Παιδιατρική | Τόμος 66 • Τεύχος 3 • Μάιος - Ιούνιος 2003

ISSN 0377-2551

∞¡∞™∫O¶∏™∂π™OÚÁ·ÓÈÎ¤˜ ‰È·Ù·Ú·¯¤˜ ÌÂ „˘¯È·ÙÚÈÎ‹ Û˘ÌÙˆÌ·ÙÔÏÔÁ›· ÛÙ· ·È‰È¿: Ë ‰ÈÂÚÂ‡ÓËÛË·fi ÙÔÓ ·È‰›·ÙÚÔ¡. ¶ÚˆÙ·ÁfiÚ·-§È·ÓÔ‡

∂Ó‰Â›ÍÂÈ˜ ÂÎÙ¤ÏÂÛË˜ ÏÂÈÙÔ˘ÚÁÈÎÒÓ ‰ÔÎÈÌ·ÛÈÒÓÙË˜ ·Ó·ÓÔ‹˜ ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›· ª. ªÔ˘ÛÙ¿ÎË

Eƒ∂À¡∏∆π∫∂™ ∂ƒ°∞™π∂™∂ÍˆÓÂ˘ÌÔÓÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ Ì˘ÎÔÏ¿ÛÌ·ÙÔ˜ ÙË˜ ÓÂ˘ÌÔÓ›·˜ ∂. ∫·Ú·ÓÙ·Ó¿, ™. ∫ˆÛÙ·Ú›‰Ô˘, ∞. ∫·Ï·ÓÙ˙‹˜, ∞. °È·ÓÓÔ‡ÏÈ·

ºÔÚÂ›· Neisseria meningitidis ÛÂ ·È‰È¿ Û¯ÔÏÈÎ‹˜ ËÏÈÎ›·˜: ·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ Î·È¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ·ÔÌÔÓˆı¤ÓÙˆÓ ÛÙÂÏÂ¯ÒÓ π. ¶·˘ÏÔÔ‡ÏÔ˘, ∂. ∞ÏÂÍ¿Ó‰ÚÔ˘, °. ¢·›ÎÔ˜, ∂. ¶ÂÙÚ›‰Ô˘, ∞. ¶¿ÁÎ·ÏË, ª. £ÂÔ‰ˆÚ›‰Ô˘, µ. ™˘ÚÈÔÔ‡ÏÔ˘

§ÂÌÊÒÌ·Ù· ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜. ∂ÌÂÈÚ›· 10 ¯ÚfiÓˆÓ º. ∞ı·Ó·ÛÈ¿‰Ô˘, £. ∆Ú·ÁÈ·ÓÓ›‰Ë˜, £. ¶··ÁÂˆÚÁ›Ô˘, µ. ∫·ÏÔ‡ÙÛË, ª. Ã·Ù˙ËÛÙ˘ÏÈ·ÓÔ‡, ª. ™Ù¿ÌÔ˘, ¢. ∫·ÙÚÈÔ‡

§È›‰È· Î·È ÏÈÔÚˆÙÂ˝ÓÂ˜ ÔÚÔ‡ ·È‰ÈÒÓ Ô˘ Ï·Ì‚¿ÓÔ˘Ó ·ÓÙÈÂÈÏËÙÈÎ¿ Ê¿ÚÌ·Î· ∫. ∞. µÔ‡‰ÚË˜, ∞. ™Î·Ú‰Ô‡ÙÛÔ˘, ª. ™ÂÚ‚ÈÙ˙fiÁÏÔ˘,™. ¢‹ÌÔ˘, ∂. ∞. µ·ÁÈ¿ÎÔ˘

REVIEW ARTICLESOrganic disorders with psychiatricsymptomatology in children: investigation bythe paediatrician D. Protagoras-Lianos

Indications for pulmonary function testing in childhood M. Moustaki

ORIGINAL ARTICLESExtrapulmonary symptoms of Mycoplasma pneumoniae infections E. Karantana, S. Kostaridou, A. Kalantzis, A. Giannoulia

Neisseria meningitidis carriage inschoolchildren: risk factors and characteristics of isolated strains I. Pavlopoulou, E. Alexandrou, G. Daikos, E. Petridou, A. Pangalis, M. Theodoridou, V. Syriopoulou

Lymphomas in childhood. Ten years’ experience F. Athanassiadou, T. Tragiannidis, T. Papageorgiou, V. Kaloutsi, M. Hatzistilianou, M. Stamou, D. Katriou

Serum lipids and lipoproteins in epilepticchildren receiving antiepileptic drugs K. Voudris, A. Skardoutsou, M. Servitzoglou, S. Dimou, E. Vagiakou

167

176

185

188

195

202

MMaayy -- JJuunnee 22000033 VVoolluummee 6666 NNoo 33.. ..

¶A

I¢IA

TP

IKH

●

TO

MO

™

66

●

TE

YX

O™

3

●E

TO

™

20

03

ªª¿¿ÈÈÔÔ˜̃ -- ππÔÔ‡‡ÓÓÈÈÔÔ˜̃ 22000033 ∆∆fifiÌÌÔÔ˜̃ 6666 ∆∆ÂÂ‡‡¯̄ÔÔ˜̃ 33.. ..

Continuation of table of contents inside title page

∏ Û˘Ó¤¯ÂÈ· ÙˆÓ ÂÚÈÂ¯ÔÌ¤ÓˆÓ ÛÙËÓ ÚÒÙËÂÛˆÙÂÚÈÎ‹ ÛÂÏ›‰·

COVER May-June 03 03-06-03 16:52 ™ÂÏ›‰·1

MM¿¿ÈÈÔÔ˜̃ -- IIÔÔ‡‡ÓÓÈÈÔÔ˜̃ 22000033 ∆∆fifiÌÌÔÔ˜̃ 6666 ∆∆ÂÂ‡‡¯̄ÔÔ˜̃ 33.. ..


EN¢π∞º∂ƒOÀ™∂™ ¶∂ƒπ¶∆ø™∂π™™‡Ó‰ÚÔÌÔ ·ÔÊÚ·ÎÙÈÎ‹˜ ¿ÓÔÈ·˜ ÛÙÔÓ ‡ÓÔ Û˘ÓÔ‰Â˘fiÌÂÓÔ ·fi Ó˘ÎÙÂÚÈÓ‹ ÂÓÔ‡ÚËÛË ∂. ∞ÏÂÍfiÔ˘ÏÔ˜, ∞. ∫·‰›ÙË˜, µ. ªÈÎÚ¿ÎË, ∂. ∫ˆÛÙ·‰‹Ì·, ¡. ™ÎÂÓÙ¤ÚË˜, ∫. °Ô˘ÚÁÔ˘ÏÈ¿ÓË˜

∂ÙÂÚfiÏÂ˘ÚË ‰È·ÏÂ›Ô˘Û· ‚ÏÂÊ·ÚfiÙˆÛË ˆ˜ÚÔ¤¯ÔÓ Û‡ÌÙˆÌ· ¯ÚfiÓÈ·˜ ÈÁÌÔÚ›ÙÈ‰·˜ °. ¶·Ú‰·Ïfi˜, ™. ªÔ‡ÛÎÔ˘, ¢. ∑·ÊÂÈÚ›Ô˘, µ. ∞˚‚¿˙Ë˜

∫ÏÈÓÈÎ‹ ÂÙÂÚÔÁ¤ÓÂÈ· ÛÙËÓ ÚÔÛˆÔˆÌÔ‚Ú·¯ÈfiÓÈÔ Ì˘˚Î‹ ‰˘ÛÙÚÔÊ›·(FSHMD). ¶ÂÚÈÁÚ·Ê‹ ÂÚÈÙÒÛÂˆÓ Î·È ·Ó·ÛÎfiËÛË ÙË˜ ‚È‚ÏÈÔÁÚ·Ê›·˜ E. ºÚ˘Û›Ú·, ™. ∞Ì¤ÓÙ·, ∫. ∫¤ÎÔ˘, ™. °ÈÔ˘ÚÔ‡ÎÔ˜, ¶. ª·ÓÙ¿, ∞. ªÂÙ·ÍˆÙÔ‡

∂¶π∫∞πƒ∞ £∂ª∞∆∞¶ÚÔ‚ÈÔÙÈÎ¿, ÚÂ‚ÈÔÙÈÎ¿, Û˘Ì‚ÈÔÙÈÎ¿: ÓÂfiÙÂÚ· ‰Â‰ÔÌ¤Ó· π. Ã·ÚˆÓ›ÙË, ª. ª·˘ÚfiÎˆÛÙ·, ∂. ∫fiÎÔÚË

∂π¢π∫O ∞ƒ£ƒO¶·ÚÔ˘Û›·ÛË ÂÚ›ÙˆÛË˜ Û·Î¯·ÚÒ‰Ô˘˜ ‰È·‚‹ÙË ÛÙÔ ÂÚÈÔ‰ÈÎfi “∂ÚÌ‹˜ Ô §fiÁÈÔ˜”ÙÔ˘ 1814 ¢. ∫·Ú·ÌÂÚfiÔ˘ÏÔ˜

¡∂∞ ∞¶O ∆O ¢π∞¢π∫∆ÀO

CASE REPORTS Obstructive sleep apnoea syndromeaccompanied by nocturnal enuresis E. Alexopoulos, A. Kaditis, V. Mikraki, E. Kostadima, N. Skenteris, K. Gourgoulianis

Unilateral intermittent blepharoptosis as anurgent symptom of chronic sinusitis G. Pardalos, S. Mouskou, D. Zafiriou, V. Aivazis

Clinical heterogeneity in facioscapulohumeral muscular dystrophy(FSHMD). Report of two cases and review of the literature H. Fryssira, S. Amenta, K. Kekou, S. Youroukos, P. Manta, C. Metaxotou

CURRENT ISSUES Probiotics, prebiotics, synbiotics: recent data I. Charoniti, M. Mavrokosta, E. Kokori

SPECIAL ARTICLE A case of diabetes mellitus presented in the journal “∂ÚÌ‹˜ Ô §fiÁÈÔ˜”, 1814 D. Karaberopoulos

NEWS FROM THE INTERNET

208

211

215

223

232

236

™˘Ó¤¯ÂÈ· ÂÚÈÂ¯ÔÌ¤ÓˆÓ Continuation of table of contents

™˘ÓÂ¯›˙ÔÓÙ·È Continued

May-June 03 03-06-03 16:55 ™ÂÏ›‰·1

MM¿¿ÈÈÔÔ˜̃ -- ππÔÔ‡‡ÓÓÈÈÔÔ˜̃ 22000033 ∆∆fifiÌÌÔÔ˜̃ 6666 ∆∆ÂÂ‡‡¯̄ÔÔ˜̃ 33.. ..


¶∂ƒπ§∏æ∂π™ ∞ƒ£ƒø¡ ∞¶O ∆∏ µπµ§πO°ƒ∞ºπ∞∞ÓÙÈ‚ÈÔÙÈÎ¿ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ÔÍÂ›·˜ Ì¤ÛË˜ ˆÙ›ÙÈ‰·˜ ÛÙ· ·È‰È¿Glasziou PP, Del Mar CB, Sanders SL, Hayem M ∞fi‰ÔÛË ÛÙ· ∂ÏÏËÓÈÎ¿: ºˆÙÂÈÓ‹ Ã·ÓÙ˙‹

¶ÚÔÁÓˆÛÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ Î·Î‹˜ ¤Î‚·ÛË˜ Î·È ÔÊ¤ÏË ·fi Ù· ·ÓÙÈ‚ÈÔÙÈÎ¿ ÛÂ ·È‰È¿ ÌÂ ÔÍÂ›·Ì¤ÛË ˆÙ›ÙÈ‰· Little P, Gould C, Moore M, Warner G, Dunleavey J, Williamson I ∞fi‰ÔÛË ÛÙ· ∂ÏÏËÓÈÎ¿: ºˆÙÂÈÓ‹ Ã·ÓÙ˙‹

¶ÚÔÛÂ¯‹ ™˘Ó¤‰ÚÈ·

™˘ÓÙÔÌÔÁÚ·Ê›Â˜

LITERATURE ABSTRACTSAntibiotics for acute otitis media in children Glasziou PP, Del Mar CB, Sanders SL, Hayem M Greek translation: F. Hantzi

Predictors of poor outcome and benefits fromantibiotics in children with acute otitis media:pragmatic randomized trial Little P, Gould C, Moore M, Warner G, Dunleavey J, Williamson I Greek translation: F. Hantzi

Scheduled Medical Meetings

Abbreviations

194

201

xi

xv

™˘Ó¤¯ÂÈ· ÂÚÈÂ¯ÔÌ¤ÓˆÓ Continuation of table of contents

May-June 03 03-06-03 16:55 ™ÂÏ›‰·2

¢ÈÌËÓÈ·›· ¤Î‰ÔÛËE›ÛËÌÔ ¶ÂÚÈÔ‰ÈÎfi ÙË˜ EÏÏËÓÈÎ‹˜ ¶·È‰È·ÙÚÈÎ‹˜ EÙ·ÈÚÂ›·˜

EÎ‰fiÙË˜K. °ÚÈ‚¤·˜

I‰ÈÔÎÙ‹ÙË˜©EÏÏËÓÈÎ‹ ¶·È‰È·ÙÚÈÎ‹ EÙ·ÈÚÂ›·MÈ¯·Ï·ÎÔÔ‡ÏÔ˘ 92Aı‹Ó·È 115 28TËÏ.: 210-7771 140 / 210-7771 663, Fax: 210-7758 354

EÈÛÙËÌÔÓÈÎ‹ ™˘ÓÙ·ÎÙÈÎ‹ EÈÙÚÔ‹¶ÚfiÂ‰ÚÔ˜ : ∞. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜¢ÈÂ˘ı˘ÓÙ‹˜ : ™. Ã·˚‰¿˜M¤ÏË : º. Aı·Ó·ÛÈ¿‰Ô˘-¶ÈÂÚÔÔ‡ÏÔ˘

: °. µ·ÚÏ¿ÌË˜: ª. ∏Ï›·: π. ¶··‰¿ÙÔ˜: ¡. ¶··‰fiÔ˘ÏÔ˜: ™. ¶ÔÏ˘¯ÚÔÓÔÔ‡ÏÔ˘: ∫. ¶ÚÔ‡ÓÙ˙Ô˘-∫·ÛÛÈÔ‡: ∫. ™ÙÂÊ·Ó›‰Ë˜: ª. ∆ÛÔÏÈ¿: ™. ºˆÙfiÔ˘ÏÔ˜

ºÈÏÔÏÔÁÈÎ‹ EÈÌ¤ÏÂÈ·∂ÈÌ¤ÏÂÈ· ÂÏÏËÓÈÎÒÓ ÎÂÈÌ¤ÓˆÓI. K·Ú·‚Ú¿ÓÔ˘

EÈÌ¤ÏÂÈ· ·ÁÁÏÈÎÒÓ ÎÂÈÌ¤ÓˆÓ™. ¡¿ÎÔ˘

∞ÏÏËÏÔÁÚ·Ê›·∂ÏÏËÓÈÎ‹ ¶·È‰È·ÙÚÈÎ‹ ∂Ù·ÈÚÂ›·ªÈ¯·Ï·ÎÔÔ‡ÏÔ˘ 92∞ı‹Ó·È 115 28∆ËÏ: 210-7771 140 / 210-7771 663, Fax: 210-7758 354

Bimonthly PublicationThe Official Journal of the Hellenic Paediatric Society

PublisherK. Griveas

Owner©Hellenic Paediatric SocietyMichalakopoulou 92Athens 115 28Tel.: 210-7771 140 / 210-7771 663, Fax: 210-7758 354

Scientific Editorial BoardPresident : A. ConstantopoulosEditor : S. HaidasMembers : F. Athanassiadou-Piperopoulou

: G. Varlamis: M. Ilia: I. Papadatos: N. Papadopoulos: S. Polychronopoulou: K. Prountzou-Kassiou: C. Stefanidis: M. Tsolia: S. Fotopoulos

Manuscript Editing

Greek EditingI. Karavranou

English EditingS. Nakou

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

™˘ÓÙÔÓÈÛÙ‹˜ ∂Î‰fiÛÂˆ˜E¶I™THMONIKE™ EK¢O™EI™ E.¶.E.¶. ∆Û·Ï‰¿ÚË 3, 151 22 M·ÚÔ‡ÛÈTËÏ.: 210-61 41 360-5 Fax: 210-61 41 366

EÙ‹ÛÈ· ™˘Ó‰ÚÔÌ‹ 40 cEÈ‰ÈÎÂ˘fiÌÂÓÔÈ, ºÔÈÙËÙ¤˜: 20 c

Publishing CoordinatorSCIENTIFIC PUBLICATIONS LtdP. Tsaldari 3, Marousi 151 22Tel.: 210-61 41 360-5 Fax: 210-61 41 366

Annual SubscriptionAll foreign countries: US $ 50

MM¿¿ÈÈÔÔ˜̃ -- ππÔÔ‡‡ÓÓÈÈÔÔ˜̃ 22000033 ∆∆fifiÌÌÔÔ˜̃ 6666 ∆∆ÂÂ‡‡¯̄ÔÔ˜̃ 33.. ..

MMaayy--JJuunnee 22000033 VVoolluummee 6666 NNoo 33.. ..

πSSN 0377-2551i

May-June 03 03-06-03 16:55 ™ÂÏ›‰·3

A. °ÂÓÈÎ¤˜ ¶ÏËÚÔÊÔÚ›Â˜∆Ô ÂÚÈÔ‰ÈÎfi “¶·È‰È·ÙÚÈÎ‹” Â›Ó·È Ë ÂÈÛÙËÌÔÓÈÎ‹ ¤Î-

‰ÔÛË Î·È È‰ÈÔÎÙËÛ›· ÙË˜ EÏÏËÓÈÎ‹˜ ¶·È‰È·ÙÚÈÎ‹˜ EÙ·ÈÚÂ›-·˜, Ô˘ ‰È·Ó¤ÌÂÙ·È ÛÙ· Ì¤ÏË ÙË˜. Œ¯ÂÈ ˆ˜ ‚·ÛÈÎÔ‡˜ ÛÙfi-¯Ô˘˜ ÙËÓ ·ÔÙ‡ˆÛË ÙÔ˘ ·È‰È·ÙÚÈÎÔ‡ ÂÈÛÙËÌÔÓÈÎÔ‡¤ÚÁÔ˘ Î·È ÙË Û˘ÓÂ¯‹ ÂÓËÌ¤ÚˆÛË ÙˆÓ ¶·È‰È¿ÙÚˆÓ. °È· ÙÔÛÎÔfi ·˘Ùfi ‰¤¯ÂÙ·È ÁÈ· ‰ËÌÔÛ›Â˘ÛË ÔÈÎÈÏ›· ¿ÚıÚˆÓ Î·ÈÛ˘ÁÎÂÎÚÈÌ¤Ó·:

1. ÕÚıÚ· Û‡ÓÙ·ÍË˜ (ÌÂÙ¿ ·fi ÚfiÛÎÏËÛË ÙË˜ EÈÛÙË-ÌÔÓÈÎ‹˜ ™˘ÓÙ·ÎÙÈÎ‹˜ EÈÙÚÔ‹˜).

2. ∞Ó·ÛÎÔ‹ÛÂÈ˜.3. µÚ·‚Â˘Ì¤ÓÂ˜ ÂÚÁ·Û›Â˜.4. ∂ÚÂ˘ÓËÙÈÎ¤˜ ÌÂÏ¤ÙÂ˜.5. ∂ÈÏÂÁÌ¤ÓÂ˜ Û˘˙ËÙ‹ÛÂÈ˜ ÛÙÚÔÁÁ˘ÏÒÓ ÙÚ·Â˙ÒÓ.6. ∂›Î·ÈÚ· ı¤Ì·Ù·.7. £¤Ì·Ù· ÂÎ·›‰Â˘ÛË˜ Î·È ÔÚÁ¿ÓˆÛË˜ ˘ÁÂ›·˜.8. ∫ÏÈÓÈÎ¤˜ Î·È ·ÂÈÎÔÓÈÛÙÈÎ¤˜ ÂÚÈÙÒÛÂÈ˜.9. ™‡ÓÙÔÌ· Ó¤·.

10. µÚ·¯Â›Â˜ ‰ËÌÔÛÈÂ‡ÛÂÈ˜.11. ∂ÈÛÙÔÏ¤˜ ÚÔ˜ ÙË Û‡ÓÙ·ÍË.12. ¶ÂÚÈÏ‹„ÂÈ˜ ÙË˜ ‚È‚ÏÈÔÁÚ·Ê›·˜.13. ∞Ó·ÎÔÈÓÒÛÂÈ˜ ÚÔÛÂ¯ÒÓ Û˘ÓÂ‰Ú›ˆÓ Î·È ÂÈÛÙËÌÔÓÈ-

ÎÒÓ ÂÎ‰ËÏÒÛÂˆÓ14. ∞Ó·ÊÔÚ¤˜ Î·È ÎÚÈÙÈÎ‹ Ó¤ˆÓ ÂÎ‰fiÛÂˆÓ, ÂÏÏËÓÈÎÒÓ Î·È

Í¤ÓˆÓ, ·È‰È·ÙÚÈÎÔ‡ ÂÓ‰È·Ê¤ÚÔÓÙÔ˜.

H EÈÛÙËÌÔÓÈÎ‹ ™˘ÓÙ·ÎÙÈÎ‹ EÈÙÚÔ‹ ‰È·ÙËÚÂ› ÙÔ ‰ÈÎ·›-ˆÌ· Ó· ‰ËÌÔÛÈÂ‡ÂÈ ¿ÚıÚ· ÌÂ È‰È·›ÙÂÚÔ ÂÈÛÙËÌÔÓÈÎfi ÂÓ‰È·-Ê¤ÚÔÓ Î·ıÒ˜ Î·È ¿ÚıÚ· ÌÂ Â›Î·ÈÚ· ı¤Ì·Ù· ¯ˆÚ›˜ Ó· ÙË-ÚÂ›Ù·È Ë ÛÂÈÚ¿ ̆ Ô‚ÔÏ‹˜. ∂›ÛË˜, ÌÔÚÂ› Ó· ·ÔÊ·Û›˙ÂÈ ÁÈ·ÙË ‰ËÌÔÛ›Â˘ÛË ÂÚÁ·ÛÈÒÓ Ô˘ ¤¯Ô˘Ó ·ÚÔ˘ÛÈ·ÛıÂ› ÛÙÔÂÙ‹ÛÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ, ÙËÓ ÔÏÈÎ‹ ‹ ÌÂÚÈÎ‹ ‰ËÌÔÛ›-Â˘ÛË ·ÚÔ˘ÛÈ¿ÛÂˆÓ È‰È·›ÙÂÚÔ˘ ÂÓ‰È·Ê¤ÚÔÓÙÔ˜ Î·È ÙËÓ ÔÏÈ-Î‹ ‹ ÌÂÚÈÎ‹ ‰ËÌÔÛ›Â˘ÛË ÂÈÛÙÔÏÒÓ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÛÂ‰ËÌÔÛÈÂ˘Ì¤Ó· ÂÈÛÙËÌÔÓÈÎ¿ ¿ÚıÚ· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡.

™ÙÈ˜ ÂÚÁ·Û›Â˜ ÌÂ Â›Î·ÈÚ· ı¤Ì·Ù· Ú¤ÂÈ Ó· ·Ó·ÁÚ¿-ÊÂÙ·È ÛÙËÓ ÚÒÙË ÛÂÏ›‰· Ë ÚfiıÂÛË ÙˆÓ Û˘ÁÁÚ·Ê¤ˆÓÁÈ· ÙËÓ ·Ó·ÁÎ·ÈfiÙËÙ· ÙË˜ Ù·¯Â›·˜ ‰ËÌÔÛ›Â˘ÛË˜. ∏ ∂È-ÙÚÔ‹ ™‡ÓÙ·ÍË˜ ‰È·ÙËÚÂ› ÙÔ ‰ÈÎ·›ˆÌ· ÙË˜ ·Ô‰Ô¯‹˜ ÙË˜Ù·¯Â›·˜ ‰ËÌÔÛ›Â˘ÛË˜.

µ. ÀÔ‚ÔÏ‹ Î·È ¢ËÌÔÛ›Â˘ÛË ÙˆÓ ∂ÚÁ·ÛÈÒÓOÈ ÂÚÁ·Û›Â˜ Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È ÚÔ˜ ÎÚ›ÛË ÁÈ· ‰ËÌÔ-

Û›Â˘ÛË ÛÙÔ ÂÚÈÔ‰ÈÎfi “¶·È‰È·ÙÚÈÎ‹” ·ÔÛÙ¤ÏÏÔÓÙ·È ÂÈ˜ÙÚÈÏÔ‡Ó ÛÙË ‰ÈÂ‡ı˘ÓÛË:

EÈÛÙËÌÔÓÈÎ‹ ™˘ÓÙ·ÎÙÈÎ‹ EÈÙÚÔ‹EÏÏËÓÈÎ‹ ¶·È‰È·ÙÚÈÎ‹ EÙ·ÈÚÂ›·MÈ¯·Ï·ÎÔÔ‡ÏÔ˘ 92115 28 Aı‹Ó·

ŸÏÂ˜ ÔÈ ÂÚÁ·Û›Â˜ Ú¤ÂÈ Ó· Û˘ÓÔ‰Â‡ÔÓÙ·È ·fi ÂÈ-ÛÙÔÏ‹, Ë ÔÔ›· ı· Û˘Ó˘ÔÁÚ¿ÊÂÙ·È ·fi fiÏÔ˘˜ ÙÔ˘˜ Û˘Á-ÁÚ·ÊÂ›˜ ÛÙËÓ ÔÔ›· ı· ‰ËÏÒÓÂÙ·È fiÙÈ Ë ÂÚÁ·Û›· ‰ÂÓ ¤¯ÂÈÂÓ Ì¤ÚÂÈ ‹ ÂÍ ÔÏÔÎÏ‹ÚÔ˘ ‰ËÌÔÛÈÂ˘ıÂ› ‹ ˘Ô‚ÏËıÂ› ÁÈ·ÎÚ›ÛË ÛÂ ¿ÏÏÔ ÂÚÈÔ‰ÈÎfi Î·È fiÙÈ ÔÈ Û˘ÁÁÚ·ÊÂ›˜ ÂÁÎÚ›ÓÔ˘ÓÙË ‰ËÌÔÛ›Â˘Û‹ ÙË˜ ÛÙÔ ÂÚÈÔ‰ÈÎfi “¶·È‰È·ÙÚÈÎ‹”. ∂ÈÏ¤-ÔÓ, ı· Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È Ù˘¯fiÓ ÂÈ‰ÔÙ‹ÛÂÈ˜ - ¯ÔÚË-

Á›Â˜ ‹ ¿ÏÏÂ˜ ËÁ¤˜ ˘ÔÛÙ‹ÚÈÍË˜. ŸÏÂ˜ ÔÈ ÎÏÈÓÈÎ¤˜ ¤ÚÂ˘ÓÂ˜Ú¤ÂÈ Ó· Û˘ÓÔ‰Â‡ÔÓÙ·È ·fi ÁÚ·Ù‹ ‰‹ÏˆÛË ÙˆÓ Û˘Á-ÁÚ·Ê¤ˆÓ fiÙÈ ¤ÁÈÓ·Ó ÌÂÙ¿ ·fi ÏËÚÔÊÔÚËÌ¤ÓË Û˘Ó·›ÓÂÛËÙˆÓ ÌÂÙÂ¯fiÓÙˆÓ ‹ ÙˆÓ ÓÔÌ›ÌˆÓ ÂÎÚÔÛÒˆÓ ÙÔ˘˜ Û‡ÌÊˆ-Ó· ÌÂ ÙÈ˜ ‰È·ÎËÚ‡ÍÂÈ˜ ÙÔ˘ EÏÛ›ÓÎÈ Î·È ÙÔ˘ TfiÎÈÔ.

∫·ıÒ˜ Î·È fiÙÈ ÙËÚ‹ıËÎ·Ó ÔÈ Ô‰ËÁ›Â˜ ÁÈ· ÙË ÊÚÔÓÙ›‰·ÂÈÚ·Ì·Ùfi˙ˆˆÓ ÙÔ˘ ∂ıÓÈÎÔ‡ πÓÛÙÈÙÔ‡ÙÔ˘ ÀÁÂ›·˜ ÙˆÓ ∏¶∞(DHEW Publication, NIH, 80-23). ™ÙÈ˜ ÎÏÈÓÈÎ¤˜ ÌÂÏ¤ÙÂ˜ ı·Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÂÙ·È fiÙÈ ¤¯Ô˘Ó ÂÁÎÚÈıÂ› ·fi ÙËÓ ÂÈÙÚÔ-‹ ∏ıÈÎ‹˜ Î·È ¢ÂÔÓÙÔÏÔÁ›·˜ ÙÔ˘ ¡ÔÛÔÎÔÌÂ›Ô˘.

ŸÏÂ˜ ÔÈ ‰ËÌÔÛÈÂ˘Ì¤ÓÂ˜ ÂÚÁ·Û›Â˜ ıÂˆÚÔ‡ÓÙ·È È‰ÈÔ-ÎÙËÛ›· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ “¶·È‰È·ÙÚÈÎ‹” Î·È Ë ÔÏÈÎ‹ ‹ ÌÂÚÈ-Î‹ ·Ó·‰ËÌÔÛ›Â˘Û‹ ÙÔ˘˜ ÂÈÙÚ¤ÂÙ·È ÌfiÓÔ ÌÂÙ¿ ·fi ¤Á-ÁÚ·ÊË Û˘ÁÎ·Ù¿ıÂÛË ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡.

∏ ¶∞π¢π∞∆ƒπ∫∏ ÚÔÙÂ›ÓÂÈ Ó· ·ÎÔÏÔ˘ıÔ‡ÓÙ·È ÔÈ “∫ÔÈ-Ó¤˜ ¶ÚÔ‰È·ÁÚ·Ê¤˜ ÁÈ· ÃÂÈÚfiÁÚ·Ê· Ô˘ ˘Ô‚¿ÏÏÔÓÙ·ÈÛÂ µÈÔ˚·ÙÚÈÎ¿ ¶ÂÚÈÔ‰ÈÎ¿” (Uniform Requirements forManuscripts Submitted to Biomedical Journals) Ô˘ ‰Ë-ÌÔÛÈÂ‡ÙËÎ·Ó ÛÙÔ JAMA 1997;277:927-934

http://jama.ama-assn.org/info/auinst_req.html

OÈ ·fi„ÂÈ˜ Î·È Ù· Û˘ÌÂÚ¿ÛÌ·Ù· ÙˆÓ Û˘ÁÁÚ·Ê¤ˆÓÔ˘ ‰È·Ù˘ÒÓÔÓÙ·È ÛÙÈ˜ ‰ËÌÔÛÈÂ˘Ì¤ÓÂ˜ ÂÚÁ·Û›Â˜ ‰ÂÓ·ÓÙÈÎ·ÙÔÙÚ›˙Ô˘Ó ··Ú·›ÙËÙ· ·˘Ù¤˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. HÎ·Ù·¯ÒÚËÛË ‰È·ÊËÌ›ÛÂˆÓ ÛÙÔ ÂÚÈÔ‰ÈÎfi ‰ÂÓ ˘Ô‰ËÏÒ-ÓÂÈ ÔˆÛ‰‹ÔÙÂ ¤ÁÎÚÈÛË ÙˆÓ ÂÚÈÂ¯ÔÌ¤ÓˆÓ ÙÔ˘˜ ·fi ÙËÓEÏÏËÓÈÎ‹ ¶·È‰È·ÙÚÈÎ‹ EÙ·ÈÚÂ›·, ÙËÓ EÈÛÙËÌÔÓÈÎ‹ ™˘ÓÙ·-ÎÙÈÎ‹ EÈÙÚÔ‹ ‹ ·fi ÙÔÓ EÎ‰fiÙË ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡.

EÊfiÛÔÓ Ë ÂÚÁ·Û›· Á›ÓÂÈ ·Ô‰ÂÎÙ‹, ÙÔ ‰ÈÔÚıˆÌ¤ÓÔÛ‡ÌÊˆÓ· ÌÂ ÙÈ˜ ˘Ô‰Â›ÍÂÈ˜ ÙˆÓ ÎÚÈÙÒÓ Î·È ÂÎ Ó¤Ô˘ ‰·ÎÙ˘-ÏÔÁÚ·ÊËÌ¤ÓÔ ÎÂ›ÌÂÓÔ Ú¤ÂÈ Ó· ˘Ô‚¿ÏÏÂÙ·È ÛÙËÓ EÈÛÙË-ÌÔÓÈÎ‹ ™˘ÓÙ·ÎÙÈÎ‹ EÈÙÚÔ‹ Û˘ÓÔ‰Â˘fiÌÂÓÔ ·fi ‰ÈÛÎ¤Ù·Ô˘ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ÂÚÁ·Û›· ÛÂ ÚfiÁÚ·ÌÌ· Word Î·ÈÙÔ˘˜ ›Ó·ÎÂ˜, ·Ó Â›Ó·È ‰˘Ó·ÙfiÓ, ÛÂ ÚfiÁÚ·ÌÌ· Excel, Î·-ıÒ˜ Î·È ÂÈÛÙÔÏ‹ fiÔ˘ Ó· ·Ó·Ê¤ÚÔÓÙ·È ·Ó·Ï˘ÙÈÎ¿ ÔÈ ÙÚÔ-ÔÔÈ‹ÛÂÈ˜ ‹ ÔÈ ·ÓÙÈÚÚ‹ÛÂÈ˜ ÛÙÈ˜ ÚÔÙ¿ÛÂÈ˜ ÙˆÓ ÎÚÈÙÒÓ.

H Î·ı˘ÛÙ¤ÚËÛË ÙË˜ Â·Ó˘Ô‚ÔÏ‹˜ ÙÔ˘ ÙÚÔÔÔÈ-ËÌ¤ÓÔ˘ ÎÂÈÌ¤ÓÔ˘ ¤Ú·Ó ÙˆÓ 30 ËÌÂÚÒÓ Û˘ÓÂ¿ÁÂÙ·ÈÓ¤· ˘Ô‚ÔÏ‹.

°È· Ó· ÂÈÙÂ˘¯ıÂ› Ë ¤ÁÎ·ÈÚË ‰ËÌÔÛ›Â˘ÛË ÙË˜ ÂÚÁ·-Û›·˜ Â›Ó·È ··Ú·›ÙËÙÔ Ó· ÂÈÛÙÚ¤ÊÂÙ·È ÙÔ ‰ÈÔÚıˆÌ¤ÓÔÙ˘ÔÁÚ·ÊÈÎfi ‰ÔÎ›ÌÈÔ ·fi ÙÔ˘˜ Û˘ÁÁÚ·ÊÂ›˜ Ì¤Û· ÛÂ‰‡Ô (2) ËÌ¤ÚÂ˜.

T· ¤ÍÔ‰· ÙˆÓ ÊÈÏÌ Î·È ÙˆÓ ·Ó·Ù‡ˆÓ ‚·Ú‡ÓÔ˘Ó ÙÔ˘˜Û˘ÁÁÚ·ÊÂ›˜ Î·È Ú¤ÂÈ Ó· ÏËÚÒÓÔÓÙ·È ÌÂ ÙËÓ ·ÔÛÙÔÏ‹ÙÔ˘ ÚÒÙÔ˘ ‰ÔÎÈÌ›Ô˘ Î·ÙÂ˘ıÂ›·Ó ÛÙÔÓ Ù˘ÔÁÚ¿ÊÔ.

T· ÎÂ›ÌÂÓ· ÙˆÓ ÂÚÁ·ÛÈÒÓ Ô˘ ‰ÂÓ Á›ÓÔÓÙ·È ·Ô‰ÂÎÙ¤˜ÁÈ· ‰ËÌÔÛ›Â˘ÛË ‰ÂÓ ÂÈÛÙÚ¤ÊÔÓÙ·È. MÔÚÂ› Ó· ÂÈÛÙÚ·-ÊÔ‡Ó, ÂÊfiÛÔÓ ˙ËÙËıÂ› ÂÓÙfi˜ ÂÍ·Ì‹ÓÔ˘, Ù· Û¯‹Ì·Ù· Î·È ÔÈÊˆÙÔÁÚ·Ê›Â˜ Ô˘ Ù· Û˘ÓÔ‰Â‡Ô˘Ó.

°. ™‡ÓÙ·ÍË ÙˆÓ ∂ÚÁ·ÛÈÒÓTÔ Û‡ÓÔÏÔ ÙË˜ ÂÚÁ·Û›·˜ (Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ

ÙˆÓ ÈÓ¿ÎˆÓ Î·È ÙˆÓ Ù›ÙÏˆÓ ÙˆÓ ÂÈÎfiÓˆÓ) Ú¤ÂÈ Ó· Â›Ó·È‰·ÎÙ˘ÏÔÁÚ·ÊËÌ¤ÓÔ ÛÙË ÌÈ· fi„Ë ÏÂ˘ÎÔ‡ ¯·ÚÙÈÔ‡ ÌÂÁ¤ıÔ˘˜

O‰ËÁ›Â˜ ÚÔ˜ ÙÔ˘˜ ™˘ÁÁÚ·ÊÂ›˜

v

May-June 03 03-06-03 16:55 ™ÂÏ›‰·5

A4 (21x29.7 cm) ÌÂ ‰ÈÏfi ‰È¿ÛÙËÌ· ÌÂÙ·Í‡ ÙˆÓ ÁÚ·ÌÌÒÓÎ·È ÂÚÈıÒÚÈ· ÙÔ˘Ï¿¯ÈÛÙÔÓ 2,5 cm ÛÙÈ˜ ‰‡Ô ÏÂ˘Ú¤˜.

TÔ ÎÂ›ÌÂÓÔ Ú¤ÂÈ Ó· ¤¯ÂÈ ÙËÓ ·ÎfiÏÔ˘ıË ‰È¿Ù·ÍË:ÛÂÏ›‰· Ù›ÙÏÔ˘, ‚Ú·¯‡˜ Ù›ÙÏÔ˜, ÂÚ›ÏË„Ë ÛÙ· ÂÏÏËÓÈÎ¿ Î·ÈÙ· ·ÁÁÏÈÎ¿, ÎÂ›ÌÂÓÔ, Â˘¯·ÚÈÛÙ›Â˜ Î·ıÒ˜ Î·È ·Ó·ÊÔÚ¿ ÛÂÂÈ‰ÔÙ‹ÛÂÈ˜-¯ÔÚËÁ›Â˜ ‹ ¿ÏÏÂ˜ ËÁ¤˜ ˘ÔÛÙ‹ÚÈÍË˜, ‚È-‚ÏÈÔÁÚ·Ê›·, ›Ó·ÎÂ˜, ÂÈÎfiÓÂ˜, Ù›ÙÏÔÈ ÂÈÎfiÓˆÓ, Î·Ù¿ÏÔÁÔ˜Û˘ÓÙÌ‹ÛÂˆÓ. K¿ıÂ ¤Ó· ·fi Ù· ·Ú·¿Óˆ ÛÙÔÈ¯Â›· Ú¤-ÂÈ Ó· ·Ú¯›˙ÂÈ ÛÂ ¯ˆÚÈÛÙfi Ê‡ÏÏÔ Î·È ÔÈ ÛÂÏ›‰Â˜ Ó· ·ÚÈı-ÌÔ‡ÓÙ·È ‰È·‰Ô¯ÈÎ¿ ·Ú¯›˙ÔÓÙ·˜ ÌÂ ÙË ÛÂÏ›‰· Ù›ÙÏÔ˘.

H ¤ÎÙ·ÛË ÚÔÛ‰ÈÔÚ›˙ÂÙ·È ÁÈ·: ·. ÙÈ˜ ·Ó·ÛÎÔ‹ÛÂÈ˜ ÛÂ 2000-3000 Ï¤ÍÂÈ˜. ‚. ÙÈ˜ ÂÚÂ˘ÓËÙÈÎ¤˜ ÂÚÁ·Û›Â˜ Î·È ÙÈ˜ ÂÓ‰È·Ê¤ÚÔ˘ÛÂ˜ Â-

ÚÈÙÒÛÂÈ˜ ÛÂ 1500-2500 Ï¤ÍÂÈ˜. Á. ÙÈ˜ ‚Ú·¯Â›Â˜ ‰ËÌÔÛÈÂ‡ÛÂÈ˜ ÛÂ 1000-1500 Ï¤ÍÂÈ˜. ‰. ÙÈ˜ ÂÈÛÙÔÏ¤˜ ÛÂ 250-500 Ï¤ÍÂÈ˜.

™ÂÏ›‰· Ù›ÙÏÔ˘¶Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ:

- ÙÔÓ Ù›ÙÏÔ (<14 Ï¤ÍÂÈ˜) Î·ıÒ˜ Î·È ÙÔÓ ‚Ú·¯‡ Ù›ÙÏÔ (<5Ï¤ÍÂÈ˜) ÙÔ˘ ¿ÚıÚÔ˘. ¢ÂÓ ÂÈÙÚ¤ÔÓÙ·È Û˘ÓÙÌ‹ÛÂÈ˜,

- ÙÔ fiÓÔÌ· Î·È ÙÔ ÂÒÓ˘ÌÔ Î¿ıÂ Û˘ÁÁÚ·Ê¤· ÛÙËÓÔÓÔÌ·ÛÙÈÎ‹,

- ÙÔ ÂÈÛÙËÌÔÓÈÎfi Î¤ÓÙÚÔ (›‰Ú˘Ì·, ÎÏÈÓÈÎ‹, ÂÚÁ·ÛÙ‹-ÚÈÔ) ·fi fiÔ˘ ÚÔ¤Ú¯ÂÙ·È Ë ÂÚÁ·Û›·. ™Â ÂÚ›ÙˆÛË¤ÏÏÂÈ„Ë˜ Û˘ÓÂÚÁ·Û›·˜ ÌÂ Û˘ÁÎÂÎÚÈÌ¤Ó· Î¤ÓÙÚ·,Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÂÙ·È Ë È‰ÈfiÙËÙ· ÙÔ˘/ÙˆÓ Û˘ÁÁÚ·-Ê¤ˆÓ (.¯. È‰ÈÒÙË˜ ·È‰›·ÙÚÔ˜) Î·È Ô ÙfiÔ˜ ‰È·ÌÔ-Ó‹˜ ÙÔ˘/ÙˆÓ,

- ÙËÓ Ï‹ÚË ‰ÈÂ‡ı˘ÓÛË, e-mail Î·È ÙÔ ÙËÏ¤ÊˆÓÔ ÙÔ˘Û˘ÁÁÚ·Ê¤· ÌÂ ÙÔÓ ÔÔ›Ô Á›ÓÂÙ·È Ë ·ÏÏËÏÔÁÚ·Ê›·.

¶ÂÚÈÏ‹„ÂÈ˜H ÂÚ›ÏË„Ë Ú¤ÂÈ Ó· ·Ó·ÎÂÊ·Ï·ÈÒÓÂÈ ÙÔ˘˜ ÛÙfi¯Ô˘˜

ÙË˜ ÂÚÁ·Û›·˜, ÙË ÌÂıÔ‰ÔÏÔÁ›·, Ù· Î˘ÚÈfiÙÂÚ· ·ÔÙÂÏ¤-ÛÌ·Ù· Î·È Ù· Û˘ÌÂÚ¿ÛÌ·Ù· ÙË˜ ÌÂÏ¤ÙË˜. £· Ú¤ÂÈ Ó·ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÔ˘Ï¿¯ÈÛÙÔÓ 200 Ï¤ÍÂÈ˜, fiÌˆ˜ ‰ÂÓ ı· Ú¤-ÂÈ Ó· ˘ÂÚ‚·›ÓÂÈ ÙÈ˜ 250 Ï¤ÍÂÈ˜. ∏ ÂÚ›ÏË„Ë ÙˆÓ ÂÚÁ·-ÛÈÒÓ Ú¤ÂÈ Ó· Â›Ó·È ‰ÔÌËÌ¤ÓË ÛÙÈ˜ ÂÍ‹˜ ·Ú·ÁÚ¿ÊÔ˘˜:ÂÈÛ·ÁˆÁ‹, Ì¤ıÔ‰ÔÈ, ·ÔÙÂÏ¤ÛÌ·Ù· Î·È Û˘ÌÂÚ¿ÛÌ·Ù·.

™ÙËÓ ÂÚ›ÏË„Ë ÛÙ· ·ÁÁÏÈÎ¿ Ú¤ÂÈ Ó· ·Ó·ÁÚ¿ÊÔ-ÓÙ·È ÛÙËÓ ·Ú¯‹ ÙÔ˘ ÎÂÈÌ¤ÓÔ˘ Ô Ù›ÙÏÔ˜ ÙË˜ ÂÚÁ·Û›·˜ Î·ÈÙ· ÔÓfiÌ·Ù· ÙˆÓ Û˘ÁÁÚ·Ê¤ˆÓ ÛÙ· ·ÁÁÏÈÎ¿. TÔ ÂÚÈÂ¯fi-ÌÂÓÔ ÙÔ˘ ·ÁÁÏÈÎÔ‡ ÎÂÈÌ¤ÓÔ˘ Ú¤ÂÈ Ó· Â›Ó·È ‰ÔÌËÌ¤ÓÔÛÂ ÂÈÛ·ÁˆÁ‹ (background), Ì¤ıÔ‰ÔÈ (methods), ·ÔÙÂ-Ï¤ÛÌ·Ù· (results) Î·È Û˘ÌÂÚ¿ÛÌ·Ù· (conclusions). HÂÚ›ÏË„Ë ÛÙ· ·ÁÁÏÈÎ¿ ‰ÂÓ Ú¤ÂÈ Ó· ‰È·Ê¤ÚÂÈ ·fi ÙËÓ·ÓÙ›ÛÙÔÈ¯Ë ÛÙ· ÂÏÏËÓÈÎ¿.

T· ¿ÚıÚ· Û‡ÓÙ·ÍË˜ Î·È ÔÈ ·ÂÈÎÔÓÈÛÙÈÎ¤˜ ÂÚÈÙÒ-ÛÂÈ˜ ¤¯Ô˘Ó ÌfiÓÔ ·ÁÁÏÈÎ‹ ÂÚ›ÏË„Ë.

K¿Ùˆ ·fi ÙËÓ ÂÏÏËÓÈÎ‹ Î·È ÙËÓ ·ÁÁÏÈÎ‹ ÂÚ›ÏË„ËÛËÌÂÈÒÓÔÓÙ·È ÙÚÂÈ˜ ¤ˆ˜ ¤ÓÙÂ Ï¤ÍÂÈ˜ ÎÏÂÈ‰È¿ Ô˘ ı·¯ÚËÛÈÌÔÔÈËıÔ‡Ó ÁÈ· ÙÔ ıÂÌ·ÙÈÎfi Â˘ÚÂÙ‹ÚÈÔ.

KÂ›ÌÂÓÔOÈ ÂÚÂ˘ÓËÙÈÎ¤˜ ÂÚÁ·Û›Â˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó: ÂÈÛ·ÁˆÁ‹,

ÌÂıfi‰Ô˘˜, ·ÔÙÂÏ¤ÛÌ·Ù· Î·È Û˘˙‹ÙËÛË. H ÂÈÛ·ÁˆÁ‹ Â-ÚÈÏ·Ì‚¿ÓÂÈ Ù· ÙÂÏÂ˘Ù·›· ‰Â‰ÔÌ¤Ó· ÙË˜ ¤ÚÂ˘Ó·˜ ÛÙÔ Û˘-ÁÎÂÎÚÈÌ¤ÓÔ ı¤Ì· ÌÂ ÙÈ˜ Î˘ÚÈfiÙÂÚÂ˜ ‚È‚ÏÈÔÁÚ·ÊÈÎ¤˜ ·Ú·-

ÔÌ¤˜ Î·È ÙÔ ÛÎÔfi ÙË˜ ÂÚÁ·Û›·˜. H ÂÚÈÁÚ·Ê‹ ÙˆÓ ÌÂ-ıfi‰ˆÓ Ú¤ÂÈ Ó· Â›Ó·È ·ÎÚÈ‚‹˜ Î·È ·ÚÎÂÙ¿ ÏÂÙÔÌÂÚ‹˜ÒÛÙÂ Ó· ÂÈÙÚ¤ÂÈ ÙËÓ ·Ó··Ú·ÁˆÁ‹ ÙÔ˘˜ ·fi ¿ÏÏÔ˘˜ÂÚÂ˘ÓËÙ¤˜. ∂›ÛË˜, Ú¤ÂÈ ÌÂ ÏÂÙÔÌ¤ÚÂÈÂ˜ Ó· ·Ó·Ê¤ÚÔ-ÓÙ·È ÔÈ ÛÙ·ÙÈÛÙÈÎ¤˜ Ì¤ıÔ‰ÔÈ ·Ó¿Ï˘ÛË˜ Î·È ·ÍÈÔÏfiÁËÛË˜ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ. T· ·ÔÙÂÏ¤ÛÌ·Ù· Ú¤ÂÈ Ó· ·ÚÔ˘-ÛÈ¿˙ÔÓÙ·È ÌÂ Û·Ê‹ÓÂÈ· Î·È Ó· Û˘ÓÔ‰Â‡ÔÓÙ·È ·fi ÙËÓ ··-Ú·›ÙËÙË ÛÙ·ÙÈÛÙÈÎ‹ ·Ó¿Ï˘ÛË. H Û˘˙‹ÙËÛË Ú¤ÂÈ Ó· ÂÚÈ-Ï·Ì‚¿ÓÂÈ Ù· Û˘ÌÂÚ¿ÛÌ·Ù· Ô˘ ÚÔÎ‡ÙÔ˘Ó ·fi ÙËÓ ÂÚ-Á·Û›·, ÙË ÛËÌ·Û›· Ô˘ ÌÔÚÂ› Ó· ¤¯Ô˘Ó Î·È ÙËÓ Èı·Ó‹ Û˘-Û¯¤ÙÈÛ‹ ÙÔ˘˜ ÌÂ ·Ú·ÙËÚ‹ÛÂÈ˜ ¿ÏÏˆÓ ÂÚÂ˘ÓËÙÒÓ.

OÈ ÂÓ‰È·Ê¤ÚÔ˘ÛÂ˜ ÂÚÈÙÒÛÂÈ˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Û‡ÓÙÔ-ÌË ÂÈÛ·ÁˆÁ‹, ÂÚÈÁÚ·Ê‹ ÙË˜ ÂÚ›ÙˆÛË˜ Î·È ‚Ú·¯Â›· Û˘˙‹-ÙËÛË. OÈ ·ÂÈÎÔÓÈÛÙÈÎ¤˜ ÂÚÈÙÒÛÂÈ˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Û‡ÓÙÔ-ÌË ÂÚÈÁÚ·Ê‹ ÙË˜ ÂÚ›ÙˆÛË˜ Î·È ‚Ú·¯Â›· Û˘˙‹ÙËÛË ÌÂ ¤Ì-Ê·ÛË ÛÙË ‰È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË. T· ˘fiÏÔÈ· ı¤Ì·Ù· ¤¯Ô˘ÓÂÏÂ‡ıÂÚË ‰ÔÌ‹ Î·Ù¿ ÙËÓ ÎÚ›ÛË ÙˆÓ Û˘ÁÁÚ·Ê¤ˆÓ ÙÔ˘˜.

∂˘¯·ÚÈÛÙ›Â˜ ‹ ·Ó·ÁÓˆÚ›ÛÂÈ˜ (·Ó·ÊÔÚ¿ ÛÂ ÂÈ‰ÔÙ‹-ÛÂÈ˜ - ¯ÔÚËÁ›Â˜ ‹ ¿ÏÏÂ˜ ËÁ¤˜ ˘ÔÛÙ‹ÚÈÍË˜) ı· Ú¤ÂÈÓ· ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔ Ù¤ÏÔ˜ ÙÔ˘ ÎÂÈÌ¤ÓÔ˘ Î·È ÚÈÓ ·fi ÙÈ˜‚È‚ÏÈÔÁÚ·ÊÈÎ¤˜ ·Ú·ÔÌ¤˜.

TÈÌ¤˜ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛÂˆÓOÈ ÙÈÌ¤˜ 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· Ì¤-Û· ÛÂ ·Ú¤ÓıÂÛË. ¶›Ó·ÎÂ˜ ÌÂÙ·ÙÚÔ‹˜ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·ÈÛÙÔ JAMA 1986;255:2329-2339.

™˘ÓÙÔÌÔÁÚ·Ê›Â˜OÈ Û˘ÓÙÔÌÔÁÚ·Ê›Â˜ Ô˘ ¤¯Ô˘Ó ÂÈ‚ÏËıÂ› ‰ÈÂıÓÒ˜ ‰Ë-

ÌÔÛÈÂ‡ÔÓÙ·È ÛÂ Î¿ıÂ ÙÂ‡¯Ô˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. ™‡ÓıÂÙÔÈÎ·È Ì·ÎÚÔÛÎÂÏÂ›˜ fiÚÔÈ Ô˘ Â·Ó·Ï·Ì‚¿ÓÔÓÙ·È Û˘¯Ó¿ÛÙÔ ÎÂ›ÌÂÓÔ ÌÔÚÔ‡Ó Ó· ·ÓÙÈÎ·ı›ÛÙ·ÓÙ·È ·fi Û˘ÓÙÔÌÔ-ÁÚ·Ê›Â˜ Ô˘ ÂÂÍËÁÔ‡ÓÙ·È ·fi ÙÔ˘˜ Û˘ÁÁÚ·ÊÂ›˜ ÛÂ ÂÈ-‰ÈÎfi Î·Ù¿ÏÔÁÔ, Ô ÔÔ›Ô˜ ˘Ô‚¿ÏÏÂÙ·È Ì·˙› ÌÂ ÙËÓ ÂÚÁ·-Û›·. OÈ Û˘ÓÙÔÌÔÁÚ·Ê›Â˜ ·Ó·Ê¤ÚÔÓÙ·È ÛÂ ·Ú¤ÓıÂÛË Ìfi-ÓÔ ÛÙÈ˜ ÂÚÈÏ‹„ÂÈ˜.

BÈ‚ÏÈÔÁÚ·ÊÈÎ¤˜ ·Ú·ÔÌ¤˜™ÙÔ ÙÌ‹Ì· ÙË˜ ‚È‚ÏÈÔÁÚ·Ê›·˜ Î·Ù·¯ˆÚÔ‡ÓÙ·È fiÏÂ˜ ÔÈ

‚È‚ÏÈÔÁÚ·ÊÈÎ¤˜ ·Ú·ÔÌ¤˜ ÌÂ ÙË ÛÂÈÚ¿ Ô˘ ·Ó·Ê¤ÚÔ-ÓÙ·È ÛÙÔ ÎÂ›ÌÂÓÔ. ™ÙÔ ÎÂ›ÌÂÓÔ ÔÈ ‚È‚ÏÈÔÁÚ·ÊÈÎ¤˜ ·Ú·Ô-Ì¤˜ ·Ó·Ê¤ÚÔÓÙ·È ÌÂ ·Ú·‚ÈÎÔ‡˜ ·ÚÈıÌÔ‡˜ ÛÂ ·Ú¤ÓıÂ-ÛË. OÈ ‚È‚ÏÈÔÁÚ·ÊÈÎ¤˜ ·Ú·ÔÌ¤˜ ‰ÂÓ Ú¤ÂÈ Ó· ˘ÂÚ-‚·›ÓÔ˘Ó ÙÈ˜ 70 ÛÙÈ˜ ·Ó·ÛÎÔ‹ÛÂÈ˜, ÙÈ˜ 30 ÛÙÈ˜ ÂÚÂ˘ÓËÙÈ-Î¤˜ ÂÚÁ·Û›Â˜, ÙÈ˜ 12 ÛÙ· Â›Î·ÈÚ· ı¤Ì·Ù· Î·È ÙÈ˜ ÂÓ‰È·-Ê¤ÚÔ˘ÛÂ˜ ÂÚÈÙÒÛÂÈ˜, ÙÈ˜ 5 ÛÙÈ˜ ‚Ú·¯Â›Â˜ ‰ËÌÔÛÈÂ‡-ÛÂÈ˜ Î·È ÛÙÈ˜ ÂÈÛÙÔÏ¤˜.

H Û‡ÓÙ·ÍË ÙˆÓ ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·ÔÌÒÓ Á›ÓÂÙ·ÈÛ‡ÌÊˆÓ· ÌÂ ÙÈ˜ ÚÔ‰È·ÁÚ·Ê¤˜ ÙË˜ InternationalCommittee of Medical Journal Editors/UniformRequirements for Manuscripts Submitted to BiomedicalJournals (JAMA 1997;277:927-934), http://jama.ama-assn.org/info/auinst_req.html. OÈ Û˘ÓÙÌ‹ÛÂÈ˜ ÙˆÓ Ù›ÙÏˆÓÙˆÓ ÂÚÈÔ‰ÈÎÒÓ Á›ÓÔÓÙ·È ÌÂ ‚¿ÛË ÙÔ Cumulated IndexMedicus (List of Journals Indexed in Index Medicus,http://www.nlm.nih.gov).

vi

May-June 03 03-06-03 16:55 ™ÂÏ›‰·6

¶·Ú·‰Â›ÁÌ·Ù· ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·ÔÌÒÓ

I. ¶ÂÚÈÔ‰ÈÎ¿AÓ ÔÈ Û˘ÁÁÚ·ÊÂ›˜ Â›Ó·È ¤ˆ˜ ¤ÍÈ ·Ó·ÁÚ¿ÊÔÓÙ·È fiÏÔÈ,

·Ó Â›Ó·È ÂÙ¿ ‹ ÂÚÈÛÛfiÙÂÚÔÈ ·Ó·ÁÚ¿ÊÔÓÙ·È ÔÈ ÚÒÙÔÈ¤ÍÈ Î·È ÚÔÛÙ›ıÂÙ·È “et al” ‹ “Î·È Û˘Ó”.

T·ÎÙÈÎ‹ ¤Î‰ÔÛË ÂÚÈÔ‰ÈÎÔ‡:∞ÓÙˆÓ›Ô˘ ¢, ª¿Ú· Ã, °È·ÓÓ¿ÙÔ˘ Ã. ∂Ì‚fiÏÈ·: Â›‰Ú·-

ÛË ÛÙËÓ ÂÈ‰ËÌÈÔÏÔÁ›· ÙˆÓ ÏÔÈÌˆ‰ÒÓ ÓÔÛËÌ¿ÙˆÓ Î·È ÙËÓ·È‰È·ÙÚÈÎ‹ Ú¿ÍË. ¶·È‰È·ÙÚÈÎ‹ 1999;59:272-279.

Proesmans W. Bartter syndrome and its neonatalvariant. Eur J Pediatr 1997;156:669-679.

™˘ÌÏËÚˆÌ·ÙÈÎfi ÙÂ‡¯Ô˜ ÂÚÈÔ‰ÈÎÔ‡:Flyvbjerg A. Role of growth hormone, insulin-like

growth factors (IGFs) and IGF-binding proteins in therenal complications of diabetes. Kidney Int 1997;52 (60Suppl):S12-S19.

ÃˆÚ›˜ Û˘ÁÁÚ·Ê¤·:National Institutes of Health Consensus Development

Conference. Neurofibromatosis conference statement.Arch Neurol 1988;45:575-578.

¶ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù‡Ô˘ ¿ÚıÚÔ˘:Ã·Ú·Ï·Ì›‰Ë˜ π, ¶··‰fiÔ˘ÏÔ˜ ∞. ¶·¯˘Û·ÚÎ›· Î·È

˘ÂÚÏÈÈ‰·ÈÌ›· [¶ÂÚ›ÏË„Ë]. 36Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘-Ó¤‰ÚÈÔ; 1998 5-7 πÔ˘Ó›Ô˘; ¶¿ÊÔ˜, ∫‡ÚÔ˜; 1998. ÛÂÏ. 199.

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

J Am Soc Nephrol 1991;2:562.

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

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

II. µÈ‚Ï›·

∫ÂÊ¿Ï·ÈÔ ÛÂ ‚È‚Ï›Ô: Clark AG, Barratt TM. Steroid-responsive nephrotic

syndrome. In: Barratt TM, Arner ED, Harmon WE, editors.Pediatric Nephrology. 4th ed. Baltimore: LippincottWilliam 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 ÛÂ ÙfiÌÔ Ú·ÎÙÈÎÒÓ:Bauer AW. The two definitions of bacterial resistance.

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

31; New York: International Society of Chemotherapy;1963. p. 484-500.

¢È‰·ÎÙÔÚÈÎ‹ ‰È·ÙÚÈ‚‹:¶··‰fiÔ˘ÏÔ˜ Ã.. ∏ ıÂÚ·Â›· ÙÔ˘ ÛÙÚ·‚ÈÛÌÔ‡. [‰È‰·-

ÎÙÔÚÈÎ‹ ‰È·ÙÚÈ‚‹]. ∞ı‹Ó·: ¶·ÓÂÈÛÙ‹ÌÈÔ ∞ıËÓÒÓ; 1979.

Kaplan SJ. Post hospital home health care: theelderly’s access and utilization [dissertation]. St. Louis(Mo): Washington Univ.; 1995.

¶›Ó·ÎÂ˜ Î·È EÈÎfiÓÂ˜AÔÛÙ¤ÏÏÔÓÙ·È ÂÈ˜ ÙÚÈÏÔ‡Ó (¤Ó· ÚˆÙfiÙ˘Ô+‰‡Ô

ÊˆÙÔ·ÓÙ›ÁÚ·Ê·). ¶Ú¤ÂÈ Ó· ¤¯Ô˘Ó Ï¿ÙÔ˜ ›ÛÔ ÌÂ ÙÔ Ï¿-ÙÔ˜ ÙÔ˘ ÌÔÓfiÛÙËÏÔ˘ (8 cm) ‹ ÌÂ ÙÔ Ï¿ÙÔ˜ fiÏË˜ ÙË˜ ÛÂ-Ï›‰·˜ (16,8 cm). TÔ Ì¤ÁÈÛÙÔ Ì‹ÎÔ˜ ÙÔ˘˜, Ì·˙› ÌÂ ÙÔ˘˜ Ù›Ù-ÏÔ˘˜, ‰ÂÓ Ú¤ÂÈ Ó· Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ ·fi 22 cm.

OÈ ›Ó·ÎÂ˜ ·ÚÈıÌÔ‡ÓÙ·È ÌÂ ·Ú·‚ÈÎÔ‡˜ ·ÚÈıÌÔ‡˜ ÌÂ ÙËÛÂÈÚ¿ Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÔ ÎÂ›ÌÂÓÔ. ¶ÂÚÈÏ·Ì‚¿ÓÔ˘Ó‚Ú·¯‡ Ù›ÙÏÔ Î·È ÂÂÍ‹ÁËÛË ÙˆÓ Û˘ÓÙÌ‹ÛÂˆÓ ÛÙÔ Î¿ÙˆÌ¤ÚÔ˜. ™ÙÔ˘˜ ›Ó·ÎÂ˜ Ú¤ÂÈ Ó· ·ÔÊÂ‡ÁÔÓÙ·È ÔÈ Î¿ıÂ-ÙÂ˜ ÁÚ·ÌÌ¤˜.

ŸÏÔ ÙÔ ·ÂÈÎÔÓÈÛÙÈÎfi ˘ÏÈÎfi (Û¯‹Ì·Ù·, ‰È·ÁÚ¿ÌÌ·Ù·,ÊˆÙÔÁÚ·Ê›Â˜, Î.Ï.) ̄ ·Ú·ÎÙËÚ›˙ÂÙ·È ̂ ˜ ÂÈÎfiÓÂ˜. £· Ú¤ÂÈÓ· Â›Ó·È ¿ÚÈÛÙË˜ ÔÈfiÙËÙ·˜ ÌÂ ÌÔÚÊ‹ ÊˆÙÔÁÚ·ÊÈÒÓ ‹ Î·ÈÚˆÙÔÙ‡ˆÓ. ™ÙÔ ›Ûˆ Ì¤ÚÔ˜ ÙˆÓ ÂÈÎfiÓˆÓ Ú¤ÂÈ Ó· ÛË-ÌÂÈÒÓÂÙ·È ÌÂ ÌÔÏ‡‚È Ô ·ÚÈıÌfi˜ ÙË˜ ÂÈÎfiÓ·˜ Î·È ÙÔ fiÓÔÌ·ÙÔ˘ ÚÒÙÔ˘ Û˘ÁÁÚ·Ê¤·, Î·ıÒ˜ Î·È ¤Ó· ‚¤ÏÔ˜ ÙÔ ÔÔ›Ô Ó·‰Â›¯ÓÂÈ ÙÔ ¿Óˆ Ì¤ÚÔ˜ ÙË˜ ÂÈÎfiÓ·˜. ™ÙÈ˜ ÊˆÙÔÁÚ·Ê›Â˜·ÛıÂÓÒÓ ‰ÂÓ Ú¤ÂÈ Ó· ·Ó·ÁÓˆÚ›˙ÂÙ·È Ë Ù·˘ÙfiÙËÙ¿ ÙÔ˘˜.OÈ ·ÛıÂÓÂ›˜ ‰ÂÓ Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È ÔÓÔÌ·ÛÙÈÎ¿.

¶ÚÈÓ ·ÔÛÙÂ›ÏÂÙÂ ÙËÓ ÂÚÁ·Û›· Û·˜ ‚Â‚·ÈˆıÂ›ÙÂ fiÙÈ Â-ÚÈÏ·Ì‚¿ÓÂÈ:

1. ∂ÈÛÙÔÏ‹ ˘Ô‚ÔÏ‹˜.2. ¢‹ÏˆÛË ÌË ÚÔÁÂÓ¤ÛÙÂÚË˜ ‰ËÌÔÛ›Â˘ÛË˜ ÙË˜ ÂÚÁ·Û›·˜.3. 3 ·ÓÙ›ÁÚ·Ê· ÙÔ˘ ÎÂÈÌ¤ÓÔ˘ ÙË˜ ÂÚÁ·Û›·˜.4. ™ÂÏ›‰· Ù›ÙÏÔ˘ (¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) ÂÚÈÏ·Ì‚¿ÓÂÈ:

·. Ù›ÙÏÔ Î·È ‚Ú·¯‡ Ù›ÙÏÔ ÂÚÁ·Û›·˜, ‚. fiÓÔÌ· Î·È ÂÒÓ˘ÌÔ Û˘ÁÁÚ·Ê¤ˆÓ (ÔÏÔÁÚ¿Êˆ˜), Á. ÂÈÛÙËÌÔÓÈÎfi/¿ Î¤ÓÙÚÔ/· fiÔ˘ ¤ÁÈÓÂ Ë ÂÚÁ·Û›·, ‰. fiÓÔÌ·, ‰ÈÂ‡ı˘ÓÛË Î·È ÙËÏ¤ÊˆÓÔ Û˘ÁÁÚ·Ê¤· ÁÈ·

·ÏÏËÏÔÁÚ·Ê›·. 5. ¶ÂÚ›ÏË„Ë ÂÏÏËÓÈÎ‹-·ÁÁÏÈÎ‹, Ï¤ÍÂÈ˜ ÎÏÂÈ‰È¿ (‰ÈÏfi

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

ÚÈÛÙ‹ ÛÂÏ›‰·).7. ∫Â›ÌÂÓÔ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·).8. ∂˘¯·ÚÈÛÙ›Â˜ ‹ ·Ó·ÁÓˆÚ›ÛÂÈ˜ (·Ó·ÊÔÚ¿ ÛÂ ÂÈ‰ÔÙ‹-

ÛÂÈ˜-¯ÔÚËÁ›Â˜ ‹ ¿ÏÏÂ˜ ËÁ¤˜ ˘ÔÛÙ‹ÚÈÍË˜).9. µÈ‚ÏÈÔÁÚ·Ê›· (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·).

10. ¶›Ó·ÎÂ˜ (Ô Î·ı¤Ó·˜ ÛÂ ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) ÂÈ˜ ÙÚÈÏÔ‡Ó.11. ∂ÈÎfiÓÂ˜, ÌÂ ‚¤ÏÔ˜ ÛÙÔ ›Ûˆ Ì¤ÚÔ˜ Ó· ‰Â›¯ÓÂÈ ÚÔ˜

Ù· Â¿Óˆ, ·ÚÈıÌËÌ¤ÓÂ˜, ÂÈ˜ ÙÚÈÏÔ‡Ó.12. ∆›ÙÏÔÈ ÂÈÎfiÓˆÓ (‰ÈÏfi ‰È¿ÛÙËÌ· - Ô Î·ı¤Ó·˜ ÛÂ ¯ˆ-

ÚÈÛÙ‹ ÛÂÏ›‰·) ÂÈ˜ ÙÚÈÏÔ‡Ó.

vii

May-June 03 03-06-03 16:55 ™ÂÏ›‰·7

¶·È‰È·ÙÚÈÎ‹ 2003;66:167-175 Paediatriki 2003;66:167-175

167

OÚÁ·ÓÈÎ¤˜ ‰È·Ù·Ú·¯¤˜ ÌÂ „˘¯È·ÙÚÈÎ‹ Û˘ÌÙˆÌ·ÙÔÏÔÁ›· ÛÙ· ·È‰È¿: Ë ‰ÈÂÚÂ‡ÓËÛË ·fi ÙÔÓ ·È‰›·ÙÚÔ ¡. ¶ÚˆÙ·ÁfiÚ· - §È·ÓÔ‡

Organic disorders with psychiatric symptomatology in children: investigation by the paediatrician D. Protagoras - Lianos

∞¡∞™∫O¶∏™∏ REVIEW ARTICLE

∞’ ¶·È‰È·ÙÚÈÎfi ∆Ì‹Ì·, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó·

1st Department of Paediatrics, “Aghia Sophia” Children’s Hospital, Athens

∂ÈÛ·ÁˆÁ‹∏ ÏÂÈÔÓfiÙËÙ· ÙˆÓ ·È‰ÈÒÓ ·ÚÔ˘ÛÈ¿˙ÂÈ Î·Ù¿

Î·ÈÚÔ‡˜ ‰È·Ù·Ú·¯¤˜ Û˘Ó·ÈÛıËÌ¿ÙˆÓ Î·È Û˘ÌÂÚÈ-ÊÔÚ¿˜ (1). ™ÙÈ˜ ÂÚÈÛÛfiÙÂÚÂ˜ ÂÚÈÙÒÛÂÈ˜, Ù·ÚÔ‚Ï‹Ì·Ù· Â›Ó·È ‹È·, ÂÓÒ Û·ÓÈfiÙÂÚ· ÏËÚÔ‡ÓÙ· Ù˘ÈÎ¿ ÎÚÈÙ‹ÚÈ· ÁÈ· ¿Á¯Ô˜, Î·Ù¿ıÏÈ„Ë, ‰È·Ù·Ú·-¯‹ ‰È·ÁˆÁ‹˜ ‹ „‡¯ˆÛË (2). ŸÙ·Ó ÔÈ ÁÔÓÂ›˜ ·Ú·-ÙËÚ‹ÛÔ˘Ó ÛÙÔ ·È‰› ÙÔ˘˜ ·ÏÏ·Á‹ ÚÔÛˆÈÎfiÙË-Ù·˜, Ë ÔÔ›· ÂËÚÂ¿˙ÂÈ ·ÚÓËÙÈÎ¿ ÙË Û¯ÔÏÈÎ‹ Â›‰Ô-ÛË, ÙÈ˜ ÎÔÈÓˆÓÈÎ¤˜ Û¯¤ÛÂÈ˜ ‹ ÙËÓ ·˘ÙÔÂÍ˘ËÚ¤ÙËÛ‹ÙÔ˘, Û˘¯Ó¿ ·Â˘ı‡ÓÔÓÙ·È ÚÒÙ· ÛÙÔÓ ·È‰›·ÙÚÔ.

¶ÔÏÏ¿ ÓÔÛ‹Ì·Ù· ÙË˜ ·È‰ÈÎ‹˜ Î·È ÂÊË‚ÈÎ‹˜ËÏÈÎ›·˜ Û˘ÓÔ‰Â‡ÔÓÙ·È ·fi „˘¯È·ÙÚÈÎ¿ Û˘ÌÙÒÌ·-Ù·. ™ÙÈ˜ ÂÚÈÛÛfiÙÂÚÂ˜ ÂÚÈÙÒÛÂÈ˜, ÙÔ ·È‰› ·-ÚÔ˘ÛÈ¿˙ÂÈ ¯·Ú·ÎÙËÚÈÛÙÈÎ‹ ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· ÙË˜ ÔÚÁ·-ÓÈÎ‹˜ ÓfiÛÔ˘. ™·ÓÈfiÙÂÚ·, fiÌˆ˜, Ù· „˘¯È·ÙÚÈÎ¿ Û˘-

ÌÙÒÌ·Ù· ÌÔÚÂ› Ó· ÚÔËÁËıÔ‡Ó ÙˆÓ ¿ÏÏˆÓ Î·Ù¿ÔÏÏÔ‡˜ Ì‹ÓÂ˜ ‹ ¯ÚfiÓÈ· (3-7).

O Goodman (5) ·Ú·ÏÏËÏ›˙ÂÈ ÙËÓ „˘¯ÈÎ‹ ‰È·Ù·-Ú·¯‹ ÌÂ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ËÏÂÎÙÚÔÓÈÎÔ‡ ˘ÔÏÔÁÈÛÙ‹(∏À). ŸÙ·Ó Ô ∏À ‰˘ÛÏÂÈÙÔ˘ÚÁÂ›, ˘¿Ú¯Ô˘Ó ÙÚÂÈ˜ È-ı·Ó¤˜ ÂÍËÁ‹ÛÂÈ˜: ‰ÂÓ ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÛˆÛÙ¿, ÂÚÈ¤-¯ÂÈ ÂÏ·ÙÙˆÌ·ÙÈÎfi ÚfiÁÚ·ÌÌ· ‹ ˘¿Ú¯ÂÈ ‚Ï¿‚Ë ÛÙ·ËÏÂÎÙÚÔÓÈÎ¿ Î˘ÎÏÒÌ·Ù¿ ÙÔ˘. ∆ÚÂÈ˜ ·ÚfiÌÔÈÂ˜ ÂÚÌË-ÓÂ›Â˜, ÌÂÌÔÓˆÌ¤ÓÂ˜ ‹ ÛÂ Û˘Ó‰˘·ÛÌfi, Ï·Ì‚¿ÓÔÓÙ·È˘’ fi„ÈÓ ÛÂ ÂÚ›ÙˆÛË „˘¯È·ÙÚÈÎÔ‡ ÚÔ‚Ï‹Ì·ÙÔ˜ÛÙÔ ·È‰›: ÙÔ ÎÔÈÓˆÓÈÎfi ÂÚÈ‚¿ÏÏÔÓ ÂÈ‚¿ÏÏÂÈ ÛÙÔ·È‰› ··ÈÙ‹ÛÂÈ˜ Ô˘ ˘ÂÚ‚·›ÓÔ˘Ó ÙÈ˜ ‰˘Ó·ÙfiÙËÙ¤˜ÙÔ˘, ¤¯ÂÈ ‰È‰·¯ÙÂ› ‰˘ÛÏÂÈÙÔ˘ÚÁÈÎÔ‡˜ ÙÚfiÔ˘˜ Û˘ÌÂ-ÚÈÊÔÚ¿˜ ‹ ˘¿Ú¯ÂÈ ÔÚÁ·ÓÈÎ‹ ‚Ï¿‚Ë ÙˆÓ ÓÂ˘ÚÒÓˆÓ.

™‡ÌÊˆÓ· ÌÂ ÙÔ “¢È·ÁÓˆÛÙÈÎfi ™Ù·ÙÈÛÙÈÎfi ∂Á¯ÂÈ-Ú›‰ÈÔ IV” ÙË˜ ∞ÌÂÚÈÎ·ÓÈÎ‹˜ æ˘¯È·ÙÚÈÎ‹˜ ∂Ù·ÈÚÂ›·˜

�¶ÂÚ›ÏË„Ë: ∏ ‰È¿ÁÓˆÛË ÙË˜ ˘ÔÎÂ›ÌÂÓË˜ ÔÚÁ·ÓÈ-Î‹˜ ÓfiÛÔ˘ ÛÙÔ ·È‰› ÌÂ „˘¯È·ÙÚÈÎ¿ Û˘ÌÙÒÌ·Ù·ÛÙËÚ›˙ÂÙ·È ÛÙË ‰ÈÂÍÔ‰ÈÎ‹ „˘¯È·ÙÚÈÎ‹ Î·È ·È‰È·ÙÚÈ-Î‹ ÂÍ¤Ù·ÛË. ™ÙÈ˜ ÂÚÈÛÛfiÙÂÚÂ˜ ÂÚÈÙÒÛÂÈ˜, ‰ÂÓ˘¿Ú¯Ô˘Ó ÂÈ‰ÈÎ¿ „˘¯È·ÙÚÈÎ¿ Û˘ÌÙÒÌ·Ù· Î·È ÔÈ·ÛıÂÓÂ›˜ ÌÔÚÂ› Ó· ·ÚÔ˘ÛÈ¿˙Ô˘Ó Â˘Ú‡ Ê¿ÛÌ·‰È·Ù·Ú·¯ÒÓ Û˘ÌÂÚÈÊÔÚ¿˜. ¶·È‰È¿ ÌÂ ÔÚÁ·ÓÈÎ¿ÓÔÛ‹Ì·Ù· ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Â›Ó·È ÈÔ ÂÈÚÚÂ‹ ÛÂ‰˘ÛÌÂÓÂ›˜ ÂÚÈ‚·ÏÏÔÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜ Î·È ÛÙÈ˜ÙÔÍÈÎ¤˜ ·ÚÂÓ¤ÚÁÂÈÂ˜ „˘¯ÔÙÚfiˆÓ Ê·ÚÌ¿ÎˆÓ. ∆Ô·ÚfiÓ ¿ÚıÚÔ ·ÚÔ˘ÛÈ¿˙ÂÈ ·Ó·ÛÎfiËÛË ÙˆÓ ÔÚÁ·-ÓÈÎÒÓ ÓÔÛËÌ¿ÙˆÓ Ô˘ ÌÔÚÂ› Ó· ÂÎ‰ËÏˆıÔ‡Ó ÌÂ„˘¯È·ÙÚÈÎ‹ Û˘ÌÙˆÌ·ÙÔÏÔÁ›· ÛÙ· ·È‰È¿, Î·ıÒ˜Î·È ÙˆÓ ÛËÌ·ÓÙÈÎÒÓ ÛÙÔÈ¯Â›ˆÓ ÙË˜ ·È‰È·ÙÚÈÎ‹˜ÎÏÈÓÈÎ‹˜ ÂÍ¤Ù·ÛË˜.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ÔÚÁ·ÓÈÎ‹ „˘¯È·ÙÚÈÎ‹ ‰È·Ù·Ú·¯‹,ÌÂÙ·‚ÔÏÈÎ‹ ÂÁÎÂÊ·ÏÔ¿ıÂÈ·, ÓÂ˘ÚÔ„˘¯È·ÙÚÈÎ‹,ÓÂ˘ÚÔÂÎÊ˘ÏÈÛÙÈÎ¿.

�Abstract: The diagnosis of underlying organicdisease in children with psychiatric symptoms isbased on a thorough psychiatric and paediatricexamination. In most cases, there are no specificpsychiatric symptoms and the patients may presentwith a wide range of behavioural disorders.Children with organic brain disease are moresusceptible both to unfavourable environmentalfactors and to the toxic side effects of psychotropicmedications. This article presents a review oforganic diseases in children which may presentwith psychiatric symptoms and outlines thesignificant elements of the paediatric clinicalexamination.

Key words: organic psychiatric disorder, meta-bolic encephalopathy, neuropsychiatry, neurode-generative disorder.

May-June 03 03-06-03 16:55 ™ÂÏ›‰·167

(DSM IV), Ë ‰È¿ÁÓˆÛË ÔÚÁ·ÓÈÎÔ‡ „˘¯È·ÙÚÈÎÔ‡ ÚÔ-‚Ï‹Ì·ÙÔ˜ ÌÔÚÂ› Ó· ÙÂıÂ› fiÙ·Ó ˘¿Ú¯Ô˘Ó “·Ô‰Â›-ÍÂÈ˜ ·fi ÙË Ê˘ÛÈÎ‹ ÂÍ¤Ù·ÛË, ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi¤ÏÂÁ¯Ô ‹ ÙÔ ÈÛÙÔÚÈÎfi ÁÈ· ÂÈ‰ÈÎfi ÔÚÁ·ÓÈÎfi ·Ú¿ÁÔ-ÓÙ·, Ô ÔÔ›Ô˜ ÎÚ›ÓÂÙ·È fiÙÈ ¤¯ÂÈ ·ÈÙÈÔÏÔÁÈÎ‹ Û¯¤ÛËÌÂ ÙË ‰È·Ù·Ú·¯‹” (8).

™Ù· Ï·›ÛÈ· ÂÈ‰ËÌÈÔÏÔÁÈÎ‹˜ ÌÂÏ¤ÙË˜ ÛÙËÓ∞ÁÁÏ›·, ÛÂ ÏÈÁfiÙÂÚÔ ·fi 10% ÙˆÓ ·È‰ÈÒÓ ÌÂ „˘-¯È·ÙÚÈÎ¤˜ ‰È·Ù·Ú·¯¤˜ Î·È Ê˘ÛÈÔÏÔÁÈÎfi ÓÔËÙÈÎfi Ë-Ï›ÎÔ ‚Ú¤ıËÎÂ ÔÚÁ·ÓÈÎ‹ ‚Ï¿‚Ë ÂÁÎÂÊ¿ÏÔ˘ (5).

∏ ¤ÁÎ·ÈÚË ‰È¿ÁÓˆÛË, Ë Î·Ù¿ÏÏËÏË È·ÙÚÈÎ‹ ·Áˆ-Á‹ Î·È Ë ·Ú·ÔÌ‹ ÛÂ ÂÈ‰ÈÎÔ‡˜ ÂÓ‰¤¯ÂÙ·È Ó· ·Ô-ÙÚ¤„ÂÈ ‹ Ó· ÌÂÙÚÈ¿ÛÂÈ ÙËÓ ÂÍ¤ÏÈÍË ÙË˜ ·Ûı¤ÓÂÈ·˜.∞ÎfiÌË Î·È fiÙ·Ó ‰ÂÓ ˘¿Ú¯ÂÈ ÂÈ‰ÈÎ‹ ıÂÚ·Â›·, ÌÔ-ÚÂ› Ó· Ô‰ËÁ‹ÛÂÈ ÛÂ ÁÂÓÂÙÈÎ‹ Û˘Ì‚Ô˘ÏÂ˘ÙÈÎ‹, ÂÓË-Ì¤ÚˆÛË ÁÈ· ÙËÓ ÚfiÁÓˆÛË Î·È Î·Ù¿ÏÏËÏË „˘¯Ô-ÎÔÈÓˆÓÈÎ‹ ÛÙ‹ÚÈÍË.

™ÙË ÌÂÏ¤ÙË ·˘Ù‹ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÔÈ ÔÚÁ·ÓÈÎ¤˜·ÈÙ›Â˜ „˘¯È·ÙÚÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ, Ù· ÛÙÔÈ¯Â›· ÙÔ˘ÈÛÙÔÚÈÎÔ‡, ÙË˜ ·ÓÙÈÎÂÈÌÂÓÈÎ‹˜ ÂÍ¤Ù·ÛË˜, Î·ıÒ˜ Î·ÈÔÈ ÂÚÁ·ÛÙËÚÈ·Î¤˜ ÂÍÂÙ¿ÛÂÈ˜ Ô˘ Ú¤ÂÈ Ó· Û˘ÓÂ-ÎÙÈÌÔ‡ÓÙ·È, ÚÔÎÂÈÌ¤ÓÔ˘ Ó· Ô‰ËÁËıÂ› Ô ·È‰›·ÙÚÔ˜ÛÙËÓ ÔÚı‹ ‰È¿ÁÓˆÛË Î·È ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ÚÔ-‚Ï‹Ì·ÙÔ˜.

OÚÁ·ÓÈÎ¤˜ ·ÈÙ›Â˜ „˘¯È·ÙÚÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ ∞. ∂Ó‰ÔÁÂÓ‹ ÌÂÙ·‚ÔÏÈÎ¿ ÓÔÛ‹Ì·Ù·™Ù· ÓÔÛ‹Ì·Ù· ·˘Ù¿, ÙÔ ÁÂÓÂÙÈÎ¿ Î·ıÔÚÈÛÌ¤ÓÔ

¤ÏÏÂÈÌÌ· ÂÓ˙‡ÌÔ˘ Ô‰ËÁÂ› ÛÂ Û˘ÛÛÒÚÂ˘ÛË ·ıÔÏÔ-ÁÈÎÒÓ ÚÔ˚fiÓÙˆÓ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ‹ Ê˘ÛÈÔÏÔÁÈÎÒÓÔ˘ÛÈÒÓ ÛÂ ·ıÔÏÔÁÈÎ‹ Û˘ÁÎ¤ÓÙÚˆÛË ÛÙÔ˘˜ÈÛÙÔ‡˜. ∏ ÚÔÛ‚ÔÏ‹ ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ ÓÂ˘ÚÈÎÔ‡ Û˘-ÛÙ‹Ì·ÙÔ˜ ÌÔÚÂ› Ó· ·ÔÙÂÏ¤ÛÂÈ ˘fiÛÙÚˆÌ· ÁÈ·„˘¯È·ÙÚÈÎ¿ Û˘ÌÙÒÌ·Ù· ÛÙÔÓ ·ÛıÂÓ‹ (3-7). ∏ Î¿-ıÂ Ì›· ÓfiÛÔ˜ Â›Ó·È Û¿ÓÈ·, ·ÏÏ¿ Ë ·ıÚÔÈÛÙÈÎ‹ ÙÔ˘˜Û˘¯ÓfiÙËÙ· ÛÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi Â›Ó·È ÂÚ›Ô˘1:2000 (9). OÈ ‚·ÚÈ¤˜ ÌÔÚÊ¤˜ Û˘Ó‹ıˆ˜ ÂÌÊ·Ó›˙Ô-ÓÙ·È ÛÙË ‚ÚÂÊÈÎ‹ ‹ ÓËÈ·Î‹ ËÏÈÎ›· ÌÂ Ï‹ÚË ÎÏÈÓÈ-Î‹ ÂÈÎfiÓ·. ™Â ¿ÙÔÌ· ÌÂ ÌÂÚÈÎ‹ ¤ÏÏÂÈ„Ë ÂÓ˙‡ÌÔ˘ ‹ÛÂ ı‹ÏÂ· ÊÔÚÂ›˜ Ê˘ÏÔÛ‡Ó‰ÂÙˆÓ ÓÔÛËÌ¿ÙˆÓ, ÌÔ-ÚÂ› Ó· ÂÎ‰ËÏˆıÔ‡Ó ÛÙË Û¯ÔÏÈÎ‹ ËÏÈÎ›·, ÙËÓ ÂÊË-‚Â›· ‹ ÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹. ∆fiÙÂ, Ù· Û˘ÌÙÒÌ·Ù· Û˘-¯Ó¿ Â›Ó·È ‹È· ‹ ÚÔÎ·ÏÔ‡ÓÙ·È ÌfiÓÔ ÛÂ Î·Ù·ÛÙ¿-ÛÂÈ˜ ÌÂÙ·‚ÔÏÈÎ‹˜ ·ÔÚÚ‡ıÌÈÛË˜, fiˆ˜ ˘ÚÂÙfi˜,ÓËÛÙÂ›·, ÏÔÈÌÒÍÂÈ˜ ‹ Î·Ù·Ó¿ÏˆÛË ÌË ·ÓÂÎÙÒÓ ıÚÂ-ÙÈÎÒÓ Ô˘ÛÈÒÓ. ∆· „˘¯È·ÙÚÈÎ¿ Û˘ÌÙÒÌ·Ù· ÌÔÚÂ›Ó· ˘ÂÚÈÛ¯‡Ô˘Ó ‹ Ó· ÚÔËÁÔ‡ÓÙ·È ÙˆÓ ¿ÏÏˆÓ Î·È,ÙfiÙÂ, Ë ‰È¿ÁÓˆÛË Â›Ó·È ‰˘Û¯ÂÚ‹˜. OÈ ÈÔ Û˘¯Ó¤˜‰È·Ù·Ú·¯¤˜ Û˘ÌÂÚÈÊÔÚ¿˜ Â›Ó·È Ë Â˘ÂÚÂıÈÛÙfiÙË-Ù·, Ë ‰È¤ÁÂÚÛË, Ë ÂÈıÂÙÈÎfiÙËÙ· Î·È Ë ·ÚÔÚÌËÙÈ-ÎfiÙËÙ· ‹, ·ÓÙÈı¤Ùˆ˜, Ë ·Ê‡ÛÈÎË ·ıËÙÈÎfiÙËÙ·.∂Ó›ÔÙÂ, ˘¿Ú¯ÂÈ ÂÈÎfiÓ· „‡¯ˆÛË˜ (3-7,10-12).

™ÙÔ ÓÔËÙÈÎfi ÙÔÌ¤·, ÙÔ ·È‰› ÌÔÚÂ› Ó· ·ÚÔ˘-ÛÈ¿ÛÂÈ ÚÔÔ‰Â˘ÙÈÎ¿ ÂÈ‰ÂÈÓÔ‡ÌÂÓÔ ¤ÏÏÂÈÌÌ· ÚÔ-

ÛÔ¯‹˜, ¤ÎÙˆÛË ÌÓ‹ÌË˜, ÌÂÈˆÌ¤ÓÔ ÏÂÍÈÏfiÁÈÔ, Î·ÎfiÚÔÛ·Ó·ÙÔÏÈÛÌfi ÛÙÔ ¯ÒÚÔ Î·È ÔÙÈÎÔ-ÎÈÓËÙÈÎ¤˜‰È·Ù·Ú·¯¤˜. ∆· Û˘ÌÙÒÌ·Ù· ÂÓ‰¤¯ÂÙ·È Ó· ÂÚÌË-ÓÂ˘ÙÔ‡Ó ·Ú¯ÈÎ¿ ˆ˜ ·Ï¤˜ ‰È·Ù·Ú·¯¤˜ ÚÔÛÔ¯‹˜ ‹Ì·ıËÛÈ·Î¤˜ ‰˘ÛÎÔÏ›Â˜. ™Â ·È‰È¿ ÌÂ ÓÔËÙÈÎ‹ ˘ÛÙ¤-ÚËÛË, Ë ‰È·Ù·Ú·¯‹ Û˘ÌÂÚÈÊÔÚ¿˜ Û˘¯Ó¿ ·Ô‰›‰Â-Ù·È ÛÙÔ ÁÓˆÛÙÈÎfi ¤ÏÏÂÈÌÌ·.

∂Ó›ÔÙÂ, ÔÈ ÚÒÙÂ˜ ÂÎ‰ËÏÒÛÂÈ˜ Â›Ó·È ÔÍÂ›Â˜, ÌÂÎ·Ù¿ıÏÈ„Ë ‹ „‡¯ˆÛË. ™Â ÔÏÏ¤˜ ÂÚÈÙÒÛÂÈ˜, ÔÈ·ÛıÂÓÂ›˜ ÓÔÛËÏÂ‡ÔÓÙ·È ·Ú¯ÈÎ¿ ÛÂ „˘¯È·ÙÚÈÎ¿ ÙÌ‹-Ì·Ù· (13).

™Ù· ÂÈÌ¤ÚÔ˘˜ ÓÔÛ‹Ì·Ù·, ÔÚÈÛÌ¤Ó· „˘¯È·ÙÚÈÎ¿Û˘ÌÙÒÌ·Ù· ··ÓÙÒÓÙ·È ÈÔ Û˘¯Ó¿, ·ÏÏ¿ ‰ÂÓ˘¿Ú¯Ô˘Ó ÂÈ‰ÈÎÔ› Ê·ÈÓfiÙ˘ÔÈ Û˘ÌÂÚÈÊÔÚ¿˜ (4).

¶·Ú¿ÏÏËÏ· ÌÂ ÙÈ˜ ÚÔÔ‰Â˘ÙÈÎ¤˜ ·ÏÏ·Á¤˜ Û˘-ÌÂÚÈÊÔÚ¿˜ Î·È ÁÓˆÛÙÈÎÒÓ ÏÂÈÙÔ˘ÚÁÈÒÓ, Ë ÛËÌ·-ÓÙÈÎfiÙÂÚË ¤Ó‰ÂÈÍË Èı·ÓÔ‡ ÌÂÙ·‚ÔÏÈÎÔ‡ ÓÔÛ‹Ì·-ÙÔ˜ Â›Ó·È Ë ÂÌÊ¿ÓÈÛË ÓÂ˘ÚÔÏÔÁÈÎÒÓ Û˘ÌÙˆÌ¿ÙˆÓ,fiˆ˜ ‰È·Ù·Ú·¯¤˜ ÔÌÈÏ›·˜ (‰˘Û·ÚıÚ›·, ·ÏÏ·Á‹¯ÚÔÈ¿˜ ÙË˜ ÊˆÓ‹˜, ÙÚ·˘ÏÈÛÌfi˜), ÙÚfiÌÔ˜ ¯ÂÚÈÒÓ,¤ÎÙˆÛË fiÚ·ÛË˜ ‹ ·ÎÔ‹˜, ·ıÔÏÔÁÈÎ¿ ˘Ú·ÌÈ‰ÈÎ¿‹ ÂÍˆ˘Ú·ÌÈ‰ÈÎ¿ ÛËÌÂ›· (3-7,10-12).

™ÙË Û˘Ó¤¯ÂÈ· ·Ó·Ê¤ÚÔÓÙ·È Ù· Û˘¯ÓfiÙÂÚ· ÌÂÙ·-‚ÔÏÈÎ¿ ÓÔÛ‹Ì·Ù· Ô˘ ÌÔÚÂ› Ó· ÂÎ‰ËÏˆıÔ‡Ó ÌÂ„˘¯È·ÙÚÈÎ¿ Û˘ÌÙÒÌ·Ù· ÛÂ ·È‰È¿ Û¯ÔÏÈÎ‹˜ ËÏÈ-Î›·˜ Î·È ÂÊ‹‚Ô˘˜. °È· ÙËÓ ÂÚÈÁÚ·Ê‹ ÙË˜ Ï‹ÚÔ˘˜ÎÏÈÓÈÎ‹˜ ÂÈÎfiÓ·˜, Ô ·Ó·ÁÓÒÛÙË˜ ÌÔÚÂ› Ó· ·Ó·ÙÚ¤-ÍÂÈ ÛÙË Û¯ÂÙÈÎ‹ ‚È‚ÏÈÔÁÚ·Ê›· (3,6,7,9).

ÀÂÚ·ÌÌˆÓÈ·ÈÌ›·: ∏ ÈÔ Û˘¯Ó‹ ‰È·Ù·Ú·¯‹ Â›Ó·ÈÙÔ Ê˘ÏÔÛ‡Ó‰ÂÙÔ ¤ÏÏÂÈÌÌ· ÙÚ·ÓÛÎ·Ú‚·Ì˘Ï¿ÛË˜ÙË˜ ÔÚÓÈı›ÓË˜. ∫ÔÚ›ÙÛÈ· ÊÔÚÂ›˜ Î·È ·ÁfiÚÈ· ÌÂ ˘Ô-ÏÂÈÌÌ·ÙÈÎ‹ ‰Ú·ÛÙËÚÈfiÙËÙ· ÂÓ˙‡ÌÔ˘ ÌÔÚÂ› Ó· ·-ÚÔ˘ÛÈ¿ÛÔ˘Ó ÔÍÂ›Â˜, ‰È·ÏÂ›Ô˘ÛÂ˜ ‰È·Ù·Ú·¯¤˜ Û˘-ÌÂÚÈÊÔÚ¿˜ Ô˘ ÚÔÎ·ÏÔ‡ÓÙ·È ·fi ÏÔÈÌÒÍÂÈ˜ ‹Î·Ù·Ó¿ÏˆÛË ÌÂÁ¿ÏË˜ ÔÛfiÙËÙ·˜ ÏÂ˘ÎÒÌ·ÙÔ˜ (4-6,9,13,14).

GM2 Á·ÁÁÏÈÔÛ›‰ˆÛË, ÌÔÚÊ‹ ÓÂ·ÓÈÎ‹ ‹ ÂÓËÏ›ÎˆÓ:OÈ „˘¯È·ÙÚÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Â˘ÂÚÂ-ıÈÛÙfiÙËÙ· Î·È ÂÈıÂÙÈÎfiÙËÙ·, Î·Ù¿ıÏÈ„Ë ‹ ÓÔËÙÈÎ‹¤ÎÙˆÛË (4-6,9).

¡fiÛÔ˜ Nieman-Pick Ù‡Ô˘ C: ∏ ·È‰ÈÎ‹ ÌÔÚÊ‹ÂÎ‰ËÏÒÓÂÙ·È ÌÂ ¤ÎÙˆÛË Û¯ÔÏÈÎ‹˜ Â›‰ÔÛË˜ Î·ÈÓÂ˘ÚÔÏÔÁÈÎ‹ Û˘ÌÙˆÌ·ÙÔÏÔÁ›·, Ë ÔÔ›· ÌÔÚÂ› Ó·ÂÌÊ·ÓÈÛÙÂ› Ì‹ÓÂ˜ ·ÚÁfiÙÂÚ·. ∏·ÙÔÛÏËÓÔÌÂÁ·Ï›·‰ÂÓ ˘¿Ú¯ÂÈ ÛÂ fiÏÂ˜ ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ (4-6,9).

¡fiÛÔ˜ Wilson: ∆· 2/3 ÙˆÓ ·ÛıÂÓÒÓ ÂÌÊ·Ó›˙Ô˘Ó„˘¯È·ÙÚÈÎ¿ Û˘ÌÙÒÌ·Ù· ÛÙËÓ ÔÚÂ›· ÙË˜ ÓfiÛÔ˘,ÂÓÒ ÛÙÔ 1/5 ÙˆÓ ·ÛıÂÓÒÓ ·ÔÙÂÏÔ‡Ó ÙÔ ÌÔÓ·‰ÈÎfi·Ú¯ÈÎfi Û‡ÌÙˆÌ·. ¶ÔÏÏÔ› ·ÛıÂÓÂ›˜ ¤¯Ô˘Ó ÓÔÛË-ÏÂ˘ÙÂ› ÛÂ „˘¯È·ÙÚÈÎ¿ ÙÌ‹Ì·Ù· ÚÈÓ ‰È·ÁÓˆÛÙÂ› ËÓfiÛÔ˜. ∆· ÈÔ Û˘¯Ó¿ ÚÔ‚Ï‹Ì·Ù· Â›Ó·È Ë Â˘ÂÚÂıÈ-ÛÙfiÙËÙ· Î·È Ë ÂÈıÂÙÈÎfiÙËÙ·, Ë Î·Ù¿ıÏÈ„Ë Î·È ËÓÔËÙÈÎ‹ ¤ÎÙˆÛË (4,15,16).

OÌÔÎ˘ÛÙÈÓÔ˘Ú›·: OÈ ÌÈÛÔ› ·ÛıÂÓÂ›˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó


168

May-June 03 03-06-03 16:55 ™ÂÏ›‰·168


169

„˘¯È·ÙÚÈÎ¿ Û˘ÌÙÒÌ·Ù·. ™˘Ó‹ıˆ˜ Û˘Ó˘¿Ú¯ÂÈ Ô¯·Ú·ÎÙËÚÈÛÙÈÎfi˜ ÛˆÌ·ÙÈÎfi˜ Ê·ÈÓfiÙ˘Ô˜ Î·È ‹È·ÓÔËÙÈÎ‹ ˘ÛÙ¤ÚËÛË (4-6).

¡fiÛÔ˜ Sanfilippo: OÈ Ù‡ÔÈ µ Î·È C ¤¯Ô˘Ó ‹È·ÔÚÂ›· Î·È Û˘¯Ó¿ ÂÎ‰ËÏÒÓÔÓÙ·È ÛÙË Û¯ÔÏÈÎ‹ ËÏÈÎ›·ÌÂ ˘ÂÚÎÈÓËÙÈÎfiÙËÙ·, ÂÈıÂÙÈÎfiÙËÙ· Î·È ‰È·Ù·Ú·-¯¤˜ ‡ÓÔ˘. ∆· ·‰Ú¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÚÔÛÒÔ˘ÂÓ›ÔÙÂ Â›Ó·È ‰È·ÎÚÈÙÈÎ¿ Î·È Ù· ÓÂ˘ÚÔÏÔÁÈÎ¿ Û˘ÌÙÒ-Ì·Ù· ÂÌÊ·Ó›˙ÔÓÙ·È ·ÚÁfiÙÂÚ· (4-6).

∫ËÚÔÂÈ‰‹˜ ÏÈÔÊÔ˘ÛÎ›ÓˆÛË: ∏ ÓfiÛÔ˜ Batten ÌÂÓÔËÙÈÎ‹ ¤ÎÙˆÛË Î·È ‰È·Ù·Ú·¯¤˜ Û˘ÌÂÚÈÊÔÚ¿˜ÂÎ‰ËÏÒÓÂÙ·È Û˘Ó‹ıˆ˜ ÛÂ ËÏÈÎ›· 6 ÂÙÒÓ. ∏ ÔÙÈÎ‹ÔÍ‡ÙËÙ· ÂËÚÂ¿˙ÂÙ·È ÓˆÚ›˜ ÛÙËÓ ÔÚÂ›· (4).

¡fiÛÔ˜ Tay Sachs: ∏ ÓfiÛÔ˜ ÌÔÚÂ› Ó· ÂÎ‰ËÏˆıÂ›ÛÂ ¿ÙÔÌ· fiÏˆÓ ÙˆÓ ËÏÈÎÈÒÓ. æ‡¯ˆÛË ·Ó·Ê¤ÚÂÙ·È ÛÂ30-50% ·ÛıÂÓÒÓ ÌÂ ÙÔÓ Ù‡Ô ÂÓËÏ›ÎˆÓ, Ô ÔÔ›Ô˜ÌÔÚÂ› Ó· ·Ú¯›˙ÂÈ ÛÙËÓ ÂÊË‚Â›·. ™˘¯Ó¿ Ù›ıÂÙ·È Ï·Ó-ı·ÛÌ¤ÓË ‰È¿ÁÓˆÛË Û¯È˙ÔÊÚ¤ÓÈ·˜ (4-6,17).

º˘ÏÔÛ‡Ó‰ÂÙË ·‰ÚÂÓÔÏÂ˘ÎÔ‰˘ÛÙÚÔÊ›· (∞§¢): ∂›-Ó·È Û¯ÂÙÈÎ¿ Û˘¯Ó‹ ‰È·Ù·Ú·¯‹ (1:20.000 ÁÂÓÓ‹ÛÂÈ˜),Ë ÔÔ›· Û˘Ó‹ıˆ˜ ÂÎ‰ËÏÒÓÂÙ·È ÛÂ ·ÁfiÚÈ· ËÏÈÎ›·˜ 6-10 ÂÙÒÓ. ∏ ÌÔÚÊ‹ ÌÂ ¤Ó·ÚÍË ÛÙËÓ ÂÊË‚Â›· ¤¯ÂÈ ÈÔ‹È· ÔÚÂ›·. ¶·ÚÔ˘ÛÈ¿˙ÂÈ ·ÓÂ¿ÚÎÂÈ· ÂÈÓÂÊÚÈ-‰›ˆÓ, ÓÂ˘ÚÔÏÔÁÈÎ‹ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Î·È, ÛÂ ÔÛÔÛÙfi56%, „˘¯È·ÙÚÈÎ¿ Û˘ÌÙÒÌ·Ù·. ∏ „‡¯ˆÛË ÌÔÚÂ›Ó· ÚÔËÁËıÂ› ÙˆÓ ¿ÏÏˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Î·Ù¿ ÔÏ-ÏÔ‡˜ Ì‹ÓÂ˜. ∞Ó·‰ÚÔÌÈÎ¿, ÛÂ ÔÏÏ¤˜ ÂÚÈÙÒÛÂÈ˜∞§¢ Ù‡Ô˘ ÂÓËÏ›ÎˆÓ ‰È·ÈÛÙÒÓÂÙ·È fiÙÈ Ë ·ÏÏ·Á‹ÙË˜ ÚÔÛˆÈÎfiÙËÙ·˜ Î·È ÔÈ ‰È·Ù·Ú·¯¤˜ Û˘ÌÂÚÈ-ÊÔÚ¿˜ ÂÌÊ·Ó›ÛÙËÎ·Ó ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›· ‹ ÙËÓÂÊË‚Â›· Î·È ·Ô‰fiıËÎ·Ó ÛÂ ¿ÏÏ· ·›ÙÈ·. ™Ù· 2/3ÙˆÓ ·ÛıÂÓÒÓ ‰È·ÈÛÙÒÓÂÙ·È ‚ÈÔ¯ËÌÈÎ¿ ·ÓÂ¿ÚÎÂÈ·ÂÈÓÂÊÚÈ‰›ˆÓ, ¯ˆÚ›˜ Ó· ˘¿Ú¯Ô˘Ó ¿ÓÙ· ÎÏÈÓÈÎ¿Û˘ÌÙÒÌ·Ù· (4,18).

OÍÂ›· ‰È·ÏÂ›Ô˘Û· ÔÚÊ˘Ú›·: ∞ÔÙÂÏÂ› Û¿ÓÈ·‰È·Ù·Ú·¯‹ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÔÚÊ˘ÚÈÓÒÓ, Ë ÔÔ›·ÚÔÛ‚¿ÏÏÂÈ Î˘Ú›ˆ˜ ÎÔÚ›ÙÛÈ·. ¶·ÚÔ˘ÛÈ¿˙ÂÈ ÔÍ¤·ÂÂÈÛfi‰È· „‡¯ˆÛË˜, ÌÂ ÈÛÙÔÚÈÎfi Û˘¯ÓÒÓ ·ÓÂÍ‹ÁË-ÙˆÓ ÂÂÈÛÔ‰›ˆÓ ÎÔÈÏÈ·ÎÔ‡ ¿ÏÁÔ˘˜ (4).

ªÂÙ·¯ÚˆÌ·ÙÈÎ‹ ÏÂ˘ÎÔ‰˘ÛÙÚÔÊ›·: ∏ ÓÂ·ÓÈÎ‹ ÌÂ-Ù·¯ÚˆÌ·ÙÈÎ‹ ÏÂ˘ÎÔ‰˘ÛÙÚÔÊ›· ÂÌÊ·Ó›˙ÂÙ·È ÛÂ ËÏÈ-Î›· 6-10 ÂÙÒÓ, ÌÂ ÓÔËÙÈÎ‹ ¤ÎÙˆÛË, ÌÂ›ˆÛË Û¯ÔÏÈ-Î‹˜ Â›‰ÔÛË˜ Î·È ÂÈıÂÙÈÎ‹ Û˘ÌÂÚÈÊÔÚ¿. ¡Â˘ÚÔ-ÏÔÁÈÎ¿ Û˘ÌÙÒÌ·Ù· ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÙËÓ ÔÚÂ›·ÙË˜ ÓfiÛÔ˘ (4,9).

µ. ¢È·Ù·Ú·¯¤˜ ÂÓ‰ÔÎÚÈÓÒÓ ·‰¤ÓˆÓ™˘Ó‹ıˆ˜ ÂÎ‰ËÏÒÓÂÙ·È Ë ¯·Ú·ÎÙËÚÈÛÙÈÎ‹ ÎÏÈÓÈÎ‹

ÂÈÎfiÓ· ÙË˜ ÓfiÛÔ˘. ¡ÔÛ‹Ì·Ù· ı˘ÚÂÔÂÈ‰Ô‡˜: ∞ÛıÂÓÂ›˜ ÌÂ ˘ÂÚı˘-

ÚÂÔÂÈ‰ÈÛÌfi Û˘¯Ó¿ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Û‡Á¯˘ÛË, ¿Á¯Ô˜‹ Î·È „‡¯ˆÛË. ™ÙÔÓ ˘Ôı˘ÚÂÔÂÈ‰ÈÛÌfi ··ÓÙ¿Ù·È‚Ú·‰˘„˘¯ÈÛÌfi˜ Î·È ÂÓ›ÔÙÂ Î·Ù¿ıÏÈ„Ë (7,10).∂ÓÙÔ‡ÙÔÈ˜, Ë Û˘¯ÓfiÙËÙ· ÓÔÛËÌ¿ÙˆÓ ı˘ÚÂÔÂÈ‰Ô‡˜‰ÂÓ Â›Ó·È ·˘ÍËÌ¤ÓË ÛÙÔÓ „˘¯È·ÙÚÈÎfi ÏËı˘ÛÌfi. °È·

ÙÔ ÏfiÁÔ ·˘Ùfi, ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ Û˘ÁÁÚ·ÊÂ›˜ ‰ÂÓ ıÂ-ˆÚÔ‡Ó ·Ó·ÁÎ·›Ô ÙÔÓ Û¯ÂÙÈÎfi ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô·Ô˘Û›· ÎÏÈÓÈÎ‹˜ ˘Ô„›·˜, ÂÓÒ ¿ÏÏÔÈ ÙÔÓ ÂÚÈÏ·Ì-‚¿ÓÔ˘Ó Û˘ÛÙËÌ·ÙÈÎ¿ (19,20).

ÕÙÔÌ· ÌÂ ·˘ÙÔ¿ÓÔÛË ı˘ÚÂÔÂÈ‰›ÙÈ‰·, Û˘Ó‹ıˆ˜ÛÂ Î·Ù¿ÛÙ·ÛË Â˘ı˘ÚÂÔÂÈ‰ÈÛÌÔ‡, ÌÔÚÂ› Ó· ·ÚÔ˘-ÛÈ¿ÛÔ˘Ó „˘¯È·ÙÚÈÎ‹ ‰È·Ù·Ú·¯‹ ÛÙ· Ï·›ÛÈ· ÂÁÎÂ-Ê·ÏÔ¿ıÂÈ·˜ Hashimoto, Ë ÔÔ›· ·Ô‰›‰ÂÙ·È ÛÂ‚Ï¿‚Ë ÓÂ˘ÚÒÓˆÓ ÌÂ ·˘ÙÔ¿ÓÔÛÔ ÌË¯·ÓÈÛÌfi. ™ÙË ‚È-‚ÏÈÔÁÚ·Ê›· ÂÚÈÁÚ¿ÊÔÓÙ·È ‰¤Î· ÂÚÈÙÒÛÂÈ˜ ıË-Ï¤ˆÓ, ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ. OÈ ÂÚÈÛÛfiÙÂÚÂ˜ ÂÚÈ-ÙÒÛÂÈ˜ ·ÚÔ˘Û›·˙·Ó ÓÂ˘ÚÔÏÔÁÈÎ¿ Û˘ÌÙÒÌ·Ù·,fiˆ˜ Û·ÛÌÔ‡˜, ÂÓÒ fiÏÂ˜ Â›¯·Ó ÛÙËÓ ÔÚÂ›· ·-ıÔÏÔÁÈÎfi ∏∂° Î·È ·˘ÍËÌ¤ÓÔ ÏÂ‡ÎˆÌ· ÛÙÔ ∂¡À. ∏‰È·Ù·Ú·¯‹ ·˘Ù‹ ·ÓÙ·ÔÎÚ›ÓÂÙ·È ÛÂ ·ÁˆÁ‹ ÌÂ ÎÔÚ-ÙÈÎÔÛÙÂÚÔÂÈ‰‹ (21-24).

¡fiÛÔ˜ Cushing: ™˘Ó‹ıˆ˜ ˘¿Ú¯Ô˘Ó Ù· ¯·Ú·-ÎÙËÚÈÛÙÈÎ¿ ÛËÌÂ›· ÛÙËÓ ·ÓÙÈÎÂÈÌÂÓÈÎ‹ ÂÍ¤Ù·ÛË. ∏ÏÂÈÔÓfiÙËÙ· ÙˆÓ ·ÛıÂÓÒÓ ·ÚÔ˘ÛÈ¿˙ÂÈ Â˘ÂÚÂıÈ-ÛÙfiÙËÙ·, Î·Ù¿ıÏÈ„Ë Î·È Â‡ÎÔÏË ÎfiˆÛË (7).

ÀÂÚÚÔÏ·ÎÙÈÓ·ÈÌ›·: ∂ÎÙfi˜ ·fi Ù· Ê˘ÛÈÎ¿ Û˘-ÌÙÒÌ·Ù· (Á˘Ó·ÈÎÔÌ·ÛÙ›·, Á·Ï·ÎÙfiÚÚÔÈ·), ÔÈ·ÛıÂÓÂ›˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÛÂ ·˘ÍËÌ¤ÓË Û˘¯ÓfiÙËÙ·¿Á¯Ô˜, Î·Ù¿ıÏÈ„Ë Î·È ÂÈıÂÙÈÎfiÙËÙ· (25).

ÀÂÚ·Ó‰ÚÔÁÔÓÈÛÌfi˜: O ˘ÂÚ·Ó‰ÚÔÁÔÓÈÛÌfi˜ÛÙ· ı‹ÏÂ· ÌÔÚÂ› Ó· Û¯ÂÙ›˙ÂÙ·È ÌÂ ‰È·Ù·Ú·¯¤˜ ÙÔ˘ı‡ÌÔ˘ ‹ ÌÂ ÂÎ‰‹ÏˆÛË Û¯È˙ÔÊÚ¤ÓÂÈ·˜ ÛÂ ÓÂfiÙÂÚËËÏÈÎ›· (›‰È·˜ ÌÂ ·˘Ù‹ ÙˆÓ ·ÁÔÚÈÒÓ). Œ¯ÂÈ ÛËÌÂÈˆıÂ›‚ÂÏÙ›ˆÛË ÌÂÙ¿ ·fi ÔÚÌÔÓÈÎ‹ ·ÁˆÁ‹ ÌÂ ·ÓÙÈÛ˘ÏÏË-ÙÈÎ¿ (26,27).

¢È·Ù·Ú·¯¤˜ ·Ú·ı˘ÚÂÔÂÈ‰ÒÓ ·‰¤ÓˆÓ: ∏ ˘ÂÚ·-Û‚ÂÛÙÈ·ÈÌ›· Û¯ÂÙ›˙ÂÙ·È ÌÂ ÔÍÂ›· Û‡Á¯˘ÛË ‹ ¯ÚfiÓÈÂ˜·ÏÏ·Á¤˜ ÚÔÛˆÈÎfiÙËÙ·˜, ‰˘ÛÎÔÏ›Â˜ Û˘ÁÎ¤ÓÙÚˆ-ÛË˜ Î·È ¤ÏÏÂÈ„Ë ÚˆÙÔ‚Ô˘Ï›·˜, Ô˘ ·Ó·ÛÙÚ¤ÊÔ-ÓÙ·È ÌÂ ÙË ‰ÈfiÚıˆÛË ÙË˜ ËÏÂÎÙÚÔÏ˘ÙÈÎ‹˜ ‰È·Ù·Ú·-¯‹˜.

∏ ˘Ô·Û‚ÂÛÙÈ·ÈÌ›· ÌÔÚÂ› Ó· ÂÌÊ·Ó›ÛÂÈ ÔÍÂ›·Û‡Á¯˘ÛË (·ÎfiÌË Î·È ·Ô˘Û›· ÙÂÙ·Ó›·˜), Â¿Ó Ë ÙÒ-ÛË ÙˆÓ ÂÈ¤‰ˆÓ ·Û‚ÂÛÙ›Ô˘ Â›Ó·È ·fiÙÔÌË. ∏ ‚·ı-ÌÈ·›· ÙÒÛË ÚÔÎ·ÏÂ› ÈÔ ‹ÈÂ˜ ·ÏÏ·Á¤˜ ÚÔÛˆÈ-ÎfiÙËÙ·˜ Î·È ÁÓˆÛÙÈÎ¿ ÂÏÏÂ›ÌÌ·Ù·, Ù· ÔÔ›· ‰ÂÓ·ÔÎ·ı›ÛÙ·ÓÙ·È ¿ÓÙ· ÌÂÙ¿ ·fi ÙËÓ Â·Ó·ÊÔÚ¿ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÂÈ¤‰ˆÓ (10).

°. ∫¿ÎˆÛË ÎÂÊ·Ï‹˜ (28-30) ∏ ÂÌÊ¿ÓÈÛË „˘¯È·ÙÚÈÎÒÓ Û˘ÌÙˆÌ¿ÙˆÓ ÌÂÙ¿

·fi Î¿ÎˆÛË ÙË˜ ÎÂÊ·Ï‹˜ ÂÍ·ÚÙ¿Ù·È ·fi ÔÏÏÔ‡˜·Ú¿ÁÔÓÙÂ˜. ∏ ·ÓÙÈÎÂÈÌÂÓÈÎ‹ ‚·Ú‡ÙËÙ· ÙË˜ Î¿Îˆ-ÛË˜ Â›Ó·È Ô Î‡ÚÈÔ˜ ÚÔÁÓˆÛÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ÛÙÔ˘˜ ÚÒÙÔ˘˜ ÙÚÂÈ˜ Ì‹ÓÂ˜ ÌÂÙ¿ ÙÔ Û˘Ì‚¿Ó, ÂÓÒ·È‰È¿ ÌÂ ‚·Ú‡ÙÂÚÂ˜ Î·ÎÒÛÂÈ˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Â-ÚÈÛÛfiÙÂÚ· ÚÔ‚Ï‹Ì·Ù· Î·È ÈÔ ÓˆÚ›˜. ™ÙËÓ ÔÍÂ›·ÂÚ›Ô‰Ô ·Ó¿ÚÚˆÛË˜ ÌÔÚÂ› Ó· ÂÎ‰ËÏÒÓÂÙ·È ¿Á¯Ô˜Î·È, ÛÙË Û˘Ó¤¯ÂÈ·, Î·Ù¿ıÏÈ„Ë (‰È·Ù·Ú·¯¤˜ ‡ÓÔ˘Î·È fiÚÂÍË˜, ·¿ıÂÈ·, Â˘ÂÚÂıÈÛÙfiÙËÙ·, ÂÓÔ¯¤˜,

May-June 03 03-06-03 16:55 ™ÂÏ›‰·169


170

·˘ÙÔÎÙÔÓÈÎfi˜ È‰Â·ÛÌfi˜). ªÂÙ¿, ÙÔ Ê¿ÛÌ· Èı·ÓÒÓ·ÏÏ·ÁÒÓ Û˘ÌÂÚÈÊÔÚ¿˜ Î˘Ì·›ÓÂÙ·È ·fi ‹È· ÎÔÈÓˆ-ÓÈÎ‹ ·‰È·ÎÚÈÛ›· ¤ˆ˜ ‚›·ÈÂ˜ ÂÈı¤ÛÂÈ˜. ¶ÂÚÈÁÚ¿ÊÂÙ·È‰È·ÎÚÈÙfi Û‡Ó‰ÚÔÌÔ ·ÚfiÌÔÈÔ ÌÂ ÙÔ “Û‡Ó‰ÚÔÌÔ ÌÂ-ÙˆÈ·›Ô˘ ÏÔ‚Ô‡”, ÙÔ ÔÔ›Ô ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ·-ÚÔÚÌËÙÈÎfiÙËÙ·, Û˘Ó·ÈÛıËÌ·ÙÈÎ¤˜ ÂÎÚ‹ÍÂÈ˜ Î·È ·Ò-ÏÂÈ· ÎÔÈÓˆÓÈÎÒÓ ·Ó·ÛÙÔÏÒÓ (.¯. Á‰‡ÓÂÙ·È ‹ ·˘Ó·Ó›-˙ÂÙ·È ‰ËÌÔÛ›ˆ˜). ∆· ı‡Ì·Ù· Î¿ÎˆÛË˜ ÎÂÊ·Ï‹˜ ‰Ë-ÏÒÓÔ˘Ó ÈÔ Û˘¯Ó¿ ¯·ÌËÏ‹ ·˘ÙÔÂÎÙ›ÌËÛË, ÌÔÓ·ÍÈ¿Î·È ‰˘ÛÎÔÏ›Â˜ ÚÔÛ·ÚÌÔÁ‹˜, ÛÂ Û‡ÁÎÚÈÛË ÌÂ Ì¿Ú-Ù˘ÚÂ˜. ∂Ó›ÔÙÂ, ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Û˘ÌÙÒÌ·Ù· ÂÓ·-ÓÙÈˆÙÈÎ‹˜ ‰È·Ù·Ú·¯‹˜ ‹ ‰È·Ù·Ú·¯‹˜ ÙË˜ ‰È·ÁˆÁ‹˜.∏ ÚÔ¸¿Ú¯Ô˘Û· ˘ÂÚÎÈÓËÙÈÎfiÙËÙ· ‹ ‰È·Ù·Ú·¯‹‰È·ÁˆÁ‹˜ ÚÔ‰È·ı¤ÙÂÈ ÁÈ· ·Ù˘¯‹Ì·Ù· Î·È ÌÔÚÂ› Ó·ÂÈ‰ÂÈÓˆıÂ› ÌÂÙ¿ ·fi ·˘Ù¿. ∆Ô ıÂÙÈÎfi ÈÛÙÔÚÈÎfi „˘-¯È·ÙÚÈÎÒÓ ÓÔÛËÌ¿ÙˆÓ ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ·, Â›ÛË˜ ·˘Í¿-ÓÂÈ ÙËÓ Èı·ÓfiÙËÙ· ÂÌÊ¿ÓÈÛË˜ ÚÔ‚ÏËÌ¿ÙˆÓ.

ªÂÙ¿ ·fi ¤ÍÈ Ì‹ÓÂ˜ ÌÂÈÒÓÂÙ·È Ë Û¯ÂÙÈÎ‹ ÛËÌ·-Û›· ÙË˜ ‚·Ú‡ÙËÙ·˜ ÙË˜ Î¿ÎˆÛË˜ Î·È ·˘Í¿ÓÂÈ Ô Úfi-ÏÔ˜ ÙÔ˘ ÎÔÈÓˆÓÈÎÔ‡ ÂÚÈ‚¿ÏÏÔÓÙÔ˜. ∏ Û¯¤ÛË ‰ÂÓ Â›-Ó·È ·Ï‹, ‰ÈfiÙÈ ÔÈ ·ÏÏ·Á¤˜ Û˘ÌÂÚÈÊÔÚ¿˜ ÌÔÚÂ›Ó· ÔÊÂ›ÏÔÓÙ·È ÛÂ ·È‰·ÁˆÁÈÎ¿ ÛÊ¿ÏÌ·Ù· (.¯.˘ÂÚÚÔÛÙ·Û›·). ¶ÚÔÔÙÈÎ‹ ÌÂÏ¤ÙË ¤¯ÂÈ ‰Â›ÍÂÈ fiÙÈ„˘¯ÔÏÔÁÈÎ¿ ÚÔ‚Ï‹Ì·Ù· ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÔ 60%ÙˆÓ ·È‰ÈÒÓ ÌÂ ÚÔ¸¿Ú¯ÔÓÙ· ÎÔÈÓˆÓÈÎ¿ ÚÔ‚Ï‹-Ì·Ù·, ÂÓÒ ÛÂ 14% ÙˆÓ ·È‰ÈÒÓ ·fi ÂÚÈ‚¿ÏÏÔÓÂÏÂ‡ıÂÚÔ Ù¤ÙÔÈˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ (5).

¢. ŸÁÎÔÈ ÂÁÎÂÊ¿ÏÔ˘ (7,10,31,32)æ˘¯È·ÙÚÈÎ¿ Û˘ÌÙÒÌ·Ù· ÂÎ‰ËÏÒÓÔÓÙ·È ÛÙËÓ

ÔÚÂ›· ÙË˜ ÓfiÛÔ˘ ÛÙÔ˘˜ ÌÈÛÔ‡˜ ·ÛıÂÓÂ›˜ ÌÂ fiÁÎÔÂÁÎÂÊ¿ÏÔ˘, ·ÏÏ¿ Û˘Ó‹ıˆ˜ Û˘ÓÔ‰Â‡ÔÓÙ·È ·fi ¿ÏÏ·ÓÂ˘ÚÔÏÔÁÈÎ¿ Û˘ÌÙÒÌ·Ù· Î·È ÛËÌÂ›·. OÈ fiÁÎÔÈ ÙÔ˘ÎÚÔÙ·ÊÈÎÔ‡ ÏÔ‚Ô‡ ¤¯Ô˘Ó Û˘Û¯ÂÙÈÛÙÂ› ÌÂ „˘¯ˆÛÈÎ¿Û˘ÌÙÒÌ·Ù·, ÂÓÒ ÙÔ˘ ÌÂÙˆÈ·›Ô˘ ÏÔ‚Ô‡ ÌÔÚÂ›·Ú¯ÈÎ¿ Ó· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó ·ÏÏ·Á‹ ÚÔÛˆÈÎfiÙËÙ·˜,ÁÓˆÛÙÈÎ¿ ÂÏÏÂ›ÌÌ·Ù· Î·È ·Ú·Í›·.

∏ Î·Ù¿ıÏÈ„Ë ÌÔÚÂ› Ó· Û˘ÓÔ‰Â‡ÂÈ Î¿ıÂ ¯ÚfiÓÈÔÓfiÛËÌ·, ÂÈ‰ÈÎ¿ fiÙ·Ó ˘¿Ú¯ÂÈ ·›ÛıËÌ· Î·ÎÔ˘¯›·˜Î·È ¤ÎÙˆÛË ÏÂÈÙÔ˘ÚÁ›·˜. ŸÙ·Ó Ù· Û˘ÌÙÒÌ·Ù· Î·-Ù¿ıÏÈ„Ë˜ Û˘ÓÔ‰Â‡ÔÓÙ·È ·fi ·ÒÏÂÈ· ‚¿ÚÔ˘˜, ÎÂ-Ê·Ï·ÏÁ›Â˜ Î·È ÂÌ¤ÙÔ˘˜ ¯ˆÚ›˜ ¿ÏÏ· Û˘ÌÙÒÌ·Ù··fi ÙÔ ÂÙÈÎfi, Û˘ÓÈÛÙ¿Ù·È ÓÂ˘ÚÔÏÔÁÈÎ‹ Î·È Èı·-ÓÒ˜ ÓÂ˘ÚÔ·ÂÈÎÔÓÈÛÙÈÎ‹ ÂÍ¤Ù·ÛË.

