹ÛË, fiˆ˜ ÈÓÙÂÚÊÂÚfiÓË, ÈÓÛÔ˘Ï›ÓË ‹ ·˘ÍËÙÈ΋ ÔÚÌfiÓË (3). ¶ÈÔ ¿ÌÂÛ˜ ıÂÚ·¢ÙÈΤ˜ ÂÊ·ÚÌÔÁ¤˜ ‚Ú›ÛÎÔ-

ÓÙ·È Û ÂͤÏÈÍË, ¤ÙÔÈ̘ Ó· ‰ÒÛÔ˘Ó Ï‡ÛÂȘ Û ÚÔ‚Ï‹Ì·Ù· Ô˘ ÂϤÁ¯ÔÓÙ·È ÁÔÓȉȷο ̤ۈ Ù˘ ÁÂÓÂÙÈ΋˜ ıÂÚ·›·˜. ∆Ô 1984 ·Ó·Ê¤ÚıËΠÁÈ· ÚÒÙË ÊÔÚ¿ Ë ¿ÌÂÛË Î·È ÛÙ·ıÂÚ‹ ÌÂÙ·ÊÔÚ¿ ÁÔÓȉ›ˆÓ ÛÂ Ê˘Ù¿ (4,5). ∆ËÓ ÙÂÏÂ˘Ù·›· ‰ÂηÂÙ›· Ë ·Ó¿Ù˘ÍË ‹Ù·Ó Ú·Á‰·›·, fiÙ·Ó ÔÏϤ˜ ÂÙ·ÈÚ›˜, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÙË ÁÂÓÂÙÈ΋ Ì˯·ÓÈ΋, ηٿÊÂÚ·Ó Ó· ÂÈÛ·Á¿ÁÔ˘Ó Í¤Ó· ÁÔÓ›‰È· Û ηÏÏȤÚÁÂȘ ÛËÌ·ÓÙÈÎÒÓ ÙÚÔʛ̈Ó, fiˆ˜ ÙÔ Î·Ï·ÌfiÎÈ Î·È Ë ÛfiÁÈ· (6). ¶ÚfiÛÊ·Ù·, ÁÂÓÂÙÈο ÙÚÔÔÔÈË̤ӷ ÙÚfiÊÈÌ· ¿Ú¯ÈÛ·Ó Ó· ÂÌÊ·Ó›˙ÔÓÙ·È Û ÔÏÏ¿ ›‰Ë ¢Ú›·˜ ηٷӿψÛ˘, ·ÔÙÂÏÒÓÙ·˜ ϤÔÓ Ì›· Ú·ÁÌ·ÙÈÎfiÙËÙ· Ô˘ ··Û¯ÔÏ› fi¯È ÌfiÓÔ ÙÔ˘˜ ÂÈÛÙ‹ÌÔÓ˜, ·ÏÏ¿ Î·È ÙÔ˘˜ ηٷӷψ٤˜. °ÂÓÂÙÈο ÙÚÔÔÔÈË̤ӷ ÙÚfiÊÈÌ· O fiÚÔ˜ “ÁÂÓÂÙÈο ÙÚÔÔÔÈË̤ӷ ÙÚfiÊÈÌ·” (°∆∆) ·Ó·Ê¤ÚÂÙ·È Û ÙÚfiÊÈÌ· Ô˘ ·Ú·Û΢¿ÛÙËÎ·Ó Ì ÙË ¯Ú‹ÛË ÙˆÓ Ì¤ÛˆÓ Ô˘ ·Ú¤¯ÂÈ Ë ÌÔÚȷ΋ ‚ÈÔÏÔÁ›·, ÁÈ· ÙËÓ Î·Ù·Ó¿ÏˆÛ‹ ÙÔ˘˜ ·fi ·ÓıÚÒÔ˘˜ ‹ ˙Ò·. ¶ÚfiÎÂÈÙ·È ÁÈ· ηÏÏȤÚÁÂȘ Ô˘ ÙÚÔÔÔÈ‹ıËÎ·Ó ÛÙÔ ÂÚÁ·ÛÙ‹ÚÈÔ, Ì ÛÎÔfi Ó· ·Ô‰ÔıÔ‡Ó Û ·˘Ù¤˜ οÔȘ ÂÈı˘ÌËÙ¤˜ ȉÈfiÙËÙ˜, fiˆ˜ ·˘ÍË̤ÓË ıÚÂÙÈ΋ ·Í›· ‹ ·ÓıÂÎÙÈÎfiÙËÙ· Û ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜ (¶›Ó·Î·˜ 1). ∏ ‰È·Ù‹ÚËÛË ÙˆÓ ÂÈı˘ÌËÙÒÓ È‰ÈÔÙ‹ÙˆÓ ·Ú·‰ÔÛȷο ÁÈÓfiÙ·Ó ·fi ÁÂÓÈ¿ Û ÁÂÓÈ¿ ̤ۈ Ù˘ ·Ó··Ú·ÁˆÁ‹˜, Ì›· ‰È·‰Èηۛ· Ô˘ ‰ÂÓ ÌÔÚÔ‡ÛÂ, fï˜, Ó· ÂÁÁ˘Ëı› ÙËÓ ·ÎÚ›‚ÂÈ· Ù˘ ÌÂÙ·‚›‚·Û‹˜ ÙÔ˘˜, ÂÓÒ Ù·˘Ùfi¯ÚÔÓ· ‹Ù·Ó ȉȷ›ÙÂÚ· ¯ÚÔÓÔ‚fiÚ·. ªÂ ÙË ÁÂÓÂÙÈ΋ Ì˯·ÓÈ΋ ÌÔÚÔ‡Ó ‰˘ÓËÙÈο Ó· ·Ú·Û΢·ÛÙÔ‡Ó ÚÔ˚fiÓÙ· ÌÂ Û˘ÁÎÂÎÚÈ̤Ó˜ ȉÈfiÙËÙ˜, ÁÚ‹ÁÔÚ· Î·È Ì ÂÍ·ÈÚÂÙÈ΋ ·ÎÚ›‚ÂÈ·. °È· ·Ú¿‰ÂÈÁÌ·, ¤Ó· ÁÔÓ›‰ÈÔ ˘‡ı˘ÓÔ ÁÈ· ÙËÓ ·ÓÔ¯‹ ÂÓfi˜ Ê˘ÙÔ‡ ÛÙËÓ ÍËÚ·Û›· ÌÔÚ› Ó· ÂÈÛ·¯ı› ÛÂ Ê˘Ùfi ‰È·ÊÔÚÂÙÈÎÔ‡ ›‰Ô˘˜, ¤ÙÛÈ

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∆ÚÔÔÔÈË̤ÓÔ Cry3Bb1, NptII ¶ÚˆÙ½ÓË Cry1F, ƒ∞∆

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∫·Ï·ÌfiÎÈ

5-EPSPS

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ƒ∞∆

ƒ‡˙È

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Bacillus thuringiensis, Escherichia coli transposon, Tn5 Bacillus thuringiensis, Streptomyces viridochromogenes Agrobacterium sp, ¿Ï˘ÛÔ˜ CP4 Bacillus amyloliquefaciens, streptomyces hygroscopicus Streptomyces hygroscopicus

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S-·‰ÂÓÔÛ˘ÏÌÂıÈÔÓ›ÓË ˘‰ÚÔÏ¿ÛË

E. coli bacteriophage T3

∞ÓÔ¯‹ ÛÙÔ ÁÏ˘ÎÔ˙˘ÏȈ̤ÓÔ ¯ÔÚÙ·Ú›‰ÈÔ ™ÙÂÈÚfiÙËÙ· ·Ó‰Úfi˜ ∞ÓÔ¯‹ ÛÙÔ Herbicide glufosinate ∫·ı˘ÛÙ¤ÚËÛË Ù˘ ·ÔÛ‡ÓıÂÛ˘ ÙÔ˘ ÊÚÔ‡ÙÔ˘ ÏfiÁˆ Ì›ˆÛ˘ Ù˘ Û‡ÓıÂÛ˘ ·Èı˘ÏÂÓ›Ô˘

1507

¡∫603 MS6 LLRICE E06, LLRICE E62 ∞ Î·È µ

419

¶·È‰È·ÙÚÈ΋ 2003;66:418-425

ÒÛÙ ӷ ÌÔÚ› ·˘Ùfi Ó· ηÏÏÈÂÚÁËı› ÛÂ Û˘Óı‹Î˜ ÂÚ‹ÌÔ˘ (7). ∆· °∆∆ ÌÔÚÔ‡Ó Ó· Ù·ÍÈÓÔÌËıÔ‡Ó Û ÙÚÂȘ ηÙËÁÔڛ˜, Ì ‚¿ÛË Ù· ›‰Ë ÌÂٷ͇ ÙˆÓ ÔÔ›ˆÓ Á›ÓÂÙ·È Ë ÌÂÙ·‚›‚·ÛË ÁÔÓȉ›ˆÓ: ·) “¢Ú›·” ÌÂÙ·‚›‚·ÛË ÁÔÓȉ›ˆÓ, ·Ó·ÊÂÚfiÌÂÓË ÛÙË ÌÂÙ·ÊÔÚ¿ ÁÔÓȉ›ˆÓ ÌÂٷ͇ ÔÚÁ·ÓÈÛÌÒÓ ‰È·ÊÔÚÂÙÈÎÒÓ ‚·ÛÈÏ›ˆÓ, ‚) “ÂÚÈÔÚÈṲ̂ÓË” ÌÂÙ·‚›‚·ÛË ÁÔÓȉ›ˆÓ, fiÙ·Ó ·ÊÔÚ¿ ÛÙË ÌÂÙ·ÊÔÚ¿ ÁÔÓȉ›ˆÓ ÌÂٷ͇ ÔÚÁ·ÓÈÛÌÒÓ ÙÔ˘ ›‰ÈÔ˘ ‚·ÛÈÏ›Ԣ Î·È Á) “Û˘ÛÙÚÔÊ‹” (tweaking), fiÙ·Ó Á›ÓÂÙ·È ·Ó·ÊÔÚ¿ ÛÙÔ˘˜ ¯ÂÈÚÈÛÌÔ‡˜ Ô˘ Á›ÓÔÓÙ·È Ì ÛÎÔfi ÙËÓ ·‡ÍËÛË Ù˘ ¤ÎÊÚ·Û˘ ÁÔÓȉ›ˆÓ ÙÔ˘ ›‰ÈÔ˘ ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ (8).

OʤÏË Î·È ÚÔÛ‰Ô˘ ·fi Ù· ÁÂÓÂÙÈο ÙÚÔÔÔÈË̤ӷ ÙÚfiÊÈÌ· ∏ ÂÍ·ÛÊ¿ÏÈÛË Â·ÚÎÒÓ ÔÛÔÙ‹ÙˆÓ ÙÚÔÊ›ÌˆÓ ÚfiÎÂÈÙ·È Ó· ·ÔÙÂϤÛÂÈ ÛËÌ·ÓÙÈ΋ ÚfiÎÏËÛË Ù· ¯ÚfiÓÈ· Ô˘ ·ÎÔÏÔ˘ıÔ‡Ó, ÂÓÒ Ù· °∆∆ ·Ó·Ì¤ÓÂÙ·È Ó· ¤¯Ô˘Ó ‚·ÛÈÎfi ÚfiÏÔ Ì ÔÈΛÏÔ˘˜ ÙÚfiÔ˘˜. ∞Ú¯Èο ·Ó·Ì¤ÓÂÙ·È Ó· ÚÔÛ‰ÒÛÔ˘Ó ÛËÌ·ÓÙÈο ÔÈÎÔÓÔÌÈο ÔʤÏË, Û·Ó ·ÔÙ¤ÏÂÛÌ· Ù˘ ·Ó¿Ù˘Í˘ Ó¤ˆÓ ÔÈÎÈÏÈÒÓ Ê˘ÙÒÓ Î·È ˙ÒˆÓ (9). ∏ Û‡Á¯ÚÔÓË ÔÈÎÔÓÔÌ›· ··ÈÙ› ‰È·Ú΋ ·Ó·˙‹ÙËÛË Ó¤ˆÓ ·ÁÔÚÒÓ Ô˘ ı· ·Ó·Ù‡ÛÛÔÓÙ·È Ì ¯·ÌËÏfiÙÂÚÔ ÎfiÛÙÔ˜ ·Ú·ÁˆÁ‹˜, ÒÛÙÂ Î·È Ù· Î¤Ú‰Ë Ó· ·˘Í¿ÓÔ˘Ó. ŒÓ·˜ Ôχ ÛËÌ·ÓÙÈÎfi˜ ·ÎfiÌ· ÏfiÁÔ˜, Ì ¿ÌÂÛË Û¯¤ÛË Ì ÙÔÓ ÚÔ·Ó·ÊÂÚfiÌÂÓÔ, Â›Ó·È Ô ˘ÔÛÈÙÈÛÌfi˜ ÙÔ˘ ÏÂÁfiÌÂÓÔ˘ “ÙÚ›ÙÔ˘ ÎfiÛÌÔ˘”, fiÔ˘ ÂηÙÔÌ̇ÚÈ· ¿ÓıÚˆÔÈ ÛÙËÚ›˙Ô˘Ó ÙË ‰È·ÙÚÔÊ‹ ÙÔ˘˜ ÛÙËÓ Î·ÏÏȤÚÁÂÈ· ÂÓfi˜ ÌfiÓÔ Î·ÚÔ‡, ÙÔ˘ Ú˘˙ÈÔ‡, ÙÔ ÔÔ›Ô ‰ÂÓ Â·ÚΛ ÁÈ· Ó· ηχ„ÂÈ ÙȘ ·Ó¿ÁΘ Û ıÚÂÙÈο Û˘ÛÙ·ÙÈο, ÒÛÙ ӷ ·ÔÙÚ·› Ë ˘ÔıÚ„›·. ªÂ ÙË ‚Ô‹ıÂÈ· Ù˘ ÁÂÓÂÙÈ΋˜ Ì˯·ÓÈ΋˜ ÙÔ Ú‡˙È ÌÔÚ› Ó· ÂÌÏÔ˘ÙÈÛÙ› Û ‚Èٷ̛Ә Î·È ÌÂÙ·ÏÏÈο ÛÙÔȯ›·, ÒÛÙ ӷ ·ÔÊ¢¯ıÔ‡Ó ‰È·ÙÚÔÊÈΤ˜ ÂÏÏ›„ÂȘ. °È· ÙÔÓ ÛÎÔfi ·˘Ùfi ¤ÁÈÓ ̛· ÚÒÙË ÚÔÛ¿ıÂÈ· Ì ÙÔ “Golden rice”, Ì›· ÔÈÎÈÏ›· Ú˘˙ÈÔ‡ Ô˘ ÙÚÔÔÔÈ‹ıËΠ·fi ∂Ï‚ÂÙÔ‡˜ ÁÂÓÂÙÈÛÙ¤˜ Ì ٤ÙÔÈÔ ÙÚfiÔ ÒÛÙ ӷ ÂÚȤ¯ÂÈ ÂÍ·ÈÚÂÙÈο ÌÂÁ¿Ï˜ ÔÛfiÙËÙ˜ ‚ÈÙ·Ì›Ó˘ ∞ (10). ∏ ·ÓÂ¿ÚÎÂÈ· ‚ÈÙ·Ì›Ó˘ ∞, Ì ٷ ÁÓˆÛÙ¿ ÎÏÈÓÈο Â·ÎfiÏÔ˘ı· (11), Ì·ÛÙ›˙ÂÈ ¿Óˆ ·fi 3.000.000 ·È‰È¿, ΢ڛˆ˜ ÛÙȘ ˘Ô·Ó¿Ù˘ÎÙ˜ ¯ÒÚ˜. ∏ ÚÔÛ¿ıÂÈ· ·˘Ù‹, Ô˘ ·¤Ù˘¯Â ÏfiÁˆ Ì›·˜ ÛÂÈÚ¿˜ Ù¯ÓÈÎÒÓ Î·È ÎÔÈÓˆÓÈÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ (12), ¿ÓÔÈÍ ÙÔ ‰ÚfiÌÔ ÁÈ· ÙËÓ ·Ú·ÁˆÁ‹ ÙÚÔÊ›ÌˆÓ Ô˘ ı· ÌÔÚÔ‡Û·Ó Ó· ηχ„Ô˘Ó Û ÌÂÁ¿ÏÔ ‚·ıÌfi ÙȘ ‰È·ÙÚÔÊÈΤ˜ ÂÏÏ›„ÂȘ ÌË-ÚÔÓÔÌÈÔ‡¯ˆÓ ÎÔÈÓˆÓÈÒÓ. ™Â ¤Ó· ¿ÏÏÔ Â›‰Ô, Ô˘ ·ÊÔÚ¿ ÛÙËÓ Î·ÏÏȤÚÁÂÈ· ÚÔ˚fiÓÙˆÓ Â˘Ú›·˜ ηٷӿψÛ˘, οÔÈ· °∆∆ ÌÔÚÔ‡Ó Ó· ʤÚÔ˘Ó Û˘ÁÎÂÎÚÈ̤ӷ ¯·Ú·ÎÙËÚÈÛÙÈο, fiˆ˜ Ù·¯‡ÙÂÚË ·‡ÍËÛË Î·È ÌÂÁ·Ï‡ÙÂÚÔ Ì¤ÁÂıÔ˜ ÙÂÏÈÎÔ‡ ÚÔ˚fiÓÙÔ˜, ÛÙÔ Ï·›ÛÈÔ Ù˘ ·Ó·˙‹ÙËÛ˘ ‰È·ÊfiÚˆÓ ÙÚfiˆÓ ·fi ÙÔ˘˜ ηÏÏÈÂÚÁËÙ¤˜, ÒÛÙ ٷ Ê˘Ù¿

420

Paediatriki 2003;66:418-425

ÙÔ˘˜ Ó· Â›Ó·È ÈÔ ·ÓıÂÎÙÈο, ˘ÁÈ‹ Î·È ·Ô‰ÔÙÈο (13). ∂ÈϤÔÓ, ÔÈ Î·Ù·Ó·ÏˆÙ¤˜ ·ÓÙȉÚÔ‡Ó ÛÙËÓ Î·Ù·Ó¿ÏˆÛË ÙÚÔÊ›ÌˆÓ Ô˘ ¤¯Ô˘Ó ‰Â¯ı› ÙËÓ Â›‰Ú·ÛË ¯ËÌÈÎÒÓ ·Ú·ÛÈÙÔÎÙfiÓˆÓ, ÂÍ·ÈÙ›·˜ ÙˆÓ Èı·ÓÒÓ ‚Ï·‚ÂÚÒÓ ÙÔ˘˜ ÂȉڿÛÂˆÓ ÛÙËÓ ˘Á›·, ·ÏÏ¿ Î·È ÛÙÔ ÂÚÈ‚¿ÏÏÔÓ. OÚÈṲ̂ӷ °∆∆, fiˆ˜ ÙÔ Bacillus thuringiensis (B.t.) ηϷÌfiÎÈ, ‚ÔËıÔ‡Ó ÛÙË Ì›ˆÛË Ù˘ ¯Ú‹Û˘ ¯ËÌÈÎÒÓ Î·È ÙÔ˘ ÎfiÛÙÔ˘˜ ·Ú·ÁˆÁ‹˜ ÙˆÓ ÚÔ˚fiÓÙˆÓ Ô˘ ÊÙ¿ÓÔ˘Ó ÛÙ· ηٷÛÙ‹Ì·Ù· ÙÚÔÊ›ÌˆÓ (14). ™ËÌ·ÓÙÈΤ˜ ÚÔÛ¿ıÂȘ ¤¯Ô˘Ó Á›ÓÂÈ ÛÙÔ ¯ÒÚÔ ÙˆÓ °∆∆, ÒÛÙ ӷ ÙÔ˘˜ ·Ô‰ÔıÔ‡Ó Ê·Ú̷΢ÙÈΤ˜ ȉÈfiÙËÙ˜. ∫¿ÔÈ· ÂÌ‚fiÏÈ· Î·È Ê¿Ú̷η ÎÔÛÙ›˙Ô˘Ó ·ÚÎÂÙ¿ ÁÈ· Ó· ·Ú·¯ıÔ‡Ó Î·È ··ÈÙÔ‡Ó ÂȉÈΤ˜ Û˘Óı‹Î˜ ÁÈ· Ó· Û˘ÓÙËÚËıÔ‡Ó ÛˆÛÙ¿, ηٷÛÙ¿ÛÂȘ Ô˘ ‰ÂÓ Â›Ó·È ¿ÓÙ· ÂÊÈÎÙ¤˜. ŒÙÛÈ ¤¯ÂÈ ·Ú·¯ı› ÁÂÓÂÙÈο ÙÚÔÔÔÈË̤ÓÔ Ú‡˙È Ô˘ ÂÚȤ¯ÂÈ Ê¿ÚÌ·ÎÔ ÁÈ· ÙËÓ Î˘ÛÙÈ΋ ›ÓˆÛË. ∏ Ê·Ú̷΢ÙÈ΋-ıÂÚ·¢ÙÈ΋ ‰È¿ÛÙ·ÛË ÙˆÓ °∆∆ ‹Ù·Ó Ë ·ÊÔÚÌ‹ ÁÈ· ÙËÓ ÂÈÛ·ÁˆÁ‹ ·ÓıÚÒÈÓˆÓ ÁÔÓȉ›ˆÓ Û ÙÚfiÊÈÌ· (15). ŒÙÛÈ, η٤ÛÙË ‰˘Ó·Ùfi Ó· ·Ú¿ÁÂÙ·È Û˘Ó¯Ҙ ·ÓıÚÒÈÓË ·Ï‚Ô˘Ì›ÓË ·fi Ê˘Ù›˜ ÁÂÓÂÙÈο ÙÚÔÔÔÈË̤ÓÔ˘ ηԢÙÛԇΠ(16). ¢ÈÂÓÂÚÁÔ‡ÓÙ·È, Â›Û˘, ·ÚÎÂÙ¤˜ ÌÂϤÙ˜ ÁÈ· ÙËÓ ·Ú·ÁˆÁ‹ ‚ÚÒÛÈÌˆÓ ÂÌ‚ÔÏ›ˆÓ Û ÓÙÔÌ¿Ù˜ Î·È ·Ù¿Ù˜ (7) Î·È ÂÚ¢ÓÒÓÙ·È ÚˆÙÔÔÚȷΤ˜ ̤ıÔ‰ÔÈ ÌÂÙ·ÊÔÚ¿˜ ·ÓÙÈÁfiÓˆÓ ÈÒÓ ‹ Ú˘ıÌÈÛÙÒÓ ÙÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡ ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ °∆∆ (17). Œ¯Ô˘Ó, Ù¤ÏÔ˜, “ۯ‰ȷÛÙ›” Ì·Ó¿Ó˜ Ô˘ ÂÚȤ¯Ô˘Ó ÙÔ ÂÌ‚fiÏÈÔ Ù˘ ¯ÔϤڷ˜ ‹/Î·È Ù˘ Ë·Ù›Ùȉ·˜ µ. ª›· ‰˘ÓËÙÈ΋ ÂÊ·ÚÌÔÁ‹ Ù˘ ÁÂÓÂÙÈ΋˜ Ì˯·ÓÈ΋˜ Ô˘ ·ÊÔÚ¿ ȉȷ›ÙÂÚ· ÛÙËÓ ·ÏÏÂÚÁÈÔÏÔÁ›·, ·ÔÙÂÏ› Ë ‰˘Ó·ÙfiÙËÙ· Ì›ˆÛ˘ ÙˆÓ ÂȉÈÎÒÓ ·ÏÏÂÚÁÈÔÁÔÓÈÎÒÓ ÚˆÙÂ˚ÓÒÓ ÛÙ· ÙÚfiÊÈÌ·. ∞˘Ùfi ÌÔÚ› Ó· ÂÈÙ¢¯ı› Ì ÙËÓ Î·Ù·ÛÙÔÏ‹ Ù˘ ÁÔÓȉȷ΋˜ ¤ÎÊÚ·Û˘ ̤ۈ Ù˘ ·ÓÙÈÓÔËÌ·ÙÈ΋˜ Ù¯ÓÔÏÔÁ›·˜ (antisense-RNA). ™‡Ìʈӷ Ì ·˘Ù‹ ÙË Ì¤ıÔ‰Ô, ÂÈÛ¿ÁÂÙ·È ¤Ó· ÁÔÓ›‰ÈÔ, ÙÔ mRNA ÙÔ˘ ÔÔ›Ô˘ Â›Ó·È Û˘ÌÏËڈ̷ÙÈÎfi Ì ÙÔ mRNA ÙÔ˘ ÁÔÓȉ›Ô˘ ÙÔ˘ ÔÔ›Ô˘ Ë ¤ÎÊÚ·ÛË ÚfiÎÂÈÙ·È Ó· ηٷÛÙ·Ï›. ŒÙÛÈ, ÙÔ mRNA ÙÔ˘ ÂÈÛ·ÁfiÌÂÓÔ˘ ÁÔÓȉ›Ô˘ ˘‚ÚȉÔÔÈÂ›Ù·È Ì ÙÔ mRNA ÙÔ˘ ÂÓ‰ÔÁÂÓÔ‡˜ ÁÔÓȉ›Ô˘ ÏfiÁˆ Û˘ÌÏËڈ̷ÙÈÎfiÙËÙ·˜. ™ÙËÓ π·ˆÓ›·, ÂÈÛÙ‹ÌÔÓ˜ ηٿÊÂÚ·Ó Ó· ·Ú·Û΢¿ÛÔ˘Ó Ú‡˙È Ì 16% ÏÈÁfiÙÂÚË ÚˆÙ½ÓË 16 kD, Ë ÔÔ›· Â›Ó·È ˘‡ı˘ÓË ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ·ÏÏÂÚÁ›·˜ ÛÙÔ Ú‡˙È (18). ™Â Ì›· ·Ó¿ÏÔÁË ÔÚ›· ‚Ú›ÛÎÔÓÙ·È, Â›Û˘, Ù· ˘Ô·ÏÏÂÚÁÈο ÊÈÛÙ›ÎÈ· Î·È ÙÔ ·Ï‡ÚÈ ¯ˆÚ›˜ ÁÏÔ˘Ù¤ÓË. ∞ÓÙÈÚÚ‹ÛÂȘ Û¯ÂÙÈο Ì ÙË ¯Ú‹ÛË ÁÂÓÂÙÈο ÙÚÔÔÔÈËÌ¤ÓˆÓ ÙÚÔÊ›ÌˆÓ ™ËÌ·ÓÙÈÎfi ÏfiÁÔ ·ÓÙ›‰Ú·Û˘ ¤Ó·ÓÙÈ ÙˆÓ °∆∆ ·ÔÙÂÏ› Ë ÔÚÈ˙fiÓÙÈ· ÌÂÙ·ÊÔÚ¿ ÁÔÓȉ›ˆÓ, Ë ÔÔ›· Û˘Ì‚·›ÓÂÈ ÌÂٷ͇ ÌË Û˘ÁÁÂÓÒÓ ÂȉÒÓ, ÂËÚ¿˙ÔÓÙ·˜ ¤ÙÛÈ ÙÔ ÂÚÈ‚¿ÏÏÔÓ Ì ·Úfi‚ÏÂÙÔ ÙÚfiÔ,

¶·È‰È·ÙÚÈ΋ 2003;66:418-425

·ÊÔ‡ ÚfiÎÂÈÙ·È ÁÈ· ÂȉڿÛÂȘ Ô˘ Û˘Ì‚·›ÓÔ˘Ó Û ˙ˆÓÙ·ÓÔ‡˜ ÔÚÁ·ÓÈÛÌÔ‡˜. ∆· ÁÔÓ›‰È· ·fi Ù· °∆∆ ÌÔÚÔ‡Ó ıˆÚËÙÈο Ó· ÂÚ¿ÛÔ˘Ó ÛÙÔ˘˜ ·ÓıÚÒÔ˘˜ Ô˘ Ù· ηٷӷÏÒÓÔ˘Ó, ÁÂÁÔÓfi˜ ÙÔ ÔÔ›Ô ˘ÔÛÙËÚ›˙ÂÙ·È Î·È ·fi οÔÈ· ÂÈÚ·Ì·ÙÈο ‰Â‰Ô̤ӷ (3). ∆· ÁÂÓÂÙÈο ÙÚÔÔÔÈË̤ӷ ÚÔ˚fiÓÙ· ·Ó··Ú¿ÁÔÓÙ·È, ÌÂÁ·ÏÒÓÔ˘Ó Î·È ÌÂÙ·Ó·ÛÙ‡ԢÓ. OÈ ÂÈÛÙ‹ÌÔÓ˜, ÁÈ· Ó· ·˘Í‹ÛÔ˘Ó ÙËÓ ·ÓıÂÎÙÈÎfiÙËÙ· ÙˆÓ Î·ÏÏÈÂÚÁÂÈÒÓ ÛÙ· ˙È˙¿ÓÈ· Î·È Ù· ·Ú¿ÛÈÙ·, ‰ËÌÈÔ‡ÚÁËÛ·Ó ÙÚÔÔÔÈË̤Ó˜ ηÏÏȤÚÁÂȘ. ªÂÁ¿ÏË ·ÓËÛ˘¯›· ˘¿Ú¯ÂÈ ÁÈ· ÙË ‰ËÌÈÔ˘ÚÁ›· ÌÂÙ·ÏÏ·ÁÌ¤ÓˆÓ ˙È˙·Ó›ˆÓ, ·ÓıÂÎÙÈÎÒÓ ÛÙ· Ê˘ÙÔÊ¿Ú̷η, ÛÙËÓ ÂÚ›ÙˆÛË Ô˘ Ù· ÁÔÓ›‰È· ·ÓÙÔ¯‹˜ “ÂÚ¿ÛÔ˘Ó” Û ·˘Ù¿, fiÔ˘ ı· ··ÈÙÂ›Ù·È ÂÎÙÂÓ¤ÛÙÂÚË ¯Ú‹ÛË ¯ËÌÈÎÒÓ ÁÈ· ÙËÓ ··ÏÏ·Á‹ ·fi Ù· “ÌÂÙ·ÏÏ·Á̤ӷ” ˙È˙¿ÓÈ·. ∏ “ÚÔ‹ ÁÔÓȉ›ˆÓ” ÌÔÚ› Ó· Ú·ÁÌ·ÙÔÔÈËı› ÌÂٷ͇ ¿ÏÏˆÓ Î·È Ì¤Ûˆ Ù˘ Á‡Ú˘ ÙˆÓ ÙÚÔÔÔÈËÌ¤ÓˆÓ Ê˘ÙÒÓ. ™Â fi,ÙÈ ·ÊÔÚ¿ ÙÔ˘˜ ÈÔ‡˜, Ë ·ÓËÛ˘¯›· Â›Ó·È ¤ÓÙÔÓË Û¯ÂÙÈο Ì ÙË ‰ËÌÈÔ˘ÚÁ›· Ó¤ˆÓ ÌË ·Ó·ÁÓˆÚ›ÛÈÌˆÓ ÈÒÓ, Ì ·Ó·Û˘Ó‰˘·Ṳ̂ÓÔ DNA Î·È ¿ÁÓˆÛÙ˜ ȉÈfiÙËÙ˜ (2). ∏ Èı·ÓfiÙËÙ· ÌÂÙ·ÊÔÚ¿˜ ÁÔÓȉ›ˆÓ, ·ÓıÂÎÙÈÎÒÓ Û ·ÓÙÈ‚ÈÔÙÈο, ·fi ÌÂÙ·ÏÏ·Á̤ӷ Ê˘Ù¿ Û ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜ ̤ۈ ÙÔ˘ ÁÂÓÂÙÈÎÔ‡ ·Ó·Û˘Ó‰˘·ÛÌÔ‡ ÛÙÔÓ ·ÓıÚÒÈÓÔ ‹ ˙ˆÈÎfi ÂÙÈÎfi ۈϋӷ, ·ÔÙÂÏ› ËÁ‹ ·ÓÙÈÚÚ‹ÛÂˆÓ ÁÈ· Ù· °∆∆. ¶ÚfiÛÊ·ÙË ÌÂϤÙË ÛÙÔ Lancet ÂͤٷÛÂ Û˘ÁÎÚÈÙÈο ÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi Û‡ÛÙËÌ· ‰‡Ô ηÙËÁÔÚÈÒÓ ÔÓÙÈÎÈÒÓ: ÂÎÂ›ÓˆÓ Ô˘ Î·Ù·Ó¿ÏˆÓ·Ó ÁÂÓÂÙÈο ÙÚÔÔÔÈË̤Ó˜ ·Ù¿Ù˜ Î·È ÂÎÂ›ÓˆÓ Ô˘ Î·Ù·Ó¿ÏˆÓ·Ó ÌË ÁÂÓÂÙÈο ÙÚÔÔÔÈË̤Ó˜ ·Ù¿Ù˜. OÈ ‰È·ÊÔÚ¤˜ Ô˘ ‰È·ÈÛÙÒıËÎ·Ó ‹Ù·Ó ÛËÌ·ÓÙÈΤ˜, ·Ó Î·È Ë ÌÂϤÙË ıˆڋıËΠ·fi ÔÏÏÔ‡˜ ·ÓÂ·ÚÎÒ˜ ÙÂÎÌËÚȈ̤ÓË (7). OÈ Û˘Ó¤ÂȘ ·ÊÔÚÔ‡Û·Ó Î˘Ú›ˆ˜ ÛÙËÓ ·Ó¿Ù˘ÍË ÙˆÓ ÔÚÁ¿ÓˆÓ ÙÔ˘˜ Î·È ÛÙÔÓ ÌÂÙ·‚ÔÏÈÛÌfi ÙÔ˘˜ (19). ÕÏÏË ÌÂϤÙË, Ô˘ Ú·ÁÌ·ÙÔÔÈ‹ıËΠÁÈ· ÏÔÁ·ÚÈ·ÛÌfi Ù˘ ÂÙ·ÈÚ›·˜ “Monsanto” ÛÙÔ πÓÛÙÈÙÔ‡ÙÔ KOCH Ù˘ °ÂÚÌ·Ó›·˜, ·Ó¤ÊÂÚ ÌÂÙ·‚ÔÏ‹ ÛÙË Û‡ÓıÂÛË ÙÔ˘ Á¿Ï·ÎÙÔ˜ ·ÁÂÏ¿‰ˆÓ Ô˘ ÙÚ¤ÊÔÓÙ·Ó Ì ÌÂÙ·ÏÏ·Á̤ÓË ÛfiÁÈ·, Ì ·‡ÍËÛË ÙˆÓ ÏÈ·ÚÒÓ Û ÔÛÔÛÙfi 8% (19). ∏ ÛÔ‚·ÚfiÙÂÚË, fï˜, ·ÓËÛ˘¯›· ÁÈ· ÙËÓ ˘Á›· ·ÊÔÚ¿ ÛÙËÓ Èı·Ó‹ ·ÏÏÂÚÁÈÔÁÔÓÈÎfiÙËÙ· ÙˆÓ °∆∆, ÁÈ· ÙËÓ ÔÔ›· ı· Á›ÓÂÈ ÂÎÙÂÓ‹˜ ÏfiÁÔ˜ ÛÙË Û˘Ó¤¯ÂÈ·. ∆ÚÔÊÈ΋ ·ÏÏÂÚÁ›· ∏ ÙÚÔÊÈ΋ ·ÏÏÂÚÁ›· ÂÚÈÏ·Ì‚¿ÓÂÈ Î¿ı Â·Ó·Ï·Ì‚·ÓfiÌÂÓË ·ÓÔÛÔÏÔÁÈ΋ ·ÓÙ›‰Ú·ÛË Ô˘ Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ Î·Ù·Ó¿ÏˆÛË ÙÚÔÊ›ÌÔ˘ ‹ ÚfiÛıÂÙÔ˘ ÙÚÔÊÒÓ. ∏ ·ÓÙ›‰Ú·ÛË ÌÔÚ› Ó· ÂΉËψı› ÌÂÙ¿ ·fi ÙËÓ Î·Ù·Ó¿ÏˆÛË ÌÈÎÚ‹˜ ÔÛfiÙËÙ·˜ ·fi ÙË Û˘ÁÎÂÎÚÈ̤ÓË Ô˘Û›· Î·È Ú¤ÂÈ Ó· ‰È·¯ˆÚ›˙ÂÙ·È ·fi

Paediatriki 2003;66:418-425

ÌË ·ÓÔÛÔÏÔÁÈΤ˜, ȉÈÔÛ˘ÛÙ·ÛȷΤ˜, ÙÔÍÈΤ˜ ‹ „˘¯ÔÏÔÁÈΤ˜ ·ÓÙȉڿÛÂȘ (20). °ÂÓÈο, ÂÎÙÈÌ¿Ù·È fiÙÈ ÙÔ 1-2% ÙÔ˘ ÁÂÓÈÎÔ‡ ÏËı˘ÛÌÔ‡ ¿Û¯ÂÈ ·fi ÙÚÔÊÈΤ˜ ·ÏÏÂÚÁ›Â˜, ÂÓÒ ÙÔ 25-30% ÙÔ˘ ·È‰ÈÎÔ‡ ÏËı˘ÛÌÔ‡ ·Ó·Ê¤ÚÂÈ Û οÔÈ· ÛÙÈÁÌ‹ Ù˘ ˙ˆ‹˜ ÙÔ˘ ·ÓÂÈı‡ÌËÙË ·ÓÙ›‰Ú·ÛË Û ÙÚÔÊ‹. ∆Ô ÌÂÁ·Ï‡ÙÂÚÔ Ì¤ÚÔ˜ ·fi ·˘Ù¤˜ ÙȘ ·ÓÙȉڿÛÂȘ ÛÙ· ·È‰È¿ ‰ÂÓ Â›Ó·È Â·Ó·Ï·Ì‚·ÓfiÌÂÓÔ. ŒÙÛÈ, fiÙ·Ó ¤ÁÈÓ·Ó ÚÔÎÏ‹ÛÂȘ, ÙÔ ÔÛÔÛÙfi ÂȂ‚·ÈˆÌ¤Ó˘ ÙÚÔÊÈ΋˜ ·ÏÏÂÚÁ›·˜ Û ·˘Ù¿ ‹Ù·Ó ÏÈÁfiÙÂÚÔ ·fi 10%. ¶·Ú·Ì¤ÓÂÈ, fï˜, ÛËÌ·ÓÙÈÎfi Úfi‚ÏËÌ· ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÔÈ ÙÚÔÊÈΤ˜ ·ÏÏÂÚÁ›Â˜, ÂÎÙfi˜ ·fi Û˘ÌÙÒÌ·Ù· ·fi ÙÔ ‰¤ÚÌ·, ÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi Î·È ÏÈÁfiÙÂÚÔ ·fi ÙÔ ·Ó·Ó¢ÛÙÈÎfi, ÌÔÚÔ‡Ó Ó· ÚÔηϤÛÔ˘Ó Û˘ÛÙËÌ·ÙÈ΋ ·Ó·Ê˘Ï·Í›·, ·ÏÏÂÚÁÈ΋ ηٷÏËÍ›· Î·È ı¿Ó·ÙÔ (21).

OÈ Î‡ÚȘ ·ÏÏÂÚÁÈÔÁfiÓ˜ ÙÚÔʤ˜ Â›Ó·È ÙÔ ·‚Áfi, ÙÔ Á¿Ï·, Ù· „¿ÚÈ·, Ù· ÔÛÙÚ·ÎÔÂȉ‹, ÔÈ ÍËÚÔ› ηÚÔ› (΢ڛˆ˜ ÙÔ ·Ú¿ÈÎÔ ÊÈÛÙ›ÎÈ Î·È Ù· ηڇ‰È·) Î·È Ë ÛfiÁÈ·. ∏ ηٷӿψÛË ÙˆÓ ·ÏÏÂÚÁÈÔÁfiÓˆÓ ÙÚÔÊÒÓ ÔÈΛÏÏÂÈ ÛÙ· ‰È¿ÊÔÚ· ̤ÚË ÙÔ˘ ÎfiÛÌÔ˘, ·Ó¿ÏÔÁ· Ì ÙȘ ‰È·ÙÚÔÊÈΤ˜ ÚÔÙÈÌ‹ÛÂȘ (22).

OÈ ·ÏÏÂÚÁÈÔÁÔÓÈΤ˜ ÚˆÙ½Ó˜ Â›Ó·È Û˘Ó‹ıˆ˜ fiÍÈÓ˜ ÁÏ˘ÎÔÚˆÙ½Ó˜, ÌÔÚÈ·ÎÔ‡ ‚¿ÚÔ˘˜ 10-40 kD, ÛÙ·ıÂÚ¤˜ ÛÙËÓ ÂÂÍÂÚÁ·Û›· Î·È ÎÔÈÓ¤˜, ¤ÙÛÈ ÒÛÙÂ Ë ¤ÎıÂÛË ÙˆÓ ·ÙfiÌˆÓ Ó· Â›Ó·È ÌÂÁ¿ÏË. ¢˘ÛÙ˘¯Ò˜, fï˜, Ù· ¯·Ú·ÎÙËÚÈÛÙÈο ·˘Ù¿ ‰ÂÓ Â›Ó·È Èηӿ ‹ ·Ó·Áη›· ÁÈ· Ó· ηٷÛÙ‹ÛÔ˘Ó Ì›· ÚˆÙ½ÓË ·ÏÏÂÚÁÈÔÁÔÓÈ΋, Ì ·ÔÙ¤ÏÂÛÌ· Ë ·ÏÏÂÚÁÈÔÁÔÓÈÎfiÙËÙ· Ó· ÌËÓ Â›Ó·È ÚԂϤ„ÈÌË. À¿Ú¯Ô˘Ó, ¿ÏψÛÙÂ, ·Ó·ÊÔÚ¤˜ Û¿ÓÈˆÓ ·ÏÏÂÚÁÈÎÒÓ ·ÓÙȉڿÛÂˆÓ Û ÂÚÈÛÛfiÙÂÚ˜ ·fi 150-200 ÙÚÔʤ˜ (20). °ÂÓÂÙÈο ÙÚÔÔÔÈË̤ӷ ÙÚfiÊÈÌ· Î·È ÙÚÔÊÈ΋ ·ÏÏÂÚÁ›· ŒÓ· ÛËÌ·ÓÙÈÎfi ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÙˆÓ °∆∆ Â›Ó·È Ë ·ÚÔ˘Û›· Ó¤ˆÓ ÚˆÙÂ˚ÓÒÓ Û ·˘Ù¿. µ¤‚·È·, fiˆ˜ ·Ó·Ê¤ÚıËΠ·Ú·¿Óˆ, ÔÈ ·ÏÏÂÚÁÈÔÁÔÓÈΤ˜ ÚˆÙ½Ó˜ Ì ÎÏÈÓÈ΋ ÛËÌ·Û›· Â›Ó·È Û¯ÂÙÈο Ï›Á˜, ·Ó ÛÎÂÊÙ› ηÓ›˜ fiÙÈ Ù· Ê˘ÙÈο ·ÙÙ·Ú· ÌÔÚÔ‡Ó Ó· ÂÎÊÚ¿ÛÔ˘Ó ¿Óˆ ·fi 100.000 ÚˆÙ½Ó˜ (23). °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi, ÔÈ ÁÂÓÂÙÈο ÙÚÔÔÔÈË̤Ó˜ ÚˆÙ½Ó˜ ¤¯Ô˘Ó ÌÈÎÚ‹ Èı·ÓfiÙËÙ· Ó· ÚÔηϤÛÔ˘Ó ·ÏÏÂÚÁ›·, ›Ûˆ˜ fiÛÔ Î·È ¤Ó· ÔÔÈÔ‰‹ÔÙ ÌË ÁÂÓÂÙÈο ÙÚÔÔÔÈË̤ÓÔ ÙÚfiÊÈÌÔ. ∆Ô ÂӉ¯fiÌÂÓÔ ·ÏÏÂÚÁÈ΋˜ ·ÓÙ›‰Ú·Û˘ Û °∆∆ Â›Ó·È Èı·ÓfiÙÂÚÔ fiÙ·Ó Ë ÂÈÛ·¯ı›۷ ÚˆÙ½ÓË Â›Ó·È ÁÓˆÛÙfi ·ÏÏÂÚÁÈÔÁfiÓÔ, fiˆ˜ ÁÈ· ·Ú¿‰ÂÈÁÌ· Ë ÂÈÛ·ÁˆÁ‹ Ù˘ ·ÏÏÂÚÁÈÔÁÔÓÈ΋˜ ‚-η˙½Ó˘ ÙÔ˘ ·ÁÂÏ·‰ÈÓÔ‡ Á¿Ï·ÙÔ˜ Û ηÏÏȤÚÁÂÈ· ÛfiÁÈ·˜, ·ÏÏ¿ Î·È ÙˆÓ ÁÏ˘ÎÈÓÈÓÒÓ Ù˘ ÛfiÁÈ·˜ Û ηÏÏȤÚÁÂÈ· Ú˘˙ÈÔ‡ (24,25). ¶·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ù¤ÙÔÈ· ÚÔ˚fiÓÙ· ‰ÂÓ ¤ÊÙ·Û·Ó (Î·È ›Ûˆ˜ ‰ÂÓ ÊÙ¿ÛÔ˘Ó ÔÙ¤) ÛÙËÓ ·ÁÔÚ¿, Ô Î›Ó‰˘ÓÔ˜ ·Ó¿ÌÂÈ͢ ‹ ‰È¿¯˘Û˘ ÙÔ˘ ÁÂÓÂÙÈÎÔ‡

421

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˘ÏÈÎÔ‡ ˘¿Ú¯ÂÈ ¿ÓÙ·. ŒÙÛÈ, ‰ËÌÈÔ˘ÚÁ‹ıËÎÂ Ë ·Ó¿ÁÎË ÁÈ· ÙË ıÂÛÌÔı¤ÙËÛË ‰È·‰ÈηÛÈÒÓ ÂϤÁ¯Ô˘ Ù˘ Èı·Ó‹˜ ·ÏÏÂÚÁÈÔÁÔÓÈÎfiÙËÙ·˜ ÙˆÓ °∆∆. ¶·Ú’ fiÏ· ·˘Ù¿, ı· Ú¤ÂÈ Ó· Á›ÓÂÈ Û·Ê¤˜ fiÙÈ Ù· ÙÚfiÊÈÌ· ·˘Ù‹˜ Ù˘ ηÙËÁÔÚ›·˜, ·ÓÙÈÎÂÈÌÂÓÈο, ‰ÂÓ Â›Ó·È Î·È, ÂÔ̤ӈ˜, ‰ÂÓ ı· Ú¤ÂÈ Ó· ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÂÎ ÙˆÓ ÚÔÙ¤ÚˆÓ ˆ˜ ÂÈ‚Ï·‚‹ Î·È ÂÈΛӉ˘Ó· ÁÈ· ÙÔÓ Î·Ù·Ó·ÏˆÙ‹ ‹ Û ÌÂÈÔÓÂÎÙÈ΋ ı¤ÛË Û ۯ¤ÛË Ì ·ÓÙ›ÛÙÔȯ· ÌË °∆∆ ‹ ıÚÂÙÈο Û˘ÛÙ·ÙÈο, ÚÔ‚¿ÏÏÔÓÙ·˜ ÙÔ Âȯ›ÚËÌ· fiÙÈ Ë ‰È·ÙÚÔÊÈ΋ ·Í›· ÙÔ˘˜ Â›Ó·È ¯·ÌËÏfiÙÂÚË. ∏ ‰È·‰Èηۛ· ·Ú·ÁˆÁ‹˜ °∆∆ ÂÚÈÏ·Ì‚¿ÓÂÈ, ÁÂÓÈο, ÙÚ›· ÛÙ¿‰È·: ÙËÓ ÂÈÏÔÁ‹ ÙÔ˘ ÁÔÓȉ›Ô˘, ÙËÓ ÂÈÏÔÁ‹ ÙÔ˘ ›‰Ô˘˜ ÙÔ˘ ÙÚÔÊ›ÌÔ˘ Ô˘ ı· ÙÚÔÔÔÈËı› ηÈ, ÙÂÏÈο, ÙËÓ ·Ó¿Ù˘ÍË Î·È ‰È¿ıÂÛ‹ ÙÔ˘ ÛÙËÓ ·ÁÔÚ¿ (26). ∏ ·ÏÏÂÚÁÈÔÁÔÓÈÎfiÙËÙ· ÙÔ˘ ÙÚÔÊ›ÌÔ˘ Ú¤ÂÈ Ó· ÂÎÙÈÌ¿Ù·È ·fi ÙÔ ÚÒÙÔ ÛÙ¿‰ÈÔ. OÈ ··Ú·›ÙËÙ˜ ÏËÚÔÊÔڛ˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó: ·) ÙÔÓ Î·ıÔÚÈÛÌfi ÙÔ˘ Ó¤Ô˘ ÙÚÔÊ›ÌÔ˘, ‚) ÙËÓ Â›‰Ú·ÛË Ù˘ ·Ú·ÁˆÁÈ΋˜ ‰È·‰Èηۛ·˜ ÛÙȘ ȉÈfiÙËÙ˜ ÙÔ˘ ÙÚÔÊ›ÌÔ˘, Á) Ù· ·ÎÚÈ‚‹ ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ Ô˘ ı· ¯ÚËÛÈÌÔÔÈËı› ˆ˜ ÁÔÓȉȷ΋ ËÁ‹ Î·È ‰) ÙȘ ÂȉڿÛÂȘ Ù˘ ÁÂÓÂÙÈ΋˜ ÙÚÔÔÔ›ËÛ˘ ÛÙȘ ȉÈfiÙËÙ˜ Ù˘ “ÌËÙÚÈ΋˜” ηÏÏȤÚÁÂÈ·˜, Ì ηıÔÚÈÛÌfi Î·È ÌÔÚÈ·Îfi ¯·Ú·ÎÙËÚÈÛÌfi Ù˘ ʇÛ˘ Ù˘ ÁÂÓÂÙÈ΋˜ ÙÚÔÔÔ›ËÛ˘, Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ Ù˘ ÁÔÓȉȷ΋˜ ı¤Û˘ ÂÈÛ·ÁˆÁ‹˜, ÙÔ˘ Ï‹ıÔ˘˜ ·ÓÙÈÁÚ¿ÊˆÓ Î·È ÙÔ˘ ÂÈ¤‰Ô˘ ‚ÈÔ¯ËÌÈ΋˜ ¤ÎÊÚ·Û˘ (27). À¿Ú¯Ô˘Ó ÔÏÏÔ› ÏfiÁÔÈ Ô˘ ηıÈÛÙÔ‡Ó ÛËÌ·ÓÙÈÎfi ÙÔÓ ·ÎÚÈ‚‹ ηıÔÚÈÛÌfi ÙˆÓ Èı·ÓÒÓ ·ÏÏÂÚÁÈÔÁfiÓˆÓ Ô˘ ÂÚȤ¯ÔÓÙ·È Û °∆∆. ∂ÊfiÛÔÓ ÙÂÏÈÎfi ÛÙfi¯Ô ·ÔÙÂÏ› Ë ·ÛÊ·Ï‹˜ ηٷӿψۋ ÙÔ˘˜ ÙfiÛÔ ·fi ÙÔ Û‡ÓÔÏÔ ÙÔ˘ ÏËı˘ÛÌÔ‡ fiÛÔ Î·È ·fi ÙÔÓ ·ÏÏÂÚÁÈÎfi ·ÛıÂÓ‹, Ú¤ÂÈ Ó· ˘¿Ú¯ÂÈ Ë ‰˘Ó·ÙfiÙËÙ· Ù˘ Û·ÊÔ‡˜ ÏËÚÔÊfiÚËÛ˘ ÁÈ· ÙÔ Â›‰Ô˜ Î·È ÙËÓ ·ÎÚÈ‚‹ Û˘ÁΤÓÙÚˆÛË ÙˆÓ Û˘ÛÙ·ÙÈÎÒÓ ÛÙÔ Ó¤Ô ÙÚfiÊÈÌÔ. ∞˘Ùfi ‰ÂÓ ·ÊÔÚ¿ ÌfiÓÔ ÛÙ· ÙÚÔÔÔÈË̤ӷ ÁÔÓ›‰È·, ·ÏÏ¿ ÛÙÔ Û‡ÓÔÏfi ÙÔ˘˜, ·ÊÔ‡ Ë ÁÂÓÂÙÈ΋ ÙÚÔÔÔ›ËÛË ÌÔÚ› Ó· ÂÈʤÚÂÈ ·ÏÏ·Á¤˜ Î·È ÛÙ· ˘fiÏÔÈ· ¯·Ú·ÎÙËÚÈÛÙÈο ¤ÎÊÚ·Û˘ ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ (27). ™Â Ì›· ‹‰Ë ·ÏÏÂÚÁÈÔÁÔÓÈ΋ ÙÚÔÊ‹, Ë ÔÛfiÙËÙ· ¤ÎÊÚ·Û˘ ÙÔ˘ ·ÏÏÂÚÁÈÔÁfiÓÔ˘ ı· ÌÔÚÔ‡Û ӷ ·ÏÏ¿ÍÂÈ, ηıÈÛÙÒÓÙ·˜ ÙËÓ ÂÚÈÛÛfiÙÂÚÔ (‹ ÏÈÁfiÙÂÚÔ) ·ÏÏÂÚÁÈÔÁÔÓÈ΋, ÂÍ·ÈÙ›·˜ Ù˘ ÁÂÓÂÙÈ΋˜ ÙÚÔÔÔ›ËÛ˘ (1).

O ηıÔÚÈÛÌfi˜ Ù˘ ·ÏÏÂÚÁÈÔÁÔÓÈÎfiÙËÙ·˜ Á›ÓÂÙ·È Ì ‚ÈÔÏÔÁÈΤ˜ in vivo Î·È in vitro ÌÂıfi‰Ô˘˜, fiˆ˜ ‰ÈÏ‹ Ù˘ÊÏ‹ ÚfiÎÏËÛË, ·ÓÔȯً ÚfiÎÏËÛË Î·È ‰ÂÚÌ·ÙÈΤ˜ ‰ÔÎÈ̷ۛ˜ Ó˘ÁÌÔ‡ Û ·ÓıÚÒÔ˘˜, ·Ó·Ê˘Ï·ÎÙÈ΋ ·¿ÓÙËÛË Û ÂÈÚ·Ì·Ùfi˙ˆ·, ηıÒ˜ Î·È Ì in vitro ̤ÙÚËÛË Ù˘ ¤ÎÏ˘Û˘ ÈÛÙ·Ì›Ó˘ ·fi ‚·ÛÂfiÊÈÏ·, ÚÔÛ‰ÈÔÚÈÛÌfi ÂȉÈ΋˜ IgE Ì ELISA, RAST, RAST-inhibition Î·È PCR, RT-PCR (27).

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Paediatriki 2003;66:418-425

∞Ó ÙÔ ÁÔÓ›‰ÈÔ ¤¯ÂÈ ÎÔÈÓ‹ ·ÏÏËÏÔ˘¯›· Ì ÎÔÈÓ‹ ·ÏÏÂÚÁÈÔÁfiÓÔ ËÁ‹, fiˆ˜ Ù· ÊÈÛÙ›ÎÈ· ‹ ÙÔ „¿ÚÈ, Ú¤ÂÈ Ó· ‰ÈÂÓÂÚÁËıÔ‡Ó ÔÈ Î·Ù¿ÏÏËϘ ‰ÔÎÈ̷ۛ˜ Ô˘ ı· ·ÔÎÏ›ÛÔ˘Ó ÙÔ ÂӉ¯fiÌÂÓÔ ÙÔ Ó¤Ô ÙÚfiÊÈÌÔ Ó· ÚÔηÏ› ·ÏÏÂÚÁ›Â˜ Û ¿ÙÔÌ· ¢·ÈÛıËÙÔÔÈË̤ӷ Û ·˘Ù‹ ÙËÓ ËÁ‹ (26). ™ÙËÓ ÂÚ›ÙˆÛË Ô˘ Ë ÚˆÙ½ÓË ·Ó‹ÎÂÈ Û ٿÍË ÚˆÙÂ˚ÓÒÓ Ô˘ ¤¯Ô˘Ó Û¯ÂÙÈÛÙ› Ì Èı·Ó‹ ·ÏÏÂÚÁÈÔÁÔÓÈÎfiÙËÙ·, Ë Û˘ÁÎÂÎÚÈ̤ÓË Ó¤· ÚˆÙ½ÓË ‰ËÌÈÔ˘ÚÁ› ÚfiÛıÂÙË ·ÓËÛ˘¯›· Î·È Ú¤ÂÈ Ó· ·ÍÈÔÏÔÁËı›. °È· ·Ú¿‰ÂÈÁÌ·, ÔÈ ¯ÈÙÈÓ¿Û˜ ÌÔÚÔ‡Ó Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó ·fi ÙË ÁÂÓÂÙÈ΋ Ì˯·ÓÈ΋ ÁÈ· ÙËÓ ÚÔÛÙ·Û›· ÙˆÓ Ê˘ÙÈÎÒÓ Î·ÏÏÈÂÚÁÂÈÒÓ ·fi ̇ÎËÙ˜. ∂ÓÙÔ‡ÙÔȘ, οÔȘ ¯ÈÙÈÓ¿Û˜ Â›Ó·È ˘‡ı˘Ó˜ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ÙÚÔÊÈÎÒÓ ·ÏÏÂÚÁÈÒÓ, Ì ·ÔÙ¤ÏÂÛÌ· Ë ÂÈÛ·ÁˆÁ‹ ÙÔ˘˜ ÛÙÔ Ó¤Ô ÙÚfiÊÈÌÔ Ó· ÂÈ‚¿ÏÏÂÈ ÙËÓ ÂÚ·ÈÙ¤Úˆ ·ÍÈÔÏfiÁËÛ‹ ÙÔ˘ (26).

OÈ Èı·ÓfiÙËÙ˜ ‰ËÌÈÔ˘ÚÁ›·˜ ÂÓfi˜ Ó¤Ô˘ ·ÏÏÂÚÁÈÔÁfiÓÔ˘ Â›Ó·È Ì¿ÏÏÔÓ ÌÈÎÚ¤˜. ∏ ·˘ÍË̤ÓË ¤ÎıÂÛË Û οÔÈ· Ô˘Û›·, Ô˘ ̤¯ÚÈ ÚfiÙÈÓÔ˜ ·Ô˘Û›·˙ ·fi ÙÔ ‰È·ÈÙÔÏfiÁÈÔ ‹ ηٷӷψÓfiÙ·Ó Û ÌÈÎÚ¤˜ ÔÛfiÙËÙ˜, ÌÔÚ› ıˆÚËÙÈο Ó· ÚÔηϤÛÂÈ ÙËÓ Â˘·ÈÛıËÙÔÔ›ËÛË Î¿ÔÈˆÓ ·ÙfiÌˆÓ Û ·˘Ù‹. ª›· ÙÂÏÂ˘Ù·›· ÛΤ„Ë, Ë ÔÔ›· fï˜ ‰ÂÓ ¤¯ÂÈ ¤Á΢ÚË ÂÈÛÙËÌÔÓÈ΋ ‚¿ÛË, ·ÊÔÚ¿ ÛÙË ÁÂÓÈÎfiÙÂÚË Â›‰Ú·ÛË Ô˘ ı· ÌÔÚÔ‡Û·Ó Ó· ¤¯Ô˘Ó ÔÈ ÁÂÓÂÙÈο ÙÚÔÔÔÈË̤Ó˜ ÙÚÔʤ˜ ÛÙÔ ·ÓÔÛÔÔÈËÙÈÎfi Û‡ÛÙËÌ·. OÈ Û˘Ó¤ÂȘ Èı·Ófiٷٷ ı· ‹Ù·Ó ·ÓÂͤÏÂÁÎÙ˜, ÁÂÁÔÓfi˜ Ô˘ ÚÔηÏ›, ·ÎfiÌ· Î·È Û ıˆÚËÙÈÎfi Â›‰Ô, ¤ÓÙÔÓË ·ÓËÛ˘¯›· (1). ¶Ú¤ÂÈ, ‚¤‚·È·, Ó· ÂÈÛËÌ·Óı› ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ì›· Ù¤ÙÔÈ· Èı·ÓfiÙËÙ·, Â¿Ó ÈÛ¯‡ÂÈ, ı· ·ÊÔÚ¿ ÛÙÔ ÌÂÁ·Ï‡ÙÂÚÔ Ì¤ÚÔ˜ Ù˘ ÙÔÓ ·È‰ÈÎfi ÏËı˘ÛÌfi, ÙfiÛÔ ÏfiÁˆ Ù˘ ÌÂÁ·Ï‡ÙÂÚ˘ ¢·ÈÛıËÛ›·˜ ÙÔ˘ ·Ó·Ù˘ÛÛfiÌÂÓÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ Û ‰È·ÙÚÔÊÈΤ˜ ·ÚÂÌ‚¿ÛÂȘ, fiÛÔ Î·È ÏfiÁˆ Ù˘ ÔÏÏ·Ï¿ Û˘¯ÓfiÙÂÚ˘ ‡·Ú͢ ÙÚÔÊÈ΋˜ ·ÏÏÂÚÁ›·˜ ÛÙ· ·È‰È¿ Û ۯ¤ÛË Ì ÙÔ˘˜ ÂÓ‹ÏÈÎÔ˘˜. ªÂ ·˘Ù¿ Ù· ‰Â‰Ô̤ӷ, ÙfiÛÔ ÛÙËÓ ∞ÌÂÚÈ΋ (Food and Drug Administration - FDA) fiÛÔ Î·È ÛÙËÓ ∂˘ÚÒË, ıÂÛÌÔıÂÙ‹ıËÎ·Ó ‰È·Ù¿ÍÂȘ ÁÈ· ÙÔÓ Î·Ù¿ÏÏËÏÔ ¤ÏÂÁ¯Ô ÙˆÓ ÁÂÓÂÙÈο ÙÚÔÔÔÈËÌ¤ÓˆÓ ÙÚÔʛ̈Ó, ÚÔÛı¤ÙˆÓ Î.Ï., ÚÔÎÂÈ̤ÓÔ˘ Ó· ‰ÈÂÓÂÚÁËı› ÚÔÛÂÎÙÈ΋ ·Ó¿Ï˘ÛË ÚÈÓ Î¿ÔÈÔ °∆∆ ΢ÎÏÔÊÔÚ‹ÛÂÈ ÛÙËÓ ·ÁÔÚ¿ (28,29). ¶·Ú’ fiÙÈ ‰ÂÓ ˘¿Ú¯ÂÈ ‰ÈÂıÓ‹˜ ÎÔÈÓ‹ ÚfiÙ˘Ë ÛÙÚ·ÙËÁÈ΋ ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô Ù˘ ·ÏÏÂÚÁÈÔÁÔÓÈÎfiÙËÙ·˜ ÙˆÓ °∆∆, Ì›· ÁÂÓÈ΋ ÚÔÛ¤ÁÁÈÛË ÂÚÈÏ·Ì‚¿ÓÂÈ ÛÙÔȯ›· fiˆ˜ Ë ·ÍÈÔÏfiÁËÛË Ù˘ ÌÂıfi‰Ô˘ Î·È Ë ÂͤٷÛË Ù˘ ÁÔÓȉȷ΋˜ ËÁ‹˜, Ù˘ ·ÌÈÓÔÍÈ΋˜ ·ÏÏËÏÔ˘¯›·˜ Î·È ÔÌÔÏÔÁ›·˜, Ù˘ ÂȉÈÎfiÙËÙ·˜ Ì ÔÚÔ‡˜ Î·È Ù˘ ·ÓÔ¯‹˜ ÛÙËÓ „›ÓË (26). °ÂÓÈο, ¤¯ÂÈ ÔÚÈÛÙ› Ô ·ÎfiÏÔ˘ıÔ˜ ·ÏÁfiÚÈıÌÔ˜, Ô˘ ·ÊÔÚ¿ ÛÙËÓ, ηٿ ÙÔ ‰˘Ó·ÙfiÓ, ‚¤ÏÙÈÛÙË ÚÔÛÙ·Û›· ·fi ·ÏÏÂÚÁ›· ÛÙ· °∆∆ (∂ÈÎfiÓ· 1). ∞Ú¯Èο, ÂÍÂÙ¿˙ÂÙ·È Â¿Ó Ë ËÁ‹ ÙÔ˘ ÁÔÓȉ›Ô˘ ›ӷÈ

¶·È‰È·ÙÚÈ΋ 2003;66:418-425

Paediatriki 2003;66:418-425

∂¿Ó Ë ·ÓÙ›‰Ú·ÛË Â›Ó·È ·ÚÓËÙÈ΋, ÙfiÙ Á›ÓÔÓÙ·È ‰ÂÚÌ·ÙÈΤ˜ ‰ÔÎÈ̷ۛ˜ ‹ ·ÎfiÌ· Î·È ÚÔÎÏ‹ÛÂȘ Û ¢·›ÛıËÙ· ¿ÙÔÌ·. ∞Ó Û ÔÔÈ·‰‹ÔÙ ʿÛË Ù˘ ‰È·‰Èηۛ·˜ ÏËÊıÔ‡Ó ıÂÙÈο ·ÔÙÂϤÛÌ·Ù·, ÚÔÙ›ÓÂÙ·È Ë Û‹Ì·ÓÛË ÙÔ˘ ÂÚȯÔ̤ÓÔ˘ Ù˘ ÙÚÔÊ‹˜ ÚÈÓ ·˘Ù‹ ÚÔˆıËı› ÛÙËÓ ·ÁÔÚ¿. ∆Ô Û˘ÁÎÂÎÚÈ̤ÓÔ ÚˆÙfiÎÔÏÏÔ ·ÎÔÏÔ˘ı‹ıËΠÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô Ù˘ ·ÏÏÂÚÁÈÔÁÔÓÈÎfiÙËÙ·˜ Ù˘ ηÏÏȤÚÁÂÈ·˜ ÛfiÁÈ·˜, ÛÙËÓ ÔÔ›· ¤¯ÂÈ ÚÔÛÙÂı› ÙÔ ÁÔÓ›‰ÈÔ 2S ÙÔ˘ ‚Ú·˙ÈÏÈ¿ÓÈÎÔ˘ ÊÈÛÙÈÎÈÔ‡. ™Â ÌÂϤÙË Ô˘ ‰ËÌÔÛ›Â˘Û ÙÔ “New England Journal of Medicine” ÙÔ 1996, ‰È·ÈÛÙÒıËΠfiÙÈ Ë ·ÏÏÂÚÁÈÔÁÔÓÈÎfiÙËÙ· ÌÂٷʤÚıËΠÛÙËÓ ÙÚÔÔÔÈË̤ÓË ÛfiÁÈ·, ·ÊÔ‡ ÛÙËÓ in vitro ·ÓÙ›‰Ú·ÛË ‚Ú¤ıËÎ·Ó ıÂÙÈο ·ÔÙÂϤÛÌ·Ù· Û 8 ·fi ÙÔ˘˜ 9 ÔÚÔ‡˜ Ô˘ ·Ó‹Î·Ó Û ¢·›ÛıËÙÔ˘˜ ·ÛıÂÓ›˜ (18). ∏ ·Ó·Î¿Ï˘„Ë ·˘Ù‹ ›¯Â Û·Ó ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·Ó·ÛÙÔÏ‹ Ù˘ ÂÌÊ¿ÓÈÛ˘ ÙÔ˘ Û˘ÁÎÂÎÚÈ̤ÓÔ˘ ÚÔ˚fiÓÙÔ˜ ÛÙËÓ ·ÁÔÚ¿ (2,14). ∂Ô̤ӈ˜, Ô Î›Ó‰˘ÓÔ˜ ·ÏÏÂÚÁÈÎÒÓ ·ÓÙȉڿÛÂˆÓ ÌÂÈÒÓÂÙ·È, ·Ó ‰ÂÓ ÂÎÌˉÂÓ›˙ÂÙ·È, Ì ηٿÏÏËÏÔ˘˜ ÂÚÁ·ÛÙËÚÈ·ÎÔ‡˜ ¯ÂÈÚÈÛÌÔ‡˜ Î·È Ì ÙË Û‹Ì·ÓÛË ÙˆÓ °∆∆ Ô˘ ΢ÎÏÔÊÔÚÔ‡Ó ÛÙÔ ÂÌfiÚÈÔ.

·ÏÏÂÚÁÈÔÁfiÓÔ ‹ fi¯È. ™ÙÔ Ï·›ÛÈÔ ·˘Ùfi Ï·Ì‚¿ÓÔÓÙ·È, Â›Û˘, ˘’ fi„ÈÓ Ù· ÎÔÈÓ¿ ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ·ÏÏÂÚÁÈÔÁfiÓˆÓ ÚˆÙÂ˚ÓÒÓ, fiˆ˜ ÙÔ ÌÔÚÈ·Îfi ‚¿ÚÔ˜. ™ÙË Û˘Ó¤¯ÂÈ·, Ë ÚˆÙÂ˚ÓÈ΋ ·ÏÏËÏÔ˘¯›· Û˘ÁÎÚ›ÓÂÙ·È Ì ̛· ‚¿ÛË ‰Â‰Ô̤ӈÓ, fiÔ˘ ˘¿Ú¯Ô˘Ó ηٷÁÂÁÚ·Ì̤Ó˜ fiϘ ÔÈ ·ÏÏÂÚÁÈÔÁÔÓÈΤ˜ ·ÏÏËÏÔ˘¯›Â˜, ̤¯ÚÈ ÙÔ Ì‹ÎÔ˜ ÙˆÓ ÔÎÙÒ ·ÌÈÓÔͤˆÓ. ŒÓ· ‰Â‡ÙÂÚÔ, ÛËÌ·ÓÙÈÎfi ÚÔ˜ ÂͤٷÛË, ÛÙÔÈ¯Â›Ô Â›Ó·È Ë ÛÙ·ıÂÚfiÙËÙ· Ù˘ ÚˆÙ½Ó˘ ÛÙËÓ ÂÂÍÂÚÁ·Û›·. OÈ Û˘Ó‹ıÂȘ ·ÏÏÂÚÁÈÔÁfiÓ˜ ÚˆÙ½Ó˜ Â›Ó·È ÛÙ·ıÂÚ¤˜ ÛÙË ıÂÚÌÔÎÚ·Û›· Î·È ÛÂ Û˘Óı‹Î˜ fiÍÈÓÔ˘ pH, Ô˘ ÚÔÛÔÌÔÈ¿˙Ô˘Ó ·˘Ù¤˜ ÙÔ˘ ÛÙÔÌ¿¯Ô˘. ∂¿Ó Ë ÚˆÙ½ÓË ÂÌÊ·ÓÈÛÙ› ·ÛÙ·ı‹˜ Û ·˘Ù¤˜ ÙȘ Û˘Óı‹Î˜, ¤¯ÂÈ ÌÈÎÚfiÙÂÚË Èı·ÓfiÙËÙ· Ó· Â›Ó·È ·ÏÏÂÚÁÈÔÁÔÓÈ΋. ∂ÓÙÔ‡ÙÔȘ, ÛÙËÓ ÂÚ›ÙˆÛË Ô˘, ÂÓÒ ‰ÂÓ ˘¿Ú¯ÂÈ ÔÌÔÏÔÁ›· ·ÏÏËÏÔ˘¯›·˜, Ë ÚˆÙ½ÓË Â›Ó·È ÛÙ·ıÂÚ‹ ÛÙËÓ ÂÂÍÂÚÁ·Û›·, ‰ÂÓ ÌÔÚԇ̠ӷ ·ÔÎÏ›ÛÔ˘Ì ÙÔ ÂӉ¯fiÌÂÓÔ ·ÏÏÂÚÁ›·˜ ηÈ, Ì¿ÏÈÛÙ·, ‰ÂÓ ÌÔÚԇ̠ӷ ÚÔÛ‰ÈÔÚ›ÛÔ˘ÌÂ Î·È ÔÌ¿‰· ·ÙfiÌˆÓ Ô˘ ÌÔÚ› Ó· Â›Ó·È Â˘¿ÏˆÙË ÛÙËÓ Èı·Ó‹ “·ÏÏÂÚÁÈÔÁfiÓÔ” ÚˆÙ½ÓË. ∞ÓÙ›ıÂÙ·, Â¿Ó ˘¿Ú¯ÂÈ ÔÌÔÏÔÁ›· ·ÏÏËÏÔ˘¯›·˜ Ì ÁÓˆÛÙfi ·ÏÏÂÚÁÈÔÁfiÓÔ ‹ ÙÔ ÁÔÓ›‰ÈÔ Ô˘ ÚÔ¤Ú¯ÂÙ·È ·fi ÁÓˆÛÙfi ·ÏÏÂÚÁÈÔÁfiÓÔ, ÌÔÚԇ̠ӷ ÚÔÛ‰ÈÔÚ›ÛÔ˘ÌÂ, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÔÚÔ‡˜ ·ÛıÂÓÒÓ, ηٿ fiÛÔ Ë Ó¤· ÚˆÙ½ÓË ı· ·ÓÙȉڿÛÂÈ Ì ·˘ÙÔ‡˜, Ì ÙȘ Ù¯ÓÈΤ˜ ELISA ‹ RAST inhibition.

∏ ‰È¿‰ÔÛË ÙˆÓ ÁÂÓÂÙÈο ÙÚÔÔÔÈËÌ¤ÓˆÓ ÙÚÔÊ›ÌˆÓ Û‹ÌÂÚ· ™‹ÌÂÚ·, ¤Ó·˜ ÙÂÚ¿ÛÙÈÔ˜ ·ÚÈıÌfi˜ ÂȉÒÓ Ô˘ ÂÚÈÏ·Ì‚¿ÓÂÈ ÙȘ ÛËÌ·ÓÙÈÎfiÙÂÚ˜ ‚·ÛÈΤ˜ ÙÚÔʤ˜, ¤¯ÂÈ ÙÚÔÔÔÈËı› ÁÂÓÂÙÈο Î·È Î˘ÎÏÔÊÔÚ› ÛÙËÓ

¶ËÁ‹ ÁÔÓȉ›Ô˘ (·ÏÏÂÚÁÈÔÁfiÓÔ)

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ŒÏÂÁ¯Ô˜ IgE (ELISA, RAST inh.)

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OÌÔÏÔÁ›· ·ÏÏËÏÔ˘¯›·˜ ‘O¯È

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‘O¯È

™Ù·ıÂÚfiÙËÙ· ÂÂÍÂÚÁ·Û›·˜ ¢ÂÚÌ·ÙÈΤ˜ ‰ÔÎÈ̷ۛ˜

(+) ™‹Ì·ÓÛË ÂÚȯÔ̤ÓÔ˘

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∞Ó·ÊÔÚ¿ ÛÙÔÓ ˘‡ı˘ÓÔ ÔÚÁ·ÓÈÛÌfi

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¶ÚÔÒıËÛË ÛÙËÓ ·ÁÔÚ¿

∂ÈÎfiÓ· 1. ŒÏÂÁ¯Ô˜ ·ÛÊ¿ÏÂÈ·˜ Û¯ÂÙÈο Ì ÙËÓ ·ÏÏÂÚÁÈÔÁÔÓÈÎfiÙËÙ· ÁÂÓÂÙÈο ÙÚÔÔÔÈËÌ¤ÓˆÓ ÙÚÔʛ̈Ó.

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·ÁÔÚ¿. ∆Ô 30% ÙÔ˘ ηϷÌÔÎÈÔ‡ Î·È ÙÔ 50% Ù˘ ÛfiÁÈ·˜ Ô˘ ·Ú¿ÁÂÙ·È Î·È Î·Ù·Ó·ÏÒÓÂÙ·È ÛÙȘ ∏.¶.∞. Â›Ó·È ÁÂÓÂÙÈο ÙÚÔÔÔÈË̤ÓÔ, ÂÓÒ ÂÚ›Ô˘ ÙÔ 75% ÙˆÓ ÚÔ˚fiÓÙˆÓ Ô˘ ˘¿Ú¯Ô˘Ó ÛÙ· Ú¿ÊÈ· Ù˘ ·ÌÂÚÈηÓÈ΋˜ ·ÁÔÚ¿˜ ÂÚÈÏ·Ì‚¿ÓÂÈ Î·È ÁÂÓÂÙÈο ÙÚÔÔÔÈË̤Ó˜ ÔÈÎÈϛ˜ (1,26). ™ÙȘ ∏.¶.∞., Ë ·Ô‰Ô¯‹ ÙˆÓ °∆∆ ¤ÁÈÓ ÈÔ Â‡ÎÔÏ· ·’ fiÙÈ ÛÙËÓ ∂˘ÚÒË, fiÔ˘ ÙÔ 1996, fiÙ·Ó ¤ÁÈÓÂ Ë ÚÒÙË Ì·˙È΋ ÂÈÛ·ÁˆÁ‹ ÁÂÓÂÙÈο ÙÚÔÔÔÈË̤Ó˘ ÛfiÁÈ·˜, Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó ÔÚÁ·ÓˆÌ¤Ó˜ ÂÎÛÙÚ·Ù›˜ ÂÓË̤ڈÛ˘ ÙˆÓ Î·Ù·Ó·ÏˆÙÒÓ Î·È ȤÛÂˆÓ ÚÔ˜ ÙȘ ÔÏÈÙÈΤ˜ ËÁÂۛ˜ (19). ∏ ∂ÏÏ¿‰·, ÙÔ 1999, Ì·˙› Ì ٤ÛÛÂÚȘ ·ÎfiÌ· Â˘Úˆ·˚Τ˜ ¯ÒÚ˜, ÚfiÙÂÈÓ ¤Ó· ‰ÈÂÙ¤˜ ÌÔÚ·ÙfiÚÈÔ˘Ì, Ì ÙÔ ÔÔ›Ô ·ÔÊ·Û›ÛÙËÎÂ Ë ·Ó·ÛÙÔÏ‹ ÙˆÓ ÂÁÎÚ›ÛÂˆÓ Ó¤ˆÓ ÁÂÓÂÙÈο ÙÚÔÔÔÈËÌ¤ÓˆÓ ÚÔ˚fiÓÙˆÓ, ̤¯ÚȘ fiÙÔ˘ ÂÊ·ÚÌÔÛÙ› ÓÔÌÔıÂÛ›· Ô˘ Ó· ÔÚ›˙ÂÈ ··ÈÙ‹ÛÂȘ ÁÈ· ÙË Û‹Ì·ÓÛË ÙˆÓ °∆∆ Î·È ÙË ‰ÈÂÍÔ‰È΋ ¤Ú¢ӷ ÙˆÓ ÚÔ˚fiÓÙˆÓ ·˘ÙÒÓ (30). ∞fi ÙËÓ ÂÈÛÙËÌÔÓÈ΋ ÛÎÔÈ¿, ÔÏÏ¿ ÂÚˆÙ‹Ì·Ù· ·Ú·Ì¤ÓÔ˘Ó ·Ó·¿ÓÙËÙ·. ∆· °∆∆ ÌÔÚ› Ó· ·ÔÙÂϤÛÔ˘Ó ÛˆÙ‹ÚÈ· χÛË ÁÈ· ·ÛıÂÓ›˜ Ì ÙÚÔÊÈ΋ ·ÏÏÂÚÁ›·, ÂÓÒ ÌÔÚ› Ó· ·Ô‰ÂȯıÔ‡Ó ÔϤıÚÈ· ÁÈ· ¿ÏÏÔ˘˜. ∆· ‰Â‰Ô̤ӷ Ô˘ ·Ó·Ê¤ÚıËηÓ, ÂÌÊ·ÓÒ˜ ‰ÂÓ ‰ÈηÈÔÏÔÁÔ‡Ó Û˘Ó·ÈÛıËÌ·ÙÈΤ˜ ·ÓÙȉڿÛÂȘ, ÔÈ Ôԛ˜ Ôχ Û˘¯Ó¿ ·Ú·ÙËÚÔ‡ÓÙ·È ÙfiÛÔ ·fi Ù· ̤۷ Ì·˙È΋˜ ÂÓË̤ڈÛ˘ fiÛÔ Î·È ·fi ÂÈÛÙ‹ÌÔÓ˜. ∏ ÈÛÔÚÚÔË̤ÓË Î·È ¯ˆÚ›˜ ˘ÂÚ‚ÔϤ˜ ÚÔÛ¤ÁÁÈÛË ÙˆÓ ÂȉÈÎÒÓ ÌÔÚ› Ó· ·Ԃ› Ôχ ¯Ú‹ÛÈÌË, ·Ú¤¯ÔÓÙ·˜ ˘‡ı˘ÓË ÂÎ·›‰Â˘ÛË Î·È ÂÓË̤ڈÛË ÛÙÔ ÎÔÈÓfi. µÈ‚ÏÈÔÁÚ·Ê›· 1. ¶··‰fiÔ˘ÏÔ˜ ¡°. °ÂÓÂÙÈο ÙÚÔÔÔÈË̤Ó˜ ÙÚÔʤ˜: ÂÈÙÒÛÂȘ ÛÙËÓ ·ÏÏÂÚÁÈÔÁÔÓÈÎfiÙËÙ·. ™ÙÔ: ∆Ô ·ÏÏÂÚÁÈÎfi ·È‰› ÛÙËÓ ÎÏÈÓÈ΋ Ú¿ÍË. ¶ÔÏÂÌÈÎfi ªÔ˘ÛÂ›Ô ∞ıËÓÒÓ; 2001.

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∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 20-01-2003 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 02-09-2003 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ¡ÈÎfiÏ·Ô˜ °. ¶··‰fiÔ˘ÏÔ˜ µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡” §Â‚·‰Â›·˜ 13, ∆.∫. 115 27, °Ô˘‰› E-mail: ngp@allergy.gr

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OÈÎÔÏÔÁ›·, ÂȉËÌÈÔÏÔÁ›· Î·È ÂÚÁ·ÛÙËÚȷ΋ ‰È¿ÁÓˆÛË Ì˘ÎËÙÈ¿ÛÂˆÓ ÙÔ˘ ÙÚȯˆÙÔ‡ Ù˘ ÎÂÊ·Ï‹˜ Û ·È‰È¿ ∂. ºÚ·ÁÎÔ‡ÏË

Ecology, epidemiology and diagnosis of tinea capitis in children E. Frangoulis

¶ÂÚ›ÏË„Ë: ∏ Ì˘ÎËÙ›·ÛË ÙÔ˘ ÙÚȯˆÙÔ‡ Ù˘ ÎÂÊ·Ï‹˜ Â›Ó·È Ì›· ·fi ÙȘ Û˘Ó‹ıÂȘ ‰ÂÚÌ·ÙÈΤ˜ ÏÔÈÌÒÍÂȘ ÙˆÓ ·È‰ÈÒÓ Î·Ù¿ ÙËÓ ÚÔÛ¯ÔÏÈ΋ Î·È Û¯ÔÏÈ΋ ËÏÈΛ·. ∞ÈÙÈÔÏÔÁÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ·ÔÙÂÏÔ‡Ó ÔÚÈṲ̂ӷ ›‰Ë ‰ÂÚÌ·ÙfiÊ˘ÙˆÓ, ÙÔ˘ Á¤ÓÔ˘˜ Microsporum Î·È Trichophyton. ∆· ›‰Ë ·˘Ù¿, ·Ó¿ÏÔÁ· Ì ÙÔ Ê˘ÛÈÎfi ÙÔ˘˜ ÂÚÈ‚¿ÏÏÔÓ Î·È ÙËÓ ÚÔÙ›ÌËÛ‹ ÙÔ˘˜ ÚÔ˜ ÙÔÓ ÍÂÓÈÛÙ‹, ‰È·ÎÚ›ÓÔÓÙ·È Û ·ÓıÚˆfiÊÈÏ·, ˙ˆfiÊÈÏ· Î·È ÁÂÒÊÈÏ·. ™ÙË ¯ÒÚ· Ì·˜, Ù· ·ÚÈ· ·›ÙÈ· Â›Ó·È ÙÔ ˙ˆfiÊÈÏÔ M. canis Û ÔÛÔÛÙfi 87% Î·È ÙÔ ·ÓıÚˆfiÊÈÏÔ ∆. violaceum Û ÔÛÔÛÙfi 6%. ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ·ÓȯÓ‡ÔÓÙ·È Î·È ÌË ÂÓ‰ËÌÈο ·ÓıÚˆfiÊÈÏ· ›‰Ë, ΢ڛˆ˜ Û ÔÈÎÔÓÔÌÈÎÔ‡˜ ÌÂÙ·Ó¿ÛÙ˜ ·fi ¯ÒÚ˜ Ù˘ ª¤Û˘ ∞Ó·ÙÔÏ‹˜, Ù˘ ∞Û›·˜ Î·È Ù˘ ∞ÊÚÈ΋˜. ¶ËÁ‹ ÌfiÏ˘ÓÛ˘ ÁÈ· ÙȘ ˙ˆÔÊÈÏÈΤ˜ ÏÔÈÌÒÍÂȘ Â›Ó·È Ù· ˙Ò· Ô˘ ÓÔÛÔ‡Ó ‹ fi¯È, ÂȉÈο ‰Â ÁÈ· ÙÔ M. canis Â›Ó·È Ù· ηÙÔÈΛ‰È· Î·È Ù· ·‰¤ÛÔÙ· (Á¿Ù˜, Û·ÏÔÈ). ∏ ÌÂÙ¿‰ÔÛË ÙˆÓ ·ÓıÚˆÔÊÈÏÈÎÒÓ ÏÔÈÌÒÍÂˆÓ Á›ÓÂÙ·È Â›Ù Ì ¿ÌÂÛË Â·Ê‹ Ì ¿Û¯ÔÓÙ˜ ‹ ·Û˘Ìو̷ÙÈÎÔ‡˜ ÊÔÚ›˜ ›Ù Ì ¯Ú‹ÛË ÌÔÏ˘ÛÌ¤ÓˆÓ ·ÓÙÈÎÂÈ̤ӈÓ. OÈ Ì˘ÎËÙÈ¿ÛÂȘ ÙÔ˘ ÙÚȯˆÙÔ‡ Ù˘ ÎÂÊ·Ï‹˜ ˆ˜ Â› ÙÔ Ï›ÛÙÔÓ Â›Ó·È ÌË ÊÏÂÁÌÔÓÒ‰ÂȘ. OÈ ÊÏÂÁÌÔÓÒ‰ÂȘ ÌÔÚʤ˜ (¤Ì˘Ô˜ ÙÚȯÔÊ˘Ù›·) Û˘Ó‰¤ÔÓÙ·È Î˘Ú›ˆ˜ Ì ˙ˆfiÊÈÏÔ˘˜ Î·È ÁÂÒÊÈÏÔ˘˜ ̇ÎËÙ˜ Î·È Û¿ÓÈ· Ì ·ÓıÚˆfiÊÈÏÔ˘˜. O ¿¯ÔÚ·˜, Û¿ÓÈ· ÌÔÚÊ‹ Ì˘ÎËÙ›·Û˘ ÙÔ˘ ÙÚȯˆÙÔ‡ Ù˘ ÎÂÊ·Ï‹˜, ÚÔηÏÂ›Ù·È ·fi ÙÔ ·ÓıÚˆfiÊÈÏÔ Â›‰Ô˜ T. schoenleinii. ∏ ÂÚÁ·ÛÙËÚȷ΋ ÂͤٷÛË Â›Ó·È ·Ó·Áη›· ÁÈ· ÙËÓ ÂȂ‚·›ˆÛË Ù˘ ÎÏÈÓÈ΋˜ ‰È¿ÁÓˆÛ˘ Î·È ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙÔ˘ ˘‡ı˘ÓÔ˘ ›‰Ô˘˜. ¶ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ¿ÌÂÛË ÌÈÎÚÔÛÎÔÈ΋ ÂͤٷÛË ‰Â›ÁÌ·ÙÔ˜ ·fi ÙËÓ ÂÚÈÔ¯‹ Ù˘ Ïԛ̈͢, ηÏÏȤÚÁÂÈ· Î·È Ù·˘ÙÔÔ›ËÛË ÙÔ˘ ̇ÎËÙ· Ì ‚¿ÛË Ù· ÌÈÎÚÔÛÎÔÈο Î·È Ì·ÎÚÔÛÎÔÈο ÌÔÚÊÔÏÔÁÈο ÛÙÔȯ›· Ù˘ ·ÔÈΛ·˜.

