∞¡∞™∫O¶∏™∂π™
OÈ Ì˘ÔηډÈÔ¿ıÂȘ ÛÙ· ·È‰È¿
∂. ∞ÔÛÙfiÏÔ˘, ∞. ∆ÛÈÏÈÌÈÁοÎË
°ÂÓÂÙÈο ÙÚÔÔÔÈË̤ӷ ÙÚfiÊÈÌ·: Èı·Ó¤˜
ÂÈÙÒÛÂȘ ÛÙËÓ ·ÏÏÂÚÁÈÔÁÔÓÈÎfiÙËÙ·
∞. µ·ÛÈÏÔÔ‡ÏÔ˘, ¡. °. ¶··‰fiÔ˘ÏÔ˜, º. ™·ÍÒÓË-¶··ÁˆÚÁ›Ô˘
OÈÎÔÏÔÁ›·, ÂȉËÌÈÔÏÔÁ›· Î·È ÂÚÁ·ÛÙËÚȷ΋
‰È¿ÁÓˆÛË Ì˘ÎËÙÈ¿ÛÂˆÓ ÙÔ˘ ÙÚȯˆÙÔ‡ Ù˘
ÎÂÊ·Ï‹˜ Û ·È‰È¿
∂. ºÚ·ÁÎÔ‡ÏË
µƒ∞µ∂Àª∂¡∏ ∂ƒ°∞™π∞
∞ÍÈÔÏfiÁËÛË 10 ÂÙÒÓ ·fi ÙËÓ ¤Ó·ÚÍË
ÚÔÁÚ¿ÌÌ·ÙÔ˜ ·ÁˆÁ‹˜ ˘Á›·˜ ÛÙ· Û¯ÔÏ›·
Ù˘ ∫Ú‹Ù˘
ª. §ÈÓ·Ú‰¿Î˘, ∫. ™·ÚÚ‹, º. ªÂÚ‚·Ó¿ÎË, ∂. ª¿ÚηÙ˙Ë, Ã. ÷Ù˙‹˜, ™. ºÏÔ˘Ú‹, ∞. ∫·Ê¿ÙÔ˜
∂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›·˜
ª. ™¯ÔÈÓ¿, °. ™¯ÔÈÓ¿˜, ∫. ¶·ÙÂÚfiÔ˘ÏÔ˜
¶ÚÔ‚Ï‹Ì·Ù· ˘Á›·˜ ·È‰ÈÒÓ-·Ú·ıÂÚÈÛÙÒÓ
Û ÓËÛ› ÙˆÓ ∫˘ÎÏ¿‰ˆÓ
∂. ¶·Ú·Ûο΢, ª. ∆ÛÈÌÈÓfi˜, ∫. ∫·Ú·Ó¿ÛÈÔ˘, ¡. ª·Î·ÚÒÓ·˜, ∂. °·Ï·Ó¿Î˘
¡Â˘ÚÔÏÔÁÈΤ˜ ÂΉËÏÒÛÂȘ ·È‰ÈÒÓ Ì ·ÈÌÔÏ˘ÙÈÎfi-Ô˘Ú·ÈÌÈÎfi Û‡Ó‰ÚÔÌÔ
∫. µÔ‡‰Ú˘, ∫. ™ÙÂÊ·Ó›‰Ë˜, ∞. ™Î·Ú‰Ô‡ÙÛÔ˘, ∂. ∫·ÙÛ·ÚÔ‡, ™. ª·ÛÙÚÔÁÈ¿ÓÓË, ∂. µ·ÁÈ¿ÎÔ˘
REVIEW ARTICLES
Cardiomyopathies in children
H. Apostolou, A. Tsilimigaki
Genetically modified food: potential effects on allergenicity
E. Vassilopoulou, N. G. Papadopoulos, F. Saxoni-Papageorgiou
Ecology, epidemiology and diagnosisof tinea capitis in children
E. Frangoulis
AWARD-WINNING ARTICLE
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
ORIGINAL ARTICLES
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
Health problems of child-tourists in a Cycladic island
E. Paraskakis, M. Tsimbinos, K. Karanasiou, N. Makaronas, E. Galanakis
Neurological complications of children with haemolytic-uraemic syndrome
K. Voudris, C. Stefanidis, A. Skardoutsou, E. Katsarou, S. Mastroyianni, E. Vagiakou
Continuation of table of contents inside title page
™˘Ó¤¯ÂÈ· ÂÚȯÔ̤ӈÓContinuation of table of contents
∫˘ÙÙ·ÚÔÁÂÓÂÙÈο Î·È ÂȉËÌÈÔÏÔÁÈο
¯·Ú·ÎÙËÚÈÛÙÈο 533 ·ÛıÂÓÒÓ Ì ۇӉÚÔÌÔ
Down Ù· ¤ÙË 1973-2001
Ã. ÷Ù˙ËÛ‚·ÛÙÔ‡-§Ô˘Î›‰Ô˘, ¶. ∫·ÌÔ˘Ú›‰Ô˘
EN¢π∞º∂ƒOÀ™∂™ ¶∂ƒπ¶∆ø™∂π™
∞Ó¿ÚÎÂÈ· Ù˘ ÔÚÓÈıÈÓÈ΋˜
ÙÚ·ÓÛηڂ·Ì˘Ï¿Û˘ - ˘Ô͇˜ Ù‡Ô˜.
¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘
™. ºÂÛÛ¿ÙÔ˘, ∞. ∞ÙÙÈÏ¿ÎÔ˜, ∂. ∆Û¿Ú·, °. ª·ÚfiÔ˘ÏÔ˜, ∂. ªÈ¯ÂϷοÎË, ∫. ™Ô‡ÏË
¡fiÛÔ˜ Cushing Û ÎÔÚ›ÙÛÈ ËÏÈΛ·˜ 15ó ÂÙÒÓ.
¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘
∂. ∫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
™˘Ó¯›˙ÔÓÙ·È
Cytogenetic and epidemiological characteristics of 533 patients with Down syndrome between the years 1973-2001
H. Hatzissevastou-Loukidou, P. Kambouridou
CASE REPORTS
Late onset ornithine transcarbamylase deficiency. A case report
S. Fessatou, A. Attilakos, H. Tsapra, G. Maropoulos, H. Michelakakis, K. Schulpis
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
NEWS FROM THE INTERNET
Hellenic Paediatric Society Greek Paediatric Society
Continued
™˘Ó¤¯ÂÈ· ÂÚȯÔ̤ӈÓContinuation of table of contents
∫ÚÈÙ¤˜ ÙÔ˘ ÙfiÌÔ˘ 66
∂˘ÚÂÙ‹ÚÈÔ ™˘ÁÁڷʤˆÓ ÙÔ˘ ÙfiÌÔ˘ 66
§¤ÍÂȘ ÎÏÂȉȿ ÙÔ˘ ÙfiÌÔ˘ 66
¶ÚÔÛ¯‹ ™˘Ó¤‰ÚÈ·
™˘ÓÙÔÌÔÁڷʛ˜
Reviewers of Manuscripts, Volume 66
Author Index, Volume 66
Subject Index, Volume 66
Scheduled Medical Meetings
Abbreviations
Hellenic Paediatric Society Greek Paediatric Society ¢ÈÌËÓÈ·›· ¤Î‰ÔÛË
E›ÛËÌÔ ¶ÂÚÈÔ‰ÈÎfi Ù˘ EÏÏËÓÈ΋˜
¶·È‰È·ÙÚÈ΋˜ EÙ·ÈÚ›·˜
EΉfiÙ˘ K. °ÚÈ‚¤·˜
I‰ÈÔÎÙ‹Ù˘©
EÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ EÙ·ÈÚ›·
Mȯ·Ï·ÎÔÔ‡ÏÔ˘ 92
Aı‹Ó·È 115 28
TËÏ.: 210-7771 140 / 210-7771 663, Fax: 210-7758 354
EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹
¶Úfi‰ÚÔ˜ : ∞. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜
¢È¢ı˘ÓÙ‹˜ : ™. ÷˚‰¿˜
M¤ÏË : º. Aı·Ó·ÛÈ¿‰Ô˘-¶ÈÂÚÔÔ‡ÏÔ˘ : °. µ·ÚÏ¿Ì˘ : ª. ∏Ï›· : π. ¶··‰¿ÙÔ˜ : ¡. ¶··‰fiÔ˘ÏÔ˜ : ™. ¶ÔÏ˘¯ÚÔÓÔÔ‡ÏÔ˘ : ∫. ¶ÚÔ‡ÓÙ˙Ô˘-∫·ÛÛÈÔ‡ : ∫. ™ÙÂÊ·Ó›‰Ë˜ : ª. ∆ÛÔÏÈ¿ : ™. ºˆÙfiÔ˘ÏÔ˜
ºÈÏÔÏÔÁÈ΋ EÈ̤ÏÂÈ·
∂È̤ÏÂÈ· ÂÏÏËÓÈÎÒÓ ÎÂÈ̤ӈÓ
I. K·Ú·‚Ú¿ÓÔ˘
EÈ̤ÏÂÈ· ·ÁÁÏÈÎÒÓ ÎÂÈÌ¤ÓˆÓ ™. ¡¿ÎÔ˘
∞ÏÏËÏÔÁÚ·Ê›·
∂ÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ ∂Ù·ÈÚ›·
ªÈ¯·Ï·ÎÔÔ‡ÏÔ˘ 92
∞ı‹Ó·È 115 28
∆ËÏ: 210-7771 140 / 210-7771 663, Fax: 210-7758 354
™˘ÓÙÔÓÈÛÙ‹˜ ∂ΉfiÛˆ˜ 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
EÙ‹ÛÈ· ™˘Ó‰ÚÔÌ‹ 40 c
EȉÈ΢fiÌÂÓÔÈ, ºÔÈÙËÙ¤˜:20 c
πSSN 0377-2551
Bimonthly Publication
The Official Journal of the Hellenic Paediatric Society
Publisher K. Griveas
Owner©
Hellenic Paediatric Society
Michalakopoulou 92
Athens 115 28
Tel.: 210-7771 140 / 210-7771 663, Fax: 210-7758 354
Hellenic Paediatric Society
Hellenic Paediatric Society
Scientific Editorial Board
President : A. Constantopoulos
Editor : S. Haidas
Members : 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
Manuscript Editing
Greek Editing I. Karavranou
English Editing S. Nakou
Correspondence
Hellenic Paediatric Society
Michalakopoulou 92
Athens 115 28
Tel: 210-7771 140 / 210-7771 663, Fax: 210-7758 354
Publishing Coordinator SCIENTIFICPUBLICATIONSLtd
P. Tsaldari 3, Marousi 151 22
Tel.: 210-61 41 360-5 Fax: 210-61 41 366
Annual Subscription
All foreign countries: US $ 50
Hellenic Paediatric Society
Greek Paediatric Society
¶·Ú·‰Â›ÁÌ·Ù· ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·ÔÌÒÓ
I. ¶ÂÚÈÔ‰Èο AÓ ÔÈ Û˘ÁÁÚ·Ê›˜ Â›Ó·È ¤ˆ˜ ¤ÍÈ ·Ó·ÁÚ¿ÊÔÓÙ·È fiÏÔÈ, ·Ó Â›Ó·È ÂÙ¿ ‹ ÂÚÈÛÛfiÙÂÚÔÈ ·Ó·ÁÚ¿ÊÔÓÙ·È ÔÈ ÚÒÙÔÈ
¤ÍÈ Î·È ÚÔÛÙ›ıÂÙ·È “et al”‹ “Î·È Û˘Ó”.
T·ÎÙÈ΋ ¤Î‰ÔÛË ÂÚÈÔ‰ÈÎÔ‡:
∞ÓÙˆÓ›Ô˘ ¢, ª¿Ú· Ã, °È·ÓÓ¿ÙÔ˘ Ã. ∂Ì‚fiÏÈ·: ›‰Ú·ÛË ÛÙËÓ ÂȉËÌÈÔÏÔÁ›· ÙˆÓ ÏÔÈ̈‰ÒÓ ÓÔÛËÌ¿ÙˆÓ Î·È ÙËÓ ·È‰È·ÙÚÈ΋ Ú¿ÍË. ¶·È‰È·ÙÚÈ΋ 1999;59:272-279.
Proesmans W. Bartter syndrome and its neonatal variant. Eur J Pediatr 1997;156:669-679.
™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜ ÂÚÈÔ‰ÈÎÔ‡:
Flyvbjerg A. Role of growth hormone, insulin-like growth factors (IGFs) and IGF-binding proteins in the renal complications of diabetes. Kidney Int 1997;52 (60 Suppl):S12-S19.
Èڛ˜ Û˘ÁÁڷʤ·:
National Institutes of Health Consensus Development Conference.Neurofibromatosis conference statement. Arch Neurol 1988;45:575-578.
¶ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù‡Ô˘ ¿ÚıÚÔ˘:
÷ڷϷ̛‰Ë˜ π, ¶··‰fiÔ˘ÏÔ˜ ∞. ¶·¯˘Û·ÚΛ· Î·È ˘ÂÚÏÈȉ·ÈÌ›· [¶ÂÚ›ÏË„Ë]. 36Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ; 1998 5-7 πÔ˘Ó›Ô˘; ¶¿ÊÔ˜, ∫‡ÚÔ˜; 1998. ÛÂÏ. 199.
Schreiner GF, Lange L. Ethanol modulation of macrophage influx in glomerulonephritis [abstract].
J Am Soc Nephrol 1991;2:562.
Should antileukotriene therapies be used instead of inhaled corticosteroids in asthma? [Editorial]. Am J Respir Crit Care Med 1998;158:1697-1701.
Laux-End R, Inaebnit D, Gerber HA, Bianchetti MG. Vasculitis associated with levamisole and circulating autoantibodies [letter]. Arch Dis Child 1996;75:355-356.
II. µÈ‚Ï›·
∫ÂÊ¿Ï·ÈÔ Û ‚È‚Ï›Ô:
Clark AG, Barratt TM. Steroid-responsive nephrotic syndrome. In: Barratt TM, Arner ED, Harmon WE, editors. Pediatric Nephrology. 4th ed. Baltimore: Lippincott William Wilkins; 1999. p. 742.
™‡ÁÁÚ·ÌÌ· ‹ ÌÔÓÔÁÚ·Ê›·:
Gorlin RJ, Cohen MM, Levin LS. Syndromes of the head and neck. 3rd ed. New York: Oxford University Press; 1990.
¢ËÌÔÛ›Â˘ÛË Û ÙfiÌÔ Ú·ÎÙÈÎÒÓ:
Bauer AW. The two definitions of bacterial resistance. In: Smith AJ, Rogers CA, eds. Proceedings of the Third International Congress of Chemotherapy; 1962 May 29-
31; New York: International Society of Chemotherapy; 1963. p. 484-500.
¢È‰·ÎÙÔÚÈ΋ ‰È·ÙÚÈ‚‹:
¶··‰fiÔ˘ÏÔ˜ Ã.. ∏ ıÂڷ›· ÙÔ˘ ÛÙÚ·‚ÈÛÌÔ‡. [‰È‰·ÎÙÔÚÈ΋ ‰È·ÙÚÈ‚‹]. ∞ı‹Ó·: ¶·ÓÂÈÛÙ‹ÌÈÔ ∞ıËÓÒÓ; 1979.
Kaplan SJ. Post hospital home health care: the elderly’s access and utilization [dissertation]. St. Louis (Mo): Washington Univ.; 1995.
¶›Ó·Î˜ Î·È EÈÎfiÓ˜
AÔÛÙ¤ÏÏÔÓÙ·È ÂȘ ÙÚÈÏÔ‡Ó (¤Ó· ÚˆÙfiÙ˘Ô+‰‡Ô ʈÙÔ·ÓÙ›ÁÚ·Ê·). ¶Ú¤ÂÈ Ó· ¤¯Ô˘Ó Ï¿ÙÔ˜ ›ÛÔ Ì ÙÔ Ï¿ÙÔ˜ ÙÔ˘ ÌÔÓfiÛÙËÏÔ˘ (8 cm) ‹ Ì ÙÔ Ï¿ÙÔ˜ fiÏ˘ Ù˘ ÛÂÏ›‰·˜ (16,8 cm). TÔ Ì¤ÁÈÛÙÔ Ì‹ÎÔ˜ ÙÔ˘˜, Ì·˙› Ì ÙÔ˘˜ Ù›ÙÏÔ˘˜, ‰ÂÓ Ú¤ÂÈ Ó· Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ ·fi 22 cm. OÈ ›Ó·Î˜ ·ÚÈıÌÔ‡ÓÙ·È Ì ·Ú·‚ÈÎÔ‡˜ ·ÚÈıÌÔ‡˜ Ì ÙË
ÛÂÈÚ¿ Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÔ Î›ÌÂÓÔ. ¶ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ‚Ú·¯‡ Ù›ÙÏÔ Î·È ÂÂÍ‹ÁËÛË ÙˆÓ Û˘ÓÙÌ‹ÛÂˆÓ ÛÙÔ Î¿Ùˆ ̤ÚÔ˜. ™ÙÔ˘˜ ›Ó·Î˜ Ú¤ÂÈ Ó· ·ÔʇÁÔÓÙ·È ÔÈ Î¿ıÂÙ˜ ÁÚ·Ì̤˜. ŸÏÔ ÙÔ ·ÂÈÎÔÓÈÛÙÈÎfi ˘ÏÈÎfi (Û¯‹Ì·Ù·, ‰È·ÁÚ¿ÌÌ·Ù·, ʈÙÔÁڷʛ˜, Î.Ï.) ¯·Ú·ÎÙËÚ›˙ÂÙ·È ˆ˜ ÂÈÎfiÓ˜. £· Ú¤ÂÈ
¿ÚÈÛÙ˘ ÔÈfiÙËÙ·˜ Ì ÌÔÚÊ‹ ʈÙÔÁÚ·ÊÈÒÓ ‹ ηÈ
̤ÚÔ˜ ÙˆÓ ÂÈÎfiÓˆÓ Ú¤ÂÈ Ó· ÛË-
Ù˘ ÂÈÎfiÓ·˜. ™ÙȘ ʈÙÔÁڷʛ˜
‰ÂÓ Ú¤ÂÈ Ó· ·Ó·ÁÓˆÚ›˙ÂÙ·È Ë Ù·˘ÙfiÙËÙ¿ ÙÔ˘˜. OÈ ·ÛıÂÓ›˜ ‰ÂÓ Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È ÔÓÔÌ·ÛÙÈο.
¶ÚÈÓ ·ÔÛÙ›ÏÂÙ ÙËÓ ÂÚÁ·Û›· Û·˜ ‚‚·Èˆı›Ù fiÙÈ ÂÚÈÏ·Ì‚¿ÓÂÈ:
1.∂ÈÛÙÔÏ‹ ˘Ô‚ÔÏ‹˜.
2. ¢‹ÏˆÛË ÌË ÚÔÁÂÓ¤ÛÙÂÚ˘ ‰ËÌÔÛ›Â˘Û˘ Ù˘ ÂÚÁ·Û›·˜.
3.3 ·ÓÙ›ÁÚ·Ê· ÙÔ˘ ÎÂÈ̤ÓÔ˘ Ù˘ ÂÚÁ·Û›·˜.
4.™ÂÏ›‰· Ù›ÙÏÔ˘ (¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) ÂÚÈÏ·Ì‚¿ÓÂÈ: ·.Ù›ÙÏÔ Î·È ‚Ú·¯‡ Ù›ÙÏÔ ÂÚÁ·Û›·˜, ‚.fiÓÔÌ· Î·È ÂÒÓ˘ÌÔ Û˘ÁÁڷʤˆÓ (ÔÏÔÁڿʈ˜), Á.ÂÈÛÙËÌÔÓÈÎfi/¿ ΤÓÙÚÔ/· fiÔ˘ ¤ÁÈÓÂ Ë ÂÚÁ·Û›·, ‰.fiÓÔÌ·, ‰È‡ı˘ÓÛË Î·È ÙËϤʈÓÔ Û˘ÁÁڷʤ· ÁÈ· ·ÏÏËÏÔÁÚ·Ê›·.
5.¶ÂÚ›ÏË„Ë ÂÏÏËÓÈ΋-·ÁÁÏÈ΋, ϤÍÂȘ ÎÏÂȉȿ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·).
6.∫·Ù¿ÏÔÁÔ Û˘ÓÙÔÌÔÁÚ·ÊÈÒÓ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·).
7.∫›ÌÂÓÔ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·).
8.∂˘¯·ÚÈÛٛ˜ ‹ ·Ó·ÁÓˆÚ›ÛÂȘ (·Ó·ÊÔÚ¿ Û ÂȉÔÙ‹ÛÂȘ-¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢).
9.µÈ‚ÏÈÔÁÚ·Ê›· (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·).
10. ¶›Ó·Î˜ (Ô Î·ı¤Ó·˜ Û ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) ÂȘ ÙÚÈÏÔ‡Ó.
11.∂ÈÎfiÓ˜, Ì ‚¤ÏÔ˜ ÛÙÔ ›Ûˆ ̤ÚÔ˜ Ó· ‰Â›¯ÓÂÈ ÚÔ˜ Ù· ¿ӈ, ·ÚÈıÌË̤Ó˜, ÂȘ ÙÚÈÏÔ‡Ó.
12.∆›ÙÏÔÈ ÂÈÎfiÓˆÓ (‰ÈÏfi ‰È¿ÛÙËÌ· - Ô Î·ı¤Ó·˜ Û ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) ÂȘ ÙÚÈÏÔ‡Ó. vii
OÈ Ì˘ÔηډÈÔ¿ıÂȘ ÛÙ· ·È‰È¿
∂. ∞ÔÛÙfiÏÔ˘, ∞. ∆ÛÈÏÈÌÈÁοÎË
Cardiomyopathies in children
H. Apostolou, A. Tsilimigaki ∞¡∞™∫O¶∏™∏REVIEW
¶ÂÚ›ÏË„Ë: OÈ Ì˘ÔηډÈÔ¿ıÂȘ ·ÔÙÂÏÔ‡Ó ÛË-
Ì·ÓÙÈ΋ ·ÈÙ›· ÓÔÛËÚfiÙËÙ·˜ Î·È ıÓËÛÈÌfiÙËÙ·˜ ÛÂ
fiÏÔ ÙÔÓ ÎfiÛÌÔ, ÙfiÛÔ ÛÙÔ˘˜ ÂÓ‹ÏÈΘ fiÛÔ Î·È ÛÙ·
·È‰È¿. OÈ Ì˘ÔηډÈÔ¿ıÂȘ ·ÔÙÂÏÔ‡Ó ·ı‹ÛÂȘ
ÙÔ˘ ηډȷÎÔ‡ Ì˘fi˜ Î·È ¯ˆÚ›˙ÔÓÙ·È ÛÙËÓ ˘ÂÚÙÚÔÊÈ΋, ÙË ‰È·Ù·ÙÈ΋, ÙËÓ ÂÚÈÔÚÈÛÙÈ΋ Ì˘ÔηډÈÔ¿-
ıÂÈ·, ÙËÓ ·ÚÚ˘ıÌÈÔÁfiÓÔ ‰˘ÛÏ·Û›· Ù˘ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜, ηıÒ˜ Î·È ÛÙÔ “ÌË Û˘Ì·Á¤˜ Ì˘ÔοډÈÔ” Ô˘
ÂÚÈÁÚ¿ÊËΠÚfiÛÊ·Ù·. OÈ Ú·Á‰·›Â˜ ÂÍÂÏ›ÍÂȘ
Ô˘ ÛËÌÂÈÒÓÔÓÙ·È ÛÙË ÌÔÚȷ΋ ÁÂÓÂÙÈ΋, ¤¯Ô˘Ó
Û˘Ì‚¿ÏÏÂÈ ÛÙËÓ Î·Ï‡ÙÂÚË Î·Ù·ÓfiËÛË Ù˘ ·ÈÙÈÔÏÔÁ›·˜ ÙˆÓ Ì˘ÔηډÈÔ·ıÂÈÒÓ, Ù˘ ÂͤÏÈ͢, ηıÒ˜ Î·È ÛÙËÓ ÙÚÔÔÔ›ËÛË ˆ˜ ¤Ó· ‚·ıÌfi Ù˘ ıÂڷ¢ÙÈ΋˜ ÛÙÚ·ÙËÁÈ΋˜.
§¤ÍÂȘ ÎÏÂȉȿ: Ì˘ÔηډÈÔ¿ıÂȘ, ‰È·Ù·ÙÈ΋, ˘ÂÚÙÚÔÊÈ΋, ÂÚÈÔÚÈÛÙÈ΋, ·ÚÚ˘ıÌÈÔÁfiÓÔ˜ ‰˘ÛÏ·Û›·
Ù˘ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜, ÌË Û˘Ì·Á¤˜ Ì˘ÔοډÈÔ.
∂ÈÛ·ÁˆÁ‹
OÈ Ì˘ÔηډÈÔ¿ıÂȘ ·ÔÙÂÏÔ‡Ó Ì›· ÔÌ¿‰· ÓfiÛˆÓ, ·ÚÈÔ ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÙˆÓ ÔÔ›ˆÓ Â›Ó·È Ë ÚÔÛ‚ÔÏ‹ ÙÔ˘ ›‰ÈÔ˘ ÙÔ˘ ηډȷÎÔ‡ Ì˘fi˜, ÂÓÒ Û˘ÓÈÛÙÔ‡Ó ‰ÔÌÈΤ˜ ‹ ÏÂÈÙÔ˘ÚÁÈΤ˜ ·ÓˆÌ·Ï›Â˜ ÙÔ˘ ηډȷÎÔ‡ Ì˘fi˜ Ô˘ ‰ÂÓ Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ˘¤ÚÙ·Û˘, ‚·Ï‚ȉԿıÂÈ·˜ ‹ Û˘ÁÁÂÓÔ‡˜ ·ÓˆÌ·Ï›·˜ ÙÔ˘ Ì˘Ôηډ›Ô˘ (1). ∏ ÙÂÏÂ˘Ù·›· Ù·ÍÈÓfiÌËÛË ÙˆÓ Ì˘ÔηډÈÔ·ıÂÈÒÓ ·fi ÙËÓ ¶·ÁÎfiÛÌÈ· OÚÁ¿ÓˆÛË ÀÁ›·˜ Ê·›ÓÂÙ·È ÛÙÔÓ ¶›Ó·Î· 1 (1). OÈ Ì˘ÔηډÈÔ¿ıÂȘ, Ì ‚¿ÛË ÙË ÏÂÈÙÔ˘ÚÁÈ΋ ÙÔ˘˜ ‰È·Ù·Ú·¯‹, Ù·ÍÈÓÔÌÔ‡ÓÙ·È ÛÂ: ·) ‰È·Ù·ÙÈ΋ ‹ Û˘ÌÊÔÚËÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ·, ÛÙËÓ ÔÔ›· Ë ·ÚÈÛÙÂÚ‹ ‹ Î·È ÔÈ ‰‡Ô ÎÔÈϛ˜ Â›Ó·È ‰È·ÙÂٷ̤Ó˜ Î·È ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÌÂȈ̤ÓË Û˘ÛÙ·ÏÙÈÎfiÙËÙ·, ‚) ˘ÂÚÙÚÔÊÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ·, Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ˘ÂÚÙÚÔÊ›· Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜, Û˘Ó‹ıˆ˜ ·Û‡Ì-
µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ µÂÓÈ˙¤ÏÂÈÔ˘ ¡ÔÛÔÎÔÌ›Ԣ, ∏Ú¿ÎÏÂÈÔ ∫Ú‹Ù˘
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.
Key words: cardiomyopathies, dilated, hypertrophic, restrictive, arrythmiogenic right ventricular dysplasia, non-compaction of the left ventricle.
ÌÂÙÚË, Á) ÂÚÈÔÚÈÛÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ·, Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÛËÌ·ÓÙÈο ‰È·ÙÂٷ̤ÓÔ˘˜ ÎfiÏÔ˘˜, ÌÂ Ê˘ÛÈÔÏÔÁÈΤ˜ ‰È·ÛÙ¿ÛÂȘ ÙˆÓ ÎÔÈÏÈÒÓ (3) (¶›Ó·Î·˜ 2), ‰) ·ÚÚ˘ıÌÈÔÁfiÓÔ ‰˘ÛÏ·Û›· Ù˘ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜, ÛÙËÓ ÔÔ›· Ù· ·ÙÙ·Ú· ÙÔ˘ Ì˘Ôηډ›Ô˘ ·ÓÙÈηı›ÛÙ·ÓÙ·È ·fi ÏÈÒ‰Ë Î·È ÈÓÒ‰Ë ÈÛÙfi (4) Î·È Â) ÌË
Û˘Ì·Á¤˜ Ì˘ÔοډÈÔ, Ì›· Ì˘ÔηډÈÔ¿ıÂÈ· Ô˘ ÂÚÈÁÚ¿ÊËΠÚfiÛÊ·Ù·. ªÂ ÙË Ú·Á‰·›· ÂͤÏÈÍË ÛÙÔÓ
ÙÔ̤· Ù˘ ÌÔÚȷ΋˜ ‚ÈÔÏÔÁ›·˜ Î·È Ì ÙË ‚ÂÏÙ›ˆÛË ÙˆÓ ‰È·ÁÓˆÛÙÈÎÒÓ Ì¤ÛˆÓ, ÔÈ Ì˘ÔηډÈÔ¿ıÂȘ ·Ó·ÁÓˆÚ›˙ÔÓÙ·È ˆ˜ ÛËÌ·ÓÙÈ΋ ·ÈÙ›· ÓÔÛËÚfiÙËÙ·˜ Î·È ıÓËÛÈÌfiÙËÙ·˜, ÙfiÛÔ ÛÙÔ˘˜ ÂÓ‹ÏÈΘ fiÛÔ Î·È ÛÙ·
·È‰È¿.
¢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·˜,
2nd Paediatric Clinic of Venizelion Hospital, Heraklion, Crete
Ì ÂÙ‹ÛÈ· ›وÛË 40-50 ÂÚÈÙÒÛÂȘ ·Ó¿ 100.000
ÏËı˘ÛÌÔ‡ ÛÙȘ ∏.¶.∞. Î·È ÙËÓ ∂˘ÚÒË (5,6). ÷ڷ-
ÎÙËÚ›˙ÂÙ·È ·fi ‰È¿Ù·ÛË Î·È ÌÂȈ̤ÓË Û˘ÛÙ·ÏÙÈÎfiÙË-
Ù· Ù˘ ·ÚÈÛÙÂÚ‹˜ ‹ Î·È ÙˆÓ ‰‡Ô ÎÔÈÏÈÒÓ.
∞ÈÙÈÔÏÔÁ›·
∏ ¢ª∫ ·ÔÙÂÏ› Ì›· ÎÔÈÓ‹ ¤ÎÊÚ·ÛË Ì˘Ôηډȷ-
΋˜ ‚Ï¿‚˘ Ô˘ ÚÔ‹Ïı ·fi Ì›· ÔÈÎÈÏ›· ÌË Ï‹-
Úˆ˜ ‰È¢ÎÚÈÓÈÛÌ¤ÓˆÓ ‚Ï·ÙÈÎÒÓ ÂȉڿÛÂˆÓ Â›
ÙÔ˘ Ì˘Ôηډ›Ô˘ (¶›Ó·Î·˜ 3). ∏ ¤Ú¢ӷ Û¯ÂÙÈο ÌÂ
ÙËÓ ·ıÔÁ¤ÓÂÈ· ¤¯ÂÈ ÂÛÙÈ·ÛÙ› Û 4 ‚·ÛÈÎÔ‡˜ Ì˯·ÓÈÛÌÔ‡˜: ÔÈÎÔÁÂÓ›˜ Î·È ÁÂÓÂÙÈÎÔ› ·Ú¿ÁÔÓÙ˜, ÈÔÁÂ-
Ó‹˜ Ì˘Ôηډ›Ùȉ·, ·ÓÔÛÔÏÔÁÈΤ˜ Î·È ÌÂÙ·‚ÔÏÈΤ˜
‰È·Ù·Ú·¯¤˜ (7).
∏ ÔÈÎÔÁÂÓ‹˜ ÌÂÙ·‚›‚·ÛË Ù˘ ‰È·Ù·ÙÈ΋˜ Ì˘ÔηÚ-
‰ÈÔ¿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∫
¶›Ó·Î·˜ 1. ∞ÈÙÈÔÏÔÁÈ΋ Ù·ÍÈÓfiÌËÛË
‹ ˘ÔÎÏÈÓÈ΋ ÓfiÛÔ, ÁÂÁÔÓfi˜ Ô˘ ˘Ô‰ÂÈÎÓ‡ÂÈ fiÙÈ Ë ÔÈÎÔÁÂÓ‹˜ ÌÂÙ·‚›‚·ÛË Â›Ó·È Ôχ Û˘¯Ó‹ (8). ªÂ ÏÈÁfiÙÂÚÔ ·˘ÛÙËÚ¿ ÎÚÈÙ‹ÚÈ·, Û ÔÛÔÛÙfi ÂÚ›Ô˘ 3548% ÙˆÓ ·ÛıÂÓÒÓ Ì ¢ª∫, ıˆÚÂ›Ù·È fiÙÈ Â›Ó·È ÔÈÎÔÁÂÓ‹˜ (9,10). ∏ ÈÔ Û˘¯Ó‹ ÌÔÚÊ‹ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜ Â›Ó·È Ì ÙÔÓ ·˘ÙÔۈ̷ÙÈÎfi ÂÈÎÚ·ÙÔ‡ÓÙ· ¯·Ú·ÎÙ‹Ú· (>90%), Ì ÔÈÎÈÏÔÌÔÚÊ›· ÛÙËÓ ¤ÎÊÚ·ÛË ·ÎfiÌ· Î·È Ì¤Û· ÛÙËÓ ›‰È· ÔÈÎÔÁ¤ÓÂÈ· Î·È Ì ‰ÈÂÈÛ‰˘ÙÈÎfiÙËÙ· Ô˘ ÂÍ·ÚÙ¿Ù·È ·fi ÙËÓ ËÏÈΛ· (9-11). ∏ ÓfiÛÔ˜ Â›Ó·È ÁÂÓÂÙÈο ·ÓÔÌÔÈÔÁÂÓ‹˜ Î·È ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ÂÚÈÙÒÛÂȘ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜ Ì ÙÔÓ ·˘ÙÔۈ̷ÙÈÎfi
˘ÔÏÂÈfiÌÂÓÔ, ÌÂ Ê˘ÏÔÛ‡Ó‰ÂÙÔ ¯·Ú·ÎÙ‹Ú·, ·ÏÏ¿
Î·È ÌÂÙ·ÏÏ¿ÍÂȘ ÛÙÔ ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi DNA (12,13). ∆·
ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ¤¯ÂÈ ÌÂÏÂÙËı› ·ÚÎÂÙ¿ Ë ÁÂÓÂÙÈ΋
Ù˘ ÔÈÎÔÁÂÓÔ‡˜ ‰È·Ù·ÙÈ΋˜ Ì˘ÔηډÈÔ¿ıÂÈ·˜ Î·È ¤¯Ô˘Ó ÂÓÔ¯ÔÔÈËı› 8 ‰È·ÊÔÚÂÙÈο ·˘ÙÔۈ̷ÙÈο ÁÔÓ›‰È· Î·È 8 ÂÈÚfiÛıÂÙ˜ ÂÚÈÔ¯¤˜
¢Â˘ÙÂÚÔ·ı›˜¶ÚˆÙÔ·ı›˜∞Ù·ÍÈÓfiÌËÙ˜ ÀÂÚÙ·ÛÈ΋¢È·Ù·ÙÈ΋πÓÔÂÏ¿ÛÙˆÛË µ·Ï‚ȉÈ΋ÀÂÚÙÚÔÊÈ΋ªË Û˘Ì·Á¤˜ Ì˘ÔοډÈÔ πÛ¯·ÈÌÈ΋¶ÂÚÈÔÚÈÛÙÈ΋ªÈÙÔ¯ÔÓ‰Úȷ΋ ™˘ÛÙËÌ·ÙÈ΋˜ ÓfiÛÔ˘∞ÚÚ˘ıÌÈÔÁfiÓÔ˜ ‰˘ÛÏ·Û›· ºÏÂÁÌÔÓ҉˘Ù˘ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜
∆ÚÔÔÔÈË̤ÓÔ ·fi Circulation 1996;93:341-342
¶›Ó·Î·˜ 2. ∫ÏÈÓÈο, ·ÈÌÔ‰˘Ó·ÌÈο Î·È ÌÔÚÊÔÏÔÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ Ì˘ÔηډÈÔ·ıÂÈÒÓ
ÀÂÚÙÚÔÊÈ΋¢È·Ù·ÙÈ΋∞ÚÚ˘ıÌÈÔÁfiÓÔ˜¶ÂÚÈÔÚÈÛÙÈ΋ ‰˘ÛÏ·Û›· Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜
∫ÏÈÓÈο
ñ ∫·Ú‰È·Î‹™ÔÚ·‰Èο™˘¯Ó¿™˘¯Ó¿™˘¯Ó¿ ·Ó¿ÚÎÂÈ·∫ÔÈÏȷΤ˜ ηÈ∫ÔÈÏȷΤ˜ ηÈ∫ÔÈÏȷ΋ Ù·¯˘Î·Ú‰›·,∫ÔÏÈ΋ Ì·ÚÌ·Ú˘Á‹ ñ ∞ÚÚ˘ı̛˜˘ÂÚÎÔÈÏȷΤ˜˘ÂÚÎÔÈÏȷΤ˜‰È·Ù·Ú·¯¤˜ ·ÁˆÁ‹˜ ·ÚÚ˘ı̛˜·ÚÚ˘ı̛˜, ‰È·Ù·Ú·¯¤˜ ·ÁˆÁ‹˜
ñ ∞ÈÊÓ›‰ÈÔ˜0,7-11%/¤ÙÔ˜™˘¯Ó¿™˘¯Ó¿1-5%/¤ÙÔ˜ ı¿Ó·ÙÔ˜
∞ÈÌÔ‰˘Ó·ÌÈο ñ ™˘ÛÙÔÏÈ΋ÀÂÚ‰˘Ó·ÌÈ΋,∂Ï·Ùو̤Ó˺˘ÛÈÔÏÔÁÈ΋/º˘ÛÈÔÏÔÁÈ΋ ÏÂÈÙÔ˘ÚÁ›··fiÊÚ·ÍË ÙÔ˘ÂÏ·Ùو̤ÓË
¯ÒÚÔ˘ ÂÍfi‰Ô˘
ñ ¢È·ÛÙÔÏÈ΋∂Ï·Ùو̤ÓË∂Ï·Ùو̤ÓË∂Ï·Ùو̤ÓË™ËÌ·ÓÙÈο ÏÂÈÙÔ˘ÚÁ›· ÂÏ·Ùو̤ÓË ªÔÚÊÔÏÔÁÈο ñ ª¤ÁÂıÔ˜∂Ï·Ùو̤ÓÔ∞˘ÍË̤ÓË ·ÚÈÛÙÂÚ‹∞˘ÍË̤ÓÔº˘ÛÈÔÏÔÁÈÎfi ÎÔÈÏÔًوÓÎÔÈÏ›· ‹ Î·È ÔÈ ‰‡Ô(‰ÂÍÈ¿ ÎÔÈÏ›·)‹ ÂÏ·Ùو̤ÓÔ (Î·È ∫ÔÈϛ˜ÎfiÏÔÈÔÈ ‰‡Ô ÎÔÈϛ˜) ∫fiÏÔȺ˘ÛÈÔÏÔÁÈÎfi/∞˘ÍË̤ÓÔ˜ ·ÚÈÛÙÂÚfi˜∞˘ÍË̤ÓÔ∞˘ÍË̤ÓÔ ·˘ÍË̤ÓÔ‹ Î·È ÔÈ ‰‡Ô ÎfiÏÔÈ(‰ÂÍÈfi˜ ÎfiÏÔ˜)(Î·È ÔÈ ‰‡Ô ÎfiÏÔÈ) (·ÚÈÛÙÂÚfi˜ ÎfiÏÔ˜) ñ ¶¿¯Ô˜∞Û‡ÌÌÂÙÚË ¿¯˘ÓÛ˺˘ÛÈÔÏÔÁÈÎfi ‹º˘ÛÈÔÏÔÁÈÎfi/º˘ÛÈÔÏÔÁÈÎfi ÙÔȯÒÌ·ÙÔ˜(·ÚÈÛÙÂÚ‹ ÎÔÈÏ›·)ÂÏ·Ùو̤ÓÔÂÏ·Ùو̤ÓÔ (‰ÂÍÈ¿ ÎÔÈÏ›·)
∆ÚÔÔÔÈË̤ÓÔ ·fi Lancet 2001;358:1628
‰-Û·ÚÎÔÁÏ˘Î¿ÓËÏ·ÌÈÓ›ÓË ·-2
ÁÏ˘ÎÔÚˆÙ½Ó˜ Ù˘ ‰˘ÛÙÚÔÊ›Ó˘ ‰˘ÛÙÚÔÊ›ÓË
¢π∞∆∞∆π∫∏
ÂÍˆÎ˘ÙÙ¿ÚÈ· Ô˘Û›·
ÂÌÂÚ›ÓËÏ·Ì›ÓË A/C ˘Ú‹Ó·˜ ¯ÚˆÌ·Ù›ÓË
‰ÂÛÌ›ÓË
·ÎÙ›ÓËÙÈÙ›ÓË ‚·ÚÈ¿ ¿Ï˘ÛÔ˜ ‚-Ì˘ÔÛ›Ó˘
À¶∂ƒ∆ƒOºπ∫∏
∞¢¢∫
∂ÈÎfiÓ· 1. ∏ ÌÔÚȷ΋
η¯ÂÚ›ÓÂ˜Î˘ÙÙ·ÚÔÏ·ÛÌ·ÙÈ΋ ÌÂÌ‚Ú¿ÓË Î˘ÙÙ·ÚÔÏ·ÛÌ·ÙÈ΋ ÌÂÌ‚Ú¿ÓË
ÙˆÓ ÚÔۂ‚ÏË̤ӈÓ
ÛÙË ‰È·Ù·ÙÈ΋, ÙËÓ ˘ÂÚÙÚÔÊÈ΋ Î·È ÙËÓ ·ÚÚ˘ıÌÈÔÁfiÓÔ ‰˘-
ÛÏ·Û›· Ù˘ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜ (∞¢¢∫) (ÙÚÔÔÔÈË̤ÓÔ ·fi Lancet 2001;358:1630).
∫fiÎÎÈÓÔ: ÔÈ ÚÔۂ‚ÏË̤Ó˜ ÚˆÙ½Ó˜ Ô˘ ÚÔηÏÔ‡Ó ‰È·Ù·ÙÈ΋
∫›ÙÚÈÓÔ: ÔÈ ÚÔۂ‚ÏË̤Ó˜ ÚˆÙ½Ó˜ Ô˘ ÚÔηÏÔ‡Ó
¶Ú¿ÛÈÓÔ: ÔÈ ÚÔۂ‚ÏË̤Ó˜ ÚˆÙ½Ó˜
ªÏÂ: ÔÈ ÚÔۂ‚ÏË̤Ó˜ ÚˆÙ½Ó˜ Ô˘ ÚÔηÏÔ‡Ó
ÂͤÏÈ͢ Ù˘ ÓfiÛÔ˘ (32). ∞ӈ̷ϛ˜ ˘ÔÏËı˘ÛÌÒÓ
∆ ΢ÙÙ¿ÚˆÓ, ÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ ÙˆÓ Î˘ÙÙ·ÚÔÙÔÍÈ-
ÎÒÓ ∆ ΢ÙÙ¿ÚˆÓ, ÙˆÓ Î·Ù·ÛÙ·ÏÙÈÎÒÓ ∆ ÏÂÌÊÔ΢ÙÙ¿-
ÚˆÓ Î·È ÙˆÓ Ê˘ÛÈÎÒÓ Î˘ÙÙ¿ÚˆÓ-ÊÔÓ¤ˆÓ, ¤¯Ô˘Ó ‚ÚÂ-
ı› Û ÌÂÚÈΤ˜ ÌÂϤÙ˜ (33). Œ¯ÂÈ ˘ÔÛÙËÚȯı› fiÙÈ
·˘Ù¤˜ ÔÈ ·ÓÔÛÔÏÔÁÈΤ˜ ‰È·Ù·Ú·¯¤˜ ÌÔÚ› Ó· ›ӷÈ
Û˘Ó¤ÂÈ· ÈÔÁÂÓÔ‡˜ Ì˘Ôηډ›Ùȉ·˜. £ÂˆÚÂ›Ù·È fiÙÈ
Û˘ÛÙ·ÙÈο ÙˆÓ ÈÒÓ ÌÔÚ› Ó· ¤¯Ô˘Ó ÂÓۈ̷وı›
ÛÙÔ Û·ÚΛÏËÌ· ÙˆÓ Ì˘ÔηډȷÎÒÓ Î˘ÙÙ¿ÚˆÓ Î·È
‰ÚÔ˘Ó ˆ˜ ·ÓÙÈÁÔÓÈ΋ ËÁ‹ Ô˘ ηÙ¢ı‡ÓÂÈ ÙËÓ ·ÓÔ-
ÛÔÏÔÁÈ΋ ·¿ÓÙËÛË ÚÔ˜ ÙÔ Ì˘ÔοډÈÔ.
¶·ıÔÊ˘ÛÈÔÏÔÁ›· ™ÙË ‰È·Ù·ÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ·, Ë ·ÚÈÛÙÂÚ‹ ‹ Î·È ÔÈ ‰‡Ô ÎÔÈϛ˜ Â›Ó·È ‰È·ÙÂٷ̤Ó˜ Î·È ·ÚÔ˘ÛÈ¿˙Ô˘Ó ˘ÔÛ˘ÛÙ·ÏÙÈÎfiÙËÙ·. ª·ÎÚÔÛÎÔÈο, Ë Î‡ÚÈ· ÌÔÚÊÔÏÔÁÈ΋ ·ÓˆÌ·Ï›· Â›Ó·È Ë ‰È¿Ù·ÛË ÙˆÓ ‰‡Ô ÎÔÈ-
ÏÈÒÓ, ηıÒ˜ Î·È Ë ‰È¿Ù·ÛË ÙˆÓ ÎfiψÓ. ∏ ηډȿ ¤¯ÂÈ ÛÊ·ÈÚÈ΋ ÂÌÊ¿ÓÈÛË Î·È ÙÔ Ì˘ÔοډÈÔ Â›Ó·È ˆ¯Úfi ηÈ, ÌÂÚÈΤ˜ ÊÔÚ¤˜, ‰È¿ÛÙÈÎÙÔ. ∆Ô ÂÓ‰ÔοډÈÔ Â›Ó·È
›ÓˆÛË (2,3,5).
ÂÏ¿ÙÙˆÛË Ù˘ Û˘ÛÙ·ÏÙÈÎfiÙËÙ·˜ ÙÔ˘ Ì˘Ôηډ›-
Ô‰ËÁ› Û ÂÏ·Ùو̤ÓÔ ÎÏ¿ÛÌ· ‚Ú¿¯˘ÓÛ˘, ÎÏ¿ÛÌ· ÂÍÒıËÛ˘ Î·È Î·Ú‰È·Î‹ ·ÚÔ¯‹, Ô˘ Ô‰ËÁÔ‡Ó Û ϛÌÓ·ÛË ·›Ì·ÙÔ˜ ÛÙȘ ÎÔÈÏfiÙËÙ˜ Î·È Û ‰Â˘ÙÂÚÔ·ı‹ ·‡ÍËÛË ÙÔ˘ ÙÂÏԉȷÛÙÔÏÈÎÔ‡ fiÁÎÔ˘ Î·È ›ÂÛ˘, ηıÒ˜ Î·È Ù˘ ›ÂÛ˘ Ï‹ÚˆÛ˘ ÙˆÓ ÎÔÈÏÈÒÓ. °È· Ó· ‰È·ÙËÚËı› ·Ú΋˜ ηډȷ΋ ·ÚÔ¯‹, ÔÈ ÎÔÈϛ˜ ‰È·Ù›ÓÔÓÙ·È Î·È ÙÔ Ì˘ÔοډÈÔ ˘ÂÚÙÚ¤ÊÂÙ·È Û οÔÈÔ ‚·ıÌfi. ∏ ‰È¿Ù·ÛË ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·‡ÍËÛË Ù˘ ÙÔȯˆÌ·ÙÈ΋˜ Ù¿Û˘ Î·È ÙËÓ ·‡ÍËÛË ÙˆÓ ·Ó·ÁÎÒÓ
ÙÔ˘ Ì˘Ôηډ›Ô˘ Û Ô͢ÁfiÓÔ. ∫·ıÒ˜ ÂÏ·ÙÙÒÓÂÙ·È Ë Î·Ú‰È·Î‹ ·ÚÔ¯‹, ÂÏ·ÙÙÒÓÂÙ·È Î·È Ë ·ÈÌ¿ÙˆÛË ÙˆÓ ÓÂÊÚÒÓ. ¶·Ú·ÙËÚÂ›Ù·È ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ Ó¢ÚÔÔÚÌÔÓÈÎÒÓ Ì˯·ÓÈÛÌÒÓ, ΢ڛˆ˜ ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ÚÂÓ›Ó˘-·ÁÁÂÈÔÙÂÓÛ›Ó˘-·Ï‰ÔÛÙÂÚfiÓ˘ Î·È ÙÔ˘ Û˘Ì·ıËÙÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ∆˘Èο, ·˘Ù¤˜ ÔÈ ·ÏÏ·Á¤˜ Á›ÓÔÓÙ·È ·ÚÁ¿ Î·È Ô‰ËÁÔ‡Ó ÛÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ· Ù˘ ηډȷ΋˜ ·Ó¿ÚÎÂÈ·˜ Î·È Ù˘ Ó¢ÌÔÓÈ΋˜ ˘¤ÚÙ·Û˘, ÂÓÒ Ë ›ÓˆÛË ÙÔ˘ ÎÔÈÏÈ·ÎÔ‡ Ì˘Ôηډ›Ô˘
ÂÛٛ˜ ÎÔÈÏÈ·ÎÒÓ ·ÚÚ˘ıÌÈÒÓ (3,6).
∫ÏÈÓÈ΋ ÂÈÎfiÓ· ŸÙ·Ó ‰ÂÓ Â›Ó·È ‰˘Ó·Ù‹ Ë ‰È·Ù‹ÚËÛË Â·ÚÎÔ‡˜
ÛËÌ›· ηÈ
(2,3,6).
¶›Ó·Î·˜ 4. ¢È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË Ù˘ ‰È·Ù·ÙÈ΋˜
¶ÚÔÛ¤ÁÁÈÛË∞ӈ̷ϛ·¶Èı·Ó‹ ‰È¿ÁÓˆÛË
ñ ∫ÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ∂ÁÎÂÊ·ÏÔ¿ıÂÈ·ªÂÙ·‚ÔÏÈÎfi ÓfiÛËÌ· ‹ ÓfiÛÔ˜ ÂÓ·fiıÂÛ˘
ª˘Ô¿ıÂÈ·
¢˘ÛÌÔÚÊÔÏÔÁÈΤ˜ ·ÏÏÔÈÒÛÂȘ
∏·ÙÔÛÏËÓÔÌÂÁ·Ï›·
ñ ∂ÚÁ·ÛÙËÚÈ·Îfi˜
¤ÏÂÁ¯Ô˜∞˘ÍË̤ÓË ∆∫∂, CRPπÔÁÂÓ‹˜ Ì˘Ôηډ›Ùȉ·
∞˘ÍË̤ӷ ηډȷο ¤Ó˙˘Ì·
£ÂÙÈÎfi˜ ÈÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜
ÀÔÁÏ˘Î·ÈÌ›· Ì ÔͤˆÛË°Ï˘ÎÔÁÔÓ›·ÛË, ÔÚÁ·ÓÈ΋ Ô͢·ÈÌ›·
ÀÔÁÏ˘Î·ÈÌ›· ¯ˆÚ›˜ ÔͤˆÛˢȷٷڷ¯¤˜ Ù˘ ÔÍ›‰ˆÛ˘ ÙˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ, ·Ó¿ÚÎÂÈ· ηÚÓÈÙ›Ó˘
ñ ∏ÏÂÎÙÚÔηډÈÔÁÚ¿ÊËÌ·ÀÂÚÎÔÈÏȷ΋ Ù·¯˘Î·Ú‰›·¢È·Ù·ÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· ÌÂÙ¿ ·fi ·ÚÚ˘ıÌ›·
∂ÈÎfiÓ· Ô˘Ï‹˜ ÛÙÔ ÚfiÛıÈÔ∞ӈ̷ϛ· Ù˘ ¤ÎÊ˘Û˘ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÛÙÂÊ·ÓÈ·›·˜ ‰È·ÊÚ·ÁÌ·ÙÈÎfi ÙÔ›¯ˆÌ··ÚÙËÚ›·˜ ·fi ÙËÓ Ó¢ÌÔÓÈ΋ ·ÚÙËÚ›·
ñ ∏¯ÔηډÈÔÁÚ¿ÊËÌ·,™˘ÁÁÂÓ‹˜ ηډÈÔ¿ıÂÈ·
ηډȷÎfi˜ ηıÂÙËÚÈ·ÛÌfi˜
ñ µÈÔ„›· ÙÔ˘ Ì˘Ôηډ›Ô˘ºÏÂÁÌÔÓ‹ Ì ӤÎÚˆÛË,ª˘Ôηډ›Ùȉ·
ıÂÙÈο ·ÓÙÈÁfiÓ· ÈÒÓ
∆ÚÔÔÔÈË̤ÓÔ ·fi Eur J Pediatr 2000;159:803-810
ŸÙ·Ó ÙÂı› Ë ‰È¿ÁÓˆÛË Ù˘ ‰È·Ù·ÙÈ΋˜ Ì˘ÔηډÈÔ¿ıÂÈ·˜, Ú¤ÂÈ Ó· ÏËÊı› ¤Ó· ÏÂÙÔÌÂÚ¤˜ ÔÈÎÔ-
ÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÙˆÓ Û˘ÁÁÂÓÒÓ ÚÒÙÔ˘ Î·È ‰Â‡ÙÂÚÔ˘ ‚·ıÌÔ‡ (ηډȷ΋˜ ·Ó¿ÚÎÂÈ·˜, ‰È·Ù·ÙÈ΋˜
Ì˘ÔηډÈÔ¿ıÂÈ·˜, ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘, ·ÚÚ˘ıÌÈÒÓ
Î.Ï.) ÁÈ· Ó· ‰ÈÂÚ¢ÓËı› Ë Èı·ÓfiÙËÙ· ÔÈÎÔÁÂÓÔ‡˜
Ì˘ÔηډÈÔ¿ıÂÈ·˜. ∆Ô ÈÛÙÔÚÈÎfi, ‚¤‚·È·, ‰ÂÓ ¤¯ÂÈ Ùfi-
ÛÔ ÌÂÁ¿ÏË Â˘·ÈÛıËÛ›· fiÛÔ ÙÔ Ë¯ÔηډÈÔÁÚ¿ÊËÌ·
fiÛÔÓ ·ÊÔÚ¿ ÛÙË ‰ÈÂÚ‡ÓËÛË ÙˆÓ Û˘ÁÁÂÓÒÓ Î·È Î·-
ıÒ˜ Ë ÔÈÎÔÁÂÓ‹˜ ‰È·Ù·ÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· ÌÂÙ·-
‚È‚¿˙ÂÙ·È Û˘¯ÓfiÙÂÚ· Ì ÙÔÓ ·˘ÙÔۈ̷ÙÈÎfi ÂÈÎÚ·-
ÙÔ‡ÓÙ· ¯·Ú·ÎÙ‹Ú·, ÚÔÙ›ÓÂÙ·È Ë ÎÏÈÓÈ΋ ÂÎÙ›ÌËÛË
ÙˆÓ Û˘ÁÁÂÓÒÓ ÚÒÙÔ˘ ‚·ıÌÔ‡ (ÁÔÓ›˜, ·‰¤ÚÊÈ·, ·È‰È¿) Ó· Á›ÓÂÙ·È Ì ηϋ Ï‹„Ë ÈÛÙÔÚÈÎÔ‡, ÎÏÈÓÈ΋
ÂͤٷÛË, ËÏÂÎÙÚÔηډÈÔÁÚ¿ÊËÌ· Î·È Ë¯ÔηډÈÔ-
ÁÚ¿ÊËÌ· (8-11). ∂Âȉ‹ ÙfiÛÔ Ë ËÏÈΛ· ¤Ó·Ú͢ fiÛÔ
Î·È Ë ÎÏÈÓÈ΋ ÂÌÊ¿ÓÈÛË Ù˘ ÔÈÎÔÁÂÓÔ‡˜ ‰È·Ù·ÙÈ΋˜
Ì˘ÔηډÈÔ¿ıÂÈ·˜ Â›Ó·È ·ÛÙ·ı‹ ·ÎfiÌ· Î·È Ì¤Û·
ÛÙËÓ ›‰È· ÔÈÎÔÁ¤ÓÂÈ·, Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÂÚÈÔ‰ÈÎfi˜
·ӤÏÂÁ¯Ô˜ ÛÙÔ˘˜ Û˘ÁÁÂÓ›˜ οı 3-5 ¯ÚfiÓÈ· (11).
ÀÂÚÙÚÔÊÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ·
∏ ˘ÂÚÙÚÔÊÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· (Àª∫) Â›Ó·È Ë
‰Â‡ÙÂÚË ÛÂ Û˘¯ÓfiÙËÙ· Ì˘ÔηډÈÔ¿ıÂÈ· ÛÙ· ·È‰È¿
Î·È ·ÔÙÂÏ› ÙÔ 20-30% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ Ì˘ÔηډÈÔ·ıÂÈÒÓ (3). ∏ ›وۋ Ù˘ ÛÙÔÓ ÁÂÓÈÎfi ÏËı˘ÛÌfi Â›Ó·È ÂÚ›Ô˘ 1/5000 ¤ˆ˜ 1/500 Ó·ÚÔ‡˜ ÂÓ‹ÏÈ-
Θ, Ì ÌÂÁ¿ÏË ÂÙÂÚÔÁ¤ÓÂÈ· ÛÙËÓ ÎÏÈÓÈ΋ ÂÌÊ¿ÓÈÛË
Î·È ‰ÈÂÈÛ‰˘ÙÈÎfiÙËÙ· (6,40,41). ŒÓ·˜ ÌÂÁ¿ÏÔ˜ ·ÚÈı-
Ìfi˜ ·ı‹ÛÂˆÓ Â˘ı‡ÓÂÙ·È ÁÈ· ÙË ‰Â˘ÙÂÚÔ·ı‹ ˘ÂÚ-
ÙÚÔÊ›· ÙÔ˘ Ì˘Ôηډ›Ô˘ ÛÙ· ·È‰È¿, fiˆ˜ Ù· ÌÂÙ·‚ÔÏÈο ÓÔÛ‹Ì·Ù·, ‰È¿ÊÔÚ· Û‡Ó‰ÚÔÌ· Î·È Ó¢ÚÔÌ˘˚Τ˜ ‰È·Ù·Ú·¯¤˜ (5) (¶›Ó·Î·˜ 5), ÂÓÒ ÛÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi Ë ·ÈÙÈÔÏÔÁ›· Â›Ó·È ¿ÁÓˆÛÙË.
ÔÈÎÔÁÂÓ‹˜ ÌÔÚÊ‹ ·ÔÙÂÏ› ÙÔ 50% ÙˆÓ ·ÈÙ›ˆÓ
ÓfiÛÔ˘ Î·È ÎÏËÚÔÓÔÌÂ›Ù·È Ì ÙÔÓ ·˘ÙfiÛˆÌÔ ÂÈÎÚ·ÙÔ‡ÓÙ· ¯·Ú·ÎÙ‹Ú· (6). OÈ ·ÛıÂÓ›˜ Ô˘ ‰ÂÓ
οÔÈÔÓ ¿Û¯ÔÓÙ· Û˘ÁÁÂÓ‹, ¤¯Ô˘Ó Èı·Ó¿ ÛÔÚ·‰ÈΤ˜ ÌÂÙ·ÏÏ¿ÍÂȘ Ù˘ ÓfiÛÔ˘ Ô˘ ‰‡ÛÎÔÏ· ·ÓȯÓ‡ÔÓÙ·È Î·È Ù·ÍÈÓÔÌÔ‡ÓÙ·È (6). ∞ÎfiÌ· Î·È Ì¤Û· ÛÙËÓ ›‰È· ÔÈÎÔÁ¤ÓÂÈ·, Ë ÓfiÛÔ˜ ·ÚÔ˘ÛÈ¿˙ÂÈ ÌÂÁ¿ÏË
ÔÈÎÈÏ›· ÂΉËÏÒÛˆÓ. ¶ÈÛÙ‡ÂÙ·È fiÙÈ ¤¯ÂÈ ·ÙÂÏ‹ ‰ÈÂÈÛ‰˘ÙÈÎfiÙËÙ· ÛÙËÓ ·È‰È΋ Î·È ÂÊË‚È΋ ËÏÈΛ·, ÂÓÒ ÛÙÔ˘˜ ÂÓ‹ÏÈΘ ¤¯ÂÈ Ï‹ÚË ‰ÈÂÈÛ‰˘ÙÈÎfiÙËÙ· (3). ∏ ÁÂÓÂÙÈ΋ ·Ó¿Ï˘ÛË ¤¯ÂÈ ·ÔΈ‰ÈÎÔÔÈ‹ÛÂÈ 9 ‰È·ÊÔÚÂÙÈΤ˜ ÂÚÈÔ¯¤˜ ¯ÚˆÌ·ÙÔÛˆÌ¿ÙˆÓ ˆ˜ ·ÈÙÈÔÏÔÁÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Ù˘ ÔÈÎÔÁÂÓÔ‡˜ ˘ÂÚÙÚÔÊÈ΋˜
Ì˘ÔηډÈÔ¿ıÂÈ·˜, ÔÈ Ôԛ˜ Έ‰ÈÎÔÔÈÔ‡Ó ÚˆÙ½Ó˜ ÙÔ˘ Û·ÚÎÔÌÂÚȉ›Ô˘ (6,41). ŸÏ˜ ·˘Ù¤˜ ÔÈ ÚˆÙ½Ó˜ ¤¯Ô˘Ó ‰È·ÊÔÚÂÙÈÎÔ‡˜ ÚfiÏÔ˘˜ ÛÙÔÓ Î‡ÎÏÔ Û˘ÛÙÔÏ‹˜-¯¿Ï·Û˘ Î·È Û˘ÓÂÈÛʤÚÔ˘Ó ÛÙËÓ ÔÌÔÈfiÛÙ·ÛË Ù˘ ηډȿ˜ (6). ∏ ‚·ÚÈ¿ ¿Ï˘ÛÔ˜ Ù˘ ·-Ì˘ÔÛ›Ó˘ Î·È Ë ‚·ÚÈ¿ ¿Ï˘ÛÔ˜ Ù˘ ‚-Ì˘ÔÛ›Ó˘ ·ÏÏËÏÂȉÚÔ‡Ó Ì ÙËÓ ·ÎÙ›ÓË ÁÈ· ÙËÓ ·Ú·ÁˆÁ‹ Ì˯·ÓÈ΋˜ ÂÓ¤ÚÁÂÈ·˜, Ë ÙÚÔÔÓ›ÓË ∆, Ë ÙÚÔÔÓ›ÓË π, Ë ·-ÙÚÔÔÌ˘ÔÛ›ÓË Î·È Ë ÂÏ·ÊÚ¿ ¿Ï˘ÛÔ˜ Ù˘ Ì˘ÔÛ›Ó˘ ¤¯Ô˘Ó Ú˘ıÌÈÛÙÈÎfi ÚfiÏÔ, ÂÓÒ Ë ÚˆÙ½ÓË C Ô˘ Û˘Ó‰¤ÂÙ·È Ì ÙË Ì˘ÔÛ›ÓË Î·È Ë ÙÈÙ›ÓË ‚ÔËıÔ‡Ó ÛÙË ÌÂÙ·ÊÔÚ¿ ÂÓ¤ÚÁÂÈ·˜ (∂ÈÎfiÓ· 1) (42-50). ¶ÂÚÈÁÚ¿ÊÔÓÙ·È ÂÚÈÛÛfiÙÂÚ˜ ·fi 150 ÌÂÙ·ÏÏ¿ÍÂȘ ÁÔÓȉ›ˆÓ Ô˘ Έ‰ÈÎÔÔÈÔ‡Ó ÚˆÙ½Ó˜ ÙÔ˘ Û·ÚÎÔÌÂÚȉ›Ô˘ Ô˘ Â›Ó·È ˘Â‡ı˘Ó˜ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ˘ÂÚÙÚÔÊÈ΋˜ Ì˘ÔηډÈÔ¿ıÂÈ·˜ (41). ∆Ô ÂӉȷʤÚÔÓ ¤¯ÂÈ ÛÙÚ·Ê› ÛÙË ‰ÈÂÚ‡ÓËÛË Èı·Ó‹˜ Û˘Û¯¤ÙÈÛ˘ ÌÂٷ͇ ÙÔ˘ ÁÔÓfiÙ˘Ô˘ Î·È ÙÔ˘ Ê·ÈÓfiÙ˘Ô˘ ÙˆÓ ‰È·ÊfiÚˆÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ (41-43). OÈ ÌÂÙ·ÏÏ¿ÍÂȘ ÙÔ˘ ÁÔÓȉ›Ô˘ Ù˘ ‚·ÚÈ¿˜ ·Ï‡ÛÔ˘ Ù˘ ‚-Ì˘ÔÛ›Ó˘ (¯ÚˆÌfiۈ̷ 14q11.212) Â›Ó·È ÔÈ Û˘¯ÓfiÙÂÚ˜ Î·È ·ÓÙÈÛÙÔÈ¯Ô‡Ó ÛÙÔ 35-50% fiÏˆÓ ÙˆÓ ÂÚÈÙÒÛÂˆÓ (41). ∫¿ÔȘ ·fi ·˘Ù¤˜ ÙȘ
¶›Ó·Î·˜ 6. ∆·ÍÈÓfiÌËÛË ÙˆÓ Ù‡ˆÓ Ù˘ ÂÚÈÔÚÈÛÙÈ΋˜ Ì˘Ô-
ηډÈÔ¿ıÂÈ·˜ ·Ó¿ÏÔÁ· Ì ÙËÓ ·ÈÙÈÔÏÔÁ›·
ª˘Ôηډȷډȷο ·›ÙÈ·
π‰ÈÔ·ı‹˜ Ì˘ÔηډÈÔ¿ıÂÈ·
OÈÎÔÁÂÓ‹˜ ÀÂÚÙÚÔÊÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ·
™ÎÏËÚfi‰ÂÚÌ·
梉ÔÍ¿ÓıˆÌ·
¢È·‚ËÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ·
¢ÈËıËÙÈΤ˜
∞Ì˘ÏÔ›‰ˆÛË
™·ÚÎÔ›‰ˆÛË ¡. Gaucher
¡. Hurler
§È҉˘ ‰È‹ıËÛË ¡fiÛÔÈ ÂÓ·Ôı¤Ûˆ˜
∞ÈÌԯڈ̿وÛË
¡. Fabry
°Ï˘ÎÔÁÔÓÈ¿ÛÂȘ
∂Ó‰ÔÌ˘Ôηډȷο ·›ÙÈ· ∂Ó‰ÔÌ˘Ôηډȷ΋ ›ÓˆÛË
ÀÂÚˈÛÈÓÔÊÈÏÈÎfi Û‡Ó‰ÚÔÌÔ
ªÂÙ·ÛÙ·ÙÈÎÔ› fiÁÎÔÈ
∞ÎÙÈÓÔ‚ÔÏ›·
£Âڷ›· Ì ·Óıڷ΢ÎÏ›ÓË
º¿Ú̷η (ÛÂÚÔÙÔÓ›ÓË, ÂÚÁÔÙ·Ì›ÓË)
∆ÚÔÔÔÈË̤ÓÔ ·fi: N Engl J Med 1997;336:267-276
ÂÈÎÚ·ÙÔ‡ÓÙ· ¯·Ú·ÎÙ‹Ú·, Ì ÔÈΛÏË ‰ÈÂÈÛ‰˘ÙÈÎfiÙËÙ· Î·È ·ÙÂÏ‹ ¤ÎÊÚ·ÛË. ∆· ÁÔÓ›‰È· Ô˘ Â›Ó·È ˘Â‡ı˘-
Ó· ÁÈ· ÙËÓ ∞¢¢∫ ‰ÂÓ ¤¯Ô˘Ó ·ÎfiÌË ·Ó·ÁÓˆÚÈÛÙ›, ·ÏÏ¿ ¤¯Ô˘Ó ¯·ÚÙÔÁÚ·ÊËı› 7 ÂÚÈÔ¯¤˜ ÛÙ· ¯ÚˆÌÔÛÒÌ·Ù· 14(14q23-q24 Î·È 14q12-q22), 1(1q42-43), 2(2q32.1-q32.2), 3(3p23) Î·È 10(10p12-p14). ¶ÚfiÛÊ·Ù·, ·Ó·ÁÓˆÚ›ÛÙËÎ·Ó ÌÂÙ·ÏÏ¿ÍÂȘ ÙˆÓ ÁÔÓȉ›ˆÓ
Ô˘ Έ‰ÈÎÔÔÈÔ‡Ó ÙȘ ÚˆÙ½Ó˜ Ï·ÎÔÛÊ·ÈÚ›ÓË Î·È
‰ÂÛÌÔϷΛÓË, ÔÈ Ôԛ˜ Â›Ó·È ÚˆÙ½Ó˜ ÙˆÓ Î˘ÙÙ·-
ÚÈÎÒÓ Û˘Ó‰¤ÛÂˆÓ Î·È Â˘ı‡ÓÔÓÙ·È ÁÈ· ÙËÓ ·˘ÙÔۈ̷ÙÈ΋ ˘ÔÏÂÈfiÌÂÓË ∞¢¢∫ (6,69,70). ∆Ô ÁÔÓ›‰ÈÔ
·Ó·ÁÓˆÚ›ÛÙËΠÛÙË ÓfiÛÔ Ù˘ ¡¿ÍÔ˘, fiÔ˘ ÛÙÔ 90%
ÙˆÓ ÂÚÈÙÒÛÂˆÓ Û˘Ó˘¿Ú¯Ô˘Ó ÂΉËÏÒÛÂȘ ·fi ÙÔ
‰¤ÚÌ·, ÛÁÔ˘Ú¿ Ì·ÏÏÈ¿ Î·È ˘ÂÚÎÂÚ¿ÙˆÛË ÙÔ˘ ‰¤Ú-
Ì·ÙÔ˜ ÙˆÓ ·Ï·ÌÒÓ Î·È ÙˆÓ ÂÏÌ¿ÙˆÓ Î·È ¤¯ÂÈ ÂÚÈ-
ÁÚ·Ê› Û ·È‰È¿ ËÏÈΛ·˜ ·fi 7 ÂÙÒÓ. ∂ÎÙfi˜ ·fi ÙË
ÁÂÓÂÙÈ΋ ·ÈÙÈÔÏÔÁ›· Ù˘ ÓfiÛÔ˘, ¤¯Ô˘Ó ‰È·Ù˘ˆı›
Î·È ¿ÏϘ ıˆڛ˜ Û¯ÂÙÈο Ì ÙËÓ ·ÈÙÈÔÏÔÁ›·, fiˆ˜
Ë ‰˘ÛÔÓÙÔÁ¤ÓÂÛË, Ë ÂÎʇÏÈÛË ÙˆÓ Ì˘ÔηډȷÎÒÓ
ÈÓÒÓ ÂÍ·ÈÙ›·˜ οÔÈÔ˘ ÌÂÙ·‚ÔÏÈÎÔ‡ ÓÔÛ‹Ì·ÙÔ˜, Ë
ÊÏÂÁÌÔÓ‹ (ÌÂÙ¿ ·fi ÈÔÁÂÓ‹ Ì˘Ôηډ›Ùȉ·) Î·È Ë
·fiÙˆÛË ÙˆÓ Ì˘ÔηډȷÎÒÓ Î˘ÙÙ¿ÚˆÓ (69).
