Παιδιατρική | Τόμος 70 • Τεύχος 3 • Μάιος - Ιούνιος 2007

Pediatri May-Jun 07

24-05-07

17:57

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∆fiÌÔ˜ 70 ñ ∆‡¯Ô˜ 3 ñ ª¿ÈÔ˜-πÔ‡ÓÈÔ˜ 2007

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¢È¢ı˘ÓÙ‹˜ ™‡ÓÙ·Í˘ ∫. ™ÙÂÊ·Ó›‰Ë˜

165 Long term outcomes of children with cancer G.A. Levitt

M¤ÏË ™. ∞Ó‰ÚÔÓ›ÎÔ˘ ¶. ∞˘ÁÔ˘ÛÙ›‰Ô˘-™·‚‚ÔÔ‡ÏÔ˘ A. µ·˙·›Ô˘-°ÂÚ·ÛÈÌ›‰Ë °. µ·ÚÏ¿Ì˘ ª. °·Ï·Ó¿Î˘ §. £ˆÌ·˝‰Ô˘ ª. ∫·Ó¿ÚÈÔ˘ ∂. ∫·ÙÛ·ÚÔ‡-¶ÂÎÙ·Û›‰Ë A. K·ÙÙ¿Ì˘ ™. K›ÙÛÈÔ˘-∆˙¤ÏË ∞. ¶··‰ÔÔ‡ÏÔ˘ ¡. ¶··‰fiÔ˘ÏÔ˜ ∞. ™È·ÌÔÔ‡ÏÔ˘-ª·˘Ú›‰Ô˘ ª. ∆ÛÔÏÈ¿ ºÈÏÔÏÔÁÈ΋ EÈ̤ÏÂÈ· ∂È̤ÏÂÈ· ÂÏÏËÓÈÎÒÓ ÎÂÈÌ¤ÓˆÓ º. ª·˘ÚÔÂȉ‹ EÈ̤ÏÂÈ· ·ÁÁÏÈÎÒÓ ÎÂÈÌ¤ÓˆÓ ™. ¡¿ÎÔ˘ EΉfiÙ˘ K. °ÚÈ‚¤·˜ ™˘ÓÙÔÓÈÛÙ‹˜ ∂ΉfiÛˆ˜ E¶I™THMONIKE™ EK¢O™EI™ E.¶.E. ¶ÈÂÚ›·˜ 1∞ 144 51 MÂÙ·ÌfiÚʈÛË TËÏ.: 210 87 78 810 Fax: 210 87 78 822 I‰ÈÔÎÙ‹Ù˘ EÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ EÙ·ÈÚ›·© Mȯ·Ï·ÎÔÔ‡ÏÔ˘ 92 Aı‹Ó· 115 28 TËÏ.: 210 7771 140 210 7771 663 Fax: 210 7758 354 e-mail: hps@ath.forthnet.gr EÙ‹ÛÈ· ™˘Ó‰ÚÔÌ‹: 40 € EȉÈ΢fiÌÂÓÔÈ, ºÔÈÙËÙ¤˜: 20 € ∫ˆ‰ÈÎfi˜ ¢È‡ı˘ÓÛ˘ ∂ÔÙ›·˜ ªª∂: 3889

ISSN 0377-2551

∞¡∞™∫O¶∏™∂π™ 167 Surviving childhood cancer: long-term outcomes M. Servitzoglou 174 √ ·ÓÔÛÔÊ·ÈÓfiÙ˘Ô˜ ÙˆÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜ ÛÙËÓ ÎÏÈÓÈ΋ ·È‰È·ÙÚÈ΋ Ú¿ÍË º. ∆˙ÈÊ‹, ª. ∆˙·ÓÔ˘‰¿ÎË, ª. ∫·Ó¿ÚÈÔ˘ 184 ™˘ÁÁÂÓ›˜ ‰È·Ì·Úٛ˜ Ó¢ÌfiÓˆÓ: ·ıÔÁ¤ÓÂÈ·, ‰È·ÁÓˆÛÙÈ΋ ÚÔÛ¤ÁÁÈÛË Î·È ·ÒÙÂÚË ¤Î‚·ÛË ∫. ¡. ¶Ú›ÊÙ˘, ¶. ¡. ¢Ô˘Ú›‰·˜, ª. B. ∞ÓıÚ·ÎfiÔ˘ÏÔ˜

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192 ¢ÈÂÚ‡ÓËÛË Ù˘ ‰È·Ù·Ú·¯‹˜ ÛÙËÓ ÈÛÔÚÚÔ›· ÌÂٷ͇ Ù‡Ô˘-1 Î·È Ù‡Ô˘-2 ·ÓÔÛȷ΋˜ ·¿ÓÙËÛ˘ ÛÙÔ ÎÔÚÙÈÎÔ¢·›ÛıËÙÔ ÓÂÊÚˆÛÈÎfi Û‡Ó‰ÚÔÌÔ - ∞Ô˘Û›· Û¯¤Û˘ ÚÔ˜ ·ÙÔ›· ¡. ¶Ú›ÓÙ˙·, º. ¶··¯Ú‹ÛÙÔ˘, µ. ∆˙ÈÌÔ‡ÏË, Õ. ∆·¿ÚÎÔ˘, º. ∫·Ó·ÎÔ‡‰Ë-∆۷ηϛ‰Ô˘

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199 ∏ ÈÓÙÂÚÏ¢ΛÓË-8 (IL-8) ÙˆÓ Ô‡ÚˆÓ ˆ˜ ‰È·ÁÓˆÛÙÈÎfi˜ ‰Â›ÎÙ˘ Ù˘ ΢ÛÙÂÔÔ˘ÚËÙËÚÈ΋˜ ·ÏÈÓ‰ÚfiÌËÛ˘ Û ·È‰È¿ ËÏÈΛ·˜ οو ÙÔ˘ ¤ÙÔ˘˜ ª. ªÈÙÛÒÚË, ∂. °·Ï·Ó¿Î˘, ∂. ¢ËÌËÙÚ›Ô˘, Ã. °È·ÓÓ·ÎÔÔ‡ÏÔ˘, ¡. ∞. ∫·Úη‚›ÙÛ·˜, ª. ∫·ÏÌ·ÓÙ‹ 205 ªÂÙ·‚ÔÏ‹ ۈ̷ÙÔÌÂÙÚÈÎÒÓ ÌÂÁÂıÒÓ, ·ÚÙËÚȷ΋˜ ›ÂÛ˘, ۷ί¿ÚÔ˘ Î·È ÏÈȉ›ˆÓ ÔÚÔ‡ ·›Ì·ÙÔ˜ ·È‰ÈÒÓ Ù˘ ∫Ú‹Ù˘ ÌÂٷ͇ ÙˆÓ ¯ÚÔÓÈÎÒÓ ÂÚÈfi‰ˆÓ 1989-1993 Î·È 1999-2003 ª. §ÈÓ·Ú‰¿Î˘, °. ªÂÚÙÛÈ¿˜, ∫. ™·ÚÚ‹, ∞. ∫·Ê¿ÙÔ˜ 217 ¶ÔÛÔÙÈÎfi˜ ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù˘ C-·ÓÙȉÚÒÛ·˜ ÚˆÙ½Ó˘ ÛÙÔ ·›Ì· ÓÂÔÁÓÒÓ - ™˘ÁÎÚÈÙÈ΋ ÌÂϤÙË ‰‡Ô ÌÂıfi‰ˆÓ ∏. ÷Ù˙ËȈ·ÓÓ›‰Ë˜, ∞. ¡·Ô‡Ì, °. MËÙÛÈ¿ÎÔ˜, Ã. ∆۷ηϛ‰Ë˜, ¢.°. °Ô˘Ï‹˜, ¡. ¡ÈÎÔÏ·˝‰Ë˜

246 ∫§π¡π∫√ ∫√Àπ∑ ª. ∂ÌÔÚÈ¿‰Ô˘, ∞. ∆Ú·ÁÈ·ÓÓ›‰Ë˜, °. ∆˙Ô˘‚ÂϤ΢, §. ºÈ‰¿ÓË, π. ∫ˆÛÙfiÔ˘ÏÔ˜, º. ∞ı·Ó·ÛÈ¿‰Ô˘ 247 ™À¡∆√ª∞ ¶∞π¢π∞∆ƒπ∫∞ ¡∂∞ - ∏ ηχÙÂÚË ‚ÈÔ˚·ÙÚÈ΋ ÌÂϤÙË Ù˘ ¯ÚÔÓÈ¿˜ - ∆· ηϿ ÙÔ˘ ıËÏ·ÛÌÔ‡ - ÃÚÂÈ¿˙ÂÙ·È Â·Ó¿ÏË„Ë Ù˘ ηÏÏȤÚÁÂÈ·˜ Ô‡ÚˆÓ ÛÙË ‰È¿ÚÎÂÈ· ıÂÚ·›·˜ Ù˘ Ô˘ÚÔÏԛ̈͢; - øÙ›Ùȉ˜ Î·È ÛˆÏËÓ¿ÎÈ· - ∫Ú˘ÙÔÛÔÚ›‰ÈÔ ÛÙÔ ‰›ÎÙ˘Ô ‡‰Ú¢Û˘ - ¶ÔÈÔ˜ ÌÂÙ·‰›‰ÂÈ ÙÔÓ ÎÔηÙË ÛÙ· ‚Ú¤ÊË; - º˘Ì·Ù›ˆÛË: ÂÌ›˜ ı· ı¤Ï·Ì ӷ ÙËÓ Í¯¿ÛÔ˘ÌÂ, ·ÏÏ¿ ÂΛÓË fi¯È

E. °·Ï·Ó¿Î˘ 249 ¡∂∞ ∞¶√ ∆√ ¢π∞¢π∫∆À√ πÛÙÔÛÂÏ›‰Â˜ ÁÈ· ÙȘ ¶ÚˆÙÔ·ı›˜ ∞ÓÔÛÔ·ÓÂ¿ÚÎÂȘ ª. ∫·Ó¿ÚÈÔ˘

Pediatri May-Jun 07

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Paediatriki Bimonthly Publication of the Greek Paediatric Society

Volume 70 ñ Number 3 ñ May-June 2007

President A. Constantopoulos

Contents

Editorial Board

EDITORIAL COMMENTARY

Editor-in-Chief C. Stefanidis Members S. Andronikou P. Augoustides-Savvopoulou A. Vazeou-Gerasimidi G. Varlamis M. Galanakis L. Thomaidou M. Kanariou ∂. Katsarou-Pectasides A. Kattamis S. Kitsiou-Tzeli ∞. Papadopoulou N. Papadopoulos A. Siamopoulou-Mavridou M. Tsolia Manuscript Editing Greek Editing F. Mavroidi English Editing S. Nakou Publisher K. Griveas Publishing Coordinator SCIENTIFIC PUBLICATIONS Ltd 1∞ Pierias St. GR - 144 51, Metamorfossi Tel.: +30 210 87 78 810 Fax: +30 210 87 78 822 Owner Greek Paediatric Society© 92 Michalakopoulou str.

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

165 Long term outcomes of children with cancer G.A. Levitt

221 Estimating the risk of urinary tract infection in febrile infants aged 15-90 days with no apparent focus of infection S. Fouzas, A. Fasouli, D. Adamidis, K. Tzelepis, I. Bakopoulou, A. Papadopoulou, D. Zafirakopoulos

REVIEW ARTICLES CASE REPORTS 167 Surviving childhood cancer: long-term outcomes M. Servitzoglou 174 Peripheral blood lymphocyte immunophenotype in paediatric clinical practice F. Tzifi, M. Tzanoudaki, M. Kanariou 184 Congenital lung malformations: pathogenesis, diagnostic approach and long-term outcome K.N. Priftis, N.P. Douridas, M.B. Anthracopoulos

227 Opsoclonus-myoclonus-ataxia syndrome in a patient with neuroblastoma: Case report and review of the literature N. Katzilakis, E. Mandadakis, A. Savidou, P. Vorgia, M. Raissaki, E. Steiakaki, M. Kalmanti 232 An infant with autoimmune neutropenia F. Stripeli, J.P. Panagiotou, E. Dimitriou, E. Koemtzidou, T. Anastasiou, A. Constantopoulos PRACTICAL ISSUE

ORIGINAL ARTICLES 192 Investigation of type-1/type-2 immune imbalance in steroid sensitive nephritic syndrome - No relationship with atopy N. Printza, F. Papachristou, V. Tzimouli, A. Taparkou, F. Kanakoudi-Tsakalidou 199 Urine interleukin-8 as a marker of vesicoureteral reflux in children aged | under 1 year M. Bitsori, E. Galanakis, E. Dimitriou, C. Giannakopoulou, N.A. Karkavitsas, M. Kalmanti 205 Secular trends during early 1990s and 2000s of body measurements, blood pressure, glucose and serum lipids in children of Crete, Greece M. Linardakis, G. Bertsias, K. Sarri, A. Kafatos 217 Quantitative determination of C-reactive protein in the blood of neonates Comparative study of two methods H. Chatziioannidis, A. Naoum, G. Mitsiakos, C. Tsakalidis, D.G. Goulis, N. Nikolaidis

237 Clinical and laboratory investigation of children with neutropenia A. Makis, N. Chaliassos 246 CLINICAL QUIZ M. Emboriadou, A. Tragiannidis, G. Tzouvelekis, L. Fidani, I. Costopoulos, F. Athanassiadou 247 PAEDIATRIC NEWS IN BRIEF E. Galanakis 249 NEWS FROM THE INTERNET M. Kanariou

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™À¡∆∞∫∆π∫∏ E¶π∆ƒ√¶∏

EDITORIAL BOARD

¢È¢ı˘ÓÙ‹˜ ™‡ÓÙ·Í˘

Editor-in-Chief

∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ™ÙÂÊ·Ó›‰Ë˜, ∞ı‹Ó·

Constantinos Stefanidis, Athens

À‡ı˘ÓÔÈ ™‡ÓÙ·Í˘ ∂ÍÂȉÈ·ۈÓ

Section Editors

™Ù¤ÏÏ· ∞Ó‰ÚfiÓÈÎÔ˘, πˆ¿ÓÓÈÓ· ¡ÂÔÁÓÔÏÔÁ›·

Stella Andronikou, Ioannina Neonatology

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

Persefoni Avgoustides-Savvopoulou, Thessaloniki Metabolic Disorders

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

Andriani Vazaiou-Gerasimidi, Athens Endocrinology

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

George Varlamis, Thessaloniki Cardiology

∂ÌÌ·ÓÔ˘‹Ï °·Ï·Ó¿Î˘, ∏Ú¿ÎÏÂÈÔ ∏ıÈ΋ Î·È ¢ÂÔÓÙÔÏÔÁ›·

Emmanouil Galanakis, Heraklion Ethics and Deontology

§ˆÚ¤ÙÙ· £ˆÌ·˚‰Ô˘, ∞ı‹Ó· ∞Ó·Ù˘ÍȷΤ˜ ‰È·Ù·Ú·¯¤˜

Loretta Thomaidou, Athens Developmental Pediatrics

ª·Ú›· ∫·Ó¿ÚÈÔ˘, ∞ı‹Ó· ∞ÓÔÛÔÏÔÁ›·

Maria Kanariou, Athens Immunology

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

Eustathia Katsarou-Pektasides, Athens Neurology

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

Antonis Kattamis, Athens Haematology - √ncology

™ÔÊ›· ∫›ÙÛÈÔ˘-∆˙¤ÏË, ∞ı‹Ó· °ÂÓÂÙÈ΋

Sophia Kitsiou-Tzeli, Athens Genetics

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

Alexandra Papadopoulou, Athens Gastroenterology - Hepatology - Nutrition

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

Nicos Papadopoulos, Athens Allergology - Pneumonology

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

Antigoni Siamopoulou-Mavridou, Ioannina Rheumatology

ª·Ú›˙· ∆ÛÔÏÈ¿, ∞ı‹Ó· §ÔÈ̈ÍÈÔÏÔÁ›·

Marisa Tsolia, Athens Infectious Diseases

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

Peter Hoyer, Essen, Germany

Ellis D. Avner, Milwaukee, USA

Jan Janda, Prague, Czech Republic

Swati Bhave, New Delhi, India

Jan Kimpen, Ultrecht, Netherlands

Alberto Bissot, Panama, Panama

Craig B. Langman, Chicago, USA

David Branski, Jerusalem, Israel

John Manis, Boston, USA

Francesco Chiarelli, Chieti, Italy

Manuel Moya, Alicante, Spain

Chok-Wan Chan, Hong Kong, China

Hugh O'Brodovich, Toronto, Canada

Denis Daneman, Toronto, Canada

Ross Petty, Vancouver, Canada

Jochen Ehrich, Hannover, Germany

Willem Proesmans, Leuven, Belgium

Demetrius Ellis, Pittsburgh, USA

Jose Ramet, Antwerp, Belgium

Yoshikatsu Eto, Tokyo, Japan

Alan Sinaiko, Minneapolis, USA

Richard N. Fine, Stony Brook, USA

Nick J. Spencer, Coventry, UK

Margaret C. Fisher, Philadelphia, USA

Alfred Tenore, Udine, Italy

Raif Geha, Boston, USA

Alkis Togias, Bethesda, USA

Adenike Grange, Lagos, Nigeria

Eva Tsalikian, Iowa City, USA

Judith G. Hall, Vancouver, Canada

Catherine Weil-Olivier, Paris, France

Patricia Hamilton, London, UK

Max Zach Graz, Austria

Enver Hasanoglu, Ankara, Turkey

Johannes Zschocke, Heidelberg, Germany

Christer Holmberg, Helsinki, Finland

v

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

2. ∞Ó·ÛÎÔ‹ÛÂȘ.

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12. ∂ÈÛÙÔϤ˜ ÚÔ˜ ÙË Û‡ÓÙ·ÍË.

13. ¶ÂÚÈÏ‹„ÂȘ Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜.

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

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

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

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

µ. ™‡ÓÙ·ÍË ÙˆÓ ∂ÚÁ·ÛÈÒÓ ŸÏ˜ ÔÈ ÂÚÁ·Û›Â˜ Ú¤ÂÈ Ó· ·ÎÔÏÔ˘ıÔ‡Ó “∫ÔÈÓ¤˜ ¶ÚԉȷÁڷʤ˜ ÁÈ· ÃÂÈÚfiÁÚ·Ê· Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È Û µÈÔ˚·ÙÚÈο ¶ÂÚÈÔ‰Èο” (Uniform Requirements for Manuscripts Submitted to Biomedical Journals), ÔÈ Ôԛ˜ ÙÚÔÔÔÈ‹ıËÎ·Ó ÚfiÛÊ·Ù· Î·È ‰ËÌÔÛȇÔÓÙ·È ÛÙȘ ‰È¢ı‡ÓÛÂȘ: http://www.icmje.org Î·È http://www.icmje.org/icmje.pdf TÔ Î›ÌÂÓÔ Ú¤ÂÈ Ó· ¤¯ÂÈ ÙËÓ ·ÎfiÏÔ˘ıË ‰È¿Ù·ÍË: ÛÂÏ›‰· Ù›ÙÏÔ˘, ‚Ú·¯‡˜ Ù›ÙÏÔ˜, ÂÚ›ÏË„Ë ÛÙ· ÂÏÏËÓÈο Î·È Ù· ·ÁÁÏÈο, ηٿÏÔÁÔ˜ Û˘ÓÙÔÌÔÁÚ·ÊÈÒÓ, ΛÌÂÓÔ, ¢¯·ÚÈÛٛ˜ ηıÒ˜ Î·È ·Ó·ÊÔÚ¿ Û ÂȉÔÙ‹ÛÂȘ-¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢, ‚È‚ÏÈÔÁÚ·Ê›·, ›Ó·Î˜, ÂÈÎfiÓ˜, Ù›ÙÏÔÈ ÂÈÎfiÓˆÓ.

H ¤ÎÙ·ÛË ÚÔÛ‰ÈÔÚ›˙ÂÙ·È ÁÈ·: ñ ÙȘ ·Ó·ÛÎÔ‹ÛÂȘ Û 2000-3000 ϤÍÂȘ. ñ ÙȘ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜ Û 1500-2500 ϤÍÂȘ Î·È ÙȘ ÂӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ Û 1000-1500 ϤÍÂȘ. ñ ÙȘ ‚Ú·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ Û 1000-1500 ϤÍÂȘ. ñ ÙȘ ÂÈÛÙÔϤ˜ Û 250-500 ϤÍÂȘ.

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

¶ÂÚÈÏ‹„ÂȘ H ÂÚ›ÏË„Ë Ú¤ÂÈ Ó· ·Ó·ÎÂÊ·Ï·ÈÒÓÂÈ ÙÔ˘˜ ÛÙfi¯Ô˘˜ Ù˘ ÂÚÁ·Û›·˜, ÙË ÌÂıÔ‰ÔÏÔÁ›·, Ù· ΢ÚÈfiÙÂÚ· ·ÔÙÂϤÛÌ·Ù· Î·È Ù· Û˘ÌÂÚ¿ÛÌ·Ù· Ù˘ ÌÂϤÙ˘. ñ £· Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÔ˘Ï¿¯ÈÛÙÔÓ 200 ϤÍÂȘ, fï˜ ‰ÂÓ ı· Ú¤ÂÈ Ó· ˘ÂÚ‚·›ÓÂÈ ÙȘ 250 ϤÍÂȘ. ñ ∏ ÂÚ›ÏË„Ë ÙˆÓ ÂÚÁ·ÛÈÒÓ Ú¤ÂÈ Ó· Â›Ó·È ‰ÔÌË̤ÓË ÛÙȘ ÂÍ‹˜ ·Ú·ÁÚ¿ÊÔ˘˜: ÂÈÛ·ÁˆÁ‹, ̤ıÔ‰ÔÈ, ·ÔÙÂϤÛÌ·Ù· Î·È Û˘ÌÂÚ¿ÛÌ·Ù·. ™ÙËÓ ÂÚ›ÏË„Ë ÛÙ· ·ÁÁÏÈο Ú¤ÂÈ Ó· ·Ó·ÁÚ¿ÊÔÓÙ·È ÛÙËÓ ·Ú¯‹ ÙÔ˘ ÎÂÈ̤ÓÔ˘ Ô Ù›ÙÏÔ˜ Ù˘ ÂÚÁ·Û›·˜ Î·È Ù· ÔÓfiÌ·Ù· ÙˆÓ Û˘ÁÁڷʤˆÓ ÛÙ· ·ÁÁÏÈο. TÔ ÂÚȯfiÌÂÓÔ ÙÔ˘ ·ÁÁÏÈÎÔ‡ ÎÂÈ̤ÓÔ˘ Ú¤ÂÈ Ó· Â›Ó·È ‰ÔÌË̤ÓÔ ÛÂ: ÂÈÛ·ÁˆÁ‹ (background), ̤ıÔ‰ÔÈ (methods), ·ÔÙÂϤÛÌ·Ù· (results) Î·È Û˘ÌÂÚ¿ÛÌ·Ù· (conclusions). H ÂÚ›ÏË„Ë ÛÙ· ·ÁÁÏÈο ‰ÂÓ Ú¤ÂÈ Ó· ‰È·Ê¤ÚÂÈ ·fi ÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë ÛÙ· ÂÏÏËÓÈο.

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

K›ÌÂÓÔ ŸÏ˜ ÔÈ ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ÂÚÁ·Û›Â˜ ıˆÚÔ‡ÓÙ·È È‰ÈÔÎÙËÛ›· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ “¶·È‰È·ÙÚÈ΋” Î·È Ë ÔÏÈ΋ ‹ ÌÂÚÈ΋

OÈ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó: ÂÈÛ·ÁˆÁ‹, ÌÂıfi‰Ô˘˜, ·ÔÙÂϤÛÌ·Ù· Î·È Û˘˙‹ÙËÛË. H ÂÈÛ·ÁˆÁ‹

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ÂÚÈÏ·Ì‚¿ÓÂÈ Ù· ÙÂÏÂ˘Ù·›· ‰Â‰Ô̤ӷ Ù˘ ¤Ú¢ӷ˜ ÛÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ ı¤Ì· Ì ÙȘ ΢ÚÈfiÙÂÚ˜ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜ Î·È ÙÔÓ ÛÎÔfi Ù˘ ÂÚÁ·Û›·˜. H ÂÚÈÁÚ·Ê‹ ÙˆÓ ÌÂıfi‰ˆÓ Ú¤ÂÈ Ó· Â›Ó·È ·ÎÚÈ‚‹˜ Î·È ·ÚÎÂÙ¿ ÏÂÙÔÌÂÚ‹˜, ÒÛÙ ӷ ÂÈÙÚ¤ÂÈ ÙËÓ ·Ó··Ú·ÁˆÁ‹ ÙÔ˘˜ ·fi ¿ÏÏÔ˘˜ ÂÚ¢ÓËÙ¤˜. ∂›Û˘, Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È Ì ÏÂÙÔ̤ÚÂȘ ÔÈ ÛÙ·ÙÈÛÙÈΤ˜ ̤ıÔ‰ÔÈ ·Ó¿Ï˘Û˘ Î·È ·ÍÈÔÏfiÁËÛ˘ ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ. T· ·ÔÙÂϤÛÌ·Ù· Ú¤ÂÈ Ó· ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ì ۷ʋÓÂÈ· Î·È Ó· Û˘Óԉ‡ÔÓÙ·È ·fi ÙËÓ ··Ú·›ÙËÙË ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË. H Û˘˙‹ÙËÛË Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ Ù· Û˘ÌÂÚ¿ÛÌ·Ù· Ô˘ ÚÔ·ÙÔ˘Ó ·fi ÙËÓ ÂÚÁ·Û›·, ÙË ÛËÌ·Û›· Ô˘ ÌÔÚ› Ó· ¤¯Ô˘Ó Î·È ÙËÓ Èı·Ó‹ Û˘Û¯¤ÙÈÛ‹ ÙÔ˘˜ Ì ·Ú·ÙËÚ‹ÛÂȘ ¿ÏÏˆÓ ÂÚ¢ÓËÙÒÓ.

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

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

T·ÎÙÈ΋ ¤Î‰ÔÛË ÂÚÈÔ‰ÈÎÔ‡: ∞ÓÙˆÓ›Ô˘ ¢, ª¿Ú· Ã, °È·ÓÓ¿ÙÔ˘ Ã. ∂Ì‚fiÏÈ·: Â›‰Ú·ÛË ÛÙËÓ ÂȉËÌÈÔÏÔÁ›· ÙˆÓ ÏÔÈ̈‰ÒÓ ÓÔÛËÌ¿ÙˆÓ Î·È ÙËÓ ·È‰È·ÙÚÈ΋ Ú¿ÍË. ¶·È‰È·ÙÚÈ΋ 1999;59:272-279.

TÈ̤˜ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛˆÓ

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

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

Proesmans W. Bartter syndrome and its neonatal variant. Eur J Pediatr 1997;156:669-679. ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜ ÂÚÈÔ‰ÈÎÔ‡: Flyvbjerg A. Role of growth hormone, insulin-like growth factors (IGFs) and IGF-binding proteins in the renal complications of diabetes. Kidney Int 1997;52 (60 Suppl):S12-S19. Èڛ˜ Û˘ÁÁڷʤ·: National Institutes of Health Consensus Development Conference. Neurofibromatosis conference statement. Arch Neurol 1988;45:575-578. ¶ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù‡Ô˘ ¿ÚıÚÔ˘: Schreiner GF, Lange L. Ethanol modulation of macrophage influx in glomerulonephritis [Abstract]. J Am Soc Nephrol 1991;2:562.

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

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

BÈ‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜ ™ÙÔ ÙÌ‹Ì· Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜ ηٷ¯ˆÚÔ‡ÓÙ·È fiϘ ÔÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜ Ì ÙË ÛÂÈÚ¿ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔ Î›ÌÂÓÔ. ™ÙÔ Î›ÌÂÓÔ, ÔÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜ ·Ó·Ê¤ÚÔÓÙ·È Ì ·Ú·‚ÈÎÔ‡˜ ·ÚÈıÌÔ‡˜ Û ·Ú¤ÓıÂÛË. OÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜ ‰ÂÓ Ú¤ÂÈ Ó· ˘ÂÚ‚·›ÓÔ˘Ó: ñ ÙȘ 70 ÛÙȘ ·Ó·ÛÎÔ‹ÛÂȘ. ñ ÙȘ 40 ÛÙȘ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜. ñ ÙȘ 20 ÛÙ· Â›Î·ÈÚ· ı¤Ì·Ù· Î·È ÙȘ ÂӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ. ñ ÙȘ 10 ÛÙȘ ‚Ú·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ Î·È ÙȘ ÂÈÛÙÔϤ˜.

H Û‡ÓÙ·ÍË ÙˆÓ ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·ÔÌÒÓ Á›ÓÂÙ·È Û‡Ìʈӷ Ì ÙȘ ÚfiÛÊ·Ù· ÙÚÔÔÔÈË̤Ó˜ ÚԉȷÁڷʤ˜ Ù˘ International Committee of Medical Journal Editors/ Uniform Requirements for Manuscripts Submitted to Biomedical Journals, (http://www.icmje.org Î·È http:// www.icmje.org/icmje.pdf). OÈ Û˘ÓÙÌ‹ÛÂȘ ÙˆÓ Ù›ÙÏˆÓ ÙˆÓ ÂÚÈÔ‰ÈÎÒÓ Á›ÓÔÓÙ·È Ì ‚¿ÛË ÙÔ Cumulated Index Medicus [List of Journals Indexed in Index Medicus(http://www.nlm.nih.gov/bsd/uniform_requirements.html)]. ¶·Ú·‰Â›ÁÌ·Ù· ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·ÔÌÒÓ I. ¶∂ƒπO¢π∫∞ AÓ ÔÈ Û˘ÁÁÚ·Ê›˜ Â›Ó·È ¤ˆ˜ ¤ÍÈ, ·Ó·ÁÚ¿ÊÔÓÙ·È fiÏÔÈ, ÂÓÒ ·Ó Â›Ó·È ÂÙ¿ ‹ ÂÚÈÛÛfiÙÂÚÔÈ, ·Ó·ÁÚ¿ÊÔÓÙ·È ÔÈ ÚÒÙÔÈ ¤ÍÈ Î·È ÚÔÛÙ›ıÂÙ·È “et al” ‹ “Î·È Û˘Ó”.

II. µπµ§π∞ ∫ÂÊ¿Ï·ÈÔ Û ‚È‚Ï›Ô: Clark AG, Barratt TM. Steroid-responsive nephrotic syndrome. In: Barratt TM, Arner ED, Harmon WE, editors. Pediatric Nephrology. 4th ed. Baltimore: Lippincott William Wilkins; 1999. p. 742. ™‡ÁÁÚ·ÌÌ· ‹ ÌÔÓÔÁÚ·Ê›·: Gorlin RJ, Cohen MM, Levin LS. Syndromes of the head and neck. 3rd ed. New York: Oxford University Press; 1990. ¢ËÌÔÛ›Â˘ÛË Û ÙfiÌÔ Ú·ÎÙÈÎÒÓ: Bauer AW. The two definitions of bacterial resistance. In: Smith AJ, Rogers CA, eds. Proceedings of the Third International Congress of Chemotherapy; 1962 May 29-31; New York: International Society of Chemotherapy; 1963. p. 484-500. ¢È‰·ÎÙÔÚÈ΋ ‰È·ÙÚÈ‚‹: ¶··‰fiÔ˘ÏÔ˜ Ã. ∏ ıÂÚ·›· ÙÔ˘ ÛÙÚ·‚ÈÛÌÔ‡ [‰È‰·ÎÙÔÚÈ΋ ‰È·ÙÚÈ‚‹]. ∞ı‹Ó·: ¶·ÓÂÈÛÙ‹ÌÈÔ ∞ıËÓÒÓ; 1979.

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

IV. ™∆O ¢π∞¢π∫∆ÀO ÕÚıÚÔ Û ÂÚÈÔ‰ÈÎfi: Abood S. Quality improvement initiative in nursing homes: the ANA acts in an advisory role. Am J Nurs [Internet]. 2002 Jun: Webpage: http://www.nursingworld.org/AJN/2002/june/Wawatch.htm

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ªÔÓÔÁÚ·Ê›·: Foley KM, Gelband H, editors. Improving palliative care for cancer [Monograph, Internet]. Washington: National Academy Press; 2001. Webpage: http://www.nap.edu/books/0309074029/html πÛÙÔÛÂÏ›‰Â˜: Cancer-Pain.org [Webpage, Internet]. New York: Association of Cancer Online Resources, Inc.; 2002: http://www.cancer-pain.org/

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

°. ÀÔ‚ÔÏ‹ Î·È ¢ËÌÔÛ›Â˘ÛË ÙˆÓ ∂ÚÁ·ÛÈÒÓ ŸÏ˜ ÔÈ ÂÚÁ·Û›Â˜ Ú¤ÂÈ Ó· ·ÔÛÙ¤ÏÏÔÓÙ·È ÛÙËÓ ËÏÂÎÙÚÔÓÈ΋ ‰È‡ı˘ÓÛË Ù˘ ÂÙ·ÈÚ›·˜ (hps@ath.forthnet.gr). ™Â ͯˆÚÈÛÙfi Ì‹Ó˘Ì· ı· ‰ËÏÒÓÂÙ·È fiÙÈ Ë ÂÚÁ·Û›· ‰ÂÓ ¤¯ÂÈ ÂÓ Ì¤ÚÂÈ ‹ ÂÍ ÔÏÔÎÏ‹ÚÔ˘ ‰ËÌÔÛÈ¢ı› ‹ ˘Ô‚ÏËı› ÁÈ· ÎÚ›ÛË Û ¿ÏÏÔ ÂÚÈÔ‰ÈÎfi Î·È fiÙÈ ÔÈ Û˘ÁÁÚ·Ê›˜ ÂÁÎÚ›ÓÔ˘Ó ÙË ‰ËÌÔÛ›Â˘Û‹ Ù˘ ÛÙÔ ÂÚÈÔ‰ÈÎfi “¶·È‰È·ÙÚÈ΋”. ∂ÈϤÔÓ, ı· Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È Ù˘¯fiÓ ÂȉÔÙ‹ÛÂȘ-¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢.

“∏ ÕÓÔÈÍË” Regla de la C. Alfonso Rames, 15 ÂÙÒÓ, ∫Ô‡‚· ∆˘ÊÏfi ·È‰› “∆· Ù˘ÊÏ¿ ·È‰È¿ ˙ˆÁÚ·Ê›˙Ô˘Ó”, ÕÓÓ· §·Ô˘Ù¿ÚË°ÎÚÈÙ˙¿Ï·, ∞ı‹Ó· 2006

“Spring”, Regla de la C. Alfonso Rames, 15 years old, Cuba Blind child “Blind children paint”, Anna Laoutari-Gritzala, Athens 2006

EÊfiÛÔÓ Ë ÂÚÁ·Û›· Á›ÓÂÈ ·Ô‰ÂÎÙ‹, ÙÔ ‰ÈÔÚıˆÌ¤ÓÔ Û‡Ìʈӷ Ì ÙȘ ˘ԉ›ÍÂȘ ÙˆÓ ÎÚÈÙÒÓ Î›ÌÂÓÔ Ú¤ÂÈ Ó· ˘Ô‚¿ÏÂÙ·È ÛÙË ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹, ̤ۈ e-mail Ô˘ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ÂÚÁ·Û›· Û ÚfiÁÚ·ÌÌ· Word. ™Â ͯˆÚÈÛÙfi ·Ú¯Â›Ô ı· ÂÚÈÏ·Ì‚¿ÓÂÙ·È ÂÈÛÙÔÏ‹ fiÔ˘ ı· ·Ó·Ê¤ÚÔÓÙ·È ·Ó·Ï˘ÙÈο ÔÈ ÙÚÔÔÔÈ‹ÛÂȘ ‹ ÔÈ ·ÓÙÈÚÚ‹ÛÂȘ ÛÙȘ ÚÔÙ¿ÛÂȘ ÙˆÓ ÎÚÈÙÒÓ.

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

T· ΛÌÂÓ· ÙˆÓ ÂÚÁ·ÛÈÒÓ Ô˘ ‰ÂÓ Á›ÓÔÓÙ·È ·Ô‰ÂÎÙ¤˜ ÁÈ· ‰ËÌÔÛ›Â˘ÛË, ‰ÂÓ ÂÈÛÙÚ¤ÊÔÓÙ·È. MÔÚ› Ó· ÂÈÛÙÚ·ÊÔ‡Ó, ÂÊfiÛÔÓ ˙ËÙËı› ÂÓÙfi˜ ÂÍ·Ì‹ÓÔ˘, Ù· Û¯‹Ì·Ù· Î·È ÔÈ ÊˆÙÔÁڷʛ˜ Ô˘ Ù· Û˘Óԉ‡ԢÓ.

¶ÚÈÓ ·ÔÛÙ›ÏÂÙ ËÏÂÎÙÚÔÓÈο ÙËÓ ÂÚÁ·Û›· Û·˜, ‚‚·Èˆı›Ù fiÙÈ ÙÔ ·Ú¯Â›Ô ÂÚÈÏ·Ì‚¿ÓÂÈ: 1. ™ÂÏ›‰· Ù›ÙÏÔ˘ Ô˘ ÂÚȤ¯ÂÈ: ·. Ù›ÙÏÔ Î·È ‚Ú·¯‡ Ù›ÙÏÔ ÂÚÁ·Û›·˜ ‚. fiÓÔÌ· Î·È ÂÒÓ˘ÌÔ Û˘ÁÁڷʤˆÓ (ÔÏÔÁڿʈ˜) Á. ÂÈÛÙËÌÔÓÈÎfi/¿ ΤÓÙÚÔ/· fiÔ˘ ¤ÁÈÓÂ Ë ÂÚÁ·Û›· ‰. fiÓÔÌ·, ‰È‡ı˘ÓÛË, ËÏÂÎÙÚÔÓÈ΋ ‰È‡ı˘ÓÛË Î·È ÙËϤʈÓÔ Û˘ÁÁڷʤ· ÁÈ· ·ÏÏËÏÔÁÚ·Ê›·.

2. ¶ÂÚ›ÏË„Ë ÂÏÏËÓÈ΋-·ÁÁÏÈ΋ (200-250 ϤÍÂȘ), ‰ÔÌË̤ÓË ÛÙȘ ÂÍ‹˜ ·Ú·ÁÚ¿ÊÔ˘˜: ÂÈÛ·ÁˆÁ‹, ̤ıÔ‰ÔÈ, ·ÔÙÂϤÛÌ·Ù· Î·È Û˘ÌÂÚ¿ÛÌ·Ù·.

3. §¤ÍÂȘ ÎÏÂȉȿ.

4. ∫·Ù¿ÏÔÁÔ Û˘ÓÙÔÌÔÁÚ·ÊÈÒÓ.

5. ∫›ÌÂÓÔ.

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

7. µÈ‚ÏÈÔÁÚ·Ê›·.

8. ¶›Ó·Î˜ (Ô Î·ı¤Ó·˜ Û ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·).

9. ∂ÈÎfiÓ˜ (Ë Î·ıÂÌ›· Û ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·).

10. ∆›ÙÏÔ˘˜ ÂÈÎfiÓˆÓ.

˘·ÓÈԇϿÛÌ·ˆ· ‰ÂÓ ÌÂϤÙ˜ ‹ÛË ÙÔ˘ ÌËÙ¤Ú·˜ · ÌfiÓÔ Ó·Ì¤ÓÂÚ¤ÂÈ Ô ª∏∆∂™ ˜ Ô˘ ÂÁ¯fiÌÂ˙›ÏË Û : ∞˘Í‹. Ÿˆ˜ ¿ÓıËÌ· Ù· Û˘‰È·ÎÔÓËÏ›· ˜. ∞ÈÌÔÓÈ·. ¡Â%), ÂÊÂÚı› Í›·, ·ÁÓ‰ÚÔÌÔ Ù˜ ·ˆÛÈÓÔÂÙ·È Î˘Î‹˜ ÏÂÈProcef ÙˆÓ 12 ÛÂ Û˘È· ˘„ËÔ‰ËÁ›Â˜ 5 ∂Àƒø ¶∂. ¶√-

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EDITORIAL COMMENTARY

∞ƒ£ƒ√ ™À¡∆∞•∏™

165

Long term outcomes of children with cancer G. A. Levitt Children diagnosed with a malignancy prior to the 1980’s had a dismal outlook but over the last three decades the long-term survival rates have substantially improved. More than 75% of children with cancer in the western world can expect to reach adulthood, in real terms 1 in 715 young adults will have experienced cancer by the year 2010 (1).

This success has been achieved by the improved supportive care and the use of multimodality treatments, surgery, intensive chemotherapy and radiotherapy. Unfortunately present day cancer treatments do not target cancer cells alone but cause damage to normal tissues.

The extent of the damage and the number of organs involved depends on many factors including the treatment intensity, scheduling and combinations, age and gender of the patient (2).

A number of studies including large epidemiological studies have shown an increased risk of early mortality, an eleven times greater risk of death compared to that expected for the general population five years from diagnosis. The main culprit was disease relapse but 20% was due to treatment related effects (3,4). Further studies have suggested that 60% of survivors suffer chronic conditions (5,6). A third of patients have moderate or severe compromise with a significant proportion with more than one organ system affected.

The paper in this edition, “Surviving childhood cancer: long-term outcome”, highlights the diversity of late sequelae and the variable onset of problems. The damage occurs at the time of treatment but clinically relevant effects may present many years later. Platinium or Ifosfamide related renal dysfunction tends to be evident at the end of treatment and may remain static, however anthracycline cardiotoxicity is progressive and clinically relevant symptoms can present many years later. Gonadotoxic treatment prescribed to prepubertal patients will not be evident until puberty or until fertility is tested.

Space limitations for the review did not allow for a full appreciation of the less common problems such as osteoporosis, renal or sensory impairment but these are no less important, particularly when they are in combination with other problems.

This review carries an important message, drawing attention to a wider audience both within paediatric and adult practice, on the needs of long-term survivors of childhood cancer. It clearly shows the problems they may present related to their previous medical history and the variable time of onset after cure has been established. History taking is vital to assist in making the correct diagnosis and apportioning a cause. In addition, this review makes the case for providing subspecialist expertise to maximize the survivors’ wellbeing. Normal life events such as pregnancy may be compromised by the cancer treatments, abdominal radiation increasing the risk of prematurity, extra workload for the heart that has received a significant dose of anthracyclines; this information needs to reach the physicians dealing with these patients (7).

The paper touches on the development of follow-up guidelines. The importance of the guidelines is to improve the long-term outcomes of these patients by detecting sequelae at an early stage, when treatment can be maximized. A number of surveillance guidelines have been published which can be adapted to produce a follow-up programme for individual patients based on the therapy received and the risks of developing a problem (8-10). Unfortunately much of the guidance is not evidence-based but nevertheless it is based on expert sensible opinion.

All countries successfully treating childhood cancer should invest in a follow-up programme.

The “where, how, by whom”, is very much dependent on the local health care organization but should incorporate a provision for transition to adult care for these childhood cancer survivors requiring ongoing monitoring or treatment.

The guidance is straightforward and the surveillance can be delivered by paediatricians and primary care physicians with explicit referral pathways when abnormalities are encountered.

This becomes important as the numbers increase and the care of the patients by their oncologist may not be appropriate and therefore different models of care need to be explored.

Work with long-term survivors shows that many wish to take control of their own followup, but they require solid information on the treatment that they received and the risks of late

Great Ormond Street Hospital for Children, NHS Trust Great Ormond St., London, UK Correspondence: Gill A. Levitt levitg@gosh.nhs.uk Great Ormond Street Hospital for Children, NHS Trust Great Ormond St., London WCIN3JH, UK

¶·È‰È·ÙÚÈ΋ 2007;70:165-166

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sequelae. This information can also be used to discuss healthy life-style issues, appropriate employment, which will be vital to improve the long-term quality of survival. These information packages should be provided by well-informed health workers as patients enter adulthood and should be an integral part of follow-up.

Long-term cancer survivors in many cases require considerable input from health professionals so that they can obtain the best possible quality of life and enable them to contribute to their community. Cure alone is not sufficient.

5.

6.

7.

8.

References 1. Campbell J, Wallace WHB, Bhatti LA, Stockton DL, Rapson T, Brewster DH. Childhood Cancer in Scotland: Trends in incidence, mortality and survival 1975-1999. NHS Scotland Information and Statistics Division. Edinburgh. 2004.

2. Jenney ME, Levitt GA. The quality of survival after childhood cancer. Eur J Cancer 2002;38:1241-1250.

3. Mertens AC, Yasui Y, Neglia JP, Potter JD, Nesbit ME Jr, Ruccione K et al. Late mortality experience in five-year survivors of childhood and adolescent cancer: the Childhood Cancer Survivor Study. J Clin Oncol 2001;19:3163-3172.

4. Moller TR, Garwicz S, Barlow L, Falck Winther J, Glattre E, Olafsdottir G et al. Decreasing late mortality among

Paediatriki 2007;70:165-166

9.

10.

11.

five-year survivors of cancer in childhood and adolescence: a population-based study in the Nordic countries. J Clin Oncol 2001;19:3173-3181.

Curry HL, Parkes SE, Powell JE, Mann JR. Caring for survivors of childhood cancers: the size of the problem. Eur J Cancer 2006;42:501-508.

Oeffinger KC, Mertens AC, Sklar CA, Kawashima T, Hudson MM, Meadows AT. Chronic health conditions in adult survivors of childhood cancer. N Engl J Med. 2006;355(15): 1572-1582.

Levitt GA, Jenney ME. The reproductive system after childhood cancer. Br J Obstet Gynaecol. 1998;105:946-953.

Skinner R, Wallace WHB, Levitt GA, eds. Therapy based long term follow up: Practice Statement. United Kingdom Children’s Cancer Study Group (Late Effects Group); 2005. [Website] http://www.ukccsg.org.uk/public/followup/PracticeStatement/index.html Scottish Intercollegiate Guidelines Network. Long term follow up of survivors of childhood cancer. A national clinical guideline. 2004. [Website] http://www.sign.ac.uk/pdf/ sign76.pdf Children’s Oncology Group. Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers. 2004. [Website] http://www.survivorshipguidelines.org Skinner R, Wallace WH, Levitt G. Long-term follow-up of children treated for cancer: why is it necessary, by whom, where and how? Arch Dis Child 2007;92:257-260.

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167

Surviving childhood cancer: long-term outcomes M. Servitzoglou Abstract: Childhood cancer survivors constitute a rapidly expanding population with special healthcare needs. The disease, in conjunction with the highly intensive therapy, results in numerous side effects that can present long after the completion of treatment. Survivors are susceptible to high morbidity and early mortality, due mainly to complications, ranging from second malignancies to heart dysfunction.

Second malignancies are frequently found at sites of prior radiation and include breast cancer, thyroid cancer and soft tissue sarcomas. Some chemotherapy agents, such as alkylating agents and topoisomerase II inhibitors, can cause acute myeloid leukaemia and myelodysplastic syndromes. Failure in linear growth is noted after cranial radiotherapy for brain tumour and leukaemia. Abnormal thyroid function is observed following neck irradiation. Pelvic irradiation and exposure to alkylating agents are significant risk factors for sub- or infertility in both sexes. Cardiac dysfunction is progressive and more frequently presents as cardiomyopathy related to anthracyclines, with adjuvant chest irradiation being an independent factor. Impaired neurocognitive performance is classically reported in children with brain tumours and leukaemia. The use of cranial irradiation and even the use of intrathecal chemotherapy alone for leukaemia can cause permanent damage, especially to younger children. The recent development of specific guidelines for the follow-up of childhood cancer survivors is an attempt to improve their long-term quality of life, ensuring the early detection and management of complications. The best model for follow-up and transition of care to the adult setting is yet to be decided.

Great Ormond Street Hospital for Children, NHS Trust London, UK Correspondence: Marina Servitzoglou marservitzoglou@hotmail.com Great Ormond Street Hospital for Children, NHS Trust Great Ormond St., London WC1N 3JH United Kingdom

Key words: Cancer, children, outcomes.

Introduction The treatment for paediatric malignancies has improved so remarkably that the overall cure rate has increased to 75% (1). This high cure rate is attributed to the effective combination of chemotherapy, radiotherapy and surgery. Over the past few decades, more aggressive multidrug regimens, together with novel therapies, have led to the current, impressive survival rates. Young individuals cured from cancer are currently an expanding population with special healthcare needs and distinctive characteristics. It is anticipated that at present, 1 individual in 1000 is a childhood cancer survivor but this prevalence is as high as 1 in 570 among young adults aged between 20 and 34 years (2).

Obviously, effective therapies can cause severe toxicity and the balance between cure and treatment-induced morbidity is extremely fine.

Complications may emerge long after the completion of treatment, which together with the normal aging process, make childhood cancer survivors susceptible to various health problems.

It appears that up to 60-70% of survivors develop at least one medical disability as a result of their disease or, more frequently, of their treatment (3). Survivors can develop problems such as endocrine dysfunction, neurological deficit,

cardiovascular or pulmonary compromise, renal impairment, gastrointestinal dysfunction, osteoporosis, and hearing or visual loss. The minimization of long-term morbidity without compromising the efficacy of treatment for affected children is now the focus of attention. In the present article the more important of these late effects are briefly described.

Late endocrine effects Growth Linear growth is significantly impaired in specific groups of childhood cancer survivors.

Nearly 40% of brain tumour and 10% of leukaemia survivors are below the 5th percentile for height (4-6). Additionally, there are children who, although they remain above the 5th percentile, experience significant drops on the standardized curves and their final height is lower than that predicted according to their growth prior to cancer diagnosis.

The strongest risk factors for adult short stature seem to be younger age at diagnosis and craniospinal irradiation treatment involving the hypothalamic-pituitary axis, with a dose-response fashion (4). Whole-brain irradiation of up to 1824 Gy, as used in older protocols for children with leukaemia, even though it is a relatively low dose, ¶·È‰È·ÙÚÈ΋ 2007;70:167-173

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can cause a reduction in the final height, but the impact in growth is much more severe with doses above 30 Gy. Recent protocols for acute lymphoblastic and myeloid leukaemia do not include cranial irradiation. Younger age at diagnosis and, possibly, female sex are additional negative prognostic factors.

Treatment effects on growth are multifactorial and include growth hormone deficiency, spinal shortening due to direct inhibition of vertebral growth, precocious puberty, latent hypothyroidism, and poor nutrition. Fifty percent to 80% of children treated with craniospinal radiation for brain tumours will experience growth failure (7). Even children who have not received irradiation as part of their leukaemia treatment have deficient growth hormone (GH) levels, but the long-term effect on final height is still unclear (8-10). Results have recently improved after the introduction of GH therapy, but the presence of concomitant endocrinopathies and the use of increased doses of spinal irradiation can reduce the benefit. On the other hand, male gender, younger bone age at the start of GH treatment and conventional higher doses of GH maximize the chances of successful therapy.

Obesity has been described in specific groups of childhood cancer survivors (4,8,11). On the basis of body mass index (BMI) female sex, young age at diagnosis and cranial irradiation are factors that have been associated with obesity risk in leukaemia survivors (11). In a recent study on individuals treated for brain tumours, 60% of subjects who were treated with cranial irradiation, compared with 20% of those who were not, had two or more of the 5 components of the metabolic syndrome. Cranial irradiation was strongly related to GH deficiency, and lower insulin-like growth factor 1 (IGF-1), higher fasting insulin, abdominal obesity, and dyslipidaemia, particularly in women (8).

Thyroid function Abnormal thyroid function is anticipated after neck irradiation for primary malignancies. Also, the use of Busulphan in conditioning for stem cell transplantation and of iodide-containing contrast material, such as 131-I-metaiodobenzylguanidine (MIBG), for neuroblastoma, are considered additional risk factors for the development of thyroid disorders (12). Survivors develop clinical or laboratory signs of deranged thyroid function after a period of 2 to 16 years (mean 7 years), usually after doses higher than 15 Gy. The percentage can be as high as 30 to 90% for individuals treated for Hodgkin disease or head and neck tumours (4,13). In a report from the Childhood Cancer Survivorship Study (CCSS) study, compared to their healthy siblings the survivors’ relative risk was 17.1 for Paediatriki 2007;70:167-173

hypothyroidism, 8 for hyperthyroidism and 27 for thyroid nodules (14). Radiation dosage higher than 25 Gy, older age at primary diagnosis and female sex were independent risk factors for the development of hypothyroidism. There is evidence that the risk of thyroid dysfunction is cumulative after the combination of chemotherapy and cervical spine radiotherapy.

Gonadal function i) Males Chemotherapy, in the form of alkylating agents, especially in high doses, can cause decreased spermatogenesis, while irradiation may also inhibit pubertal development. Testicular irradiation can result in decreased testicular volume and sperm production, with concurrent elevated levels of follicle-stimulating hormone (FSH) and reduced inhibin B levels. The effect is obviously dose-dependent, as doses of up to 3 Gy cause transient azoospermia for up to 5 years but after 6 Gy, the damage appears to be irreversible (15,16). Total body irradiation (TBI), as part of conditioning for bone marrow transplantation (BMT), causes permanent invariable azoospermia. Despite previous evidence for impaired spermatogenesis, sperm DNA studies have shown that cancer survivors have normal DNA integrity (17). However, further studies are needed to evaluate the extent of DNA abnormalities in survivors. In addition, the type of cancer also has a very strong influence on sperm function. Leydig cells are less radiosensitive than Sertoli / germ cells, but still the effect is dose-dependent and inversely related to age at treatment, with prepubertal males being more vulnerable to permanent damage.

Direct radiation with doses higher than 20 Gy could cause delayed sexual maturation, while doses lower than 12 Gy usually allow pubertal progression, even with dysfunctional Leydig cells, normal testosterone and elevated luteinizing hormone (LH) (16). ii) Females Cranial irradiation, inclusive of the area of hypothalamus and pituitary can result in delayed puberty with doses higher than 24 Gy, whilst lower doses are more commonly related with precocious puberty (18). Primary ovarian failure is not as common as premature menopause and has been reported in association with older age at diagnosis, previous Hodgkin disease, abdominal or pelvic irradiation and exposure to alkylating agents (19). However, it should be mentioned that female gonadal function is less affected by alkylating agents than male gonadal function. The ovarian and concurrent uterine impairment, when the pelvis is included in the radiation field, increases

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the risk of miscarriages, fetal death and low birth weight in subsequent pregnancies (20,21). In a recent report from CCSS, up to 30% of survivors treated with alkylating agents plus abdominopelvic radiation had premature menopause, with attained age and Hodgkin lymphoma being significant risk factors independent of the actual doses of drugs and radiation (22).

Late cardiovascular effects Cardiac dysfunction is chronic and progressive in childhood cancer survivors. Typically, cardiomyopathy is related with the use of anthracyclines. Progressive reduction in ventricular mass and wall thickening are associated with worsening contractility and increasing afterload (23). Doses higher than 300 mg/m2 place survivors at increased risk of toxicity. The risk of cardiac failure or severe abnormalities increases with anthracycline dose, adjuvant chest irradiation and time since treatment. The proportion of affected survivors in follow-up longer than 15 years is higher than 30% (23-25).

Development of coronary artery disease has been reported following chest irradiation in percentage up to 10% (26). Also, there is evidence of increased relative risk of stroke in Hodgkin survivors previously treated with mantle irradiation, possibly due to carotid artery or cardiac valvular disease (27).

Late neurocognitive effects Children treated for leukaemia, non-Hodgkin lymphoma and brain tumours are susceptible to neurocognitive disorders of variable severity, mainly because of the use of cranial irradiation. Damage is more prominent for children diagnosed at a younger age, when the brain, especially the cortical and subcortical white matter, is still developing (28,29). Even chemotherapy-only regimens, including high-dose frequently administered methotrexate, are associated with cognitive dysfunction, which can be progressive over at least a decade (4). Treatment for acute lymphocytic leukaemia (ALL), with or without central nervous system (CNS) irradiation, can lead to smaller white-matter volumes that are directly associated with impaired neurocognitive performance (30,31).

Other risk factors are perioperative morbidity, largevolume high-dose cranial irradiation, supra-tentorial brain tumour and leukoencephalopathy. Survivors may develop lower verbal and performance IQ, difficulties in information processing, maintenance of concentration and attention, memory deficits and impaired fine motor and visual-spatial skills (32,33).

It has been reported that survivors of leukaemia, CNS tumours, non-Hodgkin lymphoma, and neuroblas-

toma were significantly less likely to finish high school compared with their siblings, unless they received additional support (34).

Another feature of neurological effects is the increased rate of neurosensory impairment. Survivors of brain tumours, compared to their sibling comparison group, were found to be at elevated risk for hearing impairments, legal blindness in one or both eyes, cataract, and double vision. Radiation exposure of greater than 50 Gy to the posterior fossa was associated with a higher likelihood of developing hearing impairment. Children receiving at least 50 Gy to the frontal brain regions had a moderately elevated risk for motor problems (35).

Apart from the type of cancer and treatment, factors such as age at diagnosis or gender have been suggested as independent variables for the development of neurocognitive problems in survivors. Girls treated for ALL, with intravenous and intrathecal chemotherapy only, have been reported to have significantly lower verbal and/or nonverbal IQ scores, compared to boys (36,37).

Second malignancies Survivors have a 6-fold relative risk, compared with the normal population, of developing a second malignancy, due in part to the mutating action of chemotherapy and irradiation and in part to the genetic predisposition of the individual for cancer (38,39). The risk for second malignancy increases with time and is relatively higher in those individuals who have been treated for Hodgkin disease, those who received high doses of epipophyllotoxins, alkylating agents or radiotherapy, and those with familial cancer syndromes such as hereditary retinoblastoma or Li Fraumeni, and also in females, mainly because of the higher occurrence of breast cancer. A recent Surveillance Epidemiology and End Results (SEER) report has provided evidence that patients treated in recent years for brain tumours carry a greater risk of second malignancy, due to the increasing intensity of treatment (40).

Characteristically, breast cancer can occur in females following mantle or chest irradiation for Hodgkin disease, where it is probably the most common second malignancy (41). The cumulative incidence by the age of 40 years for female survivors treated with irradiation can be as high as 17%. The risk begins to increase approximately 8 years after treatment and is higher if radiotherapy was administered before adulthood (42). Also documented was an increasing occurrence of thyroid cancer and of epithelial neoplasms common in adults, such as colon and lung ¶·È‰È·ÙÚÈ΋ 2007;70:167-173

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cancer, at a younger age than expected in the general population.

Thyroid cancer has been reported in survivors who received radiotherapy not only for Hodgkin disease, but also for ALL, brain tumours and after TBI for BMT. For Hodgkin disease survivors, the risk can be up to 18 times that of general population. The risk increased with radiation doses of up to 20-29 Gy and for individuals treated before they reached 10 years of age (43).

Secondary bone tumours are not particularly high among survivors of childhood cancer, apart from those treated for bilateral retinoblastoma, Ewing sarcoma and soft tissue sarcomas where the cumulative probability at 20 years could reach 7.4% (44,45). Local radiotherapy and alkylating agents are independent risk factors, both increasing with cumulative exposure.

Soft tissue sarcoma (STS) is one of the most frequent second cancers occurring during the first 20 years following treatment for a solid cancer in childhood. The risk increases with the square of the dose of radiation to the site of STS development and with the administration of Procarbazine (46). On the other hand, survivors of STS in childhood are at increased risk for developing second malignancy in the form of (acute myelogenous leukaemia) AML, cutaneous melanoma, breast cancer and bone or STS, while cancers of the oral cavity are prominent. The risk is higher when they have received combination of chemotherapy and radiotherapy (47).

Secondary AML and myelodysplastic syndromes can occur 5-10 years following treatment for childhood cancer and are classically associated with the use of alkylating agents and topoisomerase II inhibitors.

For the former, the relationship is dose-dependent and is frequently associated with abnormalities in chromosomes 5 or 7 (48). For topoisomerase II inhibitors, the latency period is shorter and cytogenetic examination often reveals abnormalities in chromosome 11q23 (49).

Late psychosocial effects The milestone study of Koocher and O’Malley highlighted the fact that childhood cancer survivors are prone to psychological difficulties of sufficient severity to affect their long-term quality of life (50,51).

The results have been inconsistent, but they all point to certain vulnerable subgroups, such as brain tumour survivors, who are at greater risk for psychosocial maladjustment, and who have fewer friends and significantly more behavioural problems (52-54).

There is evidence that the cohort of childhood cancer survivors is susceptible to psychosocial problems, such as high anxiety prevalence or lowered selfPaediatriki 2007;70:167-173

esteem (55-57). Factors such as older age at diagnosis or disfiguration and body changes have been suggested as risk factors, as in these cases the normal maturation process and transition to independence are disrupted. More recently, it has been reported that survivors, due to the devastating experience of the disease and its treatment, manifest symptoms similar to post-traumatic stress disorder, especially when entering adulthood, in a percentage as high as 20% (58-60).

Nevertheless, it should be emphasized that there is also a tendency to consider childhood cancer not only a source of distress, but also as an incentive to accelerated maturation and enhanced emotional development, leading to deeper appreciation for life and wiser choices of life priorities (61-62).

Conclusion The increasing population of childhood cancer survivors is prone to a variety of disorders in many different systems, resulting from the disease itself and the aggressive treatment. Some of these problems such as anthracycline induced cardiomyopathy, can develop many years after therapy, while others, such as neurocognitive or endocrine complications, may appear during treatment and persist. Possible psychosocial difficulties can remain for many years, while the risk for secondary malignancies increases with time.

Consequently, it is important for healthcare providers to anticipate and detect these problems as early as possible in order to minimize their effects on the quality of life of survivors. Surprisingly, it was only recently that specific recommendations for the prevention and management of the cancer and treatment related complications have been developed in an attempt to improve the health of these individuals. The entire process has been delayed by the evolution of cancer therapies, the long latent period for the development of many late effects and the unspecified additional effect of aging on individuals treated in childhood for cancer (63,64). The aim of these guidelines is to provide long-tem monitoring of survivors’ health, ensuring the early detection of complications (65-67).

Moreover, because of the low incidence of disease, the majority of doctors, especially those involved in the health care of adults, are unfamiliar with childhood cancer and the treatment-related risks of survivors. In view of the particular needs of survivors, the best model for long-term follow-up, especially in case of emergencies, has raised many discussions and is far from being established. Their care needs to be smoothly transmitted from the paediatric to the adult setting in a way that the new health provider can have the opportunity to know the patient, identify his/her

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medical, psychological and social needs and organize the appropriate monitoring plan. Otherwise, patients might have to move abruptly into an adult healthcare setting, when they have already developed severe problems, for example a second malignancy, complicating further the already difficult situation.

Childhood cancer survivors are a rapidly growing population with unique characteristics and special healthcare needs, who are at high risk for late effects that could impair their long-term quality of life. They need to be closely monitored for the rest of their life for presentation of all the possible complications so that the disease- and treatment-related morbidity and mortality can be minimized.

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¶·È‰È·ÙÚÈ΋ 2007;70:167-173

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√ ·ÓÔÛÔÊ·ÈÓfiÙ˘Ô˜ ÙˆÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜ ÛÙËÓ ÎÏÈÓÈ΋ ·È‰È·ÙÚÈ΋ Ú¿ÍË ∆Ì‹Ì· ∞ÓÔÛÔÏÔÁ›·˜πÛÙÔÛ˘Ì‚·ÙfiÙËÙ·˜, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó· AÏÏËÏÔÁÚ·Ê›·: ª·Ú›· ∫·Ó¿ÚÈÔ˘ mkanariou@hol.gr ∆Ì‹Ì· ∞ÓÔÛÔÏÔÁ›·˜πÛÙÔÛ˘Ì‚·ÙfiÙËÙ·˜, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·” £Ë‚ÒÓ & ¶··‰È·Ì·ÓÙÔÔ‡ÏÔ˘, ∆.∫. 115 27, ∞ı‹Ó·

º. ∆˙ÈÊ‹, ª. ∆˙·ÓÔ˘‰¿ÎË, ª. ∫·Ó¿ÚÈÔ˘ ¶ÂÚ›ÏË„Ë: ∏ ΢ÙÙ·ÚÔÌÂÙÚ›· ÚÔ‹˜ ›ӷÈ, Û‹ÌÂÚ·, Ë ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓË Ì¤ıÔ‰Ô˜ ÁÈ· ÙËÓ ¿ÌÂÛË Î·È ÁÚ‹ÁÔÚË ·ÍÈÔÏfiÁËÛË ÙˆÓ ÏÂÌÊÔ΢ÙÙ·ÚÈÎÒÓ ÏËı˘ÛÌÒÓ ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜ Î·È ÙË ‰ÈÂÚ‡ÓËÛË ÙˆÓ ‰È·Ù·Ú·¯ÒÓ ÙÔ˘ ·ÓÔÛÈ·ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ∏ ÌÂϤÙË ÙÔ˘ ·ÓÔÛÔÊ·ÈÓfiÙ˘Ô˘ ÙˆÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜ ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÔÏÔ¤Ó· Î·È ÂÚÈÛÛfiÙÂÚÔ ÛÙËÓ ·È‰È·ÙÚÈ΋. ∏ ÂÈÛÙËÌÔÓÈ΋ ¤Ú¢ӷ ÛÙÔÓ ÙÔ̤· Ù˘ ·ÓÔÛÔÏÔÁ›·˜ ·Ó·‰ÂÈÎÓ‡ÂÈ Û˘Ó¯Ҙ ÂÈÊ·ÓÂȷο ‹ ÂÓ‰Ô΢ÙÙ¿ÚÈ· ÌfiÚÈ·, Ì ÁÓˆÛÙ¤˜ Î·È ÌË ÏÂÈÙÔ˘ÚÁ›Â˜. ∆· ÌfiÚÈ· ·˘Ù¿ ÂÎÊÚ¿˙ÔÓÙ·È Û ‰È¿ÊÔÚ· ÛÙ¿‰È· Ù˘ ·ÈÌÔÔ›ËÛ˘ Î·È ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ˆ˜ ‰Â›ÎÙ˜ ·Ó·ÁÓÒÚÈÛ˘ ÙˆÓ ÏËı˘ÛÌÒÓ Î·È ˘ÔÏËı˘ÛÌÒÓ ÙˆÓ T-, B- Î·È NK-ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ, Û˘Ì‚¿ÏÏÔ˘Ó ‰Â ÛÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙÔ˘˜ Ì ‚¿ÛË ÙÔ ÛÙ¿‰ÈÔ ˆÚ›Ì·ÓÛ‹˜ ÙÔ˘˜ Î·È ÙË ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘˜. ∏ ·Ó·ÁÓÒÚÈÛË ÙˆÓ ·ÓÙÈÁfiÓˆÓ Á›ÓÂÙ·È Ì ÙË ¯Ú‹ÛË ÌÔÓÔÎψÓÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ Ì ÙËÓ Î˘ÙÙ·ÚÔÌÂÙÚ›· ÚÔ‹˜ Î·È ¯ÚËÛÈ̇ÂÈ ÛÙË ‰È¿ÁÓˆÛË ÙˆÓ ·ÓÔÛÔ·ÓÂ·ÚÎÂÈÒÓ Î·È ÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ÏÔÈÌÒÍÂˆÓ Î·È ÙˆÓ ·ÓÔÛÔÏÔÁÈÎÒÓ ÓÔÛËÌ¿ÙˆÓ, ÛËÌ·ÓÙÈÎfi˜ ‰Â Â›Ó·È Ô ÚfiÏÔ˜ ÙÔ˘˜ ÛÙË ‰È¿ÁÓˆÛË Î·È ÙËÓ Ù·ÍÈÓfiÌËÛË ÙˆÓ Ï¢¯·ÈÌÈÒÓ Î·È ÏÂÌʈ̿وÓ. ª¤Û· Û ·˘ÙfiÓ ÙÔÓ Î·Ù·ÈÁÈÛÌfi ÏËÚÔÊÔÚÈÒÓ Î·È Ù¯ÓÔÏÔÁÈÎÒÓ ÂÈÙ¢ÁÌ¿ÙˆÓ, Â›Ó·È ÛËÌ·ÓÙÈÎfi Ô ·È‰›·ÙÚÔ˜ Ó· ÁÓˆÚ›˙ÂÈ ÙÔ˘Ï¿¯ÈÛÙÔÓ Ù· ΢ÚÈfiÙÂÚ· ÌfiÚÈ· Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ˆ˜ ‰Â›ÎÙ˜ ÁÈ· ÙËÓ ·Ó·ÁÓÒÚÈÛË ÙˆÓ ÏÂÌÊÔ΢ÙÙ·ÚÈÎÒÓ ÏËı˘ÛÌÒÓ Î·È ÙÔ Ò˜ ı· ·ÍÈÔÏÔÁ‹ÛÂÈ ·‰Ú¿ Ù· ·ÔÙÂϤÛÌ·Ù· ·˘ÙÔ‡ ÙÔ˘ ÂϤÁ¯Ô˘. ∏ ·ÚÔ‡Û· ·Ó·ÛÎfiËÛË ¤¯ÂÈ ˆ˜ ÛÙfi¯Ô Ó· ··ÓÙ‹ÛÂÈ ÛÙ· ·Ú·¿Óˆ ÂÚˆÙ‹Ì·Ù· Î·È Ó· Û˘ÓÙÂϤÛÂÈ ÛÙË ‚ÂÏÙÈÛÙÔÔ›ËÛË Ù˘ ¯Ú‹Û˘ Ù˘ ÌÂıfi‰Ô˘ ·˘Ù‹˜ ÛÙËÓ ÎÏÈÓÈ΋ Ú¿ÍË.

§¤ÍÂȘ ÎÏÂȉȿ: ∫˘ÙÙ·ÚÔÌÂÙÚ›· ÚÔ‹˜, ·ÓÔÛÔÊ·ÈÓfiÙ˘Ô˜, ÏÂÌÊÔ·ÙÙ·Ú·, ·È‰È·ÙÚÈ΋.

Peripheral blood lymphocyte immunophenotype in paediatric clinical practice Department of Immunology and Histocompatibility, “Aghia Sophia” Children’s Hospital, Athens Correspondence: Maria Kanariou mkanariou@hol.gr Department of Immunology and Histocompatibility, “Aghia Sophia” Children’s Hospital Thivon & Papadiamandopoulou St., 115 27, Athens

F. Tzifi, M. Tzanoudaki, M. Kanariou Abstract: Flow cytometry is used for rapid evaluation of the peripheral blood lymphocyte subpopulations and investigation of immune system disorders. The immunophenotype study of peripheral blood lymphocytes is now used routinely in paediatric clinical practice. Scientific research in immunology has led to the identification of lymphocyte surface or cytoplasmic molecules with a range of functions that have been elucidated to a variable degree. These molecules, which are expressed at certain stages of haemopoiesis, are used as markers for identifying lymphocyte populations and subpopulations according to their cell line, maturational stage and function. They are detected using monoclonal antibodies in conjunction with fluorochromes in the flow cytometry system. ∆hey are useful for the diagnosis of immunodeficiencies, the follow up of infectious, rheumatic and immunological disease and the classification of leukaemias and lymphomas. In view of the vast body of relevant information, it is important for paediatricians to be familiar with the basic markers that characterize the lymphocyte populations and to know how to make a rough interpretation of the immunophenotype results. The purpose of this review is to provide an answer to these questions and to enhance the use of flow cytometry for screening, diagnosis and follow up of immunological diseases.

Key words: Flow cytometry, immunophenotype, lymphocytes, paediatrics.

™˘ÓÙÔÌÔÁڷʛ˜ NK HLA MHC TCR BCR Paediatriki 2007;70:174-183

º˘ÛÈο ΢ÙÙ·ÚÔÎÙfiÓ· ∞ÓıÚÒÈÓ· Ï¢ÎÔ΢ÙÙ·ÚÈο ·ÓÙÈÁfiÓ· ªÂ›˙ÔÓ Û‡ÌÏÂÁÌ· ÈÛÙÔÛ˘Ì‚·ÙfiÙËÙ·˜ ÀÔ‰Ô¯¤·˜ ÙˆÓ ∆-ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ÀÔ‰Ô¯¤·˜ ÙˆÓ µ-ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ

HIV APC IL RAG PNP

πfi˜ Ù˘ ·ÓıÚÒÈÓ˘ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·˜ ∞ÓÙÈÁÔÓÔ·ÚÔ˘ÛÈ·ÛÙÈÎfi ·ÙÙ·ÚÔ πÓÙÂÚÏ¢ΛÓË °ÔÓ›‰È· ÂÓÂÚÁÔÔ›ËÛ˘ ·Ó·Û˘Ó‰˘·ÛÌÔ‡ ¶Ô˘ÚÈÓÈ΋ ʈÛÊÔÚ˘Ï¿ÛË

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√ ·ÓÔÛÔÊ·ÈÓfiÙ˘Ô˜ ÙˆÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜

‹‰Ë ÙÂı› Ë ‰È¿ÁÓˆÛË. øÛÙfiÛÔ, Î·È ÛÙËÓ ÚÔÛ¤Ï·ÛË ÙˆÓ ·ÓÔÛÔ·ÓÂ·ÚÎÂÈÒÓ, Ë ı¤ÛË Ù˘ ÌÂϤÙ˘ ÙˆÓ ÏÂÌÊÔ΢ÙÙ·ÚÈÎÒÓ ÏËı˘ÛÌÒÓ ‚Ú›ÛÎÂÙ·È ÌÂÙ¿ ÙËÓ ÎÏÈÓÈ΋ ÂÎÙ›ÌËÛË Î·È ÙË ‰ÈÂÓ¤ÚÁÂÈ· ·ÏÔ‡ÛÙÂÚÔ˘ ÂÚÁ·ÛÙËÚÈ·ÎÔ‡ ÂϤÁ¯Ô˘, Ô Û˘Ó‰˘·ÛÌfi˜ ÙˆÓ ÔÔ›ˆÓ ı· ı¤ÛÂÈ Û˘ÁÎÂÎÚÈ̤ӷ ‰È·ÁÓˆÛÙÈο ÂÚˆÙ‹Ì·Ù· ÚÔ˜ ·¿ÓÙËÛË. ŸÙ·Ó, ϤÔÓ, Ô ·È‰›·ÙÚÔ˜ ÎÚ›ÓÂÈ fiÙÈ Â›Ó·È ··Ú·›ÙËÙÔ˜ Ô ¤ÏÂÁ¯Ô˜ ÙÔ˘ ·ÓÔÛÔÊ·ÈÓfiÙ˘Ô˘ ÙˆÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ, ı· Ú¤ÂÈ Ó· ÁÓˆÚ›˙ÂÈ ÙÔ˘˜ ΢ÚÈfiÙÂÚÔ˘˜ ÏÂÌÊÔ΢ÙÙ·ÚÈÎÔ‡˜ ÏËı˘ÛÌÔ‡˜ Î·È Ó· Â›Ó·È Û ı¤ÛË Ó· ‰È·‚¿ÛÂÈ ÙËÓ ·¿ÓÙËÛË Î·È Ó· ·ÍÈÔÏÔÁ‹ÛÂÈ ·‰Ú¿ ÙÔ ·ÔÙ¤ÏÂÛÌ·.

∂ÈÛ·ÁˆÁ‹ ∏ ΢ÙÙ·ÚÔÌÂÙÚ›· ÚÔ‹˜ Â›Ó·È Ì›· Ù·¯Â›· Î·È ‰˘Ó·ÌÈ΋ ̤ıÔ‰Ô˜ ÔÏ˘·Ú·ÌÂÙÚÈ΋˜ ·Ó¿Ï˘Û˘ ÌÂÁ¿ÏÔ˘ ·ÚÈıÌÔ‡ ΢ÙÙ¿ÚˆÓ ‹ ¿ÏÏˆÓ ÛˆÌ·Ùȉ›ˆÓ (fiˆ˜ ÛÊ·ÈÚȉ›ˆÓ latex), Ë ÔÔ›· ·Ú¯Èο ¤Ù˘¯Â ¢Ú›·˜ ÂÊ·ÚÌÔÁ‹˜, ÏfiÁˆ Ù˘ ·ÍÈÔÔ›ËÛ‹˜ Ù˘ ÛÙËÓ ·ÓÔÛÔÏÔÁÈ΋ Ù˘ÔÔ›ËÛË ÙˆÓ Ï¢¯·ÈÌÈÒÓ Î·È ÙˆÓ ÏÂÌʈ̿وÓ, ÂÓÒ Ë ¤ÎÙ·ÛË Ù˘ HIV Ïԛ̈͢ Î·È ÔÈ ÂÍÂÏ›ÍÂȘ ÛÙÔÓ ÙÔ̤· ÙˆÓ ÌÂÙ·ÌÔۯ‡ÛÂˆÓ Â¤‚·Ï·Ó ÙËÓ Â˘Ú‡ÙÂÚË ‰È¿‰ÔÛ‹ Ù˘. ™‹ÌÂÚ·, ÔÈ ÛËÌ·ÓÙÈÎfiÙÂÚ˜ ÎÏÈÓÈΤ˜ ÂÊ·ÚÌÔÁ¤˜ Ù˘ ÛÙË ÌÂϤÙË ÙˆÓ Ï¢ÎÔ΢ÙÙ·ÚÈÎÒÓ ÏËı˘ÛÌÒÓ ÛÙËÓ ·È‰È·ÙÚÈ΋ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó: ·) ‰È¿ÁÓˆÛË ÚˆÙÔ·ıÒÓ ·ÓÔÛÔ·ÓÂ·ÚÎÂÈÒÓ, ‚) ·ÓÔÛÔÏÔÁÈ΋ Ù˘ÔÔ›ËÛË ·ÈÌ·ÙÔÏÔÁÈÎÒÓ Î·ÎÔËıÂÈÒÓ, Á) ÚÔÛ‰ÈÔÚÈÛÌfi ÙˆÓ ÌÂÙ·ÌÔÛ¯Â˘fiÌÂÓˆÓ ·Ú¯¤ÁÔÓˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ Î·È ·Ú·ÎÔÏÔ‡ıËÛË Ù˘ ÔÚ›·˜ ÙˆÓ ·ÛıÂÓÒÓ, ‰) ·Ú·ÎÔÏÔ‡ıËÛË Î·È ÛÙ·‰ÈÔÔ›ËÛË Ù˘ HIV Ïԛ̈͢ Î·È Â) ·Ú·ÎÔÏÔ‡ıËÛË ·ÛıÂÓÒÓ Ì ·˘ÙÔ¿ÓÔÛ· ÓÔÛ‹Ì·Ù· (1). ∏ Ô˘ÛÈ·ÛÙÈ΋ ‰È·ÁÓˆÛÙÈ΋ ÂÊ·ÚÌÔÁ‹ Ù˘ ÌÂϤÙ˘ ÙÔ˘ ·ÓÔÛÔÊ·ÈÓfiÙ˘Ô˘ ÙˆÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜ ÛÙËÓ ·È‰È·ÙÚÈ΋ ·ÊÔÚ¿ ÛÙȘ ÚˆÙÔ·ı›˜ ·ÓÔÛÔ·ÓÂ¿ÚÎÂȘ. √È ¿ÏϘ ÂÊ·ÚÌÔÁ¤˜ Ù˘ ·ÊÔÚÔ‡Ó ÛÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË ‹ ÛÙËÓ ÂÚ·ÈÙ¤Úˆ ‰ÈÂÚ‡ÓËÛË ·ÛıÂÓÒÓ, ÁÈ· ÙÔ˘˜ ÔÔ›Ô˘˜ ¤¯ÂÈ

∞‰Ú‹ Ù·ÍÈÓfiÌËÛË ÏÂÌÊÔ΢ÙÙ·ÚÈÎÒÓ ÏËı˘ÛÌÒÓ √È ÏËı˘ÛÌÔ› Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÛÙËÓ ÎÏÈÓÈ΋ Ú¿ÍË Â›Ó·È Ù· ∆-ÏÂÌÊÔ·ÙÙ·Ú·, Ù· µ-ÏÂÌÊÔ·ÙÙ·Ú· Î·È Ù· Ê˘ÛÈο ΢ÙÙ·ÚÔÎÙfiÓ· ‹ ¡∫- (Natural killer) ·ÙÙ·Ú· (∂ÈÎfiÓ· 1). ªÂ ÙË ¯Ú‹ÛË ÙˆÓ ÌÔÓÔÎψÓÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ÌÔÚÔ‡Ó Ó· ÚÔÛ‰ÈÔÚÈÛÙÔ‡Ó ÛÙ· ·ÙÙ·Ú· ÌfiÚÈ· Ô˘ ÂÎÊÚ¿˙ÔÓÙ·È ·fi ·˘Ù¿ Î·È Ù· ÔÔ›· ‰ÈÂıÓÒ˜ ÔÓÔÌ¿˙ÔÓÙ·È ˆ˜ CDs (Clusters of differentiation), ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ‰Â ˆ˜ ‰Â›ÎÙ˜ ÚÔÛ‰ÈÔÚÈÛÌÔ‡ ÙˆÓ ‰È·ÊfiÚˆÓ ÏËı˘ÛÌÒÓ ÙˆÓ Ï¢ÎÔ΢ÙÙ¿ÚˆÓ (2). ™Â ¤Ó·Ó ·ÓÔÛÔÊ·ÈÓfiÙ˘Ô

§ÂÌÊÔ·ÙÙ·Ú· FSdim SSdim CD45bright

µ-ÏÂÌÊÔ·ÙÙ·Ú· CD19+CD20+

CD5+ ¶ÚÒÈÌ·

CD5ÒÚÈÌ·

∆-ÏÂÌÊÔ·ÙÙ·Ú· CD3+CD16-CD56-

TCR·‚+

¡∫∆-·ÙÙ·Ú· CD3+CD16+CD56+

TCRÁ‰+

CD4-CD8+dim

CD4-CD8-

CD4+CD8‚ÔËıËÙÈο

CD4+ CD45RA+ ·Úı¤Ó·

CD4+ CD45RO+ ÌÓËÌÔÓÈο

¡∫- ·ÙÙ·Ú· CD3-CD16+/CD56+

CD8-

CD8+dim

CD8-

CD4 CD8+ ΢ÙÙ·ÚÔÙÔÍÈο

CD8+ CD45RA+ ·Úı¤Ó· ‹ ·ÓÔÛÔ‰Ú·ÛÙÈο

CD8+ CD45RO+ ÌÓËÌÔÓÈο

∂ÈÎfiÓ· 1. ∆· ›‰Ë ÙˆÓ ‚·ÛÈÎÒÓ ÏÂÌÊÔ΢ÙÙ·ÚÈÎÒÓ ÏËı˘ÛÌÒÓ Î·È ˘ÔÏËı˘ÛÌÒÓ ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜. ∞ÂÈÎÔÓ›˙ÔÓÙ·È ÔÈ ˘ԉȷÈÚ¤ÛÂȘ ÙˆÓ ÏËı˘ÛÌÒÓ Î·È fi¯È Ù· ÂÍÂÏÈÎÙÈο ÙÔ˘˜ ÛÙ¿‰È·. ¶·È‰È·ÙÚÈ΋ 2007;70:174-183

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º. ∆˙ÈÊ‹ Î·È Û˘Ó.

ÚÔÛ‰ÈÔÚ›˙ÂÙ·È ·Ú¯Èο ÙÔ ÔÛÔÛÙfi ÙˆÓ ∆-, µ- Î·È ¡∫΢ÙÙ¿ÚˆÓ Î·È ÂÌ̤ۈ˜ Ô ·fiÏ˘ÙÔ˜ ·ÚÈıÌfi˜ ÙÔ˘˜. ŸÌˆ˜, ÁÈ· ÙËÓ Î·Ù·ÓfiËÛË Î·È ÛˆÛÙ‹ ·ÍÈÔÏfiÁËÛË ÙˆÓ Î˘ÙÙ·ÚÈÎÒÓ ÏËı˘ÛÌÒÓ Î·ıÔÚÈÛÙÈÎfi ÚfiÏÔ ·›˙ÂÈ Ë ÁÓÒÛË Ù˘ ‚·ÛÈ΋˜ ·ÓÔÛÔ·¿ÓÙËÛ˘ (∂ÈÎfiÓ· 2). ∆-ÏÂÌÊÔ·ÙÙ·Ú· ∆· ∆-ÏÂÌÊÔ·ÙÙ·Ú· (CD3+) ·›˙Ô˘Ó ÎÂÓÙÚÈÎfi ÚfiÏÔ ÛÙËÓ Â›ÎÙËÙË ·ÓÔÛȷ΋ ·¿ÓÙËÛË Â›Ù ˆ˜ ‚ÔËıËÙÈο/Â·ÁˆÁÈο ·ÙÙ·Ú· (CD4+) ›Ù ˆ˜ ΢ÙÙ·ÚÔÙÔÍÈο/ηٷÛÙ·ÏÙÈο ·ÙÙ·Ú· (CD8+). ∆· ∆-ÏÂÌÊÔ·ÙÙ·Ú· ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ÙËÓ ·ÚÔ˘Û›· ÙÔ˘ Û˘ÌϤÁÌ·ÙÔ˜ ÙÔ˘ ·ÓÙÈÁÔÓÈÎÔ‡ ˘Ô‰Ô¯¤· (TCR), Ô˘ ‰ËÌÈÔ˘ÚÁÂ›Ù·È ·fi ‰‡Ô ·Ï˘Û›‰Â˜, ÔÈ Ôԛ˜ Û¯ËÌ·Ù›˙Ô˘Ó ÙÔ ÂÙÂÚÔ‰ÈÌÂÚ¤˜ ·‚ ‹ ÙÔ Á‰ Ô˘ Û˘Ó‰¤ÂÙ·È Ì ÙÔ ÌfiÚÈÔ CD3. ∂Ô̤ӈ˜, ·Ó¿ÏÔÁ· Ì ÙË ‰ÔÌ‹ ÙÔ˘ ˘Ô‰Ô¯¤·, ‰È·ÎÚ›ÓÔÓÙ·È Û ‰‡Ô ÏËı˘ÛÌÔ‡˜, ÙÔÓ CD3+ TCR·‚+ Î·È ÙÔÓ CD3+ TCRÁ‰+ (4,5). ∆· ÌfiÚÈ· Ô˘ ÂϤÁ¯ÔÓÙ·È ÛÙ· ∆-ÏÂÌÊÔ·ÙÙ·Ú· ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜ ÛÙËÓ Î·ı’ Ë̤ڷ ÎÏÈÓÈ΋ Ú¿ÍË Â›Ó·È Ù· ·ÎfiÏÔ˘ı·: ∞Ú¯ÈÎfi˜ ¤ÏÂÁ¯Ô˜: CD3: ∆Ô CD3 ÂÎÊÚ¿˙ÂÙ·È ·ÔÎÏÂÈÛÙÈο ÛÙ· ∆ÏÂÌÊÔ·ÙÙ·Ú· Î·È ÙȘ ÚÔÁÔÓÈΤ˜ ÌÔÚʤ˜ ÙÔ˘˜. ¶·›˙ÂÈ Û˘ÓÂÚÁÈÎfi ÚfiÏÔ ÛÙË ÌÂÙ·‚›‚·ÛË ÌËӇ̷ÙÔ˜ ·fi ÙÔÓ ·ÓÙÈÁÔÓÈÎfi ˘Ô‰Ô¯¤· ÙÔ˘ ∆ ΢ÙÙ¿ÚÔ˘ (TCR). ∂Ô̤ӈ˜, Ù· ·ÙÙ·Ú· Ô˘ ÂÎÊÚ¿˙Ô˘Ó CD3 ªË ÂȉÈ΋ ·ÓÔÛ›·

ÚÔÛ‰ÈÔÚ›˙Ô˘Ó ÙÔÓ Û˘ÓÔÏÈÎfi ·ÚÈıÌfi ÙˆÓ ∆-ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ (6).

CD4: ∆Ô ÌfiÚÈÔ CD4 ÂÎÊÚ¿˙ÂÙ·È ˆ˜ Û˘Ó˘Ô‰Ô¯¤·˜ ÛÙËÓ ÂÈÊ¿ÓÂÈ· ÙˆÓ ‚ÔËıËÙÈÎÒÓ ∆-ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ, Ù· ÔÔ›· ·Ó·ÁÓˆÚ›˙Ô˘Ó ·ÓÙÈÁfiÓ· Ô˘ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Û˘Ó‰Â‰Â̤ӷ Ì ÌfiÚÈ· MHC II ÙˆÓ APC. ∞˘Í¿ÓÂÈ ÙËÓ ·ÏÏËÏÂ›‰Ú·ÛË ÙÔ˘ TCR Ì ÙÔ APC, ·›˙ÂÈ Û˘ÓÂÚÁÈÎfi ÚfiÏÔ ÛÙË ÌÂÙ¿‰ÔÛË ÌËÓ˘Ì¿ÙˆÓ Î·È ÛÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ ‚ÔËıËÙÈÎÒÓ CD4+ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ. ∆· ‚ÔËıËÙÈο ∆-ÏÂÌÊÔ·ÙÙ·Ú· (CD3+CD4+CD8-) ·ÔÙÂÏÔ‡Ó ÙÔ 50-60% ÙˆÓ Û˘ÓÔÏÈÎÒÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜, Ù· ‰Â ÂÓÂÚÁÔÔÈË̤ӷ CD4+ ·ÙÙ·Ú·, ·Ó¿ÏÔÁ· Ì ÙȘ ΢ÙÙ·ÚÔΛÓ˜ Ô˘ ·Ú¿ÁÔ˘Ó, ‰È·ÎÚ›ÓÔÓÙ·È Û ‰‡Ô ˘ÔηÙËÁÔڛ˜: Th1 Î·È Th2. ŒÓ·˜ ¿ÏÏÔ˜ ÚfiÏÔ˜ ÙˆÓ CD4+ ΢ÙÙ¿ÚˆÓ Â›Ó·È Ë Û˘ÌÌÂÙÔ¯‹ ÙÔ˘˜ ÛÙË ‰È·ÊÔÚÔÔ›ËÛË ÙˆÓ µ-ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ (7,8).

CD8: √ ‰Â›ÎÙ˘ CD8 Â›Ó·È ÁÏ˘ÎÔÚˆÙ½ÓË Ô˘ ÂÎÊÚ¿˙ÂÙ·È ˆ˜ Û˘Ó˘Ô‰Ô¯¤·˜ ÛÙËÓ ÂÈÊ¿ÓÂÈ· ÙˆÓ Î·Ù·ÛÙ·ÏÙÈÎÒÓ/΢ÙÙ·ÚÔÙÔÍÈÎÒÓ ∆-ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ, Ù· ÔÔ›· ·Ó·ÁÓˆÚ›˙Ô˘Ó Î·È Û˘Ó‰¤ÔÓÙ·È Ì ·ÙÙ·Ú· Ô˘ ÂÎÊÚ¿˙Ô˘Ó ÂÓ‰ÔÁÂÓ‹, .¯. ÈÈο, ·ÓÙÈÁfiÓ· Û˘Ó‰Â‰Â̤ӷ Ì ÌfiÚÈ· MHC π. £ÂˆÚÂ›Ù·È ˆ˜ Û˘Ó˘Ô‰Ô¯¤·˜ fiÙ·Ó ÛÙË Û‡Ó‰ÂÛË Ì ÙÔ ·ÓÙÈÁfiÓÔ-MHC Û˘ÌÌÂÙ¤¯ÂÈ Î·È Ô TCR, ÂÓÒ Â¿Ó Ô TCR ‰ÂÓ Û˘ÌÌÂÙ¤¯ÂÈ, ÏÂÈÙÔ˘ÚÁ› ˆ˜ ÌfiÚÈÔ ÚÔÛÎfiÏÏËÛ˘ (7). ∆· ΢ÙÙ·ÚÔÙÔÍÈο ∆-ÏÂÌÊÔ·ÙÙ·Ú· (CD3+CD4-CD8+) ·›˙Ô˘Ó,

∞ÓÙÈÁfiÓ· HLA ÌfiÚÈÔ

APS

ÂÓ‰Ô΢ÙÙ¿ÚˆÛË ·ÓÙÈÁÔÓÔÂÂÍÂÚÁ·Û›· ·ÓÙÈÁÔÓÔ·ÚÔ˘Û›·ÛË

∂›ÎÙËÙË ·ÓÔÛ›·

∞ÓÙÈÁfiÓ·-ı˘ÌÔ·ÓÂÍ¿ÚÙËÙ· BCR µ-ÏÂÌÊÔ·ÙÙ·ÚÔ

TCR ˘Ô‰Ô¯¤·˜

§ÂÌÊÔΛÓ˜

∆-ÏÂÌÊÔ·ÙÙ·Ú· §ÂÌÊÔΛÓ˜

∂ÓÂÚÁÔÔÈË̤ÓÔ ∆-ÏÂÌÊÔ·ÙÙ·ÚÔ ∞ÓÙÈÛÒÌ·Ù· ∂ÈÎfiÓ· 2. ∞‰Ú‹ ·ÂÈÎfiÓÈÛË Ù˘ ·ÓÔÛÔ·¿ÓÙËÛ˘ (3).

Paediatriki 2007;70:174-183

Pediatri May-Jun 07

24-05-07

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√ ·ÓÔÛÔÊ·ÈÓfiÙ˘Ô˜ ÙˆÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜

Â›Û˘, ÚfiÏÔ ÛÙËÓ ·fiÚÚÈ„Ë ÙˆÓ ÌÔÛ¯Â˘Ì¿ÙˆÓ Î·È ÛÙËÓ Î·Ù·ÛÙÚÔÊ‹ ÙˆÓ Î·ÚÎÈÓÈÎÒÓ Î˘ÙÙ¿ÚˆÓ (7). ™˘ÌÏËڈ̷ÙÈÎfi˜ ¤ÏÂÁ¯Ô˜: TCR·‚: √ ¯·Ú·ÎÙËÚÈÛÙÈÎfi˜ ·ÓÙÈÁÔÓÈÎfi˜ ˘Ô‰Ô¯¤·˜ ÛÙËÓ ÏÂÈÔÓfiÙËÙ· (>90%) ÙˆÓ ∆-ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ·ÔÙÂÏÂ›Ù·È ·fi ‰‡Ô ‰È·ÌÂÌ‚Ú·ÓÈΤ˜ ÔÏ˘ÂÙȉÈΤ˜ ·Ï˘Û›‰Â˜, ÙËÓ · Î·È ÙË ‚. AÓ·ÁÓˆÚ›˙ÂÈ ·ÓÙÈÁfiÓ· Û˘Ó‰Â‰Â̤ӷ Ì ÌfiÚÈ· ÙÔ˘ Ì›˙ÔÓÔ˜ Û˘ÌϤÁÌ·ÙÔ˜ ÈÛÙÔÛ˘Ì‚·ÙfiÙËÙ·˜, ·ÚÔ˘ÛÈ·˙fiÌÂÓ· ·fi Ù· ·ÓÙÈÁÔÓÔ·ÚÔ˘ÛÈ·ÛÙÈο ·ÙÙ·Ú· (9).

TCRÁ‰: ¶ÂÚ›Ô˘ ÛÙÔ 5% fiÏˆÓ ÙˆÓ ∆-ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ, Ô TCR ·ÔÙÂÏÂ›Ù·È ·fi Á Î·È ‰ ·Ï˘Û›‰Â˜. ∆· TCRÁ‰+ ·ÙÙ·Ú· Â›Ó·È Î˘Ú›ˆ˜ CD3+CD4-CD8- ·ÙÙ·Ú· Î·È ‰ÂÓ ·Ó·ÁÓˆÚ›˙Ô˘Ó Ô‡ÙÂ Û˘Ó‰¤ÔÓÙ·È Ì ·ÓÙÈÁfiÓ· Ô˘ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ì¤Ûˆ ÙÔ˘ Ì›˙ÔÓÔ˜ Û˘ÌϤÁÌ·ÙÔ˜ ÈÛÙÔÛ˘Ì‚·ÙfiÙËÙ·˜. √ ÚfiÏÔ˜ ÙÔ˘˜ ‰ÂÓ ¤¯ÂÈ Ï‹Úˆ˜ ‰È¢ÎÚÈÓÈÛÙ› (10-12).

CD45: ∆Ô ÌfiÚÈÔ ·˘Ùfi Â›Ó·È ÁÓˆÛÙfi ˆ˜ ÎÔÈÓfi Ï¢ÎÔ΢ÙÙ·ÚÈÎfi ·ÓÙÈÁfiÓÔ Î·È ÔÈ ‰È¿ÊÔÚ˜ ÈÛÔÌÔÚʤ˜ ÙÔ˘ ÂÎÊÚ¿˙ÔÓÙ·È Û fiÏ· Ù· ¿ˆÚ· Î·È ÒÚÈÌ· Ï¢ÎÔ·ÙÙ·Ú·. £ÂˆÚÂ›Ù·È fiÙÈ ·›˙ÂÈ ÚfiÏÔ ÛÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ ∆-ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Î·È ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÛÙÔÓ ‰È·¯ˆÚÈÛÌfi ÙˆÓ Ï¢ÎÒÓ ·fi ÙÔ˘˜ ÂÚ˘ıÚÔ‚Ï¿ÛÙ˜. ∆· ÂÚÈÛÛfiÙÂÚ· ·Úı¤Ó· ·ÙÙ·Ú· ÂÎÊÚ¿˙Ô˘Ó ÙË CD45R∞ ÈÛÔÌÔÚÊ‹ ÙÔ˘, Ù· ‰Â ÌÓËÌÔÓÈο ·ÙÙ·Ú· ΢ڛˆ˜ ÙË CD45R√ (13,14).

HLA-DR (Human leukocyte antigen-DR): ªfiÚÈÔ ÙÔ˘ Ì›˙ÔÓÔ˜ Û˘ÌϤÁÌ·ÙÔ˜ ÈÛÙÔÛ˘Ì‚·ÙfiÙËÙ·˜ Ù¿Í˘ ππ, ÙÔ ÔÔ›Ô ÛÙ·ıÂÚ¿ ÂÎÊÚ¿˙ÂÙ·È ÛÙ· µ Î·È ÛÙ· ‰ÈÂÁÂṲ́ӷ ∆-ÏÂÌÊÔ·ÙÙ·Ú·. ™ÙËÓ Î·ıËÌÂÚÈÓ‹ ÎÏÈÓÈ΋ Ú¿ÍË ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙÔ CD3 ÁÈ· ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙˆÓ ‰ÈÂÁÂÚÌ¤ÓˆÓ ∆-ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ (15).

CD25: ∆Ô CD25 ·ÔÙÂÏ› Â›ÙÔÔ Ù˘ · ·Ï˘Û›‰·˜ ÙÔ˘ ˘Ô‰Ô¯¤· Ù˘ ÈÓÙÂÚÏ¢ΛÓ˘ 2 (IL-2). π‰È·›ÙÂÚÔ ÂӉȷʤÚÔÓ ¤¯Ô˘Ó Ù· Ú˘ıÌÈÛÙÈο CD4+CD25+ ·ÙÙ·Ú· (Treg), Ù· ÔÔ›· ·›˙Ô˘Ó ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ÔÌÔÈfiÛÙ·ÛË ÙÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, Ë ‰Â ‰È·Ù·Ú·¯‹ ÙÔ˘˜ Û˘Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ÂÌÊ¿ÓÈÛË ·˘ÙÔ¿ÓÔÛˆÓ ÓÔÛËÌ¿ÙˆÓ. ∂Âȉ‹ ÙÔ ÌfiÚÈÔ CD25 ‰ÂÓ ÂÎÊÚ¿˙ÂÙ·È ·ÔÎÏÂÈÛÙÈο ÛÙ· Ú˘ıÌÈÛÙÈο, ·ÏÏ¿ Î·È ÛÙ· ÂÓÂÚÁÔÔÈË̤ӷ ∆-ÏÂÌÊÔ·ÙÙ·Ú·, ÂÎÎÚÂÌ› Ë Â‡ÚÂÛË ÂȉÈÎÒÓ ÌÔÚ›ˆÓ Ô˘ Ó· Ù·˘ÙÔÔÈÔ‡Ó Ù· Ú˘ıÌÈÛÙÈο ·ÙÙ·Ú· (16,17).

CD69: ∆Ô ÌfiÚÈÔ ·˘Ùfi Â›Ó·È ÁÓˆÛÙfi Î·È ˆ˜ Â·ÁˆÁÈÎfi ÌfiÚÈÔ ÂÓÂÚÁÔÔ›ËÛ˘ (Activation inducer molecule - AIM), ÂÎÊÚ¿˙ÂÙ·È Û ÂÓÂÚÁÔÔÈË̤ӷ Ï¢ÎÔ·ÙÙ·Ú·, fiˆ˜ ∆- Î·È µ-ÏÂÌÊÔ·ÙÙ·Ú·, ¡∫·ÙÙ·Ú·, Ô˘‰ÂÙÂÚfiÊÈÏ·, ‚·ÛÂfiÊÈÏ· Î·È ËˆÛÈÓfiÊÈÏ· Î·È Èı·ÓÒ˜ ·›˙ÂÈ ÚfiÏÔ ÛÙË ÌÂÙ¿‰ÔÛË ÌËÓ˘Ì¿ÙˆÓ ÌÂٷ͇ ‰È·ÊfiÚˆÓ ÂȉÒÓ Î˘ÙÙ¿ÚˆÓ (18,19). ∂ÍÂȉÈÎÂ˘Ì¤ÓÔ˜ ¤ÏÂÁ¯Ô˜: CD40L: ªfiÚÈÔ Û˘Ó‰È¤ÁÂÚÛ˘ Ô˘ ‚Ú›ÛÎÂÙ·È ÛÙË

ÌÂÌ‚Ú¿ÓË ÙˆÓ ‚ÔËıËÙÈÎÒÓ ∆-ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Î·È Û˘Ó‰¤ÂÙ·È Ì ÙÔ CD40 ÙˆÓ µ-ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ. ∂›Ó·È ÛËÌ·ÓÙÈÎfi ÁÈ· ÙÔÓ ÔÏÏ·Ï·ÛÈ·ÛÌfi ÙˆÓ µ-ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Î·È ÁÈ· ÙËÓ ÈÛÔÙ˘È΋ ÌÂÙ·ÛÙÚÔÊ‹ (switching) ·fi ÙËÓ ·ÓÔÛÔÛÊ·ÈÚ›ÓË IgM Û IgG, IgA ‹ IgE (20).

CD2: ∂›Ó·È ·fi Ù· ÚÒÙ· ÌfiÚÈ· Ô˘ ÂÎÊÚ¿˙ÔÓÙ·È ÛÙ· ÏÂÌÊÔ·ÙÙ·Ú· Ô˘ ÂÈÛ¤Ú¯ÔÓÙ·È ÛÙÔÓ ı‡ÌÔ ·‰¤Ó· Î·È ÂÎÊÚ¿˙ÂÙ·È ·fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ ∆-ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ. ∂›Ó·È ÌfiÚÈÔ ÚÔÛÎfiÏÏËÛ˘ Î·È ÂÈϤÔÓ ·›˙ÂÈ ÚfiÏÔ ÛÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ ∆-ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ. ∂›Û˘, ÙÔ CD2 ÂÎÊÚ¿˙ÂÙ·È ÛÙ· ¡∫-·ÙÙ·Ú· (21,22).

CD7: ¶ÚfiÎÂÈÙ·È ÁÈ· ÚˆÙ½ÓË Ô˘ ·Ó‹ÎÂÈ ÛÙËÓ ˘ÂÚÔÈÎÔÁ¤ÓÂÈ· ÙˆÓ ·ÓÔÛÔÛÊ·ÈÚÈÓÒÓ Ì ¿ÁÓˆÛÙË ÏÂÈÙÔ˘ÚÁ›· Î·È ÂÎÊÚ¿˙ÂÙ·È Û ı˘ÌÔ·ÙÙ·Ú·, ¡∫- Î·È ∆-ÏÂÌÊÔ·ÙÙ·Ú·. ÃÚËÛÈÌÔÔÈÂ›Ù·È ˆ˜ ‰Â›ÎÙ˘ ÁÈ· ÙË ‰È¿ÁÓˆÛË Ù˘ ÔÍ›·˜ T-ÏÂÌÊÔ΢ÙÙ·ÚÈ΋˜ Ï¢¯·ÈÌ›·˜. ∂›Ó·È Èı·Ófi Ó· ·›˙ÂÈ ÚfiÏÔ ÛÙË Ú‡ıÌÈÛË Ù˘ ÔÓÙÔÁ¤ÓÂÛ˘ ÙˆÓ ¡∫∆- Î·È ÙˆÓ Ú˘ıÌÈÛÙÈÎÒÓ ∆-ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ (23). µ-ÏÂÌÊÔ·ÙÙ·Ú· ∆· µ-ÏÂÌÊÔ·ÙÙ·Ú· ·ÔÙÂÏÔ‡Ó ÙÔ 10-20% ÙÔ˘ ÔÏÈÎÔ‡ ·ÚÈıÌÔ‡ ÙˆÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜. ∏ ·ÍÈÔÏfiÁËÛË Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘˜ Á›ÓÂÙ·È Ì ÙË Ì¤ÙÚËÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ·ÓÔÛÔÛÊ·ÈÚÈÓÒÓ (IgG, IgM, IgA) Î·È Ù˘ ·ÓÙÈۈ̷ÙÈ΋˜ ·¿ÓÙËÛ˘, ÂÓÒ Ë Ì¤ÙÚËÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙÔ˘˜ Á›ÓÂÙ·È Ì ÙË Ì¤ıÔ‰Ô Ù˘ ΢ÙÙ·ÚÔÌÂÙÚ›·˜ ÚÔ‹˜. ∆· ÌfiÚÈ· Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ˆ˜ ‰Â›ÎÙ˜ ÙˆÓ µ-ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Û ¤Ó·Ó ·ÓÔÛÔÊ·ÈÓfiÙ˘Ô Â›Ó·È Ù· ·ÎfiÏÔ˘ı·: ∞Ú¯ÈÎfi˜ ¤ÏÂÁ¯Ô˜: CD19: ¶ÚfiÎÂÈÙ·È ÁÈ· ÌfiÚÈÔ ÂÈÊ·Ó›·˜ ۯ‰fiÓ fiÏˆÓ ÙˆÓ µ-ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Î·È ·›˙ÂÈ Û˘ÓÂÚÁÈÎfi ÚfiÏÔ ÛÙËÓ ÂÓÂÚÁÔÔ›ËÛË ·˘ÙÒÓ (24,25).

CD20: ¶ÚˆÙ½ÓË Ô˘ ÂÎÊÚ¿˙ÂÙ·È Û fiÏ· Ù· ÒÚÈÌ· µ-ÏÂÌÊÔ·ÙÙ·Ú· Î·È Ë ¤ÎÊÚ·Û‹ ÙÔ˘ ÛÙ·Ì·Ù¿ ÛÙÔ ÛÙ¿‰ÈÔ Ù˘ ‰È·ÊÔÚÔÔ›ËÛ˘ ÙÔ˘ µ-ÏÂÌÊÔ΢ÙÙ¿ÚÔ˘ Û Ï·ÛÌ·ÙÔ·ÙÙ·ÚÔ. ¶·›˙ÂÈ ÚfiÏÔ ÛÙËÓ ÂÓÂÚÁÔÔ›ËÛË ‹ ÙË Ú‡ıÌÈÛË ÙˆÓ µ-ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Î·È ·ÔÙÂÏ› ‰›·˘ÏÔ ÈfiÓÙˆÓ ·Û‚ÂÛÙ›Ô˘. ∆· ÂÚÈÛÛfiÙÂÚ· µ-ÏÂÌÊÔ·ÙÙ·Ú· Ô˘ ÌÂÙÚÒÓÙ·È ÛÙÔ ÂÚÈÊÂÚÈÎfi ·›Ì· Û˘ÓÂÎÊÚ¿˙Ô˘Ó Î·È ÙÔ CD19 Î·È ÙÔ CD20 ÌfiÚÈÔ (26-28). ∂ÍÂȉÈÎÂ˘Ì¤ÓÔ˜ ¤ÏÂÁ¯Ô˜: CD5: H ¤ÎÊÚ·ÛË ÙÔ˘ CD5 ÛÙ· µ-ÏÂÌÊÔ·ÙÙ·Ú· ÌÂÏÂÙ¿Ù·È ÛÙËÓ Î·ıËÌÂÚÈÓ‹ Ú¿ÍË, ȉ›ˆ˜ ÛÙÔ Ï·›ÛÈÔ Ù˘ ÌÂϤÙ˘ Ù˘ ·˘ÙÔ·ÓÔÛ›·˜ Î·È ÙˆÓ ÌÂÙ·ÌÔۯ‡ÛˆÓ, fiÔ˘ Â›Ó·È Î·È ·˘ÍË̤ÓË. ¶ÚfiÎÂÈÙ·È ÁÈ· ‰È·ÌÂÌ‚Ú·ÓÈ΋ ÁÏ˘ÎÔÚˆÙ½ÓË Ô˘ Ê˘ÛÈÔÏÔÁÈο ˘¿Ú¯ÂÈ ÛÙ· ∆-ÏÂÌÊÔ·ÙÙ·Ú· Î·È ›Ûˆ˜ ·›˙ÂÈ ÚfiÏÔ ÛÙËÓ ·ÏÏËÏÂ›‰Ú·ÛË ÌÂٷ͇ ∆- Î·È µ-΢ÙÙ¿ÚˆÓ. ∆Ô ¶·È‰È·ÙÚÈ΋ 2007;70:174-183

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º. ∆˙ÈÊ‹ Î·È Û˘Ó.

ÌfiÚÈÔ ·˘Ùfi ‹Ù·Ó ÁÓˆÛÙfi fiÙÈ ÂÎÊÚ¿˙ÂÙ·È Û ηÎÔ‹ıË µ-ÏÂÌÊÔ·ÙÙ·Ú· Î·È ·ÚÁfiÙÂÚ· ‚Ú¤ıËΠfiÙÈ ˘¿Ú¯ÂÈ Û ÌÈÎÚfi ÔÛÔÛÙfi Ê˘ÛÈÔÏÔÁÈÎÒÓ µ-ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ, ÛÙ· ÔÔ›· ÌÂÏÂÙ¿Ù·È Ô È‰È·›ÙÂÚÔ˜ ÚfiÏÔ˜ ÙÔ˘ (30,31).

CD23: ∆Ô ÌfiÚÈÔ ·˘Ùfi Â›Ó·È ˘Ô‰Ô¯¤·˜ ¯·ÌËÏ‹˜ Û˘ÁÁ¤ÓÂÈ·˜ ÁÈ· ÙËÓ IgE ·ÓÔÛÔÛÊ·ÈÚ›ÓË (FcÂRIIb) Î·È ‰Ú· ˆ˜ Ú˘ıÌÈÛÙ‹˜ ÙˆÓ Û˘ÁÎÂÓÙÚÒÛÂÒÓ Ù˘ (29). ¡∫-·ÙÙ·Ú· ∆· ¡∫-·ÙÙ·Ú· ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ÙËÓ ÈηÓfiÙËÙ¿ ÙÔ˘˜ Ó· ηٷÛÙÚ¤ÊÔ˘Ó Î‡ÙÙ·Ú· ÛÙfi¯Ô˘˜, ¯ˆÚ›˜ ÙËÓ ·Ó¿ÁÎË ÚÔËÁÔ‡ÌÂÓ˘ ¤ÎıÂÛ˘ Û ·ÓÙÈÁfiÓÔ Î·È ·ÔÙÂÏÔ‡Ó ÛËÌ·ÓÙÈÎfi ÎÔÌÌ¿ÙÈ Ù˘ Ê˘ÛÈ΋˜ ·ÓÔÛ›·˜. ∂ÈϤÔÓ, Ù· ¡∫-·ÙÙ·Ú· Â›Ó·È Ì›· ‚·ÛÈ΋ ËÁ‹ ΢ÙÙ·ÚÔÎÈÓÒÓ, ÔÈ Ôԛ˜ Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÙËÓ ¤Ó·ÚÍË ·ÓÔÛÔÏÔÁÈÎÒÓ ··ÓÙ‹ÛÂˆÓ ÌÂÙ¿ ·fi οÔÈÔ ·ÓÙÈÁÔÓÈÎfi ÂÚ¤ıÈÛÌ· (32). √È ‰Â›ÎÙ˜ ÂÈÊ·Ó›·˜ ÙˆÓ ¡∫-΢ÙÙ¿ÚˆÓ Â›Ó·È ÔÈ ÂÍ‹˜: CD16: ¶ÚfiÎÂÈÙ·È ÁÈ· ˘Ô‰Ô¯¤· ÙÔ˘ Fc ÙÌ‹Ì·ÙÔ˜ Ù˘ IgG Ô˘ Â›Ó·È ˘‡ı˘ÓÔ˜ ÁÈ· ÙËÓ ÂÍ·ÚÙÒÌÂÓË ·fi ·ÓÙÈÛÒÌ·Ù· ΢ÙÙ·ÚÔÙÔÍÈÎfiÙËÙ·. ∂ÎÙfi˜ ·fi Ù· ¡∫-·ÙÙ·Ú·, ÙÔ CD16 ÌfiÚÈÔ ÂÎÊÚ¿˙ÂÙ·È Û ̷ÎÚÔÊ¿Á· Î·È Ô˘‰ÂÙÂÚfiÊÈÏ· (33).

CD56: ∂ÎÊÚ¿˙ÂÙ·È Û ¡∫-·ÙÙ·Ú·, Û ÌÂÚÈο ∆Î·È µ-·ÙÙ·Ú· Î·È Û ÂÁÎÂÊ·ÏÈο ·ÙÙ·Ú· (ÈÛfiÙ˘Ô˜ ÙÔ˘ ·ÓıÚÒÈÓÔ˘ ÌÔÚ›Ô˘ Ó¢ÚÔ΢ÙÙ·ÚÈ΋˜ ÚÔÛÎfiÏÏËÛ˘). ™ÙËÓ Î˘ÙÙ·ÚÔÌÂÙÚ›· ÚÔ‹˜ ‰È·ÎÚ›ÓoÓÙ·È ‰‡Ô ÏËı˘ÛÌÔ› CD3-CD56+: Ô CD56dim, Û ÔÛÔÛÙfi 90%, Ô ÔÔ›Ô˜ Â›Ó·È CD16+ Î·È ‰Ú· ΢ڛˆ˜ ΢ÙÙ·ÚÔÙÔÍÈο Î·È Ô CD56bright, Û ÔÛÔÛÙfi 10%, Ô ÔÔ›Ô˜ Â›Ó·È CD56+CD16- Î·È ÂÎÎÚ›ÓÂÈ Î˘ÙÙ·ÚÔΛÓ˜ Ô˘ ÂÓÂÚÁÔÔÈÔ‡Ó Ù· ÌÔÓÔ·ÙÙ·Ú· (33).

NKT-ÏÂÌÊÔ·ÙÙ·Ú· ∆· ¡∫∆-ÏÂÌÊÔ·ÙÙ·Ú· ÂÎÊÚ¿˙Ô˘Ó ÙfiÛÔ ‰Â›ÎÙ˜ ∆-ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ (CD3, TCR), fiÛÔ Î·È ¡∫-΢ÙÙ¿ÚˆÓ (CD16). º·›ÓÂÙ·È Ó· ÂÌϤÎÔÓÙ·È ÛÙË Ú‡ıÌÈÛË Ù˘ ·ÓÔÛȷ΋˜ ·¿ÓÙËÛ˘. ∆ÂÏÂ˘Ù·›·, ¤¯ÂÈ ‰Ôı› ÛËÌ·Û›· ÛÙËÓ ÔÌÔÈfiÙËÙ¿ ÙÔ˘˜ Ì ٷ CD4+CD25+ Ú˘ıÌÈÛÙÈο ÏÂÌÊÔ·ÙÙ·Ú· (34). ™Â ·ÎfiÌË ÈÔ ÂÍÂȉÈÎÂ˘Ì¤Ó˜ ‹ ·‰È¢ÎÚ›ÓÈÛÙ˜ ÂÚÈÙÒÛÂȘ, ÂϤÁ¯ÔÓÙ·È ÂÚ·ÈÙ¤Úˆ ‰Â›ÎÙ˜ ÙˆÓ ÏÂÌÊÔ΢ÙÙ·ÚÈÎÒÓ ÏËı˘ÛÌÒÓ, ÔÈ ÔÔ›ÔÈ Û˘Ì‚¿ÏÏÔ˘Ó ÛÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË.

∏ ·Ó¿ÁÓˆÛË Ù˘ ·¿ÓÙËÛ˘ ÙÔ˘ ·ÓÔÛÔÊ·ÈÓfiÙ˘Ô˘ °È· ÙËÓ Î·Ù·ÓfiËÛË ÙÔ˘ ÙÚfiÔ˘ ·ÚÔ˘Û›·Û˘ ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ Î·È ÙËÓ Ù·ÍÈÓfiÌËÛË ÙˆÓ ‰Â‰Ô̤ӈÓ, ı· ÌÔÚÔ‡Û·Ó Ó· ·ÎÔÏÔ˘ıËıÔ‡Ó Ù· ·Ú·Î¿Ùˆ ‚‹Ì·Ù·: ·) ∂ϤÁ¯ÂÙ·È Ë ÁÂÓÈ΋ ÂͤٷÛË ·›Ì·ÙÔ˜ ÙÔ˘ ·ÛıÂÓÔ‡˜. ∂ÎÙfi˜ ·fi ÙË ÁÂÓÈÎfiÙÂÚË ·ÈÌ·ÙÔÏÔÁÈ΋ ÂÈÎfiÓ·, Paediatriki 2007;70:174-183

ȉȷ›ÙÂÚ· ÂӉȷʤÚÂÈ Ô ·fiÏ˘ÙÔ˜ ·ÚÈıÌfi˜ ÙˆÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ, ‰Â‰Ô̤ÓÔ˘ fiÙÈ Ë ÏÂÌÊÔÂÓ›· ·ÔÙÂÏ› ‚·ÛÈÎfi ‰È·ÁÓˆÛÙÈÎfi ÎÚÈÙ‹ÚÈÔ ÙˆÓ ·ÓÔÛÔ·ÓÂ·ÚÎÂÈÒÓ (37). ∂›Û˘, ı· Ú¤ÂÈ Ó· ÂϤÁ¯ÂÙ·È Ì‹ˆ˜ Ì›· Ù˘¯fiÓ ·fiÎÏÈÛË ÙÔ˘ ÔÛÔÛÙÔ‡ ÂÓfi˜ ÏËı˘ÛÌÔ‡ ·fi ÙÔ Ê˘ÛÈÔÏÔÁÈÎfi ·ÔÙÂÏ› ·ÏÒ˜ ·ÚÈıÌËÙÈ΋ Ï¿ÓË, ÏfiÁˆ Ù˘ ÌÂÙ·‚ÔÏ‹˜ ÂÓfi˜ ¿ÏÏÔ˘ ÏËı˘ÛÌÔ‡. ‚) ∞Ó·ÁÓˆÚ›˙ÂÙ·È Ô ÂοÛÙÔÙ ÏËı˘ÛÌfi˜ ÁÈ· ÙÔÓ ÔÔ›Ô ‰›ÓÔÓÙ·È Ù· ·ÔÙÂϤÛÌ·Ù·. ∂ÎÙfi˜ ·fi ÙÔ˘˜ ‚·ÛÈÎÔ‡˜ ÏËı˘ÛÌÔ‡˜ ÙˆÓ ÔÔ›ˆÓ Ô Û˘Ì‚ÔÏÈÛÌfi˜ Â›Ó·È ·Ïfi˜ (CD3+, CD4+, CD8+, CD19+/20+, CD16+/56+), ÛÙËÓ ·¿ÓÙËÛË ·Ó·Ê¤ÚÔÓÙ·È Î·È ‰È¿ÊÔÚÔÈ ˘ÔÏËı˘ÛÌÔ› ÙÔ˘˜, ÛÙËÓ ÔÓÔÌ·ÙÔÏÔÁ›· ÙˆÓ ÔÔ›ˆÓ ·Ó·ÁÚ¿ÊÂÙ·È ÚÒÙÔ˜ Ô ‚·ÛÈÎfi˜ ÏËı˘ÛÌfi˜ fiÔ˘ ·Ó‹ÎÔ˘Ó. °È· ·Ú¿‰ÂÈÁÌ·, Ë ¤ÎÊÚ·ÛË CD3+CD4+ Û˘Ì‚ÔÏ›˙ÂÈ Ù· ∆-ÏÂÌÊÔ·ÙÙ·Ú· Ô˘ ÂÎÊÚ¿˙Ô˘Ó ÙÔ CD4 ÌfiÚÈÔ. Á) √È ÙÈ̤˜ ÙˆÓ ‰È·ÊfiÚˆÓ ÏËı˘ÛÌÒÓ ÂϤÁ¯ÔÓÙ·È Ì ‚¿ÛË Ù· Ê˘ÛÈÔÏÔÁÈο ÁÈ· ÙËÓ ËÏÈΛ· ÙÔ˘ ·È‰ÈÔ‡ Â›‰·, Ï·Ì‚¿ÓÔÓÙ·˜ ˘’ fi„ÈÓ ÙËÓ Â›‰Ú·ÛË Ù˘ ÂıÓÈÎfiÙËÙ·˜, Ë ÔÔ›· Û ÔÚÈṲ̂Ó˜ ÂÚÈÙÒÛÂȘ Â›Ó·È ÛËÌ·ÓÙÈ΋ (35,36) (¶›Ó·Î˜ 1 Î·È 2). ‰) ÀÔÏÔÁ›˙ÂÙ·È Ô ÏfiÁÔ˜ CD4+/CD8+, Ô ÔÔ›Ô˜ Ú¤ÂÈ Ó· Â›Ó·È >1 (36). Â) ÀÔÏÔÁ›˙ÂÙ·È Ô ÏfiÁÔ˜ CD4+CD45RA+/ CD4+CD45RO+, Ô ÔÔ›Ô˜ Â›Ó·È ·ÓÙÈÛÙÚfiʈ˜ ·Ó¿ÏÔÁÔ˜ Ù˘ ËÏÈΛ·˜ Î·È ÛÙ· ·È‰È¿ Ú¤ÂÈ Ó· Â›Ó·È >1 (36). ÛÙ) ªÂ ·Ϥ˜ ·ÚÈıÌËÙÈΤ˜ Ú¿ÍÂȘ ÌÔÚ› Ó· ÂÏÂÁ¯ı› Ë ‡·ÚÍË ·ıÔÏÔÁÈÎÒÓ ÏËı˘ÛÌÒÓ. √È ‚·ÛÈÎfiÙÂÚ˜ ÂÚÈÁÚ¿ÊÔÓÙ·È ·Ú·Î¿Ùˆ Î·È ·ÊÔÚÔ‡Ó ÛÙ· ÔÛÔÛÙ¿ ÙˆÓ ÏËı˘ÛÌÒÓ: i) CD3+ + CD19+ + CD16+ ≈ 100 ∆Ô ¿ıÚÔÈÛÌ· ÙˆÓ Î˘ÚÈfiÙÂÚˆÓ ÏÂÌÊÔ΢ÙÙ·ÚÈÎÒÓ ˘ÔÏËı˘ÛÌÒÓ ı· Ú¤ÂÈ Ó· ηχÙÂÈ ÙÔ Û‡ÓÔÏÔ ÙˆÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ (100%) (38). ∏ ΢ÚÈfiÙÂÚË ·ÈÙ›· ·fiÎÏÈÛ˘ ÚÔ˜ Ù· οو Â›Ó·È Ë ‡·ÚÍË ÂÚ˘ıÚÔ‚Ï·ÛÙÒÓ, ÔÈ ÔÔ›ÔÈ ÂÎÏ·Ì‚¿ÓÔÓÙ·È ·fi ÙÔÓ ·Ó·Ï˘Ù‹ ˆ˜ ÏÂÌÊÔ·ÙÙ·Ú·, Ê·ÈÓfiÌÂÓÔ Û˘¯Ófi Û ÓÂÔÁÓ¿ Î·È Û ·ÛıÂÓ›˜ Ì ·ÈÌÔÛÊ·ÈÚÈÓÔ¿ıÂȘ. ŸÔÙ ÚÔ·ÙÂÈ ÙÔ Úfi‚ÏËÌ· ·˘Ùfi, ›Ù ÂϤÁ¯ÂÙ·È Ô ‰Â›ÎÙ˘ CD45, Ô ÔÔ›Ô˜ Â›Ó·È ¯·Ú·ÎÙËÚÈÛÙÈÎfi˜ Ù˘ Ï¢΋˜ ÛÂÈÚ¿˜ Î·È fi¯È ÙˆÓ ÂÚ˘ıÚÔ‚Ï·ÛÙÒÓ, ›Ù Á›ÓÂÙ·È ÂÍ·Ú¯‹˜ ‰È·ÊÔÚÂÙÈ΋ ηÙÂÚÁ·Û›· ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ (1,39). ∂¿Ó ·ÔÎÏÂÈÛÙ› ÙÔ ÂӉ¯fiÌÂÓÔ ‡·Ú͢ ÂÚ˘ıÚÔ‚Ï·ÛÙÒÓ, ÙfiÙ Èı·Ófiٷٷ ÚfiÎÂÈÙ·È ÁÈ· ·ıÔÏÔÁÈÎfi ÏËı˘ÛÌfi. ™Â ÂÚ›ÙˆÛË ˘¤ÚÌÂÙÚ˘ ·‡ÍËÛ˘ ÙÔ˘ ÏËı˘ÛÌÔ‡ ÙˆÓ ¡∫∆-΢ÙÙ¿ÚˆÓ ı· ·Ú·ÙËÚËı› ·‡ÍËÛË ÙÔ˘ ÂÓ ÏfiÁˆ ·ıÚÔ›ÛÌ·ÙÔ˜. ii) CD4+ + CD8+ ≈ CD3+-TCRÁ‰+ ŸÏ· Ù· Ê˘ÛÈÔÏÔÁÈο TCR·‚+ ·ÙÙ·Ú· ÂÎÊÚ¿˙Ô˘Ó ÛÙËÓ ÂÈÊ¿ÓÂÈ¿ ÙÔ˘˜ ›Ù ÙÔÓ CD4 ›Ù ÙÔÓ CD8 ‰Â›ÎÙË, ÂÓÒ Ù· ÂÚÈÛÛfiÙÂÚ· TCRÁ‰+ Û˘¯Ó¿ ‰ÂÓ ÂÎÊÚ¿˙Ô˘Ó Î·Ó¤Ó·Ó ·fi ÙÔ˘˜ ‰‡Ô (38). ∂¿Ó CD4++CD8+>CD3+-TCRÁ‰+, ·Ú¯Èο Ú¤ÂÈ

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179

√ ·ÓÔÛÔÊ·ÈÓfiÙ˘Ô˜ ÙˆÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜

¶›Ó·Î·˜ 1. ∂ηÙÔÛÙÈ·›Â˜ ·Ó·ÏÔÁ›Â˜ (%) ÙˆÓ ˘ÔÏËı˘ÛÌÒÓ ÙˆÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ˘ÁÈÒÓ ·È‰ÈÒÓ. ∫·Ù·ÓÔÌ‹ ηٿ ËÏÈΛ· ÛÙË Ï¢΋ Ê˘Ï‹ (36). ÀÔÏËı˘ÛÌfi˜ CD3

+

CD4+ CD8+ CD4+CD45RA+ CD4+CD45RO+ CD4+HLA-DR+ CD8+HLA-DR+ CD19+ CD16+/CD56+

0-3 ÌËÓÒÓ

3-6 ÌËÓÒÓ

6-12 ÌËÓÒÓ

1-2 ÂÙÒÓ

2-6 ÂÙÒÓ

6-12 ÂÙÒÓ

12-18 ÂÙÒÓ

73% (53-84) 52% (35-64) 18% (12-28) 90% (64-95) 10% (02-22) 3% (02-06) 5% (02-20) 15% (06-32) 8% (04-18)

66% (51-77) 46% (35-56) 16% (12-23) 90% (77-94) 8% (03-16) 5% (02-10) 7% (03-17) 25% (11-41) 6% (03-14)

65% (49-76) 46% (31-56) 17% (12-24) 86% (64-93) 9% (05-18) 5% (02-11) 10% (04-27) 24% (14-37) 7% (03-15)

65% (53-75) 41% (32-51) 20% (14-30) 81% (63-91) 12% (07-20) 6% (02-11) 16% (06-33) 25% (16-35) 7% (03-15)

66% (56-75) 38% (28-47) 23% (16-30) 71% (53-86) 16% (09-26) 7% (03-12) 16% (07-37) 21% (14-33) 9% (04-17)

69% (60-76) 37% (31-47) 25% (18-35) 59% (46-77) 21% (13-30) 6% (03-13) 12% (06-29) 18% (13-27) 9% (04-17)

73% (56-84) 41% (31-52) 26% (18-35) 53% (33-66) 28% (18-38) 7% (04-11) 12% (05-25) 14% (06-23) 9% (03-22)

Ó· ÂÏÂÁ¯ı› ÙÔ ÂӉ¯fiÌÂÓÔ Ù˘ ¤ÎÊÚ·Û˘ ÙÔ˘ CD8 ›Ù ÛÙ· TCRÁ‰+ ÏÂÌÊÔ·ÙÙ·Ú· (‰ËÏ·‰‹ ˘„ËÏÔ‡ ÔÛÔÛÙÔ‡ CD3+CD8+TCRÁ‰+ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ) (40), ›Ù ÛÙ· ¡∫-·ÙÙ·Ú· (˘„ËÏÔ‡ ÔÛÔÛÙÔ‡ CD3CD8+CD16+) (32) Î·È ÛÙË Û˘Ó¤¯ÂÈ·, Ë Èı·ÓfiÙËÙ· ‡·Ú͢ ·ıÔÏÔÁÈÎÔ‡ ÏËı˘ÛÌÔ‡ ‰ÈÏ¿ ıÂÙÈÎÒÓ CD3+CD4+CD8+ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ. ∂¿Ó CD4++CD8+<CD3+-TCRÁ‰+, ˘Ê›ÛÙ·Ù·È ÙÔ ÂӉ¯fiÌÂÓÔ ‡·Ú͢ ›Ù ·ıÔÏÔÁÈÎÔ‡ ÏËı˘ÛÌÔ‡ ‰ÈÏ¿ ·ÚÓËÙÈÎÒÓ CD3+TCR·‚+CD4-CD8- ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ‹ ÌÂÁ¿ÏÔ˘ ÔÛÔÛÙÔ‡ ¡∫∆-΢ÙÙ¿ÚˆÓ (34).