¶ÂÚÈÁÚ¿ÊÔÓÙ·È ÂÚÈÙÒÛÂÈ˜ Î·ı˘ÛÙÂÚËÌ¤ÓË˜‰È¿ÁÓˆÛË˜ fiÁÎÔ˘ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ ‹ ÙÔ˘ ÓˆÙÈ·›Ô˘Ì˘ÂÏÔ‡ ÛÂ ·È‰È¿ ÌÂ Û˘ÓÔ‰¿ „˘¯È·ÙÚÈÎ¿ Û˘ÌÙÒ-Ì·Ù· Î·È ‰˘ÛÎÔÏ›Â˜ ÛÙË Û¯ÔÏÈÎ‹ Â›‰ÔÛË ‹ ÌÂ Û˘-ÌÙÒÌ·Ù· Ô˘ ÂÛÊ·ÏÌ¤Ó· ·Ô‰fiıËÎ·Ó ÛÂ „˘¯Ô-ÏÔÁÈÎ¿ ·›ÙÈ·, fiˆ˜ È‰ÈfiÌÔÚÊË ÛÙ¿ÛË ÙÔ˘ ÛÒÌ·ÙÔ˜Î·È ¿ÏÁË ÛÙ· ¿ÎÚ·. ŸÙ·Ó Ù¤ıËÎÂ Ë ‰È¿ÁÓˆÛË (ÂÓ›Ô-ÙÂ ÌÂ Î·ı˘ÛÙ¤ÚËÛË ÌËÓÒÓ ‹ ÂÙÒÓ), Â›¯Â ·Ó·Ù˘¯ıÂ›Ë Ï‹ÚË˜ ÂÈÎfiÓ· ÙË˜ ÓfiÛÔ˘. ŒÙÛÈ, ÙÔÓ›˙ÂÙ·È Ë ·Ó·-ÁÎ·ÈfiÙËÙ· ÂÚÈÔ‰ÈÎ‹˜ Â·ÓÂÍ¤Ù·ÛË˜ ÙˆÓ ·ÛıÂÓÒÓ·˘ÙÒÓ (33).

∂. ∂ÈÏË„›· (7,10,34) ŸÙ·Ó ÙÔ ·È‰› ·ÚÔ˘ÛÈ¿˙ÂÈ ÔÍ¤· ÂÂÈÛfi‰È· ÔÚ-

Á‹˜ ‹ ·ÓÈÎÔ‡, Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÂÙ·È ˘’ fi„ÈÓ Ë È-ı·ÓfiÙËÙ· ÂÈÏË„›·˜ ÎÚÔÙ·ÊÈÎÔ‡ ÏÔ‚Ô‡. ∫·Ù¿ ÙË‰È¿ÚÎÂÈ· ÙÔ˘ ÂÂÈÛÔ‰›Ô˘ Î·È ÛÙË ÌÂÙ·ÎÚÈÙÈÎ‹ Ê¿ÛË,ÙÔ Â›Â‰Ô Û˘ÓÂ›‰ËÛË˜ Â›Ó·È ‰È·Ù·Ú·ÁÌ¤ÓÔ, Ë ‚›·ÈËÛ˘ÌÂÚÈÊÔÚ¿ Â›Ó·È ÛÙÂÚÂfiÙ˘Ë Î·È ¿ÛÎÔË, ÂÓÒÛ˘Ó‹ıˆ˜ ·ÎÔÏÔ˘ıÂ› ˘ÓËÏ›· Î·È ·ÌÓËÛ›· ÙÔ˘ Û˘Ì-‚¿ÓÙÔ˜.

∏ ÂÈÏÂÁÌ¤ÓË ÂÛÙÈ·Î‹ ÂÈÏË„›· ÙÔ˘ ÌÂÙˆÈ·›-Ô˘ ÏÔ‚Ô‡ ÌÔÚÂ› Ó· ÂÎ‰ËÏÒÓÂÙ·È ÌÂ ÂÈÊˆÓ‹Ì·Ù·Î·È ÔÈÎ›ÏÂ˜ ·ıÔÏÔÁÈÎ¤˜ ÎÈÓ‹ÛÂÈ˜ Ô˘ ‰ÂÓ ¤¯Ô˘ÓÎÏ·ÛÈÎfi ¯·Ú·ÎÙ‹Ú· Û·ÛÌÒÓ.

™Â ·È‰È¿ Ô˘ Ï·Ì‚¿ÓÔ˘Ó ·ÓÙÈÂÈÏËÙÈÎ¿ Ê¿Ú-Ì·Î·, ˘¿Ú¯ÂÈ Èı·ÓfiÙËÙ· Ó· ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ‰È·-Ù·Ú·¯¤˜ Û˘ÌÂÚÈÊÔÚ¿˜ ˆ˜ ·ÚÂÓ¤ÚÁÂÈ· ÙˆÓ Ê·Ú-Ì¿ÎˆÓ.

™Ù. °ÂÓÂÙÈÎ¿ Û‡Ó‰ÚÔÌ· ŸÙ·Ó Ë „˘¯ÔÎÈÓËÙÈÎ‹ Î·ı˘ÛÙ¤ÚËÛË Û˘Ó˘¿Ú¯ÂÈ

ÌÂ „˘¯È·ÙÚÈÎfi Úfi‚ÏËÌ·, Ë Û˘¯ÓfiÙËÙ· Î˘ÙÙ·ÚÔÁÂ-ÓÂÙÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ Â›Ó·È 3%, Êı¿ÓÔÓÙ·˜ ÙÔ 10% ÛÂÂÚÈÙÒÛÂÈ˜ ÚÒÈÌË˜ Û¯È˙ÔÊÚ¤ÓÂÈ·˜ (35,36).

∏ ‰È¿ÁÓˆÛË ÙË˜ ÁÂÓÂÙÈÎ‹˜ ·ÓˆÌ·Ï›·˜ ÂÈÙÚ¤ÂÈÛÙÔÓ ·È‰›·ÙÚÔ Ó· ÂÎÙÈÌ‹ÛÂÈ ÙÔ ÁÂÓÂÙÈÎfi ˘fiÛÙÚˆ-Ì· ÙË˜ Û˘ÌÂÚÈÊÔÚ¿˜ ÙÔ˘ ·È‰ÈÔ‡, Ó· ÂÏ¤ÁÍÂÈ ÁÈ·Û˘ÓÔ‰¿ ÚÔ‚Ï‹Ì·Ù·, Ó· ÚÔ‚Ï¤„ÂÈ ÙËÓ ÔÚÂ›· Î·È,Èı·ÓÒ˜, Ó· ‰È·ÁÓÒÛÂÈ ËÈfiÙÂÚÂ˜ ÌÔÚÊ¤˜ ÙË˜ Ófi-ÛÔ˘ ÛÂ ¿ÏÏ· Ì¤ÏË ÙË˜ ÔÈÎÔÁ¤ÓÂÈ·˜.

∆· ÈÔ Û˘¯Ó¿ ÁÂÓÂÙÈÎ¿ Û‡Ó‰ÚÔÌ· ÌÂ ¯·Ú·ÎÙËÚÈ-ÛÙÈÎfi Ê·ÈÓfiÙ˘Ô Û˘ÌÂÚÈÊÔÚ¿˜ Â›Ó·È Ù· ·ÎfiÏÔ˘ı·(35,37,38):

™‡Ó‰ÚÔÌÔ Down: ∏ ‰È¿ÁÓˆÛË Ù›ıÂÙ·È ÛÂ ÌÈÎÚ‹ËÏÈÎ›·, ÏfiÁˆ ¯·Ú·ÎÙËÚÈÛÙÈÎÔ‡ ÛˆÌ·ÙÈÎÔ‡ Ê·ÈÓÔÙ‡-Ô˘. ™Â Û‡ÁÎÚÈÛË ÌÂ ¿ÏÏ· ·È‰È¿ ÌÂ ÓÔËÙÈÎ‹ ˘ÛÙ¤-ÚËÛË, Â›Ó·È ÈÔ ÎÔÈÓˆÓÈÎ¿, ¤¯Ô˘Ó ¯·ÌËÏfiÙÂÚË Û˘-¯ÓfiÙËÙ· ‰È·Ù·Ú·¯ÒÓ ı‡ÌÔ˘ Î·È „‡¯ˆÛË˜, ·ÏÏ¿ ·-ÚÔ˘ÛÈ¿˙Ô˘Ó ÈÔ Û˘¯Ó¿ Û‡Ó‰ÚÔÌÔ ÂÏÏÂÈÌÌ·ÙÈÎ‹˜ÚÔÛÔ¯‹˜.

™‡Ó‰ÚÔÌÔ Â‡ıÚ·˘ÛÙÔ˘ Ã: ∂›Ó·È Ë ÈÔ Û˘¯Ó‹ ÎÏË-ÚÔÓÔÌÈÎ‹ ·ÈÙ›· ÓÔËÙÈÎ‹˜ ˘ÛÙ¤ÚËÛË˜ (1:1250 ÁÂÓÓ‹-ÛÂÈ˜ ·ÚÚ¤ÓˆÓ). ¡ÔËÙÈÎ‹ ˘ÛÙ¤ÚËÛË, Ë ‚·Ú‡ÙËÙ· ÙË˜ÔÔ›·˜ ÔÈÎ›ÏÏÂÈ, ˘¿Ú¯ÂÈ ÛÂ fiÏÔ˘˜ ÙÔ˘˜ ¿ÚÚÂÓÂ˜Î·È ÛÙ· ÌÈÛ¿ ÂÙÂÚfi˙˘Á· ı‹ÏÂ·. º·ÈÓÔÙ˘ÈÎ¿, Ù··ÁfiÚÈ· ·ÚÔ˘ÛÈ¿˙Ô˘Ó ¯·Ï·ÚfiÙËÙ· ·ÚıÚÒÛÂˆÓ,ÌÂÁ¿ÏÔ˘˜ fiÚ¯ÂÈ˜, ÌÂÁ¿ÏË ÁÓ¿ıÔ Î·È ÂÍ¤¯ÔÓÙ··ÊÙÈ¿. ∏ Û˘ÌÂÚÈÊÔÚ¿ ÙˆÓ ·ÛıÂÓÒÓ ¯·Ú·ÎÙËÚ›˙Â-Ù·È ·fi ÊÙˆ¯‹ ‚ÏÂÌÌ·ÙÈÎ‹ Â·Ê‹, ·ÔÊ˘Á‹ ÎÔÈÓˆ-ÓÈÎÒÓ Â·ÊÒÓ, ÛÙÂÚÂÔÙ˘›Â˜, ÂÌÌÔÓ¤˜, ˘ÂÚÎÈÓËÙÈ-ÎfiÙËÙ· Î·È ÂÎÚ‹ÍÂÈ˜ ı˘ÌÔ‡.

™‡Ó‰ÚÔÌÔ Williams: ∆· ·È‰È¿ ·˘Ù¿ ·ÚÔ˘ÛÈ¿-˙Ô˘Ó ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÚÔÛˆÂ›Ô, ÎÔÓÙfi ·Ó¿ÛÙËÌ·,Û˘ÁÁÂÓÂ›˜ Î·Ú‰ÈÔ¿ıÂÈÂ˜ Î·È ˘ÂÚ·Û‚ÂÛÙÈ·ÈÌ›·.Œ¯Ô˘Ó Î·Ï¿ ·ÓÂÙ˘ÁÌ¤ÓÔ ÂÎÊÚ·ÛÙÈÎfi ÏfiÁÔ, ˘ÂÚ-ÎÈÓËÙÈÎfiÙËÙ· Î·È ¿Á¯Ô˜.

May-June 03 03-06-03 16:55 ™ÂÏ›‰·170


171

™‡Ó‰ÚÔÌÔ Prader-Willi: O ÎÏÈÓÈÎfi˜ Ê·ÈÓfiÙ˘Ô˜ÂÚÈÏ·Ì‚¿ÓÂÈ ·¯˘Û·ÚÎ›·, ÎÔÓÙfi ·Ó¿ÛÙËÌ·, ÎÚ˘-„ÔÚ¯›·, ˘ÔÏ·ÛÙÈÎ¿ ÁÂÓÓËÙÈÎ¿ fiÚÁ·Ó·, ÌÈÎÚ¿ ¯¤-ÚÈ· Î·È fi‰È·. ™ÙÔ ÈÛÙÔÚÈÎfi ·Ó·Ê¤ÚÂÙ·È ˘ÔÙÔÓ›·ÛÙË ÓÂÔÁÓÈÎ‹ ÂÚ›Ô‰Ô, ÔÏ˘Ê·Á›· ·fi ÙË ÓËÈ·Î‹ËÏÈÎ›· Î·È Î·ı˘ÛÙ¤ÚËÛË „˘¯ÔÎÈÓËÙÈÎ‹˜ ·Ó¿Ù˘ÍË˜.∆· ¿ÙÔÌ· ÌÂ Û‡Ó‰ÚÔÌÔ Prader-Willi ¤¯Ô˘Ó ÔÚÈ·Î‹ ‹‹ÈÔ˘ ‚·ıÌÔ‡ ¯·ÌËÏ‹ ÓÔËÌÔÛ‡ÓË. ∆· ÈÔ Û˘¯Ó¿ÚÔ‚Ï‹Ì·Ù· Û˘ÌÂÚÈÊÔÚ¿˜ Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Â›-Ó·È ÂÌÌÔÓ¤˜, Î˘Ú›ˆ˜ ÌÂ ÙÔ Ê·ÁËÙfi, Î·ıÒ˜ Î·È ÂÂÈ-Ûfi‰È· ÂÈıÂÙÈÎ‹˜ Û˘ÌÂÚÈÊÔÚ¿˜.

™‡Ó‰ÚÔÌÔ Turner: ∏ ÌÂÚÈÎ‹ ‹ Ï‹ÚË˜ ¤ÏÏÂÈ„ËÂÓfi˜ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ Ã ÂÎ‰ËÏÒÓÂÙ·È ÌÂ ÙÔÓ ¯·Ú·-ÎÙËÚÈÛÙÈÎfi Ê·ÈÓfiÙ˘Ô: ÎÔÓÙfi ·Ó¿ÛÙËÌ·, È‰ÈfiÌÔÚÊÔÚÔÛˆÂ›Ô, ÙÂÚ‡ÁÈÔ ÙÚ·¯‹ÏÔ˘, Ê·Ú‰‡˜ ıÒÚ·Î·˜Î·È ÎÔÓÙfi Ù¤Ù·ÚÙÔ ÌÂÙ·Î¿ÚÈÔ. ∏ ÓÔËÌÔÛ‡ÓË Â›Ó·ÈÛ˘Ó‹ıˆ˜ Ì¤Û· ÛÙ· Ê˘ÛÈÔÏÔÁÈÎ¿ fiÚÈ·, ·ÏÏ¿ ÔÈ Ì·-ıËÛÈ·Î¤˜ ‰˘ÛÎÔÏ›Â˜ Â›Ó·È Û˘¯Ó¤˜. ¶ÔÏÏ¤˜ ·ÛıÂÓÂ›˜·ÚÔ˘ÛÈ¿˙Ô˘Ó Î·Ù¿ıÏÈ„Ë, ¿Á¯Ô˜ Î·È ‰˘ÛÎÔÏ›· ÛÙÈ˜ÎÔÈÓˆÓÈÎ¤˜ Û¯¤ÛÂÈ˜.

∞ÁfiÚÈ· ÌÂ Î·Ú˘fiÙ˘Ô ÃÃÀ ‹ Û‡Ó‰ÚÔÌÔ Klinefelter:∂›Ó·È „ËÏÔ›, ÌÂ ‰˘Û·Ó¿ÏÔÁ· Ì·ÎÚÈ¿ fi‰È·, ÌÈÎÚÔ‡˜fiÚ¯ÂÈ˜ Î·È Á˘Ó·ÈÎÔÌ·ÛÙ›·. ¶ÔÏÏÔ› ¤¯Ô˘Ó ¯·ÌËÏfi ÏÂ-ÎÙÈÎfi ËÏ›ÎÔ ÓÔËÌÔÛ‡ÓË˜ Î·È ‰˘ÛÎÔÏ›· ÛÙËÓ ·Ó¿-ÁÓˆÛË. ∂›Ó·È ·ıËÙÈÎÔ› ÛÙÈ˜ Û¯¤ÛÂÈ˜ ÌÂ Û˘ÓÔÌËÏ›-ÎÔ˘˜, ÔÈ ÔÔ›ÔÈ Û˘¯Ó¿ ÙÔ˘˜ ÂÈÙ›ıÂÓÙ·È.

∞ÁfiÚÈ· ÌÂ Î·Ú˘fiÙ˘Ô ÃÀÀ: Ã·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi„ËÏfi ·Ó¿ÛÙËÌ· Î·È ¤ÓÙÔÓË ·ÎÌ‹ Î·Ù¿ ÙËÓ ÂÊË‚Â›·.¶·ÚÔ˘ÛÈ¿˙Ô˘Ó Î·ı˘ÛÙ¤ÚËÛË ÙÔ˘ ÏfiÁÔ˘, ˘ÂÚÎÈÓË-ÙÈÎfiÙËÙ· Î·È ÂÈıÂÙÈÎ‹ Û˘ÌÂÚÈÊÔÚ¿, ÂÓÒ ÛÙËÓ ÂÊË-‚Â›· ÌÔÚÂ› Ó· ‰È·ÁÓˆÛÙÂ› ‰È·Ù·Ú·¯‹ ‰È·ÁˆÁ‹˜.

¶·È‰È¿ ÌÂ ÓÂ˘ÚÔ˚ÓˆÌ¿ÙˆÛË: Œ¯Ô˘Ó ÓÔËÌÔÛ‡ÓË ÛÙ·¯·ÌËÏ¿ Ê˘ÛÈÔÏÔÁÈÎ¿ fiÚÈ·, ÂÓÒ Ù· ÌÈÛ¿ ·ÚÔ˘ÛÈ¿˙Ô˘ÓÌ·ıËÛÈ·Î¤˜ ‰˘ÛÎÔÏ›Â˜ Î·È ‰È·Ù·Ú·¯‹ ÚÔÛÔ¯‹˜.

∑. §ÔÈÌÒÍÂÈ˜OÈ ·ÎfiÏÔ˘ıÂ˜ ÏÔÈÌÒÍÂÈ˜ ÙÔ˘ ∫¡™ ÌÔÚÂ› Ó· ÂÎ-

‰ËÏˆıÔ‡Ó ·Ú¯ÈÎ¿ ÌÂ „˘¯ÔÏÔÁÈÎ¤˜ ‰È·Ù·Ú·¯¤˜(7,10,39).

ÀÔÍÂ›· ÛÎÏËÚ˘ÓÙÈÎ‹ ·ÓÂÁÎÂÊ·Ï›ÙÈ‰·: ¶ÚfiÎÂÈ-Ù·È ÁÈ· Ï·Óı¿ÓÔ˘Û·, ÚÔÔ‰Â˘ÙÈÎ‹ ÊÏÂÁÌÔÓ‹ Ô˘·ÎÔÏÔ˘ıÂ› ÙËÓ ÈÏ·Ú¿ ‹ ÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi Î·Ù¿ ÙË˜ÈÏ·Ú¿˜. ∂Î‰ËÏÒÓÂÙ·È ÌÂ ·¸Ó›·, ÂÓ·ÓÙÈˆÙÈÎ‹ Û˘-ÌÂÚÈÊÔÚ¿, ÂÎÚ‹ÍÂÈ˜ ı˘ÌÔ‡ Î·È ·Ú·ÈÛı‹ÛÂÈ˜.¡Â˘ÚÔÏÔÁÈÎ¿ Û˘ÌÙÒÌ·Ù·, fiˆ˜ Û·ÛÌÔ› Î·È ·Ù·-Í›·, ÌÔÚÂ› Ó· ÂÌÊ·ÓÈÛÙÔ‡Ó ·ÚÁfiÙÂÚ· ÛÙËÓ ÔÚÂ›·ÙË˜ ÓfiÛÔ˘.

∂ÚËÙÈÎ‹ ÌËÓÈÁÁÔÂÁÎÂÊ·Ï›ÙÈ‰·: ∫·Ù¿ ÙÔ ÔÍ‡ÂÂÈÛfi‰ÈÔ, Ù· 9/10 ÙˆÓ ·ÛıÂÓÒÓ ¤¯Ô˘Ó ‰È·Ù·Ú·¯¤˜Û˘ÌÂÚÈÊÔÚ¿˜, ·Ú·ÈÛı‹ÛÂÈ˜ ‹ „‡¯ˆÛË. ™˘Ó‹ıˆ˜˘¿Ú¯ÂÈ ˘ÚÂÙfi˜, ÓÂ˘ÚÔÏÔÁÈÎ¿ Û˘ÌÙÒÌ·Ù· Î·È‚·ÚÈ¿ ÎÏÈÓÈÎ‹ ÂÈÎfiÓ·.

∂ÈÏÔÎ¤˜ ÌÈÎÚÔ‚È·Î‹˜ ÌËÓÈÁÁ›ÙÈ‰·˜: ª›· ·fiÙÈ˜ ÈÔ Û˘¯Ó¤˜ ÂÈÏÔÎ¤˜ Â›Ó·È Ë ·ÒÏÂÈ· ·ÎÔ‹˜, ËÔÔ›· ÂÓ‰¤¯ÂÙ·È Ó· ÂÎ‰ËÏˆıÂ› ÌÂ ‰È·Ù·Ú·¯¤˜ ÔÌÈ-

Ï›·˜ Î·È Û˘ÌÂÚÈÊÔÚ¿˜. ªÂÚÈÎ¤˜ Â‚‰ÔÌ¿‰Â˜ ‹ Î·ÈÌ‹ÓÂ˜ ÌÂÙ¿ ÙË ÓfiÛÔ, ÔÈ ·ÛıÂÓÂ›˜ ÌÔÚÂ› Ó· ·ÚÔ˘-ÛÈ¿ÛÔ˘Ó ÚÔ‚Ï‹Ì·Ù· Û˘ÌÂÚÈÊÔÚ¿˜ Î·È ÁÓˆÛÙÈÎ¿ÂÏÏÂ›ÌÌ·Ù·. °ÂÓÈÎ¿, fiÌˆ˜, Ë ÚfiÁÓˆÛË Â›Ó·È Â˘ÓÔ˚-Î‹ ÛÙ· ·È‰È¿ Ô˘ ‰ÂÓ Â›¯·Ó ÓÂ˘ÚÔÏÔÁÈÎ¿ ÂÏÏÂ›Ì-Ì·Ù· Î·Ù¿ ÙËÓ ¤ÍÔ‰Ô ·fi ÙÔ ÓÔÛÔÎÔÌÂ›Ô.

™‡Ó‰ÚÔÌÔ ¯ÚfiÓÈ·˜ ÎfiˆÛË˜: ™˘Ó‹ıˆ˜ ·Ú¯›˙ÂÈÌÂ ÔÍÂ›· ÏÔ›ÌˆÍË (ÏÔÈÌÒ‰Ë ÌÔÓÔ˘Ú‹ÓˆÛË ‹ ÁÚ›-Ë). ∞ÎÔÏÔ˘ıÂ› ·›ÛıËÌ· ÎfiˆÛË˜ Î·È ÌÂÈˆÌ¤ÓË˜·ÓÙÔ¯‹˜, Ô˘ ÂÌÔ‰›˙ÂÈ ÙÈ˜ Î·ÓÔÓÈÎ¤˜ ‰Ú·ÛÙËÚÈfi-ÙËÙÂ˜ Î·È ‰È·ÚÎÂ› >6 Ì‹ÓÂ˜. ™˘ÓÔ‰Â‡ÂÙ·È ·fi ÔÏ-Ï·Ï¿ Û˘ÌÙÒÌ·Ù· Î·È Ë ‰È¿ÁÓˆÛË Ù›ıÂÙ·È Â¿ÓÏËÚÔ› Ù· ÎÚÈÙ‹ÚÈ· ÙÔ˘ ∫¤ÓÙÚÔ˘ ∂Ï¤Á¯Ô˘ Î·È ¶Úfi-ÏË„Ë˜ ∞ÛıÂÓÂÈÒÓ ÙˆÓ ∏¶∞ (40). OÈ ÂÚÈÛÛfiÙÂÚÔÈ·ÛıÂÓÂ›˜ ¿Û¯Ô˘Ó ·fi ‰È·Ù·Ú·¯¤˜ ‡ÓÔ˘ (·¸Ó›·‹ ˘ÓËÏ›·), ‰˘ÛÎÔÏ›· Û˘ÁÎ¤ÓÙÚˆÛË˜ ÙË˜ ÚÔÛÔ-¯‹˜ ‹ ¤¯Ô˘Ó fiÏ· Ù· Û˘ÌÙÒÌ·Ù· Î·Ù¿ıÏÈ„Ë˜ (ÛÂÌÂÁ·Ï‡ÙÂÚ· ÔÛÔÛÙ¿ ·fi ¿ÙÔÌ· ÌÂ ¯ÚfiÓÈ· ÓÔÛ‹-Ì·Ù·, fiˆ˜ Ë Î˘ÛÙÈÎ‹ ›ÓˆÛË). ¢ÂÓ Â›Ó·È ÁÓˆÛÙfi Â¿ÓÙ· „˘¯ÈÎ¿ ÚÔ‚Ï‹Ì·Ù· Â›Ó·È ·ÈÙ›· ‹ Â›ÙˆÛË ÙˆÓÛˆÌ·ÙÈÎÒÓ Û˘ÌÙˆÌ¿ÙˆÓ ‹ Â¿Ó ˘¿Ú¯ÂÈ ÎÔÈÓfi˜ ·È-ÙÈÔÏÔÁÈÎfi˜ ·Ú¿ÁÔÓÙ·˜.

™‡Ó‰ÚÔÌÔ Â›ÎÙËÙË˜ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·˜ (AIDS):¶·È‰È¿ ÌÂ AIDS Î·È ÚÔÛ‚ÔÏ‹ ÙÔ˘ ∫¡™ ·ÚÔ˘ÛÈ¿-˙Ô˘Ó ‰È·Ù·Ú·¯¤˜ ÌÓ‹ÌË˜ Î·È ÚÔÛÔ¯‹˜, ·fiÛ˘ÚÛËÎ·È ·˘ÍËÌ¤ÓË Û˘Ó·ÈÛıËÌ·ÙÈÎ‹ ÌÂÙ·‚ÏËÙfiÙËÙ·.

∏. ∞˘ÙÔ¿ÓÔÛ· ÓÔÛ‹Ì·Ù· (7,41) ¶·È‰È·ÙÚÈÎ¤˜ ·˘ÙÔ¿ÓÔÛÂ˜ ÓÂ˘ÚÔ„˘¯È·ÙÚÈÎ¤˜

‰È·Ù·Ú·¯¤˜ Û¯ÂÙÈ˙fiÌÂÓÂ˜ ÌÂ ÛÙÚÂÙfiÎÔÎÎÔ(Pediatric autoimmune neuropsychiatric disordersassociated with streptococcus - PANDAS): ∂Î‰Ë-ÏÒÓÂÙ·È ÌÂ È‰ÂÔ„˘¯·Ó·ÁÎ·ÛÙÈÎ‹ ‰È·Ù·Ú·¯‹.

¢È·ÁÓˆÛÙÈÎ¿ ÎÚÈÙ‹ÚÈ· ·ÔÙÂÏÔ‡Ó: ·) Ë ·ÚÔ˘-Û›· È‰ÂÔ„˘¯·Ó·ÁÎ·ÛÙÈÎ‹˜ ‰È·Ù·Ú·¯‹˜ ‹ ÙÈÎ, ‚) Ë¤Ó·ÚÍË ÌÂÙ·Í‡ ËÏÈÎ›·˜ 3 ÂÙÒÓ Î·È ÂÊË‚Â›·˜, Á) Ë·ÈÊÓ›‰È· ¤Ó·ÚÍË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ, Ë ÔÚÂ›· ÌÂ˘Ê¤ÛÂÈ˜ Î·È ‰Ú·Ì·ÙÈÎ¤˜ ÂÍ¿ÚÛÂÈ˜, ‰) Ë ¯ÚÔÓÔÏÔÁÈ-Î‹ Û¯¤ÛË ÙˆÓ ÂÍ¿ÚÛÂˆÓ ÌÂ ÙË ÛÙÚÂÙÔÎÔÎÎÈÎ‹ ÏÔ›-ÌˆÍË Î·È Â) Ù· ·ıÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù· ÛÙË ÓÂ˘ÚÔ-ÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ¤Í·ÚÛË˜ (ÙÈÎ,¯ÔÚÂ›·, ˘ÂÚÎÈÓËÙÈÎfiÙËÙ·).

∞fi ÌÂÏ¤ÙÂ˜ ÌÂ ÌÈÎÚÔ‡˜ ·ÚÈıÌÔ‡˜ ·ÛıÂÓÒÓ ÚÔ-Î‡ÙÂÈ fiÙÈ ÂÚ›Ô˘ 10% ÙˆÓ ·È‰ÈÒÓ ÌÂ È‰ÂÔÏË„›Â˜Î·È „˘¯·Ó·ÁÎ·ÛÌÔ‡˜ ÌÔÚÂ› Ó· ¿Û¯ÂÈ ·fiPANDAS. ™˘ÓÈÛÙ¿Ù·È ÚÔÊ‡Ï·ÍË ÌÂ ÂÓÈÎÈÏ›ÓË, fiˆ˜ÌÂÙ¿ ·fi ÚÂ˘Ì·ÙÈÎfi ˘ÚÂÙfi, ·ÏÏ¿ ‰ÂÓ ˘¿Ú¯Ô˘Ó·ÎfiÌË ÏËÚÔÊÔÚ›Â˜ ÁÈ· ÙË Ì·ÎÚÔ¯ÚfiÓÈ· ÚfiÁÓˆÛË.

∂Ú˘ıËÌ·ÙÒ‰Ë˜ Ï‡ÎÔ˜: ¶·È‰È¿ ÌÂ ÂÚ˘ıËÌ·ÙÒ‰ËÏ‡ÎÔ Ô˘ ¤¯ÂÈ ÚÔÛ‚¿ÏÂÈ ÙÔ ∫¡™ ÌÔÚÂ› Ó· ·-ÚÔ˘ÛÈ¿ÛÔ˘Ó ÔÍÂ›· Û‡Á¯˘ÛË ‹ „‡¯ˆÛË, ÚÔÙÔ‡ ÂÌ-Ê·ÓÈÛÙÔ‡Ó Ù· ¿ÏÏ· ÓÂ˘ÚÔÏÔÁÈÎ¿ Î·È Û˘ÛÙËÌ·ÙÈÎ¿Û˘ÌÙÒÌ·Ù· ÙË˜ ÓfiÛÔ˘ (42,43).

£. ∆ÔÍÈÎ¿ ·›ÙÈ· (12,32) º·ÚÌ·ÎÔÏÔÁÈÎ¿ ·›ÙÈ·: ¶ÔÏÏ¿ Ê¿ÚÌ·Î· ÌÔÚÂ›

May-June 03 03-06-03 16:55 ™ÂÏ›‰·171


172

Ó· ÚÔÎ·Ï¤ÛÔ˘Ó „˘¯È·ÙÚÈÎ¿ Û˘ÌÙÒÌ·Ù· ˆ˜ ·-ÚÂÓ¤ÚÁÂÈ¿ ÙÔ˘˜ ‹ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÛÙ¤ÚËÛË˜. ∞fiÙËÓ ·È‰È·ÙÚÈÎ‹ Ê·ÚÌ·ÎÔÏÔÁ›· ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È·ÓÙÈ¯ÔÏÈÓÂÚÁÈÎ¿, ·ÓÙÈÂÈÏËÙÈÎ¿, ‚·Ú‚ÈÙÔ˘ÚÈÎ¿,‚ÂÓ˙Ô‰È·˙Â›ÓÂ˜, ·ÓÙ·ÁˆÓÈÛÙ¤˜ ‚-˘Ô‰Ô¯¤ˆÓ, ÎÔÚ-ÙÈÎÔÛÙÂÚÔÂÈ‰‹, ÈÛÔÓÈ·˙›‰Ë, ÌÂÙÚÔÓÈ‰·˙fiÏË, ÙÚÈÌÂ-ıÔÚ›ÌË-ÛÔ˘ÏÊ·ÌÂıÔÍ·˙fiÏË Î·È ¿ÏÏ·.

∫·Ù¿¯ÚËÛË Ô˘ÛÈÒÓ: ™Â ÂÊ‹‚Ô˘˜ ÌÂ Û¯È˙ÔÊÚ¤-ÓÂÈ·, Û˘¯Ó¿ Û˘Ó˘¿Ú¯ÂÈ ¯Ú‹ÛË ··ÁÔÚÂ˘Ì¤ÓˆÓÔ˘ÛÈÒÓ. ŸÙ·Ó Ô ¯Ú‹ÛÙË˜ ÂÍ·ÎÔÏÔ˘ıÂ› Ó· ·ÚÔ˘-ÛÈ¿˙ÂÈ „˘¯È·ÙÚÈÎ¿ Û˘ÌÙÒÌ·Ù· ÁÈ· ÂÚÈÛÛfiÙÂÚÔ·fi Ì›· Â‚‰ÔÌ¿‰· ÌÂÙ¿ ÙË ‰È·ÎÔ‹ ÙË˜ Ô˘Û›·˜, ·˘-Í¿ÓÂÈ Ë Èı·ÓfiÙËÙ· Ó· ˘¿Ú¯ÂÈ ÚˆÙÔ·ı¤˜ „˘¯È·-ÙÚÈÎfi Úfi‚ÏËÌ·. ∏ ÂıÈÛÙÈÎ‹ Ô˘Û›· ‰Ú· ˆ˜ ÚÔÎÏË-ÙÈÎfi˜ Î·È ÂÈ‚·Ú˘ÓÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜.

π. ¡Â˘ÚÔ·Ó·Ù˘ÍÈ·ÎÔ› ·Ú¿ÁÔÓÙÂ˜ ∏ Èı·ÓfiÙËÙ· ÂÌÊ¿ÓÈÛË˜ „˘¯È·ÙÚÈÎÒÓ Û˘ÌÙˆ-

Ì¿ÙˆÓ Â›Ó·È 2-3 ÊÔÚ¤˜ ·˘ÍËÌ¤ÓË ÛÂ ·È‰È¿ Ô˘ÁÂÓÓ‹ıËÎ·Ó ÌÂ ¯·ÌËÏfi ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜ ‹/Î·È ÂÚÈ-ÁÂÓÓËÙÈÎ¤˜ ÂÈÏÔÎ¤˜, fiˆ˜ Ë ·ÓÔÍ›· (44). ∏ Ì¤ÛËÂÚ›ÌÂÙÚÔ˜ ÎÂÊ·Ï‹˜ ÛÂ ·È‰È¿ ÌÂ Û¯È˙ÔÊÚ¤ÓÂÈ· Â›-Ó·È ¯·ÌËÏfiÙÂÚË ÛÂ Û‡ÁÎÚÈÛË ÌÂ Ì¿ÚÙ˘ÚÂ˜ (45).∂›ÛË˜, ÛÙËÓ ·ÂÈÎfiÓÈÛË ÂÁÎÂÊ¿ÏÔ˘ ·Ú·ÙËÚÂ›Ù·ÈÈÔ Û˘¯Ó¿ ‰ÈÂ‡Ú˘ÓÛË ÎÔÈÏÈÒÓ ÛÂ Û¯È˙ÔÊÚÂÓÈÎÔ‡˜·ÛıÂÓÂ›˜ ÌÂ ÈÛÙÔÚÈÎfi ÂÚÈÁÂÓÓËÙÈÎÒÓ ÂÈÏÔÎÒÓ(46). ∏ ÏÂÈÔÓfiÙËÙ· ÙˆÓ ·È‰ÈÒÓ ÌÂ ‚Â‚·ÚËÌ¤ÓÔÂÚÈÁÂÓÓËÙÈÎfi ÈÛÙÔÚÈÎfi ‰ÂÓ ·ÚÔ˘ÛÈ¿˙ÂÈ „˘¯È·ÙÚÈ-Î¿ ÚÔ‚Ï‹Ì·Ù· Î·È ¤ÙÛÈ Èı·ÓÔÏÔÁÂ›Ù·È fiÙÈ Ë ·ÈÙÈÔ-ÏÔÁ›· ÙÔ˘˜ ÔÊÂ›ÏÂÙ·È ÛÂ ·ÏÏËÏÂ›‰Ú·ÛË ‚Ï¿‚Ë˜ÙÔ˘ ∫¡™ ÌÂ ÁÂÓÂÙÈÎÔ‡˜ Î·È ÂÚÈ‚·ÏÏÔÓÙÈÎÔ‡˜ ·-Ú¿ÁÔÓÙÂ˜ (47,48).

∏ ¯Ú‹ÛË ÔÈÓÔÓÂ‡Ì·ÙÔ˜, ÓÈÎÔÙ›ÓË˜, Î¿ÓÓ·‚Ë˜,ÎÔÎ·˝ÓË˜ ‹ ·ÓÙÈÎ·Ù·ıÏÈÙÈÎÒÓ, ·ÓÙÈÂÈÏËÙÈÎÒÓ Î·È·ÓÙÈ„˘¯ˆÛÈÎÒÓ Ê·ÚÌ¿ÎˆÓ ·fi ÙË ÌËÙ¤Ú· Î·Ù¿ ÙË‰È¿ÚÎÂÈ· ÙË˜ Î‡ËÛË˜ Û¯ÂÙ›˙ÂÙ·È ÌÂ ·˘ÍËÌ¤ÓË Èı·-ÓfiÙËÙ· ‰È·Ù·Ú·¯ÒÓ ÙË˜ „˘¯ÔÎÈÓËÙÈÎ‹˜ ·Ó¿Ù˘ÍË˜Î·È ÙË˜ Û˘ÌÂÚÈÊÔÚ¿˜ ÛÙÔ ·È‰›. OÈ ÌÂÏ¤ÙÂ˜ ¤¯Ô˘ÓÏ¿‚ÂÈ ˘’ fi„ÈÓ ÙÔ˘˜ ÔÏÏÔ‡˜ Û˘Á¯˘ÙÈÎÔ‡˜ ·Ú¿ÁÔ-ÓÙÂ˜ Ô˘ ˘¿Ú¯Ô˘Ó ÛÂ Ù¤ÙÔÈÂ˜ ÂÚÈÙÒÛÂÈ˜ (49).

™ÙÔ ·ÙÔÌÈÎfi ÈÛÙÔÚÈÎfi ·È‰ÈÒÓ ÌÂ „˘¯È·ÙÚÈÎ¿ Û˘-ÌÙÒÌ·Ù· ·Ó·Ê¤ÚÔÓÙ·È ÈÔ Û˘¯Ó¿ ·ÔÎÏ›ÛÂÈ˜ ·fiÙË Ê˘ÛÈÔÏÔÁÈÎ‹ „˘¯ÔÎÈÓËÙÈÎ‹ ·Ó¿Ù˘ÍË, Î˘Ú›ˆ˜Î·ı˘ÛÙ¤ÚËÛË ÛÙË ‚¿‰ÈÛË Î·È ÛÙËÓ ÂÍ¤ÏÈÍË ÙÔ˘ Ïfi-ÁÔ˘. ™˘ÌÂÚ·›ÓÂÙ·È fiÙÈ Ë ‰È·Ù·Ú·ÁÌ¤ÓË ·Ó¿Ù˘ÍËÙÔ˘ ∫¡™ ı· ÌÔÚÔ‡ÛÂ Ó· ·ÔÙÂÏÂ› ÎÔÈÓfi ˘fi-ÛÙÚˆÌ· ÁÈ· Ù· ‰‡Ô Ê·ÈÓfiÌÂÓ· (48,50).

OÈ ÂÏ¿ÛÛÔÓÂ˜ Û˘ÁÁÂÓÂ›˜ ·ÓˆÌ·Ï›Â˜ Â›Ó·È Ê˘ÛÈ-Î¿ ÂÏÏÂ›ÌÌ·Ù· Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È ÛÂ ÔÛÔÛÙfi <4%ÙÔ˘ ÏËı˘ÛÌÔ‡. ¶·Ú·‰Â›ÁÌ·Ù· ·˘ÙÒÓ Â›Ó·È Ô˘ÂÚÙÂÏÔÚÈÛÌfi˜, Ë ÌÔÓ‹ÚË˜ Ù˘¯‹ ÙË˜ ·Ï¿ÌË˜, ËıÔÏˆÙ‹ ˘ÂÚÒ· Î.Ï. ™Â ·È‰È¿ ÌÂ ÔÈÎ›Ï· ÚÔ-‚Ï‹Ì·Ù· Û˘ÌÂÚÈÊÔÚ¿˜ (˘ÂÚÎÈÓËÙÈÎfiÙËÙ·, ÂÏ-ÏÂÈÌÌ·ÙÈÎ‹ ÚÔÛÔ¯‹, ‰È·Ù·Ú·¯‹ ‰È·ÁˆÁ‹˜, „‡¯ˆ-ÛË), ÔÈ ÂÏ¿ÛÛÔÓÂ˜ Û˘ÁÁÂÓÂ›˜ ·ÓˆÌ·Ï›Â˜ ··ÓÙÒ-

ÓÙ·È ÈÔ Û˘¯Ó¿ ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi(51,52). ™Â ÚÔÔÙÈÎ‹ ÌÂÏ¤ÙË ·È‰ÈÒÓ ÛÂ ˘„ËÏfiÎ›Ó‰˘ÓÔ ÁÈ· „˘¯È·ÙÚÈÎ‹ ÓfiÛÔ (ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·ÎfiÈÛÙÔÚÈÎfi, ÚÔ‚ÏËÌ·ÙÈÎfi ÂÚÈ‚¿ÏÏÔÓ), Ë Èı·ÓfiÙË-Ù· ÂÌÊ¿ÓÈÛË˜ „˘¯È·ÙÚÈÎÔ‡ ÚÔ‚Ï‹Ì·ÙÔ˜ ÛÙËÓÂÊË‚Â›· ‹Ù·Ó ÛËÌ·ÓÙÈÎ¿ ·˘ÍËÌ¤ÓË ÛÙ· ·È‰È¿ ÌÂ≥2 ÂÏ¿ÛÛÔÓÂ˜ Û˘ÁÁÂÓÂ›˜ ·ÓˆÌ·Ï›Â˜ (52). ¶Èı·ÓÔ-ÏÔÁÂ›Ù·È fiÙÈ ·˘Ù¤˜ ÛËÌ·ÙÔ‰ÔÙÔ‡Ó ‰È·ÎÚÈÙÈÎ¤˜ ·Ó·-Ù˘ÍÈ·Î¤˜ ·ÓˆÌ·Ï›Â˜ ÙÔ˘ ∫¡™ Ô˘ ÚÔ‰È·ı¤ÙÔ˘Ó,ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ÂÚÈ‚·ÏÏÔÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜,ÁÈ· „˘¯È·ÙÚÈÎ¿ ÚÔ‚Ï‹Ì·Ù·.

∫ÏÈÓÈÎ‹ ·È‰È·ÙÚÈÎ‹ ÂÍ¤Ù·ÛË πÛÙÔÚÈÎfi ∆· ·ÎfiÏÔ˘ı· ÛÙÔÈ¯Â›· ·fi ÙÔ ÈÛÙÔÚÈÎfi ˘Ô‰Ë-

ÏÒÓÔ˘Ó ÙËÓ Èı·Ó‹ ‡·ÚÍË ÔÚÁ·ÓÈÎ‹˜ ‰È·Ù·Ú·¯‹˜(3-7,9-11): ·) ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi (Û˘ÁÁÂÓÂ›˜·ÓˆÌ·Ï›Â˜, ÌÂÙ·‚ÔÏÈÎ¿ ‹ ¿ÏÏ· ÁÂÓÂÙÈÎ¿ ÓÔÛ‹Ì·Ù·,ÓÔËÙÈÎ‹ ˘ÛÙ¤ÚËÛË, Û·ÛÌÔ›, ·˘ÙfiÌ·ÙÂ˜ ·Ô‚ÔÏ¤˜,ı¿Ó·ÙÔÈ ÛÂ ·È‰ÈÎ‹ ËÏÈÎ›·, ·ÈÌÔÌÈÍ›·, „˘¯È·ÙÚÈÎ¿ÚÔ‚Ï‹Ì·Ù·), ‚) ÌËÙ¤Ú· ÌÂ AIDS, Á) ÂÚÈÁÂÓÓËÙÈÎfiÈÛÙÔÚÈÎfi (ÂÈÏÔÎ¤˜ Î‡ËÛË˜, ÙÔÎÂÙÔ‡, ÂÚÈÁÂÓÓËÙÈ-Î‹˜ ÂÚÈfi‰Ô˘, ÚÔˆÚfiÙËÙ·), ‰) „˘¯ÔÎÈÓËÙÈÎ‹ ·Ó¿-Ù˘ÍË (Î·ı˘ÛÙÂÚ‹ÛÂÈ˜, ÂÈ‰ÈÎ¿ ÛÙÔ ‚¿‰ÈÛÌ·, ÏfiÁÔ˘Î·È ÛÙËÓ ÎÔÈÓˆÓÈÎfiÙËÙ·, ¿Ù˘Ë ·Ó¿Ù˘ÍË), Â) ·ÙÔ-ÌÈÎfi ÈÛÙÔÚÈÎfi (¤ÓÙÔÓÔÈ ¤ÌÂÙÔÈ ‹ ‰È·Ù·Ú·¯¤˜ Û˘ÓÂ›-‰ËÛË˜ ÚÔÎ·ÏÔ‡ÌÂÓ· Â·ÓÂÈÏËÌÌ¤Óˆ˜ ·fi ÎÔÈÓ¤˜ÏÔÈÌÒÍÂÈ˜, ÓËÛÙÂ›· ‹ ‰È·ÈÙËÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜,·Û˘Ó‹ıÈÛÙË ÔÛÌ‹ ÛˆÌ·ÙÈÎÒÓ ÂÎÎÚ›ÛÂˆÓ, Û·ÛÌÔ›‹ ¿ÏÏ· ÓÂ˘ÚÔÏÔÁÈÎ¿ Û˘ÌÙÒÌ·Ù·) Î·È ÛÙ) ÁÂÓÈÎfiÂ›Â‰Ô ÏÂÈÙÔ˘ÚÁ›·˜ (˘ÓËÏ›· ‹ ·¸Ó›·, ÚÔÔ‰Â˘-ÙÈÎ‹ ·ÒÏÂÈ· ‰ÂÍÈÔÙ‹ÙˆÓ ·˘ÙÔÂÍ˘ËÚ¤ÙËÛË˜, ·fi-Û·ÛË ÚÔÛÔ¯‹˜, ¤ÎÙˆÛË ÌÓ‹ÌË˜, ÌÂÈˆÌ¤ÓÔ ÏÂÍÈ-ÏfiÁÈÔ ÌÂ Â·ÎfiÏÔ˘ıË ÌÂ›ˆÛË ÙË˜ Û¯ÔÏÈÎ‹˜ Â›‰Ô-ÛË˜, Î·Îfi˜ ÚÔÛ·Ó·ÙÔÏÈÛÌfi˜ ÛÙÔ ¯ÒÚÔ Î·È ÔÙÈ-ÎÔ-ÎÈÓËÙÈÎ‹ ‰È·Ù·Ú·¯‹, ‰È·Ù·Ú·¯¤˜ ÔÌÈÏ›·˜ - ‰˘-Û·ÚıÚ›·, ·ÏÏ·Á‹ ¯ÚÔÈ¿˜ ÙË˜ ÊˆÓ‹˜, ÙÚ·˘ÏÈÛÌfi˜,¤ÎÙˆÛË fiÚ·ÛË˜ ‹ ·ÎÔ‹˜).

¶Ú¤ÂÈ Ó· ÛËÌÂÈˆıÂ› fiÙÈ ÛÙ· ·ÌÈÁÒ˜ „˘¯È·ÙÚÈÎ¿ÓÔÛ‹Ì·Ù·, Ë Û˘ÌÂÚÈÊÔÚ¿ ÙÔ˘ ·È‰ÈÔ‡ ÂËÚÂ¿˙ÂÈ‰˘ÛÌÂÓÒ˜ ÙË Û¯ÔÏÈÎ‹ ÚfiÔ‰fi ÙÔ˘, ·ÏÏ¿ ·˘Ùfi Û˘-Ó‹ıˆ˜ ‰ÂÓ ÔÊÂ›ÏÂÙ·È ÛÙËÓ ¤ÎÙˆÛË ÙˆÓ ‰ÂÍÈÔÙ‹-ÙˆÓ Î·ı’ Â·˘Ù‹ (·Ó¿ÁÓˆÛË, ÁÚ·Ê‹, ÁÓˆÛÙÈÎ¤˜ ÏÂÈ-ÙÔ˘ÚÁ›Â˜), fiˆ˜ ÛÙÈ˜ ÔÚÁ·ÓÈÎ¤˜ „˘¯ÒÛÂÈ˜.

∞ÓÙÈÎÂÈÌÂÓÈÎ‹ ÂÍ¤Ù·ÛË∆· ·ÎfiÏÔ˘ı· ÛËÌÂ›· ÌÔÚÂ› Ó· Û¯ÂÙ›˙ÔÓÙ·È ÌÂ

ÙËÓ ‡·ÚÍË ÔÚÁ·ÓÈÎÔ‡ ÚÔ‚Ï‹Ì·ÙÔ˜ (3-7,9-11,51,52): ·) ÛˆÌ·ÙÔÌÂÙÚÈÎ¿ (ÛËÌ·ÓÙÈÎ‹ ·fiÎÏÈÛË·fi ÙÈ˜ Ê˘ÛÈÔÏÔÁÈÎ¤˜ ÙÈÌ¤˜ ÁÈ· ·Ó¿ÛÙËÌ· Î·È ‚¿-ÚÔ˜ ÛÒÌ·ÙÔ˜), ‚) È‰ÈfiÌÔÚÊÔ ÚÔÛˆÂ›Ô, Á) ‰Èfi-ÁÎˆÛË ı˘ÚÂÔÂÈ‰Ô‡˜, ‰) ÔÊı·ÏÌÔÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË(‰·ÎÙ‡ÏÈÔ˜ Kaiser Fleischer, ÂÓ‰Â›ÍÂÈ˜ ·˘ÍËÌ¤ÓË˜ÂÓ‰ÔÎÚ·ÓÈ·Î‹˜ ›ÂÛË˜ ÛÙË ‚˘ıÔÛÎfiËÛË, ¤ÎÙˆÛËÔÙÈÎ‹˜ ÔÍ‡ÙËÙ·˜, ÌÂ›ˆÛË ÔÙÈÎÒÓ Â‰›ˆÓ, ÔÈÎ›ÏÂ˜

May-June 03 03-06-03 16:55 ™ÂÏ›‰·172


173

·ıÔÁÓˆÌÔÓÈÎ¤˜ ·ÏÏÔÈÒÛÂÈ˜ ÛÂ ÌÂÙ·‚ÔÏÈÎ¿ ÓÔÛ‹-Ì·Ù·), Â) Î˘ÎÏÔÊÔÚÈÎfi (‰È·Ù·Ú·¯¤˜ ·ÚÙËÚÈ·Î‹˜›ÂÛË˜ Î·È ÛÊ‡ÍÂˆÓ), ÛÙ) ÎÔÈÏÈ¿ (‰ÈfiÁÎˆÛË ‹·ÙÔ˜‹ ÛÏËÓfi˜), ˙) ÂÍˆÙÂÚÈÎ¿ ÁÂÓÓËÙÈÎ¿ fiÚÁ·Ó· (‰È·Ù·-Ú·¯‹ ÛÂÍÔ˘·ÏÈÎ‹˜ ˆÚ›Ì·ÓÛË˜), Ë) ·ÓˆÌ·Ï›Â˜ ÛÎÂ-ÏÂÙÔ‡ ‹ ‰¤ÚÌ·ÙÔ˜, ı) ·ıÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù· ÛÙËÓÂ˘ÚÔÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË (‚¿‰ÈÛÌ·, ÈÛÔÚÚÔ›·, Û˘ÓÙÔ-ÓÈÛÌfi˜, ÂÁÎÂÊ·ÏÈÎ¤˜ Û˘˙˘Á›Â˜, ÏfiÁÔ˜/ÔÌÈÏ›·, ·ÎÔ‹,Ì˘˚Î‹ ÈÛ¯‡˜, Ì˘˚Îfi˜ ÙfiÓÔ˜, ·ÎÔ‡ÛÈÂ˜ ÎÈÓ‹ÛÂÈ˜-ÙÚfi-ÌÔ˜, ‰˘ÛÎÈÓËÛ›·, ·ıÔÏÔÁÈÎ¿ ÙÂÓfiÓÙÈ· ·ÓÙ·Ó·ÎÏ·-ÛÙÈÎ¿, ·ÈÛıËÙÈÎfiÙËÙ·-ÂÏ¿ÛÛÔÓ· ÓÂ˘ÚÔÏÔÁÈÎ¿ ÛË-ÌÂ›·) Î·È È) ÌÂ›˙ÔÓÂ˜ ‹ ÂÏ¿ÛÛÔÓÂ˜ Û˘ÁÁÂÓÂ›˜ ·Óˆ-Ì·Ï›Â˜.

∂ÚÁ·ÛÙËÚÈ·Î¤˜ ÂÍÂÙ¿ÛÂÈ˜¶ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ·Ï¤˜ ÂÍÂÙ¿ÛÂÈ˜ ÁÈ· ·Ó›¯ÓÂ˘ÛË

ÓÔÛËÌ¿ÙˆÓ ÛÂ ¿ÙÔÌ· ¯ˆÚ›˜ ÔÚÁ·ÓÈÎ‹ Û˘ÌÙˆÌ·-ÙÔÏÔÁ›· Î·È ‰È·ÁÓˆÛÙÈÎ¤˜ ÂÍÂÙ¿ÛÂÈ˜ ÁÈ· Û˘ÁÎÂÎÚÈ-Ì¤ÓË ÎÏÈÓÈÎ‹ ˘Ô„›· (3-7,9-11,55).

·) ∞ÓÈ¯ÓÂ˘ÙÈÎ¤˜ ÂÍÂÙ¿ÛÂÈ˜: °ÂÓÈÎ‹ ·›Ì·ÙÔ˜, ∆∫∂,ÁÂÓÈÎ‹ Ô‡ÚˆÓ, ÁÏ˘Îfi˙Ë ·›Ì·ÙÔ˜, ÈÔÓÙfiÁÚ·ÌÌ·, Ô˘-ÚÈÎfi ÔÍ‡, Ô˘Ú›· Î·È ÎÚÂ·ÙÈÓ›ÓË, ÂÍÂÙ¿ÛÂÈ˜ Ë·ÙÈÎ‹˜ÏÂÈÙÔ˘ÚÁ›·˜, ÏÈ›‰È·, CPK (54-56), ÂÍÂÙ¿ÛÂÈ˜ ÏÂÈ-ÙÔ˘ÚÁ›·˜ ı˘ÚÂÔÂÈ‰Ô‡˜.

‚) ¢È·ÁÓˆÛÙÈÎ¤˜ ÂÍÂÙ¿ÛÂÈ˜, ÔÈ ÔÔ›Â˜ ‰ÈÂÓÂÚÁÔ‡-ÓÙ·È ·Ó¿ÏÔÁ· ÌÂ Ù· ÎÏÈÓÈÎ¿ ÛÙÔÈ¯Â›·.

i) ÃÚˆÌÔÛˆÌÈÎ‹ ·Ó¿Ï˘ÛË Î·È ÂÍ¤Ù·ÛË ÁÈ· Â‡-ıÚ·˘ÛÙÔ Ã ÛÂ ÂÚÈÙÒÛÂÈ˜ ÌÂ æ∫∫, ·ıÔÁÓˆÌÔÓÈ-Î‹ ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· Î·È Ê·ÈÓfiÙ˘Ô Û˘ÌÂÚÈÊÔÚ¿˜ ‹ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi.

ii) ∫˘ÙÙ·ÚÔÁÂÓÓËÙÈÎfi˜ ¤ÏÂÁ¯Ô˜, fiÙ·Ó ˘¿Ú¯Ô˘ÓÊ˘ÛÈÎ¿ Û˘ÁÁÂÓÂ›˜ ·ÓˆÌ·Ï›Â˜ ‹/Î·È æ∫∫.

iii) ∂Í¤Ù·ÛË ·›Ì·ÙÔ˜ Î·È Ô‡ÚˆÓ ÁÈ· ÙÔÍÈÎ¤˜ Ô˘-Û›Â˜, fiÔ˘ ÂÓ‰Â›ÎÓ˘Ù·È.

iv) ŒÏÂÁ¯Ô˜ ÁÈ· ÓÂ˘ÚÔÌÂÙ·‚ÔÏÈÎ¤˜ ‰È·Ù·Ú·¯¤˜:·›Ì· (p∏, ·ÌÌˆÓ›·, ·ÌÈÓÔÍ¤·, Á·Ï·ÎÙÈÎfi ÔÍ‡, ˘-ÚÔÛÙ·Ê˘ÏÈÎfi ÔÍ‡, Î·ÚÓÈÙ›ÓË, ÏÈ·Ú¿ ÔÍ¤· ÔÏ‡ Ì·-ÎÚ¿˜ ·Ï‡ÛÔ˘, ÛÂÚÔ˘ÏÔÏ·ÛÌ›ÓË), o‡Ú·: (ÔÚÁ·ÓÈÎ¿ÔÍ¤·, ·ÌÈÓÔÍ¤·, ‚ÂÓÓÔÔÏ˘Û·Î¯·Ú›ÙÂ˜, ÔÏÈÁÔÛ·Î-¯·Ú›ÙÂ˜, ¯·ÏÎfi˜).

v) ∆· ·Ú·¿Óˆ ÌÔÚÂ› Ó· Ô‰ËÁ‹ÛÔ˘Ó ÛÂ ÈÔÂÍÂÈ‰ÈÎÂ˘Ì¤ÓÂ˜ ÂÍÂÙ¿ÛÂÈ˜, fiˆ˜ ÂÍÂÙ¿ÛÂÈ˜ ∂¡À(57), ÂÓ˙˘Ì·ÙÈÎ¤˜ ÌÂÏ¤ÙÂ˜ ‰ÂÈÁÌ¿ÙˆÓ ·fi ‚ÈÔ„›·,·Ó¿Ï˘ÛË DNA.

Á) ¡Â˘ÚÔ·ÂÈÎÔÓÈÛÙÈÎ¤˜ ÌÂÏ¤ÙÂ˜: ∂Ó‰Â›ÎÓ˘ÓÙ·ÈfiÙ·Ó ˘¿Ú¯Ô˘Ó ÓÂ˘ÚÔÏÔÁÈÎ¿ ÛËÌÂ›· ‹ ˘Ô„›· ÂÎ-Ê˘ÏÈÛÙÈÎ‹˜ ÓfiÛÔ˘ (19,58,59).

∏ Ì·ÁÓËÙÈÎ‹ ÙÔÌÔÁÚ·Ê›· ÚÔÛÊ¤ÚÂÈ ÂÚÈÛÛfi-ÙÂÚ· ·fi ÙËÓ ˘ÔÏÔÁÈÛÙÈÎ‹, ÂÈ‰ÈÎ¿ ÁÈ· ÓÔÛ‹Ì·Ù·ÙË˜ ÏÂ˘Î‹˜ Ô˘Û›·˜ Î·È fiÁÎÔ˘˜.

™ÙËÓ ·È‰ÈÎ‹ Û¯È˙ÔÊÚ¤ÓÂÈ· ‰È·ÈÛÙÒÓÂÙ·È ÚÔÔ-‰Â˘ÙÈÎ‹ ‰ÈÂ‡Ú˘ÓÛË ÎÔÈÏÈÒÓ Î·È ÌÂ›ˆÛË ÔÏÈÎÔ‡fiÁÎÔ˘ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘. ∞ÛıÂÓÂ›˜ ÌÂ ÓÂ˘ÚÔÁÂÓ‹·ÓÔÚÂÍ›· ¤¯Ô˘Ó ÌÂ›ˆÛË Ê·È¿˜ Î·È ÏÂ˘Î‹˜ Ô˘Û›·˜, Ë

ÔÔ›· ·ÔÎ·ı›ÛÙ·Ù·È ÌfiÓÔ ÌÂÚÈÎÒ˜ ÌÂÙ¿ ·fi ÙËÓ·Ó¿ÎÙËÛË Ê˘ÛÈÔÏÔÁÈÎÔ‡ ‚¿ÚÔ˘˜ ÛÒÌ·ÙÔ˜.

OÈ ÏÂÈÙÔ˘ÚÁÈÎ¤˜ Ì¤ıÔ‰ÔÈ, fiˆ˜ PET, SPECT,MRS, Â›Ó·È ·ÎfiÌË Î˘Ú›ˆ˜ ÂÚÂ˘ÓËÙÈÎ¿ ÂÚÁ·ÏÂ›·.

‰) ∏ÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ· (60): ∆Ô ∏∂° Â›-Ó·È ‰È·ÁÓˆÛÙÈÎfi ÛÂ ÂÚÈÙÒÛÂÈ˜ ÂÈÏË„›·˜. ™Â ÔÚ-Á·ÓÈÎ¤˜ ‰È·Ù·Ú·¯¤˜ ∫¡™, ÔÈ ÂÈ‰ÈÎ¤˜ ‹ ÌË-ÂÈ‰ÈÎ¤˜·ÏÏÔÈÒÛÂÈ˜ ÌÔÚÂ› Ó· ÚÔÛÊ¤ÚÔ˘Ó ÂÈÚfiÛıÂÙÂ˜ÏËÚÔÊÔÚ›Â˜.

∫ÔÈÓˆÓÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ ŸÙ·Ó ‰È·ÈÛÙÒÓÔ˘ÌÂ ÙËÓ ‡·ÚÍË ÔÚÁ·ÓÈÎÔ‡

ÚÔ‚Ï‹Ì·ÙÔ˜, ‰ÂÓ ÌÔÚÔ‡ÌÂ ¿ÓÙ· Ó· ˘Ôı¤ÛÔ˘-ÌÂ fiÙÈ ·˘Ùfi Â˘ı‡ÓÂÙ·È ·ÔÎÏÂÈÛÙÈÎ¿ ÁÈ· ÙËÓ „˘¯È·-ÙÚÈÎ‹ Û˘ÌÙˆÌ·ÙÔÏÔÁ›·. ∏ ÔÚÂ›· ÙÔ˘ ·È‰ÈÔ‡ÂËÚÂ¿˙ÂÙ·È Î·È ·fi ÂÚÈ‚·ÏÏÔÓÙÈÎÔ‡˜ ·Ú¿ÁÔ-ÓÙÂ˜. À¿Ú¯Ô˘Ó ‰‡Ô ÌÔÓÙ¤Ï· ÂÚÌËÓÂ›·˜ (5). ™‡Ì-ÊˆÓ· ÌÂ ÙÔ ¤Ó·, ÙÔ ÔÚÁ·ÓÈÎfi ÓfiÛËÌ· Î·ıÈÛÙ¿ ÙÔ·È‰› ÈÔ ÂÈÚÚÂ¤˜ ·ÎfiÌË ÛÂ ÎÔÈÓ¿ ‰˘ÛÌÂÓ‹ ÎÔÈ-ÓˆÓÈÎ¿ Û˘Ì‚¿ÓÙ·. ∂ÔÌ¤Óˆ˜, ÌÂ ÛˆÛÙ‹ ÂÚÈ‚·ÏÏÔ-ÓÙÈÎ‹ ˘ÔÛÙ‹ÚÈÍË, ÌÔÚÂ› Ó· ·ÔÙÚ·Ô‡Ó, ÛÂ Î¿-ÔÈÔ ‚·ıÌfi, Ù· „˘¯È·ÙÚÈÎ¿ ÚÔ‚Ï‹Ì·Ù·. ™‡ÌÊˆÓ·ÌÂ ÙÔ ¿ÏÏÔ ÌÔÓÙ¤ÏÔ, ÔÈ ‚ÈÔÏÔÁÈÎ¤˜ ‰ÈÂÚÁ·Û›Â˜ Î·ÈÙ· „˘¯ÔÏÔÁÈÎ¿ Ê·ÈÓfiÌÂÓ· ÂÍÂÏ›ÛÛÔÓÙ·È ·ÓÂÍ¿ÚÙË-Ù·. ÕÚ·, ÌÂÚÈÎ¿ ¿ÙÔÌ· ÌÂ ÔÚÁ·ÓÈÎfi Úfi‚ÏËÌ· ı··ÚÔ˘ÛÈ¿ÛÔ˘Ó „˘¯Ô·ıÔÏÔÁ›·, ·ÎfiÌË Î·È Î¿Ùˆ·fi ÙÈ˜ ÈÔ Â˘ÓÔ˚Î¤˜ ÎÔÈÓˆÓÈÎ¤˜ Û˘Óı‹ÎÂ˜. ªÂ ·˘Ù‹ÙËÓ ÚÔÛ¤ÁÁÈÛË, ·ÔÊÂ‡ÁÔ˘ÌÂ ÙËÓ ÂÓÔ¯ÔÔ›ËÛËÙˆÓ ‹‰Ë Ù·Ï·ÈˆÚËÌ¤ÓˆÓ ÁÔÓ¤ˆÓ.

À¿Ú¯ÂÈ Î·È Ì›· ÙÚ›ÙË ÚÔÛ¤ÁÁÈÛË, Û‡ÌÊˆÓ· ÌÂÙËÓ ÔÔ›· ÔÚÈÛÌ¤Ó· ¿ÙÔÌ· ÌÂ ÔÚÁ·ÓÈÎ‹ ‰È·Ù·Ú·¯‹ı· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó Î·È „˘¯ÈÎ‹ ‰È·Ù·Ú·¯‹ ÔÚÁ·ÓÈÎ¿ÚÔÎ·ıÔÚÈÛÌ¤ÓË. £· ˘ÔÛÙÔ‡Ó fiÌˆ˜ Î·È ÂÚÈ‚·Ï-ÏÔÓÙÈÎ¤˜ ÂÈ‰Ú¿ÛÂÈ˜, ÔÈ ÔÔ›Â˜ Â›Ó·È Î·Ïfi Ó· ÚÔ-ÛÂ¯ıÔ‡Ó, Ô‡Ùˆ˜ ÒÛÙÂ Ó· ÂÏ·¯ÈÛÙÔÔÈËıÔ‡Ó ÔÈ È-ı·ÓfiÙËÙÂ˜ ¯ÚfiÓÈ·˜ „˘¯Ô·ıÔÏÔÁ›·˜.

™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, Ô ·È‰›·ÙÚÔ˜ ÌÔÚÂ› Ó· ·›-ÍÂÈ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ·Ó›¯ÓÂ˘ÛË „˘¯ÔÏÔÁÈÎÒÓÚÔ‚ÏËÌ¿ÙˆÓ ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ÙÔ˘, ÛÙË ‰È¿ÁÓˆÛËÈı·Ó‹˜ ÔÚÁ·ÓÈÎ‹˜ ·ÈÙÈÔÏÔÁ›·˜ Î·È ÛÙËÓ ·ÓÙÈÌÂÙÒ-ÈÛ‹ ÙË˜ ˆ˜ Ì¤ÏÔ˜ ‰ÈÂÈÛÙËÌÔÓÈÎ‹˜ ÔÌ¿‰·˜.

∂ÂÈ‰‹ Û˘¯Ó¿ ˘¿Ú¯ÂÈ ‰È·¯ÚÔÓÈÎ‹ ÌÂÙ·‚ÏËÙfi-ÙËÙ· ÙË˜ ÎÏÈÓÈÎ‹˜ ÂÈÎfiÓ·˜, ÂÈÛËÌ·›ÓÂÙ·È Ë ·Ó·-ÁÎ·ÈfiÙËÙ· Û˘ÛÙËÌ·ÙÈÎ‹˜ ·Ú·ÎÔÏÔ‡ıËÛË˜ Î·ÈÂ·ÓÂÍ¤Ù·ÛË˜ ÙÔ˘ ·ÛıÂÓ‹.

∂˘¯·ÚÈÛÙ›Â˜ ∂˘¯·ÚÈÛÙÒ ÙÔÓ Î‡ÚÈÔ ¢ËÌ‹ÙÚË µ·˚fiÔ˘ÏÔ Î·È ÙËÓ Î˘Ú›·

∂‡Ë ∆ÛÂÏ·Ï›‰Ô˘-µ·˚ÔÔ‡ÏÔ˘ ÁÈ· ÙÈ˜ ¯Ú‹ÛÈÌÂ˜ ·Ú·ÙËÚ‹-ÛÂÈ˜ ÙÔ˘˜.

µÈ‚ÏÈÔÁÚ·Ê›· 1. £ˆÌ·˝‰Ô˘ §, ™Ù¤ÓÔ˘ ∞, °ÚÈ‚¿ÎË ª, ª·ÎÔ‡Ï· Ã. ∞Ó›¯ÓÂ˘-

ÛË ‰È·Ù·Ú·¯ÒÓ Û˘ÌÂÚÈÊÔÚ¿˜ ·fi ÙÔÓ ·È‰›·ÙÚÔ [ÂÚ›ÏË-„Ë]. 2Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ ¶·È‰Ô„˘¯È·ÙÚÈÎ‹˜ ∂Ù·ÈÚÂ›·˜

May-June 03 03-06-03 16:55 ™ÂÏ›‰·173

∂ÏÏ¿‰Ô˜. ∞ı‹Ó·; 2001. ÛÂÏ. 79. 2. Jellinek M, Patel BP, Froehle MC, editors. Bright futures in

practice. Mental health. Arlington VA: National Center forEducation in Maternal and Child Health, GeorgetownUniversity; 2002. p. 341-371.

3. Lyon G, Adams RD, Kolodny EH. Neurology of HereditaryMetabolic Diseases of Children. 2nd ed. New York:McGraw-Hill; 1996. p. 70-272.

4. Trifiletti RR, Packard AM. Metabolic disorders presentingwith behavioral symptoms in the school-aged child. ChildAdolesc Psychiatr Clin N Am 1999;8:791-806.

5. Goodman R. Brain disorders. In: Rutter M, Taylor E, HersowL, editors. Child and Adolescent Psychiatry. 3rd ed. London:Blackwell Scientific Publishers; 1994. p. 172-188.

6. Saudobray JM, Charpentier C. Clinical phenotypes:diagnosis/algorithms. In: Scriver CR, Beaudet AL, Sly WS,Valle D, editors. The Metabolic and Molecular Basis ofInherited Disease. New York: McGraw-Hill; 2001. p. 1327-1403.

7. Herskowitz J, Rosman NP. Pediatrics, Neurology andPsychiatry - Common Ground. New York: MacMillanPublishing Co; 1982. p. 65-110.

8. American Psychiatric Association. Diagnostic and statisticalmanual of mental disorders. 4th ed. Washington, DC:American Psychiatric Association; 1994. p. 99-103.

9. ª·ÙÛ·ÓÈÒÙË˜ ¡™, ∫·Ú¿ıÈÔ˜ £∂, ¡ÈÎÔÏ·˝‰Ô˘ ¶¡, æ‡¯Ô˘-∫fiÚÎ· º, °·ÚÔ‡ÊË-∫Ô‡ÙÛ· ∞. ¶Ú·ÎÙÈÎ¤˜ ÁÓÒÛÂÈ˜ ÁÈ· ÙÈ˜Û‡ÌÊ˘ÙÂ˜ ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡. ™ÙËÓ: ¶·È‰È·ÙÚÈ-Î‹. ∞ı‹Ó·: π·ÙÚÈÎ¤˜ ∂Î‰fiÛÂÈ˜ §›ÙÛ·˜; 1999. ÛÂÏ. 1109-1136.

10. Skuster DZ, Digre KB, Corbett JJ. Neurologic conditionspresenting as psychiatric disorders. Psychiatr Clin NorthAm 1992;15:311-333.

11. Coker SB. The diagnosis of childhood neurodegenerativedisorders presenting as dementia in adults. Neurology1991;41:794-799.

12. Sater N, Constantino JN. Pediatric emergencies in childrenwith psychiatric conditions. Pediatr Emerg Care1998;14:42-50.

13. Smith ML. Atypical psychosis. Psychiatr Clin North Am1998;21:895-904.

14. Legras A, Labarthe F, Maillot F, Garrigue MA, Kouatchet A,Ogier D. Late diagnosis of ornithine transcarbamylasedefect in three related female patients: polymorphicpresentations. Crit Care Med 2002;30:241-244.

15. Akil M, Schwartz JA, Dutchak D, Yuzbasiyan-Gurkan V,Brewer GJ. The psychiatric presentations of Wilson’sdisease. J Neuropsychiatry Clin Neurosci 1991;3:377-382.

16. Muller JL. Schizophrenia-like symptoms in the Westphal-Strumpell form of Wilson’s disease. J Neuropsychiatry ClinNeurosci 1999;11:412.

17. MacQueen GM, Rosebush PI, Mazurek MF.Neuropsychiatric aspects of the adult variant of Tay-Sachsdisease. J Neuropsychiatry Clin Neurosci 1998;10:10-12.

18. Rosebush PI, Garside S, Levinson AJ, Mazurek MF. Theneuropsychiatry of adult-onset adrenoleukodystrophy. JNeuropsychiatry Clin Neurosci 1999;11:315-327.

19. Adams M, Kutcher S, Antoniw E, Bird D. Diagnostic utility ofendocrine and neuroimaging screening tests in first-onset

adolescent psychosis. J Am Acad Child Adolesc Psychiatry1996;35:67-73.

20. Leo RJ, Batterman-Faunce JM, Pickhardt D, Cartagena M,Cohen G. Utility of thyroid function screening in adolescentpsychiatric inpatients. J Am Acad Child Adolesc Psychiatry1997;36:103-111.

21. Degner D, Meller J, Bleich S, Schlautmann V, Ruther E.Affective disorders associated with autoimmune thyroiditis. JNeuropsychiatry Clin Neurosci 2001;13:532-533.

22. Vasconcellos E, Pina-Garza JE, Fakhoury T, Fenichel GM.Pediatric manifestations of Hashimoto’s encephalopathy.Pediatr Neurol 1999;20:394-398.

23. Watemberg N, Willis D, Pellock JM. Encephalopathy as thepresenting symptom of Hashimoto’s thyroiditis. J ChildNeurol 2000;15:66-69.

24. Taylor SE, Garalda ME, Tudor-Williams G, Martinez-Alier N.An organic cause of neuropsychiatric illness inadolescence. Lancet 2003;361:572.

25. Reavley A, Fisher AD, Owen D, Creed FH, Davis JR.Psychological distress in patients with hyperprolactinaemia.Clin Endocrinol 1997;47:343-348.

26. Kopala LC, Lewine R, Good KP, Fluker M, Martzke JS,Lapointe JS et al. Clinical features of schizophrenia in awoman with hyperandrogenism. J Psychiatry Neurosci1997;22:56-60.

27. Levin TR, Terrell TR, Stoudemire A. Organic mood disorderassociated with the HAIR-AN syndrome. J NeuropsychiatryClin Neurosci 1992;4:51-54.

28. Middleton JA. Practitioner review: psychological sequelaeof head injury in children and adolescents. J Child PsycholPsychiatry 2001;42:165-181.

29. Guthrie E, Mast J, Richards P, McQuaid M, Pavlakis S.Traumatic brain injury in children and adolescents. ChildAdolesc Psychiatr Clin N Am 1999;8:807-827.

30. Stoddard FJ, Saxe G. Ten-year research review of physicalinjuries. J Am Acad Child Adolesc Psychiatry 2001;40:1128-1140.

31. Siffert J, Greenleaf M, Mannis R, Allen J. Pediatric braintumors. Child Adolesc Psychiatr Clin N Am 1999;8:879-903.

32. Rubinstein B, Shaffer D. Organicity in child psychiatry.Signs, symptoms, and syndromes. Psychiatr Clin North Am1985;8:755-777.

33. Rivinus TM, Jamison DL, Graham PJ. Childhood organicneurological disease presenting as psychiatric disorder.Arch Dis Child 1975;50:115-119.

34. Thiele EA, Gonzalez-Heydrich J, Riviello JJ Jr. Epilepsy inchildren and adolescents. Child Adolesc Psychiatr Clin NAm 1999;8:671-695.

35. Lewis KE, Lubetsky MJ, Wenger SL, Steele MW.Chromosomal abnormalities in a psychiatric population.Am J Med Genet 1995;60:53-54.

36. Nicolson R, Giedd JN, Lenane M, Hamburger S,Singaracharlu S, Bedwell J et al. Clinical andneurobiological correlates of cytogenetic abnormalities inchildhood-onset schizophrenia. Am J Psychiatry1999;156:1575-1579.

37. Guthrie E, Mast J, Engel M. Diagnosing genetic anomaliesby inspection. Child Adolesc Psychiatr Clin N Am1999;8:777-791.

174


May-June 03 03-06-03 16:55 ™ÂÏ›‰·174

38. O’Brien G, Yule W. Behavioural phenotypes. London: MacKeith Press; 1995.

39. Pontrelli L, Pavlakis S, Krilov LR. Neurobehavioralmanifestations and sequelae of HIV and other infections.Child Adolesc Psychiatr Clin N Am 1999;8:869-878.

40. Wright JB, Beverley DW. Chronic fatigue syndrome. ArchDis Child 1998;79:368-374.

41. Trifiletti RR, Packard AM. Immune mechanisms in pediatricneuropsychiatric disorders. Tourette’s syndrome, OCD, andPANDAS. Child Adolesc Psychiatr Clin N Am 1999;8:767-776.

42. Turkel SB, Miller JH, Reiff A. Case series: neuropsychiatricsymptoms with pediatric systemic lupus erythematosus. JAm Acad Child Adolesc Psychiatry 2001;40:482-485.

43. Silber TJ, Chatoor I, White PH. Psychiatric manifestations ofsystemic lupus erythematosus in children and adolescents.A review. Clin Pediatr 1984;23:331-335.

44. Cannon TD, Rosso IM, Hollister JM, Bearden CE, SanchezLE, Hadley T. ∞ prospective cohort study of genetic andperinatal influences in the etiology of schizophrenia.Schizophr Bull 2000;26:351-366.

45. Kunugi H, Takei N, Murray RM, Saito K, Nanko S. Smallhead circumference at birth in schizophrenia. SchizophrRes 1996;20:165-170.

46. Fannon D, Tennakoon L, Sumich A, O’Ceallaigh S, Doku V,Chitnis X et al. Third ventricle enlargement anddevelopmental delay in first-episode psychosis: preliminaryfindings. Br J Psychiatry 2000;177:354-359.

47. Hultman CM, Sparen P, Takei N, Murray RM, Cnattingius S.Prenatal and perinatal risk factors for schizophrenia,affective psychosis, and reactive psychosis of early onset:case-control study. BMJ 1999;318:421-426.

48. Murray RM, Lewis SW. Is schizophrenia aneurodevelopmental disorder? BMJ 1987;295:681-682.

49. Walker A, Rosenberg M, Balaban-Gil K.Neurodevelopmental and neurobehavioral sequelae ofselected substances of abuse and psychiatric medicationsin utero. Child Adolesc Psychiatr Clin N Am 1999;8:845-868.

50. Jones P, Rodgers B, Murray R, Marmot M. Childdevelopment risk factors for adult schizophrenia in theBritish 1946 birth cohort. Lancet 1994;344:1398-1402.

51. Sanders RD, Keshavan MS. Physical and neurologicexaminations in neuropsychiatry. Semin ClinNeuropsychiatry 2002;7:18-29.

52. Pine DS, Shaffer D, Schonfeld IS, Davies M. Minor physicalanomalies: modifiers of environmental risks for psychiatricimpairment? J Am Acad Child Adolesc Psychiatry1997;36:395-403.

53. American Academy of Child and Adolescent Psychiatry.Practice parameters for the assessment and treatment ofchildren and adolescents with schizophrenia. J Am AcadChild Adolesc Psychiatry 2001;40 (Suppl):4-23.

54. Blumensohn R, Yoran-Hegesh R, Golubchik P, Mester R,Fluhr H, Hermesh H et al. Elevated serum creatine kinaseactivity in adolescent psychiatric inpatients on admission.Int Clin Psychopharmacol 1998;13:269-272.

55. Crayton JW, Meltzer HY. Serum creatine phosphokinaseactivity in psychiatrically hospitalized children. Arch GenPsychiatry 1976;33:679-681.

56. Hermesh H, Stein D, Manor I, Shechtmann T, BlumensohnR, Meged S et al. Serum creatine kinase levels in untreatedhospitalized adolescents during acute psychosis. J AmAcad Child Adolesc Psychiatry 2002;41:1045-1053.

57. Hoffmann GF, Surtees RA, Wevers RA. Cerebrospinal fluidinvestigations for neurometabolic disorders.Neuropediatrics 1998;29:59-70.

58. Gordon E. Neuroimaging in neuropsychiatry. Semin ClinNeuropsychiatry 2002;7:42-53.

59. Hendren RL, De Backer I, Pandina GJ. Review ofneuroimaging studies of child and adolescent psychiatricdisorders from the past 10 years. J Am Acad Child AdolescPsychiatry 2000;39:815-828.

60. Hughes JR. A review of the usefulness of the standard EEGin psychiatry. Clin Electroencephalogr 1996;27:35-39.


175

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 08-10-2002 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛË˜: 12-03-2003

¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ¡ÙÔÏfiÚÂ˜ ¶ÚˆÙ·ÁfiÚ·-§È·ÓÔ‡ ∞’ ¶·È‰È·ÙÚÈÎfi ∆Ì‹Ì·, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”£Ë‚ÒÓ & §ÂÈ‚·‰Â›·˜, ∆.∫. 115 28, ∞ı‹Ó·

May-June 03 03-06-03 16:55 ™ÂÏ›‰·175


176

∂Ó‰Â›ÍÂÈ˜ ÂÎÙ¤ÏÂÛË˜ ÏÂÈÙÔ˘ÚÁÈÎÒÓ ‰ÔÎÈÌ·ÛÈÒÓ ÙË˜ ·Ó·ÓÔ‹˜ ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›· ª. ªÔ˘ÛÙ¿ÎË

Indications for pulmonary function testing in childhood M. Moustaki

∞¡∞™∫O¶∏™∏ REVIEW ARTICLE

µ’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”

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

�¶ÂÚ›ÏË„Ë: OÈ ÏÂÈÙÔ˘ÚÁÈÎ¤˜ ‰ÔÎÈÌ·Û›Â˜ ÙË˜ ·Ó·-ÓÔ‹˜ ·ÔÙÂÏÔ‡Ó ÔÏ‡ÙÈÌ· ÂÚÁ·ÏÂ›· ÂÎÙ›ÌËÛË˜ÙË˜ ·Ó·ÓÂ˘ÛÙÈÎ‹˜ ÏÂÈÙÔ˘ÚÁ›·˜ ·ÊÂÓfi˜ ÌÂÓ ·ÛıÂ-ÓÒÓ ÌÂ ·Ó·ÓÂ˘ÛÙÈÎ¿ ÚÔ‚Ï‹Ì·Ù·, ·ÊÂÙ¤ÚÔ˘ ‰Â‰È·ÊfiÚˆÓ ÔÌ¿‰ˆÓ ÏËı˘ÛÌÔ‡ ÌÂ ÛÎÔfi ÙËÓ ÂÍ·-ÁˆÁ‹ ÂÈ‰ËÌÈÔÏÔÁÈÎÒÓ Û˘ÌÂÚ·ÛÌ¿ÙˆÓ ¯Ú‹ÛÈÌˆÓÁÈ· ÙËÓ ÂÊ·ÚÌÔÁ‹ ·ÔÙÂÏÂÛÌ·ÙÈÎÒÓ Ì¤ÙÚˆÓ Úfi-ÏË„Ë˜. OÈ ‰ÔÎÈÌ·Û›Â˜ ·Ó·ÓÔ‹˜ Ô˘ Û˘ÓËı¤ÛÙÂÚ·ÂÓ‰Â›ÎÓ˘ÓÙ·È ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË ÙË˜ ·Ó·ÓÂ˘ÛÙÈÎ‹˜ÏÂÈÙÔ˘ÚÁ›·˜ ÛÙ· ·È‰È¿ Â›Ó·È, Î·Ù¿ Êı›ÓÔ˘Û· ÛÂÈÚ¿Û˘¯ÓfiÙËÙ·˜, Ë ÛÈÚÔÌ¤ÙÚËÛË, Ë Ì¤ÙÚËÛË ÙˆÓÓÂ˘ÌÔÓÈÎÒÓ fiÁÎˆÓ Î·È ¯ˆÚËÙÈÎÔÙ‹ÙˆÓ ÌÂ ÙË Ì¤ıÔ-‰Ô ÙË˜ ÏËı˘ÛÌÔÁÚ·Ê›·˜ ‹ ÙË˜ ‰È¿¯˘ÛË˜, Ë ‰È¿-¯˘ÛË ÙÔ˘ CO Î·È ÙÔ ÂÎÓÂfiÌÂÓÔ ¡O. ™ÙËÓ ·ÚÔ‡-Û· ·Ó·ÛÎfiËÛË ÂÚÈÁÚ¿ÊÔÓÙ·È ÔÈ ÂÓ‰Â›ÍÂÈ˜ ÂÎÙ¤-ÏÂÛË˜ ÙˆÓ ‰ÔÎÈÌ·ÛÈÒÓ ·˘ÙÒÓ ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›·ÁÈ· ‰È·ÁÓˆÛÙÈÎÔ‡˜ ÏfiÁÔ˘˜ Î·È ÁÈ· ÙË ‰È·¯ÚÔÓÈÎ‹·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ·ÛıÂÓÒÓ.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ÓÂ˘ÌÔÓÈÎ¤˜ ‰ÔÎÈÌ·Û›Â˜, ÓÂ˘ÌÔÓÈ-ÎÔ› fiÁÎÔÈ, ÛÈÚÔÌ¤ÙÚËÛË, ‰È¿¯˘ÛË CO, ÂÎÓÂfiÌÂÓÔ¡O.

�Abstract: Pulmonary function testing is avaluable tool for the assessment of respiratoryfunction of children being evaluated for eitherdiagnostic or epidemiological purposes, aiming toestablish the disease diagnosis or meaningfulpreventive measures respectively. The lungfunction tests most commonly used, in descendingorder of frequency, are: spirometry, measurementof lung volumes and capacities by using bodyplethysmography or gas dilution techniques,carbon monoxide diffusing capacity and exhalednitric oxide measurement. The purpose of thisreview is to describe the indications for the abovementioned tests in childhood for the categorization,staging and monitoring of lung disease.

Key words: lung function testing, lung volumes,spirometry, carbon monoxide diffusing capacity,exhaled NO.

∂ÈÛ·ÁˆÁ‹∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÙÂÏÂ˘Ù·›ˆÓ ‰ÂÎ·ÂÙÈÒÓ, ÔÈ

ÏÂÈÙÔ˘ÚÁÈÎ¤˜ ‰ÔÎÈÌ·Û›Â˜ ÙË˜ ·Ó·ÓÔ‹˜ ‰ÂÓ ·ÔÙÂ-ÏÔ‡Ó ·Ï¿ Ì¤ıÔ‰Ô ÌÂÏ¤ÙË˜ ÙË˜ Ê˘ÛÈÔÏÔÁ›·˜ ÙË˜·Ó·ÓÔ‹˜, ·ÏÏ¿ Î·È ÂÚÁ·ÏÂ›Ô ÂÎÙ›ÌËÛË˜ ÙË˜ ·Ó·-ÓÂ˘ÛÙÈÎ‹˜ ÏÂÈÙÔ˘ÚÁ›·˜ ·ÊÂÓfi˜ ÌÂÓ ·ÛıÂÓÒÓ ÌÂ·Ó·ÓÂ˘ÛÙÈÎ¿ ÚÔ‚Ï‹Ì·Ù·, ·ÊÂÙ¤ÚÔ˘ ‰Â ‰È·Êfi-ÚˆÓ ÔÌ¿‰ˆÓ ÏËı˘ÛÌÔ‡ ÁÈ· ÙËÓ ÂÍ·ÁˆÁ‹ ÂÈ‰Ë-ÌÈÔÏÔÁÈÎÒÓ Û˘ÌÂÚ·ÛÌ¿ÙˆÓ ¯Ú‹ÛÈÌˆÓ ÁÈ· ÙËÓÂÊ·ÚÌÔÁ‹ ·ÔÙÂÏÂÛÌ·ÙÈÎÒÓ Ì¤ÙÚˆÓ ÚfiÏË„Ë˜.

∏ ‰˘Ó·ÙfiÙËÙ· ÂÎÙ¤ÏÂÛË˜ Î·Ï‹˜ ÔÈfiÙËÙ·˜ ·Ó·-ÓÂ˘ÛÙÈÎÒÓ ‰ÔÎÈÌ·ÛÈÒÓ, Û‡ÌÊˆÓ· ÌÂ ÙÈ˜ ÚÔ‰È·-ÁÚ·Ê¤˜ ÙˆÓ ∂ÈÛÙËÌÔÓÈÎÒÓ ¶ÓÂ˘ÌÔÓÔÏÔÁÈÎÒÓ

∂Ù·ÈÚÂÈÒÓ, ÚÔ¸Ôı¤ÙÂÈ ÙËÓ Î·Ï‹ Û˘ÓÂÚÁ·Û›· ÙÔ˘·È‰ÈÔ‡, Ë ÔÔ›· Ê·›ÓÂÙ·È fiÙÈ ÁÈ· ÙËÓ ÏÂÈÔ„ËÊ›·ÙˆÓ ·È‰ÈÒÓ Â›Ó·È ‰˘Ó·Ù‹ ÌÂÙ¿ ÙËÓ ËÏÈÎ›· ÙˆÓ 6ÂÙÒÓ (1,2). °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi, Ë ·ÚÔ‡Û· ·Ó·ÛÎfi-ËÛË ÂÛÙÈ¿˙ÂÙ·È ÛÙÈ˜ ÂÓ‰Â›ÍÂÈ˜ ÙˆÓ ÏÂÈÙÔ˘ÚÁÈÎÒÓ‰ÔÎÈÌ·ÛÈÒÓ ÛÙ· ·È‰È¿ ·˘Ù‹˜ ÙË˜ ËÏÈÎ›·˜, Î·ıÒ˜ÛÂ ÌÈÎÚfiÙÂÚ· ·È‰È¿ Â›Ó·È ÂÊÈÎÙ‹ Ë ÂÎÙ¤ÏÂÛË ÔÚÈ-ÛÌ¤ÓˆÓ ‰ÔÎÈÌ·ÛÈÒÓ Î·È Ë ÏÂÈÔ„ËÊ›· ÙˆÓ ÌÂÙÚ‹-ÛÂˆÓ Á›ÓÂÙ·È ÛÙ· Ï·›ÛÈ· ÎÏÈÓÈÎÒÓ ÌÂÏÂÙÒÓ. ∏ ‰ÈÂ-Ó¤ÚÁÂÈ· ÛËÌ·ÓÙÈÎÔ‡ ·ÚÈıÌÔ‡ ÎÏÈÓÈÎÒÓ ÌÂÏÂÙÒÓ ÛÂ·È‰È¿, ÙËÓ ÙÂÏÂ˘Ù·›· ÂÈÎÔÛ·ÂÙ›·, Î·Ù¤ÛÙËÛÂ ‰˘Ó·-Ù‹ ÙËÓ ÂÍ·ÁˆÁ‹ Û˘ÌÂÚ·ÛÌ¿ÙˆÓ ÁÈ· ÙÈ˜ ÂÓ‰Â›ÍÂÈ˜ÂÎÙ¤ÏÂÛË˜ ÏÂÈÙÔ˘ÚÁÈÎÒÓ ‰ÔÎÈÌ·ÛÈÒÓ ÙË˜ ·Ó·ÓÔ‹˜

May-June 03 03-06-03 16:55 ™ÂÏ›‰·176


177

ÛÙ· ·È‰È¿ Ô˘ ¿Û¯Ô˘Ó Â›ÙÂ ·fi ÚˆÙÔ·ı‹ ·Ó·-ÓÂ˘ÛÙÈÎ¿ ÓÔÛ‹Ì·Ù·, Â›ÙÂ ·fi ÓÔÛ‹Ì·Ù· Ô˘ ‰Â˘ÙÂ-ÚÔ·ıÒ˜ ÂËÚÂ¿˙Ô˘Ó ÙËÓ ·Ó·ÓÂ˘ÛÙÈÎ‹ ÏÂÈÙÔ˘ÚÁ›·.

OÈ ÏÂÈÙÔ˘ÚÁÈÎ¤˜ ‰ÔÎÈÌ·Û›Â˜ ÙË˜ ·Ó·ÓÔ‹˜ ÂÓ-‰Â›ÎÓ˘ÓÙ·È ÁÈ· ÏfiÁÔ˘˜: ·) ‰È·ÁÓˆÛÙÈÎÔ‡˜ (¯·Ú·-ÎÙËÚÈÛÌfi˜ ÙË˜ Ê˘ÛÈÔÏÔÁ›·˜ ÙË˜ ÓÂ˘ÌÔÓÈÎ‹˜ Ófi-ÛÔ˘, ÂÓ›Û¯˘ÛË ‹ ·ÔÌ¿ÎÚ˘ÓÛË ·fi ÙËÓ ·Ú¯ÈÎ‹ ‰È¿-ÁÓˆÛË, ÔÛÔÙÈÎ‹ ÂÎÙ›ÌËÛË ÙË˜ ÛÔ‚·ÚfiÙËÙ·˜ ÙË˜ÓfiÛÔ˘, ·ÍÈÔÏfiÁËÛË ÙË˜ ÂÈÎÈÓ‰˘ÓfiÙËÙ·˜ ‰È·ÁÓˆ-ÛÙÈÎÒÓ ‹ ıÂÚ·Â˘ÙÈÎÒÓ ÂÂÌ‚·ÙÈÎÒÓ ÌÂıfi‰ˆÓ Î·È·Ó·ÁÎ·ÈfiÙËÙ· ¯ÔÚ‹ÁËÛË˜ ıÂÚ·Â˘ÙÈÎ‹˜ ·ÁˆÁ‹˜),‚) ·Ú·ÎÔÏÔ‡ıËÛË˜ ÙÔ˘ ·ÛıÂÓÔ‡˜ (·Ú·ÎÔÏÔ‡ıË-ÛË ÙË˜ ÂÍ¤ÏÈÍË˜ ÙË˜ ÓfiÛÔ˘, ÂÎÙ›ÌËÛË ÙË˜ ·ÓÙ·fi-ÎÚÈÛË˜ ÛÙËÓ ·ÁˆÁ‹, Î·ıÔÚÈÛÌfi˜ ÙË˜ ‰È¿ÚÎÂÈ·˜ Î·ÈÙÔ˘ Â›‰Ô˘˜ ÙË˜ ·ÁˆÁ‹˜) Î·È Á) ÂÈ‰ËÌÈÔÏÔÁÈÎÔ‡˜(ÂÎÙ›ÌËÛË ÙË˜ ·Ó·ÓÂ˘ÛÙÈÎ‹˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÔÌ¿‰ˆÓÏËı˘ÛÌÔ‡ ÁÈ· ÙËÓ ÂÍ·ÁˆÁ‹ Û˘ÌÂÚ·ÛÌ¿ÙˆÓ, ÌÂÛÎÔfi ÙËÓ ÂÊ·ÚÌÔÁ‹ Ì¤ÙÚˆÓ ÚfiÏË„Ë˜).

∂Ó‰Â›ÍÂÈ˜ ÛÈÚÔÌ¤ÙÚËÛË˜ °È· ÙËÓ Î·Ï‡ÙÂÚË Î·Ù·ÓfiËÛË ÙˆÓ ÂÓ‰Â›ÍÂˆÓ

˘ÂÓı˘Ì›˙ÂÙ·È fiÙÈ Ë ÛÈÚÔÌ¤ÙÚËÛË Î·Ù·ÁÚ¿ÊÂÈ ÙÔÓfiÁÎÔ ÙÔ˘ ·¤Ú· Ô˘ ÂÈÛÓ¤ÂÈ Î·È ÂÎÓ¤ÂÈ ÙÔ ¿ÙÔÌÔ ÛÂÛ¯¤ÛË ÌÂ ÙÔ ¯ÚfiÓÔ. OÈ Û˘¯ÓfiÙÂÚ· ¯ÚËÛÈÌÔÔÈÔ‡ÌÂ-ÓÂ˜ ·Ú¿ÌÂÙÚÔÈ Â›Ó·È (3,4): ·) Ë ‚›·ÈË ˙ˆÙÈÎ‹ ¯ˆÚËÙÈ-ÎfiÙËÙ· (FVC), Ô˘ ÈÛÔ‰˘Ó·ÌÂ› ÌÂ ÙÔÓ fiÁÎÔ ÙÔ˘ ·¤Ú·ÙÔÓ ÔÔ›Ô ÙÔ ÂÍÂÙ·˙fiÌÂÓÔ ¿ÙÔÌÔ ÂÎÓ¤ÂÈ, ·ÊÔ‡ ¤¯ÂÈÚÔËÁËıÂ› Ë ÈÔ ‚·ıÈ¿ ÂÈÛÓÔ‹, ‚) Ô ‚›·È· ÂÎÓÂfiÌÂ-ÓÔ˜ fiÁÎÔ˜ ÙÔ ÚÒÙÔ ‰Â˘ÙÂÚfiÏÂÙÔ ÙË˜ ÂÎÓÔ‹˜(FEV1), Á) Ô ÏfiÁÔ˜ FEV1/FVC. ∏ ·Ú¿ÌÂÙÚÔ˜ ·˘Ù‹ÂÎÊÚ¿˙ÂÈ ÙÔ ÏfiÁÔ ÙÔ˘ fiÁÎÔ˘ Ô˘ ÂÎÓ¤ÂÙ·È ÙÔ ÚÒ-ÙÔ ‰Â˘ÙÂÚfiÏÂÙÔ ÙË˜ ÂÎÓÂ˘ÛÙÈÎ‹˜ ÚÔÛ¿ıÂÈ·˜ÚÔ˜ ÙÔÓ fiÁÎÔ Ô˘ ÂÎÓ¤ÂÙ·È ÛÙÔ Û‡ÓÔÏÔ ÙË˜ ÚÔ-Û¿ıÂÈ·˜. ™Ù· Ê˘ÛÈÔÏÔÁÈÎ¿ ¿ÙÔÌ· ·Ó·Ì¤ÓÂÙ·È fiÙÈ ÙÔÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ÙÔ˘ fiÁÎÔ˘ ÂÎÓ¤ÂÙ·È ‚›·È· ÙÔÚÒÙÔ ‰Â˘ÙÂÚfiÏÂÙÔ ÙË˜ ÂÎÓÔ‹˜, ‰) Ë ÂÎÓÂ˘ÛÙÈÎ‹ÚÔ‹ Ô˘ ·Ú·ÙËÚÂ›Ù·È Î·Ù¿ ÙËÓ ÂÎÓÔ‹ ÙÔ˘ 25-75%ÙÔ˘ fiÁÎÔ˘ ÙË˜ ˙ˆÙÈÎ‹˜ ¯ˆÚËÙÈÎfiÙËÙ·˜ Î·È Â›Ó·È ÂÓ-‰ÂÈÎÙÈÎ‹ ÙË˜ ‚·ÙfiÙËÙ·˜ ÙˆÓ ÌÈÎÚÒÓ ·ÂÚ·ÁˆÁÒÓ Î·ÈÂ) Ë Ì¤ÁÈÛÙË ÂÎÓÂ˘ÛÙÈÎ‹ ÚÔ‹ Ô˘ ·ÓÙÈÛÙÔÈ¯Â› ÛÙËÌ¤ÁÈÛÙË ÙÈÌ‹ ÙË˜ ÚÔ‹˜ Î·Ù¿ ÙËÓ ÂÎÓÔ‹, Ë ÔÔ›· ÌÂ-ÙÚ¿Ù·È Î·È ÌÂ ÙÔ ·Ïfi ÚÔfiÌÂÙÚÔ.

∞Ó Ë ·Ó·ÓÂ˘ÛÙÈÎ‹ ÏÂÈÙÔ˘ÚÁ›·, fiˆ˜ ÂÎÙÈÌ¿Ù·È·fi Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ ÛÈÚÔÌ¤ÙÚËÛË˜, ‰ÂÓ Â›-Ó·È ÂÓÙfi˜ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ - ÁÈ· ÙË ÛˆÌ·ÙÈÎ‹ ·Ó¿-Ù˘ÍË - ÔÚ›ˆÓ, ÙfiÙÂ Ù· Â˘Ú‹Ì·Ù· Â›Ó·È Û˘Ì‚·Ù¿ ÌÂÓÂ˘ÌÔÓÔ¿ıÂÈ· ·ÔÊÚ·ÎÙÈÎÔ‡, ÂÚÈÔÚÈÛÙÈÎÔ‡ ‹ÌÈÎÙÔ‡ Ù‡Ô˘. ∏ ·ÔÊÚ·ÎÙÈÎÔ‡ Ù‡Ô˘ ÓfiÛÔ˜ ¯·Ú·-ÎÙËÚ›˙ÂÙ·È ·fi ÌÂ›ˆÛË ÙˆÓ ÚÔÒÓ ÌÂÁ·Ï‡ÙÂÚË ·fiÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë ÌÂ›ˆÛË ÙË˜ FVC, ÌÂ ·ÔÙ¤ÏÂÛÌ· ÔÏfiÁÔ˜ FEV1/FVC Ó· ˘ÔÏÂ›ÂÙ·È ÙÔ˘ Ê˘ÛÈÔÏÔÁÈ-ÎÔ‡, ÌÂ Û˘ÓÔ‰fi ·‡ÍËÛË ÙË˜ ÎÔ›Ï·ÓÛË˜ ÙÔ˘ ÙÂÏÈÎÔ‡ÙÌ‹Ì·ÙÔ˜ ÙË˜ Î·Ì‡ÏË˜ ÚÔ‹˜-fiÁÎÔ˘ (∂ÈÎfiÓÂ˜ 1, 2,3). ∏ ÂÚÈÔÚÈÛÙÈÎÔ‡ Ù‡Ô˘ ÓfiÛÔ˜ ¯·Ú·ÎÙËÚ›˙ÂÙ·È

·fi ·Ó¿ÏÔÁË ÌÂ›ˆÛË ÙË˜ ÚÔ‹˜ ÛÂ Û¯¤ÛË ÌÂ ÙÔÓfiÁÎÔ, ÌÂ ·ÔÙ¤ÏÂÛÌ· Ô ÏfiÁÔ˜ FEV1/FVC Ó· ·Ú·-Ì¤ÓÂÈ Ê˘ÛÈÔÏÔÁÈÎfi˜ ‹ Î·È ·˘ÍËÌ¤ÓÔ˜ (∂ÈÎfiÓ· 4). ∏ÌÈÎÙÔ‡ Ù‡Ô˘ ÓfiÛÔ˜ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÌÂ›ˆÛËÚÔ‹˜ Î·È fiÁÎÔ˘, ÛÂ ·Ó·ÏÔÁ›· Ô˘ ÂÍ·ÚÙ¿Ù·È ·fiÙÔ ÔÈÔ ÛÙÔÈ¯Â›Ô ˘ÂÚ¤¯ÂÈ (ÙÔ ·ÔÊÚ·ÎÙÈÎfi ‹ ÙÔÂÚÈÔÚÈÛÙÈÎfi). °È· ÙÔ ÏfiÁÔ ·˘Ùfi, Â› ˘Ô„›·˜ ÌÈ-ÎÙÔ‡ Ù‡Ô˘ ÓÔÛ‹Ì·ÙÔ˜ Û˘ÓÈÛÙ¿Ù·È ÂÚ·ÈÙ¤Úˆ ‰ÈÂ-ÚÂ‡ÓËÛË ÌÂ ÏËı˘ÛÌÔÁÚ·Ê›·, fiˆ˜ ÂÚÈÁÚ¿ÊÂÙ·È·Ú·Î¿Ùˆ ÛÙË Û¯ÂÙÈÎ‹ ÂÓfiÙËÙ·.

π‰È·›ÙÂÚË Â›Ó·È Ë Û˘Ì‚ÔÏ‹ ÙË˜ ÛÈÚÔÌ¤ÙÚËÛË˜ÛÙ· ·È‰È¿ ÌÂ ¿ÛıÌ·. ™Ù· ·È‰È¿ ·˘Ù¿, Ë ÛÈÚÔÌ¤-ÙÚËÛË Â›Ó·È ·Ó¿ÏÔÁË˜ ÛËÌ·Û›·˜ ÌÂ ÙË Ì¤ÙÚËÛË ÙË˜·ÚÙËÚÈ·Î‹˜ ›ÂÛË˜ ÛÂ ˘ÂÚÙ·ÛÈÎÔ‡˜ ·ÛıÂÓÂ›˜ ‹ÙÔ˘ Û·Î¯¿ÚÔ˘ ÛÂ ‰È·‚ËÙÈÎÔ‡˜. ∏ ÛÈÚÔÌ¤ÙÚËÛË‰ÂÓ ı¤ÙÂÈ Ê˘ÛÈÎ¿ ÙË ‰È¿ÁÓˆÛË, ·ÏÏ¿ Î·Ù·‰ÂÈÎÓ‡ÂÈ·Ó ÚfiÎÂÈÙ·È ÁÈ· ·ÔÊÚ·ÎÙÈÎ‹ ‹ ÂÚÈÔÚÈÛÙÈÎ‹ Ófi-ÛÔ. ™ÙÔ ¿ÛıÌ· ·Ú·ÙËÚÂ›Ù·È ÌÂÈˆÌ¤ÓÔ˜ FEV1, ÔÏfiÁÔ˜ FEV1/FVC Î·È Ë ÚÔ‹ ÛÙÔ˘˜ ÌÈÎÚÔ‡˜ ·ÂÚ·-ÁˆÁÔ‡˜ (FEF 25-75%). °È· ÙÔ ÏfiÁÔ ·˘Ùfi, Ë ÛÈÚÔ-Ì¤ÙÚËÛË Û˘ÓÈÛÙ¿Ù·È ÛÂ fiÏ· Ù· ·È‰È¿ ÌÂ ÎÏÈÓÈÎ‹Û˘ÌÙˆÌ·ÙÔÏÔÁ›· ‹/Î·È ÛËÌÂÈÔÏÔÁ›· ¿ÛıÌ·ÙÔ˜.π‰È·›ÙÂÚË Â›Ó·È Ë Û˘Ì‚ÔÏ‹ ÙË˜ ÛÂ ·È‰È¿ ÌÂ ¿Ù˘·Û˘ÌÙÒÌ·Ù·, fiˆ˜ .¯. Â›ÌÔÓÔ ‚‹¯·. ∞Ó ÛÂ ¤Ó··È‰› ÌÂ ˘Ô„›· ¿ÛıÌ·ÙÔ˜ Ë ÛÈÚÔÌ¤ÙÚËÛË Â›Ó·ÈÂÓ‰ÂÈÎÙÈÎ‹ ÂÚÈÔÚÈÛÙÈÎ‹˜ ÓfiÛÔ˘ (ÌÂÈˆÌ¤ÓÔ˜ FEV1,ÌÂÈˆÌ¤ÓË FVC Î·È Ê˘ÛÈÔÏÔÁÈÎfi˜ ÏfiÁÔ˜ FEV1/FVC),Û˘ÓÈÛÙ¿Ù·È ÂÚ·ÈÙ¤Úˆ ‰ÈÂÚÂ‡ÓËÛË ÙË˜ ÏÂÈÙÔ˘ÚÁÈ-ÎfiÙËÙ·˜ ÙˆÓ ÓÂ˘ÌfiÓˆÓ ÌÂ ÏËı˘ÛÌÔÁÚ·Ê›·, ‰Ô-ÎÈÌ·Û›Â˜ ÚfiÎÏËÛË˜, ‰È¿¯˘ÛË, Î·ıÒ˜ Î·È ÁÂÓÈÎfiÙÂ-ÚÔ˜ ¤ÏÂÁ¯Ô˜ (‰ÔÎÈÌ·Û›· È‰ÚÒÙ·, ·ÂÈÎÔÓÈÛÙÈÎfi˜

∂ÈÎfiÓ· 1. º˘ÛÈÔÏÔÁÈÎ‹ Î·Ì‡ÏË ÚÔ‹˜-fiÁÎÔ˘ Î·Ù¿ ÙËÓ ÂÎ-ÓÔ‹ Î·È ÙËÓ ÂÈÛÓÔ‹.

8

6

4

2

0

-2

-4

-6-1 0 1 2 3 4

Flow

Volume

May-June 03 03-06-03 16:55 ™ÂÏ›‰·177

¤ÏÂÁ¯Ô˜ ÓÂ˘ÌfiÓˆÓ Î.Ï.) ÁÈ· Ó· ÙÂıÂ› Ë ‰È¿ÁÓˆÛË. ™Â ·È‰È¿ ÌÂ ˘Ô„›· ¿ÛıÌ·ÙÔ˜ Î·È ÛÈÚÔÌÂÙÚÈÎ‹

ÂÈÎfiÓ· Û˘Ì‚·Ù‹ ÌÂ ·ÔÊÚ·ÎÙÈÎ‹ ÓfiÛÔ, Û˘ÓÈÛÙ¿Ù·È -ÁÈ· ÂÈ‚Â‚·›ˆÛË - Ë ‰ÔÎÈÌ·Û›· ·Ó·ÛÙÚÂ„ÈÌfiÙËÙ·˜ÌÂÙ¿ ·fi ¯ÔÚ‹ÁËÛË ‚ÚÔÁ¯Ô‰È·ÛÙ·ÏÙÈÎÔ‡ (5). ∞‡ÍË-ÛË Î·Ù¿ 12% ÙÔ˘ FEV1, 20 ÏÂÙ¿ ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛËÛ·Ï‚Ô˘Ù·ÌfiÏË˜ Î·Ù¿ ÙËÓ ÔÍÂ›· Ê¿ÛË ÙË˜ ÓfiÛÔ˘,ÂÈ‚Â‚·ÈÒÓÂÈ ÙË ‰È¿ÁÓˆÛË, Î·ıÒ˜ Î·È ÙËÓ ·ÓÙ·fi-ÎÚÈÛ‹ ÙË˜ ÛÙÔ˘˜ ‚2 ‰ÈÂÁ¤ÚÙÂ˜. ∏ ·‡ÍËÛË ÙÔ˘ FEV1Â›Ó·È Ë Û˘¯ÓfiÙÂÚ· ·ÍÈÔÏÔÁÔ‡ÌÂÓË ÌÂÙ·‚ÔÏ‹ Î·Ù¿ ÙË‰ÔÎÈÌ·Û›· ÌÂÙ¿ ·fi ¯ÔÚ‹ÁËÛË ‚ÚÔÁ¯Ô‰È·ÛÙ·ÏÙÈ-ÎÔ‡. ªÔÚÂ›, Â›ÛË˜, Ó· ·ÍÈÔÏÔÁËıÂ› ·‡ÍËÛË ÙË˜PEFR Î·Ù¿ 12-15% ‹ ÙË˜ FEF25-75% Î·Ù¿ 25-30%, ·ÓÎ·È ÂÈ‰ÈÎ¿ Ë ÙÂÏÂ˘Ù·›· ‰ÂÓ ·ÔÙÂÏÂ› ·ÍÈfiÈÛÙÔ ‰Â›-ÎÙË ÔÍÂ›·˜ ÌÂÙ·‚ÔÏ‹˜ Î·ıÒ˜ ÂËÚÂ¿˙ÂÙ·È ·fi ÙÈ˜Û˘ÓÔ‰¤˜ ÌÂÙ·‚ÔÏ¤˜ ÙË˜ FVC (6). ∏ ‰ÔÎÈÌ·Û›· ·ÓÙÈ-ÛÙÚÂÙfiÙËÙ·˜ ¤¯ÂÈ È‰È·›ÙÂÚË ÛËÌ·Û›· ÛÙ· ·È‰È¿ ÌÂ¿ÛıÌ· Ô˘ ‰ÂÓ ¤¯Ô˘Ó ¤ÓÙÔÓ· Û˘Ú›ÙÙÔ˘Û· ·Ó·ÓÔ‹,Ë ÂÍ¿ÏÂÈ„Ë ÙË˜ ÔÔ›·˜ ÂÈ‚Â‚·ÈÒÓÂÈ ÙËÓ ·ÓÙ·fiÎÚÈ-ÛË ÛÙËÓ ·ÁˆÁ‹, Î·ıÈÛÙÒÓÙ·˜ ÂÚÈÙÙ‹ ÛÙË Ê¿ÛË ·˘-Ù‹ ÙË ÛÈÚÔÌ¤ÙÚËÛË.

™Â ·È‰È¿ ÌÂ ÈÛÙÔÚÈÎfi ÂÓ‰ÂÈÎÙÈÎfi ¿ÛıÌ·ÙÔ˜, ·Ï-Ï¿ Ê˘ÛÈÔÏÔÁÈÎ‹ ÛÈÚÔÌ¤ÙÚËÛË, Û˘ÓÈÛÙ¿Ù·È Ë ÂÎÙ¤-

ÏÂÛË ÛÈÚÔÌ¤ÙÚËÛË˜ ÌÂÙ¿ ·fi ‰ÔÎÈÌ·Û›· ÚfiÎÏË-ÛË˜ (7,8), ÚÈÓ ÙËÓ ¤Ó·ÚÍË ÂÌÂÈÚÈÎ‹˜ ıÂÚ·Â›·˜.∫·Ù¿ ÙË ‰ÔÎÈÌ·Û›· ·˘Ù‹, Á›ÓÂÙ·È ÛÈÚÔÌ¤ÙÚËÛË‰È·‰Ô¯ÈÎ¿ ÚÈÓ Î·È ÌÂÙ¿ ·fi ÂÈÛÓÔ‹ ÈÛÙ·Ì›ÓË˜ ‹ÌÂÙ·¯ÔÏ›ÓË˜. ∆· ·È‰È¿ ÌÂ ˘ÂÚ·ÓÙÈ‰Ú·ÛÙÈÎfiÙËÙ··ÂÚ·ÁˆÁÒÓ ·Ó·Ì¤ÓÂÙ·È Ó· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó ‚ÚÔÁ¯fi-Û·ÛÌÔ Î·È ÙÒÛË ÙÔ˘ FEV1 Î·Ù¿ 20% ÚÈÓ ÙË ¯Ô-Ú‹ÁËÛË 225 ÌÔÓ¿‰ˆÓ ÌÂÙ·¯ÔÏ›ÓË˜. ∏ ÌÂÙ·‚ÔÏ‹Ùo˘ FEV1 Â›Ó·È Ô Û˘¯ÓfiÙÂÚ· ·ÍÈÔÏÔÁÔ‡ÌÂÓÔ˜ ‰Â›-ÎÙË˜ Î·Ù¿ ÙË ‰ÔÎÈÌ·Û›· ÚfiÎÏËÛË˜. ÀÂÓı˘Ì›˙ÂÙ·ÈfiÙÈ Ë ‰ÔÎÈÌ·Û›· ÚfiÎÏËÛË˜ Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÙÔ˘-Ï¿¯ÈÛÙÔÓ 6 Â‚‰ÔÌ¿‰Â˜ ÌÂÙ¿ ÙËÓ ÙÂÏÂ˘Ù·›· ÏÔ›ÌˆÍËÙÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡, Î·ıÒ˜ ÔÈ ÏÔÈÌÒÍÂÈ˜ ÙÔ˘ ·Ó·-ÓÂ˘ÛÙÈÎÔ‡ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÚÔÎ·Ï¤ÛÔ˘Ó ·ÚÔ‰È-Î¿ ˘ÂÚ·ÓÙÈ‰Ú·ÛÙÈÎfiÙËÙ· ÙˆÓ ·ÂÚ·ÁˆÁÒÓ (8,9).™Â ·È‰È¿ ÌÂ Û˘ÌÙˆÌ·ÙÔÏÔÁ›· ¿ÛıÌ·ÙÔ˜ ÌfiÓÔ Î·-Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ¿ÛÎËÛË˜, Û˘ÓÈÛÙ¿Ù·È Ë ÂÎÙ¤ÏÂ-ÛË ‰ÔÎÈÌ·Û›·˜ ¿ÛÎËÛË˜ ÌÂ ÙË ¯Ú‹ÛË ÂÚÁÔÌÂÙÚÈÎÔ‡Ô‰ËÏ¿ÙÔ˘ ‹ ‰È·‰ÚfiÌÔ˘. °È· ÙËÓ ÂÎÙ¤ÏÂÛË ÙË˜ ‰Ô-ÎÈÌ·Û›·˜ ·˘Ù‹˜ ··ÈÙÂ›Ù·È ¿ÛÎËÛË ÙÔ˘ ·È‰ÈÔ‡ ÁÈ·6 ÏÂÙ¿, ÛÂ Ú˘ıÌfi Ô˘ Ó· ÚÔÎ·ÏÂ› ·‡ÍËÛË ÙˆÓÛÊ‡ÍÂˆÓ ÛÂ 80% ÙÔ˘ Ì¤ÁÈÛÙÔ˘ - ÁÈ· ÙËÓ ËÏÈÎ›· ÙÔ˘- Î·Ú‰È·ÎÔ‡ Ú˘ıÌÔ‡. ∏ Ì¤ÁÈÛÙË ÙÒÛË ÙÔ˘ FEV1


178

∂ÈÎfiÓ· 2. ∂ÎÓÂ˘ÛÙÈÎ‹ Î·Ì‡ÏË ÚÔ‹˜-fiÁÎÔ˘ ÌÂ ÌÈÎÚÔ‡ ‚·ı-ÌÔ‡ ·fiÊÚ·ÍË Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ·Ó¿ÏÔÁÔ˘ ‚·ıÌÔ‡ÎÔ›Ï·ÓÛË ÙÔ˘ ÙÂÏÈÎÔ‡ ÙÌ‹Ì·ÙÔ˜ ÙË˜ ÂÎÓÂ˘ÛÙÈÎ‹˜ Î·Ì‡-ÏË˜. ∂ÈÛÓÂ˘ÛÙÈÎ‹ Î·Ì‡ÏË Ê˘ÛÈÔÏÔÁÈÎ‹.

8

6

4

2

0

-2

-4

-6-1 0 1 2 3 4

∂ÈÎfiÓ· 3. ∂ÎÓÂ˘ÛÙÈÎ‹ Î·Ì‡ÏË ÚÔ‹˜-fiÁÎÔ˘ ÌÂ ÛÔ‚·ÚÔ‡‚·ıÌÔ‡ ·fiÊÚ·ÍË Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ·Ó¿ÏÔÁÔ˘ ‚·ı-ÌÔ‡ ÎÔ›Ï·ÓÛË ÙÔ˘ ÙÂÏÈÎÔ‡ ÙÌ‹Ì·ÙÔ˜ ÙË˜ ÂÎÓÂ˘ÛÙÈÎ‹˜ Î·-Ì‡ÏË˜. ∂ÈÛÓÂ˘ÛÙÈÎ‹ Î·Ì‡ÏË Ê˘ÛÈÔÏÔÁÈÎ‹.

8

6

4

2

0

-2

-4

-60 1 2 3 4

Volume Volume

Flow Flow

May-June 03 03-06-03 16:55 ™ÂÏ›‰·178


179

·Ú·ÙËÚÂ›Ù·È 5-15 ÏÂÙ¿ ÌÂÙ¿ ÙÔ Ù¤ÏÔ˜ ÙË˜ ¿ÛÎË-ÛË˜. ¶ÙÒÛË ÙÔ˘ FEV1 >15% Â›Ó·È ÂÓ‰ÂÈÎÙÈÎ‹¿ÛıÌ·ÙÔ˜ ÌÂÙ¿ ·fi ¿ÛÎËÛË (4).

™ËÌ·ÓÙÈÎfi˜ Â›Ó·È Ô ÚfiÏÔ˜ ÙË˜ ÛÈÚÔÌ¤ÙÚËÛË˜Î·È ÁÈ· ÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË ÙË˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ÙË˜ ÓfiÛÔ˘. ∏ ‰È·¯ÚÔÓÈÎ‹ ·Ú·ÎÔÏÔ‡ıËÛË ÙË˜ ·Ó·-ÓÂ˘ÛÙÈÎ‹˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÌÂ ÛÈÚÔÌ¤ÙÚËÛË Û˘Ì‚¿Ï-ÏÂÈ ÛÙËÓ ¤ÁÎ·ÈÚË ‰È·›ÛÙˆÛË ÂÈ‰Â›ÓˆÛË˜ ‹ ‚ÂÏ-Ù›ˆÛË˜ ÙË˜ ÓfiÛÔ˘ Î·È ÙÚÔÔÔ›ËÛË˜ ÙË˜ ıÂÚ·Â˘-ÙÈÎ‹˜ ·ÁˆÁ‹˜, ·ÏÏ¿ Î·È ÛÙËÓ ·ÍÈÔÏfiÁËÛË ÙˆÓ Úfi-ÛÊ·ÙˆÓ ÌÂÙ·‚ÔÏÒÓ ÛÙË ¯ÔÚËÁÔ‡ÌÂÓË ·ÁˆÁ‹.

∏ ÂÎÙ¤ÏÂÛË ÛÈÚÔÌ¤ÙÚËÛË˜ ÂÚÈÔ‰ÈÎ¿, ÌÂ ÛÎÔ-fi ÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ÂÈÙÒÛÂˆÓ ÙË˜ Ófi-ÛÔ˘ ÛÙÔ ·Ó·ÓÂ˘ÛÙÈÎfi Î·È ÙËÓ ·Ó¿ÏÔÁË ÙÚÔÔÔ›-ËÛË ÙË˜ ıÂÚ·Â˘ÙÈÎ‹˜ ·ÁˆÁ‹˜, ÂÈ‚¿ÏÏÂÙ·È Î·ÈÛÙ· ·È‰È¿ ÌÂ ÈÓÔÎ˘ÛÙÈÎ‹ ÓfiÛÔ. ∏ ÛÈÚÔÌ¤ÙÚËÛË ‰È-Â˘ÎÔÏ‡ÓÂÈ ÙË Ï‹„Ë ÛˆÛÙÒÓ ıÂÚ·Â˘ÙÈÎÒÓ ·ÔÊ¿-ÛÂˆÓ ÙfiÛÔ ÛÂ ÂÚÈfi‰Ô˘˜ ¤Í·ÚÛË˜ ÙË˜ Û˘ÌÙˆÌ·-ÙÔÏÔÁ›·˜, fiÛÔ Î·È Î·Ù¿ ÙÔÓ ÚÔÁÚ·ÌÌ·ÙÈÛÌ¤ÓÔ Â-ÚÈÔ‰ÈÎfi ¤ÏÂÁ¯Ô ÙˆÓ ·ÛıÂÓÒÓ. ™Ù· ÚÒÈÌ· ÛÙ¿‰È·ÙË˜ ÓfiÛÔ˘, ÔÈ ·ÓˆÌ·Ï›Â˜ ·ÊÔÚÔ‡Ó ÛÙÔ˘˜ ÌÈÎÚÔ‡˜·ÂÚ·ÁˆÁÔ‡˜ (10) Î·È ·ÎÔÏÔ˘ıÂ› ÌÂ›ˆÛË ÙÔ˘ ÏfiÁÔ˘FEV1/FVC. ŸÌˆ˜, Î·Ù¿ ÙËÓ ÂÍ¤ÏÈÍË Î·È ÙËÓ ÚÔÔ-‰Â˘ÙÈÎ‹ ÂÈ‰Â›ÓˆÛË ÙË˜ ÓfiÛÔ˘, Ô ÏfiÁÔ˜ FEV1/FVC

Â·Ó¤Ú¯ÂÙ·È ÛÙÔ Ê˘ÛÈÔÏÔÁÈÎfi ‹ Î·È ·˘Í¿ÓÂÙ·È, ‰Èfi-ÙÈ ÔÈ ÈÓÒ‰ÂÈ˜ ÌÂÙ·‚ÔÏ¤˜ Ô˘ Û˘Ì‚·›ÓÔ˘Ó ÛÙÔ ÓÂ˘-ÌÔÓÈÎfi ·Ú¤Á¯˘Ì· ÚÔÛı¤ÙÔ˘Ó ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ÂÚÈÔÚÈÛÙÈÎ‹˜ ÓfiÛÔ˘ ÛÙËÓ ·Ú¯ÈÎ¿ ÂÎÊÚ·˙fiÌÂÓË ˆ˜·ÔÊÚ·ÎÙÈÎÔ‡ Ù‡Ô˘ ÈÓÔÎ˘ÛÙÈÎ‹ ÓfiÛÔ. ∏ ÂÎÙ¤ÏÂÛËÙË˜ ‰ÔÎÈÌ·Û›·˜ ‰ÈÂ˘ÎÔÏ‡ÓÂÈ ÙËÓ ·Ó›¯ÓÂ˘ÛË ·˘ÙÒÓÙˆÓ ·ÛıÂÓÒÓ Ô˘ ı· ˆÊÂÏËıÔ‡Ó ·fi ÙË Ï‹„Ë ÂÈ-ÛÓÂfiÌÂÓˆÓ ‚ÚÔÁ¯Ô‰È·ÛÙ·ÏÙÈÎÒÓ (11).