Abstract: Tinea capitis is a common scalp infection affecting predominantly children of preschool and school age. It is caused by dermatophytes mostly of the genus Microsporum and Trichophyton.

These dermatophytes, depending on their natural habitat and host preference, are classified as geophilic, zoophilic and anthropophilic. The main tinea capitis pathogens in Greece are the zoophilic M. canis (87%) and the anthropophilic T. violaceum (6%).

During the last few years a number of dermatophyte species non-endemic in Greece have been isolated from immigrants from the Middle East, Asia and Africa. The main sources of zoophilic infections are infected animals; for M. canis domestic or stray dogs and cats. The transmission mode of anthropophilic infection involves contact with infected persons, asymptomatic carriers or fomites.

Tinea capitis is usually not inflammatory.

Inflammatory infections (Kerion) involve mostly zoophilic and geophilic dermatophytes and rarely anthropophilic. Favus is a rare scalp infection caused by the anthropophilic T. schoenleinii.

Clinical diagnosis should be confirmed by mycological examination which includes direct microscopy of the specimen, culture and identification of the pathogen on the basis of the macro- and microscopic features of the colony.

Identification is necessary for the selection of the appropriate antifungal agent. Clinicians should suspect tinea capitis in all scalp infections involving children of prepubertal age.

∂ÚÁ·ÛÙ‹ÚÈÔ µÈÔ·ıÔÏÔÁ›·˜, ¡ÔÛÔÎÔÌÂ›Ô ∞ÊÚÔ‰›ÛÈˆÓ Î·È ¢ÂÚÌ·ÙÈÎÒÓ ¡fiÛˆÓ “∞. ™˘ÁÁÚfi˜”, ∞ı‹Ó·

Laboratory of Biopathology, “Andreas Sygros” Skin and Venereal Disease Hospital, Athens

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∏ Ù·˘ÙÔÔ›ËÛË Â›Ó·È ··Ú·›ÙËÙË ÁÈ· ÙËÓ ÂÈÏÔÁ‹ Ù˘ ηٿÏÏËÏ˘ ·ÓÙÈÌ˘ÎËÙÈ·ÛÈ΋˜ ·ÁˆÁ‹˜. ŸÏ˜ ÔÈ ÂÚÈÙÒÛÂȘ ·ÏÏÔÈÒÛÂˆÓ ÙÔ˘ ÙÚȯˆÙÔ‡ Ù˘ ÎÂÊ·Ï‹˜ Û ·È‰È¿ ÚÔÂÊË‚È΋˜ ËÏÈΛ·˜ ı· Ú¤ÂÈ Ó· ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È ·fi ÙÔÓ ÎÏÈÓÈÎfi È·ÙÚfi ˆ˜ ‡ÔÙ˜ Ì˘ÎËÙÈ·ÛÈΤ˜ ÏÔÈÌÒÍÂȘ. §¤ÍÂȘ ÎÏÂȉȿ: Ì˘ÎËÙ›·ÛË ÙÚȯˆÙÔ‡ ÎÂÊ·Ï‹˜, ÔÈÎÔÏÔÁ›·, ÂȉËÌÈÔÏÔÁ›·, ÂÚÁ·ÛÙËÚȷ΋ ‰È¿ÁÓˆÛË.

Key words: tinea capitis, ecology, epidemiology, mycological examination.

∂ÈÛ·ÁˆÁ‹ O fiÚÔ˜ tinea ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·Ó ·fi ÙÔ˘˜ ƒˆÌ·›Ô˘˜ ÁÈ· ÙȘ Ì˘ÎËÙÈ·ÛÈΤ˜ Î·È ·Ú·ÛÈÙÈΤ˜ ÏÔÈÌÒÍÂȘ ÙÔ˘ ÙÚȯˆÙÔ‡ Ù˘ ÎÂÊ·Ï‹˜, ηıÒ˜ ıˆÚÔ‡Û·Ó ˆ˜ ˘‡ı˘ÓÔ ÙÔÓ ÛÎfiÚÔ ÙˆÓ ÂÓ‰˘Ì¿ÙˆÓ (Ï·ÙÈÓÈο: tinea) (1). O fiÚÔ˜ ·˘Ùfi˜ ‚·ıÌÈ·›· ÂÈÎÚ¿ÙËÛÂ, ÒÛÙ ÛÙ· ̤۷ ÙÔ˘ 16Ô˘ ·ÈÒÓ· Ó· ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÁÈ· fiϘ ÙȘ ·ı‹ÛÂȘ ÙÔ˘ ÙÚȯˆÙÔ‡ Ù˘ ÎÂÊ·Ï‹˜.

OÚfiÛËÌÔ ÛÙËÓ È·ÙÚÈ΋ Ì˘ÎËÙÔÏÔÁ›· ·ÔÙÂÏ› Ë ·Ó·Î¿Ï˘„Ë ·fi ÙÔ˘˜ J. Schöenlein Î·È R. Remak, ÛÙȘ ·Ú¯¤˜ ÙÔ˘ 19Ô˘ ·ÈÒÓ·, fiÙÈ Ô Ì‡ÎËÙ·˜ ∞¯fiÚÈÔÓ (ÛËÌÂÚÈÓ‹ ÔÓÔÌ·Û›· Trichophyton schoenleinii) Â›Ó·È Ô ·ÈÙÈÔÏÔÁÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÙÔ˘ ¿¯ÔÚ· (2). ∆· ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο Ù˘ ÓfiÛÔ˘, Ô ÙÚfiÔ˜ ÌÂÙ¿‰ÔÛ˘, ηıÒ˜ Î·È Ô ÙÚfiÔ˜ ·Ú·ÛÈÙÈÛÌÔ‡ ÙÔ˘ ̇ÎËÙ· ÛÙËÓ ÙÚ›¯· ÂÚÈÁÚ¿ÊËÎ·Ó ·fi ÙÔÓ Gruby, Û ̛· ÛÂÈÚ¿ ·fi ÌÂϤÙ˜ ÙÔ˘, ÌÂٷ͇ ÙˆÓ ÂÙÒÓ 1840-1844 (3).

O Sabouraud, ÛÙ· Ù¤ÏË ÙÔ˘ 19Ô˘ ·ÈÒÓ·, ÌÂϤÙËÛ ÙË ÌÔÚÊÔÏÔÁ›· ÙˆÓ ‰ÂÚÌ·ÙfiÊ˘ÙˆÓ, ‰È¤ÎÚÈÓ ÙÔ˘˜ ‰È¿ÊÔÚÔ˘˜ Ù‡Ô˘˜ Ì˘ÎËÙÈ¿ÛÂˆÓ (ÌÈÎÚÔÛÔÚ›·, ÙÚȯÔÊ˘Ù›·, ¿¯ÔÚ·˜), ÂÚȤÁÚ·„ ÙËÓ ÎÏÈÓÈ΋ ÙÔ˘˜ ÂÈÎfiÓ· Î·È ·Ú·Ù‹ÚËÛ fiÙÈ Ô ÙÚȯÔÊ˘ÙÈÎfi˜ Ù‡Ô˜ ÌÔÚ› Ó· ÚÔÎÏËı› ·fi ÔÏÏ¿ ›‰Ë ‰ÂÚÌ·ÙfiÊ˘ÙˆÓ (4). ∂›Û˘, Ù·ÍÈÓfiÌËÛ ٷ ‰ÂÚÌ·ÙfiÊ˘Ù· Û ٤ÛÛÂÚ· Á¤ÓË: Trichophyton, Microsporum, Epidermophyton Î·È Achorion. ∆Ô 1934, Ô Emmons, ÌÂÏÂÙÒÓÙ·˜ ÙË ÌÈÎÚÔÛÎÔÈ΋ ÌÔÚÊÔÏÔÁ›· ÙˆÓ ÎÔÓȉ›ˆÓ (ÛÔÚ›ˆÓ) Î·È ÙË ‰ÔÌ‹ ÙˆÓ ˘ÊÒÓ (ÓËÌ·Ù›ˆÓ) ÙˆÓ ‰ÂÚÌ·ÙfiÊ˘ÙˆÓ, ηıfiÚÈÛ ÙÔ Ì¤¯ÚÈ Û‹ÌÂÚ· ·Ô‰ÂÎÙfi Û‡ÛÙËÌ· Ù·ÍÈÓfiÌËÛ‹˜ ÙÔ˘˜ Î·È Ù· η٤ٷÍ Û ÙÚ›· Á¤ÓË: Trichophyton, Microsporum Î·È Epidermophyton (5).

ÚÔÙ›ÌËÛ‹ ÙÔ˘˜ ÚÔ˜ ÙÔÓ ÍÂÓÈÛÙ‹ (¶›Ó·Î·˜ 1). ∆· ÁÂÒÊÈÏ· ›‰Ë ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÌÈÎÚfi ·ÚÈıÌfi ‰ÂÚÌ·ÙfiÊ˘ÙˆÓ, Û·ÚÔÊ˘ÙÔ‡Ó ÛÙÔ ¤‰·ÊÔ˜ Î·È ÚÔηÏÔ‡Ó Ì˘ÎËÙÈ¿ÛÂȘ ÙfiÛÔ ÛÙ· ˙Ò· fiÛÔ Î·È ÛÙÔÓ ¿ÓıÚˆÔ. ∆· ˙ˆfiÊÈÏ· ›‰Ë ÚÔÛ‚¿ÏÏÔ˘Ó Ù· ˙Ò·, ÔÏÏ¿ fï˜ ÛÙÂϤ¯Ë ÙÔ˘˜ ÚÔηÏÔ‡Ó Ì˘ÎËÙÈ¿ÛÂȘ Î·È ÛÙÔÓ ¿ÓıÚˆÔ. ∆· ·ÓıÚˆfiÊÈÏ· ›‰Ë ÚÔÛ‚¿ÏÏÔ˘Ó ·ÔÎÏÂÈÛÙÈο ÙÔÓ ¿ÓıÚˆÔ. ŒÙÛÈ, ÔÚÈṲ̂ӷ ›‰Ë Ì˘Î‹ÙˆÓ fiˆ˜ Ù· ª. gypseum Î·È ª. fulvum Û·ÚÔÊ˘ÙÔ‡Ó ÛÙÔ ¤‰·ÊÔ˜ Î·È ÚÔÛ‚¿ÏÏÔ˘Ó Ù· ˙Ò· Î·È ÙÔÓ ¿ÓıÚˆÔ, Ù· ª. canis Î·È T. mentagrophytes var mentagrophytes ÚÔÛ‚¿ÏÏÔ˘Ó Ù· ˙Ò· Î·È ÙÔÓ ¿ÓıÚˆÔ, ÂÓÒ ¿ÏÏ·, fiˆ˜ Ù· T. rubrum Î·È T. violaceum ·Ú·ÛÈÙÔ‡Ó ·ÔÎÏÂÈÛÙÈο ÛÙËÓ ·ÓıÚÒÈÓË ÎÂÚ·Ù›ÓË ÛÙÈ‚¿‰·. ∞fi Ù· 40 ›‰Ë ‰ÂÚÌ·ÙfiÊ˘ÙˆÓ Ô˘ Â›Ó·È ·ıÔÁfiÓ· ÁÈ· ÙÔÓ ¿ÓıÚˆÔ, ÌfiÓÔ 10-12 ›‰Ë, ·fi Ù· Á¤ÓË Microsporum Î·È Trichophyton Î·È Û·ÓÈfiٷٷ ·fi ÙÔ Á¤ÓÔ˜ Epidermophyton, Û˘Ó‰¤ÔÓÙ·È Ì ‰ÂÚÌ·ÙÔÊ˘Ù›Â˜ ÙÔ˘ ÙÚȯˆÙÔ‡ Ù˘ ÎÂÊ·Ï‹˜.

OÈÎÔÏÔÁ›· ∆· ‰ÂÚÌ·ÙfiÊ˘Ù· ·ÔÙÂÏÔ‡Ó ÔÌ¿‰· ÓËÌ·ÙÔÂȉÒÓ Ì˘Î‹ÙˆÓ Ô˘, Ì ÙË ‚Ô‹ıÂÈ· ÂȉÈÎÒÓ ÚˆÙÂ˚ÓÒÓ Î·È ÂÓ˙‡ÌˆÓ (ÎÂÚ·ÙÈÓ¿Û˜), ·ÔÈÎÔ‰ÔÌÔ‡Ó Î·È ‰ÈÂÈÛ‰‡Ô˘Ó ÛÙËÓ ÎÂÚ¿ÙÈÓË ÛÙÈ‚¿‰·, ÚÔηÏÒÓÙ·˜ ÏÔÈÌÒÍÂȘ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜, ÙˆÓ Ó˘¯ÈÒÓ Î·È ÙˆÓ ÙÚȯÒÓ. ∂ÎÙfi˜ ·fi ÙËÓ Ù·ÍÈÓfiÌËÛ‹ ÙÔ˘˜ Û ÙÚ›· ·Ó¿ÌÔÚÊ· (·ÛÂÍÔ˘·ÏÈο) Á¤ÓË (Trichophyton, Microsporum Î·È ∂pidermophyton), Ù· ‰ÂÚÌ·ÙfiÊ˘Ù· Ù·ÍÈÓÔÌÔ‡ÓÙ·È, Â›Û˘, Û ÁÂÒÊÈÏ·, ˙ˆfiÊÈÏ· Î·È ·ÓıÚˆfiÊÈÏ· (6), ·Ó¿ÏÔÁ· Ì ÙÔ Ê˘ÛÈÎfi ÙÔ˘˜ ÂÚÈ‚¿ÏÏÔÓ Î·È ÙËÓ

∂ȉËÌÈÔÏÔÁ›· ∏ Ì˘ÎËÙ›·ÛË ÙÔ˘ ÙÚȯˆÙÔ‡ Ù˘ ÎÂÊ·Ï‹˜ (ª∆∫) Â›Ó·È Ë Û˘ÓËı¤ÛÙÂÚË ‰ÂÚÌ·ÙÈ΋ Ïԛ̈ÍË ÙÔ˘ ÙÚȯˆÙÔ‡ ÎÂÊ·Ï‹˜ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜, ηٿ ÙËÓ ÔÔ›· ÚÔÛ‚¿ÏÏÔÓÙ·È ÔÈ ÙÚ›¯Â˜, ÔÈ ı‡Ï·ÎÔÈ Î·È ÙÔ ÂÚÈ‚¿ÏÏÔÓ ‰¤ÚÌ·. ∂›Ó·È ÌÔÏ˘ÛÌ·ÙÈ΋ ÓfiÛÔ˜, Ë ÔÔ›· ¤¯ÂÈ ˆ˜ ·ÈÙÈÔÏÔÁÈÎfi ·Ú¿ÁÔÓÙ· Ù· ‰ÂÚÌ·ÙfiÊ˘Ù·. ¶ÚÔÛ‚¿ÏÏÂÈ ·È‰È¿ ·fi ÙËÓ ËÏÈΛ· ÙˆÓ 6 ÌËÓÒÓ Ì¤¯ÚÈ ÙËÓ ÂÊ˂›· (7,8). ∂›Ó·È Û¿ÓÈ· ÛÙÔ˘˜ ÂÓ‹ÏÈΘ Î·È ·˘Ùfi ·Ô‰›‰ÂÙ·È ÛÙË Ì˘ÎËÙÔÎÙfiÓÔ ‰Ú¿ÛË ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ ÙÔ˘ ÛÌ‹ÁÌ·ÙÔ˜, Ë ÂÚÈÂÎÙÈÎfiÙËÙ· ÙˆÓ ÔÔ›ˆÓ ·˘Í¿ÓÂÈ ÌÂÙ¿ ÙËÓ ÂÊ˂›· (9,10). ∆· ÁÂÒÊÈÏ· ‰ÂÚÌ·ÙfiÊ˘Ù· Â›Ó·È Â˘Ú¤ˆ˜ ‰È·‰Â‰Ô̤ӷ, ÂÓÒ Ù· ·ÓıÚˆfiÊÈÏ· Î·È ÔÚÈṲ̂ӷ ˙ˆfiÊÈÏ· ›‰Ë Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ¤¯Ô˘Ó ÂÚÈÔÚÈṲ̂ÓË ÁˆÁÚ·ÊÈ΋ ηٷÓÔÌ‹, Ë ÔÔ›· ÂÍ·ÚÙ¿Ù·È ·fi ÙÔÓ ÍÂÓÈÛÙ‹. ∏ ηٷÓÔÌ‹ ·˘Ù‹ ÌÂÙ·‚¿ÏÏÂÙ·È ‰È·¯ÚÔÓÈο ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙˆÓ ‚ÂÏÙÈÒÛÂˆÓ ÛÙȘ Û˘Óı‹Î˜ ‰È·‚›ˆÛ˘ Î·È ˘ÁÈÂÈÓ‹˜, ÙˆÓ ÌÂÙ·ÎÈÓ‹ÛÂˆÓ ÏËı˘ÛÌÒÓ Î·È Ù˘ ·Ó¿Ù˘Í˘ ·ÓÙÈÌ˘ÎËÙÈ·ÛÈÎÒÓ Ê·ÚÌ¿ÎˆÓ (11). ∏ ·Ó·Î¿Ï˘„Ë Ù˘ ÁÎÚÈ˙ÂÔÊÔ˘Ï‚›Ó˘, ÙÔ 1958, ·ÔÙÂÏ› ÔÚfiÛËÌÔ ÁÈ· ÙË ıÂÚ·›· ÙˆÓ

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¶·È‰È·ÙÚÈ΋ 2003;66:426-435

Paediatriki 2003;66:426-435

¶›Ó·Î·˜ 1. ∆· ΢ÚÈfiÙÂÚ· ›‰Ë ÙˆÓ ·ıÔÁfiÓˆÓ ‰ÂÚÌ·ÙfiÊ˘ÙˆÓ ∞ÓıÚˆfiÊÈÏÔÈ Trichophyton spp T. rubrum T. mentagrophytes var interdigitale T. megninii T. violaceum T. tonsurans T. soudanense T. concentricum T. gourvilii T. youndeii T. schoenleinii ∆. raubitschekii Microsporum spp M. audouinii M. audouinii var rivalieri M. ferrugineum

∑ˆfiÊÈÏÔÈ

°ÂÒÊÈÏÔÈ

T. T. T. T. T.

T. terestre

mentagrophytes var mentagrophytes verrucosum equinum mentagrophtes var erinacei simii

M. M. M. M. M. M.

canis var canis canis var distortum equinum gallinae persicolor nanum

M. M. M. M.

gypseum fulvum paecox vanbreuseghemii

Epidermophyton spp ∂. floccosum

Ì˘ÎËÙÈ¿ÛÂˆÓ Î·È Â›¯Â Û·Ó ·ÔÙ¤ÏÂÛÌ· ÙÔÓ ÛËÌ·ÓÙÈÎfi ÂÚÈÔÚÈÛÌfi ÙˆÓ ÂÓ‰ËÌÈÎÒÓ ÏÔÈÌÒÍÂˆÓ (12). ∏ ÁˆÁÚ·ÊÈ΋ ηٷÓÔÌ‹ ÙˆÓ ‰ÂÚÌ·ÙfiÊ˘ÙˆÓ ÔÈΛÏÂÈ. ™ÙË µfiÚÂÈ· Î·È ÙËÓ ∫ÂÓÙÚÈ΋ ∞ÌÂÚÈ΋ ÂÈÎÚ·Ù¤ÛÙÂÚÔ ·›ÙÈÔ ª∆∫ ·ÔÙÂÏ› Ô ·ÓıÚˆfiÊÈÏÔ˜ ̇ÎËÙ·˜ ∆. tonsurans (90%) (13-15). O ̇ÎËÙ·˜ ÚÔÛ‚¿ÏÏÂÈ Î˘Ú›ˆ˜ πÛ·ÓfiʈÓÔ˘˜ Î·È ∞ÊÚÔ·ÌÂÚÈηÓÔ‡˜ (16). ™ÙË ¡fiÙÈ· ∞ÌÂÚÈ΋, ÙËÓ ∞˘ÛÙÚ·Ï›· Î·È ÙË ¡¤· ∑ËÏ·Ó‰›· ÂÈÎÚ·ÙÔ‡Ó Ù· ›‰Ë M. canis Î·È T. tonsurans (7,17). ™ÙË ¢˘ÙÈ΋ Î·È ¡fiÙÈ· ∞Û›· ÙÔ Û˘ÓËı¤ÛÙÂÚÔ Â›‰Ô˜ Â›Ó·È ÙÔ T. violaceum (18), ÂÓÒ ÛÙȘ ¯ÒÚ˜ Ù˘ ª¤Û˘ ∞Ó·ÙÔÏ‹˜ ÂÈÎÚ·ÙÔ‡Ó Ù· ›‰Ë M. canis, T. violaceum Î·È T. mentagrophytes var mentagrophytes (19,20). ™ÙËÓ ∞ÊÚÈ΋, Ì ÂÍ·›ÚÂÛË ÙËÓ ∞›Á˘ÙÔ fiÔ˘ ÚÔÂÍ¿Ú¯ÂÈ ÙÔ M. canis (21), ÂÓ‰ËÌÔ‡Ó Î˘Ú›ˆ˜ ·ÓıÚˆfiÊÈÏ· ›‰Ë, fiˆ˜ Ù· ∆. violaceum, M. audouinii, M. rivalieri, T. soudanense, M. ferrugineum Î·È T. schoenleinii, ∆. yaoundei Î·È T. gourvilii (22,23). ™Â ·ÚÎÂÙ¤˜ ¯ÒÚ˜ Ù˘ ∞ÊÚÈ΋˜ ÙÔ ÔÛÔÛÙfi ÙˆÓ ·ÛıÂÓÒÓ Ì ÂÓÂÚÁ‹ ÓfiÛÔ ·Ó¤Ú¯ÂÙ·È Û 10-30% (21). ™ÙË ¢˘ÙÈ΋ ∂˘ÚÒË, Û‡Ìʈӷ Ì ÚfiÛÊ·ÙË ÂȉËÌÈÔÏÔÁÈ΋ ÌÂϤÙË ÙˆÓ ª∆∫ Û 19 Â˘Úˆ·˚Τ˜ ¯ÒÚ˜, ·Ú·ÙËÚ‹ıËÎÂ, ηٿ ÙËÓ ÙÂÏÂ˘Ù·›· ‰ÂηÂÙ›·, ÌÂÁ¿ÏË ·‡ÍËÛË ÙˆÓ ·ÓıÚˆÔÊÈÏÈÎÒÓ ÏÔÈÌÒÍÂˆÓ È‰È·›ÙÂÚ· ÛÙȘ ·ÛÙÈΤ˜ ÂÚÈÔ¯¤˜, Ì ·ÔÙ¤ÏÂÛÌ· Ó· ˘ÂÚÙÂÚÔ‡Ó ÙˆÓ ˙ˆÔÊÈÏÈÎÒÓ Û ·Ó·ÏÔÁ›· 1:0,8 (24). ∏ ·‡ÍËÛË ·˘Ù‹ Û˘Ó‰¤ÂÙ·È Ì ÙËÓ ÂÈÛÚÔ‹ ÌÂÙ·Ó·ÛÙÒÓ ·fi ¯ÒÚ˜ Ù˘ ∞ÊÚÈ΋˜ Î·È Ù˘ ∞Û›·˜ (25). ¶·Ú¿ Ù·‡Ù·, Ô ˙ˆfiÊÈÏÔ˜ M. canis Â›Ó·È Ô ÂÈÎÚ·Ù¤ÛÙÂÚÔ˜ ̇ÎËÙ·˜, Ì ÌÂÁ·Ï‡ÙÂÚË Â›ÙˆÛË ÛÙȘ ¯ÒÚ˜ Ù˘ ¡fiÙÈ·˜ ∂˘ÚÒ˘ (8,26-28).

428

∆ËÓ ÙÂÏÂ˘Ù·›· ÙÚÈ·ÎÔÓÙ·ÂÙ›· ·Ú·ÙËÚ‹ıËÎ·Ó ÛËÌ·ÓÙÈΤ˜ ·ÏÏ·Á¤˜ ÛÙËÓ ÂȉËÌÈÔÏÔÁ›· ÙˆÓ ‰ÂÚÌ·ÙfiÊ˘ÙˆÓ ÛÙË ¯ÒÚ· Ì·˜. ∆· ·ÓıÚˆfiÊÈÏ· ›‰Ë ∆. schoenleinii Î·È M. audouinii, Ù· ÔÔ›· ÂÈÎÚ·ÙÔ‡Û·Ó ÙȘ ÚÒÙ˜ ‰ÂηÂٛ˜ ÙÔ˘ 20Ô‡ ·ÈÒÓ·, ·ÓÙÈηٷÛÙ¿ıËÎ·Ó ‚·ıÌÈ·›· ·fi ÙÔ T. violaceum (29,30), Ë ·ÚÔ˘Û›· ÙÔ˘ ÔÔ›Ô˘, fï˜, ÌÂÈÒıËΠÛËÌ·ÓÙÈο ÛÙË Û˘Ó¤¯ÂÈ· Î·È ·ÓÙÈηٷÛÙ¿ıËΠ·fi ÙÔ ª. canis, ÙÔ ÔÔ›Ô Û‹ÌÂÚ· Â›Ó·È Ô Î˘ÚÈfiÙÂÚÔ˜ ·ÈÙÈÔÏÔÁÈÎfi˜ ·Ú¿ÁÔÓÙ·˜. ∆· ›‰Ë ∆. schoenleinii Î·È M. audouinii ¤¯Ô˘Ó ۯ‰fiÓ ÂÎÚÈ˙ˆı› ÛÙÔÓ ÁËÁÂÓ‹ ÏËı˘ÛÌfi, ÂÓÒ ÙÔ T. violaceum ÂÚÈÔÚ›˙ÂÙ·È ϤÔÓ Û ·ÁÚÔÙÈΤ˜ ÂÚÈÔ¯¤˜ Ù˘ ¯ÒÚ·˜, fiÔ˘ ˘¿Ú¯ÂÈ Û˘Á¯ÚˆÙÈÛÌfi˜ ·ÙfiÌˆÓ Î·È ÔÈ Û˘Óı‹Î˜ ˘ÁÈÂÈÓ‹˜ Î·È ‰È·‚›ˆÛ˘ Â›Ó·È ‰˘ÛÌÂÓ›˜, ηıÒ˜ Â›Û˘ Î·È Û ÔÈÎÔÓÔÌÈÎÔ‡˜ ÌÂÙ·Ó¿ÛÙ˜, ·È‰È¿ Î·È ÂÓ‹ÏÈΘ ·fi ¯ÒÚ˜ Ù˘ µ·ÏηÓÈ΋˜ Î·È Ù˘ ∞Ó·ÙÔÏÈ΋˜ ∂˘ÚÒ˘ (31,32). ∂ȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜ Ô˘ ¤ÁÈÓ·Ó Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÛÙË ¯ÒÚ· Ì·˜ ¤‰ÂÈÍ·Ó fiÙÈ Û ·ÛıÂÓ›˜ Ì ª∆∫ ¤¯ÂÈ ·ÔÌÔÓˆı› ¢ڇ Ê¿ÛÌ· ·ıÔÁfiÓˆÓ Ì˘Î‹ÙˆÓ, fiˆ˜ Ù· ª. canis, T. violaceum, T. mentagrophytes var mentagrophytes, M. gypseum, T. verrucosum, T. tonsurans, M. audouinii, T. soudanense, M. ferrugineum, T. schoenleinii Î·È T. erinacei (¶›Ó·Î·˜ 2). ∆· ÚÒÙ· 6 ›‰Ë ·fi ·˘Ù¿ ¤¯Ô˘Ó ·ÔÌÔÓˆı› ÛÙÔÓ ÁËÁÂÓ‹ ÏËı˘ÛÌfi (28,3336), ÂÓÒ Ù· ˘fiÏÔÈ· ¤¯Ô˘Ó ·ÔÌÔÓˆı› Û ·È‰È¿ ÌÂÙ·Ó·ÛÙÒÓ ·fi ¯ÒÚ˜ Ù˘ ∞ÊÚÈ΋˜ Î·È Ù˘ ∞Û›·˜, fiÔ˘ Ù· ›‰Ë ·˘Ù¿ ÂÓ‰ËÌÔ‡Ó (37,38). ∆Ô T. violaceum ·ÔÌÔÓÒıËÎÂ, Â›Û˘, Û ·È‰È¿ ÌÂÙ·Ó·ÛÙÒÓ ·fi ÙËÓ ∞Ï‚·Ó›· Î·È ÙËÓ ∞Ó·ÙÔÏÈ΋ ∂˘ÚÒË (31,32). °È· ÙÔÓ ·ÓıÚˆfiÊÈÏÔ Ì‡ÎËÙ· ∆. rubrum,

¶·È‰È·ÙÚÈ΋ 2003;66:426-435

Paediatriki 2003;66:426-435

Û‡ÓËı˜ ·›ÙÈÔ Ì˘ÎËÙÈ¿ÛÂˆÓ Ó˘¯ÈÒÓ Î·È ‰¤ÚÌ·ÙÔ˜ ÛÙÔ˘˜ ÂÓ‹ÏÈΘ, ˘¿Ú¯Ô˘Ó ÛÔÚ·‰ÈΤ˜ ·Ó·ÊÔÚ¤˜ ª∆∫ Ì ¿Ù˘Ë ÎÏÈÓÈ΋ ÂÈÎfiÓ· (39). ∆Ô ·ÓıÚˆfiÊÈÏÔ Â›‰Ô˜ ∂. floccosum ÂÍ·ÈÚÂÙÈο Û¿ÓÈ· ·ÔÙÂÏ› ·›ÙÈÔ ª∆∫ (40), ÂÓÒ ‰ÂÓ ˘¿Ú¯ÂÈ ·Ó·ÊÔÚ¿ ÁÈ· ÙÔ ·ÓıÚˆfiÊÈÏÔ Â›‰Ô˜ ∆. concentricum (11). ™˘ÌÂÚ·ÛÌ·ÙÈο, ·Ú·ÙËÚ›ٷÈ: ·) ·‡ÍËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ ÙÔ˘ M. canis ÛÙË ¡fiÙÈ· ∞ÌÂÚÈ΋, ÛÙË ¡fiÙÈ· Î·È ∞Ó·ÙÔÏÈ΋ ∂˘ÚÒË Î·È ÛÙË ª¤ÛË ∞Ó·ÙÔÏ‹, ‚) ·‡ÍËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ ÙÔ˘ T. tonsurans ÛÙË µfiÚÂÈ· ∞ÌÂÚÈ΋ Î·È Û ÔÚÈṲ̂Ó˜ ¯ÒÚ˜ Ù˘ ∂˘ÚÒ˘ (∞ÁÁÏ›·, °·ÏÏ›·), Á) ·Ú·ÌÔÓ‹ ÙÔ˘ ∆. violaceum Û ÔÚÈṲ̂Ó˜ ÂÚÈÔ¯¤˜ Ù˘ ∞Ó·ÙÔÏÈ΋˜ ∂˘ÚÒ˘, Ù˘ ∞ÊÚÈ΋˜ Î·È ÛÙËÓ πÓ‰›·, ‰) ·Ú·ÌÔÓ‹ ÂÓ‰ËÌÈÎÒÓ Ì˘Î‹ÙˆÓ ÛÙËÓ ∞ÊÚÈ΋, fiˆ˜ ÙÔ˘ T. soudanense Î·È ÙÔ˘ M. ferrugineum Â) ÂÌÊ¿ÓÈÛË ÛÙËÓ ∂˘ÚÒË ÔÚÈÛÌ¤ÓˆÓ ·ÓıÚˆfiÊÈÏˆÓ Ì˘Î‹ÙˆÓ, fiˆ˜ Ô T. soudanense, Ô M. audouinii Î·È Ô T. Violaceum, Û ÎÔÈÓfiÙËÙ˜ ÌÂÙ·Ó·ÛÙÒÓ ·fi ÙËÓ ∞ÊÚÈ΋, ÙËÓ ∞Û›· Î·È ÙË ¡ÔÙÈÔ·Ó·ÙÔÏÈ΋ ∂˘ÚÒË Î·È ÛÙ) ÂÎÚ›˙ˆÛË ÙÔ˘ ∆. shoenleinii ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ¯ÒÚ˜, ÏËÓ Ù˘ ∞ÊÚÈ΋˜ (41). ∏ ª∆∫ ÚÔÛ‚¿ÏÏÂÈ Î˘Ú›ˆ˜ ·È‰È¿ ÚÔÛ¯ÔÏÈ΋˜ Î·È Û¯ÔÏÈ΋˜ ËÏÈΛ·˜, ÌÂٷ͇ 3-8 ÂÙÒÓ (8,27,28,42). Œ¯ÂÈ, Â›Û˘, ·Ú·ÙËÚËı› fiÙÈ Ë Û˘¯ÓfiÙËÙ¿ Ù˘ Â›Ó·È Û˘Ó¿ÚÙËÛË ÙÔ˘ ʇÏÔ˘ Î·È ÙÔ˘ ·ÈÙÈÔÏÔÁÈÎÔ‡ ·Ú¿ÁÔÓÙ· (43).

OÈ ÌÈÎÚÔÛÔÚÈÎÔ› ̇ÎËÙ˜ ÚÔÛ‚¿ÏÏÔ˘Ó Î·Ù¿ ÚÔÙ›ÌËÛË ÙÔ ¿ÚÚÂÓ Ê‡ÏÔ, ÂÓÒ ÛÙÔ˘˜ ÙÚȯÔÊ˘ÙÈÎÔ‡˜ Ë Î·Ù·ÓÔÌ‹ ÌÂٷ͇ ÙˆÓ ‰‡Ô Ê‡ÏˆÓ Â›Ó·È ÈÛfiÚÚÔË (28,43). ∆o M. canis ÚÔÛ‚¿ÏÏÂÈ Î·È Ù· ‰‡Ô ʇϷ, ȉȷ›ÙÂÚ· fï˜ Ù· ·ÁfiÚÈ·, ÂÓÒ ÙÔ M. audouinii ·ÚÔ˘ÛÈ¿˙ÂÈ ˘„ËÏ‹ ÂÈÏÂÎÙÈÎfiÙËÙ· (5:1) ÛÙ· ·ÁfiÚÈ· ¤Ó·ÓÙÈ ÙˆÓ ÎÔÚÈÙÛÈÒÓ (44). ™Â ÚfiÛÊ·ÙË ÌÂϤÙË Ô˘ ¤ÁÈÓ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô “∞. ™˘ÁÁÚfi˜”, Ë Û¯¤ÛË ÙˆÓ ·ÁÔÚÈÒÓ ÚÔ˜ Ù· ÎÔÚ›ÙÛÈ· ‹Ù·Ó 6:1 ÁÈ· ÙÔ˘˜ ÌÈÎÚÔÛÔÚÈÎÔ‡˜ ̇ÎËÙ˜ M. audouinii, M.

ferrugineum Î·È ª. gypseum, ÂÓÒ ÁÈ· ÙÔ ª. canis Ë ·Ó·ÏÔÁ›· ‹Ù·Ó ÌfiÓÔ 1,3:1. ¶Èı·ÓÒ˜, Ù· ÎÔÓÙ¿ Ì·ÏÏÈ¿ ÙˆÓ ·ÁÔÚÈÒÓ Ó· ¢ÓÔÔ‡Ó ÙËÓ ÂÌʇÙ¢ÛË ÙˆÓ ÛÔÚ›ˆÓ (16). ∞ÓÙ›ıÂÙ·, Ë Î·Ù·ÓÔÌ‹ ÙÔ˘ T. violaceum ‹Ù·Ó ÂÚ›Ô˘ 1:1 (38). ∆ÚfiÔ˜ ÌfiÏ˘ÓÛ˘ ∏ ÌÂÙ¿‰ÔÛË ÙˆÓ ˙ˆÔÊÈÏÈÎÒÓ ÏÔÈÌÒÍÂˆÓ Á›ÓÂÙ·È Â›Ù Ì ÙËÓ ¿ÌÂÛË Â·Ê‹ Ì ηÙÔÈΛ‰È· ‹ ¿ÁÚÈ· ˙Ò· Ô˘ Â›Ó·È ÌÔÏ˘Ṳ̂ӷ ‹ ÓÔÛÔ‡Ó Â›Ù ¤ÌÌÂÛ·, Ì ÂÓÂÚÁ¿ ÎÔÓ›‰È·, Ù· ÔÔ›· ·Ó¢ڛÛÎÔÓÙ·È Û ÊÚ¿ÎÙ˜, ÛÙ¿‚ÏÔ˘˜ Î.Ï. ∏ ·ÚÈ· ËÁ‹ ÌfiÏ˘ÓÛ˘ ÁÈ· ÙÔ ª. canis Â›Ó·È Ù· ηÙÔÈΛ‰È· ˙Ò· (Á¿Ù˜, Û·ÏÔÈ), ΢ڛˆ˜ Ù· ·‰¤ÛÔÙ· (28,33,36). ∏ ‰ÂÍ·ÌÂÓ‹ ·˘Ù‹ ÌfiÏ˘ÓÛ˘ Â›Ó·È ··Ú·›ÙËÙË, ‰Â‰Ô̤ÓÔ˘ fiÙÈ Ë ÌÔÏ˘ÛÌ·ÙÈ΋ ÈÛ¯‡˜ ÙÔ˘ M. canis ÂÍ·ÛıÂÓ› Û ÌÂÁ¿ÏÔ ‚·ıÌfi ÌÂÙ¿ ·fi Ù¤ÛÛÂÚȘ ‰È·‰Ô¯ÈΤ˜ ÌÂÙ·‚È‚¿ÛÂȘ ·fi ¿ÓıÚˆÔ Û ¿ÓıÚˆÔ (45). ∏ ËÁ‹ ÌfiÏ˘ÓÛ˘ ÁÈ· ÙÔ T. verrucosum Â›Ó·È Ù· ‚ÔÔÂȉ‹ Î·È Ù· ·ÈÁÔÚfi‚·Ù· Ô˘ ÓÔÛÔ‡Ó, ÂÓÒ ÁÈ· ÙÔ ∆. mentagrophytes var mentagrophytes Â›Ó·È oÈ ¯Ô›ÚÔÈ, ÔÈ ÎfiÓÈÎÏÔÈ, Ù· ·ÈÁÔÚfi‚·Ù· Î·È Ù· ÙÚˆÎÙÈο.

OÈ ÁÂÒÊÈÏÔÈ Ì‡ÎËÙ˜ Û·ÓÈfiٷٷ ÂÌϤÎÔÓÙ·È ˆ˜ ·ÈÙÈÔÏÔÁÈÎÔ› ·Ú¿ÁÔÓÙ˜ ª∆∫. ¶ËÁ‹ ÌfiÏ˘ÓÛ˘ ÁÈ· ÙȘ ·ÓıÚˆÔÊÈÏÈΤ˜ ÏÔÈÌÒÍÂȘ ·ÔÙÂÏÔ‡Ó ÔÈ ¿Û¯ÔÓÙ˜ Î·È Û ÛËÌ·ÓÙÈÎfi ‚·ıÌfi ÔÈ ·Û˘Ìو̷ÙÈÎÔ› ÊÔÚ›˜ Ù˘ ÓfiÛÔ˘ (46,47). ∏ ÌÂÙ¿‰ÔÛË ÙˆÓ ·ÓıÚˆÔÊÈÏÈÎÒÓ ÏÔÈÌÒÍÂˆÓ Á›ÓÂÙ·È Â›Ù Ì ¿ÌÂÛË Â·Ê‹ Ì ¿Û¯ÔÓÙ· ‹ ·Û˘Ìو̷ÙÈÎfi ÊÔÚ¤· ›Ù ¤ÌÌÂÛ·, Ì ÌÔÏ˘Ṳ̂ӷ ·ÓÙÈΛÌÂÓ·, fiˆ˜ ›‰Ë ÎÔÌ̈ÙÈ΋˜, ÚÔ‡¯·, η¤Ï·, ÂÙÛ¤Ù˜, ÎÏÈÓÔÛÎÂ¿ÛÌ·Ù·, ·ÎÔ˘ÛÙÈο ÙËÏÂʈÓÈÎÒÓ Û˘Û΢ÒÓ, ·È¯Ó›‰È· Î.¿. (48,49). ∫ÔÓ›‰È· (ÛfiÚÈ·) Ì˘Î‹ÙˆÓ ¤¯Ô˘Ó ·ÔÌÔÓˆı› fi¯È ÌfiÓÔÓ Û ÙÚ›¯Â˜ ·Û¯fiÓÙˆÓ Ô˘ ¤¯Ô˘Ó ·Ô¤ÛÂÈ, ·ÏÏ¿ Î·È Û ÌÔÏ˘Ṳ̂ӷ ·ÓÙÈΛÌÂÓ· Î·È ¤ÈÏ· ÙÔ˘ ÛÈÙÈÔ‡.

¶›Ó·Î·˜ 2. ∂›‰Ë ‰ÂÚÌ·ÙfiÊ˘ÙˆÓ Ô˘ ·ÔÌÔÓÒıËÎ·Ó Û ·È‰È¿ ÌÂ Ì˘ÎËÙ›·ÛË ÙÔ˘ ÙÚȯˆÙÔ‡ Ù˘ ÎÂÊ·Ï‹˜ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô “∞. ™˘ÁÁÚfi˜” ηٿ ÙËÓ ÂÍ·ÂÙ›· 1996-2001 °ËÁÂÓ›˜ ¢ÂÚÌ·ÙfiÊ˘ÙÔ

No

%

A

£

M. canis T. violaceum M. audouinii T. mentagrÔphytes var ment M. ferrugineum M. gypseum T. verrucosum T. soudanense T. rubrum T. schoenleinii T. erinacei ™‡ÓÔÏÔ

454 31 9 6 7 5 2 3 2 1 1 521

87,1 6,0 1,7 1,2 1,3 1,0 0,4 0,6 0,4 0,2 0,2 100,0

233 10 4 4 2 2 255

163 8 1 1 173

ªÂÙ·Ó¿ÛÙ˜ ∞ £ 32 6 8 1 6 2 55

26 7 1 1 1 1 1 38

429

¶·È‰È·ÙÚÈ΋ 2003;66:426-435

∆· ÎÔÓ›‰È· Â›Ó·È ‚ÈÒÛÈÌ· ÁÈ· ÌÂÁ¿ÏÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·, Ë ‰Â ·Ú·ÌÔÓ‹ ÙÔ˘˜ Û ¤ÈÏ· Î·È ·ÓÙÈΛÌÂÓ· ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ ÙÔ˘ ·ÛıÂÓÔ‡˜ ÂÍËÁ› fi¯È ÌfiÓÔÓ ÙË ÌÂÙ¿‰ÔÛË Ù˘ ÓfiÛÔ˘ ÂÓ ·Ô˘Û›· ÍÂÓÈÛÙ‹, ·ÏÏ¿ Î·È ÙËÓ Ù˘¯fiÓ ·ÔÙ˘¯›· Ù˘ ıÂÚ·›·˜, ηıÒ˜ Â›Û˘ Î·È ÙȘ Û˘¯Ó¤˜ ˘ÔÙÚÔ¤˜ Ù˘ ÓfiÛÔ˘ ÌÂÙ¿ ÙË ıÂÚ·›·. ∏ ÌÂÙ¿‰ÔÛË Á›ÓÂÙ·È Â›Ù ÛÙÔ Û›ÙÈ ·fi ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÂÚÈ‚¿ÏÏÔÓ ‹ Û ¿ÏÏÔ˘˜ ÙfiÔ˘˜ Û˘Á¯ÚˆÙÈÛÌÔ‡, fiˆ˜ Ù· ÓËÈ·ÁˆÁ›·, Ù· Û¯ÔÏ›·, Ù· ÓÔÛÔÎÔÌ›·, Ù· ÎÔ˘Ú›· Î.¿. (50,51), ÂÓÒ ‰È¢ÎÔχÓÂÙ·È ·fi ÙÔÓ ÛÙÂÓfi Û˘Á¯ÚˆÙÈÛÌfi Î·È ÙËÓ Î·Î‹ ·ÙÔÌÈ΋ ˘ÁÈÂÈÓ‹. ™ËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙË ÌÂÙ¿‰ÔÛË ·ÏÏ¿ Î·È ÙË Û˘ÓÙ‹ÚËÛË ÙˆÓ ÂȉËÌÈÒÓ Î·Ù¤¯ÂÈ Ë ‡·ÚÍË ·Û˘Ìو̷ÙÈÎÒÓ ÊÔÚ¤ˆÓ. ø˜ ·Û˘Ìو̷ÙÈÎÔ› ÊÔÚ›˜ ÔÚ›˙ÔÓÙ·È Ù· ¿ÙÔÌ· Ô˘ ‰ÂÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÂÌÊ·Ó‹ ÎÏÈÓÈ΋ ÂÈÎfiÓ· Ì˘ÎËÙ›·Û˘, ¤¯Ô˘Ó Û˘¯Ó¿ ·ÚÓËÙÈο ¿ÌÂÛ· ÌÈÎÚÔÛÎÔÈο ·Ú·Û΢¿ÛÌ·Ù·, ·ÏÏ¿ ÔÈ Î·ÏÏȤÚÁÂȘ Â›Ó·È ÙÂÏÈο ıÂÙÈΤ˜ (43,47). ŸÏ˜ ۯ‰fiÓ ÔÈ ·Ó·ÊÔÚ¤˜ Ì ˘„ËÏfi ÔÛÔÛÙfi ·Û˘Ìو̷ÙÈÎÒÓ ÊÔÚ¤ˆÓ ·ÊÔÚÔ‡Ó Û ·ÓıÚˆfiÊÈÏÔ˘˜ ̇ÎËÙ˜, fiˆ˜ ÔÈ T. tonsurans Î·È T. violaceum Î·È Û ‹È·˜ ÌÔÚÊ‹˜ Ïԛ̈ÍË, ÔÌÔÈ¿˙Ô˘Û· Ì ÛÌËÁÌ·ÙÔÚÚÔ˚΋ ‰ÂÚÌ·Ù›Ùȉ· (46). ∆Ô ÔÛÔÛÙfi ÙˆÓ ·Û˘Ìو̷ÙÈÎÒÓ ÊÔÚ¤ˆÓ ÔÈΛÏÏÂÈ ÛËÌ·ÓÙÈο Î·È Û¯ÂÙ›˙ÂÙ·È Ì ÙË Û˘¯ÓfiÙËÙ· ÙˆÓ ª∆∫ ·Ó¿ ¯ÒÚ·. OÚÈṲ̂Ó˜ ÌÂϤÙ˜, ÔÈ Ôԛ˜ ¤ÁÈÓ·Ó Û ۯÔÏ›· Î·È Û ÎÔÈÓfiÙËÙ˜, fiÔ˘ Ë ª∆∫ Â›Ó·È Û˘¯Ó‹, ¤‰ÂÈÍ·Ó fiÙÈ ÙÔ ÔÛÔÛÙfi ÙˆÓ ·Û˘Ìو̷ÙÈÎÒÓ ÊÔÚ¤ˆÓ ·Ó¤Ú¯ÂÙ·È Û 15% ÂÚ›Ô˘ (23,51), ÂÓÒ ·ÓÙ›ıÂÙ·, Û ¢Ú›· ÌÂϤÙË Ì·ıËÙÒÓ Ô˘ ¤ÁÈÓ ÛÙËÓ πÛ·Ó›· Î·È ÙËÓ πÙ·Ï›·, ÙÔ ÔÛÔÛÙfi Â›Ó·È ÂÍ·ÈÚÂÙÈο ¯·ÌËÏfi (0,2% Î·È 0,3%, ·ÓÙ›ÛÙÔȯ·) (52,53). ¶Ôχ ˘„ËÏ¿ ÔÛÔÛÙ¿ ·Û˘Ìو̷ÙÈÎÒÓ ÊÔÚ¤ˆÓ ·Ó·Ê¤ÚÔÓÙ·È ÛÙË ¡fiÙÈ· ∞ÊÚÈ΋, fiÔ˘ ÂÓ‰ËÌ› ÙÔ ∆. violaceum. OÈ Nail Î·È Û˘Ó ·Ó·Ê¤ÚÔ˘Ó fiÙÈ Û ÔÚÈṲ̂ӷ ̤ÚË Ù˘ ∞ÊÚÈ΋˜ ÔÛÔÛÙfi 41% ÙˆÓ ·È‰ÈÒÓ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ Â›Ó·È ÊÔÚ¤·˜ Î·È 30% ÙˆÓ ÌËÙ¤ÚˆÓ ·˘ÙÒÓ ÙˆÓ ·È‰ÈÒÓ Â›¯Â ÂÓÂÚÁ‹ ÓfiÛÔ (54). OÈ Vargo Î·È Cohen, ÂÍÂÙ¿˙ÔÓÙ·˜ ÙfiÛÔ Ù· ÂÓ‹ÏÈη ̤ÏË fiÛÔ Î·È Ù· ·È‰È¿ Ù˘ ›‰È·˜ ÔÈÎÔÁ¤ÓÂÈ·˜, ‚Ú‹Î·Ó fiÙÈ ÙÔ ÔÛÔÛÙfi ÙˆÓ ·Û˘Ìو̷ÙÈÎÒÓ ÂÓ‹ÏÈÎˆÓ ÊÔÚ¤ˆÓ Ì T. tonsurans ‹Ù·Ó 12%, ÂÓÒ ÙˆÓ ·È‰ÈÒÓ 44% (55). ∞Ó¿ÏÔÁË ÌÂϤÙË Ô˘ ¤ÁÈÓ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô “∞. ™˘ÁÁÚfi˜” Û 25 ·È‰È¿ Ì ª∆∫ ·fi T. violaceum ¤‰ÂÈÍ fiÙÈ ‰‡Ô Ó‹È· ÌÔχÓıËÎ·Ó ·fi ·Û˘Ìو̷ÙÈΤ˜ ÔÈÎȷΤ˜ ‚ÔËıÔ‡˜, 18 ·È‰È¿ ·fi ¿Û¯ÔÓÙ˜ Î·È ·Û˘Ìو̷ÙÈÎÔ‡˜ ÊÔÚ›˜ ÙÔ˘ ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÂÚÈ‚¿ÏÏÔÓÙÔ˜, ÂÓÒ ÁÈ· Ù· ˘fiÏÔÈ· 5 ·È‰È¿ ‰ÂÓ ‹Ù·Ó ‰˘Ó·ÙfiÓ Ó· ÂÓÙÔÈÛÙ› Ë ËÁ‹ ÌfiÏ˘ÓÛ˘ (31). OÈ ·Ú·¿Óˆ ÌÂϤÙ˜ ˘Ô‰ÂÈÎÓ‡Ô˘Ó fiÙÈ ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÂÚÈ‚¿ÏÏÔÓ ‹/Î·È ÙÔ Û¯ÔÏÂ›Ô ·ÔÙÂÏÔ‡Ó ÙÔ˘˜ ¯ÒÚÔ˘˜ fiÔ˘ Ë ÓfiÛÔ˜ ÌÂÙ·‰›‰ÂÙ·È ÛÙ· ·È‰È¿.

430

Paediatriki 2003;66:426-435

¶·ıÔÁ¤ÓÂÈ· ª˘ÎËÙ›·ÛË ÙÔ˘ ÙÚȯˆÙÔ‡ Ù˘ ÎÂÊ·Ï‹˜ ÚÔηÏÔ‡Ó ÌfiÓÔ Ù· ‰ÂÚÌ·ÙfiÊ˘Ù·. ∞Ó·ÊÔÚ¤˜ fiÙÈ ¿ÏÏ· ›‰Ë, fiˆ˜ Ù· ÌË ‰ÂÚÌ·ÙfiÊ˘Ù·, ÌÔÚÔ‡Ó Ó· ÚÔηϤÛÔ˘Ó ª∆∫ ‰ÂÓ ¤¯Ô˘Ó ÂȂ‚·Èˆı› ÌÂ Û˘Ì‚·ÙÈΤ˜ ÂÚÁ·ÛÙËÚȷΤ˜ ÌÂıfi‰Ô˘˜ (ÌÈÎÚÔÛÎfiËÛË-ηÏÏȤÚÁÂÈ·).

O Ì˯·ÓÈÛÌfi˜ ·Ó¿Ù˘Í˘ ÙˆÓ ‰ÂÚÌ·ÙfiÊ˘ÙˆÓ ÛÙËÓ ÙÚ›¯· ‰ÂÓ Â›Ó·È Ï‹Úˆ˜ ÁÓˆÛÙfi˜. ∏ ‰˘Ó·ÙfiÙËÙ· ÎÂÚ·ÙfiÏ˘Û˘ ‰ÂÓ ·ÔÙÂÏ› ¤Ó‰ÂÈÍË ·ıÔÁfiÓÔ˘ ‰˘Ó·ÌÈÎÔ‡ ÂÓfi˜ ̇ÎËÙ·, ‰Â‰Ô̤ÓÔ˘ fiÙÈ ˘¿Ú¯ÂÈ Ï‹ıÔ˜ Ì˘Î‹ÙˆÓ Ô˘ ·Ó·Ù‡ÛÛÔÓÙ·È ÛÙËÓ ÎÂÚ·Ù›ÓË ÛÙÈ‚¿‰·, ·ÏÏ¿ ‰ÂÓ ÚÔÛ‚¿ÏÏÔ˘Ó ÙËÓ ÙÚ›¯·, fiˆ˜ .¯. ÔÈ Ì‡ÎËÙ˜ T. concentricum, Scytalidium dimidiatum Î·È ∂. floccosum (13). ∏ ÌÂÙ·ÊÔÚ¿ ÎÔÓȉ›ˆÓ ‹ ˘ÊÒÓ ·fi ·ÛıÂÓ‹ ‹ ÌÔÏ˘Ṳ̂ӷ ·ÓÙÈΛÌÂÓ· ÛÙËÓ ÎÂÊ·Ï‹ ˘ÁÈÔ‡˜ ·ÙfiÌÔ˘ ‰ÂÓ Û˘ÓÂ¿ÁÂÙ·È Î·Ù’ ·Ó¿ÁÎËÓ ÙË ÌfiÏ˘ÓÛË. ™‡Ìʈӷ Ì ÙÔÓ Kligman, ÚÔËÁÂ›Ù·È ÚÔÛ‚ÔÏ‹ Ù˘ ÎÂÚ¿ÙÈÓ˘ ÛÙÈ‚¿‰·˜ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ Ù˘ ÎÂÊ·Ï‹˜ Î·È ¤ÂÙ·È Ë ÚÔÛ‚ÔÏ‹ ÙˆÓ ÙÚȯÒÓ (56). ¶Èı·ÓfiÓ Ó· Â›Ó·È ·Ó·Áη›· Ë ‡·ÚÍË ÙÚ·‡Ì·ÙÔ˜, ÙÔ ÔÔ›Ô ‚ÔËı¿ ÛÙÔÓ ÂÓÔÊı·ÏÌÈÛÌfi ÙÔ˘ ̇ÎËÙ·. ∏ Ïԛ̈ÍË ·Ú¯›˙ÂÈ Ì ÙËÓ ÚÔÛÎfiÏÏËÛË ÙˆÓ ÎÔÓȉ›ˆÓ ÛÙËÓ ÂÈÊ¿ÓÂÈ· ÙˆÓ ÎÂÚ·ÙÈÓÔ΢ÙÙ¿ÚˆÓ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜. ∞ÎÔÏÔ˘ı› Â΂ϿÛÙËÛË, ÔÏÏ·Ï·ÛÈ·ÛÌfi˜ Î·È ‰È›ۉ˘ÛË ÙÔ˘ ̇ÎËÙ· Ê˘ÁÔÎÂÓÙÚÈο ÛÙËÓ ÎÂÚ¿ÙÈÓË ÛÙÈ‚¿‰· Ì ÙË ‚Ô‹ıÂÈ· ÚˆÙÂÔÏ˘ÙÈÎÒÓ ÂÓ˙‡ÌˆÓ, ÙȘ ÎÂÚ·ÙÈÓ¿Û˜, Ô˘ ÂÎÎÚ›ÓÂÈ Ô Ì‡ÎËÙ·˜. ∏ ¯ÚÔÓÈ΋ ÂÚ›Ô‰Ô˜ ·fi ÙÔÓ ÂÓÔÊı·ÏÌÈÛÌfi ̤¯ÚÈ ÙËÓ ÚÔÛ‚ÔÏ‹ Ù˘ ÙÚ›¯·˜ Â›Ó·È ÂÚ›Ô˘ ÙÚÂȘ ‚‰ÔÌ¿‰Â˜ (57). ∆· ‰ÂÚÌ·ÙfiÊ˘Ù· ÚÔÛ‚¿ÏÏÔ˘Ó ÌfiÓÔÓ ÙȘ ·Ó·Ù˘ÛÛfiÌÂÓ˜ ÙÚ›¯Â˜ (·Ó·ÁÂÓ‹˜ Ê¿ÛË). ∆Ô Û٤ϯԘ Ù˘ ÙÚ›¯·˜ ÚÔÛ‚¿ÏÏÂÙ·È ÛÙÔ Ì¤ÛÔÓ ÂÚ›Ô˘ ÙÔ˘ ‡„Ô˘˜ ÙÔ˘ ı‡Ï·Î·. OÈ ÂÓÙfi˜ ÙÔ˘ ÛÙÂϤ¯Ô˘˜ ˘Ê¤˜ ·Ó·Ù‡ÛÛÔÓÙ·È ÚÔ˜ Ù· οو, ÚÔ˜ ÙÔÓ ‚ÔÏ‚fi, ·ÏÏ¿ Ë ·Ó¿Ù˘ÍË ÛÙ·Ì·Ù¿ ÛÙÔ ÛËÌÂ›Ô fiÔ˘ Ë ÎÂÚ·ÙÈÓÔÔ›ËÛË Â›Ó·È ·ÙÂÏ‹˜. ™ÙÔ ÛËÌÂ›Ô ·˘Ùfi, ÔÈ ÎÔÚ˘Ê¤˜ ÙˆÓ ˘ÊÒÓ Û¯ËÌ·Ù›˙Ô˘Ó ı‡Û·ÓÔ Ì ÌÔÚÊ‹ § (ı‡Û·ÓÔ˜ Adamson). OÈ ÂÓÙfi˜ ÙÔ˘ ÛÙÂϤ¯Ô˘˜ ˘Ê¤˜ ÌÂٷʤÚÔÓÙ·È, ηıÒ˜ ·Ó·Ù‡ÛÛÂÙ·È Ë ÙÚ›¯·, ÚÔ˜ Ù· Â¿Óˆ, ‰È·ÙËÚÒÓÙ·˜ fï˜ ÙË Û¯ÂÙÈ΋ ı¤ÛË ÙÔ˘˜ ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ‚ÔÏ‚Ô‡. ™ÙȘ Â͈ÙÚȯÈΤ˜ ÏÔÈÌÒÍÂȘ, ·ÚÈıÌfi˜ Ï¢ÚÈÎÒÓ ·Ï‡ÛÂˆÓ ÙˆÓ ˘ÊÒÓ ‰È·ÂÚÓ¿ ÙÔ Û٤ϯԘ Ù˘ ÙÚ›¯·˜ Î·È ·Ó·Ù‡ÛÛÂÈ ˘ÎÓfi Ì˘Î‹ÏÈÔ ÛÙËÓ ÂÈÊ¿ÓÂÈ¿ ÙÔ˘, ÙÔ ÔÔ›Ô Î·Ù·ÎÂÚÌ·Ù›˙ÂÙ·È Û¯ËÌ·Ù›˙ÔÓÙ·˜ ÔÏ˘¿ÚÈıÌ· ÛfiÚÈ·, Ù· ÔÔ›· ÂÚÈ‚¿ÏÏÔ˘Ó ÙËÓ ÙÚ›¯· Î·È ÚÔηÏÔ‡Ó Î·Ù·ÛÙÚÔÊ‹ ÙÔ˘ ÂÚÈÙÚȯ›Ô˘. ∫·Ù¿ ÙËÓ ·fiÛ·Û‹ Ù˘, Ë ÙÚ›¯· Û¿ÂÈ ÛÙÔ ÈÔ ·‰‡Ó·ÙÔ ÛËÌ›Ô, ·ÎÚÈ‚Ò˜ ¿Óˆ ·fi ÙÔÓ ı‡Û·ÓÔ ÙÔ˘ Adamson. ™ÙȘ ÂÓ‰ÔÙÚȯÈΤ˜ ÏÔÈÌÒÍÂȘ, Ë ·Ó¿Ù˘ÍË ÙˆÓ ÛÔÚ›ˆÓ Á›ÓÂÙ·È Ì¤Û· ÛÙÔ Û٤ϯԘ Ù˘ ÙÚ›¯·˜,

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ÂÓÒ ÙÔ ÂÚÈÙÚ›¯ÈÔ ·Ú·Ì¤ÓÂÈ ¿ıÈÎÙÔ. ∏ ÙÚ›¯· Á›ÓÂÙ·È Â‡ıÚ·˘ÛÙË Î·È Û¿ÂÈ ÛÙËÓ ÂÈÊ¿ÓÂÈ· ÙÔ˘ ÙÚȯˆÙÔ‡, ·Ê‹ÓÔÓÙ·˜ ÛÙÔ ÛËÌÂ›Ô ÂΛÓÔ ¤Ó· Ì·‡ÚÔ ÛÙ›ÁÌ· (black dot) (7,58). ¢È¿ÁÓˆÛË ∏ ‰È¿ÁÓˆÛË ÙˆÓ ª∆∫ Û˘Ó‹ıˆ˜ ‚·Û›˙ÂÙ·È ÛÙËÓ Ù˘È΋ ÎÏÈÓÈ΋ ÂÈÎfiÓ· Ì ÏÂȉ҉ÂȘ ϿΘ, ·ÔÎÔÌ̤Ó˜ ÙÚ›¯Â˜ Î·È ‰ÈfiÁΈÛË ÙˆÓ ÙÚ·¯ËÏÈÎÒÓ ·‰¤ÓˆÓ. ∏ ÂȂ‚·›ˆÛË Á›ÓÂÙ·È Ì ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô. ∏ ‰È·‰Èηۛ· ·˘Ù‹ ı· Ú¤ÂÈ Ó· ÂÊ·ÚÌfi˙ÂÙ·È Û οı ÌÈÎÚfi ·ÛıÂÓ‹ Ô˘ ·ÚÔ˘ÛÈ¿˙ÂÈ ·fiÙˆÛË ÙˆÓ ÙÚȯÒÓ Î·È ¤ÓÙÔÓË ·ÔϤÈÛË, ¿Û¯ÂÙ· ·fi ÙËÓ ÂÌÊ¿ÓÈÛË Ù˘È΋˜ ‹ ÌË ÎÏÈÓÈ΋˜ ÂÈÎfiÓ·˜ Ì˘ÎËÙ›·Û˘ ÙÔ˘ ÙÚȯˆÙÔ‡ Ù˘ ÎÂÊ·Ï‹˜. ∫ÏÈÓÈ΋ ÂÈÎfiÓ· ∆Ô Î‡ÚÈÔ ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÙˆÓ ª∆∫ Â›Ó·È Ë ·fiÙˆÛË ÙˆÓ ÙÚȯÒÓ Ô˘ Û˘¯Ó¿ Û˘Óԉ‡ÂÙ·È ·fi ÛËÌ›· ÊÏÂÁÌÔÓ‹˜, fiˆ˜ ·ÔϤÈÛË, ı˘Ï·ÎÈο ÊÏ˘ÎÙ·ÈÓ›‰È· Î·È ÎÓËÛÌfi. OÈ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ÔÈΛÏÏÔ˘Ó. O ‚·ıÌfi˜ ‚·Ú‡ÙËÙ·˜ ÙˆÓ ‚Ï·‚ÒÓ ÂÍ·ÚÙ¿Ù·È ·fi ÙÔ Â›‰Ô˜ ÙÔ˘ ˘‡ı˘ÓÔ˘ ̇ÎËÙ· Î·È ÙËÓ ·ÓÔÛ›· ÙÔ˘ ÍÂÓÈÛÙ‹. ¢È·ÎÚ›ÓÔÓÙ·È ÔÈ ·ÎfiÏÔ˘ıÔÈ Ù‡ÔÈ: ÌÈÎÚÔÛÔڛ˜, ÙÚȯÔÊ˘Ù›Â˜, ¿¯ÔÚ·˜ Î·È ÎËÚ›Ô. ∂ÎÙfi˜ ·fi ÙËÓ Ù·ÍÈÓfiÌËÛË ·˘Ù‹, ÔÈ ª∆∫ ‰È·ÎÚ›ÓÔÓÙ·È Û ÌË ÊÏÂÁÌÔÓÒ‰ÂȘ Î·È ÊÏÂÁÌÔÓÒ‰ÂȘ ÌÔÚʤ˜ (7,49,59). ·) ªÈÎÚÔÛÔڛ˜: ÷ڷÎÙËÚ›˙ÔÓÙ·È ·fi Ì›· ÌÂÌÔӈ̤ÓË (Û·ÓÈfiÙÂÚ· ‰‡Ô ‹ ÂÚÈÛÛfiÙÂÚ˜) ΢ÎÏÈ΋ ÏÂÈ‰Ò‰Ë Ͽη ‰È·Ì¤ÙÚÔ˘ 2-5 cm, ÂÏ·ÊÚÒ˜ ÂÚ˘ıËÌ·ÙÒ‰Ë, Ë ÂÈÊ¿ÓÂÈ· Ù˘ ÔÔ›·˜ ηχÙÂÙ·È ·fi ÎÔÌ̤Ó˜ ÙÚ›¯Â˜ Û ‡„Ô˜ 2-3 cm ¿Óˆ ·fi ÙËÓ ÂÈÊ¿ÓÂÈ· ÙÔ˘ ‰¤ÚÌ·ÙÔ˜. OÈ ÚÔۂ‚ÏË̤Ó˜ ÙÚ›¯Â˜ Â›Ó·È Ê·È¤˜ Î·È ·Ï·Ì›˜ ÏfiÁˆ Ù˘ ÂÈÎ¿Ï˘„‹˜ ÙÔ˘˜ ·fi Ù· ·ÚıÚÔÎÔÓ›‰È· ÙˆÓ ÂÍÒÙÚȯˆÓ ‰ÂÚÌ·ÙfiÊ˘ÙˆÓ. ø˜ Â› ÙÔ Ï›ÛÙÔÓ, Â›Ó·È ÌË ÊÏÂÁÌÔÓÒ‰ÂȘ Î·È Û˘Ó‰¤ÔÓÙ·È Ì ÙÔ ˙ˆfiÊÈÏÔ Â›‰Ô˜ M. canis Î·È Û·ÓÈfiÙÂÚ· Ì ٷ ·ÓıÚˆfiÊÈÏ· ›‰Ë M. audouinii Î·È ª. ferrugineum (∂ÈÎfiÓ· 1). ‚) ∆ÚȯÔÊ˘Ù›Â˜: ÷ڷÎÙËÚ›˙ÔÓÙ·È ·fi ÙË ÌÔÚÊ‹ ÌÈÎÚÒÓ ‰È¿Û·ÚÙˆÓ ÔÏ˘ÁˆÓÈÎÒÓ Ï·ÎÒÓ Ì ÈÙ˘ÚÒ‰Ë ·ÔϤÈÛË, Ì ·ÔÎÔÌ̤Ó˜ ÙÚ›¯Â˜ ÛÙÔ ÛËÌÂ›Ô Ù˘ ¤ÎÊ˘Û‹˜ ÙÔ˘˜. ∆Ô ˘fiÏÂÈÌÌ· Ù˘ ÙÚ›¯·˜ ̤۷ ÛÙÔÓ ı‡Ï·Î· ‰›ÓÂÈ ÙËÓ ÂÈÎfiÓ· Ì·‡ÚÔ˘ ÛÙ›ÁÌ·ÙÔ˜ (black dots). O ÌË ÊÏÂÁÌÔÓ҉˘ Ù‡Ô˜ ·ÚÔ˘ÛÈ¿˙ÂÈ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÔÌÔÈ¿˙Ô˘Û· Ì ÙË ÛÌËÁÌ·ÙÔÚÚÔ˚΋ ‰ÂÚÌ·Ù›Ùȉ·. OÈ ϿΘ Û˘¯Ó¿ Û˘ÚÚ¤Ô˘Ó, Û¯ËÌ·Ù›˙ÔÓÙ·˜ ÌÂÁ·Ï‡ÙÂÚ˜ Ì ·ÔϤÈÛË Î·È ÛËÌ›· ‹È·˜ ÊÏÂÁÌÔÓ‹˜. ªÂٷ͇ ÙˆÓ ÚÔۂ‚ÏËÌ¤ÓˆÓ ÙÚȯÒÓ ˘¿Ú¯Ô˘Ó ˘ÁÈ›˜ ÙÚ›¯Â˜ ‹/Î·È Ì·‡Ú· ÛÙ›ÁÌ·Ù·, Ù· ÔÔ›· Â›Ó·È ÂÍ·ÈÚÂÙÈο ‰˘Û‰È¿ÎÚÈÙ· ÛÙ· ·È‰È¿. ™˘Ó‰¤ÔÓÙ·È Ì ٷ ·ÓıÚˆfiÊÈÏ· ›‰Ë T.

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tonsurans Î·È T. violaceum (∂ÈÎfiÓ˜ 2 Î·È 3). Á) ŒÌ˘Ô˜ ÙÚȯÔÊ˘Ù›·/ÎËÚ›ÔÓ Î¤ÏÛÔ˘: ÷ڷÎÙËÚ›˙ÂÙ·È ·fi ÂÒ‰˘Ó˜ ‚Ï·ÙȉÔÔ˙Ò‰ÂȘ ϿΘ, Ì ÊÏ˘ÎÙ·ÈÓ›‰È· Ô˘ ηχÙÔÓÙ·È ·fi ÌÂÏÈÙfi¯ÚÔ˜ ÂÊÂÏΛ‰Â˜. ∞fi Ù· ÛÙfiÌÈ· ÙˆÓ ÙÚȯÔÛÌËÁÌ·ÙÔÁfiÓˆÓ ı˘Ï¿ÎˆÓ ÂͤگÂÙ·È ‡ÔÓ Î·È ˘¿Ú¯ÂÈ ·fiÙˆÛË ÙˆÓ ÙÚȯÒÓ. ∂›Ó·È ÎÓËÛÌ҉˘ Î·È Û˘¯Ó¿ Û˘Óԉ‡ÂÙ·È ·fi ˘ÚÂÙfi Î·È ÙÚ·¯ËÏÈ΋ ÏÂÌÊ·‰ÂÓ›Ùȉ·. ∏ ÊÏÂÁÌÔÓ҉˘ ·˘Ù‹ ÌÔÚÊ‹ Û˘Ó‰¤ÂÙ·È Ì ˙ˆfiÊÈÏÔ˘˜ ‹ ÁÂÒÊÈÏÔ˘˜ ̇ÎËÙ˜, fiˆ˜ Ù· ª. canis, T. verrucosum, T. mentagrophytes var mentagrophytes, M. nanum, M. gypseum ηÈ, Û·ÓÈfiÙÂÚ·, Ì Ùo ·ÓıÚˆfiÊÈÏo ›‰o˜ ∆. violaceum (∂ÈÎfiÓ· 4). ‰) Õ¯ÔÚ·˜: ¶ÚfiÎÂÈÙ·È ÁÈ· Û·ÓÈfiÙ·ÙË ÓfiÛÔ ÛÙË ¯ÒÚ· Ì·˜. ∂ÌÊ·Ó›˙ÂÈ ¯·Ú·ÎÙËÚÈÛÙÈΤ˜ ‚Ï¿‚˜, Ù· ÛÎ˘Ê›·, ‰ËÏ. ΢ÂÏÏÔÂȉ›˜ Û¯ËÌ·ÙÈÛÌÔ‡˜ Ù˘ ÂȉÂÚÌ›‰·˜, ÛÙÚÔÁÁ˘ÏÔ‡ Û¯‹Ì·ÙÔ˜, ÛÙÔ Î¤ÓÙÚÔ ÙˆÓ ÔÔ›ˆÓ ˘¿Ú¯ÂÈ Û˘Ó‹ıˆ˜ ÌÔÓ‹Ú˘, ÍËÚ‹, ·Ï·Ì‹˜ ÙÚ›¯·. ∆· ÛÎ˘Ê›· ¤¯Ô˘Ó ¯ÚÒÌ· ÎÈÙÚÈÓfiÊ·ÈÔ Î·È ·Ó·‰›‰Ô˘Ó ¯·Ú·ÎÙËÚÈÛÙÈ΋ ‰˘Û¿ÚÂÛÙË ÔÛÌ‹. OÈ ÙÚ›¯Â˜ ‰ÂÓ Â›Ó·È Â‡ıÚ·˘ÛÙ˜ fiˆ˜ ÛÙȘ ¿ÏϘ ÌÔÚʤ˜. ∞ÈÙÈÔÏÔÁÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÙÔ˘ ¿¯ÔÚ· Â›Ó·È ÙÔ ·ÓıÚˆfiÊÈÏÔ Â›‰Ô˜ T. schoenleinii (∂ÈÎfiÓ· 5). ∂ÚÁ·ÛÙËÚȷ΋ ‰È¿ÁÓˆÛË ∏ ÂÚÁ·ÛÙËÚȷ΋ ÌÂıÔ‰ÔÏÔÁ›· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ¿ÌÂÛË ÌÈÎÚÔÛÎÔÈ΋ ÂͤٷÛË ÙˆÓ ÏÂ›ˆÓ, ÙÚȯÒÓ Î·È ı˘Ï¿ÎˆÓ, ÙËÓ Î·ÏÏȤÚÁÂÈ· ÁÈ· ÙËÓ ·ÔÌfiÓˆÛË ÙÔ˘ ˘‡ı˘ÓÔ˘ ̇ÎËÙ· Î·È ÙËÓ Ù·˘ÙÔÔ›ËÛË. ∏ ‚ÈÔ„›· Û·Ó›ˆ˜ ÂӉ›ÎÓ˘Ù·È ÁÈ· ÙËÓ ÂÚÁ·ÛÙËÚȷ΋ ‰È¿ÁÓˆÛË ÙˆÓ ª∆∫. ¶ÚˆÙ·Ú¯È΋˜ ÛËÌ·Û›·˜ ÁÈ· ÙȘ ·Ú·¿Óˆ Ì˘ÎËÙÔÏÔÁÈΤ˜ ÂÍÂÙ¿ÛÂȘ Â›Ó·È Ë ÂÈÏÔÁ‹ Î·È Û˘ÏÏÔÁ‹ ÙÔ˘ ηٿÏÏËÏÔ˘ ‰Â›ÁÌ·ÙÔ˜. ∏ ÌË ÛˆÛÙ‹ Ï‹„Ë ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û „¢‰Ò˜ ·ÚÓËÙÈο ·ÔÙÂϤÛÌ·Ù·. ∏ Û˘ÏÏÔÁ‹ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜

∂ÈÎfiÓ· 1. ªÈÎÚÔÛÔÚ›· ·fi ÙÔÓ Ì‡ÎËÙ· Microsporum canis.

431

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ÂÈÙÂÏÂ›Ù·È Ì ̛· ÛÂÈÚ¿ ·ÓÒ‰˘ÓˆÓ Ù¯ÓÈÎÒÓ. ªÂ ÙË ‚Ô‹ıÂÈ· ·ÔÛÙÂÈڈ̤ÓÔ˘ ·È¯ÌËÚÔ‡ ͤÛÙÚÔ˘, ‚Ô‡ÚÙÛ·˜ Ì›·˜ ¯Ú‹Û˘, ÙÚȯÔÏ·‚›‰·˜ ‹/Î·È ‚·Ì‚·ÎÔÊfiÚÔ˘ ÛÙ˘ÏÂÔ‡ Û˘ÏϤÁÔÓÙ·È ·fi ÙËÓ ÂÚÈÔ¯‹ ÙˆÓ ·ÏÏÔÈÒÛÂˆÓ Ï¤È·, ÙÚ›¯Â˜ Î·È ÂÚȯfiÌÂÓ· ı˘Ï¿ÎˆÓ, Ù· ÔÔ›· ʤÚÔÓÙ·È Û ηı·Ú‹ ·ÓÙÈÎÂÈÌÂÓÔÊfiÚÔ Ͽη. OÈ ÚÔۂ‚ÏË̤Ó˜ ÙÚ›¯Â˜ ·ÔÛÒÓÙ·È ¯ˆÚ›˜ ·ÓÙ›ÛÙ·ÛË, ·ÓÒ‰˘Ó·, Ì ͤÛÙÚÔ ‹ Ì ÙÚȯÔÏ·‚›‰·. ∂¿Ó ‰ÂÓ ˘¿Ú¯Ô˘Ó ÂÌÊ·Ó›˜ ‚Ï¿‚˜, Ì›· ¿ÏÏË ÈηÓÔÔÈËÙÈ΋ ̤ıÔ‰Ô˜ Â›Ó·È ÙÔ ‚Ô‡ÚÙÛÈÛÌ· ÙÔ˘ ÙÚȯˆÙÔ‡ Ù˘ ÎÂÊ·Ï‹˜ Ì ԉÔÓÙfi‚Ô˘ÚÙÛ· Ì›·˜ ¯Ú‹Û˘, Ë ÔÔ›·, ÛÙË Û˘Ó¤¯ÂÈ·, ʤÚÂÙ·È Û Â·Ê‹ Ì ÙËÓ ÂÈÊ¿ÓÂÈ· ÙÔ˘ ıÚÂÙÈÎÔ‡ ˘ÔÛÙÚÒÌ·ÙÔ˜. ™Â ÂÒ‰˘Ó˜ ÊÏÂÁÌÔÓÒ‰ÂȘ ·ÏÏÔÈÒÛÂȘ, Ë Ï‹„Ë ÏÂ›ˆÓ Î·È ÙÚȯÒÓ Û˘¯Ó¿ ‰ÂÓ Â›Ó·È ÂÊÈÎÙ‹. ™ÙȘ ÂÚÈÙÒÛÂȘ ·˘Ù¤˜, Û˘ÏϤÁÂÙ·È ‡ÔÓ Ì ‚·Ì‚·ÎÔÊfiÚÔ ÛÙ˘ÏÂfi. ªÂ ÙÔÓ ÙÚfiÔ ·˘Ùfi Â›Ó·È ‰˘Ó·Ù‹ Ë ÌÂÙ·ÊÔÚ¿ ı˘Ï¿ÎˆÓ Î·È ÌÂÁ¿ÏÔ˘ ·ÚÈıÌÔ‡ ÎÔÓȉ›ˆÓ, ÒÛÙ ӷ ·Ó·Ù˘¯ı› Ô Ì‡ÎËÙ·˜ ÛÙËÓ Î·ÏÏȤÚÁÂÈ· (60). ∏ ¯Ú‹ÛË Ù˘ Ï˘¯Ó›·˜ Wood ÚÔÛʤÚÂÈ ÛËÌ·ÓÙÈ΋ ‚Ô‹ıÂÈ· ÛÙÔÓ ÂÓÙÔÈÛÌfi ÙˆÓ Â͈ÙÚȯÈÎÒÓ ·ÏÏÔÈÒÛÂˆÓ Ô˘ ÚÔηÏÔ‡Ó ÔÚÈṲ̂ӷ ›‰Ë ÙÔ˘ Á¤-

∂ÈÎfiÓ· 2. ∆ÚȯÔÊ˘Ù›· ·fi ÙÔÓ Ì‡ÎËÙ· Trichophyton violaceum.

432

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ÓÔ˘˜ Microsporum. ™ÙÔ ˘ÂÚÈ҉˜ ʈ˜ Ù˘ Ï˘¯Ó›·˜ (3650 Å), ÔÈ ÚÔۂ‚ÏË̤Ó˜ ÙÚ›¯Â˜ ÂÎ¤ÌÔ˘Ó ¤ÓÙÔÓÔ ÊıÔÚÈÛÌfi. O ÊıÔÚÈÛÌfi˜ ÔÊ›ÏÂÙ·È ÛÙÔÓ ÌÂÙ·‚ÔÏÈÛÌfi Ù˘ ÙÚ˘ÙÔÊ¿Ó˘, Ë ÔÔ›· Û˘ÛÛˆÚ‡ÂÙ·È ÛÙȘ ÚÔۂ‚ÏË̤Ó˜ ÙÚ›¯Â˜, ÔÈ Ôԛ˜ ‰ÈÂÁ›ÚÔÓÙ·È Î·È ÊıÔÚ›˙Ô˘Ó (7). £· Ú¤ÂÈ Ó· ÛËÌÂȈı› fiÙÈ ÙÔÈ΋ ıÂÚ·›· ÂÓ‰¤¯ÂÙ·È Ó· ÂËÚ¿ÛÂÈ ÙÔ ·ÔÙ¤ÏÂÛÌ· Ù˘ ÂͤٷÛ˘, ‰›‰ÔÓÙ·˜ ·¯Ófi ÊıÔÚÈÛÌfi ‹ „¢‰Ò˜ ·ÚÓËÙÈÎfi ·ÔÙ¤ÏÂÛÌ·, ÂÚÈÔÚ›˙ÔÓÙ·˜ ¤ÙÛÈ ÙËÓ ÂȉÈÎfiÙËÙ· Ù˘ ÌÂıfi‰Ô˘ (28). ™ÙȘ ÂÓ‰ÔÙÚȯÈΤ˜ ÏÔÈÌÒÍÂȘ ‰ÂÓ ·Ú·ÙËÚÂ›Ù·È ÊıÔÚÈÛÌfi˜, ÂÓÒ ÛÙÔÓ ¿¯ÔÚ· ÔÈ ÚÔۂ‚ÏË̤Ó˜ ÙÚ›¯Â˜ ‰È·ÙËÚÔ‡ÓÙ·È ·Ó¤·Ê˜ Î·È ÂÎ¤ÌÔ˘Ó ·¯Ófi ÊıÔÚÈÛÌfi. ∂Âȉ‹ Ô ·ÚÈıÌfi˜ ÙˆÓ ÏÔÈÌÒÍÂˆÓ ·fi ÂÓ‰fiÙÚÈ¯Ô˘˜ ̇ÎËÙ˜ ¤¯ÂÈ ·˘ÍËı› ÛËÌ·ÓÙÈο Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, Ë ¯Ú‹ÛË Ù˘ Ï˘¯Ó›·˜ Wood ¤¯ÂÈ ÌÂÚÈ΋ ‰È·ÁÓˆÛÙÈ΋ ·Í›· ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô ÌÂÁ¿ÏÔ˘ ·ÚÈıÌÔ‡ ·ÙfïÓ, fiˆ˜ ÁÈ· ÂȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜ ÛÙ· Û¯ÔÏ›· Î·È ÁÈ· ÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË Ù˘ ıÂÚ·›·˜ ÙÔ˘ ·ÛıÂÓÔ‡˜. ∆Ô ÚÔ˜ ÂͤٷÛË ‰Â›ÁÌ· ʤÚÂÙ·È Û ·ÓÙÈÎÂÈÌÂÓÔÊfiÚÔ Ͽη, ÚÔÛÙ›ıÂÓÙ·È ÌÂÚÈΤ˜ ÛÙ·ÁfiÓ˜

∂ÈÎfiÓ· 3. ∆ÚȯÔÊ˘Ù›· „ˆÚÈ·ÛÈ΋˜ ÌÔÚÊ‹˜ ·fi ÙÔÓ Ì‡ÎËÙ· Trichophyton violaceum.

