Παιδιατρική | Τόμος 69 • Τεύχος 1 • Ιανουάριος - Φεβρουάριος 2006 by E-chlld

°Ú›Ë ÙˆÓ ÙËÓÒÓ: ·ÂÈÏ‹ ÌÈ·˜ Ó¤·˜

·Ó‰ËÌ›·˜;

ª. ∆ÛÔÏÈ¿, π. §ÔÁÔı¤ÙË, ∞. ∫ˆÓÛÙ·ÓÙﬁÔ˘ÏÔ˜

¶ÂÚ›ÏË„Ë: ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ 20Ô‡ ·ÈÒÓ· Ë ·ÓıÚˆﬁÙËÙ· ‰ÔÎÈÌ¿ÛÙËÎÂ ·ﬁ ÙÚÂÈ˜ ·Ó‰ËÌ›Â˜

ÁÚ›Ë˜. ™ÙËÓ ·˘Á‹ ÙÔ˘ 21Ô˘ ·ÈÒÓ·, Ë ÂÌÊ¿ÓÈÛË ÌÈ·˜ Ó¤·˜ ·Ó‰ËÌ›·˜ ÌÔÈ¿˙ÂÈ ·Ó·ﬁÊÂ˘ÎÙË. ∆· ÙÂ-

ÏÂ˘Ù·›· ¯ÚfiÓÈ·, ¤Ó·˜ Û˘ÓÂ¯Ò˜ ·˘Í·ÓfiÌÂÓÔ˜ ·ÚÈıÌfi˜ ÂÈ‰ËÌÈÒÓ ÁÚ›Ë˜ ÙˆÓ ÙËÓÒÓ ÂÎ‰ËÏÒÓÔÓÙ·È

Î˘Ú›ˆ˜ ÛÙÈ˜ ·ÛÈ·ÙÈÎ¤˜ ¯ÒÚÂ˜, Î·ıÒ˜ Î·È ÛÂ ¿ÏÏ· Ì¤ÚË ÙÔ˘ ÎﬁÛÌÔ˘. ∞˘Ù¤˜ ÚÔÎ·ÏÔ‡ÓÙ·È ·ﬁ ÈÔ‡˜

Ô˘ ¤¯Ô˘Ó ·˘ÍËÌ¤ÓË ÏÔÈÌÔÁﬁÓÔ ‰‡Ó·ÌË Î·È ÚÔÎ·ÏÔ‡Ó ˘„ËÏ‹˜ ·ıÔÁÔÓÈÎﬁÙËÙ·˜ ÁÚ›Ë ÛÙ· ÙË-

Ó¿. π‰È·›ÙÂÚË ·ÓËÛ˘¯›· ¤¯ÂÈ ÚÔÎ·Ï¤ÛÂÈ Ë Â˘ÚÂ›· ÂÍ¿ÏˆÛË ÙÔ˘ ÈÔ‡ ÙË˜ ÁÚ›Ë˜ ∏5¡1 ÛÂ ¿ÁÚÈ· Î·È

ÔÈÎfiÛÈÙ· ÙËÓ¿ ÛÙËÓ ∞Û›·. ∆Ô ÛÙ¤ÏÂ¯Ô˜ ·˘Ùfi ÌÔÚÂ› Ó· ÌÂÙ·‰ÔıÂ› ·fi Ù· ÙËÓ¿ ÛÙÔÓ ¿ÓıÚˆÔ

Î·È Ó· ÚÔÎ·Ï¤ÛÂÈ ÏÔ›ÌˆÍË Î·È ı¿Ó·ÙÔ. ∞Ó Î·È ¤¯ÂÈ ·Ú·ÙËÚËıÂ› ÌÂÙ¿‰ÔÛË ÙÔ˘ ÈÔ‡ ·ﬁ ¿ÓıÚˆÔ

ÛÂ ¿ÓıÚˆÔ, Ê·›ÓÂÙ·È ﬁÙÈ ÙÔ ÛÙ¤ÏÂ¯Ô˜ ·˘Ùﬁ ‰ÂÓ ÌÔÚÂ› Ó· ÌÂÙ·‰ÔıÂ› Â‡ÎÔÏ· ÌÂÙ·Í‡ ·ÓıÚÒˆÓ.

øÛÙﬁÛÔ, ÌÔÚÂ› Ó· ·ÔÎÙ‹ÛÂÈ ÙËÓ ÈÎ·ÓﬁÙËÙ· ·˘Ù‹ ÌÂ ·Ó¿ÌÈÍË Î·È ·ÓÙ·ÏÏ·Á‹ ÙÔ˘ ÁÂÓÂÙÈÎÔ‡ ÙÔ˘

˘ÏÈÎÔ‡ (reassortment) ÌÂ ÙÔ ÁÂÓÂÙÈÎﬁ ˘ÏÈÎﬁ ·ÓıÚÒÈÓÔ˘ ÛÙÂÏ¤¯Ô˘˜ ‹ ÌÂ ‰È·‰Ô¯ÈÎ¤˜ ÌÂÙ·ÏÏ¿ÍÂÈ˜.

™Â ·˘Ù‹Ó ÙËÓ ÂÚ›ÙˆÛË, ÙÔ ÛÙ¤ÏÂ¯Ô˜ ∏5¡1 ı· ÂÍ·ÏˆıÂ› ÛÂ

ÛË˜ Î·È ·ﬁıÂÌ· ÈÎ·ÓÒÓ ÔÛÔÙ‹ÙˆÓ ·ÓÙÈ-ÈÈÎÒÓ Ê·ÚÌ¿ÎˆÓ

Ô ÂÌ‚ÔÏÈ·ÛÌﬁ˜. ™‹ÌÂÚ·, Á›ÓÂÙ·È ÂÓÙ·ÙÈÎ‹

Avian flu: a new pandemic threat?

M. Tsolia, I. Logotheti, A. Konstantopoulos

Abstract: During the course of the 20th century the world experienced three influenza pandemics. Today, at the dawn of the 21st century the emergence of a new pandemic seems inevitable. In recent years, an increasing number of epidemics caused by high pathogenicity avian influenza viruses have occurred, mainly in Asian countries but also in other parts of the world. The current widespread dissemination of H5N1 avian virus in wild and domestic birds in Asia is unprecedented and has caused global concern. What is more troubling is the fact that this virus has been transmitted from birds to humans causing disease and death. Although human-to-human transmission is known to have occurred, the virus cannot be transmitted between humans with great efficiency. However, it may acquire this capacity either by reassortment with a human strain or through adaptive mutations. In this case, the H5N1 strain will cause explosive global spread and a new influenza pandemic will occur. An effort should be made by governments and poultry producers to improve biosecurity and conduct education programmes with a view to restriction of the spread of avian influenza. An operational pandemic plan should be available in every country and an adequate amount of antiviral medication stockpiled. Immunization will be the most effective way to reduce the impact of a pandemic and researchers are currently trying to develop a vaccine against the H5N1 strain.

Key words: Influenza, avian influenza, pandemic.

23 e-mail: giannalogotheti@yahoo.gr

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

Correspondence: Logotheti Ioanna 5 Lykeias Str., N. Smyrni, 171 23, Athens e-mail: giannalogotheti@yahoo.gr

∂ÈÛ·ÁˆÁ‹

∫¿ıÂ ¯ÚﬁÓÔ, Î·Ù¿ ÙÔ˘˜ ¯ÂÈÌÂÚÈÓÔ‡˜ Ì‹ÓÂ˜, ÂÌÊ·Ó›˙ÔÓÙ·È ÂÈ‰ËÌÈÎ¤˜ ÂÍ¿ÚÛÂÈ˜ ÙÔ˘ ÈÔ‡ ÙË˜

ÁÚ›Ë˜ Ô˘ ÚÔÎ·ÏÔ‡Ó ÛËÌ·ÓÙÈÎ‹ ÓÔÛËÚﬁÙË-

Ù· Î·È ıÓËÙﬁÙËÙ· ÛÙÔÓ ÏËı˘ÛÌﬁ, È‰È·›ÙÂÚ·

ÛÙÈ˜ Â˘·ıÂ›˜ ÔÌ¿‰Â˜. √ Èﬁ˜ ÙË˜ ÁÚ›Ë˜ ÌÔ-

ÚÂ›, ﬁÌˆ˜, Ó· ÚÔÎ·Ï¤ÛÂÈ Î·È ·Ó‰ËÌ›Â˜ Î·Ù¿

ÙÈ˜ ÔÔ›Â˜ Ë ÓÔÛËÚﬁÙËÙ· Î·È Ô ·ÚÈıÌﬁ˜ ÙˆÓ

ı·Ó¿ÙˆÓ ·˘Í¿ÓÔÓÙ·È ‰Ú·Ì·ÙÈÎ¿, ·ÎﬁÌË Î·È

ÌÂÙ·Í‡ Ó¤ˆÓ Î·È ˘ÁÈÒÓ ·ÙﬁÌˆÓ. ∫·Ù¿ ÙË ‰È¿Ú-

ÎÂÈ· ÙÔ˘ 20Ô‡ ·ÈÒÓ· Ë ·ÓıÚˆﬁÙËÙ· ‰ÔÎÈÌ¿-

·ﬁ ÙÚÂÈ˜

‰ËÌÈÔ˘ÚÁËıÂ›

H5N1, Ô˘ Û‹ÌÂÚ· ÂÓ‰ËÌÂ› ÛÙ· ÙËÓ¿ ÛÂ ÔÏ-

Ï¤˜ ·ÛÈ·ÙÈÎ¤˜ ¯ÒÚÂ˜ (3-6). ∏ ‰ÈÂıÓ‹˜ ÂÈÛÙË-

ÌÔÓÈÎ‹ ÎÔÈÓfiÙËÙ· ÂÎÊÚ¿˙ÂÈ ÙË ‚Â‚·ÈfiÙËÙ· fiÙÈ

ÌÈ· Ó¤· ·Ó‰ËÌ›· ÁÚ›Ë˜ ı· ÂÎ‰ËÏˆıÂ› ÛÙÔ

ÚÔÛÂ¯¤˜ Ì¤ÏÏÔÓ, ‰ÂÓ Â›Ó·È ﬁÌˆ˜ ‰˘Ó·Ùﬁ Ó·

ÚÔ‚ÏÂÊıÂ› Ô ·ÎÚÈ‚‹˜ ¯ÚﬁÓÔ˜ ¤Ó·ÚÍ‹˜ ÙË˜.

∞fi ÙfiÙÂ Ô˘ ÂÌÊ·Ó›ÛÙËÎÂ ÙÔ ÛÙ¤ÏÂ¯Ô˜ ·˘Ùfi

Î·È Ì¤¯ÚÈ Û‹ÌÂÚ·, ¤¯Ô˘Ó ÂÎ‰ËÏˆıÂ› ·ÚÎÂÙ¤˜

ÂÚÈÙÒÛÂÈ˜ ÓﬁÛÔ˘ ·ﬁ ÌÂÙ¿‰ÔÛË ÙÔ˘ ÈÔ‡

ÛÙÔ˘˜ ·ÓıÚÒÔ˘˜ ÌÂ ÛËÌ·ÓÙÈÎ‹ ıÓËÙﬁÙËÙ·.

∆Ô ÛÙ¤ÏÂ¯Ô˜ ∏5¡1 ‰ÂÓ ÌÔÚÂ› Ó· ÌÂÙ·‰ÔıÂ›

Â‡ÎÔÏ· ·ﬁ ¿ÓıÚˆÔ ÛÂ ¿ÓıÚˆÔ Î·È ÁÈ· ÙÔÓ

ÏﬁÁÔ ·˘Ùﬁ, ‰ÂÓ ¤¯ÂÈ ÚÔÎ‡„ÂÈ Ì¤¯ÚÈ Û‹ÌÂÚ·

ÌÈ· Ó¤· ·Ó‰ËÌ›·. √È ÌË¯·ÓÈÛÌÔ› Ô˘ Û˘Ì‚¿Ï-

ÏÔ˘Ó ÛÙË ‰ËÌÈÔ˘ÚÁ›· ÌÈ·˜ ·Ó‰ËÌ›·˜, Ù· ÛËÌÂ-

ÚÈÓ¿ ÂÈ‰ËÌÈÔÏÔÁÈÎ¿ ‰Â‰ÔÌ¤Ó· Î·È ÔÈ ÛÙÚ·ÙË-

ÁÈÎ¤˜ Ô˘ ı· Ú¤ÂÈ Ó· ÂÊ·ÚÌÔÛıÔ‡Ó ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛ‹

Â›Ó·È ˘Â‡ı˘ÓË ÁÈ· ÙËÓ ÚÔÛÎfiÏÏËÛË ÛÂ ÌfiÚÈ· ÛÈ·ÏÈÎÔ‡ ÔÍ¤Ô˜ Ô˘ ‚Ú›ÛÎÔÓÙ·È ÛÂ ÁÏ˘ÎÔÚˆÙÂ˝ÓÂ˜ Î·È ÁÏ˘ÎÔÏÈ›‰È· ÛÙËÓ ÂÈÊ¿ÓÂÈ· ÙÔ˘ Î˘ÙÙ¿ÚÔ˘. ∏ ÓÂ˘Ú·ÌÈÓÈ‰¿ÛË ‰ÈÂ˘ÎÔÏ‡ÓÂÈ ÙË ‰Ú¿ÛË ÙË˜ ·ÈÌÔÛ˘ÁÎÔÏÏËÙ›ÓË˜ Î·È ÂÈÚfiÛıÂÙ·, ·›˙ÂÈ ÚfiÏÔ ÛÙËÓ ·ÂÏÂ˘ı¤ÚˆÛË ÙÔ˘ ÈÔ‡ ·fi ÙÔ Î‡ÙÙ·ÚÔ. √È ÈÔ› ÙË˜ ÁÚ›Ë˜ ‰È·ÎÚ›ÓÔÓÙ·È ÛÂ Ù‡Ô˘˜ ∞, µ, C. ∆· ÛÙÂÏ¤¯Ë C ‰ÂÓ ÚÔÎ·ÏÔ‡Ó ÛËÌ·ÓÙÈÎ‹ ÓÔÛËÚfiÙËÙ·. ∆· ÛÙÂÏ¤¯Ë Ù‡Ô˘ ∞ Â›Ó·È ·˘Ù¿ Ô˘ ÚÔÎ·ÏÔ‡Ó ÙË ÌÂÁ·Ï‡ÙÂÚË ÓÔÛËÚfiÙËÙ· Î·È Ù·ÍÈÓÔÌÔ‡ÓÙ·È ÛÂ ˘ÔÙ‡Ô˘˜, ·Ó¿ÏÔÁ· ÌÂ ÙÈ˜ ÂÈÊ·ÓÂÈ·Î¤˜ ÁÏ˘ÎÔÚˆÙÂ˝ÓÂ˜ H Î·È N. À¿Ú¯Ô˘Ó 16 Ù‡ÔÈ ∏ Î·È 9 ¡. √È ˘fiÙ˘ÔÈ ∞ ÚÔÛ‚¿ÏÏÔ˘Ó ÂÎÙfi˜ ·fi ÙÔÓ ¿ÓıÚˆÔ, Ù· ÙËÓ¿ Î·È ‰È¿ÊÔÚ· ˙Ò·, fiˆ˜ ¯Ô›ÚÔ˘˜, ¿ÏÔÁ·, ÊÒÎÈÂ˜ Î·È Ê¿Ï·ÈÓÂ˜. ∆· ÙËÓ¿ ÚÔÛ‚¿ÏÏÔÓÙ·È ·fi ÛÙÂÏ¤¯Ë fiÏˆÓ ÙˆÓ ˘ÔÙ‡ˆÓ ∏ Î·È ¡, ÂÓÒ Ù· ıËÏ·ÛÙÈÎ¿, ÌÂÙ·Í‡ ÙˆÓ ÔÔ›ˆÓ Î·È ÔÈ ¿ÓıÚˆÔÈ, ÚÔÛ‚¿ÏÏÔÓÙ·È ·fi ÂÚÈÔÚÈÛÌ¤ÓÔ ·ÚÈıÌfi ˘ÔÙ‡ˆÓ. °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi, Ù· ÙËÓ¿ ıÂˆÚÔ‡ÓÙ·È fiÙÈ Â›Ó·È Ô Ê˘ÛÈÎfi˜ ÍÂÓÈÛÙ‹˜ ÙË˜ ÁÚ›Ë˜ ∞. √È 144 (16 x 9) ‰˘Ó·ÙÔ› Û˘Ó‰˘·ÛÌÔ› ÙˆÓ Ù‡ˆÓ ∏ Î·È ¡ ¤¯Ô˘Ó ˆ˜ ·ÔÙ¤ÏÂÛÌ· Ó· Î˘ÎÏÔÊÔÚÂ› ÛÙ· ¿ÁÚÈ· ÙËÓ¿ ¤Ó·˜ ÌÂÁ¿ÏÔ˜ ·ÚÈıÌfi˜ ˘ÔÙ‡ˆÓ ÙˆÓ ÈÒÓ ·˘ÙÒÓ. ∆· ¿ÁÚÈ· ÌÂÙ·Ó·ÛÙÂ˘ÙÈÎ¿ ÙËÓ¿ ÈÛÙÂ‡ÂÙ·È fiÙÈ ·ÔÙÂÏÔ‡Ó ÙË ‰ÂÍ·ÌÂÓ‹ ÁÈ· ÙË ÌÂÙ¿‰ÔÛË ÙË˜ ÏÔ›ÌˆÍË˜ ÛÂ Î·ÙÔÈÎ›‰È· ÙËÓ¿, ¯Ô›ÚÔ˘˜ ‹ ·ÓıÚÒÔ˘˜ (2,3). ∞ÓÙ›ıÂÙ· ÌÂ Ù· ÛÙÂÏ¤¯Ë Ù‡Ô˘ ∞,Ù· ÛÙÂÏ¤¯Ë ∂ÈÎfiÓ· 1. √ Èfi˜ ÙË˜ ÁÚ›Ë˜. TÚÔÔÔÈËÌ¤ÓË

ÙÔ˘ Ù‡Ô˘ µ ¤¯Ô˘Ó ÛÙ·ıÂÚ¤˜ ∏ Î·È ¡, ‰ÂÓ ‰È·È-

ÚÔ‡ÓÙ·È ÛÂ ˘ÔÙ‡Ô˘˜ Î·È ÚÔÛ‚¿ÏÏÔ˘Ó ÌﬁÓÔ

ÙÔÓ ¿ÓıÚˆÔ. ∂Ó‰¤¯ÂÙ·È ﬁÌˆ˜, Ó· ˘¿Ú¯Ô˘Ó

·ÓÙÈÁÔÓÈÎ¤˜ ‰È·ÊÔÚ¤˜ ·ﬁ ÙÔ ¤Ó· ÛÙ¤ÏÂ¯Ô˜ ÛÙÔ

¿ÏÏÔ, ﬁˆ˜ Î·È ÌÂÙ·Í‡ ÙˆÓ ‰È·ÊﬁÚˆÓ ÛÙÂÏÂ-

¯ÒÓ ÁÚ›Ë˜ ∞ Ô˘ ·Ó‹ÎÔ˘Ó ÛÙÔÓ ›‰ÈÔ ˘ﬁÙ˘Ô.

√È ÈÔ› ÙË˜ ÁÚ›Ë˜ ˘Ê›ÛÙ·ÓÙ·È ·ÓÙÈÁÔÓÈÎ¤˜

ÌÂÙ·‚ÔÏ¤˜ Î·È ‰ÂÓ ·Ó·ÁÓˆÚ›˙ÔÓÙ·È ˆ˜ ÔÈÎÂ›ÔÈ

·ﬁ ÙÔ ·ÓÔÛÈ·Îﬁ Û‡ÛÙËÌ·, ÌÂ ·ÔÙ¤ÏÂÛÌ· Ô

¿ÓıÚˆÔ˜ Ó· ·Ú·Ì¤ÓÂÈ Â˘¿ÏˆÙÔ˜ ÛÙË ÏÔ›ÌˆÍË ÁÈ· ﬁÏË ÙË ‰È¿ÚÎÂÈ· ÙË˜ ˙ˆ‹˜ ÙÔ˘. √È ·ÓÙÈÁÔÓÈÎ¤˜ ·˘Ù¤˜ ÌÂÙ·‚ÔÏ¤˜ Á›ÓÔÓÙ·È ÌÂ ‰‡Ô ÙÚﬁ-

Ô˘˜. √ ÚÒÙÔ˜ ÂÚÈÏ·Ì‚¿ÓÂÈ ‰È·‰Ô¯ÈÎ¤˜ ÌÂ-

Ù·ÏÏ¿ÍÂÈ˜ Ô˘ ¤¯Ô˘Ó ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÂÍ¤-

ÏÈÍË ÙÔ˘ ÈÔ‡ Î·È ·ÔÙÂÏÔ‡Ó ÙËÓ ÂÏ¿ÛÛÔÓ·

·ÓÙÈÁÔÓÈÎ‹ ÌÂÙ·‚ÔÏ‹ (antigenic drift) (1-3).

√ ‰Â‡ÙÂÚÔ˜ ÙÚﬁÔ˜ ·Ú·ÙËÚÂ›Ù·È ÔÏ‡ ÈÔ

Û¿ÓÈ· Î·È ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ÂÌÊ¿ÓÈÛË ÌÈ·˜

ÌÂ›˙ÔÓÔ˜ ·ÓÙÈÁÔÓÈÎ‹˜ ÌÂÙ·‚ÔÏ‹˜ (antigenic shift) ÙË˜ ·ÈÌÔÛ˘ÁÎÔÏÏËÙ›ÓË˜ (∏) ‹/Î·È ÙË˜

ÓÂ˘Ú·ÌÈÓÈ‰¿ÛË˜ (¡), ÒÛÙÂ Ó· ÂÌÊ·Ó›˙ÂÙ·È ¤Ó·

Ó¤Ô ÌﬁÚÈÔ ∏ ‹ Î·È ¡ Î·È Ó· ÚÔÎ‡ÙÂÈ Ó¤Ô˜

˘ﬁÙ˘Ô˜. ™ÙËÓ ÙÂÏÂ˘Ù·›· ·˘Ù‹ ÂÚ›ÙˆÛË, Ô

ÏËı˘ÛÌfi˜ ÛÂ ÔÏfiÎÏËÚÔ ÙÔÓ ÎfiÛÌÔ Â›Ó·È Â˘¿-

ÏˆÙÔ˜ ·ÊÔ‡ ‰ÂÓ ‰È·ı¤ÙÂÈ ·ÓÙÈÛÒÌ·Ù· Î·Ù¿ ÙˆÓ

Ó¤ˆÓ ·˘ÙÒÓ ∏ Î·È ¡ Î·È ÌÔÚÂ› Ó· ÚÔÎ‡„ÂÈ

·Ó‰ËÌ›· (1-3).

ªÈ· ÌÂ›˙ˆÓ ·ÓÙÈÁÔÓÈÎ‹ ÌÂÙ·‚ÔÏ‹ ‰ÂÓ Â›Ó·È

‰˘Ó·Ùﬁ Ó· Á›ÓÂÈ ‰È· Ì¤ÛÔ˘ ·ÏÒÓ ÁÂÓÂÙÈÎÒÓ

ÌÂÙ·ÏÏ¿ÍÂˆÓ. ªÈ· ÙﬁÛÔ ‰Ú·ÛÙÈÎ‹ ÌÂÙ·ÌﬁÚÊˆ-

ÛË ÙÔ˘ ÈÔ‡ ÂÓ‰¤¯ÂÙ·È Ó· Ú·ÁÌ·ÙÔÔÈËıÂ› ÌÂ

ÙËÓ ·ÓÙ·ÏÏ·Á‹ ÁÂÓÂÙÈÎÔ‡ ˘ÏÈÎÔ‡ ÌÂÙ·Í‡ ‰‡Ô

‰È·ÊÔÚÂÙÈÎÒÓ ÛÙÂÏÂ¯ÒÓ ÁÚ›Ë˜, ﬁÙ·Ó ÌÔÏ‡-

ÓÔ˘Ó Ù·˘Ùﬁ¯ÚÔÓ· Ù· Î‡ÙÙ·Ú· ÂÓﬁ˜ ÍÂÓÈÛÙ‹.

™ÙËÓ ÂÚ›ÙˆÛË ·˘Ù‹, ·Ú¿ÁÂÙ·È ÛÙ¤ÏÂ¯Ô˜ Ô˘

ÂÚÈ¤¯ÂÈ ÌÈÎÙfi ÁÂÓÂÙÈÎfi ˘ÏÈÎfi (reassortant) (3).

ŒÓ· ‹ ÂÚÈÛÛﬁÙÂÚ· ·ﬁ Ù· 8 ÙÌ‹Ì·Ù· ÙÔ˘ ÛÙÂ-

Ï¤¯Ô˘˜ ·˘ÙÔ‡ ÚÔ¤Ú¯ÔÓÙ·È ·ﬁ ÙÔ ¤Ó· ·Ú¯ÈÎﬁ

ÛÙ¤ÏÂ¯Ô˜ Î·È Ù· ˘ﬁÏÔÈ· ·ﬁ ÙÔ ¿ÏÏÔ. ∏ Î·-

Ù·ÓÔÌ‹ ÙÔ˘ ÁÂÓÂÙÈÎÔ‡ ˘ÏÈÎÔ‡ ÙÔ˘ ÈÔ‡ ÙË˜ ÁÚ›-

Ë˜ ÛÂ 8 ÙÌ‹Ì·Ù·, ÙÔ Î·ı¤Ó· ·ﬁ Ù· ÔÔ›· Â-

ÚÈ¤¯ÂÈ ÙÈ˜ ÏËÚÔÊÔÚ›Â˜ ÁÈ· ÌÈ· ‹ ‰‡Ô Úˆ-

ÙÂ˝ÓÂ˜, Â˘ÓÔÂ› ÙËÓ ·Ó¿ÌÈÍË Î·È ·ÓÙ·ÏÏ·Á‹ ÙˆÓ

ÙÌËÌ¿ÙˆÓ ·˘ÙÒÓ (reassortment), ÌÂÙ·Í‡ ‰‡Ô

‰È·ÊÔÚÂÙÈÎÒÓ ÛÙÂÏÂ¯ÒÓ fiÙ·Ó ÌÔÏ‡ÓÔ˘Ó Ù·˘Ùfi¯ÚÔÓ· ÙÔ ›‰ÈÔ Î‡ÙÙ·ÚÔ. ∂¿Ó ÙÔ ÛÙ¤ÏÂ¯Ô˜ Ô˘ ÚÔÎ‡ÙÂÈ ÌÔÚÂ› Ó· ÚÔÛ‚¿ÏÂÈ ÙÔÓ ¿ÓıÚˆÔ Î·È Ó· ÌÂÙ·‰›‰ÂÙ·È ·ÔÙÂÏÂÛÌ·ÙÈÎ¿ ·fi ÙÔÓ

ﬁÙÈ Ù· ÔÈÎﬁÛÈÙ·

ÙËÓ¿ (fiÚÓÈıÂ˜ Î·È Á·ÏÔÔ‡ÏÂ˜) ÚÔÛ‚¿ÏÏÔÓÙ·È ·fi ÈÔ‡˜ ÁÚ›Ë˜ Ô˘ ¤¯Ô˘Ó ÙÔ ‰˘Ó·ÌÈÎfi Ó·

ÚÔÛ‚¿ÏÔ˘Ó Î·È ÙÔÓ ¿ÓıÚˆÔ (6). ¶ÂÈÚ·Ì·ÙÈ-

Î¤˜ ÌÂÏ¤ÙÂ˜ ¤‰ÂÈÍ·Ó ﬁÙÈ ÌÂÚÈÎ¿ ÔÈÎﬁÛÈÙ· ÙËÓ¿

‰ÚÔ˘Ó ˆ˜ ·Ê·ÓÂ›˜ ÔÏÏ·Ï·ÛÈ·ÛÙ¤˜ ÛÙÂÏÂ¯ÒÓ

ÁÚ›Ë˜ ÌÂ ‰˘Ó·ÌÈÎﬁ Ó· ÚÔÎ·Ï¤ÛÔ˘Ó ·Ó‰Ë-

Ì›·, ¯ˆÚ›˜ Ó· ÂÎ‰ËÏÒÓÔ˘Ó Û˘ÌÙÒÌ·Ù·. ¶·Ú¿-

‰ÂÈÁÌ· ·ÔÙÂÏÔ‡Ó ÔÈ ¿ÈÂ˜, ÔÈ ÔÔ›Â˜ Ê¤ÚÔ˘Ó

ÈÔ‡˜ ÁÚ›Ë˜ ÌÂ ·ÈÌÔÛ˘ÁÎÔÏÏËÙ›ÓË ∏5 ¯ˆÚ›˜ ÔÈ

Ó· ÓÔÛÔ‡Ó. ∞ÚÎÂÙ¿ ÚﬁÛÊ·Ù· ·Ú·‰Â›Á-

Ì·Ù· ¤¯Ô˘Ó ‰Â›ÍÂÈ ﬁÙÈ Ô ¿ÓıÚˆÔ˜ ÌÔÚÂ› Ó·

ÁÚ›Ë˜ ÙˆÓ ÙËÓÒÓ Î·È ÂÔÌ¤Óˆ˜, Ô ÚﬁÏÔ˜ ÙÔ˘

ÚÔËÁËıÂ› ·ÓÙ·Ï-

ÁÂÓÂÙÈÎÔ‡ ˘ÏÈÎÔ‡ ÌÂÙ·Í‡ ‰È·ÊﬁÚˆÓ ˘ÔÙ‡ˆÓ ‹ ÛÙÂÏÂ¯ÒÓ ÙÔ˘ ÈÔ‡ Ô˘ Î˘ÎÏÔÊÔÚÔ‡Ó

ÛÂ ‰È¿ÊÔÚ· ˙ˆÈÎ¿ Â›‰Ë Ù·˘Ùﬁ¯ÚÔÓ·.

√È ÚÔËÁÔ‡ÌÂÓÂ˜ ·Ó‰ËÌ›Â˜ ÁÚ›Ë˜

∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ 20Ô‡ ·ÈÒÓ· ÂÎ‰ËÏÒıËÎ·Ó ÙÚÂÈ˜ ·Ó‰ËÌ›Â˜ ÁÚ›Ë˜. ™ÙÈ˜ ·Ó‰ËÌ›Â˜

·˘Ù¤˜ ¤¯Ô˘Ó ‰ÔıÂ› ‰È·ÊÔÚÂÙÈÎ¿ ÔÓfiÌ·Ù·, ·Ó¿ÏÔÁ· ÌÂ ÙÔÓ ÙfiÔ ÛÙÔÓ ÔÔ›Ô Î¿ıÂ ÊÔÚ¿ Ê·ÈÓfiÙ·Ó Ó· ·Ú¯›˙ÂÈ Ë ·Ó‰ËÌ›·. ™‹ÌÂÚ· ıÂˆÚÂ›Ù·È

¶›Ó·Î·˜ 1. ¶·Ú·‰Â›ÁÌ·Ù· ÚﬁÛÊ·ÙˆÓ ÂÈ‰ËÌÈÒÓ ÁÚ›Ë˜ ÛÙ· ÙËÓ¿ ÌÂ ÌÂÙ¿‰ÔÛË ÛÙÔÓ ¿ÓıÚˆÔ ŒÙÔ˜, ÃÒÚ·πﬁ˜ 1995, ∏ÓˆÌ¤ÓÔ µ·Û›ÏÂÈÔ∏7¡7 1997, ÃÔÓÁÎ ∫ÔÓÁÎ∏5¡1 1999, ÃÔÓÁÎ ∫ÔÓÁÎ∏9¡2 2003, ÃÔÓÁÎ ∫ÔÓÁÎ∏5¡1 2003, √ÏÏ·Ó‰›·∏7¡7 2003, ÃÔÓÁÎ ∫ÔÓÁÎH9N2 2004, µÈÂÙÓ¿Ì∏5¡1 2004, ∆·˚Ï¿Ó‰Ë∏5¡1 2004, ∫·Ó·‰¿˜∏7¡3 2004, ∞›Á˘ÙÔ˜∏10¡7

ÂÚÈÛÛfiÙÂÚÔ Èı·Ófi fiÙÈ fiÏÂ˜ ÚÔ‹Ïı·Ó ·fi

ÙËÓ ∫›Ó·, ﬁÔ˘ ¿ÓıÚˆÔÈ, ÙËÓ¿ Î·È ¯Ô›ÚÔÈ

Û˘Á¯ÚˆÙ›˙ÔÓÙ·È (2,4). ∏ ÚÒÙË ‹Ù·Ó Ë ·Ó‰Ë-

Ì›· ÙË˜ πÛ·ÓÈÎ‹˜ ÁÚ›Ë˜ (1918) Î·È ÔÊÂÈÏﬁÙ·Ó

ÛÙÔÓ ˘ﬁÙ˘Ô ∏1¡1. ∏ ·Ó‰ËÌ›· ·˘Ù‹ ‹Ù·Ó Ë

ÛÔ‚·ÚﬁÙÂÚË Î·È ÈÔ Î·Ù·ÛÙÚÔÊÈÎ‹ ÂÈ‰ËÌ›·

ÏÔÈÌÒ‰Ô˘˜ ÓﬁÛÔ˘ Ô˘ ÂÎ‰ËÏÒıËÎÂ ÛÙË ÓÂﬁÙÂ-

ÚË ·ÓıÚÒÈÓË ÈÛÙÔÚ›· Î·È ÛÙÔ›¯ÈÛÂ ÙË ˙ˆ‹ ÛÂ

ÂÚÈÛÛﬁÙÂÚÔ˘˜ ·ﬁ 20 ÂÎ·ÙÔÌÌ‡ÚÈ· ·ÓıÚÒ-

Ô˘˜ (5). √È ‰‡Ô ÂﬁÌÂÓÂ˜ ·Ó‰ËÌ›Â˜ ‹Ù·Ó ·˘-

Ù¤˜ ÙË˜ ∞ÛÈ·ÙÈÎ‹˜ ÁÚ›Ë˜ ÙÔ 1957, ·ﬁ ÙÔ ÛÙ¤-

ÏÂ¯Ô˜ ∏2¡2, Î·È ÙË˜ ÁÚ›Ë˜ ÙÔ˘ ÃÔÓÁÎ ∫ÔÓÁÎ

ÙÔ 1968, Ô˘ ÚÔÎÏ‹ıËÎÂ ·ﬁ ÙÔ ÛÙ¤ÏÂ¯Ô˜

∏3¡2. √È ‰‡Ô ÙÂÏÂ˘Ù·›Â˜ ·Ó‰ËÌ›Â˜ ‹Ù·Ó

ËÈﬁÙÂÚÂ˜ ·ﬁ ·˘Ù‹Ó ÙÔ˘ 1918 Î·È ÚÔÎ¿ÏÂÛ·Ó

ÂÚ› ÙÔ ¤Ó· ÂÎ·ÙÔÌÌ‡ÚÈÔ ı·Ó¿ÙÔ˘˜ Ë Î·ıÂÌ›·. ™‹ÌÂÚ·, ÈÛÙÂ‡ÂÙ·È ﬁÙÈ Î·È ÛÙÈ˜ ‰‡Ô ·˘Ù¤˜ Â-

ÏÂ˘Ù·›· ¯ÚﬁÓÈ· Î˘ÎÏÔÊÔÚÂ› Î˘Ú›ˆ˜

∏3¡2, Ô˘ Û˘Ó¤¯È˙Â Ó· ˘Ê›ÛÙ·Ù·È ÂÏ¿ÛÛÔÓÂ˜

·ÓÙÈÁÔÓÈÎ¤˜ ÌÂÙ·‚ÔÏ¤˜, Î·È ÏÈÁﬁÙÂÚÔ Ô ∏1¡1

Î·ıÒ˜ Î·È ÙÔ ÛÙ¤ÏÂ¯Ô˜ µ. °È· ÙÔÓ ÏﬁÁÔ ·˘Ùﬁ, Ù·

ÂÌ‚ﬁÏÈ· ÁÚ›Ë˜ Î¿ıÂ ¯ÚﬁÓÔ, ÂÚÈ¤¯Ô˘Ó ÙÚ›·

ÛÙÂÏ¤¯Ë ÈÒÓ ÁÚ›Ë˜ ∏3¡2, ∏1¡1 Î·È µ. ™Â ·ÓÙ›ıÂÛË ÌÂ ÙÈ˜ ·Ó‰ËÌ›Â˜ ÙÔ˘ 1957 Î·È

ÙÔ˘ 1968, ·˘Ù‹ ÙÔ˘ 1918 ‰ÂÓ ÚÔ‹ÏıÂ ·ﬁ ·Ó¿-

ÌÈÍË Î·È ·ÓÙ·ÏÏ·Á‹ ÁÂÓÂÙÈÎÔ‡ ˘ÏÈÎÔ‡

(reassortment) ÌÂÙ·Í‡ ‰‡Ô ÛÙÂÏÂ¯ÒÓ (7). ∏

ÚﬁÛÊ·ÙË ·Ó¿Ï˘ÛË ÙÔ˘ ÁÔÓÈ‰ÈÒÌ·ÙÔ˜ ÙÔ˘ ÛÙÂ-

Ï¤¯Ô˘˜ ∏1¡1 ÙË˜ ÁÚ›Ë˜ ÙÔ˘ 1918 ·fi ÙÔ˘˜ Taubeneberger Î·È Û˘Ó, ¤‰ÂÈÍÂ fiÙÈ Î·È Ù· 8 ÁÔÓ›‰È· ÙÔ˘ ÈÔ‡ ÌÔÈ¿˙Ô˘Ó ÂÚÈÛÛfiÙÂÚÔ ÌÂ ÛÙÂÏ¤¯Ë

ÁÚ›Ë˜ ÙËÓÒÓ ·Ú¿ ÌÂ ÛÙÂÏ¤¯Ë Ô˘ ÚÔ¤Ú¯Ô-

ÓÙ·È ·ﬁ ¿ÏÏ· ˙ˆÈÎ¿ Â›‰Ë ‹ ÙÔÓ ¿ÓıÚˆÔ (8).

∆Ô Â‡ÚËÌ· ·˘Ùﬁ ‰Â›¯ÓÂÈ ﬁÙÈ Î¿ÔÈÔ ÛÙ¤ÏÂ¯Ô˜

ÙˆÓ ÙËÓÒÓ ÌﬁÚÂÛÂ Ó· ÚÔÛ‚¿ÏÂÈ ÙÔ˘˜ ·Ó-

ıÚÒÔ˘˜ Î·È Ó· ÚÔÛ·ÚÌÔÛÙÂ› ÛÂ ·˘ÙÔ‡˜, ÒÛÙÂ

Ó· ÌÔÚÂ› Ó· ÌÂÙ·‰›‰ÂÙ·È ·ÔÙÂÏÂÛÌ·ÙÈÎ¿

ı· ÌÔÚ¤ÛÔ˘Ó Ó· ‚ÔËı‹ÛÔ˘Ó ÙÔ˘˜ ÂÚÂ˘ÓËÙ¤˜ ÛÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË

ÈÒÓ ÙˆÓ ÙËÓÒÓ Î·È ÛÙËÓ Úﬁ‚ÏÂ„Ë

ÎÈÓ‰‡ÓÔ˘ ·Ó¿Ù˘ÍË˜ ·Ó‰ËÌ›·˜ (7). ∏ ·ÂÈÏ‹ ÌÈ·˜ Ó¤·˜ ·Ó‰ËÌ›·˜ ·ﬁ ÙÔ ÛÙ¤ÏÂ¯Ô˜ ∏5¡1 ÙË˜ ÁÚ›Ë˜ ÙˆÓ ÙËÓÒÓ

Ÿˆ˜ ·Ó·Ê¤ÚıËÎÂ ·Ú·¿Óˆ, Ù· ˘‰Úfi‚È· Î·È ÌÂÙ·Ó·ÛÙÂ˘ÙÈÎ¿ ÙËÓ¿ ·ÔÙÂÏÔ‡Ó ÙÔ˘˜ Ê˘ÛÈÎÔ‡˜ ÍÂÓÈÛÙ¤˜ ÙˆÓ ÈÒÓ ÙË˜ ÁÚ›Ë˜ Ù‡Ô˘ ∞ Î·È Û˘¯Ó¿ ÚÔÛ‚¿ÏÏÔÓÙ·È ·fi ÛÙÂÏ¤¯Ë Ô˘ Û˘Ó‹ıˆ˜ ¤¯Ô˘Ó ¯·ÌËÏ‹ ÏÔÈÌÔÁfiÓÔ ‰‡Ó·ÌË. √È ÈÔ› ÁÚ›Ë˜ ÔÏÏ·Ï·ÛÈ¿˙ÔÓÙ·È ÛÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi Û‡ÛÙËÌ· ÙˆÓ ÙËÓÒÓ Î·È ·Ô‚¿ÏÏÔÓÙ·È ÌÂ Ù· ÎfiÚ·Ó· ÛÙÔ ÓÂÚfi ÚÔÎ·ÏÒÓÙ·˜ ¤Ó·Ó Î‡ÎÏÔ ÂÓÙÂÚÔ-ÛÙÔÌ·ÙÈÎ‹˜ ÌÂÙ¿‰ÔÛË˜ (10). ∞fi Ù· ˘‰Úfi‚È· ÙËÓ¿, ÔÈ ÈÔ› ÙË˜ ÁÚ›Ë˜ ÌÂÚÈÎ¤˜ ÊÔÚ¤˜ ÌÂÙ·‰›‰ÔÓÙ·È ÛÂ ¿ÏÏ· Â›‰Ë ÙËÓÒÓ, fiˆ˜ ÔÈ fiÚÓÈıÂ˜ ‹ ÔÈ Á·ÏÔÔ‡ÏÂ˜, ·ÏÏ¿ Î·È ÛÂ ıËÏ·ÛÙÈÎ¿. ∏ ‚·Ú‡ÙËÙ· ÙË˜ ÏÔ›ÌˆÍË˜ ÛÙ· Ô˘ÏÂÚÈÎ¿ ÔÈÎ›ÏÏÂÈ ·fi ‹È· ‹ Î·È ·Û˘ÌÙˆÌ·ÙÈÎ‹ ¤ˆ˜ ÛÔ‚·Ú‹, ÂÓÒ ÌÂÚÈÎ¤˜ ÊÔÚ¤˜ Ë ÏÔ›ÌˆÍË Â›Ó·È ı·Ó·ÙËÊfiÚÔ˜. ¶ÚÔÛ‚¿ÏÏÂÙ·È Û˘Ó‹ıˆ˜ ÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi Û‡ÛÙËÌ· ·ÏÏ¿ ÛÂ ÔÚÈÛÌ¤ÓÂ˜ ÂÚÈÙÒÛÂÈ˜ ÌÔÚÂ› Ó· ÚÔÛ‚ÏËıÂ› Î·È ÙÔ ·Ó·ÓÂ˘ÛÙÈÎfi, fiˆ˜ Û˘Ì‚·›ÓÂÈ ÌÂ Ù· ıËÏ·ÛÙÈÎ¿. ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ¤¯ÂÈ ·Ú·ÙËÚËıÂ› fiÙÈ Ù· ÙËÓ¿ ÚÔÛ‚¿ÏÏÔÓÙ·È

ÁÚ›Ë˜. ∫·Ù¿ ‰Â‡ÙÂÚÔ ÏfiÁÔ, Ô Èfi˜ ·˘Ùfi˜ ¤¯ÂÈ ÙËÓ ÈÎ·ÓfiÙËÙ· Ó· ÂÓÂÚÁÔÔÈÂ› ÌfiÓÔ˜ ÙÔ˘ ÙËÓ ·ÈÌÔÛ˘ÁÎÔÏÏËÙ›ÓË ÙÔ˘ Ì¤Ûˆ ÙË˜ ‰Ú¿ÛË˜ ÙË˜ ÓÂ˘Ú·ÌÈÓÈ‰¿ÛË˜ (9). ∏ Û˘ÓÂ¯È˙fiÌÂÓË ÌÂÏ¤ÙË ı· ·˘Í‹ÛÂÈ ÙÈ˜ ÁÓÒÛÂÈ˜ Ô˘ Û‹ÌÂÚ· ¤¯Ô˘ÌÂ Û¯ÂÙÈÎ¿ ÌÂ ÙÔÓ ÙÚfiÔ Ô˘ ‰Ú· ÙÔ ÛÙ¤ÏÂ¯Ô˜ ·˘Ùfi Î·È ÚÔÎ·ÏÂ› ÛÔ‚·Ú‹ ÓfiÛÔ, Î·È ı· ‚ÔËı‹ÛÂÈ ÛÙËÓ ·Ó¿Ù˘ÍË Ó¤ˆÓ ıÂÚ·Â˘ÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ. ¡¤ÔÈ ·Ú¿ÁÔÓÙÂ˜, fiˆ˜ ·˘ÙÔ› Ô˘ ·Ó·ÛÙ¤ÏÏÔ˘Ó ÙË ‰Ú¿ÛË ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ, ÌÔÚÔ‡Ó ÙÒÚ· Ó· ÌÂÏÂÙËıÔ‡Ó ˆ˜ ıÂÚ·Â›Â˜ Ô˘ ÂÓ‰¤¯ÂÙ·È Ó· ÌÂÈÒÛÔ˘Ó ÙË ıÓËÙfiÙËÙ· ÙË˜ ÁÚ›Ë˜ ÛÂ ÂÚ›ÙˆÛË ·Ó‰ËÌ›·˜. ∏ ÚfiÛÊ·ÙË ÌÂÏ¤ÙË ÙˆÓ ÛÙÂÏÂ¯ÒÓ ÁÚ›Ë˜ Ô˘ ÚÔÎ¿ÏÂÛ·Ó ÙÈ˜ ÚÔËÁÔ‡ÌÂÓÂ˜ ·Ó‰ËÌ›Â˜, Î·Ù¿ÊÂÚÂ Ó· ÚÔÛ‰ÈÔÚ›ÛÂÈ ÛËÌ·ÓÙÈÎ¤˜ ÁÂÓÂÙÈÎ¤˜ ÌÂÙ·‚ÔÏ¤˜

¶ÙËÓ¿ÕÓıÚˆÔ˜

∫‡ÙÙ·ÚÔ Ô˘ ¤¯ÂÈ

ÌÔÏ˘ÓıÂ› Ù·˘Ùﬁ¯ÚÔÓ· Î·È ·ﬁ ÙÔ˘˜ ‰‡Ô ÈÔ‡˜

¡¤Ô ÛÙ¤ÏÂ¯Ô˜ ÌÂ ÌÈÎÙfi ÁÂÓÂÙÈÎfi ˘ÏÈÎfi

¶ÙËÓ¿ ÌÂ ÁÚ›Ë ∞ (∏5¡1)

∂ÈÎﬁÓ· 2. ¢ËÌÈÔ˘ÚÁ›· ÂÓﬁ˜

∏ ·Ó¿ÌÈÍË Î·È ·ÓÙ·ÏÏ·Á‹ ÁÂÓÂÙÈÎÔ‡ ˘ÏÈÎÔ‡ (reassortment) ÌÂÙ·Í‡ ·ÓıÚÒÈÓˆÓ ÛÙÂÏÂ¯ÒÓ ÈÔ‡ ÁÚ›Ë˜ Î·È ÛÙÂÏÂ¯ÒÓ

Ô˘ ÚÔÛ‚¿ÏÏÔ˘Ó Ù· ÙËÓ¿ ‰ÈÂ˘ÎÔÏ‡ÓÂÙ·È ·ﬁ ÙË ‰È·›ÚÂÛË ÙÔ˘ ÁÂÓÒÌ·ÙÔ˜ ÙÔ˘ ÈÔ‡ ÙË˜ ÁÚ›Ë˜ ∞ ÛÂ 8 ÙÌ‹Ì·Ù· Î·È

ÌÔÚÂ› Ó· Û˘Ì‚Â› Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù·˘Ùﬁ¯ÚÔÓË˜ ÏÔ›ÌˆÍË˜ ÂÓﬁ˜

∏ Ù·˘Ùfi¯ÚÔÓË ·˘Ù‹ ÏÔ›ÌˆÍË ÌÔÚÂ› Ó· Û˘Ì‚Â› ÛÙÔ˘˜ ¯Ô›ÚÔ˘˜ - ÔÈ ÔÔ›ÔÈ ÌÔÚÔ‡Ó Ó· ÚÔÛ‚ÏËıÔ‡Ó Î·È ·fi ·ÓıÚÒÈÓÔ Èfi Î·È ·fi Èfi ÙˆÓ ÙËÓÒÓ - ‹ ÛÙÔ˘˜ ·ÓıÚÒÔ˘˜. ∆ÚÔÔÔÈËÌ¤ÓË ·fi (5).

˘„ËÏ‹˜ ·ıÔÁÔÓÈÎﬁÙËÙ·˜ ÁÚ›Ë ÙˆÓ ÙËÓÒÓ (high patho-genicity avian influenza, HPAI).

¶ÚÈÓ ·ﬁ ÙÔ 1997, ÂÈÎÚ·ÙÔ‡ÛÂ Ë ¿Ô„Ë

ﬁÙÈ ÔÈ ˘„ËÏ‹˜ ·ıÔÁÔÓÈÎﬁÙËÙ·˜ ÈÔ› ÁÚ›Ë˜ ÙˆÓ

ÙËÓÒÓ (HPAI) ‰ÂÓ ÌÔÚÔ‡Ó Ó· ÚÔÛ‚¿ÏÔ˘Ó

ÙÔ˘˜ ·ÓıÚÒÔ˘˜ ‰ÈﬁÙÈ ˘¿Ú¯Ô˘Ó ÂÚÈÔÚÈÛÌÔ›

ÛÂ ÌÔÚÈ·Îﬁ Â›Â‰Ô Ô˘ ‰ÂÓ ÂÈÙÚ¤Ô˘Ó ÙËÓ

ÌÂÙ¿‰ÔÛË ·fi Ù· ÙËÓ¿ ÛÙÔ˘˜ ·ÓıÚÒÔ˘˜. ∫È ·˘Ùfi ÁÈ·Ù› ÔÈ ¿ÓıÚˆÔÈ ¤¯Ô˘Ó ˘Ô‰Ô¯Â›˜ ÁÈ· ·ÓıÚÒÈÓÔ˘˜ ÈÔ‡˜ Î·È Ù· ÙËÓ¿ ‰È·ı¤ÙÔ˘Ó ˘Ô‰Ô¯Â›˜ ÁÈ· ÙÔ˘˜ ÈÔ‡˜ ÙˆÓ ÙËÓÒÓ. ∏ ÂÎ‰‹ÏˆÛË ÂÈ‰ËÌÈÒÓ ÁÚ›Ë˜ ˘„ËÏ‹˜ ·ıÔÁÔÓÈÎfiÙËÙ·˜ ÛÙ· ÙËÓ¿ ÂÚÈÁÚ¿ÊËÎÂ ÁÈ· ÚÒÙË ÊÔÚ¿ ÙÔ 1878 ˆ˜ “·ÓÒÏË ÙˆÓ ÙËÓÒÓ”, ·ÏÏ¿ ‰ÂÓ Â›-

Â›ÛË˜ Ë ÌÂÙ¿‰ÔÛË ÛÙÂÏÂ¯ÒÓ ÌÂ ·ÈÌÔÛ˘ÁÎÔÏÏËÙ›ÓË ∏7 Ô˘ ÚÔÎ¿ÏÂÛ·Ó ÂÈ-

ÂÊ˘Î›ÙÈ‰· ÛÂ ·ÓıÚÒÔ˘˜.

∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, Èı·ÓfiÙ·Ù· ÏfiÁˆ Î·È

ÙÔ˘ Û‡Á¯ÚÔÓÔ˘ ÙÚﬁÔ˘ ˙ˆ‹˜, ¤¯ÂÈ ·˘ÍËıÂ› Ë

Û˘¯ÓﬁÙËÙ· ÂÌÊ¿ÓÈÛË˜ ÂÈ‰ËÌÈÒÓ ÁÚ›Ë˜ ÛÙ·

ÙËÓ¿. √È ÂÈ‰ËÌ›Â˜ ·˘Ù¤˜ ¤¯Ô˘Ó ÙÂÚ¿ÛÙÈÂ˜

ÔÈÎÔÓÔÌÈÎ¤˜ Û˘Ó¤ÂÈÂ˜ Î·È Ï‹ÙÙÔ˘Ó ÛÔ‚·Ú¿

ÙÈ˜ ÔÈÎÔÓÔÌ›Â˜ ÙˆÓ ¯ˆÚÒÓ ÛÙÈ˜ ÔÔ›Â˜ ÂÎ‰ËÏÒÓÔÓÙ·È.

π‰È·›ÙÂÚË ÛËÌ·Û›· ¤¯ÂÈ Ë ¯ˆÚ›˜ ÚÔËÁÔ‡ÌÂ-

ÓÔ ‰È¿‰ÔÛË ÙÔ˘ ÛÙÂÏ¤¯Ô˘˜ ∏5¡1 ÛÙ· ¿ÁÚÈ·

ÙËÓ¿ Î·È Ù· Ô˘ÏÂÚÈÎ¿ ÛÂ ÔÏÏ¤˜ ·ÛÈ·ÙÈÎ¤˜ ¯ÒÚÂ˜ (11-13). ÃˆÚ›˜ ÚÔËÁÔ‡ÌÂÓÔ Â›Ó·È Â›-

ÔÔ›Â˜ ÔÈ 6 ‹Ù·Ó ı·Ó·ÙËÊﬁÚÂ˜. ∏ ¯ÒÚ· ·˘Ù‹

‹Ù·Ó ÛÂ ı¤ÛË Ó· Ï¿‚ÂÈ ¿ÌÂÛ· Ì¤ÙÚ· ı·Ó·ÙÒÓÔÓÙ·˜ 1,6 ÂÎ·ÙÔÌÌ‡ÚÈ· Ô˘ÏÂÚÈÎ¿ ÌÂ ·ÔÙ¤ÏÂ-

ÛÌ· Ó· ÂÏÂÁ¯ıÂ› Ï‹Úˆ˜ Ë ÂÈ‰ËÌ›·.

·ﬁ ÙË ı·Ó¿ÙˆÛË ÙˆÓ ÙËÓÒÓ ÂÊ·ÚÌﬁÛÙËÎ·Ó

Ù·˘Ùﬁ¯ÚÔÓ· Î·È ·˘ÛÙËÚ¿ ÚÔÏËÙÈÎ¿ Ì¤ÙÚ·.

¢˘ÛÙ˘¯Ò˜, ·ÚﬁÌÔÈ· Ì¤ÙÚ· ‰ÂÓ ‹Ù·Ó ‰˘Ó·Ùﬁ

Ó· ÂÊ·ÚÌÔÛÙÔ‡Ó ÛÂ ¿ÏÏÂ˜ ·ÛÈ·ÙÈÎ¤˜ ¯ÒÚÂ˜ ÌÂ

·ÔÙ¤ÏÂÛÌ· ÔÈ ÈÔ› ∏5¡1 Ó· Î˘ÎÏÔÊÔÚÔ‡Ó ÛÙ·

ÙËÓ¿, È‰È·›ÙÂÚ· ÛÙÈ˜ ¿ÈÂ˜ Î·È ÛÙÈ˜ ¯‹ÓÂ˜,

Î·È Ó· ÌÔÚÔ‡Ó Ó· ˘Ê›ÛÙ·ÓÙ·È ÁÂÓÂÙÈÎ‹ Î·È

·ÓÙÈÁÔÓÈÎ‹ ÂÍ¤ÏÈÍË Î·È Ó· ÂÂÎÙÂ›ÓÔ˘Ó ÙË ÁÂˆ-

ÁÚ·ÊÈÎ‹ ÙÔ˘˜ Î·Ù·ÓÔÌ‹ Î·È ÙÔ Â‡ÚÔ˜ ÙˆÓ ÍÂÓÈ-

ÛÙÒÓ ÙÔ˘˜ ÔÔ›Ô˘˜ ÌÔÚÔ‡Ó Ó· ÚÔÛ‚¿ÏÔ˘Ó.

ŒÙÛÈ ÙÔ 2003 Ô Èﬁ˜ ÂÌÊ·Ó›ÛÙËÎÂ Î·È ¿ÏÈ ÛÂ

¿ÁÚÈ·, ÂÍˆÙÈÎ¿ Î·È ÔÈÎﬁÛÈÙ· ÙËÓ¿ ÛÂ Ê˘ÛÈÎ¿ ¿ÚÎ· ÙÔ˘ ÃÔÓÁÎ ∫ÔÓÁÎ (11,13). ∂Î‰ËÏÒıË-

Î·Ó Ì¿ÏÈÛÙ· Î·È ‰‡Ô ÎÚÔ‡ÛÌ·Ù· ÛÂ ·ÓıÚÒÔ˘˜, ·fi Ù· ÔÔ›· ÙÔ ¤Ó· ‹Ù·Ó ı·Ó·ÙËÊfiÚÔ. ∞fi ÙÔ Ù¤ÏÔ˜ ÙÔ˘ 2003 ¤¯ÂÈ ÛËÌÂÈˆıÂ› Ë ÌÂÁ·Ï‡ÙÂÚË ÛÙËÓ ÈÛÙÔÚ›· ÂÈ‰ËÌÈÎ‹ ¤ÎÚËÍË ÁÚ›Ë˜ ÛÙ· ÙËÓ¿, ÛÙÈ˜ ·ÛÈ·ÙÈÎ¤˜ Î˘Ú›ˆ˜ ¯ÒÚÂ˜. ∂È‰ËÌ›Â˜ ¤¯Ô˘Ó ÛËÌÂÈˆıÂ› ÛÙÔ µÈÂÙÓ¿Ì, ÙËÓ ∆·˚Ï¿Ó‰Ë, ÙËÓ πÓ‰ÔÓËÛ›·, ÙËÓ ∫·ÌfiÙ˙Ë, ÙÔ §¿Ô˜, ÙË ª·Ï·ÈÛ›·, ÙËÓ ∫›Ó·, ÙËÓ ∫ÔÚ¤· Î·È ÙËÓ π·-

ˆÓ›·, ÙË ƒˆÛ›· (‰˘ÙÈÎ‹ ™È‚ËÚ›· Î·È ∫·˙·Î-

ÛÙ¿Ó), ÙËÓ ∆Ô˘ÚÎ›·, ÙË ƒÔ˘Ì·Ó›· Î·È ÙËÓ ∫ÚÔ·Ù›· (15). ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÙÂÏÂ˘Ù·›ˆÓ

ÂÙÒÓ ‰È·ÈÛÙÒıËÎÂ ﬁÙÈ Ù· ÛÙÂÏ¤¯Ë ∏5¡1

¤¯Ô˘Ó ·ÔÎÙ‹ÛÂÈ ÙËÓ ÈÎ·ÓﬁÙËÙ· Ó· ÚÔÛ‚¿-

ÏÔ˘Ó Î·È Ù· ıËÏ·ÛÙÈÎ¿. ™ÙËÓ ∆·˚Ï¿Ó‰Ë ·Ú·-

ÙËÚ‹ıËÎÂ Èﬁ˜ ÁÚ›Ë˜ ∏5¡1 ÛÂ ¯Ô›ÚÔ˘˜ ÛÂ ‰‡Ô

·ÁÚÔÎÙ‹Ì·Ù·, ÛÂ Ù›ÁÚÂÈ˜ Î·È ÏÂÔ·Ú‰¿ÏÂÈ˜ ÛÂ

¤Ó· ˙ˆÔÏÔÁÈÎﬁ Î‹Ô, Î·ıÒ˜ Î·È ÛÂ Á¿ÙÂ˜ ÛÙËÓ

›‰È· ¯ÒÚ· (6).

¶ÚﬁÛÊ·ÙÂ˜ ÌÂÏ¤ÙÂ˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ ﬁÙÈ Ù· ÌÂ-

Ù·Ó·ÛÙÂ˘ÙÈÎ¿ ˘‰Úﬁ‚È· ÙËÓ¿ ·›˙Ô˘Ó ÛËÌ·-

ÓÙÈÎﬁ ÚﬁÏÔ ÛÙËÓ ÂÍ¿ÏˆÛË ÙˆÓ ÈÒÓ ∏5¡1 ·ÊÔ‡ ÌÔÚÔ‡Ó Ó· ‰ÈÂ˘ÎÔÏ‡ÓÔ˘Ó ÙË ÌÂÙ¿‰ÔÛ‹

ÙÔ˘˜ ÛÙÔ˘˜ ˘‰Ô‚ÈﬁÙÔÔ˘˜

Û‹ÌÂÚ· ¤¯Ô˘Ó Î·Ù·ÁÚ·ÊÂ› 3300 ÂÈ‰ËÌ›Â˜ ÙÔ˘ ÈÔ‡ ∏5 ÛÙ· ÙËÓ¿ Î·È 150 ÂÎ·ÙÔÌÌ‡ÚÈ· ¤¯Ô˘Ó ÊÔÓÂ˘ıÂ›, ÂÓÒ ¤¯Ô˘Ó ÛËÌÂÈˆıÂ› ÌfiÏÈ˜ 142 ÂÚÈÙÒÛÂÈ˜ ÛÙÔÓ ¿ÓıÚˆÔ. ∏ ÓfiÛÔ˜ ¤¯ÂÈ Î·È ˘„ËÏ‹ ıÓËÙfiÙËÙ· ·ÊÔ‡ ·fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ 142 ÂÚÁ·ÛÙËÚÈ·Î¿ ÂÈ‚Â‚·ÈˆÌ¤ÓˆÓ ÂÚÈÙÒÛÂˆÓ ÛËÌÂÈÒıËÎ·Ó 74 ı¿Ó·ÙÔÈ ·ÓÂ‚¿˙ÔÓÙ·˜ ÙË ıÓËÙfiÙËÙ· ÛÙÔ 52% (15). √ ı¿Ó·ÙÔ˜ ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ·˘ÙÔ‡˜ Â¤Ú¯ÂÙ·È ÏfiÁˆ ÓÂ˘ÌÔÓ›·˜ Î·È ÔÏ˘oÚÁ·ÓÈÎ‹˜ ·ÓÂ¿ÚÎÂÈ·˜. ªÂÙ¿‰ÔÛË ·fi ¿ÓıÚˆÔ ÛÂ ¿ÓıÚˆÔ ‰ÂÓ ¤¯ÂÈ ·Ô‰ÂÈ¯ıÂ› ÂÚÁ·ÛÙËÚÈ·Î¿, ıÂˆÚÂ›Ù·È fiÌˆ˜ Û¯Â‰fiÓ ‚¤‚·ÈË (14,16). ¶·Ú·ÙËÚ‹ıËÎ·Ó Û˘ÁÎÂÓÙÚÒÛÂÈ˜ ÂÚÈÛÙ·ÙÈÎÒÓ ÛÂ ÌÂÚÈÎ¤˜ ÔÈÎÔÁ¤ÓÂÈÂ˜ Î·ıÒ˜ Î·È ÌÈ· ÂÚ›ÙˆÛË ÌÂÙ¿‰ÔÛË˜ ·fi ÙÔ ¿ÚÚˆÛÙÔ ·È‰› ÛÙË ÌËÙ¤Ú· ÙÔ˘ (17). ™ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ ·˘Ù¤˜, ˘‹ÚÍÂ ÛÙÂÓ‹ Â·Ê‹ ¯ˆÚ›˜ ÚÔÊ˘Ï¿ÍÂÈ˜ Î·È

ÂÏÏÈ‹.

º·›ÓÂÙ·È ÂÔÌ¤Óˆ˜ fiÙÈ, ÚÔ˜ ÙÔ ·ÚfiÓ ÙÔ˘Ï¿¯ÈÛÙÔÓ, Ô Èfi˜ ∏5¡1 ‰ÂÓ ÌÔÚÂ› Ó· ÌÂÙ·‰ÔıÂ› ·ÔÙÂÏÂÛÌ·ÙÈÎ¿ ·fi ¿ÓıÚˆÔ ÛÂ ¿ÓıÚˆÔ Î·È ÂÔÌ¤Óˆ˜ ‰ÂÓ ÌÔÚÂ› Ó· ÚÔÎ·Ï¤ÛÂÈ ·Ó‰ËÌ›·. ªÔÚÂ› fiÌˆ˜ Ô Èfi˜ Ó· ·ÔÎÙ‹ÛÂÈ ÙËÓ ÈÎ·ÓfiÙËÙ· ·˘Ù‹ ·Ó¿ ¿Û· ÛÙÈÁÌ‹, Ì¤Ûˆ ÌÈ·˜ ÚÔÔ‰Â˘ÙÈÎ‹˜ ‰È·‰ÈÎ·Û›·˜ ÚÔÛ·ÚÌÔÛÙÈÎÒÓ ÁÂÓÂÙÈÎÒÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ ‹ ÌÂ ·ÓÙ·ÏÏ·Á‹ ÁÂÓÂÙÈÎÔ‡ ˘ÏÈÎÔ‡ ·fi ¤Ó· ÛÙ¤ÏÂ¯Ô˜ ·ÓıÚÒÈÓÔ˘ ÈÔ‡ ÁÚ›Ë˜ (5). ∏ ‰È·‚›ˆÛË ÙˆÓ ·ÓıÚÒˆÓ ˘fi Û˘Óı‹ÎÂ˜ Û˘Á¯ÚˆÙÈÛÌÔ‡ ÎÔÓÙ¿ ÛÂ Ô˘ÏÂÚÈÎ¿ Î·È ¯Ô›ÚÔ˘˜ ÛÙÈ˜ ·ÛÈ·ÙÈÎ¤˜ ¯ÒÚÂ˜ ·˘Í¿ÓÂÈ ÙËÓ Èı·ÓfiÙËÙ· ÂÎ‰‹ÏˆÛË˜ ÙÔ˘ Ê·ÈÓÔÌ¤ÓÔ˘ ·˘ÙÔ‡. ™ÙËÓ ÂÚ›ÙˆÛË Ô˘ Ô Èfi˜ Î·Ù·ÛÙÂ› ÈÎ·Ófi˜ Ó· ÌÂÙ·‰›‰ÂÙ·È Ù·¯¤ˆ˜ ·fi ¿ÓıÚˆÔ ÛÂ ¿ÓıÚˆÔ ÌÔÚÂ› Ó· ‰È·‰ÔıÂ› ÛÂ ÌÈÎÚfi ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÛÂ ÔÏfiÎÏËÚÔ ÙÔÓ ÎfiÛÌÔ Î·È Ó· ÚÔÎÏËıÂ› ·Ó‰ËÌ›·. ¶ÚÔÂÙÔÈÌ·Û›· ÁÈ· ÙËÓ ÚfiÏË„Ë Î·È ·ÓÙÈÌÂÙÒÈÛË ÌÈ·˜ ·Ó‰ËÌ›·˜

∞ÚÎÂÙ¤˜ ·ÓÂÙ˘ÁÌ¤ÓÂ˜ ¯ÒÚÂ˜, ÌÂÙ·Í‡ ÙˆÓ ÔÔ›ˆÓ Î·È Ë ¯ÒÚ· Ì·˜, ¤¯Ô˘Ó ‹‰Ë ‰È·ÌÔÚÊÒÛÂÈ Û¯¤‰ÈÔ ·ÓÙÈÌÂÙÒÈÛË˜ ÌÈ·˜ ÂÓ‰Â¯fiÌÂÓË˜ ·Ó‰ËÌ›·˜ ÁÚ›Ë˜. ∫¿ÙÈ Ù¤ÙÔÈÔ fiÌˆ˜, ‰ÂÓ Â›Ó·È ÂÊÈÎÙfi ÛÂ ·Ó·Ù˘ÛÛfiÌÂÓÂ˜ ÂÚÈÔ¯¤˜ ÙÔ˘ ÎfiÛÌÔ˘ Ô˘ ‹‰Ë ·ÓÙÈÌÂÙˆ›˙Ô˘Ó ÛÔ‚·Ú¿ ÎÔÈÓˆÓÈÎ¿,

·˘Ùﬁ, ÙÔ Ó¤Ô ÛÙ¤ÏÂ¯Ô˜ ÈÔ‡ Ô˘ ÛÙË Û˘Ó¤¯ÂÈ·

Î·ÏÏÈÂÚÁÂ›Ù·È ÛÂ ·‚Á¿ ÁÈ· Ì·˙ÈÎ‹ ·Ú·ÁˆÁ‹.

™‹ÌÂÚ· ¤¯Ô˘Ó Û¯Â‰È·ÛÙÂ› ÙÔ˘Ï¿¯ÈÛÙÔÓ 10

ÎÏÈÓÈÎ¤˜ ÌÂÏ¤ÙÂ˜ ÂÌ‚ÔÏ›ˆÓ Î·Ù¿ ÙÔ˘ ∏5¡1 ÛÂ

‰È¿ÊÔÚÂ˜ ¯ÒÚÂ˜ Î·È ÛÙÈ˜ ∏.¶.∞., ﬁÔ˘ ¤¯ÂÈ ‹‰Ë

ÍÂÎÈÓ‹ÛÂÈ Ë ‰ÈÂÍ·ÁˆÁ‹ ÔÚÈÛÌ¤ÓˆÓ ·fi ·˘Ù¤˜ (19). ¶ÈÛÙÂ‡ÂÙ·È fiÙÈ ·ÎfiÌË ÎÈ ·Ó Ô Èfi˜ Ô˘ ı·

ÚÔÎ·Ï¤ÛÂÈ ÙËÓ ·Ó‰ËÌ›· Â›Ó·È Î¿ˆ˜ ‰È·ÊÔ-

ÚÂÙÈÎfi˜ ·fi ·˘ÙfiÓ Ô˘ Û‹ÌÂÚ· ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ÂÌ‚ÔÏ›Ô˘, ı· Â›Ó·È ÙÔ˘Ï¿-

¯ÈÛÙÔÓ ·ÚﬁÌÔÈÔ˜ Î·È ÙÔ ÂÌ‚ﬁÏÈÔ ·Ó·Ì¤ÓÂÙ·È

ﬁÙÈ ı· ·Ú¤¯ÂÈ Î¿ÔÈ· ÚÔÛÙ·Û›·. ∏ ·Ú·Áˆ-

Á‹ ÂÌ‚ÔÏ›ˆÓ Û˘Ó·ÓÙ¿ ÚÔ‚Ï‹Ì·Ù· ‰ÈﬁÙÈ Ë ‰È·-

‰ÈÎ·Û›· Â›Ó·È ¯ÚÔÓÔ‚ﬁÚ· Î·È ÌÂ ÙÈ˜ ˘¿Ú¯Ô˘-

ÛÂ˜ Û˘Óı‹ÎÂ˜ ‰ÂÓ Â›Ó·È ‰˘Ó·Ù‹ Ë ·Ú·ÛÎÂ˘‹

ÌÂÁ¿ÏˆÓ ÔÛÔÙ‹ÙˆÓ ÈÎ·ÓÒÓ Ó· Î·Ï‡„Ô˘Ó ÛËÌ·ÓÙÈÎﬁ Ì¤ÚÔ˜ ÙÔ˘

‰È¿ÊÔÚÂ˜

Ô˘ Ô˘ ı· ÂÚÈ¤¯ÂÈ ˙ˆÓÙ·Óﬁ ÂÍ·ÛıÂÓËÌ¤ÓÔ

ÛÙ¤ÏÂ¯Ô˜ Î·È ¤ÙÛÈ ı· Â›Ó·È ·ÚÎÂÙ‹ Ì›· ÌﬁÓÔ ‰ﬁ-

ÛË. ªÂÏÂÙ¿Ù·È Â›ÛË˜, Ë ¯Ú‹ÛË ·ÓÔÛÔÂÓÈÛ¯˘ÙÒÓ (adjuvants) (20,21) Ô˘ ı· ‚ÂÏÙÈÒÛÔ˘Ó ÙËÓ

·ÓÔÛÈ·Î‹ ·¿ÓÙËÛË ÙˆÓ ÂÌ‚ÔÏ›ˆÓ Ô˘ ‰ÔÎÈ-

Ì¿˙ÔÓÙ·È Û‹ÌÂÚ·. ™‹ÌÂÚ· Ë ‰˘Ó·ÙﬁÙËÙ· ÙË˜ ‚ÈÔÌË¯·Ó›·˜ ÁÈ·

·Ú·ÁˆÁ‹ ÂÌ‚ÔÏ›Ô˘ ÁÚ›Ë˜ ‰ÂÓ ÍÂÂÚÓ¿ Ù·

300 ÂÎ·ÙÔÌÌ‡ÚÈ· ‰ﬁÛÂÈ˜ ÙÔÓ ¯ÚﬁÓÔ, ÂÓÒ ˘Ô-

ÏÔÁ›˙ÂÙ·È ﬁÙÈ ÛÂ ÂÚ›ÙˆÛË ·Ó‰ËÌ›·˜ ı·

··ÈÙËıÔ‡Ó ‰ÈÛÂÎ·ÙÔÌÌ‡ÚÈ· ‰ﬁÛÂÈ˜ (19). ∏

‚ÈÔÌË¯·Ó›· ‰ÈÛÙ¿˙ÂÈ Ó· ÂÂÓ‰‡ÛÂÈ Ù· ÙÂÚ¿ÛÙÈ·

ÎÂÊ¿Ï·È· Ô˘ ··ÈÙÔ‡ÓÙ·È ÌÂ ·‚¤‚·ÈË ÛÙÔ

Ì¤ÏÏÔÓ ÙË ˙‹ÙËÛË ÙˆÓ ÂÌ‚ÔÏ›ˆÓ ·˘ÙÒÓ. ¶ÚÔ-

ÙÂ›ÓÂÙ·È ÏÔÈﬁÓ ﬁÙÈ Ë ¯Ú‹ÛË ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ Î·Ù¿

ÙË˜ Û˘ÓËıÈÛÌ¤ÓË˜ ÁÚ›Ë˜ ı· Ú¤ÂÈ ÛÂ ﬁÏÂ˜ ÙÈ˜ ¯ÒÚÂ˜ Ó· ·˘ÍËıÂ› Î·È Ó· ˘ÈÔıÂÙËıÔ‡Ó Ú·ÎÙÈÎ¤˜ ÁÂÓÈÎÂ˘Ì¤ÓË˜ ¯Ú‹ÛË˜ ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡, ÒÛÙÂ Ë ‚ÈÔÌË¯·Ó›· Ó· ·Ó·Ù‡ÍÂÈ ÙË ‰˘Ó·ÙﬁÙËÙ· Ó· ·Ú¿ÁÂÈ ÌÂÁ¿ÏÂ˜

ÂÎÙÚÔÊ‹˜ ÙÔ˘˜ Î·È ÏÂÈÙÔ˘ÚÁ›·˜

·ÁÔÚÒÓ, Î·ıÒ˜ Î·È ÌÂ ÙËÓ ÂÊ·ÚÌÔÁ‹ ·˘ÛÙËÚ‹˜ ÂÈ‰ËÌÈÔÏÔÁÈÎ‹˜ ÂÈÙ‹ÚËÛË˜. ¢Â›ÁÌ·Ù· Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÔÓÙ·È Î·È ·fi Ù· ˘‰Úfi‚È· ÙËÓ¿ ÒÛÙÂ Ó· ·Ú·ÎÔÏÔ˘ıÂ›Ù·È Ë ÂÍ¤ÏÈÍË ÙˆÓ ÈÒÓ ÁÚ›Ë˜. ŸÏÂ˜ ÔÈ ¯ÒÚÂ˜ ÔÊÂ›ÏÔ˘Ó Ó· ·Ó·Ù‡ÍÔ˘Ó ¤Ó· ÂÈ¯ÂÈÚËÛÈ·Îfi Û¯¤‰ÈÔ ·ÓÙÈÌÂÙÒÈÛË˜ ÌÈ·˜ ·Ó‰ËÌ›·˜ ÁÚ›Ë˜. £· Ú¤ÂÈ Ó· ‰ÔıÂ› ‚¿ÚÔ˜ ÛÙË Ï‹„Ë Ì¤ÙÚˆÓ ÚÔÊ‡Ï·ÍË˜ ·fi ÙË ÌÂÙ¿‰ÔÛË ÙË˜ ÓfiÛÔ˘, ÛÙËÓ ‡·ÚÍË ‰È·ı¤ÛÈÌˆÓ ·ÔıÂÌ¿ÙˆÓ ·ÓÙÈ-ÈÈÎÒÓ Ê·ÚÌ¿ÎˆÓ Î·È ÛÙËÓ ÚÔÌ‹ıÂÈ· Â·ÚÎÒÓ ÔÛÔÙ‹ÙˆÓ ÂÌ‚ÔÏ›Ô˘ Î·Ù¿ ÙË˜

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2.Laver WG, Bischofberger N, Webster RG. Disarming flu viruses. Sci Am 1999;280:78-87.