™Â ·È‰È¿ ÌÂ ‚ÚÔÁ¯ÂÎÙ·Û›Â˜ ·ÓÂÍ¿ÚÙËÙ· ·fi ÙËÓ·ÈÙÈÔÏÔÁ›·, Û˘ÓÈÛÙ¿Ù·È Ë ÂÚÈÔ‰ÈÎ‹ ÂÎÙ›ÌËÛË ÙË˜ ·Ó·-ÓÂ˘ÛÙÈÎ‹˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÌÂ ÛÈÚÔÌ¤ÙÚËÛË. ™Ù· ·Ú¯È-Î¿ ÛÙ¿‰È·, ÂÈ‰ÈÎ¿ fiÙ·Ó ÚfiÎÂÈÙ·È ÁÈ· ÂÓÙÔÈÛÌ¤ÓÂ˜‚ÚÔÁ¯ÂÎÙ·Û›Â˜, Ë ÛÈÚÔÌ¤ÙÚËÛË Â›Ó·È Û˘Ó‹ıˆ˜ Ê˘-ÛÈÔÏÔÁÈÎ‹ (12). ™Â ÂÈ‰Â›ÓˆÛË ÙË˜ ÓfiÛÔ˘, ·Ú·ÙËÚÂ›-Ù·È ÌÂ›ˆÛË ÙÔ˘ FEV1 Î·È ÙÔ˘ ÏfiÁÔ˘ FEV1/FVC, ÌÂÙ·-‚ÔÏ¤˜ Ô˘ ·ÎÔÏÔ˘ıÔ‡ÓÙ·È Î·È ·fi ÙÒÛË ÙÔ˘ FVCÂ¿Ó ‰ÂÓ ÂÈÙÂ˘¯ıÂ› ÈÎ·ÓÔÔÈËÙÈÎfi˜ ¤ÏÂÁ¯Ô˜.

™ÈÚÔÌ¤ÙÚËÛË Û˘ÓÈÛÙ¿Ù·È Ó· Á›ÓÂÙ·È Î·È ÛÂ ·È‰È¿ÌÂ ‰È¿ÌÂÛË ÓÂ˘ÌÔÓÔ¿ıÂÈ· (13), ·ÓÂÍ¿ÚÙËÙ· ·fiÙÔÓ ÈÛÙÔÏÔÁÈÎfi Ù‡Ô ÙË˜. ™˘Ó‹ıˆ˜, ·Ú·ÙËÚÂ›Ù·È ·‡-ÍËÛË ÙÔ˘ ÏfiÁÔ˘ FEV1/FVC Î·È ÙÔ˘ ÏfiÁÔ˘ FEF25-

75%/∆LC ÛÂ ·ÛıÂÓÂ›˜ Ô˘ Â›Ó·È ‰˘Ó·Ù‹ Ë Ì¤ÙÚËÛË ÙË˜ÔÏÈÎ‹˜ ¯ˆÚËÙÈÎfiÙËÙ·˜ ÌÂ ÏËı˘ÛÌÔÁÚ·Ê›·. ∂ÈÛË-Ì·›ÓÂÙ·È, fiÌˆ˜, fiÙÈ ‰ÂÓ ·ÔÙÂÏÂ› ÏÂÈÙÔ˘ÚÁÈÎ‹ ‰ÔÎÈÌ·-Û›· ÂÎÏÔÁ‹˜ ÁÈ· ÙËÓ ÂÓ›Û¯˘ÛË ÙË˜ ‰È¿ÁÓˆÛË˜ ‹ ÁÈ· ÙË‰È·¯ÚÔÓÈÎ‹ ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ·ÛıÂÓÒÓ ÌÂ ‰È¿ÌÂ-ÛË ÓÂ˘ÌÔÓÔ¿ıÂÈ·, ÔÈ ÔÔ›ÔÈ, ·ÓÙ›ıÂÙ·, ı· Ú¤ÂÈ Ó··Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·È Û˘¯Ó¿ ÌÂ ÚÔÛ‰ÈÔÚÈÛÌfi ÙË˜ ‰È¿-¯˘ÛË˜ ÙÔ˘ CO (DLCO).

™ÈÚÔÌ¤ÙÚËÛË Û˘ÓÈÛÙ¿Ù·È, Â›ÛË˜, ÛÂ ·ÛıÂÓÂ›˜ÌÂ Û˘ÛÙËÌ·ÙÈÎ¿ ÓÔÛ‹Ì·Ù· Ô˘ ÂÈÓ¤ÌÔÓÙ·È ÚˆÙÔ-·ıÒ˜ ÙÔ ·Ó·ÓÂ˘ÛÙÈÎfi Û‡ÛÙËÌ·, fiˆ˜ ÓfiÛÔÈ ÙÔ˘Û˘Ó‰ÂÙÈÎÔ‡ ÈÛÙÔ‡ (14,15). ™Â ·˘ÙÔ‡˜, Ë ÛÈÚÔÌ¤-ÙÚËÛË ÌÔÚÂ› Ó· Â›Ó·È Ê˘ÛÈÔÏÔÁÈÎ‹ ‹ Ó· ¤¯ÂÈ ¯·Ú·-ÎÙËÚÈÛÙÈÎ¿ ÓfiÛÔ˘ ÂÚÈÔÚÈÛÙÈÎÔ‡ Ù‡Ô˘. ∂ÂÈ‰‹ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ·˘ÙÔ‡˜ ÚÔÛ‚¿ÏÏÂÙ·È Î·Ù¿ Î‡ÚÈÔÏfiÁÔ Ô ‰È¿ÌÂÛÔ˜ ÈÛÙfi˜, ÂÍ¤Ù·ÛË ÂÎÏÔÁ‹˜ Î·Ù¿ ÙË‰È¿ÁÓˆÛË, ·ÏÏ¿ Î·È ÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË ÙÔ˘ ·ÛıÂ-ÓÔ‡˜ ·ÔÙÂÏÂ› Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙË˜ ‰È¿¯˘ÛË˜ ÙÔ˘CO (DLCO) (14,15).

OÈ ÂÓ‰Â›ÍÂÈ˜ ÛÈÚÔÌ¤ÙÚËÛË˜ ‰ÂÓ Â›Ó·È ·fiÏ˘ÙÂ˜ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ÓÔÛ‹Ì·Ù· ÙˆÓ ÔÔ›ˆÓ ÔÈ ·ÒÙÂÚÂ˜ÂÈÏÔÎ¤˜ ·ÊÔÚÔ‡Ó ÛÙÔ ·Ó·ÓÂ˘ÛÙÈÎfi Û‡ÛÙËÌ·.∆· ‰Â‰ÔÌ¤Ó·, fiÌˆ˜, Ô˘ ˘¿Ú¯Ô˘Ó ·fi ÙÈ˜ Ì¤¯ÚÈÛ‹ÌÂÚ· ÎÏÈÓÈÎ¤˜ ÌÂÏ¤ÙÂ˜ ı· ‰ÈÎ·ÈÔÏÔÁÔ‡Û·Ó ÙËÓÂÎÙ¤ÏÂÛË ÙË˜ ÛÈÚÔÌ¤ÙÚËÛË˜ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ‰ÚÂ-·ÓÔÎ˘ÙÙ·ÚÈÎ‹ ·Ó·ÈÌ›· (16,17), ÌÂÙ¿ ·fi ÌÂÙ·Ìfi-Û¯Â˘ÛË Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ (18), ÛÎÔÏ›ˆÛË (19) Î·È·¯˘Û·ÚÎ›· (20). ™Â ·È‰È¿ ÌÂ ÛÔ‚·Ú‹ ÛÎÔÏ›ˆÛË(>50Ô), È‰ÈÔ·ı‹ ‹ ‰Â˘ÙÂÚÔ·ı‹, ·Ú·ÙËÚÂ›Ù·ÈÌÂ›ˆÛË ÙÔ˘ ÓÂ˘ÌÔÓÈÎÔ‡ fiÁÎÔ˘, Ë ÔÔ›· Â›Ó·È ·Ó¿-ÏÔÁË ÙÔ˘ ‚·ıÌÔ‡ Î˘ÚÙfiÙËÙ·˜ ÙË˜ ÛÔÓ‰˘ÏÈÎ‹˜ÛÙ‹ÏË˜. ∞ÔÙ¤ÏÂÛÌ· ÙË˜ ÌÂ›ˆÛË˜ ÙÔ˘ fiÁÎÔ˘ Â›Ó·ÈÎ·È Ë ÌÂ›ˆÛË ÙˆÓ ÚÔÒÓ, ÔÈ ÙÈÌ¤˜ ÙˆÓ ÔÔ›ˆÓ, fiÌˆ˜,

∂ÈÎfiÓ· 4. ∏ ÂÎÓÂ˘ÛÙÈÎ‹ Î·Ì‡ÏË ÂÚÈÔÚÈÛÙÈÎÔ‡ ÓÔÛ‹Ì·ÙÔ˜Â›Ó·È ÌÈÎÚfiÙÂÚË ÛÂ Ì¤ÁÂıÔ˜ ·fi ÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë Ê˘ÛÈÔÏÔÁÈ-Î‹, ¯ˆÚ›˜ fiÌˆ˜ Ó· ÂËÚÂ¿˙ÂÙ·È ÙÔ Û¯‹Ì· ÙË˜.

8

6

4

2

0

-2

-4

-6-1 0 1 2 3 4

Volume

Flow

May-June 03 03-06-03 16:55 ™ÂÏ›‰·179

·Ó ‰ÈÔÚıˆıÔ‡Ó ˆ˜ ÚÔ˜ ÙÔÓ fiÁÎÔ ÙˆÓ ÓÂ˘ÌfiÓˆÓ,Â›Ó·È Ê˘ÛÈÔÏÔÁÈÎ¤˜. ∂›Ó·È, Â›ÛË˜, ÁÓˆÛÙfi fiÙÈ ÂÓ‹-ÏÈÎÂ˜ ÌÂ ‰ÚÂ·ÓÔÎ˘ÙÙ·ÚÈÎ‹ ·Ó·ÈÌ›· ·ÚÔ˘ÛÈ¿˙Ô˘ÓÂÚÈÔÚÈÛÙÈÎÔ‡ Ù‡Ô˘ ÓÂ˘ÌÔÓÔ¿ıÂÈ· ÌÂ ‚¿ÛË Ù··ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ ÛÈÚÔÌ¤ÙÚËÛË˜. ∏ ÂÈ‚¿Ú˘ÓÛË·˘Ù‹ ·Ô‰›‰ÂÙ·È ·ÊÂÓfi˜ ÌÂÓ ÛÙËÓ ·Ó¿Ù˘ÍË ÓÂ˘-ÌÔÓÈÎ‹˜ ›ÓˆÛË˜ ˆ˜ ·ÔÙ¤ÏÂÛÌ· Â·Ó·Ï·Ì‚·ÓfiÌÂ-ÓˆÓ ÂÂÈÛÔ‰›ˆÓ ÔÍ¤Ô˜ ıˆÚ·ÎÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘,˘ÔÙÚÔÈ·˙Ô˘ÛÒÓ ÏÔÈÌÒÍÂˆÓ Î·È ·ÁÁÂÈ·ÎÒÓ ÂÌ-ÊÚ¿ÎÙˆÓ, ·ÊÂÙ¤ÚÔ˘ ‰Â ÛÙËÓ ˘ÔÏÂÈfiÌÂÓË ·Ó¿-Ù˘ÍË ÙÔ˘ ıˆÚ·ÎÈÎÔ‡ ÙÔÈ¯ÒÌ·ÙÔ˜ Ô˘ ·Ú·ÙËÚÂ›-Ù·È ÛÂ ÔÚÈÛÌ¤ÓÂ˜ ÂÚÈÙÒÛÂÈ˜. ¶ÚfiÛÊ·ÙÂ˜ ÌÂÏ¤ÙÂ˜ÛÂ ·È‰È¿ ÌÂ ‰ÚÂ·ÓÔÎ˘ÙÙ·ÚÈÎ‹ ·Ó·ÈÌ›· ¤‰ÂÈÍ·Ó·ÔÙÂÏ¤ÛÌ·Ù· ÛÈÚÔÌ¤ÙÚËÛË˜ ·ÔÊÚ·ÎÙÈÎÔ‡ Ù‡-Ô˘ ÛÂ 40%, ÌÂ ·ÓÙÈÛÙÚÂÙfiÙËÙ· ÌÂÙ¿ ·fi ¯ÔÚ‹-ÁËÛË ‚ÚÔÁ¯Ô‰È·ÛÙ·ÏÙÈÎÔ‡ ÛÂ 80% ÂÚ›Ô˘ ÂÍ ·˘-ÙÒÓ. ∞Ó Î·È Ù· Ì¤¯ÚÈ ÛÙÈÁÌ‹˜ ‰Â‰ÔÌ¤Ó· Â›Ó·È ÂÚÈÔ-ÚÈÛÌ¤Ó· ÁÈ· ÙËÓ ÂÍ·ÁˆÁ‹ Û˘ÌÂÚ·ÛÌ¿ÙˆÓ, ÌÂ ‰Â-‰ÔÌ¤ÓË ÙËÓ ·ÏfiÙËÙ· ÂÎÙ¤ÏÂÛË˜ ÙË˜ ÛÈÚÔÌ¤ÙÚË-ÛË˜, ı· ‹Ù·Ó ÛÎfiÈÌË Ë ÂÚÈÔ‰ÈÎ‹ ·Ú·ÎÔÏÔ‡ıËÛËÙË˜ ·Ó·ÓÂ˘ÛÙÈÎ‹˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÙˆÓ ·È‰ÈÒÓ ·˘ÙÒÓÌÂ ÛÈÚÔÌ¤ÙÚËÛË Î·È Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙË˜ ‰È¿¯˘-ÛË˜ CO (DLCO) ÛÂ ·˘Ù¿ ÌÂ Â˘Ú‹Ì·Ù· ÓÂ˘ÌÔÓÔ-¿ıÂÈ·˜ ÂÚÈÔÚÈÛÙÈÎÔ‡ Ù‡Ô˘.

∆· ‰Â‰ÔÌ¤Ó· Â›Ó·È ÈÔ ÂÚÈÔÚÈÛÌ¤Ó· ÛÂ ·ÛıÂ-ÓÂ›˜ ÌÂ ÌÂ›˙ÔÓ· ÌÂÛÔÁÂÈ·Î‹ ·Ó·ÈÌ›·, Î·ıÒ˜ ˘¿Ú-¯Ô˘Ó ÛÙÔÈ¯Â›· ÛÂ ÓÂ·ÚÔ‡˜ ÂÓ‹ÏÈÎÂ˜ (21) Ô˘ ˘Ô-‰ËÏÒÓÔ˘Ó ÌÈÎÚ‹ ÂÈ‚¿Ú˘ÓÛË ÂÚÈÔÚÈÛÙÈÎÔ‡ Ù‡Ô˘Î·È ÛÂ ÌÈÎÚfi ·ÚÈıÌfi ·È‰ÈÒÓ fiÔ˘ ÌÂÏÂÙ‹ıËÎÂ ËÂ›‰Ú·ÛË ÙË˜ ¤ÎÙ˘ÍË˜ ÙÔ˘ ÂÓ‰·ÁÁÂÈ·ÎÔ‡ fiÁÎÔ˘ÌÂÙ¿ ·fi ÌÂÙ¿ÁÁÈÛË ÚÈÓ Î·È ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË ‰È-Ô˘ÚËÙÈÎÔ‡ (22). °È· ÙÔ ÏfiÁÔ ·˘Ùfi, Ë ·Ú·ÎÔÏÔ‡ıË-ÛË ÙË˜ ÓÂ˘ÌÔÓÈÎ‹˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÌÂ ÛÈÚÔÌ¤ÙÚËÛËÛÂ ·È‰È¿ ÌÂ ÌÂ›˙ÔÓ· ÌÂÛÔÁÂÈ·Î‹ ·Ó·ÈÌ›· ÛÙËÓ ·-ÚÔ‡Û· Ê¿ÛË ÌÔÚÂ› Ó· Á›ÓÂÈ ÌfiÓÔ ÛÙ· Ï·›ÛÈ· ÎÏÈ-ÓÈÎ‹˜ ¤ÚÂ˘Ó·˜. ∆· Ï¤ÔÓ ÚfiÛÊ·Ù· ‰Â‰ÔÌ¤Ó· Û˘-ÓËÁÔÚÔ‡Ó ˘¤Ú ÙË˜ ÂÌÊ¿ÓÈÛË˜ ÓÂ˘ÌÔÓÔ¿ıÂÈ·˜ -Û˘ÓËı¤ÛÙÂÚ· ÂÚÈÔÚÈÛÙÈÎÔ‡ Î·È Û·ÓÈfiÙÂÚ· ·Ô-ÊÚ·ÎÙÈÎÔ‡ Ù‡Ô˘ - ÛÙ· ·È‰È¿ ÌÂ ÔÍÂ›· ÏÂÌÊÔ‚Ï·-ÛÙÈÎ‹ ÏÂ˘¯·ÈÌ›· ÌÂÙ¿ ·fi ÌÂÙ·ÌfiÛ¯Â˘ÛË ÙÔ˘ Ì˘Â-ÏÔ‡ ÙˆÓ ÔÛÙÒÓ, fiÙ·Ó ·˘Ù‹ Á›ÓÂÙ·È ÛÂ ÙÂÏÈÎ¿ ÛÙ¿‰È·ÙË˜ ÓfiÛÔ˘ (18,23). ∞˘Ù‹ Ë ·˘ÍËÙÈÎ‹ Ù¿ÛË Û˘Û¯ÂÙ›-˙ÂÙ·È ÛËÌ·ÓÙÈÎ¿ ÌÂ ÙÔ ÛÙ¿‰ÈÔ ÙË˜ ÓfiÛÔ˘ Î·Ù¿ ÙÔÔÔ›Ô ¤ÁÈÓÂ Ë ÌÂÙ·ÌfiÛ¯Â˘ÛË, Û˘Û¯¤ÙÈÛË Ô˘ ·Ó¿-ÁÂÈ ÛÙËÓ ÂÈ‚¿Ú˘ÓÛË ÙÔ˘ ÓÂ˘ÌÔÓÈÎÔ‡ ·ÚÂÁ¯‡Ì·-ÙÔ˜ ÛÙ· ·È‰È¿ ·˘Ù¿ ÏfiÁˆ ÙË˜ ÚÔËÁËıÂ›Û·˜ ¯Ô-Ú‹ÁËÛË˜ ÙÔÍÈÎÒÓ Ê·ÚÌ¿ÎˆÓ. ¶·ÚfiÙÈ Ù· Â˘Ú‹Ì·Ù··fi ÙË ÛÈÚÔÌ¤ÙÚËÛË ‰ÂÓ Û˘ÓÔ‰Â‡ÔÓÙ·È ·fi ÎÏÈÓÈ-Î‹ Û˘ÌÙˆÌ·ÙÔÏÔÁ›·, Ê·›ÓÂÙ·È fiÙÈ Ë ÂÚÈÔ‰ÈÎ‹ ·-Ú·ÎÔÏÔ‡ıËÛË ÙË˜ ·Ó·ÓÂ˘ÛÙÈÎ‹˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÌÂÛÈÚÔÌ¤ÙÚËÛË ı· ‚ÔËı‹ÛÂÈ ÛÙË Ï‹„Ë ÙˆÓ Î·Ù¿Ï-ÏËÏˆÓ ÚÔÏËÙÈÎÒÓ Ì¤ÙÚˆÓ ÁÈ· ·ÔÊ˘Á‹ ÂÚ·ÈÙ¤-Úˆ ÂÈ‚¿Ú˘ÓÛË˜.

™ËÌ·ÓÙÈÎ‹ Â›Ó·È Ë Û˘Ì‚ÔÏ‹ ÙË˜ ÛÈÚÔÌ¤ÙÚËÛË˜Î·È ÛÂ ÂÚÈÙÒÛÂÈ˜ ˘Ô„›·˜ ·fiÊÚ·ÍË˜ ÙˆÓ ·ÓÒ-ÙÂÚˆÓ ·ÂÚ·ÁˆÁÒÓ (24). °È· ÙÔ ÏfiÁÔ ·˘Ùfi, Û˘ÓÈ-ÛÙ¿Ù·È Ë Î·Ù·ÁÚ·Ê‹ Î·È ÙË˜ ÂÈÛÓÂ˘ÛÙÈÎ‹˜ Î·Ì‡-ÏË˜ ÚÔ‹˜ fiÁÎÔ˘ ÛÂ fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓÂ›˜ Ô˘ Á›ÓÂ-Ù·È ÛÈÚÔÌ¤ÙÚËÛË ÁÈ· ÚÒÙË ÊÔÚ¿, ‰Â‰ÔÌ¤ÓÔ˘ fiÙÈÛ˘¯Ó¤˜ ÎÏÈÓÈÎ¤˜ ÂÎÊÚ¿ÛÂÈ˜ ÙË˜ ·fiÊÚ·ÍË˜ ÙˆÓ·ÓÒÙÂÚˆÓ ·ÂÚ·ÁˆÁÒÓ Â›Ó·È Ô ‚‹¯·˜ ‹ Ë Û˘ÚÚ›ÙÔ˘-Û· ·Ó·ÓÔ‹, Û˘ÌÙÒÌ·Ù· fiÌˆ˜ Ô˘ Â›Ó·È ÂÓ‰ÂÈÎÙÈ-Î¿ Î·È ÙÔ˘ ¿ÛıÌ·ÙÔ˜. ™Â ÂÚ›ÙˆÛË ·fiÊÚ·ÍË˜ÙˆÓ ·ÂÚ·ÁˆÁÒÓ, ·Ó¿ÏÔÁ· ÌÂ ÙÔ Â›Â‰Ô ÙË˜ ·fi-ÊÚ·ÍË˜, ÙÚÔÔÔÈÂ›Ù·È ÙÔ Û¯‹Ì· ÙË˜ ÂÈÛÓÂ˘ÛÙÈ-Î‹˜ ‹ Î·È ÙË˜ ÂÎÓÂ˘ÛÙÈÎ‹˜ Î·Ì‡ÏË˜ ÚÔ‹˜ fiÁÎÔ˘(∂ÈÎfiÓÂ˜ 5, 6).

∂Ó‰Â›ÍÂÈ˜ ÏËı˘ÛÌÔÁÚ·Ê›·˜ ∏ ÏËı˘ÛÌÔÁÚ·Ê›· ÂÈÙÚ¤ÂÈ ÙÔÓ ÚÔÛ‰ÈÔÚÈ-

ÛÌfi ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ÓÂ˘ÌÔÓÈÎÒÓ fiÁÎˆÓ (RV,ERV, TV, IRV) Î·È ÙˆÓ ·ÓÙ›ÛÙÔÈ¯ˆÓ ¯ˆÚËÙÈÎÔÙ‹ÙˆÓ(∆LC, VC, FRC, IC), ÂÓÒ ÌÂ ÙË ÛÈÚÔÌ¤ÙÚËÛË Â›Ó·ÈÂÊÈÎÙ‹ ÌfiÓÔ Ë Ì¤ÙÚËÛË ÙË˜ VC Î·È ÙˆÓ ˘Ô‰È·ÈÚ¤-ÛÂˆÓ ÙË˜ ERV, TV, IRV Î·È IC (25) (∂ÈÎfiÓ· 7). OÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ ˘fiÏÔÈˆÓ ÙÚÈÒÓ ÌÂÁÂıÒÓ(RV, FRC, TLC) ÚÔ¸Ôı¤ÙÂÈ ÙË Ì¤ÙÚËÛË ÙÔ˘ RV(˘ÔÏÂÈfiÌÂÓÔ˘ fiÁÎÔ˘), Ô ÔÔ›Ô˜ ‰ÂÓ ÂÎÓ¤ÂÙ·È‰È·Ì¤ÛÔ˘ ÙÔ˘ ÛÙfiÌ·ÙÔ˜ Î·È, ÂÔÌ¤Óˆ˜, ‰ÂÓ Â›Ó·È‰˘Ó·ÙfiÓ Ó· ÚÔÛ‰ÈÔÚÈÛÙÂ› ÌÂ ÙË ÛÈÚÔÌ¤ÙÚËÛË. ∏ÂÎÙ¤ÏÂÛË ÏËı˘ÛÌÔÁÚ·Ê›·˜ Û˘Ó‹ıˆ˜ Â›Ó·È ‰˘Ó·Ù‹ÛÂ ·È‰È¿ ËÏÈÎ›·˜ >8 ÂÙÒÓ, ¯ˆÚ›˜ ÙÔ fiÚÈÔ ·˘Ùfi Ó·Â›Ó·È ·fiÏ˘ÙÔ, ‰Â‰ÔÌ¤ÓÔ˘ fiÙÈ Ë ‰˘Ó·ÙfiÙËÙ· ÂÎÙ¤-ÏÂÛË˜ ÙË˜ ÏÂÈÙÔ˘ÚÁÈÎ‹˜ ‰ÔÎÈÌ·Û›·˜ ÂÍ·ÚÙ¿Ù·È ·fiÙË Û˘ÓÂÚÁ·Û›· ÙÔ˘ ·È‰ÈÔ‡ Î·È ÙËÓ Î·Ù·ÓfiËÛË ÙˆÓÔ‰ËÁÈÒÓ. ™Â ·ÓÙ›ıÂÛË, fiÌˆ˜, ÌÂ ÙË ÛÈÚÔÌ¤ÙÚËÛË,‰ÂÓ ·ÔÙÂÏÂ› ÂÍ¤Ù·ÛË ÚÔ˘Ù›Ó·˜ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ·Ó·ÓÂ˘ÛÙÈÎ¿ ÓÔÛ‹Ì·Ù·. ∞ÓÙ›ıÂÙ·, ÂÓ‰Â›ÎÓ˘Ù·È ÛÂÂÈÏÂÁÌ¤ÓÔ ·ÚÈıÌfi ·ÛıÂÓÒÓ, ÛÙÔ˘˜ ÔÔ›Ô˘˜ ¤¯ÂÈÚÔËÁËıÂ› ÛÈÚÔÌ¤ÙÚËÛË Î·È ··ÈÙÂ›Ù·È ÏÂÙÔÌÂ-Ú¤ÛÙÂÚË ÛÙ·‰ÈÔÔ›ËÛË ÙË˜ ‚·Ú‡ÙËÙ·˜ ÙË˜ ÓfiÛÔ˘ ‹Û·Ê¤ÛÙÂÚË ‰È¿ÁÓˆÛ‹ ÙË˜ fiÙ·Ó Ù· ·ÔÙÂÏ¤ÛÌ·Ù·ÙË˜ ÛÈÚÔÌ¤ÙÚËÛË˜ ‰ÂÓ Â›Ó·È ÌÂ Û·Ê‹ÓÂÈ· ÂÓÈÛ¯˘-ÙÈÎ¿ ÙË˜ ‰È¿ÁÓˆÛË˜ Ô˘ ¤¯ÂÈ ÙÂıÂ› ÌÂ Ù· ÎÏÈÓÈÎ¿ Î·ÈÙ· ˘fiÏÔÈ· ÂÚÁ·ÛÙËÚÈ·Î¿ ÎÚÈÙ‹ÚÈ·. ∆¤ÙÔÈÂ˜ ÂÚÈ-ÙÒÛÂÈ˜ Û˘Ó·ÓÙÒÓÙ·È Û˘¯ÓfiÙÂÚ· ÛÂ ·ÛıÂÓÂ›˜ ÌÂÂÚÈÔÚÈÛÙÈÎÔ‡ Ù‡Ô˘ ·Ó·ÓÂ˘ÛÙÈÎ¿ ÓÔÛ‹Ì·Ù· Î·ÈÛÂ ·˘ÙÔ‡˜ ÌÂ ÌÈÎÙÔ‡ Ù‡Ô˘ ÚÔ‚Ï‹Ì·Ù· (ÂÚÈÔÚÈ-ÛÙÈÎÔ‡ Î·È ·ÔÊÚ·ÎÙÈÎÔ‡ Ù‡Ô˘).

°ÂÓÈÎ¿, Ë ·Ó·ÓÂ˘ÛÙÈÎ‹ ÓfiÛÔ˜ ÂÚÈÔÚÈÛÙÈÎÔ‡Ù‡Ô˘ (ÚˆÙÔ·ı‹˜ ‹ ‰Â˘ÙÂÚÔ·ı‹˜) ¯·Ú·ÎÙËÚ›˙Â-Ù·È ·fi ÌÂ›ˆÛË ÙfiÛÔ ÙË˜ VC Ô˘ Î·Ù·ÁÚ¿ÊÂÙ·È ÌÂ ÙËÛÈÚÔÌ¤ÙÚËÛË, fiÛÔ Î·È ÙË˜ TLC Ô˘ ÚÔÛ‰ÈÔÚ›˙ÂÙ·ÈÌÂ ÙËÓ ÏËı˘ÛÌÔÁÚ·Ê›·. ∞Ó¿ÏÔÁ·, fiÌˆ˜, ÌÂ ÙËÓ ·È-ÙÈÔÏÔÁ›· ÙË˜ ÓfiÛÔ˘, Ô ¤Ó·˜ ‰Â›ÎÙË˜ ÌÔÚÂ› Ó· ˘ÂÚ-ÙÂÚÂ› ÙÔ˘ ¿ÏÏÔ˘. °È· ÙÔ ÏfiÁÔ ·˘Ùfi, ÛÂ ·ÛıÂÓÂ›˜ ÌÂ


180

May-June 03 03-06-03 16:55 ™ÂÏ›‰·180


181

∂ÈÎfiÓ· 6. ∂ÈÂ‰ˆÌ¤ÓË ÂÈÛÓÂ˘ÛÙÈÎ‹ Î·È ÂÎÓÂ˘ÛÙÈÎ‹ Î·-Ì‡ÏË ÚÔ‹˜-fiÁÎÔ˘, ¯·Ú·ÎÙËÚÈÛÙÈÎ‹ ÛÙ·ıÂÚ‹˜ ·fiÊÚ·ÍË˜ÙˆÓ ·ÓÒÙÂÚˆÓ ·ÂÚ·ÁˆÁÒÓ (.¯. ÛÙ¤ÓˆÛË ÙÚ·¯Â›·˜).

8

6

4

2

0

-2

-4

-6

-1 0 1 2 3 4

Flow

Volume∂ÈÎfiÓ· 5. ∂ÈÂ‰ˆÌ¤ÓË ÂÈÛÓÂ˘ÛÙÈÎ‹ Î·Ì‡ÏË ÌÂ Û˘ÓÔ‰fiÊ˘ÛÈÔÏÔÁÈÎ‹ ÂÎÓÂ˘ÛÙÈÎ‹ Î·Ì‡ÏË ÚÔ‹˜-fiÁÎÔ˘, ¯·Ú·ÎÙËÚÈ-ÛÙÈÎ‹ ÌÂÙ·‚·ÏÏfiÌÂÓË˜ ÂÍˆıˆÚ·ÎÈÎ‹˜ ·fiÊÚ·ÍË˜ ÙˆÓ ·ÓÒ-ÙÂÚˆÓ ·ÂÚ·ÁˆÁÒÓ (.¯. ‰ÈfiÁÎˆÛË ı˘ÚÂÔÂÈ‰Ô‡˜, ·Ú¿Ï˘ÛËÊˆÓËÙÈÎÒÓ ¯ÔÚ‰ÒÓ).

8

6

4

2

0

-2

-4

-6-1 0 1 2 3 4

Flow

Volume

˘Ô„›· ÓÔÛ‹Ì·ÙÔ˜ ÂÚÈÔÚÈÛÙÈÎÔ‡ Ù‡Ô˘ ¯ˆÚ›˜ Û·Ê‹Â˘Ú‹Ì·Ù· ·fi ÙË ÛÈÚÔÌ¤ÙÚËÛË, Û˘ÓÈÛÙ¿Ù·È Ë ÏÂ-ÙÔÌÂÚ¤ÛÙÂÚË Î·Ù·ÁÚ·Ê‹ ÙˆÓ ÓÂ˘ÌÔÓÈÎÒÓ fiÁÎˆÓÎ·È ¯ˆÚËÙÈÎÔÙ‹ÙˆÓ ÌÂ ÏËı˘ÛÌÔÁÚ·Ê›·.

™Â ·ÛıÂÓÂ›˜ ÌÂ ÌÈÎÙÔ‡ Ù‡Ô˘ ÚÔ‚Ï‹Ì·Ù· (·Ô-ÊÚ·ÎÙÈÎÔ‡ Î·È ÂÚÈÔÚÈÛÙÈÎÔ‡ Ù‡Ô˘) Â›Ó·È ‰˘Ó·ÙfiÓ ÌÂÙË ÛÈÚÔÌ¤ÙÚËÛË Ó· ÚÔÛ‰ÈÔÚ›˙ÂÙ·È Û·ÊÒ˜ ÙÔ ·Ô-ÊÚ·ÎÙÈÎfi Úfi‚ÏËÌ·, ÂÓÒ ÙÔ ÂÚÈÔÚÈÛÙÈÎfi ÛÙÔÈ¯Â›Ô ÙË˜ÓfiÛÔ˘ Ó· ÌËÓ ·ÔÎ·Ï‡ÙÂÙ·È. ™Â ·ÛıÂÓÂ›˜ Ô˘ ˘¿Ú-¯ÂÈ ÎÏÈÓÈÎ‹ ˘Ô„›· Û˘Ó‡·ÚÍË˜ Î·È ÂÚÈÔÚÈÛÙÈÎÔ‡ÛÙÔÈ¯Â›Ô˘, Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙË˜ TLC ı· ‰ÈÂ˘ÎÔÏ‡ÓÂÈÙË ‰ÈÂÚÂ‡ÓËÛË ˘fi ÙËÓ ÚÔ¸fiıÂÛË fiÙÈ ı· ·ÍÈÔÏÔÁË-ıÔ‡Ó fi¯È ÌfiÓÔ ÔÈ ·ıÔÏÔÁÈÎ¿ ¯·ÌËÏ¤˜ ÙÈÌ¤˜, ·ÏÏ¿ Î·ÈÔÈ ÌË ·Ó·ÌÂÓfiÌÂÓÂ˜ Ê˘ÛÈÔÏÔÁÈÎ¤˜ ÁÈ· ·ÛıÂÓ‹ ÌÂ ·Ô-ÎÏÂÈÛÙÈÎ¿ ·ÔÊÚ·ÎÙÈÎ‹ ÓfiÛÔ (25) (¶›Ó·Î·˜ 1).

™ËÌÂÈÒÓÂÙ·È fiÙÈ Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙË˜ FRC,ÂÎÙfi˜ ·fi ÙËÓ ÏËı˘ÛÌÔÁÚ·Ê›·, ÌÔÚÂ› Ó· Á›ÓÂÈÎ·È ÌÂ ÙË Ì¤ıÔ‰Ô ‰È¿Ï˘ÛË˜ ÙˆÓ ·ÂÚ›ˆÓ ËÏ›Ô˘ ‹·˙ÒÙÔ˘ (multiple-breath gas dilution). ∂ÈÛËÌ·›ÓÂ-Ù·È, ˆÛÙfiÛÔ, fiÙÈ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ·ÔÊÚ·ÎÙÈÎÔ‡ Ù‡-Ô˘ ÓfiÛÔ ˘ÔÂÎÙÈÌ¿Ù·È Ë FRC, ‰ÈfiÙÈ Ô ÚÔÛ‰ÈÔÚÈ-ÛÌfi˜ ÂÚÈÔÚ›˙ÂÙ·È ÛÙÈ˜ ÂÚÈÔ¯¤˜ ÙˆÓ ÓÂ˘ÌfiÓˆÓ Ô˘Â›Ó·È ÛÂ Â·Ê‹ ÌÂ ÙÔ ÛÙfiÌ· Î·È ‰ÂÓ ˘ÔÏÔÁ›˙ÂÙ·È ÔfiÁÎÔ˜ ÙÔ˘ ·¤Ú· Ô˘ Â›Ó·È ÂÁÎÏˆ‚ÈÛÌ¤ÓÔ˜ (26).

∂Ó‰Â›ÍÂÈ˜ ‰È¿¯˘ÛË˜ CO O ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙË˜ ‰È¿¯˘ÛË˜ ·Ú¤¯ÂÈ ÏËÚÔ-

ÊÔÚ›Â˜ ÁÈ· ÙË ÌÂÙ·ÊÔÚ¿ ÙÔ˘ ÔÍ˘ÁfiÓÔ˘ ·fi ÙËÓ Î˘-„ÂÏ›‰· ÛÙ· ÓÂ˘ÌÔÓÈÎ¿ ÙÚÈ¯ÔÂÈ‰‹. °È· ÙËÓ Î·Ù·-ÓfiËÛË ÙˆÓ ÏËÚÔÊÔÚÈÒÓ Ô˘ ·Ú¤¯ÂÈ Ë ‰È¿¯˘ÛËÙÔ˘ CO Î·È, ÂÔÌ¤Óˆ˜, ÙˆÓ ÂÓ‰Â›ÍÂÒÓ ÙË˜, ˘ÂÓı˘-Ì›˙ÂÙ·È Ë ÂÍ›ÛˆÛË ÙˆÓ Roughton Î·È Forster (27)ÁÈ· ÙË ‰È¿¯˘ÛË: 1/DLCO = 1/Dm + 1/ıVc. H ·Ú¿-ÌÂÙÚÔ˜ Dm Û˘Û¯ÂÙ›˙ÂÙ·È ÌÂ ÙËÓ ÂÈÊ¿ÓÂÈ· Î·È ÙÔ¿¯Ô˜ ÙË˜ Î˘„ÂÏÈ‰ÈÎ‹˜ ÙÚÈ¯ÔÂÈ‰ÈÎ‹˜ ÌÂÌ‚Ú¿ÓË˜,ÙËÓ ÂÈÊ¿ÓÂÈ· Î·È ÙÔ ¿¯Ô˜ ÙË˜ ÌÂÌ‚Ú¿ÓË˜ ÙˆÓÂÚ˘ıÚÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ, ÙÔ ¿¯Ô˜ ÙË˜ ÛÙÈ‚¿‰·˜ÙÔ˘ Ï¿ÛÌ·ÙÔ˜ Î·È ÙË Ê˘ÛÈÎ‹ ‰È·¯˘ÙÈÎ‹ ÈÎ·ÓfiÙËÙ·ÙÔ˘ CO ‰È·Ì¤ÛÔ˘ ÙË˜ Î˘„ÂÏÈ‰ÈÎ‹˜ ÙÚÈ¯ÔÂÈ‰ÈÎ‹˜ÌÂÌ‚Ú¿ÓË˜, ÙÔ˘ Ï¿ÛÌ·ÙÔ˜, ÙË˜ ÌÂÌ‚Ú¿ÓË˜ ÙÔ˘ÂÚ˘ıÚÔ‡ ·ÈÌÔÛÊ·ÈÚ›Ô˘ Î·È ÙÔ˘ ÂÛˆÙÂÚÈÎÔ‡ ÙÔ˘ÂÚ˘ıÚÔ‡ ·ÈÌÔÛÊ·ÈÚ›Ô˘. ∏ ·Ú¿ÌÂÙÚÔ˜ ı Â›Ó·È ÔÛ˘ÓÙÂÏÂÛÙ‹˜ ÙË˜ ¯ËÌÈÎ‹˜ Û˘ÁÁ¤ÓÂÈ·˜ ÙÔ˘ CO ÌÂÙËÓ Hb Î·È Vc Â›Ó·È Ô fiÁÎÔ˜ ÙÔ˘ ·›Ì·ÙÔ˜ ÛÙ· ÓÂ˘-ÌÔÓÈÎ¿ ÙÚÈ¯ÔÂÈ‰‹.

∞fi ÙËÓ ·Ú·¿Óˆ ÂÍ›ÛˆÛË Â›Ó·È Ê·ÓÂÚ¿ Ù· ·Îfi-ÏÔ˘ı· (28-31): ÓÔÛ‹Ì·Ù· Ô˘ ÚÔÎ·ÏÔ‡Ó ÌÂ›ˆÛËÙË˜ ·Ú·Ì¤ÙÚÔ˘ Dm, fiˆ˜ Ë ÓÂ˘ÌÔÓÈÎ‹ ›ÓˆÛË, Ô‰Ë-ÁÔ‡Ó ÛÂ Û˘ÓÔ‰fi ÌÂ›ˆÛË ÙË˜ DLCO. ∏ ·Ú¿ÌÂÙÚÔ˜ ı

May-June 03 03-06-03 16:55 ™ÂÏ›‰·181


182

ÂËÚÂ¿˙ÂÙ·È ·fi ÙÔÓ ·ÚÈıÌfi ÙˆÓ ı¤ÛÂˆÓ ‰¤ÛÌÂ˘-ÛË˜ Î·È ·fi ÙÔÓ ·ÓÙ·ÁˆÓÈÛÌfi O2 Î·È CO ÁÈ· ÙËÛ‡Ó‰ÂÛ‹ ÙÔ˘˜ ÌÂ ÙÈ˜ ı¤ÛÂÈ˜ ·˘Ù¤˜. ∏ DLCO ·Ó·Ì¤-ÓÂÙ·È ÌÂÈˆÌ¤ÓË fiÙ·Ó ÔÈ ı¤ÛÂÈ˜ ‰¤ÛÌÂ˘ÛË˜ Â›Ó·È Â-ÚÈÔÚÈÛÌ¤ÓÂ˜, fiˆ˜ ÛÂ ÂÚ›ÙˆÛË ·Ó·ÈÌ›·˜, Î·ıÒ˜Î·È fiÙ·Ó ÌÂÈÒÓÂÙ·È Ë Û˘ÁÁ¤ÓÂÈ· ÙÔ˘ O2 ÚÔ˜ ÙÈ˜ ı¤-ÛÂÈ˜ ‰¤ÛÌÂ˘ÛË˜ ÏfiÁˆ ¯·ÌËÏ‹˜ ›ÂÛË˜, fiˆ˜ .¯.ÛÂ ÌÂÁ¿ÏÔ ˘„fiÌÂÙÚÔ. ∏ ÌÂ›ˆÛË, Â›ÛË˜, ÙÔ˘ ÙÚÈ¯Ô-ÂÈ‰ÈÎÔ‡ fiÁÎÔ˘ ·›Ì·ÙÔ˜ Vc, Ë ÔÔ›· Û˘Ì‚·›ÓÂÈ .¯.ÛÂ ÓÂ˘ÌÔÓÈÎ‹ ÂÌ‚ÔÏ‹, ÂÌÊ‡ÛËÌ· ‹ ›ÓˆÛË ÏfiÁˆ·fiÊÚ·ÍË˜ ÙˆÓ ÓÂ˘ÌÔÓÈÎÒÓ ·ÁÁÂ›ˆÓ, ¤¯ÂÈ ˆ˜·ÔÙ¤ÏÂÛÌ· ÙË Û˘ÓÔ‰fi ÂÏ¿ÙÙˆÛË ÙÔ˘ DLCO. ∏ ·-Ú·¿Óˆ ÂÍ›ÛˆÛË, Â›ÛË˜, ÂÍËÁÂ› ·Ó¿ÏÔÁ· ÙËÓ ·‡-ÍËÛË Ô˘ ·Ú·ÙËÚÂ›Ù·È ÛÂ ÔÏ˘Î˘ÙÙ·Ú·ÈÌ›·, ÛÂÓÔÛ‹Ì·Ù· Ô˘ Û˘Ó‰¤ÔÓÙ·È ÌÂ ÂÓ‰ÔÎ˘„ÂÏÈ‰ÈÎ‹ ·È-ÌÔÚÚ·Á›·, fiˆ˜ ÓÂ˘ÌÔÓÈÎ‹ ·ÈÌÔÛÈ‰‹ÚˆÛË ‹ ÎÔÎ-ÎÈˆÌ¿ÙˆÛË Wegener, Î·ıÒ˜ Î·È ÛÂ ÓÔÛ‹Ì·Ù· ÌÂ·˘ÍËÌ¤ÓË ÚÔ‹ ·›Ì·ÙÔ˜ ÛÙËÓ ÓÂ˘ÌÔÓÈÎ‹ Î˘ÎÏÔÊÔ-Ú›·, fiˆ˜ ÛÂ ‰È·Ê˘Á‹ ·›Ì·ÙÔ˜ ·fi ÙËÓ ·ÚÈÛÙÂÚ‹ÛÙË ‰ÂÍÈ¿ Î˘ÎÏÔÊÔÚ›·.

∞fi Ù· ·ÓˆÙ¤Úˆ Á›ÓÂÙ·È Ê·ÓÂÚfi fiÙÈ Ë ÂÎÙ¤ÏÂÛËÙË˜ ‰ÔÎÈÌ·Û›·˜ ÁÈ· Î·Ù·ÁÚ·Ê‹ ÙË˜ DLCO ÂÓ‰Â›-ÎÓ˘Ù·È ÛÂ ÓÔÛ‹Ì·Ù· ÙÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡ Ô˘ ·Ó·-Ì¤ÓÂÙ·È Ó· ÂÎ‰ËÏˆıÂ› ÓÂ˘ÌÔÓÈÎ‹ ›ÓˆÛË ‹ ÌÂ›ˆÛËÙÔ˘ ÙÚÈ¯ÔÂÈ‰ÈÎÔ‡ fiÁÎÔ˘. °È· ÙÔ ÏfiÁÔ ·˘Ùfi, ‰ÔÎÈÌ·-Û›· ‰È¿¯˘ÛË˜ Û˘ÓÈÛÙ¿Ù·È Ó· Á›ÓÂÙ·È ÛÂ ·ÛıÂÓÂ›˜ ÌÂ

˘Ô„›· ‰È¿ÌÂÛË˜ ÓÂ˘ÌÔÓÔ¿ıÂÈ·˜. ∏ ÌÂ›ˆÛË ÙË˜DLCO ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ·˘ÙÔ‡˜ ·ÔÙÂÏÂ› È‰È·›ÙÂÚ·ÚÒÈÌÔ Â‡ÚËÌ· Ô˘ ÚÔËÁÂ›Ù·È ÛÂ ·ÚÎÂÙ¤˜ ÂÚÈ-ÙÒÛÂÈ˜ Î·È ÙˆÓ ·ÎÙÈÓÔÏÔÁÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ (32). ™ÂÂÓ‹ÏÈÎÂ˜, Ì¿ÏÈÛÙ·, ÌÂÚÈÎÔ› Û˘ÓÈÛÙÔ‡Ó ÙËÓ ÂÎÙ¤ÏÂÛË‚ÈÔ„›·˜ ÓÂ‡ÌÔÓ· ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ‰‡ÛÓÔÈ· Î·È Ê˘-ÛÈÔÏÔÁÈÎ‹ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·Î· fiÙ·Ó ‰ÂÓ ˘¿Ú-¯Ô˘Ó ÂÓ‰Â›ÍÂÈ˜ ·ÔÊÚ·ÎÙÈÎ‹˜ ÓfiÛÔ˘ Î·È Ë DLCO Â›-Ó·È ÌÈÎÚfiÙÂÚË ·fi ÙÔ 50% ÙÔ˘ Ê˘ÛÈÔÏÔÁÈÎÔ‡. °È·Ù· ·È‰È¿ ‰ÂÓ ˘¿Ú¯ÂÈ ·ÓÙ›ÛÙÔÈ¯Ë Û‡ÛÙ·ÛË. OÚÔÛ‰ÈÔÚÈÛÌfi˜, fiÌˆ˜, ÙË˜ DLCO Â›Ó·È ··Ú·›ÙË-ÙÔ˜ Î·È ÛÙ· ·È‰È¿ ÌÂ ˘Ô„›· ‰È¿ÌÂÛË˜ ÓÂ˘ÌÔÓÔ-¿ıÂÈ·˜, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙËÓ ·ÈÙÈÔÏÔÁ›· ÙË˜. ™˘ÓÈ-ÛÙ¿Ù·È, Â›ÛË˜, Ë ‰È·¯ÚÔÓÈÎ‹ ·Ú·ÎÔÏÔ‡ıËÛË ÙË˜ÂÍ¤ÏÈÍË˜ ÙË˜ ÓfiÛÔ˘ ÌÂ ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙË˜DLCO, ÔÈ ÌÂÙ·‚ÔÏ¤˜ ÙË˜ ÔÔ›·˜ ı· Ú¤ÂÈ Ó· Ï·Ì-‚¿ÓÔÓÙ·È ˘’ fi„ÈÓ ÁÈ· ÙËÓ ÙÚÔÔÔ›ËÛË ÙË˜ ıÂÚ·-Â˘ÙÈÎ‹˜ ·ÁˆÁ‹˜. ªÂ ‚¿ÛË Ù· ‰Â‰ÔÌ¤Ó· ÎÏÈÓÈÎÒÓÌÂÏÂÙÒÓ ÛÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜, Ë DLCO Â›Ó·È ÛÎfiÈÌÔ Ó·ÚÔÛ‰ÈÔÚ›˙ÂÙ·È Î·È ÛÙ· ·È‰È¿ ÌÂ Û·ÚÎÔÂ›‰ˆÛË(33), ·ÎfiÌË Î·È ÛÂ ·˘Ù¿ Ô˘ ·Ó‹ÎÔ˘Ó ÛÙÔ ÛÙ¿‰ÈÔ π,ÙÔ ÔÔ›Ô ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·ÎÙÈÓÔÏÔÁÈÎ¿ ·fi Ê˘ÛÈÔ-ÏÔÁÈÎfi ÓÂ˘ÌÔÓÈÎfi ·Ú¤Á¯˘Ì· Î·È Û˘ÓÔ‰fi ˘Ï·›··‰ÂÓ›ÙÈ‰·. ¶ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙË˜ DLCO ¤¯ÂÈ, Â›ÛË˜,ı¤ÛË Î·È ÛÂ ·È‰È¿ ÌÂ ÔÍÂ›· ÏÂÌÊÔ‚Ï·ÛÙÈÎ‹ ÏÂ˘-¯·ÈÌ›· ÌÂÙ¿ ·fi ÌÂÙ·ÌfiÛ¯Â˘ÛË ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ

∂ÈÎfiÓ· 7. ¶ÓÂ˘ÌÔÓÈÎÔ› fiÁÎÔÈ Î·È ·ÓÙ›ÛÙÔÈ¯Â˜ ¯ˆÚËÙÈÎfiÙËÙÂ˜ Ô˘ ÚÔÛ‰ÈÔÚ›˙ÔÓÙ·È ÌÂ ÙËÓ ÏËı˘ÛÌÔÁÚ·Ê›·.

ª¤ÁÈÛÙË ÂÈÛÓÔ‹

ª¤ÁÈÛÙË ÂÎÓÔ‹

◊ÚÂÌË ÂÈÛÓÔ‹

◊ÚÂÌË ÂÎÓÔ‹

IRV

TV

ERV

RV RV

VC

IC

FRC

TLC

May-June 03 03-06-03 16:55 ™ÂÏ›‰·182


183

ÔÛÙÒÓ, È‰È·›ÙÂÚ· fiÙ·Ó ·˘Ù‹ ¤ÁÈÓÂ ÛÂ ÙÂÏÈÎ¿ ÛÙ¿‰È·ÙË˜ ÓfiÛÔ˘, Î·ıÒ˜ Î·È ÛÂ ·È‰È¿ ÌÂ ‰ÚÂ·ÓÔÎ˘ÙÙ·-ÚÈÎ‹ ·Ó·ÈÌ›·.

∂Ó‰Â›ÍÂÈ˜ Ì¤ÙÚËÛË˜ ÂÎÓÂfiÌÂÓÔ˘ ¡O∆Ô ÂÓ‰ÔÁÂÓ¤˜ ¡O ·Ú¿ÁÂÙ·È ·fi ÙËÓ L-·ÚÁÈÓ›ÓË

ÌÂ ÙË ‰Ú¿ÛË ÙÚÈÒÓ ÈÛÔÌÂÚÒÓ ÙˆÓ Û˘ÓıÂÙ·ÛÒÓ ÙÔ˘¡O (¡OS). ∆Ô ÈÛÔÌÂÚ¤˜ ¡OS2 Ê·›ÓÂÙ·È fiÙÈ Â¿ÁÂ-Ù·È ·fi ÙÈ˜ Î˘ÙÔÎ›ÓÂ˜ (34) Ô˘ Û˘Ó‰¤ÔÓÙ·È ÌÂ ÙËÊÏÂÁÌÔÓÒ‰Ë ‰È·‰ÈÎ·Û›· Î·È, ÁÈ· ÙÔ ÏfiÁÔ ·˘Ùfi, Ë‰Ú·ÛÙËÚÈfiÙËÙ¿ ÙÔ˘ Û˘Û¯ÂÙ›˙ÂÙ·È ÌÂ ÙË ÊÏÂÁÌÔÓ‹ÙˆÓ ·ÂÚ·ÁˆÁÒÓ. °È· ÚÒÙË ÊÔÚ¿ ÙÔ 1991, ÔÈGustafsson Î·È Û˘Ó ‰È·›ÛÙˆÛ·Ó ÙËÓ ·ÚÔ˘Û›· ÙÔ˘¡O ÛÙËÓ ·ÓıÚÒÈÓË ·Ó·ÓÔ‹ (35). ŒÎÙÔÙÂ, ·ÚÎÂ-ÙÔ› ÂÚÂ˘ÓËÙ¤˜ ·Ú·Ù‹ÚËÛ·Ó ˘„ËÏ¿ Â›Â‰· ¡O ÛÂ·ÛıÂÓÂ›˜ ÌÂ ¿ÛıÌ· (36-38). ™ÙË Ì¤ÙÚËÛË ÙÔ˘ ÂÎ-ÓÂfiÌÂÓÔ˘ ¡O, ·Ú¯ÈÎ¿, ‰fiıËÎÂ È‰È·›ÙÂÚË ÛËÌ·Û›·ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ ¿ÛıÌ·, ‰ÈfiÙÈ ÂÓÒ Ë ÛÈÚÔÌ¤-ÙÚËÛË ·ÔÙÂÏÂ› ‰Â›ÎÙË ÙË˜ ·fiÊÚ·ÍË˜ ÙˆÓ ·ÂÚ·-ÁˆÁÒÓ, Ë Ì¤ÙÚËÛË ÙÔ˘ ÂÎÓÂfiÌÂÓÔ˘ ¡O ·ÔÙÂÏÂ›‰Â›ÎÙË ÙË˜ ÊÏÂÁÌÔÓ‹˜ ÙˆÓ ·ÂÚ·ÁˆÁÒÓ, Ë ÔÔ›·ÛÙ· ·Ú¯ÈÎ¿ ÛÙ¿‰È· ÌÔÚÂ› Ó· ˘¿Ú¯ÂÈ ¯ˆÚ›˜ Û˘ÓÔ-‰fi ·fiÊÚ·ÍË. ∆· Â›Â‰· ÙÔ˘ ÂÎÓÂfiÌÂÓÔ˘ ¡O Â›-Ó·È Ê˘ÛÈÔÏÔÁÈÎ¿ ‹ ¯·ÌËÏ¿ ÛÂ ÌË ·ÛıÌ·ÙÈÎ¿ ·È‰È¿ÌÂ ·ÔÊÚ·ÎÙÈÎÔ‡ Ù‡Ô˘ ÓÂ˘ÌÔÓÈÎ‹ ÓfiÛÔ, fiˆ˜ÈÓÔÎ˘ÛÙÈÎ‹ ÓfiÛÔ Î·È Û‡Ó‰ÚÔÌÔ ‰˘ÛÎ›ÓËÙˆÓ ÎÚÔÛ-ÛÒÓ. °È· ÙÔ ÏfiÁÔ ·˘Ùfi, Ë Ì¤ÙÚËÛË ÙÔ˘ ÂÎÓÂfiÌÂ-ÓÔ˘ ¡O ÂÓ‰Â›ÎÓ˘Ù·È ÛÂ ·È‰È¿ ÌÂ ˘Ô„›· ¿ÛıÌ·-ÙÔ˜, ÚÈÓ ÙËÓ ¤Ó·ÚÍË ·ÓÙÈÊÏÂÁÌÔÓÒ‰Ô˘˜ ·ÁˆÁ‹˜,fiÙ·Ó ˘¿Ú¯ÂÈ ·ÌÊÈ‚ÔÏ›· ÁÈ· ÙË ‰È¿ÁÓˆÛË. ∞ÓÙ›ıÂ-Ù·, fiÌˆ˜, ·Ú¿ ÙÔÓ ·Ú¯ÈÎfi ÂÓıÔ˘ÛÈ·ÛÌfi, Ù· Â›Â-‰· ÙÔ˘ ÂÎÓÂfiÌÂÓÔ˘ ¡O ‰ÂÓ Ê·›ÓÂÙ·È fiÙÈ ·ÔÙÂ-ÏÔ‡Ó Î·Ù¿ÏÏËÏÔ ‰Â›ÎÙË ·Ú·ÎÔÏÔ‡ıËÛË˜ ·È‰ÈÒÓÌÂ ¿ÛıÌ· Ô˘ Ï·Ì‚¿ÓÔ˘Ó ÂÈÛÓÂfiÌÂÓ· ‹ Û˘ÛÙËÌ·-ÙÈÎÒ˜ ¯ÔÚËÁÔ‡ÌÂÓ· ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹. ™‡ÌÊˆÓ·ÌÂ ÚfiÛÊ·ÙÂ˜ ÌÂÏ¤ÙÂ˜, ‰È·ÈÛÙÒıËÎÂ fiÙÈ Ù· Â›Â-‰· ÂÎÓÂfiÌÂÓÔ˘ ¡O ‰ÂÓ Û˘Û¯ÂÙ›˙ÔÓÙ·È ÈÎ·ÓÔÔÈË-ÙÈÎ¿ ÌÂ ÙÔ˘˜ ˘fiÏÔÈÔ˘˜ ‰Â›ÎÙÂ˜ ÊÏÂÁÌÔÓ‹˜ (˘Â-Ú·ÓÙÈ‰Ú·ÛÙÈÎfiÙËÙ· ·ÂÚ·ÁˆÁÒÓ ÌÂÙ¿ ·fi ‰ÔÎÈÌ·-Û›· ÚfiÎÏËÛË˜ ÌÂ ÌÂÙ·¯ÔÏ›ÓË ‹ ÈÛÙ·Ì›ÓË, ËˆÛÈÓfi-ÊÈÏ· Ù˘¤ÏˆÓ) ÛÙÔ˘˜ ·ÛıÌ·ÙÈÎÔ‡˜ ·ÛıÂÓÂ›˜ ˘fiÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹, ÌÂ ·ÔÙ¤ÏÂÛÌ· Ó· ÌËÓ ÌÔÚÔ‡ÓÓ· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó ˆ˜ ·ÛÊ·Ï‹˜ ‰Â›ÎÙË˜ ÌÂ›ˆÛË˜ÙË˜ ‰fiÛË˜ ÙˆÓ ¯ÔÚËÁÔ‡ÌÂÓˆÓ Ê·ÚÌ¿ÎˆÓ ÛÂ ·ÛıÂ-ÓÂ›˜ Ô˘ ¤¯Ô˘Ó ÂÏÂÁ¯ıÂ› Ù· Û˘ÌÙÒÌ·Ù·. ªÂ Ù· Ì¤-¯ÚÈ Û‹ÌÂÚ· ‰Â‰ÔÌ¤Ó· ‰ÂÓ Â›Ó·È, Â›ÛË˜, ÂÊÈÎÙfi Ó·‰È·ÊÔÚÔ‰È·ÁÓˆÛÙÂ› ÙÔ ·ÙÔÈÎfi ·fi ÙÔ ÌË ·ÙÔÈÎfi¿ÛıÌ· ÌÂ ‚¿ÛË Ù· Â›Â‰· ÙÔ˘ ÂÎÓÂfiÌÂÓÔ˘ ¡O.

™Â ÂÚÈÔÚÈÛÌ¤ÓÔ, fiÌˆ˜, ·ÚÈıÌfi ÌÂÏÂÙÒÓ ÛÂ ·È‰È¿Î·È ÂÓ‹ÏÈÎÂ˜, ‰È·ÈÛÙÒıËÎ·Ó ˘„ËÏfiÙÂÚ· Â›Â‰·ÂÎÓÂfiÌÂÓÔ˘ ¡O ÛÙÔ˘˜ ·ÙÔÈÎÔ‡˜ ÛÂ Û¯¤ÛË ÌÂÙÔ˘˜ ÌË ·ÙÔÈÎÔ‡˜ ·ÛıÂÓÂ›˜. ∂ÔÌ¤Óˆ˜, Â›Ó·È È-ı·ÓfiÓ ÛÙÔ Ì¤ÏÏÔÓ ÙÔ ÂÎÓÂfiÌÂÓÔ ¡O Ó· Û˘Ì‚¿ÏÂÈÛÙËÓ Î·Ï‡ÙÂÚË Î·Ù·ÓfiËÛË ÙˆÓ ‰È·ÊÔÚÂÙÈÎÒÓ Ê·È-ÓÔÙ‡ˆÓ ÙÔ˘ ·È‰ÈÎÔ‡ ¿ÛıÌ·ÙÔ˜ (39).

∆· Â›Â‰· ÙÔ˘ ÚÈÓÈÎÔ‡ ¡O Â›Ó·È Û˘Ó‹ıˆ˜ ·˘-ÍËÌ¤Ó· ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ·ÏÏÂÚÁÈÎ‹ ÚÈÓ›ÙÈ‰· (39).∞ÓÙ›ıÂÙ·, ¯·ÌËÏ¿ Â›Â‰· ÚÈÓÈÎÔ‡ ¡O ·Ú·ÙËÚÔ‡-ÓÙ·È ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ÚˆÙÔ·ı‹ ‰˘ÛÎÈÓËÛ›· ÎÚÔÛ-ÛÒÓ, ÈÓÔÎ˘ÛÙÈÎ‹ ÓfiÛÔ Î·È ÔÍÂ›· ‹ ¯ÚfiÓÈ· ÈÁÌÔÚ›ÙÈ-‰·. ™Â ·ÛıÂÓÂ›˜ ÌÂ ÈÓÔÎ˘ÛÙÈÎ‹ ÓfiÛÔ ‹ ‰˘ÛÎ›ÓËÙÔ˘˜ÎÚÔÛÛÔ‡˜ ¤¯Ô˘Ó ·Ú·ÙËÚËıÂ› ¯·ÌËÏ¿ Â›Â‰· ÚÈ-ÓÈÎÔ‡ ¡O Î·È fiÙ·Ó ÔÈ ·Ú·ÚÚ›ÓÈÔÈ ÎfiÏÔÈ Â›Ó·È Ê˘-ÛÈÔÏÔÁÈÎÔ›, ÌÂ Û˘Ó¤ÂÈ· Ù· ¯·ÌËÏ¿ Â›Â‰· Ó· ÌËÓÌÔÚÔ‡Ó Ó· ·Ô‰ÔıÔ‡Ó ÛÂ Û˘Ó˘¿Ú¯Ô˘Û· ·fi-ÊÚ·ÍË ÙˆÓ ·Ú·ÚÚÈÓ›ˆÓ Î·È Û˘ÓÔ‰fi ÈÁÌÔÚ›ÙÈ‰·.ŸÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÈÓÔÎ˘ÛÙÈÎ‹ ÓfiÛÔ, ˘¿Ú¯ÂÈ ·ÏÏË-ÏÔÂÈÎ¿Ï˘„Ë ÙˆÓ ÂÈ¤‰ˆÓ ÌÂ ·˘Ù¿ Ô˘ ·Ú·ÙË-ÚÔ‡ÓÙ·È ÙfiÛÔ ÛÂ ˘ÁÈ‹ ¿ÙÔÌ·, fiÛÔ Î·È ÛÂ ¿ÏÏÂ˜ÔÌ¿‰Â˜ ·ÛıÂÓÒÓ. ∞ÓÙ›ıÂÙ·, ·ÚfiÌÔÈ· ·ÏÏËÏÔÂÈ-Î¿Ï˘„Ë ‰ÂÓ ·Ú·ÙËÚÂ›Ù·È ÌÂÙ·Í‡ ÙˆÓ ·È‰ÈÒÓ ÌÂ‰˘ÛÎÈÓËÛ›· ÙˆÓ ÎÚÔÛÛÒÓ Î·È ¿ÏÏˆÓ ÔÌ¿‰ˆÓ ·ÛıÂ-ÓÒÓ ‹ Ê˘ÛÈÔÏÔÁÈÎÒÓ ·ÙfiÌˆÓ. °È· ÙÔ ÏfiÁÔ ·˘Ùfi, Ù·Â›Â‰· ÙÔ˘ ÚÈÓÈÎÔ‡ ¡O ·ÔÙÂÏÔ‡Ó ·ÚÎÂÙ¿ ÈÎ·ÓÔ-ÔÈËÙÈÎfi ‰Â›ÎÙË ‰È·ÏÔÁ‹˜ (40) ÙˆÓ ·È‰ÈÒÓ ÌÂ ÎÏÈÓÈ-Î‹ ˘Ô„›· ÙË˜ ÓfiÛÔ˘, ÛÙ· ÔÔ›· ı· ··ÈÙËıÂ› ÂÓ-‰ÂÏÂ¯¤ÛÙÂÚÔ˜ ¤ÏÂÁ¯Ô˜ ÌÂ ÚÔÛ‰ÈÔÚÈÛÌfi ÙË˜ ÎÈÓË-ÙÈÎfiÙËÙ·˜ ÙˆÓ ÎÚÔÛÛÒÓ Î·È ÈÛÙÔÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË ÌÂËÏÂÎÙÚÔÓÈÎfi ÌÈÎÚÔÛÎfiÈÔ.

™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, Ë ÛÈÚÔÌ¤ÙÚËÛË ·ÔÙÂÏÂ› ÙËÛ˘¯ÓfiÙÂÚ· ÂÓ‰ÂÈÎÓ˘fiÌÂÓË ÂÍ¤Ù·ÛË ÛÂ ·È‰È¿ ÌÂÓÔÛ‹Ì·Ù· ÙÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡, ÛÙ· ÔÔ›· ··ÈÙÂ›-Ù·È Ë ÂÎÙ›ÌËÛË ÙË˜ ·Ó·ÓÂ˘ÛÙÈÎ‹˜ ÏÂÈÙÔ˘ÚÁ›·˜. ™ÂÂÚÈÔÚÈÛÌ¤ÓÔ ·ÚÈıÌfi ·È‰ÈÒÓ ··ÈÙÂ›Ù·È ÂÚ·ÈÙ¤-Úˆ ÏÂÈÙÔ˘ÚÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙË˜ ·Ó·ÓÔ‹˜ ÌÂ ÂÎÙ›ÌË-ÛË ÙË˜ ‰È·¯˘ÙÈÎ‹˜ ÈÎ·ÓfiÙËÙ·˜ ÙË˜ Î˘„ÂÏÈ‰ÔÙÚÈ¯Ô-ÂÈ‰ÈÎ‹˜ ÌÂÌ‚Ú¿ÓË˜ ‹ ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ·Ó·ÓÂ˘ÛÙÈ-ÎÒÓ fiÁÎˆÓ Î·È ÙˆÓ ·ÓÙ›ÛÙÔÈ¯ˆÓ ¯ˆÚËÙÈÎÔÙ‹ÙˆÓ. OÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙÔ˘ ÚÈÓÈÎÔ‡ ¡O ·ÔÙÂÏÂ› ¯Ú‹ÛÈÌÔÂÚÁ·ÏÂ›Ô ‰È·ÏÔÁ‹˜ ÙˆÓ ·ÛıÂÓÒÓ ÌÂ ˘Ô„›· ‰˘ÛÎ›-ÓËÙˆÓ ÎÚÔÛÛÒÓ, ÂÓÒ ÙÔ ÂÎÓÂfiÌÂÓÔ ¡O ÁÈ· ÎÏÈÓÈ-ÎÔ‡˜ ÏfiÁÔ˘˜ Û˘ÓÈÛÙ¿Ù·È ÛÂ ·ÛıÂÓÂ›˜ ÌÂ Û˘ÌÙÒ-Ì·Ù· ÊÏÂÁÌÔÓ‹˜ ÙˆÓ ·ÂÚ·ÁˆÁÒÓ Î·È Ê˘ÛÈÔÏÔÁÈÎ‹ÛÈÚÔÌ¤ÙÚËÛË.

µÈ‚ÏÈÔÁÚ·Ê›·1. American Thoracic Society. Standardization of spirometry:

1994 update. Am Rev Respir Dis 1994;143:1215-1223. 2. ∫·ÙÛ·Ú‰‹˜ Ã. §ÂÈÙÔ˘ÚÁÈÎ¤˜ ‰ÔÎÈÌ·Û›Â˜ ÓÂ˘ÌfiÓˆÓ ÛÙ·

·È‰È¿. ¶ÓÂ‡ÌˆÓ 1987;1:82-89. 3. American Thoracic Society. Lung function testing: selection

of reference values and interpretative strategies. Am RevRespir Dis 1991;144:1202-1218.

¶›Ó·Î·˜ 1. ∞ÍÈÔÏfiÁËÛË ·ÔÙÂÏÂÛÌ¿ÙˆÓ ÏËı˘ÛÌÔÁÚ·Ê›·˜

∞ÔÊÚ·ÎÙÈÎ‹ ¶ÂÚÈÔÚÈÛÙÈÎ‹ ªÈÎÙ‹

VC Î.Ê. ‹ � � �TLC � � Î.Ê. ‹ �

May-June 03 03-06-03 16:55 ™ÂÏ›‰·183


184

4. Mueller GA, Eigen H. Pediatric pulmonary function testing inasthma. Pediatr Clin North Am 1992;39:1243-1258.

5. ∂nright PL, Lebowitz MD, Cockroft DW. Physiologicmeasures: pulmonary function tests. Asthma outcome. AmJ Respir Crit Care Med 1994;149:S9-18.

6. ∞ÓıÚ·ÎfiÔ˘ÏÔ˜ ª. ∏ ÛÈÚÔÌÂÙÚ›· ÛÙËÓ ·È‰È·ÙÚÈÎ‹ Ú¿-ÍË: Ë ÂÚÌËÓÂ›· ÙˆÓ Â˘ÚËÌ¿ÙˆÓ. ªÔÓÔÁÚ·Ê›· 10Ë˜ ‰ÈËÌÂÚ›-‰·˜ ·È‰È·ÙÚÈÎÒÓ ·Ó·ÓÂ˘ÛÙÈÎÒÓ ·ı‹ÛÂˆÓ. ∏ ÛÈÚÔÌÂ-ÙÚ›· ÛÙËÓ ·È‰È·ÙÚÈÎ‹ Ú¿ÍË. ∞ı‹Ó·; 2001. ÛÂÏ. 67-78.

7. Zwiebel AH. Bronchoprovocation testing. Immun AllergyClin N Am 1999;19:65-75.

8. Chatham M, Bleecker ER, Norman P, Smith PL, Mason P. Ascreening test for airways reactivity. An abbreviatedmethacholine inhalation challenge. Chest 1982;82:15-18.

9. Bramam SS, Corrao WM. Bronchoprovocation testing. ClinChest Med 1989;10:165-176.

10. Cooper PJ, Robertson CF, Hudson IL, Phelan PD. Variabilityof pulmonary function tests in cystic fibrosis. PediatrPulmonol 1990;8:16-22.

11. Konig P, Poehler J, Barbero GJ. A placebo-controlled,double-blind trial of the long-term effects of albuteroladministration in patients with cystic fibrosis. PediatrPulmonol 1998;25:32-36.

12. Hansell DM. Bronchiectasis. Radiol Clin North Am1998;36:107-128.

13. Fan LL, Mullen AL, Brugman SM, Inscore SC, Parks DP,White CW. Clinical spectrum of chronic interstitial lungdisease in children. J Pediatr 1992;121:867-872.

14. Lahdensuo A, Korpela M. Pulmonary findings in patientswith primary Sjogren’s syndrome. Chest 1995;108:316-319.

15. Yang SC, Wu HD, Yang SP. Lung volume, diffusing capacity,chest roentgenogram and dyspnea index in interstitial lungdisease. J Formos Med Assoc 1991;90:244-249.

16. Koumbourlis AC, Zar HJ, Hurlet-Jensen A, Goldberg MR.Prevalence and reversibility of lower airway obstruction inchildren with sickle cell disease. J Pediatr 2001;138:188-192.

17. Pianosi P, D’Souza SJ, Charge TD, Esseltine DE, CoatesAL. Pulmonary function abnormalities in childhood sicklecell disease. J Pediatr 1993;122:366-371.

18. Cerveri I, Fulgoni P, Giorgiani G, Zoia MC, Beccaria M,Tinelli C et al. Lung function abnormalities after bonemarrow transplantation in children: has the trend recentlychanged? Chest 2001;120:1900-1906.

19. Sakic K, Pecina M, Pavicic F. Cardiorespiratory function insurgically treated thoracic scoliosis with respect to degreeand apex of scoliotic curve. Respiration 1993;60:312.

20. Kessler R, Chaouat A, Schinkewitch P, Faller M, Casel S,Krieger J et al. The obesity-hypoventilation syndromerevisited: a prospective study of 34 consecutive cases.Chest 2001;120:369-376.

21. Piatti G, Allegra L, Ambrosetti U, Cappellini MD, Turati F,Fiorelli G. Beta-thalassemia and pulmonary function.Haematologica 1999;84:804-808.

22. Lands LC, Woods S, Katsardis C, Desmond K, Coates AL.The effects of diuresis and transfusion on pulmonaryfunction in children with thalassemia major. PediatrPulmonol 1991;11:340-344.

23. Fulgoni P, Zoia MC, Corsico A, Beccaria M, Georgiani G,Bossi G et al. Lung function in survivors of childhood acute

lymphoblastic leukemia. Chest 1999;116:1163-1167. 24. Miller A. Inspiratory flows and flow-volume loops in the

diagnosis of upper airways obstruction. In: Pulmonaryfunction tests in clinical and occupational lung diseases.New York: Grune and Stratton Inc; 1986. p. 53-65.

25. Ries AL. Measurement of lung volumes. Clin Chest Med1989;10:177-186.

26. Wanger J. Lung volumes. In: pulmonary function testing: apractical approach. 2nd ed. Baltimore: Williams andWilkins; 1996. p. 77-125.

27. Roughton FJW, Forster FE. Relative importance of diffusionand chemical reaction rates in determining rate of exchangeof gases in human lung with special reference to truediffusing capacity of pulmonary membrane and volume ofblood in the lung capillaries. J Appl Physiol 1957;11:290-302.

28. Crapo RO, Forster RE 2nd. Carbon monoxide diffusingcapacity. Clin Chest Med 1989;10:187-198.

29. Crapo RO, Jensen RL, Wanger JS. Single-breath carbonmonoxide diffusing capacity. Clin Chest Med2001;22:637-649.

30. MacIntyre NR. Diffusing capacity of the lung for carbonmonoxide. Respir Care Clin N Am 1997;3:221-233.

31. Stam H, Kreuzer FJ, Versprille A. Effect of lung volume andpositional changes on pulmonary diffusing capacity and itscomponents. J Appl Physiol 1991;71:1477-1488.

32. Epler GR, McLoud TC, Gaensler EA, Mikus JP, CarringtonCB. Normal chest roentgenograms in chronic diffuseinfiltrative lung disease. N Engl J Med 1978;298:934-939.

33. Miller A, Chuang M, Teirstein AS, Siltzbach LE. Pulmonaryfunction in stage I and II pulmonary sarcoidosis. Ann NYAcad Sci 1976;278:292-300.

34. Nathan C. Inducible nitric oxide synthase: what differencedoes it make? J Clin Invest 1997;100:2417-2423.

35. Gustafsson LE, Leone AM, Persson MG, Wiklund NP,Moncada S. Endogenous nitric oxide is present in theexhaled air of rabbits, guinea pigs and humans. BiochemBiophys Res Commun 1991;181:852-857.

36. Nelson BV, Sears S, Woods J, Ling CY, Hunt J, Clapper LMet al. Expired nitric oxide as a marker for childhood asthma.J Pediatr 1997;130:423-427.

37. Massaro AF, Gaston B, Kita D, Fanta C, Stamler JS, DrazenJM. Expired nitric oxide levels during treatment of acuteasthma. Am J Respir Crit Care Med 1995;152:800-803.

38. Alving K, Weitzberg E, Lundberg JM. Increased amount ofnitric oxide in exhaled air of asthmatics. Eur Respir J1993;6:1368-1370.

39. µaraldi E, de Jongste JC. Measurement of exhaled nitricoxide in children, 2001. Eur Respir J 2002;20:223-237.

40. Karadag B, James AJ, Gultekin E, Wilson NM, Bush A.Nasal and lower airway level of nitric oxide in children withprimary ciliary dyskinesia. Eur Respir J 1999;13:1402-1405.


¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ª·Ú›· ªÔ˘ÛÙ¿ÎË µ’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”£Ë‚ÒÓ Î·È §Â‚·‰Â›·˜, ∆.∫. 115 27, ∞ı‹Ó·

May-June 03 03-06-03 16:55 ™ÂÏ›‰·184


185

∂ÍˆÓÂ˘ÌÔÓÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ Ì˘ÎÔÏ¿ÛÌ·ÙÔ˜ ÙË˜ ÓÂ˘ÌÔÓ›·˜ ∂. ∫·Ú·ÓÙ·Ó¿1, ™. ∫ˆÛÙ·Ú›‰Ô˘2, ∞. ∫·Ï·ÓÙ˙‹˜3, ∞. °È·ÓÓÔ‡ÏÈ·2

Extrapulmonary symptoms of Mycoplasma pneumoniae infections E. Karantana1, S. Kostaridou2, A. Kalantzis3, A. Giannoulia2

∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞ ORIGINAL ARTICLE

1 ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ¶.°.¡. “ÕÁÈÔ˜ ¶·ÓÙÂÏÂ‹ÌˆÓ”¡›Î·È·-¶ÂÈÚ·È¿˜

2 A’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó·

3 O˘ÚÔÏÔÁÈÎ‹ ∫ÏÈÓÈÎ‹ ¶.°.¡. “°. °ÂÓÓËÌ·Ù¿˜”, ∞ı‹Ó·

1 Paediatric Clinic of “Agios Panteleimon” General Hospital,Nikea-Piraeus

2 1st Paediatric Clinic of Athens University, “Agia Sophia” Children’s Hospital, Athens

3 Urology Clinic of “G. Gennimatas” General Hospital, Athens

�¶ÂÚ›ÏË„Ë: ∫·Ù·ÁÚ¿ÊÔÓÙ·È 114 ÂÚÈÙÒÛÂÈ˜ ÏÔ›-ÌˆÍË˜ ·fi Ì˘ÎfiÏ·ÛÌ· ÙË˜ ÓÂ˘ÌÔÓ›·˜, ÂÎ ÙˆÓÔÔ›ˆÓ 31 ÌÂ ÂÍˆÓÂ˘ÌÔÓÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜, ÌÂ ‹¯ˆÚ›˜ Û˘ÌÌÂÙÔ¯‹ ·fi ÙÔ ·Ó·ÓÂ˘ÛÙÈÎfi Û‡ÛÙËÌ·.∞Ó·ÊÂÚfiÌ·ÛÙÂ ÛÂ 10 ÂÚÈÙÒÛÂÈ˜ ÌÂ ÂÎ‰ËÏÒÛÂÈ˜·fi ÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi, ÛÂ 6 ÌÂ ‰ÂÚÌ·ÙÈÎ¤˜ ÂÎ‰Ë-ÏÒÛÂÈ˜, 5 ÌÂ ÂÎ‰ËÏÒÛÂÈ˜ ·fi ÙÔ Ì˘ÔÛÎÂÏÂÙÈÎfi Û‡-ÛÙËÌ·, 4 ÌÂ ·ÈÌ·ÙÔÏÔÁÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ Î·È, Ù¤ÏÔ˜,ÛÂ 6 ÌÂ Û˘ÌÙˆÌ·ÙÔÏÔÁ›· ·fi ÙÔ ∫¡™. ∏ ‰È¿ÁÓˆ-ÛË Ù¤ıËÎÂ ÌÂ ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi IgG Î·È IgM ·ÓÙÈ-ÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÙÔ˘ Ì˘ÎÔÏ¿ÛÌ·ÙÔ˜ ÙË˜ ÓÂ˘ÌÔ-Ó›·˜ ÌÂ ÙË Ì¤ıÔ‰Ô ÙÔ˘ ·ÓÔÛÔÊıÔÚÈÛÌÔ‡. £ÂÚ·Â›·¤Ï·‚·Ó ÔÈ 20 ·fi ÙÔ˘˜ 31 ·ÛıÂÓÂ›˜, Ë ÔÚÂ›· ÙˆÓÔÔ›ˆÓ ÂÍÂÏ›¯ıËÎÂ ÔÌ·Ï¿.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: Ì˘ÎfiÏ·ÛÌ· ÙË˜ ÓÂ˘ÌÔÓ›·˜, Ì˘Â-Ï›ÙÈ‰·, ·ÚıÚ›ÙÈ‰·, ÂÍ¿ÓıËÌ·, ·ÁÁÂÈ›ÙÈ‰·.

�Abstract: This is a presentation of 114 cases ofMycoplasma pneumoniae infection, 31 of which hadextrapulmonary symptoms, with or without respira-tory tract involvement. These include 10 cases withgastrointestinal tract symptoms, 6 with skin involve-ment, 5 with symptoms related to muscles andjoints, 4 of blood anomalies and 6 cases with centralnervous system symptoms. The diagnosis wasestablished using immunofluorescence techniques.Treatment was administered to 20 of the 31 patientsand the course of the disease was satisfactory.

Key words: Mycoplasma pneumoniae infection,myelitis, arthropathy, brainstem syndrome,exanthem, vasculitis.

∂ÈÛ·ÁˆÁ‹OÈ ÂÍˆÓÂ˘ÌÔÓÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ ÙË˜ ÏÔ›ÌˆÍË˜

·fi Ì˘ÎfiÏ·ÛÌ· ÙË˜ ÓÂ˘ÌÔÓ›·˜ ·ÔÙÂÏÔ‡Ó ‰È·-ÁÓˆÛÙÈÎfi Úfi‚ÏËÌ· ÁÈ· ÙÔÓ ·È‰›·ÙÚÔ, È‰È·›ÙÂÚ·fiÙ·Ó ·Ô˘ÛÈ¿˙Ô˘Ó Ù· Û˘ÌÙÒÌ·Ù· ·fi ÙÔ ·Ó·ÓÂ˘-ÛÙÈÎfi, ÂÓÒ Ë ‰È¿ÁÓˆÛË Ù›ıÂÙ·È ÌÂ ÙÔÓ ¤ÏÂÁ¯Ô ÙˆÓ ÂÈ-‰ÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ. OÈ ÎÏÈÓÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ ÙË˜ ÏÔ›-ÌˆÍË˜ ‰È·ÎÚ›ÓÔÓÙ·È ÛÂ ·˘Ù¤˜ ·fi ÙÔ ·ÓÒÙÂÚÔ Î·ÈÎ·ÙÒÙÂÚÔ ·Ó·ÓÂ˘ÛÙÈÎfi, Î·ıÒ˜ Î·È ÛÂ ÂÎÂ›ÓÂ˜ Ô˘ÂÌÏ¤ÎÔ˘Ó ¿ÏÏ· Û˘ÛÙ‹Ì·Ù·. ∞fi ÙÔ ·ÓÒÙÂÚÔ ·Ó·-ÓÂ˘ÛÙÈÎfi Û‡ÛÙËÌ·, Ë Ì˘ÎÔÏ·ÛÌ·ÙÈÎ‹ ÏÔ›ÌˆÍËÌÔÚÂ› Ó· ÂÎ‰ËÏˆıÂ› ˆ˜ Ê·Ú˘ÁÁ›ÙÈ˜, ÔÍÂ›· Ì¤ÛË ˆÙ›-ÙÈ˜, ·Ì˘Á‰·Ï›ÙÈ˜, ÂÓÒ ·fi ÙÔ Î·ÙÒÙÂÚÔ ·Ó·ÓÂ˘ÛÙÈ-Îfi, ÂÎÙfi˜ ·fi ÙËÓ ÓÂ˘ÌÔÓ›· Ô˘ Â›Ó·È Î·È Ë ÛËÌ·-ÓÙÈÎfiÙÂÚË ÂÎ‰‹ÏˆÛË, ÌÔÚÂ› Ó· ·ÚÔ˘ÛÈ·ÛÙÂ› ˆ˜

Ï·Ú˘ÁÁÔÙÚ·¯ÂÔ‚ÚÔÁ¯›ÙÈ˜, ‚ÚÔÁ¯›ÙÈ˜ ‹ ‚ÚÔÁ¯ÈÔÏ›ÙÈ˜(1). OÈ ÂÍˆÓÂ˘ÌÔÓÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ ÙÔ˘ Ì˘ÎÔÏ¿-ÛÌ·ÙÔ˜ ÙË˜ ÓÂ˘ÌÔÓ›·˜ Â›Ó·È ·Û˘Ó‹ıÈÛÙÂ˜, ¯ˆÚ›˜ Ó·Â›Ó·È ‰˘Ó·Ùfi Ó· Î·ıÔÚÈÛÙÂ› ÙÔ ·ÎÚÈ‚¤˜ ÔÛÔÛÙfi Î·ÈÙÔ ÎÏÈÓÈÎfi Â‡ÚÔ˜ ·˘ÙÒÓ. Œ¯Ô˘Ó ÂÚÈÁÚ·ÊÂ› ÂÚÈ-ÙÒÛÂÈ˜ ·ÈÌÔÏ˘ÙÈÎ‹˜ ·Ó·ÈÌ›·˜, Û˘Ó‰ÚfiÌÔ˘ Stevens-Johnson, ÂÚÈÎ·Ú‰›ÙÈ‰·˜, Ì˘ÔÎ·Ú‰›ÙÈ‰·˜, Ë·Ù›ÙÈ-‰·˜, ÂÁÎÂÊ·Ï›ÙÈ‰·˜, ÌËÓÈÁÁÔÂÁÎÂÊ·Ï›ÙÈ‰·˜ Î·È Û˘Ì-ÌÂÙÔ¯‹˜ ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ (2).

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ∫·Ù¿ ÙË ¯ÚÔÓÈÎ‹ ÂÚ›Ô‰Ô ·fi ÙÔÓ π·ÓÔ˘¿ÚÈÔ 1996 ¤ˆ˜

ÙÔÓ ¢ÂÎ¤Ì‚ÚÈÔ 1997, Î·ÙÂÁÚ¿ÊËÛ·Ó 114 ÂÚÈÙÒÛÂÈ˜ Ì˘ÎÔ-Ï·ÛÌ·ÙÈÎ‹˜ ÏÔ›ÌˆÍË˜, 31 ÂÎ ÙˆÓ ÔÔ›ˆÓ (25,4%) ÌÂ ÂÍˆ-ÓÂ˘ÌÔÓÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ (∂ÈÎfiÓ· 1). ™Â 16 ·fi ·˘Ù¤˜ ÙÈ˜ 31

May-June 03 03-06-03 16:55 ™ÂÏ›‰·185

ÂÚÈÙÒÛÂÈ˜, ÔÈ ·ÛıÂÓÂ›˜ ·ÚÔ˘Û›·Û·Ó Û˘ÌÙÒÌ·Ù· ·fi ÙÔ·Ó·ÓÂ˘ÛÙÈÎfi. ∏ ËÏÈÎ›· ÙˆÓ ·ÛıÂÓÒÓ Î˘Ì·ÈÓfiÙ·Ó ·fi 9 Ì‹-ÓÂ˜ ¤ˆ˜ 12 ¤ÙË (Ì¤ÛË ËÏÈÎ›·: 6 ¤ÙË), ÂÓÒ fiÛÔÓ ·ÊÔÚ¿ ÛÙÔ Ê‡-ÏÔ, 15 ·ÛıÂÓÂ›˜ ‹Ù·Ó ¿ÚÚÂÓÂ˜ Î·È 16 ı‹ÏÂÈ˜.

OÈ ÂÍˆÓÂ˘ÌÔÓÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ ÂÌÊ·Ó›ÛÙËÎ·Ó 1-30 ËÌ¤-ÚÂ˜ ÌÂÙ¿ ÙËÓ ·Ó·ÓÂ˘ÛÙÈÎ‹ ÓfiÛÔ, ‰ËÏ·‰‹ Ì¤Û· ÛÙÔ ‰È¿ÛÙË-Ì· ÙˆÓ ÚÒÙˆÓ 20 ËÌÂÚÒÓ, Î·Ù¿ ÙËÓ ÔÍÂ›· Ê¿ÛË ÙË˜ ÓfiÛÔ˘,·ÏÏ¿ Î·È ÌÂÙ¿ ·fi ·˘Ù‹Ó. ∞ÊÔÚÔ‡Û·Ó ‰Â:

·) ÛÂ ÂÎ‰ËÏÒÛÂÈ˜ ·fi ÙÔ ÂÙÈÎfi Û‡ÛÙËÌ· ÛÂ 10 ÂÚÈ-ÙÒÛÂÈ˜ (8,7%) (Î˘Ú›ˆ˜ Ó·˘Ù›·, ¤ÌÂÙÔ, ‰È¿ÚÚÔÈ· Î·È ÎÔÈÏÈ·Îfi¿ÏÁÔ˜). ŒÓ· ·È‰› ÂÌÊ¿ÓÈÛÂ ·ÈÌ·Ù¤ÌÂÛË, ÂÓÒ ÛÂ ‰‡Ô ‰È·È-ÛÙÒıËÎÂ ‹È· ÙÚ·ÓÛ·ÌÈÓ·ÈÌ›· (ÙÈÌ¤˜ SGPT: 100-200 u/dl).

‚) ÛÂ ‰ÂÚÌ·ÙÔÏÔÁÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ ÛÂ 6 ÂÚÈÙÒÛÂÈ˜(5,3%) (Ù‡Ô˘ ÂÏ¿ÛÛÔÓÔ˜ ÔÏ‡ÌÔÚÊÔ˘ ÂÚ˘ı‹Ì·ÙÔ˜ ÛÂ 2·È‰È¿ Î·È Û‡Ó‰ÚÔÌÔ Stevens-Johnson ÛÂ 3 ·È‰È¿). ™Â Ì›·ÂÚ›ÙˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Stevens-Johnson ÛËÌÂÈÒıËÎ·ÓÙÚÂÈ˜ ˘ÔÙÚÔ¤˜ ÌÈÎÚfiÙÂÚË˜ ‚·Ú‡ÙËÙ·˜ ·fi ÙËÓ ·Ú¯ÈÎ‹, ÔÈÔÔ›Â˜ ·ÚÔ˘Û›·Û·Ó ‡ÊÂÛË ÌÂÙ¿ ·fi ÔÏÈÁÔ‹ÌÂÚË per os ¯Ô-Ú‹ÁËÛË ÎÔÚÙÈ˙fiÓË˜.

Á) ÛÂ ·ÈÌ·ÙÔÏÔÁÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ ÛÂ 4 ÂÚÈÙÒÛÂÈ˜(3,5%). ◊È· ·ÈÌÔÏ˘ÙÈÎ‹ ·Ó·ÈÌ›· ·ÚÔ˘ÛÈ¿ÛÙËÎÂ ÛÂ ¤Ó· ·È-‰› ¯ˆÚ›˜ Ó· Û˘ÓÔ‰Â‡ÂÙ·È ·fi ‚·ÚÈ¿ ÓÂ˘ÌÔÓÈÎ‹ ÂÎ‰‹ÏˆÛËÙË˜ Ì˘ÎÔÏ·ÛÌ·ÙÈÎ‹˜ ÏÔ›ÌˆÍË˜, ÂÓÒ ÔÈ „˘¯ÚÔÛ˘ÁÎÔÏÏËÙ›-ÓÂ˜ ‹Ù·Ó ıÂÙÈÎ¤˜. £ÚÔÌ‚ÔÂÓ›· ÂÎ‰ËÏÒıËÎÂ ÛÂ ‰‡Ô ÂÚÈ-ÙÒÛÂÈ˜ (·ÚÈıÌfi˜ ·ÈÌÔÂÙ·Ï›ˆÓ: 5000 ÎÎ¯ Î·È 7000 ÎÎ¯). ŒÓ··È‰› ÂÌÊ¿ÓÈÛÂ ÂÙ¤¯ÂÈÂ˜, ÂÎ¯˘ÌÒÛÂÈ˜, ÚÈÓÔÚÚ·Á›· Î·È Ô˘-ÏÔÚÚ·Á›·. °È· ÙÔ ÏfiÁÔ ·˘Ùfi, ÎÚ›ıËÎÂ ·Ó·ÁÎ·›· Ë ¯ÔÚ‹ÁËÛËÁ-ÛÊ·ÈÚ›ÓË˜. ∂›ÛË˜, ÛËÌÂÈÒıËÎÂ Î·È Ì›· ÂÚ›ÙˆÛË ‚·ÚÈ¿˜Ô˘‰ÂÙÂÚÔÂÓ›·˜ (·fiÏ˘ÙÔ˜ ·ÚÈıÌfi˜ Ô˘‰ÂÙÂÚfiÊÈÏˆÓ: 400),Ô˘ fiÌˆ˜ ‰ÂÓ ÂÓÂÏ¿ÎË ·fi Î¿ÔÈ· ÏÔ›ÌˆÍË. ™ÙÈ˜ ‰‡Ô ÙÂ-ÏÂ˘Ù·›Â˜ ÂÚÈÙÒÛÂÈ˜ ¤ÁÈÓÂ Ï‹ÚË˜ ¤ÏÂÁ¯Ô˜ ËÎÙÈÎfiÙËÙ·˜,Î·ıÒ˜ Î·È ¤ÏÂÁ¯Ô˜ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ, ÒÛÙÂ Ó· ·ÔÎÏÂÈ-ÛÙÔ‡Ó ÓÔÛ‹Ì·Ù· Ô˘ ÂÌÊ·Ó›˙Ô˘Ó ·ÚfiÌÔÈ· ÎÏÈÓÈÎ‹ ÂÈÎfiÓ·.

‰) ÛÂ Ì˘ÔÛÎÂÏÂÙÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ ÛÂ 5 ÂÚÈÙÒÛÂÈ˜ (4,4%)(·ÚıÚ›ÙÈ‰· ÛÂ 2 ·È‰È¿, ·ÚıÚ·ÏÁ›Â˜ ÛÂ 1 Î·È Ì˘ÔÛ›ÙÈ‰· ÛÂ 2·È‰È¿). ™ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ ·˘Ù¤˜ ¤ÁÈÓÂ ¤ÏÂÁ¯Ô˜ ÚÔ˜ ·ÔÎÏÂÈ-ÛÌfi ·˘ÙÔ¿ÓÔÛˆÓ ÓÔÛËÌ¿ÙˆÓ. ∂Ï‹ÊıËÛ·Ó ∞¡∞, RA-TEST, AntiDNA, pANCA, ·ÓÙÈËÎÙÈÎfi ÙÔ˘ Ï‡ÎÔ˘ Î·È ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈÎ·Ú‰ÈÔÏÈ›ÓË˜ IgG-IgM, fiÔ˘ Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ‹Ù·Ó ·ÚÓËÙÈÎ¿.

Â) ÛÂ ÓÂ˘ÚÔÏÔÁÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ ÛÂ 6 ÂÚÈÙÒÛÂÈ˜ (5,3%).∞Ó·Ï˘ÙÈÎfiÙÂÚ·, ¤Ó· ·ÁfiÚÈ ËÏÈÎ›·˜ ‰‡Ô ÂÙÒÓ, ·ÚÔ˘Û›·ÛÂ ¿-ÚÂÛË ÙË˜ ·ÚÈÛÙÂÚ‹˜ ÁˆÓ›·˜ ÙÔ˘ ÛÙfiÌ·ÙÔ˜, Î·ıÒ˜ Î·È ¿ÚÂÛËÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ¿Óˆ Î·È Î¿Ùˆ ¿ÎÚÔ˘. ∂›¯Â ÚÔËÁËıÂ›, ÚÔ ‰Â-Î·ÂÓıËÌ¤ÚÔ˘, ÓÂ˘ÌÔÓ›· ÂÓÙÔÈÛÌ¤ÓË ÛÙÔÓ ·ÚÈÛÙÂÚfi Î¿ÙˆÏÔ‚fi. ™ÙËÓ ·ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›· ÂÓÙÔ›ÛÙËÎÂ ¤ÌÊÚ·ÎÙÔ ÙË˜Ì¤ÛË˜ ÂÁÎÂÊ·ÏÈÎ‹˜ ·ÚÙËÚ›·˜ (ÊÏÔÈfi˜ Î·È ÏÂ˘Î‹ Ô˘Û›· ÙË˜ ‰Â-ÍÈ¿˜ ‚ÚÂÁÌ·ÙÈÎ‹˜ ¯ÒÚ·˜). ∂Ï‹ÊıËÛ·Ó ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ Î·Ú-‰ÈÔÏÈ›ÓË˜ Î·È ‹Ù·Ó ·ÚÓËÙÈÎ¿. ŒÏÂÁ¯Ô˜ ÁÈ· ÌÂÙ·‚ÔÏÈÎfi ÓfiÛËÌ·‰ÂÓ ¤ÁÈÓÂ. ™Â Ì›· ÂÚ›ÙˆÛË ÂÎ‰ËÏÒıËÎÂ ÂÁÎÂÊ·Ï›ÙÈ‰· ÌÂ ‰‡ÔÂÂÈÛfi‰È· ÂÛÙÈ·ÎÒÓ Û·ÛÌÒÓ, ·‰˘Ó·Ì›· Î·È ‰˘Û¯ÚËÛÙ›· ·ÚÈ-ÛÙÂÚÔ‡ ¿Óˆ Î·È Î¿Ùˆ ¿ÎÚÔ˘. ™ÙÔ ∂¡À ‚Ú¤ıËÎ·Ó Î‡ÙÙ·Ú· 23ÎÎ¯, ÏÂ‡ÎˆÌ· 17 mg/dl Î·È Û¿Î¯·ÚÔ 59 mg/dl. ∏ Ì·ÁÓËÙÈÎ‹ ÙÔ-ÌÔÁÚ·Ê›· ¤‰ÂÈÍÂ ÙÚÂÈ˜ ˘¤Ú˘ÎÓÂ˜ ÂÛÙ›Â˜ ÛÙÔ ‰ÂÍÈfi ÂÁÎÂÊ·ÏÈ-Îfi ËÌÈÛÊ·›ÚÈÔ, ÛÙËÓ ÂÚÈÔ¯‹ ÙˆÓ ‚·ÛÈÎÒÓ Á·ÁÁÏ›ˆÓ, ÔÈ ÔÔ›Â˜·Ô‰fiıËÎ·Ó ÛÂ ‚Ï¿‚Â˜ ÏfiÁˆ ·ÁÁÂÈ›ÙÈ‰·˜. OÈ ¿ÏÏÂ˜ Ù¤ÛÛÂÚÈ˜ÂÚÈÙÒÛÂÈ˜ ·ÊÔÚÔ‡Û·Ó ÛÂ ·È‰È¿ ÌÂ ·ÈıÔ˘ÛÈ·›· ÓÂ˘Ú›ÙÈ‰·,ÎÏÈÓÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ ÈÏ›ÁÁÔ˘, Ì›· ÂÚ›ÙˆÛË Û˘Ó‰ÚfiÌÔ˘Guilain-Barre Î·È Ì›· ÂÚ›ÙˆÛË ·ÚÂÁÎÂÊ·ÏÈÙÈ‰ÈÎ‹˜ ·Ù·Í›·˜.™Â fiÏÂ˜ ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ ÓÂ˘ÚÔÏÔÁÈÎÒÓ ÂÎ‰ËÏÒÛÂˆÓ ‰ÂÓ ˘‹Ú-Í·Ó ÓÂ˘ÚÔÏÔÁÈÎ¿ Î·Ù¿ÏÔÈ· (¶›Ó·Î·˜ 1).

∏ ‰È¿ÁÓˆÛË ÙË˜ Ì˘ÎÔÏ·ÛÌ·ÙÈÎ‹˜ ÏÔ›ÌˆÍË˜ Ù¤ıËÎÂ ÌÂ ÙËÌ¤ıÔ‰Ô ¤ÌÌÂÛÔ˘ ·ÓÔÛÔÊıÔÚÈÛÌÔ‡ ÌÂ ¤ÏÂÁ¯Ô IgG Î·È πgM·ÓÙÈÛˆÌ¿ÙˆÓ, ÌÂ ÙÂÙÚ·Ï·ÛÈ·ÛÌfi ‹ ˘ÔÙÂÙÚ·Ï·ÛÈ·ÛÌfi ÙÔ˘Ù›ÙÏÔ˘ ÌÂÙ·Í‡ ÔÍÂ›·˜ Ê¿ÛË˜ Î·È ·Ó¿ÚÚˆÛË˜ ‹ Ù›ÙÏÔ >1/512.™ÙÔ Û‡ÓÔÏÔ ÙˆÓ ·È‰ÈÒÓ, Ë Ì¤ÛË ÙÈÌ‹ ÙˆÓ ÏÂ˘ÎÒÓ ·ÈÌÔÛÊ·È-Ú›ˆÓ ‹Ù·Ó Ã=12.200 ÎÎ¯. ™ÙË Û˘ÓÙÚÈÙÈÎ‹ ÏÂÈÔ„ËÊ›·, Ô Ù‡-Ô˜ ‹Ù·Ó ÔÏ˘ÌÔÚÊÔ˘ÚËÓÈÎfi˜, ÂÓÒ Ë ∆∫∂ ‹Ù·Ó Ã=36,7 mm(5-73 mm) Î·È Ë CRP Ã=37,1 mg/l (3,2-258 mg/l). ™ÙÔ 64% ÙˆÓÂÚÈÙÒÛÂˆÓ ÚÔËÁ‹ıËÎÂ ‹ Û˘Ó˘‹ÚÍÂ ÓÂ˘ÌÔÓ›· ‹ ·ÎfiÌ·ÛËÌÂ›· Î·È Û˘ÌÙÒÌ·Ù· ÏÔ›ÌˆÍË˜ ÙÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡.

£ÂÚ·Â›· ¯ÔÚËÁ‹ıËÎÂ ÛÂ 20 ·ÛıÂÓÂ›˜ (71%), ˆ˜ Â› ÙÔÏÂ›ÛÙÔÓ ÌÂ ÎÏ·ÚÈıÚÔÌ˘Î›ÓË. ∏ ÔÚÂ›· ÙˆÓ ·ÛıÂÓÒÓ ‹Ù·Ó ÔÌ·-Ï‹, ·Ú¿ ÙËÓ ·Ó·ÌÂÓfiÌÂÓË ‚Ú·‰Â›· ·Ó¿ÚÚˆÛË (2,3) Î·È ¯·Ú·-ÎÙËÚ›ÛÙËÎÂ ·fi Ï‹ÚË ·ÔÎ·Ù¿ÛÙ·ÛË ÙˆÓ ÚÔÛ‚Â‚ÏËÌ¤ÓˆÓÛ˘ÛÙËÌ¿ÙˆÓ, ¯ˆÚ›˜ ÛÙÔÈ¯Â›· ˘ÔÏÂÈÌÌ·ÙÈÎ‹˜ ÓfiÛÔ˘. ŒÓÙÂÎ··fi ÙÔ˘˜ 31 ·ÛıÂÓÂ›˜ Â›¯·Ó Ï¿‚ÂÈ ·ÁˆÁ‹ ÚÔ ÙË˜ ÂÈÛ·ÁˆÁ‹˜ÙÔ˘˜ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô, ÁÈ· ‰È¿ÛÙËÌ· ÂÚ›Ô˘ 5-7 ËÌÂÚÒÓ.

™˘˙‹ÙËÛË™ÙËÓ ·ıÔÁ¤ÓÂÈ· ÙˆÓ ÂÍˆÓÂ˘ÌÔÓÈÎÒÓ ÂÎ‰ËÏÒ-

ÛÂˆÓ ÂÌÏ¤ÎÔÓÙ·È ÔÏÏ·ÏÔ› ÌË¯·ÓÈÛÌÔ›, fiˆ˜Â¤ÎÙ·ÛË ÙË˜ ÌfiÏ˘ÓÛË˜, ·Ú·ÁˆÁ‹ ·ÓÙÈÛˆÌ¿ÙˆÓÎ·È ·ÓÔÛÔÛ˘ÌÏÂÁÌ¿ÙˆÓ Î·È È‰ÈfiÙ˘Ë ·ÓÔÛÈ·Î‹·¿ÓÙËÛË ÙÔ˘ ÍÂÓÈÛÙ‹ (4). OÈ ÂÎ‰ËÏÒÛÂÈ˜ ·˘Ù¤˜‰ÂÓ Â›Ó·È ÙfiÛÔ Û˘¯Ó¤˜. ™˘Ì‚·›ÓÔ˘Ó 1-21 ËÌ¤ÚÂ˜ ÌÂ-Ù¿ ÙËÓ ·Ó·ÓÂ˘ÛÙÈÎ‹ ÓfiÛÔ, ÂÓÒ ÛÂ ÔÚÈÛÌ¤ÓÔ˘˜·ÛıÂÓÂ›˜ ‰ÂÓ ÚÔËÁÂ›Ù·È ÏÔ›ÌˆÍË ÙÔ˘ ·Ó·ÓÂ˘ÛÙÈ-ÎÔ‡ (3). ∏ ÂÌÊ¿ÓÈÛË ÂÈÏÔÎÒÓ ·fi ÙÔ ∫¡™, fiˆ˜ÌËÓÈÁÁÔÂÁÎÂÊ·Ï›ÙÈ˜ (5) (Ô˘ Â›Ó·È Î·È Ë ÈÔ Û˘¯Ó‹),ÂÁÎ¿ÚÛÈ· Ì˘ÂÏ›ÙÈ˜ ‹ ÓÂ˘Ú›ÙÈ˜ (6), Û‡Ó‰ÚÔÌÔ ·Ó¿ÏÔ-ÁÔ ÙË˜ ÔÏÈÔÌ˘ÂÏ›ÙÈ‰·˜, Û‡Ó‰ÚÔÌÔ Guilain-Barre,„‡¯ˆÛË Î·È ÂÁÎÂÊ·ÏÈÎfi ¤ÌÊÚ·ÎÙÔ, ·ÓÙÈÛÙÔÈ¯Â› ÛÂÔÛÔÛÙfi 0,1% ÙˆÓ ÓÔÛÔ‡ÓÙˆÓ, ·ÏÏ¿ Î·È Ì¤¯ÚÈ 7%


186

∂ÈÎfiÓ· 1. ™˘ÁÎÂÓÙÚˆÙÈÎ‹ ·Ó¿Ï˘ÛË ÂÍˆÓÂ˘ÌÔÓÈÎÒÓ ÂÎ‰Ë-ÏÒÛÂˆÓ Ì˘ÎÔÏ¿ÛÌ·ÙÔ˜ ÙË˜ ÓÂ˘ÌÔÓ›·˜.

™‡ÓÔÏÔ ÂÚÈÙÒÛÂˆÓ

∂ÍˆÓÂ˘ÌÔÓÈÎ¤˜ Ì˘ÎÔÏ·ÛÌ·ÙÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜

31

114

May-June 03 03-06-03 16:55 ™ÂÏ›‰·186

187


ÙˆÓ ÓÔÛËÏÂ˘fiÌÂÓˆÓ ÌÂ ÓÂ˘ÌÔÓÈÎ‹ ÓfiÛÔ. ∏ ıÓËÙfiÙË-Ù· ¤¯ÂÈ ÂÎÙÈÌËıÂ› ÛÂ 10%. ™Â fiÛÔ˘˜ ÂÈ‚ÈÒÛÔ˘Ó, Ë·ÔÎ·Ù¿ÛÙ·ÛË ÙË˜ ÓÂ˘ÚÔÏÔÁÈÎ‹˜ ÏÂÈÙÔ˘ÚÁ›·˜ Â›Ó·È‚Ú·‰Â›· Î·È ÙÔ 1/3 ÙˆÓ ·ÛıÂÓÒÓ ·ÚÔ˘ÛÈ¿˙ÂÈ ‚·ÚÈ¿˘ÔÏÂÈÌÌ·ÙÈÎ‹ ÓfiÛÔ (7,8), ÁÂÁÔÓfi˜ Ô˘ ‰ÂÓ Ê·›ÓÂÙ·ÈÓ· ÈÛ¯‡ÂÈ ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜, Î·-ıÒ˜ Ë ÔÚÂ›· ÙÔ˘˜ ‹Ù·Ó ÔÌ·Ï‹ Î·È Ë ·Ó¿ÚÚˆÛË Ï‹-ÚË˜, ¯ˆÚ›˜ ÛÙÔÈ¯Â›· ˘ÔÏÂÈÌÌ·ÙÈÎ‹˜ ÓfiÛÔ˘. ŸÛÔÓ·ÊÔÚ¿ ÛÙ· ¿ÏÏ· Û˘ÛÙ‹Ì·Ù·, Ì˘·ÏÁ›Â˜ Î·È ·ÚıÚ·Ï-Á›Â˜ ·Ú·ÙËÚÔ‡ÓÙ·È Û˘¯Ó¿ (15-45%), Û‡ÌÊˆÓ· ÌÂ Ù·‚È‚ÏÈÔÁÚ·ÊÈÎ¿ ‰Â‰ÔÌ¤Ó·, Î·ıÒ˜ Î·È ÛËÌÂ›· ¿Ù˘Ë˜·ÚıÚ›ÙÈ‰·˜ (ÌÔÓÔ·ÚıÚ›ÙÈ˜ ‹ ÌÂÙ·Ó·ÛÙÂ˘ÙÈÎ‹ ·ÚıÚ›ÙÈ˜‹ ÔÏ˘·ÚıÚ›ÙÈ˜ ÌÂ ÚÔÛ‚ÔÏ‹ ÌÂÁ¿ÏˆÓ ·ÚıÚÒÛÂˆÓ)(9-10). OÈ ·ÈÌ·ÙÔÏÔÁÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ Û˘Ó‹ıˆ˜ Â›Ó·È‹ÈÂ˜, ÌÂ ÈÔ ÛËÌ·ÓÙÈÎ‹ ÙËÓ ·ÈÌÔÏ˘ÙÈÎ‹ ·Ó·ÈÌ›·, ÌÂ·‡ÍËÛË ÙÔ˘ Ù›ÙÏÔ˘ ÙˆÓ „˘¯ÚÔÛ˘ÁÎÔÏÏËÙÈÓÒÓ, ıÂÙÈÎ‹Coomps Î·È ·‡ÍËÛË ÙˆÓ ¢∂∫. §ÈÁfiÙÂÚÔ Û˘¯Ó¤˜ Â›Ó·ÈË Ì˘ÂÏÈÎ‹ ·Ï·Û›·, Ë ıÚÔÌ‚ÔÂÓ›· Î·È, ÂÍ·ÈÚÂÙÈÎ¿Û¿ÓÈ·, Ë ‰È¿¯˘ÙË ÂÓ‰Ô·ÁÁÂÈ·Î‹ ‹ÍË. ¢‡Ô ÌÔÚÊ¤˜‰ÂÚÌ·ÙÈÎÒÓ ÂÎ‰ËÏÒÛÂˆÓ Û˘Ó‰˘¿˙ÔÓÙ·È ÌÂ ÏÔ›ÌˆÍË·fi Ì˘ÎfiÏ·ÛÌ· ÙË˜ ÓÂ˘ÌÔÓ›·˜: ÙÔ ÔÏ‡ÌÔÚÊÔÂÚ‡ıËÌ· Î·È ÙÔ Û‡Ó‰ÚÔÌÔ Stevens-Johnson, ÂÓÒÛ‡ÌÊˆÓ· ÌÂ ÙË ‚È‚ÏÈÔÁÚ·Ê›·, ‹ÈÂ˜ ‰ÂÚÌ·ÙÔÏÔÁÈÎ¤˜ÂÎ‰ËÏÒÛÂÈ˜ ÌÔÚÂ› Ó· ÊÙ¿ÛÔ˘Ó ÙÔ 30% ÛÂ ·ÛıÂÓÂ›˜ÌÂ ·Ó·ÓÂ˘ÛÙÈÎ‹ ÓfiÛÔ ·fi Ì˘ÎfiÏ·ÛÌ· ÙË˜ ÓÂ˘ÌÔ-Ó›·˜. ŸÛÔÓ ·ÊÔÚ¿ ÛÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi Û‡ÛÙËÌ·, ËÛ˘ÌÙˆÌ·ÙÔÏÔÁ›· Â›Ó·È ËÈfiÙÂÚË, ÌÂ ÂÌ¤ÙÔ˘˜, ‰È¿Ú-ÚÔÈÂ˜ Î·È ÎÔÈÏÈ·Îfi ¿ÏÁÔ˜, ÂÓÒ Û¿ÓÈ· ÌÔÚÂ› Ó· ÂÌÊ·ÓÈÛÙÔ‡Ó Û˘ÌÙÒÌ·Ù· ·ÁÎÚÂ·ÙÈÎ‹˜ Î·È Ë·ÙÈ-

Î‹˜ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·˜, Î·ıÒ˜ Î·È ·ÈÌÔÚÚ·Á›· ·fi ÙÔÂÙÈÎfi. ∆¤ÏÔ˜, ¤¯Ô˘Ó ·Ó·ÊÂÚıÂ› ÂÎ‰ËÏÒÛÂÈ˜ ·fi Ù·ÓÂÊÚ¿, ÌÂ ÙË ÌÔÚÊ‹ ‰È¿ÌÂÛË˜ ÓÂÊÚ›ÙÈ‰·˜ ‹ ÛÂÈÚ·-Ì·ÙÔÓÂÊÚ›ÙÈ‰·˜, Î·ıÒ˜ Î·È ÂÚÈÙÒÛÂÈ˜ ·ÚÔ‰ÈÎ‹˜·ÓÔÛÔÏÔÁÈÎ‹˜ ·ÓÂ¿ÚÎÂÈ·˜. ∏ ÙÂÏÂ˘Ù·›·, ÌÔÚÂ› Ó·ÂÚÌËÓÂ‡ÛÂÈ ÙË Ì·ÎÚ¿ ÂÚ›Ô‰Ô ·Ú·ÌÔÓ‹˜ ÙÔ˘ Ì˘ÎÔ-Ï¿ÛÌ·ÙÔ˜ ÙË˜ ÓÂ˘ÌÔÓ›·˜ ÛÙÔ ·Ó·ÓÂ˘ÛÙÈÎfi ÌÂÙ¿ÙËÓ ‡ÊÂÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ, Î·ıÒ˜ Î·È ÙËÓ ·˘ÍË-Ì¤ÓË Èı·ÓfiÙËÙ·, Ù·˘Ùfi¯ÚÔÓ· ‹ ·Ì¤Ûˆ˜ ÌÂÙ¿, ÏÔ›-ÌˆÍË˜ ·fi ¿ÏÏÔ˘˜ ·Ú¿ÁÔÓÙÂ˜, fiˆ˜ ÈÔ‡˜ Î·È ‚·-ÎÙËÚ›‰È· (11).

µÈ‚ÏÈÔÁÚ·Ê›· 1. Stevens D, Swift PG, Johnston PG, Kearney PJ, Corner BD,

Burman D. Mycoplasma pneumoniae infections in children.Arch Dis Child 1978;53:38-42.

2. Cassell GH, Cole BC. Mycoplasmas as agents of humandisease. N Engl J Med 1981;304:80-89.

3. Lehtokoski-Lehtiniemi E, Koskiniemi ML. Mycoplasmapneumoniae encephalitis: a severe entity in children. PediatrInfect Dis J 1989;8:651-653.

4. Tjhie JH, van Kuppeveld FJ, Roosendaal R, Melchers WJ,Gordijn R, MacLaren DM et al. Direct PCR enables detectionof Mycoplasma pneumoniae in patients with respiratory tractinfections. J Clin Microbiol 1994;32:11-16.

5. Koskiniemi M, Rautonen J, Lehtokoski-Lehtiniemi E, VaheriA. Epidemiology of encephalitis in children: a 20-yearsurvey. Ann Neurol 1993;29:492-497.

6. Mills RW, Schoolfield L. Acute transverse myelitisassociated with Mycoplasma pneumoniae infection: a casereport and review of the literature. Pediatr Infect Dis J1992;11:228-231.

7. Nishimura M, Saida T, Kuroki S, Kawabata T, Obayashi H,Saida K et al. Post-infectious encephalitis with anti-galactocerebroside antibody subsequent to Mycoplasmapneumoniae infection. J Neurol Sci 1996;140:91-95.

8. Pellegrini M, O’Brien TJ, Hoy J, Sedal L. Mycoplasmapneumoniae infection associated with an acute brainstemsyndrome. Acta Neurol Scand 1996;93:203-206.

9. Perez C, Mendoza H, Hernandez R, Valcayo A, Guarch R.Leukocytoclastic vasculitis and polyarthritis associated withMycoplasma pneumoniae infection. Clin Infect Dis1997;25:154-155.

10. Cimolai N, Malleson P, Thomas E, Middleton PJ. Mycoplasmapneumoniae associated arthropathy: confirmation of theassociation by determination of the antipolypeptide IgMresponse. J Rheumatol 1989;16:1150-1152.

11. Liakopoulou-Tsisipi T. §ÔÈÌÒÍÂÈ˜ ·fi Ì˘ÎfiÏ·ÛÌ· ÙË˜ÓÂ˘ÌÔÓ›·˜. ¶·È‰È·ÙÚÈÎ¤˜ £ÂÚ·Â˘ÙÈÎ¤˜ ∂ÓËÌÂÚÒÛÂÈ˜ ∞’¶·È‰È·ÙÚÈÎ‹˜ ∫ÏÈÓÈÎ‹˜ ¶·Ó/Ì›Ô˘ ∞ıËÓÒÓ 1995;1:47-51.

¶›Ó·Î·˜ 1. ¶ÔÛÔÛÙÈ·›· ·Ó¿Ï˘ÛË ÂÍˆÓÂ˘ÌÔÓÈÎÒÓ ÂÎ‰ËÏÒ-ÛÂˆÓ Ì˘ÎÔÏ¿ÛÌ·ÙÔ˜ ÙË˜ ÓÂ˘ÌÔÓ›·˜

°·ÛÙÚÂÓÙÂÚÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ 10/114 (8,7%)(·ÏÏËÏÔÂÈÎ¿Ï˘„Ë Û˘ÌÙˆÌ¿ÙˆÓ )

¡·˘Ù›·-¤ÌÂÙÔÈ 6/114¢È¿ÚÚÔÈÂ˜ 4/114∫ÔÈÏÈ·Îfi ¿ÏÁÔ˜ 4/114∞ÈÌ·Ù¤ÌÂÛË 1/114∏·ÙÈÎ‹ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· 2/114

¢ÂÚÌ·ÙÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ 6/114 (5,3%)¶ÔÏ‡ÌÔÚÊÔ ÂÚ‡ıËÌ· 2/114Stevens-Johnson 3/114∞ÈÌÔÚÚ·ÁÈÎfi ÎËÏÈ‰Ô‚Ï·ÙÈ‰Ò‰Â˜ ÂÍ¿ÓıËÌ· 1/114

∞ÈÌ·ÙÔÏÔÁÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ 4/114 (3,5%)∞ÈÌÔÏ˘ÙÈÎ‹ ·Ó·ÈÌ›· 1/114£ÚÔÌ‚ÔÂÓ›· 2/114O˘‰ÂÙÂÚÔÂÓ›· 1/114

ª˘ÔÛÎÂÏÂÙÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ 5/114 (4,4%)∞ÚıÚ›ÙÈ‰· 2/114∞ÚıÚ·ÏÁ›Â˜ 1/114ª˘ÔÛ›ÙÈ˜ 1/114

¡Â˘ÚÔÏÔÁÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ 6/114 (5,3%)ŒÌÊÚ·ÎÙÔ Ì¤ÛË˜ ÂÁÎÂÊ·ÏÈÎ‹˜ ·ÚÙËÚ›·˜ 1/114∂ÁÎÂÊ·Ï›ÙÈ˜ 1/114∞ÈıÔ˘ÛÈ·›· ÓÂ˘Ú›ÙÈ˜ 2/114Guilain-Barre 1/114¶·ÚÂÁÎÂÊ·ÏÈÙÈ‰ÈÎ‹ ·Ù·Í›· 1/114

∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 05-09-2002∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛË˜: 31-01-2003

¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∂Ï¤ÓË ∫·Ú·ÓÙ·Ó¿ ∞Á. ¢ËÌ‹ÙÚÈÔ˘ 28, ∆.∫. 166 73, µÔ‡Ï· - ∞ÙÙÈÎ‹˜ E-mail: [email protected]

May-June 03 03-06-03 16:55 ™ÂÏ›‰·187

ºÔÚÂ›· Neisseria meningitidis ÛÂ ·È‰È¿ Û¯ÔÏÈÎ‹˜ ËÏÈÎ›·˜: ·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ Î·È ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ·ÔÌÔÓˆı¤ÓÙˆÓ ÛÙÂÏÂ¯ÒÓ π. ¶·˘ÏÔÔ‡ÏÔ˘1, ∂. ∞ÏÂÍ¿Ó‰ÚÔ˘2, °. ¢·›ÎÔ˜3, ∂. ¶ÂÙÚ›‰Ô˘2, ∞. ¶¿ÁÎ·ÏË2, ª. £ÂÔ‰ˆÚ›‰Ô˘1, µ. ™˘ÚÈÔÔ‡ÏÔ˘1

Neisseria meningitidis carriage in schoolchildren: risk factors and characteristics of isolated strains I. Pavlopoulou1, E. Alexandrou2, G. Daikos3, E. Petridou2, A. Pangalis2, M. Theodoridou1, V. Syriopoulou1


1 ∞’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó·

2 ªÈÎÚÔ‚ÈÔÏÔÁÈÎfi ∂ÚÁ·ÛÙ‹ÚÈÔ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó·

3 ∞’ ¶ÚÔ·È‰Â˘ÙÈÎ‹ ¶·ıÔÏÔÁÈÎ‹ ∫ÏÈÓÈÎ‹ ¶·ÓÂÈÛÙËÌ›Ô˘∞ıËÓÒÓ, “§·˚Îfi” °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô, ∞ı‹Ó·

1 1st Paediatric Clinic of University of Athens “Agia Sophia” Children’s Hospital, Athens

2 Microbiological Laboratory“Agia Sophia” Children’s Hospital, Athens

3 1st Academic Clinic of Pathology, University of Athens“Laiko” General Hospital, Athens

�¶ÂÚ›ÏË„Ë: ™ÎÔfi˜ ÙË˜ ÌÂÏ¤ÙË˜ ‹Ù·Ó Ë Î·Ù·ÁÚ·-Ê‹ ÙË˜ Â›ÙˆÛË˜ Î·È ÙˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ÙË˜ ÊÔÚÂ›·˜ ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˘ ÛÂ ·È‰È¿ Û¯ÔÏÈÎ‹˜ËÏÈÎ›·˜, Î·ıÒ˜ Î·È Ë ÂÚÈÁÚ·Ê‹ ÙˆÓ ·ÔÌÔÓˆı¤-ÓÙˆÓ ÛÙÂÏÂ¯ÒÓ. ∂Ï‹ÊıËÛ·Ó Î·ÏÏÈ¤ÚÁÂÈÂ˜ Ê·Ú˘ÁÁÈ-ÎÔ‡ ÂÈ¯Ú›ÛÌ·ÙÔ˜ ·fi 554 ·È‰È¿ ·È‰ÈÎÒÓ ÛÙ·ı-ÌÒÓ, ‰ËÌÔÙÈÎÒÓ Î·È Á˘ÌÓ·Û›ˆÓ ÙË˜ ∞ı‹Ó·˜, ËÏÈÎ›·˜2-19 ÂÙÒÓ. ¶ÚÔËÁÔ˘Ì¤Óˆ˜ Û˘ÌÏËÚÒıËÎÂ ·fiÙÔ˘˜ ÁÔÓÂ›˜ ÙÔ˘˜ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Ô˘ ·ÊÔÚÔ‡ÛÂÛÂ ·Ú·Ì¤ÙÚÔ˘˜ Ô˘ ı· ÌÔÚÔ‡Û·Ó Ó· Û¯ÂÙ›˙Ô-ÓÙ·È ÌÂ ÙË ÊÔÚÂ›·. ∏ Â˘·ÈÛıËÛ›· ÙˆÓ ·ÔÌÔÓˆı¤-ÓÙˆÓ ÛÙÂÏÂ¯ÒÓ ÛÂ ÎÔÈÓ¿ ·ÓÙÈÌÈÎÚÔ‚È·Î¿ ÚÔÛ‰ÈÔÚ›-ÛÙËÎÂ ÌÂ ÙË Ì¤ıÔ‰Ô E-test, Ë Ù·ÍÈÓfiÌËÛ‹ ÙÔ˘˜ ÛÂÔÚÔ-ÔÌ¿‰Â˜ ÚÔÛ‰ÈÔÚ›ÛÙËÎÂ ÌÂ Ì¤ıÔ‰Ô Û˘ÁÎfiÏÏË-ÛË˜, ÂÓÒ Ë ÁÂÓÂÙÈÎ‹ ÙÔ˘˜ Û˘ÁÁ¤ÓÂÈ· ÌÂ ËÏÂÎÙÚÔ-ÊfiÚËÛË ·ÏÏfiÌÂÓÔ˘ Â‰›Ô˘ (PFGE). °È· ÙË ÛÙ·ÙÈ-ÛÙÈÎ‹ ·Ó¿Ï˘ÛË ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ ÙÔ ·Î¤ÙÔSTATA. N. meningitidis ·ÔÌÔÓÒıËÎÂ ·fi ÙÔÓ Ê¿-Ú˘ÁÁ· 22 ·È‰ÈÒÓ (3,97%). ∏ ÏÂÈÔ„ËÊ›· ·Ó‹ÎÂÛÙÈ˜ ÔÚÔ-ÔÌ¿‰Â˜ C (31,8%) Î·È B (22,7%). ŸÏ· Ù·ÛÙÂÏ¤¯Ë ‚Ú¤ıËÎ·Ó Â˘·›ÛıËÙ· ÛÙËÓ ÎÂÊÙÚÈ·ÍfiÓË,ÚÈÊ·ÌÈÎ›ÓË Î·È ¯ÏˆÚ·ÌÊÂÓÈÎfiÏË, 5 ‚Ú¤ıËÎ·Ó ÌÂ-ÙÚ›ˆ˜ Â˘·›ÛıËÙ· ÛÙËÓ ÂÓÈÎÈÏ›ÓË (22,7%) Î·È 1 ·-ÚÔ˘Û›·ÛÂ Ï‹ÚË ·ÓÙÔ¯‹ ÛÙËÓ ÎÔÙÚÈÌÔÍ·˙fiÏË(4,5%). ∏ ÁÂÓÂÙÈÎ‹ ·Ó¿Ï˘ÛË 16 ÛÙÂÏÂ¯ÒÓ ÌÂ PFGE·ÔÎ¿Ï˘„Â 6 ‰È·ÊÔÚÂÙÈÎ¤˜ ÂÈÎfiÓÂ˜ ËÏÂÎÙÚÔÊfiÚË-ÛË˜. ™ÙÔ ›‰ÈÔ Û¯ÔÏÂ›Ô ·Ú·ÙËÚ‹ıËÎÂ Û˘ÁÎ¤ÓÙÚˆÛË·È‰ÈÒÓ ÌÂ ›‰È· PFGE ÂÈÎfiÓ·, ÂÓÒ ÛÙÔÓ ›‰ÈÔ ÎÏÒÓÔ‚Ú¤ıËÎ·Ó ÛÙÂÏ¤¯Ë ·fi ‰È·ÊÔÚÂÙÈÎ¤˜ ÔÚÔ-ÔÌ¿‰Â˜.™ÙËÓ ÔÏ˘·Ú·ÁÔÓÙÈÎ‹ ÛÙ·ÙÈÛÙÈÎ‹ ·Ó¿Ï˘ÛË, Ë ÌfiÓËÌÂÙ·‚ÏËÙ‹ Ô˘ ‚Ú¤ıËÎÂ Ó· Û¯ÂÙ›˙ÂÙ·È ÛËÌ·ÓÙÈÎ¿ÌÂ ÙË ÊÔÚÂ›· ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˘ ‹Ù·Ó Ë ËÏÈÎ›·

�Abstract: The aim of this study was to determinethe prevalence of carriage of N. meningitidis strainsin Greek schoolchildren and to identify associatedrisk factors. Oropharyngeal swabs were cultivatedfrom a total of 554 children aged 2 to 19 yearsattending nurseries and primary and secondaryschools in Athens. A questionnaire with questionsincluding parameters possibly associated withmeningococcal carriage was completed by thechildren’s parents. Susceptibilities of the isolates toantimicrobial agents were determined by E-test.Isolate serogrouping was performed by slideagglutination and their relatedness was tested bypulsed field gel electrophoresis (PFGE). Data wereanalyzed using the statistical package STATA.Twenty-two (3.97%) children were identified asmeningococcal carriers. The majority of isolatesbelonged to serogroups C (31.8%) and B (22.7%).All were sensitive to ceftriaxone, rifampicin and chloramphenicol, one was resistant to co-trimoxazole (4.5%) and 5 intermediately resistantto penicillin (22.7%). DNA analysis of 16 isolatesrevealed 6 distinct PFGE patterns. Clusters with an identical PFGE pattern were noted in thesame school. More than one serogroup wereincluded in the same clonal group. Onmultivariate logistic regression analysis, age >12years was the only variable to remainindependently associated with the carrier state(OR: 7.96; 95% CI: 2.24-28.33; p<0.001). Inconclusion, the N. meningitidis carriage rateamong Greek schoochildren increases with age.