¶·È‰È·ÙÚÈ΋ 2003;66:426-435

∫O∏ 20% (‰È·˘Á·ÛÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜), ηχÙÂÙ·È ÌÂ Î·Ï˘ÙÚ›‰· Î·È ÌÈÎÚÔÛÎÔÂ›Ù·È Ì ÍËÚfi Ê·Îfi x10 ÁÈ· ÙËÓ ÂÓÙfiÈÛË ÙˆÓ ÌÔÚÊÔÏÔÁÈÎÒÓ ÛÙÔȯ›ˆÓ, ÂÓÒ ÁÈ· ÂȂ‚·›ˆÛË ··ÈÙÂ›Ù·È ·ÓÙÈÎÂÈÌÂÓÈÎfi˜ Ê·Îfi˜ x40. ªÂ ÙËÓ ¿ÌÂÛË ÌÈÎÚÔÛÎÔÈ΋ ÂͤٷÛË ·ÓȯÓ‡ÔÓÙ·È Ù· ΢ÙÙ·ÚÈο ÛÙÔȯ›· Ù˘ ·Ú·ÛÈÙÈ΋˜ ÌÔÚÊ‹˜ ÙÔ˘ ̇ÎËÙ·. ™Ù· ϤÈ· ·Ó·˙ËÙÔ‡ÓÙ·È ÔÈ ˘·ÏÔÂȉ›˜, Û˘¯Ó¿ ‰È·ÎÏ·‰È˙fiÌÂÓ˜, ˘Ê¤˜ (ÓËÌ¿ÙÈ·) Ì ‰È·ÊÚ·ÁÌ¿ÙÈ· Î·È ÔÈ ·Ï‡ÛÂȘ ÙˆÓ ·ÚıÚÔÎÔÓȉ›ˆÓ, ÔÈ Ôԛ˜ ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙÔÓ Î·Ù·ÎÂÚÌ·ÙÈÛÌfi ÙˆÓ ˘ÊÒÓ, ÂÓÒ ÛÙȘ ÙÚ›¯Â˜ Ë ‰È¿Ù·ÍË Î·È ÙÔ Ì¤ÁÂıÔ˜ ÙˆÓ ÎÔÓȉ›ˆÓ, ÌÔÚÊÔÏÔÁÈÎÔ› ¯·Ú·ÎÙ‹Ú˜ Ô˘ ÌÔÚ› Ó· ÚÔÛ‰ÈÔÚ›ÛÔ˘Ó ÙÔ Á¤ÓÔ˜ ÙÔ˘ ˘‡ı˘ÓÔ˘ ̇ÎËÙ·. ™Â ·ÛıÂÓ›˜ Ì ÊÏÂÁÌÔÓÒ‰ÂȘ ‚Ï¿‚˜, ÛÙÔȯ›· ÙÔ˘ ̇ÎËÙ· Û¿ÓÈ· ·Ó¢ڛÛÎÔÓÙ·È ÛÙ· ¿ÌÂÛ· ·Ú·Û΢¿ÛÌ·Ù·. OÙÈο ÛÊ¿ÏÌ·Ù· ‰ÂÓ ·ÔÎÏ›ÔÓÙ·È (60). ∏ ¿ÌÂÛË ÌÈÎÚÔÛÎfiËÛË Â›Ó·È Ù·¯Â›· Î·È ·ÍÈfiÈÛÙË ‰È·ÁÓˆÛÙÈ΋ ̤ıÔ‰Ô˜. ∏ ¢·ÈÛıËÛ›· Î·È Ë ÂȉÈÎfiÙËÙ¿ Ù˘, fï˜, ÂÍ·ÚÙÒÓÙ·È ·fi ÙÔÓ ·ÚÈıÌfi ÙˆÓ Ì˘Î‹ÙˆÓ ÛÙÔ ·Ú·Û··ÛÌ·, ·fi Ù˘¯fiÓ ÚÔÁÂÓ¤ÛÙÂÚË ıÂÚ·›· Î·È ·fi ÙËÓ ÂÌÂÈÚ›· ÙÔ˘ ÂÚÁ·ÛÙËÚÈ·ÎÔ‡ È·ÙÚÔ‡. ∏ ıÂÙÈ΋ ¿ÌÂÛË ÌÈÎÚÔÛÎÔÈ΋ ÂͤٷÛË ÂȂ‚·ÈÒÓÂÈ ÙËÓ ÎÏÈÓÈ΋ ‰È¿ÁÓˆÛË Î·È ÂÈ-

∂ÈÎfiÓ· 4. ŒÌ˘Ô˜ ‰ÂÚÌ·ÙÔÊ˘Ù›· ·fi ÙÔÓ Ì‡ÎËÙ· Microsporum gypseum.

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ÙÚ¤ÂÈ ÙËÓ ¤Ó·ÚÍË ıÂÚ·›·˜. ¶·Ú¿ Ù·‡Ù·, Ë ÌË ·Ó‡ÚÂÛË ÙÔ˘ ̇ÎËÙ· ÛÙ· ¿ÌÂÛ· ·Ú·Û΢¿ÛÌ·Ù· ‰ÂÓ ·ÔÎÏ›ÂÈ ÙË Ì˘ÎËÙÈ·ÛÈ΋ Ïԛ̈ÍË. ∏ ̤ıÔ‰Ô˜ ηıÈÛÙ¿ ‰˘Ó·Ùfi ÙÔÓ Î·ıÔÚÈÛÌfi ÙˆÓ ÙÚÈÒÓ Ù‡ˆÓ ·Ú·ÛÈÙÈÛÌÔ‡ ÙÔ˘ ̇ÎËÙ· ÛÙËÓ ÙÚ›¯·: ÂÍÒÙÚȯÔ, ÂÓ‰fiÙÚÈ¯Ô Î·È ·¯ÔÚÈÎfi. ™ÙËÓ ÂÍÒÙÚÈ¯Ë Ïԛ̈ÍË, ÔÈ ˘Ê¤˜ ηٷÎÂÚÌ·Ù›˙ÔÓÙ·È Û ÌÈÎÚÔ‡ ÌÂÁ¤ıÔ˘˜ ·ÚıÚÔÎÔÓ›‰È· (ÛfiÚÈ·), Ù· ÔÔ›· ηχÙÔ˘Ó ÙËÓ ÂÈÊ¿ÓÂÈ· Î·È ÂÚÈ‚¿ÏÏÔ˘Ó ÙÔ Û٤ϯԘ Ù˘ ÙÚ›¯·˜, ÚÔηÏÒÓÙ·˜ ÔÚÈÛÙÈ΋ ηٷÛÙÚÔÊ‹ ÙÔ˘ ÂÚÈÙÚȯ›Ô˘. ∞ÓÙ›ıÂÙ·, ÛÙËÓ ÂÓ‰ÔÙÚȯÈ΋ Ïԛ̈ÍË, Ù· ·ÚıÚÔÎÔÓ›‰È· Â›Ó·È ÌÂÁ·Ï‡ÙÂÚÔ˘ ÌÂÁ¤ıÔ˘˜, ·Ú·Ì¤ÓÔ˘Ó ÛÙÔ Û٤ϯԘ Ù˘ ÙÚ›¯·˜, ¯ˆÚ›˜ fï˜ Ó· ·Ú·ÙËÚÂ›Ù·È Î·Ù·ÛÙÚÔÊ‹ ÙÔ˘ ÂÚÈÙÚȯ›Ô˘. ™ÙÔÓ ¿¯ÔÚ·, ÔÈ ÙÚ›¯Â˜ ̤ÓÔ˘Ó ·Ó¤·Ê˜ Î·È ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ÙËÓ ·Ó‡ÚÂÛË ÌfiÓÔ ÓËÌ·Ù›ˆÓ ηٿ Ì‹ÎÔ˜ Ù˘ ÙÚ›¯·˜, ÏÈÔÛÊ·ÈÚ›ˆÓ Î·È ÎÂÓÒÓ ·¤ÚÔ˜ (61). °È· ÙËÓ ÂȂ‚·›ˆÛË ÙÔ˘ ·ÔÙÂϤÛÌ·ÙÔ˜ Ù˘ ¿ÌÂÛ˘ ÌÈÎÚÔÛÎÔÈ΋˜ ÂͤٷÛ˘ Î·È ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙÔ˘ ·ÈÙÈÔÏÔÁÈÎÔ‡ ·Ú¿ÁÔÓÙ·, fiÏ· Ù· ÏËÊı¤ÓÙ· ‰Â›ÁÌ·Ù· Ú¤ÂÈ Ó· ηÏÏÈÂÚÁÔ‡ÓÙ·È. ∏ ηÏÏȤÚÁÂÈ· ·ÔÙÂÏ› ‚·ÛÈ΋ ÂͤٷÛË ÁÈ· ÙË ‰È¿ÁÓˆÛË Ù˘ Ì˘ÎËÙÈ·ÛÈ΋˜ Ïԛ̈͢. ∆· ıÚÂÙÈο ˘ÔÛÙÚÒÌ·Ù· Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Û˘Ó‹ıˆ˜ ÁÈ· ÙȘ ÚˆÙÔηÏÏȤÚÁÂȘ ÙˆÓ ‰ÂÚÌ·ÙfiÊ˘ÙˆÓ Â›Ó·È Ù· Sabouraud ‹ potato dextrose ¿Á·Ú ÂÌÏÔ˘ÙÈṲ̂ÓÔ Ì ·ÓÙÈ‚ÈÔÙÈο, fiˆ˜ ¯ÏˆÚ·ÌÊ·ÈÓÈÎfiÏË Î·È Î˘ÎÏÔÂÍ·Ì›‰Ë, Ù· ÔÔ›· ‚ÔËıÔ‡Ó ÛÙËÓ ÂÏ·¯ÈÛÙÔÔ›ËÛË

∂ÈÎfiÓ· 5. Õ¯ÔÚ·˜ ·fi ÙÔÓ Ì‡ÎËÙ· Trichophyton schoenleinii.

433

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Ù˘ ·Ó¿Ù˘Í˘ ÙˆÓ ‚·ÎÙËÚȉ›ˆÓ Î·È ÙˆÓ Û·ÚÔÊ˘ÙÈÎÒÓ Ì˘Î‹ÙˆÓ. ∆· ÙÂÏÂ˘Ù·›· ·Ó·Ù‡ÛÛÔÓÙ·È Ù·¯‡Ù·Ù·, Ì ·ÔÙ¤ÏÂÛÌ· Ó· ˘ÂÚηχÙÔ˘Ó Ù· ‚Ú·‰¤ˆ˜ ·Ó·Ù˘ÛÛfiÌÂÓ· ‰ÂÚÌ·ÙfiÊ˘Ù·. ∏ ÂÒ·ÛË ÌÔÚ› Ó· Á›ÓÂÈ Û ıÂÚÌÔÎÚ·Û›· ‰ˆÌ·Ù›Ô˘, ·ÏÏ¿ Û˘ÓÈÛÙ¿Ù·È ÎÏ›‚·ÓÔ˜ ÛÙ·ıÂÚ‹˜ ıÂÚÌÔÎÚ·Û›·˜. ∏ ¿ÚÈÛÙË ıÂÚÌÔÎÚ·Û›· ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ÙˆÓ ‰ÂÚÌ·ÙfiÊ˘ÙˆÓ Â›Ó·È 26-28ÔC Î·È Ô ¯ÚfiÓÔ˜ ÂÒ·Û˘ 24 ‚‰ÔÌ¿‰Â˜. OÈ Î·ÏÏȤÚÁÂȘ ı· Ú¤ÂÈ Ó· ÂϤÁ¯ÔÓÙ·È Û˘¯Ó¿ ÁÈ· ÙË ‰È·›ÛÙˆÛË ·Ó¿Ù˘Í˘ ÙÔ˘ ·ıÔÁfiÓÔ˘ ̇ÎËÙ· Î·È Ù˘¯fiÓ ÂÈÌÔχÓÛÂȘ ·fi Û·ÚÔÊ˘ÙÈÎÔ‡˜ ̇ÎËÙ˜ (62).

O ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙÔ˘ Á¤ÓÔ˘˜ Î·È ÙÔ˘ ›‰Ô˘˜ ÙÔ˘ ·ıÔÁfiÓÔ˘ ̇ÎËÙ· (Ù·˘ÙÔÔ›ËÛË) Â›Ó·È ··Ú·›ÙËÙÔ˜ ÁÈ· ÙËÓ ÂÈÏÔÁ‹ ÙÔ˘ ηٿÏÏËÏÔ˘ ıÂÚ·¢ÙÈÎÔ‡ Û¯‹Ì·ÙÔ˜, ‰Â‰Ô̤Ó˘ Ù˘ ‰È·ÊÔÚÂÙÈ΋˜ ¢·ÈÛıËÛ›·˜ ÔÚÈÛÌ¤ÓˆÓ ‰ÂÚÌ·ÙfiÊ˘ÙˆÓ ÛÙ· Ó¤· ·ÓÙÈÌ˘ÎËÙÈ·ÛÈο Ê¿Ú̷η, ηıÒ˜ Î·È ÁÈ· ÂȉËÌÈÔÏÔÁÈÎÔ‡˜ ÏfiÁÔ˘˜. ∂ÈÙ˘Á¯¿ÓÂÙ·È Ì ÙËÓ ·Ú·Ù‹ÚËÛË Ù˘ Ì·ÎÚÔÛÎÔÈ΋˜ ÌÔÚÊÔÏÔÁ›·˜ ÙˆÓ ·ÔÈÎÈÒÓ ÙÔ˘ ̇ÎËÙ·, ηıÒ˜ Î·È Ì ÙË ÏÂÙÔÌÂÚ‹ ÌÂϤÙË Ù˘ ÌÈÎÚÔÛÎÔÈ΋˜ ÌÔÚÊÔÏÔÁ›·˜ ÙÔ˘, ‰ËÏ. Ù˘ ‰ÔÌ‹˜ ÙˆÓ ÓËÌ·Ù›ˆÓ Î·È Ù˘ ÌÔÚÊÔÏÔÁ›·˜ ÙˆÓ ÎÔÓȉ›ˆÓ (63,64). ™˘ÌÂÚ¿ÛÌ·Ù· ªÂ ‚¿ÛË Ù· ÛÙ·ÙÈÛÙÈο ÛÙÔȯ›· ÙÔ˘ ÓÔÛÔÎÔÌ›Ԣ “∞. ™˘ÁÁÚfi˜” Î·È ÙËÓ ÂÏÏËÓÈ΋ ‚È‚ÏÈÔÁÚ·Ê›·, Û˘Ó¿ÁÂÙ·È fiÙÈ ÙÔ Î‡ÚÈÔ ·›ÙÈÔ ª∆∫ ÛÙË ¯ÒÚ· Ì·˜ Â›Ó·È o ˙ˆfiÊÈÏÔ˜ ̇ÎËÙ·˜ ª. canis Î·È ‰Â˘ÙÂÚ¢fiÓÙˆ˜ Ô ·ÓıÚˆfiÊÈÏÔ˜ T. violaceum. ∏ ·Ú·ÙËÚÔ‡ÌÂÓË, ÚfiÛÊ·Ù·, ·‡ÍËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ ÙÔ˘ ÙÂÏÂ˘Ù·›Ô˘, ηıÒ˜ Î·È Ë ·ÚÔ˘Û›· ÌË ÂÓ‰ËÌÈÎÒÓ ÂȉÒÓ ÛÙË ¯ÒÚ· Ì·˜ Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ÙÔ˘ ÌÂÙ·Ó·ÛÙ¢ÙÈÎÔ‡ ·̷ÙÔ˜ ÙˆÓ ÙÂÏÂ˘Ù·›ˆÓ ÂÙÒÓ ·fi ¯ÒÚ˜ Ù˘ µ·ÏηÓÈ΋˜, Ù˘ ∞Ó·ÙÔÏÈ΋˜ ∂˘ÚÒ˘, Ù˘ ∞Û›·˜ Î·È Ù˘ ∞ÊÚÈ΋˜, fiÔ˘ Ù· ›‰Ë ·˘Ù¿ ÂÓ‰ËÌÔ‡Ó. °È· ÙÔÓ ÂÚÈÔÚÈÛÌfi Ù˘ ÂÍ¿ψÛ˘ ÙˆÓ ª∆∫ ÛÙ· ·È‰È¿ ··ÈÙÂ›Ù·È ÛˆÛÙ‹ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ·‰¤ÛÔÙˆÓ ˙ÒˆÓ Ô˘ ÓÔÛÔ‡Ó, ÛˆÛÙ‹ ˘ÁÈÂÈÓ‹ ÙˆÓ Î·ÙÔÈΛ‰ÈˆÓ ˙ÒˆÓ ÁÈ· ÙËÓ ÂÚ›ÙˆÛË Ô˘ Â›Ó·È ˘ÁÈ›˜ ÊÔÚ›˜ Î·È ÌÂÙ·‰›‰Ô˘Ó ÙË ÓfiÛÔ, ηıÒ˜ Â›Û˘ ÛˆÛÙ‹ ·ÓÙÈÌÂÙÒÈÛË Î·È ÙˆÓ ·ÛıÂÓÒÓ ‹ ·Û˘Ìو̷ÙÈÎÒÓ ÂÓËÏ›ÎˆÓ ÙÔ˘ ÔÈΛԢ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ ÙÔ˘ ·ÛıÂÓÔ‡˜.

OÈ ÎÏÈÓÈÎÔ› È·ÙÚÔ› ı· Ú¤ÂÈ Ó· ·ÓÙÈÌÂÙˆ›˙Ô˘Ó Ì ÚÔÛÔ¯‹ Î·È ˆ˜ Èı·Ó¤˜ ª∆∫ fiϘ ÙȘ ÂÚÈÙÒÛÂȘ ·ÏÏÔÈÒÛÂˆÓ ÙÔ˘ ÙÚȯˆÙÔ‡ Ù˘ ÎÂÊ·Ï‹˜ ·È‰ÈÒÓ ÚÔÂÊË‚È΋˜ ËÏÈΛ·˜, ȉȷ›ÙÂÚ· ÙˆÓ ·È‰ÈÒÓ ÙˆÓ ÌÂÙ·Ó·ÛÙÒÓ. £· Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÂÙ·È Ï‹Ú˜ ÈÛÙÔÚÈÎfi, Ó· Á›ÓÂÙ·È Ï‹Ú˘ Ì˘ÎËÙÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ (¿ÌÂÛË ÌÈÎÚÔÛÎÔÈ΋ ÂͤٷÛË Î·È Î·ÏÏȤÚÁÂÈ·) Û ÂÍÂȉÈÎÂ˘Ì¤Ó· ÂÚÁ·ÛÙ‹ÚÈ· Î·È Ó· ÂϤÁ¯ÂÙ·È ÙÔ ¿ÌÂÛÔ ÂÚÈ‚¿ÏÏÔÓ ÙÔ˘ ÌÈÎÚÔ‡ ·ÛıÂÓÔ‡˜ ÁÈ· Ù˘¯fiÓ ·Û˘Ìو̷ÙÈÎÔ‡˜ ÊÔÚ›˜.

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33. ∫Ô˘Û›‰Ô˘ £, ¶··Ìȯ·‹Ï ∂, ∞Ϥ͢ π, ºˆÙ›‰Ô˘-∑‹ÎÔ˘ ¢, ¢ÂÏ‚ÈÒÙÔ˘-¶·Ó·ÁȈٛ‰Ô˘ ¢. ª˘ÎËÙÈ¿ÛÂȘ ÙÚȯˆÙÔ‡ Ù˘ ÎÂÊ·Ï‹˜ ηٿ ÙË ‰ÂηÂÙ›· 1981-1990 ÛÙË µ. ∂ÏÏ¿‰· (ª·Î‰ÔÓ›·). ∂ÏÏ ∂Èı ¢ÂÚÌ ∞ÊÚ 1992;3:193-199.

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Microsporum canis Û ‰ÂÚÌ·ÙÈΤ˜ ‚Ï¿‚˜ ·È‰ÈÒÓ Î·Ù¿ ÙÔ ‰È¿ÛÙËÌ· 1986-91. ∂Ê·ÚÌ ∫ÏÈÓ ªÈÎÚ ∂ÚÁ·ÛÙ ¢È·ÁÓˆÛÙ 1995;10:207-211.

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St-Germain G, Summerbell R. Identifying filamentous fungi A Clinical Laboratory Handbook. 1st ed. California: Star Publishing Company; 1996.

∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 21-02-2003 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 27-05-2003 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∂. ºÚ·ÁÎÔ‡ÏË ∂ÚÁ·ÛÙ‹ÚÈÔ µÈÔ·ıÔÏÔÁ›·˜ ¡ÔÛÔÎÔÌÂ›Ô ∞ÊÚÔ‰›ÛÈˆÓ Î·È ¢ÂÚÌ·ÙÈÎÒÓ ¡fiÛˆÓ “∞. ™˘ÁÁÚfi˜” ¢Ú·ÁÔ‡ÌË 5, ∞ı‹Ó·

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Paediatriki 2003;66:436-447

AWARD-WINNING ARTICLE

∞ÍÈÔÏfiÁËÛË 10 ÂÙÒÓ ·fi ÙËÓ ¤Ó·ÚÍË ÚÔÁÚ¿ÌÌ·ÙÔ˜ ·ÁˆÁ‹˜ ˘Á›·˜ ÛÙ· Û¯ÔÏ›· Ù˘ ∫Ú‹Ù˘* ª. §ÈÓ·Ú‰¿Î˘, ∫. ™·ÚÚ‹, º. ªÂÚ‚·Ó¿ÎË, ∂. ª¿ÚηÙ˙Ë, Ã. ÷Ù˙‹˜, ™. ºÏÔ˘Ú‹, ∞. ∫·Ê¿ÙÔ˜

Ten-year evaluation of the initiation of a health education program in the schools of Crete* M. Linardakis, K. Sarri, F. Bervanaki, I. Markatzi, C. Hatzis, S. Flouri, A. Kafatos

¶ÂÚ›ÏË„Ë: ∏ ÚfiÏË„Ë ÙˆÓ ¯ÚfiÓÈˆÓ ÓÔÛËÌ¿ÙˆÓ Ú¤ÂÈ Ó· ·Ú¯›˙ÂÈ ·fi ÙËÓ ·È‰È΋ ËÏÈΛ·, ηıÒ˜ ÔÈ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ·˘Ù¿ ÂÌÊ·Ó›˙ÔÓÙ·È Ôχ ÓˆÚ›˜. ™Ùfi¯Ô˜ Ù˘ ·ÚÔ‡Û·˜ ÂÚÁ·Û›·˜ ‹Ù·Ó Ë ·ÍÈÔÏfiÁËÛË Ù˘ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ Ù˘ ÂÎ·È‰Â˘ÙÈ΋˜ ·Ú¤Ì‚·Û˘ Û ı¤Ì·Ù· ˘Á›·˜ ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÎ·›‰Â˘Û˘ ÛÙÔ ‰ËÌÔÙÈÎfi, Û ÔÌ¿‰· ·È‰ÈÒÓ Ô˘ ÂÍÂÙ¿ÛÙËÎ·Ó ÛÙËÓ ¤Ó·ÚÍË Ù˘ ·Ú¤Ì‚·Û˘ Î·È ÙÚ›·, ¤ÍÈ Î·È ‰¤Î· ¯ÚfiÓÈ· ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË. ∆Ô ÚfiÁÚ·ÌÌ·, ‰È¿ÚÎÂÈ·˜ 6 ÂÙÒÓ, ÍÂΛÓËÛ ÙÔ 1992 Û 5681 Ì·ıËÙ¤˜ Ù˘ ∞’ Ù¿Í˘ fiÏˆÓ ÙˆÓ ‰ËÌÔÙÈÎÒÓ Û¯ÔÏ›ˆÓ ·fi ÙÚÂȘ ÓÔÌÔ‡˜ Ù˘ ∫Ú‹Ù˘. ∆· 4171 ·È‰È¿ ·ÔÙÂÏÔ‡Û·Ó ÙËÓ ÔÌ¿‰· ÂÎ·È‰Â˘ÙÈ΋˜ ·Ú¤Ì‚·Û˘ Î·È Ù· ˘fiÏÔÈ· 1510 ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘. ™Â ·ÓÙÈÚÔÛˆ¢ÙÈÎfi ‰Â›ÁÌ· 40 Û¯ÔÏ›ˆÓ, 1046 Ì·ıËÙ¤˜ (·Ú¤Ì‚·Û˘: 602, ÂϤÁ¯Ô˘: 444) ˘Ô‚Ï‹ıËÎ·Ó ÛÙȘ ·ÎfiÏÔ˘ı˜ ÂÍÂÙ¿ÛÂȘ: ۈ̷ÙÔÌÂÙÚÈΤ˜ ÌÂÙÚ‹ÛÂȘ, ÏÈÔÚˆÙ½Ó˜ ÔÚÔ‡ Î·È ·ÚÙËÚȷ΋ ›ÂÛË ·›Ì·ÙÔ˜, ÂÓÒ ·Ú¿ÏÏËÏ· ÂÎÙÈÌ‹ıËÎ·Ó Ë Ê˘ÛÈ΋ ηٿÛÙ·ÛË, ÙÔ ‰È·ÈÙËÙÈÎfi ÈÛÙÔÚÈÎfi Î·È ÔÈ Û˘Ó‹ıÂȘ ˘Á›·˜. ¢È·¯ÚÔÓÈο Î·È ‰¤Î· ¯ÚfiÓÈ· ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ·Ú¤Ì‚·Û˘ ‰È·ÈÛÙÒıËΠÛËÌ·ÓÙÈο ÌÈÎÚfiÙÂÚË ·‡ÍËÛË ÛÙÔÓ ‰Â›ÎÙË Ì¿˙·˜ ÛÒÌ·ÙÔ˜ (¢ª™) ÛÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·Û˘ (+3,3 kg/m2) Û ۇÁÎÚÈÛË Ì ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘ (+4,3 kg/m2) (p<0,001). ™ÙÔ ·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜ ÛËÌÂÈÒıËΠÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚË Â›‰ÔÛË ÛÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·Û˘ (p<0,001). ∏ ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË ÌÂÈÒıËΠÛËÌ·ÓÙÈο ÂÚÈÛÛfiÙÂÚÔ ÛÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·Û˘ Û ۯ¤ÛË Ì ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘ (-9% Î·È -0,5% ·ÓÙ›ÛÙÔȯ·, p<0,001), ÂÓÒ Ë LDL-¯ÔÏËÛÙÂÚfiÏË

Abstract: Prevention of chronic diseases should start in childhood since the risk factors related to these diseases make their appearance at early ages. The objective of this study was to assess the long-term effectiveness of a health education intervention program applied to primary school pupils, 10 years after the initiation of the program.

The 6-year-long school-based intervention program was applied to all students (5681) who registered in the first grade of primary school in three counties of Crete (intervention group: 4171, control group: 1510) in 1992. A number of biochemical and behavioural parameters (somatometric measurements, serum lipoproteins, blood pressure, physical activity, dietary record, health habits) were measured in 1046 students from 40 schools randomly selected (602 intervention group and 444 control group). Re-evaluation of the intervention program was performed at 3, 6 and 10 years after the initiation of the program. Ten years after the initiation of the program, the results showed that the body mass index (µªπ) had increased significantly less (p<0.001) and performance in the shuttle run test was significantly better (p<0.001) in the intervention group as compared to the control group. The reduction in total cholesterol noted in both groups was significantly greater in the intervention group than in the control group (p<0.001). The LDL decreased significantly in the intervention group, but increased in the control group (p<0.001). The incidence of smoking was also significantly lower in the intervention group

∆Ô̤·˜ ∫ÔÈÓˆÓÈ΋˜ π·ÙÚÈ΋˜ ∫ÏÈÓÈ΋ ¶ÚÔÏËÙÈ΋˜ π·ÙÚÈ΋˜ Î·È ¢È·ÙÚÔÊ‹˜ ∆Ì‹Ì· π·ÙÚÈ΋˜ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘

Department of Social Medicine Preventive Medicine and Nutrition Clinic University of Crete Medical School

*∞’ µÚ·‚Â›Ô ∫ÔÈÓˆÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ 41Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ, 2003

*1st Prize of Social Paediatrics 41st Panhellenic Paediatric Meeting, 2003

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ÌÂÈÒıËΠÛËÌ·ÓÙÈο ÛÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·Û˘ Î·È ·˘Í‹ıËΠÛÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘ (-10% Î·È +5% ·ÓÙ›ÛÙÔȯ·, p<0,001). ∂›Û˘, ÛËÌ·ÓÙÈο ÌÈÎÚfiÙÂÚÔ ÔÛÔÛÙfi ·È‰ÈÒÓ Ù˘ ÔÌ¿‰·˜ ·Ú¤Ì‚·Û˘ οÓÈ˙ ÙÔ 2002 Û ۇÁÎÚÈÛË Ì ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘ (7% Î·È 13% ·ÓÙ›ÛÙÔȯ·, p<0,05). ∏ ÂÎ·È‰Â˘ÙÈ΋ ·Ú¤Ì‚·ÛË Ê·›ÓÂÙ·È fiÙÈ ‚ÂÏÙÈÒÓÂÈ ÙÔ Â›Â‰Ô ˘Á›·˜ ÙˆÓ ·È‰ÈÒÓ Î·È ÂÏ·ÙÙÒÓÂÈ ÛËÌ·ÓÙÈο ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù·. ∂¿Ó ·˘Ù¤˜ ÔÈ ıÂÙÈΤ˜ ÂȉڿÛÂȘ Û˘Ó¯ÈÛÙÔ‡Ó ÙȘ ÂfiÌÂÓ˜ ‰ÂηÂٛ˜, ›Ûˆ˜ Ó· Â›Ó·È ‰˘Ó·Ù‹ Ë Ì›ˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù·.

(intervention group: 7%, control group 13%, p<0.005). This health and nutrition education program appears to improve children’s health and to decrease risk factors for chronic diseases. If these positive effects are maintained in the forthcoming decades, the risk of chronic diseases may well be reduced.

§¤ÍÂȘ ÎÏÂȉȿ: ·È‰È¿, ·ÁˆÁ‹ ˘Á›·˜, ÏÈÔÚˆÙ½Ó˜, ۈ̷ÙÔÌÂÙÚ‹ÛÂȘ, Ê˘ÛÈ΋ ηٿÛÙ·ÛË.

Key words: children, health and nutrition education, lipoproteins, anthropometric measurements, fitness.

™˘ÓÙÔÌÔÁڷʛ˜

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ

¶ ∂ ¢ª™ HDL-C LDL-C ª™

OÌ¿‰· ·Ú¤Ì‚·Û˘ OÌ¿‰· ÂϤÁ¯Ô˘ ¢Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ ÃÔÏËÛÙÂÚfiÏË ÙˆÓ ˘„ËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈÔÚˆÙÂ˚ÓÒÓ ÃÔÏËÛÙÂÚfiÏË ÙˆÓ ¯·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈÔÚˆÙÂ˚ÓÒÓ ™Ù·ÙÈÛÙÈÎÒ˜ ÌË ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿

∂ÈÛ·ÁˆÁ‹ ∏ Ù·¯Â›· ·‡ÍËÛË ÙˆÓ ‰ÂÈÎÙÒÓ ÓÔÛËÚfiÙËÙ·˜ Î·È ıÓËÛÈÌfiÙËÙ·˜ ÛÙÔÓ ÏËı˘ÛÌfi Ù˘ ¯ÒÚ·˜ Ì·˜ ηٿ ÙȘ ÙÂÏÂ˘Ù·›Â˜ ‰ÂηÂٛ˜ (2,10) ηıÈÛÙ¿ ·Ó·Áη›· ÙËÓ ¤Ó·ÚÍË ÚÔÁÚ·ÌÌ¿ÙˆÓ ÚÔ·ÁˆÁ‹˜ Ù˘ ˘Á›·˜ Î·È ÚfiÏ˄˘ Ôχ ÓˆÚ›˜ ·fi ÙËÓ ·È‰È΋ ËÏÈΛ· (1-3,23-29). ∏ ∫ÏÈÓÈ΋ ¶ÚÔÏËÙÈ΋˜ π·ÙÚÈ΋˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘ ÍÂΛÓËÛ ¤Ó· ÂÍ·ÂÙ¤˜ ÚfiÁÚ·ÌÌ· ÂÎ·È‰Â˘ÙÈ΋˜ ·Ú¤Ì‚·Û˘ ÛÙ· Û¯ÔÏ›· Ù˘ ∫Ú‹Ù˘, ÙÔ Û¯ÔÏÈÎfi ¤ÙÔ˜ 1992-1993. ™ÙÔ ÚfiÁÚ·ÌÌ· ÁÚ¿ÊÙËÎ·Ó fiÏ· Ù· ·È‰È¿ Ù˘ ∞’ Ù¿Í˘ ‰ËÌÔÙÈÎÔ‡, ÂÓÒ ÙÔ ÚfiÁÚ·ÌÌ· ÂÓÙ¿¯ıËΠÛÙËÓ ÂÎ·È‰Â˘ÙÈ΋ ‰È·‰Èηۛ· Û ‰È·Û‡Ó‰ÂÛË Ì ¿ÏÏ· Ì·ı‹Ì·Ù·. ∏ ÂÎ·È‰Â˘ÙÈ΋ ·Ú¤Ì‚·ÛË ÂÛÙÈ¿ÛÙËΠ΢ڛˆ˜ ÛÙË ‰È·ÙÚÔÊ‹, ÙË Ê˘ÛÈ΋ ¿ÛÎËÛË Î·È ÙËÓ ·ÔÊ˘Á‹ ÙÔÍÈÎÒÓ Ô˘ÛÈÒÓ. ∏ ÚÒÙË ·ÍÈÔÏfiÁËÛË ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ¤ÁÈÓ ÛÙ· 3 ¯ÚfiÓÈ· ÂÎ·È‰Â˘ÙÈ΋˜ ·Ú¤Ì‚·Û˘ (4,5) Î·È Ë ‰Â‡ÙÂÚË ¤ÁÈÓ Ì ÙËÓ ÔÏÔÎÏ‹ÚˆÛ‹ ÙÔ˘ ÛÙ· 6 ¯ÚfiÓÈ· (6-9). ∞ÎÔÏÔ‡ıËÛÂ Ë ÙÚ›ÙË ·ÍÈÔÏfiÁËÛË, 4 ¯ÚfiÓÈ· ÌÂÙ¿ ÙÔ Ù¤ÏÔ˜ Ù˘ ·Ú¤Ì‚·Û˘ Î·È ÂÓÒ Ù· ·È‰È¿ ‹Ù·Ó ËÏÈΛ·˜ 14-16 ÂÙÒÓ. ∏ ·ÚÔ‡Û· ¤Ú¢ӷ ÛÙԯ‡ÂÈ ÛÙËÓ ·ÍÈÔÏfiÁËÛË Ù˘ ÂÎ·È‰Â˘ÙÈ΋˜ ·Ú¤Ì‚·Û˘ 10 ¯ÚfiÓÈ· ·fi ÙËÓ ¤Ó·ÚÍ‹ Ù˘ Î·È 4 ¯ÚfiÓÈ· ·fi ÙË ‰È·ÎÔ‹ Ù˘ ·ÁˆÁ‹˜ ˘Á›·˜. °È· ÙËÓ ·ÍÈÔÏfiÁËÛË ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÌÂÏÂÙ‹ıËÎ·Ó Ù· Â›‰· ˘Á›·˜, ıÚ¤„˘ Î·È ·Ó¿Ù˘Í˘ ÙˆÓ ·È‰ÈÒÓ Î·È Ë ·ÚÔ˘Û›· ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù·.

∆Ô ÚfiÁÚ·ÌÌ· ÂÎ·È‰Â˘ÙÈ΋˜ ·Ú¤Ì‚·Û˘ Û ۯÔÏ›· Ù˘ ∫Ú‹Ù˘ ¿Ú¯ÈÛ Ì fiÏ· Ù· ·È‰È¿ Ô˘ ÁÚ¿ÊÙËÎ·Ó ÛÙËÓ ∞’ Ù¿ÍË ‰ËÌÔÙÈÎÔ‡ ÙÔ 1992-1993 Û ÙÚÂȘ ÓÔÌÔ‡˜ Ù˘ ∫Ú‹Ù˘. ∞fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ ‰ËÌÔÙÈÎÒÓ Û¯ÔÏ›ˆÓ ÛÙÔ˘˜ ÓÔÌÔ‡˜ ∏Ú·ÎÏ›Ԣ, ƒÂı‡ÌÓÔ˘ Î·È Ã·Ó›ˆÓ Î·È ÙˆÓ 5681 Ì·ıËÙÒÓ Ô˘ ÁÚ¿ÊÙËÎ·Ó ÛÙËÓ ∞’ Ù¿ÍË, ÂÂϤÁË ·ÓÙÈÚÔÛˆ¢ÙÈÎfi ‰Â›ÁÌ· 40 Û¯ÔÏ›ˆÓ Ì 1046 Ì·ıËÙ¤˜ ËÏÈΛ·˜ 5,5-7 ÂÙÒÓ, ÔÈ ÔÔ›ÔÈ ˘Ô‚Ï‹ıËÎ·Ó Û Ï‹ÚË ¤ÏÂÁ¯Ô Ù˘ ˘Á›·˜ ÙÔ˘˜. ∞fi Ù· 40 Û¯ÔÏ›·, Ù· 24 ‹Ù·Ó ·fi ÙÔ˘˜ ÓÔÌÔ‡˜ ∏Ú·ÎÏ›Ԣ Î·È ƒÂı‡ÌÓÔ˘ Ì 602 Ì·ıËÙ¤˜ [ÔÌ¿‰· ·Ú¤Ì‚·Û˘ (¶)] Î·È Ù· 16 ·fi ÙÔÓ ÓÔÌfi ÷ӛˆÓ Ì 444 Ì·ıËÙ¤˜ [ÔÌ¿‰· ÂϤÁ¯Ô˘ (∂)]. ∏ ÌÂıÔ‰ÔÏÔÁ›· Ù˘ ¤Ú¢ӷ˜, Ë ÂÎ·È‰Â˘ÙÈ΋ ‰È·‰Èηۛ· Î·È ÔÈ ÂÚÈÔ‰ÈΤ˜ ·ÍÈÔÏÔÁ‹ÛÂȘ Ô˘ ¤ÁÈÓ·Ó Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ¤ÍÈ ÂÙÒÓ ÂÊ·ÚÌÔÁ‹˜ Ù˘ ÂÎ·È‰Â˘ÙÈ΋˜ ·Ú¤Ì‚·Û˘ (1992-1998), ÂÚÈÁÚ¿ÊÔÓÙ·È Ï‹Úˆ˜ Û ÚÔËÁÔ‡ÌÂÓ˜ ÂÚÁ·Û›Â˜ (4-9). ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ Û¯ÔÏÈÎÔ‡ ¤ÙÔ˘˜ 2001-2002, Ù· ·È‰È¿ Ô˘ ›¯·Ó Û˘ÌÌÂÙ¿Û¯ÂÈ ÛÙÔ ÚfiÁÚ·ÌÌ· ÙÔ 1992 ÂÓÙÔ›ÛÙËÎ·Ó Û 63 Û¯ÔÏ›· ÛÙÔ˘˜ ÙÚÂȘ ÓÔÌÔ‡˜ Ù˘ ∫Ú‹Ù˘. OÈ ÁÔÓ›˜ ÙˆÓ ·È‰ÈÒÓ ÂÓËÌÂÚÒıËÎ·Ó ÁÚ·ÙÒ˜ ÁÈ· ÙȘ ÂÍÂÙ¿ÛÂȘ Ù˘ Â·Ó·ÍÈÔÏfiÁËÛ˘ Î·È ˘¤ÁÚ·„·Ó ˘‡ı˘ÓË ‰‹ÏˆÛË ÁÈ· ÙË Û˘ÌÌÂÙÔ¯‹ ‹ ÌË ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜. ∞fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ Ì·ıËÙÒÓ Ô˘ ÂÍÂÙ¿ÛÙËÎ·Ó ·fi ÙÔ 1992 ¤ˆ˜ ÙÔ 1998, ÙÔ 2002 ·¿ÓÙËÛ·Ó 728 ·È‰È¿ (70%), Ù· 49 ÂÎ ÙˆÓ ÔÔ›ˆÓ ›¯·Ó ‰È·Îfi„ÂÈ ÙË ÊÔ›ÙËÛ‹ ÙÔ˘˜. ∂‚‰ÔÌ‹ÓÙ· ÂÙ¿ ·È‰È¿ ·ÚÓ‹ıËÎ·Ó ÙË Û˘ÌÌÂÙÔ¯‹ ÙÔ˘˜, ÂÓÒ 651 ‰¤¯ÙËηÓ. ™ÙËÓ È·ÙÚÈ΋ ÂͤٷÛË ÚÔÛ‹Ïı·Ó, ÙÂÏÈο, 634 ·È‰È¿ (61%) (¶: 331, ∂: 303), ÂÓÒ ÌfiÏȘ 7 ·fi Ù· 49 ·È‰È¿ Ô˘ ›¯·Ó ‰È·Îfi„ÂÈ ÙË ÊÔ›ÙËÛ‹ ÙÔ˘˜ ÚÔÛ‹Ïı·Ó ÛÙȘ ÂÍÂÙ¿ÛÂȘ.

OÈ ÂÍÂÙ¿ÛÂȘ Ô˘ Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó ÙÔ 2002 ·fi ÙËÓ ÂÚ¢ÓËÙÈ΋ ÔÌ¿‰· Ù˘ ∫ÏÈÓÈ΋˜ ¶ÚÔÏËÙÈ΋˜ π·ÙÚÈ΋˜ Î·È ¢È·ÙÚÔÊ‹˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘, ·ÊÔÚÔ‡Û·Ó Û ۈ̷ÙÔÌÂÙÚÈΤ˜ ÌÂÙÚ‹ÛÂȘ, ·ÚÙËÚȷ΋ ›ÂÛË ·›Ì·ÙÔ˜, ·ÈÌÔÏË„›· ÁÈ· ÏÈÔÚˆÙ½Ó˜, ·ÍÈÔÏfiÁËÛË Ù˘ Ê˘ÛÈ΋˜ ηٿÛÙ·Û˘ Ì ·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜ (¶∆∞), Ï‹„Ë ‰È·ÈÙÔÏÔÁ›Ô˘ ÚÔËÁÔ‡ÌÂÓÔ˘ 24ÒÚÔ˘ Î·È ˙˘ÁÈṲ̂ÓÔ˘ Ê·ÁËÙÔ‡ 3 ËÌÂÚÒÓ Î·È

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¶·È‰È·ÙÚÈ΋ 2003;66:436-447

ηٷÁÚ·Ê‹ ÙˆÓ ÁÓÒÛÂˆÓ Î·È ÙˆÓ Û˘ÓËıÂÈÒÓ ˘Á›·˜, ηıÒ˜ Î·È ÙÔ˘ ÙÚfiÔ˘ ˙ˆ‹˜. °È· ÙȘ Û˘Ó‹ıÂȘ Î·È ÙȘ ÁÓÒÛÂȘ ˘Á›·˜ ¯ÚËÛÈÌÔÔÈ‹ıËΠÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Ô˘ ·Ó·ÊÂÚfiÙ·Ó ÛÙÔ Î¿ÓÈÛÌ·, ÛÙËÓ Î·Ù·Ó¿ÏˆÛË ÔÈÓÔÓ‡̷ÙÔ˜ Î·È Î·Ê¤, ÛÙËÓ Î·Ù·ÁÚ·Ê‹ ‰Ú·ÛÙËÚÈÔÙ‹ÙˆÓ Î·È ÛÙȘ ÁÓÒÛÂȘ Û ı¤Ì·Ù· ‰È·ÙÚÔÊ‹˜ Î·È ˘Á›·˜. ∏ ·Ó¿Ï˘ÛË ÙÔ˘ ‰È·ÈÙÔÏÔÁ›Ô˘ ¤ÁÈÓ ·fi ËÏÂÎÙÚÔÓÈ΋ ‚¿ÛË ‰Â‰ÔÌ¤ÓˆÓ ÙÚÔʛ̈Ó, ‚·ÛÈṲ̂ÓË ÙfiÛÔ ÛÙË ‚¿ÛË ÙÔ˘ ÀÔ˘ÚÁ›Ԣ °ÂˆÚÁ›·˜ ÙˆÓ ∏ÓˆÌ¤ÓˆÓ ¶ÔÏÈÙÂÈÒÓ (United States Department of Agriculture - USDA) fiÛÔ Î·È ÛÙË ¯ËÌÈ΋ ·Ó¿Ï˘ÛË 120 ÂÏÏËÓÈÎÒÓ ÙÚÔÊ›ÌˆÓ Ô˘ ¤ÁÈÓ ÛÙÔ TNO Nutrition Institute ÛÙËÓ OÏÏ·Ó‰›· ÛÙÔ Ï·›ÛÈÔ ÙÔ˘ Â˘Úˆ·˚ÎÔ‡ ÚÔÁÚ¿ÌÌ·ÙÔ˜ Transfair, ÂÓÒ 20 ÙÚfiÊÈÌ· ·Ó·Ï‡ıËÎ·Ó ¯ËÌÈο ÛÙÔ Wegeningen Agricultural University. ∞fi Ù· 634 ·È‰È¿ Ô˘ ÂÍÂÙ¿ÛÙËÎ·Ó ÙÔ 2002, Ù· 617 Û˘ÌÏ‹ÚˆÛ·Ó ‰È·ÈÙËÙÈÎfi ÈÛÙÔÚÈÎfi ÙÂÏÂ˘Ù·›Ô˘ 24ÒÚÔ˘ (¶: 329, ∂: 288), ÂÓÒ 107 ·È‰È¿ Û˘ÌÏ‹ÚˆÛ·Ó Î·È Â¤ÛÙÚ„·Ó ‰È·ÈÙÔÏfiÁÈÔ ˙˘ÁÈṲ̂ÓÔ˘ Ê·ÁËÙÔ‡ 3 ËÌÂÚÒÓ (¶: 77, ∂: 30). ∆Ô ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜ ÌÂÙÚ‹ıËΠ̠ËÏÂÎÙÚÔÓÈÎfi ˙˘Áfi Ù‡Ô˘ Seca Alpha ·ÎÚȂ›·˜ ±100 g Î·È Ë ˙‡ÁÈÛË ¤ÁÈÓ Ì ÂÛÒÚÔ˘¯·, ¯ˆÚ›˜ ·Ô‡ÙÛÈ·. ∆Ô ‡„Ô˜ ÌÂÙÚ‹ıËΠ̠·Ó·ÛÙËÌfiÌÂÙÚÔ ·ÎÚȂ›·˜ <0,5 cm, Û fiÚıÈ· ı¤ÛË, ¯ˆÚ›˜ ·Ô‡ÙÛÈ·, Ì ¯·Ï·ÚÔ‡˜ ÒÌÔ˘˜ Î·È Ù· ¯¤ÚÈ· ÙÔÔıÂÙË̤ӷ ÛÙÔ Ï¿È. O ‰Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ (¢ª™) ˘ÔÏÔÁ›ÛÙËΠ·fi ÙË Û¯¤ÛË ÙÔ˘ ‚¿ÚÔ˘˜ Û ÎÈÏ¿ ÚÔ˜ ÙÔ ‡„Ô˜ Û ̤ÙÚ· ÛÙÔ ÙÂÙÚ¿ÁˆÓÔ 2 (kg/m ). ªÂ ‚¿ÛË ÙÔÓ ‰Â›ÎÙË Ì¿˙·˜ ÛÒÌ·ÙÔ˜ ˘ÔÏÔÁ›ÛÙËÎÂ Î·È ÙÔ ÔÛÔÛÙfi ÙˆÓ ·È‰ÈÒÓ Ì ˘ÂÚ‚ÔÏÈÎfi ‚¿ÚÔ˜ Î·È ·¯˘Û·ÚΛ· (22). OÈ ‰ÂÚÌ·ÙÈΤ˜ Ù˘¯¤˜ ‰ÈΤʷÏÔ˘, ÙÚÈΤʷÏÔ˘, Ï·ÁÔÓ›Ô˘ Î·È ˆÌÔÏ¿Ù˘ ÌÂÙÚ‹ıËÎ·Ó Ì fiÚÁ·ÓÔ Ù‡Ô˘ Lange. ∆Ô ÔÛÔÛÙfi Ï›Ô˘˜ ÛÒÌ·ÙÔ˜ ˘ÔÏÔÁ›ÛÙËΠ̠‚¿ÛË ÙÔÓ ¢ª™, ÙÔ Ê‡ÏÔ Î·È ÙËÓ ËÏÈΛ· (21). ∏ ÂÚ›ÌÂÙÚÔ˜ Ù˘ ̤Û˘ ÌÂÙÚ‹ıËΠ̠Ï·ÛÙÈ΋ ÌÂÙÚÈ΋ Ù·ÈÓ›· ÛÙÔ ‡„Ô˜ ÙÔ˘ ÔÌÊ·ÏÔ‡ Î·È Î¿ÙˆıÂÓ ÙÔ˘ Ï¢ÚÈÎÔ‡ ÙfiÍÔ˘ (ÛÙÔ Ì¤ÛÔ Ù˘ ·fiÛÙ·Û˘ ÌÂٷ͇ Ï¢ÚÈÎÔ‡ ÙfiÍÔ˘ Î·È Ï·ÁÔÓ›Ô˘ ·ÎÚÔÏÔÊ›·˜) Î·È Ë ÂÚ›ÌÂÙÚÔ˜ ÏÂοÓ˘ ÛÙÔ ‡„Ô˜ ÙˆÓ Î·Ù’ ÈÛ¯›ˆÓ ·ÚıÚÒÛÂˆÓ Î·È ¿ÓˆıÂÓ ÙÔ˘ ÂÊË‚·›Ô˘. OÈ Û¯¤ÛÂȘ Ù˘ ÂÚÈ̤ÙÚÔ˘ ̤Û˘ ÚÔ˜ ÏÂοÓË Î·È ÚÔ˜ ‡„Ô˜ ˘ÔÏÔÁ›ÛÙËÎ·Ó ·fi ÙȘ ·Ú·¿Óˆ ÌÂÙÚ‹ÛÂȘ (11). ™ÙË Ì¤ÙÚËÛË ÙˆÓ ÛˆÌ·ÙÔÌÂÙÚÈÎÒÓ ÌÂÁÂıÒÓ Û˘ÌÌÂÙ›¯·Ó 617 ·È‰È¿. ∏ Û˘ÛÙÔÏÈ΋ Î·È ‰È·ÛÙÔÏÈ΋ ·ÚÙËÚȷ΋ ›ÂÛË ÌÂÙÚ‹ıËΠ۠622 ·È‰È¿ Ì ˘‰Ú·ÚÁ˘ÚÈÎfi Ì·ÓfiÌÂÙÚÔ ÙÚÂȘ ÊÔÚ¤˜, Ì ÌÂÛԉȿÛÙËÌ· 1-2 min (12). ∫¿ı ·È‰› ‚ÚÈÛÎfiÙ·Ó Û ηıÈÛÙ‹ ı¤ÛË Ì ÙËÓ Ï¿ÙË Î·È Ù· ¯¤ÚÈ· ÛÙËÚÈÁ̤ӷ ÛÙ· ÁfiÓ·Ù· Î·È Û ηٿÛÙ·ÛË ËÚÂÌ›·˜ ÚÈÓ ·fi ÙË Ì¤ÙÚËÛË ÁÈ· ÙÔ˘Ï¿¯ÈÛÙÔÓ 5 min. ∞fi ÙȘ ÙÚÂȘ ·˘Ù¤˜ ÌÂÙÚ‹ÛÂȘ ÂÏ‹ÊıË Ô Ì¤ÛÔ˜ fiÚÔ˜. ∏ ·ÚÙËÚȷ΋ ›ÂÛË Â›¯Â ÌÂÙÚËı› Î·È Î·Ù·ÁÚ·Ê› ηٿ ÙËÓ ¤Ó·ÚÍË ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÙÔ 1992 Û 932 ·È‰È¿. ¢Â›ÁÌ·Ù· ·›Ì·ÙÔ˜ ÂÏ‹ÊıËÛ·Ó ·fi 556 ·È‰È¿ ÙȘ ÚˆÈÓ¤˜ ÒÚ˜ ÌÂÙ¿ ·fi 12ˆÚË ÓËÛÙ›· Î·È ÌÂÙÚ‹ıËÎ·Ó Ë ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË (TC), Ù· ÙÚÈÁÏ˘ÎÂÚ›‰È· (Trigl) Î·È Ë HDL-¯ÔÏËÛÙÂÚfiÏË. ∏ LDL-¯ÔÏËÛÙÂÚfiÏË ˘ÔÏÔÁ›ÛÙËΠ·fi ÙÔÓ Ù‡Ô LDL=TC-(Trigl/5+HDL), ÂÓÒ Ô ·ıËڈ̷ÙÈÎfi˜ ‰Â›ÎÙ˘ ˘ÔÏÔÁ›ÛÙËΠ·fi ÙÔ ËÏ›ÎÔ Ù˘ ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ ÚÔ˜ ÙËÓ HDL-¯ÔÏËÛÙÂÚfiÏË (4).

438

Paediatriki 2003;66:436-447

∆¤ÏÔ˜, Ë ÂÎÙ›ÌËÛË Ù˘ Ê˘ÛÈ΋˜ ηٿÛÙ·Û˘ Ì ÙÔ ·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜ ¤ÁÈÓ Û 421 ·È‰È¿ (4-6). ∏ ¤ÁÎÚÈÛË ÂÊ·ÚÌÔÁ‹˜ ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ Î·È ÙˆÓ ÂÚÈÔ‰ÈÎÒÓ ·ÍÈÔÏÔÁ‹ÛÂˆÓ ÙˆÓ Ì·ıËÙÒÓ ÂÏ‹ÊıË ·fi ÙÔ ÀÔ˘ÚÁÂ›Ô ¶·È‰Â›·˜ Î·È ÙÔ ¶·È‰·ÁˆÁÈÎfi πÓÛÙÈÙÔ‡ÙÔ, ÂÓÒ fiÏÔÈ ÔÈ ÁÔÓ›˜ ¤‰ˆÛ·Ó ÂÓ˘fiÁÚ·ÊË ÏËÚÔÊÔÚË̤ÓË Û˘Ó·›ÓÂÛË ÁÈ· ÙËÓ ÂͤٷÛË ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘˜. ™Ù·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË OÈ ÛˆÌ·ÙÔÌÂÙÚÈΤ˜ ÌÂÙÚ‹ÛÂȘ, ÔÈ ÏÈÔÚˆÙ½Ó˜, Ë ·ÚÙËÚȷ΋ ›ÂÛË ·›Ì·ÙÔ˜, Ë ‰ÔÎÈÌ·Û›· ·ÓÙÔ¯‹˜ Î·È Ë ÚfiÛÏË„Ë ‰È·ÈÙËÙÈÎÒÓ ÛÙÔȯ›ˆÓ Û˘ÁÎÚ›ıËÎ·Ó ÁÈ· ÙȘ ‰‡Ô ÔÌ¿‰Â˜ (·Ú¤Ì‚·Û˘ Î·È ÂϤÁ¯Ô˘) ÁÈ· ÙȘ ÂÚÈfi‰Ô˘˜ ·ÍÈÔÏfiÁËÛ˘ 1995, 1998 Î·È 2002 Û ۯ¤ÛË Ì ÙËÓ ·Ú¯È΋ ÂͤٷÛË ÙÔ 1992. ªÂ ÙË ¯Ú‹ÛË ÁÂÓÈÎÂ˘Ì¤ÓÔ˘ ÁÚ·ÌÌÈÎÔ‡ ÌÔÓÙ¤ÏÔ˘ ·Ó¿Ï˘Û˘ Û˘Ó‰È·Î‡Ì·ÓÛ˘ (ANCOVA) Î·È Û˘ÌÌÂÙ·‚ÏËÙÒÓ Ê‡ÏÔ˘ Î·È ¢ª™, ÂϤÁ¯ıËÎÂ Ë ‡·ÚÍË ‹ ÌË ‰È·ÊÔÚ¿˜ ÌÂÙ¿ 10 ¯ÚfiÓÈ· ·fi ÙËÓ ¤Ó·ÚÍË ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜. ¶·Ú¿ÏÏËÏ· Ì ÙË ¯Ú‹ÛË ÁÂÓÈÎÂ˘Ì¤ÓÔ˘ ÌÔÓÙ¤ÏÔ˘ ·Ó¿Ï˘Û˘ Û˘Ó‰È·Î‡Ì·ÓÛ˘ Â·Ó·Ï·Ì‚·ÓfiÌÂÓˆÓ ÌÂÙÚ‹ÛÂˆÓ (GLM-Repeated measures analysis) Î·È Û˘ÌÌÂÙ·‚ÏËÙÒÓ Ê‡ÏÔ˘ Î·È Ì¤Û˘ ‰È·ÊÔÚ¿˜ ¢ª™ ·fi ÙËÓ ·Ú¯È΋ ÂͤٷÛË, ÂϤÁ¯ıËÎÂ Ë ‰È·ÊÔÚÔÔ›ËÛË ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ ·Ú¤Ì‚·Û˘ Î·È ÂϤÁ¯Ô˘ Û fiϘ ÙȘ ÂÚÈfi‰Ô˘˜ ·ÍÈÔÏfiÁËÛ˘. OÈ ¤ÏÂÁ¯ÔÈ ¤ÁÈÓ·Ó ÛÙȘ ‰È·ÊÔÚ¤˜ ÙˆÓ ÙÈÌÒÓ ·fi ÙËÓ ·Ú¯È΋ ÂͤٷÛË ÙÔ˘ 1992 Ì ÙËÓ Î¿ı ÂÚ›Ô‰Ô ·ÍÈÔÏfiÁËÛ˘. °È· ÙÔÓ ¤ÏÂÁ¯Ô ˙¢ÁÒÓ ·Ú·ÙËÚ‹ÛÂˆÓ (Student paired samples t-test) Û˘ÁÎÚ›ıËÎ·Ó Ù· 107 ‰È·ÈÙÔÏfiÁÈ· 3 ËÌÂÚÒÓ Ì ٷ ·ÓÙ›ÛÙÔȯ· ‰È·ÈÙÔÏfiÁÈ· ÙÔ˘ 24ÒÚÔ˘ ηٿ ÙËÓ ÙÚ›ÙË ·ÍÈÔÏfiÁËÛË ÙÔ 2002. ¶·Ú¿ÏÏËÏ· Ì ÙË ¯Ú‹ÛË ÂϤÁ¯Ô˘ ·Ó¿Ï˘Û˘ Û˘Ó‰È·Î‡Ì·ÓÛ˘ (ANCOVA) Î·È Û˘ÌÌÂÙ·‚ÏËÙÒÓ Ê‡ÏÔ˘, ¢ª™, ËÏÈΛ·˜ Î·È ÂÎ·È‰Â˘ÙÈ΋˜ ·Ú¤Ì‚·Û˘, ¤ÁÈÓ ۇÁÎÚÈÛË ÙˆÓ ÛˆÌ·ÙÔÌÂÙÚ‹ÛˆÓ, Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ ·›Ì·ÙÔ˜, ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ Î·È ÙÔ˘ ·Ï›Ó‰ÚÔÌÔ˘ ÙÚÂ̷͛ÙÔ˜ ·ÓÙÔ¯‹˜ ÙˆÓ ·È‰ÈÒÓ ÂÎÂ›ÓˆÓ Ô˘ Â¤ÛÙÚ„·Ó Ù· 107 ‰È·ÈÙÔÏfiÁÈ· ˙˘ÁÈṲ̂ÓÔ˘ Ê·ÁËÙÔ‡ 3 ËÌÂÚÒÓ, Ì ٷ ˘fiÏÔÈ· 498 ·È‰È¿ ÛÙ· ÔÔ›· ÂÏ‹ÊıË ‰È·ÈÙÔÏfiÁÈÔ ÙÂÏÂ˘Ù·›Ô˘ 24ÒÚÔ˘.

2 O ¯ ¤ÏÂÁ¯Ô˜ (Chi-square test) ¯ÚËÛÈÌÔÔÈ‹ıËΠÁÈ· ÙË ‰È·ÊÔÚ¿ Û˘¯ÓÔÙ‹ÙˆÓ ÛÙÔ Î¿ÓÈÛÌ· ÙˆÓ ·È‰ÈÒÓ Î·È ÙˆÓ ÁÔÓ¤ˆÓ ÙÔ˘˜, ÂÓÒ Ô ÌË ·Ú·ÌÂÙÚÈÎfi˜ ¤ÏÂÁ¯Ô˜ Mann-Whitney ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô Ù˘ ‰È¿ÚÎÂÈ·˜ Î·È Ù˘ ÔÛfiÙËÙ·˜ ÙÔ˘ ηÓ›ÛÌ·ÙÔ˜ ÙˆÓ ·È‰ÈÒÓ ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜.

∞ÔÙÂϤÛÌ·Ù· ™ÙÔÓ ¶›Ó·Î· 1 ·ÚÔ˘ÛÈ¿˙ÂÙ·È Ô Û¯Â‰È·ÛÌfi˜ ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜, fiˆ˜ ‰ÈÂÓÂÚÁ‹ıËΠÛÙ· 10 ¯ÚfiÓÈ· ·fi ÙËÓ ¤Ó·ÚÍ‹ ÙÔ˘. ∏ ÂÎ·È‰Â˘ÙÈ΋ ·Ú¤Ì‚·ÛË ‰È¿ÚÎÂÈ·˜ 6 ÂÙÒÓ ÔÏÔÎÏËÚÒıËΠÙÔ 1998 Î·È ·ÎÔÏÔ‡ıËÛÂ Ë ÙÚ›ÙË ·ÍÈÔÏfiÁËÛË ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÙÔ 2002. ∞fi Ù· 1046 ·È‰È¿ Ô˘ ÂÍÂÙ¿ÛÙËÎ·Ó ÛÙËÓ ·Ú¯È΋ ÂͤٷÛË ÙÔ 1992, 471 ·È‰È¿ Û˘ÌÌÂÙ›¯·Ó ÙÔ 1995 ÛÙËÓ 1Ë ·ÍÈÔÏfiÁËÛË (45% ÙÔ˘ ·Ú¯ÈÎÔ‡ ‰Â›ÁÌ·ÙÔ˜), 831 ·È‰È¿ (79%) Û˘ÌÌÂÙ›¯·Ó ÛÙË 2Ë ·ÍÈÔÏfiÁËÛË ÙÔ 1998 ηÈ, Ù¤ÏÔ˜, 634 ·È‰È¿ (61%) Û˘ÌÌÂÙ›¯·Ó ÛÙËÓ 3Ë ·ÍÈÔÏfiÁËÛË ÙÔ 2002.

¶·È‰È·ÙÚÈ΋ 2003;66:436-447

Paediatriki 2003;66:436-447

™ÙÔÓ ¶›Ó·Î· 2 ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ù· Â›‰· ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ Î·È Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ ÙˆÓ ·È‰ÈÒÓ Ô˘ ÂÍÂÙ¿ÛÙËÎ·Ó ÙÔ 1992 Î·È ÙÔ 2002. ∏ ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË ÌÂÈÒıËΠ۠ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚÔ ‚·ıÌfi ÛÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·Û˘ Û ۇÁÎÚÈÛË Ì ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘ (¶: -24,0±1,7 mg/dL, E: -10,1±1,8 mg/dL, p<0,001), fiˆ˜ Î·È Ë LDL-¯ÔÏËÛÙÂÚfiÏË (¶: -18,5±1,4 mg/dL, E: -3,1±1,6 mg/dL, p<0,001). O ·ıËڈ̷ÙÈÎfi˜ ‰Â›ÎÙ˘ ·˘Í‹ıËΠÛËÌ·-

ÓÙÈο ÏÈÁfiÙÂÚÔ ÛÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·Û˘ (¶: 0,06±0,05, E: 0,29±0,05, p<0,01), ÂÓÒ ‰ÂÓ ˘‹ÚÍ ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙËÓ ·ÚÙËÚȷ΋ ›ÂÛË ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ.

O ¶›Ó·Î·˜ 3 ÂÚÈÏ·Ì‚¿ÓÂÈ ÙȘ ÌÂÙ·‚ÔϤ˜ ÛÙȘ ۈ̷ÙÔÌÂÙÚÈΤ˜ ÌÂÙÚ‹ÛÂȘ Î·È ÛÙË ‰ÔÎÈÌ·Û›· ·ÓÙÔ¯‹˜ ÙˆÓ ·È‰ÈÒÓ ÙÔ 1992 Î·È ÙÔ 2002. ∆Ô ‚¿ÚÔ˜ Î·È Ô ¢ª™ ·˘Í‹ıËÎ·Ó ÛËÌ·ÓÙÈο ÂÚÈÛÛfiÙÂÚÔ ÛÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘ Û ۇÁÎÚÈÛË Ì ÙËÓ ÔÌ¿‰·

¶›Ó·Î·˜ 1. ÷ڷÎÙËÚÈÛÙÈο ÚÔÁÚ¿ÌÌ·ÙÔ˜ ·ÁˆÁ‹˜ ˘Á›·˜ ÛÙ· Û¯ÔÏ›· Ù˘ ∫Ú‹Ù˘

°’ ¢ËÌÔÙÈÎÔ‡

6,3±0,4*

8,6±0,3*

11,6±0,3*

15,1±0,5*

4171 602** 24

288** 12

457** 24

331** 37

1510 444** 16

183** 9

374* 16

303** 26

1046 545 501 40

471 242 229 21

831 427 404 42

634 302 332 63

ñ ∏ÏÈΛ· (¤ÙË) ñ OÌ¿‰· ·Ú¤Ì‚·Û˘ ª·ıËÙ¤˜ ∞’ Ù¿Í˘ ‰ËÌÔÙÈÎÒÓ Û¯ÔÏ›ˆÓ Ù˘ ∫Ú‹Ù˘ ª·ıËÙ¤˜ Ô˘ ÂÍÂÙ¿ÛÙËÎ·Ó ™¯ÔÏ›· ñ OÌ¿‰· ÂϤÁ¯Ô˘ ª·ıËÙ¤˜ ∞’ Ù¿Í˘ ‰ËÌÔÙÈÎÒÓ Û¯ÔÏ›ˆÓ Ù˘ ∫Ú‹Ù˘ ª·ıËÙ¤˜ Ô˘ ÂÍÂÙ¿ÛÙËÎ·Ó ™¯ÔÏ›· ñ ™‡ÓÔÏÔ ª·ıËÙ¤˜ Ô˘ ÂÍÂÙ¿ÛÙËÎ·Ó ∞ÁfiÚÈ· ∫ÔÚ›ÙÛÈ· ™¯ÔÏ›·

1Ë: 1995

∞•πO§O°∏™∏ 2Ë: 1998 3Ë: 2002 (∆∂§O™ ¶∞ƒ∂ªµ∞™∏™) °’ °˘ÌÓ·Û›Ô˘ & ™∆’ ¢ËÌÔÙÈÎÔ‡ ∞’ §˘Î›Ԣ

1992 (∞ƒÃ∏ ¶∞ƒ∂ªµ∞™∏™) ∞’ ¢ËÌÔÙÈÎÔ‡

* ª¤ÛÔ˜ fiÚÔ˜ ± Ù˘È΋ ·fiÎÏÈÛË ** ∂ÈÏÂÁ̤ÓÔ Ù˘¯·›Ô ‰Â›ÁÌ· ·fi ÙÔ˘˜ Ì·ıËÙ¤˜ Ô˘ ÁÚ¿ÊÙËÎ·Ó ÛÙËÓ ∞’ Ù¿ÍË ‰ËÌÔÙÈÎÔ‡ ¶›Ó·Î·˜ 2. ªÂÙ·‚ÔϤ˜ ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ Î·È Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ ÙˆÓ ÔÌ¿‰ˆÓ ·Ú¤Ì‚·Û˘ Î·È ÂϤÁ¯Ô˘ Û ‰È¿ÛÙËÌ· 10 ÂÙÒÓ ∞ƒÃ∏ 1992

3Ë ·ÍÈÔÏfiÁËÛË 2002 ª¤ÛÔ˜ ± ∆™

ªÂÙ·‚ÔÏ‹

p** <0,001

¡ OÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË (mg/dL) ∆ÚÈÁÏ˘ÎÂÚ›‰È· (mg/dL) HDL-C (mg/dL) LDL-C (mg/dL) ∞ıËڈ̷ÙÈÎfi˜ ‰Â›ÎÙ˘: ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË/HDL-C ™˘ÛÙÔÏÈ΋ ›ÂÛË ·›Ì·ÙÔ˜ (mm Hg) ¢È·ÛÙÔÏÈ΋ ›ÂÛË ·›Ì·ÙÔ˜ (mm Hg)

¶* ∂* ¶ ∂ ¶ ∂ ¶ ∂

255 214 255 214 255 214 255 214

188,1±1,9 176,0±2,1 52,9±1,3 52,9±1,4 60,5±0,9 59,7±0,9 117,2±1,8 105,7±1,9

164,1±1,8 165,9±1,9 66,9±1,7 64,8±1,8 51,9±0,7 50,3±0,7 98,7±1,5 102,6±1,6

-24,0±1,7 -10,1±1,8 13,9±1,8 11,9±1,9 -8,5±0,8 -9,3±0,9 -18,5±1,4 -3,1±1,6

¶ ∂ ¶ ∂ ¶ ∂

255 214 274 244 274 244

3,22±0,05 3,11±0,06 100,4±0,6 104,4±0,7 58,6±0,5 60,0±0,5

3,28±0,05 3,40±0,05 117,6±0,7 120,8±0,7 71,5±0,6 74,9±0,6

0,06±0,05 0,29±0,05 17,2±0,8 16,5±0,8 12,9±0,7 14,9±0,8

ª™*** ª™ <0,001

0,001 ª™ ª™

* ¶: ÔÌ¿‰· ·Ú¤Ì‚·Û˘, ∂: ÔÌ¿‰· ÂϤÁ¯Ô˘ ** ∞Ó¿Ï˘ÛË Û˘Ó‰È·Î‡Ì·ÓÛ˘ (ANCOVA): Ô ¤ÏÂÁ¯Ô˜ ¤ÁÈÓ ÛÙË ‰È·ÊÔÚ¿ Ù˘ 3˘ ·ÍÈÔÏfiÁËÛ˘ ·fi ÙËÓ ·Ú¯È΋ ÂͤٷÛË (∞ƒÃ∏) Î·È ˆ˜ Û˘ÌÌÂÙ·‚ÏËÙ¤˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÙÔ Ê‡ÏÔ Î·È Ë ‰È·ÊÔÚ¿ ÙÔ˘ ¢ª™ ·fi ÙËÓ ·Ú¯È΋ ÂͤٷÛË (1992) *** ª™: ÛÙ·ÙÈÛÙÈÎÒ˜ ÌË ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿

439

¶·È‰È·ÙÚÈ΋ 2003;66:436-447

Paediatriki 2003;66:436-447

¶›Ó·Î·˜ 3. ªÂÙ·‚ÔϤ˜ ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ÛˆÌ·ÙÔÌÂÙÚ‹ÛÂˆÓ Î·È Ù˘ Ê˘ÛÈ΋˜ ηٿÛÙ·Û˘ ÙˆÓ ÔÌ¿‰ˆÓ ·Ú¤Ì‚·Û˘ Î·È ÂϤÁ¯Ô˘ Û ‰È¿ÛÙËÌ· 10 ÂÙÒÓ ∞ƒÃ∏ 1992

3Ë ·ÍÈÔÏfiÁËÛË 2002 ª¤ÛÔ˜ ± ∆™

22,8±0,3 24,3±0,3 118,4±0,3 121,5±0,3 16,2±0,1 16,3±0,1 54,2±0,3 55,7±0,3 0,86±0,003 0,85±0,003 0,46±0,002 0,46±0,002 29,6±0,9 31,6±1,0 19,7±0,2 19,9±0,2 1,7±0,1 1,8±0,1

61,1±0,8 66,6±0,9 165,7±0,4 169,1±0,5 22,1±0,2 23,1±0,3 74,3±0,6 76,5±0,6 0,78±0,004 0,79±0,005 0,45±0,003 0,45±0,003 60,5±1,7 60,1±1,8 22,2±0,3 22,1±0,4 4,0±0,1 3,9±0,1

¡ µ¿ÚÔ˜ (kg) ⁄„Ô˜ (cm) ¢Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ ¶ÂÚ›ÌÂÙÚÔ˜ ̤Û˘ (cm) ¢Â›ÎÙ˘ ÂÚÈ̤ÙÚÔ˘ ̤Û˘/ÏÂοÓ˘ ¢Â›ÎÙ˘ ÂÚÈ̤ÙÚÔ˘ ̤Û˘/‡„Ô˜ ÕıÚÔÈÛÌ· ÙÂÛÛ¿ÚˆÓ ‰ÂÚÌ·ÙÈÎÒÓ Ù˘¯ÒÓ (mm) ¶ÔÛÔÛÙfi Ï›Ô˘˜ ÛÒÌ·ÙÔ˜ (%) ¶·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜ (ÛÙ¿‰È·)

¶* ∂* ¶ ∂ ¶ ∂ ¶ ∂ ¶ ∂ ¶ ∂ ¶ ∂ ¶ ∂ ¶ ∂

291 265 291 265 298 265 288 265 287 265 287 265 275 247 291 265 133 169

ªÂÙ·‚ÔÏ‹

p**

38,4±0,8 <0,001 42,5±0,7 47,3±0,3 ª™*** 47,6±0,3 5,9±0,2 0,001 6,9±0,2 20,1±0,5 ª™ 20,8±0,5 -0,07±0,005 ª™ -0,06±0,005 -0,01±0,003 ª™ -0,01±0,003 30,9±1,3 ª™ 28,6±1,4 2,5±0,3 ª™ 2,2±0,3 2,3±0,1 ª™ 2,1±0,1

* ¶: ÔÌ¿‰· ·Ú¤Ì‚·Û˘, ∂: ÔÌ¿‰· ÂϤÁ¯Ô˘ ** ∞Ó¿Ï˘ÛË Û˘Ó‰È·Î‡Ì·ÓÛ˘ (ANCOVA): Ô ¤ÏÂÁ¯Ô˜ ¤ÁÈÓ ÛÙË ‰È·ÊÔÚ¿ Ù˘ 3˘ ·ÍÈÔÏfiÁËÛ˘ ·fi ÙËÓ ·Ú¯È΋ ÂͤٷÛË (∞ƒÃ∏) Î·È ˆ˜ Û˘ÌÌÂÙ·‚ÏËÙ¤˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÙÔ Ê‡ÏÔ Î·È Ë ‰È·ÊÔÚ¿ ÙÔ˘ ¢ª™ ·fi ÙËÓ ·Ú¯È΋ ÂͤٷÛË (Ô ¢ª™ ¯ÚËÛÈÌÔÔÈ‹ıËΠÌfiÓÔ ÛÙÔ ·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜) *** ª™: ÛÙ·ÙÈÛÙÈÎÒ˜ ÌË ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿

·Ú¤Ì‚·Û˘ (¶: 38,4±0,8 kg, ∂: 42,5±0,7 kg, p<0,001 Î·È ¶: 5,9±0,2 kg/m2, ∂: 6,9±0,2 kg/m2, p<0,01, ·ÓÙ›ÛÙÔȯ·). OÈ ÌÂÙ·‚ÔϤ˜ ÛÙËÓ ÂÚ›ÌÂÙÚÔ Ì¤Û˘ (¶: 20,1±0,5 cm, ∂: 20,8±0,5 cm) Î·È ÛÙÔ ·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜ (¶: 2,3±0,1 ÛÙ¿‰È·, ∂: 2,1±0,1 ÛÙ¿‰È·) ‰ÂÓ ‰È¤ÊÂÚ·Ó ÛËÌ·ÓÙÈο ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ. ™ÙÔÓ ¶›Ó·Î· 4 ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ù· Â›‰· ÚfiÛÏ˄˘ ÙˆÓ ‰È·ÈÙËÙÈÎÒÓ Û˘ÛÙ·ÙÈÎÒÓ. §fiÁˆ ÙÔ˘ ÌÈÎÚÔ‡ ·ÚÈıÌÔ‡ ÙˆÓ ‰È·ÈÙÔÏÔÁ›ˆÓ Ì ˙˘ÁÈṲ̂ÓÔ Ê·ÁËÙfi 3 ËÌÂÚÒÓ (Ó=107) Ô˘ ÂÈÛÙÚ¿ÊËÎ·Ó ÙÔ 2002, ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÁÈ· ÙȘ ·Ú·Î¿Ùˆ Û˘Û¯ÂÙ›ÛÂȘ Ù· ‰Â‰Ô̤ӷ ·fi ÙÔ ‰È·ÈÙÔÏfiÁÈÔ ÙÔ˘ ÙÂÏÂ˘Ù·›Ô˘ 24ÒÚÔ˘ (Ó=617). °È· ÙÔÓ ¤ÏÂÁ¯Ô Ù˘ ·ÍÈÔÈÛÙ›·˜ ÙÔ˘ ‰È·ÈÙÔÏÔÁ›Ô˘ ÙÔ˘ ÙÂÏÂ˘Ù·›Ô˘ 24ÒÚÔ˘, ¤ÁÈÓ ۇÁÎÚÈÛË ˙¢ÁÒÓ ‰È·ÈÙÔÏÔÁ›ˆÓ ÛÙ· ›‰È· ·È‰È¿ (Student paired samples t-test) ÌÂٷ͇ ÙˆÓ 107 ‰È·ÈÙÔÏÔÁ›ˆÓ 3 ËÌÂÚÒÓ Î·È ÙˆÓ ·ÓÙ›ÛÙÔȯˆÓ 107 ÙÔ˘ ÙÂÏÂ˘Ù·›Ô˘ 24ÒÚÔ˘. O ¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍ fiÙÈ ÛÙËÓ ÙÚ›ÙË ·ÍÈÔÏfiÁËÛË (2002) ‰ÂÓ ˘‹Ú¯·Ó ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÌÂٷ͇ ÙˆÓ ‰‡Ô Ù‡ˆÓ ‰È·ÈÙÔÏÔÁ›ˆÓ, ·Ú¿ ÌfiÓÔ ÛÙËÓ ÚfiÛÏË„Ë ÓÈ·Û›Ó˘ (24ˆÚÔ: 19,1±1,0 mg, 3 ËÌÂÚÒÓ: 17,0±0,7 mg, p<0,05), ÌÔÓÔ·ÎfiÚÂÛÙˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ ˆ˜ ÔÛÔÛÙÔ‡ ÂÓ¤ÚÁÂÈ·˜ (24ˆÚÔ: 16,2±0,5%, 3 ËÌÂÚÒÓ: 17,9±0,4%, p<0,01) Î·È ÔÏ˘·ÎfiÚÂÛÙˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ, Â›Û˘ ˆ˜ ÔÛÔÛÙÔ‡ ÂÓ¤ÚÁÂÈ·˜ (24ˆÚÔ: 4,7±0,2%, 3 ËÌÂÚÒÓ: 5,2±0,2%, p<0,05). ∏ Û‡-

440

ÁÎÚÈÛË ÙˆÓ ÌÂÙÚ‹ÛÂˆÓ (ۈ̷ÙÔÌÂÙÚ‹ÛÂȘ, ·ÚÙËÚȷ΋ ›ÂÛË, ÏÈÔÚˆÙ½Ó˜ Î·È ·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜) ÙˆÓ 107 ·È‰ÈÒÓ Ô˘ Â¤ÛÙÚ„·Ó ‰È·ÈÙÔÏfiÁÈ· ˙˘ÁÈṲ̂ÓÔ˘ Ê·ÁËÙÔ‡ 3 ËÌÂÚÒÓ Ì ÂΛӘ ÙˆÓ 510 ·È‰ÈÒÓ ·fi Ù· ÔÔ›· ÂÏ‹ÊıË ‰È·ÈÙËÙÈÎfi ÈÛÙÔÚÈÎfi ÙÂÏÂ˘Ù·›Ô˘ 24ÒÚÔ˘, ¤‰ÂÈÍ fiÙÈ ˘‹ÚÍ ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÌfiÓÔ ÛÙÔ ‡„Ô˜ (·È‰È¿ Ì ‰È·ÈÙÔÏfiÁÈÔ 3 ËÌÂÚÒÓ: 165,9±0,7 cm, ·È‰È¿ Ì ‰È·ÈÙÔÏfiÁÈÔ 24ÒÚÔ˘: 167,5±0,3 cm, p<0,05) Î·È ÛÙËÓ HDL-¯ÔÏËÛÙÂÚfiÏË (·È‰È¿ Ì ‰È·ÈÙÔÏfiÁÈÔ 3 ËÌÂÚÒÓ: 54,0±1,1 mg/dl, ·È‰È¿ Ì ‰È·ÈÙÔÏfiÁÈÔ 24ÒÚÔ˘: 50,5±0,5 mg/dl, p<0,01). ∆· 107 ‰È·ÈÙÔÏfiÁÈ· 3 ËÌÂÚÒÓ ÚÔ¤Ú¯ÔÓÙ·È Û ÔÛÔÛÙfi 17% ·fi ·ÁÚÔÙÈΤ˜ ÂÚÈÔ¯¤˜ Î·È Û ÔÛÔÛÙfi 83% ·fi ·ÛÙÈΤ˜-ËÌÈ·ÛÙÈΤ˜, Û ·ÓÙ›ıÂÛË Ì ٷ 510 ÙÂÏÂ˘Ù·›Ô˘ 24ÒÚÔ˘, Ù· ÔÔ›· ÚÔ¤Ú¯ÔÓÙ·È Û ÔÛÔÛÙfi 30% ·fi ·ÁÚÔÙÈΤ˜ Î·È Î·Ù¿ 70% ·fi ·ÛÙÈΤ˜-ËÌÈ·ÛÙÈ2 Τ˜ ÂÚÈÔ¯¤˜ (¯ , p<0,01). ™ÙÔÓ ¶›Ó·Î· 4 Ê·›ÓÂÙ·È fiÙÈ Ë ÔÌ¿‰· ·Ú¤Ì‚·Û˘ ·ÚÔ˘ÛÈ¿˙ÂÈ ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚË ·‡ÍËÛË ÛÙËÓ ÚfiÛÏË„Ë ˘‰·Ù·ÓıڿΈÓ, ÌÔÓÔ·ÎfiÚÂÛÙˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ, Ê˘ÏÏÈÎÔ‡ ÔͤԘ, ‚ÈÙ·Ì›Ó˘ C Î·È ‚ÈÙ·Ì›Ó˘ µ2, ÂÓÒ Ë ÔÌ¿‰· ÂϤÁ¯Ô˘ ·ÚÔ˘ÛÈ¿˙ÂÈ ¯·ÌËÏfiÙÂÚË ÚfiÛÏË„Ë ÔÏÈ΋˜ ÂÓ¤ÚÁÂÈ·˜ Î·È trans ÏÈ·ÚÒÓ ÔͤˆÓ. ™ÙÔ˘˜ ¶›Ó·Î˜ 5 Î·È 6 ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÔÈ ÌÂÙÚ‹ÛÂȘ ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ, ÙˆÓ ÛˆÌ·ÙÔÌÂÙÚ‹ÛÂˆÓ Î·È ÙÔ˘ ·Ï›Ó‰ÚÔÌÔ˘ ÙÚÂ̷͛ÙÔ˜ ·ÓÙÔ¯‹˜ ÙˆÓ

¶·È‰È·ÙÚÈ΋ 2003;66:436-447

Paediatriki 2003;66:436-447

¶›Ó·Î·˜ 4. ªÂÙ·‚ÔϤ˜ ÛÙËÓ ÚfiÛÏË„Ë ‰È·ÈÙËÙÈÎÒÓ ÛÙÔȯ›ˆÓ ÙˆÓ ÔÌ¿‰ˆÓ ·Ú¤Ì‚·Û˘ Î·È ÂϤÁ¯Ô˘ Û ‰È¿ÛÙËÌ· 10 ÂÙÒÓ

∂Ó¤ÚÁÂÈ· (kcal) ¶ÚˆÙ½Ó˜ (g) À‰·Ù¿ÓıڷΘ (g) OÏÈÎfi Ï›Ô˜ (g) ∫ÔÚÂṲ̂ӷ ÏÈ·Ú¿ Ôͤ· (g) ªÔÓÔ·ÎfiÚÂÛÙ· ÏÈ·Ú¿ Ôͤ· (g) ¶ÔÏ˘·ÎfiÚÂÛÙ· ÏÈ·Ú¿ Ôͤ· (g) Trans ÏÈ·Ú¿ Ôͤ· (g) º˘ÙÈΤ˜ ›Ó˜ (g) º˘ÏÏÈÎfi Ô͇ (Ìg) ∞Û‚¤ÛÙÈÔ (mg) ™›‰ËÚÔ˜ (mg) µÈÙ·Ì›ÓË C (mg) µÈÙ·Ì›ÓË µ2 (mg)