∆˘Èο ÂÌÊ·Ó›˙ÂÙ·È Û Ó·ÚÔ‡˜ ÂÓ‹ÏÈΘ ¿Ó‰Ú˜
Î·È Û ÔÛÔÛÙfi 80% Ë ‰È¿ÁÓˆÛË Á›ÓÂÙ·È ÚÈÓ ÙËÓ
ËÏÈΛ· ÙˆÓ 40 ÂÙÒÓ (6,69). ∫ÏÈÓÈο ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È
Û˘ÁÎÔÙÈο ÂÂÈÛfi‰È·, ÎÔÈÏȷ΋ Ù·¯˘Î·Ú‰›· (ÌÂ
ÌÔÚÊÔÏÔÁ›· ·ÔÎÏÂÈÛÌÔ‡ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ÛΤÏÔ˘˜) Î·È Î·Ú‰È·Î‹ ·Ó¿ÚÎÂÈ· ΢ڛˆ˜ ÛÙËÓ 4Ë Î·È 5Ë ‰ÂηÂÙ›· Ù˘ ˙ˆ‹˜. O Ì˯·ÓÈÛÌfi˜ ÙÔ˘ ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿-
Â›Ó·È Ë ÂÈÙ¿¯˘ÓÛË Ù˘ ÎÔÈÏȷ΋˜ Ù·¯˘Î·Ú‰›·˜ Î·È Ë ÂÎÙÚÔ‹ Û ÎÔÈÏȷ΋ Ì·ÚÌ·Ú˘Á‹. ∏
¢ı‡ÓÂÙ·È ÁÈ· ÙÔ 3-4% ÙˆÓ ·ÈÊÓ›‰ÈˆÓ ı·Ó¿ÙˆÓ Ô˘ Û˘Ì‚·›ÓÔ˘Ó ÛÙËÓ ¿ÛÎËÛË Û Ó·ÚÔ‡˜ ·ıÏËÙ¤˜ (69). ∏ ‰È¿ÁÓˆÛË Ù›ıÂÙ·È Ì ÙË ‚ÈÔ„›· ÙÔ˘ Ì˘Ôηډ›Ô˘, ÛÙËÓ ÔÔ›· ·Ó¢ڛÛÎÔÓÙ·È ÂÚÈÔ¯¤˜ fiÔ˘ ÙÔ Ì˘ÔοډÈÔ Ù˘ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜ ¤¯ÂÈ ·ÓÙÈηٷÛÙ·ı›
·fi ÈÓÒ‰Ë Î·È ÏÈÒ‰Ë ÈÛÙfi. ∂Âȉ‹ Â›Ó·È ‰‡ÛÎÔÏË Ë
‰ÈÂÓ¤ÚÁÂÈ· ‚ÈÔ„›·˜, ¤¯Ô˘Ó ıÂÛÈÛÙ› ‰È¿ÊÔÚ· ‰È·-
ÁÓˆÛÙÈο ÎÚÈÙ‹ÚÈ· (69) (¶›Ó·Î·˜ 7), ÂÓÒ ÁÈ· Ó· ÙÂı›
Ë ‰È¿ÁÓˆÛË, Ô ·ÛıÂÓ‹˜ Ú¤ÂÈ Ó· ¤¯ÂÈ ‰‡Ô Ì›˙ÔÓ·
ÎÚÈÙ‹ÚÈ· ‹ ¤Ó· Ì›˙ÔÓ Î·È ‰‡Ô ÂÏ¿ÛÛÔÓ· ‹ Ù¤ÛÛÂÚ·
ÂÏ¿ÛÛÔÓ· ÎÚÈÙ‹ÚÈ·.
£Âڷ›·
™Â ·Û˘Ìو̷ÙÈÎÔ‡˜ ·ÛıÂÓ›˜, ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÔÈ ‚-·Ó·ÛÙÔÏ›˜ ÁÈ· Ó· ÂÏ·ÙÙˆı› Ë Èı·ÓfiÙËÙ·
‰ËÌÈÔ˘ÚÁ›·˜ ·ÚÚ˘ıÌ›·˜ ÌÂÙ¿ ·fi ‰È¤ÁÂÚÛË ÙÔ˘ Û˘Ì·ıËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ™ÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ›ӷÈ
ÎÈÓ‰‡ÓÔ˘ ÁÈ· ·ÈÊÓ›‰ÈÔ ı¿Ó·ÙÔ, ı·
Ó·
ÂÌʇÙ¢ÛË ·ÈÓȉˆÙ‹ (69). ∂Í·ÈÙ›·˜ Ù˘
ıÓËÙfiÙËÙ·˜ ΢ڛˆ˜ Û Ó·ڿ ¿ÙÔÌ·, ı·
Ó· Û˘ÓÈÛÙ¿Ù·È Ë ·ÔÊ˘Á‹ ÙˆÓ ·ÓÙ·ÁˆÓÈÛÙÈÎÒÓ ·ıÏËÌ¿ÙˆÓ.
ªË Û˘Ì·Á¤˜ Ì˘ÔοډÈÔ ∞Ó‹ÎÂÈ ÛÙȘ ·Ù·ÍÈÓfiÌËÙ˜ Ì˘ÔηډÈÔ¿ıÂȘ (1) Î·È ·ÔÙÂÏ› Ì›· Û¿ÓÈ· ‰È·Ù·Ú·¯‹ Ù˘ ·Ú¯ÈÙÂÎÙÔÓÈ΋˜ ÙÔ˘ Ì˘ÔηډȷÎÔ‡ ÙÔȯÒÌ·ÙÔ˜, Ì ÔÏϷϤ˜ ¢ÌÂÁ¤ıÂȘ ‰ÔÎȉÒÛÂȘ Î·È ‚·ıȤ˜ ÂÓÙÔ̤˜, ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÂÓ‰ÔÌ‹ÙÚÈ·˜ ·Ó·ÛÙÔÏ‹˜ Ù˘ Ì˘Ôηډȷ΋˜ ÌÔÚÊÔÁ¤ÓÂÛ˘, Ì ·Ô˘Û›· ÔÔÈ·Û‰‹ÔÙÂ Û˘Ó˘¿Ú¯Ô˘Û·˜ Û˘ÁÁÂÓÔ‡˜ ηډȷ΋˜ ·ÓˆÌ·Ï›·˜. πÛÙÔÏÔÁÈο ·Ú·ÙËÚÔ‡ÓÙ·È ÔÏϷϤ˜ ‰ÔÎȉÒÛÂȘ Î·È ‚·ıȤ˜ ÂÓÙÔ̤˜ ÌÂٷ͇ ÙÔ˘˜. ∆Ô ÂÓ‰Ôı‹ÏÈÔ Ô˘ ηχÙÂÈ ÙȘ ÂÓÙÔ̤˜ ·ÔÙÂÏ› Û˘Ó¤¯ÂÈ· ÙÔ˘ ÂÓ‰ÔıËÏ›Ô˘ ÙˆÓ ‰ÔÎȉÒÛÂˆÓ Î·È ÙÔ˘ ˘fiÏÔÈÔ˘ ÂÓ-
‰Ôηډ›Ô˘. ∆Ô Ì˘ÔοډÈÔ Î·È ÔÈ ‰ÔÎȉÒÛÂȘ ·Ú‰Â‡ÔÓÙ·È ·fi ÙÔ ÛÙÂÊ·ÓÈ·›Ô ‰›ÎÙ˘Ô, ÂÓÒ ÔÈ ÂÓÙÔ̤˜ ÏËÚÔ‡ÓÙ·È ·fi ÙÔ ·›Ì· Ù˘ ηډȷ΋˜ ÎÔÈÏfiÙËÙ·˜ (71,72).
∏ ÓfiÛÔ˜ ·ÚÔ˘ÛÈ¿˙ÂÈ ÔÈÎÔÁÂÓ‹ ¯·Ú·ÎÙ‹Ú·, Ì ÌÂÁ¿ÏË ÂÙÂÚÔÁ¤ÓÂÈ· ÛÙÔÓ ÙÚfiÔ ÌÂÙ·‚›‚·Û˘. ªÂÙ·ÏÏ¿ÍÂȘ ÛÙÔ ÁÔÓ›‰ÈÔ G4.5 ÛÙË ¯ÚˆÌ·ÙÔÛˆÌÈ΋ ÂÚÈÔ¯‹ Xq28 Ô˘ Έ‰ÈÎÔÔÈ› ÙËÓ ÚˆÙ½ÓË Ù·Ê·˙›ÓË, ¤¯ÂÈ ‚ÚÂı› fiÙÈ Û˘Ó‰˘¿˙ÔÓÙ·È Ì ÙÔ ÌË Û˘Ì·Á¤˜ Ì˘ÔοډÈÔ Î·È Ê·›ÓÂÙ·È fiÙÈ ·˘Ù‹ Ë ‰È·Ù·Ú·¯‹ Â›Ó·È ·ÏÏËÏfiÌÔÚÊË Ì ÙÔ Û‡Ó‰ÚÔÌÔ Barth Ô˘ ÎÏËÚÔÓÔÌÂ›Ù·È Ì ÙÔÓ Ê˘ÏÔÛ‡Ó‰ÂÙÔ ¯·Ú·ÎÙ‹Ú· (71,73).
∫ÏÈÓÈ΋ ÂÈÎfiÓ· ∂ÓÒ ÙÔ ÌË Û˘Ì·Á¤˜ Ì˘ÔοډÈÔ Â›Ó·È Ì›· ÓfiÛÔ˜
ªÂ›˙ÔÓ· ÎÚÈÙ‹ÚÈ·
1. OÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ‰È·ÁÓˆṲ̂Ó˘ ∞¢¢∫
2. ∫ÔÈÏȷο ÌÂÙ·‰ÈÂÁÂÚÙÈο ·̷ٷ (·̷ٷ ∂) ‹ ‰È‡ڢÓÛË
ÙÔ˘ QRS (>110 ms) ÛÙȘ ··ÁˆÁ¤˜ V1-3
3. ™Ô‚·Ú‹ ÙÌËÌ·ÙÈ΋ ‰È¿Ù·ÛË Ù˘ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜
4. ∆ÔÈο ·Ó¢ڇÛÌ·Ù· Ù˘ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜
5. πÓÔÏÈ҉˘ ·ÓÙÈηٿÛÙ·ÛË ÙÔ˘ Ì˘Ôηډ›Ô˘ ÛÙË ‚ÈÔ„›·
∂Ï¿ÛÛÔÓ· ÎÚÈÙ‹ÚÈ·
1. OÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ (<35 ÂÙÒÓ) ·fi
Èı·Ó‹ ∞¢¢∫
2. OÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÎÏÈÓÈο ‰È·ÁÓˆṲ̂Ó˘ ∞¢¢∫
3. ∞ÓÂÛÙÚ·Ì̤ӷ ¿ÚÌ·Ù· ∆ ÛÙȘ ‰ÂÍȤ˜ ÚÔοډȘ ··ÁˆÁ¤˜
4. ¶·ÚÔ˘Û›· ÌÂÙ·‰˘Ó·ÌÈÎÒÓ ÛÙÔ ∏∫° Û˘Ì„ËÊÈÛÌÔ‡
5. ∞ÔÎÏÂÈÛÌfi˜ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ÛΤÏÔ˘˜ Î·È ÎÔÈÏȷ΋ Ù·¯˘Î·Ú‰›·
6. ◊È· ÙÌËÌ·ÙÈ΋ ‰È¿Ù·ÛË Ù˘ ¢∫
7. ∆ÔÈΤ˜ ÂÚÈÔ¯¤˜ ˘ÔÎÈÓËÛ›·˜ Ù˘ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜
∆ÚÔÔÔÈË̤ÓÔ ·fi J Am Coll Cardiol 2001;38:1777
Ù˘ ÓfiÛÔ˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÚÔԉ¢ÙÈο ÂȉÂÈÓÔ‡ÌÂÓË Û˘ÛÙÔÏÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Î·È ·˘ÍË̤ÓË ÓÔÛËÚfiÙËÙ· Î·È ıÓËÙfiÙËÙ·, ΢ڛˆ˜ ÛÙÔ˘˜ Û˘Ìو̷ÙÈÎÔ‡˜ ·ÛıÂÓ›˜. ∆· Û˘¯ÓfiÙÂÚ· Û˘ÌÙÒÌ·Ù· Â›Ó·È Ë Î·Ú‰È·Î‹ ·Ó¿ÚÎÂÈ· (53%), ÔÈ ÎÔÈÏȷΤ˜ ·ÚÚ˘ı̛˜ (41%), Ù· Û˘ÛÙËÌ·ÙÈο ıÚÔÌ‚ÔÂÌ‚ÔÏÈο ÂÂÈÛfi‰È· (24%) Î·È Ù· Û˘ÁÎÔÙÈο ÂÂÈÛfi‰È· (18%). ™˘¯Ó¿ Û˘Ó‰˘¿˙ÂÙ·È Ì ‰˘ÛÌÔÚʛ˜ ÚÔÛÒÔ˘ ‹ ¿ÏϘ Â͈ηډȷΤ˜ ‰˘ÛÌÔÚʛ˜ (71).
¢È¿ÁÓˆÛË
∏ ‰È¿ÁÓˆÛË Ù›ıÂÙ·È Ì ÙÔ Ë¯ÔηډÈÔÁÚ¿ÊËÌ·, fiÔ˘ ·Ú·ÙËÚÔ‡ÓÙ·È Â·¯˘Ṳ̂ӷ ˘ÔÎÈÓËÙÈο
ÙÌ‹Ì·Ù·, Ì ÔÏ˘¿ÚÈı̘ ‰ÔÎȉÒÛÂȘ Î·È ‚·ıȤ˜
ÂÓÙÔ̤˜ ÌÂٷ͇ ·˘ÙÒÓ (71).
™˘Ó‹ıË Â˘Ú‹Ì·Ù· ÛÙÔ ∏∫° ·ÔÙÂÏÔ‡Ó Ë ‰ÂÍÈ¿ ·fiÎÏÈÛË ÙÔ˘ ¿ÍÔÓ·, ·ÓˆÌ·Ï›Â˜ ÙÔ˘ ·̷ÙÔ˜ ƒ, ·ÙÂÏ‹˜ ‹ Ï‹Ú˘ ·ÔÎÏÂÈÛÌfi˜ ÙÔ˘ ‰ÂÍÈÔ‡ ÛΤÏÔ˘˜, ·ÔÎÏÂÈÛÌfi˜ ·ÚÈÛÙÂÚÔ‡ ÛΤÏÔ˘˜, ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ST-T ‰È·ÛÙ‹Ì·ÙÔ˜, ÂÈÎfiÓ· ÎÔÈÏȷ΋˜ ˘ÂÚÙÚÔÊ›·˜, ·ã ‚·ıÌÔ‡ ÎÔÏÔÎÔÈÏÈ·Îfi˜ ·ÔÎÏÂÈÛÌfi˜ ηÈ, Û¿ÓÈ·, WPW (71,72).
∏ ·ÎÙÈÓÔÁÚ·Ê›· ÌÔÚ› Ó· Â›Ó·È Ê˘ÛÈÔÏÔÁÈ΋ Û ·Û˘Ìو̷ÙÈÎÔ‡˜ ·ÛıÂÓ›˜, ÂÓÒ Ë ·ÚÔ˘Û›· ÌÂÁ·ÏÔηډ›·˜ ·Ó¢ڛÛÎÂÙ·È ÛÙÔ 85% ÙˆÓ ·ÛıÂÓÒÓ Ì ÌÂȈ̤ÓË Û˘ÛÙÔÏÈ΋ ÏÂÈÙÔ˘ÚÁ›· ‹ ÂÌÊ·Ó‹ Û˘ÌÙÒÌ·Ù·. ªÂ ÙÔÓ Î·Ú‰È·Îfi ηıÂÙËÚÈ·ÛÌfi ÂÎÙÈÌ¿Ù·È Ë ·ÈÌÔ‰˘Ó·ÌÈ΋ ηٿÛÙ·ÛË Ù˘ ηډȿ˜, Ë ÔÔ›· ÂÍ·ÚÙ¿Ù·È ·fi ÙÔ ÛÙ¿‰ÈÔ Ù˘ ÓfiÛÔ˘. ¢ËÏ·‰‹, ÛÙ· ·Ú¯Èο ÛÙ¿‰È· Ù˘ ÓfiÛÔ˘ Î·È Û ·Û˘Ìو̷ÙÈÎÔ‡˜ ·ÛıÂÓ›˜ ‰È·ÈÛÙÒÓÂÙ·È ÂÚÈÔÚÈÛÙÈ΋ Ê˘ÛÈÔÏÔÁ›·, ÂÓÒ ÛÙÔ˘˜ Û˘Ìو̷ÙÈÎÔ‡˜ ·ÛıÂÓ›˜ ·Ú·ÙËÚÔ‡ÓÙ·È ·ÈÌÔ‰˘Ó·ÌÈο ¯·Ú·ÎÙËÚÈÛÙÈο
ıÚÔÌ‚ÔÂÌ‚ÔÏÈÎÒÓ
ÙËÓ ÂÌʇÙ¢ÛË ·ÈÓȉˆÙ‹ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ·ÚÚ˘ıÌÈÒÓ Î·È, Ù¤ÏÔ˜, ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË Î·Ú‰È¿˜.
¶ÚfiÁÓˆÛË
OÈ ·Ú¿ÁÔÓÙ˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì η΋ ÚfiÁÓˆÛË Ù˘ ÓfiÛÔ˘ Â›Ó·È Ë ·˘ÍË̤ÓË ÙÂÏԉȷÛÙÔÏÈ΋ ‰È¿ÌÂÙÚÔ˜ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜, Ë ÂΉ‹ÏˆÛË Î·Ú‰È·Î‹˜ ·Ó¿ÚÎÂÈ·˜, Ë ¯ÚfiÓÈ· ÎÔÏÈ΋ Ì·ÚÌ·Ú˘Á‹
µÈ‚ÏÈÔÁÚ·Ê›· 1. Richardson P, McKenna W, Bristow M, Maisch B, Mautner B, O’Connell J et al for the WHO/ISFC task force. Report of the 1995 World Health Organization/International Society and Federation of Cardiology Task Force on the Definition and Classification of cardiomyopathies. Circulation 1996;93:841-842.
2. Davies MJ. The cardiomyopathies: an overview. Heart 2000;83:469-474.
3. Towbin JA. Pediatric myocardial disease. Pediatr Clin North Am 1999;46:289-312.
4. Gemayel C, Pelliccia A, Thompson P. Arrhythmogenic right ventricular cardiomyopathy. J Am Coll Cardiol 2001;38:1773-1781.
5. Gajarski RJ, Towbin JA. Recent advances in the etiology, diagnosis, and treatment of myocarditis and cardiomyopathies in children. Curr Opin Pediatr 1995;7:587-594.
6. Franz WM, Muller OJ, Katus HA. Cardiomyopathies: from genetics to the prospect of treatment. Lancet 2001;358:1627-1637.
7. Dec GW, Fuster V. Idiopathic dilated cardiomyopathy. N Engl J Med 1994;331:1564-1575.
8. Michels VV, Moll PP, Miller FA, Tajik AJ, Chu JS, Driscoll DJ et al. The frequency of familial dilated cardiomyopathy in a series of patients with idiopathic dilated cardiomyopathy. N Engl J Med 1992;326:77-82.
9. Grunig E, Tasman JA, Kucherer H, Franz W, Kubler W, Katus HA. Frequency and phenotypes of familial dilated cardiomyopathy. J Am Coll Cardiol 1998;31:186-194.
10. Baig MK, Goldman JH, Caforio AL, Coonar AS, Keeling PJ, McKenna WJ. Familial dilated cardiomyopathy: cardiac abnormalities are common in asymptomatic relatives and may represent early disease. J Am Coll Cardiol 1998;31:195-201.
11. Crispell KA, Hanson EL, Coates K, Toy W, Hershberger RE. Periodic rescreening is indicated for family members at risk of developing familial dilated cardiomyopathy. J Am Coll Cardiol 2002;39:1503-1507.
12. Seliem MA, Mansara KB, Palileo M, Ye X, Zhang Z, Benson DW. Evidence for autosomal recessive inheritance of infantile dilated cardiomyopathy: studies from the Eastern Province of Saudi Arabia. Pediatr Res 2000;48:770-775.
13. Mestroni L, Rocco C, Gregori D, Sinagra G, Di Lenarda A, Miocic S et al. Familial dilated cardiomyopathy: evidence
for genetic and phenotypic heterogeneity. Heart Muscle Disease Study Group. J Am Coll Cardiol 1999;34:181-190.
14. Kamisago M, Sharma SD, DePalma SR, Solomon S, Sharma P, McDonough B et al. Mutations in sarcomere protein genes as a cause of dilated cardiomyopathy. N Engl J Med 2000;343:1688-1696.
15. Muntoni F, Cau M, Ganau A, Congiu R, Arvedi G, Mateddu A et al. Brief report: deletion of the dystrophin musclepromoter region associated with X-linked dilated cardiomyopathy. N Engl J Med 1993;329:921-925.
16. Beggs AH. Dystrophinopathy, the expanding phenotype. Dystrophin abnormalities in X-linked dilated cardiomyopathy. Circulation 1997;95:2344-2347.
17. Emery AE. The muscular dystrophies. Lancet 2002;359:687-695.
18. Tsubata S, Bowles KR, Vatta M, Zintz C, Titus J, Muhonen L et al. Mutations in the human delta-sarcoglycan gene in familial and sporadic dilated cardiomyopathy. J Clin Invest 2000;106:655-662.
19. Olson TM, Michels VV, Thibodeau SN, Tai YS, Keating MT. Actin mutations in dilated cardiomyopathy, a heritable form of heart failure. Science 1998;280:750-752.
20. Li D, Tapscoft T, Gonzalez O, Burch PE, Quinones MA, Zoghbi WA et al. Desmin mutation responsible for idiopathic dilated cardiomyopathy. Circulation 1999;100:461-464.
21. Siu BL, Niimura H, Osborne JA, Fatkin D, MacRae C, Solomon S et al. Familial dilated cardiomyopathy locus maps to chromosome 2q31. Circulation 1999;99:1022-1026
22. Fatkin D, MacRae C, Sasaki T, Wolff MR, Porcu M, Frenneaux M et al. Missense mutations in the rod domain of the lamin A/C gene as causes of dilated cardiomyopathy and conduction system disease. N Engl J Med 1999;341:1715-1724.
23. Arbustini E, Pilotto A, Repetto A, Grasso M, Negri A, Diegoli M et al. Autosomal dominant dilated cardiomyopathy with atrioventricular block: a lamin A/C defect-related disease. J Am Coll Cardiol 2002;39:981-990.
24. Michaud JL, Heon E, Guilbert F, Weill J, Puech B, Benson L et al. Natural history of Alstrom syndrome in early childhood: onset with dilated cardiomyopathy. J Pediatr 1996;128:225-229.
25. Schonberger J, Levy H, Grunig E, Sangwatanaroj S, Fatkin D, MacRae C et al. Dilated cardiomyopathy and sensorineural hearing loss: a heritable syndrome that maps to 6q23-24. Circulation 2000;101:1812-1818.
26. Su Z, Yao A, Zubair I, Sugishita K, Ritter M, Li F et al. Effects of deletion of muscle LIM protein on myocyte function. Am J Physiol Heart Circ Physiol 2001;280:H2665-H2673.
27. Olson TM, Illenberger S, Kishimoto NY, Huttelmaier S, Keating MT, Jockusch BM. Metavinculin mutations alter actin interaction in dilated cardiomyopathy. Circulation 2002;105:431-437.
28. Kawai C. From myocarditis to cardiomyopathy: mechanisms of inflammation and cell death: learning from the past for the future. Circulation 1999;99:1091-1100.
29. Fujioka S, Kitaura Y, Ukimura A, Deguchi H, Kawamura K, Isomura T et al. Evaluation of viral infection in the myocardium of patients with idiopathic dilated
cardiomyopathy. J Am Coll Cardiol 2000;36:1920-1926.
30. Noutsias M, Seeberg B, Schultheiss HP, Kuhl U. Expression of cell adhesion molecules in dilated cardiomyopathy: evidence for endothelial activation in inflammatory cardiomyopathy. Circulation 1999;99:2124-2131.
31. Limas CJ. Cardiac autoantibodies in dilated cardiomyopathy: a pathogenetic role? Circulation 1997;95:1979-1980.
32. Caforio AL, Mahon NJ, Tona F, McKenna WJ. Circulating cardiac autoantibodies in dilated cardiomyopathy and myocarditis: pathogenetic and clinical significance. Eur J Heart Fail 2002;4:411-417.
33. Cunningam MW. Cardiac myosin and the TH1/TH2 paradigm in autoimmune myocarditis. Am J Pathol 2001;159:5-12.
34. Muller G, Ulmer HE, Hagel KJ, Wolf D. Cardiac dysrhythmias in children with idiopathic dilated or hypertrophic cardiomyopathy. Pediatr Cardiol 1995;16:56-60.
35. Pogwizd SM, McKenzie JP, Cain ME. Mechanisms underlying spontaneous and induced ventricular arrhythmias in patients with idiopathic dilated cardiomyopathy. Circulation 1998;98:2404-2414.
36. Schwartz ML, Cox GF, Lin AE, Korson MS, Perez-Atayde A, Lacro RV et al. Clinical approach to genetic cardiomyopathy in children. Circulation 1996;94:2021-2038.
37. Ostman-Smith I, Wettrell G, Riesenfeld T. A cohort study of childhood hypertrophic cardiomyopathy: improved survival following high-dose beta-adrenoceptor antagonist treatment. J Am Coll Cardiol 1999;34:1813-1822.
38. Mann DL. Autoimmunity, immunoglobulin adsorption and dilated cardiomyopathy: has the time come for randomized clinical trials? J Am Coll Cardiol 2001;38:184-186.
39. Arola A, Tuominen J, Ruuskanen O, Jokinen E. Idiopathic dilated cardiomyopathy in children: prognostic indicators and outcome. Pediatrics 1998;101:369-376.
40. Branwald E. Heart disease: a textbook of cardiovascular medicine. 5th ed. Philadelphia: WB Saunders Co; 1997. p. 1811.
41. Ackerman MJ, VanDriest SL, Ommen SR, Will ML, Nishimura RA, Tajik AJ et al. Prevalence and agedependence of malignant mutations in the beta-myosin heavy chain and troponin T genes in hypertrophic cardiomyopathy: a comprehensive outpatient perspective. J Am Coll Cardiol 2002;39:2042-2048.
42. Bonne G, Carrier L, Richard P, Hainque B, Schwartz K. Familial hypertrophic cardiomyopathy: from mutations to functional defects. Circ Res 1998;83:580-593.
43. Marian AJ, Roberts R. Recent advances in the molecular genetics of hypertrophic cardiomyopathy. Circulation 1995;92:1336-1347.
44. Hwang TH, Lee WH, Kimura A, Satoh M, Nakamura T, Kim MK et al. Early expression of a malignant phenotype of familial hypertrophic cardiomyopathy associated with a Gly716Arg myosin heavy chain mutation in a Korean family. Am J Cardiol 1998;82:1509-1513.
45. Sata M, Ikebe M. Functional analysis of the mutations in the human cardiac beta-myosin that are responsible for familial hypertrophic cardiomyopathy. J Clin Invest 1996;98:2866-2873.
46. Yamashita H, Tyska MJ, Warshaw DM, Lowey S, Trybus KM. Functional consequences of mutations in the smooth muscle myosin heavy chain at sites implicated in familial hypertrophic cardiomyopathy. J Biol Chem 2000;275: 28045-28052.
47. Blair E, Redwood C, de Jesus Oliveira M, MoolmanSmook JC, Brink P, Corfield VA et al. Mutations of the light meromyosin domain of the beta-myosin heavy chain rod in hypertrophic cardiomyopathy. Circ Res 2002;90:263-269.
48. Sweeney HL, Feng HS, Yang Z, Watkins H. Functional analyses of troponin T mutations that cause hypertrophic cardiomyopathy: insights into disease pathogenesis and troponin function. Proc Natl Acad Sci 1998;95:14406-14410.
49. Watkins H, McKenna WJ, Thierfelder L, Suk HJ, Anan R, O’Donoghue A et al. Mutations in the genes for cardiac troponin T and alpha-tropomyosin in hypertrophic cardiomyopathy. N Engl J Med 1995;332:1058-1064.
50. Niimura H, Bachinski LL, Sangwatanaroj S, Watkins H, Chudley AE, McKenna W et al. Mutations in the gene for cardiac myosinbinding protein C and late-onset familial hypertrophic cardiomyopathy. N Engl J Med 1998;338:1248-1257.
51. Charron P, Dubourg O, Desnos M, Bennaceur M, Carrier L, Camproux AC et al. Clinical features and prognostic implications of familial hypertrophic cardiomyopathy related to the cardiac myosin-binding protein C gene. Circulation 1998;97:2230-2236.
52. Erdmann J, Raible J, Maki-Abadi J, Hummel M, Hammann J, Wollnik B et al. Spectrum of clinical phenotypes and gene variants in cardiac myosin-binding protein C mutation carriers with hypertrophic cardiomyopathy. J Am Coll Cardiol 2001;38:322-330.
53. Elliott K, Watkins H, Redwood CS. Altered regulatory properties of human cardiac troponin I mutants that cause hypertrophic cardiomyopathy. J Biol Chem 2000;275: 22069-22074.
54. Olson TM, Karst ML, Whitby FG, Driscoll DJ. Myosin light chain mutation causes autosomal recessive cardiomyopathy with mid-cavitary hypertrophy and restrictive physiology. Circulation 2002;105:2337-2340.
55. Ortlepp JR, Vosberg HP, Reith S, Ohme F, Mahon NG, Schroder D et al. Genetic polymorphisms in the reninangiotensin-aldosterone system associated with expression of left ventricular hypertrophy in hypertrophic cardiomyopathy: a study of five polymorphic genes in a family with a disease causing mutation in the myosin binding protein C gene. Heart 2002;87:270-275.
56. Pfeufer A, Osterziel KJ, Urata H, Borck G, Schuster H, Wienker T et al. Angiotensin-converting enzyme and heart chymase gene polymorphisms in hypertrophic cardiomyopathy. Am J Cardiol 1996;78:362-364.
57. Swynghedauw B. Molecular mechanisms of myocardial remodeling. Physiol Rev 1999;79:215-262.
58. Casali C, d’Amati G, Bernucci P, DeBiase L, Autore C, Santorelli FM et al. Maternally inherited cardiomyopathy: clinical and molecular characterization of a large kindred harboring the A4300G point mutation in mitochondrial deoxyribonucleic acid. J Am Coll Cardiol 1999;33:1584-1589.
59. Dipchand AI, McCrindle BW, Gow RM, Freedom RM, Hamilton RM. Accuracy of surface electrocardiograms for
differentiating children with hypertrophic cardiomyopathy from normal children. Am J Cardiol 1999;83:628-630.
60. Varnava AM, Elliott PM, Mahon N, Davies MJ, McKenna WJ. Relation between myocyte disarray and outcome of hypertrophic cardiomyopathy. Am J Cardiol 2001; 88:275-279.
61. Rustin P, Lebidois J, Chretien D, Bourgeron T, Piechaud JF, Rotig A et al. Endomyocardial biopsies for early detection of mitochondrial disorders in hypertrophic cardiomyopathies. J Pediatr 1994;124:224-228.
62. Yetman AT, Hamilton RM, Benson LN, McCrindle BW. Long-term outcome and prognostic determinants in children with hypertrophic cardiomyopathy. J Am Coll Cardiol 1998;32:1943-1950.
63. Mohiddin SA, Begley D, Shih J, Fananapazir L. Myocardial bridging does not predict sudden death in children with hypertrophic cardiomyopathy but is associated with more severe cardiac disease. J Am Coll Cardiol 2000;36:2270-2278.
64. Corrado D, Basso C, Schiavon M, Thiene G. Screening for hypertrophic cardiomyopathy in young athletes. N Engl J Med 1998;339:364-369.
65. Braunwald E, Seidman CE, Sigwart U. Contemporary evaluation and management of hypertrophic cardiomyopathy. Circulation 2002;106:1312-1316.
66. Kushwaha SS, Fallon JT, Fuster V. Restrictive cardiomyopathy. N Engl J Med 1997;336:267-276.
67. Ammash NM, Seward JB, Bailey KR, Edwards WD, Tajik AJ. Clinical profile and outcome of idiopathic restrictive cardiomyopathy. Circulation 2000;101:2490-2496.
68. Chen SC, Balfour IC, Jureidini S. Clinical spectrum of restrictive cardiomyopathy in children. J Heart Lung Transplant 2001;20:90-92.
69. Gemayel C, Pelliccia A, Thompson PD. Arrhythmogenic right ventricular cardiomyopathy. J Am Coll Cardiol 2001;38:1773-1781.
70. Corrado D, Fontaine G, Marcus FI, McKenna WJ, Nava A, Thiene G et al. Arrhythmogenic right ventricular dysplasia/cardiomyopathy: need for an international registry. Circulation 2000;101:E101-E106.
71. ¶Ú¿· ∂, ∞Ó·ÛÙ·Û¿Î˘ ∞, Elliott P, McKenna W, ∆Ô‡ÙÔ˘˙·˜ ¶∫. “ªË Û˘Ì·Á¤˜” Ì˘ÔοډÈÔ: Ì›· ۯ‰fiÓ ¿ÁÓˆÛÙË Ì˘ÔηډÈÔ¿ıÂÈ·. ∂ÏÏËÓÈ΋ ∫·Ú‰ÈÔÏÔÁÈ΋ ∂ÈıÂÒÚËÛË 2002;43:236-245.
72. Conraads V, Paelinck B, Vorlat A, Goethals M, Jacobs W, Vrints C. Isolated non-compaction of the left ventricle: a rare indication for transplantation. J Heart Lung Transplant 2001;20:904-907.
73. Jenni R, Oechslin E, Schneider J, Jost CA, Kaufmann PA. Echocardiographic and pathoanatomical characteristics of isolated left ventricular non-compaction: a step towards classification as a distinct cardiomyopathy. Heart 2001;86:666-671.
∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 14-01-2003
∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 02-09-2003
¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∞Ì·Ï›· ∆ÛÈÏÈÌÈÁοÎË
∏ÚÔ‰fiÙÔ˘ 214, ¡¤· ∞ÏÈηÚÓ·ÛÛfi˜
∆.∫. 716 01, ∏Ú¿ÎÏÂÈÔ ∫Ú‹Ù˘
∞¡∞™∫O¶∏™∏REVIEW
°ÂÓÂÙÈο ÙÚÔÔÔÈË̤ӷ ÙÚfiÊÈÌ·: Èı·Ó¤˜ ÂÈÙÒÛÂȘ ÛÙËÓ ·ÏÏÂÚÁÈÔÁÔÓÈÎfiÙËÙ· ∞. µ·ÛÈÏÔÔ‡ÏÔ˘, ¡. °. ¶··‰fiÔ˘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
ÔÔ›Ô Ú¤ÂÈ Ó· ÂȉÈÒÎÂÙ·È Ô ¤ÏÂÁ¯Ô˜ Ù˘ ʇÛ˘.
∆Ô ı¤Ì· ·˘Ùfi, ¤Ú· ·fi ÙÔÓ ÁÂÓÈÎfiÙÂÚÔ Û‚·ÛÌfi
ÚÔ˜ ÙË Ê‡ÛË, ÂÚÈÏ·Ì‚¿ÓÂÈ Î·È ÙË Û¯¤ÛË Ì·˜ ÌÂ
ÙËÓ ›‰È· ÙËÓ ÙÚÔÊ‹ Ô˘ ηٷӷÏÒÓÔ˘ÌÂ. ∆· ÂÈ-
Ù‡ÁÌ·Ù· ÛÙÔÓ ÙÔ̤· Ù˘ ‚ÈÔÙ¯ÓÔÏÔÁ›·˜ ·Ú¯Èο Î·È Ù˘ ÁÂÓÂÙÈ΋˜ Ì˯·ÓÈ΋˜ ÛÙË Û˘Ó¤¯ÂÈ·, ¤¯Ô˘Ó
ʤÚÂÈ ÚÈ˙ÈΤ˜ ·ÏÏ·Á¤˜ ÛÙË ‰È·ÙÚÔÊ‹, ı¤ÙÔÓÙ·˜ Ù·
·ÎfiÏÔ˘ı· ÂÚˆÙ‹Ì·Ù·: Ú¤ÂÈ Ó· ηٷӷÏÒÓÔÓÙ·È
ÁÂÓÂÙÈο ÙÚÔÔÔÈË̤ӷ ÙÚfiÊÈÌ·; À¿Ú¯ÂÈ Ë ‰˘Ó·-
ÙfiÙËÙ· ÂÓË̤ڈÛ˘ ÁÈ’ ·˘Ù¿ Ù· ÙÚfiÊÈÌ·; ¶ÔÈ· Ú¤-
ÂÈ Ó· Â›Ó·È Ë ÁÂÓÈÎfiÙÂÚË ı¤ÛË ÙÔ˘ È·ÙÚÈÎÔ‡ ÎfiÛÌÔ˘
Î·È Ò˜ ÌÔÚ› Ó· Û˘Ì‚Ô˘Ï‡ÂÈ ÙÔ˘˜ ·ÛıÂÓ›˜ Û¯Â-
ÙÈο Ì ·˘Ùfi ÙÔ ı¤Ì·; ™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ·Ó·-
ÛÎfiËÛ˘ Â›Ó·È Ë ÚÔÛ¿ıÂÈ· ÛÊ·ÈÚÈ΋˜ ÚÔÛ¤Á-
ÁÈÛ˘ ÙÔ˘ ı¤Ì·ÙÔ˜ ÙˆÓ ÁÂÓÂÙÈο ÙÚÔÔÔÈË̤ӈÓ
ÙÚÔʛ̈Ó, ÂÚÈÁÚ¿ÊÔÓÙ·˜ ηٿ ÙÔ ‰˘Ó·ÙfiÓ ÏËÚ¤-
ÛÙÂÚ· Ù· ÏÂÔÓÂÎÙ‹Ì·Ù· Î·È ÙȘ ·‰˘Ó·Ì›Â˜ ÙÔ˘˜.
∞ӷʤÚÔÓÙ·˜ ÙȘ ‰˘ÓËÙÈΤ˜ ÂÈÙÒÛÂȘ Ô˘ ÌÔÚ› Ó· ¤¯Ô˘Ó Ù¤ÙÔȘ ÙÚÔʤ˜ ÛÙËÓ ·ÏÏÂÚÁÈÔÁÔÓÈÎfiÙËÙ·, ÚÔÙ›ÓÔÓÙ·È, ›Û˘, Èı·Ó¤˜ ÚÔÛÂÁÁ›ÛÂȘ ÁÈ·
ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ·Ó·ÊÂÚfiÌÂÓˆÓ ·ÓËÛ˘¯ÈÒÓ
Ô˘ ‰ËÌÈÔ˘ÚÁÔ‡Ó.
§¤ÍÂȘ ÎÏÂȉȿ: ·ÏÏÂÚÁ›·, ÙÚfiÊÈÌ·, ÁÂÓÂÙÈ΋ ÙÚÔÔÔ›ËÛË.
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.
∞ÏÏÂÚÁÈÔÏÔÁÈÎfi ∆Ì‹Ì·, µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ
¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó·
Key words: allergy, food, genetic modification.
›‰Ô˘˜ ÂÍ·ÚÙ¿Ù·È ÙfiÛÔ ·fi ÙË Ê˘ÛÈ΋ ÔÚ›· fiÛÔ Î·È ·fi ÙËÓ Ù¯ÓÔÏÔÁÈ΋ ÚfiÔ‰Ô.
µÚÈÛÎfiÌ·ÛÙ ÛÙÔ Ì¤ÛÔ Ì›·˜ ÈÛÙÔÚÈ΋˜ ÌÂÙ¿‚·Û˘ ÚÔ˜ ÙË ‚ÈÔÙ¯ÓÔÏÔÁÈ΋ ÂÔ¯‹. ∏ Û‡Á¯ÚÔÓË
Ù¯ÓÔÏÔÁÈ΋ ·ӿÛÙ·ÛË ¤¯ÂÈ ÙÚÂȘ ΢ڛˆ˜ ·ÎÚÔÁˆÓÈ·›Ô˘˜ Ï›ıÔ˘˜: ÙËÓ ÏËÚÔÊÔÚÈ΋, ÙË Ó·ÓÔÙ¯ÓÔÏÔÁ›· Î·È ÙË ÁÂÓÂÙÈ΋ Ì˯·ÓÈ΋. ∆· ̤۷ ·˘Ù¿ ÌÔÚÔ‡Ó Ó· ·ÏÏ¿ÍÔ˘Ó ÙÔÓ ÎfiÛÌÔ Û ÙÂÚ¿ÛÙÈÔ ‚·ıÌfi,
Department of Allergology, 2nd Paediatric Clinic of the University of Athens “P. & A. Kyriakou” Children’s Hospital, Athens
Ì ·ÔÙ¤ÏÂÛÌ· Ó· ·Ó·Ì¤ÓÂÙ·È ÚÈ˙È΋ Î·È Ë ·ÏÏ·Á‹
ÛÙÔ ·ÓıÚÒÈÓÔ Â›‰Ô˜ (1). ∏ ÈηÓfiÙËÙ· ÙÔ˘ ·ÓıÚÒÔ˘ Ó· ÂÂÌ‚·›ÓÂÈ ÛÙËÓ
ÔÚ›· ÂͤÏÈ͢ ÙˆÓ ÂȉÒÓ Î·È Ó· ‰ËÌÈÔ˘ÚÁ› ÙË ‰È΋ ÙÔ˘ “¡¤· °¤ÓÂÛË”, ÂÚÈÔÚÈ˙fiÙ·Ó Ì¤¯ÚÈ ÚfiÛÊ·Ù· ·fi Ù· fiÚÈ· Ô˘ ¤ıÂÙÂ Ë ÌÔÓ·‰ÈÎfiÙËÙ· Î·È Ë ‰È·ÊÔÚÂÙÈÎfiÙËÙ· ÙˆÓ ÂȉÒÓ. OÈ Ó¤Â˜, fï˜, Ù¯ÓÔÏÔÁ›Â˜ ÂÈÙÚ¤Ô˘Ó ÛÙÔ˘˜ ÂÈÛÙ‹ÌÔÓ˜ Ó· ¯ÂÈÚÈÛÙÔ‡Ó
ÙÔÓ Ê˘ÛÈÎfi ÎfiÛÌÔ ÛÙÔ Â›Â‰Ô Ô˘ ·ÔÙÂÏ› ÙË ‚¿ÛË Ù˘ ÂͤÏÈ͢: ÙÔ ÁÔÓȉȷÎfi (2).
∏ ÁÂÓÂÙÈ΋ Ì˯·ÓÈ΋ Â›Ó·È Ë ‰È·‰Èηۛ· ηٿ ÙËÓ
ÔÔ›· Ù· ÁÔÓ›‰È· ·ÔÌÔÓÒÓÔÓÙ·È, ·Ó·ÁÓˆÚ›˙ÔÓÙ·È, ·Ó·Û˘Ó‰˘¿˙ÔÓÙ·È Î·È ÌÂٷʤÚÔÓÙ·È Ù¯ÓÔÏÔÁÈο ·fi ¤Ó·Ó ÔÚÁ·ÓÈÛÌfi Û ¤Ó·Ó ¿ÏÏÔ. ™‹ÌÂÚ·, Ô ÁÂÓÂÙÈÎfi˜ ÎÒ‰Èη˜ ÂÓfi˜ ÌÂÁ¿ÏÔ˘ ·ÚÈıÌÔ‡ ÂȉÒÓ ¤¯ÂÈ ·ÔÎÚ˘ÙÔÁÚ·ÊËı›. ∏ ÁÂÓÂÙÈ΋ Ì˯·ÓÈ΋ οÓÂÈ
‰˘Ó·Ù‹ ÙËÓ ·ÓÙ·ÏÏ·Á‹ ÁÂÓÂÙÈÎÔ‡ ˘ÏÈÎÔ‡ ÌÂٷ͇
ÔÚÁ·ÓÈÛÌÒÓ Ô˘ ‰ÂÓ ı· ÌÔÚÔ‡Û·Ó Ó· ·Ó··Ú·-
¯ıÔ‡Ó ÌÂٷ͇ ÙÔ˘˜ Ì ¿ÏÏÔ ÙÚfiÔ. ∆· ÙÂÏÂ˘Ù·›· 20
¯ÚfiÓÈ· ·ÔÌÔÓÒÓÔÓÙ·È ÁÔÓ›‰È· ·fi οÔÈÔÓ ˙ˆÓÙ·Ófi
ÔÚÁ·ÓÈÛÌfi Î·È ÂÈÛ¿ÁÔÓÙ·È Û ¿ÏÏÔÓ Ì ٤ÙÔÈÔ ÙÚfiÔ ÒÛÙ ӷ Â›Ó·È ÏÂÈÙÔ˘ÚÁÈο, Û¿˙ÔÓÙ·˜ ¤ÙÛÈ ÙÔÓ ÊÚ·ÁÌfi ·ÓÙ·ÏÏ·Á‹˜ ÁÂÓÂÙÈÎÔ‡ ˘ÏÈÎÔ‡ ÌÂٷ͇ ‰È·ÊÔÚÂÙÈ-
ÎÒÓ ÂȉÒÓ (3). ∂Ô̤ӈ˜, ÚÔ·ÙÔ˘Ó ÔÚÁ·ÓÈÛÌÔ›
Ô˘, ÂÎÙfi˜ ·fi ÙȘ ‰ÈΤ˜ ÙÔ˘˜ ÚˆÙ½Ó˜, ÂÎÊÚ¿˙Ô˘Ó Î·È ÂΛӘ ÙÔ˘ ÁÔÓȉ›Ô˘ Ô˘ ÂÈÛ‹¯ıË.
ªÂ ÙÔÓ ÙÚfiÔ ·˘Ùfi, ÌÔÚԇ̠ӷ ηٷÓÔ‹ÛÔ˘Ì ÙË ‰Ú¿ÛË ‰È·ÊfiÚˆÓ ÁÔÓȉ›ˆÓ Û ÂÚ¢ÓËÙÈÎfi ›-
‰Ô, ÂÈÛ¿ÁÔÓÙ·˜ ‹ ·Ê·ÈÚÒÓÙ·˜ ·˘Ù¿ Û ÂÈÚ·Ì·-
Ùfi˙ˆ·. ∆Ô Â‡ÚÔ˜ ÙˆÓ Ê·Ú̷΢ÙÈÎÒÓ ÂÊ·ÚÌÔÁÒÓ
Â›Ó·È ÌÂÁ¿ÏÔ, ·ÊÔ‡ ÔÏÏ¿ Ê¿Ú̷η ‹ ÂÌ‚fiÏÈ·, Ù·
·ÔηÏÔ‡ÌÂÓ· ·Ó·Û˘Ó‰˘·Ṳ̂ӷ, ÚÔ¤Ú¯ÔÓÙ·È
·fi ÁÂÓÂÙÈ΋ ÙÚÔÔÔ›ËÛË ‚·ÎÙËÚ›ˆÓ, ÒÛÙ ӷ ·Ú¿ÁÔ˘Ó Ô˘Û›Â˜ ÁÈ· ·ÓıÚÒÈÓË ¯Ú‹ÛË, fiˆ˜ ÈÓÙÂÚÊÂÚfiÓË, ÈÓÛÔ˘Ï›ÓË ‹ ·˘ÍËÙÈ΋ ÔÚÌfiÓË (3).
¶ÈÔ ¿ÌÂÛ˜ ıÂڷ¢ÙÈΤ˜ ÂÊ·ÚÌÔÁ¤˜ ‚Ú›ÛÎÔ-
ÓÙ·È Û ÂͤÏÈÍË, ¤ÙÔÈ̘ Ó· ‰ÒÛÔ˘Ó Ï‡ÛÂȘ Û ÚÔ‚Ï‹Ì·Ù· Ô˘ ÂϤÁ¯ÔÓÙ·È ÁÔÓȉȷο ̤ۈ Ù˘ ÁÂÓÂÙÈ΋˜ ıÂڷ›·˜. ∆Ô 1984 ·Ó·Ê¤ÚıËΠÁÈ· ÚÒÙË ÊÔÚ¿ Ë ¿ÌÂÛË Î·È ÛÙ·ıÂÚ‹ ÌÂÙ·ÊÔÚ¿ ÁÔÓȉ›ˆÓ ÛÂ Ê˘Ù¿ (4,5). ∆ËÓ ÙÂÏÂ˘Ù·›· ‰ÂηÂÙ›· Ë ·Ó¿Ù˘ÍË ‹Ù·Ó Ú·Á‰·›·, fiÙ·Ó ÔÏϤ˜ ÂÙ·ÈÚ›˜, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÙË ÁÂÓÂÙÈ΋ Ì˯·ÓÈ΋, ηٿÊÂÚ·Ó Ó· ÂÈÛ·Á¿ÁÔ˘Ó Í¤Ó· ÁÔÓ›‰È· Û ηÏÏȤÚÁÂȘ ÛËÌ·ÓÙÈÎÒÓ ÙÚÔʛ̈Ó, fiˆ˜
ÙÔ Î·Ï·ÌfiÎÈ Î·È Ë ÛfiÁÈ· (6). ¶ÚfiÛÊ·Ù·, ÁÂÓÂÙÈο ÙÚÔÔÔÈË̤ӷ ÙÚfiÊÈÌ·
¿Ú¯ÈÛ·Ó Ó· ÂÌÊ·Ó›˙ÔÓÙ·È Û ÔÏÏ¿ ›‰Ë ¢Ú›·˜
ηٷӿψÛ˘, ·ÔÙÂÏÒÓÙ·˜ ϤÔÓ Ì›· Ú·ÁÌ·ÙÈ-
ÎfiÙËÙ· Ô˘ ··Û¯ÔÏ› fi¯È ÌfiÓÔ ÙÔ˘˜ ÂÈÛÙ‹ÌÔÓ˜, ·ÏÏ¿ Î·È ÙÔ˘˜ ηٷӷψ٤˜.
°ÂÓÂÙÈο ÙÚÔÔÔÈË̤ӷ ÙÚfiÊÈÌ· O fiÚÔ˜ “ÁÂÓÂÙÈο ÙÚÔÔÔÈË̤ӷ ÙÚfiÊÈÌ·” (°∆∆) ·Ó·Ê¤ÚÂÙ·È Û ÙÚfiÊÈÌ· Ô˘ ·Ú·Û΢¿ÛÙË-
Î·Ó Ì ÙË ¯Ú‹ÛË ÙˆÓ Ì¤ÛˆÓ Ô˘ ·Ú¤¯ÂÈ Ë ÌÔÚȷ΋ ‚ÈÔÏÔÁ›·, ÁÈ·
Ì ÛÎÔfi Ó· ·Ô‰ÔıÔ‡Ó Û ·˘Ù¤˜ οÔȘ ÂÈı˘ÌËÙ¤˜ ȉÈfiÙËÙ˜, fiˆ˜
ıÚÂÙÈ΋ ·Í›· ‹ ·ÓıÂÎÙÈÎfiÙËÙ· Û ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜ (¶›Ó·Î·˜ 1). ∏ ‰È·Ù‹ÚËÛË ÙˆÓ ÂÈı˘ÌËÙÒÓ È‰ÈÔÙ‹ÙˆÓ ·Ú·‰ÔÛȷο ÁÈÓfiÙ·Ó ·fi ÁÂÓÈ¿ Û ÁÂÓÈ¿ ̤ۈ Ù˘ ·Ó··Ú·ÁˆÁ‹˜, Ì›· ‰È·‰Èηۛ·
Ô˘ ‰ÂÓ ÌÔÚÔ‡ÛÂ, fï˜, Ó· ÂÁÁ˘Ëı› ÙËÓ ·ÎÚ›‚ÂÈ· Ù˘ ÌÂÙ·‚›‚·Û‹˜ ÙÔ˘˜, ÂÓÒ Ù·˘Ùfi¯ÚÔÓ· ‹Ù·Ó
ȉȷ›ÙÂÚ· ¯ÚÔÓÔ‚fiÚ·. ªÂ ÙË ÁÂÓÂÙÈ΋ Ì˯·ÓÈ΋
ÌÔÚÔ‡Ó ‰˘ÓËÙÈο Ó· ·Ú·Û΢·ÛÙÔ‡Ó ÚÔ˚fiÓÙ·
ÌÂ Û˘ÁÎÂÎÚÈ̤Ó˜ ȉÈfiÙËÙ˜, ÁÚ‹ÁÔÚ· Î·È Ì ÂÍ·ÈÚÂÙÈ΋ ·ÎÚ›‚ÂÈ·. °È· ·Ú¿‰ÂÈÁÌ·, ¤Ó· ÁÔÓ›‰ÈÔ ˘Â‡ı˘ÓÔ ÁÈ· ÙËÓ ·ÓÔ¯‹ ÂÓfi˜ Ê˘ÙÔ‡ ÛÙËÓ ÍËÚ·Û›· ÌÔÚ› Ó· ÂÈÛ·¯ı› ÛÂ Ê˘Ùfi ‰È·ÊÔÚÂÙÈÎÔ‡ ›‰Ô˘˜, ¤ÙÛÈ
¶›Ó·Î·˜ 1. °ÂÓÂÙÈο ÙÚÔÔÔÈË̤ӷ ÙÚfiÊÈÌ· (ÂÓ‰ÂÈÎÙÈÎfi˜ ›Ó·Î·˜)
∆ÚfiÊÈÌÔ°ÔÓ›‰ÈÔ¶ËÁ‹™ÎÔfi˜∫ˆ‰ÈÎfi˜
∫·Ï·ÌfiÎÈ∆ÚÔÔÔÈË̤ÓÔ
Bacillus thuringiensis, ∞ÓıÂÎÙÈÎfiÙËÙ· ÛÙÔ ˙È˙¿ÓÈÔªO¡ 863
Cry3Bb1, NptII Escherichia coli Coleopteran Î·È ÛÙ· transposon, Tn5·ÌÈÓÔÁÏ˘ÎÔ˙ȉÈο ·ÓÙÈ‚ÈÔÙÈο
∫·Ï·ÌfiÎȶڈÙ½ÓË
Bacillus thuringiensis, ∞ÓıÂÎÙÈÎfiÙËÙ· ÛÂ1507
Cry1F, ƒ∞∆ Streptomyces Û˘ÁÎÂÎÚÈ̤ӷ ÏÂȉfiÙÂÚ· viridochromogenes
∫·Ï·ÌfiÎÈ5-EPSPS
∫·Ï·ÌfiÎȃ∞∆
Agrobacterium sp, ∞ÓÔ¯‹ ÛÙÔ ÁÏ˘ÎÔ˙˘ÏȈ̤ÓÔ¡∫603 ¿Ï˘ÛÔ˜ CP4¯ÔÚÙ·Ú›‰ÈÔ
Bacillus amyloliquefaciens, ™ÙÂÈÚfiÙËÙ· ·Ó‰Úfi˜MS6 streptomyces hygroscopicus
ƒ‡˙ȃ∞∆ Streptomyces hygroscopicus ∞ÓÔ¯‹ ÛÙÔ Herbicide glufosinate LLRICE E06, LLRICE E62
¶ÂfiÓÈS-·‰ÂÓÔÛ˘ÏÌÂıÈÔÓ›ÓË E. coli ∫·ı˘ÛÙ¤ÚËÛË Ù˘ ·ÔÛ‡ÓıÂÛ˘∞ Î·È µ ˘‰ÚÔÏ¿ÛËbacteriophage T3ÙÔ˘ ÊÚÔ‡ÙÔ˘ ÏfiÁˆ Ì›ˆÛ˘ Ù˘
Û‡ÓıÂÛ˘ ·Èı˘ÏÂÓ›Ô˘
·ÏÏÂÚÁÈÔÁfiÓÔ ‹ fi¯È. ™ÙÔ Ï·›ÛÈÔ ·˘Ùfi Ï·Ì‚¿ÓÔÓÙ·È, ›Û˘, ˘’ fi„ÈÓ Ù· ÎÔÈÓ¿ ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ·ÏÏÂÚÁÈÔÁfiÓˆÓ ÚˆÙÂ˚ÓÒÓ, fiˆ˜ ÙÔ ÌÔÚÈ·Îfi ‚¿ÚÔ˜. ™ÙË Û˘Ó¤¯ÂÈ·, Ë ÚˆÙÂ˚ÓÈ΋ ·ÏÏËÏÔ˘¯›· Û˘ÁÎÚ›ÓÂÙ·È
Ì ̛· ‚¿ÛË ‰Â‰Ô̤ӈÓ, fiÔ˘ ˘¿Ú¯Ô˘Ó ηٷÁÂÁÚ·Ì̤Ó˜ fiϘ ÔÈ ·ÏÏÂÚÁÈÔÁÔÓÈΤ˜ ·ÏÏËÏÔ˘¯›Â˜, ̤¯ÚÈ ÙÔ Ì‹ÎÔ˜ ÙˆÓ ÔÎÙÒ ·ÌÈÓÔͤˆÓ.
ŒÓ· ‰Â‡ÙÂÚÔ, ÛËÌ·ÓÙÈÎfi ÚÔ˜ ÂͤٷÛË, ÛÙÔÈ-
¯Â›Ô Â›Ó·È Ë ÛÙ·ıÂÚfiÙËÙ· Ù˘ ÚˆÙ½Ó˘ ÛÙËÓ ÂÂÍÂÚÁ·Û›·. OÈ Û˘Ó‹ıÂȘ ·ÏÏÂÚÁÈÔÁfiÓ˜ ÚˆÙ½Ó˜ Â›Ó·È ÛÙ·ıÂÚ¤˜ ÛÙË ıÂÚÌÔÎÚ·Û›· Î·È ÛÂ Û˘Óı‹Î˜
fiÍÈÓÔ˘ pH, Ô˘ ÚÔÛÔÌÔÈ¿˙Ô˘Ó ·˘Ù¤˜ ÙÔ˘ ÛÙÔÌ¿¯Ô˘. ∂¿Ó Ë ÚˆÙ½ÓË ÂÌÊ·ÓÈÛÙ› ·ÛÙ·ı‹˜ Û ·˘Ù¤˜ ÙȘ Û˘Óı‹Î˜, ¤¯ÂÈ ÌÈÎÚfiÙÂÚË Èı·ÓfiÙËÙ· Ó· ›ӷÈ
·ÏÏÂÚÁÈÔÁÔÓÈ΋.
∂ÓÙÔ‡ÙÔȘ, ÛÙËÓ ÂÚ›ÙˆÛË Ô˘, ÂÓÒ ‰ÂÓ ˘¿Ú¯ÂÈ ÔÌÔÏÔÁ›· ·ÏÏËÏÔ˘¯›·˜, Ë ÚˆÙ½ÓË Â›Ó·È ÛÙ·ıÂÚ‹ ÛÙËÓ ÂÂÍÂÚÁ·Û›·, ‰ÂÓ ÌÔÚԇ̠ӷ ·ÔÎÏ›ÛÔ˘Ì ÙÔ ÂӉ¯fiÌÂÓÔ ·ÏÏÂÚÁ›·˜ ηÈ, Ì¿ÏÈÛÙ·, ‰ÂÓ
ÌÔÚԇ̠ӷ ÚÔÛ‰ÈÔÚ›ÛÔ˘ÌÂ Î·È ÔÌ¿‰· ·ÙfïÓ
Ô˘ ÌÔÚ› Ó· Â›Ó·È Â˘¿ÏˆÙË ÛÙËÓ Èı·Ó‹ “·ÏÏÂÚ-
ÁÈÔÁfiÓÔ” ÚˆÙ½ÓË.
∞ÓÙ›ıÂÙ·, Â¿Ó ˘¿Ú¯ÂÈ ÔÌÔÏÔÁ›· ·ÏÏËÏÔ˘¯›·˜
Ì ÁÓˆÛÙfi ·ÏÏÂÚÁÈÔÁfiÓÔ ‹ ÙÔ ÁÔÓ›‰ÈÔ Ô˘ ÚÔ¤Ú-
¯ÂÙ·È ·fi ÁÓˆÛÙfi ·ÏÏÂÚÁÈÔÁfiÓÔ, ÌÔÚԇ̠ӷ
ÚÔÛ‰ÈÔÚ›ÛÔ˘ÌÂ, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÔÚÔ‡˜ ·ÛıÂÓÒÓ, ηٿ fiÛÔ Ë Ó¤· ÚˆÙ½ÓË ı· ·ÓÙȉڿÛÂÈ Ì ·˘ÙÔ‡˜, Ì ÙȘ Ù¯ÓÈΤ˜ ELISA ‹ RAST inhibition.
∂¿Ó Ë ·ÓÙ›‰Ú·ÛË Â›Ó·È ·ÚÓËÙÈ΋, ÙfiÙ Á›ÓÔÓÙ·È ‰ÂÚÌ·ÙÈΤ˜ ‰ÔÎÈ̷ۛ˜ ‹ ·ÎfiÌ· Î·È ÚÔÎÏ‹ÛÂȘ Û ¢-
¿ÙÔÌ·. ∞Ó Û ÔÔÈ·‰‹ÔÙ ʿÛË Ù˘ ‰È·‰Èηۛ·˜ ÏËÊıÔ‡Ó ıÂÙÈο ·ÔÙÂϤÛÌ·Ù·, ÚÔÙ›ÓÂÙ·È Ë Û‹Ì·ÓÛË ÙÔ˘ ÂÚȯÔ̤ÓÔ˘ Ù˘ ÙÚÔÊ‹˜ ÚÈÓ ·˘Ù‹ ÚÔˆıËı› ÛÙËÓ ·ÁÔÚ¿.
∆Ô Û˘ÁÎÂÎÚÈ̤ÓÔ ÚˆÙfiÎÔÏÏÔ ·ÎÔÏÔ˘ı‹ıËÎÂ
ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô Ù˘ ·ÏÏÂÚÁÈÔÁÔÓÈÎfiÙËÙ·˜ Ù˘ ηÏÏȤÚÁÂÈ·˜ ÛfiÁÈ·˜, ÛÙËÓ ÔÔ›· ¤¯ÂÈ ÚÔÛÙÂı› ÙÔ
ÁÔÓ›‰ÈÔ 2S ÙÔ˘ ‚Ú·˙ÈÏÈ¿ÓÈÎÔ˘ ÊÈÛÙÈÎÈÔ‡. ™Â ÌÂϤÙË
Ô˘ ‰ËÌÔÛ›Â˘Û ÙÔ “New England Journal of Medicine” ÙÔ 1996, ‰È·ÈÛÙÒıËΠfiÙÈ Ë ·ÏÏÂÚÁÈÔ-
ÁÔÓÈÎfiÙËÙ· ÌÂٷʤÚıËΠÛÙËÓ ÙÚÔÔÔÈË̤ÓË ÛfiÁÈ·, ·ÊÔ‡ ÛÙËÓ in vitro ·ÓÙ›‰Ú·ÛË ‚Ú¤ıËÎ·Ó ıÂÙÈο
·ÔÙÂϤÛÌ·Ù· Û 8 ·fi ÙÔ˘˜ 9 ÔÚÔ‡˜ Ô˘ ·Ó‹Î·Ó Û ¢·›ÛıËÙÔ˘˜ ·ÛıÂÓ›˜ (18). ∏ ·Ó·Î¿Ï˘„Ë ·˘Ù‹ ›¯Â Û·Ó ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·Ó·ÛÙÔÏ‹ Ù˘ ÂÌÊ¿ÓÈÛ˘
ÙÔ˘ Û˘ÁÎÂÎÚÈ̤ÓÔ˘ ÚÔ˚fiÓÙÔ˜ ÛÙËÓ ·ÁÔÚ¿ (2,14). ∂Ô̤ӈ˜, Ô Î›Ó‰˘ÓÔ˜ ·ÏÏÂÚÁÈÎÒÓ ·ÓÙȉڿÛÂˆÓ ÌÂÈÒÓÂÙ·È, ·Ó ‰ÂÓ ÂÎÌˉÂÓ›˙ÂÙ·È, Ì ηٿÏÏËÏÔ˘˜ ÂÚÁ·ÛÙËÚÈ·ÎÔ‡˜ ¯ÂÈÚÈÛÌÔ‡˜ Î·È Ì ÙË Û‹Ì·ÓÛË ÙˆÓ °∆∆ Ô˘ ΢ÎÏÔÊÔÚÔ‡Ó ÛÙÔ ÂÌfiÚÈÔ. ∏ ‰È¿‰ÔÛË ÙˆÓ ÁÂÓÂÙÈο ÙÚÔÔÔÈËÌ¤ÓˆÓ ÙÚÔʛ̈Ó
™‹ÌÂÚ·, ¤Ó·˜ ÙÂÚ¿ÛÙÈÔ˜ ·ÚÈıÌfi˜ ÂȉÒÓ Ô˘ ÂÚÈÏ·Ì‚¿ÓÂÈ ÙȘ ÛËÌ·ÓÙÈÎfiÙÂÚ˜ ‚·ÛÈΤ˜ ÙÚÔʤ˜, ¤¯ÂÈ ÙÚÔÔÔÈËı› ÁÂÓÂÙÈο Î·È Î˘ÎÏÔÊÔÚ› ÛÙËÓ
¶ËÁ‹ ÁÔÓȉ›Ô˘ (·ÏÏÂÚÁÈÔÁfiÓÔ) ¡·È
ŒÏÂÁ¯Ô˜ IgE (ELISA, RAST inh.)
¢ÂÚÌ·ÙÈΤ˜ ‰ÔÎÈ̷ۛ˜
¶ÚÔÎÏ‹ÛÂȘ
¡·È ‘O¯È ‘O¯È ‘O¯È (-)
(-) (+) (+) (+)
™‹Ì·ÓÛË ÂÚȯÔ̤ÓÔ˘
™Ù·ıÂÚfiÙËÙ· ÂÂÍÂÚÁ·Û›·˜
∞Ó·ÊÔÚ¿ ÛÙÔÓ ˘Â‡ı˘ÓÔ ÔÚÁ·ÓÈÛÌfi
·ÁÔÚ¿. ∆Ô 30% ÙÔ˘ ηϷÌÔÎÈÔ‡ Î·È ÙÔ 50% Ù˘
ÛfiÁÈ·˜ Ô˘ ·Ú¿ÁÂÙ·È Î·È Î·Ù·Ó·ÏÒÓÂÙ·È ÛÙȘ
∏.¶.∞. Â›Ó·È ÁÂÓÂÙÈο ÙÚÔÔÔÈË̤ÓÔ, ÂÓÒ ÂÚ›Ô˘
ÙÔ 75% ÙˆÓ ÚÔ˚fiÓÙˆÓ Ô˘ ˘¿Ú¯Ô˘Ó ÛÙ· Ú¿ÊÈ·
Ù˘ ·ÌÂÚÈηÓÈ΋˜ ·ÁÔÚ¿˜ ÂÚÈÏ·Ì‚¿ÓÂÈ Î·È ÁÂÓÂÙÈ-
ο ÙÚÔÔÔÈË̤Ó˜ ÔÈÎÈϛ˜ (1,26).
™ÙȘ ∏.¶.∞., Ë ·Ô‰Ô¯‹ ÙˆÓ °∆∆ ¤ÁÈÓ ÈÔ Â‡ÎÔ-
Ï· ·’ fiÙÈ ÛÙËÓ ∂˘ÚÒË, fiÔ˘ ÙÔ 1996, fiÙ·Ó ¤ÁÈÓÂ
Ë ÚÒÙË Ì·˙È΋ ÂÈÛ·ÁˆÁ‹ ÁÂÓÂÙÈο ÙÚÔÔÔÈË̤-
Ó˘ ÛfiÁÈ·˜, Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó ÔÚÁ·ÓˆÌ¤Ó˜ ÂÎ-
ÛÙÚ·Ù›˜ ÂÓË̤ڈÛ˘ ÙˆÓ Î·Ù·Ó·ÏˆÙÒÓ Î·È È¤-
ÛÂˆÓ ÚÔ˜ ÙȘ ÔÏÈÙÈΤ˜ ËÁÂۛ˜ (19).
∏ ∂ÏÏ¿‰·, ÙÔ 1999, Ì·˙› Ì ٤ÛÛÂÚȘ ·ÎfiÌ· ¢-
Úˆ·˚Τ˜ ¯ÒÚ˜, ÚfiÙÂÈÓ ¤Ó· ‰ÈÂÙ¤˜ ÌÔÚ·ÙfiÚÈ-
Ô˘Ì, Ì ÙÔ ÔÔ›Ô ·ÔÊ·Û›ÛÙËÎÂ Ë ·Ó·ÛÙÔÏ‹ ÙˆÓ
ÂÁÎÚ›ÛÂˆÓ Ó¤ˆÓ ÁÂÓÂÙÈο ÙÚÔÔÔÈËÌ¤ÓˆÓ ÚÔ˚fi-
ÓÙˆÓ, ̤¯ÚȘ fiÙÔ˘ ÂÊ·ÚÌÔÛÙ› ÓÔÌÔıÂÛ›· Ô˘ Ó·
ÔÚ›˙ÂÈ ··ÈÙ‹ÛÂȘ ÁÈ· ÙË Û‹Ì·ÓÛË ÙˆÓ °∆∆ Î·È ÙË
‰ÈÂÍÔ‰È΋ ¤Ú¢ӷ ÙˆÓ ÚÔ˚fiÓÙˆÓ ·˘ÙÒÓ (30). ∞fi ÙËÓ ÂÈÛÙËÌÔÓÈ΋ ÛÎÔÈ¿, ÔÏÏ¿ ÂÚˆÙ‹Ì·-
Ù· ·Ú·Ì¤ÓÔ˘Ó ·Ó·¿ÓÙËÙ·.
Ó· ·ÔÙÂϤÛÔ˘Ó ÛˆÙ‹ÚÈ· χÛË ÁÈ· ·ÛıÂÓ›˜ Ì ÙÚÔ-
ÊÈ΋ ·ÏÏÂÚÁ›·, ÂÓÒ ÌÔÚ› Ó· ·Ô‰ÂȯıÔ‡Ó ÔϤ-
ıÚÈ· ÁÈ· ¿ÏÏÔ˘˜. ∆· ‰Â‰Ô̤ӷ Ô˘ ·Ó·Ê¤ÚıËηÓ,
ÂÌÊ·ÓÒ˜ ‰ÂÓ ‰ÈηÈÔÏÔÁÔ‡Ó Û˘Ó·ÈÛıËÌ·ÙÈΤ˜ ·ÓÙÈ-
‰Ú¿ÛÂȘ, ÔÈ Ôԛ˜ Ôχ Û˘¯Ó¿ ·Ú·ÙËÚÔ‡ÓÙ·È Ùfi-
ÛÔ ·fi Ù· ̤۷ Ì·˙È΋˜ ÂÓË̤ڈÛ˘ fiÛÔ Î·È ·fi ÂÈÛÙ‹ÌÔÓ˜. ∏ ÈÛÔÚÚÔË̤ÓË Î·È ¯ˆÚ›˜ ˘ÂÚ‚Ô-
Ϥ˜ ÚÔÛ¤ÁÁÈÛË ÙˆÓ ÂȉÈÎÒÓ ÌÔÚ› Ó· ·Ô‚› Ô-
χ ¯Ú‹ÛÈÌË, ·Ú¤¯ÔÓÙ·˜ ˘Â‡ı˘ÓË Âη›‰Â˘ÛË Î·È
ÂÓË̤ڈÛË ÛÙÔ ÎÔÈÓfi.
µÈ‚ÏÈÔÁÚ·Ê›·
1. ¶··‰fiÔ˘ÏÔ˜ ¡°. °ÂÓÂÙÈο ÙÚÔÔÔÈË̤Ó˜ ÙÚÔʤ˜: ÂÈÙÒÛÂȘ ÛÙËÓ ·ÏÏÂÚÁÈÔÁÔÓÈÎfiÙËÙ·. ™ÙÔ: ∆Ô ·ÏÏÂÚÁÈÎfi ·È‰› ÛÙËÓ ÎÏÈÓÈ΋ Ú¿ÍË. ¶ÔÏÂÌÈÎfi ªÔ˘ÛÂ›Ô ∞ıËÓÒÓ; 2001.
2. Rifkin J, editor. Playing ecological roulette with mother nature’s designs. The Biotech Century: Harnessing the gene and remaking the world (Tarcher/Putnam). Vol. IX; 1998.
3. Burke D. Why all the fuss about genetically modified food? Much depends on who benefits. BMJ 1998;316:1845-1846.
4. Horsch RB, Fraley RT, Rogers SG, Sanders PR, Lloyd A, Hoffmann N. Inheritance of functional foreign genes in plants. Science 1984;223:496-498.
5. De Block M, Herrera-Estrella L, Van Montagu M, Schell J, Zambryski P. Expression of foreign genes in regenerated plants and their progeny. EMBO J 1984;3:1681-1689.
6. Massey R. Rachel’s environment and health news. In: Biotech: the Basics. Part 1. #716; 2001.
7. Whitman DB. Genetically modified foods: harmful or helpful. Cambridge Scientific Abstracts; 2000. http://www.csa.com/ hottopics/gmfood/oview.html.
8. Tester M. Seeking clarity in the debate over the safety of GM foods. Nature 1999;402:575.
9. Hallman WK, Metcalfe J. Public perceptions of agricultural biotechnology: a survey of New Jersey residents. Genetic Engineering News 1995;15.
10. Sommer A. Vitamin A deficiency disorders: origins of the problem and approaches to it’s control. Baltimore: The Johns Hopkins University Bloomberg School of Public Health; 2001.