188

May-June 03 03-06-03 16:55 ™ÂÏ›‰·188


189

∂ÈÛ·ÁˆÁ‹∏ ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹ ÓfiÛÔ˜ ·Ú·Ì¤ÓÂÈ ÛËÌ·ÓÙÈ-

Îfi ·›ÙÈÔ ÓÔÛËÚfiÙËÙ·˜ Î·È ıÓËÙfiÙËÙ·˜ ÛÙ· ·È‰È¿,·Ú¿ ÙÈ˜ ‚ÂÏÙÈˆÌ¤ÓÂ˜ ÌÂıfi‰Ô˘˜ ÂÚÁ·ÛÙËÚÈ·Î‹˜‰È¿ÁÓˆÛË˜ Î·È ıÂÚ·Â›·˜. ∏ Û˘Ó‹ıË˜ ËÁ‹ ‰È·-ÛÔÚ¿˜ ÙË˜ ÏÔ›ÌˆÍË˜ Â›Ó·È ÔÈ ·Û˘ÌÙˆÌ·ÙÈÎÔ› ÊÔ-ÚÂ›˜. ∏ Â›ÙˆÛË ÙË˜ ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹˜ ÊÔÚÂ›·˜ÔÈÎ›ÏÏÂÈ. ∂›Ó·È ¯·ÌËÏ‹ ÛÙ· ÌÈÎÚ¿ ·È‰È¿ (<2%),˘„ËÏfiÙÂÚË ÛÙÔ˘˜ ÂÊ‹‚Ô˘˜ Î·È ÙÔ˘˜ ÓÂ·ÚÔ‡˜ ÂÓ‹-ÏÈÎÂ˜ (5-15%) Î·È ·ÚÎÂÙ¿ ˘„ËÏ‹ ÛÂ ¿ÙÔÌ· Ô˘ ‰È·-‚ÈÔ‡Ó ÛÂ Û˘Óı‹ÎÂ˜ Û˘Á¯ÚˆÙÈÛÌÔ‡, fiˆ˜ È‰Ú‡Ì·Ù·Î·È ÛÙÚ·ÙfiÂ‰· (~50%) (1-3). ∏ ÊÔÚÂ›· N.meningitidis ‰Ú· ·ÓÔÛÔÔÈËÙÈÎ¿, ÌÂ ·ÔÙ¤ÏÂÛÌ·,‰‡Ô ÂÚ›Ô˘ Â‚‰ÔÌ¿‰Â˜ ÌÂÙ¿ ÙÔÓ ·ÔÈÎÈÛÌfi ÙÔ˘·ÙfiÌÔ˘, Ó· ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÔÓ ÔÚfi ÂÈ‰ÈÎ¿ ·ÓÙÈÛÒ-Ì·Ù· ¤Ó·ÓÙÈ ÙË˜ Û˘ÁÎÂÎÚÈÌ¤ÓË˜ ÔÚÔ-ÔÌ¿‰·˜. ø˜ÚÔ‰È·ıÂÛÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ ÊÔÚÂ›·˜ ÌËÓÈÁÁÈÙÈ‰fi-ÎÔÎÎÔ˘ ¤¯Ô˘Ó ·Ó·ÊÂÚıÂ› Ë ÚÔËÁËıÂ›Û· ÈÔÁÂÓ‹˜ÏÔ›ÌˆÍË ÙÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, ÙÔ ÂÓÂÚ-ÁËÙÈÎfi ‹ ·ıËÙÈÎfi Î¿ÓÈÛÌ·, ÙÔ ¿ÚÚÂÓ Ê‡ÏÔ Î·È ÙÔ¯·ÌËÏfi ÎÔÈÓˆÓÈÎÔ-ÔÈÎÔÓÔÌÈÎfi Â›Â‰Ô (2,4,5). ™‡Ì-ÊˆÓ· ÌÂ ÂÈ‰ËÌÈÔÏÔÁÈÎ¤˜ ÌÂÏ¤ÙÂ˜, fiÙ·Ó ÙÔ ÔÛÔ-ÛÙfi ÊÔÚÂ›·˜ ·fi Û˘ÁÎÂÎÚÈÌ¤ÓË ÔÚÔ-ÔÌ¿‰· ˘ÂÚ-‚Â› ÙÔ 20% ÛÂ Ì›· ÎÔÈÓfiÙËÙ·, ˘¿Ú¯ÂÈ Ô Î›Ó‰˘ÓÔ˜ÂÈ‰ËÌ›·˜, Û˘Ó‹ıˆ˜ ·fi ÙËÓ ›‰È· ÔÚÔ-ÔÌ¿‰·.ŒÌÊ·ÛË, fiÌˆ˜, ı· Ú¤ÂÈ Ó· ‰ÔıÂ› ÛÙÔ ÁÂÁÔÓfi˜fiÙÈ ÔÏÏ¤˜ ÂÈ‰ËÌ›Â˜ ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹˜ ÓfiÛÔ˘Î·Ù·ÁÚ¿ÊÔÓÙ·È fi¯È ÛÂ ÂÚÈfi‰Ô˘˜ ˘„ËÏ‹˜ ÊÔÚÂ›·˜ÙÔ˘ ÏËı˘ÛÌÔ‡, ·ÏÏ¿ fiÙ·Ó ˘¿Ú¯ÂÈ Ù·¯Â›· ·‡ÍËÛËÙÔ˘ Ú˘ıÌÔ‡ ÙË˜ ÛÂ ¿ÙÔÌ· Ô˘ ‰ÂÓ ‹Ù·Ó ÚÔËÁÔ˘-Ì¤Óˆ˜ ·ÔÈÎÈÛÌ¤Ó· Î·È, Î·Ù¿ Û˘Ó¤ÂÈ·, ‰ÂÓ Â›¯·Ó·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ ÙË˜ ˘Â‡ı˘ÓË˜ ÁÈ· ÙËÓ ÂÈ‰ËÌ›·ÔÚÔ-ÔÌ¿‰·˜ (6).

™ÙËÓ ∂ÏÏ¿‰·, Ë N. meningitidis Â›Ó·È Ë Î‡ÚÈ· ·È-Ù›· ÙË˜ ÌÈÎÚÔ‚È·Î‹˜ ÌËÓÈÁÁ›ÙÈ‰·˜ ÛÙ· ·È‰È¿, ÌÂ˘ÔÏÔÁÈ˙fiÌÂÓË Ì¤ÛË ÂÙ‹ÛÈ· Â›ÙˆÛË 7,5 ÂÚÈÙÒ-ÛÂÈ˜ ·Ó¿ 100.000 ·È‰È¿ ËÏÈÎ›·˜ <14 ÂÙÒÓ, ÛÙËÓ Â-

ÚÈÔ¯‹ ÙË˜ ∞ı‹Ó·˜ (7). ∏ ÏÂÈÔ„ËÊ›· ÙˆÓ ÎÚÔ˘ÛÌ¿-ÙˆÓ ·ÊÔÚ¿ ÛÂ ·È‰È¿ ËÏÈÎ›·˜ 2-5 ÂÙÒÓ, ÂÓÒ Ì›· ¿Ï-ÏË ÔÌ¿‰· Ô˘ ÚÔÛ‚¿ÏÏÂÙ·È Û˘¯Ó¿ Â›Ó·È ÔÈ ¤ÊË‚ÔÈ(8). ∞fi ÙÔ 1995 ¤¯ÂÈ ÛËÌÂÈˆıÂ› Ì›· Û˘ÓÂ¯È˙fiÌÂÓË·‡ÍËÛË ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹˜ Ófi-ÛÔ˘, ÔÊÂÈÏfiÌÂÓË˜ Î˘Ú›ˆ˜ ÛÙËÓ ÔÚÔ-ÔÌ¿‰· µ, ÂÓÒÙÔ 1997 Ë ÔÚÔ-ÔÌ¿‰· Ô˘ ·ÔÌÔÓˆÓfiÙ·Ó Û˘¯ÓfiÙÂ-Ú· ‹Ù·Ó Ë C. ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, Ô ÌËÓÈÁÁÈÙÈ‰fi-ÎÔÎÎÔ˜ µ ·ÔÌÔÓÒÓÂÙ·È ÛÙÔ 58% ÙˆÓ ÂÚÈÙÒÛÂˆÓÛÙËÓ ·ÙÚ›‰· Ì·˜. ∏ ·‡ÍËÛË ·˘Ù‹ ÙË˜ Â›ÙˆÛË˜ÔÊÂ›ÏÂÙ·È ÂÓ Ì¤ÚÂÈ ÛÙË ‚ÂÏÙ›ˆÛË ÙË˜ Î·Ù·ÁÚ·Ê‹˜ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ ·fi ÙÔ ∂ıÓÈÎfi ∫¤ÓÙÚÔ ∞Ó·ÊÔÚ¿˜ªËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˘, ·ÏÏ¿ Î·È ÛÙËÓ Â›ÛÔ‰Ô Ó¤ˆÓÛÙÂÏÂ¯ÒÓ ÛÙË ¯ÒÚ· Ì·˜, ·Ú¯ÈÎ¿ ÌÂ Ê·ÈÓfiÙ˘ÔC:2a:P1.2.P1.5 (ÎÏÒÓÔ˜ ET-37) Î·È ÚfiÛÊ·Ù· ÌÂÊ·ÈÓfiÙ˘Ô B:2a:P1.2 (ÎÏÒÓÔ˜ ET-15) (9,10). ™ÂÚÔËÁÔ‡ÌÂÓÂ˜ ÌÂÏ¤ÙÂ˜, Ô˘ ·ÊÔÚÔ‡Û·Ó ÛÂ ÛÙÚ·-ÙÈÒÙÂ˜, ·È‰È¿ Û¯ÔÏÈÎ‹˜ ËÏÈÎ›·˜ Î·È ÌÂÙ·Ó¿ÛÙÂ˜,¤¯Ô˘Ó ·Ó·ÊÂÚıÂ› ÔÛÔÛÙ¿ ÊÔÚÂ›·˜ 25%, 5,8% Î·È13%, ·ÓÙ›ÛÙÔÈ¯· (11,12). ª¤¯ÚÈ ÚfiÛÊ·Ù·, Ë ÛÙÚ·-ÙËÁÈÎ‹ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÂÚÈÂÏ¿Ì‚·ÓÂ ÂÌ‚ÔÏÈ·ÛÌfi Û˘-ÁÎÂÎÚÈÌ¤ÓˆÓ ÔÌ¿‰ˆÓ-ÛÙfi¯ˆÓ ÙÔ˘ ÏËı˘ÛÌÔ‡ ÛÙÈ˜Î·Ù¿ ÙfiÔ˘˜ ÂÈ‰ËÌ›Â˜, Î·ıÒ˜ Î·È ÂÌ‚ÔÏÈ·ÛÌfi ÙˆÓÛÙÚ·ÙÈˆÙÒÓ ÌÂ ÙÔ ‰È·ı¤ÛÈÌÔ ÛÙË ¯ÒÚ· Ì·˜ ÔÏ˘-Û·Î¯·ÚÈ‰ÈÎfi ÂÌ‚fiÏÈÔ ¤Ó·ÓÙÈ ÙÔ˘ ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˘A+C. ∂ÓÙÔ‡ÙÔÈ˜, Ë Â˘ÚÂ›· ·Ô‰Ô¯‹ ·fi ÙÔ Û‡ÓÔÏÔÙˆÓ ·È‰È¿ÙÚˆÓ, ·ÏÏ¿ Î·È ÙˆÓ ÁÔÓ¤ˆÓ, ÙÔ˘ Ó¤Ô˘Û˘˙Â˘ÁÌ¤ÓÔ˘ ÂÌ‚ÔÏ›Ô˘ ¤Ó·ÓÙÈ ÙÔ˘ ÌËÓÈÁÁÈÙÈ‰fiÎÔÎ-ÎÔ˘ C, ÙÔ ÔÔ›Ô Î˘ÎÏÔÊfiÚËÛÂ ÛÙË ¯ÒÚ· Ì·˜ ÙÔÓπ·ÓÔ˘¿ÚÈÔ ÙÔ˘ 2001, Ô‰‹ÁËÛÂ ÛÙËÓ ÔÏÔ¤Ó· ·˘Í·-ÓfiÌÂÓË ›ÂÛË ÛÙÔ ÀÔ˘ÚÁÂ›Ô ÀÁÂ›·˜ Ó· ÂÚÈÏËÊıÂ›ÙÔ ÂÌ‚fiÏÈÔ ·˘Ùfi ÛÙÔ ∂ıÓÈÎfi ¶ÚfiÁÚ·ÌÌ· ∂Ì‚ÔÏÈ·-ÛÌÒÓ, ·Ú¿ ÙÔ ˘„ËÏfi ÙÔ˘ ÎfiÛÙÔ˜.

™ÎÔfi˜ ÙË˜ ÌÂÏ¤ÙË˜ ‹Ù·Ó Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙË˜Â›ÙˆÛË˜ ÙË˜ ÊÔÚÂ›·˜ N. meningitidis ÛÂ ·È‰È¿Û¯ÔÏÈÎ‹˜ ËÏÈÎ›·˜ ÛÙËÓ ÂÚÈÔ¯‹ ÙË˜ ∞ı‹Ó·˜, Î·ıÒ˜Î·È Ë ·Ó·ÁÓÒÚÈÛË ÙˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ Ô˘

¿Óˆ ÙˆÓ 12 ÂÙÒÓ (OR: 7,96, 95% CI: 2,24-28,33,p<0,001). ™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, Ë ÊÔÚÂ›· ÌËÓÈÁÁÈÙÈ‰fi-ÎÔÎÎÔ˘ ·˘Í¿ÓÂÙ·È ÌÂ ÙËÓ ËÏÈÎ›·, ÂÓÒ ÔÈ Û˘¯ÓfiÙÂÚÂ˜ÔÚÔ-ÔÌ¿‰Â˜ ÛÙËÓ ·ÙÚ›‰· Ì·˜ Â›Ó·È ÔÈ C Î·È µ. ∆ÔÁÂÁÔÓfi˜ fiÙÈ ÛÙÔÓ ›‰ÈÔ ÎÏÒÓÔ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È Â-ÚÈÛÛfiÙÂÚÂ˜ ·fi Ì›· ÔÚÔ-ÔÌ¿‰Â˜ ˘Ô‰ËÏÒÓÂÈ fiÙÈ,Î¿Ùˆ ·fi ÙËÓ ›ÂÛË ÂÈÏÔÁ‹˜, Á›ÓÔÓÙ·È ÌÂÙ·ÙÚÔ¤˜ÛÙ· ˘Â‡ı˘Ó· ÁÈ· ÙÈ˜ ÔÚÔ-ÔÌ¿‰Â˜ ÁÔÓ›‰È·. ∆· ·-Ú·¿Óˆ Â˘Ú‹Ì·Ù· ÌÔÚÂ› Ó· ¯ÚËÛÈÌÂ‡ÛÔ˘Ó ÛÙËÏ‹„Ë ·ÔÊ¿ÛÂˆÓ ÁÈ· ÙËÓ ÂÊ·ÚÌÔÁ‹ Ì·˙ÈÎÒÓ ÚÔ-ÁÚ·ÌÌ¿ÙˆÓ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÌÂ ÙÔ Û˘Ó‰Â‰ÂÌ¤ÓÔ ÂÌ‚fi-ÏÈÔ ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˘ ÛÙË ¯ÒÚ· Ì·˜.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ÊÔÚÂ›· ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˘, ·È‰È¿,·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘.

The predominant serogroups in our geographicregion are C and B. The inclusion of more than oneserogroup within the same clonal group suggestsswitching of capsular genes. These findings haveimplications for future immunization with conjugatevaccines.

Key words: meningococcal carriage, school-children, risk factors.

May-June 03 03-06-03 16:55 ™ÂÏ›‰·189


190

Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÙË ÊÔÚÂ›·. ∂›ÛË˜, ÂÚÈÁÚ¿ÊÔÓÙ·ÈÙ· ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙˆÓ ·ÔÌÔÓˆı¤ÓÙˆÓ ÛÙÂÏÂ¯ÒÓÎ·È Û˘˙ËÙÂ›Ù·È Ë Èı·Ó‹ ¯ÚËÛÈÌfiÙËÙ· ÙˆÓ Â˘ÚËÌ¿-ÙˆÓ Ì·˜ ÛÙË Ï‹„Ë ·ÔÊ¿ÛÂˆÓ ÁÈ· ÙËÓ ÂÊ·ÚÌÔÁ‹Ì·˙ÈÎÒÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÌÂ ÙÔ Û˘Ó‰Â-‰ÂÌ¤ÓÔ ÂÌ‚fiÏÈÔ ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˘ ÛÙË ¯ÒÚ· Ì·˜.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ™ÙË ÌÂÏ¤ÙË ÂÚÈÂÏ‹ÊıËÛ·Ó Û˘ÓÔÏÈÎ¿ 580 ·È‰È¿ ËÏÈÎ›·˜

2-19 ÂÙÒÓ, Ù· ÔÔ›· ‹Ù·Ó Ì·ıËÙ¤˜ ·È‰ÈÎÒÓ ÛÙ·ıÌÒÓ, ‰ËÌÔ-ÙÈÎÒÓ Î·È Á˘ÌÓ·Û›ˆÓ ÙË˜ ÂÚÈÔ¯‹˜ ÙÔ˘ Î¤ÓÙÚÔ˘ ÙË˜ ∞ı‹Ó·˜.™ÙÔ˘˜ ÁÔÓÂ›˜ ÙˆÓ Ì·ıËÙÒÓ ·ÔÛÙ¿ÏıËÎÂ ÂÓËÌÂÚˆÙÈÎfi ÛË-ÌÂ›ˆÌ·, ÂÓÒ Ù·˘Ùfi¯ÚÔÓ· ˙ËÙ‹ıËÎÂ ·fi ·˘ÙÔ‡˜ Ó· Û˘ÌÏË-ÚÒÛÔ˘Ó ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ, ÙÔ ÔÔ›Ô ÂÚÈÂÏ¿Ì‚·ÓÂ ÂÚˆÙ‹ÛÂÈ˜Ô˘ ·ÊÔÚÔ‡Û·Ó ÛÂ ‰ËÌÔÁÚ·ÊÈÎ¿ ÛÙÔÈ¯Â›· ÙˆÓ ·È‰ÈÒÓ,fiˆ˜ ËÏÈÎ›·, Ê‡ÏÔ, ÂıÓÈÎfiÙËÙ·, Î·ıÒ˜ Î·È ÏËÚÔÊÔÚ›Â˜ Û¯Â-ÙÈÎ¿ ÌÂ ÚÔËÁËıÂ›Û· ÈÔÁÂÓ‹ ÏÔ›ÌˆÍË ÙÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡ Î·È¯ÔÚ‹ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ ÙÔÓ ÚÔËÁÔ‡ÌÂÓÔ Ì‹Ó·, Î¿ÓÈÛÌ·Î·È ÌÔÚÊˆÙÈÎfi Â›Â‰Ô ÙˆÓ ÁÔÓ¤ˆÓ, ‰Â›ÎÙË ‰È·‚›ˆÛË˜ (·ÚÈı-Ìfi˜ ·ÙfiÌˆÓ ÛÙÔ Û›ÙÈ, ·ÚÈıÌfi˜ ‰ˆÌ·Ù›ˆÓ ÛÈÙÈÔ‡), ÌËÙÚÈÎfiıËÏ·ÛÌfi Î·È ÂÌ‚ÔÏÈ·ÛÌfi ÌÂ ÔÏ˘Û·Î¯·ÚÈ‰ÈÎfi ‹ Û˘Ó‰Â‰ÂÌ¤-ÓÔ ·ÓÙÈÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎfi ÂÌ‚fiÏÈÔ. ∂Ï‹ÊıËÛ·Ó Î·ÏÏÈ¤ÚÁÂÈÂ˜Ê·Ú˘ÁÁÈÎÔ‡ ÂÈ¯Ú›ÛÌ·ÙÔ˜ ·fi ÙÔ˘˜ Ì·ıËÙ¤˜ ÛÙÈ˜ Ù¿ÍÂÈ˜ÙÔ˘˜, ·fi ÙÔÓ ›‰ÈÔ È·ÙÚfi, ÛÙÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ·fi ÙÔÓ ¡Ô-¤Ì‚ÚÈÔ 2000 ¤ˆ˜ ÙÔÓ ºÂ‚ÚÔ˘¿ÚÈÔ 2001.

∞ÔÌfiÓˆÛË ÌÈÎÚÔ‚›Ô˘: ∆· ‰Â›ÁÌ·Ù· Ê·Ú˘ÁÁÈÎÔ‡ ÂÈ¯Ú›-ÛÌ·ÙÔ˜, Ù· ÔÔ›· Ï·Ì‚¿ÓÔÓÙ·Ó ÌÂ ‚·Ì‚·ÎÔÊfiÚÔ ÛÙÂÈÏÂfi,Î·ÏÏÈÂÚÁÔ‡ÓÙ·Ó ÛÂ ÛÔÎÔÏ·ÙÔ‡¯Ô ¿Á·Ú ÂÌÏÔ˘ÙÈÛÌ¤ÓÔ ÌÂ‚·ÓÎÔÌ˘Î›ÓË, ÎÔÏÈÌ˘Î›ÓË Î·È ÓÂÔÌ˘Î›ÓË (VCN). ∆· ÙÚ˘‚Ï›·Âˆ¿˙ÔÓÙ·Ó ÛÙÔ˘˜ 35ÔC ÛÂ 5% CO2 ÁÈ· 2 ËÌ¤ÚÂ˜ Î·È Ë Ù·˘-ÙÔÔ›ËÛË ÙÔ˘ ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˘ ÁÈÓfiÙ·Ó ÌÂ ÙÈ˜ Û˘Ó‹ıÂÈ˜ ÌÈ-ÎÚÔ‚ÈÔÏÔÁÈÎ¤˜ ÙÂ¯ÓÈÎ¤˜. O ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙË˜ Â˘·ÈÛıËÛ›·˜(MIC) ÙÔ˘ ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˘ ÛÙËÓ ÂÓÈÎÈÏ›ÓË, ¯ÏˆÚ·ÌÊÂÓÈÎfi-ÏË, ÚÈÊ·ÌÈÎ›ÓË, ÎÂÊÙÚÈ·ÍfiÓË Î·È ÙÚÈÌÂıÔÚ›ÌË/ ÛÔ˘ÏÊ·ÌÂ-ıÔÍ·˙fiÏË ÁÈÓfiÙ·Ó ÌÂ ÙË Ì¤ıÔ‰Ô ∂-test ÛÂ Mueller-Hinton¿Á·Ú ÌÂ 5% HB. ∆· ÛÙÂÏ¤¯Ë ¯·Ú·ÎÙËÚ›˙ÔÓÙ·Ó ·ÓıÂÎÙÈÎ¿, ÌÂ-ÙÚ›ˆ˜ Â˘·›ÛıËÙ· Î·È Â˘·›ÛıËÙ· ÛÙËÓ ÂÓÈÎÈÏ›ÓË, Â¿Ó Ë MIC‹Ù·Ó ≥1 Ìg/ml, 0,125-0,5 Ìg/ml Î·È <0,125 Ìg/ml, ·ÓÙ›ÛÙÔÈ-¯·. ∞ÓıÂÎÙÈÎ¿ ÛÙËÓ ÎÔÙÚÈÌÔÍ·˙fiÏË, ¯ÏˆÚ·ÌÊÂÓÈÎfiÏË Î·È ÚÈ-Ê·ÌÈÎ›ÓË ÔÚ›ÛÙËÎ·Ó Ù· ÛÙÂÏ¤¯Ë ÌÂ MIC ≥2 Ìg/ml, ≥2 Ìg/mlÎ·È ≥4 Ìg/ml, ·ÓÙ›ÛÙÔÈ¯· (13).

¶ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÔÚÔ-ÔÌ¿‰·˜: ∏ Î·Ù¿Ù·ÍË ÙˆÓ ÛÙÂÏÂ¯ÒÓÛÂ ÔÚÔ-ÔÌ¿‰Â˜ A, B, C, D, Y Î·È W135 ÁÈÓfiÙ·Ó ÌÂ ÌÔÓÔ- ‹ Ô-Ï˘ÎÏˆÓÈÎÔ‡˜ ÔÚÔ‡˜ ÌÂ ÙË Ì¤ıÔ‰Ô ÙË˜ Û˘ÁÎfiÏÏËÛË˜, Û‡Ì-ÊˆÓ· ÌÂ ÙÈ˜ Ô‰ËÁ›Â˜ ÙÔ˘ Î·Ù·ÛÎÂ˘·ÛÙ‹ (Biotec LaboratoriesLtd, Suffolk, United Kingdom). ™ÙÈ˜ ·ÔÈÎ›Â˜ ÙÔ˘ ÌËÓÈÁÁÈÙÈ‰fi-ÎÔÎÎÔ˘ ÁÈÓfiÙ·Ó ·Ó·Î·ÏÏÈ¤ÚÁÂÈ· Î·È ÌÂÙ¿ Ù· ÛÙÂÏ¤¯Ë Ê˘Ï¿Û-ÛÔÓÙ·Ó ÛÙÔ˘˜ -70ÔC Ì¤¯ÚÈ Ó· Á›ÓÂÈ Ë ÁÂÓÂÙÈÎ‹ ·Ó¿Ï˘ÛË.

∏ÏÂÎÙÚÔÊfiÚËÛË ·ÏÏfiÌÂÓÔ˘ Â‰›Ô˘: ∏ ÁÂÓÂÙÈÎ‹ Û˘ÁÁ¤-ÓÂÈ· ÙˆÓ ÛÙÂÏÂ¯ÒÓ ÂÍÂÙ¿ÛÙËÎÂ ÌÂ ËÏÂÎÙÚÔÊfiÚËÛË ÛÂ ·Ï-ÏfiÌÂÓÔ Â‰›Ô ÙÔ˘ ÁÂÓÂÙÈÎÔ‡ ˘ÏÈÎÔ‡ ÌÂÙ¿ ·fi Î·Ù¿ÙÌËÛË ÌÂÙÈ˜ ÂÚÈÔÚÈÛÙÈÎ¤˜ ÂÓ‰ÔÓÔ˘ÎÏÂ¿ÛÂ˜ NotI Î·È SfiI, fiˆ˜ ¤¯ÂÈ Â-ÚÈÁÚ·ÊÂ› ÚÔËÁÔ‡ÌÂÓ· (14).

™Ù·ÙÈÛÙÈÎ‹ ·Ó¿Ï˘ÛË: ∏ ÂÂÍÂÚÁ·Û›· ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ ÙÔ˘

ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘ ¤ÁÈÓÂ ÌÂ ÙÔ ÛÙ·ÙÈÛÙÈÎfi ·Î¤ÙÔ STATA. ∏Û˘Û¯¤ÙÈÛË Î·ıÂÓfi˜ ·fi ÙÔ˘˜ ·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ ÍÂ¯ˆÚÈ-ÛÙ¿ ÛÂ Û¯¤ÛË ÌÂ ÙË ÊÔÚÂ›· ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˘ ¤ÁÈÓÂ ÌÂ ÙÔ ¯2.O Û¯ÂÙÈÎfi˜ Î›Ó‰˘ÓÔ˜ Ó· Â›Ó·È Î·ÓÂ›˜ ÊÔÚ¤·˜ ÌËÓÈÁÁÈÙÈ‰fiÎÔÎ-ÎÔ˘ ÁÈ· Î·ı¤Ó· ·fi ÙÔ˘˜ ·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ ÍÂ¯ˆÚÈÛÙ¿,˘ÔÏÔÁ›ÛÙËÎÂ ÌÂ ÌÔÓÔ·Ú·ÁÔÓÙÈÎ‹ ·Ó¿Ï˘ÛË ÏÔÁÈÛÙÈÎ‹˜ ·-ÏÈÓ‰ÚfiÌËÛË˜. OÈ ÌÂÙ·‚ÏËÙ¤˜ ÂÎÂ›ÓÂ˜ Ô˘ ÛÙË ÌÔÓÔ·Ú·ÁÔ-ÓÙÈÎ‹ ·Ó¿Ï˘ÛË ‚Ú¤ıËÎÂ Ó· Â›Ó·È ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ¤˜ ÛÂÂ›Â‰Ô ÛËÌ·ÓÙÈÎfiÙËÙ·˜ 10%, ·Ó·Ï‡ıËÎ·Ó ÂÚ·ÈÙ¤Úˆ ÌÂÔÏ˘·Ú·ÁÔÓÙÈÎ‹ ·Ó¿Ï˘ÛË ÏÔÁÈÛÙÈÎ‹˜ ·ÏÈÓ‰ÚfiÌËÛË˜.

∞ÔÙÂÏ¤ÛÌ·Ù·º·Ú˘ÁÁÈÎfi Â›¯ÚÈÛÌ· ÂÏ‹ÊıË ·fi 554 Ì·ıËÙ¤˜

(ÛÂ Û‡ÓÔÏÔ 580 ·È‰ÈÒÓ) ËÏÈÎ›·˜ 2-19 ÂÙÒÓ (Ì¤ÛËËÏÈÎ›·: 10 ¤ÙË, SD: ±4 ¤ÙË), ÔÈ ÔÔ›ÔÈ Â¤ÛÙÚÂ„·ÓÛ˘ÌÏËÚˆÌ¤ÓÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ (ÔÛÔÛÙfi Û˘ÌÌÂ-ÙÔ¯‹˜: 95,5%). ¶ÔÛÔÛÙfi 3,97% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓÌ·ıËÙÒÓ (22/554) ‚Ú¤ıËÎÂ Ó· Â›Ó·È ÊÔÚ¤·˜ ÌËÓÈÁ-ÁÈÙÈ‰fiÎÔÎÎÔ˘. ∞fi Ù· 349 ·È‰È¿ ËÏÈÎ›·˜ <12 ÂÙÒÓ,ÌfiÓÔ 3 ‚Ú¤ıËÎ·Ó Ó· Â›Ó·È ÊÔÚÂ›˜ ÌËÓÈÁÁÈÙÈ‰fiÎÔÎ-ÎÔ˘ (0,86%). ªÂÙ¿ ÙËÓ ËÏÈÎ›· ÙˆÓ 12 ÂÙÒÓ, ÙÔ Ô-ÛÔÛÙfi ÙË˜ ÊÔÚÂ›·˜ ·˘Í‹ıËÎÂ ÛËÌ·ÓÙÈÎ¿ ÛÂ 9,27%(19/205, p<0,0001). ∆· ÔÛÔÛÙ¿ ÊÔÚÂ›·˜ ·Ó¿ÌÂÛ·ÛÙ· ‰‡Ô Ê‡Ï· ‰ÂÓ ‰È¤ÊÂÚ·Ó ÛËÌ·ÓÙÈÎ¿ (13/272·ÁfiÚÈ· Î·È 9/282 ÎÔÚ›ÙÛÈ· ÊÔÚÂ›˜) (¶›Ó·Î·˜ 1).

∏ ÚÔËÁËıÂ›Û· ÈÔÁÂÓ‹˜ ÏÔ›ÌˆÍË ÙÔ˘ ·Ó·ÓÂ˘-ÛÙÈÎÔ‡ Î·È Ë ÚfiÛÊ·ÙË Ï‹„Ë ·ÓÙÈ‚ÈÔÙÈÎÒÓ ‚Ú¤ıË-Î·Ó Ó· Û¯ÂÙ›˙ÔÓÙ·È ·ÓÙ›ÛÙÚÔÊ· ÌÂ ÙË ÊÔÚÂ›· ÌËÓÈÁ-ÁÈÙÈ‰fiÎÔÎÎÔ˘ (p=0,004 Î·È p=0,06, ·ÓÙ›ÛÙÔÈ¯·). ∆··È‰È¿ ÌÂ ·˘ÍËÌ¤ÓÔ ‰Â›ÎÙË ‰È·‚›ˆÛË˜ Â›¯·Ó ÌÂÁ·-Ï‡ÙÂÚË Èı·ÓfiÙËÙ· Ó· Â›Ó·È ÊÔÚÂ›˜ (p=0,064). ∏ÊÔÚÂ›· N. meningitidis ‰ÂÓ ‚Ú¤ıËÎÂ Ó· Û¯ÂÙ›˙ÂÙ·ÈÌÂ ÙÔ ·ıËÙÈÎfi Î¿ÓÈÛÌ·, ÙËÓ ÂıÓÈÎfiÙËÙ·, ÙÔ ıËÏ·-ÛÌfi ‹ ÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi ÌÂ ÔÏ˘Û·Î¯·ÚÈ‰ÈÎfi A+C ‹ÌÂ Û˘Ó‰Â‰ÂÌ¤ÓÔ C ÂÌ‚fiÏÈÔ ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˘. ∆ÔÔÛÔÛÙfi ÊÔÚÂ›·˜ ‚Ú¤ıËÎÂ ¯·ÌËÏfiÙÂÚÔ ÛÂ ·È‰È¿ÙˆÓ ÔÔ›ˆÓ ÔÈ ÁÔÓÂ›˜ Â›¯·Ó ·ÓÂÈÛÙËÌÈ·Î‹ ÌfiÚ-ÊˆÛË, Û˘ÁÎÚÈÙÈÎ¿ ÌÂ Ù· ·È‰È¿ ÂÎÂ›ÓˆÓ Ô˘ ‰ÂÓ Â›-¯·Ó (p=0,049). O Û¯ÂÙÈÎfi˜ Î›Ó‰˘ÓÔ˜ (OR), Î·ıÂÓfi˜·fi ÙÔ˘˜ ·Ú¿ÁÔÓÙÂ˜ ÍÂ¯ˆÚÈÛÙ¿, ÙË˜ Èı·ÓfiÙËÙ·˜

¶›Ó·Î·˜ 1. ºÔÚÂ›· ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˘ ÛÂ ·È‰È¿ Û¯ÔÏÈÎ‹˜ËÏÈÎ›·˜ ·Ó¿ÏÔÁ· ÌÂ ÙËÓ ËÏÈÎ›·, ÙÔ Ê‡ÏÔ Î·È ÙËÓ ÂıÓÈÎfiÙËÙ·

ªÂÙ·‚ÏËÙ‹ ºÔÚÂ›· (¡·È/fi¯È) % p

∏ÏÈÎ›·≤12¤ÙË 3/346 0,89>12¤ÙË 19/186 9,2 <0,0001

º‡ÏÔ∞ÁfiÚÈ· 13/259 4,7∫ÔÚ›ÙÛÈ· 9/273 3,1 0,339

∂ıÓÈÎfiÙËÙ·ŒÏÏËÓ·˜ 20/491 3,9∞ÏÏÔ‰·fi˜ 2/41 4,6 0,812

™‡ÓÔÏÔ 22/532 3,97

May-June 03 03-06-03 16:55 ™ÂÏ›‰·190


191

Ó· Â›Ó·È ¤Ó· ·È‰› ÊÔÚ¤·˜ Ê·›ÓÂÙ·È ÛÙÔÓ ¶›Ó·Î· 2. ™ÙËÓ ÔÏ˘·Ú·ÁÔÓÙÈÎ‹ ·Ó¿Ï˘ÛË, ÌfiÓÔ Ë ËÏÈÎ›·

·Ú¤ÌÂÈÓÂ ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÎÈÓ-‰‡ÓÔ˘. ŒÙÛÈ, Ë ËÏÈÎ›· ¿Óˆ ÙˆÓ 12 ÂÙÒÓ ‚Ú¤ıËÎÂ Ó··˘Í¿ÓÂÈ, ÙÔ˘Ï¿¯ÈÛÙÔÓ Î·Ù¿ 8 ÊÔÚ¤˜, ÙËÓ Èı·ÓfiÙËÙ·Ó· Â›Ó·È ¤Ó· ·È‰› ÊÔÚ¤·˜ ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˘, Û˘-ÁÎÚÈÙÈÎ¿ ÌÂ ¤Ó· ·È‰› ËÏÈÎ›·˜ <12 ÂÙÒÓ (¶›Ó·Î·˜ 3).

ŸÏ· Ù· ÛÙÂÏ¤¯Ë ‚Ú¤ıËÎ·Ó Â˘·›ÛıËÙ· ÛÙËÓ ÎÂ-ÊÙÚÈ·ÍfiÓË, ÙË ÚÈÊ·ÌÈÎ›ÓË Î·È ÙË ¯ÏˆÚ·ÌÊÂÓÈÎfiÏË.ªfiÓÔ 1 ÛÙ¤ÏÂ¯Ô˜ ‚Ú¤ıËÎÂ ·ÓıÂÎÙÈÎfi ÛÙËÓ ÎÔÙÚÈÌÔ-Í·˙fiÏË (4,5%) Î·È 5 Ì¤ÙÚÈ· Â˘·›ÛıËÙ· ÛÙËÓ ÂÓÈÎÈ-Ï›ÓË (22,7%). ∞fi Ù· ·ÔÌÔÓˆı¤ÓÙ· ÛÙÂÏ¤¯Ë, 1·Ó‹ÎÂ ÛÙËÓ ÔÚÔ-ÔÌ¿‰· ∞ (4,5%), 5 ÛÙËÓ ÔÚÔ-ÔÌ¿-‰· µ (22,7%), 7 ÛÙËÓ ÔÚÔ-ÔÌ¿‰· C (31,8%), 1 ÛÙËÓÔÚÔ-ÔÌ¿‰· D (4,5%) Î·È 3 ÛÙËÓ ÔÚÔ-ÔÌ¿‰· W135(13,7%). ¶¤ÓÙÂ ÛÙÂÏ¤¯Ë (22,7%) ‹Ù·Ó ÌË Ù˘ÔÔÈ‹-ÛÈÌ·. ∏ ÁÂÓÂÙÈÎ‹ ·Ó¿Ï˘ÛË 16 ÛÙÂÏÂ¯ÒÓ ÌÂ ËÏÂ-ÎÙÚÔÊfiÚËÛË ·ÏÏfiÌÂÓÔ˘ Â‰›Ô˘ ·ÔÎ¿Ï˘„Â 6‰È·ÊÔÚÂÙÈÎ¤˜ ÂÈÎfiÓÂ˜ ËÏÂÎÙÚÔÊfiÚËÛË˜. OÎÙÒ ·fiÙ· ÛÙÂÏ¤¯Ë Â›¯·Ó fiÌÔÈ· ÂÈÎfiÓ· Î·È Î·Ù·Ù¿¯ÙËÎ·ÓÛÙËÓ ÔÌ¿‰· a, 2 ÛÙÂÏ¤¯Ë ÛÙËÓ ÔÌ¿‰· b, 2 ÛÙÂÏ¤¯ËÛÙËÓ ÔÌ¿‰· c Î·È 2 ÛÙÂÏ¤¯Ë ÛÙËÓ ÔÌ¿‰· d. ∆· ˘fi-ÏÔÈ· 2 ÛÙÂÏ¤¯Ë Â›¯·Ó ÙÔ Î·ı¤Ó· ‰È·ÊÔÚÂÙÈÎ¤˜ËÏÂÎÙÚÔÊÔÚËÙÈÎ¤˜ ÂÈÎfiÓÂ˜ Ô˘ ‰ÂÓ ¤ÌÔÈ·˙·Ó Ô‡ÙÂÌÂÙ·Í‡ ÙÔ˘˜, Ô‡ÙÂ ÌÂ Î·Ì›· ·fi ÙÈ˜ ÚÔËÁÔ‡ÌÂÓÂ˜.∆¤ÛÛÂÚ· ·fi Ù· ÛÙÂÏ¤¯Ë ‰ÂÓ ‹Ù·Ó ˙ˆÓÙ·Ó¿ ÙËÛÙÈÁÌ‹ ÙË˜ ÁÂÓÂÙÈÎ‹˜ ·Ó¿Ï˘ÛË˜ Î·È 2 ‰ÂÓ ¤‰ˆÛ·ÓÎ·Ì›· ËÏÂÎÙÚÔÊÔÚËÙÈÎ‹ ÂÈÎfiÓ· (¶›Ó·Î·˜ 4). ∆·ÛÙÂÏ¤¯Ë ÙˆÓ ÊÔÚ¤ˆÓ Û˘ÁÎÚ›ıËÎ·Ó ÌÂ 4 ÛÙÂÏ¤¯ËÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˘ (2 ·Ó‹Î·Ó ÛÙË ÔÚÔ-ÔÌ¿‰· µ Î·È2 ÛÙËÓ ÔÚÔ-ÔÌ¿‰· C), Ù˘¯·›· ÂÈÏÂÁÌ¤Ó·, Ô˘ ·Ô-ÌÔÓÒıËÎ·Ó ·fi ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚfi ·È‰ÈÒÓ ÌÂÌËÓÈÁÁ›ÙÈ‰·, Ù· ÔÔ›· ÓÔÛËÏÂ‡ıËÎ·Ó ÛÙÔ Û˘ÁÎÂÎÚÈ-Ì¤ÓÔ ÓÔÛÔÎÔÌÂ›Ô Î·Ù¿ ÙËÓ ›‰È· ¯ÚÔÓÈÎ‹ ÂÚ›Ô‰Ô.£· Ú¤ÂÈ Ó· ÛËÌÂÈˆıÂ› fiÙÈ Ù· ÛÙÂÏ¤¯Ë ÙˆÓ ·ÛıÂ-ÓÒÓ Ô˘ ·Ó‹Î·Ó ÛÙÈ˜ ÔÚÔ-ÔÌ¿‰Â˜ B Î·È C, Â›¯·Ó Ù·›‰È· ‰·ÎÙ˘ÏÈÎ¿ ·ÔÙ˘ÒÌ·Ù· ÌÂ Ù· ÛÙÂÏ¤¯Ë ÙˆÓ

ÊÔÚ¤ˆÓ Ô˘ ·Ó‹Î·Ó ÛÙÈ˜ ÔÌ¿‰Â˜ ËÏÂÎÙÚÔÊfiÚËÛË˜a Î·È b, ·ÓÙ›ÛÙÔÈ¯· (∂ÈÎfiÓ· 1).

™˘˙‹ÙËÛË∆· ·ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ ·Ú¤-

¯Ô˘Ó ÏËÚÔÊÔÚ›Â˜ ÁÈ· ÙË ÊÔÚÂ›· ÌËÓÈÁÁÈÙÈ‰fiÎÔÎ-ÎÔ˘ ÛÂ ·È‰È¿ Û¯ÔÏÈÎ‹˜ ËÏÈÎ›·˜, Î·ıÒ˜ Î·È ÁÈ· Ù·ÁÔÓÔÙ˘ÈÎ¿ Î·È Ê·ÈÓÔÙ˘ÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙˆÓÛÙÂÏÂ¯ÒÓ Neisseria meningitidis ÛÙË Û˘ÁÎÂÎÚÈÌ¤ÓËÂÚÈÔ¯‹. O ÌÈÎÚfi˜ ·ÚÈıÌfi˜ ÙˆÓ ÊÔÚ¤ˆÓ ÌËÓÈÁÁÈÙÈ-‰fiÎÔÎÎÔ˘ Î·È ÙÔ Û¯ÂÙÈÎ¿ ÌÈÎÚfi Ì¤ÁÂıÔ˜ ÙÔ˘ ÏË-ı˘ÛÌÔ‡ Ô˘ ÌÂÏÂÙ‹ıËÎÂ, ÂÚÈÔÚ›˙Ô˘Ó ÙË ¯ÚËÛÈÌfi-ÙËÙ· ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ÛÙË ¯¿Ú·ÍË ÛÙÚ·ÙËÁÈÎ‹˜ ∂ıÓÈÎÔ‡ ¶ÚÔÁÚ¿ÌÌ·ÙÔ˜∂Ì‚ÔÏÈ·ÛÌÔ‡. ¶·Ú’ fiÏ· ·˘Ù¿, ·Ó Û˘Ó‰˘·ÛÙÔ‡Ó ÌÂÂ˘Ú‹Ì·Ù· ·fi ¿ÏÏÂ˜ ÂÚÈÔ¯¤˜ ÙË˜ ¯ÒÚ·˜, ÌÔÚÂ›Ó· Â›Ó·È ¯Ú‹ÛÈÌ· ÛÙË Ï‹„Ë ·fiÊ·ÛË˜ Û¯ÂÙÈÎ¿ ÌÂÙÔ Ì·˙ÈÎfi ÂÌ‚ÔÏÈ·ÛÌfi ÔÚÈÛÌ¤ÓˆÓ Â˘·ıÒÓ ÔÌ¿‰ˆÓÏËı˘ÛÌÔ‡ ÌÂ ÙÔ Û˘Ó‰˘·ÛÌ¤ÓÔ ÂÌ‚fiÏÈÔ ÌËÓÈÁÁÈÙÈ-‰fiÎÔÎÎÔ˘, ÙÔ ÔÔ›Ô Î˘ÎÏÔÊÔÚÂ› ÛÙËÓ ∂ÏÏ¿‰· Â‰ÒÎ·È ¤Ó· ¯ÚfiÓÔ.

O ˘ÔÏÔÁÈÛÌfi˜ ÙÔ˘ ÔÛÔÛÙÔ‡ ÙË˜ ÊÔÚÂ›·˜ ÌË-ÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˘ ÛÂ ‰È·ÊÔÚÂÙÈÎ¤˜ ÔÌ¿‰Â˜ ÏËı˘-ÛÌÔ‡ ÛÂ Ì›· ‰Â‰ÔÌ¤ÓË ¯ÚÔÓÈÎ‹ ÂÚ›Ô‰Ô Â›Ó·È ‰‡-ÛÎÔÏÔ˜, ‰ÈfiÙÈ ÌÔÚÂ› Ó· ÂËÚÂ·ÛÙÂ› ·fi ·Ú¿ÁÔ-ÓÙÂ˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÙÔ ¿ÙÔÌÔ, ÙÔ ‚·ÎÙËÚ›‰ÈÔÎ·È ÙËÓ ÙÂ¯ÓÈÎ‹ ÙË˜ ‰ÂÈÁÌ·ÙÔÏË„›·˜. ∏ ÊÔÚÂ›· ÌË-ÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˘ ÛÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi ÛÙÈ˜ ∏.¶.∞Î·È ÛÙÈ˜ ÌË ÂÓ‰ËÌÈÎ¤˜ ÂÚÈÔ¯¤˜ ·Ó·Ê¤ÚÂÙ·È ÌÂÙ·Í‡5-10% (14). ™ÙË ªÂÁ¿ÏË µÚÂÙ·Ó›·, ÙÔ ˘„ËÏfiÙÂÚÔÔÛÔÛÙfi ÊÔÚÂ›·˜ (5-15%) ‚Ú›ÛÎÂÙ·È ÛÙÔ˘˜ ÂÊ‹-‚Ô˘˜ Î·È ÓÂ·ÚÔ‡˜ ÂÓ‹ÏÈÎÂ˜, ÂÓÒ ÙÔ ˘„ËÏfiÙÂÚÔ Ô-ÛÔÛÙfi ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹˜ ÓfiÛÔ˘ ·Ú·ÙËÚÂ›Ù·ÈÙÔÓ ÚÒÙÔ ¯ÚfiÓÔ ÙË˜ ˙ˆ‹˜ (50/100.000) Î·È ÛÙËÓÂÊË‚ÈÎ‹ ËÏÈÎ›· (5/100.000) (3). ∞fi ÙÔ˘˜ 554 Ì·-ıËÙ¤˜ Ô˘ ÙÂÏÈÎ¿ ¤Ï·‚·Ó Ì¤ÚÔ˜ ÛÙË ÌÂÏ¤ÙË Ì·˜, ÙÔ3,97% ‚Ú¤ıËÎÂ Ó· Â›Ó·È ÊÔÚ¤·˜ ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˘,

¶›Ó·Î·˜ 2. ºÔÚÂ›· ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˘: ·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ ÛÂ ·È‰È¿ Û¯ÔÏÈÎ‹˜ ËÏÈÎ›·˜

ªÂÙ·‚ÏËÙ‹ ºÔÚÂ›· ™¯ÂÙÈÎfi˜ Î›Ó‰˘ÓÔ˜ p¡·È Ÿ¯È (95% fiÚÈ· ·ÍÈÔÈÛÙ›·˜)

∏ÏÈÎ›· >12 ¤ÙË 19 186 11,78 (3,44-40,32) <0,0001∞ÏÏÔ‰·fi˜ 2 41 1,20 (0,27-5,30) 0,812¶ÚÔËÁËıÂ›Û· ÏÔ›ÌˆÍË 4 263 0,23 (0,08-0,68) 0,008§‹„Ë ·ÓÙÈ‚ÈÔÙÈÎÔ‡ 1 112 0,18 (0,24-1,34) 0,094¢Â›ÎÙË˜ Û˘ÁÎ·ÙÔ›ÎËÛË˜ >1 15 248 2,45 (0,98-6,12) 0,054∫¿ÓÈÛÌ· (¤Ó·˜ ÁÔÓ¤·˜) 11 190 2,55 (0,80-8,15) 0,115∫¿ÓÈÛÌ· (Î·È ÔÈ ‰‡Ô ÁÔÓÂ›˜) 7 166 1,86 (0,53-6,45) 0,331ªfiÚÊˆÛË

¶·Ó/ÌÈÔ (¤Ó·˜ ÁÔÓ¤·˜) 4 131 0,48 (0,16-1,46) 0,196¶·Ó/ÌÈÔ (Î·È ÔÈ ‰‡Ô ÁÔÓÂ›˜) 2 150 0,21 (0,47-0,92) 0,039

£ËÏ·ÛÌfi˜≥3 Ì‹ÓÂ˜ 10 184 1,13 (0,37-3,39) 0,827<3 Ì‹ÓÂ˜ 7 244 0,60 (0,19-1,92) 0,387

∂Ì‚ÔÏÈ·ÛÌfi˜ 3 42 1,84 (0,52-6,48) 0,341

May-June 03 03-06-03 16:55 ™ÂÏ›‰·191


192

ÔÛÔÛÙfi ÂÏ·ÊÚ¿ ¯·ÌËÏfiÙÂÚÔ ·fi ÂÎÂ›ÓÔ Ô˘ Â›¯Â·Ó·ÊÂÚıÂ› ÛÂ ÚÔËÁÔ‡ÌÂÓË ÌÂÏ¤ÙË Ô˘ ·ÊÔÚÔ‡ÛÂÛÂ ·È‰È¿ Û¯ÔÏÈÎ‹˜ ËÏÈÎ›·˜ ÛÙËÓ ∂ÏÏ¿‰· (11).

¶·Ú¿ÁÔÓÙÂ˜ fiˆ˜ Ë ËÏÈÎ›·, Ô ˘„ËÏfi˜ ‰Â›ÎÙË˜Û˘ÁÎ·ÙÔ›ÎËÛË˜, ÙÔ ÌÔÚÊˆÙÈÎfi Â›Â‰Ô ÙˆÓ ÁÔÓ¤ˆÓÎ·È Ë ÚÔËÁÔ‡ÌÂÓË ¯Ú‹ÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ, ‚Ú¤ıËÎÂÓ· Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÙË ÊÔÚÂ›· ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˘ Î·ÈÛÙËÓ ∂ÏÏ¿‰·, fiˆ˜ ¤¯ÂÈ ÂÚÈÁÚ·ÊÂ› Î·È ÛÂ ÚÔË-ÁÔ‡ÌÂÓÂ˜ ÌÂÏ¤ÙÂ˜ ·fi ÙË µfiÚÂÈ· ∂˘ÚÒË (14,15).∂›Ó·È ÂÓ‰È·Ê¤ÚÔÓ fiÙÈ Ë ÚÔËÁËıÂ›Û· ÈÔÁÂÓ‹˜ ÏÔ›-ÌˆÍË ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡ ‚Ú¤ıËÎÂ Ó·Û¯ÂÙ›˙ÂÙ·È ·ÓÙ›ÛÙÚÔÊ· ÌÂ ÙË ÊÔÚÂ›·, ÂÓÒ Ë Û˘Û¯¤-ÙÈÛË ÌÂ ÙÔ ·ıËÙÈÎfi Î¿ÓÈÛÌ· ‰ÂÓ ÂÈ‚Â‚·ÈÒıËÎÂ,

fiˆ˜ ÛÂ ¿ÏÏÂ˜ ÌÂÏ¤ÙÂ˜ (11). O ÚÔËÁËıÂ›˜ ÂÌ‚Ô-ÏÈ·ÛÌfi˜ ÌÂ ÔÏ˘Û·Î¯·ÚÈ‰ÈÎfi A+C ‹ Û˘Ó‰˘·ÛÌ¤ÓÔC ÂÌ‚fiÏÈÔ ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˘ ‰ÂÓ Ê¿ÓËÎÂ Ó· ÂË-ÚÂ¿˙ÂÈ ÙË ÊÔÚÂ›·. ∞Í›˙ÂÈ, fiÌˆ˜, Ó· ÛËÌÂÈˆıÂ› fiÙÈ ÙÔÛ˘ÓÔÏÈÎfi ÔÛÔÛÙfi ÂÌ‚ÔÏÈ·ÛÌÔ‡ ‹Ù·Ó ¯·ÌËÏfi(8,1%). O ÌfiÓÔ˜ ·Ú¿ÁÔÓÙ·˜ Ô˘ ·Ú¤ÌÂÈÓÂ Ó·Û¯ÂÙ›˙ÂÙ·È ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ¿ ÌÂ ÙË ÊÔÚÂ›· Î·ÈÛÙËÓ ÔÏ˘·Ú·ÁÔÓÙÈÎ‹ ·Ó¿Ï˘ÛË, ‹Ù·Ó Ë ËÏÈÎ›· ¿ÓˆÙˆÓ 12 ÂÙÒÓ.

O ÌÈÎÚfi˜ ·ÚÈıÌfi˜ ÙˆÓ ÛÙÂÏÂ¯ÒÓ ÌËÓÈÁÁÈÙÈ‰fi-ÎÔÎÎÔ˘ Ô˘ ÂÍÂÙ¿ÛÙËÎÂ ÛÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË ‰ÂÓÂÈÙÚ¤ÂÈ ÙËÓ ÂÍ·ÁˆÁ‹ Û˘ÌÂÚ·ÛÌ¿ÙˆÓ fiÛÔÓ ·ÊÔ-Ú¿ ÛÙËÓ ·ÓÙÔ¯‹ ÛÙËÓ ÂÓÈÎÈÏ›ÓË ÛÙË Û˘ÁÎÂÎÚÈÌ¤ÓËÂÚÈÔ¯‹. ∆Ô ÔÛÔÛÙfi ÙˆÓ ÛÙÂÏÂ¯ÒÓ ÙË˜ ÌÂÏ¤ÙË˜Ô˘ ‚Ú¤ıËÎ·Ó Ó· ¤¯Ô˘Ó ÂÓ‰È¿ÌÂÛË ·ÓÙÔ¯‹ ÛÙËÓ Â-ÓÈÎÈÏ›ÓË (22,7%) ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚÔ ·fi ÂÎÂ›ÓÔ Ô˘¤¯ÂÈ ·Ó·ÊÂÚıÂ› ÛÂ ÚÔËÁÔ‡ÌÂÓÂ˜ ÌÂÏ¤ÙÂ˜ Ô˘·ÊÔÚÔ‡Û·Ó ÛÙËÓ ›‰È· ÁÂˆÁÚ·ÊÈÎ‹ ÂÚÈÔ¯‹ (∆. ∆˙·-Ó·Î¿ÎË, ∂ıÓÈÎfi ∫¤ÓÙÚÔ ∞Ó·ÊÔÚ¿˜ ªËÓÈÁÁÈÙÈ‰fiÎÔÎ-ÎÔ˘, ÚÔÛˆÈÎ‹ ÂÈÎÔÈÓˆÓ›·). ∆Ô ÌÂÁ·Ï‡ÙÂÚÔ Ô-ÛÔÛÙfi ·ÓÙÔ¯‹˜ ÛÙËÓ ÂÓÈÎÈÏ›ÓË ÙˆÓ ÛÙÂÏÂ¯ÒÓ ÌË-ÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˘ Ô˘ ·Ú·ÙËÚ‹ıËÎÂ ÛÙËÓ ·ÚÔ‡Û·ÌÂÏ¤ÙË, Èı·ÓfiÓ Ó· ·ÔÙÂÏÂ› ˘ÂÚÂÎÙ›ÌËÛË Î·È Ó·ÔÊÂ›ÏÂÙ·È ÛÙÔ fiÙÈ 3 ·fi Ù· 5 ÛÙÂÏ¤¯Ë ÌÂ ÂÓ‰È¿ÌÂÛË·ÓÙÔ¯‹ Â›¯·Ó Ù·˘ÙfiÛËÌË ËÏÂÎÙÚÔÊÔÚËÙÈÎ‹ ÂÈÎfiÓ·Î·È ·ÔÌÔÓÒıËÎ·Ó ·fi Ì·ıËÙ¤˜ ÙÔ˘ ›‰ÈÔ˘ Û¯ÔÏÂ›-Ô˘, ÁÂÁÔÓfi˜ Ô˘ Èı·ÓÔÏÔÁÂ› ‰È·ÛÔÚ¿ ÙÔ˘ ›‰ÈÔ˘·ÓıÂÎÙÈÎÔ‡ ÎÏÒÓÔ˘ ·fi ·È‰› ÛÂ ·È‰›.

∏ ÏÂÈÔ„ËÊ›· ÙˆÓ ÛÙÂÏÂ¯ÒÓ Ô˘ ·ÔÌÔÓÒıË-Î·Ó ·Ó‹ÎÂ ÛÙËÓ ÔÚÔ-ÔÌ¿‰· C (31,8%) Î·È B(22,7%). ∏ ÁÂÓÂÙÈÎ‹ ·Ó¿Ï˘ÛË ÌÂ ËÏÂÎÙÚÔÊfiÚËÛËÛÂ ·ÏÏfiÌÂÓÔ Â‰›Ô ¤‰ÂÈÍÂ ÔÈÎÈÏÔÌÔÚÊ›· ÌÂÙ·Í‡ÙˆÓ ÛÙÂÏÂ¯ÒÓ, ·Ú’ fiÏÔ Ô˘ ·Ú·ÙËÚ‹ıËÎÂ Û˘-ÁÎ¤ÓÙÚˆÛË ÛÙÂÏÂ¯ÒÓ ÌÂ Ù·˘ÙfiÛËÌË ÂÈÎfiÓ· ËÏÂ-ÎÙÚÔÊfiÚËÛË˜ ÛÂ ¤Ó· ·fi Ù· Û¯ÔÏÂ›·. ∂›Ó·È ÂÓ‰È·-Ê¤ÚÔÓ fiÙÈ ÛÙÔÓ ›‰ÈÔ ÎÏÒÓÔ ·Ú·ÙËÚ‹ıËÎ·Ó ÂÚÈÛ-ÛfiÙÂÚÂ˜ ·fi Ì›· ÔÚÔ-ÔÌ¿‰Â˜, ÁÂÁÔÓfi˜ Ô˘ Èı·-ÓfiÓ ˘Ô‰ËÏÒÓÂÈ ÌÂÙ·ÙÚÔ¤˜ ÛÙ· ˘Â‡ı˘Ó· ÁÈ· ÙÈ˜ÔÚÔ-ÔÌ¿‰Â˜ ÁÔÓ›‰È·. ∞Í›˙ÂÈ Ó· ÛËÌÂÈˆıÂ› fiÙÈ 3 ·fiÙÔ˘˜ ÊÔÚÂ›˜ ‹Ù·Ó ÂÌ‚ÔÏÈ·ÛÌ¤ÓÔÈ ÌÂ ÂÌ‚fiÏÈÔ ÌËÓÈÁ-ÁÈÙÈ‰fiÎÔÎÎÔ˘. ™Â 2 ·fi Ù· 3 ÛÙÂÏ¤¯Ë ÙˆÓ ·È‰ÈÒÓ·˘ÙÒÓ (ÛÙÂÏ¤¯Ë 9 Î·È 22) (¶›Ó·Î·˜ 4), Ë ÌÂÙ·ÙÚÔ‹ÙˆÓ ÁÔÓÈ‰›ˆÓ Â›Ó·È Èı·Ófi Ó· ¤ÁÈÓÂ Î·ÙfiÈÓ ›ÂÛË˜ÂÈÏÔÁ‹˜ ÌÂÙ¿ ÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi. ∏ ÌÂÙ·ÙÚÔ‹ ÙˆÓ

¶›Ó·Î·˜ 3. ºÔÚÂ›· ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˘ ÛÂ ·È‰È¿ Û¯ÔÏÈÎ‹˜ ËÏÈÎ›·˜: ÔÏ˘·Ú·ÁÔÓÙÈÎ‹ ·Ó¿Ï˘ÛË ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘

ªÂÙ·‚ÏËÙ‹ ¢ÈÔÚıˆÌ¤ÓÔ˜ Û¯ÂÙÈÎfi˜ Î›Ó‰˘ÓÔ˜ 95% fiÚÈ· ·ÍÈÔÈÛÙ›·˜ p

∏ÏÈÎ›· >12 ¤ÙË 7,96 2,24-28,33 0,001¶ÚÔËÁËıÂ›Û· ÈÔÁÂÓ‹˜ ÏÔ›ÌˆÍË 0,45 0,13-1,58 0,214¶ÚfiÛÊ·ÙË Ï‹„Ë ·ÓÙÈ‚ÈÔÙÈÎÔ‡ 0,46 0,049-4,38 0,500¢Â›ÎÙË˜ Û˘ÁÎ·ÙÔ›ÎËÛË˜ >1 1,29 0,48-3,46 0,614ªfiÚÊˆÛË ÁÔÓ¤ˆÓ

¶·ÓÂÈÛÙ‹ÌÈÔ (¤Ó·˜ ÁÔÓ¤·˜) 0,68 0,21-2,23 0,528¶·ÓÂÈÛÙ‹ÌÈÔ (Î·È ÔÈ ‰‡Ô ÁÔÓÂ›˜) 0,42 0,09-1,98 0,275

¶›Ó·Î·˜ 4. OÚÔ-ÔÌ¿‰Â˜ Î·È ÂÈÎfiÓÂ˜ ËÏÂÎÙÚÔÊfiÚËÛË˜ ÙˆÓ·ÔÌÔÓˆı¤ÓÙˆÓ ÛÙÂÏÂ¯ÒÓ ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˘

∞/· OÌ¿‰· ËÏÂÎÙÚÔ- OÚÔ ™¯ÔÏÂ›ÔÛÙÂÏ¤¯Ô˘˜ ÊfiÚËÛË˜ -ÔÌ¿‰· (Ù¿ÍË)

1 a NG ™2 (∆1)5 a C ™3 (∆2)

17 a C ™3 (∆3)18 a B ™3 (∆2)19 a C ™3 (∆4)11 a NG ™3 (∆3)21 a C ™3 (∆5)22 a B ™3 (∆6)

9 b D ™3 (∆7)10 b C ™3 (∆7)

6 c NG ™3 (∆8)20 c W135 ™3 (c8)

4 d W135 ™3 (∆9)8 d A ™3 (∆10)

2 DP B ™2 (∆1)3 DP W135 ™3 (∆11)

13 ND NG ™3 (∆12)14 ND C ™3 (∆9)15 ND B ™3 (∆13)16 ND B ™3 (∆4)

7 ND C ™3 (∆10)12 ND NG ™2 (∆1)

NG: ÌË ÔÌ·‰ÔÔÈÔ‡ÌÂÓÔ DP: ÍÂ¯ˆÚÈÛÙ‹ ËÏÂÎÙÚÔÊÔÚËÙÈÎ‹ ÂÈÎfiÓ· ND: ‰ÂÓ ¤ÁÈÓÂ

May-June 03 03-06-03 16:55 ™ÂÏ›‰·192


193

˘Â‡ı˘ÓˆÓ ÁÈ· ÙÈ˜ ÔÚÔ-ÔÌ¿‰Â˜ ÁÔÓÈ‰›ˆÓ ¤¯ÂÈ ÂÚÈ-ÁÚ·ÊÂ› Î·È ÛÙÔ ·ÚÂÏıfiÓ, ·Ú’ fiÏÔ Ô˘ Ë ÎÏÈÓÈÎ‹ÛËÌ·Û›· ÙÔ˘ Ê·ÈÓÔÌ¤ÓÔ˘ ·˘ÙÔ‡ ‰ÂÓ Â›Ó·È ·ÔÏ‡-Ùˆ˜ ÁÓˆÛÙ‹ (16). ∂›Ó·È ¿ÓÙˆ˜ Èı·Ófi, ÌÂ ÙËÓ ·˘-ÍËÌ¤ÓË ·ÓÔÛ›· ÙË˜ ÎÔÈÓfiÙËÙ·˜ Ô˘ ı· ÂÈÙ‡¯ÂÈ ÔÌ·˙ÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜, Ó· ‰ËÌÈÔ˘ÚÁËıÔ‡Ó ·ÚfiÌÔÈ-ÔÈ ÌË¯·ÓÈÛÌÔ› ‰È·Ê˘Á‹˜, ÌÂ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÂÈÏÔ-Á‹ ÛÙÂÏÂ¯ÒÓ Ô˘ ı· ·ÔÈÎ›ÛÔ˘Ó Î·È ÌÔÚÂ› Ó· ÚÔ-ÎÏËıÔ‡Ó ÂÈ‰ËÌ›Â˜ ·fi ÔÚfiÙ˘Ô˘˜ Ô˘ ‰ÂÓ ÂÚÈ-Ï·Ì‚¿ÓÔÓÙ·È ÛÙ· ˘¿Ú¯ÔÓÙ· ÂÌ‚fiÏÈ·.

∂ÈÏ¤ÔÓ, ·fi Ù· Â˘Ú‹Ì·Ù· ÙË˜ ·ÚÔ‡Û·˜ ÌÂ-Ï¤ÙË˜ ÚÔÎ‡ÙÂÈ fiÙÈ ÔÈ ÔÚÔ-ÔÌ¿‰Â˜ Ô˘ Û˘¯ÓfiÙÂÚ··ÔÈÎ›˙Ô˘Ó ÙÔ Ê¿Ú˘ÁÁ· Â›Ó·È ›‰ÈÂ˜ ÌÂ ÙÈ˜ ÔÚÔ-ÔÌ¿-‰Â˜ Ô˘ ÚÔÎ·ÏÔ‡Ó ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹ ÓfiÛÔ ÛÙËÓ∂ÏÏ¿‰· (9,10). ∂ÈÚfiÛıÂÙ·, Ù· ÛÙÂÏ¤¯Ë ÙˆÓ ·ÛıÂ-ÓÒÓ ‚Ú¤ıËÎ·Ó ÁÂÓÂÙÈÎ¿ Ù·˘ÙfiÛËÌ· ÌÂ ÛÙÂÏ¤¯Ë ÊÔ-Ú¤ˆÓ. ŒÙÛÈ, ÂÊfiÛÔÓ Ë Î‡ÚÈ· ËÁ‹ ÌÂÙ¿‰ÔÛË˜ ·-ıÔÁfiÓˆÓ ÛÙÂÏÂ¯ÒÓ Â›Ó·È ÔÈ ·Û˘ÌÙˆÌ·ÙÈÎÔ› ÊÔ-ÚÂ›˜, ÌÂ ÙÔÓ ÂÚÈÔÚÈÛÌfi ÙË˜ ÊÔÚÂ›·˜ ÌËÓÈÁÁÈÙÈ‰fi-ÎÔÎÎÔ˘, ÌÂÈÒÓÂÙ·È ÛËÌ·ÓÙÈÎ¿ Ë Û˘¯ÓfiÙËÙ· ÌËÓÈÁÁÈ-ÙÈ‰ÔÎÔÎÎÈÎ‹˜ ÓfiÛÔ˘. ∂›Ó·È ÁÓˆÛÙfi fiÙÈ Ë ¯ÔÚ‹ÁËÛË¯ËÌÂÈÔÚÔÊ‡Ï·ÍË˜ ÁÈ· ÙËÓ ÂÍ¿ÏÂÈ„Ë ÙË˜ ÊÔÚÂ›·˜‰ÂÓ ·ÔÙÂÏÂ› ¿ÓÙ· ·ÔÙÂÏÂÛÌ·ÙÈÎfi ÙÚfiÔ ÚfiÏË-

„Ë˜ ÙË˜ ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹˜ ÓfiÛÔ˘. Œ¯ÂÈ ·Ú·ÙË-ÚËıÂ› fiÙÈ Ù· Û˘Ó‰Â‰ÂÌ¤Ó· ÂÌ‚fiÏÈ· ÌËÓÈÁÁÈÙÈ‰fiÎÔÎ-ÎÔ˘ ÚÔ¿ÁÔ˘Ó ÙËÓ ·Ú·ÁˆÁ‹ ·ÓÙÈÛˆÌ¿ÙˆÓ ÛÙÔ˘˜‚ÏÂÓÓÔÁfiÓÔ˘˜, ÌÂ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÂÏ¿ÙÙˆÛË ÙË˜ÊÔÚÂ›·˜ ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˘ ÔÌ¿‰·˜ C (16,17). ∂¿ÓÏËÊıÂ› ˘’ fi„ÈÓ fiÙÈ Ë ÔÚÔÔÌ¿‰· C ·ÓÙÈÚÔÛˆÂ‡ÂÈ¤Ó· ÌÂÁ¿ÏÔ ÔÛÔÛÙfi ÙfiÛÔ ÙË˜ ÊÔÚÂ›·˜, fiÛÔ Î·ÈÙË˜ ÓfiÛÔ˘, Ë ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ·Ó·Ì¤ÓÂ-Ù·È Ó· ÌÂÈÒÛÂÈ ÛËÌ·ÓÙÈÎ¿ ÙËÓ Â›ÙˆÛË ÙË˜ ÌËÓÈÁ-ÁÈÙÈ‰ÔÎÔÎÎÈÎ‹˜ ÓfiÛÔ˘ ÛÙËÓ ∂ÏÏ¿‰·.

∏ ·Ô˘Û›· ·ÔÙÂÏÂÛÌ·ÙÈÎÔ‡ ÂÌ‚ÔÏ›Ô˘ ÁÈ· fiÏÂ˜ÙÈ˜ ÔÌ¿‰Â˜ ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˘ ÂÈ‚¿ÏÏÂÈ ÙËÓ Î·Ï‡-ÙÂÚË Î·Ù·ÓfiËÛË ÙË˜ ‰˘Ó·ÌÈÎ‹˜ ÙË˜ ÊÔÚÂ›·˜, ·ÏÏ¿Î·È ÙË˜ ÓfiÛÔ˘, ÌÂ ÛÎÔfi ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂÚËÚfiÏË„Ë. ∂ÈÏ¤ÔÓ, Â›Ó·È ÛËÌ·ÓÙÈÎfi Ó· ˘¿Ú¯ÂÈÛ˘ÓÂ¯‹˜ ÂÈ‰ËÌÈÔÏÔÁÈÎ‹ ÂÈÙ‹ÚËÛË ÙˆÓ ÌËÓÈÁÁÈÙÈ-‰ÔÎÔÎÎÈÎÒÓ ÏÔÈÌÒÍÂˆÓ Î·È ÛÙËÓ ∂ÏÏ¿‰·, ÌÂ ÛÎÔfiÙË ‰È·ÌfiÚÊˆÛË ÛÙÚ·ÙËÁÈÎ‹˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÌÂ Ù·‹‰Ë ˘¿Ú¯ÔÓÙ· ÂÌ‚fiÏÈ·.

µÈ‚ÏÈÔÁÚ·Ê›·1. Caugant DA, Hoiby EA, Rosenqvist E, Froholm LO,

Selander RK. Transmission of Neisseria meningitidis amongasymptomatic military recruits and antibody analysis.Epidemiol Infect 1992;109:241-253.

2. Stephens DS. Uncloaking the meningococcus: dynamics ofcarriage and disease. Lancet 1999;353:941-943.

3. Cartwright K. Meningococcal carriage and disease. In:Cartwright K, editor. Meningococcal disease. 1st edition.Chichester, UK: John Wiley and Sons; 1995. p. 114-146.

4. Stuart JM, Cartwright KA, Robinson PM, Noah ND. Effect ofsmoking on meningococcal carriage. Lancet 1989;2:723-725.

5. Caugant DA, Hoiby EA, Magnus P, Scheel O, Hoel T, BjuneG et al. Asymptomatic carriage of Neisseria meningitidis in arandomly sampled population. J Clin Microbiol1994;32:323-330.

6. Apicella MA. Neisseria meningitidis. In: Mandell GL, BennettJE, Dolin R, editors. Principles and Practice of InfectiousDiseases. 5th edition. London: Churchill Livingstone; 2000.p. 2228-2241.

7. Tsolia M, Theodoridou M, Tzanakaki G, Kalabalikis P, VraniE, Mostrou G et al. A population-based multicenter study ofinvasive meningococcal disease in children in the area ofAthens. The 18th Annual Meeting of the European Societyfor Paediatric Infectious Diseases; 2000 May 3-5; Noordwijk,The Netherlands: 2000. abstr. 0-6.

8. Theodoridou M, Pavlopoulou ID, Stamatiadis D, Mostrou G,Pangalis A, Papaevangelou V et al. Acute bacterialmeningitis in Greek children: a 15-year overview. The 18thAnnual Meeting of the European Society for PaediatricInfectious Diseases; 2000 May 3-5; Noordwijk, TheNetherlands: 2000. abstr. 55.

9. ∂È‰ËÌÈÔÏÔÁÈÎfi ¢ÂÏÙ›Ô §ÔÈÌˆ‰ÒÓ ¡ÔÛËÌ¿ÙˆÓ ∂ÏÏ¿‰Ô˜.ªËÓÈ·›· ŒÎ‰ÔÛË ÙÔ˘ ∂ıÓÈÎÔ‡ ∫¤ÓÙÚÔ˘ ∂È‰ËÌÈÔÏÔÁÈÎ‹˜¶·Ú·ÎÔÏÔ‡ıËÛË˜ Î·È ¶·Ú¤Ì‚·ÛË˜ (∂∫∂¶∞¶) ÙÔ˘ ÀÔ˘Ú-ÁÂ›Ô˘ ÀÁÂ›·˜ ¶ÚfiÓÔÈ·˜ 1999;2:81-82.

∂ÈÎfiÓ· 1. ∏ÏÂÎÙÚÔÊfiÚËÛË ÛÂ ·ÏÏfiÌÂÓÔ Â‰›Ô (PFGE) ÌÂ-Ù¿ ·fi Î·Ù¿ÙÌËÛË ÌÂ ÙËÓ ÂÚÈÔÚÈÛÙÈÎ‹ ÂÓ‰ÔÓÔ˘ÎÏÂ¿ÛË Sfi IÙÔ˘ ÁÂÓÂÙÈÎÔ‡ ˘ÏÈÎÔ‡ 9 ÛÙÂÏÂ¯ÒÓ ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˘. Ï,lambda ladder, ÛÙ‹ÏÂ˜ 1,2,3,5 Î·È 6: ·ÓÙÈÚÔÛˆÂ˘ÙÈÎ¿ ÛÙÂ-Ï¤¯Ë ·fi ÊÔÚÂ›˜ ÌÂ ÂÈÎfiÓ· ËÏÂÎÙÚÔÊfiÚËÛË˜ Ô˘ ·Ó‹ÎÂÈÛÙÈ˜ ÔÌ¿‰Â˜ c, d, b, c Î·È a, ·ÓÙ›ÛÙÔÈ¯· (¶›Ó·Î·˜ 4). ™Ù‹ÏÂ˜4, 7, 8 Î·È 9: Ù˘¯·›· ÂÈÏÂÁÌ¤Ó· ÛÙÂÏ¤¯Ë ·ÛıÂÓÒÓ ÌÂ ÌËÓÈÁ-Á›ÙÈ‰·, Î·Ù¿ ÙËÓ ›‰È· ¯ÚÔÓÈÎ‹ ÂÚ›Ô‰Ô. ¡· ÛËÌÂÈˆıÂ› fiÙÈ Ù·ÛÙÂÏ¤¯Ë ÙˆÓ ·È‰ÈÒÓ ÌÂ ÌËÓÈÁÁ›ÙÈ‰· Î·È ÙˆÓ ÊÔÚ¤ˆÓ ¤¯Ô˘ÓÙ·˘ÙfiÛËÌÔ ‰·ÎÙ˘ÏÈÎfi ·ÔÙ‡ˆÌ· (ÛÙ‹ÏÂ˜ 3, 4, 9 Î·È ÛÙ‹ÏÂ˜6, 7, 8). ∆· ÛÙÂÏ¤¯Ë ·fi ÙÈ˜ ÛÙ‹ÏÂ˜ 3, 4 Î·È 9 ·Ó‹ÎÔ˘Ó ÛÙËÓÔÚÔ-ÔÌ¿‰· C, ÂÓÒ Ù· ÛÙÂÏ¤¯Ë ·fi ÙÈ˜ ÛÙ‹ÏÂ˜ 6, 7 Î·È 8 ·Ó‹-ÎÔ˘Ó ÛÙËÓ ÔÚÔ-ÔÌ¿‰· B.

Ï 1 2 3 4 5 6 7 8 9

727.5679,0630,5585,0533,5485,0436,5388,0339,5291,0242,5194,0145,5

97,0

48,5

Kb

May-June 03 03-06-03 16:55 ™ÂÏ›‰·193


194

10. Kremastinou J, Tzanakaki G, Kansouzidou A, Pagalis A,Danielides V, Kouppari G et al. Recent emergence ofserogroup C meningococcal disease in Greece. FEMSImmunol Med Microbiol 1999;23:49-55.

11. Kremastinou J, Blackwell C, Tzanakaki G, Kallergi C, EltonR, Weir D. Parental smoking and carriage of Neisseriameningitidis among Greek schoolchildren. Scand J InfectDis 1994;26:719-723.

12. Kremastinou J, Tzanakaki G, Velonakis E, Voyiatzi A,Nickolaou A, Elton RA et al. Carriage of Neisseriameningitides and Neisseria lactamica among ethnic Greekschoolchildren from Russian immigrant families in Athens.FEMS Immunol Med Microbiol 1999;23:13-20.

13. Breakpoints in in-vitro antibiotic sensitivity testing. Report bya working party of the British Society for AntimicrobialChemotherapy. J Antimicrob Chemother 1988;21:701-710.

14. Broome CV. The carrier state: Neisseria meningitidis. JAntimicrob Chemother 1986;18 (Suppl A):S25-S34.

15. Fitzpatrick PE, Salmon RL, Hunter PR, Roberts RJ, PalmerSR. Risk factors for carriage of Neisseria meningitidis duringan outbreak in Wales. Emerg Infect Dis 2000;6:65-69.

16. Ala’Aldeen DA, Neal KR, Ait-Tahar K, Nguyen-Van-Tam JS,English A, Falla TJ et al. Dynamics of meningococcal long-term carriage among university students and theirimplications for mass vaccination. J Clin Microbiol2000;38:2311-2316.

17. Zhang Q, Choo S, Everard J, Jennings R, Finn A. Mucosalimmune responses to meningococcal group C conjugateand group A and C polysaccharide vaccines inadolescents. Infect Immun 2000;68:2692-2697.


¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: πˆ¿ÓÓ· ¶·˘ÏÔÔ‡ÏÔ˘ºÂÈ‰›Ô˘ 25, ∆.∫. 155 62, ÃÔÏ·ÚÁfi˜, ∞ı‹Ó·

™ÎÔfi˜: ∏ ÔÍÂ›· Ì¤ÛË ˆÙ›ÙÈ‰· Â›Ó·È Ì›· ·fi ÙÈ˜ ÈÔ ÎÔÈÓ¤˜ÓfiÛÔ˘˜ ÙË˜ ‚ÚÂÊÈÎ‹˜ Î·È ·È‰ÈÎ‹˜ ËÏÈÎ›·˜. ∏ ¯Ú‹ÛË ·ÓÙÈ-‚ÈÔÙÈÎÒÓ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ÔÍÂ›·˜ Ì¤ÛË˜ ˆÙ›ÙÈ‰·˜ÔÈÎ›ÏÏÂÈ ·fi 31% ÛÙËÓ OÏÏ·Ó‰›· ¤ˆ˜ 98% ÛÙÈ˜ ∏¶∞ Î·È ÙËÓ∞˘ÛÙÚ·Ï›·. O ÛÎÔfi˜ ÙË˜ Û˘ÁÎÂÎÚÈÌ¤ÓË˜ ·Ó·ÛÎfiËÛË˜ Â›-Ó·È Ë ·ÔÙ›ÌËÛË ÙˆÓ Û˘ÓÂÂÈÒÓ ÙË˜ ¯Ú‹ÛË˜ ·ÓÙÈ‚ÈÔÙÈÎÒÓÛÙ· ·È‰È¿ ÌÂ ÔÍÂ›· Ì¤ÛË ˆÙ›ÙÈ‰·.ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ∂ÍÂÙ¿ÛÙËÎ·Ó ÂÓ‰ÂÏÂ¯Ò˜ ÙÔ CochraneControlled Trials Register, ÙÔ Medline, ÙÔ Index Medicus (ÚÔÙÔ˘ 1965) Î·È ÔÈ Î·Ù¿ÏÔÁÔÈ ÙˆÓ ·Ó·ÊÔÚÒÓ ÙˆÓ ¿ÚıÚˆÓ ·fiÙÔ 1958 ¤ˆ˜ ÙÔÓ π·ÓÔ˘¿ÚÈÔ ÙÔ˘ 2000. ∫ÚÈÙ‹ÚÈ· ÂÈÏÔÁ‹˜ ·Ô-Ù¤ÏÂÛ·Ó Ù˘¯·ÈÔÔÈËÌ¤ÓÂ˜ ÌÂÏ¤ÙÂ˜ ·È‰ÈÒÓ ÌÂ ÔÍÂ›· Ì¤ÛËˆÙ›ÙÈ‰·, ÛÙÈ˜ ÔÔ›Â˜ Û˘ÁÎÚ›ıËÎ·Ó ·ÓÙÈÌÈÎÚÔ‚È·Î¿ Ê¿ÚÌ·Î·ÌÂ placebo. ∞fi ÙÚÂÈ˜ ·ÓÂÍ¿ÚÙËÙÔ˘˜ ÎÚÈÙ¤˜, ÂÎÙÈÌ‹ıËÎÂ ËÔÈfiÙËÙ· ÙˆÓ ÎÏÈÓÈÎÒÓ ‰ÔÎÈÌÒÓ Î·È ÂÍ‹¯ıËÛ·Ó ÏËÚÔÊÔÚ›Â˜. ∞ÔÙÂÏ¤ÛÌ·Ù·: ¢¤Î· ÌÂÏ¤ÙÂ˜ ‹Ù·Ó Î·Ù¿ÏÏËÏÂ˜, ·ÏÏ¿ ÌfiÓÔÂÙ¿ ÌÂÏ¤ÙÂ˜ ÌÂ Û˘ÓÔÏÈÎfi ·ÚÈıÌfi 2202 ·È‰ÈÒÓ, ÂÚÈÂ›¯·ÓÛËÌÂ›· ¤Î‚·ÛË˜ Ô˘ ·Ó·Ê¤ÚÔÓÙ·Ó ÛÙÔÓ ›‰ÈÔ ÙÔÓ ·ÛıÂÓ‹. ∏ÔÈfiÙËÙ· ÙË˜ ÌÂıÔ‰ÔÏÔÁ›·˜ ÙˆÓ ÌÂÏÂÙÒÓ Ô˘ Û˘ÌÂÚÈÂÏ‹-ÊıËÛ·Ó ‹Ù·Ó ÁÂÓÈÎ¿ ˘„ËÏ‹. ŸÏÂ˜ ÔÈ ÌÂÏ¤ÙÂ˜ ‹Ù·Ó ·fi ·ÓÂ-Ù˘ÁÌ¤ÓÂ˜ ¯ÒÚÂ˜. ™‡ÌÊˆÓ· ÌÂ ÙÈ˜ ÌÂÏ¤ÙÂ˜, ÂÓÒ ‰ÂÓ ·Ú·-ÙËÚ‹ıËÎÂ ÂÍ·Ûı¤ÓËÛË ÙÔ˘ fiÓÔ˘ ÛÂ 24 ÒÚÂ˜, ÛÙÔ 28% (95%fiÚÈ· ·ÍÈÔÈÛÙ›·˜: 15% ¤ˆ˜ 38%) ̆ ‹ÚÍÂ ÂÍ·Ûı¤ÓËÛË ÙÔ˘ fi-ÓÔ˘ ÛÂ 2-7 ËÌ¤ÚÂ˜. ∂ÊfiÛÔÓ ÙÔ 80% ÂÚ›Ô˘ ÙˆÓ ·ÛıÂÓÒÓ ı·¤¯ÂÈ ·ÚÔ˘ÛÈ¿ÛÂÈ ‡ÊÂÛË ·˘ÙfiÌ·Ù· Ì¤¯ÚÈ ·˘Ùfi ÙÔ ¯ÚÔÓÈÎfi‰È¿ÛÙËÌ·, ÌÂ ‚¿ÛË Ù· ·Ú·¿Óˆ ‰Â‰ÔÌ¤Ó· Û˘ÓÂ¿ÁÂÙ·È fiÙÈË ·fiÏ˘ÙË ÂÏ¿ÙÙˆÛË ÙÔ˘ fiÓÔ˘ ı· ·ÊÔÚ¿ ÛÙÔ 5% ‹ fiÙÈ Â-

Ú›Ô˘ 17 ·ÛıÂÓÂ›˜ ı· Ú¤ÂÈ Ó· ·ÓÙÈÌÂÙˆÈÛÙÔ‡Ó ÌÂ ·ÓÙÈ‚ÈÔ-ÙÈÎ¿ ÚÔÎÂÈÌ¤ÓÔ˘ Ó· ÚÔÏËÊıÂ› ÛÂ 1 ·È‰› Ë ÂÈÌÔÓ‹ ÙÔ˘ fi-ÓÔ˘ ÁÈ· ÂÚÈÛÛfiÙÂÚÔ ·fi 2 ËÌ¤ÚÂ˜. ¢ÂÓ ‰È·ÈÛÙÒıËÎÂ Î·Ì›·Â›‰Ú·ÛË ÙˆÓ ·ÓÙÈ‚ÈÔÙÈÎÒÓ ÛÙ· ÚÔ‚Ï‹Ì·Ù· ·ÎÔ‹˜ Ô˘ ÚÔ-ÎÏ‹ıËÎ·Ó ·fi ÙËÓ ÔÍÂ›· Ì¤ÛË ˆÙ›ÙÈ‰·, fiˆ˜ Î·Ù·ÁÚ¿ÊËÎÂ·fi ÙËÓ Â·ÎfiÏÔ˘ıË Ù˘Ì·ÓÔÌÂÙÚ›·. øÛÙfiÛÔ, ·ÎÔÔÏÔÁÈÎfi˜¤ÏÂÁ¯Ô˜ Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ ÛÂ ‰‡Ô ÌfiÓÔ ÌÂÏ¤ÙÂ˜ Î·È Ë Î·-Ù·ÁÚ·Ê‹ ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ‹Ù·Ó ÂÏÏÈ‹˜. ™ÙÈ˜ Û˘ÁÎÂÎÚÈ-Ì¤ÓÂ˜ ÌÂÏ¤ÙÂ˜ ·Ú·ÙËÚ‹ıËÎ·Ó Ï›ÁÂ˜ ÛÔ‚·Ú¤˜ ÂÈÏÔÎ¤˜:Ì›· ÌfiÓÔ ÂÚ›ÙˆÛË Ì·ÛÙÔÂÈ‰›ÙÈ‰·˜, Ô˘ ÂÌÊ·Ó›ÛÙËÎÂ ÛÙËÓÔÌ¿‰· ÙˆÓ ·È‰ÈÒÓ Ô˘ ·ÓÙÈÌÂÙˆ›ÛÙËÎÂ ÌÂ ¯ÔÚ‹ÁËÛË ÂÓÈ-ÎÈÏ›ÓË˜.™˘ÌÂÚ¿ÛÌ·Ù·: ∆· ·ÓÙÈ‚ÈÔÙÈÎ¿ ÚÔÛÊ¤ÚÔ˘Ó ÌÈÎÚfi fiÊÂÏÔ˜ÛÙËÓ ÔÍÂ›· Ì¤ÛË ˆÙ›ÙÈ‰· ÛÙ· ·È‰È¿. ¢Â‰ÔÌ¤ÓÔ˘ fiÙÈ ÔÈ ÂÚÈÛ-ÛfiÙÂÚÂ˜ ÂÚÈÙÒÛÂÈ˜ ı· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó ·˘ÙfiÌ·Ù· ‡ÊÂÛË, ÙÔfiÊÂÏÔ˜ ı· Ú¤ÂÈ Ó· Û˘ÁÎÚÈıÂ› ÌÂ ÙÈ˜ Èı·Ó¤˜ ·ÓÂÈı‡ÌËÙÂ˜ÂÓ¤ÚÁÂÈÂ˜. ∏ ıÂÚ·Â›· ÌÂ ·ÓÙÈ‚ÈÔÙÈÎ¿ ÌÔÚÂ› Ó· ¤¯ÂÈ ÛËÌ·-ÓÙÈÎfi ÚfiÏÔ ÛÙË ÌÂ›ˆÛË ÙË˜ Èı·ÓfiÙËÙ·˜ Ì·ÛÙÔÂÈ‰›ÙÈ‰·˜ ÛÂÏËı˘ÛÌÔ‡˜ Ô˘ ·˘Ù‹ Â›Ó·È Û˘¯ÓfiÙÂÚË.

∞ÓÙÈ‚ÈÔÙÈÎ¿ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ÔÍÂ›·˜ Ì¤ÛË˜ ˆÙ›ÙÈ‰·˜ ÛÙ· ·È‰È¿1

¶ÂÚ›ÏË„Ë ¿ÚıÚÔ˘ ·fi ÙË µÈ‚ÏÈÔÁÚ·Ê›·

1Glasziou PP, Del Mar CB, Sanders SL, Hayem M Antibiotics for acute otitis media in children The Cochrane Library, Issue 4, 2002. Oxford: UpdateSoftware

ºˆÙÂÈÓ‹ Ã·ÓÙ˙‹

May-June 03 03-06-03 16:55 ™ÂÏ›‰·194


195

§ÂÌÊÒÌ·Ù· ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜. ∂ÌÂÈÚ›· 10 ¯ÚfiÓˆÓ º. ∞ı·Ó·ÛÈ¿‰Ô˘1, £. ∆Ú·ÁÈ·ÓÓ›‰Ë˜1, £. ¶··ÁÂˆÚÁ›Ô˘1, µ. ∫·ÏÔ‡ÙÛË2, ª. Ã·Ù˙ËÛÙ˘ÏÈ·ÓÔ‡1, ª. ™Ù¿ÌÔ˘1, ¢. ∫·ÙÚÈÔ‡1

Lymphomas in childhood. Ten years’ experienceF. Athanassiadou1, T. Tragiannidis1, T. Papageorgiou1, V. Kaloutsi2, M. Hatzistilianou1, M. Stamou1, D. Katriou1


1 µ’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹,∞ÚÈÛÙÔÙ¤ÏÂÈÔ ¶·ÓÂÈÛÙ‹ÌÈÔ £ÂÛÛ·ÏÔÓ›ÎË˜

2 ¶·ıÔÏÔÁÔ·Ó·ÙÔÌÈÎfi ∂ÚÁ·ÛÙ‹ÚÈÔ, ∞ÚÈÛÙÔÙ¤ÏÂÈÔ ¶·ÓÂÈÛÙ‹ÌÈÔ £ÂÛÛ·ÏÔÓ›ÎË˜

1 2nd Paediatric Clinic of Aristotelion University,Thessaloniki

2 Laboratory of Clinical Pathology of AristotelionUniversity, Thessaloniki

�¶ÂÚ›ÏË„Ë: ™ÎÔfi˜ ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ Â›Ó·ÈË ÎÏÈÓÈÎ‹ ·ÚÔ˘Û›·ÛË Î·È Ù· ıÂÚ·Â˘ÙÈÎ¿ ·ÔÙÂÏ¤-ÛÌ·Ù· ÙˆÓ ·È‰ÈÒÓ ÌÂ Hodgkin (HD) Î·È ÌËHodgkin Ï¤ÌÊˆÌ· (NHL) Ô˘ ÓÔÛËÏÂ‡ÙËÎ·Ó ÛÙËÛ˘ÁÎÂÎÚÈÌ¤ÓË ÎÏÈÓÈÎ‹ ÙË ‰ÂÎ·ÂÙ›· 1992-2002. ÀÏÈÎfiÙË˜ ÌÂÏ¤ÙË˜ ·ÔÙ¤ÏÂÛ·Ó 38 ·È‰È¿ ËÏÈÎ›·˜ 2 ¤ˆ˜15 ¯ÚfiÓˆÓ Ô˘ ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó ÌÂ Ù· ÚˆÙfiÎÔÏ-Ï· LSA2-L2, BFM Î·È ÙÔ ˘‚ÚÈ‰ÈÎfi ÚˆÙfiÎÔÏÏÔCOPP/ABVD. °È· Î¿ıÂ ·È‰› ¤ÁÈÓÂ Î·Ù·ÁÚ·Ê‹ ÙÔ˘Ê‡ÏÔ˘, ÙË˜ ËÏÈÎ›·˜, ÙˆÓ ÎÏÈÓÈÎÒÓ Î·È ÂÚÁ·ÛÙËÚÈ·-ÎÒÓ ‰Â‰ÔÌ¤ÓˆÓ Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹, ÙˆÓ ÈÛÙÔÏÔÁÈ-ÎÒÓ Â˘ÚËÌ¿ÙˆÓ Î·È ÙÔ˘ ·ÂÈÎÔÓÈÛÙÈÎÔ‡ ÂÏ¤Á¯Ô˘. ∏ÂÏÂ‡ıÂÚË ÓfiÛÔ˘ ÂÈ‚›ˆÛË ÛÂ ÚÒÙË ‡ÊÂÛË (eventfree survival - EFS) Î·È Ë Û˘ÓÔÏÈÎ‹ ÂÈ‚›ˆÛË ÙˆÓ·ÛıÂÓÒÓ (overall survival - OS) ˘ÔÏÔÁ›ÛÙËÎ·Ó ÌÂÙË Ì¤ıÔ‰Ô Kaplan-Meier. ∞fi Ù· 38 ·È‰È¿, 16(42,1%) Ù·ÍÈÓÔÌ‹ıËÎ·Ó ˆ˜ HD, ÂÓÒ 22 ·È‰È¿(57,9%) ˆ˜ NHL. ∆· 27 ‹Ù·Ó ·ÁfiÚÈ· (71,1%) Î·È Ù·11 ÎÔÚ›ÙÛÈ· (28,9%). ∏ Ì¤ÛË ËÏÈÎ›· Î·Ù¿ ÙË ‰È¿-ÁÓˆÛË ‹Ù·Ó 9 ¯ÚfiÓÈ· (9±6,04). ∞fi ÙÔÓ ÂÚÁ·ÛÙË-ÚÈ·Îfi ¤ÏÂÁ¯Ô Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÚÔ¤Î˘„·Ó Ù·ÂÍ‹˜: 26 ·fi Ù· 38 ·È‰È¿ Â›¯·Ó ·ÚÈıÌfi ÏÂ˘ÎÒÓ<10.000/mm3 (68,4%), 28/38 Hb >10 g/dL (73,7%),10/38 LDH >1000 U/L (26,3%) Î·È 7/38 Â›¯·Ó ∆∫∂>100 mm (18,4%). ∞fi Ù· ÎÏÈÓÈÎ¿ Â˘Ú‹Ì·Ù· Î·Ù·-ÁÚ¿ÊËÎÂ ˘ÚÂÙfi˜ ÛÂ ÔÛÔÛÙfi 39,5%, ·ÒÏÂÈ· ‚¿-ÚÔ˘˜ ÛÙÔ 42,1% Î·È Ó˘¯ÙÂÚÈÓÔ› È‰ÚÒÙÂ˜ ÛÙÔ 26,3%ÙˆÓ ·È‰ÈÒÓ. ∏·ÙÔÛÏËÓÔÌÂÁ·Ï›· (>3 cm) Â›¯Â ÙÔ36,8%, ÙÚ·¯ËÏÈÎ‹ ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ· ÙÔ 76,3%, ‰Èfi-ÁÎˆÛË ÙˆÓ ·‰¤ÓˆÓ ÙÔ˘ ÌÂÛÔıˆÚ·Î›Ô˘ ÙÔ 73,7% Î·ÈÙˆÓ ÔÈÛıÔÂÚÈÙÔÓ·˚ÎÒÓ ÏÂÌÊ·‰¤ÓˆÓ ÙÔ 26,3%. ∏Î·Ù·ÓÔÌ‹ Î·Ù¿ ÛÙ¿‰È· ‹Ù·Ó Ë ÂÍ‹˜: ÛÙÔ ÛÙ¿‰ÈÔ I·Ó‹ÎÂ ÙÔ 7,9% (3 ·È‰È¿), ÛÙÔ II ÙÔ 52,6% (20 ·È-‰È¿), ÛÙÔ III ÙÔ 31,6% (12 ·È‰È¿) Î·È ÛÙÔ IV ÙÔ 7,9%

�Abstract: This is a study of children with Hodgkindisease (HD) and non-Hodgkin lymphoma (NHL),admitted to the paediatric clinic during the period1992-2002. The study includes 38 children agedbetween 2 and 15 years with lymphoma, treatedwith the protocols LSA2-L2, BFM and COPP/ABVD.The sex of the children and age at diagnosis, clinicaland laboratory data at admission and the findingson radiological and histological investigation wereevaluated. Event free survival (EFS) and overallsurvival (OS) were estimated by the Kaplan-Meiermethod. Sixteen of the 38 children (42.1%) werediagnosed as HD and 22 (57.9%) as NHL. Twenty-seven children (71.1%) were males and 11 (28.9%)females, and their mean age at admission was 9years (9±6.04). Laboratory findings at admissionshowed that 68.4% had WBC <10.000/mm3, 73.7%had Hb >10 g/dL, 26.3% had LDH >1000 U/L and18.4% had ESR >100 mm. Fever was documentedin 39.5%, weight loss in 42.1% and night sweats in26.3%. Hepatosplenomegaly (>3 cm) was found in36.8%, and cervical, mediastinal, and retroperito-neal lymphadenopathy in 76.3%, 73.7% and 26.3%respectively. The disease was staged at: stage I7.9%, stage II 52.6%, stage III 31.6% and stage IV7.9%. Half of the children with HD were aged >10years while 72.7% with NHL were aged between 5and 10 years. Boys constituted 77.3% of thechildren with NHL and 62.5% of those with HD.Fever was present in 56.3% of those with HD and27.3% of those with NHL. EFS at the first remissionwas 77.05% (±6.58%) and OS 91.27% (±4.36%).EFS in correlation to the type of lymphoma was71.79% (±11.58%) for HD and 79.6% (±8.02%) for

May-June 03 03-06-03 16:55 ™ÂÏ›‰·195


196

∂ÈÛ·ÁˆÁ‹∆· ÏÂÌÊÒÌ·Ù· ·ÔÙÂÏÔ‡Ó ÙÔ ÙÚ›ÙÔ Î·Ù¿ Û˘¯ÓfiÙË-

Ù· Î·ÎfiËıÂ˜ ÓfiÛËÌ· ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜ ÌÂÙ¿ ÙËÓÔÍÂ›· ÏÂÌÊÔ‚Ï·ÛÙÈÎ‹ ÏÂ˘¯·ÈÌ›· Î·È ÙÔ˘˜ ÚˆÙÔ·-ıÂ›˜ fiÁÎÔ˘˜ ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ ÓÂ˘ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜,·ÓÙÈÚÔÛˆÂ‡ÔÓÙ·˜ ÂÚ›Ô˘ ÙÔ 10-15% ÙˆÓ Î·ÎÔË-ıÂÈÒÓ (1). ¢È·ÎÚ›ÓÔÓÙ·È ÛÙ· ÌË Hodgkin ÏÂÌÊÒÌ·Ù·(NHL) Î·È ÛÙ· Hodgkin ÏÂÌÊÒÌ·Ù· (HD). ∆· NHL ÂÌ-Ê·Ó›˙ÔÓÙ·È Û˘¯ÓfiÙÂÚ· ÛÂ Û¯¤ÛË ÌÂ Ù· HD ÛÙËÓ ·È-‰ÈÎ‹ ËÏÈÎ›· (·Ó·ÏÔÁ›· 3/2), ÂÓÒ Ë Î·Ù·ÓÔÌ‹ ÛÙ· ‰‡ÔÊ‡Ï· Â›Ó·È 3:1 ÌÂ ˘ÂÚÔ¯‹ ÙˆÓ ·ÁÔÚÈÒÓ (1-3).

∆· NHL ·ÔÙÂÏÔ‡Ó Î·ÎfiËıÂ˜ ÓfiÛËÌ· ÙÔ˘ ÏÂÌ-ÊÈÎÔ‡ ÈÛÙÔ‡ (ÏÂÌÊ·‰¤ÓÂ˜ ‹ ÂÍˆÏÂÌÊ·‰ÂÓÈÎ¿ fiÚÁ·-Ó·). ∞ÓÙÈÚÔÛˆÂ‡Ô˘Ó ÂÚ›Ô˘ ÙÔ 7-10% ÙˆÓ Î·-ÎÔ‹ıˆÓ ÓÔÛËÌ¿ÙˆÓ ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜ (2,4,5). ∏Û˘¯ÓfiÙËÙ· ÙˆÓ NHL Â›Ó·È ˘„ËÏfiÙÂÚË ÛÙËÓ ∞ÊÚÈÎ‹,ÁÂÁÔÓfi˜ Ô˘ ÔÊÂ›ÏÂÙ·È ÛÙËÓ ·ÚÔ˘Û›· ÙÔ˘ ÏÂÌÊÒ-Ì·ÙÔ˜ Burkitt ÛÙËÓ ÂÚÈÔ¯‹, ÙÔ ÔÔ›Ô Û¯ÂÙ›˙ÂÙ·È¿ÌÂÛ· ÌÂ ÙÔÓ Èfi Epstein-Barr (EBV) ÛÂ ÔÛÔÛÙfi¤ˆ˜ Î·È 95% (2,4,6). ∞ÓÙ›ıÂÙ·, ÛÙËÓ ∂˘ÚÒË Î·ÈÛÙË µfiÚÂÈ· ∞ÌÂÚÈÎ‹, ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ÙˆÓNHL Â›Ó·È ∆ ‹ µ (ÌË Burkitt) Î˘ÙÙ·ÚÈÎ‹˜ ÚÔ¤ÏÂ˘-ÛË˜ Î·È ÌfiÓÔ ÙÔ 10-15% Ê¤ÚÂÈ ÙÔ Á¤ÓˆÌ· ÙÔ˘ EBV(5). °ÂÓÂÙÈÎÔ› ÚÔ‰È·ıÂÛÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ Ô˘ ÂÓÔ-¯ÔÔÈÔ‡ÓÙ·È ÁÈ· ÙËÓ ·ıÔÁ¤ÓÂÛË ÙˆÓ NHL Â›Ó·È ÔÈÎÏËÚÔÓÔÌÈÎ¤˜ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈÂ˜, fiˆ˜ ÙÔ Û‡Ó-‰ÚÔÌÔ Wiskott-Aldrich, Ë ·Ù·Í›· ÙËÏ·ÁÁÂÈÂÎÙ·Û›· Î·ÈÙÔ Ê˘ÏÔÛ‡Ó‰ÂÙÔ ÏÂÌÊÔ¸ÂÚÏ·ÛÙÈÎfi Û‡Ó‰ÚÔÌÔ, Î·-ıÒ˜ Î·È ÔÈ Â›ÎÙËÙÂ˜ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈÂ˜, fiˆ˜ Ë ·ÓÔ-

ÛÔÎ·Ù·ÛÙÔÏ‹ Ô˘ ·ÎÔÏÔ˘ıÂ› ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË Ì˘Â-ÏÔ‡ ÙˆÓ ÔÛÙÒÓ ‹ ÙÔ˘ ‹·ÙÔ˜ (1,2). ÕÏÏÔÈ ·Ú¿ÁÔÓÙÂ˜Ô˘ ÚÔ‰È·ı¤ÙÔ˘Ó ÛÙËÓ ÂÎ‰‹ÏˆÛË ÙˆÓ NHL Â›Ó·È Ë·ÎÙÈÓÔ‚ÔÏ›· Î·È ÔÚÈÛÌ¤ÓÔÈ ÈÔ› fiˆ˜ Ô EBV Î·È Ô Èfi˜ÙË˜ Â›ÎÙËÙË˜ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·˜ (HIV).

∏ ÓfiÛÔ˜ ÙÔ˘ Hodgkin ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÚÔ-Ô‰Â˘ÙÈÎ‹, ·ÓÒ‰˘ÓË ‰ÈfiÁÎˆÛË ÙˆÓ ÏÂÌÊ·‰¤ÓˆÓ, Û˘-¯ÓfiÙÂÚ· ÙË˜ ÙÚ·¯ËÏÈÎ‹˜ ¯ÒÚ·˜. ∏ ÓfiÛÔ˜ ·Ú¯ÈÎ¿ÚÔÛ‚¿ÏÏÂÈ ¤Ó· ÌÔÓ‹ÚË ÏÂÌÊ·‰¤Ó· ‹ ÔÌ¿‰· ÏÂÌ-Ê·‰¤ÓˆÓ, ÂÓÒ ÛÂ ÚÔ¯ˆÚËÌ¤ÓÔ ÛÙ¿‰ÈÔ ÌÔÚÂ› Ó·ÂÈÓ¤ÌÂÙ·È Î·È fiÚÁ·Ó·. ∏ Î·Ì‡ÏË Û˘¯ÓfiÙËÙ·˜ ·-ÚÔ˘ÛÈ¿˙ÂÈ Ì›· ·È¯Ì‹ ÛÂ ËÏÈÎ›· 15-35 ÂÙÒÓ Î·È Ì›·‰Â‡ÙÂÚË ÛÂ ÌÂÁ·Ï‡ÙÂÚÂ˜ ËÏÈÎ›Â˜ (>50 ¯ÚfiÓÈ·)(1,4,7). ™ÙËÓ ·ıÔÁ¤ÓÂÈ· ÙË˜ ÓfiÛÔ˘ ÂÓ¤¯ÔÓÙ·È ·ÓÔ-ÛÔÏÔÁÈÎ¤˜ ‰È·Ù·Ú·¯¤˜, ÂÓÒ ·Ú·ÙËÚÂ›Ù·È ·˘ÍËÌ¤-ÓË Û˘¯ÓfiÙËÙ· ÛÂ ¿ÙÔÌ· ÌÂ ÓÔÛ‹Ì·Ù· fiˆ˜ Ô Û˘-ÛÙËÌ·ÙÈÎfi˜ ÂÚ˘ıËÌ·ÙÒ‰Ë˜ Ï‡ÎÔ˜ (™∂§), Ë ÚÂ˘Ì·-ÙÔÂÈ‰‹˜ ·ÚıÚ›ÙÈ‰· Î·È Ë ·Ù·Í›· ÙËÏ·ÁÁÂÈÂÎÙ·Û›·(1,7,8). ∂›ÛË˜, Ô EBV ¤¯ÂÈ ·Ô‰ÂÈ¯ıÂ› fiÙÈ Û¯ÂÙ›˙Â-Ù·È ÌÂ ÙËÓ HD, ·ÊÔ‡ ÌÂÏ¤ÙÂ˜ ·¤‰ÂÈÍ·Ó ÙËÓ ·ÚÔ˘-Û›· ÙÔ˘ ÁÂÓÒÌ·ÙÔ˜ ÙÔ˘ EBV ÛÙ· Î‡ÙÙ·Ú· Reed-Sternberg ÌÂ ÌÔÚÈ·Î¤˜ ÙÂ¯ÓÈÎ¤˜ (PCR), ÛÂ ÔÛÔÛÙfiÔ˘ ·Ó¤Ú¯ÂÙ·È ÛÙÔ 60% ÙˆÓ ÈÛÙÔÏÔÁÈÎÒÓ ·Ú·-ÛÎÂ˘·ÛÌ¿ÙˆÓ ·È‰ÈÒÓ ÌÂ HD.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ÀÏÈÎfi ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ ·ÔÙ¤ÏÂÛ·Ó 38 ·È‰È¿ ËÏÈ-

Î›·˜ 2-15 ÂÙÒÓ ÌÂ Ï¤ÌÊˆÌ·, Ù· ÔÔ›· ÓÔÛËÏÂ‡ÙËÎ·Ó ÛÙË µ’ ¶·-ÓÂÈÛÙËÌÈ·Î‹ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ÙÔ˘ ∞.¶.£. ÙÔ ¯ÚÔÓÈÎfi

(3 ·È‰È¿). ∆· ÌÈÛ¿ ·È‰È¿ ÌÂ HD (50%) ‹Ù·Ó ËÏÈÎ›·˜>10 ¯ÚfiÓˆÓ, ÂÓÒ ÙÔ 72,7% ÙˆÓ NHL ‹Ù·Ó ËÏÈÎ›·˜5-10 ¯ÚfiÓˆÓ. ∆Ô 77,3% ÙˆÓ NHL ‹Ù·Ó ·ÁfiÚÈ·, ÂÓÒÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ÔÛÔÛÙfi ÙˆÓ HD ‹Ù·Ó 62,5%. ¶˘ÚÂ-Ùfi Â›¯Â ÙÔ 56,3% ÙˆÓ HD, ¤Ó·ÓÙÈ 27,3% ÙˆÓ NHL.ªÂ Ì¤ÛÔ ¯ÚfiÓÔ ·Ú·ÎÔÏÔ‡ıËÛË˜ Ù· 4,8 ¤ÙË, Ë EFSÛÂ ÚÒÙË ‡ÊÂÛË Â›Ó·È 77,05% (±6,58%) Î·È Ë OS91,27% (±4,36%). ∏ ·Ó¿Ï˘ÛË ÙË˜ Èı·ÓfiÙËÙ·˜EFS ÛÂ Û¯¤ÛË ÌÂ ÙÔÓ Ù‡Ô ÙÔ˘ ÏÂÌÊÒÌ·ÙÔ˜ Â›Ó·È71,79% (±11,58%) ÁÈ· Ù· ·È‰È¿ ÌÂ HD, ¤Ó·ÓÙÈ79,6% (±8,02%) ÁÈ· ÂÎÂ›Ó· ÌÂ NHL. ∞fi ÙÔ Û‡ÓÔÏÔÙˆÓ 16 ·È‰ÈÒÓ ÌÂ HD Î·È ÙˆÓ 22 ÌÂ NHL, ˘ÔÙÚÔ-›·Û·Ó 5 Î·È 5 ·È‰È¿, ·ÓÙ›ÛÙÔÈ¯·. ∞fi ·˘Ù¿ Ù··ÔÙÂÏ¤ÛÌ·Ù· ÚÔÎ‡ÙÂÈ fiÙÈ Ë OS Î·È Ë EFS, ÌÂ Ù·Û‡Á¯ÚÔÓ· ıÂÚ·Â˘ÙÈÎ¿ ÚˆÙfiÎÔÏÏ·, Î·Ù·ÁÚ¿ÊË-Î·Ó ÛÂ Ï‹ÚË ·ÓÙÈÛÙÔÈ¯›· ÌÂ Ù· ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·-ÊÈÎ¿ ‰Â‰ÔÌ¤Ó·. ™˘ÁÎÚÈÙÈÎ¿ ÚÔÎ‡ÙÂÈ Î·Ï‡ÙÂÚË¤Î‚·ÛË ÁÈ· Ù· ·È‰È¿ ÌÂ NHL, Ô˘ ÔÊÂ›ÏÂÙ·È Èı·-ÓfiÓ ÛÙËÓ ·ÚÔ˘Û›· ÎÏÈÓÈÎÒÓ Û˘ÌÙˆÌ¿ÙˆÓ Ô˘ ÂÈ-‚¿ÏÏÔ˘Ó ÙËÓ ¤ÁÎ·ÈÚË ÚÔÛ¤ÏÂ˘ÛË, ‰È¿ÁÓˆÛË Î·ÈıÂÚ·Â˘ÙÈÎ‹ ·ÓÙÈÌÂÙÒÈÛË.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ÓfiÛÔ˜ Hodgkin, ÌË Hodgkin Ï¤Ì-ÊˆÌ·, ÂÈ‚›ˆÛË ÂÏÂ‡ıÂÚË ÓfiÛÔ˘, ·È‰ÈÎ‹ ËÏÈÎ›·.

NHL. Relapses occurred in 5/16 and 5/22 childrenwith HD and NHL respectively. In conclusion, theOS and EFS in this group of children wereequivalent to those treated with modernchemotherapy protocols reported in theinternational bibliography. Comparing HD and NHL,better outcome for children with NHL was noted,possibly due to more timely admission, diagnosisand start of treatment.

Key words: Hodgkin disease, non-Hodgkinlymphoma, event free survival, childhood.

May-June 03 03-06-03 16:55 ™ÂÏ›‰·196


197

‰È¿ÛÙËÌ· ·fi ÙÔÓ πÔ‡ÏÈÔ 1992 ˆ˜ ÙÔÓ πÔ‡ÏÈÔ 2002 Î·È ·ÓÙÈÌÂ-Ùˆ›ÛÙËÎ·Ó ÌÂ Ù· ÚˆÙfiÎÔÏÏ· LSA2-L2, BFM Î·È ÙÔ ˘‚ÚÈ‰ÈÎfiCOPP/ABVD. °È· Î¿ıÂ ·È‰› ¤ÁÈÓÂ Î·Ù·ÁÚ·Ê‹ ÙÔ˘ Ê‡ÏÔ˘, ÙË˜ËÏÈÎ›·˜, ÙˆÓ ÎÏÈÓÈÎÒÓ (Ë·ÙÔÌÂÁ·Ï›·, ÛÏËÓÔÌÂÁ·Ï›·, ÙÚ·¯ËÏÈ-Î‹ ÏÂÌÊ·‰ÂÓ›ÙÈ‰·, ‰ÈfiÁÎˆÛË ·‰¤ÓˆÓ ÌÂÛÔıˆÚ·Î›Ô˘/ÎÔÈÏ›·˜,˘ÚÂÙfi˜, Ó˘ÎÙÂÚÈÓÔ› È‰ÚÒÙÂ˜, ·ÒÏÂÈ· ‚¿ÚÔ˘˜) Î·È ÂÚÁ·ÛÙË-ÚÈ·ÎÒÓ ‰Â‰ÔÌ¤ÓˆÓ (ÁÂÓÈÎ‹ ·›Ì·ÙÔ˜, Á·Ï·ÎÙÈÎ‹ ‰Â¸‰ÚÔÁÂÓ¿ÛË,·ÏÎ·ÏÈÎ‹ ÊˆÛÊ·Ù¿ÛË, ∆∫∂, ÊÂÚÚÈÙ›ÓË) Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹, Î·-ıÒ˜ Î·È ÙË˜ ÈÛÙÔÏÔÁÈÎ‹˜ ÂÍ¤Ù·ÛË˜ Î·È ÙÔ˘ ·ÂÈÎÔÓÈÛÙÈÎÔ‡ÂÏ¤Á¯Ô˘. ∏ ÛÙ·‰ÈÔÔ›ËÛË ÙË˜ ÓfiÛÔ˘ Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ¤ÁÈÓÂÌÂ Ù· ÎÚÈÙ‹ÚÈ· Ann Arbor ÁÈ· Ù· ·È‰È¿ ÛÙ· ÔÔ›· ‰È·ÁÓÒÛÙË-ÎÂ HD, ÂÓÒ ÌÂ Ù· ÎÚÈÙ‹ÚÈ· Murphy ÁÈ· ÂÎÂ›Ó· ÌÂ NHL. ∏ ÂÏÂ‡-ıÂÚË ÓfiÛÔ˘ ÂÈ‚›ˆÛË ÛÂ ÚÒÙË ‡ÊÂÛË (event free survival -EFS) Î·È Ë Û˘ÓÔÏÈÎ‹ ÂÈ‚›ˆÛË ÙˆÓ ·ÛıÂÓÒÓ (overall survival -OS) ˘ÔÏÔÁ›ÛÙËÎ·Ó ÌÂ ÙË Ì¤ıÔ‰Ô Kaplan-Meier, ÌÂ Ì¤ÛÔ ¯Úfi-ÓÔ ·Ú·ÎÔÏÔ‡ıËÛË˜ Ù· 4,8 ¤ÙË Î·È Û˘Û¯ÂÙ›ÛÙËÎ·Ó ÌÂ ÙÈ˜ ÎÏÈÓÈ-Î¤˜ Î·È ÂÚÁ·ÛÙËÚÈ·Î¤˜ ·Ú·Ì¤ÙÚÔ˘˜ Ô˘ Î·Ù·ÁÚ¿ÊËÎ·Ó. ∏ÛÙ·ÙÈÛÙÈÎ‹ ÂÂÍÂÚÁ·Û›· Î·È ·Ó¿Ï˘ÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ¤ÁÈ-ÓÂ ÌÂ ÙÔ ÛÙ·ÙÈÛÙÈÎfi ·Î¤ÙÔ SPSS.

∞ÔÙÂÏ¤ÛÌ·Ù· ∞fi Ù· 38 ·È‰È¿ Ô˘ ÓÔÛËÏÂ‡ÙËÎ·Ó, 16 (42,1%)

Ù·ÍÈÓÔÌ‹ıËÎ·Ó ÛÙËÓ HD, ÂÓÒ 22 (57,9%) ÛÙ· NHL.∆· 27 (71,1%) ‹Ù·Ó ·ÁfiÚÈ· Î·È Ù· 11 (28,9%) ÎÔÚ›-ÙÛÈ·. ∏ Ì¤ÛË ËÏÈÎ›· Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ‹Ù·Ó 9 ¯Úfi-ÓÈ· (9±6,04). ∆Ô 60,5% ÙˆÓ ·È‰ÈÒÓ Â›¯Â ËÏÈÎ›· 5-10¯ÚfiÓˆÓ Î·È ÙÔ 31,5% Â›¯Â ËÏÈÎ›· >10 ¯ÚfiÓˆÓ. ∞fiÙË Û˘Û¯¤ÙÈÛË ÙÔ˘ Ù‡Ô˘ ÙÔ˘ ÏÂÌÊÒÌ·ÙÔ˜ ÌÂ ÙËÓËÏÈÎ›· ÚÔ¤Î˘„Â fiÙÈ ÛÙËÓ HD ÙÔ 50% ÙˆÓ ·È‰ÈÒÓ Â›-¯Â ËÏÈÎ›· >10 ¯ÚfiÓˆÓ Î·È ÙÔ 43,8% 5-10 ¯ÚfiÓˆÓ,ÂÓÒ ÛÙ· NHL ÙÔ 18,2% ‹Ù·Ó ËÏÈÎ›·˜ >10 ¯ÚfiÓˆÓ Î·ÈÙÔ 72,7% 5-10 ¯ÚfiÓˆÓ. ∞fi Ù· ·È‰È¿ ÌÂ HD, ÙÔ62,5% ‹Ù·Ó ·ÁfiÚÈ· (10 ·È‰È¿), ÂÓÒ ÛÙ· ·È‰È¿ ÌÂNHL ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ÔÛÔÛÙfi ‹Ù·Ó 77,3% (17 ·È‰È¿).

∞fi Ù· 38 ·È‰È¿, ÙÔ 68,4% (26 ·È‰È¿) Î·Ù¿ ÙËÓÂÈÛ·ÁˆÁ‹ Â›¯Â ·ÚÈıÌfi ÏÂ˘ÎÒÓ <10.000/mm3 Î·È ÙÔ23,7% 10.000-25.000/mm3. ∏ ÙÈÌ‹ ÙË˜ Hb ÛÙÔ73,7% ÙˆÓ ·È‰ÈÒÓ ‹Ù·Ó >10 g/dL Î·È Ô ·ÚÈıÌfi˜ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ ÛÙÔ 71,1% ÙˆÓ ·È‰ÈÒÓ Î˘Ì·ÈÓfi-Ù·Ó ·fi 100.000-450.000/mm3, ÂÓÒ ÛÙÔ 10,5%‹Ù·Ó >450.000/mm3. ∞˘ÍËÌ¤ÓË LDH >1000 U/L Â›-¯Â ÙÔ 26,3%, ÊÂÚÚÈÙ›ÓË >150 ng/dl ÙÔ 23,7% Î·ÈALP >250 U/L ÙÔ 63,2% ÙˆÓ ·È‰ÈÒÓ. ∞fi Ù· ÎÏÈÓÈ-Î¿ Â˘Ú‹Ì·Ù· ÙˆÓ ·È‰ÈÒÓ Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹, ÙÔ36,8% (10 ·È‰È¿) ÂÌÊ¿ÓÈ˙Â Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›·(>3 cm), ÙÔ 76,3% (29 ·È‰È¿) ÙÚ·¯ËÏÈÎ‹ ÏÂÌÊ·‰Â-ÓÔ¿ıÂÈ·, ÙÔ 73,7% (28 ·È‰È¿) ‰ÈÔÁÎˆÌ¤ÓÔ˘˜ ÏÂÌ-Ê·‰¤ÓÂ˜ ÌÂÛÔıˆÚ·Î›Ô˘ Î·È ÙÔ 26,3% (10 ·È‰È¿)ÔÈÛıÔÂÚÈÙÔÓ·˚ÎÔ‡˜. ¶˘ÚÂÙfi ·ÚÔ˘Û›·˙Â ÙÔ39,5% (15 ·È‰È¿), ·ÒÏÂÈ· ‚¿ÚÔ˘˜ ÙÔ 42,1% (16·È‰È¿) Î·È Ó˘ÎÙÂÚÈÓÔ‡˜ È‰ÚÒÙÂ˜ ÙÔ 26,3% ÙˆÓ ·È-‰ÈÒÓ. ™‡ÌÊˆÓ· ÌÂ ÙËÓ ÈÛÙÔÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË, 12 ·fiÙ· 16 ·È‰È¿, ÛÙ· ÔÔ›· Ë ‰È¿ÁÓˆÛË ‹Ù·Ó HD, Ù·ÍÈ-ÓÔÌ‹ıËÎ·Ó ÛÙÔÓ Ù‡Ô ÙË˜ Ô˙Ò‰Ô˘˜ ÛÎÏ‹Ú˘ÓÛË˜

(75%) Î·È 4 ÛÂ ÂÎÂ›ÓÔÓ ÙË˜ ÌÈÎÙ‹˜ Î˘ÙÙ·ÚÔ‚Ú›ıÂÈ·˜(25%). ∞fi Ù· ·È‰È¿ ÌÂ NHL, ÙÔ 54,5% (12 ·È‰È¿) Ù·-ÍÈÓÔÌ‹ıËÎÂ ÛÙ· ÏÂÌÊÔ‚Ï·ÛÙÈÎ¿ ÏÂÌÊÒÌ·Ù·, ÙÔ 41%ÛÙ· ·‰È·ÊÔÚÔÔ›ËÙ· (·fi ÌÈÎÚ¿ Î‡ÙÙ·Ú· ¯ˆÚ›˜ ÂÓÙÔ-Ì‹) Burkitt/ÌË Burkitt, ÂÓÒ, Ù¤ÏÔ˜, 1 ·È‰› ÌÂ Ki-1 Ï¤Ì-ÊˆÌ· Ù·ÍÈÓÔÌ‹ıËÎÂ ÛÙ· ·ÓÔÛÔ‚Ï·ÛÙÈÎ¿ ‹ ÈÛÙÈÔÎ˘ÙÙ·-ÚÈÎ¿ (ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ÔÛÔÛÙfi ‹Ù·Ó 4,5%) (∂ÈÎfiÓ· 1).