3.Osterhaus A. H5N1: the lessons to be learned. In: Zambon MC, ed. United Kingdom: Advances in influenza. Blackwell Science; 1999. p. 11-17.

4.Laver G, Garman E. Virology. The origin and control of pandemic influenza. Science 2001;293:1776-1777.

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Director of Pediatric Nephrology, Children's Hospital of Pittsburgh and the University of Pittsburgh School of Medicine

Correspondence: Demetrius Ellis, M.D. Children's Hospital of Pittsburgh 3705 Fifth Avenue Pittsburgh, PA 15213 e-mail: ellisd@chp.edu

Evaluation and management of hypertensive crisis in childhood

D. Ellis

Abstract: Hypertensive crisis is relatively uncommon in the paediatric age group and many emergency departments are poorly prepared to manage children with this potentially lethal disorder. This review provides guidelines aimed at facilitating the evaluation and management of children with this disorder.

Key words: Hypertension, paediatrics, hypertensive crisis, hypertensive emergencies.

Abbreviations

BP blood pressure

HTN hypertension

Introduction

Normal blood pressure (BP) levels differ by age, gender and height; accordingly no single BP level defines hypertension (HTN) in all children. Updated BP norms and definitions of HTN in children are provided in the latest of four comprehensive reports (1). HTN is generally defined as the average of three manually obtained systolic BP and/or diastolic BP measurements being ≥95th percentile for age, gender and height.

There are several recent reviews of hypertensive crisis in adults (2-8), but the clinical approach to this topic has been rarely addressed for the paediatric age group (9,10). For purposes of this review, hypertensive crisis is a syndrome classified as either a) hypertensive emergency if there are clinical manifestations of ongoing organ injury, or, b) hypertensive urgency if there are no acute clinical symptoms and evidence for end-organ damage is minimal or absent. The implication is that the former requires immediate reduction in BP, while in the latter BP reduction may take place over hours or days. Although the large majority of children who present in the emergency department with hypertensive crisis have BP above the 99th percentile, hypertensive crisis is not strictly defined by absolute BP levels.

In the absence of known preexisting renal disorder, which often predisposes to hypertensive crisis, the possibility must be considered of previously unrecognized cardiac and endocrino-

logic aetiologies of HTN, which may strongly influence the therapeutic choice for individuals in the emergency department. This brief report describes a practical clinical approach to the diagnosis and immediate management of the child presenting with hypertensive crisis, which may be facilitated by means of an algorithm, along with a table of potentially useful agents and dosage guidelines suitable for the paediatric age group. The goal of therapy is to prevent the catastrophic consequences of this potentially lethal disorder.

Symptoms and signs

Unlike adults, in whom hypertensive crises usually occur in individuals with known and often severe preexisting HTN, in children the discovery of HTN is often made at the time of presentation with a hypertensive crisis. Symptoms of HTN in children depend on the acute nature of the development of HTN as well as on the magnitude of the BP elevation. Hence, in a child with chronic HTN secondary to renal artery stenosis, mild to moderate HTN is usually well tolerated whereas the same BP level may cause severe headache or seizures in a child with acute glomerulonephritis. Similarly children with cardiac outlet obstruction or cardiomyopathy may become symptomatic despite mild HTN.

The most common symptoms of HTN in the majority of older children who present in the emergency department are those of hypertensive encephalopathy, namely headache, nausea, vomiting, mental confusion, blurred vision, agitation or frank seizures. Other manifestations

may include cerebral infarction, intracerebral or retinal haemorrhage, congestive heart failure, acute pulmonary oedema (with shortness of breath), acute renal insufficiency, and microangiopathic haemolytic anaemia. Less common sequelae of hypertensive crisis in children include myocardial infarction and aortic dissection. Newborns and infants with severe hypertension may present with congestive heart failure, hypertensive retinopathy, respiratory distress, apnoea or cyanosis, extreme irritability, hypotonia, convulsions or coma. Vomiting, diarrhoea and failure to thrive may be among the chronic manifestations of hypertension in the younger age group.

Causes of hypertensive crisis

Table 1 lists the main causes of hypertensive crisis in children. Renal disorders predominate and these include renovascular hypertension (including renal artery stenosis and aortic coarctation), accelerated HTN in children with renal failure and fluid overload together with pre-existing HTN, acute glomerulonephritis, haemolytic-uremic syndrome and other renal parenchymal disorders. Less common causes are vasculitis, head injury and phaeochromocytoma.

Pathophysiology of hypertensive emergencies

The ability to maintain almost constant perfusion to an organ over a wide range of mean arterial pressures ranging from 60-150 mmHg is known as autoregulation of blood flow. This process is mediated by multiple neurohumoral mechanisms which affect vascular resistance, and is particularly effective and well guarded in the cerebral and renal circulations. Chronic HTN leads to compensatory, functional and structural changes in arterial vessels, which maintain perfusion to these organs while protecting against injury that may otherwise result from organ hyperperfusion due to HTN (11). When the systemic BP surpasses the compensatory limits of autoregulation, arterial injury, such as fibrinoid necrosis and organ ischaemia, may follow (5, 12). Conversely when the BP is suddenly reduced below the new steady state limits of compensation, ischaemic injury may

be enhanced, particularly in individuals with structural hypertensive arterial changes. Most children with hypertensive emergencies do not have structural vascular lesions and are, therefore, less susceptible to organ ischaemia after lowering of the BP. Conversely, the lack of adaptive responses in children with an acute and rapid rise in BP may predispose to symptoms at BP levels which may not be gauged as being sufficiently high to produce such symptoms.

Evaluation of hypertensive emergencies

The algorithm shown in the Figure may facilitate the clinical assessment and management of the symptomatic child with hypertensive emergency. A similar approach may be applied in the child with hypertensive urgency, in which case the

Table 1.

ñ Abrupt increase in blood pressure in children with chronic hypertension (most common in those with renal disorders or on dialysis)

ñ Renovascular hypertension, including renal artery stenosis, partial arterial thrombosis especially in neonates with umbilical arterial lines, aortic coarctation

ñ Parenchymal renal disease (polycystic kidney disease, vasculitis, acute glomerulonephritis, hemolytic uraemic syndrome, renal scarring associated with pyelonephritis or reflux nephropathy)

ñ Renin-secreting tumour (Wilm's tumour, nephroblastomatosis, Drash syndrome)

ñ Ingestion of drugs (sympathomimetic agents [cocaine, amphetamines, phencyclidine hydrochloride, lysergic acid diethylamide, diet pills], tricyclic antidepressants, anabolic steroids, chlorpromazine, oral contraceptives, erythropoietin, cyclosporine, monoamine oxidase inhibitors, corticosteroids, nonsteroidal anti-inflammatory agents)

ñ Acute withdrawal of antihypertensive drugs (clonidine or centrally acting agents and ‚-antagonists)

ñ Ingestion of tyramine in conjunction with use of a monoamine oxidase-inhibitor

ñ Cushing's syndrome, syndrome of apparent mineralocorticoid excess, or glucocorticoid-excess states

ñ Phaeochromocytoma, neuroblastoma or ganglioneuroma

ñ Head injury, brain tumours, increased intracranial pressure

ñ Autonomic hyperactivity in patient with GuillainBarre or other spinal-cord syndromes

ñ Porphyria

ñ Hypercalcaemia

Causes of hypertensive crisis

time course needed to obtain the diagnostic studies or to implement therapeutic measures can be prolonged.

Initial evaluation includes inspection of the optic fundi for hypertensive arterial changes, mental status and neurologic assessment, and careful cardiac, pulmonary and abdominal examination to uncover cardiac dysfunction, pulmonary oedema or masses. Physical examination should include auscultation for carotid and ab-

dominal bruits along with assessment of pulses in the radial, femoral and pedal arteries, and BP measurement in both the upper and lower extremities. These examinations, together with inspection of the skin for café au lait spots, striae, adenoma sebaceum or malar rash, may provide clues as to the aetiology of HTN. The medical history may indicate pre-existing renal disorders, urinary tract infections, or other infectious illnesses which may be associated with renal involvement, such as acute

Figure. Hypertensive crisis management guidelines.

glomerulonephritis. A history of illicit or prescribed drug use which may precipitate or aggravate pre-existing HTN may be helpful.

Urinalysis and measurement of BUN, serum creatinine, electrolytes, calcium, phosphorus, magnesium and uric acid may provide evidence of renal involvement. Because anti-hypertensive therapy may alter plasma levels of renin, cortisol and aldosterone, as well as urinary VMA excretion, in undiagnosed cases, these measurements should be obtained before administering anti-hypertensive drugs. A plasma toxicology screen may be useful in children with suspected substance abuse. Chest X-ray and EKG or echocardiogram should also be done as early as possible. Once the BP improves, children with severe encephalopathy or focal neurologic deficit may be escorted by an emergency department physician to the radiology department, where computerized cranial tomography may be done to diagnose or eliminate thrombotic or haemorrhagic events.

General principles of management

There have been no controlled clinical trials of treatment of hypertensive emergencies or hypertensive urgencies in children. A review of multiple adult studies failed to produce statistical superiority of any single therapeutic agent and the outcome was not uniform between studies (6). Experience is accruing from clinical trials on adults with hypertensive emergencies of the calcium channel inhibitor lacidipine or the ·1adrenergic receptor blocker urapidil, administered for specific indications (6,13). However, it is the author's opinion that the newer vascular dopamine receptor agonist (DA1), fenoldopam (14) shows the most promise, particularly in replacing intravenous nitroprusside in children with renal dysfunction. Employment of the newer agents may be more appropriate for hypertensive emergencies due to disorders not frequently encountered in childhood, such as atherosclerotic cerebrovascular and renal arterial disease, HTN associated with pregnancy, or aortic dissection. Hence, reliance on older agents is still preferred.

As a general rule agents with a short duration of action are employed, so that if BP reduction is gauged as excessive, the effect can be quickly reversed by stopping the agent and/or administering normal saline. A major long-term objective

is to assure compliance with antihypertensive therapy during follow-up (7,8).

The goal of emergency therapy is to achieve a gradual decrease in systolic and diastolic BP to near the 99th percentile, or to reduce the mean arterial pressure (one third of the pulse pressure difference added to the diastolic BP) by 25%. With such reduction in BP over a period of minutes or hours the symptoms and signs of hypertension tend to improve or resolve. Further lowering in BP may be effected more slowly over several days or weeks in such a way that the BP remains below the 90th percentile for age, gender and height percentile (1).

Choice of oral vs. intravenous therapy in hypertensive crisis

In general, if a renal aetiology for the HTN can be readily ascertained and the child is capable of swallowing, the initial therapy in the emergency department may consist of oral agents. If the aetiology of HTN cannot be established, the initial agent could be intravenous hydrallazine, with oral or trans-dermal clonidine as an adjunctive agent. If HTN persists, the child is admitted to the intensive care unit (ICU) where more powerful parenteral agents may be urgently administered and BP can be monitored continuously and directly through an intra-arterial transducer. A list of antihypertensive agents and the recommended dosages for children with hypertensive crisis are shown in Table 2.

Specific disorders such phaeochromocytoma or drug-induced HTN from catecholamine excess (cocaine intoxication, monoamine oxidase inhibitor crisis) may be managed with an alpha adrenergic blocker such as phentolamine, while avoiding initial use of beta blockers which may potentiate the alpha adrenergic action of catecholamines. Intravenous diuretics may be very useful as adjunctive agents in the case of congestive heart failure in disorders accompanied by fluid overload, such as acute glomerulonephritis.

Oral agents used to manage hypertensive crisis

Assuming that the child does not have severe neurological symptoms and is capable of

Table 2. Pharmacologic management of hypertensive crisis in infants and in children

ActionAgents

DoseRouteComments (trade names)

VasodilatorHydrallazine

0.1-0.2 mg/kgIVAdminister at <0.2 mg/kg/minute; (Apresoline, others)(maximum onset 5-20 minutes; lower dose can 20 mg/dose)be repeated after 5-20 minutes. Duration is 2-6 hours. Can cause reflex tachycardia. Available in 20 mg/ml ampoule.

Minoxidil 0.1-0.2 mg/kgOralOnset ≤30 minutes; maximum effect (Loniten)(maximum @ 2-8 hours; long duration of effect, 50 mg/day)once daily dosing, contraindicated in phaeochromocytoma.

Diazoxide 1-3 mg/kgIV pushAdminister IV push over 10-30 (Hyperstat)(maximum seconds, maximum effect within 150 mg dose)5 minutes, can be repeated after 5 minutes, duration of effect 3-12 hours. Available in 300 mg/30 ml ampule. Alternative dosage is 1 mg/kg every 5-15 minutes until BP control is achieved.

Sodium nitroprusside 0.25-8 mcg/kg/minIV dripAdminister by continuous infusion (Nipride)only; onset within 2 minutes, duration <10 minutes. Start at 0.25 mcg/kg/minute and increase dose by 25% every 5-10 minutes until BP control is obtained. Obtain thiocyanate levels if used for more than 48 hours; protect from light. Available in 50 mg/ 5 ml vial.

Adrenergic alpha Labetalol 0.2-0.5 mg/kg/doseIV Administer IV over 2-3 minutes; and beta (Normodyne, (maximum onset 2-5 minutes; maximum effect blocking agentsTrandate)1mg/kg)in 5-15 minutes, duration 2-4 hours; lower dose can be doubled and repeated at 15 minute intervals x 2; can also be given at same dose by IV infusion over 1 hr. Avoid if child has history of asthma / bronchospasm. Contraindicated in congestive heart failure, sinus tachycardia, heart block. Available as 5 mg/ml.

Clonidine 5-10 mcg/kg/day OralDivide dose and administer q 6-12 (Catapres)(maximum hours. Also available in transdermal 25 mcg/kg/day)formulation. Avoid in cerebrovascular disorders. May cause agitation, insomnia, drowsiness, rebound hypertension after rapid withdrawal.

Esmolol Loading dose: IV dripUse for postoperative hypertension; (Brevibloc)500 mcg/kg IV, administer loading dose over 1 then use as minute; followed by continuous continuous infusion infusion; onset: beta blockade occurs 50-250 mcg/kg/min in 2-10 minutes; duration 10-30 minutes (short). Contraindicated in congestive heart failure, sinus tachycardia, heart block.

Table 2. Pharmacologic management of hypertensive crisis in infants and in children

ActionAgents

(trade names)

Isradipine

DoseRouteComments

0.2-0.9 mg/kg/dayOralAvailable in capsules (2.5 and 5 mg) (DynaCirc)(maximum and in liquid formulation 0.6 mg/kg/day)(1 mg/mL). May cause tachycardia or congestive heart failure.

Calcium-channel Nifedipine0.2-0.5 mg/kg

OralSwallow whole, or bite capsule and blocking agents(Procardia, others)(Initial dose should swallow, or remove liquid from not exceed capsule with syringe; not effective by 0.25 mg/kg)sublingual route (actual effect due to swallowing the drug with subsequent rapid oral absorption); initial dose can be repeated once within 30 minutes. Onset of effect within 1-5 minutes after bite and swallow, contraindicated in patients with heart disease; available in 10 and 20 mg capsules.

Nicardipine1 mcg/kg/minIV dripOnset 10 minutes; duration (Cardene IV)(maximum 2-6 hours; available as 2.5 mg/ml 5 mcg/kg/min)

Alpha-adrenergic Phentolamine0.05-0.1 mg/kg/doseIVDiagnostic test for blocker(Regitine)(maximum 5 mg)phaeochromocytoma. Onset immediate; maximum effect in 2 minutes, duration 30 minutes; available in 5 mg vial.

ACE inhibitorsEnalaprilat5-10 mcg/kg/doseIVAdminister undiluted over 5 minutes; onset ≤15 minutes; maximum effect in 1 hour; duration 4-6 hours. Severe hypotension can occur in sodium or volume depleted patients. Use lower dosages in neonates.

swallowing medications, the use of oral medication may be limited to children with hypertensive emergencies or urgencies associated with known or suspected renal disorders.

Short-acting nifedipine is currently a very popular drug for use in this situation. Unlike adults, where studies show that the use of this agent may be associated with a precipitous fall in BP and increased risk of myocardial infarction, stroke and death (15), data on children indicate that use of nifedipine is safe and effective (16, 17). However, both the clinical situation and the initial dose may modify safety. Guidelines for avoidance of the use of short acting nifedipine in children include:

1. Congestive heart failure, presence of myocardial ischaemia, after cardiac arrest, severe left ventricular hypertrophy, left ventricular outflow obstruction, or cardiac arrhythmia.

2. Acute hypertension with high cardiac out-

put states, such as sickle cell crisis or other chronic anaemias.

3. Cyanotic heart disease.

4. Hypovolaemic states including children with anasarca, those undergoing acute diuresis, or those with acute haemorrhage.

5. Acute hypertension associated with severe pain. The BP should be reassessed after administration of appropriate analgesics such as morphine.

6. Acute central nervous system injury.

7. Children receiving large dosages of beta blockers, such as atenolol or labetolol.

8. Infants less than one year of age.

In the absence of such conditions, orthostatic hypotension is usually avoided when the starting dose of nifedipine is 0.2 to 0.25 mg/kg body weight. Although it is often given sublingually, very little of the agent is actually absorbed via the oral mucosa. Thus, if the entire 10 mg nifedipine

capsule is to be used the “bite and swallow” method is recommended. If lesser amounts are needed, the contents of the 10 mg capsule are drawn into a 1 mL graded syringe and the portion needed (0.034 mL = 1 mg) may be administered orally so as to speed up gastrointestinal uptake and onset of action. This dose may be repeated once within 30 minutes. All subsequent dosages should not exceed 0.5 mg/kg body weight, with a maximum of 10 mg, and the frequency of administration may be every 4-6 hours. Close BP monitoring is mandatory and such children should not ambulate after receiving the medication unless they are completely free of orthostatic hypotension, dizziness or mental disturbances.

Minoxidil is an alternative oral agent, with properties of smooth arterial muscle relaxation (leading to vasodilation), which may be effective in overcoming hypertensive emergencies. Close BP monitoring and avoidance of ambulation is recommended after its use also.

Intravenous agents used to manage hypertensive crisis

In children who are unable to take oral shortacting nifedipine or minoxidil, or in those with severe neurological symptoms, intravenous medications are preferred. Diozoxide is rarely used for this purpose because of unpredictable or precipitous drops in BP. Hydrallazine has become less popular because of the common sideeffects of flushing, tachycardia, nausea and headache, although it is still useful in the emergency department setting. With more severe or refractory symptomatic HTN more potent intravenous medications are indicated.

In all instances in which intravenous medications other than hydrallazine are administered, the child should have an arterial line inserted for BP monitoring. In addition co-administered medications must be reviewed for possible synergism or drug interaction, which may exacerbate adverse effects of antihypertensive agents.

The most useful parenteral agents in children include sodium nitroprusside (9,18,19), nicardipine (20-22), and labetalol (23,24); esmolol may be a preferred drug for use in infants (9,23,25,26). These agents may be given as a constant infusion and have an onset of action of less than 5 minutes. Generally, these medications should be started with the lower dosages and increased stepwise by

25% every 5-10 minutes until the desired BP is reached.

Sodium nitroprusside may be the initial intravenous agent in any child presenting with hypertensive emergency, with the exception of closed head injury or suspected high intracranial pressure. With long-term use of this agent, accumulation of its metabolic end products, comprising cyanide and thiocyanate, may cause nausea, vomiting, neurological symptoms, hypothyroidism, dyspnoea and metabolic acidosis. Nicardipine may be more suitable for use in individuals with renal insufficiency who are unable to excrete these metabolites effectively. Less frequently, nicardipine may also be given as mini-boluses. Fenoldopan is a newer agent which is also effective and uniquely suitable for managing HTN in the case of renal insufficiency (5,6,14). Esmolol, labetalol (23,24) and enlaprilat (10,27) may be particularly useful in infants. Esmolol can be given by constant infusion while all three agents can be administered on an intermittent basis. Intravenous labetalol is particularly useful in the management of HTN after transplantation, associated with cyclosporine or tacrolimus given in conjunction with glucocorticoids. It can also be administered as an infusion over 1-hr. As with esmolol and other beta blockers, labetalol should be avoided or be used with caution in children with reactive airway disease, and with consideration of other contraindications to their use (Table 2). Infants are particularly susceptible to enalaprilat-induced inhibition of angiotensin II, and may develop significant reduction in renal blood flow and glomerular filtration rate. Hence, enalaprilat (IV enalapril) should be used with caution in infants with known or suspected renal artery stenosis. However, this agent may be used to manage renovascular HTN due to microthrombi associated with intubation of the umbilical vessels.

Acknowledgements

My gratitude to Dr. Bill McGhee and for confirming the paediatric drug dosages shown in Table 2, and to Mrs. Anne Spence who aided in the preparation of the algorithm.

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4th Pediatric Clinic of the Aristotle University, Papageorgiou Hospital, Thessaloniki

Correspondence:

Chalemis Zacharias 25, S. Karatza Str., Kalamaria 551 32, Thessaloniki E-mail: zaxosped@hol.gr

Date of submission: 07-06-2005

Date of approval: 30-09-2005

Ê·ÁÔÎ‡ÙÙˆÛË ÙˆÓ ·ÈˆÚÔ‡ÌÂÓˆÓ ÛˆÌ·ÙÈ‰›ˆÓ, ÂÎÎÚ›ÓÔ˘Ó Î˘ÙÔÎ›ÓÂ˜, ÔÈ ÔÔ›Â˜ -ÌÂÙ·Í‡ ¿ÏÏˆÓ- ÚÔÎ·ÏÔ‡Ó ·‡ÍËÛË ÙË˜ ÂÓ‰ÔıËÏ›ÓË˜ (∂∆-1) ÛÙÔ ·›Ì·, ÌÂ ·ÔÙ¤ÏÂÛÌ· ·ÁÁÂÈÔÛ‡Û·ÛË, ·‡ÍËÛË ÙË˜ ·ÚÙËÚÈ·Î‹˜ ›ÂÛË˜ Î·È ·˘ÍËÌ¤ÓÔ Î›Ó‰˘ÓÔ ÛÙÂÊ·ÓÈ·›·˜ ÓﬁÛÔ˘ Î·È ÂÌÊÚ¿ÁÌ·ÙÔ˜. ∆· ·È‰È¿ Â›Ó·È ÈÔ Â˘·›ÛıËÙ· ÛÙËÓ ·¤ÚÈ· Ú‡·ÓÛË, Ì·˙› ÌÂ ÙÔ˘˜ ˘ÂÚ‹ÏÈÎÂ˜, ÙÔ˘˜ ¯ÚﬁÓÈÔ˘˜ ÓÂ˘ÌÔÓÔ·ıÂ›˜ Î·È ÙÔ˘˜ Î·Ú‰ÈÔ·ıÂ›˜, ÂÓÒ

The effect of air pollution and the effects of fine particulate matter on the circulatory system

Z. Chalemis, G.

Varlamis

Abstract: Inhaled air pollutants and especially ambient air particulate matter (PM) have been identified as causing respiratory problems, cancer and heart disease, in both adults and children, even to the extent that increased mortality is observed in periods of increased PM air pollution. Here a brief review is made of PM and its effects in humans, with emphasis on the cardiovascular system. Special emphasis has been given to the dangers in childhood, when the mechanisms of autoprotection are less well developed. The most dangerous particles are the “fine” (aerodynamic diameter <2.5 Ìm, PM2.5) and the “ultrafine” (aerodynamic diameter <0.1 Ìm, PM0.1) particles, as they are solvable, can be transmitted easily into the circulation and exert immediate action on various systems, including the heart. In the cardiovascular system they may cause arrhythmias, exacerbation of ST-segment, bradycardia, arterial vasoconstriction even myocardial infarction. The direct effect on the autonomic nervous system can lead to dangerous tachycardia or even inidism. When alveolar macrophages are exposed to PM produce cytokines, which promote increase of the levels of endothelin-1 (ET-1) in the blood. This results in vasoconstriction, a rise in blood pressure and increased risk of coronary heart disease and myocardial infarction. Children, the elderly and patients with chronic cardiovascular disease are the groups most sensitive to air pollution, but recently even intrauterine fetal death has been reported.

Key words: Air pollution, particulate matter, cardiovascular system.

∂ÈÛ·ÁˆÁ‹

∏ Û¯¤ÛË ÙˆÓ ·ÈˆÚÔ‡ÌÂÓˆÓ ÛˆÌ·ÙÈ‰›ˆÓ ÙÔ˘ ·¤Ú· ÛÙËÓ ·ıÔÏÔÁ›· ÓfiÛˆÓ ÙÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Î·È ÙÔ˘ Î·ÚÎ›ÓÔ˘ ÙÔ˘ ÓÂ‡ÌÔÓ· ¤¯ÂÈ ·Ô‰ÂÈ¯ıÂ› Â‰Ò Î·È ·ÚÎÂÙ¿ ¯ÚfiÓÈ· (1-4). ∆ËÓ ÙÂÏÂ˘Ù·›· ‰ÂÎ·ÂÙ›· ¤¯ÂÈ ·Ó·ÁÓˆÚÈÛıÂ› Ô ÚfiÏÔ˜ ÙÔ˘˜ Î·È ÛÂ ·ı‹ÛÂÈ˜ ÙÔ˘ Î·Ú‰È·ÁÁÂÈ·ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, ÙfiÛÔ ÌÂ ÂÈ‰ËÌÈÔÏÔÁÈÎ¤˜ ÌÂÏ¤ÙÂ˜, fiÛÔ Î·È ÌÂ ÂÈÚ·Ì·ÙÈÎ¤˜ ÂÚÁ·-

Û›Â˜ (5-7), ÛÙÈ˜ ÔÔ›Â˜ ·Ô‰ÂÈÎÓ‡ÂÙ·È ﬁÙÈ Ë ·‡-

ÍËÛË ÙË˜ ·¤ÚÈ·˜ Ú‡·ÓÛË˜ Û¯ÂÙ›˙ÂÙ·È ÌÂ ·‡ÍËÛË ÙË˜ ÓÔÛËÚﬁÙËÙ·˜, ÙˆÓ ÂÈÛ·ÁˆÁÒÓ ÛÂ ÓÔÛÔ-

ÎÔÌÂ›· Î·È ÙË˜ ıÓËÛÈÌﬁÙËÙ·˜ ·ﬁ Î·Ú‰È·ÁÁÂÈ·-

Î¿ ·›ÙÈ·. ∫¿ıÂ ÁÂˆÁÚ·ÊÈÎ‹ ÂÚÈÔ¯‹ Î·È Î¿ıÂ

ﬁÏË ¤¯ÂÈ ÙË ‰ÈÎ‹ ÙË˜ ÔÈÎÈÏ›· Ú‡ˆÓ. ŒÙÛÈ ÔÈ

ı¿Ó·ÙÔÈ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÙËÓ ·¤ÚÈ· Ú‡·ÓÛË

‰È·Ê¤ÚÔ˘Ó ÛÙÈ˜ ‰È¿ÊÔÚÂ˜ ÛÙ·ÙÈÛÙÈÎ¤˜ (2-7).

∂›‰Ë ÛˆÌ·ÙÈ‰›ˆÓ

∆· ∞ÈˆÚÔ‡ÌÂÓ· ™ˆÌ·Ù›‰È· (∞™), Ù· ÔÔ›·

ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›· ·Ó·Ê¤ÚÔÓÙ·È ˆ˜

Particulate Matter (PM), Â›Ó·È ÛÙÂÚÂ¿ ‹ ˘ÁÚ¿

ÛˆÌ·Ù›‰È· (ÛÙ·ÁÔÓ›‰È·), Ô˘ ‚Ú›ÛÎÔÓÙ·È ÛÂ ‰È·-

ÛÔÚ¿ ÛÙËÓ ·ÙÌﬁÛÊ·ÈÚ· Î·È Î·Ï‡ÙÔ˘Ó Â˘Ú‡

Ê¿ÛÌ· ÌÂÁÂıÒÓ, ÌÂ ·ÂÚÔ‰˘Ó·ÌÈÎ‹ ‰È¿ÌÂÙÚÔ d ·ﬁ <0,1 Ìm Ì¤¯ÚÈ >100 Ìm. ∞ÔÙÂÏÔ‡ÓÙ·È ·ﬁ

ÌÂ›ÁÌ· ÚÔ˚fiÓÙˆÓ Î·‡ÛÂˆÓ, ‚·Ú¤ˆÓ ÌÂÙ¿ÏÏˆÓ, ¯ËÌÈÎÒÓ ·Ï¿ÙˆÓ Î·È ‚ÈÔÏÔÁÈÎÒÓ ˘ÏÈÎÒÓ fiˆ˜ ÌÈÎÚfi‚È·, ÈÔ› Î·È ÂÓ‰ÔÙÔÍ›ÓÂ˜ (8). ∏ ¯ËÌÈÎ‹ ÙÔ˘˜

Û‡ÛÙ·ÛË ‰È·Ê¤ÚÂÈ ·Ó¿ÏÔÁ· ÌÂ ÙËÓ ËÁ‹ ÂÎÔÌ‹˜ ÙÔ˘˜. ¢È·ÎÚ›ÓÔÓÙ·È ·Ó¿ÏÔÁ· ÌÂ ÙÔ Ì¤ÁÂıfi˜ ÙÔ˘˜ ·) ÛÂ “·Ó¿ÈÙ·”, ÌÂ ÌÂÁ¿ÏÔ Ì¤ÁÂıÔ˜ (>10 Ìm) Î·È ÌÈÎÚfi ¯ÚfiÓÔ ·ÈÒÚËÛË˜, Ô˘ Î·Ù·ÎÚ·ÙÔ‡ÓÙ·È ·fi ÙÔÓ ÚÈÓÈÎfi ‚ÏÂÓÓÔÁfiÓÔ Î·È ‰ÂÓ ÂÈÛ¤Ú¯ÔÓÙ·È ÛÙÔÓ ÔÚÁ·ÓÈÛÌfi, ‚) ÛÂ “·Ó·ÓÂ‡ÛÈÌ·” (coarce, PM10 2,5-10 Ìm), Ù· ÔÔ›· ·Ó¿ÏÔÁ· ÌÂ ÙË ¯ËÌÈÎ‹ ÙÔ˘˜ Û‡ÛÙ·ÛË ÂÓÔ¯ÔÔÈÔ‡ÓÙ·È ÁÈ· ·ÛıÌ·ÙÈÎ¤˜ ÎÚ›ÛÂÈ˜, Ì¤¯ÚÈ Î·ÚÎ›ÓÔ ÙÔ˘ ÓÂ‡ÌÔÓ·, Á) ÛÂ “ÏÂÙ¿” ‹ “ÌÈÎÚ¿” (fine PM2,5 <2,5 Ìm) Î·È ‰) ÛÂ “ÔÏ‡ ÏÂÙ¿” ‹ “ÔÏ‡ ÌÈÎÚ¿” (ultrafine PM0,1 <0,1 Ìm) ÛˆÌ·Ù›‰È·. √È ‰‡Ô ÙÂÏÂ˘Ù·›Â˜ Î·ÙËÁÔÚ›Â˜ ÛˆÌ·ÙÈ‰›ˆÓ ÂÓÔ¯ÔÔÈÔ‡ÓÙ·È ÁÈ· ÙÈ˜ ‚Ï¿‚Â˜ ÛÙÔ Î˘ÎÏÔÊÔÚÈÎfi Û‡ÛÙËÌ·, Î·ıÒ˜ Â›Ó·È ‰È·Ï˘Ù¿ Î·È ·fi ÙÈ˜ Î˘„ÂÏ›‰Â˜ ÌÂÙ·Ê¤ÚÔÓÙ·È ·Â˘ıÂ›·˜ ÛÙË ÁÂÓÈÎ‹ Î˘ÎÏÔÊÔÚ›· (8). ∆· ÈÔ ÂÈÎ›Ó‰˘Ó· ∞™ Â›Ó·È ÙÔ˘ ÌÔÏ‡‚‰Ô˘ (·fi ‚ÂÓ˙›ÓÂ˜ ÌÂ ·ÓÙÈÎÚÔÙÈÎ¿), ÙÔ˘ ·ÌÈ¿ÓÙÔ˘ (˘ÏÈÎ¿

·˘ÙÔÎÈÓ‹ÙˆÓ) Î·ıÒ˜ Î·È ÛˆÌ·Ù›‰È· ¯Ë-

·Ï¿ÙˆÓ Î·È ¿ÏÏˆÓ ÌÂÙ¿ÏÏˆÓ ·ﬁ ‰Â˘ÙÂ-

Î·ÚÎÈÓÔÁfiÓÔ˘˜ ÔÏ˘·ÚˆÌ·ÙÈÎÔ‡˜ ˘‰ÚÔÁÔÓ¿ÓıÚ·ÎÂ˜. √È ËÁ¤˜ Ú‡·ÓÛË˜ ÙË˜ ·ÙÌfiÛÊ·ÈÚ·˜ ÌÂ ∞™ Â›Ó·È ÔÈ ‚ÈÔÌË¯·Ó›Â˜ (ÙÛÈÌÂÓÙÔ·Ú·ÁˆÁ‹˜, Ï·ÙÔÌÂ›·, ÂÚÁÔÛÙ¿ÛÈ· ·Ú·ÁˆÁ‹˜ ËÏÂÎÙÚÈÎÔ‡ ÚÂ‡Ì·ÙÔ˜, ¯·Ï˘‚Ô˘ÚÁÂ›·), ÔÈ ÎÂÓÙÚÈÎ¤˜ ıÂÚÌ¿ÓÛÂÈ˜ ÔÈÎÈÒÓ Î·È ÔÏ˘Î·ÙÔÈÎÈÒÓ, ÔÈ ÂÍ·ÙÌ›ÛÂÈ˜ ·˘ÙÔÎÈÓ‹ÙˆÓ, Ë ÙÚÈ‚‹ ÂÏ·ÛÙÈÎÒÓ Î·È Ë ÛÎfiÓË ÙÔ˘ Â‰¿ÊÔ˘˜. ∫˘ÚÈfiÙÂÚË ËÁ‹ ·ÛÙÈÎÒÓ Ú‡ˆÓ Â›Ó·È Ù· ·˘ÙÔÎ›ÓËÙ· (ÔÛÔÛÙfi ·fi 46,7-64,3%) Î·È Ë Î·‡ÛË ÂÙÚÂÏ·›Ô˘ (ÔÛÔÛÙfi 8,4-28%) (9).

∞ÙÌÔÛÊ·ÈÚÈÎÔ› Ú‡ÔÈ

√È Î˘ÚÈﬁÙÂÚÔÈ ·ÙÌÔÛÊ·ÈÚÈÎÔ› Ú‡ÔÈ Â›Ó·È ÙÔ ‰ÈÔÍÂ›‰ÈÔ ÙÔ˘ ıÂ›Ô˘ (SO2, Î·Ù' ÂÍÔ¯‹Ó ‚ÈÔÌË¯·ÓÈÎﬁ˜ Ú‡Ô˜), Ù· ·˙ˆÍÂ›‰È·, Ô˘ ‰È·ÎÚ›ÓÔÓÙ·È

ÛÂ ÓÈÙÚÈÎ¿ ÔÍÂ›‰È· (NOx) Î·È ‰ÈÔÍÂ›‰ÈÔ ÙÔ˘ ·˙ÒÙÔ˘ (NO2) Î·È Â›Ó·È Î˘Ú›ˆ˜ ÚÔ˚fiÓÙ· Î·‡ÛÂˆÓ, ÙÔ ÌÔÓÔÍÂ›‰ÈÔ ÙÔ˘ ¿ÓıÚ·Î· (C√, ÚÔ˚fiÓ Î·‡ÛÂˆÓ Â›ÛË˜), Ë Ù¤ÊÚ· (ÂÚÈ¤¯ÂÈ ÔÍÂ›‰È· ÌÂÙ¿ÏÏˆÓ ·fi Î·‡ÛË ÏÈÁÓ›ÙË ÁÈ· ·Ú·ÁˆÁ‹ ËÏÂÎÙÚÈÎÔ‡ ÚÂ‡Ì·ÙÔ˜), ÔÈ ˘‰ÚÔÁÔÓ¿ÓıÚ·ÎÂ˜ (∏C, ·fi ·ÙÂÏ‹ Î·‡ÛË ·˘ÙÔÎÈÓ‹ÙˆÓ) Î·È ÙÔ fi˙ÔÓ (O3, ÚÔ˚fiÓ ÊˆÙÔ¯ËÌÈÎÒÓ ·ÓÙÈ‰Ú¿ÛÂˆÓ ÛÙËÓ ·ÙÌfiÛÊ·ÈÚ· ·fi NOx, O2 Î·È ËÏÈ·Î‹ ·ÎÙÈÓÔ‚ÔÏ›·). √ Î·ı¤Ó·˜ ·fi ÙÔ˘˜ Ú‡Ô˘˜ ·˘ÙÔ‡˜ ¤¯ÂÈ ‰È·ÊÔÚÂÙÈÎ‹ Â›‰Ú·ÛË ÛÙÔÓ ·ÓıÚÒÈÓÔ ÔÚÁ·ÓÈÛÌfi (¶›Ó·Î·˜ 1).

∞Ó·ÓÂ˘ÛÙÈÎﬁ

∏

¯ËÌÈÎ¤˜ ·ÓÙÈ‰Ú¿ÛÂÈ˜. ÕÏÏ· ÙÔÍÈÎ¿ ∞™ Â›Ó·È ·˘Ù¿ Ô˘

Û¯¤ÛË ÙˆÓ ·ÙÌÔÛÊ·ÈÚÈÎÒÓ Ú‡ˆÓ Î·È ÙˆÓ ∞™ ÌÂ ·ı‹ÛÂÈ˜ ÙÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡ ¤¯ÂÈ ÌÂÏÂÙËıÂ› Î·È ÂÚÈÁÚ·ÊÂ› ‰ÈÂÍÔ‰ÈÎ¿. ∆· ÌÂÁ·Ï‡ÙÂÚ· ∞™ Ô˘ Î·Ù·ÎÚ·ÙÔ‡ÓÙ·È ÛÙÔÓ ÚÈÓÈÎfi ‚ÏÂÓÓÔÁfiÓÔ, ÙËÓ ÙÚ·¯Â›· Î·È ÙÔ˘˜ ‚ÚfiÁ¯Ô˘˜ ÚÔÎ·ÏÔ‡Ó ·ÏÏÂÚÁÈÎ‹ ÚÈÓ›ÙÈ‰·, ÙÚ·¯ÂÈ›ÙÈ‰·, ¯ÚfiÓÈ· ‚ÚÔÁ¯›ÙÈ‰· Î·È ‚ÚÔÁ¯ÈÎfi ¿ÛıÌ·. √È ÂÚÂıÈÛÙÈÎ¤˜ Ô˘Û›Â˜ fiˆ˜ SO2, NOx, O3 Î·È ·ÏÏÂÚÁÈÔÁfiÓ·

ÛˆÌ·Ù›‰È· ÚÔÎ·ÏÔ‡Ó ¿ÛıÌ· Î·È ¯ÚﬁÓÈÂ˜ ·ÔÊÚ·ÎÙÈÎ¤˜ ÓÂ˘ÌÔÓÔ¿ıÂÈÂ˜, ÂÓÒ ÙÔ ‚ÂÓ˙ﬁÏÈÔ,

Î·È ¿ÏÏ· ‚·Ú¤· Ì¤Ù·ÏÏ· ÚÔÎ·ÏÔ‡Ó Î·ÚÎ›ÓÔ ÙÔ˘ ÓÂ‡ÌÔÓ· (∂ÈÎﬁÓ· 1) (1).

<10 Ìm ‰ÈÂÈÛ‰‡-

ÛÙÔÓ ‰È¿ÌÂÛÔ ÈÛÙﬁ Î·È ÚÔÎ·ÏÔ‡Ó ›ÓˆÛË Î·È

ÎÔÎÎÈˆÌ¿ÙˆÓ. ∆· ÌÈÎÚ¿ (<2,5 Ìm) Î·È Ù· ÔÏ‡ ÌÈÎÚ¿ ∞™ (<0,1 Ìm) Â›Ó·È Î·È Ù· ÈÔ

ÁÈ·Ù›

‰ÈÂÈÛ‰‡Ô˘Ó ·Â˘ıÂ›·˜ ÛÙËÓ Î˘ÎÏÔÊÔÚ›· ÙÔ˘ ·›Ì·ÙÔ˜ Î·È ‰ÚÔ˘Ó ÛÂ

µÂÓ˙ﬁÏÈÔ∞˘ÙÔÎ›ÓËÙ· ∫·ÚÎ›ÓÔ˜

ÃËÌÈÎ‹ ‚ÈÔÌË¯·Ó›·¶ÚÔÛ‚ÔÏ‹ ∫¡™

µ·Ú¤· Ì¤Ù·ÏÏ·µÈÔÌË¯·Ó›·∫·ÚÎ›ÓÔ˜ ñ ·ÚÛÂÓÈÎﬁ∞˘ÙÔÎ›ÓËÙ·µÏ¿‚Â˜ ÂÙÈÎÔ‡

ñ Î¿‰ÌÈÔµÏ¿‚Â˜ ∫¡™

ñ ÌﬁÏ˘‚‰Ô˜

ñ ˘‰Ú¿ÚÁ˘ÚÔ˜

ñ ÓÈÎ¤ÏÈÔ

¢ÈÔÍÂ›‰ÈÔ ÙÔ˘ ·˙ÒÙÔ˘∞˘ÙÔÎ›ÓËÙ·µÏ¿‚Â˜ ·Ó·ÓÂ˘ÛÙÈÎÔ‡

∫·‡ÛÂÈ˜

Ÿ˙ÔÓ¡√x ·ﬁ ·˘ÙÔÎ›ÓËÙ·µÏ¿‚Â˜ ·Ó·ÓÂ˘ÛÙÈÎÔ‡ +√2 ÕÛıÌ·, ·ÏÏÂÚÁÈÎ‹ ÚÈÓ›ÙÈ‰· + ËÏÈ·Î‹ ·ÎÙÈÓÔ‚ÔÏ›·∂Ï¿ÙÙˆÛË ·ÓÙ›ÛÙ·ÛË˜ ÛÂ ÏÔÈÌÒÍÂÈ˜

¢ÈÔÍÂ›‰ÈÔ ÙÔ˘ ıÂ›Ô˘∫·‡ÛÂÈ˜µÏ¿‚Â˜ ·Ó·ÓÂ˘ÛÙÈÎÔ‡ ∞ÈˆÚÔ‡ÌÂÓ· ÛˆÌ·Ù›‰È·∫·‡ÛÂÈ˜∫·ÚÎ›ÓÔ˜ µÈÔÌË¯·Ó›·µÏ¿‚Â˜ ·Ó·ÓÂ˘ÛÙÈÎÔ‡

µÏ¿‚Â˜ Î·Ú‰È·ÁÁÂÈ·ÎÔ‡ µÚÂÊÈÎ‹ ıÓËÛÈÌﬁÙËÙ·

·ÏÏ¿ Î·È ÙÔ˘

Î·È

Ì¤ÓÔÈ ÔÈ “‰Â›ÎÙÂ˜ ÊÏÂÁÌÔÓ‹˜”, ﬁˆ˜ Ë CRP Î·È Ô ·ÚÈıÌﬁ˜ ÙˆÓ ÏÂ˘ÎÒÓ

‰È¿ÊÔÚÂ˜ Î˘ÙÔÎ›ÓÂ˜ Î·È Ô TNF, Ô˘ ÂÎÎÚ›ÓÔÓÙ·È

Ù· ÂÓÂÚÁÔÔÈËÌ¤Ó· Ì·ÎÚÔÊ¿Á· (8,10).

∫·Ú‰È·ÁÁÂÈ·Îfi Î·È ∞˘ÙfiÓÔÌÔ ¡Â˘ÚÈÎfi ™‡ÛÙËÌ·

∂È‰ËÌÈÔÏÔÁÈÎ¤˜ ¤ÚÂ˘ÓÂ˜ ¤¯Ô˘Ó ·Ô‰Â›ÍÂÈ ÙË Û˘Û¯¤ÙÈÛË ÙË˜ ·¤ÚÈ·˜ Ú‡·ÓÛË˜ ÌÂ ÙË ÓÔÛË-

ÁÂÈ·ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ (11). ∏ ·Â˘ıÂ›·˜ Â›ÛÔ‰Ô˜ ÙˆÓ ÂÈÛÓÂfiÌÂÓˆÓ ÛˆÌ·ÙÈ‰›ˆÓ ·fi ÙÈ˜ Î˘„ÂÏ›‰Â˜ ÛÙËÓ Î˘ÎÏÔÊÔÚ›· ÙÔ˘ ·›Ì·ÙÔ˜ ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙË ‰È·ÛÔÚ¿ Î·È ÙË ‰Ú¿ÛË ÙÔ˘˜ ÛÂ ‰È¿ÊÔÚ· fiÚÁ·Ó· (‹·Ú, ÓÂÊÚÔ›, ı˘ÚÂÔÂÈ‰‹˜ ·‰¤Ó·˜, ÛÈÂÏÔÁfiÓÔÈ, ÛÙfiÌ·¯Ô˜) (10), ÂÓÒ ·Ú·ÙËÚ‹ıËÎÂ fiÙÈ ÚÔÎ·ÏÔ‡ÓÙ·È ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ·˘ÙfiÓÔÌÔ˘ ÓÂ˘ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÌÂ ·ÔÙ¤ÏÂÛÌ· Ù·¯˘Î·Ú‰›· ‹ ‚Ú·‰˘Î·Ú‰›·, ·ÁÁÂÈÔÛ‡Û·ÛË, Î·Ú‰È·Î¤˜ ·ÚÚ˘ıÌ›Â˜ ·ÎfiÌË Î·È Î·Ú‰È·Îfi ¤ÌÊÚ·ÁÌ· ‹

ƒÈÓ›ÙÈ‰· - Ï·Ú˘ÁÁ›ÙÈ‰· ∆· ÌÂÁ¿Ï· ÛˆÌ·Ù›‰È· Û˘ÁÎÚ·ÙÒÓÙ·È ÛÙË Ì‡ÙË, ÙÔÓ Ê¿Ú˘ÁÁ· Î·È ÙÔÓ Ï¿Ú˘ÁÁ·. ∆· ‰È·Ï˘Ù¿ ·¤ÚÈ· (SO2) ·ÔÚÚÔÊÒÓÙ·È ·ﬁ ÙÔ ·ÓÒÙÂÚÔ ·Ó·ÓÂ˘ÛÙÈÎﬁ Î·È ÚÔÎ·ÏÔ‡Ó Ô›‰ËÌ· Î·È ˘ÂÚ¤ÎÎÚÈÛË ‚Ï¤ÓÓË˜.

∆Ú·¯ÂÈ›ÙÈ‰· - ‚ÚÔÁ¯›ÙÈ‰· - ‚ÚÔÁ¯ÈÔÏ›ÙÈ‰·

™ˆÌ·Ù›‰È· ‰È·Ì¤ÙÚÔ˘ >10 Ìm Û˘ÁÎÚ·ÙÒÓÙ·È Î·È ·ÔÌ·ÎÚ‡ÓÔÓÙ·È

ÙÔ˘˜ ÎÚÔÛÛÔ‡˜. ªÈÎÚfiÙÂÚ· ÛˆÌ·Ù›‰È· Û˘ÁÎÚ·ÙÒÓÙ·È ÛÙ· ‚ÚÔÁ¯ÈfiÏÈ·. §ÈÁfiÙÂÚÔ ‰È·Ï˘Ù¿ ·¤ÚÈ· ‰ÈÂÈÛ‰‡Ô˘Ó ‚·ı‡ÙÂÚ·. ÕÛıÌ· Î·È ¯ÚfiÓÈ· ·ÔÊÚ. ÓÂ˘ÌÔÓÔ¿ıÂÈ· ∞ÏÏÂÚÁÈÔÁfiÓ· Î·È ÂÚÂıÈÛÙÈÎ¤˜ Ô˘Û›Â˜ ÂÓ·ÔÙ›ıÂÓÙ·È ÛÙÔ˘˜ ·ÂÚ·ÁˆÁÔ‡˜ ÚÔÎ·ÏÒÓÙ·˜

¯ÚﬁÓÈÂ˜ ÊÏÂÁÌÔÓÒ‰ÂÈ˜ ·ÏÏÔÈÒÛÂÈ˜.

William S Beckett, MD N Engl J Med 2000;342:406-412)(1)

‰È·Ù·Ú·¯¤˜ ÙË˜ Â·Ó·ﬁÏˆÛË˜ (12-18). ¶Èı·ÓÔÏÔÁÂ›Ù·È Ë ÂÏ¿ÙÙˆÛË ÙÔ˘ ÙﬁÓÔ˘ ÙÔ˘ ÓÂ˘ÌÔ-

ÓÔÁ·ÛÙÚÈÎÔ‡ ÓÂ‡ÚÔ˘ (14), ¯ˆÚ›˜ Ó· ·ÔÎÏÂ›Â-

Ù·È Â›ÛË˜ Ë ·Â˘ıÂ›·˜ ‰Ú¿ÛË ÙˆÓ ∞™ ÛÙÔ ·˘-

ÙﬁÓÔÌÔ ÓÂ˘ÚÈÎﬁ Û‡ÛÙËÌ·, Ë ÔÔ›· ÚÔÎ·ÏÂ›

Â˘ÂÚÂıÈÛÙﬁÙËÙ· ÙˆÓ Î·Ú‰È·ÎÒÓ Î˘ÙÙ¿ÚˆÓ Î·È

ÈÓÒÓ Î·È ÌÔÚÂ› Ó· Ô‰ËÁ‹ÛÂÈ ÛÂ ÂÈÎ›Ó‰˘ÓÂ˜

ÁÈ· ÙË ˙ˆ‹ Ù·¯˘Î·Ú‰›Â˜, Ì¤¯ÚÈ Î·È ÛÂ ·ÈÊÓ›‰ÈÔ

ı¿Ó·ÙÔ (14-18) (∂ÈÎﬁÓ· 2).

∞›Ì·

∞‡ÍËÛË ÙË˜ ËÎÙÈÎﬁÙËÙ·˜ ÙÔ˘ ·›Ì·ÙÔ˜ ÌÂÙ¿

·ﬁ ÂÈÛÓÔ‹ ·ÂÚ›ˆÓ Ú‡ˆÓ Â›¯Â ·Ú·ÙËÚËıÂ›

·ﬁ ∂˘Úˆ·›Ô˘˜ ÂÚÂ˘ÓËÙ¤˜ ÛÂ ÂÓ‹ÏÈÎÂ˜ ·ﬁ ÙÔ

1985 (19). ∏ ÊÏÂÁÌÔÓÒ‰Ë˜ ‰ÈÂÚÁ·Û›·, Ô˘ ¤¯ÂÈ ·ÊÂÙËÚ›· ÙÔ˘˜ ÓÂ‡ÌÔÓÂ˜ ÌÂ ÙËÓ ·ÂÏÂ˘ı¤ÚˆÛË Î˘ÙÔÎÈÓÒÓ (IL-1-beta, IL-6) Î·È TNF-alfa

¶ÚÔ¿ÁÔ˘Ó ÌÈ· Û˘ÛÙËÌ·ÙÈÎ‹ ·¿ÓÙËÛË stress

ÙÔ˘ Û˘Ì·ıËÙÈÎÔ‡

∫·Ú‰È·Î‹ Û˘¯ÓﬁÙËÙ·

¢È·Î‡Ì·ÓÛË˜ ÙË˜ Î·Ú‰È·Î‹˜ Û˘¯ÓﬁÙËÙ·˜

™¯¤ÛË Ã·ÌËÏ‹˜ Û˘¯ÓﬁÙËÙ·˜ / ˘„ËÏ‹ Û˘¯ÓﬁÙËÙ·

∆·¯˘·ÚÚ˘ıÌ›· & ∫ÔÈÏÈ·Îﬁ˜ ÈÓÈ‰ÈÛÌﬁ˜

Ù· Ì·ÎÚÔÊ¿Á·, ÌÂÙ¿ ·ﬁ ÂÈÛÓÔ‹ ∞™, ¤¯ÂÈ ·Ô‰ÂÈ¯ıÂ› ﬁÙÈ Â˘ÓÔÂ› ÙËÓ ·Ó¿Ù˘ÍË ·ıËÚˆÌ·ÙÈÎÒÓ ‚Ï·‚ÒÓ Î·È ÙËÓ ·‡ÍËÛË ÙË˜ CRP ÙÔ˘

ÔÚÔ‡, ¯ˆÚ›˜ Ó· ÂËÚÂ¿˙ÔÓÙ·È ÔÈ ÙÈÌ¤˜ ÙˆÓ ÏÈÈ‰›ˆÓ ÙÔ˘ ÔÚÔ‡ (20). ¶·Ï·ÈﬁÙÂÚÂ˜, ·ÏÏ¿ Î·È

ÚﬁÛÊ·ÙÂ˜ ÌÂÏ¤ÙÂ˜, ¤¯Ô˘Ó ·Ô‰Â›ÍÂÈ ıÂÙÈÎ‹

Û˘Û¯¤ÙÈÛË ÙˆÓ Î˘ÙÔÎÈÓÒÓ ÌÂ ÌÂÙ·‚ÔÏ¤˜ ÛÙË

Û˘ÁÎ¤ÓÙÚˆÛË ÙˆÓ ÂÚ˘ıÚÒÓ Î·È ÏÂ˘ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ ÛÙÔ ·›Ì·, ÛÂ Û˘Ó‰˘·ÛÌﬁ ÌÂ ÌÂÙ·‚ÔÏ¤˜ ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ, ÌÂ ÛËÌÂ›· ‰È·Ù·Ú·¯‹˜

ÙË˜ ËÎÙÈÎﬁÙËÙ·˜ ÙÔ˘ ·›Ì·ÙÔ˜ (·‡ÍËÛË ÈÓˆ‰ÔÁﬁÓÔ˘ Ï¿ÛÌ·ÙÔ˜) (21,22) Î·È ÂÔÌ¤Óˆ˜ ÌÂ ·˘ÍËÌ¤ÓÔ Î›Ó‰˘ÓÔ ÈÛ¯·ÈÌÈÎÒÓ ‚Ï·‚ÒÓ (19-23).

¢È¤ÁÂÚÛË Â˘·›ÛıËÙˆÓ ˘Ô‰Ô¯¤ˆÓ ÛÙÔ˘˜ ·ÂÚ·ÁˆÁÔ‡˜

∞·ÓÙ‹ÛÂÈ˜ ∫¡™

ÕÓÔÈ·

‚ÚÔÁ¯ﬁÛ·ÛÌÔ˜

ºÏÂÁÌÔÓ‹ ÛÙÔÓ ÓÂ‡ÌÔÓ·

™˘ÛÙËÌ·ÙÈÎ‹ ÊÏÂÁÌÔÓ‹

ÁÚ‹ÁÔÚÂ˜ & ÂÈﬁÏ·ÈÂ˜ ·Ó·ÓÔ¤˜

∞ÓÙ›‰Ú·ÛË ÙÔ˘ ÓÂ˘ÌÔÓÔÁ·ÛÙÚÈÎÔ‡

ÛÙË Î·Ú‰È¿

¢È·Î‡Ì·ÓÛË ÙË˜ Î·Ú‰È·Î‹˜ Û˘¯ÓﬁÙËÙ·˜

¶ÂÚÈÔ¯‹ ˘„ËÏ‹˜ Û˘¯ÓﬁÙËÙ·˜ ÙË˜

‰È·Î‡Ì·ÓÛË˜ ÙË˜ Î·Ú‰. Û˘¯ÓﬁÙËÙ·˜

µÚ·‰˘·ÚÚ˘ıÌ›Â˜

2006;69:18-24

ÂÈÛÓÔ‹ ÛˆÌ·ÙÈ‰›ˆÓ ƒª2,5 Î·È fi˙ÔÓÙÔ˜ √3 (24,25). ™Â ·˘Ù‹Ó ÂÓÔ¯ÔÔÈÂ›Ù·È Ô ÌË¯·ÓÈÛÌfi˜ ·Ú·ÁˆÁ‹˜ ÌÈ·˜ ÈÛ¯˘ÚfiÙ·ÙË˜ ·ÁÁÂÈÔÛ˘Û·ÛÙÈÎ‹˜ Ô˘Û›·˜, ÙË˜ ÂÓ‰ÔıËÏ›ÓË˜-1 (∂∆-1). ∞Ó¿ÏÔÁÔ˜ ÌË¯·ÓÈÛÌfi˜ ·Ú·ÁˆÁ‹˜ ÙË˜ ∂∆-1 ·Ú·ÙËÚ‹ıËÎÂ ÛÂ Î·ÓÈÛÙ¤˜ (26). ™‡ÌÊˆÓ· ÌÂ ÙÔÓ ÌË-

¯·ÓÈÛÌﬁ ·˘ÙﬁÓ, ÔÈ ÂÏÂ‡ıÂÚÂ˜ Ú›˙Â˜ ¿ÓıÚ·Î· Î·È

√2, Ô˘ ÂÚÈ¤¯ÔÓÙ·È ÛÂ ˘„ËÏ¤˜ Û˘ÁÎÂÓÙÚÒÛÂÈ˜

ÛÙÔÓ ÂÈÛÓÂfiÌÂÓÔ Î·Ófi, ·ÔÙÂÏÔ‡Ó ÙÔÓ ·ÈÙÈÔÏÔÁÈÎfi ·Ú¿ÁÔÓÙ·. ∞˘Ù¤˜ ‰ÚÔ˘Ó ÛÙ· ÂÓ‰ÔıËÏÈ·-

Î¿ Î‡ÙÙ·Ú· Î·È ·ÊÂÓﬁ˜ ÂÈ‰ÚÔ‡Ó ·ÚÓËÙÈÎ¿ ÛÙË

‚ÈÔ‰È·ıÂÛÈÌﬁÙËÙ· ÙË˜ L-·ÚÁÈÓ›ÓË˜, ·ÊÂÙ¤ÚÔ˘ ·Ô‰ÔÌÔ‡Ó ÙÔ Û˘ÓÙÈı¤ÌÂÓÔ ¡√, Î¿ÓÔÓÙ¿˜ ÙÔ ÌË ‰È·ı¤ÛÈÌÔ ÚÔ˜ ·ÁÁÂÈÔ‰È·ÛÙÔÏ‹. ¶·Ú¿ÏÏËÏ·

·Ó·ÛÙ¤ÏÏÔ˘Ó ÙÔ ¤Ó˙˘ÌÔ Û˘ÓıÂÙ¿ÛË ÙË˜ ÚÔÛÙ·Î˘ÎÏ›ÓË˜, ÚÔÎ·ÏÒÓÙ·˜ ¤ÙÛÈ ÙË ÌÂ›ˆÛË ÙË˜ Û˘ÓÙÈı¤ÌÂÓË˜ ÚÔÛÙ·Î˘ÎÏ›ÓË˜, Ô˘ Â›Ó·È

ÙÂ˘ÙÈÎﬁ˜ ·Ú¿ÁÔÓÙ·˜, ÌÂ ·ÁÁÂÈÔ‰È·ÛÙ·ÏÙÈÎ‹ Î·È ·ÓÙÈ·ÈÌÔÂÙ·ÏÈ·Î‹ ‰Ú¿ÛË (26). ∞ÔÙ¤ÏÂÛÌ· ÙË˜ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘ ÂÓ‰ÔıËÏ›Ô˘ Â›Ó·È Ë ·Ú·ÁˆÁ‹ ∂∆-1, Ô˘ ÚÔÎ·ÏÂ› ·ÁÁÂÈÔÛ‡Û·ÛË (27).

Œ¯ÂÈ ‚ÚÂıÂ› ÂÍ¿ÏÏÔ˘, ﬁÙÈ Ë ÂÈÛÓÔ‹ ƒª2,5 ÚÔÎ·ÏÂ› Û˘ÛÙËÌ·ÙÈÎ‹ ÊÏÂÁÌÔÓÒ‰Ë ‰ÈÂÚÁ·Û›· Î·È ·Ú·ÁˆÁ‹ Î˘ÙÔÎÈÓÒÓ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÙËÓ ·Ú·ÁˆÁ‹ Î·È ‰Ú¿ÛË ÂÏÂ˘ı¤ÚˆÓ ÚÈ˙ÒÓ, ÔÈ

ÔÔ›Â˜ ÌÂ ÙË ÛÂÈÚ¿ ÙÔ˘˜ ÂÓÂÚÁÔÔÈÔ‡Ó ÙÔ˘˜ ÌË¯·ÓÈÛÌÔ‡˜ ·Ú·ÁˆÁ‹˜ ÙË˜ ∂∆-1 ÌÂ ·ÔÙ¤ÏÂÛÌ· ·˘ÍËÌ¤ÓË ·ıËÚÔÁ¤ÓÂÛË ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ ·Ú-

ÙËÚÈÒÓ Î·È ÙË˜ ·ÔÚÙ‹˜.

∆Ô ÂÓ‰Ôı‹ÏÈÔ ÙˆÓ ·ÁÁÂ›ˆÓ ·ÔÙÂÏÂ› ÙÔÓ

·Ô‰¤ÎÙË ‚Ï·ÙÈÎÒÓ ÂÈ‰Ú¿ÛÂˆÓ ÙˆÓ ·Ú·-

ÁﬁÓÙˆÓ ÎÈÓ‰‡ÓÔ˘, ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ÛÙÂÊ·ÓÈ·›·˜ ÓﬁÛÔ˘. √È ·Ú¿ÁÔÓÙÂ˜ ·˘ÙÔ› (˘¤ÚÙ·ÛË, ˘ÂÚÏÈÈ‰·ÈÌ›·, Î¿ÓÈÛÌ·, stress) ÚÔÎ·ÏÔ‡Ó

“ÂÓ‰ÔıËÏÈ·Î‹ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·” ÌÂ ‰È¿ÊÔÚÔ˘˜

‚ÈÔ¯ËÌÈÎÔ‡˜ ÌË¯·ÓÈÛÌÔ‡˜, ÎÔÈÓ‹ Î·Ù¿ÏËÍË

ÙˆÓ ÔÔ›ˆÓ Â›Ó·È ·) Ë ·˘ÍËÌ¤ÓË ÂÓ‰ÔÎ˘ÙÙ¿ÚÈ·

Û˘ÛÛÒÚÂ˘ÛË ÂÏÂ˘ı¤ÚˆÓ ÚÈ˙ÒÓ Î·È ‚) Ë ·‡ÍËÛË

ÙÔ˘ ÂÓ‰ÔÎ˘ÙÙ¿ÚÈÔ˘ ·Û‚ÂÛÙ›Ô˘. ∏ ÂÓ‰ÔıËÏÈ·Î‹

‰˘ÛÏÂÈÙÔ˘ÚÁ›· Â›Ó·È ÙÔ ·Ú¯ÈÎfi ‚ÈÔ¯ËÌÈÎfi ÁÂÁÔÓfi˜, Ô˘ Ô‰ËÁÂ› ÛÙËÓ ·Ó¿Ù˘ÍË ˘ÂÚÏ·ÛÙÈÎÒÓ ·ÏÏ·ÁÒÓ Î·È ·ıËÚˆÌ¿ÙˆÛË˜ ÛÙÔ ÙÔ›¯ˆÌ· ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ Î·È ¿ÏÏˆÓ ·ÚÙËÚÈÒÓ (27).

Œ¯ÂÈ ·Ô‰ÂÈ¯ıÂ› Â›ÛË˜ Ô ·˘ÍËÌ¤ÓÔ˜ Î›Ó‰˘ÓÔ˜ ÂÌÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘, ÌÂÙ¿ ·ﬁ ÌÂÚÈÎ¤˜ ÒÚÂ˜ Ì¤¯ÚÈ Î·È ËÌ¤ÚÂ˜ ÂÈÛÓÔ‹˜ ÛˆÌ·ÙÈ‰›ˆÓ ƒª2,5 (28).

ÂÓ‹ÏÈÎÂ˜, ‰ÈﬁÙÈ Ô ÌË¯·ÓÈÛÌﬁ˜ ‚ÏÂÓÓÔÎÚÔÛÛˆÙ‹˜

ÙÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡ ÂÈıËÏ›Ô˘ ÛÙ·

·È‰È¿ ÙË˜ ÚÔÛ¯ÔÏÈÎ‹˜ ‹ Î·È Û¯ÔÏÈÎ‹˜ ËÏÈÎ›·˜ - ÏfiÁˆ ÙˆÓ Û˘¯ÓÒÓ ÏÔÈÌÒÍÂˆÓ ‹ ÙË˜ ·ÏÏÂÚÁÈÎ‹˜ ÚÔ‰È¿ıÂÛË˜ - Â›Ó·È ‰È·Ù·Ú·ÁÌ¤ÓÔ˜. ∏ ‚Ï¿‚Ë ÂÎ‰ËÏÒÓÂÙ·È ÌÂ ‰È·Ù·Ú·¯‹ ÙË˜ ¤ÎÎÚÈÛË˜ Î·È ·ÔÌ¿ÎÚ˘ÓÛË˜ ÙË˜ ‚Ï¤ÓÓË˜, ÏfiÁˆ Î·Ù·ÛÙÚÔÊ‹˜ ÙˆÓ ÎÚÔÛÛÒÓ (29,30). ∞˘Ùfi ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· Ù· ÛˆÌ·Ù›‰È· Ó· ‰ÈÂÈÛ‰‡Ô˘Ó ‚·ı‡ÙÂÚ· ÛÙÔ ·Ó·ÓÂ˘ÛÙÈÎfi ‰¤Ó‰ÚÔ. ∆· ·È‰È¿, Â›ÛË˜, ÂÚÓÔ‡Ó ÌÂÁ·Ï‡ÙÂÚÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ¤Íˆ ·fi ÙÔ Û›ÙÈ, ÎÈÓÔ‡ÓÙ·È ÂÚÈÛÛfiÙÂÚÔ Î·È ÈÔ ¤ÓÙÔÓ·, ·ÚÔ˘ÛÈ¿˙ÔÓÙ·˜ ÂÚÈÛÛfiÙÂÚË ˘¤ÚÓÔÈ·, ÂÓÒ ‰ÂÓ ÌÔÚÔ‡Ó Ó· ·Ó·ÁÓˆÚ›ÛÔ˘Ó Â‡ÎÔÏ· ÙÔ˘˜ ÎÈÓ‰‡ÓÔ˘˜ ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜. ¶·Ú¿ÏÏËÏ·, ÂÍ·ÈÙ›·˜ ÙÔ˘ ¯·ÌËÏfiÙÂÚÔ˘ ·Ó·ÛÙ‹Ì·Ùfi˜ ÙÔ˘˜, ‚Ú›ÛÎÔÓÙ·È ÏËÛÈ¤ÛÙÂÚ· ÛÙÔ ¤‰·ÊÔ˜, fiÔ˘ ÔÚÈÛÌ¤ÓÔÈ Ú‡ÔÈ Â›Ó·È Û˘ÁÎÂÓÙÚˆÌ¤ÓÔÈ Î·È ÙÔ˘˜ ·Ó·Ó¤Ô˘Ó Â˘ÎÔÏfiÙÂÚ· (31). ™Ù· ÌÈÎÚ¿ ·È‰È¿ Â›Ó·È ÌÂÈˆÌ¤ÓË Ë ¯˘ÌÈÎ‹ ·ÓÔÛ›·, Î·È ÙÔ ÁÂÁÔÓfi˜ ·˘Ùfi ·ÓÙÈÚÚÔÂ›Ù·È ÌfiÓÔ ÌÂÚÈÎÒ˜ ·fi ÙËÓ Î˘ÙÙ·ÚÈÎ‹ ·ÓÔÛ›·. ŸÙ·Ó ÂÎÙ›ıÂÓÙ·È ÛÂ ˘„ËÏ‹ ·ÙÌÔÛÊ·ÈÚÈÎ‹ Ú‡·ÓÛË, Ù· Ì·ÎÚÔÊ¿Á· ÂÍ·ÓÙÏÔ‡ÓÙ·È ÛÙË ‰¤ÛÌÂ˘ÛË ÙˆÓ ÏÂÙÒÓ ÌÔÚ›ˆÓ ÛÎfiÓË˜, ÌÂ ·ÔÙ¤ÏÂÛÌ· Ù· ·È‰È¿ Ó· Á›ÓÔÓÙ·È ÏÈÁfiÙÂÚÔ ·ÓıÂÎÙÈÎ¿ ÛÂ ÏÔÈÌÔÁfiÓÔ˘˜ ·Ú¿ÁÔÓÙÂ˜, ·ÏÏ¿ Î·È ÛÂ ‰È¿ÊÔÚÂ˜ ÌÔÚÊ¤˜ Î·ÚÎ›ÓÔ˘ (32,33). √È Ì¤¯ÚÈ Û‹ÌÂÚ· ÌÂÏ¤ÙÂ˜ Î·È ÂÈÚ·Ì·ÙÈÎ¤˜ ÂÚÁ·Û›Â˜ ·Ó·Ê¤ÚÔÓÙ·È Î˘Ú›ˆ˜ ÛÂ ÂÓ‹ÏÈÎÂ˜ ÛÙÔ˘˜ ÔÔ›Ô˘˜ ÌÂÏÂÙ‹ıËÎÂ Ë Â›ÙˆÛË ÙË˜ ‚Ú·¯˘¯ÚfiÓÈ·˜ ¤ÎıÂÛ‹˜ ÙÔ˘˜ ÛÂ ∞™. ∏ ‰ÈÂıÓ‹˜ ‚È‚ÏÈÔÁÚ·Ê›· Â›Ó·È ÔÏ‡ ÊÙˆ¯‹ ÛÂ ·Ó¿ÏÔÁÂ˜ ÌÂÏ¤ÙÂ˜ ÛÂ ·È‰È¿ Î·È ÔÏ‡ ÂÚÈÛÛfiÙÂÚÔ ÌÂ Ì·ÎÚÔ¯ÚfiÓÈ· ¤ÎıÂÛ‹ ÙÔ˘˜ ÛÂ ‚Â‚·ÚËÌ¤ÓÔ ÂÚÈ‚¿ÏÏÔÓ (30,32). ∏ ÚfiÛÊ·ÙË Û˘Û¯¤ÙÈÛË ÙË˜ ·¤ÚÈ·˜ Ú‡·ÓÛË˜ ÌÂ ÌÂÙ·ÏÏ¿ÍÂÈ˜, ·È‰ÈÎfi Î·ÚÎ›ÓÔ ·ÏÏ¿ Î·È ÌÂ ÂÓ‰ÔÌ‹ÙÚÈÔ ı¿Ó·ÙÔ, Î·ıÈÛÙ¿ ÙËÓ fiÏË ˘fiıÂÛË ¿ÎÚˆ˜ ·ÓËÛ˘¯ËÙÈÎ‹ (33,35). ™Â ÌÈ· ÂÚÈÔ¯‹ ÙË˜ ¶ÔÏˆÓ›·˜ ÌÂ ÔÏ‡ ˘„ËÏ‹ Ú‡·ÓÛË, ÙË ™ÈÏÂÛ›·, Ë Û˘¯ÓfiÙËÙ· ÙˆÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ ‚Ú¤ıËÎÂ ÛËÌ·ÓÙÈÎ¿ ˘„ËÏfiÙÂÚË ·fi ·ÓÙÔ‡ (36,37). ™ÙÈ˜ ™Î·Ó‰ÈÓ·‚ÈÎ¤˜ ¯ÒÚÂ˜ ÌÂÏ¤ÙÂ˜ Û˘Û¯¤ÙÈÛ·Ó ÙËÓ ÂÈÛÓÔ‹ Î·˘Û·ÂÚ›ˆÓ ·˘ÙÔÎÈÓ‹ÙˆÓ ÌÂ ÏÂÌÊÒÌ·Ù·, ÏÂ˘¯·ÈÌ›· Î·È fiÁÎÔ˘˜ ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ ÓÂ˘ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ (38), ÂÓÒ ÛÙË µÚ·˙ÈÏ›· ÂÚÂ˘ÓËÙ¤˜ ·¤‰ÂÈÍ·Ó fiÙÈ Ë ÂÈÛÓÔ‹ ÌÔÏ˘ÛÌ¤ÓÔ˘ ·¤Ú·, È‰›ˆ˜ ·fi ÌË Î·Ó›ÛÙÚÈÂ˜ ÌËÙ¤ÚÂ˜, ‹Ù·Ó ·ÈÙ›· ·˘ÍËÌ¤ÓË˜ Û˘¯ÓfiÙËÙ·˜ ÂÓ‰ÔÌ‹ÙÚÈÔ˘ ı·Ó¿ÙÔ˘, ÏfiÁˆ Û¯ËÌ·ÙÈÛÌÔ‡ ÌÂı·ÈÌÔÛÊ·ÈÚ›ÓË˜ Î·È ·ÓıÚ·Î˘Ï·ÈÌÔÛÊ·ÈÚ›ÓË˜ (35). ªÂÏ¤ÙÂ˜ Ô˘ ¤¯Ô˘Ó Á›ÓÂÈ Î·Ù¿ Î·ÈÚÔ‡˜ ÛÙË ¯ÒÚ· Ì·˜, ·ÊÔÚÔ‡Û·Ó Î˘Ú›ˆ˜ ÛÙËÓ Â›‰Ú·ÛË

∞ÈˆÚÔ‡ÌÂÓ· ™ˆÌ·Ù›‰È· (∞™)

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Î˘ÙÔÎ›ÓÂ˜ ∞¡™∞πª∞

∫˘ÎÏÔÊÔÚÈÎﬁ

EÓ‰Ôı‹ÏÈÔ (∂∆-1)

¶ËÎÙÈÎÔ› ÌË¯·ÓÈÛÌÔ›

∆·¯˘Î·Ú‰›·∞ıËÚˆÌ¿ÙˆÛË

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∂ÈÎﬁÓ· 3. ™¯ËÌ·ÙÈÎﬁ ‰È¿ÁÚ·ÌÌ· ÙË˜ ‰Ú¿ÛË˜ ÙˆÓ ∞™

ÛÙ· ‰È¿ÊÔÚ· Û˘ÛÙ‹Ì·Ù·.