11. ¶··ÓÈÎÔÏ¿Ô˘ °. ™‡Á¯ÚÔÓË ‰È·ÙÚÔÊ‹ Î·È ‰È·ÈÙÔÏÔÁ›·: ‰›·ÈÙ˜ ÁÈ· fiϘ ÙȘ ·ı‹ÛÂȘ. 4Ë ¤Î‰. ∞ı‹Ó·: ∂ΉfiÛÂȘ £˘Ì¿ÚÈ; 1997. ÛÂÏ. 615-629.
12. Shiva V. The “Golden Rice” Hoax. When public relations replaces science.
13. Kessler DA, Taylor MR, Maryanski JH, Flamm EL, Kahl LS. The safety of foods developed by biotechnology. Science 1992;256:1747-1749, 1832.
14. Stewart CN Jr, Richards HA 4th, Halfhill MD. Transgenic plants and biosafety: science, misconceptions and public perceptions. Biotechniques 2000;29:832-836, 838-843.
15. Ingham J, Moore T. GM trials to find medicine raise new ethical fears; human gene crop fury. The Express; September 8, 2001.
16. GMT. Tree of life: gene-altered rubber plants are putting human proteins on tap. New Scientist; 2001.
17. Mercenier A, Wiedermann U, Breiteneder H. Edible genetically modified microorganisms and plants for improved health. Curr Opin Biotechnol 2001;12:510-515.
18. ™·ÓÈfiÏ·˜ ™. °ÂÓÂÙÈο ÙÚÔÔÔÈË̤ӷ ÙÚfiÊÈÌ· Î·È ·ÏÏÂÚÁ›Â˜. ∞ÚÂÙ·›Ô˜ 2000;14:266-267.
19. ª·Ú·˙fiÔ˘ÏÔ˜ º. °ÂÓÂÙÈο ÌÂÙ·ÏÏ·Á̤ӷ ÙÚfiÊÈÌ·: ÁÂÓÂÙÈÎfi˜ ·Ú¿‰ÂÈÛÔ˜ ‹ ÁÂÓÂÙÈ΋ ÃÈÚÔ̷ۛ; ™ÙÔ: Metrorama. ∞ı‹Ó·; 2000. ÛÂÏ. 12-13.
20. °·Ï·Ù¿˜ π¢. ∆ÚÔÊÈ΋ ·ÏÏÂÚÁ›·. µ·ÛÈ΋ Î·È ÎÏÈÓÈ΋ ·ÓÔÛÔÏÔÁ›·. ∂.∂.∞.∫.∞. ∞ı‹Ó·: ∂ΉfiÛÂȘ ∑∏∆∞; 2001. ÛÂÏ. 722-738.
21. Bock SA. In vivo diagnosis: skin testing and oral challenge procedures. In: Metcalfe W, Sampson H, Simon RA, editors. Food allergy: adverse reactions to food and food additives. 2nd ed. Massachusetts, USA: Blackwell Science; 1997. p. 151-166.
22. Yunginger JW. Food antigens. In: Metcalfe DD, Sampson HA, Simon RA, editors. Food allergy: adverse reactions to food and food additives. Massachusetts, USA: Blackwell Science; 1997. p. 49-63.
23. Astwood JF, Fuchs RL, Lavrik PB. Food biotechnology and geneting engineering. In: Metcalfe D, Sampson H, Simon R, editors. Food allergy: adverse reactions to food and food additives. 2nd ed. Massachusetts, USA: Blackwell Science, N.Y. 1997. p. 65-92.
24. Maughan PJ, Philip R, Cho MJ, Widholm JM, Vodkin LO. Biolistic transformation, expression, and inheritance of bovine beta-casein in soy bean (glycine max). In vitro Cell Develop Biology Plant 1999;35:344-349.
25. Metcalfe DD, Astwood JD, Townsend R, Sampson HA, Taylor SL, Fuchs RL. Assessment of the allergenic potential of foods derived from genetically engineered crop plants. Crit Rev Food Sci Nutr 1996;36 (Suppl):S165-S186.
26. Taylor SL, Hefle SL. Genetically engineered foods: implications for food allergy. Curr Opin Allergy Clin Immunol 2002;2:249-252.
27. Bindslev-Jensen C, Ebner C, Madsen C, Makinen-Kiljunen S, Peltre G, Poulsen LK et al. Genetically modified foods and allergenicity. Position Paper. European Academy for Allergology and Clinical Immunology; 2000.
28. Wuthrich B. Food additives and genetically modified food: a risk for allergic patients? Schweiz Rundsch Med Prax 1999;88:609-614, 616-618.
29. Helm RM. Biotechnology and food allergy. Curr Allergy Asthma Rep 2002;2:55-62.
30. ∑·¯·ÚÈÔ˘‰¿Î˘ °. ª·ÁÂÈÚ‡ÔÓÙ·˜ ÁÂÓÂÙÈο ÙÚÔÔÔÈË̤ӷ ÙÚfiÊÈÌ· ÛÙÔ ÂÚÁ·ÛÙ‹ÚÈÔ. ™ÙÔ: Health & Style; 2002. ÛÂÏ. 38-41.
∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 20-01-2003
∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 02-09-2003
¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ¡ÈÎfiÏ·Ô˜ °. ¶··‰fiÔ˘ÏÔ˜
µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ
¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”
§Â‚·‰Â›·˜ 13, ∆.∫. 115 27, °Ô˘‰› E-mail: ngp@allergy.gr
∞¡∞™∫O¶∏™∏REVIEW ARTICLE
OÈÎÔÏÔÁ›·, ÂȉËÌÈÔÏÔÁ›· Î·È ÂÚÁ·ÛÙËÚȷ΋ ‰È¿ÁÓˆÛË Ì˘ÎËÙÈ¿ÛÂˆÓ ÙÔ˘ ÙÚȯˆÙÔ‡ Ù˘ ÎÂÊ·Ï‹˜ Û ·È‰È¿
∂. ºÚ·ÁÎÔ‡ÏË
Ecology, epidemiology and diagnosis of tinea capitis in children
E. Frangoulis
¶ÂÚ›ÏË„Ë: ∏ Ì˘ÎËÙ›·ÛË ÙÔ˘ ÙÚȯˆÙÔ‡ Ù˘ ÎÂÊ·-
Ï‹˜Â›Ó·È Ì›· ·fi ÙȘ Û˘Ó‹ıÂȘ ‰ÂÚÌ·ÙÈΤ˜ ÏÔÈÌÒ-
ÍÂȘ ÙˆÓ ·È‰ÈÒÓ Î·Ù¿ ÙËÓ ÚÔÛ¯ÔÏÈ΋ Î·È Û¯ÔÏÈ΋
ËÏÈΛ·. ∞ÈÙÈÔÏÔÁÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ·ÔÙÂÏÔ‡Ó ÔÚÈ-
Ṳ̂ӷ ›‰Ë ‰ÂÚÌ·ÙfiÊ˘ÙˆÓ, ÙÔ˘ Á¤ÓÔ˘˜
Microsporum Î·È Trichophyton. ∆· ›‰Ë ·˘Ù¿, ·Ó¿-
ÏÔÁ· Ì ÙÔ Ê˘ÛÈÎfi ÙÔ˘˜ ÂÚÈ‚¿ÏÏÔÓ Î·È ÙËÓ ÚÔÙ›-
ÌËÛ‹ ÙÔ˘˜ ÚÔ˜ ÙÔÓ ÍÂÓÈÛÙ‹, ‰È·ÎÚ›ÓÔÓÙ·È Û ·ÓıÚˆfiÊÈÏ·, ˙ˆfiÊÈÏ· Î·È ÁÂÒÊÈÏ·. ™ÙË ¯ÒÚ· Ì·˜, Ù· ·ÚÈ· ·›ÙÈ· Â›Ó·È ÙÔ ˙ˆfiÊÈÏÔ M. canis Û ÔÛÔ-
ÛÙfi 87% Î·È ÙÔ ·ÓıÚˆfiÊÈÏÔ ∆. violaceum Û Ô-
ÛÔÛÙfi 6%. ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ·ÓȯÓ‡ÔÓÙ·È Î·È
ÌË ÂÓ‰ËÌÈο ·ÓıÚˆfiÊÈÏ· ›‰Ë, ΢ڛˆ˜ Û ÔÈÎÔÓÔ-
ÌÈÎÔ‡˜ ÌÂÙ·Ó¿ÛÙ˜ ·fi ¯ÒÚ˜ Ù˘ ª¤Û˘ ∞Ó·ÙÔ-
Ï‹˜, Ù˘ ∞Û›·˜ Î·È Ù˘ ∞ÊÚÈ΋˜. ¶ËÁ‹ ÌfiÏ˘ÓÛ˘
ÁÈ· ÙȘ ˙ˆÔÊÈÏÈΤ˜ ÏÔÈÌÒÍÂȘ Â›Ó·È Ù· ˙Ò· Ô˘ ÓÔ-
ÛÔ‡Ó ‹ fi¯È, ÂȉÈο ‰Â ÁÈ· ÙÔ M. canis Â›Ó·È Ù· ηÙÔÈ-
Λ‰È· Î·È Ù· ·‰¤ÛÔÙ· (Á¿Ù˜, Û·ÏÔÈ). ∏ ÌÂÙ¿‰ÔÛË
ÙˆÓ ·ÓıÚˆÔÊÈÏÈÎÒÓ ÏÔÈÌÒÍÂˆÓ Á›ÓÂÙ·È Â›Ù ÌÂ
¿ÌÂÛË Â·Ê‹ Ì ¿Û¯ÔÓÙ˜ ‹ ·Û˘Ìو̷ÙÈÎÔ‡˜
ÊÔÚ›˜ ›Ù Ì ¯Ú‹ÛË ÌÔÏ˘ÛÌ¤ÓˆÓ ·ÓÙÈÎÂÈ̤ӈÓ. OÈ
Ì˘ÎËÙÈ¿ÛÂȘÙÔ˘ ÙÚȯˆÙÔ‡ Ù˘ ÎÂÊ·Ï‹˜ ˆ˜ › ÙÔ
Ï›ÛÙÔÓ Â›Ó·È ÌË ÊÏÂÁÌÔÓÒ‰ÂȘ. OÈ ÊÏÂÁÌÔÓÒ‰ÂȘ
ÌÔÚʤ˜ (¤Ì˘Ô˜ ÙÚȯÔÊ˘Ù›·) Û˘Ó‰¤ÔÓÙ·È Î˘Ú›ˆ˜
Ì ˙ˆfiÊÈÏÔ˘˜ Î·È ÁÂÒÊÈÏÔ˘˜ ̇ÎËÙ˜ Î·È Û¿ÓÈ·
Ì ·ÓıÚˆfiÊÈÏÔ˘˜. O ¿¯ÔÚ·˜, Û¿ÓÈ· ÌÔÚÊ‹
Ì˘ÎËÙ›·Û˘ÙÔ˘ ÙÚȯˆÙÔ‡ Ù˘ ÎÂÊ·Ï‹˜, ÚÔηÏÂ›Ù·È ·fi ÙÔ ·ÓıÚˆfiÊÈÏÔ Â›‰Ô˜ T. schoenleinii. ∏ ÂÚÁ·ÛÙËÚȷ΋ ÂͤٷÛË Â›Ó·È ·Ó·Áη›· ÁÈ· ÙËÓ ÂȂ‚·›ˆÛË Ù˘ ÎÏÈÓÈ΋˜ ‰È¿ÁÓˆÛ˘ Î·È ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙÔ˘ ˘Â‡ı˘ÓÔ˘ ›‰Ô˘˜. ¶ÂÚÈÏ·Ì‚¿ÓÂÈ
ÙËÓ ¿ÌÂÛË ÌÈÎÚÔÛÎÔÈ΋ ÂͤٷÛË ‰Â›ÁÌ·ÙÔ˜ ·fi
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
∏ Ù·˘ÙÔÔ›ËÛË Â›Ó·È ··Ú·›ÙËÙË ÁÈ· ÙËÓ ÂÈÏÔÁ‹
Ù˘ ηٿÏÏËÏ˘ ·ÓÙÈÌ˘ÎËÙÈ·ÛÈ΋˜ ·ÁˆÁ‹˜. ŸÏ˜ ÔÈ
ÂÚÈÙÒÛÂȘ ·ÏÏÔÈÒÛÂˆÓ ÙÔ˘ ÙÚȯˆÙÔ‡ Ù˘ ÎÂÊ·-
Ï‹˜ Û ·È‰È¿ ÚÔÂÊË‚È΋˜ ËÏÈΛ·˜ ı· Ú¤ÂÈ Ó·
·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È ·fi ÙÔÓ ÎÏÈÓÈÎfi È·ÙÚfi ˆ˜ ‡Ô-
Ù˜ Ì˘ÎËÙÈ·ÛÈΤ˜ ÏÔÈÌÒÍÂȘ.
§¤ÍÂȘ ÎÏÂȉȿ: Ì˘ÎËÙ›·ÛË ÙÚȯˆÙÔ‡ ÎÂÊ·Ï‹˜, ÔÈ-
ÎÔÏÔÁ›·, ÂȉËÌÈÔÏÔÁ›·, ÂÚÁ·ÛÙËÚȷ΋ ‰È¿ÁÓˆÛË.
∂ÈÛ·ÁˆÁ‹
O fiÚÔ˜ tinea ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·Ó ·fi ÙÔ˘˜ ƒˆÌ·›Ô˘˜ ÁÈ· ÙȘ Ì˘ÎËÙÈ·ÛÈΤ˜ Î·È ·Ú·ÛÈÙÈΤ˜ ÏÔÈÌÒÍÂȘ ÙÔ˘ ÙÚȯˆÙÔ‡ Ù˘ ÎÂÊ·Ï‹˜, ηıÒ˜ ıˆÚÔ‡Û·Ó ˆ˜ ˘Â‡ı˘ÓÔ ÙÔÓ ÛÎfiÚÔ ÙˆÓ ÂÓ‰˘Ì¿ÙˆÓ (Ï·ÙÈÓÈο: tinea) (1). O fiÚÔ˜ ·˘Ùfi˜ ‚·ıÌÈ·›· ÂÈÎÚ¿ÙËÛÂ, ÒÛÙ ÛÙ· ̤۷ ÙÔ˘ 16Ô˘ ·ÈÒÓ· Ó· ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÁÈ· fiϘ ÙȘ ·ı‹ÛÂȘ ÙÔ˘ ÙÚȯˆÙÔ‡ Ù˘ ÎÂÊ·Ï‹˜. OÚfiÛËÌÔ ÛÙËÓ È·ÙÚÈ΋ Ì˘ÎËÙÔÏÔÁ›· ·ÔÙÂÏ› Ë ·Ó·Î¿Ï˘„Ë ·fi ÙÔ˘˜ J. Schöenlein Î·È R. Remak, ÛÙȘ ·Ú¯¤˜ ÙÔ˘ 19Ô˘ ·ÈÒÓ·, fiÙÈ Ô Ì‡ÎËÙ·˜ ∞¯fiÚÈÔÓ
(ÛËÌÂÚÈÓ‹ ÔÓÔÌ·Û›· Trichophyton schoenleinii) ›ӷÈ
Ô ·ÈÙÈÔÏÔÁÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÙÔ˘ ¿¯ÔÚ· (2). ∆· ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο Ù˘ ÓfiÛÔ˘, Ô ÙÚfiÔ˜ ÌÂÙ¿‰ÔÛ˘, ηıÒ˜ Î·È Ô ÙÚfiÔ˜ ·Ú·ÛÈÙÈÛÌÔ‡ ÙÔ˘ ̇ÎËÙ· ÛÙËÓ ÙÚ›¯· ÂÚÈÁÚ¿ÊËÎ·Ó ·fi ÙÔÓ Gruby, Û ̛· ÛÂÈÚ¿ ·fi ÌÂϤÙ˜ ÙÔ˘, ÌÂٷ͇ ÙˆÓ ÂÙÒÓ 1840-1844 (3). O Sabouraud, ÛÙ· Ù¤ÏË ÙÔ˘ 19Ô˘ ·ÈÒÓ·, ÌÂϤÙËÛ ÙË ÌÔÚÊÔÏÔÁ›· ÙˆÓ ‰ÂÚÌ·ÙfiÊ˘ÙˆÓ, ‰È¤ÎÚÈÓÂ
ÙÔ˘˜ ‰È¿ÊÔÚÔ˘˜ Ù‡Ô˘˜ Ì˘ÎËÙÈ¿ÛÂˆÓ (ÌÈÎÚÔÛÔÚ›·, ÙÚȯÔÊ˘Ù›·, ¿¯ÔÚ·˜), ÂÚȤÁÚ·„ ÙËÓ ÎÏÈÓÈ΋ ÙÔ˘˜ ÂÈÎfiÓ· Î·È ·Ú·Ù‹ÚËÛ fiÙÈ Ô ÙÚȯÔÊ˘ÙÈÎfi˜ Ù‡Ô˜ ÌÔÚ› Ó· ÚÔÎÏËı› ·fi ÔÏÏ¿ ›‰Ë ‰ÂÚÌ·ÙfiÊ˘ÙˆÓ (4). ∂›Û˘, Ù·ÍÈÓfiÌËÛ ٷ ‰ÂÚÌ·ÙfiÊ˘Ù· Û ٤ÛÛÂÚ· Á¤ÓË: Trichophyton, Microsporum, Epidermophyton Î·È Achorion.
∆Ô 1934, Ô Emmons, ÌÂÏÂÙÒÓÙ·˜ ÙË ÌÈÎÚÔÛÎÔÈ΋ ÌÔÚÊÔÏÔÁ›· ÙˆÓ ÎÔÓȉ›ˆÓ (ÛÔÚ›ˆÓ) Î·È ÙË ‰ÔÌ‹ ÙˆÓ ˘ÊÒÓ (ÓËÌ·Ù›ˆÓ) ÙˆÓ ‰ÂÚÌ·ÙfiÊ˘ÙˆÓ, ηıfiÚÈÛÂ
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).
OÈÎÔÏÔÁ›·
∆· ‰ÂÚÌ·ÙfiÊ˘Ù· ·ÔÙÂÏÔ‡Ó ÔÌ¿‰· ÓËÌ·ÙÔÂȉÒÓ Ì˘Î‹ÙˆÓ Ô˘, Ì ÙË ‚Ô‹ıÂÈ· ÂȉÈÎÒÓ ÚˆÙÂ˚ÓÒÓ Î·È
ÂÓ˙‡ÌˆÓ (ÎÂÚ·ÙÈÓ¿Û˜), ·ÔÈÎÔ‰ÔÌÔ‡Ó Î·È ‰ÈÂÈÛ‰‡Ô˘Ó ÛÙËÓ ÎÂÚ¿ÙÈÓË ÛÙÈ‚¿‰·, ÚÔηÏÒÓÙ·˜ ÏÔÈÌÒÍÂȘ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜, ÙˆÓ Ó˘¯ÈÒÓ Î·È ÙˆÓ ÙÚȯÒÓ. ∂ÎÙfi˜ ·fi ÙËÓ Ù·ÍÈÓfiÌËÛ‹ ÙÔ˘˜ Û ÙÚ›· ·Ó¿ÌÔÚÊ· (·ÛÂÍÔ˘·ÏÈο) Á¤ÓË (Trichophyton, Microsporum Î·È ∂pidermophyton), Ù· ‰ÂÚÌ·ÙfiÊ˘Ù· Ù·ÍÈÓÔÌÔ‡ÓÙ·È, ›Û˘, Û ÁÂÒÊÈÏ·, ˙ˆfiÊÈÏ· Î·È ·ÓıÚˆfiÊÈÏ· (6), ·Ó¿ÏÔÁ· Ì ÙÔ Ê˘ÛÈÎfi ÙÔ˘˜ ÂÚÈ‚¿ÏÏÔÓ Î·È ÙËÓ
Key words: tinea capitis, ecology, epidemiology, mycological examination.
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˜ ηÈ
ÚÔηÏÔ‡Ó Ì˘ÎËÙÈ¿ÛÂȘ ÙfiÛÔÛÙ· ˙Ò· fiÛÔ Î·È ÛÙÔÓ ¿ÓıÚˆÔ. ∆· ˙ˆfiÊÈÏ· ›‰Ë ÚÔÛ‚¿ÏÏÔ˘Ó Ù· ˙Ò·, ÔÏÏ¿ fï˜ ÛÙÂϤ¯Ë ÙÔ˘˜ ÚÔηÏÔ‡Ó Ì˘ÎËÙÈ¿ÛÂȘ Î·È ÛÙÔÓ ¿ÓıÚˆÔ. ∆· ·ÓıÚˆfiÊÈÏ· ›‰Ë ÚÔÛ‚¿ÏÏÔ˘Ó ·ÔÎÏÂÈÛÙÈο ÙÔÓ ¿ÓıÚˆÔ. ŒÙÛÈ, ÔÚÈṲ̂ӷ ›‰Ë Ì˘Î‹ÙˆÓ fiˆ˜ Ù· ª. gypseum Î·È ª. fulvum Û·ÚÔÊ˘ÙÔ‡Ó ÛÙÔ ¤‰·ÊÔ˜
ÚÔÛ‚¿ÏÏÔ˘Ó Ù· ˙Ò· Î·È ÙÔÓ ¿ÓıÚˆÔ, Ù· ª. canis Î·È T. mentagrophytes var mentagrophytes ÚÔÛ‚¿ÏÏÔ˘Ó Ù· ˙Ò· Î·È ÙÔÓ ¿ÓıÚˆÔ, ÂÓÒ ¿ÏÏ·, fiˆ˜ Ù· T. rubrum Î·È T. violaceum ·Ú·ÛÈÙÔ‡Ó
ÛÙËÓ ·ÓıÚÒÈÓË ÎÂÚ·Ù›ÓË ÛÙÈ‚¿‰·. ∞fi Ù· 40 ›‰Ë ‰ÂÚÌ·ÙfiÊ˘ÙˆÓ Ô˘ Â›Ó·È ·ıÔ-
ÁÈ· ÙÔÓ ¿ÓıÚˆÔ, ÌfiÓÔ 10-12 ›‰Ë, ·fi Ù· Á¤ÓË Microsporum Î·È Trichophyton Î·È Û·ÓÈfiٷٷ ·fi ÙÔ Á¤ÓÔ˜ Epidermophyton, Û˘Ó‰¤ÔÓÙ·È Ì ‰ÂÚÌ·ÙÔÊ˘Ù›Â˜ ÙÔ˘ ÙÚȯˆÙÔ‡ Ù˘ ÎÂÊ·Ï‹˜.
∂ȉËÌÈÔÏÔÁ›· ∏ Ì˘ÎËÙ›·ÛË ÙÔ˘ ÙÚȯˆÙÔ‡ Ù˘ ÎÂÊ·Ï‹˜(ª∆∫) Â›Ó·È Ë Û˘ÓËı¤ÛÙÂÚË ‰ÂÚÌ·ÙÈ΋ Ïԛ̈ÍË ÙÔ˘ ÙÚȯˆÙÔ‡ ÎÂÊ·Ï‹˜ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜, ηٿ ÙËÓ ÔÔ›· ÚÔÛ‚¿ÏÏÔÓÙ·È ÔÈ ÙÚ›¯Â˜, ÔÈ ı‡Ï·ÎÔÈ Î·È ÙÔ
ÂÚÈ‚¿ÏÏÔÓ ‰¤ÚÌ·. ∂›Ó·È ÌÔÏ˘ÛÌ·ÙÈ΋ ÓfiÛÔ˜, Ë ÔÔ›· ¤¯ÂÈ ˆ˜ ·ÈÙÈÔÏÔÁÈÎfi ·Ú¿ÁÔÓÙ· Ù· ‰ÂÚÌ·ÙfiÊ˘Ù·. ¶ÚÔÛ‚¿ÏÏÂÈ ·È‰È¿ ·fi ÙËÓ ËÏÈΛ· ÙˆÓ 6 ÌËÓÒÓ Ì¤¯ÚÈ ÙËÓ ÂÊ˂›· (7,8). ∂›Ó·È Û¿ÓÈ· ÛÙÔ˘˜
ÂÓ‹ÏÈΘ Î·È ·˘Ùfi ·Ô‰›‰ÂÙ·È ÛÙË Ì˘ÎËÙÔÎÙfiÓÔ
‰Ú¿ÛË ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ ÙÔ˘ ÛÌ‹ÁÌ·ÙÔ˜, Ë ÂÚÈÂÎÙÈÎfiÙËÙ· ÙˆÓ ÔÔ›ˆÓ ·˘Í¿ÓÂÈ ÌÂÙ¿ ÙËÓ ÂÊ˂›· (9,10).
∆· ÁÂÒÊÈÏ· ‰ÂÚÌ·ÙfiÊ˘Ù· Â›Ó·È Â˘Ú¤ˆ˜ ‰È·‰Â‰Ô̤ӷ, ÂÓÒ Ù· ·ÓıÚˆfiÊÈÏ· Î·È ÔÚÈṲ̂ӷ ˙ˆfiÊÈÏ· ›‰Ë Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ¤¯Ô˘Ó ÂÚÈÔÚÈṲ̂ÓË ÁˆÁÚ·ÊÈ΋ ηٷÓÔÌ‹, Ë ÔÔ›· ÂÍ·ÚÙ¿Ù·È ·fi ÙÔÓ ÍÂÓÈÛÙ‹. ∏ ηٷÓÔÌ‹ ·˘Ù‹ ÌÂÙ·‚¿ÏÏÂÙ·È ‰È·¯ÚÔÓÈο ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙˆÓ ‚ÂÏÙÈÒÛÂˆÓ ÛÙȘ Û˘Óı‹Î˜ ‰È·‚›ˆÛ˘ Î·È ˘ÁÈÂÈÓ‹˜, ÙˆÓ ÌÂÙ·ÎÈÓ‹ÛÂˆÓ ÏËı˘ÛÌÒÓ Î·È Ù˘ ·Ó¿Ù˘Í˘ ·ÓÙÈÌ˘ÎËÙÈ·ÛÈÎÒÓ Ê·ÚÌ¿ÎˆÓ (11). ∏ ·Ó·Î¿Ï˘„Ë Ù˘ ÁÎÚÈ˙ÂÔÊÔ˘Ï‚›Ó˘, ÙÔ 1958, ·ÔÙÂÏ› ÔÚfiÛËÌÔ ÁÈ· ÙË ıÂڷ›· ÙˆÓ
¶›Ó·Î·˜ 1. ∆· ΢ÚÈfiÙÂÚ·
∞ÓıÚˆfiÊÈÏÔÈ∑ˆfiÊÈÏÔÈ°ÂÒÊÈÏÔÈ
Trichophyton spp
T. rubrumT. mentagrophytes var mentagrophytesT. terestre
T. mentagrophytes var interdigitaleT. verrucosum
T. megniniiT. equinum
T. violaceumT. mentagrophtes var erinacei
T. tonsuransT. simii
T. soudanense
T. concentricum
T. gourvilii
T. youndeii
T. schoenleinii
∆. raubitschekii
Microsporum spp
M. audouiniiM. canis var canisM. gypseum
M. audouinii var rivalieriM. canis var distortumM. fulvum
M. ferrugineumM. equinumM. paecox
M. gallinaeM. vanbreuseghemii
M. persicolor
M. nanum
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΋ ÂÈ-
ÎÚ·Ù¤ÛÙÂÚÔ ·›ÙÈÔ ª∆∫ ·ÔÙÂÏ› Ô ·ÓıÚˆfiÊÈÏÔ˜
̇ÎËÙ·˜ ∆. tonsurans (90%) (13-15). O ̇ÎËÙ·˜
ÚÔÛ‚¿ÏÏÂÈ Î˘Ú›ˆ˜ πÛ·ÓfiʈÓÔ˘˜ Î·È ∞ÊÚÔ·ÌÂÚÈ-
ηÓÔ‡˜ (16). ™ÙË ¡fiÙÈ· ∞ÌÂÚÈ΋, ÙËÓ ∞˘ÛÙÚ·Ï›· ηÈ
ÙË ¡¤· ∑ËÏ·Ó‰›· ÂÈÎÚ·ÙÔ‡Ó Ù· ›‰Ë M. canis Î·È T. tonsurans (7,17). ™ÙË ¢˘ÙÈ΋ Î·È ¡fiÙÈ· ∞Û›· ÙÔ Û˘-
ÓËı¤ÛÙÂÚÔ Â›‰Ô˜ Â›Ó·È ÙÔ T. violaceum (18), ÂÓÒ
ÛÙȘ ¯ÒÚ˜ Ù˘ ª¤Û˘ ∞Ó·ÙÔÏ‹˜ ÂÈÎÚ·ÙÔ‡Ó Ù· ›‰Ë M. canis, T. violaceum Î·È T. mentagrophytes var mentagrophytes (19,20). ™ÙËÓ ∞ÊÚÈ΋, Ì ÂÍ·›ÚÂÛË ÙËÓ ∞›Á˘ÙÔ fiÔ˘ ÚÔÂÍ¿Ú¯ÂÈ ÙÔ M. canis (21), ÂÓ‰Ë-
ÌÔ‡Ó Î˘Ú›ˆ˜ ·ÓıÚˆfiÊÈÏ· ›‰Ë, fiˆ˜ Ù· ∆. violaceum, M. audouinii, M. rivalieri, T. soudanense, M. ferrugineum Î·È T. schoenleinii, ∆. yaoundei Î·È T. gourvilii (22,23). ™Â ·ÚÎÂÙ¤˜ ¯ÒÚ˜ Ù˘ ∞ÊÚÈ΋˜ ÙÔ ÔÛÔÛÙfi ÙˆÓ ·ÛıÂÓÒÓ Ì ÂÓÂÚÁ‹ ÓfiÛÔ ·Ó¤Ú¯ÂÙ·È Û 10-30% (21).
™ÙË ¢˘ÙÈ΋ ∂˘ÚÒË, Û‡Ìʈӷ Ì ÚfiÛÊ·ÙË ÂȉËÌÈÔÏÔÁÈ΋ ÌÂϤÙË ÙˆÓ ª∆∫ Û 19 Â˘Úˆ·˚Τ˜
·ÏÏ·Á¤˜ ÛÙËÓ ÂȉËÌÈÔÏÔÁ›· ÙˆÓ ‰ÂÚÌ·ÙfiÊ˘ÙˆÓ ÛÙË ¯ÒÚ· Ì·˜. ∆· ·ÓıÚˆfiÊÈÏ· ›‰Ë ∆. schoenleinii Î·È M. audouinii, Ù· ÔÔ›· ÂÈÎÚ·ÙÔ‡Û·Ó ÙȘ ÚÒÙ˜ ‰ÂηÂٛ˜ ÙÔ˘ 20Ô‡ ·ÈÒÓ·, ·ÓÙÈηٷÛÙ¿ıËÎ·Ó ‚·ıÌÈ·›· ·fi ÙÔ T. violaceum (29,30), Ë ·ÚÔ˘Û›· ÙÔ˘ ÔÔ›Ô˘, fï˜, ÌÂÈÒıËΠÛËÌ·ÓÙÈο ÛÙË Û˘Ó¤¯ÂÈ· Î·È ·ÓÙÈηٷÛÙ¿ıËΠ·fi ÙÔ ª.canis, ÙÔ ÔÔ›Ô Û‹ÌÂÚ· Â›Ó·È Ô Î˘ÚÈfiÙÂÚÔ˜ ·ÈÙÈÔÏÔÁÈÎfi˜
·Ú¿ÁÔÓÙ·˜. ∆· ›‰Ë ∆. schoenleinii Î·È M. audouinii
¤¯Ô˘Ó ۯ‰fiÓ ÂÎÚÈ˙ˆı› ÛÙÔÓ ÁËÁÂÓ‹ ÏËı˘ÛÌfi, ÂÓÒ ÙÔ T. violaceum ÂÚÈÔÚ›˙ÂÙ·È Ï¤ÔÓ Û ·ÁÚÔÙÈΤ˜ ÂÚÈÔ¯¤˜ Ù˘ ¯ÒÚ·˜, fiÔ˘ ˘¿Ú¯ÂÈ Û˘Á¯ÚˆÙÈÛÌfi˜ ·ÙfiÌˆÓ Î·È ÔÈ Û˘Óı‹Î˜ ˘ÁÈÂÈÓ‹˜ Î·È ‰È·‚›ˆÛ˘ Â›Ó·È ‰˘ÛÌÂÓ›˜, ηıÒ˜ ›Û˘ Î·È Û ÔÈÎÔÓÔÌÈÎÔ‡˜ ÌÂÙ·Ó¿ÛÙ˜, ·È‰È¿ Î·È ÂÓ‹ÏÈΘ ·fi ¯ÒÚ˜ Ù˘ µ·ÏηÓÈ΋˜ Î·È Ù˘ ∞Ó·ÙÔÏÈ΋˜ ∂˘ÚÒ˘ (31,32).
∂ȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜ Ô˘ ¤ÁÈÓ·Ó Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÛÙË ¯ÒÚ· Ì·˜ ¤‰ÂÈÍ·Ó fiÙÈ Û ·ÛıÂÓ›˜ Ì ª∆∫ ¤¯ÂÈ ·ÔÌÔÓˆı› ¢ڇ Ê¿ÛÌ· ·ıÔÁfiÓˆÓ Ì˘Î‹ÙˆÓ, fiˆ˜ Ù· ª. canis, T. violaceum, T. mentagrophytes var mentagrophytes, M. gypseum, T. verrucosum, T.tonsurans, M. audouinii, T. soudanense, M. ferrugineum, T. schoenleinii Î·È T. erinacei (¶›Ó·Î·˜ 2). ∆· ÚÒÙ· 6 ›‰Ë ·fi ·˘Ù¿ ¤¯Ô˘Ó ·ÔÌÔÓˆı› ÛÙÔÓ ÁËÁÂÓ‹ ÏËı˘ÛÌfi (28,3336), ÂÓÒ Ù· ˘fiÏÔÈ· ¤¯Ô˘Ó ·ÔÌÔÓˆı› Û ·È‰È¿ ÌÂÙ·Ó·ÛÙÒÓ ·fi ¯ÒÚ˜ Ù˘ ∞ÊÚÈ΋˜ Î·È Ù˘ ∞Û›·˜, fiÔ˘ Ù· ›‰Ë ·˘Ù¿ ÂÓ‰ËÌÔ‡Ó (37,38). ∆Ô T. violaceum ·ÔÌÔÓÒıËÎÂ, ›Û˘, Û ·È‰È¿ ÌÂÙ·Ó·ÛÙÒÓ ·fi ÙËÓ ∞Ï‚·Ó›· Î·È ÙËÓ ∞Ó·ÙÔÏÈ΋ ∂˘ÚÒË (31,32). °È· ÙÔÓ ·ÓıÚˆfiÊÈÏÔ Ì‡ÎËÙ· ∆. rubrum,
¯ÒÚ˜, ·Ú·ÙËÚ‹ıËÎÂ, ηٿ ÙËÓ ÙÂÏÂ˘Ù·›· ‰ÂηÂÙ›·, ÌÂÁ¿ÏË ·‡ÍËÛË ÙˆÓ ·ÓıÚˆÔÊÈÏÈÎÒÓ ÏÔÈÌÒÍÂˆÓ È‰È·›ÙÂÚ· ÛÙȘ ·ÛÙÈΤ˜ ÂÚÈÔ¯¤˜, Ì ·ÔÙ¤ÏÂÛÌ· Ó· ˘ÂÚÙÂÚÔ‡Ó ÙˆÓ ˙ˆÔÊÈÏÈÎÒÓ Û ·Ó·ÏÔÁ›· 1:0,8 (24). ∏ ·‡ÍËÛË ·˘Ù‹ Û˘Ó‰¤ÂÙ·È Ì ÙËÓ ÂÈÛÚÔ‹ ÌÂÙ·Ó·ÛÙÒÓ ·fi ¯ÒÚ˜ Ù˘ ∞ÊÚÈ΋˜ Î·È Ù˘ ∞Û›·˜ (25). ¶·Ú¿ Ù·‡Ù·, Ô ˙ˆfiÊÈÏÔ˜ M. canis Â›Ó·È Ô ÂÈÎÚ·Ù¤ÛÙÂÚÔ˜ ̇ÎËÙ·˜, Ì ÌÂÁ·Ï‡ÙÂÚË Â›ÙˆÛË ÛÙȘ ¯ÒÚ˜ Ù˘ ¡fiÙÈ·˜ ∂˘ÚÒ˘ (8,26-28). ∆ËÓ ÙÂÏÂ˘Ù·›· ÙÚÈ·ÎÔÓÙ·ÂÙ›· ·Ú·ÙËÚ‹ıËηÓ
Û‡ÓËı˜ ·›ÙÈÔ Ì˘ÎËÙÈ¿ÛÂˆÓ Ó˘¯ÈÒÓ Î·È ‰¤ÚÌ·ÙÔ˜
ÛÙÔ˘˜ ÂÓ‹ÏÈΘ, ˘¿Ú¯Ô˘Ó ÛÔÚ·‰ÈΤ˜ ·Ó·ÊÔÚ¤˜
ª∆∫ Ì ¿Ù˘Ë ÎÏÈÓÈ΋ ÂÈÎfiÓ· (39). ∆Ô ·ÓıÚˆfiÊÈÏÔ
›‰Ô˜ ∂. floccosum ÂÍ·ÈÚÂÙÈο Û¿ÓÈ· ·ÔÙÂÏ› ·›ÙÈÔ
ª∆∫ (40), ÂÓÒ ‰ÂÓ ˘¿Ú¯ÂÈ ·Ó·ÊÔÚ¿ ÁÈ· ÙÔ ·ÓıÚˆ-
fiÊÈÏÔ Â›‰Ô˜ ∆. concentricum (11).
™˘ÌÂÚ·ÛÌ·ÙÈο, ·Ú·ÙËÚ›ٷÈ: ·) ·‡ÍËÛË Ù˘
Û˘¯ÓfiÙËÙ·˜ ÙÔ˘ M. canis ÛÙË ¡fiÙÈ· ∞ÌÂÚÈ΋, ÛÙË
¡fiÙÈ· Î·È ∞Ó·ÙÔÏÈ΋ ∂˘ÚÒË Î·È ÛÙË ª¤ÛË ∞Ó·ÙÔÏ‹, ‚) ·‡ÍËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ ÙÔ˘ T. tonsurans ÛÙË µfiÚÂÈ· ∞ÌÂÚÈ΋ Î·È Û ÔÚÈṲ̂Ó˜ ¯ÒÚ˜ Ù˘ ∂˘ÚÒ˘ (∞ÁÁÏ›·, °·ÏÏ›·), Á) ·Ú·ÌÔÓ‹ ÙÔ˘ ∆. violaceum Û ÔÚÈṲ̂Ó˜ ÂÚÈÔ¯¤˜ Ù˘ ∞Ó·ÙÔÏÈ΋˜ ∂˘ÚÒ˘, Ù˘ ∞ÊÚÈ΋˜ Î·È ÛÙËÓ πÓ‰›·, ‰) ·Ú·ÌÔÓ‹ ÂÓ‰ËÌÈÎÒÓ Ì˘Î‹ÙˆÓ ÛÙËÓ ∞ÊÚÈ΋, fiˆ˜ ÙÔ˘ T. soudanense Î·È ÙÔ˘ M. ferrugineum Â) ÂÌÊ¿ÓÈÛË
ÛÙËÓ ∂˘ÚÒË ÔÚÈÛÌ¤ÓˆÓ ·ÓıÚˆfiÊÈÏˆÓ Ì˘Î‹ÙˆÓ, fiˆ˜ Ô T. soudanense, Ô M. audouinii Î·È Ô T. Violaceum, Û ÎÔÈÓfiÙËÙ˜ ÌÂÙ·Ó·ÛÙÒÓ ·fi ÙËÓ
∞ÊÚÈ΋, ÙËÓ ∞Û›· Î·È ÙË ¡ÔÙÈÔ·Ó·ÙÔÏÈ΋ ∂˘ÚÒË
Î·È ÛÙ) ÂÎÚ›˙ˆÛË ÙÔ˘ ∆. shoenleinii ÛÙȘ ÂÚÈÛÛfiÙÂ-
Ú˜ ¯ÒÚ˜, ÏËÓ Ù˘ ∞ÊÚÈ΋˜ (41).
∏ ª∆∫ ÚÔÛ‚¿ÏÏÂÈ Î˘Ú›ˆ˜ ·È‰È¿ ÚÔÛ¯ÔÏÈ΋˜
Î·È Û¯ÔÏÈ΋˜ ËÏÈΛ·˜, ÌÂٷ͇ 3-8 ÂÙÒÓ (8,27,28,42).
Œ¯ÂÈ, ›Û˘, ·Ú·ÙËÚËı› fiÙÈ Ë Û˘¯ÓfiÙËÙ¿ Ù˘ ›-
Ó·È Û˘Ó¿ÚÙËÛË ÙÔ˘ ʇÏÔ˘ Î·È ÙÔ˘ ·ÈÙÈÔÏÔÁÈÎÔ‡ ·-
Ú¿ÁÔÓÙ· (43).
OÈ ÌÈÎÚÔÛÔÚÈÎÔ› ̇ÎËÙ˜ ÚÔÛ‚¿ÏÏÔ˘Ó Î·Ù¿
ÚÔÙ›ÌËÛË ÙÔ ¿ÚÚÂÓ Ê‡ÏÔ, ÂÓÒ ÛÙÔ˘˜ ÙÚȯÔÊ˘ÙÈÎÔ‡˜ Ë Î·Ù·ÓÔÌ‹ ÌÂٷ͇ ÙˆÓ ‰‡Ô Ê‡ÏˆÓ Â›Ó·È ÈÛfiÚÚÔË (28,43). ∆o M. canis ÚÔÛ‚¿ÏÏÂÈ Î·È Ù· ‰‡Ô ʇϷ, ȉȷ›ÙÂÚ· fï˜ Ù· ·ÁfiÚÈ·, ÂÓÒ ÙÔ M. audouinii ·ÚÔ˘ÛÈ¿˙ÂÈ ˘„ËÏ‹ ÂÈÏÂÎÙÈÎfiÙËÙ· (5:1)
ÛÙ· ·ÁfiÚÈ· ¤Ó·ÓÙÈ ÙˆÓ ÎÔÚÈÙÛÈÒÓ (44). ™Â ÚfiÛÊ·ÙË ÌÂϤÙË Ô˘ ¤ÁÈÓ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô “∞. ™˘ÁÁÚfi˜”, Ë Û¯¤ÛË ÙˆÓ ·ÁÔÚÈÒÓ ÚÔ˜ Ù· ÎÔÚ›ÙÛÈ· ‹Ù·Ó 6:1
ÁÈ· ÙÔ˘˜ ÌÈÎÚÔÛÔÚÈÎÔ‡˜ ̇ÎËÙ˜ M. audouinii, M.
ferrugineum Î·È ª. gypseum, ÂÓÒ ÁÈ· ÙÔ ª. canis Ë ·Ó·ÏÔÁ›· ‹Ù·Ó ÌfiÓÔ 1,3:1. ¶Èı·ÓÒ˜, Ù· ÎÔÓÙ¿ Ì·Ï-
ÏÈ¿ ÙˆÓ ·ÁÔÚÈÒÓ Ó· ¢ÓÔÔ‡Ó ÙËÓ ÂÌʇÙ¢ÛË ÙˆÓ
ÛÔÚ›ˆÓ (16). ∞ÓÙ›ıÂÙ·, Ë Î·Ù·ÓÔÌ‹ ÙÔ˘ T. violaceum ‹Ù·Ó ÂÚ›Ô˘ 1:1 (38).
∆ÚfiÔ˜ ÌfiÏ˘ÓÛ˘
∏ ÌÂÙ¿‰ÔÛË ÙˆÓ ˙ˆÔÊÈÏÈÎÒÓ ÏÔÈÌÒÍÂˆÓ Á›ÓÂÙ·È
›Ù Ì ÙËÓ ¿ÌÂÛË Â·Ê‹ Ì ηÙÔÈΛ‰È· ‹ ¿ÁÚÈ· ˙Ò·
Ô˘ Â›Ó·È ÌÔÏ˘Ṳ̂ӷ ‹ ÓÔÛÔ‡Ó Â›Ù ¤ÌÌÂÛ·, ÌÂ
ÂÓÂÚÁ¿ ÎÔÓ›‰È·, Ù· ÔÔ›· ·Ó¢ڛÛÎÔÓÙ·È Û ÊÚ¿ÎÙ˜, ÛÙ¿‚ÏÔ˘˜ Î.Ï. ∏ ·ÚÈ· ËÁ‹ ÌfiÏ˘ÓÛ˘ ÁÈ· ÙÔ ª. canis Â›Ó·È Ù·
ηÙÔÈΛ‰È· ˙Ò· (Á¿Ù˜, Û·ÏÔÈ), ΢ڛˆ˜ Ù· ·‰¤ÛÔÙ· (28,33,36). ∏ ‰ÂÍ·ÌÂÓ‹ ·˘Ù‹ ÌfiÏ˘ÓÛ˘ Â›Ó·È ··Ú·›ÙËÙË, ‰Â‰Ô̤ÓÔ˘ fiÙÈ Ë ÌÔÏ˘ÛÌ·ÙÈ΋ ÈÛ¯‡˜
ÙÔ˘ M. canis ÂÍ·ÛıÂÓ› Û ÌÂÁ¿ÏÔ ‚·ıÌfi ÌÂÙ¿ ·fi
Ù¤ÛÛÂÚȘ ‰È·‰Ô¯ÈΤ˜ ÌÂÙ·‚È‚¿ÛÂȘ ·fi ¿ÓıÚˆÔ
ÛÂ ¿ÓıÚˆÔ (45).
∏ ËÁ‹ ÌfiÏ˘ÓÛ˘ ÁÈ· ÙÔ T. verrucosum Â›Ó·È Ù· ‚ÔÔÂȉ‹ Î·È Ù· ·ÈÁÔÚfi‚·Ù· Ô˘ ÓÔÛÔ‡Ó, ÂÓÒ ÁÈ· ÙÔ
∆. mentagrophytes var mentagrophytes Â›Ó·È oÈ ¯Ô›ÚÔÈ, ÔÈ ÎfiÓÈÎÏÔÈ, Ù· ·ÈÁÔÚfi‚·Ù· Î·È Ù· ÙÚˆÎÙÈο.
OÈ ÁÂÒÊÈÏÔÈ Ì‡ÎËÙ˜ Û·ÓÈfiٷٷ ÂÌϤÎÔÓÙ·È ˆ˜ ·ÈÙÈÔÏÔÁÈÎÔ› ·Ú¿ÁÔÓÙ˜ ª∆∫.
¶ËÁ‹ ÌfiÏ˘ÓÛ˘ ÁÈ· ÙȘ ·ÓıÚˆÔÊÈÏÈΤ˜ ÏÔÈÌÒÍÂȘ ·ÔÙÂÏÔ‡Ó ÔÈ ¿Û¯ÔÓÙ˜ Î·È Û ÛËÌ·ÓÙÈÎfi ‚·ıÌfi ÔÈ ·Û˘Ìو̷ÙÈÎÔ› ÊÔÚ›˜ Ù˘ ÓfiÛÔ˘ (46,47).
∏ ÌÂÙ¿‰ÔÛË ÙˆÓ ·ÓıÚˆÔÊÈÏÈÎÒÓ ÏÔÈÌÒ͈Ó
Á›ÓÂÙ·È Â›Ù Ì ¿ÌÂÛË Â·Ê‹ Ì ¿Û¯ÔÓÙ· ‹ ·Û˘Ìو̷ÙÈÎfi ÊÔÚ¤· ›Ù ¤ÌÌÂÛ·, Ì ÌÔÏ˘Ṳ̂ӷ ·ÓÙÈΛÌÂÓ·, fiˆ˜ ›‰Ë ÎÔÌ̈ÙÈ΋˜, ÚÔ‡¯·, η¤Ï·, ÂÙÛ¤Ù˜, ÎÏÈÓÔÛοÛÌ·Ù·, ·ÎÔ˘ÛÙÈο ÙËÏÂʈÓÈÎÒÓ Û˘Û΢ÒÓ, ·È¯Ó›‰È· Î.¿. (48,49). ∫ÔÓ›‰È· (ÛfiÚÈ·) Ì˘Î‹ÙˆÓ ¤¯Ô˘Ó ·ÔÌÔÓˆı› fi¯È ÌfiÓÔÓ Û ÙÚ›¯Â˜ ·Û¯fiÓÙˆÓ Ô˘ ¤¯Ô˘Ó ·Ô¤ÛÂÈ, ·ÏÏ¿ Î·È Û ÌÔÏ˘Ṳ̂ӷ ·ÓÙÈΛÌÂÓ· Î·È ¤ÈÏ· ÙÔ˘ ÛÈÙÈÔ‡.
¶›Ó·Î·˜ 2. ∂›‰Ë ‰ÂÚÌ·ÙfiÊ˘ÙˆÓ Ô˘ ·ÔÌÔÓÒıËÎ·Ó Û ·È‰È¿ ÌÂ Ì˘ÎËÙ›·ÛË ÙÔ˘ ÙÚȯˆÙÔ‡ Ù˘ ÎÂÊ·Ï‹˜ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô “∞. ™˘ÁÁÚfi˜”ηٿ ÙËÓ ÂÍ·ÂÙ›· 1996-2001 °ËÁÂÓ›˜ªÂÙ·Ó¿ÛÙ˜ ¢ÂÚÌ·ÙfiÊ˘ÙÔNo%A£∞£
M. canis 45487,12331633226
T. violaceum 316,010867
M. audouinii 9 1,7--81
T. mentagrÔphytes var ment 6 1,2411M. ferrugineum 7 1,3--61
M. gypseum 5 1,041--
T. verrucosum 2 0,42---
T. soudanense 3 0,6--21
T. rubrum 2 0,42---
T. schoenleinii 1 0,2---1
T. erinacei 1 0,2---1
™‡ÓÔÏÔ 521100,02551735538
ÂÓÒ ÙÔ ÂÚÈÙÚ›¯ÈÔ ·Ú·Ì¤ÓÂÈ ¿ıÈÎÙÔ. ∏ ÙÚ›¯· Á›ÓÂÙ·È
‡ıÚ·˘ÛÙË Î·È Û¿ÂÈ ÛÙËÓ ÂÈÊ¿ÓÂÈ· ÙÔ˘ ÙÚȯˆÙÔ‡, ·Ê‹ÓÔÓÙ·˜ ÛÙÔ ÛËÌÂ›Ô ÂΛÓÔ ¤Ó· Ì·‡ÚÔ ÛÙ›ÁÌ· (black dot) (7,58).
¢È¿ÁÓˆÛË
∏ ‰È¿ÁÓˆÛË ÙˆÓ ª∆∫ Û˘Ó‹ıˆ˜ ‚·Û›˙ÂÙ·È ÛÙËÓ
Ù˘È΋ ÎÏÈÓÈ΋ ÂÈÎfiÓ· Ì ÏÂȉ҉ÂȘ ϿΘ, ·ÔÎÔÌ̤Ó˜ ÙÚ›¯Â˜ Î·È ‰ÈfiÁΈÛË ÙˆÓ ÙÚ·¯ËÏÈÎÒÓ ·‰¤ÓˆÓ. ∏ ÂȂ‚·›ˆÛË Á›ÓÂÙ·È Ì ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô. ∏ ‰È·‰Èηۛ· ·˘Ù‹ ı· Ú¤ÂÈ Ó· ÂÊ·ÚÌfi-
˙ÂÙ·È Û οı ÌÈÎÚfi ·ÛıÂÓ‹ Ô˘ ·ÚÔ˘ÛÈ¿˙ÂÈ ·fi-
ÙˆÛË ÙˆÓ ÙÚȯÒÓ Î·È ¤ÓÙÔÓË ·ÔϤÈÛË, ¿Û¯ÂÙ·
·fi ÙËÓ ÂÌÊ¿ÓÈÛË Ù˘È΋˜ ‹ ÌË ÎÏÈÓÈ΋˜ ÂÈÎfiÓ·˜
Ì˘ÎËÙ›·Û˘ ÙÔ˘ ÙÚȯˆÙÔ‡ Ù˘ ÎÂÊ·Ï‹˜.
∫ÏÈÓÈ΋ ÂÈÎfiÓ·
∆Ô Î‡ÚÈÔ ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÙˆÓ ª∆∫ Â›Ó·È Ë ·fi-
ÙˆÛË ÙˆÓ ÙÚȯÒÓ Ô˘ Û˘¯Ó¿ Û˘Óԉ‡ÂÙ·È ·fi ÛËÌ›· ÊÏÂÁÌÔÓ‹˜, fiˆ˜ ·ÔϤÈÛË, ı˘Ï·ÎÈο ÊÏ˘ÎÙ·ÈÓ›‰È· Î·È ÎÓËÛÌfi. OÈ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ÔÈΛÏÏÔ˘Ó.O ‚·ıÌfi˜ ‚·Ú‡ÙËÙ·˜ ÙˆÓ ‚Ï·‚ÒÓ ÂÍ·ÚÙ¿Ù·È ·fi ÙÔ Â›‰Ô˜ ÙÔ˘ ˘Â‡ı˘ÓÔ˘ ̇ÎËÙ· Î·È ÙËÓ ·ÓÔÛ›· ÙÔ˘ ÍÂÓÈÛÙ‹.
¢È·ÎÚ›ÓÔÓÙ·È ÔÈ·ÎfiÏÔ˘ıÔÈÙ‡ÔÈ: ÌÈÎÚÔÛÔڛ˜, ÙÚȯÔÊ˘Ù›Â˜, ¿¯ÔÚ·˜Î·È ÎËÚ›Ô. ∂ÎÙfi˜ ·fi ÙËÓ Ù·ÍÈÓfiÌËÛË ·˘Ù‹, ÔÈ ª∆∫ ‰È·ÎÚ›ÓÔÓÙ·È Û ÌË ÊÏÂÁÌÔÓÒ‰ÂȘ Î·È ÊÏÂÁÌÔÓÒ‰ÂȘ ÌÔÚʤ˜ (7,49,59).
·) ªÈÎÚÔÛÔڛ˜: ÷ڷÎÙËÚ›˙ÔÓÙ·È ·fi Ì›· ÌÂÌÔӈ̤ÓË (Û·ÓÈfiÙÂÚ· ‰‡Ô ‹ ÂÚÈÛÛfiÙÂÚ˜) ΢ÎÏÈ΋ ÏÂÈ‰Ò‰Ë Ï¿Î· ‰È·Ì¤ÙÚÔ˘ 2-5 cm, ÂÏ·ÊÚÒ˜ ÂÚ˘ıËÌ·ÙÒ‰Ë, Ë ÂÈÊ¿ÓÂÈ· Ù˘ ÔÔ›·˜ ηχÙÂÙ·È ·fi ÎÔÌ̤Ó˜ ÙÚ›¯Â˜ Û ‡„Ô˜ 2-3 cm ¿Óˆ ·fi ÙËÓ ÂÈÊ¿ÓÂÈ· ÙÔ˘ ‰¤ÚÌ·ÙÔ˜. OÈ ÚÔۂ‚ÏË̤Ó˜ ÙÚ›¯Â˜ Â›Ó·È Ê·È¤˜ Î·È ·Ï·Ì›˜ ÏfiÁˆ Ù˘ ÂÈÎ¿Ï˘„‹˜ ÙÔ˘˜ ·fi Ù· ·ÚıÚÔÎÔÓ›‰È· ÙˆÓ ÂÍÒÙÚȯˆÓ ‰ÂÚÌ·ÙfiÊ˘ÙˆÓ. ø˜ › ÙÔ Ï›ÛÙÔÓ, Â›Ó·È ÌË ÊÏÂÁÌÔÓÒ‰ÂȘ Î·È Û˘Ó‰¤ÔÓÙ·È Ì ÙÔ ˙ˆfiÊÈÏÔ Â›‰Ô˜ M. canis Î·È Û·ÓÈfiÙÂÚ· Ì ٷ ·ÓıÚˆfiÊÈÏ· ›‰Ë M. audouinii Î·È ª. ferrugineum (∂ÈÎfiÓ· 1). ‚) ∆ÚȯÔÊ˘Ù›Â˜: ÷ڷÎÙËÚ›˙ÔÓÙ·È ·fi ÙË ÌÔÚÊ‹ ÌÈÎÚÒÓ ‰È¿Û·ÚÙˆÓ ÔÏ˘ÁˆÓÈÎÒÓ Ï·ÎÒÓ Ì ÈÙ˘ÚÒ‰Ë ·ÔϤÈÛË, Ì ·ÔÎÔÌ̤Ó˜ ÙÚ›¯Â˜ ÛÙÔ ÛËÌÂ›Ô Ù˘ ¤ÎÊ˘Û‹˜ ÙÔ˘˜. ∆Ô ˘fiÏÂÈÌÌ· Ù˘ ÙÚ›¯·˜ ̤۷ ÛÙÔÓ ı‡Ï·Î· ‰›ÓÂÈ ÙËÓ ÂÈÎfiÓ· Ì·‡ÚÔ˘ ÛÙ›ÁÌ·ÙÔ˜ (black dots). O ÌË ÊÏÂÁÌÔÓ҉˘ Ù‡Ô˜ ·ÚÔ˘ÛÈ¿˙ÂÈ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÔÌÔÈ¿˙Ô˘Û· Ì ÙË ÛÌËÁÌ·ÙÔÚÚÔ˚΋ ‰ÂÚÌ·Ù›Ùȉ·. OÈ Ï¿Î˜ Û˘¯Ó¿ Û˘ÚÚ¤Ô˘Ó, Û¯ËÌ·Ù›˙ÔÓÙ·˜ ÌÂÁ·Ï‡ÙÂÚ˜ Ì ·ÔϤÈÛË Î·È ÛËÌ›· ‹È·˜ ÊÏÂÁÌÔÓ‹˜. ªÂٷ͇ ÙˆÓ ÚÔۂ‚ÏËÌ¤ÓˆÓ ÙÚȯÒÓ ˘¿Ú¯Ô˘Ó ˘ÁÈ›˜ ÙÚ›¯Â˜ ‹/Î·È Ì·‡Ú· ÛÙ›ÁÌ·Ù·, Ù· ÔÔ›· Â›Ó·È ÂÍ·ÈÚÂÙÈο
tonsurans Î·È T. violaceum (∂ÈÎfiÓ˜ 2 Î·È 3). Á) ŒÌ˘Ô˜ ÙÚȯÔÊ˘Ù›·/ÎËÚ›ÔÓ Î¤ÏÛÔ˘: ÷ڷÎÙËÚ›˙ÂÙ·È ·fi ÂÒ‰˘Ó˜ ‚Ï·ÙȉÔÔ˙Ò‰ÂȘ ϿΘ, Ì ÊÏ˘ÎÙ·ÈÓ›‰È· Ô˘ ηχÙÔÓÙ·È ·fi ÌÂÏÈÙfi¯ÚÔ˜ ÂÊÂÏΛ‰Â˜. ∞fi Ù· ÛÙfiÌÈ· ÙˆÓ ÙÚȯÔÛÌËÁÌ·ÙÔÁfiÓˆÓ ı˘Ï¿ÎˆÓ ÂͤگÂÙ·È ‡ÔÓ Î·È ˘¿Ú¯ÂÈ ·fiÙˆÛË ÙˆÓ ÙÚȯÒÓ. ∂›Ó·È ÎÓËÛÌ҉˘ Î·È Û˘¯Ó¿ Û˘Óԉ‡ÂÙ·È ·fi ˘ÚÂÙfi Î·È ÙÚ·¯ËÏÈ΋ ÏÂÌÊ·‰ÂÓ›Ùȉ·.
∏ ÊÏÂÁÌÔÓ҉˘ ·˘Ù‹ ÌÔÚÊ‹ Û˘Ó‰¤ÂÙ·È Ì ˙ˆfiÊÈÏÔ˘˜ ‹ ÁÂÒÊÈÏÔ˘˜ ̇ÎËÙ˜, fiˆ˜ Ù· ª. canis, T. verrucosum, T. mentagrophytes var mentagrophytes, M. nanum, M. gypseum ηÈ, Û·ÓÈfiÙÂÚ·, Ì Ùo ·ÓıÚˆfiÊÈÏo ›‰o˜ ∆. violaceum (∂ÈÎfiÓ· 4). ‰) Õ¯ÔÚ·˜: ¶ÚfiÎÂÈÙ·È ÁÈ· Û·ÓÈfiÙ·ÙË ÓfiÛÔ ÛÙË ¯ÒÚ· Ì·˜. ∂ÌÊ·Ó›˙ÂÈ ¯·Ú·ÎÙËÚÈÛÙÈΤ˜ ‚Ï¿‚˜, Ù· ÛÎ˘Ê›·, ‰ËÏ. ΢ÂÏÏÔÂȉ›˜ Û¯ËÌ·ÙÈÛÌÔ‡˜ Ù˘ ÂȉÂÚÌ›‰·˜, ÛÙÚÔÁÁ˘ÏÔ‡ Û¯‹Ì·ÙÔ˜, ÛÙÔ Î¤ÓÙÚÔ ÙˆÓ
ÔÔ›ˆÓ ˘¿Ú¯ÂÈ Û˘Ó‹ıˆ˜ ÌÔÓ‹Ú˘, ÍËÚ‹, ·Ï·Ì‹˜
ÙÚ›¯·. ∆· ÛÎ˘Ê›· ¤¯Ô˘Ó ¯ÚÒÌ· ÎÈÙÚÈÓfiÊ·ÈÔ Î·È ·Ó·‰›‰Ô˘Ó ¯·Ú·ÎÙËÚÈÛÙÈ΋ ‰˘Û¿ÚÂÛÙË ÔÛÌ‹. OÈ
ÙÚ›¯Â˜ ‰ÂÓ Â›Ó·È Â‡ıÚ·˘ÛÙ˜ fiˆ˜ ÛÙȘ ¿ÏϘ ÌÔÚʤ˜. ∞ÈÙÈÔÏÔÁÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÙÔ˘ ¿¯ÔÚ· Â›Ó·È ÙÔ ·ÓıÚˆfiÊÈÏÔ Â›‰Ô˜ T. schoenleinii (∂ÈÎfiÓ· 5).
∂ÚÁ·ÛÙËÚȷ΋ ‰È¿ÁÓˆÛË ∏ ÂÚÁ·ÛÙËÚȷ΋ ÌÂıÔ‰ÔÏÔÁ›· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ
¿ÌÂÛË ÌÈÎÚÔÛÎÔÈ΋ ÂͤٷÛË ÙˆÓ Ï›ˆÓ, ÙÚȯÒÓ Î·È ı˘Ï¿ÎˆÓ, ÙËÓ Î·ÏÏȤÚÁÂÈ· ÁÈ· ÙËÓ ·ÔÌfiÓˆÛË
ÙÔ˘ ˘Â‡ı˘ÓÔ˘ ̇ÎËÙ· Î·È ÙËÓ Ù·˘ÙÔÔ›ËÛË. ∏ ‚ÈÔ„›· Û·Ó›ˆ˜ ÂӉ›ÎÓ˘Ù·È ÁÈ· ÙËÓ ÂÚÁ·ÛÙËÚȷ΋ ‰È¿ÁÓˆÛË ÙˆÓ ª∆∫. ¶ÚˆÙ·Ú¯È΋˜ ÛËÌ·Û›·˜ ÁÈ· ÙȘ
·Ú·¿Óˆ Ì˘ÎËÙÔÏÔÁÈΤ˜ ÂÍÂÙ¿ÛÂȘ Â›Ó·È Ë ÂÈÏÔÁ‹ Î·È Û˘ÏÏÔÁ‹ ÙÔ˘ ηٿÏÏËÏÔ˘ ‰Â›ÁÌ·ÙÔ˜. ∏
ÌË ÛˆÛÙ‹ Ï‹„Ë ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û „¢‰Ò˜ ·ÚÓËÙÈο ·ÔÙÂϤÛÌ·Ù·. ∏ Û˘ÏÏÔÁ‹ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜
∂ÈÎfiÓ· 1. ªÈÎÚÔÛÔÚ›· ·fi ÙÔÓ Ì‡ÎËÙ· Microsporum canis.
ÂÈÙÂÏÂ›Ù·È Ì ̛· ÛÂÈÚ¿ ·ÓÒ‰˘ÓˆÓ Ù¯ÓÈÎÒÓ. ªÂ ÙË
‚Ô‹ıÂÈ· ·ÔÛÙÂÈڈ̤ÓÔ˘ ·È¯ÌËÚÔ‡ ͤÛÙÚÔ˘, ‚Ô‡ÚÙÛ·˜ Ì›·˜ ¯Ú‹Û˘, ÙÚȯÔÏ·‚›‰·˜ ‹/Î·È ‚·Ì‚·-
ÎÔÊfiÚÔ˘ ÛÙ˘ÏÂÔ‡ Û˘ÏϤÁÔÓÙ·È ·fi ÙËÓ ÂÚÈÔ¯‹
ÙˆÓ ·ÏÏÔÈÒÛÂˆÓ Ï¤È·, ÙÚ›¯Â˜ Î·È ÂÚȯfiÌÂÓ· ı˘-
ϿΈÓ, Ù· ÔÔ›· ʤÚÔÓÙ·È Û ηı·Ú‹ ·ÓÙÈÎÂÈÌÂÓÔ-
ÊfiÚÔ Ï¿Î·. OÈ ÚÔۂ‚ÏË̤Ó˜ ÙÚ›¯Â˜ ·ÔÛÒ-
ÓÙ·È ¯ˆÚ›˜ ·ÓÙ›ÛÙ·ÛË, ·ÓÒ‰˘Ó·, Ì ͤÛÙÚÔ ‹ ÌÂ
ÙÚȯÔÏ·‚›‰·. ∂¿Ó ‰ÂÓ ˘¿Ú¯Ô˘Ó ÂÌÊ·Ó›˜ ‚Ï¿‚˜,
Ì›· ¿ÏÏË ÈηÓÔÔÈËÙÈ΋ ̤ıÔ‰Ô˜ Â›Ó·È ÙÔ ‚Ô‡ÚÙÛÈ-
ÛÌ· ÙÔ˘ ÙÚȯˆÙÔ‡ Ù˘ ÎÂÊ·Ï‹˜ Ì ԉÔÓÙfi‚Ô˘ÚÙÛ·
Ì›·˜ ¯Ú‹Û˘, Ë ÔÔ›·, ÛÙË Û˘Ó¤¯ÂÈ·, ʤÚÂÙ·È ÛÂ
·ʋ Ì ÙËÓ ÂÈÊ¿ÓÂÈ· ÙÔ˘ ıÚÂÙÈÎÔ‡ ˘ÔÛÙÚÒÌ·ÙÔ˜. ™Â ÂÒ‰˘Ó˜ ÊÏÂÁÌÔÓÒ‰ÂȘ ·ÏÏÔÈÒÛÂȘ, Ë
Ï‹„Ë Ï›ˆÓ Î·È ÙÚȯÒÓ Û˘¯Ó¿ ‰ÂÓ Â›Ó·È ÂÊÈÎÙ‹.
™ÙȘ ÂÚÈÙÒÛÂȘ ·˘Ù¤˜, Û˘ÏϤÁÂÙ·È ‡ÔÓ Ì ‚·Ì-
‚·ÎÔÊfiÚÔ ÛÙ˘ÏÂfi. ªÂ ÙÔÓ ÙÚfiÔ ·˘Ùfi Â›Ó·È ‰˘Ó·-
Ù‹ Ë ÌÂÙ·ÊÔÚ¿ ı˘Ï¿ÎˆÓ Î·È ÌÂÁ¿ÏÔ˘ ·ÚÈıÌÔ‡ ÎÔ-
Óȉ›ˆÓ, ÒÛÙ ӷ ·Ó·Ù˘¯ı› Ô Ì‡ÎËÙ·˜ ÛÙËÓ Î·ÏÏȤÚÁÂÈ· (60).
∏ ¯Ú‹ÛË Ù˘ Ï˘¯Ó›·˜ Wood ÚÔÛʤÚÂÈ ÛËÌ·ÓÙÈ΋ ‚Ô‹ıÂÈ· ÛÙÔÓ ÂÓÙÔÈÛÌfi ÙˆÓ Â͈ÙÚȯÈÎÒÓ ·ÏÏÔÈÒÛÂˆÓ Ô˘ ÚÔηÏÔ‡Ó ÔÚÈṲ̂ӷ ›‰Ë ÙÔ˘ Á¤-
ÓÔ˘˜ Microsporum. ™ÙÔ ˘ÂÚÈ҉˜ ʈ˜ Ù˘ Ï˘¯Ó›·˜ (3650 Å), ÔÈ ÚÔۂ‚ÏË̤Ó˜ ÙÚ›¯Â˜ ÂΤÌÔ˘Ó ¤ÓÙÔÓÔ ÊıÔÚÈÛÌfi. O ÊıÔÚÈÛÌfi˜ ÔÊ›ÏÂÙ·È
ÛÙÔÓ ÌÂÙ·‚ÔÏÈÛÌfi Ù˘ ÙÚ˘ÙÔÊ¿Ó˘, Ë ÔÔ›· Û˘ÛÛˆÚ‡ÂÙ·È ÛÙȘ ÚÔۂ‚ÏË̤Ó˜ ÙÚ›¯Â˜, ÔÈ Ôԛ˜ ‰ÈÂÁ›ÚÔÓÙ·È Î·È ÊıÔÚ›˙Ô˘Ó (7). £· Ú¤ÂÈ Ó· ÛËÌÂȈı› fiÙÈ ÙÔÈ΋ ıÂڷ›· ÂÓ‰¤¯ÂÙ·È Ó· ÂËÚ¿ÛÂÈ ÙÔ ·ÔÙ¤ÏÂÛÌ· Ù˘ ÂͤٷÛ˘, ‰›‰ÔÓÙ·˜ ·¯Ófi ÊıÔÚÈÛÌfi ‹ „¢‰Ò˜ ·ÚÓËÙÈÎfi ·ÔÙ¤ÏÂÛÌ·, ÂÚÈÔÚ›˙ÔÓÙ·˜ ¤ÙÛÈ ÙËÓ ÂȉÈÎfiÙËÙ· Ù˘ ÌÂıfi‰Ô˘ (28). ™ÙȘ ÂÓ‰ÔÙÚȯÈΤ˜ ÏÔÈÌÒÍÂȘ ‰ÂÓ ·Ú·ÙËÚ›ٷÈ
ÊıÔÚÈÛÌfi˜, ÂÓÒ ÛÙÔÓ ¿¯ÔÚ· ÔÈ ÚÔۂ‚ÏË̤Ó˜ ÙÚ›¯Â˜ ‰È·ÙËÚÔ‡ÓÙ·È ·Ó¤·Ê˜ Î·È ÂΤÌÔ˘Ó
·¯Ófi ÊıÔÚÈÛÌfi. ∂Âȉ‹ Ô ·ÚÈıÌfi˜ ÙˆÓ ÏÔÈÌÒ͈Ó
·fi ÂÓ‰fiÙÚÈ¯Ô˘˜ ̇ÎËÙ˜ ¤¯ÂÈ ·˘ÍËı› ÛËÌ·ÓÙÈο Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, Ë ¯Ú‹ÛË Ù˘ Ï˘¯Ó›·˜ Wood ¤¯ÂÈ ÌÂÚÈ΋ ‰È·ÁÓˆÛÙÈ΋ ·Í›· ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô ÌÂÁ¿ÏÔ˘ ·ÚÈıÌÔ‡ ·ÙfïÓ, fiˆ˜ ÁÈ· ÂȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜ ÛÙ· Û¯ÔÏ›· Î·È ÁÈ· ÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË Ù˘ ıÂڷ›·˜ ÙÔ˘ ·ÛıÂÓÔ‡˜.
∂ÈÎfiÓ· 3. ∆ÚȯÔÊ˘Ù›· „ˆÚÈ·ÛÈ΋˜ ÌÔÚÊ‹˜ ·fi ÙÔÓ Ì‡ÎËÙ· Trichophyton violaceum. ∂ÈÎfiÓ· 2. ∆ÚȯÔÊ˘Ù›· ·fi ÙÔÓ Ì‡ÎËÙ· Trichophyton violaceum.