∏ Î·Ù·ÓÔÌ‹ Î·Ù¿ ÛÙ¿‰ÈÔ ‹Ù·Ó Ë ÂÍ‹˜: ÛÙ¿‰ÈÔ I7,9% (3 ·È‰È¿), ÛÙ¿‰ÈÔ II 52,6% (20 ·È‰È¿), ÛÙ¿‰ÈÔIII 31,6% (12 ·È‰È¿) Î·È ÛÙ¿‰ÈÔ IV 7,9% (3 ·È‰È¿).

∞fi ÙË Û˘Û¯¤ÙÈÛË ÙÔ˘ Ù‡Ô˘ ÙÔ˘ ÏÂÌÊÒÌ·ÙÔ˜ÌÂ ÙÔÓ ·ÚÈıÌfi ÙˆÓ ÏÂ˘ÎÒÓ ‰ÂÓ ÚÔ¤Î˘„Â Î·Ì›· Ô˘-ÛÈ·ÛÙÈÎ‹ ‰È·ÊÔÚ¿, ·ÊÔ‡ ÙÔ 68,8% ÙˆÓ ·È‰ÈÒÓ ÌÂHD Â›¯Â ·ÚÈıÌfi <10.000/mm3, ¤Ó·ÓÙÈ ÔÛÔÛÙÔ‡68,2% ÙˆÓ ·È‰ÈÒÓ ÌÂ NHL. ∞ÓÙ›ıÂÙ·, ·Ó·ÈÌ›· (Hb<10 g/dL) ··ÓÙ¿Ù·È Û˘¯ÓfiÙÂÚ· ÛÙ· ·È‰È¿ ÌÂNHL, ·ÊÔ‡ ‚Ú¤ıËÎÂ ÛÙÔ 36,4% (8 ·È‰È¿) ÌÂ NHL,ÂÓÒ ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ÔÛÔÛÙfi ÙˆÓ ·È‰ÈÒÓ ÌÂ HD‹Ù·Ó 12,5% (2 ·È‰È¿). ∞˘ÍËÌ¤ÓÔ˜ ·ÚÈıÌfi˜ ·ÈÌÔÂ-Ù·Ï›ˆÓ (>450.000/mm3) ‚Ú¤ıËÎÂ ÛÂ 4 ·È‰È¿ ÌÂ HD(25%), ÂÓÒ ÛÂ Î·Ó¤Ó· ·È‰› ÌÂ NHL. ∏ ÙÈÌ‹ ÙË˜ LDHÎ·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ‚Ú¤ıËÎÂ Ó· ¤¯ÂÈ ıÂÙÈÎ‹ Û˘Û¯¤-ÙÈÛË ÌÂ Ù· NHL, ·ÊÔ‡ 9 ·È‰È¿ ÌÂ NHL (40,9%) ·-ÚÔ˘Û›·˙·Ó ·‡ÍËÛË ÙË˜ ÙÈÌ‹˜ ÙË˜ (>1000 U/L). ∞ÓÙ›-ıÂÙ·, Ë ∆∫∂ Ê·›ÓÂÙ·È fiÙÈ ·ÚÔ˘ÛÈ¿˙ÂÈ ·‡ÍËÛË(>100 mm) Û˘¯ÓfiÙÂÚ· ÛÙ· ·È‰È¿ ÌÂ HD, ·ÊÔ‡‹Ù·Ó ·˘ÍËÌ¤ÓË ÛÙÔ 31,3% ·˘ÙÒÓ, ¤Ó·ÓÙÈ ÔÛÔÛÙÔ‡9,1% ÙˆÓ ·È‰ÈÒÓ ÌÂ NHL. ∏ ÙÈÌ‹ ÙË˜ ALP ‹Ù·Ó ·˘-ÍËÌ¤ÓË ÛÙÔ 68,8% ÙˆÓ ·È‰ÈÒÓ ÌÂ HD, ¤Ó·ÓÙÈ 59,1%ÙˆÓ ·È‰ÈÒÓ ÌÂ NHL (¶›Ó·Î·˜ 1). ∞fi Ù· ÎÏÈÓÈÎ¿ Â˘-Ú‹Ì·Ù· Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÚÔ¤Î˘„Â fiÙÈ ˘ÚÂÙfiÂ›¯Â ÙÔ 56,3% (9 ·È‰È¿) ÙˆÓ ·È‰ÈÒÓ ÌÂ HD Î·È ÙÔ

60

50

40

30

20

10

0 §ÂÌÊÔ‚Ï·ÛÙÈÎ¿

∞‰È·ÊÔÚÔÔ›ËÙ·

∞ÓÔÛÔ‚Ï·ÛÙÈÎ¿

4,5

41

54,5

∂ÈÎfiÓ· 1. ™¯ËÌ·ÙÈÎ‹ ·ÂÈÎfiÓÈÛË Î·È Û˘¯ÓfiÙËÙ· ÙˆÓ ÈÛÙÔÏÔÁÈ-ÎÒÓ Ù‡ˆÓ ÙˆÓ NHL.

May-June 03 03-06-03 16:55 ™ÂÏ›‰·197


198

27,3% ÂÎÂ›ÓˆÓ ÌÂ NHL (6 ·È‰È¿). ¡˘ÎÙÂÚÈÓÔ‡˜È‰ÚÒÙÂ˜ ·ÚÔ˘Û›·˙·Ó 5 ·È‰È¿ ·fi Î¿ıÂ ÔÌ¿‰·.∞ÒÏÂÈ· ‚¿ÚÔ˘˜ ÛÒÌ·ÙÔ˜ ·ÚÔ˘Û›·˙Â ÙÔ 37,5% ÌÂHD (6 ·È‰È¿) Î·È ÙÔ 45,5% ÌÂ NHL (10 ·È‰È¿). ™˘Ì-ÌÂÙÔ¯‹ ÙˆÓ ÔÈÛıÔÂÚÈÙÔÓ·˚ÎÒÓ ÏÂÌÊ·‰¤ÓˆÓ ·-ÚÔ˘Û›·˙Â ÙÔ 25% ÌÂ HD (4 ·È‰È¿), ¤Ó·ÓÙÈ 27,3% ÌÂNHL (6 ·È‰È¿). ∆Ú·¯ËÏÈÎ‹ ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ· Â›¯ÂÙÔ 75% ÌÂ HD (12 ·È‰È¿), ¤Ó·ÓÙÈ 77,3% ÙˆÓ ·È‰ÈÒÓÌÂ NHL (17 ·È‰È¿). ™˘ÌÌÂÙÔ¯‹ ÙˆÓ ÏÂÌÊ·‰¤ÓˆÓÙÔ˘ ÌÂÛÔıˆÚ·Î›Ô˘ ‚Ú¤ıËÎÂ ÛÙÔ 93,8% ÙˆÓ ·È‰ÈÒÓÌÂ HD (15 ·È‰È¿), ÂÓÒ ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ÔÛÔÛÙfi ÙˆÓ·È‰ÈÒÓ ÌÂ NHL ‹Ù·Ó 59,1% (13 ·È‰È¿) (¶›Ó·Î·˜ 2).

∆· ·È‰È¿ ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó ÌÂ Ù· ÚˆÙfiÎÔÏÏ·LSA2-L2, BFM Î·È ÙÔ ˘‚ÚÈ‰ÈÎfi ÚˆÙfiÎÔÏÏÔCOPP/ABVD, ·Ó¿ÏÔÁ· ÌÂ ÙÔÓ ÈÛÙÔÏÔÁÈÎfi Ù‡Ô. ∞fiÙ· 38 ·È‰È¿ Ô˘ ˘Ô‚Ï‹ıËÎ·Ó ÛÂ ¯ËÌÂÈÔıÂÚ·Â›·,10 (26,3%) ˘ÔÙÚÔ›·Û·Ó ÂÎ ÙˆÓ ÔÔ›ˆÓ 5 ÌÂ HD(29,4%) Î·È 5 ÌÂ NHL (23,8%), ÂÓÒ Î·Ù¤ÏËÍ·Ó 4 ·È-‰È¿ ÂÎ ÙˆÓ ÔÔ›ˆÓ 3 ÌÂ NHL (13,6%). ∞fi ·˘Ù¿, 2Î·Ù¤ÏËÍ·Ó Î·Ù¿ ÙË Ê¿ÛË ÙË˜ Û˘ÓÙ‹ÚËÛË˜ Î·È 1 ÛÙËÊ¿ÛË ÂÊfi‰Ô˘ ÙË˜ ıÂÚ·Â›·˜. ∞fi Ù· ·È‰È¿ ÌÂ HD,Î·Ù¤ÏËÍÂ 1 ÌÂÙ¿ ·fi ·˘ÙfiÏÔÁË ÌÂÙ·ÌfiÛ¯Â˘ÛË Ì˘Â-ÏÔ‡ ÙˆÓ ÔÛÙÒÓ, ÏfiÁˆ ˘ÔÙÚÔ‹˜ ÙË˜ ÓfiÛÔ˘ ‰‡Ô¯ÚfiÓÈ· ÌÂÙ¿ ÙËÓ ·Ú¯ÈÎ‹ ‰È¿ÁÓˆÛË.

∏ ÂÎÙ›ÌËÛË ÙË˜ Û˘ÓÔÏÈÎ‹˜ ÂÈ‚›ˆÛË˜ ÙˆÓ ·ÛıÂ-ÓÒÓ (overall survival) Î·È ÙË˜ ÂÈ‚›ˆÛË˜ ¯ˆÚ›˜ ÓfiÛÔÛÂ ÚÒÙË ‡ÊÂÛË (event-free survival) ÚÔÛ‰ÈÔÚ›-ÛÙËÎÂ ÌÂ ÙË Ì¤ıÔ‰Ô Kaplan-Meier, Û˘ÌÂÚÈÏ·Ì‚·-ÓÔÌ¤ÓˆÓ ÙÔ˘ ÛÙ·ıÂÚÔ‡ ÛÊ¿ÏÌ·ÙÔ˜ (standard error)Î·È 95% ÙÔ˘ ‰È·ÛÙ‹Ì·ÙÔ˜ ·ÍÈÔÈÛÙ›·˜ (confidenceinterval). ∏ ÂÈ‚›ˆÛË ¯ˆÚ›˜ ÓfiÛÔ ÛÂ ÚÒÙË ‡ÊÂÛË˘ÔÏÔÁ›ÛÙËÎÂ ·fi ÙËÓ ËÌÂÚÔÌËÓ›· ÙË˜ ‰È¿ÁÓˆÛË˜Ì¤¯ÚÈ ÙËÓ ËÌÂÚÔÌËÓ›· Ô˘ ·ÚÔ˘ÛÈ¿ÛÙËÎÂ ˘ÔÙÚÔ-‹, ·ÔÙ˘¯›· Ï‹ÚÔ˘˜ ‡ÊÂÛË˜, ı¿Ó·ÙÔ˜ ‹ ·Ó¿Ù˘-ÍË ‰Â‡ÙÂÚÔ˘ ÓÂÔÏ¿ÛÌ·ÙÔ˜. ∏ EFS ÛÂ ÚÒÙË ‡ÊÂ-ÛË Â›Ó·È 77,05% (±6,58%) Î·È Ë OS 91,27%(±4,36%). ∏ ·Ó¿Ï˘ÛË ÙË˜ Èı·ÓfiÙËÙ·˜ EFS ÛÂ Û¯¤-ÛË ÌÂ ÙÔÓ Ù‡Ô ÙÔ˘ ÏÂÌÊÒÌ·ÙÔ˜ ‹Ù·Ó 71,79%(±11,58%) ÁÈ· ÙËÓ HD, ¤Ó·ÓÙÈ 79,6% (±8,02%) ÁÈ·Ù· ·È‰È¿ ÌÂ NHL. ∏ Èı·ÓfiÙËÙ· EFS ÌÂ ‚¿ÛË ÙËÓËÏÈÎ›· ÁÈ· ÙÔ˘˜ ·ÛıÂÓÂ›˜ ËÏÈÎ›·˜ <10 ¯ÚfiÓˆÓ ‹Ù·Ó

79,78% (±7,9%), ÂÓÒ ÁÈ· ÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ ËÏÈÎ›·>10 ¤ÙË ‹Ù·Ó 82,39% (±11,22%), ‰È·ÊÔÚ¿ Ô˘ ‰ÂÓ‹Ù·Ó ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹. H EFS Â›¯Â ÛÙ·ÙÈÛÙÈÎ¿ÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿ ÛÂ Û¯¤ÛË ÌÂ ÙÔ ÛÙ¿‰ÈÔ ÙÔ˘·ÛıÂÓÔ‡˜ Î·Ù¿ ÙË ‰È¿ÁÓˆÛË Î·È ‹Ù·Ó 95,12%(±4,73%) ÁÈ· ÙÔ˘˜ ·ÛıÂÓÂ›˜ π Î·È II ÛÙ·‰›Ô˘, ÂÓÒÌÂÈˆÓfiÙ·Ó ÛÙÔ 50% (±26,87%) ÁÈ· ÂÎÂ›ÓÔ˘˜ πππ Î·ÈIV ÛÙ·‰›Ô˘. ∏ Èı·ÓfiÙËÙ· EFS ÙˆÓ ·È‰ÈÒÓ ÌÂ ‹ ¯ˆ-Ú›˜ ˘ÚÂÙfi ‹Ù·Ó 67,46 (±11,49%) Î·È 83,35%(±7,52%) ·ÓÙ›ÛÙÔÈ¯·, ‰È·ÊÔÚ¿ ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈ-Î‹ (p<0,01). ∂›ÛË˜, Ë Èı·ÓfiÙËÙ· EFS ÁÈ· ÙÔ˘˜·ÛıÂÓÂ›˜ ÌÂ ‹ ¯ˆÚ›˜ ·ÒÏÂÈ· ‚¿ÚÔ˘˜ ‹Ù·Ó 60,73%(±10,95%) Î·È 90,59% (±6,31%) ·ÓÙ›ÛÙÔÈ¯·, ‰È·ÊÔ-Ú¿ ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ (p<0,01). ∞fi Ù· ÂÚÁ·-ÛÙËÚÈ·Î¿ Â˘Ú‹Ì·Ù· ÚÔ¤Î˘„Â fiÙÈ ÁÈ· ÙÔ˘˜ ·ÛıÂ-ÓÂ›˜ ÌÂ ¯·ÌËÏ¿ ÏÂ˘Î¿ ·ÈÌÔÛÊ·›ÚÈ· Ë EFS ‹Ù·Ó87,9% (±6,53%), ÂÓÒ ÁÈ· ÂÎÂ›ÓÔ˘˜ ÌÂ ·˘ÍËÌ¤Ó·‹Ù·Ó 63,11% (±13,85%), ‰È·ÊÔÚ¿ ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·-ÓÙÈÎ‹. ∆Ô ›‰ÈÔ ÈÛ¯‡ÂÈ ÁÈ· ÙËÓ ÙÈÌ‹ ÙË˜ Hb, fiÔ˘ ·-Ú·ÙËÚ‹Û·ÌÂ fiÙÈ Ë EFS ‹Ù·Ó 56,3% (±15,94%) ÁÈ·ÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ ̄ ·ÌËÏ‹ Hb Î·È ¤ÊÙ·ÓÂ ÛÙÔ 83,74%(±6,53%) ÁÈ· ÂÎÂ›ÓÔ˘˜ ÌÂ Hb >10 g/dL, ‰È·ÊÔÚ¿ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ (p<0,01). ∆¤ÏÔ˜, Ë Èı·ÓfiÙË-Ù· EFS ÛÙ· ·È‰È¿ ÌÂ ‹ ¯ˆÚ›˜ ÛÏËÓÔÌÂÁ·Ï›· ‹Ù·Ó51,53% (±11,79%) Î·È 95,59% (±4,31%) ·ÓÙ›ÛÙÔÈ¯·,‰È·ÊÔÚ¿ ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹.

ø˜ ÚÔ˜ ÙËÓ Â›ÙˆÛË ÙÔ˘ ÈÛÙÔÏÔÁÈÎÔ‡ Ù‡Ô˘ÙˆÓ ·È‰ÈÒÓ ÌÂ NHL ÛÙËÓ ÚfiÁÓˆÛË, ÙÔ ÏÂÌÊÔ‚Ï·-ÛÙÈÎfi Ï¤ÌÊˆÌ· Â›¯Â ÙËÓ Î·Ï‡ÙÂÚË ÚfiÁÓˆÛË ÌÂ È-ı·ÓfiÙËÙ· EFS 92,8% (±6,83%), ÂÓÒ ÙÔ ·ÓÙ›ÛÙÔÈ¯ÔÔÛÔÛÙfi ÁÈ· Ù· ·È‰È¿ ÌÂ ·‰È·ÊÔÚÔÔ›ËÙÔ Ï¤ÌÊˆÌ·‹Ù·Ó 63% (±20,31%). ∞fi Ù· ·È‰È¿ ÌÂ HD, Î·Ï‡ÙÂ-ÚË ÚfiÁÓˆÛË Â›¯·Ó ÂÎÂ›Ó· ÌÂ ÙÔÓ ÈÛÙÔÏÔÁÈÎfi Ù‡ÔÙË˜ Ô˙Ò‰Ô˘˜ ÛÎÏ‹Ú˘ÓÛË˜, fiÔ˘ Ë EFS ‹Ù·Ó 78,25%(±13,32%), ÂÓÒ ÛÙÔÓ Ù‡Ô ÙË˜ ÌÈÎÙ‹˜ Î˘ÙÙ·ÚÔ‚Ú›-ıÂÈ·˜ ÙÔ ÔÛÔÛÙfi ‹Ù·Ó 59,75% (±20,46%).

™˘˙‹ÙËÛË ∆· ÏÂÌÊÒÌ·Ù· Hodgkin Î·È ÌË, ·ÔÙÂÏÔ‡Ó ‰È·-

ÊÔÚÂÙÈÎ¤˜ ÓÔÛÔÏÔÁÈÎ¤˜ ÔÓÙfiÙËÙÂ˜, ÌÂ ‰È·ÊÔÚÂÙÈÎ‹ÎÏÈÓÈÎ‹ Î·È ‚ÈÔÏÔÁÈÎ‹ Û˘ÌÂÚÈÊÔÚ¿, ‰È·ÊÔÚÂÙÈÎ‹

¶›Ó·Î·˜ 1. ¢È·ÊÔÚ¤˜ ÙˆÓ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ·Ú·Ì¤ÙÚˆÓ ÛÙ· ·È‰È¿ ÌÂ HD Î·È NHL

WBC <10.000/mm3 Hb >10 g/dL PLT >450.000/mm3 LDH >1000 U/L ∆∫∂ >100 mm ALP >250 U/L

HD 68,8% 87,5% 25% 7% 31,3% 68,8%NHL 68,2% 63,6% 0 40,9% 9,1% 59,1%

¶›Ó·Î·˜ 2. ∫ÏÈÓÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙˆÓ ·È‰ÈÒÓ ÌÂ HD Î·È NHL

¶˘ÚÂÙfi˜ ∞ÒÏÂÈ· ‚¿ÚÔ˘˜ π‰ÚÒÙÂ˜ ∆Ú·¯ËÏÈÎ‹ ÏÂÌÊ·‰ÂÓ›ÙÈ‰·

HD 56,3% 37,5% 31% 75%NHL 27,3% 45,5% 22% 77,3%

May-June 03 03-06-03 16:55 ™ÂÏ›‰·198


199

Î˘ÙÙ·ÚÈÎ‹ ÚÔ¤ÏÂ˘ÛË, ÂÓÙfiÈÛË Î·È ·ÚÔ˘Û›· Î˘Ù-Ù·ÚÔÁÂÓÂÙÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ (¶›Ó·Î·˜ 3).

∏ ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· ÙˆÓ NHL ÂÍ·ÚÙ¿Ù·È ·fi ÙËÓÚˆÙÔ·ı‹ ÂÓÙfiÈÛ‹ ÙÔ˘˜. ∂ÌÊ·Ó›˙ÔÓÙ·È ÌÂ ÔÈÎ›-ÏÂ˜ ÎÏÈÓÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ Î·È Û˘¯Ó¿ Ë ÓfiÛÔ˜ Â›Ó·ÈÁÂÓÈÎÂ˘Ì¤ÓË Î·Ù¿ ÙË ‰È¿ÁÓˆÛË, ·ÊÔ‡ Ù· NHL ÛÙÈ˜ÂÚÈÛÛfiÙÂÚÂ˜ ÂÚÈÙÒÛÂÈ˜ ÙˆÓ ·È‰ÈÒÓ Â›Ó·È ‰È¿-¯˘Ù· Î·È ˘„ËÏ‹˜ Î·ÎÔ‹ıÂÈ·˜ (1,4). ™˘¯Ó¤˜ Â›Ó·ÈÂ›ÛË˜ Î·È ÔÈ ·ÔÌ·ÎÚ˘ÛÌ¤ÓÂ˜ ÌÂÙ·ÛÙ¿ÛÂÈ˜. ¶ÂÚ›-Ô˘ ÙÔ 50% ÙˆÓ NHL ÛÙ· ·È‰È¿ Â›Ó·È ∆-Î˘ÙÙ·ÚÈÎ‹˜ÚÔ¤ÏÂ˘ÛË˜, ÂÓÒ ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ÔÛÔÛÙfi ÛÙÔ˘˜ÂÓËÏ›ÎÔ˘˜ Â›Ó·È 5% (9). ∏ Î·Ù·ÓÔÌ‹ ÙˆÓ NHL ÛÙ··È‰È¿ ÌÂ ‚¿ÛË ÙÔÓ ÈÛÙÔÏÔÁÈÎfi ÙÔ˘˜ Ù‡Ô Ê·›ÓÂÙ·ÈÛÙÔÓ ¶›Ó·Î· 4. ∏ Û˘¯ÓfiÙËÙ· ÙË˜ ÚˆÙÔ·ıÔ‡˜ÂÓÙfiÈÛË˜ ÛÙÔ ÌÂÛÔıˆÚ¿ÎÈÔ Î·È ÛÙËÓ ÎÔÈÏÈ¿ Â›Ó·ÈÂÚ›Ô˘ Ù·˘ÙfiÛËÌË (30-40%) Î·È ÂÍ·ÚÙ¿Ù·È Î˘Ú›ˆ˜·fi ÙÔÓ ÈÛÙÔÏÔÁÈÎfi Ù‡Ô (2,5,9). ™Â ·È‰È¿ ÌÂ ÏÂÌ-ÊÔ‚Ï·ÛÙÈÎfi Ï¤ÌÊˆÌ· (Î˘Ú›ˆ˜ ∆-Î˘ÙÙ·ÚÈÎ‹˜ ÚÔ¤-ÏÂ˘ÛË˜), Ë ÓfiÛÔ˜ ÂÎ‰ËÏÒÓÂÙ·È Û˘Ó‹ıˆ˜ ˆ˜ Ì¿˙·ÛÙÔ ÌÂÛÔıˆÚ¿ÎÈÔ ÛÂ ÔÛÔÛÙfi Ô˘ Î˘Ì·›ÓÂÙ·È ·fi50-70%, ÂÓÒ ÛÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË ÙÔ ·ÓÙ›ÛÙÔÈ¯ÔÔÛÔÛÙfi ·Ó‹ÏıÂ ÛÙÔ 75%, ÌÂ Ù·˘Ùfi¯ÚÔÓË ·ÚÔ˘-Û›· ÙÚ·¯ËÏÈÎ‹˜ ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ·˜ (2,10). ∞ÓÙ›ıÂÙ·,ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ ·‰È·ÊÔÚÔÔ›ËÙÔ NHL(Burkitt/non Burkitt) ‹ µ Î˘ÙÙ·ÚÈÎ‹˜ ÚÔ¤ÏÂ˘ÛË˜ Â›-Ó·È Û˘¯ÓfiÙÂÚË Ë ·ÓÂ‡ÚÂÛË ÎÔÈÏÈ·Î‹˜ Ì¿˙·˜ (70-90%) Î·È ·ÔÙÂÏÂ› ÙÔ Û˘¯ÓfiÙÂÚÔ ·›ÙÈÔ ÂÁÎÔÏÂ·ÛÌÔ‡ÛÙ· ·È‰È¿ ËÏÈÎ›·˜ >6 ¯ÚfiÓˆÓ (9-11). ÕÏÏÂ˜ Û·-ÓÈfiÙÂÚÂ˜ ÚˆÙÔ·ıÂ›˜ ÂÓÙÔ›ÛÂÈ˜ ·ÔÙÂÏÔ‡Ó ÙÔ‰¤ÚÌ· Î·È Ô ˘Ô‰fiÚÈÔ˜ ÈÛÙfi˜, Ô ı˘ÚÂÔÂÈ‰‹˜ ·‰¤-Ó·˜, ÔÈ ÓÂÊÚÔ›, ÂÓÒ ÌÔÚÂ› Ó· Û˘Ó˘¿Ú¯ÂÈ Î·È ‰È‹-ıËÛË ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ (2,12,13).

∞ÓÙ›ıÂÙ·, ÛÙËÓ HD Ë Û˘¯ÓfiÙÂÚË ÎÏÈÓÈÎ‹ ÂÎ‰‹Ïˆ-ÛË ÙË˜ ÓfiÛÔ˘ Â›Ó·È Ë ·ÓÒ‰˘ÓË ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ·ÛÂ ÔÛÔÛÙfi Ô˘ Î˘Ì·›ÓÂÙ·È ·fi 75-90% Î·È ·ÊÔÚ¿Î˘Ú›ˆ˜ ÛÙÔ˘˜ ÙÚ·¯ËÏÈÎÔ‡˜ ÏÂÌÊ·‰¤ÓÂ˜ ÛÙÔ 60-80%, ÂÓÒ ·fi Ù· ‰Â‰ÔÌ¤Ó· ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ÔÛÔÛÙfi ·Ó‹ÏıÂ ÛÙÔ 76,5%. OÈ ·‰¤-ÓÂ˜ Â›Ó·È ·ÓÒ‰˘ÓÔÈ, ˘fiÛÎÏËÚÔÈ, ‰ÂÓ Û˘ÌÊ‡ÔÓÙ·ÈÌÂ ÙÔ˘˜ Á‡Úˆ ÈÛÙÔ‡˜ Î·È ‰ÂÓ ÊÏÂÁÌ·›ÓÔ˘Ó (8,14).¢ÈfiÁÎˆÛË ÙˆÓ ·‰¤ÓˆÓ ÙÔ˘ ÌÂÛÔıˆÚ·Î›Ô˘ ·ÚÔ˘-ÛÈ¿˙ÂÈ ÙÔ 60% ÂÚ›Ô˘ ÙˆÓ ·È‰ÈÒÓ (ÙÔ ÔÛÔÛÙfiÛÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË ‹Ù·Ó 88,2%, ÂÓÒ ÁÈ· Ù· NHL61,9%). ™ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ ·˘Ù¤˜, ÔÈ Ì¿˙Â˜ ÛÙÔ ÌÂ-ÛÔıˆÚ¿ÎÈÔ ÌÔÚÔ‡Ó Ó· ÚÔÎ·Ï¤ÛÔ˘Ó ›ÂÛË ÙˆÓ·ÂÚÔÊfiÚˆÓ Ô‰ÒÓ ‹ ÙË˜ ¿Óˆ ÎÔ›ÏË˜ ÊÏ¤‚·˜ Î·ÈÛ˘ÏÏÔÁ‹ ˘ÁÚÔ‡ ÛÙËÓ ˘Â˙ˆÎÔÙÈÎ‹ ÎÔÈÏfiÙËÙ·. OÛÏ‹Ó·˜ ‚Ú›ÛÎÂÙ·È ‰ÈÔÁÎˆÌ¤ÓÔ˜ ÛÂ ÔÛÔÛÙfi 60-70% Î·È ÙÔ ‹·Ú ÛÙÔ 20-40% (8,14,15). ∆Ô ‚·ÛÈÎfi‰È·ÁÓˆÛÙÈÎfi ÈÛÙÔÏÔÁÈÎfi Â‡ÚËÌ· Â›Ó·È Ë ·ÓÂ‡ÚÂÛËÙˆÓ Î˘ÙÙ¿ÚˆÓ Reed-Sternberg, Ù· ÔÔ›· Â›Ó·È ÌÂ-Á¿Ï· Î‡ÙÙ·Ú· ÌÂ ‰‡Ô ˘Ú‹ÓÂ˜. OÈ ÈÛÙÔ·ıÔÏÔÁÈÎÔ›Ù‡ÔÈ ÙË˜ ÓfiÛÔ˘ ÙÔ˘ Hodgkin, Î·ıÒ˜ Î·È Ë Û˘¯Ófi-ÙËÙ¿ ÙÔ˘˜ ÛÙ· ·È‰È¿ Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 5.

ªÔÚÂ› Ó· Û˘Ó˘¿Ú¯Ô˘Ó ÁÂÓÈÎ¿ Û˘ÌÙÒÌ·Ù·fiˆ˜ ˘ÚÂÙfi˜, ·ÒÏÂÈ· ‚¿ÚÔ˘˜ >10% ÙÔ ÙÂÏÂ˘-Ù·›Ô ÂÍ¿ÌËÓÔ, È‰ÚÒÙÂ˜, ·‰˘Ó·Ì›· Î·È Î·Ù·‚ÔÏ‹. ∂›-Ó·È, fiÌˆ˜, Û˘¯ÓfiÙÂÚ· ÛÙËÓ HD, ·ÊÔ‡ ·Ó·Ê¤ÚÂÙ·ÈfiÙÈ ·Ú·ÙËÚÔ‡ÓÙ·È ÛÙÔ 30% ÂÚ›Ô˘ ÙˆÓ ·È‰ÈÒÓ.∆Ô ÁÂÁÔÓfi˜ ·˘Ùfi Û˘ÌÊˆÓÂ› ÌÂ Ù· ‰Â‰ÔÌ¤Ó· ÙË˜ ·-ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜, ·ÊÔ‡ Ù· ·Ú·¿Óˆ Û˘ÌÙÒÌ·Ù·‚Ú¤ıËÎ·Ó ÛÂ ÔÛÔÛÙfi Ô˘ Î˘Ì¿ÓıËÎÂ ·fi 30-50%.O ··Ú·›ÙËÙÔ˜ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ÂÚÈÏ·Ì-‚¿ÓÂÈ ÙË ÁÂÓÈÎ‹ ·›Ì·ÙÔ˜, ÙÔÓ ¤ÏÂÁ¯Ô ÙË˜ ÓÂÊÚÈÎ‹˜Î·È Ë·ÙÈÎ‹˜ ÏÂÈÙÔ˘ÚÁ›·˜, ÙËÓ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·-Î·, ÙÔ Ì˘ÂÏfiÁÚ·ÌÌ· Î·È ÙËÓ ÔÛÙÂÔÌ˘ÂÏÈÎ‹ ‚ÈÔ„›·,ÙËÓ Î˘ÙÙ·ÚÔÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË ÙÔ˘ ∂¡À, ÙËÓ ·ÍÔÓÈÎ‹ ‹Ì·ÁÓËÙÈÎ‹ ÙÔÌÔÁÚ·Ê›·, ÙÔ ˘ÂÚË¯ÔÁÚ¿ÊËÌ· ÎÔÈ-Ï›·˜ Î·È ÙÔÓ ÈÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô (1,4,8). ™Ù· ÏÂÌÊÒÌ·-Ù· Â›Ó·È Û˘¯ÓfiÙÂÚË Ë ÏÂ˘ÎÔÎ˘ÙÙ¿ÚˆÛË Î·È Ë ·Ó·È-Ì›· Î·È Û¿ÓÈ· Û˘Ó˘¿Ú¯ÂÈ ıÚÔÌ‚ÔÂÓ›· (16). ∆·‰Â‰ÔÌ¤Ó· ·˘Ù¿ Û˘ÌÊˆÓÔ‡Ó ÌÂ Ù· Â˘Ú‹Ì·Ù· ÙË˜Û˘ÁÎÂÎÚÈÌ¤ÓË˜ ÌÂÏ¤ÙË˜, ÂÊfiÛÔÓ ÏÂ˘ÎÔÎ˘ÙÙ¿ÚˆÛËÂ›¯Â ÙÔ 31,6% (WBC >10.000/mm3) Î·È ·Ó·ÈÌ›· ÙÔ26,3% ÙˆÓ ·È‰ÈÒÓ.

∆Ô ÔÛÔÛÙfi ÂÈ‚›ˆÛË˜ ÙˆÓ NHL ÙË˜ ·È‰ÈÎ‹˜ËÏÈÎ›·˜ ÂÍ·ÚÙ¿Ù·È Î˘Ú›ˆ˜ ·fi ÙÔ ÛÙ¿‰ÈÔ Î·Ù¿ ÙË‰È¿ÁÓˆÛË Î·È ·fi ÙÔ ÚˆÙfiÎÔÏÏÔ ıÂÚ·Â›·˜ Î·ÈÎ˘Ì·›ÓÂÙ·È ·fi 50-80%, ÂÓÒ Ë EFS ·fi 75-90%

¶›Ó·Î·˜ 3. ¢È·ÊÔÚ¤˜ ÌÂÙ·Í‡ ÙË˜ HD Î·È ÙË˜ NHL

HD NHL

¶ÚÔ¤ÏÂ˘ÛË Î˘ÙÙ¿ÚˆÓ ∞‰ÈÂ˘ÎÚ›ÓÈÛÙË µ ‹ ∆-Î‡ÙÙ·Ú·∂ÓÙÔÈÛÌ¤ÓË ÓfiÛÔ˜ ™˘¯Ó¿ ™¿ÓÈ·∂¤ÎÙ·ÛË ÙË˜ ÓfiÛÔ˘ ∂È¯ÒÚÈÔ˘˜ ∞ÔÌ·ÎÚ˘ÛÌ¤ÓÔ˘˜ªÂÛÔıˆÚ¿ÎÈÔ ™˘¯Ó¿ ™¿ÓÈ·∫ÔÈÏ›· ™¿ÓÈ· ™˘¯Ó¿™˘ÛÙËÌ·ÙÈÎ¤˜ÂÎ‰ËÏÒÛÂÈ˜ ™˘¯Ó¿ ™¿ÓÈ·ÃÚˆÌÔÛˆÌÈÎ¤˜ ÌÂÙ·ı¤ÛÂÈ˜ Ÿ¯È ™˘¯Ó¿

¶›Ó·Î·˜ 4. IÛÙÔÏÔÁÈÎÔ› Ù‡ÔÈ Î·È Û˘¯ÓfiÙËÙ· ÙˆÓ NHL

πÛÙÔÏÔÁÈÎfi˜ Ù‡Ô˜ ¢Â›ÎÙË˜ ™˘¯ÓfiÙËÙ·

§ÂÌÊÔ‚Ï·ÛÙÈÎfi ∆ Î‡ÙÙ·ÚÔ, ¿ˆÚÔ ÚÔ µ 30-40%πÛÙÈÔÎ˘ÙÙ·ÚÈÎfi µ, ÌË ∆, ÌË µ Î‡ÙÙ·ÚÔ 10-15%∞‰È·ÊÔÚÔÔ›ËÙÔ(Burkitt, ÌË Burkitt) µ Î‡ÙÙ·ÚÔ 40-50%ÕÏÏ· 5%

¶›Ó·Î·˜ 5. πÛÙÔÏÔÁÈÎÔ› Ù‡ÔÈ Î·È Û˘¯ÓfiÙËÙ· ÙË˜ HD

πÛÙÔÏÔÁÈÎfi˜ Ù‡Ô˜ ™˘¯ÓfiÙËÙ·

§ÂÌÊÔÎ˘ÙÙ·ÚÈÎfi˜ Ù‡Ô˜ 5-15%O˙Ò‰Ë˜ ÛÎÏËÚ˘ÓÙÈÎfi˜ 40-60%ªÈÎÙ‹˜ Î˘ÙÙ·ÚÔ‚Ú›ıÂÈ·˜ 15-30%§ÂÌÊÔÂÓÈÎfi˜ <5%

May-June 03 03-06-03 16:55 ™ÂÏ›‰·199


200

(2,3,17). OÈ ˘ÔÙÚÔ¤˜ Â›Ó·È ÚÒÈÌÂ˜ ÛÙ· B-NHL,ÂÓÒ ·ÓÙ›ıÂÙ· fi„ÈÌÂ˜ ÛÙ· T-NHL (1). ™Ù· ·È‰È¿ ÌÂHD, Ë Û˘ÓÔÏÈÎ‹ ÂÈ‚›ˆÛË Î˘Ì·›ÓÂÙ·È ÌÂÙ·Í‡ 80-95% Î·È Ë EFS ·fi 70-90% (3,18,19). ∞fi Ù· ·Ú·-¿Óˆ ‰Â‰ÔÌ¤Ó· ÚÔ¤Î˘„Â fiÙÈ Ë EFS ÛÂ ÚÒÙË ‡ÊÂ-ÛË ÁÈ· ÙÔ Û‡ÓÔÏÔ ÙˆÓ 38 ·È‰ÈÒÓ ÌÂ Ï¤ÌÊˆÌ· Â›Ó·È77,05% (±6,58%) Î·È Ë OS 91,27% (±4,36%). ∏·Ó¿Ï˘ÛË ÙË˜ Èı·ÓfiÙËÙ·˜ EFS ÛÂ Û¯¤ÛË ÌÂ ÙÔÓ Ù‡-Ô ÙÔ˘ ÏÂÌÊÒÌ·ÙÔ˜ Â›Ó·È 71,79% (±11,58%) ÁÈ·ÙËÓ HD, ¤Ó·ÓÙÈ 79,6% (±8,02%) ÁÈ· Ù· NHL, ÁÂÁÔ-Ófi˜ Ô˘ ¤Ú¯ÂÙ·È ÛÂ ·ÓÙ›ıÂÛË ÌÂ Ù· ‚È‚ÏÈÔÁÚ·ÊÈÎ¿‰Â‰ÔÌ¤Ó·, ÌfiÓÔ ˆ˜ ÚÔ˜ Ù· ÏÂÌÊÒÌ·Ù· Hodgkin.∏ Î·Î‹ ·ÓÙ·fiÎÚÈÛË ÛÙË ıÂÚ·Â›· ÙˆÓ ·È‰ÈÒÓ ÙË˜·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ ÌÂ HD Î·È Ë ¯·ÌËÏfiÙÂÚË - ÛÂÛ¯¤ÛË ÌÂ ÙË ‚È‚ÏÈÔÁÚ·Ê›· - EFS ÔÊÂ›ÏÔÓÙ·È ÛÙÔÚÔ¯ˆÚËÌ¤ÓÔ ÛÙ¿‰ÈÔ ÙË˜ ÓfiÛÔ˘ Î·Ù¿ ÙË ‰È¿ÁÓˆÛË.∂›Ó·È ÁÓˆÛÙfi, ÂÍ¿ÏÏÔ˘, fiÙÈ ÙÔ ÛÙ¿‰ÈÔ ÙÔ˘ ÏÂÌÊÒ-Ì·ÙÔ˜ Î·Ù¿ ÙË ‰È¿ÁÓˆÛË ·ÔÙÂÏÂ› ÙÔÓ ÛÔ˘‰·ÈfiÙÂ-ÚÔ ÚÔÁÓˆÛÙÈÎfi ‰Â›ÎÙË, Û‡ÌÊˆÓ· ÌÂ Ù· ‰ÈÂıÓ‹ ‚È-‚ÏÈÔÁÚ·ÊÈÎ¿ ‰Â‰ÔÌ¤Ó· Î·È Û˘ÌÊˆÓÂ› ·fiÏ˘Ù· ÌÂÙ· Â˘Ú‹Ì·Ù· ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜, ·ÊÔ‡ ÚÔ¤-Î˘„Â fiÙÈ Ë EFS fiÛÔÓ ·ÊÔÚ¿ ÛÙÔ ÛÙ¿‰ÈÔ ÙÔ˘ ·ÛıÂ-ÓÔ‡˜ Î·Ù¿ ÙË ‰È¿ÁÓˆÛË ‹Ù·Ó 95,12% (±4,73%) ÁÈ·ÙÔ˘˜ ·ÛıÂÓÂ›˜ I Î·È II ÛÙ·‰›Ô˘, ÂÓÒ ÌÂÈˆÓfiÙ·Ó ÛÙÔ50% (±26,87%) ÁÈ· ÂÎÂ›ÓÔ˘˜ πππ Î·È IV ÛÙ·‰›Ô˘.

™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, ÚÔÎ‡ÙÂÈ fiÙÈ ÌÂ Ù· Û‡Á¯ÚÔÓ·ıÂÚ·Â˘ÙÈÎ¿ ÚˆÙfiÎÔÏÏ· Ë OS Î·È Ë EFS Î·Ù·-ÁÚ¿ÊËÎ·Ó ÛÂ Ï‹ÚË ·ÓÙÈÛÙÔÈ¯›· ÌÂ Ù· ‰ÈÂıÓ‹ ‚È-‚ÏÈÔÁÚ·ÊÈÎ¿ ‰Â‰ÔÌ¤Ó·, ÂÓÒ ÛËÌ·ÓÙÈÎfi Â›Ó·È Â›ÛË˜ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ·Ú·ÙËÚÂ›Ù·È Î·Ï‡ÙÂÚË ¤Î‚·ÛË ÁÈ·Ù· ·È‰È¿ ÌÂ NHL. ∞˘Ùfi ÔÊÂ›ÏÂÙ·È Èı·ÓÒ˜ ÛÙËÓ ·-ÚÔ˘Û›· ÎÏÈÓÈÎÒÓ Û˘ÌÙˆÌ¿ÙˆÓ Ô˘ ÂÈ‚¿ÏÏÔ˘Ó ÙËÓ¤ÁÎ·ÈÚË ÚÔÛ¤ÏÂ˘ÛË, ‰È¿ÁÓˆÛË Î·È ıÂÚ·Â˘ÙÈÎ‹·ÓÙÈÌÂÙÒÈÛË, ÛÂ ·ÓÙ›ıÂÛË ÌÂ Ù· ·È‰È¿ ÌÂ HD, Ù·ÔÔ›· Î·Ù¿ ÙË ‰È¿ÁÓˆÛË Â›Ó·È ˘„ËÏÔ‡ ÛÙ·‰›Ô˘.

™˘ÓÂÒ˜, ·ÔÙÂÏÂ› ‚·ÛÈÎfi Ì¤ÏËÌ· Î·È Â˘ı‡ÓËÙˆÓ ·È‰È¿ÙÚˆÓ ·ÈÌ·ÙÔÏfiÁˆÓ, Ô˘ Â›Ó·È Î·È ˘Â‡-ı˘ÓÔÈ ÁÈ· ÙË ‰È¿ÁÓˆÛË Î·È ÙË ıÂÚ·Â˘ÙÈÎ‹ ·ÓÙÈÌÂ-ÙÒÈÛË ÙˆÓ ·È‰ÈÒÓ ·˘ÙÒÓ, Ó· ÂÈÛËÌ¿ÓÔ˘Ó ÙËÓ·Í›· ÙË˜ ¤ÁÎ·ÈÚË˜ ·Ú·ÔÌ‹˜ ·È‰ÈÒÓ ÌÂ ‰ÈÔÁÎˆ-Ì¤ÓÔ˘˜ ÏÂÌÊ·‰¤ÓÂ˜ ‹ ÌÂ Û˘ÌÙÒÌ·Ù· ¯·Ú·ÎÙËÚÈ-ÛÙÈÎ¿ ÙˆÓ ÏÂÌÊˆÌ¿ÙˆÓ ÛÂ ÂÈ‰ÈÎ¤˜ ·È‰È·ÙÚÈÎ¤˜ ÌÔ-Ó¿‰Â˜, ·ÊÔ‡ ÙÔ ÛÙ¿‰ÈÔ ÙË˜ ÓfiÛÔ˘ Î·Ù¿ ÙË ‰È¿ÁÓˆ-ÛË ·ÔÙÂÏÂ› ÙÔ ÎÚ›ÛÈÌÔ ÛËÌÂ›Ô ÁÈ· ÙËÓ Â˘ÓÔ˚Î‹ Úfi-ÁÓˆÛË ÙˆÓ ·È‰ÈÒÓ ·˘ÙÒÓ.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Lanzkowsky P. Pediatric haematology and oncology. 3rd

ed. New York: University Press; 2000. 2. Shad A, Magrath I. Malignant non-Hodgkin’s lymphoma in

children. In: Pizzo PA, Poplack DG, editors. Principles andpractices of pediatric oncology. Philadelphia: Lippincott-Raven; 1997. p. 545-587.

3. Zhao G, Boysen CD, Brown EF, Hassanein KM, Holmes FF,

Holmes GE. Very long survival in pediatric cancer between1944 and 1993. Chin Med J (Engl) 1999;112:615-619.

4. Buyukpamukcu M. Non-Hodgkin’s lymphomas. In: VoutePA, Kalifa C, Barrett A, editors. Cancer in Children: ClinicalManagement. 4th ed. Oxford: Oxford University Press; 1998.p. 119-136.

5. Weidmann C, Black RJ, Masuyer E, Parkin DM. Incidence ofnon-Hodgkin’s lymphoma in children between 1970 and1990 in nine European countries. Eur J Cancer1999;35:1235-1237.

6. Ojesina AI, Akang EE, Ojemakinde KO. Decline in thefrequency of Burkitt’s lymphoma relative to other childhoodmalignancies in Ibadan, Nigeria. Ann Trop Paediatr2002;22:159-163.

7. Razzouk BI, Gan YJ, Mendonca C, Jenkins JJ, Liu Q,Hudson M et al. Epstein-Barr virus in pediatric Hodgkindisease: age and histiotype are more predictive thangeographic region. Med Pediatr Oncol 1997;28:248-254.

8. Oberlin O. Hodgkin’s disease. In: Voute PA, Kalifa C, BarrettA, editors. Cancer in Children: Clinical Management. 4th ed.Oxford: Oxford University Press; 1998. p.137-153.

9. Srinivas V, Soman CS, Naresh KN. Study of the distributionof 289 non-Hodgkin lymphomas using the WHOclassification among children and adolescents in India. MedPediatr Oncol 2002;39:40-43.

10. Wilder RB, Rodriguez MA, Medeiros LJ, Tucker SL, Ha CS,Romaguera JE et al. International prognostic index-basedoutcomes for diffuse large B-cell lymphomas. Cancer2002;94:3083-3088.

11. Axdorph U, Porwit-Macdonald A, Sjoberg J, Grimfors G,Bjorkholm M. T-cell-rich B-cell lymphoma - diagnostic andtherapeutic aspects. APMIS 2002;110:379-390.

12. Weitzman S, Suryanarayan K, Weinstein HJ. Pediatric non-Hodgkin’s lymphoma: clinical and biologic prognosticfactors and risk allocation. Curr Oncol Rep 2002;4:107-113.

13. Alessandri AJ, Pritchard SL, Schultz KR, Massing BG. Apopulation-based study of pediatric anaplastic large celllymphoma. Cancer 2002;94:1830-1835.

14. Ferris Tortajada J, Garcia Castell J, Lopez Andreu JA, ClarGimeno S, Berbel Tornero O. Risk factors for Hodgkin’slymphomas. An Esp Pediatr 2001;55:239-243.

15. Vassilakopoulos TP, Angelopoulou MK, Siakantaris MP,Kontopidou FN, Dimopoulou MN, Barbounis A et al.Prognostic factors in advanced stage Hodgkin's lymphoma:the significance of the number of involved anatomic sites.Eur J Haematol 2001;67:279-288.

16. Hockenberry MJ, Hinds PS, Barrera P, Billups C, Rodriguez-Galindo C, Tan M et al. Incidence of anemia in children withsolid tumors or Hodgkin disease. J Pediatr Hematol Oncol2002;24:35-37.

17. Clarke CA, Glaser SL. Changing incidence of non-Hodgkinlymphomas in the United States. Cancer 2002;94:2015-2023.

18. Hull MC, Mendenhall NP, Colgan ME. SubdiaphragmaticHodgkin’s disease: the University of Florida experience. IntJ Radiat Oncol Biol Phys 2002;52:161-166.

19. Clarke CA, Glaser SL, Prehn AW. Age-specific survival afterHodgkin’s disease in a population-based cohort (United

May-June 03 03-06-03 16:55 ™ÂÏ›‰·200


201

States). Cancer Causes Control 2001;12:803-812. 20. Thomson AB, Wallace WH. Treatment of paediatric

Hodgkin’s disease. A balance of risks. Eur J Cancer2002;38:468-477.

21. Provencio M, Garcia-Lopez FJ, Bonilla F, Espana P.Comparison of the long-term mortality in Hodgkin’s diseasepatients with that of the general population. Ann Oncol1999;10:1199-1205.

22. Pastore G, Magnani C, Verdecchia A, Pession A, Viscomi S,Coebergh JW. Survival of childhood lymphomas in Europe,1978-1992: a report from the EUROCARE study. Eur JCancer 2001;37:703-710.

23. Pastore G, Mosso ML, Carnevale F, di Montezemolo LC,Forni M, Madon E et al. Survival trends of childhood cancerdiagnosed during 1970-1994 in Piedmont, Italy: a reportfrom the Childhood Cancer Registry. Med Pediatr Oncol2001;36:481-488.


¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: º·Ó‹ ∞ı·Ó·ÛÈ¿‰Ô˘ ™Ù. ∫˘ÚÈ·Î›‰Ë 1, ¡ÔÛÔÎÔÌÂ›Ô ∞Ã∂¶∞, £ÂÛÛ·ÏÔÓ›ÎË

™ÎÔfi˜: ™ÎÔfi˜ ÙË˜ ÌÂÏ¤ÙË˜ ‹Ù·Ó Ó· ÚÔÛ‰ÈÔÚÈÛÙÂ› ÔÈ· ·fiÙ· ·È‰È¿ ÌÂ ÔÍÂ›· Ì¤ÛË ˆÙ›ÙÈ‰· ¤¯Ô˘Ó Î›Ó‰˘ÓÔ Î·Î‹˜ ¤Î‚·ÛË˜Î·È Ó· ÂÎÙÈÌËıÂ› ÛÂ ·˘Ù¿ Ë ˆÊ¤ÏÂÈ· ·fi Ù· ·ÓÙÈ‚ÈÔÙÈÎ¿.ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ¶Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ ‰Â˘ÙÂÚÔÁÂÓ‹˜ ·Ó¿Ï˘-ÛË ÙˆÓ Ù˘¯·ÈÔÔÈËÌ¤ÓˆÓ ÂÏÂÁ¯fiÌÂÓˆÓ ÚÔÔÙÈÎÒÓ ÌÂÏÂÙÒÓ.∏ ÌÂÏ¤ÙË ‰ÈÂÍ‹¯ıË ÛÙËÓ ÚˆÙÔ‚¿ıÌÈ· ÂÚ›ı·Ï„Ë. ™˘ÌÌÂÙÂ›-¯·Ó 315 ·È‰È¿ ËÏÈÎ›·˜ 6 ÌËÓÒÓ ¤ˆ˜ 10 ÂÙÒÓ, ÛÙ· ÔÔ›· ¯Ô-ÚËÁ‹ıËÎÂ ·ÓÙÈ‚ÈÔÙÈÎfi, ¿ÌÂÛ· ‹ Î·ı˘ÛÙÂÚËÌ¤Ó· (Ï‹„Ë ÌÂÙ¿·fi 72 ÒÚÂ˜, Â¿Ó ‹Ù·Ó ··Ú·›ÙËÙÔ). ¶ÚÔÁÓˆÛÙÈÎfi ÎÚÈÙ‹ÚÈÔ‚Ú·¯˘ÚfiıÂÛÌË˜ ¤Î‚·ÛË˜ ·ÔÙ¤ÏÂÛÂ Ë ÂÌÊ¿ÓÈÛË ÂÂÈÛÔ‰›-Ô˘ ·ÓËÛ˘¯›·˜ ‹ Ó˘¯ÙÂÚÈÓ‹˜ ·Ó·ÛÙ¿ÙˆÛË˜ ¤ˆ˜ ÙÚÂÈ˜ ËÌ¤ÚÂ˜ÌÂÙ¿ ÙËÓ Â›ÛÎÂ„Ë ÙÔ˘ ·È‰ÈÔ‡ ÛÙÔ ÁÈ·ÙÚfi. ∞ÔÙÂÏ¤ÛÌ·Ù·: ∏ ÂÎ‰‹ÏˆÛË ·ÓËÛ˘¯›·˜ Ì¤¯ÚÈ ÙËÓ ÙÚ›ÙË ËÌ¤-Ú· ‹Ù·Ó ÈÔ Èı·Ó‹ ÛÙ· ·È‰È¿ Ô˘ ÙËÓ ÚÒÙË ËÌ¤Ú· ÂÌÊ¿ÓÈ-˙·Ó ˘„ËÏ‹ ıÂÚÌÔÎÚ·Û›· (Û¯ÂÙÈÎfi˜ Î›Ó‰˘ÓÔ˜: 4,5, 95% fiÚÈ··ÍÈÔÈÛÙ›·˜: 2,3 ¤ˆ˜ 9,0), ÂÌ¤ÙÔ˘˜ (2,6, 1,3 ¤ˆ˜ 5,0) Î·È ‚‹¯·(2,0, 1,1 ¤ˆ˜ 3,8). ∏ ÂÌÊ¿ÓÈÛË Ó˘¯ÙÂÚÈÓ‹˜ ·Ó·ÛÙ¿ÙˆÛË˜ Ì¤¯ÚÈÙËÓ ÙÚ›ÙË ËÌ¤Ú· ‹Ù·Ó ÈÔ Èı·Ó‹ ÛÙ· ·È‰È¿ ÌÂ ˘„ËÏ‹ ıÂÚÌÔ-ÎÚ·Û›· (2,4, 1,2 ¤ˆ˜ 4,8), ÂÌ¤ÙÔ˘˜ (2,1, 1,1 ¤ˆ˜ 4,0), ‚‹¯· (2,3,1,3 ¤ˆ˜ 4,2) Î·È ˆÙfiÚÚÔÈ· (2,1, 1,2 ¤ˆ˜ 3,9). ™Ù· ·È‰È¿ ÌÂ˘„ËÏ‹ ıÂÚÌÔÎÚ·Û›· ‹ ÂÌ¤ÙÔ˘˜, Ë ÂÎ‰‹ÏˆÛË ·ÓËÛ˘¯›·˜ Ì¤¯ÚÈÙËÓ ÙÚ›ÙË ËÌ¤Ú· ‹Ù·Ó ÏÈÁfiÙÂÚÔ Èı·Ó‹ ÌÂÙ¿ ·fi ¿ÌÂÛË ¯ÔÚ‹-ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ (32% ÛÙËÓ ¿ÌÂÛË ¯ÔÚ‹ÁËÛË ¤Ó·ÓÙÈ 53%ÛÙËÓ Î·ı˘ÛÙÂÚËÌ¤ÓË, ¯2=4,0 (p=0,045) (¯ÚÂÈ¿ÛÙËÎÂ Ó· ·ÓÙÈ-ÌÂÙˆÈÛÙÔ‡Ó 5 ·È‰È¿). ∞Ó¿ÏÔÁ· ‹Ù·Ó Ù· ·ÔÙÂÏ¤ÛÌ·Ù· Î·ÈÛÙËÓ ÂÚ›ÙˆÛË ÙˆÓ ·È‰ÈÒÓ Ô˘ ÂÌÊ¿ÓÈÛ·Ó ·Ó·ÛÙ¿ÙˆÛË Î·-

Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ Ó‡¯Ù·˜ (26% ¤Ó·ÓÙÈ 59%, ¯2=9,3 (p=0,002)(¯ÚÂÈ¿ÛÙËÎÂ Ó· ·ÓÙÈÌÂÙˆÈÛÙÔ‡Ó 3 ·È‰È¿). ™Ù· ·È‰È¿ Ô˘ ‰ÂÓÂÌÊ¿ÓÈÛ·Ó ˘„ËÏ‹ ıÂÚÌÔÎÚ·Û›· ‹ ÂÌ¤ÙÔ˘˜, Ë ¿ÌÂÛË ¯ÔÚ‹ÁË-ÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ ‰ÂÓ ‰È·ÊÔÚÔÔ›ËÛÂ ÛËÌ·ÓÙÈÎ¿ ÙËÓ Èı·ÓfiÙË-Ù· ÂÌÊ¿ÓÈÛË˜ ·ÓËÛ˘¯›·˜ (15% ¤Ó·ÓÙÈ 19%, ¯2=0,74, p=0,39) ‹Ó˘¯ÙÂÚÈÓ‹˜ ·Ó·ÛÙ¿ÙˆÛË˜ Ì¤¯ÚÈ ÙËÓ ÙÚ›ÙË ËÌ¤Ú· (20% ¤Ó·ÓÙÈ27%, ¯2=1,6, p=0,20). ™ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ Ô˘ ˘‹Ú¯Â ÂÈÚfi-ÛıÂÙ· ‚‹¯·˜, Ë ¯ÔÚ‹ÁËÛË ÙˆÓ ·ÓÙÈ‚ÈÔÙÈÎÒÓ ‰ÂÓ ‚ÂÏÙ›ˆÛÂ, Â›-ÛË˜, ÛËÌ·ÓÙÈÎ¿ ÙËÓ ÚfiÁÓˆÛË ÙË˜ ÓfiÛÔ˘. ™˘ÌÂÚ¿ÛÌ·Ù·: ™Ù· ·È‰È¿ ÌÂ Ì¤ÛË ˆÙ›ÙÈ‰·, ¯ˆÚ›˜ fiÌˆ˜ ˘-ÚÂÙfi ‹ ÂÌ¤ÙÔ˘˜, Ë ıÂÚ·Â›· ÌÂ ·ÓÙÈ‚ÈÔÙÈÎ¿ ÚÔÛ¤ÊÂÚÂ ÌÈÎÚfifiÊÂÏÔ˜. ∂›ÛË˜, Ë Èı·ÓfiÙËÙ· Î·Î‹˜ ¤Î‚·ÛË˜ ÙË˜ ÓfiÛÔ˘ ÛÂ·˘Ù¿ Ù· ·È‰È¿ ‹Ù·Ó ÌÈÎÚ‹.

¶ÚÔÁÓˆÛÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ Î·Î‹˜ ¤Î‚·ÛË˜ Î·È ÔÊ¤ÏË ·fi Ù· ·ÓÙÈ‚ÈÔÙÈÎ¿ ÛÂ ·È‰È¿ ÌÂ ÔÍÂ›· Ì¤ÛË ˆÙ›ÙÈ‰·1

¶ÂÚ›ÏË„Ë ¿ÚıÚÔ˘ ·fi ÙË µÈ‚ÏÈÔÁÚ·Ê›·

1Little P, Gould C, Moore M, Warner G, Dunleavey J, Williamson IPredictors of poor outcome and benefits fromantibiotics in children with acute otitis media:pragmatic randomized trial BMJ 2002;325:22

ºˆÙÂÈÓ‹ Ã·ÓÙ˙‹

May-June 03 03-06-03 16:55 ™ÂÏ›‰·201


202

§È›‰È· Î·È ÏÈÔÚˆÙÂ˝ÓÂ˜ ÔÚÔ‡ ·È‰ÈÒÓ Ô˘ Ï·Ì‚¿ÓÔ˘Ó ·ÓÙÈÂÈÏËÙÈÎ¿ Ê¿ÚÌ·Î·∫. ∞. µÔ‡‰ÚË˜1, ∞. ™Î·Ú‰Ô‡ÙÛÔ˘2, ª. ™ÂÚ‚ÈÙ˙fiÁÏÔ˘2, ™. ¢‹ÌÔ˘3, ∂. ∞. µ·ÁÈ¿ÎÔ˘4

Serum lipids and lipoproteins in epileptic children receiving antiepileptic drugs K. Voudris1, A. Skardoutsou2, M. Servitzoglou2, S. Dimou3, E. Vagiakou4


�¶ÂÚ›ÏË„Ë: ™ÎÔfi˜ ÙË˜ ÌÂÏ¤ÙË˜ ‹Ù·Ó Ë ·Ó›¯ÓÂ˘ÛËÌÂÙ·‚ÔÏÒÓ ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ÏÈÈ‰›ˆÓ, ÏÈÔÚˆÙÂ-˚ÓÒÓ Î·È ·ÔÏÈÔÚˆÙÂ˚ÓÒÓ ÛÙÔÓ ÔÚfi ÂÈÏËÙÈÎÒÓ·È‰ÈÒÓ Ô˘ ‚Ú›ÛÎÔÓÙ·È ÛÂ ¯ÚfiÓÈ· ÌÔÓÔıÂÚ·Â›· ÌÂÙ· ·ÓÙÈÂÈÏËÙÈÎ¿ Ê¿Ì·Î· Î·Ú‚·Ì·˙Â›ÓË, ‚·Ï-ÚÔ˚Îfi Ó¿ÙÚÈÔ ‹ Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË. ™Â Û‡ÁÎÚÈÛË ÌÂÊ˘ÛÈÔÏÔÁÈÎÔ‡˜ Ì¿ÚÙ˘ÚÂ˜, ·˘ÍËÌ¤Ó· Â›Â‰· ÛÙÔÓÔÚfi ÙË˜ ÔÏÈÎ‹˜ ¯ÔÏËÛÙÂÚfiÏË˜ (TC), ÙË˜ ¯ÔÏËÛÙÂ-ÚfiÏË˜ ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ ˘„ËÏ‹˜ (HDL-C) Î·È ¯·-ÌËÏ‹˜ (LDL-C) ˘ÎÓfiÙËÙ·˜ Î·È ÙˆÓ ·ÔÏÈÔÚˆÙÂ˚-ÓÒÓ ∞-π (ApoA-I) Î·È µ (ApoB) ‰È·ÈÛÙÒıËÎ·Ó ÌfiÓÔÛÙ· ·È‰È¿ Ô˘ ÂÏ¿Ì‚·Ó·Ó Î·Ú‚·Ì·˙Â›ÓË Î·È Ê·È-ÓÔ‚·Ú‚ÈÙ¿ÏË, ÂÓÒ ‰ÂÓ ‚Ú¤ıËÎÂ ÌÂÙ·‚ÔÏ‹ ÛÙ· Â›-Â‰· ÙˆÓ ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ (∆G) Î·È ÙË˜ ÏÈÔÚˆ-ÙÂ˝ÓË˜ a [Lp(a)] ÛÂ Î·Ì›· ·fi ÙÈ˜ ÔÌ¿‰Â˜. ¢ÂÓ ‰È·-ÈÛÙÒıËÎÂ Û˘Û¯¤ÙÈÛË ÌÂÙ·Í‡ ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ÏÈ-È‰›ˆÓ, ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ Î·È ÙˆÓ ·ÔÏÈÔÚˆÙÂ˚-ÓÒÓ ÙÔ˘ ÔÚÔ‡ Î·È ÙË˜ ‰È¿ÚÎÂÈ·˜ ıÂÚ·Â›·˜ ·ÊÂÓfi˜,Î·È ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ·ÓÙÈÂÈÏËÙÈÎÒÓ Ô˘ÛÈÒÓ ÛÙÔÓÔÚfi ·ÊÂÙ¤ÚÔ˘. OÈ ‰È·Ù·Ú·¯¤˜ Ô˘ ·Ú·ÙËÚ‹ıËÎ·Óı· Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÔÓÙ·È ˘’ fi„ÈÓ ÛÙ· ·È‰È¿ ÌÂÂÈÏË„›·, Ù· ÔÔ›· Â›Ó·È ÛÂ ¯ÚfiÓÈ· ÌÔÓÔıÂÚ·Â›·ÌÂ Ù· ÌÂÏÂÙËı¤ÓÙ· ·ÓÙÈÂÈÏËÙÈÎ¿ Ê¿ÚÌ·Î·.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ÏÈ›‰È·, ÏÈÔÚˆÙÂ˝ÓÂ˜, ·ÔÏÈÔÚˆ-ÙÂ˝ÓÂ˜, ·ÓÙÈÂÈÏËÙÈÎ¿ Ê¿ÚÌ·Î·, ·È‰ÈÎ‹ ÂÈÏË„›·.

�Abstract: The aim of this study was to evaluatechanges in serum lipids, lipoproteins andapolipoproteins in children with epilepsy on long-term antiepileptic drug monotherapy withcarbamazepine, sodium valproate, or pheno-barbital. In comparison to controls taking nomedication, significantly increased levels of serumtotal cholesterol (TC), high-density lipoproteincholesterol (HDL-C), low-density lipoproteincholesterol (LDL-C), apolipoprotein A-I (ApoA-I) andapolipoprotein B (ApoB) were found in childrenreceiving carbamazepine and phenobarbital, butnot in those on sodium valproate. No group showedsignificantly increased levels of serum triglycerides(TG) or lipoprotein a [Lp(a)]. The changes in theserum lipids profile did not correlate with either drugplasma concentrations or the duration of treatment.The possibility of such changes must be consideredin all children with epilepsy on long-termantiepileptic drug monotherapy with carbama-zepine and phenobarbital.

Key words: lipids, lipoproteins, apolipoproteins,antiepileptic drugs, epilepsy.

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

2 µ’ ¶·ÓÂÈÛÙËÌÈ·Î‹ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó·

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

4 ªÈÎÚÔ‚ÈÔÏÔÁÈÎfi ∆Ì‹Ì·, ¶. °. ¡ÔÛÔÎÔÌÂ›Ô “°. °ÂÓÓËÌ·Ù¿˜”, ∞ı‹Ó·

1 Neurology Department, “P. & A. Kyriakou” Children’s Hospital, Athens

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

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

4 Department of Microbiology, “G. Gennimatas” Peripheral General Hospital, Athens

™˘ÓÙÔÌÔÁÚ·Ê›Â˜TC OÏÈÎ‹ ¯ÔÏËÛÙÂÚfiÏË ∆G ∆ÚÈÁÏ˘ÎÂÚ›‰È· HDL-C ÃÔÏËÛÙÂÚfiÏË ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ ˘„ËÏ‹˜

˘ÎÓfiÙËÙ·˜ LDL-C ÃÔÏËÛÙÂÚfiÏË ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ

¯·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ApoA-I ∞ÔÏÈÔÚˆÙÂ˝ÓË ∞-π ApoB ∞ÔÏÈÔÚˆÙÂ˝ÓË µ Lp(a) §ÈÔÚˆÙÂ˝ÓË a ª™ ªË ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿

May-June 03 03-06-03 16:55 ™ÂÏ›‰·202


203

∂ÈÛ·ÁˆÁ‹ ªÂÙ·‚ÔÏ¤˜ ÛÙ· Â›Â‰· ÙˆÓ ÏÈÈ‰›ˆÓ, ÏÈÔÚˆ-

ÙÂ˚ÓÒÓ Î·È ·ÔÏÈÔÚˆÙÂ˚ÓÒÓ ÙÔ˘ ÔÚÔ‡ ÛÂ ¿ÙÔÌ·Ô˘ Ï·Ì‚¿ÓÔ˘Ó ·ÓÙÈÂÈÏËÙÈÎ¿ Ê¿ÚÌ·Î· ¤¯Ô˘Ó ‰È·-ÈÛÙˆıÂ› ÛÂ ‰È¿ÊÔÚÂ˜ ÂÚÂ˘ÓËÙÈÎ¤˜ ÂÚÁ·Û›Â˜ (1-11).™˘¯Ó¿, ÔÈ ·ÛıÂÓÂ›˜ ÂÏ¿Ì‚·Ó·Ó Ù·˘Ùfi¯ÚÔÓ· ÔÏÏ¿·ÓÙÈÂÈÏËÙÈÎ¿ Ê¿ÚÌ·Î· Î·È Ë ÂÓ‰Â¯fiÌÂÓË Â›‰Ú·ÛËÌÂÌÔÓˆÌ¤ÓÔ˘ ·ÓÙÈÂÈÏËÙÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘ ÛÙ· Â›Â-‰· ÙˆÓ ÏÈÈ‰›ˆÓ Î·È ÙˆÓ ·ÔÏÈÔÚˆÙÂ˚ÓÒÓ ÛÙÔÓ ÔÚfi‹Ù·Ó ‰‡ÛÎÔÏÔ Ó· ÂÏÂÁ¯ıÂ›. OÈ ÌÂÏ¤ÙÂ˜ ·˘Ù¤˜ ¤¯Ô˘Ó‰ÈÂÍ·¯ıÂ› Î˘Ú›ˆ˜ ÛÂ ÂÓ‹ÏÈÎÂ˜, ·ÏÏ¿ Ù· ÙÂÏÂ˘Ù·›·¯ÚfiÓÈ· ·ÚfiÌÔÈÂ˜ ÌÂÏ¤ÙÂ˜ ¤¯Ô˘Ó ‰ÈÂÍ·¯ıÂ› Î·È ÛÙÔÓ·È‰ÈÎfi ÏËı˘ÛÌfi, ÔÈ ÔÔ›Â˜ ·ÊÔÚÔ‡Ó ÛÙ· ·ÓÙÈÂÈ-ÏËÙÈÎ¿ Ê¿ÚÌ·Î· ÙË˜ ÌÂÏ¤ÙË˜ Ì·˜, ÌÂ ·Ó¿ÏÔÁ· ·Ô-ÙÂÏ¤ÛÌ·Ù· ÛÙÈ˜ ÂÚÈÛÛfiÙÂÚÂ˜ ·fi ·˘Ù¤˜. ∂›Ó·È ÁÓˆ-ÛÙfi fiÙÈ Ù· Â›Â‰· ÙˆÓ ÏÈÈ‰›ˆÓ ÙÔ˘ ÔÚÔ‡ ·ÚÔ˘ÛÈ¿-˙Ô˘Ó ÛËÌ·ÓÙÈÎ¤˜ ‰È·Î˘Ì¿ÓÛÂÈ˜ ·Ó¿ÏÔÁ· ÌÂ ÙËÓ ËÏÈ-Î›·, ·ÏÏ¿ Î·È ÌÂÙ·Í‡ ‰È·ÊfiÚˆÓ Ï·ÒÓ Î·È ‰È·ÊÔÚÂÙÈ-ÎÒÓ ÏËı˘ÛÌÒÓ (12). Œ¯ÂÈ ·Ó·ÊÂÚıÂ›, Â›ÛË˜, fiÙÈ ÁÂ-ÓÂÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ ‰È·‰Ú·Ì·Ù›˙Ô˘Ó ÛËÌ·ÓÙÈÎfi ÚfiÏÔÛÙËÓ ÔÈÔÙÈÎ‹ Î·È ÔÛÔÙÈÎ‹ Â›‰Ú·ÛË ÙˆÓ ·ÓÙÈÂÈÏË-ÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ ÛÙ· Â›Â‰· ÙˆÓ ÏÈÈ‰›ˆÓ ÙÔ˘ÔÚÔ‡ (10). ™ÎÔfi˜ ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ ‹Ù·Ó Ë‰È·›ÛÙˆÛË Èı·Ó‹˜ Â›‰Ú·ÛË˜ ÙË˜ ¯ÚfiÓÈ·˜ ÌÔÓÔıÂ-Ú·Â›·˜ ÌÂ Ù· Û˘¯ÓfiÙÂÚ· ¯ÔÚËÁÔ‡ÌÂÓ· ·ÓÙÈÂÈÏË-ÙÈÎ¿ Ê¿ÚÌ·Î· (Î·Ú‚·Ì·˙Â›ÓË, ‚·ÏÚÔ˚Îfi Ó¿ÙÚÈÔ ‹Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË) ÛÙ· Â›Â‰· ÔÚÔ‡ ÙË˜ TC, ÙˆÓ ∆G,ÙË˜ HDL-C, ÙË˜ LDL-C, ÙË˜ ApoA-I, ÙË˜ ApoB Î·È ÙË˜Lp(a) ÛÙ· ·È‰È¿ ÌÂ ÂÈÏË„›· ÛÙË ¯ÒÚ· Ì·˜.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ªÂÏÂÙ‹ıËÎ·Ó 151 ÂÈÏËÙÈÎ¿ ·È‰È¿, Ù· ÔÔ›· ¯ˆÚ›ÛÙË-

Î·Ó ÛÂ 3 ÔÌ¿‰·˜ ·Ó¿ÏÔÁ· ÌÂ ÙÔ Â›‰Ô˜ ÙÔ˘ ·ÓÙÈÂÈÏËÙÈÎÔ‡Ê·ÚÌ¿ÎÔ˘ Ô˘ ÂÏ¿Ì‚·Ó·Ó. ∂Í‹ÓÙ· ¤ÓÙÂ ·È‰È¿ (32 ·ÁfiÚÈ·,33 ÎÔÚ›ÙÛÈ·) ‹Ù·Ó ÛÂ ÌÔÓÔıÂÚ·Â›· ÌÂ Î·Ú‚·Ì·˙Â›ÓË, 48(22 ·ÁfiÚÈ·, 26 ÎÔÚ›ÙÛÈ·) ÌÂ ‚·ÏÚÔ˚Îfi Ó¿ÙÚÈÔ Î·È 38 (18 ·Áfi-ÚÈ·, 20 ÎÔÚ›ÙÛÈ·) ÌÂ Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË. ∏ ËÏÈÎ›· ÙˆÓ ·È‰ÈÒÓÔ˘ ÂÏ¿Ì‚·Ó·Ó Î·Ú‚·Ì·˙Â›ÓË ‹Ù·Ó ÌÂÙ·Í‡ 2 Î·È 13,5 ÂÙÒÓ(‰È¿ÌÂÛË ËÏÈÎ›·: 8,5 ¤ÙË), ‚·ÏÚÔ˚Îfi Ó¿ÙÚÈÔ 2 ¤ˆ˜ 14 ÂÙÒÓ(‰È¿ÌÂÛË ËÏÈÎ›·: 8,8 ¤ÙË) Î·È ÂÎÂ›ÓˆÓ Ô˘ ÂÏ¿Ì‚·Ó·Ó Ê·ÈÓÔ-‚·Ú‚ÈÙ¿ÏË ÌÂÙ·Í‡ 6 ÌËÓÒÓ Î·È 4 ÂÙÒÓ (‰È¿ÌÂÛË ËÏÈÎ›·: 2,4¤ÙË). ŸÏ· Ù· ·È‰È¿ ˘Ô‚Ï‹ıËÎ·Ó ÛÂ Ï‹ÚË ÎÏÈÓÈÎ‹ ÂÍ¤Ù·ÛË,ÂÓÒ ÂÏ‹ÊıË ·fi ÙÔ˘˜ ÁÔÓÂ›˜ Ï‹ÚÂ˜ ·ÙÔÌÈÎfi Î·È ÔÈÎÔÁÂÓÂÈ·-Îfi ÈÛÙÔÚÈÎfi. ∞ÔÎÏÂ›ÛÙËÎÂ Ë ·ÚÔ˘Û›· ¿ÏÏÔ˘ ÓÔÛ‹Ì·ÙÔ˜, ËÏ‹„Ë ¿ÏÏˆÓ Ê·ÚÌ¿ÎˆÓ Î·È Ë ‡·ÚÍË ıÂÙÈÎÔ‡ ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ÈÛÙÔÚÈÎÔ‡ ÚÒÈÌË˜ ·ıËÚˆÌ¿ÙˆÛË˜. ŸÏ· Ù· ·È‰È¿ ‚Ú›ÛÎÔ-ÓÙ·Ó ÙÔ˘Ï¿¯ÈÛÙÔÓ ÁÈ· 6 Ì‹ÓÂ˜ ÛÙËÓ ›‰È· ·ÓÙÈÂÈÏËÙÈÎ‹ Ê·Ú-Ì·ÎÂ˘ÙÈÎ‹ ÌÔÓÔıÂÚ·Â›·.

™Â fiÏ· Ù· ·È‰È¿ ÚÔÛ‰ÈÔÚ›ÛÙËÎ·Ó ÛÙÔÓ ÔÚfi Ù· Â›Â‰·ÙË˜ TC Î·È ÙˆÓ TG. ™Â 76 ·È‰È¿, ·fi Ù· ÔÔ›· 28 (13 ·Áfi-ÚÈ·, 15 ÎÔÚ›ÙÛÈ·) ÂÏ¿Ì‚·Ó·Ó Î·Ú‚·Ì·˙Â›ÓË, 24 (12 ·ÁfiÚÈ·,12 ÎÔÚ›ÙÛÈ·) ‚·ÏÚÔ˚Îfi Ó¿ÙÚÈÔ Î·È 24 (11 ·ÁfiÚÈ·, 13 ÎÔÚ›-ÙÛÈ·) Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË, ÚÔÛ‰ÈÔÚ›ÛÙËÎ·Ó Ù· Â›Â‰· ÙË˜LDL-C, HDL-C Î·È Lp(a) Î·È ÛÂ 85 ·È‰È¿, ·fi Ù· ÔÔ›· 32 (16

·ÁfiÚÈ·, 16 ÎÔÚ›ÙÛÈ·) ‹Ù·Ó ÛÂ ÌÔÓÔıÂÚ·Â›· ÌÂ Î·Ú‚·Ì·˙Â-›ÓË, 28 (13 ·ÁfiÚÈ·, 15 ÎÔÚ›ÙÛÈ·) ÌÂ ‚·ÏÚÔ˚Îfi Ó¿ÙÚÈÔ Î·È 25(12 ·ÁfiÚÈ·, 13 ÎÔÚ›ÙÛÈ·) ÌÂ Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË, Ù· Â›Â‰·Apo∞-I Î·È Apoµ. ∆· Â˘Ú‹Ì·Ù· Û˘ÁÎÚ›ıËÎ·Ó ÌÂ ÂÎÂ›Ó· ˘ÁÈÒÓ·È‰ÈÒÓ ·Ó¿ÏÔÁË˜ ËÏÈÎ›·˜ Î·È Ê‡ÏÔ˘.

∆· ‰Â›ÁÌ·Ù· ·›Ì·ÙÔ˜, Ù· ÔÔ›· ÂÏ‹ÊıËÛ·Ó ÚˆÈÓ‹ ÒÚ·ÌÂÙ¿ ·fi 12ˆÚË ÓËÛÙÂ›·, Ê˘Ï¿ÛÛÔÓÙ·Ó ÌÂÙ¿ ÙÔ ‰È·¯ˆÚÈÛÌfiÙÔ˘ ÔÚÔ‡ ÛÂ ıÂÚÌÔÎÚ·Û›· -40ÔC Î·È ÔÈ ÌÂÙÚ‹ÛÂÈ˜ Á›ÓÔÓÙ·ÓÎ·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ‰‡Ô ÚÒÙˆÓ Â‚‰ÔÌ¿‰ˆÓ ·fi ÙËÓ ·ÈÌÔ-ÏË„›·. O ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙË˜ ÔÏÈÎ‹˜ ¯ÔÏËÛÙÂÚfiÏË˜ Î·È ÙˆÓÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ ¤ÁÈÓÂ ÌÂ ÂÓ˙˘ÌÈÎ‹ ¯ÚˆÌ·ÙÔÌÂÙÚÈÎ‹ Ì¤ıÔ‰Ô ÛÂ·Ó·Ï˘Ù‹ Hitachi 704 ÛÂ ıÂÚÌÔÎÚ·Û›· 30ÔC Î·È ÌÂ ÔÚfiÙ˘Ô˘˜ÙË˜ Boehringer Mannheim. O ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙË˜ HDL-C ¤ÁÈ-ÓÂ ÛÙÔ ˘ÂÚÎÂ›ÌÂÓÔ ÛÙÚÒÌ· ÌÂÙ¿ ·fi Î·Ù·ÎÚ‹ÌÓÈÛË ÙˆÓVLDL Î·È LDL-C ÌÂ ÊˆÛÊÔÚÔ‚ÔÏÊÚ·ÌÈÎfi ÔÍ‡ Î·È Ì·ÁÓ‹ÛÈÔÎ·È Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ ApoA-I Î·È ApoB ¤ÁÈÓÂ ÌÂ ·ÓÔÛÔıÔ-ÏˆÛÈÌÂÙÚÈÎ‹ Ì¤ıÔ‰Ô SPIA (Serum Protein Immunoassay). ∏Lp(a) ÚÔÛ‰ÈÔÚ›ÛÙËÎÂ, Â›ÛË˜, ÌÂ ·ÓÔÛÔıÔÏˆÛÈÌÂÙÚÈÎ‹ Ì¤ıÔ-‰Ô ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÓÂÊÂÏfiÌÂÙÚÔ Behring. ∏ Û˘ÁÎ¤ÓÙÚˆÛËÙË˜ LDL-C ˘ÔÏÔÁ›ÛÙËÎÂ ·fi ÙÔÓ Ù‡Ô ÙˆÓ Friedwald Î·È Û˘Ó.

°È· ÙË ÛÙ·ÙÈÛÙÈÎ‹ ·Ó¿Ï˘ÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ¯ÚËÛÈÌÔ-ÔÈ‹ıËÎ·Ó ÔÈ ÛÙ·ÙÈÛÙÈÎ¤˜ ‰ÔÎÈÌ·Û›Â˜ t (t-test) Î·È MannWhitney Î·È ÔÈ Û˘Û¯ÂÙ›ÛÂÈ˜ Î·Ù¿ Pearson Î·È Spearman. ∆È-Ì¤˜ p<0,05 ıÂˆÚ‹ıËÎ·Ó ˆ˜ ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ¤˜.

∞ÔÙÂÏ¤ÛÌ·Ù· ∆· Â›Â‰· ÛÙÔÓ ÔÚfi ÙˆÓ TC, LDL-C Î·È HDL-C

‹Ù·Ó ÛËÌ·ÓÙÈÎ¿ ·˘ÍËÌ¤Ó· ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÂÎÂ›Ó·ÙˆÓ Ì·ÚÙ‡ÚˆÓ ÌfiÓÔ ÛÙÈ˜ ÔÌ¿‰Â˜ ÙˆÓ ·È‰ÈÒÓ ˘fi·ÁˆÁ‹ ÌÂ Î·Ú‚·Ì·˙Â›ÓË Î·È Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË (¶›-Ó·ÎÂ˜ 1 Î·È 2) (∂ÈÎfiÓÂ˜ 1 Î·È 2). ∞ÓÙ›ıÂÙ·, ÛÙ· Â›-Â‰· ÙˆÓ TG ‰ÂÓ ·Ú·ÙËÚ‹ıËÎÂ ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·-ÓÙÈÎ‹ ‰È·ÊÔÚ¿ ÛÂ Î·Ì›· ·fi ÙÈ˜ ÔÌ¿‰Â˜. ∆· Â›Â-‰· ÙË˜ Lp(a) ÛÙÔÓ ÔÚfi ·˘Í‹ıËÎ·Ó ÛÂ fiÏÂ˜ ÙÈ˜ ÔÌ¿-‰Â˜ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó, ·ÏÏ¿ Ë ‰È·ÊÔÚ¿ ‰ÂÓ ‹Ù·ÓÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹. ∆· Â›Â‰· ÙË˜ Apo∞-I Î·ÈApoµ ‚Ú¤ıËÎ·Ó ÛËÌ·ÓÙÈÎ¿ ·˘ÍËÌ¤Ó· ÌfiÓÔ ÛÙ· ·È-‰È¿ Ô˘ ÂÏ¿Ì‚·Ó·Ó Î·Ú‚·Ì·˙Â›ÓË Î·È Ê·ÈÓÔ‚·Ú‚È-Ù¿ÏË (¶›Ó·Î·˜ 3) (∂ÈÎfiÓ· 3). ¢ÂÓ ‚Ú¤ıËÎ·Ó ÛÙ·ÙÈ-ÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ¤˜ ‰È·ÊÔÚ¤˜ ÛÙÈ˜ ·ÓˆÙ¤Úˆ ·Ú·Ì¤-ÙÚÔ˘˜ ÌÂÙ·Í‡ ·ÁÔÚÈÒÓ Î·È ÎÔÚÈÙÛÈÒÓ, ÌÔÏÔÓfiÙÈ ÔÈÌ¤ÛÂ˜ ÙÈÌ¤˜ ÙˆÓ ÂÈ¤‰ˆÓ ÙÔ˘ ÔÚÔ‡ ÙˆÓ TC, LDL-C, HDL-C, Apo∞-I Î·È Apoµ ‹Ù·Ó ÈÔ ·˘ÍËÌ¤ÓÂ˜ ÛÙ··ÁfiÚÈ· ÛÙËÓ ÔÌ¿‰· ÙË˜ Î·Ú‚·Ì·˙Â›ÓË˜ Î·È ÛÙ·ÎÔÚ›ÙÛÈ· ÛÙËÓ ÔÌ¿‰· ÙË˜ Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË˜. ™Â Î·-Ì›· ·fi ÙÈ˜ ÔÌ¿‰Â˜ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó ‰ÂÓ ‚Ú¤ıËÎÂÛ˘Û¯¤ÙÈÛË ÌÂÙ·Í‡ ÙˆÓ ÙÈÌÒÓ ÙˆÓ ÏÈÈ‰›ˆÓ, ÏÈÔ-ÚˆÙÂ˚ÓÒÓ Î·È ·ÔÏÈÔÚˆÙÂ˚ÓÒÓ Î·È ÙË˜ ‰È¿ÚÎÂÈ-·˜ ÙË˜ ıÂÚ·Â›·˜ ·ÊÂÓfi˜ Î·È ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ·ÓÙÈÂÈÏËÙÈÎÒÓ Ô˘ÛÈÒÓ ÛÙÔ ·›Ì· ·ÊÂÙ¤ÚÔ˘.

™˘˙‹ÙËÛË OÈ ‰È·Ù·Ú·¯¤˜ ÙˆÓ ÏÈÈ‰›ˆÓ, ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ

Î·È ÙˆÓ ·ÔÏÈÔÚˆÙÂ˚ÓÒÓ ıÂˆÚÔ‡ÓÙ·È ˆ˜ Î‡ÚÈÔÈ

May-June 03 03-06-03 16:55 ™ÂÏ›‰·203


204

·ÈÙÈÔÏÔÁÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ ÙË˜ ·ıËÚˆÌ¿ÙˆÛË˜ Î·È,Û˘ÁÎÂÎÚÈÌ¤Ó·, Ù· ˘„ËÏ¿ Â›Â‰· TC Î·È LDL-CÛ¯ÂÙ›˙ÔÓÙ·È ıÂÙÈÎ¿ ÌÂ ÙÔÓ Î›Ó‰˘ÓÔ ·ıËÚˆÌ¿ÙˆÛË˜,ÂÓÒ Ù· ˘„ËÏ¿ Â›Â‰· HDL-C ·ÚÓËÙÈÎ¿ (13). Œ¯ÂÈ·Ô‰ÂÈ¯ıÂ› fiÙÈ Ë ÂÏ¿ÙÙˆÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙË˜ TCÎ·È ÙË˜ LDL-C Î·È Ë ·‡ÍËÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙË˜ HDL-C ÛÙÔÓ ÔÚfi ÌÔÚÔ‡Ó Ó· Ô‰ËÁ‹ÛÔ˘Ó ÛÂ ˘Ô¯ÒÚËÛËÙË˜ ·ıËÚˆÌ¿ÙˆÛË˜ Î·È ÛÂ ÂÏ¿ÙÙˆÛË ÙË˜ ıÓËÙfiÙË-Ù·˜ Î·È ÙË˜ ÓÔÛËÚfiÙËÙ·˜ ÙË˜ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘. ∏¯ÔÚ‹ÁËÛË ·ÓÙÈÂÈÏËÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ ÌÔÚÂ› Ó·ÂËÚÂ¿ÛÂÈ Ù· Â›Â‰· ÙˆÓ ÏÈÈ‰›ˆÓ ÛÙÔ ·›Ì·, ÌÔ-ÏÔÓfiÙÈ Ù· Â˘Ú‹Ì·Ù· ÔÈÎ›ÏÏÔ˘Ó Î·È ÛÂ ÌÂÚÈÎ¤˜ ÌÂ-Ï¤ÙÂ˜ Â›Ó·È ·ÓÙÈÊ·ÙÈÎ¿ (1-11). ∏ ·È‰ÈÎ‹ ÂÈÏË„›···ÈÙÂ› Û˘¯Ó¿ Ì·ÎÚÔ¯ÚfiÓÈ· ·ÁˆÁ‹ ÌÂ ·ÓÙÈÂÈÏË-ÙÈÎ¿ Ê¿ÚÌ·Î·, Ô˘ ¯ÔÚËÁÔ‡ÓÙ·È ÌÂÌÔÓˆÌ¤Ó· ‹ÛÂ Û˘Ó‰˘·ÛÌfi. ∏ Î·Ú‚·Ì·˙Â›ÓË, Ë Ê·ÈÓÔ‚·Ú‚ÈÙ¿-ÏË Î·È ÙÔ ‚·ÏÚÔ˚Îfi Ó¿ÙÚÈÔ Û˘ÌÂÚÈÏ·Ì‚¿ÓÔÓÙ·ÈÛÙ· Ê¿ÚÌ·Î· ÚÒÙË˜ ÂÈÏÔÁ‹˜ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒ-ÈÛ‹ ÙË˜.

∞‡ÍËÛË ÙË˜ TC, ÙË˜ HDL-C Î·È ÙË˜ LDL-C ÛÙÔÓÔÚfi ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ÂÈÏË„›· ˘fi ıÂÚ·Â›· ÌÂ Î·Ú-‚·Ì·˙Â›ÓË, fiˆ˜ ‚Ú¤ıËÎÂ Î·È ÛÙËÓ ·ÚÔ‡Û· ÌÂ-Ï¤ÙË, ¤¯ÂÈ ‰È·ÈÛÙˆıÂ› Î·È ÛÂ ÚÔËÁÔ‡ÌÂÓÂ˜ ÌÂÏ¤-ÙÂ˜ (4,8). ™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË, Ù· Â›Â‰· ÙˆÓ TG‰ÂÓ ÌÂÙ·‚Ï‹ıËÎ·Ó ÛËÌ·ÓÙÈÎ¿ ÛÙ· ·È‰È¿ ÌÂ Ï‹„ËÎ·Ú‚·Ì·˙Â›ÓË˜, fiˆ˜ ¤¯ÂÈ ·Ó·ÊÂÚıÂ› Î·È ÛÙÈ˜ÚÔËÁÔ‡ÌÂÓÂ˜ ÌÂÏ¤ÙÂ˜ (2,11). ∏ Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË,Ë ÔÔ›· ¤¯ÂÈ ·ÚfiÌÔÈÂ˜ Â·ÁˆÁÈÎ¤˜ È‰ÈfiÙËÙÂ˜ ÌÂÙËÓ Î·Ú‚·Ì·˙Â›ÓË, ÚÔÎ·ÏÂ› ·ÚfiÌÔÈÂ˜ ‰È·Ù·Ú·-¯¤˜ ÛÙ· ÏÈ›‰È· Î·È ÛÙÈ˜ ÏÈÔÚˆÙÂ˝ÓÂ˜ ÙÔ˘ ÔÚÔ‡(1,2,4).

∆· ‰Â‰ÔÌ¤Ó· ÁÈ· ÙÔÓ ·ıÔÁÂÓÂÙÈÎfi ÌË¯·ÓÈÛÌfiÙˆÓ ÌÂÙ·‚ÔÏÒÓ ·˘ÙÒÓ ‰ÂÓ Â›Ó·È ÙÂÏÂ›ˆ˜ ÍÂÎ¿ı·Ú·.∏ Î·Ú‚·Ì·˙Â›ÓË Î·È Ë Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË ÌÂÙ·‚ÔÏ›-˙ÔÓÙ·È Â¿ÁÔÓÙ·˜ Ù· Ë·ÙÈÎ¿ ÌÈÎÚÔÛˆÌÈ·Î¿ ¤Ó˙˘Ì·Î·È ÚÔÎ·ÏÔ‡Ó ÌÂÙ·‚ÔÏ¤˜ ÛÙÔÓ ÌÂÙ·‚ÔÏÈÛÌfi ÙˆÓ¯ÔÏÈÎÒÓ ÔÍ¤ˆÓ, ÙË˜ ¯ÔÏËÛÙÂÚfiÏË˜, ÙˆÓ ÏÈÈ‰›ˆÓ,ÙË˜ ¯ÔÏÂÚ˘ıÚ›ÓË˜ Î·È ¿ÏÏˆÓ ÂÍˆÁÂÓÒÓ Ê·ÚÌ¿ÎˆÓ

¶›Ó·Î·˜ 1. ∂›Â‰· TC Î·È TG ÔÚÔ‡ ÛÂ ·ÛıÂÓÂ›˜ Î·È Ì¿ÚÙ˘ÚÂ˜

º¿ÚÌ·Î· ∞ÚÈıÌfi˜ ·È‰ÈÒÓ TC (mg/dl) p TG (mg/dl) p(ª¤ÛË ÙÈÌ‹) (ª¤ÛË ÙÈÌ‹)

ñ ∫·Ú‚·Ì·˙Â›ÓË 65 211,7±33,8 <0,01 108,5±37,0 ª™ª¿ÚÙ˘ÚÂ˜ 71 152,2±33,9 104,8±42,9

ñ µ·ÏÚÔ˚Îfi Ó¿ÙÚÈÔ 48 158,3±35,2 ª™ 96,5±42,5 ª™ª¿ÚÙ˘ÚÂ˜ 70 151,8±34,9 105,1±42,3

ñ º·ÈÓÔ‚·Ú‚ÈÙ¿ÏË 38 201,7±25,9 <0,01 87,8±32,6 ª™ª¿ÚÙ˘ÚÂ˜ 56 148,1±29,1 84,1±37,2

∂ÈÎfiÓ· 1. ª¤ÛË ÙÈÌ‹ ÙˆÓ ÂÈ¤‰ˆÓ ÙË˜ TC Î·È ÙˆÓ TG ÛÂ fiÏÂ˜ ÙÈ˜ ÔÌ¿‰Â˜ ·ÛıÂÓÒÓ Î·È ÛÙÔ˘˜ Ì¿ÚÙ˘ÚÂ˜.

250

200

150

100

50

0

K·Ú‚·Ì·˙Â›ÓË

ª¿ÚÙ˘ÚÂ˜ 1µ·ÏÚÔ˚Îfi

Ó¿ÙÚÈÔ ª¿ÚÙ˘ÚÂ˜ 2

º·ÈÓÔ‚·Ú‚ÈÙ¿ÏËª¿ÚÙ˘ÚÂ˜ 3

ÃÔÏËÛÙÂÚfiÏË(mg/dl)

∆ÚÈÁÏÈÎÂÚ›‰È·(mg/dl)

May-June 03 03-06-03 16:55 ™ÂÏ›‰·204


205

Ô˘ ÌÂÙ·‚ÔÏ›˙ÔÓÙ·È ·fi Ù· ¤Ó˙˘Ì· ·˘Ù¿. ∆· ·ÓÙÈÂ-ÈÏËÙÈÎ¿ ·˘Ù¿ Ê¿ÚÌ·Î· ·ÓÙ·ÁˆÓ›˙ÔÓÙ·È ÙË ¯ÔÏË-ÛÙÂÚfiÏË Î·È Ù· ¿ÏÏ· ÏÈ›‰È· ÛÙÈ˜ ı¤ÛÂÈ˜ Û‡Ó‰ÂÛË˜ÌÂ ÙÔ Ë·ÙÈÎfi Î˘ÙÙfi¯ÚˆÌ· ƒ450, ÌÂ ·ÔÙ¤ÏÂÛÌ·ÙËÓ ·‡ÍËÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙÔ˘˜ (8,9). O ÌË¯·ÓÈÛÌfi˜·˘Ùfi˜, fiÌˆ˜, ‰ÂÓ ıÂˆÚÂ›Ù·È ·ÚÎÂÙfi˜ ÁÈ· Ó· ÂÍËÁ‹-ÛÂÈ ÙËÓ ·‡ÍËÛË ÙˆÓ ÏÈÈ‰›ˆÓ, ·ÊÔ‡ ¿ÏÏ· Ê¿ÚÌ·Î·,fiˆ˜ Ë ÚÈÊ·ÌÈÎ›ÓË Ô˘ Â›Ó·È ÂÓ˙˘ÌÈÎfi˜ Â·ÁˆÁ¤-·˜, ‰ÂÓ ÚÔÎ·ÏÔ‡Ó ·Ó¿ÏÔÁË ·‡ÍËÛË. ÕÏÏÔ ¤Ó˙˘ÌÔÔ˘ Â¿ÁÂÙ·È ·fi Ù· ·ÓÙÈÂÈÏËÙÈÎ¿ Â›Ó·È ÙÔ ˘‰ÚÔ-Í˘ÌÂı˘Ï-ÁÏÔ˘Ù·Ú˘ÏÔ Û˘Ó¤Ó˙˘ÌÔ ∞, Ô˘ Î·Ù·Ï‡ÂÈÙË Û‡ÓıÂÛË ÙË˜ ¯ÔÏËÛÙÂÚfiÏË˜. ∏ Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏËÎ·È Ë Î·Ú‚·Ì·˙Â›ÓË ÌÔÚÂ› Ó· ÚÔÎ·Ï¤ÛÔ˘Ó ·‡-ÍËÛË - ¤ˆ˜ Î·È ‰ÈÏ·ÛÈ·ÛÌfi - ÙÔ˘ Ë·ÙÈÎÔ‡ ˘‰ÚÔ-Í˘ÌÂı˘Ï-ÁÏÔ˘Ù·Ú˘ÏÔ Û˘ÓÂÓ˙‡ÌÔ˘ ∞, Î·Ù·Ï‹ÁÔ-ÓÙ·˜ ÛÂ ·˘ÍËÌ¤ÓË Û‡ÓıÂÛË ¯ÔÏËÛÙÂÚfiÏË˜. ÕÏÏÔ˜ÌË¯·ÓÈÛÌfi˜, Ô˘ ›Ûˆ˜ ı· ÌÔÚÔ‡ÛÂ Ó· ÂÍËÁ‹ÛÂÈÙÈ˜ ÌÂÙ·‚ÔÏ¤˜ ÙˆÓ ÏÈÈ‰›ˆÓ ÛÂ ÂÚÈÙÒÛÂÈ˜ ¯ÔÚ‹-ÁËÛË˜ Ê·ÚÌ¿ÎˆÓ ÌÂ Â·ÁˆÁÈÎ‹ ‰Ú¿ÛË, fiˆ˜ Â›Ó·ÈË Î·Ú‚·Ì·˙Â›ÓË Î·È Ë Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË, Â›Ó·È ÔÈÔÚÌÔÓÈÎ¤˜ ÌÂÙ·‚ÔÏ¤˜ Ô˘ ·Ú·ÙËÚÔ‡ÓÙ·È Î·Ù¿ ÙË¯ÚfiÓÈ· ·ÓÙÈÂÈÏËÙÈÎ‹ ·ÁˆÁ‹. ∏ ÌÂ›ˆÛË ÙË˜ ÂÏÂ‡-

ıÂÚË˜ ı˘ÚÔÍ›ÓË˜ Î·È ÙË˜ ıÂÈÈÎ‹˜ ‰Â¸‰ÚÔÂÈ·Ó‰ÚÔ-ÛÙÂÚfiÓË˜ Â›Ó·È ·fi ÙÈ˜ Î˘ÚÈfiÙÂÚÂ˜ ÔÚÌÔÓÈÎ¤˜ ÌÂ-Ù·‚ÔÏ¤˜ Ô˘ ÔÊÂ›ÏÔÓÙ·È ÛÙËÓ ÂÓ˙˘ÌÈÎ‹ Â·ÁˆÁ‹.∂›Ó·È ÁÓˆÛÙfi fiÙÈ ÔÈ ¯·ÌËÏ¤˜ Û˘ÁÎÂÓÙÚÒÛÂÈ˜ ÙˆÓÔÚÌÔÓÒÓ ·˘ÙÒÓ Û˘Ó‰¤ÔÓÙ·È ÌÂ ·˘ÍËÌ¤ÓË ÛÙ¿ıÌËÏÈÈ‰›ˆÓ ÛÙÔÓ ÔÚfi.

Ÿˆ˜ ‚Ú¤ıËÎÂ ÙfiÛÔ ÛÙËÓ ·ÚÔ‡Û·, fiÛÔ Î·È ÛÂÚÔËÁÔ‡ÌÂÓÂ˜ ÌÂÏ¤ÙÂ˜, ÙÔ ‚·ÏÚÔ˚Îfi Ó¿ÙÚÈÔ ‰ÂÓÌÂÙ·‚¿ÏÏÂÈ Ù· Â›Â‰· ÙˆÓ ÏÈÈ‰›ˆÓ ÛÙÔÓ ÔÚfi(2,4,7,9,11). ∞˘Ùfi ÌÔÚÂ› Ó· ÔÊÂ›ÏÂÙ·È ÛÙÔ ÁÂÁÔÓfi˜fiÙÈ ÙÔ ‚·ÏÚÔ˚Îfi Ó¿ÙÚÈÔ ‰ÂÓ ¤¯ÂÈ Â·ÁˆÁÈÎ¤˜ È‰Èfi-ÙËÙÂ˜ Î·È Ë Î‡ÚÈ· Ô‰fi˜ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙÔ˘ Â›Ó·È ËÛ‡˙Â˘Í‹ ÙÔ˘ ÌÂ ÙÔ ÁÏ˘ÎÔ˘ÚÔÓÈÎfi ÔÍ‡ Î·È Ë ‚-ÔÍÂ›-‰ˆÛË. £· Ú¤ÂÈ Ó· ÛËÌÂÈˆıÂ›, fiÌˆ˜, fiÙÈ Û¿ÓÈ·¤¯ÂÈ ·Ó·ÊÂÚıÂ› fiÙÈ ÌÔÚÂ› Ó· ÌÂÈÒÛÂÈ Ù· Â›Â‰·ÙˆÓ ÏÈÈ‰›ˆÓ Î·È ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ Î·È, Î˘Ú›ˆ˜,ÙË˜ TC, ÙˆÓ TG Î·È ÙË˜ LDL-C, ÌÂ ·‰ÈÂ˘ÎÚ›ÓÈÛÙÔ ÌË-¯·ÓÈÛÌfi (8).

∆· ˘„ËÏ¿ Â›Â‰· Lp(a) ıÂˆÚÔ‡ÓÙ·È ·ÓÂÍ¿ÚÙË-ÙÔ˜ ·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘ ·ıËÚÔÁ¤ÓÂÛË˜ Î·È ıÚÔÌ-‚ÔÂÌ‚ÔÏÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ, ÂÂÈ‰‹ ÌÔÚÔ‡Ó Ó· ÚÔ-Î·Ï¤ÛÔ˘Ó ·fiÊÚ·ÍË ÙˆÓ ÌÈÎÚÒÓ ·ÁÁÂ›ˆÓ ÂÍ·ÈÙ›·˜

∂ÈÎfiÓ· 2. ª¤ÛË ÙÈÌ‹ ÙˆÓ ÂÈ¤‰ˆÓ ÙË˜ HDL-C, LDL-C Î·È Lp(a) ÛÂ fiÏÂ˜ ÙÈ˜ ÔÌ¿‰Â˜ ·ÛıÂÓÒÓ Î·È ÛÙÔ˘˜ Ì¿ÚÙ˘ÚÂ˜.

140

120

100

80

60

40

20

10

K·Ú‚·Ì·˙Â›ÓËª¿ÚÙ˘ÚÂ˜ 1

µ·ÏÚÔ˚Îfi

Ó¿ÙÚÈÔ ª¿ÚÙ˘ÚÂ˜ 2º·ÈÓÔ‚·Ú‚ÈÙ¿ÏË

ª¿ÚÙ˘ÚÂ˜ 3

HDL-C (mg/dl)

LDL-C (mg/dl)

Lp(a) (mg/dl)

¶›Ó·Î·˜ 2. ∂›Â‰· HDL-C, LDL-C Î·È Lp(a) ÔÚÔ‡ ÛÂ ·ÛıÂÓÂ›˜ Î·È Ì¿ÚÙ˘ÚÂ˜

º¿ÚÌ·Î· ∞ÚÈıÌfi˜ ·È‰ÈÒÓ HDL-C (mg/dl) p LDL-C (mg/dl) p Lp(a) (mg/dl) p(ª¤ÛË ÙÈÌ‹) (ª¤ÛË ÙÈÌ‹) (ª¤ÛË ÙÈÌ‹)

ñ ∫·Ú‚·Ì·˙Â›ÓË 28 61,2±13,2 <0,01 125,1±25,2 <0,05 17,8±20,1 ª™ª¿ÚÙ˘ÚÂ˜ 42 51,3±15,7 108,8±28,1 14,8±17,3

ñ µ·ÏÚÔ˚Îfi Ó¿ÙÚÈÔ 24 51,1±11,5 ª™ 98,4±18,1 ª™ 17,6±18,2 ª™ª¿ÚÙ˘ÚÂ˜ 40 51,8±15,3 109,2±28,4 15,1±17,5

ñ º·ÈÓÔ‚·Ú‚ÈÙ¿ÏË 24 54,5±13,0 <0,01 124,0±32,6 <0,05 18,5±18,1 ª™ª¿ÚÙ˘ÚÂ˜ 36 43,0±15,1 104,5±27,2 12,3±22,0

May-June 03 03-06-03 16:55 ™ÂÏ›‰·205


206

ÙˆÓ ·ÓÙÈÈÓˆ‰ÔÏ˘ÙÈÎÒÓ È‰ÈÔÙ‹ÙˆÓ ÙÔ˘˜. ™ÙËÓ ·ÚÔ‡-Û· ÌÂÏ¤ÙË, ·Ó Î·È Ë Lp(a) ·˘Í¿ÓÂÙ·È ÛÂ fiÏÂ˜ ÙÈ˜ÔÌ¿‰Â˜ ·È‰ÈÒÓ, ‰ÂÓ Ê·›ÓÂÙ·È Ó· ÂËÚÂ¿˙ÂÙ·È ÛÂÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎfi Â›Â‰Ô. À¿Ú¯Ô˘Ó ÌfiÓÔ ‰‡ÔÚÔËÁÔ‡ÌÂÓÂ˜ ·ÚfiÌÔÈÂ˜ ÌÂÏ¤ÙÂ˜. ™ÙËÓ ÚÒÙËÌÂÏ¤ÙË ‰ÂÓ ‚Ú¤ıËÎÂ Ó· ÂËÚÂ¿˙ÔÓÙ·È Ù· Â›Â‰·ÙË˜ Lp(a) (8), ÂÓÒ ÛÙË ‰Â‡ÙÂÚË ÌÂÏ¤ÙË ‚Ú¤ıËÎÂ ·˘-ÍËÌ¤ÓË ÛÂ fiÏÂ˜ ÙÈ˜ ÔÌ¿‰Â˜, ÌÔÏÔÓfiÙÈ Ë ·‡ÍËÛË ·˘-Ù‹ ‹Ù·Ó ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ ÌfiÓÔ ÛÙ· ·È‰È¿ ÌÂÏ‹„Ë Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË˜ (11). ∏ Â·ÁˆÁ‹ ÙˆÓ Ë·-ÙÈÎÒÓ ÌÈÎÚÔÛˆÌÈ·ÎÒÓ ÂÓ˙‡ÌˆÓ ·fi ÙËÓ Î·Ú‚·Ì·-˙Â›ÓË Î·È ÙËÓ Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË ÌÔÚÂ› Ó· ıÂˆÚË-ıÂ› ˘Â‡ı˘ÓË ÁÈ· ÙËÓ ·‡ÍËÛË ·˘Ù‹ (9), ·ÏÏ¿ Â›Ó·È¿ÁÓˆÛÙÔ˜ Ô ÌË¯·ÓÈÛÌfi˜ ÁÈ· ÙËÓ ·‡ÍËÛË ÙË˜ Lp(a)ÌÂ ÙË Ï‹„Ë ÙÔ˘ ‚·ÏÚÔ˚ÎÔ‡ Ó·ÙÚ›Ô˘. ¶ÂÚ·ÈÙ¤ÚˆÌÂÏ¤ÙÂ˜ ÌÂ ÌÂÁ·Ï‡ÙÂÚÔ ·ÚÈıÌfi ·ÛıÂÓÒÓ ÂÓ‰Â¯Ô-Ì¤Óˆ˜ ı· ‰ÒÛÔ˘Ó ·¿ÓÙËÛË ÛÂ ·˘Ùfi ÙÔ ÂÚÒÙËÌ·.

ŸÛÔÓ ·ÊÔÚ¿ ÛÙËÓ Â›‰Ú·ÛË ÙˆÓ ·ÓÙÈÂÈÏËÙÈ-ÎÒÓ Ê·ÚÌ¿ÎˆÓ ÛÙ· Â›Â‰· ÙˆÓ ·ÔÏÈÔÚˆÙÂ˚-ÓÒÓ, ˘¿Ú¯Ô˘Ó ÌfiÓÔ Ï›ÁÂ˜ ÌÂÏ¤ÙÂ˜ (1,7,11). ªÔÏÔ-

ÓfiÙÈ Ù· Â›Â‰· ÙË˜ HDL-C Î·È ÙË˜ LDL-C ÛÙÔÓ ÔÚfiÛ˘¯Ó¿ ·Ó·Ê¤ÚÔÓÙ·È ·˘ÍËÌ¤Ó· ÛÂ ¿ÙÔÌ· Ô˘ Ï·Ì-‚¿ÓÔ˘Ó Â·ÁˆÁÈÎ¿ ·ÓÙÈÂÈÏËÙÈÎ¿ Ê¿ÚÌ·Î·, ÔÈApoA-I Î·È ApoB, Ô˘ ·ÔÙÂÏÔ‡Ó Î·È ÙÈ˜ Î‡ÚÈÂ˜ÚˆÙÂ˝ÓÂ˜ ÙˆÓ HDL-C Î·È HDL-C ·ÓÙ›ÛÙÔÈ¯·, Û¿-ÓÈ· ‚Ú›ÛÎÔÓÙ·È ÂËÚÂ·ÛÌ¤ÓÂ˜, fiˆ˜ ‰È·ÈÛÙÒıËÎÂÛÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË (1). ∂›Ó·È Èı·Ófi Ë Â·ÁˆÁ‹ÙˆÓ ÌÈÎÚÔÛˆÌÈ·ÎÒÓ ÂÓ˙‡ÌˆÓ ·fi ÙËÓ Î·Ú‚·Ì·˙Â›-ÓË Î·È ÙË Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË Ó· ÚÔÎ·ÏÂ› ·˘ÍËÌ¤ÓËË·ÙÈÎ‹ Û‡ÓıÂÛË ÙË˜ ApoA-I Î·È ApoB.

Œ¯ÂÈ ·Ó·ÊÂÚıÂ› fiÙÈ Ù· ¿ÙÔÌ· ÌÂ ¯ÚfiÓÈ· ·ÓÙÈÂÈ-ÏËÙÈÎ‹ ·ÁˆÁ‹ ¤¯Ô˘Ó ÁÂÓÈÎ¿ ÌÂÈˆÌ¤ÓÔ Î›Ó‰˘ÓÔ ·Ó¿-Ù˘ÍË˜ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ (14). ∫·ıÒ˜ ÈÛÙÂ‡ÂÙ·ÈfiÙÈ Ù· ·˘ÍËÌ¤Ó· Â›Â‰· ÙË˜ HDL-C ÌÂÈÒÓÔ˘Ó ÙÔÓÎ›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛË˜ ÙË˜ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ (13), Ë·Ó·ÊÂÚfiÌÂÓË ÌÂÈˆÌ¤ÓË Â›ÙˆÛË ÙË˜ ÓfiÛÔ˘ ÛÂÂÈÏËÙÈÎÔ‡˜ ·ÛıÂÓÂ›˜ Ú¤ÂÈ Ó· ·Ô‰›‰ÂÙ·È Î˘Ú›ˆ˜ ÛÂ ·‡ÍËÛË ÙË˜ HDL-C (4,8). ŸÌˆ˜, Ë ∞ÌÂ-ÚÈÎ·ÓÈÎ‹ ∞Î·‰ËÌ›· ¶·È‰È·ÙÚÈÎ‹˜ ıÂˆÚÂ› fiÙÈ Ù· ·˘-ÍËÌ¤Ó· ËÏ›Î· TC/HDL-C Î·È LDL-C/HDL-C Â›Ó·È

¶›Ó·Î·˜ 3. ∂›Â‰· ApoA-I Î·È ApoB ÔÚÔ‡ ÛÂ ·ÛıÂÓÂ›˜ Î·È Ì¿ÚÙ˘ÚÂ˜

º¿ÚÌ·Î· ∞ÚÈıÌfi˜ ·È‰ÈÒÓ ApoA-I (mg/dl) p ApoB (mg/dl) p(ª¤ÛË ÙÈÌ‹) (ª¤ÛË ÙÈÌ‹)

ñ ∫·Ú‚·Ì·˙Â›ÓË 32 192,1±27,2 <0,01 101,3±27,7 <0,01ª¿ÚÙ˘ÚÂ˜ 35 131,2±43,9 74,8±17,9

ñ µ·ÏÚÔ˚Îfi Ó¿ÙÚÈÔ 28 142,9±39,2 ª™ 84,5± 26,1 ª™ª¿ÚÙ˘ÚÂ˜ 34 131,7±42,9 75,2±17,4

ñ º·ÈÓÔ‚·Ú‚ÈÙ¿ÏË 25 156,9±27,7 <0,01 99,7±23,61 <0,01ª¿ÚÙ˘ÚÂ˜ 26 128,1±39,3 72,2±17,2

∂ÈÎfiÓ· 3. ª¤ÛË ÙÈÌ‹ ÙˆÓ ÂÈ¤‰ˆÓ ÙË˜ ApoA-I Î·È ApoB ÛÂ fiÏÂ˜ ÙÈ˜ ÔÌ¿‰Â˜ ·ÛıÂÓÒÓ Î·È ÛÙÔ˘˜ Ì¿ÚÙ˘ÚÂ˜.

250

200

150

100

50

0

K·Ú‚·Ì·˙Â›ÓËª¿ÚÙ˘ÚÂ˜ 1

µ·ÏÚÔ˚Îfi

Ó¿ÙÚÈÔ ª¿ÚÙ˘ÚÂ˜ 2

º·ÈÓÔ‚·Ú‚ÈÙ¿ÏËª¿ÚÙ˘ÚÂ˜ 3

ApoA-I (mg/dl)

ApoB (mg/dl)

May-June 03 03-06-03 16:55 ™ÂÏ›‰·206


207

ÂÚÈÛÛfiÙÂÚÔ ÂÓ‰ÂÈÎÙÈÎ¿ ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ·ıËÚÔÁ¤ÓÂ-ÛË˜ (5). ™Â ¿ÙÔÌ· Ô˘ Ï·Ì‚¿ÓÔ˘Ó ·ÓÙÈÂÈÏËÙÈÎ¿Ê¿ÚÌ·Î·, Ë ·‡ÍËÛË ÙË˜ HDL-C ÌÔÚÂ› Ó· Û˘ÓÔ-‰Â‡ÂÙ·È ·fi Ù·˘Ùfi¯ÚÔÓË ·‡ÍËÛË ÙË˜ TC Î·È ÙË˜LDL-C Î·È, ¤ÙÛÈ, Ù· ËÏ›Î· TC/HDL Î·È LDL-C/HDL-C Ó· ·Ú·Ì¤ÓÔ˘Ó ·ÌÂÙ¿‚ÏËÙ·. ∞˘ÍËÌ¤Ó· ËÏ›Î·TC/HDL-C Î·È LDL-C/HDL-C ÛÂ ·È‰È¿ Ô˘ Ï·Ì‚¿-ÓÔ˘Ó Î·Ú‚·Ì·˙Â›ÓË (7,9), ·ÏÏ¿ Î·È ÌÂÈˆÌ¤Ó· ËÏ›-Î· TC/HDL-C ÁÂÓÈÎ¿ ÛÂ ¿ÙÔÌ· Ô˘ Ï·Ì‚¿ÓÔ˘Ó·ÓÙÈÂÈÏËÙÈÎ¿ Ê¿ÚÌ·Î· ¤¯Ô˘Ó ·Ó·ÊÂÚıÂ› (14).ŸÛÔÓ ·ÊÔÚ¿ ÛÙË ÌÂÙ·‚ÔÏ‹ ÙˆÓ ·ÓˆÙ¤Úˆ ËÏ›ÎˆÓÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ ‚·ÏÚÔ˚ÎÔ‡ Ó·ÙÚ›Ô˘, Ù· ‰Â-‰ÔÌ¤Ó· ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· Â›Ó·È ·ÓÙÈÊ·ÙÈÎ¿ (4,7). £·Ú¤ÂÈ Ó· ÛËÌÂÈˆıÂ›, Â›ÛË˜, fiÙÈ ÛÂ ÚÔËÁÔ‡ÌÂÓËÌÂÏ¤ÙË ¤¯ÂÈ ·Ó·ÊÂÚıÂ› fiÙÈ Ù· ·ÓÙÈÂÈÏËÙÈÎ¿ Ê¿Ú-Ì·Î· ÚÔÎ·ÏÔ‡Ó ÌfiÓÔ ‚Ú·¯˘ÚfiıÂÛÌÂ˜ ÌÂÙ·‚Ô-Ï¤˜ Î·È ÔÈ ÌÂÙ·‚ÔÏ¤˜ ·˘Ù¤˜ ·ÔÎ·ı›ÛÙ·ÓÙ·È ÌÂÙ¿ÙÔ ¤Ú·˜ ÙË˜ ·ÓÙÈÂÈÏËÙÈÎ‹˜ ·ÁˆÁ‹˜ (8). ªÔÏÔÓfi-ÙÈ ÌÂÚÈÎÔ› ÂÚÂ˘ÓËÙ¤˜ Û˘ÓÈÛÙÔ‡Ó ‰›·ÈÙ· Ùˆ¯‹ ÛÂ ¯Ô-ÏËÛÙÂÚfiÏË ÛÂ ¿ÙÔÌ· Ô˘ Ï·Ì‚¿ÓÔ˘Ó Î·Ú‚·Ì·˙Â›-ÓË, Ù· ·ÓˆÙ¤Úˆ ‰Â‰ÔÌ¤Ó· ‰ÂÓ ·Ú¤¯Ô˘Ó ·ÛÊ·Ï‹Û˘ÌÂÚ¿ÛÌ·Ù· fiÛÔÓ ·ÊÔÚ¿ ÛÙÔÓ Î›Ó‰˘ÓÔ ·ıËÚÔ-Á¤ÓÂÛË˜ ÛÙ· ·È‰È¿ Ô˘ Ï·Ì‚¿ÓÔ˘Ó ·ÓÙÈÂÈÏËÈÎ¿Ê¿ÚÌ·Î· Î·È ··ÈÙÂ›Ù·È ÂÚ·ÈÙ¤Úˆ ÌÂÏ¤ÙË ÙÔ˘ ı¤-Ì·ÙÔ˜ (2,8).

™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, ı· Ú¤ÂÈ Ó· ·Ó·ÊÂÚıÂ› fiÙÈ Ë·ÚÔ‡Û· ÌÂÏ¤ÙË ¤‰ÂÈÍÂ fiÙÈ Ë ¯ÔÚ‹ÁËÛË ÌÔÓÔıÂÚ·-Â›·˜ ÌÂ ·ÓÙÈÂÈÏËÙÈÎ¿ Ê¿ÚÌ·Î· Î·È, Û˘ÁÎÂÎÚÈÌ¤-Ó·, ÌÂ Î·Ú‚·Ì·˙Â›ÓË Î·È Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË, ÌÔÚÂ›Ó· ÂËÚÂ¿ÛÂÈ Ù· Â›Â‰· ÙˆÓ ÏÈÈ‰›ˆÓ, ÏÈÔÚˆÙÂ-˚ÓÒÓ Î·È ·ÔÏÈÔÚˆÙÂ˚ÓÒÓ ÛÙÔÓ ÔÚfi ÂÈÏËÙÈÎÒÓ·È‰ÈÒÓ ÙË˜ ¯ÒÚ·˜ Ì·˜, ÌÔÏÔÓfiÙÈ ÙÔ Â›‰Ô˜ Î·È ÙÔÌ¤ÁÂıÔ˜ ÙˆÓ ÌÂÙ·‚ÔÏÒÓ ‰È·Ê¤ÚÂÈ ·fi ¿ÏÏÂ˜ ÚÔË-ÁÔ‡ÌÂÓÂ˜ ÌÂÏ¤ÙÂ˜. £· Ú¤ÂÈ, fiÌˆ˜, Ó· ÙÔÓÈÛÙÂ›fiÙÈ ÁÈ· Ó· Á›ÓÂÈ ·ÓÙÈÏËÙfi˜ Ô ÚfiÏÔ˜ ÙˆÓ ·ÓÙÈÂÈÏË-ÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ ÛÙËÓ Ù˘¯fiÓ ÌÂÏÏÔÓÙÈÎ‹ ·Ó¿Ù˘ÍË·ıËÚˆÌ¿ÙˆÛË˜ ̄ ÚÂÈ¿˙ÔÓÙ·È ÂÚÈÛÛfiÙÂÚÂ˜ ÌÂÏ¤ÙÂ˜ÛÂ ·È‰È·ÙÚÈÎfi ÏËı˘ÛÌfi, ·ÏÏ¿ Î·È Ì·ÎÚÔ¯ÚfiÓÈ··Ú·ÎÔÏÔ‡ıËÛË. ™˘¯Ófi ÚÔÛ‰ÈÔÚÈÛÌfi ÙˆÓ ÂÈ¤-‰ˆÓ ÙˆÓ ÏÈÈ‰›ˆÓ Î·È ‰È·ÈÙËÙÈÎ¤˜ Ô‰ËÁ›Â˜ ¯ÚÂÈ¿˙Ô-ÓÙ·È Î˘Ú›ˆ˜ Ù· ·È‰È¿ Ô˘ Ï·Ì‚¿ÓÔ˘Ó ·ÓÙÈÂÈÏËÙÈ-Î‹ ·ÁˆÁ‹ ÌÂ Î·Ú‚·Ì·˙Â›ÓË ‹ Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË Î·ÈÙ· ÔÔ›· ‰È·ÙÚ¤¯Ô˘Ó ·˘ÍËÌ¤ÓÔ Î›Ó‰˘ÓÔ ·ıËÚÔÁ¤-ÓÂÛË˜, fiˆ˜ Â›Ó·È ·˘Ù¿ ÌÂ ‰È·Ù·Ú·¯¤˜ ÏÈÈ‰›ˆÓ Î·ÈÏÈÔÚˆÙÂ˚ÓÒÓ ‹ ÌÂ ÂÈ‚·Ú˘Ì¤ÓÔ ÔÈÎÔÁÂÓÂÈ·ÎfiÈÛÙÔÚÈÎfi ·ıËÚˆÌ¿ÙˆÛË˜.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Reddy MN. Effect of anticonvulsant drugs on plasma total

cholesterol, high-density lipoprotein cholesterol, and

apolipoproteins A and B in children with epilepsy. Proc SocExp Biol Med 1985;180:359-363.

2. Franzoni E, Govoni M, D’Addato S, Gualandi S, Sangiorgi Z,Descovich GC et al. Total cholesterol, high-densitylipoprotein cholesterol and triglycerides in childrenreceiving antiepileptic drugs. Epilepsia 1992;33:932-935.

3. Brown DW, Ketter TA, Crumlish J, Post RM.Carbamazepine-induced increases in total serumcholesterol: clinical and theoretical implications. J ClinPsychopharmacol 1992;12:431-437.

4. Eiris JM, Lojo S, Del Rio MC, Novo I, Bravo M, Pavon P etal. Effects of long-term treatment with antiepileptic drugs onserum lipid levels in children with epilepsy. Neurology1995;45:1155-1157.

5. Isojarvi JI, Pakarinen AJ, Myllyla VV. Serum lipid levelsduring carbamazepine medication. A prospective study.Arch Neurol 1993;50:590-593.

6. Yalcin E, Hassanzadeh A, Mawlud K. The effects of long-term anticonvulsive treatment on serum lipid profile. ActaPaediatr Jpn 1997;39:342-345.

7. Sozuer DT, Atakil D, Dogu O, Baybas S, Arpaci B. Serumlipids in epileptic children treated with carbamazepine andvalproate. Eur J Pediatr 1997;156:565-567.

8. Verrotti A, Basciani F, Domizio S, Sabatino G, Morgese G,Chiarelli F. Serum lipids and lipoproteins in patients treatedwith antiepileptic drugs. Pediatr Neurol 1998;19:364-367.

9. Demircioglu S, Soylu A, Dirik E. Carbamazepine andvalproic acid: effects on the serum lipids and liver functionsin children. Pediatr Neurol 2000;23:142-146.

10. Papacostas S. Oxcarbazepine versus carbamazepinetreatment and induction of serum lipid abnormalities. J ChildNeurol 2000;15:138-140.

11. Aynaci FM, Orhan F, Orem A, Yildirmis S, Gedik Y. Effect ofantiepileptic drugs on plasma lipoprotein (a) and other lipidlevels in childhood. J Child Neurol 2001;16:367-369.

12. ∫·‚·˙·Ú¿ÎË˜ ∂, ∆ÛfiÏ·˜ °, ™ÎÔ‡ÚÔ˘-Ã·Ù˙Ë·ÚÁ˘ÚÔ‡ ¢,ºÔ˘ÛÙÔ‡ÎÔ˘ ª, ¢‹ÌÔ˘ ™, ¢ÂÏËÁÈ¿ÓÓË µ. ∫·Ù·ÓÔÌ‹ ÔÏÈÎ‹˜¯ÔÏËÛÙÂÚfiÏË˜, ÏÈÔÚˆÙÂ˚ÓÒÓ Î·È ·ÔÏÈÔÚˆÙÂ˚ÓÒÓ ÛÂ‚Ú¤ÊË Î·È ·È‰È¿. ¶·È‰È·ÙÚÈÎ‹ 1998;61:148-160.