ÙË˜ ·¤ÚÈ·˜ Ú‡·ÓÛË˜ ÛÙÔ ·Ó·ÓÂ˘ÛÙÈÎﬁ Û‡-

ÛÙËÌ· ÙˆÓ ·È‰ÈÒÓ (39,40). ∆· ·ÔÙÂÏ¤ÛÌ·Ù¿

ÙÔ˘˜ ·Ó·Ê¤ÚÔÓÙ·È Î˘Ú›ˆ˜ ÛÙËÓ ·˘ÍËÌ¤ÓË Û˘-

¯ÓﬁÙËÙ· ¿ÛıÌ·ÙÔ˜, ¯ÚﬁÓÈ·˜ ‚ÚÔÁ¯›ÙÈ‰·˜ Î·È

ÏÔÈÌÒÍÂˆÓ ÙÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡ (41-44). §ﬁÁˆ

ÙË˜ ·ÁÎÔÛÌÈﬁÙËÙ·˜ ÙÔ˘ Ê·ÈÓÔÌ¤ÓÔ˘ ÙË˜ ·¤-

ÚÈ·˜ Ú‡·ÓÛË˜ Î·È ÙˆÓ ÂÈÙÒÛÂˆÓ, ﬁ¯È ÌﬁÓÔ

ÛÙËÓ ˘ÁÂ›· ·ÏÏ¿ ·ÎﬁÌË Î·È ÛÙÈ˜ ÔÈÎÔÓÔÌ›Â˜ ÙˆÓ

ÙÔ˘ ÎﬁÛÌÔ˘,

ÙÈ˜ ÂﬁÌÂÓÂ˜ ‰ÂÎ·ÂÙ›Â˜ (45).

µÈ‚ÏÈÔÁÚ·Ê›·

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9.∫Ô˘˚ÌÙ˙‹˜ £, ™·Ì·Ú¿ ∫, ∆ÛÈÙÔ˘Ú›‰Ô˘ ƒ, ¡ÈÎÔÏ¿Ô˘ ∫, µÔ˘ÙÛ¿ ¢, ª·ÓÒÏË ∂ Î·È Û˘Ó. ¶ÔÛÔÛÙÔÔ›ËÛË

ÙË˜ Û˘ÌÌÂÙÔ¯‹˜ ÙˆÓ ËÁÒÓ ÂÎÔÌ‹˜ ÂÈÛÓÂ‡ÛÈÌˆÓ ·ÈˆÚÔ‡ÌÂÓˆÓ ÛˆÌ·ÙÈ‰›ˆÓ ÛÙËÓ Â˘Ú‡ÙÂÚË ÂÚÈÔ¯‹ ÙË˜ £ÂÛÛ·ÏÔÓ›ÎË˜. ∞Ó¿ÏÂÎÙ· ÙˆÓ ÂÚÂ˘ÓÒÓ [ÂÚÈÔ‰ÈÎ‹ ¤Î‰ÔÛË ∞¶£] 2003;7:34-39.

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46.∂˘Úˆ·˚Î‹ ∂ÈÙÚÔ‹ ∫·ı·ÚÔ‡ ∞¤Ú· ÁÈ· ÙÈ˜ ¶ﬁÏÂÈ˜ ÙË˜ ∂˘ÚÒË˜ - Swiss Participation in European Research Programmes. APHEA 2: Short-term effects of air pollution on health - A European approach to methodology, dose response assessment and evaluation of public health significance. [Abstract, Internet]. Webpage: http://www.sbf.admin.ch/htm/ services/publikationen/international/frp/euabstracts/html/fp/fp4/env97.0477.html.

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ÀÏÈÎﬁ Î·È ª¤ıÔ‰ÔÈ: ¢Â›ÁÌ· 210 ÎÏÈÓÈÎ¿ ˘ÁÈÒÓ ·È‰ÈÒÓ 3 ¤ˆ˜ 18 ¯ÚﬁÓˆÓ, Î·Ù·Ù¿¯ıËÎ·Ó ÛÂ ÙÚÂÈ˜

ËÏÈÎÈ·Î¤˜ ÔÌ¿‰Â˜ (√Ì¿‰· I: 3-10, √Ì¿‰· II: 11-14 Î·È √Ì¿‰· III: 15-18 ¯ÚﬁÓˆÓ). §‹„Ë ‰ÂÈÁÌ¿ÙˆÓ

¤ÁÈÓÂ ÙÔ˘˜ ¯ÂÈÌÂÚÈÓÔ‡˜ Î·È Î·ÏÔÎ·ÈÚÈÓÔ‡˜ Ì‹ÓÂ˜ ÁÈ· ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌﬁ ·Û‚ÂÛÙÈÔÙÚﬁˆÓ ÔÚÌÔÓÒÓ, ·Û‚ÂÛÙ›Ô˘, ÊˆÛÊÔÚÈÎÒÓ Î·È ‚ÈÔ¯ËÌÈÎÒÓ ‰ÂÈÎÙÒÓ ÔÛÙÈÎ‹˜ Û‡ÓıÂÛË˜.

∞ÔÙÂÏ¤ÛÌ·Ù·: TÔ 47% ÙˆÓ ·ÙﬁÌˆÓ ËÏÈÎ›·˜ 15-18 ¯ÚﬁÓˆÓ Â›¯·Ó Â›Â‰· 25OHD <10 ng/ml ÙÔÓ

¯ÂÈÌÒÓ·, ÂÓÒ Ù· ÔÛÔÛÙ¿ ÛÙÈ˜ ËÏÈÎ›Â˜ 3-14 ¯ÚﬁÓˆÓ ‹Ù·Ó ÛËÌ·ÓÙÈÎ¿ ¯·ÌËÏﬁÙÂÚ· (13-14%). TÔ Î·-

ÏÔÎ·›ÚÈ fiÏÔÈ Â›¯·Ó 25OHD>10 ng/ml. ∏ Û˘¯ÓfiÙËÙ· ˘Ô‚ÈÙ·Ì›ÓˆÛË˜ D ‹Ù·Ó ·ÎfiÌË ˘„ËÏfiÙÂÚË ÛÙ·

ÎÔÚ›ÙÛÈ· 15-18 ¯ÚfiÓˆÓ Î·È Û˘Ó‰˘·˙fiÙ·Ó ÌÂ ¯·ÌËÏfiÙÂÚ·

ÙÔÓ ¯ÂÈÌÒÓ· (¯ÂÈÌ.: 1,19±0,03, Î·Ï.: 1,39±0,03 mmol/l, p<0,001). ™ÙË ÌÂÁ·Ï‡ÙÂÚË ËÏÈÎÈ·Î‹ ÔÌ¿‰·, ÔÈ Û˘ÁÎÂÓÙÚÒÛÂÈ˜ ÙË˜ 24,25(OH)2D ÙÔÓ ¯ÂÈÌÒÓ· ‹Ù·Ó Î·Ù¿ Ù· 2/3 ¯·ÌËÏﬁÙÂÚÂ˜ ·ﬁ ÙÔ˘ Î·ÏÔÎ·ÈÚÈÔ‡ (0,73±0,10 ¤Ó·ÓÙÈ 2,41±0,20 ng/ml, p<0,001). √È ‚ÈÔ¯ËÌÈÎÔ› ‰Â›ÎÙÂ˜ ÔÛÙÈÎ‹˜ ·Ú·ÁˆÁ‹˜ ÔÛÙÂÔÎ·ÏÛ›ÓË˜ (OC) Î·È

·ÏÎ·ÏÈÎ‹˜ ÊˆÛÊ·Ù¿ÛË˜ (ALP), ‚Ú¤ıËÎ·Ó ÛËÌ·ÓÙÈÎ¿ ¯·ÌËÏﬁÙÂÚÔÈ ÛÙ· ÎÔÚ›ÙÛÈ· ÙË˜ ÔÌ¿‰·˜ III, ÁÈ·

¯ÂÈÌÒÓ· Î·È Î·ÏÔÎ·›ÚÈ ·ÓÙ›ÛÙÔÈ¯· (OC: 5,8±0,3 ¤Ó·ÓÙÈ 8,7±0,6 Î·È 4,6±0,3 ¤Ó·ÓÙÈ 7,3±0,5 ng/ml, p<0,001, ALP: 108±5 ¤Ó·ÓÙÈ 212±28 Î·È 116±7 ¤Ó·ÓÙÈ 248±31 IU/l, p<0,001).

™˘ÌÂÚ¿ÛÌ·Ù·: ™ÙËÓ ∂ÏÏ¿‰·, ÔÈ Ó¤ÔÈ 15-18 ¯ÚﬁÓˆÓ ‚Ú›ÛÎÔÓÙ·È ÛÂ ˘„ËÏﬁ Î›Ó‰˘ÓÔ ·ÓÂ¿ÚÎÂÈ·˜

‚ÈÙ·Ì›ÓË˜ D ÙÔÓ ¯ÂÈÌÒÓ·. EÌÏÔ˘ÙÈÛÌﬁ˜ ÌÂ ‚ÈÙ·Ì›ÓË D ÙÚÔÊÒÓ ﬁˆ˜ ÙÔ Á¿Ï· Î·È ÌÂÚÈÎ¿ ·Ó·„˘-

ÎÙÈÎ¿ ı· ‚ÔËıÔ‡ÛÂ ÛÂ ÛËÌ·ÓÙÈÎ‹ ÌÂ›ˆÛË ·˘ÙÔ‡ ÙÔ˘ ÎÈÓ‰‡ÓÔ˘.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ∞ÓÂ¿ÚÎÂÈ· ‚ÈÙ·Ì›ÓË˜ D, ·È‰È¿ Î·È ¤ÊË‚ÔÈ.

Is there or not vitamin D deficiency in children and adolescents in Greece?

D. Lapatsanis1, A. Moulas2, V. Cholevas2, P. Soukakos3, Z. Papadopoulou1, A. Challa2

Abstract

Background: Season and changes in the way of living significantly modify exposure to the sun, which is important for vitamin D synthesis in the skin. Children and adolescents who have high bone turnover may comprise a high-risk population for vitamin D deficiency.

Methods: A sample of 210 clinically healthy children aged 3 to 18 years, were assigned into three age groups: 3-10, 11-14 and 15-18 years of age. Blood samples were taken during winter and summer for determining calciotropic hormones, calcium, phosphate (Pi) and biochemical markers of bone synthesis.

Results: The 47% of the subjects aged 15-18 years, and 13-14% of the 3-14 years, had 25OHD levels <10 ng/ml in the winter. In the summer all had 25OHD>10 ng/ml. The prevalence of hypovitaminosis D was higher in the older girls, accompanied by lower Pi concentrations in the winter (win.: 1.19±0.03, sum.: 1.39±0.03 mmol/l, p<0.001). The 24,25(OH)2D levels in the older subjects were lower by 2/3 in the winter than in the summer (0.73±0.10 vs 2.41±0.20 ng/ml, p<0.001).

The biochemical markers of bone synthesis, osteocalcin (OC) and total alkaline phosphatase (ALP) were significantly lower in the older girls in both winter and summer, respectively (OC: 5.8±0.3 vs

˘Ô‚ÔÏ‹˜: 03-09-2004

¤ÁÎÚÈÛË˜: 28-11-2005

1 Department of Paediatrics, Medical School, University of Ioannina

2 Laboratory of Paediatrics, Medical School, University of Ioannina

3 Department of Orthopedics, Medical School, University of Ioannina

Correspondence: Anna Chala

Department of Paediatrics, Medical School, University of Ioannina 451 10, Ioannina

E-mail: achalla@cc.uoi.gr

Date of submission: 03-09-2004

Date of approval: 28-11-2005

8.7±0.6 and 4.6±0.3 vs 7.3±0.5 ng/ml, p<0.001; ALP: 108±5 vs 212±28 and 116±7 vs 248±31 IU/l, p<0.001).

Conclusions: In Greece young people aged 15-18 years, are at increased risk of vitamin D deficiency during the winter. Vitamin D supplementation of milk and popular beverages would be of help in counteracting this.

Key words: Vitamin D deficiency, children and adolescents.

ÛËÌ·Û›· ÙˆÓ ËÏÈ·ÎÒÓ ·ÎÙ›ÓˆÓ ÛÙÔÓ Û¯Ë-

ÙË˜ ‚ÈÙ·Ì›ÓË˜ D

ÁÈ·

ÊÔÚ¿ ÙÔ 1919 ﬁÙ·Ó ÔÈ Huldschinki Î·È Û˘Ó. ¤Ù˘¯·Ó ›·ÛË ÙÔ˘ Ú·¯ÈÙÈÛÌÔ‡

¤ÎıÂÛË ÛÂ ˘ÂÚÈÒ‰Ë ·ÎÙÈÓÔ‚ÔÏ›· (1). ∏ ‡·Ú-

ÍË ÌÈ·˜ ÏÈÔ‰È·Ï˘Ù‹˜ Ô˘Û›·˜, Ô˘ ·ÚÁﬁÙÂÚ·

ÔÓÔÌ¿ÛÙËÎÂ ‚ÈÙ·Ì›ÓË

ÙÔ˘˜ Mellanby Î·È Û˘Ó. ÙÔ 1919 (2). ∏ ÂÌÊ¿ÓÈÛË Ú·¯ÈÙÈÛÌÔ‡ ÛÙÔ˘˜ ·ÓıÚÒÔ˘˜ ÁÈ· ÚÒÙË ÊÔÚ¿ ·Ó·Ê¤ÚıËÎÂ ÌÂ ÙËÓ ¤Ó·ÚÍË ÙË˜ ‚ÈÔÌË¯·ÓÈÎ‹˜ Â·Ó¿ÛÙ·ÛË˜ ÛÙÔ Ù¤ÏÔ˜ ÙÔ˘ 17Ô˘ ·ÈÒÓ·. ∏ Û˘¯ÓﬁÙËÙ· Ú·¯ÈÙÈÛÌÔ‡ ÛÙ· ·È‰È¿ Ô˘

Î·ÙÔÈÎÔ‡Û·Ó ÛÙ· ·Ó‹ÏÈ· Û›ÙÈ· Î·È ‰ÚﬁÌÔ˘˜

ÙË˜ µﬁÚÂÈ·˜ ∂˘ÚÒË˜ Î·È ∞ÌÂÚÈÎ‹˜ ·Ó¤Ú¯ÔÓÙ·Ó ÛÙÔ 90% (3). ™ÙÈ˜ ‰ÂÎ·ÂÙ›Â˜ ÙÔ˘ 1930 Î·È 1940 Ô ÂÌÏÔ˘ÙÈÛÌﬁ˜ ÙÚÔÊÒÓ Î·È Á¿Ï·ÙÔ˜ ÌÂ

‚ÈÙ·Ì›ÓË D ¤ÁÈÓÂ ‰ËÌÔÊÈÏ‹˜. ªÂÙ¿ ÙÔ 1960 ¿Ú¯ÈÛ·Ó Ó· ÂÚÂ˘ÓÒÓÙ·È Î·È Ó· Á›ÓÔÓÙ·È Î·Ù·ÓÔËÙÔ› ÔÈ ÌË¯·ÓÈÛÌÔ› ÂÓÂÚÁÔÔ›ËÛË˜ ÙË˜ ‚ÈÙ·Ì›ÓË˜ D ÛÙÔ ‹·Ú (25-˘‰ÚÔÍ˘Ï›ˆÛË) Î·È ÛÙÔ˘˜

ÓÂÊÚÔ‡˜ (1·-˘‰ÚÔÍ˘Ï›ˆÛË) ·ÏÏ¿ Î·È ÔÈ ‰Ú¿-

ÛÂÈ˜ ÙË˜, ÒÛÙÂ Ó· ÌÔÚÔ‡Ó Ó· ·Ó··Ú¿ÁÔÓÙ·È

Î·È ÛÙÔ ÂÚÁ·ÛÙ‹ÚÈÔ (4,5).

∂ÎÙﬁ˜ ÙË˜ ıÂÚ·Â˘ÙÈÎ‹˜ ‰Ú¿ÛË˜ ÙË˜ ‚ÈÙ·-

Ì›ÓË˜ D ÛÂ ·ıÔÏÔÁÈÎ¤˜ Î·Ù·ÛÙ¿ÛÂÈ˜, ˘ﬁ Ê˘-

ÛÈÔÏÔÁÈÎ¤˜ Û˘Óı‹ÎÂ˜ Â›Ó·È ··Ú·›ÙËÙË ÁÈ· ÙËÓ

·ÔÚÚfiÊËÛË ÙÔ˘ ·Û‚ÂÛÙ›Ô˘ ·fi ÙÔ ¤ÓÙÂÚÔ, ÙËÓ Â·Ó·ÚÚfiÊËÛ‹ ÙÔ˘ ÛÙ· ÓÂÊÚÈÎ¿ ÛˆÏËÓ¿ÚÈ· Î·È ÙË ÌÂÙ¿ÏÏˆÛË ÙˆÓ ÔÛÙÒÓ (6). ™Ù· Ó‹È·, ‚Ú¤ÊË Î·È ·È‰È¿ Ì¤¯ÚÈ ÙËÓ ÂÓËÏÈÎ›ˆÛË, fiÔ˘ ˘¿Ú¯ÂÈ Û˘ÓÂ¯‹˜ ·‡ÍËÛË ÙÔ˘ ÛÎÂÏÂÙÔ‡, Ë

(7,8,9).

ÌÂ ‚ÈÙ·Ì›ÓË

D (40 IU/100 ml) Î·È Ù· ÎÏÈÓÈÎ¿ ÛËÌÂ›· ÙÚÔÊÈÎÔ‡ Ú·¯ÈÙÈÛÌÔ‡ Û¯Â‰fiÓ ÂÍ·Ê·Ó›ÛÙËÎ·Ó ·fi Ù· Ó‹È·. ™Ù· ∂ÏÏËÓfiÔ˘Ï· ËÏÈÎ›·˜ ÌÂÁ·Ï‡ÙÂÚË˜ ÙˆÓ 3 ÂÙÒÓ ‰ÂÓ ¯ÔÚËÁÂ›Ù·È Û˘ÛÙËÌ·ÙÈÎ¿ ‚ÈÙ·Ì›ÓË D Î·È ÔÈ ÙÚÔÊ¤˜ ÛÙËÓ ∂ÏÏ¿‰· ‰ÂÓ ÂÌÏÔ˘Ù›˙ÔÓÙ·È ÌÂ ‚ÈÙ·Ì›ÓË D. √È ˙ˆÈÎÔ› ÔÚÁ·ÓÈÛÌÔ› ÌÔÚÔ‡Ó Ó· ·ÔÎÙ‹ÛÔ˘Ó ÙÔ 90%-100% ÙË˜ ‚ÈÙ·Ì›ÓË˜ D Ô˘ ¯ÚÂÈ¿˙ÔÓÙ·È ·fi ÙËÓ ¤ÎıÂÛ‹ ÙÔ˘˜ ÛÙËÓ ËÏÈ·Î‹ ·ÎÙÈÓÔ‚ÔÏ›· (6). ŸÌˆ˜, Ë ÂÔ¯‹, Ô ÙÚfiÔ˜ ˙ˆ‹˜ (‰È·ÌÔÓ‹ Î·È ÂÚÁ·Û›· ÁÈ· ÔÏÏ¤˜ ÒÚÂ˜ ÛÂ ÎÏÂÈÛÙÔ‡˜ ¯ÒÚÔ˘˜) Î·ıÒ˜ Î·È Ë Â˘ÚÂ›· ¯Ú‹ÛË ÙˆÓ ·ÓÙÈËÏÈ·ÎÒÓ Ô˘ÛÈÒÓ, Â¤‰Ú·Û·Ó ÛËÌ·ÓÙÈÎ¿ ÛÙËÓ ·ÓÂ·ÚÎ‹ ÌÂÙ·ÙÚÔ‹ ÙË˜ ÚÔ‚ÈÙ·Ì›ÓË˜ D ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ ÛÂ ‰Ú·ÛÙÈÎ‹ ‚ÈÙ·Ì›ÓË D. ∂›ÛË˜, ÔÈ Û˘Ó‹ıÂÈÂ˜ ‰È·ÙÚÔÊ‹˜ ·›˙Ô˘Ó ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÁÈ· ÙËÓ Â·ÚÎ‹ ‹ ÌË ÚfiÛÏË„Ë ‚ÈÙ·Ì›ÓË˜ D. ∏ ·Ó·ÁÎ·›· ÔÛfiÙËÙ· ‚ÈÙ·Ì›ÓË˜ D ÌÂ ÙËÓ ÙÚÔÊ‹ ÔÈÎ›ÏÂÈ ÌÂÙ·Í‡ ÙˆÓ ¯ˆÚÒÓ ·ÏÏ¿ Î·È ÌÂÙ·Í‡ ËÏÈÎÈ·ÎÒÓ ÔÌ¿‰ˆÓ. ∏ ∞ÌÂÚÈÎ·ÓÈÎ‹ ∞Î·‰ËÌ›· ¶·È‰È·ÙÚÈÎ‹˜ Û˘ÓÈÛÙ¿ 400 ‰ÈÂıÓÂ›˜ ÌÔÓ¿‰Â˜ (IU) ËÌÂÚËÛ›ˆ˜ ÁÈ· Ó‹È·, ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ (11). ™ÎÔfi˜ ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ ‹Ù·Ó Ó· ÂÎÙÈÌËıÂ› Ë Â¿ÚÎÂÈ· ‹ ÌË ÙË˜ ‚ÈÙ·Ì›ÓË˜ D ÛÂ ¤Ó· ·ÓÙÈÚÔÛˆÂ˘ÙÈÎfi ‰Â›ÁÌ· ÎÏÈÓÈÎ¿ ˘ÁÈÒÓ ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ ËÏÈÎ›·˜ 3-18 ÂÙÒÓ, Ô˘ Î·ÙÔÈÎÔ‡Ó ÛÙË ‚ÔÚÂÈÔ‰˘ÙÈÎ‹ ∂ÏÏ¿‰· ÙËÓ Î·ÏÔÎ·ÈÚÈÓ‹ Î·È ÙË ¯ÂÈÌÂÚÈÓ‹ ÂÚ›Ô‰Ô. ™ÙË Û˘Ó¤¯ÂÈ·, ¤ÁÈÓÂ ÚÔÛ¿ıÂÈ· Ó· Û˘Û¯ÂÙÈÛıÔ‡Ó Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÌÂ ÙËÓ ËÏÈÎ›·, ÙÔ Ê‡ÏÔ Î·È ÙËÓ ÂÔ¯‹ ÙÔ˘ ¤ÙÔ˘˜ Î·È ÌÂ ‚ÈÔ¯ËÌÈÎÔ‡˜ ‰Â›ÎÙÂ˜ ÔÛÙÈÎ‹˜ Û‡ÓıÂÛË˜.

ÀÏÈÎﬁ Î·È ª¤ıÔ‰ÔÈ

¢Â›ÁÌ· ·fi 210 ·È‰È¿ ËÏÈÎ›·˜ 3 Ì¤¯ÚÈ 18 ÂÙÒÓ Ô˘ ‰ÂÓ Â›¯·Ó ÎÏÈÓÈÎ¿ Û˘ÌÙÒÌ·Ù· ÔÛÙÈÎ‹˜ Î·È Ë·ÙÈÎ‹˜ ÓfiÛÔ˘ Û˘ÌÂÚÈÏ‹ÊıËÎ·Ó ÛÙË ÌÂÏ¤ÙË Î·È ¯ˆÚ›ÛıËÎ·Ó ÛÂ ÙÚÂÈ˜ ÔÌ¿‰Â˜: ™ÙËÓ ÔÌ¿‰· π (¡ 75) ‹Ù·Ó ·È‰È¿ ËÏÈÎ›·˜ 3-10 ÂÙÒÓ, ÛÙËÓ ÔÌ¿‰· ππ (¡ 49) 11-14 ¯ÚfiÓˆÓ Î·È ÛÙËÓ ÔÌ¿‰· πππ (¡ 86) 15-18 ¯ÚfiÓˆÓ. ∆· ÌÈÛ¿ ·È‰È¿ ·fi Î¿ıÂ ÔÌ¿‰· ÌÂÏÂÙ‹ıËÎ·Ó ÙË ¯ÂÈÌÂÚÈÓ‹

ÂÚ›Ô‰Ô (ºÂ‚ÚÔ˘¿ÚÈÔ - ª¿ÚÙÈÔ) Î·È Ù· ˘ﬁÏÔÈ· ÙË

ıÂÚÈÓ‹ ÂÚ›Ô‰Ô (™ÂÙ¤Ì‚ÚÈÔ - √ÎÙÒ‚ÚÈÔ). ∆Ô ÛÙ¿‰ÈÔ ÙË˜ ÂÊË‚Â›·˜ Î·Ù¿ Tanner ÛÙ· ·È‰È¿ ÙË˜ ÔÌ¿‰·˜ πππ

ÚÔÛ‰ÈÔÚ›ÛÙËÎÂ ÌÂ ÚÔÛÂÎÙÈÎ‹ ÂÍ¤Ù·ÛË ÙˆÓ ‰Â˘ÙÂÚÔ-

ÁÂÓÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ÙÔ˘ Ê‡ÏÔ˘ Î·È ÙˆÓ ¤Íˆ ÁÂÓÓËÙÈÎÒÓ ÔÚÁ¿ÓˆÓ (12). ™ÙËÓ ÔÌ¿‰· πππ ÙÔ ¯ÂÈÌÒÓ·, 11

·È‰È¿ ‹Ù·Ó ÛÙ·‰›Ô˘ πππ ÚÔ˜ IV, 12 ÛÙÔ ÛÙ¿‰ÈÔ IV Î·È

22 ÛÙÔ ÛÙ¿‰ÈÔ IV ÚÔ˜ V, ÂÓÒ ÙÔ Î·ÏÔÎ·›ÚÈ 7 ·È‰È¿

‹Ù·Ó ÛÙÔ ÛÙ¿‰ÈÔ πππ ÚÔ˜ IV, 18 ÛÙÔ ÛÙ¿‰ÈÔ IV Î·È 16

ÛÙÔ ÛÙ¿‰ÈÔ IV ÚÔ˜ V.

∆·

·È‰È¿ ÛÙÈ˜ ÔÌ¿‰Â˜ ππ Î·È πππ ¤ÈÓ·Ó ÎﬁÎ·-ÎﬁÏ·

ÂÓ›ÔÙÂ Î·È ‰ÂÓ ¤Î·Ó·Ó Û˘ÛÙËÌ·ÙÈÎ‹ ¯Ú‹ÛË ÔÈÓÔÓÂ˘-

Ì·Ùˆ‰ÒÓ ÔÙÒÓ.

√È ·Ú¿ÌÂÙÚÔÈ Ô˘ ÚÔÛ‰ÈÔÚ›ÛÙËÎ·Ó ÛÙÔÓ ÔÚfi ‹Ù·Ó ·Û‚¤ÛÙÈÔ ÔÚÔ‡ (Ca), ·ÓfiÚÁ·ÓÔ˜ ÊˆÛÊfiÚÔ˜ (Pi), ÔÏÈÎ‹ ·ÏÎ·ÏÈÎ‹ ÊˆÛÊ·Ù¿ÛË (ÔÏÈÎ‹ ALP), ÔÛÙÂÔÎ·ÏÛ›ÓË (OC), ÔÈ ÙÚÂÈ˜ Î‡ÚÈÔÈ ÌÂÙ·‚ÔÏ›ÙÂ˜ ÙË˜ ‚ÈÙ·Ì›ÓË˜ D [25OHD, 24,25 (√∏)2D Î·È 1,25 (√∏)2D] Î·È ÙÔ Î·Ú‚ÔÍ˘ÙÂÏÈÎfi ¿ÎÚÔ ÙË˜ ·Ú·ıÔÚÌfiÓË˜ (C-PTH). ∆· ·Ôı¤Ì·Ù· ÙË˜ ‚ÈÙ·Ì›ÓË˜ D ÛÙÔÓ ÔÚÁ·ÓÈÛÌfi ÂÎÙÈÌ‹ıËÎ·Ó ·fi ÙÈ˜ Û˘ÁÎÂÓÙÚÒÛÂÈ˜ ÙË˜ 25√∏D ÛÙÔÓ

ÔÚfi. ™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË ¤ÏÏÂÈ„Ë ‚ÈÙ·Ì›ÓË˜ D ıÂˆÚ‹ıËÎÂ fiÙ·Ó Ù· Â›Â‰· ÙË˜ 25OHD ÛÙÔÓ ÔÚfi ‚Ú¤ıËÎ·Ó Ó· Â›Ó·È ÌÈÎÚfiÙÂÚ· ·fi 10 ng/ml Î·È ·ÓÂ¿ÚÎÂÈ·, fiÙ·Ó Ë ÙÈÌ‹ ÙË˜ 25OHD ‹Ù·Ó ÌÂÙ·Í‡ 10-20 ng/ml (13). To Ca ÙÔ˘ ÔÚÔ‡ ÚÔÛ‰ÈÔÚ›ÛÙËÎÂ ÌÂ ÙËÓ ÙÈÙÏÔ‰ÔÙÈÎ‹ ÌÈÎÚÔÌ¤ıÔ‰Ô ÙÔ˘ ÔÚÁ¿ÓÔ˘ Calcette, Model 4008, Precision Systems Inc, MA, ∏.¶.∞. √ ·ÓfiÚÁ·ÓÔ˜ ÊˆÛÊfiÚÔ˜ ÚÔÛ‰ÈÔÚ›ÛÙËÎÂ ÌÂ ÊˆÙÔÌÂÙÚÈÎ‹ Ì¤ıÔ‰Ô (14). √ ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙË˜ ÔÏÈÎ‹˜ ·ÏÎ·ÏÈÎ‹˜ ÊˆÛÊ·Ù¿ÛË˜ ¤ÁÈÓÂ ÌÂ ÊˆÙÔÌÂÙÚÈÎ‹ Ì¤ıÔ‰Ô ÎÈÓËÙÈÎ‹˜, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ·ÓÙÈ‰Ú·ÛÙ‹ÚÈ· ÙË˜ Elitech Diagnostics, Sees, France. √È ÚÔÛ‰ÈÔÚÈÛÌÔ› ÙÔ˘ Î·Ú‚ÔÍ˘ÙÂÏÈÎÔ‡ ¿ÎÚÔ˘ ÙË˜ ·Ú·ıÔÚÌfiÓË˜ (C-PTH) Î·È ÙË˜ ÔÛÙÂÔÎ·ÏÛ›ÓË˜ ¤ÁÈÓ·Ó ÌÂ Ú·‰ÈÔ·ÓÔÛÔÏÔÁÈÎ¤˜ ÌÂıfi‰Ô˘˜ (RIA) ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ·ÓÙÈ‰Ú·ÛÙ‹ÚÈ· ·fi ÙËÓ Incstar Co, ∏.¶.∞. √È ÌÂÙ·‚ÔÏ›ÙÂ˜ ÙË˜ ‚ÈÙ·Ì›ÓË˜ D [25(OH)D, 24,25 (OH)2D Î·È 1,25(√∏)2D] ÚÔÛ‰ÈÔÚ›ÛÙËÎ·Ó ÌÂ ÙÂ¯ÓÈÎ¤˜ Ô˘ ·Ó·Ù‡¯ıËÎ·Ó ÛÙÔ ÂÚÁ·ÛÙ‹ÚÈÔ ÙË˜ ¶·È‰È·ÙÚÈÎ‹˜ ·fi ÙÔ˘˜ ªÔ˘Ï¿ Î·È Û˘Ó (15). ∆ÚÔÔÔÈ‹ıËÎ·Ó ·fi ‹‰Ë ˘¿Ú¯Ô˘ÛÂ˜ ÌÂıfi‰Ô˘˜ ÙˆÓ Shepard Î·È Û˘Ó (1979) Î·È Reinhardt Î·È Û˘Ó (1984) ·ÍÈÔÔÈÒÓÙ·˜ ·Ú¿ÏÏËÏ· Î·È ÓÂfiÙÂÚÂ˜ ÙÂ¯ÓÈÎ¤˜ ˘ÁÚ‹˜ ¯ÚˆÌ·ÙÔÁÚ·Ê›·˜

˘„ËÏ‹˜ ›ÂÛË˜ (HPLC) ÁÈ· ÙÔÓ ‰È·¯ˆÚÈÛÌﬁ ÙˆÓ ÌÂÙ·‚ÔÏÈÙÒÓ ÌÂÙ·Í‡ ÙÔ˘˜ (16,17). MÂÙ¿ ÙËÓ ÂÎ¯‡ÏÈÛË ·ﬁ

ÙÔÓ ÔÚﬁ Î·È ÙÔÓ ‰È·¯ˆÚÈÛÌﬁ ÙÔ˘˜, ÔÈ ÌÂÙ·‚ÔÏ›ÙÂ˜ ÙË˜

25(OH)D Î·È 24,25(OH)2D ÛÙË Û˘Ó¤¯ÂÈ· ÚÔÛ‰ÈÔÚ›ÛÙËÎ·Ó ÌÂ Ú·‰ÈÔ·ÓÔÛÔÏÔÁÈÎ‹ Ì¤ıÔ‰Ô (RIA) ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ‰ÂÛÌÂ˘ÙÈÎ‹ ÚˆÙÂ˝ÓË (DBP) ·ÓıÚÒÔ˘ Î·È ÙË˜ 1,25(√∏)2D ÌÂ RIA ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÚˆÙÂ˚ÓÈÎfi ˘Ô‰Ô¯¤· ·fi ı‡ÌÔ ·‰¤Ó· ÌfiÛ¯Ô˘.

™Ù·ÙÈÛÙÈÎ‹

∏ ÛÙ·ÙÈÛÙÈÎ‹ ÂÂÍÂÚÁ·Û›· ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ

¤ÁÈÓÂ ÛÂ ˘ÔÏÔÁÈÛÙ‹, ÌÂ ÙË ¯Ú‹ÛË ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜

StatView ÙË˜ SAS Institute Inc. ∏ Û‡ÁÎÚÈÛË ÙˆÓ Ì¤ÛˆÓ

ﬁÚˆÓ ÙˆÓ ÙÈÌÒÓ ÙˆÓ ‚ÈÔ¯ËÌÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ ¤ÁÈÓÂ ÌÂ

Student's t-test Î·È ÙËÓ Ì¤ıÔ‰Ô ÙË˜ ·Ó¿Ï˘ÛË˜ ÙË˜ ÌÂÙ·‚ÏËÙfiÙËÙ·˜ Î·Ù¿ Ì›· ‰ÈÂ‡ı˘ÓÛË (ANOVA). °È· ÙË Û‡ÁÎÚÈÛË ÙˆÓ Ì¤ÛˆÓ fiÚˆÓ ÌÂÙ·Í‡ ¯ÂÈÌÒÓ· Î·È Î·ÏÔÎ·ÈÚÈÔ‡ ÛÙËÓ ›‰È· ÔÌ¿‰· ·È‰ÈÒÓ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ ÙÔ paired t-test ÌÂ fiÚÈÔ ÛËÌ·ÓÙÈÎfiÙËÙ·˜ ÙÔ 5%. √È Û˘ÓÙÂÏÂÛÙ¤˜ Û˘Û¯¤ÙÈÛË˜ ÌÂÙ·Í‡ ÙˆÓ ·Ú·Ì¤ÙÚˆÓ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó ˘ÔÏÔÁ›ÛÙËÎ·Ó ÌÂ ÙË Ì¤ıÔ‰Ô ÙË˜ ÁÚ·ÌÌÈÎ‹˜

Û˘ÌÌÂÙ·‚ÔÏ‹˜ (linear regression).

ÛÙÈ˜ ÙÚÂÈ˜ ÔÌ¿‰Â˜ ÙˆÓ ·È‰ÈÒÓ Ô˘ ÌÂ-

ÔÚﬁ

¯·ÌËÏﬁÙÂÚ· ÙË ¯ÂÈÌÂÚÈÓ‹ ÂÚ›Ô‰Ô ÛÂ

Û‡ÁÎÚÈÛË ÌÂ ÙË ıÂÚÈÓ‹ (¶›Ó·Î·˜ 1). √ Ì¤ÛÔ˜

ﬁÚÔ˜ ÙˆÓ ÙÈÌÒÓ ·ÓÙ›ÛÙÔÈ¯· ‹Ù·Ó 18,5±1,3 ¤Ó·ÓÙÈ 29,8±1,8 ng/ml (p<0,01) ÁÈ· ÙËÓ ÔÌ¿‰· π, 21,0±1,9 ¤Ó·ÓÙÈ 26,6±1,4 ng/ml (p<0,05) ÁÈ·

ÙËÓ ÔÌ¿‰· ππ, Î·È 12,7±0,9 ¤Ó·ÓÙÈ 27,7±1,3 ng/ml (p<0,01) ÁÈ· ÙËÓ ÔÌ¿‰· πππ. √È ‰È·ÊÔÚ¤˜

ÌÂÙ·Í‡ ÙˆÓ ‰‡Ô ÂÔ¯ÒÓ ‹Ù·Ó ÈÔ ¤Î‰ËÏÂ˜ ÛÙ·

ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿ (ÔÌ¿‰· πππ). ∂›ÛË˜, ÙË ¯ÂÈ-

ÌÂÚÈÓ‹ ÂÚ›Ô‰Ô ÛÙ· ·È‰È¿ ÙË˜ ÙÚ›ÙË˜ ÔÌ¿‰·˜

Ù· Â›Â‰· ÙË˜ 25OHD ‚Ú¤ıËÎ·Ó Ó· Â›Ó·È Ô-

Ï‡ ¯·ÌËÏﬁÙÂÚ· (p<0,01) ·ﬁ ÙˆÓ ¿ÏÏˆÓ ‰‡Ô

ÔÌ¿‰ˆÓ (¶›Ó·Î·˜ 1). TÔ Î·ÏÔÎ·›ÚÈ ÔÈ Ì¤ÛÔÈ

ﬁÚÔÈ ﬁÏˆÓ ÙˆÓ ÔÌ¿‰ˆÓ ‰ÂÓ ‰È¤ÊÂÚ·Ó ÌÂÙ·Í‡ ÙÔ˘˜ (¶›Ó·Î·˜ 1).

¶›Ó·Î·˜ 1. TÔ ËÏÈÎÈ·Îfi Â‡ÚÔ˜, Ô ·ÚÈıÌfi˜ (N) Î·È ÔÈ Ì¤ÛÂ˜ ÙÈÌ¤˜ (±SEM) ÛÙÔÓ ÔÚfi ÙˆÓ ÌÂÙ·‚ÔÏÈÙÒÓ ÙË˜ ‚ÈÙ·Ì›ÓË˜ D [25OHD, 24,25(OH)2D Î·È 1,25(OH)2D] Î·È ÙË˜ ·Ú·ıÔÚÌfiÓË˜ (C-PTH) ÛÙÈ˜ ÙÚÂÈ˜ ÔÌ¿‰Â˜ ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ Ì¤¯ÚÈ ÙËÓ ËÏÈÎ›· ÙˆÓ 18 ¯ÚfiÓˆÓ, Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó ¯ÂÈÌÒÓ· (X) Î·È Î·ÏÔÎ·›ÚÈ (K)

∏ÏÈÎÈ·Îﬁ Â‡ÚÔ˜ N25OHD24,25(OH)2D 1,25(OH)2D C-PTH (¯ÚﬁÓÈ·)(ng/ml)(ng/ml)(pg/ml)(ng/ml)

3-10X: 4318,5±1,3c 1,31±0,12c 23,0±1,90,73±0,07a K: 3229,4±1,8**2,17±0,19+ 26,9±1,90,70±0,07

11-14X: 2221,0±1,9e 1,47±0,17c 25,8±3,40,74±0,04a K: 2726,6±1,4*1,79±0,16c 32,4±3,0a 0,80±0,14

15-18X: 4512,7±0,9d 0,73±0,10d 26,7±1,50,47±0,06b

K: 4127,7±1,3**2,41±0,20+,d 25,7±1,9b 0,60±0,06

*p<0,05, **p<0,01, +p<0,001: ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙÈ˜ ÙÈÌ¤˜ ÙÔ˘ ¯ÂÈÌÒÓ· avs bp<0,05, cvs dp<0,01, dvs ep<0,001: Û‡ÁÎÚÈÛË ÌÂÙ·Í‡ ÙˆÓ ËÏÈÎÈ·ÎÒÓ ÔÌ¿‰ˆÓ

∆Ë ¯ÂÈÌÂÚÈÓ‹ ÂÚ›Ô‰Ô, ÙÔ 47% ÙˆÓ ÂÊ‹‚ˆÓ

ËÏÈÎ›·˜ 15-18 ¯ÚﬁÓˆÓ Â›¯·Ó ÙÈÌ¤˜ 25OHD <10

ng/ml, ÂÓÒ ÁÈ· Ù· ·È‰È¿ ÙˆÓ ÔÌ¿‰ˆÓ π Î·È ππ Ë

ÂÎ·ÙÔÛÙÈ·›· ·Ó·ÏÔÁ›· ‹Ù·Ó 14% Î·È 13% ·ÓÙ›-

ÛÙÔÈ¯·. ∂ÈÏ¤ÔÓ, Ô ·ÚÈıÌﬁ˜ ÙˆÓ ÎÔÚÈÙÛÈÒÓ ÌÂ

·ÓÂ¿ÚÎÂÈ· ‚ÈÙ·Ì›ÓË˜ D ÛÙËÓ ÔÌ¿‰· πππ, ‹Ù·Ó

‰ÈÏ¿ÛÈÔ˜ ·' ﬁ,ÙÈ ÙˆÓ ·ÁÔÚÈÒÓ, ÂÓÒ Ë Î·Ù·ÓÔ-

Ì‹ ÛÙÈ˜ ¿ÏÏÂ˜ ‰‡Ô ÔÌ¿‰Â˜ ‹Ù·Ó ›ÛË ÁÈ· Ù· ‰‡Ô

Ê‡Ï·. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ Î·ÏÔÎ·ÈÚÈÔ‡ ﬁÏ·

Ù· ·È‰È¿ ‚Ú¤ıËÎ·Ó Ó· ¤¯Ô˘Ó Â›Â‰· 25OHD

¿Óˆ ·ﬁ 10 ng/ml. ŸÌˆ˜, ÛÂ ﬁÏÂ˜ ÙÈ˜ ÔÌ¿‰Â˜,

¤Ó· ÔÛÔÛÙﬁ ·È‰ÈÒÓ Ô˘ ‹Ù·Ó 15%, 9,4% Î·È

21% ÁÈ· ÙÈ˜ ÔÌ¿‰Â˜ π, ππ Î·È πππ ·ÓÙ›ÛÙÔÈ¯·, Â›¯·Ó

Û˘ÁÎÂÓÙÚÒÛÂÈ˜ Ô˘ Î˘Ì·›ÓÔÓÙ·Ó ÌÂÙ·Í‡ 10 Î·È

20 ng/ml. °È· ÙÔÓ ¯ÂÈÌÒÓ·, ·˘Ù¿ Ù· ÔÛÔÛÙ¿ ·Ó¤Ú¯ÔÓÙ·Ó ÛÂ 37%, 35% Î·È 33% ·ÓÙ›ÛÙÔÈ¯·.

ªÂ ÙË ¯ÚÔÓÔÏÔÁÈÎ‹ ·‡ÍËÛË ÙË˜ ËÏÈÎ›·˜,

·Ú·ÙËÚ‹ıËÎÂ Ì›· Ù¿ÛË ÌÂ›ˆÛË˜ ÙˆÓ ÙÈÌÒÓ

ÙË˜ 25OHD ÛÙÔÓ ÔÚﬁ ÁÈ· ¯ÂÈÌÒÓ· Î·È Î·ÏÔÎ·›-

ÚÈ (∂ÈÎﬁÓ· 1).

√È Û˘ÁÎÂÓÙÚÒÛÂÈ˜ ÙË˜ 24,25 ‰È˘‰ÚÔÍ˘‚ÈÙ·Ì›ÓË˜ D [24,25(OH)2D] Î·È ÛÙÈ˜ ÙÚÂÈ˜ ÔÌ¿‰Â˜

·ÚÔ˘Û›·Û·Ó ÂÔ¯È·Î‹ ‰È·Î‡Ì·ÓÛË ·Ú¿ÏÏË-

Ï· ÌÂ ·˘Ù‹ ÙË˜ 25OHD. √ Ì¤ÛÔ˜ ﬁÚÔ˜ ÙˆÓ ÙÈ-

ÌÒÓ ‹Ù·Ó 1,31±0,12 ÙÔÓ ¯ÂÈÌÒÓ· ¤Ó·ÓÙÈ 2,17±0,19 ng/ml ÙÔ˘ Î·ÏÔÎ·ÈÚÈÔ‡ (p<0,001)

ÛÙËÓ ÔÌ¿‰· π, 1,47±0,17 ¤Ó·ÓÙÈ 1,79±0,19 ng/ml

ÛÙËÓ ÔÌ¿‰· ππ Î·È 0,73±0,10 ¤Ó·ÓÙÈ 2,41±0,20 ng/ml (p<0,001), ÛÙËÓ ÔÌ¿‰· πππ (¶›Ó·Î·˜ 1).

Ÿˆ˜ Î·È ÌÂ ÙËÓ 25OHD Ë ‰È·ÊÔÚ¿ ÌÂÙ·Í‡

ÂÔ¯ÒÓ ‹Ù·Ó ÈÔ ÂÌÊ·Ó‹˜ ÛÙËÓ ÔÌ¿‰· ÙˆÓ ÌÂ-

Á·Ï‡ÙÂÚˆÓ ·È‰ÈÒÓ (¶›Ó·Î·˜ 1). °È· ÙËÓ

24,25(√∏)2D ‰È·ÊÔÚ¤˜ ·Ú·ÙËÚ‹ıËÎ·Ó ÌÂÙ·-

Í‡ ÙˆÓ ÔÌ¿‰ˆÓ Û¯ÂÙÈÎ¿ ÌÂ ÙÈ˜ ÙÈÌ¤˜ Î·È ÁÈ· ÙÈ˜ ‰‡Ô ÂÔ¯¤˜ (¶›Ó·Î·˜ 1). √È ÙÈÌ¤˜ ÙÔÓ ¯ÂÈÌÒÓ·

ÛÙËÓ ÔÌ¿‰· πππ ‹Ù·Ó ÛËÌ·ÓÙÈÎ¿ ¯·ÌËÏfiÙÂÚÂ˜ ·' fi,ÙÈ ÛÙÈ˜ ÔÌ¿‰Â˜ ππ Î·È π (0,73±0,10 ¤Ó·ÓÙÈ 1,47±0,17 Î·È 1,31±0,12 ng/ml, p<0,01), ·ÏÏ¿ ÌÂÁ·Ï‡ÙÂÚÂ˜ ÙÔ Î·ÏÔÎ·›ÚÈ (2,41±0,20 ¤Ó·ÓÙÈ 1,79±0,16, p<0,01 Î·È 2,17±0,19 ng/ml). πÛ¯˘Ú‹ ıÂÙÈÎ‹ Û˘Û¯¤ÙÈÛË ÌÂÙ·Í‡ ÙˆÓ Û˘ÁÎÂÓÙÚÒÛÂˆÓ ÛÙÔÓ ÔÚfi ÙË˜ 25OHD Î·È ÙË˜ 24,25(√∏)2D ‚Ú¤ıËÎÂ ÛÂ fiÏ· Ù· ·È‰È¿ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó Î·È ÁÈ· ÙÈ˜ ‰‡Ô ÂÔ¯¤˜ (R=0,61 p<0,001). A˘Ù‹ Ë Û˘Û¯¤ÙÈÛË ‹Ù·Ó ÈÛ¯˘ÚfiÙÂÚË ÙÔÓ ¯ÂÈÌÒÓ· R=0,68, p<0,0001) ·' fi,ÙÈ ÙÔ Î·ÏÔÎ·›ÚÈ (R=0,37, p<0,001) (∂ÈÎfiÓ· 2).

¢ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ‰È·ÊÔÚ¤˜ ÛÙÈ˜ ÙÈÌ¤˜ ÙË˜ 1,25 ‰È˘‰ÚÔÍ˘‚ÈÙ·Ì›ÓË˜ D [1,25(OH)2D] ÌÂÙ·Í‡ ÙˆÓ ‰‡Ô ÂÔ¯ÒÓ Î·È ÛÙÈ˜ ÙÚÂÈ˜ ÔÌ¿‰Â˜ (¶›Ó·Î·˜ 1). ª›· Û¯ÂÙÈÎ¿ ÌÈÎÚ‹ ‰È·ÊÔÚ¿ ·Ú·ÙËÚ‹ıËÎÂ ÌÂÙ·Í‡ ÙˆÓ ÔÌ¿‰ˆÓ ππ Î·È πππ ˆ˜ ÚÔ˜ ÙÈ˜ Û˘ÁÎÂÓÙÚÒÛÂÈ˜ ÙÔ˘ ÌÂÙ·‚ÔÏ›ÙË ÙÔ Î·ÏÔÎ·›ÚÈ (32,4±3,0 ¤Ó·ÓÙÈ 25,7±1,9 pg/ml, p<0,05). √È ÙÈÌ¤˜ ÙË˜ C-PTH ÛÙÔÓ ÔÚfi ‰ÂÓ ‰È¤ÊÂÚ·Ó ÌÂÙ·Í‡ ÙˆÓ ‰‡Ô ÂÔ¯ÒÓ ÛÂ fiÏÂ˜ ÙÈ˜ ÔÌ¿‰Â˜ (¶›Ó·Î·˜ 1). ∆ÔÓ ¯ÂÈÌÒÓ·, Ù· Â›Â‰· ÙË˜ CPTH ‚Ú¤ıËÎ·Ó ÛÙ·ÙÈÛÙÈÎ¿ ¯·ÌËÏfiÙÂÚ· ÛÙÔ˘˜ Ó¤Ô˘˜ ÙË˜ ÔÌ¿‰·˜ πππ ÛÂ Û‡ÁÎÚÈÛË ÌÂ Ù· ·È‰È¿ ÙˆÓ ÔÌ¿‰ˆÓ π Î·È ππ (0,47±0,06 ¤Ó·ÓÙÈ 0,73±0,07 Î·È 0,74±0,04 ng/ml, p<0,05).

√È ÙÈÌ¤˜ ÙÔ˘ Ca ÛÙÔÓ ÔÚfi Î˘Ì·›ÓÔÓÙ·Ó ÛÂ Ê˘ÛÈÔÏÔÁÈÎ¿ fiÚÈ· ÁÈ· ÙÈ˜ ‰‡Ô ÂÔ¯¤˜ Î·È ÛÙÈ˜ ÙÚÂÈ˜ ˘fi ÌÂÏ¤ÙË ÔÌ¿‰Â˜ (¶›Ó·Î·˜ 2). ªÂÚÈÎ¤˜ ‰È·ÊÔÚ¤˜ ·Ú·ÙËÚ‹ıËÎ·Ó ÌÂÙ·Í‡ ÙˆÓ ‰‡Ô ÂÔ¯ÒÓ ÛÙËÓ ÔÌ¿‰· π (2,43±0,3 ÙÔÓ ¯ÂÈÌÒÓ· ¤Ó·ÓÙÈ 2,28±0,08 mml/L ÙÔ Î·ÏÔÎ·›ÚÈ, p<0,01) Î·È ÌÂÙ·Í‡ ÙˆÓ ÔÌ¿‰ˆÓ π Î·È ππ ÙÔ Î·ÏÔÎ·›ÚÈ (2,28±0,08 ¤Ó·ÓÙÈ 2,40±0,03 mml/L, p<0,01).

3-18 ¯ÚﬁÓˆÓ, ÁÈ· ÙÔÓ ¯ÂÈÌÒÓ· Î·È ÙÔ Î·ÏÔÎ·›ÚÈ Ì·˙› (N=209, R=-0,23, p<0,001).

24,25(OH) 2 D (ng/mL)

250HD (ng/mL) ÃÂÈÌÒÓ·˜ ∫·ÏÔÎ·›ÚÈ

304050

∂ÈÎfiÓ· 2. ™˘Û¯¤ÙÈÛË ÙˆÓ Û˘ÁÎÂÓÙÚÒÛÂˆÓ ÙË˜ 25OHD Î·È ÙË˜ 24,25(OH)2D ÛÙÔÓ ÔÚfi ÛÂ ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ 3-18 ¯ÚfiÓˆÓ, ÙÔÓ ¯ÂÈÌÒÓ· (N=102, R=0,68, p<0,0001) Î·È ÙÔ Î·ÏÔÎ·›ÚÈ (N=87, R=0,37, p<0,001).

√È Û˘ÁÎÂÓÙÚÒÛÂÈ˜ ÙˆÓ ·ÓﬁÚÁ·ÓˆÓ ÊˆÛÊÔ-

ÚÈÎÒÓ (Pi) ÛÙÔÓ ÔÚﬁ ‹Ù·Ó ÛÙ· Ê˘ÛÈÔÏÔÁÈÎ¿ ﬁÚÈ·

Î·È ÛÙÈ˜ ÙÚÂÈ˜ ÔÌ¿‰Â˜ (¶›Ó·Î·˜ 2). ŸÌˆ˜, ÔÈ

¤ÊË‚ÔÈ ÙË˜ ÔÌ¿‰·˜ πππ Â›¯·Ó ÙÈÌ¤˜ ÊˆÛÊﬁÚÔ˘

ÛÙÔÓ ÔÚfi ÙÔÓ ¯ÂÈÌÒÓ· ÌÈÎÚfiÙÂÚÂ˜ ·fi ÙˆÓ ·È-

‰ÈÒÓ ÙˆÓ ¿ÏÏˆÓ ‰‡Ô ÔÌ¿‰ˆÓ (1,26±0,03 ¤Ó·ÓÙÈ

1,45±0,06 mmol/L, p<0,05). ™ÙËÓ ›‰È· ÔÌ¿‰· ÙÔ

Î·ÏÔÎ·›ÚÈ, ÔÈ ÙÈÌ¤˜ ÙÔ˘ Pi ‚Ú¤ıËÎ·Ó Ó· Â›Ó·È

„ËÏﬁÙÂÚÂ˜ ·ﬁ ÙÔÓ ¯ÂÈÌÒÓ· (1,39±0,03 ¤Ó·ÓÙÈ 1,26±0,03 mmol/L, p<0,01) (¶›Ó·Î·˜ 2). ∏ ÌÂ›-

ˆÛË ÙˆÓ ÙÈÌÒÓ ÙÔÓ ¯ÂÈÌÒÓ· ‚Ú¤ıËÎÂ Ó· Â›Ó·È

ÈÔ ¤Î‰ËÏË ÛÙ· ÎÔÚ›ÙÛÈ· ËÏÈÎ›·˜ 15-18 ÂÙÒÓ

(1,19±0,03 ¤Ó·ÓÙÈ 1,39±0,03 mmol/L, p<0,001)

·' ﬁ,ÙÈ ÛÙ· ·ÁﬁÚÈ· (1,29±0,06 ¤Ó·ÓÙÈ 1,39±0,03 mmol/L), ÂÓÒ ‰ÂÓ ‚Ú¤ıËÎ·Ó ‰È·ÊÔÚ¤˜ ÛÙÈ˜ ÙÈ-

Ì¤˜ ÙÔ˘ Pi ÛÙÔÓ ÔÚﬁ ÌÂÙ·Í‡ ÙˆÓ ‰‡Ô Ê‡ÏˆÓ ÙÔ

Î·ÏÔÎ·›ÚÈ (¶›Ó·Î·˜ 3). ¶·Ú¿ÏÏËÏ· ÌÂ ÙËÓ ·‡-

ÍËÛË ÙË˜ ËÏÈÎ›·˜ ·Ú·ÙËÚ‹ıËÎÂ ÌÂ›ˆÛË ÙˆÓ

ÙÈÌÒÓ ÙÔ˘ Pi ÛÙÔÓ ÔÚﬁ Î·È ÁÈ· Ù· ‰‡Ô Ê‡Ï· ÙˆÓ

·È‰ÈÒÓ 3-18 ÂÙÒÓ (∂ÈÎﬁÓ· 3). ∆· Â›Â‰· ÙË˜ ÔÏÈÎ‹˜ ALP ÛÙÔÓ ÔÚﬁ ÛÙËÓ

ÔÌ¿‰· ππ ‹Ù·Ó ˘„ËÏﬁÙÂÚ· ·ﬁ ÙˆÓ ¿ÏÏˆÓ ‰‡Ô

ÔÌ¿‰ˆÓ Î·È Ë ‰È·ÊÔÚ¿ ‹Ù·Ó ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ ÙÔ Î·ÏÔÎ·›ÚÈ, ﬁˆ˜ Ê·›ÓÂÙ·È ÛÙÔÓ ¶›Ó·Î· 2. √ ·ÓÙ›ÛÙÔÈ¯Ô˜ Ì¤ÛÔ˜ ﬁÚÔ˜ ÙˆÓ ÙÈÌÒÓ ÙÔ

Î·ÏÔÎ·›ÚÈ ‹Ù·Ó 264±30 ¤Ó·ÓÙÈ 187±17 IU/L, p<0,05 ÛÙËÓ ÔÌ¿‰· π Î·È 180±18 IU/L, p<0,01 ÛÙËÓ ÔÌ¿‰· πππ Î·È ‰ÂÓ ·Ú·ÙËÚ‹ıËÎÂ ÂÔ¯È·-

Î‹ ‰È·Î‡Ì·ÓÛË.

√È ÙÈÌ¤˜ ÙË˜ ÔÛÙÂÔÎ·ÏÛ›ÓË˜ ÛÙÔÓ ÔÚﬁ ÙË˜

ÔÌ¿‰·˜ πππ ‚Ú¤ıËÎ·Ó ¯·ÌËÏﬁÙÂÚÂ˜ ·ﬁ ÂÎÂ›ÓÂ˜

ÙË˜ ÔÌ¿‰·˜ ππ Î·È ÛÙÈ˜ ‰‡Ô ÂÔ¯¤˜ (7,0±0,4 ¤Ó·ÓÙÈ 9,4±1,2, p<0,05 ÙÔÓ ¯ÂÈÌÒÓ· Î·È 5,9±0,3 ¤Ó·-

ÓÙÈ 12,7±1.2 ng/ml, p<0,001 ÙÔ Î·ÏÔÎ·›ÚÈ), ÂÓÒ ·ﬁ ÙË˜ ÔÌ¿‰·˜ π, ÌﬁÓÔ ÙÔ Î·ÏÔÎ·›ÚÈ (5,9±0,3 ¤Ó·ÓÙÈ 10,3±1,0 ng/ml, p<0,001) (¶›Ó·Î·˜ 2).

™ÙÈ˜ ‰‡Ô

ÚÒÙÂ˜ ÔÌ¿‰Â˜ ·È‰ÈÒÓ, ‰È·ÊÔÚ¤˜

·Ú·ÙËÚ‹ıËÎ·Ó Î·È ÌÂÙ·Í‡ ÙˆÓ ÂÔ¯ÒÓ ﬁÔ˘

ÔÈ Û˘ÁÎÂÓÙÚÒÛÂÈ˜ ÙË˜ ÔÛÙÂÔÎ·ÏÛ›ÓË˜ ‹Ù·Ó ¯·ÌËÏﬁÙÂÚÂ˜ ÙÔÓ ¯ÂÈÌÒÓ· ·ﬁ ÂÎÂ›ÓÂ˜ ÙÔ˘ Î·ÏÔÎ·ÈÚÈÔ‡ (7,5±0,7 ¤Ó·ÓÙÈ 10,3±1,0 ng/ml, p<0,01

ÛÙËÓ ÔÌ¿‰· π Î·È 9,4±1,2 ¤Ó·ÓÙÈ 12,7±1,2 ng/ml, p<0,01 ÛÙËÓ ÔÌ¿‰· ππ) (¶›Ó·Î·˜ 2).

£ÂÙÈÎ‹ Û˘Û¯¤ÙÈÛË ÌÂÙ·Í‡ ÙˆÓ ÙÈÌÒÓ ÙË˜

ÔÛÙÂÔÎ·ÏÛ›ÓË˜ Î·È ÙË˜ ÔÏÈÎ‹˜ ALP ÛÙÔÓ ÔÚﬁ

·Ú·ÙËÚ‹ıËÎÂ ÛÙ· ·È‰È¿ Î·È ÙˆÓ ÙÚÈÒÓ ÔÌ¿-

‰ˆÓ ËÏÈÎ›·˜ 3-18 ÂÙÒÓ Î·È ÁÈ· ÙÈ˜ ‰‡Ô ÂÔ¯¤˜ (R=0,35, p<0,001) (∂ÈÎﬁÓ· 4).

¢È·ÊÔÚ¤˜ ÛÙÈ˜ ÙÈÌ¤˜ ÌÂÚÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ

ÙÔ˘ ÔÛÙÈÎÔ‡ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ·Ú·ÙËÚ‹ıËÎ·Ó ÌÂÙ·Í‡ ÙˆÓ ‰‡Ô Ê‡ÏˆÓ ÛÙÔ˘˜ Ó¤Ô˘˜ 15-18 ÂÙÒÓ, ﬁˆ˜ Ê·›ÓÂÙ·È ÛÙÔÓ ¶›Ó·Î· 3. √È ÙÈÌ¤˜

‚ÈÔ¯ËÌÈÎÒÓ ‰ÂÈÎÙÒÓ ÙË˜ Û‡ÓıÂÛË˜ ÙˆÓ ÔÛÙÒÓ (ÔÏÈÎ‹ ALP Î·È ÔÛÙÂÔÎ·ÏÛ›ÓË) ‚Ú¤ıË-

·' ﬁ,ÙÈ ÛÙ·

Î·È ÙË ıÂÚÈÓ‹ ÂÚ›Ô‰Ô (¶›Ó·Î·˜ 3). √È ·ÓÙ›ÛÙÔÈ¯ÔÈ Ì¤ÛÔÈ ﬁÚÔÈ ÙˆÓ ÙÈÌÒÓ

ÙË˜ ÔÏÈÎ‹˜ ALP ‹Ù·Ó 108±48 ¤Ó·ÓÙÈ 212±28 IU/L p<0,001 ÙÔÓ ¯ÂÈÌÒÓ· Î·È 116±7 ¤Ó·ÓÙÈ 248±39 IU/L p<0,001 ÙÔ Î·ÏÔÎ·›ÚÈ (¶›Ó·Î·˜ 3). √ Ì¤ÛÔ˜ ﬁÚÔ˜ ÙˆÓ ÙÈÌÒÓ ÙË˜ ÔÛÙÂÔÎ·ÏÛ›ÓË˜

‚Ú¤ıËÎÂ 5,8±0,3 ¤Ó·ÓÙÈ 8,7±0,6 ng/ml p<0,001

ÁÈ· ÙÔÓ ¯ÂÈÌÒÓ· Î·È 4,6±0,3 ¤Ó·ÓÙÈ 7,3±0,5 ng/ml p<0,001 ÁÈ· ÙÔ Î·ÏÔÎ·›ÚÈ (¶›Ó·Î·˜ 3).

¢ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ‰È·ÊÔÚ¤˜ ÌÂÙ·Í‡ ÙˆÓ ‰‡Ô

Ê‡ÏˆÓ ÁÈ· ÙÔ˘˜ Ó¤Ô˘˜ ËÏÈÎ›·˜ 15-18 ¯ÚﬁÓˆÓ

ﬁÛÔÓ ·ÊÔÚ¿ ÙÔ˘˜ ÌÂÙ·‚ÔÏ›ÙÂ˜ ÙË˜ ‚ÈÙ·Ì›ÓË˜ D, C-PTH Î·È Ca (¶›Ó·Î·˜ 3).

™ÙËÓ ÔÌ¿‰· III, ÛÂ ·ÙÔÌÈÎﬁ Â›Â‰Ô, ÙÔ 61%

ÙˆÓ ÎÔÚÈÙÛÈÒÓ Â›¯·Ó ÙÈÌ¤˜ 25√HD ÛÙÔÓ ÔÚfi ÌÈÎÚfiÙÂÚÂ˜ ·fi 10 ng/ml ¤Ó·ÓÙÈ ÙÔ˘ 35% ÙˆÓ ·ÁÔÚÈÒÓ, ÂÓÒ Ù¤ÙÔÈÂ˜ ‰È·ÊÔÚ¤˜ ‰ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó

( mmol/L) 1214161820

(¤ÙË)

∂ÈÎfiÓ· 3. ™˘Û¯¤ÙÈÛË ÙˆÓ Û˘ÁÎÂÓÙÚÒÛÂˆÓ ÙÔ˘ ÊˆÛÊfiÚÔ˘ (Pi) ÛÙÔÓ ÔÚfi ÌÂ ÙËÓ ËÏÈÎ›· ÛÂ ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ 3-18 ¯ÚfiÓˆÓ ÁÈ· ÙÔÓ ¯ÂÈÌÒÓ· Î·È ÙÔ Î·ÏÔÎ·›ÚÈ Ì·˙› (N=159, R=0,18, p<0,02).

(ng/mL)

∂ÈÎﬁÓ· 4. ™˘Û¯¤ÙÈÛË ÙˆÓ Û˘ÁÎÂÓÙÚÒÛÂˆÓ ÛÙÔÓ ÔÚﬁ ÙË˜

ÊˆÛÊ·Ù¿ÛË˜ Î·È ÙË˜ ÔÛÙÂÔÎ·ÏÛ›ÓË˜ ÛÂ ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ 3-18 ¯ÚﬁÓˆÓ ÁÈ· ¯ÂÈÌÒÓ· Î·È Î·ÏÔÎ·›ÚÈ Ì·˙› (N=138, R=0,35, p<0,0001).

¶›Ó·Î·˜ 2. OÈ Ì¤ÛÂ˜ ÙÈÌ¤˜ ÛÙÔÓ ÔÚﬁ (±SEM) ÙÔ˘ ·Û‚ÂÛÙ›Ô˘ (Ca), ÊˆÛÊÔÚÈÎÒÓ (Pi), ·ÏÎ·ÏÈÎ‹˜ ÊˆÛÊ·Ù¿ÛË˜ (ALP) Î·È ÔÛÙÂÔÎ·ÏÛ›ÓË˜ (OC) ÛÙÈ˜ ÙÚÂÈ˜ ÔÌ¿‰Â˜ ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ Ì¤¯ÚÈ ÙËÓ ËÏÈÎ›· ÙˆÓ 18 ¯ÚﬁÓˆÓ, Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó ¯ÂÈÌÒÓ· (X) Î·È Î·ÏÔÎ·›ÚÈ (K)

∏ÏÈÎÈ·Îﬁ Â‡ÚÔ˜ CaPiALPOC (¯ÚﬁÓÈ·)(mmol/L)(mmol/L)(IU/L)(ng/ml)

3-10X:2,43±0,031,45±0,06d 203±107,5±0,7

K:2,28±0,08**,c 1,35±0,06187±17a 10,3±1,0**,d

11-14X:2,35±0,051,45±0,06a 240±379,4±1,2a

K:2,35±0,031,39±0,06264±30b,c 12,7±1,2**,d

15-18X:2,43±0,031,26±0,03b,e 156±157,0±0,4b

K:2,40±0,03d 1,39±0,03+ 180±18d 5,9±0,3e

**p<0,01, +p<0,001: ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙÈ˜ ÙÈÌ¤˜ ÙÔ˘ ¯ÂÈÌÒÓ· avs bp<0,05, cvs dp<0,01, dvs ep<0,001: Û‡ÁÎÚÈÛË ÌÂÙ·Í‡ ÙˆÓ ËÏÈÎÈ·ÎÒÓ ÔÌ¿‰ˆÓ

ÛÙ· ·È‰È¿ ÙˆÓ ÔÌ¿‰ˆÓ π Î·È ππ. ∂›ÛË˜, ÔÈ Û˘ÁÎÂÓÙÚÒÛÂÈ˜ ÙÔ˘ Pi ÛÙÔÓ ÔÚﬁ ÛÙ· ÎÔÚ›ÙÛÈ· ÙË˜

ÔÌ¿‰·˜ πππ ‚Ú¤ıËÎ·Ó ¯·ÌËÏﬁÙÂÚÂ˜ ÙÔÓ ¯ÂÈÌÒÓ· ·' ﬁ,ÙÈ ÙÔ Î·ÏÔÎ·›ÚÈ (1,19±0,03 ¤Ó·ÓÙÈ 1,39±0,03 mmol/L, p<0,001).

™˘˙‹ÙËÛË

·ÚÔ‡Û· ÌÂÏ¤ÙË ‰Â›¯ÓÂÈ ﬁÙÈ ·ÎﬁÌË Î·È

ÛÂ ¯ÒÚÂ˜ ÌÂ ÌÂÁ¿ÏË ËÏÈÔÊ¿ÓÂÈ· ﬁˆ˜ Ë ∂ÏÏ¿-

‰·, ÛËÌ·ÓÙÈÎ‹ ·Ó·ÏÔÁ›· ·È‰ÈÒÓ ËÏÈÎ›·˜ 3-14

ÂÙÒÓ (14%) ·ÏÏ¿ Î˘Ú›ˆ˜ Ó¤ˆÓ ËÏÈÎ›·˜ 15-18

ÂÙÒÓ (47%) ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·ÓÂ¿ÚÎÂÈ· ‚ÈÙ·Ì›-

ÓË˜ D (<10 ng/ml) Î·Ù¿ ÙË ¯ÂÈÌÂÚÈÓ‹ ÂÚ›Ô‰Ô.

¶·ÚﬁÌÔÈ· Â˘Ú‹Ì·Ù· ¤¯Ô˘Ó ‰ËÌÔÛÈÂ˘ıÂ›

·ﬁ ¿ÏÏÂ˜ Â˘Úˆ·˚Î¤˜ Î·È ÌÂÛÔÁÂÈ·Î¤˜ ¯ÒÚÂ˜.