∂¿Ó ÛÙËÓ ·¿ÓÙËÛË ‰ÂÓ ·Ó·Ê¤ÚÂÙ·È ÙÔ ÔÛÔÛÙfi ÙˆÓ TCRÁ‰+ ΢ÙÙ¿ÚˆÓ, ÙfiÙ ÙÔ ¿ıÚÔÈÛÌ· ÙˆÓ CD4+ Î·È ÙˆÓ CD8+ ı· Ú¤ÂÈ Ó· Â›Ó·È Ï›ÁÔ ÌÈÎÚfiÙÂÚÔ ·fi ÂΛÓÔ ÙˆÓ CD3+.

√È ÏÂÌÊÔ΢ÙÙ·ÚÈÎÔ› ˘ÔÏËı˘ÛÌÔ› ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜ ÛÙȘ ÚˆÙÔ·ı›˜ ·ÓÔÛÔ·ÓÂ¿ÚÎÂȘ ªÂÙ¿ ÙËÓ ·Ó¿ÁÓˆÛË ÙÔ˘ ·ÔÙÂϤÛÌ·ÙÔ˜, ÛÂÈÚ¿ ¤¯ÂÈ Ë ·ÍÈÔÏfiÁËÛË ÙˆÓ ÏÂÌÊÔ΢ÙÙ·ÚÈÎÒÓ ÏËı˘ÛÌÒÓ, Ë ÔÔ›· Á›ÓÂÙ·È ¿ÓÙ· ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙËÓ

¶›Ó·Î·˜ 2. ∞fiÏ˘Ù˜ ÙÈ̤˜ (·ÚÈıÌfi˜ ΢ÙÙ¿ÚˆÓ 10-3/Ìl) ÙˆÓ ˘ÔÏËı˘ÛÌÒÓ ÙˆÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ˘ÁÈÒÓ ·È‰ÈÒÓ. ∫·Ù·ÓÔÌ‹ ηٿ ËÏÈΛ· ÛÙË Ï¢΋ Ê˘Ï‹ (36). ÀÔÏËı˘ÛÌfi˜

0-3 ÌËÓÒÓ

3-6 ÌËÓÒÓ

6-12 ÌËÓÒÓ

1-2 ÂÙÒÓ

2-6 ÂÙÒÓ

6-12 ÂÙÒÓ

12-18 ÂÙÒÓ

CD3+

3,68 (2,5-5,5) 2,61 (1,6-4,0) 0,98 (0,56-1,7) 2,27 (1,2-3,7) 0,32 (0,06-0,9) 0,1 (0,04-0,18) 0,05 (0,02-0,16) 0,73 (0,3-2,0) 0,42 (0,17-1,1)

3,93 (2,5-5,6) 2,85 (1,8-4,0) 1,05 (0,59-1,6) 2,32 (1,3-3,7) 0,33 (0,12-0,63) 0,15 (0,06-0,28) 0,08 (0,03-0,17) 1,55 (0,43-3) 0,42 (0,17-0,83)

3,93 (1.9-5,9) 2,67 (1,4-4,3) 1,04 (0,5-1,7) 2,21 (1,1-3,7) 0,34 (0,16-0,8) 0,12 (0,05-0,26) 0,09 (0,04-0,29) 1,52 (0,61-2,6) 0,4 (0,16-0,95)

3,55 (2,1-6,2) 2,16 (1,3-3,4) 1,04 (0,62-2) 1,65 (1,0-2,9) 0,4 (0,21-0,85) 0,13 (0,07-0,28) 0,18 (0,06-0,6) 1,31 (0,72-2,6) 0,36 (0,18-0,92)

2,39 (1,4-3,7) 1,38 (0,7-2,2) 0,84 (0,49-1,3) 0,98 (0,43-1,5) 0,36 (0,22-0,66) 0,09 (0,05-0,18) 0,14 (0,07-0,42) 0,75 (0,39-1,4) 0,3 (0,13-0,72)

1,82 (1,2-2,6) 0,98 (0,65-1,5) 0,68 (0,37-1,1) 0,57 (0,32-1,0) 0,35 (0,23-0,63) 0,07 (0,04-0,12) 0,09 (0,04-0,27) 0,48 (0,27-0,86) 0,23 (0,1-0,48)

1,48 (1,0-2,2) 0,84 (0,53-1,3) 0,53 (0,33-0,92) 0,4 (0,23-0,77) 0,38 (0,24-0,7) 0,06 (0,03-1) 0,07 (0,03-0,18) 0,3 (0,11-0,57) 0,3 (0,11-0,57)

CD4+ CD8+ CD4+CD45RA+ CD4+CD45RO+ CD4+HLA-DR+ CD8+HLA-DR+ CD19+ CD16+/CD56+

¶·È‰È·ÙÚÈ΋ 2007;70:174-183

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24-05-07

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180

º. ∆˙ÈÊ‹ Î·È Û˘Ó.

ÎÏÈÓÈ΋ Î·È ÂÚÁ·ÛÙËÚȷ΋ ÂÈÎfiÓ·. ∏ ÌÂϤÙË ÙˆÓ ÏÂÌÊÔ΢ÙÙ·ÚÈÎÒÓ ÏËı˘ÛÌÒÓ Û˘Ì‚¿ÏÏÂÈ ÛÙË ‰È¿ÁÓˆÛË ÙˆÓ ÚˆÙÔ·ıÒÓ ·ÓÔÛÔ·ÓÂ·ÚÎÂÈÒÓ Î·È ÛÙËÓ Ù·ÍÈÓfiÌËÛ‹ ÙÔ˘˜. ¶·Ú·Î¿Ùˆ ·Ó·Ê¤ÚÔÓÙ·È ÔÈ ¯·Ú·ÎÙËÚÈÛÙÈÎfiÙÂÚ˜ ‰È·Ù·Ú·¯¤˜ ÙˆÓ ÏÂÌÊÔ΢ÙÙ·ÚÈÎÒÓ ÏËı˘ÛÌÒÓ ÛÙȘ ΢ÚÈfiÙÂÚ˜ ·ÓÔÛÔ·ÓÂ¿ÚÎÂȘ (37,41-43), Ì ‚¿ÛË ÙË ‰ÈÂıÓÒ˜ ÈÛ¯‡Ô˘Û· Ù·ÍÈÓfiÌËÛË (41) (∂ÈÎfiÓ· 3). ™ËÌ·ÓÙÈ΋ Ì›ˆÛË ∆- Î·È µ-ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ: ∏ ‚·ÚÈ¿ Û˘Ó‰˘·Ṳ̂ÓË ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ· (SCID) Ì ÂÎÛÂÛËÌ·Ṳ̂ÓË Ì›ˆÛË Î·È ÙˆÓ ‰‡Ô ·˘ÙÒÓ ÏËı˘ÛÌÒÓ ÔÊ›ÏÂÙ·È Û˘ÓËı¤ÛÙÂÚ· Û ‰È·Ù·Ú·¯‹ ÛÙÔ Â›Â‰Ô ÙÔ˘ ·Ó·Û˘Ó‰˘·ÛÌÔ‡ ÙˆÓ ÁÔÓȉ›ˆÓ ÙÔ˘ TCR Î·È ÙˆÓ ·ÓÔÛÔÛÊ·ÈÚÈÓÒÓ Î·È Î˘Ú›ˆ˜ Û ÌÂÙ·ÏÏ¿ÍÂȘ ÙˆÓ ÁÔÓȉ›ˆÓ ÙˆÓ ÂÓ˙‡ÌˆÓ RAG1 ‹ RAG2. ™ÙËÓ ·ÓÂ¿ÚÎÂÈ· Ù˘ ··ÌÈÓ¿Û˘ Ù˘ ·‰ÂÓÔÛ›Ó˘ (ADA ·ÓÂ¿ÚÎÂÈ·), ÂËÚ¿˙ÔÓÙ·È Î·È ÔÈ ‰‡Ô ·˘Ù¤˜ ΢ÙÙ·ÚÈΤ˜ ÛÂÈÚ¤˜, ·ÏÏ¿ Ë Ì›ˆÛ‹ ÙÔ˘˜ Â›Ó·È ÚÔԉ¢ÙÈ΋.

™ËÌ·ÓÙÈ΋ Ì›ˆÛË ÙˆÓ ∆-ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ÌÂ Ê˘ÛÈÔÏÔÁÈο ‹ ·˘ÍË̤ӷ µ-ÏÂÌÊÔ·ÙÙ·Ú·: ™ÙËÓ ÂÚ›ÙˆÛË ·˘Ù‹ ı· Ú¤ÂÈ Ó· ÂϤÁ¯ÂÙ·È Ô ·ÚÈıÌfi˜ ÙˆÓ ¡∫-΢ÙÙ¿ÚˆÓ. ™˘Ó‰˘·Ṳ̂ÓË Ì›ˆÛË ÙˆÓ ∆- Î·È ÙˆÓ ¡∫-΢ÙÙ¿ÚˆÓ Û˘ÓËı¤ÛÙÂÚ· ÔÊ›ÏÂÙ·È Û ‰È·Ù·Ú·¯‹ Ù˘ ÎÔÈÓ‹˜ Á-·Ï˘Û›‰·˜ ÙˆÓ ˘Ô‰Ô¯¤ˆÓ ÙˆÓ IL-4, IL-7, IL-9 Î·È IL-15 ‹ Û ÌÂÙ·ÏÏ¿ÍÂȘ ÙÔ˘ ÁÔÓȉ›Ô˘ Ù˘ ÎÈÓ¿Û˘ Jak3. ªÂÌÔӈ̤ÓË ÂÍ·Ú¯‹˜ Ì›ˆÛË ÙˆÓ ∆-ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ÌÔÚ› Ó· ÔÊ›ÏÂÙ·È Û ÁÂÓÂÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ˘Ô‰Ô¯¤· Ù˘ IL-7, ÙÔ˘ CD45 ‹ Ù˘ ‰ ·Ï˘Û›‰·˜ ÙÔ˘ CD3. ¶ÚÔԉ¢ÙÈ΋ Ì›ˆÛË ÙˆÓ ∆-ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ·Ú·ÙËÚÂ›Ù·È Î·È ÛÙËÓ ·ÓÂ¿ÚÎÂÈ· PNP, ÛÙÔ Û‡Ó‰ÚÔÌÔ Wiskott-Aldrich Î·È ÛÙËÓ ·Ù·Í›·-ÙËÏ·ÁÁÂÈÂÎÙ·Û›·. ™ÙÔ Û‡Ó‰ÚÔÌÔ Di George, ÙÔ ÔÔ›Ô Û˘¯Ó¿ ÂÚÈÏ·Ì‚¿ÓÂÈ Î·È ÔÈΛÏÔ˘ ‚·ıÌÔ‡ ‰È·Ù·Ú·¯‹ Ù˘ ·Ó¿Ù˘Í˘ ÙÔ˘ ı‡ÌÔ˘, ·Ú·ÙËÚÂ›Ù·È ÔÈΛÏÔ˘ ‚·ıÌÔ‡ ÌÂÌÔӈ̤ÓË Ì›ˆÛË ÙˆÓ ˆÚ›ÌˆÓ ∆-ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ, Ì ٿÛË ÁÈ· ÚÔԉ¢ÙÈ΋ ÔÏÈÁÔÎψÓÈ΋ ·‡ÍËÛË (42).

IgM

ª˘ÂÏfi˜

XLA (·ÓÂ¿ÚÎÂÈ· Btk) ™‡Ó‰ÚÔÌÔ À¤Ú-IgM

·) SCID Ì ÌÂÙ¿ÏÏ·ÍË ÛÙÔ RAG ÁÔÓ›‰ÈÔ ‚) ™‡Ó‰ÚÔÌÔ √ª∂¡

¢ÈÎÙ˘ˆÙ‹ ¢˘ÛÁÂÓÂÛ›·

IgG

Pre-B2 ·ÙÙ·ÚÔ, ÚÒÈÌÔ µ-·ÙÙ·ÚÔ CD10, CD19, CD10/ pre-BCR CD19 Pre-B1 ·ÙÙ·ÚÔ, Tdt, CD34, CD10, cCD79a, CD19 Pro-B ·ÙÙ·ÚÔ, Tdt, CD34, CD10, cCD79a

·Ú¯¤ÁÔÓÔ §ÂÌÊÈÎfi ·ÈÌÔÔÈËÙÈÎfi ÚÔÁÔÓÈÎfi ·ÙÙ·ÚÔ Î‡ÙÙ·ÚÔ/ HLA-DR, CD34, ¶ÚÔı˘ÌÔCD117 ·ÙÙ·ÚÔ Tdt, CD34, CD44

£‡ÌÔ˜ ·) SCID Ì ÌÂÙ¿ÏÏ·ÍË Ù˘ ÎÔÈÓ‹˜ Á ·Ï˘Û›‰·˜ ‚) SCID Ì Jak3 ÌÂÙ¿ÏÏ·ÍË

πg∞ ·ÓÂ¿ÚÎÂÈ· IgA

¶ÂÚÈÊÂÚÈÎfi ∞›Ì· Î·È IgE §ÂÌÊÈÎfi˜ πÛÙfi˜

ÂӉȿÌÂÛÔ ÒÚÈÌÔ ·ÓÔÛÔ‚Ï¿ÛÙË Ï·ÛÌ·ÙÔ·ÙÙ·ÚÔ µ-·ÙÙ·ÚÔ, µ-·ÙÙ·ÚÔ, CD19, CD20 CD19, CD20 CD19, CD20 ∞ÓÂ¿ÚÎÂÈ· Ù˘ ‚ ·Ï˘Û›‰·˜ ÙÔ˘ ˘Ô‰Ô¯¤· Ù˘ IL 12 IL-12 ∞ÓÂ¿ÚÎÂÈ· ÙÔ˘ IL-12R ˘Ô‰Ô¯¤· Ù˘ π¡FÁ INFÁ INFÁR

‚ÔËıËÙÈÎfi ÒÚÈÌÔ ·) ∞ÓÂ¿ÚÎÂÈ· ADA, ∞ÓÒÚÈÌÔ ı˘ÌÔ·ÙÙ·ÚÔ, ∆-·ÙÙ·ÚÔ PNP ·) SCID Ì ÌÂÙ¿ÏÏ·ÍË ı˘ÌÔ·ÙÙ·ÚÔ CD4CD3 CD4 ‚) ∞ÓÂ¿ÚÎÂÈ· ZAP70 pre-TCR, ÛÙÔ RAG ÁÔÓ›‰ÈÔ TCR CD3 ‚) ™‡Ó‰ÚÔÌÔ DiGeorge Tdt, CD44, ∞ÓÒÚÈÌÔ CD25, CD4 ı˘ÌÔ·ÙÙ·ÚÔ, ÎÔÈÓfi ÒÚÈÌÔ pre-TCR, ΢ÙÙ·ÚÔÙÔÍÈÎfi ı˘ÌÔ·ÙÙ·ÚÔ Tdt, CD25, ı˘ÌÔηٷÛÙ·ÏÙÈÎfi ·ÙÙ·ÚÔ, CD8 TCR CD4 ∆-·ÙÙ·ÚÔ CD8 CD3 Tdt, cCD3, CD3 CD4/CD8

APS

HLA-II ∞ÓÂ¿ÚÎÂÈ· ÙÔ˘ HLA-II ‹ Û‡Ó‰ÚÔÌÔ ÙÔ˘ Á˘ÌÓÔ‡ ÏÂÌÊÔ΢ÙÙ¿ÚÔ˘

∂ÈÎfiÓ· 3. √È Î˘ÚÈfiÙÂÚ˜ ·ÓÔÛÔ·ÓÂ¿ÚÎÂȘ Ô˘ ·Ú·ÙËÚÔ‡ÓÙ·È ÏfiÁˆ ÁÂÓÂÙÈÎÔ‡ ÂÏÏ›ÌÌ·ÙÔ˜ ÛÙË ‰È·‰Èηۛ· ‰È·ÊÔÚÔÔ›ËÛ˘ Î·È ÂͤÏÈ͢ ÙÔ˘ ÏÂÌÊÔ΢ÙÙ¿ÚÔ˘ ÛÙÔÓ Ì˘ÂÏfi Î·È ÛÙÔÓ ı‡ÌÔ (36).

SCID: µ·ÚÈ¿ ™˘Ó‰˘·Ṳ̂ÓË ∞ÓÔÛÔ·ÓÂ¿ÚÎÂÈ· (Severe Combined Immunodeficiency), XLA: º˘ÏÔÛ‡Ó‰ÂÙË ˘ÔÁ·ÌÌ·ÛÊ·ÈÚÈÓ·ÈÌ›·, Btk: T˘ÚÔÛÈÓÈ΋ ÎÈÓ¿ÛË Bruton (Bruton tyrosine kinase), PNP: ¶Ô˘ÚÈÓÈ΋ ʈÛÊÔÚ˘Ï¿ÛË (Purine phoshorylase), ADA: ∞·ÌÈÓ¿ÛË Ù˘ ·‰ÂÓÔÛ›Ó˘ (Adenosine deaminase), Jak3: ∫ÈÓ¿ÛË Ô˘ Û˘Ó‰¤ÂÙ·È Ì ÙËÓ Á ·Ï˘Û›‰· Î·È Û ·ÓÂ¿ÚÎÂÈ· Ù˘ ÎÈÓ¿Û˘ ·˘Ù‹˜ ÂÌÊ·Ó›˙ÂÙ·È ˘ÔÏÂÈfiÌÂÓÔ ·˘ÙÔۈ̷ÙÈÎfi SCID, RAG: °ÔÓ›‰È· ÂÓÂÚÁÔÔ›ËÛ˘ ·Ó·Û˘Ó‰˘·ÛÌÔ‡ (Recombination-activating genes), ZAP70: ∆˘ÚÔÛÈÓÈ΋ ÎÈÓ¿ÛË Ô˘ Û˘Ó‰¤ÂÙ·È Ì ÙËÓ ˙ ·Ï˘Û›‰· ÙÔ˘ TCR Û˘ÌϤÁÌ·ÙÔ˜ Î·È Â›Ó·È ÛËÌ·ÓÙÈ΋ ÁÈ· ÙËÓ ÚÒÈÌË ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ, IL-1: πÓÙÂÚÏ¢ΛÓË 1, INF-Á: πÓÙÂÚÊÂÚfiÓË Á, INF-ÁR: ÀÔ‰Ô¯¤·˜ Ù˘ INF-Á, Pre-TCR: ¶Úfi‰ÚÔÌË ÌÔÚÊ‹ ÙÔ˘ TCR ηٿ ÙËÓ ˆÚ›Ì·ÓÛË ÙˆÓ ∆ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ, Tdt: ∆ÂÏÈ΋ ‰ÂÔ͢ÚÈ‚ÔÓÔ˘ÎÏÂÔÙȉÈ΋ ÙÚ·ÓÛÊÂÚ¿ÛË (terminal deoxyribonucleotidyl transferase) Paediatriki 2007;70:174-183

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√ ·ÓÔÛÔÊ·ÈÓfiÙ˘Ô˜ ÙˆÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜

ªÂÌÔӈ̤ÓË ¤ÏÏÂÈ„Ë ÙˆÓ CD4+ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ·Ú·¤ÌÂÈ Û ·ÓÂ¿ÚÎÂÈ· ÙˆÓ ÌÔÚ›ˆÓ MHC Ù¿Í˘ ππ, ÂÓÒ ÌÂÌÔӈ̤ÓË ¤ÏÏÂÈ„Ë ÙˆÓ CD8+ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ÌÔÚ› Ó· ÔÊ›ÏÂÙ·È Û ‰È·Ù·Ú·¯‹ Ù˘ ÌÂÙ¿‰ÔÛ˘ Û‹Ì·ÙÔ˜ ̤ۈ ÙÔ˘ TCR (·ÓÂ¿ÚÎÂÈ· ÙˆÓ ÌÔÚ›ˆÓ CD8, ZAP-70, TAP-1 ‹ TAP-2) (41). ™Â ·‡ÍËÛË ÙˆÓ ‰ÈÏ¿ ·ÚÓËÙÈÎÒÓ CD3+TCR·‚+CD4-CD8- ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ı· Ú¤ÂÈ Ó· ‰ÈÂÚÂ˘Ó¿Ù·È Î·È Ë Èı·ÓfiÙËÙ· ·˘ÙÔ¿ÓÔÛÔ˘ ÏÂÌÊÔ¸ÂÚÏ·ÛÙÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ (1). ªÂÌÔӈ̤ÓË Ì¤¯ÚÈ ÌˉÂÓÈÛÌÔ‡ Ì›ˆÛË ÙˆÓ µ-ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ·Ú·ÙËÚÂ›Ù·È ÛÙËÓ ÁÔÓȉȷ΋ ‰È·Ù·Ú·¯‹ Ù˘ ÎÈÓ¿Û˘ Btk (Ê˘ÏÔÛ‡Ó‰ÂÙË ·Á·ÌÌ·ÛÊ·ÈÚÈÓ·ÈÌ›·, ÓfiÛÔ˜ ÙÔ˘ Bruton), ÌÔÚ›, fï˜, Ó· ÔÊ›ÏÂÙ·È Î·È Û ·˘ÙÔۈ̷ÙÈÎÒ˜ ÎÏËÚÔÓÔÌÔ‡ÌÂÓ˜ ÌÂÙ·ÏÏ¿ÍÂȘ (44). ªÈÎÚ‹ Ì›ˆÛË ÙˆÓ µ-ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ÌÔÚ› Ó· ·Ú·ÙËÚËı› Û ÂÚÈÙÒÛÂȘ ÎÔÈÓ‹˜ ÔÈΛÏ˘ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·˜ (45), ÂÓÒ Û ·ÓÂ¿ÚÎÂȘ ˘ÔÙ¿ÍÂˆÓ ÙˆÓ ·ÓÔÛÔÛÊ·ÈÚÈÓÒÓ ÌÔÚ› Ó· ·Ú·ÙËÚËı› ·‡ÍËÛË ÙˆÓ ·ÓÒÚÈÌˆÓ µ-ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ. £· Ú¤ÂÈ, fï˜, Ó· ÙÔÓÈÛÙ› fiÙÈ Ê˘ÛÈÔÏÔÁÈο Â›‰· µ-ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ‰ÂÓ ·ÔÎÏÂ›Ô˘Ó ÙËÓ ‡·ÚÍË Û˘Ó‰ÚfiÌÔ˘ ˘¤Ú-IgM, ÎÔÈÓ‹˜ ÔÈΛÏ˘ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·˜ ‹ ¿ÏÏ˘ ·ÓÙÈۈ̷ÙÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜. ∂›Û˘, ÛÙËÓ ·ÚÔ‰È΋ ˘ÔÁ·ÌÌ·ÛÊ·ÈÚÈÓ·ÈÌ›· ÙˆÓ ‚ÚÂÊÒÓ, Ù· ΢ÎÏÔÊÔÚÔ‡ÓÙ· µ-·ÙÙ·Ú· Â›Ó·È ÛÂ Ê˘ÛÈÔÏÔÁÈο Â›‰· (43,46). ∞Ó·ÊÔÚÈο Ì ÙËÓ ÎÔÈÓ‹ ÔÈΛÏË ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·, Ë ÔÔ›· ·ÔÙÂÏ› Ì›· ÂÙÂÚÔÁÂÓ‹ ÔÌ¿‰· Û¯ÂÙÈο Û˘¯ÓÒÓ ÓÔÛËÌ¿ÙˆÓ Ì ÎÔÈÓfi ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÙËÓ ·‰˘Ó·Ì›· ˆÚ›Ì·ÓÛ˘ ÙˆÓ µ-ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Û Â›Â‰Ô ‚Ï·ÛÙÈÎÔ‡ ΤÓÙÚÔ˘ ηÈ, Û˘ÓÂÒ˜, ÙËÓ ÌÂȈ̤ÓË ·Ú·ÁˆÁ‹ ·ÓÔÛÔÛÊ·ÈÚÈÓÒÓ, ı· Ú¤ÂÈ Ó· ÛËÌÂȈı› fiÙÈ Û˘¯Ó¿ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi Ì›ˆÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ CD4+TCR·‚+ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Î·È È‰È·›ÙÂÚ· ÙˆÓ ·Úı¤ÓˆÓ CD4+CD45RA+, ¯ˆÚ›˜, fï˜, ·˘Ùfi ÙÔ Â‡ÚËÌ· Ó· ·ÔÙÂÏ› ‰È·ÁÓˆÛÙÈÎfi ÎÚÈÙ‹ÚÈÔ (45).

¶·Ú¿ÁÔÓÙ˜ Ô˘ ÂËÚ¿˙Ô˘Ó ÙȘ ÙÈ̤˜ ÙˆÓ ÏÂÌÊÔ΢ÙÙ·ÚÈÎÒÓ ÏËı˘ÛÌÒÓ ÛÙÔ ÂÚÈÊÂÚÈÎfi ·›Ì· ∆Ô ·ÔÙ¤ÏÂÛÌ· ÙÔ˘ ·ÓÔÛÔÊ·ÈÓfiÙ˘Ô˘ ÙˆÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜ ÌÔÚ› Ó· ÂËÚ·ÛÙ› ·fi Ì›· ÏËıÒÚ· ·Ú·ÁfiÓÙˆÓ: ™‹„Ë: ¶ÔÏÏ¿ ·È‰È¿ Ô˘ ÂϤÁ¯ÔÓÙ·È ÁÈ· ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ· ¤¯Ô˘Ó ÈÛÙÔÚÈÎfi ÚfiÛÊ·ÙˆÓ ‚·Ú¤ˆÓ ÏÔÈÌÒÍÂˆÓ ‹ ÛËÙÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ. ∂›Ó·È Û˘¯Ó‹ Ë ·Ó¿ÁÎË ‰ÈÂÚ‡ÓËÛ˘ ·È‰ÈÒÓ Ì ‚·ÚÈ¿ ÎÏÈÓÈ΋ ÂÈÎfiÓ·, ΢ڛˆ˜ ÏfiÁˆ Ù˘ ¤ÏÏÂȄ˘ ÙÔ˘ ¯ÚÔÓÈÎÔ‡ ÂÚÈıˆÚ›Ô˘. ∏ Û‹„Ë, fï˜, ÌÔÚ› Ó· ÂÈʤÚÂÈ ÛËÌ·ÓÙÈÎfiٷ٘ ÌÂÙ·‚ÔϤ˜ ÛÙÔ˘˜ ÏÂÌÊÔ΢ÙÙ·ÚÈÎÔ‡˜ ÏËı˘ÛÌÔ‡˜, ·ÎfiÌË Î·È ‰‡Ô Ì‹Ó˜ ÌÂÙ¿ ÙËÓ ·Ó¿ÚÚˆÛË, fiˆ˜ ÙÒÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ CD4+ Î·È ÏÈÁfiÙÂÚÔ ÙˆÓ CD8+ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ÛÙÔ ÂÚÈÊÂÚÈÎfi ·›Ì· (47), ·Ú¯È΋ ̤¯ÚÈ ÌˉÂÓÈÛÌÔ‡ Ì›ˆÛË Î·È ·ÎÔÏÔ‡ıˆ˜ ·‡ÍËÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ¡∫-΢ÙÙ¿ÚˆÓ, ·‡ÍËÛË ÙˆÓ µ-ÏÂÌ-

ÊÔ΢ÙÙ¿ÚˆÓ Î·È ·‡ÍËÛË ÙˆÓ CD3+HLADR+ ‰ÈÂÁÂÚÌ¤ÓˆÓ ∆-ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ (48).

HIV Ïԛ̈ÍË: ∏ ÚÔԉ¢ÙÈ΋ Ì›ˆÛË ÙÔ˘ ·fiÏ˘ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ CD4+ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ (·ÚÈÔ˜ ‰Â›ÎÙ˘ ·Ú·ÎÔÏÔ‡ıËÛ˘ ÙˆÓ ·ÛıÂÓÒÓ) Î·È Ë ·˘ÍË̤ÓË ¤ÎÊÚ·ÛË ÙˆÓ ‰ÂÈÎÙÒÓ ‰È¤ÁÂÚÛ˘ (HLA-DR Î·È CD38) ÛÙ· CD8+ ∆-ÏÂÌÊÔ·ÙÙ·Ú· (‰Â›ÎÙ˘ ÂÈΛÌÂÓ˘ ·‡ÍËÛ˘ ÙÔ˘ ÈÈÎÔ‡ ÊÔÚÙ›Ô˘) Â›Ó·È ÔÈ Î˘ÚÈfiÙÂÚ˜ ‰È·Ù·Ú·¯¤˜ ÛÙËÓ HIV Ïԛ̈ÍË (49). ∆· ÔÚÔ·ÚÓËÙÈο ÓÂÔÁÓ¿ Ì HIV+ ÌËÙ¤Ú· ÌÔÚ› Ó· ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·Ó¿ÏÔÁ˜ ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ·ÓÔÛÔÊ·ÈÓfiÙ˘Ô˘, Ô˘ ÌÔÚ› Ó· ‰È·ÙËÚËıÔ‡Ó Ì¤¯ÚÈ ÙË Û˘ÌÏ‹ÚˆÛË ÙÔ˘ ÚÒÙÔ˘ ¤ÙÔ˘˜ (50). ∫ÔÚÙÈÎÔÛÙÂÚÔÂȉ‹-·ÓÔÛÔηٷÛÙ·ÏÙÈο: ∆· ·ÓÔÛÔηٷÛÙ·ÏÙÈο Î·È Ù· ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹ Ô˘ ¯ÔÚËÁÔ‡ÓÙ·È ÏfiÁˆ ÙˆÓ ·˘ÙÔ¿ÓÔÛˆÓ ÂΉËÏÒÛÂˆÓ ÔÚÈÛÌ¤ÓˆÓ ·ÓÔÛÔ·ÓÂ·ÚÎÂÈÒÓ ÂËÚ¿˙Ô˘Ó È‰È·›ÙÂÚ· ÙÔÓ ·ÓÔÛÔÊ·ÈÓfiÙ˘Ô. ∏ ÏÂÌÊÔÂÓ›· Ô˘ ÚÔηÏÂ›Ù·È ·fi Ù· ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹, ÔÊ›ÏÂÙ·È ÂÚÈÛÛfiÙÂÚÔ ÛÙË Ì›ˆÛË ÙˆÓ CD4+ Î·È ÏÈÁfiÙÂÚÔ ÛÙË Ì›ˆÛË ÙˆÓ CD8+ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ. ∏ Ì›ˆÛË ·˘Ù‹, Ì¿ÏÈÛÙ·, ·ÊÔÚ¿ ΢ڛˆ˜ ÛÙÔ˘˜ ÏËı˘ÛÌÔ‡˜ ÙˆÓ ÂÓÂÚÁÔÔÈËÌ¤ÓˆÓ Î˘ÙÙ¿ÚˆÓ (CD3+CD4+CD69+, CD3+ CD8+CD69+) (51). ø˜ Û˘Ó¤ÂÈ· ÙˆÓ ·Ú·¿Óˆ, ·Ó·ÛÙÚ¤ÊÂÙ·È Ô ÏfiÁÔ˜ CD4+/CD8+ Î·È Ë ·Ó·ÛÙÚÔÊ‹ ·˘Ù‹ ‰È·ÚΛ ÁÈ· ÌÂÁ¿ÏÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·, ÏfiÁˆ ÙÔ˘ ÌÂȈ̤ÓÔ˘ Ú˘ıÌÔ‡ ·ÔηٿÛÙ·Û˘ ÙˆÓ CD4+ (28,2 Ë̤Ú˜) Û ۯ¤ÛË Ì ٷ CD8+ (12,6 Ë̤Ú˜) ÏÂÌÊÔ·ÙÙ·Ú· (52). ∂Ô̤ӈ˜, Û˘ÓÈÛÙ¿Ù·È Ë ‰ÈÂÍ·ÁˆÁ‹ ÙÔ˘ Ù˘¯fiÓ ÂÓ‰ÂÈÎÓ˘fiÌÂÓÔ˘ ÂϤÁ¯Ô˘ ÙÔ˘ ·ÓÔÛÔÊ·ÈÓfiÙ˘Ô˘ ÚÈÓ ·fi ÙË ¯ÔÚ‹ÁËÛË ÎÔÚÙÈÎÔÛÙÂÚÔÂȉÒÓ ‹ ¿ÏÏ˘ ·ÓÔÛÔÙÚÔÔÔÈËÙÈ΋˜ ıÂÚ·›·˜. √È ÏÂÌÊÔ΢ÙÙ·ÚÈÎÔ› ˘ÔÏËı˘ÛÌÔ› ÂËÚ¿˙ÔÓÙ·È Î·È ·fi ¿ÏϘ ηٷÛÙ¿ÛÂȘ. ¶·Ú·Î¿Ùˆ ·Ó·Ê¤ÚÔÓÙ·È ÔÈ ÛËÌ·ÓÙÈÎfiÙÂÚ˜ ·fi ·˘Ù¤˜ ·Ó¿ ÏÂÌÊÔ΢ÙÙ·ÚÈÎfi ˘ÔÏËı˘ÛÌfi: ∆-ÏÂÌÊÔ·ÙÙ·Ú· CD4+: ¶ÙˆÙÈ΋ Ù¿ÛË ÙÔ˘˜ ¤¯ÂÈ Î·Ù·ÁÚ·Ê› Û ‚·ÎÙËÚȷΤ˜ ÏÔÈÌÒÍÂȘ (53), ÏfiÁˆ Ù˘ ÌÂÙ·Ó¿ÛÙÂ˘Û‹˜ ÙÔ˘˜ ÛÙ· ÏÂÌÊÈο fiÚÁ·Ó·.

CD8+: ∏ Èı·ÓfiÙÂÚË ·ÈÙ›· ·‡ÍËÛ˘ ·ÚÈıÌÔ‡ ÙˆÓ CD8+ Â›Ó·È ÔÈ ÏÔÈÌÒÍÂȘ (ÈÔÁÂÓ›˜, ‚·ÎÙËÚȷΤ˜). ™Â ·˘Ù¤˜ ·Ô‰›‰ÂÙ·È Î·È Û˘¯Ó‹ ·‡ÍËÛË ÙˆÓ CD8+ ÛÙ· ÔÏ˘ÌÂÙ·ÁÁÈ˙fiÌÂÓ· ¿ÙÔÌ· (54).

CD3HLADR: ∂ÎÙfi˜ ·fi ÙȘ ÏÔÈÌÒÍÂȘ, Ù· ‰ÈÂÁÂṲ́ӷ ∆-ÏÂÌÊÔ·ÙÙ·Ú· ·˘Í¿ÓÔÓÙ·È Î·È Û ¿ÏϘ ÂÚÈÙÒÛÂȘ ‰È¤ÁÂÚÛ˘ ÙÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡ (·˘ÙÔ¿ÓÔÛ· ÓÔÛ‹Ì·Ù·, ÌÂÙ·ÌÔۯ‡ÛÂȘ, ÔÏ˘ÌÂÙ·ÁÁÈ˙fiÌÂÓ· ¿ÙÔÌ·) (55).

TCRÁ‰: ∏ ·‡ÍËÛË ÙˆÓ TCRÁ‰ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Û˘Ó‹ıˆ˜ Û˘Ó·ÓÙ¿Ù·È Û ÏÔÈÌÒÍÂȘ ·fi ÂÓ‰Ô΢ÙÙ¿ÚÈÔ˘˜ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜ (ÂÚËÙÔ˚Ô‡˜, Ì˘ÎÔ‚·ÎÙËÚ›‰ÈÔ Ù˘ Ê˘Ì·Ù›ˆÛ˘). √È ÙÈ̤˜ ÙÔ˘˜ ›ӷÈ, Â›Û˘, Û˘¯Ó¿ ·˘ÍË̤Ó˜ Û ·˘ÙÔ¿ÓÔÛ· ÓÔÛ‹Ì·Ù· (56). ¶·È‰È·ÙÚÈ΋ 2007;70:174-183

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º. ∆˙ÈÊ‹ Î·È Û˘Ó.

µ-ÏÂÌÊÔ·ÙÙ·Ú·: ∏ Û˘ÓËı¤ÛÙÂÚË, ϤÔÓ, ·ÈÙ›· ÌˉÂÓÈÛÌÔ‡ ÙˆÓ CD19+CD20+ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Â›Ó·È Ë ¯ÔÚ‹ÁËÛË ·ÓÙÈ-CD20 ıÂÚ·›·˜. ∞˘ÍËÙÈ΋ Ù¿ÛË ¤¯ÂÈ ·Ú·ÙËÚËı› Û ÏÔÈÌÒÍÂȘ (57), ·ÏÏ¿ Û ˘ÂÚ‚ÔÏÈ΋ ·‡ÍËÛ‹ ÙÔ˘˜ ı· Ú¤ÂÈ Ó· ·ÔÎÏÂÈÛÙ› οÔÈ· ÏÂÌÊÔ΢ÙÙ·ÚÈ΋ ηÎÔ‹ıÂÈ·, Ì ÙÔÓ ¤ÏÂÁ¯Ô ‡·Ú͢ ÌÔÓÔÎψÓÈÎfiÙËÙ·˜ Î ‹ Ï ·Ï˘Û›‰ˆÓ. π‰È·›ÙÂÚÔ ÂӉȷʤÚÔÓ ¤¯Ô˘Ó ÔÈ ‰È·Î˘Ì¿ÓÛÂȘ ÙˆÓ CD19+CD5+, ÛÙÔ Ï·›ÛÈÔ Î˘Ú›ˆ˜ Ù˘ ÚÔÛ¿ıÂÈ·˜ Â͇ÚÂÛ˘ ÚÔÁÓˆÛÙÈÎÒÓ ‰ÂÈÎÙÒÓ ÙˆÓ ·˘ÙÔ¿ÓÔÛˆÓ ÓÔÛËÌ¿ÙˆÓ, fiˆ˜ ÛÙÔÓ Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË Ù‡Ô˘ π (50). ŸÌˆ˜, Ë ·ÍÈÔÏfiÁËÛË ÙˆÓ CD19+CD5+ ÛÙ· ‚Ú¤ÊË Â›Ó·È ‰˘Û¯ÂÚ‹˜, ÏfiÁˆ ÙÔ˘ Ê˘ÛÈÔÏÔÁÈο ·˘ÍË̤ÓÔ˘ ·ÚÈıÌÔ‡ ÙÔ˘˜ (58). ¡∫-·ÙÙ·Ú·: ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÙȘ Ù·¯‡ÙÂÚ˜ ‰È·Î˘Ì¿ÓÛÂȘ, ÏfiÁˆ Ù˘ ·Ó·Î·Ù·ÓÔÌ‹˜ ÙˆÓ Î˘ÎÏÔÊÔÚÔ‡ÓÙˆÓ (ÌÂÙÚÔ‡ÌÂÓˆÓ) Î·È ÙˆÓ ÚÔÛÎÔÏÏËÌ¤ÓˆÓ ÛÙ· ·ÁÁÂȷο ÙÔȯÒÌ·Ù· (ÌË ÌÂÙÚÔ‡ÌÂÓˆÓ) ¡∫-ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Ô˘ ÚÔηÏÂ›Ù·È ·fi ‰È¿ÊÔÚÔ˘˜ ·Ú¿ÁÔÓÙ˜, fiˆ˜ Ë ˘ÂÚ¤ÎÎÚÈÛË Î·Ù¯ÔÏ·ÌÈÓÒÓ (59,60).

™¯ÔÏÈ·ÛÌfi˜ £· Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÂÙ·È ˘fi„Ë fiÙÈ Ù· ·ÔÙÂϤÛÌ·Ù· ÙˆÓ ‰È·ÊfiÚˆÓ ÂÚÁ·ÛÙËÚ›ˆÓ ‰ÂÓ Â›Ó·È ¿ÓÙÔÙÂ Û˘ÁÎÚ›ÛÈÌ·, ȉ›ˆ˜ ˆ˜ ÚÔ˜ ÙÔ˘˜ ÌÈÎÚÔ‡ ·ÚÈıÌÔ‡ ˘ÔÏËı˘ÛÌÔ‡˜ (36). ∏ ÂÈÏÔÁ‹ ÙˆÓ Î·Ù¿ÏÏËÏˆÓ ÚÔ˜ ¤ÏÂÁ¯Ô ‰ÂÈÎÙÒÓ ˘·ÁÔÚ‡ÂÙ·È ·fi ÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÙÔ˘ ·ÛıÂÓÔ‡˜, ÛËÌÂ›Ô ÛÙÔ ÔÔ›Ô Â›Ó·È È‰È·›ÙÂÚ· ÛËÌ·ÓÙÈ΋ Ë Û˘ÓÂÚÁ·Û›· ÙˆÓ ÎÏÈÓÈÎÒÓ Ì ÙÔ ÂÚÁ·ÛÙ‹ÚÈÔ. ∞˘Ùfi fï˜ Ô˘ ı· Ú¤ÂÈ Ó· ÙÔÓÈÛÙ› Â›Ó·È fiÙÈ Ë ÌÂϤÙË ÙˆÓ ÏÂÌÊÔ΢ÙÙ·ÚÈÎÒÓ ÏËı˘ÛÌÒÓ ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜ ı· Ú¤ÂÈ Ó· ‰ÈÂÓÂÚÁÂ›Ù·È ÁÈ· Ó· ··ÓÙ‹ÛÂÈ Û˘ÁÎÂÎÚÈ̤ӷ ÂÚˆÙ‹Ì·Ù· (΢ڛˆ˜ ÁÈ· ÙË ‰È¿ÁÓˆÛË ·ÓÔÛÔ·ÓÂ·ÚÎÂÈÒÓ) Î·È ‰ÂÓ ¤¯ÂÈ Î·Ó¤Ó· ÚfiÏÔ ˆ˜ ‰ÔÎÈÌ·Û›· ÂϤÁ¯Ô˘ ÙÔ˘ ÁÂÓÈÎÔ‡ ÏËı˘ÛÌÔ‡, ‰ÈfiÙÈ ÔÈ ÏÂÌÊÔ΢ÙÙ·ÚÈÎÔ› ÏËı˘ÛÌÔ› ÂËÚ¿˙ÔÓÙ·È ·fi ¿Ú· ÔÏÏÔ‡˜ ·Ú¿ÁÔÓÙ˜ Î·È Ë Ù˘¯·›· ‡ÚÂÛË Ì›·˜ ·fiÎÏÈÛ‹˜ ÙÔ˘˜ ·fi ÙȘ ·Ó·ÌÂÓfiÌÂÓ˜ ÙÈ̤˜ ÌÔÚ› Ó· ·Ú·Ï·Ó‹ÛÂÈ ÙË ‰È·ÁÓˆÛÙÈ΋ ÛΤ„Ë. ∂˘¯·ÚÈÛٛ˜ ∂˘¯·ÚÈÛÙԇ̠ıÂÚÌ¿ ÙËÓ Î˘Ú›· ŒÊË µÚ·¯ÓÔ‡ ÁÈ· ÙËÓ ÔχÙÈÌË Û˘Ì‚ÔÏ‹ Ù˘ ÛÙË Û˘ÁÎÂÎÚÈ̤ÓË ÂÚÁ·Û›·.

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REVIEW ARTICLE

™˘ÁÁÂÓ›˜ ‰È·Ì·Úٛ˜ Ó¢ÌfiÓˆÓ: ·ıÔÁ¤ÓÂÈ·, ‰È·ÁÓˆÛÙÈ΋ ÚÔÛ¤ÁÁÈÛË Î·È ·ÒÙÂÚË ¤Î‚·ÛË 1 ∞ÏÏÂÚÁÈÔÏÔÁÈÎfi ∆Ì‹Ì·, °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ ¶ÂÓÙ¤Ï˘ 2 ¶·È‰ÔÓ¢ÌÔÓÔÏÔÁÈ΋ ªÔÓ¿‰·, ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ¶·ÙÚÒÓ AÏÏËÏÔÁÚ·Ê›·: ∫ÒÛÙ·˜ ¡. ¶Ú›ÊÙ˘ kpriftis@otenet.gr ∞ÏÏÂÚÁÈÔÏÔÁÈÎfi ∆Ì‹Ì·, °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ ¶ÂÓÙ¤Ï˘ T.K. 152 36, ¶. ¶ÂÓÙ¤ÏË

∫. ¡. ¶Ú›ÊÙ˘1, ¶. ¡. ¢Ô˘Ú›‰·˜1, ª. B. ∞ÓıÚ·ÎfiÔ˘ÏÔ˜2 ¶ÂÚ›ÏË„Ë: √È Û˘ÁÁÂÓ›˜ ‰È·Ì·Úٛ˜ ÙÔ˘ Ó‡ÌÔÓ· ·ÔÙÂÏÔ‡Ó ÌÈ· ·Û˘Ó‹ıË ·ÏÏ¿ ȉȷ›ÙÂÚ· ÂӉȷʤÚÔ˘Û· ÔÌ¿‰· ÓÔÛËÌ¿ÙˆÓ Ô˘ ÌÔÚ› Ó· ·ÓȯÓ¢ıÔ‡Ó Ôχ ¤ÁηÈÚ·, ÛÙÔ Ï·›ÛÈÔ ÚÔÁÂÓÓËÙÈÎÔ‡ ÂϤÁ¯Ô˘ ηٿ ÙËÓ ÂÓ‰ÔÌ‹ÙÚÈ· ÂÚ›Ô‰Ô ‹ ·ÎfiÌ· fi„ÈÌ·, ÛÂ Ù˘¯·›Ô ¤ÏÂÁ¯Ô ÛÙËÓ ÂÓ‹ÏÈÎÔ ˙ˆ‹. ∏ ·ıÔÁ¤ÓÂÈ· ÙˆÓ ‰È·Ì·ÚÙÈÒÓ Û˘Ó‰¤ÂÙ·È ¿ÌÂÛ· Ì ÙËÓ ·Ó·ÙÔÌÈ΋ ı¤ÛË Î·È ÙË Ê¿ÛË Î·Ù¿ ÙËÓ ÔÔ›· Û˘Ì‚·›ÓÂÈ Ë ‰È·Ù·Ú·¯‹ ÛÙË ‰È·‰Èηۛ· ·Ó¿Ù˘Í˘ ÙÔ˘ Ó‡ÌÔÓ· ηٿ ÙËÓ ÂÓ‰ÔÌ‹ÙÚÈ· ÂÚ›Ô‰Ô. ∏ ‰È·ÁÓˆÛÙÈ΋ ÚÔÛ¤ÁÁÈÛË Û˘Ó·ÚÙ¿Ù·È ¿ÌÂÛ· Ì ÙË ÁÓÒÛË Î·È ÙËÓ ÒÚÈÌË ÎÏÈÓÈ΋ ÛΤ„Ë. ∞Ó Î·È Ë ÎÏÈÓÈ΋ ÂÈÎfiÓ· Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ËÏÈΛ· ÙÔ˘ ·ÛıÂÓÔ‡˜, Û˘Ó‹ıˆ˜ Â›Ó·È ÌË ÂȉÈ΋ Î·È ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙË Û·ÓÈfiÙËÙ· ÙˆÓ Û˘ÁÁÂÓÒÓ ‰È·Ì·ÚÙÈÒÓ ÙÔ˘ Ó‡ÌÔÓ· Â›Ó·È ··Ú·›ÙËÙÔ ÂΠ̤ÚÔ˘˜ ÙÔ˘ ÎÏÈÓÈÎÔ‡ ÁÈ·ÙÚÔ‡ Ó· ˘¿Ú¯ÂÈ ˘„ËÏfi˜ ‰Â›ÎÙ˘ ˘Ô„›·˜. √ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ Ì ÙËÓ ÔÚı‹ ¯Ú‹ÛË Ù˘ Û‡Á¯ÚÔÓ˘ Ù¯ÓÔÏÔÁ›·˜, Û˘Ó‹ıˆ˜, Ô‰ËÁ› Û ·ÎÚȂ›˜ ‰È·ÁÓÒÛÂȘ. ∏ ÚfiÁÓˆÛË ÙˆÓ Û˘ÁÁÂÓÒÓ ‰È·Ì·ÚÙÈÒÓ ÙˆÓ Ó¢ÌfiÓˆÓ ÂÍ·ÚÙ¿Ù·È ·fi ÙÔ Â›‰Ô˜ Î·È ÙËÓ ¤ÎÙ·ÛË Ù˘ ‚Ï¿‚˘, ηıÒ˜ Â›Û˘ ÙËÓ ‡·ÚÍË ‹ ÌË Û˘ÓÔ‰ÒÓ ·ÓˆÌ·ÏÈÒÓ. ø˜ ÚÔ˜ ÙÔÓ ¯ÚfiÓÔ Ù˘ Èı·Ó‹˜ ¯ÂÈÚÔ˘ÚÁÈ΋˜ ·Ú¤Ì‚·Û˘, ÂÊfiÛÔÓ ‰ÂÓ ˘¿Ú¯ÂÈ ·Ó¿ÁÎË Â›ÁÔ˘Û·˜ ·ÓÙÈÌÂÙÒÈÛ˘, ÔÏϤ˜ ‚Ï¿‚˜ ÌÔÚÔ‡Ó Ó· ·ÓÙÈÌÂÙˆÈÛıÔ‡Ó Û˘ÓÙËÚËÙÈο ÒÛÙ ӷ ÂÈÏÂÁ› ·ÚÁfiÙÂÚ· Ô Î·Ù·ÏÏËÏfiÙÂÚÔ˜ ¯ÚfiÓÔ˜ ÁÈ· ÙËÓ Â¤Ì‚·ÛË. ∆Ô fiÊÂÏÔ˜ Ù˘ ·ÓÙÈÚÚÔÈÛÙÈ΋˜ ·‡ÍËÛ˘ ÙÔ˘ ·ÚÈıÌÔ‡ ‹ Ù˘ ‰ÔÌ‹˜ ÙˆÓ Î˘„ÂÏ›‰ˆÓ ÌÂÙ¿ ·fi Ó¢ÌÔÓÂÎÙÔÌ‹ Û ÌÈÎÚ‹ ËÏÈΛ· ‰ÂÓ ¤¯ÂÈ ÂȂ‚·Èˆı›. §¤ÍÂȘ ÎÏÂȉȿ: ∫˘ÛÙÈ΋ ·‰ÂÓÔÌ·ÙÔÂȉ‹˜ ‰˘ÛÏ·Û›·, ÏÔ‚ÂÎÙÔÌ‹, Ó¢ÌÔÓÈÎfi ·fiÏ˘Ì·, Û˘ÁÁÂÓ¤˜ ÏԂ҉˜ ÂÌʇÛËÌ·, ÙÚ·¯ÂÈÔÔÈÛÔÊ·ÁÈÎfi Û˘Ú›ÁÁÈÔ, ˘ÔÏ·Û›· Ó‡ÌÔÓ·.

Congenital lung malformations: pathogenesis, diagnostic approach and long-term outcome 1 Department of Allergology, Children’s General Hospital of Penteli 2 Paediatric Pneumonology Unit, University of Patras Paediatric Clinic Correspondence: Kostas N. Priftis kpriftis@otenet.gr Allergology Department, Children’s General Hospital of Penteli 152 36, P. Penteli, Greece

K. N. Priftis1, N. P. Douridas1, M. B. Anthracopoulos2 Abstract: Congenital lung malformations constitute an infrequent but intriguing group of diseases, some of which are diagnosed prenatally while others remain asymptomatic for many years and are incidental findings during adulthood. The pathogenesis is determined by the anatomical location of the lesion and the timing of the intrauterine insult during embryonic lung development. The diagnostic approach is dependent on the expertise and clinical skills of the physician. Clinical manifestations of congenital lung malformations depend on the age of the patient, and in most instances are non-specific. In view of their rareness a high index of suspicion is required for the diagnosis of these clinical entities. Rational use of current imaging and endoscopic techniques can provide an accurate diagnosis. The prognosis of a specific congenital lung malformation depends on the nature and the size of the lesion and the presence or absence of associated developmental defects. With regard to the timing of surgical intervention, if emergency surgery is not required, congenital malformations can be managed conservatively, and programmed surgical resection can be undertaken at a later point in time. The occurrence of postpneumonectomy compensatory lung growth, when surgical intervention takes place early in life, has not been confirmed.

Key words: Congenital lobar emphysema, cystic adenomatoid malformation, lobectomy, pulmonary hypoplasia, pulmonary sequestration, tracheo-oesophageal fistula.

∂ÈÛ·ÁˆÁ‹ √È Û˘ÁÁÂÓ›˜ ‰È·Ì·Úٛ˜ ÙÔ˘ Ó‡ÌÔÓ· ÌÔÚ› Ó· ÌË Û˘ÁηٷϤÁÔÓÙ·È ÛÙ· ÓÔÛ‹Ì·Ù· Ô˘ ··Û¯ÔÏÔ‡Ó Û˘¯Ó¿ ÙÔÓ ·È‰›·ÙÚÔ, ·ÔÙÂÏÔ‡Ó fï˜ ÂӉȷʤÚÔ˘Û· ÔÌ¿‰· ÓÔÛËÌ¿ÙˆÓ ·ıÔÁÂÓÂÙÈο, ‰È·ÁÓˆÛÙÈο, Î·È ıÂÚ·¢ÙÈο. ∏ ·ıÔÁ¤ÓÂÈ· οı ‰È·Ì·ÚÙ›·˜ Û˘Ó‰¤ÂÙ·È Paediatriki 2007;70:184-191

¿ÌÂÛ· Ì ÙËÓ ·Ó·ÙÔÌÈ΋ ı¤ÛË Î·È ÙË Ê¿ÛË Î·Ù¿ ÙËÓ ÔÔ›· Û˘Ì‚·›ÓÂÈ Ë ‰È·Ù·Ú·¯‹ ÛÙË ‰È·‰Èηۛ· ·Ó¿Ù˘Í˘ ÙÔ˘ Ó‡ÌÔÓ· ηٿ ÙËÓ ÂÓ‰ÔÌ‹ÙÚÈ· ÂÚ›Ô‰Ô. ÕÏψÛÙÂ, ̤۷ ·fi ÙË ÌÂϤÙË ÓÂÎÚÔÙÔÌÈÎÔ‡ ˘ÏÈÎÔ‡ ·È‰ÈÒÓ Ì ·˘Ù¤˜ ÙȘ ‰È·Ì·Úٛ˜, ¤ÁÈÓ·Ó ÁÓˆÛÙ¤˜ ÔÈ ÏÂÙÔ̤ÚÂȘ Á‡Úˆ ·fi ÙË ‰È·‰Èηۛ· Ù˘ Ê˘ÛÈÔÏÔÁÈ΋˜

Pediatri May-Jun 07

24-05-07

17:58

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185

™˘ÁÁÂÓ›˜ ‰È·Ì·Úٛ˜ Ó¢ÌfiÓˆÓ

ÂÓ‰ÔÌ‹ÙÚÈ·˜ ·Ó¿Ù˘Í˘. ∏ ‰È·ÁÓˆÛÙÈ΋ ÚÔÛ¤ÁÁÈÛË ·ÔÙÂÏ› ¿ÌÂÛË Û˘Ó¿ÚÙËÛË Ì ÙË ÁÓÒÛË, ÙËÓ ÎÏÈÓÈ΋ ÛΤ„Ë, ·ÏÏ¿ Î·È ÙËÓ Ù¯ÓÔÏÔÁ›·. ∏ Ù·ÎÙÈ΋ ÚÔÁÂÓÓËÙÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË ˘ÂÚ˯ÔÁÚ·ÊÈο ÂÈÙÚ¤ÂÈ ÙËÓ ¤ÁηÈÚË ‰È¿ÁÓˆÛË, ÂÓÒ Ë ÂÈÏÔÁ‹ ÙˆÓ Î·Ù·ÏÏËÏfiÙÂÚˆÓ ÂÍÂÙ¿ÛÂˆÓ Û‡Ìʈӷ Ì ٷ ÎÏÈÓÈο ‰Â‰Ô̤ӷ, Ô‰ËÁ› Û˘ÓÙÔÌfiÙÂÚ· Î·È ·ÎÚÈ‚¤ÛÙÂÚ· ÛÙË ÛˆÛÙ‹ ‰È¿ÁÓˆÛË. ∏ ¯ÂÈÚÔ˘ÚÁÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ Û˘ÁÁÂÓÒÓ ‰È·Ì·ÚÙÈÒÓ Î·È Ë ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ ˘ÔÛÙËÚÈÎÙÈ΋ ‚Ô‹ıÂÈ· ¤¯Ô˘Ó ÂÍÂÏȯı›, ÌÂ Û˘Ó¤ÂÈ· ÙËÓ ÂÓÙ˘ˆÛȷ΋ Ì›ˆÛË Ù˘ ıÓËÙfiÙËÙ·˜. ∆¤ÏÔ˜, ·fi ÙË Ì·ÎÚÔ¯ÚfiÓÈ· ·Ú·ÎÔÏÔ‡ıËÛË ·ÏÏ¿ Î·È ·fi ÌÂϤÙ˜ Û ÂÈÚ·Ì·Ùfi˙ˆ·, ¤ÁÈÓ·Ó ÁÓˆÛÙ¿ ÂÚÈÛÛfiÙÂÚ· ÛÙÔȯ›· Á‡Úˆ ·fi ÙËÓ ÂÈÏÔÁ‹ ÙÔ˘ ηٷÏÏËÏfiÙÂÚÔ˘ ¯ÚfiÓÔ˘ ÁÈ· ÙËÓ Â¤Ì‚·ÛË. ¶ÚfiÛÊ·Ù· ÂΉfiıËΠÙfiÌÔ˜ Ô˘ ·Ó·Ê¤ÚÂÙ·È ·ÔÎÏÂÈÛÙÈο ÛÙȘ Û˘ÁÁÂÓ›˜ ‰È·Ì·Úٛ˜ ÙÔ˘ Ó‡ÌÔÓ· (1). √ ·Ó·ÁÓÒÛÙ˘ ·Ú·¤ÌÂÙ·È Û ·˘ÙfiÓ ÁÈ· ·Ó·Ï˘ÙÈÎfiÙÂÚË ÂÓË̤ڈÛË ·Ó¿ ¿ıËÛË (2). ™ÙÔ Î›ÌÂÓÔ Ô˘ ·ÎÔÏÔ˘ı› ·ÚÔ˘ÛÈ¿˙ÂÙ·È Û˘ÓÔÙÈο Ë ·ıÔÁ¤ÓÂÈ·, Ë ‰È·ÁÓˆÛÙÈ΋ ÚÔÛ¤ÁÁÈÛË Î·È Ë ·ÒÙÂÚË ¤Î‚·ÛË ÙˆÓ Û˘ÁÁÂÓÒÓ ‰È·Ì·ÚÙÈÒÓ ÙÔ˘ Ó‡ÌÔÓ·. ∆·ÍÈÓfiÌËÛË Î·È ÂÌ‚Ú˘ÔÁ¤ÓÂÛË ∏ ηٿٷÍË ÌÈ·˜ Û˘ÁÁÂÓÔ‡˜ ‰È·Ì·ÚÙ›·˜ ÙÔ˘ Ó‡ÌÔÓ· Ô˘ ·ÊÔÚ¿ ·ÔÎÏÂÈÛÙÈο Û ÌÈ· ·Ó·ÙÔÌÈ΋ ‰ÔÌ‹, fiˆ˜ Â›Ó·È Ë Û˘ÁÁÂÓ‹˜ ÛÙ¤ÓˆÛË ‚ÚfiÁ¯Ô˘ ‹ Ë ‚ÚÔÁ¯ÔÁÂÓ‹˜ ·ÛÙË, Â›Ó·È Û¯ÂÙÈο ·Ï‹. ŸÙ·Ó fï˜, Ë Û˘ÁÁÂÓ‹˜ ‰È·Ì·ÚÙ›· ÂÚÈÏ·Ì‚¿ÓÂÈ ÂÚÈÛÛfiÙÂÚ˜ Û˘ÓÈÛÙÒÛ˜, fiˆ˜ Ó¢ÌÔÓÈÎfi ·Ú¤Á¯˘Ì· Î·È ·ÁÁ›·, Ì ·ÓÙÈÚÔÛˆ¢ÙÈÎfi ·Ú¿‰ÂÈÁÌ· ÙÔ Ó¢ÌÔÓÈÎfi ·fiÏ˘Ì·, Ë Î·Ù¿Ù·ÍË Î·È Ë Î·Ù·ÓfiËÛË Ù˘ ÂÌ‚Ú˘ÔÁ¤ÓÂÛ˘ Ù˘ ‚Ï¿‚˘ ÌÔÚ› Ó· ·ÔÙÂÏ› Ú·ÁÌ·ÙÈο ÔχÏÔÎË ‰È·‰Èηۛ·. ¶·Ï·ÈfiÙÂÚË Î·Ù¿Ù·ÍË ·fi ÙÔ American College of Chest Physicians ·ÚÎÂ›Ù·È Û ·Ï‹ ·Ú¿ıÂÛË, ¯ˆÚ›˜ ·ıÔÁÂÓÂÙÈ΋ ÂÚÌËÓ›· (3). ∞ÎfiÌË Î·È Û‹ÌÂÚ· fï˜, ·Ú¿ ÙȘ ‰È¿ÊÔÚ˜ ıˆڛ˜ Ô˘ ¤¯Ô˘Ó ÚÔÙ·ı› (4-6), ‰ÂÓ ˘¿Ú¯ÂÈ ÈηÓÔÔÈËÙÈ΋ ÔÚÈÔı¤ÙËÛË Î·È Î·Ù¿Ù·ÍË ÙˆÓ Û˘ÁÁÂÓÒÓ ‰È·Ì·ÚÙÈÒÓ ÙÔ˘ Ó‡ÌÔÓ· Ì ‚¿ÛË ÙËÓ ·Ó·ÙÔÌ›· Î·È ÙËÓ ·ıÔÁ¤ÓÂÈ· (7). ∆Ô 1984, ÛÙËÓ ÂÚ›ÊËÌË ‰È¿ÏÂÍ‹ Ù˘ ÂȘ ÌÓ‹ÌËÓ ÙÔ˘ Tudor Edwards (Tudor Edwards memorial lecture), Ë Lynne Reid ·Ó·Ê¤ÚıËΠÛÙÔ˘˜ “ÙÚÂȘ ÓfiÌÔ˘˜” Ô˘ ‰È¤Ô˘Ó ÙËÓ ÂͤÏÈÍË ÙÔ˘ Ó‡ÌÔÓ· (8): 1) √È ‰È·ÎÏ·‰ÒÛÂȘ ÙÔ˘ ‚ÚÔÁ¯ÈÎÔ‡ ‰¤Ó‰ÚÔ˘ ¤¯Ô˘Ó ηıÔÚÈÛı› ÚÈÓ ·fi ÙÔ Ù¤ÏÔ˜ Ù˘ 16˘ ÂÌ‚Ú˘˚΋˜ ‚‰ÔÌ¿‰·˜.

2) ∏ ‰È¿Ï·ÛË ÙˆÓ Î˘„ÂÏ›‰ˆÓ ·Ú¯›˙ÂÈ ÙËÓ 24Ë ÂÌ‚Ú˘˚΋ ‚‰ÔÌ¿‰· Î·È Û˘Ó¯›˙ÂÙ·È ÌÂÙ¿ ÙË Á¤ÓÓËÛË.

3) ∆· “ÚÔ-‚ÔÙÚ˘‰È·Î¿ ·ÁÁ›·” (ÚÈÓ ÙÔ ‚ÔÙÚ‡‰ÈÔ ‹ ÚˆÙÔÁÂÓ¤˜ Ó¢ÌÔÓÈÎfi ÏÔ‚›‰ÈÔ, pre-acinar vessels) ·ÎÔÏÔ˘ıÔ‡Ó ÙË ‰ËÌÈÔ˘ÚÁ›· ÙˆÓ ·ÂÚ·ÁˆÁÒÓ,

ÂÓÒ Ù· “ÂÓ‰Ô-‚ÔÙÚ˘‰È·Î¿ ·ÁÁ›·” (intra-acinar vessels) ·ÎÔÏÔ˘ıÔ‡Ó ÂΛÓË ÙˆÓ Î˘„ÂÏ›‰ˆÓ. √È “ÓfiÌÔÈ” ·˘ÙÔ› ¤¯Ô˘Ó ÂȂ‚·Èˆı› ·fi ÙȘ ÂÚÈÁڷʛۘ ÎÏÈÓÈΤ˜ ÂÚÈÙÒÛÂȘ. √È Clements Î·È Warner Û ÙÚ›· ‰È·‰Ô¯Èο ¿ÚıÚ· Ô˘ ‰ËÌÔÛȇıËÎ·Ó ÙÔ 1987 ÛÙÔ ›‰ÈÔ Ù‡¯Ô˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ Thorax (9-11), ÂÈÛ‹Á·Á·Ó ÙËÓ ¤ÓÓÔÈ· “‰È·Ù·Ú·¯‹ ·Ó·ÛÙfïÛ˘” (malinosculation) ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂÚÌËÓ‡ÛÔ˘Ó Î·È Ó· ηٷٿÍÔ˘Ó ÙÔ Û‡ÓÔÏÔ ÙˆÓ Û˘ÁÁÂÓÒÓ ‰È·Ì·ÚÙÈÒÓ ÙÔ˘ Ó‡ÌÔÓ·, ·ÏÒÓ Î·È Û‡ÓıÂÙˆÓ. ªÂ ‚¿ÛË ÙËÓ ˘fiıÂÛË Ô˘ ‰È·Ù‡ˆÛ·Ó, Ë Ê˘ÛÈÔÏÔÁÈ΋ ·Ó·ÛÙfïÛË (inosculation) ÙˆÓ ‰È·ÊfiÚˆÓ Û˘ÛÙËÌ¿ÙˆÓ ÛˆÏ‹ÓˆÓ (·ÁˆÁÒÓ) ÙÔ˘ Ó‡ÌÔÓ· ·ÂÚ·ÁˆÁÒÓ, ·ÚÙËÚÈÒÓ, ÊÏ‚ÒÓ Î·È ÏÂÌÊ·ÁÁ›ˆÓÔ‰ËÁ› ÛÙË ‰È¿Ï·ÛË ÙÔ˘ Ê˘ÛÈÔÏÔÁÈÎÔ‡ Ó‡ÌÔÓ·. µ¿ÛË ÙˆÓ Û˘ÁÁÂÓÒÓ ‰È·Ì·ÚÙÈÒÓ ÙÔ˘ Ó‡ÌÔÓ·, ÏÈÁfiÙÂÚÔ ‹ ÂÚÈÛÛfiÙÂÚÔ Û‡ÓıÂÙˆÓ ·ÔÙÂÏ› Ë ‰È·Ù·Ú·¯‹ ·Ó·ÛÙfïÛ˘ ÂÓfi˜ ‹ ÂÚÈÛÛÔÙ¤ÚˆÓ ·fi Ù· ·Ú·¿Óˆ Û˘ÛÙ‹Ì·Ù· ÛˆÏ‹ÓˆÓ (malinosculation). √ ¯ÚfiÓÔ˜ ‰Ú¿Û˘ ÙÔ˘ ‚Ï·ÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ηıÔÚ›˙ÂÈ Â¿Ó Ë ‰È·Ì·ÚÙ›· ı· Â›Ó·È ÂÓ‰Ô- ‹ Â͈-Ó¢ÌÔÓÈ΋. ™˘ÓÔÙÈο, ÔÈ ‰È¿ÊÔÚ˜ Û˘ÁÁÂÓ›˜ ‰È·Ì·Úٛ˜ ÌÔÚÔ‡Ó Ó· Ù·ÍÈÓÔÌËıÔ‡Ó ˆ˜ ÂÍ‹˜: 1. ¢È·Ù·Ú·¯‹ ‰È¿Ï·Û˘ ÙÔ˘ ·ÂÚ·ÁˆÁÔ‡ Î·È ÙˆÓ ·ÁÁ›ˆÓ Ô˘ ÙÔÓ ·Ú‰Â‡Ô˘Ó Ô‰ËÁ› Û ·ÁÂÓÂÛ›· ‹ ˘ÔÏ·Û›· Ó‡ÌÔÓ·, ÏÔ‚Ô‡ ‹ ÙÌ‹Ì·ÙÔ˜, ·Ó·ÏfiÁˆ˜ ÙÔ˘ ›‰Ô˘˜, Ù˘ ¤ÓÙ·Û˘ Î·È Ù˘ ¯ÚÔÓÈ΋˜ ÛÙÈÁÌ‹˜ Ô˘ ÂΉËÏÒıËΠÙÔ ‚Ï·ÙÈÎfi ÂÚ¤ıÈÛÌ·.

2. ¶ÂÚÈÔÚÈṲ̂ÓË Î·È ÂÓÙÔÈṲ̂ÓË ‰È·Ù·Ú·¯‹ ‰È¿Ï·Û˘ ÂÚÈÊÂÚÈÎÔ‡ ‚ÚfiÁ¯Ô˘ Ô˘ ·ÎÔÏÔ˘ıÂ›Ù·È ·fi Ê˘ÛÈÔÏÔÁÈ΋ ÂÚ·ÈÙ¤Úˆ ·Ó¿Ù˘ÍË, ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û ÛÙ¤ÓˆÛË ‚ÚfiÁ¯Ô˘, ‚ÚÔÁ¯ÔÁÂÓ‹ ·ÛÙË ‹ ‰˘ÛÏ·Û›· ¯fiÓ‰ÚÔ˘ Ì ·ÔÙ¤ÏÂÛÌ· ÙÚ·¯ÂÈÔ-/‚ÚÔÁ¯ÔÌ·Ï¿Î˘ÓÛË ‹ Û˘ÁÁÂÓ¤˜ ÏԂ҉˜ ÂÌʇÛËÌ·.

3. ™Â Û¿ÓȘ ÂÚÈÙÒÛÂȘ ‰È·Ù·Ú¿ÛÛÂÙ·È Ë ‰È¿Ï·ÛË Ó¢ÌÔÓÈ΋˜ ·ÚÙËÚ›·˜ ¯ˆÚ›˜ ·ÓÙ›ÛÙÔÈ¯Ë ‰È·Ù·Ú·¯‹ Ù˘ ·Ó¿Ù˘Í˘ ÙÔ˘ ‚ÚfiÁ¯Ô˘, ÒÛÙ ÙÔ Ê˘ÛÈÔÏÔÁÈÎfi ‚ÚÔÁ¯ÔÓ¢ÌÔÓÈÎfi ÙÌ‹Ì· Ó· ·Ú‰Â‡ÂÙ·È ·fi ·ÓÒÌ·ÏË ·ÚÙËÚ›· Ù˘ Û˘ÛÙËÌ·ÙÈ΋˜ ΢ÎÏÔÊÔÚ›·˜.

4. ∆Ô ‚Ï·ÙÈÎfi ÂÚ¤ıÈÛÌ· ÚÔηÏ› ‰È·Ù·Ú·¯‹ Ù˘ ‰È¿Ï·Û˘ ÙÔ˘ ·ÚÂÁ¯‡Ì·ÙÔ˜ Î·È Ù˘ ·ÚÙËÚ›·˜ ÌÂ Û˘Ó¤ÂÈ· ÙÔ “ÎÏ·ÛÈÎfi” ·fiÏ˘Ì· (sequestration), ÙȘ Û˘ÁÁÂÓ›˜ ·ÛÙÂȘ Ì ·ÓÒÌ·ÏË Û˘ÛÙËÌ·ÙÈ΋ ·ÁÁ›ˆÛË Î·È Èı·ÓfiÓ ÙË Û˘ÁÁÂÓ‹ ΢ÛÙÈ΋ ‚ÚÔÁ¯ÂÎÙ·Û›·.

5. ∆¤ÏÔ˜, Â¿Ó ‰È·Ù·Ú·¯ı› Ë ·Ó¿Ù˘ÍË ÙÔ˘ ·ÂÚ·ÁˆÁÔ‡ ¯ˆÚ›˜ Û˘ÓÔ‰fi ‰È·Ù·Ú·¯‹ Ù˘ ·ÚÙËÚȷ΋˜ ¿Ú‰Â˘Û˘, ÌÔÚ› Ó· ÚÔ·„ÂÈ Ó¢ÌÔÓÈ΋ ·ÛÙË, ·fiÏ˘Ì· ÌÂ Ê˘ÛÈÔÏÔÁÈ΋ ¿Ú‰Â˘ÛË (·fi Ó¢ÌÔÓÈ΋ ·ÚÙËÚ›·), ΢ÛÙÈ΋ ·‰ÂÓÔÌ·ÙÔÂȉ‹˜ ‰È·Ì·ÚÙ›· ‹ Û˘ÁÁÂÓ¤˜ ÏԂ҉˜ ÂÌʇÛËÌ·. ∏ ‰È¿Ï·ÛË ÙÔ˘ ÊÏ‚ÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ¤¯ÂÈ ‰ÈÂÚ¢ÓËı› ÏÈÁfiÙÂÚÔ. ™Â ÔÔÈ·‰‹ÔÙ ·fi ÙȘ ·Ú·¿Óˆ ÂÚÈÙÒÛÂȘ ÌÔÚ› Ó· Û˘Ó˘¿Ú¯ÂÈ ‰È·Ù·Ú·¯‹ ¶·È‰È·ÙÚÈ΋ 2007;70:184-191

Pediatri May-Jun 07

24-05-07

17:58

™ÂÏ›‰·186

186

∫. ¡. ¶Ú›ÊÙ˘ Î·È Û˘Ó.

Ù˘ ÊÏ‚È΋˜ ·ÚÔ¯¤Ù¢Û˘. √È ·ÓÒ̷Ϙ ÊϤ‚˜ (·Ú·ÏÏ·Á‹ Û˘Ó‰ÚfiÌÔ˘ Scimitar) ÌÔÚ› Ó· ηٷϋÁÔ˘Ó ÛÙÔÓ ‰ÂÍÈfi ÎfiÏÔ, ÛÙËÓ ¿Óˆ ‹ οو ÎÔ›ÏË ÊϤ‚· Î·È ÂÓ›ÔÙ ÛÙÔÓ ·ÚÈÛÙÂÚfi ÎfiÏÔ.

¢È·ÁÓˆÛÙÈ΋ ÚÔÛ¤ÁÁÈÛË ∏ ·ıÔÏÔÁ›· ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÂÎÊÚ¿˙ÂÙ·È Ì ÂÚÈÔÚÈṲ̂ÓÔ Ê¿ÛÌ· Û˘ÌÙˆÌ¿ÙˆÓ Î·È ÛËÌ›ˆÓ, ÔÈ Û˘Ó‰˘·ÛÌÔ› ÙˆÓ ÔÔ›ˆÓ (ÎÏÈÓÈ΋ ÂÈÎfiÓ·) Û¿ÓÈ· ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·ÍÈÔÛËÌ›ˆÙË ÂȉÈÎfiÙËÙ·. ∞Ó¿ÏÔÁÔ Úfi‚ÏËÌ· ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ù· ·Ú·ÎÏÈÓÈο ÂÚÁ·ÛÙËÚȷο ÂÚÁ·Ï›· ÚÒÙ˘ ÁÚ·ÌÌ‹˜ (·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη, ÛÈÚÔÌÂÙÚ›·, Ô͢ÌÂÙÚ›·, ·¤ÚÈ· ·›Ì·ÙÔ˜, ÁÂÓÈΤ˜ ·ÈÌ·ÙÔÏÔÁÈΤ˜ ÂÍÂÙ¿ÛÂȘ). ∫·Ù¿ Û˘Ó¤ÂÈ·, ÙÔ “ÊÙˆ¯fi ÏÂÍÈÏfiÁÈÔ” Ù˘ ·ıÔÏÔÁ›·˜ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙË Û·ÓÈfiÙËÙ· ÙˆÓ Û˘ÁÁÂÓÒÓ ‰È·Ì·ÚÙÈÒÓ ÙÔ˘ Ó‡ÌÔÓ·, ηıÈÛÙÔ‡Ó ··Ú·›ÙËÙÔ ÙÔÓ ˘„ËÏfi ‰Â›ÎÙË ˘Ô„›·˜ ÂΠ̤ÚÔ˘˜ ÙÔ˘ ÎÏÈÓÈÎÔ‡ ÁÈ·ÙÚÔ‡ ÚÔÎÂÈ̤ÓÔ˘ Ó· Ô‰ËÁËı› ÛÙË ‰È¿ÁÓˆÛ‹ ÙÔ˘˜. ∏ Û˘ÁÁÂÓ‹˜ ‰È·Ì·ÚÙ›· ÙÔ˘ Ó‡ÌÔÓ· ÌÔÚ› Ó· Â›Ó·È ÁÓˆÛÙ‹ ‹‰Ë ·fi ÙÔÓ ÚÔÁÂÓÓËÙÈÎfi ¤ÏÂÁ¯Ô, Ó· ÂΉËψı› ˆ˜ Â›ÁÔ˘Û· ηٿÛÙ·ÛË ÛÙȘ ÚÒÙ˜ ÛÙÈÁ̤˜ Ù˘ ˙ˆ‹˜ ‹ Ó· ·ÚÔ˘ÛÈ·Ûı› ·ÚÁfiÙÂÚ· (ÓÂÔÁÓÈ΋, fi„ÈÌË ‚ÚÂÊÈ΋, ·È‰È΋ ËÏÈΛ·, ÂÊ˂›·, ÂÓ‹ÏÈÎÔ ˙ˆ‹). ∂Ó›ÔÙ ÔÈ Û˘ÁÁÂÓ›˜ ‰È·Ì·Úٛ˜ ·Ú·Ì¤ÓÔ˘Ó ·Û˘Ìو̷ÙÈΤ˜ Î·È ·ÔÙÂÏÔ‡Ó Ù˘¯·›Ô ·ÎÙÈÓÔÁÚ·ÊÈÎfi ‡ÚËÌ·. Ÿ¯È Û¿ÓÈ· Ù¤ÏÔ˜, Û˘Óԉ‡ÔÓÙ·È ·fi ‰È·Ì·Úٛ˜ ¿ÏÏˆÓ Û˘ÛÙËÌ¿ÙˆÓ -Û˘¯ÓfiÙÂÚ· ÙÔ˘ ηډȷÁÁÂÈ·ÎÔ‡ ·ÏÏ¿ Î·È ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡, Ì˘ÔÛÎÂÏÂÙÈÎÔ‡, Ô˘ÚÔÔÈÔÁÂÓÓËÙÈÎÔ‡- ‹ ·ÔÙÂÏÔ‡Ó Û˘ÛÙ·ÙÈο ÛÙÔȯ›· Û˘Ó‰ÚfïÓ, Ì ·ÔÙ¤ÏÂÛÌ· Ó· ÂΉËÏÒÓÔÓÙ·È ÌÂ Û˘Ìو̷ÙÔÏÔÁ›· ÂÎÙfi˜ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ (7,12-14). ¶ÚÔÁÂÓÓËÙÈ΋ ‰È¿ÁÓˆÛË Î·È ÂΉËÏÒÛÂȘ ÛÙÔ ÓÂÔÁ¤ÓÓËÙÔ Î·È ÛÙÔ˘˜ ÚÒÙÔ˘˜ Ì‹Ó˜ ˙ˆ‹˜ √È Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜ ÙÔ˘ Ó‡ÌÔÓ· ÌÔÚ› Ó· ÂΉËψıÔ‡Ó ‹‰Ë ·fi ÙËÓ ÂÓ‰ÔÌ‹ÙÚÈÔ ˙ˆ‹ Î·È Ó· ÂÓÙÔÈÛıÔ‡Ó Ì ÙËÓ ˘ÂÚ˯ÔÁÚ·ÊÈ΋ ÂͤٷÛË ÙÔ˘ ÂÌ‚Ú‡Ô˘. ∆Ô ÔÏÈÁÔ¸‰Ú¿ÌÓÈÔ Â›Ó·È ÙÔ ‰Â‡ÙÂÚÔ ÛÂ Û˘¯ÓfiÙËÙ· ·›ÙÈÔ Ù˘ ·Ï·Û›·˜ ‹ ˘ÔÏ·Û›·˜ ÙÔ˘ Ó‡ÌÔÓ·. ¶ÔÏ˘˘‰Ú¿ÌÓÈÔ ÌÔÚ› Ó· ÚÔηϤÛÂÈ Ë ·ÙÚËÛ›· ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘, ȉȷ›ÙÂÚ· fiÙ·Ó Û˘Óԉ‡ÂÙ·È ·fi ÙÚ·¯ÂÈÔÔÈÛÔÊ·ÁÈÎfi Û˘Ú›ÁÁÈÔ Î·È ÔÔÈ·‰‹ÔÙ ¯ˆÚÔηٷÎÙËÙÈ΋ ÂÓ‰ÔıˆÚ·ÎÈ΋ ‚Ï¿‚Ë, fiÙ·Ó ·˘Ù‹ Ô‰ËÁ› Û ÛÔ‚·Ú‹ Ì›ˆÛË ÙÔ˘ fiÁÎÔ˘ ÙˆÓ Ó¢ÌfiÓˆÓ, ·ÊÔ‡ Ê˘ÛÈÔÏÔÁÈο ÂÚȤ¯Ô˘Ó ÙÔ ÂÓ‰ÔÓ¢ÌÔÓÈÎfi ˘ÁÚfi, ·Ó¿ÏÔÁÔ ÙÔ˘ ·ÌÓÈ·ÎÔ‡ (Û˘ÁÁÂÓ‹˜ ‰È·ÊÚ·ÁÌ·ÙÔ΋ÏË, ¢ÌÂÁ¤ı˘ ‚ÚÔÁ¯ÔÁÂÓ‹˜ ·ÛÙË, ΢ÛÙÈ΋ ·‰ÂÓÔÌ·ÙÔÂȉ‹˜ ‰˘ÛÏ·Û›·, Â˘Ì¤ÁÂı˜ ·fiÏ˘Ì·) (15). ¶ÔÏϤ˜ Û˘ÁÁÂÓ›˜ ‰È·Ì·Úٛ˜ ÙÔ˘ Ó‡ÌÔÓ· ÂΉËÏÒÓÔÓÙ·È ˆ˜ Â›ÁÔÓÙ· ·Ó·Ó¢ÛÙÈο ÂÚÈÛÙ·ÙÈο Paediatriki 2007;70:184-191

Ì ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ·, ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË ÙÔ˘ ¤ÚÁÔ˘ ·Ó·ÓÔ‹˜ ‹/Î·È Î˘¿ÓˆÛË (¶›Ó·Î·˜ 1) (3). ∆Ô ÈÛÙÔÚÈÎfi ‰‡ÛÎÔÏÔ˘ ÙÔÎÂÙÔ‡ ı¤ÙÂÈ ˘Ô„›· ÙÚ·˘Ì·ÙÈ΋˜ ·Ú¿Ï˘Û˘ ÙÔ˘ ÊÚÂÓÈÎÔ‡ Ó‡ÚÔ˘ Î·È Ë ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ· Ô˘ Û˘Óԉ‡ÂÙ·È ·fi ·‰˘Ó·Ì›· ‰È·ÚÚÈÓÈ΋˜ ‰È¿‚·Û˘ ÙÔ˘ ÚÈÓÔÁ·ÛÙÚÈÎÔ‡ ηıÂÙ‹Ú· ˘Ô‰ËÏÒÓÂÈ ·ÌÊÔÙÂÚfiÏ¢ÚË ·ÙÚËÛ›· ÚÈÓÈÎÒÓ ¯Ô·ÓÒÓ. ∫·Ù¿ ÙËÓ ÎÏÈÓÈ΋ ÂͤٷÛË ÙÔ˘ ÓÂÔÁ¤ÓÓËÙÔ˘, Ë ·Ô˘Û›· ·Ó·Ó¢ÛÙÈÎÒÓ ‹¯ˆÓ ÛÙÔ ¤Ó· ‹ Î·È ÛÙ· ‰‡Ô ËÌÈıˆÚ¿ÎÈ· ı¤ÙÂÈ ˙‹ÙËÌ· Èı·Ó‹˜ ÂÙÂÚfiÏ¢Ú˘ ·Ï·Û›·˜/˘ÔÏ·Û›·˜ (ÌÔÚ› Ó· Û˘Óԉ‡ÂÙ·È ·fi ÂÈ¤‰ˆÛË Î·È ÂÏ·Ùو̤ÓË ÎÈÓËÙÈÎfiÙËÙ· Û‡ÛÙÔȯ·, Û˘ÁÁÂÓ‹ ηډÈÔ¿ıÂÈ· Î·È ·ÓˆÌ·Ï›Â˜ ÚÔÛÒÔ˘), Û˘ÁÁÂÓÔ‡˜ ÏÔ‚Ò‰Ô˘˜ ÂÌÊ˘Û‹Ì·ÙÔ˜, Û˘ÁÁÂÓÔ‡˜ ‰È·ÊÚ·ÁÌ·ÙÔ΋Ï˘ (85% ÛÙÔ ·ÚÈÛÙÂÚfi ËÌÈıˆÚ¿ÎÈÔ), ÌÂÁ¿Ï˘ ¯ˆÚÔηٷÎÙËÙÈ΋˜ ‚Ï¿‚˘ (Û˘ÁÁÂÓ‹˜ ‰È·ÊÚ·ÁÌ·ÙÔ΋ÏË, Û˘ÁÁÂÓ‹˜ ÌÂÛÔıˆÚ·ÎÈ΋ ‹ ·ÚÂÁ¯˘Ì·ÙÈ΋ ·ÛÙË, ΢ÛÙÈ΋ ·‰ÂÓÔÌ·ÙÔÂȉ‹˜ ‰˘ÛÏ·Û›·, Ôχ ÌÂÁ¿ÏÔ ·fiÏ˘Ì·) ‹ Û·ÓÈfiÙÂÚ·, ÂÎÛÂÛËÌ·Ṳ̂Ó˘ ‰È¿Ù·Û˘ Ù˘ ÎÔÈÏÈ¿˜, ÔfiÙ ‰ÈÂÚÂ˘Ó¿Ù·È ÙÔ ·›ÙÈÔ Ù˘ ‰È¿Ù·Û˘. ∞ÎÚfi·ÛË ÂÓÙÂÚÈÎÒÓ ‹¯ˆÓ ÛÙÔ ·ÚÈÛÙÂÚfi ËÌÈıˆÚ¿ÎÈÔ Ô˘ Û˘Óԉ‡ÂÙ·È ·fi ÛηÊÔÂȉ‹ ÎÔÈÏÈ¿ ηÙ¢ı‡ÓÔ˘Ó ÙË ‰È·ÁÓˆÛÙÈ΋ ÛΤ„Ë ÚÔ˜ ÙË Û˘ÁÁÂÓ‹ ‰È·ÊÚ·ÁÌ·ÙÔ΋ÏË. ™ÙȘ ÂÚÈÙÒÛÂȘ ·˘Ù¤˜, Ô ·ÂÚÈÛÌfi˜ Ì ·ÛÎfi Î·È Ì¿Ûη ÌÔÚ› Ó· ÂȉÂÈÓÒÛÂÈ ÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ¶›Ó·Î·˜ 1. ™˘ÁÁÂÓ›˜ ‰È·Ì·Úٛ˜ ÙÔ˘ Ó‡ÌÔÓ· Ô˘ ÌÔÚ› Ó· ÂΉËψıÔ‡Ó ˆ˜ Â›ÁÔÓÙ· ÂÚÈÛÙ·ÙÈο ÛÙÔ ÓÂÔÁ¤ÓÓËÙÔ ñ ∞ÙÚËÛ›· ÚÈÓÈÎÒÓ ¯Ô·ÓÒÓ ñ ∞˘¯ÂÓÈΤ˜ Ì¿˙˜ (ÏÂÌÊ·ÁÁ›ˆÌ·, ·ÈÌ·ÁÁ›ˆÌ·, Û˘ÁÁÂÓ‹˜ ‚ÚÔÁ¯Ô΋ÏË, ·ÛÙË ı˘ÚÂÔÁψÛÛÈÎÔ‡ fiÚÔ˘, ‚Ú·Á¯È·Î‹ ·ÛÙË) ñ ÀÂÚÁψÙÙȉÈ΋ Û‡ÓÙËÍË Ï¿Ú˘ÁÁ·, ·ÏËı‹˜ Ï·Ú˘ÁÁÈ΋ ÌÂÌ‚Ú¿ÓË, Ï·Ú˘ÁÁÈ΋ ·ÛÙË, ‰˘ÛÏ·Û›· ÎÚÈÎÔÂȉԇ˜ ¯fiÓ‰ÚÔ˘, ·Ú¿Ï˘ÛË ÊˆÓËÙÈÎÒÓ ¯ÔÚ‰ÒÓ ñ ∞ÁÁÂÈ·Îfi˜ ‰·ÎÙ‡ÏÈÔ˜ (Û¿ÓÈÔ, Û ·ÎÚ·›Â˜ ÂÚÈÙÒÛÂȘ) ñ ∫‡ÛÙÂȘ Î·È fiÁÎÔÈ ÌÂÛÔıˆÚ·Î›Ô˘ (¢ÌÂÁ¤ıÂȘ, Â› ÛËÌ·ÓÙÈ΋˜ ·fiÊڷ͢) ñ ∞ÙÚËÛ›· ÔÈÛÔÊ¿ÁÔ˘ Ì ‹ ¯ˆÚ›˜ ÙÚ·¯ÂÈÔÔÈÛÔÊ·ÁÈÎfi Û˘Ú›ÁÁÈÔ ñ µÚÔÁ¯ÔÁÂÓ›˜ ·ÛÙÂȘ (¢ÌÂÁ¤ıÂȘ, Â› ÛËÌ·ÓÙÈ΋˜ ·fiÊڷ͢) ñ ∫˘ÛÙÈ΋ ·‰ÂÓÔÌ·ÙÔÂȉ‹˜ ‰˘ÛÏ·Û›· (75% ÂΉ‹ÏˆÛË ÛÙÔ ÓÂÔÁ¤ÓÓËÙÔ) ñ ™˘ÁÁÂÓ¤˜ ÏԂ҉˜ ÂÌʇÛËÌ· (50% ÂΉ‹ÏˆÛË ÛÙÔÓ ÚÒÙÔ Ì‹Ó· ˙ˆ‹˜) ñ ¶Ó¢ÌÔÓÈÎfi ·fiÏ˘Ì· (Û¿ÓÈÔ, ÂÊfiÛÔÓ È‰È·›ÙÂÚ· Â˘Ì¤ÁÂı˜) ñ ∞ÁÂÓÂÛ›·/˘ÔÏ·Û›· Ó‡ÌÔÓ· ñ ¶Ó¢ÌÔıÒڷη˜ (Û˘Ó¤ÂÈ· ڋ͢ ΢ÛÙÈÎÔ‡ Û¯ËÌ·ÙÈÛÌÔ‡) ñ ™˘ÁÁÂÓ‹˜ ÏÂÌÊ·ÁÁÂÈÂÎÙ·Û›·, ¯˘ÏÔıÒڷη˜ ñ ¢˘ÛϷۛ˜ ıˆÚ·ÎÈÎÔ‡ ÙÔȯÒÌ·ÙÔ˜ ñ ∂ÎÛÂÛËÌ·Ṳ̂ÓË ‰È¿Ù·ÛË Ù˘ ÎÔÈÏÈ¿˜ (ÔÈΛÏ˘ ·ÈÙÈÔÏÔÁ›·˜)

Pediatri May-Jun 07

24-05-07

17:58

™ÂÏ›‰·187

187

™˘ÁÁÂÓ›˜ ‰È·Ì·Úٛ˜ Ó¢ÌfiÓˆÓ

ÏfiÁˆ ‰È¿Ù·Û˘ ÙÔ˘ ÛÙÔÌ¿¯Ô˘ Ô˘ ‚Ú›ÛÎÂÙ·È ÛÙË ıˆÚ·ÎÈ΋ ÎÔÈÏfiÙËÙ·. ∏ ηډȷ΋ ÛÎÈ¿ ·ˆıÂ›Ù·È ÚÔ˜ Ù· ‰ÂÍÈ¿. ∫ÏÈÓÈο ÛËÌ·ÓÙÈÎfi˜ Ó¢ÌÔıÒڷη˜ ÌÔÚ› Ó· Â›Ó·È Û˘Ó¤ÂÈ· Û˘ÁÁÂÓÔ‡˜ ÏÔ‚Ò‰Ô˘˜ ÂÌÊ˘Û‹Ì·ÙÔ˜ ‹ ÔÔÈ·Û‰‹ÔÙ ¢ÌÂÁ¤ıÔ˘˜ Û˘ÁÁÂÓÔ‡˜ ΢ÛÙÈ΋˜ ·ÓˆÌ·Ï›·˜. ∞‰˘Ó·Ì›· Û›ÙÈÛ˘ Ì ÓÈÁÌÔÓ‹ Î·È Èı·Ó‹ ÂÈÛÚfiÊËÛË, Ì ·Ú¿ÏÏËÏË ·‰˘Ó·Ì›· ÚÔÒıËÛ˘ ÙÔ˘ ÚÈÓÔÁ·ÛÙÚÈÎÔ‡ ηıÂÙ‹Ú· ÛÙÔÓ ÔÈÛÔÊ¿ÁÔ, ·Ú·¤ÌÂÈ Û ÙÚ·¯ÂÈÔÔÈÛÔÊ·ÁÈÎfi Û˘Ú›ÁÁÈÔ Ì ·ÙÚËÛ›· ÔÈÛÔÊ¿ÁÔ˘ (Û˘¯ÓfiÙÂÚÔ˜ Ù‡Ô˜), Ô˘ ÌÔÚ› Ó· ÂȂ‚·Èˆı› ·ÎÙÈÓÔÁÚ·ÊÈο ·fi ÙËÓ ÔÚ›· ÙÔ˘ ÚÈÓÔÁ·ÛÙÚÈÎÔ‡ ηıÂÙ‹Ú· ‹ Ì ÙË ¯Ú‹ÛË ÛÎÈ·ÁÚ·ÊÈÎÔ‡ ˘ÏÈÎÔ‡. ÕÏϘ Û˘ÁÁÂÓ›˜ ‰È·Ì·Úٛ˜ Ô˘ ÚÔ‚¿ÏÏÔ˘Ó ˆ˜ Â›ÁÔ˘Û˜ ηٷÛÙ¿ÛÂȘ ÛÙÔ ÓÂÔÁ¤ÓÓËÙÔ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙȘ ÛÔ‚·Ú¤˜ ‰˘ÛϷۛ˜ ÙÔ˘ Ï¿Ú˘ÁÁ· Î·È Ù˘ ÙÚ·¯Â›·˜ (Ï‹Ú˘ Û‡ÓÙËÍË ÙˆÓ ˘ÂÚÁψÙÙȉÈÎÒÓ ·Ó·ÙÔÌÈÎÒÓ ÌÔÚ›ˆÓ, ·ÏËı›˜ Ï·Ú˘ÁÁÈΤ˜ ÌÂÌ‚Ú¿Ó˜, Ï·Ú˘ÁÁÈΤ˜ ·ÛÙÂȘ, ‰˘ÛÏ·Û›· ÎÚÈÎÔÂȉԇ˜ ¯fiÓ‰ÚÔ˘, ·ÌÊÔÙÂÚfiÏ¢ÚË ·Ú¿Ï˘ÛË ÊˆÓËÙÈÎÒÓ ¯ÔÚ‰ÒÓ), ÙȘ Ì¿˙˜ ·˘¯ÂÓÈ΋˜ ÌÔ›Ú·˜ (ÏÂÌÊ·ÁÁ›ˆÌ·, ·ÈÌ·ÁÁ›ˆÌ·, Û˘ÁÁÂÓ‹˜ ‚ÚÔÁ¯Ô΋ÏË, ÌÂÁ¿Ï˜ ‚Ú·Á¯È·Î¤˜ ·ÛÙÂȘ ‹ ·ÛÙÂȘ ı˘ÚÂÔÁψÛÛÈÎÔ‡ fiÚÔ˘) Û·Ó›ˆ˜ ÙȘ ·ÎÚ·›Â˜ ÌÔÚʤ˜ ·ÁÁÂÈ·ÎÔ‡ ‰·ÎÙ˘Ï›Ô˘ (·Á·ÏË ·ÚÈÛÙÂÚ¿˜ Ó¢ÌÔÓÈ΋˜ ·ÚÙËÚ›·˜ Ì ÛÙ¤ÓˆÛË ÙÚ·¯Â›·˜ ÏfiÁˆ Ï‹ÚˆÓ ¯fiÓ‰ÚÈÓˆÓ ‰·ÎÙ˘Ï›ˆÓ, ring-sling syndrome) Î·È Ù· ÂÏÏ›ÌÌ·Ù· ÙÔ˘ ıˆÚ·ÎÈÎÔ‡ ÙÔȯÒÌ·ÙÔ˜ (ÛÙÂÚÓÈ΋ Û¯ÈÛÙ›·, ·Ô˘Û›· ÙÌËÌ¿ÙˆÓ Ï¢ÚÒÓ Î.Ï.) (7,12-14,16). µÏ¿‚˜ ÛÙÔ Â›Â‰Ô Ù˘ ÁψÙÙ›‰·˜ ÌÔÚ› Ó· Û˘Óԉ‡ÔÓÙ·È ·fi ·ÊˆÓ›· ‹ ‚Ú·¯Ófi Î·È ·‰‡Ó·ÌÔ ÎÏ¿Ì·. ∏ ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ· ÏfiÁˆ Â͈ıˆÚ·ÎÈ΋˜ ·fiÊڷ͢ ÙÔ˘ ·ÂÚ·ÁˆÁÔ‡ ÚÔηÏ› ÚˆÙ›ÛÙˆ˜ ÂÈÛÓ¢ÛÙÈÎfi Î·È Èı·ÓfiÓ ‰ÈÊ·ÛÈÎfi ÛÈÁÌfi, ·Ó Î·È ·˘Ùfi ÙÔ ÎÏÈÓÈÎfi ÛËÌÂ›Ô ÂΉËÏÒÓÂÙ·È Û˘Ó‹ıˆ˜ ·ÚÁfiÙÂÚ·, ηٿ ÙÔ˘˜ ÚÒÙÔ˘˜ Ì‹Ó˜ Ù˘ ˙ˆ‹˜. √ ·ÁÁÂÈ·Îfi˜ ‰·ÎÙ‡ÏÈÔ˜ Ô˘ ÂΉËÏÒÓÂÙ·È ÓˆÚ›˜ Û˘Óԉ‡ÂÙ·È ·fi ÌÔÓÔʈÓÈÎfi ‹ Û˘¯Ó¿ ‰ÈÊ·ÛÈÎfi Û˘ÚÈÁÌfi (ÂÓ‰ÔıˆÚ·ÎÈ΋ ·fiÊÚ·ÍË ÙÚ·¯Â›·˜) ηıÒ˜ Î·È ·fi ÚÔ‚Ï‹Ì·Ù· Û›ÙÈÛ˘, ÛÈÂÏfiÚÚÔÈ· Î·È ÂÈÎfiÓ· ÔÈÛıfiÙÔÓÔ˘. ∏ ÛÔ‚·Ú‹ ÙÚ·¯ÂÈÔÌ·Ï¿Î˘ÓÛË ÏfiÁˆ ·ÁÁÂÈ·ÎÔ‡ ‰·ÎÙ˘Ï›Ô˘ ‹ Ë ·Ú·ÌÔÓ‹ Ù˘ ÌÂÙ¿ ‰ÈfiÚıˆÛË ÙÚ·¯ÂÈÔÔÈÛÔÊ·ÁÈÎÔ‡ Û˘ÚÈÁÁ›Ô˘ Î·È ÔÈ ÂÈÛÚÔÊ‹ÛÂȘ ÔÈΛÏ˘ ·ÈÙÈÔÏÔÁ›·˜ (ÙÚ·¯ÂÈÔÔÈÛÔÊ·ÁÈÎfi Û˘Ú›ÁÁÈÔ, Ï·Ú˘ÁÁÈ΋ Û¯ÈÛÌ‹, ·Û˘Ó¤ÚÁÂÈ· Ì˘ÒÓ Î·Ù¿ÔÛ˘, Á·ÛÙÚÔÔÈÛÔÊ·ÁÈ΋ ·ÏÈÓ‰ÚfiÌËÛË) ÌÔÚ› Ó· ÂΉËψıÔ‡Ó Ì ÂÂÈÛfi‰È· ¿ÓÔÈ·˜ Î·È ‚Ú·‰˘Î·Ú‰›·˜. ∏ Û˘ÁÁÂÓ‹˜ ÏÂÌÊ·ÁÁÂÈÂÎÙ·Û›· ÂΉËÏÒÓÂÙ·È Ì ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ· Î·È Î˘¿ÓˆÛË ·fi ÙȘ ÚÒÙ˜ ÒÚ˜ ˙ˆ‹˜, ÂÓÒ ÙÔ ·Ó·Ó¢ÛÙÈÎfi „Èı‡ÚÈÛÌ· ·ÎÔ‡ÁÂÙ·È ·ÚÔÛ‰fiÎËÙ· Ê˘ÛÈÔÏÔÁÈÎfi. ∏ Â›ÁÔ˘Û· ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη ÌÔÚ› Ó· ‚ÔËı‹ÛÂÈ ÛËÌ·ÓÙÈο ÛÙË ‰È¢ÎÚ›ÓÈÛË ÙˆÓ ·ÓˆÙ¤Úˆ

Û˘ÁÁÂÓÒÓ ·ÓˆÌ·ÏÈÒÓ. ™Â οı ÂÚ›ÙˆÛË, ÚÔ¤¯ÂÈ Ë Î·Ú‰ÈÔ·Ó·Ó¢ÛÙÈ΋ ÛÙ·ıÂÚÔÔ›ËÛË ÙÔ˘ ¿Û¯ÔÓÙÔ˜ ÓÂÔÁÓÔ‡, Ô˘ ÌÔÚ› Ó· ··ÈÙ‹ÛÂÈ ÂÓÙ·ÙÈ΋ ıÂÚ·›· Î·È Ì˯·ÓÈ΋ ˘ÔÛÙ‹ÚÈÍË. ÿÛˆ˜ ¯ÚÂÈ·Ûı› Â›ÁÔ˘Û· ¯ÂÈÚÔ˘ÚÁÈ΋ ·ÓÙÈÌÂÙÒÈÛË (.¯. ÙÚ·¯ÂÈÔÛÙÔÌ›·) ÚÔÎÂÈ̤ÓÔ˘ Ó· ·Úı›, ¤ÛÙˆ ÚÔÛˆÚÈÓ¿, ÙÔ ·›ÙÈÔ Ô˘ ‰È·Î˘‚‡ÂÈ ÙË ‚·ÙfiÙËÙ· ÙÔ˘ ·ÂÚ·ÁˆÁÔ‡. √ ÂÚ·ÈÙ¤Úˆ ¤ÏÂÁ¯Ô˜ ÌÔÚ› Ó· ÂÚÈÏ¿‚ÂÈ ÛÂÈÚ¿ ·ÂÈÎÔÓÈÛÙÈÎÒÓ ÌÂıfi‰ˆÓ (‚·ÚÈÔ‡¯Ô Á‡̷, ·ÍÔÓÈ΋ Î·È Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›·, ˘ÂÚ˯ÔÁÚ¿ÊËÌ·, ·ÁÁÂÈÔÁÚ·Ê›· Î.Ï., Ô˘ ‰È¢ÎÚÈÓ›˙Ô˘Ó ÙË ‚Ï¿‚Ë ·Ó·ÙÔÌÈο). ∏ ‚ÚÔÁ¯ÔÛÎfiËÛË Ì ÙÔ Â‡Î·ÌÙÔ ‹/Î·È ¿Î·ÌÙÔ ‚ÚÔÁ¯ÔÛÎfiÈÔ ·Ó·‰ÂÈÎÓ‡ÂÈ ÙȘ Û˘Ó¤ÂȘ Ù˘ Û˘ÁÁÂÓÔ‡˜ ‰È·Ì·ÚÙ›·˜ ÛÙÔÓ ·ÂÚ·ÁˆÁfi (ÂÓ‰Ô·˘ÏÈο ·›ÙÈ· ÛÙ¤ÓˆÛ˘, Â͈ÙÂÚÈ΋ Û˘Ì›ÂÛË, ‰˘Ó·ÌÈ΋ ÛÙ¤ÓˆÛË Â› Ï·Ú˘ÁÁÔ-ÙÚ·¯ÂÈÔ-‚ÚÔÁ¯ÔÌ·Ï¿Î˘ÓÛ˘), ÂÓÒ ÙÔ ‚ÚÔÁ¯Ô΢„ÂÏȉÈÎfi ¤ÎÏ˘Ì· ÌÔÚ› Ó· ÙÂÎÌËÚÈÒÛÂÈ ÂÈÛÚfiÊËÛË ‹ ·ÈÌÔÚÚ·Á›· (7,12-14,17). §fiÁˆ Û˘¯Ó‹˜ Û˘Ó‡·Ú͢ Û˘ÁÁÂÓÔ‡˜ ηډÈÔ¿ıÂÈ·˜, Ú¤ÂÈ Ó· Á›ÓÂÙ·È ˘ÂÚ˯ÔηډÈÔÁÚ·ÊÈÎfi˜ ¤ÏÂÁ¯Ô˜. ™ÙËÓ ÂÚ›ÙˆÛË ·Ôχ̷ÙÔ˜ ‹ Û·Ó›ˆ˜, Û˘ÁÁÂÓÔ‡˜ ·ÛÙ˘ ÌÂ Û˘ÛÙËÌ·ÙÈ΋ ·ÁÁ›ˆÛË Î·È ÌÂÁ¿ÏË ‰È·Ê˘Á‹ ·fi ÙËÓ ·ÚÈÛÙÂÚ‹ ÚÔ˜ ÙË ‰ÂÍÈ¿ ΢ÎÏÔÊÔÚ›·, ÚÒÙË ÂΉ‹ÏˆÛË Ù˘ Û˘ÁÁÂÓÔ‡˜ Ó¢ÌÔÓÈ΋˜ ‰È·Ì·ÚÙ›·˜ ÌÔÚ› Ó· Â›Ó·È Î·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ· (7,12-14). ∂ΉËÏÒÛÂȘ ÛÙËÓ fi„ÈÌË ‚ÚÂÊÈ΋ ËÏÈΛ· Î·È ÛÙ· ÚÒÙ· 2-3 ¤ÙË ˙ˆ‹˜ ∫·Ù¿ ÙËÓ ÂÚ›Ô‰Ô ·˘Ù‹ ¤¯Ô˘Ó ϤÔÓ ÂΉËψı› ÔÈ ÂÚÈÛÛfiÙÂÚ˜ ·fi ÙȘ ÎÏÈÓÈο ÛËÌ·ÓÙÈΤ˜ Û˘ÁÁÂÓ›˜ ‰È·Ì·Úٛ˜ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ∏ fi„ÈÌË ÂΉ‹ÏˆÛË Û˘ÁÁÂÓÔ‡˜ ‰È·Ì·ÚÙ›·˜ Â›Ó·È Ì¿ÏÏÔÓ Û˘Ó¤ÂÈ· ÂÚÈÔÚÈṲ̂ÓÔ˘ ÌÂÁ¤ıÔ˘˜ Ù˘ ‚Ï¿‚˘ ·Ú¿ Ù˘ ›‰È·˜ Ù˘ ʇÛ˘ Ù˘. ™ÙÔÓ ¶›Ó·Î· 2 ·Ó·Ê¤ÚÔÓÙ·È ÔÈ Û˘ÁÁÂÓ›˜ ‰È·Ì·Úٛ˜ ÔÈ Ôԛ˜ ηْ ÂÍÔ¯‹Ó ··Û¯ÔÏÔ‡Ó ÙÔÓ ÁÈ·ÙÚfi ÌÂÙ¿ ÙÔ˘˜ ÚÒÙÔ˘˜ Ì‹Ó˜ ˙ˆ‹˜ Î·È Ì¤¯ÚÈ ÙËÓ ÚÒÈÌË ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ·. ¶Ú¤ÂÈ Ó· Á›ÓÂÙ·È ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ÙÔ˘ ÛÈÁÌÔ‡ (stridor) Î·È ÙÔ˘ Û˘ÚÈÁÌÔ‡ (wheezing). √ ÚÒÙÔ˜ Â›Ó·È Î˘Ú›ˆ˜ ÂÈÛÓ¢ÛÙÈÎfi˜ ÌÔÓÔʈÓÈÎfi˜ ÌÔ˘ÛÈÎfi˜ ‹¯Ô˜, ÏfiÁˆ Â͈ıˆÚ·ÎÈ΋˜ ÛÙ¤ÓˆÛ˘ ÙÔ˘ ·ÂÚ·ÁˆÁÔ‡. O ‰Â‡ÙÂÚÔ˜ Â›Ó·È ÚˆÙ›ÛÙˆ˜ ÂÎÓ¢ÛÙÈÎfi˜ ÌÔÓÔʈÓÈÎfi˜ ‹ ÔÏ˘ÊˆÓÈÎfi˜ -·Ó·ÏfiÁˆ˜ Ù˘ ÂÓÙfiÈÛ˘- ÌÔ˘ÛÈÎfi˜ ‹¯Ô˜ Î·È ÔÊ›ÏÂÙ·È Û ÂÓ‰ÔıˆÚ·ÎÈ΋ ÛÙ¤ÓˆÛË ÙˆÓ ·ÂÚ·ÁˆÁÒÓ (18). ¶¿ÓÙˆ˜, ÚfiÎÂÈÙ·È ÁÈ· ÂÍ·ÈÚÂÙÈο Û˘¯Ó¿ ·Ó·Ó¢ÛÙÈο Û˘ÌÙÒÌ·Ù· ·˘Ù‹˜ Ù˘ ËÏÈΛ·˜ Ô˘ ÌÔÚ› Ó· ÔÊ›ÏÔÓÙ·È ÛÂ Û˘Ó‹ıÂȘ ·ı‹ÛÂȘ. ¶Ôχ Û˘¯Ó¿ Ù· ·ÎÚÔ·ÛÙÈο Â˘Ú‹Ì·Ù· Ù˘ Û˘ÁÁÂÓÔ‡˜ ‰È·Ì·ÚÙ›·˜ ÂȉÂÈÓÒÓÔÓÙ·È ÌÂÙ¿ ·fi Ïԛ̈ÍË ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ (.¯. Ï·Ú˘ÁÁÔÌ·Ï¿Î˘ÓÛË, ÙÚ·¯ÂÈÔÌ·Ï¿Î˘ÓÛË) Î·È ·˘Ùfi ÌÔÚ› Ó· ÂÚÈϤÍÂÈ ÂÚÈÛÛfiÙÂÚÔ ÙË ‰È¿ÁÓˆÛË. ™˘¯Ó¿ Ë ¶·È‰È·ÙÚÈ΋ 2007;70:184-191

Pediatri May-Jun 07

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∫. ¡. ¶Ú›ÊÙ˘ Î·È Û˘Ó.

¶›Ó·Î·˜ 2. ™˘ÁÁÂÓ›˜ ‰È·Ì·Úٛ˜ ÙÔ˘ Ó‡ÌÔÓ· Ô˘ Û˘Ó‹ıˆ˜ ÂΉËÏÒÓÔÓÙ·È ÌÂÙ¿ ÙÔ˘˜ ÚÒÙÔ˘˜ Ì‹Ó˜ Î·È Ì¤¯ÚÈ Ù· 2-3 ÚÒÙ· ¤ÙË ˙ˆ‹˜ ñ ª¿˙˜ (ÏÂÌÊ·ÁÁ›ˆÌ·, ·ÈÌ·ÁÁ›ˆÌ·, ·ÛÙË ı˘ÚÂÔÁψÛÛÈÎÔ‡ fiÚÔ˘, ‚Ú·Á¯È·Î‹ ·ÛÙË, Ï·Ú˘ÁÁÈ΋ ·ÛÙË) ñ ∂ÙÂÚfiÏ¢ÚË ·Ú¿Ï˘ÛË, ¿ÚÂÛË ÊˆÓËÙÈÎÒÓ ¯ÔÚ‰ÒÓ ñ §·Ú˘ÁÁÔ-ÙÚ·¯ÂÈÔ-‚ÚÔÁ¯ÔÌ·Ï¿Î˘ÓÛË (Û˘¯Ó‹) ñ ∞ÁÁÂÈ·Îfi˜ ‰·ÎÙ‡ÏÈÔ˜ (Û˘¯ÓfiÙÂÚË ÛÙË Û˘ÁÎÂÎÚÈ̤ÓË ËÏÈÎȷ΋ ÔÌ¿‰·) ñ ∫‡ÛÙÂȘ Î·È fiÁÎÔÈ ÌÂÛÔıˆÚ·Î›Ô˘ ñ ∆Ú·¯ÂÈÔÔÈÛÔÊ·ÁÈÎfi Û˘Ú›ÁÁÈÔ Ù‡Ô˘-∏ ñ µÚÔÁ¯ÔÁÂÓ›˜ ·ÛÙÂȘ (·fiÊÚ·ÍË, ÏÔÈÌÒÍÂȘ) ñ ∫˘ÛÙÈ΋ ·‰ÂÓÔÌ·ÙÔÂȉ‹˜ ‰˘ÛÏ·Û›· (ÌÈÎÚfi Û¯ÂÙÈο ÔÛÔÛÙfi) ñ ™˘ÁÁÂÓ¤˜ ÏԂ҉˜ ÂÌʇÛËÌ· (ÌÈÎÚ‹ ‰È¿Ù·ÛË) ñ ¶Ó¢ÌÔÓÈÎfi ·fiÏ˘Ì· ñ ÀÔÏ·Û›· Ó‡ÌÔÓ· (ÌÈÎÚÔ‡ ‚·ıÌÔ‡)

ÙÚ·¯ÂÈÔÌ·Ï¿Î˘ÓÛË “·ÓÙÈÌÂÙˆ›˙ÂÙ·È” Â› Ì·ÎÚfiÓ Ì ·ÓÙÈ·ÛıÌ·ÙÈ΋ ·ÁˆÁ‹ ÚÔÙÔ‡ ‰È·ÁÓˆÛı› ‹ ·ÏÒ˜ ÛÙ·Ì·Ù‹ÛÂÈ Ó· ¤¯ÂÈ ÎÏÈÓÈ΋ ÛËÌ·Û›· (7,1214,18,19). ™˘¯Ófi Û‡Ìو̷ Ù˘ Ï·Ú˘ÁÁÔ-ÙÚ·¯ÂÈÔ-‚ÚÔÁ¯ÔÌ·Ï¿Î˘ÓÛ˘ Î·È ÙˆÓ ‰È·ÊfiÚˆÓ Û˘ÁÁÂÓÒÓ ‰È·Ì·ÚÙÈÒÓ Ô˘ Ȥ˙Ô˘Ó Â͈ÙÂÚÈο ÙÔÓ ·ÂÚ·ÁˆÁfi Â›Ó·È Î·È Ô ¯ÚfiÓÈÔ˜ ‹ ˘ÔÙÚÔÈ¿˙ˆÓ ‚‹¯·˜. ™˘Ó‹ıÂȘ ·Ó·Ó¢ÛÙÈΤ˜ ·ı‹ÛÂȘ Ù˘ ‚ÚÂÊÈ΋˜ ËÏÈΛ·˜, fiˆ˜ Ë ÔÍ›· ‚ÚÔÁ¯ÈÔÏ›Ùȉ·, ÌÔÚ› Ó· ÂΉËψıÔ‡Ó Ì ·Û˘Ó‹ıÈÛÙË ‚·Ú‡ÙËÙ· fiÙ·Ó Û˘Ó˘¿Ú¯ÂÈ Û˘ÁÁÂÓ‹˜ ‰È·Ì·ÚÙ›· ÙÔ˘ Ó‡ÌÔÓ· (.¯. Û˘ÁÁÂÓ‹˜ ‰È·ÊÚ·ÁÌ·ÙÔ΋ÏË, Û˘ÁÁÂÓ¤˜ ÏԂ҉˜ ÂÌʇÛËÌ·, Û˘Ìو̷ÙÈΤ˜ ΢ÛÙÈΤ˜ ‰È·Ì·Úٛ˜). ∂Ó›ÔÙÂ, Ë Û˘ÁÁÂÓ‹˜ ‰È·Ì·ÚÙ›· ÌÔÚ› Ó· ÂΉËÏÒÓÂÙ·È ˆ˜ ˘ÔÙÚÔÈ¿˙Ô˘Û· Ó¢ÌÔÓ›· ÛÙËÓ ›‰È· ¿ÓÙÔÙ ·Ó·ÙÔÌÈ΋ ı¤ÛË (¯ Û˘ÁÁÂÓ‹˜ ·ÛÙË, ΢ÛÙÈ΋ ·‰ÂÓÔÌ·ÙÔÂȉ‹˜ ‰˘ÛÏ·Û›·, ·fiÏ˘Ì·) ‹ ˆ˜ ÌÂÙ·Ó·ÛÙ¢ÙÈ΋ Ó¢ÌÔÓ›·/·ÙÂÏÂÎÙ·Û›· (.¯. Û˘ÁÁÂÓ›˜ ‚ÚÔÁ¯ÂÎٷۛ˜, Á·ÛÙÚÔÔÈÛÔÊ·ÁÈ΋ ·ÏÈÓ‰ÚfiÌËÛË Ì ÂÈÛÚfiÊËÛË ˆ˜ ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ ÂÈÏÔ΋ ‰ÈfiÚıˆÛ˘ ·ÙÚËÛ›·˜ ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘). ™ÙËÓ ËÏÈÎȷ΋ ·˘Ù‹ ÔÌ¿‰· Ë ·ÈÌfiÙ˘ÛË ˆ˜ Û‡Ìو̷ Û·Ó›˙ÂÈ. √ÚÈṲ̂Ó˜ Û˘ÁÁÂÓ›˜ ‚Ï¿‚˜ ÌÔÚ› Ó· ·Ó·Î·Ï˘ÊıÔ‡Ó Ù˘¯·›· Û ·ÎÙÈÓÔÁÚ·ÊÈÎfi ¤ÏÂÁ¯Ô Ô˘ ¤ÁÈÓ ÁÈ· ¿ÏÏÔ ÏfiÁÔ (18,19). ∂› ˘Ô„›·˜ Û˘ÁÁÂÓÔ‡˜ ‰È·Ì·ÚÙ›·˜ Ë ÂÚÁ·ÛÙËÚȷ΋ ÚÔÛ¤ÁÁÈÛË Â›Ó·È ·ÚfiÌÔÈ· Ì ·˘Ù‹Ó Ô˘ ÂÚÈÁÚ¿ÊËΠÁÈ· ÙȘ ÌÈÎÚfiÙÂÚ˜ ËÏÈ˘. ∂ΉËÏÒÛÂȘ ÛÙËÓ fi„ÈÌË ÚÔÛ¯ÔÏÈ΋, ·È‰È΋ Î·È ÂÊË‚È΋ ËÏÈΛ· √È ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ Ù˘ ËÏÈÎȷ΋˜ ·˘Ù‹˜ ÔÌ¿‰·˜ Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 3 (7,12-14,18,19). ™ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ·È‰› Î·È ÛÙÔÓ ¤ÊË‚Ô, fiˆ˜ ÂÍ¿ÏPaediatriki 2007;70:184-191

ÏÔ˘ Î·È ÛÙÔÓ ÂÓ‹ÏÈÎÔ, Ôχ Û˘¯Ó¿ Ë ‰È¿ÁÓˆÛË Ù˘ Û˘ÁÁÂÓÔ‡˜ ‰È·Ì·ÚÙ›·˜ Á›ÓÂÙ·È Ì ·ÊÔÚÌ‹ Ù˘¯·›Ô ·ÎÙÈÓÔÁÚ·ÊÈÎfi ‡ÚËÌ·. ∫ÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ÙˆÓ Û˘ÁÁÂÓÒÓ ‰È·Ì·ÚÙÈÒÓ ÛÙȘ ÌÂÁ·Ï‡ÙÂÚ˜ ËÏÈ˘ ·ÔÙÂÏÔ‡Ó ÔÈ ˘ÔÙÚÔÈ¿˙Ô˘Û˜ ‹ ¯ÚfiÓȘ ÏÔÈÌÒÍÂȘ ÙÔ˘ ηÙÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Î·È Û·ÓÈfiÙÂÚ· Ë ·ÈÌfiÙ˘ÛË ‹ Ô ·ÈÊÓ›‰ÈÔ˜ Ó¢ÌÔıÒڷη˜. ÀÔ„›· Û˘ÁÁÂÓÔ‡˜ ‰È·Ì·ÚÙ›·˜ ÌÔÚ› Ó· ÙÂı› ·fi Ù· Â˘Ú‹Ì·Ù· ÙÔ˘ ÏÂÈÙÔ˘ÚÁÈÎÔ‡ ÂϤÁ¯Ô˘ ÙˆÓ Ó¢ÌfiÓˆÓ (.¯. ÌË ÌÂÙ·‚·ÏÏfiÌÂÓË ·fiÊÚ·ÍË ÏfiÁˆ Â͈ÁÂÓÔ‡˜ Û˘Ì›ÂÛ˘ ÙÔ˘ ·ÂÚ·ÁˆÁÔ‡ ·ÛıÂÓÔ‡˜ ÌÂ Û˘ÚÈÁÌfi ‹ ÂÚÈÔÚÈÛÙÈ΋ Ó¢ÌÔÓÔ¿ıÂÈ· ÏfiÁˆ ¯ÚfiÓÈ·˜ ÂÈÛÚfiÊËÛ˘ ÌÂÙ¿ ‰ÈfiÚıˆÛË ÙÚ·¯ÂÈÔÔÈÛÔÊ·ÁÈÎÔ‡ Û˘ÚÈÁÁ›Ô˘) (19). ∏ ΢ÛÙÈ΋ ·‰ÂÓÔÌ·ÙÔÂȉ‹˜ ‰˘ÛÏ·Û›· Úԉȷı¤ÙÂÈ Û ηÎÔ‹ıË ÂÍ·ÏÏ·Á‹ ÛÙËÓ ÂÓ‹ÏÈÎÔ ˙ˆ‹, ÁÈ’ ·˘Ùfi ¿ÏψÛÙÂ, ÂӉ›ÎÓ˘Ù·È Ë ¯ÂÈÚÔ˘ÚÁÈ΋ ÂÍ·›ÚÂÛË, ·ÎfiÌË Î·È Â› ·Û˘Ìو̷ÙÈ΋˜ ‚Ï¿‚˘ (19). ∫·ÎÔ‹ı˘ ÂÍ·ÏÏ·Á‹ ¤¯ÂÈ ÂÚÈÁÚ·Ê› Î·È Û ÂÚÈÙÒÛÂȘ ‚ÚÔÁ¯ÔÁÂÓÔ‡˜ ·ÛÙ˘ (20).