∫O∏ 20% (‰È·˘Á·ÛÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜), ηχÙÂÙ·È
ÌÂ Î·Ï˘ÙÚ›‰· Î·È ÌÈÎÚÔÛÎÔÂ›Ù·È Ì ÍËÚfi Ê·Îfi x10 ÁÈ· ÙËÓ ÂÓÙfiÈÛË ÙˆÓ ÌÔÚÊÔÏÔÁÈÎÒÓ ÛÙÔȯ›ˆÓ, ÂÓÒ ÁÈ· ÂȂ‚·›ˆÛË ··ÈÙÂ›Ù·È ·ÓÙÈÎÂÈÌÂÓÈÎfi˜ Ê·Îfi˜ x40. ªÂ ÙËÓ ¿ÌÂÛË ÌÈÎÚÔÛÎÔÈ΋ ÂͤٷÛË ·ÓȯÓ‡ÔÓÙ·È Ù· ΢ÙÙ·ÚÈο ÛÙÔȯ›· Ù˘ ·Ú·ÛÈÙÈ΋˜ ÌÔÚÊ‹˜ ÙÔ˘ ̇ÎËÙ·. ™Ù· Ϥȷ ·Ó·˙ËÙÔ‡ÓÙ·È ÔÈ ˘·ÏÔÂȉ›˜, Û˘¯Ó¿ ‰È·ÎÏ·‰È˙fiÌÂÓ˜, ˘Ê¤˜ (ÓËÌ¿ÙÈ·) Ì ‰È·ÊÚ·ÁÌ¿ÙÈ· Î·È ÔÈ ·Ï‡ÛÂȘ ÙˆÓ ·ÚıÚÔÎÔÓȉ›ˆÓ, ÔÈ Ôԛ˜ ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙÔÓ Î·Ù·ÎÂÚÌ·ÙÈÛÌfi ÙˆÓ ˘ÊÒÓ, ÂÓÒ ÛÙȘ ÙÚ›¯Â˜ Ë ‰È¿Ù·ÍË Î·È ÙÔ Ì¤ÁÂıÔ˜ ÙˆÓ ÎÔÓȉ›ˆÓ, ÌÔÚÊÔÏÔÁÈÎÔ› ¯·Ú·ÎÙ‹Ú˜ Ô˘ ÌÔÚ› Ó· ÚÔÛ‰ÈÔÚ›ÛÔ˘Ó ÙÔ Á¤ÓÔ˜ ÙÔ˘ ˘Â‡ı˘ÓÔ˘ ̇ÎËÙ·. ™Â ·ÛıÂÓ›˜ Ì ÊÏÂÁÌÔÓÒ‰ÂȘ ‚Ï¿‚˜, ÛÙÔȯ›· ÙÔ˘ ̇ÎËÙ· Û¿ÓÈ· ·Ó¢ڛÛÎÔÓÙ·È ÛÙ· ¿ÌÂÛ· ·Ú·Û΢¿ÛÌ·Ù·. OÙÈο ÛÊ¿ÏÌ·Ù· ‰ÂÓ ·ÔÎÏ›ÔÓÙ·È (60).
∏ ¿ÌÂÛË ÌÈÎÚÔÛÎfiËÛË Â›Ó·È Ù·¯Â›· Î·È ·ÍÈfiÈÛÙË ‰È·ÁÓˆÛÙÈ΋ ̤ıÔ‰Ô˜. ∏ ¢·ÈÛıËÛ›· Î·È Ë ÂȉÈÎfiÙËÙ¿ Ù˘, fï˜, ÂÍ·ÚÙÒÓÙ·È ·fi ÙÔÓ ·ÚÈıÌfi ÙˆÓ Ì˘Î‹ÙˆÓ ÛÙÔ ·Ú·Û··ÛÌ·, ·fi Ù˘¯fiÓ ÚÔÁÂÓ¤ÛÙÂÚË ıÂڷ›· Î·È ·fi ÙËÓ ÂÌÂÈÚ›· ÙÔ˘ ÂÚÁ·ÛÙËÚÈ·ÎÔ‡ È·ÙÚÔ‡. ∏ ıÂÙÈ΋ ¿ÌÂÛË ÌÈÎÚÔÛÎÔÈ΋ ÂͤٷÛË ÂȂ‚·ÈÒÓÂÈ ÙËÓ ÎÏÈÓÈ΋ ‰È¿ÁÓˆÛË Î·È ÂÈ-
∂ÈÎfiÓ· 4. ŒÌ˘Ô˜ ‰ÂÚÌ·ÙÔÊ˘Ù›· ·fi ÙÔÓ Ì‡ÎËÙ· Microsporum gypseum.
ÙÚ¤ÂÈ ÙËÓ ¤Ó·ÚÍË ıÂڷ›·˜. ¶·Ú¿ Ù·‡Ù·, Ë ÌË
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 ÂÍÒÙÚȯË
Ïԛ̈ÍË, ÔÈ ˘Ê¤˜ ηٷÎÂÚÌ·Ù›˙ÔÓÙ·È Û ÌÈÎÚÔ‡ ÌÂÁ¤ıÔ˘˜ ·ÚıÚÔÎÔÓ›‰È· (ÛfiÚÈ·), Ù· ÔÔ›· ηχÙÔ˘Ó ÙËÓ ÂÈÊ¿ÓÂÈ· Î·È ÂÚÈ‚¿ÏÏÔ˘Ó ÙÔ Û٤ϯԘ
Ù˘ ÙÚ›¯·˜, ÚÔηÏÒÓÙ·˜ ÔÚÈÛÙÈ΋ ηٷÛÙÚÔÊ‹ ÙÔ˘ ÂÚÈÙÚȯ›Ô˘. ∞ÓÙ›ıÂÙ·, ÛÙËÓ ÂÓ‰ÔÙÚȯÈ΋ Ïԛ̈ÍË, Ù· ·ÚıÚÔÎÔÓ›‰È· Â›Ó·È ÌÂÁ·Ï‡ÙÂÚÔ˘ ÌÂÁ¤ıÔ˘˜,
·Ú·Ì¤ÓÔ˘Ó ÛÙÔ Û٤ϯԘ Ù˘ ÙÚ›¯·˜, ¯ˆÚ›˜ fï˜ Ó· ·Ú·ÙËÚÂ›Ù·È Î·Ù·ÛÙÚÔÊ‹ ÙÔ˘ ÂÚÈÙÚȯ›Ô˘. ™ÙÔÓ ¿¯ÔÚ·, ÔÈ ÙÚ›¯Â˜ ̤ÓÔ˘Ó ·Ó¤·Ê˜ Î·È ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ÙËÓ ·Ó‡ÚÂÛË ÌfiÓÔ ÓËÌ·Ù›ˆÓ ηٿ Ì‹ÎÔ˜ Ù˘ ÙÚ›¯·˜, ÏÈÔÛÊ·ÈÚ›ˆÓ Î·È ÎÂÓÒÓ ·¤ÚÔ˜ (61). °È· ÙËÓ ÂȂ‚·›ˆÛË ÙÔ˘ ·ÔÙÂϤÛÌ·ÙÔ˜ Ù˘ ¿ÌÂÛ˘ ÌÈÎÚÔÛÎÔÈ΋˜ ÂͤٷÛ˘ Î·È ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙÔ˘ ·ÈÙÈÔÏÔÁÈÎÔ‡ ·Ú¿ÁÔÓÙ·, fiÏ· Ù· ÏËÊı¤ÓÙ· ‰Â›ÁÌ·Ù· Ú¤ÂÈ Ó· ηÏÏÈÂÚÁÔ‡ÓÙ·È.
‚·ÛÈ΋ ÂͤٷÛË ÁÈ· ÙË ‰È¿ÁÓˆÛË Ù˘ Ì˘ÎËÙÈ·ÛÈ΋˜ Ïԛ̈͢. ∆· ıÚÂÙÈο ˘ÔÛÙÚÒÌ·Ù· Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Û˘Ó‹ıˆ˜ ÁÈ· ÙȘ ÚˆÙÔηÏÏȤÚÁÂȘ ÙˆÓ ‰ÂÚÌ·ÙfiÊ˘ÙˆÓ Â›Ó·È Ù· Sabouraud ‹ potato dextrose ¿Á·Ú ÂÌÏÔ˘ÙÈṲ̂ÓÔ
∂ÈÎfiÓ· 5. Õ¯ÔÚ·˜·fi ÙÔÓ Ì‡ÎËÙ· Trichophyton schoenleinii.
Ù˘ ·Ó¿Ù˘Í˘ ÙˆÓ ‚·ÎÙËÚȉ›ˆÓ Î·È ÙˆÓ Û·ÚÔÊ˘ÙÈÎÒÓ Ì˘Î‹ÙˆÓ. ∆· ÙÂÏÂ˘Ù·›· ·Ó·Ù‡ÛÛÔÓÙ·È
Ù·¯‡Ù·Ù·, Ì ·ÔÙ¤ÏÂÛÌ· Ó· ˘ÂÚηχÙÔ˘Ó Ù·
‚Ú·‰¤ˆ˜ ·Ó·Ù˘ÛÛfiÌÂÓ· ‰ÂÚÌ·ÙfiÊ˘Ù·. ∏ ÂÒ·-
ÛË ÌÔÚ› Ó· Á›ÓÂÈ Û ıÂÚÌÔÎÚ·Û›· ‰ˆÌ·Ù›Ô˘, ·Ï-
Ï¿ Û˘ÓÈÛÙ¿Ù·È ÎÏ›‚·ÓÔ˜ ÛÙ·ıÂÚ‹˜ ıÂÚÌÔÎÚ·Û›·˜.
∏ ¿ÚÈÛÙË ıÂÚÌÔÎÚ·Û›· ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ÙˆÓ ‰ÂÚ-
Ì·ÙfiÊ˘ÙˆÓ Â›Ó·È 26-28ÔC Î·È Ô ¯ÚfiÓÔ˜ ÂÒ·Û˘ 24 ‚‰ÔÌ¿‰Â˜. OÈ Î·ÏÏȤÚÁÂȘ ı· Ú¤ÂÈ Ó· ÂϤÁ-
¯ÔÓÙ·È Û˘¯Ó¿ ÁÈ· ÙË ‰È·›ÛÙˆÛË ·Ó¿Ù˘Í˘ ÙÔ˘
·ıÔÁfiÓÔ˘ ̇ÎËÙ· Î·È Ù˘¯fiÓ ÂÈÌÔχÓÛÂȘ ·fi
Û·ÚÔÊ˘ÙÈÎÔ‡˜ ̇ÎËÙ˜ (62).
O
ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙÔ˘ Á¤ÓÔ˘˜ Î·È ÙÔ˘ ›‰Ô˘˜
ÙÔ˘ ·ıÔÁfiÓÔ˘ ̇ÎËÙ· (Ù·˘ÙÔÔ›ËÛË) Â›Ó·È ··-
Ú·›ÙËÙÔ˜ ÁÈ· ÙËÓ ÂÈÏÔÁ‹ ÙÔ˘ ηٿÏÏËÏÔ˘ 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· ÂȉËÌÈÔ-
ÏÔÁÈÎÔ‡˜ ÏfiÁÔ˘˜. ∂ÈÙ˘Á¯¿ÓÂÙ·È Ì ÙËÓ ·Ú·Ù‹ÚËÛË
Ù˘ Ì·ÎÚÔÛÎÔÈ΋˜ ÌÔÚÊÔÏÔÁ›·˜ ÙˆÓ ·ÔÈÎÈÒÓ ÙÔ˘
̇ÎËÙ·, ηıÒ˜ Î·È Ì ÙË ÏÂÙÔÌÂÚ‹ ÌÂϤÙË Ù˘ ÌÈ-
ÎÚÔÛÎÔÈ΋˜ ÌÔÚÊÔÏÔÁ›·˜ ÙÔ˘, ‰ËÏ. Ù˘ ‰ÔÌ‹˜ ÙˆÓ
ÓËÌ·Ù›ˆÓ Î·È Ù˘ ÌÔÚÊÔÏÔÁ›·˜ ÙˆÓ ÎÔÓȉ›ˆÓ (63,64).
™˘ÌÂÚ¿ÛÌ·Ù·
ªÂ ‚¿ÛË Ù· ÛÙ·ÙÈÛÙÈο ÛÙÔȯ›· ÙÔ˘ ÓÔÛÔÎÔÌ›-
Ô˘ “∞. ™˘ÁÁÚfi˜”Î·È ÙËÓ ÂÏÏËÓÈ΋ ‚È‚ÏÈÔÁÚ·Ê›·, Û˘-
Ó¿ÁÂÙ·È fiÙÈ ÙÔ Î‡ÚÈÔ ·›ÙÈÔ ª∆∫ ÛÙË ¯ÒÚ· Ì·˜ ›ӷÈ
o ˙ˆfiÊÈÏÔ˜ ̇ÎËÙ·˜ ª. canis Î·È ‰Â˘ÙÂÚ¢fiÓÙˆ˜ Ô
·ÓıÚˆfiÊÈÏÔ˜ T. violaceum. ∏ ·Ú·ÙËÚÔ‡ÌÂÓË,
ÚfiÛÊ·Ù·, ·‡ÍËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ ÙÔ˘ ÙÂÏÂ˘Ù·›-
Ô˘, ηıÒ˜ Î·È Ë ·ÚÔ˘Û›· ÌË ÂÓ‰ËÌÈÎÒÓ ÂȉÒÓ ÛÙË
¯ÒÚ· Ì·˜ Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ÙÔ˘ ÌÂÙ·Ó·ÛÙ¢ÙÈÎÔ‡
·̷ÙÔ˜ ÙˆÓ ÙÂÏÂ˘Ù·›ˆÓ ÂÙÒÓ ·fi ¯ÒÚ˜ Ù˘ µ·Ï-
ηÓÈ΋˜, Ù˘ ∞Ó·ÙÔÏÈ΋˜ ∂˘ÚÒ˘, Ù˘ ∞Û›·˜ Î·È Ù˘ ∞ÊÚÈ΋˜, fiÔ˘ Ù· ›‰Ë ·˘Ù¿ ÂÓ‰ËÌÔ‡Ó.
°È· ÙÔÓ ÂÚÈÔÚÈÛÌfi Ù˘ ÂͿψÛ˘ ÙˆÓ ª∆∫
ÛÙ· ·È‰È¿ ··ÈÙÂ›Ù·È ÛˆÛÙ‹ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ
·‰¤ÛÔÙˆÓ ˙ÒˆÓ Ô˘ ÓÔÛÔ‡Ó, ÛˆÛÙ‹ ˘ÁÈÂÈÓ‹ ÙˆÓ
ηÙÔÈΛ‰ÈˆÓ ˙ÒˆÓ ÁÈ· ÙËÓ ÂÚ›ÙˆÛË Ô˘ Â›Ó·È ˘ÁÈ›˜ ÊÔÚ›˜ Î·È ÌÂÙ·‰›‰Ô˘Ó ÙË ÓfiÛÔ, ηıÒ˜ ›Û˘
ÛˆÛÙ‹ ·ÓÙÈÌÂÙÒÈÛË Î·È ÙˆÓ ·ÛıÂÓÒÓ ‹ ·Û˘ÌÙˆ-
Ì·ÙÈÎÒÓ 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 ÂÚÈÙÒ-
ÛÂȘ ·ÏÏÔÈÒÛÂˆÓ ÙÔ˘ ÙÚȯˆÙÔ‡ Ù˘ ÎÂÊ·Ï‹˜ ·È‰ÈÒÓ ÚÔÂÊË‚È΋˜ ËÏÈΛ·˜,
Ó·
1. Sabouraud RJ. Maladies du cruir chevelu. Les maladies desquamatiques: pityriasis et alopécies pelliculaires. Paris: Maison et cie; 1904.
2. Remak R. De morbo scrofulo. Berlin: Von Xaverus Hube; 1837.
3. Gruby D. Recherches sur la nature le siége et la développement du Porrigo declaveus ou Phytoalopécie. Comptes rendus de l’ Académie des Sciences 1843;17:301307.
4. Sabouraud RJ. Les trichophyties humaines. Paris: Rueff et cie; 1894.
5. Emmons CW. Dermatophytes. Natural grouping based on the form of the spores and accessory organs. Arch Dermatol Syph 1934;30:337-362.
6. Ajello L. Geographic distribution and prevalence of the dermatophytes. Ann NY Acad Sci 1960;89:30-38.
7. Gupta AK, Summerbell RC. Tinea capitis. Med Mycol 2000;38:255-287.
8. Romano C. Tinea capitis in Siena, Italy. An 18-year survey. Mycoses 1999;42:559-562.
9. Barlow D, Saxe N. Tinea capitis in adults. Int J Dermatol 1988;27:388-390.
10. Aste N, Pau M, Biggio P. Tinea capitis in adults. Mycoses 1996;39:299-301.
11. Rippon JW. The changing epidemiology and emerging patterns of dermatophyte species. Curr Top Med Mycol 1985;1:208-234.
12. Clayton YM. The changing pattern of tinea capitis in London schoolchildren. Mykosen 1978;1 (Suppl):S104-S107.
13. Lucky A. Tinea capitis: current concepts. Pediatr Dermatol 1985;2:224-237.
14. Hebert AA, Head ES, Macdonald EM. Tinea capitis caused by Trichophyton tonsurans. Pediatr Dermatol 1985;2:219-223.
15. Kemna ME, Elewski BE. Epidemiological survey of superficial fungal diseases. J Am Acad Dermat 1996;135:955-958.
16. Elewski B. Tinea capitis. Dermatol Clin 1996;14:23-31.
17. Rogers M, Muir D, Pritchard R. Increasing importance of Trichophyton tonsurans in childhood tinea in New South Wales. Australas J Dermatol 1993;34:5-8.
18. Hussain I, Aman S, Haroon TS, Jahangir M, Nagi AH. Tinea capitis in Lahore, Pakistan. Int J Dermatol 1994;33:255-257.
19. Ali-Shtayeh MS, Arda HM. A study of tinea capitis in Jordan (West Bank). J Trop Med Hyg 1986;89:137-141.
20. Gargoom AM, Elyazachi MB, Al-Ani SM, Duweb GA. Tinea capitis in Benghazi, Libya. Int J Dermatol 2000;39:263-265.
21. Amer M, Taha M, Tosson Z, El-Garf A. The frequency of causative dermatophytes in Egypt. Int J Dermatol 1981;20:431-434.
22. Verhagen AR. Distribution of dermatophytes causing tinea capitis in Africa. Trop Geogr Med 1974;26:101-120.
23. Figueroa JI, Hawranek T, Abraha A, Hay RJ. Tinea capitis in south-western Ethiopia: a study of risk factors for infection and carriage. Int J Dermatol 1997;36:661-666.
24. Hay RJ, Robles W, Midgley G, Moore MK, European Confederation of Medical Mycology Working Party on Tinea Capitis. Tinea capitis in Europe: new perspective on an old problem. J Eur Acad Dermatol Venereol 2001;15:229-233.
25. Aly R, Hay RJ, Del Palacio A, Galimberti R. Epidemiology of tinea capitis. Med Mycol 2000;38 (Suppl 1):S183-S188.
26. Pereiro Miguens M, Pereiro M, Pereiro M Jr. Review of dermatophytoses in Galicia from 1951 to 1987, and comparison with other areas of Spain. Mycopathologia
1991;113:65-78.
27. Koussidou-Eremondi T, Devliotou-Panagiotidou D, MourellouTsatsou O, Fotidou D, Minas A. Tinea capitis in children in northern Greece during the period 1981-1995. Mycoses 1999;42:319-322.
28. ∞ı·Ó·ÛÔÔ‡ÏÔ˘ µ, ºÚ·ÁÎÔ‡ÏË ∂, ¶··‰ÔÁˆÚÁ¿ÎË ∂, ∞Ó‰Ú¤Ô˘ ∂, ∫·ÙÛ¿Ì·˜ ∞. ª˘ÎËÙÈ¿ÛÂȘ ÙÚȯˆÙÔ‡ ÎÂÊ·Ï‹˜
ÛÂ
·È‰È¿ Î·È ÂÓ‹ÏÈΘ ηٿ ÙËÓ ÂÓÙ·ÂÙ›· 1995-1999. ¢ÂÏÙ›Ô ∂ÏÏ ªÈÎÚ ∂Ù·ÈÚ 2001;46:30-37.
29. ™·ÎÂÏÏ·Ú›Ô˘ °. ∂ȉËÌÈÔÏÔÁÈ΋ ¤Ú¢ӷ ÙˆÓ ÙÚȯԂÚÒÙˆÓ ÙÔ˘ ÙÚȯˆÙÔ‡ Ù˘ ÎÂÊ·Ï‹˜ ÂȘ ÙËÓ µ. ∂ÏÏ¿‰· [‰È‰·ÎÙÔÚÈ΋ ‰È·ÙÚÈ‚‹]. £ÂÛÛ·ÏÔÓ›ÎË: ¶·ÓÂÈÛÙ‹ÌÈÔ £ÂÛÛ·ÏÔӛ΢; 1959. 30.Marcelou-Kinti O. Le epidemiologie des teignes en Grèce. Bull Soc Fr Myc Med 1966;11:20-21.
31. ºÚ·ÁÎÔ‡ÏË ∂, ∞ı·Ó·ÛÔÔ‡ÏÔ˘ µ, ¶··‰ÔÁˆÚÁ¿ÎË ∂, ºÏÂÌÂÙ¿Î˘ ∞, ª¿ÏÎÔ˘ ¶, ∞˘ÁÂÚÈÓÔ‡ ∂. ª˘ÎËÙ›·ÛË ÙÚȯˆÙÔ‡ ÎÂÊ·Ï‹˜ ·fi ÙÔÓ Ì‡ÎËÙ· Trichophyton violaceum. ¢ÂÏÙ›Ô
∂ÏÏ ªÈÎÚ ∂Ù·ÈÚ 1998;43:370-373.
32. ºÚ·ÁÎÔ‡ÏË ∂, ∞ı·Ó·ÛÔÔ‡ÏÔ˘ µ, ¶··‰ÔÁˆÚÁ¿ÎË ∂, ºÏÂ-
ÌÂÙ¿Î˘ ∞, ª¿ÏÎÔ˘ ¶, ∞˘ÁÂÚÈÓÔ‡ ∂. ∫ÏÈÓÈÎÔÂÚÁ·ÛÙËÚȷ΋
ÌÂϤÙË Ì˘ÎËÙÈ¿ÛÂˆÓ ÙÚȯˆÙÔ‡ ÎÂÊ·Ï‹˜ ·fi ÙÔÓ Ì‡ÎËÙ· T. violaceum ÛÙËÓ Â˘Ú‡ÙÂÚË ÂÚÈÔ¯‹ ∞ıËÓÒÓ Î·Ù¿ ÙËÓ ÂÓÙ·ÂÙ›· 1995-1999. ∂ÏÏ ∂Èı ¢ÂÚÌ ∞ÊÚ 2000;11:203-206. 33. ∫Ô˘Û›‰Ô˘ £, ¶··Ìȯ·‹Ï ∂, ∞Ϥ͢ π, ºˆÙ›‰Ô˘-∑‹ÎÔ˘ ¢, ¢ÂÏ‚ÈÒÙÔ˘-¶·Ó·ÁȈٛ‰Ô˘ ¢. ª˘ÎËÙÈ¿ÛÂȘ ÙÚȯˆÙÔ‡ Ù˘ ÎÂÊ·Ï‹˜ ηٿ ÙË ‰ÂηÂÙ›· 1981-1990 ÛÙË µ. ∂ÏÏ¿‰· (ª·Î‰ÔÓ›·). ∂ÏÏ ∂Èı ¢ÂÚÌ ∞ÊÚ 1992;3:193-199.
34. ÃÚ˘Û¿ÎË ∞, ƒ·˘ÙÔÔ‡ÏÔ˘ ∞, ∫ˆÙÛÈÁÈ¿ÓË ∞, ¶¿ÁηÏË ∞. Microsporum canis Û ‰ÂÚÌ·ÙÈΤ˜ ‚Ï¿‚˜ ·È‰ÈÒÓ Î·Ù¿ ÙÔ ‰È¿ÛÙËÌ· 1986-91. ∂Ê·ÚÌ ∫ÏÈÓ ªÈÎÚ ∂ÚÁ·ÛÙ ¢È·ÁÓˆÛÙ 1995;10:207-211.
35. ÃÚÈÛÙÔÊ›‰Ô˘ ª, ¶·Ó·ÁȈÙÔÔ‡ÏÔ˘ ∂, π·Îˆ‚›‰Ô˘ ∂, ¢ËÌËÙÚ·ÎfiÔ˘ÏÔ˜ °. ∂›‰Ë ‰ÂÚÌ·ÙfiÊ˘ÙˆÓ Î·È Û˘¯ÓfiÙËÙ· ·ÔÌfiÓˆÛ˘ ·fi ·ÛıÂÓ›˜ Ì ÎÏÈÓÈ΋ ¤Ó‰ÂÈÍË ‰ÂÚÌ·ÙÔÊ˘ÙÒÛˆ˜.
¢ÂÏÙ›Ô ∂ÏÏ ªÈÎÚ ∂Ù·ÈÚ 1996;41:49-53.
36. ª·Ú¿ÎË ™, ∆ÛÂϤÓÙ˘ π. ¢ÂÚÌ·ÙÔÊ˘ÙÒÛÂȘ ÛÙËÓ ∫Ú‹ÙË Î·Ù¿ ÙË ¯ÚÔÓÈ΋ ÂÚ›Ô‰Ô 1992-1995. ¢ÂÏÙ›Ô ∂ÏÏ ªÈÎÚ ∂Ù·ÈÚ 1996;41:452-455.
37. ºÚ·ÁÎÔ‡ÏË E, Aı·Ó·ÛÔÔ‡ÏÔ˘ µ, ºÏÂÌÂÙ¿Î˘ ∞. ™¿ÓÈ· Ì˘ÎËÙ›·ÛË ÙÚȯˆÙÔ‡ Ù˘ ÎÂÊ·Ï‹˜ ·fi ÙÔÓ̇ÎËÙ· Trichophyton soudanense. ∂Ê·ÚÌ ∫ÏÈÓ ªÈÎÚ ∂ÚÁ·ÛÙ ¢È·ÁÓˆÛÙ 2000;5:182-186.
38. ºÚ·ÁÎÔ‡ÏË ∂, ∞ı·Ó·ÛÔÔ‡ÏÔ˘ µ. ª˘ÎËÙÈ¿ÛÂȘ ÙÚȯˆÙÔ‡ ÎÂÊ·Ï‹˜ ·fi Û¿ÓÈ· ›‰Ë ‰ÂÚÌ·ÙfiÊ˘ÙˆÓ Û ·È‰È¿ ÌÂÙ·Ó·ÛÙÒÓ. ∂Ê·ÚÌ ∫ÏÈÓ ªÈÎÚ ∂ÚÁ·ÛÙ ¢È·ÁÓˆÛÙ 2002;7:33-40.
39. Schwinn A, Ebert J, Brocker EB. Frequency of Trichophyton rubrum in tinea capitis. Mycoses 1995;38:1-7.
40. Romano C. Case reports. Four paediatric cases of tinea capitis due to unusual agents. Mycoses 1999;42:421-425.
41. Al Sogair S, Hay RJ. Fungal infection in children: tinea capitis. Clin Dermatol 2000;18:679-685.
42. ∫Ô˘Ì·ÓÙ¿ÎË E, ∫·ÙÔ‡Ï˘ A, ºÚ·ÁÎÔ‡ÏË E. ª˘ÎËÙÈ¿ÛÂȘ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜. ∂ÏÏ ∂Èı ¢ÂÚÌ ∞ÊÚ 1996;7:3:139-143.
43. Elewski BE. Tinea capitis: a current perspective. J Am Acad Dermatol 2000;42:1-20.
44. Elewski BE. In: Demis DJ, editor. Tinea capitis in clinical dermatology. Vol 3, Philadelphia: JB Lippincott; 1999. p. 1-23.
45. Aly R. Ecology, epidemiology and diagnosis of tinea capitis. Pediatr Infect Dis J 1999;18:180-185.
46. Babel DE, Baughman SA. Evaluation of the adult carrier state
in juvenile tinea capitis caused by Trichophyton tonsurans. J Am Acad Dermatol 1989;21:1209-1212.
47. Frieden IJ. Tinea capitis: asymptomatic carriage of infection. Pediatr Infect Dis J 1999;18:186-190.
48. Mackenzie DW. The extra-human occurrence of T. tonsurans var sulfureum in a residential school. Sabouraudia 1961;1:58-64.
49. Elewski BE. Cutaneous mycoses in children. Br J Dermatol 1996;134 (Suppl 46):S7-S11.
50. Mackenzie DW, Burrow D, Wally AL. Trichophyton sulfureum in a residential school. BMJ 1960;2:1055-1058.
51. Hay RJ, Clayton YM, De Silva N, Midgley G, Rossor E. Tinea capitis in south-east London: a new pattern of infection with public health implications. Br J Dermatol 1996;135:955-958.
52. Cuetara MS, del Palacio A, Pereiro M, Amor E, Alvarez C, Noriega AR. Prevalence of undetected tinea capitis in a school survey in Spain. Mycoses 1997;40:131-137.
53. Polonelli L, Garcovich A, Morace G. Dermatophyte carriers among school children. Mykosen 1982;25:254-257.
54. Neil G, Hanslo D, Buccimazza S, Kibel M. Control of the carrier state of scalp dermatophytes. Pediatr Infect Dis J 1990;9:57-58.
55. Vargo K, Cohen BA. Prevalence of undetected tinea capitis in household members of children with disease. Pediatrics 1993;92:155-157.
56. Kligman AM. The pathogenesis of tinea capitis due to Microsporum audouinii and Microsporum canis. J Invest Dermatol 1952;18:231-246.
57. ∏ay RJ, Moore M. Mycology. In: Rook A, Wilkinson DS, Ebling FJG, editors. Textbook of Dermatology. 6th ed. Oxford, UK: Blackwell Scientific Ltd; 1998. p. 1303.
58. ∫·ÙÔ‡Ï˘ ∞∫, ∫Ô˘Ì·ÓÙ¿ÎË-ª·ıÈÔ˘‰¿ÎË ∂. ª˘ÎËÙÈ¿ÛÂȘ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜. ™Ùo: ∫Ô˘Ì·ÓÙ¿ÎË-ª·ıÈÔ˘‰¿ÎË ∂. ª˘ÎËÙÈ·ÛÈΤ˜ ÏÔÈÌÒÍÂȘ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜. ∞ı‹Ó·: ∫·˘Î¿˜; 2002. ÛÂÏ. 196. 59. ƒ¿ÏÏ˘ ∂, ∫Ô˘Ì·ÓÙ¿ÎË-ª·ıÈÔ˘‰¿ÎË ∂. ¢ÂÚÌ·ÙÔÊ˘Ù›Â˜. ™Ùo: ∫Ô˘Ì·ÓÙ¿ÎË-ª·ıÈÔ˘‰¿ÎË ∂. ª˘ÎËÙÈ·ÛÈΤ˜ ÏÔÈÌÒÍÂȘ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜. ∞ı‹Ó·: ∫·˘Î¿˜; 2002. ÛÂÏ. 53. 60. ºÚ·ÁÎÔ‡ÏË ∂. ∂ÚÁ·ÛÙËÚȷ΋ ‰È¿ÁÓˆÛË ÙˆÓ Ì˘ÎËÙÈ¿ÛˆÓ. ™ÙÔ: ∫Ô˘Ì·ÓÙ¿ÎË-ª·ıÈÔ˘‰¿ÎË ∂. ª˘ÎËÙÈ·ÛÈΤ˜ ÏÔÈÌÒÍÂȘ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜. ∞ı‹Ó·: ∫·˘Î¿˜; 2002. ÛÂÏ. 30. 61. Evans EGV, Gentles JC. Essentials of medical mycology. Edinburgh: Churchill Livingstone; 1985. p. 44. 62. ºÚ·ÁÎÔ‡ÏË ∂, µÂÏÂÁÚ¿ÎË ∞, ÃÚÈÛÙ¿Î˘ °. ª˘ÎËÙÈ¿ÛÂȘ. ™ÙÔ: ÃÚÈÛÙ¿ÎË °, §ÂÁ¿ÎË π. ∫ÏÈÓÈ΋ ÌÈÎÚÔ‚ÈÔÏÔÁ›· Î·È ÏÔÈÌÒÍÂȘ. ∞ı‹Ó·: ¶·ÚÈÛÈ¿ÓÔ˜; 2000. ÛÂÏ. 483.
63. Elewski BE, Hazen PG. The superficial mycoses and the dermatophytes. J Am Acad Dermatol 1989;21:655-673.
64. St-Germain G, Summerbell R. Identifying filamentous fungiA 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·
ÌÂÈÒıËΠÛËÌ·ÓÙÈο ÛÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·Û˘ ηÈ
·˘Í‹ıËΠÛÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘ (-10% Î·È +5%
·ÓÙ›ÛÙÔȯ·, p<0,001). ∂›Û˘, ÛËÌ·ÓÙÈο ÌÈÎÚfiÙÂ-
ÚÔ 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˜ ÂȉڿÛÂȘ Û˘Ó¯ÈÛÙÔ‡Ó ÙȘ ÂfiÌÂ-
Ó˜ ‰ÂηÂٛ˜, ›Ûˆ˜ Ó· Â›Ó·È ‰˘Ó·Ù‹ Ë Ì›ˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù·.
§¤ÍÂȘ ÎÏÂȉȿ: ·È‰È¿, ·ÁˆÁ‹ ˘Á›·˜, ÏÈÔÚˆÙ½Ó˜, ۈ̷ÙÔÌÂÙÚ‹ÛÂȘ, Ê˘ÛÈ΋ ηٿÛÙ·ÛË.
™˘ÓÙÔÌÔÁڷʛ˜
¶ OÌ¿‰· ·Ú¤Ì‚·Û˘
∂ OÌ¿‰· ÂϤÁ¯Ô˘
¢ª™¢Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜
HDL-CÃÔÏËÛÙÂÚfiÏË ÙˆÓ ˘„ËÏ‹˜ ˘ÎÓfiÙËÙ·˜
ÏÈÔÚˆÙÂ˚ÓÒÓ
LDL-CÃÔÏËÛÙÂÚfiÏË ÙˆÓ ¯·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜
ÏÈÔÚˆÙÂ˚ÓÒÓ
ª™™Ù·ÙÈÛÙÈÎÒ˜ ÌË ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿
∂ÈÛ·ÁˆÁ‹ ∏ Ù·¯Â›· ·‡ÍËÛË ÙˆÓ ‰ÂÈÎÙÒÓ ÓÔÛËÚfiÙËÙ·˜ ηÈ
ıÓËÛÈÌfiÙËÙ·˜ ÛÙÔÓ ÏËı˘ÛÌfi Ù˘ ¯ÒÚ·˜ Ì·˜ ηٿ
ÙȘ ÙÂÏÂ˘Ù·›Â˜ ‰ÂηÂٛ˜ (2,10) ηıÈÛÙ¿ ·Ó·Áη›·
ÙËÓ ¤Ó·ÚÍË ÚÔÁÚ·ÌÌ¿ÙˆÓ ÚÔ·ÁˆÁ‹˜ Ù˘ ˘Á›·˜
Î·È ÚfiÏ˄˘ Ôχ ÓˆÚ›˜ ·fi ÙËÓ ·È‰È΋ ËÏÈΛ· (1-3,23-29).
∏ ∫ÏÈÓÈ΋ ¶ÚÔÏËÙÈ΋˜ π·ÙÚÈ΋˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘ ÍÂΛÓËÛ ¤Ó· ÂÍ·ÂÙ¤˜ ÚfiÁÚ·ÌÌ· ÂÎ·È‰Â˘ÙÈ΋˜ ·Ú¤Ì‚·Û˘ ÛÙ· Û¯ÔÏ›· Ù˘ ∫Ú‹Ù˘, ÙÔ Û¯ÔÏÈÎfi ¤ÙÔ˜ 1992-1993. ™ÙÔ ÚfiÁÚ·ÌÌ· ÁÚ¿ÊÙËηÓ
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›·˜.
(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.
Key words: children, health and nutrition education, lipoproteins, anthropometric measurements, fitness.
ÛÙËÓ ∞’ Ù¿ÍË ‰ËÌÔÙÈÎÔ‡ ÙÔ 1992-1993 Û ÙÚÂȘ ÓÔÌÔ‡˜ Ù˘ ∫Ú‹Ù˘.
Û‡ÓÔÏÔ ÙˆÓ ‰ËÌÔÙÈÎÒÓ Û¯ÔÏ›ˆÓ ÛÙÔ˘˜ ÓÔÌÔ‡˜ ∏Ú·ÎÏ›Ԣ, ƒÂı‡ÌÓÔ˘ Î·È Ã·Ó›ˆÓ Î·È ÙˆÓ 5681 Ì·ıËÙÒÓ Ô˘ ÁÚ¿ÊÙËÎ·Ó ÛÙËÓ ∞’ Ù¿ÍË, ÂÂϤÁË ·ÓÙÈÚÔÛˆÂ˘ÙÈÎfi ‰Â›ÁÌ· 40 Û¯ÔÏ›ˆÓ Ì 1046 Ì·ıËÙ¤˜ ËÏÈΛ·˜ 5,5-7 ÂÙÒÓ, ÔÈ ÔÔ›ÔÈ ˘Ô‚Ï‹ıËÎ·Ó Û ϋÚË ¤ÏÂÁ¯Ô Ù˘ ˘Á›·˜ ÙÔ˘˜. ∞fi Ù· 40 Û¯ÔÏ›·, Ù· 24 ‹Ù·Ó ·fi ÙÔ˘˜ ÓÔÌÔ‡˜ ∏Ú·ÎÏ›Ԣ Î·È ƒÂı‡ÌÓÔ˘ Ì 602 Ì·ıËÙ¤˜ [ÔÌ¿‰· ·Ú¤Ì‚·Û˘ (¶)] Î·È Ù· 16 ·fi ÙÔÓ ÓÔÌfi ÷ӛˆÓ Ì 444 Ì·ıËÙ¤˜ [ÔÌ¿‰· ÂϤÁ¯Ô˘ (∂)]. ∏ ÌÂıÔ‰ÔÏÔÁ›· Ù˘ ¤Ú¢ӷ˜, Ë ÂÎ·È‰Â˘ÙÈ΋ ‰È·‰Èηۛ· Î·È ÔÈ ÂÚÈÔ‰ÈΤ˜ ·ÍÈÔÏÔÁ‹ÛÂȘ Ô˘ ¤ÁÈÓ·Ó Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ¤ÍÈ ÂÙÒÓ ÂÊ·ÚÌÔÁ‹˜ Ù˘ ÂÎ·È‰Â˘ÙÈ΋˜ ·Ú¤Ì‚·Û˘ (1992-1998), ÂÚÈÁÚ¿ÊÔÓÙ·È Ï‹Úˆ˜ Û ÚÔËÁÔ‡ÌÂÓ˜ ÂÚÁ·Û›Â˜ (4-9).
∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ Û¯ÔÏÈÎÔ‡ ¤ÙÔ˘˜ 2001-2002, Ù· ·È‰È¿ Ô˘ ›¯·Ó Û˘ÌÌÂÙ¿Û¯ÂÈ ÛÙÔ ÚfiÁÚ·ÌÌ· ÙÔ 1992 ÂÓÙÔ›ÛÙËÎ·Ó Û 63 Û¯ÔÏ›· ÛÙÔ˘˜ ÙÚÂȘ ÓÔÌÔ‡˜ Ù˘ ∫Ú‹Ù˘. OÈ
ÁÔÓ›˜ ÙˆÓ ·È‰ÈÒÓ ÂÓËÌÂÚÒıËÎ·Ó ÁÚ·ÙÒ˜ ÁÈ· ÙȘ ÂÍÂÙ¿ÛÂȘ Ù˘ ·ӷÍÈÔÏfiÁËÛ˘ Î·È ˘¤ÁÚ·„·Ó ˘Â‡ı˘ÓË ‰‹ÏˆÛË ÁÈ· ÙË Û˘ÌÌÂÙÔ¯‹ ‹ ÌË ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜.
∞fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ Ì·ıËÙÒÓ Ô˘ ÂÍÂÙ¿ÛÙËÎ·Ó ·fi ÙÔ 1992 ¤ˆ˜ ÙÔ 1998, ÙÔ 2002 ·¿ÓÙËÛ·Ó 728 ·È‰È¿ (70%), Ù· 49 ÂÎ ÙˆÓ ÔÔ›ˆÓ ›¯·Ó ‰È·Îfi„ÂÈ ÙË ÊÔ›ÙËÛ‹ ÙÔ˘˜. ∂‚‰ÔÌ‹ÓÙ· ÂÙ¿ ·È‰È¿ ·ÚÓ‹ıËÎ·Ó ÙË Û˘ÌÌÂÙÔ¯‹ ÙÔ˘˜, ÂÓÒ 651 ‰¤¯ÙËηÓ. ™ÙËÓ È·ÙÚÈ΋ ÂͤٷÛË ÚÔÛ‹Ïı·Ó, ÙÂÏÈο, 634 ·È‰È¿ (61%) (¶: 331, ∂: 303), ÂÓÒ ÌfiÏȘ 7 ·fi Ù· 49 ·È‰È¿ Ô˘ ›¯·Ó ‰È·Îfi„ÂÈ ÙË ÊÔ›ÙËÛ‹ ÙÔ˘˜ ÚÔÛ‹Ïı·Ó ÛÙȘ ÂÍÂÙ¿ÛÂȘ. OÈ ÂÍÂÙ¿ÛÂȘ Ô˘ Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó ÙÔ 2002 ·fi ÙËÓ ÂÚ¢ÓËÙÈ΋ ÔÌ¿‰· Ù˘ ∫ÏÈÓÈ΋˜ ¶ÚÔÏËÙÈ΋˜ π·ÙÚÈ΋˜ Î·È ¢È·ÙÚÔÊ‹˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘, ·ÊÔÚÔ‡Û·Ó Û ۈ̷ÙÔÌÂÙÚÈΤ˜ ÌÂÙÚ‹ÛÂȘ, ·ÚÙËÚȷ΋ ›ÂÛË ·›Ì·ÙÔ˜, ·ÈÌÔÏË„›· ÁÈ· ÏÈÔÚˆÙ½Ó˜, ·ÍÈÔÏfiÁËÛË Ù˘ Ê˘ÛÈ΋˜ ηٿÛÙ·Û˘ Ì ·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜ (¶∆∞), Ï‹„Ë ‰È·ÈÙÔÏÔÁ›Ô˘ ÚÔËÁÔ‡ÌÂÓÔ˘ 24ÒÚÔ˘ Î·È ˙˘ÁÈṲ̂ÓÔ˘ Ê·ÁËÙÔ‡ 3 ËÌÂÚÒÓ Î·È
™ÙÔÓ ¶›Ó·Î· 2 ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ù· ›‰· ÙˆÓ
ÏÈÔÚˆÙÂ˚ÓÒÓ Î·È Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ ÙˆÓ
·È‰ÈÒÓ Ô˘ ÂÍÂÙ¿ÛÙËÎ·Ó ÙÔ 1992 Î·È ÙÔ 2002. ∏
ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË ÌÂÈÒıËΠ۠ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚÔ ‚·ıÌfi ÛÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·Û˘ Û ۇ-
ÁÎÚÈÛË Ì ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘ (¶: -24,0±1,7 mg/dL, E: -10,1±1,8 mg/dL, p<0,001), fiˆ˜ Î·È Ë LDL-¯ÔÏËÛÙÂÚfiÏË (¶: -18,5±1,4 mg/dL, E: -3,1±1,6 mg/dL, p<0,001). O ·ıËڈ̷ÙÈÎfi˜ ‰Â›ÎÙ˘ ·˘Í‹ıËΠÛËÌ·-
ÓÙÈο ÏÈÁfiÙÂÚÔ ÛÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·Û˘ (¶: 0,06±0,05, E: 0,29±0,05, p<0,01), ÂÓÒ ‰ÂÓ ˘‹ÚÍÂ
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˘
∞•πO§O°∏™∏ 19921Ë: 19952Ë: 19983Ë: 2002
(∞ƒÃ∏ ¶∞ƒ∂ªµ∞™∏™)(∆∂§O™ ¶∞ƒ∂ªµ∞™∏™)°’ °˘ÌÓ·Û›Ô˘ & ∞’ ¢ËÌÔÙÈÎÔ‡°’ ¢ËÌÔÙÈÎÔ‡™∆’ ¢ËÌÔÙÈÎÔ‡∞’ §˘Î›Ԣ
ñ ∏ÏÈΛ· (¤ÙË)6,3±0,4*8,6±0,3*11,6±0,3*15,1±0,5* ñ OÌ¿‰· ·Ú¤Ì‚·Û˘
ª·ıËÙ¤˜ ∞’ Ù¿Í˘ ‰ËÌÔÙÈÎÒÓ
Û¯ÔÏ›ˆÓ Ù˘ ∫Ú‹Ù˘4171
ª·ıËÙ¤˜ Ô˘ ÂÍÂÙ¿ÛÙËηÓ602**288**457**331** ™¯ÔÏ›·24122437 ñ OÌ¿‰· ÂϤÁ¯Ô˘
ª·ıËÙ¤˜ ∞’ Ù¿Í˘ ‰ËÌÔÙÈÎÒÓ
Û¯ÔÏ›ˆÓ Ù˘ ∫Ú‹Ù˘1510
ª·ıËÙ¤˜ Ô˘ ÂÍÂÙ¿ÛÙËηÓ444**183**374*303** ™¯ÔÏ›·1691626
ñ ™‡ÓÔÏÔ
ª·ıËÙ¤˜ Ô˘ ÂÍÂÙ¿ÛÙËηÓ1046471831634 ∞ÁfiÚÈ·545242427302 ∫ÔÚ›ÙÛÈ·501229404332 ™¯ÔÏ›·40214263 * ª¤ÛÔ˜ fiÚÔ˜ ± Ù˘È΋ ·fiÎÏÈÛË
Ù˘¯·›Ô ‰Â›ÁÌ· ·fi ÙÔ˘˜ Ì·ıËÙ¤˜ Ô˘ ÁÚ¿ÊÙËÎ·Ó ÛÙËÓ ∞’ Ù¿ÍË ‰ËÌÔÙÈÎÔ‡
¶›Ó·Î·˜ 2. ªÂÙ·‚ÔϤ˜ ÙˆÓ ÂȤ‰ˆÓ ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ Î·È Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ ÙˆÓ ÔÌ¿‰ˆÓ ·Ú¤Ì‚·Û˘ Î·È ÂϤÁ¯Ô˘ Û ‰È¿ÛÙËÌ· 10 ÂÙÒÓ
∞ƒÃ∏3Ë ·ÍÈÔÏfiÁËÛË 19922002ªÂÙ·‚ÔÏ‹p** ¡ ª¤ÛÔ˜ ± ∆™
OÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË (mg/dL)¶*255188,1±1,9164,1±1,8-24,0±1,7<0,001 ∂*214176,0±2,1165,9±1,9-10,1±1,8
∆ÚÈÁÏ˘ÎÂÚ›‰È· (mg/dL)¶25552,9±1,366,9±1,713,9±1,8ª™*** ∂ 21452,9±1,464,8±1,811,9±1,9
HDL-C (mg/dL)¶25560,5±0,951,9±0,7-8,5±0,8ª™ ∂ 21459,7±0,950,3±0,7-9,3±0,9
LDL-C (mg/dL)¶255117,2±1,898,7±1,5-18,5±1,4<0,001 ∂ 214105,7±1,9102,6±1,6-3,1±1,6
∞ıËڈ̷ÙÈÎfi˜ ‰Â›ÎÙ˘: ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË/HDL-C¶2553,22±0,053,28±0,050,06±0,050,001 ∂ 2143,11±0,063,40±0,050,29±0,05
™˘ÛÙÔÏÈ΋ ›ÂÛË ·›Ì·ÙÔ˜ (mm Hg)¶274100,4±0,6117,6±0,717,2±0,8ª™ ∂ 244104,4±0,7120,8±0,716,5±0,8 ¢È·ÛÙÔÏÈ΋ ›ÂÛË ·›Ì·ÙÔ˜ (mm Hg)¶27458,6±0,571,5±0,612,9±0,7ª™ ∂ 24460,0±0,574,9±0,614,9±0,8
*¶: ÔÌ¿‰· ·Ú¤Ì‚·Û˘, ∂: ÔÌ¿‰· ÂϤÁ¯Ô˘
**∞Ó¿Ï˘ÛË Û˘Ó‰È·Î‡Ì·ÓÛ˘ (ANCOVA): Ô ¤ÏÂÁ¯Ô˜ ¤ÁÈÓ ÛÙË ‰È·ÊÔÚ¿ Ù˘ 3˘ ·ÍÈÔÏfiÁËÛ˘ ·fi ÙËÓ ·Ú¯È΋ ÂͤٷÛË (∞ƒÃ∏) Î·È ˆ˜ Û˘ÌÌÂÙ·‚ÏËÙ¤˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÙÔ Ê‡ÏÔ Î·È Ë ‰È·ÊÔÚ¿ ÙÔ˘ ¢ª™ ·fi ÙËÓ ·Ú¯È΋ ÂͤٷÛË (1992) ***ª™: ÛÙ·ÙÈÛÙÈÎÒ˜ ÌË ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿
·ÍÈÔÏfiÁËÛË
19922002ªÂÙ·‚ÔÏ‹p** ¡ ª¤ÛÔ˜ ± ∆™
µ¿ÚÔ˜ (kg)¶*29122,8±0,361,1±0,838,4±0,8<0,001 ∂*26524,3±0,366,6±0,942,5±0,7
⁄„Ô˜ (cm)¶291118,4±0,3165,7±0,447,3±0,3ª™*** ∂ 265121,5±0,3169,1±0,547,6±0,3
¢Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜¶29816,2±0,122,1±0,25,9±0,20,001 ∂ 26516,3±0,123,1±0,36,9±0,2
¶ÂÚ›ÌÂÙÚÔ˜ ̤Û˘ (cm)¶28854,2±0,374,3±0,620,1±0,5ª™ ∂ 26555,7±0,376,5±0,620,8±0,5
¢Â›ÎÙ˘ ÂÚÈ̤ÙÚÔ˘ ̤Û˘/ÏÂοÓ˘¶2870,86±0,0030,78±0,004-0,07±0,005ª™ ∂ 2650,85±0,0030,79±0,005-0,06±0,005
¢Â›ÎÙ˘ ÂÚÈ̤ÙÚÔ˘ ̤Û˘/‡„Ô˜¶2870,46±0,0020,45±0,003-0,01±0,003ª™ ∂ 2650,46±0,0020,45±0,003-0,01±0,003
ÕıÚÔÈÛÌ· ÙÂÛÛ¿ÚˆÓ ‰ÂÚÌ·ÙÈÎÒÓ Ù˘¯ÒÓ (mm)¶27529,6±0,960,5±1,730,9±1,3ª™ ∂ 24731,6±1,060,1±1,828,6±1,4
¶ÔÛÔÛÙfi Ï›Ô˘˜ ÛÒÌ·ÙÔ˜ (%)¶29119,7±0,222,2±0,32,5±0,3ª™ ∂ 26519,9±0,222,1±0,42,2±0,3
¶·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜ (ÛÙ¿‰È·)¶1331,7±0,14,0±0,12,3±0,1ª™ ∂ 1691,8±0,13,9±0,12,1±0,1
*¶: ÔÌ¿‰· ·Ú¤Ì‚·Û˘, ∂: ÔÌ¿‰· ÂϤÁ¯Ô˘
**∞Ó¿Ï˘ÛË Û˘Ó‰È·Î‡Ì·ÓÛ˘ (ANCOVA): Ô ¤ÏÂÁ¯Ô˜ ¤ÁÈÓ ÛÙË ‰È·ÊÔÚ¿ Ù˘ 3˘ ·ÍÈÔÏfiÁËÛ˘ ·fi ÙËÓ ·Ú¯È΋ ÂͤٷÛË (∞ƒÃ∏) Î·È ˆ˜ Û˘ÌÌÂÙ·‚ÏËÙ¤˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÙÔ Ê‡ÏÔ Î·È Ë ‰È·ÊÔÚ¿ ÙÔ˘ ¢ª™ ·fi ÙËÓ ·Ú¯È΋ ÂͤٷÛË (Ô ¢ª™ ¯ÚËÛÈÌÔÔÈ‹ıËΠÌfiÓÔ ÛÙÔ ·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜)
***ª™: ÛÙ·ÙÈÛÙÈÎÒ˜ ÌË ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿
·Ú¤Ì‚·Û˘ (¶: 38,4±0,8 kg, ∂: 42,5±0,7 kg, p<0,001 Î·È ¶: 5,9±0,2 kg/m2, ∂: 6,9±0,2 kg/m2, p<0,01, ·ÓÙ›ÛÙÔȯ·). OÈ ÌÂÙ·‚ÔϤ˜ ÛÙËÓ ÂÚ›ÌÂÙÚÔ
̤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 ÌÂÙ·-
͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ.
™ÙÔÓ ¶›Ó·Î· 4 ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ù· ›‰· Úfi-
ÛÏ˄˘ ÙˆÓ ‰È·ÈÙËÙÈÎÒÓ Û˘ÛÙ·ÙÈÎÒÓ. §fiÁˆ ÙÔ˘ ÌÈ-
ÎÚÔ‡ ·ÚÈıÌÔ‡ ÙˆÓ ‰È·ÈÙÔÏÔÁ›ˆÓ Ì ˙˘ÁÈṲ̂ÓÔ Ê·-
ÁËÙfi 3 ËÌÂÚÒÓ (Ó=107) Ô˘ ÂÈÛÙÚ¿ÊËÎ·Ó ÙÔ 2002, ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÁÈ· ÙȘ ·Ú·Î¿Ùˆ Û˘Û¯ÂÙ›ÛÂȘ Ù· ‰Â‰Ô̤ӷ ·fi ÙÔ ‰È·ÈÙÔÏfiÁÈÔ ÙÔ˘ ÙÂÏÂ˘Ù·›Ô˘ 24ÒÚÔ˘ (Ó=617). °È· ÙÔÓ ¤ÏÂÁ¯Ô Ù˘ ·ÍÈÔÈÛÙ›·˜ ÙÔ˘ ‰È·ÈÙÔÏÔÁ›Ô˘ ÙÔ˘ ÙÂÏÂ˘Ù·›Ô˘ 24ÒÚÔ˘,
¤ÁÈÓ ۇÁÎÚÈÛË ˙¢ÁÒÓ ‰È·ÈÙÔÏÔÁ›ˆÓ ÛÙ· ›‰È· ·È-
‰È¿ (Student paired samples t-test) ÌÂٷ͇ ÙˆÓ 107
‰È·ÈÙÔÏÔÁ›ˆÓ 3 ËÌÂÚÒÓ Î·È ÙˆÓ ·ÓÙ›ÛÙÔȯˆÓ 107
ÙÔ˘ ÙÂÏÂ˘Ù·›Ô˘ 24ÒÚÔ˘. O ¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍ fiÙÈ ÛÙËÓ
ÙÚ›ÙË ·ÍÈÔÏfiÁËÛË (2002) ‰ÂÓ ˘‹Ú¯·Ó ÛËÌ·ÓÙÈΤ˜
‰È·ÊÔÚ¤˜ ÌÂٷ͇ ÙˆÓ ‰‡Ô Ù‡ˆÓ ‰È·ÈÙÔÏÔÁ›ˆÓ, ·Ú¿ ÌfiÓÔ ÛÙËÓ ÚfiÛÏË„Ë ÓÈ·Û›Ó˘ (24ˆÚÔ: 19,1±1,0 mg, 3 ËÌÂÚÒÓ: 17,0±0,7 mg, p<0,05), ÌÔÓÔ·ÎfiÚÂÛÙˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ ˆ˜ ÔÛÔÛÙÔ‡ ÂÓ¤ÚÁÂÈ·˜ (24ˆÚÔ: 16,2±0,5%, 3 ËÌÂÚÒÓ: 17,9±0,4%, p<0,01) Î·È ÔÏ˘·ÎfiÚÂÛÙˆÓ ÏÈ·ÚÒÓ
ÔͤˆÓ, ›Û˘ ˆ˜ ÔÛÔÛÙÔ‡ ÂÓ¤ÚÁÂÈ·˜ (24ˆÚÔ: 4,7±0,2%, 3 ËÌÂÚÒÓ: 5,2±0,2%, p<0,05). ∏ Û‡-
ÁÎÚÈÛË ÙˆÓ ÌÂÙÚ‹ÛÂˆÓ (ۈ̷ÙÔÌÂÙÚ‹ÛÂȘ, ·ÚÙËÚȷ΋ ›ÂÛË, ÏÈÔÚˆÙ½Ó˜ Î·È ·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜) ÙˆÓ 107 ·È‰ÈÒÓ Ô˘ ¤ÛÙÚ„·Ó ‰È·ÈÙÔÏfiÁÈ· ˙˘ÁÈṲ̂ÓÔ˘ Ê·ÁËÙÔ‡ 3 ËÌÂÚÒÓ Ì ÂΛӘ ÙˆÓ 510 ·È‰ÈÒÓ ·fi Ù· ÔÔ›· ÂÏ‹ÊıË ‰È·ÈÙËÙÈÎfi ÈÛÙÔÚÈÎfi ÙÂÏÂ˘Ù·›Ô˘ 24ÒÚÔ˘, ¤‰ÂÈÍ fiÙÈ ˘‹ÚÍ ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÌfiÓÔ ÛÙÔ ‡„Ô˜ (·È‰È¿ ÌÂ
‰È·ÈÙÔÏfiÁÈÔ 3 ËÌÂÚÒÓ: 165,9±0,7 cm, ·È‰È¿ Ì ‰È·ÈÙÔÏfiÁÈÔ 24ÒÚÔ˘: 167,5±0,3 cm, p<0,05) Î·È ÛÙËÓ HDL-¯ÔÏËÛÙÂÚfiÏË (·È‰È¿ Ì ‰È·ÈÙÔÏfiÁÈÔ 3
ËÌÂÚÒÓ: 54,0±1,1 mg/dl, ·È‰È¿ Ì ‰È·ÈÙÔÏfiÁÈÔ 24ÒÚÔ˘: 50,5±0,5 mg/dl, p<0,01). ∆· 107 ‰È·ÈÙÔÏfiÁÈ· 3 ËÌÂÚÒÓ ÚÔ¤Ú¯ÔÓÙ·È Û ÔÛÔÛÙfi 17% ·fi ·ÁÚÔÙÈΤ˜ ÂÚÈÔ¯¤˜ Î·È Û ÔÛÔÛÙfi 83% ·fi ·ÛÙÈΤ˜-ËÌÈ·ÛÙÈΤ˜, Û ·ÓÙ›ıÂÛË Ì ٷ 510 ÙÂÏÂ˘Ù·›Ô˘ 24ÒÚÔ˘, Ù· ÔÔ›· ÚÔ¤Ú¯ÔÓÙ·È Û ÔÛÔÛÙfi 30% ·fi ·ÁÚÔÙÈΤ˜ Î·È Î·Ù¿ 70% ·fi ·ÛÙÈΤ˜-ËÌÈ·ÛÙÈΤ˜ ÂÚÈÔ¯¤˜ (¯2, 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 ÌÂ-
19922002ªÂÙ·‚ÔÏ‹p** ª¤ÛÔ˜ ± ∆™
∂Ó¤ÚÁÂÈ· (kcal)¶*1845±492386±89541±1030,027 ∂*1843±452066±82222±96
¶ÚˆÙ½Ó˜ (g)¶61,7±2,178,6±3,716,8±4,3ª™*** ∂ 64,2±1,970,8±3,46,6±4,0
À‰·Ù¿ÓıڷΘ (g)¶208,4±6,5274,9±10,866,6±12,80,050 ∂ 201,3±6,0232,9±9,931,7±11,9
OÏÈÎfi ϛԘ (g)¶86,1±2,6109,8±4,923,7±5,7ª™ ∂ 86,9±2,495,7±4,58,8±5,3
∫ÔÚÂṲ̂ӷ ÏÈ·Ú¿ Ôͤ· (g)¶30,6±37,437,5±0,96,9±2,1ª™ ∂ 30,7±0,932,9±1,72,2±1,9
ªÔÓÔ·ÎfiÚÂÛÙ· ÏÈ·Ú¿ Ôͤ· (g)¶35,9±1,345,7±2,29,7±2,50,036 ∂ 36,8±1,239,3±2,02,4±2,3
¶ÔÏ˘·ÎfiÚÂÛÙ· ÏÈ·Ú¿ Ôͤ· (g)¶9,6±0,413,3±1,03,7±1,0ª™ ∂9,6±0,311,9±0,92,3±0,9
Trans ÏÈ·Ú¿ Ôͤ· (g)¶1,5±0,12,9±0,11,4±0,20,022 ∂1,6±0,12,2±0,20,6±0,2
º˘ÙÈΤ˜ ›Ó˜ (g)¶14,4±0,617,7±0,93,3±1,1ª™ ∂ 14,0±0,515,3±0,91,3±1,0
º˘ÏÏÈÎfi Ô͇ (Ìg)¶183,5±14,2240,3±14,956,7±20,40,001 ∂ 248,6±13,1211,9±13,7-36,7±18,9
∞Û‚¤ÛÙÈÔ (mg)¶846,1±36,7865,6±55,719,4±64,8ª™ ∂ 899,4±33,9913,9±51,514,4±59,9
™›‰ËÚÔ˜ (mg)¶10,6±0,713,9±0,73,1±1,0ª™ ∂ 11,8±0,713,0±0,71,9±0,9
µÈÙ·Ì›ÓË C (mg)¶93,1±6,4149,9±13,956,8±15,20,019 ∂ 116,9±5,9123,7±12,96,8±14,2
µÈÙ·Ì›ÓË µ2 (mg)¶1,7±0,12,0±0,10,26±0,140,015 ∂2,0±0,11,9±0,10,21±0,13
*¶: ÔÌ¿‰· ·Ú¤Ì‚·Û˘ (¡=80), ∂: ÔÌ¿‰· ÂϤÁ¯Ô˘ (¡=93) **∞Ó¿Ï˘ÛË Û˘Ó‰È·Î‡Ì·ÓÛ˘ (ANCOVA): Ô ¤ÏÂÁ¯Ô˜ ¤ÁÈÓ ÛÙË ‰È·ÊÔÚ¿ Ù˘ 3˘ ·ÍÈÔÏfiÁËÛ˘ ·fi ÙËÓ ·Ú¯È΋ ÂͤٷÛË (∞ƒÃ∏) Î·È ˆ˜ Û˘ÌÌÂÙ·‚ÏËÙ¤˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÙÔ Ê‡ÏÔ Î·È Ë ‰È·ÊÔÚ¿ ÙÔ˘ ¢ª™ ·fi ÙËÓ ·Ú¯È΋ ÂͤٷÛË
***ª™: ÛÙ·ÙÈÛÙÈÎÒ˜ ÌË ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿
·È‰ÈÒÓ Ô˘ Û˘ÌÌÂÙ›¯·Ó ÛÙȘ ÌÂÙÚ‹ÛÂȘ Ù˘ ·Ú¯È΋˜ ÂͤٷÛ˘ ÙÔ 1992 Î·È ÙˆÓ ÂfiÌÂÓˆÓ ÙÚÈÒÓ ·ÍÈÔÏÔÁ‹ÛˆÓ.
∞fi ÙÔÓ ¶›Ó·Î· 5 ‰È·ÈÛÙÒÓÂÙ·È fiÙÈ Ë ÔÌ¿‰·
·Ú¤Ì‚·Û˘ ¤¯ÂÈ ÛËÌ·ÓÙÈ΋ Ì›ˆÛË ÙˆÓ ÂȤ‰ˆÓ
ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ Î·È LDL-¯ÔÏËÛÙÂÚfiÏ˘, ¤Ó·ÓÙÈ ·‡ÍËÛ˘ ÛÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘. ∂›Û˘, Ë ÔÌ¿‰· ·Ú¤Ì‚·Û˘ ¤¯ÂÈ ÛËÌ·ÓÙÈο ÌÈÎÚfiÙÂÚË ·‡ÍËÛË
ÛÙÔÓ ·ıËڈ̷ÙÈÎfi ‰Â›ÎÙË (ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË ÚÔ˜ HDL-¯ÔÏËÛÙÂÚfiÏË), ÂÓÒ ÔÈ ‰‡Ô ÔÌ¿‰Â˜ ‰ÂÓ ‰È·Ê¤ÚÔ˘Ó ÛËÌ·ÓÙÈο ÛÙ· ÙÚÈÁÏ˘ÎÂÚ›‰È· Î·È ÛÙËÓ
HDL-¯ÔÏËÛÙÂÚfiÏË. ™ÙÔÓ ¶›Ó·Î· 6 Ê·›ÓÂÙ·È fiÙÈ Ë ÔÌ¿‰· ÂϤÁ¯Ô˘
·ÚÔ˘ÛÈ¿˙ÂÈ ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚË ·‡ÍËÛË ÛÙÔ ‚¿ÚÔ˜, ÛÙÔÓ ¢ª™, ÛÙÔÓ ‰Â›ÎÙË ÂÚÈ̤ÙÚÔ˘ ̤Û˘
ÚÔ˜ ‡„Ô˜ Î·È ÛÙÔ ÔÛÔÛÙfi Ï›Ô˘˜ ÛÒÌ·ÙÔ˜, ÂÓÒ ·ÓÙ›ıÂÙ· ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚË ·‡ÍËÛË ·ÚÔ˘ÛÈ¿˙ÂÈ Ë ÔÌ¿‰· ·Ú¤Ì‚·Û˘ ÛÙÔ ‡„Ô˜ Î·È ÛÙÔ ·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜. ¢ÂÓ ÛËÌÂÈÒÓÔÓÙ·È ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ÛÙËÓ ÂÚ›ÌÂÙÚÔ Ì¤Û˘, ÛÙÔÓ ‰Â›ÎÙË ÂÚÈ̤ÙÚÔ˘ ̤Û˘
ÚÔ˜ ÏÂοÓË Î·È ÛÙÔ ¿ıÚÔÈÛÌ· ÙˆÓ ‰ÂÚÌ·ÙÈÎÒÓ
Ù˘¯ÒÓ.
™ÙËÓ ∂ÈÎfiÓ· 1 ·ÂÈÎÔÓ›˙ÔÓÙ·È ‰È·¯ÚÔÓÈο ÔÈ ÌÂÙ·‚ÔϤ˜ ÛÙËÓ ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË, ÛÙÔÓ ¢ª™ Î·È ÛÙÔ ·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜ ÙˆÓ ‰È·ÊfiÚˆÓ ÂÚÈfi‰ˆÓ ·ÍÈÔÏfiÁËÛ˘ Û ۯ¤ÛË Ì ÙËÓ ·Ú¯È΋ ÙÔ 1992.
∞fi ÙÔ ÌÂÙ·‚·ÏÏfiÌÂÓÔ ‰Â›ÁÌ· ÙˆÓ ·È‰ÈÒÓ Ô˘ ÂÍÂÙ¿ÛÙËÎ·Ó Û οı ÂÚ›Ô‰Ô, fiˆ˜ ·˘Ùfi Ê·›ÓÂÙ·È
ÛÙÔÓ ¶›Ó·Î· 1, ‚Ú¤ıËΠfiÙÈ ÙÔ 20,5% ÙÔ˘ Û˘ÓfiÏÔ˘
ÙˆÓ ·È‰ÈÒÓ Â›¯Â ·˘ÍË̤ÓÔ ‚¿ÚÔ˜ (¯2 ¤ÏÂÁ¯Ô˜, ¶: 19,2%, E: 21,9%, ª™) Î·È ÙÔ 8,3% ›¯Â ·¯˘Û·ÚΛ· (¯2 ¤ÏÂÁ¯Ô˜, ¶: 6,9%, ∂: 9,7%, ª™).
™ÙÔÓ ¶›Ó·Î· 7 ηٷÁÚ¿ÊÔÓÙ·È ÔÈ Û˘Ó‹ıÂȘ ηӛÛÌ·ÙÔ˜ ÙˆÓ ·È‰ÈÒÓ ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜, ηıÒ˜ Î·È ÙˆÓ ÁÔÓ¤ˆÓ ÙÔ˘˜ ÛÙÔ Û›ÙÈ, fiˆ˜ ÚԤ΢„·Ó ηٿ ÙËÓ ÙÂÏÂ˘Ù·›· ·ÍÈÔÏfiÁËÛË ÙÔ 2002. ∆Ô 7% ÙˆÓ ·È‰ÈÒÓ Ù˘ ÔÌ¿‰·˜ ·Ú¤Ì‚·Û˘ ‹Ù·Ó ηÓÈÛÙ¤˜ ¤Ó·ÓÙÈ 13% ÙˆÓ ·È‰ÈÒÓ Ù˘ ÔÌ¿‰·˜ ÂϤÁ¯Ô˘ (p<0,05). ¢ÂÓ ‰È·ÈÛÙÒıËΠÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿
19921Ë: 19952Ë: 19983Ë: 2002™‡ÓÔÏÔªÂÙ·‚ÔÏ‹p** ¡ ª¤ÛÔ˜ ± ∆™
OÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË (mg/dL)¶*139186,9±2,6173,9±2,5173,8±2,6164,4±2,4174,7±2,2-16,2±1,8<0,001 ∂*101174,2±3,1185,1±2,9172,3±3,1162,6±2,8173,6±2,6-0,9±2,0
∆ÚÈÁÏ˘ÎÂÚ›‰È· (mg/dL)¶13951,3±1,744,3±1,965,6±2,064,7±2,256,5±1,46,9±1,8ª™*** ∂ 10150,9±1,940,1±2,367,6±2,462,9±2,655,3±1,76,0±2,1
HDL-C (mg/dL)¶13760,6±1,354,3±1,358,7±1,352,7±1,056,6±1,0-5,3±1,0ª™ ∂ 10162,8±1,558,2±1,557,8±1,550,9±1,257,4±1,2-7,2±1,1
LDL-C (mg/dL)¶139115,9±2,5110,5±2,2102,7±2,398,6±2,1106,9±2,0-12,0±1,6<0,001 ∂ 101101,2±3,0118,9±2,6101,0±2,799,1±2,4105,1±2,45,1±1,9
∞ıËڈ̷ÙÈÎfi˜ ‰Â›ÎÙ˘:¶1373,21±0,073,49±0,093,12±0,073,27±0,073,27±0,060,08±0,050,002
ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË/HDL-C∂1012,92±0,093,34±0,103,15±0,083,31±0,083,18±0,070,34±0,06
*¶: ÔÌ¿‰· ·Ú¤Ì‚·Û˘, ∂: ÔÌ¿‰· ÂϤÁ¯Ô˘
**∞Ó¿Ï˘ÛË Û˘Ó‰È·Î‡Ì·ÓÛ˘ ·ӷϷ̂·ÓfiÌÂÓˆÓ ÌÂÙÚ‹ÛÂˆÓ (GLM: repeated measures analysis): Ô ¤ÏÂÁ¯Ô˜ ¤ÁÈÓ ÛÙȘ ‰È·ÊÔÚ¤˜ οı ·ÍÈÔÏfiÁËÛ˘ ·fi ÙËÓ ·Ú¯È΋ ÂͤٷÛË (∞ƒÃ∏) Î·È ˆ˜ Û˘ÌÌÂÙ·‚ÏËÙ¤˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÙÔ Ê‡ÏÔ Î·È Ë Ì¤ÛË ‰È·ÊÔÚ¿ ÙÔ˘ ¢ª™ fiÏˆÓ ÙˆÓ ÌÂÙÚ‹ÛÂˆÓ ·fi ÙËÓ ·Ú¯È΋ ÂͤٷÛË (∞ƒÃ∏)
***ª™: ÛÙ·ÙÈÛÙÈÎÒ˜ ÌË ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿
fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÔÛfiÙËÙ· ηӛÛÌ·ÙÔ˜ (¶: 8,4±1,9 ÙÛÈÁ¿Ú·/Ë̤ڷ, E: 11,0±1,3 ÙÛÈÁ¿Ú·/ Ë̤ڷ) Î·È ÛÙÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· Ô˘ ηӛ˙Ô˘Ó (¶: 15,6±2,3 Ì‹Ó˜, E: 22,5±3,2 Ì‹Ó˜). ŸÛÔÓ ·ÊÔÚ¿ ÛÙÔ˘˜ ÁÔÓ›˜, ÙÔ 38% ÙˆÓ ÌËÙ¤ÚˆÓ Â›Ó·È Î·Ó›-
ÛÙÚȘ, ¤Ó·ÓÙÈ ÙÔ˘ 55% ÙˆÓ ·Ù¤ÚˆÓ (p<0,001).
∞fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ 614 ˙¢Á·ÚÈÒÓ-ÁÔÓ¤ˆÓ, ÙÔ 25%
Â›Ó·È Î·È ÔÈ ‰‡Ô ηÓÈÛÙ¤˜, ÂÓÒ ÙÔ 33% Â›Ó·È Î·È ÔÈ
‰‡Ô ÌË Î·ÓÈÛÙ¤˜ (p<0,001). ™¯ÂÙÈο Ì ÙÔ˘˜ ÁÔ-
Ó›˜-ηÓÈÛÙ¤˜ ÚÔ·ÙÂÈ fiÙÈ ÙÔ 92% ÙˆÓ ÌËÙ¤ÚˆÓ
ηӛ˙Ô˘Ó ÛÙËÓ ÔÈΛ· ÙÔ˘˜, ¤Ó·ÓÙÈ ÙÔ˘ 84% ÙˆÓ ·Ù¤ÚˆÓ (p<0,05).