OÈ Ala Houhala Î·È Û˘Ó (18) ·ﬁ ÙË ºÈÓÏ·Ó‰›·

·Ó·Ê¤ÚÔ˘Ó ﬁÙÈ ÙÔ 22,4% ÙˆÓ ·È‰ÈÒÓ ËÏÈÎ›·˜ 11-17 ÂÙÒÓ ·ÚÔ˘Û›·Û·Ó ˘Ô‚ÈÙ·Ì›ÓˆÛË D (25OHD <5 ng/ml) Î·ı' ﬁÏË ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ¤ÙÔ˘˜ ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙÔ 16,8% ÙˆÓ ·È‰ÈÒÓ 6-

10 ÂÙÒÓ Î·È ÙÔ 7,5% ·È‰ÈÒÓ ËÏÈÎ›·˜ 2-5 ¯ÚfiÓˆÓ. ™Â Ì›· ·ÛÙÈÎ‹ ÂÚÈÔ¯‹ ÙË˜ ‚fiÚÂÈ·˜ °·ÏÏ›·˜ ‚Ú¤ıËÎÂ fiÙÈ ÛÙÔ 24% ÙˆÓ ·È‰ÈÒÓ ËÏÈÎ›·˜ 10-17 ÂÙÒÓ ÔÈ ÙÈÌ¤˜ ÔÚÔ‡ ÙË˜ 25OHD ‹Ù·Ó ¯·ÌËÏfiÙÂÚÂ˜ ·fi 6 ng/ml (19). ∞fi Ì›· ÔÌ¿‰· Ì·ıËÙÒÓ ÛÙÔÓ §›‚·ÓÔ ËÏÈÎ›·˜ 10-16 ÂÙÒÓ ÙÔ 52% (65% ÙÔÓ ¯ÂÈÌÒÓ· Î·È 40% ÙÔ Î·ÏÔÎ·›ÚÈ) Â›¯·Ó Â›Â‰· 25OHD ÛÙÔÓ ÔÚfi Î¿Ùˆ ·fi 10 ng/ml (20). ™Â Ì›· ÔÌ¿‰· ·È‰ÈÒÓ ËÏÈÎ›·˜ 7-10

ÂÙÒÓ Ô˘ Î·ÙÔÈÎÔ‡Û·Ó ÛÙË ÓÔÙÈÔ·Ó·ÙÔÏÈÎ‹

πÛ·Ó›· Ù· Â›Â‰· 25OHD ÛÙÔÓ ÔÚfi ÙÔ˘˜, Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ¯ÂÈÌÒÓ·, ‹Ù·Ó Î¿Ùˆ ·fi 12 ng/ml Î·È ÛÙ· ÂÚÈÛÛfiÙÂÚ· ·fi ·˘Ù¿ Î˘Ì·›ÓÔÓÙ·Ó ÌÂÙ·Í‡ 12 Î·È 20 ng/ml (21). ™ÙË µÚÂÙ·Ó›·, ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ §ÔÓ‰›ÓÔ˘, Ë ÏÂÈ-

ÛÙÈ·ÈÌ›· ‹ Ú·¯ÈÙÈÛÌfi ‹Ù·Ó ËÏÈÎ›·˜ Î¿Ùˆ ÙˆÓ ÙÚÈÒÓ ‹ ¿Óˆ ÙˆÓ 10 ÂÙÒÓ (22). ¶·ÚfiÌÔÈ· Î·È ÛÙËÓ KÔÂÁ¯¿ÁË (¢·Ó›·), ÔÈ ËÏÈÎ›Â˜ ·È‰ÈÒÓ Ô˘ ÂÌÊ¿ÓÈÛ·Ó Ú·¯ÈÙÈÛÌfi ‹Ù·Ó 0,5-4 Î·È 9-15 ¯ÚfiÓÈ· (23). ∂›ÛË˜, ·Ó·Ê¤ÚÔÓÙ·È Î·È ÌÂÁ¿Ï· ÔÛÔÛÙ¿ ·È‰ÈÒÓ ÌÂÙ·Ó·ÛÙÒÓ ÌÂ ˘Ô‚ÈÙ·Ì›ÓˆÛË D, ·ÚfiÙÈ ¤¯Ô˘Ó ÁÂÓÓËıÂ› Î·È ˙Ô˘Ó ÛÙË ¢·Ó›·. ∞˘Ù¿ ·Ó¤Ú¯ÔÓÙ·È ÛÂ 46% Î·È 81% ·ÓÙ›ÛÙÔÈ¯·, ÁÈ· ÙÈ˜ ËÏÈÎ›Â˜ 0-8 Î·È 9-16 ¯ÚfiÓˆÓ (24). ™ÙÈ˜ H.¶.A., fiÔ˘ ÙÚÔÊ¤˜ fiˆ˜ ÙÔ Á¿Ï· Î·È Ù· ‰ËÌËÙÚÈ·Î¿ (cereals) Â›Ó·È ÂÌÏÔ˘ÙÈÛÌ¤ÓÂ˜ ÌÂ ‚ÈÙ·Ì›ÓË D, Ú·¯ÈÙÈÛÌfi˜ ·Ó·Ê¤ÚÂÙ·È Ó· ··ÓÙ¿Ù·È ÛÙÈ˜ ËÏÈÎ›Â˜ 0,4-4,5 ¯ÚfiÓˆÓ Î·È Î˘Ú›ˆ˜ ÛÂ ·ÊÚÈÎ·ÓÈÎ‹˜ Î·Ù·ÁˆÁ‹˜ ·È‰È¿ Ô˘ Â›ÛË˜ Â›¯·Ó ıËÏ¿ÛÂÈ ÁÈ· Ì·ÎÚ‡ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·, ¯ˆÚ›˜ Û˘ÌÏËÚˆÌ·ÙÈÎ‹ ¯ÔÚ‹ÁËÛË ‚ÈÙ·Ì›ÓË˜ D (25). ™ÙË ÌÂÏ¤ÙË ÙˆÓ πˆ·ÓÓ›ÓˆÓ, Ë ÌÂÁ¿ÏË ‰È·ÊÔÚ¿ ÌÂÙ·Í‡ ÙˆÓ ÌÈÎÚfiÙÂÚˆÓ Î·È ÙˆÓ ÌÂÁ·Ï‡ÙÂÚˆÓ ·È‰ÈÒÓ ÌÔÚÂ› Ó· ·Ô‰ÔıÂ› ÛÂ ‰È·ÊÔÚ¤˜ Û˘ÌÂÚÈÊÔÚ¿˜ ˆ˜ ÚÔ˜ ÙË ‰È·ÙÚÔÊ‹ Î·È ÙÔÓ ÙÚfiÔ ‰È·‚›ˆÛË˜. ∆· ÌÂÁ¿Ï· ·È‰È¿ ·ÔÊÂ‡ÁÔ˘Ó Ó· Ï·Ì‚¿ÓÔ˘Ó ÚˆÈÓfi ‹ ÙÚÒÓÂ ÙÚÔÊ¤˜ Ù·¯Â›·˜ ·Ú·ÛÎÂ˘‹˜ (fast food) Î·È ÏÈÁfiÙÂÚ· Á·Ï·ÎÙÔÎÔÌÈÎ¿, ÂÓÒ ÙÈ˜ ÈÔ ÔÏÏ¤˜ ÒÚÂ˜ ‰È·Ì¤ÓÔ˘Ó ÛÙÔ Û›ÙÈ ‹ ÎÈÓÔ‡ÓÙ·È ÛÂ ÎÏÂÈÛÙÔ‡˜ ¯ÒÚÔ˘˜. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ Û¯ÔÏÈÎÔ‡ ¤ÙÔ˘˜ (™ÂÙ¤Ì‚ÚÈÔ˜ - πÔ‡ÓÈÔ˜), Î˘Ú›ˆ˜ ‰È·Ì¤ÓÔ˘Ó ÂÓÙfi˜ ÙÔ˘ Û¯ÔÏÂ›Ô˘ Î·È ÙÔ˘ ÛÈÙÈÔ‡ ÌÂÏÂÙÒÓÙ·˜ Â› ÒÚÂ˜ ÁÈ· Ó· ÚÔÂÙÔÈÌ·ÛıÔ‡Ó ÁÈ· ÙÈ˜ ÂÈÛ·ÁˆÁÈÎ¤˜ ÂÍÂÙ¿ÛÂÈ˜ ÛÙ· ¶·ÓÂÈÛÙ‹ÌÈ·. ∞ÎfiÌË Î·È ÁÈ· ÙË ‰È·ÛÎ¤‰·Û‹ ÙÔ˘˜ ÂÈÏ¤ÁÔ˘Ó ÎÏÂÈÛÙÔ‡˜ ¯ÒÚÔ˘˜, Î·ıÒ˜ Û' ·˘Ù‹ ÙËÓ ËÏÈÎ›· ÙÔ˘˜ ÂÏÎ‡ÂÈ Ë Ó˘¯ÙÂÚÈÓ‹ ˙ˆ‹ ÂÚÈÛÛfiÙÂÚÔ. ∞ıÏËÙÈÎ¤˜ ‰Ú·ÛÙËÚÈfiÙËÙÂ˜ ÛÙÔ ‡·ÈıÚÔ Â›Ó·È ÂÚÈÔÚÈÛÌ¤ÓÂ˜ ÛÂ ·˘Ù¤˜ ÙÈ˜ ËÏÈÎ›Â˜, È‰›ˆ˜ ÛÙ·

¶›Ó·Î·˜ 3. OÈ Ì¤ÛÂ˜ ÙÈÌ¤˜ (±SEM) ËÏÈÎ›·˜ Î·È ÙˆÓ Û˘ÁÎÂÓÙÚÒÛÂˆÓ ÛÙÔÓ ÔÚﬁ ÙÔ˘ ·Û‚ÂÛÙ›Ô˘ (Ca), ÙˆÓ ÊˆÛÊÔÚÈÎÒÓ (Pi), ÙË˜

·ÏÎ·ÏÈÎ‹˜ ÊˆÛÊ·Ù¿ÛË˜ (ALP), ÙË˜ ÔÛÙÂÔÎ·ÏÛ›ÓË˜ (OC), ÙˆÓ ÌÂÙ·‚ÔÏÈÙÒÓ ÙË˜ ‚ÈÙ·Ì›ÓË˜ D Î·È ÙË˜ ·Ú·ıÔÚÌﬁÓË˜ (C-PTH)

ÛÂ ·ÁﬁÚÈ· Î·È ÎÔÚ›ÙÛÈ· ËÏÈÎ›·˜ 15-18 ¯ÚﬁÓˆÓ ¯ÂÈÌÒÓ· Î·È Î·ÏÔÎ·›ÚÈ

XÂÈÌÒÓ·K·ÏÔÎ·›ÚÈ

AÁﬁÚÈ·KÔÚ›ÙÛÈ·AÁﬁÚÈ·KÔÚ›ÙÛÈ· N21241922

HÏÈÎ›· (¯ÚﬁÓÈ·)16,5±0,216,9±0,216,0±0,216,4±0,2

Ca (mmol/L)2,43±0,032,45±0,032,38±0,032,43±0,03 Pi (mmol/L)1,29±0,061,19±0,03a 1,39±0,031,39±0,03b

ALP (IU/L)212±28108±48*248±39116±7* OC (ng/ml)8,7±0,65,8±0,3*,c 7,3±0,54,6±0,3*,d 25OHD (ng/ml)13,4±15a 12,4±1,2a 28,4±0,2b 26,7±1,5b 24,25(OH)2D (ng/ml)0,7±0,1a 0,7±0,1a 2,8±0,3b 2,2±0,3b 1,25(OH)2D (pg/ml)27,0±2,123,4±1,323,2±2,224,0±1,8

C-PTH (ng/ml)0,6±0,10,6±0,10,5±0,10,5±0,1 *p<0,001: Û‡ÁÎÚÈÛË ÌÂÙ·Í‡ ·ÁÔÚÈÒÓ Î·È ÎÔÚÈÙÛÈÒÓ ÙËÓ ›‰È· ÂÔ¯‹ avs bp<0,001, cvs dp<0,02: Û‡ÁÎÚÈÛË ÌÂÙ·Í‡ ÂÔ¯ÒÓ ÁÈ· ÙÔ ›‰ÈÔ Ê‡ÏÔ

25OHD ‰ÂÓ Â·ÚÎÔ‡Ó Ó· ‰È·ÙËÚ‹ÛÔ˘Ó Ê˘ÛÈÔÏÔÁÈÎ¤˜ ÙÈÌ¤˜ ÙË˜ ‚ÈÙ·Ì›ÓË˜ D Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ¯ÂÈÌÒÓ·. ∂›Ó·È ÁÓˆÛÙﬁ ﬁÙÈ ÔÈ ·ÓÙËÏÈ·Î¤˜ ÎÚ¤ÌÂ˜ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÙÔ Î·ÏÔÎ·›-

ÚÈ ÂÚÈÔÚ›˙Ô˘Ó ÙËÓ Û‡ÓıÂÛË ÙË˜ ‰ÂÚÌ·ÙÈÎ‹˜ ‚ÈÙ·Ì›ÓË˜ D, ÂÔÌ¤Óˆ˜ ‰ÂÓ ·ÔÎÏÂ›ÂÙ·È Ó· Â›Ó·È

Û˘Ó˘Â‡ı˘ÓÂ˜ ÁÈ· ÙËÓ ˘Ô‚ÈÙ·Ì›ÓˆÛË D (26).

∞ÓÙ›ıÂÙ·, Ù· ·È‰È¿ ËÏÈÎ›·˜ 3-14 ÂÙÒÓ ÙÔÓ ¯ÂÈ-

ÌÒÓ· Â›Ó·È ÂÚÈÛÛﬁÙÂÚÂ˜ ÒÚÂ˜ ÛÙÔÓ ‹ÏÈÔ ·'

ﬁ,ÙÈ Ù· ·È‰È¿ ËÏÈÎ›·˜ 15-18 ÂÙÒÓ.

¶·Ú¿ ÙË ÌÂÁ¿ÏË ÛËÌ·Û›· ÙË˜ Ï‹„Ë˜ ÙÔ˘

Á¿Ï·ÙÔ˜ ÛÙËÓ ·È‰ÈÎ‹ Î·È ÂÊË‚ÈÎ‹ ËÏÈÎ›· (8), ÛÙ· Û¯ÔÏÂ›· ÙˆÓ ∏.¶.∞. ˘¿Ú¯ÂÈ Ë Ù¿ÛË Ó·

ÂÈÙÚ¤Ô˘Ó ÔÙ¿ ÌÂ ¯·ÌËÏ‹ ÂÚÈÂÎÙÈÎﬁÙËÙ·

ÛÂ Ca Î·È Û¯Â‰fiÓ Î·ıfiÏÔ˘ Á¿Ï·. ¶·ÚfiÌÔÈ· Î·-

Ù¿ÛÙ·ÛË ˘¿Ú¯ÂÈ Î·È ÛÙËÓ ∂ÏÏ¿‰·. ∆· ÙÚﬁÊÈÌ· ÛÙËÓ ∂ÏÏ¿‰· Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ Î·È

ÙˆÓ Á·Ï¿ÙˆÓ (ÂÎÙfi˜ ·fi Ù· Á¿Ï·Ù· ÁÈ· Ù· ‚Ú¤ÊË) ‰ÂÓ ÂÌÏÔ˘Ù›˙ÔÓÙ·È ÌÂ ‚ÈÙ·Ì›ÓË D. ¶ÚfiÛÊ·Ù· ¿Ú¯ÈÛÂ Ô ÂÌÏÔ˘ÙÈÛÌfi˜ ÔÚÈÛÌ¤ÓˆÓ Á·Ï¿ÙˆÓ ÌÂ ‚ÈÙ·Ì›ÓË D, ·ÏÏ¿ Ë ÂÚÈÂÎÙÈÎfiÙËÙ¿ ÙÔ˘˜ Â›Ó·È ¯·ÌËÏ‹. ŒÓ· ·È‰› ÛÙËÓ ∂ÏÏ¿‰·, ËÏÈÎ›·˜ ÌÂÁ·Ï‡ÙÂÚË˜ ÙˆÓ 3 ÂÙÒÓ, ÁÈ· Ó· ¿ÚÂÈ

400 IU ‚ÈÙ·Ì›ÓË˜ D ËÌÂÚËÛ›ˆ˜ Ú¤ÂÈ Ó· ›ÓÂÈ

1,5-2 Ï›ÙÚ· ·fi ÙÔ ÂÌÏÔ˘ÙÈÛÌ¤ÓÔ Á¿Ï·. ™Â ¿ÏÏÂ˜ ‰˘ÙÈÎ¤˜ ¯ÒÚÂ˜ ÂÎÙfi˜ ÙÔ˘ Á¿Ï·ÙÔ˜ Î·È ¿ÏÏÂ˜ ÙÚÔÊ¤˜ fiˆ˜ Ë Ì·ÚÁ·Ú›ÓË, ÂÌÏÔ˘Ù›˙Ô-

ÌÂÁ·Ï‡ÙÂÚË ÔÛÙÈÎ‹ Ì¿˙·. ∞˘Ùﬁ ı· ¤¯ÂÈ Î·Ï‡ÙÂÚÂ˜ ÚÔÔÙÈÎ¤˜ ÁÈ· ÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹ Î·È Î˘-

Ú›ˆ˜ ÁÈ· ÙÈ˜ Á˘Ó·›ÎÂ˜ Ô˘ ÚÔÛ‚¿ÏÏÔÓÙ·È ·ﬁ

ÔÛÙÂÔﬁÚˆÛË. ∆ÂÏÂ˘Ù·›·, ¤¯ÂÈ ÚÔÙ·ıÂ› Ë

È‰¤· ÂÌÏÔ˘ÙÈÛÌÔ‡ ÌÂ ‚ÈÙ·Ì›ÓË D Î·È ¿ÏÏˆÓ

ÔÙÒÓ, ﬁˆ˜ ÙÔ ·Ô‚Ô˘Ù˘ÚˆÌ¤ÓÔ Á¿Ï· Î·È Ë

ÔÚÙÔÎ·Ï¿‰· (9). TÔ ÙÂÏÂ˘Ù·›Ô ÌÔÚÂ› Ó·

‚ÔËı‹ÛÂÈ Î·È Ù· ¿ÙÔÌ· ÌÂ ·ÏÏÂÚÁ›· ÛÙÔ Á¿Ï· ‹

‰˘Û·ÓÂÍ›· ÛÙË Á·Ï·ÎÙﬁ˙Ë, ·ÓÙÈÎ·ıÈÛÙÒÓÙ·˜ ÙÔ

Á¿Ï· ˆ˜

ËÁ‹ ‚ÈÙ·Ì›ÓË˜ D.

ª›· ÚﬁÛÊ·ÙË ÌÂÏ¤ÙË ·ﬁ ÙËÓ ∂ÏÏ¿‰· ÙˆÓ

ª·ÓÈÔ‡ Î·È Û˘Ó (27), ‚Ú‹ÎÂ ﬁÙÈ ÌﬁÓÔ ÙÔ 48,4%

ÙˆÓ ·ÁÔÚÈÒÓ Î·È ÙÔ 42,7% ÙˆÓ ÎÔÚÈÙÛÈÒÓ ËÏÈÎ›·˜ 10-15 ¯ÚﬁÓˆÓ Â›¯·Ó ËÌÂÚ‹ÛÈ· ÚﬁÛÏË„Ë

·Û‚ÂÛÙ›Ô˘ ¿Óˆ ·ﬁ ÙÔ 80% ÙË˜ Û˘ÓÈÛÙÒÌÂÓË˜. ∂›ÛË˜, ÔÈ MÏ¤ÙÛ· Î·È Û˘Ó (28) ·Ó·Ê¤-

ÚÔ˘Ó fiÙÈ ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ·˘ÙÒÓ ÙˆÓ ·È‰ÈÒÓ Â›¯·Ó ËÌÂÚ‹ÛÈ· ÚfiÛÏË„Ë ‚ÈÙ·Ì›ÓË˜

D Î¿Ùˆ ÙˆÓ 10 Ìg/ËÌ¤Ú· (400 IU/ËÌ¤Ú·). ∏ ˘Ô‚ÈÙ·Ì›ÓˆÛË D ÚÔ‰È·ı¤ÙÂÈ ÛÂ ÔÛÙÈÎ‹

‹ ÔÛÙÂÔÌ·Ï¿Î˘ÓÛË˜ ÛÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜ (29). ªÂÏ¤ÙÂ˜ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÛÂ ÂÊ‹‚Ô˘˜ Î·È ÂÓ‹ÏÈÎÂ˜ ‰È·ÈÛÙÒÓÔ˘Ó ¤ÏÏÂÈ„Ë ‚ÈÙ·Ì›ÓË˜ D Û˘¯Ó¿ ÛÂ ¿ÙÔÌ· ÓÂ·Ú‹˜ ËÏÈÎ›·˜, Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ¯ÂÈÌÒÓ· (13). ™ÙË ÓÔÙÈÔ‰˘ÙÈÎ‹ ∂˘ÚÒË Ë ˘Ô‚ÈÙ·Ì›ÓˆÛË D ·Ó·Ê¤ÚÂÙ·È ÛÂ ÔÛÔÛÙﬁ 40% ÛÂ ÓÂ·ÚÔ‡˜ ÂÓ‹ÏÈÎÂ˜

ÙË ¯ÂÈÌÂÚÈÓ‹ ÂÚ›Ô‰Ô (30). ∞ﬁ ÙËÓ ·ÚÔ‡Û·

ÌÂÏ¤ÙË Ê·›ÓÂÙ·È ﬁÙÈ Ù· ÎÔÚ›ÙÛÈ· ËÏÈÎ›·˜ 15-18

ÂÙÒÓ ÚÔ‰È·Ù›ıÂÓÙ·È Ó· ·Ó·Ù‡ÍÔ˘Ó ·ÓÂ¿Ú-

ÎÂÈ· ‚ÈÙ·Ì›ÓË˜ D ÙÔÓ ¯ÂÈÌÒÓ·, Â‡ÚËÌ· Ô˘

·Ó·Ê¤ÚÂÙ·È Î·È ·ﬁ ¿ÏÏÔ˘˜ ÂÚÂ˘ÓËÙ¤˜ (18,31).

™ÙË ™·Ô˘‰ÈÎ‹ ∞Ú·‚›· ·ﬁ ÙÔ˘˜ 21 Û˘ÌÙˆÌ·-

ÙÈÎÔ‡˜ ÂÊ‹‚Ô˘˜ (ËÏÈÎ›·˜ 10-15 ÂÙÒÓ) ÌÂ Ú·¯È-

ÙÈÛÌﬁ ÔÈ 20 ‹Ù·Ó ÎÔ¤ÏÂ˜ (32).

∆· Â›Â‰· ÙË˜ 24,25(√∏)2D ÛÙÔÓ ÔÚﬁ ·ÚÔ˘Û›·Û·Ó ÂÔ¯È·Î‹ ‰È·Î‡Ì·ÓÛË ﬁˆ˜ Î·È Ë

25OHD, ÂÓÒ ·Ú·ÙËÚ‹ıËÎÂ ÈÛ¯˘Ú‹ ıÂÙÈÎ‹ Û˘-

Û¯¤ÙÈÛË ÌÂÙ·Í‡ 25OHD Î·È 24,25(√∏)2D ÛÙÔÓ

ÔÚﬁ, Ë ÔÔ›· ‹Ù·Ó ÈÛ¯˘ÚﬁÙÂÚË ÙÔÓ ¯ÂÈÌÒÓ·. ∞Ó

Î·È Ô Ê˘ÛÈÔÏÔÁÈÎﬁ˜ ÚﬁÏÔ˜ ÙË˜ 24,25(√∏)2D Â›-

Ó·È ·Û·Ê‹˜, Ë ÛËÌ·Û›· ÙË˜ ÛÙË ÌÂÙ¿ÏÏˆÛË

ÙˆÓ ÔÛÙÒÓ ¤¯ÂÈ ·Ó·ÁÓˆÚÈÛıÂ› ·ﬁ ÔÚÈÛÌ¤ÓÔ˘˜

ÂÚÂ˘ÓËÙ¤˜ (33). ™Â Ó¤Ô˘˜ ËÏÈÎ›·˜ 15-18 ÂÙÒÓ

ÛÙÔ˘˜ ÔÔ›Ô˘˜ ÌÂÏÂÙ‹ıËÎÂ Ë Î˘ÎÏÔÊÔÚ›· ÙˆÓ

ÙË˜ 24,25(√∏)2D, ‚Ú¤ıËÎÂ Î·Ù¿

ÙÚ›Ù· ¯·ÌËÏﬁÙÂÚË

√È ÙÈÌ¤˜ ÙË˜ 1,25(√∏)2D ÛÙÔÓ ÔÚﬁ ÙˆÓ ·È-

‰ÈÒÓ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó ‰ÂÓ ‰È¤ÊÂÚ·Ó ÌÂÙ·Í‡

ÙˆÓ ÙÚÈÒÓ ÔÌ¿‰ˆÓ. ¶·ÚﬁÌÔÈ· Â˘Ú‹Ì·Ù· ·Ó·-

Ê¤ÚÔÓÙ·È Î·È ·ﬁ ¿ÏÏÔ˘˜ Û˘ÁÁÚ·ÊÂ›˜ (34,35).

√È ÌÂÁ·Ï‡ÙÂÚÂ˜ ÙÈÌ¤˜ ÙË˜ 1,25(√∏)2D Î·Ù¿ ÙË

‰È¿ÚÎÂÈ· ÙÔ˘ Î·ÏÔÎ·ÈÚÈÔ‡, ÛÙ· ·È‰È¿ ËÏÈÎ›·˜

11-14 ¯ÚﬁÓˆÓ, ÌÔÚÂ› Ó· ÔÊÂ›ÏÔÓÙ·È ÛÙË ÌÂÁ·-

Ï‡ÙÂÚË Ù·¯‡ÙËÙ· ·‡ÍËÛË˜ (34,36). √È Û˘ÁÎÂ-

ÓÙÚÒÛÂÈ˜ ·Û‚ÂÛÙ›Ô˘ ÛÙÔÓ ÔÚﬁ ÙˆÓ ·È‰ÈÒÓ

Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó ‚Ú¤ıËÎ·Ó ÂÓÙﬁ˜ Ê˘ÛÈÔÏÔÁÈ-

ÎÒÓ ÔÚ›ˆÓ. √È ÙÈÌ¤˜ ÙÔ˘ ÊˆÛÊﬁÚÔ˘ ÛÙÔÓ ÔÚﬁ ‹Ù·Ó ÛÙ·

Ê˘ÛÈÔÏÔÁÈÎ¿ ﬁÚÈ· ÛÙÈ˜ ÂÚÈÛÛﬁÙÂÚÂ˜ ÂÚÈÙÒ-

ÛÂÈ˜. ŸÌˆ˜, Ù· ÎÔÚ›ÙÛÈ· ËÏÈÎ›·˜ 15-18 ¯ÚﬁÓˆÓ ‚Ú¤ıËÎ·Ó Ó· ¤¯Ô˘Ó Ì¤ÛÂ˜ ÙÈÌ¤˜ ¯·ÌËÏﬁÙÂÚÂ˜

ÙÔÓ ¯ÂÈÌÒÓ· ·' fi,ÙÈ ÙÔ Î·ÏÔÎ·›ÚÈ, ÂÓÒ ‰ÂÓ ·Ú·ÙËÚ‹ıËÎÂ ÙÔ ›‰ÈÔ ÛÙ· ·ÁfiÚÈ·. ÕÏÏÔÈ ÂÚÂ˘ÓËÙ¤˜ ·fi ÙËÓ ÎÂÓÙÚÈÎ‹ ∂˘ÚÒË ¤¯Ô˘Ó ·Ó·Ê¤ÚÂÈ ÂÔ¯È·Î‹ ‰È·Î‡Ì·ÓÛË ÙÔ˘ Pi ÔÚÔ‡ ÌÂ ˘„ËÏfiÙÂÚÂ˜ ÙÈÌ¤˜ ÙÔ Î·ÏÔÎ·›ÚÈ (37). OÈ Round Î·È Û˘Ó (1973) ·Ó·Ê¤ÚÔ˘Ó ¯·ÌËÏfiÙÂÚÂ˜ ÙÈÌ¤˜ ÊˆÛÊÔÚÈÎÒÓ ÛÙ· ÎÔÚ›ÙÛÈ· ·' fi,ÙÈ ÛÙ· ·ÁfiÚÈ· ËÏÈÎ›·˜ ¿Óˆ ÙˆÓ 13 ÂÙÒÓ, ·ÏÏ¿ ‰ÂÓ ‰È·›ÛÙˆÛ·Ó ÂÔ¯È·Î‹ ‰È·ÊÔÚ¿ ÙÔ˘ Pi ÛÂ ·È‰È¿ ËÏÈÎ›·˜ 7-17

ÂÙÒÓ (38). ∆Ô ›‰ÈÔ ÈÛ¯‡ÂÈ Î·È ÁÈ· Ù· ·È‰È¿ ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ ËÏÈÎ›·˜ 3-14 ¯ÚﬁÓˆÓ.

‚ÈÙ·Ì›ÓË˜ D ÌÔÚÂ› Ó· ¤¯ÂÈ ‰˘ÛÌÂÓ‹ Â›‰Ú·ÛË ÛÙÔÓ ÛÎÂÏÂÙfi. ∞Ó Î·È ÌÂÚÈÎ¤˜ ÌÂÏ¤ÙÂ˜, Ô˘ ÚÔÛ¿ıËÛ·Ó Ó· Û˘Û¯ÂÙ›ÛÔ˘Ó Ù· Â›Â‰· ÙË˜ 25OHD ÛÙÔÓ ÔÚfi ÌÂ ÙËÓ ÔÛÙÈÎ‹ ˘ÎÓfiÙËÙ· ‹ ÙÔÓ ÔÛÙÈÎfi ·Ó·Û¯ËÌ·ÙÈÛÌfi ÛÂ ÂÊ‹‚Ô˘˜ Î·È ÓÂ·ÚÔ‡˜ ÂÓ‹ÏÈÎÂ˜, ·Ú·Ù‹ÚËÛ·Ó ÌÈÎÚ‹ ‹ Î·ıfiÏÔ˘ ‰˘ÛÌÂÓ‹ Â›‰Ú·ÛË ÛÙÔÓ ÛÎÂÏÂÙfi, ‰ÂÓ ÌfiÚÂÛ·Ó Î·È Ó· ÙÔ ·ÔÎÏÂ›ÛÔ˘Ó (39,40). ¶·Ú·Ù‹ÚËÛ·Ó fiÌˆ˜, fiÙÈ ÙÔ ‡„Ô˜ ·ÌÊÔÙ¤ÚˆÓ ÙˆÓ Ê‡ÏˆÓ ÌÂ ¯·ÌËÏ¤˜ ÙÈÌ¤˜ 25OHD ÛÙÔÓ ÔÚfi Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ¯ÂÈÌÒÓ·, ‚Ú¤ıËÎÂ ÛËÌ·ÓÙÈÎ¿ ¯·ÌËÏfiÙÂÚÔ ·fi ÂÎÂ›ÓÔ ÙˆÓ ·È‰ÈÒÓ ÙË˜ ›‰È·˜ ËÏÈÎ›·˜ ÌÂ Â¿ÚÎÂÈ· ‚ÈÙ·Ì›ÓË˜ ÙÔÓ ¯ÂÈÌÒÓ·. E›ÛË˜, ÔÈ Oliveri Î·È Û˘Ó ·Ó·Ê¤ÚÔ˘Ó ¯·ÌËÏ‹ ÔÛÙÈÎ‹ ˘ÎÓfiÙËÙ· ÛÂ ÓÂ·Ú¤˜ ÎÔ¤ÏÂ˜ ÌÂ ¯·ÌËÏ¤˜ ÙÈÌ¤˜ 25OHD ÛÙÔÓ ÔÚfi ÙÔÓ ¯ÂÈÌÒÓ· Î·È ¯·ÌËÏ‹ ÚfiÛÏË„Ë ·Û‚ÂÛÙ›Ô˘ ¯ˆÚ›˜ ·˘Ùfi Ó· ·Ú·ÙËÚÂ›Ù·È ÛÙ· ·ÁfiÚÈ· (39). ™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË, ÔÈ Ì¤ÛÂ˜ ÙÈÌ¤˜ ÙˆÓ ÂÈ¤‰ˆÓ ÔÛÙÂÔÎ·ÏÛ›ÓË˜ ‚Ú¤ıËÎ·Ó ¯·ÌËÏfiÙÂÚÂ˜ ÙÔÓ ¯ÂÈÌÒÓ· ·' fi,ÙÈ ·˘Ù¤˜ ÙÔ˘ Î·ÏÔÎ·ÈÚÈÔ‡ ÛÙÈ˜ ‰‡Ô ÔÌ¿‰Â˜ ÙˆÓ ÌÈÎÚfiÙÂÚˆÓ ËÏÈÎÈÒÓ. ¢ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ‰È·ÊÔÚ¤˜ ÌÂÙ·Í‡ ÂÔ¯ÒÓ ÛÙ· Â›Â‰· ÙË˜ ·ÏÎ·ÏÈÎ‹˜ ÊˆÛÊ·Ù¿ÛË˜ ÛÂ fiÏÂ˜ ÙÈ˜ ÔÌ¿‰Â˜. øÛÙfiÛÔ, Â›Ó·È ‰‡ÛÎÔÏÔ Ó· ‰È·ÎÚ›ÓÔ˘ÌÂ Ù˘¯fiÓ ÂÈÙÒÛÂÈ˜ ÙË˜ ·ÓÂ¿ÚÎÂÈ·˜ ‚ÈÙ·Ì›ÓË˜ D ÛÙËÓ ÔÛÙÈÎ‹ Û‡ÓıÂÛË Î·È ÙÈ˜ ·ÏÏ·Á¤˜ Ô˘ ÔÊÂ›ÏÔÓÙ·È ÛÙËÓ ·‡ÍËÛË ÏfiÁˆ ËÏÈÎ›·˜. ŸÌˆ˜, ˘¿Ú¯Ô˘Ó ÂÓ‰Â›ÍÂÈ˜ fiÙÈ Ô ÔÛÙÈÎfi˜ ·Ó·Û¯ËÌ·ÙÈÛÌfi˜ ÛÙÈ˜ ËÏÈÎ›Â˜ 15-18 ¯ÚfiÓˆÓ ‹Ù·Ó ¯·ÌËÏfiÙÂÚÔ˜ ÛÙ· ÎÔÚ›ÙÛÈ· ·' fi,ÙÈ ÛÙ· ·ÁfiÚÈ·. √È Asknes Î·È Aarskog (1982) ·Ó·Ê¤ÚÔ˘Ó fiÙÈ ÔÈ ˘„ËÏfiÙÂÚÂ˜ ÙÈÌ¤˜ ·ÏÎ·ÏÈÎ‹˜ ÊˆÛÊ·Ù¿ÛË˜ ·Ú·ÙËÚÔ‡ÓÙ·È ÛÙ· ÎÔÚ›ÙÛÈ· 11 ÂÙÒÓ Î·È ÛÙ· ·ÁfiÚÈ· 13 ¯ÚfiÓˆÓ (41). ™Ù· ÎÔÚ›ÙÛÈ·, ÛÙ·ıÂÚ‹ ÌÂ›ˆÛË ÙÔ˘ ÂÓ˙‡ÌÔ˘ ·Ú·ÙËÚÂ›Ù·È ·fi ÙÔ ‰Â‡ÙÂÚÔ Ì¤¯ÚÈ ÙÔ Ù¤Ù·ÚÙÔ ÛÙ¿‰ÈÔ ÙË˜ ÂÊË‚Â›·˜ Î·È ÛÙ· ·ÁfiÚÈ· ·fi ÙÔ ÙÚ›ÙÔ Ì¤¯ÚÈ ÙÔ ¤ÌÙÔ. √È Round Î·È Û˘Ó (1973) ·Ó·Ê¤ÚÔ˘Ó ·‡ÍËÛË ÙË˜ ALP ÛÙ· ·È‰È¿ ËÏÈÎ›·˜ 13-14 ¯ÚfiÓˆÓ Ô˘ ‹Ù·Ó ÌÈÎÚfiÙÂÚË ÛÙ· ÎÔÚ›ÙÛÈ· (38). ªÂ›ˆÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙË˜ ÔÏÈÎ‹˜ ALP ÙÔ˘ ÔÚÔ‡ ·Ó·Ê¤ÚıËÎÂ ÁÈ· ·ÌÊfiÙÂÚ· Ù· Ê‡Ï· ÌÂÙ¿ ÙËÓ ËÏÈÎ›· ÙˆÓ 14 ÂÙÒÓ. ™Ù· ·È‰È¿ ˘fi ÌÂÏ¤ÙË, Ù· Â˘Ú‹Ì·Ù· Û˘ÌÊˆÓÔ‡Ó ÌÂ ·˘Ù¿ ÚÔËÁÔ‡ÌÂÓˆÓ ÌÂÏÂÙÒÓ ÌÂ ÙÈ˜ ÙÈÌ¤˜ ÙË˜ ALP Ó· Â›Ó·È ˘„ËÏfiÙÂÚÂ˜ ÛÙÈ˜ ËÏÈÎ›Â˜ 11-14 ¯ÚfiÓˆÓ Î·È Ó· ÌÂÈÒÓÔÓÙ·È ÛÙÈ˜ ÌÂÁ·Ï‡ÙÂÚÂ˜ ËÏÈÎ›Â˜ (15-18 ÂÙÒÓ). √È ‰È·ÊÔÚ¤˜ ÌÂÙ·Í‡ ÙˆÓ ‰‡Ô Ê‡ÏˆÓ Ô˘ ‚Ú¤ıËÎ·Ó ÛÙÔ˘˜ ÂÊ‹‚Ô˘˜ ÙË˜ ÌÂÏ¤ÙË˜ ÌÔÚÂ› Ó· ÔÊÂ›ÏÔÓÙ·È ÛÙËÓ ÚÒÈÌË ÌÂ›ˆÛË ÛÙ· ÎÔÚ›ÙÛÈ· Û˘ÁÎÚÈÙÈÎ¿ ÌÂ Ù· ·ÁfiÚÈ·.

¶·ÚﬁÌÔÈ· Â˘Ú‹Ì·Ù· ·Ú·ÙËÚ‹ıËÎ·Ó Î·È

ÌÂ ÙËÓ ÔÛÙÂÔÎ·ÏÛ›ÓË. ª›· ÈÛ¯˘Ú‹ ıÂÙÈÎ‹ Û˘-

Û¯¤ÙÈÛË ‚Ú¤ıËÎÂ ÌÂÙ·Í‡ ÔÛÙÂÔÎ·ÏÛ›ÓË˜ Î·È

ÔÏÈÎ‹˜ ALP, ·ÊÔ‡ Î·È ÔÈ ‰‡Ô Â›Ó·È ‚ÈÔ¯ËÌÈÎÔ›

‰Â›ÎÙÂ˜ ÙË˜ ÔÛÙÈÎ‹˜ Û‡ÓıÂÛË˜. ∞˘Ù‹ Ë ·Ú·-

Ù‹ÚËÛË ¤¯ÂÈ ÂÈÛËÌ·ÓıÂ› Î·È ·ﬁ ¿ÏÏÔ˘˜

ÂÚÂ˘ÓËÙ¤˜ ÛÂ ÂÓ‹ÏÈÎÂ˜ Î·È ·È‰È¿ ËÏÈÎ›·˜ 7-18

ÂÙÒÓ (42,43).

∫·È ÔÈ ‰‡Ô ‰Â›ÎÙÂ˜ ÁÈ· ¯ÂÈÌÒÓ· Î·È Î·ÏÔ-

Î·›ÚÈ ·Ú·¤ÌÔ˘Ó ÛÂ ¯·ÌËÏﬁÙÂÚÔ ÔÛÙÈÎﬁ

·Ó·Û¯ËÌ·ÙÈÛÌfi Î·È ¯·ÌËÏfi Ú˘ıÌfi ÔÛÙÈÎ‹˜

Û‡ÓıÂÛË˜ ÛÙ· ÎÔÚ›ÙÛÈ·. ∞˘Ù¿ Ù· Â˘Ú‹Ì·Ù·

Û˘ÌÊˆÓÔ‡Ó ÌÂ ÚﬁÛÊ·ÙË ÌÂÏ¤ÙË Ô˘ ¤‰ÂÈÍÂ

ﬁÙÈ Ë Ì¤ÛË ËÏÈÎ›· ÙË˜ Ì¤ÁÈÛÙË˜ Û˘ÛÛÒÚÂ˘ÛË˜

Ca ÛÙËÓ ‹‚Ë Â›Ó·È Ù· 14 ¤ÙË ÁÈ· Ù· ·ÁﬁÚÈ· Î·È

ÛÙ· 12,5 ¤ÙË ÁÈ· Ù· ÎÔÚ›ÙÛÈ· (44). ∂›ÛË˜, ÂÎÙÈ-

ÌÔ‡Ó ﬁÙÈ, Î·Ù¿ ÚÔÛ¤ÁÁÈÛË, ÙÔ 26% ÙÔ˘ Ca ÙˆÓ

ÂÓËÏ›ÎˆÓ ·ÔÎÙ¿Ù·È ÛÙ· ‰‡Ô ¯ÚﬁÓÈ· ÙË˜ Ù·¯Â›·˜ ÛÎÂÏÂÙÈÎ‹˜ ·‡ÍËÛË˜. √È ˘„ËÏ¤˜ ·Ó·ÏÔÁ›Â˜

ÙË˜ ·‡ÍËÛË˜ ÙˆÓ ÔÛÙÈÎÒÓ ÌÂÙ¿ÏÏˆÓ ÛÙËÓ ‹‚Ë ‰Â›¯ÓÔ˘Ó ﬁÙÈ ¤Ó· ·ÍÈﬁÏÔÁÔ ÎÏ¿ÛÌ· ÙË˜ ÂÚÈÂ-

ÎÙÈÎﬁÙËÙ·˜ ÙˆÓ ÌÂÙ¿ÏÏˆÓ ÙÔ˘ ÔÛÙÔ‡ ÂÈÙ˘Á-

¯¿ÓÂÙ·È ÛÙ· Ï›Á· ¯ÚﬁÓÈ· ÙË˜ ÂÊË‚Â›·˜. √È ˘„Ë-

Ï¤˜ ·Ó·ÏÔÁ›Â˜ Î·Ù·ÎÚ¿ÙËÛË˜ ·Û‚ÂÛÙ›Ô˘ ÛÙËÓ

‹‚Ë ÌÔÚÔ‡Ó Ó· ÂÈÙÂ˘¯ıÔ‡Ó ÌÂ ·‡ÍËÛË ÙË˜

‰È·ÈÙËÙÈÎ‹˜ ÚﬁÛÏË„Ë˜, Î·ıÒ˜ Î·È ÌÂ ÙËÓ

Â·ÚÎ‹ ·ÔÚÚﬁÊËÛË Î·È Î·Ù·ÎÚ¿ÙËÛË. ∆Ô

‰Â‡ÙÂÚÔ ÂÍ·ÚÙ¿Ù·È Î·Ù¿ ÌÂÁ¿ÏÔ Ì¤ÚÔ˜ ·ﬁ

ÙËÓ Â¿ÚÎÂÈ· ‚ÈÙ·Ì›ÓË˜ D. °Ú·ÌÌÈÎ‹ ıÂÙÈÎ‹ Û˘Û¯¤ÙÈÛË ‚Ú¤ıËÎÂ Î·È

ÌÂÙ·Í‡ ÙÔ˘ ‰Â›ÎÙË ÔÛÙÈÎ‹˜ Û‡ÓıÂÛË˜, ÙË˜ ÔÛÙÂÔÎ·ÏÛ›ÓË˜ Î·È ÙˆÓ ÂÈ¤‰ˆÓ ÙË˜ 1,25(OH)2D ÛÙÔÓ ÔÚfi. °ÓˆÛÙfi Â›Ó·È fiÙÈ Ë Î·ÏÛÈÙÚÈfiÏË ÚÔ¿ÁÂÈ ÙË Û‡ÓıÂÛË ÙË˜ ÔÛÙÂÔÎ·ÏÛ›ÓË˜ Î·È ·Ó·Ê¤ÚÂÙ·È fiÙÈ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÂÊË‚Â›·˜, ˘¿Ú¯ÂÈ ıÂÙÈÎ‹ Û˘Û¯¤ÙÈÛË Î·ÏÛÈÙÚÈfiÏË˜ Î·È ÔÛÙÂÔÎ·ÏÛ›ÓË˜ (45). ∂›ÛË˜ ÛÙËÓ ÂÊË‚Â›· ·Ó·Ê¤ÚÂÙ·È Û˘Û¯¤ÙÈÛË Î·È ÌÂÙ·Í‡ Î·ÏÛÈÙÚÈfiÏË˜ Î·È Û˘ÁÎ¤ÓÙÚˆÛË˜ ·Û‚ÂÛÙ›Ô˘ ÛÙÔÓ ÛÎÂÏÂÙfi ‹ ·‡ÍËÛË˜ ÙË˜ ÔÛÙÈÎ‹˜ Ì¿˙·˜ (36). £ÂˆÚËÙÈÎ¿, Ê·›ÓÂÙ·È fiÙÈ Ù· Â˘Ú‹Ì·Ù· ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ ı· ÌÔÚÔ‡Û·Ó Ó· ÂÚÌËÓÂ˘ıÔ‡Ó ˆ˜ Û¯¤ÛË ÂÈ¤‰ˆÓ Î·ÏÛÈÙÚÈfiÏË˜ Î·È ÔÛÙÈÎ‹˜ Ì¿˙·˜, Èı·ÓfiÓ ÏfiÁˆ ÙË˜ Â›‰Ú·Û‹˜ ÙË˜ ÛÙËÓ ·ÔÚÚfiÊËÛË Î·È Î·Ù·ÎÚ¿ÙËÛË

ÙÔ˘ Ca ÛÙÔ ÛÒÌ·. ªÂÏ¤ÙÂ˜ ÌÂÙ·-·Ó¿Ï˘ÛË˜

ÈÛÔ˙˘Á›ˆÓ ·Û‚ÂÛÙ›Ô˘ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ Ë ·ÔÚÚfiÊËÛË Î·È Ë Î·Ù·ÎÚ¿ÙËÛË Ca ÛÙÔ ÛÒÌ· Â›Ó·È ˘„ËÏfiÙÂÚÂ˜ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÂÊË‚Â›·˜

Î·È ÛÙ· ‰‡Ô Ê‡Ï· (46).

™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË ‰ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó

·ÏÏ·Á¤˜ ÛÙËÓ C-PTH ÌÂÙ·Í‡ ÙˆÓ ÂÔ¯ÒÓ Î·È ÛÙÈ˜ 3 ÔÌ¿‰Â˜ ·È‰ÈÒÓ Î·È ÔÈ ÙÈÌ¤˜

Ê˘ÛÈÔÏÔÁÈÎ¿ fiÚÈ·, ÌÂ ÌÈÎÚfiÙÂÚÂ˜ ÙÈÌ¤˜ ÛÙËÓ ÔÌ¿‰· ÙˆÓ ÌÂÁ¿ÏˆÓ ·È‰ÈÒÓ (15-18 ÂÙÒÓ). ÕÏÏÔÈ ÂÚÂ˘ÓËÙ¤˜ ·Ó·Ê¤ÚÔ˘Ó ·‡ÍËÛË ÙË˜ PTH ÛÂ ·È‰È¿ ÌÂ ˘Ô‚ÈÙ·Ì›ÓˆÛË D (20). ™ËÌ·ÓÙÈÎ‹ ·ÚÓËÙÈÎ‹ Û˘Û¯¤ÙÈÛË ÌÂÙ·Í‡ ÂÈ¤‰ˆÓ ÛÙÔÓ ÔÚfi 25√HD Î·È ƒ∆∏ ¤¯ÂÈ ·Ó·ÊÂÚıÂ› ÛÂ ·ÁfiÚÈ· ÂÊ‹‚Ô˘˜ (47). ∆¤ÙÔÈ· Û˘Û¯¤ÙÈÛË ‰ÂÓ ·Ú·ÙËÚ‹ıËÎÂ ÛÙ· ·È‰È¿ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó.

∆· ·ÔÙÂÏ¤ÛÌ·Ù· ·˘Ù‹˜ ÙË˜ ÌÂÏ¤ÙË˜ ﬁÛÔÓ

·ÊÔÚ¿ ÛÙ· Â›Â‰· ÙË˜ C-PTH ‰ÂÓ Â›Ó·È ‰˘Ó·ÙﬁÓ Ó· ÙËÓ ·ÔÎÏÂ›ÛÔ˘Ó ˆ˜ Â˘·›ÛıËÙÔ ‰Â›ÎÙË

·ÓÂ¿ÚÎÂÈ·˜ ‚ÈÙ·Ì›ÓË˜ D. √‡ÙÂ ÌÔÚÂ› Ó·

·ÁÓÔËıÂ› ﬁÙÈ ÂÓ‰¤¯ÂÙ·È Ó· ˘¿Ú¯Ô˘Ó ÎÏÈÓÈÎ¿

‰ÂÓ ¤¯ÂÈ ˘ÔÏÔÁÈÛıÂ› ·Ï-

Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ ‰Â›¯ÓÔ˘Ó ﬁÙÈ ·ÎﬁÌË Î·È ÛÂ

ÌÈ· ËÏÈfiÏÔ˘ÛÙË ¯ÒÚ· fiˆ˜ Ë ∂ÏÏ¿‰·, ÔÈ Ó¤ÔÈ ËÏÈÎ›·˜ 15-18 ¯ÚfiÓˆÓ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘

¯ÂÈÌÒÓ· ¤¯Ô˘Ó ·Ó¿ÁÎË Ï‹„Ë˜ ‚ÈÙ·Ì›ÓË˜ D, ·ÊÔ‡ Ù· ·Ôı¤Ì·Ù· ÛÂ ‚ÈÙ·Ì›ÓË D ÙÔ˘ Î·ÏÔÎ·ÈÚÈÔ‡ ‰ÂÓ Â·ÚÎÔ‡Ó. ∆· ÎÔÚ›ÙÛÈ· ·˘Ù‹˜ ÙË˜ ËÏÈÎ›·˜ ·ÔÙÂÏÔ‡Ó ÈÔ Â˘·›ÛıËÙÔ ÏËı˘ÛÌﬁ

·ÚfiÙÈ ‰ÂÓ ¤¯Ô˘Ó ÙÔ˘˜ ÂÚÈÔÚÈÛÌÔ‡˜ ÙË˜ ÂÓ‰˘Ì·Û›·˜ fiˆ˜ ÛÙÈ˜ ÌÔ˘ÛÔ˘ÏÌ·ÓÈÎ¤˜ ¯ÒÚÂ˜, Ô Î›Ó‰˘ÓÔ˜ ‰Â Â›Ó·È ÌÂÁ·Ï‡ÙÂÚÔ˜ ÁÈ· ÙË ¯ÂÈÌÂÚÈÓ‹ ÂÚ›Ô‰Ô. ∫·Ù¿ fiÛÔÓ ˘¿Ú¯Ô˘Ó Ì·ÎÚÔ¯ÚfiÓÈÂ˜ ÂÈÙÒÛÂÈ˜ Â› ÙË˜ ÔÛÙÈÎ‹˜ Ì¿˙·˜ ÙÔ˘˜

‰ÂÓ ÌÔÚÂ› Ó· ÂÈ‚Â‚·ÈˆıÂ› ·ﬁ Ù· ·ÔÙÂÏ¤-

ÛÌ·Ù· ÙË˜ ÌÂÏ¤ÙË˜ ·ÏÏ¿ ‰ÂÓ ÌÔÚÂ› Î·È Ó·

·ÁÓÔËıÂ›, ÂÈ‰ÈÎ¿ ÌÂ ¯·ÌËÏ¤˜ ÙÈÌ¤˜ ‰ÂÈÎÙÒÓ ÔÛÙÈÎ‹˜ Û‡ÓıÂÛË˜ ÙË ¯ÂÈÌÂÚÈÓ‹ ÂÚ›Ô‰Ô.

∂›ÛË˜, Î·Ù¿ ÙËÓ ÙÂÏÂ˘Ù·›· ‰ÂÎ·ÂÙ›·, ¤¯Ô˘Ó ‰È·ÈÛÙˆıÂ› ÂÚÂ˘ÓËÙÈÎ¿ Î·È ¿ÏÏÂ˜ ‰Ú¿ÛÂÈ˜ ÙË˜ ‚ÈÙ·Ì›ÓË˜ D ÂÎÙfi˜ ·fi ·˘Ù‹ ÛÙÔ ÌÂÙ·‚ÔÏÈÛÌfi ÙÔ˘ ·Û‚ÂÛÙ›Ô˘ (50). ŒÙÛÈ, Ù˘¯fiÓ ÂÈÙÒÛÂÈ˜ ·fi Ì·ÎÚÔ¯ÚfiÓÈ· ·ÓÂ¿ÚÎÂÈ· ‚ÈÙ·Ì›ÓË˜ D ÛÙÔÓ ¿ÓıÚˆÔ Ì¿ÏÏÔÓ ‰ÂÓ ÌÔÚÂ›

1,25(OH)2D ·ﬁ ÙËÓ ·Ú¯‹ ÙË˜ ˙ˆ‹˜ ÙÔ˘˜ (51,52,53). √È Hypponen Î·È Û˘Ó (2001) ÛÂ Ì›·

ÂÈ‰ËÌÈÔÏÔÁÈÎ‹ ÌÂÏ¤ÙË, ‚Ú‹Î·Ó ﬁÙÈ Ù· ·È‰È¿

Ô˘ ¤·ÈÚÓ·Ó 2000 IU ‚ÈÙ·Ì›ÓË˜ D ·ﬁ ÙÔÓ 1Ô

¯ÚﬁÓÔ ˙ˆ‹˜ ÌÂ›ˆÓ·Ó ÙËÓ Èı·ÓﬁÙËÙ· ÂÌÊ¿ÓÈ-

ÛË˜ Û·Î¯·ÚÒ‰Ô˘˜ ‰È·‚‹ÙË Ù‡Ô˘ I Î·Ù¿ 80%

(54). ÀÂÚÙ·ÛÈÎÔ› ·ÛıÂÓÂ›˜ Ô˘ ÂÎÙ¤ıËÎ·Ó ÛÂ ˘ÂÚÈÒ‰Ë ·ÎÙÈÓÔ‚ÔÏ›· (UVB) ÁÈ· ÌÂÚÈÎÔ‡˜

Ì‹ÓÂ˜ Î·È ·‡ÍËÛ·Ó Ù· Â›Â‰· ÙË˜ Î˘ÎÏÔÊÔÚÔ‡Û·˜ 25OHD, ‚Ú¤ıËÎ·Ó Ó· ÌÂÈÒÓÔ˘Ó ÙË Û˘-

ÛÙÔÏÈÎ‹ Î·È ‰È·ÛÙÔÏÈÎ‹ ›ÂÛ‹ ÙÔ˘˜ Û·Ó Ó·

¤·ÈÚÓ·Ó ·ÓÙÈ˘ÂÚÙ·ÛÈÎ‹ ·ÁˆÁ‹, ÂÓÒ ‰ÂÓ Û˘-

Ó¤‚·ÈÓÂ ÙÔ ›‰ÈÔ ÌÂ ·˘ÙÔ‡˜ Ô˘ ‰ÂÓ ·‡ÍËÛ·Ó

ÙËÓ 25OHD (55). ª¤Ûˆ ÌË¯·ÓÈÛÌÒÓ Ô˘ ‰ÚÔ˘Ó ·ÚÓËÙÈÎ¿

ÛÙÔÓ ÔÏÏ·Ï·ÛÈ·ÛÌﬁ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ‹ ÌÂ ÙËÓ

ÂÓÂÚÁÔÔ›ËÛË ÙË˜ ·ﬁÙˆÛË˜, Ë ‚ÈÙ·Ì›ÓË D

ÌÔÚÂ› Ó· ÂËÚÂ¿˙ÂÈ Î·È Ì¿ÏÈÛÙ· ·ÔÙÂÏÂÛÌ·-

ÙËÓ Î˘ÙÙ·ÚÈÎ‹ ·‡ÍËÛË, ÚÔÛÙ·ÙÂ‡ÔÓÙ·˜ ¤ÙÛÈ ·ﬁ ÌÂÚÈÎÔ‡˜ Ù‡Ô˘˜ Î·ÚÎ›ÓÔ˘ (56). ∆È˜

ÙÂÏÂ˘Ù·›Â˜ ‰‡Ô ‰ÂÎ·ÂÙ›Â˜, ÂÚÂ˘ÓËÙ¤˜ ÂÈ‚Â‚·›ˆÛ·Ó ·ÏÈﬁÙÂÚÂ˜ ·Ú·ÙËÚ‹ÛÂÈ˜ ﬁÙÈ ¿ÓıÚˆ-

ÔÈ ·fi ÙÈ˜ H.¶.A. Î·È ÙËÓ E˘ÚÒË Ô˘ ˙Ô‡Û·Ó ÛÂ ˘„ËÏfi ÁÂˆÁÚ·ÊÈÎfi Ï¿ÙÔ˜ ‹ ‰ÂÓ ÂÎÙ›-

ıÂÓÙÔ ·ÚÎÂÙ¿ ÛÂ UVB ·ÎÙÈÓÔ‚ÔÏ›·, ‚Ú›ÛÎÔ-

ÓÙ·Ó ÛÂ ˘„ËÏﬁÙÂÚÔ Î›Ó‰˘ÓÔ ı·Ó¿ÙÔ˘ ·ﬁ Î·Ú-

Î›ÓÔ ÙÔ˘ ·¯¤Ô˜ ÂÓÙ¤ÚÔ˘, ÙÔ˘ ÚÔÛÙ¿ÙË Î·È

ÙÔ˘ Ì·ÛÙÔ‡ (57). ™˘ÓÂÒ˜, Ô ÂÌÏÔ˘ÙÈÛÌﬁ˜ ÌÂ

ÈÎ·ÓÔÔÈËÙÈÎ‹ ÔÛﬁÙËÙ· ‚ÈÙ·Ì›ÓË˜ D ÙˆÓ Á·-

Ï¿ÙˆÓ Î·È ÙˆÓ ¿ÏÏˆÓ ·Ú·ÁÒÁˆÓ Á¿Ï·ÙÔ˜ Î·È

ÛÙËÓ ∂ÏÏ¿‰· Û›ÁÔ˘Ú· ı· Â›Ó·È Â˘ÂÚÁÂÙÈÎﬁ˜.

µÈ‚ÏÈÔÁÚ·Ê›·

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¶ÂÚ›ÏË„Ë: ¶·Ú¿ Ù· Ì¤ÙÚ· ÁÈ· ÙÔÓ ÂÚÈÔÚÈÛÌfi ÙË˜, Ë ‚ÚÔ˘Î¤ÏÏˆÛË ÂÍ·ÎÔÏÔ˘ıÂ› Ó· ÂÓ‰ËÌÂ› ÛÂ ÔÏÏ¤˜ ÂÚÈÔ¯¤˜ ÙÔ˘ ÎfiÛÌÔ˘. ™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË ·Ó·ÛÎÔ‹ıËÎ·Ó ÔÈ Ì·ÎÚÔ¯ÚfiÓÈÂ˜ Ù¿ÛÂÈ˜ ÙË˜ ÓÔÛËÚfiÙËÙ·˜ ÛÙËÓ ∂ÏÏ¿‰· Î·Ù¿ ÙËÓ 25ÂÙ›· 1979-2003, ÌÂ ¤ÌÊ·ÛË ÛÙÔÓ ·È‰ÈÎfi ÏËı˘ÛÌfi, Î·È ÌÂ ‚¿ÛË Ù· ‰Â‰ÔÌ¤Ó· ÙË˜ ∂ıÓÈÎ‹˜ ™Ù·ÙÈÛÙÈÎ‹˜ ÀËÚÂÛ›·˜ Î·È ÙÈ˜ ‰ËÌÔÛÈÂ˘Ì¤ÓÂ˜ ÌÂÏ¤ÙÂ˜. ∫·Ù¿ ÙË ‰ÂÎ·ÂÙ›· ÙÔ˘

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ÎÂ Ó¤Ô ·˘ÍËÙÈÎﬁ Î‡Ì·. ∏ Ì¤ÛË Â›ÙˆÛË ÙË˜ ÓﬁÛÔ˘ ‹Ù·Ó 4,38 ‰ËÏˆı¤ÓÙ· ÎÚÔ‡ÛÌ·Ù· Î·È 7,76 ÓÔÛË-

ÏÂ›Â˜ / 100.000 ÁÂÓÈÎÔ‡ ÏËı˘ÛÌÔ‡ / ¤ÙÔ˜. ∆Ô 11,2% ÙˆÓ ÓÔÛËÏÂÈÒÓ ·ÊÔÚÔ‡ÛÂ ·È‰È¿ ËÏÈÎ›·˜ Î¿Ùˆ

ÙˆÓ 14 ÂÙÒÓ, ÌÂ Ì¤ÛË ÙÈÌ‹ 5,08 ÓÔÛËÏÂ›Â˜ / 100.000 ·È‰ÈÎÔ‡ ÏËı˘ÛÌÔ‡ / ¤ÙÔ˜. ™Ù· ·È‰È¿ ·Ú·ÙËÚ‹ıËÎÂ ·‡ÍËÛË ÙË˜ ÓÔÛËÚﬁÙËÙ·˜ ·Ó¿ÏÔÁ· ÌÂ ÙËÓ ËÏÈÎ›·. ¢ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ‰È·ÊÔÚ¤˜ ·Ó¿ÌÂÛ· ÛÙ· ‰‡Ô Ê‡Ï· Î·Ù¿ ÙË ‚ÚÂÊÈÎ‹ Î·È ÙË ÓËÈ·Î‹ ËÏÈÎ›·, ﬁÌˆ˜ ÛÙ· ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿ Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜, Ë

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ÂÎ‰ËÏÒÛÂÈ˜

Morbidity and clinical manifestations of brucellosis in Greece

M. Mavrokosta, E. Galanakis

Abstract: Despite the preventive efforts, brucellosis remains endemic in many areas worldwide. ∆he long-term morbidity of the disease in Greece was investigated in the present study, with an emphasis on childhood morbidity. The study was based on the data reported from 1979 through 2003 by the Greek National Statistical Service and in the relevant published studies. During the 1980s, brucellosis presented with a decrease in morbidity, but a reemergence was observed in the mid 1990s. The average annual incidence was 4.38 reported cases and 7.76 admissions / 100,000 population. Among the hospitalized patients, 11,2% were children aged less than 14 years, and average annual incidence was calculated at 5.08 admissions / 100,000 child population. The morbidity in childhood and adolescence increased with age. Male and female infants and toddlers were equally affected, but males presented with a considerably higher morbidity during late childhood and adolescence. Endemic areas were identified, mainly in Northern Greece. The lowest incidence rates were observed in the islands and in urban areas. The protean clinical manifestations of brucellosis were confirmed in the Greek published studies. The persistence and the recent reemergence of brucellosis in Greece stress the need of animal control and pasteurization of milk and dairy products, and of screening the families of index cases. Physicians should think of brucellosis when caring for patients who reside in or have traveled to endemic areas and who present with atypical manifestations.

Key words: Brucellosis, endemic areas, Greece, occupational diseases, food-borne diseases, zoonotic diseases.

AÏÏËÏÔÁÚ·Ê›·: ∂ÌÌ·ÓÔ˘‹Ï °·Ï·Ó¿ÎË˜ ∆ÔÌ¤·˜ ªËÙ¤Ú·˜-¶·È‰ÈÔ‡, ∆Ì‹Ì· π·ÙÚÈÎ‹˜

∫Ú‹ÙË˜ ∆.£. 2208, T.K. 710 03 ∏Ú¿ÎÏÂÈÔ ∫Ú‹ÙË˜ ∂-mail: egalanak@med.uoc.gr

∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 10-01-2005

∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛË˜: 14-10-2005

Paediatric Department, General University Hospital of Heraklion, Crete

Correspondence: Emmanouil Galanakis School of Medicine, Mother-Child Department University of Crete P.O. Box 2208, 710 03, Heraklion, Crete ∂-mail: egalanak@med.uoc.gr

Date of submission: 10-01-2005

Date of approval: 14-10-2005

∂ÈÎﬁÓ·

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ﬁ¯È ÛÙÔÓ ÙﬁÔ ‰È·ÌÔÓ‹˜. ™ÙÔÓ ¶›Ó·Î· 3 ·ÚÔ˘-

ÛÈ¿˙ÔÓÙ·È ÔÈ ·Û˘Ó‹ıÈÛÙÂ˜ ÎÏÈÓÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ ÙË˜ ‚ÚÔ˘Î¤ÏÏˆÛË˜ Ô˘ ·Ó·Ê¤ÚıËÎ·Ó ÛÙË ¯ÒÚ· Ì·˜ ·ﬁ ÙÈ˜ ‰ËÌÔÛÈÂ˘Ì¤ÓÂ˜ ÂÚÁ·Û›Â˜ Î·È ÙÈ˜

¶›Ó·Î·˜ 1. ¡ÔÛËÏÂ›Â˜ ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ ÁÈ· ‚ÚÔ˘Î¤ÏÏˆÛË Î·Ù¿ ÙÔ ¯ÚÔÓÈÎﬁ ‰È¿ÛÙËÌ· 1980-1997 ·Ó¿ÏÔÁ· ÌÂ ÙËÓ

ËÏÈÎÈ·Î‹ ÔÌ¿‰· Î·È ÙÔ Ê‡ÏÔ

∏ÏÈÎÈ·Î‹ ™‡ÓÔÏÔÕÚÚÂÓÂ˜ £‹ÏÂÈ˜ ∞Ó·ÏÔÁ›· ÔÌ¿‰·∞/£

0-4 ÂÙÒÓ3171821351,35/1

5-9 ÂÙÒÓ4702941761,67/1

10-14 ÂÙÒÓ8735713021,89/1

15-19 ÂÙÒÓ10267602662,86/1

™‡ÓÔÏÔ 26861.8078792,06/1

0-19 ÂÙÒÓ

·Ó·ÎÔÈÓÒÛÂÈ˜. ™‡ÌÊˆÓ· ÌÂ Ù· ‰ÂÏÙ›· ÙË˜

∂™À∂, 22 ı¿Ó·ÙÔÈ ·Ô‰ﬁıËÎ·Ó ÛÙË ÓﬁÛÔ Î·Ù¿ ÙËÓ ÂÚ›Ô‰Ô 1980-1997.

™˘˙‹ÙËÛË

∏ Ú·ÁÌ·ÙÈÎ‹ ÓÔÛËÚﬁÙËÙ· ÙË˜ ‚ÚÔ˘Î¤ÏÏˆ-

ÛË˜ ÛÂ ˙Ò· Î·È ·ÓıÚÒÔ˘˜ ·Ú·Ì¤ÓÂÈ ¿ÁÓˆÛÙË, Î·ıÒ˜ Û˘¯Ó¿ Ë ‰‹ÏˆÛË ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ

Â›Ó·È ÂÏÏÈ‹˜ (2,4). ∆· ÚÔÁÚ¿ÌÌ·Ù· ÚﬁÏË„Ë˜ ÛÙËÚ›˙ÔÓÙ·È ÛÙÔÓ ¤ÏÂÁ¯Ô ÙˆÓ ˙ÒˆÓ, ÛÙÈ˜

ÚÔÊ˘Ï¿ÍÂÈ˜ Î·Ù¿ ÙËÓ Â·ÁÁÂÏÌ·ÙÈÎ‹ ¤ÎıÂÛË,

Î·È ÛÙËÓ Î·Ù¿ÏÏËÏË ·Ú·ÛÎÂ˘‹ ÙÔ˘ Á¿Ï·ÎÙÔ˜, ÙˆÓ Á·Ï·ÎÙÔÎÔÌÈÎÒÓ Î·È ¿ÏÏˆÓ ‰˘ÓËÙÈÎ¿ ÌÔÏ˘ÛÌ·ÙÈÎÒÓ ÙÚÔÊ›ÌˆÓ (3,9). ™Â ·ÚÎÂÙ¤˜ ¯ÒÚÂ˜, ÌÂ Ù· Ì¤ÙÚ· ·˘Ù¿ Ë ÂÈ‰ËÌÈÔÏÔÁ›· ÙË˜ ÓﬁÛÔ˘

¤¯ÂÈ ·ÏÏ¿ÍÂÈ ·ﬁ ÂÓ‰ËÌÈÎ‹ ‹ Â·ÁÁÂÏÌ·ÙÈÎ‹ ÛÂ ÓﬁÛÔ ÙˆÓ Ù·ÍÈ‰ÈˆÙÒÓ.

∞ﬁ Ù· 6 ÁÓˆÛÙ¿ Ì¤ÏË ÙÔ˘ Á¤ÓÔ˘˜ Brucella, (B. melitensis, B. abortus, B. suis, B. canis, B. neotomae Î·È B. ovis), ÌﬁÓÔ Ù· 4 ÚÒÙ· ¤¯Ô˘Ó

ÎÏÈÓÈÎ‹ ÛËÌ·Û›· ÁÈ· ÙÔÓ ¿ÓıÚˆÔ (2). ™ÙËÓ

∂ÏÏ¿‰·, ÙÔ Û¯Â‰fiÓ ·ÔÎÏÂÈÛÙÈÎ¿ ·ıÔÁfiÓÔ Â›‰Ô˜ ÁÈ· ÙÔÓ ¿ÓıÚˆÔ Â›Ó·È Ë B. melitensis. §ÔÈÌÒÍÂÈ˜ ·fi B. abortus ·Ó·Ê¤ÚÔÓÙ·È Û·ÓÈfiÙ·Ù·, Î·È ·ÎfiÌË Î·È Ë ‡·ÚÍ‹ ÙÔ˘˜ ÛÙË ¯ÒÚ· Ì·˜, ·ÔÙÂÏÂ› ·ÓÙÈÎÂ›ÌÂÓÔ Û˘˙‹ÙËÛË˜ (5,27-32). ∏

1980-1997

¢È·Ì¤ÚÈÛÌ·¡ÔÛËÏÂ˘ı¤ÓÙÂ˜ ¶ÏËı˘ÛÌﬁ˜ ¡ÔÛËÏÂ›Â˜ ·Ó¿ ·ÛıÂÓÂ›˜(·ÔÁÚ·Ê‹ 1991)100.000 ÏËı˘ÛÌÔ‡/¤ÙÔ˜

◊ÂÈÚÔ˜1.166339.72819,1 £Ú¿ÎË968338.00515,9 ¶ÂÏÔﬁÓÓËÛÔ˜2.2691.086.93511,6 ª·ÎÂ‰ÔÓ›·4.4722.236.01911,1 £ÂÛÛ·Ï›·1.338734.84610,1

§ÔÈ‹ ™ÙÂÚÂ¿ Î·È ∂‡‚ÔÈ·2.1231.260.9459,35 ∫Ú‹ÙË403540.0544,14

¶ÂÚÈÊ¤ÚÂÈ· ¶ÚˆÙÂ˘Ô‡ÛË˜1.3663.072.9222,47

πﬁÓÈÔÈ ¡‹ÛÔÈ86193.7342,46

¡‹ÛÔÈ ∞ÈÁ·›Ô˘132456.7121,61

°ÂÓÈÎﬁ Û‡ÓÔÏÔ14.32310.259.9007,76

ÛÙ‹ ÁÈ· ÙËÓ ÈÎ·ÓﬁÙËÙ· ÚÔÛ‚ÔÏ‹˜ ÔÔÈÔ˘‰‹ÔÙÂ Û¯Â‰ﬁÓ ÔÚÁ¿ÓÔ˘ Î·È

ÌÂ ÌÔÏ˘ÛÌ¤ÓÔ Á¿Ï· Ì¿ÏÏÔÓ, ·Ú¿ ÌÂ ¿ÌÂÛË Â·Ê‹

ÌÂ ˙Ò· (37-38). ™ÙË ¯ÒÚ· Ì·˜ ¤¯Ô˘Ó ·Ó·ÊÂÚıÂ›

ÂÓ‰ÔÔÈÎÔÁÂÓÂÈ·Î¤˜ ÂÈ‰ËÌ›Â˜ ÛÂ ÎÔÈÓﬁÙËÙÂ˜

ÎÙËÓÔÙÚﬁÊˆÓ (34,39) Î·ıÒ˜ Î·È ÌÂÙ¿‰ÔÛË ÙË˜

ÓﬁÛÔ˘ ‰È·Ï·ÎÔ˘ÓÙÈ·Î¿ Î·È ÌÂ ÌËÙÚÈÎﬁ ıËÏ·-

ÛÌﬁ (31,37,40).