¶ÚfiÁÓˆÛË Î·È ·ÒÙÂÚ˜ Û˘Ó¤ÂȘ ∏ ÚfiÁÓˆÛË ÙˆÓ Û˘ÁÁÂÓÒÓ ‰È·Ì·ÚÙÈÒÓ ÙˆÓ Ó¢ÌfiÓˆÓ ÂÍ·ÚÙ¿Ù·È ·fi ÙÔ Â›‰Ô˜ Î·È ÙËÓ ¤ÎÙ·ÛË Ù˘ ‚Ï¿‚˘, ηıÒ˜ Â›Û˘ ÙËÓ ‡·ÚÍË ‹ ÌË Û˘ÓÔ‰ÒÓ ·ÓˆÌ·ÏÈÒÓ. £· ÂÍ·ÚÙËı› ·fi ÙÔÓ ¯ÚfiÓÔ Ù˘ Èı·Ó‹˜ ¯ÂÈÚÔ˘ÚÁÈ΋˜ ·Ú¤Ì‚·Û˘, ·fi ÙËÓ ¤ÎÙ·ÛË ÙÔ˘ ·Ê·ÈÚÔ‡ÌÂÓÔ˘ Ó¢ÌÔÓÈÎÔ‡ ·ÚÂÁ¯‡Ì·ÙÔ˜, ·fi ÙȘ ÂÓ·ÔÌ›ӷÛ˜ ·Ó·ÙÔÌÈΤ˜ ·ÓˆÌ·Ï›Â˜, ·fi ÙȘ ÂÈÏÔΤ˜ ÙÔ˘ Ì˯·ÓÈÎÔ‡ ·ÂÚÈÛÌÔ‡ Ô˘ ›Ûˆ˜ ·ÚÔ˘ÛÈ·ÛıÔ‡Ó, ·fi ÙËÓ ÈηÓfiÙËÙ· Î·È ÂÌÂÈÚ›· ÙÔ˘ ¯ÂÈÚÔ˘ÚÁÔ‡ Î·È Ù¤ÏÔ˜, ·fi ÙËÓ ·ÓÙÈÚÚÔÈÛÙÈ΋ ·Ó¿Ù˘ÍË ÙÔ˘ Ó¢ÌÔÓÈÎÔ‡ ÈÛÙÔ‡ ÌÂÙ¿ ÙËÓ ÂÎÙÔÌ‹ Ù˘ ‚Ï¿‚˘. ¶›Ó·Î·˜ 3. ∂ΉËÏÒÛÂȘ Û˘ÁÁÂÓÔ‡˜ ‰È·Ì·ÚÙ›·˜ ÙÔ˘ Ó‡ÌÔÓ· ηٿ ÙËÓ fi„ÈÌË ÚÔÛ¯ÔÏÈ΋, ÙËÓ ·È‰È΋ Î·È ÙËÓ ÂÊË‚È΋ ËÏÈΛ· ñ ∆˘¯·›Ô ·ÎÙÈÓÔÁÚ·ÊÈÎfi ‡ÚËÌ· ñ ÀÔÙÚÔÈ¿˙Ô˘Û· Ó¢ÌÔÓ›·/·ÙÂÏÂÎÙ·Û›· ‹ ·fiÛÙËÌ· (Û˘ÁÁÂÓ‹˜ ·ÛÙË, ΢ÛÙÈ΋ ·‰ÂÓÔÌ·ÙÔÂȉ‹˜ ‰È·Ì·ÚÙ›·, ·fiÏ˘Ì·) ñ ™˘¯Ó¤˜ ‹ ¯ÚfiÓȘ ÏÔÈÌÒÍÂȘ ·fi ÙÔ Î·ÙÒÙÂÚÔ ·Ó·Ó¢ÛÙÈÎfi (Û˘ÁÁÂÓ›˜ ‚ÚÔÁ¯ÂÎٷۛ˜, Û‡Ó‰ÚÔÌÔ Mounier-Kuhn, Û‡Ó‰ÚÔÌÔ Williams-Campbell, ÙÚ·¯ÂÈ·Îfi ÂÎÎfiÏˆÌ·) ñ ∞ÈÌfiÙ˘ÛË (Û˘ÁÁÂÓ‹˜ ·ÛÙË, ΢ÛÙÈ΋ ·‰ÂÓÔÌ·ÙÔÂȉ‹˜ ‰È·Ì·ÚÙ›·, ·fiÏ˘Ì·, ‚ÚÔÁ¯ÂÎٷۛ˜) ñ ∞ÈÊÓ›‰ÈÔ˜ Ó¢ÌÔıÒڷη˜ (΢ÛÙÈΤ˜ ‰È·Ì·Úٛ˜) ñ ∞ÔÎÔÚÂÛÌfi˜ ·ÈÌÔÛÊ·ÈÚ›Ó˘, ΢¿ÓˆÛË, ÏËÎÙÚÔ‰·ÎÙ˘Ï›· (·ÚÙËÚÈÔÊÏ‚҉˘ ÂÈÎÔÈÓˆÓ›·) ñ ™ÈÚÔÌÂÙÚÈÎfi ‡ÚËÌ· ηٿ ÙË ‰ÈÂÚ‡ÓËÛË Û˘ÚÈÁÌÔ‡, ÂÚÈÔÚÈÛÙÈ΋ ÓfiÛÔ˜ ÌÂÙ¿ ÂÁ¯ÂÈÚËÙÈ΋ ‰ÈfiÚıˆÛË ÙÚ·¯ÂÈÔÔÈÛÔÊ·ÁÈÎÔ‡ Û˘ÚÈÁÁ›Ô˘ ñ ™˘ÁÁÂÓ›˜ ‰˘ÛϷۛ˜ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘ (Û˘ÁÁÂÓ‹˜ ÛÎÔÏ›ˆÛË, Û˘ÁÁÂÓ‹˜ ·ʈÛË), ÛÎÔÏ›ˆÛË ÌÂÙ¿ ıˆÚ·ÎÔÙÔÌ‹ (.¯. ‰ÈfiÚıˆÛË ÙÚ·¯ÂÈÔÔÈÛÔÊ·ÁÈÎÔ‡ Û˘ÚÈÁÁ›Ô˘)

Pediatri May-Jun 07

24-05-07

17:58

™ÂÏ›‰·189

189

™˘ÁÁÂÓ›˜ ‰È·Ì·Úٛ˜ Ó¢ÌfiÓˆÓ

™ÙËÓ Ú¿ÍË ˘¿Ú¯Ô˘Ó ÔÈ ÂÍ‹˜ ηÙËÁÔڛ˜ ·ÛıÂÓÒÓ (21): 1) √È ·ÛıÂÓ›˜ Ô˘ ¯ÂÈÚÔ˘ÚÁ‹ıËÎ·Ó ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË. ∆¤ÙÔÈÔÈ Â›Ó·È Î˘Ú›ˆ˜ ÔÈ ·ÛıÂÓ›˜ ÌÂ Û˘ÁÁÂÓ‹ ‰È·ÊÚ·ÁÌ·ÙÔ΋ÏË Î·È ·ÙÚËÛ›· ÔÈÛÔÊ¿ÁÔ˘.

2) √È ·ÛıÂÓ›˜ Ô˘ ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È Û˘ÓÙËÚËÙÈο Î·È ÛÙÔ˘˜ ÔÔ›Ô˘˜ ·Ó·‚¿ÏÏÂÙ·È Ë ¯ÂÈÚÔ˘ÚÁÈ΋ ‰ÈfiÚıˆÛË, ÂÊfiÛÔÓ Ë Î·Ù¿ÛÙ·Û‹ ÙÔ˘˜ ÙÔ ÂÈÙÚ¤ÂÈ. ¶·Ú¿‰ÂÈÁÌ· Â›Ó·È ÔÈ ·ÛıÂÓ›˜ Ì ΢ÛÙÈΤ˜ ·ÓˆÌ·Ï›Â˜.

3) √È ·ÛıÂÓ›˜ ÛÙÔ˘˜ ÔÔ›Ô˘˜ Ë ‰È¿ÁÓˆÛË Á›ÓÂÙ·È Û ÌÂÁ¿ÏË ËÏÈΛ·, Û˘Ó‹ıˆ˜ Ù˘¯·›·, Ô˘ ÌÔÚ› Ó· ¤¯Ô˘Ó ‹‰Ë ÂÁηÙÂÛÙË̤Ó˜ ÂÈÏÔΤ˜. ŸÛÔÓ ·ÊÔÚ¿ ÛÙË Ì·ÎÚÔ¯ÚfiÓÈ· ÔÚ›· ÙˆÓ ·Ú·¿Óˆ ·ÛıÂÓÒÓ Ô˘ ¯ÂÈÚÔ˘ÚÁ‹ıËÎ·Ó ‹ ‰ÂÓ ¯ÂÈÚÔ˘ÚÁ‹ıËηÓ, Ù›ıÂÓÙ·È Ù· ÂÍ‹˜ ‰‡Ô ÂÚˆÙ‹Ì·Ù·: ·) ∂›Ó·È Ë ·Ó¿Ù˘ÍË ÙÔ˘ ˘fiÏÔÈÔ˘ ˘ÁÈÔ‡˜ Ó‡ÌÔÓ· ÌÔÚÊÔÏÔÁÈο Î·È ÏÂÈÙÔ˘ÚÁÈο Ê˘ÛÈÔÏÔÁÈ΋; ‚) ™Â ÔÈÔ ‚·ıÌfi ÂËÚ¿˙ÂÙ·È Ë ÂÔ˘ÏˆÙÈ΋ ÈηÓfiÙËÙ· ÙÔ˘ Ó‡ÌÔÓ· ·fi ÙËÓ ËÏÈΛ· ÙÔ˘ ·ÛıÂÓÔ‡˜; ∆· ·Ú·¿Óˆ ÂÚˆÙ‹Ì·Ù· ‰ÂÓ ··Û¯ÔÏÔ‡Ó ÌfiÓÔ ÙÔÓ Ó¢ÌÔÓÔÏfiÁÔ ÂÓËϛΈÓ, ·ÊÔ‡ ·˘Ùfi˜ ‰È·ÈÛÙÒÓÂÈ ÙȘ ·ÒÙÂÚ˜ Û˘Ó¤ÂȘ Ù˘ Û˘ÁÁÂÓÔ‡˜ ‚Ï¿‚˘ ‹ Ù˘ ¯ÂÈÚÔ˘ÚÁÈ΋˜ Â¤Ì‚·Û˘, ·ÏÏ¿ Î·È ÙÔÓ ·È‰›·ÙÚÔ, ÙÔÓ ·È‰ÔÓ¢ÌÔÓÔÏfiÁÔ ‹ ÙÔÓ ·È‰Ô¯ÂÈÚÔ˘ÚÁfi Ô˘ ÚÔÛ·ı› Ó· ÂÈϤÍÂÈ ÙÔÓ Î·Ù·ÏÏËÏfiÙÂÚÔ ¯ÚfiÓÔ Ù˘ ¯ÂÈÚÔ˘ÚÁÈ΋˜ ·ÓÙÈÌÂÙÒÈÛ˘ Ù˘ Û˘ÁÁÂÓÔ‡˜ ‰È·Ì·ÚÙ›·˜. ∂¿Ó Ë ·ÓÙÈÚÚÔÈÛÙÈ΋ ·‡ÍËÛË Î·È ·Ó¿Ù˘ÍË Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË ÛÙȘ ÌÈÎÚfiÙÂÚ˜ ËÏÈ˘, Ë ÂÎÙÔÌ‹ Ù˘ ‚Ï¿‚˘ Ú¤ÂÈ Ó· Á›ÓÂÈ fiÛÔ ÙÔ ‰˘Ó·ÙfiÓ ÓˆÚ›ÙÂÚ·, ÒÛÙ ӷ ÂÈÙ¢¯ı› Ë Ì¤ÁÈÛÙË ·ÔηٿÛÙ·ÛË. ∂¿Ó ‰ÂÓ ÂÍ·ÚÙ¿Ù·È ·fi ÙË ËÏÈΛ·, Ë Â¤Ì‚·ÛË ÌÔÚ› Ó· ·Ó·‚ÏËı› ÒÛÙ ӷ ÂÍ·ÛÊ·ÏÈÛıÔ‡Ó ÔÈ Î·Ï‡ÙÂÚ˜ ÚÔ¸Ôı¤ÛÂȘ, ÂÊfiÛÔÓ Ë Û˘ÓÙËÚËÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ‰ÂÓ Â›Ó·È ÂÈÛÊ·Ï‹˜. ™·Ê›˜ ··ÓÙ‹ÛÂȘ ÛÙ· ·Ú·¿Óˆ ÂÚˆÙ‹Ì·Ù· Ê·›ÓÂÙ·È fiÙÈ ‰ÂÓ ˘¿Ú¯Ô˘Ó ÚÔ˜ ÙÔ ·ÚfiÓ, ÏfiÁˆ Ù˘ ÔÏ˘ÏÔÎfiÙËÙ·˜ ÙÔ˘ ı¤Ì·ÙÔ˜ (21). ™ÙË ‚È‚ÏÈÔÁÚ·Ê›· ˘¿Ú¯Ô˘Ó ÌÂϤÙ˜ Ì ·ÓÙÈÎÚÔ˘fiÌÂÓ· ·ÔÙÂϤÛÌ·Ù·. ™Â ·Ï·ÈfiÙÂÚË ÂÚ¢ÓËÙÈ΋ ÂÚÁ·Û›· ‰È·ÈÛÙÒıËΠ̛ˆÛË ÙˆÓ Ó¢ÌÔÓÈÎÒÓ fiÁÎˆÓ Î·È Ù˘ ‰È·¯˘ÙÈ΋˜ ÈηÓfiÙËÙ·˜ ·Ó¿ÏÔÁË ÚÔ˜ ÙËÓ ¤ÎÙ·ÛË ÙÔ˘ ÂÎٷ̤ÓÙÔ˜ Ó¢ÌÔÓÈÎÔ‡ ÈÛÙÔ‡ (22). ™Â ¿ÏϘ ÌÂϤÙ˜ fï˜, ·Ó·Ê¤ÚÂÙ·È fiÙÈ ÔÚÈṲ̂ÓÔÈ ‰Â›ÎÙ˜ ÚÔÛÂÁÁ›˙Ô˘Ó Ù· “Ê˘ÛÈÔÏÔÁÈο” Â›‰·, ˘Ô‰ËÏÒÓÔÓÙ·˜ ÙËÓ ·ÓÙÈÚÚÔÈÛÙÈ΋ ÈηÓfiÙËÙ· ÙÔ˘ ÂÓ·ÔÌ›ӷÓÙ· Ó‡ÌÔÓ· (23,24). º˘ÛÈÔÏÔÁÈΤ˜ ÏÂÈÙÔ˘ÚÁÈΤ˜ ‰ÔÎÈ̷ۛ˜ ‰È·ÈÛÙÒıËÎ·Ó ÌÂÙ¿ ÏÔ‚ÂÎÙÔÌ‹ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ Û˘ÁÁÂÓÔ‡˜ ÏÔ‚Ò‰Ô˘˜ ÂÌÊ˘Û‹Ì·ÙÔ˜ ÛÙË ‚ÚÂÊÈ΋ ËÏÈΛ·, ·Ó Î·È ÔÈ ·ÛıÂÓ›˜ Ô˘ ›¯·Ó ˘ÔÛÙ› ·Ê·›ÚÂÛË ÌÂÁ·Ï‡ÙÂÚˆÓ ÏÔ‚ÒÓ Â›¯·Ó ÌÂÁ·Ï‡ÙÂÚ˜ ÙÈ̤˜ Ó¢ÌÔÓÈÎÒÓ fiÁÎˆÓ (25). √È ÌÂÁ·Ï‡ÙÂÚ˜ ÙÈ̤˜ Ó¢ÌÔÓÈÎÒÓ fiÁÎˆÓ ‰ÂÓ ˘Ô-

‰ËÏÒÓÔ˘Ó ··Ú·›ÙËÙ· ηχÙÂÚË ÏÂÈÙÔ˘ÚÁÈ΋ ÈηÓfiÙËÙ·, ‰ÈfiÙÈ ·˘Ùfi ÌÔÚ› Ó· ·ÔÙÂÏ› Û˘Ó¤ÂÈ· Ù˘ “˘ÂډȿٷÛ˘” ÙÔ˘ Ó‡ÌÔÓ·, ·Ê‹ÓÔ˘Ó fï˜ ·ÓÔȯÙfi ÙÔ ÂӉ¯fiÌÂÓÔ ÙÔ Ì¤ÁÂıÔ˜ Ù˘ ·ÓÙÈÚÚÔÈÛÙÈ΋˜ ·¿ÓÙËÛ˘ ÙÔ˘ Ó‡ÌÔÓ· Ó· ÂÍ·ÚÙ¿Ù·È ·fi ÙËÓ ¤ÎÙ·ÛË Ù˘ ÏÔ‚ÂÎÙÔÌ‹˜. ∞ÓÙ›ÛÙÔȯ˜ ÌÂϤÙ˜ Û ÂÈÚ·Ì·Ùfi˙ˆ· ¤‰ÂÈÍ·Ó fiÙÈ Ô Ó‡ÌÔÓ·˜ Ô˘ ̤ÓÂÈ ÌÂÙ¿ ÙËÓ ÂÎÙÔÌ‹, ÎÂÚ‰›˙ÂÈ Û fiÁÎÔ Î·È ‚¿ÚÔ˜ Î·È fiÙÈ ·˘Ù‹ Ë ·¿ÓÙËÛË Û˘Ì‚·›ÓÂÈ ·ÓÂÍ¿ÚÙËÙ· ·fi ÙËÓ ËÏÈΛ· (26). ¶¿ÏÈ fï˜, Ë ·‡ÍËÛË ÙÔ˘ Ó‡ÌÔÓ· Û fiÁÎÔ Î·È ‚¿ÚÔ˜ ‰ÂÓ ÛËÌ·›ÓÂÈ ··Ú·›ÙËÙ· ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË ÙÔ˘ ÏÂÈÙÔ˘ÚÁÈÎÔ‡ Ó¢ÌÔÓÈÎÔ‡ ÈÛÙÔ‡, ·ÊÔ‡ Ô Ó‡ÌÔÓ·˜ Â›Ó·È fiÚÁ·ÓÔ Ô˘ Ú¤ÂÈ Ó· ÚÔÛ·ÚÌfi˙ÂÙ·È ÛÙÔÓ fiÁÎÔ ·ÏÌÔ‡ ȉȷ›ÙÂÚ· ÛÂ Û˘Óı‹Î˜ ̤ÁÈÛÙ˘ ÎfiˆÛ˘. ŒÙÛÈ, ÙÔ ‚·ÛÈÎfi ÂÚÒÙËÌ· Â›Ó·È ·Ó Ë ·‡ÍËÛË Ù˘ Ì¿˙·˜ ÙÔ˘ Ó¢ÌÔÓÈÎÔ‡ ÈÛÙÔ‡ ÌÂÙ¿ ÂÎÙÔÌ‹ ̤ÚÔ˘˜ ÙÔ˘ Ó‡ÌÔÓ· ÔÊ›ÏÂÙ·È Û ۯËÌ·ÙÈÛÌfi Ó¤ˆÓ ΢„ÂÏ›‰ˆÓ ‹ Û ÌÂÁ¤ı˘ÓÛË ÙˆÓ ‹‰Ë ˘·Ú¯Ô˘ÛÒÓ. ™ÙË Û˘Ó¤¯ÂÈ· ÚÔ·ÙÂÈ ÙÔ ÂÚÒÙËÌ· ·Ó ÔÈ “ÌÂÁ·Ï‡ÙÂÚ˜” ΢„ÂÏ›‰Â˜ ÈÛÔ‰˘Ó·ÌÔ‡Ó Ì ÙȘ “ÂÚÈÛÛfiÙÂÚ˜” ΢„ÂÏ›‰Â˜ (26,27). £· ÌÔÚÔ‡Û ӷ ÈÛ¯˘ÚÈÛÙ› ηÓ›˜ fiÙÈ Ë ÏÂÈÙÔ˘ÚÁÈ΋ ·Ó·Ó¢ÛÙÈ΋ ÂÈÊ¿ÓÂÈ· ÙˆÓ Î˘„ÂÏ›‰ˆÓ ÌÔÚ› Ó· ·˘ÍËı› ¯ˆÚ›˜ ÙË ‰ËÌÈÔ˘ÚÁ›· Ó¤ˆÓ, ·ÏÏ¿ Ì ÙËÓ Â¤ÎÙ·ÛË ÙˆÓ Î˘„ÂÏȉÈÎÒÓ fiÚˆÓ Î·È Û¿ÎˆÓ, Ô˘ ·ÎÔÏÔ˘ıÂ›Ù·È ·fi ÂÈÌ‹Î˘ÓÛË ÙˆÓ Î˘„ÂÏȉÈÎÒÓ ÙÔȯˆÌ¿ÙˆÓ Ì ÙÂÏÈÎfi ·ÔÙ¤ÏÂÛÌ· ÙËÓ “·Ó·ÚÚ›¯ËÛË” ÛÂ Ê˘ÛÈÔÏÔÁÈο ÏÂÈÙÔ˘ÚÁÈο Â›‰· (28). ∂Λ Ô˘ Ë ˘¿Ú¯Ô˘Û· ‚È‚ÏÈÔÁÚ·Ê›· Û˘ÌʈÓ› Â›Ó·È fiÙÈ Ë ·‡ÍËÛË ÙÔ˘ Ó¢ÌÔÓÈÎÔ‡ ÈÛÙÔ‡ ÌÂÙ¿ ÙËÓ Ó¢ÌÔÓÂÎÙÔÌ‹, ·ÊÔÚ¿ ΢ڛˆ˜ ÛÙÔ ·Ú¤Á¯˘Ì· Î·È ÏÈÁfiÙÂÚÔ ÙÔ ‰›ÎÙ˘Ô ÙˆÓ ·ÂÚ·ÁˆÁÒÓ, Ë ·‡ÍËÛË ÙÔ˘ ÔÔ›Ô˘ Â›Ó·È ·Ó·ÏÔÁÈο ÌÈÎÚfiÙÂÚË ÂΛӢ ÙÔ˘ ·ÚÂÁ¯‡Ì·ÙÔ˜ (29,30). ŸÛÔÓ ·ÊÔÚ¿ ÛÙÔ ÂÚÒÙËÌ· Â¿Ó ·˘ÙÔ› ÔÈ Ì˯·ÓÈÛÌÔ› ÂÍ·ÚÙÒÓÙ·È ·fi ÙËÓ ËÏÈΛ· ÙÔ˘ ·ÛıÂÓÔ‡˜ ηٿ ÙËÓ ÔÔ›· Á›ÓÂÙ·È Ë ÂÎÙÔÌ‹, ÌÂϤÙ˜ Û ÂÈÚ·Ì·Ùfi˙ˆ· Ô˘ ˘¤ÛÙËÛ·Ó Ó¢ÌÔÓÂÎÙÔÌ‹ Û ‰È·ÊÔÚÂÙÈΤ˜ ËÏÈ˘ ‰È·›ÛÙˆÛ·Ó fiÙÈ Û Ôχ Ó·ڿ ÂÈÚ·Ì·Ùfi˙ˆ· ˘‹ÚÍ ÔÏÏ·Ï·ÛÈ·ÛÌfi˜ ÙˆÓ Î˘„ÂÏ›‰ˆÓ, ÛÙ· ÌÂÁ·Ï‡ÙÂÚ· ΢ÚÈ·Ú¯Ô‡ÛÂ Ë ÂÈÌ‹Î˘ÓÛË ÙˆÓ Î˘„ÂÏȉÈÎÒÓ fiÚˆÓ Î·È ÙˆÓ ÙÔȯˆÌ¿ÙˆÓ, ÂÓÒ ÛÙ· ÂÓ‹ÏÈη ˙Ò· ˘‹Ú¯Â ˘ÂÚ¤ÎÙ˘ÍË ÙÔ˘ ·ÚÂÁ¯‡Ì·ÙÔ˜ (31). ∞˘Ùfi ÙÔ ÈÛÙÔÏÔÁÈÎfi ‡ÚËÌ· ÙÔ˘ ΢„ÂÏȉÈÎÔ‡ ÔÏÏ·Ï·ÛÈ·ÛÌÔ‡ ÌÂÙ¿ Ó¢ÌÔÓÂÎÙÔÌ‹ ÛÙ· Ôχ Ó·ڿ ÂÈÚ·Ì·Ùfi˙ˆ· ‰ÂÓ ˘Ô‰ËÏÒÓÂÈ ˘Ô¯ÚˆÙÈο ÂÎÙÂٷ̤ÓË ·ÓÙÈÚÚÔÈÛÙÈ΋ ·‡ÍËÛË ÙÔ˘ ÂÓ·ÔÌ›ӷÓÙ· Ó‡ÌÔÓ·. √ ÔÏÏ·Ï·ÛÈ·ÛÌfi˜ ÙˆÓ Î˘„ÂÏ›‰ˆÓ Ê˘ÛÈÔÏÔÁÈο ÂÂÎÙ›ÓÂÙ·È ¯ÚÔÓÈο Î·È ÛÙË ÌÂÙ·-ÓÂÔÁÓÈ΋ ÂÚ›Ô‰Ô ÁÈ· ÌÂÚÈο ›‰Ë ˙ÒˆÓ, fiˆ˜ ÛÙ· ÔÓÙ›ÎÈ·, ÂÓÒ ÛÙÔ˘˜ ·ÓıÚÒÔ˘˜ ·˘Ù‹ Ë ‰È·‰Èηۛ· Ù˘ ·‡ÍËÛ˘ ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ Î˘„ÂÏ›‰ˆÓ Û˘Ó¯›˙ÂÙ·È ÂÚ›Ô˘ ̤¯ÚÈ Ù· 2 ¯ÚfiÓÈ· (24-34). ¶·È‰È·ÙÚÈ΋ 2007;70:184-191

Pediatri May-Jun 07

24-05-07

17:58

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190

∫. ¡. ¶Ú›ÊÙ˘ Î·È Û˘Ó.

™˘ÓÂÒ˜, Ô ÔÏÏ·Ï·ÛÈ·ÛÌfi˜ ÙˆÓ Î˘„ÂÏ›‰ˆÓ Û Ó¢ÌÔÓÂÎÙÔÌËı¤ÓÙ· ÂÈÚ·Ì·Ùfi˙ˆ·, ÌÔÚ› Ó· Â›Ó·È ÙÔ ·ÔÙ¤ÏÂÛÌ· Ù˘ ·ÓÙÈÚÚÔÈÛÙÈ΋˜ ·‡ÍËÛ˘ Û ÌÈ· ÚÔÛ¿ıÂÈ· ·ÔηٿÛÙ·Û˘ ÙÔ˘ ·ÔÏÂÛı¤ÓÙÔ˜ ÈÛÙÔ‡ ‹ Ó· Â›Ó·È Ì¤ÚÔ˜ Ù˘ Ê˘ÛÈÔÏÔÁÈ΋˜ ‰È·‰Èηۛ·˜ ·‡ÍËÛ˘ Ô˘ Û˘Ì‚·›ÓÂÈ ·ÓÂÍ¿ÚÙËÙ· ·fi ÙËÓ Ó¢ÌÔÓÂÎÙÔÌ‹. ¶ÈÛÙ‡ÂÙ·È fiÙÈ Ì¿ÏÏÔÓ ˘¿Ú¯ÂÈ ÁÂÓÂÙÈο ÚÔηıÔÚÈṲ̂ÓÔ fiÚÈÔ Î˘ÙÙ·ÚÈÎÔ‡ ÔÏÏ·Ï·ÛÈ·ÛÌÔ‡ Ô˘ ·ÊÔÚ¿ ÛÙËÓ ·‡ÍËÛË ÙÔ˘ Ó‡ÌÔÓ· Î·È ÙÔ fiÚÈÔ ·˘Ùfi ˘Ê›ÛٷٷÈ, ·Û¯¤Ùˆ˜ Â¿Ó Ô Ó‡ÌÔÓ·˜ ˘¤ÛÙË ÂÎÙÔÌ‹ ‹ fi¯È Û ÌÈÎÚ‹ ËÏÈΛ· (21). ∞fi Ù· ·Ú·¿Óˆ ‰ÂÓ ÚÔ·ÙÂÈ Ì Â·Ú΋ Û·Ê‹ÓÂÈ· ÙÔ fiÊÂÏÔ˜ Ù˘ ·ÓÙÈÚÚÔÈÛÙÈ΋˜ ·‡ÍËÛ˘, ÛÙÔÓ ·ÚÈıÌfi ‹ ÛÙË ‰ÔÌ‹ ÙˆÓ Î˘„ÂÏ›‰ˆÓ ÌÂÙ¿ ·fi Ó¢ÌÔÓÂÎÙÔÌ‹ Û ÌÈÎÚ‹ ËÏÈΛ·. °È· ÙÔÓ ÎÏÈÓÈÎfi ÁÈ·ÙÚfi ÙÔ Î‡ÚÈÔ ÎÚÈÙ‹ÚÈÔ Ê·›ÓÂÙ·È Ó· ·Ú·Ì¤ÓÂÈ Ë Î·Ù¿ÛÙ·ÛË Î·È Ë ÈÂÚ¿Ú¯ËÛË ÙˆÓ ·Ó·ÁÎÒÓ ÙÔ˘ οı ·ÛıÂÓÔ‡˜. ∂ÊfiÛÔÓ ‰ÂÓ ˘¿Ú¯ÂÈ Â›ÁÔ˘Û· ·Ó¿ÁÎË ¯ÂÈÚÔ˘ÚÁÈ΋˜ ·ÓÙÈÌÂÙÒÈÛ˘ Ù˘ Û˘ÁÁÂÓÔ‡˜ ‰È·Ì·ÚÙ›·˜ ÙÔ˘ Ó‡ÌÔÓ· Û ÌÈÎÚ‹ ËÏÈΛ·, ÔÏϤ˜ ‚Ï¿‚˜ ÌÔÚÔ‡Ó Ó· ·ÓÙÈÌÂÙˆÈÛıÔ‡Ó Û˘ÓÙËÚËÙÈο ÒÛÙ ӷ ÂÈÏÂÁ› Ô Î·Ù·ÏÏËÏfiÙÂÚÔ˜ ¯ÚfiÓÔ˜ ÁÈ· ÙËÓ Â¤Ì‚·ÛË Î·È ·˘Ùfi ¯ˆÚ›˜ ÛËÌ·ÓÙÈÎfi ΛӉ˘ÓÔ Ó· ¯·ı› οÔÈ· ¢ηÈÚ›· ·ÓÙÈÚÚÔÈÛÙÈ΋˜ ·‡ÍËÛ˘. √È ·Ó·Ó¢ÛÙÈΤ˜ Âʉڛ˜ ÙÔ˘ ÂÓ‹ÏÈÎÔ˘ Ô˘ ¯ÂÈÚÔ˘ÚÁ‹ıËΠÛÙË ‚ÚÂÊÈ΋ ‹ ·È‰È΋ ËÏÈΛ· ηıÔÚ›˙ÔÓÙ·È ÂÚÈÛÛfiÙÂÚÔ ·fi ÙËÓ ¤ÎÙ·ÛË Ù˘ ÂÎÙÔÌ‹˜ ·Ú¿ ·fi ÙËÓ ËÏÈΛ· Ô˘ ¤ÁÈÓÂ Ë Â¤Ì‚·ÛË.

µÈ‚ÏÈÔÁÚ·Ê›· 1. ∞ÓıÚ·ÎfiÔ˘ÏÔ˜ ª, ¶Ú›ÊÙ˘ ∫, ÂÈÌ. ™˘ÁÁÂÓ›˜ ‰È·Ì·Úٛ˜ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ªÔÓÔÁÚ·Ê›· ¶·È‰È·ÙÚÈ΋˜ ¶Ó¢ÌÔÓÔÏÔÁ›·˜. ∆‡¯Ô˜ 3, ∞ı‹Ó·; 2004.

2. µ¿Ô˜ °. ÃÂÈÚÔ˘ÚÁÈ΋ ‰ÈfiÚıˆÛË Û˘ÁÁÂÓÒÓ ‰È·Ì·ÚÙÈÒÓ ÙˆÓ Ó¢ÌfiÓˆÓ. ™ÙÔ: ∞ÓıÚ·ÎfiÔ˘ÏÔ˜ ª, ¶Ú›ÊÙ˘ ∫, ÂÈÌ. ™˘ÁÁÂÓ›˜ ‰È·Ì·Úٛ˜ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ªÔÓÔÁÚ·Ê›· ¶·È‰È·ÙÚÈ΋˜ ¶Ó¢ÌÔÓÔÏÔÁ›·˜. ∆‡¯Ô˜ 3, ∞ı‹Ó·; 2004:194-206.

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Quiz 1. ¶ÔÈÔ ·fi Ù· ·Ú·Î¿Ùˆ ÂΉËÏÒÓÂÙ·È Û˘Ó‹ıˆ˜ ÛÙȘ ÚÒÙ˜ ÒÚ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË; ·. ∞ÁÁÂÈ·Îfi˜ ‰·ÎÙ‡ÏÈÔ˜ ‚. ™˘ÁÁÂÓ‹˜ ‚ÚÔÁ¯ÂÎÙ·Û›· Á. ™˘ÁÁÂÓ‹˜ ‰È·ÊÚ·ÁÌ·ÙÔ΋ÏË ‰. ¶Ó¢ÌÔÓÈÎfi ·fiÏ˘Ì· Â. ∆Ú·¯ÂÈÔÔÈÛÔÊ·ÁÈÎfi Û˘Ú›ÁÁÈÔ Ì ·ÙÚËÛ›· Ù‡Ô˘ ∏ 2. ∏ ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ÂÈÛÓ¢ÛÙÈÎÔ‡ ÛÈÁÌÔ‡ ηÈ/‹ ÂÎÓ¢ÛÙÈÎÔ‡ ÌÔÓÔʈÓÈÎÔ‡ Û˘ÚÈÁÌÔ‡ ÛÙ· 2-3 ÚÒÙ· ¤ÙË ˙ˆ‹˜ Ú¤ÂÈ Ó· ÂÚÈÏ¿‚ÂÈ: ·. ∆Ë ÌÂÙ·ÙÚ·˘Ì·ÙÈ΋ ÛÙ¤ÓˆÛË ÌÂÙ¿ ·fi ‰È·ÛˆÏ‹ÓˆÛË ‚. ∆Ë Á·ÛÙÚÔÔÈÛÔÊ·ÁÈ΋ ·ÏÈÓ‰ÚfiÌËÛË Î·È ÂÈÛÚfiÊËÛË Á. ∆ËÓ ÂÈÛÚfiÊËÛË Í¤ÓÔ˘ ÛÒÌ·ÙÔ˜ ‰. ∆ÔÓ ·ÁÁÂÈ·Îfi ‰·ÎÙ‡ÏÈÔ Â. ŸÏ· Ù· ·Ú·¿Óˆ 3. ¶ÔÈÔ ·fi Ù· ·Ú·Î¿Ùˆ Â›Ó·È ·ÏËı¤˜; ·. µÏ¿‚˜ ÛÙÔ Â›Â‰Ô Ù˘ ÁψÙÙ›‰·˜ Û˘Ó‹ıˆ˜ ‰ÂÓ Û˘Óԉ‡ÔÓÙ·È ·fi ·ÊˆÓ›· ‹ ‚Ú·¯Ófi ÎÏ¿Ì· ‚. ∆Ô Û˘ÁÁÂÓ¤˜ ÏԂ҉˜ ÂÌʇÛËÌ· Û˘Ó‰˘¿˙ÂÙ·È Ì ·˘ÍË̤ÓË Èı·ÓfiÙËÙ· ηÎÔ‹ıÔ˘˜ ÂÍ·ÏÏ·Á‹˜ ηٿ ÙËÓ ÂÓ‹ÏÈÎÔ ˙ˆ‹ Á. √ ·ÁÁÂÈ·Îfi˜ ‰·ÎÙ‡ÏÈÔ˜ ÌÔÚ› Ó· ÂΉËψı› ˆ˜ “ÔÈÛıfiÙÔÓÔ˜” ηٿ ÙÔ˘˜ ÚÒÙÔ˘˜ Ì‹Ó˜ Ù˘ ˙ˆ‹˜ ‰. ∆Ô Ó¢ÌÔÓÈÎfi ·fiÏ˘Ì· Û˘Ó‹ıˆ˜ ÂΉËÏÒÓÂÙ·È Ì Ó¢ÌÔıÒڷη ηٿ ÙÔ˘˜ ÚÒÙÔ˘˜ Ì‹Ó˜ Ù˘ ˙ˆ‹˜ Â. ∏ ·Ï·Û›· ÙÔ˘ Ó‡ÌÔÓ· ÂΉËÏÒÓÂÙ·È Ì ÔÏ˘˘‰Ú¿ÌÓÈÔ 4. ∏ ‰ÈfiÚıˆÛË ÙÚ·¯ÂÈÔÔÈÛÔÊ·ÁÈÎÔ‡ Û˘ÚÈÁÁ›Ô˘ ÌÔÚ› Ó· Û˘Óԉ‡ÂÙ·È ·fi: ·. ¢È·Ù·Ú·¯‹ Ù˘ ·‡ÍËÛ˘ ‚. ™˘Ìو̷ÙÔÏÔÁ›· Á·ÛÙÚÔÔÈÛÔÊ·ÁÈ΋˜ ·ÏÈÓ‰ÚfiÌËÛ˘ Á. ¢˘ÛÎÔÏ›· ηٿ ÙËÓ Î·Ù¿ÔÛË, ȉ›ˆ˜ ÛÙÂÚÂÒÓ ÙÚÔÊÒÓ ‰. ™˘Ìو̷ÙÔÏÔÁ›· ÙÚ·¯ÂÈÔÌ·Ï¿Î˘ÓÛ˘ Â. ŸÏ· Ù· ·Ú·¿Óˆ 5. ¶ÔÈÔ ·fi Ù· ·Ú·Î¿Ùˆ ÈÛ¯‡ÂÈ ÁÈ· ÙË ¯ÂÈÚÔ˘ÚÁÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ Û˘ÁÁÂÓÒÓ ‰È·Ì·ÚÙÈÒÓ ÙÔ˘ Ó‡ÌÔÓ·; ·. √È ·Ó·Ó¢ÛÙÈΤ˜ Âʉڛ˜ ÙˆÓ ÂÓËÏ›ÎˆÓ Î·ıÔÚ›˙ÔÓÙ·È Î˘Ú›ˆ˜ ·fi ÙËÓ ËÏÈΛ· Ô˘ ¤ÁÈÓÂ Ë ÂÎÙÔÌ‹ ‚. √È Û˘ÁÁÂÓ›˜ ‰È·Ì·Úٛ˜ ¯ÚÂÈ¿˙ÔÓÙ·È Î·Ù¿ ηÓfiÓ· ¿ÌÂÛË Â¤Ì‚·ÛË Á. ∏ ·‡ÍËÛË ÙÔ˘ Ó¢ÌÔÓÈÎÔ‡ ÈÛÙÔ‡ ÌÂÙ¿ ÙËÓ Ó¢ÌÔÓÂÎÙÔÌ‹ ·ÊÔÚ¿ ΢ڛˆ˜ ÙÔ ‰›ÎÙ˘Ô ÙˆÓ ·ÂÚ·ÁˆÁÒÓ Î·È ÏÈÁfiÙÂÚÔ ÙÔ ·Ú¤Á¯˘Ì· ‰. ¶ÂÈÚ·Ì·ÙÈο ‰Â‰Ô̤ӷ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ Ë ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ ·‡ÍËÛË ÙÔ˘ Ó‡ÌÔÓ· Û˘ÓÂ¿ÁÂÙ·È ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË ÙÔ˘ ÏÂÈÙÔ˘ÚÁÈÎÔ‡ Ó¢ÌÔÓÈÎÔ‡ ÈÛÙÔ‡ Â. ∫·Ó¤Ó· ·fi Ù· ·Ú·¿Óˆ √È ÛˆÛÙ¤˜ ··ÓÙ‹ÛÂȘ ÛÙË ÛÂÏ›‰· 204 ¶·È‰È·ÙÚÈ΋ 2007;70:184-191

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AÏÏËÏÔÁÚ·Ê›·: ¡ÈÎÔϤٷ ¶Ú›ÓÙ˙· nprintza@in.gr ∫ˆÓÛÙ·ÓÙÈÓÔ˘fiψ˜ 49 ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ∞¶£ πÔÎÚ¿ÙÂÈÔ ¡ÔÛÔÎÔÌ›Ô, £ÂÛÛ·ÏÔÓ›ÎË

∂ÈÛ·ÁˆÁ‹: ™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‹Ù·Ó Ë ÚÔÔÙÈ΋ ÌÂϤÙË ÙˆÓ ·ÓÔÛÔÏÔÁÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ÙÔ˘ ÎÔÚÙÈÎÔ¢·›ÛıËÙÔ˘ ÓÂÊÚˆÛÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ (∫∂¡™) ÛÙËÓ ÂÓÂÚÁfi Ê¿ÛË Ù˘ ÓfiÛÔ˘ Û˘ÁÎÚÈÙÈο Ì ÙË Ê¿ÛË ‡ÊÂÛ˘ Î·È Ì ٷ Â˘Ú‹Ì·Ù· ˘ÁÈÒÓ ·È‰ÈÒÓ Î·È Ë Û˘Û¯¤ÙÈÛË ÙˆÓ Â˘ÚËÌ¿ÙˆÓ Ì ÙËÓ ·ÙÔ›·. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ªÂÏÂÙ‹ıËÎ·Ó 20 ·È‰È¿, ËÏÈΛ·˜ 3-14 ÂÙÒÓ, Ì ∫∂¡™ Î·È 20 ˘ÁÈ‹ ·È‰È¿ (Ì¿ÚÙ˘Ú˜). ∆· 12/20 ·È‰È¿ Ì ∫∂¡™ ÌÂÏÂÙ‹ıËÎ·Ó Û ÂÓÂÚÁfi Ê¿ÛË, Û ʿÛË ‡ÊÂÛ˘ ˘fi ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹ Î·È Û ʿÛË ‡ÊÂÛ˘ ¯ˆÚ›˜ ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹ (8/12). ™Â 8 ÂÈϤÔÓ ·È‰È¿ Ì ∫∂¡™, Ô ¤ÏÂÁ¯Ô˜ ¤ÁÈÓ ÌfiÓÔ Û ʿÛË ‡ÊÂÛ˘ ¯ˆÚ›˜ ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹. ¶ÚÔÛ‰ÈÔÚ›ÛÙËÎ·Ó Ô ‚·ÛÈÎfi˜ ·ÓÔÛÔÊ·ÈÓfiÙ˘Ô˜ µ Î·È ∆ ΢ÙÙ¿ÚˆÓ, Ù· ÔÛÔÛÙ¿ ÙˆÓ CD23+, CD3+/CD69+/INF-Á+ Î·È CD3+/CD69+/IL-4+ ΢ÙÙ¿ÚˆÓ Î·È Ù· Â›‰· ÛÙÔÓ ÔÚfi ÙˆÓ IgE, INF-Á, IL-4, IL-13 Î·È IL-18. ∞ÔÙÂϤÛÌ·Ù·: πÛÙÔÚÈÎfi ·ÙÔ›·˜ ·ÚÔ˘Û›·˙·Ó 4/20 ·È‰È¿ Ì ∫∂¡™ Î·È 3/20 Ì¿ÚÙ˘Ú˜. T· ÔÛÔÛÙ¿ ÙˆÓ CD19+, CD23+ µ ΢ÙÙ¿ÚˆÓ, ÙˆÓ CD3+/CD69+/IL-4+ T ΢ÙÙ¿ÚˆÓ, ηıÒ˜ Î·È Ù· Â›‰· ÙˆÓ IgE, IL4, IL-13 Î·È IL-18 ‹Ù·Ó ÛËÌ·ÓÙÈο ·˘ÍË̤ӷ ÛÙËÓ ÂÓÂÚÁfi Ê¿ÛË Ù˘ ÓfiÛÔ˘ Û˘ÁÎÚÈÙÈο Ì ÙË Ê¿ÛË ‡ÊÂÛ˘ ˘fi Î·È ¯ˆÚ›˜ ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹ Î·È Ì ÙÔ˘˜ Ì¿ÚÙ˘Ú˜ (p<0,05). ∞ÓÙ›ıÂÙ·, ÙÔ ÔÛÔÛÙfi ÙˆÓ CD3+/CD69+/INF-Á+ T ΢ÙÙ¿ÚˆÓ ‹Ù·Ó ÛËÌ·ÓÙÈο ÂÏ·Ùو̤ÓÔ Û fiϘ ÙȘ Ê¿ÛÂȘ Ù˘ ÓfiÛÔ˘ Û ۯ¤ÛË Ì ÙÔ˘˜ Ì¿ÚÙ˘Ú˜ (p<0,05). ¢È·ÈÛÙÒıËΠıÂÙÈ΋ Û˘Û¯¤ÙÈÛË ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ IgE Ì ٷ Â›‰· ΢ڛˆ˜ Ù˘ πL-13, fiˆ˜ Î·È ÙˆÓ IL-4 Î·È πL-18, ·ÏÏ¿ fi¯È Ì ÙÔ ÈÛÙÔÚÈÎfi ·ÙÔ›·˜. ™˘ÌÂÚ¿ÛÌ·Ù·: ™Ù· ·È‰È¿ Ì ÂÓÂÚÁfi ∫∂¡™ ˘ÂÚ¤¯ÂÈ Ë ·ÓÔÛȷ΋ ·¿ÓÙËÛË Ù‡Ô˘-2, Ë ÔÔ›· Èı·ÓfiÓ Ó· ÔÊ›ÏÂÙ·È ÛÙËÓ ·˘ÍË̤ÓË ¤ÎÎÚÈÛË Î·È Û˘ÓÂÚÁÈ΋ ‰Ú¿ÛË ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ IL-13 Î·È IL-18 Î·È fi¯È Û Ì˯·ÓÈÛÌfi ·ÙÔ›·˜.

¶ÂÚ›ÏË„Ë

§¤ÍÂȘ ÎÏÂȉȿ: ∫ÔÚÙÈÎÔ¢·›ÛıËÙÔ ÓÂÊÚˆÛÈÎfi Û‡Ó‰ÚÔÌÔ, Ù‡Ô˘-1/Ù‡Ô˘-2 ΢ÙÙ·ÚÔΛÓ˜.

Investigation of type-1/type-2 immune imbalance in steroid sensitive nephrotic syndrome - No relationship with atopy 1st Paediatric Department, Hippokration General Hospital, Thessaloniki Correspondence: Nikoleta Printza nprintza@in.gr 49 Konstantinoupoleos Str. 1st Paediatric Department Hippokration General Hospital

N. Printza, F. Papachristou, V. Tzimouli, A. Taparkou, F. Kanakoudi - Tsakalidou Abstract Background: The purpose of this prospective study was to investigate the immune disturbances in different stages of primary steroid sensitive nephrotic syndrome (SSNS) and identify whether there is a relationship of the findings with atopy.

Methods: Twenty children with SSNS, aged 3-14 years, were studied; 12/20 both in active stage before treatment initiation and in remission still on steroid treatment; 8/12 in remission off steroids as well.

Eight additional children with previously treated primary SSNS were studied only in remission off steroids. Data were compared with those obtained from 20 age-matched controls. The following parameters were assessed: basic B and T cell populations, percentages of CD23+, CD3+/CD69+/INF-Á+ cells and CD3+/CD69+/IL-4+ as well as serum levels of IgE, INF-Á, IL-4, IL-13 and IL-18.

Results: Atopic disease was recorded in 4/20 nephrotic children and in 3/20 controls. Percentages of CD23+ and CD19+ B cells, CD3+/CD69+/IL-4+ T cells and serum levels of IgE, IL-4, IL-13 and IL-18 were significantly higher in the active stage of SSNS compared with the remission stage on steroids, remission off steroids and controls (p<0.05). On the contrary, percentage of CD3+/CD69+/INF-Á+ T cells was significantly lower in patients during different disease stages compared with controls (p<0.05). In the active disease stage, serum IgE concentrations were significantly correlated mainly with serum IL-13 as well as IL-4 and IL-18 levels but not with history of atopy.

Conclusions: These findings suggest that the type-2 immune response found in active SSNS may be the result of synergistic action of increased IL-13 and IL-18 produced during this disease stage and not to an atopy induced mechanism.

Key words: Steroid sensitive nephrotic syndrome, type-1/type-2 cytokines.

Paediatriki 2007;70:192-198

∏ ÂÚÁ·Û›· ·˘Ù‹ ‚Ú·‚‡ıËΠ̠ÙÔ ÃˆÚ¤ÌÂÈÔ Œ·ıÏÔ, ÛÙÔ 44Ô ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ, ƒfi‰Ô˜, 9-11 πÔ˘Ó›Ô˘ 2006

Pediatri May-Jun 07

24-05-07

17:58

™ÂÏ›‰·193

193

∞ÓÔÛȷ΋ ·¿ÓÙËÛË ÛÙÔ ÎÔÚÙÈÎÔ¢·›ÛıËÙÔ ÓÂÊÚˆÛÈÎfi Û‡Ó‰ÚÔÌÔ

∂ÈÛ·ÁˆÁ‹ ªÂ ÙÔÓ fiÚÔ ÓÂÊÚˆÛÈÎfi Û‡Ó‰ÚÔÌÔ (¡™) ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ÛÂÈÚ·Ì·ÙÔ¿ıÂȘ Ì ÛÔ‚·Ú‹ ÚˆÙÂ˚ÓÔ˘Ú›·, Ô˘ ÚÔηÏ› ˘ÔÏÂ˘ÎˆÌ·ÙÈÓ·ÈÌ›· (<2,5 g/dl), ˘ÂÚ¯ÔÏËÛÙÂÚÈÓ·ÈÌ›· Î·È Û˘Ó‹ıˆ˜ Ô›‰ËÌ· (1). ∫ÏÈÓÈο, ·Ó¿ÏÔÁ· Ì ÙËÓ ·¿ÓÙËÛ‹ ÙÔ˘ ÛÙË ıÂÚ·›· Ì ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹, ÙÔ ¡™ ‰È·ÎÚ›ÓÂÙ·È Û ÎÔÚÙÈÎÔ¢·›ÛıËÙÔ (∫∂¡™), Ô˘ ·ÔÙÂÏ› ÙÔ 4580% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÛÙ· ·È‰È¿ Î·È Û ÎÔÚÙÈÎÔ·ÓıÂÎÙÈÎfi (2-4). ∏ ·ÎÚÈ‚‹˜ ·ıÔÁ¤ÓÂÛË ÙÔ˘ ∫∂¡™ ‰ÂÓ ¤¯ÂÈ Ï‹Úˆ˜ ‰È¢ÎÚÈÓÈÛÙ›, fï˜ ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙ› Ì ‰È·Ù·Ú·¯‹ Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ ÙˆÓ ∆ ΢ÙÙ¿ÚˆÓ. ∆Ô 1974 Ô Shalhoud RJ ‰È·Ù‡ˆÛ ÚÒÙÔ˜ ÙËÓ ˘fiıÂÛË fiÙÈ Û ÂÓÂÚÁfi ∫∂¡™ ¤Ó·˜ ÎÏÒÓÔ˜ ∆ ΢ÙÙ¿ÚˆÓ ·Ú¿ÁÂÈ Ì›· “ÏÂÌÊÔΛÓË” Ô˘ Â›Ó·È ÙÔÍÈ΋ ÁÈ· ÙË ‚·ÛÈ΋ ÌÂÌ‚Ú¿ÓË ÙÔ˘ ÛÂÈÚ¿Ì·ÙÔ˜, ›Ù ¿ÌÂÛ· ‹ ¤ÌÌÂÛ·, ̤ۈ ÂÓÂÚÁÔÔ›ËÛ˘ ÙˆÓ ÌÂÛ·ÁÁÂÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ. ∏ ¿Ô„Ë ·˘Ù‹ ‚·Û›ÛÙËΠÛÙȘ ÂÍ‹˜ ÎÏÈÓÈΤ˜ ·Ú·ÙËÚ‹ÛÂȘ: ·) ˘‹Ú¯Â ‡ÊÂÛË Ù˘ ÓfiÛÔ˘ Û ÏÔÈÌÒÍÂȘ Ô˘ ÚÔηÏÔ‡Ó ·ÓÔÛÔηٷÛÙÔÏ‹, fiˆ˜ Ë ÈÏ·Ú¿, ‚) Ù· ·È‰È¿ Ì ¡™ ›¯·Ó ¢·ÈÛıËÛ›· Û Ó¢ÌÔÓÈÔÎÔÎÎÈΤ˜ Î·È ¿ÏϘ ÌÈÎÚԂȷΤ˜ ÏÔÈÌÒÍÂȘ Î·È Á) Ù· ·È‰È¿ Ì ¡™ ··ÓÙÔ‡Û·Ó ÛÙË ıÂÚ·›· Ì ÛÙÂÚÔÂȉ‹ Î·È Î˘ÎÏÔʈÛÊ·Ì›‰Ë, Ê¿Ú̷η Ô˘ ηٷÛÙ¤ÏÏÔ˘Ó ÙËÓ Î˘ÙÙ·ÚÈ΋ ·ÓÔÛ›· (5). ™ÙȘ ÂfiÌÂÓ˜ ‰ÂηÂٛ˜, Ë ·ÎÚÈ‚‹˜ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ÙˆÓ ∆ ΢ÙÙ¿ÚˆÓ Î·È Ô ÚfiÏÔ˜ ÙÔ˘˜ ÛÙËÓ ·ıÔÁ¤ÓÂÛË ÙÔ˘ ∫∂¡™ ·ÔÙ¤ÏÂÛ ·ÓÙÈΛÌÂÓÔ ·ÚÎÂÙÒÓ ÂÚ¢ÓÒÓ (6-15). ∫·Ù¿ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, ‰È·Ù˘ÒıËÎÂ Ë ¿Ô„Ë fiÙÈ Ù· ∆ ·ÙÙ·Ú· ÂÌϤÎÔÓÙ·È ÛÙËÓ ·ıÔÁ¤ÓÂÛË ÙÔ˘ ∫∂¡™ ̤ۈ ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ Ô˘ ·Ú¿ÁÔ˘Ó (7,9,10,12). ªÂ ‚¿ÛË ÙȘ ·Ú·ÁfiÌÂÓ˜ ΢ÙÙ·ÚÔΛÓ˜, Ù· ∆ ·ÙÙ·Ú· ‰È·ÎÚ›ÓÔÓÙ·È Û هÔ˘-1 Î·È Ù‡Ô˘-2. ∆· Ù‡Ô˘-1 ∆ ·ÙÙ·Ú· Ù˘Èο ·Ú¿ÁÔ˘Ó ÈÓÙÂÚÏ¢ΛÓË2 (IL-2), ÙÔÓ ·Ú¿ÁÔÓÙ· Ó¤ÎÚˆÛ˘ ÙˆÓ fiÁÎˆÓ (TNF) Î·È ÈÓÂÚÊÂÚfiÓË-Á (πNF-Á), ‰ËÏ·‰‹ ΢ÙÙ·ÚÔΛÓ˜ Ì ΢ÙÙ·ÚÔÙÔÍÈ΋ Î·È ÊÏÂÁÌÔÓÒ‰Ë ‰Ú¿ÛË. ∆· Ù‡Ô˘-2 ∆ ·ÙÙ·Ú· ·Ú¿ÁÔ˘Ó IL-4, IL-5, IL-9, IL-10 Î·È IL13, ‰ËÏ·‰‹ ΢ÙÙ·ÚÔΛÓ˜ Ô˘ Û˘Ó‰¤ÔÓÙ·È Ì ÙË Ú‡ıÌÈÛË ÈÛ¯˘ÚÒÓ ·ÓÔÛÈ·ÎÒÓ ··ÓÙ‹ÛÂˆÓ Û ·ÓÙÈÁfiÓ· Î·È ·ÏÏÂÚÁÈÔÁfiÓ·. √È ÚfiÛÊ·Ù˜ ÌÂϤÙ˜ Û¯ÂÙÈο Ì ÙËÓ Ù·˘ÙÔÔ›ËÛË ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ Ô˘ ÂÎÎÚ›ÓÔÓÙ·È ÛÙÔ ∫∂¡™ ¤‰ÂÈÍ·Ó ·ÔÙÂϤÛÌ·Ù· Ô˘ Û˘¯Ó¿ ‹Ù·Ó ·ÓÙÈÎÚÔ˘fiÌÂÓ· (16). ∏ ˘ÂÚÔ¯‹ Ù˘ ·ÓÔÛȷ΋˜ ·¿ÓÙËÛ˘ Ù‡Ô˘-2, fiˆ˜ ÚԤ΢„ ·fi ÔÚÈṲ̂Ó˜ ÌÂϤÙ˜ (16), ÛÂ Û˘Ó‰˘·ÛÌfi Ì ٷ ·˘ÍË̤ӷ Â›‰· Ù˘ ·ÓÔÛÔÛÊ·ÈÚ›Ó˘ ∂ (πgE) Ô˘ ‚Ú¤ıËÎ·Ó Û ÂÓÂÚÁfi ∫∂¡™ (15,17), Ô‰‹ÁËÛ·Ó ÛÙË Û‡Ó‰ÂÛË ÙÔ˘ ∫∂¡™ Ì ÙËÓ ·ÙÔ›·. ¶·Ú’ fiÏ· ·˘Ù¿, ÎÏÈÓÈΤ˜ ·Ú·ÙËÚ‹ÛÂȘ (18,19) ηıÒ˜ Î·È ÂÚÁ·ÛÙËÚȷο ‰Â‰Ô̤ӷ (20) ¤ıÂÛ·Ó Û ·ÌÊÈÛ‚‹ÙËÛË ÙËÓ ·Ú·¿Óˆ ˘fiıÂÛË.

™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‹Ù·Ó Ë ÚÔÔÙÈ΋ ‰ÈÂÚ‡ÓËÛË ÙˆÓ ·ÓÔÛÔÏÔÁÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ ÛÙ· ·È‰È¿ Ì ∫∂¡™ ÛÙȘ ‰È·ÊÔÚÂÙÈΤ˜ Ê¿ÛÂȘ Ù˘ ÓfiÛÔ˘, Û ۇÁÎÚÈÛË Ì ˘ÁÈ‹ ·È‰È¿, Ì ÂÈΤÓÙÚˆÛË ÛÙËÓ Ù·˘ÙÔÔ›ËÛË ÙÔ˘ Ù‡Ô˘ Ù˘ ·ÓÔÛȷ΋˜ ·¿ÓÙËÛ˘ (1 ‹ 2) Ô˘ ˘ÂÚÈÛ¯‡ÂÈ Û ÂÓÂÚÁfi Ê¿ÛË Ù˘ ÓfiÛÔ˘ Î·È ÛÙË Û¯¤ÛË Ù˘ Ì ·ÙÔ›·.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ªÂÏÂÙ‹ıËÎ·Ó 20 ·È‰È¿ (7 ·ÁfiÚÈ· Î·È 13 ÎÔÚ›ÙÛÈ·), ËÏÈΛ·˜ 3-14 ÂÙÒÓ, Ì ∫∂¡™. ∆· 12/20 ·È‰È¿ ÌÂÏÂÙ‹ıËÎ·Ó ·ÊÂÓfi˜ Û ÂÓÂÚÁfi Ê¿ÛË Ù˘ ÓfiÛÔ˘ (3/12 ÛÙÔ ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ∫∂¡™ Î·È 9/12 Û ˘ÔÙÚÔ‹ Ù˘ ÓfiÛÔ˘), ÚÈÓ ÙËÓ ¤Ó·ÚÍË Ù˘ ·ÁˆÁ‹˜ Ì ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹, ·ÊÂÙ¤ÚÔ˘ Û ʿÛË ‡ÊÂÛ˘ Î·È ÂÓÒ Ï¿Ì‚·Ó·Ó ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹. ∞fi ·˘Ù¿ Ù· 12 ·È‰È¿, 8 ÌÂÏÂÙ‹ıËÎ·Ó Î·È Û ʿÛË ‡ÊÂÛ˘ ¯ˆÚ›˜ ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹ (6 Ì‹Ó˜ ÌÂÙ¿ ÙË ‰È·ÎÔ‹). ™Â 8/20 ·È‰È¿ Ì ∫∂¡™, Ô ¤ÏÂÁ¯Ô˜ ¤ÁÈÓ ÌfiÓÔ Û ʿÛË ‡ÊÂÛ˘ ¯ˆÚ›˜ ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹. ∫·È ÔÈ 12 ·ÛıÂÓ›˜, ÔÈ ÔÔ›ÔÈ ÌÂÏÂÙ‹ıËÎ·Ó Û ʿÛË ‡ÊÂÛ˘ ˘fi ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹, Ï¿Ì‚·Ó·Ó ÙËÓ ›‰È· ‰fiÛË Ú‰ÓÈ˙fiÓ˘ (40 mg/m2 ·Ó¿ 48ˆÚÔ). ∏ ‰È¿ÁÓˆÛË ÙÔ˘ ∫∂¡™ Î·È Ù˘ ˘ÔÙÚÔ‹˜ ‚·Û›ÛÙËΠÛÙ· ‰ÈÂıÓ‹ ÎÚÈÙ‹ÚÈ· (6) Î·È Ô Î·ıÔÚÈÛÌfi˜ Ù˘ ÎÔÚÙÈÎÔ¢·ÈÛıËÛ›·˜ ¤ÁÈÓ Ì ‚¿ÛË ÙËÓ ·Ú¯È΋ ·¿ÓÙËÛË ÙÔ˘ ÓÂÊÚˆÛÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ ÛÙ· ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹ ÂÓÙfi˜ 4 ‚‰ÔÌ¿‰ˆÓ. ∆ËÓ ÔÌ¿‰· Ì·ÚÙ‡ÚˆÓ ·ÔÙ¤ÏÂÛ·Ó 20 ˘ÁÈ‹ ·È‰È¿, ËÏÈΛ·˜ 2,5-14 ÂÙÒÓ, Ô˘ ÚÔÛ‹Ïı·Ó ÛÙÔ ∞ÈÌ·ÙÔÏÔÁÈÎfi ∂ÚÁ·ÛÙ‹ÚÈÔ Ù˘ ∞’ ¶·È‰È·ÙÚÈ΋˜ ∫ÏÈÓÈ΋˜ ÁÈ· ¤ÏÂÁ¯Ô Û˘ÁÁÂÓÔ‡˜ ·ÈÌÔÏ˘ÙÈ΋˜ ·Ó·ÈÌ›·˜ Î·È ¯ÚËÛ›ÌÂ˘Û·Ó ˆ˜ ÔÌ¿‰· ˘ÁÈÒÓ Ì·ÚÙ‡ÚˆÓ ÁÈ· ÙË Û‡ÁÎÚÈÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ Ì ÂΛӷ ÙˆÓ ·ÛıÂÓÒÓ. ∞ÈÌÔÏË„›· Î·È ¤ÏÂÁ¯Ô˜ ÙˆÓ ·ÓÔÛÔÏÔÁÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ ÛÙÔ˘˜ Ì¿ÚÙ˘Ú˜ Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó Ì›· ÊÔÚ¿. ∞ÓÔÛÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ™Â fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ Î·È ÙÔ˘˜ Ì¿ÚÙ˘Ú˜ ÌÂÏÂÙ‹ıËÎ·Ó ÔÈ ·ÎfiÏÔ˘ı˜ ·ÓÔÛÔÏÔÁÈΤ˜ ·Ú¿ÌÂÙÚÔÈ: ‚·ÛÈÎfi˜ ·ÓÔÛÔÛÔÊ·ÈÓfiÙ˘Ô˜, ÏfiÁÔ˜ CD4+/CD8+ ∆ ΢ÙÙ¿ÚˆÓ, CD25+ T ·ÙÙ·Ú·, CD23+ B ·ÙÙ·Ú·, ÔÛÔÛÙfi CD3+/CD69+/INF-Á+ Î·È CD3+/CD69+/IL-4+ T ΢ÙÙ¿ÚˆÓ Î·È Û˘ÁÎÂÓÙÚÒÛÂȘ ÛÙÔÓ ÔÚfi ÙˆÓ πgE, INF-Á, IL-4, IL-13 Î·È IL-18. ·) ¶ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙÔ˘ ‚·ÛÈÎÔ‡ ·ÓÔÛÔÊ·ÈÓfiÙ˘Ô˘ °È· ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙˆÓ ÂÈÊ·ÓÂÈ·ÎÒÓ ÌÔÚ›ˆÓ ÙˆÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ (‚·ÛÈÎfi˜ ·ÓÔÛÔÊ·ÈÓfiÙ˘Ô˜) ÂÊ·ÚÌfiÛÙËΠÙÚÈÏfi˜ ¿ÌÂÛÔ˜ ·ÓÔÛÔÊıÔÚÈÛÌfi˜ Ì ÙË ‚Ô‹ıÂÈ· ηٿÏÏËÏˆÓ ÌÔÓÔÎψÓÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ÙˆÓ ÂÙ·ÈÚÂÈÒÓ COULTER (Miami, Florida) Î·È IMMUNOTECH (Hamburg, Germany) Û˘Ó‰Â‰ÂÌ¤ÓˆÓ Ì ÊıÔÚ›˙Ô˘Û˜ ¯ÚˆÛÙÈΤ˜, fiˆ˜ ÈÛÔıÂÈÔ΢·ÓÈ΋ ÊÏÔ˘ÚÂÛνÓË (FITC): CD3, CD4, CD8, CD23, Ê˘ÎÔÂÚ˘ıÚ›ÓË (PE): CD4, CD19, CD25 Î·È Ê˘ÎÔÂÚ˘ıÚ›ÓË-΢·Ó›ÓË 5 (PE-Cy5): CD45. ∆· ÔÛÔÛÙ¿ ÙˆÓ µ ΢ÙÙ¿ÚˆÓ (CD19+), ÙˆÓ ÂÓÂÚÁÔÔÈËÌ¤ÓˆÓ µ ΢ÙÙ¿ÚˆÓ Ô˘ ÂÎÊÚ¿˙Ô˘Ó ÙÔÓ ˘Ô‰Ô¯¤· ππ Ù˘ IgE (CD23+), ÙˆÓ ÂÓÂÚÁÔÔÈËÌ¤ÓˆÓ ∆ ΢ÙÙ¿ÚˆÓ Ô˘ ÂÎÊÚ¿˙Ô˘Ó ÙÔÓ ˘Ô‰Ô¯¤· Ù˘ IL-2 (CD25+) Î·È ÔÈ ˘ÔÏËı˘ÛÌÔ› ÙˆÓ ∆ ΢ÙÙ¿ÚˆÓ (CD3+/CD4+ Î·È CD3+/CD8+) ÚÔÛ‰ÈÔÚ›ÛÙËÎ·Ó ÛÙÔÓ Î˘ÙÙ·ÚÔÌÂÙÚËÙ‹ ÚÔ‹˜ EPICS-XL Ù˘ ÂÙ·ÈÚ›·˜ COULTER, ÌÂÙ¿ ·fi ηٿÏÏËÏË ÂÂÍÂÚÁ·Û›· ÁÈ· χÛË ÙˆÓ ÂÚ˘ıÚÒÓ ÛÙË Û˘Û΢‹ multi Q-PREP Ì ÙË ‚Ô‹ıÂÈ· ÙÔ˘ Immunoprep Reagent System.

T· ·ÔÙÂϤÛÌ·Ù· ÂÎÊÚ¿˙ÔÓÙ·È ˆ˜ ÔÛÔÛÙfi ıÂÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ (‰ËÏ·‰‹ % ÔÛÔÛÙfi ÙˆÓ Î˘ÙÙ¿ÚˆÓ Ô˘ ÂÎÊÚ¿˙Ô˘Ó ÙÔÓ Û˘ÁÎÂÎÚÈ̤ÓÔ ÂÈÊ·ÓÂÈ·Îfi ‰Â›ÎÙË). ¶·È‰È·ÙÚÈ΋ 2007;70:192-198

Pediatri May-Jun 07

24-05-07

17:58

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194

¡. ¶Ú›ÓÙ˙· Î·È Û˘Ó.

‚) EÓ‰Ô΢ÙÙ¿ÚÈÔ˜ ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ INF-Á Î·È IL-4 ∏ ÂÓ‰Ô΢ÙÙ¿ÚÈ· ·Ú·ÁˆÁ‹ ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ π¡F-Á Î·È IL-4 ÌÂÙÚ‹ıËΠ۠ÂÚÈÊÂÚÈÎfi ·›Ì· Ì ΢ÙÙ·ÚÔÌÂÙÚ›· ÚÔ‹˜. ÃÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÌÔÓÔÎψÓÈο ·ÓÙÈÛÒÌ·Ù· Û ÛËÌ·Ṳ̂ӷ Ì ٷ ηٿÏÏËÏ· ÊıÔÚÈÔ¯ÚÒÌ·Ù·: CD3 (PE-Cy5), CD69 (FITC) (Beckman, COULTER, Maiami, Florida), ηıÒ˜ Î·È ·ÓÙÈ-IL-4 PE Î·È ·ÓÙÈ-INF-Á ƒ∂ (R&D Systems, Abingon, United Kingdom). ŒÁÈÓ ÌË ÂȉÈ΋ ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ Ì ÂÛÙ¤Ú· Ù˘ ÊÔÚÌfiÏ˘ PMA (phorbol-12-mystrate-13-acetate) Î·È ÈÔÓÔÌ˘Î›ÓË (iomycin) Ù˘ ÂÙ·ÈÚ›·˜ SIGMA. ªÂÙ¿ ·fi ÌË ÂȉÈ΋ ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ Ì PMA Î·È ÂÂÍÂÚÁ·Û›· Ì ηٿÏÏËÏ· ·ÓÙȉڷÛÙ‹ÚÈ· (intra-prep kit, Beckman, Coulter), ÌÂÙÚ‹ıËÎÂ Ë ¤ÓÙ·ÛË ÙÔ˘ ÊıÔÚÈÛÌÔ‡ ÙˆÓ Î˘ÙÙ¿ÚˆÓ Ô˘ ¤¯Ô˘Ó ‰ÂÛ̇ÛÂÈ ÙÔ ÂȉÈÎfi ·Óٛۈ̷ ÁÈ· ÙËÓ INF-Á Î·È ÙËÓ IL-4 Ì ÙË Ì¤ıÔ‰Ô ÙÔ˘ ÙÚÈÏÔ‡ ¿ÌÂÛÔ˘ ·ÓÔÛÔÊıÔÚÈÛÌÔ‡ ÛÙÔÓ Î˘ÙÙ·ÚÔÌÂÙÚËÙ‹ ÚÔ‹˜ Coulter EPIX XL. ∏ ÂÈÏÔÁ‹ ÙÔ˘ ÏËı˘ÛÌÔ‡ ÙˆÓ ∆ ΢ÙÙ¿ÚˆÓ ¤ÁÈÓ Ì ÙÔ CD3+ PE-Cy5 (Fluorescence channel 3, FL3) Î·È ÙËÓ ·Ú¿ÌÂÙÚÔ ÙÔ˘ Ï¿ÁÈÔ˘ ÛΉ·ÛÌÔ‡ (Sidescatter, SSC). ™ÙË Û˘Ó¤¯ÂÈ·, Ì ÙË ‚Ô‹ıÂÈ· ÙˆÓ ·Ú·Ì¤ÙÚˆÓ FL1 (Fluorescence channel 1) ÁÈ· ÙÔ CD9 Î·È FL2 (Fluorescence channel 2) ÁÈ· ÙËÓ INF-Á ‹ IL-4, ÚÔÛ‰ÈÔÚ›ÛÙËΠÙÔ ÔÛÔÛÙfi ÙˆÓ ÂÓÂÚÁÔÔÈËÌ¤ÓˆÓ ∆ ΢ÙÙ¿ÚˆÓ (CD3+CD69+) Ô˘ ·Ú¿ÁÔ˘Ó ÙȘ ·ÓÙ›ÛÙÔȯ˜ ΢ÙÙ·ÚÔΛÓ˜. °È· ÙËÓ ÂÍ·›ÚÂÛË ÙÔ˘ ÌË ÂȉÈÎÔ‡ Û‹Ì·ÙÔ˜ ·fi ÙËÓ ·Ó¿Ï˘ÛË, ¯ÚËÛÈÌÔÔÈ‹ıËΠÈÛÔÙ˘ÈÎfi ‰Â›ÁÌ· ÂϤÁ¯Ô˘, ηıÒ˜ Î·È ‰Â›ÁÌ· ¯ˆÚ›˜ ÙËÓ ÚÔÛı‹ÎË ÂÓÂÚÁÔÔÈËÙ‹ ƒª∞. ∆· ·ÔÙÂϤÛÌ·Ù· ÂÎÊÚ¿˙ÔÓÙ·È ˆ˜ ÙÔ % ÔÛÔÛÙfi ÙˆÓ ÂÓÂÚÁÔÔÈËÌ¤ÓˆÓ Î˘ÙÙ¿ÚˆÓ CD3+ CD69+ Ô˘ ·Ú¿ÁÔ˘Ó INF-Á ‹ IL-4. Á) ª¤ÙÚËÛË ÙˆÓ Û˘ÁÎÂÓÙÚÒÛÂˆÓ Ù˘ πgE ÛÙÔÓ ÔÚfi ∆· Â›‰· Ù˘ IgE ÌÂÙÚ‹ıËÎ·Ó ÛÙÔÓ ÔÚfi Ì ÙËÓ Ù¯ÓÈ΋ Ù˘ ÎÈÓËÙÈ΋˜ ÓÂÊÂÏÔÌÂÙÚ›·˜ Î·È ÂȉÈÎfiÙÂÚ· Ì ÙËÓ Ù¯ÓÈ΋ Ù˘ ÂÓ›Û¯˘Û˘ Ì ÂȉÈο ۈ̷ٛ‰È· latex (Particle enhanced nephelometry) Ì ÓÂÊÂÏfiÌÂÙÚÔ µ¡∞ (Behring Nephelometry Analyzer) BN100 Ù˘ ÂÙ·ÈÚ›·˜ Behring. °È· ÙȘ ÌÂÙÚ‹ÛÂȘ ¯ÚËÛÈÌÔÔÈ‹ıËΠÙÔ ÂȉÈÎfi ·ÓÙȉڷÛÙ‹ÚÈÔ Ù˘ ÂÙ·ÈÚ›·˜ Behring Ô˘ ·ÔÙÂÏÂ›Ù·È ·fi ۈ̷ٛ‰È· ÔÏ˘ÛÙ˘ÚÂÓ›Ô˘ ÂÈÎ·Ï˘ÙfiÌÂÓ· Ì ÌÔÓÔÎψÓÈο ·ÓÙÈÛÒÌ·Ù· IgE Î·È ÚfiÙ˘Ô˜ ·ÓÙÈÔÚfi˜ Ù˘ ›‰È·˜ ÂÙ·ÈÚ›·˜ (IgE-standard) ÁÈ· ÙË ‰ËÌÈÔ˘ÚÁ›· ηÌ‡Ï˘ ·Ó·ÊÔÚ¿˜. ‰) ¶ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ Û˘ÁÎÂÓÙÚÒÛÂˆÓ ÛÙÔÓ ÔÚfi ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ INF-Á, IL-4, IL-13 Î·È IL-18 ∆· Â›‰· ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ INF-Á, IL-4, IL-13 Î·È IL18 ÛÙÔÓ ÔÚfi ÌÂÙÚ‹ıËÎ·Ó Ì ·ÓÔÛÔÂÓ˙˘ÌÈ΋ ̤ıÔ‰Ô ELISA (R&D Systems, UK) Û‡Ìʈӷ Ì ÙȘ Ô‰ËÁ›Â˜ Ù˘ ·Ú·Û΢¿ÛÙÚÈ·˜ ÂÙ·ÈÚ›·˜. ∆· fiÚÈ· ¢·ÈÛıËÛ›·˜ ÙˆÓ ÌÂÙÚ‹ÛÂˆÓ ÙˆÓ INF-Á, IL-4, IL-13 Î·È IL-18 Â›Ó·È 13,8 pg/ml, 6,6 pg/ml, 14,3 pg/ml Î·È 12,5 pg/ml, ·ÓÙ›ÛÙÔȯ·. ™Ù·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ∏ ÛÙ·ÙÈÛÙÈ΋ ÂÂÍÂÚÁ·Û›· ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ¤ÁÈÓ Ì ÙË ¯Ú‹ÛË ÙÔ˘ ÛÙ·ÙÈÛÙÈÎÔ‡ ·Î¤ÙÔ˘ SPSS ¤Î‰ÔÛË 11.5. °È· fiϘ ÙȘ ·Ú·Ì¤ÙÚÔ˘˜ ˘ÔÏÔÁ›ÛÙËÎÂ Ë ‰È¿ÌÂÛË ÙÈÌ‹ Î·È Ë ‰È·Î‡Ì·ÓÛË. °È· ÙËÓ Î·Ù¿ ˙‡ÁË ·Ó¿Ï˘ÛË ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë ÌË ·Ú·ÌÂÙÚÈ΋ ‰ÔÎÈÌ·Û›· Wilcoxon signed-rank test Î·È ÁÈ· ÙË Û‡ÁÎÚÈÛË ÙˆÓ ‰È¿ÌÂÛˆÓ ÙÈÌÒÓ ÙˆÓ ·Ú·Ì¤ÙÚˆÓ Ë ÌË ·Ú·ÌÂÙÚÈ΋ ‰ÔÎÈÌ·Û›· Mann-Whitney rank test. ∏ Û˘Û¯¤ÙÈÛË (r) ¤ÁÈÓ Ì ÙË ‰ÔÎÈÌ·Û›· Spearman’s coefficient of correlation. ∏ ÛÙ·ÙÈÛÙÈ΋ ÛËÌ·ÓÙÈÎfiÙËÙ· ÔÚ›ÛÙËΠÛÙÔ Â›Â‰Ô p<0,05.

Paediatriki 2007;70:192-198

∞ÔÙÂϤÛÌ·Ù· πÛÙÔÚÈÎfi ·ÏÏÂÚÁ›·˜ πÛÙÔÚÈÎfi ·ÙÔ›·˜ ·ÚÔ˘Û›·˙·Ó 4/20 ·È‰È¿ Ì ∫∂¡™ (2 ·È‰È¿ Ì ¿ÛıÌ·, 1 ·È‰› Ì ·ÙÔÈ΋ ‰ÂÚÌ·Ù›Ùȉ· Î·È 1 ·È‰› Ì ¿ÛıÌ· Î·È ·ÙÔÈ΋ ‰ÂÚÌ·Ù›Ùȉ·) Î·È 3/20 Ì¿ÚÙ˘Ú˜ (1 ·È‰› Ì ¿ÛıÌ·, 1 ·È‰› Ì ·ÙÔÈ΋ ‰ÂÚÌ·Ù›Ùȉ· Î·È 1 ·È‰› Ì ¿ÛıÌ· Î·È ·ÙÔÈ΋ ‰ÂÚÌ·Ù›Ùȉ·). ÀÔÏËı˘ÛÌÔ› ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ∆· ÔÛÔÛÙ¿ ÙˆÓ ˘ÔÏËı˘ÛÌÒÓ CD3+ fiˆ˜ Î·È CD25+, CD4+ Î·È CD8+ ∆ ΢ÙÙ¿ÚˆÓ ÛÙ· ·È‰È¿ Ì ∫∂¡™ ηٿ ÙËÓ ÂÓÂÚÁfi Ê¿ÛË Ù˘ ÓfiÛÔ˘ Î·È Î·Ù¿ ÙË Ê¿ÛË ‡ÊÂÛ˘ ˘fi Î·È ¯ˆÚ›˜ ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹, ‹Ù·Ó Û˘ÁÎÚ›ÛÈÌ· Ì ·˘Ù¿ ÙˆÓ Ì·ÚÙ‡ÚˆÓ. ™ÙËÓ Î·Ù¿ ˙‡ÁË ·Ó¿Ï˘ÛË ÙˆÓ 12 ·È‰ÈÒÓ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó ÙfiÛÔ Û ÂÓÂÚÁfi Ê¿ÛË, fiÛÔ Î·È Û ʿÛË ‡ÊÂÛ˘ ˘fi ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹, ‚Ú¤ıËΠfiÙÈ Ô ÏfiÁÔ˜ CD4+/CD8+ ∆ ΢ÙÙ¿ÚˆÓ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚÔ˜ ÛÙËÓ ÂÓÂÚÁfi Ê¿ÛË Ù˘ ÓfiÛÔ˘ (p=0,017). ∞˘Ùfi ÔÊÂÈÏfiÙ·Ó Û ·‡ÍËÛË ÙÔ˘ ÔÛÔÛÙÔ‡ ÙˆÓ CD8+ ∆ ΢ÙÙ¿ÚˆÓ. ∆Ô ÔÛÔÛÙfi ÙˆÓ CD19+ µ ΢ÙÙ¿ÚˆÓ ‹Ù·Ó ÛËÌ·ÓÙÈο ·˘ÍË̤ÓÔ ÛÙËÓ ÂÓÂÚÁfi Ê¿ÛË Ù˘ ÓfiÛÔ˘ (‰È¿ÌÂÛÔ˜: 17,12, ‰È·Î‡Ì·ÓÛË: 12,22-24,54) Û ۯ¤ÛË Ì ÙË Ê¿ÛË ‡ÊÂÛ˘ ÙfiÛÔ ˘fi ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹ (‰È¿ÌÂÛÔ˜: 14,16, ‰È·Î‡Ì·ÓÛË: 10,23-18,3 Î·È p<0,0001), fiÛÔ Î·È ¯ˆÚ›˜ ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹ (‰È¿ÌÂÛÔ˜: 13,92, ‰È·Î‡Ì·ÓÛË: 10,8-17,4 Î·È p=0,035), ηıÒ˜ Î·È Ì ÙÔ˘˜ Ì¿ÚÙ˘Ú˜ (‰È¿ÌÂÛÔ˜: 13,78, ‰È·Î‡Ì·ÓÛË: 10,2-16,8 Î·È p=0,022). ∂›Û˘, ÙÔ ÔÛÔÛÙfi ÙˆÓ µ ΢ÙÙ¿ÚˆÓ Ô˘ ÂÎÊÚ¿˙Ô˘Ó ÙÔÓ ˘Ô‰Ô¯¤· Ù˘ IgE (CD23+) ‹Ù·Ó ÛËÌ·ÓÙÈο ·˘ÍË̤ÓÔ ÛÙËÓ ÂÓÂÚÁfi Ê¿ÛË Ù˘ ÓfiÛÔ˘ (‰È¿ÌÂÛÔ˜: 3,62, ‰È·Î‡Ì·ÓÛË: 1,80-11) Û˘ÁÎÚÈÙÈο Ì ÙË Ê¿ÛË ‡ÊÂÛ˘ ˘fi ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹ (‰È¿ÌÂÛÔ˜: 2,02, ‰È·Î‡Ì·ÓÛË: 1,21-8,53 Î·È p=0,002) Î·È ¯ˆÚ›˜ ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹ (‰È¿ÌÂÛÔ˜: 1,43, ‰È·Î‡Ì·ÓÛË: 0,44-8,06 Î·È p=0,012), ηıÒ˜ Î·È Ì ÙËÓ ÔÌ¿‰· ÙˆÓ Ì·ÚÙ‡ÚˆÓ (‰È¿ÌÂÛÔ˜: 1,13, ‰È·Î‡Ì·ÓÛË: 0,37-6,53 Î·È p<0,001).

EÓ‰Ô΢ÙÙ¿ÚÈÔ˜ ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ INF-Á Î·È IL-4 ø˜ ÚÔ˜ ÙËÓ ÂÓ‰Ô΢ÙÙ¿ÚÈ· ·Ú·ÁˆÁ‹ ΢ÙÙ·ÚÔÎÈÓÒÓ, ÙÔ ÔÛÔÛÙfi ÙˆÓ CD3+/CD69+/INF-Á ∆ ΢ÙÙ¿ÚˆÓ (Ù‡Ô˘-1 ·ÙÙ·Ú·) ‹Ù·Ó Ôχ ÂÏ·Ùو̤ÓÔ ÛÙ· ·È‰È¿ Ì ∫∂¡™ Û fiϘ ÙȘ Ê¿ÛÂȘ Ù˘ ÓfiÛÔ˘ (‰È¿ÌÂÛÔ˜: 10,85, ‰È·Î‡Ì·ÓÛË: 8,47-16,49) Û ۯ¤ÛË Ì ÙÔ˘˜ Ì¿ÚÙ˘Ú˜ (‰È¿ÌÂÛÔ˜: 23,85, ‰È·Î‡Ì·ÓÛË: 13,4-28,7 Î·È p<0,0001). ∞ÓÙ›ıÂÙ·, ÙÔ ÔÛÔÛÙfi ÙˆÓ CD3+/CD69+/IL4+ ∆ ΢ÙÙ¿ÚˆÓ (Ù‡Ô˘-2 ·ÙÙ·Ú·) ‹Ù·Ó ÛËÌ·ÓÙÈο ·˘ÍË̤ÓÔ, fi¯È ÌfiÓÔ Î·Ù¿ ÙËÓ ÂÓÂÚÁfi Ê¿ÛË Ù˘ ÓfiÛÔ˘ (‰È¿ÌÂÛÔ˜: 19,59, ‰È·Î‡Ì·ÓÛË: 13,68-26,29), ·ÏÏ¿ Î·È Î·Ù¿ ÙË Ê¿ÛË ‡ÊÂÛ˘ ÙfiÛÔ ˘fi ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹

Pediatri May-Jun 07

24-05-07

17:58

™ÂÏ›‰·195

195

∞ÓÔÛȷ΋ ·¿ÓÙËÛË ÛÙÔ ÎÔÚÙÈÎÔ¢·›ÛıËÙÔ ÓÂÊÚˆÛÈÎfi Û‡Ó‰ÚÔÌÔ

∂›‰· ÛÙÔÓ ÔÚfi Ù˘ πgE Ÿˆ˜ Ê·›ÓÂÙ·È ÛÙÔÓ ¶›Ó·Î· 1, Ù· Â›‰· Ù˘ IgE ÛÙÔÓ ÔÚfi ÛÙ· ·È‰È¿ Ì ∫∂¡™ ‹Ù·Ó ÛËÌ·ÓÙÈο ·˘ÍË̤ӷ ÛÙËÓ ÂÓÂÚÁfi Ê¿ÛË Ù˘ ÓfiÛÔ˘ (‰È¿ÌÂÛÔ˜: 230 IU/ml, ‰È·Î‡Ì·ÓÛË: 84-2100 IU/ml) Û ۯ¤ÛË Ì ÙË Ê¿ÛË ‡ÊÂÛ˘, ÙfiÛÔ ˘fi ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹ (‰È¿ÌÂÛÔ˜: 102 IU/ml, ‰È·Î‡Ì·ÓÛË: 19-1000 IU/ml Î·È p=0,002), (∂ÈÎfiÓ· 1), fiÛÔ Î·È ¯ˆÚ›˜ ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹ (‰È¿ÌÂÛÔ˜: 57 IU/ml, ‰È·Î‡Ì·ÓÛË:18-759 IU/ml Î·È p=0,012), ηıÒ˜ Î·È Ì ÙÔ˘˜ Ì¿ÚÙ˘Ú˜ (‰È¿ÌÂÛÔ˜: 27 IU/ml, ‰È·Î‡Ì·ÓÛË: 5-125 IU/ml Î·È p<0,0001). ¢ÂÓ ‰È·ÈÛÙÒıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÙˆÓ ÙÈÌÒÓ Ù˘ IgE Î·È Ù˘ ·ÚÔ˘Û›·˜ ·ÙÔ›·˜ (p>0,05). ∂›‰· ÛÙÔÓ ÔÚfi ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ π¡F-Á, IL-4, IL-13 Î·È IL-18 ™ÙÔÓ ¶›Ó·Î· 1 ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Û˘ÓÔÙÈο Ù· ·ÔÙÂϤÛÌ·Ù· ·Ó·ÊÔÚÈο Ì ٷ Â›‰· ÛÙÔÓ ÔÚfi

2500 2000 IgE (IU/ml)

(‰È¿ÌÂÛÔ˜: 15,158, ‰È·Î‡Ì·ÓÛË: 10,43-19,63 Î·È p=0,015), fiÛÔ Î·È ¯ˆÚ›˜ ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹ (‰È¿ÌÂÛÔ˜: 11,68, ‰È·Î‡Ì·ÓÛË: 7,57-14,56 Î·È p=0,004) Û˘ÁÎÚÈÙÈο Ì ÙÔ˘˜ Ì¿ÚÙ˘Ú˜ (‰È¿ÌÂÛÔ˜: 2,14, ‰È·Î‡Ì·ÓÛË: 1,25-5,63 Î·È p<0,0001).

1500 1000 500 0

1 2 ∂ÓÂÚÁfi˜ Ê¿ÛË ¡™. ⁄ÊÂÛË ˘fi ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹

∂ÈÎfiÓ· 1. √È Î·Ù¿ ˙‡ÁË ÙÈ̤˜ Ù˘ πgE ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ∫∂¡™ Û ÂÓÂÚÁfi Ê¿ÛË Î·È Û ʿÛË ‡ÊÂÛ˘ ˘fi ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹.

ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ π¡F-Á, IL-4, IL-13 Î·È IL-18 .∆· Â›‰· Ù˘ INF-Á ÛÙÔÓ ÔÚfi, ÛÂ Û˘Ìʈӛ· Ì ·˘Ù¿ ·fi ÙËÓ ÂÓ‰Ô΢ÙÙ¿ÚÈ· ÂÎÙ›ÌËÛË, ‹Ù·Ó Ôχ ÂÏ·Ùو̤ӷ ÛÙ· ·È‰È¿ Ì ∫∂¡™ Û ÂÓÂÚÁfi Ê¿ÛË Û ۯ¤ÛË Ì ÙÔ˘˜ Ì¿ÚÙ˘Ú˜. ∞ÓÙ›ıÂÙ·, Ù˘ IL-4 ‹Ù·Ó ÛËÌ·ÓÙÈο ·˘ÍË̤ӷ fi¯È ÌfiÓÔ Î·Ù¿ ÙËÓ ÂÓÂÚÁfi Ê¿ÛË Ù˘ ÓfiÛÔ˘, ·ÏÏ¿ Î·È Î·Ù¿ ÙË Ê¿ÛË ‡ÊÂÛ˘ ÙfiÛÔ ˘fi ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹, fiÛÔ Î·È ¯ˆÚ›˜ ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹ Û˘ÁÎÚÈÙÈο Ì ÙÔ˘˜ Ì¿ÚÙ˘Ú˜. ∆· Â›‰· Ù˘ IL-13 ÛÙÔÓ ÔÚfi ÙˆÓ ·È‰ÈÒÓ Ì ∫∂¡™ ‹Ù·Ó Â›Û˘ ÛËÌ·ÓÙÈο ·˘ÍË̤ӷ ÛÙËÓ ÂÓÂÚÁfi

¶›Ó·Î·˜ 1. ∂›‰· ÛÙÔÓ ÔÚfi, ‰È¿ÌÂÛË ÙÈÌ‹ Î·È ‰È·Î‡Ì·ÓÛË, Ù˘ IgE Î·È ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ INF-Á, IL4, IL-13 Î·È IL-18 ÛÙ· ·È‰È¿ Ì ∫∂¡™ Î·È ÛÙÔ˘˜ Ì¿ÚÙ˘Ú˜ ∂›‰· ÛÙÔÓ ÔÚfi IgE (IU/ml) ¢È¿ÌÂÛÔ˜ ¢È·Î‡Ì·ÓÛË INF-Á (pg/ml) ¢È¿ÌÂÛÔ˜ ¢È·Î‡Ì·ÓÛË IL-4 (pg/ml) ¢È¿ÌÂÛÔ˜ ¢È·Î‡Ì·ÓÛË IL-13 (pg/ml) ¢È¿ÌÂÛÔ˜ ¢È·Î‡Ì·ÓÛË IL-18(pg/ml) ¢È¿ÌÂÛÔ˜ ¢È·Î‡Ì·ÓÛË

∂ÓÂÚÁfi˜ Ê¿ÛË

⁄ÊÂÛË ˘fi ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹

⁄ÊÂÛË ¯ˆÚ›˜ ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹

ª¿ÚÙ˘Ú˜

2301 84-2100

102 19-1005

57 18-759

27 5-125

14,822 13,7-27,37

21,95 13,92-34,45

24,2 16,9-35,56

19,23 13,96-32,27

583 17,8-194

30,33 12,13-72,04

21,76 10,8-51,65

12,4 6,43-33,53

75,694 20-187

41,03 13,7-134

37 12-88

14,6 14,2-19,2

1613,755 521-4090

926,75 455-1291

670 394-1136

214,8 78,3-386,8

1

p=0,002, p=0,012, p<0,0001 ÁÈ· Û‡ÁÎÚÈÛË ÌÂٷ͇ ÂÓÂÚÁÔ‡ Ê¿Û˘ Û ۯ¤ÛË Ì ʿÛË ‡ÊÂÛ˘ ˘fi ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹, Ê¿ÛË ‡ÊÂÛ˘ ¯ˆÚ›˜ ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹ Î·È Ì¿ÚÙ˘Ú˜, ·ÓÙ›ÛÙÔȯ· 2 p<0,0001, p<0,0001, p=0,019 ÁÈ· Û‡ÁÎÚÈÛË ÌÂٷ͇ ÂÓÂÚÁÔ‡ Ê¿Û˘ Û ۯ¤ÛË Ì ʿÛË ‡ÊÂÛ˘ ˘fi ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹, Ê¿ÛË ‡ÊÂÛ˘ ¯ˆÚ›˜ ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹ Î·È Ì¿ÚÙ˘Ú˜, ·ÓÙ›ÛÙÔȯ· 3 p<0,0001, p<0,0001, p<0,0001 ÁÈ· Û‡ÁÎÚÈÛË ÌÂٷ͇ ÂÓÂÚÁÔ‡ Ê¿Û˘ Û ۯ¤ÛË Ì ʿÛË ‡ÊÂÛ˘ ˘fi ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹, Ê¿ÛË ‡ÊÂÛ˘ ¯ˆÚ›˜ ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹ Î·È Ì¿ÚÙ˘Ú˜, ·ÓÙ›ÛÙÔȯ· 4 p<0,0001, p<0,0001, p<0,0001 ÁÈ· Û‡ÁÎÚÈÛË ÌÂٷ͇ ÂÓÂÚÁÔ‡ Ê¿Û˘ Û ۯ¤ÛË Ì ʿÛË ‡ÊÂÛ˘ ˘fi ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹, Ê¿ÛË ‡ÊÂÛ˘ ¯ˆÚ›˜ ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹ Î·È Ì¿ÚÙ˘Ú˜, ·ÓÙ›ÛÙÔȯ· 5 p<0,0001, p<0,0001, p<0,0001 ÁÈ· Û‡ÁÎÚÈÛË ÌÂٷ͇ ÂÓÂÚÁÔ‡ Ê¿Û˘ Û ۯ¤ÛË Ì ʿÛË ‡ÊÂÛ˘ ˘fi ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹, Ê¿ÛË ‡ÊÂÛ˘ ¯ˆÚ›˜ ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹ Î·È Ì¿ÚÙ˘Ú˜, ·ÓÙ›ÛÙÔȯ· ¶·È‰È·ÙÚÈ΋ 2007;70:192-198

Pediatri May-Jun 07

24-05-07

17:58

™ÂÏ›‰·196

196

¡. ¶Ú›ÓÙ˙· Î·È Û˘Ó.

™˘Û¯ÂÙ›ÛÂȘ ¶Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó Û˘Û¯ÂÙ›ÛÂȘ: ·) ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ IgE ÙÔ˘ ÔÚÔ‡ Ì ÙÔ ÔÛÔÛÙfi ÙˆÓ CD23+ B ΢ÙÙ¿ÚˆÓ, fiÔ˘ ‚Ú¤ıËΠÛËÌ·ÓÙÈ΋ ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ IgE ÙÔ˘ ÔÚÔ‡ Î·È ÙˆÓ CD23+ B ΢ÙÙ¿ÚˆÓ (r=0,773 Î·È p<0,0001) ηÈ, ‚) ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ IgE ÙÔ˘ ÔÚÔ‡ Ì ٷ Â›‰· ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ πL-13, IL-4 Î·È πL-18 Û ÂÓÂÚÁfi Ê¿ÛË Ù˘ ÓfiÛÔ˘, fiÔ˘ ˘‹Ú¯Â ÛËÌ·ÓÙÈ΋ ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ IgE ÙÔ˘ ÔÚÔ‡ ΢ڛˆ˜ Ì ٷ Â›‰· Ù˘ πL-13 (r=0,628 Î·È p<0,05) Î·È ÏÈÁfiÙÂÚ· Ì ·˘Ù¿ Ù˘ IL-4 Î·È Ù˘ πL-18 (r=0,459 Î·È p<0,05, r=0,502 Î·È p<0,05, ·ÓÙ›ÛÙÔȯ·) (∂ÈÎfiÓ˜ 2, 3, 4).

™˘˙‹ÙËÛË ™ÙËÓ ·ÚÔ‡Û· ÚÔÔÙÈ΋ ÌÂϤÙË ¤ÁÈÓ ÚÔÛ¿ıÂÈ· Ó· ‰ÈÂÚ¢ÓËıÔ‡Ó ÔÈ ·ÓÔÛÔÏÔÁÈΤ˜ ‰È·Ù·Ú·¯¤˜ Ô˘ ·Ú·ÙËÚÔ‡ÓÙ·È ÛÙ· ·È‰È¿ Ì ÚˆÙÔ·ı¤˜ ∫∂¡™ Î·È Ó· Û˘Û¯ÂÙÈÛÙÔ‡Ó ·˘Ù¤˜ Ì ÙËÓ ·ÙÔ›·. ∆· ·ÚÈ· Â˘Ú‹Ì·Ù· Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ù· ·ÎfiÏÔ˘ı·: Ù· ·È‰È¿ Ì ∫∂¡™, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙË Ê¿ÛË Ù˘ ÓfiÛÔ˘, ›¯·Ó Ê˘ÛÈÔÏÔÁÈÎfi ÙfiÛÔ ÙÔÓ ·fiÏ˘ÙÔ ·ÚÈıÌfi ÙˆÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ, ÙˆÓ ∆ ΢ÙÙ¿ÚˆÓ, ÙˆÓ CD4+ ∆ ΢ÙÙ¿ÚˆÓ

2.000,00

0,00

✟ ✟

✟ ✟

100,00 150,00 IL-4 (pg/ml)

200,00

∂ÈÎfiÓ· 3. ™˘Û¯¤ÙÈÛË ÌÂٷ͇ ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ IgE ÙÔ˘ ÔÚÔ‡ Ì ٷ Â›‰· Ù˘ πL-4 ÛÙ· ·È‰È¿ Ì ÂÓÂÚÁfi ∫∂¡™.

Î·È ÙˆÓ CD8+ ∆ ΢ÙÙ¿ÚˆÓ, fiÛÔ Î·È ÙÔÓ ÏfiÁÔ CD4+/CD8+ Û ۇÁÎÚÈÛË Ì ÙÔ˘˜ Ì¿ÚÙ˘Ú˜. √ ÏfiÁÔ˜ CD4+/CD8+ ∆ ΢ÙÙ¿ÚˆÓ, ·Ú’ fiÏÔ Ô˘ ‹Ù·Ó ̤۷ ÛÙ· fiÚÈ· ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÙÈÌÒÓ, ‚Ú¤ıËΠÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚÔ˜ ÛÙËÓ ÂÓÂÚÁfi Ê¿ÛË Ù˘ ÓfiÛÔ˘ Û ۇÁÎÚÈÛË Ì ÙË Ê¿ÛË ‡ÊÂÛ˘ ˘fi ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹. ∞˘Ùfi ÔÊÂÈÏfiÙ·Ó Û ·‡ÍËÛË ÙÔ˘ ÔÛÔÛÙÔ‡ ÙˆÓ CD8+ ∆ ΢ÙÙ¿ÚˆÓ. ∆Ô ÔÛÔÛÙfi ÙˆÓ ÂÓÂÚÁÔÔÈËÌ¤ÓˆÓ ∆ ΢ÙÙ¿ÚˆÓ ÛÙËÓ Î˘ÎÏÔÊÔÚ›· ÙˆÓ ·È‰ÈÒÓ Ì ∫∂¡™ ‚È‚ÏÈÔÁÚ·ÊÈο ·Ó·Ê¤ÚÂÙ·È fiÙÈ Û˘Ó‹ıˆ˜ Â›Ó·È ÛÙ· Ê˘ÛÈÔÏÔÁÈο fiÚÈ· (10-12), fiˆ˜ Î·È ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, ÛÙËÓ ÔÔ›· ‰ÂÓ ˘‹Ú¯Â ÌÂÙ·‚ÔÏ‹ ÙˆÓ CD25+ ΢ÙÙ¿ÚˆÓ Û η̛· Ê¿ÛË Ù˘ ÓfiÛÔ˘.

2.000,00

IgE IU/ml

✟

r=0,502 p<0,05

✟ ✟

500,00

500,00

0,00

40,00

80,00 120,00 IL-13 (pg/ml)

✟

1.000,00

160,00

∂ÈÎfiÓ· 2. ™˘Û¯¤ÙÈÛË ÌÂٷ͇ ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ IgE ÙÔ˘ ÔÚÔ‡ Ì ٷ Â›‰· Ù˘ πL-13 ÛÙ· ·È‰È¿ Ì ÂÓÂÚÁfi ∫∂¡™.

Paediatriki 2007;70:192-198

✟✟ ✟ ✟✟ ✟ ✟✟✟ ✟✟✟ ✟✟ ✟✟

1.500,00

1.000,00

0,00

✟

50,00

1.500,00 IgE IU/ml

1.000,00

500,00

r=0,628 p<0,05

2.000,00

✟

r=0,459 p<0,05

1.500,00 IgE IU/ml

Ê¿ÛË Ù˘ ÓfiÛÔ˘ Û˘ÁÎÚÈÙÈο Ì ÙË Ê¿ÛË ‡ÊÂÛ˘, ÙfiÛÔ ˘fi ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹, fiÛÔ Î·È ¯ˆÚ›˜ ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹ ηıÒ˜ Î·È Ì ÙÔ˘˜ Ì¿ÚÙ˘Ú˜. ∆Ô ›‰ÈÔ ‚Ú¤ıËÎÂ Î·È ÁÈ· Ù· Â›‰· Ù˘ IL-18 Ô˘ ‹Ù·Ó Ôχ ·˘ÍË̤ӷ ηٿ ÙËÓ ÂÓÂÚÁfi Ê¿ÛË Ù˘ ÓfiÛÔ˘ Û˘ÁÎÚÈÙÈο Ì ÙÔ˘˜ Ì¿ÚÙ˘Ú˜. ∆· Â›‰· ÂÏ·ÙÙÒÓÔÓÙ·Ó ÛËÌ·ÓÙÈο ηٿ ÙË Ê¿ÛË ‡ÊÂÛ˘ ˘fi Î·È ¯ˆÚ›˜ ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹, ·ÏÏ¿ ·Ú¤ÌÂÓ·Ó ÛËÌ·ÓÙÈο ·˘ÍË̤ӷ Û ۯ¤ÛË Ì ·˘Ù¿ ÙˆÓ Ì·ÚÙ‡ÚˆÓ (p<0,01).

✟ ✟ ✟ ✟ ✟ ✟ ✟ ✟ ✟ ✟ ✟✟✟✟ ✟ ✟✟✟✟

✟

✟ ✟ ✟ ✟ ✟ ✟ ✟ ✟✟

1.000,00

✟

2.000,00 3.000,00 IL-18 (pg/ml)

4.000,00

∂ÈÎfiÓ· 4. ™˘Û¯¤ÙÈÛË ÌÂٷ͇ ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ IgE ÙÔ˘ ÔÚÔ‡ Ì ٷ Â›‰· Ù˘ πL-18 ÛÙ· ·È‰È¿ Ì ÂÓÂÚÁfi ∫∂¡™.

Pediatri May-Jun 07

24-05-07

17:58

™ÂÏ›‰·197

197

∞ÓÔÛȷ΋ ·¿ÓÙËÛË ÛÙÔ ÎÔÚÙÈÎÔ¢·›ÛıËÙÔ ÓÂÊÚˆÛÈÎfi Û‡Ó‰ÚÔÌÔ

∞ÓÙ›ıÂÙ·, ÙÔ ÔÛÔÛÙfi ÙˆÓ CD19+ Î·È CD23+ µ ΢ÙÙ¿ÚˆÓ ‚Ú¤ıËΠÛËÌ·ÓÙÈο ·˘ÍË̤ÓÔ ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ÛÙËÓ ÂÓÂÚÁfi Ê¿ÛË Ù˘ ÓfiÛÔ˘, Û˘ÁÎÚÈÙÈο Ì ÙȘ Ê¿ÛÂȘ ‡ÊÂÛ˘ Î·È Ì ÙÔ˘˜ Ì¿ÚÙ˘Ú˜. ∂ÈϤÔÓ, ÙÔ ·˘ÍË̤ÓÔ ÔÛÔÛÙfi ÙˆÓ CD23+ µ ΢ÙÙ¿ÚˆÓ ÛÙËÓ ÂÓÂÚÁfi Ê¿ÛË Ù˘ ÓfiÛÔ˘ ·ÚÔ˘Û›·˙ ÛËÌ·ÓÙÈ΋ Û˘Û¯¤ÙÈÛË Ì ٷ Â›Û˘ ·˘ÍË̤ӷ Â›‰· Ù˘ IgE ÛÙÔÓ ÔÚfi, ·ÓÂÍ·Úًو˜ ÙÔ˘ ÈÛÙÔÚÈÎÔ‡ ·ÙÔ›·˜. ∆· ÈÔ ÂÓÙ˘ˆÛȷο Â˘Ú‹Ì·Ù· Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘, fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÂÓ‰Ô΢ÙÙ¿ÚÈ· Û‡ÓıÂÛË ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ Î·È Ù· Â›‰¿ ÙÔ˘˜ ÛÙÔÓ ÔÚfi, ‹Ù·Ó Ù· ÂÍ‹˜: ·È‰È¿ Ì ∫∂¡™ Û fiϘ ÙȘ Ê¿ÛÂȘ Ù˘ ÓfiÛÔ˘ ·ÚÔ˘Û›·˙·Ó ·˘ÍË̤ӷ ÔÛÔÛÙ¿ CD3+/CD69+/IL-4+ ∆ ΢ÙÙ¿ÚˆÓ (Ù‡Ô˘-2), ÌÂȈ̤ӷ ÔÛÔÛÙ¿ CD3+/CD69+/ INF-Á ∆ ΢ÙÙ¿ÚˆÓ (Ù‡Ô˘-1), ÛÂ Û˘Ó‰˘·ÛÌfi Ì ·˘ÍË̤ӷ Â›‰· ÛÙÔÓ ÔÚfi ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ IL-4, IL-13 Î·È IL-18 Î·È ·˘ÍË̤ӷ Â›‰· IgE, Â˘Ú‹Ì·Ù· Ô˘ Û˘ÓËÁÔÚÔ‡Ó ÁÈ· ·ÓÔÛȷ΋ ·¿ÓÙËÛË Ù‡Ô˘-2. À‹Ú¯Â, Â›Û˘, ÛËÌ·ÓÙÈο ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙÔ˘ ÔÚÔ‡ Ù˘ IgE ΢ڛˆ˜ Ì ·˘Ù¿ Ù˘ πL-13, ·ÏÏ¿ Î·È Ù˘ IL-4 Î·È Ù˘ πL-18. ™¯ÂÙÈο Ì ÙÔÓ ·ÓÔÛÔÊ·ÈÓfiÙ˘Ô ÙˆÓ µ Î·È ∆ ΢ÙÙ¿ÚˆÓ ÛÙ· ·È‰È¿ Ì ÂÓÂÚÁfi ∫∂¡™, Ù· ·ÔÙÂϤÛÌ·Ù· ÙˆÓ ‰È·ÊfiÚˆÓ ÌÂÏÂÙÒÓ Â›Ó·È ·ÓÙÈÎÚÔ˘fiÌÂÓ· (710,16). ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, Ù· ÌfiÓ· ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù· ‹Ù·Ó ÙÔ ·˘ÍË̤ÓÔ ÔÛÔÛÙfi ÙˆÓ CD19+ Î·È CD23+ µ ΢ÙÙ¿ÚˆÓ. ø˜ ÚÔ˜ ÙÔÓ ÏfiÁÔ CD4+/CD8+ ∆ ΢ÙÙ¿ÚˆÓ, Û ÂÓÂÚÁfi Ê¿ÛË Ù˘ ÓfiÛÔ˘ ÌÔÚ› Ó· Â›Ó·È ÂÏ·Ùو̤ÓÔ˜, ÂÓÒ ÛÙËÓ ‡ÊÂÛË ÔÈ ÙÈ̤˜ Â·Ó¤Ú¯ÔÓÙ·È ÛÙÔ Ê˘ÛÈÔÏÔÁÈÎfi (8,10), fiˆ˜ ‚Ú¤ıËÎÂ Î·È ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË.

T· ·ÔÙÂϤÛÌ·Ù· Ù˘ Û˘ÁÎÂÎÚÈ̤Ó˘ ÌÂϤÙ˘, ·Ó·ÊÔÚÈο Ì ÙȘ ·Ú·ÁfiÌÂÓ˜ ΢ÙÙ·ÚÔΛÓ˜ ‰Â›¯ÓÔ˘Ó fiÙÈ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ∫∂¡™ ˘¿Ú¯ÂÈ ‰È·Ù·Ú·Á̤ÓË ÈÛÔÚÚÔ›· Ù˘ Ù‡Ô˘-1 ÚÔ˜ Ù‡Ô-2 ·ÓÔÛȷ΋˜ ·¿ÓÙËÛ˘ Ì ˘ÂÚÔ¯‹ Ù˘ Ù‡Ô˘-2 (·ÓÙ› Ù˘ Ù‡Ô˘-1, Ô˘ Û˘Ì‚·›ÓÂÈ Û ˘ÁÈ‹ ¿ÙÔÌ· Î·È fiˆ˜ ‚Ú¤ıËΠÛÙÔ˘˜ Ì¿ÚÙ˘Ú˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘), fiˆ˜ ·˘Ù‹ ÂÎÊÚ¿˙ÂÙ·È Î˘Ú›ˆ˜ ·fi ÙËÓ ·˘ÍË̤ÓË Û‡ÓıÂÛË ÙˆÓ Î˘Ù·ÚÔÎÈÓÒÓ IL-4 Î·È IL-13 Î·È ÙË ÌÂȈ̤ÓË Û‡ÓıÂÛË Ù˘ INF-Á. ∞Ó·ÊÔÚÈο Ì ÙËÓ IL-4, Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ Û˘ÌʈÓÔ‡Ó Ì ·˘Ù¿ ÙˆÓ Neuhaus Î·È Û˘Ó (14) Î·È Cho Î·È Û˘Ó (15), ÔÈ ÔÔ›ÔÈ ‚Ú‹Î·Ó ·˘ÍË̤ӷ Â›‰· Ù˘ IL-4 ÛÙÔÓ ÔÚfi. ∞ÓÙ›ıÂÙ·, ÔÈ Stachowski Î·È Û˘Ó (21) Û ÂÓÂÚÁfi Ê¿ÛË ÙÔ˘ ∫∂¡™ ·Ú·Ù‹ÚËÛ·Ó ÌÂȈ̤ӷ Â›‰· Ù˘ IL-4, Èı·ÓÒ˜ ÁÈ·Ù› ¯ÚËÛÈÌÔÔÈ‹ıËΠ‰È·ÊÔÚÂÙÈ΋ Ù¯ÓÈ΋, Ë ÔÔ›· ‰ÂÓ ÌÂÙÚ¿ÂÈ ¿ÌÂÛ· Ù· ·ÙÙ·Ú· Ô˘ ·Ú¿ÁÔ˘Ó IL-4, fiˆ˜ ¤ÁÈÓ ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË. ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ‰È·ÈÛÙÒıËΠ۠fiϘ ÙȘ Ê¿ÛÂȘ ÙÔ˘ ∫∂¡™ ·Ú·ÁˆÁ‹ ΢ÙÙ·ÚÔÎÈÓÒÓ Ô˘ ¯·Ú·ÎÙËÚ›˙Ô˘Ó ÙËÓ Ù‡Ô˘-2 ·ÓÔÛȷ΋ ·¿ÓÙËÛË. ∆· Â˘Ú‹Ì·Ù· ·˘Ù¿ ÂÓÈÛ¯‡ÔÓÙ·È Î·È ·fi ÙËÓ ·Ó‡ÚÂÛË ÌÂȈ̤Ó˘

ÂÓ‰Ô΢ÙÙ¿ÚÈ·˜ Û‡ÓıÂÛ˘ Ù˘ INF-Á (΢ÙÙ·ÚÔΛÓË Ù˘ Ù‡Ô˘-1 ·ÓÔÛȷ΋˜ ·¿ÓÙËÛ˘). ™Â ÚÔËÁÔ‡ÌÂÓ˜ ÌÂϤÙ˜, ÔÈ Yap Î·È Û˘Ó (13) ‚Ú‹Î·Ó ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ÂÓÂÚÁfi ∫∂¡™, Ì ÙË ¯Ú‹ÛË ËÌÈÔÛÔÙÈ΋˜ PCR Ù¯ÓÈ΋˜, ·˘ÍË̤ÓË ¤ÎÊÚ·ÛË ÙÔ˘ mRNA Ù˘ IL-13, ÙfiÛÔ ÛÙ· CD4+ fiÛÔ Î·È ÛÙ· CD8+ ∆ ÏÂÌÊÔ·ÙÙ·Ú· Û ۇÁÎÚÈÛË Ì ÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ‚Ú›ÛÎÔÓÙ·È Û ʿÛË ‡ÊÂÛ˘ Ù˘ ÓfiÛÔ˘ Î·È Ì ÙÔ˘˜ ˘ÁÈ›˜ Ì¿ÚÙ˘Ú˜. ∏ IL13, Û‡Ìʈӷ Ì ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜, Èı·Ófiٷٷ ‰Ú· ÛÙ· ÌÔÓÔ·ÙÙ·Ú·, Â¿ÁÔÓÙ·˜ ÙËÓ ·Ú·ÁˆÁ‹ ÂÓfi˜ ˘ÔıÂÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· Ô˘ ·˘Í¿ÓÂÈ ÙËÓ ·ÁÁÂȷ΋ ‰È·ÂÚ·ÙfiÙËÙ· (vascular permeability factor) Î·È Û˘Ì‚¿ÏÏÔÓÙ·˜ ¤ÙÛÈ ÛÙËÓ ÂÌÊ¿ÓÈÛË Ù˘ ÚˆÙÂ˚ÓÔ˘Ú›·˜. ¢ÂÓ Â›Ó·È ÁÓˆÛÙfi˜ Ô Ì˯·ÓÈÛÌfi˜ Ô˘ Û˘ÓÙÂÏ› ÛÙËÓ ·˘ÍË̤ÓË ¤ÎÊÚ·ÛË Ù˘ IL-13 ÛÙ· ¿ÙÔÌ· Ì ÂÓÂÚÁfi ∫∂¡™, Ê·›ÓÂÙ·È fï˜ fiÙÈ ‰ÂÓ Û¯ÂÙ›˙ÂÙ·È Ì ÁÂÓÂÙÈÎfi ˘fiÛÙڈ̷, ÙÔ˘Ï¿¯ÈÛÙÔÓ fiÛÔÓ ·ÊÔÚ¿ ÛÙÔ˘˜ ÁÓˆÛÙÔ‡˜ ̤¯ÚÈ Û‹ÌÂÚ· ÔÏ˘ÌÔÚÊÈÛÌÔ‡˜ ÙÔ˘ ÁÔÓȉ›Ô˘ Ù˘ IL-13 (22), Ô‡ÙÂ Î·È Ì ÔÏ˘ÌÔÚÊÈÛÌÔ‡˜ ÙˆÓ ÁÔÓȉ›ˆÓ Ô˘ Έ‰ÈÎÔÔÈÔ‡Ó ÙÔ˘˜ ‰È·ÌÂÌ‚Ú·ÓÈÎÔ‡˜ ˘ԉԯ›˜ Ù˘ IL-4 Î·È Ù˘ IL-13 (23,24). π‰È·›ÙÂÚÔ ÂӉȷʤÚÔÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ Û¯ÂÙÈο Ì ٷ ·˘ÍË̤ӷ Â›‰· Ù˘ IL-18 Û fiϘ ÙȘ Ê¿ÛÂȘ ÙÔ˘ ∫∂¡™, ȉȷ›ÙÂÚ· ‰Â ÛÙËÓ ÂÓÂÚÁfi Ê¿ÛË, Û ۇÁÎÚÈÛË Ì ÙÔ˘˜ Ì¿ÚÙ˘Ú˜. ∏ IL-18 ·ÔÙÂÏ› Ì›· ΢ÙÙ·ÚÔΛÓË Ô˘ ¿ÏÏÔÙ Â¿ÁÂÈ ÙËÓ Ù‡Ô˘ π Î·È ¿ÏÏÔÙ ÙËÓ Ù‡Ô˘ ππ ·ÓÔÛȷ΋ ·¿ÓÙËÛË Î·È Ë ‰Ú¿ÛË Ù˘ Û οı ÂÚ›ÙˆÛË ÂÍ·ÚÙ¿Ù·È ·fi ÙÔ ÂÚÈ‚¿ÏÏÔÓ ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ ÛÙÔ ÔÔ›Ô ‰Ú· (25). ∂›Û˘, Û ÂÈÚ·Ì·ÙÈο ÌÔÓ٤Ϸ Ê¿ÓËΠfiÙÈ Ë IL-18 ˆ˜ ÌÔÓ·‰ÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÌÔÚ› Ó· Â¿ÁÂÈ ÙËÓ ·Ú·ÁˆÁ‹ Ù˘ IL4 Î·È Ù˘ IL-13 ·fi Ù· Ì·ÛÙÔ·ÙÙ·Ú· Î·È Ù· ‚·ÛÂfiÊÈÏ·, ·˘Í¿ÓÔÓÙ·˜ Ù· Â›‰· Ù˘ πgE, ηıÒ˜ Â›Û˘ fiÙÈ Ë Î·ıËÌÂÚÈÓ‹ ¯ÔÚ‹ÁËÛ‹ Ù˘ ÚÔηÏ› ‰ÔÛÔÂÍ·ÚÙÒÌÂÓË ·‡ÍËÛË Ù˘ IgE Â¿ÁÔÓÙ·˜ ÙËÓ ·ÂÏ¢ı¤ÚˆÛË Ù˘ IL-4 ·fi Ù· ∆ ·ÙÙ·Ú· (25). ∞Ó·ÊÔÚÈο Ì ÙÔ ∫∂¡™, Û ÚÔËÁÔ‡ÌÂÓË ÌÂϤÙË ÔÈ Matsumoto Î·È Û˘Ó (26) ‚Ú‹Î·Ó ·˘ÍË̤ӷ Â›‰· Ù˘ IL-18 Û ÂÓ‹ÏÈΘ Ì ÂÓÂÚÁfi ∫∂¡™. ª¤¯ÚÈ Û‹ÌÂÚ· ‰ÂÓ ˘¿Ú¯Ô˘Ó ÂÚÈÛÛfiÙÂÚ· ‰Â‰Ô̤ӷ Û¯ÂÙÈο Ì ÙÔÓ ÚfiÏÔ Ù˘ IL-18 ÛÙËÓ ·ıÔÁ¤ÓÂÈ· ÙÔ˘ ∫∂¡™. ™Â ÔÚÈṲ̂Ó˜ ÌÂϤÙ˜ (16,20), fiˆ˜ Î·È ÛÙËÓ ·ÚÔ‡Û·, ¤¯ÂÈ Ê·Ó› fiÙÈ Ù· Â›‰· Ù˘ IgE ÌÔÚ› Ó· Â›Ó·È ·˘ÍË̤ӷ ÛÙ· ·È‰È¿ Ì ÎÔÚÙÈÎÔ¢·›ÛıËÙÔ ÓÂÊÚˆÛÈÎfi Û‡Ó‰ÚÔÌÔ Û ÔÛÔÛÙfi ¤ˆ˜ 60%, ȉȷ›ÙÂÚ· ÛÙËÓ ÂÓÂÚÁfi Ê¿ÛË Ù˘ ÓfiÛÔ˘. ∆· ·˘ÍË̤ӷ Â›‰· ıˆڋıËÎ·Ó ·Ú¯Èο ˆ˜ ‰Â›ÎÙ˘ ·ÚÔ˘Û›·˜ ·ÙÔ›·˜ ÛÙ· ·È‰È¿ ·˘Ù¿ (18,19). ∂›Û˘, ¿ÏÏÔÈ ÂÚ¢ÓËÙ¤˜ ¤‰ÂÈÍ·Ó fiÙÈ Û ·È‰È¿ Ì ∫∂¡™ ˘¿Ú¯ÂÈ ·˘ÍË̤ÓË ¤ÎÊÚ·ÛË ÙÔ˘ CD23+, ÂÈÊ·ÓÂÈ·ÎÔ‡ ÌÔÚ›Ô˘ Ô˘ Â›Ó·È Ô ˘Ô‰Ô¯¤·˜ II Ù˘ IgE ÛÙ· µ ·ÙÙ·Ú· (15). ™Â ÌÂÙ·ÁÂÓ¤ÛÙÂÚ˜ ÌÂϤÙ˜ ‚Ú¤ıËΠfiÙÈ ·˘ÍË̤ӷ ¶·È‰È·ÙÚÈ΋ 2007;70:192-198

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Â›‰· IgE Î·È ·˘ÍË̤ÓÔ ÔÛÔÛÙfi CD23+ ΢ÙÙ¿ÚˆÓ Â›¯·Ó ÙfiÛÔ Ù· ·ÏÏÂÚÁÈο fiÛÔ Î·È Ù· ÌË ·ÏÏÂÚÁÈο ·È‰È¿ Ì ÂÓÂÚÁfi ∫∂¡™ (20). ªÂ Ù· Â˘Ú‹Ì·Ù· ÙˆÓ ·Ú·¿Óˆ ÌÂÏÂÙÒÓ Â›Ó·È Û˘Ì‚·Ù¿ Î·È Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘, Û‡Ìʈӷ Ì ٷ ÔÔ›· Ë ·˘ÍË̤ÓË IgE ‰ÂÓ Û¯ÂÙÈ˙fiÙ·Ó Ì ÙÔ ÈÛÙÔÚÈÎfi ·ÙÔ›·˜ ÛÙ· ·È‰È¿ Ì ∫∂¡™. √È Cheung Î·È Û˘Ó (20) ‚Ú‹Î·Ó fiÙÈ Ë ·˘ÍË̤ÓË ·Ú·ÁˆÁ‹ Ù˘ IgE ÛÙ· ·È‰È¿ Ì ∫∂¡™ Û˘Û¯ÂÙÈ˙fiÙ·Ó Ì ·˘ÍË̤ÓË ·Ú·ÁˆÁ‹ Ù˘ IL-13. ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ‚Ú¤ıËÎÂ, Â›Û˘, ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ Ù˘ IgE ΢ڛˆ˜ Ì ÙËÓ IL-13. º·›ÓÂÙ·È, ÏÔÈfiÓ, fiÙÈ Ë ·‡ÍËÛË Ù˘ IgE ·ÔÙÂÏ› Èı·Ófiٷٷ ¤Ó· ÂÈÊ·ÈÓfiÌÂÓÔ, ÏfiÁˆ Ù˘ Ù‡Ô˘-2 ·ÓÔÛȷ΋˜ ·¿ÓÙËÛ˘ Ô˘ ˘ÂÚÈÛ¯‡ÂÈ ÛÙËÓ ÂÓÂÚÁfi Ê¿ÛË ÙÔ˘ ∫∂¡™. ™˘ÌÂÚ·ÛÌ·ÙÈο, Ù· Â˘Ú‹Ì·Ù· Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‰Â›¯ÓÔ˘Ó fiÙÈ ÛÙ· ·È‰È¿ Ì ÂÓÂÚÁfi ∫∂¡™ ˘ÂÚ¤¯ÂÈ Ë ·ÓÔÛȷ΋ ·¿ÓÙËÛË Ù‡Ô˘-2, Ë ÔÔ›· Â›Ó·È Èı·Ófi Ó· Â¿ÁÂÙ·È ·fi ÙË Û˘ÓÂÚÁÈ΋ ‰Ú¿ÛË ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ IL-18 Î·È IL-13. ∏ ·‡ÍËÛË Ù˘ IgE, Ë ÔÔ›· ·Ú·ÙËÚÂ›Ù·È Û ÂÓÂÚÁfi Ê¿ÛË Ù˘ ÓfiÛÔ˘, Ê·›ÓÂÙ·È fiÙÈ ‰ÂÓ Û¯ÂÙ›˙ÂÙ·È Ì Ì˯·ÓÈÛÌfi ·ÙÔ›·˜, ·ÏÏ¿ ·ÔÙÂÏ› ·ÔÙ¤ÏÂÛÌ· ‹ ÂÈÊ·ÈÓfiÌÂÓÔ Ù˘ Ù‡Ô˘-2 ·ÓÔÛȷ΋˜ ·¿ÓÙËÛ˘. ªÂÏÏÔÓÙÈΤ˜ ÌÂϤÙ˜ ı· Ú›ÍÔ˘Ó ÂÚÈÛÛfiÙÂÚÔ Êˆ˜ ÛÙ· ·›ÙÈ· ‹/Î·È ÛÙÔ˘˜ Ì˯·ÓÈÛÌÔ‡˜ Ô˘ ÚÔηÏÔ‡Ó ·˘Ù‹ ÙË ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË ÙˆÓ Ù‡Ô˘-2 ΢ÙÙ·ÚÔÎÈÓÒÓ.