™˘˙‹ÙËÛË
∏ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙÔ˘ ÂÎ·È‰Â˘ÙÈÎÔ‡ ÚÔ-
ÁÚ¿ÌÌ·ÙÔ˜ ·Ú¤Ì‚·Û˘ Û ı¤Ì·Ù· ˘Á›·˜, ‰È·ÙÚÔÊ‹˜ Î·È ¿ıÏËÛ˘ Û ̷ıËÙ¤˜ Ù˘ ∫Ú‹Ù˘ ·ÍÈÔ-
ÏÔÁ‹ıËΠηٿ Ù· 6 ¯ÚfiÓÈ· ÂÊ·ÚÌÔÁ‹˜ ÙÔ˘ ÛÂ
ÚÔËÁÔ‡ÌÂÓ˜ ÂÚÁ·Û›Â˜ (4-9). ∏ Û˘Ó¯È˙fiÌÂÓË, fï˜, ıÂÙÈ΋ ›‰Ú·ÛË ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÛÙÔ˘˜
‰Â›ÎÙ˜ ˘Á›·˜ 4 ¯ÚfiÓÈ· ·fi ÙË ‰È·ÎÔ‹ ÙÔ˘ Î·È 10
¯ÚfiÓÈ· ·fi ÙËÓ ¤Ó·ÚÍ‹ ÙÔ˘, ·ÔÙÂÏ› ÂÍ·ÈÚÂÙÈο
ÂÏȉÔÊfiÚÔ Â‡ÚËÌ·. º·›ÓÂÙ·È fiÙÈ Ë ÂȉËÌ›· ÙˆÓ
¯ÚfiÓÈˆÓ ÓÔÛËÌ¿ÙˆÓ Ì ÙËÓ ·ÚÔ˘Û›· ·Ú·ÁfiÓÙˆÓ
ÎÈÓ‰‡ÓÔ˘ ·fi ÙËÓ ·È‰È΋ ËÏÈΛ· Â›Ó·È ‰˘Ó·ÙfiÓ Ó·
ÂÚÈÛÙ·Ï›.
¢È·¯ÚÔÓÈο, ·fi ÙÔ 1992 ¤ˆ˜ ÙÔ 2002, ÙÔ ‚¿ÚÔ˜
ÙˆÓ ·È‰ÈÒÓ ¯ˆÚ›˜ ·Ú¤Ì‚·ÛË (ÔÌ¿‰· ÂϤÁ¯Ô˘)
·˘Í‹ıËΠηٿ 2,3 kg ÂÚÈÛÛfiÙÂÚÔ Û ۇÁÎÚÈÛË
Ì ÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·Û˘ (p<0,01), fiˆ˜ ›Û˘
Î·È o ¢ª™ ·˘Í‹ıËΠηٿ 1 kg/m2 (p<0,01), ÂÓÒ ÙÔ
‡„Ô˜ ÛÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·Û˘ ·˘Í‹ıËΠÛËÌ·ÓÙÈο ÂÚÈÛÛfiÙÂÚÔ Î·Ù¿ 2,1 cm (p<0,001). ¶·Úfi-
ÌÔÈ·, Ë ÔÌ¿‰· ·Ú¤Ì‚·Û˘ ›¯Â ÛËÌ·ÓÙÈο ÌÂÁ·-
Ô˘ ·ÚÔ˘Û›·Û ÛÙÔÓ ·ıËڈ̷ÙÈÎfi ‰Â›ÎÙË, ηٿ 0,26 ÌÔÓ¿‰Â˜ (p<0,01). ∆· ·ÔÙÂϤÛÌ·Ù· ·˘Ù¿ ·Ú¤¯Ô˘Ó Ì›· ÂÏ›‰· fiÙÈ Ë ÂȉËÌ›· Ù˘
fiÙÈ Ë ÂÌÊ¿ÓÈÛË ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ηډȷÁÁÂȷο Î·È ¿ÏÏ· ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù· ÛÙËÓ ·È‰È΋ ËÏÈΛ· Ô‰ËÁ› ÛÙË ‰È·Ù‹ÚËÛË Î·È Â·‡ÍËÛË ·˘ÙÒÓ Î·È ÛÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹ (19-20), ÒıËÛ ÙÔ˘˜ ÂÚ¢ÓËÙ¤˜ Ó· ÚÔÛ·ı‹ÛÔ˘Ó Ì¤Ûˆ ÚÔÁÚ·ÌÌ¿ÙˆÓ ·Ú¤Ì‚·Û˘ Ó· ÌÂÈÒÛÔ˘Ó Ù· ›‰· ‹ ·ÎfiÌ· Î·È Ó· ÂÍ·Ï›„Ô˘Ó ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ ·˘ÙÔ‡˜ ηٿ ÙËÓ ·È‰È΋ ËÏÈΛ· (1,3,23-29).
¶·ÚfiÌÔÈ· Ì ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, Ì›· ¿ÏÏË ÌÔÓÔÂÙÔ‡˜ ÂÎ·È‰Â˘ÙÈ΋˜ ·Ú¤Ì‚·Û˘ Ô˘ ÂÊ·ÚÌfiÛÙËΠ۠171 Ì·ıËÙ¤˜ Ù˘ ∫Ú‹Ù˘ ËÏÈΛ·˜ 13 Î·È 14 ÂÙÒÓ, ¤‰ÂÈÍ fiÙÈ Ë ÔÌ¿‰· ·Ú¤Ì‚·Û˘ ›¯Â ÌÈÎÚfiÙÂÚË ·‡ÍËÛË ÛÙËÓ ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË, ÛÙÔÓ ¢ª™, ÛÙËÓ LDL-¯ÔÏËÛÙÂÚfiÏË Î·È ÛÙÔÓ ·ıËڈ̷ÙÈÎfi ‰Â›ÎÙË ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ ÚÔ˜ HDL-¯ÔÏËÛÙÂÚfiÏË Û ۇÁÎÚÈÛË Ì ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘ (1). ÕÏÏË ¤Ú¢ӷ ÛÙȘ ∏ӈ̤Ó˜ ¶ÔÏÈÙ›˜ (24) ¤‰ÂÈÍÂ
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 ÌÂ
χÙÂÚË Ì›ˆÛË ÛÙËÓ ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË Î·Ù¿ 15,3 mg/dl (p<0,001), ÛÙËÓ LDL-¯ÔÏËÛÙÂÚfiÏË Î·Ù¿ 6,9 mg/dl (p<0,001), ÂÓÒ ÛËÌ·ÓÙÈο ÌÈÎÚfiÙÂÚË ‹Ù·Ó Ë
∞ƒÃ∏∞•πO§O°∏™∏ 19921Ë: 19952Ë: 19983Ë: 2002™‡ÓÔÏÔªÂÙ·‚ÔÏ‹p** ¡
µ¿ÚÔ˜ (kg)¶*16722,7±0,330,1±0,543,9±0,960,8±1,139,4±0,722,4±0,50,004 ∂*12024,9±0,433,2±0,647,4±1,068,2±1,343,4±0,824,7±0,6 ⁄„Ô˜ (cm)¶167118,0±0,4133,5±0,5149,0±0,6165,5±0,6141,5±0,531,3±0,2<0,001 ∂ 120122,5±0,5134,6±0,6150,3±0,7169,8±0,7144,3±0,629,1±0,3
¢Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜¶16716,2±0,216,9±0,219,5±0,322,0±0,318,7±0,23,3±0,2<0,001 ∂ 12016,5±0,218,2±0,320,8±0,323,6±0,419,8±0,34,3±0,2
¶ÂÚ›ÌÂÙÚÔ˜ ̤Û˘ (cm)¶16354,3±0,459,5±0,668,6±0,874,2±0,864,2±0,613,1±0,4ª™*** ∂ 12056,3±0,561,8±0,773,1±0,977,2±0,967,1±0,714,3±0,5 ¢Â›ÎÙ˘ ÂÚÈ̤ÙÚÔ˘ ¶1620,86±0,0030,83±0,0040,86±0,0050,79±0,0070,83±0,003-0,03±0,01ª™ ̤Û˘/ÏÂοÓ˘∂1200,85±0,0040,82±0,0040,86±0,0060,79±0,0080,83±0,003-0,03±0,01 ¢Â›ÎÙ˘ ÂÚÈ̤ÙÚÔ˘¶1630,46±0,0030,45±0,0040,46±0,0050,45±0,0040,45±0,003-0,009±0,003<0,001 ̤Û˘/‡„Ô˜∂1200,46±0,0040,46±0,0040,49±0,0060,46±0,0050,47±0,0040,006±0,003 ÕıÚÔÈÛÌ· ÙÂÛÛ¿ÚˆÓ¶15528,6±1,331,4±1,255,8±2,358,1±2,243,5±1,619,8±1,1ª™ ‰ÂÚÌ·ÙÈÎÒÓ Ù˘¯ÒÓ (mm)∂11632,4±1,535,1±1,462,7±2,760,5±2,547,7±1,820,3±1,3 ¶ÔÛÔÛÙfi Ï›Ô˘˜¶16719,6±0,319,0±0,320,1±0,421,8±0,520,3±0,31,0±0,20,001 ÛÒÌ·ÙÔ˜ (%)∂12020,0±0,320,9±0,422,9±0,522,3±0,521,7±0,52,2±0,3 ¶·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ¶771,7±0,13,4±0,24,8±0,24,2±0,23,5±0,12,4±0,1<0,001
·ÓÙÔ¯‹˜ (ÛÙ¿‰È·)∂851,9±0,13,3±0,33,1±0,24,0±0,23,1±0,11,5±0,1 *¶: ÔÌ¿‰· ·Ú¤Ì‚·Û˘, ∂: ÔÌ¿‰· ÂϤÁ¯Ô˘
∞Ó¿Ï˘ÛË Û˘Ó‰È·Î‡Ì·ÓÛ˘ ·ӷϷ̂·ÓfiÌÂÓˆÓ ÌÂÙÚ‹ÛÂˆÓ (GLM: repeated measures analysis): Ô ¤ÏÂÁ¯Ô˜ ¤ÁÈÓ ÛÙȘ ‰È·ÊÔÚ¤˜ οı ·ÍÈÔÏfiÁËÛ˘ ·fi ÙËÓ ·Ú¯È΋ ÂͤٷÛË (∞ƒÃ∏) Î·È ˆ˜ Û˘ÌÌÂÙ·‚ÏËÙ¤˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÙÔ Ê‡ÏÔ Î·È Ë Ì¤ÛË
‰È·ÊÔÚ¿ ÙÔ˘ ¢ª™ fiÏˆÓ ÙˆÓ ÌÂÙÚ‹ÛÂˆÓ ·fi ÙËÓ ·Ú¯È΋ ÂͤٷÛË (Ô ¢ª™ ¯ÚËÛÈÌÔÔÈ‹ıËΠÌfiÓÔ ÛÙÔ ·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ
·ÓÙÔ¯‹˜)
***ª™: ÛÙ·ÙÈÛÙÈÎÒ˜ ÌË ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿
ÛÙËÓ ¤Ú¢ӷ KNOW YOUR BODY (25). ™ÙȘ ¤Ú¢-
Ó˜ CHIC II (27), Ô˘ Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó ÛÙË µfi-
ÚÂÈ· ∫·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 Âη›‰Â˘Û˘)
Ì›ˆÛ ٷ ›‰· ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ Î·È ÙÔ˘
Û˘ÓfiÏÔ˘ ÙˆÓ ‰ÂÚÌ·ÙÈÎÒÓ Ù˘¯ÒÓ, ηıÒ˜ ›Û˘
·‡ÍËÛ ÛËÌ·ÓÙÈο ÙËÓ ·ÂÚfi‚È· ÈηÓfiÙËÙ¿ Ù˘. ¶·ÚfiÌÔÈ· ‹Ù·Ó Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘ CHIC, Ë ÔÔ›· Ú·ÁÌ·ÙÔÔÈ‹ıËΠÛÙËÓ ›‰È· ÂÚÈÔ¯‹ ηÈ
‰È‹ÚÎÂÛ 12 Ì‹Ó˜ (29).
OÈ ·Ú·¿Óˆ ÌÂϤÙ˜, ·Ó Î·È ÂȂ‚·ÈÒÓÔ˘Ó ÙË
ıÂÙÈ΋ ›‰Ú·ÛË Ù˘ ÂÎ·È‰Â˘ÙÈ΋˜ ·Ú¤Ì‚·Û˘
ÛÙË Ì›ˆÛË ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÈÎÒÓ ÂȤ‰ˆÓ, ηıÒ˜
Î·È ÙˆÓ ‰ÂÈÎÙÒÓ ·¯˘Û·ÚΛ·˜, ¤¯Ô˘Ó Û˘ÁÎÚÈÙÈο
Ôχ ÌÈÎÚfiÙÂÚË ‰È¿ÚÎÂÈ· ·Ú¤Ì‚·Û˘ Û ۯ¤ÛË
Ì ÙËÓ ·ÚÔ‡Û· ¤Ú¢ӷ. ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, ·Ú¿ ÙË ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙË ÌÂÙ·‚ÔÏ‹ ÙˆÓ ÂȤ‰ˆÓ ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ ÙˆÓ ·È‰ÈÒÓ ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜, ˘‹Ú¯Â ÔÛÔÛÙfi 18,5% ÙˆÓ ·È‰ÈÒÓ ÛÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·Û˘ Î·È 21,5% ÛÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘ Ì LDL-¯ÔÏËÛÙÂÚfiÏË >130 mg/dl. ¶·Ú¿ÏÏËÏ·, ÙÔ ÔÛÔÛÙfi ÙˆÓ ·È‰ÈÒÓ Ì ˘ÂÚ‚ÔÏÈÎfi ‚¿ÚÔ˜ Î·È ·¯˘Û·ÚΛ·
¤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›ÛÙÔȯÔ
ÔÛÔÛÙfi ‹Ù·Ó 26,3% (22,2% ›¯Â ˘ÂÚ‚ÔÏÈÎfi ‚¿ÚÔ˜ Î·È 4,1% ·¯˘Û·ÚΛ·).
™ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘
ÁÈ· ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù·, ÂÎÙfi˜ ·fi ÙË Ê˘ÛÈ΋ ¿ÛÎËÛË, ÛÔ˘‰·›Ô˜ Â›Ó·È Ô ÚfiÏÔ˜ Ù˘ ‰È·ÙÚÔÊ‹˜. ∏ “‰˘ÙÈÎÔÔ›ËÛË” Ù˘ Û‡Á¯ÚÔÓ˘ ‰È·ÙÚÔÊ‹˜ ÙˆÓ
∫ÚËÙÒÓ Ù· ÙÂÏÂ˘Ù·›· Û·Ú¿ÓÙ· ¯ÚfiÓÈ·, Ô˘ ·Ú·ÙËÚÂ›Ù·È Î·È ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ ∂ÏÏ‹ÓˆÓ, ηıÒ˜ Î·È Ë
·ÔÌ¿ÎÚ˘ÓÛ‹ ÙÔ˘˜ ·fi ÙËÓ ·Ú·‰ÔÛȷ΋ ÎÚËÙÈ΋ ‰È·ÙÚÔÊ‹ (30), ÙÔ˘˜ Ô‰ËÁÔ‡Ó Û ‰È·ÚÎÒ˜ ·˘Í·ÓfiÌÂÓÔ˘˜ ‰Â›ÎÙ˜ ıÓËÛÈÌfiÙËÙ·˜ ·fi ηډȷÁÁÂȷο
Î·È ¿ÏÏ· ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù·, ÂÓÒ Û ¿ÏϘ ÚÔËÁ̤Ó˜ ¯ÒÚ˜ ÔÈ ‰Â›ÎÙ˜ ·˘ÙÔ› ÂÏ·ÙÙÒÓÔÓÙ·È ·ÔÙÂÏÂÛÌ·ÙÈο ÙȘ ÙÂÏÂ˘Ù·›Â˜ ‰ÂηÂٛ˜ (10).
∏ ÂÏ¿ÙÙˆÛË Ù˘ ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ Î·È Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘ ‰ÂÓ ÂÍËÁÂ›Ù·È ·fi Ù· ‰È·ÈÙËÙÈο ‰Â‰Ô̤ӷ, ηı’ fiÙÈ ‰ÂÓ ‰È·ÈÛÙÒıËΠÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙË Ï‹„Ë ÎÔÚÂṲ̂ÓÔ˘ Ï›Ô˘˜ ÛÙË ‰È·ÙÚÔÊ‹ ÙˆÓ ·È‰ÈÒÓ ÙˆÓ ÔÌ¿‰ˆÓ ·Ú¤Ì‚·Û˘ ηÈ
‰È·ÊÔÚ¿ (mg/dL)
OÏÈ΋ xÔÏËÛÙÂÚfiÏË (mg/dL)
OÌ¿‰· ·Ú¤Ì‚·Û˘ (¡=139)
OÌ¿‰· ÂϤÁ¯Ô˘ (¡=101)
¢Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ (kg/m2)
OÌ¿‰· ·Ú¤Ì‚·Û˘ (¡=167)
OÌ¿‰· ÂϤÁ¯Ô˘ (¡=120)
ª¤ÛË ‰È·ÊÔÚ¿ (kg/m 2 ) ª¤ÛË ‰È·ÊÔÚ¿ (ÛÙ¿‰È·)
ŒÙÔ˜ ·ÍÈÔÏfiÁËÛ˘ (·ÓÂͤٷÛË)
¶·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜ (ÛÙ¿‰È·)
OÌ¿‰· ¶·Ú¤Ì‚·Û˘ (¡=77)
OÌ¿‰· ∂ϤÁ¯Ô˘ (¡=85)
ŒÙÔ˜ ·ÍÈÔÏfiÁËÛ˘ (·ÓÂͤٷÛË)
∂ÈÎfiÓ· 1. ¢È·ÊÔÚ¤˜ ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘, ¢ª™ Î·È ·Ï›Ó‰ÚÔÌÔ˘
·ÍÈÔÏfiÁËÛ˘ (1994, 1998 Î·È 2002) ·fi ÙËÓ ·Ú¯È΋ ÂͤٷÛË (1992).
¶›Ó·Î·˜ 7. ™˘Ó‹ıÂȘ ηӛÛÌ·ÙÔ˜ ·È‰ÈÒÓ Î·È ÁÔÓ¤ˆÓ
∫·ÓÈÛÙ¤˜ªË ηÓÈÛÙ¤˜p-value**
ñ ¶·È‰È¿
OÌ¿‰· ·Ú¤Ì‚·Û˘7 (23)*93 (303)0,016
OÌ¿‰· ÂϤÁ¯Ô˘13 (37)87 (260)
ñ °ÔÓ›˜
ªËÙ¤Ú·38 (236)62 (386)<0,001
¶·Ù¤Ú·˜55 (337)45 (277)
™˘Ó‰˘·ÛÌfi˜ ÁÔÓ¤ˆÓ ηÓÈÛÙÒÓ ‹ Ì˶·Ù¤Ú·˜
∫·ÓÈÛÙ‹˜ªË ηÓÈÛÙ‹˜
ñ ªËÙ¤Ú·
∫·Ó›ÛÙÚÈ·25 (156)13 (76)<0,001
ªË ηӛÛÙÚÈ·29 (180)33 (202)
∫¿ÓÈÛÌ· ÛÙÔ Û›ÙÈ
¡·ÈŸ¯È
ªËÙ¤Ú·92 (213)8 (19)0,010
¶·Ù¤Ú·˜84 (280)16 (84)
*OÈ ÙÈ̤˜ ‰›ÓÔÓÙ·È ˆ˜ % (¡)
**ŒÏÂÁ¯Ô˜ ¯2
ÂϤÁ¯Ô˘. ∏ ÚfiÛÏË„Ë ÂÓ¤ÚÁÂÈ·˜ ·fi Ù· ·È‰È¿
ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ÁÈÓfiÙ·Ó Î·Ù¿ 41% ·fi ÔÏÈÎfi ϛԘ, 14% ·fi ÙÔ ÔÔ›Ô ‹Ù·Ó ÎÔÚÂṲ̂ÓÔ. ∆Ô ÔÛÔÛÙfi ÂÓ¤ÚÁÂÈ·˜ ·fi ÎÔÚÂṲ̂ÓÔ Ï›Ô˜ ‹Ù·Ó ÌfiÏȘ 7% fiÙ·Ó ¿Ú¯ÈÛÂ Ë ÌÂϤÙË ÙˆÓ ∂Ù¿ ÈÚÒÓ ÙÔ 1960. ∆· ıÂÙÈο ·ÔÙÂϤÛÌ·Ù· fiÛÔÓ ·ÊÔÚ¿ ÛÙȘ ÏÈÔÚˆ-
Ù½Ó˜ Èı·ÓfiÓ Ó· Û¯ÂÙ›˙ÔÓÙ·È Ì ÙÔÓ ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚÔ ¢ª™ Î·È ÙË ÛËÌ·ÓÙÈο ηχÙÂÚË ·ıÏËÙÈ΋ ›‰ÔÛË ÙˆÓ ·È‰ÈÒÓ Ù˘ ÔÌ¿‰·˜ ·Ú¤Ì‚·Û˘ ÛÂ
Û‡ÁÎÚÈÛË Ì ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘. ∞ÓÙ›ıÂÙ·, ÛÙËÓ ¤Ú¢ӷ CATCH (26) ÛËÌÂÈÒıËÎ·Ó ÛËÌ·ÓÙÈΤ˜ ÌÂÙ·‚ÔϤ˜ ÛÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·Û˘ ·fi ÙËÓ °’ ÛÙËÓ ∂’
Ù¿ÍË ‰ËÌÔÙÈÎÔ‡, Ì Ì›ˆÛË ÛÙËÓ ÚfiÛÏË„Ë ÂÓ¤ÚÁÂÈ·˜ Î·È ÛÙ· ÔÛÔÛÙ¿ ÂÓ¤ÚÁÂÈ·˜ ·fi ÔÏÈÎfi, ÎÔÚÂṲ̂ÓÔ Î·È ÌÔÓÔ·ÎfiÚÂÛÙÔ Ï›Ô˜. ™Â ¿ÏÏË ¤Ú¢ӷ ÛÙËÓ
ÂÚÈÔ¯‹ ÙÔ˘ Leeds (28), ÌÂÙ¿ ·fi 12 Ì‹Ó˜ ÂÎ·È‰Â˘ÙÈ΋˜ ÂÈÌfiÚʈÛ˘ Î·È ÂÓË̤ڈÛ˘, ·Ú·ÙËÚ‹ıËΠfiÙÈ Ë ÔÌ¿‰· ·Ú¤Ì‚·Û˘ ηٷӿψÓ ÂÚÈÛ-
ÛfiÙÂÚ· Ï·¯·ÓÈο. ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, Ë ÔÌ¿‰·
·Ú¤Ì‚·Û˘ ›¯Â ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚË Ï‹„Ë Ê˘ÏÏÈÎÔ‡ Î·È ·ÛÎÔÚ‚ÈÎÔ‡ ÔͤԘ, ‰ËÏ·‰‹ ˘„ËÏfiÙÂÚË Ï‹„Ë ÊÚÔ‡ÙˆÓ Î·È Ï·¯·ÓÈÎÒÓ. ªÂϤÙË Ô˘ Ú·ÁÌ·ÙÔÔÈ‹ıËΠ۠·È‰È¿ Ù˘ µfiÚÂÈ·˜ ∂ÏÏ¿‰·˜ ËÏÈΛ·˜ 11,616,6 ÂÙÒÓ, ¯ˆÚ›˜ ÙËÓ ÂÊ·ÚÌÔÁ‹ ÂÎ·È‰Â˘ÙÈ΋˜ ·Ú¤Ì‚·Û˘, ¤‰ÂÈÍ fiÙÈ ÙÔ 45% Ù˘ ÚÔÛÏ·Ì‚·ÓfiÌÂÓ˘ ÂÓ¤ÚÁÂÈ·˜ ÚÔ¤Ú¯ÂÙ·È ·fi ˘‰·Ù¿ÓıڷΘ, ÂÓÒ ÙÔ 42% ÚÔ¤Ú¯ÂÙ·È ·fi ÔÏÈÎfi ϛԘ, ·fi ÙÔ ÔÔ›Ô ÔÛÔÛÙfi 12% Â›Ó·È ÎÔÚÂṲ̂ÓÔ (18).
ÕÏÏÔÓ ÚˆÙ‡ÔÓÙ· ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ·ÔÙÂÏ› ÙÔ Î¿ÓÈÛÌ· Ô˘ ·Ú¯›˙ÂÈ Û˘Ó‹ıˆ˜ ÛÙËÓ ÂÊË‚È΋ ËÏÈΛ· (14,17). ∆Ô Î¿ÓÈÛÌ· ·ÔÙÂÏ› ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ Úfi‚ÏËÌ· ‰ËÌfiÛÈ·˜ ˘Á›·˜ ÙfiÛÔ ÛÙË ¯ÒÚ· Ì·˜
™ÙȘ ·Ú¯¤˜ Ù˘ ‰ÂηÂÙ›·˜ ÙÔ˘ ’80, Û ̛·
ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ η-
(17), ÙÔ ÀÔ˘ÚÁÂ›Ô ÀÁ›·˜ ÍÂΛÓËÛ ÙË
ÌÂÙ¿‰ÔÛË ·ÓÙÈηÓÈÛÙÈÎÒÓ ÌËÓ˘Ì¿ÙˆÓ Ì¤Ûˆ Ù˘ ÙËÏÂfiÚ·Û˘ Î·È ÙÔ˘ Ú·‰ÈÔÊÒÓÔ˘. O Ú˘ıÌfi˜ Ù˘
ÂÙ‹ÛÈ·˜ ·‡ÍËÛ˘ ηٷӿψÛ˘ ηÓÔ‡ ÌÂÈÒıËÎÂ
ÛËÌ·ÓÙÈο Ù· ¤ÙË 1979 Î·È 1980, ‰ËÏ·‰‹ ÛÙ· ‰‡Ô ¯ÚfiÓÈ· Ù˘ ÌÂÙ¿‰ÔÛ˘ ÙˆÓ ÌËÓ˘Ì¿ÙˆÓ, Ë ÔÔ›·
ÚÔÛ¤ÁÁÈÛ ÙÔ 0%. ¶·Ú¿ÏÏËÏ·, ÛÙÔ ‰È¿ÛÙËÌ· ·˘Ùfi ‰È·ÈÛÙÒıËΠfiÙÈ ÙÔ 10,5% ‰Â›ÁÌ·ÙÔ˜ 1500 ·ÙfiÌˆÓ ËÏÈΛ·˜ 15-64 ÂÙÒÓ ‰È¤ÎÔ„Â ÌfiÓÈÌ· ÙÔ Î¿ÓÈÛÌ·, ÂÓÒ fiÙ·Ó ÛÙ·Ì¿ÙËÛ·Ó Ù· ·ÓÙÈηÓÈÛÙÈο ÌËӇ̷ٷ, ÔÈ Ú˘ıÌÔ› ·‡ÍËÛ˘ Ù˘ ηٷӿψÛ˘ η-
ÓÔ‡ ·ӋÏı·Ó ÛÙ· ·Ú¯Èο ›‰·. ™Â ¤Ú¢ӷ Ô˘ ¤ÁÈÓ ÛÙËÓ ∫Ú‹ÙË (1) ÌÂÙ¿ ·fi ¤Ó·Ó ¯ÚfiÓÔ ÂÎ·È‰Â˘ÙÈ΋˜ ·Ú¤Ì‚·Û˘, ‚Ú¤ıËΠӷ ηӛ˙ÂÈ ÙÔ 6% Ù˘ ÔÌ¿‰·˜ ·Ú¤Ì‚·Û˘ Î·È ÙÔ 20% Ù˘ ÔÌ¿‰·˜ ÂϤÁ¯Ô˘, Û ۯ¤ÛË Ì ٷ ·ÓÙ›ÛÙÔȯ· ÔÛÔÛÙ¿ 7% Î·È 13% Ù˘ ·ÚÔ‡Û·˜ ¤Ú¢ӷ˜. ™Â ¿ÏÏË ¤Ú¢ӷ Û ÂÊ‹‚Ô˘˜ Î·È Ó·ÚÔ‡˜ ÂÓ‹ÏÈΘ ÛÙËÓ ∫·ÏÈÊfiÚÓÈ·, Ô˘ ‰ÈÂÍ‹¯ıË ·fi ÙÔ 1979 ¤ˆ˜ ÙÔ 1990 (16), ·Ú·ÙËÚ‹ıËΠfiÙÈ Î·Ù¿ ÙÔ 1979 ÙÔ 28,7% ÙˆÓ ‰ÂÈÁÌ¿ÙˆÓ ·Ú¤Ì‚·Û˘ Î·È ÙÔ 21,7% ÙˆÓ ‰ÂÈÁÌ¿ÙˆÓ ÂϤÁ¯Ô˘ ‹Ù·Ó ηÓÈÛÙ¤˜, ÂÓÒ ÙÔ 1990 Ù· ÔÛÔÛÙ¿ ·˘Ù¿ ÌÂÈÒıËÎ·Ó Û 15,2% Î·È 15,8%, ·ÓÙ›ÛÙÔȯ·. ¶·Ú¿ÏÏËÏ·, ¯ˆÚ›˜ ÙËÓ ÂÊ·ÚÌÔÁ‹ ÚÔÁÚ·ÌÌ¿ÙˆÓ ·Ú¤Ì‚·Û˘, Û ‰È·¯ÚÔÓÈ΋ ÌÂϤÙË
‰È·ÊfiÚˆÓ ÂÚÈÔ¯ÒÓ Ù˘ ∂ÏÏ¿‰·˜ (14) ÛÙ· Ù¤ÏË Ù˘ ‰ÂηÂÙ›·˜ ÙÔ˘ ’80 Î·È Û ‰Â›ÁÌ· 4268 Ì·ıËÙÒÓ
§˘Î›Ԣ ‚Ú¤ıËΠfiÙÈ ÙÔ 29,7% ‹Ù·Ó ηÓÈÛÙ¤˜, ÂÓÒ ÛÙ· ̤۷ Ù˘ ›‰È·˜ ‰ÂηÂÙ›·˜ ÙÔ ÔÛÔÛÙfi ›¯Â ÊÙ¿ÛÂÈ ÙÔ 43,4%. ∫·Ù¿ ÙËÓ ›‰È· ¯ÚÔÓÈ΋ ÂÚ›Ô‰Ô, ¤Ú¢ӷ ÛÙËÓ ∞ı‹Ó· (15) ¤‰ÂÈÍ fiÙÈ Û ‰Â›ÁÌ· 11.058 Ì·ıËÙÒÓ ËÏÈΛ·˜ 14-18 ÂÙÒÓ, ÙÔ ÔÛÔÛÙfi ÙˆÓ Î·ÓÈÛÙÒÓ ‹Ù·Ó 22,3%.
¶·È‰È·ÙÚÈ΋ 2003;66:436-447Paediatriki 2003;66:436-447 445
ªÂÁ¿Ï˘ ÛÔ˘‰·ÈfiÙËÙ·˜ ›Ù¢ÁÌ· ÁÈ· ÙË ‰ËÌfiÛÈ· ˘Á›· Â›Ó·È Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ·ÚÔ‡Û·˜
ÌÂϤÙ˘, Ù· ÔÔ›· ¤‰ÂÈÍ·Ó ÂÏ¿ÙÙˆÛË Î·Ù¿ 50% Â-
Ú›Ô˘ ÙÔ˘ ÔÛÔÛÙÔ‡ ÙˆÓ ÂÊ‹‚ˆÓ ηÓÈÛÙÒÓ ÛÙËÓ
ÔÌ¿‰· ·Ú¤Ì‚·Û˘. º˘ÛÈο, ‰ÂÓ ÌÔÚ› Ó· ÚÔ-
‚ÏÂÊı› fiÙÈ ·˘Ù¿ Ù· ·È‰È¿ ËÏÈΛ·˜ 14-16 ÂÙÒÓ ‰ÂÓ
ı· ·Ú¯›ÛÔ˘Ó ÙÔ Î¿ÓÈÛÌ· ÛÙ· ÂfiÌÂÓ· ¯ÚfiÓÈ·, ȉÈ-
·›ÙÂÚ· ÂΛӷ ÙˆÓ ÔÔ›ˆÓ Ô ¤Ó·˜ ‹ Î·È ÔÈ ‰‡Ô ÁÔÓ›˜
ηӛ˙Ô˘Ó, ·ÊÔ‡ ÌfiÓÔ ÛÙÔ 33% ÙˆÓ ˙¢Á·ÚÈÒÓ-ÁÔ-
Ó¤ˆÓ ‰ÂÓ Î·Ó›˙ÂÈ Î·Ó›˜ ·fi ÙÔ˘˜ ‰‡Ô ÁÔÓ›˜. °È·
ÙÔÓ ÏfiÁÔ ·˘Ùfi, Ù· ÚÔÁÚ¿ÌÌ·Ù· ‰ËÌfiÛÈ·˜ ˘Á›·˜
Ú¤ÂÈ Ó· ÛÙÔ¯Â‡Ô˘Ó ÛÙËÓ ·ÚÂÌfi‰ÈÛË Ù˘ ¤Ó·Ú-
͢ ÙÔ˘ ηӛÛÌ·ÙÔ˜ Û ·˘Ù¤˜ ÙȘ ËÏÈ˘.
∞‰˘Ó·Ì›· ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ·ÔÙ¤ÏÂÛÂ Ë ¤Ï-
ÏÂÈ„Ë ÛÙÂÓ‹˜ ÂÈÎÔÈÓˆÓ›·˜ Î·È ·ÍÈÔÏfiÁËÛ˘ ÙÔ˘
¤ÚÁÔ˘ ÙˆÓ ÂÎ·È‰Â˘ÙÈÎÒÓ, ÛÙÔ˘˜ ÔÔ›Ô˘˜ ‰fiıËÎÂ
ÙÔ Î·Ù¿ÏÏËÏÔ ¤ÓÙ˘Ô ˘ÏÈÎfi ÁÈ· ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙÔ˘
ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÛÙËÓ Ù¿ÍË ÙÔ˘˜ Û ¤Ó· ‹ ‰‡Ô ÛÂÌÈ-
Ó¿ÚÈ·. ¢ÂÓ Â›Ó·È ÁÓˆÛÙfi ÙÔ Ì¤ÁÂıÔ˜ ÙÔ˘ ÂӉȷʤ-
ÚÔÓÙÔ˜ Î·È Ù˘ ÚÔÛ¿ıÂÈ·˜ Ô˘ η٤‚·Ï οıÂ
ÂÎ·È‰Â˘ÙÈÎfi˜ ÁÈ’ ·˘Ùfi ÙÔ ÚfiÁÚ·ÌÌ·,
·ÁˆÁ‹ Û ı¤Ì·Ù· ˘Á›·˜. ∏ Â-
ÚÈÔÚÈṲ̂ÓË ¯ÚËÌ·ÙÔ‰fiÙËÛË ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜
‰ÂÓ Â¤ÙÚ„ ÙË ‰ÈÂÚ‡ÓËÛË ÙˆÓ 300 ÂÚ›Ô˘ ÂÎ-
·È‰Â˘ÙÈÎÒÓ Ô˘ Û˘ÌÌÂÙ›¯·Ó ÛÙÔ ÚfiÁÚ·ÌÌ·
·˘Ùfi. ∆· ÌÂÏÏÔÓÙÈο ÚÔÁÚ¿ÌÌ·Ù· Ú¤ÂÈ Ó· Û˘-
ÌÂÚÈÏ¿‚Ô˘Ó ÙËÓ Ô˘ÛÈÒ‰Ë ·˘Ù‹ ‰È¿ÛÙ·ÛË, ÌÂ
ÂÓÙ·ÙÈÎfiÙÂÚË ·Ú¤Ì‚·ÛË Î·È ·ÍÈÔÏfiÁËÛË ÙÔ˘ ¤Ú-
ÁÔ˘ ÙˆÓ ÂÎ·È‰Â˘ÙÈÎÒÓ.
∏ Û˘Ì‚ÔÏ‹ ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÂÎ·È‰Â˘ÙÈ΋˜
·Ú¤Ì‚·Û˘ Û ı¤Ì·Ù· ˘Á›·˜, ‰È·ÙÚÔÊ‹˜ ηÈ
¿ıÏËÛ˘ Û ̷ıËÙ¤˜ Ù˘ ∫Ú‹Ù˘ ÁÈ· ÙËÓ ÂÏ¿ÙÙˆÛË
ÙˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù·, ıÂ-
ˆÚÂ›Ù·È ÛËÌ·ÓÙÈ΋ ÚÔÛ¿ıÂÈ· Ù˘ ‰ËÌfiÛÈ·˜ ˘Á›·˜ Ì ıÂÙÈο ·ÔÙÂϤÛÌ·Ù· ηٿ Ù· 10 ¯ÚfiÓÈ· ·Ú·ÎÔÏÔ‡ıËÛ˘-·ÍÈÔÏfiÁËÛ˘. ¶·Ú¿ ÙË ‰È·ÎÔ‹ Ù˘
ÂÎ·È‰Â˘ÙÈ΋˜ ·Ú¤Ì‚·Û˘ ÙÔ 1998, Ë Â·Ó·ÍÈÔÏfiÁËÛË ÙˆÓ ·È‰ÈÒÓ ÌÂÙ¿ ·fi 4 ¯ÚfiÓÈ· ¤‰ÂÈÍ fiÙÈ Ë ıÂÙÈ΋ ›‰Ú·ÛË ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÛÙË Û˘ÌÂÚÈÊÔ-
Ú¿ ÙÔ˘˜ Û ı¤Ì·Ù· ˘Á›·˜, ‰È·ÙÚÔÊ‹˜ Î·È ¿ıÏËÛ˘,
fiˆ˜ ·˘Ù‹ ‰È·ÌÔÚÊÒıËΠÛÙ· 6 ¯ÚfiÓÈ· Ù˘ Âη›-
‰Â˘Û‹˜ ÙÔ˘˜ ÛÙÔ ‰ËÌÔÙÈÎfi, ·Ú¤ÌÂÈÓ Û ÌÂÁ¿ÏÔ ‚·ıÌfi ÛÙ·ıÂÚ‹. ∞˘Ùfi ‰È·ÈÛÙÒıËΠ·fi ÙÔ˘˜ ‚ÂÏ-
ÙȈ̤ÓÔ˘˜ ‰Â›ÎÙ˜ ˘Á›·˜ Ù˘ ÔÌ¿‰·˜ ·Ú¤Ì‚·Û˘. °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi, Ú¤ÂÈ Ó· ÂÊ·ÚÌÔÛÙÔ‡Ó ·Úfi-
ÙËÓ Kellogg’s. ∂›Û˘, Û˘Ó¤‚·Ï·Ó ·ÔÙÂÏÂÛÌ·ÙÈο ÔÈ Û˘ÓÂÚÁ¿Ù˜ Î.Î. ªÈ¯¿Ï˘ ∫˘Úȷο΢, ª·Ú›· ªÈÙÛÒÚË, πˆ¿ÓÓ· ∞ÔÛÙÔÏ¿ÎË, ∞ÁÁÂÏÈ΋ ¶··‰¿ÎË, ¢ËÌ‹ÙÚ˘ ∞ı·Ó·ÛfiÔ˘ÏÔ˜, ∂‡· ªÔ‡Î·, πˆ¿ÓÓ· ªÔÛ¯·Ó‰Ú¤·, ∫·ÚÔÏ¿ÈÓ ∫fi‰ÚÈÁÎÙÔÓ Î·È °È¿ÓÓ˘ ª·ÓÈfi˜.
µÈ‚ÏÈÔÁÚ·Ê›· 1. Lionis C, Kafatos A, Vlachonikolis J, Vakaki M, Tzortzi M, Petraki A. The effects of a health education program among Cretan adolescents. Prev Med 1991;20:685-699.
2. Kafatos A, Mamalakis G. Policies and programs in nutrition and physical fitness in Greece. World Rev Nutr Diet 1993;72:206-217.
3. ∫·Ê¿ÙÔ˜ ∞, ∆Û›ÙÔ˘Ú· ™, ¶·ÓÙÂÏ¿Î˘ ™, ¢ÔÍÈ¿‰Ë˜ ™. ∂›‰Ú·ÛË ÂÎ·È‰Â˘ÙÈ΋˜ ·Ú¤Ì‚·Û˘ ÛÙËÓ ¤ÁÎ˘Ô Î·È ÙÔ ‚Ú¤ÊÔ˜. πÓÛÙÈÙÔ‡ÙÔ ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡. ∞ı‹Ó·; 1985.
4. ∫·Ê¿ÙÔ˜ ∞, ª·ÓÈfi˜ °, ÷Ù˙‹˜ Ã, ªÔÛ¯·Ó‰Ú¤· π, ª·ÏˆÌÂÓ¿ÎË ∂, ∞ı·Ó·ÛfiÔ˘ÏÔ˜ ¢ Î·È Û˘Ó. ∞ÍÈÔÏfiÁËÛË ÚÔÁÚ¿ÌÌ·ÙÔ˜ ∞ÁˆÁ‹˜ ÀÁ›·˜ ÌÂÙ¿ ·fi ÙÚ›· ¯ÚfiÓÈ· ÂÎ·È‰Â˘ÙÈ΋˜ ·Ú¤Ì‚·Û˘ ÛÙ· ‰ËÌÔÙÈο Û¯ÔÏ›· Ù˘ ∫Ú‹Ù˘. ¶·È‰È·ÙÚÈ΋ 1998;61:483-497.
5. Manios Y, Moschandreas J, Hatzis C, Kafatos A. Evaluation of a health and nutrition education program in primary school children of Crete over a three-year period. Prev Med 1999;28:149-159.
6. Manios Y, Kafatos A. Health and nutrition education in elementary schools: changes in health knowledge, nutrient intakes and physical activity over a six year period. Public Health Nutr 1999;2:445-448.
7. Manios Y, Moschandreas J, Hatzis C, Kafatos A. Health and nutrition education in primary schools of Crete: changes in chronic disease risk factors following a 6-year intervention program. Br J Nutr 2002;88:315-324.
8. ∫·Ê¿ÙÔ˜ ∫, ÷Ù˙‹˜ Ã, ª·ÓÈfi˜ °, §ÈÓ·Ú‰¿Î˘ ª, ªÔÛ¯·Ó‰Ú¤· π, ª¿ÚηÙ˙Ë ƒ. ∞ÁˆÁ‹ ˘Á›·˜ ÛÙ· Û¯ÔÏ›· Ù˘ ∫Ú‹Ù˘. ¶·È‰È·ÙÚÈ΋ 1999;62:371-378.
9. ª·ÓÈfi˜ °, ªÔÛ¯·Ó‰Ú¤· π, ÷Ù˙‹˜ Ã, ∫·Ê¿ÙÔ˜ ∞. ¶·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ¯ÚfiÓÈˆÓ ÓÔÛËÌ¿ÙˆÓ Û ·È‰È¿ ‰ËÌÔÙÈÎÔ‡ Ù˘ ∫Ú‹Ù˘ ÌÂÙ¿ ÙËÓ ÔÏÔÎÏ‹ÚˆÛË ÂÍ·ÂÙÔ‡˜ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ·ÁˆÁ‹˜ ˘Á›·˜. ¶·È‰È·ÙÚÈ΋ 2002;65:66-76.
10. Voukiklaris GE, Kafatos A, Dontas AS. Changing prevalence of coronary heart disease risk factors and cardiovascular diseases in men of a rural area of Crete from 1960 to 1991. Angiology 1996;47:43-49.
11. Savva SC, Tornaritis M, Savva ME, Kourides Y, Panagi A, Silikiotou N et al. Waist circumference and waist-to-height ratio are better predictors of cardiovascular disease risk factors in children than body mass index. Int J Obes Relat Metab Disord 2000;24:1453-1458.
12. Fordyce-Baum MK, Duncan R, Kafatos A, Christakis G. The cross-cultural study of U.S. and Greek adolescents: blood pressure data. J Chronic Dis 1987;40:221-227.
13. Krassas GE, Tzotzas T, Tsametis C, Konstantinidis T. Prevalence and trends in overweight and obesity among children and adolescents in Thessaloniki, Greece. J Pediatr Endocrinol Metab 2001;14 (Suppl 5):S1319-S1326.
14. ª·ÚÛ¤ÏÔ˜ ª, ºÚ·ÁΛ‰Ë˜ Ã, ªÈ¯·ÏfiÔ˘ÏÔ˜ µ. ¢È·¯ÚÔÓÈ΋ ÌÂϤÙË ÙÔ˘ Ì·ıËÙÈÎÔ‡ ηӛÛÌ·ÙÔ˜. π. ™˘¯ÓfiÙËÙ·. π·ÙÚÈ΋
1993;63:140-146.
15. Kokkevi A, Stefanis C. The epidemiology of licit and illicit substance use among high school students in Greece. Am J Public Health 1991;81:48-52.
16. Winkleby MA, Fortmanm SP, Rockhill B. Cigarette smoking trends in adolescents and young adults: the Stanford FiveCity Project. Prev Med 1993;22:325-334.
17. Doxiades S, Trichopoulos D, Phylactou-Dimou H. Impact of a national anti-smoking campaign. Lancet 1985;ii:712-713.
18. Hassapidou MN, Fotiadou E. Dietary intakes and food habits of adolescents in northern Greece. Int J Food Sci Nutr 2001;52:109-116.
19. Serdula MK, Ivery D, Coates RJ, Freedman DS, Williamson DF, Byers T. Do obese children become obese adults? A review of the literature. Prev Med 1993;22:167-177.
20. Srinivasan SR, Bao W, Wattigney WA, Berenson GS. Adolescent overweight is associated with adult overweight and related multiple cardiovascular risk factors: the Bogalusa Heart Study. Metabolism 1996;45:235-240.
21. Lohman TG, Caballero B, Himes JH, Hunsberger S, Reid R, Stewart D et al. Body composition assessment in American Indian children. Am J Clin Nutr 1999;69 (Suppl 4):S764-S766.
22. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 2000;320:1240-1243.
23. McGraw SA, Sellers D, Stone E, Resnicow KA, Kuester S, Fridinger F et al. Measuring implementation of school programs and policies to promote healthy eating and physical activity among youth. Prev Med 2000;31:S86-S97.
24. Walter HJ, Hofman A, Connelly PA, Barrett LT, Kost KL. Primary prevention of chronic disease in childhood: changes in risk factors after one year of intervention. Am J Epidemiol 1985;122:772-781.
25. Resnicow K, Cohn L, Reinhardt J, Cross D, Futterman R, Kirschner E et al. A three-year evaluation of the know your body program in inner-city schoolchildren. Health Educ Q 1992;19:463-480.
26. Lytle LA, Stone EJ, Nichaman MZ, Perry CL, Montgomery DH, Nicklas TA et al. Changes in nutrient intakes of elementary school children following a school-based intervention: results from the CATCH Study. Prev Med 1996;25:465-477.
27. McMurray RG, Harrell JS, Bangdiwala SI, Bradley CB, Deng S, Levine A. A school-based intervention can reduce body fat and blood pressure in young adolescents. J Adolesc Health 2002;31:125-132.
28. Sahota P, Rudolf MC, Dixey R, Hill AJ, Barth JH, Cade J. Randomised controlled trial of primary school based intervention to reduce risk factors for obesity. BMJ 2001;323:1029-1032.
29. Harrell JS, McMurray RG, Bangdiwala SI, Frauman AC, Gansky SA, Bradley CB. Effects of a school-based intervention to reduce cardiovascular disease risk factors in elementary-school children: the Cardiovascular Health in Children (CHIC) study. J Pediatr 1996;128:797-805.
30. Kafatos A, Mamalakis G. Changing patterns of fat intake in Crete. Eur J Clin Nutr 1993;47 (Suppl 1):S21-S24.
µÔ‡Ù˜-™Ù·˘Ú¿ÎÈ·, ∆.∫. 710 03 ∆.£. 2208, ∏Ú¿ÎÏÂÈÔ ∫Ú‹Ù˘ E-mail: linman@med.uoc.gr
∂ƒ∂À¡∏∆π∫∏
Û˘Ó¤ÂÈ· ÛÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi ÙˆÓ ·È‰ÈÒÓ ÛÙËÓ ŒÚ¢ӷ Û ·È‰ÈÎfi ÏËı˘ÛÌfi ∫¤ÓÙÚÔ˘ ÀÁ›·˜
ª. ™¯ÔÈÓ¿, °. ™¯ÔÈÓ¿˜, ∫. ¶·ÙÂÚfiÔ˘ÏÔ˜
Is there consistency in immunization of children who live in the countryside?
Study of the child population of a Rural Health Centre
M. Schina, G. Schinas, K. Pateropoulos
¶ÂÚ›ÏË„Ë: ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ë ‰ÈÂÚ‡-
ÓËÛË Î·È Î·Ù·ÁÚ·Ê‹ Ù˘ ÂÌ‚ÔÏÈ·ÛÙÈ΋˜ Î¿Ï˘„˘
ÙˆÓ ·È‰ÈÒÓ Ô˘ ηÙÔÈÎÔ‡Ó ÛÙËÓ ÂÚÈÔ¯‹ ¢ı‡Ó˘
ÙÔ˘ ∫¤ÓÙÚÔ˘ ÀÁ›·˜ π¿ÛÌÔ˘ ÙÔ˘ ¡ÔÌÔ‡ ƒÔ‰fi˘,
ηıÒ˜ Î·È Ë Û‡ÁÎÚÈÛË ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ Ù˘ ÂÚÈÔ¯‹˜ Ì ÙÔ˘˜ ÛÙfi¯Ô˘˜ Ô˘ ÚԂϤÔÓÙ·È ·fi ÙËÓ
¶·ÁÎfiÛÌÈ·OÚÁ¿ÓˆÛËÀÁ›·˜ Î·È Ì ·Ó¿ÏÔÁ· ÛÙÔȯ›· ¿ÏÏˆÓ ÌÂÏÂÙÒÓ. ∞ÓÙÈΛÌÂÓÔ Ù˘ ÌÂϤÙ˘ ·ÔÙ¤ÏÂÛ·Ó 230 ·È‰È¿ Ù˘ ÂÚÈÔ¯‹˜, ËÏÈΛ·˜ 6-14
ÂÙÒÓ, Ô˘ ÂÈÛΤÊıËÎ·Ó ÙÔ ∫¤ÓÙÚÔ ÀÁ›·˜ÁÈ· Ïfi-
ÁÔ˘˜ ˘Á›·˜ ‹ ÁÈ· ÚÔÏËÙÈ΋ ÂͤٷÛË Î·Ù¿ Ù· ¤ÙË
2000-2001, ÙˆÓ ÔÔ›ˆÓ Ù· ‚È‚ÏÈ¿ÚÈ· ÌÂÏÂÙ‹ıËηÓ
Î·È Î·Ù·ÁÚ¿ÊËÎÂ Ë ÂÌ‚ÔÏÈ·ÛÙÈ΋ ÙÔ˘˜ ΛÓËÛË. O
·ÚÈıÌfi˜ ÙˆÓ ‰fiÛÂˆÓ ÌÂÏÂÙ‹ıËΠ¯ÚËÛÈÌÔÔÈÒ-
ÓÙ·˜ ˆ˜ ËÏÈ˘ ÔÚfiÛËÌÔ ÙÔ 1Ô Î·È 2Ô ¤ÙÔ˜, ηıÒ˜
Î·È Û˘ÓÔÏÈο ÛÙÔ Î¿ı ·È‰› ·ÓÂÍ·Úًو˜ ËÏÈΛ·˜.
™‡Ìʈӷ Ì ٷ ·ÔÙÂϤÛÌ·Ù· ÁÈ· ÙË ‰ÈÊıÂÚ›Ùȉ·,
ÙÔÓ Ù¤Ù·ÓÔ, ÙÔÓ ÎÔηÙË Î·È ÙËÓ ÔÏÈÔÌ˘ÂÏ›Ùȉ·, ÙÔ 63%, 63%, 62,2% Î·È ÙÔ 63,5% ÙˆÓ ·È‰ÈÒÓ ·ÓÙÈÛÙÔ›¯ˆ˜ ‹Ù·Ó ÂÌ‚ÔÏÈ·Ṳ̂ÓÔ Ì 3 ‰fiÛÂȘ Û ËÏÈΛ· ÌÈÎÚfiÙÂÚË ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜, ÙÔ 51%, 51%, 49,1% Î·È 49,6% ·ÓÙ›ÛÙÔȯ· ‹Ù·Ó ÂÌ‚ÔÏÈ·Ṳ̂ÓÔ Ì 4 ‰fiÛÂȘ Û ËÏÈΛ· οو ÙˆÓ 2 ÂÙÒÓ Î·È ÙÔ 83,9%, 83,9%, 64,8% Î·È 82,2% ·ÓÙÈÛÙÔ›¯ˆ˜ ›¯Â 5 ‰fiÛÂȘ Û˘ÓÔÏÈο, ·ÓÂÍ·Úًو˜ ËÏÈΛ·˜, ÁÈ· ÙËÓ Î¿ı ÓfiÛÔ. °È· ÙËÓ ÈÏ·Ú¿, ÙËÓ ÂÚ˘ıÚ¿ Î·È ÙËÓ ·ÚˆÙ›Ùȉ·, Ì›· ‰fiÛË Û ËÏÈΛ· ÌÈÎÚfiÙÂÚË ÙˆÓ ‰‡Ô ÂÙÒÓ Â›¯Â Ï¿‚ÂÈ ÙÔ
4,8% ÙˆÓ ·È‰ÈÒÓ, ‰‡Ô ‰fiÛÂȘ ·ÓÂÍ·Úًو˜ ËÏÈΛ·˜ ÙÔ 53,9%, ÂÓÒ ÙÔ 8,7% ·Ú¤ÌÂÓ ·ÓÂÌ‚ÔÏ›·-
ÛÙÔ. ∫·Ù¿ ÙË Û‡ÁÎÚÈÛË ÙˆÓ ÛÙÔȯ›ˆÓ ·˘ÙÒÓ, ‰È·-
ÈÛÙÒÓÂÙ·È ÛËÌ·ÓÙÈ΋ ·fiÎÏÈÛË ·fi ÙÔ˘˜ ÛÙfi¯Ô˘˜
Ù˘¶·ÁÎfiÛÌÈ·˜OÚÁ¿ÓˆÛ˘ ÀÁ›·˜, fiÔ˘ ÂÓ‰ÂÈ-
ÎÙÈο ·Ó·Ê¤ÚÂÙ·È fiÙÈ ··ÈÙÂ›Ù·È ÂÌ‚ÔÏÈ·ÛÙÈ΋ Î¿Ï˘„Ë ≥90% ÁÈ·
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.
Health Care Centre of Soufli, Prefecture of Evros
ÏÔÈfiÓ,·Ó·ÁηÈfiÙËÙ· Ë ‰ÈÂÓ¤ÚÁÂÈ· ÌÂϤÙ˘ Ù˘ ηٿÛÙ·Û˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Û ÙÔÈÎfi Â›Â‰Ô Î·È Ë
ÚÔÒıËÛË ÙÔÈÎÔ‡ ۯ‰ȷÛÌÔ‡ ‰Ú·ÛÙËÚÈÔًوÓ
ÚÔ·ÁˆÁ‹˜ ÙˆÓ ÂÌ‚ÔÏÈ·ÛÌÒÓ.
§¤ÍÂȘ ÎÏÂȉȿ: ÂÌ‚ÔÏÈ·ÛÌÔ›, ·È‰È¿, ∫¤ÓÙÚÔ ÀÁ›·˜, £Ú¿ÎË.
™˘ÓÙÔÌÔÁڷʛ˜
∫À∫¤ÓÙÚÔ ÀÁ›·˜
¶OÀ¶·ÁÎfiÛÌÈ·OÚÁ¿ÓˆÛËÀÁ›·˜
πÀ¶πÓÛÙÈÙÔ‡ÙÔ ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡
∂ÈÛ·ÁˆÁ‹
∏ ·ÓÙ›ÏË„Ë fiÙÈ Ë ÚfiÏË„Ë ÙˆÓ ·ÛıÂÓÂÈÒÓ ·ÔÙÂÏ› ÙËÓ Î·Ï‡ÙÂÚË Ì¤ıÔ‰Ô ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘˜ Â›Ó·È ·Ô‰ÂÎÙ‹ ·fi ·Ú¯·ÈÔÙ¿ÙˆÓ ¯ÚfiÓˆÓ. ∞˘Ùfi ÂȂ‚·ÈÒÓÂÙ·È ·fi ÙËÓ ÂÊ·ÚÌÔÁ‹ ÌÂıfi‰ˆÓ ÂÌ-
‚ÔÏÈ·ÛÌÔ‡ ÚÈÓ ·ÎfiÌË ·fi ÙË Á¤ÓÓËÛË ÙÔ˘ ÃÚÈÛÙÔ‡, ·Ú¯Èο Ì ÛÔ‚·Ú¤˜ ·ÚÂÓ¤ÚÁÂȘ Î·È ÎÈÓ‰‡-
ÓÔ˘˜ ÁÈ· ÙËÓ ˘Á›· ÙÔ˘ ÂÌ‚ÔÏÈ·˙fiÌÂÓÔ˘.
™‹ÌÂÚ·, Ë ÂͤÏÈÍË Ù˘ ÌÔÚȷ΋˜ Î·È Î˘ÙÙ·ÚÈ΋˜
‚ÈÔÏÔÁ›·˜ ¤¯ÂÈ Ê¤ÚÂÈ Â·Ó¿ÛÙ·ÛË ÛÙËÓ ·Ú·Û΢‹ ·ÔÙÂÏÂÛÌ·ÙÈÎÒÓ Î·È ·Î›Ó‰˘ÓˆÓ ÂÌ‚ÔÏ›ˆÓ, Ì ÙȘ ÏÈÁfiÙÂÚ˜ ‰˘Ó·Ù¤˜ ·ÚÂÓ¤ÚÁÂȘ ÁÈ· ÙÔÓ ÂÌ‚ÔÏÈ·˙fiÌÂÓÔ.
O ·ÒÙÂÚÔ˜ ÛÙfi¯Ô˜ Ù˘ ÂÓÂÚÁËÙÈ΋˜ ·ÓÔÛÔÔ›ËÛ˘ Â›Ó·È Ë ÂÍ¿ÏÂÈ„Ë Ù˘ ÓfiÛÔ˘. O ÂӉȿÌÂÛÔ˜ ÛÙfi¯Ô˜ Â›Ó·È Ó· ·ÔÙڷ› Ë ÂΉ‹ÏˆÛË Ù˘ ÓfiÛÔ˘ Û ¿ÙÔÌ· ‹ ÔÌ¿‰Â˜ ·ÙfïÓ. °È· Ó· ÂÈÙ¢¯ıÔ‡Ó ·˘ÙÔ› ÔÈ ÛÙfi¯ÔÈ, ÔÈ ÁÈ·ÙÚÔ› Ú¤ÂÈ Ó· ÙËÚÔ‡Ó ÛÙ·ıÂÚfi
ÚfiÁÚ·ÌÌ· ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÙˆÓ ‚ÚÂÊÒÓ, ÙˆÓ ·È-
‰ÈÒÓ, ÙˆÓ ÂÊ‹‚ˆÓ Î·È ÙˆÓ ÂÓËϛΈÓ, ‰Â‰Ô̤ÓÔ˘ fiÙÈ
·˘Ùfi ·ÔÙÂÏ› Ú¿ÍË Ì¤ÁÈÛÙ˘ ÛÔ˘‰·ÈfiÙËÙ·˜.
∞fi‰ÂÈÍË ·˘ÙÔ‡ ·ÔÙÂÏ› Ë Ï‹Ú˘ ÂÍ¿ÏÂÈ„Ë Ù˘ ¢ÏÔÁÈ¿˜ ÙÔ 1979 Î·È Ô ÛËÌ·ÓÙÈÎfi˜ ÂÚÈÔÚÈÛÌfi˜
Ù˘ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜, ·ÏÏ¿ Î·È ¿ÏÏˆÓ ÓÔÛËÌ¿ÙˆÓ
Ô˘ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÛÙÔ ‚·ÛÈÎfi ÚfiÁÚ·ÌÌ· ÂÌ‚ÔÏÈ·ÛÌÒÓ.
™ÎÔfi Ù˘ ÌÂϤÙ˘ ·˘Ù‹˜ ·ÔÙÂÏ› Ë ‰ÈÂÚ‡ÓËÛË Î·È Î·Ù·ÁÚ·Ê‹ Ù˘ ÂÌ‚ÔÏÈ·ÛÙÈ΋˜ Î¿Ï˘„˘ ÙˆÓ
·È‰ÈÒÓ Ô˘ ηÙÔÈÎÔ‡Ó ÛÙËÓ ÂÚÈÔ¯‹ ¢ı‡Ó˘ ÙÔ˘
∫¤ÓÙÚÔ˘ ÀÁ›·˜ π¿ÛÌÔ˘ ÙÔ˘ ÓÔÌÔ‡ ƒÔ‰fi˘, Ì›·˜ ÔÚÂÈÓ‹˜ ÂÚÈÔ¯‹˜ Ì ÏËı˘ÛÌȷΤ˜ ȉȷÈÙÂÚfiÙËÙ˜, ηıÒ˜ Î·È Ë Û‡ÁÎÚÈÛË ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ Ù˘ ÂÚÈÔ¯‹˜ Ì ÙÔ˘˜ ÛÙfi¯Ô˘˜Ù˘¶·ÁÎfiÛÌÈ·˜OÚÁ¿ÓˆÛ˘ ÀÁ›·˜(¶OÀ) Î·È Ì ÛÙÔȯ›· ¿ÏÏˆÓ ·Ó¿ÏÔÁˆÓ ÌÂÏÂÙÒÓ.
ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ
∞ÓÙÈΛÌÂÓÔ Ù˘ ÌÂϤÙ˘ ·ÔÙ¤ÏÂÛ·Ó 230 ·È‰È¿ Ù˘ ÂÚÈÔ¯‹˜, ËÏÈΛ·˜ 6-14 ÂÙÒÓ, Ù· ÔÔ›· ÂÈÛΤÊıËÎ·Ó ÙÔ ∫À ÁÈ· ÏfiÁÔ˘˜ ÔÍ›·˜ ÓfiÛËÛ˘ ‹ ÁÈ· ÚÔÏËÙÈ΋ ÂͤٷÛË Î·È Û˘ÌÏ‹ÚˆÛË ÙÔ˘ ·ÙÔÌÈÎÔ‡ ‰ÂÏÙ›Ô˘ ˘Á›·˜, ηٿ Ù· ¤ÙË 20002001. ªÂÏÂÙ‹ıËÎ·Ó Ù· ‚È‚ÏÈ¿ÚÈ· ·˘ÙÒÓ ÙˆÓ ·È‰ÈÒÓ Î·È Î·-
Key words: immunization, children, Health Care Centre, Thrace.
Ù·ÁÚ¿ÊËÎÂ Ë ÂÌ‚ÔÏÈ·ÛÙÈ΋ ÙÔ˘˜ ηٿÛÙ·ÛË. ∞Í›˙ÂÈ Ó· ÛËÌÂȈı› fiÙÈ ÙÔ 80% ÙˆÓ ·È‰ÈÒÓ ‹Ù·Ó ªÔ˘ÛÔ˘ÏÌ¿ÓÔÈ ÂÏÏËÓÈ΋˜ ηٷÁˆÁ‹˜.
∏ ÂÌ‚ÔÏÈ·ÛÙÈ΋ ÙÔ˘˜ Î¿Ï˘„Ë ÌÂÏÂÙ‹ıËÎÂ: ·) ÁÈ· ÙË ‰ÈÊıÂÚ›Ùȉ·, ÙÔÓ Ù¤Ù·ÓÔ, ÙÔÓ ÎÔηÙË Î·È ÙËÓ ÔÏÈÔÌ˘ÂÏ›Ùȉ· ˆ˜ ÚÔ˜ ÙÔÓ ·ÚÈıÌfi ÙˆÓ ‰fiÛÂˆÓ Ô˘ ¯ÔÚËÁ‹ıËÎ·Ó Û ËÏÈΛ· ÌÈÎÚfiÙÂÚË ÙÔ˘ 1Ô˘ Î·È ÙÔ˘ 2Ô˘ ¤ÙÔ˘˜ Î·È ˆ˜ ÚÔ˜ ÙÔÓ ·ÚÈıÌfi ÙˆÓ ‰fiÛÂˆÓ Ô˘ ¯ÔÚËÁ‹ıËÎ·Ó Û˘ÓÔÏÈο, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙËÓ ËÏÈΛ·, ‚) ÁÈ· ÙËÓ ÈÏ·Ú¿, ÙËÓ ÂÚ˘ıÚ¿ Î·È ÙËÓ ·ÚˆÙ›Ùȉ·, ˆ˜
ÚÔ˜ ÙÔÓ ·ÚÈıÌfi ÙˆÓ ‰fiÛÂˆÓ Ô˘ ¯ÔÚËÁ‹ıËÎ·Ó Û ËÏÈΛ· ÌÈ-
ÎÚfiÙÂÚË ÙÔ˘ 2Ô˘ ¤ÙÔ˘˜ Î·È ˆ˜ ÚÔ˜ ÙÔÓ ·ÚÈıÌfi ÙˆÓ ‰fiÛˆÓ
ÙËÓ ËÏÈΛ· ¯ÔÚ‹ÁËÛ˘. ™ËÌÂÈÒÓÂÙ·È fiÙÈ ÛÂ
ۯ‰fiÓ Ù· ·È‰È¿ ›¯Â ¯ÔÚËÁËı› ÙÔ ÙÚÈÏfi ÂÌ‚fiÏÈÔ MMR
‰ÂÓ Â›¯·Ó Á›ÓÂÈ Í¯ˆÚÈÛÙÔ› ÂÌ‚ÔÏÈ·ÛÌÔ› ÁÈ· οı ÓfiÛÔ, Á) ÁÈ· ÙËÓ Ë·Ù›Ùȉ· µ, ˆ˜ ÚÔ˜ ÙÔÓ ·ÚÈıÌfi ÙˆÓ ·È‰ÈÒÓ Ô˘ ›¯·Ó Ï¿‚ÂÈ ÙÔ ÚÔ‚ÏÂfiÌÂÓÔ Û¯‹Ì· ÙˆÓ 3 ‰fiÛˆÓ, ‰) ÁÈ· ÙÔÓ ·ÈÌfiÊÈÏÔ Ù˘ ÈÓÊÏÔ˘¤ÓÙÛ·˜, ˆ˜ ÚÔ˜ ÙÔÓ ·ÚÈıÌfi ÙˆÓ ·È‰ÈÒÓ Ô˘ ›¯·Ó Ï¿‚ÂÈ ÙÔ Ï‹Ú˜ Û¯‹Ì· ÙˆÓ ‰fiÛˆÓ, fiˆ˜ ÚԂϤÂÙ·È Û‡Ìʈӷ Ì ÙËÓ ËÏÈΛ·, Â) ÁÈ· ÙËÓ Ë·Ù›Ùȉ· ∞: ‰‡Ô ‰fiÛÂȘ ·ÓÂÍ¿ÚÙËÙ· ·fi ÙËÓ
ËÏÈΛ· ÂÌ‚ÔÏÈ·ÛÌÔ‡ ηÈ, Ù¤ÏÔ˜, ÛÙ) Ë Î¿Ï˘„‹ ÙÔ˘˜ Ì ÙÔ BCG.
™¯ÂÙÈο Ì ÙÔ Ó¤Ô ÂÌ‚fiÏÈÔ ÙÔ˘ ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘ ÔÌ¿‰·˜
C, ·Ó·Ê¤ÚÂÙ·È fiÙÈ Î·Ó¤Ó· ·È‰› ‰ÂÓ ‹Ù·Ó ÂÌ‚ÔÏÈ·Ṳ̂ÓÔ.
¶ÚfiÙ˘Ô ÁÈ· ÙË ÌÂϤÙË ·ÔÙ¤ÏÂÛ ÌÂıÔ‰ÔÏÔÁ›· ·Ó¿ÏÔÁË
Ù˘ ·ÓÂÏÏ·‰È΋˜ ÌÂϤÙ˘ Ô˘ ¤Ï·‚ ¯ÒÚ· ÙÔ 1996-1997 Î·È ‰ÈÔÚÁ·ÓÒıËΠ·fi ÙÔ πÓÛÙÈÙÔ‡ÙÔ ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡ (πÀ¶).
∞ÔÙÂϤÛÌ·Ù·
∏ Î¿Ï˘„Ë ÙˆÓ ·È‰ÈÒÓ ÁÈ· ÙË ‰ÈÊıÂÚ›Ùȉ·, ÙÔÓ Ù¤Ù·ÓÔ, ÙÔÓ ÎÔηÙË Î·È ÙËÓ ÔÏÈÔÌ˘ÂÏ›Ùȉ· Ê·›ÓÂÙ·È ÛÙÔÓ ¶›Ó·Î· 1. °›ÓÂÙ·È, ÏÔÈfiÓ, ·ÓÙÈÏËÙfi fiÙÈ
ÌfiÏȘ ÙÔ 51% ÙˆÓ ·È‰ÈÒÓ Â›Ó·È ÂÌ‚ÔÏÈ·Ṳ̂ÓÔ Ì 4 ‰fiÛÂȘ ÁÈ· ‰ÈÊıÂÚ›Ùȉ· Î·È Ù¤Ù·ÓÔ Û ËÏÈΛ· ÌÈÎÚfiÙÂÚË ÙˆÓ 2 ÂÙÒÓ, ÂÓÒ ÙÂÏÈο, ÛÙȘ ÌÂÁ·Ï‡ÙÂÚ˜ ËÏÈ˘, ÙÔ ÔÛÔÛÙfi Î¿Ï˘„˘ Ì 5 ‰fiÛÂȘ ÊÙ¿ÓÂÈ ÙÔ
83,9% (ÔÛÔÛÙfi Ô˘ Â›Ó·È Û ·ÓÙÈÛÙÔȯ›· Ì ٷ
ÛÙÔȯ›· ·fi ÙËÓ ·ÓÂÏÏ·‰È΋ ÌÂϤÙË) (¶›Ó·Î·˜ 2) Î·È ¿ÏϘ ·ÓÙ›ÛÙÔȯ˜ ÌÂϤÙ˜. ∂ȉÈο ÁÈ· ÙÔÓ ÎÔηÙË, ÂÎÙfi˜ ·fi ÙËÓ Î·ı˘ÛÙ¤ÚËÛË ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡, ·Ú·ÙËÚÂ›Ù·È Î·È ·ÚÎÂÙ¿ ¯·ÌËÏfiÙÂÚÔ ÔÛÔÛÙfi ·È‰ÈÒÓ ÂÌ‚ÔÏÈ·ÛÌ¤ÓˆÓ Ì 5 ‰fiÛÂȘ ÏfiÁˆ ¯ÔÚ‹ÁËÛ˘ ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ DT ÛÙËÓ 5Ë ‰fiÛË, ·ÏÏ¿ Ù· ÔÛÔÛÙ¿ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚ·
ÂÙÒÓ·ÓÂÍ·Úًو˜ ËÏÈΛ·˜
¢ÈÊıÂÚ›Ùȉ·*63%51%83,9%3,9% ∫ÔÎ·Ù˘62,2%49,6%64,8%10,4%3% Sabin63,5%49,6%82,2%4%
* ∏ 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·˜ 2. ™ÙÔȯ›· ·ÓÂÏÏ·‰È΋˜ ÌÂϤÙ˘
3 ‰fiÛÂȘ4 ‰fiÛÂȘ5 ‰fiÛÂȘ <1 ¤ÙÔ˘˜<2 ÂÙÒÓ·ÓÂÍ·Úًو˜ ËÏÈΛ·˜
·fi Ù· ·Ó¿ÏÔÁ· Ù˘ ·ÓÂÏÏ·‰È΋˜ ÌÂϤÙ˘, Êı¿-
ÓÔÓÙ·˜ ÙÔ 64,8%, ÂÓÒ ÂÈÛËÌ·›ÓÂÙ·È Î·È ÙÔ 3% ÙˆÓ
·ÓÂÌ‚ÔÏ›·ÛÙˆÓ ·È‰ÈÒÓ.