√È Û˘Ó‹ıÂÈ˜ ÂÎ‰ËÏÒÛÂÈ˜ ÙË˜ ‚ÚÔ˘Î¤ÏÏˆÛË˜

ÛÙÔÓ ¿ÓıÚˆÔ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ˘ÚÂÙfi, ·ÓÔÚÂÍ›·, ·ÒÏÂÈ· ‚¿ÚÔ˘˜, Â‡ÎÔÏË ÎfiˆÛË, ÂÊ›‰ÚˆÛË, ·ÚıÚ·ÏÁ›Â˜ ‹ Î·È ·ÚıÚ›ÙÈ‰·, ÎÂÊ·Ï·ÏÁ›·, Ì˘·ÏÁ›Â˜, Ë·ÙÔ-ÛÏËÓÔÌÂÁ·Ï›·, Î·È ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ· (2-4). øÛÙfiÛÔ, Ë ÓfiÛÔ˜ Â›Ó·È ÁÓˆ-

ÂÎ‰ËÏÒÛÂˆÓ ÛÂ ·È‰È¿ Î·È ÛÂ ÂÓ‹ÏÈÎÂ˜. ∏ ıÓËÙﬁÙËÙ·

¯·ÌËÏ‹ ÁÈ· ÙË ¯ÒÚ· Ì·˜ Î·Ù¿ ÙËÓ ÂÚ›Ô‰Ô ÙË˜ ÌÂÏ¤ÙË˜. ø˜ Î˘ÚÈfiÙÂÚË ·ÈÙ›· ı·Ó¿ÙÔ˘ ıÂˆÚÂ›Ù·È Ë ÂÓ‰ÔÎ·Ú‰›ÙÈ‰· (41-42). ™Ù· ˙Ò· Ë ‚ÚÔ˘Î¤ÏÏˆÛË ÚÔÎ·ÏÂ› ¯ÚfiÓÈ· ÏÔ›ÌˆÍË, ·˘ÙfiÌ·ÙÂ˜ ·Ô‚ÔÏ¤˜ Î·È ÛÙÂÈÚfiÙËÙ·. ∆Ô ÂÌ‚fiÏÈÔ µ19 Ô˘ Á›ÓÂÙ·È ÛÙ· ‚ÔÔÂÈ‰‹ ·Ú¤¯ÂÈ ÚÔÛÙ·Û›· ÌfiÓÔ ·fi ÙË B. abortus Î·È ÙÔ ÂÌ‚fiÏÈÔ Rev-1 ÁÈ· ÙË B. melitensis Ô˘ Á›ÓÂÙ·È ÛÙ· ·ÈÁÔÚfi‚·Ù· ‰ÂÓ ¤¯ÂÈ ÌÂÏÂÙËıÂ› ÛÙ· ‚ÔÔÂÈ‰‹ (2,9,33). ∏ ÂÎÚ›˙ˆÛË ÙË˜ ÓfiÛÔ˘ ÛÙ· ‚ÔÔÂÈ‰‹ ¤¯ÂÈ ÂÈÙÂ˘¯ıÂ› ÛÂ ·ÚÎÂÙ¤˜ ¯ÒÚÂ˜, ÂÓÒ, ·ÓÙ›ıÂÙ·, Ù· ÚÔÁÚ¿ÌÌ·Ù· ÂÏ¤Á¯Ô˘ ÛÙ· ·ÈÁÔÚfi‚·Ù·

¶›Ó·Î·˜ 3. ∞Û˘Ó‹ıÈÛÙÂ˜ ÂÎ‰ËÏÒÛÂÈ˜ ‚ÚÔ˘Î¤ÏÏˆÛË˜ Ô˘ ¤¯Ô˘Ó ÂÚÈÁÚ·ÊÂ› ÛÙËÓ ∂ÏÏ¿‰·

∂ÓÙﬁÈÛË∂Î‰ËÏÒÛÂÈ˜ Ô˘ ¤¯Ô˘Ó ÂÚÈÁÚ·ÊÂ› ÛÙËÓ ∂ÏÏ¿‰·

¡Â˘ÚÈÎfi Û‡ÛÙËÌ·∫ÂÊ·Ï·ÏÁ›· (34,47), ÌËÓÈÁÁ›ÙÈ‰· (29,39,47-52), ˘ÔÙÚÔÈ¿˙Ô˘Û· ÌËÓÈÁÁÔÂÁÎÂÊ·Ï›ÙÈ‰· (42,53), ÂÁÎÂÊ·ÏÈÎfi ·fiÛÙËÌ· (29), ÚÈ˙›ÙÈ‰· (12,54), ÂÚÈÊÂÚÈÎ‹ ÓÂ˘ÚÔ¿ıÂÈ· (13,21,48), ¿ÚÂÛË ÚÔÛˆÈÎÔ‡ ÓÂ‡ÚÔ˘ (39), ÈÛ¯È·ÏÁ›· (55), „˘¯ÈÎ¤˜ ‰È·Ù·Ú·¯¤˜ (34,55)

∞ÈÛıËÙ‹ÚÈ·πÚÈ‰ÔÎ˘ÎÏ›ÙÈ‰· (39)

∫·Ú‰È¿¶ÂÚÈÎ·Ú‰›ÙÈ‰· (41), ÂÓ‰ÔÎ·Ú‰›ÙÈ‰· (42)

∞Ó·ÓÂ˘ÛÙÈÎﬁ¶ÓÂ˘ÌÔÓÈÎ¤˜ ‰ÈËı‹ÛÂÈ˜ (29)

¶ÂÙÈÎﬁ√ÍÂ›· ÎÔÈÏ›· (57), ·ÛÎ›ÙË˜ (58), ¯ÔÏÔÎ˘ÛÙ›ÙÈ‰· (57), Ë·ÙÈÎ‹ ·ÓÂ¿ÚÎÂÈ· ÛÂ ¤‰·ÊÔ˜ ·ÏÎÔÔÏÈÎ‹˜ Ë·ÙÔ¿ıÂÈ·˜ (59), Ë·ÙÔÓÂÊÚÈÎﬁ Û‡Ó‰ÚÔÌÔ (60)

√ÛÙ¿ Î·È ·ÚıÚÒÛÂÈ˜√ÛÙÂÔÌ˘ÂÏ›ÙÈ‰· (60, 61), ÛÔÓ‰˘Ï›ÙÈ‰· (62)

√˘ÚÔÔÈÔÁÂÓÓËÙÈÎﬁ√Ú¯›ÙÈ‰· (35), ÔÚ¯ÂÔÂÈ‰È‰˘Ì›ÙÈ‰· (44,56,63-65), ÚÔÛÙ·Ù›ÙÈ‰· (55)

∞ÈÌÔÔÈËÙÈÎﬁ ∞Ó·ÈÌ›·, Ô˘‰ÂÙÂÚÔÂÓ›·, ÏÂÌÊÔÂÓ›·, ıÚÔÌ‚ÔÂÓ›· (21,29,39,66), ·ÓÎ˘ÙÙ·ÚÔÂÓ›· (67-68), ÏÂ˘¯·ÈÌÔÂÈ‰‹˜ ·ÓÙ›‰Ú·ÛË, ËˆÛÈÓÔÊÈÏ›·, ÌÔÓÔÎ˘ÙÙ¿ÚˆÛË (39,68), ıÚÔÌ‚ÔÂÓÈÎ‹ ÔÚÊ‡Ú· (39,69)

∫‡ËÛË§Ô›ÌˆÍË ÓÂÔÁÓÔ‡ (31,37,40)

ÕÏÏÂ˜ ÂÓÙÔ›ÛÂÈ˜∂Ì‡ËÌ· ‚Ú·Á¯È·Î‹˜ Î‡ÛÙË˜ (70), ·ﬁÛÙËÌ· Ì·ÛÙÔ‡ (71), ÂÍ¿ÓıËÌ· (29), ÂÈÎﬁÓ· ÚÂ˘Ì·ÙÔÂÈ‰Ô‡˜ ·ÚıÚ›ÙÈ‰·˜ (60)

11,1

10,1 ◊ÂÈÚÔ˜ 19,1‰

2,46 ¶ÂÏÔﬁÓÓËÛÔ˜ 11,6

∂ÈÎﬁÓ· 2. ¡ÔÛËÏÂ›Â˜ ÁÈ· ‚ÚÔ˘Î¤ÏÏˆÛË ·Ó¿ 100.000

ÏËı˘ÛÌÔ‡, ·Ó¿ ¤ÙÔ˜ ÛÙ· ÂÈÌ¤ÚÔ˘˜ ÁÂˆÁÚ·ÊÈÎ¿ ‰È·-

ÌÂÚ›ÛÌ·Ù· ÙË˜ ∂ÏÏ¿‰Ô˜ Î·Ù¿ ÙÔ ¯ÚÔÓÈÎﬁ ‰È¿ÛÙËÌ· 1980-1997.

¤¯Ô˘Ó ÂÚÈÔÚÈÛÌ¤ÓË ÂÈÙ˘¯›· (3,31). ™ÙËÓ

∂ÏÏ¿‰· Ô ÂÌ‚ÔÏÈ·ÛÌﬁ˜ ÙˆÓ ‚ÔÔÂÈ‰ÒÓ Î·È ÙˆÓ

·ÈÁÔÚÔ‚¿ÙˆÓ ËÏÈÎ›·˜ Î¿Ùˆ ÙÔ˘ ¤ÙÔ˘˜ ¿Ú¯ÈÛÂ

·fi ÙÔ 1975 (8,9). ∆Ô ÚfiÁÚ·ÌÌ· ·˘Ùfi ·ÓÙÈÎ·-

Ù·ÛÙ¿ıËÎÂ ÙÔ 1994 ·ﬁ ÙÔÓ ÔÚÔÏÔÁÈÎﬁ ¤ÏÂÁ¯Ô

ÁÈ· ÙËÓ ÂÓÙfiÈÛË ÙˆÓ ÌÔÏ˘ÛÌ¤ÓˆÓ ˙ÒˆÓ (5-6, 8,33), ˆÛÙfiÛÔ ·fi ÙÔ 1997 Î·È ÌÂÙ¿, ÙÔ Úfi-

ÁÚ·ÌÌ· ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÌÂ Rev-1 Î·ıÈÂÚÒıËÎÂ

¿ÏÈ, ÛÙËÓ ËÂÈÚˆÙÈÎ‹ ÙÔ˘Ï¿¯ÈÛÙÔÓ ∂ÏÏ¿‰·

Î·È ¤¯ÂÈ ÚÔÁÚ·ÌÌ·ÙÈÛÙÂ› Ó· ‰È·ÚÎ¤ÛÂÈ ¤ˆ˜ Î·È ÙÔ 2004, ·ÎÔÏÔ˘ıÒÓÙ·˜ ÙÈ˜ Ô‰ËÁ›Â˜ ÙË˜ ∂˘Úˆ·˚Î‹˜ ∫ÔÈÓfiÙËÙ·˜ (5). ™ÙÈ˜ ÂÚÈÔ¯¤˜ ÌÈÎÚfiÙÂÚË˜ Â›ÙˆÛË˜, fiˆ˜ Â›Ó·È Ë ÓËÛÈˆÙÈÎ‹ ∂ÏÏ¿‰·, ÂÍ·ÎÔÏÔ˘ıÂ› Ë Ù·ÎÙÈÎ‹ ÙÔ˘ ÔÚÔÏÔÁÈÎÔ‡ ÂÏ¤Á¯Ô˘ ÙˆÓ ˙ÒˆÓ Î·È ÙË˜ ÛÊ·Á‹˜ ÙˆÓ ÓÔÛÔ‡ÓÙˆÓ (5). Ÿˆ˜ ÚÔÎ‡ÙÂÈ ·fi ÙËÓ ∂ÈÎfiÓ· 1, Ë ÓÔÛËÚfiÙËÙ· ÛÙÔÓ ¿ÓıÚˆÔ Û¯ÂÙ›˙ÂÙ·È ÌÂ ÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi ÙˆÓ ˙ÒˆÓ (9). ∫·È ÔÈ ‰‡Ô ÂÌÊ·ÓÂ›˜ ˘Ê¤ÛÂÈ˜ ÙË˜ Â›ÙˆÛË˜, ÛÙË ‰ÂÎ·ÂÙ›· ÙÔ˘ 1980 Î·È ÌÂÙ¿ ÙÔ 2000, ·ÎÔÏÔ˘ıÔ‡Ó ÙËÓ ÂÊ·ÚÌÔÁ‹ ÚÔÁÚ·ÌÌ¿ÙˆÓ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÙˆÓ ˙ÒˆÓ Î·È Ë ·‡ÍËÛË ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ ÌÂÙ¿ ÙÔ

1995 ·ÎÔÏÔ˘ıÂ› ÙËÓ ·Ó·ÛÙÔÏ‹ ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡. ¶ÚﬁÛÊ·ÙË ·Ó·˙ˆ‡ÚˆÛË ÙË˜ ÓﬁÛÔ˘ ¤¯ÂÈ ÂÚÈÁÚ·ÊÂ› ÛÙË ª¿ÏÙ· Î·È ÛÙÔ

ÙËÓ ÂÚ›Ô‰Ô Á·Ï·ÎÙÔ·Ú·ÁˆÁ‹˜ (29,44). √ ¤ÏÂÁ¯Ô˜ ﬁÏˆÓ ÙˆÓ ÌÂÏÒÓ ÙË˜ ÔÈÎÔÁ¤ÓÂÈ·˜ Â›Ó·È ··Ú·›ÙËÙÔ˜, ‰Â‰ÔÌ¤ÓÔ˘ ﬁÙÈ ÛÂ

Î¿ıÂ ÁÓˆÛÙfi ÎÚÔ‡ÛÌ· ÌÔÚÂ› Ó· ·ÓÙÈÛÙÔÈ¯Ô‡Ó ·ÚÎÂÙ¿ ·‰È¿ÁÓˆÛÙ· (45-46). ∞Í›˙ÂÈ Ó· ˘ÔÁÚ·ÌÌÈÛÙÂ› fiÙÈ ÙÔ ÚÔÛÂÎÙÈÎfi ÈÛÙÔÚÈÎfi, Î·Ù¿

Î·ÓfiÓ·, ·Ó·‰ÂÈÎÓ‡ÂÈ È‰È·›ÙÂÚË Û¯¤ÛË ÙÔ˘ ·ÛıÂÓÔ‡˜ ÌÂ ˙Ò· (16,28) Î·È fiÙÈ Û˘ÓÂÒ˜ Ô Î›Ó‰˘ÓÔ˜ ÌfiÏ˘ÓÛË˜ ·fi Ù· Á·Ï·ÎÙÔÎÔÌÈÎ¿ Ô˘ ‰È·ÎÈÓÔ‡ÓÙ·È ÛÙÔ ÂÌfiÚÈÔ Â›Ó·È ·ÌÂÏËÙ¤Ô˜. °È·

ÙÔÓ ¿ÓıÚˆÔ ‰ÂÓ ¤¯ÂÈ ·Ú·ÛÎÂ˘·ÛÙÂ› Ì¤¯ÚÈ

Û‹ÌÂÚ· Î¿ÔÈÔ ÈÎ·ÓÔÔÈËÙÈÎfi ÂÌ‚fiÏÈÔ (2,3), ÌÔÏÔÓfiÙÈ ·ÚÎÂÙ¿ ¤¯Ô˘Ó ‰ÔÎÈÌ·ÛÙÂ› (3,43). ∞fi ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË ÚÔÎ‡ÙÂÈ fiÙÈ Î·-

¯ÚﬁÓÈ· ÁÈ· ÙËÓ Â›ÙÂ˘ÍË ·˘ÙÔ‡ ÙÔ˘ ÛÎÔÔ‡. ∂ÎÙﬁ˜

µÈ‚ÏÈÔÁÚ·Ê›·

1.Vassalo DJ. The saga of brucellosis: controversy over credit for linking Malta fever with goats’ milk. Lancet 1996;348:804-808.

2.Young EJ. An overview of human brucellosis. Clin Infect Dis 1995;21:283-290.

3.Corbel MJ. Brucellosis: an overview. Emerg Infect Dis 1997;3:213-221.

4.Sauret JM, Vilissova N. Human brucellosis. J Am Board Fam Pract 2002;15:401-406.

5.Taleski V, Zerva L, Kantardjiev T, Cvetnic Z, ErskiBiljic M, Nikolovski B et al. An overview of the epidemiology and epizootology of brucellosis in selected countries of Central and Southeast Europe. Vet Microbiol 2002;90:147-155.

6.∫·ÓÛÔ˘˙›‰Ô˘-∫·Ó·ÎÔ‡‰Ë ∞. µÚÔ˘ÎÂÏÏÒÛÂÈ˜. ¢ÂÏÙ›ÔÓ ∂ÏÏËÓÈÎ‹˜ ªÈÎÚÔ‚ÈÔÏÔÁÈÎ‹˜ ∂Ù·ÈÚÂ›·˜ 1997; 42:37-41.

7.K·ÓÛÔ˘˙›‰Ô˘ A, ª‹ÙÎ· ™, ¢·ÓÈËÏ›‰Ë˜ µ. ∂›‰Ë Î·È ‚ÈﬁÙ˘ÔÈ ‚ÚÔ˘ÎÂÏÏÒÓ Ô˘ ·ÔÌÔÓÒıËÎ·Ó ·ﬁ ·ÓıÚÒÔ˘˜. ¢ÂÏÙ›ÔÓ ∂ÏÏËÓÈÎ‹˜ ªÈÎÚÔ‚ÈÔÏÔÁÈÎ‹˜

∂Ù·ÈÚÂ›·˜ 1996;41:598-602.

8.∫·ÓÛÔ˘˙›‰Ô˘-∫·Ó·ÎÔ‡‰Ë ∞. µÚÔ˘Î¤ÏÏˆÛË. ªÈ· ÓﬁÛÔ˜ Ô˘ Û˘ÓÂ¯›˙ÂÈ Ó· ·ÔÙÂÏÂ› Úﬁ‚ÏËÌ· ÛÙËÓ

∂ÏÏ¿‰·. π·ÙÚÈÎ‹ 1998;73:371-376.

9.Minas A, Minas M, Stournara A, Tselepidis S. The “effects” of Rev-1 vaccination of sheep and goats on

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10.ºÔ˘ÓÙ˙‹Ï·˜ °, ™·ÚÚ‹˜ ∫, °ÂˆÚÁÈ¿‰Ë˜ π, §ÂÔÓÙ›‰Ë˜ ™. ∏ ‚ÚÔ˘Î¤ÏÏˆÛË ÂÈ˜ ˆÚÈÛÌ¤Ó·˜ ÂÚÈÔ¯¿˜ ÙË˜ µÔÚÂÈÔ‰˘ÙÈÎ‹˜ ∂ÏÏ¿‰Ô˜. π·ÙÚÈÎ‹ ∂ÈıÂÒÚËÛÈ˜

∂ÓﬁÏˆÓ ¢˘Ó¿ÌÂˆÓ 1978;12:47-53.

11.∆ÛÈÎÚ›Î·˜ £, ∫·Ú¿ÓË˜ £, ∫·ÙÛÈ·ÊÏÈ¿Î·˜ ¢, ∞ÏÂÍ·Ó‰ÚÔÔ‡ÏÔ˘ µ, Ã·ÏÎÈ¿˜ Ã, ∫·Ï˘ÌﬁÔ˘ÏÔ˜ ∏. ∂È‰ËÌÈÔÏÔÁÈÎ¤˜, ÎÏÈÓÈÎ¤˜, ÂÚÁ·ÛÙËÚÈ·Î¤˜ Î·È ¿ÏÏÂ˜ ÂÓ‰È·Ê¤ÚÔ˘ÛÂ˜ ·Ú·ÙËÚ‹ÛÂÈ˜ ÛÂ 157 ÂÚÈÙÒÛÂÈ˜ ÌÂÏÈÙ·›Ô˘ ˘ÚÂÙÔ‡. π·ÙÚÈÎ‹ ∂ÈıÂÒÚËÛÈ˜ ∂ÓﬁÏˆÓ ¢˘Ó¿ÌÂˆÓ 1981;15:39-49.

12.°ÈˆÙ¿ÎË ∂, ∫ÔÎÎ›ÓË °, ¶··¯·Ú›ÛË˜ °, ¢ﬁÓÔ˜ ∞, ªÔ˘ÙÛﬁÔ˘ÏÔ˜ Ã. ∏ ‚ÚÔ˘Î¤ÏÏˆÛË ÛÙËÓ ◊ÂÈÚÔ. Materia Medica Greca 1982;10:391-394.

13.∑È¿Î·˜ °, º˘Ï·ÎÙ¿ÎË˜ ¡, ™·Ú·Ê›‰Ë˜ ™, ¶··‰fiÔ˘ÏÔ˜ ª, ∞Ï·‚·Ó‹˜ ¶. ∞Ó¿Ï˘ÛË 804 ÂÚÈÙÒÛÂˆÓ ‚ÚÔ˘Î¤ÏÏˆÛË˜ (ÌÂÏ¤ÙË ÙË˜ ÓfiÛÔ˘ ÛÙÔ ÓÔÌfi ∫ÈÏÎ›˜). °·ÏËÓfi˜ 1985;27:366-376.

14.∫ÈÔÛ¤˜ µ, ¶¿ÁÎ·ÏÔ˜ ∂, ª·ÚÎfiÔ˘ÏÔ˜ ∞, ª·Ó¤˜ Ã, ∫·ÏÏÈÁÎ¿ÙÛË˜ Ã, ¶··¯Ú‹ÛÙÔ˘ ∞, µÔ˘ÁÈÔ‡Î·˜ ∞. ∏ ÂÈ‰ËÌÈÔÏÔÁ›· ÙˆÓ ÏÔÈÌˆ‰ÒÓ ÓfiÛˆÓ ÛÙË µfiÚ. ∂ÏÏ¿‰· Î·Ù¿ ÙËÓ ÙÚÈÂÙ›· 1980-82. °·ÏËÓfi˜ 1986; 28:473-488.

15.∫·‚Ô‡ÚË˜ ∫, ∫ÚÔÎ›‰·˜ °, §ﬁÓÙÔ˜ µ, ™‰Ô‡ÁÎÔ˜ °, ¶ÂÙÚÔÔ‡ÏÔ˘ ∂, ªÈıÔ‡ÏÎ· ª, º›ÏÈ·˜ ¡. ∞Ó·‰ÚÔÌÈÎ‹ ÂÈ‰ËÌÈÔÏÔÁÈÎ‹ ÌÂÏ¤ÙË ÙÔ˘ ÌÂÏÈÙ·›Ô˘ ÛÙ· ·È‰È¿ ÙË˜ ¡.¢. ∂ÏÏ¿‰·˜. ¶Ú·ÎÙÈÎ¿ 30Ô˘ ¶·ÓÂÏÏ‹ÓÈÔ˘ ¶·È‰È·ÙÚÈÎÔ‡ ™˘ÓÂ‰Ú›Ô˘; 1992 πÔ‡ÓÈÔ˜ 1314; §ÂÌÂÛﬁ˜: ∂ÏÏËÓÈÎ‹ ¶·È‰È·ÙÚÈÎ‹ ∂Ù·ÈÚÂ›·; 1992:167∞∞.

16.Ã·Ù˙Ë¯ÚÈÛÙÔ‰Ô‡ÏÔ˘ Ã, ª¿Ì·ÏË˜ £, °ÎÔ˘Ù˙È¿Ó· °, µÔ‡ÏÁ·ÚË˜ ¶, ™ˆÙËÚÈ¿‰Ë˜ ∂, ∆ÛÂÏ¤ÓÙÈ˜ °. ¶Ú·ÎÙÈÎ¿ 30Ô˘ ¶·ÓÂÏÏ‹ÓÈÔ˘ ¶·È‰È·ÙÚÈÎÔ‡ ™˘ÓÂ‰Ú›Ô˘; 1992, πÔ‡ÓÈÔ˜ 13-14; §ÂÌÂÛﬁ˜: ∂ÏÏËÓÈÎ‹

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26. ª·ÛÔ‡ÎÔ˘-ª·Ì¿ÛË ¶. √ÚÔÏÔÁÈÎ‹ ‰È¿ÁÓˆÛË ‚ÚÔ˘Î¤ÏÏˆÛË˜ - ∫Ï·ÛÈÎ¤˜ ‰ÔÎÈÌ·Û›Â˜. ∂Ê·ÚÌÔÛÌ¤ÓË ∫ÏÈÓÈÎ‹ ªÈÎÚÔ‚ÈÔÏÔÁ›· Î·È ∂ÚÁ·ÛÙËÚÈ·Î‹

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33.æ˘ÏÏ¿ÎË-ª˘ÎÔÓÈÔ‡ Ã. ∂È‰ËÌÈÔÏÔÁ›· - ÚﬁÏË„Ë ‚ÚÔ˘Î¤ÏÏˆÛË˜. ∂Ê·ÚÌÔÛÌ¤ÓË ∫ÏÈÓÈÎ‹ ªÈÎÚÔ‚ÈÔÏÔÁ›· Î·È ∂ÚÁ·ÛÙËÚÈ·Î‹ ¢È·ÁÓˆÛÙÈÎ‹ 1998; ÂÚ›Ô‰Ô˜ µ’(3):154-158.

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68.°·Ï·Ó¿ÎË˜ ∂, ªÔ˘Ú¿ÓÙ·˜ ∫§, ∫ÂÊ·ÏÏËÓÔ‡ ∞, ∫·ÎÔÛ›ÌÔ˜ °, §··ÙÛ¿ÓË˜ ¶¢. ∞ÈÌ·ÙÔÏÔÁÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ ÙË˜ ‚ÚÔ˘Î¤ÏÏˆÛË˜ ÙˆÓ ·È‰ÈÒÓ. ¶·È‰È·ÙÚÈÎ‹ µÔÚÂ›Ô˘ ∂ÏÏ¿‰Ô˜ 1994;6:146-151.

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71.∆ÛÈÚÒÓË ª, ∞Ó‰ÚÈfiÔ˘ÏÔ˜ ¶, ∫·ÏÎ¿ÓË ª, µÔ˘Ó¿ÛË˜ ∞, ¡ÙÔÚÔ‚›ÙÛ· Ã, ¢ÈÔÓ˘ÛÔÔ‡ÏÔ˘ ª, ¶ÂÚÈ‰›ÎË ª. ∞fiÛÙËÌ· Ì·ÛÙÔ‡ ÔÊÂÈÏfiÌÂÓÔ ÛÂ Brucella melitensis. ¶Ú·ÎÙÈÎ¿ 29Ô˘ ¶·ÓÂÏÏ‹ÓÈÔ˘ π·ÙÚÈÎÔ‡ ™˘ÓÂ‰Ú›Ô˘; 2003, ª¿ÈÔ˜ 20-24; ∞ı‹Ó·: π·ÙÚÈÎ‹ ∂Ù·ÈÚÂ›· ∞ıËÓÒÓ; 2003:169.

∆˘ÚÔÛÈÓ·ÈÌ›· Ù‡Ô˘ π: ·ÛıÂÓ‹˜ ÌÂ ¤ÓÙÂ ¯ÚﬁÓÈ·

·ÔÙÂÏÂÛÌ·ÙÈÎ‹˜

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ÚÔÛ‚¿ÏÏÂÈ Î˘Ú›ˆ˜ ÙÔ ‹·Ú (ÔÍÂ›· Ë·ÙÈÎ‹ ·ÓÂ¿ÚÎÂÈ· ·ﬁ ‚ÚÂÊÈÎ‹ ËÏÈÎ›·, ÂÍÂÏÈÛÛﬁÌÂÓË Ë·-

ÙÈÎ‹ Î›ÚÚˆÛË, Ë·ÙÔÎ˘ÙÙ·ÚÈÎﬁ Î·ÚÎ›ÓÔ), ÙÔ˘˜ ÓÂÊÚÔ‡˜ (Û‡Ó‰ÚÔÌÔ Fanconi) Î·È Ù· ÂÚÈÊÂÚÈÎ¿

ÓÂ‡Ú· (ÎÚ›ÛÂÈ˜ ÂÚÈÊÂÚÈÎ‹˜ ÓÂ˘ÚÔ¿ıÂÈ·˜ Ù‡Ô˘ ÔÚÊ˘Ú›·˜). ¶·ıÔÁÓˆÌÔÓÈÎ‹ ÁÈ· ÙËÓ ¿ıËÛË Â›Ó·È Ë ·ÚÔ˘Û›· ÛÔ˘ÎÈÓ˘Ï·ÎÂÙﬁÓË˜ ÛÙÔ Ï¿ÛÌ· ‹ ÛÙ· Ô‡Ú·. ∏ Ë·ÙÔÓÂÊÚÈÎ‹ Ù˘ÚÔÛÈÓ·ÈÌ›· Â›Ó·È ÙÔ

ÎÏËÚÔÓÔÌÈÎfi ÌÂÙ·‚ÔÏÈÎfi ÓfiÛËÌ· ÌÂ ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi Ë·ÙÔÎ˘ÙÙ·ÚÈÎÔ‡ Î·ÚÎ›ÓÔ˘ Î·È Ì¤-

¯ÚÈ ÚfiÙÈÓÔ˜, Ë ÌfiÓË ıÂÚ·Â˘ÙÈÎ‹ ·ÓÙÈÌÂÙÒÈÛË ‹Ù·Ó Ë ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜ Î·È Ë ÌÂÈˆÌ¤ÓË ‰È·ÈÙËÙÈÎ‹ ÚfiÛÏË„Ë Ê·ÈÓ˘Ï·Ï·Ó›ÓË˜ Î·È Ù˘ÚÔÛ›ÓË˜. ∏ ÂÊ·ÚÌÔÁ‹ ÙË˜ ıÂÚ·Â›·˜ ÌÂ NTBC [2-(2nitro 4 -trifluoromethylbenzoyl)-1,3-cyclohexanedione] ÛÂ ·ÛıÂÓÂ›˜ ÌÂ Ù˘ÚÔÛÈÓ·ÈÌ›· Ù‡Ô˘ 1 ¤¯ÂÈ ·˘Í‹ÛÂÈ ıÂ·Ì·ÙÈÎ¿ ÙÔ ÔÛÔÛÙfi ÂÈ‚›ˆÛË˜ ÌÂ

ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÌÂÙ·ÌÔÛ¯Â‡ÛÂˆÓ ‹·ÙÔ˜, ÒÛÙÂ Û‹ÌÂÚ· Ó· ÂÓÙ¿ÛÛÂÙ·È

ÁÚ·ÌÌ‹˜ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ÓﬁÛÔ˘. ¶ÂÚÈÁÚ¿ÊÂÙ·È ŒÏÏËÓ·˜ ·ÛıÂÓ‹˜ ÌÂ Ù˘ÚÔÛÈÓ·ÈÌ›· Ù‡Ô˘ π Ô˘ ‰È·ÁÓÒÛÙËÎÂ ÛÂ ËÏÈÎ›· 5 ÌËÓÒÓ Î·È ÛÙÔÓ ÔÔ›Ô ¯ÔÚËÁ‹ıËÎÂ NTBC, ·Ú¿ÏÏËÏ· ÌÂ ÙËÓ ÂÈ‰ÈÎ‹ ‰È·ÈÙËÙÈÎ‹ ·ÁˆÁ‹. ª›· Â‚‰ÔÌ¿-

ÙËÓ ¤Ó·ÚÍË ÙË˜ ıÂÚ·Â›·˜, ÙÔ ‚Ú¤ÊÔ˜ ·ÚÔ˘Û›·ÛÂ ÂÓÙ˘ˆÛÈ·Î‹ ÎÏÈÓÈÎ‹ ‚ÂÏÙ›ˆÛË Î·È ÔÈ

‚ÈÔ¯ËÌÈÎÔ› ·Ú¿ÌÂÙÚÔÈ ÙË˜ Ë·ÙÈÎ‹˜ ÙÔ˘ ÏÂÈÙÔ˘ÚÁ›·˜ Â·Ó‹Ïı·Ó ÛÙ· Ê˘ÛÈÔÏÔÁÈÎ¿ ﬁÚÈ·. ™‹ÌÂÚ·,

¤ÓÙÂ ¯ÚfiÓÈ· ·fi ÙËÓ ¤Ó·ÚÍË ÙË˜ ·ÁˆÁ‹˜ ÌÂ NTBC, Ô ·ÛıÂÓ‹˜ ‚Ú›ÛÎÂÙ·È ÛÂ ¿ÚÈÛÙË ÁÂÓÈÎ‹ Î·Ù¿ÛÙ·ÛË Î·È ·' fi,ÙÈ ÁÓˆÚ›˙Ô˘ÌÂ, ·ÔÙÂÏÂ› ÙËÓ ÚÒÙË ÂÚ›ÙˆÛË Ù˘ÚÔÛÈÓ·ÈÌ›·˜ Ù‡Ô˘ π ÛÙËÓ ∂ÏÏ¿‰· Ô˘ ·ÓÙÈÌÂÙˆ›˙ÂÙ·È ÌÂ NTBC.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ∆˘ÚÔÛÈÓ·ÈÌ›· Ù‡Ô˘ π, Ë·ÙÔÓÂÊÚÈÎ‹ Ù˘ÚÔÛÈÓ·ÈÌ›·, ıÂÚ·Â›·, NTBC.

Five years effective therapy of a patient with tyrosinaemia type I without transplantation

P. Augoustides - Savvopoulou1, S. Karyda - Kavalioti1, E. Hatzipantelis1, ∂. Zafeiriadou2, K. Fotiadou3 , N. Kozeis4, K. Patsiaoura5, S. Moussiou1, E. Holme6, K. Malaka - Zafeiriou1, F. Kanakoudi - Tsakalidou1

Abstract: Tyrosinaemia type I or hepatorenal tyrosinaemia (OMIM 276700) is a rare autosomal recessive inborn error of tyrosine metabolism caused by deficiency of fumarylacetoacetate hydrolase (FAH) and involving mainly the liver (acute liver failure in infancy, cirrhosis, hepatocellular carcinoma), kidneys (renal Fanconi syndrome) and peripheral nerves (porphyria-like crises). The presence of succinylacetone in plasma or urine is diagnostic for this disorder. Tyrosinaemia type I is the inborn error of metabolism with the highest incidence of hepatocellular carcinoma and till relatively recently, the only treatment for this disorder was liver transplantation in combination with dietary restriction of phenylalanine and tyrosine. Treatment with NTBC (2-(2-nitro-4trifluoromethylbenzoyl)-1,3-cyclohexanedione) has greatly increased survival and has reduced the need for liver transplantation during early childhood establishing NTBC as first-line treatment for patients with tyrosinemia type I. We present a Greek boy with hepatorenal tyrosinaemia who was diagnosed at the age of 5 months and immediately started on a regimen of NTBC in parallel with the dietary therapy indicated in this disorder. Significant clinical improvement with normalization of liver function tests was apparent after one week of treatment. Currently, after five years treatment

Gothenburg, Sweden

49 T.K. 546 42, £ÂÛÛ·ÏÔÓ›ÎË ∂-mail: persefon@med.auth.gr ∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 21-03-2005 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛË˜: 28-11-2005

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

2 Laboratory of Radiology, “Ippokration” General Hospital Thessaloniki

3 Department of Nutrition, “Ippokration” General Hospital Thessaloniki

4 Department of Ophtalmology, “Ippokration” General Hospital Thessaloniki

5 Laboratory of Pathology, “Ippokration” General Hospital Thessaloniki

6 Dept. of Clinical Chemistry, Sahlgrenska University Hospital, Gothenburg, Sweden

Correspondence: P. Augoustides-Savvopoulou Biochemistry-Metabolism Laboratory

1st Paediatric Clinic of Aristotle University “Ippokration” General Hospital Thessaloniki 49, Konstantinoupoleos Str., 546 42, Thessaloniki

∂-mail: persefon@med.auth.gr

Date of submission: 21-03-2005

Date of approval: 28-11-2005

2006;69:45-51

with NTBC, the patient is in excellent clinical condition. As far as we are aware, he is the first tyrosinaemia type I patient on a therapeutic regimen of NTBC in Greece.

Key words: ∆yrosinaemia type I, therapy, NTBC, hepato-renal. ∂ÈÛ·ÁˆÁ‹

(√ªπª 276700) Â›Ó·È Û¿ÓÈÔ (1:100.000-120.000 ÁÂÓÓ‹ÛÂÈ˜) ˘ÔÏÂÈfiÌÂÓÔ ·˘ÙÔÛˆÌ·ÙÈÎfi ÓfiÛËÌ· ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙË˜

Ù˘ÚÔÛ›ÓË˜ Ô˘ ÔÊÂ›ÏÂÙ·È ÛÙËÓ ·ÓÂ¿ÚÎÂÈ· ˘‰ÚÔÏ¿ÛË˜ ÙÔ˘ ÊÔ˘Ì·Ú˘Ï·ÎÂÙÔÍÂÈÎÔ‡ ÔÍ¤Ô˜ (fumarylacetate hydrolase-FAH), ¤Ó˙˘ÌÔ Ô˘ Îˆ‰ÈÎÔÔÈÂ›Ù·È ·ﬁ ÁÔÓ›‰ÈÔ Ô˘ ‚Ú›ÛÎÂÙ·È ÛÙÔ

¯ÚˆÌﬁÛˆÌ· 15q23-q25 (1). ¶ÚÔÛ‚¿ÏÏÔÓÙ·È

Î˘Ú›ˆ˜ ÙÔ ‹·Ú (ÂÍÂÏÈÛÛfiÌÂÓË Ë·ÙÈÎ‹ ·ÓÂ¿ÚÎÂÈ·, Î›ÚÚˆÛË, Ë·ÙÔÎ˘ÙÙ·ÚÈÎfi Î·ÚÎ›ÓÔ), ÔÈ ÓÂÊÚÔ› (ÓÂÊÚÈÎ‹ ÛˆÏËÓ·ÚÈ·Î‹ ‚Ï¿‚Ë, ˘ÔÊˆÛÊ·Ù·ÈÌÈÎ‹ Ú·¯›ÙÈ‰·) Î·È Ù· ÂÚÈÊÂÚÈÎ¿ ÓÂ‡Ú· (ÓÂ˘ÚÔÏÔÁÈÎfi Û‡Ó‰ÚÔÌÔ

Ú›·˜). ∞fi Ù· ÎÏËÚÔÓÔÌÈÎ¿ ÌÂÙ·‚ÔÏÈÎ¿ ÓÔÛ‹Ì·Ù·, Ë Ë·ÙÔÓÂÊÚÈÎ‹ Ù˘ÚÔÛÈÓ·ÈÌ›· ·ÚÔ˘ÛÈ¿˙ÂÈ ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ÂÌÊ¿ÓÈÛË˜ Ë·ÙÔÎ˘ÙÙ·ÚÈÎÔ‡ Î·ÚÎ›ÓÔ˘. ª¤¯ÚÈ ÙÔ 1980, Ë ÌfiÓË

·ÓÙÈÌÂÙÒÈÛË ÙË˜ Ù˘ÚÔÛÈÓ·ÈÌ›·˜ π ‹Ù·Ó Ë ÌÂÈˆÌ¤ÓË ‰È·ÈÙËÙÈÎ‹ ÚfiÛÏË„Ë Ê·ÈÓ˘Ï·Ï·Ó›ÓË˜ Î·È Ù˘ÚÔÛ›ÓË˜ Î·È ÌÂÙ¿ ·fi ÙÔ 1980, ÚÔÛÙ¤ıËÎÂ Ë ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜ (1-5). ∂·Ó¿ÛÙ·ÛË ÛÙË ıÂÚ·Â›· ÙË˜ ÓfiÛÔ˘ ·ÔÙ¤ÏÂÛÂ Ë ·Ó·Î¿Ï˘„Ë ÙË˜ ‰Ú¿ÛË˜ ÌÈ·˜ ÙÚÈÎÂÙfiÓË˜, ÙÔ˘ NTBC (2-(2-nitro 4 -trifluoromethylbenzoyl)1,3-cyclohexanedione) ÛÙÔ ÌÂÙ·‚ÔÏÈÎfi ÌÔÓÔ¿ÙÈ ÙË˜ Ù˘ÚÔÛ›ÓË˜ (∂ÈÎfiÓ· 1) (1,2,5-9). ∏ ™Ô˘Ë‰ÈÎ‹ ÂÚÂ˘ÓËÙÈÎ‹ ÔÌ¿‰· ÙˆÓ Lindstedt Î·È Û˘Ó (ÔÌ¿‰· ÙÔ˘ Gothenburg), ‹Ù·Ó ÔÈ ÚÒÙÔÈ Ô˘ ·Ú·Ù‹ÚËÛ·Ó ÙÈ˜ ıÂÚ·Â˘ÙÈÎ¤˜ È‰ÈfiÙËÙÂ˜ ÙÔ˘ NTBC ÛÂ ·ÛıÂÓÂ›˜ ÌÂ Ë·ÙÔÓÂÊÚÈÎ‹ Ù˘ÚÔÛÈÓ·ÈÌ›· ÙÔ 1991 (8). ¶ÂÚÈÁÚ¿ÊÂÙ·È ŒÏÏËÓ·˜ ·ÛıÂÓ‹˜ ÌÂ Ù˘ÚÔÛÈÓ·ÈÌ›· π, Ô ÔÔ›Ô˜ Â‰Ò Î·È ¤ÓÙÂ ¯ÚfiÓÈ·, ·ÓÙÈÌÂÙˆ›˙ÂÙ·È ÂÈÙ˘¯Ò˜ ÌÂ NTBC. ∞' fi,ÙÈ ÁÓˆÚ›˙Ô˘ÌÂ, Â›Ó·È Ô ÚÒÙÔ˜ ·ÛıÂÓ‹˜ ÌÂ Ë·ÙÔÓÂÊÚÈÎ‹ Ù˘ÚÔÛÈÓ·ÈÌ›· ÛÙËÓ ∂ÏÏ¿‰· Ô˘ ·ÓÙÈÌÂÙˆ›˙ÂÙ·È ÌÂ NTBC.

4-˘‰ÚÔÍ˘Ê·ÈÓ˘ÏÔÁ·Ï·ÎÙÈÎﬁ ÔÍ‡

4-˘‰ÚÔÍ˘Ê·ÈÓ˘ÏÔ˘ÚÔ˘‚ÈÎﬁ ÔÍ‡ ·Ó·ÛÙÔÏ‹ ·ﬁ NTBC

ÔÌÔÁÂÓÙÈÛÈÎfi ÔÍ‡ ÛÔ˘ÎÈÓ˘ÏÔ·ÎÂÙÔÍÂÈÎfi ÔÍ‡ Ì·ÏÂ¸ÏÔ·ÎÂÙÔÍÂÈÎfi ÔÍ‡ ∆ÔÍÈÎÔ› ÌÂÙ·‚ÔÏ›ÙÂ˜ ∆˘ÚÔÛÈÓ·ÈÌ›· Ù‡Ô˘

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛË˜

¶ÚﬁÎÂÈÙ·È ÁÈ· ·ÁﬁÚÈ ËÏÈÎ›·˜ 5 ÌËÓÒÓ, Ô˘

ÂÈÛ‹ÏıÂ ÛÙËÓ ÎÏÈÓÈÎ‹ Ì·˜ ÏﬁÁˆ ÂÎÛÂÛËÌ·ÛÌ¤ÓË˜ Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›·˜, ‰˘ÛÙÚÔÊ›·˜ Î·È

·ÈÌÔÚÚ·ÁÈÎ‹˜ ‰È¿ıÂÛË˜. ∂›Ó·È ÙÔ 2Ô ·È‰› Ê·È-

ÓÔÙ˘ÈÎ¿ ˘ÁÈÒÓ ÁÔÓ¤ˆÓ ÌÂ Û˘ÁÁ¤ÓÂÈ· 4Ô˘ ‚·ı-

ÌÔ‡. ∆Ô Ì·ÈÂ˘ÙÈÎfi Î·È ÂÚÈÁÂÓÓËÙÈÎfi ÈÛÙÔÚÈÎfi

ÙÔ˘ ·ÛıÂÓÔ‡˜ ‹Ù·Ó ÂÏÂ‡ıÂÚ·. ∞ﬁ ÙÔ ·ÙÔÌÈÎﬁ

ÈÛÙÔÚÈÎﬁ ·Ó·Ê¤ÚÂÙ·È ·ÈÌÔÚÚ·Á›· ·ﬁ ÙÔ ÔÌÊ·-

ÏÈÎﬁ ÎÔÏﬁ‚ˆÌ· ÙË 10Ë ËÌ¤Ú· ˙ˆ‹˜, Ô˘ ·ÓÙÈ-

ÌÂÙˆ›ÛÙËÎÂ ÌÂ ÂÓ‰ÔÌ˘˚Î‹ ¯ÔÚ‹ÁËÛË ‚ÈÙ·Ì›-

ÓË˜ K. ∞ﬁ ÙÔÓ 3Ô Ì‹Ó· ˙ˆ‹˜ ·Ú·ÙËÚ‹ıËÎÂ

˘ÔÏÂÈﬁÌÂÓË ÛˆÌ·ÙÈÎ‹ ·Ó¿Ù˘ÍË. ªÂ Èı·Ó‹ ‰È¿ÁÓˆÛË “·ÏÏÂÚÁ›· ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜”

¯ÔÚËÁ‹ıËÎÂ ˘Ô·ÏÏÂÚÁÈÎﬁ Á¿Ï·. ∆ÔÓ 4Ô Ì‹Ó·

˙ˆ‹˜, ÛÙËÓ ÎÏÈÓÈÎ‹ ÂÈÎﬁÓ· ÚÔÛÙ¤ıËÎ·Ó ‚ÏÂÓ-

ÓÔ·ÈÌ·ÙËÚ¤˜ ÎÂÓÒÛÂÈ˜. ∞ÎÔÏÔ‡ıËÛÂ ·ÏÏ·Á‹

ÙË˜ ‰È·ÙÚÔÊ‹˜ ÛÂ Á¿Ï· Ï‹ÚÔ˘˜ ˘‰ÚﬁÏ˘ÛË˜

ÙˆÓ ÚˆÙÂ˚ÓÒÓ ¯ˆÚ›˜ Î·Ì›· ‚ÂÏÙ›ˆÛË. ∫·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ÛÙËÓ ∫ÏÈÓÈÎ‹ Ì·˜, ¯·Ú·ÎÙËÚÈÛÙÈÎ‹ ‹Ù·Ó Ë ¤ÓÙÔÓË ‰˘ÛÙÚÔÊ›· (‚¿ÚÔ˜, Ì‹ÎÔ˜ Î·È ÂÚ›ÌÂÙÚÔ˜ ÎÂÊ·Ï‹˜ <3Ë ÂÎ·ÙÔÛÙÈ·›·

ı¤ÛË) ÂÓÒ ‰È·ÈÛÙÒıËÎÂ ˆ¯ÚfiÙËÙ·, ÛÙÔÌ·Ù›ÙÈ‰· Î·È ·Ú¿ÙÚÈÌÌ·. ∏ ÎÔÈÏÈ¿ ‹Ù·Ó ÌÂÙÂˆÚÈÛÌ¤ÓË, ÌÂ „ËÏ·ÊËÙfi ÛÎÏËÚfi ‹·Ú Î·È ÛÏ‹Ó· 8 Î·È 5 cm Î¿Ùˆ ·fi Ù· ÏÂ˘ÚÈÎ¿ ÙfiÍ· ·ÓÙ›ÛÙÔÈ¯·. ∏ ÂÍ¤Ù·ÛË ÙˆÓ ˘ÔÏÔ›ˆÓ Û˘ÛÙËÌ¿-

ÙˆÓ Î·ıÒ˜ Î·È Ë ÓÂ˘ÚÔÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË ‹Ù·Ó

¯ˆÚ›˜ ·ıÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù·. ∞ﬁ ÙÔÓ ÚÒÙÔ

ÂÚÁ·ÛÙËÚÈ·Îﬁ ¤ÏÂÁ¯Ô ‰È·ÈÛÙÒıËÎ·Ó ıÚÔÌ‚Ô-

ÂÓ›·, ·Ó·ÈÌ›·, ˘ÔÁÏ˘Î·ÈÌ›·, ÌÈÎÚ‹ ·‡ÍËÛË

ÙˆÓ ÙÚ·ÓÛ·ÌÈÓ·ÛÒÓ Î·È ÙË˜ ¯ÔÏÂÚ˘ı˘Ú›ÓË˜, Ì¤ÙÚÈ· ·‡ÍËÛË ÙË˜ ·ÏÎ·ÏÈÎ‹˜ ÊˆÛÊ·Ù¿ÛË˜, ¯·ÌËÏ¿ Â›Â‰· ÊˆÛÊÒÚÔ˘, ÛËÌ·ÓÙÈÎ‹ ·Ú¿Ù·ÛË ÙÔ˘ ¯ÚfiÓÔ˘ ÚÔıÚÔÌ‚›ÓË˜ Î·È ÙË˜ ÌÂÚÈÎ‹˜ ıÚÔÌ‚ÔÏ·ÛÙ›ÓË˜ Î·È ÔÏ‡ ˘„ËÏ¿ Â›Â‰· ·-ÊÂÙÔÚˆÙÂ˝ÓË˜ ÔÚÔ‡ (¶›Ó·Î·˜ 1). ∞fi ÙÔÓ ·ÂÈÎÔÓÈÛÙÈÎfi ¤ÏÂÁ¯Ô, ÙÔ ˘ÂÚË¯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜ ¤‰ÂÈÍÂ ·‡ÍËÛË ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙÔ˘

‹·ÙÔ˜ ÌÂ ·‰Ú‹ Ë¯Ô‰ÔÌ‹, ·‡ÍËÛË ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙÔ˘ ÛÏËÓﬁ˜ ÌÂ ÔÌÔÈÔÁÂÓ‹ Ë¯Ô‰ÔÌ‹ Î·È ·‡ÍËÛË ÙÔ˘ ÌÂÁ¤ıÔ˘˜ Î·È ÙˆÓ ‰‡Ô ÓÂÊÚÒÓ ÌÂ ·˘ÍËÌ¤ÓË Ë¯ÔÁ¤ÓÂÈ·. ∏ ·ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›· (CT) ÎÔÈÏ›·˜ ¤‰ÂÈÍÂ ÔÏ˘Ô˙Ò‰Ë ·ÂÈÎﬁÓÈÛË ÙÔ˘ ‹·ÙÔ˜, ÛÏËÓÔÌÂÁ·Ï›·, ·‡ÍËÛË ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙˆÓ ÓÂÊÚÒÓ Î·È ·Ô˘Û›· ÏÂÌÊ·‰¤ÓˆÓ, ÂÓÒ ÛÙË Ì·ÁÓËÙÈÎ‹ ÙÔÌÔÁÚ·Ê›· (MRI) ÎÔÈÏ›·˜

‰È·ÈÛÙÒıËÎÂ ÂÈÎﬁÓ· Î›ÚÚˆÛË˜ ‹·ÙÔ˜ ÌÂ

ÔÏÏ·ÏÔ‡˜ ·Ó·ÁÂÓÓËÙÈÎÔ‡˜ fi˙Ô˘˜ ÂÓÙfi˜ ·˘ÙÔ‡, ¯ˆÚ›˜ ÛÙÔÈ¯Â›· Ë·ÙÔÎ˘ÙÙ·ÚÈÎÔ‡ Î·ÚÎ›ÓÔ˘ (∂ÈÎfiÓÂ˜ 2· Î·È 2‚). ∏ ÈÛÙÔÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË ‚ÈÔ„›·˜ ‹·ÙÔ˜ ÂÈ‚Â‚·›ˆÛÂ ÙË ‰È¿ÁÓˆÛË ÙË˜

¶›Ó·Î·˜ 1. ∞ÔÙÂÏ¤ÛÌ·Ù· ·Ú¯ÈÎÔ‡ ÂÚÁ·ÛÙËÚÈ·ÎÔ‡ ÂÏ¤Á¯Ô˘

∞›Ì·

∞ÈÌÔÛÊ·ÈÚ›ÓË (g/dl, Ê.Ù.: 9,5-11 )9,8

∞ÈÌÔÂÙ¿ÏÈ· (k/ml, Ê.Ù.: 150-300)83

ƒ∆ (sec)17,7/12

PTT (sec)74.4/36

∞ÏÎ. ÊˆÛÊ·Ù¿ÛË 1677

(U/L, Ê.Ù.: 1-3 x ÂÓËÏ›ÎˆÓ)

SGOT (U/L, Ê.Ù.: 20-40)152

SGPT (U/L, Ê.Ù.: 20-40)80

ÃÔÏÂÚ˘ıÚ›ÓË ÔÏ.

(mg/dl, Ê.Ù.: 0,1-0,5)2,2 (Ìmol/L, Ê.Ù.: 1,71-8,55)37,62

ÁGT (mU/L, Ê.Ù.: 6-26)199

ºˆÛÊﬁÚÔ˜ (mg/dl, Ê.Ù.: 3,5-5,5)2,1 (Ìmol/L, Ê.Ù.: 1,71-8,55)1,03

·-ÊÂÙÔÚˆÙÂ˝ÓË (ng/ml, Ê.Ù. <12)151000

∆˘ÚÔÛ›ÓË (Ìmol/L, Ê.Ù.: 50-130)354 (mg/dl, Ê.Ù.: 0,90-2,35)6,41

ªÂıÂÈÔÓ›ÓË

(Ìmol/L, Ê.Ù.: 20-50)220 (mg/dl, Ê.Ù.: 0,45-0,95)3,28

º·ÈÓ˘Ï·Ï·Ó›ÓË

(Ìmol/L, Ê.Ù.: 40-120)

193 (mg/dl, Ê.Ù.: 0,07- 0,20)0,318

Î›ÚÚˆÛË˜ (∂ÈÎfiÓ· 3). ¶·Ú¿ÏÏËÏ· ÌÂ ÙÔÓ ·ÂÈÎÔÓÈÛÙÈÎfi ¤ÏÂÁ¯Ô, ¤ÁÈÓÂ ÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜

ÁÈ· CMV, EBV, HBV, HAV, HCV Î·È ÙÔÍÔÏ¿ÛÌˆÛË ÌÂ ·ÚÓËÙÈÎ¿ ·ÔÙÂÏ¤ÛÌ·Ù· Î·È ¤ÏÂÁ¯Ô˜

ÁÈ· ÎÏËÚÔÓÔÌÈÎ¿ ÌÂÙ·‚ÔÏÈÎ¿ ÓÔÛ‹Ì·Ù·. √ ÔÛÔÙÈÎfi˜ ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ ·ÌÈÓÔÍ¤ˆÓ ÛÙÔ Ï¿ÛÌ· ¤‰ÂÈÍÂ ˘„ËÏ¿ Â›Â‰· Ù˘ÚÔÛ›ÓË˜, ÌÂıÂÈÔÓ›ÓË˜, Ê·ÈÓ˘Ï·Ï·Ó›ÓË˜, ÂÓ‰ÂÈÎÙÈÎ¿ ÙË˜ ‚·Ú‡ÙËÙ·˜ ÙË˜ Ë·ÙÈÎ‹˜ ·ÓÂ¿ÚÎÂÈ·˜, Î·È ÂÎÛÂÛËÌ·ÛÌ¤ÓË ÁÂÓÈÎÂ˘Ì¤ÓË ·ÌÈÓÔÍÔ˘Ú›· Ô˘ Û˘ÓËÁÔÚÔ‡ÛÂ ÁÈ· Û‡Ó‰ÚÔÌÔ Fanconi. √ ¤ÏÂÁ¯Ô˜ ÙË˜ ÓÂÊÚÈÎ‹˜ ÛˆÏËÓ·ÚÈ·Î‹˜ ÏÂÈÙÔ˘ÚÁ›·˜ ¤‰ÂÈÍÂ Î¿ı·ÚÛË ÎÚÂ·ÙÈÓ›ÓË˜ ÛÙ· Ê˘ÛÈÔÏÔÁÈÎ¿ fiÚÈ·, ÂÓÒ ‰ÂÓ ‰È·ÈÛÙÒıËÎÂ ·Û‚ÂÛÙÈÔ˘Ú›· ‹ ÊˆÛÊ·ÙÔ˘Ú›· ‹ ÁÏ˘ÎÔ˙Ô˘Ú›·.

ÛÂ Û˘Ó‰˘·ÛÌﬁ

Ë ·‡ÍËÛË ÙÔ˘ ‰-·ÌÈÓÔÏÂ‚Ô˘ÏÈÓÈÎÔ‡ ÔÍ¤Ô˜ ÛÙ· Ô‡Ú· Î·È Ë ·˘ÍËÌ¤ÓË Û˘ÁÎ¤ÓÙÚˆÛË ÛÔ˘ÎÈÓ˘Ï·ÎÂÙﬁ-

∂ÈÎfiÓ· 2. ∞ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ Î·Ù¿ ÙË ‰È¿ÁÓˆÛË, fiÔ˘ Ê·›ÓÂÙ·È Ë ÔÏ˘Ô˙Ò‰Ë˜ ˘Ê‹ ÙÔ˘ ‹·ÙÔ˜ ÛÂ ·ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›· 2·) Î·È ÛÂ Ì·ÁÓËÙÈÎ‹ ÙÔÌÔÁÚ·Ê›· (MRI - gradient echo) 2‚)

(¶›Ó·Î·˜ 2). √ ¤ÏÂÁ¯Ô˜ ÙÔ˘ DNA ÙÔ˘ ·ÛıÂÓ‹ ·ÂÎ¿Ï˘„Â ÔÌÔ˙˘ÁˆÙ›· ÁÈ· ÙËÓ ÌÂÙ¿ÏÏ·ÍË

Met 1 Val ÛÙÔ ÚÒÙÔ ÂÍﬁÓÈÔ ÙÔ˘ ÁÔÓÈ‰›Ô˘ Ô˘ Îˆ‰ÈÎÔÔÈÂ› ÙÔ ¤Ó˙˘ÌÔ FAH. ™ÙÔÓ ˘ﬁÏÔÈÔ

ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô Ô˘ ·ÎÔÏÔ‡ıËÛÂ, ÔÈ Ù·¯‡ÙËÙÂ˜ ·ÁˆÁÈÌfiÙËÙ·˜ ÓÂ‡ÚˆÓ ¤‰ÂÈÍ·Ó Â˘Ú‹Ì·Ù· ‹È·˜ ÂÚÈÊÂÚÈÎ‹˜ ÓÂ˘ÚÔ¿ıÂÈ·˜, ÂÓÒ Ê˘ÛÈÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù· ¤‰ÂÈÍ·Ó Ë ‚˘ıÔÛÎfiËÛË, Ë ÔÊı·ÏÌÔÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË ÌÂ Û¯ÈÛÌÔÂÈ‰‹ Ï˘¯Ó›·, ÙÔ ˘ÂÚË¯ÔÁÚ¿ÊËÌ· Î·Ú‰È¿˜ Î·È Ë ·ÎÙÈÓÔÁÚ·Ê›· Ì·ÎÚÒÓ ÔÛÙÒÓ. ªÂÙ¿ ÙË ‰È¿ÁÓˆÛË ÙË˜ ÓfiÛÔ˘, Ô ·ÛıÂÓ‹˜ Ù¤ıËÎÂ ÛÂ ÂÈ‰ÈÎ‹ ‰›·ÈÙ· ÂÚÈÔÚÈÛÌ¤ÓË˜ ÂÚÈÂÎÙÈÎfiÙËÙ·˜ ÛÂ ÚˆÙÂ˝ÓË, Ù˘ÚÔÛ›ÓË Î·È Ê·ÈÓ˘Ï·Ï·Ó›ÓË. ∆·˘Ùfi¯ÚÔÓ· ÍÂÎ›ÓËÛÂ ·ÁˆÁ‹ ÌÂ NTBC ·fi ÙÔ ÛÙfiÌ·, 1 mg/kg/24ˆÚÔ ÛÂ ‰‡Ô ‰fiÛÂÈ˜, Û‡ÌÊˆÓ· ÌÂ ÙÔ ÚˆÙfiÎÔÏÏÔ ÙË˜ ™Ô˘Ë‰ÈÎ‹˜ ÔÌ¿‰·˜. ∏ ·¿ÓÙËÛË ÛÙË ıÂÚ·Â›· ÌÂ NTBC ‹Ù·Ó ÂÓÙ˘ˆÛÈ·Î‹. ª›· Â‚‰ÔÌ¿‰· ·fi ÙËÓ ¤Ó·ÚÍË ÙË˜ ·ÁˆÁ‹˜, ·Ú·ÙËÚ‹ıËÎÂ ÛËÌ·ÓÙÈÎ‹

¤ÏÂÁ¯Ô Â›¯·Ó ‚ÂÏÙÈˆıÂ› ÂÓÙ˘ˆÛÈ·Î¿ (¶›Ó·Î·˜ 2). π‰È·›ÙÂÚË ÂÓÙ‡ˆÛË ¤Î·ÓÂ Ë ÌÂÁ¿ÏË ÙÒÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙË˜ ·-ÊÂÙÔÚˆÙÂ˝ÓË˜. ŒÍÈ Ì‹ÓÂ˜ ·fi ÙËÓ ¤Ó·ÚÍË ÙË˜ ıÂÚ·Â›·˜, Ô ·ÛıÂÓ‹˜ ‹Ù·Ó ÛÂ Î·Ï‹ ÁÂÓÈÎ‹ Î·Ù¿ÛÙ·ÛË, Ë ÛˆÌ·ÙÈÎ‹ Î·È „˘¯ÔÎÈÓËÙÈÎ‹ ÙÔ˘ ·Ó¿Ù˘ÍË ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ‹ (‚¿ÚÔ˜, Ì‹ÎÔ˜, ÂÚ›ÌÂÙÚÔ˜ ÎÂÊ·Ï‹˜ ÛÙËÓ 50Ë ÂÎ·ÙÔÛÙÈ·›· ı¤ÛË), ÂÓÒ ÙÔ „ËÏ·ÊËÙfi Ì¤ÁÂıÔ˜ ÙÔ˘ ‹·ÙÔ˜ ÌÂÈÒıËÎÂ ÛÙ· 4 cm Î¿Ùˆ ·fi ÙÔ ÏÂ˘ÚÈÎfi ÙfiÍÔ. √ ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙÔ˘ ‹·ÙÔ˜ Î·È Ë ‚ÈÔ„›· ‹·ÙÔ˜ Ô˘ ¤ÁÈÓ·Ó ÙËÓ ›‰È· ¯ÚÔÓÈÎ‹ ÂÚ›Ô‰Ô, ¤‰ÂÈÍ·Ó ·Ú·ÌÔÓ‹ ÙˆÓ ·ÏÏÔÈÒÛÂˆÓ ·ÏÏ¿ ¯ˆÚ›˜ ÛËÌÂ›· Î·ÎÔ‹ıÂÈ·˜. ™‹ÌÂÚ·, ¤ÓÙÂ ¯ÚfiÓÈ· ·fi ÙË ‰È¿ÁÓˆÛË Î·È ÙËÓ ¤Ó·ÚÍË ÙË˜ ıÂÚ·Â›·˜, Ô ·ÛıÂÓ‹˜ Û˘ÓÂ¯›˙ÂÈ ÙËÓ ›‰È· ·ÁˆÁ‹, Ë ÁÂÓÈÎ‹ ÙÔ˘ Î·Ù¿ÛÙ·ÛË ·Ú·Ì¤ÓÂÈ ¿ÚÈÛÙË, Ë ÛˆÌ·ÙÈÎ‹ ·Ó¿Ù˘ÍË Î·È Ô ·Ó·Ù˘ÍÈÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ Â›Ó·È Ê˘ÛÈÔÏÔÁÈÎ¿ Î·È ÙÔ ‹·Ú Û¯Â‰fiÓ ·„ËÏ¿ÊËÙÔ (1 cm). ™ÙÔÓ ¶›Ó·Î· 2 Ê·›ÓÂÙ·È Ë Ï‹ÚË˜ ·ÔÎ·Ù¿ÛÙ·ÛË ÙˆÓ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ·Ú·Ì¤ÙÚˆÓ. ™ÙÔÓ ·ÂÈÎÔÓÈÛÙÈÎfi ¤ÏÂÁ¯Ô ÙÔ˘ ‹·ÙÔ˜ (CT spiral) Ô˘ ¤ÁÈÓÂ ÙÔ 2Ô Î·È 3Ô ¯ÚfiÓÔ ·fi ÙËÓ ¤Ó·ÚÍË ÙË˜ ıÂÚ·Â›·˜, ‰È·ÈÛÙÒıËÎÂ ÛËÌ·ÓÙÈÎ‹ ‚ÂÏÙ›ˆÛË ÙË˜ ÂÈÎfiÓ·˜ ÙÔ˘ ‹·ÙÔ˜ (∂ÈÎfiÓ· 4).

¶·Ú·ÎÔÏÔ‡ıËÛË¶ÚÔ-+1 Â‚‰.+1Ì12Ì+24Ì+36Ì+48Ì+ 60Ì NTBC

∏Ì. 000214000225000317010217020217030217040217050217

ÚˆÙÔÎﬁÏÏÔ˘

¢È¿ÚÎÂÈ· ∏Ì¤ÚÂ˜

ıÂÚ·Â›·˜

∞›Ì·ªÔÓ¿‰Â˜∆ÈÌ¤˜ ·Ó·ÊÔÚ¿˜

PBG synthase, Nkat/g Hb0,58-1,250,031,050,80,720,60,670,750,69 ÂÚ˘ıÚ¿

™Ô˘ÎÈÓ˘Ï·ÎÂÙﬁÓË, Ìg/ml<0,4427,82,5<0,1<0,1<0,1<0,1<0,1

Ï¿ÛÌ·

·-ÊÂÙÔÚˆÙÂ˝ÓË, Ìmol/L<12151000510002640010021192015

ÔÚﬁ˜

∆˘ÚÔÛ›ÓË, Ìmol/L50-130354136121335479450657550

Ï¿ÛÌ·

º·ÈÓ˘Ï·Ï·Ó›ÓË Ìmol/L40-12019330465555926863

Ï¿ÛÌ·

ªÂıÂÈÔÓ›ÓË, Ìmol/L20-5022022381819281515

Ï¿ÛÌ·

√‡Ú·

‰-·ÌÈÓÔÏÂ‚Ô˘ÏÈÓÈÎﬁ mmol/mol0-31606,76,38,135,56,33,6

ÔÍ‡ÎÚÂ·ÙÈÓ›ÓË˜

™Ô˘ÎÈÓ˘Ï·ÎÂÙﬁÓËmmol/mol <1320<1<1<1<1<1<1<1

ÎÚÂ·ÙÈÓ›ÓË˜

™Ô˘ÎÈÓ˘ÏÔ·ÎÂÙÔÍÂÈÎﬁ mmol/mol <1330<1<1<1<1<1<1<1 ÔÍ‡ÎÚÂ·ÙÈÓ›ÓË˜

NBTC, ÔÚﬁ˜ Ìmol/L31,946,150,750,246,947,148,1

™˘˙‹ÙËÛË

∏ Ù˘ÚÔÛÈÓ·ÈÌ›· Ù‡Ô˘ π ÂÚÈÁÚ¿ÊËÎÂ ÁÈ·

ÚÒÙË ÊÔÚ¿ ÚÈÓ ·fi 50 ¯ÚfiÓÈ· Î·È Â›Ó·È ·fi Ù·

ÈÔ Î·Ï¿ ÙÂÎÌËÚÈˆÌ¤Ó· ÎÏËÚÔÓÔÌÈÎ¿ ÌÂÙ·‚ÔÏÈ-

Î¿ ÓÔÛ‹Ì·Ù· (1). ∆Ô ‹·Ú Â›Ó·È ÙÔ Î‡ÚÈÔ fiÚÁ·ÓÔ Ô˘ ÚÔÛ‚¿ÏÏÂÙ·È ÛÙËÓ Ù˘ÚÔÛÈÓ·ÈÌ›· Ù‡Ô˘ 1 Î·È ÛÂ ‰ÈÂıÓ‹ ÌÂÏ¤ÙË, 69% ÙˆÓ ı·Ó¿ÙˆÓ ·Ô‰fiıËÎ·Ó ÛÙËÓ Ë·ÙÈÎ‹ ·ÓÂ¿ÚÎÂÈ· Î·È ·ÈÌÔÚÚ·Á›· Î·È 16% ÛÙÔÓ Ë·ÙÔÎ˘ÙÙ·ÚÈÎfi Î·ÚÎ›ÓÔ

(10). ™‡ÌÊˆÓ· ÌÂ ÙÔ˘˜ van Spronsen Î·È Û˘Ó, ‚·ÛÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÁÈ· ÙË ‚·Ú‡ÙËÙ· Î·È ÚfiÁÓˆÛË ÙË˜ ¿ıËÛË˜ Â›Ó·È Ë ËÏÈÎ›· ¤Ó·ÚÍË˜ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ (10). √ ·ÛıÂÓ‹˜ Ì·˜ ÚÔÛ‹ÏıÂ ÌÂ ÙËÓ Ù˘ÈÎ‹ ‚·ÚÈ¿ ÂÈÎfiÓ· ÙË˜ ÔÍÂ›·˜ Ë·ÙÔÓÂÊÚÈÎ‹˜ Ù˘ÚÔÛÈÓ·ÈÌ›·˜, ÛÂ ËÏÈÎ›· 5 ÌËÓÒÓ, ÌÂ Î·ı˘ÛÙ¤ÚËÛË ÙË˜ ·Ó¿Ù˘ÍË˜, ¤ÓÙÔÓË ‰˘ÛÙÚÔÊ›·, Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›·, Ë·ÙÈÎ‹ ·ÓÂ¿ÚÎÂÈ· ÌÂ Î›ÚÚˆÛË, ˘ÂÚÙ˘ÚÔÛÈÓ·ÈÌ›·, ˘ÂÚÌÂıÂÈÔÓÈÓ·ÈÌ›·, ÁÂÓÈÎÂ˘Ì¤ÓË ·ÌÈÓÔÍÔ˘Ú›· Î·È

˘„ËÏ¿ Â›Â‰· ÛÔ˘ÎÈÓ˘Ï·ÎÂÙﬁÓË˜ ÛÙ· Ô‡Ú·.

∂ÈÎﬁÓ· 4. Spiral CT ‹·ÙÔ˜ 3

Â›Â‰· ÙË˜ ·-ÊÂÙÔÚˆÙÂ˝ÓË˜ Â·Ó‹Ïı·Ó ÛÙ·

Ê˘ÛÈÔÏÔÁÈÎ¿ fiÚÈ· ÌÂÙ¿ ·fi ¤Ó·Ó ¯ÚfiÓÔ ıÂÚ·-

Â›·˜. √ ·ÂÈÎÔÓÈÛÙÈÎﬁ˜ ¤ÏÂÁ¯Ô˜ ‰‡Ô Î·È ÙÚ›·

¯ÚﬁÓÈ· ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË ÙË˜ ıÂÚ·Â›·˜ ¤‰ÂÈÍÂ

Û·Ê‹ ‚ÂÏÙ›ˆÛË ÙË˜ Ë·ÙÈÎ‹˜ ÂÈÎﬁÓ·˜. √ ·ÛıÂ-

Ó‹˜ Ì·˜ ‰ÂÓ ¤¯ÂÈ ÂÌÊ·Ó›ÛÂÈ ÓÂ˘ÚÔÏÔÁÈÎ¤˜ ÎÚ›-

ÛÂÈ˜ Ù‡Ô˘ ÔÚÊ˘Ú›·˜, ÁÂÁÔÓﬁ˜ Ô˘ Û˘ÓËÁÔÚÂ›

ﬁÙÈ ÙÔ NTBC ÚÔÛÙ·ÙÂ‡ÂÈ ·ﬁ ·˘Ù‹ ÙËÓ ÂÈ-

ÏÔÎ‹ Î·È ÂÈÏ¤ÔÓ, ‰ÂÓ ¤¯ÂÈ ·ÚÔ˘ÛÈ¿ÛÂÈ Î·-

Ì›· ·ÓÂÈı‡ÌËÙË ÂÓ¤ÚÁÂÈ· ·ﬁ ÙË ıÂÚ·Â›· Ì¤-

¯ÚÈ Û‹ÌÂÚ·.

∞Í›˙ÂÈ Ó· ÛËÌÂÈˆıÂ› fiÙÈ ÂÎÙfi˜ ·fi ÙËÓ ·Ô-

Î·Ù¿ÛÙ·ÛË ÙË˜ ÓÂÊÚÈÎ‹˜ ÏÂÈÙÔ˘ÚÁ›·˜ (Ô˘ ‰È·-

ÈÛÙÒıËÎÂ Î·È ÛÙÔÓ ·ÛıÂÓ‹ Ì·˜), ÛÙﬁ¯Ô˜ ÙË˜

‰›·ÈÙ·˜ ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ Ô˘ ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È

ÌÂ NTBC Â›Ó·È Ë ‰È·Ù‹ÚËÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙË˜

Ù˘ÚÔÛ›ÓË˜ Î¿Ùˆ ·ﬁ 500 Ìmol/L, ÁÈ· Ó· ÚÔÏË-

ÊıÂ› Ë ÂÓ·ﬁıÂÛË ÎÚ˘ÛÙ¿ÏÏˆÓ Î˘ÛÙ›ÓË˜ ÛÙÔÓ

ÎÂÚ·ÙÔÂÈ‰‹. √È ÂÓ·Ôı¤ÛÂÈ˜ Ù˘ÚÔÛ›ÓË˜ ÛÙÔÓ

ÎÂÚ·ÙÔÂÈ‰‹ ÌÔÚÔ‡Ó Ó· ÚÔÎ·Ï¤ÛÔ˘Ó ·›ÛıËÌ·

Î·‡ÛÔ˘ Î·È ‰·ÎÚ‡ÚÚÔÈ·, ÁÈ' ·˘Ùﬁ ÔÈ ·ÛıÂÓÂ›˜

Ô˘ ·›ÚÓÔ˘Ó NTBC ı· Ú¤ÂÈ Ó· ÂÍÂÙ¿˙ÔÓÙ·È

ÔÊı·ÏÌÔÏÔÁÈÎ¿ ÛÂ Ù·ÎÙ¿ ‰È·ÛÙ‹Ì·Ù· (·Ó¿ ÙÚ›ÌËÓÔ) ÌÂ Û¯ÈÛÌÔÂÈ‰‹ Ï˘¯Ó›·. √ ·ÛıÂÓ‹˜ Ì·˜

‰ÂÓ ·ÚÔ˘Û›·ÛÂ Û˘ÌÙˆÌ·ÙÔÏÔÁ›· Ô‡ÙÂ ·ıÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù· ÛÙÈ˜ ÂÚÈÔ‰ÈÎ¤˜ ÔÊı·ÏÌÔÏÔ-

ÁÈÎ¤˜ ÂÍÂÙ¿ÛÂÈ˜.

¶ÚÔ˜ ÙÔ ·ÚﬁÓ, Ô ·ÚÈıÌﬁ˜ ÙˆÓ ·ÛıÂÓÒÓ Î·È

Ô ¯ÚﬁÓÔ˜ ·Ú·ÎÔÏÔ‡ıËÛË˜ ‰ÂÓ Â›Ó·È ·ÚÎÂÙﬁ˜

ÁÈ· ÙËÓ ÂÍ·ÁˆÁ‹ ÔÚÈÛÙÈÎÒÓ Û˘ÌÂÚ·ÛÌ¿ÙˆÓ ÁÈ·

ÙËÓ ·ÔÙÚÂÙÈÎ‹ ‰Ú¿ÛË ÙÔ˘ NTBC ÛÙËÓ ÂÌÊ¿ÓÈÛË ÙÔ˘ Ë·ÙÔÎ˘ÙÙ·ÚÈÎÔ‡ Î·ÚÎ›ÓÔ˘ ÛÙ· ·È‰È¿ ÌÂ Ù˘ÚÔÛÈÓ·ÈÌ›· Ù‡Ô˘ π. ¶·Ú¿ÏÏËÏ· ÌÂ ÙËÓ

ÔÌ¿‰· ÙÔ˘ Gothenburg, ÌÂÏÂÙ¿Ù·È Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙÔ˘ NTBC ·fi ÙËÓ ÔÌ¿‰· ÙÔ˘ Quebec, ÏfiÁˆ ÙˆÓ È‰È·›ÙÂÚˆÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ

ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ÂÚÂ˘ÓÒÓÙ·È ÂÎÂ› (3). ∂›Ó·È ·Ó·ÁÎ·›· Ë Û˘ÌÌÂÙÔ¯‹ fiÏˆÓ ÙˆÓ ·ÛıÂÓÒÓ ÌÂ Ë·ÙÔÓÂÊÚÈÎ‹ Ù˘ÚÔÛÈÓ·ÈÌ›· ÛÙ· ÚˆÙfiÎÔÏÏ· ıÂÚ·Â›·˜ Î·È ·Ú·ÎÔÏÔ‡ıËÛË˜, ÁÈ· ÙË Û˘ÏÏÔÁ‹ fiÛÔ ÙÔ ‰˘Ó·ÙfiÓ ÂÚÈÛÛfiÙÂÚˆÓ ÏËÚÔÊÔÚÈÒÓ

ÁÈ· ÙË ÓﬁÛÔ Î·È ÙË Ì·ÎÚÔ¯ÚﬁÓÈ· Â›‰Ú·ÛË ÙÔ˘

NTBC. ∏ ·Ó¿Ù˘ÍË Ë·ÙÔÎ˘ÙÙ·ÚÈÎÔ‡ Î·ÚÎ›ÓÔ˘, ÛÂ ÂÈÚ·Ì·ÙÈÎ¿ ÌÔÓÙ¤Ï· ÔÓÙÈÎÒÓ ÌÂ ·ÓÂ¿ÚÎÂÈ· FAH ÛÙÔ˘˜ ÔÔ›Ô˘˜ ¯ÔÚËÁ‹ıËÎÂ NTBC, ·ÔÙÂÏÂ› ·fi‰ÂÈÍË fiÙÈ ÔÈ ·ÛıÂÓÂ›˜ ÌÂ Ù˘ÚÔÛÈÓ·ÈÌ›· Ù‡Ô˘ π ˘fi ·ÁˆÁ‹ ÌÂ NTBC ı· Ú¤ÂÈ Ó· ·Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·È ÛÙÂÓ¿ ÁÈ· Ù˘¯fiÓ ·Ó¿-

Î·ÚÎ›ÓÔ˘ (1,13).