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Nakanishi K, Yoshimoto T, Tsutsui H, Okamura H. Interleukin-18 is a unique cytokine that stimulates both Th1 and Th2 responses depending on its cytokine milieu. Cytokine Growth Factor Rev 2001;12:53-72.

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∏ ÈÓÙÂÚÏ¢ΛÓË-8 (IL-8) ÙˆÓ Ô‡ÚˆÓ ˆ˜ ‰È·ÁÓˆÛÙÈÎfi˜ ‰Â›ÎÙ˘ Ù˘ ΢ÛÙÂÔÔ˘ÚËÙËÚÈ΋˜ ·ÏÈÓ‰ÚfiÌËÛ˘ Û ·È‰È¿ ËÏÈΛ·˜ οو ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜ ª. ªÈÙÛÒÚË1, ∂. °·Ï·Ó¿Î˘1, ∂. ¢ËÌËÙÚ›Ô˘1, Ã. °È·ÓÓ·ÎÔÔ‡ÏÔ˘2, ¡.∞. ∫·Úη‚›ÙÛ·˜3, ª. ∫·ÏÌ·ÓÙ‹1 ¶ÂÚ›ÏË„Ë ∂ÈÛ·ÁˆÁ‹: ∏ ‰È¿ÁÓˆÛË Ù˘ ΢ÛÙÂÔÔ˘ÚËÙËÚÈ΋˜ ·ÏÈÓ‰ÚfiÌËÛ˘ (∫√¶) ‚·Û›˙ÂÙ·È Û ÂÂÌ‚·ÙÈΤ˜ ·ÂÈÎÔÓÈÛÙÈΤ˜ ÌÂıfi‰Ô˘˜ Ô˘ Û˘ÓÂ¿ÁÔÓÙ·È ·ÎÙÈÓÔ‚ÔÏ›· Î·È ÛËÌ·ÓÙÈÎfi ÎfiÛÙÔ˜. √ ÛÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‹Ù·Ó Ë ÂÎÙ›ÌËÛË ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ ÈÓÙÂÚÏ¢ΛÓ˘ 8 (IL-8) ÛÙ· Ô‡Ú·, ˆ˜ ÌË ÂÂÌ‚·ÙÈÎÔ‡ ‰Â›ÎÙË ∫√¶ Û ·È‰È¿ ËÏÈΛ·˜ οو ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ªÂÏÂÙ‹ıËÎ·Ó ÔÈ Û˘ÁÎÂÓÙÚÒÛÂȘ Ù˘ IL-8 ÛÙ· Ô‡Ú· 69 ‚ÚÂÊÒÓ ËÏÈΛ·˜ ÂÓfi˜ ÌËÓfi˜ ¤ˆ˜ ÂÓfi˜ ¤ÙÔ˘˜. ∞fi ·˘Ù¿, 37 ›¯·Ó ÂȂ‚·ÈˆÌ¤ÓË ∫√¶ ¯ˆÚ›˜ ÚfiÛÊ·ÙË Ô˘ÚÔÏԛ̈ÍË (ÔÌ¿‰· ∞), 13 ›¯·Ó ·Ó·ÌÓËÛÙÈÎfi ·Ô‰Ú·ÌÔ‡Û·˜ Ô˘ÚÔÏԛ̈͢ ·ÏÏ¿ fi¯È ∫√¶ (ÔÌ¿‰· µ) Î·È Ù· ˘fiÏÔÈ· 19 ‹Û·Ó ÂχıÂÚ· ·Ó·ÌÓËÛÙÈÎÔ‡ ÁÓˆÛÙ‹˜ ÔÍ›·˜ ‹ ¯ÚfiÓÈ·˜ ÓfiÛÔ˘ Ô˘ ı· ÌÔÚÔ‡Û ӷ ÂËÚ¿ÛÂÈ ÙË ÓÂÊÚÈ΋ ÏÂÈÙÔ˘ÚÁ›· (ÔÌ¿‰· °). √È ÙÈ̤˜ IL-8 ÌÂÙÚ‹ıËÎ·Ó Ì ELISA Î·È ÌÂÏÂÙ‹ıËÎ·Ó ÌÂÙ¿ ·fi ·Ó·ÁˆÁ‹ ÛÙËÓ ÙÈÌ‹ Ù˘ ÎÚ·ÙÈÓ›Ó˘ ÙˆÓ Ô‡ÚˆÓ. ∞ÔÙÂϤÛÌ·Ù·: ∆· ‚Ú¤ÊË Ù˘ ÔÌ¿‰·˜ ∞ ›¯·Ó ÛËÌ·ÓÙÈο ·˘ÍË̤ӷ Â›‰· IL-8 ÛÙ· Ô‡Ú· Û ۯ¤ÛË ÙfiÛÔ Ì ٷ ‚Ú¤ÊË Ù˘ ÔÌ¿‰·˜ µ (p=0,0491) fiÛÔ Î·È Ì ÂΛӷ Ù˘ ÔÌ¿‰·˜ ° (p=0,0095). ∆È̤˜ IL-8/ÎÚ·ÙÈÓ›Ó˘ Ô‡ÚˆÓ >5 mg/Ìmol ›¯·Ó ¢·ÈÛıËÛ›· 73% Î·È ÂȉÈÎfiÙËÙ· 56% ÛÙË ‰È¿ÁÓˆÛË Ù˘ ∫√¶. ™˘ÌÂÚ¿ÛÌ·Ù·: ∏ ·ÚÔ˘Û›· ·˘ÍËÌ¤ÓˆÓ ÂÈ¤‰ˆÓ IL-8 ÛÙ· Ô‡Ú· ‚ÚÂÊÒÓ Ì ∫√¶ ÌÂÙ¿ ÙËÓ ·Ô‰ÚÔÌ‹ Ù˘ ÂÓÂÚÁÔ‡ Ïԛ̈͢, ˘Ô‰ÂÈÎÓ‡ÂÈ Û˘Ó¯È˙fiÌÂÓË ÊÏÂÁÌÔÓÒ‰Ë ‰È·‰Èηۛ· Î·È ÌÔÚ› Ó· ¯ÚËÛÈ̇ÛÂÈ ˆ˜ ÌË ÂÂÌ‚·ÙÈÎfi˜ ‰Â›ÎÙ˘ ÈηÓÔÔÈËÙÈ΋˜ ¢·ÈÛıËÛ›·˜ Î·È ÂȉÈÎfiÙËÙ·˜ ÁÈ· ÙÔÓ ·Ú¯ÈÎfi ·ÓȯÓ¢ÙÈÎfi ¤ÏÂÁ¯Ô Ù˘ ∫√¶.

1 ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋, °ÂÓÈÎfi ¶·ÓÂÈÛÙËÌÈ·Îfi ¡ÔÛÔÎÔÌÂ›Ô ∏Ú·ÎÏ›Ԣ 2 ¡ÂÔÁÓÔÏÔÁÈ΋ ∫ÏÈÓÈ΋, °ÂÓÈÎfi ¶·ÓÂÈÛÙËÌÈ·Îfi ¡ÔÛÔÎÔÌÂ›Ô ∏Ú·ÎÏ›Ԣ 3 ∆Ì‹Ì· ¶˘ÚËÓÈ΋˜ π·ÙÚÈ΋˜, ¶·ÓÂÈÛÙËÌÈ·Îfi °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ∏Ú·ÎÏ›Ԣ AÏÏËÏÔÁÚ·Ê›·: ∂ÌÌ·ÓÔ˘‹Ï °·Ï·Ó¿Î˘, egalanak@med.uoc.gr ∆Ô̤·˜ ªËÙ¤Ú·˜ ¶·È‰ÈÔ‡, ∆Ì‹Ì· π·ÙÚÈ΋˜, ¶·ÓÂÈÛÙ‹ÌÈÔ ∫Ú‹Ù˘, ∆.£. 2208, T.K. 71003, ∏Ú¿ÎÏÂÈÔ

§¤ÍÂȘ ÎÏÂȉȿ: ¢È·ÁÓˆÛÙÈΤ˜ ‰ÔÎÈ̷ۛ˜, ÈÓÙÂÚÏ¢ΛÓË-8, ΢ÛÙÂÔÔ˘ÚËÙËÚÈ΋ ·ÏÈÓ‰ÚfiÌËÛË, Ô˘ÚÔÏԛ̈ÍË.

Urine interleukin-8 as a marker of vesicoureteral reflux in children aged under 1 year M. µitsori1, E. Galanakis1, E. Dimitriou1, C. Giannakopoulou2, N.A. Karkavitsas3, M. Kalmanti1 Abstract Background: Diagnosis of vesicoureteral reflux (VUR) is based on imaging modalities that are associated with radiation, invasiveness and expense. The aim of this study was to assess the urine levels of IL-8 as a non-invasive marker of VUR in children aged under 1 year.

Methods: Urine concentrations of IL-8 were measured in 69 infants aged 1 month to 1 year. Among the infants, 37 had established VUR without recent UTI (group A), 13 had a history of past UTI without VUR (group B), and 19 had no history of any known acute or chronic condition that might impair renal function (group C). IL-8 concentrations were determined by ELISA and standardized with urine creatinine.

Results: The infants in group A had higher urine IL-8 levels than those in groups B (p=0.0491) and C (p=0.0095). Urine IL-8/creatinine concentrations of >5 mg/Ìmol had a sensitivity of 73% and a specificity of 56% for diagnosing VUR. Conclusions: The findings of this study suggest that urinary IL-8 levels remain increased in infants with VUR after acute UTI has resolved, pointing to an ongoing inflammatory process. Increased urinary IL-8 levels may serve as non-invasive marker of adequate sensitivity and specificity for an initial screening for VUR in young infants.

1 Paediatrics Department, University General Hospital of Heraklion, Crete 2 Neonatal Department, University General Hospital of Heraklion, Crete 3 Nuclear Medicine Department, University General Hospital of Heraklion, Crete Correspondence: Emmanouil Galanakis, egalanak@med.uoc.gr University of Crete, Faculty of Medicine Division of Mother and Child Medicine, PO Box 2208, 71003, Heraklion, Crete

Key words: Diagnostic tests, interleukin-8, urinary tract infection, vesicoureteral reflux.

∏ ÂÚÁ·Û›· ·˘Ù‹ ‚Ú·‚‡ıËΠ̠ÙÔ ÃˆÚ¤ÌÂÈÔ Œ·ıÏÔ ÛÙÔ 44Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ, ƒfi‰Ô˜, 9-11 πÔ˘Ó›Ô˘ 2006 ¶·È‰È·ÙÚÈ΋ 2007;70:199-204

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ª. ªÈÙÛÒÚË Î·È Û˘Ó.

∂ÈÛ·ÁˆÁ‹ ∏ ΢ÛÙÂÔÔ˘ÚËÙËÚÈ΋ ·ÏÈÓ‰ÚfiÌËÛË (∫√¶) Â›Ó·È Û˘¯Ófi ‡ÚËÌ· Û ·È‰È¿ Ì ԢÚÔÏÔÈÌÒÍÂȘ, Û ÓÂÔÁÓ¿ Ì ÚÔÁÂÓÓËÙÈ΋ ˘‰ÚÔÓ¤ÊÚˆÛË Î·È ÛÂ Û˘ÁÁÂÓ›˜ ·Û¯fiÓÙˆÓ ·fi ∫√¶ (1). ∏ ¤ÁηÈÚË ‰È¿ÁÓˆÛ‹ Ù˘, ÚÈÓ ÙÔ ÚÒÙÔ ÂÂÈÛfi‰ÈÔ Ô˘ÚÔÏԛ̈͢ - ·Ó ÚfiÎÂÈÙ·È ÁÈ· ∫√¶ ÌÂÁ¿ÏÔ˘ ‚·ıÌÔ‡ - Â›Ó·È È‰È·›ÙÂÚ· ÛËÌ·ÓÙÈ΋ ÁÈ· ÙËÓ ÚfiÏË„Ë Ù˘ ÓÂÊÚÔ¿ıÂÈ·˜ ·fi ·ÏÈÓ‰ÚfiÌËÛË, Ë ÔÔ›· ıˆÚÂ›Ù·È ¤Ó· ·fi Ù· ÛËÌ·ÓÙÈÎfiÙÂÚ· ·›ÙÈ· ˘¤ÚÙ·Û˘ Î·È ÓÂÊÚÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ ÛÙ· ·È‰È¿ (2,3). ∏ ∫√¶ ¢ÓÔ› ÙËÓ ·ÓÈÔ‡Û· Ïԛ̈ÍË Î·È ÙË ÌÂÙ·ÊÔÚ¿ Ù˘ ÂÓ‰Ô΢ÛÙÈ΋˜ ›ÂÛ˘ ÛÙÔ˘˜ ÓÂÊÚÔ‡˜, ˆÛÙfiÛÔ ÔÈ ·ÎÚȂ›˜ Ì˯·ÓÈÛÌÔ› Ô˘ Ô‰ËÁÔ‡Ó ·fi ÙËÓ ∫√¶ Î·È ÙËÓ Ô˘ÚÔÏԛ̈ÍË ÛÙË ÓÂÊÚÈ΋ ·ÚÂÁ¯˘Ì·ÙÈ΋ ‚Ï¿‚Ë Î·È ÙË ¯ÚfiÓÈ· ÓÂÊÚÈ΋ ÓfiÛÔ ‰ÂÓ Â›Ó·È ·ÎfiÌË Ï‹Úˆ˜ ηٷÓÔËÙÔ› (4-6). ∏ ·Ó›¯Ó¢ÛË Ù˘ ∫√¶ Î·È Ù˘ ÓÂÊÚÈ΋˜ Ô˘Ï‹˜ ‚·Û›˙ÂÙ·È Â› ÙÔ˘ ·ÚfiÓÙÔ˜ Û ÂÂÌ‚·ÙÈΤ˜ ·ÂÈÎÔÓÈÛÙÈΤ˜ ÌÂıfi‰Ô˘˜ Ô˘ ÂÈ‚·Ú‡ÓÔ˘Ó ÙÔÓ ·ÛıÂÓ‹ Ì ·ÎÙÈÓÔ‚ÔÏ›· Î·È ¤¯Ô˘Ó ˘ÔÏÔÁ›ÛÈÌÔ ÎfiÛÙÔ˜ (1,6-7). ∂Âȉ‹ ÛËÌ·ÓÙÈÎfi˜ ·ÚÈıÌfi˜ ·È‰ÈÒÓ ˘Ô‚¿ÏÏÂÙ·È Û ÂÎÙÂٷ̤ÓÔ ·ÂÈÎÔÓÈÛÙÈÎfi ¤ÏÂÁ¯Ô, Ë ·Ó‡ÚÂÛË ÌË ÂÂÌ‚·ÙÈÎÒÓ ÌÂıfi‰ˆÓ ·Ó›¯Ó¢Û˘ Ù˘ ∫√¶ ı· ‰È¢ÎfiÏ˘Ó ÛËÌ·ÓÙÈο ÙË ‰È·ÁÓˆÛÙÈ΋ Ù˘ ÚÔÛ¤ÁÁÈÛË. √È ‰Â›ÎÙ˜ ·˘ÙÔ› ı· ÌÔÚÔ‡Û·Ó Ó· ·Ô‰ÂȯÙÔ‡Ó ¯Ú‹ÛÈÌÔÈ Î·È ÁÈ· ÙÔÓ ÚÔÏËÙÈÎfi ¤ÏÂÁ¯Ô, ÛÙÔÓ ÔÔ›Ô Û˘ÓÈÛÙ¿Ù·È Ó· ˘Ô‚ÏËıÔ‡Ó Ù· ·‰¤ÏÊÈ· Î·È Ù· ·È‰È¿ ÙˆÓ ·ÙfiÌˆÓ Ì ∫√¶, ηıÒ˜ Î·È Ù· ‚Ú¤ÊË ÛÙ· ÔÔ›· ¤¯ÂÈ ‰È·ÁÓˆÛÙ› ˘‰ÚÔÓ¤ÊÚˆÛË ÚÔÁÂÓÓËÙÈο (2,8). ∆Ô ÂÈı‹ÏÈÔ ÙÔ˘ Ô˘ÚÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, ÂÎÙfi˜ ÙÔ˘ fiÙÈ ·ÔÙÂÏ› Ê˘ÛÈÎfi ÊÚ·ÁÌfi ¤Ó·ÓÙÈ ÙˆÓ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÒÓ, ‰È·‰Ú·Ì·Ù›˙ÂÈ Î·È ÂÓÂÚÁfi ·Ì˘ÓÙÈÎfi ÚfiÏÔ Ì ÙËÓ ·Ú·ÁˆÁ‹ ¯ËÌÂÈÔÎÈÓÒÓ Î·È Î˘ÙÙ·ÚÔÎÈÓÒÓ, Ô˘ Ú˘ıÌ›˙Ô˘Ó ÙËÓ ·ÓÙ›‰Ú·ÛË ÛÙË Ïԛ̈ÍË (9). ∏ ÊÏÂÁÌÔÓ҉˘ ·˘Ù‹ ‰È·‰Èηۛ· ‰È·‰Ú·Ì·Ù›˙ÂÈ Ì ÙË ÛÂÈÚ¿ Ù˘ ÎÂÓÙÚÈÎfi ÚfiÏÔ ÛÙË ‰ËÌÈÔ˘ÚÁ›· ÓÂÊÚÈ΋˜ ·ÚÂÁ¯˘Ì·ÙÈ΋˜ ‚Ï¿‚˘. ¶Ôχ Ï›Á· Â›Ó·È ÁÓˆÛÙ¿ ÁÈ· ÙÔÓ ÚfiÏÔ ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ ÌÂÙ¿ ÙËÓ ·Ô‰ÚÔÌ‹ Ù˘ ÔÍ›·˜ Ïԛ̈͢ (6,10-15). ∞Ó·˙ËÙÒÓÙ·˜ ÌË ÂÂÌ‚·ÙÈÎÔ‡˜ ‰Â›ÎÙ˜ ∫√¶, ÚÔÛ‰ÈÔÚ›Û·Ì ÙȘ Û˘ÁÎÂÓÙÚÒÛÂȘ ÛÙ· Ô‡Ú· Ù˘ ΢ÙÙ·ÚÔΛÓ˘¯ËÌÂÈÔΛÓ˘ ÈÓÙÂÚÏ¢ΛÓ˘-8 (IL-8) Û ‚Ú¤ÊË Ì ·ÏÈÓ‰ÚfiÌËÛË ¯ˆÚ›˜ ÚfiÛÊ·ÙË Ô˘ÚÔÏԛ̈ÍË. ∏ IL-8, ÚÔ-ÊÏÂÁÌÔÓ҉˘ ‰È·ÌÂÛÔÏ·‚ËÙ‹˜ Î·È ¯ËÌÂÈÔÙ·ÎÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÙˆÓ Ô˘‰ÂÙÂÚfiÊÈψÓ, ·Ú¿ÁÂÙ·È ·fi Ù· ÂÈıËÏȷο ·ÙÙ·Ú· ÙÔ˘ Ô˘ÚÔÔÈËÙÈÎÔ‡ ˆ˜ ·¿ÓÙËÛË Û ÊÏÂÁÌÔÓÒ‰Ë ÂÚÂı›ÛÌ·Ù·. √ Ú˘ıÌÈÛÙÈÎfi˜ Ù˘ ÚfiÏÔ˜ ÛÙË ‰È·‰ÚÔÌ‹ Ù˘ ÔÍ›·˜ Ïԛ̈͢ ÙÔ˘ Ô˘ÚÔÔÈËÙÈÎÔ‡ ¤¯ÂÈ ÂÈÛËÌ·Óı› ·fi ÌÂϤÙ˜ Ì ÚÔÎÏËÙ‹ ˘ÂÏÔÓÂÊÚ›Ùȉ·, Û‡Ìʈӷ Ì ÙȘ Ôԛ˜ ÂÈÚ·Ì·Ùfi˙ˆ· Ì Â·ÁfiÌÂÓË ·‰˘Ó·Ì›· ·Ú·ÁˆÁ‹˜ IL-8 ·ÚÔ˘Û›·Û·Ó ·˘ÍË̤ÓË ‚·Ú‡ÙËÙ· Paediatriki 2007;70:199-204

Ïԛ̈͢ Î·È ÛÔ‚·Ú¤˜ ÓÂÊÚÈΤ˜ ·ÚÂÁ¯˘Ì·ÙÈΤ˜ ‚Ï¿‚˜ (16). ∞˘ÍË̤ӷ Â›‰· IL-8 ¤¯Ô˘Ó ‹‰Ë ‰È·ÈÛÙˆı› ÛÙ· Ô‡Ú· ·ÛıÂÓÒÓ Ì ÔÍ›· Ô˘ÚÔÏԛ̈ÍË (8,12-13,15,17-21).

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ∞ÛıÂÓ›˜ ∆· Â›‰· IL-8 ÚÔÛ‰ÈÔÚ›ÛÙËÎ·Ó ÛÙ· Ô‡Ú· 69 ‚ÚÂÊÒÓ ËÏÈΛ·˜ 1 ÌËÓfi˜ ¤ˆ˜ 1 ¤ÙÔ˘˜. ŸÏ· Ù· ·È‰È¿ Ô˘ Û˘ÌÂÚÈÏ‹ÊıËÎ·Ó ÛÙË ÌÂϤÙË ‹Ù·Ó ÂχıÂÚ· Ô˘ÚÔÏԛ̈͢ ÁÈ· ÙÚÂȘ ÙÔ˘Ï¿¯ÈÛÙÔÓ Â‚‰ÔÌ¿‰Â˜, fiˆ˜ ηıÔÚ›ÛÙËΠ·fi ÙËÓ ÎÏÈÓÈ΋ ÙÔ˘˜ ÂÈÎfiÓ·, ÙȘ Ê˘ÛÈÔÏÔÁÈΤ˜ ÙÈ̤˜ ÙˆÓ Ï¢ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜, Ù˘ Ù·¯‡ÙËÙ·˜ ηı›˙ËÛ˘ ÂÚ˘ıÚÒÓ Î·È C-·ÓÙȉÚÒÛ·˜ ÚˆÙ½Ó˘ ηıÒ˜ Î·È ·fi ÙË Ê˘ÛÈÔÏÔÁÈ΋ ÌÈÎÚÔÛÎÔÈ΋ ÂͤٷÛË Î·È Î·ÏÏȤÚÁÂÈ· Ô‡ÚˆÓ (1113). ∏ ‰È¿ÁÓˆÛË Ù˘ Ô˘ÚÔÏԛ̈͢ ‚·Û›ÛÙËΠÛÙËÓ ·ÚÔ˘Û›· ‚·ÎÙËÚÈÔ˘Ú›·˜, Ë ÔÔ›· ÔÚ›ÛÙËΠˆ˜ ÔÔÈ·‰‹ÔÙ ·Ó¿Ù˘ÍË ‚·ÎÙËÚ›ˆÓ Û ηÏÏȤÚÁÂÈ· ‰Â›ÁÌ·ÙÔ˜ Ô‡ÚˆÓ ·fi ˘ÂÚË‚È΋ ·Ú·Î¤ÓÙËÛË, ÌÔÓÔ·Ó¿Ù˘ÍË ÙÔ˘Ï¿¯ÈÛÙÔÓ 105 ‚·ÎÙËÚ›ˆÓ/ml Û ηÏÏȤÚÁÂÈ· ‰‡Ô ‰È·‰Ô¯ÈÎÒÓ ‰ÂÈÁÌ¿ÙˆÓ Ô‡ÚˆÓ ‹ ·Ó¿Ù˘ÍË ÙÔ˘Ï¿¯ÈÛÙÔÓ 104 ‚·ÎÙËÚ›ˆÓ/ml Û ηÏÏȤÚÁÂÈ· ‰Â›ÁÌ·ÙÔ˜ Ô‡ÚˆÓ ·fi ηıÂÙËÚÈ·ÛÌfi Ù˘ ·ÛÙ˘. ∆· ‚Ú¤ÊË Ù·ÍÈÓÔÌ‹ıËÎ·Ó Û 3 ÔÌ¿‰Â˜: ÔÌ¿‰· ∞, ‚Ú¤ÊË Ì ·ԉ‰ÂÈÁ̤ÓË ∫√¶ (37 ‚Ú¤ÊË ËÏÈΛ·˜ 0,13 ¤ˆ˜ 0,99 ÂÙÒÓ, ‰È¿ÌÂÛË ÙÈÌ‹ 0,36), ÔÌ¿‰· µ, ‚Ú¤ÊË Ì ·Ó·ÌÓËÛÙÈÎfi Ô˘ÚÔÏԛ̈͢, ·ÏÏ¿ ·ÚÓËÙÈÎfi ¤ÏÂÁ¯Ô ÁÈ· ∫√¶ (13 ‚Ú¤ÊË ËÏÈΛ·˜ 0,24 ¤ˆ˜ 0,70 ÂÙÒÓ, ‰È¿ÌÂÛË ÙÈÌ‹ 0,39), Î·È ÔÌ¿‰· °, ‚Ú¤ÊË ¯ˆÚ›˜ ·Ó·ÌÓËÛÙÈÎfi ÁÓˆÛÙ‹˜ ÔÍ›·˜ ‹ ¯ÚfiÓÈ·˜ ηٿÛÙ·Û˘ Ô˘ ı· ÌÔÚÔ‡Û ӷ ÂËÚ¿ÛÂÈ ÙË ÓÂÊÚÈ΋ ÏÂÈÙÔ˘ÚÁ›· (19 ‚Ú¤ÊË ËÏÈΛ·˜ 0,08 ¤ˆ˜ 0,96 ÂÙÒÓ, ‰È¿ÌÂÛË ÙÈÌ‹ 0,28). ∏ ÌÂϤÙË ÂÁÎÚ›ıËΠ·fi ÙËÓ ∂ÈÙÚÔ‹ ¢ÂÔÓÙÔÏÔÁ›·˜ ÙÔ˘ ∂ÈÛÙËÌÔÓÈÎÔ‡ ™˘Ì‚Ô˘Ï›Ô˘ ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ. ∂Ú¢ÓËÙÈÎfi ÚˆÙfiÎÔÏÏÔ ∆· ‰Â›ÁÌ·Ù· ·fi Ù· ‚Ú¤ÊË ÙˆÓ ÔÌ¿‰ˆÓ ∞ Î·È µ Û˘ÁÎÂÓÙÚÒıËÎ·Ó Î·Ù¿ ÙË ‰ÈÂÓ¤ÚÁÂÈ· ÙÔ˘ ·ÂÈÎÔÓÈÛÙÈÎÔ‡ ÂϤÁ¯Ô˘ ÌÂÙ¿ ·fi ·ԉ‰ÂÈÁ̤ÓË Ô˘ÚÔÏԛ̈ÍË ‹ ÌÂÙ¿ ·fi ‰È·›ÛÙˆÛË ÚÔÁÂÓÓËÙÈ΋˜ ˘‰ÚÔÓ¤ÊÚˆÛ˘. ∆Ô ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÓÂÊÚÒÓ ¤ÁÈÓ ηٿ ÙËÓ ÚÒÙË Â‚‰ÔÌ¿‰· ·fi ÙË ‰È¿ÁÓˆÛË Ù˘ Ô˘ÚÔÏԛ̈͢. ∏ ·ÚÔ˘Û›· Î·È Ô ‚·ıÌfi˜ ∫√¶ ÚÔÛ‰ÈÔÚ›ÛÙËÎ·Ó Ì ÎÏ·ÛÈ΋ ·ÓÈÔ‡Û· ΢ÛÙÂÔ-Ô˘ÚËıÚÔÁÚ·Ê›· ηٿ ÙËÓ Ô‡ÚËÛË, Ô˘ Ú·ÁÌ·ÙÔÔÈ‹ıËΠ6-8 ‚‰ÔÌ¿‰Â˜ ÌÂÙ¿ ÙË Ïԛ̈ÍË. ∏ ·ÏÈÓ‰ÚfiÌËÛË ‚·ıÌÔÏÔÁ‹ıËΠ·fi 0-V Û‡Ìʈӷ Ì ÙË ¢ÈÂıÓ‹ ∂ÈÙÚÔ‹ ÁÈ· ÙË ªÂϤÙË Ù˘ ¶·ÏÈÓ‰ÚfiÌËÛ˘ (International Reflux Study Committee) (1,22). ™Â ÂÚ›ÙˆÛË ·ÌÊÔÙÂÚfiÏ¢Ú˘ ·ÏÈÓ‰ÚfiÌËÛ˘, ·Ó·Ê¤ÚÂÙ·È Ô ·ÓÙ›ÛÙÔȯԘ ·ıÚÔÈÛÙÈÎfi˜ ·ÚÈıÌfi˜. ∏ ·ÚÔ˘Û›· Î·È ÙÔ Ì¤ÁÂıÔ˜ ÙˆÓ ÓÂÊÚÈÎÒÓ ·ÚÂÁ¯˘Ì·ÙÈÎÒÓ ‚Ï·‚ÒÓ ÚÔÛ‰ÈÔÚ›ÛÙËΠ3-6 Ì‹Ó˜ ÌÂÙ¿ ÙË Ïԛ̈ÍË Ì ÛÈÓıËÚÔÁÚ¿ÊËÌ· Ì ‰ÈÌÂÚηÙÔÛÔ˘ÎÎÈÓÈÎfi Ô͇ ÛËÌ·Ṳ̂ÓÔ Ì Ù¯ӋÙÈÔ 99m (DMSA). ø˜ ÓÂÊÚÈ΋ ·ÚÂÁ¯˘Ì·ÙÈ΋ ‚Ï¿‚Ë ÔÚ›ÛÙËΠÙÔ ÂÛÙÈ·Îfi ‹ ÔÏ˘ÂÛÙÈ·Îfi ¤ÏÏÂÈÌÌ· Ï‹ÚˆÛ˘ ‹ Ë Û¯ÂÙÈ΋ ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ· οو ·fi 45%. ∏ ÓÂÊÚÈ΋ Ô˘Ï‹ ÔÚ›ÛÙËΠˆ˜ ¤ÏÏÂÈÌÌ· ÛÙÔ Ê˘ÛÈÔÏÔÁÈÎfi ÓÂÊÚÈÎfi ÂÚ›ÁÚ·ÌÌ· (1,23). ∏ ÔÌ¿‰· ° ÂÚÈÂÏ¿Ì‚·Ó ‚Ú¤ÊË ÂχıÂÚ· ·Ó·ÌÓËÛÙÈÎÔ‡ Ô˘ÚÔÏԛ̈͢ ‹ ¿ÏÏ˘ ÁÓˆÛÙ‹˜ ˘ÔΛÌÂÓ˘ ηٿÛÙ·Û˘ Ô˘ ı· ÌÔÚÔ‡Û ӷ ÂËÚ¿ÛÂÈ ÙË ÓÂÊÚÈ΋ ÏÂÈÙÔ˘ÚÁ›·. ¶ÚÔÛ‰ÈÔÚÈÛÌfi˜ IL-8 ™ÙË ÌÂϤÙË ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ˘ÔÏÂÈÌÌ·ÙÈο ‰Â›ÁÌ·Ù· Ô‡ÚˆÓ ·fi ·˘Ù¿ Ô˘ ›¯·Ó ÏËÊı› ÁÈ· ÙÔÓ Û˘Ó‹ıË ¤ÏÂÁ¯Ô

Pediatri May-Jun 07

24-05-07

17:58

™ÂÏ›‰·201

201

IL-8 Î·È Î˘ÛÙÂÔÔ˘ÚËÙËÚÈ΋ ·ÏÈÓ‰ÚfiÌËÛË

™Ù·ÙÈÛÙÈ΋ °È· ÙËÓ ·Ó¿Ï˘ÛË ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÔÈ ÌË ·Ú·ÌÂÙÚÈΤ˜ ‰ÔÎÈ̷ۛ˜ Kruskal-Wallis Î·È Mann-Whitney Î·È Ë ‰ÔÎÈÌ·Û›· Û˘Û¯¤ÙÈÛ˘ Spearman. ™Â fiϘ ÙȘ ÂÚÈÙÒÛÂȘ ÂÊ·ÚÌfiÛÙËΠÙÔ Û˘Ì‚·ÙÈÎfi Â›Â‰Ô ÛËÌ·ÓÙÈÎfiÙËÙ·˜ p<0,05.

∞ÔÙÂϤÛÌ·Ù· ∆· ‚Ú¤ÊË ÛÙȘ ÔÌ¿‰Â˜ ∞ Î·È µ ‹Ù·Ó ÂχıÂÚ· Ô˘ÚÔÏԛ̈͢ ÁÈ· ‰È¿ÛÙËÌ· 3 ¤ˆ˜ 48 (‰È¿ÌÂÛË ÙÈÌ‹ 5) ‚‰ÔÌ¿‰ˆÓ Î·È 3 ¤ˆ˜ 10,3 (‰È¿ÌÂÛË ÙÈÌ‹ 5) ‚‰ÔÌ¿‰ˆÓ, ·ÓÙ›ÛÙÔȯ·, ÚÈÓ ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi Ù˘ IL-8. ¢ÂÓ ·Ú·ÙËÚ‹ıËΠÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ˆ˜ ÚÔ˜ ÙÔÓ ÂχıÂÚÔ Ô˘ÚÔÏԛ̈͢ ¯ÚfiÓÔ ·Ó¿ÌÂÛ· ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜ (p=0,460). ∆· 35 ·fi Ù· 37 ‚Ú¤ÊË Ù˘ ÔÌ¿‰·˜ ∞ ›¯·Ó ·ÚÔ˘ÛÈ¿ÛÂÈ ÂÂÈÛfi‰ÈÔ Ô˘ÚÔÏԛ̈͢ ÚÈÓ ÙË ‰È·›ÛÙˆÛË Ù˘ ∫√¶. ™Â 2 ‚Ú¤ÊË ËÏÈΛ·˜ 3 ÌËÓÒÓ, Ë ∫√¶ ›¯Â ‰È·ÁÓˆÛı› ÛÙ· Ï·›ÛÈ· ‰ÈÂÚ‡ÓËÛ˘ ÚÔÁÂÓÓËÙÈ΋˜ ˘‰ÚÔÓ¤ÊÚˆÛ˘ Î·È Î·Ó¤Ó· ÂÂÈÛfi‰ÈÔ Ô˘ÚÔÏԛ̈͢ ‰ÂÓ Â›¯Â ÙÂÎÌËÚȈı› ¤ˆ˜ ÙÔÓ ¯ÚfiÓÔ Ù˘ ÌÂϤÙ˘. ™ÙËÓ ÔÌ¿‰· ∞, Ë ·ÏÈÓ‰ÚfiÌËÛË ‹Ù·Ó ‰ÂÍÈ¿ Û 10 ‚Ú¤ÊË, ·ÚÈÛÙÂÚ¿ Û 10 Î·È ·ÌÊÔÙÂÚfiÏ¢ÚË Û 17. ¡ÂÊÚÈ΋ ·ÚÂÁ¯˘Ì·ÙÈ΋ ‚Ï¿‚Ë ÙÂÎÌËÚÈÒıËΠ۠20 ‚Ú¤ÊË Ù˘ ÔÌ¿‰·˜ ∞ Î·È Û ηӤӷ ·fi Ù· ‚Ú¤ÊË Ù˘ ÔÌ¿‰·˜ µ. √È ÙÈ̤˜ ÎÚ·ÙÈÓ›Ó˘ Ô‡ÚˆÓ ‰ÂÓ ‰È¤ÊÂÚ·Ó ÛËÌ·ÓÙÈο ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ ∞, µ Î·È ° (‰È¿ÌÂÛ˜ ÙÈ̤˜ 1,06, 1,5 Î·È 1,15 Ìmol/mL ·ÓÙ›ÛÙÔȯ·, p=0,070). √È ‰È¿ÌÂÛ˜ ÙÈ̤˜ IL-8/ÎÚ·ÙÈÓ›ÓË (pg/Ìmol) ‹Ù·Ó 16,97 (0,00-3.874) ÛÙËÓ ÔÌ¿‰· ∞, 4,47 (0,01-386) ÛÙËÓ ÔÌ¿‰· µ Î·È 4,19 (0,00-55,6) ÛÙËÓ ÔÌ¿‰· ° (∂ÈÎfiÓ· 1). √È ÙÈ̤˜ IL-8/ÎÚ·ÙÈÓ›ÓË ‹Ù·Ó ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚ˜ ÛÙËÓ ÔÌ¿‰· ∞ ÙfiÛÔ Û ۯ¤ÛË Ì ÙËÓ ÔÌ¿‰· µ (p=0,0491) fiÛÔ Î·È Û ۯ¤ÛË Ì ÙËÓ ÔÌ¿‰· ° (p=0,0095), ¯ˆÚ›˜ Ó· ·Ú·ÙËÚËı› ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÌÂٷ͇ Ù˘ ÔÌ¿‰·˜ µ Î·È Ù˘ ÔÌ¿‰·˜ ° (p=0,759). ™ÙËÓ ÔÌ¿‰· ∞ ‰ÂÓ Î·Ù·‰Â›¯ÙËÎ·Ó ÛËÌ·ÓÙÈΤ˜ Û˘Û¯ÂÙ›ÛÂȘ ·fi ÙËÓ ·Ó¿Ï˘ÛË ÙˆÓ ÙÈÌÒÓ IL8/ÎÚ·ÙÈÓ›ÓË Û ۯ¤ÛË Ì ÙËÓ ·ÚÔ˘Û›· ÓÂÊÚÈ΋˜ ·ÚÂÁ¯˘Ì·ÙÈ΋˜ ‚Ï¿‚˘ (p=0,272), ÓÂÊÚÈ΋˜ Ô˘Ï‹˜ (p=0,266), ‹ Ì ÙÔÓ ‚·ıÌfi Ù˘ ·ÏÈÓ‰ÚfiÌËÛ˘ (Spearman r=-0,049, p=0,775) ‹ ÙÔÓ ¯ÚfiÓÔ Ô˘ ÌÂÛÔÏ¿‚ËÛ ·fi ÙËÓ ÙÂÏÂ˘Ù·›· Ô˘ÚÔÏԛ̈ÍË (Spearman r=-0,091, p=0,601). ™ÙËÓ ∂ÈÎfiÓ· 2 ·ÚÔ˘ÛÈ¿˙ÂÙ·È Ë Î·Ì‡ÏË Ù‡Ô˘

3900

™˘ÁÎÂÓÙÚÒÛÂȘ IL-8/ÎÚ·ÙÈÓ›ÓË Ô‡ÚˆÓ

ÙˆÓ ‚ÚÂÊÒÓ. ∆· ‰Â›ÁÌ·Ù· ηٷ„‡¯ıËÎ·Ó ÛÙÔ˘˜ -70ÔC ¯ˆÚ›˜ ÚÔËÁÔ‡ÌÂÓË Ê˘ÁÔΤÓÙÚËÛË Î·È ·Ô„‡¯ıËÎ·Ó ÚÈÓ ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi Ù˘ IL-8. √È Û˘ÁÎÂÓÙÚÒÛÂȘ Ù˘ IL-8 ÌÂÙÚ‹ıËÎ·Ó Ì ÔÛÔÙÈ΋ ̤ıÔ‰Ô ELISA (quantitative sandwich enzyme-linked immunosorbent assay, R&D systems, Abingdon, UK). ŸÏ˜ ÔÈ ÌÂÙÚ‹ÛÂȘ ¤ÁÈÓ·Ó ÂȘ ‰ÈÏÔ‡Ó. ™‡Ìʈӷ Ì ÙÔÓ Î·Ù·Û΢·ÛÙ‹, ÙÔ Î·ÙÒÙÂÚÔ fiÚÈÔ ·Ó›¯Ó¢Û˘ ÁÈ· ÙËÓ IL-8 ‹Ù·Ó <10 pg/mL. ¶ÚÔÎÂÈ̤ÓÔ˘ Ó· ·ÔÊ¢¯ıÔ‡Ó ÂȉڿÛÂȘ Ù˘ Û˘Ì‡ÎÓˆÛ˘ ÙˆÓ Ô‡ÚˆÓ ÛÙËÓ ÙÈÌ‹ Ù˘ IL-8, Ù· Â›‰· IL-8 ÂÎÊÚ¿ÛÙËÎ·Ó ˆ˜ ÏfiÁÔ˜ IL-8/ ÎÚ·ÙÈÓ›ÓË Ô‡ÚˆÓ (pg/Ìmol ÎÚ·ÙÈÓ›Ó˘) (6,11,17).

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∂ÈÎfiÓ· 1. ™˘ÁÎÂÓÙÚÒÛÂȘ IL-8/ÎÚ·ÙÈÓ›ÓË ÛÙ· Ô‡Ú· ‚ÚÂÊÒÓ Ì ·ԉ‰ÂÈÁ̤ÓË ∫√¶ (ÔÌ¿‰· ∞), ‚ÚÂÊÒÓ Ì ·Ó·ÌÓËÛÙÈÎfi Ô˘ÚÔÏԛ̈͢ ·ÏÏ¿ ¯ˆÚ›˜ ∫√¶ (ÔÌ¿‰· µ) Î·È ‚ÚÂÊÒÓ Ì ÂχıÂÚÔ ·Ó·ÌÓËÛÙÈÎfi ·ı‹ÛÂˆÓ ÙÔ˘ Ô˘ÚÔÔÈËÙÈÎÔ‡ (ÔÌ¿‰· °).

ROC (receiver-operator curve) Ô˘ ÚԤ΢„ ·fi ÙËÓ ·ÂÈÎfiÓÈÛË Ù˘ ¢·ÈÛıËÛ›·˜ Î·È Ù˘ ÂȉÈÎfiÙËÙ·˜ Û ‰È·ÊÔÚÂÙÈΤ˜ ÙÈ̤˜ ÙÔ˘ ÏfiÁÔ˘ IL-8/ÎÚ·ÙÈÓ›ÓË ÛÙ· Ô‡Ú·. ∞fi ÙËÓ Î·Ì‡ÏË ÚÔ·ÙÂÈ fiÙÈ ÛÙËÓ ÙÈÌ‹ 5 pg/Ìmol ÙÔ˘ ÏfiÁÔ˘ IL-8/ÎÚ·ÙÈÓ›ÓË, Ë Â˘·ÈÛıËÛ›· ·˘ÙÔ‡ ÙÔ˘ ‰Â›ÎÙË ÛÙË ‰È¿ÁÓˆÛË Ù˘ ∫√¶ Â›Ó·È 73% Î·È Ë ÂȉÈÎfiÙËÙ· Â›Ó·È 56%. °È· ÙËÓ ›‰È· ÙÈÌ‹ IL8/ÎÚ·ÙÈÓ›ÓË, Ë ıÂÙÈ΋ ÚÔÁÓˆÛÙÈ΋ ·Í›· ˘ÔÏÔÁ›ÛÙËΠ۠66% Î·È Ë ·ÚÓËÙÈ΋ ÚÔÁÓˆÛÙÈ΋ ·Í›· Û 64%. ªÂ ÙÔÓ ‰È·ÁÓˆÛÙÈÎfi Ô˘‰fi ÛÙËÓ ÙÈÌ‹ 10 pg/Ìmol ÙÔ˘ ÏfiÁÔ˘ IL-8/ÎÚ·ÙÈÓ›ÓË ÛÙ· Ô‡Ú·, Ë Â˘·ÈÛıËÛ›· ·˘ÙÔ‡ ÙÔ˘ ‰Â›ÎÙË ÛÙË ‰È¿ÁÓˆÛË Ù˘ ∫√¶ Â›Ó·È 62%, Ë ÂȉÈÎfiÙËÙ· Â›Ó·È 69%, Ë ıÂÙÈ΋ ÚÔÁÓˆÛÙÈ΋ ·Í›· 70% Î·È Ë ·ÚÓËÙÈ΋ ÚÔÁÓˆÛÙÈ΋ ·Í›· 61%. ∏ ¯Ú‹ÛË ˘„ËÏfiÙÂÚˆÓ ÙÈÌÒÓ ÙÔ˘ ÏfiÁÔ˘ IL8/ÎÚ·ÙÈÓ›ÓË ·˘Í¿ÓÂÈ ÙËÓ ÂȉÈÎfiÙËÙ· ·ÏÏ¿ ÌÂÈÒÓÂÈ Ú·Á‰·›· ÙËÓ Â˘·ÈÛıËÛ›·. ∂Ó‰ÂÈÎÙÈο ÁÈ· ÙÈ̤˜ IL8/ÎÚ·ÙÈÓ›ÓË 100 pg/Ìmol, Ë ÂȉÈÎfiÙËÙ· ·˘Í‹ıËΠÛÙÔ 97%, ·ÏÏ¿ Ë Â˘·ÈÛıËÛ›· ÌÂÈÒıËΠÛÙÔ 27%.

™˘˙‹ÙËÛË ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÙÔ ÂÚ¢ÓËÙÈÎfi ÂӉȷʤÚÔÓ Û¯ÂÙÈο Ì ÙËÓ ∫√¶ ÛÙÚ¤ÊÂÙ·È ÛÙËÓ ·Ó·˙‹ÙËÛË ÌÂıfi‰ˆÓ ·Ó·ÁÓÒÚÈÛ˘ ÙˆÓ ·È‰ÈÒÓ Ô˘ ·Ó‹ÎÔ˘Ó ÛÙËÓ ¶·È‰È·ÙÚÈ΋ 2007;70:199-204

Pediatri May-Jun 07

24-05-07

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∂ȉÈÎfiÙËÙ· (%) ∂ÈÎfiÓ· 2. ∂˘·ÈÛıËÛ›· Î·È ÂȉÈÎfiÙËÙ· ÙÈÌÒÓ IL-8/ÎÚ·ÙÈÓ›ÓË Ô‡ÚˆÓ (pg/Ìmol) ÁÈ· ÙË ‰È¿ÁÓˆÛË Ù˘ ∫√¶ Û ‚Ú¤ÊË ¯ˆÚ›˜ ÚfiÛÊ·ÙË Ô˘ÚÔÏԛ̈ÍË.

ηÙËÁÔÚ›· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ∫√¶, ÓÂÊÚÈ΋ ·ÚÂÁ¯˘Ì·ÙÈ΋ ‚Ï¿‚Ë Î·È ÓÂÊÚÔ¿ıÂÈ· ·fi ·ÏÈÓ‰ÚfiÌËÛË. √ Û˘Ó‰˘·ÛÌfi˜ ÎÏÈÓÈÎÒÓ Î·È ·ÏÒÓ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ·Ú·Ì¤ÙÚˆÓ Â›¯Â ̤ÙÚÈ· ÌfiÓÔ ·ÔÙÂϤÛÌ·Ù· ÛÙËÓ Î·Ù‡ı˘ÓÛË ·˘Ù‹ (24). ∆ÂÏÂ˘Ù·›·, ÔÈ ÂÚ¢ÓËÙÈΤ˜ ÚÔÛ¿ıÂȘ ÂÛÙÈ¿˙ÔÓÙ·È ÛÙÔ˘˜ ‰Â›ÎÙ˜ Î·È ÙÔ˘˜ ÌÂÛÔÏ·‚ËÙ¤˜ Ù˘ ÊÏÂÁÌÔÓ‹˜. ∏ ÚÔηÏÛÈÙÔÓ›ÓË (PCT), ¤Ó·˜ ·fi ÙÔ˘˜ ÙÂÏÂ˘Ù·›· ·Ó·ÁÓˆÚÈÛı¤ÓÙ˜ ‰Â›ÎÙ˜ ÊÏÂÁÌÔÓ‹˜, ÌÂÏÂÙ‹ıËΠ۠‚Ú¤ÊË Î·È Ó‹È· Ì ÚÒÙÔ ÂÂÈÛfi‰ÈÔ Ô˘ÚÔÏԛ̈͢ Î·È Ù· Â›‰¿ Ù˘ ‚Ú¤ıËÎ·Ó ·˘ÍË̤ӷ ÛÙÔÓ ÔÚfi ·È‰ÈÒÓ Ì ∫√¶ (25,26), fï˜, ‰ÂÓ ˘¿Ú¯Ô˘Ó ÛÙÔȯ›· ÁÈ· ÙË Û˘ÌÂÚÈÊÔÚ¿ ÙÔ˘ Û˘ÁÎÂÎÚÈ̤ÓÔ˘ ‰Â›ÎÙË Û ·È‰È¿ Ì ∫√¶ ¯ˆÚ›˜ Ô˘ÚÔÏԛ̈ÍË. ∏ ÌÂϤÙË Î˘ÙÙ·ÚÔÎÈÓÒÓ Î·È ÌÂÛÔÏ·‚ËÙÒÓ, fiˆ˜ Ë ÈÓÙÂÚÏ¢ΛÓË-6 (IL-6) Î·È Ô ˘Ô‰Ô¯¤·˜ ÙÔ˘ ·Ú¿ÁÔÓÙ· Ó¤ÎÚˆÛ˘ ÙÔ˘ fiÁÎÔ˘ 1 (TNF-1) ‰ÂÓ Î·Ù¤‰ÂÈÍ ȉȷ›ÙÂÚË ÌÂÙ·‚ÔÏ‹ Û ·È‰È¿ Ì ∫√¶ ¯ˆÚ›˜ ÚfiÛÊ·ÙË ÔÍ›· Ïԛ̈ÍË (5). ∏ ·ÚÔ‡Û· ÌÂϤÙË ˘Ô‰ÂÈÎÓ‡ÂÈ fiÙÈ ·ÎfiÌ· Î·È ¯ˆÚ›˜ ÚfiÛÊ·ÙË Ô˘ÚÔÏԛ̈ÍË, Ù· Â›‰· Ù˘ IL-8 ÛÙ· Ô‡Ú· ·Ú·Ì¤ÓÔ˘Ó ˘„ËÏfiÙÂÚ· ÛÙ· ‚Ú¤ÊË Ì ∫√¶ Û˘ÁÎÚÈÙÈο Ì ٷ ‚Ú¤ÊË Ì ·Ó·ÌÓËÛÙÈÎfi Ô˘ÚÔÏԛ̈͢ ¯ˆÚ›˜ ∫√¶ Î·È Ù· ‚Ú¤ÊË Ù˘ ÔÌ¿‰·˜ ÂϤÁ¯Ô˘. ∞˘ÍË̤ӷ Â›‰· IL-8 ÛÙ· Ô‡Ú· ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› Û ·È‰È¿ Ì ‰È¿ÊÔÚ˜ ÓÂÊÚÈΤ˜ ÊÏÂÁÌÔÓÒ‰ÂȘ ‰È·Ù·Ú·¯¤˜, Û˘ÌÂÚÈÏ·Ì‚·ÓÔ̤Ó˘ Ù˘ Ô˘ÚÔÏԛ̈͢ (6,10,12-15), Î·È Ë ÙÈÌ‹ 200 pg/ml ¤¯ÂÈ ÚÔÙ·ı› ˆ˜ ·ÍÈfiÈÛÙÔ˜ ‰Â›ÎÙ˘ ÁÈ· ÙË ‰È¿ÁÓˆÛË Ô˘ÚÔÏԛ̈͢ (15). ∏ ·¤ÎÎÚÈÛË Ù˘ IL-8 ÛÙ· Ô‡Ú· ÌÂÈÒÓÂÙ·È ÁÚ‹ÁÔÚ· ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Paediatriki 2007;70:199-204

Ù˘ ·ÓÙÈ‚ÈÔÙÈ΋˜ ·ÁˆÁ‹˜ (27), ‡ÚËÌ· Ô˘ ÂȂ‚·ÈÒıËÎÂ Î·È ÛÙËÓ ÔÌ¿‰· µ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘. ∆· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘ ˘Ô‰ÂÈÎÓ‡Ô˘Ó ÂÚ·ÈÙ¤Úˆ fiÙÈ ÙÈ̤˜ IL-8/ÎÚ·ÙÈÓ›ÓË ÌÂÁ·Ï‡ÙÂÚ˜ ÙˆÓ 5-10 pg/Ìmol ¤¯Ô˘Ó ÈηÓÔÔÈËÙÈ΋ ¢·ÈÛıËÛ›· Î·È ÂȉÈÎfiÙËÙ· ÛÙË ‰È¿ÁÓˆÛË Ù˘ ∫√¶. À„ËÏfiÙÂÚ˜ ÙÈ̤˜ ·˘Í¿ÓÔ˘Ó ÙËÓ ÂȉÈÎfiÙËÙ·, ÌÂÈÒÓÔÓÙ·˜ fï˜ ÛËÌ·ÓÙÈο ÙËÓ Â˘·ÈÛıËÛ›·. Œ¯Ô˘Ó ‹‰Ë ÂÚÈÁÚ·Ê› ·˘ÍË̤ӷ Â›‰· IL-8 ÛÙ· Ô‡Ú· ·È‰ÈÒÓ Ì ∫√¶ Î·È ÓÂÊÚÈΤ˜ Ô˘Ï¤˜ ¯ˆÚ›˜ ÚfiÛÊ·ÙË Ô˘ÚÔÏԛ̈ÍË (9,14). ∆· Â˘Ú‹Ì·Ù· Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ÂȂ‚·ÈÒÓÔ˘Ó fiÙÈ ˘¿Ú¯Ô˘Ó ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÌÂٷ͇ ‚ÚÂÊÒÓ Ì ∫√¶ Î·È ‚ÚÂÊÒÓ Ì ·Ó·ÌÓËÛÙÈÎfi Ô˘ÚÔÏԛ̈͢ ·ÏÏ¿ fi¯È ∫√¶ ‹ ‚ÚÂÊÒÓ ¯ˆÚ›˜ ·Ó·ÌÓËÛÙÈÎfi ÓfiÛÔ˘ ÙÔ˘ Ô˘ÚÔÔÈËÙÈÎÔ‡, Î·È ˘Ô‰ÂÈÎÓ‡Ô˘Ó ÙȘ ·˘ÍË̤Ó˜ ÙÈ̤˜ IL-8/ÎÚ·ÙÈÓ›ÓË ÙˆÓ Ô‡ÚˆÓ ˆ˜ ·ÍÈfiÈÛÙÔ ‰È·ÁÓˆÛÙÈÎfi ‰Â›ÎÙË Ù˘ ∫√¶. ¢Â‰Ô̤ÓÔ˘ fiÙÈ Ù· ‚Ú¤ÊË Ù˘ ÔÌ¿‰·˜ ∞ ÂÌÊ¿ÓÈ˙·Ó ·ÚÂÁ¯˘Ì·ÙÈ΋ ‚Ï¿‚Ë/ÓÂÊÚÈ΋ Ô˘Ï‹ Û ۷ÊÒ˜ ÌÂÁ·Ï‡ÙÂÚË Û˘¯ÓfiÙËÙ· ·fi Ù· ‚Ú¤ÊË Ù˘ ÔÌ¿‰·˜ µ, Ë ·˘ÍË̤ÓË IL-8 ı· ÌÔÚÔ‡Û ÂӉ¯Ô̤ӈ˜ Ó· ·Ô‰Ôı› ÛÙËÓ ·ÚÂÁ¯˘Ì·ÙÈ΋ ‚Ï¿‚Ë Ì¿ÏÏÔÓ ·Ú¿ ÛÙËÓ Î˘ÛÙÂÔÔ˘ÚËÙËÚÈ΋ ·ÏÈÓ‰ÚfiÌËÛË. øÛÙfiÛÔ, ÛÙ· ‚Ú¤ÊË Ù˘ ÔÌ¿‰·˜ ∞ ‰ÂÓ ‰È·ÈÛÙÒıËΠۯ¤ÛË ÙˆÓ ÂÈ¤‰ˆÓ IL-8 Ì ÙËÓ ‡·ÚÍË ‹ ÌË ·ÚÂÁ¯˘Ì·ÙÈ΋˜ ‚Ï¿‚˘. √ˆÛ‰‹ÔÙÂ, ÌÂϤÙ˜ Ì ÌÂÁ·Ï‡ÙÂÚÔ ÏËı˘ÛÌfi ı· ‹Ù·Ó ÔχÙÈ̘ ÁÈ· ÙËÓ ÂÍ·ÁˆÁ‹ ÔÚÈÛÙÈÎÒÓ Û˘ÌÂÚ·ÛÌ¿ÙˆÓ Û¯ÂÙÈο Ì ·˘Ùfi ÙÔ Ôχ ÂӉȷʤÚÔÓ ÂÚÒÙËÌ·. ∆· Â˘Ú‹Ì·Ù· Ù˘ ÌÂϤÙ˘ ·Ô‰ÂÈÎÓ‡Ô˘Ó ÂÈϤÔÓ fiÙÈ Ë ÊÏÂÁÌÔÓ҉˘ ‰È·‰Èηۛ· ÂÍ·ÎÔÏÔ˘ı› Ó· ˘Ê›ÛÙ·Ù·È ÛÙËÓ ∫√¶ Î·È ÌÂÙ¿ ÙËÓ ·Ô‰ÚÔÌ‹ Ù˘ Ô˘ÚÔÏԛ̈͢, Û ·ÓÙ›ıÂÛË Ì ÙËÓ ¿Ô„Ë fiÙÈ Ë ·ÏÈÓ‰ÚfiÌËÛË Ô‡ÚˆÓ ÛÙÂ›ÚˆÓ ÌÈÎÚÔ‚›ˆÓ ‰ÂÓ ‰ËÌÈÔ˘ÚÁ› ÓÂÊÚÈ΋ ‚Ï¿‚Ë (3). ∏ ·‡ÍËÛË Ù˘ IL-8 ÛÙ· ·È‰È¿ Ì ∫√¶ Ê·›ÓÂÙ·È Ó· Â›Ó·È ÓÂÊÚÈ΋˜ Î·È fi¯È Û˘ÛÙËÌ·ÙÈ΋˜ ÚÔ¤Ï¢Û˘, ·ÊÔ‡ Ù· Â›‰· IL-8 ÛÙÔÓ ÔÚfi ·È‰ÈÒÓ Ì ∫√¶ ¯ˆÚ›˜ Ô˘ÚÔÏԛ̈ÍË ¤¯Ô˘Ó ·Ó·ÊÂÚı› Ê˘ÛÈÔÏÔÁÈο (13,20). ∏ ·‡ÍËÛË ·˘Ù‹ ‰ÂÓ ı· ÌÔÚÔ‡Û ӷ ·Ô‰Ôı› Û ˘ÔÏÂÈfiÌÂÓË ÊÏÂÁÌÔÓ‹ ÏfiÁˆ Ù˘ ÚÔËÁËı›۷˜ Ô˘ÚÔÏԛ̈͢, ηıÒ˜ ‰ÂÓ ·Ú·ÙËÚ‹ıËΠ۠·È‰È¿ Ì ÚÔËÁËı›۷ Ô˘ÚÔÏԛ̈ÍË ¯ˆÚ›˜ ∫√¶. ∂ÈϤÔÓ, Â›Ó·È ÂӉȷʤÚÔÓ fiÙÈ ÌÂٷ͇ fiÏˆÓ ÙˆÓ ·È‰ÈÒÓ Ù˘ ÌÂϤÙ˘, Ë ‰Â‡ÙÂÚË ˘„ËÏfiÙÂÚË ÙÈÌ‹ IL-8 ·Ú·ÙËÚ‹ıËΠ۠¤Ó· ‚Ú¤ÊÔ˜ Ì ÚÔÁÂÓÓËÙÈ΋ ‰È¿ÁÓˆÛË ∫√¶ Î·È ¯ˆÚ›˜ ÈÛÙÔÚÈÎfi Ô˘ÚÔÏԛ̈͢. ∏ ¯ÚfiÓÈ· ÊÏÂÁÌÔÓ҉˘ ΢ÙÙ·ÚÈ΋ ‰È‹ıËÛË Ô˘ Û¯ÂÙ›˙ÂÙ·È ÂÚÈÛÛfiÙÂÚÔ Ì ÙË ÓÂÊÚÔ¿ıÂÈ· Ù˘ ·ÏÈÓ‰ÚfiÌËÛ˘ ·Ú¿ Ì ÙËÓ ›‰È· ÙËÓ ·ÏÈÓ‰ÚfiÌËÛË, ·ÔÙÂÏ› ÂӉ¯Ô̤ӈ˜ ÌÈ· ÂÍ‹ÁËÛË ÁÈ· Ù· ·˘ÍË̤ӷ Â›‰· IL-8 ÛÙ· ·È‰È¿ Ì ∫√¶, Ô˘ ÌÔÚ› Ó· Â›Ó·È ·ÓÂÍ¿ÚÙËÙ· ·fi ÙÔÓ ‚·ıÌfi Ù˘ ·ÏÈÓ‰ÚfiÌËÛ˘.

Pediatri May-Jun 07

24-05-07

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IL-8 Î·È Î˘ÛÙÂÔÔ˘ÚËÙËÚÈ΋ ·ÏÈÓ‰ÚfiÌËÛË

∏ ÌÂϤÙË ÂÈÎÂÓÙÚÒıËΠÛÙ· ÌÈÎÚ¿ ‚Ú¤ÊË, ÂÂȉ‹ ·˘Ù‹ Ë ËÏÈÎȷ΋ ÔÌ¿‰· ·ÓÙÈÌÂÙˆ›˙ÂÈ ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ·Ó¿Ù˘Í˘ ÓÂÊÚÈ΋˜ ‚Ï¿‚˘ (1). ∏ ·Ó›¯Ó¢ÛË ∫√¶, ¯ÚfiÓÈ·˜ ˘ÂÏÔÓÂÊÚ›Ùȉ·˜ Î·È ÓÂÊÚÈ΋˜ Ô˘Ï‹˜ ‚·Û›˙ÂÙ·È Û‹ÌÂÚ· Û ·ÂÈÎÔÓÈÛÙÈΤ˜ ÌÂıfi‰Ô˘˜, fiˆ˜ Ù· Ú·‰ÈÔ˚ÛfiÙÔ· Î·È Ë Î˘ÛÙÂÔÔ˘ÚËıÚÔÁÚ·Ê›·, Ô˘ Û˘ÓÂ¿ÁÔÓÙ·È ¤ÎıÂÛË Û ·ÎÙÈÓÔ‚ÔÏ›·, ÂÂÌ‚·ÙÈÎfiÙËÙ· Î·È ÛËÌ·ÓÙÈÎfi ÎfiÛÙÔ˜. ∏ ¯Ú‹ÛË ÌË ÂÂÌ‚·ÙÈÎÒÓ ÌÂıfi‰ˆÓ ı· ›¯Â ·Ó·ÌÊ›‚ÔÏ· ÛËÌ·ÓÙÈο ÔʤÏË. ∆Ô ˘ÂÚ˯ÔÁÚ¿ÊËÌ· Â›Ó·È Ì›· ÔχÙÈÌË ÌË ÂÂÌ‚·ÙÈ΋ ̤ıÔ‰Ô˜ ÁÈ· ÙË ‰È¢ÎÚ›ÓÈÛË Ù˘ ·Ó·ÙÔÌ›·˜ ÙÔ˘ Ô˘ÚÔÔÈËÙÈÎÔ‡, ˆÛÙfiÛÔ Â›Ó·È ÁÓˆÛÙ‹ Ë ¯·ÌËÏ‹ ÙÔ˘ ¢·ÈÛıËÛ›· ÛÙË ‰È¿ÁÓˆÛË Ù˘ ∫√¶, Ì ·ÔÙ¤ÏÂÛÌ· ÙÔÓ ÂÚÈÔÚÈÛÌfi Ù˘ ¯Ú‹Û˘ ÙÔ˘ ˆ˜ ·ÓȯÓ¢ÙÈ΋˜ ÌÂıfi‰Ô˘ (28). √ ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù˘ IL-8 ÛÙ· Ô‡Ú· Ê·›ÓÂÙ·È Ó· ·ÔÙÂÏ› ˘ÔÛ¯fiÌÂÓÔ ÌË ÂÂÌ‚·ÙÈÎfi ‰È·ÁÓˆÛÙÈÎfi ‰Â›ÎÙË ÁÈ· ÙËÓ ∫√¶ ÛÙ· ÌÈÎÚ¿ ‚Ú¤ÊË. √ ‰Â›ÎÙ˘ ·˘Ùfi˜ ‰ÂÓ Â›Ó·È ¯ˆÚ›˜ ÂÚÈÔÚÈÛÌÔ‡˜. ∆· Â›‰· Ù˘ IL-8 ÌÔÚ› Ó· ‚ÚÂıÔ‡Ó ·˘ÍË̤ӷ ÛÙÔ Ï·›ÛÈÔ ¯ÂÈÚÔ˘ÚÁÈÎÒÓ ¯ÂÈÚÈÛÌÒÓ ÛÙÔ Ô˘ÚÔÔÈËÙÈÎfi Û‡ÛÙËÌ·, ¿ÏÏ˘ ·ıÔÏÔÁÈ΋˜ ηٿÛÙ·Û˘ ÙÔ˘ Ô˘ÚÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, ÎÔÏ›Ùȉ·˜/Ô˘ÚËıÚ›Ùȉ·˜ (14), ‹ Ô˘ÚÔÏԛ̈͢ Ô˘ ‰ÂÓ ·ÓȯÓ‡ÙËÎÂ. ¶Èı·ÓfiÓ, ÙÔ ÙÂÏÂ˘Ù·›Ô ÂӉ¯fiÌÂÓÔ ÂÍËÁ› ÙËÓ ·˘ÍË̤ÓË Û˘ÁΤÓÙÚˆÛË IL-8 Û ¤Ó· ‚Ú¤ÊÔ˜ Ù˘ ¯ˆÚ›˜ ∫√¶ ÔÌ¿‰·˜ µ (∂ÈÎfiÓ· 1). ∆¤ÏÔ˜, Ë ÌÂϤÙË ÂÚȤϷ‚ ÌfiÓÔ ‚Ú¤ÊË, Û˘ÓÂÒ˜ Â›Ó·È ·ÌÊ›‚ÔÏÔ Î·Ù¿ fiÛÔ Ù· Â˘Ú‹Ì·Ù¿ Ù˘ ÈÛ¯‡Ô˘Ó ÁÈ· ÌÂÁ·Ï‡ÙÂÚ· Ó‹È· Î·È ·È‰È¿. ¶·Ú¿ ÙÔ˘˜ ÂÚÈÔÚÈÛÌÔ‡˜ ·˘ÙÔ‡˜, Ë Ì¤ÙÚËÛË Ù˘ IL-8 ÛÙ· Ô‡Ú· ÌÂÙ¿ ÙËÓ ·Ô‰ÚÔÌ‹ Ù˘ Ô˘ÚÔÏԛ̈͢ ÌÔÚ› Ó· ÚÔÛʤÚÂÈ Ô˘ÛÈÒ‰Ë ‰È·ÁÓˆÛÙÈ΋ ‚Ô‹ıÂÈ· ˆ˜ ·ÓȯÓ¢ÙÈ΋ ̤ıÔ‰Ô˜ ηٿ ÙËÓ ·Ó·ÁÓÒÚÈÛË ‚ÚÂÊÒÓ Ô˘ ·Ó‹ÎÔ˘Ó ÛÙËÓ Î·ÙËÁÔÚ›· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ∫√¶, Ì ·ÒÙÂÚÔ ÛÎÔfi ÙËÓ ·˘ÛÙËÚfiÙÂÚË ÂÈÏÔÁ‹ ÙˆÓ ·È‰ÈÒÓ Ô˘ ı· ˆÊÂÏËıÔ‡Ó ·fi ÙË ‰ÈÂÓ¤ÚÁÂÈ· Ù˘ ΢ÛÙÂÔÔ˘ÚËıÚÔÁÚ·Ê›·˜.

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23. Christian MT, McColl JH, MacKenzie JR, Beattie TJ. Risk assessment of renal cortical scarring with urinary tract infection by clinical features and ultrasonography. Arch Dis Child 2000;82:376-380. ¶·È‰È·ÙÚÈ΋ 2007;70:199-204

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24. Leroy S, Marc E, Adamsbaum C, Gendrel D, Breart G, Chalumeau M. Prediction of vesicoureteral reflux after a first febrile urinary tract infection in children: validation of a clinical decision rule. Arch Dis Child 2006;91:241-244.

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number of unnecessary cystographies in children with a urinary tract infection: a European validation study. J Pediatr 2007;150:89-95.

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™ˆÛÙ¤˜ ··ÓÙ‹ÛÂȘ ÙÔ˘ Quiz ÁÈ· ÙÔ ¿ÚıÚÔ “™˘ÁÁÂÓ›˜ ‰È·Ì·Úٛ˜ Ó¢ÌfiÓˆÓ” 1. ¶ÔÈÔ ·fi Ù· ·Ú·Î¿Ùˆ ÂΉËÏÒÓÂÙ·È Û˘Ó‹ıˆ˜ ÛÙȘ ÚÒÙ˜ ÒÚ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË; Á. ™˘ÁÁÂÓ‹˜ ‰È·ÊÚ·ÁÌ·ÙÔ΋ÏË 2. ∏ ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ÂÈÛÓ¢ÛÙÈÎÔ‡ ÛÈÁÌÔ‡ ηÈ/‹ ÂÎÓ¢ÛÙÈÎÔ‡ ÌÔÓÔʈÓÈÎÔ‡ Û˘ÚÈÁÌÔ‡ ÛÙ· 2-3 ÚÒÙ· ¤ÙË ˙ˆ‹˜ Ú¤ÂÈ Ó· ÂÚÈÏ¿‚ÂÈ: Â. ŸÏ· Ù· ·Ú·¿Óˆ (ÙË ÌÂÙ·ÙÚ·˘Ì·ÙÈ΋ ÛÙ¤ÓˆÛË ÌÂÙ¿ ·fi ‰È·ÛˆÏ‹ÓˆÛË, ÙË Á·ÛÙÚÔÔÈÛÔÊ·ÁÈ΋ ·ÏÈÓ‰ÚfiÌËÛË Î·È ÂÈÛÚfiÊËÛË, ÙËÓ ÂÈÛÚfiÊËÛË Í¤ÓÔ˘ ÛÒÌ·ÙÔ˜, ÙÔÓ ·ÁÁÂÈ·Îfi ‰·ÎÙ‡ÏÈÔ) 3. ¶ÔÈÔ ·fi Ù· ·Ú·Î¿Ùˆ Â›Ó·È ·ÏËı¤˜; Á. √ ·ÁÁÂÈ·Îfi˜ ‰·ÎÙ‡ÏÈÔ˜ ÌÔÚ› Ó· ÂΉËψı› ˆ˜ "ÔÈÛıfiÙÔÓÔ˜" ηٿ ÙÔ˘˜ ÚÒÙÔ˘˜ Ì‹Ó˜ Ù˘ ˙ˆ‹˜ 4. ∏ ‰ÈfiÚıˆÛË ÙÚ·¯ÂÈÔÔÈÛÔÊ·ÁÈÎÔ‡ Û˘ÚÈÁÁ›Ô˘ ÌÔÚ› Ó· Û˘Óԉ‡ÂÙ·È ·fi: Â. ŸÏ· Ù· ·Ú·¿Óˆ (‰È·Ù·Ú·¯‹ Ù˘ ·‡ÍËÛ˘, Û˘Ìو̷ÙÔÏÔÁ›· Á·ÛÙÚÔÔÈÛÔÊ·ÁÈ΋˜ ·ÏÈÓ‰ÚfiÌËÛ˘, ‰˘ÛÎÔÏ›· ηٿ ÙËÓ Î·Ù¿ÔÛË, ȉ›ˆ˜ ÛÙÂÚÂÒÓ ÙÚÔÊÒÓ, Û˘Ìو̷ÙÔÏÔÁ›· ÙÚ·¯ÂÈÔÌ·Ï¿Î˘ÓÛ˘) 5. ¶ÔÈÔ ·fi Ù· ·Ú·Î¿Ùˆ ÈÛ¯‡ÂÈ ÁÈ· ÙË ¯ÂÈÚÔ˘ÚÁÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ Û˘ÁÁÂÓÒÓ ‰È·Ì·ÚÙÈÒÓ ÙÔ˘ Ó‡ÌÔÓ·; Â. ∫·Ó¤Ó· ·fi Ù· ·Ú·¿Óˆ (ÔÈ ·Ó·Ó¢ÛÙÈΤ˜ Âʉڛ˜ ÙˆÓ ÂÓËÏ›ÎˆÓ Î·ıÔÚ›˙ÔÓÙ·È Î˘Ú›ˆ˜ ·fi ÙËÓ ËÏÈΛ· Ô˘ ¤ÁÈÓÂ Ë ÂÎÙÔÌ‹ - ÔÈ Û˘ÁÁÂÓ›˜ ‰È·Ì·Úٛ˜ ¯ÚÂÈ¿˙ÔÓÙ·È Î·Ù¿ ηÓfiÓ· ¿ÌÂÛË Â¤Ì‚·ÛË - Ë ·‡ÍËÛË ÙÔ˘ Ó¢ÌÔÓÈÎÔ‡ ÈÛÙÔ‡ ÌÂÙ¿ ÙËÓ Ó¢ÌÔÓÂÎÙÔÌ‹ ·ÊÔÚ¿ ΢ڛˆ˜ ÙÔ ‰›ÎÙ˘Ô ÙˆÓ ·ÂÚ·ÁˆÁÒÓ Î·È ÏÈÁfiÙÂÚÔ ÙÔ ·Ú¤Á¯˘Ì· - ÂÈÚ·Ì·ÙÈο ‰Â‰Ô̤ӷ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ Ë ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ ·‡ÍËÛË ÙÔ˘ Ó‡ÌÔÓ· Û˘ÓÂ¿ÁÂÙ·È ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË ÙÔ˘ ÏÂÈÙÔ˘ÚÁÈÎÔ‡ Ó¢ÌÔÓÈÎÔ‡ ÈÛÙÔ‡)

Paediatriki 2007;70:199-204

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ORIGINAL ARTICLE

205

ªÂÙ·‚ÔÏ‹ ۈ̷ÙÔÌÂÙÚÈÎÒÓ ÌÂÁÂıÒÓ, ·ÚÙËÚȷ΋˜ ›ÂÛ˘, ۷ί¿ÚÔ˘ Î·È ÏÈȉ›ˆÓ ÔÚÔ‡ ·›Ì·ÙÔ˜ ·È‰ÈÒÓ Ù˘ ∫Ú‹Ù˘ ÌÂٷ͇ ÙˆÓ ¯ÚÔÓÈÎÒÓ ÂÚÈfi‰ˆÓ 1989-1993 Î·È 1999-2003 ª. §ÈÓ·Ú‰¿Î˘, °. ªÂÚÙÛÈ¿˜, ∫. ™·ÚÚ‹, ∞. ∫·Ê¿ÙÔ˜ ¶ÂÚ›ÏË„Ë ∂ÈÛ·ÁˆÁ‹: ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ë ÂÎÙ›ÌËÛË Ù˘ ÌÂÙ·‚ÔÏ‹˜ ÙˆÓ ÛˆÌ·ÙÔÌÂÙÚ‹ÛˆÓ, Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ (∞¶), ÙÔ˘ ۷ί¿ÚÔ˘ Î·È ÙˆÓ ÏÈȉ›ˆÓ ÔÚÔ‡ ·›Ì·ÙÔ˜ ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ Ù˘ ∫Ú‹Ù˘, ÌÂٷ͇ ÙˆÓ ÂÙÒÓ 1989-1993 Î·È 1999-2003. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ªÂÏÂÙ‹ıËÎ·Ó ‰‡Ô ·ÓÙÈÚÔÛˆ¢ÙÈο ‰Â›ÁÌ·Ù· ·È‰ÈÒÓ ËÏÈΛ·˜ 5-15 ÂÙÒÓ, ·fi ÙȘ ÂÚÈfi‰Ô˘˜ 1989-1993 (¡=987) Î·È 1999-2003 (¡=891). ¶ÚÔ‹Ïı·Ó ·fi ÏËı˘ÛÌfi 5337 ·È‰ÈÒÓ 12 ÌÂÏÂÙÒÓ Ô˘ ‰ÈÂÍ‹¯ıËÛ·Ó ÛÙȘ ‰‡Ô ÂÚÈfi‰Ô˘˜ ·fi ÙËÓ ∫ÏÈÓÈ΋ ¶ÚÔÏËÙÈ΋˜ π·ÙÚÈ΋˜ Î·È ¢È·ÙÚÔÊ‹˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘. ªÂÙÚ‹ıËÎ·Ó ÙÔ ‚¿ÚÔ˜, ÙÔ ‡„Ô˜, ÔÈ ‰ÂÚÌ·ÙÈΤ˜ Ù˘¯¤˜, Ë ÂÚ›ÌÂÙÚÔ˜ ·ÚÈÛÙÂÚÔ‡ ‚Ú·¯›ÔÓ·, Ë ∞¶, ÙÔ Û¿Î¯·ÚÔ Î·È Ù· ÏÈ›‰È· ÔÚÔ‡ ·›Ì·ÙÔ˜. ÀÔÏÔÁ›ÛÙËÎÂ Î·È Ô ÂÈÔÏ·ÛÌfi˜ ÙÔ˘ ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ (ªÂÙ™˘Ó) ˆ˜ Ë Û˘ÁΤÓÙÚˆÛË ÙÚÈÒÓ ‹ ÂÚÈÛÛfiÙÂÚˆÓ ·fi ÙÔ˘˜ ¤ÓÙ ·Ú¿ÁÔÓÙ˜: ·˘ÍË̤ÓÔ Û¿Î¯·ÚÔ, ·˘ÍË̤ÓË ∞¶, ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›·, ¯·ÌËÏ‹ HDL ¯ÔÏËÛÙÂÚfiÏË Î·È ·¯˘Û·ÚΛ·. ∞ÔÙÂϤÛÌ·Ù·: ªÂٷ͇ ÙˆÓ ÂÚÈfi‰ˆÓ 1989-1993 Î·È 1999-2003 ‚Ú¤ıËΠÛËÌ·ÓÙÈ΋ ̤ÛË ·‡ÍËÛË ÙÔ˘ ‚¿ÚÔ˘˜ ηٿ 4 kg, ÙÔ˘ ‡„Ô˘˜ ηٿ 3,3 cm, ÙÔ˘ ‰Â›ÎÙË Ì¿˙·˜ ÛÒÌ·ÙÔ˜ ηٿ 0,92 kg/m2 Î·È ÙÔ˘ ·ıÚÔ›ÛÌ·ÙÔ˜ ÙÂÛÛ¿ÚˆÓ ‰ÂÚÌ·ÙÈÎÒÓ Ù˘¯ÒÓ Î·Ù¿ 13,2 mm (p<0,001). √ ÂÈÔÏ·ÛÌfi˜ ÙˆÓ ˘¤Ú‚·ÚˆÓ ·È‰ÈÒÓ ·˘Í‹ıËΠ·fi 21,3% Û 24,7% (p<0,001) Î·È Ù˘ ·¯˘Û·ÚΛ·˜ ·fi 5,4% Û 10,4% (p<0,001). ∆Ô ÔÛÔÛÙfi ÙˆÓ ·È‰ÈÒÓ Ì ·˘ÍË̤ÓË ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË ·Ú¤ÌÂÈÓ ·ÌÂÙ¿‚ÏËÙÔ ÛÙÔ 15,9%, ÂÓÒ ÂÎÂ›ÓˆÓ Ì ·˘ÍË̤ÓË LDL-C ÌÂÈÒıËΠ·fi 18,8% Û 17,1% (p=0,006). ™˘ÓÔÏÈο, ÙÔ 4,5% ÙˆÓ ·È‰ÈÒÓ ‚Ú¤ıËΠÙÔ 1989-1993 Ì ÙÚÂȘ ‹ ÂÚÈÛÛfiÙÂÚÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÙÔ˘ ªÂÙ™˘Ó ¤Ó·ÓÙÈ 5,6% ÙÔ 1999-2003 (p>0,05). ™˘ÌÂÚ¿ÛÌ·Ù·: ™ËÌ·ÓÙÈ΋ ·‡ÍËÛË ‰È·ÈÛÙÒÓÂÙ·È ÛÙÔ˘˜ ‰Â›ÎÙ˜ ·¯˘Û·ÚΛ·˜ ÙˆÓ ·È‰ÈÒÓ Ù˘ ∫Ú‹Ù˘ ÛÙËÓ ÂÚ›Ô‰Ô ÌÂٷ͇ 1989-1993 Î·È 1999-2003. ¢ÂÓ ‚Ú¤ıËÎÂ, ˆÛÙfiÛÔ, ·Ó¿ÏÔÁË ÛËÌ·ÓÙÈ΋ ÌÂÙ·‚ÔÏ‹ ÛÙËÓ ·ÚÙËÚȷ΋ ›ÂÛË, ÛÙÔ Û¿Î¯·ÚÔ Î·È Ù· ÏÈ›‰È· ÔÚÔ‡ ·›Ì·ÙÔ˜, ·ÏÏ¿ ÌÈÎÚ‹ ·‡ÍËÛË ÛÙÔÓ ÂÈÔÏ·ÛÌfi ÙÔ˘ ªÂÙ™˘Ó. ∆· ·ÔÙÂϤÛÌ·Ù· ‰Â›¯ÓÔ˘Ó fiÙÈ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ·¯˘Û·ÚΛ·˜ ÎÚ›ÓÂÙ·È ·Ó·Áη›· Ë ÂÊ·ÚÌÔÁ‹ ÂıÓÈ΋˜ ÔÏÈÙÈ΋˜ ÁÈ· ÙËÓ ÚÔ·ÁˆÁ‹ Ù˘ ˘Á›·˜ ÙˆÓ ·È‰ÈÒÓ.

¶·ÓÂÈÛÙ‹ÌÈÔ ∫Ú‹Ù˘, ∆Ì‹Ì· π·ÙÚÈ΋˜, ∆Ô̤·˜ ∫ÔÈÓˆÓÈ΋˜ π·ÙÚÈ΋˜, ∫ÏÈÓÈ΋ ¶ÚÔÏËÙÈ΋˜ π·ÙÚÈ΋˜ Î·È ¢È·ÙÚÔÊ‹˜, ∏Ú¿ÎÏÂÈÔ ∫Ú‹Ù˘ AÏÏËÏÔÁÚ·Ê›·: ª·ÓfiÏ˘ §ÈÓ·Ú‰¿Î˘ linman@med.uoc.gr ¢È·ÛÙ·‡ÚˆÛË µÔ‡Ù˜-™Ù·˘Ú¿ÎÈ· ∆.∫. 710 03, ∆.£. 2208, ∏Ú¿ÎÏÂÈÔ ∫Ú‹Ù˘

§¤ÍÂȘ ÎÏÂȉȿ: ¶ÏËı˘ÛÌȷ΋ Ù¿ÛË, ·È‰È¿, ۈ̷ÙÔÌÂÙÚ‹ÛÂȘ, ÏÈ›‰È· ÔÚÔ‡ ·›Ì·ÙÔ˜, ÌÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ.

Secular trends during early 1990s and 2000s of body measurements, blood pressure, glucose and serum lipids in children of Crete, Greece M. Linardakis, G. Bertsias, K. Sarri, A. Kafatos Abstract Background: This study aimed at assessing secular changes in anthropometric measurements, blood pressure, glucose, and serum lipids in children and adolescents in Crete between 1989-1993 and 1999-2003.

Methods: Two representative samples of children aged 5-15 years were studied during the time periods 1989-1993 (N=987) and 1999-2003 (N=891). The study samples came from a population of 5,337 children who participated in a series of 12 studies conducted by the same study team. Body weight and height, skin fold thickness, blood pressure, glucose, and serum lipids were measured, and body mass index (BMI) was derived. The prevalence of metabolic syndrome (MetSyn) was estimated as the clustering of three or more cardiovascular disease risk factors such as hyperglycaemia, high blood pressure, hypertriglyceridaemia, low HDL cholesterol and obesity.

Results: Between 1989-1993 and 1999-2003 there was a significant increase in body weight (by 4 kg), height (by 3.3 cm), BMI (by 0.92 kg/m2), and the sum of skin folds (by 13.2 mm) (p<0.001). The prevalence of overweight children increased from 21.3% to 24.7% (p<0.001) and obesity from 5.4% to 10.4% (p<0.001). The percentage of children with increased total cholesterol remained unchanged, while that of children with elevated LDL-C decreased from 18.8% to 17.1% (p=0.006). Overall, 4.5% of children had ≥3 risk factors for MetSyn in 1989-1993, compared to 5.6% in 1999-2003 (p>0.05).

University of Crete, Faculty of Medicine, Department of Social Medicine, Division of Preventive Medicine and Nutrition, Heraklion, Crete Correspondence: Manolis Linardakis linman@med.uoc.gr Voutes-Stavrakia Junction 710 03, Po Box 2208, heraklion, Crete

¶·È‰È·ÙÚÈ΋ 2007;70:205-216

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Conclusions: A significant increase in obesity indices was found in children in Crete between 1989-1993

and 1999-2003, but with no significant changes in blood pressure or blood glucose or serum lipid levels.

A small increase was also found in the prevalence of the MetSyn. These results highlight the need for implementation of national health promotion policies focusing on childhood obesity in Greece.

Key words: Secular trends, children, body measurements, serum lipids, metabolic syndrome.

™˘ÓÙÔÌÔÁڷʛ˜ ¢ª™ ∞¢¶ ¶∞µ ™∞¶ ¢∞¶ ∞¶ GLU TC TG HDL-C LDL-C ∂£ OR

¢Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ ÕıÚÔÈÛÌ· 4 ‰ÂÚÌ·ÙÈÎÒÓ Ù˘¯ÒÓ ¶ÂÚ›ÌÂÙÚÔ˜ ·ÚÈÛÙÂÚÔ‡ ‚Ú·¯›ÔÓ· ™˘ÛÙÔÏÈ΋ ·ÚÙËÚȷ΋ ›ÂÛË ¢È·ÛÙÔÏÈ΋ ·ÚÙËÚȷ΋ ›ÂÛË ∞ÚÙËÚȷ΋ ›ÂÛË ™¿Î¯·ÚÔ √ÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË ∆ÚÈÁÏ˘ÎÂÚ›‰È· ÃÔÏËÛÙÂÚfiÏË ÙˆÓ ˘„ËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈÔÚˆÙÂ˚ÓÒÓ ÃÔÏËÛÙÂÚfiÏË ÙˆÓ ¯·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈÔÚˆÙÂ˚ÓÒÓ ∂ηÙÔÛÙÈ·›· ı¤ÛË Odds ratio

∂ÈÛ·ÁˆÁ‹ T· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, ·ÚÎÂÙ¤˜ ÌÂϤÙ˜ Û ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ ηٷ‰ÂÈÎÓ‡Ô˘Ó ÙË Ú·Á‰·›· ÌÂÙ·‚ÔÏ‹ ÙˆÓ ÛˆÌ·ÙÔÌÂÙÚÈÎÒÓ ÙÔ˘˜ ÌÂÁÂıÒÓ, Ô˘ ¤¯ÂÈ ˆ˜ Û˘Ó¤ÂÈ· ÙËÓ ÂȉËÌÈ΋ ¤Í·ÚÛË Ù˘ ·¯˘Û·ÚΛ·˜ (1-3). √ ÂÈÔÏ·ÛÌfi˜ ·˘ÍË̤ÓÔ˘ ‚¿ÚÔ˘˜ Î·È ·¯˘Û·ÚΛ·˜ ·È‰ÈÒÓ ËÏÈΛ·˜ 5-17 ÂÙÒÓ, ˘ÔÏÔÁ›˙ÂÙ·È ·ÁÎÔÛÌ›ˆ˜ ÛÙÔ 10% ÛÙË ‰ÂηÂÙ›· ÙÔ˘ 1990. ∆ËÓ ÚÒÙË ı¤ÛË Î·Ù¤¯Ô˘Ó ÔÈ ∏¶∞ Ì 36% Î·È ·ÎÔÏÔ˘ı› Ë Â˘Úˆ·˚΋ ‹ÂÈÚÔ˜ Ì 20% (1,2,4). √ ·ÈÙÈÔÏÔÁÈÎfi˜ Ì˯·ÓÈÛÌfi˜ Ù˘ ·¯˘Û·ÚΛ·˜ ıˆÚÂ›Ù·È ÔÏ˘·Ú·ÁÔÓÙÈÎfi˜ ·Ó Î·È ‰ÂÓ ¤¯ÂÈ Ï‹Úˆ˜ ηٷÓÔËı›. ∂ÎÙfi˜ ·fi ÙÔÓ ÚˆÙ‡ÔÓÙ· ÚfiÏÔ Ô˘ η٤¯Ô˘Ó Ë ·ÓÈÛÔÚÚÔ›· ÚÔÛÏ·Ì‚·ÓfiÌÂÓ˘ - ηٷӷÏÈÛÎfiÌÂÓ˘ ÂÓ¤ÚÁÂÈ·˜ Î·È Ë ¤ÏÏÂÈ„Ë ÛˆÌ·ÙÈ΋˜ ¿ÛÎËÛ˘, ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ‰È·‰Ú·Ì·Ù›˙Ô˘Ó ÂÚÈ‚·ÏÏÔÓÙÈÎÔ›, ÎÔÈÓˆÓÈÎÔ›, ÔÏÈÙÈÛÌÈÎÔ›, ηıÒ˜ Î·È ‚ÈÔÏÔÁÈÎÔ› ·Ú¿ÁÔÓÙ˜ (2,5). ∏ ÂȉËÌÈ΋ ¤Í·ÚÛË Ù˘ ·¯˘Û·ÚΛ·˜ ¿Ú¯ÈÛ ÙË ‰ÂηÂÙ›· ÙÔ˘ 1960 ÁÈ· ÙÔ˘˜ ÂÓ‹ÏÈΘ Î·È ÙË ‰ÂηÂÙ›· ÙÔ˘ 1980 ÁÈ· Ù· ·È‰È¿ (5). ∏ ·‡ÍËÛË ÙÔ˘ ۈ̷ÙÈÎÔ‡ Ï›Ô˘˜ Û˘Óԉ‡ÂÙ·È ·fi ¿ÏÏÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù·, fiˆ˜ ˘¤ÚÙ·ÛË, ·˘ÍË̤ÓÔ Û¿Î¯·ÚÔ ÔÚÔ‡ ·›Ì·ÙÔ˜ (GLU), ˘ÂÚÏÈȉ·ÈÌ›· ‹ ηÈ

Paediatriki 2007;70:205-216

¯·ÌËÏ‹ HDL ¯ÔÏËÛÙÂÚfiÏË, ÂÓÒ Ô Û˘Ó‰˘·ÛÌfi˜ ÙÔ˘˜ (ÙÚÂȘ ‹ ÂÚÈÛÛfiÙÂÚÔÈ ·Ú¿ÁÔÓÙ˜) ηıÔÚ›˙ÂÈ ÙÔ ÌÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ (ªÂÙ™˘Ó) (6-10). ªÂ ÂӉȷʤÚÔÓ Ù›ıÂÙ·È, ÂÔ̤ӈ˜, ÙÔ ÂÚÒÙËÌ· Â¿Ó Ë ÌÂÙ·‚ÔÏ‹ Ù˘ ·¯˘Û·ÚΛ·˜ ÛÙ· ·È‰È¿ Î·È ÛÙÔ˘˜ ÂÊ‹‚Ô˘˜ Û˘Óԉ‡ÂÙ·È ·fi ·Ó¿ÏÔÁË ÌÂÙ·‚ÔÏ‹ ÛÙ· ÏÈ›‰È· ÔÚÔ‡ ·›Ì·ÙÔ˜, ÛÙÔ GLU Î·È ÛÙËÓ ·ÚÙËÚȷ΋ ›ÂÛË (∞¶). √ J. Eisenmann Û ·Ó·ÛÎfiËÛË, ÙÔ 2003, Û ÌÂϤÙ˜ ·È‰ÈÒÓ ÙˆÓ ∏¶∞ Î·È ÙÔ˘ ∫·Ó·‰¿ (11), ÙÔÓ›˙ÂÈ fiÙÈ “·Ú¿ ÙËÓ ÂȉËÌÈ΋ ·‡ÍËÛË Ù˘ ·¯˘Û·ÚΛ·˜ ÙȘ ÙÂÏÂ˘Ù·›Â˜ ‰ÂηÂٛ˜, ˘¿Ú¯Ô˘Ó ÂӉ›ÍÂȘ ÁÈ· ·ÓÙ›ıÂÙË ·ÏÏ·Á‹ ÛÙ· Â›‰· ÙˆÓ ÏÈȉ›ˆÓ Î·È Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘”. ø˜ ηıÔÚÈÛÙÈ΋ ·Ó·Ê¤ÚÂÈ ÙËÓ Â›‰Ú·ÛË Î·È ¿ÏÏˆÓ ·Ú·ÁfiÓÙˆÓ, fiˆ˜ Ë ÛˆÌ·ÙÈ΋ ¿ÛÎËÛË, Ô Û‡Á¯ÚÔÓÔ˜ ÙÚfiÔ˜ ˙ˆ‹˜, Ë ‰È·ÙÚÔÊ‹, ÙÔ stress Î·È Ë ‰È·Ù·Ú·¯‹ Î·È ·ÔÚ‡ıÌÈÛË ÙÔ˘ ¿ÍÔÓ· ˘Ôı·Ï¿ÌÔ˘-˘fiÊ˘Û˘ Î·È ÂÈÓÂÊÚȉ›ˆÓ. øÛÙfiÛÔ, ÛÙËÓ ÏËı˘ÛÌȷ΋ Ù¿ÛË (secular trend) ÁÈ· ·‡ÍËÛË ÙˆÓ ÛˆÌ·ÙÔÌÂÙÚÈÎÒÓ ÌÂÁÂıÒÓ, Ï·Ì‚¿ÓÔÓÙ·È ˘’ fi„ÈÓ Î·È ¿ÏÏÔÈ ·Ú¿ÁÔÓÙ˜, fiˆ˜ .¯. Ë ÌÂÙ·‚ÔÏ‹ ÛÙȘ ÎÔÈÓˆÓÈÎoÔÈÎÔÓÔÌÈΤ˜ Û˘Óı‹Î˜ Î·È ÛÙÔÓ ÙfiÔ Î·ÙÔÈΛ·˜ (12). ™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‹Ù·Ó Ë ÂÎÙ›ÌËÛË Ù˘ ÌÂÙ·‚ÔÏ‹˜ ÙˆÓ ÛˆÌ·ÙÔÌÂÙÚÈÎÒÓ ÌÂÁÂıÒÓ, Ù˘ ∞¶, ÙÔ˘ GLU Î·È ÙˆÓ ÏÈȉ›ˆÓ ·È‰ÈÒÓ Ù˘ ∫Ú‹Ù˘, ËÏÈΛ·˜ 5-15 ÂÙÒÓ, ÌÂٷ͇ ÙˆÓ ¯ÚÔÓÈÎÒÓ ÂÚÈfi‰ˆÓ 1989-1993 Î·È 19992003, ηıÒ˜ Î·È Ë ÂÎÙ›ÌËÛË Ù˘ ÌÂÙ·‚ÔÏ‹˜ ÙÔ˘ ÂÈÔÏ·ÛÌÔ‡ ÙÔ˘ ªÂÙ™˘Ó.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ¶ÂÚÈÔ¯‹ ÌÂϤÙ˘ ∏ ÌÂϤÙË Ú·ÁÌ·ÙÔÔÈ‹ıËΠ۠·È‰È¿ Ù˘ ∫Ú‹Ù˘ Ô˘ Û˘ÌÌÂÙ›¯·Ó Û ÌÂϤÙ˜ Ù˘ ∫ÏÈÓÈ΋˜ ¶ÚÔÏËÙÈ΋˜ π·ÙÚÈ΋˜ Î·È ¢È·ÙÚÔÊ‹˜, Ù˘ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘. √ ÌfiÓÈÌÔ˜ ÏËı˘ÛÌfi˜ ÙÔ˘ ÓËÛÈÔ‡ ·˘Í‹ıËΠÙË ‰ÂηÂÙ›· ÙÔ˘ 1990 ·fi 540.054 Û 594.368 ηÙÔ›ÎÔ˘˜ ‹ 9,1%. ∆Ô 2001, ÙÔ 46% ÙÔ˘ ÏËı˘ÛÌÔ‡ ‹Ù·Ó ·ÛÙÈÎfi˜,

Pediatri May-Jun 07

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ªÂÙ·‚ÔÏ‹ ۈ̷ÙÔÌÂÙÚ‹ÛˆÓ, ·ÚÙËÚȷ΋˜ ›ÂÛ˘ Î·È ‰ÂÈÎÙÒÓ ÔÚÔ‡ ·›Ì·ÙÔ˜ ·È‰ÈÒÓ

42% ·ÁÚÔÙÈÎfi˜ Î·È 12% ËÌÈ·ÛÙÈÎfi˜. ∆Ô Î·Ù¿ ÎÂÊ·Ï‹Ó ∞∂¶ ÙˆÓ ∫ÚËÙÈÎÒÓ ·˘Í‹ıËΠηٿ 41% (ÛÙÔȯ›· ∂™À∂). ¶ÏËı˘ÛÌfi˜ ÌÂϤÙ˘ ªÂÏÂÙ‹ıËÎ·Ó ‰‡Ô ·ÓÙÈÚÔÛˆ¢ÙÈο ‰Â›ÁÌ·Ù· 1878 ·È‰ÈÒÓ ËÏÈΛ·˜ 5-15 ÂÙÒÓ ·fi fiÏË ÙËÓ ∫Ú‹ÙË. ∆Ô ÚÒÙÔ ‰Â›ÁÌ· ·ÔÙÂÏÔ‡Ó 987 ·È‰È¿ (491 ·ÁfiÚÈ·). ∂ÈϤ¯ıËÎ·Ó ·fi 2785 Ô˘ Û˘ÌÌÂÙ›¯·Ó Û ¤ÍÈ ÌÂϤÙ˜, ÔÈ Ôԛ˜ Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó ·fi ÙËÓ ∫ÏÈÓÈ΋, ηٿ ÙË ¯ÚÔÓÈ΋ ÂÚ›Ô‰Ô 1989-1993 Î·È ·ÊÔÚÔ‡Û·Ó ¶ÚÔÁÚ¿ÌÌ·Ù· ∞ÁˆÁ‹˜ Î·È ¶ÚÔ·ÁˆÁ‹˜ Ù˘ ÀÁ›·˜ ÁÈ· ÙË ÛˆÌ·ÙÈ΋ ·Ó¿Ù˘ÍË Î·È ÙËÓ ÚfiÏË„Ë ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ηډȷÁÁÂȷ΋ ÓfiÛÔ (13-18). ¶·ÚfiÌÔÈ·, Ì ·ÓÙÈÛÙÔ›¯ÈÛË (ˆ˜ ÚÔ˜ ʇÏÔËÏÈΛ·-ÂÚÈÔ¯‹ ηÙÔÈΛ·˜) ÂÈϤ¯ıËΠÙÔ ‰Â‡ÙÂÚÔ ‰Â›ÁÌ· ÙˆÓ 891 ·È‰ÈÒÓ (442 ·ÁfiÚÈ·) ·fi Û‡ÓÔÏÔ 2572 Ô˘ Û˘ÌÌÂÙ›¯·Ó Û ¤ÍÈ ·Ó¿ÏÔÁ˜ ÌÂϤÙ˜, ÔÈ Ôԛ˜ Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó Î·Ù¿ ÙË ¯ÚÔÓÈ΋ ÂÚ›Ô‰Ô 1999-2003 (9,19-21). ∏ ÂÈÏÔÁ‹ ÙÔ˘˜ ÛÙȘ ‰Ò‰Âη ÌÂϤÙ˜ ‹Ù·Ó Ù˘¯·›·-ÔÏ˘ÛÙ·‰È·Î‹. ∞Ú¯Èο, ÂÈϤ¯ıËÎ·Ó Ù˘¯·›· ÔÈ ÂÚÈÔ¯¤˜ ÌÂϤÙ˘ (·ÁÚÔÙÈΤ˜-·ÛÙÈΤ˜-ËÌÈ·ÛÙÈΤ˜) Î·È ÂÓ Û˘Ó¯›·, Ù· Û¯ÔÏ›· ÛÙ· ÔÔ›· ·Ó‹Î·Ó fiÏ· Ù· ·È‰È¿. ∏ ÂÈÏÔÁ‹ ÙÔ˘˜, ˆÛÙfiÛÔ, ÁÈ· ÙË Û˘ÁÎÚfiÙËÛË Î·È ·ÓÙÈÛÙÔ›¯ÈÛË ÙˆÓ ‰‡Ô ‰ÂÈÁÌ¿ÙˆÓ ‹Ù·Ó Ù˘¯·›· Î·È Î·ıÔÚ›ÛÙËΠ·fi ÙË Û‡ÓıÂÛË (ηٿ ʇÏÔ-ËÏÈΛ·ÂÚÈÔ¯‹ ηÙÔÈΛ·˜) ÙÔ˘ ˘ÔÏÔÁÈ˙fiÌÂÓÔ˘ ·È‰ÈÎÔ‡ ÎÚËÙÈÎÔ‡ ÏËı˘ÛÌÔ‡ ËÏÈΛ·˜ 5-15 ÂÙÒÓ, fiˆ˜ ÂÎÙÈÌ‹ıËΠ·fi ÙËÓ ∂™À∂ ÁÈ· Ù· ¤ÙË 1989 Î·È 1999. ªÂÙÚ‹ÛÂȘ √È ÌÂÙÚ‹ÛÂȘ ·ÊÔÚÔ‡Û·Ó ÛÙ· ۈ̷ÙÔÌÂÙÚÈο ÌÂÁ¤ıË, ÙËÓ ∞¶, ηıÒ˜ Î·È ÛÙË Ï‹„Ë ÔÚÔ‡ ·›Ì·ÙÔ˜ ÁÈ· ÙË Ì¤ÙÚËÛË ÙÔ˘ GLU Î·È ÙˆÓ ÏÈȉ›ˆÓ. ∏ Û˘ÌÌÂÙÔ¯‹ ÙˆÓ ·È‰ÈÒÓ ¤ÁÈÓ ÌÂÙ¿ ·fi ¤ÁÁÚ·ÊË Û˘ÁηٿıÂÛË ÙˆÓ ÁÔÓ¤ˆÓ ÙÔ˘˜ Î·È ·ÊÔ‡ ÚÔËÁ‹ıËΠÁÚ·Ù‹ ÂÓË̤ڈÛË ÁÈ· ÙË ‰È·‰Èηۛ· Î·È Ù· ›‰Ë ÙˆÓ ÌÂÙÚ‹ÛˆÓ. √È ÌÂÙÚ‹ÛÂȘ ¤ÁÈÓ·Ó ÛÙ· ηٿ ÙfiÔ˘˜ Û¯ÔÏ›·, ÌÂÙ¿ ·fi Û¯ÂÙÈ΋ ¤ÁÎÚÈÛË ÙˆÓ ¶ÚÔÁÚ·ÌÌ¿ÙˆÓ ∞ÁˆÁ‹˜ Î·È ¶ÚÔ·ÁˆÁ‹˜ Ù˘ ÀÁ›·˜ Î·È ÙˆÓ ·ÍÈÔÏÔÁ‹ÛÂÒÓ ÙÔ˘˜ ·fi ÙÔ ¶·È‰·ÁˆÁÈÎfi πÓÛÙÈÙÔ‡ÙÔ Î·È ÙÔ ÀÔ˘ÚÁÂ›Ô ¶·È‰Â›·˜. ŒÁÎÚÈÛË, Â›Û˘, ÚÔËÁ‹ıËÎÂ Î·È ·fi ÙËÓ ∂ÈÙÚÔ‹ ∏ıÈ΋˜ Î·È ¢ÂÔÓÙÔÏÔÁ›·˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘. ™ˆÌ·ÙÔÌÂÙÚ‹ÛÂȘ √È ÛˆÌ·ÙÔÌÂÙÚ‹ÛÂȘ ·ÊÔÚÔ‡Û·Ó ÛÙÔ ‚¿ÚÔ˜, ÙÔ ‡„Ô˜, ÙȘ ‰ÂÚÌ·ÙÈΤ˜ Ù˘¯¤˜ ˆÌÔÏ¿Ù˘, Ï·ÁÔÓ›Ô˘, ‰ÈÎÂÊ¿ÏÔ˘, ÙÚÈÎÂÊ¿ÏÔ˘ Î·È ÛÙËÓ ÂÚ›ÌÂÙÚÔ ·ÚÈÛÙÂÚÔ‡ ‚Ú·¯›ÔÓ· (¶∞µ), ÂÓÒ ˘ÔÏÔÁ›ÛÙËÎÂ Ô ¢ª™ Î·È ÙÔ ¿ıÚÔÈÛÌ· ÙˆÓ 4 ‰ÂÚÌ·ÙÈÎÒÓ Ù˘¯ÒÓ. ¶Ï‹Ú˘ ÂÚÈÁÚ·Ê‹ ÙˆÓ ÌÂıfi‰ˆÓ-ÌÂÙÚ‹ÛÂˆÓ ·Ó·Ê¤ÚÂÙ·È Û ÚÔËÁÔ‡ÌÂÓ˜ ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ÌÂϤÙ˜ (9,19,20). °È· ÙÔÓ Î·ıÔÚÈÛÌfi ÙˆÓ ˘¤Ú‚·ÚˆÓ Î·È ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ, ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó Ù· ηٿ ʇÏÔ Î·È ËÏÈΛ· fiÚÈ·, fiˆ˜ ÔÚ›˙ÔÓÙ·È ·fi ÙÔÓ International Obesity Task Force (IOTF) (1). √ ·ÚÈıÌfi˜ ÙˆÓ ·È‰ÈÒÓ Ô˘ ÌÂÙÚ‹ıËÎ·Ó ‰È·Ê¤ÚÂÈ ·fi ̤ÙÚËÛË Û ̤ÙÚËÛË. øÛÙfiÛÔ, Ë Û˘ÌÌÂÙÔ¯‹ ÚÔÛÂÁÁ›˙ÂÈ ÙÔ 99% Î·È ÛÙȘ ‰‡Ô ¯ÚÔÓÈΤ˜ ÂÚÈfi‰Ô˘˜, Ì ÂÍ·›ÚÂÛË ÙË Ì¤ÙÚËÛË ÙˆÓ ‰ÂÚÌ·ÙÈÎÒÓ Ù˘¯ÒÓ. ŸÛ· ·È‰È¿ ›¯·Ó ̤ÙÚËÛË ¶∞µ ›¯·Ó ÌÂÙÚËı› Û ÙÔ˘Ï¿¯ÈÛÙÔÓ Ì›· ·fi ÙȘ ‰ÂÚÌ·ÙÈΤ˜ Ù˘¯¤˜. ª¤ÙÚËÛË ·ÚÙËÚȷ΋˜ ›ÂÛ˘ ·›Ì·ÙÔ˜ ∏ ∞¶ ÌÂÙÚ‹ıËΠ۠928 ·È‰È¿ (94%) ÙÔ 1989-1993 Î·È Û 563 ·È‰È¿ (63%) ÙÔ 1999-2003, Û ηıÈÛÙ‹ ı¤ÛË Î·È ÌÂÙ¿ ·fi ·Ó¿·˘ÛË 5-10 ÏÂÙÒÓ. ∏ ̤ÙÚËÛË ¤ÁÈÓ Ì ˘‰Ú·Ú-

Á˘ÚÈÎfi ÛÊ˘ÁÌÔÌ·ÓfiÌÂÙÚÔ Î·Ù¿ÏÏËÏÔ Û ̤ÁÂıÔ˜ ÂÚȯÂÈÚ›‰Ô˜, ηχÙÔÓÙ·˜ ÙÔ 50-75% Ù˘ ÂÚÈ̤ÙÚÔ˘ ÙÔ˘ ‰ÂÍÈÔ‡ ‚Ú·¯›ÔÓ·. O ÚÒÙÔ˜ Î·È ¤ÌÙÔ˜ ÙfiÓÔ˜ Korotkoff ·ÔÙ¤ÏÂÛ·Ó ÙË Û˘ÛÙÔÏÈ΋ (™∞¶) Î·È ‰È·ÛÙÔÏÈ΋ (¢∞¶) ∞¶, ·ÓÙ›ÛÙÔȯ·. ∞˘Ù¤˜ ÌÂÙÚ‹ıËÎ·Ó ÙÚÂȘ ÊÔÚ¤˜ Ì ÌÂÛԉȿÛÙËÌ· ÂÓfi˜ Ì ‰‡Ô ÏÂÙÒÓ Î·È ÂÎÙÈÌ‹ıËÎÂ Ô Ì¤ÛÔ˜ fiÚÔ˜, fiˆ˜ ÔÚ›˙ÂÙ·È ÛÙÔ ÚˆÙfiÎÔÏÏÔ MONICA (9,21). ø˜ ·ıÔÏÔÁÈο fiÚÈ· ÂÏ‹ÊıËÛ·Ó ÔÈ Î·Ù¿ ʇÏÔ-ËÏÈΛ· 90¤˜ ÂηÙÔÛÙÈ·›Â˜ ı¤ÛÂȘ (∂.£.) Ù˘ ™∞¶ Î·È ¢∞¶, Ô˘ ·ÓÙÈÛÙÔÈ¯Ô‡Ó ÛÙËÓ 50‹ ∂.£. ÙÔ˘ ‡„Ô˘˜ ·È‰ÈÒÓ ÙˆÓ ∏¶∞ (23). §‹„Ë ·›Ì·ÙÔ˜ Î·È ‚ÈÔ¯ËÌÈΤ˜ ·Ó·Ï‡ÛÂȘ ∏ ·ÈÌÔÏË„›· Ú·ÁÌ·ÙÔÔÈ‹ıËΠÚˆÈÓ¤˜ ÒÚ˜, ÌÂÙ¿ ·fi 12ˆÚË ÓËÛÙ›· Î·È Û ‡ÙÈ· ı¤ÛË. ¢Â›ÁÌ·Ù· ·›Ì·ÙÔ˜ ÙˆÓ 10 ml ÂÏ‹ÊıËÛ·Ó Û ۈÏËÓ¿ÚÈ· ¯ˆÚ›˜ ·ÓÙÈËÎÙÈÎfi ÁÈ· ÙÔÓ ‰È·¯ˆÚÈÛÌfi ÙÔ˘ ÔÚÔ‡. ∞̤ۈ˜ ÌÂÙ¿, ÁÈ· ÙË Û˘ÓÙ‹ÚËÛ‹ ÙÔ˘˜ Û ¯·ÌËÏ‹ ıÂÚÌÔÎÚ·Û›· (3-4ÔC), ÙÔÔıÂÙ‹ıËÎ·Ó Û ÊÔÚËÙfi „˘ÁÂ›Ô Ì ·ÁÔ·ÛÙ˜ Î·È ÌÂٷʤÚıËÎ·Ó ÂÓÙfi˜ 4 ˆÚÒÓ ÛÙ· ÂÚÁ·ÛÙ‹ÚÈ· Ù˘ ∫ÏÈÓÈ΋˜ (9,17-20). ∆Ô GLU ÌÂÙÚ‹ıËΠ۠410 ·È‰È¿ (42%) ÙÔ 1989-1993 Î·È Û 633 ·È‰È¿ (71%) ÙÔ 1999-2003, ÂÓÒ Ù· ÏÈ›‰È·: ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË (TC), ÙÚÈÁÏ˘ÎÂÚ›‰È· (TG), HDL-C, LDL-C Î·È Ë ÂÎÙ›ÌËÛË ÙÔ˘ ·ıËڈ̷ÙÈÎÔ‡ ‰Â›ÎÙË TC:HDL-C, Û 591 ·È‰È¿ (60%) ÙÔ 1989-1993 Î·È Û 826 ·È‰È¿ (93%) ÙÔ 1999-2003. ø˜ ·ıÔÏÔÁÈο fiÚÈ· ÂÏ‹ÊıËÛ·Ó Ù· 100 mg/dl ÛÙÔ GLU (6), Ù· 180 Î·È 200 mg/dl ÛÙËÓ TC, Ù· 110 Î·È 130 mg/dl ÛÙËÓ LDL-C Î·È ÙÔ 4,00 ÛÙÔÓ ‰Â›ÎÙË TC:HDL-C. ™Ù· TG Î·È ÙËÓ HDL-C ÂÏ‹ÊıËÛ·Ó ÔÈ Î·Ù¿ ʇÏÔ-ËÏÈΛ· 90‹ & 10Ë ∂.£. ·ÓÙ›ÛÙÔȯ·, 6000 ÂÚ›Ô˘ ÌÂÙÚ‹ÛÂˆÓ Û ·È‰È¿ Ù˘ ∫Ú‹Ù˘ (9). ™ÙËÓ ÂÎÙ›ÌËÛË Ù˘ Û˘ÁΤÓÙÚˆÛ˘ ·Ú·ÁfiÓÙˆÓ ªÂÙ™˘Ó ÂÚÈÂÏ‹ÊıËÛ·Ó ¤ÓÙ ‰Â›ÎÙ˜, fiˆ˜: ¢ª™ (·¯˘Û·ÚΛ·), ∞¶ (™∞¶ ‹/Î·È ¢∞¶ ≥90‹ ∂.£.), GLU (≥100 mg/dl), TG (≥90‹ ∂.£.) Î·È HDL-C (≤10Ë ∂.£.). ™Ù·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË °È· ÙËÓ ·Ó¿Ï˘ÛË ÙˆÓ ‰Â‰Ô̤ӈÓ, ÂÎÙfi˜ ·fi ÙË ÛÙڈ̷ÙÔÔÈË̤ÓË Ù˘¯·›· ÂÈÏÔÁ‹ ÙˆÓ ·È‰ÈÒÓ Û οı ÂÚ›Ô‰Ô (ηٿ ʇÏÔ-ËÏÈΛ·-ÂÚÈÔ¯‹ ηÙÔÈΛ·˜), ·ÎÔÏÔ‡ıËÛ ËÏÈÎȷ΋ ÔÌ·‰ÔÔ›ËÛË Î·È ¤ÏÂÁ¯Ô˜ ·˘ÙÒÓ ÙˆÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ÙˆÓ ·È‰ÈÒÓ, ÌÂٷ͇ ÙˆÓ ‰‡Ô ‰ÂÈÁÌ¿ÙˆÓ. ∏ ÔÌ·‰ÔÔ›ËÛË ·ÊÔÚÔ‡Û ÛÙȘ ËÏÈ˘ 5-9,9 ÂÙÒÓ Î·È 10-15 ÂÙÒÓ Î·È ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÔÈ Ì¤ıÔ‰ÔÈ Student t Î·È χ2 (¶›Ó·Î·˜ 1). ªÂٷ͇ ÙˆÓ ¯ÚÔÓÈÎÒÓ ÂÚÈfi‰ˆÓ ‰ÂÓ ‚Ú¤ıËΠÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙËÓ Î·Ù·ÓÔÌ‹ ÙˆÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ÙˆÓ ÂÈÏÂÁÌ¤ÓˆÓ ·È‰ÈÒÓ, ·Ú¿ ÌfiÓÔ ÛÙËÓ ÂÚÈÔ¯‹ ηÙÔÈΛ·˜ ÙÔ˘˜ (·ÁÚÔÙÈ΋: 47,8% ¤Ó·ÓÙÈ 42,9%, ·ÓÙ›ÛÙÔȯ·, p=0,011), ηıÒ˜ ·ÏÏ¿˙ÂÈ ‰È·¯ÚÔÓÈο Ë Î·Ù·ÓÔÌ‹ ÙÔ˘ Û˘ÓÔÏÈÎÔ‡ ÏËı˘ÛÌÔ‡ ˆ˜ ÚÔ˜ ÙËÓ ÂÚÈÔ¯‹ ηÙÔÈΛ·˜. ªÂ ÙȘ ›‰È˜ ÌÂıfi‰Ô˘˜ ÂϤÁ¯ıËÎ·Ó ·ÎfiÌË ÔÈ Î·Ù·ÓÔ̤˜ ˆ˜ ÚÔ˜ ʇÏÔ-ËÏÈΛ·-ÂÚÈÔ¯‹ ηÙÔÈΛ·˜ (·ÔÙÂϤÛÌ·Ù· ‰ÂÓ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Û ›Ó·Î·) ÁÈ· Ù· ·È‰È¿ Ô˘ ›¯·Ó ÏÈÁfiÙÂÚ˜ ÌÂÙÚ‹ÛÂȘ (ÌÈÎÚfi Ú˘ıÌfi Û˘ÌÌÂÙÔ¯‹˜). ¢ÂÓ ‚Ú¤ıËηÓ, ˆÛÙfiÛÔ, ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÛÙËÓ Î·Ù·ÓÔÌ‹ ÙÔ˘˜. ªÂ ÙË Ì¤ıÔ‰Ô Student t (equal variances not assumed) ÂϤÁ¯ıËÎ·Ó ·ÎfiÌË ÔÈ ÌÂÙ·‚ÔϤ˜ ÙˆÓ ÌÂÙÚ‹ÛÂˆÓ Û οı ʇÏÔ, ÌÂٷ͇ ÙˆÓ ‰‡Ô ¯ÚÔÓÈÎÒÓ ÂÚÈfi‰ˆÓ. ªÂ ÙË χ2 ÂϤÁ¯ıËΠÛÙȘ ‰‡Ô ÂÚÈfi‰Ô˘˜ Ô ÂÈÔÏ·ÛÌfi˜ Ù˘ ·¯˘Û·ÚΛ·˜ Î·È ÙˆÓ ˘„ËÏÒÓ ÂÈ¤‰ˆÓ Ù˘ ∞¶, ÙÔ˘ GLU Î·È ÙˆÓ ÏÈȉ›ˆÓ. ªÂ ÙËÓ ·Ó¿Ï˘ÛË ÏÔÁÈÛÙÈ΋˜ ·ÏÈÓ‰ÚfiÌËÛ˘ (logistic linear regression) ˘ÔÏÔÁ›ÛÙËÎ·Ó ÔÈ ‰Â›ÎÙ˜ Û¯ÂÙÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘ (Odds ratio) Î·È Ù· 95% ‰È·ÛÙ‹Ì·Ù· ÂÌÈÛÙÔÛ‡Ó˘ ÛÙȘ ‰‡Ô ¶·È‰È·ÙÚÈ΋ 2007;70:205-216

Pediatri May-Jun 07

24-05-07

17:58

™ÂÏ›‰·208

208

ª. §ÈÓ·Ú‰¿Î˘ Î·È Û˘Ó.