™¯ÔÏÈ¿˙ÔÓÙ·˜ Ù· ÛÙÔȯ›· ÁÈ· ÙËÓ ÈÏ·Ú¿, ÙËÓ
ÂÚ˘ıÚ¿ Î·È ÙËÓ ·ÚˆÙ›Ùȉ· (¶›Ó·Î·˜ 3), ȉȷ›ÙÂÚË
¶›Ó·Î·˜ 3. ¢Â›ÎÙ˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÁÈ· ÙËÓ ÈÏ·Ú¿, ÙËÓ ÂÚ˘ıÚ¿
Î·È ÙËÓ ·ÚˆÙ›Ùȉ·
πÏ·Ú¿∂Ú˘ıÚ¿¶·ÚˆÙ›Ùȉ·
ñ 0 ‰fiÛÂȘ8,7%8,7%8,7% ñ 1 ‰fiÛË4,8%4,8%4,8% (<2ÂÙÒÓ)
ñ 1 ‰fiÛË26,1%25,2%26,1% ñ 2 ‰fiÛÂȘ 53,9%54,3%53,9%
(·ÓÂÍ·Úًو˜
ËÏÈΛ·˜)
ñ 2 ‰fiÛÂȘ6,5%6,9%6,5% (<6 ÂÙÒÓ)
¢ÈÊıÂÚ›Ùȉ·84,1%69%80,8% ∫ÔÎ·Ù˘82,4%65%46,3% ¶ÔÏÈÔÌ˘ÂÏ›Ùȉ·81,2%65,6%80,3% ¶›Ó·Î·˜ 4. ™Ùfi¯ÔÈ Ù˘¶·ÁÎfiÛÌÈ·˜OÚÁ·ÓˆÛ˘ ÀÁ›·˜ (¶OÀ)
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·ÈÚÂÙÈ-
ο ‰‡ÛÎÔÏÔ ÛÙfi¯Ô ÙËÓ ÂÎÚ›˙ˆÛË ÙˆÓ ÓfiÛˆÓ ·˘ÙÒÓ
ÛÙ· ·Ì¤Ûˆ˜ ÂfiÌÂÓ· ¯ÚfiÓÈ·. OÈ ÔÌÔÈfiÙËÙ˜ ÛÙ·
ÔÛÔÛÙ¿ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÁÈ· ÙȘ ÙÚÂȘ ÓfiÛÔ˘˜ ÔÊ›-
ÏÔÓÙ·È ÛÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ ÙÚÈÏÔ‡ ÂÌ‚ÔÏ›Ô˘ MMR
Û fiÏ· ۯ‰fiÓ Ù· ·È‰È¿.
™Â ·Ó¿ÏÔÁË ÌÂϤÙË Ô˘ ¤Ï·‚ ¯ÒÚ· ÛÙÔÓ ÓÔÌfi
¶ÈÂÚ›·˜ ÙÔ 2000 (8), Ù· ÔÛÔÛÙ¿ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÁÈ·
ÙȘ ÙÚÂȘ ÓfiÛÔ˘˜ ‹Ù·Ó 34,4% ÁÈ· Ù· ·È‰È¿ ÙÔ˘ §˘-
ΛԢ Î·È 34,8% ÁÈ· Ù· ·È‰È¿ ÙÔ˘ °˘ÌÓ·Û›Ô˘. ∆·
ÔÛÔÛÙ¿ ·˘Ù¿ Â›Ó·È ‚¤‚·È· ˘„ËÏfiÙÂÚ· ·fi ÙÔ
26,1% Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ (¶›Ó·Î·˜ 3), ·ÏÏ¿
ÙÔÓ›˙ÂÙ·È ÁÈ· ¿ÏÏË Ì›· ÊÔÚ¿ Ë ÛËÌ·ÓÙÈ΋ ·fiÎÏÈÛË ·fi ÙÔ˘˜ ÛÙfi¯Ô˘˜ Ù˘¶OÀ. ™Â ÌÂϤÙË Ô˘ ‰ÈÂÓÂÚÁ‹ıËΠ·fi ÙËÓ ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ÙÔ 1995, Û ÓÔÛÔÎÔÌÂÈ·Îfi ÏËı˘ÛÌfi (3), Ù· ÔÛÔÛÙ¿ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ›¯·Ó ÌÈÎÚ¤˜ ‰È·ÊÔÚ¤˜ ÁÈ· ÙË ‰ÈÊıÂÚ›Ùȉ·, ÙÔÓ ÎÔηÙË Î·È ÙËÓ ÔÏÈÔÌ˘ÂÏ›Ùȉ·, ÂÓÒ ·Ú·ÙËÚ‹ıËΠÌÂÁ¿ÏË ‰È·ÊÔÚ¿ ÁÈ· ÙËÓ ÈÏ·Ú¿, ÙËÓ ÂÚ˘ıÚ¿ ηÈ
ÙËÓ ·ÚˆÙ›Ùȉ·, fiÔ˘ Ù· ÔÛÔÛÙ¿ ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡
‹Ù·Ó 89%, 76% Î·È 82%, ·ÓÙ›ÛÙÔȯ·, ÂÓÒ Ù· ÔÛÔÛÙ¿ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ Êı¿ÓÔ˘Ó ÌfiÏȘ ÙÔ 26,1% ÁÈ·
ÙËÓ ÈÏ·Ú¿, ÙÔ 25,2% ÁÈ· ÙËÓ ÂÚ˘ıÚ¿ Î·È ÙÔ 26,1% ÁÈ·
ÙËÓ ·ÚˆÙ›Ùȉ·. ∞ÎfiÌË, ÂÈÛËÌ·›ÓÂÙ·È ÙÔ ¯·ÌËÏfi ÔÛÔÛÙfi ÂÌ‚Ô-
ñ
™Ùfi¯ÔÈ Ù˘¶OÀ
¢ÈÊıÂÚ›Ùȉ·/٤ٷÓÔ˜≥90% (3 ¤Á΢Ú˜ ‰fiÛÂȘ ¤ˆ˜ 1 ¤ÙÔ˘˜)
ñ ∫ÔÎ·Ù˘≥90% (3 ¤Á΢Ú˜ ‰fiÛÂȘ ¤ˆ˜ 1 ¤ÙÔ˘˜)
ñ ¶ÔÏÈÔÌ˘ÂÏ›Ùȉ·≥90% (3 ¤Á΢Ú˜ ‰fiÛÂȘ ¤ˆ˜ 1 ¤ÙÔ˘˜)
ñ πÏ·Ú¿, ÂÚ˘ıÚ¿, ·ÚˆÙ›Ùȉ·≥90% (1 ¤Á΢ÚË ‰fiÛË ¤ˆ˜ 2 ÂÙÒÓ)
¶›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· µ80,4% (3 ‰fiÛÂȘ ·ÓÂÍ·Úًو˜ ËÏÈΛ·˜)
ñ ∏·Ù›Ùȉ· ∞1,7% (3 ‰fiÛÂȘ ·ÓÂÍ·Úًو˜ ËÏÈΛ·˜)
ñ ∞ÈÌfiÊÈÏÔ˜11,7% (Ï‹Ú˘ ÂÌ‚ÔÏÈ·ÛÌfi˜)
ñ BCG32,6%
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 ¯¿ÚËÛÙȘ ÚÔÛ¿ıÂȘ ÙÔ˘ ÚÔÛˆÈÎÔ‡ ÙÔ˘ ∫¤ÓÙÚÔ˘ ÀÁ›·˜ Ô˘ ¤ÌÂÓ ÛÙȘ ÂÈÛΤ„ÂȘ Î·È Î·ıfiÚÈ˙ ۷ʤ˜ ¯ÚÔÓԉȿÁÚ·ÌÌ·
¶ÔÛÔÛÙfi ÂÌ‚ÔÏÈ·ÛÌÔ‡ ∏ÏÈΛ· Û ̋Ó˜ 135791113151924273036487285110
∂ÈÎfiÓ· 1. ∏ÏÈÎȷ΋ ηٷÓÔÌ‹ ÙˆÓ ·È‰ÈÒÓ Î·Ù¿ ÙËÓ ¤Ó·ÚÍË ÙˆÓ
ÂÌ‚ÔÏÈ·ÛÌÒÓ.
ÙˆÓ ˘Ô¯ÚˆÙÈÎÒÓ ÂÌ‚ÔÏÈ·ÛÌÒÓ ÛÙËÓ ÂÚÈÔ¯‹ Ù˘ ÌÂϤÙ˘. ∞˘Ùfi ÔÊ›ÏÂÙ·È ·ÊÂÓfi˜ ÛÙËÓ ÂÏÏÈ‹ ÏËÚÔÊfiÚËÛË Î·È ·ÊÂÙ¤ÚÔ˘ ÛÙÔ ˘„ËÏfi ÔÛÔÛÙfi ·Ó·ÏÊ·‚ËÙÈÛÌÔ‡. ∏ ‰˘ÛÎÔÏ›· Ù˘ ÂÓË̤ڈÛ˘ ÂÈÙ›ÓÂÙ·È ·ÎfiÌË ÂÚÈÛÛfiÙÂÚÔ ·fi ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ¤Ó· ÌÂÁ¿ÏÔ ÔÛÔÛÙfi ÙˆÓ Î·ÙÔ›ÎˆÓ ·Ó‹ÎÂÈ ÛÙË ÌÔ˘-
ÛÔ˘ÏÌ·ÓÈ΋ ÌÂÈÔÓfiÙËÙ· Î·È ÂÌÊ·Ó›˙ÂÈ Úfi‚ÏËÌ·
ÂÈÎÔÈÓˆÓ›·˜ ÌË Î·Ù·ÓÔÒÓÙ·˜ ·ÚÎÒ˜ ÙË ÁÏÒÛÛ·, ȉ›ˆ˜ ÔÈ ÌËÙ¤Ú˜ Ô˘ Û˘Ó‹ıˆ˜ ÊÚÔÓÙ›˙Ô˘Ó ÁÈ· ÙËÓ
Ù‹ÚËÛË ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÂÌ‚ÔÏÈ·ÛÌÒÓ Î·È ¤¯Ô˘Ó
ηٿ ·ÚÈÔ ÏfiÁÔ ÙËÓ ÂÈ̤ÏÂÈ· ÙˆÓ ·È‰ÈÒÓ. ŒÙÛÈ
‰È·ÈÛÙÒÓÂÙ·È fiÙÈ ÙÔ ÚfiÁÚ·ÌÌ· ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÌÂ-
ٷʤÚÂÙ·È Û ÌÂÁ·Ï‡ÙÂÚ˜ ËÏÈ˘, fiÙ·Ó ‰ËÏ. ÂÈ‚¿ÏÏÂÙ·È Ë ÂͤٷÛË ÙˆÓ ·È‰ÈÒÓ ·fi ·È‰›·ÙÚÔ ÁÈ·
ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ ‰ÂÏÙ›Ô˘ ˘Á›·˜ ÙÔ˘ ·È‰ÈÔ‡. µÚ¤-
ıËΠÏÔÈfiÓ fiÙÈ ÌfiÓÔ ÙÔ 75% ÙˆÓ ·È‰ÈÒÓ ·Ú¯›˙ÂÈ
ÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi ÙÔ˘ Û ËÏÈ˘ <7 ÌËÓÒÓ, ÂÓÒ ¤Ó· 20% ÙˆÓ ·È‰ÈÒÓ ·Ú¯›˙ÂÈ Ó· ÂÌ‚ÔÏÈ¿˙ÂÙ·È ÌÂÙ¿ ÙËÓ
ËÏÈΛ· ÙˆÓ 2 ÂÙÒÓ (∂ÈÎfiÓ· 1).∆ÔÓ›˙ÂÙ·È, Ù¤ÏÔ˜, Ë ÌÂ-
Á¿ÏË ÛËÌ·Û›· Ù˘ ÂÊ·ÚÌÔÁ‹˜ ÙˆÓ ‰‡Ô ‰fiÛÂˆÓ ÂÌ-
‚ÔÏÈ·ÛÌÔ‡ ÁÈ· ÙËÓ ÈÏ·Ú¿, ÙËÓ ÂÚ˘ıÚ¿ Î·È ÙËÓ ·ÚˆÙ›Ùȉ·, ÚÔÎÂÈ̤ÓÔ˘ Ó· ·ÔÊ¢¯ıÔ‡Ó ÂȉË̛˜
fiˆ˜ ·˘Ù‹ Ù˘ ÈÏ·Ú¿˜ ÙÔ 1996 Î·È Ù˘ Û˘ÁÁÂÓÔ‡˜ ÂÚ˘ıÚ¿˜ ÙÔ 1993.
§·Ì‚¿ÓÔÓÙ·˜, ÏÔÈfiÓ, ˘’ fi„ÈÓ Ù· ¯·ÌËÏ¿ ÔÛÔÛÙ¿ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Ù˘ ÂÚÈÔ¯‹˜ ‰È·ÈÛÙÒÓÂÙ·È fiÙÈ Â›Ó·È ··Ú·›ÙËÙ· ÙfiÛÔ Ë ÂÎfiÓËÛË Û¯Â‰›Ô˘ ÂÊ·ÚÌÔÁ‹˜ ÙˆÓ ÂÌ‚ÔÏÈ·ÛÌÒÓ fiÛÔ Î·È Ô Û·Ê‹˜ ηıÔÚÈÛÌfi˜ ÙˆÓ ÛÙfi¯ˆÓ ÛÙÔ˘˜ ·ÓıÚÒÔ˘˜ Ô˘ ·Û¯ÔÏÔ‡ÓÙ·È Ì ÙÔ˘˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡˜ ÁÈ· ÙË ¯¿Ú·ÍË ÎÔÈÓ‹˜ ÛÙÚ·ÙËÁÈ΋˜, ·ÏÏ¿ Î·È ÁÈ· ÙËÓ ÂÓË̤ڈÛË ÙÔ˘ ÏËı˘ÛÌÔ‡, ηıÒ˜ Î·È Ô ¤ÏÂÁ¯Ô˜ ˆ˜ ÚÔ˜ ÙËÓ ·ÓÙ·fiÎÚÈÛË ‹ fi¯È ÛÙȘ ÚԉȷÁڷʤ˜ ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜.
ªÂÁ¿Ï˘, ›Û˘, ÛÔ˘‰·ÈfiÙËÙ·˜ Â›Ó·È Ë ÌÂϤÙË Ù˘ ηٿÛÙ·Û˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Û ÙÔÈÎfi ›‰Ô, ¤ÙÛÈ ÒÛÙ ӷ Á›ÓÂÙ·È ÁÓˆÛÙ‹ Ë ÂÌ‚ÔÏÈ·ÛÙÈ΋
ÙˆÓ ·ÙfiÌˆÓ Ù˘ οı ÂÚÈÔ¯‹˜ Î·È Ó·
ÚÔÁÚ¿ÌÌ·Ù· ÁÈ· Ó· ÂÈÙ¢¯ıÔ‡Ó, ÙÂÏÈο, ÔÈ ÛÙfi¯ÔÈ Ô˘ Ù›ıÂÓÙ·È ·fi
ÙËÓ¶·ÁÎfiÛÌÈ·OÚÁ¿ÓˆÛË ÀÁ›·˜.
µÈ‚ÏÈÔÁÚ·Ê›·
1. ¶·Ó·ÁȈÙfiÔ˘ÏÔ˜ ∆, µ·Ï¿ÛÛË-∞‰¿Ì ∂. ŒÎıÂÛË. ¶·ÓÂÏÏ·‰È΋ ÌÂϤÙË Î·Ù¿ÛÙ·Û˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡. ∞ı‹Ó·: πÓÛÙÈÙÔ‡ÙÔ ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡; 1998.
2. ¶·Ó·ÁȈÙfiÔ˘ÏÔ˜ T. ªÂıÔ‰ÔÏÔÁÈο ÚÔ‚Ï‹Ì·Ù· ÛÙËÓ ¤Ú¢ӷ ÁÈ· ÙËÓ Î·Ù¿ÛÙ·ÛË ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÛÙËÓ ∂ÏÏ¿‰·: Û˘ÛÙËÌ·ÙÈ΋ ·Ó·ÛÎfiËÛË ÌÂÏÂÙÒÓ, 1970-1995. ¶·È‰È·ÙÚÈ΋ 1999;62:116-130.
3. µ·Ï¿ÛÛË-∞‰¿Ì ∂. ∞ÔÙ‡ˆÛË Î·Ù¿ÛÙ·Û˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Û ÓÔÛÔÎÔÌÂÈ·Îfi ÏËı˘ÛÌfi. ¢ÂÏÙ›Ô ∞’ ¶·È‰È·ÙÚÈ΋˜ ∫ÏÈÓÈ΋˜ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ 1995;42:82-86.
4. ºˆÙ›Ô˘ ∫, ¶··‰¿ÎË ∂. O ÂÌ‚ÔÏÈ·ÛÌfi˜ ÁÈ· ÙËÓ Ë·Ù›Ùȉ· µ ÛÙËÓ ·È‰È΋ ËÏÈΛ·. ¶·È‰È·ÙÚÈο ÃÚÔÓÈο 1995;22:63-68.
5. °ÂˆÚÁ¿ÙÔ˜ ¢, ∫·Ú·Î·˚‰fi˜ ¢, ªÔÛ¯ÔÓ¿ ¢, ™·ÍÈÒÓË ∂, ∆˙ÈÔ˘‚¿Ú· Ã, ƒËÁ¿ÙÔ˘ ∂ Î·È Û˘Ó. ∫·Ù¿ÛÙ·ÛË ÂÌ‚ÔÏÈ·ÛÌÔ‡ ·È‰ÈÎÔ‡ ÏËı˘ÛÌÔ‡ ∫ÂÊ·ÏÔÓÈ¿˜ [¶ÂÚ›ÏË„Ë]. 35Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ; 1997 13-15 πÔ˘Ó›Ô˘; ∫Ú‹ÙË; 1997. ÛÂÏ. 69. #62µ∞.
6. American Academy of Pediatrics (Active and Passive Immunization). In: Pickering LK, editor. 2000 Red Book: Report of the Committee on Infectious Diseases. 25th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2000. p. 1.
7. ª·ÏˆÌ¤ÓÔ˜ ∫, ¶··‰ËÌËÙÚ›Ô˘ ∂, °Ú‡ÏÏ˘ ™, ∫ÔÏ˘¤Ú·˜ ¢, ∞ÁÔÚ›ÙÛ· ™. ªÂϤÙË Î·Ù¿ÛÙ·Û˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Ì·ıËÙÒÓ §˘Î›Ԣ ÛÙÔ ¡ÔÌfi ∆ÚÈÎ¿ÏˆÓ [¶ÂÚ›ÏË„Ë]. 38Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ; 2000 16-18 πÔ˘Ó›Ô˘; ∫ˆ˜; 2000. ÛÂÏ. 289. #568.
8. ºÈ‰¿ÓË §, ¢¿Ú‰· ∞, ∞ÎÙÛ¤ÏË ∫, ªfi˙ÔÁÏÔ˘ ª, ºÈÏÈ›‰Ë˜ ™, µ·Ï·‚¿ÓË Ã Î·È Û˘Ó. ∫·Ù¿ÛÙ·ÛË ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÁÈ· ÈÏ·Ú¿, ÂÚ˘ıÚ¿ Î·È ·ÚˆÙ›Ùȉ· ÛÙÔÓ ¡ÔÌfi ¶ÈÂÚ›·˜ [¶ÂÚ›ÏË„Ë]. 38Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ; 2000 16-18 πÔ˘Ó›Ô˘; ∫ˆ˜; 2000. ÛÂÏ. 5. #002. 9. ∆˙Ô˘‚ÂϤ΢ °, ¡¿Ó·˜ Ã, ÷Ù˙ËÛÙ˘ÏÈ·ÓÔ‡ ª, ∫·ÙÚÈÔ‡ ¢. ∫·Ù¿ÛÙ·ÛË ÂÌ‚ÔÏÈ·ÛÌÒÓ ÙˆÓ Ì·ıËÙÒÓ ËÏÈΛ·˜ 7-15 ÂÙÒÓ ÙÔ˘ ¡. ∫ÈÏΛ˜ [¶ÂÚ›ÏË„Ë]. 38Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ; 2000 16-18 πÔ˘Ó›Ô˘; ∫ˆ˜; 2000. ÛÂÏ. 289. #569. 10. ¶ÂÙÚÔÔ‡ÏÔ˘ º, ªÂÚ›‰Ë˜ £, ∆Û¿ÌÈÚ· ¶, ¶·Ó·ÁȈÙfiÔ˘ÏÔ˜ ∆. ∂ȉËÌÈÔÏÔÁÈ΋ ÌÂϤÙË Ù˘ ηٿÛÙ·Û˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÙÔ˘ ·È‰ÈÎÔ‡ ÏËı˘ÛÌÔ‡ ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ¢‹ÌÔ˘ µfiÏÔ˘ [¶ÂÚ›ÏË„Ë]. 36Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ; 1998 5-7 πÔ˘Ó›Ô˘; ¶¿ÊÔ˜, ∫‡ÚÔ˜; 1998. ÛÂÏ. 161. #306∞∞.
∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 10-01-2003
∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 09-09-2003
¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ª·Ú›· ™¯ÔÈÓ¿
∞Ó. £Ú¿Î˘ 23, ∆.∫. 681 00
∞ÏÂÍ·Ó‰ÚÔ‡ÔÏË, ¡. Œ‚ÚÔ˘
∂ƒ∂À¡∏∆π∫∏
¶ÚÔ‚Ï‹Ì·Ù· ˘Á›·˜ ·È‰ÈÒÓ-·Ú·ıÂÚÈÛÙÒÓ Û ÓËÛ› ÙˆÓ ∫˘ÎÏ¿‰ˆÓ
∂. ¶·Ú·Ûο΢1, ª. ∆ÛÈÌÈÓfi˜1, ∫. ∫·Ú·Ó¿ÛÈÔ˘1, ¡. ª·Î·ÚÒÓ·˜1, ∂. °·Ï·Ó¿Î˘2
Health problems of child-tourists in a Cycladic island E. Paraskakis1, M. Tsimbinos1, K. Karanasiou1, N. Makaronas1, E. Galanakis2
¶ÂÚ›ÏË„Ë: ∏ ÁÓÒÛË ÙˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ ˘Á›·˜
ÙˆÓ ·È‰ÈÒÓ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù·ÍȉÈÒÓ Î·È ‰È·ÎÔ-
ÒÓ ÌÔÚ› Ó· Û˘Ì‚¿ÏÂÈ ÛÙËÓ ÚfiÏË„Ë Î·È ÙË Ûˆ-
ÛÙ‹ ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘˜ ÛÙÔ˘˜ ÙfiÔ˘˜ ˘Ô‰Ô¯‹˜.
™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ë Î·Ù·ÁÚ·Ê‹ ·˘ÙÒÓ ÙˆÓ
ÚÔ‚ÏËÌ¿ÙˆÓ Û ·È‰È¿ Ô˘ ‹Ù·Ó ıÂÚÈÓÔ› ÂÈÛΤÙ˜ ÛÙÔ ÓËÛ› Ù˘ ™›ÊÓÔ˘. ªÂÏÂÙ‹ıËÎ·Ó 311 ·È-
‰È¿-·Ú·ıÂÚÈÛÙ¤˜, Ù· ÔÔ›· ÂÍÂÙ¿ÛÙËÎ·Ó ÛÙÔ Ô-
Ï˘‰‡Ó·ÌÔ ÂÚÈÊÂÚÂÈ·Îfi È·ÙÚÂ›Ô ™›ÊÓÔ˘ ηٿ ÙÔ˘˜
ıÂÚÈÓÔ‡˜ Ì‹Ó˜ Ù˘ ‰ÈÂÙ›·˜ 2001-2002 Î·È Û˘ÁÎÚ›-
ıËÎ·Ó Ì 311 ·È‰È¿-ÌfiÓÈÌÔ˘˜ οÙÔÈÎÔ˘˜, Ù· ÔÔ›· ·ÔÙ¤ÏÂÛ·Ó ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘. ™˘¯ÓfiÙÂÚË ·ÈÙ›·
ÚÔÛ¤Ï¢Û˘ ÙˆÓ ·È‰ÈÒÓ-·Ú·ıÂÚÈÛÙÒÓ ÛÙÔ È·-
ÙÚÂ›Ô ‹Ù·Ó Ù· ·Ù˘¯‹Ì·Ù· (16%) Î·È ·ÎÔÏÔ˘ıÔ‡Û·Ó
ÔÈ ˆÙ›Ùȉ˜ (13%), ÔÈ ‰ÂÚÌ·Ù›Ùȉ˜ (13%), ÔÈ ÏÔÈÌÒÍÂȘ ηÙÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ (12%) Î·È Ë Á·-
ÛÙÚÂÓÙÂÚ›Ùȉ· (10%). ∆· ·È‰È¿-ÌfiÓÈÌÔÈ Î¿ÙÔÈÎÔÈ
·ÚÔ˘Û›·˙·Ó ‰È·ÊÔÚÂÙÈο ÔÛÔÛÙ¿ ÛÙȘ ·Èٛ˜
ÚÔÛ¤Ï¢Û˘ (ÏÔÈÌÒÍÂȘ ηÙÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ 16%, ‰ÂÚÌ·Ù›Ùȉ˜ 12%, ÏÔÈÌÒÍÂȘ ·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ 7%, ¿ÛıÌ· 6%, ˆÙ›Ùȉ˜ 5%). ∆·
·È‰È¿-·Ú·ıÂÚÈÛÙ¤˜ ·ÚÔ˘Û›·Û·Ó ÛÙ·ÙÈÛÙÈο ÛË-
Ì·ÓÙÈο ·˘ÍË̤ÓË ÓÔÛËÚfiÙËÙ· ·fi Á·ÛÙÚÂÓÙÂÚ›ÙÈ-
‰Â˜, ˆÙ›Ùȉ˜ Î·È ·Ù˘¯‹Ì·Ù· (p=0,0002, p=0,0012
Î·È p=0,011, ·ÓÙ›ÛÙÔȯ·). ™˘ÌÂÚ·ÛÌ·ÙÈο, Ù· ·È-
‰È¿ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ıÂÚÈÓÒÓ ‰È·ÎÔÒÓ ·-
ÚÔ˘ÛÈ¿˙Ô˘Ó ÓÔÛ‹Ì·Ù· ‰È·ÊÔÚÂÙÈο ·fi ÂΛӷ ÙˆÓ
·È‰ÈÒÓ-ÌfiÓÈÌˆÓ Î·ÙԛΈÓ. ∏ ηٿÏÏËÏË ÚfiÏË„Ë
Î·È ·Ú¤Ì‚·ÛË ÌÔÚ› Ó· Û˘Ì‚¿ÏÂÈ ÛÙËÓ ÂÍ·ÛÊ¿-
ÏÈÛË ‰È·ÎÔÒÓ Ì ٷ ÏÈÁfiÙÂÚ· ηٿ ÙÔ ‰˘Ó·ÙfiÓ
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.
Key words: health problems, child-tourists, Cyclades.
Health Centre of Sifnos
Paediatric Clinic of University of Crete
ηÙÔ›ÎÔ˘˜ Ù˘ ™›ÊÓÔ˘
οÙÔÈÎÔÈ ¡ (%)¡ (%)
∞Ù˘¯‹Ì·Ù·50 (16%)29 (9,3%)
øÙ›Ùȉ˜40 (12,9%)16 (5%)
∫Ó›‰ˆÛË, ‰ÂÚÌ·Ù›Ùȉ·40 (12,9%)36 (11,6%)
§ÔÈÌÒÍÂȘ ηÙÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡39 (12,5%)50 (16%)
°·ÛÙÚÂÓÙÂÚ›Ùȉ·31 (10%)7 (2,3%)
§ÔÈÌÒÍÂȘ ·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡*27 (8,7%)23 (7,4%)
ÕÛıÌ·15 (4,8%)18 (5,9%)
º·Ú˘ÁÁÔ·Ì˘Á‰·Ï›Ùȉ·10 (3,2%)12 (3,9%)
ƒÈÓ›Ùȉ·6 (2%)2 (0,6%)
∂ÈÂÊ˘Î›Ùȉ·3 (1%)12 (3,9%)
∞ÓÂÌÔ‚ÏÔÁÈ¿2 (0,6%)11 (3,5%)
πÁÌÔÚ›Ùȉ·1 (0,3%)3 (1%)
§ÔÈ¿ ÓÔÛ‹Ì·Ù·47 (15,1%)92 (29,6%)
* ÕÏϘ ÔÍ›˜ ÏÔÈÌÒÍÂȘ ·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ ÌÂ
¶›Ó·Î·˜ 2. ¶ÚÔ‚Ï‹Ì·Ù· ˘Á›·˜ Ô˘ ·ÚÔ˘ÛÈ¿ÛÙËηÓ
Ì ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ Û ۇÁÎÚÈÛË Ì ٷ ·È‰È¿-ÌfiÓÈÌÔ˘˜ ηÙÔ›ÎÔ˘˜
¶Úfi‚ÏËÌ· ˘Á›·˜¶·È‰È¿-·Ú·ıÂÚÈÛÙ¤˜¶·È‰È¿-ÌfiÓÈÌÔÈ Î¿ÙÔÈÎÔÈ™¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜p (95% CI)(Ì ¯2)
°·ÛÙÚÂÓÙÂÚ›Ùȉ·3174,43 (1,98-9,91)0,0002 øÙ›Ùȉ˜40162,50 (1,43-4,37)0,0012
∞Ù˘¯‹Ì·Ù·50291,72 (1,12-2,65)0,0111
Ù·Í›‰È· ÛÙÔ Â͈ÙÂÚÈÎfi (1,7), ·Ó Î·È ÔÈ Û˘Óı‹Î˜
Ô˘ ·Ú¤¯ÔÓÙ·È ÛÙÔ ÓËÛ› Ù˘ ™›ÊÓÔ˘ ›-
Ó·È ˘„ËÏÔ‡ ÂȤ‰Ô˘ Î·È ·Ó¿ÏÔÁ˜ ÂÎÂ›ÓˆÓ ÙÔ˘ Ìfi-
ÓÈÌÔ˘ ÙfiÔ˘ ηÙÔÈΛ·˜. ¶Ú¤ÂÈ Ó· ÛËÌÂȈı› fiÙÈ Ù·
·È‰È¿-·Ú·ıÂÚÈÛÙ¤˜ ÛÙË ™›ÊÓÔ ÚÔ¤Ú¯ÔÓÙ·È Û¯Â-
‰fiÓ ·ÔÎÏÂÈÛÙÈο ·fi ÙËÓ ˘fiÏÔÈË ∂ÏÏ¿‰·, ÌÂ
·ÔÙ¤ÏÂÛÌ· ÔÈ Û˘Óı‹Î˜ ‰È·‚›ˆÛ˘ ÛÙË ÌfiÓÈÌË Î·-
ÙÔÈΛ· ÙÔ˘˜ Ó· ÌËÓ ‰È·Ê¤ÚÔ˘Ó Û ÌÂÁ¿ÏÔ ‚·ıÌfi
·fi ÂΛӘ ÙˆÓ ‰È·ÎÔÒÓ ÙÔ˘˜. º·›ÓÂÙ·È, ÏÔÈfiÓ,
fiÙÈ Ë ·fiÙÔÌË ÌÂٷΛÓËÛË Î·È Ë ÌÈÎÚ‹, ¤ÛÙˆ, ·ÏÏ·-
Á‹ ÙˆÓ Û˘ÓıËÎÒÓ ‰È·‚›ˆÛ˘ Î·È „˘¯·ÁˆÁ›·˜ ·Ú-
ÎÔ‡Ó ÁÈ· ÙË Û˘¯Ó‹ ÂΉ‹ÏˆÛË ÔÚÈÛÌ¤ÓˆÓ ÓÔÛËÌ¿-
ÙˆÓ Î·Ù¿ ÙËÓ ÂÚ›Ô‰Ô ÙˆÓ ‰È·ÎÔÒÓ (8).
∏ ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· ·Ù˘¯ËÌ¿ÙˆÓ ÛÙ· ·È-
‰È¿-ÙÔ˘Ú›ÛÙ˜ Â›Ó·È ·Ó·ÌÂÓfiÌÂÓË, ΢ڛˆ˜ ÏfiÁˆ Ù˘
·˘ÍË̤Ó˘ Ê˘ÛÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ¿˜ ÙÔ˘˜ ·˘Ù‹
ÙËÓ ÂÚ›Ô‰Ô Î·È Ù˘ ‰˘ÛÎÔÏ›·˜ ÂÈÙ‹ÚËÛ‹˜ ÙÔ˘˜ ÂÎ
̤ÚÔ˘˜ ÙˆÓ ÁÔÓ¤ˆÓ. ∏ Û˘¯Ó‹ Î·È ·Ú·ÙÂٷ̤Ó˘
‰È¿ÚÎÂÈ·˜ ·ʋ ÙˆÓ ·È‰ÈÒÓ Ì ÙÔ ı·Ï·ÛÛÈÓfi ÓÂ-
Úfi Î·È ÙÔÓ ˙ÂÛÙfi ·¤Ú· ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙË ÌÈÎÚ‹
ËÏÈΛ· ·ÔÙÂÏÔ‡Ó ÁÓˆÛÙÔ‡˜ ·Ú¿ÁÔÓÙ˜ Ô˘ Û¯Â-
Ù›˙ÔÓÙ·È Ì ÙËÓ ·˘ÍË̤ÓË Â›ÙˆÛË Ù˘ Â͈ÙÂÚÈ΋˜
ˆÙ›Ùȉ·˜ (“swimmer’s ear”, fiˆ˜ ¯·Ú·ÎÙËÚÈÛÙÈο
ÔÓÔÌ¿˙ÂÙ·È ‰ÈÂıÓÒ˜) (9-14). øÛÙfiÛÔ, ¤¯ÂÈ ˘ÔÛÙË-
Úȯı› 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˘ ηÈ
ËÏÈÔÊ¿ÓÂÈ· ̤ÚË, ȉȷ›ÙÂÚ· fiÙ·Ó Ë ¤ÓÙÔÓË
Û˘¯Ó¿ Û ηٷfiÓËÛË ÙÔ˘ ‰¤ÚÌ·ÙÔ˜. OÈ ‰È·Ù·Ú·¯¤˜ ·fi ÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi, ·Ó Î·È Û˘¯ÓfiÙÂÚ˜ ÛÙ· ·È‰È¿-·Ú·ıÂÚÈÛÙ¤˜ ÛÂ
Û¯¤ÛË Ì ٷ ·È‰È¿-ÌfiÓÈÌÔ˘˜ ηÙÔ›ÎÔ˘˜, ‰ÂÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÙËÓ ˘„ËÏ‹ Û˘¯ÓfiÙËÙ· Ô˘ ·Ó·ÌÂÓfiÙ·Ó ÛÙ· ·È‰È¿ Ô˘ ·ÏÏ¿˙Ô˘Ó ·fiÙÔÌ· ÙË ‰È·ÙÚÔÊ‹ ÙÔ˘˜ Î·È ÙËÓ Î·ıËÌÂÚÈÓ‹ ˘ÁÈÂÈÓ‹ ÙÔ˘˜. ∞˘Ùfi ÌÔÚ› Ó· ·Ô‰Ôı› ÛÙȘ ηϤ˜ Û˘Óı‹Î˜ ‰È·‚›ˆÛ˘, Û ·ÓÙ›ıÂÛË Ì ¿ÏÏÔ˘˜ ÚÔÔÚÈÛÌÔ‡˜ Ì η΋ ˘ÁÈÂÈÓ‹, fiÔ˘ Ë Á·ÛÙÚÂÓÙÂÚ›Ùȉ· ·ÔÙÂÏ› ÙÔ ÚÒÙÔ ÛÂ Û˘¯ÓfiÙËÙ· ÓfiÛËÌ· (1,2).
™˘ÌÂÚ·ÛÌ·ÙÈο, Ù· ·È‰È¿ Ô˘ ·Ú·ıÂÚ›˙Ô˘Ó ÛÙË ¯ÒÚ· ÙÔ˘˜ ¤¯Ô˘Ó ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ Ó· ÂÌÊ·Ó›ÛÔ˘Ó Û˘ÁÎÂÎÚÈ̤ӷ ÚÔ‚Ï‹Ì·Ù· ˘Á›·˜. ∆Ô ÓÔÛÔÏÔÁÈÎfi Ê¿ÛÌ· ÚÔÛÔÌÔÈ¿˙ÂÈ Ì ÂΛÓÔ Ô˘ ·Ú·ÙËÚÂ›Ù·È ÛÙ· ÌÂÁ¿Ï· Ù·Í›‰È· ÛÙÔ Â͈ÙÂÚÈÎfi, ‰È·ÙËÚÒÓÙ·˜ fï˜ οÔȘ ȉÈÔÌÔÚʛ˜. ªÂϤÙ˜ Ì ÌÂÁ·Ï‡ÙÂÚ· ‰Â›ÁÌ·Ù· Î·È Û ¿ÏϘ ÁˆÁÚ·ÊÈΤ˜
ÂÚÈÔ¯¤˜ Ù˘ ¯ÒÚ·˜ ı· ‚ÔËıÔ‡Û·Ó ÛÙËÓ Î·Ï‡ÙÂÚË Î·Ù·ÁÚ·Ê‹ ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜ Î·È ÛÙË ‰È¿ÚıÚˆÛË Î·Ù¿ÏÏËÏ˘ ÛÙÚ·ÙËÁÈ΋˜ ÚfiÏ˄˘ Î·È ·ÓÙÈÌÂÙÒ-
1. Hill DR. Health problems in a large cohort of Americans traveling to developing countries. J Travel Med 2000;7:259266.
2. Reinthaler FF, Feierl G, Stunzner D, Marth E. Diarrhea in
returning Austrian tourists: epidemiology, etiology, and cost-analyses. J Travel Med 1998;5:65-72.
3. Prazuck T, Semaille C, Halioua B, Burcombe A, Papon B, Espinoza P et al. Health hazards in international tourists visiting Paris in August: a five-year retrospective epidemiologic survey. J Travel Med 1998;5:178-183.
4. Zuckerman JN. Recent developments: travel medicine. BMJ 2002;325:260-264.
5. World Health Organization. Manual of the international statistical classification of diseases, injuries and causes of death. Geneva, Switzerland: World Health Organization, Office of Publications; 1977.
6. Looke DF, Robson JM. Infections in the returned traveler. Med J Aust 2002;177:212-219.
7. °·Ï·Ó¿Î˘ ∂, ¶·Ú·Ûο΢ ∂, ªÈÎÔ˘‚·Ú¿Î˘ ™, ∫·Ù˙ËÏ¿Î˘ ¡, ™Ì˘Ú¿ÎȘ ™. ¶ÚÔ‚Ï‹Ì·Ù· ˘Á›·˜ Û ·È‰È¿ ·fi ÙËÓ ∂˘ÚÒË Ô˘ ·Ú·ıÂÚ›˙Ô˘Ó ÛÙËÓ ∫Ú‹ÙË. ¶·È‰È·ÙÚÈ΋ µÔÚ›Ԣ ∂ÏÏ¿‰Ô˜ 1999;11:28-31.
8. Falkenbach A, Sedlmeyer A. Travel to sunny countries is associated with changes in immunological parameters. Photodermatol Photoimmunol Photomed 1997;13:139-142.
9. Russell JD, Donnelly M, McShane DP, Alun-Jones T, Walsh
M. What causes acute otitis externa? J Laryngol Otol 1993;107:898-901.
10. Agius AM, Pickles JM, Burch KL. A prospective study of otitis externa. Clin Otolaryngol 1992;17:150-154.
11. Steffen R. Epidemiologic studies of travelers’ diarrhea, severe gastrointestinal infections, and cholera. Rev Infect Dis 1986;8 (Suppl 2):S122-S130.
12. Simchen E, Franklin D, Shuval HI. “Swimmer’s ear” among children of kindergarten age and water quality of swimming pools in 11 Kibbutzim. Isr J Med Sci 1984;20:584-588.
13. Calderon R, Mood EW. An epidemiological assessment of water quality and “swimmer’s ear”. Arch Environ Health 1982;37:300-305.
14. Hoadley AW, Knight DE. External otitis among swimmers and nonswimmers. Arch Environ Health 1975;30:445-448. ∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 07-02-2003 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 22-07-2003
¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∂ÌÌ·ÓÔ˘‹Ï ¡. ¶·Ú·Ûο΢
4, ∆.∫. 712 02, ∏Ú¿ÎÏÂÈÔ ∫Ú‹Ù˘
∂ƒ∂À¡∏∆π∫∏
¡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¢ÚÔÏÔ-
ÁÈΤ˜ ÂΉËÏÒÛÂȘ Û ·ÛıÂÓ›˜ Ì ·ÈÌÔÏ˘ÙÈÎfi-Ô˘Ú·È-
ÌÈÎfi Û‡Ó‰ÚÔÌÔ (∞O™), ˘¿Ú¯Ô˘Ó ÂÏ¿¯ÈÛÙ˜ ÂÚ¢ÓË-
ÙÈΤ˜ 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˘ ηÈ
Ù·
¤ÁÈÓ ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Ì ̷ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›·
ÔÍ›· Ê¿ÛË Ù˘ ÓfiÛÔ˘, ÂÓÒ Û 3 ·È‰È¿ ¤ÁÈÓ ·-
Ó¤ÏÂÁ¯Ô˜ ÙÚÂȘ Ì‹Ó˜ ·ÚÁfiÙÂÚ·. ŸÏ· Ù· ·È‰È¿ ·-
ÚÔ˘Û›·Û·Ó ÌÂÙ·‚ÔÏ‹ ÙÔ˘ ÂȤ‰Ô˘ Û˘Ó›‰ËÛ˘ ηÈ
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˜ ÎÂÓÒ-
ÛÂȘ Î·È ÔÈ Û·ÛÌÔ› ÂÌÊ·Ó›ÛÙËÎ·Ó ÛÙ· ·Ú¯Èο ÛÙ¿-
‰È· Ù˘ ÓfiÛÔ˘, ÔÈ ÔÔ›ÔÈ Èı·Ófiٷٷ ÔÊ›ÏÔÓÙ·Ó ÛÂ
˘ÔÓ·ÙÚÈ·ÈÌ›·. ™Â ¤Ó·Ó ·ÛıÂÓ‹ ‚Ú¤ıËÎ·Ó ·ÌÊÔÙÂ-
ÚfiÏ¢Ú˜ ÂÛٛ˜ ÛÙÔÓ ÂÁΤʷÏÔ, ΢ڛˆ˜ ÛÙËÓ
˘ÔÊÏÔÈÒ‰Ë Ï¢΋ Ô˘Û›· ÙˆÓ ÌÂوȷ›ˆÓ Î·È ‚ÚÂÁ-
Ì·ÙÈÎÒÓ ÏÔ‚ÒÓ, ÔÈ Ôԛ˜ ÂÍ·ÎÔÏÔ˘ıÔ‡Û·Ó Ó· ˘¿Ú¯Ô˘Ó ÛÙÔÓ Â·Ó¤ÏÂÁ¯Ô Î·È Èı·Ófiٷٷ ÔÊ›ÏÔ-
ÓÙ·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.
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 ¡Â˘ÚÔÏÔÁÈÎfi ∆Ì‹Ì·, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó·
2 ¡ÂÊÚÔÏÔÁÈÎfi ∆Ì‹Ì·, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó·
3 µ’ ¶·ÓÂÈÛÙËÌȷ΋ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó·
4 ªÈÎÚÔ‚ÈÔÏÔÁÈÎfi ∆Ì‹Ì·, ¶ÂÚÈÊÂÚÂÈ·Îfi ¡ÔÛÔÎÔÌÂ›Ô “°. °ÂÓÓËÌ·Ù¿˜”, ∞ı‹Ó·
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
ÛÙ¿‰È· ÙÔ˘ ∞O™ ‰ÂÓ ÛËÌ·ÙÔ‰ÔÙÔ‡Ó Î·Ù’ ·Ó¿ÁÎËÓ
η΋ ÚfiÁÓˆÛË. A˘Ù¤˜ ÔÈ Ó¢ÚÔÏÔÁÈΤ˜ ÂΉËÏÒÛÂȘ Â›Ó·È Û˘Ó‹ıˆ˜ ·ÔÙ¤ÏÂÛÌ· ÌÂÙ·‚ÔÏÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ, ÙˆÓ ÔÔ›ˆÓ Ë ¤ÁηÈÚË ·ÓÙÈÌÂÙÒÈÛË ÂӉ¯fiÌÂÓ· ı· ·ÔÙÚ¤„ÂÈ ÙËÓ ÂÌÊ¿ÓÈÛ‹ ÙÔ˘˜.
§¤ÍÂȘ ÎÏÂȉȿ: ·ÈÌÔÏ˘ÙÈÎfi-Ô˘Ú·ÈÌÈÎfi Û‡Ó‰ÚÔÌÔ, Ó¢ÚÔÏÔÁÈΤ˜ ÂΉËÏÒÛÂȘ, Û·ÛÌÔ›, ˘ÔÓ·ÙÚÈ·ÈÌ›·, ¤ÌÊÚ·ÎÙ· ÂÁÎÂÊ¿ÏÔ˘, Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›·, ·È‰È¿.
™˘ÓÙÔÌÔÁڷʛ˜
∞O™∞ÈÌÔÏ˘ÙÈÎfi-Ô˘Ú·ÈÌÈÎfi Û‡Ó‰ÚÔÌÔ
HUSHaemolytic-uraemic syndrome
MRIMagnetic resonance imaging
∂ÈÛ·ÁˆÁ‹
∆Ô ∞O™ Â›Ó·È ¤Ó· ÔÏ˘Û˘ÛÙËÌ·ÙÈÎfi ÓfiÛËÌ· Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÌÈÎÚÔ·ÁÁÂÈÔ·ıËÙÈ΋ ·ÈÌÔÏ˘ÙÈ΋ ·Ó·ÈÌ›·, ıÚÔÌ‚ÔÂÓ›· Î·È ÔÍ›· ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ·. ∆Ô Ê¿ÛÌ· Ù˘ ÓfiÛÔ˘ Â›Ó·È Â˘Ú‡, ÂÓÒ ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ‹È˜ ˘ÔÎÏÈÓÈΤ˜ ̤¯ÚÈ ·ÂÈÏËÙÈΤ˜ ÁÈ· ÙË ˙ˆ‹ ÙˆÓ ·ÛıÂÓÒÓ ÂÚÈÙÒÛÂȘ. ∆Ô ∞O™ ÂÌÊ·Ó›˙ÂÙ·È Î˘Ú›ˆ˜ Û ‚Ú¤ÊË Î·È ·È‰È¿ ËÏÈΛ·˜ ÌÈÎÚfiÙÂ-
Ú˘ ÙˆÓ 5 ÂÙÒÓ Î·È ·ÔÙÂÏ› ÙËÓ ÈÔ Û˘¯Ó‹ ·ÈÙ›·
ÔÍ›·˜ ÓÂÊÚÈ΋˜ ·Ó¿ÚÎÂÈ·˜ Û ·˘Ù¿. ™¯ÂÙ›˙ÂÙ·È
Ì ÚÔËÁËı›Û˜ ÏÔÈÌÒÍÂȘ ‹ Ï‹„Ë Ê·ÚÌ¿ÎˆÓ Î·È
Û˘¯Ó¿ ÚÔËÁÂ›Ù·È Á·ÛÙÚÂÓÙÂÚ›Ùȉ· ‹ Ïԛ̈ÍË ÙÔ˘
·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜.
¡Â˘ÚÔÏÔÁÈΤ˜ ÂΉËÏÒÛÂȘ ÂÌÊ·Ó›˙ÔÓÙ·È Û˘¯Ó¿
Û ·ÛıÂÓ›˜ Ì ∞O™ Î·È ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ÔÈΛϷ
·ÂÈÎÔÓÈÛÙÈο Â˘Ú‹Ì·Ù· ÛÙËÓ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›·
ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ (1-11), ÂÓÒ Û¿ÓÈ· ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ÂÚÈÙÒÛÂȘ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó Ì ̷ÁÓËÙÈ΋
ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ (7-11). ∏ ·ÚÔ˘Û›· Ó¢ÚÔÏÔÁÈÎÒÓ ÂΉËÏÒÛÂˆÓ Î·È È‰È·›ÙÂÚ· Û·ÛÌÒÓ
ηٿ ÙËÓ ÔÍ›· Ê¿ÛË Ù˘ ÓfiÛÔ˘ ¤¯ÂÈ ÂÓÔ¯ÔÔÈËı› fiÙÈ Û¯ÂÙ›˙ÂÙ·È Ì η΋ ÚfiÁÓˆÛË Ù˘ ÓfiÛÔ˘, ·ÏÏ¿ Ù· ·ÔÙÂϤÛÌ·Ù· ÙˆÓ ÂÏ¿¯ÈÛÙˆÓ ÌÂÏÂÙÒÓ Ô˘ ¤¯Ô˘Ó Á›ÓÂÈ Â›Ó·È ·ÓÙÈÊ·ÙÈο (10,12-14). ™Â ·˘Ù‹ ÙË ÌÂϤÙË ÂÚÈÁÚ¿ÊÔÓÙ·È 5 ·È‰È¿ Ì ∞O™ Î·È Ó¢ÚÔÏÔÁÈΤ˜ ÂΉËÏÒÛÂȘ, 4 ·fi Ù· ÔÔ›· ›¯·Ó ÚÒÈÌË ÂÌÊ¿ÓÈÛË Û·ÛÌÒÓ, ÔÈ ÔÔ›ÔÈ Èı·Ó¿ ÔÊ›ÏÔÓÙ·Ó Û ˘ÔÓ·ÙÚÈ·ÈÌ›·. ™Â fiÏ· Ù· ·È‰È¿ ¤ÁÈÓ ̷ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ ηٿ ÙËÓ ÔÍ›· Ê¿ÛË Ù˘ ÓfiÛÔ˘, ÂÓÒ Û 3 ·È‰È¿ ·ӷϋÊıËΠÙÚÂȘ Ì‹Ó˜ ·ÚÁfiÙÂÚ·. ŸÏ· Ù· ·È‰È¿ ›¯·Ó ηϋ ÂͤÏÈÍË, ¯ˆÚ›˜ Ó¢ÚÔÏÔÁÈο ÚÔ‚Ï‹Ì·Ù·, ÂÓÒ ÔÈ Û·ÛÌÔ› ‰ÂÓ Â·Ó·Ï‹ÊıËηÓ.
¶ÂÚÈÁÚ·Ê‹ ÂÚÈÙÒÛˆÓ
¶ÂÚÈÁÚ¿ÊÔÓÙ·È 5 ·È‰È¿ (3 ·ÁfiÚÈ· Î·È 2 ÎÔÚ›ÙÛÈ·) Ì ∞O™, ÙˆÓ ÔÔ›ˆÓ Ë ËÏÈΛ· Î˘Ì·ÈÓfiÙ·Ó ·fi 1 ¤ˆ˜ 5 ¤ÙË (‰È¿ÌÂÛË ËÏÈΛ·: 2,5 ¤ÙË). ∂ÎÙfi˜ ·fi
Key words: haemolytic-uraemic syndrome, neurological complications, seizures, hyponatraemia, microinfarctions, magnetic resonance imaging, children.
¤Ó· ·È‰› Ì ‹È· „˘¯ÔÎÈÓËÙÈ΋ ηı˘ÛÙ¤ÚËÛË, fiÏ·
Ù· ¿ÏÏ· ·È‰È¿ ›¯·Ó ηϋ „˘¯ÔÎÈÓËÙÈ΋ ÂͤÏÈÍË Î·È
ÂχıÂÚÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi. ¶ÚÈÓ ÂÈÛ·¯ıÔ‡Ó
ÛÙÔ ¡ÔÛÔÎÔÌ›Ô, fiÏ· Ù· ·È‰È¿ ›¯·Ó Á·ÛÙÚÂÓÙÂÚ›Ùȉ· Ì ·ÈÌÔÚÚ·ÁÈΤ˜ ÎÂÓÒÛÂȘ. ∆Ú›· ·fi ·˘Ù¿ ›-
¯·Ó Ï¿‚ÂÈ ·ÓÙÈ‚›ˆÛË Î·È 4 ·È‰È¿ ›¯·Ó ·ÚÔ˘ÛÈ¿-
ÛÂÈ ÂÂÈÛfi‰È· ÁÂÓÈÎÂ˘Ì¤ÓˆÓ ÙÔÓÈÎÔÎÏÔÓÈÎÒÓ Û·ÛÌÒÓ ‚Ú·¯Â›·˜ ‰È¿ÚÎÂÈ·˜ (4-6 Ë̤Ú˜ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ Á·ÛÙÚÂÓÙÂÚ›Ùȉ·˜). ∫·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘˜ ÛÙÔ ¡ÔÛÔÎÔÌ›Ô, fiÏ· ‹Ù·Ó ·‡ÚÂÙ· Î·È Â›¯·Ó ˘ÓËÏ›·, ÂÙ¤¯ÂȘ ÛÙÔ ‰¤ÚÌ·, Ôȉ‹Ì·Ù·, ÔÏÈÁÔ˘Ú›·, ˆ¯ÚfiÙËÙ· Î·È Ê˘ÛÈÔÏÔÁÈ΋ ·ÚÙËÚȷ΋ ›ÂÛË. ∂›Û˘, ηٿ ÙË Ó¢ÚÔÏÔÁÈ΋ ÂͤٷÛË, ηӤӷ ·È‰› ‰ÂÓ Â›¯Â ÂÛÙȷο Ó¢ÚÔÏÔÁÈο Â˘Ú‹Ì·Ù· Î·È ÛÙË ‚˘ıÔÛÎfiËÛË ‰ÂÓ ‰È·ÈÛÙÒıËÎ·Ó ·ıÔÏÔÁÈο
O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ Û fiÏ· Ù· ·È‰È¿ ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ¤‰ÂÈ͠ϢÎÔ΢ÙÙ¿ÚˆÛË, ¯·ÌËÏ¿ ›‰· ·ÈÌÔÛÊ·ÈÚ›Ó˘ Î·È ÌÂȈ̤ÓÔ ·ÚÈıÌfi ·ÈÌÔÂÙ·Ï›ˆÓ, ηٷÎÂÚÌ·ÙÈṲ̂ӷ ÂÚ˘ıÚ¿, ‰ÈÎÙ˘ÔÂÚ˘ıÚÔ΢ÙÙ¿ÚˆÛË, ·˘ÍË̤ӷ ›‰· Ô˘Ú›·˜, ÎÚ·ÙÈÓ›Ó˘, ÙÚ·ÓÛ·ÌÈÓ·ÛÒÓ, ¯ÔÏËÛÙÂÚfiÏ˘, ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ Î·È Ô˘ÚÈÎÔ‡ ÔͤԘ ÛÙÔÓ ÔÚfi ·›Ì·ÙÔ˜, ·ÈÌ·ÙÔ˘Ú›· Î·È ÚˆÙÂ˚ÓÔ˘Ú›·, ÂÓÒ ¤‰ÂÈÍÂ Î·È ˘ÔÓ·ÙÚÈ·ÈÌ›· ÛÙ· 4 ·È‰È¿ Ì ÙÔ˘˜ ÚÔËÁËı¤ÓÙ˜ Û·ÛÌÔ‡˜ (¶›Ó·Î·˜ 1). OÈ Î·ÏÏȤÚÁÂȘ ÎÔÚ¿ÓˆÓ
‹Ù·Ó ·ÚÓËÙÈΤ˜ Û 4 ·È‰È¿, ÂÓÒ Û 1 ·ÔÌÔÓÒıËΠÙÔ ÂÓÙÂÚÔ·ıÔÁfiÓÔ Û٤ϯԘ Escherichia coli O157:H7. O ¤ÏÂÁ¯Ô˜ Ì ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ¤‰ÂÈÍÂ
·‡ÍËÛË ÙˆÓ ‰È·ÛÙ¿ÛÂˆÓ ÙˆÓ ÓÂÊÚÒÓ Ì ·˘ÍË̤ÓË
˯ÔÁ¤ÓÂÈ· ÛÙÔ ÓÂÊÚÈÎfi ÊÏÔÈfi, ÂÓÒ ÛÙÔ ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ· ‰È·ÈÛÙÒıËΠ‚Ú·‰˘ÚÚ˘ıÌ›· ÛÂ
fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜. O ¤ÏÂÁ¯Ô˜ Ì ÙË Ì·ÁÓËÙÈ΋
ÙÔÌÔÁÚ·Ê›· ηٿ ÙËÓ ÔÍ›· Ê¿ÛË Î·È ÛÙÔÓ Â·Ó¤ÏÂÁ¯Ô ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜ Û 4 ·È‰È¿, ÂÓÒ Û ¤Ó·
·È‰› ¤‰ÂÈÍ ·ÌÊÔÙÂÚfiÏ¢Ú˜, ˘„ËÏÔ‡ Û‹Ì·ÙÔ˜
ÛÙȘ ∆2 ÂÈÎfiÓ˜, ÌÈÎÚ¤˜ ÂÛٛ˜ ÛÙËÓ ˘ÔÊÏÔÈÒ‰Ë
ÌÔ›Ú· Ù˘ Ï¢΋˜ Ô˘Û›·˜ ÙˆÓ ÌÂوȷ›ˆÓ Î·È ‚ÚÂÁÌ·ÙÈÎÒÓ ÏÔ‚ÒÓ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Î·È Ì›· ÌÂÁ·Ï‡ÙÂÚË
¶›Ó·Î·˜ 1. ∂ÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· ÙˆÓ ·ÛıÂÓÒÓ Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹
·/·∞ÛıÂÓ›˜§Â˘Î¿Hb¢∂∫AMTO˘Ú›·Cr¡¿ÙÚÈÔ ·ÈÌÔÛÊ·›ÚÈ·(g/dl)(%)(/mm3) (mg/dl)(mg/dl)(mEq/l) ·›Ì·ÙÔ˜ (/mm3)
1∞ÁfiÚÈ 2,5 ÂÙÒÓ18.6005,42,880.0002096,8105
2∞ÁfiÚÈ 5 ÂÙÒÓ15.4005,52,622.0003697,8129
3∞ÁfiÚÈ 3 ÂÙÒÓ21.3007,52,962.00041111,2118
4 ∫ÔÚ›ÙÛÈ 1 ¤ÙÔ˘˜21.5007,12,922.0001994,8115
5 ∫ÔÚ›ÙÛÈ 1 ¤ÙÔ˘˜22.9006,24,221.0001753,8119
Hb: ∞ÈÌÔÛÊ·ÈÚ›ÓË Ï¿ÛÌ·ÙÔ˜
¢∂∫: ¢ÈÎÙ˘ÔÂÚ˘ıÚÔ·ÙÙ·Ú· ·›Ì·ÙÔ˜
∞ª∆: ∞ÈÌÔÂÙ¿ÏÈ· ·›Ì·ÙÔ˜
Cr: ∫Ú·ÙÈÓ›ÓË ÔÚÔ‡
OÈ Û·ÛÌÔ› ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó Â‡ÎÔÏ· Ì ÂÓ‰Ô-
ÊϤ‚È· ¯ÔÚ‹ÁËÛË ·ÓÙÈÂÈÏËÙÈ΋˜ ·ÁˆÁ‹˜ (Ìȉ·-
˙ÔÏ¿ÌË Î·È Ê·ÈÓ˘ÙÔ˝ÓË) Î·È ‰ÈfiÚıˆÛË Ù˘ ˘ÔÓ·-
ÙÚÈ·ÈÌ›·˜. ŒÁÈÓ·Ó ÌÂÙ·ÁÁ›ÛÂȘ Û˘Ì˘Îӈ̤ӈÓ
ÂÚ˘ıÚÒÓ. ∆Ú›· ·È‰È¿ ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó Ì ·ÈÌÔ-
οı·ÚÛË Î·È 1 Ì ÂÚÈÙÔÓ·˚΋ οı·ÚÛË. ∏ ηٿ-
ÛÙ·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, 3-
4 ¯ÚfiÓÈ· ÌÂÙ¿ ÙËÓ ÔÍ›· ÓfiÛËÛË, fiÏ· Ù· ·È‰È¿ ›-
¯·Ó ηϋ ÂͤÏÈÍË, ¯ˆÚ›˜ Ó¢ÚÔÏÔÁÈο ‹ ÓÂÊÚÈο
ÚÔ‚Ï‹Ì·Ù·.
™˘˙‹ÙËÛË
¡Â˘ÚÔÏÔÁÈΤ˜ ÂÈÏÔΤ˜, ‹È˜ ‹ ÛÔ‚·Ú¤˜ ηÈ
ÌfiÓÈ̘ ‹ ·ÚÔ‰ÈΤ˜, ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÔ 20-50%
ÙˆÓ ·ÛıÂÓÒÓ Ì ∞O™. Œ¯ÂÈ ÂÚÈÁÚ·Ê› ¤Ó· ¢ڇ
Ê¿ÛÌ· Ó¢ÚÔÏÔÁÈÎÒÓ ÂÈÏÔÎÒÓ, fiˆ˜ ÂÈÏËÙÈ-
Τ˜ ÎÚ›ÛÂȘ, ‰˘ÛÙÔÓ›·, ·Ù·Í›·, ÌÂÙ·‚ÔÏ‹ ÙÔ˘ ÂȤ-
‰Ô˘ Û˘Ó›‰ËÛ˘, ÎÒÌ·, ÊÏÔÈ҉˘ Ù‡ÊψÛË, Â͈-
˘Ú·ÌȉÈο Û˘ÌÙÒÌ·Ù· ‹ ÂÛÙȷο Â˘Ú‹Ì·Ù·,
fiˆ˜ ËÌÈ¿ÚÂÛË. ∞˘Ù¤˜ ÔÈ ÂΉËÏÒÛÂȘ ÂÌÊ·Ó›˙Ô-
ÓÙ·È Û˘¯Ó¿ ÛÙËÓ Úfi‰ÚÔÌË Ê¿ÛË Ù˘ ÓfiÛÔ˘ ηÈ
ÛÙÔ 15% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ·ÔÙÂÏÔ‡Ó ÙËÓ ·ÈÙ›· ÂÈ-
Ûfi‰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· ÂÈ‚Â-
‚·›ˆÛ·Ó ÙË ‰È¿ÁÓˆÛË ÙÔ˘ ∞O™ Ì Ó¢ÚÔÏÔÁÈΤ˜
ÂÈÏÔΤ˜ Û fiϘ ÙȘ ÂÚÈÙÒÛÂȘ. ∫·Ó¤Ó·˜ ·ÛıÂÓ‹˜ ‰ÂÓ Â›¯Â ÂÛÙȷο Ó¢ÚÔÏÔÁÈο Â˘Ú‹Ì·Ù· Î·È ÔÈ
Ó¢ÚÔÏÔÁÈΤ˜ ÂΉËÏÒÛÂȘ - Î·È Û˘ÁÎÂÎÚÈ̤ӷ Ë ÌÂÙ·‚ÔÏ‹ ÙÔ˘ ÂȤ‰Ô˘ Û˘Ó›‰ËÛ˘ Î·È ÔÈ ÂÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ - ·ÚÔ˘ÛÈ¿ÛÙËÎ·Ó ÙȘ ÚÒÙ˜ Ë̤Ú˜ Ù˘ ÓfiÛÔ˘ Û fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜. OÈ ÂÈÏËÙÈΤ˜
ÎÚ›ÛÂȘ Î·È ÛÙÔ˘˜ 4 ·ÛıÂÓ›˜ ‹Ù·Ó ‚Ú·¯Â›·˜ ‰È¿ÚÎÂÈ·˜ ÁÂÓÈÎÂ˘Ì¤ÓÔÈ
Â›Ó·È ÔÏ˘·Ú·ÁÔÓÙÈ΋. OÈ Ó¢ÚÔÏÔÁÈΤ˜ ÂΉËÏÒÛÂȘ ¤¯Ô˘Ó ·Ô‰Ôı› Û ¤ÌÊÚ·ÎÙ· ÙˆÓ
ÌÈÎÚÒÓ Î·È ÙˆÓ ÌÂÁ¿ÏˆÓ ·ÁÁ›ˆÓ, ÂÁÎÂÊ·ÏÈ΋ ·ÈÌÔÚÚ·Á›·, ÌÂÙ·‚ÔÏÈΤ˜ Î·È ËÏÂÎÙÚÔÏ˘ÙÈΤ˜ ‰È·Ù·Ú·¯¤˜, ˘ÔÍ›·, ÂÁÎÂÊ·ÏÈÎfi Ô›‰ËÌ· Î·È ˘¤ÚÙ·ÛË (1-3,5,6). ™Â ·ıÔÏÔÁÔ·Ó·ÙÔÌÈΤ˜ ÌÂϤÙ˜ ¤¯Ô˘Ó ‚ÚÂı› ıÚfiÌ‚ÔÈ Û ÌÈÎÚ¿, ·ÏÏ¿ Î·È Û ÌÂÁ¿Ï· ·ÁÁ›· ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘, ·ÚÂÁ¯˘Ì·ÙÈΤ˜ ·ÈÌÔÚÚ·Á›Â˜, ÌË ÂȉÈΤ˜ ÈÛ¯·ÈÌÈΤ˜ Î·È ·ÓÔÍÈΤ˜ ·ÏÏÔÈÒÛÂȘ Î·È ÂÁÎÂÊ·ÏÈÎfi Ô›‰ËÌ· (1-3,5,6). ∏ÏÂÎÙÚÔÏ˘ÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ Î·È ˘¤ÚÙ·ÛË Ô˘ Û˘¯Ó¿ Û˘ÓÔ‰Â‡Ô˘Ó ÙÔ˘˜ ·ÛıÂÓ›˜ Ì ∞O™ ¤¯Ô˘Ó ›Û˘ ÂÓÔ¯ÔÔÈËı› ÁÈ· ÙȘ ÔÈΛϘ Ó¢ÚÔÏÔÁÈΤ˜ ÂΉËÏÒÛÂȘ. ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, Ë ˘¤ÚÙ·ÛË ‰ÂÓ ¤·ÈÍ ηӤӷ
ÚfiÏÔ, ηıÒ˜ ηӤӷ˜ ·ÛıÂÓ‹˜ ‰ÂÓ Â›¯Â ·ÚÔ˘ÛÈ¿ÛÂÈ ˘¤ÚÙ·ÛË, ÂÓÒ Ë Ô˘Ú·ÈÌ›· Î·È Ë ˘ÔÓ·ÙÚÈ·ÈÌ›·
ÚÔÊ·ÓÒ˜ Û˘Ó¤‚·Ï·Ó ÛÙËÓ ÚfiÎÏËÛË ÙˆÓ Ó¢ÚÔÏÔÁÈÎÒÓ ÂΉËÏÒÛˆÓ. ™ÙÔÓ ·ÛıÂÓ‹ Ì ÙȘ ·ÏÏÔÈÒÛÂȘ ÛÙË Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘, ÔÈ ÈÛ¯·ÈÌÈΤ˜ ·ÏÏÔÈÒÛÂȘ ÙˆÓ ÌÈÎÚÒÓ ·ÁÁ›ˆÓ Èı·Ó¿ Û˘Ó¤‚·Ï·Ó ÛÙËÓ ÂΉ‹ÏˆÛË ÙˆÓ Ó¢ÚÔÏÔÁÈÎÒÓ ÂΉËÏÒÛˆÓ. ∏ ‚ÂÚÔÙÔÍ›ÓË, Ë ÔÔ›· ÂÏ¢ıÂÚÒÓÂÙ·È ·fi ÙÔ ÂÓÙÂÚÔ·ıÔÁfiÓÔ Û٤ϯԘ Escherichia coli O157:H7, ÌÔÚ› Ó· ¢ı‡ÓÂÙ·È ÁÈ· ÙȘ Ó¢ÚÔÏÔÁÈΤ˜ ÂΉËÏÒÛÂȘ (16). ŸÌˆ˜, Ë ‚ÂÚÔÙÔÍ›ÓË ‰ÂÓ ÚÔÛ‰ÈÔÚ›ÛÙËΠÛÙȘ ÂÚÈÙÒÛÂȘ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘
Î·È ÔÈ Î·ÏÏȤÚÁÂȘ ÎÔÚ¿ÓˆÓ ÁÈ· Escherichia coli
O157:H7 ‹Ù·Ó ıÂÙÈΤ˜ ÌfiÓÔ Û ̛· ÂÚ›ÙˆÛË. £·
Ú¤ÂÈ Ó· ÛËÌÂȈı›, fï˜, fiÙÈ 3 ·fi ÙÔ˘˜ ·ÛıÂÓ›˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ›¯·Ó Ï¿‚ÂÈ ·ÓÙÈ‚ÈÔÙÈ΋ ·ÁˆÁ‹ ÚÈÓ ÂÈÛ·¯ıÔ‡Ó ÛÙÔ ÓÔÛÔÎÔÌ›Ô.
¶ÔÏϤ˜ ÂÚÈÙÒÛÂȘ ∞O™ Ì Ó¢ÚÔÏÔÁÈΤ˜ ÂÈÏÔΤ˜ ¤¯Ô˘Ó ÂÏÂÁ¯ı› Ì ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· Î·È ÔÈΛϷ Â˘Ú‹Ì·Ù· ¤¯Ô˘Ó ÂÚÈÁÚ·Ê›, fiˆ˜ Ô›‰ËÌ· ÂÁÎÂÊ¿ÏÔ˘, ¤ÌÊÚ·ÎÙ· ÔÈΛÏÔ˘ ÌÂÁ¤ıÔ˘˜ Î·È ÂÓ‰ÔÎÚ·ÓȷΤ˜ ·ÈÌÔÚÚ·Á›Â˜ (4-6). ¶ÈÛÙ‡ÂÙ·È fiÙÈ
∂ÈÎfiÓ· 1. ª·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘, Û ∆2 ÂÈÎfiÓ˜, ÙÔ˘ ‰Â‡ÙÂÚÔ˘ ·ÛıÂÓÔ‡˜ ηٿ ÙËÓ ÔÍ›· Ê¿ÛË Ù˘ ÓfiÛÔ˘. ¢Â›¯ÓÂÈ ·˘ÍË̤ÓÔ˘ Û‹Ì·ÙÔ˜ ·ÌÊÔÙÂÚfiÏ¢Ú˜ ÂÛٛ˜ ÂÓÙÔÈ˙fiÌÂÓ˜ ÛÙËÓ ˘ÔÊÏÔÈÒ‰Ë Ï¢΋ Ô˘Û›· ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘, ΢ڛˆ˜ ÛÙÔ˘˜ ÌÂوȷ›Ô˘˜ Î·È ‚ÚÂÁÌ·ÙÈÎÔ‡˜ ÏÔ‚Ô‡˜ (·) Î·È Ì›· ·ÚfiÌÔÈ· ÌÂÁ·Ï‡ÙÂÚË ÂÛÙ›· (‚) ÎÔÓÙ¿ ÛÙÔ ÌÂوȷ›Ô Τڷ˜ Ù˘ ·ÚÈÛÙÂÚ‹˜ Ï¿ÁÈ·˜ ÎÔÈÏ›·˜ (‚¤ÏË). ·‚
·ÓˆÌ·ÏÈÒÓ Û ·ÛıÂÓ›˜ Ì ∞O™, Û ·ÓÙ›ıÂÛË Ì ÙË Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ Ô˘ Â›Ó·È ÈÔ Â˘·›ÛıËÙË ÛÙËÓ ·Ó¿‰ÂÈÍË ·˘ÙÒÓ ÙˆÓ ·ÓˆÌ·ÏÈÒÓ, ·ÎfiÌË Î·È ÛÙ· ·Ú¯Èο ÛÙ¿‰È· Ù˘ ÓfiÛÔ˘ (10).
ŒÏÂÁ¯Ô˜ Ì ̷ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘
¤¯ÂÈ ·Ó·ÊÂÚı› ÌfiÓÔ Û ϛÁ˜ ÚÔËÁÔ‡ÌÂÓ˜ ÂÚÈÙÒÛÂȘ ∞O™ Î·È Ù· ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù· Â›Ó·È Î˘Ú›ˆ˜ ¤ÌÊÚ·ÎÙ· ‹ ·ÈÌÔÚÚ·Á›Â˜ ÛÙËÓ ÂÚÈÔ¯‹ ÙˆÓ
‚·ÛÈÎÒÓ Á·ÁÁÏ›ˆÓ (7-11). ŒÌÊÚ·ÎÙ· ÛÙË Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ ·ÚfiÌÔÈ· Ì ÂΛӷ Ù˘
·ÚÔ‡Û·˜ ÂÚ›ÙˆÛ˘, ·ÏÏ¿ ÂÓÙÔÈ˙fiÌÂÓ· ΢ڛˆ˜ ÛÙË ÂÚÈÔ¯‹ ÙˆÓ ‚·ÛÈÎÒÓ Á·ÁÁÏ›ˆÓ Î·È ÛÙËÓ ÂÓ Ùˆ ‚¿ıÂÈ Ï¢΋ Ô˘Û›·, ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› Û ÚÔËÁÔ‡ÌÂÓÔ ·ÛıÂÓ‹ Ì ∞O™ Î·È ÔÊı·ÏÌÈ΋ Û˘ÌÌÂÙÔ¯‹ (17). ¶ÈÛÙ‡ÂÙ·È, fï˜, fiÙÈ Ù· Â˘Ú‹Ì·Ù· ÛÙË Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ‰ÂÓ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ÚfiÁÓˆÛË (10), fiˆ˜ ‰È·ÈÛÙÒıËÎÂ Î·È ÛÙÔÓ ·ÛıÂÓ‹ ·˘Ù‹˜ Ù˘ ÌÂϤÙ˘, fiÔ˘ ÂÓÒ ÔÈ ·ÓˆÌ·Ï›Â˜ ÛÙË Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ·Ú¤ÌÂÈÓ·Ó ÛÙÔÓ Â·Ó¤ÏÂÁ¯Ô, ÙÔ ·È‰› ‰ÂÓ ·ÚÔ˘Û›·˙ Ó¢ÚÔÏÔÁÈο ÚÔ‚Ï‹Ì·Ù·.