¶* ∂* ¶ ∂ ¶ ∂ ¶ ∂ ¶ ∂ ¶ ∂ ¶ ∂ ¶ ∂ ¶ ∂ ¶ ∂ ¶ ∂ ¶ ∂ ¶ ∂ ¶ ∂

∞ƒÃ∏ 1992

3Ë ·ÍÈÔÏfiÁËÛË 2002 ª¤ÛÔ˜ ± ∆™

ªÂÙ·‚ÔÏ‹

p**

1845±49 1843±45 61,7±2,1 64,2±1,9 208,4±6,5 201,3±6,0 86,1±2,6 86,9±2,4 30,6±37,4 30,7±0,9 35,9±1,3 36,8±1,2 9,6±0,4 9,6±0,3 1,5±0,1 1,6±0,1 14,4±0,6 14,0±0,5 183,5±14,2 248,6±13,1 846,1±36,7 899,4±33,9 10,6±0,7 11,8±0,7 93,1±6,4 116,9±5,9 1,7±0,1 2,0±0,1

2386±89 2066±82 78,6±3,7 70,8±3,4 274,9±10,8 232,9±9,9 109,8±4,9 95,7±4,5 37,5±0,9 32,9±1,7 45,7±2,2 39,3±2,0 13,3±1,0 11,9±0,9 2,9±0,1 2,2±0,2 17,7±0,9 15,3±0,9 240,3±14,9 211,9±13,7 865,6±55,7 913,9±51,5 13,9±0,7 13,0±0,7 149,9±13,9 123,7±12,9 2,0±0,1 1,9±0,1

541±103 222±96 16,8±4,3 6,6±4,0 66,6±12,8 31,7±11,9 23,7±5,7 8,8±5,3 6,9±2,1 2,2±1,9 9,7±2,5 2,4±2,3 3,7±1,0 2,3±0,9 1,4±0,2 0,6±0,2 3,3±1,1 1,3±1,0 56,7±20,4 -36,7±18,9 19,4±64,8 14,4±59,9 3,1±1,0 1,9±0,9 56,8±15,2 6,8±14,2 0,26±0,14 0,21±0,13

0,027 ª™*** 0,050 ª™ ª™ 0,036 ª™ 0,022 ª™ 0,001 ª™ ª™ 0,019 0,015

* ¶: ÔÌ¿‰· ·Ú¤Ì‚·Û˘ (¡=80), ∂: ÔÌ¿‰· ÂϤÁ¯Ô˘ (¡=93) ** ∞Ó¿Ï˘ÛË Û˘Ó‰È·Î‡Ì·ÓÛ˘ (ANCOVA): Ô ¤ÏÂÁ¯Ô˜ ¤ÁÈÓ ÛÙË ‰È·ÊÔÚ¿ Ù˘ 3˘ ·ÍÈÔÏfiÁËÛ˘ ·fi ÙËÓ ·Ú¯È΋ ÂͤٷÛË (∞ƒÃ∏) Î·È ˆ˜ Û˘ÌÌÂÙ·‚ÏËÙ¤˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÙÔ Ê‡ÏÔ Î·È Ë ‰È·ÊÔÚ¿ ÙÔ˘ ¢ª™ ·fi ÙËÓ ·Ú¯È΋ ÂͤٷÛË *** ª™: ÛÙ·ÙÈÛÙÈÎÒ˜ ÌË ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿

·È‰ÈÒÓ Ô˘ Û˘ÌÌÂÙ›¯·Ó ÛÙȘ ÌÂÙÚ‹ÛÂȘ Ù˘ ·Ú¯È΋˜ ÂͤٷÛ˘ ÙÔ 1992 Î·È ÙˆÓ ÂfiÌÂÓˆÓ ÙÚÈÒÓ ·ÍÈÔÏÔÁ‹ÛˆÓ. ∞fi ÙÔÓ ¶›Ó·Î· 5 ‰È·ÈÛÙÒÓÂÙ·È fiÙÈ Ë ÔÌ¿‰· ·Ú¤Ì‚·Û˘ ¤¯ÂÈ ÛËÌ·ÓÙÈ΋ Ì›ˆÛË ÙˆÓ ÂÈ¤‰ˆÓ ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ Î·È LDL-¯ÔÏËÛÙÂÚfiÏ˘, ¤Ó·ÓÙÈ ·‡ÍËÛ˘ ÛÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘. ∂›Û˘, Ë ÔÌ¿‰· ·Ú¤Ì‚·Û˘ ¤¯ÂÈ ÛËÌ·ÓÙÈο ÌÈÎÚfiÙÂÚË ·‡ÍËÛË ÛÙÔÓ ·ıËڈ̷ÙÈÎfi ‰Â›ÎÙË (ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË ÚÔ˜ HDL-¯ÔÏËÛÙÂÚfiÏË), ÂÓÒ ÔÈ ‰‡Ô ÔÌ¿‰Â˜ ‰ÂÓ ‰È·Ê¤ÚÔ˘Ó ÛËÌ·ÓÙÈο ÛÙ· ÙÚÈÁÏ˘ÎÂÚ›‰È· Î·È ÛÙËÓ HDL-¯ÔÏËÛÙÂÚfiÏË. ™ÙÔÓ ¶›Ó·Î· 6 Ê·›ÓÂÙ·È fiÙÈ Ë ÔÌ¿‰· ÂϤÁ¯Ô˘ ·ÚÔ˘ÛÈ¿˙ÂÈ ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚË ·‡ÍËÛË ÛÙÔ ‚¿ÚÔ˜, ÛÙÔÓ ¢ª™, ÛÙÔÓ ‰Â›ÎÙË ÂÚÈ̤ÙÚÔ˘ ̤Û˘ ÚÔ˜ ‡„Ô˜ Î·È ÛÙÔ ÔÛÔÛÙfi Ï›Ô˘˜ ÛÒÌ·ÙÔ˜, ÂÓÒ ·ÓÙ›ıÂÙ· ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚË ·‡ÍËÛË ·ÚÔ˘ÛÈ¿˙ÂÈ Ë ÔÌ¿‰· ·Ú¤Ì‚·Û˘ ÛÙÔ ‡„Ô˜ Î·È ÛÙÔ ·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜. ¢ÂÓ ÛËÌÂÈÒÓÔÓÙ·È ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ÛÙËÓ ÂÚ›ÌÂÙÚÔ Ì¤Û˘, ÛÙÔÓ ‰Â›ÎÙË ÂÚÈ̤ÙÚÔ˘ ̤Û˘

ÚÔ˜ ÏÂοÓË Î·È ÛÙÔ ¿ıÚÔÈÛÌ· ÙˆÓ ‰ÂÚÌ·ÙÈÎÒÓ Ù˘¯ÒÓ. ™ÙËÓ ∂ÈÎfiÓ· 1 ·ÂÈÎÔÓ›˙ÔÓÙ·È ‰È·¯ÚÔÓÈο ÔÈ ÌÂÙ·‚ÔϤ˜ ÛÙËÓ ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË, ÛÙÔÓ ¢ª™ Î·È ÛÙÔ ·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜ ÙˆÓ ‰È·ÊfiÚˆÓ ÂÚÈfi‰ˆÓ ·ÍÈÔÏfiÁËÛ˘ Û ۯ¤ÛË Ì ÙËÓ ·Ú¯È΋ ÙÔ 1992. ∞fi ÙÔ ÌÂÙ·‚·ÏÏfiÌÂÓÔ ‰Â›ÁÌ· ÙˆÓ ·È‰ÈÒÓ Ô˘ ÂÍÂÙ¿ÛÙËÎ·Ó Û οı ÂÚ›Ô‰Ô, fiˆ˜ ·˘Ùfi Ê·›ÓÂÙ·È ÛÙÔÓ ¶›Ó·Î· 1, ‚Ú¤ıËΠfiÙÈ ÙÔ 20,5% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ·È‰ÈÒÓ Â›¯Â ·˘ÍË̤ÓÔ ‚¿ÚÔ˜ (¯2 ¤ÏÂÁ¯Ô˜, ¶: 19,2%, E: 21,9%, ª™) Î·È ÙÔ 8,3% ›¯Â ·¯˘Û·ÚΛ· 2 (¯ ¤ÏÂÁ¯Ô˜, ¶: 6,9%, ∂: 9,7%, ª™). ™ÙÔÓ ¶›Ó·Î· 7 ηٷÁÚ¿ÊÔÓÙ·È ÔÈ Û˘Ó‹ıÂȘ ηÓ›ÛÌ·ÙÔ˜ ÙˆÓ ·È‰ÈÒÓ ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜, ηıÒ˜ Î·È ÙˆÓ ÁÔÓ¤ˆÓ ÙÔ˘˜ ÛÙÔ Û›ÙÈ, fiˆ˜ ÚԤ΢„·Ó ηٿ ÙËÓ ÙÂÏÂ˘Ù·›· ·ÍÈÔÏfiÁËÛË ÙÔ 2002. ∆Ô 7% ÙˆÓ ·È‰ÈÒÓ Ù˘ ÔÌ¿‰·˜ ·Ú¤Ì‚·Û˘ ‹Ù·Ó ηÓÈÛÙ¤˜ ¤Ó·ÓÙÈ 13% ÙˆÓ ·È‰ÈÒÓ Ù˘ ÔÌ¿‰·˜ ÂϤÁ¯Ô˘ (p<0,05). ¢ÂÓ ‰È·ÈÛÙÒıËΠÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙ· ·È‰È¿ ÙˆÓ ÔÌ¿‰ˆÓ ·Ú¤Ì‚·Û˘ Î·È ÂϤÁ¯Ô˘

441

¶·È‰È·ÙÚÈ΋ 2003;66:436-447

Paediatriki 2003;66:436-447

¶›Ó·Î·˜ 5. ∂›‰· ÏÈÔÚˆÙÂ˚ÓÒÓ ÙˆÓ ·È‰ÈÒÓ Ù˘ ∫Ú‹Ù˘ ηٿ ÙË ‰È·¯ÚÔÓÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË 10 ÂÙÒÓ ∞ƒÃ∏ 1992

1Ë: 1995

186,9±2,6 174,2±3,1 51,3±1,7 50,9±1,9 60,6±1,3 62,8±1,5 115,9±2,5 101,2±3,0 3,21±0,07 2,92±0,09

173,9±2,5 185,1±2,9 44,3±1,9 40,1±2,3 54,3±1,3 58,2±1,5 110,5±2,2 118,9±2,6 3,49±0,09 3,34±0,10

¡ OÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË (mg/dL) ∆ÚÈÁÏ˘ÎÂÚ›‰È· (mg/dL) HDL-C (mg/dL) LDL-C (mg/dL) ∞ıËڈ̷ÙÈÎfi˜ ‰Â›ÎÙ˘: ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË/HDL-C

¶* ∂* ¶ ∂ ¶ ∂ ¶ ∂ ¶ ∂

139 101 139 101 137 101 139 101 137 101

∞•πO§O°∏™∏ 2Ë: 1998 3Ë: 2002 ª¤ÛÔ˜ ± ∆™ 173,8±2,6 172,3±3,1 65,6±2,0 67,6±2,4 58,7±1,3 57,8±1,5 102,7±2,3 101,0±2,7 3,12±0,07 3,15±0,08

164,4±2,4 162,6±2,8 64,7±2,2 62,9±2,6 52,7±1,0 50,9±1,2 98,6±2,1 99,1±2,4 3,27±0,07 3,31±0,08

™‡ÓÔÏÔ

ªÂÙ·‚ÔÏ‹

p**

174,7±2,2 -16,2±1,8 <0,001 173,6±2,6 -0,9±2,0 56,5±1,4 6,9±1,8 ª™*** 55,3±1,7 6,0±2,1 56,6±1,0 -5,3±1,0 ª™ 57,4±1,2 -7,2±1,1 106,9±2,0 -12,0±1,6 <0,001 105,1±2,4 5,1±1,9 3,27±0,06 0,08±0,05 0,002 3,18±0,07 0,34±0,06

* ¶: ÔÌ¿‰· ·Ú¤Ì‚·Û˘, ∂: ÔÌ¿‰· ÂϤÁ¯Ô˘ ** ∞Ó¿Ï˘ÛË Û˘Ó‰È·Î‡Ì·ÓÛ˘ Â·Ó·Ï·Ì‚·ÓfiÌÂÓˆÓ ÌÂÙÚ‹ÛÂˆÓ (GLM: repeated measures analysis): Ô ¤ÏÂÁ¯Ô˜ ¤ÁÈÓ ÛÙȘ ‰È·ÊÔÚ¤˜ οı ·ÍÈÔÏfiÁËÛ˘ ·fi ÙËÓ ·Ú¯È΋ ÂͤٷÛË (∞ƒÃ∏) Î·È ˆ˜ Û˘ÌÌÂÙ·‚ÏËÙ¤˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÙÔ Ê‡ÏÔ Î·È Ë Ì¤ÛË ‰È·ÊÔÚ¿ ÙÔ˘ ¢ª™ fiÏˆÓ ÙˆÓ ÌÂÙÚ‹ÛÂˆÓ ·fi ÙËÓ ·Ú¯È΋ ÂͤٷÛË (∞ƒÃ∏) ***ª™: ÛÙ·ÙÈÛÙÈÎÒ˜ ÌË ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿

fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÔÛfiÙËÙ· ηÓ›ÛÌ·ÙÔ˜ (¶: 8,4±1,9 ÙÛÈÁ¿Ú·/Ë̤ڷ, E: 11,0±1,3 ÙÛÈÁ¿Ú·/ Ë̤ڷ) Î·È ÛÙÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· Ô˘ ηÓ›˙Ô˘Ó (¶: 15,6±2,3 Ì‹Ó˜, E: 22,5±3,2 Ì‹Ó˜). ŸÛÔÓ ·ÊÔÚ¿ ÛÙÔ˘˜ ÁÔÓ›˜, ÙÔ 38% ÙˆÓ ÌËÙ¤ÚˆÓ Â›Ó·È Î·Ó›ÛÙÚȘ, ¤Ó·ÓÙÈ ÙÔ˘ 55% ÙˆÓ ·Ù¤ÚˆÓ (p<0,001). ∞fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ 614 ˙¢Á·ÚÈÒÓ-ÁÔÓ¤ˆÓ, ÙÔ 25% Â›Ó·È Î·È ÔÈ ‰‡Ô ηÓÈÛÙ¤˜, ÂÓÒ ÙÔ 33% Â›Ó·È Î·È ÔÈ ‰‡Ô ÌË Î·ÓÈÛÙ¤˜ (p<0,001). ™¯ÂÙÈο Ì ÙÔ˘˜ ÁÔÓ›˜-ηÓÈÛÙ¤˜ ÚÔ·ÙÂÈ fiÙÈ ÙÔ 92% ÙˆÓ ÌËÙ¤ÚˆÓ Î·Ó›˙Ô˘Ó ÛÙËÓ ÔÈΛ· ÙÔ˘˜, ¤Ó·ÓÙÈ ÙÔ˘ 84% ÙˆÓ ·Ù¤ÚˆÓ (p<0,05). ™˘˙‹ÙËÛË ∏ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙÔ˘ ÂÎ·È‰Â˘ÙÈÎÔ‡ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ·Ú¤Ì‚·Û˘ Û ı¤Ì·Ù· ˘Á›·˜, ‰È·ÙÚÔÊ‹˜ Î·È ¿ıÏËÛ˘ Û ̷ıËÙ¤˜ Ù˘ ∫Ú‹Ù˘ ·ÍÈÔÏÔÁ‹ıËΠηٿ Ù· 6 ¯ÚfiÓÈ· ÂÊ·ÚÌÔÁ‹˜ ÙÔ˘ Û ÚÔËÁÔ‡ÌÂÓ˜ ÂÚÁ·Û›Â˜ (4-9). ∏ Û˘Ó¯È˙fiÌÂÓË, fï˜, ıÂÙÈ΋ Â›‰Ú·ÛË ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÛÙÔ˘˜ ‰Â›ÎÙ˜ ˘Á›·˜ 4 ¯ÚfiÓÈ· ·fi ÙË ‰È·ÎÔ‹ ÙÔ˘ Î·È 10 ¯ÚfiÓÈ· ·fi ÙËÓ ¤Ó·ÚÍ‹ ÙÔ˘, ·ÔÙÂÏ› ÂÍ·ÈÚÂÙÈο ÂÏȉÔÊfiÚÔ Â‡ÚËÌ·. º·›ÓÂÙ·È fiÙÈ Ë ÂȉËÌ›· ÙˆÓ ¯ÚfiÓÈˆÓ ÓÔÛËÌ¿ÙˆÓ Ì ÙËÓ ·ÚÔ˘Û›· ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ·fi ÙËÓ ·È‰È΋ ËÏÈΛ· Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÂÚÈÛÙ·Ï›. ¢È·¯ÚÔÓÈο, ·fi ÙÔ 1992 ¤ˆ˜ ÙÔ 2002, ÙÔ ‚¿ÚÔ˜ ÙˆÓ ·È‰ÈÒÓ ¯ˆÚ›˜ ·Ú¤Ì‚·ÛË (ÔÌ¿‰· ÂϤÁ¯Ô˘) ·˘Í‹ıËΠηٿ 2,3 kg ÂÚÈÛÛfiÙÂÚÔ Û ۇÁÎÚÈÛË Ì ÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·Û˘ (p<0,01), fiˆ˜ Â›Û˘ Î·È o ¢ª™ ·˘Í‹ıËΠηٿ 1 kg/m2 (p<0,01), ÂÓÒ ÙÔ ‡„Ô˜ ÛÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·Û˘ ·˘Í‹ıËΠÛËÌ·ÓÙÈο ÂÚÈÛÛfiÙÂÚÔ Î·Ù¿ 2,1 cm (p<0,001). ¶·ÚfiÌÔÈ·, Ë ÔÌ¿‰· ·Ú¤Ì‚·Û˘ ›¯Â ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚË Ì›ˆÛË ÛÙËÓ ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË Î·Ù¿ 15,3

442

mg/dl (p<0,001), ÛÙËÓ LDL-¯ÔÏËÛÙÂÚfiÏË Î·Ù¿ 6,9 mg/dl (p<0,001), ÂÓÒ ÛËÌ·ÓÙÈο ÌÈÎÚfiÙÂÚË ‹Ù·Ó Ë ·‡ÍËÛË Ô˘ ·ÚÔ˘Û›·Û ÛÙÔÓ ·ıËڈ̷ÙÈÎfi ‰Â›ÎÙË, ηٿ 0,26 ÌÔÓ¿‰Â˜ (p<0,01). ∆· ·ÔÙÂϤÛÌ·Ù· ·˘Ù¿ ·Ú¤¯Ô˘Ó Ì›· ÂÏ›‰· fiÙÈ Ë ÂȉËÌ›· Ù˘ ·¯˘Û·ÚΛ·˜ Î·È Ù˘ ·ıËڈ̿وÛ˘ ı· ÌÔÚÔ‡Û ӷ ÙÂı› ˘fi ¤ÏÂÁ¯Ô Ì ÙË ‰ÈÂÓ¤ÚÁÂÈ· ·ÚfiÌÔÈˆÓ ·ÓÂÏÏ‹ÓÈˆÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ ÂÎ·›‰Â˘Û˘ Û ı¤Ì·Ù· ˘Á›·˜, ‰È·ÙÚÔÊ‹˜ Î·È ¿ıÏËÛ˘. ∏ ‰È·›ÛÙˆÛË fiÙÈ Ë ÂÌÊ¿ÓÈÛË ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ηډȷÁÁÂȷο Î·È ¿ÏÏ· ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù· ÛÙËÓ ·È‰È΋ ËÏÈΛ· Ô‰ËÁ› ÛÙË ‰È·Ù‹ÚËÛË Î·È Â·‡ÍËÛË ·˘ÙÒÓ Î·È ÛÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹ (19-20), ÒıËÛ ÙÔ˘˜ ÂÚ¢ÓËÙ¤˜ Ó· ÚÔÛ·ı‹ÛÔ˘Ó Ì¤Ûˆ ÚÔÁÚ·ÌÌ¿ÙˆÓ ·Ú¤Ì‚·Û˘ Ó· ÌÂÈÒÛÔ˘Ó Ù· Â›‰· ‹ ·ÎfiÌ· Î·È Ó· ÂÍ·Ï›„Ô˘Ó ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ ·˘ÙÔ‡˜ ηٿ ÙËÓ ·È‰È΋ ËÏÈΛ· (1,3,23-29). ¶·ÚfiÌÔÈ· Ì ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, Ì›· ¿ÏÏË ÌÔÓÔÂÙÔ‡˜ ÂÎ·È‰Â˘ÙÈ΋˜ ·Ú¤Ì‚·Û˘ Ô˘ ÂÊ·ÚÌfiÛÙËΠ۠171 Ì·ıËÙ¤˜ Ù˘ ∫Ú‹Ù˘ ËÏÈΛ·˜ 13 Î·È 14 ÂÙÒÓ, ¤‰ÂÈÍ fiÙÈ Ë ÔÌ¿‰· ·Ú¤Ì‚·Û˘ ›¯Â ÌÈÎÚfiÙÂÚË ·‡ÍËÛË ÛÙËÓ ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË, ÛÙÔÓ ¢ª™, ÛÙËÓ LDL-¯ÔÏËÛÙÂÚfiÏË Î·È ÛÙÔÓ ·ıËڈ̷ÙÈÎfi ‰Â›ÎÙË ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ ÚÔ˜ HDL-¯ÔÏËÛÙÂÚfiÏË Û ۇÁÎÚÈÛË Ì ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘ (1). ÕÏÏË ¤Ú¢ӷ ÛÙȘ ∏ӈ̤Ó˜ ¶ÔÏÈÙ›˜ (24) ¤‰ÂÈÍ fiÙÈ ÌÂÙ¿ ·fi ¤Ó· ¯ÚfiÓÔ ÂÎ·È‰Â˘ÙÈ΋˜ ·Ú¤Ì‚·Û˘, Ë ÔÌ¿‰· ·Ú¤Ì‚·Û˘ ›¯Â ÌÈÎÚfiÙÂÚË ·‡ÍËÛË Ù˘ Û˘ÛÙÔÏÈ΋˜ ›ÂÛ˘, ÌÂÁ·Ï‡ÙÂÚË Ì›ˆÛË Ù˘ ‰È·ÛÙÔÏÈ΋˜ ›ÂÛ˘, Ì›ˆÛË Ù˘ ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ Î·È ÙÔ˘ ·ıËڈ̷ÙÈÎÔ‡ ‰Â›ÎÙË ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ ÚÔ˜ HDL-¯ÔÏËÛÙÂÚfiÏË Û ۯ¤ÛË Ì ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘. ªÂȈ̤ÓË ·ÚÙËÚȷ΋ ›ÂÛË Î·È ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË ·ÚÔ˘Û›·ÛÂ Ë ÔÌ¿‰· ·Ú¤Ì‚·Û˘ ÌÂÙ¿ ·fi ÙÚ›· ¯ÚfiÓÈ· ·Ú¤Ì‚·Û˘ ηÈ

¶·È‰È·ÙÚÈ΋ 2003;66:436-447

Paediatriki 2003;66:436-447

¶›Ó·Î·˜ 6. ∂›‰· ۈ̷ÙÔÌÂÙÚ‹ÛÂˆÓ Î·È Ê˘ÛÈ΋˜ ηٿÛÙ·Û˘ ÙˆÓ ·È‰ÈÒÓ Ù˘ ∫Ú‹Ù˘ ηٿ ÙË ‰È·¯ÚÔÓÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË 10 ÂÙÒÓ ∞ƒÃ∏ 1992 ¡ µ¿ÚÔ˜ (kg) ⁄„Ô˜ (cm) ¢Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ ¶ÂÚ›ÌÂÙÚÔ˜ ̤Û˘ (cm) ¢Â›ÎÙ˘ ÂÚÈ̤ÙÚÔ˘ ̤Û˘/ÏÂοÓ˘ ¢Â›ÎÙ˘ ÂÚÈ̤ÙÚÔ˘ ̤Û˘/‡„Ô˜ ÕıÚÔÈÛÌ· ÙÂÛÛ¿ÚˆÓ ‰ÂÚÌ·ÙÈÎÒÓ Ù˘¯ÒÓ (mm) ¶ÔÛÔÛÙfi Ï›Ô˘˜ ÛÒÌ·ÙÔ˜ (%) ¶·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜ (ÛÙ¿‰È·)

¶* ∂* ¶ ∂ ¶ ∂ ¶ ∂ ¶ ∂ ¶ ∂ ¶ ∂ ¶ ∂ ¶ ∂

167 120 167 120 167 120 163 120 162 120 163 120 155 116 167 120 77 85

22,7±0,3 24,9±0,4 118,0±0,4 122,5±0,5 16,2±0,2 16,5±0,2 54,3±0,4 56,3±0,5 0,86±0,003 0,85±0,004 0,46±0,003 0,46±0,004 28,6±1,3 32,4±1,5 19,6±0,3 20,0±0,3 1,7±0,1 1,9±0,1

∞•πO§O°∏™∏ 1Ë: 1995 2Ë: 1998 3Ë: 2002 ª¤ÛÔ˜ ± ∆™ 30,1±0,5 33,2±0,6 133,5±0,5 134,6±0,6 16,9±0,2 18,2±0,3 59,5±0,6 61,8±0,7 0,83±0,004 0,82±0,004 0,45±0,004 0,46±0,004 31,4±1,2 35,1±1,4 19,0±0,3 20,9±0,4 3,4±0,2 3,3±0,3

43,9±0,9 47,4±1,0 149,0±0,6 150,3±0,7 19,5±0,3 20,8±0,3 68,6±0,8 73,1±0,9 0,86±0,005 0,86±0,006 0,46±0,005 0,49±0,006 55,8±2,3 62,7±2,7 20,1±0,4 22,9±0,5 4,8±0,2 3,1±0,2

60,8±1,1 68,2±1,3 165,5±0,6 169,8±0,7 22,0±0,3 23,6±0,4 74,2±0,8 77,2±0,9 0,79±0,007 0,79±0,008 0,45±0,004 0,46±0,005 58,1±2,2 60,5±2,5 21,8±0,5 22,3±0,5 4,2±0,2 4,0±0,2

™‡ÓÔÏÔ

ªÂÙ·‚ÔÏ‹

p**

39,4±0,7 22,4±0,5 0,004 43,4±0,8 24,7±0,6 141,5±0,5 31,3±0,2 <0,001 144,3±0,6 29,1±0,3 18,7±0,2 3,3±0,2 <0,001 19,8±0,3 4,3±0,2 64,2±0,6 13,1±0,4 ª™*** 67,1±0,7 14,3±0,5 0,83±0,003 -0,03±0,01 ª™ 0,83±0,003 -0,03±0,01 0,45±0,003 -0,009±0,003 <0,001 0,47±0,004 0,006±0,003 43,5±1,6 19,8±1,1 ª™ 47,7±1,8 20,3±1,3 20,3±0,3 1,0±0,2 0,001 21,7±0,5 2,2±0,3 3,5±0,1 2,4±0,1 <0,001 3,1±0,1 1,5±0,1

* ¶: ÔÌ¿‰· ·Ú¤Ì‚·Û˘, ∂: ÔÌ¿‰· ÂϤÁ¯Ô˘ ** ∞Ó¿Ï˘ÛË Û˘Ó‰È·Î‡Ì·ÓÛ˘ Â·Ó·Ï·Ì‚·ÓfiÌÂÓˆÓ ÌÂÙÚ‹ÛÂˆÓ (GLM: repeated measures analysis): Ô ¤ÏÂÁ¯Ô˜ ¤ÁÈÓ ÛÙȘ ‰È·ÊÔÚ¤˜ οı ·ÍÈÔÏfiÁËÛ˘ ·fi ÙËÓ ·Ú¯È΋ ÂͤٷÛË (∞ƒÃ∏) Î·È ˆ˜ Û˘ÌÌÂÙ·‚ÏËÙ¤˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÙÔ Ê‡ÏÔ Î·È Ë Ì¤ÛË ‰È·ÊÔÚ¿ ÙÔ˘ ¢ª™ fiÏˆÓ ÙˆÓ ÌÂÙÚ‹ÛÂˆÓ ·fi ÙËÓ ·Ú¯È΋ ÂͤٷÛË (Ô ¢ª™ ¯ÚËÛÈÌÔÔÈ‹ıËΠÌfiÓÔ ÛÙÔ ·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜) *** ª™: ÛÙ·ÙÈÛÙÈÎÒ˜ ÌË ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿

ÛÙËÓ ¤Ú¢ӷ KNOW YOUR BODY (25). ™ÙȘ ¤Ú¢Ó˜ CHIC II (27), Ô˘ Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó ÛÙË µfiÚÂÈ· ∫·ÚÔϛӷ, ¤ÁÈÓ ÂÎ·È‰Â˘ÙÈ΋ ·Ú¤Ì‚·ÛË ÁÈ· 8 ‚‰ÔÌ¿‰Â˜ ÌfiÓÔ ÌÂ Ê˘ÛÈ΋ ¿ÛÎËÛË, ÌfiÓÔ Ì ÂÎ·›‰Â˘ÛË ‹ ÌÂ Û˘Ó‰˘·ÛÌfi ÙÔ˘˜. ¢È·ÈÛÙÒıËΠfiÙÈ Ë ÙÂÏÂ˘Ù·›· ÔÌ¿‰· Ô˘ Û˘Ó‰‡·˙ ÙȘ ‰‡Ô ÌÔÚʤ˜ ·Ú¤Ì‚·Û˘ (Ê˘ÛÈ΋˜ ¿ÛÎËÛ˘ Î·È ÂÎ·›‰Â˘Û˘) Ì›ˆÛ ٷ Â›‰· ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ Î·È ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ‰ÂÚÌ·ÙÈÎÒÓ Ù˘¯ÒÓ, ηıÒ˜ Â›Û˘ ·‡ÍËÛ ÛËÌ·ÓÙÈο ÙËÓ ·ÂÚfi‚È· ÈηÓfiÙËÙ¿ Ù˘. ¶·ÚfiÌÔÈ· ‹Ù·Ó Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘ CHIC, Ë ÔÔ›· Ú·ÁÌ·ÙÔÔÈ‹ıËΠÛÙËÓ ›‰È· ÂÚÈÔ¯‹ Î·È ‰È‹ÚÎÂÛ 12 Ì‹Ó˜ (29).

OÈ ·Ú·¿Óˆ ÌÂϤÙ˜, ·Ó Î·È ÂȂ‚·ÈÒÓÔ˘Ó ÙË ıÂÙÈ΋ Â›‰Ú·ÛË Ù˘ ÂÎ·È‰Â˘ÙÈ΋˜ ·Ú¤Ì‚·Û˘ ÛÙË Ì›ˆÛË ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÈÎÒÓ ÂÈ¤‰ˆÓ, ηıÒ˜ Î·È ÙˆÓ ‰ÂÈÎÙÒÓ ·¯˘Û·ÚΛ·˜, ¤¯Ô˘Ó Û˘ÁÎÚÈÙÈο Ôχ ÌÈÎÚfiÙÂÚË ‰È¿ÚÎÂÈ· ·Ú¤Ì‚·Û˘ Û ۯ¤ÛË Ì ÙËÓ ·ÚÔ‡Û· ¤Ú¢ӷ. ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, ·Ú¿ ÙË ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙË ÌÂÙ·‚ÔÏ‹ ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ ÙˆÓ ·È‰ÈÒÓ ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜, ˘‹Ú¯Â ÔÛÔÛÙfi 18,5% ÙˆÓ ·È‰ÈÒÓ ÛÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·Û˘ Î·È 21,5% ÛÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘ Ì LDL-¯ÔÏËÛÙÂÚfiÏË >130 mg/dl. ¶·Ú¿ÏÏËÏ·, ÙÔ ÔÛÔÛÙfi ÙˆÓ ·È‰ÈÒÓ Ì ˘ÂÚ‚ÔÏÈÎfi ‚¿ÚÔ˜ Î·È ·¯˘Û·ÚΛ· ·ÔÙÂ-

Ï› ¤Ó‰ÂÈÍË ÙˆÓ ‰È·ÛÙ¿ÛÂˆÓ Ô˘ ¤¯ÂÈ Ï¿‚ÂÈ ÛÙË ¯ÒÚ· Ì·˜ Ë ·¯˘Û·ÚΛ·. ∆Ô 28,8% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ·È‰ÈÒÓ Â›¯Â ·˘ÍË̤ÓÔ ‹ ˘ÂÚ‚ÔÏÈο ·˘ÍË̤ÓÔ ‚¿ÚÔ˜/·¯˘Û·ÚΛ·, ÂÓÒ Û ÌË ‰È·¯ÚÔÓÈ΋ ÌÂϤÙË ·È‰ÈÒÓ ËÏÈΛ·˜ 6-17 ÂÙÒÓ ÛÙËÓ ÂÚÈÔ¯‹ Ù˘ £ÂÛÛ·ÏÔӛ΢ ÙÔ 2000-2001 (13) Î·È ¯ˆÚ›˜ ÙËÓ ÂÊ·ÚÌÔÁ‹ ÂÎ·È‰Â˘ÙÈ΋˜ ·Ú¤Ì‚·Û˘, ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ÔÛÔÛÙfi ‹Ù·Ó 26,3% (22,2% ›¯Â ˘ÂÚ‚ÔÏÈÎfi ‚¿ÚÔ˜ Î·È 4,1% ·¯˘Û·ÚΛ·). ™ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù·, ÂÎÙfi˜ ·fi ÙË Ê˘ÛÈ΋ ¿ÛÎËÛË, ÛÔ˘‰·›Ô˜ Â›Ó·È Ô ÚfiÏÔ˜ Ù˘ ‰È·ÙÚÔÊ‹˜. ∏ “‰˘ÙÈÎÔÔ›ËÛË” Ù˘ Û‡Á¯ÚÔÓ˘ ‰È·ÙÚÔÊ‹˜ ÙˆÓ ∫ÚËÙÒÓ Ù· ÙÂÏÂ˘Ù·›· Û·Ú¿ÓÙ· ¯ÚfiÓÈ·, Ô˘ ·Ú·ÙËÚÂ›Ù·È Î·È ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ ∂ÏÏ‹ÓˆÓ, ηıÒ˜ Î·È Ë ·ÔÌ¿ÎÚ˘ÓÛ‹ ÙÔ˘˜ ·fi ÙËÓ ·Ú·‰ÔÛȷ΋ ÎÚËÙÈ΋ ‰È·ÙÚÔÊ‹ (30), ÙÔ˘˜ Ô‰ËÁÔ‡Ó Û ‰È·ÚÎÒ˜ ·˘Í·ÓfiÌÂÓÔ˘˜ ‰Â›ÎÙ˜ ıÓËÛÈÌfiÙËÙ·˜ ·fi ηډȷÁÁÂȷο Î·È ¿ÏÏ· ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù·, ÂÓÒ Û ¿ÏϘ ÚÔËÁ̤Ó˜ ¯ÒÚ˜ ÔÈ ‰Â›ÎÙ˜ ·˘ÙÔ› ÂÏ·ÙÙÒÓÔÓÙ·È ·ÔÙÂÏÂÛÌ·ÙÈο ÙȘ ÙÂÏÂ˘Ù·›Â˜ ‰ÂηÂٛ˜ (10). ∏ ÂÏ¿ÙÙˆÛË Ù˘ ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ Î·È Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘ ‰ÂÓ ÂÍËÁÂ›Ù·È ·fi Ù· ‰È·ÈÙËÙÈο ‰Â‰Ô̤ӷ, ηı’ fiÙÈ ‰ÂÓ ‰È·ÈÛÙÒıËΠÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙË Ï‹„Ë ÎÔÚÂṲ̂ÓÔ˘ Ï›Ô˘˜ ÛÙË ‰È·ÙÚÔÊ‹ ÙˆÓ ·È‰ÈÒÓ ÙˆÓ ÔÌ¿‰ˆÓ ·Ú¤Ì‚·Û˘ ηÈ

443

¶·È‰È·ÙÚÈ΋ 2003;66:436-447

Paediatriki 2003;66:436-447

OÏÈ΋ xÔÏËÛÙÂÚfiÏË (mg/dL)

15,0

OÌ¿‰· ·Ú¤Ì‚·Û˘ (¡=139)

10,0 ª¤ÛË ‰È·ÊÔÚ¿ (mg/dL)

OÌ¿‰· ÂϤÁ¯Ô˘ (¡=101) 5,0 0,0

1994

1998

2002

-5,0 -10,0 -15,0 -20,0 -25,0

ŒÙÔ˜ ·ÍÈÔÏfiÁËÛ˘ (Â·ÓÂͤٷÛË) ¢Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ (kg/m2)

8,0

ª¤ÛË ‰È·ÊÔÚ¿ (kg/m2)

7,0 6,0

OÌ¿‰· ·Ú¤Ì‚·Û˘ (¡=167) OÌ¿‰· ÂϤÁ¯Ô˘ (¡=120)

5,0 4,0 3,0 2,0 1,0 0,0 1994

1998 ŒÙÔ˜ ·ÍÈÔÏfiÁËÛ˘ (Â·ÓÂͤٷÛË)

2002

¶·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜ (ÛÙ¿‰È·)

4,0

OÌ¿‰· ¶·Ú¤Ì‚·Û˘ (¡=77) ª¤ÛË ‰È·ÊÔÚ¿ (ÛÙ¿‰È·)

3,5

OÌ¿‰· ∂ϤÁ¯Ô˘ (¡=85)

3,0 2,5 2,0 1,5 1,0

1994

1998

2002

ŒÙÔ˜ ·ÍÈÔÏfiÁËÛ˘ (Â·ÓÂͤٷÛË) ∂ÈÎfiÓ· 1. ¢È·ÊÔÚ¤˜ ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘, ¢ª™ Î·È ·Ï›Ó‰ÚÔÌÔ˘ ÙÚÂ̷͛ÙÔ˜ ·ÓÙÔ¯‹˜ ÙˆÓ ÂÚÈfi‰ˆÓ ·ÍÈÔÏfiÁËÛ˘ (1994, 1998 Î·È 2002) ·fi ÙËÓ ·Ú¯È΋ ÂͤٷÛË (1992).

444

¶·È‰È·ÙÚÈ΋ 2003;66:436-447

Paediatriki 2003;66:436-447

¶›Ó·Î·˜ 7. ™˘Ó‹ıÂȘ ηÓ›ÛÌ·ÙÔ˜ ·È‰ÈÒÓ Î·È ÁÔÓ¤ˆÓ ñ ¶·È‰È¿ OÌ¿‰· ·Ú¤Ì‚·Û˘ OÌ¿‰· ÂϤÁ¯Ô˘ ñ °ÔÓ›˜ ªËÙ¤Ú· ¶·Ù¤Ú·˜ ™˘Ó‰˘·ÛÌfi˜ ÁÔÓ¤ˆÓ ηÓÈÛÙÒÓ ‹ ÌË

∫·ÓÈÛÙ¤˜

ªË ηÓÈÛÙ¤˜

p-value**

7 (23)* 13 (37)

93 (303) 87 (260)

0,016

38 (236) 55 (337)

62 (386) 45 (277)

<0,001

¶·Ù¤Ú·˜ ∫·ÓÈÛÙ‹˜

ñ ªËÙ¤Ú· ∫·Ó›ÛÙÚÈ· ªË ηÓ›ÛÙÚÈ·

ªËÙ¤Ú· ¶·Ù¤Ú·˜

ªË ηÓÈÛÙ‹˜

25 (156) 13 (76) 29 (180) 33 (202) ∫¿ÓÈÛÌ· ÛÙÔ Û›ÙÈ ¡·È Ÿ¯È 92 (213) 8 (19) 84 (280) 16 (84)

<0,001

0,010

* OÈ ÙÈ̤˜ ‰›ÓÔÓÙ·È ˆ˜ % (¡) 2 ** ŒÏÂÁ¯Ô˜ ¯

ÂϤÁ¯Ô˘. ∏ ÚfiÛÏË„Ë ÂÓ¤ÚÁÂÈ·˜ ·fi Ù· ·È‰È¿ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ÁÈÓfiÙ·Ó Î·Ù¿ 41% ·fi ÔÏÈÎfi Ï›Ô˜, 14% ·fi ÙÔ ÔÔ›Ô ‹Ù·Ó ÎÔÚÂṲ̂ÓÔ. ∆Ô ÔÛÔÛÙfi ÂÓ¤ÚÁÂÈ·˜ ·fi ÎÔÚÂṲ̂ÓÔ Ï›Ô˜ ‹Ù·Ó ÌfiÏȘ 7% fiÙ·Ó ¿Ú¯ÈÛÂ Ë ÌÂϤÙË ÙˆÓ ∂Ù¿ ÈÚÒÓ ÙÔ 1960. ∆· ıÂÙÈο ·ÔÙÂϤÛÌ·Ù· fiÛÔÓ ·ÊÔÚ¿ ÛÙȘ ÏÈÔÚˆÙ½Ó˜ Èı·ÓfiÓ Ó· Û¯ÂÙ›˙ÔÓÙ·È Ì ÙÔÓ ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚÔ ¢ª™ Î·È ÙË ÛËÌ·ÓÙÈο ηχÙÂÚË ·ıÏËÙÈ΋ Â›‰ÔÛË ÙˆÓ ·È‰ÈÒÓ Ù˘ ÔÌ¿‰·˜ ·Ú¤Ì‚·Û˘ Û ۇÁÎÚÈÛË Ì ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘. ∞ÓÙ›ıÂÙ·, ÛÙËÓ ¤Ú¢ӷ CATCH (26) ÛËÌÂÈÒıËÎ·Ó ÛËÌ·ÓÙÈΤ˜ ÌÂÙ·‚ÔϤ˜ ÛÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·Û˘ ·fi ÙËÓ °’ ÛÙËÓ ∂’ Ù¿ÍË ‰ËÌÔÙÈÎÔ‡, Ì Ì›ˆÛË ÛÙËÓ ÚfiÛÏË„Ë ÂÓ¤ÚÁÂÈ·˜ Î·È ÛÙ· ÔÛÔÛÙ¿ ÂÓ¤ÚÁÂÈ·˜ ·fi ÔÏÈÎfi, ÎÔÚÂṲ̂ÓÔ Î·È ÌÔÓÔ·ÎfiÚÂÛÙÔ Ï›Ô˜. ™Â ¿ÏÏË ¤Ú¢ӷ ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ Leeds (28), ÌÂÙ¿ ·fi 12 Ì‹Ó˜ ÂÎ·È‰Â˘ÙÈ΋˜ ÂÈÌfiÚʈÛ˘ Î·È ÂÓË̤ڈÛ˘, ·Ú·ÙËÚ‹ıËΠfiÙÈ Ë ÔÌ¿‰· ·Ú¤Ì‚·Û˘ ηٷӿψÓ ÂÚÈÛÛfiÙÂÚ· Ï·¯·ÓÈο. ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, Ë ÔÌ¿‰· ·Ú¤Ì‚·Û˘ ›¯Â ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚË Ï‹„Ë Ê˘ÏÏÈÎÔ‡ Î·È ·ÛÎÔÚ‚ÈÎÔ‡ ÔͤԘ, ‰ËÏ·‰‹ ˘„ËÏfiÙÂÚË Ï‹„Ë ÊÚÔ‡ÙˆÓ Î·È Ï·¯·ÓÈÎÒÓ. ªÂϤÙË Ô˘ Ú·ÁÌ·ÙÔÔÈ‹ıËΠ۠·È‰È¿ Ù˘ µfiÚÂÈ·˜ ∂ÏÏ¿‰·˜ ËÏÈΛ·˜ 11,616,6 ÂÙÒÓ, ¯ˆÚ›˜ ÙËÓ ÂÊ·ÚÌÔÁ‹ ÂÎ·È‰Â˘ÙÈ΋˜ ·Ú¤Ì‚·Û˘, ¤‰ÂÈÍ fiÙÈ ÙÔ 45% Ù˘ ÚÔÛÏ·Ì‚·ÓfiÌÂÓ˘ ÂÓ¤ÚÁÂÈ·˜ ÚÔ¤Ú¯ÂÙ·È ·fi ˘‰·Ù¿ÓıڷΘ, ÂÓÒ ÙÔ 42% ÚÔ¤Ú¯ÂÙ·È ·fi ÔÏÈÎfi Ï›Ô˜, ·fi ÙÔ ÔÔ›Ô ÔÛÔÛÙfi 12% Â›Ó·È ÎÔÚÂṲ̂ÓÔ (18). ÕÏÏÔÓ ÚˆÙ‡ÔÓÙ· ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ·ÔÙÂÏ› ÙÔ Î¿ÓÈÛÌ· Ô˘ ·Ú¯›˙ÂÈ Û˘Ó‹ıˆ˜ ÛÙËÓ ÂÊË‚È΋ ËÏÈΛ· (14,17). ∆Ô Î¿ÓÈÛÌ· ·ÔÙÂÏ› ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ Úfi‚ÏËÌ· ‰ËÌfiÛÈ·˜ ˘Á›·˜ ÙfiÛÔ ÛÙË ¯ÒÚ· Ì·˜ fiÛÔ Î·È ·ÁÎÔÛÌ›ˆ˜, ÂÓÒ ÔÈ ‚ÈÔÌ˯·Ó›Â˜ ηÓÔ‡ ¤¯Ô˘Ó ÛÙÚ¤„ÂÈ ÙȘ ‰È·ÊËÌÈÛÙÈΤ˜ ÙÔ˘˜ ÚÔÛ¿ıÂȘ ÚÔ˜ Ù· ·È‰È¿, ÙÔ˘˜ ÂÊ‹‚Ô˘˜ Î·È ÙȘ Á˘-

Ó·›Î˜. ™ÙȘ ·Ú¯¤˜ Ù˘ ‰ÂηÂÙ›·˜ ÙÔ˘ ’80, Û ̛· ÂıÓÈ΋ ÚÔÛ¿ıÂÈ· ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ηÓ›ÛÌ·ÙÔ˜ (17), ÙÔ ÀÔ˘ÚÁÂ›Ô ÀÁ›·˜ ÍÂΛÓËÛ ÙË ÌÂÙ¿‰ÔÛË ·ÓÙÈηÓÈÛÙÈÎÒÓ ÌËÓ˘Ì¿ÙˆÓ Ì¤Ûˆ Ù˘ ÙËÏÂfiÚ·Û˘ Î·È ÙÔ˘ Ú·‰ÈÔÊÒÓÔ˘. O Ú˘ıÌfi˜ Ù˘ ÂÙ‹ÛÈ·˜ ·‡ÍËÛ˘ ηٷӿψÛ˘ ηÓÔ‡ ÌÂÈÒıËΠÛËÌ·ÓÙÈο Ù· ¤ÙË 1979 Î·È 1980, ‰ËÏ·‰‹ ÛÙ· ‰‡Ô ¯ÚfiÓÈ· Ù˘ ÌÂÙ¿‰ÔÛ˘ ÙˆÓ ÌËÓ˘Ì¿ÙˆÓ, Ë ÔÔ›· ÚÔÛ¤ÁÁÈÛ ÙÔ 0%. ¶·Ú¿ÏÏËÏ·, ÛÙÔ ‰È¿ÛÙËÌ· ·˘Ùfi ‰È·ÈÛÙÒıËΠfiÙÈ ÙÔ 10,5% ‰Â›ÁÌ·ÙÔ˜ 1500 ·ÙfiÌˆÓ ËÏÈΛ·˜ 15-64 ÂÙÒÓ ‰È¤ÎÔ„Â ÌfiÓÈÌ· ÙÔ Î¿ÓÈÛÌ·, ÂÓÒ fiÙ·Ó ÛÙ·Ì¿ÙËÛ·Ó Ù· ·ÓÙÈηÓÈÛÙÈο ÌËӇ̷ٷ, ÔÈ Ú˘ıÌÔ› ·‡ÍËÛ˘ Ù˘ ηٷӿψÛ˘ ηÓÔ‡ Â·Ó‹Ïı·Ó ÛÙ· ·Ú¯Èο Â›‰·. ™Â ¤Ú¢ӷ Ô˘ ¤ÁÈÓ ÛÙËÓ ∫Ú‹ÙË (1) ÌÂÙ¿ ·fi ¤Ó·Ó ¯ÚfiÓÔ ÂÎ·È‰Â˘ÙÈ΋˜ ·Ú¤Ì‚·Û˘, ‚Ú¤ıËΠӷ ηÓ›˙ÂÈ ÙÔ 6% Ù˘ ÔÌ¿‰·˜ ·Ú¤Ì‚·Û˘ Î·È ÙÔ 20% Ù˘ ÔÌ¿‰·˜ ÂϤÁ¯Ô˘, Û ۯ¤ÛË Ì ٷ ·ÓÙ›ÛÙÔȯ· ÔÛÔÛÙ¿ 7% Î·È 13% Ù˘ ·ÚÔ‡Û·˜ ¤Ú¢ӷ˜. ™Â ¿ÏÏË ¤Ú¢ӷ Û ÂÊ‹‚Ô˘˜ Î·È Ó·ÚÔ‡˜ ÂÓ‹ÏÈΘ ÛÙËÓ ∫·ÏÈÊfiÚÓÈ·, Ô˘ ‰ÈÂÍ‹¯ıË ·fi ÙÔ 1979 ¤ˆ˜ ÙÔ 1990 (16), ·Ú·ÙËÚ‹ıËΠfiÙÈ Î·Ù¿ ÙÔ 1979 ÙÔ 28,7% ÙˆÓ ‰ÂÈÁÌ¿ÙˆÓ ·Ú¤Ì‚·Û˘ Î·È ÙÔ 21,7% ÙˆÓ ‰ÂÈÁÌ¿ÙˆÓ ÂϤÁ¯Ô˘ ‹Ù·Ó ηÓÈÛÙ¤˜, ÂÓÒ ÙÔ 1990 Ù· ÔÛÔÛÙ¿ ·˘Ù¿ ÌÂÈÒıËÎ·Ó Û 15,2% Î·È 15,8%, ·ÓÙ›ÛÙÔȯ·. ¶·Ú¿ÏÏËÏ·, ¯ˆÚ›˜ ÙËÓ ÂÊ·ÚÌÔÁ‹ ÚÔÁÚ·ÌÌ¿ÙˆÓ ·Ú¤Ì‚·Û˘, Û ‰È·¯ÚÔÓÈ΋ ÌÂϤÙË ‰È·ÊfiÚˆÓ ÂÚÈÔ¯ÒÓ Ù˘ ∂ÏÏ¿‰·˜ (14) ÛÙ· Ù¤ÏË Ù˘ ‰ÂηÂÙ›·˜ ÙÔ˘ ’80 Î·È Û ‰Â›ÁÌ· 4268 Ì·ıËÙÒÓ §˘Î›Ԣ ‚Ú¤ıËΠfiÙÈ ÙÔ 29,7% ‹Ù·Ó ηÓÈÛÙ¤˜, ÂÓÒ ÛÙ· ̤۷ Ù˘ ›‰È·˜ ‰ÂηÂÙ›·˜ ÙÔ ÔÛÔÛÙfi ›¯Â ÊÙ¿ÛÂÈ ÙÔ 43,4%. ∫·Ù¿ ÙËÓ ›‰È· ¯ÚÔÓÈ΋ ÂÚ›Ô‰Ô, ¤Ú¢ӷ ÛÙËÓ ∞ı‹Ó· (15) ¤‰ÂÈÍ fiÙÈ Û ‰Â›ÁÌ· 11.058 Ì·ıËÙÒÓ ËÏÈΛ·˜ 14-18 ÂÙÒÓ, ÙÔ ÔÛÔÛÙfi ÙˆÓ Î·ÓÈÛÙÒÓ ‹Ù·Ó 22,3%.

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ÙËÓ Kellogg’s. ∂›Û˘, Û˘Ó¤‚·Ï·Ó ·ÔÙÂÏÂÛÌ·ÙÈο ÔÈ Û˘ÓÂÚÁ¿Ù˜ Î.Î. ªÈ¯¿Ï˘ ∫˘Úȷο΢, ª·Ú›· ªÈÙÛÒÚË, πˆ¿ÓÓ· ∞ÔÛÙÔÏ¿ÎË, ∞ÁÁÂÏÈ΋ ¶··‰¿ÎË, ¢ËÌ‹ÙÚ˘ ∞ı·Ó·ÛfiÔ˘ÏÔ˜, ∂‡· ªÔ‡Î·, πˆ¿ÓÓ· ªÔÛ¯·Ó‰Ú¤·, ∫·ÚÔÏ¿ÈÓ ∫fi‰ÚÈÁÎÙÔÓ Î·È °È¿ÓÓ˘ ª·ÓÈfi˜.

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ORIGINAL ARTICLE

À¿Ú¯ÂÈ Û˘Ó¤ÂÈ· ÛÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi ÙˆÓ ·È‰ÈÒÓ ÛÙËÓ Â·Ú¯›·; ŒÚ¢ӷ Û ·È‰ÈÎfi ÏËı˘ÛÌfi ∫¤ÓÙÚÔ˘ ÀÁ›·˜ ª. ™¯ÔÈÓ¿, °. ™¯ÔÈÓ¿˜, ∫. ¶·ÙÂÚfiÔ˘ÏÔ˜

Is there consistency in immunization of children who live in the countryside?

Study of the child population of a Rural Health Centre M. Schina, G. Schinas, K. Pateropoulos

¶ÂÚ›ÏË„Ë: ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ë ‰ÈÂÚ‡ÓËÛË Î·È Î·Ù·ÁÚ·Ê‹ Ù˘ ÂÌ‚ÔÏÈ·ÛÙÈ΋˜ Î¿Ï˘„˘ ÙˆÓ ·È‰ÈÒÓ Ô˘ ηÙÔÈÎÔ‡Ó ÛÙËÓ ÂÚÈÔ¯‹ ¢ı‡Ó˘ ÙÔ˘ ∫¤ÓÙÚÔ˘ ÀÁ›·˜ π¿ÛÌÔ˘ ÙÔ˘ ¡ÔÌÔ‡ ƒÔ‰fi˘, ηıÒ˜ Î·È Ë Û‡ÁÎÚÈÛË ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ Ù˘ ÂÚÈÔ¯‹˜ Ì ÙÔ˘˜ ÛÙfi¯Ô˘˜ Ô˘ ÚԂϤÔÓÙ·È ·fi ÙËÓ ¶·ÁÎfiÛÌÈ· OÚÁ¿ÓˆÛË ÀÁ›·˜ Î·È Ì ·Ó¿ÏÔÁ· ÛÙÔȯ›· ¿ÏÏˆÓ ÌÂÏÂÙÒÓ. ∞ÓÙÈΛÌÂÓÔ Ù˘ ÌÂϤÙ˘ ·ÔÙ¤ÏÂÛ·Ó 230 ·È‰È¿ Ù˘ ÂÚÈÔ¯‹˜, ËÏÈΛ·˜ 6-14 ÂÙÒÓ, Ô˘ ÂÈÛΤÊıËÎ·Ó ÙÔ ∫¤ÓÙÚÔ ÀÁ›·˜ ÁÈ· ÏfiÁÔ˘˜ ˘Á›·˜ ‹ ÁÈ· ÚÔÏËÙÈ΋ ÂͤٷÛË Î·Ù¿ Ù· ¤ÙË 2000-2001, ÙˆÓ ÔÔ›ˆÓ Ù· ‚È‚ÏÈ¿ÚÈ· ÌÂÏÂÙ‹ıËÎ·Ó Î·È Î·Ù·ÁÚ¿ÊËÎÂ Ë ÂÌ‚ÔÏÈ·ÛÙÈ΋ ÙÔ˘˜ ΛÓËÛË. O ·ÚÈıÌfi˜ ÙˆÓ ‰fiÛÂˆÓ ÌÂÏÂÙ‹ıËΠ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ˆ˜ ËÏÈ˘ ÔÚfiÛËÌÔ ÙÔ 1Ô Î·È 2Ô ¤ÙÔ˜, ηıÒ˜ Î·È Û˘ÓÔÏÈο ÛÙÔ Î¿ı ·È‰› ·ÓÂÍ·Úًو˜ ËÏÈΛ·˜. ™‡Ìʈӷ Ì ٷ ·ÔÙÂϤÛÌ·Ù· ÁÈ· ÙË ‰ÈÊıÂÚ›Ùȉ·, ÙÔÓ Ù¤Ù·ÓÔ, ÙÔÓ ÎÔηÙË Î·È ÙËÓ ÔÏÈÔÌ˘ÂÏ›Ùȉ·, ÙÔ 63%, 63%, 62,2% Î·È ÙÔ 63,5% ÙˆÓ ·È‰ÈÒÓ ·ÓÙÈÛÙÔ›¯ˆ˜ ‹Ù·Ó ÂÌ‚ÔÏÈ·Ṳ̂ÓÔ Ì 3 ‰fiÛÂȘ Û ËÏÈΛ· ÌÈÎÚfiÙÂÚË ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜, ÙÔ 51%, 51%, 49,1% Î·È 49,6% ·ÓÙ›ÛÙÔȯ· ‹Ù·Ó ÂÌ‚ÔÏÈ·Ṳ̂ÓÔ Ì 4 ‰fiÛÂȘ Û ËÏÈΛ· οو ÙˆÓ 2 ÂÙÒÓ Î·È ÙÔ 83,9%, 83,9%, 64,8% Î·È 82,2% ·ÓÙÈÛÙÔ›¯ˆ˜ ›¯Â 5 ‰fiÛÂȘ Û˘ÓÔÏÈο, ·ÓÂÍ·Úًو˜ ËÏÈΛ·˜, ÁÈ· ÙËÓ Î¿ı ÓfiÛÔ. °È· ÙËÓ ÈÏ·Ú¿, ÙËÓ ÂÚ˘ıÚ¿ Î·È ÙËÓ ·ÚˆÙ›Ùȉ·, Ì›· ‰fiÛË Û ËÏÈΛ· ÌÈÎÚfiÙÂÚË ÙˆÓ ‰‡Ô ÂÙÒÓ Â›¯Â Ï¿‚ÂÈ ÙÔ 4,8% ÙˆÓ ·È‰ÈÒÓ, ‰‡Ô ‰fiÛÂȘ ·ÓÂÍ·Úًو˜ ËÏÈΛ·˜ ÙÔ 53,9%, ÂÓÒ ÙÔ 8,7% ·Ú¤ÌÂÓ ·ÓÂÌ‚ÔÏ›·ÛÙÔ. ∫·Ù¿ ÙË Û‡ÁÎÚÈÛË ÙˆÓ ÛÙÔȯ›ˆÓ ·˘ÙÒÓ, ‰È·ÈÛÙÒÓÂÙ·È ÛËÌ·ÓÙÈ΋ ·fiÎÏÈÛË ·fi ÙÔ˘˜ ÛÙfi¯Ô˘˜ Ù˘ ¶·ÁÎfiÛÌÈ·˜ OÚÁ¿ÓˆÛ˘ ÀÁ›·˜, fiÔ˘ ÂÓ‰ÂÈÎÙÈο ·Ó·Ê¤ÚÂÙ·È fiÙÈ ··ÈÙÂ›Ù·È ÂÌ‚ÔÏÈ·ÛÙÈ΋ Î¿Ï˘„Ë ≥90% ÁÈ· ÙË ‰ÈÊıÂÚ›Ùȉ· Î·È ÙÔÓ Ù¤Ù·ÓÔ Û ·È‰È¿ ËÏÈΛ·˜ <1 ¤ÙÔ˘˜, ·ÏÏ¿ Î·È ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ Ì ¿ÏϘ ÂÚÈÔ¯¤˜ Ù˘ ∂ÏÏ¿‰·˜. ∞ÔÙÂÏ›,

Abstract: The aim of this study was to examine and record the degree of sufficiency of immunization of the children living in the area covered by the Iasmos Health Care Centre and to compare the findings with the standards set by the World Health Organization (WHO) and results from similar studies. The subjects of the study were 230 children aged 6-14 years, living in the area, who had visited the Health Care Centre for preventive examination or acute disease in the years 20002001. Their health booklets were examined and their immunizations were recorded, specifically the number of doses which had been administered in the 1st and 2nd years of life, and the total number of doses given to each child independent of age. It was found that for diphtheria, tetanus, pertussis and poliomyelitis vaccines, three doses had been given before the end of the first year to respectively 63%, 63%, 62.2% and 63.5% of the children, four doses by the end of the second year to respectively 51%, 51%, 49.1% and 49.6%, and a total of five doses, irrespective of age, had been given to respectively 83.9%, 83.9%, 64.8% and 82.2% of the children.

Regarding the vaccine for measles, mumps and rubella, 4.8% of the children had received one dose before the end of the second year and 53.9% had received two doses irrespective of age, while 8.7% were unimmunized. The study revealed significant deviation from the targets set by the WHO, whereby 90% cover of children for diphtheria and tetanus is demanded for children in the first year of life. There was also less effective coverage in comparison to studies conducted in other parts of Greece. It is necessary for similar studies to be conducted at a local level in order for effective planning of immunization promotion programmes to be carried out.

∫¤ÓÙÚÔ ÀÁ›·˜ ™Ô˘ÊÏ›Ô˘, ¡ÔÌfi˜ Œ‚ÚÔ˘

Health Care Centre of Soufli, Prefecture of Evros

448

¶·È‰È·ÙÚÈ΋ 2003;66:448-451

Paediatriki 2003;66:448-451

ÏÔÈfiÓ, ·Ó·ÁηÈfiÙËÙ· Ë ‰ÈÂÓ¤ÚÁÂÈ· ÌÂϤÙ˘ Ù˘ ηٿÛÙ·Û˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Û ÙÔÈÎfi Â›Â‰Ô Î·È Ë ÚÔÒıËÛË ÙÔÈÎÔ‡ ۯ‰ȷÛÌÔ‡ ‰Ú·ÛÙËÚÈÔÙ‹ÙˆÓ ÚÔ·ÁˆÁ‹˜ ÙˆÓ ÂÌ‚ÔÏÈ·ÛÌÒÓ. §¤ÍÂȘ ÎÏÂȉȿ: ÂÌ‚ÔÏÈ·ÛÌÔ›, ·È‰È¿, ∫¤ÓÙÚÔ ÀÁ›·˜, £Ú¿ÎË.

Key words: immunization, children, Health Care Centre, Thrace.

™˘ÓÙÔÌÔÁڷʛ˜

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∫À ¶OÀ πÀ¶

∫¤ÓÙÚÔ ÀÁ›·˜ ¶·ÁÎfiÛÌÈ· OÚÁ¿ÓˆÛË ÀÁ›·˜ πÓÛÙÈÙÔ‡ÙÔ ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡

∂ÈÛ·ÁˆÁ‹ ∏ ·ÓÙ›ÏË„Ë fiÙÈ Ë ÚfiÏË„Ë ÙˆÓ ·ÛıÂÓÂÈÒÓ ·ÔÙÂÏ› ÙËÓ Î·Ï‡ÙÂÚË Ì¤ıÔ‰Ô ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘˜ Â›Ó·È ·Ô‰ÂÎÙ‹ ·fi ·Ú¯·ÈÔÙ¿ÙˆÓ ¯ÚfiÓˆÓ. ∞˘Ùfi ÂȂ‚·ÈÒÓÂÙ·È ·fi ÙËÓ ÂÊ·ÚÌÔÁ‹ ÌÂıfi‰ˆÓ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÚÈÓ ·ÎfiÌË ·fi ÙË Á¤ÓÓËÛË ÙÔ˘ ÃÚÈÛÙÔ‡, ·Ú¯Èο Ì ÛÔ‚·Ú¤˜ ·ÚÂÓ¤ÚÁÂȘ Î·È ÎÈÓ‰‡ÓÔ˘˜ ÁÈ· ÙËÓ ˘Á›· ÙÔ˘ ÂÌ‚ÔÏÈ·˙fiÌÂÓÔ˘. ™‹ÌÂÚ·, Ë ÂͤÏÈÍË Ù˘ ÌÔÚȷ΋˜ Î·È Î˘ÙÙ·ÚÈ΋˜ ‚ÈÔÏÔÁ›·˜ ¤¯ÂÈ Ê¤ÚÂÈ Â·Ó¿ÛÙ·ÛË ÛÙËÓ ·Ú·Û΢‹ ·ÔÙÂÏÂÛÌ·ÙÈÎÒÓ Î·È ·Î›Ó‰˘ÓˆÓ ÂÌ‚ÔÏ›ˆÓ, Ì ÙȘ ÏÈÁfiÙÂÚ˜ ‰˘Ó·Ù¤˜ ·ÚÂÓ¤ÚÁÂȘ ÁÈ· ÙÔÓ ÂÌ‚ÔÏÈ·˙fiÌÂÓÔ.

O ·ÒÙÂÚÔ˜ ÛÙfi¯Ô˜ Ù˘ ÂÓÂÚÁËÙÈ΋˜ ·ÓÔÛÔÔ›ËÛ˘ Â›Ó·È Ë ÂÍ¿ÏÂÈ„Ë Ù˘ ÓfiÛÔ˘. O ÂӉȿÌÂÛÔ˜ ÛÙfi¯Ô˜ Â›Ó·È Ó· ·ÔÙÚ·› Ë ÂΉ‹ÏˆÛË Ù˘ ÓfiÛÔ˘ Û ¿ÙÔÌ· ‹ ÔÌ¿‰Â˜ ·ÙfïÓ. °È· Ó· ÂÈÙ¢¯ıÔ‡Ó ·˘ÙÔ› ÔÈ ÛÙfi¯ÔÈ, ÔÈ ÁÈ·ÙÚÔ› Ú¤ÂÈ Ó· ÙËÚÔ‡Ó ÛÙ·ıÂÚfi ÚfiÁÚ·ÌÌ· ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÙˆÓ ‚ÚÂÊÒÓ, ÙˆÓ ·È‰ÈÒÓ, ÙˆÓ ÂÊ‹‚ˆÓ Î·È ÙˆÓ ÂÓËϛΈÓ, ‰Â‰Ô̤ÓÔ˘ fiÙÈ ·˘Ùfi ·ÔÙÂÏ› Ú¿ÍË Ì¤ÁÈÛÙ˘ ÛÔ˘‰·ÈfiÙËÙ·˜. ∞fi‰ÂÈÍË ·˘ÙÔ‡ ·ÔÙÂÏ› Ë Ï‹Ú˘ ÂÍ¿ÏÂÈ„Ë Ù˘ ¢ÏÔÁÈ¿˜ ÙÔ 1979 Î·È Ô ÛËÌ·ÓÙÈÎfi˜ ÂÚÈÔÚÈÛÌfi˜ Ù˘ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜, ·ÏÏ¿ Î·È ¿ÏÏˆÓ ÓÔÛËÌ¿ÙˆÓ Ô˘ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÛÙÔ ‚·ÛÈÎfi ÚfiÁÚ·ÌÌ· ÂÌ‚ÔÏÈ·ÛÌÒÓ. ™ÎÔfi Ù˘ ÌÂϤÙ˘ ·˘Ù‹˜ ·ÔÙÂÏ› Ë ‰ÈÂÚ‡ÓËÛË Î·È Î·Ù·ÁÚ·Ê‹ Ù˘ ÂÌ‚ÔÏÈ·ÛÙÈ΋˜ Î¿Ï˘„˘ ÙˆÓ ·È‰ÈÒÓ Ô˘ ηÙÔÈÎÔ‡Ó ÛÙËÓ ÂÚÈÔ¯‹ ¢ı‡Ó˘ ÙÔ˘ ∫¤ÓÙÚÔ˘ ÀÁ›·˜ π¿ÛÌÔ˘ ÙÔ˘ ÓÔÌÔ‡ ƒÔ‰fi˘, Ì›·˜ ÔÚÂÈÓ‹˜ ÂÚÈÔ¯‹˜ Ì ÏËı˘ÛÌȷΤ˜ ȉȷÈÙÂÚfiÙËÙ˜, ηıÒ˜ Î·È Ë Û‡ÁÎÚÈÛË ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ Ù˘ ÂÚÈÔ¯‹˜ Ì ÙÔ˘˜ ÛÙfi¯Ô˘˜ Ù˘ ¶·ÁÎfiÛÌÈ·˜ OÚÁ¿ÓˆÛ˘ ÀÁ›·˜ (¶OÀ) Î·È Ì ÛÙÔȯ›· ¿ÏÏˆÓ ·Ó¿ÏÔÁˆÓ ÌÂÏÂÙÒÓ. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ∞ÓÙÈΛÌÂÓÔ Ù˘ ÌÂϤÙ˘ ·ÔÙ¤ÏÂÛ·Ó 230 ·È‰È¿ Ù˘ ÂÚÈÔ¯‹˜, ËÏÈΛ·˜ 6-14 ÂÙÒÓ, Ù· ÔÔ›· ÂÈÛΤÊıËÎ·Ó ÙÔ ∫À ÁÈ· ÏfiÁÔ˘˜ ÔÍ›·˜ ÓfiÛËÛ˘ ‹ ÁÈ· ÚÔÏËÙÈ΋ ÂͤٷÛË Î·È Û˘ÌÏ‹ÚˆÛË ÙÔ˘ ·ÙÔÌÈÎÔ‡ ‰ÂÏÙ›Ô˘ ˘Á›·˜, ηٿ Ù· ¤ÙË 20002001. ªÂÏÂÙ‹ıËÎ·Ó Ù· ‚È‚ÏÈ¿ÚÈ· ·˘ÙÒÓ ÙˆÓ ·È‰ÈÒÓ Î·È Î·-

∞ÔÙÂϤÛÌ·Ù· ∏ Î¿Ï˘„Ë ÙˆÓ ·È‰ÈÒÓ ÁÈ· ÙË ‰ÈÊıÂÚ›Ùȉ·, ÙÔÓ Ù¤Ù·ÓÔ, ÙÔÓ ÎÔηÙË Î·È ÙËÓ ÔÏÈÔÌ˘ÂÏ›Ùȉ· Ê·›ÓÂÙ·È ÛÙÔÓ ¶›Ó·Î· 1. °›ÓÂÙ·È, ÏÔÈfiÓ, ·ÓÙÈÏËÙfi fiÙÈ ÌfiÏȘ ÙÔ 51% ÙˆÓ ·È‰ÈÒÓ Â›Ó·È ÂÌ‚ÔÏÈ·Ṳ̂ÓÔ Ì 4 ‰fiÛÂȘ ÁÈ· ‰ÈÊıÂÚ›Ùȉ· Î·È Ù¤Ù·ÓÔ Û ËÏÈΛ· ÌÈÎÚfiÙÂÚË ÙˆÓ 2 ÂÙÒÓ, ÂÓÒ ÙÂÏÈο, ÛÙȘ ÌÂÁ·Ï‡ÙÂÚ˜ ËÏÈ˘, ÙÔ ÔÛÔÛÙfi Î¿Ï˘„˘ Ì 5 ‰fiÛÂȘ ÊÙ¿ÓÂÈ ÙÔ 83,9% (ÔÛÔÛÙfi Ô˘ Â›Ó·È Û ·ÓÙÈÛÙÔȯ›· Ì ٷ ÛÙÔȯ›· ·fi ÙËÓ ·ÓÂÏÏ·‰È΋ ÌÂϤÙË) (¶›Ó·Î·˜ 2) Î·È ¿ÏϘ ·ÓÙ›ÛÙÔȯ˜ ÌÂϤÙ˜. ∂ȉÈο ÁÈ· ÙÔÓ ÎÔηÙË, ÂÎÙfi˜ ·fi ÙËÓ Î·ı˘ÛÙ¤ÚËÛË ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡, ·Ú·ÙËÚÂ›Ù·È Î·È ·ÚÎÂÙ¿ ¯·ÌËÏfiÙÂÚÔ ÔÛÔÛÙfi ·È‰ÈÒÓ ÂÌ‚ÔÏÈ·ÛÌ¤ÓˆÓ Ì 5 ‰fiÛÂȘ ÏfiÁˆ ¯ÔÚ‹ÁËÛ˘ ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ DT ÛÙËÓ 5Ë ‰fiÛË, ·ÏÏ¿ Ù· ÔÛÔÛÙ¿ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚ·

449

¶·È‰È·ÙÚÈ΋ 2003;66:448-451

Paediatriki 2003;66:448-451

¶›Ó·Î·˜ 1. ¢Â›ÎÙ˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÁÈ· ÙË ‰ÈÊıÂÚ›Ùȉ·, ÙÔÓ Ù¤Ù·ÓÔ Î·È ÙÔÓ ÎÔηÙË

¢ÈÊıÂÚ›Ùȉ·* ∫ÔÎ·Ù˘ Sabin

3 ‰fiÛÂȘ <1 ¤ÙÔ˘˜

4 ‰fiÛÂȘ <2 ÂÙÒÓ

5 ‰fiÛÂȘ ·ÓÂÍ·Úًو˜ ËÏÈΛ·˜

<3 ‰fiÛÂȘ

∞ÓÂÌ‚ÔÏ›·ÛÙ·

63% 62,2% 63,5%

51% 49,6% 49,6%

83,9% 64,8% 82,2%

3,9% 10,4% 4%

3%

* ∏ Î¿Ï˘„Ë ÙˆÓ ·È‰ÈÒÓ ÁÈ· ٤ٷÓÔ Â›Ó·È Ë ›‰È· Ì Ù˘ ‰ÈÊıÂÚ›Ùȉ·˜, ÁÈ’ ·˘Ùfi Î·È ‰ÂÓ ÌÂÏÂÙÒÓÙ·È ¯ˆÚÈÛÙ¿ ¶›Ó·Î·˜ 3. ¢Â›ÎÙ˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÁÈ· ÙËÓ ÈÏ·Ú¿, ÙËÓ ÂÚ˘ıÚ¿ Î·È ÙËÓ ·ÚˆÙ›Ùȉ·

¶›Ó·Î·˜ 2. ™ÙÔȯ›· ·ÓÂÏÏ·‰È΋˜ ÌÂϤÙ˘

¢ÈÊıÂÚ›Ùȉ· ∫ÔÎ·Ù˘ ¶ÔÏÈÔÌ˘ÂÏ›Ùȉ·

3 ‰fiÛÂȘ <1 ¤ÙÔ˘˜

4 ‰fiÛÂȘ <2 ÂÙÒÓ

5 ‰fiÛÂȘ ·ÓÂÍ·Úًو˜ ËÏÈΛ·˜

84,1% 82,4% 81,2%

69% 65% 65,6%

80,8% 46,3% 80,3%

·fi Ù· ·Ó¿ÏÔÁ· Ù˘ ·ÓÂÏÏ·‰È΋˜ ÌÂϤÙ˘, Êı¿ÓÔÓÙ·˜ ÙÔ 64,8%, ÂÓÒ ÂÈÛËÌ·›ÓÂÙ·È Î·È ÙÔ 3% ÙˆÓ ·ÓÂÌ‚ÔÏ›·ÛÙˆÓ ·È‰ÈÒÓ. ™¯ÔÏÈ¿˙ÔÓÙ·˜ Ù· ÛÙÔȯ›· ÁÈ· ÙËÓ ÈÏ·Ú¿, ÙËÓ ÂÚ˘ıÚ¿ Î·È ÙËÓ ·ÚˆÙ›Ùȉ· (¶›Ó·Î·˜ 3), ȉȷ›ÙÂÚË ÂÓÙ‡ˆÛË ÚÔηÏ› ÙÔ ¯·ÌËÏfi ÔÛÔÛÙfi ÂÌ‚ÔÏÈ·ÛÌÔ‡ Û ËÏÈ˘ οو ÙˆÓ 2 ÂÙÒÓ (4,8% ÁÈ· ÙËÓ ÈÏ·Ú¿), fiÙ·Ó Ô ÛÙfi¯Ô˜ Ù˘ ¶OÀ (¶›Ó·Î·˜ 4) Â›Ó·È Ó· ÂÌ‚ÔÏÈ·ÛÙ› Ì ÙÔ˘Ï¿¯ÈÛÙÔÓ Ì›· ‰fiÛË ÙÔ 90% ÙˆÓ ·È‰ÈÒÓ ËÏÈΛ·˜ οو ÙˆÓ 2 ÂÙÒÓ. ∞Ó¿ÏÔÁ· Â›Ó·È Î·È Ù· ÛÙÔȯ›· ÁÈ· ÙËÓ ÂÚ˘ıÚ¿ Î·È ÙËÓ ·ÚˆÙ›Ùȉ·, ÁÂÁÔÓfi˜ Ô˘ ηıÈÛÙ¿ ÂÍ·ÈÚÂÙÈο ‰‡ÛÎÔÏÔ ÛÙfi¯Ô ÙËÓ ÂÎÚ›˙ˆÛË ÙˆÓ ÓfiÛˆÓ ·˘ÙÒÓ ÛÙ· ·Ì¤Ûˆ˜ ÂfiÌÂÓ· ¯ÚfiÓÈ·. OÈ ÔÌÔÈfiÙËÙ˜ ÛÙ· ÔÛÔÛÙ¿ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÁÈ· ÙȘ ÙÚÂȘ ÓfiÛÔ˘˜ ÔÊ›ÏÔÓÙ·È ÛÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ ÙÚÈÏÔ‡ ÂÌ‚ÔÏ›Ô˘ MMR Û fiÏ· ۯ‰fiÓ Ù· ·È‰È¿. ™Â ·Ó¿ÏÔÁË ÌÂϤÙË Ô˘ ¤Ï·‚ ¯ÒÚ· ÛÙÔÓ ÓÔÌfi ¶ÈÂÚ›·˜ ÙÔ 2000 (8), Ù· ÔÛÔÛÙ¿ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÁÈ· ÙȘ ÙÚÂȘ ÓfiÛÔ˘˜ ‹Ù·Ó 34,4% ÁÈ· Ù· ·È‰È¿ ÙÔ˘ §˘Î›Ԣ Î·È 34,8% ÁÈ· Ù· ·È‰È¿ ÙÔ˘ °˘ÌÓ·Û›Ô˘. ∆· ÔÛÔÛÙ¿ ·˘Ù¿ Â›Ó·È ‚¤‚·È· ˘„ËÏfiÙÂÚ· ·fi ÙÔ 26,1% Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ (¶›Ó·Î·˜ 3), ·ÏÏ¿ ÙÔÓ›˙ÂÙ·È ÁÈ· ¿ÏÏË Ì›· ÊÔÚ¿ Ë ÛËÌ·ÓÙÈ΋ ·fiÎÏÈÛË ·fi ÙÔ˘˜ ÛÙfi¯Ô˘˜ Ù˘ ¶OÀ. ™Â ÌÂϤÙË Ô˘ ‰ÈÂÓÂÚÁ‹ıËΠ·fi ÙËÓ ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ÙÔ 1995, Û ÓÔÛÔÎÔÌÂÈ·Îfi ÏËı˘ÛÌfi (3), Ù· ÔÛÔÛÙ¿ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ›¯·Ó ÌÈÎÚ¤˜ ‰È·ÊÔÚ¤˜ ÁÈ· ÙË ‰ÈÊıÂÚ›Ùȉ·, ÙÔÓ ÎÔηÙË Î·È ÙËÓ ÔÏÈÔÌ˘ÂÏ›Ùȉ·, ÂÓÒ ·Ú·ÙËÚ‹ıËΠÌÂÁ¿ÏË ‰È·ÊÔÚ¿ ÁÈ· ÙËÓ ÈÏ·Ú¿, ÙËÓ ÂÚ˘ıÚ¿ Î·È ÙËÓ ·ÚˆÙ›Ùȉ·, fiÔ˘ Ù· ÔÛÔÛÙ¿ ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ‹Ù·Ó 89%, 76% Î·È 82%, ·ÓÙ›ÛÙÔȯ·, ÂÓÒ Ù· ÔÛÔÛÙ¿ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ Êı¿ÓÔ˘Ó ÌfiÏȘ ÙÔ 26,1% ÁÈ· ÙËÓ ÈÏ·Ú¿, ÙÔ 25,2% ÁÈ· ÙËÓ ÂÚ˘ıÚ¿ Î·È ÙÔ 26,1% ÁÈ· ÙËÓ ·ÚˆÙ›Ùȉ·. ∞ÎfiÌË, ÂÈÛËÌ·›ÓÂÙ·È ÙÔ ¯·ÌËÏfi ÔÛÔÛÙfi ÂÌ‚Ô-

450

ñ 0 ‰fiÛÂȘ ñ 1 ‰fiÛË (<2ÂÙÒÓ) ñ 1 ‰fiÛË ñ 2 ‰fiÛÂȘ (·ÓÂÍ·Úًو˜ ËÏÈΛ·˜) ñ 2 ‰fiÛÂȘ (<6 ÂÙÒÓ)

πÏ·Ú¿

∂Ú˘ıÚ¿

¶·ÚˆÙ›Ùȉ·

8,7% 4,8%

8,7% 4,8%

8,7% 4,8%

26,1% 53,9%

25,2% 54,3%

26,1% 53,9%

6,5%

6,9%

6,5%

¶›Ó·Î·˜ 4. ™Ùfi¯ÔÈ Ù˘ ¶·ÁÎfiÛÌÈ·˜ OÚÁ·ÓˆÛ˘ ÀÁ›·˜ (¶OÀ) ™Ùfi¯ÔÈ Ù˘ ¶OÀ ñ ¢ÈÊıÂÚ›Ùȉ·/٤ٷÓÔ˜ (3 ¤Á΢Ú˜ ‰fiÛÂȘ ¤ˆ˜ 1 ¤ÙÔ˘˜) ñ ∫ÔÎ·Ù˘ (3 ¤Á΢Ú˜ ‰fiÛÂȘ ¤ˆ˜ 1 ¤ÙÔ˘˜) ñ ¶ÔÏÈÔÌ˘ÂÏ›Ùȉ· (3 ¤Á΢Ú˜ ‰fiÛÂȘ ¤ˆ˜ 1 ¤ÙÔ˘˜) ñ πÏ·Ú¿, ÂÚ˘ıÚ¿, ·ÚˆÙ›Ùȉ· (1 ¤Á΢ÚË ‰fiÛË ¤ˆ˜ 2 ÂÙÒÓ)

≥90% ≥90% ≥90% ≥90%

¶›Ó·Î·˜ 5. ¢Â›ÎÙ˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÁÈ· ÙËÓ Ë·Ù›Ùȉ· µ, ÙËÓ Ë·Ù›Ùȉ· ∞, ÙÔÓ ·ÈÌfiÊÈÏÔ Î·È ÙË Ê˘Ì·Ù›ˆÛË ñ ∏·Ù›Ùȉ· µ (3 ‰fiÛÂȘ ·ÓÂÍ·Úًو˜ ËÏÈΛ·˜) ñ ∏·Ù›Ùȉ· ∞ (3 ‰fiÛÂȘ ·ÓÂÍ·Úًو˜ ËÏÈΛ·˜) ñ ∞ÈÌfiÊÈÏÔ˜ (Ï‹Ú˘ ÂÌ‚ÔÏÈ·ÛÌfi˜) ñ BCG

80,4% 1,7% 11,7% 32,6%

ÏÈ·ÛÌÔ‡ ÁÈ· ÙÔÓ ·ÈÌfiÊÈÏÔ Ù˘ ÈÓÊÏÔ˘¤ÓÙÛ·˜ (ÌfiÏȘ 11,7%) (¶›Ó·Î·˜ 5) Î·È ÙÔ ˘„ËÏfi ÔÛÔÛÙfi ÂÌ‚ÔÏÈ·ÛÌÔ‡ Ù˘ Ë·Ù›Ùȉ·˜ µ ¯¿ÚË ÛÙȘ ÚÔÛ¿ıÂȘ ÙÔ˘ ÚÔÛˆÈÎÔ‡ ÙÔ˘ ∫¤ÓÙÚÔ˘ ÀÁ›·˜ Ô˘ Â¤ÌÂÓ ÛÙȘ ÂÈÛΤ„ÂȘ Î·È Î·ıfiÚÈ˙ ۷ʤ˜ ¯ÚÔÓԉȿÁÚ·ÌÌ· ÂÌ‚ÔÏÈ·ÛÌÒÓ ÛÙ· ·È‰È¿ Ù˘ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ Ô˘ ÂÈÛΤÙÔÓÙ·Ó ÙÔ ∫À ÁÈ· ÚÔÏËÙÈÎfi ¤ÏÂÁ¯Ô (¶›Ó·Î·˜ 5). ™˘˙‹ÙËÛË ∞fi Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘ Á›ÓÂÙ·È ·ÓÙÈÏËÙ‹ Ë ÛËÌ·ÓÙÈ΋ ηı˘ÛÙ¤ÚËÛË ÛÙË ‰ÈÂÓ¤ÚÁÂÈ·

¶·È‰È·ÙÚÈ΋ 2003;66:448-451

¶ÔÛÔÛÙfi ÂÌ‚ÔÏÈ·ÛÌÔ‡

30

Paediatriki 2003;66:448-451

ηٿÛÙ·ÛË ÙˆÓ ·ÙfiÌˆÓ Ù˘ οı ÂÚÈÔ¯‹˜ Î·È Ó· ÂÊ·ÚÌfi˙ÔÓÙ·È Û˘ÁÎÂÎÚÈ̤ӷ ÚÔÁÚ¿ÌÌ·Ù· ÁÈ· Ó· ÂÈÙ¢¯ıÔ‡Ó, ÙÂÏÈο, ÔÈ ÛÙfi¯ÔÈ Ô˘ Ù›ıÂÓÙ·È ·fi ÙËÓ ¶·ÁÎfiÛÌÈ· OÚÁ¿ÓˆÛË ÀÁ›·˜.