¶›Ó·Î·˜ 1. ÷ڷÎÙËÚÈÛÙÈο Î·È ‰È·ÊÔÚ¤˜ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ÙˆÓ 1878 ·È‰ÈÒÓ Ù˘ ∫Ú‹Ù˘, ËÏÈΛ·˜ 5 ¤ˆ˜ 15 ÂÙÒÓ, ÛÙȘ ÂÚÈfi‰Ô˘˜ 1989-1993 Î·È 1999-2003 1989-1993

1999-2003 N (%)

p-value*

∞ÁfiÚÈ· ∫ÔÚ›ÙÛÈ·

491 (49,7) 496 (50,3)

442 (49,6) 449 (50,4)

0,952

5,0-9,9 ÂÙÒÓ 10,0-15,0 ÂÙÒÓ

458 (46,4) 429 (53,6)

383 (43,0) 508 (57,0)

0,137

∞ÁÚÔÙÈ΋ ∏ÌÈ·ÛÙÈ΋ ∞ÛÙÈ΋

472 (47,8) 66 (6,7) 449 (46,5)

382 (42,9) 89 (10,0) 420 (47,1)

0,011

ª¤ÛË ËÏÈΛ· ± ∆∞ (¡) ∏ÏÈΛ· (¤ÙË)

∞ÁfiÚÈ· ∫ÔÚ›ÙÛÈ·

p-value**

10,4±2,7 (491) 10,4±2,8 (496)

10,5±2,7 (442) 10,5±2,9 (449)

0,298 0,330

10,4±2,8 (987)

10,5±2,8 (891)

0,609

5,0-9,9

∞ÁfiÚÈ· ∫ÔÚ›ÙÛÈ·

7,8±1,5 (224) 7,8±1,4 (234)

7,8±1,6 (183) 7,7±1,5 (200)

0,809 0,523

10,0-15,0

∞ÁfiÚÈ· ∫ÔÚ›ÙÛÈ·

12,6±1,1 (267) 12,7±1,3 (262)

12,5±1,3 (259) 12,7±1,4 (249)

0,471 0,954

™‡ÓÔÏÔ

* ŒÏÂÁ¯Ô˜ χ2, ** ŒÏÂÁ¯Ô˜ Student t

ÂÚÈfi‰Ô˘˜, ÁÈ· ·ÁfiÚÈ· Î·È ÎÔÚ›ÙÛÈ· Ì ·˘ÍË̤ӷ Â›‰· ¢ª™, ·ÚÙËÚȷ΋˜ ›ÂÛ˘, GLU Î·È ÏÈȉ›ˆÓ Î·È ÌÂ Û˘ÌÌÂÙ·‚ÏËÙ‹ ÂϤÁ¯Ô˘ ÙËÓ ËÏÈΛ·. ªÂ ÙË ¯Ú‹ÛË ÔÏ˘ˆÓ˘ÌÈÎÔ‡ ÌÔÓÙ¤ÏÔ˘ 3Ô˘ ‚·ıÌÔ‡ ·ÂÈÎÔÓ›ÛÙËΠ۠ÙÚÈۉȿÛÙ·ÙË ÌÔÚÊ‹ Ì ÙËÓ ·‡ÍËÛË Ù˘ ËÏÈΛ·˜, Ë Û˘Û¯¤ÙÈÛË ÙÔ˘ ¢ª™ Ì ÙËÓ TC Î·È HDL-C. ∆¤ÏÔ˜, Ì ÙÔ ‰È¿ÁÚ·ÌÌ· ladder ·ÂÈÎÔÓ›ÛÙËÎÂ Ë Û¯ÂÙÈ΋ ÌÂÙ·‚ÔÏ‹ ÌÂٷ͇ ÙˆÓ ‰‡Ô ÂÚÈfi‰ˆÓ ÙÔ˘ ÂÈÔÏ·ÛÌÔ‡ ÙˆÓ ˘„ËÏÒÓ ÂÈ¤‰ˆÓ: ÙÔ˘ ¢ª™, Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘, ÙÔ˘ GLU Î·È ÙˆÓ ÏÈȉ›ˆÓ.

∞ÔÙÂϤÛÌ·Ù· ªÂٷ͇ ÙˆÓ ÂÚÈfi‰ˆÓ 1989-1993 Î·È 1999-2003, ÙÔ ‚¿ÚÔ˜ ÙˆÓ ·ÁÔÚÈÒÓ (¶›Ó·Î·˜ 2) ·˘Í‹ıËΠηٿ 4,3 kg ‹ 11,4% (p<0,001), ÙÔ ‡„Ô˜ ηٿ 4 cm ‹ 2,9% (p<0,001), Ô ¢ª™ ηٿ 0,92 kg/m2 ‹ 4,9% (p<0,001), ÙÔ ∞¢¶ ηٿ 12,2 mm (p<0,001) Î·È Ë ¶∞µ ηٿ 1,8 mm (p<0,001). ∏ ™∞¶ ·˘Í‹ıËΠηٿ 6,7 mmHg (p<0,001) ÛÙȘ ËÏÈ˘ 10,0-15,0 ÂÙÒÓ, ÂÓÒ ÌÂÈÒıËÎ·Ó Ë ¢∞¶ ηٿ 8,9 mmHg (p<0,001), ÙÔ GLU ηٿ 2,9 mg/dl (p<0,001) Î·È Ë LDL-C ηٿ 4,4 mg/dl (p=0,036). ™Ù· ÎÔÚ›ÙÛÈ· (¶›Ó·Î·˜ 3) ÙÔ ‚¿ÚÔ˜ ·˘Í‹ıËΠηٿ 3,6 kg ‹ 9,4% (p<0,001), ÙÔ ‡„Ô˜ ηٿ 2,5 cm ‹ 1,8% (p<0,001), Ô ¢ª™ ηٿ 1,02 kg/m2 ‹ 5,4% (p<0,001), ÙÔ ∞¢¶ ηٿ 14,2 mm (p<0,001) Î·È Ë ¶∞µ ηٿ 1,5 mm (p<0,001). ∏ ™∞¶ ·˘Í‹ıËΠηٿ 2,5 mmHg (p=0,020), ÂÓÒ Ì›ˆÛË - fiˆ˜ ÛÙ· ·ÁfiÚÈ· - ‚Ú¤ıËΠÛÙË ¢∞¶ 5,6 mmHg (p=0,020) Î·È ÛÙÔ GLU 4,1 mg/dl (p<0,001). √ ÂÈÔÏ·ÛÌfi˜ ÙˆÓ ˘¤Ú‚·ÚˆÓ ·ÁÔÚÈÒÓ (¶›Ó·Paediatriki 2007;70:205-216

η˜ 4) ·˘Í‹ıËΠηٿ 18,8% ·fi ÙÔ 1989-1993 ÛÙÔ 1999-2003 Î·È Î·Ù¿ 82% ÙˆÓ ·¯‡Û·ÚÎˆÓ (·fi 20,7% Û 24,6% Î·È ·fi 5,0% Û 9,1%, ·ÓÙ›ÛÙÔȯ·, p=0,011) Î·È ÛÙ· ÎÔÚ›ÙÛÈ· ηٿ 13,8% Î·È 96,6%, ·ÓÙ›ÛÙÔȯ· (·fi 21,8 Û 24,8% Î·È ·fi 5,9 Û 11,6%, ·ÓÙ›ÛÙÔȯ·, p=0,002). ™˘ÓÔÏÈο, Ô ÂÈÔÏ·ÛÌfi˜ ˘¤Ú‚·ÚˆÓ ·È‰ÈÒÓ ·˘Í‹ıËΠ·fi 21,3% Û 24,7% (p<0,001) Î·È ÙˆÓ ·¯‡Û·ÚÎˆÓ ·fi 5,4% ÛÙÔ 10,4% (p<0,001). ∆· ÔÛÔÛÙ¿ ·ÁÔÚÈÒÓ Î·È ÎÔÚÈÙÛÈÒÓ Ì ˘„ËÏ‹ ™∞¶ ·˘Í‹ıËÎ·Ó Î·Ù¿ 48,4% (p=0,001) Î·È 72,2% (p<0,001), ÂÓÒ ÌÂÈÒıËÎ·Ó ÛÙË ¢∞¶ ηٿ 57,5% (p<0,001) Î·È 28,9% (p<0,001), ·ÓÙ›ÛÙÔȯ·. ™ËÌ·ÓÙÈ΋ Ì›ˆÛË ‚Ú¤ıËÎÂ Î·È ÛÙ· ÎÔÚ›ÙÛÈ· Ì LDL-C ÌÂٷ͇ 111-130 mg/dl (Ì›ˆÛË Î·Ù¿ 30,4%, p=0,015). ∂›Û˘, fiÏ· Ù· ·È‰È¿ ·Ú¤ÌÂÈÓ·Ó Ì ·˘ÍË̤ÓË TC ÛÙÔ 15,9% (p>0,05), ÂÓÒ ÂÎÂ›ÓˆÓ Ì ·˘ÍË̤ÓË LDL-C ÌÂÈÒıËÎ·Ó ·fi 18,8% Û 17,1% (p=0,006), ·ÓÙ›ÛÙÔȯ· (·ÔÙÂϤÛÌ·Ù· ‰ÂÓ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÙÔÓ ›Ó·Î·). ™ÙÔÓ Û˘Ó‰˘·ÛÌfi ·Ú·ÁfiÓÙˆÓ ÙÔ˘ ªÂÙ™˘Ó, ‰ÂÓ ‚Ú¤ıËΠÛËÌ·ÓÙÈ΋ ÌÂÙ·‚ÔÏ‹ ÛÙÔ ÔÛÔÛÙfi ÙˆÓ ·È‰ÈÒÓ Ì ÙÚÂȘ ‹ ÂÚÈÛÛfiÙÂÚÔ˘˜ ·Ú¿ÁÔÓÙ˜. ™˘ÁÎÂÎÚÈ̤ӷ, ÙÔ 4,5% fiÏˆÓ ÙˆÓ ·È‰ÈÒÓ ‚Ú¤ıËΠÙÔ 1989-1993 Ì ªÂÙ™˘Ó ¤Ó·ÓÙÈ 5,6% ÙÔ 1999-2003. ∆¤ÏÔ˜, ÛÙÔÓ ¶›Ó·Î· 5 ÔÈ ‰Â›ÎÙ˜ Û¯ÂÙÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘ (Odds Ratio) ¤‰ÂÈÍ·Ó ÁÈ· ÙËÓ ÂÚ›Ô‰Ô 19992003 Û ۯ¤ÛË Ì ÙËÓ ÂÚ›Ô‰Ô 1989-1993, Ù· ·ÁfiÚÈ· Ó· ¤¯Ô˘Ó 2,06 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚÔ Î›Ó‰˘ÓÔ ÁÈ·

Pediatri May-Jun 07

24-05-07

17:58

™ÂÏ›‰·209

209

ªÂÙ·‚ÔÏ‹ ۈ̷ÙÔÌÂÙÚ‹ÛˆÓ, ·ÚÙËÚȷ΋˜ ›ÂÛ˘ Î·È ‰ÂÈÎÙÒÓ ÔÚÔ‡ ·›Ì·ÙÔ˜ ·È‰ÈÒÓ

¶›Ó·Î·˜ 2. ∂›‰· ۈ̷ÙÔÌÂÙÚÈÎÒÓ ÌÂÁÂıÒÓ, ·ÚÙËÚȷ΋˜ ›ÂÛ˘ Î·È ÏÈȉ›ˆÓ ÔÚÔ‡ ·›Ì·ÙÔ˜ ·ÁÔÚÈÒÓ Ù˘ ∫Ú‹Ù˘, ËÏÈΛ·˜ 5-15 ÂÙÒÓ, ÌÂٷ͇ ÙˆÓ ¯ÚÔÓÈÎÒÓ ÂÚÈfi‰ˆÓ 1989-1993 Î·È 1999-2003 1989-1993 ª¤ÙÚËÛË

∏ÏÈΛ·

µ¿ÚÔ˜ (kg)

5,0-9,9 10,0-15,0 ™‡ÓÔÏÔ

⁄„Ô˜ (cm)

5,0-9,9 10,0-15,0 ™‡ÓÔÏÔ

¢ª™ (kg/m2)

5,0-9,9 10,0-15,0 ™‡ÓÔÏÔ

∞¢¶ (mm)

5,0-9,9 10,0-15,0 ™‡ÓÔÏÔ

¶∞µ (mm)

5,0-9,9 10,0-15,0 ™‡ÓÔÏÔ

™∞¶ (mmHg)

5,0-9,9 10,0-15,0 ™‡ÓÔÏÔ

¢∞¶ (mmHg)

5,0-9,9 10,0-15,0 ™‡ÓÔÏÔ

GLU (mg/dl)

5,0-9,9 10,0-15,0 ™‡ÓÔÏÔ

TC (mg/dl)

5,0-9,9 10,0-15,0 ™‡ÓÔÏÔ

TG (mg/dl)

5,0-9,9 10,0-15,0

™‡ÓÔÏÔ HDL-C (mg/dl)

5,0-9,9 10,0-15,0

™‡ÓÔÏÔ LDL-C (mg/dl)

5,0-9,9 10,0-15,0

™‡ÓÔÏÔ ¢Â›ÎÙ˘ TC:HDL ™‡ÓÔÏÔ

5,0-9,9 10,0-15,0

1999-2003

¡

ª¤ÛË ÙÈÌ‹ (∆∞)

¡

ª¤ÛË ÙÈÌ‹ (∆∞)

220 259 479 220 258 478 220 258 478 131 170 301 200 181 381 208 256 464 208 256 464 45 162 207 102 188 290 97 171 268 101 187 288 102 188 290 101 187 288

27,7 (6,4) 46,4 (11,5) 37,8 (13,4) 126,8 (9,8) 151,6 (9,3) 140,2 (15,6) 17,07 (2,49) 20,01 (3,49) 18,66 (3,39) 33,6 (18,5) 43,5 (23,8) 39,2 (22,2) 19,3 (2,3) 22,9 (3,7) 21,0 (3,5) 105,1 (10,9) 111,8 (11,7) 108,8 (11,8) 71,8 (10,9) 74,0 (9,3) 73,0 (10,1) 85,0 (10,8) 91,8 (7,7) 90,3 (8,9) 175,5 (29,5) 171,2 (31,3) 172,7 (30,7) 61,5 (30,1) 66,1 (32,5) 64,5 (31,7) 53,3 (13,4) 52,9 (12,6) 53,0 (12,9) 110,9 (28,7) 106,6 (28,6) 108,0 (28,6) 3,47 (0,97) 3,40 (1,00) 3,43 (0,99)

181 258 439 181 258 439 181 258 439 181 258 439 181 258 439 128 135 263 128 135 263 163 148 311 166 241 407 166 241 407 166 241 407 166 241 407 166 241 407

30,2 (9,3) 50,6 (13,0) 42,2 (15,4) 128,1 (10,3) 155,4 (12,4) 144,2 (17,8) 18,00 (3,23) 20,69 (3,65) 19,58 (3,72) 47,5 (24,2) 54,3 (28,9) 51,5 (27,3) 20,4 (3,3) 24,4 (3,4) 22,8 (3,9) 102,7 (15,8) 118,5 (11,0) 110,8 (15,6) 65,1 (11,0) 63,1 (12,9) 64,1 (12,0) 87,1 (8,8) 87,6 (9,7) 87,4 (9,2) 172,8 (25,6) 166,2 (29,4) 168,9 (20,1) 55,7 (21,0) 66,2 (29,0) 61,9 (26,6) 54,3 (11,8) 51,4 (13,3) 52,6 (12,8) 107,1 (23,6) 101,5 (25,3) 103,7 (24,8) 3,30 (0,81) 3,40 (0,89) 3,36 (0,86)

ªÂÙ·‚ÔÏ‹ p-value 2,5 4,2 4,3 1,3 3,9 4,0 0,93 0,67 0,92 13,9 10,8 12,2 1,2 1,6 1,8 -2,4 6,7 2,0 -6,7 -10,9 -8,9 2,1 -4,2 -2,9 -2,7 -5,0 -3,8 -5,9 0,1 -2,6 1,0 -1,5 -0,4 -3,6 -2,6 -4,4 -0,13 0,00 -0,07

0,003 <0,001 <0,001 0,187 <0,001 <0,001 0,002 0,033 <0,001 <0,001 <0,001 <0,001 <0,001 <0,001 <0,001 0,129 <0,001 0,070 <0,001 <0,001 <0,001 0,229 <0,001 <0,001 0,445 0,093 0,094 0,091 0,989 0,270 0,530 0,250 0,673 0,254 0,054 0,036 0,146 0,932 0,340

Student t test (equal variances not assumed)

·¯˘Û·ÚΛ· (95% ¢∂: 1,21-3,49, p=0,008) Î·È Ù· ÎÔÚ›ÙÛÈ· 2,31 ÊÔÚ¤˜ (95% ¢∂: 1,42-3,76, p=0,001). √ ΛӉ˘ÓÔ˜ ÁÈ· ˘„ËÏ‹ ™∞¶ ‚Ú¤ıËΠ1,81 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚÔ˜ ÛÙ· ·ÁfiÚÈ· (p<0,001) Î·È 2,39 ÛÙ· ÎÔÚ›ÙÛÈ· (p<0,001). ∞ÓÙ›ıÂÙ·, ÌÂȈ̤ÓË Èı·ÓfiÙËÙ· ÁÈ· ˘„ËÏ‹ ¢∞¶ ‚Ú¤ıËΠηٿ 75% ÛÙ· ·ÁfiÚÈ· (p<0,001) Î·È 46% ÛÙ· ÎÔÚ›ÙÛÈ· (p<0,001). ∂›Û˘, ÌÂȈ̤ÓË Èı·ÓfiÙËÙ· ÁÈ· ˘„ËÏ¿ Â›‰· GLU ‚Ú¤ıËΠÙÔ 1999-2003 ÛÙ· ÎÔÚ›ÙÛÈ· ηٿ 56% (p=0,025). ∂ÈϤÔÓ, Ù· ·ÁfiÚÈ· Ù˘ ÂÚÈfi‰Ô˘ 1999-2003 ‚Ú¤ıËÎ·Ó Û ۯ¤ÛË Ì ÂΛӷ Ù˘ 1989-1993, ÌÂ

ÌÂȈ̤ÓË Èı·ÓfiÙËÙ· ηٿ 57% (p=0,098) Ó· ·Ó·Ù‡ÍÔ˘Ó ªÂÙ™˘Ó, ÂÓÒ ÛÙ· ÎÔÚ›ÙÛÈ· Ô Î›Ó‰˘ÓÔ˜ ‹Ù·Ó 2,69 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚÔ˜ (p=0,064). ∆Ô 19891993 ÌfiÏȘ ÙÔ 14,3% ÙˆÓ ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ ‚Ú¤ıËΠ̠ªÂÙ™˘Ó, ÂÓÒ ÙÔ 1999-2003 ÙÔ 37,3% (p<0,001) (·ÔÙÂϤÛÌ·Ù· ‰ÂÓ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÙÔÓ ›Ó·Î·). ∂ÈϤÔÓ, ÛÙ· ·¯‡Û·Úη ·È‰È¿ Ô Î›Ó‰˘ÓÔ˜ Ó· ·Ó·Ù‡ÍÔ˘Ó ªÂÙ™˘Ó ‹Ù·Ó 3,89 ÙÔ 1989-1993 (95% ¢∂: 0,38-20,15, p>0,05), ηıÒ˜ ÙÔ 1999-2003 ·˘Í‹ıËΠÂÙ¿ ÊÔÚ¤˜ Î·È ·Ó‹Ïı ÛÙÔ 27,08 (95% ¢∂: 10,77-69,99, p<0,001). ¶·È‰È·ÙÚÈ΋ 2007;70:205-216

Pediatri May-Jun 07

24-05-07

17:58

™ÂÏ›‰·210

210

ª. §ÈÓ·Ú‰¿Î˘ Î·È Û˘Ó.

¶›Ó·Î·˜ 3. ∂›‰· ۈ̷ÙÔÌÂÙÚÈÎÒÓ ÌÂÁÂıÒÓ, ·ÚÙËÚȷ΋˜ ›ÂÛ˘ Î·È ÏÈȉ›ˆÓ ÔÚÔ‡ ·›Ì·ÙÔ˜ ÎÔÚÈÙÛÈÒÓ Ù˘ ∫Ú‹Ù˘, ËÏÈΛ·˜ 5-15 ÂÙÒÓ, ÌÂٷ͇ ÙˆÓ ¯ÚÔÓÈÎÒÓ ÂÚÈfi‰ˆÓ 1989-1993 Î·È 1999-2003 1989-1993 ª¤ÙÚËÛË

∏ÏÈΛ·

µ¿ÚÔ˜ (kg)

27,8 (7,5)

198

30,4 (7,4)

2,6

0,004

47,9 (10,8) 38,2 (13,7) 126,7 (9,8) 152,1 (8,3) 139,8 (15,6) 17,07 (2,75) 20,55 (3,57) 18,87 (3,64) 34,0 (20,3) 50,6 (21,0) 44,5 (21,8) 19,7 (20,9) 23,4 (3,1) 21,4 (3,5) 103,9 (11,1) 111,0 (11,3) 107,7 (11,8) 69,7 (10,3) 75,8 (7,9) 72,9 (9,6) 83,6 (10,1) 91,4 (8,6) 89,2 (9,7) 180,4 (32,2) 170,4 (28,6) 174,3 (30,5) 63,9 (25,4) 70,0 (30,9) 67,5 (28,9) 52,7 (12,3) 53,5 (15,1) 53,2 (14,0) 115,6 (29,6) 104,3 (28,1) 108,8 (29,2) 3,59 (1,00) 3,39 (0,94) 3,47 (0,96)

249 447 198 249 447 198 249 447 199 248 447 198 249 447 159 141 300 159 141 300 173 149 322 177 242 419 176 242 418 177 242 419 176 242 418 177 242 419

50,9 (11,9) 41,8 (15,1) 126,9 (9,9) 154,5 (8,3) 142,3 (16,5) 18,36 (3,75) 21,12 (3,84) 19,90 (4,03) 55,1 (26,3) 61,7 (25,1) 58,8 (25,8) 20,9 (3,5) 24,6 (3,3) 22,9 (3,9) 102,0 (15,0) 119,4 (10,0) 110,1 (15,6) 66,7 (10,9) 67,5 (11,8) 67,0 (11,3) 85,4 (8,3) 84,7 (8,7) 85,1 (8,5) 173,2 (30,6) 174,6 (34,9) 174,0 (33,2) 63,7 (26,5) 74,8 (31,5) 70,1 (30,0) 52,1 (11,9) 52,5 (12,9) 52,3 (12,4) 108,3 (28,0) 107,2 (30,5) 107,7 (29,5) 3,45 (0,84) 3,50 (1,07) 3,48 (0,98)

2,9 3,6 0,2 2,5 2,5 1,30 0,60 1,02 18,1 11,1 14,2 1,2 1,2 1,5 -1,9 8,4 2,5 -3,0 -8,3 -5,6 1,8 -6,8 -4,1 -7,2 4,2 -0,3 -0,3 4,9 2,6 -0,6 -1,0 -0,9 -7,3 2,9 -1,0 -0,14 0,11 0,01

0,004 <0,001 0,812 0,001 0,020 <0,001 0,088 <0,001 <0,001 <0,001 <0,001 <0,001 <0,001 <0,001 0,174 <0,001 0,020 0,007 <0,001 <0,001 0,112 <0,001 <0,001 0,057 0,174 0,888 0,934 0,120 0,252 0,698 0,475 0,413 0,035 0,315 0,614 0,201 0,300 0,958

™‡ÓÔÏÔ 5,0-9,9 10,0-15,0 ™‡ÓÔÏÔ 5,0-9,9 10,0-15,0 ™‡ÓÔÏÔ ™∞¶ (mmHg)

5,0-9,9 10,0-15,0 ™‡ÓÔÏÔ

¢∞¶ (mmHg)

5,0-9,9 10,0-15,0 ™‡ÓÔÏÔ

GLU (mg/dl)

5,0-9,9 10,0-15,0 ™‡ÓÔÏÔ

TC (mg/dl)

5,0-9,9 10,0-15,0 ™‡ÓÔÏÔ

TG (mg/dl)

5,0-9,9 10,0-15,0 ™‡ÓÔÏÔ

HDL-C (mg/dl)

5,0-9,9 10,0-15,0 ™‡ÓÔÏÔ

LDL-C (mg/dl)

5,0-9,9 10,0-15,0

™‡ÓÔÏÔ ¢Â›ÎÙ˘ TC:HDL ™‡ÓÔÏÔ

p-value

230

5,0-9,9 10,0-15,0

¶∞µ (mm)

ª¤ÛË ÙÈÌ‹ (∆∞)

247 477 230 247 477 230 247 477 134 167 301 205 177 382 217 247 464 217 247 464 58 145 303 119 182 301 113 168 281 119 181 300 119 182 301 119 181 300

™‡ÓÔÏÔ

∞¢¶ (mm)

¡

5,0-9,9

5,0-9,9 10,0-15,0

¢ª™ (kg/m2)

ª¤ÛË ÙÈÌ‹ (∆∞)

ªÂÙ·‚ÔÏ‹

10,0-15,0 ™‡ÓÔÏÔ ⁄„Ô˜ (cm)

¡

1999-2003

5,0-9,9 10,0-15,0

Student t test (equal variances not assumed)

∞fi ÙËÓ ∂ÈÎfiÓ· 1 ‰È·ÈÛÙÒÓÂÙ·È fiÙÈ ÙÔ 19992003 Û ۯ¤ÛË Ì ÙÔ 1989-1993, Ë ÂÈÊ¿ÓÂÈ· ÙˆÓ ÙÈÌÒÓ ÙÔ˘ ¢ª™ Ù›ÓÂÈ Ó· ·˘Í¿ÓÂÙ·È Ì ÙËÓ ·‡ÍËÛË Ù˘ ËÏÈΛ·˜ Î·È Ù˘ TC. ∞ÓÙ›ıÂÙ·, ÌÈÎÚ¤˜ ÙÈ̤˜ HDL-C (∂ÈÎfiÓ· 2) ·ÓÙÈÛÙÔÈ¯Ô‡Ó Û ˘„ËÏfiÙÂÚ˜ ÙÈ̤˜ ÙÔ˘ ¢ª™. ∞fi ÙËÓ ∂ÈÎfiÓ· 3 ‰È·ÈÛÙÒÓÂÙ·È ·‡ÍËÛË ÙÔ˘ ÂÈÔÏ·ÛÌÔ‡ ÙˆÓ ˘¤Ú‚·ÚˆÓ Î·È ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ (¢ª™) Î·È Ù˘ ·˘ÍË̤Ó˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘, ÛÙ·ıÂÚÔÔ›ËÛË ÙÔ˘ ÂÈÔÏ·ÛÌÔ‡ Ù˘ ·˘ÍË̤Ó˘ TC ηıÒ˜ Î·È Ì›ˆÛË ÙÔ˘ ÂÈÔÏ·ÛÌÔ‡ Ì ·˘ÍË̤ÓÔ Paediatriki 2007;70:205-216

GLU Î·È Ì ¯·ÌËÏ‹ HDL-C. °ÂÓÈο, ÌÈÎÚ‹ ·‡ÍËÛË ‰È·ÈÛÙÒÓÂÙ·È Î·È ÛÙÔÓ ÂÈÔÏ·ÛÌfi ÙÔ˘ ªÂÙ™˘Ó.

™˘˙‹ÙËÛË ∆· ۈ̷ÙÔÌÂÙÚÈο ÌÂÁ¤ıË ·È‰ÈÒÓ Ù˘ ∫Ú‹Ù˘, fiˆ˜ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, ·˘Í‹ıËÎ·Ó ÛËÌ·ÓÙÈο ÂÓÙfi˜ ÙÔ˘ ‚Ú·¯¤Ô˜ ‰È·ÛÙ‹Ì·ÙÔ˜ ÌÂٷ͇ 1989-1993 Î·È 1999-2003. ∆Ô Ì¤ÛÔ ‚¿ÚÔ˜ ·˘Í‹ıËΠηٿ 4 kg ‹ 10,4% (4,3 kg ÛÙ· ·ÁfiÚÈ· Î·È 3,6 kg ÛÙ· ÎÔÚ›ÙÛÈ·) Ì ·Ú¿ÏÏËÏË ·‡ÍËÛË ÙÔ˘ ‡„Ô˘˜ ηٿ 3,3 cm ‹ 2,4% (4 cm ÛÙ·

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211

ªÂÙ·‚ÔÏ‹ ۈ̷ÙÔÌÂÙÚ‹ÛˆÓ, ·ÚÙËÚȷ΋˜ ›ÂÛ˘ Î·È ‰ÂÈÎÙÒÓ ÔÚÔ‡ ·›Ì·ÙÔ˜ ·È‰ÈÒÓ

¶›Ó·Î·˜ 4. ∂ÈÔÏ·ÛÌfi˜ ˘ÂÚ‚ÔÏÈÎÔ‡ ‚¿ÚÔ˘˜ Î·È ·¯˘Û·ÚΛ·˜, ·˘ÍË̤Ó˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘, ۷ί¿ÚÔ˘ Î·È ÏÈȉ›ˆÓ ÔÚÔ‡ ·›Ì·ÙÔ˜ ·È‰ÈÒÓ Ù˘ ∫Ú‹Ù˘, ÌÂٷ͇ ÙˆÓ ÂÚÈfi‰ˆÓ 1989-1993 Î·È 1999-2003 ∞ÁfiÚÈ· 1989-1993 ª¤ÙÚËÛË

ŸÚÈ·

¢ª™

º˘ÛÈÔÏÔÁÈο À¤Ú‚·Ú· ¶·¯‡Û·Úη p-value*

™∞¶

<90 ∂.£. ≥90 ∂.£. p-value

¢∞¶

<90 ∂.£. ≥90 ∂.£. p-value

GLU

<100 mg/dl ≥100 p-value

TC

<180 mg/dl 180-200 >200 p-value

TG

<90 ∂.£. ≥90 ∂.£. p-value

HDL-C

≥10 ∂.£. <10 ∂.£. p-value

LDL-C

≤110 mg/dl 111-113 >130

p-value ¢Â›ÎÙ˘ TC:HDL ≤4,00 >4,00 p-value ™˘Ó‰˘·ÛÌfi˜ 0 ·Ú·ÁfiÓÙˆÓ 1-2 ÎÈÓ‰‡ÓÔ˘** ≥3 p-value

1999-2003

¡ (%) 355 (74,3) 291 (66,3) 99 (20,7) 108 (24,6) 24 (5,0) 40 (9,1) 0,011 350 (75,4) 167 (63,5) 114 (24,6) 96 (36,5) 0,001 252 (54,3) 212 (80,6) 212 (45,7) 51 (19,4) <0,001 188 (90,8) 283 (91,0) 19 (9,2) 28 (9,0) 0,946 169 (58,3) 268 (65,8) 79 (27,2) 88 (21,6) 42 (14,5) 51 (12,5) 0,119 230 (85,8) 361 (88,7) 38 (14,2) 46 (11,3) 0,268 251 (87,2) 366 (89,9) 37 (12,8) 41 (10,1) 0,254 155 (53,4) 245 (60,2) 83 (28,6) 100 (24,6) 52 (17,9) 62 (15,2) 0,206 232 (80,6) 33,2 (81,6) 56 (19,4) 75 (18,4) 0,736 69 (38,8) 95 (39,7) 98 (55,1) 135 (56,5) 11 (6,2) 9 (3,8) 0,522

∫ÔÚ›ÙÛÈ· ¶ÔÛÔÛÙÈ·›· ÌÂÙ·‚ÔÏ‹ -9,7 18,8 82,0 -15,8 48,4 48,4 -57,5 0,2 -2,2 12,9 -20,6 -13,8 3,3 -25,7 3,0 -26,7 12,7 -14,0 -15,1 1,2 -5,2 2,3 2,5 -63,2

1989-1993

1999-2003

¡ (%) 345 (72,3) 284 (63,5) 104 (21,8) 111 (24,8) 28 (5,9) 52 (11,6) 0,002 349 (75,2) 172 (57,3) 115 (24,8) 128 (42,7) <0,001 260 (56,0) 206 (68,7) 204 (44,0) 94 (31,3) <0,001 182 (89,7) 308 (95,7) 21 (10,3) 14 (4,3) 0,007 179 (59,5) 256 (61,1) 70 (23,3) 83 (19,8) 52 (17,3) 80 (19,1) 0,504 248 (88,3) 362 (86,6) 33 (11,7) 56 (13,4) 0,520 260 (86,7) 371 (88,5) 40 (13,3) 48 (11,5) 0,449 156 (51,8) 256 (61,2) 86 (28,6) 83 (19,9) 59 (19,6) 79 (18,9) 0,015 234 (78,0) 338 (80,7) 66 (22,0) 81 (19,3) 0,382 66 (37,3) 90 (32,4) 106 (59,9) 168 (60,4) 5 (2,8) 20 (7,2) 0,104

¶ÔÛÔÛÙÈ·›· ÌÂÙ·‚ÔÏ‹ -12,2 13,8 96,6 -23,8 72,2 22,7 -28,9 6,7 -58,3 2,7 -15,0 10,4 -2,0 12,7 2,0 -15,7 18,1 -30,4 -3,6 3,5 -12,3 -15,1 0,8 61,1

* ŒÏÂÁ¯Ô˜ χ2, ** √ Û˘Ó‰˘·ÛÌfi˜ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ·ÊÔÚ¿ ÛÙÔÓ ¢ª™, ÛÙËÓ ·ÚÙËÚȷ΋ ›ÂÛË, ÛÙÔ GLU, ÛÙËÓ HDL-C Î·È ÛÙ· TG

·ÁfiÚÈ· Î·È 2,5 cm ÛÙ· ÎÔÚ›ÙÛÈ·). ø˜ Û˘Ó¤ÂÈ·, fï˜, Ù˘ ÌÂÁ·Ï‡ÙÂÚ˘ ·‡ÍËÛ˘ ÙÔ˘ ‚¿ÚÔ˘˜, Ô ¢ª™ ·˘Í‹ıËΠηٿ 0,97 kg/m2 ‹ 5,2%, Ì ÙË ÌÂÁ·Ï‡ÙÂÚË ·‡ÍËÛË Ó· ‰È·ÈÛÙÒÓÂÙ·È ÛÙ· ÎÔÚ›ÙÛÈ· Ì ÔÛÔÛÙfi 5,4%. ∞fi ÌÂϤÙË Û ·ÁfiÚÈ· Ù˘ ∫Ú‹Ù˘ ËÏÈΛ·˜ 9-15 ÂÙÒÓ (22) Î·È ÁÈ· ‰È¿ÛÙËÌ· ÌÂÁ·Ï‡ÙÂÚÔ ·fi ·˘Ùfi Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ (1982 ¤ˆ˜ 2002), ‚Ú¤ıËΠ·‡ÍËÛË 4,4 kg (9,6%) ÛÙÔ ‚¿ÚÔ˜, 1,7 cm (1,1%) ÛÙÔ ‡„Ô˜ Î·È 1,64 kg/m2 (8,4%) ÛÙÔÓ ¢ª™. ∂›Û˘ ·fi ÙË Û‡ÁÎÚÈÛË Ù˘ 50˘ ∂.£. ÙÔ˘ ‚¿ÚÔ˘˜ Î·È ÙÔ˘ ‡„Ô˘˜ ÙˆÓ ·È‰ÈÒÓ (∂ÈÎfiÓ· 4) Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ Î·È ÙˆÓ ·È‰ÈÒÓ Ù˘ ÌÂϤÙ˘ ÙÔ˘ πÓÛÙÈÙÔ‡ÙÔ˘ ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡ (24), ‰È·ÈÛÙÒÓÂÙ·È Ë ÌÂÁ·Ï‡-

ÙÂÚË ·‡ÍËÛË ÙÔ˘ ‚¿ÚÔ˘˜ Î·È ÌÈÎÚfiÙÂÚË ÙÔ˘ ‡„Ô˘˜ Û fiϘ ۯ‰fiÓ ÙȘ ËÏÈ˘ ÙˆÓ ·È‰ÈÒÓ, ÁÈ· ÙËÓ ÂÚ›Ô‰Ô 1999-2003. ™Â ÌÂϤÙË ·ÁÔÚÈÒÓ ËÏÈΛ·˜ 6-15 ÂÙÒÓ Ù˘ ™·Ú·ÁfiÛ· (25), ÌÂٷ͇ ÙˆÓ ÂÙÒÓ 1980 Î·È 1995, ‚Ú¤ıËÎ·Ó ÌÈÎÚfiÙÂÚ˜ ·˘Í‹ÛÂȘ, Û ۯ¤ÛË Ì ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, ÛÙÔ ‚¿ÚÔ˜ (3,4 kg ‹ 9,9%), ÛÙÔ ‡„Ô˜ (3,9 cm ‹ 2,8%) Î·È ÛÙÔÓ ¢ª™ (0,64 kg/m2 ‹ 3,6%). øÛÙfiÛÔ, Ù· ·ÁfiÚÈ· Ù˘ ™·Ú·ÁfiÛ· ›¯·Ó, ÙÔ 1995, Û ۯ¤ÛË Ì ٷ ·ÁfiÚÈ· ·Ó¿ÏÔÁ˘ ËÏÈΛ·˜ Ù˘ ∫Ú‹Ù˘ Ù˘ ÂÚÈfi‰Ô˘ 1989-1993, ÛËÌ·ÓÙÈο ÌÈÎÚfiÙÂÚÔ ‡„Ô˜ (139,2 ¤Ó·ÓÙÈ 141,4 cm, p=0,001, ·ÓÙ›ÛÙÔȯ·) Î·È ¢ª™ (18,2 ¤Ó·ÓÙÈ 18,7 kg/m2, p=0,001, ·ÓÙ›ÛÙÔȯ·). ¶·È‰È·ÙÚÈ΋ 2007;70:205-216

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™ÂÏ›‰·212

212

ª. §ÈÓ·Ú‰¿Î˘ Î·È Û˘Ó.

¶›Ó·Î·˜ 5. ¢Â›ÎÙ˜ Û¯ÂÙÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘ (Odds Ratio) ¢ª™, ·ÚÙËÚȷ΋˜ ›ÂÛ˘ Î·È ÏÈȉ›ˆÓ ÔÚÔ‡ ·›Ì·ÙÔ˜ ·È‰ÈÒÓ Ù˘ ∫Ú‹Ù˘, ηٿ ÙË ¯ÚÔÓÈ΋ ÂÚ›Ô‰Ô 1999-2003 Û ۯ¤ÛË Ì ÙËÓ ÂÚ›Ô‰Ô 1989-1993 ∞ÁfiÚÈ· ª¤ÙÚËÛË

ŸÚÈ·

¢ª™

™∞¶ ¢∞¶ GLU TC

TG HDL-C LDL-C

¢Â›ÎÙ˘ TC:HDL ™˘Ó‰˘·ÛÌfi˜ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘**

¡

√R (95% ¢∂)

º˘ÛÈÔÏÔÁÈο À¤Ú‚·Ú· ¶·¯‡Û·Úη <90 ∂.£. ≥90 ∂.£. <90 ∂.£. ≥90 ∂.£. <100 mg/dl ≥100 <180 180-200 >200 <90 ∂.£. ≥90 ∂.£. ≥10 ∂.£. <10 ∂.£. ≤110 mg/dl 111-113 >130 ≤4,00 >4,00

646 207 64 517 210 464 263 471 47 437 167 93 591 84 617 78 400 183 114 564 131

1,00 1,32 (0,96-1,80) 2,06 (1,21-3,49) 1,00 1,81 (1,30-2,52) 1,00 0,25 (0,17-0,36) 1,00 0,95 (0,50-1,79) 1,00 0,70 (0,48-1,00) 0,76 (0,48-1,20) 1,00 0,77 (0,49-1,22) 1,00 0,76 (0,47-1,22) 1,00 0,76 (0,53-1,08) 0,75 (0,49-1,14) 1,00 0,94 (0,64-1,39)

0 1-2 ≥3

164 233 20

1,00 0,88 (0,57-1,34) 0,43 (0,16-1,17)

∫ÔÚ›ÙÛÈ· p*

¡

√R (95% ¢∂)

0,742

629 215 80 521 243 466 298 490 35 435 153 132 610 89 631 88 412 169 138 572 147

1,00 1,29 (0,95-1,77) 2,31 (1,42-3,76) 1,00 2,39 (1,74-3,27) 1,00 0,54 (0,40-0,74) 1,00 0,44 (0,22-0,90) 1,00 0,84 (0,58-1,21) 1,09 (0,73-1,63) 1,00 1,16 (0,74-1,84) 1,00 0,86 (0,55-1,34) 1,00 0,59 (0,41-0,85) 0,83 (0,56-1,23) 1,00 0,85 (0,59-1,23)

0,543 0,098

156 274 25

1,00 1,10 (0,73-1,66) 2,69 (0,95-7,65)

0,087 0,008 <0,001 <0,001 0,870 0,049 0,240 0,265 0,253 0,124 0,179

p* 0,104 0,001 <0,001 <0,001 0,025 0,350 0,666 0,519 0,496 0,005 0,352 0,388 0,636 0,064

* §ÔÁÈÛÙÈ΋ ·Ó¿Ï˘ÛË ·ÏÈÓ‰ÚfiÌËÛ˘ (ˆ˜ Û˘ÌÌÂÙ·‚ÏËÙ‹ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë ËÏÈΛ·), ** √ Û˘Ó‰˘·ÛÌfi˜ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ·ÊÔÚ¿ ÛÙÔÓ ¢ª™, ÛÙËÓ ·ÚÙËÚȷ΋ ›ÂÛË, ÛÙÔ GLU, ÛÙËÓ HDL-C Î·È ÛÙ· TG

¶·È‰È¿ ÂÚÈfi‰Ô˘ 1999-2003

¶·È‰È¿ ÂÚÈfi‰Ô˘ 1989-1993

¢ª™

¢ª™

√

14 13 12 11 10 9

ÛÙ

8 7 6

)

g/

dl

5

g/

6

(m

(m

7

5

Ë

8

fiÏ

fiÏ

ÂÚ

ÂÚ

ÛÙ

ÈΛ·

ÏË

ÏË

14 13 12 11 10 9

¯Ô

∏Ï

Ë) (¤Ù

¯Ô

΋

΋

ÏÈ

Ë

30,0 28,7 27,3 25,9 24,6 23,2 21,8 20,4 19,1 17,7 16,4 15,0 13,7 12,3 11,00 40375 353025 302075 252025 201075 151025 10075 50

ÏÈ

√

29,4 27,5 26,0 24,6 23,3 21,9 20,6 19,2 17,9 16,5 15,2 13,9 12,5 115,20 3 25 3 00 3 75 2 50 2 25 2 00 2 75 1 50 1 25 1 00 1 75 50 dl )

∂ÈÎfiÓ· 1. ™˘Û¯¤ÙÈÛË ¢ª™ Î·È TC ÛÙȘ ‰‡Ô ÂÚÈfi‰Ô˘˜ (ÂÊ·ÚÌÔÁ‹ ÔÏ˘ˆÓ˘ÌÈÎÔ‡ ÌÔÓÙ¤ÏÔ˘ 3Ô˘ ‚·ıÌÔ‡).

Paediatriki 2007;70:205-216

∏

›· ÏÈÎ

(¤Ù

Ë)

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24-05-07

17:58

™ÂÏ›‰·213

213

ªÂÙ·‚ÔÏ‹ ۈ̷ÙÔÌÂÙÚ‹ÛˆÓ, ·ÚÙËÚȷ΋˜ ›ÂÛ˘ Î·È ‰ÂÈÎÙÒÓ ÔÚÔ‡ ·›Ì·ÙÔ˜ ·È‰ÈÒÓ

¶·È‰È¿ ÂÚÈfi‰Ô˘ 1999-2003

g/dl)

56

78

(¤

ÙË

)

-C (m

·

HDL

Λ

ÙË

(¤

·

78

14 1213 1 1 9 10

ÏÈ

g/dl)

56

Λ

-C (m

ÏÈ

HDL

∏

13 0 11 5 10 0 85 70 55 40 25 10

)

14 1213 1 1 9 10

5 30,,9 28 ,4 27 ,9 25 ,4 24 ,9 22 ,5 21 ,0 20 ,5 18 ,0 17 ,6 15 ,1 14 ,6 12 ,2 11

13 0 11 5 10 0 85 70 55 40 25 10

¢ª™

¢ª™

,5 30 ,9 8 2 ,4 27 ,9 25 ,4 24 ,9 22 ,5 21 ,0 20 ,5 18 ,0 17 ,6 15 ,1 14 ,6 12 ,2 11

∏

¶·È‰È¿ ÂÚÈfi‰Ô˘ 1989-1993

∂ÈÎfiÓ· 2. ™˘Û¯¤ÙÈÛË ¢ª™ Î·È HDL ÛÙȘ ‰‡Ô ÂÚÈfi‰Ô˘˜ (ÂÊ·ÚÌÔÁ‹ ÔÏ˘ˆÓ˘ÌÈÎÔ‡ ÌÔÓÙ¤ÏÔ˘ 3Ô˘ ‚·ıÌÔ‡).

∂›Û˘, ·fi ÌÂϤÙË Û ·È‰È¿ Ù˘ ∆Ô˘ÚΛ·˜ (26), ·Ó¿ÏÔÁ˘ ËÏÈΛ·˜ Î·È ¯ÚÔÓÈ΋˜ ÂÚÈfi‰Ô˘ Ì ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, ‚Ú¤ıËÎ·Ó ÌÂÁ·Ï‡ÙÂÚ˜ ·˘Í‹ÛÂȘ ÛÙÔ ‚¿ÚÔ˜ (4,4 kg) Î·È ÛÙÔ ‡„Ô˜ (3,9 cm), ÂÓÒ ÌÂϤÙË Û ¤ÊË‚Ô˘˜ 15-18 ÂÙÒÓ Ù˘ ºÈÓÏ·Ó‰›·˜ (31), ¤‰ÂÈÍ ·‡ÍËÛË 4,8% ÛÙÔÓ ¢ª™ ÌÂٷ͇ ÙˆÓ ÂÙÒÓ 1980 Î·È 1992. ∞fi ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ‚Ú¤ıËΠÂ›Û˘ fiÙÈ ÙÔ ÔÛÔÛÙfi ÙˆÓ ˘¤Ú‚·ÚˆÓ Î·È ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ ·˘Í‹ıËΠηٿ 31,5% (·fi 26,7% ·Ó‹Ïı·Ó ÛÂ

ªÂÙ·‚ÔÏ‹ ÂÈÔÏ·ÛÌÔ‡

˘ÂÚ‚ÔÏÈÎfi ‚¿ÚÔ˜ & ·¯˘Û·ÚΛ· ·ÚÙËÚȷ΋ ›ÂÛË GLU TC TG HDL-C LDL-C TC:HDL-C Û˘Ó‰˘·ÛÌfi˜ ·Ú·ÁfiÓÙˆÓ 1989-1993

1999-2003

#

À¤Ú‚·Ú· Î·È ·¯‡Û·Úη ·È‰È¿: Ù·ÍÈÓfiÌËÛË IOTF, ·ÚÙËÚȷ΋ ›ÂÛË: ™∞¶ ‹/Î·È ¢∞¶ ≥90‹ ∂.£., GLU ≥100 mg/dl, TC >200 mg/dl, TG ≥90‹ ∂.£., HDL-C <10Ë ∂.£., LDL-C >130 mg/dl, TC:HDL-C >4,00 ## ™˘Ó‰˘·ÛÌfi˜ ·Ú·ÁfiÓÙˆÓ: ¢ª™ (·¯˘Û·ÚΛ·), ·ÚÙËÚȷ΋ ›ÂÛË (™∞¶ ‹/Î·È ¢∞¶), GLU, TG Î·È HDL-C

∂ÈÎfiÓ· 3. ™¯ÂÙÈ΋ ÌÂÙ·‚ÔÏ‹ ÙÔ˘ ÂÈÔÏ·ÛÌÔ‡ ÙˆÓ ˘„ËÏÒÓ ÂÈ¤‰ˆÓ ÙÔ˘ ¢ª™, Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘, ÙÔ˘ GLU Î·È ÙˆÓ ÏÈȉ›ˆÓ ·È‰ÈÒÓ Ù˘ ∫Ú‹Ù˘ ËÏÈΛ·˜ 5-15 ÂÙÒÓ, ÌÂٷ͇ ÙˆÓ ¯ÚÔÓÈÎÒÓ ÂÚÈfi‰ˆÓ 1989-1993 Î·È 1999-2003.

35,1%), Ì ΢ÚÈfiÙÂÚÔ fï˜, ÙÔÓ ‰ÈÏ·ÛÈ·ÛÌfi ÙˆÓ ·¯‡Û·ÚÎˆÓ (·fi 5,4 Û 10,4%). ¶·Ú¿ÏÏËÏ·, ·fi ÙÔ˘˜ Magkos Î·È Û˘Ó (22) ·Ó·Ê¤ÚıËΠ·‡ÍËÛË ÙÔ˘ ÂÈÔÏ·ÛÌÔ‡ ÙˆÓ ˘¤Ú‚·ÚˆÓ ·ÁÔÚÈÒÓ Ù˘ ∫Ú‹Ù˘ ηٿ 63% Î·È ÙˆÓ ·¯‡Û·ÚÎˆÓ Î·Ù¿ 202% ÌÂٷ͇ ÙˆÓ ÂÙÒÓ 1982 Î·È 2002, ÂÓÒ Û ÌÂϤÙË ÙÔ 2002 Û 2458 ·È‰È¿ Ù˘ £ÂÛÛ·ÏÔӛ΢ (27), ËÏÈΛ·˜ 6-17 ÂÙÒÓ, ‚Ú¤ıËΠÂÈÔÏ·ÛÌfi˜ ˘¤Ú‚·ÚˆÓ 22,2% Î·È ·¯‡Û·ÚÎˆÓ 4,1% Î·È ·‡ÍËÛË ÙÔ˘ ¢ª™ ηٿ 5% ÂÚ›Ô˘ ·fi ÙÔ 1982. ªÂٷ͇ ÙˆÓ ÂÙÒÓ 1985 Î·È 1995, ‚Ú¤ıËΠÂ›Û˘ Û ·È‰È¿ Ù˘ ∞˘ÛÙÚ·Ï›·˜ (28), ËÏÈΛ·˜ 2-18 ÂÙÒÓ, 50% ·‡ÍËÛË ÙˆÓ ˘¤Ú‚·ÚˆÓ ·È‰ÈÒÓ (·fi 10% ·Ó‹Ïı·Ó Û 15,4%) Î·È 276% ÙˆÓ ·¯‡Û·ÚÎˆÓ (·fi 1,3% ÛÙÔ 4,9%), Ì 3,28 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚÔ Î›Ó‰˘ÓÔ ÙÔ 1995 ÁÈ· ·Ó¿Ù˘ÍË ·¯˘Û·ÚΛ·˜. ¶·ÚfiÌÔÈ·, ·fi ÌÂϤÙË ÁÈ· ÙË ÌÂÙ·‚ÔÏ‹ ÙÔ˘ ¢ª™ Û ·ÓÙÈÚÔÛˆ¢ÙÈÎfi ‰Â›ÁÌ· ·È‰ÈÒÓ ÙÔ˘ ∫·Ó·‰¿ (29), ËÏÈΛ·˜ 7-13 ÂÙÒÓ, ‚Ú¤ıËΠfiÙÈ Ù· ˘¤Ú‚·Ú· ·È‰È¿ ·˘Í‹ıËÎ·Ó ÌÂٷ͇ ÙˆÓ ÂÙÒÓ 1981 Î·È 1996 ·fi 15% Û 21,2% Î·È ˘ÂÚ‰ÈÏ·ÛÈ¿ÛÙËÎ·Ó Ù· ·¯‡Û·Úη (·fi 5% Û 12,7%), Ì ÙÔ Û‡ÓÔÏÔ ÙˆÓ ˘¤Ú‚·ÚˆÓ Î·È ·¯‡Û·ÚÎˆÓ Ó· ·Ó¤Ú¯ÂÙ·È ÙÔ 1996 Û 38,9%. ∆· ·Ú·¿Óˆ Â˘Ú‹Ì·Ù· ·ÔÙÂÏÔ‡Ó ÈÛ¯˘Ú¤˜ ÂӉ›ÍÂȘ Ù˘ ·‡ÍËÛ˘ ÙÔ˘ ˘ÂÚ‚ÔÏÈÎÔ‡ ‚¿ÚÔ˘˜ Î·È Ù˘ ·¯˘Û·ÚΛ·˜, ·ÎfiÌ· Î·È ÂÓÙfi˜ ‚Ú·¯¤ˆÓ ¯ÚÔÓÈÎÒÓ ÂÚÈfi‰ˆÓ. ¶·Ú¿ÏÏËÏ·, ηٷ‰ÂÈÎÓ‡ÂÙ·È fiÙÈ Ù· ˘¤Ú‚·Ú· ·È‰È¿ ·˘Í¿ÓÔ˘Ó ÙÔ ‚¿ÚÔ˜ ÙÔ˘˜ Û˘Ó¯Ҙ, Ì ·ÔÙ¤ÏÂÛÌ· Ó· ·˘Í¿ÓÂÙ·È ‰È·ÚÎÒ˜ Ë ·È‰È΋ ·¯˘Û·ÚΛ·. °È· ·Ú¿‰ÂÈÁÌ·, ÛÙË ÌÂϤÙË NHANES 1999-2002 ÙˆÓ ∏¶∞ (30), ÌÂٷ͇ ÙˆÓ ÂÙÒÓ 19992000 Î·È 2001-2002, ‚Ú¤ıËΠÌÂÁ·Ï‡ÙÂÚË ·‡ÍËÛË Î·Ù¿ 10% ÙˆÓ ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ (·fi 15% ·Ó‹Ïı·Ó Û 16,5%) Û ۯ¤ÛË Ì ÙËÓ ·‡ÍËÛË Î·Ù¿ ¶·È‰È·ÙÚÈ΋ 2007;70:205-216

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24-05-07

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∂ÈÎfiÓ· 4. ™¯ËÌ·ÙÈ΋ Û‡ÁÎÚÈÛË 50‹˜ ∂.£. ‚¿ÚÔ˘˜ Î·È ‡„Ô˘˜ ·È‰ÈÒÓ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ Î·È ÙÔ˘ πÓÛÙÈÙÔ‡ÙÔ˘ ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡ (πÀ¶).

5,4% ÙˆÓ ˘¤Ú‚·ÚˆÓ (·fi 29,9% ·Ó‹Ïı·Ó Û 31,5%). ∂ӉȷʤÚÔÓ, fï˜, ·ÚÔ˘ÛÈ¿˙ÂÈ Ë Û˘Û¯¤ÙÈÛË Ù˘ ·‡ÍËÛ˘ ÙÔ˘ ‚¿ÚÔ˘˜ ÙˆÓ ·È‰ÈÒÓ Ì ÙË ÌÂÙ·‚ÔÏ‹ ¿ÏÏˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù·. ∞Ó Î·È ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË Ë ™∞¶ ÙˆÓ ·È‰ÈÒÓ Ù˘ ÂÚÈfi‰Ô˘ 1999-2003 ‚Ú¤ıËΠ·˘ÍË̤ÓË Î·Ù¿ 2%, Û ۯ¤ÛË Ì ÂΛÓË Ù˘ ÂÚÈfi‰Ô˘ 1989-1993, ÌË ÛËÌ·ÓÙÈ΋ Ì›ˆÛË ‚Ú¤ıËΠÛÙ· Â›‰· ÙÔ˘ GLU, Ù˘ TC, Ù˘ HDL-C Î·È Ù˘ LDL-C ηٿ 3,9%, 1,2%, 0,7% Î·È 2,5%, ·ÓÙ›ÛÙÔȯ·. ™Â ÌÂϤÙË ÂÊ‹‚ˆÓ Ù˘ ºÈÓÏ·Ó‰›·˜ (31), ·Ó·Ê¤ÚÔÓÙ·È ÌÂÁ·Ï‡ÙÂÚ˜ ÌÂÈÒÛÂȘ ÌÂٷ͇ 1980 Î·È 1992 ÛÙËÓ TC, ÛÙËÓ HDL-C Î·È ÙËÓ LDL-C ηٿ -8,5%, 19,2% Î·È -7,5%, ·ÓÙ›ÛÙÔȯ·. √È ·ÏÏ·Á¤˜ ·˘Ù¤˜ ·ÔÙÂÏÔ‡Ó Û˘Ó¤ÂÈ· Ù˘ ÂıÓÈ΋˜ ÔÏÈÙÈ΋˜ Ô˘ ·ÎÔÏÔ˘ıÂ›Ù·È ·fi ÙȘ ·Ú¯¤˜ ÙÔ˘ 1970, Ì ·ÚÈÔ Paediatriki 2007;70:205-216

ÛÙfi¯Ô ÙË Ì›ˆÛË ÙˆÓ ÂÈ¤‰ˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ηډȷÁÁÂȷο ÓÔÛ‹Ì·Ù·, ̤ۈ Ù˘ Ì›ˆÛ˘ ηٷӿψÛ˘ ÎÔÚÂṲ̂ÓÔ˘ Ï›Ô˘˜, Ó·ÙÚ›Ô˘ Î·È ÙËÓ ·‡ÍËÛË Î·Ù·Ó¿ÏˆÛ˘ ÊÚÔ‡ÙˆÓ Î·È Ï·¯·ÓÈÎÒÓ (32). ∞ÓÙ›ıÂÙ·, ÔÈ Magkos Î·È Û˘Ó (22) ·Ó·Ê¤ÚÔ˘Ó ÛËÌ·ÓÙÈΤ˜ ·˘Í‹ÛÂȘ ÛÙ· ÏÈ›‰È· ÔÚÔ‡ ·›Ì·ÙÔ˜ ·ÁÔÚÈÒÓ Ù˘ ∫Ú‹Ù˘, Ì ΢ÚÈfiÙÂÚË ÙËÓ ·˘ÍË̤ÓË LDL-C ηٿ 25,3%. ™˘ÓÔÙÈο Î·È Û ۯ¤ÛË Ì ٷ ·Ú·¿Óˆ ·ÔÙÂϤÛÌ·Ù·, Ô Û˘Ó‰˘·ÛÌfi˜ ·Ú·ÁfiÓÙˆÓ ªÂÙ™˘Ó ‚Ú¤ıËΠ·˘ÍË̤ÓÔ˜ ÛÙ· ·È‰È¿ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ηٿ 24% ÂÓÙfi˜ ÙˆÓ ‰‡Ô ÂÚÈfi‰ˆÓ (·fi 4,5% ·Ó‹Ïı Û 5,6%). ∞fi Ù· ·È‰È¿, fï˜, Ì ªÂÙ™˘Ó, ÔÛÔÛÙfi ÌfiÏȘ 14,3% ‹Ù·Ó ·¯‡Û·Úη ÙÔ 1989-1993, ÂÓÒ ˘ÂÚ‰ÈÏ·ÛÈ¿ÛÙËÎ·Ó ÙÔ 1999-2003 Î·È ·Ó‹Ïı·Ó ÛÙÔ 37,3%. ™Ù· ·¯‡Û·Úη ·È‰È¿, Ô Î›Ó‰˘ÓÔ˜ Ó· ·Ó·Ù‡ÍÔ˘Ó ªÂÙ™˘Ó ÙÔ 1989-1993

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215

ªÂÙ·‚ÔÏ‹ ۈ̷ÙÔÌÂÙÚ‹ÛˆÓ, ·ÚÙËÚȷ΋˜ ›ÂÛ˘ Î·È ‰ÂÈÎÙÒÓ ÔÚÔ‡ ·›Ì·ÙÔ˜ ·È‰ÈÒÓ

‹Ù·Ó 3,89 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚÔ˜ ¤Ó·ÓÙÈ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ, ηıÒ˜ ÙÔ 1999-2003 Ô Î›Ó‰˘ÓÔ˜ ·˘Ùfi˜ ‹Ù·Ó ÂÙ¿ ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚÔ˜ (27,08). ¢È·ÈÛÙÒÓÂÙ·È, ÏÔÈfiÓ, fiÙÈ ·Ó Î·È ÙÔ ªÂÙ™˘Ó ·ÔÙÂÏ› Û˘Ó¿ÚÙËÛË Ù˘ ‰˘Ó·ÌÈ΋˜ ÙˆÓ Û˘ÓÈÛÙˆÛÒÓ ÙÔ˘, ÂÓÙÔ‡ÙÔȘ, ÌÂÙ·‚¿ÏÏÂÙ·È Î·Ù¿ ·ÚÈÔ ÏfiÁÔ Û‡Ìʈӷ Ì ÙË ÌÂÙ·‚ÔÏ‹ Ù˘ ·¯˘Û·ÚΛ·˜. ™ÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›· ‰ÂÓ Î·Ù·ÁÚ¿ÊÂÙ·È Ë ‰È·¯ÚÔÓÈ΋ Ù¿ÛË ÙÔ˘ ªÂÙ™˘Ó Û ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜, ·Ú¿ ÙË ‰ÈÂÚ‡ÓËÛË ÙÔ˘ ÂÈÔÏ·ÛÌÔ‡ ÙÔ˘ ÛÙ· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·. ™Â ·È‰È¿ Ù˘ ∫Ú‹Ù˘, ËÏÈΛ·˜ 3-18 ÂÙÒÓ, ÛÙÔ ‰È¿ÛÙËÌ· 2001-2003 (9), ‚Ú¤ıËΠfiÙÈ ÂÚ›Ô˘ 4% ›¯·Ó ªÂÙ™˘Ó, ·fi Ù· ÔÔ›· Ù· ‰‡Ô ÙÚ›Ù· ‹Ù·Ó ·¯‡Û·Úη. ∂›Û˘, Û ·¯‡Û·Úη ·È‰È¿ Ù˘ πÙ·Ï›·˜ ËÏÈΛ·˜ 6-14 ÂÙÒÓ (33), ÙÔ 38% ›¯Â ·ÚÔ˘Û›· ÙÔ˘Ï¿¯ÈÛÙÔÓ ÙÚÈÒÓ ·Ú·ÁfiÓÙˆÓ ªÂÙ™˘Ó, ÂÓÒ ‚Ú¤ıËÎ·Ó Ó· ¤¯Ô˘Ó ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚ· Â›‰· ÈÓÛÔ˘Ï›Ó˘, C-·ÓÙȉÚÒÛ·˜ ÚˆÙ½Ó˘ Î·È ÌÂÁ·Ï‡ÙÂÚË ·ÓÂÏ·ÛÙÈÎfiÙËÙ· ηڈÙȉÈ΋˜ ·ÚÙËÚ›·˜ (carotid artery stiffness). ¶·Ú¿ ÙȘ ·Ú·¿Óˆ ·Ó·ÊÔÚ¤˜ Î·È Û˘ÁÎÚ›ÛÂȘ, ÛÙË ‰È·¯ÚÔÓÈ΋ Û‡ÁÎÚÈÛË ·ÔÙÂÏÂÛÌ¿ÙˆÓ ı· Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÂÙ·È ˘’ fi„ÈÓ ÙÔ Ì¤ÁÂıÔ˜ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜, Ë ·ÓÙÈÚÔÛˆ¢ÙÈÎfiÙËÙ·, Ë Ì¤ıÔ‰Ô˜ ‰ÂÈÁÌ·ÙÔÏË„›·˜, ÔÈ ÌÂıÔ‰ÔÏÔÁÈÎÔ› ÂÚÈÔÚÈÛÌÔ› ‹ ‰È·ÊÔÚ¤˜, ηıÒ˜ Î·È Ë ÌÂÙ·‚ÏËÙfiÙËÙ· ÙˆÓ ÌÂÙÚ‹ÛÂˆÓ (11). ∞Ó Î·È Ù· ·ÔÙÂϤÛÌ·Ù· ÙˆÓ ÂÚÈÛÛfiÙÂÚˆÓ ÌÂÏÂÙÒÓ, fiˆ˜ Î·È Ù˘ ·ÚÔ‡Û·˜, ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·ÓÙÈÎÚÔ˘fiÌÂÓ· ·ÔÙÂϤÛÌ·Ù·, ÛËÌ·ÓÙÈÎfi ÛÙÔÈ¯Â›Ô ·ÔÙÂÏ› Ë ‰È·›ÛÙˆÛË ÙÔ˘ Eisenmann (11) fiÙÈ ·Ó Î·È ÛÙ·ÙÈÛÙÈÎÒ˜ ÔÈ ‰È·ÊÔÚÔÔÈ‹ÛÂȘ Â›Ó·È ÛËÌ·ÓÙÈΤ˜ Î·È ·ÓÙ›ıÂÙ˜, ˆÛÙfiÛÔ ˆ˜ ÎÏÈÓÈο Â˘Ú‹Ì·Ù· ‰ÂÓ ·ÔÙÂÏÔ‡Ó ÔˆÛ‰‹ÔÙ ·ÍÈfiÏÔÁ˜ ÌÂÙ·‚ÔϤ˜. ∏ ¿Ô„Ë ·˘Ù‹ ÂÓÈÛ¯‡ÂÙ·È ÂÚÈÛÛfiÙÂÚÔ Â¿Ó ÙÔ ‰È¿ÛÙËÌ· ÌÂϤÙ˘ Â›Ó·È ‚Ú·¯Â›· ÂÚ›Ô‰Ô˜ Î·È ·Ó Ï·Ì‚¿ÓÂÙ·È ˘’ fi„ÈÓ Ô ÚfiÏÔ˜ Ù˘ ÂӉ¯fiÌÂÓ˘ Â›‰Ú·Û˘ ‹ ÌÂÙ·‚ÔÏ‹˜ ¿ÏÏˆÓ Û˘Ì·Ú·ÁfiÓÙˆÓ, fiˆ˜ ÔÈ ‰È·ÈÙËÙÈΤ˜ Û˘Ó‹ıÂȘ Î·È Ë ÛˆÌ·ÙÈ΋ ¿ÛÎËÛË, Ô˘ ˆÛÙfiÛÔ ‰ÂÓ ÂÎÙÈÌ‹ıËÎ·Ó ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË. ™˘ÌÂÚ·ÛÌ·ÙÈο, ηٿ ÙËÓ ÙÂÏÂ˘Ù·›· ‰ÂηÂÙ›· ‰È·ÈÛÙÒÓÂÙ·È ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË ÛÙÔ˘˜ ‰Â›ÎÙ˜ ·¯˘Û·ÚΛ·˜ ÙˆÓ ·È‰ÈÒÓ Ù˘ ∫Ú‹Ù˘. ∏ ¤ÏÏÂÈ„Ë ÛˆÛÙÒÓ ÂÈÏÔÁÒÓ ÛÙË ‰È·ÙÚÔÊ‹, Ô ÂÚÈÔÚÈÛÌfi˜ Ù˘ ۈ̷ÙÈ΋˜ ¿ÛÎËÛ˘, Ë ˘ÈÔı¤ÙËÛË ÂÈ‚Ï·‚ÒÓ ÁÈ· ÙËÓ ˘Á›· Û˘ÓËıÂÈÒÓ fiˆ˜ ÙÔ Î¿ÓÈÛÌ· Î·È Ë Î·Ù·Ó¿ÏˆÛË ÔÈÓÔÓ‡̷ÙÔ˜, ·ÔÙÂÏÔ‡Ó ÌÂÚÈΤ˜ ·Ú·Ì¤ÙÚÔ˘˜ Ô˘ Û˘ÓÂÈÛʤÚÔ˘Ó ÛÙȘ ·ÚÓËÙÈΤ˜ ÌÂÙ·‚ÔϤ˜ ÙˆÓ ‰ÂÈÎÙÒÓ ˘Á›·˜. ¢Â‰Ô̤Ó˘ Ù˘ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ Ù˘ ÂÊ·ÚÌÔÁ‹˜ ÚÔÁÚ·ÌÌ¿ÙˆÓ ÂÎ·È‰Â˘ÙÈ΋˜ ·Ú¤Ì‚·Û˘ Û ̷ıËÙ¤˜ (17,18,21), ÎÚ›ÓÔÓÙ·È ·Ó·Áη›· Ô Û¯Â‰È·ÛÌfi˜ Î·È Ë ÂÊ·ÚÌÔÁ‹ ÂıÓÈ΋˜ ÔÏÈÙÈ΋˜ ÁÈ· ÙËÓ ÚÔ·ÁˆÁ‹ Ù˘ ˘Á›·˜ Î·È ÙËÓ ÚfiÏË„Ë Û ·ÚfiÌÔÈÔ Ï·›ÛÈÔ ‰Ú¿Û˘.

∂˘¯·ÚÈÛٛ˜ ∂˘¯·ÚÈÛÙԇ̠ıÂÚÌ¿ ÁÈ· ÙË ¯ÚËÌ·ÙÔ‰fiÙËÛË Ù˘ ÌÂϤÙ˘ ÙË °ÂÓÈ΋ °Ú·ÌÌ·Ù›· ∞ıÏËÙÈÛÌÔ‡, ÙÔ ÀÔ˘ÚÁÂ›Ô ¶·È‰Â›·˜ Î·È £ÚËÛÎÂ˘Ì¿ÙˆÓ, ÙÔ ¶·È‰·ÁˆÁÈÎfi πÓÛÙÈÙÔ‡ÙÔ, ÙËÓ ÂÙ·ÈÚ›· Kellogg’s, ηıÒ˜ Î·È ÙȘ ‰ËÌÔÙÈΤ˜ ·˘ÙÔ‰ÈÔÈ΋ÛÂȘ ÙˆÓ ¢‹ÌˆÓ ∞Á. ¡ÈÎÔÏ¿Ô˘, ƒÔ‡‚·, ÃÂÚÛÔÓ‹ÛÔ˘ Î·È ∏Ú·ÎÏ›Ԣ. ∂›Û˘, Û˘Ó¤‚·Ï·Ó ·ÔÙÂÏÂÛÌ·ÙÈο ÔÈ Û˘ÓÂÚÁ¿Ù˜: ÃÚ‹ÛÙÔ˜ ÷Ù˙‹˜, ∂ÈÚ‹ÓË ª¿ÚηÙ˙Ë, πˆ¿ÓÓ· ªÔÛ¯·Ó‰Ú¤·, ªÈ¯¿Ï˘ ∫˘Úȷο΢, ™ÔÊ›· ºÏÔ˘Ú‹, ª·Ú›· ªÈÙÛÒÚË, πˆ¿ÓÓ· ∞ÔÛÙÔÏ¿ÎË, ºÚfiÛˆ ªÂÚ‚·Ó¿ÎË Î·È Caroline Codrington.

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14. ∫·Ê¿ÙÔ˜ ∞, ∫ˆÓÛÙ·ÓÙÈÓ¿ÎÔ˜ ¶, ¶··‰¿Î˘ ∂, £ÂÔ‰ÒÚÔ˘ Ã. ŒÏÂÁ¯Ô˜ ·ÂÚfi‚È·˜ ÈηÓfiÙËÙ·˜ ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ ËÏÈΛ·˜ 12-14 ¯ÚfiÓˆÓ. ¶·È‰È·ÙÚÈ΋ 1992;55:249-257.

15. ªÈÙÛÒÚË ª, ¡Â¿Ú¯Ô˘ ∞, ∫·˙Ì·Ù˙‹ µ, ª·Ï·ıÚ¿ÎË ª, ∫ÔÏ˘‰¿ÎË-™˘Úȉ¿ÎË ª, ƒÂÌÂÏ¿Î˘ µ Î·È Û˘Ó. ¶·È‰È·ÙÚÈ΋ 2007;70:205-216

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ORIGINAL ARTICLE

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¶ÔÛÔÙÈÎfi˜ ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù˘ C-·ÓÙȉÚÒÛ·˜ ÚˆÙ½Ó˘ ÛÙÔ ·›Ì· ÓÂÔÁÓÒÓ - ™˘ÁÎÚÈÙÈ΋ ÌÂϤÙË ‰‡Ô ÌÂıfi‰ˆÓ ∏. ÷Ù˙ËȈ·ÓÓ›‰Ë˜, ∞. ¡·Ô‡Ì, °. MËÙÛÈ¿ÎÔ˜, Ã. ∆۷ηϛ‰Ë˜, ¢. °. °Ô˘Ï‹˜, ¡. ¡ÈÎÔÏ·˝‰Ë˜ ¶ÂÚ›ÏË„Ë ∂ÈÛ·ÁˆÁ‹: ∏ ıÔψÛÈÌÂÙÚÈ΋ (£√§) ̤ıÔ‰Ô˜ ̤ÙÚËÛ˘ Ù˘ C-·ÓÙȉÚÒÛ·˜ ÚˆÙ½Ó˘ (CRP) ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÌÂÁ¿ÏË Ú·ÎÙÈÎfiÙËÙ·, ηıÒ˜ ‰ÂÓ ··ÈÙÂ›Ù·È ÂÚÁ·ÛÙ‹ÚÈÔ, ‰ÈÂÓÂÚÁÂ›Ù·È Ì ϋ„Ë Ôχ ÌÈÎÚ‹˜ ÔÛfiÙËÙ·˜ ÙÚȯoÂȉÈÎÔ‡ ·›Ì·ÙÔ˜ Î·È ÙÔ ·ÔÙ¤ÏÂÛÌ· Â›Ó·È ‰È·ı¤ÛÈÌÔ Û Ôχ ÌÈÎÚfi ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·. ™ÎÔfi˜ Ù˘ ÂÚÁ·Û›·˜ ‹Ù·Ó Ë Û‡ÁÎÚÈÛË Ù˘ ·ÍÈÔÈÛÙ›·˜ Ù˘ £√§ ÌÂıfi‰Ô˘ ̤ÙÚËÛ˘ Ù˘ CRP Ì ·˘Ù‹ Ù˘ ÓÂÊÂÏÔÌÂÙÚÈ΋˜ ÌÂıfi‰Ô˘ (¡∂º). ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ∏ ÌÂϤÙË ÂͤٷÛ 163 ‰Â›ÁÌ·Ù· Ï‹ÚÔ˘˜ ·›Ì·ÙÔ˜ ·fi 79 ÓÂÔÁÓ¿, Ù· ÔÔ›· ÓÔÛËχıËÎ·Ó ÛÙË µ’ ªÔÓ¿‰· ∂ÓÙ·ÙÈ΋˜ ¡ÔÛËÏ›·˜ ¡ÂÔÁÓÒÓ ÙÔ˘ A.¶.£. ∏ CRP ÌÂÙÚ‹ıËΠ۠97 ‰Â›ÁÌ·Ù· ·›Ì·ÙÔ˜ ηıÈÂڈ̤Ó˘ ·Ú·ÎÔÏÔ‡ıËÛ˘ (65 ÓÂÔÁÓ¿, ÔÌ¿‰· ∞) Î·È Û 66 ‰Â›ÁÌ·Ù· ·›Ì·ÙÔ˜ ÓÂÔÁÓÒÓ Ì ÎÏÈÓÈ΋ ÂÈÎfiÓ· ‡ÔÙË ÁÈ· Ïԛ̈ÍË (43 ÓÂÔÁÓ¿, ÔÌ¿‰· µ). √ £√§ ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù˘ CRP ‰ÈÂÓÂÚÁ‹ıËΠÛÙËÓ ÎÏÈÓÈ΋ ·fi ÙÔ ÚÔÛˆÈÎfi Ù˘ ÌÔÓ¿‰·˜ Î·È ¤ÁÈÓ Ì ÙËÓ Ù¯ÓÈ΋ Quick Read System, ÂÓÒ Ô ¡∂º Ì ÓÂÊÂÏfiÌÂÙÚÔ Ù˘ ÂÙ·ÈÚ›·˜ µeckman ÛÙÔ ÂÚÁ·ÛÙ‹ÚÈÔ ÙÔ˘ ÓÔÛÔÎÔÌ›Ԣ. ∞ÔÙÂϤÛÌ·Ù·: ¢È·ÈÛÙÒıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÌÂٷ͇ ÙˆÓ ÂÈ¤‰ˆÓ CRP Ì ÙË £√§ Î·È ¡∂º ̤ıÔ‰Ô (18,7±22,6 mg/l ¤Ó·ÓÙÈ 14,9±20,7 mg/l, ·ÓÙ›ÛÙÔȯ·, p<0,001). √È £√§ Î·È ¡∂º ̤ıÔ‰ÔÈ ‚Ú›ÛÎÔÓÙ·Ó Û ÈÛ¯˘Ú¿ ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË (r2=0,8935, p<0,001). ™ÙËÓ ·Ó¿Ï˘ÛË Bland-Altman ‰È·ÈÛÙÒıËΠ˘ÂÚÂÎÙ›ÌËÛË Ù˘ CRP Ì ÙË £√§ ̤ıÔ‰Ô Û ۯ¤ÛË Ì ÙË ¡∂º ÛÙËÓ ÂÚÈÔ¯‹ ÙÈÌÒÓ Ì¤¯ÚÈ 40 mg/l. ªÂ Ô˘‰fi Ù· 11 mg/l, Ë Â˘·ÈÛıËÛ›· Î·È Ë ÂȉÈÎfiÙËÙ· Ù˘ £√§ ÌÂıfi‰Ô˘ ‹Ù·Ó 93% Î·È 55%, ·ÓÙ›ÛÙÔȯ· Û ۯ¤ÛË Ì ÙË ıÂÙÈ΋ ·ÈÌÔηÏÏȤÚÁÂÈ·. ™˘ÌÂÚ¿ÛÌ·Ù·: √ ÁÚ‹ÁÔÚÔ˜ ˘ÔÏÔÁÈÛÌfi˜ Ù˘ CRP Ì ÙË £√§ ̤ıÔ‰Ô Ê·›ÓÂÙ·È ˆ˜ Â›Ó·È ·ÍÈfiÈÛÙÔ˜, ηıÒ˜ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ˘„ËÏ‹ ¢·ÈÛıËÛ›· Î·È ·ÚÓËÙÈ΋ ÚÔÁÓˆÛÙÈ΋ ·Í›·.

µ’ ªÔÓ¿‰· ∂ÓÙ·ÙÈ΋˜ ¡ÔÛËÏ›·˜ ¡ÂÔÁÓÒÓ ∞¶£, °¶¡ “¶··ÁˆÚÁ›Ô˘”, £ÂÛÛ·ÏÔÓ›ÎË AÏÏËÏÔÁÚ·Ê›·: ∏. ÷Ù˙ËȈ·ÓÓ›‰Ë˜ hatziel@med.auth.gr ∫·ÈÛ·Ú›·˜ 52, T.K. 54454, £ÂÛÛ·ÏÔÓ›ÎË

§¤ÍÂȘ ÎÏÂȉȿ: C-·ÓÙȉÚÒÛ· ÚˆÙ½ÓË, ıÔψÛÈÌÂÙÚÈ΋ ̤ıÔ‰Ô˜, ÓÂÊÂÏÔÌÂÙÚ›·.

Quantitative determination of C-reactive protein in the blood of neonates - Comparative study of two methods H. Chatziioannidis, A. Naoum, G. Mitsiakos, C. Tsakalidis, D. G. Goulis, N. Nikolaidis Abstract Background: The turbidometric (TUR) method of measurement of C-reactive protein (CRP) is characterized by practicality, since it can be carried out at the bedside, it requires a very small quantity of blood and the result is available within a very short period of time. The aim of this study was to compare the TUR method of CRP measurement with that of nephelometry (NEP).

Methods: The study included 163 samples of whole blood from 79 neonates hospitalized in the 2nd Unit of Neonatal Intensive Care of the Aristotle University of Thessaloniki. The CRP was measured in 97 samples of blood as a routine examination (65 neonates, group A), and in 66 samples from neonates with possible or suspected sepsis (43 neonates, group B). The TUR determination of CRP was performed by the Quick Read System, and the NEP determination using the Beckman nephelometer.

Results: A statistically significant difference was observed between the mean CRP levels measured by the TUR and NEP methods (18.7±22.6 mg/l versus 14.9±20.7 mg/l respectively, p<0.001). The TUR and NEP methods were found to have a strong positive correlation (r2=0.945, p<0.001). On Bland-Altman analysis a CRP over-estimate was noted with the TUR method compared with the NEP, for levels of up to 40 mg/l. With a threshold of 11 mg/l the sensitivity and specificity of the TUR method were 93% and 55% respectively, compared to positive blood culture.

Conclusions: Fast CRP determination with the TUR method appears to be reliable, as it is characterized by high sensitivity and a negative predictive value.

2nd Unit of Neonatal Intensive Care, Aristotle University of Thessaloniki, General Hospital “Papageorgiou”, Thessaloniki Correspondence: H. Chatziioannidis hatziel@med.auth.gr 52, Kesarias St., 54454 Thessaloniki

Key words: C-reactive protein, turbidometric method, nephelometry.

¶·È‰È·ÙÚÈ΋ 2007;70:217-220

Pediatri May-Jun 07

24-05-07

17:58

™ÂÏ›‰·218

218

∏. ÷Ù˙ËȈ·ÓÓ›‰Ë˜ Î·È Û˘Ó.

∂ÈÛ·ÁˆÁ‹ √È ÚˆÙ½Ó˜ ÔÍ›·˜ Ê¿Û˘, fiˆ˜ Ë C-·ÓÙȉÚÒÛ· ÚˆÙ½ÓË (C-reactive protein, CRP), Ë ·1-Ô͢ÁÏ˘ÎÔÚˆÙ½ÓË, ÙÔ ∞-·Ì˘ÏÔÂȉ¤˜ ÙÔ˘ ÔÚÔ‡, Ë ÛÂÚÔ˘ÏÔÏ·ÛÌ›ÓË, Ù· C3 Î·È C4 ÎÏ¿ÛÌ·Ù· ÙÔ˘ Û˘ÌÏËÚÒÌ·ÙÔ˜, Ë ·1-·ÓÙÈıÚ˘„›ÓË, Ë ·ÙÔÛÊ·ÈÚ›ÓË Î·È ÙÔ ÈÓˆ‰ÔÁfiÓÔ ÔÓÔÌ¿ÛıËÎ·Ó ¤ÙÛÈ ÁÈ·Ù› Ë ·‡ÍËÛ‹ ÙÔ˘˜ Á›ÓÂÙ·È Ù·¯‡Ù·Ù·, Û˘¯Ó¿ ÚÈÓ ÔÏÔÎÏËÚˆı› Ë ÎÏÈÓÈ΋ Î·È ÂÚÁ·ÛÙËÚȷ΋ ÂÈÎfiÓ· Ù˘ ·ıÔÏÔÁÈ΋˜ ‰ÈÂÚÁ·Û›·˜ Ô˘ ÚÔοÏÂÛ ÙËÓ ·Ú·ÁˆÁ‹ ÙÔ˘˜. ∂Ô̤ӈ˜, Ë ‰˘Ó·ÙfiÙËÙ· ÁÚ‹ÁÔÚÔ˘ Î·È Â‡ÎÔÏÔ˘ ÚÔÛ‰ÈÔÚÈÛÌÔ‡ ÙˆÓ ÂÈ¤‰ˆÓ ÙÔ˘˜ ‰È¢ÎÔχÓÂÈ Ôχ ÙË ‰È¿ÁÓˆÛË ·ÏÏ¿ Î·È ÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË ÙfiÛÔ ÙˆÓ ÂÓËϛΈÓ, fiÛÔ Î·È ÙˆÓ ÓÂÔÁÓÒÓ (1). ∏ CRP ıˆÚÂ›Ù·È Ë Î˘ÚÈfiÙÂÚË ÂÎÚfiÛˆÔ˜ ÙˆÓ ÚˆÙÂ˚ÓÒÓ ÔÍ›·˜ Ê¿Û˘ ηıÒ˜ ·˘Í¿ÓÂÙ·È Ù·¯‡ÙÂÚ· Î·È ÂÚÈÛÛfiÙÂÚÔ ·fi ÙȘ ¿ÏϘ, Â·Ó¤Ú¯ÂÙ·È ‰Â ÛÙ· Ê˘ÛÈÔÏÔÁÈο Â›‰· Ôχ ÁÚ‹ÁÔÚ· ÌÂÙ¿ ÙËÓ ¿ÚÛË ÙÔ˘ ·ÈÙ›Ô˘ Ô˘ ÚÔοÏÂÛ ÙËÓ ·‡ÍËÛ‹ Ù˘. Œ¯ÂÈ ÌÔÚÈ·Îfi ‚¿ÚÔ˜ 106 kDa ÂÚ›Ô˘ Î·È ‚Ú›ÛÎÂÙ·È ËÏÂÎÙÚÔÊÔÚËÙÈο ÛÙËÓ ÂÚÈÔ¯‹ ÙˆÓ Á-ÛÊ·ÈÚÈÓÒÓ (2). ∏ CRP ıˆÚÂ›Ù·È Â˘·›ÛıËÙÔ˜ ‰Â›ÎÙ˘ Ïԛ̈͢, ·ÏÏ¿ ÌË ÂȉÈÎfi˜, ηıÒ˜ ·˘Í¿ÓÂÙ·È Û ÊÏÂÁÌÔÓÒ‰ÂȘ ηٷÛÙ¿ÛÂȘ, ˘ÔÍ›·, Ì·È¢ÙÈΤ˜ ηÎÒÛÂȘ, ÂÚÈÁÂÓÓËÙÈ΋ ·ÛÊ˘Í›· Î·È ÂÈÛÚfiÊËÛË ÌËÎˆÓ›Ô˘ (3). ™ÙË ªÔÓ¿‰· ∂ÓÙ·ÙÈ΋˜ ¡ÔÛËÏ›·˜ ¡ÂÔÁÓÒÓ (ª∂¡¡) Ù˘ µã ¡ÂÔÁÓÔÏÔÁÈ΋˜ ∫ÏÈÓÈ΋˜ ∞.¶.£. ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÌÈ· ıÔψÛÈÌÂÙÚÈ΋ ̤ıÔ‰Ô˜ ÚÔÛ‰ÈÔÚÈÛÌÔ‡ Ù˘ CRP Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÌÂÁ¿ÏË Ú·ÎÙÈÎfiÙËÙ·, ηıÒ˜ ÂÎÙÂÏÂ›Ù·È ÛÙËÓ ›‰È· ÙË ªÔÓ¿‰· Ì ϋ„Ë Ôχ ÌÈÎÚ‹˜ ÔÛfiÙËÙ·˜ ÙÚȯÔÂȉÈÎÔ‡ ·›Ì·ÙÔ˜ Î·È ÙÔ ·ÔÙ¤ÏÂÛÌ· Â›Ó·È ‰È·ı¤ÛÈÌÔ Û Ôχ ÌÈÎÚfi ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·. ™ÎÔfi˜ ·˘Ù‹˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ë Û‡ÁÎÚÈÛË Ù˘ ıÔψÛÈÌÂÙÚÈ΋˜ ÌÂıfi‰Ô˘ (£√§) Ì ÙÔÓ ÎÏ·ÛÈÎfi ÙÚfiÔ ÚÔÛ‰ÈÔÚÈÛÌÔ‡ Ù˘ CRP Ì ÓÂÊÂÏfiÌÂÙÚÔ (¡∂º). ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ∏ ÌÂϤÙË ‹Ù·Ó ·Ó·‰ÚÔÌÈ΋. ¶ÂÚȤϷ‚ 163 ‰Â›ÁÌ·Ù· Ï‹ÚÔ˘˜ ·›Ì·ÙÔ˜ ·fi 79 ÓÂÔÁÓ¿, Ù· ÔÔ›· ÓÔÛËχıËÎ·Ó ÛÙË ª∂¡¡, ·fi ÙÔÓ ∞Ú›ÏÈÔ ¤ˆ˜ ÙÔÓ ™Â٤̂ÚÈÔ 2004. ∏ CRP ÌÂÙÚ‹ıËΠ۠97 ‰Â›ÁÌ·Ù· ·›Ì·ÙÔ˜ ˆ˜ ÚÔ˘Ù›Ó· (√Ì¿‰· ∞: n=65) Î·È Û 66 ‰Â›ÁÌ·Ù· ·›Ì·ÙÔ˜ ÓÂÔÁÓÒÓ Ì ÎÏÈÓÈ΋ ÂÈÎfiÓ· ‡ÔÙË ÁÈ· Ïԛ̈ÍË (OÌ¿‰· µ, n=43). ∂ÈÎfiÓ· ‡ÔÙË ÁÈ· Ïԛ̈ÍË ıˆڋıËÎÂ Ë ·ÚÔ˘Û›· ÙÔ˘Ï¿¯ÈÛÙÔÓ ‰‡Ô ‹ ÂÚÈÛÛÔÙ¤ÚˆÓ ÎÏÈÓÈÎÒÓ ÛËÌ›ˆÓ ·fi: (·) ÙÔ Ó¢ÚÈÎfi Û‡ÛÙËÌ· (˘ÔÙÔÓ›·, Ï‹ı·ÚÁÔ˜, Û·ÛÌÔ›), (‚) ÙÔ ·Ó·Ó¢ÛÙÈÎfi Û‡ÛÙËÌ· (·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ·, ¿ÓÔÈ·, Ù·¯‡ÓÔÈ·, ΢¿ÓˆÛË), (Á) ÙÔ Î·Ú‰È·ÁÁÂÈ·Îfi Û‡ÛÙËÌ· (‚Ú·‰˘Î·Ú‰›·, Ù·¯˘Î·Ú‰›·, ˘fiÙ·ÛË), (‰) ÙÔ ÂÙÈÎfi Û‡ÛÙËÌ· (‰˘Û·ÓÂÍ›· ÛÙË Û›ÙÈÛË, ÌÂÙˆÚÈÛÌfi˜) Î·È Â) ÙË ıÂÚÌÔÚ‡ıÌÈÛË (˘ÔıÂÚÌ›·, ˘ÂÚıÂÚÌ›·). ∆· Â›‰· Ù˘ CRP ÚÔÛ‰ÈÔÚ›ÛıËÎ·Ó ÙfiÛÔ Ì ÙË £√§ ̤ıÔ‰Ô, fiÛÔ Î·È Ì ÙË ¡∂º, ˆ˜ ̤ıÔ‰Ô ·Ó·ÊÔÚ¿˜ Û fiÏ· Ù· ‰Â›ÁÌ·Ù·. ∂ÈÚfiÛıÂÙ·, ηÏÏȤÚÁÂȘ ·›Ì·ÙÔ˜, Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ˆ˜ ‰Â‡ÙÂÚË Ì¤ıÔ‰Ô˜ ·Ó·ÊÔÚ¿˜, ÂÏ‹ÊıËPaediatriki 2007;70:217-220

Û·Ó Û 37 ÂÚÈÙÒÛÂȘ ·fi 28 ÓÂÔÁÓ¿ Ù˘ ÔÌ¿‰·˜ ∞ Î·È Û 45 ÂÚÈÙÒÛÂȘ ·fi 34 ÓÂÔÁÓ¿ Ù˘ ÔÌ¿‰·˜ µ. √ £√§ ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù˘ CRP ¤ÁÈÓ Ì ÙËÓ Ù¯ÓÈ΋ Quick Read System (√RION Diagnostica, Espoo, Finland). ¶ÚfiÎÂÈÙ·È ÁÈ· Ù·¯Â›· ̤ıÔ‰Ô ‰È¿ÚÎÂÈ·˜ 2,5 ÏÂÙÒÓ, Ô˘ ÛÙËÚ›˙ÂÙ·È ÛÙË Û‡Ó‰ÂÛË Ù˘ CRP Ì ÌÔÓÔÎψÓÈÎfi ·Óٛۈ̷, Ì ÙÔ ÔÔ›Ô ÂÂÓ‰‡ÂÈ ÌÈÎÚÔۈ̷ٛ‰È· latex. ∏ ÌÂÙ·‚ÔÏ‹ Ù˘ ıÔÏÂÚfiÙËÙ·˜ ÌÂÙ¿ ÙË Û‡Ó‰ÂÛË ÌÂÙÚ¿Ù·È Ì ÂȉÈÎfi fiÚÁ·ÓÔ. √ fiÁÎÔ˜ ÙÔ˘ ·›Ì·ÙÔ˜ Ô˘ ··ÈÙÂ›Ù·È Â›Ó·È 20 Ìl Î·È ÙÔ Â‡ÚÔ˜ ̤ÙÚËÛ˘ ‚Ú›ÛÎÂÙ·È ÌÂٷ͇ 8 Î·È 160 mg/l. ™‡Ìʈӷ Ì ÙÔÓ Î·Ù·Û΢·ÛÙ‹, Ë Ì¤ıÔ‰Ô˜ ¤¯ÂÈ Û˘ÓÙÂÏÂÛÙ‹ ÌÂÙ·‚ÏËÙfiÙËÙ·˜ ÛÙËÓ ›‰È· ̤ÙÚËÛË (within-assay CV) 4,9% Î·È Û Â·Ó·Ï·Ì‚·ÓfiÌÂÓ˜ ÌÂÙÚ‹ÛÂȘ (between-assay CV) 8,3%. √ ¡∂º ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù˘ CRP (Ì ϋ„Ë ÔÚÔ‡ ·›Ì·ÙÔ˜) ¤ÁÈÓ Ì ÓÂÊÂÏfiÌÂÙÚÔ Ù˘ ÂÙ·ÈÚ›·˜ Beckman (withinassay CV 2,6% Î·È between-assay CV 3,0%) ÛÙÔ ‚ÈÔ¯ËÌÈÎfi ÂÚÁ·ÛÙ‹ÚÈÔ. √ ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù˘ CRP ÁÈÓfiÙ·Ó ÛÙËÓ ›‰È· ·ÈÌÔÏË„›· Ù·˘Ùfi¯ÚÔÓ· Î·È Ì ÙȘ ‰‡Ô ÌÂıfi‰Ô˘˜. ∏ ÂÂÍÂÚÁ·Û›· ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ ¤ÁÈÓ Ì ÙË ¯Ú‹ÛË ÙÔ˘ SPSS 11.5 for Windows (SPSS Inc., Chicago, Ill). ∆· ·ÔÙÂϤÛÌ·Ù· ÂÎÊÚ¿ÛÙËÎ·Ó ˆ˜ ̤Û˜ ÙÈ̤˜ Ì ÙȘ ÛÙ·ıÂÚ¤˜ ÙÔ˘˜ ·ÔÎÏ›ÛÂȘ (x±SD). °È· ÙË Û‡ÁÎÚÈÛË ÙˆÓ ÙÈÌÒÓ Ù˘ CRP ÌÂٷ͇ Ù˘ £√§ Î·È ¡∂º ÌÂıfi‰Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë ÌË ·Ú·ÌÂÙÚÈ΋ ̤ıÔ‰Ô˜ Wilcoxon Signed Rank test Î·È Ë ·Ó¿Ï˘ÛË BlandAltman, ÂÓÒ ÁÈ· ÙË Û‡ÁÎÚÈÛË ÙˆÓ ÔÛÔÛÙÈ·›ˆÓ ·Ó·ÏÔÁÈÒÓ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë ·ÎÚÈ‚‹˜ ‰ÔÎÈÌ·Û›· Fisher (Fisher’s exact test). ∆¤ÏÔ˜, ÚÔÛ‰ÈÔÚ›ÛıËÎ·Ó Î·Ì‡Ï˜ ROC (Receiver Operative Characteristics) ÙfiÛÔ ÁÈ· ÙË £√§, fiÛÔ Î·È ÁÈ· ÙË ¡∂º ̤ıÔ‰Ô, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÙËÓ Î·ÏÏȤÚÁÂÈ· ·›Ì·ÙÔ˜ ˆ˜ ̤ıÔ‰Ô ·Ó·ÊÔÚ¿˜. TÈÌ‹ p ÌÈÎÚfiÙÂÚË ·fi 0,05 ÔÚ›ÛÙËΠˆ˜ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ Û fiϘ ÙȘ ‰ÔÎÈ̷ۛ˜.

∞ÔÙÂϤÛÌ·Ù· ∞. ™‡ÁÎÚÈÛË ÙÈÌÒÓ CRP Ì £√§ Î·È ¡∂º ̤ıÔ‰Ô ¢È·ÈÛÙÒıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÌÂٷ͇ ÙˆÓ ÂÈ¤‰ˆÓ CRP Ì £√§ Î·È ¡∂º ÌÂıfi‰Ô˘˜ (18,7±22,6 mg/l ¤Ó·ÓÙÈ 14,9±20,7 mg/l, ·ÓÙ›ÛÙÔȯ·, Wilcoxon Signed Rank test, p<0,001). √È £√§ Î·È ¡∂º ̤ıÔ‰ÔÈ ‚Ú›ÛÎÔÓÙ·Ó Û ÈÛ¯˘Ú‹ ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË (Spearman’s rho, r2=0,945, p<0,001). ™ÙÔ ÁÚ¿ÊËÌ· ‰È·ÛÔÚ¿˜ Ë Â˘ı›· ·ÏÈÓ‰ÚfiÌËÛ˘ ÌÂٷ͇ ÙˆÓ ‰‡Ô ÌÂıfi‰ˆÓ ÚÔÛ‰ÈÔÚÈÛÌÔ‡ Ù˘ CRP ‰Â›¯ÓÂÈ ÙË ıÂÙÈ΋ Û¯¤ÛË (∂ÈÎfiÓ· 1). ™ÙËÓ ·Ó¿Ï˘ÛË Bland-Altman ‰È·ÈÛÙÒÓÂÙ·È ˘ÂÚÂÎÙ›ÌËÛË Ù˘ CRP Ì ÙË £√§ ̤ıÔ‰Ô Û ۯ¤ÛË Ì ÙË ¡∂º ̤ıÔ‰Ô ÛÙËÓ ÂÚÈÔ¯‹ ÙÈÌÒÓ Ì¤¯ÚÈ 40 mg/l („¢‰Ò˜ ıÂÙÈΤ˜ ÙÈ̤˜) (∂ÈÎfiÓ· 2). µ. ™‡ÁÎÚÈÛË £√§ Î·È ¡∂º ÌÂıfi‰ˆÓ Ì ÙËÓ Î·ÏÏȤÚÁÂÈ· ·›Ì·ÙÔ˜ ™ÙËÓ ÔÌ¿‰· ∞ Ë CRP ‚Ú¤ıËΠ·˘ÍË̤ÓË (>10 mg/l) Û 45 ‰Â›ÁÌ·Ù· Ì ÙË £√§ ̤ıÔ‰Ô Î·È Û 15 ‰Â›ÁÌ·Ù· Ì ÙË ¡∂º ̤ıÔ‰Ô, ÂÓÒ ÛÙËÓ ÔÌ¿‰· µ Û 36 Î·È 18, ·ÓÙ›ÛÙÔȯ·. ™Ë„·ÈÌ›· Ì ıÂÙÈ΋ ηÏÏȤÚÁÂÈ· ·›Ì·ÙÔ˜ ‰È·ÈÛÙÒıËΠ۠6 ÓÂÔÁÓ¿ Ù˘ ÔÌ¿‰·˜ ∞ Î·È 8 ÓÂÔÁÓ¿ Ù˘ ÔÌ¿‰·˜ µ. ÀÔÏÔÁ›ÛıËΠfiÙÈ Ë CRP-£√§ ¤¯ÂÈ Â˘·ÈÛıËÛ›· 93% (13/14) Î·È ÂȉÈÎfiÙËÙ· 56% (38/68) ¤Ó·ÓÙÈ Ù˘

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™‡ÁÎÚÈÛË ‰˘Ô ÌÂıfi‰ˆÓ ÚÔÛ‰ÈÔÚÈÛÌÔ‡ Ù˘ CRP

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ÙÔ˜ ˆ˜ ̤ıÔ‰Ô ·Ó·ÊÔÚ¿˜ (Area Under Curve= 0,782), ‰È·ÈÛÙÒıËΠfiÙÈ Ô ‚¤ÏÙÈÛÙÔ˜ Ô˘‰fi˜ Ù˘ £√§ ÌÂıfi‰Ô˘ ˆ˜ ÚÔ˜ ÙË ‰È¿ÁÓˆÛË ÌÈ·˜ Ïԛ̈͢ Â›Ó·È Ù· 11 mg/l (∂ÈÎfiÓ· 3). ™ÙÔÓ Ô˘‰fi ·˘Ùfi, Ë Â˘·ÈÛıËÛ›· Î·È Ë ÂȉÈÎfiÙËÙ· Ù˘ £√§ ÌÂıfi‰Ô˘ Â›Ó·È 93% Î·È 55%, ·ÓÙ›ÛÙÔȯ·. ŒÓ·Ó ÂÓ·ÏÏ·ÎÙÈÎfi Ô˘‰fi ·ÔÙÂÏÔ‡Ó Ù· 14 mg/l. ™ÙÔÓ Ô˘‰fi ·˘Ùfi, Ë Â˘·ÈÛıËÛ›· Î·È Ë ÂȉÈÎfiÙËÙ· Ù˘ £√§ ÌÂıfi‰Ô˘ Â›Ó·È 71% Î·È 63%, ·ÓÙ›ÛÙÔȯ·.

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CRP - £√§ (mg/l)

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y = 0,864 x - 1,213 R2 = 0,8935

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20

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60 80 100 120 CRP - ¡∂º (mg/l)

140

160

∂ÈÎfiÓ· 1. ™˘Û¯¤ÙÈÛË ÙÈÌÒÓ Ù˘ CRP Ì ¡∂º Î·È £√§ ̤ıÔ‰Ô.

ηÏÏȤÚÁÂÈ·˜, ÂÓÒ Ë CRP-¡∂º 72% (10/14) Î·È 82% (56/68), ·ÓÙ›ÛÙÔȯ·. H ıÂÙÈ΋ ÚÔÁÓˆÛÙÈ΋ ·Í›· (PPV) Ù˘ CRP-£√§ Â›Ó·È 30% (13/43) Î·È Ë ·ÚÓËÙÈ΋ ÚÔÁÓˆÛÙÈ΋ ·Í›· (NPV) 97% (38/39), ÂÓÒ Ù˘ CRP-¡∂º 46% (10/22) Î·È 94% (56/60), ·ÓÙ›ÛÙÔȯ·. √ ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù˘ CRP Ì £√§ Î·È ¡∂º ÌÂıfi‰Ô˘˜ ‰ÂÓ ·ÚÔ˘Û›·˙ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ˆ˜ ÚÔ˜ ÙËÓ Â˘·ÈÛıËÛ›·, PPV Î·È NPV. ∞ÓÙ›ıÂÙ·, ˆ˜ ÚÔ˜ ÙËÓ ÂȉÈÎfiÙËÙ· ‚Ú¤ıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ (Fisher’s exact test, p<0,001).

™˘˙‹ÙËÛË ∏ ̤ÙÚËÛË Ù˘ CRP Û ÊÏÂÁÌÔÓÒ‰ÂȘ ηٷÛÙ¿ÛÂȘ ÌÔÚ› Ó· ¯ÚËÛÈÌÔÔÈËı› ˆ˜ ¢·›ÛıËÙÔ˜ ‰Â›ÎÙ˘ Ù˘ ÓfiÛÔ˘, Ù˘ ·ÓÙ·fiÎÚÈÛ˘ ÛÙË ıÂÚ·›· ·ÏÏ¿ Î·È Ù˘ Ïԛ̈͢ ÙÔ˘ ÓÂÔÁÓÔ‡ (4). ∏ ÂÎÙ›ÌËÛË Ù˘ CRP Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ ¯Ú‹ÛÈÌË ÛÙË ‰È¿ÁÓˆÛË Ù˘ Ïԛ̈͢ ÌÂÙ¿ ·fi Â·Ó·Ï·Ì‚·ÓfiÌÂÓ˜ ÌÂÙÚ‹ÛÂȘ (5). °ÓˆÚ›˙ÔÓÙ·˜ fiÙÈ ·˘Í¿ÓÂÙ·È ÌÂÙ¿ ·fi 4 ¤ˆ˜ 6 ÒÚ˜ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ÓfiÛÔ˘, ı· Ú¤ÂÈ Ó· ‰ÈÂÓÂÚÁÂ›Ù·È ÙÔ˘Ï¿¯ÈÛÙÔÓ Ì›· ‰Â‡ÙÂÚË Ì¤ÙÚËÛË ÌÂÙ¿ ·fi ÌÂÚÈΤ˜ ÒÚ˜, ȉȷ›ÙÂÚ· ·Ó Ë ÚÒÙË Ì¤ÙÚËÛË ¤‰ˆÛ ÔÚÈ·Îfi ·ÔÙ¤ÏÂÛÌ· (2,6). ∏ ¡∂º Â›Ó·È Ë Ì¤ıÔ‰Ô˜ ÂÎÏÔÁ‹˜ ÁÈ· ÙË Ì¤ÙÚËÛË Ù˘ CRP ÁÈ·Ù› Â›Ó·È Â˘·›ÛıËÙË Î·È ·ÎÚÈ‚‹˜ (7). ∞·ÈÙ› fï˜ ÂÍÔÏÈÛÌfi Î·È ÂȉÈο ÂÎ·È‰Â˘Ì¤ÓÔ ÚÔÛˆÈÎfi Î·È ÔÚÁ·ÓˆÌ¤ÓÔ ÂÚÁ·ÛÙ‹ÚÈÔ. ∂ÈÚfiÛıÂÙ·, ÔÏϤ˜ ÊÔÚ¤˜ Ô ¯ÚfiÓÔ˜ Ô˘ ··ÈÙÂ›Ù·È ÁÈ· ÙËÓ ·Ú·Ï·‚‹ ÙÔ˘ ·ÔÙÂϤÛÌ·ÙÔ˜ ÌÔÚ› Ó· Â›Ó·È ÛËÌ·ÓÙÈÎfi˜ ÁÈ· ÙȘ ·ÔÊ¿ÛÂȘ Ô˘ Ú¤ÂÈ Ó· ÏËÊıÔ‡Ó Û ÓÂÔÁÓ¿ Ì ΛӉ˘ÓÔ ÛË„·ÈÌ›·˜. ∞fi ÙËÓ ¿ÏÏË ÌÂÚÈ¿, Ë ÂÊ·ÚÌÔÁ‹ Ù˘ £√§ ÌÂıfi‰Ô˘ Â›Ó·È Ù·¯‡Ù·ÙË (·ÔÙ¤ÏÂÛÌ·

°. ¶ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ô˘‰Ô‡ £√§ ÌÂıfi‰Ô˘ Û ۯ¤ÛË Ì ÙËÓ Î·ÏÏȤÚÁÂÈ· ·›Ì·ÙÔ˜ ∂Ê·ÚÌfi˙ÔÓÙ·˜ ÙË ‰È·‰Èηۛ· ROC ÁÈ· ÙË £√§ ̤ıÔ‰Ô Î·È ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÙËÓ Î·ÏÏȤÚÁÂÈ· ·›Ì·-

1,0

50 40 30

0,5

20 10 0

∂˘·ÈÛıËÛ›·

¢È¿ÊÔÚ· CRP £√§ Î·È ¡∂º ÌÂıfi‰ˆÓ

0,8

-10 -20 -30

0

20 40 60 80 100 120 140 160 180 ª¤ÛÔ˜ fiÚÔ˜ CRP £√§ Î·È ¡∂º ÌÂıfi‰ˆÓ

∂ÈÎfiÓ· 2. ∞Ó¿Ï˘ÛË Bland-Altman ÙˆÓ ÙÈÌÒÓ Ù˘ CRP Ì ¡∂º Î·È £√§ ̤ıÔ‰Ô.

0,3

0,0 0,0

0,3

0,5

0,8

1,0

1 - ∂ȉÈÎfiÙËÙ· ∂ÈÎfiÓ· 3. ROC ηÌ‡ÏË Ù˘ £√§ ÌÂıfi‰Ô˘ ÚÔÛ‰ÈÔÚÈÛÌÔ‡ Ù˘ CRP, Ì ÙËÓ Î·ÏÏȤÚÁÂÈ· ·›Ì·ÙÔ˜ ˆ˜ ̤ıÔ‰Ô ·Ó·ÊÔÚ¿˜. ¶·È‰È·ÙÚÈ΋ 2007;70:217-220

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220

∏. ÷Ù˙ËȈ·ÓÓ›‰Ë˜ Î·È Û˘Ó.

Û 3 ÏÂÙ¿), ¯ˆÚ›˜ Ó· ··ÈÙ› ÂȉÈÎfi ÂÍÔÏÈÛÌfi Î·È ÂÍÂȉÈÎÂ˘Ì¤ÓÔ ÚÔÛˆÈÎfi, ·ÏÏ¿ ‰ÂÓ Â›Ó·È ·fiÏ˘Ù· ÙÂÎÌËÚȈ̤ÓË Î·ıÒ˜ ÔÈ ÌÂϤÙ˜ Û‡ÁÎÚÈÛ˘ ¡∂º Î·È £√§ ÌÂıfi‰ˆÓ Â›Ó·È ÂÚÈÔÚÈṲ̂Ó˜ (1,7,8). ™ÙËÓ ÂÚÁ·Û›· ÙˆÓ Imad E. Makhoul Î·È S. Esposito Û ÓÂÔÁÓ¿ Î·È ·È‰È¿ ·ÓÙ›ÛÙÔȯ·, ·ÍÈÔÏÔÁ‹ıËÎÂ Ë Ì¤ÙÚËÛË Ù˘ CRP Ì £√§ ̤ıÔ‰Ô ˆ˜ ÈÛÔ‰‡Ó·ÌË Ù˘ ¡∂º ÌÂıfi‰Ô˘, ÂÓÒ Û ·˘Ù‹ Ù˘ °È·ÓÓ¿ÎÔ˘ ª. Î·È Û˘Ó. ‰È·ÈÛÙÒÓÂÙ·È Î·Ï‹ Û˘Ìʈӛ· ÌÂÙÚ‹ÛÂˆÓ ÌÂٷ͇ ÙˆÓ ‰‡Ô ÌÂıfi‰ˆÓ. ™ÙË ÌÂϤÙË ·˘Ù‹ Û˘ÁÎÚ›ıËÎÂ Ë £√§ ̤ıÔ‰Ô˜ ÚÔÛ‰ÈÔÚÈÛÌÔ‡ Ù˘ CRP Ì ·˘Ù‹ Ù˘ ¡∂º Î·È ‰È·ÈÛÙÒıËΠÈÛ¯˘Ú‹ ıÂÙÈ΋ ÁÚ·ÌÌÈ΋ Û˘Û¯¤ÙÈÛË. ¶·Ú¿ ÙË Û˘Û¯¤ÙÈÛË ·˘Ù‹, ÔÈ Ì¤ÛÔÈ fiÚÔÈ ÙˆÓ ÙÈÌÒÓ ÙˆÓ ‰‡Ô ÌÂıfi‰ˆÓ ‰È¤ÊÂÚ·Ó ÛËÌ·ÓÙÈο, Ì ÙË £√§ ̤ıÔ‰Ô Ó· ÂÌÊ·Ó›˙ÂÈ ˘„ËÏfiÙÂÚ˜ ÙÈ̤˜. °È’ ·˘Ùfi ÙÔÓ ÛÎÔfi ÂÊ·ÚÌfiÛ·Ì ÙËÓ ·Ó¿Ï˘ÛË Î·Ù¿ Bland-Altman, fiÔ˘ Û˘ÁÎÚ›ÓÔÓÙ·È ÔÈ ‰È·ÊÔÚ¤˜ ÙˆÓ ÙÈÌÒÓ ÙˆÓ ‰‡Ô ÌÂıfi‰ˆÓ Ì ÙÔÓ Ì¤ÛÔ fiÚÔ ÙÔ˘˜ Û fiÏÔ ÙÔ Ê¿ÛÌ· ÙÈÌÒÓ Ù˘ CRP. ∞fi ÙËÓ ·Ó¿Ï˘ÛË ·˘Ù‹ ‰È·ÈÛÙÒıËΠfiÙÈ ÁÈ· ÙÈ̤˜ CRP ÌÈÎÚfiÙÂÚ˜ ·fi 40 mg/l, Ë ¡∂º ̤ıÔ‰Ô˜ Û˘ÛÙËÌ·ÙÈο ˘ÂÚÂÎÙÈÌÔ‡Û ٷ ·ÔÙÂϤÛÌ·Ù·. π‰È·›ÙÂÚ· ¤¯ÂÈ ··Û¯ÔÏ‹ÛÂÈ ÙË ‚È‚ÏÈÔÁÚ·Ê›· Ë Û˘ÁΤÓÙÚˆÛË Ù˘ CRP ¿Óˆ ·fi ÙËÓ ÔÔ›· Ë Ïԛ̈ÍË ıˆÚÂ›Ù·È ‚·ÎÙËÚȷ΋. ∫·Ù¿ ÙÔ˘˜ ÂÚÈÛÛfiÙÂÚÔ˘˜ ÂÚ¢ÓËÙ¤˜ ÙÔ fiÚÈÔ Ù›ıÂÙ·È ÛÙ· 20 mg/l. ∫·Ù’ ¿ÏÏÔ˘˜ ÙÔ fiÚÈÔ ÙˆÓ 40 mg/l ·˘Í¿ÓÂÈ ÙËÓ Â˘·ÈÛıËÛ›· Î·È ÙËÓ ÂȉÈÎfiÙËÙ· Ù˘ ÌÂıfi‰Ô˘ (6). ™ÙË ‰È΋ Ì·˜ ÌÂϤÙË, ÛÙË ROC ·Ó¿Ï˘ÛË ÁÈ· ÙË £√§ ̤ıÔ‰Ô, ˆ˜ ‚¤ÏÙÈÛÙÔ˜ Ô˘‰fi˜ ˆ˜ ÚÔ˜ ÙË ‰È¿ÁÓˆÛË Ù˘ Ïԛ̈͢ Û ۇÁÎÚÈÛË Ì ÙË ıÂÙÈ΋ ηÏÏȤÚÁÂÈ· ·›Ì·ÙÔ˜ ‚Ú¤ıËΠÙÈÌ‹ CRP 11 mg/l. ™ÙÔÓ Ô˘‰fi ·˘Ùfi ˘‹Ú¯Â ¢·ÈÛıËÛ›· 93% Î·È ÂȉÈÎfiÙËÙ· 55%. ŸÙ·Ó Ô Ô˘‰fi˜ ÙÔÔıÂÙ‹ıËΠÛÙ· 14 mg/l, Ë Â˘·ÈÛıËÛ›· Î·È Ë ÂȉÈÎfiÙËÙ· Ù˘ £√§ ÌÂıfi‰Ô˘ ‹Ù·Ó 71% Î·È 63%, ·ÓÙ›ÛÙÔȯ·. £ÂˆÚԇ̠fiÙÈ ÛÙÔ ÎÏÈÓÈÎfi Â›Â‰Ô ı· Ú¤ÂÈ Ó· ÂÊ·ÚÌfi˙ÂÙ·È Ô Ô˘‰fi˜ ÙˆÓ 11 mg/l ηıÒ˜ Â›Ó·È ÚÔÙÈÌfiÙÂÚË Ë ¤Ó·ÚÍË ıÂÚ·›·˜ Û ·Ô˘Û›· ÛË„·ÈÌ›·˜ ·fi ÙȘ Û˘Ó¤ÂȘ ÌË ¯ÔÚËÁÔ‡ÌÂÓ˘ ·ÁˆÁ‹˜ Û ÓÂÔÁÓfi Ì ·ÚÔ˘Û›· ÛÔ‚·Ú‹˜ Ïԛ̈͢ (2). ∏ ·ÚÓËÙÈ΋ ÚÔÁÓˆÛÙÈ΋ ·Í›· (NPV) Î·È Ì ÙȘ ‰‡Ô ÌÂıfi‰Ô˘˜ Î˘Ì¿ÓıËΠ۠˘„ËÏ¿ Â›‰·. ∏

Paediatriki 2007;70:217-220

˘„ËÏ‹ NPV ÛËÌ·›ÓÂÈ fiÙÈ ·Ó ÙÔ ·ÔÙ¤ÏÂÛÌ· Ù˘ ÂͤٷÛ˘ Â›Ó·È ·ÚÓËÙÈÎfi, Ë Èı·ÓfiÙËÙ· ‡·Ú͢ Ïԛ̈͢ Â›Ó·È ÌÈÎÚ‹. ∆Ô ÁÂÁÔÓfi˜ ·˘Ùfi ‚ÔËı¿ ÛÙÔÓ ·ÔÎÏÂÈÛÌfi Ù˘ Ïԛ̈͢ Ì Â·ÎfiÏÔ˘ıÔ ÙËÓ ÂÏ¿ÙÙˆÛË Ù˘ ¯Ú‹Û˘ ÙˆÓ ·ÓÙÈ‚ÈÔÙÈÎÒÓ (9). ™˘ÌÂÚ·ÛÌ·ÙÈο, ÛÙ· ÓÔÛÔÎÔÌÂȷο ÂÚÁ·ÛÙ‹ÚÈ·, ·ÎfiÌË ÎÈ ·Ó ‰È·Ù›ıÂÙ·È ÓÂÊÂÏfiÌÂÙÚÔ, ¯ÚÂÈ¿˙ÂÙ·È Ó· ˘¿Ú¯ÂÈ Î·È ÌÈ· ¿ÏÏË ·ÏÔ‡ÛÙÂÚË Î·È Ù·¯‡ÙÂÚË Ù¯ÓÈ΋. √ ÁÚ‹ÁÔÚÔ˜ ˘ÔÏÔÁÈÛÌfi˜ Ù˘ CRP Ì ÙË £√§ ̤ıÔ‰Ô ¯ˆÚ›˜ ·ÈÌÔÏË„›· Û ÙÚȯÔÂȉÈÎfi ·›Ì· Ê·›ÓÂÙ·È ˆ˜ Â›Ó·È ·ÍÈfiÈÛÙÔ˜, ηıÒ˜ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ˘„ËÏ‹ ¢·ÈÛıËÛ›· Î·È ·ÚÓËÙÈ΋ ÚÔÁÓˆÛÙÈ΋ ·Í›·. ∏ £√§ ̤ıÔ‰Ô˜ ·Ó·Ì¤ÓÂÙ·È Ó· Ô‰ËÁ‹ÛÂÈ Û ÂÏ¿ÙÙˆÛË ÙÔ˘ ÎfiÛÙÔ˘˜ ÓÔÛËÏ›·˜ ηıÒ˜ ÂÚÈÔÚ›˙ÂÈ ÛËÌ·ÓÙÈο ÙȘ ÂÚÁ·ÛÙËÚȷΤ˜ ÂÍÂÙ¿ÛÂȘ ηÈ, ÙÔ ÛËÌ·ÓÙÈÎfiÙÂÚÔ, Ô‰ËÁ› Û ÏÔÁÈ΋ ¯ÔÚ‹ÁËÛË ÙˆÓ ·ÓÙÈ‚ÈÔÙÈÎÒÓ.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Makhoul IR, Smolkin T, Zinder O, Diamond E, ∆amir A, Sujov P. Fast bedside measurement of blood count and Creactive protein in neonates with suspected late-onset sespsis. Acta Paediatr 2005;94:960-963.

2. Jaye DL, Waites KB. Clinical applications of C-reactive protein in pediatrics. Pediatr Infect Dis J 1997;16:735-747.

3. ∆·Ú·ÓÙ˙‹ ¶, ∫Ô˘ÎÔ˘ÏÔÌ¿ÙË-ºÚ¿ÁÎÔ˘ ∂., ∫Ô˘Ú¿Î˘ °. ∏ C-·ÓÙȉÚÒÛ· ÚˆÙ½ÓË (CRP) ÛÙË ‰È¿ÁÓˆÛË ÓÂÔÁÓÈÎÒÓ ÏÔÈÌÒ͈Ó. ¶·È‰È·ÙÚÈ΋ 1989;52:226-230.

4. Stuart J, Whicher JT. Tests for detecting and monitoring the acute phase response. Arch Dis Child 1988;63:115-117.

5. Hengst JM. The role of C-reactive protein in the evaluation and management of infants with suspected sepsis.

Adv Neonatal Care 2003;3:3-13.

6. °È·ÓÓ¿ÎË-æÈÓ¿ÎË ª. C-·ÓÙȉÚÒÛ· ÚˆÙ½ÓË. ªÈÎÚÔ‚ÈÔÏÔÁ›· Î·È ∂ÚÁ·ÛÙËÚȷ΋ ¢È·ÁÓˆÛÙÈ΋ 1990;5:211-217.

7. °È·ÓÓ¿ÎË ª, µÔ˘Ó¿ÙÛÔ˘ ª, ∆ÛÈÏ¿ÎÔ˘ ™. ∞ÍÈÔÏfiÁËÛË ‰‡Ô ÁÚ‹ÁÔÚˆÓ Ù¯ÓÈÎÒÓ ÔÛÔÙÈÎÔ‡ ÚÔÛ‰ÈÔÚÈÛÌÔ‡ Ù˘ CRP Û Ï‹Ú˜ ·›Ì·. ªÈÎÚÔ‚ÈÔÏÔÁ›· Î·È ∂ÚÁ·ÛÙËÚȷ΋ ¢È·ÁÓˆÛÙÈ΋ 2001;6:177-181.

8. Esposito S, Tremolati E, Begliatti E, Bosis S, Gualtieri L, Principi N. Evaluation of a rapid bedside test for the quantitative determination of C-reactive protein. Clin Chem Lab Med 2005;43:438-440.

9. Mathai E, Christopher U, Mathai M, Jana AK, Rose D, Bergstrom S. Is C-reactive protein level useful in differentiating infected from uninfected neonates among those at risk of infection? Indian Pediatr 2004;41:895-900.

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∞ÍÈÔÏfiÁËÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ Ô˘ÚÔÏԛ̈͢ Û ÂÌ‡ÚÂÙ· ‚Ú¤ÊË ¯ˆÚ›˜ ÂÌÊ·Ó‹ ÂÛÙ›· Ïԛ̈͢ ™. ºÔ‡˙·˜, ∞. º·ÛÔ˘Ï‹, ¢. ∞‰·Ì›‰Ë˜, ∫. ∆˙ÂϤ˘, π. ª·ÎÔÔ‡ÏÔ˘, ∞. ¶··‰ÔÔ‡ÏÔ˘, ¢. ∑·ÊÂÈÚ·ÎfiÔ˘ÏÔ˜

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AÏÏËÏÔÁÚ·Ê›·: ™ˆÙ‹Ú˘ ºÔ‡˙·˜ sfouzas73@hotmail.com ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ °.¡. •¿Óı˘ ∆.∫. 671 00, ¡Â¿ÔÏË •¿Óı˘

∂ÈÛ·ÁˆÁ‹: √È Ô˘ÚÔÏÔÈÌÒÍÂȘ ·ÔÙÂÏÔ‡Ó Û˘¯Ófi ·›ÙÈÔ ÌÈÎÚԂȷ΋˜ ÓfiÛÔ˘ ÛÙË ‚ÚÂÊÈ΋ ËÏÈΛ·. ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ë ·ÍÈÔÏfiÁËÛË ÙˆÓ ˘ÔÛÊ·ÈÚ›ˆÓ ÛÙË ÌÈÎÚÔÛÎÔÈ΋ ÂͤٷÛË Ô‡ÚˆÓ, ÙˆÓ Ï¢ÎÒÓ ÛÙË ÁÂÓÈ΋ ÂͤٷÛË ·›Ì·ÙÔ˜, Ù˘ ∆∫∂ Î·È Ù˘ CRP, ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂÎÙÈÌËı› Ô Î›Ó‰˘ÓÔ˜ Ô˘ÚÔÏԛ̈͢ Û ÂÌ‡ÚÂÙ· ‚Ú¤ÊË ¯ˆÚ›˜ ÂÌÊ·Ó‹ ÂÛÙ›· Ïԛ̈͢. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ªÂÏÂÙ‹ıËÎ·Ó ·Ó·‰ÚÔÌÈο 115 ‚Ú¤ÊË ËÏÈΛ·˜ 15-90 ËÌÂÚÒÓ Ô˘ ÂÈÛ‹¯ıËÛ·Ó ÁÈ· ¤ÏÂÁ¯Ô ˘ÚÂÙÔ‡ ¯ˆÚ›˜ ÂÌÊ·Ó‹ ÂÛÙ›·. ™Â fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ ›¯Â Á›ÓÂÈ Ï‹Ú˘ ¤ÏÂÁ¯Ô˜ ÛË„·ÈÌ›·˜: ηÏÏȤÚÁÂÈ· ·›Ì·ÙÔ˜, ÁÂÓÈ΋ Î·È Î·ÏÏȤÚÁÂÈ· Ô‡ÚˆÓ, ÁÂÓÈ΋ Î·È Î·ÏÏȤÚÁÂÈ· ∂¡À. °È· ÙËÓ Î¿ı ÂÚÁ·ÛÙËÚȷ΋ ·Ú¿ÌÂÙÚÔ Î·ıÔÚ›ÛÙËÎ·Ó Ë Â˘·ÈÛıËÛ›·, Ë ÂȉÈÎfiÙËÙ·, Ë ıÂÙÈ΋ Î·È ·ÚÓËÙÈ΋ ÚÔÁÓˆÛÙÈ΋ ·Í›·, ÔÈ ·Ó·ÏÔÁ›Â˜ Èı·ÓÔÙ‹ÙˆÓ (LR), ηıÒ˜ Î·È Ë Û˘ÓÔÏÈ΋ ·fi‰ÔÛË ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÙȘ ηÌ‡Ï˜ ROC. ∞ÔÙÂϤÛÌ·Ù·: ∏ Û˘¯ÓfiÙËÙ· Ô˘ÚÔÏԛ̈͢ ‹Ù·Ó 23,5%. ∏ ˘Ô˘Ú›· ‹Ù·Ó Ë ÌfiÓË ·Ú¿ÌÂÙÚÔ˜ Ì ηϋ ‰È·ÎÚÈÙÈ΋ ÈηÓfiÙËÙ· (AUC: 0,825). √ ·ÚÈıÌfi˜ ˘ÔÛÊ·ÈÚ›ˆÓ >10 ÎÔ ·ÚÔ˘Û›·Û ¢·ÈÛıËÛ›· 56%, ÂȉÈÎfiÙËÙ· 99%, ÂÍ·ÈÚÂÙÈ΋ ıÂÙÈ΋ LR (48,9) Î·È ·Û‹Ì·ÓÙË ·ÚÓËÙÈ΋ LR (0,45). ∆· ÏÂ˘Î¿ ·ÈÌÔÛÊ·›ÚÈ· (>15.000/ÌL ‹ <5.000/ÌL) ›¯·Ó 78% ¢·ÈÛıËÛ›·, 76% ÂȉÈÎfiÙËÙ· Î·È ·Û‹Ì·ÓÙ˜ ·Ó·ÏÔÁ›Â˜ Èı·ÓÔÙ‹ÙˆÓ (ıÂÙÈ΋ LR 3,26 Î·È ·ÚÓËÙÈ΋ LR 0,29). °È· ÙËÓ ∆∫∂ Î·È ÙË CRP Ù· ·ÔÙÂϤÛÌ·Ù· ‰ÂÓ ‹Ù·Ó ÈηÓÔÔÈËÙÈο. √ Û˘Ó‰˘·ÛÌfi˜ ˘ÔÛÊ·ÈÚ›ˆÓ Î·È Ï¢ÎÒÓ ı· Ô‰ËÁÔ‡Û Û ·ÔÙ˘¯›· ‰È¿ÁÓˆÛ˘ 3 Ô˘ÚÔÏÔÈÌÒÍÂˆÓ (11%). ™˘ÌÂÚ¿ÛÌ·Ù·: ∫·Ó¤Ó·˜ ·fi ÙÔ˘˜ ÂÚÁ·ÛÙËÚÈ·ÎÔ‡˜ ‰Â›ÎÙ˜ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó ‰ÂÓ ·ԉ›¯ıËΠÈηÓfi˜ Ó· ÚԂϤ„ÂÈ Ì ·ÛÊ¿ÏÂÈ· ÙÔ ·ÔÙ¤ÏÂÛÌ· Ù˘ ηÏÏȤÚÁÂÈ·˜ Ô‡ÚˆÓ. ∏ ·Ó‡ÚÂÛË >10 ˘ÔÛÊ·ÈÚ›ˆÓ ÎÔ ÛÙË ÌÈÎÚÔÛÎÔÈ΋ ÂͤٷÛË Ô‡ÚˆÓ Î·Ù¢ı‡ÓÂÈ ÚÔ˜ ÙËÓ Èı·ÓfiÙËÙ· Ô˘ÚÔÏԛ̈͢, ·ÏÏ¿ Ë ¤ÏÏÂÈ„Ë ˘Ô˘Ú›·˜ ‰ÂÓ ·ÔÎÏ›ÂÈ ÙË ÓfiÛÔ. ∞ÎfiÌ· Î·È Ô Û˘Ó‰˘·ÛÌfi˜ ˘ÔÛÊ·ÈÚ›ˆÓ Ì ÙÔÓ ·ÚÈıÌfi ÙˆÓ Ï¢ÎÒÓ ‰ÂÓ ·ÔÎÏ›ÂÈ ÙËÓ Èı·ÓfiÙËÙ· Ô˘ÚÔÏԛ̈͢.