∞Ó Î·È Ë ˘ÔÛÙËÚÈÎÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË, Ë ·ÈÌÔοı·ÚÛË Î·È Ë ÂÚÈÙÔÓ·˚΋ οı·ÚÛË ¤¯Ô˘Ó ÌÂÈÒÛÂÈ ÙË ıÓËÛÈÌfiÙËÙ· Û ·ÛıÂÓ›˜ Ì ∞O™, ÔÈ Ì·ÎÚÔ¯ÚfiÓȘ Û˘Ó¤ÂȘ, ÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ ÙˆÓ Ó¢ÚÔÏÔÁÈÎÒÓ ÂÈÏÔÎÒÓ, Ù˘ ¯ÚfiÓÈ·˜ ÓÂÊÚÈ΋˜ ·Ó¿ÚÎÂÈ·˜
Î·È Ù˘ ˘¤ÚÙ·Û˘, ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÔ 10-20% ÙˆÓ ·ÛıÂÓÒÓ (1,6). Œ¯ÂÈ ·Ó·ÊÂÚı› fiÙÈ Ë ÚfiÁÓˆÛË
Û¯ÂÙ›˙ÂÙ·È Ì ÙË ÛÔ‚·ÚfiÙËÙ· ÙˆÓ Ó¢ÚÔÏÔÁÈÎÒÓ
‰È·Ù·Ú·¯ÒÓ Î·Ù¿ ÙËÓ ÔÍ›· Ê¿ÛË Ù˘ ÓfiÛÔ˘. ™˘ÁÎÂÎÚÈ̤ӷ, Ë ‡·ÚÍË ÎÒÌ·ÙÔ˜ Û¯ÂÙ›˙ÂÙ·È Ì η΋ ÚfiÁÓˆÛË. ∞ÓÙ›ıÂÙ·, οÔÈÔÈ ÂÚ¢ÓËÙ¤˜ ÈÛÙ‡ԢÓ
fiÙÈ Ù· Ó¢ÚÔÏÔÁÈο Û˘ÌÙÒÌ·Ù· ˘Ô¯ˆÚÔ‡Ó ÁÚ‹ÁÔÚ· Î·È ‰ÂÓ ÛËÌ·ÙÔ‰ÔÙÔ‡Ó Î·Î‹ ÚfiÁÓˆÛË (10).
∂›Û˘, ¤¯ÂÈ ·Ó·ÊÂÚı› fiÙÈ Ë ·ÚÔ˘Û›· Û·ÛÌÒÓ
ηٿ ÙËÓ ÔÍ›· Ê¿ÛË Ù˘ ÓfiÛÔ˘ Û¯ÂÙ›˙ÂÙ·È Ì ÌÂÁ¿ÏË ıÓËÛÈÌfiÙËÙ· ‹ Ì·ÎÚÔ¯ÚfiÓȘ Ó¢ÚÔÏÔÁÈΤ˜
ÂÈÏÔΤ˜ (12), ¿Ô„Ë Ô˘ ¤¯ÂÈ, fï˜, ·ÌÊÈÛ‚ËÙËı› ·fi ¿ÏÏÔ˘˜ ÂÚ¢ÓËÙ¤˜ (13). ∂›Ó·È Èı·Ófi Ë ·ÚÔ˘Û›· ÂÛÙÈ·ÎÒÓ Û·ÛÌÒÓ Ô˘ ·Ú·ÙËÚÔ‡ÓÙ·È Î˘Ú›ˆ˜ Û ¿Û¯ÔÓÙ˜ Ì ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù· ÛÙÔÓ ·ÂÈÎÔÓÈÛÙÈÎfi ¤ÏÂÁ¯Ô ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Î·È Ô˘ ˘Ô‰ËÏÒÓÔ˘Ó ‚·Ú‡ÙÂÚË ÂÁÎÂÊ·ÏÈ΋ ‚Ï¿‚Ë, Ó· ÛËÌ·ÙÔ‰ÔÙ› η΋ ÚfiÁÓˆÛË Ù˘ ÓfiÛÔ˘ (14), ÂÓÒ ÔÈ ÁÂÓÈÎÂ˘Ì¤ÓÔÈ, ‚Ú·¯Â›˜ Û·ÛÌÔ›, Ô˘ ÔÊ›ÏÔÓÙ·È Î˘Ú›ˆ˜ Û ÌÂÙ·‚ÔÏÈΤ˜ ‰È·Ù·Ú·¯¤˜, Ó· ¤¯Ô˘Ó ηϋ
ÚfiÁÓˆÛË (13,14), fiˆ˜ ·Ú·ÙËÚ‹ıËÎÂ Î·È ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË. ™˘ÌÂÚ·ÛÌ·ÙÈο, Û ·ÛıÂÓ›˜ Ì ∞O™ Î·È Ó¢ÚÔÏÔÁÈΤ˜ ÂΉËÏÒÛÂȘ, Ë
ÏÔ˘. ∞˘ÙÔ› ÔÈ Û·ÛÌÔ› ÂϤÁ¯ÔÓÙ·È Â‡ÎÔÏ· Î·È ÁÚ‹-
ÁÔÚ· Î·È ‰ÂÓ Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì η΋ ÚfiÁÓˆÛË. ∏
¤ÁηÈÚË ·Ó·ÁÓÒÚÈÛË Î·È Ë Î·Ù¿ÏÏËÏË ·ÓÙÈÌÂÙÒÈÛË
ÙˆÓ ÌÂÙ·‚ÔÏÈÎÒÓ
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.
9.Jeong YK, Kim IO, Kim WS, Hwang YS, Choi Y, Yeon KM.
Hemolytic uremic syndrome: MR findings of CNS complications. Pediatr Radiol 1994;24:585-586.
10. 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.
11. 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.
12. Eriksson KJ, Boyd SG, Tasker RC. Acute neurology and neurophysiology of haemolytic-uraemic syndrome. Arch Dis Child 2001;84:434-435.
13. 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.
14. Dhuna A, Pascual-Leone A, Talwar D, Torres F. EEG and seizures in children with hemolytic-uremic syndrome. Epilepsia 1992;33:482-486.
15. Sheth KJ, Swick HM, Haworth N. Neurological involvement in the haemolytic-uremic syndrome. Ann Neurol 1986;19:90-93.
16. 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.
17. 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
∂ƒ∂À¡∏∆π∫∏
∫˘ÙÙ·ÚÔÁÂÓÂÙÈο
ÌÂ Û‡Ó‰ÚÔÌÔ Down Ù· ¤ÙË 1973-2001
Ã. ÷Ù˙ËÛ‚·ÛÙÔ‡ - §Ô˘Î›‰Ô˘, ¶. ∫·ÌÔ˘Ú›‰Ô˘
533 ·ÛıÂÓÒÓ Cytogenetic and epidemiological characteristics of 533 patients with Down syndrome between the years 1973-2001
H. Hatzissevastou - Loukidou, P. Kambouridou
¶ÂÚ›ÏË„Ë: ∏ ¯ÚˆÌÔÛˆÌÈ΋ Û‡ÓıÂÛË ÙˆÓ ÂÚÈÛÛfiÙÂÚˆÓ ·ÙfiÌˆÓ Ì ۇӉÚÔÌÔ Down Â›Ó·È Ë ÂχıÂÚË ÙÚÈۈ̛· 21, ÂÓÒ ¤Ó·˜ ÂÚÈÔÚÈṲ̂ÓÔ˜ ·ÚÈıÌfi˜ ¤¯ÂÈ ÌÂÙ¿ıÂÛË ÎÂÓÙÚÈ΋˜ Û‡ÓÙË͢ (Robertsonian translocation). ™ÎÔfi˜ Ù˘ ÂÚÁ·Û›·˜ ‹Ù·Ó: ·) Ë ÌÂϤÙË ÙˆÓ Î˘ÙÙ·ÚÔÁÂÓÂÙÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ·ÛıÂÓÒÓ Ì ۇӉÚÔÌÔ Down, ‚) Ë ÂÎÙ›ÌËÛË ÙˆÓ Û˘Ó‹ıˆÓ ·Ú·Ì¤ÙÚˆÓ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ÚfiÏË„Ë Á¤ÓÓËÛ‹˜ ÙÔ˘˜ Î·È Á) Ë ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘˜. ∞Ó·ÛÎÔ‹ıËÎ·Ó ·Ó·‰ÚÔÌÈο ÔÈ Ê¿ÎÂÏÔÈ 533 ·ÛıÂÓÒÓ Ì ۇӉÚÔÌÔ Down, ÔÈ ÔÔ›ÔÈ ÂÚ¢ӋıËÎ·Ó ÂÈÙ˘¯Ò˜ ¯ÚˆÌÔÛˆÌÈο Ù· ¤ÙË 1973-2001, ÂÓÒ ÂÚ¢ӋıËÎ·Ó ÂÈÏÂÎÙÈο Î·È ÔÈ Ê¿ÎÂÏÔÈ ÔÚÈṲ̂ӈÓ
ÔÈÎÔÁÂÓÂÈÒÓ ÂÍ ·˘ÙÒÓ ÁÈ· ·ÔÎÏÂÈÛÌfi Ù˘ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜. ∫·Ù·ÁÚ¿ÊËηÓ: ·) ÙÔ Ê‡ÏÔ,‚) Ë ËÏÈΛ· ηٿ ÙË ‰È¿ÁÓˆÛË,Á) ÔÈ Î·Ú˘fiÙ˘ÔÈ,‰) ÔÈ ÌÔÓ‹ÚÂȘ ‹ ‰›‰˘Ì˜ ΢‹ÛÂȘ, Â) Ë ËÏÈΛ· ÙˆÓ ÁÔÓ¤ˆÓ ηٿ ÙÔÓ ÙÔÎÂÙfi,ÛÙ) Ô ÙfiÔ˜ ηÙÔÈΛ·˜ ηÈ, Ù¤ÏÔ˜, Û˘ÁÎÚ›ıËÎ·Ó Ù· Â˘Ú‹Ì·Ù· Ì ÂΛӷ ¿ÏÏˆÓ ÂÚ¢ÓËÙÒÓ. ∆Ô ÔÛÔÛÙfi ÙˆÓ ·ÁÔÚÈÒÓ ‹Ù·Ó 56% Î·È ÙˆÓ ÎÔÚÈÙÛÈÒÓ 44%. ∞ÌÈÁ‹ ÂχıÂÚË ÙÚÈۈ̛· ›¯Â ÙÔ 90%, ̈۷˚ÎÈÛÌfi ÙÔ 5,5%, ÌÂÙ¿ıÂÛË ÎÂÓÙÚÈ΋˜ Û‡ÓÙË͢ ÙÔ 4,5%, ÂÓÒ ·fi ·˘ÙÔ‡˜ ÌfiÓÔ ÙÔ 1% ›¯Â ÎÏËÚÔÓÔÌÈÎfiÙËÙ·. ∏ ̤ÛË ËÏÈΛ· ÙˆÓ ÌËÙ¤ÚˆÓ Î·Ù¿ ÙÔÓ ÙÔÎÂÙfi ‹Ù·Ó Ù· 30,5 ¤ÙË Î·È ÙˆÓ ·Ù¤ÚˆÓ Ù· 34 ¤ÙË. ∏ ËÏÈΛ· ÙˆÓ ·ÛıÂÓÒÓ Î·Ù¿ ÙË ‰È¿ÁÓˆÛË ‰È·-
ÌÔÚʈÓfiÙ·Ó ˆ˜ ÂÍ‹˜: 4 ‹Ù·Ó ¤Ì‚Ú˘· ·fi ‰È·ÎÔ‹
Ù˘ ·ËÛ˘ ÏfiÁˆ ÚÔÁÂÓÓËÙÈÎÔ‡ ÂϤÁ¯Ô˘,56%
‹Ù·Ó ÓÂÔÁÓ¿, 27% ‹Ù·Ó ‚Ú¤ÊË Î·È 11% ›¯Â ËÏÈΛ·
ÌÂÁ·Ï‡ÙÂÚË ÙÔ˘ 1 ¤ÙÔ˘˜. ∞fi ÙËÓ Â·Ú¯›· ·Ú·-
¤ÌÊıËÎÂ Û˘ÓÔÏÈο ÙÔ 56% ÙˆÓ ·ÛıÂÓÒÓ Î·È
·fi ÙËÓ fiÏË Ù˘ £ÂÛÛ·ÏÔӛ΢ ÙÔ 38%. ∆· Â˘Ú‹Ì·Ù· Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ Û˘ÌʈÓÔ‡Ó
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 attendingphysicians in the neonatal age (47%)and 23% of thepatients were neonates from the
∂ÚÁ·ÛÙ‹ÚÈÔ ∫˘ÙÙ·ÚÔÁÂÓÂÙÈ΋˜,
∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ∞.¶.£.
°¶¡ “πÔÎÚ¿ÙÂÈÔ”£ÂÛÛ·ÏÔӛ΢
Cytogenetic Laboratory, 1st Paediatric Clinic of Aristotle University of Thessaloniki “Ippokration”General Hospital, Thessaloniki
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 ηٷ-
ÁÂÁÚ·Ì̤ÓÔ˜ Ô ÙfiÔ˜ ηÙÔÈΛ·˜. ™Â Û¯¤ÛË Ì ÙËÓ
ËÏÈΛ· ÙÔ˘˜, ·fi ÙËÓ Â·Ú¯›· ·Ú·¤ÌÊıËÎ·Ó 160 ÓÂÔÁÓ¿ (30%), 98 ‚Ú¤ÊË (18%) Î·È 31 ·È‰È¿ ËÏÈΛ·˜ ÌÂÁ·Ï‡ÙÂÚ˘ ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜ (6%), ÂÓÒ ·fi
∂ÈÎfiÓ· 1. ™¯¤ÛË ÙˆÓ ·ÁÔÚÈÒÓ ÚÔ˜ Ù· ÎÔÚ›ÙÛÈ·. 44%56% ∞ÁfiÚÈ·
ÙËÓ fiÏË Ù˘ £ÂÛÛ·ÏÔӛ΢ 125 ÓÂÔÁÓ¿ (23%), 51 ‚Ú¤ÊË (10%) Î·È 26 ·È‰È¿ ËÏÈΛ·˜ ÌÂÁ·Ï‡ÙÂÚ˘
ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜ (5%) (∂ÈÎfiÓ· 4). ¶ÚÈÓ ·fi ÙÔ 1985 ·Ú·¤ÌÊıËÎ·Ó ÁÈ· ¤ÏÂÁ¯Ô 220 ·ÛıÂÓ›˜, 103 ·fi ÙÔ˘˜ ÔÔ›Ô˘˜ ‹Ù·Ó ÓÂÔÁÓ¿ (47%), 87 ‹Ù·Ó ‚Ú¤ÊË (37%) Î·È 25 ‹Ù·Ó ·È‰È¿ ËÏÈΛ·˜ ÌÂÁ·Ï‡ÙÂÚ˘ ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜ (11%). ªÂÙ¿ ÙÔ 1986 ·Ú·¤ÌÊıËÎ·Ó 281 ·ÛıÂÓ›˜, 182 ·fi ÙÔ˘˜ ÔÔ›Ô˘˜ ‹Ù·Ó ÓÂÔÁÓ¿ (65%), 67 ‹Ù·Ó ÌÈÎÚ¿ ‚Ú¤ÊË (24%) Î·È 32 ‹Ù·Ó ·È‰È¿ ËÏÈΛ·˜ ÌÂÁ·Ï‡ÙÂÚ˘ ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜ (11%) (∂ÈÎfiÓ· 5).
¶ÚÈÓ ·fi ÙÔ 1985 ·Ú·¤ÌÊıËÎ·Ó ·fi ÙËÓ Â·Ú¯›· 110/220 ·ÛıÂÓ›˜ (55%) Î·È ÌÂÙ¿ ÙÔ 1986 179/281 (63%), ÂÓÒ ·fi ÙËÓ fiÏË Ù˘ £ÂÛÛ·ÏÔӛ΢ ·Ú·¤ÌÊıËÎ·Ó 100/220 (45%) Î·È 102/281 (36%), ·ÓÙ›ÛÙÔȯ· (∂ÈÎfiÓ· 6).
∂ÈÎfiÓ· 2. ÃÚˆÌÔÛˆÌÈο ¯·Ú·ÎÙËÚÈÛÙÈο (∂∆: ÂχıÂÚË ÙÚÈۈ̛·, ª∫™: ÌÂÙ¿ıÂÛË ÎÂÓÙÚÈ΋˜ Û‡ÓÙË͢).
∂ÈÎfiÓ· 4. ∏ÏÈÎȷ΋ ηٷÓÔÌ‹ ηٿ ÙË ‰È¿ÁÓˆÛË Û ۯ¤ÛË Ì ÙÔÓ ÙfiÔ ‰È·ÌÔÓ‹˜.
∞ӷχÔÓÙ·˜ ÂÚ·ÈÙ¤Úˆ ÙËÓ ËÏÈΛ· ·Ú·ÔÌ‹˜
Û˘Ó‰˘·ÛÌfi Ì ÙÔÓ ÙfiÔ Î·ÙÔÈΛ·˜ ‰È·ÈÛÙÒıËÎÂ
fiÙÈ 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 ÌÂ-
Ù¿ 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
ÙÚÈۈ̛·, 1% ̈۷˚ÎÈÛÌfi Î·È 3-4% ÌË ÈÛÔ˙˘ÁÈṲ̂ÓË ÌÂÙ¿ıÂÛË ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ 21 Î·È ÂÓfi˜ ·ÎÚÔÎÂÓÙÚÈÎÔ‡ ¯ÚˆÌÔÛÒÌ·ÙÔ˜, Û˘Ó‹ıˆ˜ ÙÔ˘ 14. ªfiÓÔ ÙÔ Å/4 ÙˆÓ ÌÂÙ·ı¤ÛÂˆÓ Â›Ó·È ÎÏËÚÔÓÔÌÈΤ˜ Î·È ÔÈ ˘fiÏÔȘ Â›Ó·È de novo (3,15-17).
∆· ΢ÙÙ·ÚÔÁÂÓÂÙÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ·ÛıÂÓÒÓ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ Û˘ÌʈÓÔ‡Ó Ì ·˘Ù¿ Ù˘ ‰ÈÂıÓÔ‡˜ ‚È‚ÏÈÔÁÚ·Ê›·˜: 95,5% ›¯Â ÂχıÂÚË ÙÚÈۈ̛·, 4,5% ›¯Â ª∫™ ηÈ, ·fi ·˘ÙÔ‡˜, ÎÏËÚÔÓÔÌÈ΋ ÌÂÙ¿ıÂÛË Â›¯·Ó ÌfiÓÔ 6/533 ·ÛıÂÓ›˜ (1%) (∂ÈÎfiÓ· 2).
OÈ ÔÈÎÔÁ¤ÓÂȘ ÙˆÓ ·ÛıÂÓÒÓ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‰¤¯ıËÎ·Ó Î·Ù¿ÏÏËÏË ÁÂÓÂÙÈ΋ ηıÔ‰‹ÁËÛË, ÂÓÒ ‰ÈÂÚ¢ӋıËÎ·Ó Î˘ÙÙ·ÚÔÁÂÓÂÙÈο Ù· ̤ÏË ÙˆÓ
ÔÈÎÔÁÂÓÂÈÒÓ ÙˆÓ ·ÛıÂÓÒÓ ÛÙÔ˘˜ ÔÔ›Ô˘˜ ‰È·ÈÛÙÒıËΠÎÏËÚÔÓÔÌÈÎfiÙËÙ·. ªÂ ·˘ÙfiÓ ÙÔÓ ÙÚfiÔ ÂÓËÌÂÚÒıËÎ·Ó ÔÈ Û˘ÁÁÂÓ›˜ ÊÔÚ›˜ ÁÈ· ÙË ÛˆÛÙ‹ ·ÓÙÈÌÂÙÒÈÛË Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ·Ó··Ú·ÁˆÁ‹˜, ‰ËÏ·‰‹ ÙËÓ ·Ó·ÁηÈfiÙËÙ· Ù˘ ‰ÈÂÓ¤ÚÁÂÈ·˜
ÚÔÁÂÓÓËÙÈ΋˜ ‰È¿ÁÓˆÛ˘ ÛÙÔ Î‡ËÌ¿ ÙÔ˘˜ (18). ∏ ËÏÈΛ· Ù˘ ‰È¿ÁÓˆÛ˘, ·ÓÂÍ·Úًو˜ ¿ÏÏˆÓ ·Ú·Ì¤ÙÚˆÓ, ‹Ù·Ó ΢ڛˆ˜ Ë ÓÂÔÁÓÈ΋. ¶ÂÚÈÛÛfiÙÂÚÔÈ ·fi ÙÔ˘˜ ÌÈÛÔ‡˜ ·ÛıÂÓ›˜ ·Ú·¤ÌÊıËÎ·Ó ÁÈ· ¤ÏÂÁ¯Ô ÛÙË ÓÂÔÁÓÈ΋ ËÏÈΛ· (56%), Ï›ÁÔÈ ÛÙË ‚ÚÂÊÈ΋ (27%) Î·È ·ÎfiÌË ÏÈÁfiÙÂÚÔÈ (11%) ÌÂÙ¿ ÙËÓ ËÏÈΛ· ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜ (1-50 ÂÙÒÓ) (∂ÈÎfiÓ· 3).
ŸÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ËÏÈΛ·, Ë Î·Ù·ÓÔÌ‹ ÙˆÓ ·ÛıÂÓÒÓ ‰ÂÓ ÙÚÔÔÔÈ‹ıËΠ۠ۯ¤ÛË Ì ÙÔÓ ÙfiÔ Î·ÙÔÈΛ·˜ ηٿ Ù· ¤ÙË 1973-2001. ¢ËÏ·‰‹, ÙfiÛÔ ·fi ÙËÓ Â·Ú¯›· fiÛÔ Î·È ·fi ÙËÓ fiÏË Ù˘ £ÂÛÛ·ÏÔӛ΢, ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ ·ÛıÂÓ›˜ ‹Ù·Ó ÓÂÔÁÓ¿ Î·È ÔÈ
ÏÈÁfiÙÂÚÔÈ ‹Ù·Ó ·È‰È¿ ËÏÈΛ·˜ ÌÂÁ·Ï‡ÙÂÚ˘ ÙÔ˘ 1 ¤ÙÔ˘˜ (∂ÈÎfiÓ· 4).
™ÙËÓ ·ÚÔ‡Û· ÂÚÁ·Û›· ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Û·Ó
ÔÚfiÛËÌÔ ÙÔ ¤ÙÔ˜ 1985, ηٿ ÙÔ ÔÔ›Ô ¿Ú¯ÈÛÂ Ë ÂÊ·ÚÌÔÁ‹ Ù˘ ÚÔÁÂÓÓËÙÈ΋˜ ‰È¿ÁÓˆÛ˘ ¯ÚˆÌÔÛˆÌÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ ÙÔ˘ ÂÌ‚Ú‡Ô˘ ÛÙÔ ÓÔÛÔÎÔÌ›Ô. ∆Ô ¤ÙÔ˜ ·˘Ùfi ·ÔÙ¤ÏÂÛ ÛÙ·ıÌfi ·ÏÏ·Á‹˜ ÛÙËÓ Î·ıËÌÂÚÈÓ‹ Ú·ÎÙÈ΋ ·ÓÙÈÌÂÙÒÈÛ˘ ÙˆÓ ÂÁ·ˆÓ
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 ‚ÔÚÂÈÔÂÏ-
Ï·‰ÈÎfi ¯ÒÚÔ, fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ Âη›‰Â˘ÛË ÙˆÓ
·È‰È¿ÙÚˆÓ Î·È ÙˆÓ Ì·ÈÂ˘Ù‹ÚˆÓ.
¶ÚÈÓ ·fi ÙÔ 1985, ÏÈÁfiÙÂÚ· ·fi Ù· ÌÈÛ¿ ·È‰È¿
Ô˘ ·Ú·¤ÌÊıËÎ·Ó ‹Ù·Ó ÓÂÔÁÓ¿ (47%), 37% ‹Ù·Ó
‚Ú¤ÊË Î·È ÌfiÓÔÓ 11% ‹Ù·Ó ËÏÈΛ·˜ ÌÂÁ·Ï‡ÙÂÚ˘
ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜. ªÂÙ¿ ÙÔ 1986, fï˜, Ù· ÓÂÔÁÓ¿ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ÂÚÈÛÛfiÙÂÚ· (65%, p=0,001), Ù· ‚Ú¤ÊË ÛËÌ·ÓÙÈο ÏÈÁfiÙÂÚ· (24%, p<0,005), ÂÓÒ ÙÔ ÔÛÔÛÙfi ÙˆÓ ·È‰ÈÒÓ Ô˘ ‹Ù·Ó ËÏÈΛ·˜ ÌÂÁ·Ï‡ÙÂÚ˘ ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜ ‰ÂÓ ÌÂÙ·‚Ï‹ıËΠ(11%) (∂ÈÎfiÓ· 5).
ªÂÙ¿ ÙÔ 1986 ·Ú·ÙËÚ‹ıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·-
ÓÙÈ΋ ·‡ÍËÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ·Ú·-
¤ÌÊıËÎ·Ó ·fi ÙËÓ Â·Ú¯›· (·fi 55% Û 63%, p<0,05), ÂÓÒ ·ÓÙ›ıÂÙ· ·Ú·ÙËÚ‹ıËΠÛÙ·ÙÈÛÙÈο
ÛËÌ·ÓÙÈ΋ Ì›ˆÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ·ÛıÂÓÒÓ Ô˘
·Ú·¤ÌÊıËÎ·Ó ·fi ÙËÓ fiÏË Ù˘ £ÂÛÛ·ÏÔӛ΢ (·fi 45% Û 36%, p<0,05) (∂ÈÎfiÓ· 6).
™ÙËÓ ∂ÈÎfiÓ· 7 Ê·›ÓÂÙ·È, ·ÎfiÌË, fiÙÈ ÌÂÙ¿ ÙÔ 1986
˘‹Ú¯Â ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË ÙˆÓ ÓÂÔÁÓÒÓ
Ô˘ ·Ú·¤ÌÊıËÎ·Ó ·fi ÙËÓ Â·Ú¯›· (·fi 23% Û 39%, p<0,001) Î·È ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ Ì›ˆÛË
ÙˆÓ ‚ÚÂÊÒÓ Ô˘ ·Ú·¤ÌÊıËÎ·Ó ·fi ÙËÓ fiÏË
Ù˘ £ÂÛÛ·ÏÔӛ΢ (·fi 15% Û 7%, p<0,005). OÈ
·ÛıÂÓ›˜ ÙˆÓ ¿ÏÏˆÓ ËÏÈÎÈÒÓ ‰ÂÓ Â›¯·Ó ÛÙ·ÙÈÛÙÈο
ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿.
∆· Â˘Ú‹Ì·Ù· Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ÂÚÌËÓ‡ıËÎ·Ó Ì ‚¿ÛË ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ì ÙËÓ ÂÊ·ÚÌÔÁ‹
ÙÔ˘ ÚÔÁÂÓÓËÙÈÎÔ‡ ÂϤÁ¯Ô˘ ÛÙÔ ÓÔÛÔÎÔÌ›Ô, ÔÈ ÁÈ·ÙÚÔ› Ô˘ ÂȉÈ·ÔÓÙ·È ÛÙȘ ¶·ÓÂÈÛÙËÌȷΤ˜ ÎÏÈÓÈΤ˜
¢·ÈÛıËÙÔÔÈ‹ıËÎ·Ó ÛÙËÓ ÚÒÈÌË ‰È¿ÁÓˆÛË ÙÔ˘ DS. ªÂ ÙËÓ ÚfiÔ‰Ô ÙˆÓ ÂÙÒÓ ÛÙÂϤ¯ˆÛ·Ó ÙËÓ Â·Ú¯›·, ÒÛÙ ӷ ·Ú·¤ÌÔÓÙ·È ¤ÁηÈÚ· Ù· ·È‰È¿. ∏ ‰È·›ÛÙˆÛË ·˘Ù‹ Û˘ÌʈÓ› Ì ÚÔËÁÔ‡ÌÂÓ˜ ‰ËÌÔÁÚ·ÊÈΤ˜ ÌÂϤÙ˜ ÛÙÔÓ ÂÏÏËÓÈÎfi ¯ÒÚÔ (19,20).
ªÂÙ¿ ÙË ‰È¿ÁÓˆÛË, 139/533 ·ÛıÂÓ›˜ ÂÓÙ¿¯ıËÎ·Ó ÛÙÔ ÚfiÁÚ·ÌÌ· ÚˆÙÔ‚¿ıÌÈ·˜ ·Ú·ÎÔÏÔ‡ıËÛ˘ ·È‰ÈÒÓ Ì DS ÛÙ· ÂȉÈο Â͈ÙÂÚÈο È·ÙÚ›·.
∞ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó ÔÚÁ·ÓÈο ÚÔ‚Ï‹Ì·Ù· ηٿ ÙË
ÓÂÔÁÓÈ΋ ÂÚ›Ô‰Ô (Û˘ÁÁÂÓ›˜ ηډÈÔ¿ıÂȘ, Û˘ÁÁÂÓ‹˜ ηٷÚÚ¿ÎÙ˘, ·ÙÚËÛ›· ‰ˆ‰Âη‰·ÎÙ‡ÏÔ˘, Û˘ÁÁÂÓ‹˜ ˘Ôı˘ÚÂÔÂȉÈÛÌfi˜), ÂÓËÌÂÚÒıËÎ·Ó ÔÈ
ÁÔÓ›˜ ÁÈ· ÙȘ ‰È·Ù·Ú·¯¤˜ Ô˘ Â›Ó·È Û˘¯ÓfiÙÂÚ˜
ÛÙ· ·È‰È¿ Ì DS Î·È ÙÔ˘˜ ‰fiıËÎ·Ó Ô‰ËÁ›Â˜ ÁÈ· ÙËÓ
¤ÓÙ·ÍË ÙˆÓ ·È‰ÈÒÓ Û ÂȉÈο ÚÔÁÚ¿ÌÌ·Ù· Âη›‰Â˘Û˘ (3,15-16).
∏ÏÈÎȷο, ÔÈ ÂÚÈÛÛfiÙÂÚ˜ ÌËÙ¤Ú˜ ‹Ù·Ó Ӥ˜. ∏ ̤ÛË ËÏÈΛ· ÙˆÓ ÌËÙ¤ÚˆÓ ‹Ù·Ó Ù· 30,5 ¤ÙË Î·È
ÙˆÓ ·Ù¤ÚˆÓ Ù· 34 ¤ÙË. ∆Ô 78% ÙˆÓ ÌËÙ¤ÚˆÓ ÛÙË
‰È¿ÚÎÂÈ· fiÏˆÓ ÙˆÓ ÂÙÒÓ Û˘ÓÔÏÈο ›¯Â ËÏÈΛ· ÌÈÎÚfiÙÂÚË ÙˆÓ 35 ÂÙÒÓ Î·È ÌfiÓÔ ÙÔ 22% ›¯Â ËÏÈΛ· ÌÂÁ·Ï‡ÙÂÚË ÙˆÓ 35 ÂÙÒÓ (∂ÈÎfiÓ· 8). ∆· ÔÛÔÛÙ¿ ‰ÂÓ ÌÂÙ·‚Ï‹ıËÎ·Ó ÌÂÙ¿ ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ÚÔÁÂÓÓËÙÈÎÔ‡ ÂϤÁ¯Ô˘, ‰ËÏ·‰‹ ÚÈÓ ·fi ÙÔ 1985 ÙÔ 72% ÙˆÓ ÌËÙ¤ÚˆÓ ‹Ù·Ó ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ 35 ÂÙÒÓ Î·È ÌÂÙ¿ ÙÔ 1986 ÙÔ 80% ÙˆÓ ÌËÙ¤ÚˆÓ ‹Ù·Ó ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ 35 ÂÙÒÓ.∆Ô ÔÛÔÛÙfi ÙˆÓ
ÌËÙ¤ÚˆÓ ËÏÈΛ·˜ ÌÂÁ·Ï‡ÙÂÚ˘ ÙˆÓ 35 ÂÙÒÓ ‹Ù·Ó 27% Î·È ¤ÁÈÓ 20%, ·ÓÙ›ÛÙÔȯ· (‰È·ÊÔÚ¿ ÌË ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋). ™Ù·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË ˘‹ÚÍ ÌfiÓÔ ÛÙÔÓ ·ÚÈıÌfi ÙˆÓ ÌËÙ¤ÚˆÓ ËÏÈΛ·˜ 2530 ÂÙÒÓ (·fi 24% Û 37%, p=0,006) (∂ÈÎfiÓ· 9).
∞˘Ù‹ Ë ·Ú·Ù‹ÚËÛË ÂȂ‚·ÈÒÓÂÈ ÙË ÁÓÒÛË fiÙÈ Ù· ÂÚÈÛÛfiÙÂÚ· ·È‰È¿ Ì DS ÁÂÓÓÈÔ‡ÓÙ·È ·fi Á˘Ó·›Î˜ Ó¤ˆÓ ËÏÈÎÈÒÓ (<35ÂÙÒÓ), ÛÙȘ Ôԛ˜ ‰ÂÓ
˘¿Ú¯ÂÈ ¤Ó‰ÂÈÍË ÂÂÌ‚·ÙÈ΋˜ ÌÂıfi‰Ô˘ ÚÔÁÂÓÓËÙÈ΋˜ ‰È¿ÁÓˆÛ˘ (·ÌÓÈԷڷΤÓÙËÛ˘ ‹ Ï¿¯Ó˘), ·Ú¿ ÌfiÓÔ Ù· screening tests ÙÔ˘ 1Ô˘ Î·È 2Ô˘ ÙÚÈÌ‹ÓÔ˘ (˘ÂÚ˯ÔÁÚ·ÊÈο Î·È ÔÚÔÏÔÁÈο), Ù· ÔÔ›·
8. ∏ÏÈÎȷ΋ ηٷÓÔÌ‹ ÙˆÓ ÌËÙ¤ÚˆÓ Î·Ù¿ ÙÔÓ ÙÔÎÂÙfi.
∂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˜
ˆ˜ ÁÓˆÛÙfiÓ ‰ÂÓ Â›Ó·È ‰È·ÁÓˆÛÙÈο ·ÛÊ·Ï‹ (12-14).
™˘ÌÂÚ·›ÓÂÙ·È, ÏÔÈfiÓ, fiÙÈ ı· Ú¤ÂÈ Ó· ·Ó·˙ËÙË-
ıÔ‡Ó Î·È Ó· ÂÊ·ÚÌÔÛÙÔ‡Ó ·ÍÈfiÈÛÙ˜ ÌË ÂÂÌ‚·-
ÙÈΤ˜ ̤ıÔ‰ÔÈ Ì ÌÈÎÚfi ÔÛÔÛÙfi „¢‰Ò˜ ıÂÙÈÎÔ‡
·ÔÙÂϤÛÌ·ÙÔ˜, ÔÈ Ôԛ˜ ı· ÂÈϤÁÔ˘Ó ÙȘ ˘„Ë-
ÏÔ‡ ÎÈÓ‰‡ÓÔ˘ Ó·ڤ˜ ¤ÁÎ˘Â˜, ÒÛÙ ·˘Ù¤˜ ÂÎÏÂ-
ÎÙÈο Ó· ˘Ô‚¿ÏÏÔÓÙ·È Û ÂÂÌ‚·ÙÈΤ˜ ÌÂıfi‰Ô˘˜
ÚÔÁÂÓÓËÙÈ΋˜ ‰È¿ÁÓˆÛ˘ (12-14,21-23).
∂˘¯·ÚÈÛٛ˜
£ÂṲ́˜ ¢¯·ÚÈÛٛ˜ ÛÙȘ ·Ú·Û΢¿ÛÙÚȘ Î.Î. ¢. ∑·-
ÁηڤÙÔ˘ Î·È ∑. OÓÔ˘ÊÚÈ¿‰Ô˘ ÁÈ· ÙË Û˘Ì‚ÔÏ‹ ÙÔ˘˜ ÛÙÔ ÙÂ-
¯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˘ ™,
∫Ô‡ÙÚ· ¶, ÃÚÈÛÙÔÊÔÚ¿ÎË ª Î·È Û˘Ó. ¶ÚÔÁÂÓÓËÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÁÈ· Û‡Ó‰ÚÔÌÔ Down Ì ÙË ¯Ú‹ÛË ‚ÈÔ¯ËÌÈÎÒÓ ‰ÂÈÎÙÒÓ. ∏ ÂÌÂÈÚ›· ·fi Ì›· ÌÂÁ¿ÏË Ì·È¢ÙÈ΋ ÌÔÓ¿‰·. ∂ÊË‚ °˘Ó ∞Ó· ∂ÌÌËÓ 2001;13:299-303. 13. ∞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∞∞. 14. 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∂∞.
15. Saenz RB. Primary care of infants and young children with Down syndrome. Am Fam Physician 1999;59:381-390, 392, 395-396.
16. American Academy of Pediatrics, Committee on Genetics. Health supervision for children with Down syndrome. Pediatrics 2001;107:442-449.
17. 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.
18. ¶¿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∞.
19. Mavrou A, Metaxotou C, Trichopoulos D. Awareness and use of prenatal diagnosis among Greek women: a national survey. Prenat Diagn 1998;18:349-355.
20. ª·Ú·ÁÎfi˜ Ã, µ·Ï¿ÛÛË-∞‰¿Ì ∂. ¶ÚÔÁÂÓÓËÙÈÎfi˜ Î·È ÚÔÛ˘Ìو̷ÙÈÎfi˜ ÁÂÓÂÙÈÎfi˜ ¤ÏÂÁ¯Ô˜: ·fi„ÂȘ ·È‰È¿ÙÚˆÓ. ¶·È‰È·ÙÚÈ΋ 1999;62:490-498.
21. ∫ÔÏȷϤÍË ∞, ª·ÎԇϷ˜ µ, ¶·Ó·ÁȈÙÔÔ‡ÏÔ˘ ¶, ¢·Ê¤ÚÌÔ˘ ∂, ª·‡ÚÔ˘ ∞, ªÂٷ͈ÙÔ‡ ∞. In situ ˘‚ÚȉÈÛÌfi˜ ·ÌÓÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ [¶ÂÚ›ÏË„Ë]. 34Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ; 1996 31 ª·˝Ô˘ & 1-2 πÔ˘Ó›Ô˘; ƒfi‰Ô˜; 1996. #307∞. 22. ª·‡ÚÔ˘ ∞, ∫ÔÏȷϤÍË ∞, ∆Û¿ÁηÚ˘ °, ∞ÓÙÛ·ÎÏ‹˜ ∞, ¢·Ê¤ÚÌÔ˘ ∂, ∆ÛÂÁ΋ ÃÎ·È Û˘Ó. ∞ÔÌfiÓˆÛË ÂÌ‚Ú˘˚ÎÒÓ Î˘ÙÙ¿ÚˆÓ ·fi ÙË ÌËÙÚÈ΋ ΢ÎÏÔÊÔÚ›· Ì ̷ÁÓËÙÈÎfi ‰È·¯ˆÚÈÛÌfi, ·ÓÔÛÔÊ·ÈÓÔÙ˘È΋ ¯ÚÒÛË Î·È FISH. °ÂÓÂÙÈ΋ ÙÔ˘ ∞ÓıÚÒÔ˘ 1999;1:40-46. 23. ∫·ÌÔ˘Ú¿Î˘ °, ∫ÔÓÙÔÁÈ¿ÓÓË ∂. ¶ÚÔÂÌÊ˘Ù¢ÙÈ΋ ‰È¿ÁÓˆÛË ÙˆÓ ÁÂÓÂÙÈÎÒÓ ÓÔÛËÌ¿ÙˆÓ: ÂÈÙ‡ÁÌ·Ù· Î·È ÌÂÏÏÔÓÙÈΤ˜ ÚÔÔÙÈΤ˜. ∂ÊË‚ °˘Ó ∞Ó· ∂ÌÌËÓ 2000;12:46-54.
HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 24-01-2003
HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 31-10-2003
¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ÷ڛÎÏÂÈ· ÷Ù˙ËÛ‚·ÛÙÔ‡-§Ô˘Î›‰Ô˘
∂ÚÁ·ÛÙ‹ÚÈÔ ∫˘ÙÙ·ÚÔÁÂÓÂÙÈ΋˜, ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ∞.¶.£. °¶¡ “πÔÎÚ¿ÙÂÈÔ”£ÂÛÛ·ÏÔӛ΢ ∫ˆÓÛÙ·ÓÙÈÓÔ˘fiψ˜ 49, ∆.∫. 544 62, £ÂÛÛ·ÏÔÓ›ÎË
∂¡¢π∞º∂ƒOÀ™∞
∞Ó¿ÚÎÂÈ· Ù˘ ÔÚÓÈıÈÓÈ΋˜
¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘
™. ºÂÛÛ¿ÙÔ˘1, ∞. ∞ÙÙÈÏ¿ÎÔ˜1, ∂. ∆Û¿Ú·1, °. ª·ÚfiÔ˘ÏÔ˜2, ∂. ªÈ¯ÂϷοÎË3, ∫. ™Ô‡ÏË4
Late onset ornithine transcarbamylase deficiency. A case report
S. Fessatou1, A. Attilakos1, H. Tsapra1, G. Maropoulos2, H. Michelakakis3, K. Schulpis4
¶ÂÚ›ÏË„Ë: ∏ ·Ó¿ÚÎÂÈ· Ù˘ ÔÚÓÈıÈÓÈ΋˜ ÙÚ·ÓÛηڂ·Ì˘Ï¿Û˘, Ì›· Ê˘ÏÔÛ‡Ó‰ÂÙË ‰È·Ù·Ú·¯‹, Â›Ó·È Ë ÈÔ Û˘¯Ó‹ ÎÏËÚÔÓÔÌÔ‡ÌÂÓË ÌÂÙ·‚ÔÏÈ΋ ‰È·Ù·Ú·¯‹ ÙÔ˘ ·ÎÏÔ˘ Ù˘ Ô˘Ú›·˜. ªÂϤÙ˜ ¤¯Ô˘Ó ÂÚÈÁÚ¿„ÂÈ ÙËÓ ‡·ÚÍË ·ÚÎÂÙÒÓ ‰È·ÊÔÚÂÙÈÎÒÓ ÌÂÙ·ÏϿ͈Ó, ÔÈ Ôԛ˜ ÂÓ Ì¤ÚÂÈ ÌÔÚÔ‡Ó Ó· ÂÍËÁ‹ÛÔ˘Ó ÙË Ê·ÈÓÔÙ˘È΋ ÔÈÎÈÏ›· ÛÙËÓ ¤ÎÊÚ·ÛË Ù˘ ÓfiÛÔ˘. ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÚÒÙË ÂÚ›ÙˆÛË ·ÁÔÚÈÔ‡ Ì ÌÂÙ¿ÏÏ·ÍË ∆343∫, ÙËÓ ÔÔ›· ÎÏËÚÔÓfiÌËÛ ·fi
ÙË ÌËÙ¤Ú· ÙÔ˘. ÀÔÁÚ·ÌÌ›˙ÂÙ·È Ô ·Ú¯ÈÎfi˜ ‰È·ÁÓˆÛÙÈÎfi˜ ·ÔÚÔÛ·Ó·ÙÔÏÈÛÌfi˜ ÛÙËÓ ·Ú¯È΋ ÂΉ‹Ïˆ-
ÛË ÙˆÓ Û˘Ìو̿وÓ, ‰ÈfiÙÈ Ù· ÚÒÙ· Û˘ÌÙÒÌ·Ù·
ÂÌÊ·Ó›ÛÙËÎ·Ó ÌÂÙ¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙˆÓ ÊÚÔ‡ÙˆÓ
ÛÙË ‰È·ÙÚÔÊ‹ ÙÔ˘ ·È‰ÈÔ‡.
§¤ÍÂȘ ÎÏÂȉȿ: ·Ó¿ÚÎÂÈ· Ù˘ ÔÚÓÈıÈÓÈ΋˜ ÙÚ·Ó-
Ûηڂ·Ì˘Ï¿Û˘, ·ÎÏÔ˜ Ù˘ Ô˘Ú›·˜, ˘ÂÚ·Ì̈ÓÈ·ÈÌ›·.
™˘ÓÙÔÌÔÁڷʛ˜
OTCOÚÓÈıÈÓÈ΋ ÙÚ·ÓÛηڂ·Ì˘Ï¿ÛË
°O¶°·ÛÙÚÔÔÈÛÔÊ·ÁÈ΋ ·ÏÈÓ‰ÚfiÌËÛË
∂ÈÛ·ÁˆÁ‹
∏ ·Ó¿ÚÎÂÈ· Ù˘ ÔÚÓÈıÈÓÈ΋˜ ÙÚ·ÓÛηڂ·Ì˘Ï¿Û˘ (O∆C) Â›Ó·È Ë ÈÔ Û˘¯Ó‹ ÎÏËÚÔÓÔÌÔ‡ÌÂÓË ‰È·Ù·Ú·¯‹ ÙÔ˘ ·ÎÏÔ˘ Ù˘ Ô˘Ú›·˜. ∫ÏËÚÔÓÔÌÂ›Ù·È Ì ÂÈÎÚ·ÙËÙÈÎfi Ê˘ÏÔÛ‡Ó‰ÂÙÔ Ù‡Ô Î·È, fiˆ˜ Î·È ÔÈ ¿ÏϘ ·Ó¿ÚÎÂȘ ÂÓ˙‡ÌˆÓ ÙÔ˘ ·ÎÏÔ˘ Ù˘ Ô˘Ú›·˜, ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÎÏÈÓÈο ÛËÌ›· Î·È Û˘-
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·
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.
Keywords: ornithine transcarbamylase deficiency, urea cycle, hyperammonaemia.
ÌÙÒÌ·Ù· Ô˘ Â›Ó·È ·ÔÙ¤ÏÂÛÌ· Ù˘ ¿ıÚÔÈÛ˘ ÌÂÙ·‚ÔÏÈÙÒÓ Ù˘ Ô˘Ú›·˜, ΢ڛˆ˜ ·Ì̈ӛ·˜ Î·È ÁÏÔ˘Ù·Ì›Ó˘. ∏ ÛÔ‚·ÚfiÙÂÚË ÎÏÈÓÈ΋ ÂΉ‹ÏˆÛË Ù˘ ÓfiÛÔ˘ Û˘Ì‚·›ÓÂÈ Û ¿Û¯ÔÓÙ· ¿ÚÚÂÓ· ÓÂÔÁÓ¿ Î·È ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÔ ˘ÂÚ·Ì̈ÓÈ·ÈÌÈÎfi ÎÒÌ· Î·È ÙÔÓ ı¿Ó·ÙÔ. O ˘Ô͇˜ Ù‡Ô˜ (late onset) ÂΉËÏÒÓÂÙ·È ÛÂ
¿ÚÚÂÓ˜ Ì ÌÂÚÈ΋ ÂÓ˙˘ÌÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· Î·È ÛÂ
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
‡ÚÔ˜ ÂΉËÏÒÛÂˆÓ Î·È ÌÔÚ› ÌfiÓÔ ÌÂÚÈÎÒ˜ Ó·
ÂÍËÁËı› ·fi ÙÔÓ ÁÔÓfiÙ˘Ô (3).
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
JB, Fredrickson DS, Goldstein JL, Brown MS, editors. The metabolic basis of inherited disease. 5th ed. New York: McGraw-Hill; 1983. p. 403.
2. Soulpis C, Markosoglou D, Papadelis F, Caraboula A, Giouroukos S, Skarpalezou A et al. Ornithine transcarbamylase deficiency: findings and treatment in a symptomatic female heterozygote. J Inherit Metab Dis 1991;14:107-108.
3. Tuchman M, McCullough BA, Yudkoff M. The molecular basis of ornithine transcarbamylase definciency. Eur J Pediatr 2000;159 (Suppl 3):S196-S198.
4. 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.
5. 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.
6. 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.
7. Tuchman M, Plante RJ. Mutations and polymorphisms in the human ornithine transcarbamylase gene: mutation update addendum. Hum Mutat 1995;5:293-295.
8. Oppliger Leibundgut EO, Wermuth B, Colombo JP, LiechtiGallati S. Ornithine transcarbamylase deficiency: characterization of gene mutations and polymorphisms. Hum Mutat 1996;8:333-339.
9. Hamano Y, Kodama H, Fujikawa Y, Tanaka Y, Nishimura K,
Yanagisawa M. Use of immunocytochemical analysis of a duodenal biopsy specimen to identify a carrier of ornithine transcarbamylase deficiency. N Engl J Med 1988;318:15211523.
10. Drogari E, Leonard JV. Late onset ornithine carbamoyl transferase deficiency in males. Arch Dis Child 1988;63: 1363-1367.
11. Brusilow SW. Protocol for treatment of intercurrent hyperammonemia in patients with urea cycle defects. http://divis17.pedgen.uiowa.edu/genetics/HyperAmmonem iaTx.html.
12. Maestri NE, Hauser ER, Bartholomew D, Brusilow SW. Prospective treatment of urea cycle disorders. J Pediatr 1991;119:923-928.
13. 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.
14. 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·
∂¡¢π∞º∂ƒOÀ™∞
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˙Ô-
Ï·ÈÌ›· Ù˘ ÓfiÛÔ˘ Ô‰ËÁ› Û ηٷÛÙÔÏ‹ ÙˆÓ ÂÚÈÛÛfiÙÂÚˆÓ ÔÚÌÔÓÒÓ Ù˘ ÚfiÛıÈ·˜ ˘fiÊ˘Û˘, fiˆ˜
ÙˆÓ FSH, LH, PRL, TSH Î·È GH. ¶ÂÚÈÁÚ¿ÊÂÙ·È ÓfiÛÔ˜ Cushing Û ÎÔÚ›ÙÛÈ ËÏÈΛ·˜ 15ó ÂÙÒÓ, Ô˘
ÚÔ¤‚·ÏÏ Ì ·ÓÛÂÏËÓÔÂȉ¤˜ ÚÔۈ›Ô, ηı˘ÛÙ¤ÚËÛË ÛˆÌ·ÙÈ΋˜ ·Ó¿Ù˘Í˘, ·¯˘Û·ÚΛ·, ·ÎÌ‹, ˘ÂÚÙÚ›¯ˆÛË Î·È ˘¤ÚÙ·ÛË. O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍ ˘ÂÚÎÔÚÙÈ˙ÔÏ·ÈÌ›· Î·È Ë Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÌÈÎÚÔ·‰¤ÓˆÌ· Ù˘ ˘fiÊ˘Û˘. ∏ ·ÛıÂÓ‹˜ ¯ÂÈÚÔ˘ÚÁ‹ıËΠÂÈÙ˘¯Ò˜ Î·È ÙÔ ·‰¤ÓˆÌ· Ù˘ ˘fiÊ˘Û˘ ·Ê·ÈÚ¤ıËΠ̠‰È·ÛÊËÓÔÂȉ‹ ÚÔۤϷÛË. ™˘˙ËÙÂ›Ù·È Ë ÎÏÈÓÈ΋ ÚÔ‚ÔÏ‹, Ù· ÔÚÌÔÓÔÏÔÁÈο Î·È ·ÂÈÎÔÓÈÛÙÈο Â˘Ú‹Ì·Ù·, ηıÒ˜ Î·È Ë ıÂڷ›· Ù˘ ÓfiÛÔ˘ Cushing.
§¤ÍÂȘ ÎÏÂȉȿ: ·‰¤ÓˆÌ· ˘fiÊ˘Û˘, Û‡Ó‰ÚÔÌÔ Cushing, ˘ÂÚÎÔÚÙÈ˙ÔÏ·ÈÌ›·, ÎÔÓÙfi ·Ó¿ÛÙËÌ·, ‰È·ÛÊËÓÔÂȉ‹˜ ¯ÂÈÚÔ˘ÚÁÈ΋ ·ÓÙÈÌÂÙÒÈÛË.
™˘ÓÙÔÌÔÁڷʛ˜
ACTHºÏÔÈÔÂÈÓÂÊÚȉÈÔÙÚfiÔ˜ ÔÚÌfiÓË
FSH£˘Ï·ÎÈÔÙÚfiÔ˜ ÔÚÌfiÓË
LHø¯ÚÈÓÔÙÚfiÔ˜ ÔÚÌfiÓË E2 OÈÛÙÚ·‰ÈfiÏË
DHEA’S£ÂÈ˚΋ ‰Â¸‰ÚÔÂÈ·Ó‰ÚÔÛÙÂÚfiÓË 17-OHÚÔÁÂÛÙÂÚfiÓË17-˘‰ÚÔ͢-ÚÔÁÂÛÙÂÚfiÓË TSH£˘ÚÂÔÂȉÔÙÚfiÔ˜ ÔÚÌfiÓË
T4 £˘ÚÔÍ›ÓË FT4 ∂χıÂÚË ı˘ÚÔÍ›ÓË T3 ∆ÚÈȈ‰Ôı˘ÚÔÓ›ÓË FT3 ∂χıÂÚË ÙÚÈȈ‰Ôı˘ÚÔÓ›ÓË DXM¢ÂÍ·ÌÂı·˙fiÓË GH∞˘ÍËÙÈ΋ ÔÚÌfiÓË U/SÀÂÚ˯ÔÁÚ¿ÊËÌ· MRIª·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›·
∂Ó‰ÔÎÚÈÓÔÏÔÁÈÎfi ∆Ì‹Ì·, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó·
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.
Key words: pituitary adenoma, Cushing’s syndrome, hypercortisolism, short stature, transsphenoidal surgical treatment.
∂ÈÛ·ÁˆÁ‹ ∏ ÓfiÛÔ˜ Cushing ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ˘ÂÚ¤ÎÎÚÈÛË Ù˘ ÊÏÔÈÔÂÈÓÂÊÚȉÈÔÙÚfiÔ˘ ÔÚÌfiÓ˘ ACTH, ÔÊÂÈÏfiÌÂÓË Û ÎÔÚÙÈÎÔÙÚfiÊÔ ·‰¤ÓˆÌ· Ù˘ ˘fiÊ˘Û˘ (1,2), Ë ÔÔ›· Ô‰ËÁ› Û ˘ÂÚ·Ú·ÁˆÁ‹ ÎÔÚÙÈ˙fiÏ˘ ·fi ÙÔÓ ÊÏÔÈfi ÙˆÓ ÂÈÓÂÊÚȉ›ˆÓ, ÂÓÒ ÙÔ Û‡Ó‰ÚÔÌÔ Cushing ·ÊÔÚ¿ Û οı ˘ÂÚÎÔÚÙÈ˙ÔÏ·ÈÌ›· ·ÓÂÍ·ÚÙ‹ÙÔ˘ ·ÈÙÈÔÏÔÁ›·˜ (ÂÓ‰ÔÁÂÓ‹˜ ‹ Â͈ÁÂÓ‹˜) (2,3). ∏ Û˘¯ÓfiÙÂÚË ·ÈÙ›· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Cushing Â›Ó·È Ë È·ÙÚÔÁÂÓ‹˜, Ë ÔÔ›· ·Ú·ÙËÚÂ›Ù·È ÌÂÙ¿ ·fi Ì·ÎÚÔ¯ÚfiÓÈ· ¯ÔÚ‹ÁËÛË ÎÔÚÙÈ˙fiÓ˘, Û˘ÛÙËÌ·ÙÈ΋˜ ‹ Î·È ÙÔÈ΋˜ (4,5). ∆· ÂÓ‰ÔÁÂÓ‹ ·›ÙÈ· ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙÔ ·‰¤ÓˆÌ· ÙˆÓ ÂÈÓÂÊÚȉ›ˆÓ (3,5), ÙÔ Î·ÚΛӈ̷ (6), ÙÔ ·‰¤ÓˆÌ· Ù˘ ˘fiÊ˘Û˘
Department of Endocrinology, “P. & A. Kyriakou”Children’s Hospital, Athens
(1), ÙË ‰È¿¯˘ÙË ÔÏ˘Ô˙Ò‰Ë ˘ÂÚÏ·Û›· ÙˆÓ ÂÈÓÂ-
ÊÚȉ›ˆÓ (3,7,8) ηÈ, Ôχ Û¿ÓÈ·, ÙËÓ ¤ÎÙÔË ·Ú·-
ÁˆÁ‹ ACTH (7). ∏ ÓfiÛÔ˜ Cushing ÚÔÛ‚¿ÏÏÂÈ ·È-
‰È¿ fiÏˆÓ ÙˆÓ ËÏÈÎÈÒÓ, ·ÏÏ¿ Â›Ó·È Û˘¯ÓfiÙÂÚË Û ËÏÈ-
˘ ÌÂÁ·Ï‡ÙÂÚ˜ ÙˆÓ 7 ÂÙÒÓ (7). ∏ Û˘¯ÓfiÙËÙ¿ Ù˘
Â›Ó·È ›‰È· ÛÙ· ‰‡Ô ʇϷ (2), Û ·ÓÙ›ıÂÛË Ì ÙÔ˘˜
fiÁÎÔ˘˜ ÙˆÓ ÂÈÓÂÊÚȉ›ˆÓ, ÔÈ ÔÔ›ÔÈ ˘ÂÚÙÂÚÔ‡Ó
ÛÙ· ÎÔÚ›ÙÛÈ· (3:1) (7).
∏ ›وÛË Ù˘ ÓfiÛÔ˘ Cushing ÛÙÔÓ ÁÂÓÈÎfi
ÏËı˘ÛÌfi Â›Ó·È 5-10 ÂÚÈÙÒÛÂȘ/¤ÙÔ˜, ·Ó¿
1.000.000 ÏËı˘ÛÌÔ‡ (9). ∏ ÓfiÛÔ˜ Cushing ›ӷÈ
·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΋ Â-
Ú›Ô‰Ô (1,2). ∏ ¤ÁηÈÚË ‰È¿ÁÓˆÛË ÛÙËÓ ·È‰È΋ ËÏÈ-
Λ· ÂÍ·ÛÊ·Ï›˙ÂÈ Ê˘ÛÈÔÏÔÁÈ΋ ÂÊ˂›· Î·È ‚ÂÏÙȈ-
̤ÓÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· (2,10).
¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘
∫ÔÚ›ÙÛÈ ËÏÈΛ·˜ 15ó ÂÙÒÓ ÚÔÛ‹Ïı ÛÙÔ ÂÓ‰Ô-
ÎÚÈÓÔÏÔÁÈÎfi 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 ηÈ
ÎÏËÚÔÓÔÌÈÎfi ÈÛÙÔÚÈÎfi ‹Ù·Ó ÂχıÂÚ·. ∏ „˘¯ÔÎÈÓË-
ÙÈ΋ ÂͤÏÈÍË ÙÔ˘ ·È‰ÈÔ‡ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋. ∞fi
‰ÈÂÙ›·˜, ÔÈ ÁÔÓ›˜ ·Ú·Ù‹ÚËÛ·Ó È‰È·›ÙÂÚË ·‡ÍËÛË
ÙÔ˘ ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜, Ì ·Ó·Î·Ù·ÓÔÌ‹ ÙÔ˘ Ï›-
Ô˘˜ ÛÙËÓ ÎÔÈÏÈ¿ Î·È ÙÔÓ ıÒڷη, ÂÈ‚Ú¿‰˘ÓÛË ÙÔ˘
Ú˘ıÌÔ‡ ۈ̷ÙÈ΋˜ ·Ó¿Ù˘Í˘ Î·È ‹È˜ ÎÂÊ·Ï·Ï-
Á›Â˜ Ô˘ ˘Ô¯ˆÚÔ‡Û·Ó ¯ˆÚ›˜ ·ÁˆÁ‹.
∫·Ù¿ ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË ‰È·ÈÛÙÒıËÎÂ
¯·ÌËÏfi ·Ó¿ÛÙËÌ· (<3Ë ∂£), ·ÓÛÂÏËÓÔÂȉ¤˜ ÚÔ-
ÛˆÂ›Ô Ì ÂͤڢıÚ˜ ·ÚÂȤ˜, ÎÂÓÙÚÈÎÔ‡ Ù‡Ô˘
·¯˘Û·ÚΛ·, ȉȷ›ÙÂÚ· ¤Î‰ËÏË ÛÙÔÓ ÎÔÚÌfi, Ì ¯·-
Ú·ÎÙËÚÈÛÙÈÎfi ‡‚Ô ÛÙÔÓ ·˘¯¤Ó·, Û¯ÂÙÈο ·‰‡Ó·Ù·
¿ÎÚ·, ¯ÓÔÒ‰Ë ÙÚ›¯ˆÛË ÚÔÛÒÔ˘, ¿ÎÚˆÓ, ÎÔÚÌÔ‡ Î·È Ú¿¯Ë˜. ∆Ô ‡„Ô˜ Ù˘ ·ÛıÂÓÔ‡˜ ‹Ù·Ó 137,3 cm
(<3Ë ∂£, -4,1 SDS) Ì ‡„Ô˜-ÛÙfi¯Ô 160,7 cm, ÙÔ ‚¿ÚÔ˜ 43,1 kg (3Ë ∂£, -1,3 SDS) Î·È Ô ‰Â›ÎÙ˘ Ì¿-
˙·˜ ÛÒÌ·ÙÔ˜ 22,9 kg/m2 (0,9 SDS). ∆· ÛËÌ›· ÂÓ‹-
‚ˆÛ˘ ηٿ Tanner ‹Ù·Ó: ÙÚ›¯ˆÛË ÂÊË‚·›Ô˘ ÛÙ¿-
‰ÈÔ πππ, ÙÚ›¯ˆÛË Ì·Û¯¿Ï˘ ÛÙ¿‰ÈÔ ππ Î·È ·Ó¿Ù˘ÍË
Ì·ÛÙÒÓ ÛÙ¿‰ÈÔ ππ ÚÔ˜ πππ. ∆· ¤Íˆ ÁÂÓÓËÙÈο fiÚÁ·-
Ó· ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο. ∏ ·ÛıÂÓ‹˜ ·ÚÔ˘Û›·˙ ڈ-
ÙÔ·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
24ÒÚÔ˘: 750 Ìg/24ˆÚÔ (Ê.Ù.:6,5-90 Ìg/24ˆÚÔ), ACTH (Úˆ›): 118 pg/ml (Ê.Ù.: 9-52), FSH: 0,53 mIU/ml, LH <0,1 mIU/ml, E2 <10 pg/ml, ÙÂÛÙÔÛÙÂÚfiÓË: 0,9 ng/ml (Ê.Ù.: 0,7-3,9), DHEA’S: 6,3 Ìg/ml (Ê.Ù.: 0,4-1,4), 17-OH-ÚÔÁÂÛÙÂÚfiÓË: 5,7 ng/ml (Ê.Ù.: 0,25-1,9), ¢4-·Ó‰ÚÔÛÙÂÓ‰ÈfiÓË: 5,8 ng/ml (Ê.Ù.: 0,55-2,5), TSH: 0,5 mIU/ml (Ê.Ù.: 0,4-5), T4: 5,8 Ìg/dl (Ê.Ù.: 5,6-13,9), FT4: 1,0 ng/dl (Ê.Ù.: 0,9-2), ∆3: 0,7 ng/dl (Ê.Ù.: 0,9-2) Î·È FT3: 1,5 pg/dl (Ê.Ù.: 2,4-5).
∏
ÚˆÈÓ‹ ÎÔÚÙÈ˙fiÏË Î·È Ë ACTH ·›Ì·ÙÔ˜ ÌÂÙ¿ ·fi ¯ÔÚ‹ÁËÛË ÌÂÁ¿ÏˆÓ ‰fiÛÂˆÓ ‰ÂÍ·ÌÂı·˙fiÓ˘ (DXM) (8 mg ËÌÂÚËÛ›ˆ˜: 2 mg DXM ·Ó¿ ÂÍ¿ˆÚÔ Â› ‰‡Ô Ë̤Ú˜) ηÙÂÛÙ¿ÏËÛ·Ó ·fi 64,3 Ìg/dl Î·È 118 pg/ml Û 31,82 Ìg/dl Î·È 45 pg/ml, ·ÓÙ›ÛÙÔȯ·.
OÈ ‰ÔÎÈ̷ۛ˜ ‰È¤ÁÂÚÛ˘ ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ (GH) ÌÂÙ¿ ·fi ¯ÔÚ‹ÁËÛË L-DOPA Î·È ÎÏÔÓȉ›Ó˘
¤‰ÂÈÍ·Ó ·Ó·Ú΋ ¤ÎÎÚÈÛË ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ (̤ÁÈÛÙË ·ÓÙ·fiÎÚÈÛË 0,57 Î·È 3,32 ÌIU/ml, ·ÓÙ›ÛÙÔȯ·). O ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù˘ ÎÔÚÙÈ˙fiÏ˘, ÙˆÓ TSH, T3, T4, FSH, LH, E2, Ù˘ ÙÂÛÙÔÛÙÂÚfiÓ˘, Ù˘ DHEA’S, Ù˘ 17-OH-ÚÔÁÂÛÙÂÚfiÓ˘ Î·È Ù˘ ¢4-·Ó‰ÚÔÛÙÂÓ‰ÈfiÓ˘ ¤ÁÈÓ Ì ÙË Ì¤ıÔ‰Ô Ù˘ ËÏÂÎÙÚÔ¯ËÌÂÈÔʈٷ‡ÁÂÈ·˜ (¯ÚËÛÈÌÔÔÈÒÓÙ·˜ Ù· kits Ù˘ ROCHE). ∏ ACTH Î·È Ë GH ÚÔÛ‰ÈÔÚ›ÛÙËÎ·Ó Ì ÙË Ì¤ıÔ‰Ô Ù˘ ¯ËÌÂÈÔʈٷ‡ÁÂÈ·˜ (kit: Nichols Advantaged) Î·È Ë ÂχıÂÚË ÎÔÚÙÈ˙fiÏË Ô‡ÚˆÓ 24ÒÚÔ˘ Ì ÙË Ì¤ıÔ‰Ô RIA (̤ıÔ‰Ô˜ Ú·‰ÈÔ·ÓÔÛÔÌÂÙÚ›·˜, kit: DSL).
∏ ÔÛÙÈ΋ ËÏÈΛ· Ù˘ ·ÛıÂÓÔ‡˜ ‹Ù·Ó 12,5 ÂÙÒÓ, ÂÓÒ Ë ¯ÚÔÓÔÏÔÁÈ΋ 15ó. ∆Ô U/S ÂÈÓÂÊÚȉ›ˆÓ ¤‰ÂÈÍ ·ÌÊÔÙÂÚfiÏ¢ÚË ‰ÈfiÁΈÛË ÙˆÓ ÂÈÓÂÊÚȉ›ˆÓ (ÙÔ ‰ÂÍ›: 2,4 x 1,1 cm Î·È ÙÔ ·ÚÈÛÙÂÚfi: 2,06 x 0,98 cm). ™ÙÔ U/S Ì‹ÙÚ·˜-ˆÔıËÎÒÓ, Ë Ì‹ÙÚ· ›¯Â ‰È·ÛÙ¿ÛÂȘ 4,37 x 1,18 cm, Ì ·Ó·ÏÔÁ›· ÛÒÌ·ÙÔ˜ Ì‹ÙÚ·˜-ÙÚ·¯‹ÏÔ˘ 2/1,ÂÓÒ ÔÈ ˆÔı‹Î˜ ‹Ù·Ó ÌÈÎÚ¤˜ (fiÁÎÔ˜ ‰ÂÍÈ¿˜ ˆÔı‹Î˘:0,83 cc Î·È ·ÚÈÛÙÂÚ‹˜: 1,11 cc). ™ÙËÓ MRI ˘fiÊ˘Û˘ ·ÂÈÎÔÓÈ˙fiÙ·Ó ÌÈÎÚÔ·‰¤ÓˆÌ· ‰È·Ì¤ÙÚÔ˘ <1 cm, ÛÙÔ ·ÚÈÛÙÂÚfi Ï¿ÁÈÔ ÙÔ˘ ·‰¤Ó· Ù˘ ˘fiÊ˘Û˘, Ì ·ÚÔ˘Û›· ·ÈÌÔÚÚ·ÁÈ΋˜ ÂÛÙ›·˜, ÂÓÒ Ô Ì›Û¯Ô˜ ÚÔ¤‚·ÏÏ ÚÔ˜ Ù· ‰ÂÍÈ¿. ∫·Ù¿ ÙËÓ ÔÊı·ÏÌÔÏÔÁÈ΋ ÂͤٷÛË, Ô ‚˘ıfi˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜. ™ÙÔ U/S ηډȿ˜ ‰È·ÈÛÙÒıËΠÔÚȷ΋ ˘ÂÚÙÚÔÊ›· ÙÔ˘ ÌÂÛÔÎÔÈÏÈ·ÎÔ‡ ‰È·ÊÚ¿ÁÌ·ÙÔ˜. ∏ ·ÛıÂÓ‹˜, ÏfiÁˆ Ù˘ ˘¤ÚÙ·Û˘, ¤Ï·‚ ·ÓÙÈ˘ÂÚÙ·ÛÈ΋ ·ÁˆÁ‹ Ì ‚-·Ó·ÛÙÔÏ›˜ (ÚÔÚ·ÓÔÏfiÏË, 20 mg ËÌÂÚËÛ›ˆ˜).
∆Ô ÌÈÎÚÔ·‰¤ÓˆÌ· ·Ê·ÈÚ¤ıËΠÂÈÙ˘¯Ò˜ Ì ‰È·ÛÊËÓÔÂȉ‹ ÚÔۤϷÛË. ª›· ‚‰ÔÌ¿‰· ÌÂÙÂÁ¯ÂÈÚËÙÈο, ÔÈ ÙÈ̤˜ Ù˘ ÚˆÈÓ‹˜ ÎÔÚÙÈ˙fiÏ˘ ÂÏ·ÙÙÒıËÎ·Ó ·fi 64,3 Ìg/dl Û 0,04 Ìg/dl Î·È Ù˘ ACTH ·fi 118 pg/ml Û 10 pg/ml, fiˆ˜ ›Û˘ Î·È ÔÈ ÙÈ̤˜ Ù˘ ÂχıÂÚ˘ ÎÔÚÙÈ˙fiÏ˘ Ô‡ÚˆÓ 24ÒÚÔ˘ ·fi 750 Ìg/24ˆÚÔ Û 5 Ìg/24ˆÚÔ. ∏ ·ÛıÂÓ‹˜ Ï·Ì‚¿ÓÂÈ ·ÁˆÁ‹ ˘ÔηٿÛÙ·Û˘ Ì ˘‰ÚÔÎÔÚÙÈ˙fiÓË. ªÂÙÂÁ¯ÂÈÚËÙÈο ‰ÂÓ ·ÚÔ˘Û›·Û ¿ÔÈÔ ‰È·‚‹ÙË. ¶·È‰È·ÙÚÈ΋ 2003;66:471-474Paediatriki 2003;66:471-474
˘fiÊ˘Û˘ (8). ™ÙÔ˘˜ ÂÓ‹ÏÈΘ, ÂÎÙfi˜ ·fi ÙË ‰È·-
ÛÊËÓÔÂȉ‹ ÚÔۤϷÛË, ÌÔÚ› Ó· ¯ÚËÛÈÌÔÔÈËı›
Î·È Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ (fiˆ˜ Ë ÌÂÙ˘Ú·fiÓË Î·È
Ë ÌÈÙÔÙ¿ÓË, Ô˘ ·Ó·ÛÙ¤ÏÏÔ˘Ó ÙËÓ ·Ú·ÁˆÁ‹ ÎÔÚÙÈ-
˙fiÏ˘ ·fi Ù· ÂÈÓÂÊÚ›‰È·). ™Ù· ·È‰È¿ ‰ÂÓ Û˘ÓÈ-
ÛÙ¿Ù·È ÏfiÁˆ ÙˆÓ ·ÚÂÓÂÚÁÂÈÒÓ (8).
∏ ‰È·ÛÊËÓÔÂȉ‹˜ ¯ÂÈÚÔ˘ÚÁÈ΋ ÚÔۤϷÛË
ÛÙËÓ ·ÛıÂÓ‹ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ¤‰ˆÛ ÈηÓÔ-
ÔÈËÙÈο ·ÔÙÂϤÛÌ·Ù·. ∆Ô ÔÚÌÔÓÔÏÔÁÈÎfi Ù˘ ÚÔ-
Ê›Ï ‚ÂÏÙÈÒıËÎÂ Î·È Â›Ó·È ˘fi ·ÁˆÁ‹ Ì ˘‰ÚÔÎÔÚÙÈ˙fiÓË. ¢Ò‰Âη Ì‹Ó˜ ÌÂÙ¿, Ë ·ÛıÂÓ‹˜ Â›Ó·È ˘ÁÈ‹˜ Î·È ‰ÂÓ ¤¯ÂÈ ·ÚÔ˘ÛÈ¿ÛÂÈ ÛËÌ›· ˘ÔÙÚÔ‹˜.
µÈ‚ÏÈÔÁÚ·Ê›·
1. Savage MO, Lienhardt A, Lebrethon MC, Johnston LB, Huebner A, Grossman AB et al. Cushing’s disease in childhood: presentation, investigation, treatment and longterm outcome. Horm Res 2001;55 (Suppl 1):S24-S30.