13. American Academy of Pediatrics Committee on Nutrition.Statement on cholesterol. Pediatrics 1992;90:469-473.

14. Muuronen A, Kaste M, Nikkila EA, Tolppanen EM. Mortalityfrom ischaemic heart disease among patients usinganticonvulsive drugs: a case-control study. BMJ1985;291:1481-1483.


¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ∞. µÔ‡‰ÚË˜ ¡Â˘ÚÔÏÔÁÈÎfi ∆Ì‹Ì·, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, £Ë‚ÒÓ & §Â‚·‰Â›·˜, ∆.∫. 115 27, ∞ı‹Ó· E-mail: [email protected]

May-June 03 03-06-03 16:55 ™ÂÏ›‰·207


208

™‡Ó‰ÚÔÌÔ ·ÔÊÚ·ÎÙÈÎ‹˜ ¿ÓÔÈ·˜ ÛÙÔÓ ‡ÓÔ Û˘ÓÔ‰Â˘fiÌÂÓÔ ·fi Ó˘ÎÙÂÚÈÓ‹ ÂÓÔ‡ÚËÛË ∂. ∞ÏÂÍfiÔ˘ÏÔ˜, ∞. ∫·‰›ÙË˜, µ. ªÈÎÚ¿ÎË, ∂. ∫ˆÛÙ·‰‹Ì·, ¡. ™ÎÂÓÙ¤ÚË˜, ∫. °Ô˘ÚÁÔ˘ÏÈ¿ÓË˜

Obstructive sleep apnoea syndrome accompanied by nocturnal enuresis E. Alexopoulos, A. Kaditis, V. Mikraki, E. Kostadima, N. Skenteris, K. Gourgoulianis

∂¡¢π∞º∂ƒOÀ™∞ ¶∂ƒπ¶∆ø™∏ CASE REPORT

�¶ÂÚ›ÏË„Ë: ∏ Ó˘ÎÙÂÚÈÓ‹ ÂÓÔ‡ÚËÛË ıÂˆÚÂ›Ù·È ÂÈ-ÏÔÎ‹ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ·ÔÊÚ·ÎÙÈÎ‹˜ ¿ÓÔÈ·˜ ÙÔ˘‡ÓÔ˘, ÂÂÈ‰‹ Û˘¯Ó¿ ˘Ô¯ˆÚÂ› ÌÂÙ¿ ·fi ·Ì˘Á‰·-ÏÂÎÙÔÌ‹ Î·È ·‰ÂÓÔÂÈ‰ÂÎÙÔÌ‹, ÔÈ ÔÔ›Â˜ ·ÔÛÎÔ-Ô‡Ó ÛÙË ‚ÂÏÙ›ˆÛË ÙË˜ ‚·ÙfiÙËÙ·˜ ÙÔ˘ ·ÓÒÙÂÚÔ˘·ÂÚ·ÁˆÁÔ‡. øÛÙfiÛÔ, ÛÙÈ˜ ÂÚÈÙÒÛÂÈ˜ Ô˘ ¤¯Ô˘ÓÂÚÈÁÚ·ÊÂ› Ì¤¯ÚÈ Û‹ÌÂÚ· ÛÙË ‚È‚ÏÈÔÁÚ·Ê›·, Ë˘Ô¯ÒÚËÛË ÙË˜ ·ÔÊÚ·ÎÙÈÎ‹˜ ¿ÓÔÈ·˜ Èı·ÓÔÏÔ-Á‹ıËÎÂ ·fi ÙË ‚ÂÏÙ›ˆÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÌÂÙ¿ÙËÓ Â¤Ì‚·ÛË Î·È ‰ÂÓ ÙÂÎÌËÚÈÒıËÎÂ ÌÂ ÔÏ˘Î·Ù·-ÁÚ·ÊÈÎ‹ ÌÂÏ¤ÙË ‡ÓÔ˘ ÚÈÓ Î·È ÌÂÙ¿ ÙËÓ ·Ì˘Á‰·-ÏÂÎÙÔÌ‹/·‰ÂÓÔÂÈ‰ÂÎÙÔÌ‹. ¶ÂÚÈÁÚ¿ÊÂÙ·È ÂÚ›Ùˆ-ÛË ·ÁÔÚÈÔ‡ ËÏÈÎ›·˜ 9 ÂÙÒÓ ÌÂ ÈÛÙÔÚÈÎfi Î·ı’ ¤ÍÈÓÚÔ¯·ÏËÙÔ‡ Î·È ÚˆÙÔ·ıÔ‡˜ Ó˘ÎÙÂÚÈÓ‹˜ ÂÓÔ‡ÚË-ÛË˜, Ù· Û˘ÌÙÒÌ·Ù· ÙÔ˘ ÔÔ›Ô˘ ˘Ô¯ÒÚËÛ·Ó ÌÂ-Ù¿ ·fi Û˘Ó‰˘·ÛÌ¤ÓË ·Ì˘Á‰·ÏÂÎÙÔÌ‹ Î·È ·‰ÂÓÔÂÈ-‰ÂÎÙÔÌ‹. ¶ÔÏ˘·Ú·ÌÂÙÚÈÎ‹ ÌÂÏ¤ÙË ‡ÓÔ˘ Ô˘ ¤ÁÈ-ÓÂ ÚÈÓ Î·È ÌÂÙ¿ ÙËÓ Â¤Ì‚·ÛË ·Ó¤‰ÂÈÍÂ ÛËÌ·ÓÙÈÎ‹‚ÂÏÙ›ˆÛË ÙˆÓ ‰È·Ù·Ú·¯ÒÓ ÙË˜ ·Ó·ÓÔ‹˜ ÛÙÔÓ‡ÓÔ. ∂Í·ÈÙ›·˜ ÙË˜ Èı·Ó‹˜ Û˘Û¯¤ÙÈÛË˜ ÙË˜ Ó˘ÎÙÂ-ÚÈÓ‹˜ ÂÓÔ‡ÚËÛË˜ ÌÂ ÙÈ˜ ‰È·Ù·Ú·¯¤˜ ÙË˜ ·Ó·ÓÔ‹˜ÛÙÔÓ ‡ÓÔ, ÏÂÙÔÌÂÚ¤˜ ÈÛÙÔÚÈÎfi ı· Ú¤ÂÈ Ó· Ï·Ì-‚¿ÓÂÙ·È ÛÂ fiÏ· Ù· ·È‰È¿ Ô˘ ÚÔÛÎÔÌ›˙ÔÓÙ·È ÁÈ··ÓÙÈÌÂÙÒÈÛË ÙË˜ ÂÓÔ‡ÚËÛË˜. £ÂÚ·Â›· ÙË˜ ·Ô-ÊÚ·ÎÙÈÎ‹˜ ¿ÓÔÈ·˜ ÙÔ˘ ‡ÓÔ˘ ÌÔÚÂ› Ó· Ô‰ËÁ‹ÛÂÈÛÂ ˘Ô¯ÒÚËÛË ÙË˜ ÂÓÔ‡ÚËÛË˜.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ·ÔÊÚ·ÎÙÈÎ‹ ¿ÓÔÈ· ÙÔ˘ ‡ÓÔ˘,‰È·Ù·Ú·¯¤˜ ÙË˜ ·Ó·ÓÔ‹˜ ÛÙÔÓ ‡ÓÔ, Ó˘ÎÙÂÚÈÓ‹ÂÓÔ‡ÚËÛË, ·Ì˘Á‰·ÏÂÎÙÔÌ‹, ·‰ÂÓÔÂÈ‰ÂÎÙÔÌ‹.

�Abstract: A causative link between nocturnalenuresis and obstructive sleep apnoea (OSA) inchildren has been suggested, since bedwettingfrequently improves or resolves completely afteradenotonsillectomy for the relief of upper airwayobstruction. However, in the patients reported in thepaediatric literature, the improvement of sleep-disordered breathing was not assessed bycomparing preoperative and postoperativepolysomnography findings. This is a report of achild with a long history of snoring and primarynocturnal enuresis whose symptoms ceasedfollowing adenotonsillectomy for OSA.Polysomnograms performed before and after thesurgical procedure demonstrated appreciableimprovement in the sleep pattern. Since nocturnalenuresis has been associated with sleep-disordered breathing, questions regardingrespiratory symptoms during sleep should beasked in children undergoing an evaluation forbedwetting. Treatment of OSA may contribute toresolution of enuresis.

Key words: obstructive sleep apnoea syndrome,sleep disordered breathing, nocturnal enuresis,adenoidectomy, tonsillectomy.

¶·È‰È·ÙÚÈÎ‹ Î·È ¶ÓÂ˘ÌÔÓÔÏÔÁÈÎ‹ ∫ÏÈÓÈÎ‹ ¶·ÓÂÈÛÙËÌ›Ô˘£ÂÛÛ·Ï›·˜¶·È‰ÔÓÂ˘ÌÔÓÔÏÔÁÈÎfi π·ÙÚÂ›Ô Î·È ∂ÚÁ·ÛÙ‹ÚÈÔ ªÂÏ¤ÙË˜¢È·Ù·Ú·¯ÒÓ ÙË˜ ∞Ó·ÓÔ‹˜ ÛÙÔÓ ⁄ÓÔ, ¶·ÓÂÈÛÙËÌÈ·Îfi ¡ÔÛÔÎÔÌÂ›Ô §¿ÚÈÛ·˜

Pediatric and Respiratory Medicine Clinic of University ofThessalia Department of Pediatric Respiratory Medicine andLaboratory for the Study of Sleep and Breathing Disorders,University Hospital of Larissa

™˘ÓÙÔÌÔÁÚ·Ê›Â˜™∞∞À ™‡Ó‰ÚÔÌÔ ·ÔÊÚ·ÎÙÈÎ‹˜ ¿ÓÔÈ·˜ ÙÔ˘ ‡ÓÔ˘

May-June 03 03-06-03 16:55 ™ÂÏ›‰·208


209

∂ÈÛ·ÁˆÁ‹Œ¯ÂÈ ‰È·Ù˘ˆıÂ› ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· Ë ¿Ô„Ë fiÙÈ

Î¿ÔÈÂ˜ ÂÚÈÙÒÛÂÈ˜ Ó˘ÎÙÂÚÈÓ‹˜ ÂÓÔ‡ÚËÛË˜ ·ÔÙÂ-ÏÔ‡Ó ÂÈÏÔÎ‹ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ·ÔÊÚ·ÎÙÈÎ‹˜¿ÓÔÈ·˜ ÙÔ˘ ‡ÓÔ˘ (1,2). ∏ ı¤ÛË ·˘Ù‹, fiÌˆ˜, ‰ÂÓÛÙËÚ›˙ÂÙ·È ÛÂ ÂÈ‰ËÌÈÔÏÔÁÈÎ¤˜ ÌÂÏ¤ÙÂ˜, ·ÏÏ¿ ÛÙË‚ÂÏÙ›ˆÛË ‹ Î·È Ï‹ÚË ˘Ô¯ÒÚËÛË ÙË˜ ÂÓÔ‡ÚËÛË˜ÌÂÙ¿ ÙË ıÂÚ·Â›· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ·ÔÊÚ·ÎÙÈÎ‹˜¿ÓÔÈ·˜ ÙÔ˘ ‡ÓÔ˘ (™∞∞À) (3-5). øÛÙfiÛÔ, ÛÙÈ˜ Â-ÚÈÙÒÛÂÈ˜ Ô˘ ¤¯Ô˘Ó ÂÚÈÁÚ·ÊÂ› Ì¤¯ÚÈ Û‹ÌÂÚ· ÛÙË‚È‚ÏÈÔÁÚ·Ê›· ‰ÂÓ ¤¯ÂÈ Á›ÓÂÈ ÔÏ˘Î·Ù·ÁÚ·ÊÈÎ‹ ÌÂÏ¤-ÙË ‡ÓÔ˘ ÚÈÓ Î·È ÌÂÙ¿ ÙËÓ ·Ì˘Á‰·ÏÂÎÙÔÌ‹/·‰ÂÓÔ-ÂÈ‰ÂÎÙÔÌ‹, ÂÓÒ Ë ˘Ô¯ÒÚËÛË ÙÔ˘ ™∞∞À Èı·ÓÔÏÔ-Á‹ıËÎÂ ·fi ÙË ‚ÂÏÙ›ˆÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÌÂÙ¿ÙËÓ Â¤Ì‚·ÛË.

¶·ÚÔ˘ÛÈ¿˙ÂÙ·È Ë ÂÚ›ÙˆÛË ÂÓfi˜ ·È‰ÈÔ‡ ÌÂÚÔ¯·ÏËÙfi, ·Ó‹Û˘¯Ô ‡ÓÔ, ™∞∞À Î·È ÚˆÙÔ·ı‹ Ó˘-ÎÙÂÚÈÓ‹ ÂÓÔ‡ÚËÛË, Ù· Û˘ÌÙÒÌ·Ù· ÙÔ˘ ÔÔ›Ô˘ Î·ÈÙ· Â˘Ú‹Ì·Ù· ÙË˜ ÔÏ˘Î·Ù·ÁÚ·ÊÈÎ‹˜ ÌÂÏ¤ÙË˜ ‚ÂÏ-ÙÈÒıËÎ·Ó ÌÂÙ¿ ÙË Û˘Ó‰˘·ÛÌ¤ÓË ·Ì˘Á‰·ÏÂÎÙÔÌ‹/·‰ÂÓÔÂÈ‰ÂÎÙÔÌ‹.

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛË˜∞ÁfiÚÈ ËÏÈÎ›·˜ 9 ÂÙÒÓ ÚÔÛÎÔÌ›ÛÙËÎÂ ÛÙÔ ÁÂÓÈÎfi

·È‰È·ÙÚÈÎfi È·ÙÚÂ›Ô, Î·ıÒ˜ ·ÚÔ˘Û›·˙Â ÚˆÙÔ·ı‹Ó˘ÎÙÂÚÈÓ‹ ÂÓÔ‡ÚËÛË Û¯Â‰fiÓ Î¿ıÂ ‚Ú¿‰˘. OÈ ÁÔÓÂ›˜·Ó¤ÊÂÚ·Ó ‰È·Ù·Ú·¯¤˜ ÙË˜ ·Ó·ÓÔ‹˜ ÛÙÔÓ ‡ÓÔ ·fiÙËÓ ËÏÈÎ›· ÙˆÓ 3,5 ÂÙÒÓ. ∆· Û˘ÌÙÒÌ·Ù· ÂÚÈÂÏ¿Ì-‚·Ó·Ó ˘ÓËÏ›· Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ËÌ¤Ú·˜, ·Ó·-ÓÔ‹ ·fi ÙÔ ÛÙfiÌ· ÙfiÛÔ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘‡ÓÔ˘ fiÛÔ Î·È Î·Ù¿ ÙËÓ ÂÁÚ‹ÁÔÚÛË, Ë¯ËÚfi ÚÔ¯·-ÏËÙfi Î¿ıÂ ‚Ú¿‰˘ Î·È ¿ÓÔÈÂ˜ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘‡ÓÔ˘. ¶ÚfiÛÊ·ÙË ÚÔÛ¿ıÂÈ· ·ÓÙÈÌÂÙÒÈÛË˜ ÙË˜Ó˘ÎÙÂÚÈÓ‹˜ ÂÓÔ‡ÚËÛË˜ ÌÂ ÙÚÔÔÔ›ËÛË ÙË˜ Û˘ÌÂ-ÚÈÊÔÚ¿˜ ‰ÂÓ Â›¯Â ·ÔÙ¤ÏÂÛÌ·.

∫·Ù¿ ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈÎ‹ ÂÍ¤Ù·ÛË ÙÔ˘ ·È‰ÈÔ‡ ‰È·-ÈÛÙÒıËÎ·Ó ÛÙÔÌ·ÙÈÎ‹ ·Ó·ÓÔ‹ Î·È ˘ÂÚÙÚÔÊÈÎ¤˜·Ì˘Á‰·Ï¤˜ Ô˘ ·¤ÊÚ·ÛÛ·Ó ÛÂ ÛËÌ·ÓÙÈÎfi ‚·ıÌfiÙËÓ Â›ÛÔ‰Ô ÙÔ˘ ÛÙÔÌ·ÙÔÊ¿Ú˘ÁÁ·. ¶Ï¿ÁÈ· ·ÎÙÈÓÔ-ÁÚ·Ê›· Ì·Ï·ÎÒÓ ÌÔÚ›ˆÓ ÙÔ˘ ÚÈÓÔÊ¿Ú˘ÁÁ· ÌÂ ÙÔÛÙfiÌ· ·ÓÔÈÎÙfi ·Ó¤‰ÂÈÍÂ Ì¤ÙÚÈÔ˘ ‚·ıÌÔ‡ ˘ÂÚÙÚÔ-Ê›· ÙˆÓ ·‰ÂÓÔÂÈ‰ÒÓ ÂÎ‚Ï·ÛÙ‹ÛÂˆÓ, ÂÓÒ Ô ˘fiÏÔÈ-Ô˜ ÎÏÈÓÈÎfi˜ Î·È ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ·¤ÎÏÂÈÛÂ¿ÏÏ· ÔÚÁ·ÓÈÎ¿ ·›ÙÈ· ÛÙ· ÔÔ›· ı· ÌÔÚÔ‡ÛÂ Ó··Ô‰ÔıÂ› Ë ÂÓÔ‡ÚËÛË.

¶Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ ÔÏ˘·Ú·ÌÂÙÚÈÎ‹ ÌÂÏ¤ÙË‡ÓÔ˘ ÌÂ ˘ÔÏÔÁÈÛÙÈÎfi Û‡ÛÙËÌ· (Alice 4,Respironics, Mariette, GA), ÛÙËÓ ÔÔ›· Î·Ù·ÁÚ¿ÊË-ÎÂ Ë ÚÔ‹ ÙÔ˘ ·¤Ú· ·fi ÙË Ì‡ÙË Î·È ÙÔ ÛÙfiÌ·, ÔÈ ÎÈ-Ó‹ÛÂÈ˜ ÙÔ˘ ıˆÚ·ÎÈÎÔ‡ Î·È ÎÔÈÏÈ·ÎÔ‡ ÙÔÈ¯ÒÌ·ÙÔ˜, ÔÎÔÚÂÛÌfi˜ ÙË˜ ·ÈÌÔÛÊ·ÈÚ›ÓË˜ ÛÂ ÔÍ˘ÁfiÓÔ, Ë Î·Ú-‰È·Î‹ Û˘¯ÓfiÙËÙ· Î·È Ë ·ÏÏ·Á‹ ÙË˜ ı¤ÛË˜ ÙÔ˘ ÛÒ-Ì·ÙÔ˜. ∂ÈÏ¤ÔÓ, ¤ÁÈÓÂ Î·È ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊÈ-Î‹ Î·Ù·ÁÚ·Ê‹ ÁÈ· ÛÙ·‰ÈÔÔ›ËÛË ÙÔ˘ ‡ÓÔ˘. ø˜

·ÔÊÚ·ÎÙÈÎ‹ ¿ÓÔÈ· ÙÔ˘ ‡ÓÔ˘ ÔÚ›ÛÙËÎÂ Ë ‰È·ÎÔ-‹ ÙË˜ ÚÔ‹˜ ÙÔ˘ ·¤Ú· ·fi ÙË Ì‡ÙË Î·È ÙÔ ÛÙfiÌ·‰È¿ÚÎÂÈ·˜ ÙÔ˘Ï¿¯ÈÛÙÔÓ ‰‡Ô ·Ó·ÓÂ˘ÛÙÈÎÒÓ Î‡ÎÏˆÓ,ÌÂ Ù·˘Ùfi¯ÚÔÓË Î·Ù·ÁÚ·Ê‹ ÎÈÓ‹ÛÂˆÓ ÙË˜ ÎÔÈÏÈ¿˜.ø˜ ·ÔÊÚ·ÎÙÈÎ‹ ˘fiÓÔÈ· ıÂˆÚ‹ıËÎÂ Ë ÂÏ¿ÙÙˆÛËÙÔ˘Ï¿¯ÈÛÙÔÓ Î·Ù¿ 50% ÙË˜ ÚÔ‹˜ ÙÔ˘ ·¤Ú· ·fi ÙËÌ‡ÙË Î·È ÙÔ ÛÙfiÌ·, ÌÂ Ù·˘Ùfi¯ÚÔÓË ·ÚÔ˘Û›· ·Ú¿-‰ÔÍË˜ ·Ó·ÓÔ‹˜ Î·È ·ÔÎÔÚÂÛÌfi ÙË˜ ·ÈÌÔÛÊ·ÈÚ›-ÓË˜ ÙÔ˘Ï¿¯ÈÛÙÔÓ Î·Ù¿ 4% (6). ∆· ·ÔÙÂÏ¤ÛÌ·Ù·ÙË˜ ÌÂÏ¤ÙË˜ Î·Ù·ÁÚ¿ÊÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1.

∆Ô ·È‰› ˘Ô‚Ï‹ıËÎÂ ÛÂ ·Ì˘Á‰·ÏÂÎÙÔÌ‹ Î·È·‰ÂÓÔÂÈ‰ÂÎÙÔÌ‹. ∏ ˘ÓËÏ›· Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ËÌ¤Ú·˜ Î·È ÔÈ ·Ú·ÙËÚÔ‡ÌÂÓÂ˜ ¿ÓÔÈÂ˜ Î·Ù¿ ÙË‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘ ˘Ô¯ÒÚËÛ·Ó Ï‹Úˆ˜, ÂÓÒ ÙÔÚÔ¯·ÏËÙfi ‚ÂÏÙÈÒıËÎÂ ÛËÌ·ÓÙÈÎ¿.

∆Ô ·È‰› ·ÚÔ˘Û›·ÛÂ ÌfiÓÔ ÙÚ›· ÂÂÈÛfi‰È· Ó˘-ÎÙÂÚÈÓ‹˜ ÂÓÔ‡ÚËÛË˜ ÛÙÈ˜ ÚÒÙÂ˜ ‰‡Ô Â‚‰ÔÌ¿‰Â˜ÌÂÙ¿ ÙËÓ Â¤Ì‚·ÛË Î·È Â›Ó·È ÂÏÂ‡ıÂÚÔ Ó˘ÎÙÂÚÈÓ‹˜ÂÓÔ‡ÚËÛË˜ ÁÈ· ÂÚÈÛÛfiÙÂÚÔ ·fi 18 Ì‹ÓÂ˜. ŒÁÈÓÂÓ¤· ÔÏ˘·Ú·ÌÂÙÚÈÎ‹ ÌÂÏ¤ÙË ‡ÓÔ˘ 6 Â‚‰ÔÌ¿‰Â˜ÌÂÙ¿ ÙËÓ Â¤Ì‚·ÛË. ∆· ·ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ ÌÂÏ¤ÙË˜Î·Ù·ÁÚ¿ÊÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1.

™˘˙‹ÙËÛË ∞ÚÎÂÙ¤˜ ÌÂÏ¤ÙÂ˜ ÛÂ ·È‰È¿ ÌÂ ·ÔÊÚ·ÎÙÈÎ‹

¿ÓÔÈ· ÛÙÔÓ ‡ÓÔ ·Ó·Ê¤ÚÔ˘Ó ÂÚÈÙÒÛÂÈ˜ ÌÂ Ó˘-ÎÙÂÚÈÓ‹ ÂÓÔ‡ÚËÛË (2,3). OÈ Swift Î·È Û˘Ó ·Ó¤ÊÂÚ·Ó3 ·È‰È¿ ÌÂ ™∞∞À Î·È ÂÓÔ‡ÚËÛË, ÛÙÔ ¤Ó· ·fi Ù·ÔÔ›· Ë ÂÓÔ‡ÚËÛË ˘Ô¯ÒÚËÛÂ ÌÂÙÂÁ¯ÂÈÚËÙÈÎ¿ (4).ª›· ÈÔ Û˘ÛÙËÌ·ÙÈÎ‹ ÚÔÛ¤ÁÁÈÛË ÙÔ˘ ÚÔ‚Ï‹Ì·-ÙÔ˜ ÙË˜ Ó˘ÎÙÂÚÈÓ‹˜ ÂÓÔ‡ÚËÛË˜ Î·È ÙË˜ ·fiÊÚ·ÍË˜ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·ÂÚ·ÁˆÁÔ‡ ¤¯ÂÈ ·ÚÔ˘ÛÈ·ÛÙÂ› ·fi ÙÔ˘˜ Weider Î·È Û˘Ó (5). ¶ÂÚÈÁÚ¿ÊÔ˘Ó ÙËÓÂÌÂÈÚ›· ÙÔ˘˜ ·fi 115 ·ÛıÂÓÂ›˜ ËÏÈÎ›·˜ 3-19 ÂÙÒÓÔ˘ ˘Ô‚Ï‹ıËÎ·Ó ÛÂ ·Ì˘Á‰·ÏÂÎÙÔÌ‹ ‹ ·‰ÂÓÔÂÈ‰Â-ÎÙÔÌ‹ ÌÂ ÔÈÎ›ÏÂ˜ ÂÓ‰Â›ÍÂÈ˜. ¶·Ú·ÙËÚ‹ıËÎÂ ÌÂ›ˆ-ÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ Ó˘ÎÙÒÓ ÌÂ ÂÓÔ˘ÚËÙÈÎ¿ ÂÂÈÛfi-‰È· Î·Ù¿ 66% ¤Ó· Ì‹Ó· ÌÂÙ¿ ÙËÓ Â¤Ì‚·ÛË Î·È Î·-Ù¿ 76% ¤ÍÈ Ì‹ÓÂ˜ ÌÂÙ¿. ™Â 3 ·fi Ù· 11 ·È‰È¿ Ô˘

¶›Ó·Î·˜ 1. ∞ÔÙÂÏ¤ÛÌ·Ù· ÔÏ˘Î·Ù·ÁÚ·ÊÈÎÒÓ ÌÂÏÂÙÒÓ

¶ÚÈÓ ÙËÓ ªÂÙ¿ ÙËÓÂ¤Ì‚·ÛË Â¤Ì‚·ÛË

™‡ÓÔÏÔ ·ÓÔÈÒÓ 12 4™‡ÓÔÏÔ ˘ÔÓÔÈÒÓ 41 7™‡ÓÔÏÔ ·ÔÎÔÚÂÛÌÒÓ >4% 57 12∞π (‰Â›ÎÙË˜ ·ÓÔÈÒÓ) 1,5/ÒÚ· 0,5/ÒÚ·∞∏π (‰Â›ÎÙË˜ ·ÓÔÈÒÓ-˘ÔÓÔÈÒÓ) 6,6/ÒÚ· 1,5/ÒÚ·DI (‰Â›ÎÙË˜ ·ÔÎÔÚÂÛÌÒÓ) 7,1/ÒÚ· 1,6/ÒÚ·∂Ï¿¯ÈÛÙÔ SaO2 82% 93%ÃÚfiÓÔ˜ ‡ÓÔ˘ ÌÂ SaO2 <95% 32 min 1,5 minÃÚfiÓÔ˜ ‡ÓÔ˘ ÌÂ SaO2 <90% 6 min 0 minÃÚfiÓÔ˜ ‡ÓÔ˘ ÌÂ SaO2 <85% 0,5 min 0 min

May-June 03 03-06-03 16:55 ™ÂÏ›‰·209


210

¤ÁÈÓÂ ÔÏ˘Î·Ù·ÁÚ·ÊÈÎ‹ ÌÂÏ¤ÙË ‡ÓÔ˘ ÚÔÂÁ¯ÂÈÚË-ÙÈÎ¿ ‚Ú¤ıËÎÂ ™∞∞À. ∏ ÂÓÔ‡ÚËÛË ˘Ô¯ÒÚËÛÂ Î·ÈÛÙ· 3 ·È‰È¿ ÌÂÙ¿ ÙË ¯ÂÈÚÔ˘ÚÁÈÎ‹ ·ÓÙÈÌÂÙÒÈÛË.

∏ ˘¤ÚÌÂÙÚË ·Ú·ÁˆÁ‹ Ô‡ÚˆÓ Î·Ù¿ ÙË ‰È¿Ú-ÎÂÈ· ÙÔ˘ ‡ÓÔ˘ ¤¯ÂÈ ÚÔÙ·ıÂ› ˆ˜ ¤Ó·˜ ·fi ÙÔ˘˜ ÌË-¯·ÓÈÛÌÔ‡˜ Ô˘ Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÙËÓ ÂÌÊ¿ÓÈÛË Ó˘ÎÙÂ-ÚÈÓ‹˜ ÂÓÔ‡ÚËÛË˜ (8). ∆· ÂÂÈÛfi‰È· ÙË˜ ·ÔÊÚ·ÎÙÈ-Î‹˜ ¿ÓÔÈ·˜ Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ·ÚÓËÙÈÎ‹ ÂÓ‰ÔıˆÚ·ÎÈ-Î‹ ›ÂÛË, ·˘ÍËÌ¤ÓË ÊÏÂ‚ÈÎ‹ ÂÈÛÙÚÔÊ‹, ‰È¿Ù·ÛËÙÔ˘ ‰ÂÍÈÔ‡ ÎfiÏÔ˘ Î·È ¤ÎÎÚÈÛË ÎÔÏÈÎÔ‡ Ó·ÙÚÈÔ‰È-Ô˘ÚËÙÈÎÔ‡ ÂÙÈ‰›Ô˘. ∏ ˘ÔÍ·ÈÌ›· Ô˘ Û˘¯Ó¿ Û˘-ÓÔ‰Â‡ÂÈ ÙÈ˜ ¿ÓÔÈÂ˜, ÌÔÚÂ› Ó· Ô‰ËÁ‹ÛÂÈ ÛÂ ·ÁÁÂÈ-ÔÛ‡Û·ÛË ÙˆÓ ÓÂ˘ÌÔÓÈÎÒÓ ·ÁÁÂ›ˆÓ Î·È ÌÔÚÂ›Â›ÛË˜ Ó· Ô‰ËÁ‹ÛÂÈ ÛÂ ‰È¿Ù·ÛË ÙÔ˘ ‰ÂÍÈÔ‡ ÎfiÏÔ˘.∆Ô ÎÔÏÈÎfi Ó·ÙÚÈÔ‰ÈÔ˘ÚËÙÈÎfi ÂÙ›‰ÈÔ Â˘Ô‰ÒÓÂÈÙËÓ ·Ô‚ÔÏ‹ Ó·ÙÚ›Ô˘ ·fi ÙÔÓ ÓÂÊÚfi Î·È ·˘Í¿ÓÂÈÙÔÓ fiÁÎÔ ÙˆÓ Ô‡ÚˆÓ (9,10).

ÀÔ¯ÒÚËÛË ÙË˜ Ó˘ÎÙÂÚÈÓ‹˜ ÂÓÔ‡ÚËÛË˜ ¤¯ÂÈ·Ó·ÊÂÚıÂ› ÛÙ· ·È‰È¿ ÌÂ ‰È·ÏÂ›Ô˘Û· ·fiÊÚ·ÍËÙÔ˘ ·ÓÒÙÂÚÔ˘ ·ÂÚ·ÁˆÁÔ‡ ÌÂÙ¿ ·fi ıÂÚ·Â›· ÌÂÚÈÓÈÎfi ÂÎÓ¤ÊˆÌ· ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰ÒÓ (11) Î·È ÛÙÔ˘˜ÂÓËÏ›ÎÔ˘˜ ÌÂ ™∞∞À ÌÂÙ¿ ·fi ÂÊ·ÚÌÔÁ‹ Û˘ÓÂ¯Ô‡˜ıÂÙÈÎ‹˜ ›ÂÛË˜ ·fi ÙË Ì‡ÙË (nasal CPAP) (12).

OÈ ‰È·Ù·Ú·¯¤˜ ÙË˜ ·Ó·ÓÔ‹˜ ÛÙÔÓ ‡ÓÔ ‰ÂÓ Â›-Ó·È ÙÔ Û˘¯ÓfiÙÂÚÔ ·›ÙÈÔ ÙË˜ Ó˘ÎÙÂÚÈÓ‹˜ ÂÓÔ‡ÚËÛË˜.ŸÙ·Ó fiÌˆ˜ ˘¿Ú¯Ô˘Ó, ·ÔÙÂÏÔ‡Ó ·Ú¿ÁÔÓÙ· Ô˘Û˘Ó‹ıˆ˜ ÌÔÚÂ› Â‡ÎÔÏ· Ó· ‰ÈÔÚıˆıÂ›. §ÂÙÔÌÂ-Ú¤˜ ÈÛÙÔÚÈÎfi ÁÈ· Ù˘¯fiÓ ‰È·Ù·Ú·¯¤˜ ÙË˜ ·Ó·ÓÔ‹˜ÛÙÔÓ ‡ÓÔ ı· Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÂÙ·È ·fi fiÏ· Ù··È‰È¿ Ô˘ ÚÔÛÎÔÌ›˙ÔÓÙ·È ÁÈ· ·ÓÙÈÌÂÙÒÈÛË Ó˘-ÎÙÂÚÈÓ‹˜ ÂÓÔ‡ÚËÛË˜ Î·È ÂÊfiÛÔÓ ÚÔÎ‡ÙÔ˘Ó ÂÓ-‰Â›ÍÂÈ˜ Èı·ÓÔ‡ ™∞∞À, ı· Ú¤ÂÈ Ó· ÙÂÎÌËÚÈÒÓÂÙ·ÈË ‰È¿ÁÓˆÛË ÌÂ ÔÏ˘·Ú·ÌÂÙÚÈÎ‹ ÌÂÏ¤ÙË Î·È Ó··ÎÔÏÔ˘ıÂ› ıÂÚ·Â›·. ∏ ‚ÂÏÙ›ˆÛË ÙÔ˘ ™∞∞À Û˘¯Ó¿·ÎÔÏÔ˘ıÂ›Ù·È ·fi ˘Ô¯ÒÚËÛË ÙË˜ ÂÓÔ‡ÚËÛË˜.

µÈ‚ÏÈÔÁÚ·Ê›· 1. American Academy of Pediatrics, Section on Pediatric

Pulmonology, Subcommittee on Obstructive Sleep ApneaSyndrome. Clinical practice guideline: diagnosis andmanagement of childhood obstructive sleep apnea

syndrome. Pediatrics 2002;109:704-712. 2. Guilleminault C, Winkle R, Korobkin R, Simmons B. Children

and nocturnal snoring: evaluation of the effects of sleeprelated respiratory resistive load and daytime functioning.Eur J Pediatr 1982;139:165-171.

3. Richardson MA, Seid AB, Cotton RT, Benton C, Kramer M.Evaluation of tonsils and adenoids in sleep apneasyndrome. Laryngoscope 1980;90:1106-1110.

4. Swift AC. Upper airway obstruction, sleep disturbance andadenotonsillectomy in children. J Laryngol Otol1988;102:419-422.

5. Weider DJ, Sateia MJ, West RP. Nocturnal enuresis inchildren with upper airway obstruction. Otolaryngol HeadNeck Surg 1991;105:427-432.

6. American Thoracic Society. Standards and indications forcardiopulmonary sleep studies in children. Am J Respir CritCare Med 1996;153:866-878.

7. Goh DY, Galster P, Marcus CL. Sleep architecture andrespiratory disturbances in children with obstructive sleepapnea. Am J Respir Crit Care Med 2000;162:682-686.

8. Neveus T, Lackgren G, Tuvemo T, Hetta J, Hjalmas K,Stenberg A. Enuresis - background and treatment. Scand JUrol Nephrol 2000;206 (Suppl):S1-S44.

9. Krieger J, Follenius M, Sforza E, Brandenberger G, PeterJD. Effects of treatment with nasal continuous positiveairway pressure on atrial natriuretic peptide and argininevasopressin release during sleep in patients with obstructivesleep apnoea. Clin Sci 1991;80:443-449.

10. Warley AR, Stradling JR. Abnormal diurnal variation in saltand water excretion in patients with obstructive sleepapnoea. Clin Sci 1988;74:183-185.

11. Demain JG, Goetz DW. Pediatric adenoidal hypertrophyand nasal airway obstruction: reduction with aqueous nasalbeclomethasone. Pediatrics 1995;95:355-364.

12. Kramer NR, Bonitati AE, Millman RP. Enuresis andobstructive sleep apnea in adults. Chest 1998;114:634-637.

∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 22-10-2002∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛË˜: 07-03-2003

¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∂ÌÌ·ÓÔ˘‹Ï ∞ÏÂÍfiÔ˘ÏÔ˜ ÃÚ˘ÛÔÛÙfiÌÔ˘ ™Ì‡ÚÓË˜ 2, ¶ÂÚÈÔ¯‹ ™Ù·ıÌÔ‡ ∆.∫. 412 23, §¿ÚÈÛ· E-mail: [email protected]

May-June 03 03-06-03 16:55 ™ÂÏ›‰·210


211

∂ÙÂÚfiÏÂ˘ÚË ‰È·ÏÂ›Ô˘Û· ‚ÏÂÊ·ÚfiÙˆÛË ˆ˜ ÚÔ¤¯ÔÓ Û‡ÌÙˆÌ· ¯ÚfiÓÈ·˜ ÈÁÌÔÚ›ÙÈ‰·˜ °. ¶·Ú‰·Ïfi˜, ™. ªÔ‡ÛÎÔ˘, ¢. ∑·ÊÂÈÚ›Ô˘, µ. ∞˚‚¿˙Ë˜

Unilateral intermittent blepharoptosis as an urgent symptom of chronic sinusitis G. Pardalos, S. Mouskou, D. Zafiriou, V. Aivazis


�¶ÂÚ›ÏË„Ë: H Â›ÎÙËÙË ÙÒÛË ÙÔ˘ ¿Óˆ ‚ÏÂÊ¿ÚÔ˘ÛÙ· ·È‰È¿ ¯ÚÂÈ¿˙ÂÙ·È ¿ÌÂÛË ·ÓÙÈÌÂÙÒÈÛË, ÁÈ·Ù›Û˘Ó‹ıˆ˜ ‰ËÏÒÓÂÈ ÛÔ‚·Ú‹ ‰È·Ù·Ú·¯‹ ÙÔ˘ ÓÂ˘ÚÈÎÔ‡Û˘ÛÙ‹Ì·ÙÔ˜. ∂È‰ÈÎfiÙÂÚ·, Ë ‚ÏÂÊ·ÚfiÙˆÛË ̂ ˜ ÚÔ-¤¯ÔÓ Û‡ÌÙˆÌ· ÂÈÏÔÎ‹˜ ·Ú·ÚÚÈÓÔÎÔÏ›ÙÈ‰·˜,·Ó Î·È Û¿ÓÈ· ÛÙ· ·È‰È¿, Ú¤ÂÈ ¿ÓÙÔÙÂ Ó· Û˘-ÌÂÚÈÏ·Ì‚¿ÓÂÙ·È ÛÙË ‰È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË, ÁÈ·Ù› Â›-Ó·È ‰˘Ó·ÙfiÓ Ó· ·ÔÙÂÏÂ› ÚÒÈÌÔ Û‡ÌÙˆÌ· ÔÍÂ›·˜ÊÏÂÁÌÔÓ‹˜ ‹ ÌÂÌÔÓˆÌ¤ÓÔ Û‡ÌÙˆÌ· ̄ ÚfiÓÈ·˜ ÊÏÂÁ-ÌÔÓ‹˜ ÙÔ˘ ÔÊı·ÏÌÈÎÔ‡ ÎfiÁ¯Ô˘. ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë Â-Ú›ÙˆÛË ÎÔÚÈÙÛÈÔ‡ ËÏÈÎ›·˜ 13 ÂÙÒÓ ÌÂ ÂÙÂÚfiÏÂ˘ÚË‰È·ÏÂ›Ô˘Û· ‚ÏÂÊ·ÚfiÙˆÛË ·ÚÈÛÙÂÚ¿, ÏfiÁˆ Â¤-ÎÙ·ÛË˜ ÙË˜ ÊÏÂÁÌÔÓ‹˜ ÙˆÓ ·Ú·ÚÚ›ÓÈˆÓ ÎfiÏˆÓÛÙÔ˘˜ ·Ú·ÎÂ›ÌÂÓÔ˘˜ ÈÛÙÔ‡˜ ÙÔ˘ ÔÊı·ÏÌÈÎÔ‡ ÎfiÁ-¯Ô˘ Î·È ›ÂÛË˜ ÙÔ˘ ÎÏ¿‰Ô˘ ÙÔ˘ ÎÔÈÓÔ‡ ÎÈÓËÙÈÎÔ‡ÓÂ‡ÚÔ˘ Ô˘ ÓÂ˘ÚÒÓÂÈ ÂÎÏÂÎÙÈÎ¿ ÙÔÓ ·ÓÂÏÎÙ‹Ú· Ì˘ÙÔ˘ ¿Óˆ ‚ÏÂÊ¿ÚÔ˘.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ‚ÏÂÊ·ÚfiÙˆÛË, ·Ú·ÚÚÈÓÔÎÔÏ›-ÙÈ‰·, ¿ÚÂÛË ·ÓÂÏÎÙ‹Ú· Ì˘fi˜ ¿Óˆ ‚ÏÂÊ¿ÚÔ˘.

�Abstract: Acquired blepharoptosis in childhooddemands special attention because it usuallyindicates a potentially serious neurologic disorder.In particular, blepharoptosis as an urgent symptomof complicated sinusitis, although rare in children,must be included in the differential diagnosisbecause it may constitute an early sign of acuteinflammation or an isolated sign of chronicinflammation of the orbit. The case is reported of a13-year-old girl with unilateral intermittentblepharoptosis of the left upper lid due tointraorbital extension of chronic sinusitis withpressure on the oculomotor nerve branch whichsupplies only the inferior levator palpebrae muscle.

Key words: blepharoptosis, sinusitis, paresis of theinferior levator palpebrae muscle.

∞’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ∞.¶.£. “πÔÎÚ¿ÙÂÈÔ” °.¶.¡. £ÂÛÛ·ÏÔÓ›ÎË˜

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

∂ÈÛ·ÁˆÁ‹∏ ÔÍÂ›· ·Ú·ÚÚÈÓÔÎÔÏ›ÙÈ‰· ·ÔÙÂÏÂ› Û˘¯Ófi

Úfi‚ÏËÌ· ÛÙËÓ ·È‰È·ÙÚÈÎ‹ Ú¿ÍË Î·È ·ÚÔ˘ÛÈ¿-˙ÂÙ·È Û˘Ó‹ıˆ˜ ÌÂÙ¿ ·fi Î¿ÔÈÔ ÂÂÈÛfi‰ÈÔ ÔÍÂ›·˜ÚÈÓ›ÙÈ‰·˜ ÈÔÁÂÓÔ‡˜ ‹ ·ÏÏÂÚÁÈÎ‹˜ ·ÈÙÈÔÏÔÁ›·˜. ∏¯ÚfiÓÈ· ·Ú·ÚÚÈÓÔÎÔÏ›ÙÈ‰· Â›Ó·È Û·ÓÈfiÙÂÚË Î·È‰ËÏÒÓÂÈ Û˘Ó‹ıˆ˜ ÙËÓ ‡·ÚÍË ÙÔÈÎ‹˜ (·ÏÏÂÚÁÈÎ‹ÚÈÓ›ÙÈ‰·, ·Ó·ÙÔÌÈÎ‹ ·ÓˆÌ·Ï›· ÚÈÓÔÊ¿Ú˘ÁÁ· Î.¿.) ‹ÁÂÓÈÎÂ˘Ì¤ÓË˜ ‰È·Ù·Ú·¯‹˜ (‰˘ÛÎÈÓËÛ›· ÎÚÔÛÛÒÓ,·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ· Î.¿.), Ë ÔÔ›· ‰ÈÂ˘ÎÔÏ‡ÓÂÈ ÙËÓÂÈÌÔÓ‹ ÙË˜ ÊÏÂÁÌÔÓ‹˜ (1).

OÈ ÂÈÏÔÎ¤˜ ÙˆÓ ·Ú·ÚÚÈÓÔÎÔÏ›ÙÈ‰ˆÓ Â›Ó·ÈÛ¯ÂÙÈÎ¿ Û¿ÓÈÂ˜, ·ÏÏ¿ Ë ·ÚÔ˘Û›· ÙÔ˘˜ Î·È È‰›ˆ˜ ËÂ¤ÎÙ·ÛË ÙË˜ ÊÏÂÁÌÔÓ‹˜ ÂÓ‰ÔÎÚ·ÓÈ·Î¿, ÌÔÚÂ› Ó·Â›Ó·È ·ÂÈÏËÙÈÎ¤˜ ÁÈ· ÙË ˙ˆ‹ ÙÔ˘ ·ÛıÂÓÔ‡˜ (1-3).

¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ÂÓfi˜ ·È‰ÈÔ‡ ÌÂ ÂÙÂ-

ÚfiÏÂ˘ÚË ‰È·ÏÂ›Ô˘Û· ‚ÏÂÊ·ÚfiÙˆÛË ·ÚÈÛÙÂÚ¿ÏfiÁˆ Â¤ÎÙ·ÛË˜ ÙË˜ ÊÏÂÁÌÔÓ‹˜ ÙˆÓ ·Ú·ÚÚ›ÓÈˆÓÎfiÏˆÓ ÛÙÔ˘˜ ·Ú·ÎÂ›ÌÂÓÔ˘˜ ÈÛÙÔ‡˜ ÙÔ˘ ÔÊı·ÏÌÈ-ÎÔ‡ ÎfiÁ¯Ô˘ Î·È ›ÂÛË˜ ÙÔ˘ ÎÏ¿‰Ô˘ ÙÔ˘ ÎÔÈÓÔ‡ ÎÈ-ÓËÙÈÎÔ‡ ÓÂ‡ÚÔ˘ Ô˘ ÓÂ˘ÚÒÓÂÈ ÂÎÏÂÎÙÈÎ¿ ÙÔÓ ·ÓÂÏ-ÎÙ‹Ú· Ì˘ ÙÔ˘ ¿Óˆ ‚ÏÂÊ¿ÚÔ˘. ∏ ÂÈÏÔÎ‹ ·˘Ù‹ Â›-Ó·È Û¿ÓÈ· (4-6), È‰È·›ÙÂÚ· ÛÙ· ·È‰È¿ (7). ¢ÂÓ ÂÚÈ-ÁÚ¿ÊÂÙ·È ÛÙÈ˜ Û˘Ó‹ıÂÈ˜ ÂÈÏÔÎ¤˜ ÙˆÓ ·Ú·ÚÚÈÓÔ-ÎÔÏ›ÙÈ‰ˆÓ (1-3) Î·È ·Ó·Ê¤ÚÂÙ·È ÌfiÓÔ ÛÙË ‰È·ÊÔÚÈ-Î‹ ‰È¿ÁÓˆÛË ÙË˜ ‚ÏÂÊ·ÚfiÙˆÛË˜ ˆ˜ Û¿ÓÈÔ ·›ÙÈÔÚfiÎÏËÛ‹˜ ÙË˜ (8,9).

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛË˜ ∫ÔÚ›ÙÛÈ ËÏÈÎ›·˜ 13 ÂÙÒÓ ÂÈÛ‹¯ıË ÛÙËÓ ÎÏÈÓÈÎ‹

ÏfiÁˆ ÂÙÂÚfiÏÂ˘ÚË˜ ‰È·ÏÂ›Ô˘Û·˜ ‚ÏÂÊ·ÚfiÙˆ-ÛË˜ ·ÚÈÛÙÂÚ¿ ·fi ÂÓıËÌ¤ÚÔ˘.

May-June 03 03-06-03 16:55 ™ÂÏ›‰·211


212

∆Ô ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ‹Ù·Ó ÂÏÂ‡ıÂÚÔ, ÂÓÒ·fi ÙÔ ·ÙÔÌÈÎfi ·Ó·ÌÓËÛÙÈÎfi ·ÍÈÔÛËÌÂ›ˆÙË ‹Ù·Ó Ë·Ó·ÊÔÚ¿ 4 ÂÂÈÛÔ‰›ˆÓ ÈÁÌÔÚ›ÙÈ‰·˜ ÙÔ ÙÂÏÂ˘Ù·›ÔÂÍ¿ÌËÓÔ. ∆· ÂÂÈÛfi‰È· ·˘Ù¿ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·Ó ·fiÚÈÓÈÎ‹ Û˘ÌÊfiÚËÛË Î·È ÌÂÙˆÈ·›· ÎÂÊ·Ï·ÏÁ›·. ∏‰È¿ÁÓˆÛË ÙË˜ ÈÁÌÔÚ›ÙÈ‰·˜ ¿ÌÊˆ ÂÈ‚Â‚·ÈÒıËÎÂ·ÎÙÈÓÔÏÔÁÈÎ¿ ÛÙ· 3 ·fi Ù· 4 ÂÂÈÛfi‰È·. ÃÔÚËÁ‹ıË-ÎÂ ·ÓÙÈ‚ÈÔÙÈÎ‹ ·ÁˆÁ‹ per os ÁÈ· 10 ËÌ¤ÚÂ˜ Î·È ÙÈ˜Ù¤ÛÛÂÚÈ˜ ÊÔÚ¤˜, ÌÂ ‰È·ÊÔÚÂÙÈÎfi Î¿ıÂ ÊÔÚ¿ ·ÓÙÈ-‚ÈÔÙÈÎfi Î·È ÚfiÛÎ·ÈÚË ‚ÂÏÙ›ˆÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ.∞Ó·Ê¤ÚÂÙ·È, Â›ÛË˜, fiÙÈ ÌÂ ÙËÓ ¤Ó·ÚÍË ÙˆÓ Û˘-ÌÙˆÌ¿ÙˆÓ ÈÁÌÔÚ›ÙÈ‰·˜ Î·Ù¿ Ù· ‰‡Ô ÙÂÏÂ˘Ù·›·ÂÂÈÛfi‰È·, ·ÚÔ˘ÛÈ¿ÛÙËÎÂ Î·È ÂÙÂÚfiÏÂ˘ÚË ‰È·ÏÂ›-Ô˘Û· ‚ÏÂÊ·ÚfiÙˆÛË ·ÚÈÛÙÂÚ¿, Ë ÔÔ›· ÂÈÙÂÈÓfi-Ù·Ó ÌÂ ÙËÓ ÚfiÔ‰Ô ÙË˜ ËÌ¤Ú·˜ Î·È ‚ÂÏÙÈˆÓfiÙ·Ó ‹ÂÍ·ÏÂÈÊfiÙ·Ó ÌÂ ÙËÓ Î·Ù¿ÎÏÈÛË. ∆Ô Û‡ÌÙˆÌ· ·˘Ùfi‰È‹ÚÎÂÛÂ Ï›ÁÂ˜ ËÌ¤ÚÂ˜ Î·È ÙÈ˜ ‰‡Ô ÊÔÚ¤˜ Î·È ·Ô-‰fiıËÎÂ ÛÙËÓ ÈÁÌÔÚ›ÙÈ‰·, ÁÈ·Ù› ÂÍ·ÏÂ›ÊıËÎÂ Ï‹Úˆ˜ÌÂÙ¿ ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙË˜ ·ÓÙÈ‚ÈÔÙÈÎ‹˜ ·ÁˆÁ‹˜.

∏ ·ÛıÂÓ‹˜ ‹Ù·Ó ÛÂ Î·Ï‹ Î·Ù¿ÛÙ·ÛË ÌÂÙ¿ ÙÔ ÙÂ-ÏÂ˘Ù·›Ô, ÚÔ ‰ÈÌ‹ÓÔ˘, ÂÂÈÛfi‰ÈÔ ÈÁÌÔÚ›ÙÈ‰·˜, ·ÓÂÍ·ÈÚ¤ÛÔ˘ÌÂ Î¿ÔÈÂ˜ ÂÍ¿ÚÛÂÈ˜ ‹È·˜ ÚÈÓÈÎ‹˜ Û˘Ì-ÊfiÚËÛË˜ Ô˘ ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·Ó Â˘Î·ÈÚÈ·Î¿ ÌÂ ÙÔ-ÈÎ¿ ·ÔÛ˘ÌÊÔÚËÙÈÎ¿. ¶¤ÓÙÂ ËÌ¤ÚÂ˜ ÚÔ ÙË˜ ÂÈÛ·-ÁˆÁ‹˜ ÙË˜ ·ÚÔ˘ÛÈ¿ÛÙËÎÂ Í·Ó¿ ‚ÏÂÊ·ÚfiÙˆÛË·ÚÈÛÙÂÚ¿ ÌÂ Ù· ›‰È· ‰È·ÏÂ›ÔÓÙ· ¯·Ú·ÎÙËÚÈÛÙÈÎ¿Â›Ù·ÛË˜ ÌÂ ÙËÓ ÚfiÔ‰Ô ÙË˜ ËÌ¤Ú·˜ Î·È ˘Ô¯ÒÚË-ÛË˜ ÌÂ ÙËÓ Î·Ù¿ÎÏÈÛË, ·ÏÏ¿ ¯ˆÚ›˜ ÙËÓ ·ÚÔ˘Û›·¿ÏÏˆÓ Û˘ÌÙˆÌ¿ÙˆÓ, fiˆ˜ Î·Ù·ÚÚÔ‹˜, ¤ÓÙÔÓË˜ÚÈÓÈÎ‹˜ Û˘ÌÊfiÚËÛË˜, ÎÂÊ·Ï·ÏÁ›·˜ ‹ ˘ÚÂÙÔ‡. ¢ÂÓ·Ó·Ê¤ÚÔÓÙ·Ó, Â›ÛË˜, ¿ÏÏ· ÔÊı·ÏÌÈÎ¿ ÂÓÔ¯Ï‹Ì·-Ù·, fiˆ˜ fiÓÔ˜, ÂÚ˘ıÚfiÙËÙ·, ‰·ÎÚ‡ÚÚÔÈ·, ‰ÈÏˆ-›· ‹ ÚfiÛÊ·ÙÔ˜ ÙÚ·˘Ì·ÙÈÛÌfi˜.

∏ ÎÏÈÓÈÎ‹ ÂÍ¤Ù·ÛË Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ¤‰ÂÈÍÂ Ì›·Ê˘ÛÈÔÏÔÁÈÎ‹, Î·Ù¿ Ù· ¿ÏÏ·, ¤ÊË‚Ë ÌÂ Î·Ï‹ ·Ó¿-Ù˘ÍË, ıÚ¤„Ë Î·È ÁÂÓÈÎ‹ Î·Ù¿ÛÙ·ÛË. ¶·Ú·ÙËÚ‹ıË-ÎÂ ÙÒÛË ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ¿Óˆ ‚ÏÂÊ¿ÚÔ˘ ÂÚ›Ô˘ 5mm, ¯ˆÚ›˜ Ô›‰ËÌ·, ÂÚ˘ıÚfiÙËÙ· ‹ ¿ÏÁÔ˜. ∏ ÓÂ˘ÚÔ-ÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË ÙˆÓ ÔÊı·ÏÌÔÎÈÓËÙÈÎÒÓ ÓÂ‡ÚˆÓ¤‰ÂÈÍÂ ¿ÚÂÛË ÙÔ˘ ·ÓÂÏÎÙ‹Ú· Ì˘fi˜ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡‚ÏÂÊ¿ÚÔ˘ Ô˘ ÓÂ˘ÚÒÓÂÙ·È ·fi ÎÏ¿‰Ô ÙÔ˘ ÎÔÈÓÔ‡ÎÈÓËÙÈÎÔ‡, ÂÓÒ ÔÈ ˘fiÏÔÈÔÈ Ì‡Â˜ Ô˘ ÓÂ˘ÚÒÓÔÓÙ·ÈÙfiÛÔ ·fi ¿ÏÏÔ˘˜ ÎÏ¿‰Ô˘˜ ÙÔ˘ ÎÔÈÓÔ‡ ÎÈÓËÙÈÎÔ‡(¤Ûˆ, ¿Óˆ Î·È Î¿Ùˆ ÔÚıfi˜, Î¿Ùˆ ÏÔÍfi˜, ÛÊÈÁÎÙ‹-Ú·˜ ÙË˜ ÎfiÚË˜ Î·È ·ÎÙÈÓˆÙfi˜ Ì˘˜), fiÛÔ Î·È ·fi ÙÔÙÚÔ¯ÈÏÈ·Îfi (¿Óˆ ÏÔÍfi˜) Î·È ÙÔ ··ÁˆÁfi (¤Íˆ ÔÚ-ıfi˜) Â˘Ú¤ıËÛ·Ó Ê˘ÛÈÔÏÔÁÈÎÔ›. º˘ÛÈÔÏÔÁÈÎ¿ ‹Ù·ÓÙ· Â˘Ú‹Ì·Ù· Î·È ·fi ÙËÓ ˘fiÏÔÈË ÓÂ˘ÚÔÏÔÁÈÎ‹ Î·ÈÔÊı·ÏÌÔÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË, fiˆ˜ Â›ÛË˜ Î·È ·fi ÙËÓˆÙÔÚÈÓÔÏ·Ú˘ÁÁÔÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË ÙÔ˘ ÚÈÓÔÊ¿Ú˘ÁÁ·,ÏËÓ ÙË˜ ·ÚÔ˘Û›·˜ ‹È·˜ ÔÈÛıÔÚÈÓÈÎ‹˜ ¤ÎÎÚÈÛË˜Ô˘ Û˘ÓËÁÔÚÔ‡ÛÂ ˘¤Ú ÙË˜ ÈÁÌÔÚ›ÙÈ‰·˜.

O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ Ô˘ ÂÚÈÂÏ¿Ì‚·ÓÂ

Ï‹ÚË ·ÈÌ·ÙÔÏÔÁÈÎfi, ‚ÈÔ¯ËÌÈÎfi, ÔÚÔÏÔÁÈÎfi, ·ÓÔÛÔ-ÏÔÁÈÎfi, ·ÏÏÂÚÁÈÔÏÔÁÈÎfi Î·È ÓÂ˘ÚÔÊ˘ÛÈÔÏÔÁÈÎfi¤ÏÂÁ¯Ô, ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜ Î·È Ë Mantoux ‹Ù·Ó ·Ú-ÓËÙÈÎ‹.

O ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜, ÏËÓ ÙË˜ Ê˘ÛÈÔÏÔÁÈ-Î‹˜ ·ÎÙÈÓÔÁÚ·Ê›·˜ ıÒÚ·ÎÔ˜, ÂÚÈÔÚ›ÛÙËÎÂ ÛÙËÓMRI ÂÁÎÂÊ¿ÏÔ˘ ÁÈ· Î·Ï‡ÙÂÚË Â˘ÎÚ›ÓÂÈ·. ∏ ÙÂÏÂ˘-Ù·›· ¤‰ÂÈÍÂ ÊÏÂÁÌÔÓ‹ fiÏˆÓ ÙˆÓ ·Ú·ÚÚ›ÓÈˆÓ ÎÔÈ-ÏÔÙ‹ÙˆÓ, È‰È·›ÙÂÚ· ÙˆÓ ËıÌÔÂÈ‰ÒÓ Î˘„ÂÏÒÓ, ÌÂ ÂÈ-ÎfiÓ· ·Ó·Î·Ù·ÛÎÂ˘‹˜ ÙÔ˘ ÔÛÙÔ‡ (boneremodeling), Ô˘ ·ÔÙÂÏÂ› ÂÓ‰ÂÈÎÙÈÎfi Â‡ÚËÌ· ¯Úfi-ÓÈ·˜ ÊÏÂÁÌÔÓ‹˜ (∂ÈÎfiÓ· 1). ∂ÈÏ¤ÔÓ, ·Ú·ÙËÚ‹ıË-ÎÂ ›ÂÛË ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ¤Ûˆ ÔÚıÔ‡ ÔÊı·ÏÌÈÎÔ‡Ì˘fi˜ ÂÍ·ÈÙ›·˜ ÙË˜ ÂÓÙÔÓfiÙÂÚË˜ ÊÏÂÁÌÔÓ‹˜ ÚÔ˜ ÙÔ¤Ûˆ ÙÔ›¯ˆÌ· ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ÔÊı·ÏÌÈÎÔ‡ ÎfiÁ¯Ô˘(∂ÈÎfiÓ· 2).

∞˘Ù¿ Ù· Â˘Ú‹Ì·Ù· ÙË˜ ¯ÚfiÓÈ·˜ ÊÏÂÁÌÔÓ‹˜ ÙˆÓ·Ú·ÚÚ›ÓÈˆÓ ÎÔÈÏÔÙ‹ÙˆÓ ÌÂ Â¤ÎÙ·ÛË ÙË˜ ÊÏÂÁÌÔ-Ó‹˜ ÛÙÔÓ ÔÊı·ÏÌÈÎfi ÎfiÁ¯Ô, ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ÙÔÓ·ÔÎÏÂÈÛÌfi ¿ÏÏˆÓ ·ÈÙ›ˆÓ ‚ÏÂÊ·ÚfiÙˆÛË˜ (ÙÚ·‡-Ì·, fiÁÎÔÈ, Ì˘·Ûı¤ÓÂÈ·, Û. Horner), ÂÓ›Û¯˘Û·Ó ÙËÓ·Ú¯ÈÎ‹ ˘fiÓÔÈ· ÙË˜ ¿ÚÂÛË˜ ÙÔ˘ ·ÓÂÏÎÙ‹Ú· Ì˘fi˜ÙÔ˘ ¿Óˆ ‚ÏÂÊ¿ÚÔ˘ ÏfiÁˆ ÊÏÂÁÌÔÓ‹˜ ÙˆÓ ·Ú·ÎÂ›-ÌÂÓˆÓ ÈÛÙÒÓ ÙÔ˘ ÔÊı·ÏÌÈÎÔ‡ ÎfiÁ¯Ô˘ Î·È ›ÂÛË˜ÙÔ˘ ÎÏ¿‰Ô˘ ÙÔ˘ ÎÔÈÓÔ‡ ÎÈÓËÙÈÎÔ‡ ÓÂ‡ÚÔ˘ Ô˘ ÓÂ˘-ÚÒÓÂÈ ÙÔÓ ÂÓ ÏfiÁˆ Ì˘. ŒÙÛÈ, Ë ·ÛıÂÓ‹˜ Ù¤ıËÎÂ ÛÂÂÓ‰ÔÊÏ¤‚È· ·ÁˆÁ‹ ÌÂ ÎÏÈÓ‰·Ì˘Î›ÓË ÁÈ· 7 ËÌ¤ÚÂ˜,·ÓÙÈ-ÈÛÙ·ÌÈÓÈÎ‹ ·ÁˆÁ‹ per os Î·È ÚÈÓÈÎ¤˜ ÂÓÛÙ·Ï¿-ÍÂÈ˜ ·ÔÛ˘ÌÊÔÚËÙÈÎÒÓ. ∆ÚÂÈ˜ ËÌ¤ÚÂ˜ ÌÂÙ¿ ·fi ÙËÓ¤Ó·ÚÍË ÙË˜ ·ÁˆÁ‹˜, Ë ‚ÏÂÊ·ÚfiÙˆÛË ˘Ô¯ÒÚËÛÂÏ‹Úˆ˜ Î·È Ë ·ÛıÂÓ‹˜ ÂÍ‹ÏıÂ ÙËÓ 8Ë ËÌ¤Ú· ÌÂÔ‰ËÁ›Â˜ ÁÈ· Û˘Ó¤¯ÈÛË ÙË˜ ·ÓÙÈ‚ÈÔÙÈÎ‹˜ ·ÁˆÁ‹˜ peros ÁÈ· 7 ·ÎfiÌË ËÌ¤ÚÂ˜. ™ÙÔÓ Ù·ÎÙÈÎfi Â·Ó¤ÏÂÁ¯ÔÌÂÙ¿ ·fi 2, 4 Î·È 6 Ì‹ÓÂ˜, Ë ·ÛıÂÓ‹˜ ‹Ù·Ó ÙÂÏÂ›ˆ˜Î·Ï¿, ¯ˆÚ›˜ Î·Ó¤Ó· ÂÂÈÛfi‰ÈÔ ‚ÏÂÊ·ÚfiÙˆÛË˜ ‹¿ÏÏ· Û˘ÌÙÒÌ·Ù·.

™˘˙‹ÙËÛË∏ Â›ÎÙËÙË ÙÒÛË ÙÔ˘ ¿Óˆ ‚ÏÂÊ¿ÚÔ˘, ·Ó Î·È

Û¿ÓÈ· ÛÙ· ·È‰È¿, ··ÈÙÂ› ¿ÌÂÛË ·ÓÙÈÌÂÙÒÈÛË,ÁÈ·Ù› ‰ËÏÒÓÂÈ ÓÂ˘ÚÈÎ‹ ‹/Î·È Ì˘˚Î‹ ÔÊı·ÏÌÔÎÈÓËÙÈÎ‹‰È·Ù·Ú·¯‹, Ë ÔÔ›· ÌÔÚÂ› Ó· ÔÊÂ›ÏÂÙ·È ÛÂ ÂÓ‰Ô-ÎÚ·ÓÈ·Î¤˜ ‹ ÂÓ‰ÔÎÔÁ¯ÈÎ¤˜ ‚Ï¿‚Â˜ (ÙÚ·‡Ì·, ÊÏÂÁ-ÌÔÓ‹, fiÁÎÔÈ), Ì˘Ô¿ıÂÈÂ˜ (‚·ÚÈ¿ Ì˘·Ûı¤ÓÂÈ·, Ì˘Ô-Û›ÙÈ‰·) ‹ ¿ÏÏÂ˜ Î·Ù·ÛÙ¿ÛÂÈ˜ (Û. Horner, ·ÏÏ·ÓÙ›·-ÛË, ÂÓ‰ÔÎÚÈÓÔ¿ıÂÈ·) (8,9).

∏ ÂÙÂÚfiÏÂ˘ÚË ‰È·ÏÂ›Ô˘Û· ‚ÏÂÊ·ÚfiÙˆÛË ÙË˜Û˘ÁÎÂÎÚÈÌ¤ÓË˜ ·ÛıÂÓÔ‡˜, ÌÂ ÙÔ ÂÈ‚·Ú˘Ì¤ÓÔ Úfi-ÛÊ·ÙÔ ÈÛÙÔÚÈÎfi ÙˆÓ Û˘¯ÓÒÓ ÈÁÌÔÚ›ÙÈ‰ˆÓ Î·È, È‰È·›ÙÂ-Ú·, Ë ·ÚÔ˘Û›· ·ÚfiÌÔÈ·˜ ÛËÌÂÈÔÏÔÁ›·˜ Î·Ù¿ ÙË‰È·‰ÚÔÌ‹ ÙˆÓ ‰‡Ô ÙÂÏÂ˘Ù·›ˆÓ ÂÂÈÛÔ‰›ˆÓ ÈÁÌÔÚ›ÙÈ-‰·˜ Ô˘ ˘Ô¯ÒÚËÛÂ ÌÂ ÙËÓ ·ÓÙÈ‚ÈÔÙÈÎ‹ ıÂÚ·Â›·,¤ıÂÙ·Ó ÙËÓ ˘fiÓÔÈ· Â¤ÎÙ·ÛË˜ ÙË˜ ·Ú·ÚÚ›ÓÈ·˜

May-June 03 03-06-03 16:55 ™ÂÏ›‰·212


213

ÊÏÂÁÌÔÓ‹˜ ÚÔ˜ ÙÔÓ ÔÊı·ÏÌÈÎfi ÎfiÁ¯Ô Î·È ÙËÓ Úfi-ÎÏËÛË ‚ÏÂÊ·ÚfiÙˆÛË˜. ∏ ˘fiÓÔÈ· ÙË˜ ÂÓ‰ÔÎÔÁ¯È-Î‹˜ ‚Ï¿‚Ë˜ ÂÓÈÛ¯‡ıËÎÂ ·fi ÙÔ Â‡ÚËÌ· ÙË˜ ÌÂÌÔ-ÓˆÌ¤ÓË˜ ¿ÚÂÛË˜ ÙÔ˘ ·ÓÂÏÎÙ‹Ú· Ì˘fi˜ ÙÔ˘ ¿Óˆ‚ÏÂÊ¿ÚÔ˘, ÁÈ·Ù› Ô Ì˘˜ ·˘Ùfi˜ ÓÂ˘ÚÒÓÂÙ·È ·fi ÙÔÓ¿Óˆ ÎÏ¿‰Ô ÙÔ˘ ÎÔÈÓÔ‡ ÎÈÓËÙÈÎÔ‡ ÓÂ‡ÚÔ˘ Ô˘ Ô-ÚÂ‡ÂÙ·È ÂÍ·Ú¯‹˜ ÂÓÙfi˜ ÙÔ˘ ÔÊı·ÏÌÈÎÔ‡ ÎfiÁ¯Ô˘. ∆·˘fiÏÔÈ· ÔÊı·ÏÌÔÎÈÓËÙÈÎ¿ ÓÂ‡Ú· ‹Ù·Ó ·ÓÂËÚ¤·-ÛÙ·, fiˆ˜ Ê˘ÛÈÔÏÔÁÈÎ‹ ‹Ù·Ó Î·È Ë ÏÔÈ‹ ÓÂ˘ÚÔÏÔ-ÁÈÎ‹ Î·È ÔÊı·ÏÌÔÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË. ∞ÚÓËÙÈÎfi ÛËÌÂ›Ô·ÔÙ¤ÏÂÛÂ Ë ·Ô˘Û›· ¤ÓÙÔÓË˜ ÎÏÈÓÈÎ‹˜ ÛËÌÂÈÔÏÔ-Á›·˜ Î·È Â˘ÚËÌ¿ÙˆÓ ·Ú·ÚÚÈÓÔÎÔÏ›ÙÈ‰·˜, ÏËÓÌ›·˜ ‹È·˜ ÔÈÛıÔÚÚÈÓÈÎ‹˜ ¤ÎÎÚÈÛË˜. °È· ÙÔ ÏfiÁÔ·˘Ùfi, ‰ÈÂÓÂÚÁ‹ıËÎÂ ÏËÚ¤ÛÙÂÚÔ˜ ÂÚÁ·ÛÙËÚÈ·Îfi˜¤ÏÂÁ¯Ô˜ Ô˘ ÂÛÙÈ¿ÛÙËÎÂ Î˘Ú›ˆ˜ ÛÙËÓ MRI ÂÁÎÂÊ¿-ÏÔ˘ ÁÈ· Î·Ï‡ÙÂÚË Â˘ÎÚ›ÓÂÈ·. ∆· Â˘Ú‹Ì·Ù· ÙË˜ ¯Úfi-ÓÈ·˜ ·Ú·ÚÚÈÓÔÎÔÏ›ÙÈ‰·˜ ÌÂ Â¤ÎÙ·ÛË ÙË˜ ÊÏÂÁ-ÌÔÓ‹˜ ÛÙÔ˘˜ ÔÊı·ÏÌÈÎÔ‡˜ ÎfiÁ¯Ô˘˜, Ô˘ ‹Ù·ÓÂÓÙÔÓfiÙÂÚË ·ÚÈÛÙÂÚ¿, ÂÓ›Û¯˘Û·Ó ÙË ‰È¿ÁÓˆÛË ÙË˜¿ÚÂÛË˜ ÙÔ˘ ·ÓÂÏÎÙ‹Ú· Ì˘fi˜ ÙÔ˘ ¿Óˆ ‚ÏÂÊ¿ÚÔ˘ÏfiÁˆ ÂÓ‰ÔÎÔÁ¯ÈÎ‹˜ ÊÏÂÁÌÔÓ‹˜ Î·È Ë ‰È¿ÁÓˆÛË ÙÂÎ-ÌËÚÈÒıËÎÂ ·fi ÙËÓ ˘Ô¯ÒÚËÛË ÙË˜ ‚ÏÂÊ·ÚfiÙˆ-ÛË˜ Û¯Â‰fiÓ ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË ÙË˜ ıÂÚ·-Â˘ÙÈÎ‹˜ ·ÁˆÁ‹˜ Î·È ÙË ÌË Â·ÓÂÌÊ¿ÓÈÛ‹ ÙË˜ ÁÈ· 6Ì‹ÓÂ˜ ÌÂÙ¿ ÙËÓ ·ÔıÂÚ·Â›·.

OÈ ÂÈÏÔÎ¤˜ ÙˆÓ ·Ú·ÚÚÈÓÔÎÔÏ›ÙÈ‰ˆÓ Â›Ó·ÈÛ¯ÂÙÈÎ¿ Û¿ÓÈÂ˜ Û‹ÌÂÚ·, ÏfiÁˆ ÙË˜ Â˘ÚÂ›·˜ ¯Ú‹-ÛË˜ ÙˆÓ ·ÓÙÈ‚ÈÔÙÈÎÒÓ. ∏ ·ÚÔ˘Û›· ÙÔ˘˜, fiÌˆ˜,ÌÔÚÂ› Ó· Â›Ó·È ·ÂÈÏËÙÈÎ‹ ÁÈ· ÙË ˙ˆ‹ ÙÔ˘ ·ÛıÂ-

ÓÔ‡˜. OÈ ÛÔ‚·ÚfiÙÂÚÂ˜ ÂÈÏÔÎ¤˜ ÚÔ¤Ú¯ÔÓÙ·È ·fiÙËÓ Â¤ÎÙ·ÛË ÙË˜ ·Ú·ÚÚ›ÓÈ·˜ ÊÏÂÁÌÔÓ‹˜ ÚÔ˜ÙÔÓ ÔÊı·ÏÌÈÎfi ÎfiÁ¯Ô (Î˘ÙÙ·Ú›ÙÈ‰·, ÚfiÙˆÛË ÙÔ˘‚ÔÏ‚Ô‡, ÓÂ˘Ú›ÙÈ‰· ÙÔ˘ ÔÙÈÎÔ‡ ÓÂ‡ÚÔ˘), ÙËÓ ÂÓ‰Ô-ÎÚ¿ÓÈ· ÎÔÈÏfiÙËÙ· (ÂÁÎÂÊ·ÏÈÎfi ·fiÛÙËÌ·, ıÚfiÌ‚ˆ-ÛË ÙÔ˘ ÛËÚ·ÁÁÒ‰Ô˘˜ ÎfiÏÔ˘, ÌËÓÈÁÁ›ÙÈ‰·) Î·È Ù·ÔÛÙ¿ ÙË˜ ÂÚÈÔ¯‹˜ (ÔÛÙÂÔÌ˘ÂÏ›ÙÈ‰·, ˘ÔÂÚÈÔÛÙÈ-Îfi ·fiÛÙËÌ·) (1-3). ∏ ÂÍ¿ÏˆÛË ÙË˜ ÊÏÂÁÌÔÓ‹˜ Á›-ÓÂÙ·È Â›ÙÂ ÌÂ ÙËÓ ·Â˘ıÂ›·˜ ‰È¿‚ÚˆÛË ÙÔ˘ ÔÛÙÔ‡,Â›ÙÂ ‰È·Ì¤ÛÔ˘ ÙˆÓ ·ÁÁÂ›ˆÓ ÙÔ˘ ÔÛÙÔ‡ (3,10).

∏ ‚ÏÂÊ·ÚfiÙˆÛË ˆ˜ ÂÈÏÔÎ‹ ÙË˜ ·Ú·ÚÚÈÓÔ-ÎÔÏ›ÙÈ‰·˜ ÏfiÁˆ Â¤ÎÙ·ÛË˜ ÙË˜ ÊÏÂÁÌÔÓ‹˜ ÂÓ‰Ô-ÎÔÁ¯ÈÎ¿ Â›Ó·È Û¿ÓÈ· Î·È ÔÊÂ›ÏÂÙ·È ÛÂ ¿ÚÂÛË ‹ ·-Ú¿Ï˘ÛË ÙÔ˘ ·ÓÂÏÎÙ‹Ú· Ì˘fi˜ ÙÔ˘ ¿Óˆ ‚ÏÂÊ¿ÚÔ˘, ÔÔÔ›Ô˜ ÓÂ˘ÚÒÓÂÙ·È ·fi ÙÔÓ ¿Óˆ ÎÏ¿‰Ô ÙÔ˘ ÎÔÈÓÔ‡ÎÈÓËÙÈÎÔ‡ ÓÂ‡ÚÔ˘ (4-7). ∏ ÔÚÂ›· ÙÔ˘ ÓÂ‡ÚÔ˘ ·˘ÙÔ‡Â›Ó·È ÂÍ·Ú¯‹˜ ÂÓ‰ÔÎÔÁ¯ÈÎ‹ Î·È ÓÂ˘ÚÒÓÂÈ ÂÈÏ¤ÔÓÎ·È ÙÔÓ ¿Óˆ ÔÚıfi Ì˘. ™˘ÁÎÂÎÚÈÌ¤Ó·, ÚÒÙ· ‰›‰ÂÈÎÏ¿‰Ô˘˜ Ô˘ ÓÂ˘ÚÒÓÔ˘Ó ÙÔÓ ¿Óˆ ÔÚıfi Ì˘, ÛÙË Û˘-Ó¤¯ÂÈ· ÔÚÂ‡ÂÙ·È Î¿Ùˆ ·fi ·˘ÙfiÓ Î·È, ·ÎÔÏÔ˘ıÒ-ÓÙ·˜ ·ÁÎ‡ÏË ÔÚÂ›·, Êı¿ÓÂÈ Ì¤¯ÚÈ ÈÔ ¿Óˆ ·fiÙÔÓ ¿Óˆ ÔÚıfi Ì˘ fiÔ˘ Î·È ‰›ÓÂÈ ÙÔ˘˜ ÙÂÏÈÎÔ‡˜ ÎÏ¿-‰Ô˘˜ Ô˘ ÓÂ˘ÚÒÓÔ˘Ó ÙÔÓ ·ÓÂÏÎÙ‹Ú· Ì˘ ÙÔ˘ ¿Óˆ‚ÏÂÊ¿ÚÔ˘. O ÎÏ¿‰Ô˜ ·˘Ùfi˜, ‰ËÏ·‰‹, ‚Ú›ÛÎÂÙ·È Â-ÚÈÔÚÈÛÌ¤ÓÔ˜ ·Ó¿ÌÂÛ· ÛÙÔ˘˜ ÔÊı·ÏÌÔÎÈÓËÙÈÎÔ‡˜Ì˘˜. ∞˘Ù¤˜ ÔÈ ÛÙÂÓ¤˜ ·Ó·ÙÔÌÈÎ¤˜ Û¯¤ÛÂÈ˜ Â›Ó·È ‰˘-Ó·ÙfiÓ Ó· Ô‰ËÁ‹ÛÔ˘Ó ÛÂ ÚÒÈÌÔ ÂÁÎÏˆ‚ÈÛÌfi ÙÔ˘ ÓÂ‡ÚÔ˘ ÛÂ ÂÚ›ÙˆÛË ÂÓ‰ÔÎÔÁ¯ÈÎ‹˜ ÊÏÂÁÌÔ-Ó‹˜ Î·È ÂÍÔ›‰ËÛË˜ ÙˆÓ ·Ú·ÎÂ›ÌÂÓˆÓ Ì˘ÒÓ. ∆ÂÏÈÎfi

∂ÈÎfiÓ· 1. MRI ÂÁÎÂÊ¿ÏÔ˘, ∆1 ·ÎÔÏÔ˘ı›· ÌÂÙ¿ ·fi ¯ÔÚ‹ÁË-ÛË ÛÎÈ·ÛÙÈÎÔ‡: ÊÏÂÁÌÔÓ‹ ·ÌÊfiÙÂÚˆÓ ÙˆÓ ËıÌÔÂÈ‰ÒÓ Î˘„Â-ÏÒÓ ÛÙÔÓ ÔÊı·ÏÌÈÎfi ÎfiÁ¯Ô ÌÂ ÂÈÎfiÓ· ·Ó·Î·Ù·ÛÎÂ˘‹˜ ÙÔ˘ÔÛÙÔ‡ (bone remodeling).

∂ÈÎfiÓ· 2. MRI ÂÁÎÂÊ¿ÏÔ˘, ∆2 ·ÎÔÏÔ˘ı›·: ›ÂÛË ÙÔ˘ ·ÚÈÛÙÂ-ÚÔ‡ ¤Ûˆ ÔÚıÔ‡ ÔÊı·ÏÌÈÎÔ‡ Ì˘fi˜ ÏfiÁˆ ÙË˜ ¤ÓÙÔÓË˜ ÊÏÂÁ-ÌÔÓ‹˜ ÙˆÓ ËıÌÔÂÈ‰ÒÓ Î˘„ÂÏÒÓ ÚÔ˜ ÙÔ ¤Ûˆ ÙÔ›¯ˆÌ· ÙÔ˘·ÚÈÛÙÂÚÔ‡ ÔÊı·ÏÌÈÎÔ‡ ÎfiÁ¯Ô˘.

May-June 03 03-06-03 16:55 ™ÂÏ›‰·213


214

·ÔÙ¤ÏÂÛÌ· ÙˆÓ ÈÂÛÙÈÎÒÓ Â› ÙÔ˘ ÓÂ‡ÚÔ˘ ‰˘Ó¿ÌÂ-ˆÓ Â›Ó·È Ë ¿ÚÂÛË ‹ ·Ú¿Ï˘ÛË ÙÔ˘ ·ÓÂÏÎÙ‹Ú·Ì˘fi˜ Î·È Ë ÙÒÛË ÙÔ˘ ¿Óˆ ‚ÏÂÊ¿ÚÔ˘ (7).

™ÙËÓ ÂÏÏËÓÈÎ‹ ‚È‚ÏÈÔÁÚ·Ê›· ‰ÂÓ ‚Ú¤ıËÎÂ ·Úfi-ÌÔÈ· ÂÚ›ÙˆÛË, ÂÓÒ ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›· ·Ó·-Ê¤ÚÔÓÙ·È ÂÏ¿¯ÈÛÙÂ˜ ÌÂÌÔÓˆÌ¤ÓÂ˜ ÂÚÈÙÒÛÂÈ˜·Ó¿ÏÔÁÂ˜ ÙÔ˘ ·ÚfiÓÙÔ˜ ÂÚÈÛÙ·ÙÈÎÔ‡ ÛÂ ÂÓ‹ÏÈÎÂ˜·ÛıÂÓÂ›˜ (4,6). ™Â Ì›· ÂÎÙÂÓ‹ ÌÂÏ¤ÙË 113 ÂÓ‹ÏÈÎˆÓ·ÛıÂÓÒÓ ÌÂ ÊÏÂÁÌÔÓ‹ ÙÔ˘ ÎfiÁ¯Ô˘ ÏfiÁˆ ·Ú·ÚÚÈ-ÓÔÎÔÏ›ÙÈ‰·˜, ‰È·ÈÛÙÒıËÎ·Ó ÌfiÓÔ 3 ÂÚÈÙÒÛÂÈ˜ÌÂÌÔÓˆÌ¤ÓË˜ ‚ÏÂÊ·ÚfiÙˆÛË˜ (5).

∂ÚÂ˘ÓÒÓÙ·˜ ÙË ‚È‚ÏÈÔÁÚ·Ê›· ‰ÂÓ ‚Ú¤ıËÎÂ ·-ÚfiÌÔÈ· ÂÚ›ÙˆÛË ‰ËÌÔÛÈÂ˘Ì¤ÓË Ô˘ Ó· ·ÊÔÚ¿ ÛÂ·È‰È¿, ÂÓÒ ‚Ú¤ıËÎÂ Ì›· ÌfiÓÔ ‰ËÌÔÛ›Â˘ÛË ÌÂÌÔÓˆ-Ì¤ÓÔ˘ ÂÚÈÛÙ·ÙÈÎÔ‡ Ô˘ ·ÊÔÚÔ‡ÛÂ ÛÂ ¤ÊË‚Ô. ∏ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· Ô˘ ·ÚÔ˘Û›·˙Â ‹Ù·Ó ·ÚfiÌÔÈ· ÌÂÂÎÂ›ÓË ÙË˜ ·ÚÔ‡Û·˜ ·ÛıÂÓÔ‡˜, ÏËÓ fiÌˆ˜ Ë ‚ÏÂ-Ê·ÚfiÙˆÛ‹ ÙÔ˘ ‹Ù·Ó ÌfiÓÈÌË Î·È ÚÔÂ›¯Â Ô ¤ÓÙÔÓÔ˜ÔÊı·ÏÌÈÎfi˜ fiÓÔ˜ (7). ∏ ·¿ÓÙËÛË ÛÙËÓ ·ÓÙÈ‚ÈÔÙÈ-Î‹ ·ÁˆÁ‹ ·˘ÙÔ‡ ÙÔ˘ ·ÛıÂÓÔ‡˜ ‹Ù·Ó ÂÈÙ˘¯‹˜ (7),fiˆ˜ Î·È ÛÙËÓ ·ÚÔ‡Û· ÂÚ›ÙˆÛË, ÂÓÒ ·¤Ù˘¯ÂÛÂ 2 ÂÚÈÙÒÛÂÈ˜ ÂÓËÏ›ÎˆÓ Ô˘ ¯ÚÂÈ¿ÛÙËÎ·Ó ¯ÂÈ-ÚÔ˘ÚÁÈÎ‹ ‰È¿ÓÔÈÍË ÙÔ˘ ¿Û¯ÔÓÙÔ˜ ·Ú·ÚÚ›ÓÈÔ˘ÎfiÏÔ˘ ÌÂ ÈÎ·ÓÔÔÈËÙÈÎ¿, ÙÂÏÈÎÒ˜, ·ÔÙÂÏ¤ÛÌ·Ù·(4,6).

™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, Ú¤ÂÈ Ó· ÙÔÓÈÛÙÂ› fiÙÈ Ë ‚ÏÂ-Ê·ÚfiÙˆÛË ˆ˜ ÚÔ¤¯ÔÓ Û‡ÌÙˆÌ· ÂÈÏÔÎ‹˜ ·-Ú·ÚÚÈÓÔÎÔÏ›ÙÈ‰·˜, ·Ó Î·È Û¿ÓÈ· ÛÙ· ·È‰È¿, Ú¤-ÂÈ ¿ÓÙÔÙÂ Ó· Û˘ÌÂÚÈÏ·Ì‚¿ÓÂÙ·È ÛÙË ‰È·ÊÔÚÈÎ‹‰È¿ÁÓˆÛË, ÁÈ·Ù› Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ·ÔÙÂÏÂ› ÚÒÈÌÔÛ‡ÌÙˆÌ· ÔÍÂ›·˜ ÊÏÂÁÌÔÓ‹˜ ‹ ÌÂÌÔÓˆÌ¤ÓÔ Û‡-ÌÙˆÌ· ¯ÚfiÓÈ·˜ ÊÏÂÁÌÔÓ‹˜ ÙÔ˘ ÔÊı·ÏÌÈÎÔ‡ ÎfiÁ-¯Ô˘. ∞˘Ùfi ÚÔÎ‡ÙÂÈ ·fi ÙÈ˜ ÛÙÂÓ¤˜ ·Ó·ÙÔÌÈÎ¤˜Û¯¤ÛÂÈ˜ ÙË˜ ÔÚÂ›·˜ ÙÔ˘ ÓÂ‡ÚÔ˘ Ô˘ ÓÂ˘ÚÒÓÂÈ ÙÔÓ·ÓÂÏÎÙ‹Ú· Ì˘ ÙÔ˘ ¿Óˆ ‚ÏÂÊ¿ÚÔ˘ ‰È·Ì¤ÛÔ˘ ÙˆÓÔÊı·ÏÌÔÎÈÓËÙÈÎÒÓ Ì˘ÒÓ Î·È ÙÔÓ ÚÒÈÌÔ ÂÁÎÏˆ‚È-ÛÌfi ÙÔ˘ ÛÂ ÂÚ›ÙˆÛË ÂÓ‰ÔÎÔÁ¯ÈÎ‹˜ ÊÏÂÁÌÔÓ‹˜Î·È ÂÍÔ›‰ËÛË˜ ÙˆÓ ·Ú·ÎÂ›ÌÂÓˆÓ Ì˘ÒÓ. ∞˘Ù¤˜ ÔÈÈÂÛÙÈÎ¤˜ ‰˘Ó¿ÌÂÈ˜ Â› ÙÔ˘ ÓÂ‡ÚÔ˘ ¤¯Ô˘Ó Û·Ó Â·-

ÎfiÏÔ˘ıÔ ÙËÓ ¿ÚÂÛË ‹ ·Ú¿Ï˘ÛË ÙÔ˘ ·ÓÂÏÎÙ‹Ú·Ì˘fi˜ Î·È ÙËÓ ÙÒÛË ÙÔ˘ ¿Óˆ ‚ÏÂÊ¿ÚÔ˘, fiˆ˜ Û˘-Ó¤‚Ë Î·È ÛÙËÓ ·ÚÔ‡Û· ÂÚ›ÙˆÛË. ∏ Û˘Ó‰˘·ÛÌ¤-ÓË ıÂÚ·Â›· ÙË˜ ÈÁÌÔÚ›ÙÈ‰·˜ Ê·›ÓÂÙ·È fiÙÈ ¤¯ÂÈ Î·-Ï‡ÙÂÚÔ ·ÔÙ¤ÏÂÛÌ· ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ÚÔ-‚Ï‹Ì·ÙÔ˜.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Nash D, Wald E. Sinusitis. Pediatr Rev 2001;22:111-117. 2. Wagenmann M, Naclerio RM. Complications of sinusitis. J

Allergy Clin Immunol 1992;90:552-554. 3. Stankiewicz JA, Newell DJ, Park AH. Complications of

inflammatory diseases of the sinuses. Otolaryngol ClinNorth Am 1993;26:639-655.

4. Stefanis L, Przedborski S. Isolated palsy of the superiorbranch of the oculomotor nerve due to chronic erosivesphenoid sinusitis. J Clin Neuroophthalmol 1993;13:229-231.

5. Pogosov VS, Akopian RG, Davudov KhSh, El’kun GB.Rhinogenous inflammatory diseases of the orbit. VestnOtorinolaringol 1996;14-17.

6. Chotmongkol V, Chainunsamit S. Superior branch palsy ofthe oculomotor nerve caused by acute sphenoid sinusitis.J Med Assoc Thai 1999;82:410-413.

7. Coker SB, Ros SP. Ptosis associated with sinusitis. PediatrNeurol 1996;14:62-63.

8. Weiss AH. The swollen and droopy eyelid. Signs ofsystemic disease. Pediatr Clin North Am 1993;40:789-804.

9. Olitsky SE, Nelson LB. Abnormalities of the lids: ptosis. In:Behrman RE, Kliegman RM, Jenson HB, editors. NelsonTextbook of Pediatrics. 16th ed. Philadelphia: WBSaunders Co; 2000. p. 1909.

10. Jabor MA, Amedee RG. Orbital complications of sinusitis.J La State Med Soc 1997;149:105-108.

∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 01-11-2002 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛË˜: 07-03-2003

¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: °ÚËÁfiÚË˜ ¶·Ú‰·Ïfi˜ §‡ÙÚ· 3, ∆.∫. 546 40, £ÂÛÛ·ÏÔÓ›ÎË E-mail: [email protected]

May-June 03 03-06-03 16:55 ™ÂÏ›‰·214


215

∫ÏÈÓÈÎ‹ ÂÙÂÚÔÁ¤ÓÂÈ· ÛÙËÓ ÚÔÛˆÔˆÌÔ‚Ú·¯ÈfiÓÈÔ Ì˘˚Î‹ ‰˘ÛÙÚÔÊ›· (FSHMD). ¶ÂÚÈÁÚ·Ê‹ ÂÚÈÙÒÛÂˆÓ Î·È ·Ó·ÛÎfiËÛË ÙË˜ ‚È‚ÏÈÔÁÚ·Ê›·˜ E. ºÚ˘Û›Ú·1, ™. ∞Ì¤ÓÙ·1, ∫. ∫¤ÎÔ˘1, ™. °ÈÔ˘ÚÔ‡ÎÔ˜2, ¶. ª·ÓÙ¿3, ∞. ªÂÙ·ÍˆÙÔ‡1

Clinical heterogeneity in facioscapulohumeral muscular dystrophy (FSHMD). Report of two cases and review of the literature H. Fryssira1, S. Amenta1, K. Kekou1, S. Youroukos2, P. Manta3, C. Metaxotou1


1 ∂ÚÁ·ÛÙ‹ÚÈÔ π·ÙÚÈÎ‹˜ °ÂÓÂÙÈÎ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ,ÃˆÚ¤ÌÂÈÔ ∂ÚÂ˘ÓËÙÈÎfi ∂ÚÁ·ÛÙ‹ÚÈÔ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ“∞Á›· ™ÔÊ›·”, ∞ı‹Ó·

2 A’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó·

3 ¡Â˘ÚÔÏÔÁÈÎ‹ ∫ÏÈÓÈÎ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ,“∞ÈÁÈÓ‹ÙÂÈÔ” ¡ÔÛÔÎÔÌÂ›Ô, ∞ı‹Ó·

1 Medical Genetics, Athens University, “Aghia Sophia”Children’s Hospital, Choremio Research Laboratory,∞thens

2 1st Paediatric Department of Athens University, “Aghia Sophia” Children’s Hospital, Athens

3 Neurology Department of Athens University, “Aeginition” Hospital, Athens

∂ÈÛ·ÁˆÁ‹∏ ÚÔÛˆÔ-ˆÌÔ-‚Ú·¯ÈfiÓÈÔ˜ Ì˘˚Î‹ ‰˘ÛÙÚÔÊ›·

(FSHMD, OMIM 158900) ÎÏËÚÔÓÔÌÂ›Ù·È ÌÂ ·˘ÙoÛˆ-Ì·ÙÈÎfi ÂÈÎÚ·ÙÔ‡ÓÙ· ¯·Ú·ÎÙ‹Ú· Î·È Â›Ó·È Ë ÙÚ›ÙËÈÔ Û˘¯Ó‹ Ì˘Ô¿ıÂÈ·. ∏ Û˘¯ÓfiÙËÙ¿ ÙË˜ ˘ÔÏÔÁ›˙Â-Ù·È ÛÂ 1 ·Ó¿ 20.000, ÂÓÒ Ë ‰ÈÂÈÛ‰˘ÙÈÎfiÙËÙ· Â›Ó·È90% ÛÙËÓ ËÏÈÎ›· ÙˆÓ 20 ¯ÚfiÓˆÓ (1,2). Ã·Ú·ÎÙËÚ›-˙ÂÙ·È ·fi ÚÔÔ‰Â˘ÙÈÎ‹, ·Û‡ÌÌÂÙÚË ·‰˘Ó·Ì›· Î·È·ÙÚÔÊ›· ÙˆÓ Ì˘ÒÓ ÙÔ˘ ÚÔÛÒÔ˘, ÙË˜ ˆÌÈÎ‹˜ ˙Ò-ÓË˜ Î·È ÙˆÓ ¿Óˆ ¿ÎÚˆÓ, fiˆ˜ ¿ÏÏˆÛÙÂ Ê·›ÓÂÙ·È·fi ÙËÓ ÔÓÔÌ·Û›· ÙË˜ (3,4).

™Â ÌÂÚÈÎ¤˜ ÂÚÈÙÒÛÂÈ˜ ÚÔÛ‚¿ÏÏÔÓÙ·È Î·È ÔÈ

�¶ÂÚ›ÏË„Ë: ∏ ÚÔÛˆÔ-ˆÌÔ-‚Ú·¯ÈfiÓÈÔ˜ Ì˘˚Î‹‰˘ÛÙÚÔÊ›· (FSHMD) Â›Ó·È Ì›· Ì˘Ô¿ıÂÈ· Ô˘ ÌÂ-Ù·‚È‚¿˙ÂÙ·È ÌÂ ÙÔÓ ·˘ÙÔÛˆÌ·ÙÈÎfi ÂÈÎÚ·ÙÔ‡ÓÙ·ÙÚfiÔ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜. ∫ÏÈÓÈÎ¿ ¯·Ú·ÎÙËÚ›˙ÂÙ·È·fi ·Û‡ÌÌÂÙÚË, ÚÔÔ‰Â˘ÙÈÎ‹ ·‰˘Ó·Ì›· ÙˆÓ Ì˘ÒÓÙÔ˘ ÚÔÛÒÔ˘, ÙË˜ ˆÌÈÎ‹˜ ˙ÒÓË˜ Î·È ÙˆÓ ¿Óˆ¿ÎÚˆÓ. ∏ ÓfiÛÔ˜ ÔÊÂ›ÏÂÙ·È ÛÙÔ 95% ÙˆÓ ÂÚÈÙÒ-ÛÂˆÓ ÛÂ ÂÏÏÂ›„ÂÈ˜ ÙˆÓ Â·Ó·Ï·Ì‚·ÓfiÌÂÓˆÓ ·ÏÏË-ÏÔ˘¯ÈÒÓ D4Z4 ÛÙËÓ ÂÚÈÔ¯‹ q35 ÙÔ˘ ¯ÚˆÌÔÛÒÌ·-ÙÔ˜ 4. ¶ÂÚÈÁÚ¿ÊÔÓÙ·È ‰‡Ô ÂÚÈÙÒÛÂÈ˜ ·È‰ÈÒÓ ÌÂÌÂÁ¿ÏÔ˘ ‚·ıÌÔ‡ Ì˘˚Î‹ ·‰˘Ó·Ì›· Î·È ¤Ó·ÚÍË ÙË˜ÓfiÛÔ˘ ÛÂ ÔÏ‡ ÌÈÎÚ‹ ËÏÈÎ›·, ÛÙÈ˜ ÔÔ›Â˜ Û˘Ó˘‹Ú-¯Â ÓÔËÙÈÎ‹ ˘ÛÙ¤ÚËÛË Î·È ‚·ÚËÎÔ˝·, ˆ˜ ·ÎÚ·›Â˜ Â-ÚÈÙÒÛÂÈ˜ ‚·Ú¤ˆ˜ Ê·ÈÓÔÙ‡Ô˘. ∫·È ÛÙÈ˜ ‰‡Ô ·˘Ù¤˜ÂÚÈÙÒÛÂÈ˜, Ë ÌÔÚÈ·Î‹ ·Ó¿Ï˘ÛË DNA ÂÈ‚Â‚·›ˆÛÂÙËÓ ÎÏÈÓÈÎ‹ ‰È¿ÁÓˆÛË.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ÚÔÛˆÔ-ˆÌÔ-‚Ú·¯ÈfiÓÈÔ˜ Ì˘˚Î‹‰˘ÛÙÚÔÊ›·, ÌÔÚÈ·Î‹ ‰È¿ÁÓˆÛË, ÓÔËÙÈÎ‹ ˘ÛÙ¤ÚËÛË,‚·ÚËÎÔ˝·.

�Abstract: Facioscapulohumeral musculardystrophy (FSHMD) is a myopathy which istransmitted by autosomal dominant inheritance. It ischaracterized clinically by asymmetric andprogressive weakness of the facial, shoulder-girdleand upper arm muscles. The disease is caused bythe size reduction of a polymorphic repeat arrayD4Z4 on locus 4q35. ∆wo cases of children arepresented with severe early onset muscularweakness, co-existing mental retardation anddeafness which represent an unusual side of thedisease spectrum. In both cases the clinicaldiagnosis was confirmed by molecular analysis.

Key words: FSHMD, molecular diagnosis, mentalretardation, deafness.

™˘ÓÙÔÌÔÁÚ·Ê›Â˜ FSHMD ¶ÚÔÛˆÔˆÌÔ‚Ú·¯ÈfiÓÈÔ˜ Ì˘˚Î‹ ‰˘ÛÙÚÔÊ›·OMIM On line Mendelian inheritance in manDNA ¢ÂÔÍ˘ÚÈ‚ÔÓÔ˘ÎÏÂ˚Îfi ÔÍ‡∫¡™ ∫ÂÓÙÚÈÎfi ÓÂ˘ÚÈÎfi Û‡ÛÙËÌ·∏∫° ∏ÏÂÎÙÚÔÎ·Ú‰ÈÔÁÚ¿ÊËÌ·∏ª° ∏ÏÂÎÙÚÔÌ˘ÔÁÚ¿ÊËÌ·CPK ∫ÚÂ·ÙÈÓÔÊˆÛÊÔÚÈÎ‹ ÎÈÓ¿ÛË∫b ∫ÈÏÔ‚¿ÛÂÈ˜AvrIIBlnI ¶ÂÚÈÔÚÈÛÙÈÎ¿ ¤Ó˙˘Ì·EcoRI

}

May-June 03 03-06-03 16:55 ™ÂÏ›‰·215


216

ÎÔÈÏÈ·ÎÔ›, ÔÈ ÂÎÙÂ›ÓÔÓÙÂ˜ Ù· Î¿Ùˆ ¿ÎÚ· Î·È ÔÈ Ì‡Â˜ÙË˜ ˘ÂÏÈÎ‹˜ ˙ÒÓË˜. À¿Ú¯ÂÈ ·ÍÈÔÛËÌÂ›ˆÙË ÎÏÈÓÈÎ‹ÂÙÂÚÔÁ¤ÓÂÈ· ·ÎfiÌ· Î·È ÛÙËÓ ›‰È· ÔÈÎÔÁ¤ÓÂÈ· (5).

∆Ô 1990, Ë ˘Â‡ı˘ÓË ÂÚÈÔ¯‹ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛËÙË˜ ÓfiÛÔ˘ ¯·ÚÙÔÁÚ·Ê‹ıËÎÂ ÌÂÙ¿ ·fi ·Ó¿Ï˘ÛË Û‡Ó-‰ÂÛË˜ ÛÙËÓ ˘ÔÙÂÏÔÌÂÚÈÎ‹ ÂÚÈÔ¯‹ ÙˆÓ Ì·ÎÚÒÓ ÛÎÂ-ÏÒÓ ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ 4 (4q35), fiÔ˘ Ô ·ÓÈ¯ÓÂ˘Ù‹˜p13∂-11 ·Ó·ÁÓˆÚ›˙ÂÈ ¤Ó· È‰È·›ÙÂÚ· ÔÏ˘ÌÔÚÊÈÎfiıÚ·‡ÛÌ· ∂coRI (6-9). ∏ ‰È¿ÁÓˆÛË, Û‹ÌÂÚ·, ÂÈ‚Â‚·È-ÒÓÂÙ·È ÛÙËÓ ÏÂÈÔÓfiÙËÙ· ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÌÂ ÌÔÚÈ·-Î‹ ·Ó¿Ï˘ÛË DNA. ¶ÂÚÈÁÚ¿ÊÔÓÙ·È ‰‡Ô ÂÚÈÙÒÛÂÈ˜·È‰ÈÒÓ ËÏÈÎ›·˜ 10 Î·È 15 ¯ÚfiÓˆÓ ·ÓÙ›ÛÙÔÈ¯·, ÌÂ ·Û˘-Ó‹ıÈÛÙË ÎÏÈÓÈÎ‹ ÚÔ‚ÔÏ‹ ÙË˜ FSHMD Î·È ÚÒÈÌË¤Ó·ÚÍË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ.

™ÎÔfi˜ ÙË˜ ÂÚÈÁÚ·Ê‹˜ ÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ ·˘ÙÒÓÂ›Ó·È ·ÊÂÓfi˜ ÌÂÓ Ó· ÙÔÓ›ÛÂÈ ÙÔ Â˘Ú‡ÙÂÚÔ ÎÏÈÓÈÎfi Ê¿-ÛÌ· ÙË˜ FSHMD, È‰›ˆ˜ fiÙ·Ó Ë ¤Ó·ÚÍË ÙˆÓ Û˘ÌÙˆ-Ì¿ÙˆÓ Â›Ó·È ÛÂ ÔÏ‡ ÌÈÎÚ‹ ËÏÈÎ›·, ·ÊÂÙ¤ÚÔ˘ ‰Â Ó· ‰Â›-ÍÂÈ ÙË ÌÂÁ¿ÏË Û˘Ì‚ÔÏ‹ ÙË˜ ÌÔÚÈ·Î‹˜ ÁÂÓÂÙÈÎ‹˜ ÛÙË‰È¿ÁÓˆÛË, ÛÙËÓ ÚÔÛ˘ÌÙˆÌ·ÙÈÎ‹ ·Ó›¯ÓÂ˘ÛË ÊÔÚ¤ˆÓÎ·È ÛÙËÓ ÚÔÁÂÓÓËÙÈÎ‹ ‰È¿ÁÓˆÛË.

¶ÂÚÈÁÚ·Ê‹ ÂÚÈÙÒÛÂˆÓ ¶ÂÚ›ÙˆÛË ÚÒÙË ∫ÔÚ›ÙÛÈ ËÏÈÎ›·˜ 10 ¯ÚfiÓˆÓ ÚÔÛ‹ÏıÂ ÁÈ· ¤ÏÂÁ¯Ô

‚·ÚÈ¿˜ ÓÔËÙÈÎ‹˜ Î·ı˘ÛÙ¤ÚËÛË˜ Î·È ·‰˘Ó·Ì›·˜ ÛÙË‚¿‰ÈÛË. ¶ÚfiÎÂÈÙ·È ÁÈ· ÙÔ ÌÔÓ·‰ÈÎfi ·È‰› ˘ÁÈÒÓ ÁÔ-Ó¤ˆÓ, ÌË Û˘ÁÁÂÓÒÓ ÌÂÙ·Í‡ ÙÔ˘˜. ™ÙÔ ÔÈÎÔÁÂÓÂÈ·ÎfiÈÛÙÔÚÈÎfi ·Ó·Ê¤ÚÂÙ·È ¤Ó·˜ ‰Â‡ÙÂÚÔ˜ ÂÍ¿‰ÂÏÊÔ˜·fi ÙÔÓ ·Ù¤Ú· ÌÂ ÓÔËÙÈÎ‹ ˘ÛÙ¤ÚËÛË Î·È ¤Ó·˜ ıÂ›-Ô˜ Ô˘ Â›¯Â ÂÌÊ·Ó›ÛÂÈ Û·ÛÌÔ‡˜ Î·È Î·ı˘ÛÙ¤ÚËÛËÏfiÁÔ˘. °ÂÓÓ‹ıËÎÂ ÙÂÏÂÈfiÌËÓË ÌÂ Î·ÈÛ·ÚÈÎ‹ ÙÔÌ‹ÏfiÁˆ ÈÛ¯È·Î‹˜ ÚÔ‚ÔÏ‹˜ Î·È Ë ÂÚÈÁÂÓÓËÙÈÎ‹ Â-Ú›Ô‰Ô˜ ·Ó·ÊÂÚfiÙ·Ó ÂÏÂ‡ıÂÚË. ∆Ô ‚¿ÚÔ˜ Á¤ÓÓËÛË˜‹Ù·Ó 3250 g. ◊‰Ë ·fi ÙË ÓÂÔÁÓÈÎ‹ ËÏÈÎ›· ·Ú·ÙË-Ú‹ıËÎÂ ··ı¤˜ ÚÔÛˆÂ›Ô Î·È ˘ÔÙÔÓ›·.

™Â ËÏÈÎ›· 20 ÌËÓÒÓ ÂÈÛ‹¯ıË ÁÈ· ÚÒÙË ÊÔÚ¿ÛÙËÓ ∞’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘∞ıËÓÒÓ ÏfiÁˆ ÛÔ‚·Ú‹˜ Î·ı˘ÛÙ¤ÚËÛË˜ ÛÙ· ÛÙ¿‰È··Ó·Ù˘ÍÈ·Î‹˜ ÂÍ¤ÏÈÍË˜ - Î¿ıÈÛÂ ÛÂ ËÏÈÎ›· 12 ÌË-ÓÒÓ, ÂÚ¿ÙËÛÂ ÛÂ ËÏÈÎ›· 20 ÌËÓÒÓ Î·È ‰ÂÓ Â›¯Â·ÎfiÌ· ·Ó·Ù‡ÍÂÈ ÏfiÁÔ Î·È ÎÔÈÓˆÓÈÎfiÙËÙ·. ™ÙËÓ·ÓÙÈÎÂÈÌÂÓÈÎ‹ ÂÍ¤Ù·ÛË ‰È·ÈÛÙÒıËÎÂ fiÙÈ ÂÚfiÎÂÈÙÔÁÈ· ¤Ó· ·È‰› ˘ÔÙÔÓÈÎfi ÌÂ ··ı¤˜ ÚÔÛˆÂ›ÔÔ˘ ‰ÂÓ ¯·ÌÔÁÂÏÔ‡ÛÂ Â‡ÎÔÏ·, ¤ÎÏ·ÈÁÂ ¯ˆÚ›˜ Ó·Û˘ÛÒÓÙ·È ÔÈ Ì‡Â˜ ÙÔ˘ ÚÔÛÒÔ˘ Î·È Â›¯Â ÛÈÂÏfiÚ-ÚÔÈ·. ¢ÂÓ Â›¯Â ÈÓÈ‰ÈÛÌÔ‡˜ ÁÏÒÛÛ·˜. ∆· ·ÓÙ·Ó·ÎÏ·-ÛÙÈÎ¿ ÂÎÏ‡ÔÓÙ·Ó Ê˘ÛÈÔÏÔÁÈÎ¿. O ÂÚÁ·ÛÙËÚÈ·Îfi˜¤ÏÂÁ¯Ô˜ (·ÈÌ·ÙÔÏÔÁÈÎfi˜, ‚ÈÔ¯ËÌÈÎfi˜, ÌÂÙ·‚ÔÏÈ-Îfi˜, ·ÓÔÛÔÏÔÁÈÎfi˜) ‹Ù·Ó ÌË ‰È·ÁÓˆÛÙÈÎfi˜, ·Ú¿ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ë CPK Î·È Ë ·Ï‰ÔÏ¿ÛË ‹Ù·Ó ÂÏ·-ÊÚÒ˜ ·˘ÍËÌ¤ÓÂ˜. ∏ ÌÂÏ¤ÙË ÙˆÓ ¯ÚˆÌÔÛˆÌ¿ÙˆÓ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ‹. ∏ ‚˘ıÔÛÎfiËÛË, Ë ˘ÔÏÔÁÈÛÙÈ-

Î‹ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ Î·È ÙÔ ·ÎÔfiÁÚ·ÌÌ·ÂÏÂ‡ıÂÚÔ˘ Â‰›Ô˘ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ¿.

™Â ËÏÈÎ›· 5 ¯ÚfiÓˆÓ ÂÚ›Ô˘ ¤ÁÈÓÂ Â·Ó¤ÏÂÁ¯Ô˜ÙÔ˘ ·È‰ÈÔ‡. ∂Í·ÎÔÏÔ˘ıÔ‡ÛÂ Ó· ÂÌÊ·Ó›˙ÂÈ ‚·ÚÈ¿ÓÔËÙÈÎ‹ ˘ÛÙ¤ÚËÛË, ÁÂÓÈÎÂ˘Ì¤ÓË ˘ÔÙÔÓ›·, È‰È·›ÙÂ-Ú· ÛÙÔ˘˜ Ì˘˜ ÙÔ˘ ÚÔÛÒÔ˘ Î·È ÙË˜ ˆÌÈÎ‹˜ ˙Ò-ÓË˜. À‹Ú¯·Ó, Â›ÛË˜, ÛÈÙÈÛÙÈÎ¿ ÚÔ‚Ï‹Ì·Ù· ÏfiÁˆ‰˘ÛÎÔÏÈÒÓ ÛÙËÓ Î·Ù¿ÔÛË. ¢ÂÓ ÌÈÏÔ‡ÛÂ ÈÎ·ÓÔÔÈ-ËÙÈÎ¿ (¤ÏÂÁÂ 10-12 Ï¤ÍÂÈ˜). ∂›¯Â ÂÈ‰ÂÈÓÔ‡ÌÂÓË ‰˘-ÛÎÔÏ›· ÛÙË ‚¿‰ÈÛË Î·È ÏfiÚ‰ˆÛË ÔÛÊ˘˚Î‹˜ ÌÔ›Ú·˜ÙË˜ ÛÔÓ‰˘ÏÈÎ‹˜ ÛÙ‹ÏË˜. ∂›¯Â, Â›ÛË˜, ·Ú¯›ÛÂÈ Ó··Ú·ÙËÚÂ›Ù·È ·‰˘Ó·Ì›· ·Ó¿‚·ÛË˜ ÎÏ›Ì·Î·˜ Î·È‚¿‰ÈÛË ÛÙÈ˜ Ì‡ÙÂ˜ ÙˆÓ Ô‰ÈÒÓ. ™ÙËÓ ÎÏÈÓÈÎ‹ ÂÍ¤Ù·-ÛË, ÙÔ ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜ ‹Ù·Ó ÛÙËÓ 75Ë ∂.£. Î·È ËÂÚ›ÌÂÙÚÔ˜ ÎÂÊ·Ï‹˜ ÛÙËÓ 50Ë ∂.£. ¢ÂÓ ·Ú·ÙË-Ú‹ıËÎ·Ó ‰˘ÛÌÔÚÊÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ Î·È ·ÓˆÌ·-Ï›Â˜ ·fi ÙÔ ‰¤ÚÌ·. ¢ÂÓ ·Ú·ÙËÚ‹ıËÎÂ Ì˘ÔÙÔÓÈÎfiÊ·ÈÓfiÌÂÓÔ, Ô‡ÙÂ ÙÚfiÌÔ˜, ˘‹Ú¯Â fiÌˆ˜ ÂÁÁ‡˜ Î·È¿ˆ ÁÂÓÈÎÂ˘Ì¤ÓË Ì˘˚Î‹ ·‰˘Ó·Ì›·. O ÂÚÁ·ÛÙËÚÈ·-Îfi˜ ¤ÏÂÁ¯Ô˜ ÂÍ·ÎÔÏÔ˘ıÔ‡ÛÂ Ó· Â›Ó·È Ê˘ÛÈÔÏÔÁÈ-Îfi˜, ÂÎÙfi˜ ÙË˜ CPK Ô˘ ‹Ù·Ó 900 U/l (º.∆. Ì¤¯ÚÈ140) Î·È ÙË˜ ·Ï‰ÔÏ¿ÛË˜ Ô˘ ‹Ù·Ó 35 U/l (º.∆. Ì¤-¯ÚÈ 16). ∏ ÙÈÌ‹ ÙË˜ Î·ÚÓÈÙ›ÓË˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ‹. OÔÊı·ÏÌÔÏÔÁÈÎfi˜ Î·È ·ÎÔÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÂÍ·ÎÔ-ÏÔ˘ıÔ‡Û·Ó Ó· Â›Ó·È ¯ˆÚ›˜ ·ıÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù·.

∏ ‚ÈÔ„›· ‰ÂÏÙÔÂÈ‰Ô‡˜ ·ÔÎ¿Ï˘„Â ‹ÈÂ˜, ÌË ‰È·-ÁÓˆÛÙÈÎ¤˜ ÈÛÙÔ·ıÔÏÔÁÈÎ¤˜ ·ÏÏÔÈÒÛÂÈ˜ Ì˘Ô·ıËÙÈ-ÎÔ‡ Ù‡Ô˘. ™ÙÔ ËÏÂÎÙÚÔÌ˘ÔÁÚ¿ÊËÌ· ·Ú·ÙËÚ‹ıË-Î·Ó ‹ÈÂ˜ ·ÏÏÔÈÒÛÂÈ˜ Ì˘Ô·ıËÙÈÎ‹˜ ‰ÈÂÚÁ·Û›·˜. ∏Ù·¯‡ÙËÙ· ·ÁˆÁ‹˜ ÓÂ‡ÚˆÓ ‹Ù·Ó ¯ˆÚ›˜ ·ıÔÏÔÁÈÎ¿Â˘Ú‹Ì·Ù·. µ¿ÛÂÈ ÙˆÓ ·ÓˆÙ¤Úˆ ÎÏÈÓÈÎÒÓ Î·È ÂÚÁ·-ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛÂˆÓ Ù¤ıËÎÂ Ë ‰È¿ÁÓˆÛË Î¿ÔÈ·˜ÌÔÚÊ‹˜ Ì˘Ô¿ıÂÈ·˜ Ì·˙› ÌÂ ÓÔËÙÈÎ‹ ˘ÛÙ¤ÚËÛË. ∏‰È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË Ô˘ ı· ÌÔÚÔ‡ÛÂ Ó· Á›ÓÂÈ Ïfi-Áˆ ÙË˜ Û˘Ó‡·ÚÍË˜ Ì˘Ô¿ıÂÈ·˜ ÌÂ ÚÔÛ‚ÔÏ‹ ÙÔ˘ÎÂÓÙÚÈÎÔ‡ ÓÂ˘ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ‹Ù·Ó ÌÂÙ·Í‡ Û˘Á-ÁÂÓÔ‡˜ Ì˘˚Î‹˜ ‰˘ÛÙÚÔÊ›·˜ Î·È ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ ÓÔ-Û‹Ì·ÙÔ˜, ‰È·ÁÓÒÛÂÈ˜ Ô˘ ‰ÂÓ ÂÈ‚Â‚·ÈÒıËÎ·Ó ·fiÙ· ÂÚÁ·ÛÙËÚÈ·Î¿ Â˘Ú‹Ì·Ù·.

™ÙËÓ ÙÂÏÂ˘Ù·›· ÎÏÈÓÈÎ‹ ÂÍ¤Ù·ÛË, ÛÂ ËÏÈÎ›· 10ÂÙÒÓ, Â›¯Â ÂÎÛÂÛËÌ·ÛÌ¤ÓË ÂÈ‰Â›ÓˆÛË ÙË˜ ÎÈÓËÙÈ-Î‹˜ Î·È ÓÔËÙÈÎ‹˜ ÂÍ¤ÏÈÍË˜. ◊Ù·Ó Î·ıËÏˆÌ¤ÓË ÛÂ·Ó·ËÚÈÎfi ·Ì·Í›‰ÈÔ Î·È Â›¯Â ¤Î‰ËÏË ÏfiÚ‰ˆÛË Î·ÈÎ˘ÊÔÛÎÔÏ›ˆÛË ÙË˜ ÛÔÓ‰˘ÏÈÎ‹˜ ÛÙ‹ÏË˜ ÌÂ ÚÔ‚Ô-Ï‹ ÙË˜ ˆÌÔÏ¿ÙË˜. ∆Ô ÛÙfiÌ· ·Ú¤ÌÂÓÂ ·ÓÔÈÎÙfi ÌÂÛÈÂÏfiÚÚÔÈ· Î·È ‰ÂÓ ÂÈÎÔÈÓˆÓÔ‡ÛÂ ÌÂ ÙÔ ÂÚÈ‚¿Ï-ÏÔÓ (∂ÈÎfiÓÂ˜ 1 Î·È 2).

¶ÂÚ›ÙˆÛË ‰Â‡ÙÂÚË ∞ÁfiÚÈ ËÏÈÎ›·˜ 15 ¯ÚfiÓˆÓ ÚÔÛ‹ÏıÂ ÏfiÁˆ Ì˘˚Î‹˜

·‰˘Ó·Ì›·˜, ÌÂÙÚ›Ô˘ ‚·ıÌÔ‡ ÓÔËÙÈÎ‹˜ ˘ÛÙ¤ÚËÛË˜Î·È ‚·ÚËÎÔ˝·˜. ◊Ù·Ó ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ·È‰› ÙË˜ ÔÈ-ÎÔÁ¤ÓÂÈ·˜. ∆Ô ‰Â‡ÙÂÚÔ ·È‰› ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi ·ÁfiÚÈ. ∆Ô ÔÈÎÔÁÂÓÂÈ·Îfi Î·È ÂÚÈÁÂÓÓËÙÈÎfi ÈÛÙÔÚÈÎfi

May-June 03 03-06-03 16:55 ™ÂÏ›‰·216


217

·Ó·ÊÂÚfiÙ·Ó ÂÏÂ‡ıÂÚÔ. °ÂÓÓ‹ıËÎÂ ÌÂ Î·ÈÛ·ÚÈÎ‹ ÙÔÌ‹ÏfiÁˆ ·ÓÒÌ·ÏË˜ ı¤ÛË˜, ÌÂÙ¿ ·fi ÙÂÏÂÈfiÌËÓË Î‡ËÛË,ÛÙË ‰È¿ÚÎÂÈ· ÙË˜ ÔÔ›·˜ Ë ÌËÙ¤Ú· ‰ÂÓ ÓfiÛËÛÂ, ‰ÂÓÂÎÙ¤ıËÎÂ ÛÂ ÂÌ‚Ú˘ÔÙÔÍÈÎ¿ Ê¿ÚÌ·Î· ‹ ÛËÌ·ÓÙÈÎ‹ ‰fi-ÛË ·ÎÙÈÓÔ‚ÔÏ›·˜. ∆Ô ‚¿ÚÔ˜ Á¤ÓÓËÛË˜ ‹Ù·Ó 3 kg. ∏ ÎÈ-ÓËÙÈÎ‹ ÙÔ˘ ÂÍ¤ÏÈÍË ‹Ù·Ó ÂÓÙfi˜ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓÔÚ›ˆÓ - Î¿ıÈÛÂ ÛÂ ËÏÈÎ›· 7 ÌËÓÒÓ Î·È ÂÚ¿ÙËÛÂ ÛÂËÏÈÎ›· 14 ÌËÓÒÓ. ™ÙËÓ ËÏÈÎ›· ÙˆÓ 2 ¯ÚfiÓˆÓ, ‹Ù·Ó ‹Û˘-¯Ô ·È‰›, ÌÂ ÌÂÁ¿ÏÔ ·ÚÓËÙÈÛÌfi Î·È ‰ÂÓ Â›¯Â ·Ó¿Ù˘ÍËÙÔ˘ ÏfiÁÔ˘. ™Â ·ÎÔfiÁÚ·ÌÌ· Ô˘ ¤ÁÈÓÂ ÛÙËÓ ËÏÈÎ›· ÙˆÓ4 ¯ÚfiÓˆÓ, ‚Ú¤ıËÎÂ ÌÂÁ¿ÏÔ˘ ‚·ıÌÔ‡ ‚·ÚËÎÔ˝· ·ÌÊÔ-ÙÂÚfiÏÂ˘Ú·. O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ Ô˘ ¤ÁÈÓÂ Ùfi-ÙÂ ÌÂ ·ÈÌ·ÙÔÏÔÁÈÎfi, ‚ÈÔ¯ËÌÈÎfi, ÌÂÙ·‚ÔÏÈÎfi, ·ÂÈÎÔÓÈ-ÛÙÈÎfi ¤ÏÂÁ¯Ô ÂÁÎÂÊ¿ÏÔ˘ ÌÂ Ì·ÁÓËÙÈÎfi Û˘ÓÙÔÓÈÛÌfi,∏∂° Î·È Î·Ú˘fiÙ˘Ô ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜. ∏ ÙÈÌ‹ ÙË˜CPK Î˘Ì·ÈÓfiÙ·Ó ·fi 240-460 U/l.

∆Ô ·È‰› ¿Ú¯ÈÛÂ ÚfiÁÚ·ÌÌ· ÂÈ‰ÈÎ‹˜ ·ÁˆÁ‹˜Î·È ÏÔÁÔıÂÚ·Â›·˜ ÏfiÁˆ ÙË˜ ‚·ÚËÎÔ˝·˜ Î·È ÙË˜ÂÓÙÔÓfiÙ·ÙË˜ ‰˘Û·ÚıÚ›·˜. ™ÙËÓ ËÏÈÎ›· ÙˆÓ 10¯ÚfiÓˆÓ, ÚÔÛÙ¤ıËÎÂ ÛÙËÓ ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· ‰˘ÛÎÔ-Ï›· ÛÙË ‚¿‰ÈÛË, ·‰˘Ó·Ì›· ·Ó¿‚·ÛË˜ ÎÏ›Ì·Î·˜ Î·È·Ó¤ÁÂÚÛË˜ ·fi ÙËÓ Î·ıÈÛÙ‹ ÛÙËÓ fiÚıÈ· ı¤ÛË. ∆·ÙÂÏÂ˘Ù·›· 3 ¯ÚfiÓÈ· Â›¯Â ÚÔÔ‰Â˘ÙÈÎ‹ ÂÈ‰Â›ÓˆÛËÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÙÔ˘, È‰›ˆ˜ ÙÔ˘ ÏfiÁÔ˘ (·Ú¿ ÙËÏÔÁÔıÂÚ·Â˘ÙÈÎ‹ ·Ú¤Ì‚·ÛË) Î·È ÙË˜ ‚¿‰ÈÛË˜.∂›ÛË˜, ¿Ú¯ÈÛÂ Ó· ÂÌÊ·Ó›˙ÂÈ Î·È ‰˘ÛÎÔÏ›· ÛÙËÌ¿ÛËÛË. ∫·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘, ÛÙËÓ ·ÓÙÈÎÂÈÌÂ-ÓÈÎ‹ ÂÍ¤Ù·ÛË, ÂÎÙfi˜ ·fi ÙË ÌÂÙÚ›Ô˘ ‚·ıÌÔ‡ ÓÔË-ÙÈÎ‹ ˘ÛÙ¤ÚËÛË Î·È ÙË ‚·ÚËÎÔ˝·, ·Ú·ÙËÚ‹ıËÎÂÌÂÁ¿ÏË ·‰˘Ó·Ì›· ÙˆÓ Ì˘ÒÓ ÙÔ˘ ÚÔÛÒÔ˘, ¤Ï-ÏÂÈ„Ë ¤ÎÊÚ·ÛË˜ ÌÂ ÙÒÛË ÙÔ˘ Î¿Ùˆ ¯Â›ÏÔ˘˜ Î·ÈÛÈÂÏfiÚÚÔÈ·. À‹Ú¯Â ·ÙÚÔÊ›· Î·È ÛËÌ·ÓÙÈÎ‹ ·‰˘-Ó·Ì›· ÙˆÓ Ì˘ÒÓ ÙË˜ ˆÌÈÎ‹˜ ˙ÒÓË˜ Î·È ËÈfiÙÂÚË

ÙˆÓ Ì˘ÒÓ ÙË˜ ˘ÂÏÈÎ‹˜ ˙ÒÓË˜ Î·È ÙˆÓ Ì˘ÒÓ ÙˆÓ¿ÎÚˆÓ. ¶·Ú·ÙËÚ‹ıËÎÂ „Â˘‰Ô¸ÂÚÙÚÔÊ›· ÙˆÓÁ·ÛÙÚÔÎÓËÌÈÒÓ, ·ÏÏ¿ Î·È ·ÍÈÔÛËÌÂ›ˆÙË ÏfiÚ‰ˆÛËÙË˜ ÔÛÊ˘˚Î‹˜ ÌÔ›Ú·˜ ÙË˜ ÛÔÓ‰˘ÏÈÎ‹˜ ÛÙ‹ÏË˜Î·È ·Û‡ÌÌÂÙÚË ÙÂÚ˘ÁÔÂÈ‰‹˜ ˆÌÔÏ¿ÙË (∂ÈÎfiÓÂ˜3 Î·È 4). ∞fi ÙËÓ ˘fiÏÔÈË ÓÂ˘ÚÔÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË,Ù· ÙÂÓfiÓÙÈ· ·ÓÙ·Ó·ÎÏ·ÛÙÈÎ¿ ÂÎÏ‡ÔÓÙ·Ó Ê˘ÛÈÔÏÔ-ÁÈÎ¿. O ÔÊı·ÏÌÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ‹Ù·Ó Ê˘ÛÈÔÏÔ-ÁÈÎfi˜. ∞fi ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô ‰È·ÈÛÙÒıË-ÎÂ ÂÚ·ÈÙ¤Úˆ ·‡ÍËÛË ÙË˜ ÙÈÌ‹˜ ÙË˜ CPK. ∆Ô ËÏÂ-ÎÙÚÔÌ˘ÔÁÚ¿ÊËÌ· ¤‰ÂÈÍÂ ‰È¿¯˘ÙÂ˜ ·ÏÏÔÈÒÛÂÈ˜Ì˘Ô·ıËÙÈÎÔ‡ Ù‡Ô˘.