20

µÈ‚ÏÈÔÁÚ·Ê›· 10

0 1 3 5 7 9 11 13 15 19 24 27 30 36 48 72 85 110 ∏ÏÈΛ· Û ̋Ó˜ ∂ÈÎfiÓ· 1. ∏ÏÈÎȷ΋ ηٷÓÔÌ‹ ÙˆÓ ·È‰ÈÒÓ Î·Ù¿ ÙËÓ ¤Ó·ÚÍË ÙˆÓ ÂÌ‚ÔÏÈ·ÛÌÒÓ.

ÙˆÓ ˘Ô¯ÚˆÙÈÎÒÓ ÂÌ‚ÔÏÈ·ÛÌÒÓ ÛÙËÓ ÂÚÈÔ¯‹ Ù˘ ÌÂϤÙ˘. ∞˘Ùfi ÔÊ›ÏÂÙ·È ·ÊÂÓfi˜ ÛÙËÓ ÂÏÏÈ‹ ÏËÚÔÊfiÚËÛË Î·È ·ÊÂÙ¤ÚÔ˘ ÛÙÔ ˘„ËÏfi ÔÛÔÛÙfi ·Ó·ÏÊ·‚ËÙÈÛÌÔ‡. ∏ ‰˘ÛÎÔÏ›· Ù˘ ÂÓË̤ڈÛ˘ ÂÈÙ›ÓÂÙ·È ·ÎfiÌË ÂÚÈÛÛfiÙÂÚÔ ·fi ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ¤Ó· ÌÂÁ¿ÏÔ ÔÛÔÛÙfi ÙˆÓ Î·ÙÔ›ÎˆÓ ·Ó‹ÎÂÈ ÛÙË ÌÔ˘ÛÔ˘ÏÌ·ÓÈ΋ ÌÂÈÔÓfiÙËÙ· Î·È ÂÌÊ·Ó›˙ÂÈ Úfi‚ÏËÌ· ÂÈÎÔÈÓˆÓ›·˜ ÌË Î·Ù·ÓÔÒÓÙ·˜ Â·ÚÎÒ˜ ÙË ÁÏÒÛÛ·, ȉ›ˆ˜ ÔÈ ÌËÙ¤Ú˜ Ô˘ Û˘Ó‹ıˆ˜ ÊÚÔÓÙ›˙Ô˘Ó ÁÈ· ÙËÓ Ù‹ÚËÛË ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÂÌ‚ÔÏÈ·ÛÌÒÓ Î·È ¤¯Ô˘Ó ηٿ ·ÚÈÔ ÏfiÁÔ ÙËÓ ÂÈ̤ÏÂÈ· ÙˆÓ ·È‰ÈÒÓ. ŒÙÛÈ ‰È·ÈÛÙÒÓÂÙ·È fiÙÈ ÙÔ ÚfiÁÚ·ÌÌ· ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÌÂٷʤÚÂÙ·È Û ÌÂÁ·Ï‡ÙÂÚ˜ ËÏÈ˘, fiÙ·Ó ‰ËÏ. ÂÈ‚¿ÏÏÂÙ·È Ë ÂͤٷÛË ÙˆÓ ·È‰ÈÒÓ ·fi ·È‰›·ÙÚÔ ÁÈ· ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ ‰ÂÏÙ›Ô˘ ˘Á›·˜ ÙÔ˘ ·È‰ÈÔ‡. µÚ¤ıËΠÏÔÈfiÓ fiÙÈ ÌfiÓÔ ÙÔ 75% ÙˆÓ ·È‰ÈÒÓ ·Ú¯›˙ÂÈ ÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi ÙÔ˘ Û ËÏÈ˘ <7 ÌËÓÒÓ, ÂÓÒ ¤Ó· 20% ÙˆÓ ·È‰ÈÒÓ ·Ú¯›˙ÂÈ Ó· ÂÌ‚ÔÏÈ¿˙ÂÙ·È ÌÂÙ¿ ÙËÓ ËÏÈΛ· ÙˆÓ 2 ÂÙÒÓ (∂ÈÎfiÓ· 1). ∆ÔÓ›˙ÂÙ·È, Ù¤ÏÔ˜, Ë ÌÂÁ¿ÏË ÛËÌ·Û›· Ù˘ ÂÊ·ÚÌÔÁ‹˜ ÙˆÓ ‰‡Ô ‰fiÛÂˆÓ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÁÈ· ÙËÓ ÈÏ·Ú¿, ÙËÓ ÂÚ˘ıÚ¿ Î·È ÙËÓ ·ÚˆÙ›Ùȉ·, ÚÔÎÂÈ̤ÓÔ˘ Ó· ·ÔÊ¢¯ıÔ‡Ó ÂȉË̛˜ fiˆ˜ ·˘Ù‹ Ù˘ ÈÏ·Ú¿˜ ÙÔ 1996 Î·È Ù˘ Û˘ÁÁÂÓÔ‡˜ ÂÚ˘ıÚ¿˜ ÙÔ 1993. §·Ì‚¿ÓÔÓÙ·˜, ÏÔÈfiÓ, ˘’ fi„ÈÓ Ù· ¯·ÌËÏ¿ ÔÛÔÛÙ¿ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Ù˘ ÂÚÈÔ¯‹˜ ‰È·ÈÛÙÒÓÂÙ·È fiÙÈ Â›Ó·È ··Ú·›ÙËÙ· ÙfiÛÔ Ë ÂÎfiÓËÛË Û¯Â‰›Ô˘ ÂÊ·ÚÌÔÁ‹˜ ÙˆÓ ÂÌ‚ÔÏÈ·ÛÌÒÓ fiÛÔ Î·È Ô Û·Ê‹˜ ηıÔÚÈÛÌfi˜ ÙˆÓ ÛÙfi¯ˆÓ ÛÙÔ˘˜ ·ÓıÚÒÔ˘˜ Ô˘ ·Û¯ÔÏÔ‡ÓÙ·È Ì ÙÔ˘˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡˜ ÁÈ· ÙË ¯¿Ú·ÍË ÎÔÈÓ‹˜ ÛÙÚ·ÙËÁÈ΋˜, ·ÏÏ¿ Î·È ÁÈ· ÙËÓ ÂÓË̤ڈÛË ÙÔ˘ ÏËı˘ÛÌÔ‡, ηıÒ˜ Î·È Ô ¤ÏÂÁ¯Ô˜ ˆ˜ ÚÔ˜ ÙËÓ ·ÓÙ·fiÎÚÈÛË ‹ fi¯È ÛÙȘ ÚԉȷÁڷʤ˜ ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜. ªÂÁ¿Ï˘, Â›Û˘, ÛÔ˘‰·ÈfiÙËÙ·˜ Â›Ó·È Ë ÌÂϤÙË Ù˘ ηٿÛÙ·Û˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Û ÙÔÈÎfi Â›‰Ô, ¤ÙÛÈ ÒÛÙ ӷ Á›ÓÂÙ·È ÁÓˆÛÙ‹ Ë ÂÌ‚ÔÏÈ·ÛÙÈ΋

1. ¶·Ó·ÁȈÙfiÔ˘ÏÔ˜ ∆, µ·Ï¿ÛÛË-∞‰¿Ì ∂. ŒÎıÂÛË. ¶·ÓÂÏÏ·‰È΋ ÌÂϤÙË Î·Ù¿ÛÙ·Û˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡. ∞ı‹Ó·: πÓÛÙÈÙÔ‡ÙÔ ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡; 1998.

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

3. µ·Ï¿ÛÛË-∞‰¿Ì ∂. ∞ÔÙ‡ˆÛË Î·Ù¿ÛÙ·Û˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Û ÓÔÛÔÎÔÌÂÈ·Îfi ÏËı˘ÛÌfi. ¢ÂÏÙ›Ô ∞’ ¶·È‰È·ÙÚÈ΋˜ ∫ÏÈÓÈ΋˜ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ 1995;42:82-86.

4. ºˆÙ›Ô˘ ∫, ¶··‰¿ÎË ∂. O ÂÌ‚ÔÏÈ·ÛÌfi˜ ÁÈ· ÙËÓ Ë·Ù›Ùȉ· µ ÛÙËÓ ·È‰È΋ ËÏÈΛ·. ¶·È‰È·ÙÚÈο ÃÚÔÓÈο 1995;22:63-68.

5. °ÂˆÚÁ¿ÙÔ˜ ¢, ∫·Ú·Î·˚‰fi˜ ¢, ªÔÛ¯ÔÓ¿ ¢, ™·ÍÈÒÓË ∂, ∆˙ÈÔ˘‚¿Ú· Ã, ƒËÁ¿ÙÔ˘ ∂ Î·È Û˘Ó. ∫·Ù¿ÛÙ·ÛË ÂÌ‚ÔÏÈ·ÛÌÔ‡ ·È‰ÈÎÔ‡ ÏËı˘ÛÌÔ‡ ∫ÂÊ·ÏÔÓÈ¿˜ [¶ÂÚ›ÏË„Ë]. 35Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ; 1997 13-15 πÔ˘Ó›Ô˘; ∫Ú‹ÙË; 1997. ÛÂÏ. 69. #62µ∞.

6. American Academy of Pediatrics (Active and Passive Immunization). In: Pickering LK, editor. 2000 Red Book: Report of the Committee on Infectious Diseases. 25th ed.

Elk Grove Village, IL: American Academy of Pediatrics; 2000. p. 1.

7. ª·ÏˆÌ¤ÓÔ˜ ∫, ¶··‰ËÌËÙÚ›Ô˘ ∂, °Ú‡ÏÏ˘ ™, ∫ÔÏ˘¤Ú·˜ ¢, ∞ÁÔÚ›ÙÛ· ™. ªÂϤÙË Î·Ù¿ÛÙ·Û˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Ì·ıËÙÒÓ §˘Î›Ԣ ÛÙÔ ¡ÔÌfi ∆ÚÈÎ¿ÏˆÓ [¶ÂÚ›ÏË„Ë]. 38Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ; 2000 16-18 πÔ˘Ó›Ô˘; ∫ˆ˜; 2000. ÛÂÏ.

289. #568.

8. ºÈ‰¿ÓË §, ¢¿Ú‰· ∞, ∞ÎÙÛ¤ÏË ∫, ªfi˙ÔÁÏÔ˘ ª, ºÈÏÈ›‰Ë˜ ™, µ·Ï·‚¿ÓË Ã Î·È Û˘Ó. ∫·Ù¿ÛÙ·ÛË ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÁÈ· ÈÏ·Ú¿, ÂÚ˘ıÚ¿ Î·È ·ÚˆÙ›Ùȉ· ÛÙÔÓ ¡ÔÌfi ¶ÈÂÚ›·˜ [¶ÂÚ›ÏË„Ë]. 38Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ; 2000 16-18 πÔ˘Ó›Ô˘; ∫ˆ˜; 2000. ÛÂÏ. 5. #002.

9. ∆˙Ô˘‚ÂϤ΢ °, ¡¿Ó·˜ Ã, ÷Ù˙ËÛÙ˘ÏÈ·ÓÔ‡ ª, ∫·ÙÚÈÔ‡ ¢. ∫·Ù¿ÛÙ·ÛË ÂÌ‚ÔÏÈ·ÛÌÒÓ ÙˆÓ Ì·ıËÙÒÓ ËÏÈΛ·˜ 7-15 ÂÙÒÓ ÙÔ˘ ¡. ∫ÈÏΛ˜ [¶ÂÚ›ÏË„Ë]. 38Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ; 2000 16-18 πÔ˘Ó›Ô˘; ∫ˆ˜; 2000. ÛÂÏ. 289. #569.

10. ¶ÂÙÚÔÔ‡ÏÔ˘ º, ªÂÚ›‰Ë˜ £, ∆Û¿ÌÈÚ· ¶, ¶·Ó·ÁȈÙfiÔ˘ÏÔ˜ ∆. ∂ȉËÌÈÔÏÔÁÈ΋ ÌÂϤÙË Ù˘ ηٿÛÙ·Û˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÙÔ˘ ·È‰ÈÎÔ‡ ÏËı˘ÛÌÔ‡ ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ¢‹ÌÔ˘ µfiÏÔ˘ [¶ÂÚ›ÏË„Ë]. 36Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ; 1998 5-7 πÔ˘Ó›Ô˘; ¶¿ÊÔ˜, ∫‡ÚÔ˜; 1998. ÛÂÏ. 161. #306∞∞.

∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 10-01-2003 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 09-09-2003 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ª·Ú›· ™¯ÔÈÓ¿ ∞Ó. £Ú¿Î˘ 23, ∆.∫. 681 00 ∞ÏÂÍ·Ó‰ÚÔ‡ÔÏË, ¡. Œ‚ÚÔ˘

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Paediatriki 2003;66:452-455

ORIGINAL ARTICLE

¶ÚÔ‚Ï‹Ì·Ù· ˘Á›·˜ ·È‰ÈÒÓ-·Ú·ıÂÚÈÛÙÒÓ Û ÓËÛ› ÙˆÓ ∫˘ÎÏ¿‰ˆÓ ∂. ¶·Ú·Ûο΢1, ª. ∆ÛÈÌÈÓfi˜1, ∫. ∫·Ú·Ó¿ÛÈÔ˘1, ¡. ª·Î·ÚÒÓ·˜1, ∂. °·Ï·Ó¿Î˘2

Health problems of child-tourists in a Cycladic island E. Paraskakis1, M. Tsimbinos1, K. Karanasiou1, N. Makaronas1, E. Galanakis2

¶ÂÚ›ÏË„Ë: ∏ ÁÓÒÛË ÙˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ ˘Á›·˜ ÙˆÓ ·È‰ÈÒÓ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù·ÍȉÈÒÓ Î·È ‰È·ÎÔÒÓ ÌÔÚ› Ó· Û˘Ì‚¿ÏÂÈ ÛÙËÓ ÚfiÏË„Ë Î·È ÙË ÛˆÛÙ‹ ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘˜ ÛÙÔ˘˜ ÙfiÔ˘˜ ˘Ô‰Ô¯‹˜. ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ë Î·Ù·ÁÚ·Ê‹ ·˘ÙÒÓ ÙˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ Û ·È‰È¿ Ô˘ ‹Ù·Ó ıÂÚÈÓÔ› ÂÈÛΤÙ˜ ÛÙÔ ÓËÛ› Ù˘ ™›ÊÓÔ˘. ªÂÏÂÙ‹ıËÎ·Ó 311 ·È‰È¿-·Ú·ıÂÚÈÛÙ¤˜, Ù· ÔÔ›· ÂÍÂÙ¿ÛÙËÎ·Ó ÛÙÔ ÔÏ˘‰‡Ó·ÌÔ ÂÚÈÊÂÚÂÈ·Îfi È·ÙÚÂ›Ô ™›ÊÓÔ˘ ηٿ ÙÔ˘˜ ıÂÚÈÓÔ‡˜ Ì‹Ó˜ Ù˘ ‰ÈÂÙ›·˜ 2001-2002 Î·È Û˘ÁÎÚ›ıËÎ·Ó Ì 311 ·È‰È¿-ÌfiÓÈÌÔ˘˜ οÙÔÈÎÔ˘˜, Ù· ÔÔ›· ·ÔÙ¤ÏÂÛ·Ó ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘. ™˘¯ÓfiÙÂÚË ·ÈÙ›· ÚÔÛ¤Ï¢Û˘ ÙˆÓ ·È‰ÈÒÓ-·Ú·ıÂÚÈÛÙÒÓ ÛÙÔ È·ÙÚÂ›Ô ‹Ù·Ó Ù· ·Ù˘¯‹Ì·Ù· (16%) Î·È ·ÎÔÏÔ˘ıÔ‡Û·Ó ÔÈ ˆÙ›Ùȉ˜ (13%), ÔÈ ‰ÂÚÌ·Ù›Ùȉ˜ (13%), ÔÈ ÏÔÈÌÒÍÂȘ ηÙÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ (12%) Î·È Ë Á·ÛÙÚÂÓÙÂÚ›Ùȉ· (10%). ∆· ·È‰È¿-ÌfiÓÈÌÔÈ Î¿ÙÔÈÎÔÈ ·ÚÔ˘Û›·˙·Ó ‰È·ÊÔÚÂÙÈο ÔÛÔÛÙ¿ ÛÙȘ ·Èٛ˜ ÚÔÛ¤Ï¢Û˘ (ÏÔÈÌÒÍÂȘ ηÙÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ 16%, ‰ÂÚÌ·Ù›Ùȉ˜ 12%, ÏÔÈÌÒÍÂȘ ·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ 7%, ¿ÛıÌ· 6%, ˆÙ›Ùȉ˜ 5%). ∆· ·È‰È¿-·Ú·ıÂÚÈÛÙ¤˜ ·ÚÔ˘Û›·Û·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ·˘ÍË̤ÓË ÓÔÛËÚfiÙËÙ· ·fi Á·ÛÙÚÂÓÙÂÚ›Ùȉ˜, ˆÙ›Ùȉ˜ Î·È ·Ù˘¯‹Ì·Ù· (p=0,0002, p=0,0012 Î·È p=0,011, ·ÓÙ›ÛÙÔȯ·). ™˘ÌÂÚ·ÛÌ·ÙÈο, Ù· ·È‰È¿ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ıÂÚÈÓÒÓ ‰È·ÎÔÒÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÓÔÛ‹Ì·Ù· ‰È·ÊÔÚÂÙÈο ·fi ÂΛӷ ÙˆÓ ·È‰ÈÒÓ-ÌfiÓÈÌˆÓ Î·ÙԛΈÓ. ∏ ηٿÏÏËÏË ÚfiÏË„Ë Î·È ·Ú¤Ì‚·ÛË ÌÔÚ› Ó· Û˘Ì‚¿ÏÂÈ ÛÙËÓ ÂÍ·ÛÊ¿ÏÈÛË ‰È·ÎÔÒÓ Ì ٷ ÏÈÁfiÙÂÚ· ηٿ ÙÔ ‰˘Ó·ÙfiÓ ÚÔ‚Ï‹Ì·Ù· ˘Á›·˜.

Abstract: Information about children’s health problems on holiday is essential for their appropriate prevention and management. The aim of this study was to investigate the health problems of child-tourists on the island of Sifnos during the summer. All 311 child-tourists who visited the Health Centre of Sifnos during the summers of the years 2001-2002 were included and compared with 311 children-residents of the island, who were used as the control group. Child-tourists presented with (in descending order of frequency) accidents (16%), otitis (13%), dermatitis (13%), lower respiratory tract infection (12%) and gastroenteritis (10%). In contrast, the resident children presented more frequently with lower respiratory tract infection (16%), dermatitis (12)%, upper respiratory tract infection (7%), asthma (6%) and otitis (5%). Childtourists compared to their age matched residents of the island presented more often with gastroenteritis, otitis and accidents (p=0.0002, p=0.0012 and p=0.011, respectively). In conclusion, children on holiday appear to have health problems in a distribution quite different from that observed in the resident children. Appropriate prevention and intervention may lead to children’s holidays free from severe health problems.

§¤ÍÂȘ ÎÏÂȉȿ: ÚÔ‚Ï‹Ì·Ù· ˘Á›·˜, ·È‰È¿-·Ú·ıÂÚÈÛÙ¤˜, ∫˘ÎÏ¿‰Â˜.

Key words: health problems, child-tourists, Cyclades.

1 ¶ÔÏ˘‰‡Ó·ÌÔ ¶ÂÚÈÊÂÚÂÈ·Îfi π·ÙÚÂ›Ô ™›ÊÓÔ˘ 2 ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘

1 Health Centre of Sifnos 2 Paediatric Clinic of University of Crete

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∂ÈÛ·ÁˆÁ‹ ∆· Ù·Í›‰È· ·Ó·„˘¯‹˜, ÙfiÛÔ ÛÙÔ Â͈ÙÂÚÈÎfi fiÛÔ Î·È ÂÓÙfi˜ ∂ÏÏ¿‰·˜, ·ÔÙÂÏÔ‡Ó ϤÔÓ Ì›· ηıÈÂڈ̤ÓË Û˘Ó‹ıÂÈ· Ù˘ ÂÏÏËÓÈ΋˜ ÔÈÎÔÁ¤ÓÂÈ·˜. ∫·ıÒ˜ ÔÈ ·Ú¯fiÌÂÓ˜ ˘ËÚÂۛ˜ ÛÙÔ˘˜ ÙÔ˘ÚÈÛÙÈÎÔ‡˜ ÚÔÔÚÈÛÌÔ‡˜ Ù˘ ∂ÏÏ¿‰·˜ Â›Ó·È Î·Ù¿ ηÓfiÓ· ˘„ËÏÔ‡ ÂÈ¤‰Ô˘, ÔÈ ÁÔÓ›˜ ·ÈÛı¿ÓÔÓÙ·È ·ÛÊ¿ÏÂÈ· Î·È Î¿ÓÔ˘Ó ‰È·ÎÔ¤˜ Ì·˙› Ì ٷ ·È‰È¿ ÙÔ˘˜. ŒÙÛÈ, Ô ·È‰ÈÎfi˜ ÏËı˘ÛÌfi˜ ·ÔÙÂÏ› ¤Ó· ÛËÌ·ÓÙÈÎfi ̤ÚÔ˜ ÙˆÓ ·Ú·ıÂÚÈÛÙÒÓ. ∂›Ó·È ÁÓˆÛÙfi fiÙÈ Ù· ÚÔ‚Ï‹Ì·Ù· ˘Á›·˜ Û ٷÍȉÈÒÙ˜ Â›Ó·È Û˘¯Ó¿, ÙfiÛÔ Î·Ù¿ ÙËÓ ÂÚ›Ô‰Ô ÙˆÓ ‰È·ÎÔÒÓ fiÛÔ Î·È ÌÂÙ¿ ÙËÓ ÂÈÛÙÚÔÊ‹ ÙÔ˘˜. øÛÙfiÛÔ, ÔÈ ÌÂϤÙ˜ Ô˘ ¤¯Ô˘Ó ‰ÈÂÍ·¯ı› ·Ó·Ê¤ÚÔÓÙ·È Î˘Ú›ˆ˜ Û ·Ú·ıÂÚÈÛÙ¤˜ Ô˘ ‚Ú›ÛÎÔÓÙ·È ‹ ÂÈÛÙÚ¤ÊÔ˘Ó ·fi ÌÂÁ¿Ï· Ù·Í›‰È· ÛÙÔ Â͈ÙÂÚÈÎfi, ÂÓÒ ÂÏ¿¯ÈÛÙ˜ ·Û¯ÔÏÔ‡ÓÙ·È Ì ٷ ÚÔ‚Ï‹Ì·Ù· ˘Á›·˜ Ô˘ ·ÓÙÈÌÂÙˆ›˙Ô˘Ó ÔÈ ·Ú·ıÂÚÈÛÙ¤˜ Û ÌÈÎÚfiÙÂÚ· Ù·Í›‰È· ÛÙÔ ÂÛˆÙÂÚÈÎfi Ù˘ ¯ÒÚ·˜ (1-4). ∞ÎfiÌË, fï˜ Î·È ÛÙȘ ÂÚÈÙÒÛÂȘ Ô˘ ÙÔ Â›Â‰Ô ÙˆÓ Û˘ÓıËÎÒÓ ‰È·‚›ˆÛ˘ Â›Ó·È ÙÔ Î·Ï‡ÙÂÚÔ, Ë ·ÏÏ·Á‹ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ Î·È ÔÈ Û˘Óı‹Î˜ „˘¯·ÁˆÁ›·˜ Ô˘ Û˘ÓÔ‰Â‡Ô˘Ó ÙÔ Î¿ı ٷ͛‰È, Â›Ó·È ·Ó·ÌÂÓfiÌÂÓÔ Ó· ÌÂÙ·‚¿ÏÏÔ˘Ó Ù· Û˘Ó‹ıË ·›ÙÈ· ÓÔÛËÚfiÙËÙ·˜ ÛÙËÓ ÂÚ›Ô‰Ô ÙˆÓ ‰È·ÎÔÒÓ. ∏ ÁÓÒÛË ÙˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ ˘Á›·˜ ÛÙ· ·È‰È¿ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ‰È·ÎÔÒÓ ÙÔ˘˜ Â›Ó·È ÚÔ¸fiıÂÛË ÁÈ· ÙË ÛˆÛÙ‹ ·ÓÙÈÌÂÙÒÈÛË Î·È ÚfiÏË„‹ ÙÔ˘˜. ∆Ô ÓËÛ› Ù˘ ™›ÊÓÔ˘ ·ÔÙÂÏ› ÚÔÛÊÈϤ˜ ı¤ÚÂÙÚÔ, ΢ڛˆ˜ ∂ÏÏ‹ÓˆÓ ·Ú·ıÂÚÈÛÙÒÓ. ™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ Â›Ó·È Ë Î·Ù·ÁÚ·Ê‹ ÙˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ ˘Á›·˜ Ô˘ ·Ú·ÙËÚ‹ıËÎ·Ó Û ·È‰È¿ ËÏÈΛ·˜ ¤ˆ˜ 14 ÂÙÒÓ Î·Ù¿ ÙȘ ıÂÚÈÓ¤˜ ‰È·ÎÔ¤˜ ÙÔ˘˜ ÛÙÔ ÓËÛ› Î·È Ë Û‡ÁÎÚÈÛ‹ ÙÔ˘˜ Ì ·˘Ù¿ ÙˆÓ ·È‰ÈÒÓ Ô˘ Â›Ó·È ÌfiÓÈÌÔÈ Î¿ÙÔÈÎÔÈ ÙÔ˘ ÓËÛÈÔ‡, ÙËÓ ›‰È· ÂÚ›Ô‰Ô. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ∏ ˘ÁÂÈÔÓÔÌÈ΋ Î¿Ï˘„Ë fiÏˆÓ ÙˆÓ ÂÈÛÎÂÙÒÓ, ηıÒ˜ Î·È ÙˆÓ ÌfiÓÈÌˆÓ Î·ÙÔ›ÎˆÓ Ù˘ ™›ÊÓÔ˘ Á›ÓÂÙ·È ·fi ÙÔ ÔÏ˘‰‡Ó·ÌÔ ÂÚÈÊÂÚÂÈ·Îfi È·ÙÚÂ›Ô ÙÔ˘ ÓËÛÈÔ‡, ÙÔ ÔÔ›Ô ÛÙÂϯÒÓÂÙ·È ·fi ·ıÔÏfiÁÔ˘˜, ·È‰›·ÙÚÔ Î·È È·ÙÚÔ‡˜ ˘fi¯ÚÂÔ˘˜ ˘ËÚÂÛ›·˜ ˘·›ıÚÔ˘ Î·È ‰È·ı¤ÙÂÈ ÌÈÎÚÔ‚ÈÔÏÔÁÈÎfi Î·È ·ÎÙÈÓÔÏÔÁÈÎfi ÂÚÁ·ÛÙ‹ÚÈÔ. ∆Ô È·ÙÚÂ›Ô ·ÓÙÈÌÂÙˆ›˙ÂÈ ÙÔ Û‡ÓÔÏÔ ÙˆÓ ·ÛıÂÓÒÓ, ·ÊÔ‡ ÛÙÔ ÓËÛ› ‰ÂÓ ˘¿Ú¯Ô˘Ó ȉȈÙÈο È·ÙÚ›· ‹ È·ÙÚÈο ΤÓÙÚ·. ªÂÏÂÙ‹ıËÎ·Ó 311 ·È‰È¿-·Ú·ıÂÚÈÛÙ¤˜, ËÏÈΛ·˜ 1 ÌËÓfi˜ ¤ˆ˜ 14 ÂÙÒÓ (̤ÛË ËÏÈΛ·±SD: 6,3±4 ¤ÙË) Î·È 311 ·È‰È¿-ÌfiÓÈÌÔÈ Î¿ÙÔÈÎÔÈ ™›ÊÓÔ˘ (̤ÛË ËÏÈΛ·±SD: 6,4±3,8 ¤ÙË). ∆· ·È‰È¿ ·˘Ù¿ ÂÍÂÙ¿ÛÙËÎ·Ó Î·Ù¿ ÙÔ˘˜ ıÂÚÈÓÔ‡˜ Ì‹Ó˜ (πÔ‡ÓÈÔ˜, πÔ‡ÏÈÔ˜, ∞‡ÁÔ˘ÛÙÔ˜) Ù˘ ‰ÈÂÙ›·˜ 2001-2002. °È· οı ·È‰›·Ú·ıÂÚÈÛÙ‹ ηٷÁÚ¿ÊËΠÙÔ ·Ì¤Ûˆ˜ ÂfiÌÂÓÔ ·È‰›-ÌfiÓÈÌÔ˜ οÙÔÈÎÔ˜ Ô˘ ÂÍÂÙ¿ÛÙËÎÂ. ∆· 311 ·È‰È¿-ÌfiÓÈÌÔÈ Î¿ÙÔÈÎÔÈ Ô˘ ÂÍÂÙ¿ÛÙËÎ·Ó ÌÂÙ¿ Ù· ·È‰È¿-·Ú·ıÂÚÈÛÙ¤˜, ·ÔÙ¤-

Paediatriki 2003;66:452-455

ÏÂÛ·Ó ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘. OÈ ·Èٛ˜ ÚÔÛ¤Ï¢Û˘ Ù·ÍÈÓÔÌ‹ıËÎ·Ó Ì ‚¿ÛË ÙË ¢ÈÂıÓ‹ ∆·ÍÈÓfiÌËÛË ¡ÔÛËÌ¿ÙˆÓ (5). °È· ÙÔ˘˜ ÛÎÔÔ‡˜ Ù˘ ·Ó·‰ÚÔÌÈ΋˜ ·˘Ù‹˜ ÌÂϤÙ˘, ÛÙËÓ ÔÌ¿‰· ÙˆÓ ·Ù˘¯ËÌ¿ÙˆÓ Û˘ÌÂÚÈÏ‹ÊıËÎ·Ó Î·ÎÒÛÂȘ, ͤӷ ÛÒÌ·Ù·, ‰‹ÁÌ·Ù· ÂÓÙfiÌˆÓ Î·È Ê·Ú̷΢ÙÈΤ˜ ‰ËÏËÙËÚÈ¿ÛÂȘ. ™ÙËÓ ÔÌ¿‰· ÙˆÓ ˆÙ›ÙȉˆÓ Û˘ÌÂÚÈÏ‹ÊıËÎ·Ó Ë ÔÍ›· ̤ÛË Î·È Ë Â͈ÙÂÚÈ΋ ˆÙ›Ùȉ·. ∞fi ÙȘ ÏÔÈÌÒÍÂȘ ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ ηٷÁÚ¿ÊËÎ·Ó ¯ˆÚÈÛÙ¿ ÂΛӘ Ô˘ ›¯·Ó Û·Ê‹ ÂÓÙfiÈÛË (.¯. ˆÙ›Ùȉ˜, Ê·Ú˘ÁÁÔ·Ì˘Á‰·Ï›Ùȉ˜) Î·È ÂΛӘ Ô˘ ‰ÂÓ Â›¯·Ó. OÈ ÏÔÈÌÒÍÂȘ ÙÔ˘ ηÙÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ ÌÂÏÂÙ‹ıËÎ·Ó ˆ˜ ÎÔÈÓ‹ ÔÌ¿‰·. °È· ÙË ÛÙ·ÙÈÛÙÈ΋ ÂÂÍÂÚÁ·Û›· ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÔÈ ‰ÔÎÈ̷ۛ˜ ¯2 Î·È Ô ˘ÔÏÔÁÈÛÌfi˜ ÙˆÓ Û¯ÂÙÈÎÒÓ ÎÈÓ‰‡ÓˆÓ Ì 95% ‰È·ÛÙ‹Ì·Ù· ÂÌÈÛÙÔÛ‡Ó˘. ™Ù·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ıˆڋıËÎ·Ó ÔÈ ‰È·ÊÔÚ¤˜ Ì p<0,05.

∞ÔÙÂϤÛÌ·Ù· OÈ Û˘¯ÓfiÙÂÚ˜ ·Èٛ˜ ÚÔÛ¤Ï¢Û˘ ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜ ·È‰ÈÒÓ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1. ∆· ·È‰È¿-·Ú·ıÂÚÈÛÙ¤˜ ·ÚÔ˘Û›·Û·Ó ÛËÌ·ÓÙÈο ·˘ÍË̤ÓË ÓÔÛËÚfiÙËÙ· ÛÙ· ÓÔÛ‹Ì·Ù· Ô˘ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2. OÈ ÂÈÛΤ„ÂȘ ÙˆÓ ·È‰ÈÒÓ·Ú·ıÂÚÈÛÙÒÓ ·Ó¿ ¤ÙÔ˜ ‹Ù·Ó ÂÚ›Ô˘ ÔÈ ›‰È˜ ÛÙ· ¤ÙË 2001 Î·È 2002 (153 Î·È 158, ·ÓÙ›ÛÙÔȯ·). ∞˘ÍË̤ÓË ÚÔۤϢÛË Î·Ù·ÁÚ¿ÊËΠηٿ ÙÔÓ Ì‹Ó· ∞‡ÁÔ˘ÛÙÔ (50% ÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ, ¤Ó·ÓÙÈ 29% ÙÔÓ πÔ‡ÏÈÔ Î·È 21% ÙÔÓ πÔ‡ÓÈÔ). ¢ÂÓ ‰È·ÈÛÙÒıËÎ·Ó ‰È·ÊÔÚ¤˜ fiÛÔÓ ·ÊÔÚ¿ ÛÙÔ Ê‡ÏÔ ·Ó¿ÌÂÛ· ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜ (56% ·ÁfiÚÈ· Î·È 44% ÎÔÚ›ÙÛÈ·). ™˘˙‹ÙËÛË ∏ ·ÚÔ‡Û· ÌÂϤÙË ÂȂ‚·ÈÒÓÂÈ Ù· Â˘Ú‹Ì·Ù· ÚÔËÁÔ‡ÌÂÓˆÓ ÌÂÏÂÙÒÓ, ÛÙȘ Ôԛ˜ ¤¯ÂÈ ·Ó·ÊÂÚı› ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· ÓÔÛËÌ¿ÙˆÓ fiˆ˜ Ù· ·Ù˘¯‹Ì·Ù·, Ë ˆÙ›Ùȉ·, Ù· ‰ÂÚÌ·ÙÈο ÓÔÛ‹Ì·Ù· Î·È Ë Á·ÛÙÚÂÓÙÂÚ›Ùȉ·, ηٿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ‰È·ÎÔÒÓ (1-4). ∂›Ó·È ÁÓˆÛÙfi fiÙÈ Û ÙÚÔÈΤ˜ ‹ ·Ó·Ù˘ÛÛfiÌÂÓ˜ ¯ÒÚ˜ ¤Ó·˜ ÛËÌ·ÓÙÈÎfi˜ ÏfiÁÔ˜ ·˘ÍË̤Ó˘ ÓÔÛËÚfiÙËÙ·˜ ÙˆÓ ·Ú·ıÂÚÈÛÙÒÓ Â›Ó·È ÔÈ Î·Î¤˜ Û˘Óı‹Î˜ ˘ÁÈÂÈÓ‹˜ (1,2). ∞˘Ùfi ÈÛ¯‡ÂÈ ·ÎfiÌ· ÂÚÈÛÛfiÙÂÚÔ ÁÈ· Ù· ·È‰È¿, Ù· ÔÔ›· Â›Ó·È Û ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ Û ۯ¤ÛË Ì ÙȘ ÌÂÁ·Ï‡ÙÂÚ˜ ËÏÈ˘ (6). øÛÙfiÛÔ, ·ÎfiÌ· Î·È ÛÙȘ ÈÔ ·Ó·Ù˘Á̤Ó˜ ¯ÒÚ˜ Î·È ÛÙȘ ÂÚÈÔ¯¤˜ Ì ÂÍ·ÈÚÂÙÈΤ˜ Û˘Óı‹Î˜ ˘ÁÈÂÈÓ‹˜, fiˆ˜ Â›Ó·È Ù· ÂÏÏËÓÈο ı¤ÚÂÙÚ·, ÔÈ ‰È·ÊÔÚ¤˜ ÛÙȘ Û˘Óı‹Î˜ ‰È·‚›ˆÛ˘, Ë ·˘ÍË̤ÓË ‰Ú·ÛÙËÚÈfiÙËÙ· ÙˆÓ ·È‰ÈÒÓ, Ë Â·Ê‹ Ì ÙË ı¿Ï·ÛÛ· Î·È ÙÔÓ ‹ÏÈÔ, ηıÒ˜ Î·È Ë ·fiÙÔÌË ·ÏÏ·Á‹ ÛÙȘ ‰È·ÙÚÔÊÈΤ˜ Û˘Ó‹ıÂȘ Ô‰ËÁÔ‡Ó Û ·˘ÍË̤ÓË ÓÔÛËÚfiÙËÙ· ÛÂ Û˘ÁÎÂÎÚÈ̤ӷ ÓÔÛ‹Ì·Ù· (2,3). ∆· Â˘Ú‹Ì·Ù· ·˘Ù¿ ÂȂ‚·ÈÒıËÎ·Ó Î·È ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, fiÔ˘ ·Ú·ÙËÚ‹ıËΠ·‡ÍËÛË ÂÎÂ›ÓˆÓ ÙˆÓ ÓÔÛËÌ¿ÙˆÓ Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È Û ÙÔ˘Ú›ÛÙ˜ Ì ÌÂÁ¿Ï·

453

¶·È‰È·ÙÚÈ΋ 2003;66:452-455

Paediatriki 2003;66:452-455

¶›Ó·Î·˜ 1. ∞Èٛ˜ ÚÔÛ¤Ï¢Û˘ Û ·È‰È¿-·Ú·ıÂÚÈÛÙ¤˜ Î·È Û ·È‰È¿-ÌfiÓÈÌÔ˘˜ ηÙÔ›ÎÔ˘˜ Ù˘ ™›ÊÓÔ˘

∞Ù˘¯‹Ì·Ù· øÙ›Ùȉ˜ ∫Ó›‰ˆÛË, ‰ÂÚÌ·Ù›Ùȉ· §ÔÈÌÒÍÂȘ ηÙÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ °·ÛÙÚÂÓÙÂÚ›Ùȉ· §ÔÈÌÒÍÂȘ ·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡* ÕÛıÌ· º·Ú˘ÁÁÔ·Ì˘Á‰·Ï›Ùȉ· ƒÈÓ›Ùȉ· ∂ÈÂÊ˘Î›Ùȉ· ∞ÓÂÌÔ‚ÏÔÁÈ¿ πÁÌÔÚ›Ùȉ· §ÔÈ¿ ÓÔÛ‹Ì·Ù·

¶·È‰È¿-·Ú·ıÂÚÈÛÙ¤˜ ¡ (%)

¶·È‰È¿-ÌfiÓÈÌÔÈ Î¿ÙÔÈÎÔÈ ¡ (%)

50 (16%) 40 (12,9%) 40 (12,9%) 39 (12,5%) 31 (10%) 27 (8,7%) 15 (4,8%) 10 (3,2%) 6 (2%) 3 (1%) 2 (0,6%) 1 (0,3%) 47 (15,1%)

29 (9,3%) 16 (5%) 36 (11,6%) 50 (16%) 7 (2,3%) 23 (7,4%) 18 (5,9%) 12 (3,9%) 2 (0,6%) 12 (3,9%) 11 (3,5%) 3 (1%) 92 (29,6%)

* ÕÏϘ ÔÍ›˜ ÏÔÈÌÒÍÂȘ ·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Ì ÔÏÏ·Ï‹ ÂÓÙfiÈÛË ¶›Ó·Î·˜ 2. ¶ÚÔ‚Ï‹Ì·Ù· ˘Á›·˜ Ô˘ ·ÚÔ˘ÛÈ¿ÛÙËÎ·Ó Û ·È‰È¿-·Ú·ıÂÚÈÛÙ¤˜ Ì ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ Û ۇÁÎÚÈÛË Ì ٷ ·È‰È¿-ÌfiÓÈÌÔ˘˜ ηÙÔ›ÎÔ˘˜ ¶Úfi‚ÏËÌ· ˘Á›·˜ °·ÛÙÚÂÓÙÂÚ›Ùȉ· øÙ›Ùȉ˜ ∞Ù˘¯‹Ì·Ù·

¶·È‰È¿-·Ú·ıÂÚÈÛÙ¤˜

¶·È‰È¿-ÌfiÓÈÌÔÈ Î¿ÙÔÈÎÔÈ

™¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜ (95% CI)

p 2 (ÌÂ ¯ )

31 40 50

7 16 29

4,43 (1,98-9,91) 2,50 (1,43-4,37) 1,72 (1,12-2,65)

0,0002 0,0012 0,0111

Ù·Í›‰È· ÛÙÔ Â͈ÙÂÚÈÎfi (1,7), ·Ó Î·È ÔÈ Û˘Óı‹Î˜ ‰È·‚›ˆÛ˘ Ô˘ ·Ú¤¯ÔÓÙ·È ÛÙÔ ÓËÛ› Ù˘ ™›ÊÓÔ˘ Â›Ó·È ˘„ËÏÔ‡ ÂÈ¤‰Ô˘ Î·È ·Ó¿ÏÔÁ˜ ÂÎÂ›ÓˆÓ ÙÔ˘ ÌfiÓÈÌÔ˘ ÙfiÔ˘ ηÙÔÈΛ·˜. ¶Ú¤ÂÈ Ó· ÛËÌÂȈı› fiÙÈ Ù· ·È‰È¿-·Ú·ıÂÚÈÛÙ¤˜ ÛÙË ™›ÊÓÔ ÚÔ¤Ú¯ÔÓÙ·È Û¯Â‰fiÓ ·ÔÎÏÂÈÛÙÈο ·fi ÙËÓ ˘fiÏÔÈË ∂ÏÏ¿‰·, Ì ·ÔÙ¤ÏÂÛÌ· ÔÈ Û˘Óı‹Î˜ ‰È·‚›ˆÛ˘ ÛÙË ÌfiÓÈÌË Î·ÙÔÈΛ· ÙÔ˘˜ Ó· ÌËÓ ‰È·Ê¤ÚÔ˘Ó Û ÌÂÁ¿ÏÔ ‚·ıÌfi ·fi ÂΛӘ ÙˆÓ ‰È·ÎÔÒÓ ÙÔ˘˜. º·›ÓÂÙ·È, ÏÔÈfiÓ, fiÙÈ Ë ·fiÙÔÌË ÌÂٷΛÓËÛË Î·È Ë ÌÈÎÚ‹, ¤ÛÙˆ, ·ÏÏ·Á‹ ÙˆÓ Û˘ÓıËÎÒÓ ‰È·‚›ˆÛ˘ Î·È „˘¯·ÁˆÁ›·˜ ·ÚÎÔ‡Ó ÁÈ· ÙË Û˘¯Ó‹ ÂΉ‹ÏˆÛË ÔÚÈÛÌ¤ÓˆÓ ÓÔÛËÌ¿ÙˆÓ Î·Ù¿ ÙËÓ ÂÚ›Ô‰Ô ÙˆÓ ‰È·ÎÔÒÓ (8). ∏ ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· ·Ù˘¯ËÌ¿ÙˆÓ ÛÙ· ·È‰È¿-ÙÔ˘Ú›ÛÙ˜ Â›Ó·È ·Ó·ÌÂÓfiÌÂÓË, ΢ڛˆ˜ ÏfiÁˆ Ù˘ ·˘ÍË̤Ó˘ Ê˘ÛÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ¿˜ ÙÔ˘˜ ·˘Ù‹ ÙËÓ ÂÚ›Ô‰Ô Î·È Ù˘ ‰˘ÛÎÔÏ›·˜ ÂÈÙ‹ÚËÛ‹˜ ÙÔ˘˜ ÂΠ̤ÚÔ˘˜ ÙˆÓ ÁÔÓ¤ˆÓ. ∏ Û˘¯Ó‹ Î·È ·Ú·ÙÂٷ̤Ó˘ ‰È¿ÚÎÂÈ·˜ Â·Ê‹ ÙˆÓ ·È‰ÈÒÓ Ì ÙÔ ı·Ï·ÛÛÈÓfi ÓÂÚfi Î·È ÙÔÓ ˙ÂÛÙfi ·¤Ú· ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙË ÌÈÎÚ‹ ËÏÈΛ· ·ÔÙÂÏÔ‡Ó ÁÓˆÛÙÔ‡˜ ·Ú¿ÁÔÓÙ˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ·˘ÍË̤ÓË Â›ÙˆÛË Ù˘ Â͈ÙÂÚÈ΋˜ ˆÙ›Ùȉ·˜ (“swimmer’s ear”, fiˆ˜ ¯·Ú·ÎÙËÚÈÛÙÈο ÔÓÔÌ¿˙ÂÙ·È ‰ÈÂıÓÒ˜) (9-14). øÛÙfiÛÔ, ¤¯ÂÈ ˘ÔÛÙËÚȯı› fiÙÈ Î·È Ë Ì¤ÛË ˆÙ›Ùȉ· Â›Ó·È ÈÔ Û˘¯Ó‹ ÛÙ· ·È‰È¿-·Ú·ıÂÚÈÛÙ¤˜ (7). ∏ ·‡ÍËÛË ÙˆÓ ‰ÂÚÌ·Ù›ÙȉˆÓ, Ù˘ ÎÓ›‰ˆÛ˘ Î·È ÙˆÓ ÏÔÈÌÒÍÂˆÓ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ Â›Ó·È ·Ó·ÌÂÓfiÌÂÓË ÙËÓ ÂÚ›Ô‰Ô ÙˆÓ ‰È·ÎÔÒÓ Û ıÂÚÌ¿ Î·È Ì ·˘ÍË-

454

̤ÓË ËÏÈÔÊ¿ÓÂÈ· ̤ÚË, ȉȷ›ÙÂÚ· fiÙ·Ó Ë ¤ÓÙÔÓË ‰Ú·ÛÙËÚÈfiÙËÙ· Ô‰ËÁ› Û˘¯Ó¿ Û ηٷfiÓËÛË ÙÔ˘ ‰¤ÚÌ·ÙÔ˜. OÈ ‰È·Ù·Ú·¯¤˜ ·fi ÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi, ·Ó Î·È Û˘¯ÓfiÙÂÚ˜ ÛÙ· ·È‰È¿-·Ú·ıÂÚÈÛÙ¤˜ Û ۯ¤ÛË Ì ٷ ·È‰È¿-ÌfiÓÈÌÔ˘˜ ηÙÔ›ÎÔ˘˜, ‰ÂÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÙËÓ ˘„ËÏ‹ Û˘¯ÓfiÙËÙ· Ô˘ ·Ó·ÌÂÓfiÙ·Ó ÛÙ· ·È‰È¿ Ô˘ ·ÏÏ¿˙Ô˘Ó ·fiÙÔÌ· ÙË ‰È·ÙÚÔÊ‹ ÙÔ˘˜ Î·È ÙËÓ Î·ıËÌÂÚÈÓ‹ ˘ÁÈÂÈÓ‹ ÙÔ˘˜. ∞˘Ùfi ÌÔÚ› Ó· ·Ô‰Ôı› ÛÙȘ ηϤ˜ Û˘Óı‹Î˜ ‰È·‚›ˆÛ˘, Û ·ÓÙ›ıÂÛË Ì ¿ÏÏÔ˘˜ ÚÔÔÚÈÛÌÔ‡˜ Ì η΋ ˘ÁÈÂÈÓ‹, fiÔ˘ Ë Á·ÛÙÚÂÓÙÂÚ›Ùȉ· ·ÔÙÂÏ› ÙÔ ÚÒÙÔ ÛÂ Û˘¯ÓfiÙËÙ· ÓfiÛËÌ· (1,2). ™˘ÌÂÚ·ÛÌ·ÙÈο, Ù· ·È‰È¿ Ô˘ ·Ú·ıÂÚ›˙Ô˘Ó ÛÙË ¯ÒÚ· ÙÔ˘˜ ¤¯Ô˘Ó ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ Ó· ÂÌÊ·Ó›ÛÔ˘Ó Û˘ÁÎÂÎÚÈ̤ӷ ÚÔ‚Ï‹Ì·Ù· ˘Á›·˜. ∆Ô ÓÔÛÔÏÔÁÈÎfi Ê¿ÛÌ· ÚÔÛÔÌÔÈ¿˙ÂÈ Ì ÂΛÓÔ Ô˘ ·Ú·ÙËÚÂ›Ù·È ÛÙ· ÌÂÁ¿Ï· Ù·Í›‰È· ÛÙÔ Â͈ÙÂÚÈÎfi, ‰È·ÙËÚÒÓÙ·˜ fï˜ οÔȘ ȉÈÔÌÔÚʛ˜. ªÂϤÙ˜ Ì ÌÂÁ·Ï‡ÙÂÚ· ‰Â›ÁÌ·Ù· Î·È Û ¿ÏϘ ÁˆÁÚ·ÊÈΤ˜ ÂÚÈÔ¯¤˜ Ù˘ ¯ÒÚ·˜ ı· ‚ÔËıÔ‡Û·Ó ÛÙËÓ Î·Ï‡ÙÂÚË Î·Ù·ÁÚ·Ê‹ ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜ Î·È ÛÙË ‰È¿ÚıÚˆÛË Î·Ù¿ÏÏËÏ˘ ÛÙÚ·ÙËÁÈ΋˜ ÚfiÏ˄˘ Î·È ·ÓÙÈÌÂÙÒÈÛ˘ ÛÙÔ˘˜ ÙfiÔ˘˜ ˘Ô‰Ô¯‹˜. µÈ‚ÏÈÔÁÚ·Ê›· 1. Hill DR. Health problems in a large cohort of Americans traveling to developing countries. J Travel Med 2000;7:259266.

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∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 07-02-2003 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 22-07-2003 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∂ÌÌ·ÓÔ˘‹Ï ¡. ¶·Ú·Ûο΢ ™·ÊÔ‡˜ 4, ∆.∫. 712 02, ∏Ú¿ÎÏÂÈÔ ∫Ú‹Ù˘

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¶·È‰È·ÙÚÈ΋ 2003;66:456-460

∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞

Paediatriki 2003;66:456-460

ORIGINAL ARTICLE

¡Â˘ÚÔÏÔÁÈΤ˜ ÂΉËÏÒÛÂȘ ·È‰ÈÒÓ Ì ·ÈÌÔÏ˘ÙÈÎfi-Ô˘Ú·ÈÌÈÎfi Û‡Ó‰ÚÔÌÔ ∫. µÔ‡‰Ú˘1, ∫. ™ÙÂÊ·Ó›‰Ë˜2, ∞. ™Î·Ú‰Ô‡ÙÛÔ˘3, ∂. ∫·ÙÛ·ÚÔ‡1, ™. ª·ÛÙÚÔÁÈ¿ÓÓË1, ∂. µ·ÁÈ¿ÎÔ˘4

Neurological complications of children with haemolytic-uraemic syndrome K. Voudris1, C. Stefanidis2, A. Skardoutsou3, E. Katsarou1, S. Mastroyianni1, E. Vagiakou4

¶ÂÚ›ÏË„Ë: ∞Ó Î·È ÂÌÊ·Ó›˙ÔÓÙ·È Û˘¯Ó¿ Ó¢ÚÔÏÔÁÈΤ˜ ÂΉËÏÒÛÂȘ Û ·ÛıÂÓ›˜ Ì ·ÈÌÔÏ˘ÙÈÎfi-Ô˘Ú·ÈÌÈÎfi Û‡Ó‰ÚÔÌÔ (∞O™), ˘¿Ú¯Ô˘Ó ÂÏ¿¯ÈÛÙ˜ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜ Ô˘ ‰ÈÂÚ¢ÓÔ‡Ó ÙËÓ ÂӉ¯fiÌÂÓË Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÙˆÓ Ó¢ÚÔÏÔÁÈÎÒÓ ÂΉËÏÒÛÂˆÓ Î·Ù¿ ÙËÓ ÔÍ›· Ê¿ÛË Ù˘ ÓfiÛÔ˘ Î·È ÙË Ì·ÎÚÔ¯ÚfiÓÈ· ÚfiÁÓˆÛË. ∂›Û˘, Ù· ·ÔÙÂϤÛÌ·Ù· ·˘ÙÒÓ ÙˆÓ ÌÂÏÂÙÒÓ Â›Ó·È ·ÓÙÈÊ·ÙÈο. ¶ÂÚÈÁÚ¿ÊÔÓÙ·È 5 ·È‰È¿ Ì ∞O™ Ô˘ ·ÚÔ˘Û›·Û·Ó Ó¢ÚÔÏÔÁÈο Û˘ÌÙÒÌ·Ù· Î·È Î·ı˘ÛÙÂÚË̤ÓË ÂÈÛ·ÁˆÁ‹ ÛÙÔ ¡ÔÛÔÎÔÌ›Ô. ™Â fiÏ· Ù· ·È‰È¿ ¤ÁÈÓ ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Ì ̷ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ηٿ ÙËÓ ÔÍ›· Ê¿ÛË Ù˘ ÓfiÛÔ˘, ÂÓÒ Û 3 ·È‰È¿ ¤ÁÈÓ Â·Ó¤ÏÂÁ¯Ô˜ ÙÚÂȘ Ì‹Ó˜ ·ÚÁfiÙÂÚ·. ŸÏ· Ù· ·È‰È¿ ·ÚÔ˘Û›·Û·Ó ÌÂÙ·‚ÔÏ‹ ÙÔ˘ ÂÈ¤‰Ô˘ Û˘Ó›‰ËÛ˘ Î·È 4 ·È‰È¿ ·ÚÔ˘Û›·Û·Ó ÌÈÎÚ‹˜ ‰È¿ÚÎÂÈ·˜ ÁÂÓÈÎÂ˘Ì¤ÓÔ˘˜ ÙÔÓÈÎÔÎÏÔÓÈÎÔ‡˜ Û·ÛÌÔ‡˜, Ô˘ ·ÔÙ¤ÏÂÛ·Ó ÙËÓ ·ÈÙ›· ÂÈÛ·ÁˆÁ‹˜ ÙÔ˘˜. ™Â fiÏ· Ù· ·È‰È¿ ›¯Â ÚÔËÁËı› Á·ÛÙÚÂÓÙÂÚ›Ùȉ· Ì ·ÈÌÔÚÚ·ÁÈΤ˜ ÎÂÓÒÛÂȘ Î·È ÔÈ Û·ÛÌÔ› ÂÌÊ·Ó›ÛÙËÎ·Ó ÛÙ· ·Ú¯Èο ÛÙ¿‰È· Ù˘ ÓfiÛÔ˘, ÔÈ ÔÔ›ÔÈ Èı·Ófiٷٷ ÔÊ›ÏÔÓÙ·Ó Û ˘ÔÓ·ÙÚÈ·ÈÌ›·. ™Â ¤Ó·Ó ·ÛıÂÓ‹ ‚Ú¤ıËÎ·Ó ·ÌÊÔÙÂÚfiÏ¢Ú˜ ÂÛٛ˜ ÛÙÔÓ ÂÁΤʷÏÔ, ΢ڛˆ˜ ÛÙËÓ ˘ÔÊÏÔÈÒ‰Ë Ï¢΋ Ô˘Û›· ÙˆÓ ÌÂÙˆÈ·›ˆÓ Î·È ‚ÚÂÁÌ·ÙÈÎÒÓ ÏÔ‚ÒÓ, ÔÈ Ôԛ˜ ÂÍ·ÎÔÏÔ˘ıÔ‡Û·Ó Ó· ˘¿Ú¯Ô˘Ó ÛÙÔÓ Â·Ó¤ÏÂÁ¯Ô Î·È Èı·Ófiٷٷ ÔÊ›ÏÔÓÙ·Ó Û ÌÈÎÚ¿ ·ÁÁÂȷο ¤ÌÊÚ·ÎÙ·. ŸÏ· Ù· ·È‰È¿ ›¯·Ó Ï‹ÚË Ó¢ÚÔÏÔÁÈ΋ Î·È ÓÂÊÚÈ΋ ·ÔηٿÛÙ·ÛË Î·È ÔÈ Û·ÛÌÔ› ‰ÂÓ Â·Ó·Ï‹ÊıËηÓ. ∆· Â˘Ú‹Ì·Ù· Ù˘ ÌÂϤÙ˘ ‰Â›¯ÓÔ˘Ó fiÙÈ Ù· Ó¢ÚÔÏÔÁÈο Û˘ÌÙÒÌ·Ù· Î·È È‰È·›ÙÂÚ· ÔÈ Û·ÛÌÔ› ÛÙ· ·Ú¯Èο 1 ¡Â˘ÚÔÏÔÁÈÎfi ∆Ì‹Ì·, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó· 2 ¡ÂÊÚÔÏÔÁÈÎfi ∆Ì‹Ì·, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó· 3 µ’ ¶·ÓÂÈÛÙËÌȷ΋ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó· 4 ªÈÎÚÔ‚ÈÔÏÔÁÈÎfi ∆Ì‹Ì·, ¶ÂÚÈÊÂÚÂÈ·Îfi ¡ÔÛÔÎÔÌÂ›Ô “°. °ÂÓÓËÌ·Ù¿˜”, ∞ı‹Ó·

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Abstract: Although neurological complications often occur in children with haemolytic-uraemic syndrome (HUS), there are few reports describing the presence of neurological symptoms and the long-term neurological prognosis, and their findings are variable. Five children with HUS and neurological symptoms, with late referral, are described. Brain magnetic resonance imaging (MRI) was performed in all five children in the acute phase, and repeated in three children three months later. Lethargy was observed in all children and brief, generalized tonic-clonic seizures in four, leading to hospitalization. All of the patients had prodromal gastrointestinal symptoms and the seizures which occurred early in the illness were probably due to hyponatraemia. Distinctive subcortical white matter lesions in the frontal and parietal lobes bilaterally, which remained unchanged three months later, were found on brain MRI in one child and were probably due to microinfarctions. All patients had a full recovery free from neurological deficits or recurrent seizures. The findings of this study suggest that the presence of neurological manifestations and particularly of seizures in children with HUS does not usually imply an unfavourable prognosis. These neurological manifestations are probably related to metabolic abnormalities. Earlier diagnosis and better fluid and electrolyte management might prevent these complications.

1 Department of Neurology, “P. & A. Kyriakou” Children’s Hospital, Athens 2 Department of Nephrology, “P. & A. Kyriakou” Children’s Hospital, Athens 3 2nd Paediatric Clinic of the University of Athens, “P. & A. Kyriakou” Children’s Hospital, Athens 4 Department of Microbiology, “G. Gennimatas” General Hospital, Athens

¶·È‰È·ÙÚÈ΋ 2003;66:456-460

Paediatriki 2003;66:456-460

ÛÙ¿‰È· ÙÔ˘ ∞O™ ‰ÂÓ ÛËÌ·ÙÔ‰ÔÙÔ‡Ó Î·Ù’ ·Ó¿ÁÎËÓ Î·Î‹ ÚfiÁÓˆÛË. A˘Ù¤˜ ÔÈ Ó¢ÚÔÏÔÁÈΤ˜ ÂΉËÏÒÛÂȘ Â›Ó·È Û˘Ó‹ıˆ˜ ·ÔÙ¤ÏÂÛÌ· ÌÂÙ·‚ÔÏÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ, ÙˆÓ ÔÔ›ˆÓ Ë ¤ÁηÈÚË ·ÓÙÈÌÂÙÒÈÛË ÂӉ¯fiÌÂÓ· ı· ·ÔÙÚ¤„ÂÈ ÙËÓ ÂÌÊ¿ÓÈÛ‹ ÙÔ˘˜. §¤ÍÂȘ ÎÏÂȉȿ: ·ÈÌÔÏ˘ÙÈÎfi-Ô˘Ú·ÈÌÈÎfi Û‡Ó‰ÚÔÌÔ, Ó¢ÚÔÏÔÁÈΤ˜ ÂΉËÏÒÛÂȘ, Û·ÛÌÔ›, ˘ÔÓ·ÙÚÈ·ÈÌ›·, ¤ÌÊÚ·ÎÙ· ÂÁÎÂÊ¿ÏÔ˘, Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›·, ·È‰È¿.

Key words: haemolytic-uraemic syndrome, neurological complications, seizures, hyponatraemia, microinfarctions, magnetic resonance imaging, children.

™˘ÓÙÔÌÔÁڷʛ˜

¤Ó· ·È‰› Ì ‹È· „˘¯ÔÎÈÓËÙÈ΋ ηı˘ÛÙ¤ÚËÛË, fiÏ· Ù· ¿ÏÏ· ·È‰È¿ ›¯·Ó ηϋ „˘¯ÔÎÈÓËÙÈ΋ ÂͤÏÈÍË Î·È ÂχıÂÚÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi. ¶ÚÈÓ ÂÈÛ·¯ıÔ‡Ó ÛÙÔ ¡ÔÛÔÎÔÌ›Ô, fiÏ· Ù· ·È‰È¿ ›¯·Ó Á·ÛÙÚÂÓÙÂÚ›Ùȉ· Ì ·ÈÌÔÚÚ·ÁÈΤ˜ ÎÂÓÒÛÂȘ. ∆Ú›· ·fi ·˘Ù¿ ›¯·Ó Ï¿‚ÂÈ ·ÓÙÈ‚›ˆÛË Î·È 4 ·È‰È¿ ›¯·Ó ·ÚÔ˘ÛÈ¿ÛÂÈ ÂÂÈÛfi‰È· ÁÂÓÈÎÂ˘Ì¤ÓˆÓ ÙÔÓÈÎÔÎÏÔÓÈÎÒÓ Û·ÛÌÒÓ ‚Ú·¯Â›·˜ ‰È¿ÚÎÂÈ·˜ (4-6 Ë̤Ú˜ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ Á·ÛÙÚÂÓÙÂÚ›Ùȉ·˜). ∫·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘˜ ÛÙÔ ¡ÔÛÔÎÔÌ›Ô, fiÏ· ‹Ù·Ó ·‡ÚÂÙ· Î·È Â›¯·Ó ˘ÓËÏ›·, ÂÙ¤¯ÂȘ ÛÙÔ ‰¤ÚÌ·, Ôȉ‹Ì·Ù·, ÔÏÈÁÔ˘Ú›·, ˆ¯ÚfiÙËÙ· Î·È Ê˘ÛÈÔÏÔÁÈ΋ ·ÚÙËÚȷ΋ ›ÂÛË. ∂›Û˘, ηٿ ÙË Ó¢ÚÔÏÔÁÈ΋ ÂͤٷÛË, ηӤӷ ·È‰› ‰ÂÓ Â›¯Â ÂÛÙȷο Ó¢ÚÔÏÔÁÈο Â˘Ú‹Ì·Ù· Î·È ÛÙË ‚˘ıÔÛÎfiËÛË ‰ÂÓ ‰È·ÈÛÙÒıËÎ·Ó ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·.

O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ Û fiÏ· Ù· ·È‰È¿ ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ¤‰ÂÈ͠ϢÎÔ΢ÙÙ¿ÚˆÛË, ¯·ÌËÏ¿ Â›‰· ·ÈÌÔÛÊ·ÈÚ›Ó˘ Î·È ÌÂȈ̤ÓÔ ·ÚÈıÌfi ·ÈÌÔÂÙ·Ï›ˆÓ, ηٷÎÂÚÌ·ÙÈṲ̂ӷ ÂÚ˘ıÚ¿, ‰ÈÎÙ˘ÔÂÚ˘ıÚÔ΢ÙÙ¿ÚˆÛË, ·˘ÍË̤ӷ Â›‰· Ô˘Ú›·˜, ÎÚ·ÙÈÓ›Ó˘, ÙÚ·ÓÛ·ÌÈÓ·ÛÒÓ, ¯ÔÏËÛÙÂÚfiÏ˘, ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ Î·È Ô˘ÚÈÎÔ‡ ÔͤԘ ÛÙÔÓ ÔÚfi ·›Ì·ÙÔ˜, ·ÈÌ·ÙÔ˘Ú›· Î·È ÚˆÙÂ˚ÓÔ˘Ú›·, ÂÓÒ ¤‰ÂÈÍÂ Î·È ˘ÔÓ·ÙÚÈ·ÈÌ›· ÛÙ· 4 ·È‰È¿ Ì ÙÔ˘˜ ÚÔËÁËı¤ÓÙ˜ Û·ÛÌÔ‡˜ (¶›Ó·Î·˜ 1). OÈ Î·ÏÏȤÚÁÂȘ ÎÔÚ¿ÓˆÓ ‹Ù·Ó ·ÚÓËÙÈΤ˜ Û 4 ·È‰È¿, ÂÓÒ Û 1 ·ÔÌÔÓÒıËΠÙÔ ÂÓÙÂÚÔ·ıÔÁfiÓÔ Û٤ϯԘ Escherichia coli O157:H7. O ¤ÏÂÁ¯Ô˜ Ì ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ¤‰ÂÈÍ ·‡ÍËÛË ÙˆÓ ‰È·ÛÙ¿ÛÂˆÓ ÙˆÓ ÓÂÊÚÒÓ Ì ·˘ÍË̤ÓË Ë¯ÔÁ¤ÓÂÈ· ÛÙÔ ÓÂÊÚÈÎfi ÊÏÔÈfi, ÂÓÒ ÛÙÔ ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ· ‰È·ÈÛÙÒıËΠ‚Ú·‰˘ÚÚ˘ıÌ›· Û fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜. O ¤ÏÂÁ¯Ô˜ Ì ÙË Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ηٿ ÙËÓ ÔÍ›· Ê¿ÛË Î·È ÛÙÔÓ Â·Ó¤ÏÂÁ¯Ô ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜ Û 4 ·È‰È¿, ÂÓÒ Û ¤Ó· ·È‰› ¤‰ÂÈÍ ·ÌÊÔÙÂÚfiÏ¢Ú˜, ˘„ËÏÔ‡ Û‹Ì·ÙÔ˜ ÛÙȘ ∆2 ÂÈÎfiÓ˜, ÌÈÎÚ¤˜ ÂÛٛ˜ ÛÙËÓ ˘ÔÊÏÔÈÒ‰Ë ÌÔ›Ú· Ù˘ Ï¢΋˜ Ô˘Û›·˜ ÙˆÓ ÌÂÙˆÈ·›ˆÓ Î·È ‚ÚÂÁÌ·ÙÈÎÒÓ ÏÔ‚ÒÓ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Î·È Ì›· ÌÂÁ·Ï‡ÙÂÚË ·ÚfiÌÔÈ· ÂÛÙ›· ÎÔÓÙ¿ ÛÙÔ ÌÂÙˆÈ·›Ô Τڷ˜ Ù˘ ·ÚÈÛÙÂÚ‹˜ Ï¿ÁÈ·˜ ÎÔÈÏ›·˜ (∂ÈÎfiÓ· 1). OÈ ·ÓˆÌ·Ï›Â˜ ·˘Ù¤˜ Â¤ÌÂÓ·Ó Î·È ÛÙÔÓ Â·Ó¤ÏÂÁ¯Ô 3 Ì‹Ó˜ ·ÚÁfiÙÂÚ·.

∞O™ HUS MRI

∞ÈÌÔÏ˘ÙÈÎfi-Ô˘Ú·ÈÌÈÎfi Û‡Ó‰ÚÔÌÔ Haemolytic-uraemic syndrome Magnetic resonance imaging

∂ÈÛ·ÁˆÁ‹ ∆Ô ∞O™ Â›Ó·È ¤Ó· ÔÏ˘Û˘ÛÙËÌ·ÙÈÎfi ÓfiÛËÌ· Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÌÈÎÚÔ·ÁÁÂÈÔ·ıËÙÈ΋ ·ÈÌÔÏ˘ÙÈ΋ ·Ó·ÈÌ›·, ıÚÔÌ‚ÔÂÓ›· Î·È ÔÍ›· ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ·. ∆Ô Ê¿ÛÌ· Ù˘ ÓfiÛÔ˘ Â›Ó·È Â˘Ú‡, ÂÓÒ ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ‹Ș ˘ÔÎÏÈÓÈΤ˜ ̤¯ÚÈ ·ÂÈÏËÙÈΤ˜ ÁÈ· ÙË ˙ˆ‹ ÙˆÓ ·ÛıÂÓÒÓ ÂÚÈÙÒÛÂȘ. ∆Ô ∞O™ ÂÌÊ·Ó›˙ÂÙ·È Î˘Ú›ˆ˜ Û ‚Ú¤ÊË Î·È ·È‰È¿ ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ 5 ÂÙÒÓ Î·È ·ÔÙÂÏ› ÙËÓ ÈÔ Û˘¯Ó‹ ·ÈÙ›· ÔÍ›·˜ ÓÂÊÚÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ Û ·˘Ù¿. ™¯ÂÙ›˙ÂÙ·È Ì ÚÔËÁËı›Û˜ ÏÔÈÌÒÍÂȘ ‹ Ï‹„Ë Ê·ÚÌ¿ÎˆÓ Î·È Û˘¯Ó¿ ÚÔËÁÂ›Ù·È Á·ÛÙÚÂÓÙÂÚ›Ùȉ· ‹ Ïԛ̈ÍË ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ¡Â˘ÚÔÏÔÁÈΤ˜ ÂΉËÏÒÛÂȘ ÂÌÊ·Ó›˙ÔÓÙ·È Û˘¯Ó¿ Û ·ÛıÂÓ›˜ Ì ∞O™ Î·È ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ÔÈΛϷ ·ÂÈÎÔÓÈÛÙÈο Â˘Ú‹Ì·Ù· ÛÙËÓ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ (1-11), ÂÓÒ Û¿ÓÈ· ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ÂÚÈÙÒÛÂȘ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó Ì ̷ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ (7-11). ∏ ·ÚÔ˘Û›· Ó¢ÚÔÏÔÁÈÎÒÓ ÂΉËÏÒÛÂˆÓ Î·È È‰È·›ÙÂÚ· Û·ÛÌÒÓ Î·Ù¿ ÙËÓ ÔÍ›· Ê¿ÛË Ù˘ ÓfiÛÔ˘ ¤¯ÂÈ ÂÓÔ¯ÔÔÈËı› fiÙÈ Û¯ÂÙ›˙ÂÙ·È Ì η΋ ÚfiÁÓˆÛË Ù˘ ÓfiÛÔ˘, ·ÏÏ¿ Ù· ·ÔÙÂϤÛÌ·Ù· ÙˆÓ ÂÏ¿¯ÈÛÙˆÓ ÌÂÏÂÙÒÓ Ô˘ ¤¯Ô˘Ó Á›ÓÂÈ Â›Ó·È ·ÓÙÈÊ·ÙÈο (10,12-14). ™Â ·˘Ù‹ ÙË ÌÂϤÙË ÂÚÈÁÚ¿ÊÔÓÙ·È 5 ·È‰È¿ Ì ∞O™ Î·È Ó¢ÚÔÏÔÁÈΤ˜ ÂΉËÏÒÛÂȘ, 4 ·fi Ù· ÔÔ›· ›¯·Ó ÚÒÈÌË ÂÌÊ¿ÓÈÛË Û·ÛÌÒÓ, ÔÈ ÔÔ›ÔÈ Èı·Ó¿ ÔÊ›ÏÔÓÙ·Ó Û ˘ÔÓ·ÙÚÈ·ÈÌ›·. ™Â fiÏ· Ù· ·È‰È¿ ¤ÁÈÓ ̷ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ ηٿ ÙËÓ ÔÍ›· Ê¿ÛË Ù˘ ÓfiÛÔ˘, ÂÓÒ Û 3 ·È‰È¿ Â·Ó·Ï‹ÊıËΠÙÚÂȘ Ì‹Ó˜ ·ÚÁfiÙÂÚ·. ŸÏ· Ù· ·È‰È¿ ›¯·Ó ηϋ ÂͤÏÈÍË, ¯ˆÚ›˜ Ó¢ÚÔÏÔÁÈο ÚÔ‚Ï‹Ì·Ù·, ÂÓÒ ÔÈ Û·ÛÌÔ› ‰ÂÓ Â·Ó·Ï‹ÊıËηÓ. ¶ÂÚÈÁÚ·Ê‹ ÂÚÈÙÒÛÂˆÓ ¶ÂÚÈÁÚ¿ÊÔÓÙ·È 5 ·È‰È¿ (3 ·ÁfiÚÈ· Î·È 2 ÎÔÚ›ÙÛÈ·) Ì ∞O™, ÙˆÓ ÔÔ›ˆÓ Ë ËÏÈΛ· Î˘Ì·ÈÓfiÙ·Ó ·fi 1 ¤ˆ˜ 5 ¤ÙË (‰È¿ÌÂÛË ËÏÈΛ·: 2,5 ¤ÙË). ∂ÎÙfi˜ ·fi

457

¶·È‰È·ÙÚÈ΋ 2003;66:456-460

Paediatriki 2003;66:456-460

¶›Ó·Î·˜ 1. ∂ÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· ÙˆÓ ·ÛıÂÓÒÓ Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ·/·

1 2 3 4 5

∞ÛıÂÓ›˜

§Â˘Î¿ ·ÈÌÔÛÊ·›ÚÈ· ·›Ì·ÙÔ˜ (/mm3)

Hb (g/dl)

¢∂∫ (%)

AMT 3 (/mm )

O˘Ú›· (mg/dl)

Cr (mg/dl)

¡¿ÙÚÈÔ (mEq/l)

∞ÁfiÚÈ 2,5 ÂÙÒÓ ∞ÁfiÚÈ 5 ÂÙÒÓ ∞ÁfiÚÈ 3 ÂÙÒÓ ∫ÔÚ›ÙÛÈ 1 ¤ÙÔ˘˜ ∫ÔÚ›ÙÛÈ 1 ¤ÙÔ˘˜

18.600 15.400 21.300 21.500 22.900

5,4 5,5 7,5 7,1 6,2

2,8 2,6 2,9 2,9 4,2

80.000 22.000 62.000 22.000 21.000

209 369 411 199 175

6,8 7,8 11,2 4,8 3,8

105 129 118 115 119

Hb: ∞ÈÌÔÛÊ·ÈÚ›ÓË Ï¿ÛÌ·ÙÔ˜ ¢∂∫: ¢ÈÎÙ˘ÔÂÚ˘ıÚÔ·ÙÙ·Ú· ·›Ì·ÙÔ˜ ∞ª∆: ∞ÈÌÔÂÙ¿ÏÈ· ·›Ì·ÙÔ˜ Cr: ∫Ú·ÙÈÓ›ÓË ÔÚÔ‡

OÈ Û·ÛÌÔ› ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó Â‡ÎÔÏ· Ì ÂÓ‰ÔÊϤ‚È· ¯ÔÚ‹ÁËÛË ·ÓÙÈÂÈÏËÙÈ΋˜ ·ÁˆÁ‹˜ (Ìȉ·˙ÔÏ¿ÌË Î·È Ê·ÈÓ˘ÙÔ˝ÓË) Î·È ‰ÈfiÚıˆÛË Ù˘ ˘ÔÓ·ÙÚÈ·ÈÌ›·˜. ŒÁÈÓ·Ó ÌÂÙ·ÁÁ›ÛÂȘ Û˘Ì˘ÎÓˆÌ¤ÓˆÓ ÂÚ˘ıÚÒÓ. ∆Ú›· ·È‰È¿ ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó Ì ·ÈÌÔοı·ÚÛË Î·È 1 Ì ÂÚÈÙÔÓ·˚΋ οı·ÚÛË. ∏ ηٿÛÙ·ÛË ÙˆÓ ·È‰ÈÒÓ ÛÙ·‰È·Î¿ ‚ÂÏÙÈÒıËÎÂ, ÙÔ Â›Â‰Ô Û˘Ó›‰ËÛ˘ ÛÙ·‰È·Î¿ ·ÔηٷÛÙ¿ıËÎÂ Î·È ÔÈ Û·ÛÌÔ› ‰ÂÓ Â·Ó·Ï‹ÊıËηÓ. ™ÙÔÓ Â·Ó¤ÏÂÁ¯Ô, 34 ¯ÚfiÓÈ· ÌÂÙ¿ ÙËÓ ÔÍ›· ÓfiÛËÛË, fiÏ· Ù· ·È‰È¿ ›¯·Ó ηϋ ÂͤÏÈÍË, ¯ˆÚ›˜ Ó¢ÚÔÏÔÁÈο ‹ ÓÂÊÚÈο ÚÔ‚Ï‹Ì·Ù·. ™˘˙‹ÙËÛË ¡Â˘ÚÔÏÔÁÈΤ˜ ÂÈÏÔΤ˜, ‹Ș ‹ ÛÔ‚·Ú¤˜ Î·È ÌfiÓÈ̘ ‹ ·ÚÔ‰ÈΤ˜, ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÔ 20-50% ÙˆÓ ·ÛıÂÓÒÓ Ì ∞O™. Œ¯ÂÈ ÂÚÈÁÚ·Ê› ¤Ó· ¢ڇ Ê¿ÛÌ· Ó¢ÚÔÏÔÁÈÎÒÓ ÂÈÏÔÎÒÓ, fiˆ˜ ÂÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ, ‰˘ÛÙÔÓ›·, ·Ù·Í›·, ÌÂÙ·‚ÔÏ‹ ÙÔ˘ ÂÈ¤‰Ô˘ Û˘Ó›‰ËÛ˘, ÎÒÌ·, ÊÏÔÈ҉˘ Ù‡ÊψÛË, Â͈˘Ú·ÌȉÈο Û˘ÌÙÒÌ·Ù· ‹ ÂÛÙȷο Â˘Ú‹Ì·Ù·, fiˆ˜ ËÌÈ¿ÚÂÛË. ∞˘Ù¤˜ ÔÈ ÂΉËÏÒÛÂȘ ÂÌÊ·Ó›˙ÔÓÙ·È Û˘¯Ó¿ ÛÙËÓ Úfi‰ÚÔÌË Ê¿ÛË Ù˘ ÓfiÛÔ˘ Î·È ÛÙÔ 15% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ·ÔÙÂÏÔ‡Ó ÙËÓ ·ÈÙ›· ÂÈÛfi‰Ô˘ ÙˆÓ ·ÛıÂÓÒÓ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô (1,3,6,12). ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, ÙÔ Ù˘ÈÎfi ÈÛÙÔÚÈÎfi, Ë ÎÏÈÓÈ΋ ÂÈÎfiÓ· Î·È Ù· ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· ÂȂ‚·›ˆÛ·Ó ÙË ‰È¿ÁÓˆÛË ÙÔ˘ ∞O™ Ì Ó¢ÚÔÏÔÁÈΤ˜ ÂÈÏÔΤ˜ Û fiϘ ÙȘ ÂÚÈÙÒÛÂȘ. ∫·Ó¤Ó·˜ ·ÛıÂÓ‹˜ ‰ÂÓ Â›¯Â ÂÛÙȷο Ó¢ÚÔÏÔÁÈο Â˘Ú‹Ì·Ù· Î·È ÔÈ Ó¢ÚÔÏÔÁÈΤ˜ ÂΉËÏÒÛÂȘ - Î·È Û˘ÁÎÂÎÚÈ̤ӷ Ë ÌÂÙ·‚ÔÏ‹ ÙÔ˘ ÂÈ¤‰Ô˘ Û˘Ó›‰ËÛ˘ Î·È ÔÈ ÂÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ - ·ÚÔ˘ÛÈ¿ÛÙËÎ·Ó ÙȘ ÚÒÙ˜ Ë̤Ú˜ Ù˘ ÓfiÛÔ˘ Û fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜. OÈ ÂÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ Î·È ÛÙÔ˘˜ 4 ·ÛıÂÓ›˜ ‹Ù·Ó ‚Ú·¯Â›·˜ ‰È¿ÚÎÂÈ·˜ ÁÂÓÈÎÂ˘Ì¤ÓÔÈ ÙÔÓÈÎÔÎÏÔÓÈÎÔ› Û·ÛÌÔ› Î·È Èı·Ó¿ Û¯ÂÙ›˙ÔÓÙ·Ó Ì ÙËÓ ˘ÔÓ·ÙÚÈ·ÈÌ›· Ô˘ ‰È·ÈÛÙÒıËΠÌÂÙ¿ ÙËÓ Â›ÛÔ‰Ô ÛÙÔ ÓÔÛÔÎÔÌ›Ô. ∏ ·ıÔÁ¤ÓÂÈ· ÙˆÓ ÂΉËÏÒÛÂˆÓ ·fi ÙÔ ÎÂÓÙÚÈÎfi

458

Ó¢ÚÈÎfi Û‡ÛÙËÌ· ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ∞O™ ÔÈΛÏÏÂÈ Î·È Èı·ÓÒ˜ Â›Ó·È ÔÏ˘·Ú·ÁÔÓÙÈ΋. OÈ Ó¢ÚÔÏÔÁÈΤ˜ ÂΉËÏÒÛÂȘ ¤¯Ô˘Ó ·Ô‰Ôı› Û ¤ÌÊÚ·ÎÙ· ÙˆÓ ÌÈÎÚÒÓ Î·È ÙˆÓ ÌÂÁ¿ÏˆÓ ·ÁÁ›ˆÓ, ÂÁÎÂÊ·ÏÈ΋ ·ÈÌÔÚÚ·Á›·, ÌÂÙ·‚ÔÏÈΤ˜ Î·È ËÏÂÎÙÚÔÏ˘ÙÈΤ˜ ‰È·Ù·Ú·¯¤˜, ˘ÔÍ›·, ÂÁÎÂÊ·ÏÈÎfi Ô›‰ËÌ· Î·È ˘¤ÚÙ·ÛË (1-3,5,6). ™Â ·ıÔÏÔÁÔ·Ó·ÙÔÌÈΤ˜ ÌÂϤÙ˜ ¤¯Ô˘Ó ‚ÚÂı› ıÚfiÌ‚ÔÈ Û ÌÈÎÚ¿, ·ÏÏ¿ Î·È Û ÌÂÁ¿Ï· ·ÁÁ›· ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘, ·ÚÂÁ¯˘Ì·ÙÈΤ˜ ·ÈÌÔÚÚ·Á›Â˜, ÌË ÂȉÈΤ˜ ÈÛ¯·ÈÌÈΤ˜ Î·È ·ÓÔÍÈΤ˜ ·ÏÏÔÈÒÛÂȘ Î·È ÂÁÎÂÊ·ÏÈÎfi Ô›‰ËÌ· (1-3,5,6). ∏ÏÂÎÙÚÔÏ˘ÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ Î·È ˘¤ÚÙ·ÛË Ô˘ Û˘¯Ó¿ Û˘ÓÔ‰Â‡Ô˘Ó ÙÔ˘˜ ·ÛıÂÓ›˜ Ì ∞O™ ¤¯Ô˘Ó Â›Û˘ ÂÓÔ¯ÔÔÈËı› ÁÈ· ÙȘ ÔÈΛϘ Ó¢ÚÔÏÔÁÈΤ˜ ÂΉËÏÒÛÂȘ. ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, Ë ˘¤ÚÙ·ÛË ‰ÂÓ ¤·ÈÍ ηӤӷ ÚfiÏÔ, ηıÒ˜ ηӤӷ˜ ·ÛıÂÓ‹˜ ‰ÂÓ Â›¯Â ·ÚÔ˘ÛÈ¿ÛÂÈ ˘¤ÚÙ·ÛË, ÂÓÒ Ë Ô˘Ú·ÈÌ›· Î·È Ë ˘ÔÓ·ÙÚÈ·ÈÌ›· ÚÔÊ·ÓÒ˜ Û˘Ó¤‚·Ï·Ó ÛÙËÓ ÚfiÎÏËÛË ÙˆÓ Ó¢ÚÔÏÔÁÈÎÒÓ ÂΉËÏÒÛˆÓ. ™ÙÔÓ ·ÛıÂÓ‹ Ì ÙȘ ·ÏÏÔÈÒÛÂȘ ÛÙË Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘, ÔÈ ÈÛ¯·ÈÌÈΤ˜ ·ÏÏÔÈÒÛÂȘ ÙˆÓ ÌÈÎÚÒÓ ·ÁÁ›ˆÓ Èı·Ó¿ Û˘Ó¤‚·Ï·Ó ÛÙËÓ ÂΉ‹ÏˆÛË ÙˆÓ Ó¢ÚÔÏÔÁÈÎÒÓ ÂΉËÏÒÛˆÓ. ∏ ‚ÂÚÔÙÔÍ›ÓË, Ë ÔÔ›· ÂÏ¢ıÂÚÒÓÂÙ·È ·fi ÙÔ ÂÓÙÂÚÔ·ıÔÁfiÓÔ Û٤ϯԘ Escherichia coli O157:H7, ÌÔÚ› Ó· ¢ı‡ÓÂÙ·È ÁÈ· ÙȘ Ó¢ÚÔÏÔÁÈΤ˜ ÂΉËÏÒÛÂȘ (16). ŸÌˆ˜, Ë ‚ÂÚÔÙÔÍ›ÓË ‰ÂÓ ÚÔÛ‰ÈÔÚ›ÛÙËΠÛÙȘ ÂÚÈÙÒÛÂȘ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ Î·È ÔÈ Î·ÏÏȤÚÁÂȘ ÎÔÚ¿ÓˆÓ ÁÈ· Escherichia coli O157:H7 ‹Ù·Ó ıÂÙÈΤ˜ ÌfiÓÔ Û ̛· ÂÚ›ÙˆÛË. £· Ú¤ÂÈ Ó· ÛËÌÂȈı›, fï˜, fiÙÈ 3 ·fi ÙÔ˘˜ ·ÛıÂÓ›˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ›¯·Ó Ï¿‚ÂÈ ·ÓÙÈ‚ÈÔÙÈ΋ ·ÁˆÁ‹ ÚÈÓ ÂÈÛ·¯ıÔ‡Ó ÛÙÔ ÓÔÛÔÎÔÌ›Ô. ¶ÔÏϤ˜ ÂÚÈÙÒÛÂȘ ∞O™ Ì Ó¢ÚÔÏÔÁÈΤ˜ ÂÈÏÔΤ˜ ¤¯Ô˘Ó ÂÏÂÁ¯ı› Ì ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· Î·È ÔÈΛϷ Â˘Ú‹Ì·Ù· ¤¯Ô˘Ó ÂÚÈÁÚ·Ê›, fiˆ˜ Ô›‰ËÌ· ÂÁÎÂÊ¿ÏÔ˘, ¤ÌÊÚ·ÎÙ· ÔÈΛÏÔ˘ ÌÂÁ¤ıÔ˘˜ Î·È ÂÓ‰ÔÎÚ·ÓȷΤ˜ ·ÈÌÔÚÚ·Á›Â˜ (4-6). ¶ÈÛÙ‡ÂÙ·È fiÙÈ Ë ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ ÌÔÚ› Ó· ÌËÓ Â›Ó·È ·ÚÎÂÙ¿ ¢·›ÛıËÙË ÛÙËÓ ·Ó¿‰ÂÈÍË ÌÈÎÚÒÓ

¶·È‰È·ÙÚÈ΋ 2003;66:456-460

·

Paediatriki 2003;66:456-460

‚

∂ÈÎfiÓ· 1. ª·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘, Û ∆2 ÂÈÎfiÓ˜, ÙÔ˘ ‰Â‡ÙÂÚÔ˘ ·ÛıÂÓÔ‡˜ ηٿ ÙËÓ ÔÍ›· Ê¿ÛË Ù˘ ÓfiÛÔ˘. ¢Â›¯ÓÂÈ ·˘ÍË̤ÓÔ˘ Û‹Ì·ÙÔ˜ ·ÌÊÔÙÂÚfiÏ¢Ú˜ ÂÛٛ˜ ÂÓÙÔÈ˙fiÌÂÓ˜ ÛÙËÓ ˘ÔÊÏÔÈÒ‰Ë Ï¢΋ Ô˘Û›· ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘, ΢ڛˆ˜ ÛÙÔ˘˜ ÌÂÙˆÈ·›Ô˘˜ Î·È ‚ÚÂÁÌ·ÙÈÎÔ‡˜ ÏÔ‚Ô‡˜ (·) Î·È Ì›· ·ÚfiÌÔÈ· ÌÂÁ·Ï‡ÙÂÚË ÂÛÙ›· (‚) ÎÔÓÙ¿ ÛÙÔ ÌÂÙˆÈ·›Ô Τڷ˜ Ù˘ ·ÚÈÛÙÂÚ‹˜ Ï¿ÁÈ·˜ ÎÔÈÏ›·˜ (‚¤ÏË).