2. Devoe DJ, Miller WL, Conte FA, Kaplan SL, Grumbach MM, Rosenthal SM et al. Long-term outcome in children and adolescents after transsphenoidal surgery for Cushing’s disease. J Clin Endocrinol Metab 1997;82:3196-3202.
3. ∫·˚Ì¿Ú·-¶··ı·Ó·Û›Ô˘ ∞, ÷Ù˙Ë·ı·Ó·Û›Ô˘ Ã, §··ÙÛ¿Ó˘ ¶, ªÔ˘ÙÛÔ‡Ú˘ Ã, ¶··ıÂÔ‰ÒÚÔ˘ ∞, £ÂÔ‰ˆÚ›‰Ë˜ Ã. ™‡Ó‰ÚÔÌÔ Cushing ·fi ·‰¤ÓˆÌ· ÊÏÔÈÔ‡ ÙˆÓ ÂÈÓÂÊÚȉ›ˆÓ Û ÎÔÚ›ÙÛÈ ËÏÈΛ·˜ 12 ÂÙÒÓ. ¶·È‰È·ÙÚÈ΋ 1991;54:300-306. 4. ª›ÙÛË ª, £ÂÔ‰ˆÚ›‰Ë˜ Ã, ™˘ÚÈÔÔ‡ÏÔ˘ µ, ∫·ÙÂÚ¤ÏÔ˜ Ã, ª·ÙÛ·ÓÈÒÙ˘ ¡. ™‡Ó‰ÚÔÌÔ Cushing ·fi Ì·ÎÚÔ¯ÚfiÓÈ· ÙÔÈ΋ ¯Ú‹ÛË ÎÔÚÙÈ˙ÔÓÔ‡¯Ô˘ ·ÏÔÈÊ‹˜ Clobetasol propionate. ¢ÂÏÙ›Ô ∞’ ∫ÏÈÓÈ΋˜ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ 1982;29:135-145.
5. £ÂÔ‰ˆÚ›‰Ë˜ Ã, ªÚÈ·ÛÔ‡Ï˘ °, ∆ÛÈ‚ÈÙ·Ó›‰Ô˘ ∆, ªÔ˘Û¿ÙÔ˜ °, ∆˙ˆÚÙ˙¿ÙÔ˘ º, ∫·ÙÂÚ¤ÏÔ˜ Ã. ™‡Ó‰ÚÔÌÔ Cushing ·fi ·‰¤ÓˆÌ· ÙÔ˘ ÊÏÔÈÔ‡ ÙˆÓ ÂÈÓÂÊÚȉ›ˆÓ Û ÎÔÚ›ÙÛÈ ËÏÈΛ·˜
5ó ÌËÓÒÓ. ¶·È‰È·ÙÚÈ΋ 1983;46:57-62.
6. £ÂÔ‰ˆÚ›‰Ë˜ Ã, ªÔ˘ÚÏÔÁÈ¿ÓÓ˘ Ã, ∫·Ú¿ıÈÔ˜ £, µÏ¿¯Ô˘ ¶, ∫·ÙÙ¿Ì˘ Ã. ∞‰ÂÓÔηÚΛӈ̷ ÙÔ˘ ÊÏÔÈÔ‡ ÙˆÓ ÂÈÓÂÊÚȉ›ˆÓ. ¶·È‰È·ÙÚÈ΋ 1979;42:295-301.
7. McArthur RG, Cloutier MD, Hayles AB, Sprague RG. Cushing’s disease in children. Findings in 13 cases. Mayo Clin Proc 1972;47:318-326.
8. Magiakou MA, Mastorakos G, Oldfield EH, Gomez MT, Doppman JL, Cutler GB et al. Cushing’s syndrome in children and adolescents. Presentation, diagnosis, and therapy. N Engl J Med 1994;331:629-636.
9. Stewart PM. The adrenal cortex. In: Larsen PR, Kronenberg HM, Melmed S, Polonsky KS, editors. Williams Textbook of Endocrinology. 10th edition. Philadelphia: WB Saunders Company; 2003. p. 509.
10. Styne DM, Grumbach MM, Kaplan SL, Wilson CB, Conte FA. Treatment of Cushing’s disease in childhood and adolescence by transsphenoidal microadenomectomy. N Engl J Med 1984;310:889-893.
11. Magiakou MA, Mastorakos G, Gomez MT, Rose SR, Chrousos GP. Suppressed spontaneous and stimulated growth hormone secretion in patients with Cushing’s disease before and after surgical cure. J Clin Endocrinol Metab 1994;78:131-137.
12. Trainer PJ, Lawrie HS, Verhelst J, Howlett TA, Lowe DG, Grossman AB et al. Transsphenoidal resection in Cushing’s disease: undetectable serum cortisol as the definition of successful treatment. Clin Endocrinol 1993;38:73-78.
HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 11-04-2003
HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 17-11-2003
¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∂ϤÓË ¢. ∫ˆÛÙ·ÎÈÒÙË
¶˘ÚÁȈٛÛÛ˘ 25, ∆.∫. 121 36, ∞ı‹Ó· E-mail: lenakostakioti@hotmail.com
¡∂∞ ∞¶O ∆O ¢π∞¢π∫∆ÀO ¶·È‰È·ÙÚÈ΋ 2003;66:475-477Paediatriki 2003;66:475-477
¡∂∞
∏ ıÂڷ›· Ù˘ ÔÍ›·˜ ̤Û˘ ˆÙ›Ùȉ·˜ Û˘Ó‰˘·Ṳ̂ÓË Ì ·ÓÙÈÈÛÙ·ÌÈÓÈο ‹ Î·È ÎÔÚÙÈ˙fiÓË ‰ÂÓ
‚ÂÏÙÈÒÓÂÈ ÙÔ ÙÂÏÈÎfi ·ÔÙ¤ÏÂÛÌ·
∫ÔÚ›Ó· ¶ÚÔ‡ÓÙ˙Ô˘ - ∫·ÛÛÈÔ‡, ¶·È‰›·ÙÚÔ˜
™‡Ìʈӷ Ì ·˘Ù‹ ÙË ÌÂϤÙË, ÔÈ Chonmaitree Î·È Û˘Ó ·fi ÙÔ Galveston Ù˘ ÔÏÈÙ›·˜ ÙÔ˘
Texas (∏¶∞) ÂÚ‡ÓËÛ·Ó ÙËÓ ˘fiıÂÛË fiÙÈ ÚfiÛıÂÙË ıÂڷ›·, ÂÎÙfi˜ ÙˆÓ ·ÓÙÈ‚ÈÔÙÈÎÒÓ, ÌÂ
·ÓÙÈÈÛÙ·ÌÈÓÈο ‹ Î·È ÎÔÚÙÈ˙fiÓË ı· ÌÔÚÔ‡Û ӷ ÂÏ·ÙÙÒÛÂÈ ÙË ‚·Ú‡ÙËÙ· Ù˘ ÊÏÂÁÌÔÓ‹˜ ηÈ, ηٿ Û˘Ó¤ÂÈ·, Ó· ‚ÂÏÙÈÒÛÂÈ ÙËÓ ¿ÌÂÛË ‹ Ì·ÎÚÔÚfiıÂÛÌË ¤Î‚·ÛË Ù˘ Oªø. ∫·Ù¤ÓÂÈÌ·Ó Ù˘-
¯·›· Û ̛· ‰ÈÏ‹-Ù˘ÊÏ‹, Ì ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ, ÌÂϤÙË 179 ·È‰È¿ ËÏÈΛ·˜ 3 ÌËÓÒÓ ¤ˆ˜ 6 ÂÙÒÓ Û ÙÚÂȘ ÔÌ¿‰Â˜, ·ÊÔ‡ fiÏ· ¤Ï·‚·Ó Ì›· ¤ÓÂÛË ÎÂÊÙÚÈ·ÍfiÓ˘: Ë ÚÒÙË ÔÌ¿‰· ¤Ï·‚ ÚfiÛıÂ-
Ù· ¯ÏˆÚÔÊÂÓÈÚ·Ì›ÓË 0,35 mg/kg ÙËÓ Ë̤ڷ, Ë ‰Â‡ÙÂÚË Ú‰ÓÈ˙ÔÏfiÓË 2 mg/kg ÙËÓ Ë̤ڷ, Ë
ÙÚ›ÙË ÔÌ¿‰· ¤Ï·‚ ¯ÏˆÚÔÊÂÓÈÚ·Ì›ÓË Î·È Ú‰ÓÈ˙fiÓË ÛÙȘ ·ÓˆÙ¤Úˆ ‰fiÛÂȘ Î·È Ë Ù¤Ù·ÚÙË ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ ÁÈ· 5 Ë̤Ú˜. ¢ÂÓ ˘‹ÚÍ ‰È·ÊÔÚ¿ ÌÂٷ͇ ÙˆÓ ÙÚÈÒÓ ÔÌ¿‰ˆÓ ÛÙËÓ ÂÏ¿ÙÙˆÛË ÙˆÓ Û˘Ìو̿وÓ, Û‡Ìʈӷ Ì ÙË ‚·ıÌÔÏÔÁ›· ‚·Ú‡ÙËÙ·˜, ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂڷ›·˜ Î·È Î·Ù¿ ÙËÓ ÂͤٷÛË ÙËÓ 5Ë Î·È 14Ë Ë̤ڷ. ¢ÂÓ ˘‹ÚÍÂ, ›Û˘, ‰È·ÊÔÚ¿ ÛÙÔÓ ·ÚÈıÌfi ÙˆÓ ˘ÔÙÚÔÒÓ Î·È ÁÈ· 6 Ì‹Ó˜ ÌÂÙ¿.
ªË ·Ó·ÌÂÓfiÌÂÓË ‹Ù·Ó Ë ·Ú·Ù‹ÚËÛË fiÙÈ ÛÙ· ·È‰È¿ Ô˘ ¯ÔÚËÁ‹ıËΠ·ÓÙÈÈÛÙ·ÌÈÓÈÎfi, ·Ú·Ù¿ıËÎÂ Ë Û˘ÏÏÔÁ‹ ˘ÁÚÔ‡ ÛÙÔ Ì¤ÛÔ Ô˘˜ (̤ÛË ‰È¿ÚÎÂÈ· 73 Ë̤Ú˜ Û ۯ¤ÛË Ì ÙȘ ¿ÏϘ
3 ÔÌ¿‰Â˜ fiÔ˘ Ë Ì¤ÛË ‰È¿ÚÎÂÈ· ‹Ù·Ó 23-36 Ë̤Ú˜). ¢ÂÓ Â›Ó·È ÍÂοı·ÚÔ˜ Ô Ì˯·ÓÈÛÌfi˜ Ì ‚¿ÛË ÙÔÓ ÔÔ›Ô Ù· ·È‰È¿ Ô˘ ¤Ï·‚·Ó ·ÓÙÈÈÛÙ·ÌÈÓÈÎfi ›¯·Ó ·Ú·ÌÔÓ‹ ÙÔ˘ ˘ÁÚÔ‡ ÛÙÔ Ì¤ÛÔ Ô˘˜ ÁÈ· ÌÂÁ·Ï‡ÙÂÚÔ ‰È¿ÛÙËÌ·. OÈ Û˘ÁÁÚ·Ê›˜ Èı·ÓÔÏÔÁÔ‡Ó fiÙÈ Ù· ·ÓÙÈÈÛÙ·ÌÈÓÈο ·˘Í¿ÓÔ˘Ó
ÙË ÁÏÔÈfiÙËÙ· ÙÔ˘ ˘ÁÚÔ‡ Î·È ¤ÙÛÈ ·ÚÂÌ‚·›ÓÔ˘Ó ÛÙËÓ ·ÔÚÚfiÊËÛË Î·È ÙËÓ ·ÚÔ¯¤ÙÂ˘Û‹ ÙÔ˘. ∫·Ù·Ï‹ÁÔ˘Ó, ÏÔÈfiÓ, fiÙÈ Ë ¯Ú‹ÛË ·ÓÙÈÈÛÙ·ÌÈÓÈÎÒÓ ÛÙËÓ Oªø Ú¤ÂÈ Ó· ·ÔʇÁÂÙ·È. ¢ÂÓ Â›Ó·È Û·Ê¤˜, ·fi ·˘Ù‹ ÙË ÌÂϤÙË, Â¿Ó Ë ¯Ú‹ÛË ÎÔÚÙÈÎÔÂȉÒÓ ˆÊÂÏ› ‹ ‚Ï¿ÙÂÈ.
J Pediatr 2003;143:377-385
∏ ÛȉËÚÔÂÓ›· ÌÔÚ› Ó· ·ÔÙÂÏ›
‚‰Ô ÛÙ· ·È‰È¿
∫ÔÚ›Ó· ¶ÚÔ‡ÓÙ˙Ô˘ - ∫·ÛÛÈÔ‡, ¶·È‰›·ÙÚÔ˜
ÁÈ· ÙË ‰ËÏËÙËÚ›·ÛË·fi ÌfiÏ˘-
∞˘Ùfi Â›Ó·È ÙÔ Û˘Ì¤Ú·ÛÌ· Ì›·˜ ÌÂϤÙ˘ ÙˆÓ Choi J Î·È Kim S ·fi ÙË ¡fiÙÈ· ∫ÔÚ¤·. ∏ ÛȉËÚÔÂÓ›· ηÙËÁÔÚÈÔÔÈÂ›Ù·È Û 3 ÛÙ¿‰È·: ÛÙ¿‰ÈÔ π (ÂÍ¿ÓÙÏËÛË ÙˆÓ ·ÔıÂÌ¿ÙˆÓ Ûȉ‹ÚÔ˘) Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÙËÓ ·Ô˘Û›· ·Ó·ÈÌ›·˜, Ê˘ÛÈÔÏÔÁÈο ›‰· Ûȉ‹ÚÔ˘ ÛÙÔ ·›Ì· (>50 mcg/dL) Î·È ÂÏ·Ùو̤ÓË ÊÂÚÚÈÙ›ÓË (<12 mcg/L), ÛÙ¿‰ÈÔ ππ (Ê¿ÛË ÛȉËÚÔÂÓÈ΋˜ ÂÚ˘ıÚÔÔ›ËÛ˘) Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ¯·ÌËÏ‹ ÊÂÚÚÈÙ›ÓË ÔÚÔ‡ <12 mcg/L Î·È Û›‰ËÚÔ ÔÚÔ‡ <50 mcg/dL ¯ˆÚ›˜ ÚÔÊ·Ó‹ ·Ó·ÈÌ›· Î·È ÛÙ¿‰ÈÔ πππ (ÛȉËÚÔÂÓÈ΋ ·Ó·ÈÌ›·) Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ¯·ÌËÏfi Û›‰ËÚÔ ÔÚÔ‡, ¯·ÌËÏ‹ ÊÂÚÚÈÙ›ÓË ÔÚÔ‡ Î·È ·ÈÌÔÛÊ·ÈÚ›ÓË <12 g/dL.
ÛȉËÚÔıÂڷ›·. ¶ÚÔÛ‰ÈfiÚÈÛ·Ó ÙËÓ ·ÈÌÔÛÊ·ÈÚ›ÓË, ÙÔÓ Û›‰ËÚÔ ÔÚÔ‡, ÙË ÊÂÚÚÈÙ›ÓË ÔÚÔ‡ Î·È Ù· ›‰· ÌÔχ‚‰Ô˘ ÛÙÔ ·›Ì· Û 279 ·È‰È¿ (ËÏÈΛ·˜ 10-15 ÂÙÒÓ) Ô˘ ‰È¤ÌÂÓ·Ó Û ÂÚÈ-
‚¿ÏÏÔÓ ÂÚÁÔÛÙ·Ûȷ΋˜ ÌfiÏ˘ÓÛ˘. ∆· ·È‰È¿ ¯ˆÚ›ÛÙËÎ·Ó Û 4 ÔÌ¿‰Â˜ (ÛÙ¿‰È· π, ππ, πππ Î·È ˘ÁÈ›˜ Ì¿ÚÙ˘Ú˜). ŸÏ· Ù· ·È‰È¿ Ì ÛȉËÚÔÂÓ›· ›¯·Ó ÂÏ·Ùو̤ÓË ÊÂÚÚÈÙ›ÓË ÔÚÔ‡, ·ÏÏ¿ ÌfiÓÔ Ù· ·È‰È¿ ÛÙ· ÛÙ¿‰È· ππ Î·È πππ ‚Ú¤ıËÎ·Ó Ó· ¤¯Ô˘Ó ·˘ÍË̤ӷ ›‰· ÌÔχ‚‰Ô˘. OÈ Û˘ÁÁÚ·Ê›˜ ηٷϋÁÔ˘Ó fiÙÈ Ë ÂÏ·Ùو̤ÓË ÊÂÚÚÈÙ›ÓË ÔÚÔ‡ ‰ÂÓ ÂËÚ¿˙ÂÈ Ù· ›‰· ÌÔχ‚‰Ô˘, ÂÓÒ Ù· ¯·ÌËÏ¿ ›‰· Ûȉ‹ÚÔ˘ ÛÙÔÓ ÔÚfi (ÛÙ¿‰È· ππ Î·È πππ) ·˘Í¿ÓÔ˘Ó Ù· ›‰· ÌÔχ‚‰Ô˘ ÛÙÔ
‚Ú¤ıËÎ·Ó ·˘ÍË̤ӷ 1,6 ÊÔÚ¤˜ Û ۇÁÎÚÈÛË Ì ÙÔ˘˜ Ì¿ÚÙ˘Ú˜. ∆ÚÈ¿ÓÙ· Ù¤ÛÛÂÚ· ·È‰È¿ Ì ·Ó·ÈÌ›· ıÂڷ‡ÙËÎ·Ó Ì Û··ÛÌ· ıÂÈÈÎÔ‡ Ûȉ‹ÚÔ˘ (3-6 mg ÛÙÔȯÂÈ·ÎÔ‡ Ûȉ‹ÚÔ˘ ·Ó¿ kg µ™ ÙËÓ Ë̤ڷ) Î·È ÌÂÙ¿ ¤Ó· Ì‹Ó· Ù· ›‰· ÌÔχ‚‰Ô˘ ›¯·Ó ÌÂȈı›
(·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
Arch Dis Child 2003;88:791-792
§·ÌÚfi ª¤ÏÏÔÓ!! http://www.brightfutures.org/
¶·ÓÂÈÛÙ‹ÌÈÔ Ù˘ Georgetown Î·È ÙÔ ∂ıÓÈÎfi ∫¤ÓÙÚÔ ∂η›‰Â˘Û˘ Û¯ÂÙÈο Ì ÙËÓ ÀÁ›· ªËÙ¤Ú·˜ Î·È ¶·È‰ÈÔ‡ ÙˆÓ ∏.¶.∞. ¤¯Ô˘Ó ۯ‰ȿÛÂÈ ¤Ó·Ó ÎÔÌ„fiÙ·ÙÔ ‰È·‰ÈÎÙ˘·Îfi ÙfiÔ Ô˘ ÂÚȤ¯ÂÈ Ï‹ıÔ˜ Ú·ÎÙÈÎÒÓ Ô‰ËÁÈÒÓ. ¶ÔÏÏ¿ ·fi Ù· ÂÁ¯ÂÈÚ›‰È· Ô˘ ÂΉ›‰ÂÈ Ë ÔÚÁ¿ÓˆÛË ·˘Ù‹ ·Ú¤¯ÔÓÙ·È ‰ˆÚ¿Ó, Ì ÙË ÌÔÚÊ‹ ·Ú¯Â›ˆÓ .pdf. ∏ ÂÈÎÔÓÔÁÚ¿ÊËÛË Â›Ó·È Î·ı·Ú‹ Î·È ¿„ÔÁË, Ù·ÈÚÈ¿˙ÔÓÙ·˜ ·fiÏ˘Ù· Ì ÙÔ ÏÈÙfi ΛÌÂÓÔ, ÙÔ ÔÔ›Ô Â›Ó·È ÚÔÛ·ÚÌÔṲ̂ÓÔ ÛÙȘ ·Ó¿ÁΘ ÙÔ˘ ÔÏ˘¿Û¯ÔÏÔ˘ ·ÁÁÂÏÌ·Ù›· ˘Á›·˜, ηٷʤÚÓÔÓÙ·˜ Ó· ·ÚÔ˘ÛÈ¿˙ÂÈ ÂÚ›ÏÔη ı¤Ì·Ù· Ì ÙÚfiÔ Î·Ù·ÓÔËÙfi, ¯ˆÚ›˜ Ó· ¯¿ÓÂÈ ÙËÓ Ô˘Û›· ÙÔ˘˜. ™˘ÛÙ‹ÓÂÙ·È ·ÓÂÈʇϷÎÙ·, ·ÊÔ‡ ¿ÏψÛÙ ¤¯ÂÈ Î·Ù·ÎÙ‹ÛÂÈ ÔÏÏ¿ Û¯ÂÙÈο ‚Ú·‚›·.
¶·È‰È·ÙÚÈ΋ 2003;66:475-477Paediatriki 2003;66:475-477 ¡∂∞ ∞¶O ∆O ¢π∞¢π∫∆ÀO
∞Ó¿Ï˘ÛË ‚È‚ÏÈÔÁÚ·Ê›·˜: ÚÈÓ ·fi ÂÛ¿˜... ÁÈ· ÂÛ¿˜! http://pediatrics.jwatch.org/
¢Â‰Ô̤ÓÔ˘ fiÙÈ Ë ÔÛfiÙËÙ· Ù˘ ÎÏÈÓÈ΋˜ ¤Ú¢ӷ˜ ÛÙȘ ̤Ú˜ Ì·˜ fiÏÔ Î·È ·˘Í¿ÓÂÈ, ¤Ó·˜ ÛËÌ·ÓÙÈÎfi˜ ·ÚÈıÌfi˜ ÔÚÁ·ÓÒÛÂˆÓ ·Ó·Ï·Ì‚¿ÓÂÈ ÙËÓ ·Ô‰ÂÏÙ›ˆÛË ÙˆÓ Û¯ÂÙÈÎÒÓ ·È‰È·ÙÚÈÎÒÓ ÂÚÈÔ‰ÈÎÒÓ, ÙË Û‡ÓÔ„Ë Î·È ÙÔÓ Û¯ÔÏÈ·ÛÌfi ÙÔ˘˜. OÈ ÚˆÙÔ‚Ô˘Ï›Â˜ ·˘Ù¤˜ ‰ÂÓ Â›Ó·È ¿ÓÙ· ÂÈÙ˘-
¯Ë̤Ó˜, ·ÊÔ‡ Ú¤ÂÈ Ó· ÈÛÔÚÚÔ‹ÛÔ˘Ó ÌÂٷ͇ Ù˘ ÈÛÔ¤‰ˆÛ˘ ÙÔ˘ ‚¿ıÔ˘˜ Î·È Ù˘ ÎÔ‡Ú·Û˘ Ù˘ ÏÂÙÔ̤ÚÂÈ·˜. ŸÙ·Ó, fï˜, ÙÔ ÂÁ¯Â›ÚËÌ· ÚÔ¤Ú¯ÂÙ·È ·fi ÙÔ˘˜ ÂΉfiÙ˜ ÙÔ˘ New England Journal of Medicine, ÔÈ ÂÁÁ˘‹ÛÂȘ Â›Ó·È ˘„ËϤ˜. ∆Ô Journal Watch Pediatrics and Adolescent Medicine, ÂÌÊ·Ó›˙ÂÙ·È ‰‡Ô ÊÔÚ¤˜ ÙËÓ Â‚‰ÔÌ¿‰· ÛÙÔ ‰›ÎÙ˘Ô, ÂÓÒ Ë ¤ÓÙ˘Ë ¤Î‰ÔÛË Î˘ÎÏÔÊÔÚ› ÌËÓÈ·›·. ∞Ó¿ÌÂÛ· ÛÙ· 28 ÂȉÈο ÂÚÈÔ‰Èο Ô˘ ·Ô‰ÂÏÙÈÒÓÂÈ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È Ù· ÛËÌ·ÓÙÈÎfiÙÂÚ· Ù˘ ÂȉÈÎfiÙËÙ·˜, ·Ï-
Ï¿ Î·È ÁÂÓÈο ÂÚÈÔ‰Èο ˘„ËÏÔ‡ impact, fiˆ˜ ÙÔ Lancet, ÙÔ NEJM Î.¿. ∏ ¯Ú‹ÛË fiÏˆÓ ÙˆÓ ‰˘-
Ó·ÙÔÙ‹ÙˆÓ ÙÔ˘ ‰ÈÎÙ˘·ÎÔ‡ ÙfiÔ˘ ··ÈÙ› ÂÙ‹ÛÈ· Û˘Ó‰ÚÔÌ‹, Ë ÔÔ›· ÁÈ· ÙËÓ ∂ÏÏ¿‰· ·Ó¤Ú¯ÂÙ·È
Û 115 £ ÁÈ· ÙÔ˘˜ ÂȉÈÎÂ˘Ì¤ÓÔ˘˜ Î·È Û 66 £ ÁÈ· ÙÔ˘˜ ÂȉÈ΢fiÌÂÓÔ˘˜.
∏ ¢È‡ı˘ÓÛË Î·È Ù· ª¤ÏË Ù˘ ∂ÈÛÙËÌÔÓÈ΋˜
∂ÈÙÚÔ‹˜ ¢¯·ÚÈÛÙÔ‡Ó ıÂÚÌ¿ ÙÔ˘˜ ÎÚÈÙ¤˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ “¶·È‰È·ÙÚÈ΋”Ô˘
ÙËÓ Â›Ú· Î·È ÙÔÓ ¯ÚfiÓÔ ÙÔ˘˜ ÁÈ· Ó· ÂÍ·ÛÊ·Ï›ÛÔ˘ÌÂ Û˘ÛÙËÌ·ÙÈΤ˜, ÙÂÎÌËÚȈ̤Ó˜ Î·È ·ÓÙÈÎÂÈÌÂÓÈΤ˜ ·ÍÈÔÏÔÁ‹ÛÂȘ ÁÈ· ÙȘ ÂÈÛÙËÌÔÓÈΤ˜ ÂÚÁ·Û›Â˜ Ô˘ ‰ËÌÔÛȇıËÎ·Ó Î·Ù¿ ÙÔ ¤ÙÔ˜ 2003.
∫ÚÈÙ¤˜ ÙˆÓ ÂÚÁ·ÛÈÒÓ Ô˘ ‰ËÌÔÛȇıËÎ·Ó ÛÙÔÓ ÙfiÌÔ 66 ÙÔ˘ ¤ÙÔ˘˜ 2003
∞˚‚¿˙˘ µ›ÎÙˆÚ·˜
∞Ó·ÁÓˆÛÙ¿Î˘ ¢ËÌ‹ÙÚÈÔ˜
∞Ó·ÁÓˆÛÙ¿Î˘ πˆÛ‹Ê
∞Ó·ÛÙ·Û¤·-µÏ¿¯Ô˘ ∫·ÏÏÈfiË
∞Ó‰Ú¤Ô˘ ∞ϤͷӉÚÔ˜
∞Ó‰ÚÔÓ›ÎÔ˘ ™Ù˘ÏÈ·Ó‹
∞Ó‰ÚÔ˘Ï·Î¿Î˘ ª·ÓÒÏ˘
∞Ó‰ÚÔ˘Ï·Î¿Î˘ º›ÏÈÔ˜
∞Ó‰ÚÔ˘Ï¿Î˘ πˆ¿ÓÓ˘
∞ÓıÚ·ÎfiÔ˘ÏÔ˜ ªÈ¯¿Ï˘
∞ÓÙˆÓÈ¿‰Ë˜ ™Ù˘ÏÈ·Ófi˜
∞ÚÒÓË-µÔ˘ÚÓ¿ ™ÔÊ›·
µ·Ú‚·Ú‹ÁÔ˘-ºÚ›Ì· ∞Ó·ÛÙ·Û›·
µ·ÚÏ¿Ì˘ °ÂÒÚÁÈÔ˜
°·ÚÔ‡ÊË-∫Ô‡ÙÛ· ∞Ó·ÛÙ·Û›·
°ÂˆÚÁ¿ÎË-∞ÁÁÂÏ¿ÎË ∂ϤÓË
°ÈÔ˘ÚÔ‡ÎÔ˜ ™ˆÙ‹Ú˘
°ÎÈÒÓ˘ ¢ËÌ‹ÙÚÈÔ˜
°Ú·Ê¿ÎÔ˜ ™Ù¤ÏÈÔ˜
¢·‚¿Î˘ ªÈ¯·‹Ï
¢¿ÎÔ˘-µÔ˘ÙÂÙ¿ÎË ∞ÈηÙÂÚ›ÓË
¢È·Ì·ÓÙ‹ ∂ÏÈÛ¿‚ÂÙ
∑ÂÚ‚fi˜ °ÂÚ¿ÛÈÌÔ˜
∏Ï›· ª·Ú›·
£ÂÔ‰ˆÚ›‰Ë˜ ÷ڿϷÌÔ˜
£ÂÔ‰ÒÚÔ˘ ™Ù·Ì¿Ù˘
πÔÚ‰·Ó›‰Ô˘ ∞ÓÙÈÁfiÓË
∫·ÏÔÁÈ¿ÓÓ˘ ¡ÈÎfiÏ·Ô˜
∫·Ó·ÎÔ‡‰Ë-∆۷ηϛ‰Ô˘ ºÏˆÚÂÓÙ›·
∫·Ó¿ÚÈÔ˘ ª·Ú›·
∫·Ú·Ó›Î·˜ ∏Ï›·˜
∫·Ú‹˜ ÃÚ›ÛÙÔ˜
∫·ÙÚÈÔ‡-¡ÈÎÔϷοÎË ¢ˆÚÔı¤·
∫·ÙÛ·Ú‰‹˜ ÷ڿϷÌÔ˜
∫·ÙÛ·ÚÔ‡-¶ÂÎÙ·Û›‰Ë ∂˘ÛÙ·ı›·
∫·ÙÙ¿Ì˘ ∞ÓÙÒÓÈÔ˜
∫·Ê¿ÙÔ˜ ∞ÓÙÒÓÈÔ˜
∫·ÊÂÙ˙‹˜ ¢ËÌ‹ÙÚÈÔ˜
∫›ÙÛÈÔ˘-∆˙¤ÏË ™ÔÊ›·
∫Ô‚¿Ó˘ ∞ı·Ó¿ÛÈÔ˜
∫ÔÏÏÈfi˜ ∫ˆÓÛÙ·ÓÙ›ÓÔ˜
∫Ô˘Ú¿Î˘ °ÂÒÚÁÈÔ˜
∫Ô˘ÙÛÔ˘ÏȤÚ˘ ∏Ï›·˜
•¿ÓıÔ˘ ª·ÚȤÙÙ· •˘ÔÏÈÙ¿-∑·¯·ÚÈ¿‰Ë
OÈÎÔÓÔÌ›‰Ë˜ πˆ¿ÓÓ˘
¶¿ÁηÏÔ˜ ∫ˆÓÛÙ·ÓÙ›ÓÔ˜
¶·Ó·ÁȈÙfiÔ˘ÏÔ˜ ∆¿Î˘
¶·Ó·ÁȈÙÔÔ‡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›·
™ÎÂÓÙ¤Ú˘ ¡ÈÎfiÏ·Ô˜
™ÎÈ·‰¿˜ ∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ™ÌÒÎÔ˘-µÂÚÈÁ¿ÎË ¢fiÍ· ™ËÏÈÒÙË-°Îڤη µ·ÛÈÏÈ΋ ™Ù·ÌÔ˘Ï·Î¿ÙÔ˘ ∞ÏÂÍ¿Ó‰Ú· ™ÙÈ‚·ÎÙ¿ÎË-¶··‰¿ÎË ∂ÚÁ¿ÓË ™˘Ú›ÁÔ˘-¶··‚·ÛÈÏ›Ԣ ∞ÓÙÈÁfiÓË ™˘ÚÔÁÈ·ÓÓfiÔ˘ÏÔ˜ °ÂÒÚÁÈÔ˜ ∆˙Ô˘Ì¿Î·-ª·ÎԇϷ ÃÚ‡Û· ∆Û·ÁηÚÔÔ‡ÏÔ˘-™Ù›ÁÁ· ∏Ú·ÎÏ›· ∆۷ӿη˜ πˆ¿ÓÓ˘ ∆ÛÈ‚ÈÙ·Ó›‰Ô˘-∫¿ÎÔ˘ÚÔ˘ ∆¿ÏÈ· ∆ÛÈÏÈÁÈ¿ÓÓ˘ £ÂÔÊ¿Ó˘ ∆Ûfiη-°ÂÓÓ·Ù¿ ∂ϤÓË ∆ÛÔÏÈ¿-¶·Û·Ú¿ÎË ª·Ú›˙· ∆ÛÔ˘Ì¿Î·˜ ∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ºÚÂÙ˙¿ÁÈ·˜ ∞Ó‰Ú¤·˜ ºÚ˘Û›Ú·-∫·ÓÈÔ‡Ú· ∂ϤÓË ºˆÙfiÔ˘ÏÔ˜ ™˘Ú›‰ˆÓ·˜ ºˆÙÔÔ‡ÏÔ˘ ª·Ú›· ÷Ù˙‹˜ ∞Ó·ÛÙ¿ÛÈÔ˜ ÃÈÒÙ˘ ¢ËÌ‹ÙÚÈÔ˜
ºˆÙÂÈÓ‹
∂ÌÌ·ÓÔ˘‹Ï
Wevers R.A.133
∞
∞ÁÁÂÏ¿ÎÔ˘ µ.392
∞ÁÁÂÏfiÔ˘ÏÔ˜ ¢.316
∞˙·ÚÈ¿‰Ë˜ ¶.381
∞ı·Ó·ÛÈ¿‰Ô˘ º.195,284
∞ı·Ó·Û›Ô˘-ªÂÙ·Í¿ ª.52,55,128
∞˚‚¿˙˘ µ.55,211
∞ÏÂÍ¿Ó‰ÚÔ˘ ∂.188
∞ϤÍ ¡.ª.20
∞ÏÂ͛Ԣ ¡.278
∞ÏÂÍfiÔ˘ÏÔ˜ ∂.208
∞̤ÓÙ· ™.215
∞Ó·ÛÙ·ÛÈ¿‰Ë˜ °.316
∞Ó·ÛÙ·ÛÈ¿‰Ô˘-∫·Ú·ÁˆÚÁÔÔ‡ÏÔ˘ ∂.304
∞Ó·ÛÙ·Û›Ô˘ ∞.364
∞Ó‰Ú¤Ô˘ ∞.304
∞ÓÙˆÓÔÁÂÒÚÁÔ˜ °.155
∞ÔÛÙfiÏÔ˘ ∂.405
∞ÚÁ˘ÚÔ‡ ™.145
ÕÚÛÔ˜ °.296
∞ÚÒÓË ™.387
∞ÙÙÈÏ¿ÎÔ˜ ∞.467
∞˘ÁÔ˘ÛÙ›‰Ô˘-™·‚‚ÔÔ‡ÏÔ˘ ¶.118
µ
µ·ÁÈ¿ÎÔ˘ ∂.∞.202,456
µ·ÚÏ¿Ì˘ °.128
µ·ÛÈÏÂÈ¿‰Ô˘ ∂.145
µ·ÛÈÏfiÔ˘ÏÔ˜ ∞.97
µ·ÛÈÏÔÔ‡ÏÔ˘ ∞.418
µÔÚÁÈ¿ ¶.133
µÔ‡‰Ú˘ ∫.∞.118,202,387,456
°
°·‚Ú›ÏË ™.344
°·Ï·Ó¿Î˘ ∂.452
°È·ÓÓ·ÎÔÔ‡ÏÔ˘ Ã.58,255
°È·ÓÓÔ‡ÏÈ· ∞.185
°ÈÔ˘ÚÔ‡ÎÔ˜ ™.215
°ÎÈÒÓ˘ ¢.37
°ÎÔ˘ÁÎÔ‡‰Ë ∂.145
°Ô˘‰ÂÛ›‰Ô˘ ª.∑.140
°Ô‡Ó·Ú˘ ∞.278
°Ô˘ÚÁÔ˘ÏÈ¿Ó˘ ∫.208
¢
¢·›ÎÔ˜ °.188
¢ÂÌÂÚÙ˙›‰Ô˘ µ.296
¢ÂÛ‡Ú˘ ¡.364
¢‹ÌÔ˘ ™.202
¢ÚÔÁοÚË ∂.118
µ.29,148
∞.133
•.364
¢.211
ª.239 £
Ã.471
ª.188
°.381
∞.185
π.278,344
Ã.¶.311
µ.195
¡.247
¶.461
∫·Ó¿ÚÈÔ˘ ª.47
∫·ÓÈÙÛ¿Î˘ ∞.133 ∫·Ú·ÁÈ¿ÓÓË ¶.29
∫·Ú·Ì¤Ú˘ ™.128
∫·Ú·ÌÂÚfiÔ˘ÏÔ˜ ¢.232
∫·Ú·Ó¿ÛÈÔ˘ ∫.452
∫·Ú·Ó›Î·˜ ∏.47
∫·Ú·ÓÙ·Ó¿ ∂.185
∫·Ú·Ù˙¿ ∞.∞.311
∫·Ú·Ù˙¿ ∂.296
∫·Ú·Ù˙¿˜ ¡.296
∫·Ú›Î·˜ °.∞.113
∫·Úη‚›ÙÛ·˜ ¡.264
∫·Ù˙ËÏ¿Î˘ ¡.133
∫·ÙÚÈÔ‡ ¢.195,284
∫·ÙÛ·ÚÔ‡ ∂.456 ∫·ÙÛÈ·Ú‰¿Ó˘ ∫.364 ∫·Ê¿ÙÔ˜
∫˘Úȷο΢ ª.264
∫˘ÚȷΛ‰Ë˜ °.148
∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜ ∞.42
∫ˆÛÙ·‰‹Ì· ∂.208
∫ˆÛÙ·ÎÈÒÙË ∂.471
∫ÒÛÙ·ÏÔ˜ Ã.278,344
∫ˆÛÙ·ÓÙ¤ÏÏÔ˘ ∂.278
∫ˆÛÙ·Ú›‰Ô˘ ™.185
§
§··ÙÛ¿Ó˘ ¶.¢.82
§·Ú›Ô˘ ª.™.89
§¿ÛηÚË Ã.316
§ÂÈ‚·‰›ÙË ∂.145
§ÈıÔÍÔÔ‡ÏÔ˘ ª.55
§ÈÓ·Ú‰¿Î˘ ª.264,436
§ÈÔÓ‹˜ Ã.133 ª
ª·Î·ÚÒÓ·˜ ¡.452
ª·ÌÌ¿˜ π.264
ª·ÌÔ˘Ï¿Î˘ ¢.334
ª·ÓÈ·‰¿ÎË ∏.133
ª¿ÓÔ˜ ¡.304
ª·ÓÔ˘Ú¿ ∞.58
ª·ÓÙ¿ ¶.215
ª·ÓÙ·Áfi˜ ™.¶.311
ª·ÚÁȈڋ˜ ∞.264
ª¿ÚηÙ˙Ë ∂.436
ª¿ÚÎÔ˘ °.¡.311
ª·ÚfiÔ˘ÏÔ˜ °.118,467
ª¿ÛÙÔÚ· ™.118
ª·ÛÙÚÔÁÈ¿ÓÓË ™.456
ª·˘ÚfiΈÛÙ· ª.12,223
ªÂÁÚ¤Ì˘ ™.352
ªÂٷ͈ÙÔ‡ ∞.215
ªËÙÛÈ¿ÎÔ˜ °.148
ªÈÎÚ¿ÎË µ.208
ªÈ¯·ËÏ›‰Ô˘ ∂.133
ªÈ¯ÂϷοÎË ∂.113,467
ªÔÛ¯·Ó‰Ú¤· π.264
ªÔÛ¯fi‚Ë ª.47
ªÔ‡ÛÎÔ˘ ™.211
ªÔ˘ÛÙ¿ÎË ª.176
ª·ÛÈ¿ÎÔ˜ Ã.304
ª¿ÛÙ· ∂.381
ª¤ÓÔ˜ ∞.284
ªÂÚ‚·Ó¿ÎË º.436
ªÂÚÙÛÈ¿˜ °.264
ªfiÓÔ˘ ¶.37
¡
¡ÈÎËÙ¿Î˘ ¶.133
¡ÈÎÔÏ¿Ô˘ ™.145
π.296
OÈÎÔÓÔÌ›‰Ô˘ O.344 OÈÎÔÓfiÌÔ˘ ª.52
¶
¶¿ÁηÏË ∞.188
¶·Ó·ÁȈٷÎfiÔ˘ÏÔ˜ °.316
¶·Ó·ÁÈÒÙÔ˘ π.¶.65
¶·ÓÙÂÏÈ¿‰Ë˜ Ã.296
¶··‚·ÛÈÏ›Ԣ ∂.247
¶··ÁˆÚÁ›Ô˘ £.195,284
¶··‰¿ÙÔ˜ π.37,387
¶··‰ËÌËÙÚ›Ô˘ ª.¡.2
¶··‰fiÔ˘ÏÔ˜ °.381 ¶··‰fiÔ˘ÏÔ˜ ¡.°.418
º.20 ¶··‰ÔÔ‡ÏÔ˘ ∞.§.140
∂.133,334
∑.104
∫.128
¶·¿˙ÔÁÏÔ˘ ∫.387
¶··ı·Ó·Û›Ô˘ ∞.471
¶··ıˆÌ¿ ∂.344
¶··Ó‰Ú¤Ô˘ ∂.145
¶·Ú·Ûο΢ ∂.452
¶·Ú‰·Ïfi˜ °.211
¶·ÛÈ¿˜ π.104
¶·Û·Ï¿ÎË ¶.133
¶·ÙÂÚfiÔ˘ÏÔ˜ ∫.448
¶·˘ÏÔÔ‡ÏÔ˘ π.188
¶·‡ÏÔ˘ µ.¡.311
¶·Ê›Ù˘ Ã.381
¶ÂÙÚ›‰Ô˘ ∂.20,188
¶ÂÙÚÔÔ‡ÏÔ˘ Ã.344
¶¤ÙÚÔ˘ µ.471
¶Ï·ÎԇϷ µ.316
¶ÔÏ˘¯ÚÔÓ¿ÎË ª.392
¶ÔÏ˘¯ÚÔÓÔÔ‡ÏÔ˘-∞Ó‰ÚÔ˘Ï·Î¿ÎË ™.65
¶ÚÔ‡ÓÙ˙Ô˘-∫·ÛÛÈÔ‡ ∫.316
¶ÚˆÙ·ÁfiÚ·-§È·ÓÔ‡ ¡.167
ƒ
ƒ·ÊÙÔÔ‡ÏÔ˘ ∞.47
™
™·ÍÒÓË-¶··ÁˆÚÁ›Ô˘ º.418
™·Ú·Ê›‰Ë˜ ∫.29,148 ™·ÚÚ‹ ∫.436
™Â‚·ÛÙÈ¿‰Ô˘ ™.278
™ÂÚ‚ÈÙ˙fiÁÏÔ˘ ª.202
™ËÊ¿Î˘ ™.334
2003;66:479-481Paediatriki 2003;66:479-481
™È·ÌÔÔ‡ÏÔ˘-ª·˘Ú›‰Ô˘ ∞.104
™È‰ÂÚ‹ °.97,387
™ÈÒÌÔ˘ ∞.104
™Î·Ú‰Ô‡ÙÛÔ˘ ∞.202,387,456
™ÎÂÓÙ¤Ú˘ ¡.208
™Ì˘Ú¿ÎȘ ™.133
™Ô‡ÏË ∫.∂.113,118,467
™ËÏÈÒÙË ª.133
™˘Ú¿ÎÔ˜ ™.145
™‡ÚÔÁÏÔ˘ ∫.296
™Ù·ÌÔÁÈ¿ÓÓÔ˘ §.89
™Ù¿ÌÔ˘ ª.195,284
™ÙÂÊ·Ó¿ÎË ∫.65
™ÙÂÊ·Ó¿ÎË ™.352
™ÙÂÊ·Ó›‰Ë˜ ∫.456
™˘ÚÈÔÔ‡ÏÔ˘ µ.188
™¯ÔÈÓ¿ ª.448
™¯ÔÈÓ¿ÎË ∞.352
™¯ÔÈÓ¿˜ °.448
∆
∆ÂÚÙ›Ë ∞.471
∆˙·ÌÔ˘Ú¿ÓË π.113
∆˙Ô‡ÊË ª.104
∆˙ˆÚÙ˙¿ÙÔ˘-™Ù·ıÔÔ‡ÏÔ˘ º.47
∆˙ÒÚÙ˙Ë ¶.65
∆Ú·ÁÈ·ÓÓ›‰Ë˜ £.195
∆Ú›Ì˘ °.47
∆ÚȯfiÔ˘ÏÔ˜ ¢.20
∆ÚÔ˘Ì¤Ù·˜ §.37
∆۷ηϛ‰Ë˜ Ã.55
∆۷ΛÚ˘ ™.113
∆Û·Ì·ÚÏ‹-∫ÈÙÛ·Ú¿ ∞.357
∆Û·¿ÎË Œ.133
∆Û¿Ú· ∂.467
∆Û¿ÙÚ· π.52
∆ÛÂÎÔ˘Ú¿ £.352
∆ÛÈÏÈÌÈÁοÎË ∞.352,405
∆ÛÈÌÈÓfi˜ ª.452
∆Û›ÙÛÈη˜ ∫.65
∆ÛÔÏÈ¿ ª.387
∆ÛÔ˘Ì¿Î·˜ ∫.140
∆ÛÔ˘ÚÔ˘Ó¿Î˘ ¡.352
∆ÛÔ‡ÙÛÔ˘ ∞.37
∆ÛÒÙ· ∂.π.311
∆˘ÏÈÁ¿‰· ∞.155
º
º·Ú̷ο΢ £.364
ºÂÛÛ¿ÙÔ˘ ™.327,467
ºÏÔ˘Ú‹ ™.436
ºÚ·ÁÎÔ‡ÏË ∂.426
ºÚ˘Û›Ú· ∂.215
à ÷˚‰¿˜ ™.65 ÷ڛÛË ª.104
÷ڈӛÙË π.12,223,392 ÷Ù˙‹ §.264
÷Ù˙Ë·ı·Ó·Û›Ô˘ Ã.471 ÷Ù˙ˉ¿ÎË ∂.255 ÷Ù˙‹˜ Ã.264,436
÷Ù˙ËÛ‚·ÛÙÔ‡-§Ô˘Î›‰Ô˘ Ã.461
÷Ù˙ËÛÙ·Ì·Ù›Ô˘ ∑.278,344
÷Ù˙ËÛÙ˘ÏÈ·ÓÔ‡ ª.195,284
÷Ù˙Ë„¿ÏÙË ª.239
APAAP65
Bartonella henselae55
Henoch-Schonlein ÔÚʇڷ327
LHX3 89 Nail-Patella140 Pit-189
Power Doppler352 Prop-189
P-ÁÏ˘ÎÔÚˆÙ½ÓË65
Screening (ÚÔÛ˘Ìو̷ÙÈÎfi˜ ¤ÏÂÁ¯Ô˜)296 Turner-Kieser140
∞
∞ÁÁÂÈ›Ùȉ·185,327
∞ÁÁÂÈÔÂÓÂÚÁfi ÂÓÙÂÚÈÎfi ÂÙ›‰ÈÔ278
∞ÁˆÁ‹ ˘Á›·˜436
∞‰ÂÓÔÂȉÂÎÙÔÌ‹208
∞‰¤ÓˆÌ· ˘fiÊ˘Û˘471
∞‰Âӈ̷Ù҉˘ ‰˘ÛÏ·Û›· Ó‡ÌÔÓ·148
∞¤ÚÈ· ¯ÚˆÌ·ÙÔÁÚ·Ê›·-Ê·ÛÌ·ÙÔÁÚ·Ê›· Ì·˙ÒÓ118
∞ÈÌÔÏ˘ÙÈÎfi-Ô˘Ú·ÈÌÈÎfi Û‡Ó‰ÚÔÌÔ456
∞ÎÂÙ˘Ï¯ÔÏÈÓÂÛÙÂÚ¿ÛË113
∞Ï·Ó›ÓË113
·-ÏÈÓÔÏÂÓÈÎfi Ô͇12
∞ÏÏÂÚÁ›·418
∞ÏÏÂÚÁÈ΋ ÔÚʇڷ327
∞Ì˘Á‰·ÏÂÎÙÔÌ‹208
∞Ì˘Á‰·Ï›Ùȉ·42
∞ÌÊÈ‚ÏËÛÙÚÔÂȉԿıÂÈ· Ù˘ ÚÔˆÚfiÙËÙ·˜304
∞Ó·ÏÁËÛ›·29
∞Ó¿ÚÎÂÈ· ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘89
∞Ó¿ÚÎÂÈ· Ù˘ ÔÚÓÈıÈÓÈ΋˜
ÙÚ·ÓÛηڂ·Ì˘Ï¿Û˘467
∞ÓıÂÎÙÈΤ˜ ÛÙ· Ê¿Ú̷η ÂÈÏË„›Â˜104
∞ÓÔÛÔ˚ÛÙÔ¯ËÌ›·65
∞ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η202
∞ÓÙÈÌÂÙÒÈÛË304
∞ÓÙÈËÎÙÈÎfi ÙÔ˘ χÎÔ˘55
∞ÓÙÈ„˘¯ˆÛÈΤ˜ Ô˘Û›Â˜247
∞ÓÒÌ·ÏË Ó¢ÌÔÓÈ΋ ·ÚÙËÚ›·381
∞ÔÏÈÔÚˆÙ½Ó˜202
∞ÔÛȉ‹ÚˆÛË128
∞ÔÊÚ·ÎÙÈ΋ ¿ÓÔÈ· ÙÔ˘ ‡ÓÔ˘208
∞Ú·¯È‰ÔÓÈÎfi Ô͇12
∞ÚıÚ›Ùȉ·185
∞ÚÚ˘ıÌÈÔÁfiÓÔ˜ ‰˘ÛÏ·Û›· Ù˘
‰ÂÍÈ¿˜ ÎÔÈÏ›·˜405
∞Ù‡¯ËÌ·20,364
µ
µ·ÚËÎÔ˝·215
µÏÂÊ·ÚfiÙˆÛË211
µÚÔÁ¯ÔÓ¢ÌÔÓÈ΋ ‰˘ÛÏ·Û›·344
°
°·ÛÙÚÂÓÙÂÚÈΤ˜ ÔÚÌfiÓ˜278
°·ÛÙÚ›ÓË278
°·ÛÙÚÔÔÈÛÔÊ·ÁÈ΋ ·ÏÈÓ‰ÚfiÌËÛË296 °ÂÓÂÙÈ΋ ÙÚÔÔÔ›ËÛË418 °Ï˘ÎÔ˙˘ÏȈ̤ÓË ·ÈÌÔÛÊ·ÈÚ›ÓË HbA1c 264 °ÔÓ›‰ÈÔ GH89 °ÔÓÈÎfiÙËÙ·357
¢
¢Â›ÎÙ˜ ∏Oª∞264 ¢ËÌfiÛÈ· ˘Á›·82 ¢È¿ÁÓˆÛË239 ¢È·ÛÊËÓÔÂȉ‹˜ ¯ÂÈÚÔ˘ÚÁÈ΋ ·ÓÙÈÌÂÙÒÈÛË471 ¢È·Ù·Ú·¯¤˜ Ù˘ ·Ó·ÓÔ‹˜ ÛÙÔÓ ‡ÓÔ208 ¢È·Ù·ÙÈ΋405 ¢È¿¯˘ÛË CO176
∂ÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË296 ∂ÈÚ‹ÓË82 ∂ÎÓÂfiÌÂÓÔ NO176 ∂Ì‚ÔÏÈ·ÛÌÔ›448 ŒÌÌÂÛË ˘ÂÚ¯ÔÏÂÚ˘ıÚÈÓ·ÈÌ›·52 ŒÌÊÚ·ÎÙ· ÂÁÎÂÊ¿ÏÔ˘456 ∂Ó‰ÔÁÂÓ‹ ÌÂÙ·‚ÔÏÈο ÓÔÛ‹Ì·Ù·118,133 ∂Ó‰ÔÎÔÈÏȷ΋316 ∂Í¿ÓıËÌ·185 ∂͈ۈ̷ÙÈ΋ ÁÔÓÈÌÔÔ›ËÛË58 ∂È‚›ˆÛË ÂχıÂÚË ÓfiÛÔ˘195 ∂ȉËÌÈÔÏÔÁ›·426 ∂ȉËÌÈÔÏÔÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο461 ∂ÈÏË„›·255 ∂ÚÁ·ÛÙËÚȷ΋ ‰È¿ÁÓˆÛË426 ∏ ∏ÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ·2
£ £Âڷ›·42 £ÂÚÌ·ÓÙÈÎfi ÛÒÌ·20 £ËÏ·ÛÌfi˜247 £Ú¿ÎË448 £ÚÔÌ‚ÔÂÌ‚ÔÏÈο ÂÂÈÛfi‰È·387 £ÚÔÌ‚ÔÊÈÏ›·387 £ÚfiÌ‚ˆÛË387
π
πÓÛÔ˘Ï›ÓË264
πÓÛÔ˘ÏÈÓÔÂÍ·ÚÙÒÌÂÓÔ˜ ۷ί·Ú҉˘
‰È·‚‹Ù˘ 1334
πÓÛÔ˘ÏÈÓÔÂÍ·ÚÙÒÌÂÓÔ˜ ۷ί·Ú҉˘
‰È·‚‹Ù˘ 12334
πÓÛÔ˘ÏÈÓÔÂÍ·ÚÙÒÌÂÓÔ˜ ۷ί·Ú҉˘
‰È·‚‹Ù˘ 2334
∫
∫·ÏÔÚÈʤÚ20
∫·Ú˘fiÙ˘Ô˜461
∫·Ù·ÛÙÔÏ‹29
∫¤ÓÙÚÔ ÀÁ›·˜448
∫ÂÊÚÔ˙›ÏË42
∫ÏËÚÔÓÔÌÈ΋ ÛÊ·ÈÚÔ΢ÙÙ¿ÚˆÛË52
∫ÔÓÙfi ·Ó¿ÛÙËÌ·471
∫Ú·ÓÈÔÂÁÎÂÊ·ÏÈ΋ οΈÛË37
∫‡ËÛË247,255
∫˘ÎÏ¿‰Â˜452
∫‡ÎÏÔ˜ Ù˘ Ô˘Ú›·˜467
§
§··ÚÔÛÎÔÈ΋ ¯ÂÈÚÔ˘ÚÁÈ΋145
§ÂÌÊ·‰ÂÓ›Ùȉ·55 §Â˘ÎÔÙÚȤÓÈ·155
§ÈÓÔÏÂ˚Îfi Ô͇12
§È›‰È·202
§ÈÔÚˆÙ½Ó˜202,264,436
§Ô›ÌˆÍË42
ª
ª·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘2 ª·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›·456
ªÂÙ·‚ÔÏÈ΋ ÂÁÎÂÊ·ÏÔ¿ıÂÈ·167
ªÂÙ·ÏÏ·Á̤ÓÔ˜ ·Ú¿ÁÔÓÙ·˜ FV Leiden387 ªÂÙ·ÊÔÚ¿ ‚·Ú¤ˆ˜ ·Û¯fiÓÙˆÓ ·È‰ÈÒÓ37 ªË Hodgkin ϤÌʈ̷195 ªË Û˘Ì·Á¤˜ Ì˘ÔοډÈÔ405
ªÔÚȷ΋ ‰È¿ÁÓˆÛË215
ªÔÙÈÏ›ÓË278
ª˘ÂÏ›Ùȉ·185
ª˘ÎËÙ›·ÛË ÙÚȯˆÙÔ‡ ÎÂÊ·Ï‹˜426 ª˘ÎfiÏ·ÛÌ· Ù˘ Ó¢ÌÔÓ›·˜185
ª˘ÔηډÈÔ¿ıÂȘ405 ¡ ¡ÂÔÁÓ¿ ‰È·‚ËÙÈÎÒÓ ÌËÙ¤ÚˆÓ278 ¡ÂÔÁÓfi2,29,145,311
¡ÂÔÂÏÏËÓÈÎfi˜ ¢È·ÊˆÙÈÛÌfi˜232 ¡Â˘ÚÔÂÎÊ˘ÏÈÛÙÈο167 ¡Â˘ÚÔÏÔÁÈΤ˜ ÂΉËÏÒÛÂȘ456 ¡Â˘ÚÔ„˘¯È·ÙÚÈ΋167 ¡ÔËÙÈ΋ ˘ÛÙ¤ÚËÛË215
¡fiÛÔ˜ Gilbert52
¡fiÛÔ˜ Hodgkin195
¡fiÛÔ˜ Kawasaki392
¡fiÛÔ˜ ·fi ·Ì˘¯‹ Ó˘¯ÈÒÓ Á¿Ù·˜55
¡ÙÔÎÔÛ·ÂÍ·ÓÔ˚Îfi Ô͇12
¡ÙÔ·Ì›ÓË113
¡˘ÎÙÂÚÈÓ‹ ÂÓÔ‡ÚËÛË208
O
OÈÎÔÏÔÁ›·426
OÌfi˙˘ÁË ‚-ª∞128 OÓ˘¯Ô‰˘ÛÏ·Û›·140 OÍ›· Ï¢¯·ÈÌ›·65
OÍ›· ˘ÂÏÔÓÂÊÚ›Ùȉ·352
OÚÁ·ÓÈΤ˜ ÔÍ˘Ô˘Ú›Â˜118
OÚÁ·ÓÈ΋ „˘¯È·ÙÚÈ΋ ‰È·Ù·Ú·¯‹167
OÛÙÂÔÌ˘ÂÏ›ÙȘ47
O˘ÚÔÏÔÈÌÒÍÂȘ352
¶
¶·È‰› / ¶·È‰È¿20,42,188,316,436,448,456
¶·È‰È¿-·Ú·ıÂÚÈÛÙ¤˜452
¶·È‰È΋ ÂÈÏË„›·202
¶·È‰È΋ ËÏÈΛ·65,104,195
¶·È‰È΋ ÔÍ›· ÏÂÌÊÔ‚Ï·ÛÙÈ΋ Ï¢¯·ÈÌ›·284
¶·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘188,264,344,364
¶·Ú·ÚÚÈÓÔÎÔÏ›Ùȉ·211
¶·Ú¤Ì‚·ÛË364
¶¿ÚÂÛË ·ÓÂÏÎÙ‹Ú· Ì˘fi˜ ¿Óˆ ‚ÏÂÊ¿ÚÔ˘211
¶·¯˘Û·ÚΛ·264
¶ÂÚÈÔÚÈÛÙÈ΋405
¶Ó¢ÌÔÓÈΤ˜ ‰ÔÎÈ̷ۛ˜176
¶Ó¢ÌÔÓÈ΋ ˘¤ÚÙ·ÛË381
¶Ó¢ÌÔÓÈÎÔ› fiÁÎÔÈ176
¶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‡ËÛË58
¶ÔÏ˘ÙÚ·˘Ì·Ù›·˜37
¶fiÓÔ˜29
¶Ú‚ÈÔÙÈο223
¶ÚÔ‚ÈÔÙÈο223
¶ÚÔ‚Ï‹Ì·Ù· ˘Á›·˜452
¶ÚÔÁÂÓÓËÙÈ΋ ‰È¿ÁÓˆÛË461
¶ÚÔÁÓˆÛÙÈÎÔ› ·Ú¿ÁÔÓÙ˜284
¶ÚÔÎÏËÙ¿ ‰˘Ó·ÌÈο2
¶ÚfiÏË„Ë364
¶ÚÔÛˆÔ-ˆÌÔ-‚Ú·¯ÈfiÓÈÔ˜ Ì˘˚΋ ‰˘ÛÙÚÔÊ›·215
¶ÚÔˆÚfiÙËÙ·311
¶ÚˆÙÔ‚¿ıÌÈ· ÊÚÔÓÙ›‰· ˘Á›·˜133
¶ÚˆÙfiÎÔÏÏÔ BFM-90284
™ ™·Î¯·Ú҉˘ ‰È·‚‹Ù˘ Ù‡Ô˘ 1334,357
™·Î¯·Ú҉˘ ‰È·‚‹Ù˘47,232
™·ÛÌÔ›456
™ÈÚÔ̤ÙÚËÛË176
¶·È‰È·ÙÚÈ΋ 2003;66:482-484Paediatriki 2003;66:482-484 483
™ÔÓ‰˘ÏÈ΋ ÛÙ‹ÏË47
™Ù·Ê˘ÏÔÎÔÎÎÈÎfi ÙÔÍÈÎfi Û‡Ó‰ÚÔÌÔ97
™ÙÚÂÙÔÎÔÎÎÈÎfi ÙÔÍÈÎfi Û‡Ó‰ÚÔÌÔ97
™ÙÚÂÙfiÎÔÎÎÔ˜42
™˘ÁÁÂÓ›˜ ηډÈÔ¿ıÂȘ381
™˘ÁÁÂÓ›˜ ·ÛÙÂȘ148
ˆ-3 ÏÈ·Ú¿ Ôͤ·12 ˆ-6 ÏÈ·Ú¿ Ôͤ·12 ¶·È‰È·ÙÚÈ΋ 2003;66:482-484Paediatriki 2003;66:482-484
™˘ÁÁÂÓ¤˜ ÌÂÁ¿ÎÔÏÔ145
™‡ÁÎ·Ì„Ë ·ÁÎÒÓˆÓ140
™˘Ì‚ÈÔÙÈο223
™˘ÌÌfiÚʈÛË ÛÙËÓ ·ÔÛȉ‹ÚˆÛË128
™‡Ó‰ÚÔÌ· ÙÔÍÈ΋˜ ηٷÏËÍ›·˜97
™‡Ó‰ÚÔÌÔ Cushing471
™‡Ó‰ÚÔÌÔ Down461
™˘¯ÓfiÙËÙ·304,461
™ˆÌ·ÙÔÌÂÙÚ‹ÛÂȘ436
∆
∆ÔÍ›ÓË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Ù˘ ÙÔÍÈ΋˜
ηٷÏËÍ›·˜97
∆ÔÈÚ·Ì¿ÙË104
∆Ú·˘Ì·ÙÈÛÌÔ› ÂÊ‹‚ˆÓ364
∆Ú·˘Ì·ÙÈÛÌÔ› ·È‰ÈÒÓ364
∆Ú·˘Ì·ÙÈÛÌfi˜20
∆ÚÔÌÔÎÚ·Ù›·82
∆ÚÔÔÔÈËÙ¤˜155
∆ÚÔÊÈ΋ ·ÏÏÂÚÁ›·239
∆ÚÔÊÈ΋ ÚfiÎÏËÛË239
∆ÚfiÊÈÌ·418
∆‡Ô˘ ÂÓËÏ›ÎÔ˘316
À
ÀÂÚ·Ì̈ÓÈ·ÈÌ›·467
ÀÂÚ·ÓÙÈÁfiÓ·392
ÀÂÚ˯ÔÁÚ¿ÊËÌ· ÂÁÎÂÊ¿ÏÔ˘2
ÀÂÚÎÔÚÙÈ˙ÔÏ·ÈÌ›·471
ÀÂÚÙÚÔÊÈ΋405
ÀÔ‰fiÚÈÔ Ï›Ô˜264
Àԉԯ›˜155
ÀÔÓ·ÙÚÈ·ÈÌ›·456
º
º·ÈÓ˘Ï·Ï·Ó›ÓË113
º¿Ú̷η247
ºÔÚ›· ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘188
º˘Ì·Ù›ˆÛË316
º˘ÛÈ΋ ηٿÛÙ·ÛË436
ºˆÛÊfiÚÔ˜232
Ã
ÃÔÏÔÏÈı›·ÛË52,311
ÃÚfiÓÈ· ·ÈÌfiÏ˘ÛË52
ÃÚfiÓÔ˜ ÂÓÂÚÁÔÔÈË̤Ó˘ ÌÂÚÈ΋˜ ıÚÔÌ‚ÔÏ·ÛÙ›Ó˘55
¶PO™EXH ™YNE¢PIA
9-12 ºÂ‚ÚÔ˘·Ú›Ô˘ 200415th International CongressParis, France 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
28 ºÂ‚ÚÔ˘·Ú›Ô˘-6th International CongressLisbon, Portugal 2 ª·ÚÙ›Ô˘ 2004on Pediatric Pulmonology
¶ÏËÚÔÊÔڛ˜: Annie Bidart
Tel.: 33-0-497-038-597
Fax: 33-0-497-038-598
13-14 ª·ÚÙ›Ô˘ 20043Ô ¶·ÓÂÏÏ‹ÓÈÔ
•ÂÓÔ‰Ô¯Â›Ô Divani Caravel
∂ÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋
¶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
28-31 ª·ÚÙ›Ô˘ 200430th Annual Meeting of the Barcelona, Spain 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
23-25 ∞ÚÈÏ›Ô˘ 2004
16Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ
∂Ù·ÈÚ›·˜ ∫ÔÈÓˆÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ Î·È ¶ÚÔ·ÁˆÁ‹˜ Ù˘ ÀÁ›·˜ “¶·È‰› Î·È ∞ıÏËÙÈÛÌfi˜”
∂ÚÁ·ÛÙ‹ÚÈÔ ÀÁÈÂÈÓ‹˜ Î·È ∂ȉËÌÈÔÏÔÁ›·˜
π·ÙÚÈ΋ ™¯ÔÏ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ
¶ÏËÚÔÊÔڛ˜: ∂‡Ë ∞Ù˙¤ÌË, ÃÚ‡Û· ª·˘Ú›‰Ô˘
Tel.: 22410-99101
Website: www.socped.gr
27 ∞ÚÈÏ›Ô˘-30Ô ∂Ù‹ÛÈÔ ¶·ÓÂÏÏ‹ÓÈÔ π·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ∞ı‹Ó·
1 ª·˝Ô˘ 2004
•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
6-8 ª·˝Ô˘ 20042nd International Congress on Adult ∞ı‹Ó· 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
13-16 ª·˝Ô˘ 20043Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ ∫˘ÙÙ·ÚÔÌÂÙÚ›·˜ª‡ÎÔÓÔ˜
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
28-30 ª·˝Ô˘ 200442Ô ¶·ÓÂÏÏ‹ÓÈÔ
•ÂÓÔ‰Ô¯Â›Ô Creta Maris
∂ÏÏËÓÈ΋
¶ÏËÚÔÊÔڛ˜: C&C International
∆ËÏ.: 210-68 89 100
Fax: 210-68 44 777
E-mail: pediatric2004@cnc.gr
Website: www.pediatric2004.gr
6-9 πÔ˘Ó›Ô˘ 2004
7Ô ¶·ÁÎfiÛÌÈÔ ™˘Ó¤‰ÚÈÔ ÁÈ· ÙËÓ ¶ÚfiÏË„ËVienna, Austria
¶ÏËÚÔÊÔڛ˜: ∫∂¶¶∞
∆ËÏ.: 210-74 62 187 & 74 62 201
Fax: 210-74 62 105
Website: www.safety2004.info
10-13 πÔ˘Ó›Ô˘ 2004
9th Congress of the European Geneva, Hematology Association Switzerland
¶ÏËÚÔÊÔڛ˜: Eurocongres Conference
Management
∆el.: +31 20679 3411
Fax: +31 20673 7306
E-mail: eha2004@eurocongres.com
Website: www.eurocongres.com/eha2004
16-19 πÔ˘Ó›Ô˘ 2004Advances in Neuroblastoma Research 2004Genoa, Italy
¶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
28-31 ∞˘ÁÔ‡ÛÙÔ˘ 2004
6th Balkan Meeting on Human£ÂÛÛ·ÏÔÓ›ÎË Genetics (BMHG 2004)
¶ÏËÚÔÊÔڛ˜: TOPLINE Travel and Tourism
Tel.: +30 2310-538 001
Fax: +30 2310-566 713
E-mail: info@toplinetravel.gr
26 ™ÂÙÂÌ‚Ú›Ô˘-XII Meeting of the European Association£ÂÛÛ·ÏÔÓ›ÎË
1 OÎÙˆ‚Ú›Ô˘ 2004for Haematopathology
¶ÏËÚÔÊÔڛ˜: Triaena Tours & Congress
∆ËÏ.: +30 2310-25 61 94-5
Fax: +30 2310-25 61 96
E-mail: salonica@triaenatours.gr
™˘ÓÙÔÌÔÁڷʛ˜
AIDS
AMP, ADP, ATP
ATPase cal
CSF ‹ ENY
CNS ‹ ∫¡™ cm
CoA cmÑ cm2
cAMP ÆC
CRP DNA
ECG ‹ ∏∫° EEG ‹ ∏∂° ELISA
ESR ‹ ∆∫∂ EDTA
g Hct
Hb
HLA
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
ABBREVIATIONS EÏÏËÓÈÎÔ› fiÚÔÈ
Û‡Ó‰ÚÔÌÔ Â›ÎÙËÙ˘ ·ÓÔÛÔ·Ó¿ÚÎÂÈ·˜
ÌÔÓÔ-, ‰È-, ÙÚÈʈÛÊÔÚÈ΋ ·‰ÂÓÔÛ›ÓË
ÙÚÈʈÛÊ·Ù¿ÛË Ù˘ ·‰ÂÓÔÛ›Ó˘
ıÂÚÌ›‰·
ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚfi
ÎÂÓÙÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ·
ÂηÙÔÛÙfi
Û˘Ó¤Ó˙˘ÌÔ ∞
΢‚ÈÎfi ÂηÙÔÛÙfi
ÙÂÙÚ·ÁˆÓÈÎfi ÂηÙÔÛÙfi
΢ÎÏÈÎfi AMP
‚·ıÌfi˜ KÂÏÛ›Ô˘
C-·ÓÙȉÚÒÛ· ÚˆÙ½ÓË
‰ÂÔ͢ÚÈ‚Ô˙ÔÓÔ˘ÎÏÂ˚ÓÈÎfi Ô͇ ËÏÂÎÙÚÔηډÈÔÁÚ¿ÊËÌ·
ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ·
¤Ó˙˘ÌÔ-Û˘Ó‰¤Ù˘ ·ÓÔÛÔÚÔÛÚfiÊËÛ˘
ÚÔÛ‰ÈÔÚÈÛÌfi˜
Ù·¯‡ÙËÙ· ηıÈ˙‹Ûˆ˜ ÂÚ˘ıÚÒÓ
Âı˘ÏÂÓԉȷÌÈÓÔÙÂÙÚ·ÔÍÂ˚Îfi Ô͇
ÁÚ·ÌÌ¿ÚÈo
·ÈÌ·ÙÔÎÚ›Ù˘
·ÈÌÔÛÊ·ÈÚ›ÓË ·ÓÙÈÁfiÓÔ ÈÛÙÔÛ˘Ì‚·ÙfiÙËÙ·˜
·ÓÔÛÔÛÊ·ÈÚ›ÓË
ÌÔÓ¿‰· ÂÓÙ·ÙÈ΋˜ ıÂڷ›·˜
‰ÈÂıÓ‹˜ ÌÔÓ¿‰· ÂÓ‰ÔÌ˘˚ο ÂÓ‰ÔÂÚÈÙÔÓ·˚ο ÂÓ‰ÔÊϤ‚È·
Ï›ÙÚÔ(·)
ÏÔÁ¿ÚÈıÌÔ˜
ÁÚ·ÌÌÔÌfiÚÈÔ
ÌÔÚÈ·Îfi ‚¿ÚÔ˜
̤ÛË ·ÈÌÔÛÊ·ÈÚ›ÓË ÂÚ˘ıÚÒÓ
̤ÛÔ˜ fiÁÎÔ˜ ÂÚ˘ıÚÒÓ
·ÁÁÂÏÈÔÊfiÚÔ˜ RNA
̤ÙÚÔ
ÏÂÙfi ·ÚÈıÌfi˜
Ó¢ÙÒÓÈÔ
ÌË ÛËÌ·ÓÙÈÎfi
ÔÛÌÒÏÈÔ
› ÙÔȘ ÂηÙfi
·Ï˘ÛȉˆÙ‹
AÁÁÏÈÎÔ› fiÚÔÈ acquiredimmunodeficiency 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
p.o. RIA RNA RDS sec s.c. ‹ À.¢. SD SE
U ™˘Ó‰˘·˙fiÌÂÓ· ÚÔı¤Ì·Ù·
tera- (1012) giga- (109) mega-(106) kilo- (103) hecto(102) deca (101) deci (10-1) centi- (10-2) milli(10-3) micro (10-6) nano (10-9) pico (10-12) femto (10-15) atto (10-18)
‰Â˘ÙÂÚfiÏÂÙÔ ˘Ô‰fiÚÈ·
ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË
ÛÙ·ıÂÚfi ÛÊ¿ÏÌ· ÌÔÓ¿‰·
Combining prefixes T G M k h da d c m Ì n p f a
AÁÁÏÈÎÔ› fiÚÔÈ
by mouth radioimmunoassay ribonucleic acid respiratory distress syndrome second subcutaneous standard deviation standard error unit