§¤ÍÂȘ ÎÏÂȉȿ: √˘ÚÔÏԛ̈ÍË, ˘Ô˘Ú›·, ÌÈÎÚÔÛÎÔÈ΋ Ô‡ÚˆÓ, ηÏÏȤÚÁÂÈ· Ô‡ÚˆÓ, ÂÌ‡ÚÂÙ· ‚Ú¤ÊË.

Estimating the risk of urinary tract infection in febrile infants aged 15-90 days with no apparent focus of infection S. Fouzas, A. Fasouli, D. Adamidis, K. Tzelepis, I. Bakopoulou, A. Papadopoulou, D. Zafirakopoulos ∞bstract Background: Urinary tract infection (UTI) is a common cause of bacterial disease in infancy. The aim of this study was to assess the usefulness of microscopic urinalysis, peripheral white blood cell count (WBC), CRP and ESR, for estimating the risk of UTI in febrile infants without a focus of infection.

Methods: The records of 115 infants aged 15-90 days, hospitalized for investigation of fever with no apparent focus, were evaluated retrospectively. All the patients had undergone a full sepsis investigation: blood culture, urine microscopy and culture, CSF microscopy, biochemistry and culture.

The sensitivity, specificity, positive and negative predictive value, likelihood ratio (LR) and overall test performance were determined for each of the laboratory parameters, using ROC curves.

Results: The incidence of UTI was 23.5%. Pyuria was the only parameter with good discrimination ability (AUC: 0.825). Pyuria of >10 WBCs/hpf had 56% sensitivity, 99% specificity, an exceptional positive LR (48.9) and insignificant negative LR (0.45). A WBC count of >15,000/ÌL or <5,000/ÌL, had 78% sensitivity, 76% specificity and insignificant likelihood ratios (positive LR 3.26 and negative LR 0.29). The findings for ESR and CRP were not satisfactory indicators. Use of a combination of pyuria and WBC count would have led to misdiagnosis in 3 cases of UTI (11%).

Conclusions: None of the tested laboratory parameters can safely predict the results of the urine culture.

Pyuria of >10 WBCs/hpf points to the possibility of UTI but the absence of pyuria cannot rule out the disease. Even the use of the combination of pyuria and peripheral WBC count does not eliminate the possibility of UTI.

Paediatric Clinic, General Hospital, Xanthi Correspondence: Sotiris Fouzas sfouzas73@hotmail.com Paediatric Clinic, General Hospital, Xanthi 671 00, Neapoli, Xanthi

Key words: Urinary tract infection, pyuria, microscopic urinalysis, urine culture, febrile infants.

¶·È‰È·ÙÚÈ΋ 2007;70:221-226

Pediatri May-Jun 07

24-05-07

17:58

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™˘ÓÙÔÌÔÁڷʛ˜ ∆∫∂ CRP √¡¶ ∂¡À LR ROC curve AUC

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ∆·¯‡ÙËÙ· ηı›˙ËÛ˘ ÂÚ˘ıÚÒÓ ∞ÓÙȉÚÒÛ· ÚˆÙ½ÓË C √ÛÊ˘ÔÓˆÙÈ·›· ·Ú·Î¤ÓÙËÛË ∂ÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚfi ∞Ó·ÏÔÁ›· Èı·ÓÔÙ‹ÙˆÓ ∫·Ì‡ÏË ROC ¶ÂÚÈÔ¯‹ οو ·fi ÙËÓ Î·Ì‡ÏË

∂ÈÛ·ÁˆÁ‹ √È Ô˘ÚÔÏÔÈÌÒÍÂȘ ·ÔÙÂÏÔ‡Ó ÙË Û˘¯ÓfiÙÂÚË ·ÈÙ›· ÌÈÎÚԂȷ΋˜ Ïԛ̈͢ ηٿ ÙË ÓÂÔÁÓÈ΋ Î·È ÚÒÙË ‚ÚÂÊÈ΋ ËÏÈΛ·. ∏ ¤ÁηÈÚË ‰È¿ÁÓˆÛË Î·Ù¿ ÙËÓ ÎÚ›ÛÈÌË ·˘Ù‹ ÂÚ›Ô‰Ô Â›Ó·È ÛËÌ·ÓÙÈ΋, ·ÊÂÓfi˜ ÁÈ·Ù› ÌÔÚ› Ó· Û˘Ó˘¿Ú¯ÂÈ ·Ó·ÙÔÌÈ΋ ·ÓˆÌ·Ï›· ÙÔ˘ Ô˘ÚÔÔÈËÙÈÎÔ‡, ·ÊÂÙ¤ÚÔ˘ ÁÈ·Ù› Ë ÔÍ›· ˘ÂÏÔÓÂÊÚ›Ùȉ· Â›Ó·È ‰˘Ó·Ùfi Ó· ÚÔηϤÛÂÈ ·ÒÏÂÈ· ÓÂÊÚÈÎÔ‡ ÈÛÙÔ‡, ‰ËÌÈÔ˘ÚÁ›· Ô˘ÏÒÓ Î·È ¤ÎÙˆÛË Ù˘ ÓÂÊÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜. ∂ÈϤÔÓ, ¤Ó· ÛËÌ·ÓÙÈÎfi ÔÛÔÛÙfi ‚ÚÂÊÒÓ ·ÚÔ˘ÛÈ¿˙ÂÈ ‰È·ÛÔÚ¿ Ù˘ ÓfiÛÔ˘ Î·È ÂÈΛӉ˘ÓË ÁÈ· ÙË ˙ˆ‹ ÁÂÓÈÎÂ˘Ì¤ÓË Ïԛ̈ÍË (1-3). ∏ ηÏÏȤÚÁÂÈ· Ô‡ÚˆÓ ·Ú·Ì¤ÓÂÈ Ë ÈÔ ·ÍÈfiÈÛÙË Ì¤ıÔ‰Ô˜ ÁÈ· ÙË ‰È¿ÁÓˆÛË Ù˘ Ô˘ÚÔÏԛ̈͢, ¤¯ÔÓÙ·˜ fï˜ ÙÔ ÌÂÈÔÓ¤ÎÙËÌ· Ù˘ ηı˘ÛÙ¤ÚËÛ˘ ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ. ŒÙÛÈ, ¤¯Ô˘Ó ·Ó·˙ËÙËı› ÂÚÁ·ÛÙËÚÈ·ÎÔ› ‰Â›ÎÙ˜ Ô˘ ı· ÌÔÚÔ‡Û·Ó ¿ÌÂÛ· Ó· ÚԂϤ„Ô˘Ó ÙÔ ·ÔÙ¤ÏÂÛÌ· Ù˘ ηÏÏȤÚÁÂÈ·˜, ÁÂÁÔÓfi˜ Ì ȉȷ›ÙÂÚË ÛËÌ·Û›· ÛÙËÓ ÂÚ›ÙˆÛË ‚ÚÂÊÒÓ Ì ԢÚÔÏԛ̈ÍË, fiÔ˘ Ë Û˘Ìو̷ÙÔÏÔÁ›· ‰ÂÓ Â›Ó·È ÂȉÈ΋ Î·È Ë ¤ÁηÈÚË ıÂÚ·¢ÙÈ΋ ·Ú¤Ì‚·ÛË Â›Ó·È Ô˘ÛÈ҉˘. ∏ ·Ï‹ ÌÈÎÚÔÛÎÔÈ΋ ÂͤٷÛË ÙˆÓ Ô‡ÚˆÓ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ‰È¿ÊÔÚÔ˘˜ ‚ÈÔ¯ËÌÈÎÔ‡˜ ‰Â›ÎÙ˜ (ÓÈÙÚÒ‰Ë, ÂÛÙÂÚ¿ÛË Ï¢ÎÔ΢ÙÙ¿ÚˆÓ), ηıÒ˜ Î·È Ì¤ıÔ‰ÔÈ ÂÓÈÛ¯˘Ì¤Ó˘ ·Ó¿Ï˘Û˘ Ô‡ÚˆÓ ¤¯Ô˘Ó ·ÍÈÔÏÔÁËı› Û ÛËÌ·ÓÙÈÎfi ·ÚÈıÌfi ÌÂÏÂÙÒÓ. ∏ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ¿ ÙÔ˘˜, ˆÛÙfiÛÔ, Â›Ó·È ÂÚÈÔÚÈṲ̂ÓË, ΢ڛˆ˜ ÂÍ·ÈÙ›·˜ Ù˘ ·‰˘Ó·Ì›·˜ ·ÔÎÏÂÈÛÌÔ‡ Ù˘ ÓfiÛÔ˘ (3-12). ¶·Ú’ fiÏ· ·˘Ù¿, ÛÙËÓ Î·ıËÌÂÚÈÓ‹ ÎÏÈÓÈ΋ Ú¿ÍË Ë ˘Ô„›· Ô˘ÚÔÏԛ̈͢, ·ÎfiÌ· Î·È Ë ·fiÊ·ÛË ÁÈ· ηÏÏȤÚÁÂÈ·, ‚·Û›˙ÔÓÙ·È Û˘¯Ó¿ ÛÙ· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÁÂÓÈ΋˜ ÂͤٷÛ˘ Ô‡ÚˆÓ (3,7,9,11,12). ∂ÈϤÔÓ, Ô ·ÚÈıÌfi˜ ˘ÔÛÊ·ÈÚ›ˆÓ ÛÙË ÌÈÎÚÔÛÎÔÈ΋ Ô‡ÚˆÓ ·ÔÙÂÏ› ‚·ÛÈÎfi ÎÚÈÙ‹ÚÈÔ ÛÙ· ÚˆÙfiÎÔÏÏ· ÂÎÙ›ÌËÛ˘ ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÛÔ‚·Ú‹˜ ÌÈÎÚԂȷ΋˜ ÓfiÛÔ˘ Û ÂÌ‡ÚÂÙ· ‚Ú¤ÊË ¯ˆÚ›˜ ÂÌÊ·Ó‹ ÂÛÙ›· Ïԛ̈͢ (13-15), ·Ó Î·È Ë Û¯ÂÙÈ΋ ·‰˘Ó·Ì›· ·˘ÙÒÓ ÙˆÓ ÚˆÙÔÎfiÏÏˆÓ ÛÙÔÓ ·ÔÎÏÂÈÛÌfi Ù˘ Ô˘ÚÔÏԛ̈͢ ¤¯ÂÈ ·Ó·ÁÓˆÚÈÛÙ› (16-18). ™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‹Ù·Ó Ë ·ÍÈÔÏfiÁËÛË ÙÔ˘ ·ÚÈıÌÔ‡ ˘ÔÛÊ·ÈÚ›ˆÓ ÛÙË ÁÂÓÈ΋ Ô‡ÚˆÓ, ÙÔ˘ ·ÚÈıÌÔ‡ Ï¢ÎÒÓ ÛÙË ÁÂÓÈ΋ ·›Ì·ÙÔ˜, Ù˘ ∆∫∂ Î·È Ù˘ CRP, ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ Ô˘ÚÔÏԛ̈͢ Û ÂÌ‡ÚÂÙ· ‚Ú¤ÊË ËÏÈΛ·˜ 15-90 ËÌÂÚÒÓ ¯ˆÚ›˜ ÂÌÊ·Ó‹ ÂÛÙ›· Ïԛ̈͢.

Paediatriki 2007;70:221-226

ªÂÏÂÙ‹ıËÎ·Ó ·Ó·‰ÚÔÌÈο ÔÈ Ê¿ÎÂÏÔÈ ‚ÚÂÊÒÓ ËÏÈΛ·˜ 15-90 ËÌÂÚÒÓ Ô˘ ÂÈÛ‹¯ıËÛ·Ó ÛÙËÓ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ηٿ ÙË ¯ÚÔÓÈ΋ ÂÚ›Ô‰Ô 01/06/2001 Î·È 31/05/2005 ÁÈ· ¤ÏÂÁ¯Ô ˘ÚÂÙÔ‡ (ıÂÚÌÔÎÚ·Û›· ÔÚıÔ‡ >38ÔC), ¯ˆÚ›˜ ÂÌÊ·Ó‹ ÂÛÙ›· Ïԛ̈͢. ™Â fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ ›¯Â Á›ÓÂÈ Ï‹Ú˘ ¤ÏÂÁ¯Ô˜ ÛË„·ÈÌ›·˜: ÁÂÓÈ΋ ·›Ì·ÙÔ˜, ∆∫∂, CRP, ηÏÏȤÚÁÂÈ· ·›Ì·ÙÔ˜, ÁÂÓÈ΋ Î·È Î·ÏÏȤÚÁÂÈ· Ô‡ÚˆÓ, √¡¶ ÁÈ· ÁÂÓÈ΋ ∂¡À, ۿί·ÚÔ, χΈ̷, ¯ÚÒÛË Î·Ù¿ Gram Î·È Î·ÏÏȤÚÁÂÈ· ∂¡À ηÈ, ηٿ ÂÚ›ÙˆÛË, ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ Î·È Î·ÏÏȤÚÁÂÈ· ÎÔÚ¿ÓˆÓ. ŸÏ· Ù· ‰Â›ÁÌ·Ù· Ô‡ÚˆÓ Â›¯·Ó ÏËÊı› Ì ˘ÂÚË‚È΋ ·Ú·Î¤ÓÙËÛË Ù˘ Ô˘ÚÔ‰fi¯Ô˘ ·ÛÙ˘. ∞fi ÙË ÌÂϤÙË ·ÔÎÏ›ÛÙËÎ·Ó 3 ‚Ú¤ÊË Ô˘ ›¯·Ó Ï¿‚ÂÈ ·ÓÙÈ‚ÈÔÙÈ΋ ·ÁˆÁ‹ ÚÈÓ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘˜ Î·È 16 ‚Ú¤ÊË Ô˘ ‰ÂÓ ÔÏÔÎÏ‹ÚˆÛ·Ó ÙÔÓ ÚÔηıÔÚÈṲ̂ÓÔ ¤ÏÂÁ¯Ô ÛË„·ÈÌ›·˜. °È· ÙËÓ ·ÍÈÔÏfiÁËÛË ÙˆÓ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ‰ÂÈÎÙÒÓ Î·ıÔÚ›ÛÙËÎ·Ó Ë Â˘·ÈÛıËÛ›·, Ë ÂȉÈÎfiÙËÙ·, Ë ıÂÙÈ΋ Î·È ·ÚÓËÙÈ΋ ÚÔÁÓˆÛÙÈ΋ ·Í›·, ηıÒ˜ Î·È ÔÈ ·Ó·ÏÔÁ›Â˜ Èı·ÓÔًوÓ. √È ·Ó·ÏÔÁ›Â˜ Èı·ÓÔÙ‹ÙˆÓ (likelihood ratios - LR), ıÂÙÈ΋ ‹ ·ÚÓËÙÈ΋ (LR + ‹ LR -), ÂÎÊÚ¿˙Ô˘Ó ÙËÓ Èı·ÓfiÙËÙ· Ë ‰ÔÎÈÌ·Û›· Ó· Â›Ó·È ıÂÙÈ΋ ‹ ·ÚÓËÙÈ΋ ÛÙÔ˘˜ ¿Û¯ÔÓÙ˜ Û ۯ¤ÛË Ì ÙËÓ Èı·ÓfiÙËÙ· Ë ‰ÔÎÈÌ·Û›· Ó· Â›Ó·È ·ÓÙ›ÛÙÔȯ· ıÂÙÈ΋ ‹ ·ÚÓËÙÈ΋ ÛÙÔ˘˜ ÌË ¿Û¯ÔÓÙ˜. √È ·Ó·ÏÔÁ›Â˜ Èı·ÓÔÙ‹ÙˆÓ ıˆÚÔ‡ÓÙ·È ÔÈ ÈÔ ·ÍÈfiÈÛÙÔÈ ‰Â›ÎÙ˜ ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË Ù˘ ‰È·ÁÓˆÛÙÈ΋˜ ·Í›·˜ Ì›·˜ ‰ÔÎÈÌ·Û›·˜. ™ËÌ·ÓÙÈΤ˜ ÁÈ· ÙËÓ ÎÏÈÓÈ΋ Ú¿ÍË ıˆÚÔ‡ÓÙ·È ÙÈ̤˜ ÌÂÁ·Ï‡ÙÂÚ˜ ÙÔ˘ 10 ÁÈ· ÙË ıÂÙÈ΋ Î·È ÌÈÎÚfiÙÂÚ˜ ÙÔ˘ 0,1 ÁÈ· ÙËÓ ·ÚÓËÙÈ΋ ·Ó·ÏÔÁ›· Èı·ÓÔÙ‹ÙˆÓ (19,20). ∏ Û˘ÓÔÏÈ΋ ·fi‰ÔÛË Ù˘ οı ‰ÔÎÈÌ·Û›·˜ ·ÍÈÔÏÔÁ‹ıËΠ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÙȘ ηÌ‡Ï˜ ROC (Receiver operating characteristics). √È Î·Ì‡Ï˜ ROC Â›Ó·È ÁÚ·ÊÈΤ˜ ·Ú·ÛÙ¿ÛÂȘ Ù˘ ¢·ÈÛıËÛ›·˜ Û ۯ¤ÛË Ì ÙËÓ ÂȉÈÎfiÙËÙ·. ∞fi ÙÔ ÂÌ‚·‰fiÓ Ù˘ ÂÚÈÔ¯‹˜ ÌÂٷ͇ Ù˘ ηÌ‡Ï˘ Î·È ÙÔ˘ ÔÚÈ˙fiÓÙÈÔ˘ ¿ÍÔÓ· (Area under curve - AUC) ÌÔÚ› Ó· ÂÎÙÈÌËı› Ë Û˘ÓÔÏÈ΋ ‰È·ÁÓˆÛÙÈ΋ ÈηÓfiÙËÙ·. ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, ηÙÒÙÂÚÔ ·Ô‰ÂÎÙfi fiÚÈÔ ÁÈ· ÙËÓ AUC ıˆڋıËÎÂ Ë ÙÈÌ‹ 0,7, ÂÓÒ ÔÈ ÙÈ̤˜ 0,7-0,8 ıˆڋıËΠˆ˜ ÂÎÊÚ¿˙Ô˘Ó Ì¤ÙÚÈ· ‰È·ÎÚÈÙÈ΋ ÈηÓfiÙËÙ·, ÔÈ ÙÈ̤˜ 0,8-0,9 ηϋ Î·È ÔÈ ÙÈ̤˜ 0,9-1 ¿ÚÈÛÙË ‰È·ÎÚÈÙÈ΋ ÈηÓfiÙËÙ· (19,21,22). °È· ÙÔÓ Î·ıÔÚÈÛÌfi Ù˘ ¢·ÈÛıËÛ›·˜, Ù˘ ÂȉÈÎfiÙËÙ·˜, Ù˘ ÚÔÁÓˆÛÙÈ΋˜ ·Í›·˜ Î·È ÙˆÓ ·Ó·ÏÔÁÈÒÓ Èı·ÓÔًوÓ, ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ‰È·ÊÔÚÂÙÈο ÛËÌ›· ÙÔÌ‹˜ (cutoff points) ÁÈ· ÙÔÓ Î¿ı ÂÚÁ·ÛÙËÚÈ·Îfi ‰Â›ÎÙË, ‰È·ÊÔÚÂÙÈΤ˜ ‰ËÏ·‰‹ ÙÈ̤˜ ÁÈ· ÙȘ Ôԛ˜ Ë ‰ÔÎÈÌ·Û›· ıˆڋıËΠıÂÙÈ΋. °È· Ù· ÏÂ˘Î¿ ·ÈÌÔÛÊ·›ÚÈ· ·ÍÈÔÏÔÁ‹ıËÎ·Ó ˆ˜ ·ıÔÏÔÁÈΤ˜: ·) ÙÈ̤˜ >15.000/ÌL ‹ <5.000/ÌL (15), ‚) ÙÈ̤˜ >15.000/ÌL (13) Î·È Á) ÙÈ̤˜ >20.000/ÌL (14) (¶›Ó·Î·˜ 1). °È· Ù· ˘ÔÛÊ·›ÚÈ· ÛÙË ÌÈÎÚÔÛÎÔÈ΋ Ô‡ÚˆÓ ·ÍÈÔÏÔÁ‹ıËÎ·Ó ˆ˜ ·ıÔÏÔÁÈΤ˜ ÙÈ̤˜ >5 ÎÔ (ÙÈÌ‹ Ô˘ ·ÔÙÂÏ› ÙÔÓ ÎÏ·ÛÈÎfi ÔÚÈÛÌfi Ù˘ ÛËÌ·ÓÙÈ΋˜ ˘Ô˘Ú›·˜) Î·È ÙÈ̤˜ >10 ÎÔ (ÎÚÈÙ‹ÚÈÔ Ô˘ ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÛÙ· ÚˆÙfiÎÔÏÏ· ÂÎÙ›ÌËÛ˘ ÛÔ‚·Ú‹˜ ÌÈÎÚԂȷ΋˜ ÓfiÛÔ˘). °È· ÙËÓ ∆∫∂ ÛËÌÂ›Ô ÙÔÌ‹˜ ıˆڋıËÎÂ Ë ÙÈÌ‹ 30 mm/h Î·È ÁÈ· ÙË CRP Ë ÙÈÌ‹ 1 mg/dL (16-18,22,23). ∏ ÛÙ·ÙÈÛÙÈ΋ ÂÂÍÂÚÁ·Û›· ¤ÁÈÓ Ì ÙÔ ÚfiÁÚ·ÌÌ· SPSS 11.0, ÂÓÒ Ë Î·Ù·Û΢‹ ÙˆÓ Î·Ì˘ÏÒÓ ROC, Ô ˘ÔÏÔÁÈÛÌfi˜ ÙˆÓ AUC Î·È Ë ÌÂٷ͇ ÙÔ˘˜ Û‡ÁÎÚÈÛË, Ì ÙÔ ÚfiÁÚ·ÌÌ· MedCalc 8.1.0.0.

∞ÔÙÂϤÛÌ·Ù· ∞fi Ù· 115 ·È‰È¿ Ô˘ ÏËÚÔ‡Û·Ó Ù· ÎÚÈÙ‹ÚÈ· ÂÈÛ·ÁˆÁ‹˜ ÛÙË ÌÂϤÙË, 27 ›¯·Ó ıÂÙÈ΋ ηÏÏȤÚÁÂÈ·

Pediatri May-Jun 07

24-05-07

17:58

™ÂÏ›‰·223

223

∫›Ó‰˘ÓÔ˜ Ô˘ÚÔÏԛ̈͢ Û ÂÌ‡ÚÂÙ· ‚Ú¤ÊË

¶›Ó·Î·˜ 1. ™˘ÁÎÚÈÙÈ΋ ·ÍÈÔÏfiÁËÛË ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ‰ÂÈÎÙÒÓ ÁÈ· ÙË ‰È¿ÁÓˆÛË Ô˘ÚÔÏԛ̈͢ ¶˘ÔÛÊ·›ÚÈ· (ÎÔ)

∂˘·ÈÛıËÛ›· ∂ȉÈÎfiÙËÙ· PPV NPV LR(+)* LR(-)**

§Â˘Î¿ (/ÌL)

∆∫∂

CRP

>5

>10

>20.000

>15.000

>15.000 ‹ <5.000

>30 mm/h

>1 mg/dL

56% 96% 83% 88% 16,3 0,46

56% 99% 94% 88% 48,9 0,45

45% 83% 45% 83% 2,6 0,67

74% 76% 49% 90% 3,1 0,35

78% 76% 50% 92% 3,26 0,29

48% 78% 40% 83% 2,23 0,66

59% 70% 38% 85% 2 0,58

PPV: £ÂÙÈ΋ ÚÔÁÓˆÛÙÈ΋ ·Í›·, NPV: ∞ÚÓËÙÈ΋ ÚÔÁÓˆÛÙÈ΋ ·Í›·, LR(+): £ÂÙÈ΋ ·Ó·ÏÔÁ›· Èı·ÓÔًوÓ, LR(-): ∞ÚÓËÙÈ΋ ·Ó·ÏÔÁ›· Èı·ÓÔًوÓ, *: ™ËÌ·ÓÙÈΤ˜ ıˆÚÔ‡ÓÙ·È ÙÈ̤˜ >10, **: ™ËÌ·ÓÙÈΤ˜ ıˆÚÔ‡ÓÙ·È ÙÈ̤˜ <0,1

ÛÙ·ÙÈÛÙÈÎÔ‡ Ï¿ıÔ˘˜ (7,3 ± 19 mg/dL ¤Ó·ÓÙÈ 2,8 ± 5,8 mg/dL, p=0,049). √È ROC ηÌ‡Ï˜ ÁÈ· ÙËÓ Î¿ı ÂÚÁ·ÛÙËÚȷ΋ ·Ú¿ÌÂÙÚÔ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÙËÓ ∂ÈÎfiÓ· 1. √ ·ÚÈıÌfi˜ ÙˆÓ ˘ÔÛÊ·ÈÚ›ˆÓ ÛÙË ÁÂÓÈ΋ Ô‡ÚˆÓ Ì AUC 0,825 (95%CI: 0,743-0,889) ÂÌÊ¿ÓÈÛ ηϋ ‰È·ÎÚÈÙÈ΋ ÈηÓfiÙËÙ·, ÂÓÒ Ë ∆∫∂ ›¯Â ̤ÙÚÈ· ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÛÙË ‰È¿ÎÚÈÛË Ù˘ ÓfiÛÔ˘ Ì AUC 0,771 (95% CI: 0,684-0,845). ∏ ‰È·ÎÚÈÙÈ΋ ÈηÓfiÙËÙ· ÙfiÛÔ ÙÔ˘ ·ÚÈıÌÔ‡ Ï¢ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ ÛÙË ÁÂÓÈ΋ ·›Ì·ÙÔ˜ (AUC: 0,683), fiÛÔ Î·È Ù˘ CRP (AUC: 0,663) ‹Ù·Ó ÌÈÎÚ‹. ∞fi ÙË Û‡ÁÎÚÈÛË ÙˆÓ Î·Ì˘ÏÒÓ ROC ‰È·ÈÛÙÒıËΠÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙË ‰È·ÎÚÈÙÈ΋ ÈηÓfiÙËÙ· ÙÔ˘ ·ÚÈıÌÔ‡ ˘ÔÛÊ·ÈÚ›ˆÓ ÛÙË ÁÂÓÈ΋ Ô‡ÚˆÓ Û ۯ¤ÛË Ì ÙÔÓ ·ÚÈıÌfi Ï¢ÎÒÓ (p=0,04) Î·È ÙË CRP (p=0,03). ∏ ¢·ÈÛıËÛ›·, Ë ÂȉÈÎfiÙËÙ·, Ë ıÂÙÈ΋ Î·È ·ÚÓËÙÈ΋ ÚÔÁÓˆÛÙÈ΋ ·Í›· Î·È Ë ıÂÙÈ΋ Î·È ·ÚÓËÙÈ΋ ·Ó·ÏÔÁ›· Èı·ÓÔÙ‹ÙˆÓ ÁÈ· ÙËÓ Î¿ı ÂÚÁ·ÛÙËÚȷ΋ ·Ú¿ÌÂÙÚÔ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1. √ ·ÚÈıÌfi˜ ˘ÔÛÊ·ÈÚ›ˆÓ >10 ÎÔ ·ÚÔ˘Û›·ÛÂ

1

1

0,9

0,9

0,8

0,8

0,7

0,7

0,6

∂˘·ÈÛıËÛ›·

∂˘·ÈÛıËÛ›·

Ô‡ÚˆÓ. ∞fi ·˘Ù¿, Ù· 14 ‹Ù·Ó ÎÔÚ›ÙÛÈ· Î·È Ù· 13 ·ÁfiÚÈ·. ∏ Û˘¯ÓfiÙËÙ· Ù˘ Ô˘ÚÔÏԛ̈͢ ηٿ ËÏÈÎȷ΋ ÔÌ¿‰· ‹Ù·Ó 16% ÁÈ· Ù· ÓÂÔÁÓ¿ ËÏÈΛ·˜ 15-29 ËÌÂÚÒÓ, 25% ÁÈ· Ù· ‚Ú¤ÊË ËÏÈΛ·˜ 30-59 ËÌÂÚÒÓ Î·È 29% ÁÈ· Ù· ‚Ú¤ÊË ËÏÈΛ·˜ 60-90 ËÌÂÚÒÓ. √È ˘‡ı˘ÓÔÈ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ› ‹Ù·Ó: Escherichia coli 85%, Klebsiella pneumoniae 7%, Enterobacter spp. 4% Î·È Pseudomonas aeruginosa 4%. ¢‡Ô ·ÛıÂÓ›˜ Ì ԢÚÔÏԛ̈ÍË - Î·È ÔÈ ‰‡Ô ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ 30 ËÌÂÚÒÓ - ·ÚÔ˘Û›·Û·Ó ‰È·ÛÔÚ¿ Ù˘ ÓfiÛÔ˘ Ì ıÂÙÈ΋ ηÏÏȤÚÁÂÈ· ·›Ì·ÙÔ˜ (E. coli). ∆· ‚Ú¤ÊË Ì ԢÚÔÏԛ̈ÍË, Û˘ÁÎÚÈÓfiÌÂÓ· Ì ÂΛӷ ¯ˆÚ›˜ Ô˘ÚÔÏԛ̈ÍË, ·ÚÔ˘Û›·Û·Ó ÌÂÁ·Ï‡ÙÂÚÔ ·ÚÈıÌfi ˘ÔÛÊ·ÈÚ›ˆÓ ÛÙË ÌÈÎÚÔÛÎÔÈ΋ Ô‡ÚˆÓ (38,8 ± 56,4 ÎÔ ¤Ó·ÓÙÈ 1,6 ± 1,8 ÎÔ, p<0,0001), ÌÂÁ·Ï‡ÙÂÚÔ ·ÚÈıÌfi Ï¢ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ ÛÙË ÁÂÓÈ΋ ·›Ì·ÙÔ˜ (17.495 ± 7.491 /ÌL ¤Ó·ÓÙÈ 13.356 ± 9.547 /ÌL, p=0,041) Î·È ÌÂÁ·Ï‡ÙÂÚË ∆∫∂ (38,9 ± 27,4 mm/h ¤Ó·ÓÙÈ 17,4 ± 14,6 mm/h, p<0,0001), ÂÓÒ Ë ‰È·ÊÔÚ¿ ÛÙȘ ÙÈ̤˜ Ù˘ CRP ÎÈÓ‹ıËΠÛÙ· fiÚÈ· ÙÔ˘

§Â˘Î¿

0,5 0,4

0,6

CRP

0,5 0,4 0,3

0,3 TKE

0,2 0,1

¶˘ÔÛÊ·›ÚÈ·

0,2 0,1

∞

µ

0

0 0

0,2

0,4 0,6 1 - ∂ȉÈÎfiÙËÙ·

0,8

1

0

0,2

0,4 0,6 1 - ∂ȉÈÎfiÙËÙ·

0,8

1

∂ÈÎfiÓ· 1. ∫·Ì‡Ï˜ ROC. ∞: §Â˘Î¿ ·ÈÌÔÛÊ·›ÚÈ· ÛÙË ÁÂÓÈ΋ ·›Ì·ÙÔ˜ Î·È ∆∫∂ Î·È µ: ¶˘ÔÛÊ·›ÚÈ· ÛÙË ÁÂÓÈ΋ Ô‡ÚˆÓ Î·È CRP. ∏ ‰È·ÁÓˆÛÙÈ΋ ÈηÓfiÙËÙ· ηıÔÚ›˙ÂÙ·È ·fi ÙËÓ ÂÚÈÔ¯‹ οو ·fi ÙËÓ Î·Ì‡ÏË (AUC). ªÂÁ·Ï‡ÙÂÚË AUC ÛËÌ·›ÓÂÈ Î·È Î·Ï‡ÙÂÚË ·fi‰ÔÛË Ù˘ ‰ÔÎÈÌ·Û›·˜. ¶·È‰È·ÙÚÈ΋ 2007;70:221-226

Pediatri May-Jun 07

24-05-07

17:58

™ÂÏ›‰·224

224

™. ºÔ‡˙·˜ Î·È Û˘Ó.

˘„ËÏ‹ ıÂÙÈ΋ ÚÔÁÓˆÛÙÈ΋ ·Í›· (94%) Î·È ÂÍ·ÈÚÂÙÈ΋ ıÂÙÈ΋ ·Ó·ÏÔÁ›· Èı·ÓÔÙ‹ÙˆÓ (48,9), ·ÔÙÂϤÛÌ·Ù· Û·ÊÒ˜ ·ÓÒÙÂÚ· Û ۇÁÎÚÈÛË Ì ÙÔÓ ·ÚÈıÌfi ˘ÔÛÊ·ÈÚ›ˆÓ >5 ÎÔ (ıÂÙÈ΋ ÚÔÁÓˆÛÙÈ΋ ·Í›· 83% Î·È ıÂÙÈ΋ ·Ó·ÏÔÁ›· Èı·ÓÔÙ‹ÙˆÓ 16,3, p=0,016 Î·È p<0,001, ·ÓÙ›ÛÙÔȯ·). ∆· ˘ÔÛÊ·›ÚÈ·, ÙfiÛÔ ÁÈ· ÙÈ̤˜ >5 ÎÔ fiÛÔ Î·È ÁÈ· ÙÈ̤˜ >10 ÎÔ, ·ÚÔ˘Û›·Û·Ó ˘„ËÏ‹ ÂȉÈÎfiÙËÙ· (96% Î·È 99%, ·ÓÙ›ÛÙÔȯ·), ·ÏÏ¿ ¯·ÌËÏ‹ ¢·ÈÛıËÛ›· (56%), ¯·ÌËÏ‹ ·ÚÓËÙÈ΋ ÚÔÁÓˆÛÙÈ΋ ·Í›· (88%) Î·È ÌË ÛËÌ·ÓÙÈ΋ ·ÚÓËÙÈ΋ ·Ó·ÏÔÁ›· Èı·ÓÔÙ‹ÙˆÓ (0,46 Î·È 0,45, ·ÓÙ›ÛÙÔȯ·). ™Â fi,ÙÈ ·ÊÔÚ¿ Ù· ÏÂ˘Î¿ ·ÈÌÔÛÊ·›ÚÈ· ÛÙË ÁÂÓÈ΋ ·›Ì·ÙÔ˜, ÔÈ ϤÔÓ ÈηÓÔÔÈËÙÈÎÔ› ‰È·ÁÓˆÛÙÈÎÔ› ‰Â›ÎÙ˜ ÚԤ΢„·Ó fiÙ·Ó ıˆڋıËÎ·Ó ·ıÔÏÔÁÈΤ˜ ÙÈ̤˜ ÌÂÁ·Ï‡ÙÂÚ˜ ÙˆÓ 15.000/ÌL ‹ ÌÈÎÚfiÙÂÚ˜ ÙˆÓ 5.000/ÌL. øÛÙfiÛÔ, Ì ÂÍ·›ÚÂÛË ÙËÓ ·ÚÓËÙÈ΋ ÚÔÁÓˆÛÙÈ΋ ·Í›· (92%), ÔÈ ˘fiÏÔÈÔÈ ‰Â›ÎÙ˜ ‹Ù·Ó ¯·ÌËÏÔ› Î·È ÔÈ ·Ó·ÏÔÁ›Â˜ Èı·ÓÔÙ‹ÙˆÓ ÌË ÛËÌ·ÓÙÈΤ˜ (ıÂÙÈ΋ LR: 3,26 Î·È ·ÚÓËÙÈ΋ LR: 0,29). ™Â Û‡ÁÎÚÈÛË Ì ٷ ˘ÔÛÊ·›ÚÈ· ÛÙË ÁÂÓÈ΋ Ô‡ÚˆÓ (>10 ÎÔ), Ù· ÏÂ˘Î¿ ÛÙË ÁÂÓÈ΋ ·›Ì·ÙÔ˜ (>15.000/ÌL ‹ <5.000/ÌL) ·ÚÔ˘Û›·Û·Ó ÌÂÁ·Ï‡ÙÂÚË Â˘·ÈÛıËÛ›· (p<0,001), ·ÚfiÌÔÈ· ·ÚÓËÙÈ΋ ÚÔÁÓˆÛÙÈ΋ ·Í›· (p=0,42) Î·È ÌÈÎÚfiÙÂÚË ÂȉÈÎfiÙËÙ· (p<0,0001) Î·È ıÂÙÈ΋ ÚÔÁÓˆÛÙÈ΋ ·Í›· (p<0,0001) (¶›Ó·Î·˜ 1). °È· ÙËÓ ∆∫∂ Î·È ÙË CRP, Ë Â˘·ÈÛıËÛ›·, Ë ÂȉÈÎfiÙËÙ·, Ë ıÂÙÈ΋ Î·È ·ÚÓËÙÈ΋ ÚÔÁÓˆÛÙÈ΋ ·Í›·, ηıÒ˜ Î·È ÔÈ ·Ó·ÏÔÁ›Â˜ Èı·ÓÔًوÓ, ÎÈÓ‹ıËÎ·Ó Û ÌË ÈηÓÔÔÈËÙÈο Â›‰· (¶›Ó·Î·˜ 1).

™˘˙‹ÙËÛË ∏ Û˘¯ÓfiÙËÙ· Ù˘ Ô˘ÚÔÏԛ̈͢ ÛÙ· 115 ‚Ú¤ÊË Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‹Ù·Ó 23,5% (27 ‚Ú¤ÊË), ·Ó·‰ÂÈÎÓ‡ÔÓÙ·˜ ÙËÓ Ô˘ÚÔÏԛ̈ÍË ˆ˜ ȉȷ›ÙÂÚ· ÛËÌ·ÓÙÈ΋ ·ÈÙ›· ˘ÚÂÙÔ‡ Û ‚Ú¤ÊË ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ 3 ÌËÓÒÓ ¯ˆÚ›˜ ÂÛÙ›· Ïԛ̈͢. ∏ Û˘¯ÓfiÙËÙ· ‹Ù·Ó ›‰È· ÁÈ· ·ÁfiÚÈ· Î·È ÎÔÚ›ÙÛÈ·, ÂÓÒ ‰È·ÛÔÚ¿ Ù˘ ÓfiÛÔ˘ Î·È ‚·ÎÙËÚÈ·ÈÌ›· ·Ú·ÙËÚ‹ıËΠ۠ÔÛÔÛÙfi 7,4% (2 ·ÛıÂÓ›˜ ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ 30 ËÌÂÚÒÓ). ∆· ·Ú·¿Óˆ ·ÔÙÂϤÛÌ·Ù· Â›Ó·È Û˘ÁÎÚ›ÛÈÌ· Ì ·˘Ù¿ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›· (1-3,6,18). ∞fi ÙË ÌÂϤÙË Ù˘ Û˘ÓÔÏÈ΋˜ ·fi‰ÔÛ˘ ÙˆÓ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ‰ÂÈÎÙÒÓ ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÙȘ ηÌ‡Ï˜ ROC, ÚÔ·ÙÂÈ fiÙÈ ÌfiÓÔ Ô ·ÚÈıÌfi˜ ˘ÔÛÊ·ÈÚ›ˆÓ ·ÚÔ˘ÛÈ¿˙ÂÈ ÛËÌ·ÓÙÈ΋ ‰È·ÎÚÈÙÈ΋ ÈηÓfiÙËÙ· (AUC: 0,825). øÛÙfiÛÔ, Ë ÛËÌ·Û›· Ù˘ ÌÈÎÚÔÛÎÔÈ΋˜ ÂͤٷÛ˘ ÙˆÓ Ô‡ÚˆÓ ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ Ô˘ÚÔÏԛ̈͢ ¯Ú‹˙ÂÈ ÂÚ·ÈÙ¤Úˆ ·Ó¿Ï˘Û˘. ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, Ë ˘Ô˘Ú›· ·ÚÔ˘Û›·Û ˘„ËÏ‹ ÂȉÈÎfiÙËÙ· ÙfiÛÔ ÁÈ· ÙÈ̤˜ >5 ÎÔ (94%), fiÛÔ Î·È ÁÈ· ÙÈ̤˜ >10 ÎÔ (99%). ∆Ô ÁÂÁÔÓfi˜ ·˘Ùfi, fï˜, ‰ÂÓ Ú¤ÂÈ Ó· ıˆÚËı› Û·Ó ÈηÓfiPaediatriki 2007;70:221-226

ÙËÙ· ·ÔÎÏÂÈÛÌÔ‡ Ù˘ Ô˘ÚÔÏԛ̈͢, ÈηÓfiÙËÙ· Ô˘ ÌÔÚ› Ó· ÂÎÊÚ·ÛÙ› ·ÍÈfiÈÛÙ· ÌfiÓÔ ·fi ÙËÓ ·ÚÓËÙÈ΋ ·Ó·ÏÔÁ›· Èı·ÓÔًوÓ, Ë ÔÔ›· Î˘Ì¿ÓıËΠ۠ÌË ÛËÌ·ÓÙÈο Â›‰· (0,46 ÁÈ· ÙÈ̤˜ >5 ÎÔ Î·È 0,45 ÁÈ· ÙÈ̤˜ >10 ÎÔ, Ì ÛËÌ·ÓÙÈΤ˜ ÙȘ ÙÈ̤˜ <0,1). ∂Ô̤ӈ˜, Ô ¯·ÌËÏfi˜ ·ÚÈıÌfi˜ ˘ÔÛÊ·ÈÚ›ˆÓ ‰ÂÓ ÌÔÚ› Ó· ıˆÚËı› ·ÍÈfiÈÛÙÔ˜ ‰Â›ÎÙ˘ ÁÈ· ÙÔÓ ·ÔÎÏÂÈÛÌfi Ù˘ Ô˘ÚÔÏԛ̈͢. ŒÙÛÈ, Â¿Ó Ë ·fiÊ·ÛË ÁÈ· ηÏÏȤÚÁÂÈ· ÛÙ· ‚Ú¤ÊË Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‚·ÛÈ˙fiÙ·Ó ÛÙË ÌÈÎÚÔÛÎÔÈ΋ Ô‡ÚˆÓ Î·È ıˆÚÒÓÙ·˜ Û·Ó ·ıÔÏÔÁÈ΋ ÙÈÌ‹ Ù· >10 ˘ÔÛÊ·›ÚÈ· ÎÔ, ÔÈ 12 ·fi ÙȘ 27 Ô˘ÚÔÏÔÈÌÒÍÂȘ ‰ÂÓ ı· ›¯·Ó ‰È·ÁÓˆÛÙ›. ∞ÓÙ›ıÂÙ·, Ë ıÂÙÈ΋ ·Ó·ÏÔÁ›· Èı·ÓÔÙ‹ÙˆÓ ‹Ù·Ó ÂÍ·ÈÚÂÙÈ΋ ÙfiÛÔ ÁÈ· ÙÈ̤˜ >5 ÎÔ, fiÛÔ Î·È ÁÈ· ÙÈ̤˜ >10 ÎÔ (16,3 Î·È 48,9, ·ÓÙ›ÛÙÔȯ·, Ì ÛËÌ·ÓÙÈΤ˜ ÙȘ ÙÈ̤˜ >10), ·Ó·‰ÂÈÎÓ‡ÔÓÙ·˜ ÙËÓ ˘Ô˘Ú›· Û ȉȷ›ÙÂÚ· ¯Ú‹ÛÈÌÔ ‰Â›ÎÙË ÁÈ· ÙÔÓ ÂÓÙÔÈÛÌfi ÙˆÓ ‚ÚÂÊÒÓ Ì ԢÚÔÏԛ̈ÍË. √ ·ÚÈıÌfi˜ ˘ÔÛÊ·ÈÚ›ˆÓ >10 ÎÔ ·ԉ›¯ıËΠÂÚÈÛÛfiÙÂÚÔ ·ÍÈfiÈÛÙÔ˜ Û ۯ¤ÛË Ì ٷ >5 ˘ÔÛÊ·›ÚÈ· ÎÔ, ÂÂȉ‹ Û˘Ó‰˘¿ÛÙËΠ̠ÏÈÁfiÙÂÚ· „¢‰Ò˜ ıÂÙÈο ·ÔÙÂϤÛÌ·Ù· Î·È ·ÚÔ˘Û›·Û ηχÙÂÚË ıÂÙÈ΋ ·Ó·ÏÔÁ›· Èı·ÓÔًوÓ. ∏ ¯ÚËÛÈÌfiÙËÙ· ÙˆÓ Ï¢ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ ˆ˜ ÌÂÌÔӈ̤ÓË ÂͤٷÛË ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ Ô˘ÚÔÏԛ̈͢ ·ԉ›¯ıËΠÂÚÈÔÚÈṲ̂ÓË. √È ÙÈ̤˜ Ï¢ÎÒÓ >15.000/ÌL ‹ <5.000/ÌL ˘ÂÚ›¯·Ó ¤Ó·ÓÙÈ ÙˆÓ ¿ÏÏˆÓ ÙÈÌÒÓ Ï¢ÎÒÓ Ô˘ ÌÂÏÂÙ‹ıËηÓ. ªË ÈηÓÔÔÈËÙÈο ·ÔÙÂϤÛÌ·Ù· ÚԤ΢„·Ó Î·È ·fi ÙË ÌÂϤÙË Ù˘ ∆∫∂ Î·È Ù˘ CRP, Ì ·ÔÙ¤ÏÂÛÌ· Ô ÚfiÏÔ˜ ÙÔ˘˜ ÛÙËÓ ÂÎÙ›ÌËÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ Ô˘ÚÔÏԛ̈͢ Ó· Â›Ó·È ÂÚÈÔÚÈṲ̂ÓÔ˜. ∫·Ó¤Ó·˜ ·fi ÙÔ˘˜ ÂÚÁ·ÛÙËÚÈ·ÎÔ‡˜ ‰Â›ÎÙ˜ ‰ÂÓ ·ԉ›¯ıËΠ·fi ÌfiÓÔ˜ ÙÔ˘ ÈηÓfi˜ Ó· ·ÔÎÏ›ÛÂÈ ÙËÓ Èı·ÓfiÙËÙ· Ô˘ÚÔÏԛ̈͢ Û ‚Ú¤ÊË Ì ˘ÚÂÙfi ¯ˆÚ›˜ ÂÛÙ›·. øÛÙfiÛÔ, Ô Û˘Ó‰˘·ÛÌfi˜ ˘ÔÛÊ·ÈÚ›ˆÓ <10 ÎÔ Î·È Ï¢ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ 5.000-15.000/ÌL ›¯Â ηχÙÂÚ· ·ÔÙÂϤÛÌ·Ù· Û ۯ¤ÛË Ì ÙÔÓ Î¿ı ‰Â›ÎÙË Í¯ˆÚÈÛÙ¿. ∏ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ·Ú·¿Óˆ ÎÚÈÙËÚ›Ô˘ ÛÙ· ‚Ú¤ÊË Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘, ı· Ô‰ËÁÔ‡Û Û ·ÔÙ˘¯›· ‰È¿ÁÓˆÛ˘ 3 Ô˘ÚÔÏÔÈÌÒÍÂˆÓ (11%) Û ۯ¤ÛË Ì ÙȘ 12 Ô˘ÚÔÏÔÈÌÒÍÂȘ (44%) Ô˘ ‰ÂÓ ı· ›¯·Ó ‰È·ÁÓˆÛÙ› Â¿Ó ÎÚÈÙ‹ÚÈÔ ·ÔÎÏÂÈÛÌÔ‡ ‹Ù·Ó ÌfiÓÔ Ù· ˘ÔÛÊ·›ÚÈ· (p<0,0001) Î·È ÙȘ 6 Ô˘ÚÔÏÔÈÌÒÍÂȘ (22%) Ô˘ ‰ÂÓ ı· ›¯·Ó ‰È·ÁÓˆÛÙ› Â¿Ó ÎÚÈÙ‹ÚÈÔ ·ÔÎÏÂÈÛÌÔ‡ ‹Ù·Ó ÌfiÓÔ Ù· ÏÂ˘Î¿ (p=0,38). ∞˘Ù¿ Ù· ˘„ËÏ¿ ÔÛÔÛÙ¿ ·ÔÙ˘¯›·˜ ‚Ú›ÛÎÔÓÙ·È Û ·ÓÙÈÛÙÔȯ›· Ì ٷ ÔÛÔÛÙ¿ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È Û ÛÂÈÚ¿ ¿ÏÏˆÓ ÌÂÏÂÙÒÓ (13-18). √È ÂÚÁ·ÛÙËÚÈ·ÎÔ› ‰Â›ÎÙ˜ Ô˘ ·ÍÈÔÏÔÁ‹ıËÎ·Ó ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, ÂÈϤ¯ıËÎ·Ó ‰ÈfiÙÈ Î·ıÔÚ›˙ÔÓÙ·È ¿ÌÂÛ·, Ì ¯·ÌËÏfi ÎfiÛÙÔ˜ Î·È ¯ˆÚ›˜ ÂÍÂȉÈÎÂ˘Ì¤ÓÔ ÂÚÁ·ÛÙËÚÈ·Îfi ÂÍÔÏÈÛÌfi. ª›· Ó¤· ̤ıÔ‰Ô˜

Pediatri May-Jun 07

24-05-07

17:58

™ÂÏ›‰·225

225

∫›Ó‰˘ÓÔ˜ Ô˘ÚÔÏԛ̈͢ Û ÂÌ‡ÚÂÙ· ‚Ú¤ÊË

ÂÓÈÛ¯˘Ì¤Ó˘ ·Ó¿Ï˘Û˘ Ô‡ÚˆÓ Ì ÙË ¯Ú‹ÛË Î˘ÙÙ·ÚÔÌÂÙÚËÙ‹ Î·È ÙÔÓ Î·ıÔÚÈÛÌfi Ù˘ ˘Ô˘Ú›·˜ ˆ˜ ÙÔÓ ·ÚÈıÌfi Ï¢ÎÔ΢ÙÙ¿ÚˆÓ/mm3 Û ÌË Ê˘ÁÔÎÂÓÙÚË̤ÓÔ ‰Â›ÁÌ· Ô‡ÚˆÓ, ¤¯ÂÈ ·Ô‰Âȯı› ÂÚÈÛÛfiÙÂÚÔ ·ÍÈfiÈÛÙË ·fi ÙËÓ ·Ï‹ ÌÈÎÚÔÛÎÔÈ΋ Ô‡ÚˆÓ (25). øÛÙfiÛÔ, ÚfiÎÂÈÙ·È ÁÈ· ÂͤٷÛË Ô˘ ··ÈÙ› ÂÍÂȉÈÎÂ˘Ì¤ÓÔ ÚÔÛˆÈÎfi, Ì ·ÌÊÈÛ‚ËÙÔ‡ÌÂÓË Û¯¤ÛË ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜-ÎfiÛÙÔ˘˜ Î·È ·ÛÊ·ÏÒ˜ ‰˘ÛÚfiÛÈÙË ÙfiÛÔ Û Â›Â‰Ô ÚˆÙÔ‚¿ıÌÈ·˜ ÂÚ›ı·Ï„˘, fiÛÔ Î·È Û ÌË ÂÍÂȉÈÎÂ˘Ì¤Ó˜ ÓÔÛËÏ¢ÙÈΤ˜ ÌÔÓ¿‰Â˜ Ù˘ ÂÚÈʤÚÂÈ·˜ (3-8,18). ∆Ô ˘„ËÏfi ÔÛÔÛÙfi Ô˘ÚÔÏÔÈÌÒÍÂˆÓ Ô˘ ÚԤ΢„ ·fi ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ‰ÂÓ ÌÔÚ› Ó· ıˆÚËı› ·ÓÙÈÚÔÛˆ¢ÙÈÎfi ÙÔ˘ ÁÂÓÈÎÔ‡ ÏËı˘ÛÌÔ‡. ∞Ó Î·È Ë ÂÈÛ·ÁˆÁ‹ ÁÈ· Ï‹ÚË ¤ÏÂÁ¯Ô ÙˆÓ ÂÌ‡ÚÂÙˆÓ ‚ÚÂÊÒÓ ¯ˆÚ›˜ ÂÛÙ›· Ïԛ̈͢ ·ÔÙÂÏ› ÔÏÈÙÈ΋ Ù˘ Û˘ÁÎÂÎÚÈ̤Ó˘ ÎÏÈÓÈ΋˜, Â›Ó·È ÚÔÊ·Ó¤˜ fiÙÈ ¤Ó·˜ ÛËÌ·ÓÙÈÎfi˜ ·ÚÈıÌfi˜ Ù¤ÙÔÈˆÓ ‚ÚÂÊÒÓ ‰ÂÓ Î·Ù·Ï‹ÁÂÈ ÛÙÔ ÓÔÛÔÎÔÌ›Ô. ∂ÈϤÔÓ, ¤Ó· ̤ÚÔ˜ ÙˆÓ ‚ÚÂÊÒÓ Ô˘ ›¯·Ó ÂÈÛ·¯ı› ÁÈ· ¤ÏÂÁ¯Ô ‰ÂÓ ÏËÚÔ‡Û ٷ ÎÚÈÙ‹ÚÈ· ÂÈÛ·ÁˆÁ‹˜ ÛÙË ÌÂϤÙË (Ï‹Ú˘ ¤ÏÂÁ¯Ô˜ ÛË„·ÈÌ›·˜, Ï‹„Ë Ô‡ÚˆÓ ÌfiÓÔ Ì ˘ÂÚË‚È΋ ·Ú·Î¤ÓÙËÛË, ¯ˆÚ›˜ ·ÓÙÈ‚›ˆÛË ÚÈÓ ÙËÓ ÂÈÛ·ÁˆÁ‹). øÛÙfiÛÔ, Ë ÂÊ·ÚÌÔÁ‹ ·˘ÙÒÓ ÙˆÓ ÎÚÈÙËÚ›ˆÓ ÎÚ›ıËΠ·Ó·Áη›· ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂÍ·ÛÊ·ÏÈÛÙ› Ë ÔÌÔÈÔÁ¤ÓÂÈ· ÙÔ˘ ÏËı˘ÛÌÔ‡ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ Î·È Ó· ÂÚÈÔÚÈÛÙ› ÙÔ ÂӉ¯fiÌÂÓÔ „¢‰Ò˜ ıÂÙÈÎÒÓ ‹ ·ÚÓËÙÈÎÒÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ. ∏ ·ÍÈÔÏfiÁËÛË, Ù¤ÏÔ˜, ÙˆÓ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ·Ú·Ì¤ÙÚˆÓ ¤ÁÈÓ ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÓÂfiÙÂÚ˜ Î·È ÂÚÈÛÛfiÙÂÚÔ ·ÍÈfiÈÛÙ˜ ÛÙ·ÙÈÛÙÈΤ˜ ÌÂıfi‰Ô˘˜, fiˆ˜ ÔÈ ·Ó·ÏÔÁ›Â˜ Èı·ÓÔÙ‹ÙˆÓ Î·È ÔÈ Î·Ì‡Ï˜ ROC ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË Ù˘ Û˘ÓÔÏÈ΋˜ ·fi‰ÔÛ˘ Ù˘ οı ‰ÔÎÈÌ·Û›·˜. ∂ÈϤÔÓ, Ù· ˘ÔÛÊ·›ÚÈ· ÛÙË ÌÈÎÚÔÛÎÔÈ΋ Ô‡ÚˆÓ Î·È Ù· ÏÂ˘Î¿ ÛÙË ÁÂÓÈ΋ ·›Ì·ÙÔ˜ ÂÎÙÈÌ‹ıËÎ·Ó Ì ‚¿ÛË ÂÚÈÛÛfiÙÂÚ˜ ·ıÔÏÔÁÈΤ˜ ÙÈ̤˜, ÙÈ̤˜ Ô˘ ¤¯Ô˘Ó ·ÍÈÔÏÔÁËı› Û ÛÂÈÚ¿ ÌÂÏÂÙÒÓ Î·È Ô˘ ·ÔÙÂÏÔ‡Ó ‚·ÛÈο ÎÚÈÙ‹ÚÈ· ÛÙ· ÚˆÙfiÎÔÏÏ· ÂÎÙ›ÌËÛ˘ ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÛÔ‚·Ú‹˜ ÌÈÎÚԂȷ΋˜ Ïԛ̈͢ Û ÂÌ‡ÚÂÙ· ‚Ú¤ÊË ¯ˆÚ›˜ ÂÛÙ›· (13-15). ŒÙÛÈ, ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ÂȯÂÈÚÂ›Ù·È Î·È Ë ÂÎÙ›ÌËÛË Ù˘ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ ·˘ÙÒÓ ÙˆÓ ÚˆÙÔÎfiÏÏˆÓ Û fi,ÙÈ ·ÊÔÚ¿ Ê˘ÛÈο ÙËÓ ·Ó¿‰ÂÈÍË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ Ô˘ÚÔÏԛ̈͢. ™˘ÌÂÚ·ÛÌ·ÙÈο, Ë ÂÎÙ›ÌËÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ Ô˘ÚÔÏԛ̈͢ Û ÂÌ‡ÚÂÙ· ‚Ú¤ÊË ¯ˆÚ›˜ ÂÌÊ·Ó‹ ÂÛÙ›· ‰ÂÓ ÌÔÚ› Ó· ‚·ÛÈÛÙ› ÛÙË ÌÈÎÚÔÛÎÔÈ΋ ÂͤٷÛË Ô‡ÚˆÓ, ÛÙË ÁÂÓÈ΋ ·›Ì·ÙÔ˜, ÛÙËÓ ∆∫∂ Î·È ÛÙË CRP. ∏ ·Ó‡ÚÂÛË >10 ˘ÔÛÊ·ÈÚ›ˆÓ ÎÔ ÛÙË ÌÈÎÚÔÛÎÔÈ΋ ÂͤٷÛË ÙˆÓ Ô‡ÚˆÓ ı· Ú¤ÂÈ Ó· ηÙ¢ı‡ÓÂÈ ÙÔÓ ıÂÚ¿ÔÓÙ· È·ÙÚfi ÚÔ˜ ÙËÓ Èı·ÓfiÙËÙ· Ô˘ÚÔÏԛ̈͢. øÛÙfiÛÔ, Û η̛· ÂÚ›ÙˆÛË Ô ¯·ÌËÏfiÙÂÚÔ˜ ·ÚÈıÌfi˜ ˘ÔÛÊ·ÈÚ›ˆÓ (·ÎfiÌ· Î·È <5 ÎÔ)

‰ÂÓ ÌÔÚ› Ó· ıˆÚËı› ÎÚÈÙ‹ÚÈÔ ÁÈ· ÙÔÓ ·ÔÎÏÂÈÛÌfi Ù˘ ÓfiÛÔ˘. ∞ÎfiÌË Î·È Ô Û˘Ó‰˘·ÛÌfi˜ ÙÔ˘ ·ÚÈıÌÔ‡ ˘ÔÛÊ·ÈÚ›ˆÓ Ì ÙÔÓ ·ÚÈıÌfi Ï¢ÎÒÓ ÛÙË ÁÂÓÈ΋ ·›Ì·ÙÔ˜, ÎÚÈÙ‹ÚÈÔ Ô˘ ¯ÚËÛÈÌÔÔÈÂ›Ù·È Â˘Ú¤ˆ˜ ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÛÔ‚·Ú‹˜ ÌÈÎÚԂȷ΋˜ ÓfiÛÔ˘, ‰ÂÓ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û ·ÛÊ·Ï‹ Û˘ÌÂÚ¿ÛÌ·Ù· Û fi,ÙÈ ·ÊÔÚ¿ ÙÔÓ ·ÔÎÏÂÈÛÌfi Ù˘ Ô˘ÚÔÏԛ̈͢. ∂Ô̤ӈ˜, Ë Î·ÏÏȤÚÁÂÈ· Ô‡ÚˆÓ ·ÔÙÂÏ› ÙË ÌfiÓË ·ÍÈfiÈÛÙË ÂͤٷÛË ÁÈ· ÙË ‰È¿ÁÓˆÛË Ô˘ÚÔÏԛ̈͢ Û ÂÌ‡ÚÂÙ· ‚Ú¤ÊË ËÏÈΛ·˜ 15-90 ËÌÂÚÒÓ ¯ˆÚ›˜ ÂÌÊ·Ó‹ ÂÛÙ›· Ïԛ̈͢ Î·È ı· Ú¤ÂÈ Ó· Ú·ÁÌ·ÙÔÔÈÂ›Ù·È ¿ÌÂÛ·, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙÔ ÚˆÙfiÎÔÏÏÔ ‰È·ÁÓˆÛÙÈ΋˜ ÚÔÛ¤ÁÁÈÛ˘ Î·È ·ÓÙÈÌÂÙÒÈÛ˘ Ô˘ ¯ÚËÛÈÌÔÔÈ›ٷÈ.

µÈ‚ÏÈÔÁÚ·Ê›· 1. American Academy of Pediatrics. Committee on Quality Improvement. Subcommittee on Urinary Tract Infection.

Practice parameter: the diagnosis, treatment, and evaluation of the initial urinary tract infection in febrile infants and young children. Pediatrics 1999;103:843-852.

2. Shaw KN, Gorelick MH, McGowan KL, McDanielYakscoe N, Schwartz JS. Prevalence of urinary tract infection and occult bacteremia in febrile young children in the emergency department. Arch Pediatr Adolesc Med 1996; 150:37.

3. Newman TB, Bernzweig JA, Takayama JI, Finch SA, Wasserman RC, Pantell RH. Urine testing and urinary tract infections in febrile infants seen in office settings: the Pediatric Research in Office Settings’ Febrile Infant Study.

Arch Pediatr Adolesc Med 2002;156:44-54.

4. Shaw KN, McGowan KL, Gorelick MH, Schwartz JS. Screening for urinary tract infection in infants in the emergency department: which test is best? Pediatrics 1998; 101:E1.

5. Gorelick MH, Shaw KN. Screening tests for urinary tract infection in children: A meta-analysis. Pediatrics 1999; 104:E54.

6. Lin DS, Huang SH, Lin CC, Tung YC, Huang TT, Chiu NC et al. Urinary tract infection in febrile infants younger than eight weeks of age. Pediatrics 2000;105:E20.

7. Bachur R, Harper MB. Reliability of the urinalysis for predicting urinary tract infections in young febrile children.

Arch Pediatr Adolesc Med 2001;155:60-65.

8. Lin DS, Huang FY, Chiu NC, Koa HA, Hung HY, Hsu CH et al. Comparison of hemocytometer leukocyte counts and standard urinalyses for predicting urinary tract infections in febrile infants. Pediatr Infect Dis J 2000;19:223-227.

9. Doley A, Nelligan M. Is a negative dipstick urinalysis good enough to exclude urinary tract infection in paediatric emergency department patients? Emerg Med 2003;15:77-80.

10. Tamim MM, Alesseh H, Aziz H. Analysis of the efficacy of urine culture as part of sepsis evaluation in the premature infant. Pediatr Infect Dis J 2003;22:805-808.

11. Hoberman A, Wald ER, Reynolds EA, Penchansky L, Charron M. Is urine culture necessary to rule out urinary tract infection in young febrile children? Pediatr Infect Dis J 1996;15:304-309.

12. Martin B, Ghosh A. Towards evidence based emergency ¶·È‰È·ÙÚÈ΋ 2007;70:221-226

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Baskin MN, O’Rourke EJ, Fleisher GR. Outpatient treatment of febrile infants 28 to 89 days of age with intramuscular administration of ceftriaxone. J Pediatr 1992;120:22-27.

Jaskiewicz JA, McCarthy CA, Richardson AC, White KC, Fisher DJ, Dagan R et al. Febrile infants at low risk for serious bacterial infection--an appraisal of the Rochester criteria and implications for management. Febrile Infant Collaborative Study Group. Pediatrics 1994;94:390-396.

Bachur RG, Harper MB. Predictive model for serious bacterial infections among infants younger than 3 months of age. Pediatrics 2001;108:311-316.

Pantell RH, Newman TB, Bernzweig J, Bergman DA, Takayama JI, Segal M et al. Management and outcomes of care of fever in early infancy. JAMA 2004;291:1203-1212.

Herr SM, Wald ER, Pitetti RD, Choi SS. Enhanced urinalysis improves identification of febrile infants ages 60 days and younger at low risk for serious bacterial illness. Pediatrics 2001;108:866-871.

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19. Jaeschke R, Guyatt GH, Sackett DL. Users’ guides to the medical literature. III. How to use an article about a diagnostic test. B. What are the results and will they help me in caring for my patients? The Evidence-Based Medicine Working Group. JAMA 1994;271:703-707.

20. Gallagher EJ. Clinical utility of likelihood ratios. Ann Emerg Med 1998;31:391-397.

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23. Gervaix A, Galetto-Lacour A, Gueron T, Vadas L, Zamora S, Suter S et al. Usefulness of procalcitonin and C-reactive protein rapid tests for the management of children with urinary tract infection. Pediatr Infect Dis J 2001;20:507-511.

24. Gassler N, Paul H, Runge M. Rapid detection of urinary tract infection-evaluation of flow cytometry. Clin Nephrol 2006;66:331-335.

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CASE REPORT

227

™‡Ó‰ÚÔÌÔ Ô„oÌ˘fiÎÏoÓÔ˘-·Ù·Í›·˜ Û ·ÛıÂÓ‹ Ì Ó¢ÚÔ‚Ï¿Ûو̷: ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ Î·È ·Ó·ÛÎfiËÛË Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜ ¡. ∫·Ù˙ËÏ¿Î˘1, ∂. ª·ÓÙ·‰¿Î˘1, ∞. ™·‚‚›‰Ô˘1, ¶. µÔÚÁÈ¿1, ª. ƒ·˚Û¿ÎË2, ∂. ™ÙÂȷοÎË1, ª. ∫·ÏÌ·ÓÙ‹1 ¶ÂÚ›ÏË„Ë: ∆Ô Ó¢ÚÔ‚Ï¿Ûو̷ ·ÔÙÂÏ› ÙÔ 7-8% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ Î·ÎÔËıÂÈÒÓ ÛÙ· ·È‰È¿, ÂÓÒ Â˘ı‡ÓÂÙ·È ÁÈ· ÙÔ 15% ÙˆÓ ı·Ó¿ÙˆÓ ·fi ÓÂÔϷۛ˜ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜. ∏ Ù·ÍÈÓfiÌËÛË ‚·Û›˙ÂÙ·È ÛÙËÓ ¤ÎÙ·ÛË Ù˘ ÓfiÛÔ˘, ÙËÓ ËÏÈΛ·, ÙËÓ ÈÛÙÔ·ıÔÏÔÁ›· Î·È Û ÌÔÚÈ·ÎÔ‡˜ ÚÔÁÓˆÛÙÈÎÔ‡˜ ‰Â›ÎÙ˜, fiˆ˜ Ë ÂÓ›Û¯˘ÛË ÙÔ˘ ÔÁÎÔÁÔÓȉ›Ô˘ N-myc. ™˘Ó‹ıˆ˜ ÂÌÊ·Ó›˙ÂÙ·È ˆ˜ Ì¿˙· ηٿ Ì‹ÎÔ˜ Ù˘ Û˘Ì·ıËÙÈ΋˜ ·Ï˘Û›‰·˜. √È ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ÙÔ˘ Ó¢ÚÔ‚Ï·ÛÙÒÌ·ÙÔ˜ ÔÈΛÏÏÔ˘Ó ·Ó¿ÏÔÁ· Ì ÙË ı¤ÛË ÙÔ˘ ÚˆÙÔ·ıÔ‡˜ fiÁÎÔ˘ Î·È ÙËÓ ·ÚÔ˘Û›· ‹ fi¯È ÌÂÙ·ÛÙ·ÙÈ΋˜ ÓfiÛÔ˘. √ ÚˆÙÔ·ı‹˜ fiÁÎÔ˜ ÌÔÚ› Ó· ÂÓÙÔÈÛÙ› ÔÔ˘‰‹ÔÙ ÛÙÔ Û˘Ì·ıËÙÈÎfi Û‡ÛÙËÌ·, fiˆ˜ ÛÙ· ÂÈÓÂÊÚ›‰È·, ÛÙ· ÎÔÈÏȷο Û˘Ì·ıËÙÈο Á¿ÁÁÏÈ· ‹ ÛÙÔ Ô›ÛıÈÔ ÌÂÛÔıˆÚ¿ÎÈÔ. ∆· ‚Ú¤ÊË Ì Ó¢ÚÔ‚Ï¿Ûو̷ Û˘Ó‹ıˆ˜ ¤¯Ô˘Ó ÂÓÙÔÈṲ̂ÓË ÓfiÛÔ Î·Ï‹˜ ÚfiÁÓˆÛ˘, Ì ¢ÓÔ˚ÎÔ‡˜ ÌÔÚÈ·ÎÔ‡˜ ‰Â›ÎÙ˜ Û ·ÓÙ›ıÂÛË Ì ·È‰È¿ ËÏÈΛ·˜ ¿Óˆ ÙÔ˘ ¤ÙÔ˘˜. ∆Ô Î˘ÚÈfiÙÂÚÔ ·Ú·ÓÂÔÏ·ÛÌ·ÙÈÎfi Û‡Ó‰ÚÔÌÔ Û ·ÛıÂÓ›˜ Ì Ó¢ÚÔ‚Ï¿Ûو̷ Â›Ó·È Ô Ô„ÔÌ˘fiÎÏoÓÔ˜-·Ù·Í›· Ô˘ ·Ú·ÙËÚÂ›Ù·È ÛÙÔ 2-3% ÙˆÓ ·ÛıÂÓÒÓ. ™ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ÔÈ ·ÛıÂÓ›˜ ·˘ÙÔ› ¤¯Ô˘Ó ¯·ÌËÏfi ÛÙ¿‰ÈÔ ÓfiÛÔ˘ Î·È ¿ÚÈÛÙË Ì·ÎÚÔ¯ÚfiÓÈ· ÂÈ‚›ˆÛË. øÛÙfiÛÔ, ˆ˜ ÚÔ˜ ÙËÓ „˘¯ÔÎÈÓËÙÈ΋ ÂͤÏÈÍË, Û ÌÂÁ¿ÏÔ ÔÛÔÛÙfi ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÂÈ̤ÓÔ˘Û· ηı˘ÛÙ¤ÚËÛË. √È ˘¿Ú¯Ô˘Û˜ ıÂÚ·¢ÙÈΤ˜ ÂÈÏÔÁ¤˜, fiˆ˜ Ù· ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹, Ë ÂÓ‰ÔÊϤ‚È· Á-ÛÊ·ÈÚ›ÓË, Ë Ï·ÛÌ·Ê·›ÚÂÛË Î·È Ë ¯ËÌÂÈÔıÂÚ·›·, ‰ÂÓ ¤¯Ô˘Ó ÚÔÛʤÚÂÈ Ù· ·Ó·ÌÂÓfiÌÂÓ·. ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ·È‰ÈÔ‡ ËÏÈΛ·˜ 16 ÌËÓÒÓ Ì Ó¢ÚÔ‚Ï¿Ûو̷, Ô„ÔÌ˘fiÎÏoÓÔ-·Ù·Í›· Î·È „˘¯ÔÎÈÓËÙÈ΋ ·ÏÈÓ‰ÚfiÌËÛË, ÂÓÒ ·Ó·ÛÎÔÂ›Ù·È Ë ‚È‚ÏÈÔÁÚ·Ê›· ˆ˜ ÚÔ˜ ÙËÓ ·ÈÙÈÔ·ıÔÁ¤ÓÂÈ·, ÙË ıÂÚ·›· Î·È ÙË Ó¢ÚÔÏÔÁÈ΋ ¤Î‚·ÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘.

1 ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ∞ÈÌ·ÙÔÏÔÁ›·˜-√ÁÎÔÏÔÁ›·˜, ¶·ÓÂÈÛÙËÌÈ·Îfi °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ∏Ú·ÎÏ›Ԣ ∫Ú‹Ù˘ 2 ∆Ì‹Ì· ∞ÎÙÈÓԉȷÁÓˆÛÙÈ΋˜, ¶·ÓÂÈÛÙËÌÈ·Îfi °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ∏Ú·ÎÏ›Ԣ ∫Ú‹Ù˘ AÏÏËÏÔÁÚ·Ê›·: ª·Ú›· ∫·ÏÌ·ÓÙ‹ pedhem@med.uoc.gr ¶·ÓÂÈÛÙËÌÈ·Îfi °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ∏Ú·ÎÏ›Ԣ, µ’ ∫Ù‹ÚÈÔ ∆.∫. 711 10, ∏Ú¿ÎÏÂÈÔ ∫Ú‹Ù˘

§¤ÍÂȘ ÎÏÂȉȿ: N¢ÚÔ‚Ï¿Ûو̷, o„ÔÌ˘fiÎÏoÓÔ˜-·Ù·Í›·.

Opsoclonus-myoclonus-ataxia syndrome in a patient with neuroblastoma: Case report and review of the literature N. Katzilakis1, E. Mandadakis1, A. Savidou1, P. Vorgia1, M. Raissaki2, E. Steiakaki1, M. Kalmanti1 Abstract: Neuroblastoma represents 7-8% of all childhood malignancies and is responsible for 15% of cancer-related deaths in children. Staging is based on the age of the child, the extent of the disease and the histopathology and molecular prognostic markers, such as amplification of the N-myc oncogene.

Neuroblastoma usually presents as a mass along the sympathetic chain, and its clinical manifestations are based on the site of the primary tumour and the presence or absence of metastatic disease. Infants with neuroblastoma usually have localized disease with favourable molecular markers (absence of N-myc amplification) in contrast to children >1 year of age. The most frequent paraneoplastic syndrome in neuroblastoma is opsomyoclonus-ataxia (OMA), which is seen in 2-3% of cases. Most of these patients have low-stage disease with a favourable prognosis regarding long-term survival, although their mental and motor development may be substantially delayed. The available therapeutic options such as corticosteroids, intravenous Á-globulin, exchange transfusion and chemotherapy do not offer the anticipated results in the development of these children. The case is presented of a 16 month-old boy with neuroblastoma, OMA and developmental retardation, along with a review of the literature of this paraneoplastic syndrome, with emphasis on its treatment and the neurological outcome of children with neuroblastoma and OMA.

1 Haematology-Oncology Paediatric Department, General University Hospital of Heraklion, Crete 2 Diagnostic Radiology Department, General University Hospital of Heraklion, Crete Correspondence: Maria Kalmanti pedhem@med.uoc.gr General University Hospital of Heraklion, 2nd Building 711 10, Heraklion, Crete

Key words: Neuroblastoma, opsoclonus-myoclonus-ataxia (OMA) syndrome.

∂ÈÛ·ÁˆÁ‹ ∆Ô Ó¢ÚÔ‚Ï¿Ûو̷ Â›Ó·È o ‰Â‡ÙÂÚÔ˜ ÛÂ Û˘¯ÓfiÙËÙ· Û˘Ì·Á‹˜ fiÁÎÔ˜ Ù˘ ·È‰È΋˜ ËÏÈ-

Λ·˜. ∏ Â›ÙˆÛË Ù˘ ÓfiÛÔ˘ ÂÎÙÈÌ¿Ù·È Û 9-10 ÂÚÈÙÒÛÂȘ ·Ó¿ 1.000.000 ·È‰È¿ ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ 15 ÂÙÒÓ ÂÙËÛ›ˆ˜ Î·È Â›Ó·È Ï›ÁÔ ¶·È‰È·ÙÚÈ΋ 2007;70:227-231

Pediatri May-Jun 07

24-05-07

17:58

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228

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ÌÂÁ·Ï‡ÙÂÚË ÛÙ· ·ÁfiÚÈ· (·Ó·ÏÔÁ›· ·ÁÔÚÈÒÓ ÚÔ˜ ÎÔÚ›ÙÛÈ· 1,2:1). ∏ ̤ÛË ËÏÈΛ· ‰È¿ÁÓˆÛ˘ ÙˆÓ ·ÛıÂÓÒÓ Ì Ó¢ÚÔ‚Ï¿Ûو̷ Â›Ó·È ÔÈ 23 Ì‹Ó˜ ÌÂ Û˘¯ÓfiÙÂÚÔ Â‡ÚÔ˜ Ù· 0-4 ¤ÙË. ™ÙË ‰È¿ÁÓˆÛË, ÙÔ 40% Â›Ó·È ‚Ú¤ÊË, ÂÓÒ ÔÛÔÛÙfi ÌÈÎÚfiÙÂÚÔ ÙÔ˘ 5% ¤¯Ô˘Ó ËÏÈΛ· ÌÂÁ·Ï‡ÙÂÚË ÙˆÓ 10 ÂÙÒÓ (1). ∆Ô ÌÂÙ·ÛÙ·ÙÈÎfi Ó¢ÚÔ‚Ï¿Ûو̷ Û ·È‰È¿ ËÏÈΛ·˜ ÌÂÁ·Ï‡ÙÂÚ˘ ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜ Û¯ÂÙ›˙ÂÙ·È Ì ̛· ·fi ÙȘ ¯ÂÈÚfiÙÂÚ˜ ÚÔÁÓÒÛÂȘ ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ Î·ÎÔËıÂÈÒÓ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜. ∞Ó Î·È ·Ú¯Èο ··ÓÙ¿ ÛÙË ¯ËÌÂÈÔıÂÚ·›·, Ë ÏÂÈÔÓfiÙËÙ· ÙˆÓ ·È‰ÈÒÓ ˘ÔÙÚÔÈ¿˙ÂÈ Î·È Î·Ù·Ï‹ÁÂÈ Ì ÚfiÔ‰Ô Ù˘ ÓfiÛÔ˘. √È Ó¢ÚÔÁÂÓ›˜ fiÁÎÔÈ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ ÚÔ¤Ú¯ÔÓÙ·È ·fi ÚÔÁÔÓÈο-ÔÏ˘‰‡Ó·Ì· Û˘Ì·ıËÙÈο ·ÙÙ·Ú· Ù˘ Ó¢ÚÈ΋˜ ·ÎÚÔÏÔÊ›·˜ ‹ ¯ÚˆÌÈfiÊÈÏ· ·ÙÙ·Ú· ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÂÈÓÂÊÚȉ›ˆÓ. πÛÙÔÏÔÁÈο ‰È·ÎÚ›ÓÔÓÙ·È Û Ó¢ÚÔ‚Ï¿Ûو̷, Á·ÁÁÏÈÔÓ¢ÚÔ‚Ï¿Ûو̷ (fiÁÎÔ˜ Ì ÒÚÈÌ· Á·ÁÁÏȷο ·ÙÙ·Ú· Î·È Ó¢ÚÔ‚Ï¿ÛÙ˜) Î·È Á·ÁÁÏÈÔÓ‡ڈ̷. √È ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ÔÈΛÏÏÔ˘Ó ·Ó¿ÏÔÁ· Ì ÙË ı¤ÛË ÙÔ˘ ÚˆÙÔ·ıÔ‡˜ fiÁÎÔ˘ Î·È ÙËÓ ·ÚÔ˘Û›· ‹ fi¯È ÌÂÙ·ÛÙ·ÙÈ΋˜ ÓfiÛÔ˘. ¶ÂÚ›Ô˘ ÙÔ 70% ÙˆÓ ÚˆÙÔ·ıÒÓ fiÁÎˆÓ ÂÓÙÔ›˙ÂÙ·È ÛÙËÓ ÎÔÈÏÈ¿, 25% ÛÙÔÓ ÙÚ¿¯ËÏÔ ‹ ÛÙÔÓ ıÒڷη Î·È 5% ÛÙËÓ ‡ÂÏÔ. √È ÌÂÙ·ÛÙ¿ÛÂȘ ··ÓÙÒÓÙ·È Û˘¯ÓfiÙÂÚ· ÛÙÔÓ Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ, ÛÙ· ÔÛÙ¿ Î·È ÛÙÔ˘˜ ÏÂÌÊ·‰¤Ó˜. ∆Ô ‹·Ú Î·È ÙÔ ‰¤ÚÌ· ÚÔÛ‚¿ÏÏÔÓÙ·È Û˘¯ÓfiÙÂÚ· Û ‚Ú¤ÊË Ì ÓfiÛÔ ÛÙ·‰›Ô˘ IVS (1). √ Ô„ÔÌ˘fiÎÏoÓÔ˜ (Û‡Ó‰ÚÔÌÔ Kinsbourne) Â›Ó·È Û¿ÓÈÔ ·Ú·ÓÂÔÏ·ÛÌ·ÙÈÎfi ‹ ÌÂÙ·ÏÔÈÌ҉˜ Ó¢ÚÔÏÔÁÈÎfi Û‡Ó‰ÚÔÌÔ, Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ‚Ú·¯Â›Â˜ Â·Ó·Ï·Ì‚·ÓfiÌÂÓ˜ ÎÈÓ‹ÛÂȘ ÙˆÓ ÔÊı·ÏÌÒÓ, ÙÔ˘ ÎÔÚÌÔ‡ Î·È ÙˆÓ ¿ÎÚˆÓ Ô˘ Û˘¯Ó¿ Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì ·ÚÂÁÎÂÊ·ÏȉÈ΋ ·Ù·Í›· (Û‡Ó‰ÚÔÌÔ Ô„ÔÌ˘fiÎÏoÓÔ˘-·Ù·Í›·˜, OMA) (2,3). ™Ù· ·È‰È¿, ÙÔ Û‡Ó‰ÚÔÌÔ OMA Û˘ÓËı¤ÛÙÂÚ· Û˘Ó‰¤ÂÙ·È Ì Ó¢ÚÔ‚Ï¿Ûو̷, ÙÔ˘ ÔÔ›Ô˘ ·ÔÙÂÏ› ÂΉ‹ÏˆÛË ÛÙÔ 2-3% ÙˆÓ ÂÚÈÙÒÛÂˆÓ (4). ™ÙÔ˘˜ ÂÓ‹ÏÈΘ, ÙÔ Û‡Ó‰ÚÔÌÔ OMA ¤¯ÂÈ Û˘Ó‰Âı› Ì ÔÈΛϷ ÓÂÔÏ¿ÛÌ·Ù·, fiˆ˜ ηÚΛÓÔ Ì·ÛÙÒÓ, ˆÔıËÎÒÓ Î·È ÌÈÎÚÔ΢ÙÙ·ÚÈÎfi ηÚΛӈ̷ Ó‡ÌÔÓ· (5). ∆Ô ÌÂÙ·ÏÔÈÌ҉˜ Ó¢ÚÔÏÔÁÈÎfi Û‡Ó‰ÚÔÌÔ √ª∞ ¤¯ÂÈ Û˘Ó‰Âı› Ì Ïԛ̈ÍË ·fi ‰È¿ÊÔÚÔ˘˜ ÈÔ‡˜ (6).

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ·ÁÔÚÈÔ‡ ËÏÈΛ·˜ 16 ÌËÓÒÓ Ô˘ ·Ú·¤ÌÊıËΠÏfiÁˆ „˘¯ÔÎÈÓËÙÈ΋˜ ·ÏÈÓ‰ÚfiÌËÛ˘, Ô„ÔÌ˘fiÎÏoÓÔ˘-·Ù·Í›·˜ Î·È ÙÚfiÌÔ˘ ÎÔÚÌÔ‡, ÎÂÊ·Ï‹˜ Î·È ¿ÎÚˆÓ ·fi 15Ë̤ÚÔ˘ ÚÔ Ù˘ ÂÈÛ·ÁˆÁ‹˜ ÙÔ˘. ∆Ô ·È‰› ÁÂÓÓ‹ıËΠ̠ηÈÛ·ÚÈ΋ ÙÔÌ‹ ÌÂÙ¿ ·fi ‰›‰˘ÌË Î‡ËÛË 37 ‚‰ÔÌ¿‰ˆÓ Ì ‚¿ÚÔ˜ Á¤ÓÓËPaediatriki 2007;70:227-231

Û˘ 2030 g, ÂÚ›ÌÂÙÚÔ ÎÂÊ·Ï‹˜ 32,5 cm Î·È Ì‹ÎÔ˜ ÛÒÌ·ÙÔ˜ 46 cm. ∆Ô ÂÚÈÁÂÓÓËÙÈÎfi, Ì·È¢ÙÈÎfi Î·È ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ‹Ù·Ó ÂχıÂÚÔ. ∆Ô ‚Ú¤ÊÔ˜ ›¯Â Ê˘ÛÈÔÏÔÁÈ΋ „˘¯ÔÎÈÓËÙÈ΋ ·Ó¿Ù˘ÍË Ì¤¯ÚÈ ÙËÓ ËÏÈΛ· ÙˆÓ 15 ÌËÓÒÓ, ηıÒ˜ ÛÙ‹ÚÈÍ ÙÔ ÎÂÊ¿ÏÈ Û ËÏÈΛ· 3 ÌËÓÒÓ, οıÈÛ Û ËÏÈΛ· 6-7 ÌËÓÒÓ, ‚¿‰ÈÛ Û ËÏÈΛ· 13 ÌËÓÒÓ Î·È Â› ϤÍÂȘ ÛÙËÓ ËÏÈΛ· ÙˆÓ 14-15 ÌËÓÒÓ. ∞fi 15Ë̤ÚÔ˘ ÚÔ Ù˘ ÂÈÛ·ÁˆÁ‹˜, ÙÔ ·È‰› ·ÚÔ˘Û›·Û ·Ù·Í›·, ÚÔԉ¢ÙÈο ÂȉÂÈÓÔ‡ÌÂÓË ·‰˘Ó·Ì›· ÛÙ‹ÚÈ͢ ÎÂÊ·Ï‹˜, ·Ú·ÌÔÓ‹˜ Û fiÚıÈ· Î·È Î·ıÈÛÙ‹ ı¤ÛË, Ô„ÔÌ˘fiÎÏoÓÔ, ÙÚfiÌÔ ÎÔÚÌÔ‡, ÎÂÊ·Ï‹˜ Î·È ¿ÎÚˆÓ Î·È ·ÏÈÓ‰ÚfiÌËÛË ÏfiÁÔ˘. ªÂÙ¿ ÙËÓ ÂͤٷÛË ·fi ·È‰›·ÙÚÔ Î·È ·È‰ÔÓ¢ÚÔÏfiÁÔ, ·Ú·¤ÌÊıËΠÛÙËÓ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ÁÈ· ÂÚ·ÈÙ¤Úˆ ‰ÈÂÚ‡ÓËÛË. ∫·Ù¿ ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË ÛÙËÓ ÂÈÛ·ÁˆÁ‹ ‹Ù·Ó ·‡ÚÂÙÔ, Ì ηϿ ˙ˆÙÈο ÛËÌ›·, ÂÚ›ÌÂÙÚÔ ÎÂÊ·Ï‹˜ ÛÙËÓ 25Ë ÂηÙÔÛÙÈ·›· ı¤ÛË (∂£), ‡„Ô˜ ÛÒÌ·ÙÔ˜ ÛÙËÓ 3Ë-10Ë ∂£ Î·È ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜ οو ·fi ÙËÓ 3Ë ∂£. ∏ ηٿ Û˘ÛÙ‹Ì·Ù· ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË ‰ÂÓ ·Ó¤‰ÂÈÍ ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·, ÂÓÒ Ó¢ÚÔÏÔÁÈο ›¯Â ·‰˘Ó·Ì›· ÛÙ‹ÚÈ͢ ÎÂÊ·Ï‹˜, ·‰˘Ó·Ì›· ÛÙ‹ÚÈ͢ Û fiÚıÈ· Î·È Î·ıÈÛÙ‹ ı¤ÛË, ·‰˘Ó·Ì›· ‚¿‰ÈÛ˘ Î·È Ô„ÔÌ˘fiÎÏoÓÔ-ÙÚfiÌÔ ÎÔÚÌÔ‡, ÎÂÊ·Ï‹˜ Î·È ¿ÎÚˆÓ. ∏ Ì˘˚΋ ÈÛ¯‡˜, Ô Ì˘˚Îfi˜ ÙfiÓÔ˜ Î·È Ù· ÙÂÓfiÓÙÈ· ·ÓÙ·Ó·ÎÏ·ÛÙÈο ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο. ∏ ·ÍÈÔÏfiÁËÛË Î·Ù¿ Denver ‹Ù·Ó Û˘Ì‚·Ù‹ Ì ËÏÈΛ· 6-7 ÌËÓÒÓ ÛÙËÓ ·‰Ú‹, ÏÂÙ‹ ÎÈÓËÙÈÎfiÙËÙ· Î·È ÔÌÈÏ›· Î·È 10 ÌËÓÒÓ ÛÙËÓ ÎÔÈÓˆÓÈÎfiÙËÙ·. ∞fi ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô, Ë ÔÛÊ˘ÔÓˆÙÈ·›· ·Ú·Î¤ÓÙËÛË ‹Ù·Ó ·ÚÓËÙÈ΋, fiˆ˜ Î·È Ô ÈÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜. ∏ ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη, ÙÔ ˘ÂÚ˯ÔÙÔÌÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜ Î·È Ë ·ÍÔÓÈ΋ Î·È Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ Ì ÛÎÈ·ÁÚ·ÊÈÎfi ‰ÂÓ ¤‰ÂÈÍ·Ó ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·. ∞ÓÙ›ıÂÙ·, Ë Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘ Ì ÛÎÈ·ÁÚ·ÊÈÎfi ·Ó¤‰ÂÈÍ ·Ú·ÛÔÓ‰˘ÏÈ΋ ‚Ï¿‚Ë ÛÙÔ ‡„Ô˜ ÙÔ˘ £8-£9 ÛÔÓ‰‡ÏÔ˘ ‰ÂÍÈ¿ ˆ˜ ÙËÓ Î¿Ùˆ ÂÈÊ˘Ûȷ΋ Ͽη ÙÔ˘ £10, Ë ÔÔ›· ‰ÂÓ ÂÂÎÙÂÈÓfiÙ·Ó ÂÓÙfi˜ ÙÔ˘ ÛÔÓ‰˘ÏÈÎÔ‡ ۈϋӷ, Ì ̤ÁÈÛÙË ÚÔÛıÈÔ›ÛıÈ· ‰È¿ÌÂÙÚÔ 2,4 cm, ÂÁοÚÛÈ· 0,6 cm, Î·È ÎÂÊ·ÏÔ˘Ú·›· 2,3 cm ÛÙÔ Î·ÙÒÙÂÚÔ Ô›ÛıÈÔ ÌÂÛÔıˆÚ¿ÎÈÔ ·Ú¿ ÙË ‰ÂÍÈ¿ ¤Íˆ Ï¢ÚԉȷÊÚ·ÁÌ·ÙÈ΋ ÁˆÓ›· (∂ÈÎfiÓ˜ 1 Î·È 2). ªÂ Èı·Ó‹ ‰È¿ÁÓˆÛË Ó¢ÚÔ‚Ï¿Ûو̷, ÙÔ ·È‰› ÌÂٷʤÚıËΠÛÙËÓ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ∞ÈÌ·ÙÔÏÔÁ›·˜-√ÁÎÔÏÔÁ›·˜ ÁÈ· ÂÚ·ÈÙ¤Úˆ ‰ÈÂÚ‡ÓËÛË. ∆Ô ÛÈÓıËÚÔÁÚ¿ÊËÌ· Ì 123π MIBG ‰ÂÓ ¤‰ÂÈÍ ·ıÔÏÔÁÈ΋ ÚfiÛÏË„Ë Ú·‰ÈÔÊ·ÚÌ¿ÎÔ˘, ÂÓÒ Ë ÊÂÚÚÈÙ›ÓË ÔÚÔ‡ Î·È ÙÔ ‚·Ó˘ÏÌ·Ó‰ÂÏÈÓÈÎfi Ô͇ ÙˆÓ Ô‡ÚˆÓ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο. ∆Ô Ì˘ÂÏfiÁÚ·ÌÌ· ‰ÂÓ ·Ó¤‰ÂÈÍ ·ÚÔ˘Û›· ÌÂÌÔÓˆÌ¤ÓˆÓ Ó¢ÚÔ‚Ï·ÛÙÒÓ ‹ ÚÔ˙ÂÙÒÓ. ∏

Pediatri May-Jun 07

24-05-07

17:58

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229

¡Â˘ÚÔ‚Ï¿Ûو̷ Î·È Û‡Ó‰ÚÔÌÔ Ô„ÔÌ˘fiÎÏoÓÔ˘-·Ù·Í›·˜

N-myc. H ÛÙ·‰ÈÔÔ›ËÛË Û‡Ìʈӷ Ì ÙÔ ‰ÈÂıÓ¤˜ Û‡ÛÙËÌ· ÛÙ·‰ÈÔÔ›ËÛ˘ Ó¢ÚÔ‚Ï·ÛÙÒÌ·ÙÔ˜ ‹Ù·Ó Û˘Ì‚·Ù‹ Ì ÓfiÛÔ ÛÙ·‰›Ô˘ π. ø˜ ·ÓÔÛÔÙÚÔÔÔÈËÙÈ΋ Î·È ·ÓÔÛÔηٷÛÙ·ÏÙÈ΋ ·ÁˆÁ‹ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ √ª∞ ¯ÔÚËÁ‹ıËΠÂÓ‰ÔÊϤ‚È· Á-ÛÊ·ÈÚ›ÓË ÙÚȘ, ‹È· ¯ËÌÂÈÔıÂÚ·›· Ì ‚ÈÓÎÚÈÛÙ›ÓË (0,05 mg/kg) Î·È Î·Ù·ÙÂÙÌË̤ÓË Î˘ÎÏÔʈÛÊ·Ì›‰Ë (5 mg/kg/ Ë̤ڷ ÂÓ‰ÔÊÏ‚›ˆ˜ ÁÈ· 5 Ë̤Ú˜, οı 21 Ë̤Ú˜) ÁÈ· 4 ·ÎÏÔ˘˜, ·ÏÏ¿ Î·È ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹ ·fi ÙÔ ÛÙfiÌ· Û ‰È·ÊÔÚÂÙÈο ¯ÚÔÓÈο ‰È·ÛÙ‹Ì·Ù·. ™ÙÔ Ï·›ÛÈÔ Ù·ÎÙÈ΋˜ ·Ú·ÎÔÏÔ‡ıËÛ˘, ÙÔ ·È‰› ‰ÂÓ ·ÚÔ˘ÛÈ¿˙ÂÈ ‚ÂÏÙ›ˆÛË ÛÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ √ª∞ ‰¤Î· Ì‹Ó˜ ÌÂÙ¿ ÙËÓ ·Ú¯È΋ ‰È¿ÁÓˆÛË, ÂÓÒ ÙfiÛÔ Ë ÛˆÌ·ÙÈ΋ fiÛÔ Î·È Ë „˘¯ÔÎÈÓËÙÈ΋ ÙÔ˘ ÂͤÏÈÍË ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ÛÙ·ÛÈÌfiÙËÙ·.

∂ÈÎfiÓ· 1. ¶·Ú·Ô‚ÂÏÈ·›· ÙÔÌ‹ Ì·ÁÓËÙÈ΋˜ ÙÔÌÔÁÚ·Ê›·˜, fiÔ˘ ‰È·ÎÚ›ÓÂÙ·È ·ÙÚ·ÎÙÔÂȉ‹˜ ÈÛÙfi˜ (‚¤ÏÔ˜) Û·ÊÒÓ ÔÚ›ˆÓ Î·È ·ıÔÏÔÁÈÎÔ‡ Û‹Ì·ÙÔ˜.

ÈÛÙÔÏÔÁÈ΋ ÂͤٷÛË Ù˘ Ì¿˙·˜ Ô˘ ÂÍ·ÈÚ¤ıËΠ̠ıˆÚ·ÎÔÎÔÈÏȷ΋ ÚÔÛ¤Ï·ÛË ¤‰ÂÈÍ ÂÈÎfiÓ· Ó¢ÚÔ‚Ï·ÛÙÒÌ·ÙÔ˜ ¢ÓÔ˚΋˜ ÈÛÙÔÏÔÁ›·˜ ηٿ Shimada. ∏ Ì¿˙· ·Ê·ÈÚ¤ıËΠÂ› ˘ÁÈÒÓ ÔÚ›ˆÓ, ÂÓÒ ÔÈ ÏÂÌÊ·‰¤Ó˜ ‹Ù·Ó ·ÚÓËÙÈÎÔ› ÁÈ· ÌÂÙ·ÛÙ·ÙÈ΋ ÓfiÛÔ. ªÂ ÙÔÓ ÌÔÚÈ·Îfi ¤ÏÂÁ¯Ô ΢ÙÙ¿ÚˆÓ ÙÔ˘ ÚˆÙÔ·ıÔ‡˜ fiÁÎÔ˘ Ì in situ ˘‚ÚȉÈÛÌfi ÊıÔÚÈÔ¯ÚÒÌ·ÙÔ˜ ‰ÂÓ ‰È·ÈÛÙÒıËΠÂÓ›Û¯˘ÛË ÙÔ˘ ÔÁÎÔÁÔÓȉ›Ô˘

∂ÈÎfiÓ· 2. ∂ÁοÚÛÈ· ÙÔÌ‹ Ì·ÁÓËÙÈ΋˜ ÙÔÌÔÁÚ·Ê›·˜, fiÔ˘ ‰È·ÎÚ›ÓÂÙ·È Ë Ù˘È΋ ·Ú·ÛÔÓ‰˘ÏÈ΋ ı¤ÛË ÙÔ˘ ·ıÔÏÔÁÈÎÔ‡ ÈÛÙÔ‡ (‚¤ÏÔ˜).

™˘˙‹ÙËÛË ∆Ô Û‡Ó‰ÚÔÌÔ √ª∞ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ·Î·ÓfiÓÈÛÙ˜, Ù˘¯·›Â˜ ÎÈÓ‹ÛÂȘ ÔÊı·ÏÌÔ‡, Ì˘ÔÎÏÔÓÈΤ˜ ÎÈÓ‹ÛÂȘ ¿ÎÚˆÓ Î·È ÎÔÚÌÔ‡ Î·È ·Ù·Í›· (dancing eyes, dancing feet) (2-12). ∆Ô 62% ÙˆÓ ·ÛıÂÓÒÓ ·ÚÔ˘ÛÈ¿˙ÂÙ·È Ì ԄfiÎÏoÓÔ, Ì˘fiÎÏÔÓÔ Î·È ·Ù·Í›· Î·È ÙÔ 38% Ì ¤Ó· ‹ ‰‡Ô ·fi Ù· ·Ú·¿Óˆ Û˘ÌÙÒÌ·Ù· (8). ∏ ËÏÈΛ· ¤Ó·Ú͢ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Î˘Ì·›ÓÂÙ·È ·fi 11 ¤ˆ˜ 31 Ì‹Ó˜ (̤ÛË ËÏÈΛ·: 18 Ì‹Ó˜). ∏ ‰È¿ÚÎÂÈ· ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ √ª∞ ÚÈÓ ·fi ÙË ‰È¿ÁÓˆÛË ÙÔ˘ Ó¢ÚÔ‚Ï·ÛÙÒÌ·ÙÔ˜ ˘ÔÏÔÁ›˙ÂÙ·È Û 6 Ë̤Ú˜ ¤ˆ˜ 17 Ì‹Ó˜, Ì ̤ÛË ‰È¿ÚÎÂÈ· ÙȘ 6 ‚‰ÔÌ¿‰Â˜ (2). ÀÔÛÙËÚ›˙ÂÙ·È fiÙÈ ÙÔ Û‡Ó‰ÚÔÌÔ ¤¯ÂÈ ·ÓÔÛÔÏÔÁÈ΋ ‚¿ÛË (2,7,8). √È ÌÂϤÙ˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ Ù· ·È‰È¿ Ì √ª∞ ·Ó·Ù‡ÛÛÔ˘Ó IgG ‹ IgM ·˘ÙÔ·ÓÙÈÛÒÌ·Ù· ηٿ ÙÔ˘ fiÁÎÔ˘, Ù· ÔÔ›· ÛÙÚ¤ÊÔÓÙ·È fï˜ Î·È Î·Ù¿ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ Ó¢ÚÈÎÒÓ Î˘ÙÙ¿ÚˆÓ, Ì ·ÔÙ¤ÏÂÛÌ· Ó· ÚÔηÏÂ›Ù·È ‚Ï¿‚Ë Î·È ÔÍ›· Ó¢ÚÔÏÔÁÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·. √È ·ÛıÂÓ›˜ Ì ۇӉÚÔÌÔ √ª∞ ¤¯Ô˘Ó Û˘Ó‹ıˆ˜ Ó¢ÚÔ‚Ï¿Ûو̷ ¯·ÌËÏÔ‡ ÛÙ·‰›Ô˘ π ‹ ππ Î·È Î·Ï‹˜ ÚfiÁÓˆÛ˘, Èı·ÓfiÓ ÏfiÁˆ ÂÚÈÔÚÈÛÌÔ‡ Ù˘ ·Ó¿Ù˘Í˘ ÙÔ˘ fiÁÎÔ˘ ·fi Ù· ·˘ÙÔ·ÓÙÈÛÒÌ·Ù· (8,9). ∆Ô ÌÂÛÔıˆÚ¿ÎÈÔ Â›Ó·È Û˘¯Ó‹ ÚˆÙÔ·ı‹˜ ÂÓÙfiÈÛË ÙÔ˘ Ó¢ÚÔ‚Ï·ÛÙÒÌ·ÙÔ˜ Û ·ÛıÂÓ›˜ Ì √ª∞, Û ·ÓÙ›ıÂÛË Ì ·ÛıÂÓ›˜ Ì Ó¢ÚÔ‚Ï¿Ûو̷ ¯ˆÚ›˜ ÙÔ ·Ú·ÓÂÔÏ·ÛÌ·ÙÈÎfi Û‡Ó‰ÚÔÌÔ, fiÔ˘ Ë ÓfiÛÔ˜ ÂÓÙÔ›˙ÂÙ·È Û˘¯ÓfiÙÂÚ· ÛÙËÓ ÎÔÈÏÈ¿. ∆Ô Û‡Ó‰ÚÔÌÔ Â›Ó·È Û¿ÓÈÔ Û ‚Ú¤ÊË ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙÔ˘ ¤ÙÔ˘˜, Èı·Ófiٷٷ ÏfiÁˆ Ù˘ ÌÂȈ̤Ó˘ ·Ú·ÁˆÁ‹˜ ·ÓÙÈÛˆÌ¿ÙˆÓ ÛÙÔÓ ÚÒÙÔ ¯ÚfiÓÔ Ù˘ ˙ˆ‹˜. ∞ÛıÂÓ›˜ Ì √ª∞ ¤¯Ô˘Ó Ó¢ÚÔ‚Ï¿Ûو̷ ¢ÓÔ˚΋˜ ÈÛÙÔ·ıÔÏÔÁ›·˜ Î·È ‰ÂÓ ÂÌÊ·Ó›˙Ô˘Ó ÂÓ›Û¯˘ÛË ÙÔ˘ ÔÁÎÔÁÔÓ›‰ÈÔ˘ N-myc, ÁÂÁÔÓfi˜ Ô˘ ‰È·ÈÛÙÒıËÎÂ Î·È ÛÙËÓ ÂÚ›ÙˆÛË ÙÔ˘ ·ÛıÂÓ‹ Ù˘ ·ÚÔ‡Û·˜ ÂÚ›ÙˆÛ˘. ∏ ÏÂÈÔ„ËÊ›· ÙÔ˘˜ ÂÌÊ·Ó›˙ÂÙ·È Ì ÌË ¶·È‰È·ÙÚÈ΋ 2007;70:227-231

Pediatri May-Jun 07

24-05-07

17:58

™ÂÏ›‰·230

230

¡. ∫·Ù˙ËÏ¿Î˘ Î·È Û˘Ó.

ÌÂÙ·ÛÙ·ÙÈ΋ ÓfiÛÔ, Û ·ÓÙ›ıÂÛË Ì ·ÛıÂÓ›˜ Ì Ó¢ÚÔ‚Ï¿Ûو̷ ËÏÈΛ·˜ ¿Óˆ ÙÔ˘ ¤ÙÔ˘˜ ¯ˆÚ›˜ √ª∞ Ô˘ Û˘¯Ó¿ ¿Û¯Ô˘Ó ·fi ÌÂÙ·ÛÙ·ÙÈ΋ ÓfiÛÔ Î·Ù¿ ÙË ‰È¿ÁÓˆÛË. ∞ÎfiÌ· fï˜ Î·È ÁÈ· ÓfiÛÔ ÙÔ˘ ȉ›Ô˘ ÛÙ·‰›Ô˘, ÔÈ ·ÛıÂÓ›˜ Ì Ó¢ÚÔ‚Ï¿Ûو̷ Î·È √ª∞ ¤¯Ô˘Ó ηχÙÂÚË ÚfiÁÓˆÛË. ŒÙÛÈ, Ë ÙÚÈÂÙ‹˜ ÂÈ‚›ˆÛË ·ÛıÂÓÒÓ ËÏÈΛ·˜ ¿Óˆ ÙÔ˘ ¤ÙÔ˘˜ Ì ÌË ÌÂÙ·ÛÙ·ÙÈÎfi Ó¢ÚÔ‚Ï¿Ûو̷ ÛÙ·‰›ˆÓ π, ππ Î·È πππ Î·È √ª∞ Â›Ó·È 100% ¤Ó·ÓÙÈ 77% ·˘Ù‹˜ ·ÚfiÌÔÈˆÓ ·ÛıÂÓÒÓ ·ÏÏ¿ ¯ˆÚ›˜ √ª∞ (9). ¶·Ú’ fiÏÔ Ô˘ ÔÈ ·ÛıÂÓ›˜ Ì Ó¢ÚÔ‚Ï¿Ûو̷ Î·È Û‡Ó‰ÚÔÌÔ √ª∞ ¤¯Ô˘Ó ¿ÚÈÛÙË Ì·ÎÚÔ¯ÚfiÓÈ· ÂÈ‚›ˆÛË, Û˘¯Ó¿ ÂÌÊ·Ó›˙Ô˘Ó Â›ÌÔÓ· Ó¢ÚÔÏÔÁÈο Û˘ÌÙÒÌ·Ù· Î·È ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ ¿Û¯Ô˘Ó ·fi Ì·ÎÚÔ¯ÚfiÓÈ· Â›ÌÔÓË ÎÈÓËÙÈ΋ (ÚÔ¤¯ÔÓ Û‡Ìو̷) Î·È ÓÔËÙÈ΋ ηı˘ÛÙ¤ÚËÛË, ηı˘ÛÙ¤ÚËÛË ÏfiÁÔ˘ Î·È ÚÔ‚Ï‹Ì·Ù· Û˘ÌÂÚÈÊÔÚ¿˜ (2-4,9,10). ∞Í›˙ÂÈ Ó· ÛËÌÂȈı› fiÙÈ ‰ÂÓ ˘¿Ú¯ÂÈ Û˘Û¯ÂÙÈÛÌfi˜ ÌÂٷ͇ Ù˘ ‰È¿ÚÎÂÈ·˜ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ OM∞ ÚÈÓ ·fi ÙË ‰È¿ÁÓˆÛË ÙÔ˘ Ó¢ÚÔ‚Ï·ÛÙÒÌ·ÙÔ˜ Î·È Ù˘ Ó¢ÚÔÏÔÁÈ΋˜ ÂͤÏÈ͢ ÙˆÓ ·ÛıÂÓÒÓ (9). ™¯Â‰fiÓ fiÏ· Ù· ·È‰È¿ Ì √ª∞ ··ÈÙÔ‡Ó ·Ú·ÙÂٷ̤ÓË ·ÓÔÛÔηٷÛÙ·ÏÙÈ΋ Î·È ·ÓÔÛÔÙÚÔÔÔÈËÙÈ΋ ıÂÚ·›· ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô ÙˆÓ Ó¢ÚÔÏÔÁÈÎÒÓ ÂΉËÏÒÛÂˆÓ (2-4,8-12). ∏ ıÂÚ·¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ÂÚÈÏ·Ì‚¿ÓÂÈ ¯ÔÚ‹ÁËÛË ÎÔÚÙÈÎÔÛÙÂÚÔÂȉÒÓ, ÎÔÚÙÈÎÔÙÚÔ›Ó˘ (ACTH), ÂÓ‰ÔÊϤ‚È·˜ Á-ÛÊ·ÈÚ›Ó˘, Ï·ÛÌ·Ê·›ÚÂÛË Î·È ·ÓÔÛÔηٷÛÙ·ÏÙÈ΋ ¯ËÌÂÈÔıÂÚ·›·. ªÂÁ¿ÏÔ ÔÛÔÛÙfi ·ÛıÂÓÒÓ ÌÔÚ› Ó· ·ÓÙ·ÔÎÚÈı› ÛÙËÓ ·Ú¯È΋ ıÂÚ·›· Ì ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹ ‹ ACTH. ∏ ·Ú¯È΋, fï˜, ·¿ÓÙËÛË ‰ÂÓ Û˘Û¯ÂÙ›˙ÂÙ·È Ì ÏÈÁfiÙÂÚ· ·ÒÙÂÚ· Ó¢ÚÔÏÔÁÈο Û˘ÌÙÒÌ·Ù· Î·È Ë ÏÂÈÔ„ËÊ›· ÙˆÓ ·ÛıÂÓÒÓ ÂÌÊ·Ó›˙ÂÈ ˘ÔÙÚÔ¤˜ ÛÙË Ê¿ÛË Ù˘ ÛÙ·‰È·Î‹˜ Ì›ˆÛ˘ Ùo˘ Ê·ÚÌ¿ÎÔ˘ (9). ¶Ôχ Û˘¯Ó‹ Â›Ó·È Î·È Ë ÂÌÊ¿ÓÈÛË ·ÚÂÁÎÂÊ·ÏȉÈ΋˜ ·ÙÚÔÊ›·˜ ¯ˆÚ›˜ ¿ÏÏ· ˘ÂÚÛÎËÓȉȷο ·ÂÈÎÔÓÈÛÙÈο Â˘Ú‹Ì·Ù· Û ·ÛıÂÓ›˜ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó Ì ̷ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ (4). ∏ ¯ÔÚ‹ÁËÛË ÂÓ‰ÔÊϤ‚È·˜ Á-ÛÊ·ÈÚ›Ó˘ ‚ÂÏÙÈÒÓÂÈ Ù· Û˘ÌÙÒÌ·Ù·, Èı·ÓfiÓ ÏfiÁˆ Ì›ˆÛ˘ ·Ú·ÁˆÁ‹˜ ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ Î·È ·ÚÂÌfi‰ÈÛ˘ Ù˘ ‰Ú¿Û˘ ÙÔ˘˜. ∆· ·È‰È¿ Ì Ó¢ÚÔ‚Ï¿Ûو̷ Î·È √ª∞ Ô˘ ¤Ï·‚·Ó ·ÓÔÛÔÙÚÔÔÔÈËÙÈ΋ ¯ËÌÂÈÔıÂÚ·›· Ê·›ÓÂÙ·È Â›Û˘ Ó· ¤¯Ô˘Ó ηχÙÂÚË Ó¢ÚÔÏÔÁÈ΋ ¤Î‚·ÛË ÏfiÁˆ Ù˘ Ì›ˆÛ˘ ·Ú·ÁˆÁ‹˜ ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ Ô˘ ÚÔηÏ› Ë ¯ËÌÂÈÔıÂÚ·›· (9). ∂Óı·ÚÚ˘ÓÙÈο ·ÔÙÂϤÛÌ·Ù· ·Ó·Ê¤ÚÔÓÙ·È ÙÂÏÂ˘Ù·›· Ì ÙË ¯Ú‹ÛË ÙÔ˘ ·ÓÙÈ-CD20 ¯ÂÈÌÂÚÈÎÔ‡ ÌÔÓÔÎÏoÓÈÎÔ‡ ·ÓÙÈÛÒÌ·ÙÔ˜ ÚÈÙÔ˘ÍÈÌ¿ÌË, ÙÔ ÔÔ›Ô ÛÙÚ¤ÊÂÙ·È Î·Ù¿ ÙˆÓ CD20+ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Ô˘ ÂÓ¤¯ÔÓÙ·È ÛÙËÓ ·ÈÙÈÔ·ıÔÁ¤ÓÂÈ· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ (11,12). √È Pranzatelli Î·È Û˘ÓÂÚÁ¿Ù˜ ÌÂϤÙËÛ·Ó ÙȘ ·ÓÔÛÔÏÔPaediatriki 2007;70:227-231

ÁÈΤ˜ ·ÓÙȉڿÛÂȘ ÛÙÔ ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚfi (∂¡À) 36 ·È‰ÈÒÓ Ì √ª∞ (16 ·Ú·ÓÂÔÏ·ÛÌ·ÙÈ΋˜ ·ÈÙÈÔÏÔÁ›·˜ Î·È 20 ÌË Û˘Û¯ÂÙÈ˙fiÌÂÓÔ Ì fiÁÎÔ˘˜) Î·È 18 Ì¿ÚÙ˘Ú˜ Ì ‰È¿ÊÔÚ· ÌÔÓÔÎÏoÓÈο ·ÓÙÈÛÒÌ·Ù· ηıÔÚÈÛÌÔ‡ ˘ÔÏËı˘ÛÌÒÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ. ¶·Ú’ fiÏÔ Ô˘ ‰ÂÓ ·Ú·ÙËÚ‹ıËΠÏÂÈÔ·ÙÙˆÛË ÛÙÔ ∂¡À, ‚Ú¤ıËΠ‰È·Ù·Ú·¯‹ ÛÙÔ˘˜ ˘ÔÏËı˘ÛÌÔ‡˜ ÙˆÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ. ∂ӉȷʤÚÔÓ Â›Ó·È ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÛÂ Ù˘ÊÏ‹ - ˆ˜ ÚÔ˜ Ù· Â˘Ú‹Ì·Ù· ÙÔ˘ ∂¡À - ηٷÁÚ·Ê‹ ÙˆÓ Ó¢ÚÔÏÔÁÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ Ì ‚›ÓÙÂÔ, Ù· Â˘Ú‹Ì·Ù· ÙÔ˘ ∂¡À Û˘Û¯ÂÙ›˙ÔÓÙ·Ó Ì ÙȘ Ó¢ÚÔÏÔÁÈΤ˜ ‰È·Ù·Ú·¯¤˜ ÙˆÓ ·ÛıÂÓÒÓ (12). ™˘ÌÂÚ·ÛÌ·ÙÈο, fiÛÔÓ ·ÊÔÚ¿ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì Ó¢ÚÔ‚Ï¿Ûو̷ Î·È √ª∞: ·) Ë ÏÂÈÔ„ËÊ›· (62%) ·ÚÔ˘ÛÈ¿˙ÂÙ·È Î·È Ì ٷ 3 Û˘ÌÙÒÌ·Ù· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘, ‚) ÔÈ ·ÛıÂÓ›˜ Â›Ó·È Û˘Ó‹ıˆ˜ ÛÙ·‰›Ô˘ π Î·È ππ, Á) ¤¯Ô˘Ó ¢ÓÔ˚΋ ÈÛÙÔ·ıÔÏÔÁ›·, ‰) Û¿ÓÈ· ¤¯Ô˘Ó ÂÓ›Û¯˘ÛË ÙÔ˘ ÔÁÎÔÁÔÓȉ›Ô˘ ¡-myc, Â) ÔÛÔÛÙfi 70-80% ¤¯ÂÈ Ì·ÎÚÔÚfiıÂÛÌ· Ó¢ÚÔÏÔÁÈο ÂÏÏ›ÌÌ·Ù· Î·È ÛËÌ·ÓÙÈÎÔ‡ ‚·ıÌÔ‡ „˘¯ÔÎÈÓËÙÈ΋ ηı˘ÛÙ¤ÚËÛË Î·È ÛÙ) Ë ÂÍ·ÙÔÌÈÎÂ˘Ì¤ÓË ·ÓÙÈÌÂÙÒÈÛË Ì ·ÓÔÛÔηٷÛÙ·ÏÙÈΤ˜ ıÂÚ·›˜ ‰ÂÓ Ô‰ËÁ› Û ÈηÓÔÔÈËÙÈο ·ÔÙÂϤÛÌ·Ù· ÛÙËÓ ÏÂÈÔ„ËÊ›· ÙˆÓ ÂÚÈÙÒÛˆÓ.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Castleberry RP, Pritchard J, Ambros P, Berthold F, Brodeur GM, Castel V et al. The International Neuroblastoma Risk Groups (INRG): a preliminary report. Eur J Cancer 1997;33:2113-2116.

2. Mitchell WG, Davalos-Gonzalez Y, Brumm VL, Aller SK, Burger E, Turkel SB et al. Opsoclonus-ataxia caused by childhood neuroblastoma: developmental and neurologic sequelae. Pediatrics 2002;109:86-98.

3. Mitchell WG, Brumm VL, Azen CG, Patterson KE, Aller SK, Rodriguez J. Longitudinal neurodevelopmental evaluation of children with opsoclonus-ataxia. Pediatrics 2005;116:901-907.

4. Hayward K, Jeremy RJ, Jenkins S, Barkovich AJ, Gultekin SH, Kramer J et al. Long-term neurobehavioral outcomes in children with neuroblastoma and opsoclonus-myoclonus-ataxia syndrome: relationship to MRI findings and anti-neuronal antibodies. J Pediatr 2001;139:552-559.

5. Darnell RB, Posner JB. Paraneoplastic syndromes involving the nervous system. N Engl J Med 2003;349:1543-1554.

6. Araga S, Nakashima K. Neurologic signs and symptoms in viral infections - disease involving meninges, central nervous system or peripheral nerve system. Nippon Rinsho 1997;55:805-808.

7. ∞ntunes NL, Khakoo Y, Matthay KK, Seeger RC, Stram DO, Gerstner E et al. Antineuronal antibodies in patients with neuroblastoma and paraneoplastic opsoclonus-myoclonus. J Pediatr Hematol Oncol 2000;22:315-320.

8. Cooper R, Khakoo Y, Matthay KK, Lukens JN, Seeger RC, Stram DO et al. Opsoclonus-myoclonus-ataxia syndrome in neuroblastoma: histopathologic features - a report from the Children’s Cancer Group. Med Pediatr Oncol 2001;36:623-629.

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9. Rudnick E, Khakoo Y, Antunes NL, Seeger RC, Brodeur GM, Shimada H et al. Opsoclonus-myoclonus-ataxia syndrome in neuroblastoma: clinical outcome and antineuronal antibodies-a report from the Children’s Cancer Group Study. Med Pediatr Oncol 2001;36:612-622.

10. Tate ED, Allison TJ, Pranzatelli MR, Verhulst SJ. Neuroepidemiologic trends in 105 US cases of pediatric opsoclonus-myoclonus syndrome. J Pediatr Oncol Nurs 2005;22:8-19.

11. Pranzatelli MR, Tate ED, Travelstead AL, Barbosa J, Bergamini RA, Civitello L et al. Rituximab (anti-CD20) adjunctive therapy for opsoclonus-myoclonus syndrome. J Pediatr Hematol Oncol 2006;28:585-593.

12. Pranzatelli MR, Travelstead AL, Tate ED, Allison TJ, Moticka EJ, Franz DN et al. B- and T-cell markers in opsoclonus-myoclonus syndrome: immunophenotyping of CSF lymphocytes. Neurology 2004;62:1526-1532.