·ÓˆÌ·ÏÈÒÓ Û ·ÛıÂÓ›˜ Ì ∞O™, Û ·ÓÙ›ıÂÛË Ì ÙË Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ Ô˘ Â›Ó·È ÈÔ Â˘·›ÛıËÙË ÛÙËÓ ·Ó¿‰ÂÈÍË ·˘ÙÒÓ ÙˆÓ ·ÓˆÌ·ÏÈÒÓ, ·ÎfiÌË Î·È ÛÙ· ·Ú¯Èο ÛÙ¿‰È· Ù˘ ÓfiÛÔ˘ (10). ŒÏÂÁ¯Ô˜ Ì ̷ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ ¤¯ÂÈ ·Ó·ÊÂÚı› ÌfiÓÔ Û ϛÁ˜ ÚÔËÁÔ‡ÌÂÓ˜ ÂÚÈÙÒÛÂȘ ∞O™ Î·È Ù· ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù· Â›Ó·È Î˘Ú›ˆ˜ ¤ÌÊÚ·ÎÙ· ‹ ·ÈÌÔÚÚ·Á›Â˜ ÛÙËÓ ÂÚÈÔ¯‹ ÙˆÓ ‚·ÛÈÎÒÓ Á·ÁÁÏ›ˆÓ (7-11). ŒÌÊÚ·ÎÙ· ÛÙË Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ ·ÚfiÌÔÈ· Ì ÂΛӷ Ù˘ ·ÚÔ‡Û·˜ ÂÚ›ÙˆÛ˘, ·ÏÏ¿ ÂÓÙÔÈ˙fiÌÂÓ· ΢ڛˆ˜ ÛÙË ÂÚÈÔ¯‹ ÙˆÓ ‚·ÛÈÎÒÓ Á·ÁÁÏ›ˆÓ Î·È ÛÙËÓ ÂÓ Ùˆ ‚¿ıÂÈ Ï¢΋ Ô˘Û›·, ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› Û ÚÔËÁÔ‡ÌÂÓÔ ·ÛıÂÓ‹ Ì ∞O™ Î·È ÔÊı·ÏÌÈ΋ Û˘ÌÌÂÙÔ¯‹ (17). ¶ÈÛÙ‡ÂÙ·È, fï˜, fiÙÈ Ù· Â˘Ú‹Ì·Ù· ÛÙË Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ‰ÂÓ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ÚfiÁÓˆÛË (10), fiˆ˜ ‰È·ÈÛÙÒıËÎÂ Î·È ÛÙÔÓ ·ÛıÂÓ‹ ·˘Ù‹˜ Ù˘ ÌÂϤÙ˘, fiÔ˘ ÂÓÒ ÔÈ ·ÓˆÌ·Ï›Â˜ ÛÙË Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ·Ú¤ÌÂÈÓ·Ó ÛÙÔÓ Â·Ó¤ÏÂÁ¯Ô, ÙÔ ·È‰› ‰ÂÓ ·ÚÔ˘Û›·˙ Ó¢ÚÔÏÔÁÈο ÚÔ‚Ï‹Ì·Ù·. ∞Ó Î·È Ë ˘ÔÛÙËÚÈÎÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË, Ë ·ÈÌÔοı·ÚÛË Î·È Ë ÂÚÈÙÔÓ·˚΋ οı·ÚÛË ¤¯Ô˘Ó ÌÂÈÒÛÂÈ ÙË ıÓËÛÈÌfiÙËÙ· Û ·ÛıÂÓ›˜ Ì ∞O™, ÔÈ Ì·ÎÚÔ¯ÚfiÓȘ Û˘Ó¤ÂȘ, ÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ ÙˆÓ Ó¢ÚÔÏÔÁÈÎÒÓ ÂÈÏÔÎÒÓ, Ù˘ ¯ÚfiÓÈ·˜ ÓÂÊÚÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜

Î·È Ù˘ ˘¤ÚÙ·Û˘, ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÔ 10-20% ÙˆÓ ·ÛıÂÓÒÓ (1,6). Œ¯ÂÈ ·Ó·ÊÂÚı› fiÙÈ Ë ÚfiÁÓˆÛË Û¯ÂÙ›˙ÂÙ·È Ì ÙË ÛÔ‚·ÚfiÙËÙ· ÙˆÓ Ó¢ÚÔÏÔÁÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ Î·Ù¿ ÙËÓ ÔÍ›· Ê¿ÛË Ù˘ ÓfiÛÔ˘. ™˘ÁÎÂÎÚÈ̤ӷ, Ë ‡·ÚÍË ÎÒÌ·ÙÔ˜ Û¯ÂÙ›˙ÂÙ·È Ì η΋ ÚfiÁÓˆÛË. ∞ÓÙ›ıÂÙ·, οÔÈÔÈ ÂÚ¢ÓËÙ¤˜ ÈÛÙÂ‡Ô˘Ó fiÙÈ Ù· Ó¢ÚÔÏÔÁÈο Û˘ÌÙÒÌ·Ù· ˘Ô¯ˆÚÔ‡Ó ÁÚ‹ÁÔÚ· Î·È ‰ÂÓ ÛËÌ·ÙÔ‰ÔÙÔ‡Ó Î·Î‹ ÚfiÁÓˆÛË (10). ∂›Û˘, ¤¯ÂÈ ·Ó·ÊÂÚı› fiÙÈ Ë ·ÚÔ˘Û›· Û·ÛÌÒÓ Î·Ù¿ ÙËÓ ÔÍ›· Ê¿ÛË Ù˘ ÓfiÛÔ˘ Û¯ÂÙ›˙ÂÙ·È Ì ÌÂÁ¿ÏË ıÓËÛÈÌfiÙËÙ· ‹ Ì·ÎÚÔ¯ÚfiÓȘ Ó¢ÚÔÏÔÁÈΤ˜ ÂÈÏÔΤ˜ (12), ¿Ô„Ë Ô˘ ¤¯ÂÈ, fï˜, ·ÌÊÈÛ‚ËÙËı› ·fi ¿ÏÏÔ˘˜ ÂÚ¢ÓËÙ¤˜ (13). ∂›Ó·È Èı·Ófi Ë ·ÚÔ˘Û›· ÂÛÙÈ·ÎÒÓ Û·ÛÌÒÓ Ô˘ ·Ú·ÙËÚÔ‡ÓÙ·È Î˘Ú›ˆ˜ Û ¿Û¯ÔÓÙ˜ Ì ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù· ÛÙÔÓ ·ÂÈÎÔÓÈÛÙÈÎfi ¤ÏÂÁ¯Ô ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Î·È Ô˘ ˘Ô‰ËÏÒÓÔ˘Ó ‚·Ú‡ÙÂÚË ÂÁÎÂÊ·ÏÈ΋ ‚Ï¿‚Ë, Ó· ÛËÌ·ÙÔ‰ÔÙ› η΋ ÚfiÁÓˆÛË Ù˘ ÓfiÛÔ˘ (14), ÂÓÒ ÔÈ ÁÂÓÈÎÂ˘Ì¤ÓÔÈ, ‚Ú·¯Â›˜ Û·ÛÌÔ›, Ô˘ ÔÊ›ÏÔÓÙ·È Î˘Ú›ˆ˜ Û ÌÂÙ·‚ÔÏÈΤ˜ ‰È·Ù·Ú·¯¤˜, Ó· ¤¯Ô˘Ó ηϋ ÚfiÁÓˆÛË (13,14), fiˆ˜ ·Ú·ÙËÚ‹ıËÎÂ Î·È ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË. ™˘ÌÂÚ·ÛÌ·ÙÈο, Û ·ÛıÂÓ›˜ Ì ∞O™ Î·È Ó¢ÚÔÏÔÁÈΤ˜ ÂΉËÏÒÛÂȘ, Ë ·ÚÔ˘Û›· ‚Ú·¯Â›·˜ ‰È¿ÚÎÂÈ·˜ ÁÂÓÈÎÂ˘Ì¤ÓˆÓ Û·ÛÌÒÓ Èı·Ó¿ ÔÊ›ÏÂÙ·È ÛÂ

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ÌÂÙ·‚ÔÏÈΤ˜ ‰È·Ù·Ú·¯¤˜ Î·È ‰ÂÓ Û˘Óԉ‡ÂÙ·È ·fi ·ÓˆÌ·Ï›Â˜ ÛÙÔÓ ·ÂÈÎÔÓÈÛÙÈÎfi ¤ÏÂÁ¯Ô ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘. ∞˘ÙÔ› ÔÈ Û·ÛÌÔ› ÂϤÁ¯ÔÓÙ·È Â‡ÎÔÏ· Î·È ÁÚ‹ÁÔÚ· Î·È ‰ÂÓ Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì η΋ ÚfiÁÓˆÛË. ∏ ¤ÁηÈÚË ·Ó·ÁÓÒÚÈÛË Î·È Ë Î·Ù¿ÏÏËÏË ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÌÂÙ·‚ÔÏÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ Èı·ÓÒ˜ ı· ·ÔÙÚ¤„ÂÈ ÙËÓ ÂÌÊ¿ÓÈÛË ÙˆÓ Û·ÛÌÒÓ.

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µÈ‚ÏÈÔÁÚ·Ê›· 1. Rooney JC, Anderson RM, Hopkins IJ. Clinical and pathological aspects of central nervous system involvement in the haemolytic uraemic syndrome. Aust Paediatr J 1971;7:28-33.

2. Gianantonio CA, Vitacco M, Mendilaharzu F, Gallo GE, Sojo ET. The haemolytic-uremic syndrome. Nephron 1973;11: 174-192.

3. Upadhyaya K, Barwick K, Fishaut M, Kashgarian M, Siegel NJ. The importance of nonrenal involvement in hemolyticuremic syndrome. Pediatrics 1980;65:115-120.

4. Crisp DE, Siegler RL, Bale JF, Thompson JA. Hemorrhagic cerebral infarction in the haemolytic-uremic syndrome. J Pediatr 1981;99:273-276.

5. Trevathan E, Dooling EC. Large thrombotic strokes in haemolytic-uremic syndrome. J Pediatr 1987;111:863-866.

6. Hahn JS, Havens PL, Higgins JJ, O’Rourke PP, Estroff JA, Strand R. Neurological complications of hemolytic-uremic syndrome. J Child Neurol 1989;4:108-113.

7. DiMario FJ Jr, Bronte-Stewart H, Sherbotie J, Turner ME. Lacunar infarction of the basal ganglia as a complication of hemolytic-uremic syndrome. MRI and clinical correlations.

Clin Pediatr 1987;26:586-590.

8. Sherwood JW, Wagle WA. Hemolytic uremic syndrome: MR findings of CNS complications. Am J Neuroradiol 1991;12:703-704.

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Barnett ND, Kaplan AM, Bernes SM, Cohen ML. Hemolytic uremic syndrome with particular involvement of basal ganglia and favorable outcome. Pediatr Neurol 1995;12:155-158.

Ogura H, Takaoka M, Kishi M, Kimoto M, Shimazu T, Yoshioka T et al. Reversible MR findings of hemolytic uremic syndrome with mild encephalopathy. Am J Neuroradiol 1998;19:1144-1145.

Eriksson KJ, Boyd SG, Tasker RC. Acute neurology and neurophysiology of haemolytic-uraemic syndrome. Arch Dis Child 2001;84:434-435.

Bale JF Jr, Brasher C, Siegler RL. CNS manifestations of the hemolytic-uremic syndrome. Relationship to metabolic alterations and prognosis. Am J Dis Child 1980;134:869-872.

Dhuna A, Pascual-Leone A, Talwar D, Torres F. EEG and seizures in children with hemolytic-uremic syndrome.

Epilepsia 1992;33:482-486.

Sheth KJ, Swick HM, Haworth N. Neurological involvement in the haemolytic-uremic syndrome. Ann Neurol 1986;19:90-93.

Cimolai N, Morrison BJ, Carter JE. Risk factors for the central nervous system manifestations of gastroenteritisassociated hemolytic uremic syndrome. Am J Dis Child 1980;134:869-872.

Siegler RL, Brewer ED, Swartz M. Ocular involvement in hemolytic-uremic syndrome. J Pediatr 1988;112:594-597.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 11-04-2003 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 27-06-2003 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ∞. µÔ‡‰Ú˘ ¡Â˘ÚÔÏÔÁÈÎfi ∆Ì‹Ì·, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. &∞. ∫˘ÚÈ·ÎÔ‡” £Ë‚ÒÓ & §Â‚·‰Â›·˜, ∆.∫. 115 27, ∞ı‹Ó· E-mail: kvoudris@otenet.gr

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ORIGINAL ARTICLE

∫˘ÙÙ·ÚÔÁÂÓÂÙÈο Î·È ÂȉËÌÈÔÏÔÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο 533 ·ÛıÂÓÒÓ Ì ۇӉÚÔÌÔ Down Ù· ¤ÙË 1973-2001 Ã. ÷Ù˙ËÛ‚·ÛÙÔ‡ - §Ô˘Î›‰Ô˘, ¶. ∫·ÌÔ˘Ú›‰Ô˘

Cytogenetic and epidemiological characteristics of 533 patients with Down syndrome between the years 1973-2001 H. Hatzissevastou - Loukidou, P. Kambouridou

¶ÂÚ›ÏË„Ë: ∏ ¯ÚˆÌÔÛˆÌÈ΋ Û‡ÓıÂÛË ÙˆÓ ÂÚÈÛÛfiÙÂÚˆÓ ·ÙfiÌˆÓ Ì ۇӉÚÔÌÔ Down Â›Ó·È Ë ÂχıÂÚË ÙÚÈۈ̛· 21, ÂÓÒ ¤Ó·˜ ÂÚÈÔÚÈṲ̂ÓÔ˜ ·ÚÈıÌfi˜ ¤¯ÂÈ ÌÂÙ¿ıÂÛË ÎÂÓÙÚÈ΋˜ Û‡ÓÙË͢ (Robertsonian translocation). ™ÎÔfi˜ Ù˘ ÂÚÁ·Û›·˜ ‹Ù·Ó: ·) Ë ÌÂϤÙË ÙˆÓ Î˘ÙÙ·ÚÔÁÂÓÂÙÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ·ÛıÂÓÒÓ Ì ۇӉÚÔÌÔ Down, ‚) Ë ÂÎÙ›ÌËÛË ÙˆÓ Û˘Ó‹ıˆÓ ·Ú·Ì¤ÙÚˆÓ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ÚfiÏË„Ë Á¤ÓÓËÛ‹˜ ÙÔ˘˜ Î·È Á) Ë ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘˜. ∞Ó·ÛÎÔ‹ıËÎ·Ó ·Ó·‰ÚÔÌÈο ÔÈ Ê¿ÎÂÏÔÈ 533 ·ÛıÂÓÒÓ Ì ۇӉÚÔÌÔ Down, ÔÈ ÔÔ›ÔÈ ÂÚ¢ӋıËÎ·Ó ÂÈÙ˘¯Ò˜ ¯ÚˆÌÔÛˆÌÈο Ù· ¤ÙË 1973-2001, ÂÓÒ ÂÚ¢ӋıËÎ·Ó ÂÈÏÂÎÙÈο Î·È ÔÈ Ê¿ÎÂÏÔÈ ÔÚÈÛÌ¤ÓˆÓ ÔÈÎÔÁÂÓÂÈÒÓ ÂÍ ·˘ÙÒÓ ÁÈ· ·ÔÎÏÂÈÛÌfi Ù˘ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜. ∫·Ù·ÁÚ¿ÊËηÓ: ·) ÙÔ Ê‡ÏÔ, ‚) Ë ËÏÈΛ· ηٿ ÙË ‰È¿ÁÓˆÛË, Á) ÔÈ Î·Ú˘fiÙ˘ÔÈ, ‰) ÔÈ ÌÔÓ‹ÚÂȘ ‹ ‰›‰˘Ì˜ ΢‹ÛÂȘ, Â) Ë ËÏÈΛ· ÙˆÓ ÁÔÓ¤ˆÓ ηٿ ÙÔÓ ÙÔÎÂÙfi, ÛÙ) Ô ÙfiÔ˜ ηÙÔÈΛ·˜ ηÈ, Ù¤ÏÔ˜, Û˘ÁÎÚ›ıËÎ·Ó Ù· Â˘Ú‹Ì·Ù· Ì ÂΛӷ ¿ÏÏˆÓ ÂÚ¢ÓËÙÒÓ. ∆Ô ÔÛÔÛÙfi ÙˆÓ ·ÁÔÚÈÒÓ ‹Ù·Ó 56% Î·È ÙˆÓ ÎÔÚÈÙÛÈÒÓ 44%. ∞ÌÈÁ‹ ÂχıÂÚË ÙÚÈۈ̛· ›¯Â ÙÔ 90%, ̈۷˚ÎÈÛÌfi ÙÔ 5,5%, ÌÂÙ¿ıÂÛË ÎÂÓÙÚÈ΋˜ Û‡ÓÙË͢ ÙÔ 4,5%, ÂÓÒ ·fi ·˘ÙÔ‡˜ ÌfiÓÔ ÙÔ 1% ›¯Â ÎÏËÚÔÓÔÌÈÎfiÙËÙ·. ∏ ̤ÛË ËÏÈΛ· ÙˆÓ ÌËÙ¤ÚˆÓ Î·Ù¿ ÙÔÓ ÙÔÎÂÙfi ‹Ù·Ó Ù· 30,5 ¤ÙË Î·È ÙˆÓ ·Ù¤ÚˆÓ Ù· 34 ¤ÙË. ∏ ËÏÈΛ· ÙˆÓ ·ÛıÂÓÒÓ Î·Ù¿ ÙË ‰È¿ÁÓˆÛË ‰È·ÌÔÚʈÓfiÙ·Ó ˆ˜ ÂÍ‹˜: 4 ‹Ù·Ó ¤Ì‚Ú˘· ·fi ‰È·ÎÔ‹ Ù˘ ·ËÛ˘ ÏfiÁˆ ÚÔÁÂÓÓËÙÈÎÔ‡ ÂϤÁ¯Ô˘, 56% ‹Ù·Ó ÓÂÔÁÓ¿, 27% ‹Ù·Ó ‚Ú¤ÊË Î·È 11% ›¯Â ËÏÈΛ· ÌÂÁ·Ï‡ÙÂÚË ÙÔ˘ 1 ¤ÙÔ˘˜. ∞fi ÙËÓ Â·Ú¯›· ·Ú·¤ÌÊıËÎÂ Û˘ÓÔÏÈο ÙÔ 56% ÙˆÓ ·ÛıÂÓÒÓ Î·È ·fi ÙËÓ fiÏË Ù˘ £ÂÛÛ·ÏÔӛ΢ ÙÔ 38%. ∆· Â˘Ú‹Ì·Ù· Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ Û˘ÌʈÓÔ‡Ó Ì ·˘Ù¿ Ù˘ ‰ÈÂıÓÔ‡˜ ‚È‚ÏÈÔÁÚ·Ê›·˜. ∆· ÚÒÙ· 12 ¯ÚfiÓÈ·, ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ ·ÛıÂÓ›˜ ·Ú·¤ÌÊıËÎ·Ó ÛÙË

Abstract: In most patients with Down syndrome, the condition derives from non-familial trisomy 21 and in a few of them the extra chromosomal material is the result of Robertsonian translocation. The aim of this study was: a) investigation of the cytogenetic characteristics of the patients with Down syndrome, b) evaluation of the usual characteristics relevant to their birth control, c) evaluation of the most prevalent medical problems and their management. The files were reviewed of 533 patients with Down syndrome who had been successfully examined chromosomically between 1973 and 2001. Selectively, some of the families had been examined in order to estimate the prevalence of heredity. For each patient, record was made of the: a) sex, b) age at diagnosis, c) karyotype, d) occurrence of single or twin pregnancy, e) parents’ age at delivery, and f) residential area, and the findings were compared to those of other researchers. Girls comprised 44% and boys 56% of the group.

Chromosomal examination revealed free trisomy 21 in 90%, mosaicism in 5.5% and Robertsonian translocation in 4.5%, and among these only 1% showed heredity. The average age of the mothers was 30.5 years and of the fathers 34 years. Regarding the patients’ age at diagnosis, 4 were fetuses derived from termination of pregnancy due to prenatal diagnosis, 56% were neonates, 27% were infants and 11% were aged over 12 months. The residence of 56% of the patients was in the provinces and 38% lived in the city of Thessaloniki. The findings of this study are similar to those reported in the international bibliography.

Most of the mothers were younger than 35 years.

In the first 12 years most of the patients were referred by the attending physicians in the neonatal age (47%) and 23% of the patients were neonates from the

∂ÚÁ·ÛÙ‹ÚÈÔ ∫˘ÙÙ·ÚÔÁÂÓÂÙÈ΋˜, ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ∞.¶.£. °¶¡ “πÔÎÚ¿ÙÂÈÔ” £ÂÛÛ·ÏÔӛ΢

Cytogenetic Laboratory, 1st Paediatric Clinic of Aristotle University of Thessaloniki “Ippokration” General Hospital, Thessaloniki

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ÓÂÔÁÓÈ΋ ËÏÈΛ· (47%) Î·È ÙÔ 23% ‹Ù·Ó ÓÂÔÁÓ¿ ·fi ÙËÓ Â·Ú¯›·. ∆· ÔÛÔÛÙ¿ ·˘Ù¿ ÂÓÈÛ¯‡ıËÎ·Ó ÛËÌ·ÓÙÈο ÌÂÙ¿ ÙÔ 1985 (65% Î·È 39%, ·ÓÙ›ÛÙÔȯ·). ∞ÔηχÊıËΠÎÏËÚÔÓÔÌÈÎfiÙËÙ· Û 6 ÔÈÎÔÁ¤ÓÂȘ Î·È ‰fiıËΠηٿÏÏËÏË ÁÂÓÂÙÈ΋ ηıÔ‰‹ÁËÛË Û fiÏ· Ù· ˙¢Á¿ÚÈ·. OÈ 139/533 ·ÛıÂÓ›˜ Ù¤ıËÎ·Ó ÛÂ Û˘ÛÙËÌ·ÙÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË ÛÙÔ Â͈ÙÂÚÈÎfi È·ÙÚ›Ô.

provinces. These percentages rose markedly after 1985. Heredity was discovered in 6 families and appropriate genetic counseling was provided to all of them. Of the group, 139/533 children have been under systematic follow-up in outpatient department.

§¤ÍÂȘ ÎÏÂȉȿ: Û‡Ó‰ÚÔÌÔ Down, Û˘¯ÓfiÙËÙ·, ηڢfiÙ˘Ô˜, ÚÔÁÂÓÓËÙÈ΋ ‰È¿ÁÓˆÛË, ÂȉËÌÈÔÏÔÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο.

Key words: Down syndrome, prevalence, karyotype, prenatal diagnosis, epidemiological characteristics.

™˘ÓÙÔÌÔÁڷʛ˜

Î·Ó ÔÈ Ê¿ÎÂÏÔÈ ÔÚÈÛÌ¤ÓˆÓ ÔÈÎÔÁÂÓÂÈÒÓ ÂÍ ·˘ÙÒÓ, ÔÈ Ôԛ˜ ÂÚ¢ӋıËÎ·Ó ¯ÚˆÌÔÛˆÌÈο ÁÈ· Ó· ·ÔÎÏÂÈÛÙ› Ë ÎÏËÚÔÓÔÌÈÎfiÙËÙ·. ∫·Ù·ÁÚ¿ÊËηÓ: ·) ÙÔ Ê‡ÏÔ, ‚) Ë ËÏÈΛ· ÙˆÓ ·ÛıÂÓÒÓ Î·Ù¿ ÙË ‰È¿ÁÓˆÛË, Á) ÔÈ Î·Ú˘fiÙ˘ÔÈ: ÂχıÂÚË ÙÚÈۈ̛· (·ÌÈÁ‹˜ ÌÔÚÊ‹ ‹ ̈۷˚ÎÈÛÌfi˜), ÌÂÙ¿ıÂÛË ÎÂÓÙÚÈ΋˜ Û‡ÓÙË͢ (de novo ‹ ÎÏËÚÔÓÔÌÈ΋), ‰) ÔÈ ÌÔÓ‹ÚÂȘ ‹ ‰›‰˘Ì˜ ΢‹ÛÂȘ, Â) Ô ÙfiÔ˜ ηÙÔÈΛ·˜ (Â·Ú¯›· ‹ fiÏË Ù˘ £ÂÛÛ·ÏÔӛ΢) Î·È ÛÙ) ÔÈ ËÏÈ˘ ÙˆÓ ÁÔÓ¤ˆÓ ηٿ ÙÔÓ ÙÔÎÂÙfi. ∆Ô 1985 ÂÊ·ÚÌfiÛÙËΠÁÈ· ÚÒÙË ÊÔÚ¿ Ë ÚÔÁÂÓÓËÙÈ΋ ‰È¿ÁÓˆÛË ¯ÚˆÌÔÛˆÌÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ ÙÔ˘ ÂÌ‚Ú‡Ô˘ ÛÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ ÂÚÁ·ÛÙ‹ÚÈÔ, ÛÂ Û˘ÓÂÚÁ·Û›· Ì fiϘ ÙȘ ¶·ÓÂÈÛÙËÌȷΤ˜ Ì·È¢ÙÈΤ˜ ÎÏÈÓÈΤ˜ ÙÔ˘ “πÔÎÚ¿ÙÂÈÔ˘” ¡ÔÛÔÎÔÌ›Ԣ £ÂÛÛ·ÏÔӛ΢. ∆Ô ¤ÙÔ˜ ·˘Ùfi ¯ÚËÛÈÌÔÔÈ‹ıËΠˆ˜ ÔÚfiÛËÌÔ ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË Ù˘¯fiÓ ÌÂÙ·‚ÔÏÒÓ ÙˆÓ ·Ú·¿Óˆ ·Ú·Ì¤ÙÚˆÓ. ŒÁÈÓ ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ÙˆÓ Â˘ÚËÌ¿ÙˆÓ Ì ÙË ‰ÔÎÈÌ·Û›· ¯2. £ÂˆÚ‹ıËÎ·Ó ÛËÌ·ÓÙÈΤ˜ ÔÈ ‰È·ÊÔÚ¤˜ Ô˘ ›¯·Ó ÛÙ¿ıÌË ÛËÌ·ÓÙÈÎfiÙËÙ·˜ Ì p<0,05. ∆· Â˘Ú‹Ì·Ù· Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ Û˘ÁÎÚ›ıËÎ·Ó Ì ·˘Ù¿ ¿ÏÏˆÓ ÂÚ¢ÓËÙÒÓ. ∫˘ÙÙ·ÚÔÁÂÓÂÙÈ΋ ÌÂϤÙË ·) ¶ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜: ŒÁÈÓ ηڢfiÙ˘Ô˜ ÌÂÙ¿ ·fi ηÏÏȤÚÁÂÈ· ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ (ÌÂÏÂÙ‹ıËÎ·Ó 20-30 ÌÂÙ·Ê¿ÛÂȘ ÁÈ· οı ·ÛıÂÓ‹). ∏ Û‹Ì·ÓÛË ¤ÁÈÓ Ì G Î·È Q-banding. ‚) ∞ÌÓÈ·ÎÔ‡ ˘ÁÚÔ‡: ŒÁÈÓ ·Ó¿Ï˘ÛË 20-30 ÌÂÙ·Ê¿ÛÂˆÓ ·fi 2-3 ηÏÏȤÚÁÂȘ ·ÌÓÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ ÛÙ· 4 ¤Ì‚Ú˘· Ô˘ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÛÙËÓ ·ÚÔ‡Û· ÂÚÁ·Û›·. ∏ Û‹Ì·ÓÛË ¤ÁÈÓ Ì G Î·È Q-banding.

DS ª∫™ ∂∆

™‡Ó‰ÚÔÌÔ Down ªÂÙ¿ıÂÛË ÎÂÓÙÚÈ΋˜ Û‡ÓÙË͢ ∂χıÂÚË ÙÚÈۈ̛·

∂ÈÛ·ÁˆÁ‹ ∆Ô Û‡Ó‰ÚÔÌÔ Down (DS) Â›Ó·È Ë ÈÔ Û˘¯Ó‹ ¯ÚˆÌÔÛˆÌÈ΋ ·ÓˆÌ·Ï›· ÛÙ· ·È‰È¿ Î·È Ë ÈÔ Û˘¯Ó‹ ÁÂÓÂÙÈ΋ ·ÈÙ›· ÓÔËÙÈ΋˜ ˘ÛÙ¤ÚËÛ˘ (1-3). ™Â fiÏÔ ÙÔÓ ÎfiÛÌÔ, Ë Û˘¯ÓfiÙËÙ· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Â›Ó·È 1/800 ¤ˆ˜ 1/1000 ÁÂÓÓ‹ÛÂȘ (2). ∆· ·ÁfiÚÈ· Â›Ó·È ÂÚÈÛÛfiÙÂÚ· ·fi Ù· ÎÔÚ›ÙÛÈ· Ì ·Ó·ÏÔÁ›· 1,3/1 (3). ¶·Ï·ÈfiÙÂÚ·, Ë ÁÔÓÂ˚΋ ÚԤϢÛË ÙÔ˘ ˘ÂÚ¿ÚÈıÌÔ˘ ¯ÚˆÌ·ÙÔÛÒÌ·ÙÔ˜ 21 ÛÙËÚÈ˙fiÙ·Ó Û ΢ÙÙ·ÚÔÁÂÓÂÙÈÎÔ‡˜ ÂÙÂÚÔÌÔÚÊÈÛÌÔ‡˜ Î·È Ì ‚¿ÛË ÂΛӘ ÙȘ ÌÂϤÙ˜, ÔÛÔÛÙfi 80% ‹Ù·Ó ÌËÙÚÈ΋˜ Î·È 20% ·ÙÚÈ΋˜ ÚÔ¤Ï¢Û˘. ™‹ÌÂÚ·, fï˜, Ì ÙÔ˘˜ ÔÏ˘ÌÔÚÊÈÛÌÔ‡˜ ÙÔ˘ DNA ‚Ú¤ıËΠfiÙÈ ÔÛÔÛÙfi 95% Â›Ó·È ÌËÙÚÈ΋˜ ÚÔ¤Ï¢Û˘ Î·È ÌfiÓÔÓ 5% ·ÙÚÈ΋˜ (1,410). O ΛӉ˘ÓÔ˜ Ô˘ ·ÓÙÈÌÂÙˆ›˙ÂÈ Ì›· Á˘Ó·›Î· ËÏÈΛ·˜ 35-39 ÂÙÒÓ Ó· ·ÔÎÙ‹ÛÂÈ ·È‰› Ì ÙÚÈۈ̛· 21 Â›Ó·È 6,5 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚÔ˜ ·fi ·˘ÙfiÓ Ì›·˜ ¿ÏÏ˘ ËÏÈΛ·˜ 20-24 ÂÙÒÓ. ∞˘Ù‹ Ë ·Ó·ÏÔÁ›· Êı¿ÓÂÈ ÛÙÔ 20,5 ÁÈ· Á˘Ó·›Î˜ ËÏÈΛ·˜ 40-44 ÂÙÒÓ. ∞ÔÙ¤ÏÂÛÌ· Â›Ó·È fiÙÈ ÔÈ Á˘Ó·›Î˜ ËÏÈΛ·˜ ÌÂÁ·Ï‡ÙÂÚ˘ ÙˆÓ 35 ¯ÚfiÓˆÓ Î˘ÔÊÔÚÔ‡Ó ÙÔ 20-25% ÙˆÓ ÂÌ‚Ú‡ˆÓ Ì DS, fï˜ ÛÙËÓ ËÏÈΛ· ·˘Ù‹ ·Ó·ÏÔÁ› ÌfiÓÔ ÙÔ 7% ÙˆÓ Î˘‹ÛÂˆÓ (2,11-14). ™ÎÔfi˜ Ù˘ ÂÚÁ·Û›·˜ ‹Ù·Ó Ó· ‰ÈÂÚ¢ӋÛÂÈ Ù· ΢ÙÙ·ÚÔÁÂÓÂÙÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ·ÛıÂÓÒÓ, ÙËÓ ËÏÈΛ· ÎÏÈÓÈ΋˜ ‰È¿ÁÓˆÛ˘ Î·È ·Ú·ÔÌ‹˜ Û ۯ¤ÛË Ì ÙËÓ ÚfiÔ‰Ô ÙˆÓ ÂÙÒÓ Î·È ÙÔÓ ÙfiÔ Î·ÙÔÈΛ·˜, ÙËÓ ËÏÈΛ· ÙˆÓ ÁÔÓ¤ˆÓ ηٿ ÙÔÓ ÙÔÎÂÙfi ηÈ, Ù¤ÏÔ˜, Ó· Û˘Ì‚¿ÏÂÈ: ·) ÛÙËÓ ÚfiÏË„Ë Á¤ÓÓËÛ˘ ·È‰ÈÒÓ Ì DS Î·È ‚) ÛÙËÓ ÚÒÈÌË ·Ú¤Ì‚·ÛË Û Â›Â‰Ô ÚˆÙÔ‚¿ıÌÈ·˜ ÂÚ›ı·Ï„˘. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ∞Ó·ÛÎÔ‹ıËÎ·Ó ÔÈ Ê¿ÎÂÏÔÈ 533 ·ÛıÂÓÒÓ Ì DS (¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ˆ˜ “·ÛıÂÓ›˜”, ηıÒ˜ Ë ËÏÈÎȷ΋ ÙÔ˘˜ ηٷÓÔÌ‹ Â›Ó·È ·fi 0-50 ÂÙÒÓ) Ô˘ ÂÚ¢ӋıËÎ·Ó ÂÈÙ˘¯Ò˜ ¯ÚˆÌÔÛˆÌÈο ÛÙÔ ÂÚÁ·ÛÙ‹ÚÈÔ Ù· ¤ÙË 1973-2001. ∂›Û˘, ·Ó·ÛÎÔ‹ıË-

462

∞ÔÙÂϤÛÌ·Ù· ∞fi ÙÔ˘˜ 533 ·ÛıÂÓ›˜, 292 (56%) ‹Ù·Ó ·ÁfiÚÈ· Î·È 235 (44%) ‹Ù·Ó ÎÔÚ›ÙÛÈ·. ∏ Û¯¤ÛË ·ÁfiÚÈ·/ÎÔÚ›ÙÛÈ· ‹Ù·Ó 1,3/1 (∂ÈÎfiÓ· 1). ∞ÌÈÁ‹ ÂχıÂÚË ÙÚÈۈ̛· ›¯·Ó 478/533 (90%), ̈۷˚ÎÈÛÌfi 30/533 (5,5%), ª∫™ 25/533 (4,5%) ηÈ, ÌÂÙ¿ ÙÔÓ ¤ÏÂÁ¯Ô ÙˆÓ ÁÔÓ¤ˆÓ ÙÔ˘˜, Ê¿ÓËΠfiÙÈ ÎÏËÚÔÓÔÌÈÎfiÙËÙ· ˘‹Ú¯Â ÌfiÓÔ Û 6/25 (1%) (∂ÈÎfiÓ· 2). ¢ÈÏ‹ ¯ÚˆÌÔÛˆÌÈ΋ ·Ù˘›· ›¯·Ó 2 ·ÛıÂÓ›˜: 48,ÃÃÃ,+21 Î·È 46,ÃÀ,-13,-14,+t(13;14),+21. ¢›‰˘Ì˜ ΢‹ÛÂȘ ‹Ù·Ó 8, ÂÓÒ ÌfiÓÔ Û ̛· ›¯·Ó Î·È Ù· ‰‡Ô ·È‰È¿ DS. ª›· ÔÈÎÔÁ¤ÓÂÈ· ·¤ÎÙËÛ 2 ·È‰È¿ Ì ÂχıÂÚË ÙÚÈۈ̛· Û ‰‡Ô ‰È·ÊÔÚÂÙÈΤ˜ ΢‹ÛÂȘ Î·È ÔÈ ÁÔÓ›˜ ›¯·Ó Ê˘ÛÈÔÏÔÁÈÎfi ηڢfiÙ˘Ô ÛÙÔ ÂÚÈÊÂÚÈÎfi ·›Ì·, Û Â·ÓÂÈÏËÌ̤Ó˜ ηÏÏȤÚÁÂȘ

¶·È‰È·ÙÚÈ΋ 2003;66:461-466

Paediatriki 2003;66:461-466

ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Î·È ÌÂÁ¿ÏÔ ·ÚÈıÌfi ÌÂÙ·Ê¿ÛˆÓ. ŸÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ËÏÈΛ· ÙˆÓ ·ÛıÂÓÒÓ Î·Ù¿ ÙË ‰È¿ÁÓˆÛË, 4 ‹Ù·Ó ¤Ì‚Ú˘· ·fi ‰È·ÎÔ‹ ·ËÛ˘ ÌÂÙ¿ ·fi ·ÌÓÈÔΤÓÙËÛË (Û ÚÔÁÂÓÓËÙÈÎfi ¤ÏÂÁ¯Ô ÏfiÁˆ ÚÔ¯ˆÚË̤Ó˘ ËÏÈΛ·˜ Ù˘ ÌËÙ¤Ú·˜ ‹ ÌËÙ¤Ú·˜ ÊÔÚ¤· ÌÂÙ¿ıÂÛ˘), 298/533 (56%) ‹Ù·Ó ÓÂÔÁÓ¿, 144/533 (27%) ‹Ù·Ó ‚Ú¤ÊË Î·È 58/533 (11%) ‹Ù·Ó ·ÛıÂÓ›˜ ËÏÈΛ·˜ ÌÂÁ·Ï‡ÙÂÚ˘ ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜ (150 ÂÙÒÓ). ™Â 33/533 (6%) ·ÛıÂÓ›˜, Ë ËÏÈΛ· ‰ÂÓ ‹Ù·Ó ηٷÁÂÁÚ·Ì̤ÓË (∂ÈÎfiÓ· 3). ∞fi ÙËÓ Â·Ú¯›· ·Ú·¤ÌÊıËÎ·Ó 289/533 ·ÛıÂÓ›˜ (54%) Î·È ·fi ÙËÓ fiÏË Ù˘ £ÂÛÛ·ÏÔӛ΢ 202/533 (38%). °È· 42/533 (8%) ‰ÂÓ ‹Ù·Ó ηٷÁÂÁÚ·Ì̤ÓÔ˜ Ô ÙfiÔ˜ ηÙÔÈΛ·˜. ™Â Û¯¤ÛË Ì ÙËÓ ËÏÈΛ· ÙÔ˘˜, ·fi ÙËÓ Â·Ú¯›· ·Ú·¤ÌÊıËÎ·Ó 160 ÓÂÔÁÓ¿ (30%), 98 ‚Ú¤ÊË (18%) Î·È 31 ·È‰È¿ ËÏÈΛ·˜ ÌÂÁ·Ï‡ÙÂÚ˘ ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜ (6%), ÂÓÒ ·fi

ÙËÓ fiÏË Ù˘ £ÂÛÛ·ÏÔӛ΢ 125 ÓÂÔÁÓ¿ (23%), 51 ‚Ú¤ÊË (10%) Î·È 26 ·È‰È¿ ËÏÈΛ·˜ ÌÂÁ·Ï‡ÙÂÚ˘ ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜ (5%) (∂ÈÎfiÓ· 4). ¶ÚÈÓ ·fi ÙÔ 1985 ·Ú·¤ÌÊıËÎ·Ó ÁÈ· ¤ÏÂÁ¯Ô 220 ·ÛıÂÓ›˜, 103 ·fi ÙÔ˘˜ ÔÔ›Ô˘˜ ‹Ù·Ó ÓÂÔÁÓ¿ (47%), 87 ‹Ù·Ó ‚Ú¤ÊË (37%) Î·È 25 ‹Ù·Ó ·È‰È¿ ËÏÈΛ·˜ ÌÂÁ·Ï‡ÙÂÚ˘ ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜ (11%). ªÂÙ¿ ÙÔ 1986 ·Ú·¤ÌÊıËÎ·Ó 281 ·ÛıÂÓ›˜, 182 ·fi ÙÔ˘˜ ÔÔ›Ô˘˜ ‹Ù·Ó ÓÂÔÁÓ¿ (65%), 67 ‹Ù·Ó ÌÈÎÚ¿ ‚Ú¤ÊË (24%) Î·È 32 ‹Ù·Ó ·È‰È¿ ËÏÈΛ·˜ ÌÂÁ·Ï‡ÙÂÚ˘ ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜ (11%) (∂ÈÎfiÓ· 5). ¶ÚÈÓ ·fi ÙÔ 1985 ·Ú·¤ÌÊıËÎ·Ó ·fi ÙËÓ Â·Ú¯›· 110/220 ·ÛıÂÓ›˜ (55%) Î·È ÌÂÙ¿ ÙÔ 1986 179/281 (63%), ÂÓÒ ·fi ÙËÓ fiÏË Ù˘ £ÂÛÛ·ÏÔӛ΢ ·Ú·¤ÌÊıËÎ·Ó 100/220 (45%) Î·È 102/281 (36%), ·ÓÙ›ÛÙÔȯ· (∂ÈÎfiÓ· 6).

40%

∂·Ú¯›· £ÂÛÛ·ÏÔÓ›ÎË

35% 30%

∞ÁfiÚÈ· 44%

30%

56% ∫ÔÚ›ÙÛÈ·

25%

23%

20%

18%

∂ÈÎfiÓ· 1. ™¯¤ÛË ÙˆÓ ·ÁÔÚÈÒÓ ÚÔ˜ Ù· ÎÔÚ›ÙÛÈ·.

15% 10% 10% 6%

∂∆ - ·ÌÈÁ‹˜ ÌÔÚÊ‹

1%

5%

5% ∂∆ - ̈۷˚ÎÈÛÌfi˜

3,5%

0% ¡ÂÔÁÓ¿

ª∫™ de novo 5,5%

90%

µÚ¤ÊË

¶·È‰È¿

∂ÈÎfiÓ· 4. ∏ÏÈÎȷ΋ ηٷÓÔÌ‹ ηٿ ÙË ‰È¿ÁÓˆÛË Û ۯ¤ÛË Ì ÙÔÓ ÙfiÔ ‰È·ÌÔÓ‹˜.

ª∫™ ÎÏËÚÔÓÔÌÈ΋ 80% 70% ∂ÈÎfiÓ· 2. ÃÚˆÌÔÛˆÌÈο ¯·Ú·ÎÙËÚÈÛÙÈο (∂∆: ÂχıÂÚË ÙÚÈۈ̛·, ª∫™: ÌÂÙ¿ıÂÛË ÎÂÓÙÚÈ΋˜ Û‡ÓÙË͢).

60% 50% 40%

6%

30%

11%

¡ÂÔÁÓ¿ µÚ¤ÊË

27%

¶·È‰È¿ ÕÁÓˆÛÙ· 56%

∂ÈÎfiÓ· 3. ∫·Ù·ÓÔÌ‹ ηٿ ËÏÈ˘ ÛÙË ‰È¿ÁÓˆÛË.

65% 47% 37%

20%

11%

10% 0%

24% 11%

Ë È¿ Ó¿ ÔÁ µÚ¤Ê ¶·È‰ ¡Â 1973-1985

Ë È¿ Ó¿ ÔÁ µÚ¤Ê ¶·È‰ ¡Â 1986-2001

∂ÈÎfiÓ· 5. ∞ÏÏ·Á¤˜ ÛÙËÓ ËÏÈÎȷ΋ ηٷÓÔÌ‹ ηٿ ÙË ‰È¿ÁÓˆÛË Ì ÙËÓ ÚfiÔ‰Ô ÙˆÓ ÂÙÒÓ (ÓÂÔÁÓ¿: p=0,001, ‚Ú¤ÊË: p<0,005).

463

¶·È‰È·ÙÚÈ΋ 2003;66:461-466

Paediatriki 2003;66:461-466

∞ӷχÔÓÙ·˜ ÂÚ·ÈÙ¤Úˆ ÙËÓ ËÏÈΛ· ·Ú·ÔÌ‹˜ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙÔÓ ÙfiÔ Î·ÙÔÈΛ·˜ ‰È·ÈÛÙÒıËΠfiÙÈ ÚÈÓ ·fi ÙÔ 1985 ·fi ÙËÓ Â·Ú¯›· ‹Ù·Ó 50/220 ÓÂÔÁÓ¿ (23%), 50/220 ‚Ú¤ÊË (23%) Î·È 10/220 ·È‰È¿ ËÏÈΛ·˜ ÌÂÁ·Ï‡ÙÂÚ˘ ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜ (5%), ÂÓÒ ÌÂÙ¿ ÙÔ 1986 ÓÂÔÁÓ¿ ‹Ù·Ó 110/281 (39%), ‚Ú¤ÊË 48/281 (17%) Î·È ·È‰È¿ ËÏÈΛ·˜ ÌÂÁ·Ï‡ÙÂÚ˘ ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜ ‹Ù·Ó 21/281 (7%). ∞fi ÙËÓ fiÏË Ù˘ £ÂÛÛ·ÏÔӛ΢ ÚÈÓ ·fi ÙÔ 1985 ‹Ù·Ó 53/220 ÓÂÔÁÓ¿ (24%), 32/220 ‚Ú¤ÊË (15%) Î·È 15/220 ·È‰È¿ ËÏÈΛ·˜ ÌÂÁ·Ï‡ÙÂÚ˘ ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜ (7%), ÂÓÒ ÌÂÙ¿ ÙÔ 1986 ÓÂÔÁÓ¿ ‹Ù·Ó 72/281 (26%), ‚Ú¤ÊË 19/281 (7%) Î·È ·È‰È¿ ËÏÈΛ·˜ ÌÂÁ·Ï‡ÙÂÚ˘ ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜ ‹Ù·Ó 11/281 (4%) (∂ÈÎfiÓ· 7). ∞Ó·ÊÔÚÈο Ì ÙËÓ ËÏÈΛ· ÙˆÓ ÌËÙ¤ÚˆÓ Î·Ù¿ ÙÔÓ ÙÔÎÂÙfi, ÏËÚÔÊÔڛ˜ ˘‹Ú¯·Ó ÁÈ· 460/533. OÈ 105/460 ‹Ù·Ó ÌÈÎÚfiÙÂÚ˜ ÙˆÓ 25 ÂÙÒÓ (23%), 146/460 ‹Ù·Ó 25-30 ÂÙÒÓ (32%), 104/460 ‹Ù·Ó 30-35 ÂÙÒÓ (23%) Î·È 104/560 ›¯·Ó ËÏÈΛ· ÌÂÁ·Ï‡ÙÂÚË ÙˆÓ 35 ÂÙÒÓ (22%) (∂ÈÎfiÓ· 8). ŒÁÈÓ ·Ó¿Ï˘ÛË Ù˘ ËÏÈΛ·˜ ÙˆÓ ÌËÙ¤ÚˆÓ ÚÈÓ Î·È ÌÂÙ¿ ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ÚÔÁÂÓÓËÙÈÎÔ‡ ÂϤÁ¯Ô˘ Î·È ‰È·ÈÛÙÒıËΠfiÙÈ ÚÈÓ ·fi ÙÔ 1985 55/193 ‹Ù·Ó ÌÈÎÚfiÙÂÚ˜ ÙˆÓ 25 ÂÙÒÓ (28%), 47/193 ‹Ù·Ó 25-30 ÂÙÒÓ (24%), 39/193 ‹Ù·Ó 30-35 ÂÙÒÓ (20%) Î·È 52/193 ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚ˜ ÙˆÓ 35 ÂÙÒÓ (27%). ªÂÙ¿ ÙÔ 1986, 50/267 ‹Ù·Ó ÌÈÎÚfiÙÂÚ˜ ÙˆÓ 25 ÂÙÒÓ (19%), 98/267 ‹Ù·Ó 25-30 ÂÙÒÓ (37%), 65/267 ‹Ù·Ó 30-35 ÂÙÒÓ (24%) Î·È 54/267 ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚ˜ ÙˆÓ 35 ÂÙÒÓ (20%) (∂ÈÎfiÓ· 9). ™˘˙‹ÙËÛË ™ÙË ‚È‚ÏÈÔÁÚ·Ê›· ·Ó·Ê¤ÚÂÙ·È fiÙÈ ·fi ÙÔ˘˜ ·ÛıÂÓ›˜ Ì ۇӉÚÔÌÔ Down, 95% ¤¯ÂÈ ÂχıÂÚË 0,85

∂·Ú¯›·

0,75

£ÂÛÛ·ÏÔÓ›ÎË

0,65

ÙÚÈۈ̛·, 1% ̈۷˚ÎÈÛÌfi Î·È 3-4% ÌË ÈÛÔ˙˘ÁÈṲ̂ÓË ÌÂÙ¿ıÂÛË ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ 21 Î·È ÂÓfi˜ ·ÎÚÔÎÂÓÙÚÈÎÔ‡ ¯ÚˆÌÔÛÒÌ·ÙÔ˜, Û˘Ó‹ıˆ˜ ÙÔ˘ 14. ªfiÓÔ ÙÔ Å/4 ÙˆÓ ÌÂÙ·ı¤ÛÂˆÓ Â›Ó·È ÎÏËÚÔÓÔÌÈΤ˜ Î·È ÔÈ ˘fiÏÔÈ˜ Â›Ó·È de novo (3,15-17). ∆· ΢ÙÙ·ÚÔÁÂÓÂÙÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ·ÛıÂÓÒÓ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ Û˘ÌʈÓÔ‡Ó Ì ·˘Ù¿ Ù˘ ‰ÈÂıÓÔ‡˜ ‚È‚ÏÈÔÁÚ·Ê›·˜: 95,5% ›¯Â ÂχıÂÚË ÙÚÈۈ̛·, 4,5% ›¯Â ª∫™ ηÈ, ·fi ·˘ÙÔ‡˜, ÎÏËÚÔÓÔÌÈ΋ ÌÂÙ¿ıÂÛË Â›¯·Ó ÌfiÓÔ 6/533 ·ÛıÂÓ›˜ (1%) (∂ÈÎfiÓ· 2).

OÈ ÔÈÎÔÁ¤ÓÂȘ ÙˆÓ ·ÛıÂÓÒÓ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‰¤¯ıËÎ·Ó Î·Ù¿ÏÏËÏË ÁÂÓÂÙÈ΋ ηıÔ‰‹ÁËÛË, ÂÓÒ ‰ÈÂÚ¢ӋıËÎ·Ó Î˘ÙÙ·ÚÔÁÂÓÂÙÈο Ù· ̤ÏË ÙˆÓ ÔÈÎÔÁÂÓÂÈÒÓ ÙˆÓ ·ÛıÂÓÒÓ ÛÙÔ˘˜ ÔÔ›Ô˘˜ ‰È·ÈÛÙÒıËΠÎÏËÚÔÓÔÌÈÎfiÙËÙ·. ªÂ ·˘ÙfiÓ ÙÔÓ ÙÚfiÔ ÂÓËÌÂÚÒıËÎ·Ó ÔÈ Û˘ÁÁÂÓ›˜ ÊÔÚ›˜ ÁÈ· ÙË ÛˆÛÙ‹ ·ÓÙÈÌÂÙÒÈÛË Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ·Ó··Ú·ÁˆÁ‹˜, ‰ËÏ·‰‹ ÙËÓ ·Ó·ÁηÈfiÙËÙ· Ù˘ ‰ÈÂÓ¤ÚÁÂÈ·˜ ÚÔÁÂÓÓËÙÈ΋˜ ‰È¿ÁÓˆÛ˘ ÛÙÔ Î‡ËÌ¿ ÙÔ˘˜ (18). ∏ ËÏÈΛ· Ù˘ ‰È¿ÁÓˆÛ˘, ·ÓÂÍ·Úًو˜ ¿ÏÏˆÓ ·Ú·Ì¤ÙÚˆÓ, ‹Ù·Ó ΢ڛˆ˜ Ë ÓÂÔÁÓÈ΋. ¶ÂÚÈÛÛfiÙÂÚÔÈ ·fi ÙÔ˘˜ ÌÈÛÔ‡˜ ·ÛıÂÓ›˜ ·Ú·¤ÌÊıËÎ·Ó ÁÈ· ¤ÏÂÁ¯Ô ÛÙË ÓÂÔÁÓÈ΋ ËÏÈΛ· (56%), Ï›ÁÔÈ ÛÙË ‚ÚÂÊÈ΋ (27%) Î·È ·ÎfiÌË ÏÈÁfiÙÂÚÔÈ (11%) ÌÂÙ¿ ÙËÓ ËÏÈΛ· ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜ (1-50 ÂÙÒÓ) (∂ÈÎfiÓ· 3). ŸÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ËÏÈΛ·, Ë Î·Ù·ÓÔÌ‹ ÙˆÓ ·ÛıÂÓÒÓ ‰ÂÓ ÙÚÔÔÔÈ‹ıËΠ۠ۯ¤ÛË Ì ÙÔÓ ÙfiÔ Î·ÙÔÈΛ·˜ ηٿ Ù· ¤ÙË 1973-2001. ¢ËÏ·‰‹, ÙfiÛÔ ·fi ÙËÓ Â·Ú¯›· fiÛÔ Î·È ·fi ÙËÓ fiÏË Ù˘ £ÂÛÛ·ÏÔӛ΢, ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ ·ÛıÂÓ›˜ ‹Ù·Ó ÓÂÔÁÓ¿ Î·È ÔÈ ÏÈÁfiÙÂÚÔÈ ‹Ù·Ó ·È‰È¿ ËÏÈΛ·˜ ÌÂÁ·Ï‡ÙÂÚ˘ ÙÔ˘ 1 ¤ÙÔ˘˜ (∂ÈÎfiÓ· 4). ™ÙËÓ ·ÚÔ‡Û· ÂÚÁ·Û›· ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Û·Ó ÔÚfiÛËÌÔ ÙÔ ¤ÙÔ˜ 1985, ηٿ ÙÔ ÔÔ›Ô ¿Ú¯ÈÛÂ Ë ÂÊ·ÚÌÔÁ‹ Ù˘ ÚÔÁÂÓÓËÙÈ΋˜ ‰È¿ÁÓˆÛ˘ ¯ÚˆÌÔÛˆÌÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ ÙÔ˘ ÂÌ‚Ú‡Ô˘ ÛÙÔ ÓÔÛÔÎÔÌ›Ô. ∆Ô ¤ÙÔ˜ ·˘Ùfi ·ÔÙ¤ÏÂÛ ÛÙ·ıÌfi ·ÏÏ·Á‹˜ ÛÙËÓ Î·ıËÌÂÚÈÓ‹ Ú·ÎÙÈ΋ ·ÓÙÈÌÂÙÒÈÛ˘ ÙˆÓ ÂÁ·ˆÓ

0,55

50%

0,45

40%

63% 0,35

30%

55% 45% 36%

0,15

15% 5% 7%

10% 0%

0,05

¡ÂÔÁÓ¿

µÚ¤ÊË

1973-1985

-0,05 1973-1985

1986-2001

∂ÈÎfiÓ· 6. ∞ÏÏ·Á¤˜ ÛÙÔÓ ·ÚÈıÌfi ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ·Ú·¤ÌÊıËÎ·Ó Û ۯ¤ÛË Ì ÙÔÓ ÙfiÔ ‰È·ÌÔÓ‹˜ ÚÈÓ Î·È ÌÂÙ¿ ÙÔ 1985 (Â·Ú¯›·: p<0,05, £ÂÛÛ·ÏÔÓ›ÎË: p<0,05).

39%

24% 23% 23%

20%

0,25

464

∂·Ú¯›· £ÂÛÛ·ÏÔÓ›ÎË

26% 17% 7%

¶·È‰È¿ ¡ÂÔÁÓ¿ µÚ¤ÊË

7%4% ¶·È‰È¿

1986-2001

∂ÈÎfiÓ· 7. ∞ÏÏ·Á¤˜ ÛÙÔÓ ·ÚÈıÌfi ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ·Ú·¤ÌÊıËÎ·Ó Û ۯ¤ÛË Ì ÙËÓ ËÏÈΛ· Î·È ÙÔÓ ÙfiÔ ‰È·ÌÔÓ‹˜ ÚÈÓ Î·È ÌÂÙ¿ ÙÔ 1985 (ÓÂÔÁÓ¿ ·fi ÙËÓ Â·Ú¯›·: p<0,001, ‚Ú¤ÊË ·fi ÙË £ÂÛÛ·ÏÔÓ›ÎË: p<0,005).

¶·È‰È·ÙÚÈ΋ 2003;66:461-466

Paediatriki 2003;66:461-466

Á˘Ó·ÈÎÒÓ Ì ˘„ËÏfi ΛӉ˘ÓÔ ÁÈ· ¯ÚˆÌÔÛˆÌÈÎfi Úfi‚ÏËÌ· ÛÙË µfiÚÂÈ· ∂ÏÏ¿‰·. ∆Ô Û˘ÁÎÂÎÚÈ̤ÓÔ ÂÚÁ·ÛÙ‹ÚÈÔ Û˘ÛÙÂÁ¿˙ÂÙ·È ÛÙÔ ›‰ÈÔ ÓÔÛÔÎÔÌÂ›Ô Ì fiϘ ÙȘ Ì·È¢ÙÈΤ˜ ÎÏÈÓÈΤ˜ ÙÔ˘ ∞.¶.£. Î·È ·fi fi,ÙÈ ‹Ù·Ó ÁÓˆÛÙfi ‰ÂÓ ˘‹Ú¯Â ·ÔÛÙÔÏ‹ ‰ÂÈÁÌ¿ÙˆÓ ·ÌÓÈ·ÎÔ‡ ˘ÏÈÎÔ‡ Û ȉȈÙÈο ÂÚÁ·ÛÙ‹ÚÈ· ÂÓÙfi˜ Î·È ÂÎÙfi˜ ∂ÏÏ¿‰·˜ ÙËÓ ›‰È· ÂÚ›Ô‰Ô. ªÂ ·˘Ù¿ Ù· ‰Â‰Ô̤ӷ ÂÎÙÈÌ‹ıËÎÂ Ë Û˘Ì‚ÔÏ‹ Ù˘ ÌÂϤÙ˘ ÛÙÔÓ ‚ÔÚÂÈÔÂÏÏ·‰ÈÎfi ¯ÒÚÔ, fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÂÎ·›‰Â˘ÛË ÙˆÓ ·È‰È¿ÙÚˆÓ Î·È ÙˆÓ Ì·ÈÂ˘Ù‹ÚˆÓ. ¶ÚÈÓ ·fi ÙÔ 1985, ÏÈÁfiÙÂÚ· ·fi Ù· ÌÈÛ¿ ·È‰È¿ Ô˘ ·Ú·¤ÌÊıËÎ·Ó ‹Ù·Ó ÓÂÔÁÓ¿ (47%), 37% ‹Ù·Ó ‚Ú¤ÊË Î·È ÌfiÓÔÓ 11% ‹Ù·Ó ËÏÈΛ·˜ ÌÂÁ·Ï‡ÙÂÚ˘ ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜. ªÂÙ¿ ÙÔ 1986, fï˜, Ù· ÓÂÔÁÓ¿ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ÂÚÈÛÛfiÙÂÚ· (65%, p=0,001), Ù· ‚Ú¤ÊË ÛËÌ·ÓÙÈο ÏÈÁfiÙÂÚ· (24%, p<0,005), ÂÓÒ ÙÔ ÔÛÔÛÙfi ÙˆÓ ·È‰ÈÒÓ Ô˘ ‹Ù·Ó ËÏÈΛ·˜ ÌÂÁ·Ï‡ÙÂÚ˘ ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜ ‰ÂÓ ÌÂÙ·‚Ï‹ıËΠ(11%) (∂ÈÎfiÓ· 5). ªÂÙ¿ ÙÔ 1986 ·Ú·ÙËÚ‹ıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ·Ú·¤ÌÊıËÎ·Ó ·fi ÙËÓ Â·Ú¯›· (·fi 55% Û 63%, p<0,05), ÂÓÒ ·ÓÙ›ıÂÙ· ·Ú·ÙËÚ‹ıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ Ì›ˆÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ·Ú·¤ÌÊıËÎ·Ó ·fi ÙËÓ fiÏË Ù˘ £ÂÛÛ·ÏÔӛ΢ (·fi 45% Û 36%, p<0,05) (∂ÈÎfiÓ· 6). ™ÙËÓ ∂ÈÎfiÓ· 7 Ê·›ÓÂÙ·È, ·ÎfiÌË, fiÙÈ ÌÂÙ¿ ÙÔ 1986 ˘‹Ú¯Â ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË ÙˆÓ ÓÂÔÁÓÒÓ Ô˘ ·Ú·¤ÌÊıËÎ·Ó ·fi ÙËÓ Â·Ú¯›· (·fi 23% Û 39%, p<0,001) Î·È ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ Ì›ˆÛË ÙˆÓ ‚ÚÂÊÒÓ Ô˘ ·Ú·¤ÌÊıËÎ·Ó ·fi ÙËÓ fiÏË Ù˘ £ÂÛÛ·ÏÔӛ΢ (·fi 15% Û 7%, p<0,005). OÈ ·ÛıÂÓ›˜ ÙˆÓ ¿ÏÏˆÓ ËÏÈÎÈÒÓ ‰ÂÓ Â›¯·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿. ∆· Â˘Ú‹Ì·Ù· Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ÂÚÌËÓ‡ıËÎ·Ó Ì ‚¿ÛË ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ì ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ÚÔÁÂÓÓËÙÈÎÔ‡ ÂϤÁ¯Ô˘ ÛÙÔ ÓÔÛÔÎÔÌ›Ô, ÔÈ ÁÈ·ÙÚÔ› Ô˘ ÂȉÈ·ÔÓÙ·È ÛÙȘ ¶·ÓÂÈÛÙËÌȷΤ˜ ÎÏÈÓÈΤ˜

¢·ÈÛıËÙÔÔÈ‹ıËÎ·Ó ÛÙËÓ ÚÒÈÌË ‰È¿ÁÓˆÛË ÙÔ˘ DS. ªÂ ÙËÓ ÚfiÔ‰Ô ÙˆÓ ÂÙÒÓ ÛÙÂϤ¯ˆÛ·Ó ÙËÓ Â·Ú¯›·, ÒÛÙ ӷ ·Ú·¤ÌÔÓÙ·È ¤ÁηÈÚ· Ù· ·È‰È¿. ∏ ‰È·›ÛÙˆÛË ·˘Ù‹ Û˘ÌʈÓ› Ì ÚÔËÁÔ‡ÌÂÓ˜ ‰ËÌÔÁÚ·ÊÈΤ˜ ÌÂϤÙ˜ ÛÙÔÓ ÂÏÏËÓÈÎfi ¯ÒÚÔ (19,20). ªÂÙ¿ ÙË ‰È¿ÁÓˆÛË, 139/533 ·ÛıÂÓ›˜ ÂÓÙ¿¯ıËÎ·Ó ÛÙÔ ÚfiÁÚ·ÌÌ· ÚˆÙÔ‚¿ıÌÈ·˜ ·Ú·ÎÔÏÔ‡ıËÛ˘ ·È‰ÈÒÓ Ì DS ÛÙ· ÂȉÈο Â͈ÙÂÚÈο È·ÙÚ›·. ∞ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó ÔÚÁ·ÓÈο ÚÔ‚Ï‹Ì·Ù· ηٿ ÙË ÓÂÔÁÓÈ΋ ÂÚ›Ô‰Ô (Û˘ÁÁÂÓ›˜ ηډÈÔ¿ıÂȘ, Û˘ÁÁÂÓ‹˜ ηٷÚÚ¿ÎÙ˘, ·ÙÚËÛ›· ‰ˆ‰Âη‰·ÎÙ‡ÏÔ˘, Û˘ÁÁÂÓ‹˜ ˘Ôı˘ÚÂÔÂȉÈÛÌfi˜), ÂÓËÌÂÚÒıËÎ·Ó ÔÈ ÁÔÓ›˜ ÁÈ· ÙȘ ‰È·Ù·Ú·¯¤˜ Ô˘ Â›Ó·È Û˘¯ÓfiÙÂÚ˜ ÛÙ· ·È‰È¿ Ì DS Î·È ÙÔ˘˜ ‰fiıËÎ·Ó Ô‰ËÁ›Â˜ ÁÈ· ÙËÓ ¤ÓÙ·ÍË ÙˆÓ ·È‰ÈÒÓ Û ÂȉÈο ÚÔÁÚ¿ÌÌ·Ù· ÂÎ·›‰Â˘Û˘ (3,15-16). ∏ÏÈÎȷο, ÔÈ ÂÚÈÛÛfiÙÂÚ˜ ÌËÙ¤Ú˜ ‹Ù·Ó Ӥ˜. ∏ ̤ÛË ËÏÈΛ· ÙˆÓ ÌËÙ¤ÚˆÓ ‹Ù·Ó Ù· 30,5 ¤ÙË Î·È ÙˆÓ ·Ù¤ÚˆÓ Ù· 34 ¤ÙË. ∆Ô 78% ÙˆÓ ÌËÙ¤ÚˆÓ ÛÙË ‰È¿ÚÎÂÈ· fiÏˆÓ ÙˆÓ ÂÙÒÓ Û˘ÓÔÏÈο ›¯Â ËÏÈΛ· ÌÈÎÚfiÙÂÚË ÙˆÓ 35 ÂÙÒÓ Î·È ÌfiÓÔ ÙÔ 22% ›¯Â ËÏÈΛ· ÌÂÁ·Ï‡ÙÂÚË ÙˆÓ 35 ÂÙÒÓ (∂ÈÎfiÓ· 8). ∆· ÔÛÔÛÙ¿ ‰ÂÓ ÌÂÙ·‚Ï‹ıËÎ·Ó ÌÂÙ¿ ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ÚÔÁÂÓÓËÙÈÎÔ‡ ÂϤÁ¯Ô˘, ‰ËÏ·‰‹ ÚÈÓ ·fi ÙÔ 1985 ÙÔ 72% ÙˆÓ ÌËÙ¤ÚˆÓ ‹Ù·Ó ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ 35 ÂÙÒÓ Î·È ÌÂÙ¿ ÙÔ 1986 ÙÔ 80% ÙˆÓ ÌËÙ¤ÚˆÓ ‹Ù·Ó ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ 35 ÂÙÒÓ. ∆Ô ÔÛÔÛÙfi ÙˆÓ ÌËÙ¤ÚˆÓ ËÏÈΛ·˜ ÌÂÁ·Ï‡ÙÂÚ˘ ÙˆÓ 35 ÂÙÒÓ ‹Ù·Ó 27% Î·È ¤ÁÈÓ 20%, ·ÓÙ›ÛÙÔȯ· (‰È·ÊÔÚ¿ ÌË ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋). ™Ù·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË ˘‹ÚÍ ÌfiÓÔ ÛÙÔÓ ·ÚÈıÌfi ÙˆÓ ÌËÙ¤ÚˆÓ ËÏÈΛ·˜ 2530 ÂÙÒÓ (·fi 24% Û 37%, p=0,006) (∂ÈÎfiÓ· 9). ∞˘Ù‹ Ë ·Ú·Ù‹ÚËÛË ÂȂ‚·ÈÒÓÂÈ ÙË ÁÓÒÛË fiÙÈ Ù· ÂÚÈÛÛfiÙÂÚ· ·È‰È¿ Ì DS ÁÂÓÓÈÔ‡ÓÙ·È ·fi Á˘Ó·›Î˜ Ó¤ˆÓ ËÏÈÎÈÒÓ (<35 ÂÙÒÓ), ÛÙȘ Ôԛ˜ ‰ÂÓ ˘¿Ú¯ÂÈ ¤Ó‰ÂÈÍË ÂÂÌ‚·ÙÈ΋˜ ÌÂıfi‰Ô˘ ÚÔÁÂÓÓËÙÈ΋˜ ‰È¿ÁÓˆÛ˘ (·ÌÓÈÔ·Ú·Î¤ÓÙËÛ˘ ‹ Ï¿¯Ó˘), ·Ú¿ ÌfiÓÔ Ù· screening tests ÙÔ˘ 1Ô˘ Î·È 2Ô˘ ÙÚÈÌ‹ÓÔ˘ (˘ÂÚ˯ÔÁÚ·ÊÈο Î·È ÔÚÔÏÔÁÈο), Ù· ÔÔ›·

40% 35%

32%

30% 25%

23%

23%

22%

20% 15% 10% 5% 0% <25

25-30

31-35

>35

∂ÈÎfiÓ· 8. ∏ÏÈÎȷ΋ ηٷÓÔÌ‹ ÙˆÓ ÌËÙ¤ÚˆÓ Î·Ù¿ ÙÔÓ ÙÔÎÂÙfi.

45% 40% 35% 30% 25% 20% 15% 10% 5% 0%

<25 25-30 31-35 >35 37% 28% 24%

19% 20% 27%

24% 20%

1973-1985 1986-2001 ∂ÈÎfiÓ· 9. ∞ÏÏ·Á‹ ÛÙËÓ ËÏÈÎȷ΋ ηٷÓÔÌ‹ ÙˆÓ ÌËÙ¤ÚˆÓ Î·Ù¿ ÙÔÓ ÙÔÎÂÙfi ÚÈÓ Î·È ÌÂÙ¿ ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ÚÔÁÂÓÓËÙÈÎÔ‡ ÂϤÁ¯Ô˘ (ÌËÙ¤Ú˜ <25 ÂÙÒÓ: ¡S, ÌËÙ¤Ú˜ 31-35 ÂÙÒÓ: NS, ÌËÙ¤Ú˜ 25-30 ÂÙÒÓ: p=0,006, ÌËÙ¤Ú˜ >35 ÂÙÒÓ: NS).

465

¶·È‰È·ÙÚÈ΋ 2003;66:461-466

Paediatriki 2003;66:461-466

ˆ˜ ÁÓˆÛÙfiÓ ‰ÂÓ Â›Ó·È ‰È·ÁÓˆÛÙÈο ·ÛÊ·Ï‹ (12-14). ™˘ÌÂÚ·›ÓÂÙ·È, ÏÔÈfiÓ, fiÙÈ ı· Ú¤ÂÈ Ó· ·Ó·˙ËÙËıÔ‡Ó Î·È Ó· ÂÊ·ÚÌÔÛÙÔ‡Ó ·ÍÈfiÈÛÙ˜ ÌË ÂÂÌ‚·ÙÈΤ˜ ̤ıÔ‰ÔÈ Ì ÌÈÎÚfi ÔÛÔÛÙfi „¢‰Ò˜ ıÂÙÈÎÔ‡ ·ÔÙÂϤÛÌ·ÙÔ˜, ÔÈ Ôԛ˜ ı· ÂÈϤÁÔ˘Ó ÙȘ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ Ó·ڤ˜ ¤ÁÎ˘Â˜, ÒÛÙ ·˘Ù¤˜ ÂÎÏÂÎÙÈο Ó· ˘Ô‚¿ÏÏÔÓÙ·È Û ÂÂÌ‚·ÙÈΤ˜ ÌÂıfi‰Ô˘˜ ÚÔÁÂÓÓËÙÈ΋˜ ‰È¿ÁÓˆÛ˘ (12-14,21-23).

13.

∂˘¯·ÚÈÛٛ˜

14.

£ÂṲ́˜ ¢¯·ÚÈÛٛ˜ ÛÙȘ ·Ú·Û΢¿ÛÙÚȘ Î.Î. ¢. ∑·ÁηڤÙÔ˘ Î·È ∑. OÓÔ˘ÊÚÈ¿‰Ô˘ ÁÈ· ÙË Û˘Ì‚ÔÏ‹ ÙÔ˘˜ ÛÙÔ Ù¯ÓÈÎfi ̤ÚÔ˜ Ù˘ ÂÚÁ·Û›·˜.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Antonarakis SE, Down Syndrome Collaborative Group.

Parental origin of the extra chromosome in trisomy 21 as indicated by analysis of DNA polymorphisms. N Engl J Med 1991;324:872-876.

2. Baird PA, Sadovnick AD. Life tables for Down syndrome.

Hum Genet 1989;82:291-292.

3. Hayes A, Batshaw ML. Down syndrome. Clin Pediatr 1993;40:699-715.

4. Hassold TJ, Jacobs PA. Trisomy in man. Annu Rev Genet 1984;18:69-97.

5. Antonarakis SE, Adelsberger PA, Petersen MB, Binkert F, Schinzel AA. Analysis of DNA polymorphisms suggests that most de novo dup(21q) chromosomes in patients with Down syndrome are isochromosomes and not translocations. Am J Hum Genet 1990;47:968-972.

6. Petersen MB, Adelsberger PA, Schinzel AA, Binkert F, Hinkel GK, Antonarakis SE. Down syndrome due to de novo Robertsonian translocation t(14q;21q): DNA polymorphism analysis suggests that the origin of the extra 21q is maternal.

Am J Hum Genet 1991;49:529-536.

7. Davies KE, Harper K, Bonthron D, Krumlauf R, Polkey A, Pembrey ME et al. Use of a chromosome 21 cloned DNA probe for the analysis of non-disjunction in Down syndrome.

Hum Genet 1984;66:54-56.

8. Antonarakis SE, Kittur SD, Metaxotou C, Watkins PC, Patel AS. Analysis of DNA haplotypes suggests a genetic predisposition to trisomy 21 associated with DNA sequences on chromosome 21. Proc Natl Acad Sci USA 1985;82:3360-3364.

9. Gardiner K, Horisberger M, Kraus J, Tantravahi U, Korenberg J, Rao V et al. Analysis of human chromosome 21: correlation of physical and cytogenetic maps; gene and CpG island distributions. Embo J 1990;9:25-34.

10. Petersen MB, Slaugenhaupt SA, Lewis JD, Warren AC, Chakravarti A, Antonarakis SE. A genetic linkage map of 27 markers on human chromosome 21. Genomics 1991;9:407419.

11. Carothers AD. Down syndrome and maternal age: the effect of erroneous assignment of parental origin. Am J Hum Genet 1987;40:147-150.

12. ¶··ÓÙˆÓ›Ô˘ ¡, ¢·ÛηϿ΢ °, µfiÁÁ·˜ ∂, ªÂÛÔÁ›Ù˘ ™,

466

15.

16.

17.

18.

19.

20.

21.

22.

23.

∫Ô‡ÙÚ· ¶, ÃÚÈÛÙÔÊÔÚ¿ÎË ª Î·È Û˘Ó. ¶ÚÔÁÂÓÓËÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÁÈ· Û‡Ó‰ÚÔÌÔ Down Ì ÙË ¯Ú‹ÛË ‚ÈÔ¯ËÌÈÎÒÓ ‰ÂÈÎÙÒÓ. ∏ ÂÌÂÈÚ›· ·fi Ì›· ÌÂÁ¿ÏË Ì·È¢ÙÈ΋ ÌÔÓ¿‰·. ∂ÊË‚ °˘Ó ∞Ó· ∂ÌÌËÓ 2001;13:299-303. ∞ÓÙˆÓÈ¿‰Ë˜ ™, ¶·ÏÈÔ‡ÚË ∫, ¶··‰¿ÎÔ˘ ∞, ª›Ù˙ÈÔ˘ °, ∫·Ú‚ÂÏ¿ ∞, ¶¿ÁηÏÔ˜ ∫ Î·È Û˘Ó. O ÚfiÏÔ˜ ÙÔ˘ a-test (‚ÈÔ¯ËÌÈÎÔ› ‰Â›ÎÙ˜: AFP, HCG, UE3 ÛÙÔÓ ÌËÙÚÈÎfi ÔÚfi) ÛÙËÓ ·Ó›¯Ó¢ÛË Û˘ÁÁÂÓÒÓ ·ÓˆÌ·ÏÈÒÓ ÙÔ˘ ÂÌ‚Ú‡Ô˘ [¶ÂÚ›ÏË„Ë]. 37Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ; 1999 28-30 ª·˝Ô˘; £ÂÛÛ·ÏÔÓ›ÎË; 1999. ÛÂÏ. 148. #285∞∞. µÔÁÈ·˙·Ófi˜ ª, ∞ÚÁ˘Ú›Ô˘ ∞, ∫fiÏÔÎÔ˜ °, °·‚ÚÈ‹Ï ™, ∆ÈÁÁÈÚ›‰Ô˘ ª. µÈÔ¯ËÌÈÎfi ·ÓȯÓ¢ÙÈÎfi ÚfiÁÚ·ÌÌ· ÁÈ· ÙÔ Û‡Ó‰ÚÔÌÔ Down ·fi ÙÔ Î¤ÓÙÚÔ ÚfiÏ˄˘ ÓÂ˘Ì·ÙÈ΋˜ ηı˘ÛÙ¤ÚËÛ˘ [¶ÂÚ›ÏË„Ë]. 36Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ; 1998 5-7 πÔ˘Ó›Ô˘; ¶¿ÊÔ˜; 1998. ÛÂÏ. 76. #136∂∞.

Saenz RB. Primary care of infants and young children with Down syndrome. Am Fam Physician 1999;59:381-390, 392, 395-396.

American Academy of Pediatrics, Committee on Genetics.

Health supervision for children with Down syndrome.

Pediatrics 2001;107:442-449.

Kovaleva NV, Butomo IV, Verlinskaia DK, Il’iashenko TN, Pantova IG, Prozorova MV et al. Karyological characteristics of Down’s syndrome: clinical and theoretical aspects.

Tsitologiia 1999;41:1014-1021. ¶¿ÁηÏÔ˜ ∫. ¡¤· ‰Â‰Ô̤ӷ ÛÙË ÁÂÓÂÙÈ΋ ηıÔ‰‹ÁËÛË ÔÈÎÔÁÂÓÂÈÒÓ Ì ÙÚÈۈ̛· 21 (Û‡Ó‰ÚÔÌÔ Down) ·fi ÌÂϤÙ˜ ÌÔÚȷ΋˜ ÁÂÓÂÙÈ΋˜ [¶ÂÚ›ÏË„Ë]. 31Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ; 1993 4-6 πÔ˘Ó›Ô˘; ∫·ÛÛ¿Ó‰Ú·, ÷ÏÎȉÈ΋; 1993. #195∞.

Mavrou A, Metaxotou C, Trichopoulos D. Awareness and use of prenatal diagnosis among Greek women: a national survey. Prenat Diagn 1998;18:349-355. ª·Ú·ÁÎfi˜ Ã, µ·Ï¿ÛÛË-∞‰¿Ì ∂. ¶ÚÔÁÂÓÓËÙÈÎfi˜ Î·È ÚÔÛ˘Ìو̷ÙÈÎfi˜ ÁÂÓÂÙÈÎfi˜ ¤ÏÂÁ¯Ô˜: ·fi„ÂȘ ·È‰È¿ÙÚˆÓ. ¶·È‰È·ÙÚÈ΋ 1999;62:490-498. ∫ÔÏȷϤÍË ∞, ª·ÎԇϷ˜ µ, ¶·Ó·ÁȈÙÔÔ‡ÏÔ˘ ¶, ¢·Ê¤ÚÌÔ˘ ∂, ª·‡ÚÔ˘ ∞, ªÂٷ͈ÙÔ‡ ∞. In situ ˘‚ÚȉÈÛÌfi˜ ·ÌÓÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ [¶ÂÚ›ÏË„Ë]. 34Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ; 1996 31 ª·˝Ô˘ & 1-2 πÔ˘Ó›Ô˘; ƒfi‰Ô˜; 1996. #307∞. ª·‡ÚÔ˘ ∞, ∫ÔÏȷϤÍË ∞, ∆Û¿ÁηÚ˘ °, ∞ÓÙÛ·ÎÏ‹˜ ∞, ¢·Ê¤ÚÌÔ˘ ∂, ∆ÛÂÁ΋ Ã Î·È Û˘Ó. ∞ÔÌfiÓˆÛË ÂÌ‚Ú˘˚ÎÒÓ Î˘ÙÙ¿ÚˆÓ ·fi ÙË ÌËÙÚÈ΋ ΢ÎÏÔÊÔÚ›· Ì ̷ÁÓËÙÈÎfi ‰È·¯ˆÚÈÛÌfi, ·ÓÔÛÔÊ·ÈÓÔÙ˘È΋ ¯ÚÒÛË Î·È FISH. °ÂÓÂÙÈ΋ ÙÔ˘ ∞ÓıÚÒÔ˘ 1999;1:40-46. ∫·ÌÔ˘Ú¿Î˘ °, ∫ÔÓÙÔÁÈ¿ÓÓË ∂. ¶ÚÔÂÌÊ˘Ù¢ÙÈ΋ ‰È¿ÁÓˆÛË ÙˆÓ ÁÂÓÂÙÈÎÒÓ ÓÔÛËÌ¿ÙˆÓ: ÂÈÙ‡ÁÌ·Ù· Î·È ÌÂÏÏÔÓÙÈΤ˜ ÚÔÔÙÈΤ˜. ∂ÊË‚ °˘Ó ∞Ó· ∂ÌÌËÓ 2000;12:46-54.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 24-01-2003 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 31-10-2003 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ÷ڛÎÏÂÈ· ÷Ù˙ËÛ‚·ÛÙÔ‡-§Ô˘Î›‰Ô˘ ∂ÚÁ·ÛÙ‹ÚÈÔ ∫˘ÙÙ·ÚÔÁÂÓÂÙÈ΋˜, ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ∞.¶.£. °¶¡ “πÔÎÚ¿ÙÂÈÔ” £ÂÛÛ·ÏÔӛ΢ ∫ˆÓÛÙ·ÓÙÈÓÔ˘fiψ˜ 49, ∆.∫. 544 62, £ÂÛÛ·ÏÔÓ›ÎË

¶·È‰È·ÙÚÈ΋ 2003;66:467-470

∂¡¢π∞º∂ƒOÀ™∞ ¶∂ƒπ¶∆ø™∏

Paediatriki 2003;66:467-470

CASE REPORT

∞ÓÂ¿ÚÎÂÈ· Ù˘ ÔÚÓÈıÈÓÈ΋˜ ÙÚ·ÓÛηڂ·Ì˘Ï¿Û˘ - ˘Ô͇˜ Ù‡Ô˜. ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ™. ºÂÛÛ¿ÙÔ˘1, ∞. ∞ÙÙÈÏ¿ÎÔ˜1, ∂. ∆Û¿Ú·1, °. ª·ÚfiÔ˘ÏÔ˜2, ∂. ªÈ¯ÂϷοÎË3, ∫. ™Ô‡ÏË4

Late onset ornithine transcarbamylase deficiency. A case report S. Fessatou1, A. Attilakos1, H. Tsapra1, G. Maropoulos2, H. Michelakakis3, K. Schulpis4

¶ÂÚ›ÏË„Ë: ∏ ·ÓÂ¿ÚÎÂÈ· Ù˘ ÔÚÓÈıÈÓÈ΋˜ ÙÚ·ÓÛηڂ·Ì˘Ï¿Û˘, Ì›· Ê˘ÏÔÛ‡Ó‰ÂÙË ‰È·Ù·Ú·¯‹, Â›Ó·È Ë ÈÔ Û˘¯Ó‹ ÎÏËÚÔÓÔÌÔ‡ÌÂÓË ÌÂÙ·‚ÔÏÈ΋ ‰È·Ù·Ú·¯‹ ÙÔ˘ ·ÎÏÔ˘ Ù˘ Ô˘Ú›·˜. ªÂϤÙ˜ ¤¯Ô˘Ó ÂÚÈÁÚ¿„ÂÈ ÙËÓ ‡·ÚÍË ·ÚÎÂÙÒÓ ‰È·ÊÔÚÂÙÈÎÒÓ ÌÂÙ·ÏϿ͈Ó, ÔÈ Ôԛ˜ ÂÓ Ì¤ÚÂÈ ÌÔÚÔ‡Ó Ó· ÂÍËÁ‹ÛÔ˘Ó ÙË Ê·ÈÓÔÙ˘È΋ ÔÈÎÈÏ›· ÛÙËÓ ¤ÎÊÚ·ÛË Ù˘ ÓfiÛÔ˘. ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÚÒÙË ÂÚ›ÙˆÛË ·ÁÔÚÈÔ‡ Ì ÌÂÙ¿ÏÏ·ÍË ∆343∫, ÙËÓ ÔÔ›· ÎÏËÚÔÓfiÌËÛ ·fi ÙË ÌËÙ¤Ú· ÙÔ˘. ÀÔÁÚ·ÌÌ›˙ÂÙ·È Ô ·Ú¯ÈÎfi˜ ‰È·ÁÓˆÛÙÈÎfi˜ ·ÔÚÔÛ·Ó·ÙÔÏÈÛÌfi˜ ÛÙËÓ ·Ú¯È΋ ÂΉ‹ÏˆÛË ÙˆÓ Û˘Ìو̿وÓ, ‰ÈfiÙÈ Ù· ÚÒÙ· Û˘ÌÙÒÌ·Ù· ÂÌÊ·Ó›ÛÙËÎ·Ó ÌÂÙ¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙˆÓ ÊÚÔ‡ÙˆÓ ÛÙË ‰È·ÙÚÔÊ‹ ÙÔ˘ ·È‰ÈÔ‡.