Î·ıÔÚÈÛÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ ÁÈ· ÙËÓ Î·Ï‹ ÔÚÂ›· ÙˆÓ ·ÛıÂÓÒÓ Â›Ó·È Ë ¤ÁÎ·ÈÚË ‰È¿ÁÓˆÛË Î·È ¤Ó·ÚÍË ÙË˜ ıÂÚ·Â›·˜ ÌÂ ·Ú·ÎÔÏÔ‡ıËÛË ‚¿ÛÂÈ ÙÔ˘ Û˘ÁÎÂÎÚÈÌ¤ÓÔ˘ ÚˆÙÔÎﬁÏÏÔ˘ ÙË˜ ÔÌ¿‰·˜ ÙÔ˘ Gothenburg, Ô˘ ÚÔ¸Ô-

µÈ‚ÏÈÔÁÚ·Ê›·

1.Mitchell G, Grompe M, Lambert M, Tanguay R. Hypertyrosinemia. In: Scriver RC, Beaudet A, Sly WS, Valle D eds. The Metabolic and Molecular Bases of Inherited Disease. 8th ed. New York: McGrawHill; 2001. p. 1777-1806.

2.Russo PA, Mitchell GA, Tanguay RM. Tyrosinemia: a review. Pediatr Dev Pathol 2001;4(3):212-221.

3.Paradis K. Tyrosinemia: the Quebec experience. Clin Invest Med 1996;19:311-316.

4.Holme E, Lindstedt S. Tyrosinaemia type I and NTBC (2-(2-nitro-4-trifluoromethylbenzoyl)-1,3-cyclohexanedione). J Inherit Metab Dis 1998;21:507-517.

5.Wijburg FA, Reitsma WC, Slooff MJ, van Spronsen FJ, Koetse HA, Reijngoud DJ et al. Liver transplantation in tyrosinaemia type I: the Groningen experience. J Inherit Metab Dis 1995;18:115-118.

6.Holme E, Lindstedt S. Diagnosis and management of tyrosinemia type I. Curr Opin Pediatr 1995;7:726-732.

7.Lock EA, Ellis MK, Gaskin P, Robinson M, Auton TR, Provan WM et al. From toxicological problem to therapeutic use: the discovery of the mode of action of 2-(2-nitro-4-trifluoromethylbenzoyl)-1,3-cyclohexanedione (NTBC), its toxicology and development as a drug. J Inher Metab Dis 1998;21:498-506.

8.Lindstedt S, Holme E, Lock EA, Hjalmarson O, Strandvik B. Treatment of hereditary tyrosinemia type I by inhibition of 4-hydroxyphenylpyruvate dioxygenase. Lancet 1992;340:813-817.

9.Holme E, Lindstedt S. Nontransplant treatment of tyrosinemia. Clin Liver Dis 2000;4:805-814.

10.van Spronsen FJ, Thomasse Y, Smit GP, Leonard JV, Clayton PT, Fidler V et al. Hereditary tyrosinemia type I: a new clinical classification with difference in prognosis on dietary treatment. Hepatology 1994; 20: 1187-1191.

11.∆ÛÈ·Ú¿˙Ë-™Ù¿ÌÔ˘ ª, §·Ê·˙¿ÓË˜ µ, ™·‚‚ÔÔ‡ÏÔ˘-∞˘ÁÔ˘ÛÙ›‰Ô˘ ¶, Sewell A, Berger Rª, ¶·ÈÔÓ›‰Ë˜ ∞. ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛË˜ ∆˘ÚÔÛÈÓ·ÈÌ›·˜ Ù‡Ô˘ π. ¶·È‰È·ÙÚ µ ∂ÏÏ¿‰·˜ 1997;9:257-261.

12.Bergeron A, D'Astous M, Timm DE, Tanguay RM. Structural and functional analysis of missense mutations in fumarylacetoacetate hydrolase, the gene deficient in hereditary tyrosinemia type 1. J Biol Chem. 2001;276:15225-15231.

13.Grompe M, Overturf K, Al-Dhalimy M, Finegold. Therapeutic trials in the murine model of hereditary tyrosinemia type I: A progress report. J Inherit Metab Dis 1998;21:518-531. ¶·È‰È·ÙÚÈÎ‹

∂ÚÁ·ÛÙ‹ÚÈÔ π·ÙÚÈÎ‹˜

°ÂÓÂÙÈÎ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘

∞ıËÓÒÓ, ¡ÔÛÔÎÔÌÂ›Ô

¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó·

2 ¶·È‰ÔÓÂÊÚÔÏÔÁÈÎﬁ ∆Ì‹Ì·, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó·

3 ∞ÓÔÛÔÏÔÁÈÎﬁ ∆Ì‹Ì·, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ

“∞Á›· ™ÔÊ›·”, ∞ı‹Ó·

4 ¡ÂÊÚÔ·ıÔÏÔÁÔ·Ó·ÙÔÌÈÎﬁ

∆Ì‹Ì·, ¡ÔÛÔÎÔÌÂ›Ô “∂˘·ÁÁÂÏÈÛÌﬁ˜”, ∞ı‹Ó·

AÏÏËÏÔÁÚ·Ê›·:

ŒÏÂÓ· ºÚ˘Û›Ú·

∂ÚÁ·ÛÙ‹ÚÈÔ π·ÙÚÈÎ‹˜ °ÂÓÂÙÈÎ‹˜, ÃˆÚ¤ÌÂÈÔ ∂ÚÂ˘ÓËÙÈÎﬁ

∂ÚÁ·ÛÙ‹ÚÈÔ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ

“∞Á›· ™ÔÊ›·”,

∆.∫. 115 27, ∞ı‹Ó· E-mail: efrysira@cc.uoa.gr

∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 15-11-2004

∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛË˜: 21-09-2005

1 Medical Genetics Laboratory, University of Athens, “Aghia Sophia” Children's Hospital, Athens

2 Department of Paediatric Nephrology, “Aghia Sophia” Children's Hospital, Athens

3 Department of Immunology, “Aghia Sophia” Children's Hospital, Athens

4 Department of Renal Pathology, “Evaggelismos” General Hospital, Athens

Correspondence: Helen Fryssira

Medical Genetics Laboratory, Choremio Research Laboratory, “Aghia Sophia” Children's Hospital, 115 27, Athens

E-mail: efrysira@cc.uoa.gr

Date of submission: 15-11-2004

Date of approval: 21-09-2005

Schimke ·ÓÔÛÔ-ÔÛÙÈÎ‹ ‰˘ÛÏ·Û›·.

ÂÚ›ÙˆÛË˜ Î·È ·Ó·ÛÎﬁËÛË ÙË˜ ‚È‚ÏÈÔÁÚ·Ê›·˜

™. æÒÓË1, ∂. °ÂˆÚÁ¿ÎË2, ∞. ∫·ﬁÁÈ·ÓÓË˜2, ∞. ™·Ï·‚Ô‡Ú·3, ª. ∫·Ó¿ÚÈÔ˘3, º. ™ﬁÙÛÈÔ˘4, Œ. ºÚ˘Û›Ú·1

¶ÂÚ›ÏË„Ë:∏ ·ÓÔÛÔ-ÔÛÙÈÎ‹ ‰˘ÛÏ·Û›· Ù‡Ô˘ Schimke (Schimke immuno-osseous dysplasiaSIOD, Online Mendelian Inheritance In Man, website: http://www.ncbi.nlm.nih.gov/htbinpost/OMIM; OMIM:242900) Â›Ó·È Û¿ÓÈÔ ÁÂÓÂÙÈÎfi ÓfiÛËÌ· Ô˘ ÎÏËÚÔÓÔÌÂ›Ù·È ÌÂ ˘ÔÏÂÈfiÌÂÓÔ ·˘ÙÔÛˆÌ·ÙÈÎfi ¯·Ú·ÎÙ‹Ú·, ÙÔ ÔÔ›Ô ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÛÔÓ‰˘ÏÔ-ÂÈÊ˘ÛÈ·Î‹ ‰˘ÛÏ·Û›·, ÓÂÊÚÈÎ‹ ·ÓÂ¿ÚÎÂÈ·, ÂÏ·ÙÙˆÌ·ÙÈÎ‹ Î˘ÙÙ·ÚÈÎ‹ ·ÓÔÛ›· Î·È ¯·Ú·ÎÙËÚÈÛÙÈÎfi Ê·ÈÓfiÙ˘Ô ÌÂ ‰˘Û·Ó¿ÏÔÁÔ ÎÔÓÙfi ·Ó¿ÛÙËÌ·, ÙÚÈÁˆÓÈÎfi ÚfiÛˆÔ, ·ÔÛÙÚÔÁÁ˘ÏÂÌ¤ÓË Ì‡ÙË Î·È ˘ÂÚ¯ÚˆÌ·ÙÈÎ¤˜

¶·È‰È·ÙÚÈÎ‹ 2006;69:52-58

Schimke immuno-osseous dysplasia. Case report and review of the literature

S. Psoni1, H. Georgaki2, A. Kapogiannis2, A. Salavoura3, M. Kanariou3, F. Sotsiou4, H. Fryssira1

Abstract: Schimke immuno-osseous dysplasia (SIOD) [(Schimke immuno-osseous dysplasiaSIOD, Online Mendelian Inheritance In Man, website: http://www.ncbi.nlm.nih.gov/htbinpost/OMIM; OMIM:242900)] is a rare autosomal recessive disorder characterized by spondyloepiphyseal dysplasia, renal failure, defective cellular immunity and distinct phenotype with disproportionate short stature, triangular face, bulbous nose and abdominal pigmented spots. The responsible gene has been mapped recently. SIOD must be included in the differential diagnosis of cases with growth retardation and osseous dysplasia, as the prognosis can be poor, because of severe damage of the cellular immunity and renal insult. A case of a three year-old boy with short stature and proteinuria, characteristic features in this condition, is described.

Key words: Schimke immuno-osseous dysplasia, proteinuria, dysmorphic features.

√ªπªOnline Mendelian inheritance in man

SIODSchimke immuno-osseous dysplasia

µ™µ¿ÚÔ˜ ÛÒÌ·ÙÔ˜

À™⁄„Ô˜ ÛÒÌ·ÙÔ˜

PHAPhytohemagglutinin

FSGS Focal segmental glomerular sclerosis (ÂÛÙÈ·Î‹ ÙÌËÌ·ÙÈÎ‹ ÛÂÈÚ·Ì·ÙÔÛÎÏ‹Ú˘ÓÛË)

G-CSFGranulocyte-colony stimulating factor (‰ÈÂÁÂÚÙÈÎﬁ˜ ·Ú¿ÁÔÓÙ·˜ ·ÔÈÎÈÒÓ ÙˆÓ ÎÔÎÎÈÔÎ˘ÙÙ¿ÚˆÓ)

GM-CSFGranulocyte-monocyte-colony stimulating factor (‰ÈÂÁÂÚÙÈÎﬁ˜ ·Ú¿ÁÔÓÙ·˜ ·ÔÈÎÈÒÓ ÙˆÓ ÎÔÎÎÈÔÎ˘ÙÙ¿ÚˆÓ-ÌÔÓÔÎ˘ÙÙ¿ÚˆÓ)

∂ÈÛ·ÁˆÁ‹

(Schimke immuno-osseous dysplasia - SIOD, √ªπª: 242900)

˘ÔÏÂÈﬁÌÂÓÔ ·˘ÙÔÛˆÌ·ÙÈÎﬁ ¯·Ú·ÎÙ‹Ú·.

√ÊÂ›ÏÂÙ·È ÛÂ ÌÂÙ¿ÏÏ·ÍË ÂÓﬁ˜ Ú˘ıÌÈÛÙÈÎÔ‡ ÁÔÓÈ‰›Ô˘ Ô˘ ·Ó·Î·Ï‡ÊıËÎÂ ÚﬁÛÊ·Ù· Î·È ¤¯ÂÈ

Û¯¤ÛË ÌÂ ÙËÓ ·Ó·‰ÈÔÚÁ¿ÓˆÛË ÙË˜ ¯ÚˆÌ·Ù›ÓË˜

(chromatin remodelling) (1). ∏ ÎÏÈÓÈÎ‹ ÂÈÎﬁÓ·

ÂÚÈÏ·Ì‚¿ÓÂÈ ¯·Ú·ÎÙËÚÈÛÙÈÎﬁ Ê·ÈÓﬁÙ˘Ô,

ÛÔÓ‰˘ÏÔÂÈÊ˘ÛÈ·Î‹ ‰˘ÛÏ·Û›· ÌÂ Â·ÎﬁÏÔ˘ıÔ ¯·ÌËÏﬁ ·Ó¿ÛÙËÌ·, ‰È·Ù·Ú·¯‹ ÙË˜ Î˘ÙÙ·ÚÈ-

Î‹˜ ·ÓÔÛ›·˜ Î·È ÏÂ˘ÎˆÌ·ÙÔ˘Ú›· ÓÂÊÚˆÛÈÎÔ‡ Ù‡Ô˘ (2). ¢È·¯ˆÚ›˙ÂÙ·È ·‰Ú¿ ÛÂ ‰‡Ô Ù‡Ô˘˜: ·)

‚ÚÂÊÈÎﬁ˜ Ù‡Ô˜, ÌÂ Î·ı˘ÛÙ¤ÚËÛË ÂÓ‰ÔÌ‹ÙÚÈ·˜ ·Ó¿Ù˘ÍË˜, ‚·ÚÈ¿ ÎÏÈÓÈÎ‹ ÂÈÎﬁÓ· Î·È ÚÒÈÌË

ıÓËÛÈÌfiÙËÙ· Î·È ıÓËÙfiÙËÙ· Î·È ‚) ÂÊË‚ÈÎfi˜ Ù‡-

Ô˜ (8-13 ¤ÙË), Ô˘ ¤¯ÂÈ ËÈﬁÙÂÚË ÎÏÈÓÈÎ‹ ‰È·-

‰ÚÔÌ‹, ÌÂ ÚÔ˚Ô‡Û· ÓÂÊÚÈÎ‹ ‚Ï¿‚Ë, ·Ó·ÛÙÔÏ‹

·‡ÍËÛË˜ Î·Ù¿ ÙËÓ ÂÊË‚Â›· Î·È ÌÂÁ·Ï‡ÙÂÚË ÂÈ‚›ˆÛË (3). ¶·ÚÔ˘ÛÈ¿˙ÂÙ·È Ë ÂÚ›ÙˆÛË ·ÁÔÚÈÔ‡

ËÏÈÎ›·˜ 3 ÂÙÒÓ ÌÂ ÎÏÈÓÈÎÔÂÚÁ·ÛÙËÚÈ·Î¿ Â˘Ú‹Ì·Ù· Û˘Ì‚·Ù¿ ÌÂ ÙÔ ÂÍ·ÈÚÂÙÈÎ¿ Û¿ÓÈÔ ·˘Ùﬁ ÁÂÓÂ-

ÙÈÎfi ÓfiÛËÌ·, ÂÓÒ Á›ÓÂÙ·È ‰È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË Î·È ·Ó·ÛÎfiËÛË ÙË˜ ‚È‚ÏÈÔÁÚ·Ê›·˜.

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛË˜

∞ÁfiÚÈ ËÏÈÎ›·˜ 3 ÂÙÒÓ ÚÔÛ‹ÏıÂ ÛÙÔ ¶·È‰ÔÓÂÊÚÔÏÔÁÈÎfi ∆Ì‹Ì· ÙÔ˘ ¡ÔÛÔÎÔÌÂ›Ô˘ Î·ÙfiÈÓ

·Ú·ÔÌ‹˜ ·fi ÂÍˆÙÂÚÈÎfi È·ÙÚfi ÁÈ· ¤ÏÂÁ¯Ô

Î˘ÛÙÂÔÔ˘ÚËÙËÚÈÎ‹˜ ·ÏÈÓ‰ÚfiÌËÛË˜. ™˘Á¯ÚfiÓˆ˜, fiÌˆ˜, ·Ú·ÙËÚ‹ıËÎÂ ¯·ÌËÏfi ·Ó¿ÛÙËÌ·

Î·È Î¿ÔÈ· È‰È·›ÙÂÚ· ÌÔÚÊÔÏÔÁÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿. ø˜ ÂÎ ÙÔ‡ÙÔ˘, ·Ú·¤ÌÊıËÎÂ ÁÈ· ÂÚ·ÈÙ¤Úˆ ‰ÈÂÚÂ‡ÓËÛË ÛÙÔ È·ÙÚÂ›Ô °ÂÓÂÙÈÎ‹˜. ¶Úﬁ-

ÎÂÈÙ·È ÁÈ· ÙÔ ÚÒÙÔ ·È‰› Ê·ÈÓÔÙ˘ÈÎ¿ ˘ÁÈÒÓ ÁÔÓ¤ˆÓ, ÌË Û˘ÁÁÂÓÒÓ ÌÂÙ·Í‡ ÙÔ˘˜ Î·È ÌÂ ÂÏÂ‡ıÂÚÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi. ∆Ô ÌÈÎÚfiÙÂÚÔ ·‰ÂÏÊ¿ÎÈ ÙÔ˘ ‹Ù·Ó ˘ÁÈ¤˜. ∞fi ÙÔ ·ÙÔÌÈÎfi ·Ó·-

ÌÓËÛÙÈÎfi ·Ó·Ê¤ÚÂÙ·È fiÙÈ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÂÁÎ˘ÌÔÛ‡ÓË˜ (28Ë Â‚‰ÔÌ¿‰·) Â›¯Â ‰È·ÈÛÙˆıÂ› ˘ÂÚË¯ÔÁÚ·ÊÈÎ¿ ÔÏÈÁÔ¸‰Ú¿ÌÓÈÔ. √ ·ÛıÂÓ‹˜ ÁÂÓÓ‹ıËÎÂ ÌÂ Î·ÈÛ·ÚÈÎ‹ ÙÔÌ‹ ÙËÓ 36Ë Â‚‰ÔÌ¿‰· ÙË˜ Î˘‹ÛÂˆ˜, ÏfiÁˆ ∂∫∞ (‚¿ÚÔ˜ Á¤ÓÓËÛË˜: 2000 g), ÂÓÒ Ù· ˘fiÏÔÈ· ÛˆÌ·ÙÔÌÂÙÚÈÎ¿ ÛÙÔÈ¯Â›· ‹Ù·Ó ÛÙ· Î·ÙÒÙÂÚ· Ê˘ÛÈÔÏÔÁÈÎ¿ fiÚÈ· (ª™: 48 cm Î·È ¶∫: 32,5 cm ÛÙËÓ 3Ë ∂£). ™Â ËÏÈÎ›· 37 ËÌÂÚÒÓ ·ÚÔ˘Û›·ÛÂ Ô˘ÚÔÏÔ›ÌˆÍË. √ ¤ÏÂÁ¯Ô˜ Ô˘ ·ÎÔÏÔ‡ıËÛÂ ¤‰ÂÈÍÂ Î˘ÛÙÂÔÔ˘ÚËÙËÚÈÎ‹ ·ÏÈÓ‰ÚfiÌËÛË 4Ô˘-5Ô˘ ‚·ıÌÔ‡ ‰ÂÍÈ¿ Î·È 2Ô˘ ‚·ıÌÔ‡ ·ÚÈÛÙÂÚ¿, ÁÈ· ÙËÓ ÔÔ›· ¤Ï·‚Â ¯ËÌÂÈÔÚÔÊ‡Ï·ÍË. ∞fi ÙÔÓ 8Ô Ì‹Ó· ·Ú·ÙËÚ‹ıËÎÂ ‚Ú·¯˘ÛˆÌ›· (À™: 63 cm, <3Ë E£), ÂÓÒ ÙÔ µ™ Î·È Ë ¶∫ ·Ú¤ÌÂÓ·Ó ÛÙËÓ 3Ë ∂£. ™Â ËÏÈÎ›· 1,5 ¤ÙÔ˘˜, ÏfiÁˆ ÙÔ˘ ¯·ÌËÏÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜, ¤ÁÈÓÂ

ÂÓ‰ÔÎÚÈÓÔÏÔÁÈÎﬁ˜

¤ÏÂÁ¯Ô˜, Ô ÔÔ›Ô˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜. ∆ÔÓ ÙÂÏÂ˘Ù·›Ô ¯ÚfiÓÔ ·Ó·Ê¤ÚÔÓÙ·Ó Â›ÛË˜ Û˘¯Ó¿ ÂÂÈÛfi‰È· ÔÍÂ›·˜ Ì¤ÛË˜

ˆÙ›ÙÈ‰·˜ Î·È ÏÔÈÌÒÍÂˆÓ ·Ó·ÓÂ˘ÛÙÈÎÔ‡. ∫·Ù¿

ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈÎ‹ ÂÍ¤Ù·ÛË ÛÂ ËÏÈÎ›· 3 ÂÙÒÓ, ‰È·ÈÛÙÒıËÎÂ ﬁÙÈ ÙÔ µ™ ‹Ù·Ó 10.700 g (3Ë-10Ë

∂£), ÙÔ À™ ‹Ù·Ó 81 cm (3Ë ∂£) Î·È Ë ¶∫ ‹Ù·Ó 47 cm (<3Ë ∂£). º·ÈÓÔÙ˘ÈÎ¿, ·ÚÔ˘Û›·˙Â

ÙÚÈÁˆÓÈÎﬁ Û¯‹Ì· ÚÔÛÒÔ˘, ÂÌ‚¿ı˘ÓÛË ÔÊı·ÏÌÒÓ, ‹ÈÔ Ô›‰ËÌ· ‚ÏÂÊ¿ÚˆÓ, ÚÔ¤¯Ô˘Û·

Ì‡ÙË ÌÂ Â˘ÚÂ›· Á¤Ê˘Ú· Î·È Ï·Ù‡ ·ÎÚÔÚÚ›ÓÈÔ, ıÔÏˆÙ‹ ˘ÂÚÒ· Î·È Ì·ÎÚ‡ ÏÂÙﬁ ¿Óˆ ¯Â›ÏÔ˜.

√ ·˘¯¤Ó·˜ ‹Ù·Ó ÎÔÓÙfi˜, Ô ÎÔÚÌfi˜ ‚Ú·¯‡˜ Î˘ÏÈÓ‰ÚÈÎfi˜ (barrel chest) Î·È Ë ÎÔÈÏ›· ÚÔ¤¯Ô˘Û·. ∂›¯Â ÔÛÊ˘˚Î‹ ÏfiÚ‰ˆÛË Î·È ÌÈÎÚ‹ ‰˘Û·Ó·ÏÔÁ›· ÎÔÚÌÔ‡-¿ÎÚˆÓ (∂ÈÎfiÓÂ˜ 1, 2). ™ÙÔ ‰¤ÚÌ· ÂÌÊ¿ÓÈ˙Â ˘ÂÚ¯ÚˆÌ·ÙÈÎ¤˜ ÎËÏ›‰Â˜, ÌÈÎÚÔ‡ ÌÂ-

Î·È ‰È·ÊﬁÚÔ˘ Û¯‹Ì·ÙÔ˜, ÂÚÈÛÛﬁÙÂÚÔ

ÙË˜ ÎÔÈÏ›·˜ (∂ÈÎﬁÓ· 3).

‹Ù·Ó ÔÏ‡ Î·Ïﬁ, ÂÓÒ Ë ÊˆÓ‹ ‹Ù·Ó ˘„›Û˘¯ÓË (high pitched voice).

ÙÔÓ ·Ú¯ÈÎfi ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô, Ë ÁÂÓÈÎ‹ ·›Ì·ÙÔ˜ ¤‰ÂÈÍÂ ‹È· ÏÂÌÊÔÂÓ›· Î·È ÏÂ˘ÎÔÂÓ›·: §Â˘Î¿ ·ÈÌÔÛÊ·›ÚÈ·: 4x103/ÌL, Ô˘‰ÂÙÂÚfiÊÈÏ·: 46%, ÏÂÌÊÔÎ‡ÙÙ·Ú·: 36%, ÌÔÓÔÎ‡ÙÙ·Ú·: 8%, ¿Ù˘· ÏÂÌÊÔÎ‡ÙÙ·Ú·: 10%. √ ‚ÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜, ÂÎÙfi˜ ·fi ÙËÓ ÂÏ·ÊÚ¿ ·˘ÍËÌ¤ÓË ¯ÔÏËÛÙÂÚfiÏË: 255 mg/dL. ∞fi ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô Î·È ÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË ÙÔ˘ ·È‰ÈÔ‡ ‰È·ÈÛÙÒıËÎÂ, ÂÎÙfi˜ ÙË˜ ∫√¶, ÌÈÎÚÔÛÎÔÈÎ‹ ·ÈÌ·ÙÔ˘Ú›· (ÌÂ ‰È·Î˘Ì¿ÓÛÂÈ˜ ÙË˜ Ù¿ÍÂˆ˜ ÙˆÓ 10-30 ÂÚ˘ıÚÒÓ

Î·Ù¿ ÔÙÈÎﬁ Â‰›Ô) Î·È ÛÙË Û˘Ó¤¯ÂÈ· ÏÂ˘ÎˆÌ·ÙÔ˘Ú›·. ∆Ô ÏÂ‡ÎˆÌ· Ô‡ÚˆÓ 24ÒÚÔ˘ ‹Ù·Ó 1,2 g.

§ﬁÁˆ ÙÔ˘ ÎÔÓÙÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜ ¤ÁÈÓÂ ·ÎÙÈ-

ÓÔÏÔÁÈÎﬁ˜ ¤ÏÂÁ¯Ô˜: 1) ¿ÎÚ·˜ ¯ÂÈÚﬁ˜, Ô˘ ¤‰ÂÈÍÂ

fiÙÈ Ë ÔÛÙÈÎ‹ ËÏÈÎ›· Û˘Ì‚¿‰È˙Â ÌÂ ÙË ¯ÚÔÓÔÏÔÁÈÎ‹. 2) ·fi ÙÔÓ ÏÔÈfi ÛÎÂÏÂÙfi ·Ú·ÙËÚ‹ıËÎÂ ÌÈÎÚfi ‡„Ô˜ ÛÔÓ‰˘ÏÈÎÒÓ ÛˆÌ¿ÙˆÓ ÌÂ ‚Ú·¯‡ÙÂÚÔ ÙÔ Ô›ÛıÈÔ ÙÌ‹Ì· ·˘ÙÒÓ, ÚfiÛıÈ· Î¿Ùˆ

ÁˆÓ›ˆÛË ÙÔ˘ √2 ÛÔÓ‰‡ÏÔ˘, ˘ÔÏ·Û›· Ï·ÁÔÓ›ˆÓ, ·ÓˆÌ·Ï›· ÙË˜ ·Ú˘Ê‹˜ ÙË˜ ÎÔÙ‡ÏË˜ Î·È ÙÔ˘ ¿Óˆ ¯Â›ÏÔ˘˜ ÙˆÓ ÌÂÙ·Ê‡ÛÂˆÓ ˆ˜ Î·È ·ÓÂ-

∂ÈÎfiÓ· 1. º·›ÓÂÙ·È ÙÔ ÎÔÓÙfi ·Ó¿ÛÙËÌ· ÙÔ˘ ·ÛıÂÓ‹, ÙÔ È‰ÈfiÌÔÚÊÔ ÚÔÛˆÂ›Ô, Ô Â˘Ú‡˜ ıÒÚ·Î·˜, Ë ÔÛÊ˘˚Î‹ ÏfiÚ‰ˆÛË, Ë ÚÔ¤¯Ô˘Û· ÎÔÈÏ›· Î·È Ù· ÌÂÁ¿Ï· ¯¤ÚÈ·.

Û˘¯ÓÒÓ ÏÔÈÌÒÍÂˆÓ ¤ÁÈÓÂ Î·È Ï‹ÚË˜ ·ÓÔÛÔÏÔÁÈ-

Îﬁ˜ ¤ÏÂÁ¯Ô˜: ·) √ ·ÓÔÛÔÊ·ÈÓﬁÙ˘Ô˜ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜ ·ÔÎ¿Ï˘„Â ÛÔ‚·Ú‹ ÌÂ›ˆÛË ÙˆÓ CD4 T ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ Î·È ·‡ÍËÛË ÙˆÓ ˘Ô‰Ô¯¤ˆÓ TCRÁ‰ (CD4: 18%, CD3TCRÁ‰: 14% ÌÂ Ê˘ÛÈÔÏÔÁÈÎ¤˜ ÙÈÌ¤˜ <7,5).

√È ‰Â›ÎÙÂ˜ ÙˆÓ µ Î˘ÙÙ¿ÚˆÓ Î·È ÙˆÓ Î˘ÙÙ·ÚÔÎÙﬁÓˆÓ ·Ú¤ÌÂÈÓ·Ó ·ÓÂËÚ¤·ÛÙÔÈ, ﬁˆ˜ Â›ÛË˜

Î·È ÔÈ ‰Â›ÎÙÂ˜ ‰ÈÂÁ¤ÚÛÂˆ˜-ÂÓÂÚÁÔÔÈ‹ÛÂˆ˜. ‚)

™ÙÈ˜ ·ÓÔÛÔÛÊ·ÈÚ›ÓÂ˜ ÔÚÔ‡ ·Ú·ÙËÚ‹ıËÎÂ ÌÂ›ˆÛË ÙÔ˘ IgG ÎÏ¿ÛÌ·ÙÔ˜: IgG: 521 mg/dl (Ê.Ù. 7001622). Á) ∆¤ÏÔ˜, ¤ÁÈÓÂ Î·È ‰È¤ÁÂÚÛË Î·ÏÏÈ¤ÚÁÂÈ·˜ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ ÌÂ ÙË ÌÈÙÔÁﬁÓÔ Ô˘Û›· PHA Ë ÔÔ›· ¤‰ÂÈÍÂ ÛÙÔÓ ·ÛıÂÓ‹: 16.870 bits Ú·‰ÈÂÓ¤ÚÁÂÈ·˜ Î·È ÛÙÔÓ Ì¿ÚÙ˘Ú·: 110.650 bits Ú·‰ÈÂÓ¤ÚÁÂÈ·˜ (Ê.Ù. 60.000-150.000), ‰ËÏ·‰‹ ·Ú·ÙËÚ‹ıËÎÂ ÂÚ›Ô˘ ‰¤Î· ÊÔÚ¤˜ ¯·ÌËÏﬁÙÂÚË ·¿ÓÙËÛË ÙÔ˘ ·ÛıÂÓÔ‡˜ ÛÂ Û¯¤ÛË ÌÂ ÙÔÓ Ì¿ÚÙ˘Ú·. ∂ÔÌ¤Óˆ˜, ÂÈ‚Â‚·ÈÒıËÎÂ ÛÙÔÓ

∂ÈÎfiÓ· 2. ¶·Ú·ÙËÚÂ›Ù·È Ë ÔÛÊ˘˚Î‹ ÏfiÚ‰ˆÛË, Ô Î˘ÏÈÓ‰ÚÈÎfi˜ ıÒÚ·Î·˜ Î·È Ù· ÌÂÁ¿Ï· ¯¤ÚÈ·.

24ÒÚÔ˘, Ë ÙÈÌ‹ ÙÔ˘ Î˘Ì·ÈÓfiÙ·Ó ·fi 1,2 ¤ˆ˜ 1,5 g/24ˆÚÔ. ŒÏÂÁ¯Ô˜ ÙË˜ ÓÂÊÚÈÎ‹˜ ÏÂÈÙÔ˘ÚÁ›·˜ ¤‰ÂÈÍÂ: Û¿Î¯·ÚÔ: 80 mg/dl, ÔÏÈÎ¿ ÏÂ˘ÎÒÌ·Ù·: 5,4 g/dl, ÏÂ˘ÎˆÌ·Ù›ÓË: 3,4 g/dl, ¯ÔÏËÛÙÂÚ›ÓË: 218 mg/dl, ÙÚÈÁÏ˘ÎÂÚ›‰È·: 136 mg/dl, HDL: 62 mg/dl, LDL: 119 mg/dl, Ô˘Ú›·: 28 mg/dl, ÎÚÂ·ÙÈÓ›ÓË: 0,4 mg/dl, Ô˘ÚÈÎfi ÔÍ‡: 3,6 mg/dl, SGOT: 48 mg/dl, SGPT: 17 mg/dl, ÁGT: 19 mg/dl, ·ÏÎ·ÏÈÎ‹ ÊˆÛÊ·Ù¿ÛË: 185 IU/dl, K+:4,1 mmoll/l, Na+:140 mmol/l, Cl-: 109 mmol/l, Ca oÏÈÎfi: 9 mg/dl, P: 4,2 mg/dl, Mg: 1,7 mg/dl. ¶ÚÔÁÚ·ÌÌ·Ù›ÛÙËÎÂ ‚ÈÔ„›· ÓÂÊÚÔ‡, Ë ÔÔ›· ¤‰ÂÈÍÂ ÚÈÎÓˆÙÈÎ¤˜ ·ÏÏÔÈÒÛÂÈ˜ ÛÙÔ 68% ÙˆÓ ÛÂÈÚ·Ì¿ÙˆÓ Î·È ÂÓ·Ôı¤ÛÂÈ˜ C3 ÛÙ· ·ÚÙËÚ›‰È· Î·È ÛÙËÓ Î¿„· ÙÔ˘ Bowman, Â˘Ú‹Ì·Ù· ·Ú¯fiÌÂÓË˜ ÂÛÙÈ·Î‹˜ ÙÌËÌ·ÙÈÎ‹˜ ÛÂÈÚ·Ì·ÙÔÛÎÏ‹Ú˘ÓÛË˜ (FSGS) (∂ÈÎfiÓ· 7).

§ﬁÁˆ ÙˆÓ ÎÏÈÓÈÎÒÓ, ÂÚÁ·ÛÙËÚÈ·ÎÒÓ Î·È ·ÎÙÈÓÔÏÔÁÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ Ù¤ıËÎÂ Ë ‰È¿ÁÓˆÛË ÙË˜ SIOD. °È· ÙËÓ ÙÂÎÌËÚ›ˆÛË ÙË˜ ‰È¿ÁÓˆÛË˜ ÂÛÙ¿ÏË ‰Â›ÁÌ· ·›Ì·ÙÔ˜ ÛÙÈ˜ ∏¶∞ ÁÈ· ÌÔÚÈ·Î‹ ·Ó¿Ï˘ÛË DNA ÛÙÔ ·È‰› Î·È ÛÙÔ˘˜ ÁÔÓÂ›˜. ∆· ÚÒÙ· ·ÔÙÂÏ¤ÛÌ·Ù· Â›Ó·È ÂÈ‚Â‚·ÈˆÙÈÎ¿ ÁÈ· ·ÚÔ˘Û›· ÂÙÂÚﬁ˙˘ÁË˜ ÌÂÙ¿ÏÏ·ÍË˜ 1736C>T, Ô˘ ·ÓÈ¯ÓÂ‡ıËÎÂ ÛÙÔ ÂÍÒÓÈÔ 11 ÙÔ˘ ÁÔÓÈ‰›Ô˘ SMARCAL1, ÌÂ ÙË Ì¤ıÔ‰Ô ÙÔ˘ ¿ÌÂÛÔ˘

∂ÈÎﬁÓ· 3. ¶ÚÔ¤¯Ô˘Û· ÎÔÈÏ›· Î·È ÌÂÏ·Á¯ÚˆÌ·ÙÈÎ¤˜ ÎËÏ›‰Â˜.

ÚÔÛ‰ÈÔÚÈÛÌÔ‡ ·ÏÏËÏÔ˘¯›·˜ DNA (direct sequencing). √ ·Ù¤Ú·˜ Â›Ó·È ÂÙÂÚÔ˙˘ÁÒÙË˜ ÁÈ· ÙËÓ ›‰È· ÌÂÙ¿ÏÏ·ÍË. ∏ ÂÍ¤Ù·ÛË ‚Ú›ÛÎÂÙ·È

·ÎfiÌË ÛÂ ÂÍ¤ÏÈÍË ÁÈ· ÙËÓ ·Ó›¯ÓÂ˘ÛË ÌÂÙ¿ÏÏ·ÍË˜ Î·È ÛÙÔ ·ÏÏËÏfiÌÔÚÊÔ Ô˘ ÚÔ¤Ú¯ÂÙ·È ·fi

ÙË ÌËÙ¤Ú·.

∏ ıÂÚ·Â›· ÙÔ˘ ·È‰ÈÔ‡ Ì¤¯ÚÈ Û‹ÌÂÚ· Â›Ó·È Û˘ÌÙˆÌ·ÙÈÎ‹ Î·È ·Ú·ÎÔÏÔ˘ıÂ›Ù·È Û˘ÛÙËÌ·ÙÈÎ¿ ÁÈ· ÙÔ ÂÓ‰Â¯ﬁÌÂÓÔ ·Ó¿Ù˘ÍË˜ ‰Â˘ÙÂÚÔ·ıÒÓ ÂÈÏÔÎÒÓ.

™˘˙‹ÙËÛË

∏ ·ÓÔÛÔ-ÔÛÙÈÎ‹ ‰˘ÛÏ·Û›· Ù‡Ô˘ Schimke (Schimke immuno-osseous dysplasia, SIOD, √ªπª: 242900) ÂÚÈÁÚ¿ÊËÎÂ ÁÈ· ÚÒÙË ÊÔÚ¿ ÙÔ 1974 ·ﬁ ÙÔÓ Schimke ÛÂ ¤Ó· ÎÔÚ›ÙÛÈ 6 ÂÙÒÓ

Ô˘ ·ÚÔ˘Û›·˙Â ÛÔÓ‰˘ÏÔÂÈÊ˘ÛÈ·Î‹ ‰˘ÛÏ·Û›·, ÂÍÂÏÈÛÛfiÌÂÓË ÓÂÊÚÈÎ‹ ÓfiÛÔ, ÂÓ‰Â›ÍÂÈ˜ ‰È·Ù·Ú·ÁÌ¤ÓË˜ Î˘ÙÙ·ÚÈÎ‹˜ ·ÓÔÛ›·˜ Î·È ·˘ÍËÌ¤ÓË ·Ô‚ÔÏ‹ 6-ıÂÈÈÎ‹˜ ¯ÔÓ‰ÚÔ˚Ù›ÓË˜ ÛÙ· Ô‡Ú· (2). §fiÁˆ ·˘ÙÔ‡ ÙÔ˘ ÙÂÏÂ˘Ù·›Ô˘ Â˘Ú‹Ì·ÙÔ˜, ıÂˆÚ‹ıËÎÂ fiÙÈ ÚfiÎÂÈÙ·È ÁÈ· Ó¤Ô Ù‡Ô ‚ÏÂÓÓÔÔÏ˘Û·Î¯·Ú›‰ˆÛË˜, ÁÂÁÔÓfi˜ ÙÔ ÔÔ›Ô ·ÚÁfiÙÂÚ· ‰ÂÓ Â·ÏËıÂ‡ÙËÎÂ. ∆Ô 1991, ÔÈ Spranger Î·È Û˘Ó ÂÚÈ¤ÁÚ·„·Ó ¿ÏÏÂ˜ ¤ÓÙÂ ·ÚfiÌÔÈÂ˜ ÂÚÈÙÒÛÂÈ˜, ¯ˆÚ›˜ ·Ó›¯ÓÂ˘ÛË ÌÂÙ·‚ÔÏÈÙÒÓ ÛÙ· Ô‡Ú·, ÂÓÒ Ô Spranger ‹Ù·Ó ·˘Ùfi˜ Ô˘

¤‰ˆÛÂ ÙÔ ﬁÓÔÌ· SIOD ÛÙË ‰È·Ù·Ú·¯‹ (4). √ÊÂ›ÏÂÙ·È ÛÂ ÌÂÙ¿ÏÏ·ÍË ÙÔ˘ ÁÔÓÈ‰›Ô˘ SMARCAL 1 (SW1/SNF2-related matrix-associated actindependent regulator of chromatin, sub-family alike 1), ÙÔ ÔÔ›Ô Îˆ‰ÈÎÔÔÈÂ› Ì›· Ú˘ıÌÈÛÙÈÎ‹

ÚˆÙÂ˝ÓË Ô˘ Û¯ÂÙ›˙ÂÙ·È ÌÂ ÙËÓ Â·Ó·‰fiÌËÛË ÙÔ˘ ÓÔ˘ÎÏÂÔÛÒÌ·ÙÔ˜ (5). ∏ Â·Ó·‰fiÌËÛË ·˘Ù‹ ·Ú·ÙËÚÂ›Ù·È Û˘Ó‹ıˆ˜ Î·Ù¿ ÙË ÁÔÓÈ‰È·Î‹ Ú‡ıÌÈÛË, fiˆ˜ ÙÔÓ ·Ó·‰ÈÏ·ÛÈ·ÛÌfi, ÙÔÓ ·Ó·Û˘Ó‰˘·ÛÌfi, ÙË ÌÂı˘Ï›ˆÛË Î·È ÙËÓ ÂÈ‰ÈfiÚıˆ-

∂ÈÎﬁÓ· 4. ∞ÎÙÈÓÔÁÚ·Ê›· ÛÔÓ‰˘ÏÈÎ‹˜ ÛÙ‹ÏË˜. ¶·Ú·ÙËÚÂ›Ù·È ÌÈÎÚﬁ ‡„Ô˜ ÛÔÓ‰˘ÏÈÎÒÓ ÛˆÌ¿ÙˆÓ, ÂÈ‰ÈÎ¿ ÛÙÔ

Ô›ÛıÈÔ Ì¤ÚÔ˜ ·˘ÙÒÓ. ¶ÚﬁÛıÈ· Î¿Ùˆ ÁˆÓ›ˆÛË ÙÔ˘ √2.

ÛË ÙÔ˘ DNA. Œ¯ÂÈ ÚﬁÛÊ·Ù· ¯·ÚÙÔÁÚ·ÊËıÂ›

ÛÙË ı¤ÛË 2q34-q36 Î·È ¤¯Ô˘Ó ÌÂÏÂÙËıÂ› ·ÚÎÂ-

Ù¤˜ ÌÂÙ·ÏÏ¿ÍÂÈ˜ (1). ∏ ‡·ÚÍË ·ÚÎÂÙÒÓ Î·È ‰È·ÊﬁÚˆÓ ÂÈ‰ÒÓ ÛËÌÂÈ·ÎÒÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ ÛÙÔ

›‰ÈÔ ÁÔÓ›‰ÈÔ Ê·›ÓÂÙ·È fiÙÈ Û˘Ó‰¤ÂÙ·È ÌÂ ÙËÓ ÎÏÈÓÈÎ‹ ÔÈÎÈÏÔÌÔÚÊ›· Î·È ÙËÓ ËÏÈÎ›· ÂÌÊ¿ÓÈÛË˜ ÙÔ˘ ÓÔÛ‹Ì·ÙÔ˜. ∏ ‡·ÚÍË ·ÚÂÚÌËÓÂ‡ÛÈÌË˜ (missense) ÌÂÙ¿ÏÏ·ÍË˜ ‚ÔËı¿ ÛÙË ‰È·Ù‹ÚËÛË Î¿ÔÈ·˜ ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ·˜ ÙÔ˘ SMARCAL1 ÁÔÓÈ‰›Ô˘ Î·È Ô‰ËÁÂ› ÛÂ ËÈfiÙÂÚË ÓfiÛÔ (ÂÊË‚ÈÎfi˜ Ù‡Ô˜), ÛÂ ·ÓÙ›ıÂÛË ÌÂ ÙÈ˜ ·ÓÂÚÌËÓÂ‡ÛÈÌÂ˜ (nonsense), Ï·ÈÛÈÔÙÚÔÔÔÈËÙÈÎ¤˜ (frameshift) ‹ ÌÂÙ·ÏÏ¿ÍÂÈ˜ Ì·Ù›ÛÌ·ÙÔ˜ (splicing) Ô˘ Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÈÔ ÛÔ‚·Ú‹ Î·È ÂÈ‰ÂÈÓÔ‡ÌÂÓË ÔÚÂ›· (‚ÚÂÊÈÎfi˜ Ù‡Ô˜) (1,5). ∏ ·Ó›¯ÓÂ˘ÛË ÛÙÔÓ ·ÛıÂÓ‹ ÙË˜ ·ÚÔ‡Û·˜ ÂÚ›ÙˆÛË˜ ÙË˜ ·ÚÂÚÌËÓÂ‡ÛÈÌË˜ ÌÂÙ¿ÏÏ·ÍË˜ 1736C>T Ô‰ËÁÂ› ÛÂ ·ÓÙÈÎ·Ù¿ÛÙ·ÛË ÂÓfi˜ ·ÌÈÓÔÍ¤Ô˜ (S579L) ÛÙËÓ

∂ÈÎﬁÓ· 5. ∞ÎÙÈÓÔÁÚ·Ê›· ÏÂÎ¿ÓË˜-ÈÛ¯›ˆÓ.

∂ÈÎﬁÓ· 7. µÈÔ„›· ÓÂÊÚÔ‡. ∞ÂÈÎÔÓ›˙ÂÙ·È ¤Ó· ÛÂ›Ú·Ì· Ô˘ Û˘ÌÊ‡ÂÙ·È ÌÂ ÙËÓ Î¿„· ÙÔ˘ Bowman Î·È ¤Ó· ÌÂ ÚÈÎÓˆÙÈÎ‹ ÛÎÏ‹Ú˘ÓÛË. ∆· Ô˘ÚÔÊﬁÚ· ÛˆÏËÓ¿ÚÈ· ÂÌÊ·Ó›˙Ô˘Ó ÂÛÙ›Â˜ ·ÙÚÔÊ›·˜ Î·È ·ıÚÔ›ÛÂÈ˜ ·ÔÊÔÏÈ‰ˆÌ¤ÓˆÓ Î˘ÙÙ¿ÚˆÓ.

ÚˆÙÂ˝ÓË SMARCAL1. ∂›Ó·È Ë ‰Â‡ÙÂÚË ÊÔÚ¿ Ô˘ ·ÓÈ¯ÓÂ‡ÂÙ·È Ë Û˘ÁÎÂÎÚÈÌ¤ÓË ÌÂÙ¿ÏÏ·ÍË ÛÂ ·ÛıÂÓ‹ ÌÂ SIOD (5). ∂ÂÈ‰‹ ÙÔ ÓfiÛËÌ· Â›Ó·È ˘ÔÏÂÈfiÌÂÓÔ, Ú¤ÂÈ Ó· ˘¿Ú¯Ô˘Ó ‰‡Ô ‹ ÂÚÈÛÛfiÙÂÚÂ˜ ‰È·ÊÔÚÂÙÈÎ¤˜ ÌÂÙ·ÏÏ¿ÍÂÈ˜ ÛÙÔ ›‰ÈÔ ÁÔÓ›‰ÈÔ. Œˆ˜ ÙÒÚ· ‰ÂÓ ¤¯ÂÈ ·ÓÈ¯ÓÂ˘ıÂ› Ë ‰Â‡ÙÂÚË ÌÂÙ¿ÏÏ·ÍË, Ô˘ ˘Ô¯ÚÂˆÙÈÎ¿

ÓÈÎ‹˜ ¤ÎÊÚ·ÛË˜ ÛÙÔ ·È‰›. ∏ ·ıÔÁ¤ÓÂÈ· ÙÔ˘ ÓÔÛ‹Ì·ÙÔ˜ ‰ÂÓ Â›Ó·È Ï‹Úˆ˜ ‰ÈÂ˘ÎÚÈÓÈÛÌ¤ÓË. ∫·Ù¿ Ì›· ˘fiıÂÛË, Ù· ÁÔÓ›‰È· Ô˘ ÂËÚÂ¿˙ÔÓÙ·È ·fi ÙÈ˜ ÌÂÙ·ÏÏ¿ÍÂÈ˜ ÙÔ˘ SMARCAL1 Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÙËÓ ·Ó¿Ù˘ÍË Î·È ‰È·ÊÔÚÔÔ›ËÛË ÙˆÓ ¯ÔÓ‰ÚÔÎ˘ÙÙ¿ÚˆÓ, ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ Î·È ›Ûˆ˜ ÙˆÓ ÌÂÏ·ÓÔÎ˘ÙÙ¿ÚˆÓ, ÂÓÒ ÌÂÚÈÎ¿ ·fi ·˘Ù¿ ›Ûˆ˜ Â›Ó·È ··Ú·›ÙËÙ· ÁÈ· ÙË Û˘ÓÙ‹ÚËÛË ÙÔ˘ ÓÂÊÚÈÎÔ‡ ÈÛÙÔ‡ Î·È ÙÔ˘ ·ÚÙËÚÈ·ÎÔ‡ ÙÔÈ¯ÒÌ·ÙÔ˜. ø˜ ÚÔ˜ Ù· ÏÂÌÊÔÎ‡ÙÙ·Ú·, ÈÛÙÂ‡ÂÙ·È fiÙÈ ˘¿Ú¯ÂÈ Î¿ÔÈ· ·ÓˆÌ·Ï›· ÛÙË ‰È·ÊÔÚÔÔ›ËÛË Î·È ‰È·ÏÔÁ‹ ÙˆÓ ∆Î˘ÙÙ¿ÚˆÓ ÛÙÔÓ ı‡ÌÔ ·‰¤Ó·, ÏfiÁˆ ·ÔÙ˘¯›·˜ Û‡Ó‰ÂÛË˜ ÙÔ˘ DNA Î·Ù¿ ÙÈ˜ ·Ó·Î·Ù·Ù¿ÍÂÈ˜ ÁÔÓÈ‰›ˆÓ Ô˘ Û˘Ì‚·›ÓÔ˘Ó Ê˘ÛÈÔÏÔÁÈÎ¿ ÛÂ ·˘Ù‹ ÙË ‰È·‰ÈÎ·Û›· (1). ™˘˙ËÙÂ›Ù·È, Â›ÛË˜, Ë ˘fiıÂÛË fiÙÈ Ë ÓÂÊÚÈÎ‹ ‚Ï¿‚Ë Â›Ó·È ‰Â˘ÙÂÚÔÁÂÓ¤˜ Ê·ÈÓfiÌÂÓÔ, ÔÊÂÈÏfiÌÂÓÔ ÛÙËÓ ÂÏ·ÙÙˆÌ·ÙÈÎ‹ Î˘ÙÙ·ÚÈÎ‹ ·ÓÔÛ›·, Ë ÔÔ›· ÚÔ‰È·ı¤ÙÂÈ ÛÂ ÏÔÈÌÒÍÂÈ˜ Î·È ·ÎÔÏÔ‡ıˆ˜ ÛÂ ÂÓ·fiıÂÛË ·ÓÔÛÔÛ˘ÌÏÂÁÌ¿ÙˆÓ ÛÙÔÓ ÓÂÊÚÈÎfi ÈÛÙfi (1). ™Â ÌÂÁ·Ï‡ÙÂÚÂ˜ ËÏÈÎ›Â˜ ·Ú·ÙËÚÂ›Ù·È ÂÁÎÂÊ·ÏÈÎ‹ ÈÛ¯·ÈÌ›·, ÏfiÁˆ ·ÏÏÔ›ˆÛË˜ ÙÔ˘ Û˘Ó‰ÂÙÈÎÔ‡ ÈÛÙÔ‡, ÌÂ Û˘Ó¤ÂÈ· ÙËÓ Â˘ıÚ·˘ÛÙfiÙËÙ· ÙÔ˘ ·ÚÙËÚÈ·ÎÔ‡ ÙÔÈ¯ÒÌ·ÙÔ˜ Î·È ·ÚÙËÚÈÔÛÎÏ‹Ú˘ÓÛË, ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ÙËÓ ˘¤ÚÙ·ÛË Î·È ÙËÓ ˘ÂÚÏÈÈ‰·ÈÌ›· Ô˘ Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÙË ÓÂÊÚÈÎ‹ ‚Ï¿‚Ë (6,7). ªÂ›˙ÔÓ· ÎÚÈÙ‹ÚÈ· ÁÈ· ÙË ‰È¿ÁÓˆÛË ÙË˜ SIOD ·ÔÙÂÏÔ‡Ó Ë ·Ó·ÛÙÔÏ‹ ÙË˜ ÛˆÌ·ÙÈÎ‹˜ ·Ó¿Ù˘ÍË˜, Ë ·ÓÂ¿ÚÎÂÈ· ÙË˜ ∆ Î˘ÙÙ·ÚÈÎ‹˜ ·ÓÔÛ›·˜, Ë ÚÔÔ‰Â˘ÙÈÎ¿ ÂÍÂÏÈÛÛfiÌÂÓË ÓÂÊÚÔ¿ıÂÈ·, ÔÈ ˘ÂÚ¯ÚˆÌ·ÙÈÎ¤˜ ÎËÏ›‰Â˜ ÛÙÔÓ ÎÔÚÌfi Î·È Ô ¯·Ú·ÎÙËÚÈÛÙÈÎfi˜

Â›Ó·È ¯·Ú·ÎÙËÚÈÛÙÈÎ¤˜,

¶›Ó·Î·˜ 1. ªÔÚÊÔÏÔÁÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÚÔÛÒÔ˘

1. ∂Ì‚¿ı˘ÓÛË ÔÊı·ÏÌÒÓ

2. ªÈÎÚ¤˜ ‚ÏÂÊ·ÚÈÎ¤˜ Û¯ÈÛÌ¤˜

3. Ã·ÌËÏ‹ Î·È Â˘ÚÂ›· ÚÈÓÈÎ‹ Á¤Ê˘Ú·

4. ∞ÔÛÙÚÔÁÁ˘ÏÂÌ¤ÓÔ ·ÎÚÔÚÚ›ÓÈÔ

5. ªÈÎÚÔ‰ÔÓÙ›·

6. ª·ÎÚ‡ ¿Óˆ ¯Â›ÏÔ˜

7. À„›Û˘¯ÓË ÊˆÓ‹ (high pitched voice)

8. ∂ÛÙ›Â˜ ıÔÏÂÚﬁÙËÙ·˜ ÛÙÔÓ ÎÂÚ·ÙÔÂÈ‰‹ ¯ÈÙÒÓ·

9. §ÂÙ¿ Ì·ÏÏÈ¿

ﬁˆ˜ Ê·›ÓÂÙ·È ÛÙÔÓ ¶›Ó·Î· 1 Î·È ‰È·ÈÛÙÒıËÎ·Ó Î·È ÛÙÔÓ ·ÛıÂÓ‹ Ì·˜ (∂ÈÎﬁÓÂ˜ 1, 2, 3) (8). ∆· ·ÎÙÈÓÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù· ÂÈ‚Â‚·ÈÒÓÔ˘Ó ÙË

ÛÔÓ‰˘ÏÔÂÈÊ˘ÛÈ·Î‹ ‰˘ÛÏ·Û›· (ˆÔÂÈ‰Â›˜ ÔÈ-

Ûı›ˆ˜ ÂÈÂ‰ˆÌ¤ÓÔÈ ÛﬁÓ‰˘ÏÔÈ, ˘ÔÏ·ÛÙÈÎ‹

‡ÂÏÔ˜, ·ÓÒÌ·ÏÂ˜ ÎÂÊ·Ï¤˜ ÌËÚÈ·›ˆÓ, ÔÛÙÂÔÂÓ›·, ıˆÚ·ÎÈÎ‹ Î‡ÊˆÛË) (∂ÈÎﬁÓÂ˜ 4, 5, 6).

∏ ÚˆÙÂ˚ÓÔ˘Ú›· Ô˘ ·ÚÔ˘Û›·˙Â Ô ·ÛıÂÓ‹˜ ÙË˜ ·ÚÔ‡Û·˜ ÂÚ›ÙˆÛË˜, ‹Ù·Ó ÛËÌ·ÓÙÈÎ‹ Î·È Ë ˘ÔÎÂ›ÌÂÓË ÈÛÙÔÏÔÁÈÎ‹ ÂÈÎfiÓ· ‹Ù·Ó Û˘Ì‚·Ù‹ ÌÂ ÂÛÙÈ·Î‹ ÙÌËÌ·ÙÈÎ‹ ÛÂÈÚ·Ì·ÙÔÛÎÏ‹Ú˘ÓÛË. Ÿˆ˜ Â›Ó·È ÁÓˆÛÙfi, Ô ÈÛÙÔÏÔÁÈÎfi˜ ·˘Ùfi˜ Ù‡Ô˜ Û˘¯Ó¿ Ô‰ËÁÂ› ÛÂ ÓÂÊÚÈÎ‹ ·ÓÂ¿Ú-

ÎÂÈ·. √È ·ÁÁÂÈ·Î¤˜ ‰È·Ù·Ú·¯¤˜ Ô˘ ÂÌÊ·Ó›˙Ô-

ÓÙ·È Û˘Ó‹ıˆ˜ ÛÂ ÌÂÁ·Ï‡ÙÂÚË ËÏÈÎ›·, ÚÔ‚¿Ï-

ÏÔ˘Ó ÌÂ ÎÂÊ·Ï·ÏÁ›Â˜ Ù‡Ô˘ ËÌÈÎÚ·Ó›·˜ ‹ ÌÂ

·ÚÔ‰ÈÎ¿ ‹ Î·È ÌﬁÓÈÌ· ÈÛ¯·ÈÌÈÎ¿ ÂÁÎÂÊ·ÏÈÎ¿

ÂÂÈÛﬁ‰È· (6,8-10). ∏ MRI ·Ó·‰ÂÈÎÓ‡ÂÈ ÂÍÂÏÈÛ-

ÛﬁÌÂÓÂ˜ ·ÏÏÔÈÒÛÂÈ˜ ÙË˜ ÏÂ˘Î‹˜ Ô˘Û›·˜, Û˘Ì‚·Ù¤˜ ÌÂ ÂÁÎÂÊ·ÏÈÎ‹ ÈÛ¯·ÈÌ›·, Î·ıÒ˜ Â›ÛË˜

Î·È ÂÚÈÔ¯¤˜ Î˘ÛÙÈÎ‹˜ ·ÏÏÔ›ˆÛË˜ (ÂÁÎÂÊ·ÏÔÌ·Ï¿Î˘ÓÛË ÌÂ Û˘Ó¤ÂÈ· Î¿ÔÈÂ˜ ÊÔÚ¤˜ ÙË ÓÔË-

ÙÈÎ‹ ¤ÎÙˆÛË), ˆ˜ ÚÔ˚ﬁÓ ÂÍ¤ÏÈÍË˜ ÙÔ˘ ÈÛ¯·ÈÌÈÎÔ‡ ÂÌÊÚ¿ÎÙÔ˘ (3,7). ™·ÓÈﬁÙÂÚÂ˜ ÂÎ‰ËÏÒ-

ÛÂÈ˜ Ô˘ ¤¯Ô˘Ó ·Ó·ÊÂÚıÂ› ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Ê·È-

ÓﬁÌÂÓ· ·˘ÙÔ·ÓÔÛ›·˜, ﬁˆ˜ ÂÓÙÂÚÔ¿ıÂÈ·, ·Ó·ÈÌ›·-ıÚÔÌ‚ÔÎ˘ÙÙÔÂÓ›· Ô˘ ÌÔÚÂ› Ó·

Ô‰ËÁ‹ÛÂÈ ÛÂ Ì˘ÂÏÈÎ‹ ·Ï·Û›· Î·È ·‡ÍËÛË ÙÔ˘ Ù›ÙÏÔ˘ ·ÓÙÈÊˆÛÊÔÏÈÈ‰ÈÎÒÓ Î·È ·ÓÙÈÁÏÈ·‰ÈÓÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ (6,11). ∏ ÚÔÛ‚ÔÏ‹ ÙÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Û˘Ó›ÛÙ·Ù·È Î˘Ú›ˆ˜ ÛÂ

‚Ï¿‚Ë ÙË˜ Î˘ÙÙ·ÚÈÎ‹˜ ·ÓÔÛ›·˜, ÂÓÒ ÂÓ›ÔÙÂ ÛËÌÂÈÒÓÂÙ·È Î·È ˘ÔÁ·ÌÌ·ÛÊ·ÈÚÈÓ·ÈÌ›· (9). √ ·ÛıÂÓ‹˜ ÙË˜ ·ÚÔ‡Û·˜ ÂÚ›ÙˆÛË˜ ·ÚÔ˘Û›·ÛÂ ÌÂ›ˆÛË ÙÔ˘ IgG ÎÏ¿ÛÌ·ÙÔ˜ ÙˆÓ ·ÓÔÛÔÛÊ·È-

ÚÈÓÒÓ. ∆Ô Â›‰Ô˜ ÙË˜ ·ÓÂ¿ÚÎÂÈ·˜ ÙˆÓ ∆ Î˘ÙÙ¿ÚˆÓ ÙÔ˘ ·ÛıÂÓÔ‡˜ Â›Ó·È Ù˘ÈÎﬁ ÙË˜ SIOD, Î·ıÒ˜ ·ÚÔ˘Û›·ÛÂ ÌÂ›ˆÛË ÙˆÓ CD4+ Î·È CD3+/CD4+, ˘ÂÚ¤ÎÊÚ·ÛË ÙˆÓ Á‰ ˘Ô‰Ô¯¤ˆÓ ÙˆÓ CD3 T Î˘ÙÙ¿ÚˆÓ Î·È ÂÏ·ÙÙˆÌ¤ÓË ·ÓÙ·ﬁ-

ÙË˜ Î·ÏÏÈ¤ÚÁÂÈ·˜ ∆ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ ÛÂ

ÌÈÙÔÁﬁÓÂ˜ Ô˘Û›Â˜ (9). ∞ﬁ ÙËÓ ÔÌ¿‰·

ÌÂÈÒÓÔÓÙ·È ÌﬁÓÔ Ù· µ ÏÂÌÊÔÎ‡ÙÙ·Ú· Ô˘ ÂÍ·ÚÙÒÓÙ·È ·ﬁ Ù· ∆ ÏÂÌÊÔÎ‡ÙÙ·Ú·.

Î˘ÙÙ·ÚÔÎÙfiÓ· ·Ú·Ì¤ÓÔ˘Ó Î·È ·˘Ù¿ ·ÓÂËÚ¤·ÛÙ· (9). ¶Ú¤ÂÈ Ó· ÛËÌÂÈˆıÂ›, fiÌˆ˜, fiÙÈ Ë ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·, ·Ó Î·È ÌÔÚÂ› Ó· Â›Ó·È ÛÔ‚·Ú‹ ·fi ÙËÓ ¤Ó·ÚÍË ÙË˜

ÓfiÛÔ˘, ‰ÂÓ Î˘ÚÈ·Ú¯Â› ÛÙËÓ ÎÏÈÓÈÎ‹ ÂÈÎfiÓ·, ·Ú¿ ÌfiÓÔ ÌÂÙ¿ ÙËÓ ÂÁÎ·Ù¿ÛÙ·ÛË ·ÓıÂÎÙÈÎ‹˜ ÓÂÊÚÔ¿ıÂÈ·˜ (6,9).

∏ ÚﬁÁÓˆÛË Â›Ó·È Î·Î‹. √È ÂÈÏÔÎ¤˜, ﬁˆ˜ Ë ÓÂÊÚÈÎ‹ ·ÓÂ¿ÚÎÂÈ·, Ë Ì˘ÂÏÈÎ‹ ·Ï·Û›·, ÔÈ ÛÔ‚·Ú¤˜ ˘ÔÙÚÔÈ¿˙Ô˘ÛÂ˜ ÏÔÈÌÒÍÂÈ˜ Î·È Ù·

¶›Ó·Î·˜ 2. ¢È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË ·ÓÔÛÔ-ÔÛÙÈÎ‹˜ ‰˘ÛÏ·Û›·˜ Ù‡Ô˘ Schimke

¶·ı‹ÛÂÈ˜ ÌÂ ÛÎÂÏÂÙÈÎ¤˜ ·ÓˆÌ·Ï›Â˜ ¶·ı‹ÛÂÈ˜ ÌÂ ÛÎÂÏÂÙÈÎ¤˜ ·ÓˆÌ·Ï›Â˜

Î·È ÓÂÊÚÈÎ‹ Û˘ÌÌÂÙÔ¯‹Î·È ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ· ™. Jeune (asphyxiating ¢˘ÛÏ·Û›· ıÒÚ·ÎÔ˜ ∞ÓÂ¿ÚÎÂÈ· thoracic dystrophy)·fi ÙË Á¤ÓÓËÛË ‰Â·ÌÈÓ¿ÛË˜-·‰ÂÓÔÛ›ÓË˜ µÚ·¯˘ÌÂÛÔÌÂÏ›· ÌÂ™. ÌÂÙ·Ê˘ÛÈ·Î‹˜ ÓÂÊÚÈÎ‹ ‰˘ÛÏ·Û›·‰˘ÛÏ·Û›·˜(brachymesomelia-renal ‰˘Û·ÔÚÚfiÊËÛË˜dysplasia) Ô˘‰ÂÙÂÚÔÂÓ›·˜ ™. ªainzer-Saldino ∞ÓˆÌ·Ï›Â˜ ÀÔÏ·Û›· ¯fiÓ‰ÚˆÓ- ∞ÎÙÈÓÔÏÔÁÈÎ¤˜ ·ÏÏÔÈÒÛÂÈ˜ ·ÌÊÈ‚ÏËÛÙÚÔÂÈ‰Ô‡˜ ÙÚÈ¯ˆÙÔ‡ ÎÂÊ·Ï‹˜ ÌÂÙ·Ê˘ÛÈ·Î‹˜ ‰˘ÛÏ·Û›·˜, Î·È ÔÙÈÎÔ‡ ÓÂ‡ÚÔ˘(cartilage-hair hypoplasia)‰È·Ù·Ú·¯‹ Î˘Ù. ·ÓÔÛ›·˜, ÏÂÙ¿, ·Ú·È¿ Î·È

¡ÂÊÚÔÛÈ·Ï›‰ˆÛË ªÂÙ·‚ÔÏÈÎﬁ ÓﬁÛËÌ· (‹ ÛÈ·Ï›‰ˆÛË Ù‡Ô˘ ππ)

™. Wolkott-Rallison

∞ÓÔÛÔ-ÔÛÙÈÎ‹ ‰˘ÛÏ·Û›· Ù‡Ô˘ Schimke

ÂÁÎÂÊ·ÏÈÎ¿ ¤ÌÊÚ·ÎÙ·, ·ÔÙÂÏÔ‡Ó ÙÈ˜ ·ÈÙ›Â˜ ı·-

Ó¿ÙÔ˘. ∏ ÚÒÈÌË ¤Ó·ÚÍË ÙË˜ ÓﬁÛÔ˘ Î·È È‰›ˆ˜ Ô ‚ÚÂÊÈÎﬁ˜ Ù‡Ô˜ Ô˘ Û˘Ó‰¤ÂÙ·È ÌÂ IUGR, ¤¯ÂÈ

Û˘Ó‹ıˆ˜ ‚·ÚÈ¿ ÂÍÂÏÈÛÛﬁÌÂÓË ÔÚÂ›· Î·È ÌÈÎÚﬁ-

ÙÂÚË ÂÈ‚›ˆÛË. ∏ ·Ó¿Ù˘ÍË ÙÔ˘ ÓÂÊÚˆÛÈÎÔ‡

Û˘Ó‰ÚfiÌÔ˘ Â›Ó·È ¤Ó· ÛËÌÂ›Ô ÔÚfiÛËÌÔ, ÁÈ·Ù› ·fi

ÂÎÂ› Î·È ÌÂÙ¿ Ë ÂÍ¤ÏÈÍË ÙË˜ ÓÂÊÚÈÎ‹˜ ‚Ï¿‚Ë˜ Â›Ó·È ÈÔ ÁÚ‹ÁÔÚË, ÌÂ ·Ú¿ÏÏËÏÂ˜ ÂÈÏÔÎ¤˜ Ïﬁ-

Áˆ ÙË˜ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·˜ (1,6). ∏ ÛÂÈÚ¿ ÂÌÊ¿-

ÓÈÛË˜ ÙˆÓ ÎÏÈÓÈÎÒÓ ÂÎ‰ËÏÒÛÂˆÓ Â›Ó·È: ·Ó·ÛÙÔ-

Ï‹ ·‡ÍËÛË˜, ÏÂ˘ÎˆÌ·ÙÔ˘Ú›·, ÓÂÊÚˆÛÈÎﬁ Û‡Ó-

‰ÚÔÌÔ, ·˘ÍËÌ¤ÓË Â˘·ÈÛıËÛ›· ÛÙÈ˜ ÏÔÈÌÒÍÂÈ˜

Ô˘ Î·Ù·Ï‹ÁÂÈ ÛÂ ÛÔ‚·Ú¤˜ ÏÔÈÌÒÍÂÈ˜ ÌÂ ‰˘ÛÌÂÓ‹ ¤Î‚·ÛË. ∏ ‰È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË ÙË˜ ÓﬁÛÔ˘, ﬁˆ˜ Ê·›-

ÓÂÙ·È ÛÙÔÓ ¶›Ó·Î· 2, ÂÚÈÏ·Ì‚¿ÓÂÈ Î·Ù·ÛÙ¿ÛÂÈ˜

ﬁÔ˘ ·Ú·ÙËÚÔ‡ÓÙ·È: ·) ÛÎÂÏÂÙÈÎ¤˜ ·ÓˆÌ·Ï›Â˜

ÌÂ ÓÂÊÚÈÎ‹ Û˘ÌÌÂÙÔ¯‹ Î·È ‚) ÓÔÛ‹Ì·Ù· Ô˘

Û˘Ó‰˘¿˙Ô˘Ó ÛÎÂÏÂÙÈÎ¤˜ ‰˘ÛÏ·Û›Â˜ ÌÂ

ÏÔÁÈÎﬁ ¤ÏÏÂÈÌÌ·. ™ÙÔÓ ·ÛıÂÓ‹ Ì·˜ Ù¤ıËÎÂ Ë ‰È¿-

ÁÓˆÛË ÙË˜ ·ÓÔÛÔ-ÔÛÙÈÎ‹˜ ‰˘ÛÏ·Û›·˜

Schimke, ÁÈ·Ù› ‹Ù·Ó Ë ÌﬁÓË ÓﬁÛÔ˜ ÌÂ Û˘ÌÌÂÙÔ¯‹

Ù· ÔÛÙ¿, ÙÔ˘˜ ÓÂÊÚÔ‡˜ Î·È ÙÔ ·ÓÔÛÔÏÔÁÈÎﬁ

Û‡ÛÙËÌ·. ∏ ÓÂÊÚÈÎ‹ ‚Ï¿‚Ë Â›Ó·È ·ÓıÂÎÙÈÎ‹ ÛÙË ıÂÚ·Â›· ÌÂ ÛÙÂÚÔÂÈ‰‹ Î·È ·ÓÔÛÔÎ·Ù·ÛÙ·ÏÙÈÎ¿ Î·È

ÙÂÏÈÎ¿, ÌÂÙ¿ ÙËÓ ÂÁÎ·Ù¿ÛÙ·ÛË ÙË˜ ¯ÚﬁÓÈ·˜ ÓÂ-

ÊÚÈÎ‹˜ ·ÓÂ¿ÚÎÂÈ·˜, Ô ·ÛıÂÓ‹˜ Ô‰ËÁÂ›Ù·È ÛÙË

ÌÂÙ·ÌﬁÛ¯Â˘ÛË ÓÂÊÚÔ‡. ∏ ÏÔÈ‹ ıÂÚ·Â›· Â›Ó·È

˘ÔÛÙËÚÈÎÙÈÎ‹, ¯ˆÚ›˜ Ó· ˘¿Ú¯ÂÈ Ë ‰˘Ó·ÙﬁÙËÙ· ·Ó·ÎÔ‹˜ ÙË˜ ÂÍÂÏÈÎÙÈÎ‹˜ ÔÚÂ›·˜ ÙË˜ ÓﬁÛÔ˘.

°È· ÙËÓ ·ÔÎ·Ù¿ÛÙ·ÛË ÙˆÓ ·ÈÌ·ÙÔÏÔÁÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ ¤¯Ô˘Ó ‰ÔÎÈÌ·ÛÙÂ› ıÂÚ·Â˘ÙÈÎ¿ G-CSF, GM-CSF, ÂÚ˘ıÚÔÔÈËÙ›ÓË, ÌÂÙ·ÁÁ›ÛÂÈ˜ ÂÚ˘ıÚÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ Î·È ·ÈÌÔÂÙ·Ï›ˆÓ, ÂÓÒ ¯ÔÚËÁÂ›Ù·È ·ÓÙÈ˘ÂÚÙ·ÛÈÎ‹, ·ÓÙÈÏÈÈ‰·ÈÌÈÎ‹ ·ÁˆÁ‹ Î·È ÚÔÊ˘Ï·ÎÙÈÎ‹ ·ÓÙÈÌÈÎÚÔ‚È·Î‹, ﬁÔ˘ ¯ÚÂÈ¿˙ÂÙ·È (6). √È ·ÁÁÂÈ·Î¤˜ ‰È·Ù·Ú·¯¤˜ ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È ÌÂ ·ÓÙÈËÎÙÈÎ¿, ·ÈÌÔÚÚÂÔÏÔÁÈÎ¿ Î·È Î·Ù¿

ÙË˜ ËÌÈÎÚ·Ó›·˜ Ê¿ÚÌ·Î· (6,7). ∆ÂÏÂ˘Ù·›·, ·Ó·Ê¤ÚÂÙ·È ÂÈÙ˘¯ËÌ¤ÓË ÌÂÙ·ÌﬁÛ¯Â˘ÛË Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ ÛÂ Ì›· ÂÚ›ÙˆÛË SIOD Ô˘ Â›¯Â ÂÌÊ·Ó›ÛÂÈ Ì˘ÂÏÈÎ‹ ·Ï·Û›·.