¶·È‰È·ÙÚÈ΋ 2007;70:227-231

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∂¡¢π∞º∂ƒ√À™∞ ¶∂ƒπ¶∆ø™∏

CASE REPORT

µÚ¤ÊÔ˜ Ì ·˘ÙÔ¿ÓÔÛË Ô˘‰ÂÙÂÚÔÂÓ›· 1 µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ ∞ıËÓÒÓ “¶. Î·È ∞. ∫˘ÚÈ·ÎÔ‡” 2 ∞ÈÌ·ÙÔÏÔÁÈÎfi ∆Ì‹Ì·, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ ∞ıËÓÒÓ “¶. Î·È ∞. ∫˘ÚÈ·ÎÔ‡” AÏÏËÏÔÁÚ·Ê›·: ºˆÙÂÈÓ‹ ™ÙÚÈ¤ÏË stripeli@med.uoa.gr ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ ∞ıËÓÒÓ “¶. Î·È ∞. ∫˘ÚÈ·ÎÔ‡” £Ë‚ÒÓ Î·È §Â‚·‰Â›·˜, ∆.∫. 115 27, ∞ı‹Ó·

º. ™ÙÚÈ¤ÏË1, π. ¶. ¶·Ó·ÁÈÒÙÔ˘1, ∂. ¢ËÌËÙÚ›Ô˘1, ∂. ∫ÔÂÌÙ˙›‰Ô˘1, £. ∞Ó·ÛÙ·Û›Ô˘2, ∞. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜1 ¶ÂÚ›ÏË„Ë: ∏ ·˘ÙÔ¿ÓÔÛË Ô˘‰ÂÙÂÚÔÂÓ›· ÙˆÓ ‚ÚÂÊÒÓ Â›Ó·È Ë ÈÔ Û˘¯Ó‹ ÌÔÚÊ‹ ¯ÚfiÓÈ·˜ Ô˘‰ÂÙÂÚÔÂÓ›·˜ ÛÙ· ·È‰È¿. √Ê›ÏÂÙ·È ÛÙËÓ ·ÚÔ˘Û›· ·ÓÙÈÔ˘‰ÂÙÂÚÔÊÈÏÈÎÒÓ ·ÓÙÈۈ̿وÓ, Ù· ÔÔ›· ÛÙÚ¤ÊÔÓÙ·È Î·Ù¿ Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ·ÓÙÈÁfiÓˆÓ Ù˘ ÂÈÊ¿ÓÂÈ·˜ ÙˆÓ Ô˘‰ÂÙÂÚfiÊÈÏˆÓ ÔÏ˘ÌÔÚÊÔ‡ÚËÓˆÓ. ∏ ‰È¿ÁÓˆÛ‹ Ù˘ Û˘¯Ó¿ ‰È·Ê‡ÁÂÈ, ηıÒ˜ Ë ÎÏÈÓÈ΋ ÂÈÎfiÓ· Ù˘ ÓfiÛÔ˘ Â›Ó·È Û˘Ó‹ıˆ˜ ‹È·. ¶ÂÚÈÁÚ¿ÊÂÙ·È ‚Ú¤ÊÔ˜ ËÏÈΛ·˜ 9,5 ÌËÓÒÓ Ì ÈÛÙÔÚÈÎfi Û˘¯ÓÒÓ ÏÔÈÌÒÍÂˆÓ ·fi ÙËÓ ËÏÈΛ· ÙˆÓ ÙÚÈÒÓ ÌËÓÒÓ, Ô˘ ·ÚÔ˘Û›·Û ÂÌ‡ÚÂÙË Û˘Ó‰ÚÔÌ‹, ¤ÏÎË ÛÙÔÌ·ÙÈ΋˜ ÎÔÈÏfiÙËÙ·˜ Î·È ·Ú¯fiÌÂÓÔ ÂÚȉÚÈÎfi ·fiÛÙËÌ·. ¢È·ÁÓÒÛıËΠԢ‰ÂÙÂÚÔÂÓ›· ¯ˆÚ›˜ ¿ÏϘ ‰È·Ù·Ú·¯¤˜ Û Â›Â‰Ô ¯˘ÌÈ΋˜ ‹ ΢ÙÙ·ÚÈ΋˜ ·ÓÔÛ›·˜. ∏ ·Ó‡ÚÂÛË ·ÓÙÈÛˆÌ¿ÙˆÓ Î·Ù¿ ÙˆÓ Ô˘‰ÂÙÂÚfiÊÈÏˆÓ ÔÏ˘ÌÔÚÊÔ‡ÚËÓˆÓ Û ÂÚÁ·ÛÙ‹ÚÈÔ ÙÔ˘ Â͈ÙÂÚÈÎÔ‡ ¤ıÂÛ ÙË ‰È¿ÁÓˆÛË Ù˘ ·˘ÙÔ¿ÓÔÛ˘ Ô˘‰ÂÙÂÚÔÂÓ›·˜. ÃÔÚËÁ‹ıËΠ‰‡Ô ÊÔÚ¤˜ ·˘ÍËÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÙˆÓ ÎÔÎÎÈÔ΢ÙÙ¿ÚˆÓ Ì ÈηÓÔÔÈËÙÈο ·ÔÙÂϤÛÌ·Ù·. ∏ ÂÚ·ÈÙ¤Úˆ ÔÚ›· ÙÔ˘ ·ÛıÂÓÔ‡˜ ‹Ù·Ó ηϋ, ·Ú¿ ÙËÓ ÂÈ̤ÓÔ˘Û· Ô˘‰ÂÙÂÚÔÂÓ›·.

§¤ÍÂȘ ÎÏÂȉȿ: ∞˘ÙÔ¿ÓÔÛË Ô˘‰ÂÙÂÚÔÂÓ›·, ‚Ú¤ÊË, ‰È¿ÁÓˆÛË, ıÂÚ·›·.

An infant with autoimmune neutropenia 1 2nd Paediatric Clinic, Kapodistrian University of Athens, “P and A. Kyriakou” Children’s Hospital 2 Haematology Laboratory, “P and A. Kyriakou” Children’s Hospital Correspondence: Fotini Stripeli stripeli@med.uoa.gr “P. and A. Kyriakou” Children’s Hospital Thivon & Levadias, 115 27 Athens

F. Stripeli 1, J. P. Panagiotou1, E. Dimitriou1, E. Koemzidou1, T. Anastasiou2, A. Constantopoulos1 Abstract: Autoimmune neutropenia of infancy, which is the most common cause of chronic neutropenia in childhood, is characterised by the presence of antineutrophil antibodies against specific neutrophil membrane antigens. The diagnosis of autoimmune neutropenia is often missed because the clinical findings are frequently mild. A case of a 9.5 month-old male infant with a history of recurrent infections is described, who presented with fever, mouth ulcers and perianal abscess. Initial laboratory evaluation revealed neutropenia with no evidence of humoral or cellular immunodeficiency. Detection of antineutrophil antibodies established the diagnosis of autoimmune neutropenia. The administration of granulocyte-colony stimulating factor was effective. The clinical course of the patient was uncomplicated, despite persisting neutropenia.

Key words: Immune neutropenia, infants, diagnosis, treatment.

∂ÈÛ·ÁˆÁ‹ ªÂ ÙÔÓ fiÚÔ Ô˘‰ÂÙÂÚÔÂÓ›· ÚÔÛ‰ÈÔÚ›˙ÂÙ·È Ë Ì›ˆÛË ÙÔ˘ ·fiÏ˘ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ Ô˘‰ÂÙÂÚfiÊÈÏˆÓ ÔÏ˘ÌÔÚÊÔ‡ÚËÓˆÓ (∞∞√¶) οو ·fi Ù· 1500/ÌL, ÁÈ· ËÏÈ˘ ÌÂÁ·Ï‡ÙÂÚ˜ ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜. ™Ù· ‚Ú¤ÊË ˆ˜ ηÙÒÙÂÚË ÙÈÌ‹ ıˆÚÂ›Ù·È ·˘Ù‹ ÙˆÓ 1000/mL, ‰Â‰Ô̤ÓÔ Ô˘ Ú¤ÂÈ Ó· Â›Ó·È ÁÓˆÛÙfi ÚÔÎÂÈ̤ÓÔ˘ Ó· ·ÔʇÁÂÙ·È Ë ˘ÂډȿÁÓˆÛË (1). ∏ Ô˘‰ÂÙÂÚÔÂÓ›· ·ÔÙÂÏ› Û˘¯Ófi ·ÈÌ·ÙÔÏÔÁÈÎfi ‡ÚËÌ· Ù˘ ·È‰È΋˜ ËÏÈΛ·˜, Û˘Ó‹ıˆ˜ Û˘Óԉ‡ÂÈ ÈÔÁÂÓ›˜ ÏÔÈÌÒÍÂȘ Î·È ¤¯ÂÈ ·ÚÔ‰ÈÎfi ¯·Ú·ÎÙ‹Ú·. ∞Ó¿ÏÔÁ· Ì ÙË ¯ÚÔÓÈ΋ ‰È¿ÚÎÂÈ· ‰È·ÎÚ›ÓÂÙ·È Û ÔÍ›· Î·È ¯ÚfiÓÈ·, ·Ó Ë ‰È¿ÁÓˆÛË ¤¯ÂÈ ÙÂı› Û ÌÈÎÚfiÙÂÚÔ ‹ ÌÂÁ·Ï‡ÙÂÚÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ·fi ¤ÍÈ Ì‹Ó˜. ™ÙËÓ ÂÚ›ÙˆÛË Ô˘ Ë ÓfiÛÔ˜ ‰È·ÚΛ ÁÈ· ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÌÂÁ·Ï‡ÙÂÚÔ ·fi ¤ÍÈ Ì‹Ó˜ Ú¤ÂÈ Ó· ·Ó·˙ËÙËı› Ë ·ÈÙ›· Ô˘ ÙËÓ ÚÔοÏÂÛÂ.

Paediatriki 2007;70:232-236

∏ ·˘ÙÔ¿ÓÔÛË Ô˘‰ÂÙÂÚÔÂÓ›· ·ÔÙÂÏ› Ù‡Ô ¯ÚfiÓÈ·˜ Ô˘‰ÂÙÂÚÔÂÓ›·˜, Ë ÔÔ›· ‰È·ÎÚ›ÓÂÙ·È Û ‰‡Ô ˘ÔÔÌ¿‰Â˜: ·) ÛÙËÓ ÚˆÙÔ·ı‹, fiÔ˘ Ë Ô˘‰ÂÙÂÚÔÂÓ›· ·ÔÙÂÏ› ÌÔÓ·‰È΋ ·ÈÌ·ÙÔÏÔÁÈ΋ ‰È·Ù·Ú·¯‹ ¯ˆÚ›˜ Ó· Û˘Ó˘¿Ú¯ÂÈ Ì ¿ÏÏÔ ÓfiÛËÌ· Î·È ‚) ÛÙË ‰Â˘ÙÂÚÔ·ı‹, fiÔ˘ Ë Ô˘‰ÂÙÂÚÔÂÓ›· ÂΉËÏÒÓÂÙ·È ÛÙÔ Ï·›ÛÈÔ Û˘ÛÙËÌ·ÙÈÎÔ‡ ·˘ÙÔ¿ÓÔÛÔ˘ ÓÔÛ‹Ì·ÙÔ˜ ‹ Û˘Û¯ÂÙ›˙ÂÙ·È Ì ÏÂÌÊÔ¸ÂÚÏ·ÛÙÈÎfi ÓfiÛËÌ· (2). ∏ ÚˆÙÔ·ı‹˜ ·˘ÙÔ¿ÓÔÛË Ô˘‰ÂÙÂÚÔÂÓ›· ·ÔÙÂÏ› ÙË Û˘¯ÓfiÙÂÚË ·ÈÙ›· Ù˘ ¯ÚfiÓÈ·˜ Ô˘‰ÂÙÂÚÔÂÓ›·˜. √Ê›ÏÂÙ·È ÛÙËÓ ·ÚÔ˘Û›· ·ÓÙÈÔ˘‰ÂÙÂÚÔÊÈÏÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ (∞√∞), Ù· ÔÔ›· ÛÙÚ¤ÊÔÓÙ·È Î·Ù¿ Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ·ÓÙÈÁfiÓˆÓ Ù˘ ÂÈÊ¿ÓÂÈ·˜ ÙˆÓ Ô˘‰ÂÙÂÚfiÊÈÏˆÓ ÔÏ˘ÌÔÚÊÔ‡ÚËÓˆÓ (3-5). ∏ ‰È¿ÁÓˆÛË Ù˘ ·˘ÙÔ¿ÓÔÛ˘ Ô˘‰ÂÙÂÚÔÂÓ›·˜, fï˜, Û˘¯Ó¿ ‰È·Ê‡ÁÂÈ ÁÈ·Ù› Ë ÎÏÈÓÈ΋ ÂÈÎfiÓ· Ù˘ ÓfiÛÔ˘ Â›Ó·È ‹È· Î·È ÂÔ̤ӈ˜ ‰ÂÓ ·Ó·˙ËÙ›ٷÈ.

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¶ÂÚÈÁÚ·Ê‹ ÂÚÈÛÙ·ÙÈÎÔ‡ ÕÚÚÂÓ ‚Ú¤ÊÔ˜ 9,5 ÌËÓÒÓ ÚÔÛ‹Ïı ÛÙ· Â͈ÙÂÚÈο È·ÙÚ›· Ù˘ ÎÏÈÓÈ΋˜ Ì·˜ ÏfiÁˆ ÂÌ‡ÚÂÙ˘ Û˘Ó‰ÚÔÌ‹˜ ‰È¿ÚÎÂÈ·˜ 4 ËÌÂÚÒÓ. ¢‡Ô Ë̤Ú˜ ÚÈÓ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ›¯Â ÂÌÊ·Ó›ÛÂÈ ¤ÏÎË ÛÙÔÌ·ÙÈ΋˜ ÎÔÈÏfiÙËÙ·˜ Î·È ·Ú¯fiÌÂÓÔ ÂÚȉÚÈÎfi ·fiÛÙËÌ·. ™ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ·Ó·Ê¤ÚÂÙ·È ÌÂÁ·Ï‡ÙÂÚË ·‰ÂÏÊ‹ Ì ÂÙÂÚÔ˙˘ÁˆÙÈÛÌfi ‚-ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜. ∞fi ÙÔ ·ÙÔÌÈÎfi ÈÛÙÔÚÈÎfi ÛËÌÂÈÒÓÔÓÙ·È: ·) Û˘¯Ó¿ ÂÂÈÛfi‰È· ÛÙÔÌ·Ù›Ùȉ·˜ ·fi ÙË Á¤ÓÓËÛË, ‚) ·ÛÙ˜ ·Ó·ÙÔÏ‹˜, Á) ÂÂÈÛfi‰ÈÔ ÔÍ›·˜ ̤Û˘ ˆÙ›Ùȉ·˜, ‰) ÚÔÛ‚ÔÏ‹ ·fi ÎÔηÙË Î·È ·ÓÂÌ¢ÏÔÁÈ¿ Û ËÏÈΛ· 3 Î·È 4 ÌËÓÒÓ ·ÓÙ›ÛÙÔȯ·. ∆ÔÓ›˙ÂÙ·È fiÙÈ ÛÙÔ ÈÛÙÔÚÈÎfi ÙÔ˘ ·È‰ÈÔ‡ ‰ÂÓ ·Ó·Ê¤ÚÂÙ·È ÚÔËÁÔ‡ÌÂÓÔ˜ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜. ∫·Ù¿ ÙËÓ Â›ÛÔ‰fi ÙÔ˘ ÂÌÊ¿ÓÈ˙ ˆ¯ÚfiÙËÙ· ‰¤ÚÌ·ÙÔ˜, ¿Êı˜ ÛÙË ÛÙÔÌ·ÙÈ΋ ÎÔÈÏfiÙËÙ· Î·È ÂÚȉÚÈÎfi ·fiÛÙËÌ·. ∏ ۈ̷ÙÈ΋ ·Ó¿Ù˘ÍË ÙÔ˘ ·È‰ÈÔ‡ ‹Ù·Ó ¿ÚÈÛÙË. ™ÙË ÁÂÓÈ΋ ·›Ì·ÙÔ˜ ‚Ú¤ıËΠ∞∞√¶ 265/mL Î·È ÙÔ ‚Ú¤ÊÔ˜ ÂÈÛ‹¯ıË ÚÔ˜ ÂÚ·ÈÙ¤Úˆ ¤ÏÂÁ¯Ô Î·È ıÂÚ·›·. ∞fi ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô ÛËÌÂÈÒÓÔÓÙ·È Ù· οوıÈ: 1) °ÂÓÈ΋ ·›Ì·ÙÔ˜: Hb=8,8 g/dl, Ht=27,7%, MCV=56,2 fl, RDW=21,7%, ÏÂ˘Î¿ ·ÈÌÔÛÊ·›ÚÈ·=5300/mL (ÔÏ˘ÌÔÚÊÔ‡ÚËÓ·: 5%, ÏÂÌÊÔ·ÙÙ·Ú·: 59%, ÌÔÓÔ·ÙÙ·Ú·: 35%), ·ÈÌÔÂÙ¿ÏÈ·= 278000/mL, ¢∂∫=0,85%. ™ÙÔ Â›¯ÚÈÛÌ· ·›Ì·ÙÔ˜ ‰È·ÈÛÙÒıËÎ·Ó ¤ÓÙÔÓ˜ ÌÔÚÊÔÏÔÁÈΤ˜ ·ÓˆÌ·Ï›Â˜ ÙˆÓ ÂÚ˘ıÚÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ (·ÓÈÛÔ΢ÙÙ¿ÚˆÛË, ÌÈÎÚÔ΢ÙÙ¿ÚˆÛË, ˘ԯڈ̛·, ÔÈÎÈÏÔ΢ÙÙ¿ÚˆÛË) Û˘Ì‚·Ù¤˜ Ì ÂÙÂÚÔ˙˘ÁˆÙÈÛÌfi ‚-ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜.

2) ª˘ÂÏfiÁÚ·ÌÌ·: √ Ì˘ÂÏfi˜ ÙˆÓ ÔÛÙÒÓ ÂÌÊ¿ÓÈ˙ ÌÈÎÚÔ‡ ‚·ıÌÔ‡ ·Ó·ÛÙÔÏ‹ ˆÚ›Ì·ÓÛ˘ Ù˘ ÎÔÎÎÈÒ‰Ô˘˜ ÛÂÈÚ¿˜ ÛÙÔ Â›Â‰Ô ÙÔ˘ Ú·‚‰Ô‡ÚËÓÔ˘ (ÛÙÚÔÊ‹ ÚÔ˜ Ù· ·ÚÈÛÙÂÚ¿).

3) µÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ë·ÙÈ΋˜ Î·È ÓÂÊÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜: ¯ˆÚ›˜ ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·.

4) ŒÏÂÁ¯Ô˜ ‹Í˘: Ê˘ÛÈÔÏÔÁÈÎfi˜.

5) ∞ÓÔÛÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜: √È ·ÓÔÛÔÛÊ·ÈÚ›Ó˜ Ì·˙› Ì ÙȘ ˘ÔÔÌ¿‰Â˜ Ù˘ IgG, Ô ¤ÏÂÁ¯Ô˜ ÙÔ˘ Û˘ÌÏËÚÒÌ·ÙÔ˜ Î·È Ë Î˘ÙÙ·ÚÈ΋ ·ÓÔÛ›· ‹Ù·Ó ÂÓÙfi˜ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÔÚ›ˆÓ.

6) √ÚÔÏÔÁÈΤ˜ ·ÓÙȉڿÛÂȘ ÁÈ· Ïԛ̈ÍË ·fi ÙÔ˘˜ ÈÔ‡˜ Epstein Barr (EBV), ÌÂÁ·ÏÔ΢ÙÙ·ÚÔ˚fi (CMV), ÂÚ˘ıÚ¿˜, ¤ÚËÙ· 1, 2, 6, Coxsackie, Parvovirus B19, Ë·Ù›Ùȉ·˜ µ, Ë·Ù›Ùȉ·˜ C Î·È ·ÓıÚÒÈÓ˘ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·˜ (HIV), ‹Ù·Ó ·ÚÓËÙÈΤ˜. ∞ÓÙ›ÛÙÔȯԘ ¤ÏÂÁ¯Ô˜ ÁÈ· ÙÔ˘˜ ÈÔ‡˜ EBV, CMV, ÂÚËÙÔ˚Ô‡˜-1/2 Î·È Parvovirus B19 Ì ÙËÓ Ù¯ÓÈ΋ Ù˘ ·Ï˘ÛȉˆÙ‹˜ ·ÓÙ›‰Ú·Û˘ ÔÏ˘ÌÂÚ¿Û˘ Û ‰Â›ÁÌ· Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ, ·¤‚Ë Â›Û˘ ·ÚÓËÙÈÎfi˜. ∆ËÓ 7Ë Ë̤ڷ Ù˘ ÓÔÛËÏ›·˜ ·ÂÛÙ¿ÏË ÔÚfi˜ Û ÂÍÂȉÈÎÂ˘Ì¤ÓÔ Î¤ÓÙÚÔ ÙÔ˘ Â͈ÙÂÚÈÎÔ‡ ÁÈ· ÙËÓ ·Ó›-

¯Ó¢ÛË ÙˆÓ ∞√∞. ∆· ·ÓÙÈÛÒÌ·Ù· ÂϤÁ¯ıËÎ·Ó Ì ÙË Ì¤ıÔ‰Ô ·ÓÔÛÔÊıÔÚÈÛÌÔ‡ (GIFT) Î·È Ì ÙË Ì¤ıÔ‰Ô Ù˘ Û˘ÁÎfiÏÏËÛ˘ ÙˆÓ Ô˘‰ÂÙÂÚfiÊÈÏˆÓ (GAT). ªÂ ÙË Ì¤ıÔ‰Ô GIFT ·ÓȯÓ‡ÙËÎ·Ó ÛÙÔÓ ÔÚfi ÙÔ˘ ·ÛıÂÓÔ‡˜ ·ÓÙÈ-Ô˘‰ÂÙÂÚÔÊÈÏÈο ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ ÙÔ˘ ·ÓÙÈÁfiÓÔ˘ H¡∞1a ÙˆÓ Ô˘‰ÂÙÂÚfiÊÈÏˆÓ Î·È ¤ÙÛÈ Ù¤ıËÎÂ Ë ‰È¿ÁÓˆÛË Ù˘ ·˘ÙÔ¿ÓÔÛ˘ ‚ÚÂÊÈ΋˜ Ô˘‰ÂÙÂÚÔÂÓ›·˜. ∞fi ÙËÓ ÚÒÙË Ë̤ڷ ÓÔÛËÏ›·˜ ¯ÔÚËÁ‹ıËΠÛÙÔ ‚Ú¤ÊÔ˜ ‰ÈÏ‹ ·ÓÙÈÌÈÎÚԂȷ΋ ·ÁˆÁ‹ (ÎÏÈÓ‰·Ì˘Î›ÓË Î·È ÓÂÙÈÏÌÈΛÓË). ∆ËÓ 5Ë Ë̤ڷ Ù˘ ÓÔÛËÏ›·˜, ¤ÁÈÓ ‰È¿ÓÔÈÍË Î·È ·ÚÔ¯¤Ù¢ÛË ÙÔ˘ ·ÔÛÙ‹Ì·ÙÔ˜ Î·È ¯ÔÚËÁ‹ıËΠ·˘ÍËÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÙˆÓ ÎÔÎÎÈÔ΢ÙÙ¿ÚˆÓ (G-CSF) Ì ‰fiÛË 3 Ìg/kg/24ˆÚÔ. ∆¤ÛÛÂÚȘ Ë̤Ú˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË ÙÔ˘ G-CSF, Ô ∞∞√¶ ¤Êı·Û ÙȘ 8900/mL Î·È ‰ÈÂÎfiË Ë ¯ÔÚ‹ÁËÛ‹ ÙÔ˘. ªÂ ‚¿ÛË ÙËÓ Î·ÏÏȤÚÁÂÈ· ÙÔ˘ ‡Ô˘ (∂. coli, Proteus mirabilis Î·È Klebsiella pneumoniae ESBL) Î·È ÙÔ ·ÓÙÈ‚ÈfiÁÚ·ÌÌ· ¤ÁÈÓ ·ÓÙÈηٿÛÙ·ÛË Ù˘ ÎÏÈÓ‰·Ì˘Î›Ó˘ Ì ٷ˙ÔÌ·ÎÙ¿ÌË/ÈÂÚ·ÎÈÏÏ›ÓË. ∆Ô ‚Ú¤ÊÔ˜ ¤ÌÂÈÓ ÂχıÂÚÔ Û˘ÌÙˆÌ¿ÙˆÓ ·fi ÙÔ ‰¤Î·ÙÔ 24ˆÚÔ Ù˘ ÓÔÛËÏ›·˜ ÙÔ˘. ∫·Ù¿ ÙËÓ ¤ÍÔ‰Ô, ÙÔ‡ ¯ÔÚËÁ‹ıËΠ¯ËÌÂÈÔÚÔʇϷÍË Ì ÙÚÈÌÂıÔÚ›ÌË/ ÛÔ˘ÏÊÔÌÂıÔÍ·˙fiÏË Û ‰ÔÛÔÏÔÁÈÎfi Û¯‹Ì· 2 mg/kg/‰fiÛË Î¿ı 12 ÒÚ˜ ÁÈ· ÙÚÂȘ Û˘Ó¯fiÌÂÓ˜ Ë̤Ú˜ Ù˘ ‚‰ÔÌ¿‰·˜. ∂›Û˘, Û˘ÓÂÛÙ‹ıË ¤ÏÂÁ¯Ô˜ ÙÔ˘ ∞∞√¶ Û οı ÂÌ‡ÚÂÙÔ ÂÂÈÛfi‰ÈÔ. ¢‡Ô Ì‹Ó˜ ÌÂÙ¿ ÙËÓ ¤ÍÔ‰fi ÙÔ˘ ·fi ÙËÓ ÎÏÈÓÈ΋ Ì·˜ ÓÔÛËχÙËÎÂ Î·È ¿ÏÈ, ÏfiÁˆ ÂÌ‡ÚÂÙ˘ Ô˘ÏÔÛÙÔÌ·Ù›Ùȉ·˜ Ì ∞∞√¶ 535/mL. ¶·Ú·ÙËÚ‹ıËΠÂ›Û˘ ·˘ÍË̤ÓË C-·ÓÙȉÚÒÛ· ÚˆÙ½ÓË (189 mg/dl) Î·È Ù·¯‡ÙËÙ· ηı›˙ËÛ˘ ÂÚ˘ıÚÒÓ (82 mm/h). ÃÔÚËÁ‹ıËΠ‰ÈÏ‹ ·ÓÙÈÌÈÎÚԂȷ΋ ·ÁˆÁ‹ (ÎÏÈÓ‰·Ì˘Î›ÓË - ÓÂÙÈÏÌÈΛÓË) ÁÈ· ¤ÓÙ Ë̤Ú˜ Î·È G-CSF Û ‰fiÛË 3 Ìg/kg/24ˆÚÔ ÁÈ· ÙÚÂȘ Ë̤Ú˜ Î·È Ô ·ÛıÂÓ‹˜ ÂÍ‹Ïı Û ¿ÚÈÛÙË ÁÂÓÈ΋ ηٿÛÙ·ÛË. ª¤¯ÚÈ ÙËÓ ËÏÈΛ· ÙˆÓ 18 ÌËÓÒÓ Ù· Ô˘‰ÂÙÂÚfiÊÈÏ· ÂÍ·ÎÔÏÔ˘ıÔ‡Û·Ó Ó· Â›Ó·È ¯·ÌËÏ¿, ÏÈÁfiÙÂÚ· ·fi 1000/ÌL, ¯ˆÚ›˜ fï˜ Ó· ·ÚÔ˘ÛÈ·ÛÙÔ‡Ó Ó¤Â˜ ÏÔÈÌÒÍÂȘ (∂ÈÎfiÓ· 1). ™˘˙‹ÙËÛË ∏ Ô˘‰ÂÙÂÚÔÂÓ›· ·ÔÙÂÏ› Û¯ÂÙÈο Û˘¯Ófi ‡ÚËÌ· ÛÙ· ·È‰È¿. ∆· ÓÔÛ‹Ì·Ù· Ô˘ ÌÔÚÔ‡Ó Ó· ÚÔηϤÛÔ˘Ó ÙËÓ ÙÒÛË ÙˆÓ Ô˘‰ÂÙÂÚfiÊÈÏˆÓ ÔÏ˘ÌÔÚÊÔ‡ÚËÓˆÓ ·Ó·ÁÚ¿ÊÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1. ∏ Û˘¯ÓfiÙÂÚË ÌÔÚÊ‹ Ù˘ ¯ÚfiÓÈ·˜ Ô˘‰ÂÙÂÚÔÂÓ›·˜ ÛÙË ‚ÚÂÊÈ΋ ËÏÈΛ· Â›Ó·È Ë ÚˆÙÔ·ı‹˜ ·˘ÙÔ¿ÓÔÛË Ô˘‰ÂÙÂÚÔÂÓ›·. ∏ ÚÒÙË ·Ó·ÊÔÚ¿ ÛÙËÓ ÔÓÙfiÙËÙ· ·˘Ù‹ ¤ÁÈÓ ÛÙȘ ·Ú¯¤˜ Ù˘ ‰ÂηÂÙ›·˜ ÙÔ˘ ’60 ·fi ÙÔ˘˜ Zuelzer Î·È Bajoghli (6), ÂÓÒ ·ÚÁfiÙÂÚ· ÔÈ Lalezari Î·È Û˘Ó. ÂȂ‚·›ˆÛ·Ó Ù· Â˘Ú‹Ì·Ù· Ù˘ ÚÔËÁÔ‡ÌÂÓ˘ ÂÚ¢ÓËÙÈ΋˜ ÔÌ¿‰·˜ ·ÔÌÔÓÒÓÔÓÙ·˜ ·ÓÙÈÔ˘‰ÂÙÂÚÔÊÈÏÈο ·ÓÙÈÛÒÌ·Ù· Û 119 ·fi Ù· 121 ‚Ú¤ÊË Î·È ·È‰È¿ Ì ¯ÚfiÓÈ· Ô˘‰ÂÙÂÚÔÂÓ›· (7). ¶·È‰È·ÙÚÈ΋ 2007;70:232-236

Pediatri May-Jun 07

24-05-07

17:58

™ÂÏ›‰·234

234

∞fiÏ˘ÙÔ˜ ·ÚÈıÌfi˜ Ô˘‰ÂÙÂÚfiÊÈψÓ

º. ™ÙÚÈ¤ÏË Î·È Û˘Ó.

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ÃÔÚ‹ÁËÛË G-CSF ŒÍÔ‰Ô˜ ·fi ÙÔ ÃÔÚ‹ÁËÛË G-CSF ÓÔÛÔÎÔÌÂ›Ô ∂·ÓÂÈÛ·ÁˆÁ‹ 0

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90 120 150 180 210 240 270 ∏̤Ú˜ ·Ú·ÎÔÏÔ‡ıËÛ˘

∂ÈÎfiÓ· 1. ¶ÔÚ›· ÙÔ˘ ·fiÏ˘ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ Ô˘‰ÂÙÂÚfiÊÈÏˆÓ ÙÔ˘ ·ÛıÂÓÔ‡˜

™ÙÔÓ ¶›Ó·Î· 2 ·Ó·ÁÚ¿ÊÔÓÙ·È ÔÈ ¤ÓÙ ÔÌ¿‰Â˜ ÙˆÓ ÂÙ¿ ÁÓˆÛÙÒÓ Ô˘‰ÂÙÂÚÔÊÈÏÈÎÒÓ ·ÓÙÈÁfiÓˆÓ (HNA = Human Neutrophil Alloantigens) Û‡Ìʈӷ Ì ÙËÓ Î·Ù¿Ù·ÍË Ù˘ ÔÌ¿‰·˜ ÂÚÁ·Û›·˜ Granulocyte Antigen Working Party of the International Society of Blood Transfusion (8). √ ‰È·¯ˆÚÈÛÌfi˜ ·˘Ùfi˜ ‚·Û›ÛıËΠÛÙË ı¤ÛË Ô˘ η٤¯Ô˘Ó Ù· ÂÓ ÏfiÁˆ ·ÓÙÈÁfiÓ· (·ÓÙÈÁÔÓÈΤ˜ ÚˆÙ½Ó˜) ÛÙËÓ Î˘ÙÙ·ÚÈ΋ ÌÂÌ‚Ú¿ÓË ÙˆÓ Ô˘‰ÂÙÂÚfiÊÈψÓ. √È ·ÓÔÛÔÁfiÓ˜ ÁÏ˘ÎÔÚˆÙ½Ó˜ Û˘Ì‚ÔÏ›˙ÔÓÙ·È Ì ·Ú·‚ÈÎÔ‡˜ ·ÚÈıÌÔ‡˜ Î·È ·ÎÔÏÔ˘ıÔ‡ÓÙ·È ·fi ¤Ó· ÁÚ¿ÌÌ· ÙÔ˘ ·ÏÊ·‚‹ÙÔ˘ Ô˘ Û˘Ì‚ÔÏ›˙ÂÈ ÙÔ˘˜ ·ÓÙ›ÛÙÔÈ¯Ô˘˜ ÔÏ˘ÌÔÚÊÈÛÌÔ‡˜ ÙˆÓ ÁÏ˘ÎÔÚˆÙÂ˚ÓÒÓ. ∆· ·ÓÙÈÁfiÓ· HNA-1a, HNA¶›Ó·Î·˜ 1. ∞›ÙÈ· Ô˘‰ÂÙÂÚÔÂÓ›·˜ √˘‰ÂÙÂÚÔÂÓ›· ·fi Â͈ÁÂÓ‹ ·›ÙÈ· ñ §ÔÈÌÒÍÂȘ ñ º¿Ú̷η ñ ∞˘ÙÔ¿ÓÔÛË (ÚˆÙÔ·ı‹˜ Î·È ‰Â˘ÙÂÚÔ·ı‹˜) ñ ∞ÏÏÔ¿ÓÔÛË ñ ∞ÓÙÈηٿÛÙ·ÛË ‹ ·Ï·Û›· ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ (ηÎÔ‹ıÂȘ, ·Ï·Û›·) ñ ∞Ó·ÔÙÂÏÂÛÌ·ÙÈ΋ Ì˘ÂÏÔÔ›ËÛË (.¯. ¤ÏÏÂÈ„Ë µ12 Î·È Ê˘ÏÏÈÎÔ‡) ñ ÀÂÚÛÏËÓÈÛÌfi˜ (¯ÚfiÓÈ· ·ÈÌfiÏ˘ÛË, ÂÏÔÓÔÛ›· Î.¿.) ñ ¡fiÛÔÈ ÙÔ˘ ÎÔÏÏ·ÁfiÓÔ˘ (.¯. ™˘ÛÙËÌ·ÙÈÎfi˜ ∂Ú˘ıËÌ·Ù҉˘ §‡ÎÔ˜) √˘‰ÂÙÂÚÔÂÓ›· ·fi ÂÓ‰ÔÁÂÓ‹ ·›ÙÈ· ñ ÃÚfiÓÈ· Ô˘‰ÂÙÂÚÔÂÓ›· (.¯. ΢ÎÏÈ΋ Ô˘‰ÂÙÂÚÔÂÓ›·) ñ µ·ÚÈ¿ Û˘ÁÁÂÓ‹˜ Ô˘‰ÂÙÂÚÔÂÓ›· (Û‡Ó‰ÚÔÌÔ Kostmann) ñ √˘‰ÂÙÂÚÔÂÓ›· Ô˘ Û˘Ó‰˘¿˙ÂÙ·È Ì ·Á·Ì·ÛÊ·ÈÚÈÓ·ÈÌ›· ‹ Û‡Ó‰ÚÔÌÔ ˘ÂÚ-IgM ñ √˘‰ÂÙÂÚÔÂÓ›· Ô˘ Û¯ÂÙ›˙ÂÙ·È Ì ۇӉÚÔÌ· (·ÔıË΢ÙÈ΋ ÓfiÛÔ˜ ÙÔ˘ ÁÏ˘ÎÔÁfiÓÔ˘ Ù‡Ô˘ π‚, Û‡Ó‰ÚÔÌÔ Shwachman-Diamond, ηډÈÔÛÎÂÏÂÙÈ΋ Ì˘Ô¿ıÂÈ·, ÔÓ˘¯ÔÙÚȯԉ˘ÛÏ·Û›·) ñ ∞Ó·ÈÌ›· Fanconi ñ ª˘ÂÏÔ‰˘ÛÏ·Û›· ñ ™˘ÁÁÂÓ‹˜ ‰˘ÛÎÂÚ¿ÙˆÛË Paediatriki 2007;70:232-236

lb and HNA-1c, ·ÔÙÂÏÔ‡Ó ÙÚÂȘ ‰È·ÊÔÚÂÙÈÎÔ‡˜ ÔÏ˘ÌÔÚÊÈÎÔ‡˜ Ù‡Ô˘˜ ÙÔ˘ ›‰ÈÔ˘ Ô˘‰ÂÙÂÚfiÊÈÏÔ˘ ˘Ô‰Ô¯¤· FcÁIIIb (CD16). ∆Ô ·ÓÙÈÁfiÓÔ HNA-2a ·ÓÙÈÛÙÔȯ› ÛÙË ÁÏ˘ÎÔÚˆÙ½ÓË Gp50-64 (CD177). ∆Ô ·ÓÙÈÁfiÓÔ HNA-3a, ÂÓÙÔ›˙ÂÙ·È Û ̛· ÁÏ˘ÎÔÚˆÙ½ÓË Ì ÌÔÚÈ·Îfi ‚¿ÚÔ˜ 70-95 kDa. ∆· ·ÓÙÈÁfiÓ· HNA-4a Î·È HNA-5a, Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì ÙȘ ÁÏ˘ÎÔÚˆÙ½Ó˜ CD11b Î·È CD11a. ∞fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ ·ÓÙÈÁÔÓÈÎÒÓ ÚˆÙÂ˚ÓÒÓ, ÙÔ˘˜ ÈÔ Û˘¯ÓÔ‡˜ “ÛÙfi¯Ô˘˜” ÙˆÓ ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ ·ÔÙÂÏÔ‡Ó ÔÈ ÚˆÙ½Ó˜ D11b, CD16b Î·È CD177, ÂÓÒ ÌfiÓÔ ÙÔ 30% ÙˆÓ ·ÓÙÈÔ˘‰ÂÙÂÚÔÊÈÏÈÎÒÓ ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ ÛÙÚ¤ÊÂÙ·È Î·Ù¿ Ù˘ ÚˆÙ½Ó˘ CD16b. √ ·ÎÚÈ‚‹˜ ·ıÔÁÂÓÂÙÈÎfi˜ Ì˯·ÓÈÛÌfi˜ ·Ó¿Ù˘Í˘ Ù˘ ·˘ÙÔ¿ÓÔÛ˘ Ô˘‰ÂÙÂÚÔÂÓ›·˜ ‰ÂÓ Â›Ó·È ·ÎfiÌË Ï‹Úˆ˜ ‰È¢ÎÚÈÓÈṲ̂ÓÔ˜. Œ¯ÂÈ ·Ó·ÊÂÚı› Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÙÔ˘ ·ÓÙÈ-HNA-1a ·ÓÙÈÛÒÌ·ÙÔ˜ Î·È ÙÔ˘ HLA-DR2, fï˜, Ë ÂΉ‹ÏˆÛË Ù˘ ·˘ÙÔ¿ÓÔÛ˘ Ô˘‰ÂÙÂÚÔÂÓ›·˜ Û ¤Ó·Ó ÌfiÓÔ ·fi ÙÔ˘˜ ‰‡Ô ÌÔÓÔ˙˘ÁˆÙÈÎÔ‡˜ ‰È‰‡ÌÔ˘˜ ·ÔÙÂÏ› ÈÛ¯˘Ú‹ ¤Ó‰ÂÈÍË fiÙÈ ‰ÂÓ ˘¿Ú¯ÂÈ Î¿ÔÈÔ˜ ÎÏËÚÔÓÔÌÔ‡ÌÂÓÔ˜ Ì˯·ÓÈÛÌfi˜ Ô˘ Ó· ·ÚÂÌ‚·›ÓÂÈ ÛÙÔ Ì›˙ÔÓ Û‡ÛÙËÌ· ÈÛÙÔÛ˘Ì‚·ÙfiÙËÙ·˜ (9). ÕÏÏË ÔÌ¿‰· ÂÚ¢ÓËÙÒÓ ÂÓÙfiÈÛ ·ÓÙÈÛÒÌ·Ù· IgM ηٿ ÙÔ˘ ·Ú‚Ô˚Ô‡ µ19 Û 5 ·fi 11 ·ÛıÂÓ›˜ Ì ¯ÚfiÓÈ· Ô˘‰ÂÙÂÚÔÂÓ›· Î·È ıÂÒÚËÛ fiÙÈ Ú¤ÂÈ Ó· ˘¿Ú¯ÂÈ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÙÔ˘ ·Ú‚Ô˚Ô‡ µ19 Î·È Ù˘ ·˘ÙÔ¿ÓÔÛ˘ Ô˘‰ÂÙÂÚÔÂÓ›·˜ (10). ªÂÙ·ÁÂÓ¤ÛÙÂÚË fï˜ ÌÂϤÙË ÙˆÓ Bux Î·È Û˘Ó. ·Ó›¯Ó¢Û ÙÔ DNA ÙÔ˘ ·Ú‚Ô˚Ô‡ Î·È Ù· IgG/IgM ·ÓÙÈÛÒÌ·Ù· ηٿ ÙÔ˘ ÈÔ‡ ÌfiÓÔ Û 36 ·fi ÙÔ˘˜ 110 ·ÛıÂÓ›˜ Î·È ˘ÔÛÙ‹ÚÈÍ fiÙÈ ‰ÂÓ ˘¿Ú¯ÂÈ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ Û¯¤ÛË ÌÂٷ͇ Ù˘ Ïԛ̈͢ ·fi ÙÔÓ ·Ú‚Ô˚fi µ19 Î·È Ù˘ ·˘ÙÔ¿ÓÔÛ˘ Ô˘‰ÂÙÂÚÔÂÓ›·˜ (11). ŒÙÛÈ, ̤¯ÚÈ Û‹ÌÂÚ· ˘¿Ú¯Ô˘Ó ÔÏÏ¿ ·Ó·¿ÓÙËÙ· ÂÚˆÙ‹Ì·Ù· ÁÈ· ÙÔÓ ˘‡ı˘ÓÔ ·Ú¿ÁÔÓÙ· Î·È ÙÔÓ ÙÚfiÔ Ì ÙÔÓ ÔÔ›Ô ·˘Ùfi˜ ‰Ú· ‰ËÌÈÔ˘ÚÁÒÓÙ·˜ Ù· ·ÓÙÈÔ˘‰ÂÙÂÚÔÊÈÏÈο ·ÓÙÈÛÒÌ·Ù·. ™ÙÔ ÂÚÈÛÙ·ÙÈÎfi Ô˘ ÂÚÈÁÚ¿ÊÔ˘ÌÂ, ‰ÂÓ ÚԤ΢„ ‡ÚËÌ· ·fi ÙÔÓ ÂÎÙÂٷ̤ÓÔ ¤ÏÂÁ¯Ô Ô˘ Ó· ÌÔÚÔ‡Û ӷ ‰ÈηÈÔÏÔÁ‹ÛÂÈ ÙËÓ ÂÌÊ¿ÓÈÛË Ù˘ ÓfiÛÔ˘. ∏ ̤ÛË ËÏÈΛ· ÂÌÊ¿ÓÈÛ˘ Ù˘ ·˘ÙÔ¿ÓÔÛ˘ Ô˘‰ÂÙÂÚÔÂÓ›·˜ Î˘Ì·›ÓÂÙ·È ÌÂٷ͇ 6 Î·È 12 ÌËÓÒÓ. ™ÙÔ ‰ÈÎfi Ì·˜ ÂÚÈÛÙ·ÙÈÎfi ÈÛÙ‡ԢÌ fiÙÈ ÙÔ Úfi‚ÏËÌ· ÂÌÊ·Ó›ÛÙËΠ۠ËÏÈΛ· 3 ÌËÓÒÓ ÂÚ›Ô˘, ¯ÚÔÓÈ΋ ÛÙÈÁÌ‹ ηٿ ÙËÓ ÔÔ›· ÙÔ ‚Ú¤ÊÔ˜ ÂÌÊ¿ÓÈÛ ÙËÓ ÚÒÙË ÙÔ˘ ÛÔ‚·Ú‹ Ïԛ̈ÍË (ÎÔηÙË). øÛÙfiÛÔ ‰ÂÓ ˘¿Ú¯ÂÈ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ Ô˘ Ó· ÙÔ ÂȂ‚·ÈÒÓÂÈ. ∏ ‚·Ú‡ÙËÙ· ÙÔ˘ ∞∞√¶ Û˘¯Ó¿ Î˘Ì·›ÓÂÙ·È Û ÂӉȿÌÂÛ· Â›‰· (500-1000/mL), ·ÏÏ¿ ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ÂÚÈÛÙ·ÙÈο Î·È Ì ÙÈ̤˜ οو ÙˆÓ 200/mL. ∆Ô Û˘¯ÓfiÙÂÚÔ Úfi‚ÏËÌ· ÙˆÓ ·ÛıÂÓÒÓ Ì ·˘ÙÔ¿ÓÔÛË Ô˘‰ÂÙÂÚÔÂÓ›· Â›Ó·È ÔÈ ÌÈÎÚԂȷΤ˜ ÏÔÈÌÒÍÂȘ, ÔÈ Ôԛ˜ ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÊÔÚ¤˜ ›ӷÈ

Pediatri May-Jun 07

24-05-07

17:58

™ÂÏ›‰·235

235

µÚ¤ÊÔ˜ Ì ·˘ÙÔ¿ÓÔÛË Ô˘‰ÂÙÂÚÔÂÓ›·

¶›Ó·Î·˜ 2. ∞ÓÙÈÔ˘‰ÂÙÂÚÔÊÈÏÈο ·ÓÙÈÛÒÌ·Ù· √Ì¿‰Â˜ ·ÓÙÈÁfiÓˆÓ

∞ÓÙÈÁfiÓ·

¶ÚÔËÁÔ‡ÌÂÓË ÔÓÔÌ·Û›·

°Ï˘ÎÔÚˆÙ½ÓË

HNA-1

HNA-1a HNA-1b HNA-1c HNA-2a HNA-3a HNA-4a HNA-5a

NA1 NA2 SH NB1 5b MART OND

FcÁπππb (CD16) FcÁπππb (CD16) FcÁπππb (CD16) CD177 (gp50-64) Gp70-95 CD11a CD11b

HNA-2 HNA-3 HNA-4 HNA-5

̤ÙÚÈ·˜ ‚·Ú‡ÙËÙ·˜. ŒÙÛÈ, Û˘¯Ó¿ ‰È·ÈÛÙÒÓÔÓÙ·È ˘ÔÙÚÔÈ¿˙Ô˘Û˜ ·Ó·Ó¢ÛÙÈΤ˜ ÏÔÈÌÒÍÂȘ, ˘Ô‰ÂÚÌ›·, ̤ÛË ˆÙ›Ùȉ· Î·È Á·ÛÙÚ›Ùȉ· (12). ∏ ÂÌÊ¿ÓÈÛË ÂÚȉÚÈÎÔ‡ ·ÔÛÙ‹Ì·ÙÔ˜ Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È Â‰Ò, Â›Ó·È Û¿ÓÈ· ÂΉ‹ÏˆÛË Ù˘ ÓfiÛÔ˘ (13). ∂›Û˘ Û¿ÓÈ· Â›Ó·È Ë ÂÌÊ¿ÓÈÛË ÂÁÎÂÊ·ÏÈÎÒÓ ·ÔÛÙËÌ¿ÙˆÓ (12). ™ÙÔ Ì˘ÂÏfiÁÚ·ÌÌ·, Ô Ì˘ÂÏfi˜ ÙˆÓ ÔÛÙÒÓ ‰Â›¯ÓÂÈ Ê˘ÛÈÔÏÔÁÈ΋ ‹ ·˘ÍË̤ÓË Î˘ÙÙ·ÚÔ‚Ú›ıÂÈ· ÙˆÓ Úfi‰ÚÔÌˆÓ Ì˘ÂÏÈÎÒÓ Î˘ÙÙ¿ÚˆÓ, ·ÏÏ¿ ÛÙËÓ ÏÂÈÔÓfiÙËÙ· ÙˆÓ ·ÛıÂÓÒÓ ·Ú·ÙËÚÂ›Ù·È Û·Ê‹˜ Ì›ˆÛË ÙˆÓ ÒÚÈÌˆÓ Ô˘‰ÂÙÂÚfiÊÈψÓ. ∏ ÂͤٷÛË Ô˘ ÂȂ‚·ÈÒÓÂÈ ÙË ‰È¿ÁÓˆÛË Ù˘ ·˘ÙÔ¿ÓÔÛ˘ Ô˘‰ÂÙÂÚÔÂÓ›·˜ Â›Ó·È Ë ·Ó›¯Ó¢ÛË ÙˆÓ ÂȉÈÎÒÓ ·ÓÙÈÔ˘‰ÂÙÂÚÔÊÈÏÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ÛÙÔÓ ÔÚfi ÙˆÓ ·ÛıÂÓÒÓ. √ ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ÂÈÙ˘Á¯¿ÓÂÙ·È Ì¤Ûˆ ‰È¿ÊÔÚˆÓ Ù¯ÓÈÎÒÓ, ‰‡Ô fï˜ Â›Ó·È ÔÈ ÂÈÎÚ·Ù¤ÛÙÂÚ˜: Ë Ì¤ıÔ‰Ô˜ Û˘ÁÎfiÏÏËÛ˘ ÙˆÓ Ô˘‰ÂÙÂÚfiÊÈÏˆÓ (Granulocyte Agglutination Test GAT) Î·È Ë Ì¤ıÔ‰Ô˜ ·ÓÔÛÔÊıÔÚÈÛÌÔ‡ (Granulocyte Immunofluorescence Test - GIFT) (14). ¶·ÚfiÙÈ Ë Ì¤ıÔ‰Ô˜ GIFT Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ Â˘·›ÛıËÙË (¢·ÈÛıËÛ›· 97%), Û ÔÛÔÛÙfi 3% ÙˆÓ ÂÚÈÙÒÛÂˆÓ Ù· ·˘ÙÔ·ÓÙÈÛÒÌ·Ù· ÌÔÚ› Ó· Â›Ó·È ıÂÙÈο ÌfiÓÔ ÛÙË Ì¤ıÔ‰Ô GAT. ªÂÈÔÓÂÎÙ‹Ì·Ù· ÂÌÊ·Ó›˙Ô˘Ó Î·È ÔÈ ‰‡Ô Ù¯ÓÈΤ˜. ∂Âȉ‹ Ô Ù›ÙÏÔ˜ ÙˆÓ ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ ·ÚÎÂÙ¿ Û˘¯Ó¿ Â›Ó·È ÌË ·ÓȯÓ‡ÛÈÌÔ˜, Ë ÂͤٷÛË ¯ÚÂÈ¿˙ÂÙ·È Ó· Â·Ó·ÏËÊı› ‰‡Ô Î·È ÙÚÂȘ ÊÔÚ¤˜ ÁÈ· ÙËÓ Â‰Ú·›ˆÛË ‹ ÙÔÓ ·ÔÎÏÂÈÛÌfi Ù˘ ‰È¿ÁÓˆÛ˘. ∂›Û˘, Û ηٷÛÙ¿ÛÂȘ fiÔ˘ ·Ú·ÙËÚÂ›Ù·È ˘ÂÚÁ·Ì·ÛÊ·ÈÚÈÓ·ÈÌ›·, .¯. ÔÏÏ·ÏÔ‡Ó Ì˘¤ÏˆÌ·, Û‡Ó‰ÚÔÌÔ Â›ÎÙËÙ˘ ·ÓÔÛÔÏÔÁÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ Î·È ·˘ÙÔ¿ÓÔÛ· ÓÔÛ‹Ì·Ù·, ÔÈ ·Ú·¿Óˆ Ù¯ÓÈΤ˜ ‰›ÓÔ˘Ó „¢‰Ò˜ ıÂÙÈο ·ÔÙÂϤÛÌ·Ù· (15). ™ÙÔ ÂÚÈÛÙ·ÙÈÎfi Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘ÌÂ, Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ ·ÓÙÈÔ˘‰ÂÙÂÚÔÊÈÏÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ÂÈÙ‡¯ıËΠ̠ÙȘ ÌÂıfi‰Ô˘˜ GIFT Î·È GAT. ∏ ÔÚ›· Ù˘ ÓfiÛÔ˘ Â›Ó·È Î·Ï‹ Î·È ÙÔ 95% ÙˆÓ ·ÛıÂÓÒÓ ÂÌÊ·Ó›˙ÂÈ ·˘ÙfiÌ·ÙË ‡ÊÂÛË Û ̤ÁÈÛÙÔ ‰È¿ÛÙËÌ· 2 ÂÙÒÓ ·fi ÙË ‰È¿ÁÓˆÛË (11). ªÂ ‰Â‰Ô̤ÓË ÙËÓ Î·Ï‹ ÂͤÏÈÍË ÙÔ˘ ÓÔÛ‹Ì·ÙÔ˜ ‰ÂÓ ¯ÔÚËÁÂ›Ù·È ÂȉÈ΋ ıÂÚ·›·, ÂÎÙfi˜ ·fi ÙË Û˘Ìو̷ÙÈ΋ Î·È ·ÈÙÈÔÏÔÁÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÏÔÈÌÒ͈Ó, fiÙ·Ó ·˘Ù¤˜

ÂÌÊ·ÓÈÛıÔ‡Ó. ∂ÈϤÔÓ, ÌÂϤÙ˜ ·¤‰ÂÈÍ·Ó fiÙÈ Ë ÚÔÊ˘Ï·ÎÙÈ΋ ¯ÔÚ‹ÁËÛË ÙÚÈÌÂıÔÚ›Ì˘ - ÛÔ˘ÏÊÔÌÂıÔÍ·˙fiÏ˘ Ì›ˆÛ ÙË Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ÙˆÓ ÏÔÈÌÒ͈Ó, ¯ˆÚ›˜ fï˜ Ó· ÂËÚ¿ÛÂÈ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÓfiÛÔ˘ (16). ∞fiÏ˘ÙË ¤Ó‰ÂÈÍË ÚÔÊ˘Ï·ÎÙÈ΋˜ ¯ÔÚ‹ÁËÛ˘ ·ÓÙÈ‚ÈÔÙÈÎÒÓ ÛÙ· ‚Ú¤ÊË ·ÔÙÂÏÔ‡Ó ÔÈ Â·Ó·Ï·Ì‚·ÓfiÌÂÓ˜ ÏÔÈÌÒÍÂȘ, ȉ›ˆ˜ ÛÂ Û˘¯Ó¿ ÂÂÈÛfi‰È· ÔÍ›·˜ ̤Û˘ ˆÙ›Ùȉ·˜, ÚÔÎÂÈ̤ÓÔ˘ Ó· ·ÔÊ¢¯ı› Ë Î·Ù·ÛÙÚÔÊ‹ ÙˆÓ ÈÛÙÒÓ ÙÔ˘ ̤ÛÔ˘ ˆÙfi˜. ™ÙÔ ÂÚÈÛÙ·ÙÈÎfi Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È, ¯ÔÚËÁ‹ıËΠÚÔÊ˘Ï·ÎÙÈο ÙÚÈÌÂıÔÚ›ÌË - ÛÔ˘ÏÊÔÌÂıÔÍ·˙fiÏË, ÏfiÁˆ ÙˆÓ Û˘¯ÓÒÓ ÏÔÈÌÒÍÂˆÓ Ô˘ ›¯Â ÂÌÊ·Ó›ÛÂÈ Î·Ù¿ ÙÔ˘˜ Ì‹Ó˜ Ô˘ ÚÔËÁ‹ıËÎ·Ó Ù˘ ‰È¿ÁÓˆÛ˘. ∂ÎÙfi˜ ·fi ÙËÓ ·ÈÙÈÔÏÔÁÈ΋ ıÂÚ·›· ÙˆÓ ÏÔÈÌÒ͈Ó, ÌÂÏÂÙ¿Ù·È Ë ¯ÔÚ‹ÁËÛË ·ÓÔÛÔÂÓÈÛ¯˘ÙÈ΋˜ ˘ÔÛÙËÚÈÎÙÈ΋˜ ·ÁˆÁ‹˜ Û ÂÚÈÙÒÛÂȘ ÂÈΛӉ˘ÓˆÓ ÁÈ· ÙË ˙ˆ‹ ÙˆÓ ·ÛıÂÓÒÓ ÏÔÈÌÒ͈Ó. ¢ÔÎÈÌ¿ÛıËÎÂ Ë ÂÓ‰ÔÊϤ‚È· ¯ÔÚ‹ÁËÛË Á-ÛÊ·ÈÚ›Ó˘ (IVIG), Ë ÔÔ›· Ô‰‹ÁËÛ Û ٷ¯Â›· ¿ÓÔ‰Ô ÙˆÓ Ô˘‰ÂÙÂÚfiÊÈψÓ, Ô˘ ‰È‹ÚÎÂÛ fï˜, Ï›Á˜ Ë̤Ú˜. ¶ÈÔ ·ÔÙÂÏÂÛÌ·ÙÈ΋ Ê·›ÓÂÙ·È Ë ¯ÔÚ‹ÁËÛË ÙÔ˘ G-CSF, ·ÏÏ¿ Ë ¯ÚfiÓÈ· ¯ÔÚ‹ÁËÛ‹ ÙÔ˘ ‰ÂÓ Â›Ó·È Û˘Ó‹ıˆ˜ ··Ú·›ÙËÙË Î·È ÂӉ›ÎÓ˘Ù·È ÌfiÓÔ Û Â·Ó·Ï·Ì‚·ÓfiÌÂÓ˜ / ÛÔ‚·Ú¤˜ ÏÔÈÌÒÍÂȘ (17) ‹ Û ÂÚÈÙÒÛÂȘ ÛÙȘ Ôԛ˜ ··ÈÙÂ›Ù·È ¯ÂÈÚÔ˘ÚÁÈ΋ Â¤Ì‚·ÛË. ∏ ·ÓÙ·fiÎÚÈÛË ÛÙÔÓ G-CSF Â›Ó·È ¿ÌÂÛË Î·È ‰È·ÚΛ ÌÂÁ·Ï‡ÙÂÚÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· Ô˘ Êı¿ÓÂÈ Ì¤¯ÚÈ Î·È ‰‡Ô Ì‹Ó˜. ™ÙÔ ‰ÈÎfi Ì·˜ ÂÚÈÛÙ·ÙÈÎfi ¯ÔÚËÁ‹ıËΠ‰‡Ô ÊÔÚ¤˜ ·˘ÍËÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ Î·È Ë ·ÓÙ·fiÎÚÈÛË ÙÔ˘ ·ÛıÂÓÔ‡˜ ‹Ù·Ó ¿ÌÂÛË. £· Ú¤ÂÈ Ó· ‰È¢ÎÚÈÓÈÛÙ› fiÙÈ ÛÙË ‰Â‡ÙÂÚË ÓÔÛËÏ›· ÙÔ˘ ‚Ú¤ÊÔ˘˜, Ë ¯ÔÚ‹ÁËÛË ÙÔ˘ G-CSF ‚·Û›ÛıËΠÛÙËÓ ˘Ô„›· ÁÈ· ÛÔ‚·Ú‹ ÌÈÎÚԂȷ΋ ÂÈÏÔ΋. ∆¤ÏÔ˜, ¤¯ÂÈ ‰ÔÎÈÌ·Ûı› Î·È Ë ¯ÔÚ‹ÁËÛË ÎÔÚÙÈÎÔÛÙÂÚÔÂȉÒÓ Ì ηϋ ·ÓÙ·fiÎÚÈÛË ÙˆÓ ·ÛıÂÓÒÓ ÛÙËÓ ¿ÓÔ‰Ô ÙÔ˘ ∞∞√ (12). ∆Ô ÂÚÈÛÙ·ÙÈÎfi ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÁÈ·Ù›, ÂÓÒ Ë ·˘ÙÔ¿ÓÔÛË Ô˘‰ÂÙÂÚÔÂÓ›· Â›Ó·È Ë Û˘¯ÓfiÙÂÚË ÌÔÚÊ‹ Ô˘‰ÂÙÂÚÔÂÓ›·˜ ÙˆÓ ‚ÚÂÊÒÓ Î·È ·È‰ÈÒÓ ÌÈÎÚ‹˜ ËÏÈΛ·˜, ·ÔÙÂÏ› ÓÔÛÔÏÔÁÈ΋ ÔÓÙfiÙËÙ· ¿ÁÓˆÛÙË ÛÙÔ˘˜ ÂÚÈÛÛfiÙÂÚÔ˘˜ ·È‰È¿ÙÚÔ˘˜. ∏ ‰È¿ÁÓˆÛ‹ Ù˘ Ù›ıÂÙ·È Û˘Ó‹ıˆ˜ ÂÍ ·ÔÎÏÂÈÛÌÔ‡ ¿ÏÏˆÓ Î·Ù·ÛÙ¿ÛÂˆÓ Î·È ˘ÔÛÙËÚ›˙ÂÙ·È ·fi ÙËÓ ·Ó‡ÚÂÛË ¶·È‰È·ÙÚÈ΋ 2007;70:232-236

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236

º. ™ÙÚÈ¤ÏË Î·È Û˘Ó.

·ÓÙÈÔ˘‰ÂÙÂÚÔÊÈÏÈÎÒÓ ·ÓÙÈۈ̿وÓ. ∏ ¤ÁηÈÚË ‰È¿ÁÓˆÛË ‚ÔËı¿ Î·È ÛÙËÓ ÈÔ ÔÚı‹ ·ÓÙÈÌÂÙÒÈÛË, Ì ·ÚÈÔ ÛÙÔÈ¯Â›Ô ÙË ÛÙÂÓ‹ ·Ú·ÎÔÏÔ‡ıËÛË Î·È ÙË ıÂÚ·¢ÙÈ΋ ·Ú¤Ì‚·ÛË ÌfiÓÔ Â› ÂӉ›ÍˆÓ.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Lakshman R, Finn A. Neutrophil disorders and their management. J Clin Pathol 2001;54:7-19.

2. Bux J, Mueller-Eckhardt C. Autoimmune neutropenia.

Semin Hematol 1992;29:45-53.

3. Lalezari P, Khorshidi M, Petrosova M. Autoimmune neutropenia of infancy. J Pediatr 1986;109:764-769.

4. Boxer LA, Greenberg MS, Boxer GJ, Stossel TP. Autoimmune neutropenia. N Engl J Med 1975;293:748-753.

5. Bux J, Kissel K, Nowak K, Spengel U, Mueller-Eckhardt C. Autoimmune neutropenia: clinical and laboratory studies in 143 patients. Ann Hematol 1991; 63:249-252.

6. Zuelzer WW, Bajoghli M. Chronic granulocytopenia in childhood. Blood 1964;23:359-374.

7. Lalezari P, Jiang AF, Yegen L, Santorineou M. Chronic autoimmune neutropenia due to anti-NA2 antibody. N Engl J Med 1975;293: 744-747.

8. Bux J. Molecular nature of antigens implicated in immune neutropenias. Int J Hematol 2002;76 (Suppl 1):S399-S403.

9. Bux J, Mueller-Eckhardt G, Mueller-Eckhardt C. Autoimmunization against the neutrophil-specific NA1 antigen is associated with HLA-DR2. Hum Immunol 1991;30:18-21.

Paediatriki 2007;70:232-236

10. Cartron J, Bader-Meunier B, Deplanche M, et al. Human Parvovirus B19-associated childhood autoimmune neutropenia. Int J Pediatr Hematol Oncol 1995;2:471-473.

11. Bux J, Behrens G, Jaeger G, Welte K. Diagnosis and clinical course of autoimmune neutropenia in infancy: analysis of 240 cases. Blood 1998;91:181-186.

12. Lejkowski M, Maheshwari A, Calhoun DA, Christensen RD, Skoda-Smith S, Dabrow S. Persistent perianal abscess in early infancy as a presentation of autoimmune neutropenia. J Perinatol 2003;23:428-430.

13. Tokushima-Imayoshi M, Onoue T, Matsuo M, Yoshida N, Sato T, Kobayashi M, et al. Autoimmune neutropenia of infancy with multiple brain abscesses during the course of human herpesvirus-6 infection. Int J Hematol 2006;84: 151-153.

14. Bux J, Chapman J. Report on the Second International Granulocyte Serology Workshop. Transfusion 1997;37: 977-983.

15. Bux J, Sohn M, Hachmann R, Mueller-Eckhardt C. Quantitation of granulocyte antibodies in sera and determination of their binding sites. Br J Haematol 1992;82:20-25 16. Kobayashi M, Sato T, Kawaguchi H, Nakamura K, Kihara H, Hiraoka A, et al. Efficacy of prophylactic use of trimethoprim-sulfamethoxazole in autoimmune neutropenia in infancy. J Pediatr Hematol Oncol 2003;25:553-537.

17. Palmblad JE, von dem Borne AE. Idiopathic, immune, infectious and idiosyncratic neutropenias. Semin Hematol 2002;39:113-120.

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PRACTICAL ISSUE

237

∫ÏÈÓÈ΋ Î·È ÂÚÁ·ÛÙËÚȷ΋ ÚÔÛ¤ÁÁÈÛË ÙÔ˘ ·È‰ÈÔ‡ Ì Ԣ‰ÂÙÂÚÔÂÓ›· ∞. ª¿Î˘, ¡. ÷ÏÈ¿ÛÔ˜ ¶ÂÚ›ÏË„Ë: √˘‰ÂÙÂÚÔÂÓ›· Â›Ó·È Ë ÛËÌ·ÓÙÈ΋ ÂÏ¿ÙÙˆÛË ÙÔ˘ ·fiÏ˘ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ Î˘ÎÏÔÊÔÚÔ‡ÓÙˆÓ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ ÛÙÔ ÂÚÈÊÂÚÈÎfi ·›Ì·, Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ Â˘·ÈÛıËÛ›· Û ÏÔÈÌÒÍÂȘ ·fi ˘ÔÁfiÓÔ˘˜ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜. ∏ Ô˘‰ÂÙÂÚÔÂÓ›· ÌÔÚ› Ó· Â›Ó·È ÔÍ›· ‹ ¯ÚfiÓÈ·, ÎÏËÚÔÓÔÌÈ΋ ‹ Â›ÎÙËÙË Î·È ÂÓ‰¤¯ÂÙ·È Ó· ÂÌÊ·ÓÈÛÙ› ηٿ ÙË ÓÂÔÁÓÈ΋ ËÏÈΛ· (Û˘ÁÁÂÓ‹˜) ‹ ÛÙË ÌÂÙ¤ÂÈÙ· ˙ˆ‹. √È ÎÏËÚÔÓÔÌÈΤ˜ Ô˘‰ÂÙÂÚÔÂӛ˜ ÔÊ›ÏÔÓÙ·È Û ÂÓ‰ÔÁÂÓ›˜ ‰È·Ù·Ú·¯¤˜ ÙˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ Î·È ÂÓ‰¤¯ÂÙ·È Ó· Û˘Ó˘¿Ú¯Ô˘Ó Ê·ÈÓÔÙ˘ÈΤ˜ ·ÓˆÌ·Ï›Â˜, ÂÓÒ ÔÈ Â›ÎÙËÙ˜ ÚÔ¤Ú¯ÔÓÙ·È Û˘Ó‹ıˆ˜ ·fi Â͈ÁÂÓ›˜ ·Ú¿ÁÔÓÙ˜ Ô˘ ÂȉÚÔ‡Ó ÛÙÔ Ô˘‰ÂÙÂÚfiÊÈÏÔ. ∆· Û˘¯ÓfiÙÂÚ· ·›ÙÈ· ÛÙ· ·È‰È¿ Â›Ó·È Â›ÎÙËÙ· Î·È È‰È·›ÙÂÚ· ÔÈ ÈÔÁÂÓ›˜ ÏÔÈÌÒÍÂȘ Î·È Ù· Ê¿Ú̷η. √È ÏÔÈÌÒÍÂȘ ÛÙ· ·È‰È¿ Ì Ԣ‰ÂÙÂÚÔÂÓ›· ÚÔηÏÔ‡ÓÙ·È Û˘Ó‹ıˆ˜ ·fi ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜ Ù˘ ÂÓ‰ÔÁÂÓÔ‡˜ ¯ÏˆÚ›‰·˜. ∏ ¢·ÈÛıËÛ›· ÛÙȘ ‚·ÎÙËÚȷΤ˜ ÏÔÈÌÒÍÂȘ ÂÍ·ÚÙ¿Ù·È ·fi ÙÔÓ ‚·ıÌfi Î·È ÙË ¯ÚÔÓÈfiÙËÙ· Ù˘ Ô˘‰ÂÙÂÚÔÂÓ›·˜, ·ÏÏ¿ Î·È ·fi ÙË Ê‡ÛË Ù˘ ˘ÔΛÌÂÓ˘ ·ÈÙÈÔÏÔÁ›·˜. ∏ ·Ú¯È΋ ÚÔÛ¤ÁÁÈÛË ÙÔ˘ ·È‰ÈÔ‡ Ì Ԣ‰ÂÙÂÚÔÂÓ›· ··ÈÙ› ȉȷ›ÙÂÚË ÚÔÛÔ¯‹, ȉȷ›ÙÂÚ· fiÙ·Ó ÂÌÊ·Ó›˙ÂÙ·È ÛÙË ‚ÚÂÊÈ΋ ËÏÈΛ·, fiÙ·Ó ‰È·ÚΛ ·ÚÎÂÙfi ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ‹ fiÙ·Ó Û˘Ó‰˘¿˙ÂÙ·È Ì ÛÔ‚·Ú¤˜ ÏÔÈÌÒÍÂȘ ‹ ۈ̷ÙÈΤ˜ ·ÓˆÌ·Ï›Â˜. ∆Ô ·Ó·Ï˘ÙÈÎfi ÈÛÙÔÚÈÎfi, Ë ÚÔÛÂÎÙÈ΋ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË Î·È Ô Î·ıÔ‰ËÁÔ‡ÌÂÓÔ˜ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ Ô‰ËÁÔ‡Ó ÛÙËÓ ·Ó‡ÚÂÛË Ù˘ ˘ÔΛÌÂÓ˘ ·ÈÙÈÔÏÔÁ›·˜.

¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌÈ·ÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ πˆ·ÓÓ›ÓˆÓ AÏÏËÏÔÁÚ·Ê›·: ∞ϤͷӉÚÔ˜ ª¿Î˘ alexandros.makis@medai.gr √Ì‹ÚÔ˘, ∫·Ú‰·Ì›ÙÛÈ·, ∆.∫. 459 00, πˆ¿ÓÓÈÓ·

§¤ÍÂȘ ÎÏÂȉȿ: √˘‰ÂÙÂÚÔÂÓ›·, ·È‰È¿.

Clinical and laboratory investigation of children with neutropenia A. Makis, N. Chaliassos Abstract: Neutropenia is defined as a decrease in the absolute neutrophil count to below normal levels and is characterized by an increased risk of pyogenic infections. Neutropenia is classified as acute or chronic, inherited or acquired. Inherited neutropenias are caused by an intrinsic defect of proliferation and maturation of stem or myeloid cells. Most of the acquired neutropenias are secondary to extrinsic factors, postinfectious and drug-induced neutropenia being the commonest forms in children. Neutropenic patients usually become infected by organisms of their own endogenous flora; the resident bacteria of the mouth and oropharynx, gastrointestinal tract, and skin. The type of infection depends on the degree and chronicity of the neutropenia and on the nature of the associated diseases. The risk of severe infection does not increase until the neutrophil count falls below 0.5x109/L, but it rises rapidly when the count is below 0.2x109/L. The age of the child at presentation, the depth of the neutropenia, the severity of infections and the presence or absence of non-haematological signs and symptoms all guide the initial investigation of a child with neutropenia.

Paediatric Department of the University General Hospital of Ioannina Correspondence: Alexandros Makis alexandros.makis@medai.gr Omirou St., Kardamitsia, 459 00, Ioannina, Greece

Key words: Neutropenia, children.

∂ÈÛ·ÁˆÁ‹ ∆· Ô˘‰ÂÙÂÚfiÊÈÏ· Â›Ó·È Î‡ÙÙ·Ú· Ù· ÔÔ›· ÚÔ¤Ú¯ÔÓÙ·È ·fi ÔÏ˘‰‡Ó·Ì· ·ÙÙ·Ú· Ù˘ ÎÔÎÎÈÒ‰Ô˘˜ Ì˘ÂÏÈ΋˜ ÛÂÈÚ¿˜, ÌÂÙ¿ ·fi ÙË ‰Ú¿ÛË ÙˆÓ ·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ GM-CSF Î·È GCSF Î·È ÚÔÊ˘Ï¿ÛÛÔ˘Ó ÙÔÓ ÔÚÁ·ÓÈÛÌfi ·fi ÙÔ˘˜ ˘ÔÁfiÓÔ˘˜ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜. √˘‰ÂÙÂÚÔÂÓ›· Â›Ó·È Ë ÛËÌ·ÓÙÈ΋ ÂÏ¿ÙÙˆÛË ÙÔ˘ ·fiÏ˘ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ Î˘ÎÏÔÊÔÚÔ‡ÓÙˆÓ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ ÛÙÔ ÂÚÈÊÂÚÈÎfi ·›Ì·. Ÿˆ˜ Ê·›ÓÂÙ·È ÛÙÔÓ ¶›Ó·Î· 1, ÙÔ Î·ÙÒÙÂÚÔ Ê˘ÛÈÔÏÔÁÈÎfi fiÚÈÔ ÛÙ· ‚Ú¤ÊË Â›Ó·È 1,0x109/L. ªÂÙ¿ ÙË ‚ÚÂÊÈ΋ ÂÚ›Ô‰Ô, ̤¯ÚÈ

ÙËÓ ËÏÈΛ· ÙˆÓ ‰¤Î· ÂÙÒÓ Â›Ó·È 1,5x109/L, ÂÓÒ ÌÂÙ¤ÂÈÙ· ÙÔ fiÚÈÔ 1,8x109/L ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÁÈ· ÙÔÓ ÔÚÈÛÌfi Ù˘ Ô˘‰ÂÙÂÚÔÂÓ›·˜ (1). ∏ Ô˘‰ÂÙÂÚÔÂÓ›· Ù·ÍÈÓÔÌÂ›Ù·È ˆ˜ ‹È· (οو ·fi ÙÔ ¯·ÌËÏfiÙÂÚÔ fiÚÈÔ, ·ÏÏ¿ >1,0x109/L), ̤ÙÚÈ· (ÌÂٷ͇ 0,5 Î·È 1,0x109/L), ÛÔ‚·Ú‹ (ÌÂٷ͇ 0,2 Î·È 0,5x109/L) Î·È Ôχ ÛÔ‚·Ú‹ (<0,2x109/L). ∆· ηÙÒÙÂÚ· fiÚÈ· Â›Ó·È ¯Ú‹ÛÈÌ· ÛÙËÓ ÎÏÈÓÈ΋ Ú¿ÍË, ÂÂȉ‹ Ô Î›Ó‰˘ÓÔ˜ ÛÔ‚·ÚÒÓ ÏÔÈÌÒÍÂˆÓ ˘Ê›ÛÙ·Ù·È Â¿Ó Ô ·ÚÈıÌfi˜ ÙˆÓ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ Â›Ó·È Î¿Ùˆ ·fi 0,5x109/L Î·È ·˘Í¿ÓÂÙ·È ÛËÌ·ÓÙÈο fiÙ·Ó Â›Ó·È Î¿Ùˆ ·fi ¶·È‰È·ÙÚÈ΋ 2007;70:237-245

Pediatri May-Jun 07

24-05-07

17:58

™ÂÏ›‰·238

238

∞. ª¿Î˘, ¡. ÷ÏÈ¿ÛÔ˜

¶›Ó·Î·˜ 1. º˘ÛÈÔÏÔÁÈΤ˜ ÙÈ̤˜ ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ ·fi ÙË Á¤ÓÓËÛË Ì¤¯ÚÈ ÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹

°¤ÓÓËÛË 12 ÒÚ˜ 24 ÒÚ˜ 1Ë Â‚‰ÔÌ¿‰· 2Ë Â‚‰ÔÌ¿‰· 1Ô˜ Ì‹Ó·˜ 1Ô ¤ÙÔ˜ 6Ô ¤ÙÔ˜ 10Ô ¤ÙÔ˜ 16Ô ¤ÙÔ˜

ª¤ÛÔ˜ fiÚÔ˜ (x109/L)

∂‡ÚÔ˜ (x109/L)

¶ÔÛÔÛÙfi %

11,0 15,5 11,5 5,5 4,5 3,8 3,5 4,3 4,4 4,4

6,0-26,0 6,0-28,0 5,0-21,0 1,5-10,0 1,0-9,5 1,0-9,0 1,5-8,5 1,5-8,0 1,8-8,0 1,8-8,0

61 68 61 45 40 35 31 51 54 59

0,2x109/L (2). ∏ Ô˘‰ÂÙÂÚÔÂÓ›· ÌÔÚ› Ó· Â›Ó·È ÎÏËÚÔÓÔÌÈ΋ ‹ Â›ÎÙËÙË Î·È ÂÓ‰¤¯ÂÙ·È Ó· ÂÌÊ·ÓÈÛÙ› ηٿ ÙË ÓÂÔÁÓÈ΋ ËÏÈΛ· (Û˘ÁÁÂÓ‹˜) ‹ ÛÙË ÌÂÙ¤ÂÈÙ· ˙ˆ‹. ∆· Û˘¯ÓfiÙÂÚ· ·›ÙÈ· Â›Ó·È Ù· Â›ÎÙËÙ· Î·È È‰È·›ÙÂÚ· ÔÈ ÈÔÁÂÓ›˜ ÏÔÈÌÒÍÂȘ. ∏ ÚÔÛ¤ÁÁÈÛË ÙÔ˘ ·È‰ÈÔ‡ Ì Ԣ‰ÂÙÂÚÔÂÓ›· ·ÔÙÂÏ› ÚfiÎÏËÛË ÁÈ· ÙÔÓ ÁÂÓÈÎfi ·È‰›·ÙÚÔ, ȉȷ›ÙÂÚ· fiÙ·Ó ÂÌÊ·Ó›˙ÂÙ·È ÛÙË ‚ÚÂÊÈ΋ ËÏÈΛ·, fiÙ·Ó ‰È·ÚΛ ·ÚÎÂÙfi ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ‹ fiÙ·Ó Û˘Ó‰˘¿˙ÂÙ·È Ì ÛÔ‚·Ú¤˜ ÏÔÈÌÒÍÂȘ ‹ ۈ̷ÙÈΤ˜ ·ÓˆÌ·Ï›Â˜. ∆Ô ·Ó·Ï˘ÙÈÎfi ÈÛÙÔÚÈÎfi, Ë ÚÔÛÂÎÙÈ΋ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË Î·È Ô Î·ıÔ‰ËÁÔ‡ÌÂÓÔ˜ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ Ô‰ËÁÔ‡Ó ÛÙË ‰È·Ï‡ηÓÛË Ù˘ ˘ÔΛÌÂÓ˘ ·ÈÙÈÔÏÔÁ›·˜. ™ÙÔ ·ÚfiÓ ¿ÚıÚÔ ı· ·ÚÔ˘ÛÈ·ÛÙÔ‡Ó ÔÈ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ Ù˘ Ô˘‰ÂÙÂÚÔÂÓ›·˜, Ù· ·›ÙÈ· Ô˘ Ô‰ËÁÔ‡Ó Û Ԣ‰ÂÙÂÚÔÂÓ›· Î·È ı· ·Ó·Ï˘ı› Ô ·ÏÁfiÚÈıÌÔ˜ Ù˘ ÎÏÈÓÈ΋˜ Î·È ÂÚÁ·ÛÙËÚȷ΋˜ ÚÔÛ¤ÁÁÈÛ˘.

∫ÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ Ô˘‰ÂÙÂÚÔÂÓ›·˜ √È ÏÔÈÌÒÍÂȘ ÛÙ· ·È‰È¿ Ì Ԣ‰ÂÙÂÚÔÂÓ›· ÚÔηÏÔ‡ÓÙ·È Û˘Ó‹ıˆ˜ ·fi ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜ Ù˘ ÂÓ‰ÔÁÂÓÔ‡˜ ¯ÏˆÚ›‰·˜, fiˆ˜ Â›Ó·È Ù· ÌÈÎÚfi‚È· Ô˘ ·ÔÈΛ˙Ô˘Ó ÙË ÛÙÔÌ·ÙÈ΋ ÎÔÈÏfiÙËÙ·, ÙÔÓ Ê¿Ú˘ÁÁ·, ÙÔÓ Á·ÛÙÚÂÓÙÂÚÈÎfi ۈϋӷ Î·È ÙÔ ‰¤ÚÌ·. ∏ ¢·ÈÛıËÛ›· ÛÙȘ ‚·ÎÙËÚȷΤ˜ ÏÔÈÌÒÍÂȘ ÂÍ·ÚÙ¿Ù·È ·fi ÙÔÓ ‚·ıÌfi Î·È ÙË ¯ÚÔÓÈfiÙËÙ· Ù˘ Ô˘‰ÂÙÂÚÔÂÓ›·˜, ·ÏÏ¿ Î·È ·fi ÙË Ê‡ÛË Ù˘ ˘ÔΛÌÂÓ˘ ·ÈÙÈÔÏÔÁ›·˜ (3). ŸÙ·Ó Ë Ô˘‰ÂÙÂÚÔÂÓ›· ÔÊ›ÏÂÙ·È Û ÂÏ·Ùو̤ÓË ·Ú·ÁˆÁ‹ ·fi ÙÔÓ Ì˘ÂÏfi, Ë ÛÔ‚·ÚfiÙËÙ· Î·È Ë Û˘¯ÓfiÙËÙ· ÙˆÓ ÏÔÈÌÒÍÂˆÓ Â›Ó·È ·Ó¿ÏÔÁË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ Î·È ÙÔ˘ ›‰Ô˘˜ Ù˘ ‚Ï¿‚˘. ªÂ Ô˘‰ÂÙÂÚfiÊÈÏ· <0,2x109/L ˘¿Ú¯ÂÈ ·˘ÍË̤ÓÔ˜ ΛӉ˘ÓÔ˜ ÁÈ· ÛË„·ÈÌ›· ·fi ¯Ú˘Û›˙ÔÓÙ· ÛÙ·Ê˘ÏfiÎÔÎÎÔ Î·È ·ÚÓËÙÈο ηٿ gram ÌÈÎÚfi‚È· (Pseudomonas aeruginosa, Escherichia coli, Klebsiella spp). ŸÙ·Ó Ô ·ÚÈıÌfi˜ ÙˆÓ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ Â›Ó·È >0,2x109/L, ÙfiÙ ·ÚÔ˘ÛÈ¿˙ÂÙ·È Î˘Ú›ˆ˜ Ô˘ÏÔÛÙÔÌ·Ù›Ùȉ·, ÂÚÈÚˆÎÙÈÎfi ·fiÛÙËÌ· ‹ ΢ÙÙ·Ú›Ùȉ·, ˘ÔÙÚÔÈ¿˙Ô˘Û˜ ˆÙ›Ùȉ˜ ‹ ÈÁÌÔÚ›Ùȉ˜. ∞ÔÛÙ‹Paediatriki 2007;70:237-245

Ì·Ù·, Ó¢ÌÔÓ›· ‹ ÛË„·ÈÌ›· ÌÔÚÔ‡Ó Ó· ÂÌÊ·ÓÈÛÙÔ‡Ó, ·ÏÏ¿ Ì ÌÈÎÚfiÙÂÚË Û˘¯ÓfiÙËÙ·. ∞ÓÙÈı¤Ùˆ˜, Ù¤ÙÔÈ· ·Ó¿ÏÔÁË Û˘Û¯¤ÙÈÛË ‰ÂÓ ˘¿Ú¯ÂÈ fiÙ·Ó ÙÔ ·›ÙÈÔ Â›Ó·È Ë ·˘ÍË̤ÓË Î·Ù·ÛÙÚÔÊ‹, fiˆ˜ Â›Ó·È Ë ·˘ÙÔ¿ÓÔÛË Ô˘‰ÂÙÂÚÔÂÓ›· ‹ Ë Ô˘‰ÂÙÂÚÔÂÓ›· ÌÂÙ¿ ·fi ÈÔÁÂÓ›˜ ÏÔÈÌÒÍÂȘ. ¶·È‰È¿ Ì ·˘ÙÔ¿ÓÔÛË Ô˘‰ÂÙÂÚÔÂÓ›· ÂÓ‰¤¯ÂÙ·È Ó· ¤¯Ô˘Ó Ô˘‰ÂÙÂÚfiÊÈÏ· <0,2x109/L ÁÈ· Ì‹Ó˜ ‹ ¯ÚfiÓÈ· ¯ˆÚ›˜ ÛÔ‚·Ú¤˜ ÏÔÈÌÒÍÂȘ. ∆· ·È‰È¿ Ì ¯ÚfiÓÈ· ÛÔ‚·Ú‹ Ô˘‰ÂÙÂÚÔÂÓ›· ÏfiÁˆ ÂÏ·Ùو̤Ó˘ ·Ú·ÁˆÁ‹˜ ·fi ÙÔÓ Ì˘ÂÏfi, ÂÌÊ·Ó›˙Ô˘Ó ÏÈÁfiÙÂÚÔ Û˘¯Ó¿ ‚·ÚȤ˜ ÏÔÈÌÒÍÂȘ Û ۯ¤ÛË Ì ٷ ·È‰È¿ Ô˘ ¤¯Ô˘Ó Ô˘‰ÂÙÂÚÔÂÓ›· ÏfiÁˆ ¯ÔÚ‹ÁËÛ˘ ·ÓÔÛÔηٷÛÙ·ÏÙÈÎÒÓ ‹ ¯ËÌÂÈÔıÂÚ·›·˜. √ ÏfiÁÔ˜ Â›Ó·È fiÙÈ ÛÙËÓ ÂÚ›ÙˆÛË Ù˘ ¯ÚfiÓÈ·˜ ÛÔ‚·Ú‹˜ Ô˘‰ÂÙÂÚÔÂÓ›·˜ ˘¿Ú¯ÂÈ Û˘Ó‹ıˆ˜ Ì›· ÌÂÌÔӈ̤ÓË Î·È ÂÚÈÔÚÈṲ̂ÓË ‰È·Ù·Ú·¯‹ Ô˘ ·ÊÔÚ¿ ÌfiÓÔ ÛÙ· Ô˘‰ÂÙÂÚfiÊÈÏ·, ÌÂ Û˘ÓÔ‰fi ·ÓÙÈÚÚÔÈÛÙÈ΋ ·‡ÍËÛË ÙˆÓ ÌÔÓÔ΢ÙÙ¿ÚˆÓ Î·È ÙˆÓ ËˆÛÈÓÔʛψÓ, Ô˘ Ì ÙË Ê·ÁÔ΢ÙÙ·ÚÈ΋ ÙÔ˘˜ ‰Ú¿ÛË ·Ó·ÏËÚÒÓÔ˘Ó ÌÂÚÈÎÒ˜ ÙÔ ¤ÏÏÂÈÌ· ÙˆÓ Ô˘‰ÂÙÂÚÔʛψÓ. ∞ÓÙ›ıÂÙ·, Ë ¯ËÌÂÈÔıÂÚ·›· Âȉڿ ηٷÛÙÚÔÊÈο fi¯È ÌfiÓÔ ÛÙ· Ô˘‰ÂÙÂÚfiÊÈÏ·, ·ÏÏ¿ Î·È Û ¿ÏÏÔ˘˜ Ì˯·ÓÈÛÌÔ‡˜ Ù˘ ¿Ì˘Ó·˜ ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡, Û˘ÌÂÚÈÏ·Ì‚·ÓÔ̤ÓÔ˘ Î·È ÙÔ˘ ÊÚ·ÁÌÔ‡ ÙÔ˘ ‚ÏÂÓÓÔÁfiÓÔ˘ Ù˘ ÛÙÔÌ·ÙÈ΋˜ ÎÔÈÏfiÙËÙ·˜ Î·È ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ ۈϋӷ, Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ Â›ÛÔ‰Ô ÛÙÔ ·›Ì· ÙˆÓ ÌÈÎÚÔ‚›ˆÓ Ù˘ Ê˘ÛÈÔÏÔÁÈ΋˜ ¯ÏˆÚ›‰·˜ Î·È ÙËÓ Â·ÎfiÏÔ˘ıË ÌÈÎÚÔ‚È·ÈÌ›· ‹ ÛË„·ÈÌ›·.

∞›ÙÈ· Ô˘‰ÂÙÂÚÔÂÓ›·˜ ÛÙ· ·È‰È¿ ∏ Ô˘‰ÂÙÂÚÔÂÓ›· ÛÙ· ·È‰È¿ ¤¯ÂÈ ÔÏÏ¿ ·›ÙÈ·, fiˆ˜ Ê·›ÓÂÙ·È ÛÙÔÓ ¶›Ó·Î· 2. ∆·ÍÈÓÔÌÂ›Ù·È Û ÎÏËÚÔÓÔÌÈ΋ Î·È Â›ÎÙËÙË, ÔÍ›· ‹ ¯ÚfiÓÈ·. ™˘ÁÁÂÓ‹˜ Â›Ó·È Ë Ô˘‰ÂÙÂÚÔÂÓ›· Ô˘ ÂÌÊ·Ó›˙ÂÙ·È Ï›ÁÔ ÌÂÙ¿ ÙË Á¤ÓÓËÛË ‹ ÙȘ ÚÒÙ˜ ‚‰ÔÌ¿‰Â˜ Ù˘ ˙ˆ‹˜. √È Û˘ÁÁÂÓ›˜ Ô˘‰ÂÙÂÚÔÂӛ˜ Â›Ó·È ˆ˜ Â› ÙÔ Ï›ÛÙÔÓ ÎÏËÚÔÓÔÌÈΤ˜ (.¯. ÓfiÛÔ˜ Kostmann, ΢ÎÏÈ΋ Ô˘‰ÂÙÂÚÔÂÓ›·), ·ÏÏ¿ ÌÔÚ› Ó· Â›Ó·È Î·È Â›ÎÙËÙ˜ (.¯. ÈÛÔ¿ÓÔÛË Ô˘‰ÂÙÂÚÔÂÓ›·). √È ÎÏËÚÔÓÔÌÈΤ˜

Pediatri May-Jun 07

24-05-07

17:58

™ÂÏ›‰·239

239

¢ÈÂÚ‡ÓËÛË Ô˘‰ÂÙÂÚoÂÓ›·˜ ÛÙ· ·È‰È¿

¶›Ó·Î·˜ 2. ∞›ÙÈ· Ô˘‰ÂÙÂÚÔÂÓ›·˜ ÛÙ· ·È‰È¿ ∫ÏËÚÔÓÔÌÈ΋

∂›ÎÙËÙË

™‡Ó‰ÚÔÌÔ Kostmann ∫˘ÎÏÈ΋ Ô˘‰ÂÙÂÚÔÂÓ›· ™‡Ó‰ÚÔÌÔ ShwachmanDiamond ™‡Ó‰ÚÔÌÔ Pearson °Ï˘ÎÔÁÔÓ›·ÛË Ù‡Ô˘ 1b ™‡Ó‰ÚÔÌ· ÚˆÙÔ·ıÒÓ ·ÓÔÛÔ·ÓÂ·ÚÎÂÈÒÓ ∞Ó·ÈÌ›· Fanconi ™˘ÁÁÂÓ‹˜ ‰˘ÛÎÂÚ¿ÙˆÛË

§Ô›ÌˆÍË º¿Ú̷η πÛÔ- Î·È ·˘ÙÔ-¿ÓÔÛË

ª˘ÂÏÔη¯ÂÍ›· ™‡Ó‰ÚÔÌÔ Barth

¢È‹ıËÛË Ì˘ÂÏÔ‡ ÀÂÚÛÏËÓÈÛÌfi˜ ∞Ï·ÛÙÈ΋ ·Ó·ÈÌ›· ª˘ÂÏÔ‰˘ÛÏ·ÛÙÈÎfi Û‡Ó‰ÚÔÌÔ ¶·ÚÔ͢ÛÌÈ΋ Ó˘¯ÙÂÚÈÓ‹ ·ÈÌÔÛÊ·ÈÚÈÓÔ˘Ú›· ∞ÓÂ¿ÚÎÂÈ· µ12, Ê˘ÏÏÈÎÔ‡

Ô˘‰ÂÙÂÚÔÂӛ˜ ÔÊ›ÏÔÓÙ·È Û ÂÓ‰ÔÁÂÓ›˜ ‰È·Ù·Ú·¯¤˜ ÙˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ, ÂÓÒ ÔÈ Â›ÎÙËÙ˜ ÚÔ¤Ú¯ÔÓÙ·È Û˘Ó‹ıˆ˜ ·fi Â͈ÁÂÓ›˜ ·Ú¿ÁÔÓÙ˜ Ô˘ ÂȉÚÔ‡Ó ÛÙÔ Ô˘‰ÂÙÂÚfiÊÈÏÔ.

∞. ∫ÏËÚÔÓÔÌÈΤ˜ Ô˘‰ÂÙÂÚÔÂӛ˜ ¡fiÛÔ˜ Kostmann (ÛÔ‚·Ú‹ ‚ÚÂÊÈ΋ ·ÎÔÎÎÈÔ΢ÙÙ·Ú·ÈÌ›·) ¶ÚfiÎÂÈÙ·È ÁÈ· ¤Ó· ÓfiÛËÌ· Ô˘ ÌÂÙ·‚È‚¿˙ÂÙ·È Ì ÙÔÓ ·˘ÙÔÛˆÌÈÎfi ˘ÔÏÂÈfiÌÂÓÔ ¯·Ú·ÎÙ‹Ú·. ∆˘Èο, ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÛÙË ‚ÚÂÊÈ΋ ËÏÈΛ· Ì ÛÔ‚·Ú‹ ‹ Ôχ ÛÔ‚·Ú‹ Ô˘‰ÂÙÂÚÔÂÓ›· Î·È Û˘¯Ó¤˜ ÛÔ‚·Ú¤˜ ‚·ÎÙËÚȷΤ˜ ÏÔÈÌÒÍÂȘ, ÂÓÒ ÛÙÔ Ì˘ÂÏfiÁÚ·ÌÌ· ·Ó·‰ÂÈÎÓ‡ÂÙ·È ·Ó·ÛÙÔÏ‹ Ù˘ ˆÚ›Ì·ÓÛ˘ ÛÙË Ê¿ÛË ÙÔ˘ ÚÔÌ˘ÂÏÔ΢ÙÙ¿ÚÔ˘ / Ì˘ÂÏÔ΢ÙÙ¿ÚÔ˘ (4). ™˘¯Ó¿ ˘¿Ú¯ÂÈ ·ÓÙȉڷÛÙÈ΋ ÌÔÓÔ΢ÙÙ¿ÚˆÛË Î·È ‹È· ˈÛÈÓÔÊÈÏ›·. ™Â ¤Ó· ÛËÌ·ÓÙÈÎfi ÔÛÔÛÙfi ÙˆÓ ·ÛıÂÓÒÓ, ÂÚ›Ô˘ 12%, ˘¿Ú¯ÂÈ ÂÍ·ÏÏ·Á‹ ÛÂ Ì˘ÂÏÔ‰˘ÛÏ·ÛÙÈÎfi Û‡Ó‰ÚÔÌÔ ‹ ÔÍ›· Ì˘ÂÏÔÁÂÓ‹ Ï¢¯·ÈÌ›· (5-7). ∏ ·ıÔÊ˘ÛÈÔÏÔÁ›· Ù˘ ÓfiÛÔ˘ ·Ú·Ì¤ÓÂÈ ·ÎfiÌË ·‰È¢ÎÚ›ÓÈÛÙË. ¶ÚfiÛÊ·Ù·, ¤¯Ô˘Ó ‚ÚÂı› ÌÂÙ·ÏÏ¿ÍÂȘ ÛÙÔ ÁÔÓ›‰ÈÔ ELA2 Ô˘ Â›Ó·È ˘‡ı˘ÓÔ ÁÈ· ÙËÓ ·Ú·ÁˆÁ‹ Ù˘ ÂÏ·ÛÙ¿Û˘ ÙˆÓ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ (8,9). ªÂÙ·ÏÏ¿ÍÂȘ ÛÙÔ ÁÔÓ›‰ÈÔ ELA2 ›Ûˆ˜ Ó· Ô‰ËÁÔ‡Ó Û ·Ú·ÁˆÁ‹ ÙÚÔÔÔÈË̤Ó˘ ÂÏ·ÛÙ¿Û˘, Ë ÔÔ›· ·Ô‰ÂÛ̇ÂÙ·È Ì¤Û· ÛÙÔ ÚÔÌ˘ÂÏÔ·ÙÙ·ÚÔ Î·È ÙÔ Î·Ù·ÛÙÚ¤ÊÂÈ ‹ Â¿ÁÂÈ ÙËÓ ·fiÙˆÛ‹ ÙÔ˘ (10). ∏ ıÂÚ·›· Â›Ó·È Ë ¯ÔÚ‹ÁËÛË G-CSF Î·È Ë ÚÔÊ˘Ï·ÎÙÈ΋ Ï‹„Ë ·ÓÙÈ‚ÈÔÙÈÎÒÓ. ¢Â‰Ô̤ÓÔ˘ ÙÔ˘ ÛËÌ·ÓÙÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘ ηÎÔ‹ıÔ˘˜ ÂÍ·ÏÏ·Á‹˜, Û ·ÚÎÂÙ¿ ΤÓÙÚ· Á›ÓÂÙ·È ÌÂÙ·ÌfiÛ¯Â˘ÛË Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ, Â¿Ó ˘¿Ú¯ÂÈ Û˘Ì‚·Ùfi˜ ·‰ÂÚÊfi˜, ÚÈÓ ÙËÓ ÂÌÊ¿ÓÈÛË ¯ÚˆÌÔÛˆÌÈ·ÎÒÓ ·ÓˆÌ·ÏÈÒÓ (11). ∫˘ÎÏÈ΋ Ô˘‰ÂÙÂÚÔÂÓ›· ∏ ΢ÎÏÈ΋ Ô˘‰ÂÙÂÚÔÂÓ›· ÌÂÙ·‚È‚¿˙ÂÙ·È Ì ÙÔÓ ·˘ÙÔÛˆÌÈÎfi ÂÈÎÚ·ÙÔ‡ÓÙ· ¯·Ú·ÎÙ‹Ú· Î·È Û ۯ¤ÛË

Ì ÙË ÓfiÛÔ ÙÔ˘ Kostmann ÂΉËÏÒÓÂÙ·È Ï›ÁÔ ·ÚÁfiÙÂÚ· ·fi ÙË ‚ÚÂÊÈ΋ ËÏÈΛ· Î·È Ì ÏÈÁfiÙÂÚÔ ÛÔ‚·Ú¤˜ ÏÔÈÌÒÍÂȘ, ÂÓÒ ‰ÂÓ ˘¿Ú¯ÂÈ Î›Ó‰˘ÓÔ˜ Ï¢¯·ÈÌÔÁ¤ÓÂÛ˘ (12). ∆˘Èο ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÂÚÈÔ‰È΋ Ô˘‰ÂÙÂÚÔÂÓ›· <0,2x109/L ÁÈ· 3-5 Ë̤Ú˜, οı ÂÚ›Ô˘ 21 Ë̤Ú˜ (Ì ‡ÚÔ˜ 13-35 Ë̤Ú˜), ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ‹ ۯ‰fiÓ Ê˘ÛÈÔÏÔÁÈÎfi ·ÚÈıÌfi Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ ÛÙ· ÌÂÛԉȷÛÙ‹Ì·Ù·. ™ÙÔ Ó·‰›Ú ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Û˘Ó‹ıˆ˜ ÛÙÔÌ·ÙÈο ¤ÏÎË ·fi ·Ó·ÂÚfi‚È· ÌÎÚfi‚È· Ì ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÁÈ· ÁÂÓÈÎÂ˘Ì¤ÓË Ïԛ̈ÍË, ˘ÚÂÙfi˜, ˆÙ›Ùȉ·, ÏÔÈÌÒÍÂȘ ·Ó·Ó¢ÛÙÈÎÔ‡ Î·È Û·ÓÈfiÙÂÚ· ÂÚÈÚˆÎÙÈο ·ÔÛÙ‹Ì·Ù·. ™Â ÔÚÈṲ̂Ó˜ ÂÚÈÙÒÛÂȘ ˘¿Ú¯ÂÈ Î·È ÂÚÈÔ‰È΋ ıÚÔÌ‚ÔÂÓ›· Î·È ÂÏ¿ÙÙˆÛË ÙˆÓ ‰ÈÎÙ˘ÔÂÚ˘ıÚÔ΢ÙÙ¿ÚˆÓ. ™ËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ·ıÔÁ¤ÓÂÛË Ù˘ ÓfiÛÔ˘ ·›˙Ô˘Ó ÔÈ ÌÂÙ·ÏÏ¿ÍÂȘ ÛÙÔ ÁÔÓ›‰ÈÔ ELA2 Ù˘ ÂÏ·ÛÙ¿Û˘ ÙˆÓ Ô˘‰ÂÙÂÚÔʛψÓ, ηıÒ˜ ¤¯Ô˘Ó ‚ÚÂı› ÛÙËÓ ÏÂÈÔ„ËÊ›· ÙˆÓ ·ÛıÂÓÒÓ (13). ∏ ‰È¿ÁÓˆÛË Ù›ıÂÙ·È ·fi ÙÔ ÎÏËÚÔÓÔÌÈÎfi Î·È ·ÙÔÌÈÎfi ·Ó·ÌÓËÛÙÈÎfi Î·È ÙËÓ ·Ó›¯Ó¢ÛË ÙˆÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ ELA2. ∂¿Ó ‰ÂÓ ˘¿Ú¯ÂÈ Ë ‰˘Ó·ÙfiÙËÙ· ÙÔ˘ ÌÔÚÈ·ÎÔ‡ ÂϤÁ¯Ô˘, ÙfiÙ Ú¤ÂÈ Ó· Á›ÓÂÙ·È ·ÈÌÔÏË„›· Î·È ÁÂÓÈ΋ ·›Ì·ÙÔ˜ ÙÚÂȘ ÊÔÚ¤˜ ÙËÓ Â‚‰ÔÌ¿‰· ÁÈ· ¤ÍÈ Â‚‰ÔÌ¿‰Â˜ ÁÈ· Ó· ·Ó·‰Âȯı› Ë Î˘ÎÏÈ΋ Ô˘‰ÂÙÂÚÔÂÓ›·. £ÂÚ·›· ·ÔÙÂÏÔ‡Ó Ë ¯ÔÚ‹ÁËÛË G-CSF Î·È Ë ÚÔÊ˘Ï·ÎÙÈ΋ Ï‹„Ë ·ÓÙÈ‚ÈÔÙÈÎÒÓ. ™‡Ó‰ÚÔÌÔ Shwachman-Diamond ¶ÚfiÎÂÈÙ·È ÁÈ· Ì›· Û¿ÓÈ· ÓfiÛÔ Ô˘ ÌÂÙ·‚È‚¿˙ÂÙ·È Ì ÙÔÓ ·˘ÙÔÛˆÌÈÎfi ˘ÔÏÂÈfiÌÂÓÔ ÙÚfiÔ Î·È ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi Â͈ÎÚÈÓ‹ ·ÁÎÚ·ÙÈ΋ ·ÓÂ¿ÚÎÂÈ·, ÛÎÂÏÂÙÈΤ˜ ·ÓˆÌ·Ï›Â˜ Î·È Ô˘‰ÂÙÂÚÔÂÓ›· (14). ªÂÙ¿ ÙËÓ ÈÓÔ΢ÛÙÈ΋ ÓfiÛÔ Â›Ó·È Ë ‰Â‡ÙÂÚË ÛÂ Û˘¯ÓfiÙËÙ· ·ÈÙ›· Â͈ÎÚÈÓÔ‡˜ ·ÁÎÚ·ÙÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ ÛÙ· ·È‰È¿. ¶·ÚÔ˘ÛÈ¿˙ÂÙ·È ÛÙË ‚ÚÂÊÈ΋ ËÏÈΛ· Ì ·ÓÂ·Ú΋ ÚfiÛÏË„Ë ‚¿ÚÔ˘˜, ‰˘Û·ÔÚÚfiÊËÛË Î·È Û˘¯Ó¤˜ Î·È ÛÔ‚·Ú¤˜ ‚·ÎÙËÚȷΤ˜ ÏÔÈÌÒÍÂȘ. ÕÏϘ ÂΉËÏÒÛÂȘ Â›Ó·È ÙÔ ÎÔÓÙfi ·Ó¿ÛÙËÌ·, Ë ‰˘ÛÏ·Û›· ÂÈʇÛÂˆÓ Î·È ÌÂٷʇÛˆÓ, Ë Ë·ÙÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·, ÔÈ ÓÂÊÚÔÛˆÏËÓ·ÚȷΤ˜ ‰È·Ù·Ú·¯¤˜ Î·È ÂӉ¯Ô̤ӈ˜ Ë „˘¯ÔÎÈÓËÙÈ΋ ηı˘ÛÙ¤ÚËÛË. ™ÙÔ 50% ÙˆÓ ÂÚÈÙÒÛÂˆÓ Ë ·ÁÎÚ·ÙÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ·Ôηı›ÛÙ·Ù·È ÛÙ·‰È·Î¿ Û ÌÂÁ·Ï‡ÙÂÚË ËÏÈΛ·. ∂Í·ÏÏ·Á‹ ÛÂ Ì˘ÂÏÔ‰˘ÛÏ·ÛÙÈÎfi Û‡Ó‰ÚÔÌÔ ‹ ÔÍ›· Ì˘ÂÏÔÁÂÓ‹ Ï¢¯·ÈÌ›· ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÛÙÔ 15% ÙˆÓ ÂÚÈÙÒÛÂˆÓ (15). £ÂÚ·¢ÙÈο ¯ÔÚËÁÔ‡ÓÙ·È ·ÁÎÚ·ÙÈο ¤Ó˙˘Ì· ηÈ, Â¿Ó Û˘Ì‚·›ÓÔ˘Ó ÛÔ‚·Ú¤˜ ÏÔÈÌÒÍÂȘ, ¯ÔÚËÁÂ›Ù·È Î·È G-CSF. ™‡Ó‰ÚÔÌÔ Pearson ∏ Û¿ÓÈ· ·˘Ù‹ ÓfiÛÔ˜ ‚Ú›ÛÎÂÙ·È ÛÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË fiÙ·Ó ‰ÈÂÚ¢Óԇ̠·È‰› Ì Èı·Ófi Û‡Ó‰ÚÔÌÔ Shwachman-Diamond, ·ÏÏ¿ ÙË ‰È¿ÁÓˆÛË ı¤ÙÂÈ Ë ¶·È‰È·ÙÚÈ΋ 2007;70:237-245

Pediatri May-Jun 07

24-05-07

17:58

™ÂÏ›‰·240

240

∞. ª¿Î˘, ¡. ÷ÏÈ¿ÛÔ˜

¯·Ú·ÎÙËÚÈÛÙÈ΋ ÂÈÎfiÓ· ÙÔ˘ Ì˘ÂÏÔ‡. ¶ÚfiÎÂÈÙ·È Ô˘ÛÈ·ÛÙÈο ÁÈ· Ì›· Û˘ÛÙËÌ·ÙÈ΋ ÓfiÛÔ Ô˘ ÚÔ·ÙÂÈ ·fi ÌÂÙ·ÏÏ¿ÍÂȘ ÙÔ˘ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ DNA Î·È ÂΉËÏÒÓÂÙ·È Û ÌÈÎÚ‹ ËÏÈΛ· Ì ·ÓıÂÎÙÈ΋ ÛȉËÚÔ‚Ï·ÛÙÈ΋ ·Ó·ÈÌ›·, Ì ÎÂÓÔÙfiÈ· ÛÙ· ¿ˆÚ· Ì˘ÂÏÈο ·ÙÙ·Ú·, Ô˘‰ÂÙÂÚÔÂÓ›·, ıÚÔÌ‚ÔÂÓ›·, Â͈ÎÚÈÓ‹ ·ÁÎÚ·ÙÈ΋ ·ÓÂ¿ÚÎÂÈ· Î·È Á·Ï·ÎÙÈ΋ ÔͤˆÛË (16,17). °Ï˘ÎÔÁÔÓ›·ÛË Ù‡Ô˘ 1b ∏ ÁÏ˘ÎÔÁÔÓ›·ÛË ·˘Ù‹ ÌÂÙ·‚È‚¿˙ÂÙ·È Ì ÙÔÓ ·˘ÙÔÛˆÌÈÎfi ˘ÔÏÂÈfiÌÂÓÔ ÙÚfiÔ Î·È ÚÔ·ÙÂÈ ·fi ÙËÓ ¤ÏÏÂÈ„Ë ÙÔ˘ ÂÓ˙‡ÌÔ˘ ÁÏ˘ÎÔ˙Ô-6-ʈÛÊÔtranslocase Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·ÓÂ·Ú΋ ·Ú·ÁˆÁ‹ ÁÏ˘Îfi˙˘ Ì ÙË ÁÏ˘ÎÔÓÂÔÁ¤ÓÂÛË ‹ ÙË ÁÏ˘ÎÔÁÔÓfiÏ˘ÛË. ∆· ·È‰È¿ ·˘Ù¿ ÂÌÊ·Ó›˙Ô˘Ó ˘ÔÁÏ˘Î·ÈÌ›·, Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›·, Û·ÛÌÔ‡˜ Î·È ÌÂÚÈΤ˜ ÊÔÚ¤˜ ÛÔ‚·Ú‹ Ô˘‰ÂÙÂÚÔÂÓ›· ÌÂ Û˘ÓÔ‰fi ‰È·Ù·Ú·¯‹ Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ ÙˆÓ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ Ì Ì˯·ÓÈÛÌfi Ô˘ ·Ú·Ì¤ÓÂÈ ·‰È¢ÎÚ›ÓÈÛÙÔ˜ (18). ∂Ӊ¯fiÌÂÓˆ˜ Ó· ÂËÚ¿˙ÂÙ·È ¿ÌÂÛ· Ë Ì˘ÂÏÔÔ›ËÛË, ‰ÈfiÙÈ Û ÂÚÈÙÒÛÂȘ Ô˘ ¤ÁÈÓ ÔÚıÔÙÔÈ΋ ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜ ‰ÂÓ ‰ÈÔÚıÒıËÎÂ Ë Ô˘‰ÂÙÂÚÔÂÓ›· (19). ™‡Ó‰ÚÔÌ· ÚˆÙÔ·ıÒÓ ·ÓÔÛÔ·ÓÂ·ÚÎÂÈÒÓ ∏ Ô˘‰ÂÙÂÚÔÂÓ›· ·ÔÙÂÏ› ÂΉ‹ÏˆÛË ·ÚÎÂÙÒÓ Û˘Ó‰ÚfiÌˆÓ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·˜, fiˆ˜ Â›Ó·È Ë Ê˘ÏÔÛ‡Ó‰ÂÙË ·Á·ÌÌ·ÛÊ·ÈÚÈÓ·ÈÌ›· (ÓfiÛÔ˜ Bruton), ·ÓÂ¿ÚÎÂÈ· CD40-ligand (Ê˘ÏÔÛ‡Ó‰ÂÙÔ ˘ÂÚ-IgM Û‡Ó‰ÚÔÌÔ), cartilage hair hypoplasia, ‰ÈÎÙ˘ˆÙ‹ ‰˘ÛÁÂÓÂÛ›· (reticular dysgenesis) Î.¿. ¶Èı·ÓfiÓ, Ô Ì˯·ÓÈÛÌfi˜ Ù˘ Ô˘‰ÂÙÂÚÔÂÓ›·˜ Ó· Â›Ó·È ·˘ÙÔ¿ÓÔÛÔ˜, fï˜ ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ ·Ó¢ڛÛÎÔÓÙ·È Û ¤Ó· Û¯ÂÙÈο ÌÈÎÚfi ÔÛÔÛÙfi ·˘ÙÒÓ ÙˆÓ ·È‰ÈÒÓ (20). ¶ÚfiÛÊ·Ù· ·Ó·‰Â›¯ıËΠfiÙÈ Ô CD40 ligand ‰ÈÂÁ›ÚÂÈ Ù· ·ÙÙ·Ú· ÙÔ˘ ÛÙÚÒÌ·ÙÔ˜ ÙÔ˘ Ì˘ÂÏÔ‡ ÁÈ· Ó· ·Ú¿ÁÔ˘Ó flt3-ligand Î·È ıÚÔÌ‚ÔÔÈËÙ›ÓË Ô˘ Â›Ó·È ··Ú·›ÙËÙÔÈ ·˘ÍËÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ÁÈ· ÙË Ì˘ÂÏÔÔ›ËÛË (21). ∆Ô Â‡ÚËÌ· ·˘Ùfi ›Ûˆ˜ Ó· ÂÍËÁ› ÙËÓ Ô˘‰ÂÙÂÚÔÂÓ›· ÛÙ· ·È‰È¿ Ì ·ÓÂ¿ÚÎÂÈ· CD40ligand. ∞Í›˙ÂÈ Ó· ÛËÌÂȈı› fiÙÈ ÛÙËÓ ·ÓÂ¿ÚÎÂÈ· CD40-ligand, Ë ÂÈÎfiÓ· ÙÔ˘ Ì˘ÂÏÔ‡ Â›Ó·È ·ÚfiÌÔÈ· Ì ÙË ÓfiÛÔ Kostmann, ‰ËÏ·‰‹ Ì ·Ó·ÛÙÔÏ‹ Ù˘ ˆÚ›Ì·ÓÛ˘ ÛÙË Ê¿ÛË ÙÔ˘ ÚÔÌ˘ÂÏÔ΢ÙÙ¿ÚÔ˘-Ì˘ÂÏÔ΢ÙÙ¿ÚÔ˘. ∞˘Ùfi ·Ó·‰ÂÈÎÓ‡ÂÈ ÙË ÛËÌ·Û›· ÙÔ˘ ·ÓÔÛÔÏÔÁÈÎÔ‡ ÂϤÁ¯Ô˘ Û ·È‰È¿ Ô˘ ‰ÈÂÚ¢ÓÒÓÙ·È ÁÈ· ÛÔ‚·Ú‹ ¯ÚfiÓÈ· Ô˘‰ÂÙÂÚÔÂÓ›·. ™‡Ó‰ÚÔÌÔ Chediak-Higashi: AÓ‹ÎÂÈ ÛÙ· Û‡Ó‰ÚÔÌ· ·ÏÊÈÛÌÔ‡ Î·È ÌÂÙ·‚È‚¿˙ÂÙ·È Ì ÙÔÓ ·˘ÙÔÛˆÌÈÎfi ˘ÔÏÂÈfiÌÂÓÔ ¯·Ú·ÎÙ‹Ú·. ÷ڷÎÙËÚ›˙ÂÙ·È ·fi ÌÂÚÈÎfi ÔÊı·ÏÌÔ‰ÂÚÌ·ÙÈÎfi ·ÏÊÈÛÌfi, ÂÚÈÊÂÚÈ΋ Ó¢ڛÙȉ·, Ô˘‰ÂÙÂÚÔÂÓ›· Ì ¯·Ú·ÎÙËÚÈÛÙÈο ÌÂÁ¿Ï· ¤ÁÎÏÂÈÛÙ· ÛÙ· Ô˘‰ÂÙÂÚfiÊÈÏ· Î·È ÔÈÔÙÈΤ˜ ‰È·Ù·Ú·Paediatriki 2007;70:237-245

¯¤˜ ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ (22). ™ÙËÓ ÂÈÙ·¯˘ÓfiÌÂÓË Ê¿ÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ˘¿Ú¯ÂÈ ·Ó΢ÙÙ·ÚÔÂÓ›·, ÁÂÓÈÎÂ˘Ì¤ÓË ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ·, Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›· Î·È ÂÎÙÂٷ̤ÓË ‰È‹ıËÛË ÙˆÓ ÈÛÙÒÓ ·fi ÏÂÌÊÔÂȉ‹ ·ÙÙ·Ú·. ™‡Ó‰ÚÔÌÔ Wiskott Aldrich: ªÂÙ·‚È‚¿˙ÂÙ·È Ì ÙÔÓ Ê˘ÏÔÛ‡Ó‰ÂÙÔ ˘ÔÏÂÈfiÌÂÓÔ ¯·Ú·ÎÙ‹Ú· Î·È ÂΉËÏÒÓÂÙ·È Î˘Ú›ˆ˜ ÌÂ: ·) ¤Î˙ÂÌ·, ‚) ·ÈÌÔÚÚ·Á›Â˜ ÏfiÁˆ ıÚÔÌ‚ÔÂÓ›·˜ (Ì Ôχ ÌÈÎÚ¿ ·ÈÌÔÂÙ¿ÏÈ·) Î·È ÔÈÔÙÈ΋˜ ‰È·Ù·Ú·¯‹˜ ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ Î·È Á) ÏÔÈÌÒÍÂȘ ÏfiÁˆ Ù˘ Ô˘‰ÂÙÂÚÔÂÓ›·˜ Î·È Ù˘ ÌÈÎÙ‹˜ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·˜ (23). À¿Ú¯ÂÈ, Â›Û˘, ·˘ÍË̤ÓÔ˜ ΛӉ˘ÓÔ˜ ÁÈ· ÂÌÊ¿ÓÈÛË ÏÂÌÊˆÌ¿ÙˆÓ (24). ∂ÊfiÛÔÓ ˘¿Ú¯ÂÈ Û˘Ì‚·Ùfi˜ ·‰ÂÚÊfi˜, Ë ıÂÚ·›· Â›Ó·È Ë ÌÂÙ·ÌfiÛ¯Â˘ÛË ·Ú¯¤ÁÔÓˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ. ™Â ·ÓÙ›ıÂÙË ÂÚ›ÙˆÛË, Á›ÓÂÙ·È ÛÏËÓÂÎÙÔÌ‹, Ë ÔÔ›· fï˜ ‰ÈÔÚıÒÓÂÈ ÌfiÓÔ ÙË ıÚÔÌ‚ÔÂÓ›·. ∞Ó·ÈÌ›· Fanconi ∏ ·Ó·ÈÌ›· Fanconi Â›Ó·È Ì›· ÌÔÚÊ‹ ·Ï·ÛÙÈ΋˜ ·Ó·ÈÌ›·˜ Ô˘ ·Ó‹ÎÂÈ ÛÙ· ÎÏËÚÔÓÔÌÈο Û‡Ó‰ÚÔÌ· Ì˘ÂÏÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ (25). ªÂÙ·‚È‚¿˙ÂÙ·È Ì ÙÔÓ ·˘ÙÔÛˆÌÈÎfi ˘ÔÏÂÈfiÌÂÓÔ ¯·Ú·ÎÙ‹Ú· Î·È ˘¿Ú¯ÂÈ ‚·ÛÈ΋ ·ÓÂ¿ÚÎÂÈ· ÛÙËÓ ÂȉÈfiÚıˆÛË ÙˆÓ ‚Ï·‚ÒÓ ÙÔ˘ DNA. ∂ΉËÏÒÓÂÙ·È Î˘Ú›ˆ˜ Û ËÏÈΛ· 5-10 ÂÙÒÓ Î·È Û¿ÓÈ· ÛÙË ‚ÚÂÊÈ΋ ËÏÈΛ·. ™˘Ó‹ıˆ˜ Û˘Ó˘¿Ú¯Ô˘Ó ÔÏÏ·Ϥ˜ ·ÓˆÌ·Ï›Â˜, fiˆ˜ Â›Ó·È ÙÔ ÎÔÓÙfi ·Ó¿ÛÙËÌ·, ÌÈÎÚÔÎÂÊ·Ï›·, café-au-lait ÎËÏ›‰Â˜, ·ԯڈ̷ÙÈÛÌfi˜ ‰¤ÚÌ·ÙÔ˜, ÔÛÙÈΤ˜ ·ÓˆÌ·Ï›Â˜, ·Ó·ÙÔÌÈο ÚÔ‚Ï‹Ì·Ù· ·fi ÙÔ Ô˘ÚÔÔÈÔÁÂÓÓËÙÈÎfi, Ù· ÒÙ· Î·È ÙÔ˘˜ ÔÊı·ÏÌÔ‡˜ Î·È ‰È·ÓÔËÙÈ΋ ηı˘ÛÙ¤ÚËÛË. ™˘Ó‹ıˆ˜ ÂΉËÏÒÓÂÙ·È Ì ·Ó·ÈÌ›· Î·È ıÚÔÌ‚ÔÂÓ›· Î·È Û·ÓÈfiÙÂÚ· Ì ÌÂÌÔӈ̤ÓË Ô˘‰ÂÙÂÚÔÂÓ›·. ∏ ‰È¿ÁÓˆÛË ÂȂ‚·ÈÒÓÂÙ·È Ì ÙË ‰ÔÎÈÌ·Û›· ¢ıÚ·˘ÛÙfiÙËÙ·˜ ÙˆÓ ¯ÚˆÌÔÛˆÌ¿ÙˆÓ Û ÌÈÙÔÁfiÓ˜ Ô˘Û›Â˜. ¢˘ÓËÙÈο ˘¿Ú¯ÂÈ Î›Ó‰˘ÓÔ˜ ÁÈ· ÂÍ·ÏÏ·Á‹ ÛÂ Ì˘ÂÏÔ‰˘ÛÏ·ÛÙÈÎfi Û‡Ó‰ÚÔÌÔ ‹ ÔÍ›· Ì˘ÂÏÔÁÂÓ‹ Ï¢¯·ÈÌ›·, fiˆ˜ Â›Û˘ Î·È ÁÈ· ÂÌÊ¿ÓÈÛË Î·ÚΛÓÔ˘ ÙÔ˘ ÚÈÓÔÊ¿Ú˘ÁÁ· (26). ™˘ÁÁÂÓ‹˜ ‰˘ÛÎÂÚ¿ÙˆÛË ∞ÔÙÂÏ› ¤Ó· Û¿ÓÈÔ ÓfiÛËÌ· Ô˘ ·Ó‹ÎÂÈ Î·È ·˘Ùfi ÛÙ· ÎÏËÚÔÓÔÌÈο Û‡Ó‰ÚÔÌ· Ì˘ÂÏÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜. ªÂÙ·‚È‚¿˙ÂÙ·È Ì ÙÔÓ Ê˘ÏÔÛ‡Ó‰ÂÙÔ ˘ÔÏÂÈfiÌÂÓÔ ¯·Ú·ÎÙ‹Ú· Î·È ÂΉËÏÒÓÂÙ·È Î˘Ú›ˆ˜ ÛÙËÓ ÂÊË‚È΋ ËÏÈΛ· ‹ ÛÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹. ÷ڷÎÙËÚ›˙ÂÙ·È ·fi ˘¤Ú¯ÚˆÛË ‰¤ÚÌ·ÙÔ˜, ‰˘ÛÙÚÔÊ›· ÔÓ‡¯ˆÓ, Ï¢ÎÔϷΛ· Î·È ·Ï·ÛÙÈ΋ ·Ó·ÈÌ›· ÛÙÔ 50% ÙˆÓ ÂÚÈÙÒÛˆÓ. ∏ Ô˘‰ÂÙÂÚÔÂÓ›· ÂÓ‰¤¯ÂÙ·È Ó· ÂÌÊ·ÓÈÛÙ› ·Ú¯Èο ÚÈÓ ÙËÓ ·Ï·Û›· Î·È ÙˆÓ ˘ÔÏÔ›ˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ ÛÂÈÚÒÓ. À¿Ú¯ÂÈ ·˘ÍË̤ÓÔ˜ ΛӉ˘ÓÔ˜ ÁÈ· Ï¢¯·ÈÌÔÁ¤ÓÂÛË, ηıÒ˜ Î·È ÁÈ· ηÚΛÓÔ˘˜ ·fi ÂÈıËÏȷο ·ÙÙ·Ú· (27,28).

Pediatri May-Jun 07

24-05-07

17:58

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¢ÈÂÚ‡ÓËÛË Ô˘‰ÂÙÂÚoÂÓ›·˜ ÛÙ· ·È‰È¿

ª˘ÂÏÔη¯ÂÍ›· ªÂÙ·‚È‚¿˙ÂÙ·È Ì ÙÔÓ ·˘ÙÔÛˆÌÈÎfi ÂÈÎÚ·ÙÔ‡ÓÙ· ÙÚfiÔ. À¿Ú¯ÂÈ Ì¤ÙÚÈ· ¤ˆ˜ ÛÔ‚·Ú‹ Ô˘‰ÂÙÂÚÔÂÓ›· Ì ¯·Ú·ÎÙËÚÈÛÙÈ΋ ÌÔÚÊÔÏÔÁ›· ÙˆÓ Ô˘‰ÂÙÂÚÔʛψÓ, Ù· ÔÔ›· ¤¯Ô˘Ó ΢ÙÙ·ÚÔÏ·ÛÌ·ÙÈο ÎÂÓÔÙfiÈ· Î·È ·ÓÒÌ·ÏÔ˘˜ ÔÏ˘Î·Ù¿ÙÌËÙÔ˘˜ ˘Ú‹Ó˜. º·›ÓÂÙ·È fiÙÈ Ô Ì˯·ÓÈÛÌfi˜ Ù˘ Ô˘‰ÂÙÂÚÔÂÓ›·˜ Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ÂÏ·Ùو̤ÓË ¤ÎÊÚ·ÛË ÙÔ˘ bcl-x Î·È ÛÙËÓ Â·ÁˆÁ‹ Ù˘ ·fiÙˆÛ˘ ÙˆÓ Úfi‰ÚÔÌˆÓ Î˘ÙÙ¿ÚˆÓ (29). ™‡Ó‰ÚÔÌÔ Barth ∆Ô Û¿ÓÈÔ ·˘Ùfi Û‡Ó‰ÚÔÌÔ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÙÔÓ Û˘Ó‰˘·ÛÌfi Ô˘‰ÂÙÂÚÔÂÓ›·˜ Î·È Î·Ú‰ÈÔÌ˘Ô¿ıÂÈ·˜. √È ÂÚÈÛÛfiÙÂÚÔÈ ·ÛıÂÓ›˜ ¤¯Ô˘Ó ÛÔ‚·Ú¿ ÚÔ‚Ï‹Ì·Ù· ηډȷ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ ηٿ ÙË ‰È¿ÚÎÂÈ· ÏÔÈÌÒ͈Ó. ªÂÙ·‚È‚¿˙ÂÙ·È Ì ÙÔÓ Ê˘ÏÔÛ‡Ó‰ÂÙÔ ˘ÔÏÂÈfiÌÂÓÔ ¯·Ú·ÎÙ‹Ú· Î·È ˘¿Ú¯Ô˘Ó ÌÂÙ·ÏÏ¿ÍÂȘ ÙÔ˘ ÁÔÓȉ›Ô˘ Ô˘ Â›Ó·È ˘‡ı˘ÓÔ ÁÈ· ÙË Û‡ÓıÂÛË Ù˘ ηډÈÔÏÈ›Ó˘ (30).