Abstract: Ornithine transcarbamylase deficiency, an X-linked metabolic disorder, is the most common inherited urea cycle defect. Previous reports have documented the existence of several different mutations that can explain, at least in part, the phenotypic variability of the disorder. The case is described of a male infant with T343K mutation, also present in his mother, which is described for the first time. The disorientation of the clinicians at the time of presentation of symptoms is underlined, because the patient started vomiting after fruits were added to his diet.

§¤ÍÂȘ ÎÏÂȉȿ: ·ÓÂ¿ÚÎÂÈ· Ù˘ ÔÚÓÈıÈÓÈ΋˜ ÙÚ·ÓÛηڂ·Ì˘Ï¿Û˘, ·ÎÏÔ˜ Ù˘ Ô˘Ú›·˜, ˘ÂÚ·Ì̈ÓÈ·ÈÌ›·.

Key words: ornithine transcarbamylase deficiency, urea cycle, hyperammonaemia.

™˘ÓÙÔÌÔÁڷʛ˜

∂ÈÛ·ÁˆÁ‹ ∏ ·ÓÂ¿ÚÎÂÈ· Ù˘ ÔÚÓÈıÈÓÈ΋˜ ÙÚ·ÓÛηڂ·Ì˘Ï¿Û˘ (O∆C) Â›Ó·È Ë ÈÔ Û˘¯Ó‹ ÎÏËÚÔÓÔÌÔ‡ÌÂÓË ‰È·Ù·Ú·¯‹ ÙÔ˘ ·ÎÏÔ˘ Ù˘ Ô˘Ú›·˜. ∫ÏËÚÔÓÔÌÂ›Ù·È Ì ÂÈÎÚ·ÙËÙÈÎfi Ê˘ÏÔÛ‡Ó‰ÂÙÔ Ù‡Ô Î·È, fiˆ˜ Î·È ÔÈ ¿ÏϘ ·ÓÂ¿ÚÎÂȘ ÂÓ˙‡ÌˆÓ ÙÔ˘ ·ÎÏÔ˘ Ù˘ Ô˘Ú›·˜, ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÎÏÈÓÈο ÛËÌ›· Î·È Û˘-

ÌÙÒÌ·Ù· Ô˘ Â›Ó·È ·ÔÙ¤ÏÂÛÌ· Ù˘ ¿ıÚÔÈÛ˘ ÌÂÙ·‚ÔÏÈÙÒÓ Ù˘ Ô˘Ú›·˜, ΢ڛˆ˜ ·Ì̈ӛ·˜ Î·È ÁÏÔ˘Ù·Ì›Ó˘. ∏ ÛÔ‚·ÚfiÙÂÚË ÎÏÈÓÈ΋ ÂΉ‹ÏˆÛË Ù˘ ÓfiÛÔ˘ Û˘Ì‚·›ÓÂÈ Û ¿Û¯ÔÓÙ· ¿ÚÚÂÓ· ÓÂÔÁÓ¿ Î·È ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÔ ˘ÂÚ·Ì̈ÓÈ·ÈÌÈÎfi ÎÒÌ· Î·È ÙÔÓ ı¿Ó·ÙÔ. O ˘Ô͇˜ Ù‡Ô˜ (late onset) ÂΉËÏÒÓÂÙ·È Û ¿ÚÚÂÓ˜ Ì ÌÂÚÈ΋ ÂÓ˙˘ÌÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· Î·È Û ı‹Ï· Ô˘ Â›Ó·È ÂÙÂÚÔ˙˘ÁÒÙ˜ Ù˘ ÓfiÛÔ˘ (1,2). O ÎÏÈÓÈÎfi˜ Î·È Ô ‚ÈÔ¯ËÌÈÎfi˜ Ê·ÈÓfiÙ˘Ô˜ ¤¯ÂÈ ÌÂÁ¿ÏÔ Â‡ÚÔ˜ ÂΉËÏÒÛÂˆÓ Î·È ÌÔÚ› ÌfiÓÔ ÌÂÚÈÎÒ˜ Ó· ÂÍËÁËı› ·fi ÙÔÓ ÁÔÓfiÙ˘Ô (3).

1 µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó· 2 µÈÔ¯ËÌÈÎfi ∆Ì‹Ì·, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó· 3 ∆Ì‹Ì· ∂Ó˙˘ÌÔÏÔÁ›·˜, πÓÛÙÈÙÔ‡ÙÔ ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “AÁ. ™ÔÊ›·”, ∞ı‹Ó· 4 ∆Ì‹Ì· ªÂÙ·‚ÔÏÈÎÒÓ ¡ÔÛËÌ¿ÙˆÓ, πÓÛÙÈÙÔ‡ÙÔ ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “AÁ. ™ÔÊ›·”, ∞ı‹Ó·

1 2nd Paediatric Clinic, “P. & A. Kyriakou” Children’s Hospital, Athens 2 Department of Biochemistry, “P. & A. Kyriakou” Children’s Hospital, Athens 3 Department of Enzymology, Institute of Child Health, “Aghia Sophia” Children’s Hospital, Athens 4 Department of Metabolic Diseases, Institute of Child Health, “Aghia Sophia” Children’s Hospital, Athens

OTC °O¶

OÚÓÈıÈÓÈ΋ ÙÚ·ÓÛηڂ·Ì˘Ï¿ÛË °·ÛÙÚÔÔÈÛÔÊ·ÁÈ΋ ·ÏÈÓ‰ÚfiÌËÛË

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∆Ô ÁÔÓ›‰ÈÔ Ù˘ OTC ¤¯ÂÈ ‚ÚÂı› ÛÙÔ ‚Ú·¯‡ ÛΤÏÔ˜ ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ Ã, ÛÙË ı¤ÛË p21.1 Î·È ¤¯ÂÈ ÌÂÏÂÙËı› ·fi ÙÔ˘˜ Horwich Î·È Û˘Ó Î·È ÙÔ˘˜ Hata Î·È Û˘Ó. ¶ÚfiÎÂÈÙ·È ÁÈ· ¤Ó· ÙÚÈÌÂÚ¤˜ Ô˘ ·ÔÙÂÏÂ›Ù·È ·fi 322 ·ÌÈÓÔͤ· Î·È ¤¯ÂÈ ÌÔÚÈ·Îfi ‚¿ÚÔ˜ ÂÚ›Ô˘ 36000 Daltons ·Ó¿ ÔÏ˘ÂÙȉÈ΋ ·Ï˘Û›‰· (4,5). ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ¿ÚÚÂÓÔ˜ ‚Ú¤ÊÔ˘˜ Ì ·ÓÂ¿ÚÎÂÈ· OTC, Ô˘ ÂΉËÏÒıËΠ۠ËÏÈΛ· 6 ÌËÓÒÓ, Û˘Á¯ÚfiÓˆ˜ Ì ÙËÓ ÂÈÛ·ÁˆÁ‹ ÊÚÔ‡ÙˆÓ ÛÙË ‰È·ÙÚÔÊ‹ ÙÔ˘. ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ¶ÚfiÎÂÈÙ·È ÁÈ· ¤Ó· ·ÁfiÚÈ Ô˘ ÁÂÓÓ‹ıËΠÌÂÙ¿ ·fi Ê˘ÛÈÔÏÔÁÈ΋ ·ËÛË Î·È ÙÔÎÂÙfi, Ì ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ 3350 g. ∏ ÂÚÈÁÂÓÓËÙÈ΋ ÂÚ›Ô‰Ô˜ ‹Ù·Ó ¯ˆÚ›˜ ÚÔ‚Ï‹Ì·Ù· Î·È Ë ·Ó¿Ù˘Í‹ ÙÔ˘ Ôχ ηϋ ̤¯ÚÈ ÙËÓ ËÏÈΛ· ÙˆÓ 6 ÌËÓÒÓ. ™Â ·˘Ù‹ ÙËÓ ËÏÈΛ· ÚÔÛÙ¤ıËÎ·Ó ÊÚÔ‡Ù· ÛÙË ‰È·ÙÚÔÊ‹ ÙÔ˘ Î·È ¿Ú¯ÈÛ ӷ ÂÌÊ·Ó›˙ÂÈ Â̤ÙÔ˘˜. ŒÁÈÓ ¤ÏÂÁ¯Ô˜ Ì ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÔÈÛÔÊ¿ÁÔ˘-ÛÙÔÌ¿¯Ô˘ ÁÈ· Èı·Ó‹ Á·ÛÙÚÔÔÈÛÔÊ·ÁÈ΋ ·ÏÈÓ‰ÚfiÌËÛË (°O¶) Î·È Ë ÂͤٷÛË ¤‰ÂÈÍ ¢Ú›· °O¶. ∂Ù¤ıË ·ÁˆÁ‹ ÁÈ· ÙË °O¶ Ì ÛÈ˙·Ú›‰Ë Î·È ÔÈ ¤ÌÂÙÔÈ ‚ÂÏÙÈÒıËηÓ. ™Â ËÏÈΛ· 7 ÌËÓÒÓ ÂÌÊ¿ÓÈÛ ·ÈÊÓ›‰È· ÂÂÈÛfi‰È· ÌÂ Û˘Ó¯fiÌÂÓÔ˘˜ Â̤ÙÔ˘˜, ηٿÛÙ·ÛË Ô˘ Ô‰‹ÁËÛ ÙÔ˘˜ ÁÔÓ›˜ Ó· ʤÚÔ˘Ó ÙÔ ·È‰› ÛÙÔ ÓÔÛÔÎÔÌ›Ô. ∫·Ù¿ ÙËÓ ÎÏÈÓÈ΋ ÂͤٷÛË ‰ÂÓ ‰È·ÈÛÙÒıËΠοÙÈ ÙÔ ·ıÔÏÔÁÈÎfi, ÏËÓ ·ÒÏÂÈ·˜ ‚¿ÚÔ˘˜ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÙÂÏÂ˘Ù·›ˆÓ ‰‡Ô ‚‰ÔÌ¿‰ˆÓ. O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍ ·˘ÍË̤ÓË ·Ì̈ӛ· (250 Ìg/dl), ·ıÔÏÔÁÈΤ˜ ÂÍÂÙ¿ÛÂȘ ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ·˜ ‹·ÙÔ˜ (SGOT: 835 U/L, SGPT: 1490 U/L, PT: 39,9 sec, PTTK: 62,6 sec, INR: 4,09) Î·È ·˘ÍË̤ӷ Â›‰· ÛÙ· Ô‡Ú· ÔÚÔÙÈÎÔ‡ ÔͤԘ (>1900 Ìmol/mmol creatinine, Ê.Ù.: <13) Î·È Ô˘Ú·Î›Ï˘. ™ÙÔ ·ÌÈÓfiÁÚ·ÌÌ· ·›Ì·ÙÔ˜ ·ÚÔ˘Û›·˙ ·˘ÍË̤ӷ Â›‰· ÁÏÔ˘Ù·Ì›Ó˘ (35,64 mg/dl, Ê.Ù.: 8,4-10,8), Ï˘Û›Ó˘ (7,14 mg/dl, Ê.Ù.: 1,65-3,05), ·Û·ÚÙÈÎÔ‡ (1,57 mg/dl, Ê.Ù.: 0,29-0,51) Î·È ÌÂıÂÈÔÓ›Ó˘ (2,97 mg/dl, Ê.Ù.: 0,17-0,43) Î·È ÂÏ·Ùو̤ӷ Â›‰· ÎÈÙÚÔ˘ÏÏ›Ó˘ Î·È ·ÚÁÈÓ›Ó˘. O ¤ÏÂÁ¯Ô˜ ÁÈ· ‰È·Ù·Ú·¯‹ ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ Ù˘ ÊÚÔ˘ÎÙfi˙˘ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÓÔÛËÏ›·˜ ÙÔ˘, ÙÔ ·È‰› ÂÌÊ¿ÓÈÛ ÂÚ·ÈÙ¤Úˆ ·‡ÍËÛË Ù˘ ·Ì̈ӛ·˜ (700 Ìg/dl) Î·È ÙˆÓ ÙÚ·ÓÛ·ÌÈÓ·ÛÒÓ (SGOT: 2500 U/L, SGPT: 2200 U/L). ªÂÙ¿ ·fi ·˘Ù¿ Ù· Â˘Ú‹Ì·Ù·, Ë ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ÚÔÛ·Ó·ÙÔÏ›ÛÙËΠ۠‰È·Ù·Ú·¯¤˜ ÙÔ˘ ·ÎÏÔ˘ Ù˘ Ô˘Ú›·˜. ŒÁÈÓ ‚ÈÔ„›· ‹·ÙÔ˜ ‰È¿ ‚ÂÏfiÓ˘ ·Ì¤Ûˆ˜ ÌfiÏȘ ‚ÂÏÙÈÒıËÎÂ Ë Ë·ÙÈ΋ ÏÂÈÙÔ˘ÚÁ›·, fiÔ˘ ÂȂ‚·ÈÒıËÎÂ Ë ÌÂȈ̤ÓË ÂÓ˙˘ÌÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ OTC: i) ‰Ú·ÛÙËÚÈfiÙËÙ· OTC: 1,1 Ìmol/mg/h (Ê.Ù.: 13-43) Î·È ii) ‰Ú·ÛÙËÚÈfiÙËÙ· ηڂ·Ì˘ÏÔʈÛÊÔÚÈ΋˜ Û˘ÓıÂÙ¿Û˘ (CPS): 4,61 Ìmol/mg/h (Ê.Ù.: 0,65,5). ∏ Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘

468

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(MRI) ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋. £ÂÚ·¢ÙÈο, ÛÙËÓ ÎÚ›ÛË Ù˘ ˘ÂÚ·Ì̈ÓÈ·ÈÌ›·˜ ¯ÔÚËÁ‹ıËÎ·Ó ÂÓ‰ÔÊÏ‚›ˆ˜ ˘ÁÚ¿, ıÂÚÌȉÈ΋ Î¿Ï˘„Ë Ì ۷ί·ÚÔ‡¯· ˘ÁÚ¿, ÊÚ¤ÛÎÔ Î·Ù„˘Á̤ÓÔ Ï¿ÛÌ·, ‚ÂÓ˙Ô˚Îfi Ó¿ÙÚÈÔ, L-·ÚÁÈÓ›ÓË Î·È L-ηÚÓÈÙ›ÓË Î·È ¤ÁÈÓ ÛÙ¤ÚËÛË ÚˆÙÂ˚ÓÒÓ. ∆· Â›‰· Ù˘ ·Ì̈ӛ·˜ ÛÙÔ Ï¿ÛÌ· ¤ÊÙ·Û·Ó ÛÙ· Ê˘ÛÈÔÏÔÁÈο Â›‰· ÌÂÙ¿ ·fi 7 Ë̤Ú˜ Î·È Ë Ë·ÙÈ΋ ÏÂÈÙÔ˘ÚÁ›· ·ÔηٷÛÙ¿ıËΠÌÂÙ¿ ·fi 20 Ë̤Ú˜. ∞fi ÙfiÙÂ, ÙÔ ·È‰› ‚Ú›ÛÎÂÙ·È Û ‰›·ÈÙ· Ì ¯·ÌËÏ‹ ÚfiÛÏË„Ë ÚˆÙ½Ó˘ (~2 g/kg/24ˆÚÔ). ÃÔÚËÁÔ‡ÓÙ·È Ù· ··Ú·›ÙËÙ· ·ÌÈÓÔͤ·, ‚Èٷ̛Ә, ¿Ï·Ù· Î·È È¯ÓÔÛÙÔȯ›· Ì ÙË ÌÔÚÊ‹ ȉÈÔÛ΢·ÛÌ¿ÙˆÓ (UCD), Û˘Ìϋڈ̷ ıÂÚÌ›‰ˆÓ Ì caloreen Î·È ‚ÂÓ˙Ô˚Îfi Ó¿ÙÚÈÔ. ∆Ô ·È‰› ‚Ú›ÛÎÂÙ·È Û Ôχ ηϋ ÁÂÓÈ΋ ηٿÛÙ·ÛË Î·È Ë „˘¯ÔÎÈÓËÙÈ΋ ÙÔ˘ ÂͤÏÈÍË Â›Ó·È Ì¤¯ÚÈ ÙÒÚ· Û¯ÂÙÈο ηϋ (˘¿Ú¯ÂÈ Ì›· Û¯ÂÙÈ΋ ηı˘ÛÙ¤ÚËÛË Î·Ù¿ 6 ÂÚ›Ô˘ Ì‹Ó˜). ∏ ÁÂÓÂÙÈ΋ ·Ó¿Ï˘ÛË ÙÔ˘ ·ÛıÂÓÔ‡˜ ¤‰ÂÈÍ ÌÂÙ¿ÏÏ·ÍË c a ÛÙÔ ÂÍfiÓÈÔ 10 ÙÔ˘ ÁÔÓȉ›Ô˘ Ù˘ OTC. ∞˘Ù‹ Ë ·ÏÏ·Á‹ Â›Ó·È ·ÔÙ¤ÏÂÛÌ· Ù˘ ·ÓÙÈηٿÛÙ·Û˘ Ù˘ ıÚÂÔÓ›Ó˘ ·fi Ï˘Û›ÓË ÛÙË ı¤ÛË 343 (∆343∫). ∏ ÁÂÓÂÙÈ΋ ·Ó¿Ï˘ÛË Ô˘ ¤ÁÈÓ ÛÙË ÌËÙ¤Ú· ¤‰ÂÈÍ fiÙÈ ‹Ù·Ó ÂÙÂÚÔ˙˘ÁÒÙ˘ ÛÙÔ ÂÍfiÓÈÔ 10 ÁÈ· ÙËÓ ∆343∫ ÌÂÙ¿ÏÏ·ÍË. ∏ ÌËÙ¤Ú· ·Ó¤ÊÂÚ fiÙÈ ‹Ù·Ó Ê˘ÙÔÊ¿ÁÔ˜, ‰ÈfiÙÈ Î¿ı ÊÔÚ¿ Ô˘ ¤·ÈÚÓ Á‡̷ Ì ˘„ËÏ‹ ÂÚÈÂÎÙÈÎfiÙËÙ· Û ÚˆÙ½Ó˜ ÂÌÊ¿ÓÈ˙ ÎÂÊ·Ï·ÏÁ›· Î·È Ó·˘Ù›· (Û˘ÌÙÒÌ·Ù· Ô˘ ÂÚÈÁÚ¿ÊÔÓÙ·È ÛÙÔ˘˜ ÊÔÚ›˜ Ù˘ ÓfiÛÔ˘). ™˘˙‹ÙËÛË ∏ OTC Â›Ó·È ¤Ó· ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi ¤Ó˙˘ÌÔ Ô˘ ηٷχÂÈ ÙÔ Î·Ú‚·Ì˘ÏÔʈÛÊÔÚÈÎfi Ô͇ Û ÎÈÙÚÔ˘ÏÏ›ÓË ÛÙÔÓ Î‡ÎÏÔ Ù˘ Ô˘Ú›·˜. ∆Ô ÁÔÓ›‰ÈÔ Ù˘ OTC ‚Ú›ÛÎÂÙ·È ÛÙÔ ‚Ú·¯‡ ¿ÎÚÔ ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ à (Ãp21.1). ¶ÂÚȤ¯ÂÈ 10 ÂÍfiÓÈ· Ô˘ Έ‰ÈÎÔÔÈÔ‡Ó Ì›· ÚÔ-ÚˆÙ½ÓË, Ë ÔÔ›· ·ÔÙÂÏÂ›Ù·È ·fi 354 ·ÌÈÓÔͤ·. ∏ ·ÚÈ· ÚˆÙ½ÓË ·ÔÙÂÏÂ›Ù·È ·fi 32 ·ÌÈÓÔͤ· Î·È ·ÂÏ¢ıÂÚÒÓÂÙ·È ÌÂÙ¿ ÙË ÌÂÙ·ÊÔÚ¿ Ù˘ ̤۷ ÛÙ· ÌÈÙÔ¯fiÓ‰ÚÈ· (3).

OÈ Tuchman Î·È Û˘Ó ¯ÚËÛÈÌÔÔ›ËÛ·Ó ÂȉÈΤ˜ ·Ó·Ï‡ÛÂȘ ÙˆÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ ÁÈ· Ó· ˘ÔÏÔÁ›ÛÔ˘Ó ÙËÓ ·Ó·ÏÔÁ›· ·ÚÚ¤ÓˆÓ Î·È ıËϤˆÓ, ÙˆÓ ÔÔ›ˆÓ ÔÈ ÌÂÙ·ÏÏ¿ÍÂȘ ¤¯Ô˘Ó Û˘Ì‚Â› ÛÙ· ÁÂÓÓËÙÈο ·ÙÙ·Ú· ÂÓfi˜ ·fi ÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘˜. ∞fi Ù· 28 ·ÁfiÚÈ· Ì ·ÓÂ¿ÚÎÂÈ· OTC, ÌfiÓÔ 2 (7%) ›¯·Ó ÛÔÚ·‰ÈΤ˜ ÌÂÙ·ÏÏ¿ÍÂȘ, ÂÓÒ ·fi Ù· 15 ÎÔÚ›ÙÛÈ· Ì ·ÓÂ¿ÚÎÂÈ· OTC, 12 (80%) ›¯·Ó ÛÔÚ·‰ÈΤ˜ ÌÂÙ·ÏÏ¿ÍÂȘ. ∞fi ·˘Ù¤˜ ÙȘ ÌÔÚȷΤ˜ ‰ÔÎÈ̷ۛ˜ Ê·›ÓÂÙ·È fiÙÈ Ô Î›Ó‰˘ÓÔ˜ ÁÈ· Ì›· ÌËÙ¤Ú· ·ÁÔÚÈÔ‡ Ô˘ ÓÔÛ› Ó· Â›Ó·È ÂÙÂÚÔ˙˘ÁÒÙ˘ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚÔ˜ ·fi fi,ÙÈ ·Ó·ÌÂÓfiÙ·Ó (2/3) Î·È ÏËÛÈ¿˙ÂÈ ÙÔ 9/10. ∞ÓÙÈÛÙÚfiʈ˜, Ì›· ÌËÙ¤Ú· ¿Û¯ÔÓÙÔ˜ ı‹ÏÂÔ˜ ¤¯ÂÈ Ôχ ÌÈÎÚfiÙÂÚË Èı·ÓfiÙËÙ· Ó· Â›Ó·È ÂÙÂÚÔ˙˘ÁÒÙ˘ (6).

¶·È‰È·ÙÚÈ΋ 2003;66:467-470

ª¤¯ÚÈ Û‹ÌÂÚ· ¤¯Ô˘Ó ÌÂÏÂÙËı› 230 ÌÂÙ·ÏÏ¿ÍÂȘ Î·È 13 ÔÏ˘ÌÔÚÊÈÛÌÔ› ÙÔ˘ ÁÔÓȉ›Ô˘ Ù˘ OTC. O ·ÛıÂÓ‹˜ Ù˘ ·ÚÔ‡Û·˜ ÂÚ›ÙˆÛ˘ Â›Ó·È ÙÔ ÌÔÓ·‰ÈÎfi ·ÁfiÚÈ Ì ÙË ÌÂÙ¿ÏÏ·ÍË ∆343∫, ÛÙËÓ ÔÔ›· Ë ÌËÙ¤Ú· ÙÔ˘ Â›Ó·È ÂÙÂÚÔ˙˘ÁÒÙ˘. OÈ ¿ÏÏÔÈ ‰‡Ô ·ÛıÂÓ›˜ Ì ÙËÓ ›‰È· ÌÂÙ¿ÏÏ·ÍË Â›Ó·È ¤Ó· ÎÔÚ›ÙÛÈ ËÏÈΛ·˜ 8 ÂÙÒÓ Ô˘ ÂÚÈÁÚ¿ÊËΠ·fi ÙÔ˘˜ Tuchman Î·È Û˘Ó ÙÔ 1995 (7) Î·È ¤Ó· ·ÁfiÚÈ ËÏÈΛ·˜ 7 ÂÙÒÓ Ô˘ ÂÚÈÁÚ¿ÊËΠ·fi ÙÔ˘˜ Leibundgut Î·È Û˘Ó ÙÔ 1996, ÔÈ ÔÔ›ÔÈ ‰ÂÓ ¤¯Ô˘Ó ÎÏËÚÔÓÔÌÈ΋ ÌÂÙ¿ÏÏ·ÍË (8). ∏ OTC ˘¿Ú¯ÂÈ ÛÙÔ ‹·Ú Î·È ÛÙÔÓ ‚ÏÂÓÓÔÁfiÓÔ ÙÔ˘ ÏÂÙÔ‡ ÂÓÙ¤ÚÔ˘. ∆Ô ¤Ó˙˘ÌÔ ÚÔ¤Ú¯ÂÙ·È ·fi ÙÔ ›‰ÈÔ ÁÔÓ›‰ÈÔ Î·È ÛÙ· ‰‡Ô fiÚÁ·Ó·. OÈ Hamano Î·È Û˘Ó ¤¯Ô˘Ó ÚÔÛ‰ÈÔÚ›ÛÂÈ ÂÙÂÚÔ˙˘ÁÒÙË Ù˘ OTC Ì ·ÓÔÛÔ΢ÙÙ·ÚÔ¯ËÌÈ΋ ÌÂϤÙË ‚ÈÔ„›·˜ ·fi ÙÔÓ ‚ÏÂÓÓÔÁfiÓÔ ÙÔ˘ ‰ˆ‰Âη‰·ÎÙ‡ÏÔ˘ (9).

O Ê·ÈÓfiÙ˘Ô˜ ÙˆÓ ·ÁÔÚÈÒÓ Ô˘ ÓÔÛÔ‡Ó Î·È ÙˆÓ ÂÙÂÚÔ˙˘ÁˆÙÒÓ ÎÔÚÈÙÛÈÒÓ ¤¯ÂÈ ÌÂÁ¿ÏÔ Â‡ÚÔ˜, ·fi ÙÔ ÛÔ‚·ÚfiÙ·ÙÔ ÓÂÔÁÓÈÎfi ˘ÂÚ·Ì̈ÓÈ·ÈÌÈÎfi ÎÒÌ· ̤¯ÚÈ ÙÔÓ ·Û˘Ìو̷ÙÈÎfi ÂÓ‹ÏÈη (3). ∆· ·Ú¯Èο Û˘ÌÙÒÌ·Ù· Ù˘ ˘ÂÚ·Ì̈ÓÈ·ÈÌ›·˜ Î˘Ì·›ÓÔÓÙ·È Â›Û˘ Î·È ÌÔÚ› Ó· Â›Ó·È ÌfiÓÔ ‹È· Û˘Á¯˘ÙÈο ÂÂÈÛfi‰È·, ¢ÂÚÂıÈÛÙfiÙËÙ· ‹ ‰È·Ù·Ú·¯¤˜ Û˘ÌÂÚÈÊÔÚ¿˜, Ù· ÔÔ›· ÌÔÚÔ‡Ó Ó· ÂÎÏËÊıÔ‡Ó ÏfiÁˆ Ï¿ıÔ˘˜ ˆ˜ „˘¯È·ÙÚÈο ÚÔ‚Ï‹Ì·Ù·, ¯Ú‹ÛË “Ô˘ÛÈÒÓ” ‹ ÙÚÔÊÈ΋ ·ÏÏÂÚÁ›·. øÛÙfiÛÔ, ÙÔ Î‡ÚÈÔ Û‡Ìو̷ ÌÔÚ› Ó· Â›Ó·È ÔÈ ¤ÌÂÙÔÈ, ȉ›ˆ˜ Û ÂÚÈÙÒÛÂȘ Ì ÌÂÙ·‚ÔÏÈÎfi ÛÙÚ˜, fiˆ˜ ÔÈ ÏÔÈÌÒÍÂȘ Î·È Ó· ÂÛÙÈ·ÛÙ› Ë ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË Û ÚÔ‚Ï‹Ì·Ù· ·fi ÙÔ ÂÙÈÎfi Û‡ÛÙËÌ·. OÈ ¤ÌÂÙÔÈ Â›Ó·È Û˘¯ÓÔ› ΢ڛˆ˜ ÛÙË ‚ÚÂÊÈ΋ ËÏÈΛ· Î·È Û˘Ó‰˘¿˙ÔÓÙ·È Ì ηı˘ÛÙ¤ÚËÛË Ù˘ ۈ̷ÙÈ΋˜ ·Ó¿Ù˘Í˘. O ·‰Úfi˜ ‚ÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ ·ÔηχÙÂÈ ·˘ÍË̤Ó˜ ÙÚ·ÓÛ·ÌÈÓ¿Û˜ Î·È ·Ú·¤ÌÂÈ Û Ë·Ù›Ùȉ· (10). ™ÙÔÓ ·ÛıÂÓ‹ Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È, Ë ¤Ó·ÚÍË ÙˆÓ ÂÌ¤ÙˆÓ Û˘Ó¤ÂÛ Ì ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙˆÓ ÊÚÔ‡ÙˆÓ ÛÙË ‰È·ÙÚÔÊ‹ ÙÔ˘ Î·È Ë ·Ó‡ÚÂÛË Â˘Ú›·˜ °O¶ Ì ÙÔÓ ˘ÂÚ˯ÔÁÚ·ÊÈÎfi ¤ÏÂÁ¯Ô ‹Ù·Ó ÔÈ ÏfiÁÔÈ Ô˘ “ηı˘ÛÙ¤ÚËÛ·Ó” ÙËÓ ·Ú·ÔÌ‹ ÙÔ˘ ·È‰ÈÔ‡ ÁÈ· ¤ÏÂÁ¯Ô. ∂›Ó·È Ôχ ÛËÌ·ÓÙÈÎfi ÁÈ· ÙÔÓ ·ÛıÂÓ‹ Ì ‰È·Ù·Ú·¯‹ ÛÙÔÓ Î‡ÎÏÔ Ù˘ Ô˘Ú›·˜ Ô˘ ÂÌÊ·Ó›˙ÂÈ ˘ÂÚ·Ì̈ÓÈ·ÈÌ›· Ó· ·Ú¯›ÛÂÈ fiÛÔ ÙÔ ‰˘Ó·ÙfiÓ ÓˆÚ›ÙÂÚ· ıÂÚ·›·. °ÓˆÚ›˙ÔÓÙ·˜ fiÙÈ ÔÈ ¤ÌÂÙÔÈ ‹/Î·È Ô Ï‹ı·ÚÁÔ˜ ·ÔÙÂÏÔ‡Ó ÚÒÈÌ· ÛËÌ›· ˘ÂÚ·Ì̈ÓÈ·ÈÌ›·˜, Ú¤ÂÈ ·Ì¤Ûˆ˜ Ó· ÚÔÛ‰ÈÔÚ›˙ÔÓÙ·È Ù· Â›‰· Ù˘ ·Ì̈ӛ·˜ ÛÙÔ Ï¿ÛÌ·. ∂¿Ó Ù· Â›‰· Â›Ó·È ÙÚÈÏ¿ÛÈ· ·fi ÙÔ Ê˘ÛÈÔÏÔÁÈÎfi ‹ ·ÓÒÙÂÚ· ·fi 120 uM, Ï·Ì‚¿ÓÂÙ·È Ó¤Ô ‰Â›ÁÌ· ÁÈ· Â·Ï‹ı¢ÛË ÙÔ˘ ·ÔÙÂϤÛÌ·ÙÔ˜, ·¤ÚÈ· ·›Ì·ÙÔ˜, ÈÔÓÙfiÁÚ·ÌÌ· Î·È ÔÈÔÙÈÎfi ·ÌÈÓfiÁÚ·ÌÌ· Î·È Ú¤ÂÈ Ó· ·Ú¯›ÛÂÈ ¿ÌÂÛ· Ë ıÂÚ·›·, ¯ˆÚ›˜ Ó· ·Ó·Ì¤ÓÔÓÙ·È ÔÈ ··ÓÙ‹ÛÂȘ ÙÔ˘ ‰Â‡ÙÂÚÔ˘ ‰Â›ÁÌ·ÙÔ˜ (11). ∆Ô Î‡ÚÈÔ Ì¤ÏËÌ· ÛÙËÓ Î·ıËÌÂÚÈÓ‹ ·ÁˆÁ‹ Â›Ó·È Ë ‰›·ÈÙ· Ì ¯·ÌËÏ‹ ÂÚÈÂÎÙÈÎfiÙËÙ· Û ÚˆÙ½Ó˜,

Paediatriki 2003;66:467-470

·Ó Î·È ÔÈ ·ÛıÂÓ›˜ Ì ÙÔÓ ˘Ô͇ Ù‡Ô (late onset) ¯ÚÂÈ¿˙ÔÓÙ·È Ì¤ÙÚÈÔ ÂÚÈÔÚÈÛÌfi ÙÔ˘ Ï¢ÎÒÌ·ÙÔ˜ (1,5-2,2 g/kg/Ë̤ڷ). ªÂÚÈÎÔ› ·ÛıÂÓ›˜ ÌÔÚ› Ó· ·Ó¯ÙÔ‡Ó ·ÎfiÌ· Î·È Î·ÓÔÓÈ΋ ‰›·ÈÙ·, ¯ˆÚ›˜ ÂÚÈÔÚÈÛÌfi Ï¢ÎÒÌ·ÙÔ˜. ÕÏÏÔÈ ·ÛıÂÓ›˜ ÚÔÙÈÌÔ‡Ó Ó· ¤¯Ô˘Ó ÂχıÂÚË ‰›·ÈÙ· Î·È Ó· Ï·Ì‚¿ÓÔ˘Ó ‚ÂÓ˙Ô˚Îfi Ó¿ÙÚÈÔ ·ÓÙ› Ó· ÂÚÈÔÚ›˙Ô˘Ó ÙÔ Ï‡Έ̷ ÛÙË ‰È·ÙÚÔÊ‹ ÙÔ˘˜ (10). ∏ ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜ ·ÔÙÂÏ› ıÂÚ·›· Ô˘ ·Ó Â›Ó·È ÂÈÙ˘¯Ë̤ÓË, ‰›ÓÂÈ Ï‡ÛË ÛÙÔ Úfi‚ÏËÌ· ·˘ÙÒÓ ÙˆÓ ·ÛıÂÓÒÓ. ÃÚÂÈ¿˙ÂÙ·È Ôχ ηϋ ÂÓË̤ڈÛË ÙˆÓ ÁÔÓ¤ˆÓ ÁÈ· ÙÔ˘˜ ÎÈÓ‰‡ÓÔ˘˜ Ù˘ ÌÂÁ¿Ï˘ ·˘Ù‹˜ Â¤Ì‚·Û˘. ªÂ ÙË Û˘ÓÙËÚËÙÈ΋ ·ÁˆÁ‹ ÔÈ ·ÛıÂÓ›˜ ÍÂÂÚÓÔ‡Ó Ù· ÚÒÙ· ‰‡Ô ¯ÚfiÓÈ· ˙ˆ‹˜ Î·È ·ÔÎÙÔ‡Ó Ù¤ÙÔȘ ۈ̷ÙÈΤ˜ ‰È·ÛÙ¿ÛÂȘ, ÒÛÙ ӷ ÌÔÚÔ‡Ó Ó· ˘ÔÛÙÔ‡Ó ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË Î·È Ó· ÌÂȈıÔ‡Ó Û οÔÈÔ ‚·ıÌfi ÔÈ Î›Ó‰˘ÓÔÈ ·fi ÙËÓ Â¤Ì‚·ÛË (12).

OÈ Morsy Î·È Û˘Ó Î·Ù¿ÊÂÚ·Ó Ó· ‚ÂÏÙÈÒÛÔ˘Ó ÙË ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ OTC Û ÂÈÚ·Ì·ÙÈÎfi ÌÔÓÙ¤ÏÔ Ì ÔÓÙ›ÎÈ·, οÓÔÓÙ·˜ ÌÂÙ·ÊÔÚ¿ ÙÔ˘ ÁÔÓȉ›Ô˘ Ù˘ ·ÓıÚÒÈÓ˘ OTC Ì ÌÂÙ·ÊÔÚ¤· ·‰ÂÓÔ˚fi. ∏ Ì›ˆÛË Ù˘ ÔÚÔÙÈÎÔ˘Ú›·˜ ·Ú·ÙËÚ‹ıËΠÂÓÙfi˜ 24 ˆÚÒÓ ·fi ÙË ÌÂÙ·ÊÔÚ¿ ÙÔ˘ ÁÔÓȉ›Ô˘. ∏ ‰ÈfiÚıˆÛË Ù˘ ÌÂÙ·‚ÔÏÈ΋˜ ‰È·Ù·Ú·¯‹˜ ›¯Â Û·Ó ·ÔÙ¤ÏÂÛÌ· ÙË ‚ÂÏÙ›ˆÛË ÙÔ˘ Ê·ÈÓfiÙ˘Ô˘ Î·È ÙË Ì¤ÙÚÈ· ·‡ÍËÛË Ù˘ ÂÓ˙˘ÌÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ (13). ∏ ηٷÁÚ·Ê‹ ÙˆÓ ÛˆÌ·ÙÔÌÂÙÚÈÎÒÓ ÛÙÔȯ›ˆÓ ÙˆÓ ·Û¯fiÓÙˆÓ ·fi ·ÓÂ¿ÚÎÂÈ· OTC ‰Â›¯ÓÂÈ fiÙÈ ÔÈ ÌÂÙÚ‹ÛÂȘ Â›Ó·È Î¿Ùˆ ·fi ÙÔÓ Ì¤ÛÔ fiÚÔ ÁÈ· ÙËÓ ËÏÈΛ· ÙÔ˘˜, Èı·Ó¿ ÏfiÁˆ Ù˘ ÌÂȈ̤Ó˘ Ï‹„˘ ÚˆÙ½Ó˘ ÛÙË ‰È·ÙÚÔÊ‹ ÙÔ˘˜ (12). OÈ Msall Î·È Û˘Ó ÂÚȤÁÚ·„·Ó ÙË Ó¢ÚÔÏÔÁÈ΋ ÂͤÏÈÍË 26 ·È‰ÈÒÓ Ì ‰È·Ù·Ú·¯¤˜ ÛÙÔÓ Î‡ÎÏÔ Ù˘ Ô˘Ú›·˜. ∆Ô 79% ›¯Â Ì›· ‹ ÂÚÈÛÛfiÙÂÚ˜ Ó¢ÚÔÏÔÁÈΤ˜ ‰È·Ù·Ú·¯¤˜ Î·È Ì¤ÛÔ fiÚÔ IQ 43±6. £ÂˆÚÂ›Ù·È fiÙÈ Ë ÚfiÏË„Ë ‹ Ë ÚÒÈÌË ·Ú¤Ì‚·ÛË ÛÙË ÓÂÔÁÓÈ΋ ˘ÂÚ·Ì̈ÓÈ·ÈÌ›· ÌÔÚ› Ó· ·ÔÙÚ¤„ÂÈ ÛÔ‚·Ú¤˜ Ó¢ÚÔÏÔÁÈΤ˜ ‰È·Ù·Ú·¯¤˜ Ô˘ ¯·Ú·ÎÙËÚ›˙Ô˘Ó ·˘Ù‹ ÙËÓ ÔÌ¿‰· ÓÔÛËÌ¿ÙˆÓ (14). OÈ Maestri Î·È Û˘Ó ÛËÌÂÈÒÓÔ˘Ó fiÙÈ ÔÈ ·ÛıÂÓ›˜ Ô˘ Ù¤ıËÎ·Ó Û ıÂÚ·›· ·fi ÙËÓ ·Ú¯‹, ¤¯Ô˘Ó ηχÙÂÚË Ó¢ÚÔÏÔÁÈ΋ ·Ó¿Ù˘ÍË ·fi ÙÔ˘˜ ÂΛÓÔ˘˜ Ô˘ Â¤˙ËÛ·Ó ·fi ¤Ó· ÓÂÔÁÓÈÎfi ˘ÂÚ·Ì̈ÓÈ·ÈÌÈÎfi ÎÒÌ·. ∏ ·ÔÊ˘Á‹ ÙÔ˘ ÓÂÔÁÓÈÎÔ‡ ˘ÂÚ·Ì̈ÓÈ·ÈÌÈÎÔ‡ ÎÒÌ·ÙÔ˜ ÌÔÚ› Ó· Â›Ó·È Ô Î‡ÚÈÔ˜ ÏfiÁÔ˜ ÁÈ· ·˘Ù¤˜ ÙȘ ·Ú·ÙËÚÔ‡ÌÂÓ˜ ‰È·ÊÔÚ¤˜ ÛÙË Ó¢ÚÔÏÔÁÈ΋ ·Ó¿Ù˘ÍË (12). ¶·Ú¿ ÙË Û·ÓÈfiÙËÙ¿ Ù˘ Î·È ÙËÓ ¿Ù˘Ë ÎÏÈÓÈ΋ Ù˘ ·ÚÔ˘Û›·ÛË, Ë ÓfiÛÔ˜ ‰ÂÓ ı· Ú¤ÂÈ Ó· ·ÁÓÔÂ›Ù·È ÛÙËÓ ÎÏÈÓÈ΋ Ú¿ÍË. µÈ‚ÏÈÔÁÚ·Ê›· 1. Walser M. Urea cycle disorders and other hereditary hyperammonemic syndromes. In: Stanbury JB, Wyngaarden

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Tuchman M, McCullough BA, Yudkoff M. The molecular basis of ornithine transcarbamylase definciency. Eur J Pediatr 2000;159 (Suppl 3):S196-S198.

Horwich AL, Fenton WA, Williams KR, Kalousek F, Kraus JP, Doolittle RF et al. Structure and expression of a complementary DNA for the nuclear coded precursor of human mitochondrial ornithine transcarbamylase. Science 1984;224:1068-1074.

Hata A, Tsuzuki T, Shimada K, Takiguchi M, Mori M, Matsuda I. Structure of the human ornithine transcarbamylase gene. J Biochem 1988;103:302-308.

Tuchman M, Matsuda I, Munnich A, Malcolm S, Strautnieks S, Briede T. Proportions of spontaneous mutations in males and females with ornithine transcarbamylase deficiency. Am J Med Genet 1995;55:67-70.

Tuchman M, Plante RJ. Mutations and polymorphisms in the human ornithine transcarbamylase gene: mutation update addendum. Hum Mutat 1995;5:293-295.

Oppliger Leibundgut EO, Wermuth B, Colombo JP, LiechtiGallati S. Ornithine transcarbamylase deficiency: characterization of gene mutations and polymorphisms.

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Drogari E, Leonard JV. Late onset ornithine carbamoyl transferase deficiency in males. Arch Dis Child 1988;63: 1363-1367.

Brusilow SW. Protocol for treatment of intercurrent hyperammonemia in patients with urea cycle defects. http://divis17.pedgen.uiowa.edu/genetics/HyperAmmonem iaTx.html.

Maestri NE, Hauser ER, Bartholomew D, Brusilow SW. Prospective treatment of urea cycle disorders. J Pediatr 1991;119:923-928.

Morsy MA, Zhao JZ, Ngo TT, Warman AW, O’Brien WE, Graham FL et al. Patient selection may affect gene therapy success. Dominant negative effects observed for ornithine transcarbamylase in mouse and human hepatocytes. J Clin Invest 1996;97:826-832.

Msall M, Batshaw ML, Suss R, Brusilow SW, Mellits ED. Neurologic outcome in children with inborn errors of urea synthesis. Outcome of urea-cycle enzymopathies. N Engl J Med 1984;310:1500-1505.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 03-01-2003 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 09-09-2003 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ™Ì·Ú·Á‰‹ ºÂÛÛ¿ÙÔ˘ ¶·ÙÚ. °ÚËÁÔÚ›Ô˘ 16, ∆.∫. 143 42 ¡. ºÈÏ·‰¤ÏÊÂÈ·, ∞ı‹Ó·

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CASE REPORT

¡fiÛÔ˜ Cushing Û ÎÔÚ›ÙÛÈ ËÏÈΛ·˜ 15ó ÂÙÒÓ. ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ∂. ∫ˆÛÙ·ÎÈÒÙË, Ã. £ÂÔ‰ˆÚ›‰Ë˜, ∂. ∫Ô‡ÛÙ·, ∞. ∆ÂÚÙ›Ë, Ã. ÷Ù˙Ë·ı·Ó·Û›Ô˘, µ. ¶¤ÙÚÔ˘, ∞. ¶··ı·Ó·Û›Ô˘

Cushing’s disease in a 15ó year-old girl. A case report E. Kostakioti, C. Theodoridis, E. Kousta, A. Tertipi, C. Hadjiathanasiou, V. Petrou, A. Papathanasiou

¶ÂÚ›ÏË„Ë: ∏ ÓfiÛÔ˜ Cushing Â›Ó·È Û¿ÓÈ· ·Ûı¤ÓÂÈ· Ù˘ ·È‰È΋˜ ËÏÈΛ·˜, Ô˘ ÔÊ›ÏÂÙ·È Û ÎÔÚÙÈÎÔÙÚfiÊÔ ·‰¤ÓˆÌ· Ù˘ ˘fiÊ˘Û˘. ∏ ˘ÂÚÎÔÚÙÈ˙ÔÏ·ÈÌ›· Ù˘ ÓfiÛÔ˘ Ô‰ËÁ› Û ηٷÛÙÔÏ‹ ÙˆÓ ÂÚÈÛÛfiÙÂÚˆÓ ÔÚÌÔÓÒÓ Ù˘ ÚfiÛıÈ·˜ ˘fiÊ˘Û˘, fiˆ˜ ÙˆÓ FSH, LH, PRL, TSH Î·È GH. ¶ÂÚÈÁÚ¿ÊÂÙ·È ÓfiÛÔ˜ Cushing Û ÎÔÚ›ÙÛÈ ËÏÈΛ·˜ 15ó ÂÙÒÓ, Ô˘ ÚÔ¤‚·ÏÏ Ì ·ÓÛÂÏËÓÔÂȉ¤˜ ÚÔÛˆ›Ô, ηı˘ÛÙ¤ÚËÛË ÛˆÌ·ÙÈ΋˜ ·Ó¿Ù˘Í˘, ·¯˘Û·ÚΛ·, ·ÎÌ‹, ˘ÂÚÙÚ›¯ˆÛË Î·È ˘¤ÚÙ·ÛË. O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍ ˘ÂÚÎÔÚÙÈ˙ÔÏ·ÈÌ›· Î·È Ë Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÌÈÎÚÔ·‰¤ÓˆÌ· Ù˘ ˘fiÊ˘Û˘. ∏ ·ÛıÂÓ‹˜ ¯ÂÈÚÔ˘ÚÁ‹ıËΠÂÈÙ˘¯Ò˜ Î·È ÙÔ ·‰¤ÓˆÌ· Ù˘ ˘fiÊ˘Û˘ ·Ê·ÈÚ¤ıËΠ̠‰È·ÛÊËÓÔÂȉ‹ ÚÔÛ¤Ï·ÛË. ™˘˙ËÙÂ›Ù·È Ë ÎÏÈÓÈ΋ ÚÔ‚ÔÏ‹, Ù· ÔÚÌÔÓÔÏÔÁÈο Î·È ·ÂÈÎÔÓÈÛÙÈο Â˘Ú‹Ì·Ù·, ηıÒ˜ Î·È Ë ıÂÚ·›· Ù˘ ÓfiÛÔ˘ Cushing.

Abstract: Cushing’s disease refers specifically to an ACTH-producing pituitary adenoma that stimulates excess cortisol production and it is very rare in children and adolescents. Hypercortisolism leads to suppression of most of the anterior pituitary hormones: FSH, LH, PRL, TSH and GH. The case is described of a 15ó year-old girl with Cushing’s disease who presented with the characteristic moon face, short stature, obesity, acne, hirsutism and hypertension. Hypercortisolism was detected during the laboratory examination and MRI of the pituitary revealed a microadenoma. She was successfully treated surgically by transsphenoidal removal of the pituitary adenoma. The clinical features at presentation, the diagnosis, hormonal changes and imaging findings, as well as the treatment of Cushing’s disease are discussed.

§¤ÍÂȘ ÎÏÂȉȿ: ·‰¤ÓˆÌ· ˘fiÊ˘Û˘, Û‡Ó‰ÚÔÌÔ Cushing, ˘ÂÚÎÔÚÙÈ˙ÔÏ·ÈÌ›·, ÎÔÓÙfi ·Ó¿ÛÙËÌ·, ‰È·ÛÊËÓÔÂȉ‹˜ ¯ÂÈÚÔ˘ÚÁÈ΋ ·ÓÙÈÌÂÙÒÈÛË.

Key words: pituitary adenoma, Cushing’s syndrome, hypercortisolism, short stature, transsphenoidal surgical treatment.

™˘ÓÙÔÌÔÁڷʛ˜

∂ÈÛ·ÁˆÁ‹ ∏ ÓfiÛÔ˜ Cushing ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ˘ÂÚ¤ÎÎÚÈÛË Ù˘ ÊÏÔÈÔÂÈÓÂÊÚȉÈÔÙÚfiÔ˘ ÔÚÌfiÓ˘ ACTH, ÔÊÂÈÏfiÌÂÓË Û ÎÔÚÙÈÎÔÙÚfiÊÔ ·‰¤ÓˆÌ· Ù˘ ˘fiÊ˘Û˘ (1,2), Ë ÔÔ›· Ô‰ËÁ› Û ˘ÂÚ·Ú·ÁˆÁ‹ ÎÔÚÙÈ˙fiÏ˘ ·fi ÙÔÓ ÊÏÔÈfi ÙˆÓ ÂÈÓÂÊÚȉ›ˆÓ, ÂÓÒ ÙÔ Û‡Ó‰ÚÔÌÔ Cushing ·ÊÔÚ¿ Û οı ˘ÂÚÎÔÚÙÈ˙ÔÏ·ÈÌ›· ·ÓÂÍ·ÚÙ‹ÙÔ˘ ·ÈÙÈÔÏÔÁ›·˜ (ÂÓ‰ÔÁÂÓ‹˜ ‹ Â͈ÁÂÓ‹˜) (2,3). ∏ Û˘¯ÓfiÙÂÚË ·ÈÙ›· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Cushing Â›Ó·È Ë È·ÙÚÔÁÂÓ‹˜, Ë ÔÔ›· ·Ú·ÙËÚÂ›Ù·È ÌÂÙ¿ ·fi Ì·ÎÚÔ¯ÚfiÓÈ· ¯ÔÚ‹ÁËÛË ÎÔÚÙÈ˙fiÓ˘, Û˘ÛÙËÌ·ÙÈ΋˜ ‹ Î·È ÙÔÈ΋˜ (4,5). ∆· ÂÓ‰ÔÁÂÓ‹ ·›ÙÈ· ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙÔ ·‰¤ÓˆÌ· ÙˆÓ ÂÈÓÂÊÚȉ›ˆÓ (3,5), ÙÔ Î·ÚΛӈ̷ (6), ÙÔ ·‰¤ÓˆÌ· Ù˘ ˘fiÊ˘Û˘

ACTH FSH LH E2 DHEA’S 17-OHÚÔÁÂÛÙÂÚfiÓË TSH T4 FT4 T3 FT3 DXM GH U/S MRI

ºÏÔÈÔÂÈÓÂÊÚȉÈÔÙÚfiÔ˜ ÔÚÌfiÓË £˘Ï·ÎÈÔÙÚfiÔ˜ ÔÚÌfiÓË ø¯ÚÈÓÔÙÚfiÔ˜ ÔÚÌfiÓË OÈÛÙÚ·‰ÈfiÏË £ÂÈ˚΋ ‰Â¸‰ÚÔÂÈ·Ó‰ÚÔÛÙÂÚfiÓË 17-˘‰ÚÔ͢-ÚÔÁÂÛÙÂÚfiÓË £˘ÚÂÔÂȉÔÙÚfiÔ˜ ÔÚÌfiÓË £˘ÚÔÍ›ÓË ∂χıÂÚË ı˘ÚÔÍ›ÓË ∆ÚÈȈ‰Ôı˘ÚÔÓ›ÓË ∂χıÂÚË ÙÚÈȈ‰Ôı˘ÚÔÓ›ÓË ¢ÂÍ·ÌÂı·˙fiÓË ∞˘ÍËÙÈ΋ ÔÚÌfiÓË ÀÂÚ˯ÔÁÚ¿ÊËÌ· ª·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›·

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

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

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(1), ÙË ‰È¿¯˘ÙË ÔÏ˘Ô˙Ò‰Ë ˘ÂÚÏ·Û›· ÙˆÓ ÂÈÓÂÊÚȉ›ˆÓ (3,7,8) ηÈ, Ôχ Û¿ÓÈ·, ÙËÓ ¤ÎÙÔË ·Ú·ÁˆÁ‹ ACTH (7). ∏ ÓfiÛÔ˜ Cushing ÚÔÛ‚¿ÏÏÂÈ ·È‰È¿ fiÏˆÓ ÙˆÓ ËÏÈÎÈÒÓ, ·ÏÏ¿ Â›Ó·È Û˘¯ÓfiÙÂÚË Û ËÏÈ˘ ÌÂÁ·Ï‡ÙÂÚ˜ ÙˆÓ 7 ÂÙÒÓ (7). ∏ Û˘¯ÓfiÙËÙ¿ Ù˘ Â›Ó·È ›‰È· ÛÙ· ‰‡Ô ʇϷ (2), Û ·ÓÙ›ıÂÛË Ì ÙÔ˘˜ fiÁÎÔ˘˜ ÙˆÓ ÂÈÓÂÊÚȉ›ˆÓ, ÔÈ ÔÔ›ÔÈ ˘ÂÚÙÂÚÔ‡Ó ÛÙ· ÎÔÚ›ÙÛÈ· (3:1) (7). ∏ Â›ÙˆÛË Ù˘ ÓfiÛÔ˘ Cushing ÛÙÔÓ ÁÂÓÈÎfi ÏËı˘ÛÌfi Â›Ó·È 5-10 ÂÚÈÙÒÛÂȘ/¤ÙÔ˜, ·Ó¿ 1.000.000 ÏËı˘ÛÌÔ‡ (9). ∏ ÓfiÛÔ˜ Cushing Â›Ó·È ·ÎfiÌË ÈÔ Û¿ÓÈ· ÛÙËÓ ·È‰È΋ ËÏÈΛ· (1,8,10). ∏ ˘ÂÚÎÔÚÙÈ˙ÔÏ·ÈÌ›· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Cushing Ô‰ËÁ› Û ηٷÛÙÔÏ‹ ÙˆÓ ÂÚÈÛÛfiÙÂÚˆÓ ÔÚÌÔÓÒÓ Ù˘ ÚfiÛıÈ·˜ ˘fiÊ˘Û˘ (10). ™˘¯Ó¿, Ë ÎÏÈÓÈ΋ ‰È·Ù·Ú·¯‹ ‰ÂÓ ·Ó·ÁÓˆÚ›˙ÂÙ·È, ÙfiÛÔ ·fi ÙÔ˘˜ ÁÔÓ›˜ fiÛÔ Î·È ·fi ÙÔ˘˜ ÁÈ·ÙÚÔ‡˜, ÁÈ· ÌÂÁ¿ÏË ¯ÚÔÓÈ΋ ÂÚ›Ô‰Ô (1,2). ∏ ¤ÁηÈÚË ‰È¿ÁÓˆÛË ÛÙËÓ ·È‰È΋ ËÏÈΛ· ÂÍ·ÛÊ·Ï›˙ÂÈ Ê˘ÛÈÔÏÔÁÈ΋ ÂÊ˂›· Î·È ‚ÂÏÙȈ̤ÓÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· (2,10). ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ∫ÔÚ›ÙÛÈ ËÏÈΛ·˜ 15ó ÂÙÒÓ ÚÔÛ‹Ïı ÛÙÔ ÂÓ‰ÔÎÚÈÓÔÏÔÁÈÎfi È·ÙÚÂ›Ô Ì ηı˘ÛÙ¤ÚËÛË ÛˆÌ·ÙÈ΋˜ ·Ó¿Ù˘Í˘ Î·È ·¯˘Û·ÚΛ·. °ÂÓÓ‹ıËΠÌÂÙ¿ ·fi Ê˘ÛÈÔÏÔÁÈ΋ ÙÂÏÂÈfiÌËÓË Î‡ËÛË Î·È ÙÔÎÂÙfi, Ì µ° 1500 g. ∏ ÂÚÈÁÂÓÓËÙÈ΋ ÂÚ›Ô‰Ô˜, ÙÔ ·ÙÔÌÈÎfi Î·È ÎÏËÚÔÓÔÌÈÎfi ÈÛÙÔÚÈÎfi ‹Ù·Ó ÂχıÂÚ·. ∏ „˘¯ÔÎÈÓËÙÈ΋ ÂͤÏÈÍË ÙÔ˘ ·È‰ÈÔ‡ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋. ∞fi ‰ÈÂÙ›·˜, ÔÈ ÁÔÓ›˜ ·Ú·Ù‹ÚËÛ·Ó È‰È·›ÙÂÚË ·‡ÍËÛË ÙÔ˘ ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜, Ì ·Ó·Î·Ù·ÓÔÌ‹ ÙÔ˘ Ï›Ô˘˜ ÛÙËÓ ÎÔÈÏÈ¿ Î·È ÙÔÓ ıÒڷη, ÂÈ‚Ú¿‰˘ÓÛË ÙÔ˘ Ú˘ıÌÔ‡ ۈ̷ÙÈ΋˜ ·Ó¿Ù˘Í˘ Î·È ‹Ș ÎÂÊ·Ï·ÏÁ›Â˜ Ô˘ ˘Ô¯ˆÚÔ‡Û·Ó ¯ˆÚ›˜ ·ÁˆÁ‹. ∫·Ù¿ ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË ‰È·ÈÛÙÒıËΠ¯·ÌËÏfi ·Ó¿ÛÙËÌ· (<3Ë ∂£), ·ÓÛÂÏËÓÔÂȉ¤˜ ÚÔÛˆÂ›Ô Ì ÂͤڢıÚ˜ ·ÚÂȤ˜, ÎÂÓÙÚÈÎÔ‡ Ù‡Ô˘ ·¯˘Û·ÚΛ·, ȉȷ›ÙÂÚ· ¤Î‰ËÏË ÛÙÔÓ ÎÔÚÌfi, Ì ¯·Ú·ÎÙËÚÈÛÙÈÎfi ‡‚Ô ÛÙÔÓ ·˘¯¤Ó·, Û¯ÂÙÈο ·‰‡Ó·Ù· ¿ÎÚ·, ¯ÓÔÒ‰Ë ÙÚ›¯ˆÛË ÚÔÛÒÔ˘, ¿ÎÚˆÓ, ÎÔÚÌÔ‡ Î·È Ú¿¯Ë˜. ∆Ô ‡„Ô˜ Ù˘ ·ÛıÂÓÔ‡˜ ‹Ù·Ó 137,3 cm (<3Ë ∂£, -4,1 SDS) Ì ‡„Ô˜-ÛÙfi¯Ô 160,7 cm, ÙÔ ‚¿ÚÔ˜ 43,1 kg (3Ë ∂£, -1,3 SDS) Î·È Ô ‰Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ 22,9 kg/m2 (0,9 SDS). ∆· ÛËÌ›· ÂÓ‹‚ˆÛ˘ ηٿ Tanner ‹Ù·Ó: ÙÚ›¯ˆÛË ÂÊË‚·›Ô˘ ÛÙ¿‰ÈÔ πππ, ÙÚ›¯ˆÛË Ì·Û¯¿Ï˘ ÛÙ¿‰ÈÔ ππ Î·È ·Ó¿Ù˘ÍË Ì·ÛÙÒÓ ÛÙ¿‰ÈÔ ππ ÚÔ˜ πππ. ∆· ¤Íˆ ÁÂÓÓËÙÈο fiÚÁ·Ó· ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο. ∏ ·ÛıÂÓ‹˜ ·ÚÔ˘Û›·˙ ÚˆÙÔ·ı‹ ·ÌËÓfiÚÚÔÈ·. ∏ ·ÚÙËÚȷ΋ ›ÂÛË Û fiϘ ÙȘ ÌÂÙÚ‹ÛÂȘ ‹Ù·Ó >140/90 mmHg. ∏ ÂͤٷÛË ·fi Ù· ÏÔÈ¿ Û˘ÛÙ‹Ì·Ù· ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋.

O ÔÚÌÔÓÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍÂ: ÎÔÚÙÈ˙fiÏË (Úˆ›): 64,3 Ìg/dl (Ê.Ù.: 7-25), ÎÔÚÙÈ˙fiÏË (‚Ú¿‰˘): 42,6 Ìg/dl (Ê.Ù.: 2-9), ÂχıÂÚË ÎÔÚÙÈ˙fiÏË Ô‡ÚˆÓ

472

Paediatriki 2003;66:471-474

24ÒÚÔ˘: 750 Ìg/24ˆÚÔ (Ê.Ù.: 6,5-90 Ìg/ 24ˆÚÔ), ACTH (Úˆ›): 118 pg/ml (Ê.Ù.: 9-52), FSH: 0,53 mIU/ml, LH <0,1 mIU/ml, E2 <10 pg/ml, ÙÂÛÙÔÛÙÂÚfiÓË: 0,9 ng/ml (Ê.Ù.: 0,7-3,9), DHEA’S: 6,3 Ìg/ml (Ê.Ù.: 0,4-1,4), 17-OH-ÚÔÁÂÛÙÂÚfiÓË: 5,7 ng/ml (Ê.Ù.: 0,25-1,9), ¢4-·Ó‰ÚÔÛÙÂÓ‰ÈfiÓË: 5,8 ng/ml (Ê.Ù.: 0,55-2,5), TSH: 0,5 mIU/ml (Ê.Ù.: 0,4-5), T4: 5,8 Ìg/dl (Ê.Ù.: 5,6-13,9), FT4: 1,0 ng/dl (Ê.Ù.: 0,9-2), ∆3: 0,7 ng/dl (Ê.Ù.: 0,9-2) Î·È FT3: 1,5 pg/dl (Ê.Ù.: 2,4-5). ∏ ÚˆÈÓ‹ ÎÔÚÙÈ˙fiÏË Î·È Ë ACTH ·›Ì·ÙÔ˜ ÌÂÙ¿ ·fi ¯ÔÚ‹ÁËÛË ÌÂÁ¿ÏˆÓ ‰fiÛÂˆÓ ‰ÂÍ·ÌÂı·˙fiÓ˘ (DXM) (8 mg ËÌÂÚËÛ›ˆ˜: 2 mg DXM ·Ó¿ ÂÍ¿ˆÚÔ Â› ‰‡Ô Ë̤Ú˜) ηÙÂÛÙ¿ÏËÛ·Ó ·fi 64,3 Ìg/dl Î·È 118 pg/ml Û 31,82 Ìg/dl Î·È 45 pg/ml, ·ÓÙ›ÛÙÔȯ·.

OÈ ‰ÔÎÈ̷ۛ˜ ‰È¤ÁÂÚÛ˘ ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ (GH) ÌÂÙ¿ ·fi ¯ÔÚ‹ÁËÛË L-DOPA Î·È ÎÏÔÓȉ›Ó˘ ¤‰ÂÈÍ·Ó ·ÓÂ·Ú΋ ¤ÎÎÚÈÛË ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ (̤ÁÈÛÙË ·ÓÙ·fiÎÚÈÛË 0,57 Î·È 3,32 ÌIU/ml, ·ÓÙ›ÛÙÔȯ·).

O ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù˘ ÎÔÚÙÈ˙fiÏ˘, ÙˆÓ TSH, T3, T4, FSH, LH, E2, Ù˘ ÙÂÛÙÔÛÙÂÚfiÓ˘, Ù˘ DHEA’S, Ù˘ 17-OH-ÚÔÁÂÛÙÂÚfiÓ˘ Î·È Ù˘ ¢4-·Ó‰ÚÔÛÙÂÓ‰ÈfiÓ˘ ¤ÁÈÓ Ì ÙË Ì¤ıÔ‰Ô Ù˘ ËÏÂÎÙÚÔ¯ËÌÂÈÔʈٷ‡ÁÂÈ·˜ (¯ÚËÛÈÌÔÔÈÒÓÙ·˜ Ù· kits Ù˘ ROCHE). ∏ ACTH Î·È Ë GH ÚÔÛ‰ÈÔÚ›ÛÙËÎ·Ó Ì ÙË Ì¤ıÔ‰Ô Ù˘ ¯ËÌÂÈÔʈٷ‡ÁÂÈ·˜ (kit: Nichols Advantaged) Î·È Ë ÂχıÂÚË ÎÔÚÙÈ˙fiÏË Ô‡ÚˆÓ 24ÒÚÔ˘ Ì ÙË Ì¤ıÔ‰Ô RIA (̤ıÔ‰Ô˜ Ú·‰ÈÔ·ÓÔÛÔÌÂÙÚ›·˜, kit: DSL). ∏ ÔÛÙÈ΋ ËÏÈΛ· Ù˘ ·ÛıÂÓÔ‡˜ ‹Ù·Ó 12,5 ÂÙÒÓ, ÂÓÒ Ë ¯ÚÔÓÔÏÔÁÈ΋ 15ó. ∆Ô U/S ÂÈÓÂÊÚȉ›ˆÓ ¤‰ÂÈÍ ·ÌÊÔÙÂÚfiÏ¢ÚË ‰ÈfiÁΈÛË ÙˆÓ ÂÈÓÂÊÚȉ›ˆÓ (ÙÔ ‰ÂÍ›: 2,4 x 1,1 cm Î·È ÙÔ ·ÚÈÛÙÂÚfi: 2,06 x 0,98 cm). ™ÙÔ U/S Ì‹ÙÚ·˜-ˆÔıËÎÒÓ, Ë Ì‹ÙÚ· ›¯Â ‰È·ÛÙ¿ÛÂȘ 4,37 x 1,18 cm, Ì ·Ó·ÏÔÁ›· ÛÒÌ·ÙÔ˜ Ì‹ÙÚ·˜-ÙÚ·¯‹ÏÔ˘ 2/1, ÂÓÒ ÔÈ ˆÔı‹Î˜ ‹Ù·Ó ÌÈÎÚ¤˜ (fiÁÎÔ˜ ‰ÂÍÈ¿˜ ˆÔı‹Î˘: 0,83 cc Î·È ·ÚÈÛÙÂÚ‹˜: 1,11 cc). ™ÙËÓ MRI ˘fiÊ˘Û˘ ·ÂÈÎÔÓÈ˙fiÙ·Ó ÌÈÎÚÔ·‰¤ÓˆÌ· ‰È·Ì¤ÙÚÔ˘ <1 cm, ÛÙÔ ·ÚÈÛÙÂÚfi Ï¿ÁÈÔ ÙÔ˘ ·‰¤Ó· Ù˘ ˘fiÊ˘Û˘, Ì ·ÚÔ˘Û›· ·ÈÌÔÚÚ·ÁÈ΋˜ ÂÛÙ›·˜, ÂÓÒ Ô Ì›Û¯Ô˜ ÚÔ¤‚·ÏÏ ÚÔ˜ Ù· ‰ÂÍÈ¿. ∫·Ù¿ ÙËÓ ÔÊı·ÏÌÔÏÔÁÈ΋ ÂͤٷÛË, Ô ‚˘ıfi˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜. ™ÙÔ U/S ηډȿ˜ ‰È·ÈÛÙÒıËΠÔÚȷ΋ ˘ÂÚÙÚÔÊ›· ÙÔ˘ ÌÂÛÔÎÔÈÏÈ·ÎÔ‡ ‰È·ÊÚ¿ÁÌ·ÙÔ˜. ∏ ·ÛıÂÓ‹˜, ÏfiÁˆ Ù˘ ˘¤ÚÙ·Û˘, ¤Ï·‚ ·ÓÙÈ˘ÂÚÙ·ÛÈ΋ ·ÁˆÁ‹ Ì ‚-·Ó·ÛÙÔÏ›˜ (ÚÔÚ·ÓÔÏfiÏË, 20 mg ËÌÂÚËÛ›ˆ˜). ∆Ô ÌÈÎÚÔ·‰¤ÓˆÌ· ·Ê·ÈÚ¤ıËΠÂÈÙ˘¯Ò˜ Ì ‰È·ÛÊËÓÔÂȉ‹ ÚÔÛ¤Ï·ÛË. ª›· ‚‰ÔÌ¿‰· ÌÂÙÂÁ¯ÂÈÚËÙÈο, ÔÈ ÙÈ̤˜ Ù˘ ÚˆÈÓ‹˜ ÎÔÚÙÈ˙fiÏ˘ ÂÏ·ÙÙÒıËÎ·Ó ·fi 64,3 Ìg/dl Û 0,04 Ìg/dl Î·È Ù˘ ACTH ·fi 118 pg/ml Û 10 pg/ml, fiˆ˜ Â›Û˘ Î·È ÔÈ ÙÈ̤˜ Ù˘ ÂχıÂÚ˘ ÎÔÚÙÈ˙fiÏ˘ Ô‡ÚˆÓ 24ÒÚÔ˘ ·fi 750 Ìg/24ˆÚÔ Û 5 Ìg/24ˆÚÔ. ∏ ·ÛıÂÓ‹˜ Ï·Ì‚¿ÓÂÈ ·ÁˆÁ‹ ˘ÔηٿÛÙ·Û˘ Ì ˘‰ÚÔÎÔÚÙÈ˙fiÓË. ªÂÙÂÁ¯ÂÈÚËÙÈο ‰ÂÓ ·ÚÔ˘Û›·Û ¿ÔÈÔ ‰È·‚‹ÙË.

¶·È‰È·ÙÚÈ΋ 2003;66:471-474

¶¤ÓÙ ̋Ó˜ ÌÂÙ¿ ÙËÓ Â¤Ì‚·ÛË Â›¯Â ÂÌÌËÓ·Ú¯‹ Î·È ÔÈ ÙÈ̤˜ ÙˆÓ FSH, LH, E2, TSH, T3 Î·È T4 ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈΤ˜.

O Ú˘ıÌfi˜ ·Ó¿Ù˘Í˘ Ù˘ ·ÛıÂÓÔ‡˜ ‚ÂÏÙÈÒıËÎÂ Î·È ‰Ò‰Âη Ì‹Ó˜ ÌÂÙ¿ ÙËÓ ÂÁ¯Â›ÚËÛË ÙÔ ‡„Ô˜ Ù˘ Â›Ó·È 143 cm, ÙÔ ‚¿ÚÔ˜ 38,5 kg, Ë ÂÌÊ¿ÓÈÛ‹ Ù˘ ¤¯ÂÈ ‚ÂÏÙȈı› ÛËÌ·ÓÙÈο Î·È Ù· ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο Ù˘ ÓfiÛÔ˘ Cushing ¤¯Ô˘Ó ˘Ô¯ˆÚ‹ÛÂÈ. ∏ ·ÚÙËÚȷ΋ Ù˘ ›ÂÛË Â›Ó·È Ê˘ÛÈÔÏÔÁÈ΋ ¯ˆÚ›˜ ıÂÚ·›·. ™˘˙‹ÙËÛË ∆· ·È‰È¿ Î·È ÔÈ ¤ÊË‚ÔÈ Ì ÓfiÛÔ Cushing ·ÚÔ˘ÛÈ¿˙Ô˘Ó Û˘Ìو̷ÙÔÏÔÁ›· Ô˘ ‰È·Ê¤ÚÂÈ ·fi ÂΛÓË ÙˆÓ ÂÓËÏ›ÎˆÓ (1,2). O ÈÔ Â˘·›ÛıËÙÔ˜ ‰Â›ÎÙ˘ ˘ÂÚÎÔÚÙÈ˙ÔÏ·ÈÌ›·˜ ÛÙ· ·È‰È¿ Â›Ó·È Ë Î·ı˘ÛÙ¤ÚËÛË Ù˘ ۈ̷ÙÈ΋˜ ·Ó¿Ù˘Í˘, Ë ÔÔ›· Û˘Ó‹ıˆ˜ ÚÔËÁÂ›Ù·È ÙˆÓ ¿ÏÏˆÓ ÂΉËÏÒÛÂˆÓ (2,10), ÂÓÒ Ë ·¯˘Û·ÚΛ· ÛÙ· ·È‰È¿ Ì ۇӉÚÔÌÔ Cushing Â›Ó·È ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÊÔÚ¤˜ ÁÂÓÈÎÂ˘Ì¤ÓË, ·Ú¿ ÎÂÓÙÚÈÎÔ‡ Ù‡Ô˘ (2). ∏ ˘ÂÚÎÔÚÙÈ˙ÔÏ·ÈÌ›· ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙËÓ Î·Ù¿ÚÁËÛË ÙÔ˘ ËÌÂÚ‹ÛÈÔ˘ Ú˘ıÌÔ‡ ¤ÎÎÚÈÛ˘ Ù˘ ÎÔÚÙÈ˙fiÏ˘ Î·È Ë Î·Ù·ÛÙÔÏ‹ Ù˘ ÌÂÙ¿ ·fi ¯ÔÚ‹ÁËÛË ˘„ËÏÒÓ ‰fiÛÂˆÓ DXM, ·ÏÏ¿ fi¯È ÌÂÙ¿ ·fi ¯ÔÚ‹ÁËÛË ÌÈÎÚÒÓ ‰fiÛˆÓ, Â›Ó·È ·fi Ù· ¯·Ú·ÎÙËÚÈÛÙÈο ·ıÔÁÓˆÌÔÓÈο Â˘Ú‹Ì·Ù· Ù˘ ÓfiÛÔ˘ Cushing (1,2). ∏ ·ÛıÂÓ‹˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ›¯Â fiÏ· Ù· ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Cushing: ηı˘ÛÙ¤ÚËÛË ·‡ÍËÛ˘ Î·È ÂÓ‹‚ˆÛ˘, ÎÂÓÙÚÈÎÔ‡ Ù‡Ô˘ ·¯˘Û·ÚΛ·, ·ÓÛÂÏËÓÔÂȉ¤˜ ÚÔÛˆÂ›Ô Î·È ‡‚Ô ÛÙÔÓ ·˘¯¤Ó·, ˘¤ÚÙ·ÛË Î·È ˘ÂÚÙÚ›¯ˆÛË. ∏ ÂχıÂÚË ÎÔÚÙÈ˙fiÏË Ô‡ÚˆÓ 24ÒÚÔ˘ ‹Ù·Ó Ôχ ·˘ÍË̤ÓË, ηıÒ˜ Î·È Ë ACTH. OÈ È‰È·›ÙÂÚ· ·˘ÍË̤Ó˜ ÙÈ̤˜ Ù˘ ÎÔÚÙÈ˙fiÏ˘ Û˘Óԉ‡ÔÓÙ·Ó ·fi ·‡ÍËÛË fiÏˆÓ ÙˆÓ ÛÙÂÚÔÂȉÈÎÒÓ ·Ú·ÁÒÁˆÓ ÙˆÓ ÂÈÓÂÊÚȉ›ˆÓ (17-O∏-ÚÔÁÂÛÙÂÚfiÓË, ·Ó‰ÚÔÁfiÓ·), ÂÓÒ Â›¯Â ηٷÚÁËı› Ë ËÌÂÚ‹ÛÈ· ‰È·Î‡Ì·ÓÛË Ù˘ ÎÔÚÙÈ˙fiÏ˘. ∏ ¯ÔÚ‹ÁËÛË ÌÂÁ¿ÏˆÓ ‰fiÛÂˆÓ DXM η٤ÛÙÂÈÏ ÙËÓ ÎÔÚÙÈ˙fiÏË Î·È ÙËÓ ACTH Û ÔÛÔÛÙfi >50%. ∏ ·˘ÍË̤ÓË ACTH Î·È Ë Î·Ù·ÛÙÔÏ‹ Ù˘ ÎÔÚÙÈ˙fiÏ˘ Î·È Ù˘ ACTH ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË ÌÂÁ¿ÏˆÓ ‰fiÛÂˆÓ DXM, Û˘ÓËÁÔÚÔ‡Û·Ó ˘¤Ú Ù˘ ÓfiÛÔ˘ Cushing Î·È ·˘Ùfi ÂȂ‚·ÈÒıËΠ·ÂÈÎÔÓÈÛÙÈο Ì MRI ˘fiÊ˘Û˘ Î·È U/S ÂÈÓÂÊÚȉ›ˆÓ. ∏ ˘ÂÚÎÔÚÙÈ˙ÔÏ·ÈÌ›· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Cushing Ô‰ËÁ› Û ηٷÛÙÔÏ‹ ÙˆÓ ÂÚÈÛÛfiÙÂÚˆÓ ÔÚÌÔÓÒÓ Ù˘ ÚfiÛıÈ·˜ ˘fiÊ˘Û˘ (FSH, LH, PRL, TSH Î·È GH) (10). O Ú˘ıÌfi˜ Ù˘ ۈ̷ÙÈ΋˜ ·Ó¿Ù˘Í˘ ÂÈ‚Ú·‰‡ÓÂÙ·È Ì¤¯ÚÈ ÌˉÂÓÈÛÌÔ‡ (11). ∏ ·Ó·ÛÙÔÏ‹ Ù˘ ·Ó¿Ù˘Í˘ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙËÓ ÂÌÊ¿ÓÈÛË ·¯˘Û·ÚΛ·˜ ÛÙ· ·È‰È¿, ı¤ÙÂÈ ÙËÓ ˘Ô„›· Û˘Ó‰ÚfiÌÔ˘ Cushing (10), ·ÊÔ‡ Â›Ó·È ÁÓˆÛÙfi fiÙÈ Ë ·‡ÍËÛË ÙÔ˘ ‚¿ÚÔ˘˜ ÛÙËÓ ·È‰È΋ ËÏÈΛ· Û˘Óԉ‡ÂÙ·È ·fi Ù·¯‡ÙÂÚÔ Ú˘ıÌfi ·Ó¿Ù˘Í˘. ∏ ·ÓÙ·fiÎÚÈÛË Ù˘

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·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ ÛÙȘ ‰ÔÎÈ̷ۛ˜ ‰È¤ÁÂÚÛ˘ ÌÔÚ› Ó· Â›Ó·È Ê˘ÛÈÔÏÔÁÈ΋ ‹ ÂÏ·Ùو̤ÓË (2,10,11). ™ÙËÓ ·ÛıÂÓ‹ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‹Ù·Ó ÂÏ·Ùو̤ÓË. ∆Ô ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· ÙˆÓ ·ÛıÂÓÒÓ Â›Ó·È Û˘Ó‹ıˆ˜ ¯·ÌËÏfiÙÂÚÔ ·fi ÙÔ ÚÔ‚ÏÂfiÌÂÓÔ (2). ∆Ô ÚÔ‚ÏÂfiÌÂÓÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· Ù˘ Û˘ÁÎÂÎÚÈ̤Ó˘ ·ÛıÂÓÔ‡˜, ‚¿ÛË Ù˘ ÔÛÙÈ΋˜ ËÏÈΛ·˜, ‹Ù·Ó 144,7 cm, ÙÔ ÔÔ›Ô ˘ÔÏ›ÂÙ·È ÛËÌ·ÓÙÈο ÙÔ˘ ‡„Ô˘˜-ÛÙfi¯Ô˘ (160,7 cm).