Û˘Ó›ÛÙ·Ù·È ÛÙËÓ ·Ó›¯ÓÂ˘ÛË ÊÔÚ¤ˆÓ Î·È ÛÙË ‰˘Ó·ÙﬁÙËÙ· ÚÔÁÂÓÓËÙÈÎÔ‡ ÂÏ¤Á¯Ô˘ ÛÙÈ˜ ÔÈÎÔÁ¤ÓÂÈÂ˜ ÙˆÓ ·Û¯ﬁÓÙˆÓ.

∂˘¯·ÚÈÛÙ›Â˜

£ÂÚÌ¤˜ Â˘¯·ÚÈÛÙ›Â˜ ÛÙÔÓ Assistant Professor C.F. Boerkoel ·ﬁ ÙÔ ∆Ì‹Ì· ªÔÚÈ·Î‹˜ °ÂÓÂÙÈÎ‹˜ ÙÔ˘ ∞ÓıÚÒÔ˘ ÙÔ˘ Baylor College of Medicine, USA.

µÈ‚ÏÈÔÁÚ·Ê›·

1.Lou S, Lamfers P, McGuire N, Boerkoel CF. Longevity in Schimke immuno-osseous dysplasia. J Med Genet 2002;39:922-925.

2.Schimke RN, Horton WA, King CR, Martin NL. Chondroitin-6-sulfate mucopoly-saccharidosis in conjunction with lymphopenia, defective cellular immunity and the nephrotic syndrome. Birth Defects Orig Artic Ser 1974;10:258-266.

3.Sigurdardorttir S, Myers SM, Woodworth JM, Raymond GV. Mental retardation and seizure disorder in Schimke immunoosseous dysplasia. Am J Med Genet 2000;90:294-298.

4.Spranger J, Hinkel GK, Stoss H, Thoenes W, Wargowski D, Zepp F. Schimke immuno-osseous dysplasia: a newly recognized multisystem disease. J Pediatr 1991;119:64-72.

5.Boerkoel CF, Takashima H, John J, Yan J, Stankiewicz P, Rosenbarker L et al. Mutant chromatin remodeling protein SMARCAL1 causes Schimke immuno-osseous dysplasia. Nat Genet 2002;30:215-220.

6.Boerkoel CF, O'Neill S, Andre JL, Benke PJ, Bogdanovic R, Bulla M et al. Manifestations and treatment of Schimke immuno-osseous dysplasia: 14 new cases and a review of the literature. Eur J Pediatr 2000;159:1-7.

7.Schmidt B, Christen HJ, Herkenrath P, Benz-Bohm G, Muller-Berghaus J, Querfeld U. Cerebral complications in Schimke immuno-osseous dysplasia. Eur J Pediatr 1997;156:789-791.

8.Ludman MD, Cole DE, Crocker JF, Cohen MM Jr. Schimke immuno-osseous dysplasia: case report and review. Am J Med Genet 1993;47:793-796.

9.Saraiva JM, Dinis A, Resende C, Faria E, Gomes C, Correia AJ et al. Schimke immuno-osseous dysplasia: case report and review of 25 patients. J Med Genet 1999;36:786-789.

10.Tylki-Szymanska A, Pyrkosz A, Krajewska-Walasek M, Michalkiewicz J, Kowalska A, Rokicki D. Schimke immuno-osseous dysplasia: two cases. Pediatr Radiol 2003;33:216-218.

11.Stormon M, Friedman J, King S, Cutz E, Furuya KN. An unusual case of diarrhea in schimke immuno-osseous dysplasia. J Pediatr Gastroenterol Nutr 2002;35:369-371.

12.Petty EM, Yanik GA, Hutchinson RJ, Alter BP, Schmalstieg FC, Levine JE et al. Successful bone marrow transplantation in a patient with Schimke immunoosseous dysplasia. J Pediatr 2000;137:882-886.

¤¯ÂÈ ‰˘ÛÎÔÏ›Â˜, Î·È ¤ÙÛÈ, ÔÈ ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓÂ˜ Ì¤ıÔ‰ÔÈ Û˘¯Ó¿ ·ÏÏ¿˙Ô˘Ó ÛÙËÓ ÚÔÛ¿ıÂÈ· Ó· ·˘ÍËıÂ› Ë ·ÔÙÂÏÂÛÌ·ÙÈÎﬁÙËÙ¿ ÙÔ˘˜. ™‹ÌÂÚ·, ¯ÒÚÂ˜ Ô˘ ¤¯Ô˘Ó Û˘ÛÙËÌ·ÙÈÎ¿

ÂÊ·ÚÌfiÛÂÈ ÌÂıfi‰Ô˘˜ screening ÁÈ· ÙËÓ fiÚ·ÛË

(∏¶∞, ∏ÓˆÌ¤ÓÔ µ·Û›ÏÂÈÔ, ™Î·Ó‰ÈÓ·‚ÈÎ¿ ÎÚ¿-

ÙË) Û˘ÓÂ¯›˙Ô˘Ó Ó· ÂÈÛËÌ·›ÓÔ˘Ó ÚÔ‚Ï‹Ì·Ù·

ÛÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎﬁÙËÙ· Ù¤ÙÔÈˆÓ ÚÔÁÚ·Ì-

Ì¿ÙˆÓ (fiˆ˜ Ô ÙÚfiÔ˜ ÂÊ·ÚÌÔÁ‹˜ Î·È Ë Î·ıÔÏÈÎfiÙËÙ· ÂÊ·ÚÌÔÁ‹˜) Î·È Î·Ù¿ Û˘Ó¤ÂÈ· ÚÔ-

‚Ï‹Ì·Ù· ÛÙË Û¯¤ÛË ÎﬁÛÙÔ˘˜/·ÔÙÂÏÂÛÌ·ÙÈÎﬁ-

ÙËÙ·˜ (4-9). ∏ ÂÌÂÈÚ›· ·˘ÙÒÓ ÙˆÓ ¯ˆÚÒÓ ¤¯ÂÈ

‰Â›ÍÂÈ ﬁÙÈ Ë Ù·ÎÙÈÎ‹ ·Ú·ÎÔÏÔ‡ıËÛË Î·È Ë

¤ÁÎ·ÈÚË ·Ó›¯ÓÂ˘ÛË ÌÂÈÒÓÔ˘Ó ÛËÌ·ÓÙÈÎ¿ ÙËÓ

Â›ÙˆÛË ÙË˜ ·Ì‚Ï˘ˆ›·˜ (1,21,32), ¤ÙÛÈ ÛÂ

Î·Ì›· ·ﬁ ·˘Ù¤˜ ÙÈ˜ ¯ÒÚÂ˜ ‰ÂÓ ¤¯ÂÈ Î·Ù·ÚÁË-

ıÂ› Ô Ì·˙ÈÎﬁ˜ ÚÔÏËÙÈÎﬁ˜ ¤ÏÂÁ¯Ô˜ ÁÈ· ÚÔ-

‚Ï‹Ì·Ù· ﬁÚ·ÛË˜ ·ÚﬁÏÔ Ô˘ Û˘ÓÂ¯Ò˜ ·Ó·˙Ë-

ÙÔ‡ÓÙ·È ÙÚfiÔÈ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂÚË˜ ÂÊ·ÚÌÔÁ‹˜ ÙÔ˘ (2,9-13). ™ÙËÓ ∂ÏÏ¿‰·, ÂÓÒ ˘¿Ú¯ÂÈ ıÂÛÌÔıÂÙËÌ¤ÓË Ú·ÎÙÈÎ‹ ÁÈ· ¤ÏÂÁ¯Ô fiÚ·ÛË˜ (ÙÔ˘Ï¿¯ÈÛÙÔÓ ÁÈ· Ù· ·È‰È¿ ÚÔÛ¯ÔÏÈÎ‹˜ Î·È Û¯ÔÏÈÎ‹˜ ËÏÈÎ›·˜

Ì¤Ûˆ ÙÔ˘ ∞ÙÔÌÈÎÔ‡ ¢ÂÏÙ›Ô˘ ÀÁÂ›·˜ ÙÔ˘ ª·ıËÙ‹), ‰ÂÓ ˘¿Ú¯ÂÈ

ÌÔÚÂ› Ó· ¯ÚËÛÈÌÔÔÈËıÂ› ·ﬁ

Ô˘˜ Â·ÁÁÂÏÌ·Ù›Â˜ ˘ÁÂ›·˜.

¶ﬁÛÔ ÛËÌ·ÓÙÈÎ‹ Â›Ó·È Ë ÚÒÈÌË

‰È¿ÁÓˆÛË ÙË˜ ·Ì‚Ï˘ˆ›·˜; ∞Ì‚Ï˘ˆ›· Â›Ó·È Ë ÂÏ·ÙÙˆÌ¤ÓË ÔÙÈÎ‹

ÔÍ‡ÙËÙ· ÛÙÔ ¤Ó· ‹ Î·È ÛÙ· ‰‡Ô Ì¿ÙÈ·. £ÂˆÚÂ›-

Ù·È ÌÈ· ‰È·Ù·Ú·¯‹ ·Ó·Ù˘ÍÈ·ÎÔ‡ ¯·Ú·ÎÙ‹Ú·

Ô˘ Û˘Ó‰¤ÂÙ·È ÌÂ ÙËÓ «Â˘·›ÛıËÙË-ÎÚ›ÛÈÌË»

ÂÚ›Ô‰Ô ÙÔ˘ Ì·ÙÈÔ‡ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË Ê˘ÛÈÔ-

ÏÔÁÈÎ‹˜ ﬁÚ·ÛË˜, ÁÂÁÔÓﬁ˜ Ô˘ ·ÔÙ¤ÏÂÛÂ Î·È

ÙËÓ ÚˆÙ·Ú¯ÈÎ‹ ·ÈÙ›· ÁÈ· ÙËÓ ¤ÁÎ·ÈÚË ·Ó›¯ÓÂ˘ÛË ·ÓˆÌ·ÏÈÒÓ ÙË˜ ﬁÚ·ÛË˜ (3,32).

™˘Ó‹ıÂÈ˜ ·ÈÙ›Â˜ ·Ì‚Ï˘ˆ›·˜ Â›Ó·È Ô Î·Ù·Ú-

Ú¿ÎÙË˜, Ô ÛÙÚ·‚ÈÛÌﬁ˜, Ë ÙÒÛË ÙÔ˘ ‚ÏÂÊ¿ÚÔ˘, Ë ÛËÌ·ÓÙÈÎ‹ ·ÓÈÛÔÌÂÙÚˆ›· (28) Î·È ÔÈ ‰È·ıÏ·ÛÙÈÎ¤˜ ·ÓˆÌ·Ï›Â˜. ™ÙÔÓ ÛÙÚ·‚ÈÛÌﬁ ÔÊÂ›ÏÔÓÙ·È ÂÚ›Ô˘ ÙÔ 48% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ·Ì‚Ï˘ˆ›·˜, ÂÓÒ ÛÙÈ˜ ‰È·ıÏ·ÛÙÈÎ¤˜ ·ÓˆÌ·Ï›Â˜ ÙÔ 20% (32). ™ËÌÂÈÒÓÂÙ·È

ÌÂÙ¿ ÙËÓ ËÏÈÎ›· ÙˆÓ 6-8 ÂÙÒÓ Û˘Ó‹ıˆ˜

·Ì‚Ï˘ˆ›· (32). ŒÙÛÈ, ÛÂ ·Ì‚Ï˘ˆ›· ÌÔÚÂ› Ó· Ô‰ËÁ‹ÛÔ˘Ó ÔÈ ‰È·ıÏ·ÛÙÈÎ¤˜ ·ÓˆÌ·Ï›Â˜ (Ì˘ˆ›·-˘ÂÚÌÂÙÚˆ›·-·ÛÙÈÁÌ·ÙÈÛÌfi˜), Ë ·ÓÈÛÔÌÂÙÚˆ›· (ÌÂÁ¿ÏË ‰È·ÊÔÚ¿ ÛÙË ‰È·ıÏ·ÛÙÈÎ‹ ÈÎ·ÓfiÙËÙ· ÌÂÙ·Í‡ ÙˆÓ ‰‡Ô Ì·ÙÈÒÓ) ‹ Ë ·Ó¿Ù˘ÍË ÛÙÚ·‚ÈÛÌÔ‡. ∏ ·ÍÈÔÏfiÁËÛ‹ ÙÔ˘˜ fiÌˆ˜, ÛÙ· ÔÏ‡ ÌÈÎÚ¿ ·È‰È¿ ¤¯ÂÈ Î·È ÌÈ· ÚfiÛıÂÙË ÛËÌ·Û›·. ∫·ıÒ˜ Ù· ·È‰È¿ ÌÂÁ·ÏÒÓÔ˘Ó, ·ÏÏ¿˙ÂÈ Ë ‰È·ıÏ·ÛÙÈÎ‹ ÈÎ·ÓfiÙËÙ· ÙÔ˘ Ì·ÙÈÔ‡. ∆Ô Ì¤ÁÂıÔ˜ ÙÔ˘ Ì·ÙÈÔ‡ ·˘Í¿ÓÂÈ ÛËÌ·ÓÙÈÎ¿ Ì¤¯ÚÈ Ù· 3 ¯ÚfiÓÈ· ˙ˆ‹˜, ÂÓÒ Ô Ú˘ıÌfi˜ ·‡ÍËÛË˜ ÛÙË Û˘Ó¤¯ÂÈ· ÂÏ·ÙÙÒÓÂÙ·È. ªÂ ÛÙfi¯Ô ÙË ‰È·Ù‹ÚËÛË ÈÎ·ÓÔÔÈËÙÈÎ‹˜ fiÚ·ÛË˜, Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÂÚÈfi‰Ô˘ ÙË˜ ÁÚ‹ÁÔÚË˜ ·‡ÍËÛË˜, ·ÏÏ¿˙ÂÈ ÙÔ ·ÍÔÓÈÎfi Ì‹ÎÔ˜ Î·È Ì¤ÁÂıÔ˜ ÙÔ˘ ÔÊı·ÏÌÔ‡ Î·È Ô Ê·Îfi˜ ÙÔ˘ Ì·ÙÈÔ‡ ·ÏÏ¿˙ÂÈ ÁÂˆÌÂÙÚ›· (emmetropization). ¶ÂÈÚ¿Ì·Ù· ÛÂ ˙Ò· ¤‰ÂÈÍ·Ó fiÙÈ Ë ÂÍ¤ÏÈÍË ·˘Ù‹ ‰ÂÓ ÚÔÎ‡ÙÂÈ ·Ó ÙÔ Ì¿ÙÈ ‰ÂÓ ‰¤¯ÂÙ·È ÈÎ·Ó¿ ÔÙÈÎ¿ ÂÚÂı›ÛÌ·Ù· (32). ∂Í·ÈÙ›·˜ ÙË˜ ÌÂÁ¿ÏË˜ ÂÙÂÚÔÁ¤ÓÂÈ·˜ ÙˆÓ ·ÈÙ›ˆÓ Ô˘ ÚÔÎ·ÏÔ‡Ó ·Ì‚Ï˘ˆ›·, ÙˆÓ ‰È·ÊÔÚÒÓ ÛÙË ‰È¿ÚÎÂÈ· Î·È ÙÔ Â›‰Ô˜ ÙË˜ ıÂÚ·Â›·˜, ÙÔ˘ ‚·ıÌÔ‡ ÙË˜ Û˘ÌÌfiÚÊˆÛË˜ ÙÔ˘ ·ÛıÂÓ‹ Î·È ÛÙË ‰È¿ÚÎÂÈ· ÙË˜ ÌÂÙ¿ ÙË ıÂÚ·Â›· ·Ú·ÎÔÏÔ‡ıËÛË˜ (follow-up), ÔÈ ‚È‚ÏÈÔÁÚ·ÊÈÎ¤˜ ·Ó·ÊÔÚ¤˜ ‰ÂÓ Â›Ó·È Â‡ÎÔÏ· Û˘ÁÎÚ›ÛÈÌÂ˜ ˆ˜ ÚÔ˜ ÙÔ ıÂÚ·Â˘ÙÈÎfi ·ÔÙ¤ÏÂÛÌ·.

¶¿ÓÙˆ˜ ·Ó·Ê¤ÚÂÙ·È ‚ÂÏÙ›ˆÛË ÙË˜ ÔÙÈÎ‹˜ ÔÍ‡ÙËÙ·˜ ÙˆÓ ·È‰ÈÒÓ ÛÂ ÔÛÔÛÙﬁ 41%-96% (ÚÔÔÙÈÎ¤˜ ÌÂÏ¤ÙÂ˜) Î·È ÛÂ ÔÛÔÛÙﬁ 40%95% (·Ó·‰ÚÔÌÈÎ¤˜ ÌÂÏ¤ÙÂ˜) (32).

™ËÌ·ÓÙÈÎfi Â›ÛË˜, Â›Ó·È ÙÔ Û˘Ì¤Ú·ÛÌ· ÌÂÚÈÎÒÓ ÌÂÏÂÙÒÓ fiÙÈ Ë ÂÈÙ˘¯›· ÙË˜ ıÂÚ·Â›·˜ ÂÍ·ÚÙ¿Ù·È ·fi ÙËÓ ¤Ó·ÚÍË ÙË˜ ıÂÚ·Â›·˜ ÛÂ ÌÈÎÚ‹ ËÏÈÎ›·. ŒÙÛÈ, Ê·›ÓÂÙ·È fiÙÈ ·˘Í¿ÓÂÙ·È Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙË˜ ıÂÚ·Â›·˜ ÛÂ ·È‰È¿ ÌÈÎÚfiÙÂÚ· ÙˆÓ 3 ÂÙÒÓ. √ Ú˘ıÌfi˜ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ ÙË˜ ıÂÚ·Â›·˜ ÂÏ·ÙÙÒÓÂÙ·È ÌÂÙ¿ Ù· 5 ¯ÚfiÓÈ· ˙ˆ‹˜, ÂÓÒ ÛÂ ·È‰È¿ 12 ÂÙÒÓ Â›Ó·È ·Ó·ÔÙÂÏÂÛÌ·ÙÈÎ‹ (32).

™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, Ë ¤ÁÎ·ÈÚË ‰È¿ÁÓˆÛË ÙË˜ ·Ì‚Ï˘ˆ›·˜ È‰È·›ÙÂÚ· ÛÂ ËÏÈÎ›· <5 ¯ÚfiÓˆÓ ÌÔÈ¿˙ÂÈ Ó· ¤¯ÂÈ ıÂÙÈÎfi ·ÔÙ¤ÏÂÛÌ· ÛÙËÓ Î·Ï‹ fiÚ·ÛË, ÂÊfiÛÔÓ Ë ıÂÚ·Â›· Â›Ó·È ‰˘ÛÎÔÏfiÙÂÚË Î·È ÙÂÏÈÎ¿

ÙˆÓ 10 ¯ÚﬁÓˆÓ. ªÈ· ·Ó·‰ÚÔÌÈÎ‹ ÌÂÏ¤ÙË ¤‰ÂÈÍÂ

ﬁÙÈ ÛÙËÓ ËÏÈÎ›· ÙˆÓ 10 ÂÙÒÓ, Ë Â›ÙˆÛË (prevalence) ÙË˜ ·Ì‚Ï˘ˆ›·˜ ‹Ù·Ó 0,03% -Ô-

Ï‡ ÌÈÎÚﬁÙÂÚË ·ﬁ ÙÔ 3% ¿ÏÏˆÓ ÌÂÏÂÙÒÓ Â›-

ÙˆÛË˜ ÙË˜ ·Ì‚Ï˘ˆ›·˜ ÛÂ ÏËı˘ÛÌÔ‡˜ Ô˘

‰ÂÓ ˘ﬁÎÂÈÓÙ·È ÛÂ Û˘ÛÙËÌ·ÙÈÎﬁ screening. ¶·-

ÚﬁÌÔÈ· ·ÔÙÂÏ¤ÛÌ·Ù· ÛÙÔ πÛÚ·‹Ï ¤‰ÂÈÍ·Ó ﬁÙÈ

Ë Â›ÙˆÛË ÙË˜ ·Ì‚Ï˘ˆ›·˜ ÛÙ· ·È‰È¿ ËÏÈ-

Î›·˜ 8 ÂÙÒÓ Ô˘ Â›¯·Ó ÂÏÂÁ¯ıÂ› ÌÂ screening ÛÂ

ÌÈÎÚﬁÙÂÚË ËÏÈÎ›· ‹Ù·Ó 1% Û˘ÁÎÚÈÓﬁÌÂÓË ÌÂ ÙÔ

2,6% ÛÂ ËÏÈÎÈ·Î¤˜ Ê¤ÙÂ˜ Ô˘ ‰ÂÓ Â›¯·Ó ˘ÔÛÙÂ› ·ÓÈ¯ÓÂ˘ÙÈÎ¤˜ ‰ÔÎÈÌ·Û›Â˜ (32).

∞ÓÈ¯ÓÂ˘ÙÈÎ¿ ÂÚÁ·ÏÂ›· ÂÏ¤Á¯Ô˘ ÔÙÈÎ‹˜

ÈÎ·ÓﬁÙËÙ·˜ (ÔÙﬁÙ˘·)

°È· ÙËÓ ÂÎÙ›ÌËÛË ÙË˜ ÔÙÈÎ‹˜ ÈÎ·ÓfiÙËÙ·˜ ÂÓfi˜ ‚Ú¤ÊÔ˘˜ ‹ ÂÓfi˜ ÌÈÎÚÔ‡ ·È‰ÈÔ‡ Â›Ó·È ÛËÌ·ÓÙÈÎ¤˜ ÔÈ Û¯ÂÙÈÎ¤˜ ÏËÚÔÊÔÚ›Â˜ ·fi ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi Î·È ÔÈ ·Ó·ÊÂÚfiÌÂÓÂ˜ Û¯Â-

ÙÈÎ¤˜ ·ÓËÛ˘¯›Â˜ ÙˆÓ ÁÔÓ¤ˆÓ. ∂›ÛË˜, ÛËÌ·ÓÙÈÎ¿ Â›Ó·È Î·È Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ Ê˘ÛÈÎ‹˜

ÂÍ¤Ù·ÛË˜ ﬁˆ˜ Ë Úﬁ‰ÈÓË ·ÓÙ·‡ÁÂÈ· ÙÔ˘ ·ÌÊÈ‚ÏËÛÙÚÔÂÈ‰‹ (red reflex) ÛÂ ‚Ú¤ÊË ÁÈ· ÙËÓ

·Ó·˙‹ÙËÛË Î·Ù·ÚÚ¿ÎÙË ‹ Ë ‰ÔÎÈÌ·Û›· Î¿Ï˘„Ë˜ ‹ ÙÔ Hirschberg test ÁÈ· ÙËÓ ·Ó·˙‹ÙËÛË ÛÙÚ·‚ÈÛÌÔ‡.

™Â ·È‰È¿ fiÌˆ˜ ËÏÈÎ›·˜ ÌÂÁ·Ï‡ÙÂÚË˜ ÙˆÓ ÙÚÈÒÓ ¯ÚfiÓˆÓ, Ô ¤ÏÂÁ¯Ô˜ ÙË˜ ÔÙÈÎ‹˜ ÈÎ·ÓfiÙËÙ·˜ Û˘ÌÏËÚÒÓÂÙ·È ÌÂ ÙËÓ ÂÎÙ›ÌËÛË ÙË˜ ÔÙÈÎ‹˜ ÔÍ‡ÙËÙ·˜ ÙÔ˘ ·È‰ÈÔ‡. °È· ÙÔÓ ÛÎÔfi ·˘Ùfi

¯ÚËÛÈÌÔÔÈÂ›Ù·È ¤Ó· ÂÚÁ·ÏÂ›Ô (ÙÂÛÙ ﬁÚ·ÛË˜) ÌÂ ÙË ‚Ô‹ıÂÈ· ÙÔ˘ ÔÔ›Ô˘ ‰È·ÈÛÙÒÓÂÙ·È ·Ó ÙÔ ·È‰› ¤¯ÂÈ ÙËÓ ·Ó·ÌÂÓﬁÌÂÓË ÁÈ· ÙËÓ ËÏÈÎ›· ÙÔ˘

ÔÙÈÎ‹ ÔÍ‡ÙËÙ·. ∏ ÂÈÏÔÁ‹ ÙÔ˘ ÂÚÁ·ÏÂ›Ô˘ ÔÊÂ›ÏÂÈ Ó· Û˘ÌÌÔÚÊÒÓÂÙ·È ÌÂ ÔÚÈÛÌ¤Ó· ÎÚÈÙ‹ÚÈ·.

∞Ó ﬁÌˆ˜ ˙ËÙ‹ÛÔ˘ÌÂ ·ﬁ ¤Ó· ·È‰› ÚÔÛ¯ÔÏÈÎ‹˜ ËÏÈÎ›·˜ Ó· ·Ó·ÁÓˆÚ›ÛÂÈ Î·È Ó· ÔÓÔÌ¿ÛÂÈ

Û‡Ì‚ÔÏ· Ô˘ ˘¿Ú¯Ô˘Ó ¿Óˆ ÛÂ ¤Ó· ÙÂÛÙ fiÚ·ÛË˜ ÁÈ· Ó· ‰È·ÈÛÙÒÛÔ˘ÌÂ fiÛÔ Î·Ï¿ ‚Ï¤ÂÈ, ˘Ôı¤ÙÔ˘ÌÂ fiÙÈ ÛÂ Î¿ıÂ ÂÍÂÙ·˙fiÌÂÓÔ ¿ÙÔÌÔ, ÚÔ¸¿Ú¯Ô˘Ó ÂÍ›ÛÔ˘ fiÏÂ˜ ÔÈ ··Ú·›ÙËÙÂ˜ ÁÓˆÛÙÈÎ¤˜, ·ÓÙÈÏËÙÈÎ¤˜, ÂÈÎÔÈÓˆÓÈ·Î¤˜ Î·È ÔÊı·ÏÌÔÎÈÓËÙÈÎ¤˜ ÈÎ·ÓfiÙËÙÂ˜. ∫·È ÂÂÈ‰‹ ·˘Ùfi ‰ÂÓ Â›Ó·È ‰˘Ó·Ùfi Ó· ÈÛ¯‡ÂÈ ÂÍ›ÛÔ˘ ÁÈ· fiÏ· Ù·

·È‰È¿ Î·È È‰È·›ÙÂÚ· ÁÈ· Ù· ÌÈÎÚfiÙÂÚ·, ÙÔ ÔÔÈÔ‰‹ÔÙÂ ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓÔ ÙÂÛÙ ¯¿ÓÂÈ ÙËÓ ÂÈ‰ÈÎfiÙËÙ¿ ÙÔ˘. ¶Ú¿ÁÌ· Ô˘ ÛËÌ·›ÓÂÈ fiÙÈ ÙÔ ·ÔÙ¤ÏÂÛÌ· ÙË˜ ‰ÔÎÈÌ·Û›·˜ ‰ÂÓ Û˘Û¯ÂÙ›˙ÂÙ·È ÌÂ ÙËÓ Ú·ÁÌ·ÙÈÎ‹ ÔÙÈÎ‹ ÔÍ‡ÙËÙ· ÙÔ˘ ·È‰ÈÔ‡, ·ÏÏ¿ ÙËÓ ˘ÔÂÎÙÈÌ¿

ŒÓ·

Î·Ù¿ÏÏËÏÔ ÙÂÛÙ

fiÚ·ÛË˜ ı· Ú¤ÂÈ Ó· ¤¯ÂÈ ˘„ËÏ‹ ÂÈ‰ÈÎfiÙËÙ· (ÌÈÎÚfi ÔÛÔÛÙfi „Â˘‰Ò˜ ıÂÙÈÎÒÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ, ‰ËÏ·‰‹ Ó· ÌÂÙÚ¿ÂÈ ÌfiÓÔ ÔÙÈÎ‹ ÔÍ‡ÙËÙ·) Î·È ˘„ËÏ‹ Â˘·ÈÛıËÛ›· (ÌÈÎÚfi ÔÛÔÛÙfi „Â˘‰Ò˜ ·ÚÓËÙÈÎÒÓ

·ÔÙÂÏÂÛÌ¿ÙˆÓ, ‰ËÏ·‰‹ Ó· ·ÓÈ¯ÓÂ‡ÂÈ Î·È ÌÈ-

ÎÚ¤˜ ÔÙÈÎ¤˜ ‰È·Ù·Ú·¯¤˜). ∏ ·ﬁ‰ÔÛË ÙÔ˘

ÔÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ (visual performance)

ÂÍ·ÚÙ¿Ù·È ·ﬁ:

1. ¶ÔÏÏ¤˜ ÔÙÈÎ¤˜ ÏÂÈÙÔ˘ÚÁ›Â˜ ﬁˆ˜ ÙËÓ

ÔÙÈÎ‹ ÔÍ‡ÙËÙ·, ÙËÓ Â˘·ÈÛıËÛ›· ·ÓÙ›ıÂÛË˜, ÙËÓ ·ÓÙ›ÏË„Ë ¯ÚˆÌ¿ÙˆÓ, ÙËÓ ÚÔÛ·ÚÌÔÁ‹ ÛÙÔ

Êˆ˜ Î·È ÛÙÔ ÛÎÔÙ¿‰È, ÙË ‰ÈﬁÊı·ÏÌË ﬁÚ·ÛË.

2. ¶ÔÏÏ¤˜ ÔÙÈÎÔ-ÓÔËÙÈÎ¤˜ ‰˘Ó·ÙfiÙËÙÂ˜, fiˆ˜ ÙËÓ ·ÓÙÈÏËÙÈÎfiÙËÙ· ÙÔ˘ ¯ÒÚÔ˘ Î·È ÙˆÓ Û¯ËÌ¿ÙˆÓ, ÙËÓ ÔÙÈÎ‹ ÌÓ‹ÌË Î·È

3. ∆È˜ ÔÊı·ÏÌÔ-ÎÈÓËÙÈÎ¤˜ ÏÂÈÙÔ˘ÚÁ›Â˜. ™ÙÈ˜ ¯ÒÚÂ˜ ÙÔ˘ ‰˘ÙÈÎÔ‡ ÎfiÛÌÔ˘ Ô˘ ÂÊ·ÚÌfi˙ÔÓÙ·È screening test fiÚ·ÛË˜ ·fi ÙÈ˜ ÚˆÙÔ-

˘ÁÂ›·˜, ¤¯ÂÈ ÏËÊıÂ› Ì¤ÚÈÌÓ· ÒÛÙÂ Ù· ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓ· ÂÚÁ·ÏÂ›· Ó· ÙËÚÔ‡Ó

‰ÈÂıÓÂ›˜ Û˘ÛÙ¿ÛÂÈ˜ Î·Ù·ÛÎÂ˘‹˜ ÔÙÔÙ‡ˆÓ Î·È ÙÔ ·ÔÙ¤ÏÂÛÌ· ÙÔ˘ ÙÂÛÙ Ó· ÂÎÊÚ¿˙ÂÈ ÔÙÈÎ‹ ÔÍ‡ÙËÙ· Î·È ﬁ¯È ÁÓˆÛÙÈÎ‹ ÈÎ·ÓﬁÙËÙ·.

¢ÈÂıÓÒ˜ (32), ¤¯Ô˘Ó ¯ÚËÛÈÌÔÔÈËıÂ› ÔÏÏ¿ ÙÂÛÙ (È‰›ˆ˜ ÁÈ· ÙËÓ ÚÔÛ¯ÔÏÈÎ‹ ËÏÈÎ›·) Ô˘ Â›¯·Ó ÛËÌ·ÓÙÈÎ¤˜ ‰È·ÊÔÚ¤˜ ÌÂÙ·Í‡ ÙÔ˘˜ (22) (.¯. ÛÙË ‰È¿Ù·ÍË ÙˆÓ ¯·Ú·ÎÙ‹ÚˆÓ, ÙËÓ ·fiÛÙ·ÛË ÌÂÙ·Í‡ ÙÔ˘˜, ÙÔÓ ÙÚfiÔ ÂÊ·ÚÌÔÁ‹˜ ÙÔ˘˜ ÎÏ.). √ÙfiÙ˘ÔÈ Ô˘ ¤¯Ô˘Ó Â˘Ú¤ˆ˜ ¯ÚËÛÈÌÔÔÈËıÂ› ‰ÈÂıÓÒ˜ Â›Ó·È ÙÔ Kay Picture Test, ÙÔ Sheridan Gardirer Test, ÙÔ Stycar Test ÙÔ Cambridge Crowded Cards, ÙÔ Snellen Test, ÙÔ Sonksen-Silver Acuity System Test (SSAS), Ù· test Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡Ó LEA ¯·Ú·ÎÙ‹ÚÂ˜ ÎÏ. ∏ ‰ÈÂÚÂ‡ÓËÛË ÙË˜ Û¯ÂÙÈÎ‹˜ ‚È‚ÏÈÔÁÚ·Ê›·˜ (14,22-25) ¤‰ÂÈÍÂ fiÙÈ ÛÙÈ˜ ÙÂÏÂ˘Ù·›Â˜ ‰ÂÎ·ÂÙ›Â˜ ˘¿Ú¯ÂÈ ‰ÈÂıÓÒ˜ Ë Ù¿ÛË ÛÙ· ·È‰È¿ ÚÔÛ¯ÔÏÈÎ‹˜ ËÏÈÎ›·˜ Ó· ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ‰ÔÎÈÌ·Û›Â˜ Ù‡Ô˘ «Ù·ÈÚÈ¿ÛÌ·ÙÔ˜» ‹ «Ù·‡ÙÈÛË˜» (matching test) fiˆ˜ Â›Ó·È ÙÔ SSAS ‹ ÌÂÚÈÎ¿ ·fi Ù· LEA tests. °È· Ù· ·È‰È¿ Û¯ÔÏÈÎ‹˜ ËÏÈÎ›·˜ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÙÂÛÙ fiÚ·ÛË˜ ÌÂ ·ÚÈıÌÔ‡˜, Ô˘ fiÌˆ˜ ÏËÚÔ‡Ó Û˘ÁÎÂÎÚÈÌ¤ÓÂ˜ ÚÔ¸Ôı¤ÛÂÈ˜ Î·Ù·ÛÎÂ˘‹˜.

∫ÚÈÙ‹ÚÈ· Î·Ù·ÏÏËÏﬁÙËÙ·˜ ·ÓÈ¯ÓÂ˘ÙÈÎÒÓ

ÂÚÁ·ÏÂ›ˆÓ (ÔÙÔÙ‡ˆÓ)

∫¿ıÂ ÙÂÛÙ ﬁÚ·ÛË˜ ÁÈ· ·È‰È¿ ı· Ú¤ÂÈ Ó·

ÏËÚÔ› ÔÚÈÛÌ¤Ó· ÎÚÈÙ‹ÚÈ· Ô˘ Ó· ÙÔ Î¿ÓÔ˘Ó

Î·Ù¿ÏÏËÏÔ ÁÈ· ¯Ú‹ÛË ÛÂ Û˘ÁÎÂÎÚÈÌ¤ÓË ËÏÈÎÈ·-

Î‹ ÔÌ¿‰· (33). ŒÙÛÈ:

∞) ¶ÚÔÛ¯ÔÏÈÎ‹ ËÏÈÎ›·

√ÔÈÔ‰‹ÔÙÂ ÙÂÛÙ ﬁÚ·ÛË˜ ÁÈ· ÙËÓ ÚÔÛ¯Ô-

ÏÈÎ‹ ËÏÈÎ›· ı· Ú¤ÂÈ Ó· ÂÍ·ÛÊ·Ï›˙ÂÈ ﬁÙÈ:

1. ∆Ô ·È‰› Î·Ù·Ï·‚·›ÓÂÈ ÙÔ ˘ÏÈÎﬁ Î·È ÙË ‰È·‰ÈÎ·Û›· ÙÔ˘ ÙÂÛÙ.

2. ¢ÈÂÁÂ›ÚÂÙ·È ÙÔ Î›ÓËÙÚÔ, Ë ÚÔÛÔ¯‹ Î·È Ë Û˘ÓÂÚÁ·Û›· ÙÔ˘ ·È‰ÈÔ‡.

3. ∆Ô ·È‰› ÌÔÚÂ› Â‡ÎÔÏ· Ó· «‰Â›ÍÂÈ» ÛÙÔÓ ÂÍÂÙ·ÛÙ‹ ﬁÙÈ Â›‰Â ÙÔ ˙ËÙÔ‡ÌÂÓÔ.

4. ∆Ô ÙÂÛÙ Â›Ó·È “ÂÈ‰ÈÎﬁ”, ‰ËÏ·‰‹ ÌÂÙÚ¿ ÙËÓ ÔÙÈÎ‹ ÔÍ‡ÙËÙ· ·ÓÂÍ·ÚÙ‹Ùˆ˜

ÓÙˆÓ (.¯. ·Ó·Ù˘ÍÈ·ÎÒÓ ‰È·ÊÔÚÒÓ).

1. ∆· Û‡Ì‚ÔÏ· ÙÔ˘ ÙÂÛÙ Ó· Â›Ó·È Û·Ê‹. ¢ÂÓ

ÙÔ ·È‰› (¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ¿ÏÏÂ˜ ÓÔËÙÈÎ¤˜ ÏÂÈÙÔ˘ÚÁ›Â˜) ·fi ÙÔ ·‰Úfi ÂÚ›Ô˘ “ÁÓˆÛÙfi ÂÚ›ÁÚ·ÌÌ·”.

2. ∏ Ù·˘ÙÔÔ›ËÛË ÙˆÓ Û˘Ì‚ﬁÏˆÓ ÙÔ˘ ÙÂÛÙ

Ó· ÌËÓ Â›Ó·È ‰‡ÛÎÔÏË ÒÛÙÂ Ó· ÌËÓ ÂÍ·ÚÙ¿Ù·È

·ﬁ ·Ó·Ù˘ÍÈ·Î¤˜ ‰˘Ó·ÙﬁÙËÙÂ˜.

3. ∏ ‰˘Ó·ÙﬁÙËÙ· Ó· ‰È·ÎÚ›ÓÂÈ ÙÔ ·È‰› ¤Ó·

Û‡Ì‚ÔÏÔ ˆ˜ ÍÂ¯ˆÚÈÛÙﬁ ·ﬁ ¿ÏÏ· Û‡Ì‚ÔÏ·

Ô˘ ˘¿Ú¯Ô˘Ó ‰›Ï· ÙÔ˘, ·Ó·Ù‡ÛÛÂÙ·È ÚÔÔ‰Â˘ÙÈÎ¿ Î·È ÛÂ ÌÂÚÈÎ¿ ·È‰È¿, ﬁ¯È Ì¤¯ÚÈ ÙËÓ

ËÏÈÎ›· ÙˆÓ 4 ¯ÚﬁÓˆÓ. ŸÛÔ ÈÔ ÎÔÓÙ¿ Â›Ó·È ÙÔ-

ÔıÂÙËÌ¤Ó· Ù· Û‡Ì‚ÔÏ· ÙÔ ¤Ó· ÛÂ Û¯¤ÛË ÌÂ

ÙÔ ¿ÏÏÔ, ÙﬁÛÔ ÈÔ ‰‡ÛÎÔÏÔ˜ Á›ÓÂÙ·È Ô ‰È·¯ˆ-

ÚÈÛÌfi˜ ÙÔ˘˜ ·fi Ù· ÌÈÎÚ¿ ·È‰È¿. ∞˘Ùfi ¤¯ÂÈ Û¯¤ÛË ÌÂ ÙÔÓ ·Ú¿ÁÔÓÙ· Û˘Á¯ÚˆÙÈÛÌÔ‡ (14) (crowding factor) fiÚÔ˜ Ô˘ ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÛÙÈ˜ Û¯ÂÙÈÎ¤˜ ÌÂ ÔÙfiÙ˘· ‚È‚ÏÈÔÁÚ·ÊÈÎ¤˜ ·Ó·ÊÔÚ¤˜. ŒÙÛÈ, Ô Û˘Á¯ÚˆÙÈÛÌfi˜ ÔÏÏÒÓ Û˘Ì‚fiÏˆÓ ÛÂ ÛÂÈÚ¿ ÛÂ ¤Ó· ÙÂÛÙ fiÚ·ÛË˜, ÌÔÚÂ› Ó· Ô‰ËÁ‹ÛÂÈ ÛÂ ÛÊ¿ÏÌ·Ù· ÛÙË Ì¤ÙÚËÛË ÙË˜ ÔÙÈÎ‹˜ ÔÍ‡ÙËÙ·˜ ÛÙ· ÔÏ‡ ÌÈÎÚ¿ ·È‰È¿. ¢È·ÛÙ·˘ÚˆÌ¤ÓÂ˜ ÌÂÏ¤ÙÂ˜ (22) ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ ÛÙÈ˜ ÌÈÎÚ¤˜ ËÏÈÎ›Â˜ Ë ÔÙÈÎ‹ ÔÍ‡ÙËÙ· ˘ÂÚÂÎÙÈÌ¿Ù·È fiÙ·Ó ‰Â›¯ÓÔÓÙ·È ÍÂ¯ˆÚÈÛÙ¿ Û‡Ì‚ÔÏ·

fi,ÙÈ fiÙ·Ó ‰Â›¯ÓÔÓÙ·È ÂÚÈÛÛfiÙÂÚ· Û‡Ì‚ÔÏ· ÛÂ ÛÂÈÚ¿ (crowding phenomenon). ∆· ÙÂÛÙ Ù‡Ô˘ “Ù·ÈÚÈ¿ÛÌ·ÙÔ˜” (matching test) Ê·›ÓÂÙ·È fiÙÈ ÏËÚÔ‡Ó Ù· ·Ú·¿Óˆ ÎÚÈÙ‹ÚÈ·. ™Ù· ÙÂÛÙ

‚Ú›ÛÎÂÙ·È

Î·È Ë ÔÔ›· Ê¤ÚÂÈ fiÏ· Ù· ÂÍÂÙ·˙fiÌÂÓ· Û‡Ì‚ÔÏ·. ¢ÂÓ ÙÔ˘ ˙ËÙÈ¤Ù·È Ó· ·Ó·ÁÓˆÚ›ÛÂÈ Î·È Ó· ÔÓÔÌ¿ÛÂÈ ÙÔ Û‡Ì‚ÔÏÔ ·ÏÏ¿ ÌfiÓÔ Ó· ÙÔ “Ù·ÈÚÈ¿ÍÂÈ”. ™Â Î¿ıÂ ÙÂÛÙ ˘¿Ú¯Ô˘Ó Î¿ÚÙÂ˜ ÁÈ· ÙÔÓ ‰ÈfiÊı·ÏÌÔ ‹ ÂÙÂÚfiÊı·ÏÌÔ ¤ÏÂÁ¯Ô ÙË˜ ÎÔÓÙÈÓ‹˜ Î·È Ì·ÎÚÈÓ‹˜ fiÚ·ÛË˜.

∆ËÓ Î·Ù·ÏÏËÏfiÙËÙ· ·˘ÙÒÓ ÙˆÓ ‰ÔÎÈÌ·ÛÈÒÓ “Ù·ÈÚÈ¿ÛÌ·ÙÔ˜” ÁÈ· ÙËÓ ÚÔÛ¯ÔÏÈÎ‹ ËÏÈÎ›· ¤¯Ô˘Ó ÚÔÛ·ı‹ÛÂÈ Ó· ‰Â›ÍÔ˘Ó ÔÏÏ¤˜ ÌÂÏ¤ÙÂ˜. √È Sonksen et al (22) ÂÊ¿ÚÌÔÛ·Ó matching test ÛÂ ·È‰È¿ ÚÔÛ¯ÔÏÈÎ‹˜ ËÏÈÎ›·˜. ∏ ÌÂÏ¤ÙË ·˘Ù‹ ‰›ÓÂÈ ¯Ú‹ÛÈÌ· ÛÙÔÈ¯Â›· ÁÈ· Ù· ÙÂÛÙ Ù‡Ô˘ “Ù·ÈÚÈ¿ÛÌ·ÙÔ˜”, fiˆ˜: 1. ∏ ÂÍ¤Ù·ÛË ÙË˜ ‰ÈfiÊı·ÏÌË˜ fiÚ·ÛË˜ Â›Ó·È ¯Ú‹ÛÈÌË ÛÂ

∆Ô ·Ú·¿Óˆ

Îfi ÁÈ·Ù› fiÛÔ ÌÈÎÚfiÙÂÚÔ Â›Ó·È ÙÔ ·È‰›, ÙfiÛÔ ‰˘ÛÎÔÏfiÙÂÚ· ‰¤¯ÂÙ·È ÙÔÓ ·ÔÎÏÂÈÛÌfi ÙÔ˘ Ì·ÙÈÔ‡. 2. ŒÓ· ÔÛÔÛÙfi ·È‰ÈÒÓ Î¿ÓÂÈ “Ù·›ÚÈ·ÛÌ·” ÛÙËÓ ÚÔÂÙÔÈÌ·Û›· ÙÔ˘ ÙÂÛÙ, ·ÏÏ¿ fiÙ·Ó Ô ÂÍÂÙ·ÛÙ‹˜ ·ÔÌ·ÎÚ‡ÓÂÙ·È ÛÙ· 3 Ì¤ÙÚ· ‰ÂÓ ÌÔÚÂ› Ó· ÙÔ Î·Ù·Ê¤ÚÂÈ. ÿÛˆ˜ ·˘Ùfi ¤¯ÂÈ Û¯¤ÛË ÌÂ ÙÔ fiÙÈ Î·Ù¿ ÙËÓ ÚÔÂÙÔÈÌ·Û›· ‰Â›¯ÓÂÙ·È ¤Ó·-¤Ó· Û‡Ì‚ÔÏÔ ·fi ÙÔ ÂÎ·È‰Â˘ÙÈÎfi Ê˘ÏÏ¿‰ÈÔ. ∂ÓÒ ÛÙËÓ ·fiÛÙ·ÛË ÙˆÓ 3 Ì. ÙÔ ÙÂÛÙ ¤¯ÂÈ 5 Û‡Ì‚ÔÏ· ÛÙË ÛÂÈÚ¿. ÿÛˆ˜ fiÌˆ˜, Ó· ¤¯ÂÈ Ó· Î¿ÓÂÈ ÌÂ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ù· ÈÔ ÌÈÎÚ¿ ·È‰È¿ ‰ÂÓ ÌÔÚÔ‡Ó Ó· Û˘ÁÎÂÓÙÚˆıÔ‡Ó fiÙ·Ó Ô ÂÍÂÙ·ÛÙ‹˜ Â›Ó·È Ì·ÎÚÈ¿. 3. ™Â Î¿ıÂ ËÏÈÎ›· Ë ‰ÈfiÊı·ÏÌË fiÚ·ÛË ‰È·ÈÛÙÒıËÎÂ Î·Ï‡ÙÂÚË ·fi ÙË ÌÔÓfiÊı·ÏÌË ÌÂ ÙË ‰È·ÊÔÚ¿ Ó· ÌÂÈÒÓÂÙ·È Î·ıÒ˜ ÌÂÁ·ÏÒÓÂÈ Ë ËÏÈÎ›·. √È ÂÚÂ˘ÓËÙ¤˜ Û˘Ì¤Ú·Ó·Ó fiÙÈ Ë Û˘ÌÌÔÚÊˆÙÈÎfiÙËÙ· ÛÙÔ ÙÂÛÙ Â›Ó·È Î·Ï‹ ÁÈ· Ù· ·È‰È¿ ËÏÈÎ›·˜ 2,5-6 ¯ÚfiÓˆÓ Î·È ÙÔ Î·ıÈÛÙ¿ Î·Ù¿ÏÏËÏÔ ÁÈ· ÙËÓ ·Ó›¯ÓÂ˘ÛË ÔÙÈÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ. √ ¯ÚfiÓÔ˜ ÂÊ·ÚÌÔÁ‹˜ ÙÔ˘ Â›ÛË˜, ÙÔ Î¿ÓÂÈ Û˘Ì‚·Ùfi ÌÂ ÙÈ˜ Û˘ÁÎÂÎÚÈÌ¤ÓÂ˜ ËÏÈÎ›Â˜. µ) ™¯ÔÏÈÎ‹ ËÏÈÎ›· ∆Ô ‚·ÛÈÎfi ÙÂÛÙ Â›Ó·È ÙÔ ÁÚ·ÌÌÈÎfi ÙÂÛÙ ÌÂ ÙÔ˘Ï¿¯ÈÛÙÔÓ ¤ÓÙÂ Û‡Ì‚ÔÏ· ÛÂ Î¿ıÂ ÛÂÈÚ¿ ÙÔ˘ ÙÂÛÙ (26). µ·ÛÈÎ‹ Î·Ù·ÛÎÂ˘·ÛÙÈÎ‹ ÚÔ¸fiıÂÛË Â›Ó·È: 1. √È ·ÔÛÙ¿ÛÂÈ˜ ÌÂÙ·Í‡ ÙˆÓ Û˘Ì‚fiÏˆÓ Ó· Â›Ó·È ›ÛÂ˜ ÌÂ ÙÔ Ï¿ÙÔ˜ ÙÔ˘ Î¿ıÂ Û˘Ì‚fiÏÔ˘ ·˘Ù‹˜ ÙË˜ ÛÂÈÚ¿˜. 2. ∏ ·fiÛÙ·ÛË ÌÂÙ·Í‡ ÙˆÓ ÛÂÈÚÒÓ ÙÔ˘ ÙÂÛÙ

Ó· Â›Ó·È ›ÛË ÌÂ ÙÔ ‡„Ô˜ ÙˆÓ Û˘Ì‚ﬁÏˆÓ ÙË˜ Î·-

ÙÒÙÂÚË˜ ÛÂÈÚ¿˜. ∞˘Ùﬁ Á›ÓÂÙ·È ÒÛÙÂ Ô ·Ú¿ÁÔÓÙ·˜ Û˘Á¯ÚˆÙÈÛÌÔ‡ Ó· ‰È·ÙËÚÂ›Ù·È ÛÙ·ıÂÚﬁ˜.

ŒÙÛÈ ÙÔ ÙÂÛÙ ·›ÚÓÂÈ ÌÈ· ¯·Ú·ÎÙËÚÈÛÙÈÎ‹ ÌÔÚÊ‹ Ô˘ ÌÔÈ¿˙ÂÈ Ó· ÛÙÂÓÂ‡ÂÈ ÚÔ˜ Ù· Î¿Ùˆ (Î·Ù·ÚÚ¿ÎÙË˜).

∆· ·Ú·¿Óˆ ÎÚÈÙ‹ÚÈ· ÈÛ¯‡Ô˘Ó Î·È ÁÈ· Ù· ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓ· ÙÂÛÙ ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô ÙË˜ ÎÔÓÙÈÓ‹˜ ﬁÚ·ÛË˜. ™‡ÌÊˆÓ· ÌÂ Ù· ·Ú·¿Óˆ ÎÚÈÙ‹ÚÈ·, Ù· ÔÙﬁÙ˘· Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È

ÛÙËÓ ∂ÏÏ¿‰· ÛÙÔ˘˜ ÚˆÙÔ‚¿ıÌÈÔ˘˜ ¯ÒÚÔ˘˜ ˘ÁÂ›·˜ Â›Ó·È ·Î·Ù¿ÏÏËÏ· ÚÔ˜ ¯Ú‹ÛË ‰ÈﬁÙÈ: ∞/ ¶ÚÔÛ¯ÔÏÈÎ‹ ËÏÈÎ›·: ∆Ô ÔÙﬁÙ˘Ô ÌÂ Û¯‹Ì·Ù· Ô˘ ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÛÙËÓ ÚÔÛ¯ÔÏÈÎ‹ ËÏÈÎ›·:

1. ¢ÂÓ Â›Ó·È ÙÂÛÙ “Ù·ÈÚÈ¿ÛÌ·ÙÔ˜” (matching test).

2. À¿Ú¯ÂÈ Û·Ê‹˜ Û˘Û¯¤ÙÈÛË ÌÂ ·Ó·Ù˘ÍÈ·Î¤˜ ‰˘Ó·ÙﬁÙËÙÂ˜ (ÙÔ ·È‰› Ú¤ÂÈ Ó· ÔÓÔÌ¿˙ÂÈ ÙÔ Û‡Ì‚ÔÏÔ).

3. ∆· Û‡Ì‚ÔÏ· ¤¯Ô˘Ó ·‰Úﬁ ÂÚ›ÁÚ·ÌÌ· Ô˘

·Ú·¤ÌÔ˘Ó Ù· ·È‰È¿ ÛÂ ‰È·ÊÔÚÂÙÈÎ¿ ·ÓÙÈÎÂ›ÌÂÓ· Î·È Ô‰ËÁÔ‡Ó ÙÔÓ ÂÍÂÙ·ÛÙ‹ “Ó· ÂÚ¿ÛÂÈ

ÙÔ ÙÂÛÙ” Î·Ù' ÂÎÙ›ÌËÛË.

4. ¢›ÓÂÙ·È ·ﬁ ·ﬁÛÙ·ÛË 5 Ì¤ÙÚˆÓ. Œ¯ÂÈ

‰ÂÈ¯ıÂ› fiÙÈ fiÛÔ ÌÂÁ·Ï‡ÙÂÚË Â›Ó·È Ë ·fiÛÙ·ÛË, ÙfiÛÔ ÏÈÁfiÙÂÚÔ Û˘ÌÌÔÚÊÒÓÔÓÙ·È Ù· ·È‰È¿ (22).

∂ÈÏ¤ÔÓ, Ë ·ﬁÛÙ·ÛË ÙˆÓ 5 Ì¤ÙÚˆÓ Â›Ó·È

··ÁÔÚÂ˘ÙÈÎ‹ ÁÈ· ÙÈ˜ ‰Â‰ÔÌ¤ÓÂ˜ ‰È·ÛÙ¿ÛÂÈ˜

ÙˆÓ ÂÚÈÛÛﬁÙÂÚˆÓ È·ÙÚÂ›ˆÓ.

5. ¢ÂÓ Û˘ÓÔ‰Â‡ÂÙ·È ·ﬁ Û·ÊÂ›˜ Ô‰ËÁ›Â˜

¯Ú‹ÛË˜ Ô˘ Ó· ÔÚ›˙Ô˘Ó ÙÔ ÛËÌÂ›Ô ·Ú·ÔÌ‹˜

ÛÂ ÂÈ‰ÈÎfi ÙfiÛÔ ÌÂÙ¿ ·fi ÙËÓ ÂÍ¤Ù·ÛË ÙË˜ ÎÔÓÙÈÓ‹˜ fiÛÔ Î·È ÙË˜ Ì·ÎÚÈÓ‹˜ fiÚ·ÛË˜. µ/ ™¯ÔÏÈÎ‹ ËÏÈÎ›·: ∆Ô ÔÙfiÙ˘Ô ÌÂ ÙÔ˘˜ ·ÚÈıÌÔ‡˜ ÁÈ· ¯Ú‹ÛË ÛÙË Û¯ÔÏÈÎ‹ ËÏÈÎ›·:

1. ¢ÂÓ ÏËÚÔ› ÙÈ˜ ‰ÈÂıÓÂ›˜ Û˘ÛÙ¿ÛÂÈ˜ Î·Ù·ÛÎÂ˘‹˜ ÔÙÔÙ‡ˆÓ ﬁˆ˜ ·Ó·Ê¤ÚıËÎ·Ó ÛÙ· ÎÚÈÙ‹ÚÈ· (ÙÂÛÙ Ù‡Ô˘ “Î·Ù·ÚÚ¿ÎÙË”).

2. ¢›ÓÂÙ·È ·ﬁ ·ﬁÛÙ·ÛË 5 Ì¤ÙÚˆÓ (··ÁÔÚÂ˘ÙÈÎ‹ ÁÈ· ¯ÒÚÔ˘˜ ˘ÁÂ›·˜, .¯. È·ÙÚÂ›·).

3. ¢ÂÓ Û˘ÓÔ‰Â‡ÂÙ·È Û˘Ó‹ıˆ˜ ·ﬁ Ô‰ËÁ›Â˜ ¯Ú‹ÛË˜ Ô˘ Ó· ÔÚ›˙Ô˘Ó Î·È ÙÔ ÛËÌÂ›Ô ·Ú·ÔÌ‹˜ ÛÂ ÂÈ‰ÈÎﬁ. ™ÙËÓ ∂ÏÏ¿‰· ‰ÂÓ ˘¿Ú¯ÂÈ ÙÂÛÙ ÁÈ· ÙÔÓ ¤ÏÂÁ-

ËÏÈÎ›· ÙﬁÛÔ ÁÈ· ÙÔÓ ¤ÏÂÁ-

¯Ô ÙË˜ ÎÔÓÙÈÓ‹˜ ﬁÛÔ Î·È ÙË˜ Ì·ÎÚÈÓ‹˜ ﬁÚ·ÛË˜.

∆¤ÙÔÈ· ÙÂÛÙ ﬁÚ·ÛË˜ Î˘ÎÏÔÊÔÚÔ‡Ó Â˘Ú¤ˆ˜ ÛÂ

¯ÒÚÂ˜ ÙÔ˘ ÂÍˆÙÂÚÈÎÔ‡. ∏ ÂÈÏÔÁ‹ ﬁÌˆ˜ ÙÔ˘

Î·Ù¿ÏÏËÏÔ˘ ÙÂÛÙ ﬁÚ·ÛË˜, ·ÏÏ¿ Î·È Ë ·ﬁÎÙË-

Û‹ ÙÔ˘ (ÌﬁÓÔ Î·ÙﬁÈÓ ·Ú·ÁÁÂÏ›·˜) ·ÔÙÂÏÂ›

µÈ‚ÏÈÔÁÚ·Ê›·

1.Appelboom TM. A history of vision screening. J Sch Health 1985;55:138-141.

2.Hartmann EE, Dobson V, Hainline L, Marsh-Tootle W, Quinn GE, Ruttum MS, et al. Preschool vision screening: summary of a Task Force report. Behalf of the Maternal and Child Health Bureau and the National Eye Institute Task Force on Vision Screening in the Preschool Child. Pediatrics 2000;106: 1105-1161.

3.The Official Website of the Nobel Foundation. The 1981 Prize in Physiology or Medicine. [Webpage, Internet]. The Nobel Assembly of Karolinska Institutet. www.nobel.se/medicine/laureates/1981/press.html.

4.Snowdon SK, Stewart Brown SL. Preschool vision screening [Executive Summary]. Health Technol Assess 1997;1:1-83.

5.Stewart-Brown SL, Snowdon SK. Evidence base dilemmas in preschool vision screening. Arch Dis Child 1998;78:406-407.

6.Moseley MJ. Preschool vision screening: a recent report calls for a halt [Commentary]. Br J Opthalmol 1998;82:722-723.

7.Rahi JS, Dezateux C. The future of preschool vision screening services in Britain [Editorials]. BMJ 1997; 315:1247-1248.

8. Ciner EB, Schmidt PP, Orel-Bixler D, Dobson V, Maguire M, Cyert L, et al. Vision screening of preschool children: evaluating the past, looking toward the future. Optom Vis Sci 1998;75:571-584.

9.Wasserman RC, Croft CA, Brotherton SE. Preschool vision screening in pediatric practice: A study from the pediatric research in office setting (PROS) Network. Pediatrics 1992;89:834-838.

10.Newman DK, Hitchcock A, McCarthy H, KeastButler J, Moore AT. Preschool vision screening: outcome of children referred to the hospital eye service. Br J Ophthalmol 1996;80:1077-1082.

11.Preslan MW, Novak A. Baltimore Vision Screening Project. Ophthalmology 1996;103:105-109.

12.Bolger PG, Stewart-Brown SL, Newcombe E, Starbuck A. Vision screening in preschool children: comparison of orthoptists and clinical medical officers as primary screeners. BMJ 1997;303:1291-1294.

13.Yang YF. Visual acuity testing in schools: what needs to be done [Paper]. BMJ 1996;313:1053.

14.Hall DBM, ed. Health for all children. Report of the

third joint working party on child Health Surveillance. 3rd ed. Oxford: Oxford University Press; 1996. p. 164.

15.AAP Policy statement: Eye examination and Vision screening in infants, children and young adults. Pediatrics 1996;98:153-157.

16.Polnay L, Hull D, eds. Community Paediatrics, 2nd ed. London: Churchill Livingstone, 1993

17.American Optometric Association. Pediatric eye and vision examination. Reference guide for clinicians. Prepared by the American Optometric Association Consensus Approved by the AOA Board of Trustees. 1994 June 23, 2nd ed. 1997.

18.∫Ô˘ÛÔ˘Ú‹ ª, ∆˙ˆÚÙ˙¿ÙÔ˘ °, ™ÌÒÎÔ˘ ¢, °ÎÈÒÓË˜ ¢, ¡ÈÎÔÏ¿Ô˘-¶·Ó·ÁÈÒÙÔ˘

Û¯ÔÏÈÎ‹˜ ËÏÈÎ›·˜. 4Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ «ÀÁÂ›· Î·È ¶ÔÈﬁÙËÙ· ∑ˆ‹˜»: ŸÚ·Ì· Î·È ÂÈ‰›ˆÍË ÁÈ· ÙÔ

·È‰› ÙÔ˘ ¢ËÌÔÙÈÎÔ‡ ™¯ÔÏÂ›Ô˘. ∂ÏÏËÓÈÎ‹ ∂Ù·ÈÚÂ›·

∫ÔÈÓˆÓÈÎ‹˜ ¶·È‰È·ÙÚÈÎ‹˜ Î·È ¶ÚÔ·ÁˆÁ‹˜ ÙË˜

ÀÁÂ›·˜ 1992;12. 19.∆Û·Ó¿Î·˜ π, ƒÔËÏ›‰Ë˜ ª, Ã·Ù˙ËÌÈ¯·‹Ï ∞, £Ò‰Ë˜ ™, µ¿ÚÓ·ÏË˜ ¶, ∫·ÚÔ‡˙·˜ π. ∏ ÛËÌ·Û›· ÙˆÓ ÚÔÏËÙÈÎÒÓ ÂÏ¤Á¯ˆÓ ÛÙ· ·È‰È¿ Û¯ÔÏÈÎ‹˜ ËÏÈÎ›·˜.

¶·È‰È·ÙÚÈÎ‹ 1986;49:154-164.

20.¶Ï·Ù‹˜ √, ™ÎÔ‡ÊË ∂. ¶ÚÔÏËÙÈÎ‹ ÂÍ¤Ù·ÛË ·È‰ÈÒÓ Û¯ÔÏÈÎ‹˜ ËÏÈÎ›·˜ ÛÂ ·ÁÚÔÙÈÎ‹ ÂÚÈÔ¯‹. 18Ô ∂Ù‹ÛÈÔ ¶·ÓÂÏÏ‹ÓÈÔ π·ÙÚÈÎﬁ ™˘Ó¤‰ÚÈÔ. π·ÙÚÈÎ‹

∂Ù·ÈÚÂ›· ∞ıËÓÒÓ 1991;519.

21.¶·Ó·ÁÈˆÙﬁÔ˘Ïo˜ ∆. ÀÁÂ›· ÛÙËÓ ÚÔÛ¯ÔÏÈÎ‹ ËÏÈÎ›· [EÌÂÈÚÈÎ‹ ŒÚÂ˘Ó·]. ÿ‰Ú˘Ì· ∂ÚÂ˘ÓÒÓ ÁÈ· ÙÔ

¶·È‰›, ∞ı‹Ó· 1991.

22.Salt AT, Sonksen PM, Wade A, Jayatunga R. The maturation of linear acuity and compliance with the Sonksen-Silver Acuity System in young children. Dev Med Child Neurol 1995;37:505-514.

23.Jayatunga R, Sonksen PM, Bhide, A, Wade A. Measures of acuity in primary-school children and their

ability to detect minor errors of vision. Dev Med Child Neurology 1995;37:515-527.

24.Hered RW, Murphy S, Clancy M. Comparison of the HOTV and LEA Symbols charts for preschool vision screening. J Ophthalmic Nurs Technol 1997; 16:68-73.

25.Wade AM, Ades AE, Salt AT, Jayatunga R, Sonksen PM. Age-related standards for ordinal data: modeling the changes in visual acuity form 2 to 9 years of age. Stat Med 1995;15,14(3):257-266.

26. Lea Huvärinen MD. Precision Vision. Instruction Manual for vision testing products. http://www.leatest.sgic.fi ‹ http://med-apos.bu.edu/leaweb/index. html. 2001; p. 4.

27.Newman, East MM. Preschool vision screening: negative predictive value for amblyopia. Br J Opthalmol 1999;83:676-679.

28.Simons K. Preschool vision screening: rationale, methodology, and outcome. Surv Ophthalmol 1996; 41:3-30.

29.Morad Y, Werker E, Nemet P. Visual acuity tests using chart, line and single optotype in healthy amblyopic children. J AAPOS 1999;3:94-97.

30.Fern KD, Manny RE. Visual acuity of the preschool child: a review. Am J Optom Physiol Opt 1986;63: 319-345.

31.Kohler L. Early detection and screening evaluation of preventive programmes. Pediatriki 1983;46 (Suppl):S337-S341.

32.U.S. Department of Health and Human Services. Agency for Healthcare Research and Quality. Screening for Visual Impairment in Children Younger than Age 5 Years. Systematic Evidence Review for the U.S. Preventive Services Task Force. May 2004.

33.Lindstedt E. What is a vision test. Presented Oct 26th 1991 at the opening of the Eva Lindstedt Early Intervention Programme at the Eye Clinic-Santa Casa Hospital-SaoPaulo, Brazil.

∏ ·Í›· ÙË˜ ÂÍ¤Ù·ÛË˜ ÙË˜ Úﬁ‰ÈÓË˜ ·ÓÙ·‡ÁÂÈ·˜

ÛÂ ÓÂÔÁÓ¿ Î·È ‚Ú¤ÊË

∞. ¡ÈÎÔÏ·˝‰Ô˘, °. ∆ÛﬁÏ·˜

¶ÂÚ›ÏË„Ë: ∏ ÂÍ¤Ù·ÛË ÙË˜ Úﬁ‰ÈÓË˜ ·ÓÙ·‡ÁÂÈ·˜ ÙÔ˘ ·ÌÊÈ‚ÏËÛÙÚÔÂÈ‰Ô‡˜ Û˘ÓÈÛÙ¿Ù·È ÛÂ ﬁÏ· Ù· ÓÂ-

ÔÁÓ¿ Î·È Ù· ‚Ú¤ÊË. ∆Ô Û‡ÓÙÔÌÔ ·˘Ùﬁ ¿ÚıÚÔ ·ÔÛÎÔÂ› ÛÙÔÓ Î·ıÔÚÈÛÌﬁ ÙˆÓ ÂÓ‰Â›ÍÂˆÓ Î·È ÙË˜ ÙÂ-

¯ÓÈÎ‹˜ Ô˘ Ú¤ÂÈ Ó· ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÁÈ· ÙË ÛˆÛÙ‹ ‰ÈÂÓ¤ÚÁÂÈ· ·˘Ù‹˜ ÙË˜ ÂÍ¤Ù·ÛË˜, Î·ıÒ˜ Â›ÛË˜

Î·È ÙˆÓ ÂÓ‰Â›ÍÂˆÓ ÁÈ· ‰È·ÛÙÔÏ‹ ÙË˜ ÎﬁÚË˜, ·ÏÏ¿ Î·È ÙˆÓ ÂÚÈÙÒÛÂˆÓ Ô˘ Î·ıÈÛÙÔ‡Ó ·Ó·ÁÎ·›· ÙËÓ ·Ú·ÔÌ‹ ÙÔ˘ ·È‰ÈÔ‡ ÛÙÔÓ ÔÊı·ÏÌ›·ÙÚÔ.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿ : ƒﬁ‰ÈÓË ·ÓÙ·‡ÁÂÈ·, ·ÓˆÌ·Ï›Â˜ ·ÌÊÈ‚ÏËÛÙÚÔÂÈ‰Ô‡˜,

Red reflex examination in newborn babies and infants as a basic part of the physical examination

A. Nikolaidou, G. Tsolas

Abstract: The red reflex examination is recommended for all newborn babies and infants. This article describes the indications for and the technique of performing this examination, including the indications for dilation of the pupils before examination and the indications for referral to an ophthalmologist.

Key words: Red reflex, retinal abnormalities, vision screening, eye examination.

∂ÈÛ·ÁˆÁ‹

OÈ ÔÊı·ÏÌÔ› ·ÔÙÂÏÔ‡Ó fi¯È ÌfiÓÔ ÙÔ ÛËÌ·ÓÙÈÎfiÙÂÚÔ ·ÈÛıËÙ‹ÚÈÔ fiÚÁ·ÓÔ, ·ÏÏ¿ Ù·˘Ùfi¯ÚÔÓ· ÙÔ ·Ú¿ı˘ÚÔ ÁÈ· ÙËÓ ÂÍ¤Ù·ÛË ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ ÓÂ˘ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ∂›Ó·È, Â›ÛË˜, ÁÓˆÛÙfi fiÙÈ

ÂÎ‰ËÏÒÛÂÈ˜ ·ﬁ ÙÔ˘˜ ÔÊı·ÏÌÔ‡˜, È‰È·›ÙÂÚË˜ Ì¿ÏÈÛÙ· ‰È·ÁÓˆÛÙÈÎ‹˜ ·Í›·˜, ·ÓÂ˘Ú›ÛÎÔÓÙ·È Î·È

ÛÂ ·ÚÎÂÙ¿ Û˘ÛÙËÌ·ÙÈÎ¿ ÓÔÛ‹Ì·Ù·. ∂ÔÌ¤Óˆ˜, Ë ÂÍ¤Ù·ÛË ÙˆÓ ÔÊı·ÏÌÒÓ, ÏÔÁÈ˙ﬁÌÂÓË ˆ˜ Ì¤ÚÔ˜ ÙË˜ Ê˘ÛÈÎ‹˜ ÂÍ¤Ù·ÛË˜ ÙˆÓ ‰È·ÊﬁÚˆÓ Û˘ÛÙËÌ¿ÙˆÓ, ·ÔÎÙ¿ ÍÂ¯ˆÚÈÛÙ‹ ÛËÌ·Û›· Î·È ÔÊÂ›ÏÂÈ Ó·

Á›ÓÂÙ·È ‹‰Ë ·ﬁ ÙËÓ ÚÒÙË Â›ÛÎÂ„Ë ÙÔ˘ ·È‰È¿ÙÚÔ˘ ÛÙÔ ÓÂÔÁ¤ÓÓËÙÔ (1-4). ™‡ÌÊˆÓ· ÌÂ ÙËÓ ÙÚ¤¯Ô˘Û· ÔÏÈÙÈÎ‹ ÙË˜

(5),

(vision screening) Î·È Ë ÔÊı·ÏÌÔÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË Â›Ó·È ˙ˆÙÈÎ‹˜ ÛËÌ·Û›·˜ ÁÈ· ÙËÓ ·Ó·ÁÓÒÚÈÛË

Î·Ù·ÛÙ¿ÛÂˆÓ Ô˘ ‰È·ÛÙÚÂ‚ÏÒÓÔ˘Ó ‹ ·ÚÂÌÔ‰›˙Ô˘Ó ÙÔÓ Û¯ËÌ·ÙÈÛÌﬁ Ê˘ÛÈÔÏÔÁÈÎÔ‡

ÔÙÈÎÔ‡ ÂÈ‰ÒÏÔ˘, ÁÂÁÔÓﬁ˜ Ô˘ ı· ÌÔÚÔ‡ÛÂ Ó·

Ô‰ËÁ‹ÛÂÈ ÛÂ ·ÓÂ·ÚÎ‹ Û¯ÔÏÈÎ‹ Â›‰ÔÛË, ÂÊﬁ-

ÛÔÓ ÙÔ Úﬁ‚ÏËÌ· Â›Ó·È ·ÌÊÔÙÂÚﬁÏÂ˘ÚÔ, ÂÓÒ

ÛÙÈ˜ Ï¤ÔÓ ÛÔ‚·Ú¤˜ ÂÚÈÙÒÛÂÈ˜ ¤ˆ˜ Î·È ÛÂ

Ï‹ÚË ·ÒÏÂÈ· ÙË˜ ﬁÚ·ÛË˜ ÙÔ˘ ·È‰ÈÔ‡. ¶·-

ıÔÏÔÁÈÎ¤˜ Î·Ù·ÛÙ¿ÛÂÈ˜ ÙÔ˘ ·ÌÊÈ‚ÏËÛÙÚÔÂÈ‰Ô‡˜, Ô Î·Ù·ÚÚ¿ÎÙË˜, ÙÔ ÁÏ·‡ÎˆÌ·, ÙÔ ÚÂÙÈÓÔ‚Ï¿ÛÙˆÌ·, ÔÈ ‰È·Ù·Ú·¯¤˜ ÙˆÓ ÔÊı·ÏÌÈÎÒÓ Ì˘ÒÓ Î·È ÔÈ Û˘ÛÙËÌ·ÙÈÎ¤˜ ÓﬁÛÔÈ ÌÂ ÂÎ‰ËÏÒÛÂÈ˜ ·ﬁ ÙÔ˘˜ ÔÊı·ÏÌÔ‡˜, ı· ÌÔÚÔ‡Û·Ó Ó· ·Ó·-

¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹, °ÂÓÈÎﬁ ¡ÔÛÔÎÔÌÂ›Ô ¡›Î·È·˜ “ÕÁÈÔ˜ ¶·ÓÙÂÏÂ‹ÌˆÓ”, ¶ÂÈÚ·È¿˜

AÏÏËÏÔÁÚ·Ê›·: °ÂÒÚÁÈÔ˜ ∆ÛﬁÏ·˜ ¶¿ÚÓËıÔ˜ 32, ∆.∫. 190 13, ™·ÚˆÓ›‰· ∞ÙÙÈÎ‹˜ E-mail: geotsol@otenet.gr

∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 17-09-2004

∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛË˜: 13-04-2005

Department of Pediatrics, “Aghios Panteleimon” General Hospital of Nikea, Piraeus

Correspondence: Georgios Tsolas 32 Parnithos Str., 190 13, Saronida, Attica E-mail: geotsol@otenet.gr

Date of submission: 17-09-2004

Date of approval: 13-04-2005

ÙÌ‹Ì·ÙÔ˜ ÙˆÓ ÔÊı·ÏÌÒÓ (ÂÈÂÊ˘ÎfiÙ·˜, ÎÂÚ·ÙÔÂÈ‰‹˜), Á) ÙË˜ ÎÈÓËÙÈÎfiÙËÙ·˜ ÙˆÓ ÔÊı·ÏÌÈÎÒÓ Ì˘ÒÓ, ‰) ÙË˜ ÈÛÔÚÚÔ›·˜ ÙˆÓ ÔÊı·ÏÌÈÎÒÓ Ì˘ÒÓ, Â) ÙˆÓ ÎÔÚÒÓ Î·È ÛÙ) ÙË˜ Úfi‰ÈÓË˜ ·ÓÙ·‡ÁÂÈ·˜.