µ. ∂›ÎÙËÙ˜ Ô˘‰ÂÙÂÚÔÂӛ˜ ªÂÙ·ÏÔÈÌ҉˘ Ô˘‰ÂÙÂÚÔÂÓ›· ª·˙› Ì ٷ Ê¿Ú̷η, ·ÔÙÂÏ› ÙÔ Û˘¯ÓfiÙÂÚÔ ·›ÙÈÔ Ô˘‰ÂÙÂÚÔÂÓ›·˜ ÛÙËÓ Î·ıËÌÂÚÈÓ‹ ÎÏÈÓÈ΋ Ú¿ÍË ÛÙ· ·È‰È¿. ∂ÌÊ·Ó›˙ÂÙ·È ÌÂÙ¿ ·fi Ïԛ̈ÍË ·fi ÈÔ‡˜, ‚·ÎÙ‹ÚÈ·, ÚˆÙfi˙ˆ· ‹ ̇ÎËÙ˜. √È Ì˯·ÓÈÛÌÔ› Â›Ó·È Î˘Ú›ˆ˜ Ë ¿ÌÂÛË Î·Ù·ÛÙÔÏ‹ ÙÔ˘ Ì˘ÂÏÔ‡, Ë Â›‰Ú·ÛË ÛÙËÓ ·Ó·Î·Ù·ÓÔÌ‹, ηıÒ˜ Â›Û˘ Î·È Ë Î·Ù·ÛÙÚÔÊ‹ ÙˆÓ Ô˘‰ÂÙÂÚÔʛψÓ. ∏ Ô˘‰ÂÙÂÚÔÂÓ›· ÌÔÚ› Ó· ÍÂÎÈÓ¿ÂÈ Ï›Á˜ Ë̤Ú˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ Ïԛ̈͢ Î·È Ó· ‰È·ÚΛ ̤¯ÚÈ 4-6 ‚‰ÔÌ¿‰Â˜. ∂ÈÚfiÛıÂÙ·, ÔÚÈṲ̂ÓÔÈ ÈÔ› Â›Ó·È ‰˘Ó·ÙfiÓ Ó· Â¿ÁÔ˘Ó ÙËÓ ·Ú·ÁˆÁ‹ ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÙˆÓ Ô˘‰ÂÙÂÚÔʛψÓ, ÌÂ Û˘Ó¤ÂÈ· Ë Ô˘‰ÂÙÂÚÔÂÓ›· Ó· ‰È·ÚΛ ÁÈ· Ì‹Ó˜. √È ÛÔ‚·Ú¤˜ ‚·ÎÙËÚȷΤ˜ ÏÔÈÌÒÍÂȘ Â›Ó·È ÂÍ·ÈÚÂÙÈο Û¿ÓÈ· ÂÈÏÔ΋ Ù˘ ÌÂÙ·ÏÔÈÌÒ‰Ô˘˜ Ô˘‰ÂÙÂÚÔÂÓ›·˜ (31). √È ÈÔ› Ô˘ ÚÔηÏÔ‡Ó Ô˘‰ÂÙÂÚÔÂÓ›· Â›Ó·È Î˘Ú›ˆ˜ ÔÈ ÂÍ‹˜: EBV, CMV, RSV, Èfi˜ Ù˘ ÂÚ˘ıÚ¿˜, ÈÏ·Ú¿˜, ·ÓÂÌ¢ÏÔÁÈ¿˜, ÁÚ›˘, Ë·Ù›Ùȉ·˜ ∞, µ, C, Èfi˜ Parvo B19, HSV-6 Î·È HIV (32). √È ÏÔÈÌÒÍÂȘ ·fi ÛÙ·Ê˘ÏfiÎÔÎÎÔ, Ê˘Ì·Ù›ˆÛË, ‚ÚԢΤÏÏ· ‹ Û·ÏÌÔÓ¤ÏÏ· ÚÔηÏÔ‡Ó Ì¤ÙÚÈ· Ô˘‰ÂÙÂÚÔÂÓ›·, ÂÎÙfi˜ Â¿Ó ÚÔ¸¿Ú¯ÂÈ ÛË„·ÈÌ›·, ÔfiÙÂ Ë Ô˘‰ÂÙÂÚÔÂÓ›· ÌÔÚ› Ó· Â›Ó·È Ôχ ÛÔ‚·Ú‹. √˘‰ÂÙÂÚÔÂÓ›· ÌÔÚ›, Â›Û˘, Ó· ÚÔηϤÛÂÈ Ë Ïԛ̈ÍË ·fi ÏÂ˚ÛÌ¿ÓÈ·, ÂÏÔÓÔÛ›· ‹ ÈÛÙÔÏ¿Û̈ÛË. º·Ú̷΢ÙÈ΋ Ô˘‰ÂÙÂÚÔÂÓ›· ∆· Ê¿Ú̷η ·ÔÙÂÏÔ‡Ó Û˘¯Ó¿ ·›ÙÈÔ Ô˘‰ÂÙÂÚÔÂÓ›·˜, Ë ÔÔ›· ÔÚÈṲ̂Ó˜ ÊÔÚ¤˜ ÌÔÚ› Ó· Â›Ó·È Ôχ ÛÔ‚·Ú‹. √È Ì˯·ÓÈÛÌÔ› Ô˘ Ô‰ËÁÔ‡Ó Û Ԣ‰Â-

ÙÂÚÔÂÓ›· Â›Ó·È Î˘Ú›ˆ˜ Ë ¿ÌÂÛË Î·Ù·ÛÙÔÏ‹ ÙÔ˘ Ì˘ÂÏÔ‡, Ë Î·Ù·ÛÙÚÔÊ‹ ÙˆÓ Úfi‰ÚÔÌˆÓ Î˘ÙÙ¿ÚˆÓ Ì¤Ûˆ ·ÓÙÈÛˆÌ¿ÙˆÓ ‹ ÂÓÂÚÁÔÔ›ËÛ˘ ÙÔ˘ Û˘ÌÏËÚÒÌ·ÙÔ˜, ηıÒ˜ Î·È Ë ¿ÌÂÛË ÂÚÈÊÂÚÈ΋ ηٷÛÙÚÔÊ‹. ∆· Ê¿Ú̷η Ô˘ ÚÔηÏÔ‡Ó Ô˘‰ÂÙÂÚÔÂÓ›· Â›Ó·È ÔÏÏ¿. ∆· ΢ÚÈfiÙÂÚ· Â›Ó·È Ù· ¯ËÌÂÈÔıÂÚ·¢ÙÈο, Ù· ·ÓÙÈ‚ÈÔÙÈο (.¯. ÎÂÊ·ÏÔÛÔÚ›Ó˜, ÙÚÈÌÂıÔÚ›ÌËÛÔ˘ÏÊ·ÌÂıÔÍ·˙fiÏË), Ù· ·ÓÙÈÂÈÏËÙÈο, Ù· ·ÓÙÈı˘ÚÂÔÂȉÈο, Ô ¯Ú˘Ûfi˜, Ë ‰ÂÊÂÚÈÚfiÓË Î·È Ù· ÌË-ÛÙÂÚÔÂȉ‹ ·ÓÙÈÊÏÂÁÌÔÓÒ‰Ë (33,34). ∏ ‰È·ÎÔ‹ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Ô‰ËÁ› Û˘Ó‹ıˆ˜ Û ÁÚ‹ÁÔÚË ·Ó¿Î·Ì„Ë ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ Ô˘‰ÂÙÂÚÔʛψÓ. øÛÙfiÛÔ, ˘¿Ú¯Ô˘Ó ÂÚÈÙÒÛÂȘ Ô˘ Ë Û˘Ó¤¯ÈÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Â›Ó·È ·Ó·Áη›· ÁÈ· ÙÔ ·È‰›, fiˆ˜ Û˘Ì‚·›ÓÂÈ .¯. Ì ٷ ·ÓÙÈÂÈÏËÙÈο. ™ÙȘ ÂÚÈÙÒÛÂȘ ·˘Ù¤˜, Â¿Ó Ô ·ÚÈıÌfi˜ ÙˆÓ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ Â›Ó·È >0,5-0,7x109/L Î·È ‰ÂÓ Û˘Ì‚·›ÓÔ˘Ó ÏÔÈÌÒÍÂȘ, ÙfiÙ ÌÔÚ› Ó· Û˘Ó¯ÈÛÙ› Ë ¯ÔÚ‹ÁËÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ˘fi ÛÙÂÓ‹ ·Ú·ÎÔÏÔ‡ıËÛË. πÛÔ- Î·È ·˘ÙÔ-¿ÓÔÛË Ô˘‰ÂÙÂÚÔÂÓ›· √È ‰‡Ô ·˘Ù¤˜ ηٷÛÙ¿ÛÂȘ ÚÔ·ÙÔ˘Ó ·fi ÙËÓ ·Ú·ÁˆÁ‹ ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ·ÓÙÈÁfiÓˆÓ Ù˘ ÂÈÊ¿ÓÂÈ·˜ ÙˆÓ Ô˘‰ÂÙÂÚÔʛψÓ. ∏ ÓÂÔÁÓÈ΋ ÈÛÔ¿ÓÔÛË Ô˘‰ÂÙÂÚÔÂÓ›· ÂÌÊ·Ó›˙ÂÙ·È ÌÂÙ¿ ÙË Á¤ÓÓËÛË ‹ ̤۷ ÛÙÔ˘˜ ÚÒÙÔ˘˜ Ì‹Ó˜ Ù˘ ˙ˆ‹˜ Î·È Â›Ó·È ·Ó¿ÏÔÁË Ù˘ ·ÈÌÔÏ˘ÙÈ΋˜ ÓfiÛÔ˘ Rhesus. À¿Ú¯ÂÈ, fï˜, Ì›· ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿: Ë ÓÂÔÁÓÈ΋ ÈÛÔ¿ÓÔÛË Ô˘‰ÂÙÂÚÔÂÓ›· Û˘¯Ó¿ ·ÚÔ˘ÛÈ¿˙ÂÙ·È Î·È ÛÙÔ ÚÒÙÔ ·È‰›. ¶ÚfiÎÂÈÙ·È ÁÈ· Û¿ÓÈ· ηٿÛÙ·ÛË Î·È ÔÈ ÛÔ‚·Ú¤˜ ÏÔÈÌÒÍÂȘ Â›Ó·È ÂÍ·ÈÚÂÙÈο Û¿ÓÈ· ÂÈÏÔ΋, ·Ú¿ ÙȘ Ôχ ¯·ÌËϤ˜ ÙÈ̤˜ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ (<0,2x109/L) (35). ∏ ‰È¿ÁÓˆÛË ÂȂ‚·ÈÒÓÂÙ·È Ì ÙËÓ ·Ó›¯Ó¢ÛË ÙˆÓ ÂȉÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ÛÙÔÓ ÔÚfi Ù˘ ÌËÙ¤Ú·˜ Î·È ÙÔ˘ ·È‰ÈÔ‡ ¤Ó·ÓÙÈ ÙˆÓ ·ÓÙÈÁfiÓˆÓ ÙˆÓ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ Ô˘ ÎÏËÚÔÓfiÌËÛ ÙÔ ·È‰› ·fi ÙÔÓ ·Ù¤Ú·. ∆· ·ÓÙÈÛÒÌ·Ù· ·˘Ù¿ ‰È¤Ú¯ÔÓÙ·È ÙÔÓ Ï·ÎÔ‡ÓÙ· Î·È ÌÔÚ› Ó· ÚÔηÏÔ‡Ó Ô˘‰ÂÙÂÚÔÂÓ›· ÛÙÔ ‚Ú¤ÊÔ˜ ̤¯ÚÈ Ó· ÂÍ·Ê·ÓÈÛÙÔ‡Ó, Û˘Ó‹ıˆ˜ Û 3-28 ‚‰ÔÌ¿‰Â˜ (̤ÛÔ˜ fiÚÔ˜: 11 ‚‰ÔÌ¿‰Â˜). ¶·ÚfiÌÔÈ· ÂÈÎfiÓ· Ì ÙË ÓÂÔÁÓÈ΋ ÈÛÔ¿ÓÔÛË Ô˘‰ÂÙÂÚÔÂÓ›· ÌÔÚ› Ó· ÚÔηϤÛÂÈ Ë ·ıËÙÈ΋ ‰È¤Ï¢ÛË ·fi ÙÔÓ Ï·ÎÔ‡ÓÙ· ·ÓÙÈÛˆÌ¿ÙˆÓ ·fi ÙË ÌËÙ¤Ú· Ô˘ ¿Û¯ÂÈ ·fi ·˘ÙÔ¿ÓÔÛË Ô˘‰ÂÙÂÚÔÂÓ›·. ∏ ÚˆÙÔ·ı‹˜ ·˘ÙÔ¿ÓÔÛË Ô˘‰ÂÙÂÚÔÂÓ›· Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ Â›Ó·È Ì›· Û¯ÂÙÈο ηÏÔ‹ı˘ ¿ıËÛË Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ·Ú·ÁˆÁ‹ ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ·ÓÙÈÁfiÓˆÓ Ù˘ ÂÈÊ¿ÓÂÈ·˜ ÙˆÓ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ ÌÂ Û˘¯Ó¿ ÛÔ‚·Ú‹ Ô˘‰ÂÙÂÚÔÂÓ›·, ¯ˆÚ›˜ fï˜ ‚·ÚȤ˜ ‚·ÎÙËÚȷΤ˜ ÏÔÈÌÒÍÂȘ. ∂ÌÊ·Ó›˙ÂÙ·È Û˘Ó‹ıˆ˜ ÛÙË ‚ÚÂÊÈ΋ ËÏÈΛ· (5-15 ÌËÓÒÓ) Î·È ÛÙ· ÂÚÈÛÛfiÙÂÚ· ·È‰È¿ (95%) ˘¿Ú¯ÂÈ ·˘ÙfiÌ·ÙË ·Ó¿Î·Ì„Ë ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ Ì¤¯ÚÈ ÙËÓ ¶·È‰È·ÙÚÈ΋ 2007;70:237-245

Pediatri May-Jun 07

24-05-07

17:58

™ÂÏ›‰·242

242

∞. ª¿Î˘, ¡. ÷ÏÈ¿ÛÔ˜

ËÏÈΛ· ÙˆÓ 3-4 ÂÙÒÓ (17 Ì‹Ó˜ ηٿ ̤ÛÔ fiÚÔ) (36,37). ∞˘ÍËÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ G-CSF ‹ Î·È ÚÔÊ˘Ï·ÎÙÈ΋ ¯ÔÚ‹ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ ÂÊ·ÚÌfi˙ÂÙ·È ÌfiÓÔ ÛÙȘ Û¿ÓȘ ÂÚÈÙÒÛÂȘ Ô˘ Û˘Ì‚·›ÓÔ˘Ó ÛÔ‚·Ú¤˜ ÏÔÈÌÒÍÂȘ. ¢ÂÓ ˘¿Ú¯ÂÈ Î›Ó‰˘ÓÔ˜ ηÎÔ‹ıÔ˘˜ ÂÍ·ÏÏ·Á‹˜. ∏ ‰È¿ÁÓˆÛË Ù›ıÂÙ·È Ì ‚¿ÛË: ·) ÙÔ ÈÛÙÔÚÈÎfi, fiÔ˘ ‰ÂÓ ·Ó·‰ÂÈÎÓ‡ÔÓÙ·È ÛÔ‚·Ú¤˜ ÏÔÈÌÒÍÂȘ, ‚) ÙË ¯ˆÚ›˜ ȉȷ›ÙÂÚ· Â˘Ú‹Ì·Ù· ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË, Á) ÙË ÌÈÎÚÔÛÎÔÈ΋ ÂͤٷÛË ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜ fiÔ˘ ‰ÂÓ ‰È·ÈÛÙÒÓÔÓÙ·È ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù· Î·È ‰) ÙËÓ ·Ó›¯Ó¢ÛË ÙˆÓ ÂȉÈÎÒÓ ·ÓÙÈÔ˘‰ÂÙÂÚÔÊÈÏÈÎÒÓ ·ÓÙÈۈ̿وÓ. ŸÙ·Ó Û˘Ó˘¿Ú¯Ô˘Ó Ù· ·ÓˆÙ¤Úˆ, ‰ÂÓ ¯ÚÂÈ¿˙ÂÙ·È Ó· Á›ÓÂÙ·È Ì˘ÂÏfiÁÚ·ÌÌ· (38). ¢Â˘ÙÂÚÔ·ı‹˜ ·˘ÙÔ¿ÓÔÛË Ô˘‰ÂÙÂÚÔÂÓ›· ÌÔÚ› Ó· ·Ú·ÙËÚËı› ÛÙÔ Ï·›ÛÈÔ ˘ÔΛÌÂÓÔ˘ ·˘ÙÔ·ÓfiÛÔ˘ ÓÔÛ‹Ì·ÙÔ˜, fiˆ˜ Â›Ó·È Ô Û˘ÛÙËÌ·ÙÈÎfi˜ ÂÚ˘ıËÌ·Ù҉˘ χÎÔ˜ ‹ Ë Ó·ÓÈ΋ ȉÈÔ·ı‹˜ ·ÚıÚ›Ùȉ·. ∆Ô Û‡Ó‰ÚÔÌÔ Felty Â›Ó·È Ô Û˘Ó‰˘·ÛÌfi˜ ÛÏËÓÔÌÂÁ·Ï›·˜ Î·È Ô˘‰ÂÙÂÚÔÂÓ›·˜ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì Ó·ÓÈ΋ ȉÈÔ·ı‹ ·ÚıÚ›Ùȉ·. ¢Â˘ÙÂÚÔ·ı‹˜ ·˘ÙÔ¿ÓÔÛË Ô˘‰ÂÙÂÚÔÂÓ›· ÌÔÚ› Ó· ÚÔ·„ÂÈ ÌÂÙ¿ ·fi ÈÔÁÂÓ›˜ ÏÔÈÌÒÍÂȘ ‹ Ï‹„Ë Ê·ÚÌ¿ÎˆÓ (39). ¢È‹ıËÛË Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ √˘‰ÂÙÂÚÔÂÓ›· ÌÔÚ› Ó· ÚÔ¤ÏıÂÈ ·fi ÙËÓ ·ÓÙÈηٿÛÙ·ÛË ÙˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ ·fi ηÎÔ‹ıË ‹ ÌË Î‡ÙÙ·Ú·, Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·ÓÂ·Ú΋ ·Ú·ÁˆÁ‹ Ô˘‰ÂÙÂÚÔʛψÓ. ™˘Ó‹ıˆ˜ Û˘Ó˘¿Ú¯ÂÈ ·Ó·ÈÌ›· ‹/Î·È ıÚÔÌ‚ÔÂÓ›·. ∆¤ÙÔȘ ·ı‹ÛÂȘ Â›Ó·È Ë ÔÍ›· Ï¢¯·ÈÌ›·, ÙÔ Ï¤Ì-

ʈ̷, ÌÂÙ·ÛÙ¿ÛÂȘ ·fi ÌË-·ÈÌ·ÙÔÏÔÁÈΤ˜ ηÎÔ‹ıÂȘ (.¯. Ó¢ÚÔ‚Ï¿Ûو̷, Ú·‚‰ÔÌ˘ÔÛ¿ÛÚΈ̷, ÔÛÙÂÔÛ¿ÚΈ̷), ÈÛÙÈÔ΢ÙÙ¿ÚˆÛË, ÓfiÛÔ˜ Gaucher Î·È ÔÛÙÂÔ¤ÙÚˆÛË. ∏ ÔÛÙÂÔ¤ÙÚˆÛË ÚÔηÏ› ΢ÙÙ·ÚÔÂӛ˜ ÂÂȉ‹ Ô Ì˘ÂÏÈÎfi˜ ¯ÒÚÔ˜ ηٷϷ̂¿ÓÂÙ·È ·fi ÔÛÙ›ÙË ÈÛÙfi ÏfiÁˆ ·ÓÂ¿ÚÎÂÈ·˜ ÙˆÓ ÔÛÙÂÔÎÏ·ÛÙÒÓ Ó· ÙÔÓ ·Ô‰ÔÌ‹ÛÔ˘Ó. ÕÏÏ· ·›ÙÈ· √˘‰ÂÙÂÚÔÂÓ›· ÌÔÚ› Ó· ·ÚÔ˘ÛÈ·ÛÙ› Û ÂÚÈÙÒÛÂȘ ˘ÂÚÛÏËÓÈÛÌÔ‡ (.¯. ÛÙË ÌÂÛÔÁÂȷ΋ ·Ó·ÈÌ›·), ·Ï·ÛÙÈ΋˜ ·Ó·ÈÌ›·˜ (ȉÈÔ·ı‹˜, Â›ÎÙËÙË), Ì˘ÂÏÔ‰˘ÛÏ·ÛÙÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘, ·ÚÔ͢ÛÌÈ΋˜ Ó˘¯ÙÂÚÈÓ‹˜ ·ÈÌÔÛÊ·ÈÚÈÓÔ˘Ú›·˜ ‹ ·ÓÂ¿ÚÎÂÈ·˜ µ12 ‹ Ê˘ÏÏÈÎÔ‡ ÔͤԘ. ™˘Ó‹ıˆ˜ Û˘Ó˘¿Ú¯Ô˘Ó ·Ó·ÈÌ›· ‹/Î·È ıÚÔÌ‚ÔÂÓ›·.

¶ÚÔÛ¤ÁÁÈÛË ÙÔ˘ ·È‰ÈÔ‡ Ì Ԣ‰ÂÙÂÚÔÂÓ›· ™ÙËÓ ∂ÈÎfiÓ· 1 ·ÚÔ˘ÛÈ¿˙ÂÙ·È ¤Ó·˜ ÚÔÙÂÈÓfiÌÂÓÔ˜ ·ÏÁfiÚÈıÌÔ˜ Ù˘ ÎÏÈÓÈ΋˜ Î·È ÂÚÁ·ÛÙËÚȷ΋˜ ÚÔÛ¤ÁÁÈÛ˘ ÙÔ˘ ·È‰ÈÔ‡ Ì Ԣ‰ÂÙÂÚÔÂÓ›·: 1) ∏ ÚÔÛ¤ÁÁÈÛË ·Ú¯›˙ÂÈ Ì ÙËÓ ÂȂ‚·›ˆÛË Ù˘ Ô˘‰ÂÙÂÚÔÂÓ›·˜ Û‡Ìʈӷ Ì ÙÔ Ê˘ÛÈÔÏÔÁÈÎfi ‡ÚÔ˜, ·Ó¿ÏÔÁ· Ì ÙËÓ ËÏÈΛ·.

2) ∆Ô ÈÛÙÔÚÈÎfi Î·È Ë ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË Î·Ù¢ı‡ÓÔ˘Ó ÙËÓ ÚÔÛ¤ÁÁÈÛË. ∆Ô ÈÛÙÔÚÈÎfi ‚ÔËı¿ ÛÙË ‰È¿ÎÚÈÛË Ù˘ ÔÍ›·˜ ·fi ÙË ¯ÚfiÓÈ· Ô˘‰ÂÙÂÚÔÂÓ›·. ªÂ ÙÔ ÈÛÙÔÚÈÎfi Û˘ÏϤÁÔÓÙ·È ÛËÌ·ÓÙÈΤ˜ ÏËÚÔÊÔڛ˜, fiˆ˜: ÂÂÈÛfi‰È· ÏÔÈÌÒÍÂˆÓ ÛÙÔ ·ÚÂÏıfiÓ (Ô˘ÏÔÛÙÔÌ·Ù›Ùȉ·, ÂÚÈÚˆÎÙÈο ·ÔÛÙ‹Ì·Ù·,

1 2 3 πÛÙÔÚÈÎfi, ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË, ÁÂÓÈ΋ ·›Ì·ÙÔ˜

4 √Í›· ÓfiÛÔ˜

5 º¿Ú̷η

6 ™Ô‚·Ú‹ ÂÌ‡ÚÂÙË Ïԛ̈ÍË

8

7

9

10

ÃÚfiÓÈ· Ô˘‰ÂÙÂÚÔÂÓ›· ‹ ÏÔÈÌÒÍÂȘ ‹/Î·È Ô˘‰ÂÙÂÚfiÊÈÏ· <0,5 Û 3 ÌÂÙÚ‹ÛÂȘ

11

πÔÁÂÓ‹˜ ¶ÂÚÈÔ‰ÈÎfiÙËÙ· ∞ÓÙÈÛÒÌ·Ù· ∫·Î‹ Ïԛ̈ÍË ∫ÏËÚÔÓÔÌÈÎfi ¤Ó·ÓÙÈ ‰È·ÙÚÔÊ‹ πÛÙÔÚÈÎfi Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ ¢È¿ÚÚÔȘ °ÔÓ›‰ÈÔ ELA2 ∞ÓÂ·Ú΋˜ ÚfiÛÏË„Ë ‚¿ÚÔ˘˜

12 º·ÈÓÔÙ˘ÈΤ˜ ·ÓˆÌ·Ï›Â˜ ªÂÙ·‚ÔÏÈΤ˜ ‰È·Ù·Ú·¯¤˜ ∫·Ú‰ÈÔÏÔÁÈο ÚÔ‚Ï‹Ì·Ù·

13 ™˘¯Ó¤˜ ¿Ù˘˜ ÏÔÈÌÒÍÂȘ

14 ª˘ÂÏfiÁÚ·ÌÌ· ∫˘ÙÙ·ÚÔÌÂÙÚ›· ÚÔ‹˜ √ÛÙÂÔÌ˘ÂÏÈ΋ ‚ÈÔ„›· ∫˘ÙÙ·ÚÔÁÂÓÂÙÈ΋

¢È·ÎÔ‹ µ·ÎÙ‹ÚÈ· 4-6 ‚‰. ∫˘ÎÏÈ΋ πÛÔ¿ÓÔÛË µ12 Fanconi’s HIV ¢È‹ıËÛË Ì˘ÂÏÔ‡ MDS Ê·ÚÌ¿ÎÔ˘ ¶ÚˆÙfi˙ˆ· ¤ˆ˜ Ô˘‰ÂÙÂÚÔÂÓ›· ‹ º˘ÏÏÈÎfi ™˘ÁÁ. ‰˘ÛÎÂÚ¿ÙˆÛË ™˘ÁÁÂÓ›˜ Kostmann’s ∞‡ÍËÛË ª‡ÎËÙ˜ 6-17 Ì‹Ó˜ ·˘ÙÔ¿ÓÔÛË SDS Chediak-Higashi ·ÓÔÛÔ·ÓÂ¿ÚÎÂȘ ∞Ï·ÛÙÈ΋ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ 3-4 ‚‰. Ô˘‰ÂÙÂÚÔÂÓ›· Pearson’s ªÂÙ·‚ÔÏÈο ·Ó·ÈÌ›· ÓÔÛ‹Ì·Ù· PNH Barth’s

∂ÈÎfiÓ· 1. ∞ÏÁfiÚÈıÌÔ˜ ‰È·ÁÓˆÛÙÈ΋˜ ÚÔÛ¤ÁÁÈÛ˘ ·È‰ÈÔ‡ Ì Ԣ‰ÂÙÂÚÔÂÓ›·. ∆ÚÔÔÔÈË̤ÓÔ˜ ·ÏÁfiÚÈıÌÔ˜ ·fi ÙÔ ‚È‚Ï›Ô: Practical Algorithms in Pediatric Hematology and Oncology. R.H. Stills, editor. S. Karger AG; 2003.

Paediatriki 2007;70:237-245

Pediatri May-Jun 07

24-05-07

17:58

™ÂÏ›‰·243

243

¢ÈÂÚ‡ÓËÛË Ô˘‰ÂÙÂÚoÂÓ›·˜ ÛÙ· ·È‰È¿

΢ÙÙ·Ú›Ùȉ·, Ó¢ÌÔÓ›·, ˆÙ›Ùȉ˜, Ë Û˘¯ÓfiÙËÙ· Î·È Ë ÛÔ‚·ÚfiÙËÙ¿ ÙÔ˘˜, ηıÒ˜ Î·È Ë ·ÓÙ·fiÎÚÈÛË ÛÙË ıÂÚ·›·), ·ÓÂ·Ú΋˜ ÚfiÛÏË„Ë ‚¿ÚÔ˘˜ ‹ ‰È¿ÚÚÔȘ, Ï‹„Ë Ê·ÚÌ¿ÎˆÓ ‹ ÂÌÊ¿ÓÈÛË Ô˘‰ÂÙÂÚÔÂÓ›·˜ Î·È ÏÔÈÌÒÍÂˆÓ Û ¿ÏÏ· ̤ÏË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜. ∏ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË Ú¤ÂÈ Ó· ÂÛÙÈ¿˙ÂÙ·È ÛÙËÓ Èı·Ó‹ ·Ó‡ÚÂÛË ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ·˜, Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›·˜, ˆ¯ÚfiÙËÙ·˜, ·ÈÌÔÚÚ·ÁÈÎÒÓ ÂΉËÏÒÛˆÓ, ·ÒÏÂÈ· ‚¿ÚÔ˘˜ ‹ Ô˘ÏÔÛÙÔÌ·Ù›Ùȉ·˜. ™ËÌ·ÓÙÈÎfi Â›Ó·È Ó· ·Ó·˙ËÙÔ‡ÓÙ·È ÌË-·ÈÌ·ÙÔÏÔÁÈο ÛËÌ›· Ô˘ ηÙ¢ı‡ÓÔ˘Ó Û ÎÏËÚÔÓÔÌÈΤ˜ Ô˘‰ÂÙÂÚÔÂӛ˜. ∆¤ÙÔÈ· ÛËÌ›· Â›Ó·È ÙÔ ÎÔÓÙfi ·Ó¿ÛÙËÌ·, ÔÈ ÔÛÙÈΤ˜ ·ÓˆÌ·Ï›Â˜, ÔÈ ‰ÂÚÌ·ÙÈΤ˜ ·ÏÏÔÈÒÛÂȘ, Ë ÌÈÎÚÔÎÂÊ·Ï›·, Ë ‰˘ÛÙÚÔÊ›· ÔÓ‡¯ˆÓ, Ë Ï¢ÎÔϷΛ·, Ô ·ÏÊÈÛÌfi˜ ‹ ÙÔ ¤Î˙ÂÌ·. ∏ ËÏÈΛ· ÂÌÊ¿ÓÈÛ˘ Ù˘ Ô˘‰ÂÙÂÚÔÂÓ›·˜ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙÔÓ ‚·ıÌfi Ù˘ Â›Ó·È È‰È·›ÙÂÚ· ¯Ú‹ÛÈÌ·. ∂ÌÊ¿ÓÈÛË Ô˘‰ÂÙÂÚÔÂÓ›·˜ Î·È ÛÔ‚·ÚÒÓ ‚·ÎÙËÚÈ·ÎÒÓ ÏÔÈÌÒÍÂˆÓ ÛÙȘ ÚÒÙ˜ ‚‰ÔÌ¿‰Â˜ Ù˘ ˙ˆ‹˜ ηÙ¢ı‡ÓÔ˘Ó ÙË ‰ÈÂÚ‡ÓËÛË Î˘Ú›ˆ˜ ÚÔ˜ ÙË ÓfiÛÔ Kostmann, ΢ÎÏÈ΋ Ô˘‰ÂÙÂÚÔÂÓ›· ‹ ÓÂÔÁÓÈ΋ ÈÛÔ¿ÓÔÛË Ô˘‰ÂÙÂÚÔÂÓ›·, ÂÊfiÛÔÓ ÛÙÔ Ì˘ÂÏfiÁÚ·ÌÌ· ‰ÂÓ ·Ó·Ê·›ÓÂÙ·È Î·ÎÔ‹ıÂÈ·. ãAÙ˘˜ Î·È ÛÔ‚·Ú¤˜ ÏÔÈÌÒÍÂȘ ˘Ô‰ÂÈÎÓ‡Ô˘Ó Û˘ÁÁÂÓ‹ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ· ‹ Ïԛ̈ÍË ·fi HIV. 3) ∏ ÂÎÙ›ÌËÛË Ù˘ ÁÂÓÈ΋˜ ·›Ì·ÙÔ˜ Î·È Ë ÌÈÎÚÔÛÎÔÈ΋ ÂÎÙ›ÌËÛË ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜ Â›Ó·È ·Ôχو˜ ··Ú·›ÙËÙ·. ∏ Û˘Ó‡·ÚÍË ·Ó·ÈÌ›·˜ ‹/Î·È ıÚÔÌ‚ÔÂÓ›·˜ ηÙ¢ı‡ÓÂÈ ÙË ‰ÈÂÚ‡ÓËÛË ÚÔ˜ Û˘ÁÎÂÎÚÈ̤Ó˜ ·Èٛ˜, ΢ڛˆ˜ ηÎÔ‹ıÂȘ Î·È ·Ï·ÛÙÈ΋ ·Ó·ÈÌ›·. ™ÙÔ ÌÈÎÚÔÛÎfiÈÔ Ú¤ÂÈ ÔˆÛ‰‹ÔÙ ӷ Á›ÓÂÈ ·Ó·˙‹ÙËÛË ÁÈ· ‚Ï¿ÛÙ˜ (Ï¢¯·ÈÌ›·), ÂÌ‡ÚËÓ· ÂÚ˘ıÚ¿ (‰È‹ıËÛË, ·ÓÙÈηٿÛÙ·ÛË Ì˘ÂÏÔ‡), ÔÏ˘Î·Ù¿ÙÌËÙ· Ô˘‰ÂÙÂÚfiÊÈÏ· (·ÓÂ¿ÚÎÂÈ· µ12, Ê˘ÏÏÈÎÔ‡), ·ÓÒÌ·ÏÔ˘˜ ˘Ú‹Ó˜ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ (Ì˘ÂÏÔη¯ÂÍ›·), ·ÓÒÌ·Ï· ÌÂÁ¿Ï· ÎÔÎΛ· ÛÙ· Ô˘‰ÂÙÂÚfiÊÈÏ· (Û‡Ó‰ÚÔÌÔ Chediak-Higashi), ÌÈÎÚÔıÚÔÌ‚ÔÂÓ›· (Û‡Ó‰ÚÔÌÔ Wiskott Aldrich) ‹ Ì·ÎÚÔ΢ÙÙ¿ÚˆÛË (·Ó·ÈÌ›· Fanconi).

4) ™ÙËÓ ÂÚ›ÙˆÛË Ô˘ Ù· Ô˘‰ÂÙÂÚfiÊÈÏ· Â›Ó·È <1,0x109/L Î·È Ê·›ÓÂÙ·È fiÙÈ Ë Ô˘‰ÂÙÂÚÔÂÓ›· ÂÌÊ·Ó›ÛÙËΠÔͤˆ˜, ÙfiÙÂ Ë ‰ÈÂÚ‡ÓËÛË Ú¤ÂÈ Ó· Á›ÓÂÈ ˆ˜ ÂÍ‹˜: 5) ¶Ú¤ÂÈ Ó· ·Ó·˙ËÙËıÔ‡Ó Èı·Ó¿ Ê·Ú̷΢ÙÈο ·›ÙÈ·. ™Â ·˘Ù‹ ÙËÓ ÂÚ›ÙˆÛË Ë ‰È·ÎÔ‹ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ı· Ô‰ËÁ‹ÛÂÈ Û ¿ÓÔ‰Ô ÙˆÓ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ Î·È ı· ı¤ÛÂÈ ÙË ‰È¿ÁÓˆÛË.

6) ∂¿Ó ÙÔ ·È‰› ¤¯ÂÈ ÛÔ‚·Ú‹ ÂÌ‡ÚÂÙË ÓfiÛÔ Î·È ‰Â›ÎÙ˜ Ô˘ ˘Ô‰ÂÈÎÓ‡Ô˘Ó ÌÈÎÚԂȷ΋ Ïԛ̈ÍË, ÙfiÙ Èı·ÓÒ˜ Ë Ô˘‰ÂÙÂÚÔÂÓ›· ÔÊ›ÏÂÙ·È ÛÙÔÓ ÌÈÎÚÔ‚È·Îfi ·Ú¿ÁÔÓÙ·. ∂¿Ó Ë Ô˘‰ÂÙÂÚÔÂÓ›· ‰ÂÓ ·Ôηı›ÛÙ·Ù·È Û 3-4 ‚‰ÔÌ¿‰Â˜ ÌÂÙ¿ ÙË Ïԛ̈ÍË, ÙfiÙ Ú¤ÂÈ Ó· ˘ÔÏÔÁÈÛÙ› ÙÔ ÂӉ¯fiÌÂÓÔ Ó· ˘¿Ú¯ÂÈ ˘ÔΛÌÂÓË ¯ÚfiÓÈ· Ô˘‰ÂÙÂÚÔÂÓ›· Î·È Ë ·ÚÂÏıÔ‡Û· Ïԛ̈ÍË Ó· ÔÊ›ÏÂÙ·È Û ·˘Ù‹.

7) ™ÙËÓ ÂÚ›ÙˆÛË Ô˘ ÙÔ ·È‰› ¤¯ÂÈ ÂÚ¿ÛÂÈ Ì›· ‹È· ÓfiÛÔ Ì ¯·Ú·ÎÙ‹Ú˜ Î·È ‰Â›ÎÙ˜ ÈÔÁÂÓÔ‡˜ Ïԛ̈͢, ÙfiÙÂ Ë ÙÂÏÂ˘Ù·›· Â›Ó·È Ì¿ÏÏÔÓ Ë ·ÈÙ›· Ù˘ Ô˘‰ÂÙÂÚÔÂÓ›·˜. ∏ ‰È¿ÁÓˆÛË ı· ÂȂ‚·Èˆı›, Â¿Ó Û Â·Ó¿ÏË„Ë Ù˘ ÁÂÓÈ΋˜ ·›Ì·ÙÔ˜ Û 4-6 ‚‰ÔÌ¿‰Â˜ ¤¯ÂÈ ·ÔηٷÛÙ·ı› Ô ·ÚÈıÌfi˜ ÙˆÓ Ô˘‰ÂÙÂÚÔʛψÓ. ™Â ÔÚÈṲ̂Ó˜ ÂÚÈÙÒÛÂȘ ÔÈ ÈÔÁÂÓ›˜ ÏÔÈÌÒÍÂȘ Â¿ÁÔ˘Ó ÙËÓ ·Ú·ÁˆÁ‹ ·ÓÙÈÛˆÌ¿ÙˆÓ Ì ·ÔÙ¤ÏÂÛÌ· Ë Ô˘‰ÂÙÂÚÔÂÓ›· Ó· ‰È·ÚΛ ÂÚÈÛÛfiÙÂÚÔ Î·È Ó· ¯ÚÂÈ¿˙ÂÙ·È, ÙfiÙÂ, Ó· Á›ÓÂÙ·È ÂÚÁ·ÛÙËÚȷ΋ ·Ó›¯Ó¢ÛË ÙˆÓ ·ÓÙÈÔ˘‰ÂÙÂÚÔÊÈÏÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ÁÈ· ηıÔÚÈÛÌfi Ù˘ ‰È¿ÁÓˆÛ˘.

8) ∂¿Ó ˘¿Ú¯ÂÈ ÈÛÙÔÚÈÎfi ¯ÚfiÓÈ·˜ Ô˘‰ÂÙÂÚÔÂÓ›·˜ ‹ ÏÔÈÌÒÍÂˆÓ ‹/Î·È Ô˘‰ÂÙÂÚfiÊÈÏ· <0,5x109/L Û ÙÚÂȘ ÌÂÙÚ‹ÛÂȘ, Ë ‰ÈÂÚ‡ÓËÛË Ú¤ÂÈ Ó· Á›ÓÂÈ ˆ˜ ÂÍ‹˜: 9) ŸÙ·Ó ˘¿Ú¯ÂÈ ÂÚÈÔ‰ÈÎfiÙËÙ· ÛÙËÓ ÂÌÊ¿ÓÈÛË ÙˆÓ ÏÔÈÌÒÍÂˆÓ ‹ Ù˘ Ô˘ÏÔÛÙÔÌ·Ù›Ùȉ·˜ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ıÂÙÈÎfi ÎÏËÚÔÓÔÌÈÎfi ÈÛÙÔÚÈÎfi Î·È ·Ó‡ÚÂÛ˘ ÌÂÙ·ÏÏ¿ÍÂˆÓ ÛÙÔ ÁÔÓ›‰ÈÔ ELA2, Ù›ıÂÙ·È Ë ‰È¿ÁÓˆÛË Ù˘ ΢ÎÏÈ΋˜ Ô˘‰ÂÙÂÚÔÂÓ›·˜. ∂¿Ó ‰ÂÓ ˘¿Ú¯ÂÈ Ë ‰˘Ó·ÙfiÙËÙ· ÙÔ˘ ÌÔÚÈ·ÎÔ‡ ÂϤÁ¯Ô˘, ÙfiÙ Ú¤ÂÈ Ó· Á›ÓÂÙ·È ·ÈÌÔÏË„›· Î·È ÁÂÓÈ΋ ·›Ì·ÙÔ˜ ÙÚÂȘ ÊÔÚ¤˜ ÙËÓ Â‚‰ÔÌ¿‰· ÁÈ· ¤ÍÈ Â‚‰ÔÌ¿‰Â˜ ÁÈ· Ó· ·Ó·‰Âȯı› Ë Î˘ÎÏÈ΋ Ô˘‰ÂÙÂÚÔÂÓ›·.

10) ∏ ÂÌÊ¿ÓÈÛË Ô˘‰ÂÙÂÚÔÂÓ›·˜ ¯ˆÚ›˜ ȉȷ›ÙÂÚ· Û˘¯Ó¤˜ ÛÔ‚·Ú¤˜ ‚·ÎÙËÚȷΤ˜ ÏÔÈÌÒÍÂȘ ÛÙȘ ÚÒÙ˜ ‚‰ÔÌ¿‰Â˜ Ù˘ ˙ˆ‹˜ ηÙ¢ı‡ÓÂÈ ÙË ‰ÈÂÚ‡ÓËÛË Î˘Ú›ˆ˜ ÚÔ˜ ÙË ÓÂÔÁÓÈ΋ ÈÛÔ¿ÓÔÛË Ô˘‰ÂÙÂÚÔÂÓ›·, ÂÊfiÛÔÓ ·ÓȯÓ¢ÙÔ‡Ó Î·È Ù· ÂȉÈο ·ÓÙÈÔ˘‰ÂÙÂÚÔÊÈÏÈο ·ÓÙÈÛÒÌ·Ù· ÛÙÔÓ ÔÚfi Ù˘ ÌËÙ¤Ú·˜ Î·È ÙÔ˘ ·È‰ÈÔ‡. ™Â ·È‰È¿ ËÏÈΛ·˜ >6 ÌËÓÒÓ Ô˘ ‰ÂÓ ¤¯Ô˘Ó ÈÛÙÔÚÈÎfi ÛÔ‚·ÚÒÓ ÏÔÈÌÒ͈Ó, Û˘Ó‹ıˆ˜ Ë ‰È¿ÁÓˆÛË Â›Ó·È ·˘ÙÔ¿ÓÔÛË Ô˘‰ÂÙÂÚÔÂÓ›· Î·È ÂÊfiÛÔÓ ·ÓȯÓ‡ÔÓÙ·È ·ÓÙÈÔ˘‰ÂÙÂÚÔÊÈÏÈο ·ÓÙÈÛÒÌ·Ù·, ‰ÂÓ ¯ÚÂÈ¿˙ÂÙ·È Ó· Á›ÓÂÈ Ì˘ÂÏfiÁÚ·ÌÌ·.

11) ŸÙ·Ó ˘¿Ú¯ÂÈ Î·Î‹ ‰È·ÙÚÔÊ‹ ‹ ÛËÌ›· ‰˘Û·ÔÚÚfiÊËÛ˘ ÂÓ‰ÂÈÎÙÈο Â͈ÎÚÈÓÔ‡˜ ·ÁÎÚ·ÙÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ (.¯. ÛÙ·ÙfiÚÚÔÈ·, ·ÓÂ·Ú΋˜ ÚfiÛÏË„Ë ‚¿ÚÔ˘˜), ÙfiÙ Ú¤ÂÈ Ó· Á›ÓÂÙ·È ¤ÏÂÁ¯Ô˜ ÁÈ· ·ÓÂ¿ÚÎÂÈ· µ12/Ê˘ÏÏÈÎÔ‡ Î·È ‰ÈÂÚ‡ÓËÛË ÁÈ· Ù· Û‡Ó‰ÚÔÌ· Shwachman-Diamond (SDS) Î·È Pearson.

12) ™Ù· ·È‰È¿ Ì ¯ÚfiÓÈ· Ô˘‰ÂÙÂÚÔÂÓ›· Ô˘ Û˘Ó˘¿Ú¯Ô˘Ó Ê·ÈÓÔÙ˘ÈΤ˜ ·ÓˆÌ·Ï›Â˜, ÌÂÙ·‚ÔÏÈΤ˜ ‰È·Ù·Ú·¯¤˜ ‹ ηډÈÔÏÔÁÈο ÚÔ‚Ï‹Ì·Ù· Ú¤ÂÈ Ó· Á›ÓÂÙ·È ¤ÏÂÁ¯Ô˜ ÁÈ· ·Ó·ÈÌ›· Fanconi, Û˘ÁÁÂÓ‹ ‰˘ÛÎÂÚ¿ÙˆÛË, Û‡Ó‰ÚÔÌÔ Chediak-Higashi, ÁÏ˘ÎÔÁÔÓ›·ÛË Ù‡Ô˘ 1b Î·È Û‡Ó‰ÚÔÌÔ Barth, ·ÓÙ›ÛÙÔȯ·.

13) ™ÙȘ ÂÚÈÙÒÛÂȘ Ô˘ Û˘Ì‚·›ÓÔ˘Ó Û˘¯Ó¤˜ Î·È ÛÔ‚·Ú¤˜ ¿Ù˘˜ ÏÔÈÌÒÍÂȘ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ¿ÏϘ ‰È·Ù·Ú·¯¤˜, Ú¤ÂÈ Ó· Á›ÓÂÙ·È ‰ÈÂÚ‡ÓËÛË ÁÈ· Û˘ÁÁÂÓ›˜ ·ÓÔÛÔ·ÓÂ¿ÚÎÂȘ ‹ Ïԛ̈ÍË ·fi HIV. ¶·È‰È·ÙÚÈ΋ 2007;70:237-245

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14) ™ÙȘ ÂÚÈÙÒÛÂȘ Ô˘ ‰È·ÈÛÙÒÓÔÓÙ·È ·ÓËÛ˘¯ËÙÈο ÛËÌ›· ÛÙËÓ ÎÏÈÓÈ΋ ÂͤٷÛË (.¯. ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ·, Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›·), fiÙ·Ó Û˘Ó˘¿Ú¯ÂÈ ·Ó·ÈÌ›· ‹ ıÚÔÌ‚ÔÂÓ›· ‹ fiÙ·Ó ·Ó¢ڛÛÎÔÓÙ·È ‚Ï¿ÛÙ˜ ÛÙÔ ÂÚÈÊÂÚÈÎfi ·›Ì·, ηıÒ˜ Â›Û˘ fiÙ·Ó Ë ·Ú¯È΋ ‰ÈÂÚ‡ÓËÛË ‰ÂÓ ¤¯ÂÈ Ô‰ËÁ‹ÛÂÈ ÛÂ Û˘ÁÎÂÎÚÈ̤ÓË ·ÈÙ›· Î·È ˘¿Ú¯ÂÈ ÈÛÙÔÚÈÎfi ÛÔ‚·ÚÒÓ ÏÔÈÌÒ͈Ó, Ú¤ÂÈ Ó· Á›ÓÂÙ·È Ì˘ÂÏfiÁÚ·ÌÌ·, ‚ÈÔ„›· ÔÛÙÔ‡ Î·È ·ÓÔÛÔÊ·ÈÓÔÙ˘ÈÎfi˜ Î·È Î˘ÙÙ·ÚÔÁÂÓÂÙÈÎfi˜ ¤ÏÂÁ¯Ô˜. ∏ ·ÓÙÈηٿÛÙ·ÛË ÙÔ˘ Ì˘ÂÏÔ‡ ·fi ηÎÔ‹ıË Î‡ÙÙ·Ú· (Ï¢¯·ÈÌ›·, ϤÌʈ̷, ÌÂÙ·ÛÙ·ÙÈÎÔ› Û˘Ì·Á›˜ fiÁÎÔÈ) ÚÔηÏ› Û˘Ó‹ıˆ˜ ·Ó΢ÙÙ·ÚÔÂÓ›·, ·Ú¿ ÌÂÌÔӈ̤ÓË Ô˘‰ÂÙÂÚÔÂÓ›·. ™Â ÂÚ›ÙˆÛË ÓfiÛÔ˘ Kostmann ı· Ê·Ó› ·Ó·ÛÙÔÏ‹ ÛÙË Ê¿ÛË ÙÔ˘ ÚÔÌ˘ÂÏÔ΢ÙÙ¿ÚÔ˘/Ì˘ÂÏÔ΢ÙÙ¿ÚÔ˘. ∏ ÂÈÎfiÓ· ‰˘ÛÏ·Û›·˜ ÙÔ˘ Ì˘ÂÏÔ‡ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ·ÓÒÌ·Ï· ΢ÙÙ·ÚÔÁÂÓÂÙÈο Â˘Ú‹Ì·Ù· Ô‰ËÁ› ÛÙË ‰È¿ÁÓˆÛË ÙÔ˘ Ì˘ÂÏÔ‰˘ÛÏ·ÛÙÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ (MDS). ∏ ‚ÈÔ„›· ÔÛÙÔ‡ ‚ÔËı¿ ÛÙË ‰È¿ÁÓˆÛË Ù˘ ·Ï·ÛÙÈ΋˜ ·Ó·ÈÌ›·˜. ∏ ‰È¿ÁÓˆÛË Ù˘ ·ÚÔ͢ÛÌÈ΋˜ Ó˘¯ÙÂÚÈÓ‹˜ ·ÈÌÔÛÊ·ÈÚÈÓÔ˘Ú›·˜ (PNH) Ù›ıÂÙ·È Ì ÙËÓ Î˘ÙÙ·ÚÔÌÂÙÚ›· ÚÔ‹˜.

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“¶fiÏË Ù˘ º·ÓÙ·Û›·˜” Markovic Predrag, 14 ¯ÚÔÓÒÓ, ™ÂÚ‚›· & ª·˘ÚÔ‚Ô‡ÓÈÔ ¶·È‰› Ì ÌÂÚÈ΋ fiÚ·ÛË “∆· Ù˘ÊÏ¿ ·È‰È¿ ˙ˆÁÚ·Ê›˙Ô˘Ó”, ÕÓÓ· §·Ô˘Ù¿ÚË°ÎÚÈÙ˙¿Ï·, ∞ı‹Ó· 2006

“City of Fantasy”, Markovic Predrag, 14 years old, Serbia & Montenegro Partially blind child “Blind children paint”, Anna Laoutari-Gritzala, Athens 2006

¶·È‰È·ÙÚÈ΋ 2007;70:237-245

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ª. ∂ÌÔÚÈ¿‰Ô˘1, ∞. ∆Ú·ÁÈ·ÓÓ›‰Ë˜1, °. ∆˙Ô˘‚ÂϤ΢1, §. ºÈ‰¿ÓË1, π. ∫ˆÛÙfiÔ˘ÏÔ˜2, º. ∞ı·Ó·ÛÈ¿‰Ô˘1

AÏÏËÏÔÁÚ·Ê›·: ª. ∂ÌÔÚÈ¿‰Ô˘ µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ∞.¶.£., ¡ÔÛÔÎÔÌÂ›Ô ∞Ã∂¶∞ ™Ù. ∫˘ÚȷΛ‰Ë 1, ∆.∫. 546 36, £ÂÛÛ·ÏÔÓ›ÎË

∞ÁfiÚÈ ËÏÈΛ·˜ 13 ÂÙÒÓ ·Ú·¤ÌÂÙ·È ÛÙËÓ ÎÏÈÓÈ΋ Ì·˜ ÏfiÁˆ ·ÓÒ‰˘Ó˘, ˘fiÛÎÏËÚ˘ ‰ÈfiÁΈÛ˘ ÏÂÌÊ·‰¤ÓˆÓ Ì ÂÓÙfiÈÛË ÛÙËÓ ÂÚÈÔ¯‹ Ù˘ ‰ÂÍÈ¿˜ ·ÚÂÈ¿˜ Î·È ÛÙÔÓ Û‡ÛÙÔÈ¯Ô ˘ÔÁÓ¿ıÈÔ ¯ÒÚÔ, ‰È·ÛÙ¿ÛÂˆÓ 5x6 cm ·fi 5Ë̤ÚÔ˘. √ ·ÛıÂÓ‹˜ ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ‹Ù·Ó ·‡ÚÂÙÔ˜, ·Ó¤ÊÂÚÂ Ì˘·ÏÁ›Â˜, ηٷ‚ÔÏ‹ Î·È ·ÓÔÚÂÍ›· ·fi 10Ë̤ÚÔ˘, ÂÓÒ ·fi 5Ë̤ÚÔ˘ ›¯Â Ï¿‚ÂÈ ·ÁˆÁ‹ Ì ·ÌÔ͢ÎÈÏÏ›ÓË/ÎÏ·‚Ô˘Ï·ÓÈÎfi Ô͇ ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜, ¯ˆÚ›˜ ÎÏÈÓÈ΋ ‚ÂÏÙ›ˆÛË. ∆· ·ÔÙÂϤÛÌ·Ù· ÙÔ˘ ·ÈÌ·ÙÔÏÔÁÈÎÔ‡ Î·È ‚ÈÔ¯ËÌÈÎÔ‡ ÂϤÁ¯Ô˘ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο, ÔÈ ‰Â›ÎÙ˜ ÊÏÂÁÌÔÓ‹˜ Î·È Ë Mantoux ·ÚÓËÙÈÎÔ›. ∞fi ÙÔÓ ·ÂÈÎÔÓÈÛÙÈÎfi ¤ÏÂÁ¯Ô Ô˘ ‰ÈÂÓÂÚÁ‹ıËΠ̠˘ÂÚ˯ÔÁÚ¿ÊËÌ· Î·È CT Ù˘ ÂÚÈÔ¯‹˜ ‰È·ÈÛÙÒıËÎÂ Ë ·ÚÔ˘Û›· ¢ÌÂÁ¤ıÔ˘˜ ÏÂÌÊ·‰¤Ó· ‰È·ÛÙ¿ÛÂˆÓ 4,8x2,5x2,8 cm ˘ÔÁÓ¿ıÈ· ‰ÂÍÈ¿, Ì ÈÂÛÙÈο Ê·ÈÓfiÌÂÓ· ÛÙȘ ÁÂÈÙÔÓÈΤ˜ ‰Ô̤˜, ·ÚÔ˘Û›· ÔÏÏ·ÏÒÓ ÌÈÎÚfiÙÂÚˆÓ ÏÂÌÊ·‰¤ÓˆÓ ÛÙÔ Ô›ÛıÈÔ ÙÚ›ÁˆÓÔ, ¿¯˘ÓÛË ÙÔ˘ ‰ÂÍÈÔ‡ Ï¿ÁÈÔ˘ ÙÔȯÒÌ·ÙÔ˜ ÙÔ˘ Ê¿Ú˘ÁÁ· Ì ÚÔ‚ÔÏ‹ ‚Ï¿‚˘ Ì·Ï·ÎÔ‡ ÈÛÙÔ‡ Î·È ÏÂÌÊÈ΋ ÛÙ¿ÛË Û‡ÛÙÔȯ·. √ ·ÛıÂÓ‹˜ ÛÙËÓ ÎÏÈÓÈ΋ Ì·˜ Ù¤ıËΠ۠·ÁˆÁ‹ Ì ·ÌÔ͢ÎÈÏÏ›ÓË/ÎÏ·‚Ô˘Ï·ÓÈÎfi Ô͇ Î·È ÙÂ˚ÎÔÏ·Ó›ÓË. ∆Ô ¤ÎÙÔ 24ˆÚÔ ·fi ÙËÓ ÂÈÛ·ÁˆÁ‹ ·ÚÔ˘Û›·Û ˘„ËÏfi ˘ÚÂÙfi ˆ˜ 40ÔC Ô˘ Û˘Óԉ‡ıËΠ·fi Âȉ›ӈÛË Ù˘ ÎÏÈÓÈ΋˜ ηٿÛÙ·Û˘ Ì ·ÒÏÂÈ· ‚¿ÚÔ˘˜, ÂÌÊ¿ÓÈÛË ÂÙ¯ÂÈÒ‰Ô˘˜ ÂÍ·Óı‹Ì·ÙÔ˜, Ì˘·ÏÁ›Â˜, ηٷ‚ÔÏ‹ Î·È Â̤ÙÔ˘˜. ∞fi ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË ‰È·ÈÛÙÒıËΠÌË ÌÂÙ·‚ÔÏ‹ ÙÔ˘ ÌÂÁ¤ıÔ˘˜ Ù˘ ÏÂÌÊ·‰ÂÓÈ΋˜ Ì¿˙·˜ Î·È ·fi ÙÔÓ ·ÈÌ·ÙÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô Ï¢ÎÔÂÓ›· (WBC:

1200/mm3) Î·È ıÚÔÌ‚ÔÂÓ›· (PLT: 22000/mm3), ÂÓÒ ÔÈ ‰Â›ÎÙ˜ ÊÏÂÁÌÔÓ‹˜ ‹Ù·Ó ÂÎ Ó¤Ô˘ ·ÚÓËÙÈÎÔ›. √È Î·ÏÏȤÚÁÂȘ ·›Ì·ÙÔ˜ Ô˘ ÂÏ‹ÊıËÛ·Ó ‹Ù·Ó ·ÚÓËÙÈΤ˜. §fiÁˆ ÙÔ˘ ˘„ËÏÔ‡ ˘ÚÂÙÔ‡, ÙÔ˘ ÂÙ¯ÂÈÒ‰Ô˘˜ ÂÍ·Óı‹Ì·ÙÔ˜ Î·È Ù˘ ÌË ·ÓÙ·fiÎÚÈÛ˘ ÛÙËÓ ·Ú¯È΋ ·ÓÙÈÌÈÎÚԂȷ΋ ıÂÚ·›· Ô ·ÛıÂÓ‹˜ Ù¤ıËΠ۠·ÁˆÁ‹ Ì ÈÌÈÂÓ¤ÌË/ÛÈÏ·ÛÙ·Ù›ÓË, ·ÌÈηۛÓË Î·È ‚·ÓÎÔÌ˘Î›ÓË. ∆· ·ÓÙÈÛÒÌ·Ù· ÛÙÔÓ ÔÚfi ÁÈ· Toxoplasma, Bartonella henselae, Mycoplasma, Coxsackie B1-5, Salmonella, Shigella, Û‡ÊÈÏË, ÏÂ˚ÛÌ¿ÓÈ· ‹Ù·Ó ·ÚÓËÙÈο, ÂÓÒ Û fi,ÙÈ ·ÊÔÚ¿ ÛÙ· ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ CMV Î·È EBV ‰È·ÈÛÙÒıËΠ·ÓÔÛ›·. √ ·ÛıÂÓ‹˜ ˘Ô‚Ï‹ıËΠÛÂ Ì˘ÂÏfiÁÚ·ÌÌ· Î·È ÔÛÙÂÔÌ˘ÂÏÈ΋ ‚ÈÔ„›·, Ù· ·ÔÙÂϤÛÌ·Ù· ÙˆÓ ÔÔ›ˆÓ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο, ÂÓÒ ·Ú¿ÏÏËÏ·, o ¤ÏÂÁ¯Ô˜ ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ ¤‰ÂÈÍÂ: ANA+ (1/80), p-ANCA+ (6,31 U/ml) Î·È ‰ÈÂÓÂÚÁ‹ıËΠ·Ê·›ÚÂÛË Ù˘ ÏÂÌÊ·‰ÂÓÈ΋˜ ‰ÈfiÁΈÛ˘, Ë ÔÔ›· ÙÂÎÌËÚ›ˆÛ ÙË ‰È¿ÁÓˆÛË Ï›Á˜ Ë̤Ú˜ ·ÚÁfiÙÂÚ·. ªÂÙ¿ ÙËÓ ·Ê·›ÚÂÛË Ù˘ Ì¿˙·˜, ¤ÁÈÓ ‰È·ÎÔ‹ Ù˘ ·ÓÙÈÌÈÎÚԂȷ΋˜ ·ÁˆÁ‹˜ Î·È ‰‡Ô 24ˆÚ· ·ÚÁfiÙÂÚ·, Ô ·ÛıÂÓ‹˜ ·˘Ú¤ÙËÛÂ.

¶Èı·Ó¤˜ ‰È·ÁÓÒÛÂȘ: 1. NfiÛÔ˜ Kawasaki 2. §Ô›ÌˆÍË ·fi ¿Ù˘· Ì˘ÎÔ‚·ÎÙËÚ›‰È· 3. ¡fiÛÔ˜ Kikuchi-Fujimoto 4. ¡fiÛÔ˜ ·fi ·Ì˘¯‹ Á·Ï‹˜ 5. ƒ·‚‰ÔÌ˘ÔÛ¿ÚΈ̷

∏ ·¿ÓÙËÛË ·ÎÔÏÔ˘ı› ÛÙË ÛÂÏ›‰· 252 Paediatriki 2007;70:246,252

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247

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∏ ηχÙÂÚË ‚ÈÔ˚·ÙÚÈ΋ ÌÂϤÙË Ù˘ ¯ÚÔÓÈ¿˜ ∆Ô 2006 ‹Ù·Ó ÌÈ· ηϋ ÂÚ¢ÓËÙÈ΋ ¯ÚÔÓÈ¿: ÂÚ›Ô˘ 700.000 ¿ÚıÚ· ηٷ¯ˆÚ‹ıËÎ·Ó ÛÙË ‚¿ÛË ‰Â‰ÔÌ¤ÓˆÓ PubMed. ∏ ‰ÈÂıÓ‹˜ ÂΉÔÙÈ΋ ÔÌ¿‰· ÙÔ˘ Lancet, ÙËÚÒÓÙ·˜ ·Ú¿‰ÔÛË ÂÙÒÓ, ͯÒÚÈÛ 23 ÂÍ ·˘ÙÒÓ Î·È Ù· ÚfiÙÂÈÓ ÛÙÔ˘˜ 13 ÂΉfiÙ˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. ªÂÙ¿ ·fi Û˘˙‹ÙËÛË, ÔÈ ÂΉfiÙ˜ Â¤ÏÂÍ·Ó (Lancet 2007;369:91) ˆ˜ ηχÙÂÚË ‚ÈÔ˚·ÙÚÈ΋ ÌÂϤÙË ÙÔ˘ 2006 ‰‡Ô Û˘Ó¯fiÌÂÓ· ¿ÚıÚ· ÛÙÔ New England Journal of Medicine (2006;354:11 Î·È 354:23) Ô˘ ·ÊÔÚÔ‡Û·Ó ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Î·È ÙËÓ ·ÛÊ¿ÏÂÈ· ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ηٿ ÙÔ˘ ÈÔ‡ ÚfiÙ· (rotavirus). √È ÌÂϤÙ˜ ›¯·Ó ‰È·Í·¯ı› ·fi ÙȘ ÔÏ˘ÎÂÓÙÚÈΤ˜ ÔÌ¿‰Â˜ ÙˆÓ Gulielmo Ruiz-Palacios (™·ÓÙÈ¿ÁÔ, ÃÈÏ‹) Î·È Timo Vesikari (∆¿ÌÂÚÂ, ºÈÓÏ·Ó‰›·). ∆Ô “·ÚÁ˘Úfi ÌÂÙ¿ÏÏÈÔ” ·ÔÓÂÌ‹ıËΠÂ›Û˘ Û ÌÂϤÙË ÁÈ· ÂÌ‚fiÏÈÔ, ÂΛÓÔ ÙÔ˘ ÈÔ‡ ÙˆÓ ·ÓıÚÒÈÓˆÓ ıËÏˆÌ¿ÙˆÓ HPV (Diane Harper, Darmouth/¡∏, ∏¶∞, Lancet 2006;367:1247). ÕÏϘ ÌÂϤÙ˜ Ô˘ ‰È·ÎÚ›ıËÎ·Ó ·ÊÔÚÔ‡Û·Ó ÙËÓ ÚÒÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË ÚÔÛÒÔ˘ (Lancet 2006;368:203) Î·È ÙË Û‡ÁÎÚÈÛË ÙˆÓ ÂÁÎÂÊ¿ÏˆÓ ÙÔ˘ ·ÓıÚÒÔ˘ Î·È ÙÔ˘ ¯ÈÌ·ÓÙ˙‹ (Nature 2006;443:167). ∆· ηϿ ÙÔ˘ ıËÏ·ÛÌÔ‡ ∆· ÏÂÔÓÂÎÙ‹Ì·Ù· ÙÔ˘ ıËÏ·ÛÌÔ‡ Â›Ó·È ·ÛÈÊ·Ó‹ ÎÈ Â›Ó·È ·ÔÚ›·˜ ¿ÍÈÔ Ò˜ ÊÙ¿Û·Ì ÛÙÔ ÛËÌÂ›Ô Ù· ̈ڿ Ô˘ ıËÏ¿˙Ô˘Ó Ó· ·ÔÙÂÏÔ‡Ó ÂÍ·›ÚÂÛË. √ ıËÏ·ÛÌfi˜ ÚÔÛٷهÂÈ, ÌÂٷ͇ ¿ÏψÓ, ·fi ÏÔÈÌÒÍÂȘ Î·È ÙÔ ÁÂÁÔÓfi˜ ·˘Ùfi ÂȂ‚·ÈÒÓÂÈ ÚfiÛÊ·ÙË ÌÂϤÙË ·fi ÙÔ ∏ӈ̤ÓÔ µ·Û›ÏÂÈÔ Ô˘ Û˘ÌÂÚȤϷ‚ 15.890 ˘ÁÈ‹ ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿ (Pediatrics 2007;119:e837). ∆· ‚Ú¤ÊË Ô˘ ıËÏ¿˙Ô˘Ó ÓÔÛËχÔÓÙ·È ÁÈ· ÏÈÁfiÙÂÚÔ ¯ÚfiÓÔ ÁÈ· ‰È¿ÚÚÔÈ· Î·È ÏÔÈÌÒÍÂȘ ÙÔ˘ ηÙÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡. ÀÔÏÔÁ›ÛÙËΠfiÙÈ Ô ·ÔÎÏÂÈÛÙÈÎfi˜ ıËÏ·ÛÌfi˜ ı· Ì›ˆÓ ÙÔÓ ¯ÚfiÓÔ ÓÔÛËÏ›·˜ ÁÈ· ‰È¿ÚÚÔÈ· ηٿ 53% Î·È ÁÈ· Ïԛ̈ÍË ÙÔ˘ ηÙÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ ηٿ 27% ÛÙÔ˘˜ ÚÒÙÔ˘˜ 8 Ì‹Ó˜ Ù˘ ˙ˆ‹˜ ÙÔ˘ ·ÙfiÌÔ˘. ∆· ·ÓÙ›ÛÙÔȯ· ÔÛÔÛÙ¿ ÁÈ· ÙÔ ÌÂÚÈÎfi ıËÏ·ÛÌfi ı· ‹Ù·Ó 31% Î·È 25%. ∏ ¶·ÁÎfiÛÌÈ· √ÚÁ¿ÓˆÛË ÀÁ›·˜ ¤¯ÂÈ ÚÔ ÔÏÏÔ‡ Û˘ÛÙ‹ÛÂÈ ·ÔÎÏÂÈÛÙÈÎfi ıËÏ·-

AÏÏËÏÔÁÚ·Ê›·: ∂ÌÌ·ÓÔ˘‹Ï °·Ï·Ó¿Î˘ egalanak@med.uoc.gr ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘

ÛÌfi ¤ˆ˜ ÙÔ˘˜ 6 Ì‹Ó˜ ÁÈ· ÙÔ 100% ÙˆÓ ‚ÚÂÊÒÓ. ™ÙËÓ ∫Ú‹ÙË ÌfiÓÔ 10% ÙˆÓ ‚ÚÂÊÒÓ ıËÏ¿˙Ô˘Ó ·ÔÎÏÂÈÛÙÈο ÛÙÔ˘˜ 6 Ì‹Ó˜ Î·È ÚfiÛÊ·Ù˜ ÌÂϤÙ˜ (J Pediatr Gastroenterol Nutr 2006;43:379 Î·È ¶·È‰È·ÙÚÈ΋ µÔÚ›Ԣ ∂ÏÏ¿‰Ô˜ 2006;18:347) ÂȂ‚·ÈÒÓÔ˘Ó ¯·ÌËÏ¿ ÔÛÔÛÙ¿ Î·È ÛÙËÓ ∞ı‹Ó· (12%) Î·È ÙË µÔÚÂÈÔ‰˘ÙÈ΋ ∂ÏÏ¿‰· (9%).

ÃÚÂÈ¿˙ÂÙ·È Â·Ó¿ÏË„Ë Ù˘ ηÏÏȤÚÁÂÈ·˜ Ô‡ÚˆÓ ÛÙË ‰È¿ÚÎÂÈ· ıÂÚ·›·˜ Ù˘ Ô˘ÚÔÏԛ̈͢; ™Â 328 ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ Ô˘ ÓÔÛËχıËÎ·Ó ÁÈ· Ô˘ÚÔÏԛ̈ÍË Û ÓÔÛÔÎÔÌÂ›Ô Ù˘ ¡¤·˜ ÀfiÚ΢ ¤ÁÈÓ Â·Ó¿ÏË„Ë Ù˘ ηÏÏȤÚÁÂÈ·˜ Ô‡ÚˆÓ ‰‡Ô Ë̤Ú˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ÂÌÂÈÚÈ΋˜ ·ÓÙÈ‚›ˆÛ˘ (Pediatrics 2007;119:e325). ªfiÓÔ Û ¤Ó· ·È‰› (0,3%, 95% ‰È¿ÛÙËÌ· ÂÌÈÛÙÔÛ‡Ó˘ 0%-1,7%) ‰ÂÓ Â›¯·Ó ·ÔÛÙÂÈÚˆı› Ù· Ô‡Ú·. ∂ÚfiÎÂÈÙÔ ÁÈ· ‚Ú¤ÊÔ˜ 7 ÌËÓÒÓ Ô˘ ›¯Â ÂÈÛ·¯ı› ÁÈ· Ô˘ÚÔÏԛ̈ÍË Î·È ‚ÚÔÁ¯ÈÔÏ›Ùȉ·, ›¯Â Ï¿‚ÂÈ ÙÚÈÌÂıÔÚ›ÌË-ÛÔ˘ÏÊ·ÌÂıÔÍ·˙fiÏË (ÏfiÁˆ ·ÏÏÂÚÁ›·˜ ÛÙËÓ ·ÌÔ͢ÎÈÏÏ›ÓË) Î·È ÛÙËÓ Î·ÏÏȤÚÁÂÈ· Ô‡ÚˆÓ ·Ó¤Ù˘Í Escherichia coli ·ÓıÂÎÙÈÎfi ÛÙËÓ ÙÚÈÌÂıÔÚ›ÌË-ÛÔ˘ÏÊ·ÌÂıÔÍ·˙fiÏË. ∆Ô Â‡ÏÔÁÔ Û˘Ì¤Ú·ÛÌ·-ÂÚÒÙËÌ· Ù˘ ÌÂϤÙ˘ Â›Ó·È ·Ó ·Í›˙ÂÈ Ë ÂÈÌÔÓ‹ ÛÙËÓ Î·ÏÏȤÚÁÂÈ· Ô‡ÚˆÓ ˘fi ·ÓÙÈ‚›ˆÛË. ∏ ·ÓÙÔ¯‹ ÙˆÓ Ô˘ÚÔ·ıÔÁfiÓˆÓ, Û˘ÓÂÒ˜ Î·È Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ÂÌÂÈÚÈ΋˜ ·ÁˆÁ‹˜, ‰È·Ê¤ÚÂÈ ·fi ¯ÒÚ· Û ¯ÒÚ· - ¿Ú·Á fiÛÔ Û˘¯Ó¿ ‚ϤÔ˘Ì ÛÙËÓ ∂ÏÏ¿‰· ıÂÙÈΤ˜ ηÏÏȤÚÁÂȘ Ô‡ÚˆÓ 2 ‹ 3 24ˆÚ· ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ·ÓÙÈ‚ÈÔÙÈ΋˜ ·ÁˆÁ‹˜;

øÙ›Ùȉ˜ Î·È ÛˆÏËÓ¿ÎÈ· ∏ ¯Ú‹ÛË ÛˆÏËÓ›ÛÎˆÓ ·ÂÚÈÛÌÔ‡ ÁÈ· ÙË ¯ÚfiÓÈ· ˆÙ›Ùȉ· ÛÙËÚ›¯ıËΠ۠·Ó·‰ÚÔÌÈΤ˜ ÌÂϤÙ˜ ÙˆÓ ‰ÂηÂÙÈÒÓ 1950-1970 Ô˘ ›¯·Ó Û˘Û¯ÂÙ›ÛÂÈ ÙË ¯ÚfiÓÈ· Û˘ÏÏÔÁ‹ ˘ÁÚÔ‡ Ì ·Ó·Ù˘Íȷ΋ ηı˘ÛÙ¤ÚËÛË. ∆· ÛˆÏËÓ¿ÎÈ· ¤ÁÈÓ·Ó ÁÚ‹ÁÔÚ· ‰ËÌÔÊÈÏ‹ Î·È ¤ÊÙ·Û·Ó Ó· Â›Ó·È Ë ‰Â‡ÙÂÚË ÛÂ Û˘¯ÓfiÙËÙ· ¯ÂÈÚÔ˘ÚÁÈ΋ ·Ú¤Ì‚·ÛË ÛÙȘ ∏¶∞ (ÌÂÙ¿ ÙËÓ ÂÚÈÙÔÌ‹). ∏ ÚÔÛ¤ÁÁÈÛË ·˘Ù‹ ÎÚ›ÓÂÙ·È ÂÎ ÙˆÓ ˘ÛÙ¤ÚˆÓ Ì¿ÏÏÔÓ ÂÈıÂÙÈ΋. ™ÙÔ Pittsburg ÙˆÓ ∏¶∞ Ë ÔÌ¿‰· ÙÔ˘ John Paradise, ÁÓˆÛÙ‹ ÁÈ· ¶·È‰È·ÙÚÈ΋ 2007;70:247-248

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PAEDIATRIC NEWS IN BRIEF ÍÂȘ Û ·ÓÔÛÔηٷÛÙ·Ï̤ÓÔ˘˜ ÔÚÁ·ÓÈÛÌÔ‡˜ Î·È ÊÙˆ¯¤˜ ¯ÒÚ˜. øÛÙfiÛÔ, Ë ÓÔÛËÚfiÙËÙ· ‰ÂÓ Â›Ó·È ·ÌÂÏËÙ¤· Î·È ÛÙȘ ÈÔ ÏÔ‡ÛȘ ¯ÒÚ˜, Ì ÂÍ¿ÚÛÂȘ Û ‚ÚÂÊÔÓËÈ·ÎÔ‡˜ ÛÙ·ıÌÔ‡˜ Î·È ÈÛ›Ó˜ Î·È Ì ÙÔÈΤ˜ ÂȉË̛˜, fiˆ˜ ·˘Ù‹ ÛÙÔ Galway. ∆Ô ÎÚ˘ÙÔÛÔÚ›‰ÈÔ ÌÂÙ·‰›‰ÂÙ·È Î˘Ú›ˆ˜ ·fi ¿ÓıÚˆÔ Û ¿ÓıÚˆÔ (Û˘Ó‹ıˆ˜ ̤ۈ Ï˘Ì¿ÙˆÓ Ô˘ ηٷϋÁÔ˘Ó ÛÙÔ ‰›ÎÙ˘Ô ‡‰Ú¢Û˘, fiˆ˜ Û˘Ó¤‚Ë Î·È ÛÙÔ Galway Û‡Ìʈӷ Ì ٷ ‰È·ı¤ÛÈÌ· ÛÙÔȯ›·) Î·È ·ÓÙ¤¯ÂÈ Â› Ì·ÎÚfiÓ ÛÙÔ ÂÚÈ‚¿ÏÏÔÓ Î·È ÛÙË ¯ÏˆÚ›ˆÛË.

ÙËÓ ¤ÚÂ˘Ó¿ Ù˘ Û¯ÂÙÈο Ì ÙË Ì¤ÛË ˆÙ›Ùȉ·, ·Ú·ÎÔÏÔ‡ıËÛ 6.350 ÓÂÔÁÓ¿ ·fi ÙȘ ·Ú¯¤˜ Ù˘ ‰ÂηÂÙ›·˜ ÙÔ˘ 1990. ™Â 429 ‚ÚÂÊÔÓ‹È· Ì ¯ÚfiÓÈ· ·ÚÔ˘Û›· ˘ÁÚÔ‡ ÛÙÔ Ì¤ÛÔ Ô˘˜, ÙÔÔıÂÙ‹ıËηÓ, ÌÂ Ù˘¯·›· ηٷÓÔÌ‹, ÛˆÏËÓ¿ÎÈ· ·Ì¤Ûˆ˜ ‹ ÌÂÙ¿ ·fi 9 Ì‹Ó˜ (·Ó Â¤ÌÂÓÂ Ë Û˘ÏÏÔÁ‹ ˘ÁÚÔ‡). 391 ·È‰È¿ ·Ú·ÎÔÏÔ˘ı‹ıËÎ·Ó ÁÈ· 9-11 ¤ÙË (·ÍÈÔı·‡Ì·ÛÙË ÂÈÙ˘¯›· ÁÈ· Ù¤ÙÔȘ ÌÂϤÙ˜). ∞ÔÙÂϤÛÌ·Ù·: Ù· ÛˆÏËÓ¿ÎÈ· ‰ÂÓ ‚ÂÏÙÈÒÓÔ˘Ó ·Ó·Ù˘ÍȷΤ˜ ·Ú·Ì¤ÙÚÔ˘˜, fiˆ˜ Ë ÔÌÈÏ›·, Ë ÁÏÒÛÛ·, Ë ÁÓˆÛÙÈ΋ Î·È Ë „˘¯ÔÎÔÈÓˆÓÈ΋ ÂͤÏÈÍË (N Engl J Med 2007;356:248). ™‡Ìʈӷ Ì Ùo Û˘Óԉ¢ÙÈÎfi Û¯fiÏÈÔ ·fi ÙË Û‡ÓÙ·ÍË (N Engl J Med 2007;356:300), Ù· Â˘Ú‹Ì·Ù· ·˘Ù¿ ÛËÌ·ÙÔ‰ÔÙÔ‡Ó ÙÔ Ù¤ÏÔ˜ Ù˘ ÂÈıÂÙÈ΋˜ ¯Ú‹Û˘ ÛˆÏËÓ›ÛÎˆÓ ·ÂÚÈÛÌÔ‡, ¿Ô„Ë Ô˘ Û˘ÌÌÂÚ›˙ÔÓÙ·È Î·È ÔÈ ÂΉfiÙ˜ ÙÔ˘ Pediatric Infections Disease Journal (Newsletter ∞ÚÈÏ›Ô˘ 2007). √È ·ÏȤ˜ Ô‰ËÁ›Â˜ ‹ıÂÏ·Ó ÛˆÏËÓ¿ÎÈ· ÌÂÙ¿ ·fi 3 Ì‹Ó˜ ÂÈÌÔÓ‹˜ ÙÔ˘ ˘ÁÚÔ‡, ÙÒÚ· fï˜ ÔÈ ∞ÌÂÚÈηÓÈΤ˜ ∂Ù·ÈÚ›˜ ¶·È‰È·ÙÚÈ΋˜, √ÈÎÔÁÂÓÂȷ΋˜ π·ÙÚÈ΋˜ Î·È øÙÔÚÈÓÔÏ·Ú˘ÁÁÔÏÔÁ›·˜ Ù· Û˘ÓÈÛÙÔ‡Ó ÌfiÓÔ Û ÂÚ›ÙˆÛË ÛÔ‚·Ú‹˜ ·ÎÔ˘ÛÙÈ΋˜ ¤ÎÙˆÛ˘ (40 decibels ÙÔ˘Ï¿¯ÈÛÙÔÓ), ηı˘ÛÙ¤ÚËÛ˘ ÏfiÁÔ˘ ‹ ·Ó·ÙÔÌÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ. ∂ÎÙfi˜ ·fi ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ¿ ÙÔ˘˜ ·ÌÊÈÛ‚ËÙÂ›Ù·È Î·È Ë ·ÛÊ¿ÏÂÈ¿ ÙÔ˘˜: ÛÙÔ Ù‡¯Ô˜ ª·˝Ô˘ 2007 ÙÔ˘ European Journal of Pediatrics (2007;166:385), ·Ó·ÛÎfiËÛË ·fi ÂÏÏËÓÈ΋ ÔÌ¿‰· ·Ó·‰ÂÈÎÓ‡ÂÈ Ï‹ıÔ˜ ÂÈÏÔÎÒÓ Ù˘ ÙÔÔı¤ÙËÛ˘ ÛˆÏËÓ›ÛÎˆÓ ·ÂÚÈÛÌÔ‡, ·fi ˘Ò‰Ë ˆÙfiÚÚÔÈ· (1026%) ¤ˆ˜ Ô˘Ï¤˜ Î·È ÎÔÎÎÈÒÌ·Ù·. ∏ ÔÏÈ΋ Û˘¯ÓfiÙËÙ· ÂÈÏÔÎÒÓ ÌÔÚ› Ó· ÊÙ¿ÛÂÈ Û ÔÛÔÛÙfi ¤ˆ˜ Î·È 80% ÙˆÓ ¯ÂÈÚÔ˘ÚÁËÌ¤ÓˆÓ ·˘ÙÈÒÓ.

¶ÔÈÔ˜ ÌÂÙ·‰›‰ÂÈ ÙÔÓ ÎÔηÙË ÛÙ· ‚Ú¤ÊË; √È ÁÔÓ›˜ (55%), Ù· ·‰¤ÏÊÈ· (16%), ı›ÔÈ-ı›˜ Î·È ·Ô‡‰Â˜-ÁÈ·ÁÈ¿‰Â˜ (16%), ¿ÏÏÔÈ Û˘ÁÁÂÓ›˜ Î·È Ê›ÏÔÈ (10%), ¿ÏÏÔÈ ÁÂÓÈÎÒ˜ 3%. ∆· ·ÔÙÂϤÛÌ·Ù· ÚÔ¤Ú¯ÔÓÙ·È ·fi ·ÌÂÚÈηÓÔ-Á·ÏÏÔ-ηӷ‰È΋ ÌÂϤÙË Û ‚Ú¤ÊË ËÏÈΛ·˜ οو ÙˆÓ 6 ÌËÓÒÓ Ô˘ ‰ËÌÔÛȇıËΠÛÙÔ Ù‡¯Ô˜ ∞ÚÈÏ›Ô˘ ÙÔ˘ Pediatric Infections Disease Journal (2007;26:293). ŸÛÔ ‰ÂÓ ÂÌ‚ÔÏÈ¿˙ÔÓÙ·È ÔÈ ¤ÊË‚ÔÈ Î·È ÔÈ ÂÓ‹ÏÈΘ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜, ÙfiÛÔ Ù· ‚Ú¤ÊË ı· ÎÈÓ‰˘ÓÂ‡Ô˘Ó ·fi ÎÔηÙË. ™ÙÔ ›‰ÈÔ Ù‡¯Ô˜ (PIDJ 2007;26:316), ÊÈÓÏ·Ó‰È΋ ÌÂϤÙË Î·Ù·Ï‹ÁÂÈ ÛÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ 8% ÙˆÓ ‚ÚÂÊÒÓ Ô˘ ÓÔÛËχÔÓÙ·È Ì ÂȂ‚·ÈˆÌ¤ÓË Ïԛ̈ÍË ·fi Èfi ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÁÎ˘Ù›Ô˘ (RSV) ¿Û¯Ô˘Ó Î·È ·fi ÎÔηÙË. ∞Ï‹ıÂÈ·, ÎÔÎ·Ù˘ fiˆ˜ ÙÔÓ Í¤Ú·Ì ‹ ÎÔΛÙ˘ fiˆ˜ ÂÈ̤ÓÔ˘Ó ÔÈ ·˘ÙfiÌ·ÙÔÈ ÔÚıÔÁÚ¿ÊÔÈ ÛÙȘ ÔıfiÓ˜ Ì·˜; ∫Ôη˙ˆ ÛËÌ·›ÓÂÈ (·fi ÙÔÓ Î·ÈÚfi ÙÔ˘ ∏Û›Ô‰Ô˘ ÙÔ˘Ï¿¯ÈÛÙÔÓ) ÎÚ¿˙ˆ (ÁÈ· ÎÔ‡ÎÔ˘˜, ÎfiڷΘ Î·È ÂÙÂÈÓÔ‡˜). ∆Ô ÎÔÎ·Ù˘ ·Ú·¤ÌÂÈ ÛÙÔ ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÎÔÎÎÔÚfi‚˯·, ÂÓÒ ÙÔ ÎÔΛÙ˘ ·Ú·¤ÌÂÈ ÛÙËÓ ÔÚıÔÁÚ·ÊÈ΋ Ì·˜ ¿ÓÂÛË.

∫Ú˘ÙÔÛÔÚ›‰ÈÔ ÛÙÔ ‰›ÎÙ˘Ô ‡‰Ú¢Û˘ ªÂ›˙ÔÓ Úfi‚ÏËÌ· ‰ËÌfiÛÈ·˜ ˘Á›·˜ Ì ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈΤ˜ ÚÔÂÎÙ¿ÛÂȘ ÚԤ΢„ ÛÙÔ Galway Ù˘ πÚÏ·Ó‰›·˜ (BBC News, 29 ª·ÚÙ›Ô˘ Î·È 6 ∞ÚÈÏ›Ô˘ 2007) fiÙ·Ó ÙÔ ‰›ÎÙ˘Ô ‡‰Ú¢Û˘ ÌÔχÓıËΠ·fi ÙÔ ÚˆÙfi˙ˆÔ Cryptosporidium parvum ÛÂ Û˘ÁÎÂÓÙÚÒÛÂȘ ÂÍËÎÔÓÙ·Ï¿ÛȘ ÙÔ˘ ÔÚ›Ô˘ ·ÛÊ·Ï›·˜. ∆· ·È‰È¿ ‹Ù·Ó ÌÂٷ͇ ÙˆÓ ÈÔ Â˘¿ÏˆÙˆÓ ÔÌ¿‰ˆÓ. ∆Ô Galway Â›Ó·È Ë ÙÚ›ÙË Û ̤ÁÂıÔ˜ fiÏË Ù˘ πÚÏ·Ó‰›·˜ Ì 700.000 ÂÚ›Ô˘ ηÙÔ›ÎÔ˘˜. ∆Ô Úfi‚ÏËÌ· ˘ÔÏÔÁ›˙ÂÙ·È Ó· ‰È·ÚΤÛÂÈ Ì‹Ó˜ Î·È ·Ó·Ì¤ÓÂÙ·È Ó· ¤¯ÂÈ ÂÈÙÒÛÂȘ ÛÙËÓ ÙÔ˘ÚÈÛÙÈ΋ ÂÚ›Ô‰Ô - ‹‰Ë Ù· ÍÂÓԉԯ›· ÂÁηıÈÛÙÔ‡Ó Î·Ù¿ÏÏËÏ· Ê›ÏÙÚ·. ™ÙÔ˘˜ ηÙÔ›ÎÔ˘˜ Û˘ÛÙ‹ıËΠӷ ·ÔʇÁÔ˘Ó ÙÔ ÓÂÚfi ÙÔ˘ ‰ÈÎÙ‡Ô˘ ÁÈ· fiÛË, χÛÈÌÔ ÙÚÔʛ̈Ó, χÛÈÌÔ ‰ÔÓÙÈÒÓ Î·È ·Á¿ÎÈ·. ∫·ıÒ˜ Ì¿ÏÈÛÙ· Ë ÌfiÏ˘ÓÛË Û˘Ó¤ÂÛ Ì ÙÔ ¶¿Û¯·, fiÙ·Ó ÔÈ Î·ıÔÏÈÎÔ› Ù˘ ÂÚÈÔ¯‹˜ Ú·›ÓÔÓÙ·È Ì ·ÁÈ·ÛÌfi (Î·È ÂÓ›ÔÙ ÙÔÓ ›ÓÔ˘Ó), Ë ÙÔÈ΋ ∂ÎÎÏËÛ›· ÊÚfiÓÙÈÛ ӷ ÂÍ·ÛÊ·Ï›ÛÂÈ ÁÈ· ÙÔÓ ·ÁÈ·ÛÌfi ¯ÈÏÈ¿‰Â˜ ÊȿϘ ÓÂÚÔ‡ ηÙ¢ı›·Ó ·fi ËÁ¤˜. Œ¯Ô˘ÌÂ Û˘Ó‰¤ÛÂÈ ÙÔ ÎÚ˘ÙÔÛÔÚ›‰ÈÔ Ì ÏÔÈÌÒ-

º˘Ì·Ù›ˆÛË: ÂÌ›˜ ı· ı¤Ï·Ì ӷ ÙËÓ Í¯¿ÛÔ˘ÌÂ, ·ÏÏ¿ ÂΛÓË fi¯È ∏ ÚfiÛÊ·ÙË ·ÁÎfiÛÌÈ· ·Ó·˙ˆ‡ÚˆÛË Ù˘ Ê˘Ì·Ù›ˆÛ˘ ·fi ÙÔ M. tuberculosis Ì¿˜ ‚ڋΠοˆ˜ ·ÚÔÂÙԛ̷ÛÙÔ˘˜. ∞fi ÙËÓ ¿ÏÏË, Ë Ê˘Ì·Ù›ˆÛË ·fi M. bovis, Ë ÔÔ›· ÂÌÊ·ÓÈ˙fiÙ·Ó ·ÚÎÂÙ¿ Û˘¯Ó¿ ÚÈÓ Î¿ÔȘ ‰ÂηÂٛ˜, ›¯Â ۯ‰fiÓ ÂÍ·ÏÂÈÊı› ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË ·ÛÙÂÚ›ˆÛ˘ ÙÔ˘ ·ÁÂÏ·‰ÈÓÔ‡ Á¿Ï·ÎÙÔ˜. øÛÙfiÛÔ, Î·È ÙÔ M. bovis ͤÚÂÈ Ó· ·ÈÊÓȉȿ˙ÂÈ: ÛÙÔ Lancet ÙÔ˘ ∞ÚÈÏ›Ô˘ 2007 (369:1270) ÂÚÈÁÚ¿ÊÂÙ·È Û˘ÛÛÒÚ¢ÛË ÎÚÔ˘ÛÌ¿ÙˆÓ M. bovis ÛÙËÓ ∞ÁÁÏ›· Û 6 Ó¤Ô˘˜ ÂÓ‹ÏÈΘ- ÔÈ 5 ‹Ù·Ó ÂÌ‚ÔÏÈ·Ṳ̂ÓÔÈ Ì BCG Î·È Ô ¤Ó·˜ η٤ÏËÍ ÌÂ Ê˘Ì·ÙÈÒ‰Ë ÌËÓÈÁÁ›Ùȉ·. ª¤Ûˆ ÌÔÚȷ΋˜ ÂȉËÌÈÔÏÔÁ›·˜ ‰È·ÈÛÙÒıËΠfiÙÈ ÙÔ Ì˘ÎÔ‚·ÎÙËÚ›‰ÈÔ ÌÂÙ·‰fiıËΠ·fi ¿ÓıÚˆÔ Û ¿ÓıÚˆÔ Î·È Ì¿ÏÈÛÙ· ·fi Û˘Á¯ÚˆÙÈÛÌfi Û Ì·Ú. •¤Ú·Ì fiÙÈ ÙÔ M. bovis ÌÂÙ·‰›‰ÂÙ·È Ì¤Ûˆ ÙÔ˘ ··ÛÙÂÚ›ˆÙÔ˘ ‚fiÂÈÔ˘ Á¿Ï·ÎÙÔ˜ Î·È fi¯È ÛÙ· ÔÙÔˆÏ›·, ·ÏÏ¿ Ë Ê˘Ì·Ù›ˆÛË ÎÚ‡‚ÂÈ ÂÎÏ‹ÍÂȘ, Î·È fiˆ˜ ˘ÔÁÚ·ÌÌ›˙ÂÙ·È ÛÙÔ Û¯fiÏÈÔ Ù˘ Û‡ÓÙ·Í˘ (Lancet;2007;369:1236), ÙË Ê˘Ì·Ù›ˆÛË ·fi M. bovis ÙËÓ Í¯¿Û·ÌÂ, ·ÏÏ¿ ÂΛÓË ·Ú·Ì¤ÓÂÈ.

Paediatriki 2007;70:247-248

Pediatri May-Jun 07

24-05-07

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ª·Ú›· ∫·Ó¿ÚÈÔ˘ πÛÙÔÛÂÏ›‰Â˜ ÁÈ· ÙȘ ¶ÚˆÙÔ·ı›˜ ∞ÓÔÛÔ·ÓÂ¿ÚÎÂȘ √È ¶ÚˆÙÔ·ı›˜ ∞ÓÔÛÔ·ÓÂ¿ÚÎÂȘ (¶∞∞) Â›Ó·È ÎÏËÚÔÓÔÌÈο ÓÔÛ‹Ì·Ù· Î·È Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ·Ô˘Û›·˜ ‹ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·˜ Ì›·˜ ‹ ÂÚÈÛÛfiÙÂÚˆÓ ·ÓÔÛÈ·ÎÒÓ ·Ú·Ì¤ÙÚˆÓ. ∏ Û˘ÓËı¤ÛÙÂÚË ÎÏÈÓÈ΋ ÂΉ‹ÏˆÛË Â›Ó·È ÔÈ ÏÔÈÌÒÍÂȘ, ÛÙȘ Ôԛ˜ ÔÈ ·ÛıÂÓ›˜ ÂÌÊ·Ó›˙Ô˘Ó ·˘ÍË̤ÓË Â˘·ÈÛıËÛ›·. øÛÙfiÛÔ, ‰ÂÓ Â›Ó·È Û¿ÓȘ ÔÈ ÂÚÈÙÒÛÂȘ Ô˘ ÔÈ ¶∞∞ ÚÔ‚¿ÏÏÔ˘Ó ˆ˜ ·˘ÙÔ¿ÓÔÛ· ‹ ·ÏÏÂÚÁÈο ÓÔÛ‹Ì·Ù· ‹ ÏÂÌÊÔ¸ÂÚϷۛ˜. ¶ÔÏϤ˜ ÊÔÚ¤˜ Ë ·ÓÂ¿ÚÎÂÈ· ÙÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Â›Ó·È ‰‡ÛÎÔÏÔ Ó· ·Ó·ÁÓˆÚÈÛÙ› Î·È ·Ú·Ì¤ÓÂÈ ·‰È¿ÁÓˆÛÙË, ÌÂ Û˘Ó¤ÂÈ· ÔÈ ·ÛıÂÓ›˜ Ó· ÌË ÁÓˆÚ›˙Ô˘Ó ÙËÓ ·ÈÙ›· ÙˆÓ ·ıÔÏÔÁÈÎÒÓ ÙÔ˘˜ ÂΉËÏÒÛˆÓ, ηÈ, fi¯È Û¿ÓÈ·, Ó· Ï·Ì‚¿ÓÔ˘Ó Ï·Óı·Ṳ̂ÓË ıÂÚ·›· Î·È ÊÚÔÓÙ›‰·. ∏ ¿Ù˘Ë ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ· ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙË Ì·ÎÚfi¯ÚÔÓË Ù·Ï·ÈˆÚ›· ÙÔ˘ ·ÛıÂÓÔ‡˜ Ì ÓÔÛËÏ›˜ Î·È Èı·ÓÒ˜, Âȉ›ӈÛË Ù˘ ÎÏÈÓÈ΋˜ ÙÔ˘ ηٿÛÙ·Û˘.

∆Ì‹Ì· ∞ÓÔÛÔÏÔÁ›·˜πÛÙÔÛ˘Ì‚·ÙfiÙËÙ·˜, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó· AÏÏËÏÔÁÚ·Ê›·: ª·Ú›· ∫·Ó¿ÚÈÔ˘ mkanariou@hol.gr

∂˘Úˆ·˚Τ˜ ™˘ÛÙ¿ÛÂȘ ÁÈ· ÙȘ ¶ÚˆÙÔ·ı›˜ ∞ÓÔÛÔ·ÓÂ¿ÚÎÂȘ ÛÙÔ ¢È·‰›ÎÙ˘Ô http://www.eupidconference.com √È ¶ÚˆÙÔ·ı›˜ ∞ÓÔÛÔ·ÓÂ¿ÚÎÂȘ Â›Ó·È Ôχ Û˘¯ÓfiÙÂÚ˜ ·’ fiÛÔ Î·Ù·ÁÚ¿ÊÂÙ·È. ∏ ÌË ·Ó·ÁÓˆÚÈÛÈÌfiÙËÙ¿ ÙÔ˘˜, ÙÔ ·ÚÓËÙÈÎfi ÎfiÛÙÔ˜, Ë ÌÂÁ¿ÏË Â›ÙˆÛË ÛÙË ‰ËÌfiÛÈ· ˘Á›·, ηıÈÛÙÔ‡Ó ·Ó·Áη›· ÙËÓ ÂÊ·ÚÌÔÁ‹ Û˘ÛÙ¿ÛÂˆÓ ÁÈ· ÙȘ ÂÓ¤ÚÁÂȘ Ô˘ ··ÈÙÔ‡ÓÙ·È ÂΠ̤ÚÔ˘˜ ÙˆÓ ÂıÓÈÎÒÓ Î˘‚ÂÚÓ‹ÛÂˆÓ ÙˆÓ ¯ˆÚÒÓ ÌÂÏÒÓ Ù˘ ∂˘Úˆ·˚΋˜ ŒÓˆÛ˘, ÒÛÙ ӷ ·Ú¯›ÛÂÈ Ë ‰È·‰Èηۛ· ·Ó·ÁÓÒÚÈÛ˘ ·˘ÙÔ‡ ÙÔ˘ “ÎÚ˘ÊÔ‡” ı¤Ì·ÙÔ˜ ‰ËÌfiÛÈ·˜ ˘Á›·˜. √ÏÔÎÏËڈ̤Ó˜ Î·È Û·Ê›˜ Û˘ÛÙ¿ÛÂȘ ÁÈ· ÙȘ ¶∞∞, ÙËÓ ¤ÁηÈÚË ‰È¿ÁÓˆÛË, ÙËÓ ÚfiÁÓˆÛË Î·È ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂÚË ıÂÚ·›· ÚÔÛʤÚÂÈ Ë ÈÛÙÔÛÂÏ›‰· ·fi ÙÔ ∂˘Úˆ·˚Îfi Consensus Conference 2006.

∂˘Úˆ·˚΋ ∂Ù·ÈÚ›· ÁÈ· ÙȘ ∞ÓÔÛÔ·ÓÂ¿ÚÎÂȘ - http://www.esid.org ∏ ∂˘Úˆ·˚΋ ∂Ù·ÈÚ›· ÁÈ· ÙȘ ∞ÓÔÛÔ·ÓÂ¿ÚÎÂȘ (ESID) ÛÙԯ‡ÂÈ ÛÙË ‰È¢ÎfiÏ˘ÓÛË Ù˘ ·ÓÙ·ÏÏ·Á‹˜ ȉÂÒÓ Î·È ÏËÚÔÊÔÚÈÒÓ ·Ó¿ÌÂÛ· Û ȷÙÚÔ‡˜, ÓÔÛËÏÂ˘Ù¤˜, ÂÚ¢ÓËÙ¤˜, ·ÛıÂÓ›˜ Î·È ÙȘ ÔÈÎÔÁ¤ÓÂȘ Ô˘ ÂӉȷʤÚÔÓÙ·È ‹ ÂËÚ¿˙ÔÓÙ·È ·fi ÙȘ ¶ÚˆÙÔ·ı›˜ ∞ÓÔÛÔ·ÓÂ¿ÚÎÂȘ. ∂ÓÈÛ¯‡ÂÈ ÙËÓ ¤Ú¢ӷ ÁÈ· ÙËÓ Î·Ù·ÓfiËÛË ÙˆÓ ·ÈÙÈÔ·ıÔÁÂÓÂÙÈÎÒÓ Ì˯·ÓÈÛÌÒÓ Î·È ÙËÓ ÚÔÒıËÛË ıÂÚ·ÂÈÒÓ ÁÈ· Ù· Û˘ÁÎÂÎÚÈ̤ӷ ÓÔÛ‹Ì·Ù·. ∏ ÈÛÙÔÛÂÏ›‰· Ù˘ ∂Ù·ÈÚ›·˜ ·Ú¤¯ÂÈ, ÌÂٷ͇ ¿ÏψÓ, ÏËÚÔÊÔڛ˜ ÁÈ· Ù· ÂÈÛÙËÌÔÓÈο ‰ÚÒÌÂÓ·, Ù· ÛÙ·ÙÈÛÙÈο ÛÙÔȯ›·, Ù· ‰È·ÁÓˆÛÙÈο ÎÚÈÙ‹ÚÈ·, ÙȘ ÂÈÛÙËÌÔÓÈΤ˜ ÂÍÂÏ›ÍÂȘ Î·È Ù· Ó¤· ıÂÚ·¢ÙÈο ̤۷, Û ·˘ÙfiÓ ÙÔÓ Û˘Ó¯Ҙ ÂÍÂÏÈÛÛfiÌÂÓÔ ÙÔ̤· Ù˘ µ·ÛÈ΋˜ Î·È ∫ÏÈÓÈ΋˜ ∞ÓÔÛÔÏÔÁ›·˜.

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¡∂∞ ∞¶√ ∆√ ¢π∞¢π∫∆À√ International Nursing Group for Immunodeficiencies - http://www.ingid.org πÛÙÔÛÂÏ›‰· Ù˘ ¢ÈÂıÓÔ‡˜ √Ì¿‰·˜ ¡ÔÛËÏ¢ÙÒÓ Ô˘ ÂÚÁ¿˙ÔÓÙ·È Ì ·È‰È¿ Î·È ÂÓ‹ÏÈΘ Ì ¶ÚˆÙÔ·ı›˜ ∞ÓÔÛÔ·ÓÂ¿ÚÎÂȘ. ∞Ó·Ù‡ÛÛÔ˘Ó Î·È ÂÂÎÙ›ÓÔ˘Ó ÙËÓ ÔÈfiÙËÙ· Ù˘ ÊÚÔÓÙ›‰·˜ ÙˆÓ ·ÛıÂÓÒÓ Ì ¶∞∞ Î·È ÂȉÈÒÎÔ˘Ó ÙËÓ Î·Ï‡ÙÂÚË Î·Ù·ÓfiËÛË ÙˆÓ Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ÓÔÛËÌ¿ÙˆÓ Î·È ÙˆÓ È‰È·ÈÙÂÚÔÙ‹ÙˆÓ ÙˆÓ ·Û¯fiÓÙˆÓ ·fi ·˘Ù¿. Ÿ¯È ÌfiÓÔ ÔÈ ÓÔÛËÏÂ˘Ù¤˜ Ô˘ ÂӉȷʤÚÔÓÙ·È ÁÈ· ÙȘ ¶∞∞, ·ÏÏ¿ Î·È ÂΛÓÔÈ Ô˘ ÂÚÁ¿˙ÔÓÙ·È ÁÂÓÈÎfiÙÂÚ· Ì ·ÓÔÛÔηٷÛÙ·Ï̤ÓÔ˘˜ ·ÛıÂÓ›˜, ı· ‚ÚÔ˘Ó ÛÙËÓ ÈÛÙÔÛÂÏ›‰· ÔÏϤ˜ Î·È ¯Ú‹ÛÈ̘ ÏËÚÔÊÔڛ˜ ÁÈ· ÙË ‚ÂÏÙ›ˆÛË Ù˘ ÔÈfiÙËÙ·˜ ÙˆÓ ˘ËÚÂÛÈÒÓ ÙÔ˘˜.

International Patient Organisation for Primary Immunodeficiencies http://www.ipopi.org ªÈ· ·ÁÎfiÛÌÈ· ÔÚÁ¿ÓˆÛË Ô˘ ÂÚÁ¿˙ÂÙ·È ÁÈ· ÙË ‚ÂÏÙ›ˆÛË ÙÔ˘ ÂÈ¤‰Ô˘ ˙ˆ‹˜ ÙˆÓ ·ÓıÚÒˆÓ Ì ¶∞∞, ÂȯÂÈÚ› Ó· Û˘Ì‚¿ÏÂÈ ÛÙËÓ ¤ÁηÈÚË ‰È¿ÁÓˆÛË Î·È ÙËÓ È‰·ÓÈÎfiÙÂÚË ıÂÚ·›· Î·È ÊÚÔÓÙ›‰· ÙˆÓ ·ÛıÂÓÒÓ. ¶·Ú¿ÏÏËÏ·, ÂÓÈÛ¯‡ÂÈ ÙȘ ÂıÓÈΤ˜ ÔÚÁ·ÓÒÛÂȘ ÙˆÓ ·Û¯fiÓÙˆÓ Ó· ÛÙËÓ ÚÔÛ¿ıÂÈ¿ ÙÔ˘˜ ÁÈ· ÙË ‰ËÌÈÔ˘ÚÁ›· ÂÓfi˜ ηχÙÂÚÔ˘ ÎfiÛÌÔ˘ ÁÈ· ÙÔ˘˜ ·ÓıÚÒÔ˘˜ Ì ¶∞∞.

Immune Deficiency Foundation - http://www.primaryimmune.org ªÈ· ÈÛÙÔÛÂÏ›‰· Ì ÔÏÏ·Ϥ˜ ÏËÚÔÊÔڛ˜ Î·È ÁÈ· Ù· È·ÙÚÈο, ÂÈÛÙËÌÔÓÈο-ÂÚ¢ÓËÙÈο, ÎÔÈÓˆÓÈο ı¤Ì·Ù· Ô˘ ··Û¯ÔÏÔ‡Ó ÙfiÛÔ ÙÔ˘˜ ÂÚÁ·˙fiÌÂÓÔ˘˜ ‹ ÙÔ˘˜ ¤¯ÔÓÙ˜ ÂӉȷʤÚÔÓ ÛÙÔÓ ÙÔ̤· ÙˆÓ ¶∞∞, fiÛÔ Î·È ÙÔ˘˜ ›‰ÈÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜. ™ËÌ·ÓÙÈ΋ Û˘Ì‚ÔÏ‹ ·ÔÙÂÏ› Ë ‰ËÌÔÛ›Â˘ÛË ÙˆÓ Ô‰ËÁÈÒÓ ÁÈ· ÙË ‰È¿ÁÓˆÛË ÙˆÓ ¶∞∞ Î·È ÙË ÊÚÔÓÙ›‰· ÙˆÓ ·ÛıÂÓÒÓ.

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Institute of Medical Technology - Bioinformatics Group - http://bioinf.uta.fi ñ Immunodeficiency Resource ñ ID diagnostics ñ ID bases √È ÈÛÙÔÛÂÏ›‰Â˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ÙÔ˘ Tampere Ù˘ ºÈÓÏ·Ó‰›·˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ‚¿ÛÂȘ ‰Â‰ÔÌ¤ÓˆÓ Ô˘ ÛÙÔ¯Â‡Ô˘Ó ÛÙË Û˘ÏÏÔÁ‹, ÙËÓ Ù·˘ÙÔÔ›ËÛË, ÙËÓ ÂÚÈÁÚ·Ê‹ Î·È ÙË ÁÓˆÛÙÔÔ›ËÛË ÙˆÓ ˘ËÚÂÛÈÒÓ Ô˘ ÚÔÛʤÚÔÓÙ·È ÁÈ· ÙË ‰È¿ÁÓˆÛË ÙˆÓ ·ÓÔÛÔ·ÓÂ·ÚÎÂÈÒÓ.

The Jeffrey Modell Foundation - http://www.jmfworld.com πÛÙÔÛÂÏ›‰· Ô˘ ÔÚÁ·ÓÒıËÎÂ Î·È ÛÙËÚ›˙ÂÙ·È ·fi ÎÏËÚÔ‰fiÙËÌ· ÙˆÓ ÁÔÓ¤ˆÓ ÙÔ˘ Jeffrey Modell, ·ÊÈÂڈ̤ÓÔ ÛÙË ÌÓ‹ÌË ÙÔ˘. ™ÎÔfi ¤¯ÂÈ Ó· ‚ÂÏÙÈÒÛÂÈ ÙËÓ ÔÈfiÙËÙ· ˙ˆ‹˜ ÙˆÓ ·ÛıÂÓÒÓ Î·È Ó· ÂÍ·ÛÊ·Ï›ÛÂÈ ÚfiÛ‚·Û‹ ÙÔ˘˜ ÛÙ· ÂȉÈο ΤÓÙÚ· ÁÈ· ÙȘ ¶∞∞ Î·È ÛÙȘ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂÚ˜ Û‡Á¯ÚÔÓ˜ ıÂÚ·›˜. ¶ÚÔˆı› ÙËÓ ·Ó¿Ù˘ÍË ÙˆÓ ‰È·ÁÓˆÛÙÈÎÒÓ ÎÚÈÙËÚ›ˆÓ Ô˘ ı· Û˘Ì‚¿ÏÔ˘Ó ÛÙËÓ ¤ÁηÈÚË ‰È¿ÁÓˆÛË ÙˆÓ ¶∞∞ Î·È ÛÙËÓ Â›Ù¢ÍË ·ÚÔ¯‹˜ ˘ËÚÂÛÈÒÓ ˘„ËÏ‹˜ ÔÈfiÙËÙ·˜ ÛÙÔ˘˜ ·ÛıÂÓ›˜.

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CLINICAL QUIZ

∫ÏÈÓÈÎfi QUIZ ∞¶∞¡∆∏™∏

¡fiÛÔ˜ Kikuchi-Fujimoto ∏ ÓfiÛÔ˜ Kikuchi-Fujimoto ÂÚÈÁÚ¿ÊËΠÁÈ· ÚÒÙË ÊÔÚ¿ ÙÔ 1972 ÛÙËÓ π·ˆÓ›· ·fi ÙÔ˘˜ Kikuchi Î·È Fujimoto Î·È ÚÔÛ‚¿ÏÏÂÈ Û˘¯ÓfiÙÂÚ·, ¿ÙÔÌ· Ó·ڋ˜ ËÏÈΛ·˜ (̤ÛË ËÏÈΛ· 30 ¤ÙË). ∂›Ó·È Û˘¯ÓfiÙÂÚË ÛÙȘ Á˘Ó·›Î˜ Î·È ÛÙÔ˘˜ ∞ÛÈ¿Ù˜, ÂÓÒ ·Ó·Ê¤ÚÂÙ·È Û¿ÓÈ· ÛÙËÓ ·È‰È΋ ËÏÈΛ· (1). ¶ÚfiÎÂÈÙ·È ÁÈ· ·˘ÙÔ˚¿ÛÈÌË, ηÏÔ‹ıË ÓfiÛÔ ¿ÁÓˆÛÙ˘ ̤¯ÚÈ Û‹ÌÂÚ· ·ÈÙÈÔÏÔÁ›·˜, ‰È¿ÚÎÂÈ·˜ ·fi 2 ‚‰ÔÌ¿‰Â˜ ˆ˜ 4 Ì‹Ó˜. ∏ ÓfiÛÔ˜ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ÎÏÈÓÈο ·fi ÙËÓ ·ÚÔ˘Û›· ˘ÚÂÙÔ‡ (‰È¿ÚÎÂÈ·˜ 1 ‚‰ÔÌ¿‰·˜-1 Ì‹Ó·) Î·È ÙË ‰ÈfiÁΈÛË ÙˆÓ ÏÂÌÊ·‰¤ÓˆÓ (‰È·Ì¤ÙÚÔ˘ 1-2 cm, ˘fiÛÎÏËÚˆÓ, ¢ΛÓËÙˆÓ ÌÂ Û˘¯ÓfiÙÂÚË ÂÓÙfiÈÛË ÛÙÔÓ ÙÚ¿¯ËÏÔ). ø˜ Û˘ÓÔ‰¿ Û˘ÌÙÒÌ·Ù· ·Ó·Ê¤ÚÔÓÙ·È Ù· ·ÎfiÏÔ˘ı·: Ó·˘Ù›·, ¤ÌÂÙÔÈ, ·ÒÏÂÈ· ‚¿ÚÔ˘˜, ·ÚıÚ·ÏÁ›Â˜, Ì˘·ÏÁ›Â˜, Ó˘¯ÙÂÚÈÓÔ› ȉÚÒÙ˜ Î·È ÛÙÔÌ·ÙÈο ¤ÏÎË (1,2). ∞fi ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô ‰È·ÈÛÙÒÓÂÙ·È Û˘Ó‹ıˆ˜ Ï¢ÎÔÂÓ›·, ıÚÔÌ‚ÔÂÓ›·, ·Á΢ÙÙ·ÚÔÂÓ›· Î·È Ì¤ÙÚÈ· ·‡ÍËÛË Ù˘ ∆∫∂ (1). ∏ ‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘ ÙÂÎÌËÚÈÒÓÂÙ·È ·fi Ù· ·ıÔÏÔÁÔ·Ó·ÙÔÌÈο Â˘Ú‹Ì·Ù· Ô˘ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ÙËÓ ·ÚÔ˘Û›· ÂÚÈÔ¯ÒÓ Ó¤ÎÚˆÛ˘ fiÔ˘ ·Ó¢ڛÛÎÔÓÙ·È Û˘¯ÓfiÙÂÚ· ˈÛÈÓfiÊÈÏ·, ÌÂ Û˘ÓÔ‰fi Ï‹ÚË ·Ô˘Û›· ÔÏ˘ÌÔÚÊÔ˘Ú‹ÓˆÓ Î·È ·ıÚÔ›ÛÌ·Ù· (clusters) ÌÔÓÔ΢ÙÙ¿ÚˆÓ, ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Î˘Ú›ˆ˜ ∆-ÚÔ¤Ï¢Û˘ (1). ∏ ·ÈÙÈÔ·ıÔÁ¤ÓÂÈ· Ù˘ ÓfiÛÔ˘ ·Ú·Ì¤ÓÂÈ ¿ÁÓˆÛÙË Ì¤¯ÚÈ Û‹ÌÂÚ·, ÂÓÒ ¤¯ÂÈ ÚÔÙ·ı› Ë ‰È¤ÁÂÚÛË ÙˆÓ ∆ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ˆ˜ ·¿ÓÙËÛË Û Â›‰Ú·ÛË ÏÔÈÌÒ‰Ô˘˜ ·Ú¿ÁÔÓÙ·. ∫·Ù¿ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· Ë ÓfiÛÔ˜ ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙ› Ì ÙÔÓ Û˘ÛÙËÌ·ÙÈÎfi ÂÚ˘ıËÌ·ÙÒ‰Ë Ï‡ÎÔ (™∂§)

Paediatriki 2007;70:246,252

Î·È ÚfiÛÊ·Ù· ‚È‚ÏÈÔÁÚ·ÊÈο ‰Â‰Ô̤ӷ ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ Ë ÓfiÛÔ˜ Kikuchi-Fujimoto Â›Ó·È Èı·ÓfiÓ Ó· ·ÔÙÂÏ› ¤Ó·Ó Ù‡Ô ·˘ÙÔÂÚÈÔÚÈ˙fiÌÂÓÔ˘ ™∂§ (3,4). À¤Ú Ù˘ Û˘Û¯¤ÙÈÛ˘ ÙˆÓ ‰‡Ô ÓÔÛËÌ¿ÙˆÓ Î·È ÙÔ˘ ·˘ÙÔ¿ÓÔÛÔ˘ ˘ÔÛÙÚÒÌ·ÙÔ˜ Ù˘ ÓfiÛÔ˘ Û˘ÓËÁÔÚ› ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ·ÚÎÂÙÔ› ·ÛıÂÓ›˜ ÂÌÊ·Ó›˙Ô˘Ó ıÂÙÈο ·˘ÙÔ·ÓÙÈÛÒÌ·Ù·, ηıÒ˜ Î·È Ë ·Ú·Ù‹ÚËÛË fiÙÈ ÔÚÈṲ̂ÓÔÈ ÂΉËÏÒÓÔ˘Ó ™∂§ ·ÎfiÌË Î·È 10 ˆ˜ 20 ¯ÚfiÓÈ· ÌÂÙ¿ ÙËÓ ÂΉ‹ÏˆÛË Ù˘ ÓfiÛÔ˘ Kikuchi-Fujimoto (1,3). ∆¤ÏÔ˜, Û‡Ìʈӷ Ì ÚfiÛÊ·ÙË ÌÂÙ·Ó¿Ï˘ÛË Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜ ·Ó·Ê¤ÚÂÙ·È fiÙÈ ıÂÙÈο ANA ÂÌÊ¿ÓÈ˙ ÙÔ 15% Î·È ™∂§ ÂΉ‹ÏˆÛ ÙÔ 23% ∞ÛÈ·ÙÒÓ Ì ÓfiÛÔ Kikuchi-Fujimoto (5).

µÈ‚ÏÈÔÁÚ·Ê›· 1. Lazzareschi I, Barone G, Ruggiero A, Liotti L, Maurizi P, Larocca LM, et al. Paediatric Kikuchi-Fujimoto disease: A benign cause of fever and lymphadenopathy. Pediatr Blood Cancer 2006 [Epub ahead of print].

2. Scagni P, Peisino MG, Bianchi M, Morello M, Sardi N, Linari A, et al. Kikuchi-Fujimoto disease is a rare cause of lymphadenopathy and fever of unknown origin in children: report of two cases and review of the literature. J Pediatr Hematol Oncol 2005;27:337-340.

3. Rao GS, Vohra D, Kuruvilla M. Is Kikuchi-Fujimoto disease a manifestation of systemic lupus erythematosus? Int J Dermatol 2006;45:454-456.

4. Hedia G, Jamel A, Maher A, Hanadi A, Agnes H, Nidhameddine K. Kikuchi-Fujimoto disease associated with systemic lupus erythematosus. J Clin Rheumatol 2005;11:341-342.

5. Kucukardali Y, Solmazgul E, Kunter E, Oncul O, Yildirim S, Kaplan M. Kikuchi-Fujimoto Disease: analysis of 244 cases. Clin Rheumatol 2007;26:50-54.

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xix

8-10 πÔ˘Ó›Ô˘ 2007

5Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ ¶·È‰Ô„˘¯È·ÙÚÈ΋˜ ∂Ù·ÈÚ›·˜ ∂ÏÏ¿‰Ô˜ ª¤Á·ÚÔ ªÔ˘ÛÈ΋˜ ∞ıËÓÒÓ ¶ÏËÚÔÊÔڛ˜: AC&C International ∆ËÏ.: 210 68 89 100 Fax: 210 68 44 777 E-mail: hscaconinfo@acnc.gr Website: www.hscapcongress2007.com

∞ı‹Ó·

24-28 πÔ˘Ó›Ô˘ 2007

5th World Congress on Pediatric Critical Care Geneva Palexpo Website: www.pcc2007.com

Geneva, Switzerland

27-30 πÔ˘Ó›Ô˘ 2007

46th European Society for Pediatric Endocrinology Meeting Contact: Pauline Bertrand, ESPE Secretariat, BioScientifica, Euro House, 22 Apex Court.

Woodlands, Bristol, BS32 4JT, UK Tel.: 44-0-01-454-642-208 Fax: 44-0-1-454-642-222 Website: www.espe2007.org

Helsinki, Finland

29 πÔ˘Ó›Ô˘-3 πÔ˘Ï›Ô˘ 2007

GA2LEN Allergy Summer School 2007 Pantheon Palace ¢ÈÔÚÁ¿ÓˆÛË: ∞ÏÏÂÚÁÈÔÏÔÁÈÎfi ∆Ì‹Ì· µ’ ¶·È‰È·ÙÚÈ΋˜ ∫ÏÈÓÈ΋˜ ¶·ÓÂπÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ¶ÏËÚÔÊÔڛ˜: Everest travel, Î. ¢Ú·ÎÔÔ‡ÏÔ˘ ∆ËÏ.: 210 3249242 Website: www.allergy.gr

ÃÂÚÛfiÓËÛÔ˜, ∫Ú‹ÙË

5-7 πÔ˘Ï›Ô˘ 2007

17th Annual Meeting of the European Childhood Obesity Group (ECOG) Athenaeum Intercontinental ¶ÏËÚÔÊÔڛ˜: Triaena Tours & Congress S.A 15, Mesogion Avenue. 115 26 Athens, Greece ∆ËÏ.: 210 7499 372 / 304 / 300 Fax: 210 7713 795 E-mail: congress@triaenatours.gr Website: www.ecog2007.gr

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25-30 ∞˘ÁÔ‡ÛÙÔ˘ 2007

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

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31 ∞˘ÁÔ‡ÛÙÔ˘ 4 ™ÂÙÂÌ‚Ú›Ô˘ 2007

14th Congress of the International Pediatric Nephrology Association Blaguss Congress Bureau Tel.: +36 1 374 7030, Fax: +36 1 312 1582 E-mail: info@blaguss-congress.hu Website: www.blaguss-congress.hu

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5-6 ™ÂÙÂÌ‚Ú›Ô˘ 2007

3rd International Multi-disciplinary symposium on Congenital Malformations in Fetus and Child Contact: Dr Liana Beni-Adani Tel.: 972-524-262-057 Fax: 972-36-973-451 E-mail: lianabenia@gmail.com

Jerusalem, Israel

9-13 ™ÂÙÂÌ‚Ú›Ô˘ 2007

8th World Congress of Perinatal Medicine Contact: MCA Events - Roberto Caflisch Tel.: 39-0-234-934-404 Fax: 39-0-234-934-397 E-mail: caflisch@mcaevents.org

Florence, Italy

14-16 ™ÂÙÂÌ‚Ú›Ô˘ 2007

European Society for Paediatric Haematology & Immunology 2007 Athens Hilton ¶ÏËÚÔÊÔڛ˜: Triaena Tours & Congress S.A 15, Mesogion Avenue, 115 26 Athens, Greece ∆ËÏ.: 210 74 99 372 / 304 / 300 Fax: 210 77 13 795 E-mail: congress@triaenatours.gr Website: www.esphi2007-athens.gr

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13-14 ™ÂÙÂÌ‚Ú›Ô˘ 2007

European Society for Social Pediatrics and Child Health Annual Meeting Contact: Dr. Stella Tsitoura Dept of Social Pediatrics Aglaia Kyriakou Children's Hospital 18, Mesogeion Avenue Athens, Greece E-mail: socmed@otenet.gr Website: www.essop.org

Trieste, Italy

17-20 ™ÂÙÂÌ‚Ú›Ô˘ 2007

II World Congress of the World Federation of Associations of Pediatric Surgeons, WOFAPS General Secretariat: Uniline Exhibitions S.A. Av. Cfirdoba 632, 11th floor (C1054AAS) E-mail: pedsurg2007@uniline.com.ar Website: www.pedsurg2007.org.ar

Buenos Aires, Argentina

21 - 23 ™ÂÙÂÌ‚Ú›Ô˘ 2007

™ÂÌÈÓ¿ÚÈÔ ∂ÍÂȉÈÎÂ˘Ì¤Ó˘ ÀÔÛÙ‹ÚÈ͢ Ù˘ ∑ˆ‹˜ ÛÙ· ¶·È‰È¿ (APLS) ∆Ì‹Ì· π·ÙÚÈ΋˜, ¶·ÓÂÈÛÙ‹ÌÈÔ ∫Ú‹Ù˘ ¶ÏËÚÔÊÔڛ˜: ª.∂.£.¶. ¶·.°.¡.∏. ∆ËÏ.: 2810 392447 Fax: 2810 392652 ∂-mail: julietaperezg@hotmail.com

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21-23 ™ÂÙÂÌ‚Ú›Ô˘ 2007

2Ë ∂ÈÛÙËÌÔÓÈ΋ ™˘Ó¿ÓÙËÛË ∂ÏÏËÓÈ΋˜ ∞η‰ËÌ›·˜ ¶·È‰È·ÙÚÈ΋˜ Aldemar Olympian Village Resort ¶ÏËÚÔÊÔڛ˜: FIRSTEVENT ∆ËÏ.: 210 8228950 Fax: 210 8228901 E-mail: info@firstevent.gr

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