O ˘ÔÁÔÓ·‰ÔÙÚÔÊÈÎfi˜ ˘ÔÁÔÓ·‰ÈÛÌfi˜ Û˘Óԉ‡ÂÈ Ù· ·È‰È¿ Ô˘ ÂÌÊ·Ó›˙Ô˘Ó Û‡Ó‰ÚÔÌÔ Cushing ÛÙËÓ ·Ú¯‹ Ù˘ ÂÊ˂›·˜ (8,10). ∏ ·ÛıÂÓ‹˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ·ÚÔ˘Û›·Û Â›Û˘ ˘ÔÁÔÓ·‰ÔÙÚÔÊÈÎfi ˘ÔÁÔÓ·‰ÈÛÌfi (¯·ÌËϤ˜ ÙÈ̤˜ FSH, LH Î·È ∂2 Î·È ÛÙÔ U/S ¤Ûˆ ÁÂÓÓËÙÈÎÒÓ ÔÚÁ¿ÓˆÓ ÌÈÎÚ¤˜ ˆÔı‹Î˜). ªÂÙ¿ ÙËÓ ·Ê·›ÚÂÛË ÙÔ˘ ·‰ÂÓÒÌ·ÙÔ˜, Ë ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ ÁÔÓ¿‰ˆÓ Û˘Ó‹ıˆ˜ ·Ôηı›ÛÙ·Ù·È Î·È ÔÈ ·ÛıÂÓ›˜ Ù˘ ÂÊË‚È΋˜ ËÏÈΛ·˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ê˘ÛÈÔÏÔÁÈ΋ ÂÊË‚È΋ ÂͤÏÈÍË, Ê˘ÛÈÔÏÔÁÈÎÔ‡˜ ·ÎÏÔ˘˜ ÂÌÌËÓÔÚÚ˘Û›·˜ Î·È Ê˘ÛÈÔÏÔÁÈο Â›‰· ÛÙÂÚÔÂȉÒÓ ÙÔ˘ ʇÏÔ˘ (10), fiˆ˜ Û˘Ó¤‚Ë Î·È Ì ÙË Û˘ÁÎÂÎÚÈ̤ÓË ·ÛıÂÓ‹. ¶ÔÏÏÔ› ·ÛıÂÓ›˜ Ì ۇӉÚÔÌÔ Cushing ÂÌÊ·Ó›˙Ô˘Ó ¯·ÌËÏ‹ TSH, T3 Î·È FT3 (10). ∏ Û˘ÁΤÓÙÚˆÛË Ù˘ TSH Â›Ó·È ÌÂȈ̤ÓË ˆ˜ ·ÔÙ¤ÏÂÛÌ· Ù˘ ‰Ú¿Û˘ ÙˆÓ ÁÏ˘ÎÔÎÔÚÙÈÎÔÂȉÒÓ, ÙfiÛÔ Û Â›Â‰Ô ˘Ôı·Ï¿ÌÔ˘ fiÛÔ Î·È ˘fiÊ˘Û˘ (10). ∏ T3 Â›Ó·È Â›Û˘ ÌÂȈ̤ÓË, ·ÊÔ‡ Ë ˘ÂÚÎÔÚÙÈ˙ÔÏ·ÈÌ›· ÂÌÔ‰›˙ÂÈ ÙËÓ ÂÚÈÊÂÚÈ΋ ÌÂÙ·ÙÚÔ‹ Ù˘ ·fi ÙËÓ T4. ∫ÏÈÓÈο, Ë ı˘ÚÂÔÂȉÈ΋ ÏÂÈÙÔ˘ÚÁ›· Â›Ó·È Ê˘ÛÈÔÏÔÁÈ΋. ªÂÙÂÁ¯ÂÈÚËÙÈο, ÔÈ ÙÈ̤˜ ÙˆÓ ı˘ÚÂÔÂȉÈÎÒÓ ÔÚÌÔÓÒÓ TSH, T3 Î·È FT3 ·Ôηı›ÛÙ·ÓÙ·È ÛÙ· Ê˘ÛÈÔÏÔÁÈο, fiˆ˜ ·Ú·ÙËÚ‹ıËÎÂ Î·È ÛÙËÓ ·ÛıÂÓ‹ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘. ∏ ıÂÚ·›· ÂÈÏÔÁ‹˜ ÛÙË ÓfiÛÔ Cushing Â›Ó·È Ë ‰È·ÛÊËÓÔÂȉ‹˜ ·Ê·›ÚÂÛË ÙÔ˘ ˘ÔÊ˘ÛÈ·ÎÔ‡ ·‰ÂÓÒÌ·ÙÔ˜ (2,8). ∏ ÂÈÙ˘¯‹˜ ·Ê·›ÚÂÛË fiÏÔ˘ ÙÔ˘ ·‰ÂÓÒÌ·ÙÔ˜ ¤¯ÂÈ Û·Ó ·ÔÙ¤ÏÂÛÌ· Ù· Ôχ ¯·ÌËÏ¿ Â›‰· ÎÔÚÙÈ˙fiÏ˘ ÌÂÙÂÁ¯ÂÈÚËÙÈο (12). ∞˘Ùfi Û˘Ì‚·›ÓÂÈ ÁÈ·Ù› Ù· ·˘ÍË̤ӷ Â›‰· ÎÔÚÙÈ˙fiÏ˘ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÓfiÛÔ˘ Ô‰ËÁÔ‡Ó Û ηٷÛÙÔÏ‹ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÎÔÚÙÈÎÔÙÚfiÊˆÓ Î˘ÙÙ¿ÚˆÓ Ù˘ ˘fiÊ˘Û˘, Ô˘ ‚Ú›ÛÎÔÓÙ·È Á‡Úˆ ·fi ÙÔÓ fiÁÎÔ Ù˘ ˘fiÊ˘Û˘ (12). ªÂÙ¿ ÙËÓ ·Ê·›ÚÂÛË ÙÔ˘ ·‰ÂÓÒÌ·ÙÔ˜, Ë ACTH Î·È Ë ·Ú·ÁˆÁ‹ Ù˘ ÎÔÚÙÈ˙fiÏ˘ ·Ó·ÛÙ¤ÏÏÔÓÙ·È ÁÈ· ·ÚÎÂÙfi ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·. ∏ ·ÔηٿÛÙ·ÛË Ù˘ ÎÔÚÙÈ˙fiÏ˘ ÛÂ Ê˘ÛÈÔÏÔÁÈο Â›‰· Û˘Ó‹ıˆ˜ ÂÈÙ˘Á¯¿ÓÂÙ·È Û ‰È¿ÛÙËÌ· 6 ¤ˆ˜ 45 ÌËÓÒÓ (12). ∏ Û˘ÁÎÂÎÚÈ̤ÓË ·ÛıÂÓ‹˜ ·ÚÔ˘Û›·Û ÂÏ¿ÙÙˆÛË Ù˘ ÎÔÚÙÈ˙fiÏ˘ Î·È Ù˘ ACTH ÌÂÙÂÁ¯ÂÈÚËÙÈο Î·È ¯ÚÂÈ¿ÛÙËΠ·ÁˆÁ‹ Ì ˘‰ÚÔÎÔÚÙÈ˙fiÓË. ∂› ·ÔÙ˘¯›·˜ Ù˘ ‰È·ÛÊËÓÔÂȉԇ˜ ¯ÂÈÚÔ˘ÚÁÈ΋˜ ÚÔÛ¤Ï·Û˘, Û˘ÓÈÛÙ¿Ù·È Â·Ó¿ÏË„Ë (2). ∂› Ó¤·˜ ·ÔÙ˘¯›·˜, Û˘ÓÈÛÙ¿Ù·È ·ÎÙÈÓÔıÂÚ·›· Ù˘

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˘fiÊ˘Û˘ (8). ™ÙÔ˘˜ ÂÓ‹ÏÈΘ, ÂÎÙfi˜ ·fi ÙË ‰È·ÛÊËÓÔÂȉ‹ ÚÔÛ¤Ï·ÛË, ÌÔÚ› Ó· ¯ÚËÛÈÌÔÔÈËı› Î·È Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ (fiˆ˜ Ë ÌÂÙ˘Ú·fiÓË Î·È Ë ÌÈÙÔÙ¿ÓË, Ô˘ ·Ó·ÛÙ¤ÏÏÔ˘Ó ÙËÓ ·Ú·ÁˆÁ‹ ÎÔÚÙÈ˙fiÏ˘ ·fi Ù· ÂÈÓÂÊÚ›‰È·). ™Ù· ·È‰È¿ ‰ÂÓ Û˘ÓÈÛÙ¿Ù·È ÏfiÁˆ ÙˆÓ ·ÚÂÓÂÚÁÂÈÒÓ (8). ∏ ‰È·ÛÊËÓÔÂȉ‹˜ ¯ÂÈÚÔ˘ÚÁÈ΋ ÚÔÛ¤Ï·ÛË ÛÙËÓ ·ÛıÂÓ‹ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ¤‰ˆÛ ÈηÓÔÔÈËÙÈο ·ÔÙÂϤÛÌ·Ù·. ∆Ô ÔÚÌÔÓÔÏÔÁÈÎfi Ù˘ ÚÔÊ›Ï ‚ÂÏÙÈÒıËÎÂ Î·È Â›Ó·È ˘fi ·ÁˆÁ‹ Ì ˘‰ÚÔÎÔÚÙÈ˙fiÓË. ¢Ò‰Âη Ì‹Ó˜ ÌÂÙ¿, Ë ·ÛıÂÓ‹˜ Â›Ó·È ˘ÁÈ‹˜ Î·È ‰ÂÓ ¤¯ÂÈ ·ÚÔ˘ÛÈ¿ÛÂÈ ÛËÌ›· ˘ÔÙÚÔ‹˜. µÈ‚ÏÈÔÁÚ·Ê›· 1. Savage MO, Lienhardt A, Lebrethon MC, Johnston LB, Huebner A, Grossman AB et al. Cushing’s disease in childhood: presentation, investigation, treatment and longterm outcome. Horm Res 2001;55 (Suppl 1):S24-S30.

2. Devoe DJ, Miller WL, Conte FA, Kaplan SL, Grumbach MM, Rosenthal SM et al. Long-term outcome in children and adolescents after transsphenoidal surgery for Cushing’s disease. J Clin Endocrinol Metab 1997;82:3196-3202.

3. ∫·˚Ì¿Ú·-¶··ı·Ó·Û›Ô˘ ∞, ÷Ù˙Ë·ı·Ó·Û›Ô˘ Ã, §··ÙÛ¿Ó˘ ¶, ªÔ˘ÙÛÔ‡Ú˘ Ã, ¶··ıÂÔ‰ÒÚÔ˘ ∞, £ÂÔ‰ˆÚ›‰Ë˜ Ã. ™‡Ó‰ÚÔÌÔ Cushing ·fi ·‰¤ÓˆÌ· ÊÏÔÈÔ‡ ÙˆÓ ÂÈÓÂÊÚȉ›ˆÓ Û ÎÔÚ›ÙÛÈ ËÏÈΛ·˜ 12 ÂÙÒÓ. ¶·È‰È·ÙÚÈ΋ 1991;54:300-306.

4. ª›ÙÛË ª, £ÂÔ‰ˆÚ›‰Ë˜ Ã, ™˘ÚÈÔÔ‡ÏÔ˘ µ, ∫·ÙÂÚ¤ÏÔ˜ Ã, ª·ÙÛ·ÓÈÒÙ˘ ¡. ™‡Ó‰ÚÔÌÔ Cushing ·fi Ì·ÎÚÔ¯ÚfiÓÈ· ÙÔÈ΋ ¯Ú‹ÛË ÎÔÚÙÈ˙ÔÓÔ‡¯Ô˘ ·ÏÔÈÊ‹˜ Clobetasol propionate. ¢ÂÏÙ›Ô ∞’ ∫ÏÈÓÈ΋˜ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ 1982;29:135-145.

5. £ÂÔ‰ˆÚ›‰Ë˜ Ã, ªÚÈ·ÛÔ‡Ï˘ °, ∆ÛÈ‚ÈÙ·Ó›‰Ô˘ ∆, ªÔ˘Û¿ÙÔ˜ °, ∆˙ˆÚÙ˙¿ÙÔ˘ º, ∫·ÙÂÚ¤ÏÔ˜ Ã. ™‡Ó‰ÚÔÌÔ Cushing ·fi ·‰¤ÓˆÌ· ÙÔ˘ ÊÏÔÈÔ‡ ÙˆÓ ÂÈÓÂÊÚȉ›ˆÓ Û ÎÔÚ›ÙÛÈ ËÏÈΛ·˜

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5ó ÌËÓÒÓ. ¶·È‰È·ÙÚÈ΋ 1983;46:57-62.

6. £ÂÔ‰ˆÚ›‰Ë˜ Ã, ªÔ˘ÚÏÔÁÈ¿ÓÓ˘ Ã, ∫·Ú¿ıÈÔ˜ £, µÏ¿¯Ô˘ ¶, ∫·ÙÙ¿Ì˘ Ã. ∞‰ÂÓÔηÚΛӈ̷ ÙÔ˘ ÊÏÔÈÔ‡ ÙˆÓ ÂÈÓÂÊÚȉ›ˆÓ. ¶·È‰È·ÙÚÈ΋ 1979;42:295-301.

7. McArthur RG, Cloutier MD, Hayles AB, Sprague RG. Cushing’s disease in children. Findings in 13 cases. Mayo Clin Proc 1972;47:318-326.

8. Magiakou MA, Mastorakos G, Oldfield EH, Gomez MT, Doppman JL, Cutler GB et al. Cushing’s syndrome in children and adolescents. Presentation, diagnosis, and therapy. N Engl J Med 1994;331:629-636.

9. Stewart PM. The adrenal cortex. In: Larsen PR, Kronenberg HM, Melmed S, Polonsky KS, editors. Williams Textbook of Endocrinology. 10th edition. Philadelphia: WB Saunders Company; 2003. p. 509.

10. Styne DM, Grumbach MM, Kaplan SL, Wilson CB, Conte FA. Treatment of Cushing’s disease in childhood and adolescence by transsphenoidal microadenomectomy. N Engl J Med 1984;310:889-893.

11. Magiakou MA, Mastorakos G, Gomez MT, Rose SR, Chrousos GP. Suppressed spontaneous and stimulated growth hormone secretion in patients with Cushing’s disease before and after surgical cure. J Clin Endocrinol Metab 1994;78:131-137.

12. Trainer PJ, Lawrie HS, Verhelst J, Howlett TA, Lowe DG, Grossman AB et al. Transsphenoidal resection in Cushing’s disease: undetectable serum cortisol as the definition of successful treatment. Clin Endocrinol 1993;38:73-78.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 11-04-2003 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 17-11-2003 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∂ϤÓË ¢. ∫ˆÛÙ·ÎÈÒÙË ¶˘ÚÁȈٛÛÛ˘ 25, ∆.∫. 121 36, ∞ı‹Ó· E-mail: lenakostakioti@hotmail.com

¶·È‰È·ÙÚÈ΋ 2003;66:475-477

Paediatriki 2003;66:475-477

¡∂∞ ∞¶O ∆O ¢π∞¢π∫∆ÀO

¡∂∞ ∏ ıÂÚ·›· Ù˘ ÔÍ›·˜ ̤Û˘ ˆÙ›Ùȉ·˜ Û˘Ó‰˘·Ṳ̂ÓË Ì ·ÓÙÈÈÛÙ·ÌÈÓÈο ‹ Î·È ÎÔÚÙÈ˙fiÓË ‰ÂÓ ‚ÂÏÙÈÒÓÂÈ ÙÔ ÙÂÏÈÎfi ·ÔÙ¤ÏÂÛÌ· ∫ÔÚ›Ó· ¶ÚÔ‡ÓÙ˙Ô˘ - ∫·ÛÛÈÔ‡, ¶·È‰›·ÙÚÔ˜

™‡Ìʈӷ Ì ·˘Ù‹ ÙË ÌÂϤÙË, ÔÈ Chonmaitree Î·È Û˘Ó ·fi ÙÔ Galveston Ù˘ ÔÏÈÙ›·˜ ÙÔ˘ Texas (∏¶∞) ÂÚ‡ÓËÛ·Ó ÙËÓ ˘fiıÂÛË fiÙÈ ÚfiÛıÂÙË ıÂÚ·›·, ÂÎÙfi˜ ÙˆÓ ·ÓÙÈ‚ÈÔÙÈÎÒÓ, Ì ·ÓÙÈÈÛÙ·ÌÈÓÈο ‹ Î·È ÎÔÚÙÈ˙fiÓË ı· ÌÔÚÔ‡Û ӷ ÂÏ·ÙÙÒÛÂÈ ÙË ‚·Ú‡ÙËÙ· Ù˘ ÊÏÂÁÌÔÓ‹˜ ηÈ, ηٿ Û˘Ó¤ÂÈ·, Ó· ‚ÂÏÙÈÒÛÂÈ ÙËÓ ¿ÌÂÛË ‹ Ì·ÎÚÔÚfiıÂÛÌË ¤Î‚·ÛË Ù˘ Oªø. ∫·Ù¤ÓÂÈÌ·Ó Ù˘¯·›· Û ̛· ‰ÈÏ‹-Ù˘ÊÏ‹, Ì ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ, ÌÂϤÙË 179 ·È‰È¿ ËÏÈΛ·˜ 3 ÌËÓÒÓ ¤ˆ˜ 6 ÂÙÒÓ Û ÙÚÂȘ ÔÌ¿‰Â˜, ·ÊÔ‡ fiÏ· ¤Ï·‚·Ó Ì›· ¤ÓÂÛË ÎÂÊÙÚÈ·ÍfiÓ˘: Ë ÚÒÙË ÔÌ¿‰· ¤Ï·‚ ÚfiÛıÂÙ· ¯ÏˆÚÔÊÂÓÈÚ·Ì›ÓË 0,35 mg/kg ÙËÓ Ë̤ڷ, Ë ‰Â‡ÙÂÚË Ú‰ÓÈ˙ÔÏfiÓË 2 mg/kg ÙËÓ Ë̤ڷ, Ë ÙÚ›ÙË ÔÌ¿‰· ¤Ï·‚ ¯ÏˆÚÔÊÂÓÈÚ·Ì›ÓË Î·È Ú‰ÓÈ˙fiÓË ÛÙȘ ·ÓˆÙ¤Úˆ ‰fiÛÂȘ Î·È Ë Ù¤Ù·ÚÙË ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ ÁÈ· 5 Ë̤Ú˜. ¢ÂÓ ˘‹ÚÍ ‰È·ÊÔÚ¿ ÌÂٷ͇ ÙˆÓ ÙÚÈÒÓ ÔÌ¿‰ˆÓ ÛÙËÓ ÂÏ¿ÙÙˆÛË ÙˆÓ Û˘Ìو̿وÓ, Û‡Ìʈӷ Ì ÙË ‚·ıÌÔÏÔÁ›· ‚·Ú‡ÙËÙ·˜, ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜ Î·È Î·Ù¿ ÙËÓ ÂͤٷÛË ÙËÓ 5Ë Î·È 14Ë Ë̤ڷ. ¢ÂÓ ˘‹ÚÍÂ, Â›Û˘, ‰È·ÊÔÚ¿ ÛÙÔÓ ·ÚÈıÌfi ÙˆÓ ˘ÔÙÚÔÒÓ Î·È ÁÈ· 6 Ì‹Ó˜ ÌÂÙ¿. ªË ·Ó·ÌÂÓfiÌÂÓË ‹Ù·Ó Ë ·Ú·Ù‹ÚËÛË fiÙÈ ÛÙ· ·È‰È¿ Ô˘ ¯ÔÚËÁ‹ıËΠ·ÓÙÈÈÛÙ·ÌÈÓÈÎfi, ·Ú·Ù¿ıËÎÂ Ë Û˘ÏÏÔÁ‹ ˘ÁÚÔ‡ ÛÙÔ Ì¤ÛÔ Ô˘˜ (̤ÛË ‰È¿ÚÎÂÈ· 73 Ë̤Ú˜ Û ۯ¤ÛË Ì ÙȘ ¿ÏϘ 3 ÔÌ¿‰Â˜ fiÔ˘ Ë Ì¤ÛË ‰È¿ÚÎÂÈ· ‹Ù·Ó 23-36 Ë̤Ú˜). ¢ÂÓ Â›Ó·È ÍÂοı·ÚÔ˜ Ô Ì˯·ÓÈÛÌfi˜ Ì ‚¿ÛË ÙÔÓ ÔÔ›Ô Ù· ·È‰È¿ Ô˘ ¤Ï·‚·Ó ·ÓÙÈÈÛÙ·ÌÈÓÈÎfi ›¯·Ó ·Ú·ÌÔÓ‹ ÙÔ˘ ˘ÁÚÔ‡ ÛÙÔ Ì¤ÛÔ Ô˘˜ ÁÈ· ÌÂÁ·Ï‡ÙÂÚÔ ‰È¿ÛÙËÌ·. OÈ Û˘ÁÁÚ·Ê›˜ Èı·ÓÔÏÔÁÔ‡Ó fiÙÈ Ù· ·ÓÙÈÈÛÙ·ÌÈÓÈο ·˘Í¿ÓÔ˘Ó ÙË ÁÏÔÈfiÙËÙ· ÙÔ˘ ˘ÁÚÔ‡ Î·È ¤ÙÛÈ ·ÚÂÌ‚·›ÓÔ˘Ó ÛÙËÓ ·ÔÚÚfiÊËÛË Î·È ÙËÓ ·ÚÔ¯¤ÙÂ˘Û‹ ÙÔ˘. ∫·Ù·Ï‹ÁÔ˘Ó, ÏÔÈfiÓ, fiÙÈ Ë ¯Ú‹ÛË ·ÓÙÈÈÛÙ·ÌÈÓÈÎÒÓ ÛÙËÓ Oªø Ú¤ÂÈ Ó· ·ÔʇÁÂÙ·È. ¢ÂÓ Â›Ó·È Û·Ê¤˜, ·fi ·˘Ù‹ ÙË ÌÂϤÙË, Â¿Ó Ë ¯Ú‹ÛË ÎÔÚÙÈÎÔÂȉÒÓ ˆÊÂÏ› ‹ ‚Ï¿ÙÂÈ.

J Pediatr 2003;143:377-385 ∏ ÛȉËÚÔÂÓ›· ÌÔÚ› Ó· ·ÔÙÂÏ› ÚԉȷıÂÛÈÎfi ·Ú¿ÁÔÓÙ· ÁÈ· ÙË ‰ËÏËÙËÚ›·ÛË ·fi ÌfiÏ˘‚‰Ô ÛÙ· ·È‰È¿ ∫ÔÚ›Ó· ¶ÚÔ‡ÓÙ˙Ô˘ - ∫·ÛÛÈÔ‡, ¶·È‰›·ÙÚÔ˜

∞˘Ùfi Â›Ó·È ÙÔ Û˘Ì¤Ú·ÛÌ· Ì›·˜ ÌÂϤÙ˘ ÙˆÓ Choi J Î·È Kim S ·fi ÙË ¡fiÙÈ· ∫ÔÚ¤·. ∏ ÛȉËÚÔÂÓ›· ηÙËÁÔÚÈÔÔÈÂ›Ù·È Û 3 ÛÙ¿‰È·: ÛÙ¿‰ÈÔ π (ÂÍ¿ÓÙÏËÛË ÙˆÓ ·ÔıÂÌ¿ÙˆÓ Ûȉ‹ÚÔ˘) Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÙËÓ ·Ô˘Û›· ·Ó·ÈÌ›·˜, Ê˘ÛÈÔÏÔÁÈο Â›‰· Ûȉ‹ÚÔ˘ ÛÙÔ ·›Ì· (>50 mcg/dL) Î·È ÂÏ·Ùو̤ÓË ÊÂÚÚÈÙ›ÓË (<12 mcg/L), ÛÙ¿‰ÈÔ ππ (Ê¿ÛË ÛȉËÚÔÂÓÈ΋˜ ÂÚ˘ıÚÔÔ›ËÛ˘) Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ¯·ÌËÏ‹ ÊÂÚÚÈÙ›ÓË ÔÚÔ‡ <12 mcg/L Î·È Û›‰ËÚÔ ÔÚÔ‡ <50 mcg/dL ¯ˆÚ›˜ ÚÔÊ·Ó‹ ·Ó·ÈÌ›· Î·È ÛÙ¿‰ÈÔ πππ (ÛȉËÚÔÂÓÈ΋ ·Ó·ÈÌ›·) Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ¯·ÌËÏfi Û›‰ËÚÔ ÔÚÔ‡, ¯·ÌËÏ‹ ÊÂÚÚÈÙ›ÓË ÔÚÔ‡ Î·È ·ÈÌÔÛÊ·ÈÚ›ÓË <12 g/dL. ∞fi ÚÔËÁÔ‡ÌÂÓ˜ ÌÂϤÙ˜ Â›Ó·È ÁÓˆÛÙfi fiÙÈ Ù· ·È‰È¿ Ì ÛȉËÚÔÂÓ›· ¤¯Ô˘Ó ˘„ËÏfiÙÂÚ· Â›‰· ÌÔχ‚‰Ô˘ ÛÙÔ ·›Ì·.

OÈ ÂÚ¢ÓËÙ¤˜ ÚÔÛ‰ÈfiÚÈÛ·Ó Ù· Â›‰· ÌÔχ‚‰Ô˘ ÛÙÔ ·›Ì· Û οı ¤Ó· ·fi Ù· 3 ÛÙ¿‰È· Ù˘ ÛȉËÚÔÂÓÈ΋˜ ·Ó·ÈÌ›·˜, ηıÒ˜ Â›Û˘ Î·È Ù· Â›‰· ÌÔχ‚‰Ô˘ ÛÙÔ ·›Ì· ÌÂÙ¿ ·fi

475

¶·È‰È·ÙÚÈ΋ 2003;66:475-477

Paediatriki 2003;66:475-477

¡∂∞ ∞¶O ∆O ¢π∞¢π∫∆ÀO

ÛȉËÚÔıÂÚ·›·. ¶ÚÔÛ‰ÈfiÚÈÛ·Ó ÙËÓ ·ÈÌÔÛÊ·ÈÚ›ÓË, ÙÔÓ Û›‰ËÚÔ ÔÚÔ‡, ÙË ÊÂÚÚÈÙ›ÓË ÔÚÔ‡ Î·È Ù· Â›‰· ÌÔχ‚‰Ô˘ ÛÙÔ ·›Ì· Û 279 ·È‰È¿ (ËÏÈΛ·˜ 10-15 ÂÙÒÓ) Ô˘ ‰È¤ÌÂÓ·Ó Û ÂÚÈ‚¿ÏÏÔÓ ÂÚÁÔÛÙ·Ûȷ΋˜ ÌfiÏ˘ÓÛ˘. ∆· ·È‰È¿ ¯ˆÚ›ÛÙËÎ·Ó Û 4 ÔÌ¿‰Â˜ (ÛÙ¿‰È· π, ππ, πππ Î·È ˘ÁÈ›˜ Ì¿ÚÙ˘Ú˜). ŸÏ· Ù· ·È‰È¿ Ì ÛȉËÚÔÂÓ›· ›¯·Ó ÂÏ·Ùو̤ÓË ÊÂÚÚÈÙ›ÓË ÔÚÔ‡, ·ÏÏ¿ ÌfiÓÔ Ù· ·È‰È¿ ÛÙ· ÛÙ¿‰È· ππ Î·È πππ ‚Ú¤ıËÎ·Ó Ó· ¤¯Ô˘Ó ·˘ÍË̤ӷ Â›‰· ÌÔχ‚‰Ô˘. OÈ Û˘ÁÁÚ·Ê›˜ ηٷϋÁÔ˘Ó fiÙÈ Ë ÂÏ·Ùو̤ÓË ÊÂÚÚÈÙ›ÓË ÔÚÔ‡ ‰ÂÓ ÂËÚ¿˙ÂÈ Ù· Â›‰· ÌÔχ‚‰Ô˘, ÂÓÒ Ù· ¯·ÌËÏ¿ Â›‰· Ûȉ‹ÚÔ˘ ÛÙÔÓ ÔÚfi (ÛÙ¿‰È· ππ Î·È πππ) ·˘Í¿ÓÔ˘Ó Ù· Â›‰· ÌÔχ‚‰Ô˘ ÛÙÔ ·›Ì·. ∆· Â›‰· ÌÔχ‚‰Ô˘ ÛÙÔ ·›Ì· ÙˆÓ ·Ó·ÈÌÈÎÒÓ ·È‰ÈÒÓ ‚Ú¤ıËÎ·Ó ·˘ÍË̤ӷ 1,6 ÊÔÚ¤˜ Û ۇÁÎÚÈÛË Ì ÙÔ˘˜ Ì¿ÚÙ˘Ú˜. ∆ÚÈ¿ÓÙ· Ù¤ÛÛÂÚ· ·È‰È¿ Ì ·Ó·ÈÌ›· ıÂÚ·‡ÙËÎ·Ó Ì Û··ÛÌ· ıÂÈÈÎÔ‡ Ûȉ‹ÚÔ˘ (3-6 mg ÛÙÔȯÂÈ·ÎÔ‡ Ûȉ‹ÚÔ˘ ·Ó¿ kg µ™ ÙËÓ Ë̤ڷ) Î·È ÌÂÙ¿ ¤Ó· Ì‹Ó· Ù· Â›‰· ÌÔχ‚‰Ô˘ ›¯·Ó ÌÂȈı› ÛËÌ·ÓÙÈο (·fi 6,8 ± 1,7 Û 2,7 ± 1,2 mcg/dL, p<0,01). µ·ÛÈ˙fiÌÂÓÔÈ Û ·˘Ù¿ Ù· Â˘Ú‹Ì·Ù·, ÔÈ ÂÚ¢ÓËÙ¤˜ ηٷϋÁÔ˘Ó fiÙÈ Ë ÛȉËÚÔÂÓ›· Â›Ó·È Èı·ÓfiÓ Ó· ·ÔÙÂÏ› ÚԉȷıÂÛÈÎfi ·Ú¿ÁÔÓÙ· ÁÈ· ‰ËÏËÙËÚ›·ÛË ·fi ÌfiÏ˘‚‰Ô, ÂÓÒ ‚ÂÏÙÈÒÓÔÓÙ·˜ ÙË ÛȉËÚÔÂÓ›·, ÌÔÚ› Ó· ÂÏ·ÙÙˆıÔ‡Ó Î·È Ù· Â›‰· ÌÔχ‚‰Ô˘ ÛÙÔ ·›Ì·. ™¯fiÏÈÔ: ™ÙËÓ ∂ÏÏ¿‰·, Ë ‰ËÏËÙËÚ›·ÛË ·fi ÌfiÏ˘‚‰Ô Û·Ó›ˆ˜ ıˆÚÂ›Ù·È ˆ˜ Èı·ÓfiÙËÙ·. ÿÛˆ˜, Û‡Ìʈӷ Ì ٷ ·ÓˆÙ¤Úˆ Â˘Ú‹Ì·Ù·, ı· Ú¤ÂÈ Ó· ‰ÈÂÚÂ˘Ó¿Ù·È Û˘ÛÙËÌ·ÙÈο Ë ‰È·ÁÓˆÛÙÈ΋ ·˘Ù‹ Èı·ÓfiÙËÙ· Û ‚ÈÔÌ˯·ÓÈΤ˜ ÂÚÈÔ¯¤˜ Î·È Û ·È‰È¿ Ì ÛȉËÚÔÂÓ›·. ∏ ‰ËÏËÙËÚ›·ÛË ·fi ÌfiÏ˘‚‰Ô Â›Ó·È ‡Ô˘ÏË Î·È ¤¯ÂÈ ÚˆÙÂ˚Τ˜ ÂΉËÏÒÛÂȘ, Â›Ó·È fï˜ ÛÔ‚·Ú‹ Î·È Ú¤ÂÈ Ó· ‰È·ÁÈÁÓÒÛÎÂÙ·È ¤ÁηÈÚ· ÁÈ· Ó· ·ÔÊ¢¯ıÔ‡Ó ÛÔ‚·Ú¤˜ Î·È Ì·ÎÚÔ¯ÚfiÓȘ ÂÈÏÔΤ˜.

Arch Dis Child 2003;88:791-792

∏§∂∫∆ƒO¡π∫∂™ ¢π∂À£À¡™∂π™ §·ÌÚfi ª¤ÏÏÔÓ!! http://www.brightfutures.org/ ∆Ô ¶·ÓÂÈÛÙ‹ÌÈÔ Ù˘ Georgetown Î·È ÙÔ ∂ıÓÈÎfi ∫¤ÓÙÚÔ ∂Î·›‰Â˘Û˘ Û¯ÂÙÈο Ì ÙËÓ ÀÁ›· ªËÙ¤Ú·˜ Î·È ¶·È‰ÈÔ‡ ÙˆÓ ∏.¶.∞. ¤¯Ô˘Ó ۯ‰ȿÛÂÈ ¤Ó·Ó ÎÔÌ„fiÙ·ÙÔ ‰È·‰ÈÎÙ˘·Îfi ÙfiÔ Ô˘ ÂÚȤ¯ÂÈ Ï‹ıÔ˜ Ú·ÎÙÈÎÒÓ Ô‰ËÁÈÒÓ. ¶ÔÏÏ¿ ·fi Ù· ÂÁ¯ÂÈÚ›‰È· Ô˘ ÂΉ›‰ÂÈ Ë ÔÚÁ¿ÓˆÛË ·˘Ù‹ ·Ú¤¯ÔÓÙ·È ‰ˆÚ¿Ó, Ì ÙË ÌÔÚÊ‹ ·Ú¯Â›ˆÓ .pdf. ∏ ÂÈÎÔÓÔÁÚ¿ÊËÛË Â›Ó·È Î·ı·Ú‹ Î·È ¿„ÔÁË, Ù·ÈÚÈ¿˙ÔÓÙ·˜ ·fiÏ˘Ù· Ì ÙÔ ÏÈÙfi ΛÌÂÓÔ, ÙÔ ÔÔ›Ô Â›Ó·È ÚÔÛ·ÚÌÔṲ̂ÓÔ ÛÙȘ ·Ó¿ÁΘ ÙÔ˘ ÔÏ˘¿Û¯ÔÏÔ˘ Â·ÁÁÂÏÌ·Ù›· ˘Á›·˜, ηٷʤÚÓÔÓÙ·˜ Ó· ·ÚÔ˘ÛÈ¿˙ÂÈ ÂÚ›ÏÔη ı¤Ì·Ù· Ì ÙÚfiÔ Î·Ù·ÓÔËÙfi, ¯ˆÚ›˜ Ó· ¯¿ÓÂÈ ÙËÓ Ô˘Û›· ÙÔ˘˜. ™˘ÛÙ‹ÓÂÙ·È ·ÓÂÈʇϷÎÙ·, ·ÊÔ‡ ¿ÏψÛÙ ¤¯ÂÈ Î·Ù·ÎÙ‹ÛÂÈ ÔÏÏ¿ Û¯ÂÙÈο ‚Ú·‚›·.

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¡∂∞ ∞¶O ∆O ¢π∞¢π∫∆ÀO

∞Ó¿Ï˘ÛË ‚È‚ÏÈÔÁÚ·Ê›·˜: ÚÈÓ ·fi ÂÛ¿˜... ÁÈ· ÂÛ¿˜! http://pediatrics.jwatch.org/ ¢Â‰Ô̤ÓÔ˘ fiÙÈ Ë ÔÛfiÙËÙ· Ù˘ ÎÏÈÓÈ΋˜ ¤Ú¢ӷ˜ ÛÙȘ ̤Ú˜ Ì·˜ fiÏÔ Î·È ·˘Í¿ÓÂÈ, ¤Ó·˜ ÛËÌ·ÓÙÈÎfi˜ ·ÚÈıÌfi˜ ÔÚÁ·ÓÒÛÂˆÓ ·Ó·Ï·Ì‚¿ÓÂÈ ÙËÓ ·Ô‰ÂÏÙ›ˆÛË ÙˆÓ Û¯ÂÙÈÎÒÓ ·È‰È·ÙÚÈÎÒÓ ÂÚÈÔ‰ÈÎÒÓ, ÙË Û‡ÓÔ„Ë Î·È ÙÔÓ Û¯ÔÏÈ·ÛÌfi ÙÔ˘˜. OÈ ÚˆÙÔ‚Ô˘Ï›Â˜ ·˘Ù¤˜ ‰ÂÓ Â›Ó·È ¿ÓÙ· ÂÈÙ˘¯Ë̤Ó˜, ·ÊÔ‡ Ú¤ÂÈ Ó· ÈÛÔÚÚÔ‹ÛÔ˘Ó ÌÂٷ͇ Ù˘ ÈÛÔ¤‰ˆÛ˘ ÙÔ˘ ‚¿ıÔ˘˜ Î·È Ù˘ ÎÔ‡Ú·Û˘ Ù˘ ÏÂÙÔ̤ÚÂÈ·˜. ŸÙ·Ó, fï˜, ÙÔ ÂÁ¯Â›ÚËÌ· ÚÔ¤Ú¯ÂÙ·È ·fi ÙÔ˘˜ ÂΉfiÙ˜ ÙÔ˘ New England Journal of Medicine, ÔÈ ÂÁÁ˘‹ÛÂȘ Â›Ó·È ˘„ËϤ˜. ∆Ô Journal Watch Pediatrics and Adolescent Medicine, ÂÌÊ·Ó›˙ÂÙ·È ‰‡Ô ÊÔÚ¤˜ ÙËÓ Â‚‰ÔÌ¿‰· ÛÙÔ ‰›ÎÙ˘Ô, ÂÓÒ Ë ¤ÓÙ˘Ë ¤Î‰ÔÛË Î˘ÎÏÔÊÔÚ› ÌËÓÈ·›·. ∞Ó¿ÌÂÛ· ÛÙ· 28 ÂȉÈο ÂÚÈÔ‰Èο Ô˘ ·Ô‰ÂÏÙÈÒÓÂÈ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È Ù· ÛËÌ·ÓÙÈÎfiÙÂÚ· Ù˘ ÂȉÈÎfiÙËÙ·˜, ·ÏÏ¿ Î·È ÁÂÓÈο ÂÚÈÔ‰Èο ˘„ËÏÔ‡ impact, fiˆ˜ ÙÔ Lancet, ÙÔ NEJM Î.¿. ∏ ¯Ú‹ÛË fiÏˆÓ ÙˆÓ ‰˘Ó·ÙÔÙ‹ÙˆÓ ÙÔ˘ ‰ÈÎÙ˘·ÎÔ‡ ÙfiÔ˘ ··ÈÙ› ÂÙ‹ÛÈ· Û˘Ó‰ÚÔÌ‹, Ë ÔÔ›· ÁÈ· ÙËÓ ∂ÏÏ¿‰· ·Ó¤Ú¯ÂÙ·È Û 115 £ ÁÈ· ÙÔ˘˜ ÂȉÈÎÂ˘Ì¤ÓÔ˘˜ Î·È Û 66 £ ÁÈ· ÙÔ˘˜ ÂȉÈ΢fiÌÂÓÔ˘˜.

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¶·È‰È·ÙÚÈ΋ 2003;66:478

Paediatriki 2003;66:478

∂˘¯·ÚÈÛٛ˜ ÚÔ˜ ÙÔ˘˜ ∫ÚÈÙ¤˜ Ù˘ “¶·È‰È·ÙÚÈ΋˜” ∏ ¢È‡ı˘ÓÛË Î·È Ù· ª¤ÏË Ù˘ ∂ÈÛÙËÌÔÓÈ΋˜ ™˘ÓÙ·ÎÙÈ΋˜ ∂ÈÙÚÔ‹˜ ¢¯·ÚÈÛÙÔ‡Ó ıÂÚÌ¿ ÙÔ˘˜ ÎÚÈÙ¤˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ “¶·È‰È·ÙÚÈ΋” Ô˘ ÚÔÛ¤ÊÂÚ·Ó ÙËÓ ›ڷ Î·È ÙÔÓ ¯ÚfiÓÔ ÙÔ˘˜ ÁÈ· Ó· ÂÍ·ÛÊ·Ï›ÛÔ˘ÌÂ Û˘ÛÙËÌ·ÙÈΤ˜, ÙÂÎÌËÚȈ̤Ó˜ Î·È ·ÓÙÈÎÂÈÌÂÓÈΤ˜ ·ÍÈÔÏÔÁ‹ÛÂȘ ÁÈ· ÙȘ ÂÈÛÙËÌÔÓÈΤ˜ ÂÚÁ·Û›Â˜ Ô˘ ‰ËÌÔÛȇıËÎ·Ó Î·Ù¿ ÙÔ ¤ÙÔ˜ 2003.

∫ÚÈÙ¤˜ ÙˆÓ ÂÚÁ·ÛÈÒÓ Ô˘ ‰ËÌÔÛȇıËÎ·Ó ÛÙÔÓ ÙfiÌÔ 66 ÙÔ˘ ¤ÙÔ˘˜ 2003 ∞˚‚¿˙˘ µ›ÎÙˆÚ·˜ ∞Ó·ÁÓˆÛÙ¿Î˘ ¢ËÌ‹ÙÚÈÔ˜ ∞Ó·ÁÓˆÛÙ¿Î˘ πˆÛ‹Ê ∞Ó·ÛÙ·Û¤·-µÏ¿¯Ô˘ ∫·ÏÏÈfiË ∞Ó‰Ú¤Ô˘ ∞ϤͷӉÚÔ˜ ∞Ó‰ÚÔÓ›ÎÔ˘ ™Ù˘ÏÈ·Ó‹ ∞Ó‰ÚÔ˘Ï·Î¿Î˘ ª·ÓÒÏ˘ ∞Ó‰ÚÔ˘Ï·Î¿Î˘ º›ÏÈÔ˜ ∞Ó‰ÚÔ˘Ï¿Î˘ πˆ¿ÓÓ˘ ∞ÓıÚ·ÎfiÔ˘ÏÔ˜ ªÈ¯¿Ï˘ ∞ÓÙˆÓÈ¿‰Ë˜ ™Ù˘ÏÈ·Ófi˜ ∞ÚÒÓË-µÔ˘ÚÓ¿ ™ÔÊ›· µ·Ú‚·Ú‹ÁÔ˘-ºÚ›Ì· ∞Ó·ÛÙ·Û›· µ·ÚÏ¿Ì˘ °ÂÒÚÁÈÔ˜ °·ÚÔ‡ÊË-∫Ô‡ÙÛ· ∞Ó·ÛÙ·Û›· °ÂˆÚÁ¿ÎË-∞ÁÁÂÏ¿ÎË ∂ϤÓË °ÈÔ˘ÚÔ‡ÎÔ˜ ™ˆÙ‹Ú˘ °ÎÈÒÓ˘ ¢ËÌ‹ÙÚÈÔ˜ °Ú·Ê¿ÎÔ˜ ™Ù¤ÏÈÔ˜ ¢·‚¿Î˘ ªÈ¯·‹Ï ¢¿ÎÔ˘-µÔ˘ÙÂÙ¿ÎË ∞ÈηÙÂÚ›ÓË ¢È·Ì·ÓÙ‹ ∂ÏÈÛ¿‚ÂÙ ∑ÂÚ‚fi˜ °ÂÚ¿ÛÈÌÔ˜ ∏Ï›· ª·Ú›· £ÂÔ‰ˆÚ›‰Ë˜ ÷ڿϷÌÔ˜ £ÂÔ‰ÒÚÔ˘ ™Ù·Ì¿Ù˘ πÔÚ‰·Ó›‰Ô˘ ∞ÓÙÈÁfiÓË ∫·ÏÔÁÈ¿ÓÓ˘ ¡ÈÎfiÏ·Ô˜ ∫·Ó·ÎÔ‡‰Ë-∆۷ηϛ‰Ô˘ ºÏˆÚÂÓÙ›· ∫·Ó¿ÚÈÔ˘ ª·Ú›· ∫·Ú·Ó›Î·˜ ∏Ï›·˜ ∫·Ú‹˜ ÃÚ›ÛÙÔ˜ ∫·ÙÚÈÔ‡-¡ÈÎÔϷοÎË ¢ˆÚÔı¤· ∫·ÙÛ·Ú‰‹˜ ÷ڿϷÌÔ˜ ∫·ÙÛ·ÚÔ‡-¶ÂÎÙ·Û›‰Ë ∂˘ÛÙ·ı›· ∫·ÙÙ¿Ì˘ ∞ÓÙÒÓÈÔ˜ ∫·Ê¿ÙÔ˜ ∞ÓÙÒÓÈÔ˜ ∫·ÊÂÙ˙‹˜ ¢ËÌ‹ÙÚÈÔ˜ ∫›ÙÛÈÔ˘-∆˙¤ÏË ™ÔÊ›· ∫Ô‚¿Ó˘ ∞ı·Ó¿ÛÈÔ˜ ∫ÔÏÏÈfi˜ ∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ∫Ô˘Ú¿Î˘ °ÂÒÚÁÈÔ˜

478

∫Ô˘ÙÛÔ˘ÏȤÚ˘ ∏Ï›·˜ ™ÎÂÓÙ¤Ú˘ ¡ÈÎfiÏ·Ô˜ ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜ ∞Ó‰Ú¤·˜ ™ÎÈ·‰¿˜ ∫ˆÓÛÙ·ÓÙ›ÓÔ˜ §·ÁÎÒÓ·-™Ù¿ıË ∂˘·ÁÁÂÏ›· ™ÌÒÎÔ˘-µÂÚÈÁ¿ÎË ¢fiÍ· §·Áfi˜ ¶·Ó·ÁÈÒÙ˘ ™ËÏÈÒÙË-°Îڤη µ·ÛÈÏÈ΋ §·Ì·‰·Ú›‰Ë˜ πˆ¿ÓÓ˘ ™Ù·ÌÔ˘Ï·Î¿ÙÔ˘ ∞ÏÂÍ¿Ó‰Ú· §··ÙÛ¿Ó˘ ¶¤ÙÚÔ˜ ™ÙÈ‚·ÎÙ¿ÎË-¶··‰¿ÎË ∂ÚÁ¿ÓË §È·ÎÔÔ‡ÏÔ˘ ª¿Á‰· ™˘Ú›ÁÔ˘-¶··‚·ÛÈÏ›Ԣ ∞ÓÙÈÁfiÓË ª·Ï·Ì›ÙÛË-¶Ô‡¯ÓÂÚ ∞ÚÈ¿‰ÓË ™˘ÚÔÁÈ·ÓÓfiÔ˘ÏÔ˜ °ÂÒÚÁÈÔ˜ ª·ÓÙ˙Ô˘Ú¿ÓË ∂˘·ÁÁÂÏ›· ∆˙Ô˘Ì¿Î·-ª·ÎԇϷ ÃÚ‡Û· ª·ÓˆÏ¿ÎË ¡›Ó·-∞Ú¯ÔÓÙ›· ∆Û·ÁηÚÔÔ‡ÏÔ˘-™Ù›ÁÁ· ∏Ú·ÎÏ›· ª·ÚÁÂÙ¿Î˘ ∞Ó‰Ú¤·˜ ∆۷ӿη˜ πˆ¿ÓÓ˘ ª¿ÚÎÔ˘ ∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ∆ÛÈ‚ÈÙ·Ó›‰Ô˘-∫¿ÎÔ˘ÚÔ˘ ∆¿ÏÈ· ª·˘ÚÔÌ¿Ù˘ ¶·Ó·ÁÈÒÙ˘ ∆ÛÈÏÈÁÈ¿ÓÓ˘ £ÂÔÊ¿Ó˘ ª·˘ÚÔÌȯ¿Ï˘ πˆ¿ÓÓ˘ ∆Ûfiη-°ÂÓÓ·Ù¿ ∂ϤÓË ªÈ¯·Ï¿ÎÔ˜ ™Ù¤Ê·ÓÔ˜ ∆ÛÔÏÈ¿-¶·Û·Ú¿ÎË ª·Ú›˙· ªÈ¯ÂϷοÎË ∂ϤÓË ∆ÛÔ˘Ì¿Î·˜ ∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ª·˙›ÁÔ˘-ºˆÙÔÔ‡ÏÔ˘ ∂ϤÓË ºÚÂÙ˙¿ÁÈ·˜ ∞Ó‰Ú¤·˜ ª·ÚÙÛfiη˜ ÃÚ‹ÛÙÔ˜ ºÚ˘Û›Ú·-∫·ÓÈÔ‡Ú· ∂ϤÓË ¡·Ó¿˜ ÃÚ‹ÛÙÔ˜ ºˆÙfiÔ˘ÏÔ˜ ™˘Ú›‰ˆÓ·˜ ¡ÈÎÔÏ·˝‰Ô˘ ¶ÔÏ˘Í¤ÓË ºˆÙÔÔ‡ÏÔ˘ ª·Ú›· ¡Ô‡ÛÈ·-∞Ú‚·ÓÈÙ¿ÎË ™¿ÓÙ· ÷Ù˙‹˜ ∞Ó·ÛÙ¿ÛÈÔ˜ ¡Ù·Ú›ÏÏ˘ ∂˘Á¤ÓÈÔ˜-∂ÌÌ·ÓÔ˘‹Ï ÃÈÒÙ˘ ¢ËÌ‹ÙÚÈÔ˜ •¿ÓıÔ˘ ª·ÚȤÙÙ· •˘ÔÏÈÙ¿-∑·¯·ÚÈ¿‰Ë ∞ÛË̛ӷ OÈÎÔÓÔÌ›‰Ë˜ πˆ¿ÓÓ˘ ¶¿ÁηÏÔ˜ ∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ¶·Ó·ÁȈÙfiÔ˘ÏÔ˜ ∆¿Î˘ ¶·Ó·ÁȈÙÔÔ‡ÏÔ˘-°·ÚÙ·Á¿ÓË ¶ÔÏ˘Ù›ÌË ¶·Ó·ÁÈÒÙÔ˘ πˆ¿ÓÓ˘ ¶·ÓÙÂÏÈ¿‰Ë˜ ÃÚ‹ÛÙÔ˜ ¶··Á·ÚÔ˘Ê¿Ï˘ ∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ¶··ÁÚËÁÔÚ›Ô˘-£ÂÔ‰ˆÚ›‰Ô˘ ª·Ú›· ¶··‰¿ÙÔ˜ πˆ¿ÓÓ˘ ¶··‰¿ÙÔ˘ ¢·Ó¿Ë ¶··‰ÔÔ‡ÏÔ˘-∫Ô˘ÏÔ˘Ì‹ ∑ˆ‹ ¶··Ï¿ÌÚÔ˘ ª·ÚÈ¿ÓÓ· ¶··¯·Ù˙‹-∫·ÏÌ·ÓÙ‹ ª·Ú›· ¶ÔÏ˘¯ÚÔÓÔÔ‡ÏÔ˘-∞Ó‰ÚÔ˘Ï·Î¿ÎË ™ÔÊ›· ¶Ú›ÊÙ˘ ∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ¶ÚÔ‡ÓÙ˙Ô˘-∫·ÛÛÈÔ‡ ∫ÔÚ›Ó· ƒÂÌÂÏ¿ÎÔ˘-¶Ô˘Ï¿ÎÔ˘ ∂Ï¢ıÂÚ›·- ºˆÙÂÈÓ‹ ƒÔËÏ›‰Ë˜ ∂ÌÌ·ÓÔ˘‹Ï

¶·È‰È·ÙÚÈ΋ 2003;66:479-481

Paediatriki 2003;66:479-481

∂˘ÚÂÙ‹ÚÈÔ ™˘ÁÁڷʤˆÓ ÙÔ˘ ∆fiÌÔ˘ 66 Wevers R.A.

133

∞ ∞ÁÁÂÏ¿ÎÔ˘ µ. ∞ÁÁÂÏfiÔ˘ÏÔ˜ ¢. ∞˙·ÚÈ¿‰Ë˜ ¶. ∞ı·Ó·ÛÈ¿‰Ô˘ º. ∞ı·Ó·Û›Ô˘-ªÂÙ·Í¿ ª. ∞˚‚¿˙˘ µ. ∞ÏÂÍ¿Ó‰ÚÔ˘ ∂. ∞ϤÍ ¡.ª. ∞ÏÂ͛Ԣ ¡. ∞ÏÂÍfiÔ˘ÏÔ˜ ∂. ∞̤ÓÙ· ™. ∞Ó·ÛÙ·ÛÈ¿‰Ë˜ °. ∞Ó·ÛÙ·ÛÈ¿‰Ô˘-∫·Ú·ÁˆÚÁÔÔ‡ÏÔ˘ ∂. ∞Ó·ÛÙ·Û›Ô˘ ∞. ∞Ó‰Ú¤Ô˘ ∞. ∞ÓÙˆÓÔÁÂÒÚÁÔ˜ °. ∞ÔÛÙfiÏÔ˘ ∂. ∞ÚÁ˘ÚÔ‡ ™. ÕÚÛÔ˜ °. ∞ÚÒÓË ™. ∞ÙÙÈÏ¿ÎÔ˜ ∞. ∞˘ÁÔ˘ÛÙ›‰Ô˘-™·‚‚ÔÔ‡ÏÔ˘ ¶. µ µ·ÁÈ¿ÎÔ˘ ∂.∞. µ·ÚÏ¿Ì˘ °. µ·ÛÈÏÂÈ¿‰Ô˘ ∂. µ·ÛÈÏfiÔ˘ÏÔ˜ ∞. µ·ÛÈÏÔÔ‡ÏÔ˘ ∞. µÔÚÁÈ¿ ¶. µÔ‡‰Ú˘ ∫.∞. ° °·‚Ú›ÏË ™. °·Ï·Ó¿Î˘ ∂. °È·ÓÓ·ÎÔÔ‡ÏÔ˘ Ã. °È·ÓÓÔ‡ÏÈ· ∞. °ÈÔ˘ÚÔ‡ÎÔ˜ ™. °ÎÈÒÓ˘ ¢. °ÎÔ˘ÁÎÔ‡‰Ë ∂. °Ô˘‰ÂÛ›‰Ô˘ ª.∑. °Ô‡Ó·Ú˘ ∞. °Ô˘ÚÁÔ˘ÏÈ¿Ó˘ ∫. ¢ ¢·›ÎÔ˜ °. ¢ÂÌÂÚÙ˙›‰Ô˘ µ. ¢ÂÛ‡Ú˘ ¡. ¢‹ÌÔ˘ ™. ¢ÚÔÁοÚË ∂.

392 316 381 195,284 52,55,128 55,211 188 20 278 208 215 316 304 364 304 155 405 145 296 387 467 118

202,456 128 145 97 418 133 118,202,387,456

344 452 58,255 185 215 37 145 140 278 208

188 296 364 202 118

¢ÚfiÛÔ˘-∞Á·Î›‰Ô˘ µ.

29,148

∂ ∂˘·ÁÁÂÏ›Ô˘ ∞.

133

∑ ∑·‚ÈÙÛ¿ÓÔ˜ •. ∑·ÊÂÈÚ›Ô˘ ¢. ∑‹‚·-¶ÂÙÚÔÔ‡ÏÔ˘ ª.

364 211 239

£ £ÂÔ‰ˆÚ›‰Ë˜ Ã. £ÂÔ‰ˆÚ›‰Ô˘ ª.

471 188

π πÁÓ·ÙÈ¿‰Ë˜ π.π.

140

∫ ∫·‰›Ù˘ ∞. ∫·Ï·‚ÚÔ˘˙ÈÒÙ˘ °. ∫·Ï·ÓÙ˙‹˜ ∞. ∫·Ï¤ÁÈ·˜ π. ∫·ÏÔÁÂÚÔÔ‡ÏÔ˘ Ã.¶. ∫·ÏÔ‡ÙÛË µ. ∫·Ì¿˜ ¡. ∫·ÌÔ˘Ú›‰Ô˘ ¶. ∫·Ó¿ÚÈÔ˘ ª. ∫·ÓÈÙÛ¿Î˘ ∞. ∫·Ú·ÁÈ¿ÓÓË ¶. ∫·Ú·Ì¤Ú˘ ™. ∫·Ú·ÌÂÚfiÔ˘ÏÔ˜ ¢. ∫·Ú·Ó¿ÛÈÔ˘ ∫. ∫·Ú·Ó›Î·˜ ∏. ∫·Ú·ÓÙ·Ó¿ ∂. ∫·Ú·Ù˙¿ ∞.∞. ∫·Ú·Ù˙¿ ∂. ∫·Ú·Ù˙¿˜ ¡. ∫·Ú›Î·˜ °.∞. ∫·Úη‚›ÙÛ·˜ ¡. ∫·Ù˙ËÏ¿Î˘ ¡. ∫·ÙÚÈÔ‡ ¢. ∫·ÙÛ·ÚÔ‡ ∂. ∫·ÙÛÈ·Ú‰¿Ó˘ ∫. ∫·Ê¿ÙÔ˜ ∞. ∫¤ÎÔ˘ ∫. ∫ÂÚ·Ì›‰·˜ ¢. ∫fiÎÔÚË ∂. ∫ԇϷÏË ∂. ∫Ô˘ÓÂÓÔ‡ ∫. ∫Ô˘ÚÙ¤Û˘ ∞. ∫Ô‡ÚÙË ª. ∫Ô‡ÛÙ· ∂. ∫ÚÂÌÂÓfiÔ˘ÏÔ˜ °.

208 381 185 278,344 311 195 247 461 47 133 29 128 232 452 47 185 311 296 296 113 264 133 195,284 456 364 264,436 215 145 12,133,223 304 357 381 284 471 29,148

479

¶·È‰È·ÙÚÈ΋ 2003;66:479-481

∫˘Úȷο΢ ª. ∫˘ÚȷΛ‰Ë˜ °. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜ ∞. ∫ˆÛÙ·‰‹Ì· ∂. ∫ˆÛÙ·ÎÈÒÙË ∂. ∫ÒÛÙ·ÏÔ˜ Ã. ∫ˆÛÙ·ÓÙ¤ÏÏÔ˘ ∂. ∫ˆÛÙ·Ú›‰Ô˘ ™.

Paediatriki 2003;66:479-481

264 148 42 208 471 278,344 278 185

§ §··ÙÛ¿Ó˘ ¶.¢. §·Ú›Ô˘ ª.™. §¿ÛηÚË Ã. §ÂÈ‚·‰›ÙË ∂. §ÈıÔÍÔÔ‡ÏÔ˘ ª. §ÈÓ·Ú‰¿Î˘ ª. §ÈÔÓ‹˜ Ã.

82 89 316 145 55 264,436 133

ª ª·Î·ÚÒÓ·˜ ¡. ª·ÌÌ¿˜ π. ª·ÌÔ˘Ï¿Î˘ ¢. ª·ÓÈ·‰¿ÎË ∏. ª¿ÓÔ˜ ¡. ª·ÓÔ˘Ú¿ ∞. ª·ÓÙ¿ ¶. ª·ÓÙ·Áfi˜ ™.¶. ª·ÚÁȈڋ˜ ∞. ª¿ÚηÙ˙Ë ∂. ª¿ÚÎÔ˘ °.¡. ª·ÚfiÔ˘ÏÔ˜ °. ª¿ÛÙÔÚ· ™. ª·ÛÙÚÔÁÈ¿ÓÓË ™. ª·˘ÚfiΈÛÙ· ª. ªÂÁÚ¤Ì˘ ™. ªÂٷ͈ÙÔ‡ ∞. ªËÙÛÈ¿ÎÔ˜ °. ªÈÎÚ¿ÎË µ. ªÈ¯·ËÏ›‰Ô˘ ∂. ªÈ¯ÂϷοÎË ∂. ªÔÛ¯·Ó‰Ú¤· π. ªÔÛ¯fi‚Ë ª. ªÔ‡ÛÎÔ˘ ™. ªÔ˘ÛÙ¿ÎË ª. ª·ÛÈ¿ÎÔ˜ Ã. ª¿ÛÙ· ∂. ª¤ÓÔ˜ ∞. ªÂÚ‚·Ó¿ÎË º. ªÂÚÙÛÈ¿˜ °. ªfiÓÔ˘ ¶.

452 264 334 133 304 58 215 311 264 436 311 118,467 118 456 12,223 352 215 148 208 133 113,467 264 47 211 176 304 381 284 436 264 37

¡ ¡ÈÎËÙ¿Î˘ ¶. ¡ÈÎÔÏ¿Ô˘ ™.

480

133 145

• •˘ÓÈ¿˜ π.

296

O OÈÎÔÓÔÌ›‰Ô˘ O. OÈÎÔÓfiÌÔ˘ ª.

344 52

¶ ¶¿ÁηÏË ∞. ¶·Ó·ÁȈٷÎfiÔ˘ÏÔ˜ °. ¶·Ó·ÁÈÒÙÔ˘ π.¶. ¶·ÓÙÂÏÈ¿‰Ë˜ Ã. ¶··‚·ÛÈÏ›Ԣ ∂. ¶··ÁˆÚÁ›Ô˘ £. ¶··‰¿ÙÔ˜ π. ¶··‰ËÌËÙÚ›Ô˘ ª.¡. ¶··‰fiÔ˘ÏÔ˜ °. ¶··‰fiÔ˘ÏÔ˜ ¡.°. ¶··‰fiÔ˘ÏÔ˜ º. ¶··‰ÔÔ‡ÏÔ˘ ∞.§. ¶··‰ÔÔ‡ÏÔ˘ ∂. ¶··‰ÔÔ‡ÏÔ˘-∫Ô˘ÏÔ˘Ì‹ ∑. ¶··‰ÔÔ‡ÏÔ˘-§ÂÁÌ¤ÏÔ˘ ∫. ¶·¿˙ÔÁÏÔ˘ ∫. ¶··ı·Ó·Û›Ô˘ ∞. ¶··ıˆÌ¿ ∂. ¶··Ó‰Ú¤Ô˘ ∂. ¶·Ú·Ûο΢ ∂. ¶·Ú‰·Ïfi˜ °. ¶·ÛÈ¿˜ π. ¶·Û·Ï¿ÎË ¶. ¶·ÙÂÚfiÔ˘ÏÔ˜ ∫. ¶·˘ÏÔÔ‡ÏÔ˘ π. ¶·‡ÏÔ˘ µ.¡. ¶·Ê›Ù˘ Ã. ¶ÂÙÚ›‰Ô˘ ∂. ¶ÂÙÚÔÔ‡ÏÔ˘ Ã. ¶¤ÙÚÔ˘ µ. ¶Ï·ÎԇϷ µ. ¶ÔÏ˘¯ÚÔÓ¿ÎË ª. ¶ÔÏ˘¯ÚÔÓÔÔ‡ÏÔ˘-∞Ó‰ÚÔ˘Ï·Î¿ÎË ™. ¶ÚÔ‡ÓÙ˙Ô˘-∫·ÛÛÈÔ‡ ∫. ¶ÚˆÙ·ÁfiÚ·-§È·ÓÔ‡ ¡. ƒ ƒ·ÊÙÔÔ‡ÏÔ˘ ∞. ™ ™·ÍÒÓË-¶··ÁˆÚÁ›Ô˘ º. ™·Ú·Ê›‰Ë˜ ∫. ™·ÚÚ‹ ∫. ™Â‚·ÛÙÈ¿‰Ô˘ ™. ™ÂÚ‚ÈÙ˙fiÁÏÔ˘ ª. ™ËÊ¿Î˘ ™.

188 316 65 296 247 195,284 37,387 2 381 418 20 140 133,334 104 128 387 471 344 145 452 211 104 133 448 188 311 381 20,188 344 471 316 392 65 316 167

47

418 29,148 436 278 202 334

¶·È‰È·ÙÚÈ΋ 2003;66:479-481

™È·ÌÔÔ‡ÏÔ˘-ª·˘Ú›‰Ô˘ ∞. ™È‰ÂÚ‹ °. ™ÈÒÌÔ˘ ∞. ™Î·Ú‰Ô‡ÙÛÔ˘ ∞. ™ÎÂÓÙ¤Ú˘ ¡. ™Ì˘Ú¿ÎȘ ™. ™Ô‡ÏË ∫.∂. ™ËÏÈÒÙË ª. ™˘Ú¿ÎÔ˜ ™. ™‡ÚÔÁÏÔ˘ ∫. ™Ù·ÌÔÁÈ¿ÓÓÔ˘ §. ™Ù¿ÌÔ˘ ª. ™ÙÂÊ·Ó¿ÎË ∫. ™ÙÂÊ·Ó¿ÎË ™. ™ÙÂÊ·Ó›‰Ë˜ ∫. ™˘ÚÈÔÔ‡ÏÔ˘ µ. ™¯ÔÈÓ¿ ª. ™¯ÔÈÓ¿ÎË ∞. ™¯ÔÈÓ¿˜ °.

Paediatriki 2003;66:479-481

104 97,387 104 202,387,456 208 133 113,118,467 133 145 296 89 195,284 65 352 456 188 448 352 448

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364 327,467 436 426 215

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Paediatriki 2003;66:482-484

∂˘ÚÂÙ‹ÚÈÔ Ï¤ÍˆÓ-ÎÏÂȉÈÒÓ ÙÔ˘ ∆fiÌÔ˘ 66 APAAP Bartonella henselae Henoch-Schonlein ÔÚʇڷ LHX3 Nail-Patella Pit-1 Power Doppler Prop-1 P-ÁÏ˘ÎÔÚˆÙ½ÓË Screening (ÚÔÛ˘Ìو̷ÙÈÎfi˜ ¤ÏÂÁ¯Ô˜) Turner-Kieser

65 55 327 89 140 89 352 89 65 296 140

∞ ∞ÁÁÂÈ›Ùȉ· 185,327 ∞ÁÁÂÈÔÂÓÂÚÁfi ÂÓÙÂÚÈÎfi ÂÙ›‰ÈÔ 278 ∞ÁˆÁ‹ ˘Á›·˜ 436 ∞‰ÂÓÔÂȉÂÎÙÔÌ‹ 208 ∞‰¤ÓˆÌ· ˘fiÊ˘Û˘ 471 ∞‰Âӈ̷Ù҉˘ ‰˘ÛÏ·Û›· Ó‡ÌÔÓ· 148 ∞¤ÚÈ· ¯ÚˆÌ·ÙÔÁÚ·Ê›·-Ê·ÛÌ·ÙÔÁÚ·Ê›· Ì·˙ÒÓ 118 ∞ÈÌÔÏ˘ÙÈÎfi-Ô˘Ú·ÈÌÈÎfi Û‡Ó‰ÚÔÌÔ 456 ∞ÎÂÙ˘Ï¯ÔÏÈÓÂÛÙÂÚ¿ÛË 113 ∞Ï·Ó›ÓË 113 ·-ÏÈÓÔÏÂÓÈÎfi Ô͇ 12 ∞ÏÏÂÚÁ›· 418 ∞ÏÏÂÚÁÈ΋ ÔÚʇڷ 327 ∞Ì˘Á‰·ÏÂÎÙÔÌ‹ 208 ∞Ì˘Á‰·Ï›Ùȉ· 42 ∞ÌÊÈ‚ÏËÛÙÚÔÂȉÔ¿ıÂÈ· Ù˘ ÚÔˆÚfiÙËÙ·˜ 304 ∞Ó·ÏÁËÛ›· 29 ∞ÓÂ¿ÚÎÂÈ· ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ 89 ∞ÓÂ¿ÚÎÂÈ· Ù˘ ÔÚÓÈıÈÓÈ΋˜ ÙÚ·ÓÛηڂ·Ì˘Ï¿Û˘ 467 ∞ÓıÂÎÙÈΤ˜ ÛÙ· Ê¿Ú̷η ÂÈÏË„›Â˜ 104 ∞ÓÔÛÔ˚ÛÙÔ¯ËÌ›· 65 ∞ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η 202 ∞ÓÙÈÌÂÙÒÈÛË 304 ∞ÓÙÈËÎÙÈÎfi ÙÔ˘ χÎÔ˘ 55 ∞ÓÙÈ„˘¯ˆÛÈΤ˜ Ô˘Û›Â˜ 247 ∞ÓÒÌ·ÏË Ó¢ÌÔÓÈ΋ ·ÚÙËÚ›· 381 ∞ÔÏÈÔÚˆÙ½Ó˜ 202 ∞ÔÛȉ‹ÚˆÛË 128 ∞ÔÊÚ·ÎÙÈ΋ ¿ÓÔÈ· ÙÔ˘ ‡ÓÔ˘ 208 ∞Ú·¯È‰ÔÓÈÎfi Ô͇ 12 ∞ÚıÚ›Ùȉ· 185 ∞ÚÚ˘ıÌÈÔÁfiÓÔ˜ ‰˘ÛÏ·Û›· Ù˘ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜ 405 ∞Ù‡¯ËÌ· 20,364 µ µ·ÚËÎÔ˝· µÏÂÊ·ÚfiÙˆÛË

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264 82 239 471 208 405 176

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296 82 176 448 52 456 118,133 316 185 58 195 426 461 255 426

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2

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264

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Paediatriki 2003;66:482-484

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55 12 113 208

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145 55 155 12 202 202,264,436 42

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¡fiÛÔ˜ ·fi ·Ì˘¯‹ Ó˘¯ÈÒÓ Á¿Ù·˜ ¡ÙÔÎÔÛ·ÂÍ·ÓÔ˚Îfi Ô͇ ¡ÙÔ·Ì›ÓË ¡˘ÎÙÂÚÈÓ‹ ÂÓÔ‡ÚËÛË

2 456 167 387 37 195 405 215 278 185 426 185 405

278 2,29,145,311 232 167 456 167 215 52 195 392

¶ ¶·È‰› / ¶·È‰È¿ 20,42,188,316,436,448,456 ¶·È‰È¿-·Ú·ıÂÚÈÛÙ¤˜ 452 ¶·È‰È΋ ÂÈÏË„›· 202 ¶·È‰È΋ ËÏÈΛ· 65,104,195 ¶·È‰È΋ ÔÍ›· ÏÂÌÊÔ‚Ï·ÛÙÈ΋ Ï¢¯·ÈÌ›· 284 ¶·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ 188,264,344,364 ¶·Ú·ÚÚÈÓÔÎÔÏ›Ùȉ· 211 ¶·Ú¤Ì‚·ÛË 364 ¶¿ÚÂÛË ·ÓÂÏÎÙ‹Ú· Ì˘fi˜ ¿Óˆ ‚ÏÂÊ¿ÚÔ˘ 211 ¶·¯˘Û·ÚΛ· 264 ¶ÂÚÈÔÚÈÛÙÈ΋ 405 ¶Ó¢ÌÔÓÈΤ˜ ‰ÔÎÈ̷ۛ˜ 176 ¶Ó¢ÌÔÓÈ΋ ˘¤ÚÙ·ÛË 381 ¶Ó¢ÌÔÓÈÎÔ› fiÁÎÔÈ 176 ¶ÔÏÏ·Ï‹ Ê·ÚÌ·ÎÔ·ÓÙÔ¯‹ 65 ¶Ôχ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓ¿ 344 ¶ÔÏ˘·ÎfiÚÂÛÙ· ÏÈ·Ú¿ Ôͤ· Ì·ÎÚ¿˜ ·Ï‡ÛÔ˘ 12 ¶Ôχ‰˘ÌË Î‡ËÛË 58 ¶ÔÏ˘ÙÚ·˘Ì·Ù›·˜ 37 ¶fiÓÔ˜ 29 ¶Ú‚ÈÔÙÈο 223 ¶ÚÔ‚ÈÔÙÈο 223 ¶ÚÔ‚Ï‹Ì·Ù· ˘Á›·˜ 452 ¶ÚÔÁÂÓÓËÙÈ΋ ‰È¿ÁÓˆÛË 461 ¶ÚÔÁÓˆÛÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ 284 ¶ÚÔÎÏËÙ¿ ‰˘Ó·ÌÈο 2 ¶ÚfiÏË„Ë 364 ¶ÚÔÛˆÔ-ˆÌÔ-‚Ú·¯ÈfiÓÈÔ˜ Ì˘˚΋ ‰˘ÛÙÚÔÊ›· 215 ¶ÚÔˆÚfiÙËÙ· 311 ¶ÚˆÙÔ‚¿ıÌÈ· ÊÚÔÓÙ›‰· ˘Á›·˜ 133 ¶ÚˆÙfiÎÔÏÏÔ BFM-90 284 ™ ™·Î¯·Ú҉˘ ‰È·‚‹Ù˘ Ù‡Ô˘ 1 ™·Î¯·Ú҉˘ ‰È·‚‹Ù˘ ™·ÛÌÔ› ™ÈÚÔ̤ÙÚËÛË

334,357 47,232 456 176

483

¶·È‰È·ÙÚÈ΋ 2003;66:482-484

™ÔÓ‰˘ÏÈ΋ ÛÙ‹ÏË ™Ù·Ê˘ÏÔÎÔÎÎÈÎfi ÙÔÍÈÎfi Û‡Ó‰ÚÔÌÔ ™ÙÚÂÙÔÎÔÎÎÈÎfi ÙÔÍÈÎfi Û‡Ó‰ÚÔÌÔ ™ÙÚÂÙfiÎÔÎÎÔ˜ ™˘ÁÁÂÓ›˜ ηډÈÔ¿ıÂȘ ™˘ÁÁÂÓ›˜ ·ÛÙÂȘ ™˘ÁÁÂÓ¤˜ ÌÂÁ¿ÎÔÏÔ ™‡ÁÎ·Ì„Ë ·ÁÎÒÓˆÓ ™˘Ì‚ÈÔÙÈο ™˘ÌÌfiÚʈÛË ÛÙËÓ ·ÔÛȉ‹ÚˆÛË ™‡Ó‰ÚÔÌ· ÙÔÍÈ΋˜ ηٷÏËÍ›·˜ ™‡Ó‰ÚÔÌÔ Cushing ™‡Ó‰ÚÔÌÔ Down ™˘¯ÓfiÙËÙ· ™ˆÌ·ÙÔÌÂÙÚ‹ÛÂȘ

Paediatriki 2003;66:482-484

47 97 97 42 381 148 145 140 223 128 97 471 461 304,461 436

∆ ∆ÔÍ›ÓË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Ù˘ ÙÔÍÈ΋˜ ηٷÏËÍ›·˜ ∆ÔÈÚ·Ì¿ÙË ∆Ú·˘Ì·ÙÈÛÌÔ› ÂÊ‹‚ˆÓ ∆Ú·˘Ì·ÙÈÛÌÔ› ·È‰ÈÒÓ ∆Ú·˘Ì·ÙÈÛÌfi˜ ∆ÚÔÌÔÎÚ·Ù›· ∆ÚÔÔÔÈËÙ¤˜ ∆ÚÔÊÈ΋ ·ÏÏÂÚÁ›· ∆ÚÔÊÈ΋ ÚfiÎÏËÛË ∆ÚfiÊÈÌ· ∆‡Ô˘ ÂÓËÏ›ÎÔ˘

97 104 364 364 20 82 155 239 239 418 316

À ÀÂÚ·Ì̈ÓÈ·ÈÌ›· ÀÂÚ·ÓÙÈÁfiÓ· ÀÂÚ˯ÔÁÚ¿ÊËÌ· ÂÁÎÂÊ¿ÏÔ˘ ÀÂÚÎÔÚÙÈ˙ÔÏ·ÈÌ›· ÀÂÚÙÚÔÊÈ΋ ÀÔ‰fiÚÈÔ Ï›Ô˜ Àԉԯ›˜ ÀÔÓ·ÙÚÈ·ÈÌ›·

467 392 2 471 405 264 155 456

º º·ÈÓ˘Ï·Ï·Ó›ÓË º¿Ú̷η ºÔÚ›· ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘ º˘Ì·Ù›ˆÛË º˘ÛÈ΋ ηٿÛÙ·ÛË ºˆÛÊfiÚÔ˜

113 247 188 316 436 232

à ÃÔÏÔÏÈı›·ÛË ÃÚfiÓÈ· ·ÈÌfiÏ˘ÛË ÃÚfiÓÔ˜ ÂÓÂÚÁÔÔÈË̤Ó˘ ÌÂÚÈ΋˜ ıÚÔÌ‚ÔÏ·ÛÙ›Ó˘

484

52,311 52 55

æ “æ˘¯Ôۈ̷ÙÈ΋ ÔÈÎÔÁ¤ÓÂÈ·” ø ˆ-3 ÏÈ·Ú¿ Ôͤ· ˆ-6 ÏÈ·Ú¿ Ôͤ·

357

12 12

¶PO™EXH ™YNE¢PIA 9-12 ºÂ‚ÚÔ˘·Ú›Ô˘ 2004

15th International Congress on anti-Cancer Treatment ¶ÏËÚÔÊÔڛ˜: T.C.O. Tel.: (33-1) 42 94 87 32 Fax: (33-1) 42 94 87 33 Website: www.icact.com E-mail: info@icact.com

Paris, France

28 ºÂ‚ÚÔ˘·Ú›Ô˘2 ª·ÚÙ›Ô˘ 2004

6th International Congress on Pediatric Pulmonology ¶ÏËÚÔÊÔڛ˜: Annie Bidart Tel.: 33-0-497-038-597 Fax: 33-0-497-038-598

Lisbon, Portugal

13-14 ª·ÚÙ›Ô˘ 2004

3Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ ÀÔÂȉÈÎÔÙ‹ÙˆÓ Ù˘ ¶·È‰È·ÙÚÈ΋˜ •ÂÓÔ‰Ô¯Â›Ô Divani Caravel ∂ÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ ∂Ù·ÈÚ›· ¶ÏËÚÔÊÔڛ˜: C&C International ∆ËÏ.: 210-68 89 100 Fax: 210-68 44 777 E-mail: ped-subspec2004@cnc.gr Website: www.ped-subspec2004.gr

∞ı‹Ó·

28-31 ª·ÚÙ›Ô˘ 2004

30th Annual Meeting of the European Group for Blood and Marrow Transplantation ¶ÏËÚÔÊÔڛ˜: ISAM-EBMT AKM Congress Service Tel.: +41 61 686 77 11 Fax: +41 61 686 77 88 Website: www.akm.ch/ebmt2004 E-mail: ebmt@akm.ch

Barcelona, Spain

23-25 ∞ÚÈÏ›Ô˘ 2004

16Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ ∂ÏÏËÓÈ΋˜ ∂Ù·ÈÚ›·˜ ∫ÔÈÓˆÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ Î·È ¶ÚÔ·ÁˆÁ‹˜ Ù˘ ÀÁ›·˜ “¶·È‰› Î·È ∞ıÏËÙÈÛÌfi˜” ∂ÚÁ·ÛÙ‹ÚÈÔ ÀÁÈÂÈÓ‹˜ Î·È ∂ȉËÌÈÔÏÔÁ›·˜ π·ÙÚÈ΋ ™¯ÔÏ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ¶ÏËÚÔÊÔڛ˜: ∂‡Ë ∞Ù˙¤ÌË, ÃÚ‡Û· ª·˘Ú›‰Ô˘ Tel.: 22410-99101 Website: www.socped.gr

ƒfi‰Ô˜

27 ∞ÚÈÏ›Ô˘1 ª·˝Ô˘ 2004

30Ô ∂Ù‹ÛÈÔ ¶·ÓÂÏÏ‹ÓÈÔ π·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ •ÂÓÔ‰Ô¯Â›Ô Hilton ¶ÏËÚÔÊÔڛ˜: π·ÙÚÈ΋ ∂Ù·ÈÚ›· ∞ıËÓÒÓ ∆ËÏ.: 210-72 11 845 Fax: 210-72 15 082 E-mail: iea@mednet.gr

∞ı‹Ó·

6-8 ª·˝Ô˘ 2004

2nd International Congress on Adult Consequences of Childhood Endocrine Diseases ¶ÏËÚÔÊÔڛ˜: ÕÓÓ· °È·Ï·ÓÙ˙‹ Tel.: (0030) 2310-447.444 Fax: (0030) 2310-447.444 & 2310-282476 E-mail: info@ghsociety.gr Website: www.ghsociety.gr

∞ı‹Ó·

xi

¶PO™EXH ™YNE¢PIA 13-16 ª·˝Ô˘ 2004

3Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ ∫˘ÙÙ·ÚÔÌÂÙÚ›·˜ Ì ¢ÈÂıÓ‹ ™˘ÌÌÂÙÔ¯‹ •ÂÓÔ‰Ô¯Â›Ô Royal Myconian & Spa ∂ÏÏËÓÈ΋ ∂Ù·ÈÚ›· ∫˘ÙÙ·ÚÔÌÂÙÚ›·˜ ¶ÏËÚÔÊÔڛ˜: ∑π∆∞ Congress & Travel ∆ËÏ.: +30 210-66 41 190 Fax: +30 210-66 42 116 E-mail: info@zita-congress.gr

ª‡ÎÔÓÔ˜

28-30 ª·˝Ô˘ 2004

42Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ •ÂÓÔ‰Ô¯Â›Ô Creta Maris ∂ÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ ∂Ù·ÈÚ›· ¶ÏËÚÔÊÔڛ˜: C&C International ∆ËÏ.: 210-68 89 100 Fax: 210-68 44 777 E-mail: pediatric2004@cnc.gr Website: www.pediatric2004.gr

∫Ú‹ÙË

6-9 πÔ˘Ó›Ô˘ 2004

7Ô ¶·ÁÎfiÛÌÈÔ ™˘Ó¤‰ÚÈÔ ÁÈ· ÙËÓ ¶ÚfiÏË„Ë ∞Ù˘¯ËÌ¿ÙˆÓ Î·È ÙËÓ ¶ÚÔ·ÁˆÁ‹ ÀÁ›·˜/∞ÛÊ¿ÏÂÈ·˜ ¶ÏËÚÔÊÔڛ˜: ∫∂¶¶∞ ∆ËÏ.: 210-74 62 187 & 74 62 201 Fax: 210-74 62 105 Website: www.safety2004.info

Vienna, Austria

10-13 πÔ˘Ó›Ô˘ 2004

9th Congress of the European Hematology Association ¶ÏËÚÔÊÔڛ˜: Eurocongres Conference Management ∆el.: +31 20 679 3411 Fax: +31 20 673 7306 E-mail: eha2004@eurocongres.com Website: www.eurocongres.com/eha2004

Geneva, Switzerland

16-19 πÔ˘Ó›Ô˘ 2004

Advances in Neuroblastoma Research 2004 ¶ÏËÚÔÊÔڛ˜: ANR 2004 Secretariat Italian Neuroblastoma Association Tel.: +39 010 60 18 938 Fax: +39 010 60 18 961 Website: www.anr2004.org E-mail: anr2004@neuroblastoma.org

Genoa, Italy

28-31 ∞˘ÁÔ‡ÛÙÔ˘ 2004

6th Balkan Meeting on Human Genetics (BMHG 2004) ¶ÏËÚÔÊÔڛ˜: TOPLINE Travel and Tourism Tel.: +30 2310-538 001 Fax: +30 2310-566 713 E-mail: info@toplinetravel.gr

£ÂÛÛ·ÏÔÓ›ÎË

26 ™ÂÙÂÌ‚Ú›Ô˘1 OÎÙˆ‚Ú›Ô˘ 2004

XII Meeting of the European Association for Haematopathology ¶ÏËÚÔÊÔڛ˜: Triaena Tours & Congress ∆ËÏ.: +30 2310-25 61 94-5 Fax: +30 2310-25 61 96 E-mail: salonica@triaenatours.gr

£ÂÛÛ·ÏÔÓ›ÎË

xii

™YNTOMO°PAºIE™

ABBREVIATIONS

™˘ÓÙÔÌÔÁڷʛ˜

EÏÏËÓÈÎÔ› fiÚÔÈ

AÁÁÏÈÎÔ› fiÚÔÈ

AIDS

Û‡Ó‰ÚÔÌÔ Â›ÎÙËÙ˘ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·˜

AMP, ADP, ATP

ÌÔÓÔ-, ‰È-, ÙÚÈʈÛÊÔÚÈ΋ ·‰ÂÓÔÛ›ÓË

ATPase cal CSF ‹ ENY CNS ‹ ∫¡™ cm CoA cmÑ cm2 cAMP ÆC CRP DNA ECG ‹ ∏∫° EEG ‹ ∏∂° ELISA ESR ‹ ∆∫∂ EDTA g Hct Hb HLA

ÙÚÈʈÛÊ·Ù¿ÛË Ù˘ ·‰ÂÓÔÛ›Ó˘ ıÂÚÌ›‰· ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚfi ÎÂÓÙÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ· ÂηÙÔÛÙfi Û˘Ó¤Ó˙˘ÌÔ ∞ ΢‚ÈÎfi ÂηÙÔÛÙfi ÙÂÙÚ·ÁˆÓÈÎfi ÂηÙÔÛÙfi ΢ÎÏÈÎfi AMP ‚·ıÌfi˜ KÂÏÛ›Ô˘ C-·ÓÙȉÚÒÛ· ÚˆÙ½ÓË ‰ÂÔ͢ÚÈ‚Ô˙ÔÓÔ˘ÎÏÂ˚ÓÈÎfi Ô͇ ËÏÂÎÙÚÔηډÈÔÁÚ¿ÊËÌ· ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ· ¤Ó˙˘ÌÔ-Û˘Ó‰¤Ù˘ ·ÓÔÛÔÚÔÛÚfiÊËÛ˘ ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù·¯‡ÙËÙ· ηıÈ˙‹Ûˆ˜ ÂÚ˘ıÚÒÓ Âı˘ÏÂÓԉȷÌÈÓÔÙÂÙÚ·ÔÍÂ˚Îfi Ô͇ ÁÚ·ÌÌ¿ÚÈo ·ÈÌ·ÙÔÎÚ›Ù˘ ·ÈÌÔÛÊ·ÈÚ›ÓË ·ÓÙÈÁfiÓÔ ÈÛÙÔÛ˘Ì‚·ÙfiÙËÙ·˜

Ig ICU ‹ ª∂£ IU i.m. ‹ ∂.ª. i.p. ‹ ∂.¶. i.v. ‹ ∂.º.

L log mol ªW ‹ MB MCH MCV mRNA m min n N NS ‹ ª™ Ôsm % PCR pH PCO2 PO2 p

·ÓÔÛÔÛÊ·ÈÚ›ÓË ÌÔÓ¿‰· ÂÓÙ·ÙÈ΋˜ ıÂÚ·›·˜ ‰ÈÂıÓ‹˜ ÌÔÓ¿‰· ÂÓ‰ÔÌ˘˚ο ÂÓ‰ÔÂÚÈÙÔÓ·˚ο ÂÓ‰ÔÊϤ‚È· Ï›ÙÚÔ(·) ÏÔÁ¿ÚÈıÌÔ˜ ÁÚ·ÌÌÔÌfiÚÈÔ ÌÔÚÈ·Îfi ‚¿ÚÔ˜ ̤ÛË ·ÈÌÔÛÊ·ÈÚ›ÓË ÂÚ˘ıÚÒÓ Ì¤ÛÔ˜ fiÁÎÔ˜ ÂÚ˘ıÚÒÓ ·ÁÁÂÏÈÔÊfiÚÔ˜ RNA ̤ÙÚÔ ÏÂÙfi ·ÚÈıÌfi˜ Ó¢ÙÒÓÈÔ ÌË ÛËÌ·ÓÙÈÎfi ÔÛÌÒÏÈÔ Â› ÙÔȘ ÂηÙfi ·Ï˘ÛȉˆÙ‹ ·ÓÙ›‰Ú·ÛË ÔÏ˘ÌÂÚ¿Û˘ Û˘ÁΤÓÙÚˆÛË ÈfiÓÙˆÓ ˘‰ÚÔÁfiÓÔ˘ ÌÂÚÈ΋ Ù¿ÛË CO2 ÌÂÚÈ΋ Ù¿ÛË Ô͢ÁfiÓÔ˘ Èı·ÓfiÙËÙ·

acquired immunodeficiency syndrome adenosine 5mono-, di-, triphosphate adenosine triphosphatase calorie cerebrospinal fluid central nervous system centimeter coenzyme A cubic centimeter square centimeter cyclic AMP degree(s) Celsius C-reactive protein deoxyribonucleic acid electrocardiogram electroencephalogram enzyme-linked immunoabsorbent assay erythrocyte sedimentation rate ethylenediaminetetracetate gram haematocrit haemoglobin (human) histocompatibility leucocyte antigen immunoglobulin intensive care unit international Unit intramuscular intraperitoneal intravenous liter logarithm mole molecular weight mean corpuscular haemoglobin mean corpuscular volume messenger RNA meter minute number newton not significant osmole percent polymerase chain reaction potentia hydrogenii carbon dioxide pressure oxygen pressure probability

xv

™˘ÓÙÔÌÔÁڷʛ˜

EÏÏËÓÈÎÔ› fiÚÔÈ

AÁÁÏÈÎÔ› fiÚÔÈ

p.o.

RIA RNA RDS sec s.c. ‹ À.¢.

SD SE U

·fi ÙÔ ÛÙfiÌ· Ú·‰ÈÔ·ÓÔÛÔ·ÔÚÚÔÊËÙÈ΋ ‰ÔÎÈÌ·Û›· ÚÈ‚ÔÓÔ˘ÎÏÂ˚ÓÈÎfi Ô͇ Û‡Ó‰ÚÔÌÔ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÈ·˜ ‰Â˘ÙÂÚfiÏÂÙÔ ˘Ô‰fiÚÈ· ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË ÛÙ·ıÂÚfi ÛÊ¿ÏÌ· ÌÔÓ¿‰·

by mouth radioimmunoassay ribonucleic acid respiratory distress syndrome second subcutaneous standard deviation standard error unit

™˘Ó‰˘·˙fiÌÂÓ· ÚÔı¤Ì·Ù· 12

tera- (10 ) giga- (10 ) mega-(10 ) kilo- (10 ) hecto(10 ) deca (10 ) deci (10 ) centi- (10 ) milli(10 ) micro (10 ) nano (10 ) pico (10 ) femto (10 ) atto (10 ) 9

6

3

2

1

-1

-2

-3

-6

-9

-12

-15

-18

xvi

Combining prefixes T G M k h da d c m Ì n p f a