Ÿˆ˜ Ê·›ÓÂÙ·È ·fi ÙËÓ ÂÚÈÁÚ·Ê‹ ÙˆÓ ÂÚÈ-ÛÙ·ÙÈÎÒÓ, Ë ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· Î·È Ë ÂÏ·ÊÚÒ˜ ·˘ÍËÌ¤-ÓË CPK Û˘ÓËÁÔÚÔ‡Û·Ó ˘¤Ú ÙË˜ ÚÔÛˆÔ-ˆÌÔ-‚Ú·¯ÈÔÓ›Ô˘ Ì˘˚Î‹˜ ‰˘ÛÙÚÔÊ›·˜.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈªÔÚÈ·Î‹ ·Ó¿Ï˘ÛË ∏ ‰È¿ÁÓˆÛË Î·È ÛÙÈ˜ ‰‡Ô ÂÚÈÙÒÛÂÈ˜ ÚÔÛˆÔ-ˆÌÔ-

‚Ú·¯ÈÔÓ›Ô˘ Ì˘˚Î‹˜ ‰˘ÛÙÚÔÊ›·˜ ÂÈ‚Â‚·ÈÒıËÎÂ ÂÚÁ·ÛÙËÚÈ·-Î¿ ÌÂ ÌÔÚÈ·Î‹ ·Ó¿Ï˘ÛË DNA.

∞ÔÌÔÓÒıËÎÂ DNA ·fi ÙÔ ÂÚÈÊÂÚÈÎfi ·›Ì· ÙˆÓ ·ÛıÂÓÒÓÎ·È ÌÂÏÂÙ‹ıËÎÂ ÌÂ ÙËÓ ÙÂ¯ÓÈÎ‹ Southern blotting, ÌÂÙ¿ ·fi ‰È-Ï‹ ÂÒ·ÛË ÌÂ Ù· ÂÚÈÔÚÈÛÙÈÎ¿ ¤Ó˙˘Ì· EcoRI Î·È ∞vrII.

ªÂ ÙÔÓ ÙÚfiÔ ·˘Ùfi ‰È·ÈÛÙÒıËÎÂ Â¿Ó ÔÈ ÂÏÏÂ›„ÂÈ˜ ÚÔ¤Ú-¯ÔÓÙ·Ó ·fi ÙËÓ ÂÚÈÔ¯‹ 4q35 Ô˘ Û¯ÂÙ›˙ÂÙ·È ÌÂ ÙÔ ÓfiÛËÌ· ‹·fi Ì›· ÔÌfiÏÔÁË ÂÚÈÔ¯‹ ÛÙÔ ¯ÚˆÌfiÛˆÌ· 10 (10q26), ÙÔÔÔ›Ô ‰ÂÓ Û˘ÓÔ‰Â‡ÂÙ·È ÌÂ ·ıÔÏÔÁÈÎfi Ê·ÈÓfiÙ˘Ô.

°È· ÙÔÓ ˘‚ÚÈ‰ÈÛÌfi ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ô ·ÓÈ¯ÓÂ˘Ù‹˜ p13∂-11 (ÚÔÛÊÔÚ¿ ÙÔ˘ ÙÌ‹Ì·ÙÔ˜ °ÂÓÂÙÈÎ‹˜ ÙÔ˘ Sylvius Lab,Leiden). ∏ Û‹Ì·ÓÛË ¤ÁÈÓÂ ÌÂ ÌË Ú·‰ÈÂÓÂÚÁfi ÙÚfiÔ Î·È ¯ÚË-ÛÈÌÔÔÈ‹ıËÎÂ ÙÔ Û‡ÛÙËÌ· Û‹Ì·ÓÛË˜ Î·È ·Ó›¯ÓÂ˘ÛË˜ ÌÂ ‰È-ÁÔÍÈÁÂÓ›ÓË (Roche).

∆· ·ÔÙÂÏ¤ÛÌ·Ù· Î·È ÛÙÔ˘˜ ‰‡Ô ·ÛıÂÓÂ›˜ ¤‰ÂÈÍ·Ó ÙÔ ›‰ÈÔıÚ·‡ÛÌ·, fiˆ˜ Ê·›ÓÂÙ·È ÛÙËÓ ∂ÈÎfiÓ· 5. ¢ËÏ·‰‹, ·Ú·ÙËÚ‹-ıËÎÂ fiÙÈ ˘‹Ú¯Â ıÚ·‡ÛÌ· ÂÚ›Ô˘ 7 kb ÌÂÙ¿ ·fi ‰ÈÏ‹ ÂÒ-·ÛË ÌÂ Ù· ¤Ó˙˘Ì· EcoRI Î·È ∞vrII.

∂ÈÎfiÓ· 1. O ·ÛıÂÓ‹˜ ÙË˜ ÚÒÙË˜ ÂÚ›ÙˆÛË˜ Î·ıËÏˆÌ¤ÓÔ˜ÛÂ ·Ó·ËÚÈÎ‹ Î·Ú¤ÎÏ·. ∂›Ó·È ¤Î‰ËÏË Ë Î˘ÊÔÛÎÔÏ›ˆÛË ÙË˜ÛÔÓ‰˘ÏÈÎ‹˜ ÛÙ‹ÏË˜ Î·È Ë ÚÔ¤ÙÂÈ· ÙË˜ ˆÌÔÏ¿ÙË˜.

∂ÈÎfiÓ· 2. O ·ÛıÂÓ‹˜ ÙË˜ ÚÒÙË˜ ÂÚ›ÙˆÛË˜ ÌÂ ·ÓÔÈ¯Ùfi ÛÙfi-Ì· Î·È ÛÈÂÏfiÚÚÔÈ·.

May-June 03 03-06-03 16:55 ™ÂÏ›‰·217


218

™˘˙‹ÙËÛË∏ FSHMD ·ÚÔ˘ÛÈ¿˙ÂÈ ÌÂÁ¿ÏË ÁÂÓÂÙÈÎ‹ ÂÙÂÚÔ-

Á¤ÓÂÈ·. ∏ ÂÙÂÚÔÁ¤ÓÂÈ· Â›Ó·È ¤Î‰ËÏË ·ÎfiÌ· Î·È ÛÙËÓ›‰È· ÔÈÎÔÁ¤ÓÂÈ· (5,10). ∞Ó·Ê¤ÚÂÙ·È ÛÙË ‚È‚ÏÈÔÁÚ·-Ê›· ÂÚ›ÙˆÛË ÌÔÓÔ˙˘ÁˆÙÈÎÒÓ ‰È‰‡ÌˆÓ ÌÂ ÌÂÁ¿ÏËÔÈÎÈÏÔÌÔÚÊ›· ÛÙËÓ ¤ÎÊÚ·ÛË (1).

¶·Ú¿ ÙÈ˜ ÚÔÛ¿ıÂÈÂ˜ ‰ÂÓ ¤¯ÂÈ ·ÔÌÔÓˆıÂ› Ì¤-¯ÚÈ Û‹ÌÂÚ· ÙÔ ˘Â‡ı˘ÓÔ ÁÈ· ÙË ÓfiÛÔ ÁÔÓ›‰ÈÔ(9,11,12). ™ÙÔ 95% ÙˆÓ ·Û¯fiÓÙˆÓ ·ÓÈ¯ÓÂ‡ÔÓÙ·È ÂÏ-ÏÂ›„ÂÈ˜ Â·Ó·Ï·Ì‚·ÓfiÌÂÓˆÓ ·ÏÏËÏÔ˘¯ÈÒÓ, Ô˘ÔÓÔÌ¿˙ÔÓÙ·È D4Z4 Î·È ¤¯Ô˘Ó Ì¤ÁÂıÔ˜ 3,3 kb (13).§fiÁˆ ÙˆÓ ÂÏÏÂ›„ÂˆÓ, ‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È ·Ó·Î·Ù·Ù¿-ÍÂÈ˜ ÛÙËÓ ÙÂÏÔÌÂÚÈÎ‹ ÂÚÈÔ¯‹ ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜4. A˘Ù¤˜ ¤¯Ô˘Ó ˆ˜ Û˘Ó¤ÂÈ· ÌÂÙ·‚ÔÏ‹ ¤ÎÊÚ·ÛË˜Î·È ·ÏÏ·Á‹ ÛÙË ÌÂÙ·ÁÚ·ÊÈÎ‹ ÈÎ·ÓfiÙËÙ· ÁÂÈÙÔÓÈÎÒÓÛÙËÓ ÂÚÈÔ¯‹ ·˘Ù‹ ÁÔÓÈ‰›ˆÓ ÌÂ ÙÔ ÌË¯·ÓÈÛÌfi ÙË˜“Â›‰Ú·ÛË˜ ı¤ÛË˜” (positional effect). ∞˘Ùfi ıÂˆÚÂ›-Ù·È Û‹ÌÂÚ· Ô Èı·ÓfiÙÂÚÔ˜ ·ıÔÁÂÓÂÙÈÎfi˜ ÌË¯·ÓÈ-ÛÌfi˜ ÙË˜ FSHMD (6-9,14). ∏ ·Ó›¯ÓÂ˘ÛË ÙˆÓ ÂÏÏÂ›-„ÂˆÓ Á›ÓÂÙ·È ÌÂ ÙËÓ ÙÂ¯ÓÈÎ‹ ÙÔ˘ Southern blot, ÌÂÙË ¯Ú‹ÛË ÙÔ˘ ÂÚÈÔÚÈÛÙÈÎÔ‡ ÂÓ˙‡ÌÔ˘ EcoRI Î·È ÙÔ˘·ÓÈ¯ÓÂ˘Ù‹ p13-11 (5). ™˘ÁÎÂÎÚÈÌ¤Ó·, ÛÙÔ˘˜ ·ÛıÂ-ÓÂ›˜ ·ÓÈ¯ÓÂ‡ÂÙ·È ıÚ·‡ÛÌ· ≤35 kb, ÂÓÒ ÛÙÔÓ Ê˘ÛÈÔ-ÏÔÁÈÎfi ÏËı˘ÛÌfi ·˘Ùfi ÙÔ ıÚ·‡ÛÌ· ÔÈÎ›ÏÏÂÈ ÛÂ Ì¤-ÁÂıÔ˜ ·fi 35 kb Ì¤¯ÚÈ 300 kb (15). ªÂ ÙÔÓ ›‰ÈÔ ÙÚfi-Ô, ·ÓÈ¯ÓÂ‡ÔÓÙ·È ÔÌfiÏÔÁÂ˜ ·ÏÏËÏÔ˘¯›Â˜ ÂÎÙfi˜ ·fiÙÔ ¯ÚˆÌfiÛˆÌ· 4 Î·È ÛÙÔ ¯ÚˆÌfiÛˆÌ· 10, ÁÂÁÔÓfi˜Ô˘ ÛÙÔ ·ÚÂÏıfiÓ ‰ËÌÈÔ˘ÚÁÔ‡ÛÂ ‰È·ÁÓˆÛÙÈÎfiÚfi‚ÏËÌ· (13). ŒÓ· ÂÚÈÔÚÈÛÙÈÎfi ¤Ó˙˘ÌÔ, ÙÔ BlnI (‹

AvRII), ·Ó·ÁÓˆÚ›˙ÂÈ ·ÔÎÏÂÈÛÙÈÎ¿ ÙÔ ÙÌ‹Ì· ÌfiÓÔÛÙÔ ¯ÚˆÌfiÛˆÌ· 10 Î·È fi¯È ÛÙÔ 4. ŒÙÛÈ, ‰ÈÏ‹ ÂÒ-·ÛË ÌÂ Ù· ‰‡Ô ÂÚÈÔÚÈÛÙÈÎ¿ ¤Ó˙˘Ì· (∂coRI-BlnI ‹AvrII) ÂÈÙÚ¤ÂÈ ÙÔÓ ‰È·¯ˆÚÈÛÌfi Î·È ÙËÓ ·Ó·ÁÓÒÚÈÛËÙÔ˘ ıÚ·‡ÛÌ·ÙÔ˜ ÛÙÔ ¯ÚˆÌfiÛˆÌ· 4, ·˘Í¿ÓÔÓÙ·˜ÙËÓ ·ÍÈÔÈÛÙ›· ÙË˜ ·Ó¿Ï˘ÛË˜ (9,19).

ªÂÙ¿ ÙËÓ ·Ó·Î¿Ï˘„Ë ÙË˜ ÌÔÚÈ·Î‹˜ ‚Ï¿‚Ë˜,¤¯Ô˘Ó Á›ÓÂÈ ‰È¿ÊÔÚÂ˜ ÌÂÏ¤ÙÂ˜ ÁÈ· ÙÔ Û˘Û¯ÂÙÈÛÌfiÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙÔ˘ ıÚ·‡ÛÌ·ÙÔ˜ Î·È ÙË˜ ‚·Ú‡ÙËÙ·˜ÙˆÓ ÎÏÈÓÈÎÒÓ ÂÎ‰ËÏÒÛÂˆÓ (16,17). Œ¯ÂÈ ·Ú·ÙËÚË-ıÂ› fiÙÈ fiÛÔ ÈÔ ÌÈÎÚfi Â›Ó·È ÙÔ ıÚ·‡ÛÌ·, ‰ËÏ·‰‹ ÌÂ-Á¿ÏÂ˜ ÂÏÏÂ›„ÂÈ˜, ÔÈ ÎÏÈÓÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ Û˘Ó‰¤ÔÓÙ·ÈÌÂ ‚·Ú‡ÙÂÚÔ Ê·ÈÓfiÙ˘Ô Î·È Û˘ÌÌÂÙÔ¯‹ ·fi ÙÔ ∫¡™(18). OÈ ·ÛıÂÓÂ›˜ ·˘ÙÔ› ÂÌÊ·Ó›˙Ô˘Ó Û˘Ó‹ıˆ˜ ÓÂ˘-Ì·ÙÈÎ‹ Î·ı˘ÛÙ¤ÚËÛË Î·È ÂÈÏË„›·.

∏ ‰È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË ÂÚÈÏ·Ì‚¿ÓÂÈ ÙË Û˘ÁÁÂÓ‹·ÁÂÓÂÛ›· ÙˆÓ ÚÔÛˆÈÎÒÓ ÓÂ‡ÚˆÓ, ÙË ÓˆÙÈ·›· Ì˘˚Î‹·ÙÚÔÊ›·, ÙËÓ ÔÏ˘Ì˘ÔÛ›ÙÈ‰·, ÙË ˙ˆÓÈ·›· Ì˘˚Î‹ ‰˘-ÛÙÚÔÊ›·, ÙË Ì˘˚Î‹ ‰˘ÛÙÚÔÊ›· Ù‡Ô˘ Becker, ÙÈ˜ ÌÈ-ÙÔ¯ÔÓ‰ÚÈ·Î¤˜ Ì˘Ô¿ıÂÈÂ˜, ÙÔ Û‡Ó‰ÚÔÌÔ MoebiusÎ·È ÙË Û˘ÁÁÂÓ‹ Ì˘ÔÙÔÓÈÎ‹ ‰˘ÛÙÚÔÊ›· (3,5). ∫·È ÛÙÈ˜‰‡Ô ÂÚÈÙÒÛÂÈ˜ Ô˘ ÂÚÈÁÚ¿ÊÔÓÙ·È, Ë ‰È¿ÁÓˆÛË‚·Û›ÛÙËÎÂ ÙfiÛÔ ÛÙ· ÎÏÈÓÈÎ¿ Â˘Ú‹Ì·Ù·, fiÛÔ Î·È ÛÙËÌÔÚÈ·Î‹ ·Ó¿Ï˘ÛË, fiÔ˘ ·ÓÈ¯ÓÂ‡ıËÎÂ ÙÔ ÌÈÎÚfiÙÂÚÔıÚ·‡ÛÌ· Ô˘ ·Ó·Ê¤ÚÂÙ·È ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· (7,5 kb).∞˘Ùfi Û˘ÌÊˆÓÂ› ÌÂ ÙË ‚·ÚÈ¿ ÎÏÈÓÈÎ‹ ÚÔ‚ÔÏ‹ Î·È ÙËÓÚÒÈÌË ¤Ó·ÚÍË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ (4,9,17,19,20).

∏ ËÏÈÎ›· ¤Ó·ÚÍË˜ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÔÈÎ›ÏÏÂÈ. ∏·‰˘Ó·Ì›· ÙˆÓ Ì˘ÒÓ Û˘Ó‹ıˆ˜ Á›ÓÂÙ·È ·ÓÙÈÏËÙ‹ Î·Ù¿

∂ÈÎfiÓÂ˜ 3 Î·È 4. ¢Â‡ÙÂÚË ÂÚ›ÙˆÛË. º·›ÓÔÓÙ·È Ù· ·ÎÔ˘ÛÙÈÎ¿ ‚·ÚËÎÔ˝·˜, Ë ·‰˘Ó·Ì›· ÙˆÓ Ì˘ÒÓ ÙÔ˘ ÚÔÛÒÔ˘ Î·È Ë ·Û‡ÌÌÂÙÚË ÙÂ-Ú˘ÁÔÂÈ‰‹˜ ˆÌÔÏ¿ÙË.

May-June 03 03-06-03 16:55 ™ÂÏ›‰·218


219

ÙÔ Ù¤ÏÔ˜ ÙË˜ ÚÒÙË˜ ‹ ÛÙË ‰Â‡ÙÂÚË ‰ÂÎ·ÂÙ›· ˙ˆ-‹˜. ™Â ÔÛÔÛÙfi 15% ÙˆÓ ÂÚÈÙÒÛÂˆÓ FSHªD, Ù·Û˘ÌÙÒÌ·Ù· ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙËÓ ÚÒÙË ÂÓÙ·ÂÙ›·Î·È Û˘Ó‹ıˆ˜ ·˘Ùfi ˘Ô‰ËÏÒÓÂÈ Î·ÈÓÔ‡ÚÈ· ÌÂÙ¿ÏÏ·-ÍË Î·È ‚·Ú‡ÙÂÚË ÓfiÛËÛË (4,5). ∏ ËÏÈÎ›· ¤Ó·ÚÍË˜ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÛÙËÓ ÚÒÙË ÂÚ›ÙˆÛË ‹Ù·ÓÚÈÓ ÙÔ˘˜ 20 Ì‹ÓÂ˜ ˙ˆ‹˜, ÂÓÒ ÛÙË ‰Â‡ÙÂÚË ÂÚ›-ÙˆÛË ‹Ù·Ó Ù· 3 ¯ÚfiÓÈ·. ∫·È Ù· ‰‡Ô ÂÚÈÛÙ·ÙÈÎ¿ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ Â›¯·Ó ÂÏÂ‡ıÂÚÔ ÔÈÎÔÁÂÓÂÈ·-Îfi ÈÛÙÔÚÈÎfi. ™Â ÔÈÎÔÁÂÓÂ›˜ ÂÚÈÙÒÛÂÈ˜, Ë ÓfiÛËÛËÊ·›ÓÂÙ·È Ó· Â›Ó·È ÂÏ·ÊÚ‡ÙÂÚË. ™Â ·È‰È¿ ÌÂ ÚÔ-ÛˆÈÎ‹ ‰ÈÏËÁ›· (·‰˘Ó·Ì›· Ó· ÛÊ˘Ú›ÍÔ˘Ó, ÂÍ·Ê¿-

ÓÈÛË ÚÈÓÔ¯ÂÈÏÈÎÒÓ ·˘Ï¿ÎˆÓ, ·‰˘Ó·Ì›· Û‡ÁÎÏÂÈÛË˜‚ÏÂÊ¿ÚˆÓ Î·È, ÁÂÓÈÎfiÙÂÚ·, ·‰˘Ó·Ì›· ¤ÎÊÚ·ÛË˜ÚÔÛÒÔ˘), Ú¤ÂÈ Ó· Û˘ÌÂÚÈÏ·Ì‚¿ÓÂÙ·È Î·È ÌÔ-ÚÈ·Î‹ ·Ó¿Ï˘ÛË DNA ÁÈ· FSHMD (5). ∆· Û˘ÌÙÒÌ·-Ù· ·Ú¯›˙Ô˘Ó Û˘Ó‹ıˆ˜ ÌÂ ·‰˘Ó·Ì›· Î·È ·ÙÚÔÊ›· ÙˆÓÌ˘ÒÓ ÙË˜ ˆÌÈÎ‹˜ ˙ÒÓË˜ Î·È ÙÔ˘ ÚÔÛÒÔ˘ Î·È ÌÔ-ÚÂ› Ó· ·ÎÔÏÔ˘ı‹ÛÂÈ Û˘ÌÌÂÙÔ¯‹ ÙˆÓ Ì˘ÒÓ ÙË˜ ˘Â-ÏÈÎ‹˜ ˙ÒÓË˜. ∞Ó, fiÌˆ˜, Ë ¤Ó·ÚÍË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓÁ›ÓÂÈ ·fi ÙÔ˘˜ Ì‡Â˜ ÙË˜ ˘ÂÏÈÎ‹˜ ˙ÒÓË˜, ı· Ú¤ÂÈÓ· ÙÂıÂ› ˘fi ·ÌÊÈÛ‚‹ÙËÛË Ë ‰È¿ÁÓˆÛË ÙË˜ FSHMD(2). ŸÙ·Ó ‰ÂÓ ·Ú·ÙËÚÂ›Ù·È ÚÔÛˆÈÎ‹ ‰ÈÏËÁ›·, Ë‰È¿ÁÓˆÛË Ù›ıÂÙ·È ÌfiÓÔ ·Ó ˘¿Ú¯Ô˘Ó Î·È ¿ÏÏ· ¿-Û¯ÔÓÙ· Ì¤ÏË ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ· Ô˘ ÂÌÊ·Ó›˙Ô˘Ó Û˘Ì-ÌÂÙÔ¯‹ ÙˆÓ Ì˘ÒÓ ÙÔ˘ ÚÔÛÒÔ˘ (4).

¢ÂÓ ÚÔÛ‚¿ÏÏÔÓÙ·È ÔÈ Ì·ÛËÙ‹ÚÂ˜, ÔÈ ÔÊı·ÏÌÔ-ÎÈÓËÙÈÎÔ›, ÔÈ ÁÏˆÛÛÈÎÔ› Î·È ÔÈ Ê·Ú˘ÁÁÈÎÔ› Ì‡Â˜. ∏·‰˘Ó·Ì›· ÙÔ˘ ÚÔÛÒÔ˘ ÌÔÚÂ› Ó· Â›Ó·È ÔÏ‡ ÂÏ·-ÊÚÈ¿ Î·È Ó· ·Ú·ÙËÚÂ›Ù·È ÌfiÓÔ Ì›· ÌÈÎÚ‹ ·Û˘ÌÌÂ-ÙÚ›· ÛÙËÓ ¤ÎÊÚ·ÛË. O ÈÔ ÛÔ‚·Ú¿ ÚÔÛ‚Â‚ÏËÌ¤-ÓÔ˜ Ì˘˜ Â›Ó·È Û˘Ó‹ıˆ˜ Ô ˆÌÔÏ·ÙÈ·›Ô˜, ÁÂÁÔÓfi˜Ô˘ Ô‰ËÁÂ› ÛÙÈ˜ ¯·Ú·ÎÙËÚÈÛÙÈÎ¤˜ ÙÂÚ˘ÁÔÂÈ‰Â›˜ˆÌÔÏ¿ÙÂ˜, Ô˘ ‹Ù·Ó ÂÌÊ·ÓÂ›˜ Î·È ÛÙ· ‰‡Ô ÂÚÈ-ÛÙ·ÙÈÎ¿ ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜. ∞ÎÔÏÔ˘ıÔ‡Ó, ÛÂÛÂÈÚ¿ ÚÔÛ‚ÔÏ‹˜, Ô ÌÂ›˙ˆÓ ıˆÚ·ÎÈÎfi˜ Î·È Ô ‰ÂÏ-ÙÔÂÈ‰‹˜ (2,5). ∏ ·Û˘ÌÌÂÙÚ›· ÚÔÛ‚ÔÏ‹˜ ÙˆÓ Ì˘ÒÓÙË˜ ˆÌÈÎ‹˜ ˙ÒÓË˜ Â›Ó·È Î·ÓfiÓ·˜ Î·È Û˘Ó‹ıˆ˜ ÚÔ-Û‚¿ÏÏÂÙ·È ÚÒÙ· ÙÔ ‰ÂÍÈfi ÙÌ‹Ì·. ™˘¯Ó¿ ·Ú·ÙË-ÚÂ›Ù·È ·Û˘ÌÌÂÙÚ›· Î·È ÛÙËÓ ÚÔÛ‚ÔÏ‹ ÙˆÓ Ì˘ÒÓÙÔ˘ ÚÔÛÒÔ˘. ∏ Û˘ÌÌÂÙÚÈÎ‹ ·‰˘Ó·Ì›· Î·È ·ÙÚÔ-Ê›· ÛÙËÓ ¤Ó·ÚÍË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Â›Ó·È ·Û˘Ó‹ıË˜Î·È ··ÈÙÂ›Ù·È ÌÂÁ¿ÏË ÚÔÛÔ¯‹ ÚÈÓ ÙÂıÂ› Ë ‰È¿-ÁÓˆÛË ÙË˜ FSHMD (4).

∏ ÓfiÛÔ˜ ¤¯ÂÈ ·Ó·fiÊÂ˘ÎÙ· ÂÍÂÏÈÎÙÈÎfi ¯·Ú·ÎÙ‹-Ú·, ÌÂ Ú˘ıÌfi Ô˘ ÔÈÎ›ÏÏÂÈ Î·È Â›Ó·È ·ÓÙÈÛÙÚfiÊˆ˜·Ó¿ÏÔÁÔ˜ ÙË˜ ËÏÈÎ›·˜ ¤Ó·ÚÍË˜ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ.™¿ÓÈ·, ÌÔÚÂ› Ó· ·Ú·ÙËÚËıÔ‡Ó ÂÚ›Ô‰ÔÈ ÛÙ·ÛÈ-ÌfiÙËÙ·˜. ∫·Ù¿ ÙËÓ ÂÍ¤ÏÈÍË ÙË˜ ÓfiÛÔ˘ ÚÔÛ‚¿ÏÏÔ-ÓÙ·È ÔÈ ÎÔÈÏÈ·ÎÔ› Î·È ÔÈ ÂÎÙÂ›ÓÔÓÙÂ˜ ÙÔÓ ¿ÎÚÔ fi‰·Ì‡Â˜ (2). ∞‰˘Ó·Ì›· ÙˆÓ Ì˘ÒÓ ÙË˜ ˘¤ÏÔ˘ Î·È ÙˆÓ¿Óˆ ¿ÎÚˆÓ ÌÔÚÂ› Ó· Û˘Ì‚Â› ÛÂ ÔÔÈ·‰‹ÔÙÂ ÛÙÈÁ-Ì‹, ÌÂÙ¿ ÙËÓ ÂÌÊ¿ÓÈÛË ÙË˜ ·‰˘Ó·Ì›·˜ ÙˆÓ Ì˘ÒÓÙË˜ ˆÌÈÎ‹˜ ˙ÒÓË˜.

™˘Û¿ÛÂÈ˜ Î·È „Â˘‰Ô¸ÂÚÙÚÔÊ›· ÙˆÓ Ì˘ÒÓ ÙË˜Á·ÛÙÚÔÎÓËÌ›·˜ ÌÔÚÂ› Ó· ·Ú·ÙËÚËıÔ‡Ó, ÂÓÒ ÛÔ-‚·Ú¤˜ Î·È ÁÂÓÈÎÂ˘Ì¤ÓÂ˜ Û˘ÁÎ¿Ì„ÂÈ˜ ·ÔÎÏÂ›Ô˘Ó ÙË‰È¿ÁÓˆÛË. ∏ „Â˘‰Ô¸ÂÚÙÚÔÊ›· Ô˘ ·Ú·ÙËÚ‹ıË-ÎÂ ÛÙÔÓ ‰Â‡ÙÂÚÔ ·ÛıÂÓ‹ ÙË˜ ÌÂÏ¤ÙË˜, ˘Ô‰ËÏÒÓÂÈfiÙÈ ·˘Ùfi Â›Ó·È Û‡ÓËıÂ˜, È‰›ˆ˜ fiÙ·Ó Ë FSHMD ·Ú¯›-˙ÂÈ ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›· Î·È ‰ÂÓ Ú¤ÂÈ Ó· Û˘Á¯¤ÂÙ·ÈÌÂ ÙË Ì˘˚Î‹ ‰˘ÛÙÚÔÊ›· Ù‡Ô˘ Becker (21).

°ÂÓÈÎÒ˜, Ë FSHMD ‰ÂÓ ÚÔÛ‚¿ÏÏÂÈ ÙÔÓ Î·Ú‰È·ÎfiÌ˘. ª˘ÔÎ·Ú‰ÈÔ¿ıÂÈ· ‰ÂÓ ·Ó·Ê¤ÚÂÙ·È ÛÂ Î·Ì›· ÌÂ-Ï¤ÙË fiÔ˘ Á›ÓÂÙ·È Û˘Û¯¤ÙÈÛË Ê·ÈÓfiÙ˘Ô˘-ÁÔÓfiÙ˘Ô˘Î·È ‰ÂÓ Ê·›ÓÂÙ·È Ó· ·Ó‹ÎÂÈ ÛÙ· ÎÏÈÓÈÎ¿ ÎÚÈÙ‹ÚÈ· ÙË˜

∂ÈÎfiÓ· 5. ∞Ó›¯ÓÂ˘ÛË: ·) ıÚ·‡ÛÌ·ÙÔ˜ ÂÚ›Ô˘ 10 kb ÌÂÙ¿ ·fiÂÒ·ÛË ÌÂ ÙÔ ¤Ó˙˘ÌÔ ∂coRI (∂) Î·È ‚) ıÚ·‡ÛÌ·ÙÔ˜ ÂÚ›Ô˘ 7kb ÌÂÙ¿ ·fi ‰ÈÏ‹ ÂÒ·ÛË ÌÂ Ù· ¤Ó˙˘Ì· ∂coRI/AvrII (E/A) ÛÙÔÚÒÙÔ ÂÚÈÛÙ·ÙÈÎfi. ∫Ï›Ì·Î· ÌÂÁ¤ıÔ˘˜ 1:1 kb ladder (BRL), ÎÏ›-Ì·Î· ÌÂÁ¤ıÔ˘˜ 2:Ï Cut mix (Biolabs).

6 kb

7 kb

8 kb

9 kb

10 kb

11 kb

12 kb

48,5 kb∫Ï›

Ì·Î·

ÌÂ

Á¤ıÔ

˘˜ 1

∫Ï›

Ì·Î·

ÌÂ

Á¤ıÔ

˘˜ 2

∂ ∂/∞

38,4 kb

33,5 kb

29,9 kb

24 kb

17 kb

15 kb

10 kb

May-June 03 03-06-03 16:55 ™ÂÏ›‰·219


220

ÓfiÛÔ˘. ™Â ÌÈÎÚfi ÔÛÔÛÙfi (5%) ÌÔÚÂ› Ó· ÚÔÎÏË-ıÔ‡Ó ‰È·Ù·Ú·¯¤˜ ·ÁˆÁÈÌfiÙËÙ·˜ ‹ ·ÚÚ˘ıÌ›Â˜ (22).¢ÂÓ ˘¿Ú¯ÂÈ Û˘Û¯¤ÙÈÛË ÌÂÙ·Í‡ ÙË˜ ‚·Ú‡ÙËÙ·˜ ÙË˜Ì˘˚Î‹˜ ·‰˘Ó·Ì›·˜ Î·È ÙË˜ ÚÔÛ‚ÔÏ‹˜ ÙÔ˘ Î·Ú‰È·-ÎÔ‡ Ì˘fi˜. ¶·Ú’ fiÏ· ·˘Ù¿, Û˘ÓÈÛÙ¿Ù·È ÂÙ‹ÛÈ· ·Ú·-ÎÔÏÔ‡ıËÛË ÙˆÓ ·ÛıÂÓÒÓ ÌÂ ∏∫°. ∫·È ÔÈ ‰‡Ô ·ÛıÂ-ÓÂ›˜ ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ ‰ÂÓ Â›¯·Ó Â˘Ú‹Ì·Ù··fi ÙÔ Î˘ÎÏÔÊÔÚÈÎfi.

¶·Ú·ÙËÚÂ›Ù·È ‚·ÚËÎÔ˝· ÓÂ˘ÚÔ·ÈÛıËÙËÚÈ·ÎÔ‡Ù‡Ô˘, Ë ÔÔ›· ÌÔÚÂ› Ó· ÂÂÎÙ·ıÂ› ÛÂ fiÏÂ˜ ÙÈ˜ Û˘-¯ÓfiÙËÙÂ˜ Î·È Â›Ó·È ÂÍÂÏÈÎÙÈÎ‹. ŸÛÔÓ ·ÊÔÚ¿ ÛÙË ‰È¿-ÁÓˆÛË ÙË˜ ‚·ÚËÎÔ˝·˜, Ë ÔÔ›· ÌÔÚÂ› Ó· ÂÎÏËÊıÂ›Ï·Óı·ÛÌ¤Ó· ˆ˜ ¯·ÌËÏfi ÓÔËÙÈÎfi Â›Â‰Ô, ˘¿Ú¯ÂÈÎ·ı˘ÛÙ¤ÚËÛË, fiˆ˜ Ê¿ÓËÎÂ Î·È ÛÙË ‰Â‡ÙÂÚË ÂÚ›-ÙˆÛË. ∞ÎÔÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÛÂÎ¿ıÂ ÂÚ›ÙˆÛË FSHMD Ô˘ ‰È·ÁÈÁÓÒÛÎÂÙ·È ÛÙËÓÚÒÙË ·È‰ÈÎ‹ ËÏÈÎ›· (5). OÈ Brouwer Î·È Û˘Ó ·Ó·-Ê¤ÚÔ˘Ó fiÙÈ ‚·ÚËÎÔ˝·, È‰›ˆ˜ ÛÙÈ˜ ˘„ËÏ¤˜ Û˘¯ÓfiÙË-ÙÂ˜, ·Ú·ÙËÚÂ›Ù·È Û¯Â‰fiÓ ÛÂ fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓÂ›˜ÌÂ FSHMD (23). ¶ÚfiÛÊ·ÙË ‚È‚ÏÈÔÁÚ·Ê›· ˘ÔÛÙË-Ú›˙ÂÈ fiÙÈ Ë Û˘¯ÓfiÙËÙ· ÙË˜ ‚·ÚËÎÔ˝·˜ ÛÂ ÂÚÈÙÒ-ÛÂÈ˜ FSHMD ÌÂ ¤Ó·ÚÍË ÛÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹ ‰ÂÓ Â›Ó·ÈÛ˘¯ÓfiÙÂÚË ·fi ÂÎÂ›ÓË ÛÙÔÓ ÁÂÓÈÎfi ÏËı˘ÛÌfi. ∏ ËÏÈ-Î›· ¤Ó·ÚÍË˜, Ë ‰È¿ÚÎÂÈ· Î·È Ë ‚·Ú‡ÙËÙ· ÙË˜ ÓfiÛÔ˘,Ô ‚·ıÌfi˜ ÙË˜ Ì˘˚Î‹˜ ·‰˘Ó·Ì›·˜ ÙÔ˘ ÚÔÛÒÔ˘, ·Ï-Ï¿ Î·È ÙÔ Ì¤ÁÂıÔ˜ ÙÔ˘ ıÚ·‡ÛÌ·ÙÔ˜ ‰ÂÓ ‚Ú¤ıËÎÂ Ó·Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÙÔÓ ‚·ıÌfi ÙË˜ ‚·ÚËÎÔ˝·˜ (24).

∞ÌÊÈ‚ÏËÛÙÚÔÂÈ‰ÈÎ‹ ·ÁÁÂÈÔ¿ıÂÈ· ÌÂ ÙÚÈ¯ÔÂÈ‰ÈÎ‹ÙËÏÂ·ÁÁÂÈÂÎÙ·Û›·, ÌÈÎÚÔ·ÓÂ˘Ú‡ÛÌ·Ù· Î·È ·ÔÊÚ¿-ÍÂÈ˜ ÙÚÈ¯ÔÂÈ‰ÒÓ ·ÁÁÂ›ˆÓ (ÓfiÛÔ˜ Coats) ¤¯Ô˘Ó ÂÚÈ-ÁÚ·ÊÂ› ÛÙËÓ FSHMD (25). OÈ Shapiro Î·È Û˘Ó ·Ó·-Ê¤ÚÔ˘Ó fiÙÈ ÔÊı·ÏÌÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ì·˙› ÌÂ ÎÏÈÓÈ-Î‹ ÂÎÙ›ÌËÛË ÛÙ· ˘fiÏÔÈ· Ì¤ÏË ÙË˜ ÔÈÎÔÁ¤ÓÂÈ·˜ ı·ÌÔÚÔ‡ÛÂ Ó· Â›Ó·È ¯Ú‹ÛÈÌ· ˆ˜ ÚÔ˜ ÙË ÁÂÓÂÙÈÎ‹Î·ıÔ‰‹ÁËÛË (26). ∂ÂÈ‰‹ Ë ÓfiÛÔ˜ Coats ÌÔÚÂ› Ó·ÂÌÊ·ÓÈÛÙÂ› ÛÂ ÔÔÈ·‰‹ÔÙÂ ËÏÈÎ›·, ÎÚ›ÓÂÙ·È ··-Ú·›ÙËÙË Ë ·Ú·ÎÔÏÔ‡ıËÛË ÌÂ ‚˘ıÔÛÎfiËÛË. ∏ÚÒÈÌË ‰È¿ÁÓˆÛ‹ ÙË˜ ÌÔÚÂ› ÛÙ· ·Ú¯fiÌÂÓ· ÛÙ¿‰È·Ó· Î·ı˘ÛÙÂÚ‹ÛÂÈ ÙËÓ ÂÍ¤ÏÈÍË ÙË˜ ÓfiÛÔ˘, ÌÂ ÎÚ˘Ô-ËÍ›· Î·È ÊˆÙÔËÍ›· ÙˆÓ ‰ÈÂ˘Ú˘ÛÌ¤ÓˆÓ ·ÁÁÂ›ˆÓ.∂ÂÈ‰‹ Ù· Â˘Ú‹Ì·Ù· ·fi ÙËÓ ·ÎÔ‹ Î·È ÙËÓ fiÚ·ÛË‰ÂÓ Â›Ó·È ÛÙ·ıÂÚ¿, ‰ÂÓ ÌÔÚÔ‡Ó Ó· ¯ÚËÛÈÌÔÔÈË-ıÔ‡Ó ÁÈ· ÚÔÛ˘ÌÙˆÌ·ÙÈÎfi ¤ÏÂÁ¯Ô, È‰›ˆ˜ Â› ·Ô˘-Û›·˜ Ì˘˚Î‹˜ ·‰˘Ó·Ì›·˜ (9).

™ÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ FSHMD, ÁÂÓÈÎ¿, Ë Û˘¯ÓfiÙËÙ·ÙË˜ ÓÂ˘Ì·ÙÈÎ‹˜ Î·ı˘ÛÙ¤ÚËÛË˜ Â›Ó·È ÂÚ›Ô˘ 2% Î·ÈÛ¿ÓÈ· Û˘ÓÔ‰Â‡ÂÙ·È ·fi ÂÈÏË„›· (18,27,28). ™ÙÔ˘˜¿Û¯ÔÓÙÂ˜, fiÌˆ˜, ÌÂ ÚÒÈÌË ¤Ó·ÚÍË ÙˆÓ Û˘ÌÙˆÌ¿-ÙˆÓ, Ë Û˘¯ÓfiÙËÙ· ÙË˜ ÓÂ˘Ì·ÙÈÎ‹˜ Î·ı˘ÛÙ¤ÚËÛË˜·Ó¤Ú¯ÂÙ·È ÛÙÔ 20%. ™ÙÔ ÔÛÔÛÙfi ·˘Ùfi ÂÚÈÏ·Ì‚¿ÓÔ-ÓÙ·È Î·È ÔÈ ‰‡Ô ÂÚÈÙÒÛÂÈ˜ Ô˘ ÂÚÈÁÚ¿ÊÔÓÙ·È.∂ÂÈÛfi‰È· Û·ÛÌÒÓ ‰ÂÓ ¤¯Ô˘Ó Ì¤¯ÚÈ ÙÒÚ· ·Ú·ÙË-ÚËıÂ› ÛÙÔ˘˜ ‰‡Ô ·ÛıÂÓÂ›˜ ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜.

∞fi ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô, Ù· Â›Â‰· ÙË˜CPK Î˘Ì·›ÓÔÓÙ·È ·fi Ê˘ÛÈÔÏÔÁÈÎ¿ ¤ˆ˜ ·˘ÍËÌ¤Ó·.¶·Ú’ fiÏ· ·˘Ù¿, Û¿ÓÈ· ÊÙ¿ÓÔ˘Ó ÙÔ ÂÓÙ·Ï¿ÛÈÔÙË˜ Ê˘ÛÈÔÏÔÁÈÎ‹˜ ÙÈÌ‹˜. ™Â ·˘Ù‹ ÙËÓ ÂÚ›ÙˆÛË,Ú¤ÂÈ Ó· ·ÔÎÏÂÈÛÙÔ‡Ó ¿ÏÏ· ÓÂ˘ÚÔÌ˘˚Î¿ ÓÔÛ‹Ì·-Ù·. ∏ Ì¤ÙÚËÛË ÙË˜ CPK Â›Ó·È ÂÚÈÔÚÈÛÌ¤ÓË Û·ÓÚÔÛ˘ÌÙˆÌ·ÙÈÎfi test. ™˘Ó‹ıˆ˜ ‰ÂÓ ˘¿Ú¯ÂÈ Û˘-Û¯¤ÙÈÛË ÌÂ ÙË ÛÔ‚·ÚfiÙËÙ· ÙË˜ ÓfiÛÔ˘ Î·È Ë ÙÈÌ‹ ÙË˜ÌÂÈÒÓÂÙ·È ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ ÙËÓ ¿ÚÔ‰Ô ÙË˜ ËÏÈ-Î›·˜ (2).

∆Ô ∏ª° Û˘¯Ó¿ ‰Â›¯ÓÂÈ ÌÈÎÚ‹˜ ‰È¿ÚÎÂÈ·˜ Î·È ¯·-ÌËÏÔ‡ Â‡ÚÔ˘˜ ÔÏ˘Ê·ÛÈÎ¿ ‰˘Ó·ÌÈÎ¿. ∏ ÎÈÓËÙÈÎ‹Î·È Ë ·ÈÛıËÙÈÎ‹ ·ÁˆÁÈÌfiÙËÙ· ÙˆÓ ÓÂ‡ÚˆÓ Â›Ó·È Ê˘-ÛÈÔÏÔÁÈÎ‹ (2). ∆Ô ∏ª° Î·È ÛÙ· ‰‡Ô ·È‰È¿ ÙË˜ ÌÂÏ¤-ÙË˜ ‹Ù·Ó ·ıÔÏÔÁÈÎfi.

∏ ‚ÈÔ„›· Ì˘fi˜ Â›Ó·È ÂÈ‚Â‚ÏËÌ¤ÓË, ·ÏÏ¿ ˘¿Ú-¯ÂÈ ÌÂÁ¿ÏË ÔÈÎÈÏÔÌÔÚÊ›· ÌÂ Â˘Ú‹Ì·Ù· Û˘¯Ó¿ ÌËÂÈ‰ÈÎ¿, Û˘Ó‹ıˆ˜ Ì˘Ô·ıËÙÈÎÔ‡ Ù‡Ô˘. ¶·Ú·ÙËÚÂ›-Ù·È ÌÂÁ¿ÏË ‰È·ÊÔÚÔÔ›ËÛË ÛÙÔ Ì¤ÁÂıÔ˜ ÙˆÓ Ì˘˚-ÎÒÓ ÈÓÒÓ, ÌÂ ÂÓ‰ÔÎ‡ÙÙˆÛË ÙˆÓ ˘Ú‹ÓˆÓ Î·È ÊÏÂÁ-ÌÔÓÒ‰Ë ·ÓÙ›‰Ú·ÛË ÂÓ‰ÂÈÎÙÈÎ‹ Ì˘Ô¿ıÂÈ·˜. ºÏÂÁ-ÌÔÓÒ‰Ë ÌÔÓÔ˘ÚËÓÈÎ¿ Î‡ÙÙ·Ú· ‰È·ÈÛÙÒÓÔÓÙ·È ÛÂ·È‰È¿ ËÏÈÎ›·˜ <2 ¯ÚfiÓˆÓ (2). ∞ÓÂ˘Ú›ÛÎÔÓÙ·È ÔÏ-Ï¤˜ ˘ÂÚÙÚÔÊÈÎ¤˜, fiˆ˜ Î·È ·ÙÚÔÊÈÎ¤˜, ÌÈÎÚ¤˜,ÁˆÓÈÒ‰ÂÈ˜ Ì˘˚Î¤˜ ›ÓÂ˜ Ô˘ ‰ËÌÈÔ˘ÚÁÔ‡Ó Û‡Á¯˘ÛËÌÂ ‚Ï¿‚Ë ÓÂ˘ÚÔÁÂÓÔ‡˜ Ù‡Ô˘. À¿Ú¯Ô˘Ó ·Ó·ÊÔ-Ú¤˜ ·ÛıÂÓÒÓ ÌÂ ÓˆÙÈ·›· Ì˘˚Î‹ ·ÙÚÔÊ›· Ù‡Ô˘FSHªD, Ë ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· ÙˆÓ ÔÔ›ˆÓ ÔÌÔÈ¿˙ÂÈ ÙfiÛÔÌÂ ÙËÓ ÂÈÎfiÓ· ÙˆÓ ·Û¯fiÓÙˆÓ ÌÂ FSHMD, Ô˘ ‰Ë-ÌÈÔ˘ÚÁÂ› ·ÌÊÈ‚ÔÏ›· ÁÈ· ÙÔ ·Ó ÔÈ ‰‡Ô ÔÓÙfiÙËÙÂ˜ Â›Ó·È‰È·ÊÔÚÂÙÈÎ¤˜. ¶ÚfiÛÊ·Ù· ‰Â‰ÔÌ¤Ó· ¤‰ÂÈÍ·Ó fiÙÈ ·-Ú·ÙËÚÂ›Ù·È ÛˆÌ·ÙÈÎfi˜ ÌˆÛ·˚ÎÈÛÌfi˜ ÛÙÔ 40% ÙˆÓÂÚÈÙÒÛÂˆÓ, Â›ÙÂ ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ Â›ÙÂ ÛÙÔ˘˜ ·Û˘-ÌÙˆÌ·ÙÈÎÔ‡˜ ÁÔÓÂ›˜ (29).

ŸÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÚfiÁÓˆÛË ÙˆÓ ·ÛıÂÓÒÓ, Ô-ÛÔÛÙfi 10-20% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÂÌÊ·Ó›˙ÂÈ ·‰˘Ó·-Ì›· ‚¿‰ÈÛË˜ ÛÂ ËÏÈÎ›· ÂÚ›Ô˘ 40 ÂÙÒÓ Î·È Î·Ù·Ï‹-ÁÂÈ ÛÂ ·Ó·ËÚÈÎ‹ Î·Ú¤ÎÏ·. ¶ÚÔÛ˘ÌÙˆÌ·ÙÈÎ¤˜ Â-ÚÈÙÒÛÂÈ˜ ÌÔÚÂ› Ó· ‰È·ÁÓˆÛÙÔ‡Ó ÛÂ ÔÔÈ·‰‹ÔÙÂËÏÈÎ›· Î·È ·ÔÙÂÏÔ‡Ó ÙÔ 30% ÙˆÓ ÔÈÎÔÁÂÓÒÓ ÂÚÈ-ÙÒÛÂˆÓ (2,4,5,17). º·›ÓÂÙ·È fiÙÈ Ë ‚·Ú‡ÙËÙ· ÙË˜ÓfiÛÔ˘ ÛÙÔ˘˜ ·ÔÁfiÓÔ˘˜ Â›Ó·È ÙÔ˘Ï¿¯ÈÛÙÔÓ ·Úfi-ÌÔÈ· ÌÂ ÙÔÓ ¿Û¯ÔÓÙ· ÁÔÓ¤·. ¢ÂÓ ¤¯ÂÈ ‰ÈÂ˘ÎÚÈÓÈÛÙÂ›·Ó ÛÙÔ ÓfiÛËÌ· ·Ú·ÙËÚÂ›Ù·È ÙÔ Ê·ÈÓfiÌÂÓÔ ÙË˜“Â›ÛÂ˘ÛË˜ ‹ ÚÒÈÌË˜ ¤ÎÊÚ·ÛË˜” ÛÂ Î¿ıÂ ÂfiÌÂ-ÓË ÁÂÓÈ¿ (30).

¶·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÁÂÓÈÎ¿ ‰ÂÓ Ê·›ÓÂÙ·È Ó·ÂËÚÂ¿˙ÔÓÙ·È Ë ÂÈ‚›ˆÛË Î·È Ë ·Ó··Ú·ÁˆÁ‹ (2,3),ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· ·Ó·Ê¤ÚÂÙ·È ı·Ó·ÙËÊfiÚ· ¤Î‚·ÛËÛÂ ‰‡Ô ÔÈÎÔÁ¤ÓÂÈÂ˜ ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›· ÔÊÂÈÏfiÌÂÓËÛÙËÓ FSHMD (31,32).

Ÿˆ˜ Î·È ÛÂ ¿ÏÏÔ˘˜ Ù‡Ô˘˜ Ì˘˚Î‹˜ ‰˘ÛÙÚÔ-Ê›·˜, ‰ÂÓ ˘¿Ú¯ÂÈ ÂÈ‰ÈÎ‹ ıÂÚ·Â›·. ™˘ÓÈÛÙ¿Ù·È

May-June 03 03-06-03 16:55 ™ÂÏ›‰·220


221

¿ÛÎËÛË ¯ˆÚ›˜ ˘ÂÚ‚ÔÏ‹ Î·È, ÂÈ‰ÈÎfiÙÂÚ·, ·ÔÊ˘Á‹·ÛÎ‹ÛÂˆÓ ÙÔ˘ Ù‡Ô˘ body building (2).

™‹ÌÂÚ· ˘¿Ú¯ÂÈ ‰˘Ó·ÙfiÙËÙ· ÚÔÛ˘ÌÙˆÌ·ÙÈ-ÎÔ‡ ÂÏ¤Á¯Ô˘. ∏ Southern blot ·Ó¿Ï˘ÛË, ¯ÚËÛÈÌÔ-ÔÈÒÓÙ·˜ ÙÔÓ ·ÓÈ¯ÓÂ˘Ù‹ p13-11, ‰ËÌÈÔ‡ÚÁËÛÂ ¤Ó·Ó·ÍÈfiÏÔÁÔ ÌÔÚÈ·Îfi ¤ÏÂÁ¯Ô ÁÈ· ÙË ‰È¿ÁÓˆÛË ÙË˜FSHMD. ™ÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ ıÚ·‡ÛÌ· ÌÈÎÚfiÙÂÚÔ·fi 35 kb, ·˘Ùfi˜ Ô ¤ÏÂÁ¯Ô˜ ¤¯ÂÈ Â˘·ÈÛıËÛ›· ÂÚ›-Ô˘ 95%, ÂÓÒ Ë ÂÍÂÈ‰›ÎÂ˘ÛË ÏËÛÈ¿˙ÂÈ ÙÔ 100%(19). Œ¯ÂÈ ‚ÔËı‹ÛÂÈ ÛÙË ÁÂÓÂÙÈÎ‹ Î·ıÔ‰‹ÁËÛË ÙˆÓÔÈÎÔÁÂÓÂÈÒÓ Î·È ÛÙËÓ ·Ó·ÎÔ‡ÊÈÛË ÙˆÓ ·Û¯fiÓÙˆÓÌÂÙ¿ ·fi ¯ÚfiÓÈ· ·ÌÊ›‚ÔÏË˜ ‰È¿ÁÓˆÛË˜. ¶ÚÔÁÂÓÓË-ÙÈÎ‹ ‰È¿ÁÓˆÛË Á›ÓÂÙ·È ÛÂ ÔÈÎÔÁ¤ÓÂÈÂ˜ ÌÂ ÔÈÎÔÁÂÓÂÈ-·Îfi ÈÛÙÔÚÈÎfi FSHMD, ·Ú¿ ÙÈ˜ ·ÓÙÈÌÂÙˆÈ˙fiÌÂÓÂ˜Ú·ÎÙÈÎ¤˜ ‰˘ÛÎÔÏ›Â˜ (33). ªÂ È‰È·›ÙÂÚÔ ÂÓ‰È·Ê¤ÚÔÓ·Ó·Ì¤ÓÔÓÙ·È Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ·fi ÙËÓ ÚÔÛ¿ıÂÈ··ÔÌfiÓˆÛË˜ Î·È ÎÏˆÓÔÔ›ËÛË˜ ÙÔ˘ ÁÔÓÈ‰›Ô˘ ÙË˜FSHMD Î·È ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙË˜ ‰Ú¿ÛË˜ ÙÔ˘. ∞˘-Ùfi ı· ‚ÔËı‹ÛÂÈ ÛÙËÓ Î·Ï‡ÙÂÚË Î·Ù·ÓfiËÛË ÙÔ˘ ·-ıÔÁÂÓÂÙÈÎÔ‡ ÌË¯·ÓÈÛÌÔ‡ ÙË˜ ÓfiÛÔ˘ Î·È ı· ÂÓÈÛ¯‡-ÛÂÈ ÙËÓ ·ÍÈÔÈÛÙ›· ÙË˜ ÌÔÚÈ·Î‹˜ ‰È¿ÁÓˆÛË˜ (9).

µÈ‚ÏÈÔÁÚ·Ê›· 1. Tawil R, Storvick D, Feasby TE, Weiffenbach B, Griggs RC.

Extreme variability of expression in monozygotic twins withFSH muscular dystrophy. Neurology 1993;43:345-348.

2. Lunt PW, Harper PS. Genetic counselling infacioscapulohumeral muscular dystrophy. J Med Genet1991;28:655-664.

3. Eggers S, Zatz M. How the magnitude of clinical severityand recurrence risk affects reproductive decisions in adultmales with different forms of progressive musculardystrophy. J Med Genet 1998;35:189-195.

4. Padberg GW, Lunt PW, Koch M, Fardeau M. Diagnosticcriteria for facioscapulohumeral muscular dystrophy.Neuromuscul Disord 1991;1:231-234.

5. Jardine PE, Koch MC, Lunt PW, Maynard J, Bathke KD,Harper PS et al. De novo facioscapulohumeral musculardystrophy defined by DNA probe p13E-11(D4F104S1). ArchDis Child 1994;71:221-227.

6. Wijmenga C, Frants RR, Brouwer OF, Moerer P, Weber JL,Padberg GW. Location of facioscapulohumeral musculardystrophy gene on chromosome 4. Lancet 1990;336:651-653.

7. Upadhyaya M, Lunt PW, Sarfarazi M, Broadhead W, DanielsJ, Owen M et al. DNA marker applicable to presymptomaticand prenatal diagnosis of facioscapulohumeral disease.Lancet 1990;336:1320-1321.

8. Wijmenga C, Padberg GW, Moerer P, Wiegant J, Liem L,Brouwer OF et al. Mapping of facioscapulohumeralmuscular dystrophy gene to chromosome 4q35-qter bymultipoint linkage analysis and in situ hybridization.Genomics 1991;9:570-575.

9. Upadhyaya M, Lunt PW, Sarfarazi M, Broadhead W, DanielsJ, Owen M et al. A closely linked DNA marker forfacioscapulohumeral disease on chromosome 4q. J Med

Genet 1991;28:665-671. 10. Padberg GW, Frants RR, Brouwer OF, Wijmenga C, Bakker

E, Sandkuijl LA. Facioscapulohumeral muscular dystrophyin the Dutch population. Muscle Nerve 1995;2:S81-S84.

11. Ding H, Beckers MC, Plaisance S, Marynen P, Collen D,Belayew A. Characterization of a double homeodomainprotein (DUX1) encoded by a cDNA homologous to 3.3 kbdispersed repeated elements. Hum Mol Genet1998;7:1681-1694.

12. van Deutekom JC, Lemmers RJ, Grewal PK, van Geel M,Romberg S, Dauwerse HG et al. Identification of the firstgene (FRG1) from the FSHD region on humanchromosome 4q35. Hum Mol Genet 1996;5:581-590.

13. Lemmers RJ, van der Maarel SM, van Deutekom JC, vander Wielen MJ, Deidda G, Dauwerse HG et al. Inter- andintrachromosomal sub-telomeric rearrangements on 4q35:implications for facioscapulohumeral muscular dystrophy(FSHD) aetiology and diagnosis. Hum Mol Genet1998;7:1207-1214.

14. Sarfarazi M, Wijmenga C, Upadhyaya M, Weiffenbach B,Hyser C, Mathews K et al. Regional mapping offacioscapulohumeral muscular dystrophy gene on 4q35:combined analysis of an international consortium. Am JHum Genet 1992;51:396-403.

15. Bakker E, Van der Wielen MJ, Voorhoeve E, Ippel PF,Padberg GW, Frants RR et al. Diagnostic, predictive, andprenatal testing for facioscapulohumeral musculardystrophy: diagnostic approach for sporadic and familialcases. J Med Genet 1996;33:29-35.

16. Ricci E, Galluzzi G, Deidda G, Cacurri S, Colantoni L, MericoB et al. Progress in the molecular diagnosis offacioscapulohumeral muscular dystrophy and correlationbetween the number of KpnI repeats at the 4q35 locus andclinical phenotype. Ann Neurol 1999;45:751-757.

17. Lunt PW, Jardine PE, Koch MC, Maynard J, Osborn M,Williams M et al. Correlation between fragment size atD4F104S1 and age at onset or at wheelchair use, with apossible generational effect, accounts for much phenotypicvariation in 4q35-facioscapulohumeral muscular dystrophy(FSHD). Hum Mol Genet 1995;4:951-958.

18. Funakoshi M, Goto K, Arahata K. Epilepsy and mentalretardation in a subset of early onset 4q35-facioscapulohumeral muscular dystrophy. Neurology1998;50:1791-1794.

19. Upadhyaya M, Maynard J, Rogers MT, Lunt PW, Jardine P,Ravine D et al. Improved molecular diagnosis offacioscapulohumeral muscular dystrophy (FSHD):validation of the differential double digestion for FSHD. JMed Genet 1997;34:476-479.

20. Van Deutekom JC, Wijmenga C, van Tienhoven EA, GruterAM, Hewitt JE, Padberg GW et al. FSHD associated DNArearrangements are due to deletions of integral copies of a3.2 kb tandemly repeated unit. Hum Mol Genet1993;2:2037-2042.

21. Reardon W, Temple IK, Harwood G, Baraitser M. Atypicalfacioscapulohumeral muscular dystrophy - a counsellingdilemma. Clin Genet 1991;39:172-177.

22. Laforet P, de Toma C, Eymard B, Becane HM, Jeanpierre M,

May-June 03 03-06-03 16:55 ™ÂÏ›‰·221


222

Fardeau M et al. Cardiac involvement in geneticallyconfirmed facioscapulohumeral muscular dystrophy.Neurology 1998;51:1454-1456.

23. Brouwer OF, Padberg GW, Ruys CJ, Brand R, de Laat JA,Grote JJ. Hearing loss in facioscapulohumeral musculardystrophy. Neurology 1991;41:1878-1881.

24. Rogers MT, Zhao F, Harper PS, Stephens D. Absence ofhearing impairment in adult onset facioscapulohumeralmuscular dystrophy. Neuromuscul Disord 2002;12:358-365.

25. Desai UR, Sabates FN. Long-term follow-up offacioscapulohumeral muscular dystrophy and Coat’sdisease. Am J Ophthalmol 1990;110:568-569.

26. Shapiro F, Specht L, Korf BR. Locomotor problems ininfantile facioscapulohumeral muscular dystrophy.Retrospective study of 9 patients. Acta Orthop Scand1991;62:367-371.

27. Funakoshi M, Goto K, Arahata K. Epilepsy and mentalretardation in a subset of early onset 4q35-facioscapulohumeral muscular dystrophy. Neurology1998;50:1791-1794.

28. Miura K, Kumagai T, Matsumoto A, Iriyama E, Watanabe K,Goto K et al. Two cases of chromosome 4q35-linked earlyonset facioscapulohumeral muscular dystrophy with mentalretardation and epilepsy. Neuropediatrics 1998;29:239-241.

29. Van der Maarel SM, Deidda G, Lemmers RJ, van OverveldPG, Van der Wielen M, Hewitt JE et al. De novo

facioscapulohumeral muscular dystrophy: frequent somaticmosaicism, sex-dependent phenotype, and the role ofmitotic transchromosomal repeat interaction betweenchromosomes 4 and 10. Am J Hum Genet 2000;66:26-35.

30. Tawil R, Forrester J, Griggs RC, Mendell J, Kissel J,McDermott M et al. Evidence for anticipation andassociation of deletion size with severity infacioscapulohumeral muscular dystrophy. The FSH-DYGroup. Ann Neurol 1996;39:744-748.

31. Bailey RO, Marzulo DC, Hans MB. Infantile facioscapu-lohumeral muscular dystrophy: new observations. ActaNeurol Scand 1986;74:51-58.

32. McGarry J, Garg B, Silbert S. Death in childhood due tofacioscapulohumeral dystrophy. Acta Neurol Scand1983;68:61-63.

33. Upadhyaya M, MacDonald M, Ravine D. Prenatal diagnosisfor facioscapulohumeral muscular dystrophy (FSHD).Prenat Diagn 1999;19:959-965.


¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ŒÏÂÓ· ºÚ˘Û›Ú· ª·ÎÚ˘Ó›ÙÛ·˜ 16, ∆.∫. 115 22, ∞ÌÂÏfiÎËÔÈ, ∞ı‹Ó· E-mail: [email protected]

May-June 03 03-06-03 16:55 ™ÂÏ›‰·222


223

∂ÈÛ·ÁˆÁ‹∏ ÂÓÙÂÚÈÎ‹ ¯ÏˆÚ›‰· ‰È·‰Ú·Ì·Ù›˙ÂÈ ÛËÌ·ÓÙÈÎfi

ÚfiÏÔ ÛÙË ‰È·Ù‹ÚËÛË ÙË˜ ˘ÁÂ›·˜ ÙÔ˘ ·ÓıÚÒÈÓÔ˘ÔÚÁ·ÓÈÛÌÔ‡. ™ÙÈ˜ ˆÊ¤ÏÈÌÂ˜ ÏÂÈÙÔ˘ÚÁ›Â˜ ÙË˜ ·Ó‹-ÎÔ˘Ó Ë ·ÚÂÌfi‰ÈÛË ·Ó¿Ù˘ÍË˜ ‚Ï·‚ÂÚÒÓ ‚·ÎÙË-ÚÈ‰›ˆÓ, Ë Û˘ÌÌÂÙÔ¯‹ ÛÂ ·ÓÔÛÔÏÔÁÈÎÔ‡˜ ÌË¯·ÓÈ-ÛÌÔ‡˜, Ë Û˘Ì‚ÔÏ‹ ÛÙË ÌÂ›ˆÛË ÂÓÙÂÚÈÎ‹˜ ‰È¿Ù·ÛË˜ÏfiÁˆ ·ÂÚ›ˆÓ, Ë ‚ÂÏÙ›ˆÛË ÙË˜ ¤„Ë˜ Î·È ÙË˜ ·ÔÚ-ÚfiÊËÛË˜ ıÚÂÙÈÎÒÓ Û˘ÛÙ·ÙÈÎÒÓ, Î·ıÒ˜ Î·È Ë Û‡Ó-ıÂÛË ‚ÈÙ·ÌÈÓÒÓ (1). ∏ Ê˘ÛÈÔÏÔÁÈÎ‹ ÂÓÙÂÚÈÎ‹ ¯ÏˆÚ›-‰· ÛÙÔÓ ¿ÓıÚˆÔ ÂÚÈÔÚ›˙ÂÙ·È Î˘Ú›ˆ˜ ÛÙÔ ·¯‡¤ÓÙÂÚÔ, ÙÔ ÔÔ›Ô ·ÔÈÎ›˙ÂÙ·È ÌÂ ÂÚÈÛÛfiÙÂÚ· ·fi1012 ·ÂÚfi‚È· Î·È ˘Ô¯ÚÂˆÙÈÎ¿ ·Ó·ÂÚfi‚È· Gram(-)

Î·È Gram(+) ‚·ÎÙ‹ÚÈ· ·Ó¿ ÁÚ·ÌÌ¿ÚÈÔ ÂÓÙÂÚÈÎÔ‡ÂÚÈÂ¯ÔÌ¤ÓÔ˘. ∞fi Ù· 400 Â›‰Ë Ô˘ Û˘Ì‚ÈÒÓÔ˘Ó,Ù· 30-40 ·ÔÙÂÏÔ‡Ó ÙÔ 99% ÙË˜ ÂÓÙÂÚÈÎ‹˜ ¯ÏˆÚ›-‰·˜. ∆· ·Ó·ÂÚfi‚È· ˘ÂÚÙÂÚÔ‡Ó Î·Ù¿ ÔÏ‡ ÙˆÓ ·Â-Úfi‚ÈˆÓ (ÁÈ· Î¿ıÂ 1000 ·Ó·ÂÚfi‚È· ·ÓÙÈÛÙÔÈ¯Â› 1 ·Â-Úfi‚ÈÔ ‚·ÎÙ‹ÚÈÔ) (2). ™Ù· ÂÈÎÚ·ÙÔ‡ÓÙ· ·Ó·ÂÚfi‚È·Â›‰Ë ·Ó‹ÎÔ˘Ó Ù· Bacteroides spp, bifidobacteria,propionibacteria Î·È clostridia. ªÂÙ·Í‡ ÙˆÓ ·ÂÚfi-‚ÈˆÓ Î˘ÚÈ·Ú¯Ô‡Ó Ù· enterobacteria Î·È Î˘Ú›ˆ˜ Ù·escherichia coli Î·È enterococci (2). O ·ÔÈÎÈÛÌfi˜ÙÔ˘ ÂÓÙ¤ÚÔ˘ ·Ú¯›˙ÂÈ ÙÈ˜ ÚÒÙÂ˜ ÒÚÂ˜ ÙË˜ ˙ˆ‹˜,·fi ÙËÓ Î·Ù¿ÔÛË ÎÔÏÈÎÒÓ ˘ÁÚÒÓ Î·Ù¿ ÙË ‰È¿Ú-ÎÂÈ· ÙÔ˘ Ê˘ÛÈÔÏÔÁÈÎÔ‡ ÙÔÎÂÙÔ‡ ÌÂ ‚·ÎÙ‹ÚÈ· ÙÔ˘

¶ÚÔ‚ÈÔÙÈÎ¿, ÚÂ‚ÈÔÙÈÎ¿, Û˘Ì‚ÈÔÙÈÎ¿: ÓÂfiÙÂÚ· ‰Â‰ÔÌ¤Ó· π. Ã·ÚˆÓ›ÙË, ª. ª·˘ÚfiÎˆÛÙ·, ∂. ∫fiÎÔÚË

Probiotics, prebiotics, synbiotics: recent data I. Charoniti, M. Mavrokosta, E. Kokori

∂¶π∫∞πƒ∞ £∂ª∞∆∞ CURRENT ISSUES

A’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ µÂÓÈ˙¤ÏÂÈÔ °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ∏Ú·ÎÏÂ›Ô˘, ∫Ú‹ÙË

1st Paediatric Clinic Venizelion General Hospital of Heraklion, Crete

�¶ÂÚ›ÏË„Ë: ∏ ·ÓıÚÒÈÓË ÂÓÙÂÚÈÎ‹ ¯ÏˆÚ›‰· Û˘Ì-‚¿ÏÏÂÈ ÛËÌ·ÓÙÈÎ¿ ÛÙË ‰È·Ù‹ÚËÛË Î·È ÚÔ·ÁˆÁ‹ ÙË˜˘ÁÂ›·˜. ∏ ÙÚÔÔÔ›ËÛ‹ ÙË˜ ÛÂ Ì›· Â˘ÓÔ˚ÎfiÙÂÚË ÁÈ·ÙÔÓ ·ÓıÚÒÈÓÔ ÔÚÁ·ÓÈÛÌfi Û‡ÛÙ·ÛË ¤¯ÂÈ ÂÈÎÂÓÙÚÒ-ÛÂÈ ÙÔ ÂÓ‰È·Ê¤ÚÔÓ ÙˆÓ ÂÈÛÙËÌfiÓˆÓ ˘ÁÂ›·˜. ∏ ÌÂÙ·-‚ÔÏ‹ ÙË˜ ÌÔÚÂ› Ó· ÂÈÙÂ˘¯ıÂ› Â›ÙÂ ÌÂ ÙË ¯ÔÚ‹ÁËÛË˙ÒÓÙˆÓ ‚·ÎÙËÚ›ˆÓ, ÌÂÙ·‚ÔÏÈÎ¿ ÂÓÂÚÁÒÓ, Ô˘ ÌÔ-ÚÔ‡Ó Ó· Êı¿ÓÔ˘Ó ÛÙÔ ·¯‡ ¤ÓÙÂÚÔ ·Ó·ÏÏÔ›ˆÙ· ·fiÙË ‰Ú¿ÛË ÙˆÓ ÂÓ˙‡ÌˆÓ ÙÔ˘ ÏÂÙÔ‡ ÂÓÙ¤ÚÔ˘ (ÚÔ‚ÈÔ-ÙÈÎ¿), Â›ÙÂ ÌÂ ÙË ¯ÔÚ‹ÁËÛË ÌË ÂÙÒÓ ˘‰·Ù·ÓıÚ¿-ÎˆÓ Ô˘ ·ÔÙÂÏÔ‡Ó ÂÎÏÂÎÙÈÎfi ˘fiÛÙÚˆÌ· ÁÈ· Û˘-ÁÎÂÎÚÈÌ¤Ó· Â›‰Ë ‚·ÎÙËÚ›ˆÓ ÌÂ È‰ÈfiÙËÙÂ˜ ˆÊ¤ÏÈÌÂ˜ÁÈ· ÙÔÓ ÍÂÓÈÛÙ‹ (ÚÂ‚ÈÔÙÈÎ¿), Â›ÙÂ Ù¤ÏÔ˜ ÌÂ ÙË Û˘Ó-‰˘·ÛÌ¤ÓË ¯ÔÚ‹ÁËÛË ÙˆÓ ·Ú·¿Óˆ (Û˘Ì‚ÈÔÙÈÎ¿). ∏ÙÚÔÔÔ›ËÛË ÙË˜ ÂÓÙÂÚÈÎ‹˜ ¯ÏˆÚ›‰·˜ ‚Ú›ÛÎÂÈ ÂÊ·Ú-ÌÔÁ‹ ÛÂ ÔÏÏ¤˜ ÓÔÛÔÏÔÁÈÎ¤˜ ÔÓÙfiÙËÙÂ˜ ÌÂ ÂÓı·Ú-Ú˘ÓÙÈÎ¿ ·ÔÙÂÏ¤ÛÌ·Ù·, fiˆ˜ ÛÂ ‰È·ÚÚÔ˚Î¿ Û‡Ó‰ÚÔ-Ì· ÔÈÎ›ÏË˜ ·ÈÙÈÔÏÔÁ›·˜, ÊÏÂÁÌÔÓÒ‰ÂÈ˜ ÓfiÛÔ˘˜ ÙÔ˘ÂÓÙ¤ÚÔ˘ Î·È Î·Ù·ÛÙ¿ÛÂÈ˜ ÌÂ ˘ÂÚ·Ó¿Ù˘ÍË ·ıÔÁfi-ÓˆÓ ÌÈÎÚÔ‚›ˆÓ ÙÔ˘ ÂÓÙ¤ÚÔ˘.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ÚÔ‚ÈÔÙÈÎ¿, ÚÂ‚ÈÔÙÈÎ¿, Û˘Ì‚ÈÔÙÈÎ¿.

�Abstract: Human gut microflora play a significantrole in the maintenance and promotion of the healthof the host and scientists in the field of health haveshown great interest in modifying gut microfloratowards a more beneficial composition. Alteration ofthe gut microflora can be achieved by the ingestionof either live, metabolically active bacteria able toreach the colon intact through the action of the smallintestine enzymes (probiotics), nondigestiblecarbohydrates which act as substrates to a limitednumber of bacteria beneficial to the host (prebiotics),or a combination of pro- and prebiotics (synbiotics).Modification of gut microflora has been applied withencouraging results in several clinical conditionssuch as various diarrhoeal illnesses, inflammatorybowel disease and conditions associated withbacterial overgrowth.

Key words: probiotics, prebiotics, synbiotics.

May-June 03 03-06-03 16:55 ™ÂÏ›‰·223


224

ÎfiÏÔ˘ Î·È ÙË˜ ÂÚÈÁÂÓÓËÙÈÎ‹˜ ÂÚÈÔ¯‹˜ ÙË˜ ÌËÙ¤-Ú·˜ ‹ ·fi ‚·ÎÙ‹ÚÈ· ÙÔ˘ ÂÓ‰ÔÓÔÛÔÎÔÌÂÈ·ÎÔ‡ ÂÚÈ-‚¿ÏÏÔÓÙÔ˜ ÛÂ ÓÂÔÁÓ¿ Ô˘ ÁÂÓÓÈÔ‡ÓÙ·È ÌÂ Î·ÈÛ·ÚÈÎ‹ÙÔÌ‹ (2,3). ∂ÎÙfi˜ ·fi ÙÔÓ Ù‡Ô ÙÔ˘ ÙÔÎÂÙÔ‡, ÚfiÏÔÛÙË Û‡ÛÙ·ÛË ÙË˜ ÂÓÙÂÚÈÎ‹˜ ¯ÏˆÚ›‰·˜ ¤¯ÂÈ Î·È Ë Û›-ÙÈÛË ÙÔ˘ ‚Ú¤ÊÔ˘˜ (4). ™Â ıËÏ¿˙ÔÓÙ· ‚Ú¤ÊË, Î˘-ÚÈ·Ú¯Ô‡Ó Ù· bifidobacteria. ™Â ‚Ú¤ÊË Ô˘ ÛÈÙ›˙ÔÓÙ·ÈÌÂ ÙÂ¯ÓËÙ‹ ‰È·ÙÚÔÊ‹, Ë ÌÈÎÚÔ¯ÏˆÚ›‰· Â›Ó·È ÈÔ Â-Ú›ÏÔÎË, ·ÔÙÂÏÔ‡ÌÂÓË ·fi bifidobacteria, ‚·ÎÙË-ÚÈÔÂÈ‰‹, ÎÏˆÛÙËÚ›‰È· Î·È ÛÙÚÂÙfiÎÔÎÎÔ˘˜ (5,6). OÈ‰È·ÊÔÚ¤˜ Ô˘ ˘¿Ú¯Ô˘Ó Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÌÂÈˆÌ¤ÓÔÎ›Ó‰˘ÓÔ Á·ÛÙÚ›ÙÈ‰·˜ ÛÙ· ıËÏ¿˙ÔÓÙ· ‚Ú¤ÊË. §›Á·ÂÈÏ¤ÔÓ ‚·ÎÙ‹ÚÈ· ÚÔÛÙ›ıÂÓÙ·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ·ÙˆÓ ÂfiÌÂÓˆÓ ‰‡Ô ¯ÚfiÓˆÓ ÙË˜ ˙ˆ‹˜, ÒÛÙÂ Ë ÂÓÙÂ-ÚÈÎ‹ ¯ÏˆÚ›‰· ÌÂÙ¿ ÙËÓ ËÏÈÎ›· ·˘Ù‹ Ó· ÔÌÔÈ¿˙ÂÈ ÌÂÂÎÂ›ÓË ÙÔ˘ ÂÓËÏ›ÎÔ˘ (7). ∆Ô ÔÈÎÔÛ‡ÛÙËÌ· ÙÔ˘ ÂÓÙ¤-ÚÔ˘, Î¿Ùˆ ·fi Ê˘ÛÈÔÏÔÁÈÎ¤˜ Û˘Óı‹ÎÂ˜, ‰È·ÙËÚÂ›Ù·ÈÛ¯ÂÙÈÎ¿ ÛÙ·ıÂÚfi Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ˙ˆ‹˜ ÙÔ˘ ·Ó-ıÚÒÔ˘ (7). O ÛËÌ·ÓÙÈÎfi˜ ÚfiÏÔ˜ ÙˆÓ ‚·ÎÙËÚ›ˆÓÙÔ˘ ÂÓÙ¤ÚÔ˘ ÛÙË ‰È·Ù‹ÚËÛË Î·È ÚÔ·ÁˆÁ‹ ÙË˜˘ÁÂ›·˜ ¤¯ÂÈ ·Ó·ÁÓˆÚÈÛÙÂ› ·fi ·ÚÎÂÙ¿ ·ÏÈ¿. ∆Ô ÂÓ-‰È·Ê¤ÚÔÓ ÙˆÓ ÂÈÛÙËÌfiÓˆÓ ·fi ÓˆÚ›˜ ÛÙÚ¿ÊËÎÂ ÛÂÚÔÛ¿ıÂÈÂ˜ ÙÚÔÔÔ›ËÛË˜ ÙË˜ ÂÓÙÂÚÈÎ‹˜ ¯ÏˆÚ›‰·˜,ÒÛÙÂ Ó· ·˘ÍËıÂ› Ô ·ÚÈıÌfi˜ ‹ Ë ‰Ú·ÛÙËÚÈfiÙËÙ· ÔÌ¿-‰ˆÓ ‚·ÎÙËÚ›ˆÓ ÌÂ È‰ÈfiÙËÙÂ˜ Ô˘ Â˘ÓÔÔ‡Ó ÙËÓ ˘ÁÂ›·.™Â ·˘Ùfi ÙÔ ÛËÌÂ›Ô ÂÈÛ¿ÁÂÙ·È Ë È‰¤· ÙˆÓ ÚÔ‚ÈÔÙÈÎÒÓ,ÙˆÓ ÚÂ‚ÈÔÙÈÎÒÓ Î·È ÙˆÓ Û˘Ì‚ÈÔÙÈÎÒÓ, Ô˘ Â›Ó·È ÁÓˆ-ÛÙ¿ ˆ˜ ÚfiÛıÂÙ· ÙÚÔÊÒÓ.

¶ÚÔ‚ÈÔÙÈÎ¿ ∆· ÚÔ‚ÈÔÙÈÎ¿ Â›Ó·È ‰È·ÙÚÔÊÈÎ¿ Û˘ÌÏËÚÒÌ·Ù·

·fi ˙ÒÓÙÂ˜ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜ Ô˘ ·ÛÎÔ‡Ó ˆÊ¤ÏÈ-ÌË ‰Ú¿ÛË ÛÙÔÓ ÍÂÓÈÛÙ‹, ÌÂÙ·‚¿ÏÏÔÓÙ·˜ ÙË Û‡ÛÙ·-ÛË Î·È ÙË ‰Ú·ÛÙËÚÈfiÙËÙ· ÙË˜ ÌÈÎÚÔ¯ÏˆÚ›‰·˜ ÙÔ˘ÂÓÙ¤ÚÔ˘ (8).

°È· Ó· ıÂˆÚËıÂ› ¤Ó·˜ ÌÈÎÚÔÔÚÁ·ÓÈÛÌfi˜ fiÙÈ ·Ó‹-ÎÂÈ ÛÙËÓ ÔÌ¿‰· ÙˆÓ ÚÔ‚ÈÔÙÈÎÒÓ, Ú¤ÂÈ Ó· ÏËÚÔ›Ù· ÎÚÈÙ‹ÚÈ· Ô˘ Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1. OÈ ÌÈÎÚÔ-ÔÚÁ·ÓÈÛÌÔ› Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ˆ˜ ÚÔ‚ÈÔÙÈÎ¿Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2. ¶ÚfiÎÂÈÙ·È Î˘Ú›ˆ˜ ÁÈ· Á·-Ï·ÎÙÔ‚¿ÎÈÏÏÔ˘˜ Î·È bifidobacteria Ô˘ Û˘Ó‹ıˆ˜ ·-Ú¿ÁÔ˘Ó Î·Ù¿ ÙË ˙‡ÌˆÛ‹ ÙÔ˘˜ Á·Ï·ÎÙÈÎfi ÔÍ‡. ∆Ô ·Ô-

Ù¤ÏÂÛÌ· ÙË˜ ‰Ú¿ÛË˜ ÙÔ˘˜ ÂÍ·ÚÙ¿Ù·È ·fi ÙÔ ÛÙ¤ÏÂ-¯Ô˜ ÙÔ˘ ÌÈÎÚÔ‚›Ô˘ Ô˘ ¯ÔÚËÁÂ›Ù·È (9). ™ÙÈ˜ È‰ÈfiÙËÙ¤˜ÙÔ˘˜ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È: ·) Ë ·‡ÍËÛË ÙË˜ ·ÓÙ›ÛÙ·ÛË˜ÛÙÈ˜ ÏÔÈÌÒÍÂÈ˜ ÙÔ˘ ÂÙÈÎÔ‡, ‚) Ë ‰È¤ÁÂÚÛË ÙË˜ ·ÓÔ-Û›·˜ ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡, Á) Ë ‰È·Ù‹ÚËÛË ÙË˜ Ê˘ÛÈÔ-ÏÔÁÈÎ‹˜ ¯ÏˆÚ›‰·˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ¯Ô-Ú‹ÁËÛË˜ ·ÓÙÈ‚ÈÔÙÈÎ‹˜ ıÂÚ·Â›·˜, ‰) Ë ‚ÂÏÙ›ˆÛË ÙË˜¤„Ë˜ Î·È Â) Ë ‚ÂÏÙ›ˆÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÙË˜ ‰˘-Û·ÓÂÍ›·˜ ÛÙË Ï·ÎÙfi˙Ë. ¶Èı·Ó¿ Û˘Ì‚¿ÏÏÔ˘Ó ÛÙË ÌÂ›-ˆÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙË˜ ¯ÔÏËÛÙÂÚfiÏË˜ Î·È ÙË˜ ·ÌÌˆ-Ó›·˜ ÛÙÔ ·›Ì· Î·È ÛÙË ÌÂ›ˆÛË ÙË˜ Â›ÙˆÛË˜ ÙˆÓ Î·-ÎÔËıÂÈÒÓ ÙÔ˘ ÂÙÈÎÔ‡ (10).

O Î‡ÚÈÔ˜ ÌË¯·ÓÈÛÌfi˜ ‰Ú¿ÛË˜ ÙˆÓ ÚÔ‚ÈÔÙÈÎÒÓıÂˆÚÂ›Ù·È Ô “·ÓÙ·ÁˆÓÈÛÙÈÎfi˜ ·ÔÎÏÂÈÛÌfi˜” (10). OfiÚÔ˜ ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÁÈ· Ó· ÂÚÈÁÚ¿„ÂÈ ÙË ‰È·‰ÈÎ·-Û›· ÚÔÛÎfiÏÏËÛË˜ ÙˆÓ ÚÔ‚ÈÔÙÈÎÒÓ ÛÙÔÓ ÂÓÙÂÚÈÎfi‚ÏÂÓÓÔÁfiÓÔ Î·È, Ì¤Ûˆ ·˘Ù‹˜, ÙËÓ ·ÚÂÌfi‰ÈÛË ÙË˜ÚÔÛÎfiÏÏËÛË˜ ¿ÏÏˆÓ ‚·ÎÙËÚ›ˆÓ, Èı·Ó¿ ·ıÔÁfi-ÓˆÓ, ÏfiÁˆ Î·Ù¿ÏË„Ë˜ ÙˆÓ ı¤ÛÂˆÓ ÚÔÛÎfiÏÏËÛË˜.ÕÏÏÔÈ ÌË¯·ÓÈÛÌÔ› ‰Ú¿ÛË˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙËÓ ·Ú·-ÁˆÁ‹ ‚·ÎÙËÚÈÔÎÙfiÓˆÓ Ô˘ÛÈÒÓ (11) Î·È ÙËÓ ÂÓ›Û¯˘ÛË‹ ÙÚÔÔÔ›ËÛË ÙË˜ ·ÓÔÛ›·˜ ÙÔ˘ ÍÂÓÈÛÙ‹ (·Ú·ÁˆÁ‹·ÓÙÈÛˆÌ¿ÙˆÓ, ÂÓÂÚÁÔÔ›ËÛË ·ÓÙÈ‰Ú¿ÛÂˆÓ Î·ı˘ÛÙÂ-ÚËÌ¤ÓË˜ ˘ÂÚÂ˘·ÈÛıËÛ›·˜, Â›Ù·ÛË ÙË˜ ÏÂÈÙÔ˘ÚÁ›·˜ÙˆÓ ÌÔÓÔ‡ÚËÓˆÓ Ê·ÁÔÎ˘ÙÙ¿ÚˆÓ, ‰È¤ÁÂÚÛË ÙË˜ ·-Ú·ÁˆÁ‹˜ ÈÓÙÂÚÊÂÚfiÓË˜, IL-1a Î·È TNF-a) (12).

∆· bifidobacteria Ê·›ÓÂÙ·È fiÙÈ ·ÛÎÔ‡Ó ÙË ‰Ú¿ÛËÙÔ˘˜ Ì¤Ûˆ ·Ú·ÁˆÁ‹˜ Ô˘ÛÈÒÓ ·Ó·ÛÙ·ÏÙÈÎÒÓ ÙË˜ ·Ó¿-Ù˘ÍË˜ ¿ÏÏˆÓ ‚·ÎÙËÚ›ˆÓ, ·ÏÏ¿ Î·È Ì¤Ûˆ ·Ú·ÁˆÁ‹˜ÈÛ¯˘ÚÒÓ ÔÍ¤ˆÓ, Ù· ÔÔ›· ·ÛÎÔ‡Ó ÙË ‚·ÎÙËÚÈÔÎÙfiÓÔ

¶›Ó·Î·˜ 1. ∫ÚÈÙ‹ÚÈ· ÚÔ‚ÈÔÙÈÎÒÓ ‰È·ÙÚÔÊÈÎÒÓ Û˘ÌÏËÚˆ-Ì¿ÙˆÓ

∆· ÚÔ‚ÈÔÙÈÎ¿ Ú¤ÂÈ: ñ Ó· ·ÛÎÔ‡Ó ˆÊ¤ÏÈÌË ‰Ú¿ÛË ÛÙÔÓ ÔÚÁ·ÓÈÛÌfiñ Ó· ÌËÓ Â›Ó·È ÙÔÍÈÎ¿ Î·È ·ıÔÁfiÓ·ñ Ó· ÂÚÈ¤¯Ô˘Ó ÌÂÁ¿ÏÔ ·ÚÈıÌfi ‚ÈÒÛÈÌˆÓ Î˘ÙÙ¿ÚˆÓñ Ó· ‰È·ÙËÚÔ‡Ó ÙÈ˜ È‰ÈfiÙËÙ¤˜ ÙÔ˘˜ Î·Ù¿ ÙÈ˜ ‰È·‰ÈÎ·Û›Â˜ ·Ô-

ı‹ÎÂ˘ÛË˜, ‰È·Ù‹ÚËÛË˜ Î·È ¯Ú‹ÛË˜ñ Ó· Â›Ó·È ‰˘Ó·Ùfi Ó· ·Ó··Ú·¯ıÔ‡Ó ÛÂ ÌÂÁ¿ÏÂ˜ ÔÛfiÙËÙÂ˜

(‚ÈÔÌË¯·ÓÈÎ‹ ·Ó··Ú·ÁˆÁ‹)

¶›Ó·Î·˜ 2. ™˘Ó‹ıË ÚÔ‚ÈÔÙÈÎ¿

Lactobacilli L. acidophilusL. caseiL. deibrueckii subsp. bulgriusL. reuteriL. cellobiosusL. curvarusL. fermentumL. plantarumGram positive cocciLactococcus lactis subsp. cremorisStreptococcus salivaris subsp. thermophilusEnterococcus faeciumS. diaacetylactisS. intermediusBifidobacteriaB. bifidumB. adolescentisB. animalisB. infantisB. longumB. thermophilum

May-June 03 03-06-03 16:55 ™ÂÏ›‰·224


225

‰Ú¿ÛË ÙÔ˘˜ Ì¤Ûˆ ÌÂ›ˆÛË˜ ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ pH (13). ™Â fi,ÙÈ ·ÊÔÚ¿ ÙÈ˜ Á·ÛÙÚÂÓÙÂÚ›ÙÈ‰Â˜, Ù· ÚÔ‚ÈÔ-

ÙÈÎ¿ Ê·›ÓÂÙ·È fiÙÈ ÌÔÚÂ› Ó· ÌÂÈÒÛÔ˘Ó ÙË ‰È¿ÚÎÂÈ·Î·È ÙË ‚·Ú‡ÙËÙ· ·˘ÙÒÓ ÙˆÓ ÏÔÈÌÒÍÂˆÓ ‹ ·ÎfiÌË Î·ÈÓ· ÚÔÏ¿‚Ô˘Ó ÙËÓ ÂÎ‰‹ÏˆÛ‹ ÙÔ˘˜. ™˘ÁÎÂÎÚÈÌ¤Ó·,ÛÂ ·ÚÎÂÙ¤˜ ÌÂÏ¤ÙÂ˜ ¤¯ÂÈ ·Ô‰ÂÈ¯ÙÂ› Ô ÛËÌ·ÓÙÈÎfi˜ÚfiÏÔ˜ ÙÔ˘ Lactobacillus rhamnosus GG ÛÙË ıÂÙÈÎ‹¤Î‚·ÛË ÙË˜ ‰È¿ÚÚÔÈ·˜ ·fi Èfi Rota ÛÙ· ‚Ú¤ÊË (14-17). ™Â Ì›· ÚfiÛÊ·ÙË, ÌÂÁ¿ÏË ÔÏ˘ÎÂÓÙÚÈÎ‹ ÌÂÏ¤-ÙË Ô˘ Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ ÛÙËÓ ∂˘ÚÒË Î·È ¤Ï·-‚·Ó Ì¤ÚÔ˜ ·È‰È¿ ËÏÈÎ›·˜ ·fi 1-36 ÌËÓÒÓ ÌÂ ÔÍÂ›·‰È¿ÚÚÔÈ·, ¯ÔÚËÁ‹ıËÎÂ ÎÔÈÓfi ËÏÂÎÙÚÔÏ˘ÙÈÎfi ‰È¿Ï˘-Ì· Î·È ËÏÂÎÙÚÔÏ˘ÙÈÎfi ‰È¿Ï˘Ì· ÂÌÏÔ˘ÙÈÛÌ¤ÓÔ ÌÂLactobacillus rhamnosus GG. ™Ù· ·È‰È¿ Ô˘ ¤Ï·-‚·Ó ÙÔ ÂÌÏÔ˘ÙÈÛÌ¤ÓÔ ÌÂ Lactobacillus rhamnosusGG ËÏÂÎÙÚÔÏ˘ÙÈÎfi ‰È¿Ï˘Ì· Î·È ÂÈ‰ÈÎ¿ ÛÂ ·˘Ù¿ Ô˘¤·Û¯·Ó ·fi ÏÔ›ÌˆÍË ·fi Èfi Rota, Ë ‰È¿ÚÎÂÈ· ÙˆÓÛ˘ÌÙˆÌ¿ÙˆÓ ÌÂÈÒıËÎÂ ÛËÌ·ÓÙÈÎ¿ (58±28 ÒÚÂ˜ÛÙ· ·È‰È¿ ÌÂ ÙÔ ÂÌÏÔ˘ÙÈÛÌ¤ÓÔ ‰È¿Ï˘Ì· Î·È76±36 ÒÚÂ˜ ÛÙ· ·È‰È¿ ÌÂ ÙÔ ÎÔÈÓfi ËÏÂÎÙÚÔÏ˘ÙÈÎfi‰È¿Ï˘Ì·) (18,19). O Lactobacillus GG Ê·›ÓÂÙ·È fiÙÈÌÂÈÒÓÂÈ Î·È ÙÔ Ú˘ıÌfi ·Ô‚ÔÏ‹˜ ÙÔ˘ ÈÔ‡ Rota ÛÙ·ÎfiÚ·Ó· Î·È, ¿Ú·, fiÙÈ ÂÚÈÔÚ›˙ÂÈ ÙË ÌÂÙ¿‰ÔÛ‹ ÙÔ˘(20). ™Â ¿ÏÏÂ˜ ÌÂÏ¤ÙÂ˜, fiÔ˘ ÙÔ ·›ÙÈÔ ÙˆÓ ‰È·ÚÚÔÈ-ÒÓ ‰ÂÓ ·Ó·Ê¤ÚÂÙ·È, ÚÔ‚ÈÔÙÈÎ¿ Ô˘ ¤¯Ô˘Ó ÌÂÈÒÛÂÈÙË ‰È¿ÚÎÂÈ· ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Â›Ó·È, ÂÎÙfi˜ ÙÔ˘Lactobacillus rhamnosus GG, Ô Enterococcus faeciumSF68 (21), Ô Saccharomyces boulardii (22) Î·È ÔLactobacillus reuteri (20). O Lactobacillus acidophilusÊ·›ÓÂÙ·È fiÙÈ ÌÂÈÒÓÂÈ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓÙˆÓ ÌÈÎÚÔ‚È·ÎÒÓ Á·ÛÙÚÂÓÙÂÚ›ÙÈ‰ˆÓ (23).

À¿Ú¯Ô˘Ó ÌÂÏ¤ÙÂ˜ Ô˘ Û˘Û¯ÂÙ›˙Ô˘Ó ÙË ¯ÔÚ‹ÁË-ÛË ÚÔ‚ÈÔÙÈÎÔ‡ ÌÂ ÙË ÌÂ›ˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÂÌÊ¿ÓÈ-ÛË˜ ‰È¿ÚÚÔÈ·˜ ÙˆÓ Ù·ÍÈ‰ÈˆÙÒÓ (24,25), Î·ıÒ˜ Î·ÈÙËÓ ÂÎÚ›˙ˆÛË ·ıÔÁfiÓˆÓ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÒÓ fiˆ˜Ë Salmonella Î·È ÙÔ Campylobacter ·fi ÙÔ ¤ÓÙÂÚÔ¯ÚfiÓÈˆÓ ÊÔÚ¤ˆÓ (26,27). ∏ ˘ÔÙÚÔÈ¿˙Ô˘Û· ÂÓÙÂ-Ú›ÙÈ‰· ·fi Cl. difficile Ê·›ÓÂÙ·È, Â›ÛË˜, Ó· ·ÓÙ·Ô-ÎÚ›ÓÂÙ·È ÛÙË ¯ÔÚ‹ÁËÛË Ï·ÎÙÔ‚¿ÎÈÏÏˆÓ (28).

∞ÔÙÂÏÂÛÌ·ÙÈÎ¿ ÚÔ‚ÈÔÙÈÎ¿ ÛÙËÓ ÚfiÏË„Ë ÙË˜‰È¿ÚÚÔÈ·˜ Ô˘ Û¯ÂÙ›˙ÂÙ·È ÌÂ Ù· ·ÓÙÈ‚ÈÔÙÈÎ¿ ıÂˆ-ÚÔ‡ÓÙ·È Ô Lactobacillus rhamnosus GG Î·È ÔSaccharomyces boulardii (29). ™Â ‰ÈÏ‹-Ù˘ÊÏ‹ ÌÂ-Ï¤ÙË Ô˘ ÂÚÈÂÏ¿Ì‚·ÓÂ ·È‰È¿ Ô˘ ÂÏ¿Ì‚·Ó·Ó·ÓÙÈ‚ÈÔÙÈÎ‹ ·ÁˆÁ‹ ÁÈ· ÏÔÈÌÒÍÂÈ˜ ÙÔ˘ ·Ó·ÓÂ˘ÛÙÈ-ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, Ë ¯ÔÚ‹ÁËÛË Lactobacillusrhamnosus GG ÌÂ›ˆÛÂ ÙËÓ Â›ÙˆÛË ÙˆÓ ¯·Ï·ÚÒÓÎÂÓÒÛÂˆÓ ·fi 42% ÛÂ 17% (30).

∏ ¯ÔÚ‹ÁËÛË ÚÔ‚ÈÔÙÈÎÒÓ ¤¯ÂÈ ÂÚÈÔÚÈÛÌ¤Ó··ÔÙÂÏ¤ÛÌ·Ù· ÛÙËÓ ÂÎÚ›˙ˆÛË ÙÔ˘ H. Pylori, ·Ú’fiÏÔ Ô˘ ÛÂ in vitro ÌÂÏ¤ÙÂ˜ ¤¯ÂÈ ‰È·ÈÛÙˆıÂ› ·ÓÙ·-ÁˆÓÈÛÙÈÎ‹ Û¯¤ÛË ÌÂÙ·Í‡ ÙÔ˘ H. Pylori Î·È ÛÙÂÏÂ¯ÒÓLactobacillus (31).

∆· ÚÔ‚ÈÔÙÈÎ¿ ¤¯Ô˘Ó ‰ÔÎÈÌ·ÛÙÂ› ÌÂ ÂÈÙ˘¯›· ÛÂÂÓËÏ›ÎÔ˘˜ ÛÙË ıÂÚ·Â›· ÙË˜ ÂÓÙÂÚÔÎÔÏ›ÙÈ‰·˜ ·fiÌÂıÔÙÚÂÍ¿ÙË (32), ÙË˜ ·ÎÙÈÓÈÎ‹˜ ÂÓÙÂÚ›ÙÈ‰·˜ (33)Î·È ÛÙÔÓ ÂÚÈÔÚÈÛÌfi ÙË˜ ¯ÚfiÓÈ·˜ ‰È¿ÚÚÔÈ·˜ Ô˘Û¯ÂÙ›˙ÂÙ·È ÌÂ ÙÔ AIDS (34).

º·›ÓÂÙ·È fiÙÈ ¤¯Ô˘Ó Â˘ÂÚÁÂÙÈÎ‹ Â›‰Ú·ÛË fiÙ·Ó¯ÔÚËÁÔ‡ÓÙ·È ÛÂ ÓÂÔÁÓ¿ ¿Û¯ÔÓÙ· ·fi ÓÂÎÚˆÙÈÎ‹ÂÓÙÂÚÔÎÔÏ›ÙÈ‰· Î·È ·ÏÏÂÚÁÈÎ‹ ÎÔÏ›ÙÈ‰·, Î·ıÒ˜ Î·ÈÛÂ ·È‰È¿ ÌÂ Î˘ÛÙÈÎ‹ ›ÓˆÛË (35).

™Â fi,ÙÈ ¤¯ÂÈ Û¯¤ÛË ÌÂ ÙË ¯Ú‹ÛË ÙˆÓ ÚÔ‚ÈÔÙÈÎÒÓÛÙÈ˜ ÊÏÂÁÌÔÓÒ‰ÂÈ˜ ÓfiÛÔ˘˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘, Ù· ·ÔÙÂ-Ï¤ÛÌ·Ù· ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·ÚÎÂÙfi ÂÓ‰È·Ê¤ÚÔÓ. OÈ Ï·-ÎÙÔ‚¿ÎÈÏÏÔÈ Ê·›ÓÂÙ·È fiÙÈ ·Ó·ÎÔ˘Ê›˙Ô˘Ó fi¯È ÌfiÓÔ ·fiÙÈ˜ ÂÓÙÂÚÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ Ô˘ ÔÊÂ›ÏÔÓÙ·È ÛÙËÓ ˘Â-Ú·Ó¿Ù˘ÍË ‚·ÎÙËÚ›ˆÓ, ·ÏÏ¿ Î·È ·fi ÙÈ˜ ÂÍˆÂÓÙÂÚÈ-Î¤˜ ÂÈÏÔÎ¤˜, fiˆ˜ Ë ·ÚıÚ›ÙÈ‰· (35,36). ∏ ¯ÔÚ‹ÁË-ÛË Saccharomyces boulardii ÛÂ ·È‰È¿ ÌÂ Ì¤ÙÚÈ·˜‚·Ú‡ÙËÙ·˜ ÂÓÂÚÁfi ÓfiÛÔ Crohn ¤Ù˘¯Â ÛËÌ·ÓÙÈÎ‹ÌÂ›ˆÛË ÙË˜ Û˘¯ÓfiÙËÙ·˜ ÙˆÓ ÎÂÓÒÛÂˆÓ Î·È ÙË˜ ‰Ú·-ÛÙËÚÈfiÙËÙ·˜ ÙË˜ ÓfiÛÔ˘, ÛÂ Û¯¤ÛË ÌÂ ÙÔ˘˜ Ì¿ÚÙ˘ÚÂ˜Ô˘ ‰ÂÓ ¤Ï·‚·Ó ÚÔ‚ÈÔÙÈÎfi (37). ∆· ÚÔ‚ÈÔÙÈÎ¿ Ê·›-ÓÂÙ·È Ó· Â›Ó·È ÙÔ ›‰ÈÔ ·ÔÙÂÏÂÛÌ·ÙÈÎ¿ ÌÂ ÙË ÌÂÛ·Ï·-˙›ÓË ÛÙË ‰È·Ù‹ÚËÛË ÙË˜ ‡ÊÂÛË˜ ÛÙË ÓfiÛÔ Crohn Î·ÈÛÙËÓ ÚfiÏË„Ë ÙˆÓ ˘ÔÙÚÔÒÓ (38). ™Â fi,ÙÈ ¤¯ÂÈ Û¯¤-ÛË ÌÂ ÙË ‰˘Û·ÓÂÍ›· ÛÙË Ï·ÎÙfi˙Ë, Ô Lactobacillusacidophilus Ê·›ÓÂÙ·È fiÙÈ ‚ÂÏÙÈÒÓÂÈ Ù· Û˘ÌÙÒÌ·Ù·,Ì¤Ûˆ ·Ú·ÁˆÁ‹˜ ‚-Á·Ï·ÎÙÔÛÈ‰¿ÛË˜ (39).

∆· ÚÔ‚ÈÔÙÈÎ¿ ¤¯Ô˘Ó ¯ÚËÛÈÌÔÔÈËıÂ› ÌÂ ÂÈÙ˘¯›·ÛÙËÓ ÚfiÏË„Ë, ·ÏÏ¿ Î·È ÛÙË ıÂÚ·Â›· ÙˆÓ ·ÏÏÂÚ-ÁÈÎÒÓ ÓfiÛˆÓ (40). ∏ ‰Ú¿ÛË ÙÔ˘˜ ÔÈÎ›ÏÏÂÈ. ∂ÓÈÛ¯‡-Ô˘Ó ÙÔÓ ‚ÏÂÓÓÔÁfiÓÈÔ ÊÚ·ÁÌfi ÙÔ˘ ÂÓÙ¤ÚÔ˘ (41) Î·È·ÓÙÈÛÙÚ¤ÊÔ˘Ó ÙËÓ ·˘ÍËÌ¤ÓË ‰È·ÂÚ·ÙfiÙËÙ· ÙÔ˘ÂÓÙ¤ÚÔ˘, Ô˘ ·Ú·ÙËÚÂ›Ù·È Û˘¯Ó¿ ÛÂ ·ÛıÂÓÂ›˜ ÌÂÙÚÔÊÈÎ‹ ·ÏÏÂÚÁ›· (42). ∂›ÛË˜, ÂÓÈÛ¯‡Ô˘Ó ÙËÓ ÂÈ‰È-Î‹, ÂÈÙÂÏÔ‡ÌÂÓË Ì¤Ûˆ IgA, ·¿ÓÙËÛË ÙÔ˘ ÂÓÙ¤ÚÔ˘,Ô˘ Û˘¯Ó¿ Â›Ó·È ÂÏÏÂÈÌÌ·ÙÈÎ‹ ÛÙÔ˘˜ ·Ú·¿Óˆ·ÛıÂÓÂ›˜ (42). ∆¤ÏÔ˜, ÌÂÈÒÓÔ˘Ó ÙËÓ ÚÔÎ·ÏÔ‡ÌÂÓË·fi ÙËÓ ·ÏÏÂÚÁ›· ÊÏÂÁÌÔÓÒ‰Ë ·ÓÙ›‰Ú·ÛË, Ì¤Ûˆ·Ú·ÁˆÁ‹˜ ·ÓÙÈÊÏÂÁÌÔÓˆ‰ÒÓ Î˘ÙÔÎÈÓÒÓ, fiˆ˜ ËÈÓÙÂÚÏÂ˘Î›ÓË 10 Î·È Ô ÌÂÙ·ÙÚÂÙÈÎfi˜ ·˘ÍËÙÈÎfi˜ ·-Ú¿ÁÔÓÙ·˜ ‚ (41). O˘ÛÈ·ÛÙÈÎ¿, Ù· ÚÔ‚ÈÔÙÈÎ¿ ·ÔÙÚ¤-Ô˘Ó ÙËÓ ÂÁÎ·Ù¿ÛÙ·ÛË ·ÓÔÛÔÏÔÁÈÎ‹˜ ·ÓÙ›‰Ú·ÛË˜ Ù‡-Ô˘ 2 (TH2) Î·È ‰È·‰Ú·Ì·Ù›˙Ô˘Ó Ú˘ıÌÈÛÙÈÎfi ÚfiÏÔÛÙËÓ ÙÔÈÎ‹, ·ÏÏ¿ Î·È ÙË Û˘ÛÙËÌ·ÙÈÎ‹ ÂÎ‰‹ÏˆÛËÊÏÂÁÌÔÓ‹˜ ÏfiÁˆ ¤ÎıÂÛË˜ ÛÂ ·ÏÏÂÚÁÈÔÁfiÓ· ÙÔ˘ ÂÚÈ-‚¿ÏÏÔÓÙÔ˜ (43). ™ÙËÓ ÎÏÈÓÈÎ‹ Ú¿ÍË Ù· ·Ú·¿Óˆ·Ô‰ÂÈÎÓ‡ÔÓÙ·È Ì¤Û· ·fi ÌÂÏ¤ÙÂ˜, fiÔ˘ Ë ¯ÔÚ‹ÁËÛËÚÔ‚ÈÔÙÈÎÒÓ ÛÂ ÂÁÎ‡Ô˘˜ Î·Ù¿ ÙÈ˜ ÙÂÏÂ˘Ù·›Â˜ Â‚‰ÔÌ¿-‰Â˜ ÙË˜ Î‡ËÛË˜ Î·È ÛÂ ÓÂÔÁÓ¿ ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙÔÓ ÙÔ-ÎÂÙfi ÌÂ›ˆÛÂ ÛËÌ·ÓÙÈÎ¿ ÙËÓ ÂÎ‰‹ÏˆÛË ·ÙÔ›·˜ (44).

O ÚfiÏÔ˜ ÙˆÓ ÚÔ‚ÈÔÙÈÎÒÓ ÛÙË ÌÂ›ˆÛË ÙˆÓ ÂÈ-¤‰ˆÓ ¯ÔÏËÛÙÂÚfiÏË˜ ‰ÂÓ Â›Ó·È ·fiÏ˘Ù· ÙÂÎÌËÚÈˆ-Ì¤ÓÔ˜, ·ÏÏ¿ ˘¿Ú¯Ô˘Ó ÌÂÏ¤ÙÂ˜ Ô˘ ‰Â›¯ÓÔ˘Ó ÙËÓ

May-June 03 03-06-03 16:55 ™ÂÏ›‰·225


226

Â˘ÓÔ˚Î‹ Â›‰Ú·Û‹ ÙÔ˘˜, È‰È·›ÙÂÚ· ÛÙ· Â›Â‰· ÙË˜LDL (45).

∆· ÚÔ‚ÈÔÙÈÎ¿ Ê·›ÓÂÙ·È Ó· ·˘Í¿ÓÔ˘Ó ÙË ‚ÈÔ‰È·-ıÂÛÈÌfiÙËÙ· ÙÔ˘ ·Û‚ÂÛÙ›Ô˘ Î·È ÙÔ˘ Ì·ÁÓËÛ›Ô˘ fiÙ·ÓÚÔÛÙ›ıÂÓÙ·È ÛÂ Á¿Ï·Ù·. ∂›ÛË˜, ÂÓ¤¯ÔÓÙ·È ÛÙËÓ·Ú·ÁˆÁ‹ ‚ÈÙ·ÌÈÓÒÓ ÙÔ˘ Û˘ÌÏ¤ÁÌ·ÙÔ˜ µ Î·È ÙÔ˘Ê˘ÏÏÈÎÔ‡ ÔÍ¤Ô˜ (46).

O Lactobacillus GG ¤¯ÂÈ Î·Ù·ÛÙ·ÏÙÈÎ‹ ‰Ú¿ÛËÛÙË ‚·ÎÙËÚÈ·Î‹ ÂÓ˙˘ÌÈÎ‹ ‰Ú·ÛÙËÚÈfiÙËÙ·. ∏ ¯ÔÚ‹-ÁËÛ‹ ÙÔ˘ ¤¯ÂÈ Û˘Ó‰ÂıÂ› ÌÂ ÌÂÈˆÌ¤ÓË ‰Ú·ÛÙËÚÈfiÙË-Ù· ÙˆÓ ÂÓ˙‡ÌˆÓ ‚-ÁÏ˘ÎÔ˘ÚÔÛÈ‰¿‰Ë˜, ‚-ÁÏ˘ÎÔÓÈ‰¿-ÛË˜, ÓÈÙÚÔÚÂ‰Ô˘ÎÙ¿ÛË˜ Î·È ·˙ˆÙÔÚÂ‰Ô˘ÎÙ¿ÛË˜, Ù·ÔÔ›· ıÂˆÚÂ›Ù·È fiÙÈ Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÙË ‰È¤ÁÂÚÛËÚÔÎ·ÚÎÈÓÔÁfiÓˆÓ Ô˘ÛÈÒÓ ÛÙÔ ·¯‡ ¤ÓÙÂÚÔ. ∂›-ÛË˜, Ê·›ÓÂÙ·È Ó· Û¯ÂÙ›˙ÂÙ·È ÌÂ ÌÂ›ˆÛË ÙˆÓ ÌÂÙ·Ï-Ï¿ÍÂˆÓ Ô˘ Û˘Ì‚·›ÓÔ˘Ó Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ˙ˆ‹˜Î·È Ô‰ËÁÔ‡Ó ÛÂ Î·ÚÎÈÓÔÁ¤ÓÂÛË (46).

∏ ¯Ú‹ÛË ÙˆÓ ÚÔ‚ÈÔÙÈÎÒÓ ÛÙÔÓ ·Ó·Ù˘ÛÛfiÌÂÓÔÎfiÛÌÔ, ÛÂ ·È‰È¿ ÌÂ ‰È·ÚÚÔ˚Î¿ Û‡Ó‰ÚÔÌ·, ˆ˜ Ì¤-ÚÔ˜ ÙˆÓ ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜ ¯ÔÚËÁÔ‡ÌÂÓˆÓ ËÏÂ-ÎÙÚÔÏ˘ÙÈÎÒÓ ‰È·Ï˘Ì¿ÙˆÓ, ›Ûˆ˜ ÚÔÛÊ¤ÚÂÈ ÔÏ‡ÙÈ-ÌË ‚Ô‹ıÂÈ· ÛÂ ·˘Ùfi ÙÔ ÙÂÚ¿ÛÙÈÔ Úfi‚ÏËÌ· ÙË˜ ‰Ë-ÌfiÛÈ·˜ ˘ÁÂ›·˜. ◊‰Ë, ÛÙÈ˜ Û˘ÛÙ¿ÛÂÈ˜ ÙË˜ ¶·ÁÎfi-ÛÌÈ·˜ OÚÁ¿ÓˆÛË˜ ÀÁÂ›·˜ (WHO) ÁÈ· ÙÔÓ ÂÚÈÔÚÈ-ÛÌfi ÙË˜ ¯Ú‹ÛË˜ ÙˆÓ ·ÓÙÈ‚ÈÔÙÈÎÒÓ, ÂÚÈÏ·Ì‚¿ÓÂÙ·ÈË ¯Ú‹ÛË ÚÔ‚ÈÔÙÈÎÒÓ fiˆ˜ ÔÈ Lactobacillirhamnosus Î·È plantarum.

∆· ÚÔ‚ÈÔÙÈÎ¿ ÚÔÛÙ›ıÂÓÙ·È ÛÂ Á¿Ï·Ù·, ‰È¿ÊÔ-Ú· Â›‰Ë ÁÈ·Ô˘ÚÙÈÔ‡, Ù˘ÚÈ¿, ÚÔÊ‹Ì·Ù· Î·È ·ÁˆÙ¿.™ÙËÓ π·ˆÓ›·, ÚˆÙÔfiÚÔ ¯ÒÚ· ÛÙËÓ ·Ú·ÛÎÂ˘‹ÔÚÁ·ÓÈÎÒÓ ÚÔ˚fiÓÙˆÓ, ÁÈ· Ó· ıÂˆÚËıÂ› Î¿ÔÈÔÚÔ˚fiÓ ÚÔ‚ÈÔÙÈÎ‹ ÙÚÔÊ‹, ı· Ú¤ÂÈ Ó· ÂÚÈ¤¯ÂÈ˙ˆÓÙ·ÓÔ‡˜ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜ ÛÂ ÔÛfiÙËÙ· ÙÔ˘Ï¿-¯ÈÛÙÔÓ 107/g ‹ ml ÚÔ˚fiÓÙÔ˜ (47). ¶·Ú·Ì¤ÓÂÈ, fiÌˆ˜,·‰ÈÂ˘ÎÚ›ÓÈÛÙÔ ·ÎfiÌË ÙÔ ÂÏ¿¯ÈÛÙÔ ÔÛfi ÙˆÓ ÚÔÛÙÈ-ı¤ÌÂÓˆÓ ÚÔ‚ÈÔÙÈÎÒÓ, Î·ıÒ˜ Î·È Ô È‰·ÓÈÎfi˜ ¯ÚfiÓÔ˜¯ÔÚ‹ÁËÛ‹˜ ÙÔ˘˜, ÒÛÙÂ Ó· ˘¿ÚÍÂÈ Â˘ÂÚÁÂÙÈÎfi ·Ô-Ù¤ÏÂÛÌ·. ™‹ÌÂÚ·, ÙÂ›ÓÂÈ Ó· ÂÈÎÚ·Ù‹ÛÂÈ Ë ¿Ô„ËfiÙÈ Û˘ÁÎ¤ÓÙÚˆÛË ÌÈÎÚfiÙÂÚË ·fi 105 ˙ˆÓÙ·ÓÒÓ ÌÈ-ÎÚÔÔÚÁ·ÓÈÛÌÒÓ ·Ó¿ g ‹ ml ÚÔ˚fiÓÙÔ˜ ‰ÂÓ Â›Ó·È ÈÎ·-Ó‹ Ó· ·Ú¿ÁÂÈ ıÂÙÈÎfi ·ÔÙ¤ÏÂÛÌ·, ·Ó Î·È Ë È‰·ÓÈÎ‹Û˘ÁÎ¤ÓÙÚˆÛË ÙÔ˘ ÚÔ‚ÈÔÙÈÎÔ‡ Û¯ÂÙ›˙ÂÙ·È ÌÂ ÙÔÛÙ¤ÏÂ¯Ô˜ Ô˘ ¯ÚËÛÈÌÔÔÈÂ›Ù·È, Î·ıÒ˜ Î·È ÌÂ ÙÔ Â›-‰Ô˜ ÙË˜ ÙÚÔÊ‹˜ ÛÙËÓ ÔÔ›· ÂÓÛˆÌ·ÙÒÓÂÙ·È (47).™ÙÔ ÂÌfiÚÈÔ Î˘ÎÏÔÊÔÚÔ‡Ó ÌÂ ÙË ÌÔÚÊ‹ ÛÎfiÓË˜,ÔÏÙÔ‡, Ù·ÌÏ¤Ù·˜, Î¿„Ô˘Ï·˜, ˘ÁÚÔ‡ ÂÓ·ÈˆÚ‹Ì·-ÙÔ˜ Î·È ÛÚ¤È. ÃÚËÛÈÌÔÔÈÔ‡ÓÙ·È Â˘Ú‡Ù·Ù· ÛÙËÓÎÙËÓÔÙÚÔÊ›·, ·ÏÏ¿ ÛÙ·‰È·Î¿ Î·ıÈÂÚÒÓÔÓÙ·È Î·È ˆ˜Û˘ÌÏËÚÒÌ·Ù· ÛÙËÓ ·ÓıÚÒÈÓË ‰È·ÙÚÔÊ‹. ¶¿-ÓÙˆ˜, ¯ÚÂÈ¿˙ÔÓÙ·È ·ÎfiÌË ·ÚÎÂÙ¤˜ ÌÂÏ¤ÙÂ˜ ÚÔÎÂÈ-Ì¤ÓÔ˘ Ó· ÁÂÓÈÎÂ˘ÙÂ› Ë ¯Ú‹ÛË ÙÔ˘˜ ˆ˜ ·ÛÊ·Ï‹ ‰È·-ÙÚÔÊÈÎ¿ Û˘ÌÏËÚÒÌ·Ù·. ¶ÚÔ‚Ï‹Ì·Ù· ËÁ¿˙Ô˘Ó·fi ÙËÓ ·ÓÔÌÔÈÔÌÔÚÊ›· ÙˆÓ ÌÂÏÂÙÒÓ, ·fi ÙÔ ÁÂÁÔ-

Ófi˜ fiÙÈ Û˘¯Ó¿ Â›Ó·È ‰‡ÛÎÔÏÔ Ó· ÂÓÙÔÈÛÙÔ‡Ó ÔÈ ÏË-ı˘ÛÌÔ› ÙˆÓ ÂÍˆÁÂÓÒ˜ ¯ÔÚËÁÔ‡ÌÂÓˆÓ ÚÔ‚ÈÔÙÈÎÒÓ,ÏfiÁˆ ‡·ÚÍË˜ ›‰ÈˆÓ ‹ ·Ú·Ï‹ÛÈˆÓ ÂÓ‰ÔÁÂÓÒÓÏËı˘ÛÌÒÓ, Î·ıÒ˜ Î·È ·fi ÙÔ fiÙÈ ·Ô‚¿ÏÏÔÓÙ·ÈÙ·¯‡Ù·Ù· ·fi ÙÔÓ ÔÚÁ·ÓÈÛÌfi (Ì¤Û· ÛÂ ÂÚ›Ô˘Ô¯ÙÒ ËÌ¤ÚÂ˜ ¤ˆ˜ Ï›ÁÂ˜ Â‚‰ÔÌ¿‰Â˜) ÌÂÙ¿ ÙË ‰È·ÎÔ-‹ ÙË˜ ¯ÔÚ‹ÁËÛ‹˜ ÙÔ˘˜.

∆· ÚÔ‚Ï‹Ì·Ù· Ô˘ ‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È ·fi ÙËÓÎ·Ù¿ÔÛË ˙ÒÓÙˆÓ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÒÓ, ˘ÂÚÛÎÂÏ›-˙Ô˘Ó ÛÂ Î¿ÔÈÔ ‚·ıÌfi Ù· ÚÂ‚ÈÔÙÈÎ¿, Ô˘Û›Â˜ ÌË ˙Ò-ÛÂ˜, ÔÈ ÔÔ›Â˜ ·ÔÙÂÏÔ‡Ó ˘fiÛÙÚˆÌ· ÁÈ· ÙËÓ ˘Â-Ú·Ó¿Ù˘ÍË Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ‚·ÎÙËÚÈ·ÎÒÓ ÔÌ¿‰ˆÓÔ˘ ‹‰Ë ˘¿Ú¯Ô˘Ó ÛÙÔ ÂÙÈÎfi Û‡ÛÙËÌ· ÙÔ˘ ÍÂÓÈ-ÛÙ‹ Î·È ·ÛÎÔ‡Ó Â˘ÂÚÁÂÙÈÎ‹ ‰Ú¿ÛË.

¶ÚÂ‚ÈÔÙÈÎ¿ ™˘ÛÙ·ÙÈÎ¿ ÙˆÓ ÙÚÔÊÒÓ, fiˆ˜ Ê˘ÙÈÎ¤˜ ›ÓÂ˜, Û‡Ó-

ıÂÙÂ˜ ÚˆÙÂ˝ÓÂ˜, ÌË ÂÙÔ› ˘‰·Ù¿ÓıÚ·ÎÂ˜ (ÔÏÈÁÔ-Î·È ÔÏ˘Û·Î¯·Ú›ÙÂ˜) Î·È ÔÚÈÛÌ¤Ó· ÏÈ›‰È·, Ô˘ ‰ÂÓ˘fiÎÂÈÓÙ·È ÛÂ ÂÓ˙˘ÌÈÎ‹ ‰È¿Û·ÛË ÛÙÔ ÏÂÙfi ¤ÓÙÂÚÔÎ·È Êı¿ÓÔ˘Ó ·Ó·ÏÏÔ›ˆÙ· ÛÙÔ ·¯‡ ¤ÓÙÂÚÔ, Û˘Ì-‚¿ÏÏÔ˘Ó ÛÙË ıÚ¤„Ë ÙÔ˘ ‚ÏÂÓÓÔÁfiÓÔ˘ ÙÔ˘. ∞Ó·Ê¤-ÚÔÓÙ·È ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· ˆ˜ “ÙÚÔÊ‹ ÙÔ˘ ·¯¤Ô˜ÂÓÙ¤ÚÔ˘”. ∏ “ÙÚÔÊ‹ ÙÔ˘ ·¯¤Ô˜ ÂÓÙ¤ÚÔ˘” ·ÔÙÂÏÂ›˘fiÛÙÚˆÌ· ÁÈ· Ù· ‚·ÎÙËÚ›‰È· ÙÔ˘ ·¯¤Ô˜ ÂÓÙ¤ÚÔ˘,Ù· ÔÔ›· ‰È·ÛÒÓÙ·˜ ÙËÓ, ÙÚÔÊÔ‰ÔÙÔ‡Ó ÙÔÓ ÔÚÁ·-ÓÈÛÌfi ÌÂ ··Ú·›ÙËÙ· ıÚÂÙÈÎ¿ Û˘ÛÙ·ÙÈÎ¿ Î·È ÂÓ¤Ú-ÁÂÈ·. ™˘ÓÈÛÙ¿Ù·È Ó· ·Ú¤¯ÂÙ·È ÙÔ 10% ÙˆÓ ËÌÂÚ‹-ÛÈˆÓ ıÂÚÌ›‰ˆÓ Î·È ÙÔ 20% ÙÔ˘ Û˘ÓÔÏÈÎÔ‡ fiÁÎÔ˘ÙË˜ ËÌÂÚ‹ÛÈ·˜ ‰È·ÙÚÔÊ‹˜ ÌÂ ÙË ÌÔÚÊ‹ “ÙË˜ ÙÚÔÊ‹˜ÙÔ˘ ·¯¤Ô˜ ÂÓÙ¤ÚÔ˘” (48). ∆· ÂÚÈÛÛfiÙÂÚ· Û˘ÛÙ·ÙÈ-Î¿ “ÙË˜ ÙÚÔÊ‹˜ ÙÔ˘ ·¯¤Ô˜ ÂÓÙ¤ÚÔ˘” ·ÔÙÂÏÔ‡Ó˘fiÛÙÚˆÌ· ÌË ÂÈ‰ÈÎ‹˜ ˙‡ÌˆÛË˜ ·fi ‰È·ÊÔÚÂÙÈÎ¿ Â›-‰Ë ‚·ÎÙËÚ›ˆÓ ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ·˘ÏÔ‡, Û˘ÌÂÚÈÏ·Ì‚·-ÓÔÌ¤ÓˆÓ ÂÓ›ÔÙÂ Î·È ·ıÔÁfiÓˆÓ ÛÙÂÏÂ¯ÒÓ.

™˘ÛÙ·ÙÈÎ¿ “ÙË˜ ÙÚÔÊ‹˜ ÙÔ˘ ·¯¤Ô˜ ÂÓÙ¤ÚÔ˘” Ô˘·ÔÙÂÏÔ‡Ó ·ÔÎÏÂÈÛÙÈÎfi ˘fiÛÙÚˆÌ· ÂÈ‰ÈÎ‹˜ ÂÓ˙˘ÌÈ-Î‹˜ ‰È¿Û·ÛË˜ ·fi ˆÊ¤ÏÈÌ· ÁÈ· ÙÔÓ ÔÚÁ·ÓÈÛÌfi ‚·-ÎÙ‹ÚÈ·, fiˆ˜ lactobacilli Î·È bifidobacteria, Î·Ù·Ù¿Û-ÛÔÓÙ·È ÛÙ· ÚÂ‚ÈÔÙÈÎ¿.