ªÂ ÙËÓ ·Ó·˙‹ÙËÛË, ÂÈ‰ÈÎﬁÙÂÚ·, ÙË˜ Úﬁ‰ÈÓË˜

·ÓÙ·‡ÁÂÈ·˜, Ë ÔÔ›· ·ÔÙÂÏÂ› ‚·ÛÈÎﬁ ÙÌ‹Ì· ÙË˜

ÂÍ¤Ù·ÛË˜ ÙÔ˘ ÓÂÔÁÓÔ‡ Î·È ÙÔ˘ ‚Ú¤ÊÔ˘˜, ·ÓÈ-

¯ÓÂ‡ÔÓÙ·È ·ÓˆÌ·Ï›Â˜ ÙÔ˘ Ô›ÛıÈÔ˘ ‰È·ÌÂÚ›ÛÌ·ÙÔ˜ ÙÔ˘ ÔÊı·ÏÌÔ‡ ‹ ıÔÏÂÚﬁÙËÙÂ˜ Î·Ù¿ Ì‹ÎÔ˜

ÙÔ˘ ÔÙÈÎÔ‡ ¿ÍÔÓ·, ﬁˆ˜ Â›Ó·È Ô Î·Ù·ÚÚ¿ÎÙË˜, Ë ·‰È·Ê¿ÓÂÈ· ÙÔ˘ ÎÂÚ·ÙÔÂÈ‰Ô‡˜ ‹ ÙÔ ÚÂÙÈÓÔ‚Ï¿ÛÙˆÌ· (6).

™ÙË Û˘Ó¤¯ÂÈ· ·Ó·Ï‡ÔÓÙ·È ÙfiÛÔ Ë ÙÂ¯ÓÈÎ‹ ‰ÈÂÓ¤ÚÁÂÈ·˜ ÙË˜ ÂÍ¤Ù·ÛË˜ ÙË˜ Úfi‰ÈÓË˜ ·ÓÙ·‡ÁÂÈ·˜, fiÛÔ Î·È Ë ·Í›· ÙË˜ fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ¤ÁÎ·ÈÚË ·Ó›¯ÓÂ˘ÛË ÛÔ‚·ÚÒÓ ÔÊı·ÏÌÈÎÒÓ ÓfiÛˆÓ. ∆Â¯ÓÈÎ‹ ÂÍ¤Ù·ÛË˜

·ÓÙ·‡ÁÂÈ·˜ ∏ Úﬁ‰ÈÓË ·ÓÙ·‡ÁÂÈ·, ÁÓˆÛÙ‹ Î·È ˆ˜ ‰ÔÎÈÌ·Û›· ÙÔ˘ Bruckner (Bruckner test), ‚·Û›˙ÂÙ·È ÛÙÔ ·Ó·ÎÏÒÌÂÓÔ Â› ÙÔ˘ ·ÌÊÈ‚ÏËÛÙÚÔÂÈ‰Ô‡˜ Êˆ˜ ÙÔ˘ ÔÊı·ÏÌÔÛÎÔ›Ô˘ ÌÂÙ¿ ÙËÓ Â›ÛÔ‰ﬁ ÙÔ˘ Ì¤Û·

ÛÙÔ Ì¿ÙÈ. ∏ Ï‹„Ë ÂÍ¤Ú˘ıÚË˜ ·ÓÙ·Ó¿ÎÏ·ÛË˜ ÙÔ˘

ÊˆÙﬁ˜ ÌÂ ÙË Ì¤ıÔ‰Ô ·˘Ù‹ ‰Â›¯ÓÂÈ Ô˘ÛÈ·ÛÙÈÎ¿

ÙËÓ ‡·ÚÍË Î·ı·ÚÔ‡ ÎÂÚ·ÙÔÂÈ‰Ô‡˜, Ê·ÎÔ‡ Î·È

·ÌÊÈ‚ÏËÛÙÚÔÂÈ‰Ô‡˜ (7) (∂ÈÎﬁÓ· 1). ∏ ÂÍ¤Ù·ÛË

ÙË˜ Úﬁ‰ÈÓË˜ ·ÓÙ·‡ÁÂÈ·˜ ı· Ú¤ÂÈ Ó· ‰ÈÂÓÂÚÁÂ›-

Ù·È ÛÂ Û¯ÂÙÈÎ¿ ÛÎÔÙÂÈÓﬁ ¯ÒÚÔ, ÒÛÙÂ Ó· ÂÈÙ˘Á¯¿-

ÓÂÙ·È Ë Ì¤ÁÈÛÙË ‰˘Ó·Ù‹ Ì˘‰Ú›·ÛË ÙË˜ ÎﬁÚË˜, ÂÓÒ

·Ú¿ÏÏËÏ· ·˘Í¿ÓÂÙ·È Î·È Ë Â˘·ÈÛıËÛ›· ÙˆÓ Ì·-

ÙÈÒÓ ÙÔ˘ ÂÍÂÙ·ÛÙ‹. ∫Ú·ÙÒÓÙ·˜ ÙÔ ÔÊı·ÏÌÔÛÎﬁ-

ÈÔ ÎÔÓÙ¿ ÛÙÔ Ì¿ÙÈ Î·È ÂÛÙÈ¿˙ÔÓÙ·˜ ÛÙËÓ ÎﬁÚË, Ô

ÂÍÂÙ·ÛÙ‹˜ ÂÈÛÎÔÂ› Î·È Ù· ‰‡Ô Ì¿ÙÈ· ÙÔ˘ ·È‰È-

Ô‡ ·fi ·fiÛÙ·ÛË 30-45 cm ·fi ÙÔ ‰ÈÎfi ÙÔ˘

ÚfiÛˆÔ. ∏ ÂÍ¤Ù·ÛË ÙË˜ Úfi‰ÈÓË˜ ·ÓÙ·‡ÁÂÈ·˜ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ˆ˜ ·ÚÓËÙÈÎ‹ fiÙ·Ó Ë ·ÓÙ·‡ÁÂÈ·

Â›Ó·È Û˘ÌÌÂÙÚÈÎ‹ Î·È ÈÛfiÙÈÌË Î·È ÛÙ· ‰‡Ô Ì¿ÙÈ·. ™˘ÓÂÒ˜, fiÙ·Ó Ë Úfi‰ÈÓË ·ÓÙ·‡ÁÂÈ· Â›Ó·È Û˘ÌÌÂÙÚÈÎ‹ ÛÂ ¤ÓÙ·ÛË Î·È ·fi ÙÔ˘˜ ‰‡Ô ÔÊı·ÏÌÔ‡˜, ÙfiÙÂ Ë fiÚ·ÛË Â›Ó·È

∂ÈÎﬁÓ· 1. º˘ÛÈÔÏÔÁÈÎ‹ Úﬁ‰ÈÓË ·ÓÙ·‡ÁÂÈ·.

‰˘ÛÙÚÔÊ›·˜ ÙÔ˘ ·ÌÊÈ‚ÏËÛÙÚÔÂÈ‰Ô‡˜. OÈ ÛÎÔÙÂÈÓ¤˜ ÎËÏ›‰Â˜ Ì¤Û· ÛÙË Úfi‰ÈÓË ·ÓÙ·‡ÁÂÈ·, ÔÔÈ·‰‹ÔÙÂ ·Û˘ÌÌÂÙÚ›· ÛÙËÓ ¤ÓÙ·ÛË ÙË˜ Úfi‰ÈÓË˜ ·ÓÙ·‡ÁÂÈ·˜ ÌÂÙ·Í‡ ÙˆÓ ‰‡Ô ÔÊı·ÏÌÒÓ, ·ÓÙÂÏ‹˜ ·Ô˘Û›· ÙË˜ ·fi ÙÔ ¤Ó· Ì¿ÙÈ ‹ ·ÚÔ˘Û›· ÏÂ˘Î‹˜ ·ÓÙ·Ó¿ÎÏ·ÛË˜, ˘Ô‰ËÏÒÓÔ˘Ó ˘ÔÎÂ›ÌÂÓË ·ıÔÏÔÁ›· Î·Ù¿ ÙÔÓ ÔÙÈÎfi ¿ÍÔÓ· Î·È ÂÈ‚¿ÏÏÔ˘Ó ÙËÓ ¿ÌÂÛË ·Ú·ÔÌ‹ ÙÔ˘ ·È‰ÈÔ‡ ÛÙÔÓ ÔÊı·ÏÌ›·ÙÚÔ (∂ÈÎfiÓÂ˜ 2 Î·È 3). ∞fi Ù· ·Ú·¿Óˆ Î·ı›ÛÙ·Ù·È Û·Ê‹˜ Ë ÙÂÚ¿ÛÙÈ· ÛËÌ·Û›· ÙË˜ ÂÍ¤Ù·ÛË˜ ÙË˜ Úfi‰ÈÓË˜ ·ÓÙ·‡ÁÂÈ·˜ ÙÔ˘ ·ÌÊÈ‚ÏËÛÙÚÔÂÈ‰Ô‡˜, Ë ÔÔ›· Ì¿ÏÈÛÙ· ı· Ú¤ÂÈ Î·Ù¿ ‰È·ÛÙ‹Ì·Ù· Ó· Â·ÓÂÍÂÙ¿˙ÂÙ·È ÛÙË ‚ÚÂÊÈÎ‹ ËÏÈÎ›·, ·ÎfiÌË Î·È fiÙ·Ó ¤¯ÂÈ ıÂˆÚËıÂ› Ê˘ÛÈÔÏÔÁÈÎ‹ ÛÙË ÓÂÔÁÓÈÎ‹ ÂÚ›Ô‰Ô. ÕÏÏˆÛÙÂ, ÔÈ ÂÈ‰ÈÎÔ› ÂÊÈÛÙÔ‡Ó ÙËÓ ÚÔÛÔ¯‹ ˆ˜ ÚÔ˜ ÙËÓ ¤ÁÎ·ÈÚË ‰È¿ÁÓˆÛË ÛÔ‚·ÚÒÓ ·ı‹ÛÂˆÓ, fiˆ˜ ÙÔ˘ ÚÂÙÈÓÔ‚Ï·ÛÙÒÌ·ÙÔ˜ Î·È ÙÔ˘ Û˘ÁÁÂÓÔ‡˜ Î·Ù·ÚÚ¿ÎÙË, Ë ¤ÁÎ·ÈÚË ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÔÔ›ˆÓ Â›Ó·È Ô˘ÛÈ·ÛÙÈÎ‹˜ ÛËÌ·Û›·˜ fiÛÔÓ ·ÊÔÚ¿ ÛÙË ‰È¿ÛˆÛË ÙË˜ fiÚ·ÛË˜, ÔÚÈÛÌ¤ÓÂ˜ ‰Â ÊÔÚ¤˜ Î·È ÁÈ' ·˘Ù‹ Î·ıÂ·˘Ù‹ ÙËÓ ÂÈ‚›ˆÛË ÙÔ˘ ·ÛıÂÓÔ‡˜. ªÔÏÔÓfiÙÈ ÛÙ· ‚Ú¤ÊË ÔÈ ÎfiÚÂ˜ ‰È·ÛÙ¤ÏÏÔÓÙ·È Â‡ÎÔÏ· ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÔÈÎ›ÏÔ˘˜ ·Ú¿ÁÔÓÙÂ˜, ÛÔÚ·‰ÈÎ¿ ¤¯Ô˘Ó Î·Ù·ÁÚ·ÊÂ› ÛÔ‚·Ú¤˜ ·ÓÂÈı‡ÌËÙÂ˜ ÂÓ¤ÚÁÂÈÂ˜ ·fi Ù· ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓ· Ì˘‰ÚÈ·ÙÈÎ¿ ÛÎÂ˘¿ÛÌ·Ù·, ÙfiÛÔ Ù· Û˘Ì·ıËÙÈÎÔÌÈÌËÙÈÎ¿, fiˆ˜ Ë Ê·ÈÓ˘ÏÂÊÚ›ÓË, fiÛÔ Î·È Ù· ·ÓÙÈ¯ÔÏÈÓÂÚÁÈÎ¿, fiˆ˜ Ë ˘‰ÚÔ¯ÏˆÚÈÎ‹ Î˘ÎÏÔÂÓÙÔÏ¿ÙË Î·È Ë ÙÚÔÈÎ·Ì›‰Ë. ™ÙÈ˜ ·ÓÂÈı‡ÌËÙÂ˜ ÂÓ¤ÚÁÂÈÂ˜ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È Ë ·‡ÍËÛË ÙË˜ ·ÚÙËÚÈ·Î‹˜ ›ÂÛË˜ Î·È ÙÔ˘ Î·Ú‰È·ÎÔ‡ Ú˘ıÌÔ‡,

∂ÈÎﬁÓ· 2. ∫·Ù·ÚÚ¿ÎÙË˜.

ÔÈ ‰È·Ù·Ú·¯¤˜ ÙÔ˘ Î·Ú‰È·ÎÔ‡ Ú˘ıÌÔ‡, Ë ÔÍÂ›·

ÎÓ›‰ˆÛË, Î·ıÒ˜ Î·È Ë ‰ÂÚÌ·Ù›ÙÈ‰· ÂÍ Â·Ê‹˜ (8-12). ¶·Ú' ﬁÏ· ·˘Ù¿, Ë ‰È·ÛÙÔÏ‹ ÙË˜ ÎﬁÚË˜

ÙˆÓ ÌÈÎÚÒÓ ·È‰ÈÒÓ ·ÔÙÂÏÂ› ‰È·‰ÈÎ·Û›· ÚÔ˘Ù›Ó·˜ Â‰Ò Î·È ÔÏÏ¿ ¯ÚﬁÓÈ· ÛÙ· ÂÚÈÛÛﬁÙÂÚ·

·È‰Ô-ÔÊı·ÏÌÔÏÔÁÈÎ¿ È·ÙÚÂ›·, ¯ˆÚ›˜ Ó· ·Ú·ÙËÚÔ‡ÓÙ·È ÙﬁÛÔ Û˘¯Ó¤˜ ·ÓÂÈı‡ÌËÙÂ˜ ÂÓ¤ÚÁÂÈÂ˜, Î·ıÈÛÙÒÓÙ·˜ ·˘Ù‹ ÙË ‰È·‰ÈÎ·Û›· ·ÛÊ·Ï‹, ﬁÙ·Ó Á›ÓÂÙ·È ÛÂ ¯ÒÚÔ ÔÚÁ·ÓˆÌ¤ÓÔ˘ È·ÙÚÂ›Ô˘, ÛÂ

‚Ú¤ÊË, ·ÎfiÌË Î·È ÛÂ ÓÂÔÁÓ¿ ËÏÈÎ›·˜ ÌÂÁ·Ï‡ÙÂÚË˜ ÙˆÓ ‰‡Ô Â‚‰ÔÌ¿‰ˆÓ. ∆¤ÏÔ˜, fiÛÔÓ ·ÊÔÚ¿ ÛÙ· ÚfiˆÚ· ÓÂÔÁÓ¿, ·˘Ù¿ ÂÍÂÙ¿˙ÔÓÙ·È ÂÓÒ ·ÎfiÌË ÓÔÛËÏÂ‡ÔÓÙ·È ÛÙË ªÔÓ¿‰· ¡ÂÔÁÓÒÓ, Ô‡Ùˆ˜ ÒÛÙÂ Ë Ì˘‰Ú›·ÛË Ó· Â›Ó·È Û¯ÂÙÈÎÒ˜ ·ÛÊ·Ï‹˜, ·ÎfiÌË Î·È ÛÂ ·˘Ù‹ ÙËÓ ÔÌ¿‰· ·È‰ÈÒÓ. ∏ ÚÔ·Ó·ÊÂÚıÂ›Û· ÔÏÈÙÈÎ‹ ÛÙÔ¯Â‡ÂÈ ÛÙË Û‡ÓÙ·ÍË Î·ÙÂ˘ı˘ÓÙ‹ÚÈˆÓ Ô‰ËÁÈÒÓ-Û˘ÛÙ¿ÛÂˆÓ, ‚·ÛÈÛÌ¤ÓˆÓ ÙfiÛÔ ÛÙË ÁÓÒÛË fiÛÔ Î·È ÛÙËÓ Â›Ú· Ô˘ ¤¯ÂÈ ·ÔÎÙËıÂ› Û¯ÂÙÈÎ¿ ÌÂ ÙÔ ı¤Ì· ÙË˜ ÔÊı·ÏÌÔÏÔÁÈÎ‹˜ ÂÍ¤Ù·ÛË˜ ÓÂÔÁ¤ÓÓËÙˆÓ Î·È ÌÈÎÚÒÓ ‚ÚÂÊÒÓ, ÒÛÙÂ Ó· ÂÏ·¯ÈÛÙÔÔÈËıÂ› Ô Î›Ó‰˘ÓÔ˜ ·fi ÙËÓ Î·ı˘ÛÙ¤ÚËÛË ‰È¿ÁÓˆÛË˜ ·ÂÈÏËÙÈÎÒÓ - ÁÈ· ÙËÓ fiÚ·ÛË ‹ Î·È ÙË ˙ˆ‹ ÙÔ˘

·È‰ÈÔ‡ - Î·Ù·ÛÙ¿ÛÂˆÓ.

∂ÈÎﬁÓ· 3. §Â˘ÎÔÎÔÚ›·.

ÛÂ ÛÎÔÙÂÈÓﬁ ¯ÒÚÔ, ÒÛÙÂ Ó· ÌÂÁÈÛÙÔÔÈÂ›Ù·È Ë Ì˘‰Ú›·ÛË ÙË˜ ÎﬁÚË˜ Î·È Ó· ·˘Í¿ÓÂÙ·È Ë Â˘·ÈÛıËÛ›· ÙˆÓ Ì·ÙÈÒÓ ÙÔ˘ ÂÍÂÙ·ÛÙ‹. ∏ ÂÍ¤Ù·ÛË

Á›ÓÂÙ·È Î·Ù¿ ÙÔÓ ÎÏ·ÛÈÎfi ÌÔÓfiÊı·ÏÌÔ ÙÚfiÔ, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÔÊı·ÏÌÔÛÎfiÈÔ, ÙÔ ÔÔ›Ô Ô ÂÍÂÙ·ÛÙ‹˜ ÎÚ·Ù¿ ÎÔÓÙ¿ ÛÙÔ Ì¿ÙÈ ÙÔ˘ Î·È ÛÂ

·fiÛÙ·ÛË ·fi Ù· Ì¿ÙÈ· ÙÔ˘ ‚Ú¤ÊÔ˘˜ fiÛÔ ÂÚ›-

Ô˘ ÙÔ Ì‹ÎÔ˜ ÂÓﬁ˜ ‚Ú·¯›ÔÓ·. ‚) ∆Ô ·ÔÙ¤ÏÂÛÌ· ÙË˜ ÂÍ¤Ù·ÛË˜ ¯·Ú·ÎÙËÚ›-

˙ÂÙ·È ˆ˜ ·ÚÓËÙÈÎfi ‹ Ê˘ÛÈÔÏÔÁÈÎfi fiÙ·Ó Ë ·ÓÙ·Ó¿ÎÏ·ÛË Î·È ·fi Ù· ‰‡Ô Ì¿ÙÈ· Â›Ó·È Û˘ÌÌÂÙÚÈÎ‹ Î·È ÈÛÔ‰‡Ó·ÌË ÛÂ ¯ÚÒÌ·, ¤ÓÙ·ÛË Î·È Î·ı·ÚfiÙËÙ· Î·È ‰ÂÓ ˘¿Ú¯Ô˘Ó ıÔÏÂÚfiÙËÙÂ˜ ‹ ÏÂ˘Î¤˜ ÎËÏ›‰Â˜ Ì¤Û· ÛÙÔ Â‰›Ô ÙË˜ Úfi‰ÈÓË˜ ·ÓÙ·‡ÁÂÈ·˜ ÙÔ˘ Î¿ıÂ ÔÊı·ÏÌÔ‡, Ô‡ÙÂ ‚Â‚·›ˆ˜ ÏÂ˘Î‹ ·ÓÙ·Ó¿ÎÏ·ÛË ·fi ÙËÓ ÎfiÚË (ÏÂ˘ÎÔÎÔÚ›·).

Á) ∆Ô ıÂÙÈÎfi ‹ ·ıÔÏÔÁÈÎfi ·ÔÙ¤ÏÂÛÌ· ÙË˜ ÂÍ¤Ù·ÛË˜ (·Û˘ÌÌÂÙÚ›· ÛÙËÓ ¤ÓÙ·ÛË ÙË˜ Úfi‰ÈÓË˜ ·ÓÙ·‡ÁÂÈ·˜, ‰È·ÊÔÚ¿ ÛÙÔ ¯ÚÒÌ· ‹ ÙË ‰È·‡ÁÂÈ· ‹, Ù¤ÏÔ˜, ·ÒÏÂÈ· ‹ ÏÂ˘Î‹ ·ÓÙ·Ó¿ÎÏ·ÛË) ı· Ú¤ÂÈ, Ì¤Û· ÛÂ Â‡ıÂÙÔ ¯ÚfiÓÔ, Ó· ‰ÈÂÚÂ˘Ó¿Ù·È ÂÚ·ÈÙ¤Úˆ: i) Â›ÙÂ ÌÂ Â·Ó¤ÏÂÁ¯Ô ÙË˜ Úfi‰ÈÓË˜ ·ÓÙ·‡ÁÂÈ·˜, 15 ÂÚ›Ô˘ ÏÂÙ¿ ÌÂÙ¿ ÙËÓ ÂÓÛÙ¿Ï·ÍË ÛÙÔ Î¿ıÂ Ì¿ÙÈ Ì˘‰ÚÈ·ÙÈÎÔ‡ ÎÔÏÏ˘Ú›Ô˘ (ÙÚÔÈÎ·Ì›‰Ë <1% ‹ ÌÂ›ÁÌ· ÙÚÔÈÎ·Ì›‰Ë˜ <1% Î·È Ê·ÈÓ˘ÏÂÊÚ›ÓË˜ 2,5% ‹ ÌÂ›ÁÌ· Î˘ÎÏÔÂÓÙÔÏ¿ÙË˜ 0,25% Î·È Ê·ÈÓ˘ÏÂÊÚ›ÓË˜ 2,5%), ‰Â‰ÔÌ¤ÓÔ˘ fiÙÈ, ·ÎfiÌË Î·È ÛÂ Ê˘ÛÈÔÏÔÁÈÎ‹ fiÚ·ÛË, Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ·Ô˘ÛÈ¿˙ÂÈ Ë Úfi‰ÈÓË ·ÓÙ·‡ÁÂÈ· („Â˘‰Ò˜ ıÂÙÈÎ‹ ‰ÔÎÈÌ·Û›·), È‰›ˆ˜

ﬁÙ·Ó ‰ÂÓ ÂÛÙÈ¿˙ÂÙ·È ÙÔ ‚Ï¤ÌÌ· ÛÙË ÊˆÙÂÈÓ‹

ËÁ‹, ÂÓÒ ·ÓÙÈı¤Ùˆ˜

‰Ú›·ÛË ÙË˜ ÎﬁÚË˜ ÙÔ˘ ÔÊı·ÏÌÔ‡.

™ÙÔ ÛËÌÂ›Ô ·˘Ùﬁ ·Í›˙ÂÈ Ó· ·Ó·ÊÂÚıÂ› ﬁÙÈ

ÔÏÏ¿ ·ﬁ Ù· ÚÔ·Ó·ÊÂÚı¤ÓÙ· Ì˘‰ÚÈ·ÙÈÎ¿

ÎÔÏÏ‡ÚÈ· Î˘ÎÏÔÊÔÚÔ‡Ó ÌÂ ÙÈ˜ ·Ú·¿Óˆ ·Ó·-

ÁÚ·ÊﬁÌÂÓÂ˜ Û˘ÁÎÂÓÙÚÒÛÂÈ˜ ÛÙÈ˜ ∏.¶.∞. Î·È ÛÂ

¿ÏÏÂ˜ ¯ÒÚÂ˜ ÙÔ˘ ÂÍˆÙÂÚÈÎÔ‡. ¶ÚÔÎÂÈÌ¤ÓÔ˘ ÁÈ·

ÙË ¯ÒÚ· Ì·˜, Â›Ó·È ¯Ú‹ÛÈÌÔ Ó· ÁÓˆÚ›˙Ô˘ÌÂ ﬁÙÈ ¯ÚÂÈ¿˙ÂÙ·È Ó· Á›ÓÂÈ ·Ú·›ˆÛË

ÁÈ·

ÎÙË ‹ Û˘ÁÁÂÓ‹ ‰˘ÛÏ·Û›· ÙÔ˘ ·ÌÊÈ‚ÏËÛÙÚÔÂÈ-

ÂÈ‰Ô‡˜ ‹ ÙÔ˘ Ê·ÎÔ‡, ı· Ú¤ÂÈ ÂÍ·Ú¯‹˜ Ó· ˘Ô-

ÛÂ ÂÍ¤Ù·ÛË Úﬁ‰ÈÓË˜ ·ÓÙ·‡ÁÂÈ·˜ Î·-

ÙﬁÈÓ Ì˘‰ÚÈ¿ÛÂˆ˜ ‹ Ó· ÂÍÂÙ¿˙ÔÓÙ·È Î·ÙÂ˘ıÂ›·Ó

·ﬁ ¤ÌÂÈÚÔ ·È‰Ô-ÔÊı·ÏÌ›·ÙÚÔ.

Â) µÚ¤ÊË ÌÂ ÏÂ˘ÎÔÎÔÚ›· ÛÙÔ ¤Ó· ‹ Î·È Ù· ‰‡Ô

Ì¿ÙÈ·, Î·ıÒ˜ Î·È ·˘Ù¿ ÛÙ· ÔÔ›· ·Ô˘ÛÈ¿˙ÂÈ Ë

Úﬁ‰ÈÓË ·ÓÙ·‡ÁÂÈ·, ı· Ú¤ÂÈ Ó· ·Ú·¤ÌÔÓÙ·È ·Ì¤Ûˆ˜ ÛÂ ¤ÌÂÈÚÔ ·È‰Ô-ÔÊı·ÏÌ›·ÙÚÔ.

™˘ÌÂÚ¿ÛÌ·Ù·

∏ ÂÍ¤Ù·ÛË ÙË˜ Úﬁ‰ÈÓË˜ ·ÓÙ·‡ÁÂÈ·˜ ÙÔ˘ ·ÌÊÈ‚ÏËÛÙÚÔÂÈ‰Ô‡˜ ·ÔÙÂÏÂ› ‚·ÛÈÎﬁ Ì¤ÚÔ˜ ÙË˜ Ê˘ÛÈÎ‹˜ ÂÍ¤Ù·ÛË˜ ÙÔ˘ ÓÂÔÁÓÔ‡ Î·È ÙÔ˘ ‚Ú¤ÊÔ˘˜, Î·ıÒ˜ Û˘Ì‚¿ÏÏÂÈ

ÙÔÓ

ÔÊÂ›ÏÂÈ Ó· Â›Ó·È ÂÍÔÈÎÂÈˆÌ¤ÓÔ˜ ÌÂ ÙËÓ ÔÚı‹ Î·È Û˘ÓÂ‹ ‰ÈÂÓ¤ÚÁÂÈ¿ ÙË˜. ∂˘¯·ÚÈÛÙ›Â˜

OÈ ÊˆÙÔÁÚ·Ê›Â˜ ÚÔ¤Ú¯ÔÓÙ·È ·ﬁ ÙÔ ·Ú¯Â›Ô ÙË˜ Î˘Ú›·˜ ∫ˆÓÛÙ·ÓÙ›Ó·˜ µÏ¿¯Ô˘, ∂ÈÌÂÏ‹ÙÚÈ·˜ ∞' ÙË˜ OÊı·ÏÌÔÏÔÁÈÎ‹˜ ∫ÏÈÓÈÎ‹˜ ÙÔ˘ ¡ÔÛÔÎÔÌÂ›Ô˘ ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ÙËÓ ÔÔ›· Î·È Â˘¯·ÚÈÛÙÔ‡ÌÂ ıÂÚÌ¿.

µÈ‚ÏÈÔÁÚ·Ê›·

1.Calhoun JH. Consultation with the specialist. Eye examinations in infants and children. Pediatr Rev 1997;18:28-31.

2.Mills MD. The eye in childhood. Am Fam Physician 1999;60:907-916.

3.Olitsky SE, Nelson LB. Common ophthalmologic concerns in infants and children. Pediatr Clin North Am 1998;45:993-1012.

4.Curnyn KM, Kaufman LM. The eye examination in the pediatrician's office. Pediatr Clin North Am 2003;50:25-40.

5.American Academy of Pediatrics, Committee on Practice and Ambulatory Medicine, Section on Ophthalmology. Eye examination and vision screening in infants, children, and young adults. Pediatrics 1996;98:153-157.

6.American Academy of Pediatrics, Section on Ophthalmology. Red reflex examination in infants. Pediatrics 2002;109:980-981.

7.Tongue AC, Cibis GW. Bruckner test. Ophthalmology 1981;88:1041-1044.

8. Ogut MS, Bozkurt N, Ozek E, Birgen H, Kazokoglu H, Ogut M. Effects and side effects of mydriatic eyedrops in neonates. Eur J Ophthalmol 1996;6:192-196.

9.Fraunfelder FT. Pupil dilation using phenylephrine alone or in combination with tropicamide. Ophthalmology 1999;106:4.

10.Gaynes BI. Monitoring drug safety; cardiac events in routine mydriasis. Optom Vis Sci 1998;75:245-246.

11.Resano A, Esteve C, Fernandez Benitez M. Allergic contact blepharoconjunctivitis due to phenylephrine eye drops. J Investig Allergol Clin Immunol 1999; 9:55-57.

12.Boukhman MP, Maibach HI. Allergic contact dermatitis from tropicamide ophthalmic solution. Contact Dermatitis 1999;41:47-48.

∂ÈÛ‹ÁËÛË ÁÈ· ¯ÔÚ‹ÁËÛË Synagis ÁÈ· ÚﬁÏË„Ë

ÓfiÛÔ˘ ·fi ·Ó·ÓÂ˘ÛÙÈÎfi

∂ÏÏËÓÈÎ‹ ¡ÂÔÁÓÔÏÔÁÈÎ‹ ∂Ù·ÈÚÂ›·

Û˘ÁÎ˘ÙÈ·Îﬁ Èﬁ (RSV)

Recommendation on administration of Palivizumab (Synagis) for the prevention of disease caused by respiratory syncytial virus (RSV)

Hellenic Society of Neonatology

Abstract: The aim of this article is to make recommendations about the use of Palivizumab (Synagis) for the disease caused by respiratory syncytial virus (RSV), according to the literature accessible to the Hellenic Society of Neonatology at the present time.

RSV is the main cause of lower respiratory tract infection in the first two years of life. Seventy per cent of infants are infected during their first year of life and 95% by the end of their second year. Of those infected, 15-22% will present with bronchiolitis, pneumonitis or pneumonia, and 0.5-2% will need hospitalization. The mortality from RSV ranges between 0.5-3.5% (1,2). Reinfection occurs in 50% of infants. The presentation of RSV is seasonal, differing between countries. In Greece it is reported mainly from November until March.

The infants at highest risk are premature infants ≤28 weeks of gestation, with or without chronic bronchopulmonary disease (BPD), or more mature infants with BPD, congenital heart disease or immunodeficiencies.

Synagis is a monoclonal antibody against RSV.

The prophylactic administration of Synagis at a dose of 15 mg/kg i.m. during the season of RSV infection has been reported to reduce the rates of hospitalization for RSV infections by 55%. According to this information, Synagis is recommended for the following groups:

a) Infants ≤2 years of age with BPD, if they have been on treatment in the last 6 months before the start of the RSV season.

b) Premature infants without BPD, if they have been born at:

1. gestational age ≤28 weeks and are aged <1 year during the RSV season

2. gestational age 29-32 weeks and are aged <6 months during the RSV season

3. gestational age 33-35 weeks, if they have additional risk factors and are aged <6 months during the RSV season.

c) Infants with congenital heart disease, with or without cyanosis, if they are aged <1 year, or if they need surgery or hospitalization during the RSV season. Also infants with cardiomyopathies, if they are aged <1 year of age during the RSV season.

d) Infants with immunodeficiencies.

ÙË˜ ÓfiÛÔ˘ ·fi ÙÔÓ ·Ó·ÓÂ˘ÛÙÈÎfi Û˘ÁÎ˘ÙÈ·Îfi Èfi (RSV) ‚¿ÛÂÈ ÙË˜ ÚÔÛÈÙ‹˜ ÛÂ Ì·˜ ‚È‚ÏÈÔÁÚ·Ê›·˜. √ RSV (·Ó·ÓÂ˘ÛÙÈÎfi˜ Û˘ÁÎ˘ÙÈ·Îfi˜ Èfi˜) Â›Ó·È Ë Î˘ÚÈfiÙÂÚË ·ÈÙ›· ÏÔ›ÌˆÍË˜ ÙÔ˘ Î·ÙÒÙÂÚÔ˘

˙ˆ‹˜. ¶ÂÚ›Ô˘ 70% ÙˆÓ ·È‰ÈÒÓ ÌÔÏ‡-

ÛÙÔÓ 1Ô ¯ÚﬁÓÔ ˙ˆ‹˜ Î·È 95% ı· ¤¯Ô˘Ó

Ì¤¯ÚÈ ÙÔÓ 2Ô ¯ÚfiÓÔ ˙ˆ‹˜. ∞fi ·˘Ù¿, 15-22% ı· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó ‚ÚÔÁ¯›ÙÈ‰·, ÓÂ˘ÌÔÓ›ÙÈ‰·, ÓÂ˘ÌÔÓ›·, ÂÓÒ 0,5-2% ı· ¯ÚÂÈ·ÛÙÂ› ÂÈÛ·ÁˆÁ‹ ÛÂ ÓÔÛÔÎÔÌÂ›Ô. ∆Ô ÔÛÔÛÙfi ıÓËÛÈÌfiÙËÙ·˜ ·fi RSV Î˘Ì·›ÓÂÙ·È ·fi 0,53,5% (1,2). ∂·Ó·ÌfiÏ˘ÓÛË ÌÔÚÂ› Ó· Û˘Ì‚Â› ÛÙÔ 50% ÙˆÓ ·È‰ÈÒÓ (2). √ RSV ¤¯ÂÈ ÂÔ¯È·Î‹ ÂÌÊ¿ÓÈÛË. ∏ ÂÔ¯‹

Paediatrician-Neonatologist Head of Neonatal ICU, “Mitera” Maternity Clinic

Date of submission: 27-06-2005

Date of approval: 15-09-2005

Editor: Dr Sofia Petmezaki

‰È·Ê¤ÚÂÈ ·ﬁ ¯ÒÚ· ÛÂ ¯ÒÚ·. ™ÙËÓ ∂ÏÏ¿‰· ÂÌÊ·Ó›˙ÂÙ·È Î˘Ú›ˆ˜ ÌÂÙ·Í‡ ¡ÔÂÌ‚Ú›Ô˘ Î·È ª·ÚÙ›Ô˘.

¶Ï¤ÔÓ ÂÈÚÚÂ‹ ÁÈ· ÛÔ‚·Ú‹ ÓﬁÛËÛË ·ﬁ

ÙÔÓ RSV Â›Ó·È: - Ù· ÚﬁˆÚ· Î·È Î˘Ú›ˆ˜ ÂÎÂ›Ó· Ô˘ ÂÍ¤Ú¯Ô-

ÓÙ·È ·ﬁ ÙË ªÔÓ¿‰· ∂ÓÙ·ÙÈÎ‹˜ ¡ÔÛËÏÂ›·˜ ¡Â-

ÔÁÓÒÓ, ÙËÓ ÂÔ¯‹ ÙË˜ ¤Í·ÚÛË˜ ÙÔ˘ ÈÔ‡ - ·È‰È¿ ÌÂ ¯ÚﬁÓÈ· ÓÂ˘ÌÔÓÈÎ‹ ÓﬁÛÔ, .¯. ‚ÚÔÁ¯ÔÓÂ˘ÌÔÓÈÎ‹ ‰˘ÛÏ·Û›· (B¶¢), Î˘ÛÙÈÎ‹

›ÓˆÛË, ‰È·ÊÚ·ÁÌ·ÙÔÎ‹ÏË - ·È‰È¿ ÌÂ Û˘ÁÁÂÓ‹ Î·Ú‰ÈÔ¿ıÂÈ· - ·È‰È¿ ÌÂ ÚˆÙÔ·ı‹ ‹ ‰Â˘ÙÂÚÔ·ı‹ ‰È·Ù·Ú·¯‹ ÙÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜

·È‰È¿ ÌÂ ·ÓÔÛÔÎ·Ù·ÛÙÔÏ‹ - ·È‰È¿ ÌÂ ÓÂ˘ÚÔÌ˘˚Î‹ ÓﬁÛÔ (3)

RSV Â›Ó·È: (2,4)

ÚÔ¤Ú¯ÂÙ·È

- ¡Â˘ÚÔÏÔÁÈÎ¤˜ ·ı‹ÛÂÈ˜ - ªÂÁ¿ÏË ·ﬁÛÙ·ÛË ·ﬁ ÓÔÛÔÎÔÌÂ›Ô (·˘-

ÍËÌ¤ÓË ÓÔÛËÚfiÙËÙ·) - ¶·ıËÙÈÎfi Î¿ÓÈÛÌ· - Ã·ÌËÏfi ÎÔÈÓˆÓÈÎÔ-ÔÈÎÔÓÔÌÈÎfi Â›Â‰Ô

£ÂÚ·Â˘ÙÈÎ¿, ÛÙË ÓfiÛËÛË ·fi RSV ¤¯Ô˘Ó ¯ÚËÛÈÌÔÔÈËıÂ› ÂÎÙfi˜ ·fi Ù· ÎÔÈÓ¿ Ì¤ÙÚ· ·ÔÊ˘Á‹˜ ‰È·ÛÔÚ¿˜ ÏÔÈÌÒÍÂˆÓ (Ï‡ÛÈÌÔ ¯ÂÚÈÒÓ, Ì¿ÛÎÂ˜, ·ÔÊ˘Á‹ Û˘Á¯ÚˆÙÈÛÌÔ‡) Î·È ‚ÚÔÁ¯Ô‰È·ÛÙ·ÏÙÈÎ¿, ÛÙÂÚÔÂÈ‰‹, O2, πgGIV, ¯ˆÚ›˜ È‰È·›ÙÂÚ· Î·Ï¿ ·ÔÙÂÏ¤ÛÌ·Ù·.

¶ÚÔÏËÙÈÎ¿, ¯ÔÚËÁ‹ıËÎÂ ÂÈ‰ÈÎ‹ RSV IgGIV, ·ÏÏ¿ ··ÈÙÂ›ÙÔ IV ÌﬁÓÔ ¯ÔÚ‹ÁËÛË, ÂÌÊ¿ÓÈÛÂ ÙÔ˘˜ ÎÈÓ‰‡ÓÔ˘˜ ÙˆÓ ·Ú·ÁÒÁˆÓ ·›Ì·ÙÔ˜ Î·È

ÂÓ›ÔÙÂ ·Ú·ÙËÚ‹ıËÎÂ Î·È ‚·Ú‡ÙÂÚË ÓfiÛËÛË ÛÂ Â·Ó·ÌfiÏ˘ÓÛË ÛÙ· ·È‰È¿ Ô˘ Â›¯·Ó Ï¿‚ÂÈ RSV IgGIV (2). ∆Ô 1998, ÙÔ FDA Â¤ÙÚÂ„Â ÙË ¯Ú‹ÛË ÙË˜ palivizumab (Synagis) ÁÈ· ÚfiÏË„Ë ÌfiÏ˘ÓÛË˜ ·fi ÙÔÓ RSV. ∏ ¯Ú‹ÛË ÙÔ˘ Synagis ÌÂ›ˆÛÂ Î·Ù¿ 55% ÙËÓ ·Ó¿ÁÎË ÁÈ· ÂÈÛ·ÁˆÁ‹ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô ÁÈ· ÏÔ›ÌˆÍË ·fi RSV (5). ™Ù· ÚfiˆÚ· ¯ˆÚ›˜ B¶¢, ÙÔ ÔÛÔÛÙfi ÌÂ›ˆÛË˜ ‹Ù·Ó 78% ÂÓÒ ÛÂ

ÌÂ B¶¢ ‹Ù·Ó 39% (1).

Synagis Â›Ó·È ÂÍ·ÓıÚˆÔÔÈËÌ¤ÓÔ ÌÔÓÔ-

ÎÏˆÓÈÎfi ·ÓÙ›ÛˆÌ· ÂÓ·ÓÙ›ÔÓ ÙË˜ F-ÁÏ˘ÎÔÚˆÙÂ˝ÓË˜ ÙÔ˘ RSV. ∏ ¯ÔÚ‹ÁËÛË ÙÔ˘ Synagis ˘ÂÚÙÂÚÂ› ÙË˜ RSV IgGIV, ‰ÈfiÙÈ ·Â‰Â›¯ıË ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂÚË ÛÙËÓ ÚfiÏË„Ë, Â›Ó·È Â‡ÎÔÏË ÛÙËÓ ¯ÔÚ‹ÁËÛ‹ ÙË˜, ‰ÂÓ ¤¯ÂÈ ÙÔ˘˜ ÎÈÓ‰‡ÓÔ˘˜ ÙˆÓ ·Ú·ÁÒÁˆÓ ·›Ì·ÙÔ˜ Î·È Â›ÛË˜, ‰‡Ó·Ù·È Ó· ¯ÔÚËÁËıÂ› Û˘Á¯ÚfiÓˆ˜ ÌÂ ÂÌ‚fiÏÈ· ÌÂ ˙ÒÓÙÂ˜ ÈÔ‡˜ .¯. ªªR (6,7).

∆o Synagis ¯ÔÚËÁÂ›Ù·È πª ÛÂ ‰fiÛË 15 mg/kg ·Ó¿ Ì‹Ó· ÛÂ maximum 5 ‰fiÛÂÈ˜, ÛÙËÓ ÂÔ¯‹ ¤Í·ÚÛË˜ ÙÔ˘ RSV. ™Â ‚·ÚÈ¤˜ ÂÚÈÙÒÛÂÈ˜ ÌÔÚÂ› Ó· ¯ÚÂÈ·ÛÙÂ› ¯ÔÚ‹ÁËÛË Î·È ÛÙÔÓ 2Ô ¯ÚfiÓÔ ˙ˆ‹˜, ÛÙËÓ ÂÔ¯‹ ¤Í·ÚÛË˜ ÙÔ˘ ÈÔ‡ (4). ™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, ‚¿ÛÂÈ ÙˆÓ ·ÓˆÙ¤Úˆ, Ë ∂ÏÏËÓÈÎ‹ ¡ÂÔÁÓÔÏÔÁÈÎ‹ ∂Ù·ÈÚÂ›· ÂÈÛËÁÂ›Ù·È ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ Synagis: ·) ™Â ·È‰È¿ ≤2 ÂÙÒÓ, ·Ó ¿Û¯Ô˘Ó ·fi ¯ÚfiÓÈ· ÓÂ˘ÌÔÓÔ¿ıÂÈ· (µ¶¢) Î·È Ï·Ì‚¿ÓÔ˘Ó ıÂÚ·Â›· ÁÈ' ·˘Ù‹, ÙÔ˘˜ ÙÂÏÂ˘Ù·›Ô˘˜ 6 Ì‹ÓÂ˜ ÚÈÓ ÙËÓ ¤Í·ÚÛË ÙÔ˘ RSV. ‚) ™Â ÚfiˆÚ· ¯ˆÚ›˜ µ¶¢ ·Ó Â›Ó·È: 1. ∏.∫. ≤28 Â‚‰. Î·È ÙËÓ ÂÔ¯‹ ÙË˜ ¤Í·ÚÛË˜ ÙÔ˘ RSV Â›Ó·È ËÏÈÎ›·˜ ≤1 ¤ÙÔ˘˜, 2. ∏.∫. 29-32 Â‚‰. Î·È ÙËÓ ÂÔ¯‹ ÙË˜ ¤Í·ÚÛË˜ ÙÔ˘ RSV Â›Ó·È ËÏÈÎ›·˜ <6 ÌËÓÒÓ, 3. ∏.∫. 33-35 Â‚‰. ·Ó Û˘Ó˘¿Ú¯Ô˘Ó ÂÈÏ¤ÔÓ ÂÈ‚·Ú˘ÓÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ Î·È ·Ó ÙËÓ ÂÔ¯‹ ÙË˜ ¤Í·ÚÛË˜ ÙÔ˘ RSV Â›Ó·È ËÏÈÎ›·˜ <6 ÌËÓÒÓ. Á) ™Â Û˘ÁÁÂÓÂ›˜ Î·Ú‰ÈÔ¿ıÂÈÂ˜ ÌÂ ·ÈÌÔ‰˘Ó·ÌÈÎ¿ ÛËÌ·ÓÙÈÎ‹ ·ÓˆÌ·Ï›·, ÌÂ Î˘¿ÓˆÛË ‹ ÌË, ·Ó Â›Ó·È <1 ¤ÙÔ˘˜ ÛÙËÓ ÂÔ¯‹ ¤Í·ÚÛË˜ ÙÔ˘ RSV. ∂›ÛË˜, ÛÂ Û˘ÁÁÂÓÂ›˜ Î·Ú‰ÈÔ¿ıÂÈÂ˜ Ô˘ ÚfiÎÂÈÙ·È Ó· ¯ÂÈÚÔ˘ÚÁËıÔ‡Ó ‹ ¯ÚÂÈ¿˙ÔÓÙ·È ÓÔÛÔÎÔÌÂÈ·Î‹ ÂÚ›ı·Ï„Ë ÙËÓ ÂÔ¯‹ ¤Í·ÚÛË˜ ÙÔ˘ RSV, fiˆ˜ Â›ÛË˜ ÛÂ Î·Ú‰ÈÔÌ˘Ô¿ıÂÈÂ˜ Ô˘ ¯ÚÂÈ¿˙ÔÓÙ·È ıÂÚ·Â›· ÛÂ ‚Ú¤ÊË ËÏÈÎ›·˜ <1 ¤ÙÔ˘˜ ÙËÓ ÂÔ¯‹ ¤Í·ÚÛË˜ ÙÔ˘ RSV (8).

‰) ™Â ·È‰È¿ ÌÂ Û˘ÁÁÂÓ‹ ‹ Â›ÎÙËÙË ‰È·Ù·Ú·¯‹ ÙÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜.

√È Û˘ÛÙ¿ÛÂÈ˜ ·˘Ù¤˜ ÂÊ·ÚÌﬁ˙ÔÓÙ·È ÛÙÈ˜ ∏¶∞ (4), IÛ·Ó›· (1), πÙ·Ï›· (5), µÚÂÙ·Ó›· (3), ∂˘ÚÒË (6), ∫·Ó·‰¿˜ (7), °ÂÚÌ·Ó›· (9), §·ÙÈÓÈÎ‹ ∞ÌÂÚÈÎ‹ (2), √ÏÏ·Ó‰›· (10), ¶ÔÏˆÓ›· (11), √˘ÁÁ·Ú›· (12).

µÈ‚ÏÈÔÁÚ·Ê›·

1.Spanish Consensus Committee: Prevention of Respiratory Syncytial Virus Infection in Spain. Pediatric Infectious Diseases Journal en Espanol, Octubre 1999.

2.Azar P, Broglia B, Miceli INP, Parga L, Castillo S, Edwin A et al. Guidelines for the use of Palivizumab

in the prevention of RSV disease. A consensus opinion. Pediatrics in Review en Espanol, Abril 2000; 21(2):62-68.

3.U.K. Guidelines for the use of Synagis. Document issued by Abbott U.K., 1999.

4. American Academy of Pediatrics Committee on Infectious Diseases and Committee on Fetus and Newborn. Prevention of Respiratory Syncytial Virus Infections: Indications for the use of Palivizumab and Update on the use of RSV-IGIV. Pediatrics 1998; 102(5):1211-1216.

5.Giovannini M, Giuffre L, Marini A, Rondini G, Rossi G, Salvioli GP. Respiratory Syncytial Virus Infections in children. State of the Art. Neonatologica 1999;13(2):89-92.

6.Carbonell-Estrany X, Giuffre L, Kimpen Jan LL, Adan D, Calenius H, Devlieger H et al. Guidelines for the use of Synagis® (Palivizumab), a Humanised Monoclonal Antibody for the prevention of Respiratory Syncytial Virus (RSV) Disease in High Risk Infants. A consensus opinion. Supplement to Infections in Medicine, December 1999;16(G):29-33.

7.A joint statement of the Canadian Paediatric Society and the Fetus and Newborn Committee. Palivizumab and respiratory syncytial virus immune globulin intravenously for the prophylaxis of respiratory syncytial virus infection in high risk infants. Paediatrics and Child Health 1999;4(7):474-480.

8.Tulloh R, Marsh M, Blackburn M, Casey F, Lennen W, Weller P et al. Recommendations for the use of Palivizumab as prophylaxis against respiratory syncytial virus in infants with congenital cardiac disease. Cardiol Young 2003;13(5):420-423.

9.Prophylaxis of RSV Infections with immunoglobulin. Statement / report of the German Society of Pediatric Infectology. Coordinator Prof. Dr. J. Foster. Monatsschrift Kinderheilkunde, October 1999;971-972.

10.Duiverman EJ, Lafeber HN, Hartwig N. The standpoint of the pediatric pulmonary diseases, neonatology and infectious diseases divisions of the Pediatric Association of the Netherlands (NVK) regarding the indication in children for the use of Palivizumab. Groningen, 21 September 2001.

11.The National Consultant for Pediatrics and the National Consultant for Neonatology. Guidelines for the Prevention of Respiratory Syncytial Virus (RSV) Infections in High Risk Infants. Prepared by P. Januszewicz et al. Warszawa 2000.

12.Pinter S, Adamovich K, Hajdu J, Katona M, Megyeri P, Nobilis A et al. Professional Guidelines for the use of SYNAGISTM (Palivizumab) for the Prevention of Respiratory Syncytial Virus Infections in Infants, 15 December 1999.

∞’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ

“¶. & ∞. ∫˘ÚÈ·ÎÔ‡”

AÏÏËÏÔÁÚ·Ê›·:

∞. ¶··‰ÔÔ‡ÏÔ˘

E-mail: papadop5@otenet.gr ¶·È‰È·ÙÚÈÎ‹ 2006;69:72,76

∞ÁﬁÚÈ 11 ÂÙÒÓ ÂÈÛ‹¯ıË ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô

∞ÙÔÌÈÎfi Î·È ÔÈÎÔÁÂÓÂÈ·Îfi ·Ó·ÌÓËÛÙÈÎfi ÂÏÂ‡ıÂÚÔ.

∞ﬁ ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈÎ‹ ÂÍ¤Ù·ÛË Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ‰ÂÓ ÚÔ¤Î˘„·Ó ·ıÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù· ¤Ú·Ó

ÙË˜ ˆ¯ÚfiÙËÙ·˜. ∞fi ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô

ÚÔ¤Î˘„·Ó Ù· ·Ú·Î¿Ùˆ: ∏b: 7,3g/dl, Ht: 25,5%, MCV: 56,7, RDW: 19, WBC: 9.900 (N: 46%, L: 26%, M:11% ), PLT: 849.000, ∆∫∂: 118 ¯ÈÏ./1Ë ÒÚ·, CRP: 129 mg/L, Fe ÔÚÔ‡: 15Ìg/dl, ÊÂÚÚÈÙ›ÓË: 22 ng/ml (º™ 20-250 ng/ml), ªayer ÎÔÚ¿ÓˆÓ: ·ÚÓËÙÈÎ‹. BÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜: ÎÊ. ∞ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ ÁÏÔÈ·‰›ÓË˜, ÚÂÙÈÎÔ˘Ï›ÓË˜, ÂÓ‰ÔÌ˘˝Ô˘: ·ÚÓËÙÈÎ¿, ·˘ÙÔ·ÓÙÈÛÒÌ·Ù·, Î‡ÙÙ·Ú· Ï‡ÎÔ˘, Ra test: ·ÚÓËÙÈÎ¿, VMA, · - ÊÂÙÔÚˆÙÂ˝ÓË: ·ÚÓËÙÈÎ¿, ·ÓÔÛÔÛÊ·ÈÚ›ÓÂ˜: IgG: 2050 mg/dl (↑), IgA: 460 mg;dl (↑), C3: 231 mg/dl (↑). ¢ÂÚÌ·ÙÔ·ÓÙ›‰Ú·ÛË Mantoux (-). ∞ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜: ∞/· ıÒÚ·ÎÔ˜, U/S ÎÔÈÏ›·˜, ‚·ÚÈÔ‡¯Ô˜ ‰È¿‚·ÛË ÏÂÙÔ‡ ÂÓÙ¤ÚÔ˘: fiÏ· ÎÊ. CT ÎÔÈÏ›·˜: Î.Ê. ª˘ÂÏfiÁÚ·ÌÌ·: ŸÏÂ˜ ÔÈ Î˘ÙÙ·ÚÈÎ¤˜ ÛÂÈÚ¤˜ ·ÚÔ‡ÛÂ˜. EÚ˘ıÚ¿ ÛÂÈÚ¿ ˆÚÈÌ¿˙ÂÈ ÌÂ ÌÈÎÚÔ-ÔÚıÔ‚Ï·ÛÙÈÎfi ¯·Ú·ÎÙ‹Ú·, ÛÈ‰ËÚ·Ôı‹ÎÂ˜ ÎÂÓ¤˜. °·ÛÙÚÔÛÎfiËÛË: ÛÔ‚·Ú‹

∂ÈÎﬁÓ· 1.

Á·ÛÙÚ›ÙÈ‰· - ‰ˆ‰ÂÎ·‰·ÎÙ˘Ï›ÙÈ‰· Î·È ·ÓÂ‡ÚÂÛË Helicobacter pylori ÛÙËÓ ÈÛÙÔÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË Î·È ÙÔ CLO test ÌÂ Î·Ï‹ ·Ú¯ÈÙÂÎÙÔÓÈÎ‹ ÙˆÓ Ï·¯ÓÒÓ ÙÔ˘ ‰ˆ‰ÂÎ·‰·ÎÙ‡ÏÔ˘. ∆Ô ·È‰› ÂÍ‹ÏıÂ ÌÂ ‰È¿ ÛÙﬁÌ·ÙÔ˜ ¯ÔÚ‹ÁËÛË Fe (Hb ÂÍﬁ‰Ô˘: 9 g/dl) Î·È ·ÁˆÁ‹ ÂÎÚ›˙ˆÛË˜ ÙÔ˘ Helicobacter pylori

∂·ÓÂÍ¤Ù·ÛË ÌÂÙ¿ 45 ËÌ¤ÚÂ˜

∆Ô ·È‰› ÚÔÛ‹ÏıÂ ÁÈ· ÚÔÁÚ·ÌÌ·ÙÈÛÌ¤ÓÔ Â·Ó¤ÏÂÁ¯Ô. ∏ ÂÈÁ·ÛÙÚ·ÏÁ›· Â›¯Â Ï‹Úˆ˜ ˘Ô¯ˆÚ‹ÛÂÈ, ﬁÌˆ˜ ÙÔ ·È‰› ·ÚÔ˘Û›·ÛÂ

ÎÏÈÓÈÎ‹ ÂÍ¤Ù·ÛË ‚Ú¤ıËÎÂ

ˆ¯ÚfiÙËÙ·. ∞fi ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô ÚÔ¤Î˘„·Ó Ù· ·Ú·Î¿Ùˆ: ∏b:10g/dl, ∆∫∂ >100 mm/1Ë ÒÚ·, CRP >100 mg/L. §fiÁˆ ÙÔ˘ ‚‹¯·, ÙÔ ·È‰› ˘Ô‚Ï‹ıËÎÂ ÛÂ Ó¤· ·/· ıÒÚ·ÎÔ˜: ‰ÈÂ‡Ú˘ÓÛË ÌÂÛÔıˆÚ·Î›Ô˘ (ÂÈÎfiÓ· 1), CT ıÒÚ·ÎÔ˜: Ì¿˙· ÛÙÔ Ô›ÛıÈÔ ÌÂÛÔıˆÚ¿ÎÈÔ (ÂÈÎfiÓ· 2), MIBG ·ÚÓËÙÈÎfi ÁÈ· ÓÂ˘ÚÔ‚Ï¿ÛÙˆÌ·, ÂÍ¤Ù·ÛË Á·ÛÙÚÈÎÔ‡ ˘ÁÚÔ‡ ÁÈ· ÔÍÂ¿ÓÙÔ¯· (-), ‰ÂÚÌ·ÙÈÎ¤˜ ‰ÔÎÈÌ·Û›Â˜ ÁÈ· ¿Ù˘· (-), Ì˘ÎÔ‚·ÎÙËÚ›‰È· VMA, HVA (-).

∏ ‰ÈÂ‡Ú˘ÓÛË ÙÔ˘ Ô›ÛıÈÔ˘ ÌÂÛÔıˆÚ·Î›Ô˘ ÛÙËÓ ÚÔÎÂÈÌ¤ÓË ÂÚ›ÙˆÛË ÔÊÂ›ÏÂÙ·È ÛÂ:

1. §¤ÌÊˆÌ·

2. ¡Â˘ÚÔ‚Ï¿ÛÙˆÌ·

3. ¡ﬁÛÔ Castelman

4. ∆ÂÚ¿ÙˆÌ·

5. ∫˘ÛÙÈÎﬁ ‡ÁÚˆÌ·

∂ÈÎfiÓ· 2. CT ıÒÚ·ÎÔ˜: ∂ÍÂÚÁ·Û›· ÛÙÔ Ô›ÛıÈÔ ÌÂÛÔıˆÚ¿ÎÈÔ, ‰ÂÍÈ¿ ÙË˜ Ì¤ÛË˜ ÁÚ·ÌÌ‹˜. ÕÚ¯ÂÙ·È ÂÚ›Ô˘ ·fi ÙÔ ‡„Ô˜ ÙË˜ ÌÂÛfiÙËÙÔ˜ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ÎfiÏÔ˘ Î·È ÚÔ˜ Ù· ¿Óˆ ÂÎÙÂ›ÓÂÙ·È Ì¤¯ÚÈ ÙÔ ‡„Ô˜ ÙË˜ ÙÚfiÈ‰Ô˜. ¢È·ÛÙ¿ÛÂÈ˜: 6 x 5 cm.

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

∞ÏÏÂÚÁ›Â˜, ˘ÂÚÂ˘·ÈÛıËÛ›Â˜ Î·È ¿ÛıÌ·

http://www.allergyped.gr

ÂÙ·ÈÚÂ›· ÌË ÎÂÚ‰ÔÛÎÔÈÎÔ‡ ¯·Ú·ÎÙ‹Ú·, Ô˘ ÛÙﬁ¯Ô ¤¯ÂÈ Ó· Û˘Ì‚¿ÏÂÈ ÛÙËÓ Î·Ù·ÔÏ¤ÌËÛË ÙˆÓ ·ÏÏÂÚÁÈÒÓ Î·È ÙÔ˘ ¿ÛıÌ·ÙÔ˜ Ì¤Ûˆ ÙË˜ ÂÓËÌ¤ÚˆÛË˜, ÙË˜ ÂÎ·›‰Â˘ÛË˜, ÙË˜ ÎÔÈÓˆÓÈÎ‹˜ ·ÚÔ˘Û›·˜ Î·È ÙË˜ ¤ÚÂ˘Ó·˜. H

(EFA), Î·È ÂÚÂ˘ÓËÙÈÎ¿ ‰›ÎÙ˘· (GA2LEN) Î·È ÂÎ‰ËÏÒÛÂÈ˜

ﬁˆ˜ ÙËÓ ¶·ÁÎﬁÛÌÈ·

ÕÛıÌ·ÙÔ˜. √ ‰ÈÎÙ˘·Îfi˜ ÙfiÔ˜ ÙË˜ ÕÓÔÈÍË˜ ·ÔÙÂÏÂ› ‚·ÛÈÎfi ÂÚÁ·ÏÂ›Ô

ÙË˜. ∂ÎÙfi˜ ·fi ÙËÓ ÂÏÏËÓÈÎ‹ ¤Î‰ÔÛË, ÌÂ Ï‹ÚÂ˜ ÂÚÈÂ¯fiÌÂÓÔ, ˘¿Ú¯ÂÈ Î·È Ë ·ÁÁÏÈÎ‹, Ô˘ ¤¯ÂÈ ÂÚÈÏËÙÈÎfi ¯·Ú·ÎÙ‹Ú·.

∆Ô Î‡ÚÈÔ ‚¿ÚÔ˜ ÙË˜ ÈÛÙÔÛÂÏ›‰·˜ ‰›ÓÂÙ·È ÛÙËÓ ÏËÚÔÊfiÚËÛË ÛÙÔ Â˘Ú‡ Â‰›Ô ÙË˜ ·ÏÏÂÚÁÈÔÏÔÁ›·˜, ÌÂ ÏÔ‡ÛÈÔ ÂÓËÌÂÚˆÙÈÎfi ˘ÏÈÎfi Û¯ÂÙÈÎ¿ ÌÂ Ù· ‚·ÛÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ ÓÔÛËÌ¿ÙˆÓ, Ô‰ËÁ›Â˜ ÚÔÊ‡Ï·ÍË˜ Î·È ÚfiÏË„Ë˜ Î·ıÒ˜ Î·È ¯Ú‹ÛÈÌÂ˜ Û˘Ì‚Ô˘Ï¤˜ ÁÈ· ÙËÓ Î·Ï‡ÙÂÚË ÔÈfiÙËÙ· ˙ˆ‹˜ ÙˆÓ ·ÙfiÌˆÓ ÌÂ ·ÏÏÂÚÁ›Â˜ Î·È ¿ÛıÌ·. À¿Ú¯Ô˘Ó Â›ÛË˜ ÏËÚÔÊÔÚ›Â˜ Û¯ÂÙÈÎ¿ ÌÂ ÙÈ˜ ÂÎ‰ËÏÒÛÂÈ˜ ÙË˜ ÔÚÁ¿ÓˆÛË˜. ∞ÈÛıËÙÈÎ¿ Ô ÙfiÔ˜ Â›Ó·È fiÌÔÚÊÔ˜ Î·È Ë Î›ÓËÛË ·Ó¿ÌÂÛ· ÛÙÈ˜ ÂÓfiÙËÙÂ˜ ·ÚfiÛÎÔÙË.

E-mail: ngp@allergy.gr

º§√°∞ - ™˘ÓÂ¯‹˜ ºÚÔÓÙ›‰· ÁÈ· ÙÔ ·È‰› - http://www.floga.org.gr

µ·ÛÈÛÌ¤ÓÔ˜ ÛÙËÓ ·Ú¯‹ ÙÔ˘ ÂıÂÏÔÓÙÈÛÌÔ‡, Ë ºÏﬁÁ· Â›Ó·È Û‡ÏÏÔÁÔ˜ ÌË-ÎÂÚ‰ÔÛÎÔÈÎÔ‡

√ ‰ÈÎÙ˘·Îfi˜ ÙfiÔ˜ ÙÔ˘ Û˘ÏÏfiÁÔ˘ ºÏfiÁ· Â›Ó·È ·ÚÎÂÙ¿ ·Ïfi˜ ÛÙËÓ ÏÔ‹ÁËÛË Î·È ÏÈÙfi˜ ÛÙÔ ÂÚÈÂ¯fiÌÂÓÔ, ÌÂ Ù¤ÛÛÂÚÈ˜ ıÂÌ·ÙÈÎ¤˜ Î·ÙËÁÔÚ›Â˜. ¶ÂÚÈ¤¯ÂÈ ¯Ú‹ÛÈÌÂ˜ ÏËÚÔÊÔÚ›Â˜ ÁÈ· ÙÔ˘˜ ÙÚfiÔ˘˜ Î·È Ù· Ì¤Û· ÌÂ Ù· ÔÔ›·

ÁÈ· ÙËÓ ·ÚÔ¯‹ Û˘Ì‚Ô˘ÏÒÓ Î·È ˘Ô‰Â›ÍÂˆÓ.

Î·È Â‡ÎÔÏË ÏÔ‹ÁËÛË. ∏ Î·ÙËÁÔÚ›· “∂Î‰ËÏÒÛÂÈ˜”

Â‡ÎÔÏË ÌË¯·Ó‹ ·Ó·˙‹ÙËÛË˜ ÙˆÓ ÂÎ‰ËÏÒÛÂˆÓ Ô˘ ¤¯Ô˘Ó Ï¿‚ÂÈ ¯ÒÚ· ÛÙÔ ·ÚÂÏıﬁÓ ÂÓÒ ÂÓËÌÂÚÒÓÂÙ·È ÛÂ Ù·ÎÙ¿ ¯ÚÔÓÈÎ¿ ‰È·ÛÙ‹Ì·Ù·. ¶¡√∏ - ∞Ó¿Û· ·Ó·ÎÔ‡ÊÈÛË˜ ÁÈ· Ù· ·È‰È¿ - http://www.pnoe.gr/

- º›ÏÔÈ

ÌË ÎÂÚ‰ÔÛÎÔÈÎÔ‡ ¯·Ú·ÎÙ‹Ú·, ÌÂ ¤‰Ú·

ÙˆÓ ªÔÓ¿‰ˆÓ ∂ÓÙ·ÙÈÎ‹˜ £ÂÚ·Â›·˜ ·È‰ÈÒÓ

∫·Ú‰ÈÔ·Ó·ÓÂ˘ÛÙÈÎ‹˜ ∞Ó¿ÓË„Ë˜ (Ì·Ï¿ÍÂÈ˜, ÊÈÏ› ÙË˜ ˙ˆ‹˜) Ù· ÔÔ›· Á›ÓÔÓÙ·È ·ﬁ ÂÎ·È‰Â˘Ì¤ÓÔ˘˜

ÁÈ·ÙÚÔ‡˜ ÛÂ ÂÈ‰ÈÎ¿ ‰È·ÌÔÚÊˆÌ¤ÓÔ˘˜ ¯ÒÚÔ˘˜ ·ÏÏ¿ Î·È ÛÂ Û¯ÔÏÂ›·, Á˘ÌÓ·ÛÙ‹ÚÈ· Î·È ÂÈ¯ÂÈÚ‹ÛÂÈ˜. ∆·

Ì·ı‹Ì·Ù· Â·Ó·Ï·Ì‚¿ÓÔÓÙ·È ÛÂ Ù·ÎÙ¿ ¯ÚÔÓÈÎ¿ ‰È·ÛÙ‹Ì·Ù· ÒÛÙÂ Ó· ÂÍ·ÛÊ·Ï›˙ÂÙ·È Ë Û˘ÓÂ¯‹ Â·Ê‹

ÌÂ ÙÔ ·ÓÙÈÎÂ›ÌÂÓÔ. ™ÙË Û¯ÂÙÈÎ‹ ÛÂÏ›‰· ÙÔ˘ ‰ÈÎÙ˘·ÎÔ‡ ÙﬁÔ˘ ˘¿Ú¯ÂÈ Î·È Ë ÊﬁÚÌ· ÂÎ‰‹ÏˆÛË˜ ÂÓ-

‰È·Ê¤ÚÔÓÙÔ˜ ÁÈ· ÙË Û˘ÌÌÂÙÔ¯‹ ÛÙÔ ÚﬁÁÚ·ÌÌ·.

√ ‰ÈÎÙ˘·Îﬁ˜ ÙﬁÔ˜ ¶¡√∏ ÚÔÛÊ¤ÚÂÈ ÏËÚÔÊÔÚ›Â˜ Û¯ÂÙÈÎ¿ ÌÂ ÙÈ˜ ‰Ú¿ÛÂÈ˜ ÙÔ˘ ÛˆÌ·ÙÂ›Ô˘ ÛÙÔ

·ÚÂÏıfiÓ, fiˆ˜ ÂÎ‰ËÏÒÛÂÈ˜, ËÌÂÚ›‰Â˜, ÂÍÔÏÈÛÌfi È·ÙÚÈÎÒÓ È‰Ú˘Ì¿ÙˆÓ ÂÓÒ ·Ó·Ê¤ÚÔÓÙ·È Î·È Ù·

ÌÂÏÏÔÓÙÈÎ¿ Û¯¤‰È·. √ Û¯Â‰È·ÛÌﬁ˜ Â›Ó·È ÌÔÓÙ¤ÚÓÔ˜

∫ÏÈÓÈÎﬁ QUIZ

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™ÙÔ ·È‰› ¤ÁÈÓÂ ‚ÈÔ„›· ‰È¿ ÏÂÙ‹˜ ‚ÂÏﬁÓË˜

(FNA) ˘ﬁ ÙËÓ Î·ıÔ‰‹ÁËÛË ·ÍÔÓÈÎÔ‡ ÙÔÌÔ-

ÁÚ¿ÊÔ˘, Ë ÔÔ›· ‰ÂÓ Â›¯Â ‰È·ÁÓˆÛÙÈÎﬁ ·ÔÙ¤-

ÏÂÛÌ· ÁÈ’ ·˘Ùﬁ Î·È ˘Ô‚Ï‹ıËÎÂ ÛÂ ıˆÚ·ÎÔÙÔÌ‹ Î·È ¯ÂÈÚÔ˘ÚÁÈÎ‹ ·Ê·›ÚÂÛË ÙË˜ Ì¿˙·˜ ·ﬁ ÙÔ

ÌÂÛÔıˆÚ¿ÎÈÔ. ∏ ÈÛÙÔÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË ¤‰ÂÈÍÂ ﬁÙÈ

ÚﬁÎÂÈÙ·È ÁÈ· ¡ﬁÛÔ Castleman ÌÈÎÙÔ‡ Ù‡Ô˘.

ªÂÙ¿ ÙË ¯ÂÈÚÔ˘ÚÁÈÎ‹ ÂÍ·›ÚÂÛË ÙÔ ·È‰› ‰ÂÓ

·ÚÔ˘Û›·ÛÂ Î·Ó¤Ó· Úﬁ‚ÏËÌ·. ∏ ÓﬁÛÔ˜ Castleman Â›Ó·È ÏÂÌÊÔ¸ÂÚÏ·-

ÛÙÈÎ‹ ‰È·Ù·Ú·¯‹ ·ÁÓÒÛÙÔ˘ ·ÈÙÈÔÏÔÁ›·˜. ∂Î‰ËÏÒÓÂÙ·È Û˘Ó‹ıˆ˜ ÛÙËÓ 4Ë ‰ÂÎ·ÂÙ›· ÙË˜

ÓfiÌÂÓË Ì¿˙· Ô˘ ÂÓÙÔ›˙ÂÙ·È ÛÙÔ Ô›ÛıÈÔ ÌÂÛÔıˆÚ¿ÎÈÔ (ÛÂ ·ÓÙ›ıÂÛË ÌÂ ÙÔ ÙÂÚ¿ÙˆÌ· Ô˘ ÂÓÙÔ›˙ÂÙ·È ÛÙÔ Ì¤ÛÔ Î·È ÙÔ Ï¤ÌÊˆÌ· Î·È ÙÔ Î˘ÛÙÈÎfi ‡ÁÚˆÌ· Ô˘ ÂÓÙÔ›˙ÔÓÙ·È Û˘Ó‹ıˆ˜ ÛÙÔ ÚfiÛıÈÔ ÌÂÛÔıˆÚ¿ÎÈÔ), ÙËÓ ÎÔÈÏÈ·Î‹ ¯ÒÚ· ‹ ÙÔ˘˜ ÂÚÈÊÂÚÈÎÔ‡˜ ÏÂÌÊ·‰¤ÓÂ˜. ∏ ‰È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË ı· Ú¤ÂÈ Ó· Á›ÓÂÈ Â›ÛË˜ ·fi ÙÔ ÓÂ˘ÚÔ‚Ï¿ÛÙˆÌ· Î·È ÙÔ˘˜ ÂÚÈÊÂÚÈÎÔ‡˜ fiÁÎÔ˘˜ ÓÂ˘ÚÔÂÍˆ‰ÂÚÌÈÎ‹˜ ÚÔ¤ÏÂ˘ÛË˜. ∏ ÎÏÈÓÈÎ‹ ÔÚÂ›· Â›Ó·È ‹È· ÌÂ Î‡ÚÈ· ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙÔÓ ˘ÚÂÙfi, ÙË ÛÈ‰ËÚÔÂÓÈÎ‹ ·Ó·ÈÌ›·, ÙËÓ ˘ÂÚÁ·ÌÌ·ÛÊ·ÈÚÈÓ·ÈÌ›·, ÙÔ˘˜ ·˘ÍËÌ¤ÓÔ˘˜ ‰Â›ÎÙÂ˜ ÊÏÂÁÌÔÓ‹˜. ∏ ÚfiÁÓˆÛË ÌÂÙ¿ ÙË ¯ÂÈÚÔ˘ÚÁÈÎ‹ ·Ê·›ÚÂÛË Â›Ó·È Î·Ï‹. ∏ ÔÏ˘ÂÛÙÈ·Î‹ ÌÔÚÊ‹ ··ÓÙ¿Ù·È ÛÂ

ÌÈÎÙﬁ Ù‡Ô. ∏ ÂÓÙÔÈÛÌ¤ÓË ÌÔÚÊ‹ (85%)

1. Parez N, Bader-Meunier B, Roy CC, Dommergues JP. Paediatric Castleman disease: report of seven cases and review of the literature. Eur J Pediatr. 1999 Aug;158(8):631-7.

2. Salisbury JR. Castleman's disease in childhood and adolescence: report of a case and review of literature. Pediatr Pathol. 1990;10(4):609-15.