∆· ÚÂ‚ÈÔÙÈÎ¿ Â›Ó·È ÌË ÂÙÒÌÂÓ· ÙÚÔÊÈÎ¿ Û˘-ÛÙ·ÙÈÎ¿ Ô˘ ÂËÚÂ¿˙Ô˘Ó Â˘ÂÚÁÂÙÈÎ¿ ÙÔÓ ÍÂÓÈÛÙ‹,ÚÔ¿ÁÔÓÙ·˜ ÙËÓ ·‡ÍËÛË Î·È ÂÓÂÚÁÔÔÈÒÓÙ·˜ ÂÎÏÂ-ÎÙÈÎ¿ ÙË ‰Ú·ÛÙËÚÈfiÙËÙ· ÂÚÈÔÚÈÛÌ¤ÓÔ˘ ·ÚÈıÌÔ‡“ˆÊ¤ÏÈÌˆÓ” ‚·ÎÙËÚ›ˆÓ Ô˘ ‹‰Ë ·ÔÈÎÔ‡Ó ÙÔ ¤ÓÙÂ-ÚÔ, Û˘ÓÙÂÏÒÓÙ·˜ ÛÙË ‚ÂÏÙ›ˆÛË ÙË˜ ˘ÁÂ›·˜ ÙÔ˘ ÍÂ-ÓÈÛÙ‹ (49). ™ÙËÓ ÏÂÈÔ„ËÊ›· ÙÔ˘˜ ÚfiÎÂÈÙ·È ÁÈ·˘‰·Ù¿ÓıÚ·ÎÂ˜ ÌÈÎÚ‹˜ ·Ï˘Û›‰·˜ Ô˘ ‰ÂÓ ‰È·ÛÒ-ÓÙ·È ·fi Ù· ¤Ó˙˘Ì· ÙÔ˘ ·ÁÎÚ¤·ÙÔ˜ Î·È ÂÎÂ›Ó· ÙË˜„ËÎÙÚÔÂÈ‰Ô‡˜ ·Ú˘Ê‹˜ ÙÔ˘ ÏÂÙÔ‡ ÂÓÙ¤ÚÔ˘ Î·ÈÁÈ· ÙÔ ÏfiÁÔ ·˘Ùfi Î·ÏÔ‡ÓÙ·È ÌË ÂÙÔ› ÔÏÈÁÔÛ·Î¯·-Ú›ÙÂ˜ (50).

°È· Ó· ¯·Ú·ÎÙËÚÈÛÙÂ›, ÂÔÌ¤Óˆ˜, ¤Ó· Û˘ÛÙ·ÙÈÎfi

May-June 03 03-06-03 16:55 ™ÂÏ›‰·226


227

ÙË˜ ÙÚÔÊ‹˜ ˆ˜ ÚÂ‚ÈÔÙÈÎfi ı· Ú¤ÂÈ: ·) Ó· ÌËÓ˘‰ÚÔÏ‡ÂÙ·È, Ô‡ÙÂ Ó· ·ÔÚÚÔÊ¿Ù·È ·fi ÙÔ ·ÓÒÙÂÚÔÙÌ‹Ì· ÙÔ˘ ÂÙÈÎÔ‡, ‚) Ó· ·ÔÙÂÏÂ› ÂÎÏÂÎÙÈÎfi ˘fi-ÛÙÚˆÌ· ÁÈ· ÔÚÈÛÌ¤ÓÔ ·ÚÈıÌfi ‚·ÎÙËÚ›ˆÓ Ô˘ ¤¯Ô˘ÓÂ˘ÂÚÁÂÙÈÎ‹ ‰Ú¿ÛË ÛÙÔÓ ÍÂÓÈÛÙ‹ Î·È Á) Ó· ÌÔÚÂ› Ó·ÌÂÙ·‚¿ÏÂÈ ÙË ÌÈÎÚÔ¯ÏˆÚ›‰· ÙÔ˘ ÂÓÙ¤ÚÔ˘ ÚÔ˜ Ì›·ÏÂÔÓÂÎÙÈÎfiÙÂÚË, ÁÈ· ÙËÓ ˘ÁÂ›· ÙÔ˘ ÍÂÓÈÛÙ‹, Û‡-ÛÙ·ÛË (10,48,49).

∞·ÓÙÒÓÙ·È ÛÙÔ ÎÚÂÌÌ‡‰È, ÙËÓ ·ÁÎÈÓ¿Ú·, Ù·Û·Ú¿ÁÁÈ·, Ù· Ú·‰›ÎÈ· Î·È ÛÙË Ì·Ó¿Ó·. OÈ È‰ÈfiÙË-Ù¤˜ ÙÔ˘˜ ÂÍ·ÚÙÒÓÙ·È ·fi ÙË ¯ËÌÈÎ‹ ÙÔ˘˜ ‰ÔÌ‹, ÙÔÌÔÚÈ·Îfi ÙÔ˘˜ ‚¿ÚÔ˜ Î·È ·fi ÙÔ ÔÛÔÛÙfi ÌÔÓÔÛ·Î-¯·ÚÈÙÒÓ Î·È ‰ÈÛ·Î¯·ÚÈÙÒÓ Ô˘ ÂÚÈ¤¯Ô˘Ó (10). ∏Â˘ÓÔ˚Î‹ ÁÈ· ÙÔÓ ÍÂÓÈÛÙ‹ ‰Ú¿ÛË ÙÔ˘˜ ÂÈÙ˘Á¯¿ÓÂÙ·ÈÌ¤Ûˆ ÚÔ·ÁˆÁ‹˜ ÙË˜ ·Ó¿Ù˘ÍË˜ ÙˆÓ ˆÊ¤ÏÈÌˆÓ‚·ÎÙËÚ›ˆÓ, Ì¤Ûˆ ‰Ú·ÛÙËÚÈÔÔ›ËÛË˜ ·˘ÙÒÓ ‹ Ì¤ÛˆÛ˘Ó‰˘·ÛÌÔ‡ ÙˆÓ ·Ú·¿Óˆ ‰Ú¿ÛÂˆÓ.

¶ÚÔ˜ ÙÔ ·ÚfiÓ, ÔÈ ÂÚÈÛÛfiÙÂÚÂ˜ ¤ÚÂ˘ÓÂ˜ ÁÈ·Ù· ÚÂ‚ÈÔÙÈÎ¿ Î·ÙÂ˘ı‡ÓÔÓÙ·È ÚÔ˜ ÙËÓ ·Ó¿Ù˘ÍËÔ˘ÛÈÒÓ Ô˘ ·ÔÙÂÏÔ‡Ó ˘fiÛÙÚˆÌ· ÌÈÎÚÔÔÚÁ·ÓÈ-ÛÌÒÓ Ô˘ ·Ú¿ÁÔ˘Ó Á·Ï·ÎÙÈÎfi ÔÍ‡, ÏfiÁˆ ÙˆÓ Â˘-ÂÚÁÂÙÈÎÒÓ È‰ÈÔÙ‹ÙˆÓ Ô˘ Ê·›ÓÂÙ·È Ó· ¤¯Ô˘Ó ÔÈ ÌÈ-ÎÚÔÔÚÁ·ÓÈÛÌÔ› ·˘ÙÔ› ÁÈ· ÙÔÓ ·ÓıÚÒÈÓÔ ÔÚÁ·ÓÈ-ÛÌfi. ¶·Ú’ fiÏ· ·˘Ù¿, ›Ûˆ˜ Î¿ÔÈÂ˜ ÌÂÏÏÔÓÙÈÎ¤˜ ÌÂ-Ï¤ÙÂ˜ Ó· Û˘ÌÂÚÈÏ¿‚Ô˘Ó Î·È Ô˘Û›Â˜ Ô˘ ı· Û¯ÂÙ›-˙ÔÓÙ·È ÌÂ ÙËÓ ·ÚÂÌfi‰ÈÛË ÙË˜ ·Ó¿Ù˘ÍË˜ ·ıÔ-ÁfiÓˆÓ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÒÓ. ŒÓ· Ù¤ÙÔÈÔ ·Ú¿‰ÂÈÁÌ··ÔÙÂÏÂ› Ë Ô˘Û›· cellobiose, Ë ÔÔ›· ·Ô‰Â›¯ÙËÎÂfiÙÈ ÌÂÈÒÓÂÈ ÙË ÏÔÈÌÔÁfiÓÔ ‰‡Ó·ÌË ÙË˜ Listeriamonocytoges (51).

∆· Û˘Ó‹ıË ÚÂ‚ÈÔÙÈÎ¿ Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 3. OÈ ÊÚÔ˘ÎÙÔÔÏÈÛ·Î¯·Ú›ÙÂ˜ ·ÔÙÂÏÔ‡Ó Ì›· ÌÂÁ¿ÏË

Î·ÙËÁÔÚ›· Ê˘ÛÈÎÒÓ ÔÏÈÁÔÛ·Î¯·ÚÈÙÒÓ. ¶ÚfiÎÂÈÙ·È ÁÈ·ÔÏÈÁÔÌÂÚ‹ ÙË˜ ÊÚÔ˘ÎÙfi˙Ë˜ Ô˘, ·Ó¿ÏÔÁ· ÌÂ ÙÔÓ ‚·ı-Ìfi ÔÏ˘ÌÂÚÈÛÌÔ‡ ÙÔ˘˜, ‰È·ÎÚ›ÓÔÓÙ·È ÛÙËÓ ÈÓÔ˘Ï›ÓË(‚·ıÌfi˜ ÔÏ˘ÌÂÚÈÛÌÔ‡ 2-60) Î·È ÛÙËÓ ÔÏÈÁÔÊÚÔ˘ÎÙfi-˙Ë (Ì¤ÛÔ˜ ‚·ıÌfi˜ ÔÏ˘ÌÂÚÈÛÌÔ‡ 4) (52,53).

∞fi ÔÏÏ¤˜ ÌÂÏ¤ÙÂ˜ ¤¯ÂÈ ÙÂÎÌËÚÈˆıÂ› fiÙÈ Ë ÈÓÔ˘-Ï›ÓË Ô˘ ÚÔ¤Ú¯ÂÙ·È ·fi Ù· Ú·‰›ÎÈ·, ·˘Í¿ÓÂÈ ÙÔ˘˜ÏËı˘ÛÌÔ‡˜ ÙˆÓ bifidobacteria Î·È ·Ó·ÛÙ¤ÏÏÂÈ ÙËÓ·Ó¿Ù˘ÍË ÌË Â˘ÓÔ˚ÎÒÓ ÁÈ· ÙÔÓ ¿ÓıÚˆÔ ‚·ÎÙËÚ›ˆÓ(52-55).

OÈ ÊÚÔ˘ÎÙÔÔÏÈÛ·Î¯·Ú›ÙÂ˜ Â›Ó·È Ù· Ï¤ÔÓ ÌÂÏÂ-ÙËÌ¤Ó· ˆ˜ Û‹ÌÂÚ· ÚÂ‚ÈÔÙÈÎ¿. ∞ÔÙÂÏÔ‡Ó ÂÈ‰ÈÎfi˘fiÛÙÚˆÌ· ÁÈ· Ù· bifidobacteria, Ù· ÔÔ›· fiÙ·Ó ˙˘-ÌÒÓÔ˘Ó ÙÔ˘˜ ÊÚÔ˘ÎÙÔÔÏÈÛ·Î¯·Ú›ÙÂ˜, ÙÔ Î¿ÓÔ˘Ó ÛÂ‚¿ÚÔ˜ ÙˆÓ bacteroides, clostridia Î·È coliforms. ∞˘-Ùfi ˘ÔÛÙËÚ›˙ÂÙ·È Î·È ·fi Ù· ÂÈÚ·Ì·ÙÈÎ¿ ÌÔÓÙ¤Ï·Î·ÏÏÈÂÚÁÂÈÒÓ ÙˆÓ Gibson Î·È Wang (55), ÔÈ ÔÔ›ÔÈÎ·ÏÏÈ¤ÚÁËÛ·Ó, ÛÂ Û˘Óı‹ÎÂ˜ ÂÏÂÁ¯fiÌÂÓÔ˘ pH,bifidobacterium infantis, e. coli Î·È c. perfingens,¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ˆ˜ ˘fiÛÙÚˆÌ· ÔÏÈÁÔÊÚÔ˘ÎÙfi˙Ë.∆Ô bifidobacterium infantis ·Ó·Ù‡¯ıËÎÂ ÛÂ ‚¿ÚÔ˜

ÙˆÓ ˘ÔÏÔ›ˆÓ. ∆· ·ÔÙÂÏ¤ÛÌ·Ù· ÙˆÓ in vitro ÌÂ-ÏÂÙÒÓ ÙˆÓ ·Ú·¿Óˆ ÂÚÂ˘ÓËÙÒÓ Â·ÏËıÂ‡ÙËÎ·Ó·fi in vivo ÌÂÏ¤ÙÂ˜ (56). ∏ ÂÈ‰ÈÎfiÙËÙ· ·˘Ù‹ ÙˆÓbifidobacteria ÚÔ˜ ÙÔ˘˜ ÊÚÔ˘ÎÙÔÔÏÈÛ·Î¯·Ú›ÙÂ˜ÈÛÙÂ‡ÂÙ·È fiÙÈ ÔÊÂ›ÏÂÙ·È ÛÙËÓ ÈÎ·ÓfiÙËÙ¿ ÙÔ˘˜ Ó··Ú¿ÁÔ˘Ó ‚-ÊÚÔ˘ÎÙÔÛÈ‰¿ÛË.

∏ ·Ó·ÛÙÔÏ‹ ÙË˜ ·Ó¿Ù˘ÍË˜ ‚·ÎÙËÚ›ˆÓ, fiˆ˜clostridia, e. coli Î·È ÔÏÏÒÓ ¿ÏÏˆÓ ÂÓÙÂÚÔ·ıÔÁfi-ÓˆÓ, fiˆ˜ listeria, shigella, salmonella Î·È v.Cholerae, ÔÊÂ›ÏÂÙ·È ÛÙËÓ ·ÂÏÂ˘ı¤ÚˆÛË ‚·ÎÙËÚÈÔ-ÎÙfiÓˆÓ Ô˘ÛÈÒÓ ·fi Ù· bifidobacteria (57,58). ∆Ô ÁÂ-ÁÔÓfi˜ fiÙÈ ÔÈ ÊÚÔ˘ÎÙÔÔÏÈÛ·Î¯·Ú›ÙÂ˜ ·ÔÙÂÏÔ‡Ó ÂÈ-‰ÈÎfi ˘fiÛÙÚˆÌ· ÁÈ· ÙËÓ ÂÎÏÂÎÙÈÎ‹ ·Ó¿Ù˘ÍË ÙˆÓbifidobacteria ¤¯ÂÈ ·Ô‰ÂÈ¯ÙÂ› Î·È ·fi ¿ÏÏÂ˜ ÌÂÏ¤-ÙÂ˜, fiÔ˘ ˘ÁÈÂ›˜ ÂıÂÏÔÓÙ¤˜, fiÙ·Ó ÂÏ¿Ì‚·Ó·Ó 3x5 gÊÚÔ˘ÎÙÔÔÏÈÛ·Î¯·ÚÈÙÒÓ ·Ó¿ ËÌ¤Ú·, ·‡ÍËÛ·Ó Ù·bifidobacteria ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ÂÚÈÂ¯ÔÌ¤ÓÔ˘ ÙÔ˘˜·fi 6% ¤ˆ˜ 22%. ™Â ÚfiÛÊ·Ù· ‰ËÌÔÛÈÂ˘Ì¤ÓË ÌÂ-Ï¤ÙË (59) ˘ÔÛÙËÚ›˙ÂÙ·È fiÙÈ Ô ÂÌÏÔ˘ÙÈÛÌfi˜ ÙÔ˘Á¿Ï·ÎÙÔ˜ ‚ÚÂÊÒÓ ÌÂ Ì›ÁÌ· Á·Ï·ÎÙÔ- Î·È ÊÚÔ˘ÎÙÔ-ÔÏÈÛ·Î¯·ÚÈÙÒÓ Â˘ÓÔÂ› ÙËÓ ·Ó¿Ù˘ÍË ÙˆÓbifidobacteria Î·È ÙˆÓ lactobacilli, ÌÂ ÙÚfiÔ ‰ÔÛÔÂ-Í·ÚÙÒÌÂÓÔ Î·È ¯ˆÚ›˜ ·ÚÂÓ¤ÚÁÂÈÂ˜. ∂›Ó·È ÛËÌ·ÓÙÈ-Îfi Ó· ÙÔÓÈÛÙÂ› fiÙÈ ÌÂÏ¤ÙÂ˜ ÛÂ ÂÓ‹ÏÈÎÂ˜ (60,61), ·Ï-Ï¿ Î·È ÛÂ ÂÈÚ·Ì·Ùfi˙ˆ· (62,63) Û˘ÁÎÏ›ÓÔ˘Ó ÛÙÔ fiÙÈË ·Ó¿Ù˘ÍË ÙˆÓ bifidobacteria Â›Ó·È ·Ó¿ÏÔÁË ÙË˜ÚÔ¸¿Ú¯Ô˘Û·˜ Û˘ÁÎ¤ÓÙÚˆÛË˜ bifidobacteria ÛÙÔ¤ÓÙÂÚÔ, ÂÓÒ fiÙ·Ó ·˘Ù¿ ·Ô˘ÛÈ¿˙Ô˘Ó ·fi ÙËÓ ·Ú¯È-Î‹ ÂÓÙÂÚÈÎ‹ ¯ÏˆÚ›‰·, Ë ÂÍˆÁÂÓ‹˜ ¯ÔÚ‹ÁËÛË ÚÂ-‚ÈÔÙÈÎÒÓ Â›Ó·È ÂÓÙÂÏÒ˜ ·Ó·ÔÙÂÏÂÛÌ·ÙÈÎ‹.

OÈ ÊÚÔ˘ÎÙÔÔÏÈÛ·Î¯·Ú›ÙÂ˜ Ê·›ÓÂÙ·È fiÙÈ ·ÛÎÔ‡ÓÂ˘ÓÔ˚Î‹ Â›‰Ú·ÛË ÛÙËÓ ·ÔÚÚfiÊËÛË ÈfiÓÙˆÓ fiˆ˜Ô Û›‰ËÚÔ˜, ÙÔ ·Û‚¤ÛÙÈÔ Î·È ÙÔ Ì·ÁÓ‹ÛÈÔ, Ì¤Ûˆ ÙË˜·Ú·ÁˆÁ‹˜ - Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÂÓ˙˘ÌÈÎ‹˜ ÙÔ˘˜˙‡ÌˆÛË˜ - ÏÈ·ÚÒÓ ÔÍ¤ˆÓ ‚Ú·¯Â›·˜ ·Ï‡ÛÔ˘ Î·È Á·-Ï·ÎÙÈÎÔ‡ ÔÍ¤Ô˜. º·›ÓÂÙ·È, Â›ÛË˜, fiÙÈ Â›Ó·È ·ÔÙÂ-ÏÂÛÌ·ÙÈÎÔ› ÛÙË ÌÂ›ˆÛË ÙˆÓ ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ ÙÔ˘ÔÚÔ‡, ÛÙË ÌÂ›ˆÛË ÂÓ·fiıÂÛË˜ Ï›Ô˘˜ ÛÙÔ˘˜ÈÛÙÔ‡˜ Î·È ÛÙËÓ ÂÏ¿ÙÙˆÛË ÙˆÓ ÊˆÛÊÔÏÈÈ‰›ˆÓ, Ïfi-Áˆ Èı·ÓÒ˜ ÙË˜ ÙÚÔÔÔ›ËÛË˜ ÙÔ˘ Ë·ÙÈÎÔ‡ ÌÂÙ·-‚ÔÏÈÛÌÔ‡ ÙÔ˘ Ï›Ô˘˜. OÈ ·Ú·¿Óˆ ıÂˆÚ›Â˜ ¯ÚÂÈ¿-˙ÔÓÙ·È ÂÚ·ÈÙ¤Úˆ ÙÂÎÌËÚ›ˆÛË.

¶¿ÓÙˆ˜, Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÙfiÛÔ Ë ÈÓÔ˘Ï›ÓË,fiÛÔ Î·È Ë ÔÏÈÁÔÊÚÔ˘ÎÙfi˙Ë ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÛÙÈ˜‚ÈÔÌË¯·Ó›Â˜ ÙÚÔÊ›ÌˆÓ Â˘Ú‡Ù·Ù·. ∏ ¯Ú‹ÛË ÙÔ˘˜

¶›Ó·Î·˜ 3. ™˘Ó‹ıË ÚÂ‚ÈÔÙÈÎ¿

ºÚÔ˘ÎÙÔÔÏÈÛ·Î¯·Ú›ÙÂ˜ [ÔÏÈÁÔÊÚÔ˘ÎÙfi˙Ë, ÈÓÔ˘Ï›ÓË Î·È Û˘ÓıÂÙÈÎÔ› ˘‰·Ù¿ÓıÚ·ÎÂ˜(Neosugar)]

°·Ï·ÎÙÔÔÏÈÛ·Î¯·Ú›ÙÂ˜§·ÎÙÔ˘Ïfi˙Ë §·ÎÙÈÙfiÏË

May-June 03 03-06-03 16:55 ™ÂÏ›‰·227


228

Û˘ÓÂÈÛÊ¤ÚÂÈ ÛÙËÓ ·‡ÍËÛË ÙÔ˘ ÂÚÈÂ¯ÔÌ¤ÓÔ˘ ÙˆÓ ÙÚÔ-ÊÒÓ ÛÂ ‰È·ÈÙËÙÈÎ¤˜ ›ÓÂ˜, ÛÙË ÌÂ›ˆÛË ÙË˜ ıÂÚÌÈ‰ÈÎ‹˜·Í›·˜ ÙÔ˘˜ Î·È ÛÙË ‚ÂÏÙ›ˆÛË ÙˆÓ ‰˘Ó·ÙÔÙ‹ÙˆÓ ÙˆÓÙÚÔÊ›ÌˆÓ Ó· ·˘Í¿ÓÔ˘Ó ÙÔ˘˜ ÏËı˘ÛÌÔ‡˜ ÙˆÓ ˆÊ¤ÏÈ-ÌˆÓ ‚·ÎÙËÚ›ˆÓ ÛÙÔ ¤ÓÙÂÚÔ ·˘ÙÒÓ Ô˘ Î·Ù·Ó·ÏÒÓÔ˘ÓÙÈ˜ Û˘ÁÎÂÎÚÈÌ¤ÓÂ˜ ÙÚÔÊ¤˜. ∏ Î·Ù·Ó¿ÏˆÛË ÔÏÈÁÔ-ÊÚÔ˘ÎÙfi˙Ë˜ Û˘ÓÙÂÏÂ› Î·È ÛÙËÓ Î·Ï‡ÙÂÚË ÛÙÔÌ·ÙÈÎ‹˘ÁÈÂÈÓ‹, Î·ıÒ˜ ÈÛÙÂ‡ÂÙ·È fiÙÈ ÌÂÈÒÓÂÈ ÙËÓ ÙÂÚË‰fiÓ·.

ª›· ¿ÏÏË ÛËÌ·ÓÙÈÎ‹ ÔÌ¿‰· ÔÏÈÁÔÛ·Î¯·ÚÈÙÒÓ Â›-Ó·È ÔÈ Á·Ï·ÎÙÔÔÏÈÛ·Î¯·Ú›ÙÂ˜. OÈ Á·Ï·ÎÙÔÔÏÈÛ·Î¯·-Ú›ÙÂ˜ Ê˘ÛÈÔÏÔÁÈÎ¿ ·ÓÂ˘Ú›ÛÎÔÓÙ·È ÛÙÔ ÌËÙÚÈÎfi Á¿Ï·Î·È ÛÂ ·˘ÙÔ‡˜ ·Ô‰›‰ÂÙ·È Ë ‰È·ÊÔÚÂÙÈÎ‹ ¯ÏˆÚ›‰·ÙÔ˘ ÂÙÈÎÔ‡ ÙˆÓ ıËÏ·˙fiÓÙˆÓ ‚ÚÂÊÒÓ (64). ™‹ÌÂÚ·,Â›Ó·È ‰˘Ó·Ù‹ Î·È Ë ‚ÈÔÌË¯·ÓÈÎ‹ ·Ú·ÛÎÂ˘‹ ÙÔ˘˜.

OÈ ÔÏÈÁÔÛ·Î¯·Ú›ÙÂ˜ Î·È ÔÈ Û‡ÌÏÔÎÔÈ ˘‰·Ù¿Ó-ıÚ·ÎÂ˜ ÙÔ˘ ÌËÙÚÈÎÔ‡ Á¿Ï·ÎÙÔ˜ ·ÔÙÂÏÔ‡Ó ÙÔ ÙÚ›ÙÔÛÂ ÔÛfiÙËÙ· ÛÙÂÚÂfi Û˘ÛÙ·ÙÈÎfi ÙÔ˘, ÌÂÙ¿ ÙÔ Ï›Ô˜Î·È ÙË Ï·ÎÙfi˙Ë (65). ∏ Û˘ÁÎ¤ÓÙÚˆÛ‹ ÙÔ˘˜ ÛÙÔ ‡·Ú·Ó¤Ú¯ÂÙ·È ÂÚ›Ô˘ ÛÂ 22 g/L Î·È ÛÙÔ ÒÚÈÌÔ Á¿Ï· ÛÂ12 g/L (65). OÈ ÔÏÈÁÔÛ·Î¯·Ú›ÙÂ˜ Â›Ó·È Û‡ÓıÂÙ· Û¿Î-¯·Ú· ÂÓˆÌ¤Ó· ÌÂ ÌfiÚÈ· Ï·ÎÙfi˙Ë˜ ÛÙÔ ·Ó·ÁˆÁÈÎfiÙÔ˘˜ ¿ÎÚÔ Î·È ÌfiÚÈ· ÊÔ˘Îfi˙Ë˜ ‹ ÛÈ·ÏÈÎÔ‡ ÔÍ¤Ô˜ÛÙÔ ÌË ·Ó·ÁˆÁÈÎfi ÙÔ˘˜ ¿ÎÚÔ. OÈ Û‡ÌÏÔÎÔÈ ˘‰·-Ù¿ÓıÚ·ÎÂ˜ Â›Ó·È Î·È ·˘ÙÔ› Û‡ÓıÂÙ· Û¿Î¯·Ú·, Ô˘fiÌˆ˜ Â›Ó·È ÂÓˆÌ¤Ó· ÌÂ ÚˆÙÂ˝ÓÂ˜, ÏÈ›‰È· ‹ ¿ÏÏ·ÌfiÚÈ·, ÛÂ ‰ÔÌ¤˜ Ô˘ Î·ÏÔ‡ÓÙ·È ÁÏ˘ÎÔÚˆÙÂ˝ÓÂ˜,ÁÏ˘ÎÔÏÈ›‰È·, ÁÏ˘ÎÔ˙·ÌÈÓÔÁÏ˘Î¿ÓÂ˜, ‚ÏÂÓÓ›ÓÂ˜(mucins) Î.¿. Œ¯ÂÈ ·Ô‰ÂÈ¯ÙÂ› fiÙÈ ÔÈ ÔÏÈÁÔÛ·Î¯·Ú›-ÙÂ˜ Î·È ÔÈ Û‡ÌÏÔÎÔÈ ˘‰·Ù¿ÓıÚ·ÎÂ˜ ÙÔ˘ ÌËÙÚÈÎÔ‡Á¿Ï·ÎÙÔ˜ ‰È·‰Ú·Ì·Ù›˙Ô˘Ó ÚfiÏÔ˘˜ ÎÏÂÈ‰È¿ ÛÙËÓ¿Ì˘Ó· ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ‚ÏÂÓÓÔÁfiÓÔ˘ ÂÓ·ÓÙ›ÔÓ ·ıÔ-ÁfiÓˆÓ ‚·ÎÙËÚ›ˆÓ, ÈÒÓ Î·È ·Ú·Û›ÙˆÓ. ™˘ÁÎÂÎÚÈÌ¤-Ó·, Ù· ‚·ÎÙ‹ÚÈ· Ô˘ ÂÈÛ¤Ú¯ÔÓÙ·È ÛÙÔÓ ÂÓÙÂÚÈÎfi ·˘-Ïfi ÁÈ· Ó· ·ÛÎ‹ÛÔ˘Ó ÙËÓ ·ıÔÁfiÓÔ ‰Ú¿ÛË ÙÔ˘˜ ı·Ú¤ÂÈ Ó· ÚÔÛÎÔÏÏËıÔ‡Ó ÛÙÔÓ ÂÓÙÂÚÈÎfi ‚ÏÂÓÓÔ-ÁfiÓÔ. ∏ ÚÔÛÎfiÏÏËÛË Ú·ÁÌ·ÙÔÔÈÂ›Ù·È ÛÂ ı¤ÛÂÈ˜-˘Ô‰Ô¯Â›˜ ÙˆÓ ÏÂÎÙÈÓÒÓ ÙˆÓ ‚·ÎÙËÚ›ˆÓ. ∞˘Ù¤˜ ÔÈı¤ÛÂÈ˜-˘Ô‰Ô¯Â›˜ ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ‚ÏÂÓÓÔÁfiÓÔ˘ Û˘Ó›-ÛÙ·ÓÙ·È ·fi ÁÏ˘ÎÔÚˆÙÂ˝ÓÂ˜ Î·È ÁÏ˘ÎÔÏÈ›‰È· ÙË˜ÂÈÊ¿ÓÂÈ·˜ ÙˆÓ ÂÓÙÂÚÈÎÒÓ Î˘ÙÙ¿ÚˆÓ, ÙˆÓ ÔÔ›ˆÓÙÔ ÔÏÈÁÔÛ·Î¯·ÚÈÎfi ÙÌ‹Ì· ÚÔ¤¯ÂÈ Ì¤Û· ÛÙÔÓ ÂÓÙÂ-ÚÈÎfi ·˘Ïfi. OÈ ÔÏÈÁÔÛ·Î¯·Ú›ÙÂ˜ ÙÔ˘ ÌËÙÚÈÎÔ‡ Á¿Ï·-ÎÙÔ˜ ·ÔÙÂÏÔ‡Ó ÔÌfiÏÔÁÂ˜ ‰ÔÌ¤˜ ÙˆÓ ÔÏÈÁÔÛ·Î¯·-ÚÈÙÒÓ ÙË˜ ÂÈÊ¿ÓÂÈ·˜ ÙˆÓ ÂÓÙÂÚÈÎÒÓ Î˘ÙÙ¿ÚˆÓ.ÕÚ·, ÌÔÚÔ‡Ó Ó· Û˘Ó‰¤ÔÓÙ·È ÌÂ Ù· ‚·ÎÙ‹ÚÈ· Î·È Ó·ÂÌÔ‰›˙Ô˘Ó ÌÂ ·˘Ùfi ÙÔÓ ÙÚfiÔ ÙË Û‡Ó‰ÂÛË ÙˆÓ ÙÂ-ÏÂ˘Ù·›ˆÓ ÛÙËÓ ÂÈÊ¿ÓÂÈ· ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ‚ÏÂÓÓÔÁfi-ÓÔ˘. ∞ÔÙÂÏÔ‡Ó, Î·Ù¿ Ì›· ¤ÓÓÔÈ·, ‰fiÏˆÌ· ÙˆÓ ‚·-ÎÙËÚ›ˆÓ, ÒÛÙÂ Ó· ·Ó·¯·ÈÙ›˙ÂÙ·È Ë ·ıÔÁfiÓÔ˜ ‰Ú¿-ÛË ÙÔ˘˜. ªÂ ÙÔÓ ·Ú·¿Óˆ ÙÚfiÔ ¤¯ÂÈ ·Ô‰ÂÈ¯ÙÂ›fiÙÈ ·Ó·ÛÙ¤ÏÏÂÙ·È Ë ‰Ú¿ÛË ÙÔ˘ ÂÓÙÂÚÔÙÔÍÈÓÔÁfiÓÔ˘(66) Î·È ÙÔ˘ ÂÓÙÂÚÔ·ÈÌÔÚÚ·ÁÈÎÔ‡ e. coli (67), ÙÔ˘ v.cholerae (66), ÙÔ˘ streptococcus pneumoniae (68),

ÙÔ˘ haemophilus influenzae (68), ÙË˜ shigelladysenteriae (69), ÙÔ˘ clostridium difficile (70) Î·ÈÙÔ˘ campylobacter jejuni (71), ÂÓÒ Ë ¤ÚÂ˘Ó· ÔÏÔ¤-Ó· Î·È ·Ó·‰ÂÈÎÓ‡ÂÈ Ó¤· ·ıÔÁfiÓ·, Ë ‰Ú¿ÛË ÙˆÓÔÔ›ˆÓ ·Ó·ÛÙ¤ÏÏÂÙ·È ·fi ÙÔ˘˜ ÔÏÈÁÔÛ·Î¯·Ú›ÙÂ˜ÙÔ˘ ÌËÙÚÈÎÔ‡ Á¿Ï·ÎÙÔ˜. ªÂ ·ÚfiÌÔÈÔ ÙÚfiÔ ·Ó·-ÛÙ¤ÏÏÂÙ·È Ë ‰Ú¿ÛË ÙÔ˘ ÈÔ‡ Rota, Ì¤Ûˆ Ì›·˜ ÁÏ˘ÎÔ-ÚˆÙÂ˝ÓË˜, ÙË˜ Ï·ÎÙÔÚÔÛÎÔÏÏËÙ›ÓË˜ (72). OÈ Û˘-ÁÎÂÓÙÚÒÛÂÈ˜ ÙˆÓ ÔÏÈÁÔÛ·Î¯·ÚÈÙÒÓ ÙÔ˘ ÌËÙÚÈÎÔ‡Á¿Ï·ÎÙÔ˜ ÌÂÙ·‚¿ÏÏÔÓÙ·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ›‰È-Ô˘ ÁÂ‡Ì·ÙÔ˜ (73) Î·È, Â›ÛË˜, ·ÚÔ˘ÛÈ¿˙Ô˘Ó ËÌÂ-Ú‹ÛÈ· ‰È·Î‡Ì·ÓÛË (73). ∆Ô ÌËÙÚÈÎfi Á¿Ï· ÙË˜ ÚÒ-ÙË˜ Â‚‰ÔÌ¿‰·˜ ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi ¤¯ÂÈ ‰È·ÊÔÚÂÙÈÎ‹Û‡ÛÙ·ÛË ÔÏÈÁÔÛ·Î¯·ÚÈÙÒÓ ·fi ÂÎÂ›ÓË ÙˆÓ ÂfiÌÂ-ÓˆÓ ÌËÓÒÓ (74).

°›ÓÂÙ·È Ê·ÓÂÚfi fiÙÈ ÙÔ ÌËÙÚÈÎfi Á¿Ï· ÚÔÛÙ·ÙÂ‡ÂÈ·fi ÏÔÈÌÒÍÂÈ˜ ·fi ÔÏ‡ ÓˆÚ›˜, ÛÙË ÓÂÔÁÓÈÎ‹ ËÏÈÎ›·,fiÙ·Ó ÔÈ ¿ÏÏÔÈ ÌË¯·ÓÈÛÌÔ› ¿Ì˘Ó·˜ ‰ÂÓ ¤¯Ô˘Ó ·ÎfiÌË·Ó·Ù˘¯ıÂ› ÛÂ ÈÎ·ÓÔÔÈËÙÈÎfi ‚·ıÌfi. ∆· ÙÂÏÂ˘Ù·›·¯ÚfiÓÈ· Î·Ù·‚¿ÏÏÔÓÙ·È ÚÔÛ¿ıÂÈÂ˜ ·Ú·ÛÎÂ˘‹˜ÚÂ‚ÈÔÙÈÎÒÓ ÌÂ Û‡ÛÙ·ÛË ·ÚfiÌÔÈ· ÌÂ ·˘Ù‹ ÙÔ˘ ÌË-ÙÚÈÎÔ‡ Á¿Ï·ÎÙÔ˜, ·ÊÔ‡ Ô ÂÌÏÔ˘ÙÈÛÌfi˜ ÙˆÓ Á·Ï¿ÙˆÓÌÂ ÚÂ‚ÈÔÙÈÎ¿ ¤¯ÂÈ ·Ú¯›ÛÂÈ Ó· Á›ÓÂÙ·È Ú¿ÍË. ∏ ̄ Ú‹ÛË,fiÌˆ˜, ÙˆÓ ÚÂ‚ÈÔÙÈÎÒÓ ÂÂÎÙÂ›ÓÂÙ·È Î·È ¤Ú· ·fi Ù·‚ÚÂÊÈÎ¿ Á¿Ï·Ù·. ∫¿ıÂ ¯ÚfiÓÔ ·Ú¿ÁÔÓÙ·È, ÌÂ ÂÓ˙˘Ì·-ÙÈÎ¤˜ ‰È·‰ÈÎ·Û›Â˜, ÔÏÏ¿ Ó¤· ÚÂ‚ÈÔÙÈÎ¿.

°È· Ó· Î·Ù·Ù·¯ıÂ› ÛÙ· ÚÂ‚ÈÔÙÈÎ¿ Ì›· ‚ÈÔÌË¯·-ÓÈÎ¿ ·Ú·ÁfiÌÂÓË Ô˘Û›·, ı· Ú¤ÂÈ Ó· ÂÎ‰ËÏÒÓÂÈÎ·Ï‹ Û˘Û¯¤ÙÈÛË ÙˆÓ in vitro Î·È in vivo È‰ÈÔÙ‹ÙˆÓ ÙË˜Î·È Ó· ÏËÚÔ› Ì›· ÛÂÈÚ¿ ·fi ÎÚÈÙ‹ÚÈ·, ‰Â‰ÔÌ¤ÓÔ˘fiÙÈ ‰ÂÓ Â›Ó·È ÂÊÈÎÙfi Î¿ıÂ Ó¤· ˘Ô„‹ÊÈ· Ô˘Û›· Ó·ÂÏ¤Á¯ÂÙ·È Î·È ÛÂ ÌÂÏ¤ÙÂ˜ ÛÂ ·ÓıÚÒÔ˘˜. ¢Ò‰ÂÎ·Î·ÙËÁÔÚ›Â˜ Ô˘ÛÈÒÓ ÌÂ ÚÂ‚ÈÔÙÈÎ¤˜ È‰ÈfiÙËÙÂ˜ ¤¯Ô˘Ó·Ú·¯ıÂ› ‚ÈÔÌË¯·ÓÈÎ¿. OÈ Ô˘Û›Â˜ ·˘Ù¤˜ Ê·›ÓÔÓÙ·ÈÛÙÔÓ ¶›Ó·Î· 4. OÈ ÂÚÈÛÛfiÙÂÚÂ˜ Û˘ÓÙ›ıÂÓÙ·È ·fi·ÏÔ‡˜ ˘‰·Ù¿ÓıÚ·ÎÂ˜, fiˆ˜ Ë ÛÔ˘ÎÚfi˙Ë Î·È Ë Ï·-ÎÙfi˙Ë ‹ ÚÔÎ‡ÙÔ˘Ó ·fi ÙËÓ ÂÏÂÁ¯fiÌÂÓË ˘‰ÚfiÏ˘-ÛË ·Ì‡ÏÔ˘ ‹ ¿ÏÏˆÓ ÔÏ˘Û·Î¯·ÚÈÙÒÓ (67). ∏ Ï·-ÎÙfi˙Ë ·ÔÙÂÏÂ› ÚÒÙË ‡ÏË ÁÈ· ÙËÓ ·Ú·ÛÎÂ˘‹ ÙˆÓÁ·Ï·ÎÙÔÔÏÈÛ·Î¯·ÚÈÙÒÓ, ÙË˜ Ï·ÎÙÔ˘Ïfi˙Ë˜ Î·È ÙË˜Ï·ÎÙÔÛÔ˘ÎÚfi˙Ë˜.

∆· ÚÂ‚ÈÔÙÈÎ¿ ÌÔÚÔ‡Ó Ó· ÂÓÛˆÌ·ÙˆıÔ‡Ó ÛÂÚÔÊ‹Ì·Ù·, ÁÏ˘Î›ÛÌ·Ù·, Ì·ÚÌÂÏ¿‰Â˜, ·ÁˆÙ¿, ÛÔ-ÎÔÏ¿ÙÂ˜, ˙˘Ì·ÚÈÎ¿, Û¿ÏÙÛÂ˜ Î·È ÛÂ Á·Ï·ÎÙÔÎÔÌÈÎ¿ÚÔ˚fiÓÙ· (67).

OÈ ÏËı˘ÛÌÔ› Ô˘ Ê·›ÓÂÙ·È fiÙÈ ˆÊÂÏÔ‡ÓÙ·È Â-ÚÈÛÛfiÙÂÚÔ ·fi ÙË ¯Ú‹ÛË ÙˆÓ ÚÂ‚ÈÔÙÈÎÒÓ Â›Ó·È ·˘-ÙÔ› ÌÂ ÚÔ¸¿Ú¯Ô˘ÛÂ˜ ¯·ÌËÏ¤˜ Û˘ÁÎÂÓÙÚÒÛÂÈ˜bifidobacteria ÛÙÔÓ ·˘Ïfi ÙÔ˘ ·¯¤Ô˜ ÂÓÙ¤ÚÔ˘. ¶Úfi-ÎÂÈÙ·È ÁÈ· ËÏÈÎÈˆÌ¤ÓÔ˘˜, ·ÛıÂÓÂ›˜ ÌÂ ‰È¿ÚÚÔÈ· ·fiÏ‹„Ë ·ÓÙÈ‚ÈÔÙÈÎÒÓ, ·ÛıÂÓÂ›˜ ÌÂ Á·ÛÙÚÂÓÙÂÚ›ÙÈ‰·,ÌÂ ÊÏÂÁÌÔÓÒ‰Ë ÓfiÛÔ ÙÔ˘ ÂÓÙ¤ÚÔ˘ Î·È ÚfiˆÚ· ÓÂÔÁÓ¿, ÛÙ· ÔÔ›· Ê·›ÓÂÙ·È Ó· ÌÂÈÒÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ

May-June 03 03-06-03 16:55 ™ÂÏ›‰·228


229

ÂÎ‰‹ÏˆÛË˜ ÓÂÎÚˆÙÈÎ‹˜ ÂÓÙÂÚÔÎÔÏ›ÙÈ‰·˜. ¶¿ÓÙˆ˜, fiˆ˜ Û˘Ì‚·›ÓÂÈ Î·È ÌÂ ÙËÓ ÚfiÛÏË„Ë

ÙˆÓ ÚÔ‚ÈÔÙÈÎÒÓ, ÙÔ Â˘ÂÚÁÂÙÈÎfi ÙÔ˘˜ ·ÔÙ¤ÏÂÛÌ·Û¯Â‰fiÓ ÂÍ·ÓÙÏÂ›Ù·È ÛÙÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÙË˜ Ï‹-„Ë˜ ÙÔ˘˜. ™Â Â·ÓÂÈÏËÌÌ¤ÓÂ˜ ÌÂÏ¤ÙÂ˜ ¤¯ÂÈ ·Ô‰ÂÈ-¯ÙÂ› fiÙÈ ÔÈ ÏËı˘ÛÌÔ› ÙˆÓ bifidobacteria Â·Ó¤Ú¯Ô-ÓÙ·È ÛÙ· ÚÈÓ ÙËÓ ¤Ó·ÚÍË ÙË˜ ¯ÔÚ‹ÁËÛ‹˜ ÙÔ˘˜ Â›-Â‰· ÛÂ 7-8 ËÌ¤ÚÂ˜ ¤ˆ˜ 3-4 Â‚‰ÔÌ¿‰Â˜.

¶ÚÔÎÂÈÌ¤ÓÔ˘ Ó· ÌÂÁÈÛÙÔÔÈËıÂ› Ë Â˘ÓÔ˚Î‹ ‰Ú¿-ÛË ÚÔ‚ÈÔÙÈÎÒÓ Î·È ÚÂ‚ÈÔÙÈÎÒÓ, ÔÈ ÂÚÂ˘ÓËÙ¤˜ ÂÍÂ-Ù¿˙Ô˘Ó ÙË Û˘Ó‰˘·ÛÌ¤ÓË ¯ÔÚ‹ÁËÛ‹ ÙÔ˘˜. ∞fi ÙÔ˘˜‰È¿ÊÔÚÔ˘˜ ÌÂÙ·Í‡ ÙÔ˘˜ Û˘Ó‰˘·ÛÌÔ‡˜ ¤¯Ô˘Ó ÚÔ-Î‡„ÂÈ Ù· Û˘Ì‚ÈÔÙÈÎ¿.

™˘Ì‚ÈÔÙÈÎ¿ ¶ÚÂ‚ÈÔÙÈÎ¿ Î·È ÚÔ‚ÈÔÙÈÎ¿ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÛÂ

Û˘Ó‰˘·ÛÌfi. ∆· ˙ˆÓÙ·Ó¿ ÌÈÎÚÔ‚È·Î¿ ÚfiÛıÂÙ·(ÚÔ‚ÈÔÙÈÎ¿) ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂÂÈ‰ÈÎ¿ Û˘ÛÙ·ÙÈÎ¿ (ÚÂ‚ÈÔÙÈÎ¿) ÁÈ· ÙËÓ ·Ó¿Ù˘Í‹ÙÔ˘˜ (3,10). ∆· Û˘Ó‹ıË ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓ· Û˘Ì‚ÈÔ-ÙÈÎ¿ Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 5.

O Û˘Ó‰˘·ÛÌfi˜ ‚ÂÏÙÈÒÓÂÈ ÙËÓ ÂÈ‚›ˆÛË ÙÔ˘ ÚÔ-‚ÈÔÙÈÎÔ‡ ÔÚÁ·ÓÈÛÌÔ‡ Î·È ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÏÂ-ÔÓÂÎÙ‹Ì·Ù· ÛÙÔÓ ÍÂÓÈÛÙ‹ Ô˘ ÚÔÛÊ¤ÚÔ˘Ó ÙfiÛÔ ÔÌÈÎÚÔÔÚÁ·ÓÈÛÌfi˜ fiÛÔ Î·È Ù· ÚÂ‚ÈÔÙÈÎ¿. ™˘ÁÎÂÎÚÈ-Ì¤Ó·, Ô Û˘Ó‰˘·ÛÌfi˜ Ê·›ÓÂÙ·È fiÙÈ ‚ÂÏÙÈÒÓÂÈ ÙËÓ ÂÈ-‚›ˆÛË ÙˆÓ ˙ÒÓÙˆÓ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÒÓ ÛÙ· ‰È·ÙÚÔÊÈ-Î¿ Û˘ÌÏËÚÒÌ·Ù·, ÌÂ Â·ÎfiÏÔ˘ıÔ ÙËÓ ·Ú¿Ù·ÛËÛÙË ‰È¿ÚÎÂÈ· ˙ˆ‹˜ ÙÔ˘˜. ∂›ÛË˜, ·˘Í¿ÓÂÈ ÙÔÓ ·ÚÈı-Ìfi ÙˆÓ ‚·ÎÙËÚ›ˆÓ Ô˘ Êı¿ÓÔ˘Ó ˙ˆÓÙ·Ó¿ ÛÙÔ ·¯‡¤ÓÙÂÚÔ Î·È ÙÔÓ ·ÚÈıÌfi ÙˆÓ ‹‰Ë ˘·Ú¯fiÓÙˆÓ Û˘Ì-‚ÈÔÙÈÎÒÓ ‚·ÎÙËÚ›ˆÓ. ∂ÓÂÚÁÔÔÈÂ› ÌÂÙ·‚ÔÏÈÎ¿ Ù·ÂÍˆÁÂÓÒ˜ ¯ÔÚËÁÔ‡ÌÂÓ·, ·ÏÏ¿ Î·È Ù· ‚·ÎÙ‹ÚÈ· Ô˘ÚÔ¸¿Ú¯Ô˘Ó ˆ˜ ÙÌ‹Ì· ÙË˜ ¯ÏˆÚ›‰·˜ ÙÔ˘ ÂÓÙ¤-ÚÔ˘. ∏ ÙÂÏÂ˘Ù·›· ·˘Ù‹ ‰Ú¿ÛË ÎÚ›ÓÂÙ·È ˆ˜ Ë Ï¤ÔÓÛËÌ·ÓÙÈÎ‹, Î·ıÒ˜ ÌfiÓÔ Ù· ÂÓÂÚÁ¿ ÌÂÙ·‚ÔÏÈÎ¿ ‚·-ÎÙ‹ÚÈ· ÌÔÚÔ‡Ó Ó· ·ÛÎ‹ÛÔ˘Ó ˆÊ¤ÏÈÌË ‰Ú¿ÛË ÛÙÔÓÍÂÓÈÛÙ‹. ™˘Ì‚ÈÔÙÈÎ¿ ˘¿Ú¯Ô˘Ó Î˘Ú›ˆ˜ ÛÂ ·Ú¿Áˆ-Á· Á¿Ï·ÎÙÔ˜ Ô˘ ¤¯Ô˘Ó ˘ÔÛÙÂ› ˙‡ÌˆÛË.

™˘ÌÂÚ¿ÛÌ·Ù· ™ÙÈ˜ ËÌ¤ÚÂ˜ Ì·˜ ‰›ÓÂÙ·È ÔÏÔ¤Ó· Î·È ÂÚÈÛÛfiÙÂ-

ÚË ÛËÌ·Û›· ÛÙË Û‡ÛÙ·ÛË ÙË˜ ÂÓÙÂÚÈÎ‹˜ ¯ÏˆÚ›‰·˜.∏ Î·Ù¿ÏÏËÏË ÙÚÔÔÔ›ËÛ‹ ÙË˜ ÌÔÚÂ› Ó· ·ÔÊ¤ÚÂÈÂ˘ÂÚÁÂÙÈÎ¿ ·ÔÙÂÏ¤ÛÌ·Ù· ÛÙËÓ ˘ÁÂ›·. OÈ ‰È·ÈÙËÙÈ-Î¤˜ Û˘Ó‹ıÂÈÂ˜ Î·È Ú·ÎÙÈÎ¤˜ ÌÔÚÔ‡Ó Ó· ÂËÚÂ¿-ÛÔ˘Ó ÙËÓ ÂÓÙÂÚÈÎ‹ ¯ÏˆÚ›‰·. ∞˘Ùfi ÌÔÚÂ› Ó· ÂÈ-ÙÂ˘¯ıÂ› Â›ÙÂ ÌÂ ÙËÓ ÚfiÛÏË„Ë Î·Ù¿ÏÏËÏˆÓ ˙ÒÓÙˆÓÌÈÎÚÔÔÚÁ·ÓÈÛÌÒÓ (ÚÔ‚ÈÔÙÈÎ¿), Â›ÙÂ ÌÂ ÙËÓ Úfi-ÛÏË„Ë ÂÈ‰ÈÎÒÓ Ô˘ÛÈÒÓ Ô˘ ·ÔÙÂÏÔ‡Ó ÙÔ ÌÂÙ·‚ÔÏÈ-Îfi ÙÔ˘˜ ˘fiÛÙÚˆÌ· (ÚÂ‚ÈÔÙÈÎ¿) ‹, Ù¤ÏÔ˜, ÌÂ ÙÔÛ˘Ó‰˘·ÛÌfi ÙˆÓ ·Ú·¿Óˆ (Û˘Ì‚ÈÔÙÈÎ¿). ŸÏÂ˜ ÔÈ·Ú·¿Óˆ Ô˘Û›Â˜ Î·È ÂÈ‰ÈÎ¿ Ù· Û˘Ì‚ÈÔÙÈÎ¿ ÌÔ-ÚÔ‡Ó Ó· ·ÛÎ‹ÛÔ˘Ó Â˘ÓÔ˚Î‹ ‰Ú¿ÛË ÛÂ Û˘ÁÎÂÎÚÈÌ¤-ÓÂ˜ ÓÔÛÔÏÔÁÈÎ¤˜ ÔÓÙfiÙËÙÂ˜, fiˆ˜ ‰È¿ÊÔÚ· ‰È·Ú-ÚÔ˚Î¿ Û‡Ó‰ÚÔÌ·, ÊÏÂÁÌÔÓÒ‰ÂÈ˜ ÓfiÛÔÈ ÙÔ˘ ÂÓÙ¤ÚÔ˘Î·È Î·Ù·ÛÙ¿ÛÂÈ˜ fiÔ˘ Ë ˘ÂÚ·Ó¿Ù˘ÍË ·ıÔÁfiÓˆÓÌÈÎÚÔ‚›ˆÓ ÙË˜ ÂÓÙÂÚÈÎ‹˜ ¯ÏˆÚ›‰·˜ Â›Ó·È ‰˘ÓËÙÈÎ¿ÂÈÎ›Ó‰˘ÓË (ÂÎÙÂÙ·Ì¤Ó· ÂÁÎ·‡Ì·Ù·, ÌÂÙÂÁ¯ÂÈÚËÙÈÎfistress, ÌÂÙ·ÌÔÛ¯Â‡ÛÂÈ˜ ÔÚÁ¿ÓˆÓ, Û‡Ó‰ÚÔÌÔ ‚Ú·-¯¤Ô˜ ÂÓÙ¤ÚÔ˘) (57).

∏ ·ÚˆÁ‹ ÙË˜ ÌÔÚÈ·Î‹˜ ‚ÈÔÏÔÁ›·˜ Â›Ó·È ÔÏ‡ÙÈÌËÛÙËÓ ÙÂÎÌËÚ›ˆÛË ÙˆÓ ·ÏÏ·ÁÒÓ Ô˘ ÂÈÊ¤ÚÂÈ Ë ¯Ú‹-ÛË ÙˆÓ ·Ú·¿Óˆ ·Ó·ÊÂÚfiÌÂÓˆÓ Ô˘ÛÈÒÓ ÛÙËÓÂÓÙÂÚÈÎ‹ ¯ÏˆÚ›‰· ÙÔ˘ ·ÓıÚÒÔ˘. ∏ ÚfiÔ‰fi˜ ÙË˜ÌÂ Ó¤Â˜ ÌÔÚÈ·Î¤˜ ÙÂ¯ÓÈÎ¤˜ ı· ·ÓÔ›ÍÂÈ Èı·Ó¿ ÙÔÓ‰ÚfiÌÔ ÙË˜ Â˘ÚÂ›·˜ ¯Ú‹ÛË˜ ÙÔ˘˜.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Hill MJ. The normal gut bacterial flora. In: Hill MJ, editor.

Role of gut bacteria in human toxicology andpharmacology. London: Taylor and Francis; 1995. p. 3-17.

2. Nord CE, Kager L. The normal flora of the gastrointestinaltract. Neth J Med 1984;27:249-252.

3. Mandar R, Mikelsaar M. Transmission of mother’s microflorato the newborn at birth. Biol Neonate 1996;69:30-35.

4. Orrhage ∫, Nord CE. Factors controlling the bacterialcolonization of the intestine in breastfed infants. ActaPaediatr 1999;88 (Suppl):S47-S57.

5. Lundequist B, Nord CE, Winberg J. The composition of thefaecal microflora in breastfed and bottle fed infants frombirth to eight weeks. Acta Paediatr Scand 1985;74:45-51.

6. Kleessen B, Bunke H, Tovar K, Noack J, Sawatzki G.Influence of two infant formulas and human milk on thedevelopment of the faecal flora in newborn infants. ActaPaediatr 1995;84:1347-1356.

7. Midtvedt AC, Carlstedt-Duke B, Midtvedt T. Establishment ofa mucin-degrading intestinal microflora during the first twoyears of human life. J Pediatr Gastroenterol Nutr1994;18:321-326.

¶›Ó·Î·˜ 4. ∫·ÙËÁÔÚ›Â˜ Ô˘ÛÈÒÓ ÌÂ ÚÂ‚ÈÔÙÈÎ¤˜ È‰ÈfiÙËÙÂ˜ Ô˘¤¯Ô˘Ó ·Ú·¯ıÂ› ‚ÈÔÌË¯·ÓÈÎ¿

°·Ï·ÎÙÔÔÏÈÁÔÛ·Î¯·Ú›ÙÂ˜§·ÎÙÔ˘Ïfi˙Ë§·ÎÙÔÛÔ˘ÎÚfi˙ËºÚÔ˘ÎÙÔÔÏÈÁÔÛ·Î¯·Ú›ÙÂ˜¶·Ï·ÙÈÓfi˙Ë - ÔÏÈÁÔÛ·Î¯·Ú›ÙÂ˜°Ï˘ÎÔ˙˘ÏÔÛÔ˘ÎÚfi˙Ëª·ÏÙÔÔÏÈÁÔÛ·Î¯·Ú›ÙÂ˜πÛÔÌ·ÏÙÔÔÏÈÁÔÛ·Î¯·Ú›ÙÂ˜∫˘ÎÏÔ‰ÂÍÙÚ›ÓÂ˜°ÂÓÙÈÔÔÏÈÁÔÛ·Î¯·Ú›ÙÂ˜OÏÈÁÔÛ·Î¯·Ú›ÙÂ˜ ÙÔ˘ Î·ÚÔ‡ ÙË˜ ÛfiÁÈ·˜•˘ÏÔÔÏÈÁÔÛ·Î¯·Ú›ÙÂ˜

¶›Ó·Î·˜ 5. ™˘Ó‹ıË Û˘Ì‚ÈÔÙÈÎ¿

Bifidobacteria Î·È ÊÚÔ˘ÎÙÔÔÏÈÛ·Î¯·Ú›ÙÂ˜Lactobacilli Î·È Ï·ÎÙÈÙfiÏËBifidobacteria Î·È Á·Ï·ÎÙÔÔÏÈÛ·Î¯·Ú›ÙÂ˜

May-June 03 03-06-03 16:55 ™ÂÏ›‰·229


230

8. Fuller R. Probiotics in man and animals. J Appl Bacteriol1989;66:365-378.

9. Marteau P, Pochart P, Bouhnik Y, Rambaud JC. The fateand effects of transiting, nonpathogenic microorganisms inthe human intestine. World Rev Nutr Diet 1993;74:1-21.

10. Collins MD, Gibson GR. Probiotics, prebiotics, andsynbiotics: approaches for modulating the microbial ecologyof the gut. Am J Clin Nutr 1999;69 (Suppl):S1052-S1057.

11. Silva M, Jacobus NV, Deneke C, Gorbach SL. Antimicrobialsubstance from a human Lactobacillus strain. AntimicrobAgents Chemother 1987;31:1231-1233.

12. DeSimone C, Rosati E, Moretti S, µianchi-Salvadon B,Veseln R, Jivillo E. Probiotics and stimulation of the immuneresponse. Eur J Clin Nutr 1991;45:32-34.

13. Conway PL, Gorbach SL, Goldin BR. Survival of lactic acidbacteria in the human stomach and adhesion to intestinalcells. J Dairy Sci 1987;70:1-12.

14. Majamaa H, Isolauri E, Saxelin M, Vesikari T. Lactic acidbacteria in the treatment of acute rotavirus gastroenteritis. JPediatr Gastroenterol Nutr 1995;20:333-338.

15. Isolauri E, Kaila M, Mykkanen H, Ling WH, Salminen S. Oralbacteriotherapy for viral gastroenteritis. Dig Dis Sci1994;39:2595-2600.

16. Sugita T, Togawa M. Efficacy of lactobacillus preparationbiolactis powder in children with rotavirus enteritis. JpnPediatr 1994;47:2755-2762.

17. Raza S, Graham SM, Allen SJ, Sultana S, Cuevas L, HartCA. Lactobacillus GG promotes recovery from acutenonbloody diarrhea in Pakistan. Pediatr Infect Dis J1995;14:107-111.

18. Guandalini S, Pensabene L, Zikri MA, Dias JA, Casali LG,Hoekstra H et al. Lactobacillus GG administered in oralrehydration solution to children with acute diarrhea: amulticenter European trial. J Pediatr Gastroenterol Nutr2000;30:54-60.

19. Kaila M, Isolauri E, Saxelin M, Arvilommi H, Vesikari T. Viableversus inactivated lactobacillus strain GG in acute rotavirusdiarrhoea. Arch Dis Child 1995;72:51-53.

20. Shornikova AV, Casas IA, Mykkanen H, Salo E, Vesikari T.Bacteriotherapy with Lactobacillus reuteri in rotavirusgastroenteritis. Pediatr Infect Dis J 1997;16:1103-1107.

21. Bellomo G, Mangiagle A, Nicastro L, Frigerio G. A controlleddouble-blind study of SF68 strain as a new biologicalpreparation for the treatment of diarrhoea in paediatrics.Curr Ther Res 1980;28:927-936.

22. Camarri E, Belvisi A, Guidoni G, Marini G, Frigerio G. Adouble-blind comparison of two different treatments foracute enteritis in adults. Chemotherapy 1981;27:466-470.

23. Marteau PR, de Vrese M, Cellier CJ, Schrezenmeir J.Protection from gastrointestinal diseases with the use ofprobiotics. Am J Clin Nutr 2001;73 (2 Suppl): S430- S436.

24. Katelaris PH, Salam I, Farthing MJ. Lactobacilli to preventtraveller’s diarrhea? N Engl J Med 1995;333:1360-1361.

25. Oksanen PJ, Salminen S, Saxelin M, Hamalainen P,Ihantola-Vormisto A, Muurasniemi-Isoviita L et al.Prophylactic efficacy of lactobacilli on traveller’s diarrhoea.Travel Med 1989;7:333-335.

26. Alm L. The effect of Lactobacillus acidophilus administrationupon the survival of Salmonella in randomly selected human

carriers. Prog Food Nutr Sci 1983;7:13-17. 27. Tojo M, Oikawa T, Morikawa Y, Yamashita N, Iwata S, Satoh

Y et al. The effects of Bifidobacterium breve administrationon Campylobacter enteritis. Acta Paediatr Jpn 1987;29:160-167.

28. Saavedra J. Probiotics and infectious diarrhea. Am JGastroenterol 2000;95 (1 Suppl):S16-S18.

29. McFarland LV, Surawicz CM, Greenberg RN, Elmer GW,Moyer KA, Melcher SA et al. Prevention of beta-lactam-associated diarrhea by Saccharomyces boulardii comparedwith placebo. Am J Gastroenterol 1995;90:439-448.

30. Vanderhoof JA. Summary. Am J Gastroenterol 2000;95:S26-S27.

31. Bazzoli F, Zagari RM, Fossi S, Morelli MC, Pozzato P,Ventrucci M et al. In vivo Helicobacter pylori clearance failurewith Lactobacillus acidophilus. Gastroenterology1992;102:A38.

32. Mao Y, Nobaek S, Kasravi B, Adawi D, Stenram U, Molin Get al. The effects of Lactobacillus strains and oat fiber onmethotrexate-induced enterocolitis in rats. Gastroenterology1996;111:334-344.

33. Salminen E, Elomaa I, Minkkinen J, Vapaatalo H, SalminenS. Preservation of intestinal integrity during radiotherapyusing live Lactobacillus acidophilus cultures. Clin Radiol1988;39:435-437.

34. Elmer GW, Moyer KA, Surawicz CM, Collier AC, Hooton TM,McFarland LV. Evaluation of Saccharomyces boulardii forpatients with HIV-related chronic diarrhoea and in healthyvolunteers receiving anti-fungals. Microecol Ther1995;25:23-31.

35. Vanderhoof JA. Probiotics and intestinal inflammatorydisorders in infants and children. J Pediatr GastroenterolNutr 2000;30 (2 Suppl):S34-S38.

36. Malin M, Suomalainen H, Saxelin M, Isolauri E. Promotion ofIgA immune response in patients with Crohn’s disease byoral bacteriotherapy with Lactobacillus GG. Ann Nutr Metab1996;40:137-145.

37. Plein K, Hotz J. Therapeutic effects of Saccharomycesboulardii on mild residual symptoms in a stable phase ofCrohn’s disease with special respect to chronic diarrhea - apilot study. Z Gastroenterol 1993;31:129-134.

38. Kruis W, Schutz E, Fric P, Fixa B, Judmaier G, Stolte M.Double-blind comparison of an oral Escherichia colipreperation and mesalazine in maintaining remission ofulcerative colitis. Aliment Pharmacol Ther 1997;11:853-858.

39. Lin MY, Yen CL, Chen SH. Management of lactosemaldigestion by consuming milk containing lactobacilli. DigDis Sci 1998;43:133-137.

40. Majamaa H, Isolauri E. Probiotics: a novel approach in themanagement of food allergy. J Allergy Clin Immunol1997;99:179-185.

41. Salminen S, Bouley C, Boutron-Ruault MC, Cummings JH,Franck A, Gibson GR et al. Functional food science andgastrointestinal physiology and function. Br J Nutr 1998;80(1 Suppl):S147-S171.

42. Isolauri E, Majamaa H, Arvola T, Rantala I, Virtanen E,Arvilommi H. Lactobacillus casei strain GG reversesincreased intestinal permeability induced by cow milk insuckling rats. Gastroenterology 1993;105:1643-1650.

May-June 03 03-06-03 16:55 ™ÂÏ›‰·230


231

43. Prescott SL, Macaubas C, Smallacombe T, Holt BJ, Sly PD,Holt PG. Development of allergen-specific T-cell memory inatopic and normal children. Lancet 1999;353:196-200.

44. Kalliomaki M, Salminen S, Arvilommi H, Kero P, Koskinen P,Isolauri E. Probiotics in primary prevention of atopicdisease: a randomised placebo-controlled trial. Lancet2001;357:1076-1079.

45. Gilliland SE, Nelson CR, Maxwell C. Assimilation ofcholesterol by Lactobacillus acidophilus. Appl EnvironMicrobiol 1985;49:377-381.

46. Lee YK, Salminen S. The coming of age of probiotics.Trends Food Sci Technol 1995;6:241-245.

47. Ishibashi N, Shimamura S. Bifidobacteria: research anddevelopment in Japan. Food Technol 1993;47:126-135.

48. Bengmark S. Colonic food: pre- and probiotics. Am JGastroenterol 2000;95 (1 Suppl):S5-S7.

49. Gibson GR, Roberfroid MB. Dietary modulation of thehuman colonic microbiota: introducing the concept ofprebiotics. J Nutr 1995;125:1401-1412.

50. Quigley ME, Hudson GJ, Englyst HN. Determination ofresistant short-chain carbohydrates (non-digestibleoligosaccharides) using gas-liquid chromatography. FoodChem 1999;65:381-390.

51. Park SF, Kroll RG. Expression of listeriolysin andphosphatidylinositol-specific phospholipase C is repressedby the plant-derived molecule cellobiose in Listeriamonocytogenes. Mol Microbiol 1993;8:653-661.

52. Niness KR. Inulin and oligofructose: what are they? J Nutrit1999;129 (7 Suppl):S1402-S1406.

53. Roberfroid M. Dietary fiber, inulin, and oligofructose: areview comparing their physiological effects. Crit Rev FoodSci Nutr 1993;33:103-148.

54. Kruse HP, Kleessen B, Blaut M. Effects of inulin on faecalbifidobacteria in human subjects. Br J Nutr 1999;82:375-382.

55. Gibson GR, Wang X. Regulatory effects of bifidobacteria onthe growth of other colonic bacteria. J Appl Bacteriol1994;77:412-420.

56. Gibson GR, Beatty ER, Wang X, Cummings JH. Selectivestimulation of bifidobacteria in the human colon byoligofructose and inulin. Gastroenterology 1995;108:975-982.

57. Garleb KA, Snook JT, Marcon MJ, Wolf BW, Johnson WA.Effect of fructooligosaccharide containing enteral formulason subjective tolerance factors, serum chemistry profiles,and faecal bifidobacteria in healthy adult male subjects.Microb Ecol Health Dis 1996;9:279-285.

58. Dai D, Nanthkumar NN, Newburg DS, Walker WA. Role ofoligosaccharides and glycoconjugates in intestinal hostdefense. J Pediatr Gastroenterol Nutr 2000;30 (2Suppl):S23-S33.

59. Moro G, Minoli I, Mosca M, Fanaro S, Jelinek J, Stahl B et al.Dosage-related bifidogenic effects of galacto- andfructooligosaccharides in formula-fed term infants. J PediatrGastroenterol Nutr 2002;34:291-295.

60. Roberfroid MB. Caloric value of inulin and oligofructose. JNutr 1999;129 (7 Suppl):S1436-S1437.

61. Danan C, Huret Y, Tessedre AC, Bensaada M, Szylit O,Butel MJ. Could oligosaccharide supplementation promotegut colonization with a beneficial flora in preterm infants? J

Pediatr Gastroenterol Nutr 2000;30:217-219. 62. Catala I, Butel MJ, Bensaada M, Popot F, Tessedre AC,

Rimbault A et al. Oligofructose contributes to the protectiverole of bifidobacteria in experimental necrotisingenterocolitis in quails. J Med Microbiol 1999;48:89-94.

63. Howard MD, Gordon DT, Pace LW, Garleb KA, Kerley MS.Effects of dietary supplementation with fructooligosaccharideson colonic microbiota populations and epithelial cellproliferation in neonatal pigs. J Pediatr Gastroenterol Nutr1995;21:297-303.

64. Kunz C, Rudloff S. Biological functions of oligosaccharidesin human milk. Acta Paediatr 1993;82:903-912.

65. Newburg DS, Neubauer SH. Carbohydrates in milk. In:Jensen RG, ed. Handbook of Milk Composition. San Diego:Academic Press; 1995. p. 273-349.

66. Holmgren J. Comparison of the tissue receptors for Vibriocholerae and Escherichia coli enterotoxins by means ofgangliosides and natural cholera toxoid. Infect Immun1973;8:851-859.

67. Ashkenazi S, Newburg DS, Cleary TG. The effect of humanmilk on the adherence of enterohemorrhagic E. coli to rabbitintestinal cells. Adv Exp Med Biol 1991;310:173-177.

68. Andersson B, Porras O, Hanson LA, Lagergard T, Svanborg-Eden C. Inhibition of attachment of Streptococcuspneumoniae and Haemophilus influenzae by human milk andreceptor oligosaccharides. J Infect Dis 1986;153:232-237.

69. Lindberg AA, Brown JE, Stromberg N, Westling-Ryd M,Schultz JE, Karlsson KA. Identification of the carbohydratereceptor for Shiga toxin produced by Shigella dysenteriaetype 1. J Biol Chem 1987;262:1779-1785.

70. Clark GF, Krivan HC, Wilkins TD, Smith DF. Toxin A fromClostridium difficile binds to rabbit erythrocyte glycolipidiswith terminal Gal alpha 1-3Gal beta 1-4GlcNAc sequences.Arch Biochem Biophys 1987;257:217-229.

71. Cervantes LE, Newburg DS, Ruiz-Palacios GM. ∞1-2fucosylated chains (H-2 and Lewisb) are the main humanreceptor analogues for Campylobacter. Pediatr Res1995;37:171A.

72. Newburg DS, Peterson JA, Ruiz-Palacios GM, Matson DO,Morrow AL, Shults J et al. Role of human-milk lactadherin inprotection against symptomatic rotavirus infection. Lancet1998;351:1160-1164.

73. Viverge D, Grimmonprez L, Cassanas G, Bardet L, Solere M.Diurnal variations and within the feed in lactose andoligosaccharides of human milk. Ann Nutr Metab1986;30:196-209.

74. Coppa GV, Gabrielli O, Pierani P, Catassi C, Carlucci A,Giorgi PL. Changes in carbohydrate composition in humanmilk over 4 months of lactation. Pediatrics 1993;91:637-641.


¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: πˆ¿ÓÓ· Ã·ÚˆÓ›ÙË A’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹µÂÓÈ˙¤ÏÂÈÔ °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ∏Ú·ÎÏÂ›Ô˘, ∫Ú‹ÙË

May-June 03 03-06-03 16:55 ™ÂÏ›‰·231


232

¶·ÚÔ˘ÛÈ¿˙ÂÙ·È ÂÚ›ÙˆÛË Û·Î¯·ÚÒ‰Ô˘˜ ‰È·-‚‹ÙË, Ô˘ ‰ËÌÔÛÈÂ‡ıËÎÂ ÙÔ 1814 ÛÙÔ ·ÍÈfiÏÔÁÔÚÔÂ·Ó·ÛÙ·ÙÈÎfi ÂÚÈÔ‰ÈÎfi “∂ÚÌ‹˜ Ô §fiÁÈÔ˜”. ∆ÔÂÚÈÔ‰ÈÎfi ·˘Ùfi, ÂÎÙfi˜ ÙˆÓ ¿ÏÏˆÓ ¿ÚıÚˆÓ, ÂÚÈÂ-Ï¿Ì‚·ÓÂ Î·È È·ÙÚÈÎ¿ ı¤Ì·Ù·, ‰ÈfiÙÈ ‰ÂÓ Î˘ÎÏÔÊÔ-ÚÔ‡Û·Ó, Î·Ù¿ ÙËÓ ÂÈÛ‹Ì·ÓÛË ÙÔ˘ ÂÎ‰fiÙË ÙÔ˘, ÂÏ-ÏËÓÈÎ¿ È·ÙÚÈÎ¿ ÂÚÈÔ‰ÈÎ¿, fiˆ˜ Û˘Ó¤‚·ÈÓÂ ÛÙÈ˜ Â˘-Úˆ·˚Î¤˜ ÁÏÒÛÛÂ˜ (1).

™˘ÁÁÚ·Ê¤·˜ ÙÔ˘ Û˘ÁÎÂÎÚÈÌ¤ÓÔ˘ ¿ÚıÚÔ˘ ‹Ù·Ó ÔÂÎ ∫ÂÊ·ÏÏËÓ›·˜ Î·Ù·ÁfiÌÂÓÔ˜ È·ÙÚfi˜ πˆ¿ÓÓË˜ ∞Û¿-ÓË˜ (2) (1790-1850), Ô ÔÔ›Ô˜ ÛÔ‡‰·ÛÂ π·ÙÚÈÎ‹ Î·Èª·ıËÌ·ÙÈÎ¿ ÛÙËÓ ¶¿‰Ô‚·, ÙË µÈ¤ÓÓË Î·È ÙÔ ¶·Ú›ÛÈÎ·È Â›¯Â ‰ËÌÔÛÈÂ‡ÛÂÈ Â›ÛË˜ ÛÙÔ ÂÚÈÔ‰ÈÎfi “∂ÚÌ‹˜Ô §fiÁÈÔ˜” (3) ¿ÚıÚÔ ÌÂ Ù›ÙÏÔ “∞¿ÓÙËÛÈ˜ ÂÈ˜ ÙËÓ Â-Ú› ÙÔ˘ µÚÔÓÈ·ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÂÚÒÙËÛÈÓ”, ÙÔ ÔÔ›Ô·Ó·ÊÂÚfiÙ·Ó ÛÙÔ ıÂÚ·Â˘ÙÈÎfi Û‡ÛÙËÌ· ÙÔ˘ ÕÁÁÏÔ˘È·ÙÚÔ‡ John Brown (1735-1788). ∂›ÛË˜, Â›¯Â ÌÂÙ·-ÊÚ¿ÛÂÈ ·fi ÙËÓ ÈÙ·ÏÈÎ‹ ÁÏÒÛÛ· ÙÔ ‚È‚Ï›Ô ÁÈ· ÙÔ˘˜ÂÚÈÔ‰ÈÎÔ‡˜ ˘ÚÂÙÔ‡˜, fiˆ˜ ÔÓÔÌ·˙fiÙ·Ó ÙfiÙÂ ËÂÏÔÓÔÛ›·, ÌÂ Ù›ÙÏÔ: “¶ÂÚ› ÙÔ˘ ·ÚÌÔ‰ÈˆÙ¤ÚÔ˘ ÙÚfi-Ô˘ ÂÈ˜ ÙÔ Ó· ÂÌÔ‰›˙ˆÓÙ·È ·È ˘ÔÛÙÚÔÊ·› ÙˆÓ Â-ÚÈÔ‰ÈÎÒÓ ˘ÚÂÙÒÓ ·ÊÔ‡ ‹‰Ë ÎÔÒÛÈ ÌÂ ÙËÓ Î›Ó·Ó

‰È·ÙÚÈ‚‹ ¶¤ÙÚÔ˘ ƒÔ˘‚›ÓÔ˘. ªÂÙ·ÊÚ·ÛıÂ›Û· ÂÎ ÙÔ˘πÙ·ÏÈÎÔ‡ ˘fi πˆ¿ÓÓË ∞Û¿ÓË. ∂Ó ∫ˆÓÛÙ·ÓÙÈÓÔ˘fiÏÂÈ,ÂÎ ÙË˜ ∆˘ÔÁÚ·Ê›·˜ ∫. ∞. ∫ÔÏÔÓ¤ÏÏÔ˘, 1841”. ∂È-Ï¤ÔÓ, Ô È·ÙÚfi˜ ¡ÈÎfiÏ·Ô˜ ¶›ÎÎÔÏÔ˜ (1792-1865),Î·ıËÁËÙ‹˜ ÛÙËÓ πfiÓÈÔ ∞Î·‰ËÌ›·, ·ÊÈ¤ÚˆÛÂ ÛÙÔÓ πˆ-¿ÓÓË ∞Û¿ÓË ÙÔ ‚È‚Ï›Ô Ô˘ ÌÂÙ¤ÊÚ·ÛÂ Î·È ÂÍ¤‰ˆÛÂÛÙËÓ ∫¤ÚÎ˘Ú· ÙÔ 1824 “ƒÂÓ¿ÙÔ˘ ∫·ÚÙÂÛ›Ô˘, §fiÁÔ˜ÂÚ› ÌÂıfi‰Ô˘ ÙÔ˘ Ô‰ËÁÂ›Ó Î·ÏÒ˜ ÙÔÓ ÓÔ‡Ó Î·È ˙Ë-ÙÂ›Ó ÙËÓ ·Ï‹ıÂÈ·Ó ÂÈ˜ Ù·˜ ÂÈÛÙ‹Ì·˜”.

O πˆ¿ÓÓË˜ ∞Û¿ÓË˜ ·ÛÎÔ‡ÛÂ ÙËÓ È·ÙÚÈÎ‹ ÛÙÔ π¿-ÛÈÔ ÙË˜ ªÔÏ‰·‚›·˜ Î·È ¤ÛÙÂÈÏÂ ÛÙÔÓ ÕÓıÈÌÔ °·˙‹,ÂÎ‰fiÙË ÙÔ˘ ÚÔÂ·Ó·ÛÙ·ÙÈÎÔ‡ ÂÚÈÔ‰ÈÎÔ‡ “∂ÚÌ‹˜Ô §fiÁÈÔ˜”, ÙÔ ¿ÚıÚÔ Û¯ÂÙÈÎ¿ ÌÂ ÙËÓ ÂÚ›ÙˆÛË ÙÔ˘Û·Î¯·ÚÒ‰Ô˘˜ ‰È·‚‹ÙË ÛÂ Ó¤Ô ËÏÈÎ›·˜ 14 ÂÙÒÓ Î·ÈÙÈ˜ Ó¤Â˜ ıÂÚ·Â˘ÙÈÎ¤˜ ÙÔ˘ ÚÔÛ¿ıÂÈÂ˜ (4).

™ÙÔ ÚÒÙÔ Ì¤ÚÔ˜ ÙÔ˘ ¿ÚıÚÔ˘, Ô πˆ¿ÓÓË˜ ∞Û¿-ÓË˜ ·Ú·ı¤ÙÂÈ ÙÈ˜ Û‡Á¯ÚÔÓÂ˜ ÁÓÒÛÂÈ˜ ÁÈ· ÙÔÓ Û·Î-¯·ÚÒ‰Ë ‰È·‚‹ÙË, ‰›‰ÔÓÙ·˜ Ì¿ÏÈÛÙ· Î·È ÙÔÓ ÔÚÈÛÌfiÙÔ˘: “¢È·‚‹ÙË˜ Ï¤ÁÂÙ·È ·Ú¿ ÙˆÓ ÓÔÛÔÏfiÁˆÓ Ë˘ÂÚ‚ÔÏÈÎ‹ ¤ÎÚ˘ÛÈ˜ Ô‡ÚÔ˘˜, ÌÂÙ¿ ‰›„Ë˜ ·Û‚¤-ÛÙÔ˘, ÔÚ¤ÍÂˆ˜ ·Ï‹ÛÙÔ˘, Î·È Ì·Ú·ÛÌÔ‡”. ™ËÌÂÈÒ-ÓÂÈ fiÙÈ ÙÔ 1778 ·Ó·Î·Ï‡ÊıËÎÂ ·fi ÙÔÓ “∫·ÓÏ¤È”

¶·ÚÔ˘Û›·ÛË ÂÚ›ÙˆÛË˜ Û·Î¯·ÚÒ‰Ô˘˜ ‰È·‚‹ÙË ÛÙÔ ÂÚÈÔ‰ÈÎfi “∂ÚÌ‹˜ Ô §fiÁÈÔ˜” ÙÔ˘ 1814 ¢. ∫·Ú·ÌÂÚfiÔ˘ÏÔ˜

A case of diabetes mellitus presented in the journal “∂ÚÌ‹˜ Ô §fiÁÈÔ˜”, 1814 D. Karaberopoulos

∂π¢π∫O ∞ƒ£ƒO SPECIAL ARTICLE

¢ÈÂıÓ¤˜ πÔÎÚ¿ÙÂÈÔ ÿ‰Ú˘Ì· ÙË˜ ∫ˆ, ∞ı‹Ó· International Hippocratic Foundation of Kos, Athens

�¶ÂÚ›ÏË„Ë: ¶·ÚÔ˘ÛÈ¿˙ÂÙ·È ÂÚ›ÙˆÛË Û·Î¯·ÚÒ-‰Ô˘˜ ‰È·‚‹ÙË ·fi ÙÔÓ È·ÙÚfi πˆ¿ÓÓË ∞Û¿ÓË (1790-1850) ÛÙÔ ÂÚÈÔ‰ÈÎfi “∂ÚÌ‹˜ Ô §fiÁÈÔ˜” (µÈ¤ÓÓË1814, ÛÂÏ. 117-123). ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë Î·Ù¿ÛÙ·ÛËÓ¤Ô˘ ËÏÈÎ›·˜ 14 ÂÙÒÓ Î·È Î·Ù·ÁÚ¿ÊÔÓÙ·È ÔÈ Û‡Á-¯ÚÔÓÂ˜ ÁÓÒÛÂÈ˜ ÁÈ· ÙË ÓfiÛÔ. ø˜ ıÂÚ·Â›· ÚÔÙÂ›-ÓÂÙ·È ÏÂ˘ÎˆÌ·ÙÔ‡¯Ô˜ ‰›·ÈÙ· Î·È ¯ÔÚ‹ÁËÛË ÊˆÛÊfi-ÚÔ˘, Ì›· Ó¤· ÚfiÙ·ÛË ıÂÚ·Â˘ÙÈÎ‹˜ ·ÁˆÁ‹˜. ™ÙÔ¿ÚıÚÔ ÂÈÛ¿ÁÂÙ·È ÛÙËÓ ÂÏÏËÓÈÎ‹ È·ÙÚÈÎ‹ ÔÚÔÏÔÁ›· ÔfiÚÔ˜ “Û·Î¯·ÚÒ‰Ë˜ ‰È·‚‹ÙË˜”.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: Û·Î¯·ÚÒ‰Ë˜ ‰È·‚‹ÙË˜, ¡ÂÔÂÏÏËÓÈ-Îfi˜ ¢È·ÊˆÙÈÛÌfi˜, ÊˆÛÊfiÚÔ˜.

�Abstract: A case of diabetes mellitus waspresented by doctor John Assanis (1790-1850) inthe journal “∂ÚÌ‹˜ Ô §fiÁÈÔ˜” (Wien 1814, p. 117-123). The condition of a fourteen year-oldadolescent is described and updated information forthe disease is recorded. A new proposal fortreatment is recommended, consisting of a proteindiet and phosphorus as medication. In the articlethe term “diabetes mellitus” is introduced into theGreek medical terminology.

Key words: diabetes mellitus, NeohellenicEnlightenment, phosphorus.

May-June 03 03-06-03 16:55 ™ÂÏ›‰·232


233

(William Cullen, 1710-1790) ÛÙ· Ô‡Ú· ÙˆÓ ‰È·‚ËÙÈ-ÎÒÓ “Ë ÂÌÂÚÈÂ¯ÔÌ¤ÓË Û¿Î¯·ÚÈ˜” Î·È fiÙÈ ÙÔ 1803 Ë“ÂÓÙÂÏÂÛÙ¤Ú· ·Ó¿Ï˘ÛÈ˜ ÙÔ˘ Ô‡ÚÔ˘˜ ÙˆÓ ‰È·‚ËÙÈ-ÎÒÓ” ¤‰ÂÈÍÂ ˆ˜ “‰ÂÓ ˘¿Ú¯ÂÈ Ô˘Ú›· Ì‹ÙÂ Ô˘ÚÈÎfiÓÔÍ‡”. ∞ÎfiÌË, ·Ó·Ê¤ÚÂÈ fiÙÈ “ÔÈ Î‡ÚÈÔÈ ∆ÂÓ¿Ú Î·È ¢Ô˘-Ô˘¸ÙÚ¤Ó ¤Î·Ì·Ó Ó¤·˜ Û˘˙ËÙ‹ÛÂÈ˜ Î·È ÂÍÂÙ¿ÛÂÈ˜ÂÈ˜ ÙÔÓ Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙËÓ” (5) Î·È ÁÈ· Ù· ·ÔÙÂ-Ï¤ÛÌ·Ù· ÙË˜ “˙ˆÙÈÎ‹˜ ‰È·›ÙË˜”, ‰ËÏ. ˙ˆÈÎ‹˜, fiˆ˜·ÔÎ·ÏÂ›Ù·È Ë ÏÂ˘ÎˆÌ·ÙÔ‡¯Ô˜. ∂ÈÛËÌ·›ÓÂÙ·È fiÙÈ ÔfiÚÔ˜ “Û·Î¯·ÚÒ‰Ë˜ ‰È·‚‹ÙË˜” Î·Ù·ÁÚ¿ÊÂÙ·È ÁÈ·ÚÒÙË ÊÔÚ¿ ÛÙËÓ ÂÏÏËÓÈÎ‹ È·ÙÚÈÎ‹ ÔÚÔÏÔÁ›· Èı·-ÓfiÓ ÂÎÂ›ÓË ÙËÓ ÂÔ¯‹ (1814).

O ∞Û¿ÓË˜ ÛËÌÂÈÒÓÂÈ fiÙÈ “fiÙ·Ó ÔÈ ‰È·‚ËÙÈÎÔ› ÙÚÒ-ÁˆÛÈ ÌfiÓÔÓ ˙ˆÙÈÎ¿ (˙ˆÈÎ¿) Ê·ÁËÙ¿, ÙÔ Ô‡ÚÔ˜ ·˘ÙÒÓÂÓÙfi˜ ÔÏ›ÁÔÓ ÌÂÙ·ÏÏ¿ÙÙÂÈ ÙËÓ Â·˘ÙÔ‡ Ê‡ÛÈÓ”. ™¯ÂÙÈ-Î¿ ÌÂ ÙËÓ ·ÈÙ›· ÙÔ˘ Û·Î¯·ÚÒ‰Ô˘˜ ‰È·‚‹ÙË, ·Ó·Ê¤-ÚÂÈ ÙËÓ ˘fiıÂÛË ÙÔ˘ ∂Ú¿ÛÌÔ˘ ¢·Ú‚›ÓÔ˘ (ErasmusDarwin, 1731-1802), ·Ù¤Ú· ÙÔ˘ ÁÓˆÛÙÔ‡ Ê˘ÛÈÔ‰›-ÊË ÙË˜ ÂÍÂÏ›ÍÂˆ˜ ÙˆÓ ÂÈ‰ÒÓ ∫·ÚfiÏÔ˘ ¢·Ú‚›ÓÔ˘,Û‡ÌÊˆÓ· ÌÂ ÙËÓ ÔÔ›· Ô Û·Î¯·ÚÒ‰Ë˜ ‰È·‚‹ÙË˜ÔÊÂ›ÏÂÙ·È ÛÙËÓ “ÔÈÛıfi‰ÚÔÌÔÓ Î›ÓËÛÈÓ ÙˆÓ ¯˘ÏÔ-ÊfiÚˆÓ ·ÁÁÂ›ˆÓ”. øÛÙfiÛÔ, Ô ∞Û¿ÓË˜ ‰È·Ù˘ÒÓÂÈ Î·ÈÙË ‰ÈÎ‹ ÙÔ˘ ¿Ô„Ë ÛËÌÂÈÒÓÔÓÙ·˜ Û¯ÂÙÈÎ¿ fiÙÈ “ÂÈ˜ÂÌ¤ fiÌˆ˜ Ê·›ÓÂÙ·È Â˘ÛÙÔ¯ÒÙÂÚÔÓ ÙÔ Ó· ˘ÔÙÂıÂ› Ë·ÙÔÓ›· Î·È Ù¤ÏÔ˜ Ë ÂÓÙÂÏ‹˜ ·Ú·Ï˘Û›· ÙˆÓ ¯˘ÏÔ-ÊfiÚˆÓ ·ÁÁÂ›ˆÓ, ÂÓÒ Ù· Ï˘ÌÊ·ÙÈÎ¿ ÙÔ˘ Ô˘ÚÈÎÔ‡ Û˘-ÛÙ‹Ì·ÙÔ˜ ·ÁÁÂ›· ·˘Í¿ÓÔ˘ÛÈÓ ÙËÓ ÂÓ¤ÚÁÂÈ·Ó ·˘ÙÒÓ”(6). O fiÚÔ˜ “¯˘ÏÔÊfiÚ·” ·ÁÁÂ›· Â›Ó·È ÁÈ· Ù· ÌÂÛÂ-ÓÙÂÚÈÎ¿ ÏÂÌÊ·ÁÁÂ›·, ÂÍ Ô˘ Î·È Ô fiÚÔ˜ “¯˘ÏÔÊfiÚÔ˜‰ÂÍ·ÌÂÓ‹” Ô˘ ·Ú¤ÌÂÈÓÂ.

∞ÎfiÌË, ·Ó·Ê¤ÚÂÈ fiÙÈ Ê¿ÚÌ·ÎÔ ÛÂ ·˘Ù‹ ÙËÓ “·-Ú·Ï˘Û›·Ó” ÙˆÓ ¯˘ÏÔÊfiÚˆÓ ·ÁÁÂ›ˆÓ Â›Ó·È Ï¤ÔÓ ÔÊˆÛÊfiÚÔ˜, ÁÈ’ ·˘Ùfi ÙÔÓ›˙ÂÈ ÌÂ ¤ÌÊ·ÛË fiÙÈ “‰¤ÓÚ¤ÂÈ Ï¤ÔÓ Ó· ·ÂÏÈ˙fiÌÂı·”. ∫·È Û˘ÌÏËÚÒÓÂÈfiÙÈ “fiÛÙÈ˜ ÂÈı˘ÌÂ› ÏÂ›ÔÓ·˜ È‰¤·˜ ÙË˜ ÙÂ ÂÚÈÁÚ·-Ê‹˜ Î·È ıÂÚ·Â›·˜ ¿¯ÚÈ ÙÔ˘ Ó‡Ó Ì·Ù·›ˆ˜ ÂÓÂÚÁÔ˘-Ì¤ÓË˜, ·˜ ·Ó·ÁÓÒÛÂÈ ÙÔÓ ¶¤ÙÚÔ ºÚ¿ÓÎ Î·È Ù·˜ ÌÔ-ÓÔÁÚ·Ê›·˜”. ∞˜ ÛËÌÂÈˆıÂ› fiÙÈ Ô “¶¤ÙÚÔ˜ ºÚ¿ÓÎ”(Peter Frank, 1745-1821), ÂÎÙfi˜ ÙˆÓ ¿ÏÏˆÓ, fiÚÈÛÂÙÔ 1794 ÙÔÓ ¿ÔÈÔ ‰È·‚‹ÙË Î·È ¤ÁÚ·„Â Ì›· ÔÏ‡ÙÔ-ÌË Ú·ÁÌ·ÙÂ›· ÛÙË ıÂÚ·Â˘ÙÈÎ‹ “De curandishominum morbis epitome”, Ô˘ ¿Ú¯ÈÛÂ Ó· ÂÎ‰›‰ÂÙ·ÈÙÔ 1792 Î·È Û˘ÓÂ¯›ÛÙËÎÂ Ì¤¯ÚÈ ÙÔ 1821 (7). ∂›Ó·È È-ı·Ófi Ô ∞Û¿ÓË˜ Ó· ÂÓÓÔÂ› ·˘Ù‹ ÌÂ ÙÔÓ fiÚÔ “ÌÔÓÔ-ÁÚ·Ê›·”. ™ËÌÂÈÒÓÔ˘ÌÂ fiÙÈ ÛÙÔ ‚È‚Ï›Ô ÙÔ˘ FourcroyAF, Ô˘ ÌÂÙ¤ÊÚ·ÛÂ Ô £ÂÔ‰fiÛÈÔ˜ ∏ÏÈ¿‰Ë˜, ÌÓËÌÔ-ÓÂ‡ÔÓÙ·È ÔÈ ·Ú·ÙËÚ‹ÛÂÈ˜ ÙÔ˘ Peter Frank ÁÈ· ÙËÁÏ˘ÎÈ¿ ÁÂ‡ÛË ÙˆÓ Ô‡ÚˆÓ ÙˆÓ ‰È·‚ËÙÈÎÒÓ (8). ™‡Ì-ÊˆÓ· ÌÂ ÙÔÓ ¡ÈÎ. ∫ˆÛÙ‹, Ô ÊˆÛÊfiÚÔ˜ ·fi ÙÔ 1751¿Ú¯ÈÛÂ Ó· ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÂÛˆÙÂÚÈÎÒ˜ ˆ˜ Ê¿ÚÌ·-ÎÔ ÛÂ ‰È¿ÊÔÚÂ˜ ·ı‹ÛÂÈ˜ (9).

O ∞Ó·ÛÙ¿ÛÈÔ˜ °ÂˆÚÁÈ¿‰Ë˜ ·Ó·Ê¤ÚÂÈ fiÙÈ Ô ‰È·-‚‹ÙË˜ ÔÓÔÌ¿˙ÂÙ·È Î·Ù¿ ÙÔÓ ∞Ï¤Í·Ó‰ÚÔÓ ∆Ú·ÏÏÈ·-

ÓfiÓ “‰È¿ÚÚÔÈ· ÂÈ˜ Ô‡Ú·, Î·È ¿ıÔ˜ ‰›„·ÎÔÓ Î·È ‡‰Â-ÚÔ˜ Â›˜ ·Ì›‰·” (10). ª¿ÏÈÛÙ·, Ô ÙÂÏÂ˘Ù·›Ô˜ fiÚÔ˜“‡‰ÂÚÔ˜ ÂÈ˜ ·Ì›‰·” ÌÓËÌÔÓÂ‡ÂÙ·È Î·È ·fi ÙÔÓ £ˆ-Ì¿ ª·Ó‰·Î¿ÛË ÙÔ 1757 (11).

¶ÚÒÙË ÂÚÈÁÚ·Ê‹ ÙË˜ ÓÔÛÔÏÔÁÈÎ‹˜ ÔÓÙfiÙËÙ·˜ÙÔ˘ Û·Î¯·ÚÒ‰Ô˘˜ ‰È·‚‹ÙË ¤¯ÂÈ Á›ÓÂÈ ·fi ÙÔÓ È·ÙÚfi∞ÚÂÙ·›Ô, Ô ÔÔ›Ô˜ ÂÈÏ¤ÔÓ ÂÍËÁÂ› fiÙÈ ‰fiıËÎÂ ÛÙËÓ¿ıËÛË ·˘Ù‹ Ô fiÚÔ˜ “‰È·‚‹ÙË˜” ·fi ÙÔ Ú‹Ì· ‰È·-‚·›Óˆ (12). ™˘ÁÎÂÎÚÈÌ¤Ó·, ÙÔ ÎÂ›ÌÂÓÔ ÛÂ ÓÂÔÂÏÏËÓÈ-Î‹ ·fi‰ÔÛË ¤¯ÂÈ ˆ˜ ·ÎÔÏÔ‡ıˆ˜: “ŸÙ·Ó Ë ¤ÓÙÔÓË·˘Ù‹ ·›ÛıËÛË (ÏËÚfiÙËÙ·˜) Êı¿ÛÂÈ ÛÙÔ ¿ÎÚÔ ÙÔ˘ÙÚ·¯‹ÏÔ˘ ÙË˜ Î‡ÛÙÂˆ˜, ÔÈ ·ÛıÂÓÂ›˜ ·Ì¤Ûˆ˜ Ô˘-ÚÔ‡Ó. °È’ ·˘Ùfi ÙÔÓ ÏfiÁÔ ÔÓÔÌ¿ÛıËÎÂ ‰È·‚‹ÙË˜ Ë ¿-ıËÛË, ÂÂÈ‰‹ ÌÔÈ¿˙ÂÈ ÌÂ ‰È·‚‹ÙË, Î·ı’ fiÙÈ Ù· ˘ÁÚ¿‰ÂÓ ·Ú·Ì¤ÓÔ˘Ó ÛÙÔ ÛÒÌ· ·Ú¿ ¯ÚËÛÈÌÔÔÈÔ‡Ó ÙÔ·ÓıÚÒÈÓÔ ÛÒÌ· ˆ˜ ‰È·‚¿ıÚË (ÎÏ›Ì·Î·, ÛÎ¿Ï·) Ì¤-Ûˆ ÙË˜ ÔÔ›·˜ ÂÍ¤Ú¯ÔÓÙ·È”.

™ÙÔ ‰Â‡ÙÂÚÔ Ì¤ÚÔ˜ ÙË˜ ÂÚÁ·Û›·˜ ÙÔ˘, Ô È·ÙÚfi˜∞Û¿ÓË˜ ·ÚÔ˘ÛÈ¿˙ÂÈ ÙÔ È·ÙÚÈÎfi ÈÛÙÔÚÈÎfi, “ÙËÓ πÛÙÔ-Ú›· ÙË˜ π·ÙÚÈÎ‹˜ ÂÈÛÎ¤„Âˆ˜” fiˆ˜ ÙÔ ·ÔÎ·ÏÂ›,ÂÓfi˜ Ó¤Ô˘ ËÏÈÎ›·˜ 14 ÂÙÒÓ ÌÂ Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË.∞Ó·Ê¤ÚÂÈ fi,ÙÈ Â›¯Â ÚÔËÁËıÂ› ÚÈÓ ·Ó·Ï¿‚ÂÈ ÙË ıÂ-Ú·Â›· ÙÔ˘ ·ÛıÂÓÔ‡˜. ™ËÌÂÈÒÓÂÈ fiÙÈ Ù· Û˘ÌÙÒÌ·-Ù· ÙÔ˘ ‰È·‚‹ÙË ¿Ú¯ÈÛ·Ó ·ÈÊÓÈ‰›ˆ˜ ÚÈÓ ·fi Ù¤ÛÛÂ-ÚÈ˜ Ì‹ÓÂ˜, ÙÔ ¢ÂÎ¤Ì‚ÚÈÔ ÙÔ˘ 1813, ÌÂ “Û˘ÓÂ¯Â›˜ ÏÂÈ-Ôı˘Ì›·˜ Î·È ÎÒÏÈÎ·˜”. °È· ‰‡Ô Ì‹ÓÂ˜ ·Ú·ÎÔÏÔ˘-ıÔ‡ÓÙ·Ó ·fi È·ÙÚÔ‡˜, ÔÈ ÔÔ›ÔÈ ÙÔ˘ ¤‰ÈÓ·Ó “·ÓıÂÏ-ÌÈÓÙÈÎ¿” Ê¿ÚÌ·Î· “ÂÂÈ‰‹ ÂÓfiÌÈ˙ÔÓ ÙÔ ¿ıÔ˜ ÛÎˆ-ÏÈÎÒ‰Â˜, Ï‹Ó Ì·Ù·›ˆ˜ Î·ıfiÙÈ Ì‹ÙÂ ¤ÏÌÈ˜ ÔÙ¤ ÂÊ¿-ÓË, Ì‹ÙÂ Ù·ÈÓ›·”. ∫·È Û˘ÓÂ¯›˙ÂÈ Ô ∞Û¿ÓË˜ fiÙÈ “ÌÂÙ¿Ù·‡Ù· ¿Ú¯ÈÛ·Ó Ù· ÙÔ˘ ‰È·‚‹ÙÔ˘ ÛËÌÂ›·” Î·È fiÙÈ ¤Î·-ÓÂ ·Ó¿Ï˘ÛË ÙˆÓ Ô‡ÚˆÓ Î·È ‰È·›ÛÙˆÛÂ ÙËÓ ‡·ÚÍËÙË˜ Û·Î¯·ÚÔ˘Ú›·˜, “Ë ÙÔ˘ Ô‡ÚÔ˘˜ ·Ó¿Ï˘ÛÈ˜ ·¤-‰ÂÈÍÂ ÙËÓ Û¿Î¯·ÚÈÓ ¿ÊıÔÓÔÓ”. ∂ÈÛËÌ·›ÓÂÈ fiÙÈ ¯ÚË-ÛÈÌÔÔÈ‹ıËÎ·Ó “fiÏ· Ù· È·ÙÚÈÎ¿ fiÛ· Ì¤¯ÚÈ ÙÔ‡‰Â ËÙ¤¯ÓË ˘·ÁÔÚÂ‡ÂÈ”. ª¿ÏÈÛÙ·, ˘ÔÁÚ·ÌÌ›˙ÂÈ fiÙÈ ÔÈÁÔÓÂ›˜ ·Â˘ı‡ÓıËÎ·Ó Î·È ÛÙÔ˘˜ È·ÙÚÔ‡˜ ÙË˜ µÈ¤Ó-ÓË˜, ÔÈ ÔÔ›ÔÈ ‰˘ÛÙ˘¯Ò˜ ıÂÒÚËÛ·Ó ·ıÂÚ¿Â˘ÙË ÙËÓfiÛÔ ÌÂ ·ÔÙ¤ÏÂÛÌ·, fiˆ˜ Á›ÓÂÙ·È ÛÙÈ˜ ·Ó›·ÙÂ˜ Â-ÚÈÙÒÛÂÈ˜ Ô˘ ÔÈ ÁÔÓÂ›˜ ÚÔÛÙÚ¤¯Ô˘Ó ÛÙÔ˘˜ ÁfiË-ÙÂ˜ Î·È ÛÙÈ˜ Ì·ÁÂ›Â˜, Î·È ÛÙËÓ ÂÚ›ÙˆÛË ·˘Ù‹ “Î·-Ù¿ ÙÔ Û‡ÓËıÂ˜, Ë ·Ó›Û¯˘ÚÔ˜ π·ÙÚÈÎ‹ ·ÚÂ¯ÒÚËÛÂÙË ÁÔËÙÂ›·. ∫·È Ô Ù·Ï·›ˆÚÔ˜ Ó¤Ô˜ ˘¤ÂÛÂÓ ÂÈ˜Ù·˜ ¯Â›Ú·˜ ÙˆÓ ÁÚ·˚‰›ˆÓ Î·È ÙË˜ Ì·ÁÂ›·˜ ·˘ÙÒÓ”.

™ÙË Û˘Ó¤¯ÂÈ·, ÂÚÈÁÚ¿ÊÂÈ ÙËÓ Î·Ù¿ÛÙ·ÛË ÙÔ˘ Ó¤-Ô˘ Î·È Ù· Â˘Ú‹Ì·Ù· ·fi ÙË Ê˘ÛÈÎ‹ ÂÍ¤Ù·ÛË, fiÔ˘ ·-Ú·Ù‹ÚËÛÂ “·ÙÚÔÊ›· ÔÏÔÌÂÏ‹˜, ‰¤ÚÌ· ÍËÚfiÓ, ÛÎÏË-ÚfiÓ Î·È Ú˘ÙÈ‰Ò‰Â˜ ÂÍ Ô‡ ¤ÈÙÂ ÌÂ ÙËÓ ÙÚÈ‚‹Ó ·ÏÂ˘-ÚÒ‰Ë˜ ÎfiÓÈ˜, Ë ÁÏÒÛÛ·, Ô Ê¿Ú˘ÁÍ, fiÏË Ë ÌÂÌ‚Ú¿ÓËÍËÚÔÙ¿ÙË, ‰›„· Î·È Â›Ó· Û˘ÓÂ¯‹˜ Î·È ·‰È¿ÎÔÔ˜. ∆Ô¯ÚÒÌ· ˘fiÏÂ˘ÎÔÓ Î·È ÁÏ˘Î‡, Ô ÛÊ˘ÁÌfi˜ Ù·¯‡˜”.

∏ ÔÛfiÙËÙ· ÙˆÓ Ô‡ÚˆÓ ÁÚ¿ÊÂÈ fiÙÈ ‹Ù·Ó 24 Ï›ÙÚ·,ÙÚÈÏ¿ÛÈ· ·’ fi,ÙÈ ¤ÈÓÂ. ∏ ÎÔÈÏÈ¿ ‹Ù·Ó “ÊÔ˘ÛÎˆÌ¤ÓË”

May-June 03 03-06-03 16:55 ™ÂÏ›‰·233


234

ÌÂ “·‰˘Ó·Ì›· ÛÙ· ¿ÎÚ·” Î·È Â›¯Â ‰˘ÛÎÔÈÏÈfiÙËÙ· Î·ÈÛÎÏËÚ¿ ÎfiÚ·Ó· “ÂÍ¤‚·ÈÓÔÓ ‰È¿ ÙÔ˘ ÎÏ˘ÛÙËÚ›Ô˘”.¶ÚÔÛı¤ÙÂÈ fiÙÈ Û˘ÁÎÏ‹ıËÎÂ È·ÙÚÈÎfi Û˘Ì‚Ô‡ÏÈÔ, Ô˘ÙÔ ·ÔÎ·ÏÂ› “π·ÙÚÈÎ‹ Û˘Ó¤ÏÂ˘ÛÈ˜”, ÛÙÔ ÔÔ›Ô ÚfiÙÂÈ-ÓÂ, ÛÙËÚÈ˙fiÌÂÓÔ˜ “ÛÙËÓ ÂÈÎ·Û›·Ó” ÂÓfi˜ ÊËÌÈÛÌ¤ÓÔ˘È·ÙÚÔ‡ ÙË˜ ¶·˘˝·˜, Ó· ‰ÔÎÈÌ·ÛÙÂ› ÛÙÔÓ ·ÛıÂÓ‹ ·fiÙÔ˘ ÛÙfiÌ·ÙÔ˜, “ÂÛˆÙÂÚÈÎÒ˜”, ¤Ó· Ó¤Ô Ê¿ÚÌ·ÎÔ, “ÔÊˆÛÊfiÚÔ˜” “·Ó·Ï˘fiÌÂÓÔ˜ ÂÈ˜ ÙÔÓ ıÂÈÈÎfiÓ ·Èı¤Ú·”. HıÂÚ·Â›· ı· Û˘ÓÔ‰Â‡ÂÙ·È ÌÂ Û¯ÂÙÈÎ‹ ˙ˆÈÎ‹ ‰›·ÈÙ· Î·Èı· ÚÔÛÊ¤ÚÂÙ·È ˆ˜ “Î·ıËÌÂÚÈÓfiÓ ÔÙfiÓ ÙÔ ˘‰ÚfiÁ·-ÏÔÓ”, ‰ÈfiÙÈ fiˆ˜ ÛËÌÂÈÒÓÂÈ “Î·Ù¿ ÙËÓ ÂÌ‹Ó ÂÈÎ·Û›·Ó ËÙˆÓ ÎÂÓˆÙÈÎÒÓ Î·Ù¿¯ÚËÛÈ˜ Ó· ¤ÚÚÈ„Â Ù· ıÚÂÙÈÎ¿ ·Á-ÁÂ›· ÂÈ˜ ·ÙÔÓ›·Ó”.

∏ Ó¤· ıÂÚ·Â˘ÙÈÎ‹ ·ÁˆÁ‹ ÙÔ˘ ÓÂ·ÓÈÎÔ‡ Û·Î¯·-ÚÒ‰Ô˘˜ ‰È·‚‹ÙË ÌÂ ÙÔÓ ÊˆÛÊfiÚÔ ‰È‹ÚÎÂÛÂ 2 Î·ÈÏ¤ÔÓ Ì‹ÓÂ˜ (15 ∞ÚÈÏ›Ô˘ 1814 ¤ˆ˜ 24 πÔ˘Ó›Ô˘1814), ÂÓÒ ·Ú¿ÏÏËÏ· Û˘ÓÔ‰Â˘fiÙ·Ó ·fi ÙÚÈ„›Ì·-Ù· ÙÔ˘ Ï›Ô˘˜ ‰È¿ Ó· ·Ú·ÎˆÏ˘ıÂ› Ô ÂÍˆÙÂÚÈÎfi˜“ÂÎÚÔÊÈÛÌfi˜”, Ë ¿‰ËÏÔ˜ ‰È·ÓÔ‹. π‰È·›ÙÂÚ· ÙÔÓ›˙ÂÈfiÙÈ Û˘Ó¤ÛÙËÛÂ ÙË “Á·Ï·ÎÙÔÙÚÔÊ›·”, ÂÂÈ‰‹ Ô ÓÂ·-Úfi˜ ·ÛıÂÓ‹˜ Â›¯Â ·ÈÛı·ÓıÂ› ÎÔÚÂÛÌfi ·fi ÙÔ ÎÚ¤-·˜. ™ËÌÂÈÒÓÂÈ fiÙÈ ÌÂ ÙË Û˘ÁÎÂÎÚÈÌ¤ÓË ıÂÚ·Â˘ÙÈÎ‹·ÁˆÁ‹ Ô ·ÛıÂÓ‹˜ ÙÔ˘ Â›¯Â ¿ÚÂÈ ‚¿ÚÔ˜, Ë ÔÛfiÙË-Ù· ÙˆÓ Ô‡ÚˆÓ ÌÂÈˆÓfiÙ·Ó, ÙÔ ¯ÚÒÌ· Î·È Ë ÔÛÌ‹ ÙˆÓÔ‡ÚˆÓ ‹Ù·Ó Ê˘ÛÈÎ‹, “Ë fiÚÂÍÈ˜ Î·È Ë ‰›„· ÌÂÙÚÈˆ-Ù¿ÙË. ∆Ô ‰¤ÚÌ· Ì·Ï·ÎfiÓ, ÏÂ›ÔÓ. ∂Ó›ÔÙÂ ›‰ÚˆÓÂ ÂÈ˜fiÏÔÓ ÙÔ ÛÒÌ·” Î·È fiÙÈ Â›¯Â “·¯‡ÓË ÙfiÛÔÓ fiÛÔÓ‹ÙÔÓ Úfi ÙË˜ ÓfiÛÔ˘”.

∆¤ÏÔ˜, ÂÚÈÁÚ¿ÊÂÈ ÙËÓ Î·Ù¿ÏËÍË ÙÔ˘ ·ÛıÂÓ‹,Ô˘ Û˘Ó¤‚Ë (ÙÔÓ πÔ‡ÏÈÔ ÙÔ˘ 1814) Î·Ù¿ ÙË ‰È·ÌÔÓ‹ÙÔ˘ ÛÙËÓ ÂÍÔ¯‹. ∞Ó·Ê¤ÚÂÈ fiÙÈ Ô ÓÂ·Úfi˜ ·ÛıÂÓ‹˜“ÂÛ˘Á¯›ÛıË ‰È¿ ÙËÓ ‰›·ÈÙ¿Ó ÙÔ˘ ÌÂ ÙËÓ ÌËÙ¤Ú· ÙÔ˘,ÒÛÙÂ ‰ÂÓ ‹ıÂÏÂ Î·Ù’ Ô˘‰¤Ó· ÙÚfiÔÓ Ó· Î·Ù·ÂÈ-ÛıÂ› Ó· Ê¿ÁË Ì‹ÙÂ Ó· ›Ë ‰‡Ô ÔÏÔÎÏ‹ÚÔ˘˜ ËÌ¤-Ú·˜” Î·È ·Ú·‚·›ÓÔÓÙ·˜ ÙË ‰›·ÈÙ· Ô˘ ÙÔ˘ Â›¯Â Û˘-ÛÙËıÂ›, ·ÚÔ˘Û›·ÛÂ Û˘ÓÂ¯Â›˜ ÂÌ¤ÙÔ˘˜ Î·È ÎÔÈÏÈ·Î¿¿ÏÁË. ∆ËÓ ÙÚ›ÙË ËÌ¤Ú· ÙˆÓ ÛÔ‚·ÚÒÓ Û˘ÌÙˆÌ¿-ÙˆÓ, fiÙ·Ó ÚÔÛÎÏ‹ıËÎÂ Ô È·ÙÚfi˜ ∞Û¿ÓË˜, Â›¯·Ó·Ú¯›ÛÂÈ ‹‰Ë, fiˆ˜ ÁÚ¿ÊÂÈ, Ù· ÛËÌÂ›· ÙÔ˘ ı·Ó¿ÙÔ˘.øÛÙfiÛÔ, ·Ú·ÙËÚÂ› fiÙÈ “ÙÔ ÂÚ›ÂÚÁÔÓ Â›Ó·È fiÙÈ ÂÈ˜·˘Ù¿˜ Ù·˜ ÙÚÂ›˜ ÙÂÏÂ˘Ù·›·˜ ËÌ¤Ú·˜ ÙÔ Ô‡ÚÔ˜ ‹ÙÔÓÂÈ˜ ÂÏ·¯›ÛÙËÓ ÔÛfiÙËÙ·, ÂÚ˘ıÚfiÓ Î·È ÌÂ ÔÛÌ‹Ó ‚·-ÚÂ›·Ó ·ÌÌˆÓÈ·ÎÔ‡”. ∫·È Î·Ù·Ï‹ÁÂÈ ˆ˜, ·Ó Î·È ‹ıÂ-ÏÂ Ó· Î¿ÓÂÈ ÓÂÎÚÔÙÔÌ‹ ÁÈ· ÙË ‰ÈÂÚÂ‡ÓËÛË ÙË˜ ÂÚÈ-ÙÒÛÂˆ˜, ÙËÓ ·¤Ê˘ÁÂ “ÁÓˆÚ›˙ˆÓ ÙËÓ ÎÔÈÓ‹Ó ‰ÂÈ-ÛÈ‰·ÈÌÔÓ›·Ó Î·È ·¤¯ıÂÈ·Ó” ÙÔ˘ Ï·Ô‡ ÚÔ˜ ÙÈ˜ ÓÂ-ÎÚÔÙÔÌ¤˜.

™ËÌÂÈÒÓÂÙ·È fiÙÈ ÁÈ· ÙË ıÂÚ·Â˘ÙÈÎ‹ ·ÓÙÈÌÂÙÒÈ-ÛË ÙÔ˘ Û·Î¯·ÚÒ‰Ô˘˜ ‰È·‚‹ÙË ¯ÚËÛÈÌÔÔÈ‹ıËÎ·ÓÔÏÏ¤˜ Ê·ÚÌ·ÎÂ˘ÙÈÎ¤˜ Ô˘Û›Â˜, Ô˘ Î·Ù·ÁÚ¿ÊÔ-ÓÙ·È Î·È ÛÂ ÌÂÙ·ÁÂÓ¤ÛÙÂÚ· ‚È‚Ï›·, fiˆ˜ ÁÈ· ·Ú¿-‰ÂÈÁÌ· ·fi ÙÔÓ ¢ÈÔÓ‡ÛÈÔ ¶‡ÚÚÔ (13), Ô ÔÔ›Ô˜ ÂÈ-Ï¤ÔÓ ·Ú·ı¤ÙÂÈ Î·È Û¯ÂÙÈÎfi ∞ÊÔÚÈÛÌfi ÙÔ˘ πÔ-

ÎÚ¿ÙÔ˘˜ (ÙÌ‹Ì· 4ÔÓ, 83) “°ÈÁÓÒÌÂÓÔÓ ÔÏ‡ Ô‡ÚÔ˜ÙËÓ Ó‡ÎÙ·, ‰ËÏÔ› ÌÈÎÚ¿Ó ÙËÓ ˘Ô¯ÒÚËÛÈÓ”, Ô˘·ÓÙÈÛÙÔÈ¯Â› ÛÙÔ ·Ú¯·›Ô ÎÂ›ÌÂÓÔ “O‡ÚËÛÈ˜ Ó‡ÎÙˆÚÔÏÏ‹ ÁÈÓÔÌ¤ÓË, ÛÌÈÎÚ‹Ó ÙËÓ ˘Ô¯ÒÚËÛÈÓ ÛËÌ·›-ÓÂÈ” Î·È Èı·ÓfiÓ Ó· ·Ó·Ê¤ÚÂÙ·È ÛÙÔÓ Û·Î¯·ÚÒ‰Ë‰È·‚‹ÙË. OÌÔ›ˆ˜, Ô §. ¢. ÃÚ‹ÛÙÔ‚ÈÙ˙ ÛÙ· “¡¤·Ê¿ÚÌ·Î·” ÁÈ· ÙÔÓ ‰È·‚‹ÙË ·Ó·ÁÚ¿ÊÂÈ Ù· ·ÎfiÏÔ˘-ı·: “Èˆ‰ÔÊfiÚÌÈÔÓ, Â„›ÓË, ÂÙfiÓ·È, Ó¿ÙÚÈÔÓ ÛÂÈ-Ú·˚ÎfiÓ, Ó·Ú‰ÈÎfi˜ „Â˘‰¿ÚÁ˘ÚÔ˜, ÔÍ‡ Á·Ï·ÎÙÈÎfiÓ,ıÂÈÒ‰Â˜ ·Û‚¤ÛÙÈÔÓ” (14).

™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, ÛÙÔ ÎÂ›ÌÂÓÔ ÙÔ˘ È·ÙÚÔ‡ πˆ¿Ó-ÓË ∞Û¿ÓË Î·Ù·¯ˆÚ›˙ÂÙ·È Ë Û˘ÌÙˆÌ·ÙÔÏÔÁ›· ÙÔ˘Û·Î¯·ÚÒ‰Ô˘˜ ‰È·‚‹ÙË ÛÂ Ó¤Ô ËÏÈÎ›·˜ 14 ÂÙÒÓ, Ë‰È·ÈÙËÙÈÎ‹ ·ÁˆÁ‹ ÌÂ ÏÂ˘ÎˆÌ·ÙÔ‡¯Ô ÙÚÔÊ‹ Î·È Ì›·ÚÔÛ¿ıÂÈ· ıÂÚ·Â˘ÙÈÎ‹˜ ‰ÔÎÈÌ‹˜ ÂÓfi˜ Ó¤Ô˘ Ê·Ú-Ì¿ÎÔ˘, ÙÔÓ “ÊˆÛÊfiÚÔÓ, ·ÏÂÍÈÊ¿ÚÌ·ÎÔÓ ÙË˜ ÊÚÈ-ÎÒ‰Ô˘˜ Î·È ·ÓÈ¿ÙÔ˘ Û¯Â‰fiÓ ÓfiÛÔ˘, ÙÔ˘ ‰È·‚‹ÙÔ˘”.

∞ÎfiÌË, Ú¤ÂÈ Ó· ÙÔÓÈÛÙÂ› fiÙÈ ÛÙÔ ÂÚÈÔ‰ÈÎfi“∂ÚÌ‹˜ Ô §fiÁÈÔ˜” Î·Ù·ÁÚ¿ÊÔÓÙ·È Û‡Á¯ÚÔÓÂ˜ ÂÈ-ÛÙËÌÔÓÈÎ¤˜ È·ÙÚÈÎ¤˜ ÏËÚÔÊÔÚ›Â˜ ÁÈ· ÙËÓ ÂÓËÌ¤-ÚˆÛË ÙˆÓ ·Ó·ÁÓˆÛÙÒÓ ÙÔ˘, ÛÂ Ì›· ÂÚ›Ô‰Ô Ô˘‰ÂÓ Î˘ÎÏÔÊÔÚÔ‡ÛÂ ÂÈ‰ÈÎfi ÂÏÏËÓÈÎfi È·ÙÚÈÎfi ÂÚÈÔ-‰ÈÎfi.

∆¤ÏÔ˜, ÛÂ ·˘Ù‹ ÙËÓ ÂÚÁ·Û›· ÙÔ˘ È·ÙÚÔ‡ πˆ¿ÓÓË∞Û¿ÓË ·Ó·ÁÚ¿ÊÔÓÙ·È, ›Ûˆ˜ ÁÈ· ÚÒÙË ÊÔÚ¿ ÛÙÔÓÂÔÂÏÏËÓÈÎfi ÏÂÍÈÏfiÁÈÔ, ÔÈ fiÚÔÈ “Û·Î¯·ÚÒ‰Ë˜ ‰È·-‚‹ÙË˜”, “‰È·‚ËÙÈÎfi˜” Î·È “ÌÔÓÔÁÚ·Ê›·”, ÔÈ ÔÔ›ÔÈ,ˆÛÙfiÛÔ, ·Ô‰›‰ÔÓÙ·È Ì¤¯ÚÈ ÙÒÚ· ÛÂ ÌÂÙ·ÁÂÓ¤ÛÙÂ-Ú· ‚È‚Ï›· (15).

µÈ‚ÏÈÔÁÚ·Ê›· Î·È ™ËÌÂÈÒÛÂÈ˜1. ∂ÚÌ‹˜ Ô §fiÁÈÔ˜. ∂Ó µÈ¤ÓÓË, ÂÎ ÙË˜ Ù˘ÔÁÚ·Ê›·˜ ÙÔ˘ πˆ.

µ·ÚıÔÏ. ∆˙‚ÂÎ›Ô˘, 1817, Â·Ó·Ù‡ˆÛË ∂Ù·ÈÚÂ›· ∂ÏÏËÓÈ-ÎÔ‡ §ÔÁÔÙÂ¯ÓÈÎÔ‡ ∞Ú¯Â›Ô˘, ∞ı‹Ó·; 1989. ÛÂÏ. 578: “ …ÂÂÈ‰‹ ·ÎfiÌË ‰ÂÓ ÂÊı¿Û·ÌÂÓ ÂÈ˜ ÙÔÓ ‚·ıÌfiÓ ÂÎÂ›ÓÔÓÙË˜ ·È‰Â›·˜, Î·ı fiÓ ÂÌÔÚÔ‡ÌÂÓ Ó· ¤¯ˆÌÂÓ ÂÎ¿ÛÙË˜ ÂÈ-ÛÙ‹ÌË˜ È‰›·Ó ÂÊËÌÂÚ›‰·Ó, ˆ˜ ¤¯Ô˘ÛÈ Ù· ÛÔÊ¿ ÙË˜ ‰˘ÙÈÎ‹˜∂˘ÚÒË˜ ¤ıÓË, ·Ó·ÁÎ·˙fiÌÂı· Ó· ÂÎ‰›‰ˆÌÂÓ ‰È· ÙÔ˘§.[ÔÁ›Ô˘] ∂.[ÚÌÔ‡] ·Ó fi,ÙÈ ‹ıÂÏÂ Ê¤ÚÂÈ ̂ Ê¤ÏÂÈ·Ó ÂÈ˜ ÙÔ Á¤-ÓÔ˜…”.

2. ∆ÛÈÙÛ¤ÏË˜ ∏. ∫ÂÊ·ÏÏËÓÈ·Î¿ Û‡ÌÌÈÎÙ·. ∆fiÌÔ˜ ∞’: ∞ı‹Ó·;1904. ÛÂÏ. 33-34.

3. ∂ÚÌ‹˜ Ô §fiÁÈÔ˜. µÈ¤ÓÓË; 1811, ÛÂÏ. 91-95, 111-118. ∂Ó‰È·-Ê¤ÚÔÓ ¤¯ÂÈ Ó· ÙÔÓÈÛÙÂ› fiÙÈ ÛÙÔ ¿ÚıÚÔ ·˘Ùfi Î·Ù·ÁÚ¿ÊÂÙ·ÈÔ fiÚÔ˜ “‰ÈÂÁÂÚÛÈÌfiÙË˜” Î·È ÂÈÛ¿ÁÂÙ·È ÛÙËÓ ÂÏÏËÓÈÎ‹ ÔÚÔ-ÏÔÁ›·. µÏ. ™ÙÂÊ. ∫Ô˘Ì·ÓÔ‡‰Ë˜. ™˘Ó·ÁˆÁ‹ Ó¤ˆÓ Ï¤ÍÂˆÓ.∞ı‹Ó·; 1900. ∞Ó·Ù‡ˆÛË ∂ÚÌ‹˜: ∞ı‹Ó·; 1980. ÛÂÏ. 288.

4. ∂ÚÌ‹˜ Ô §fiÁÈÔ˜. µÈ¤ÓÓË; 1814. ÛÂÏ. 117-123. 5. O Thenar Luis (1777-1857) ‹Ù·Ó °¿ÏÏÔ˜ ¯ËÌÈÎfi˜ Î·È Ê·Ú-

Ì·ÎÔÔÈfi˜ Î·È Ô Dupuytren Guillaume (1777-1835) ‰È¿ÛË-ÌÔ˜ °¿ÏÏÔ˜ ¯ÂÈÚÔ˘ÚÁfi˜, Ô˘ ÌÂÙ·Í‡ ¿ÏÏˆÓ ·Ó·Ê¤ÚÂÙ·Èˆ˜ Ô ÚÒÙÔ˜ Ô˘ ıÂÚ¿Â˘ÛÂ ·ÓÂ‡Ú˘ÛÌ· Î·È Â›Ó·È ÁÓˆÛÙfi˜Î·È ·fi ÙÔ Î¿Ù·ÁÌ· ¡Ù˘Ô˘˚ÙÚ¤Ó, Ô˘ ÂÚÈ¤ÁÚ·„Â ÙÔ1812. µÏ. ∂ÌÌ·ÓÔ˘‹Ï ∂. πÛÙÔÚ›· ÙË˜ º·ÚÌ·ÎÂ˘ÙÈÎ‹˜. ∞ı‹-Ó·È; 1948. ÛÂÏ. 415 Î·È Garrison F. An Introduction to the

May-June 03 03-06-03 16:55 ™ÂÏ›‰·234

235


History of Medicine. 4th edition. Reprinted. Philadelphia andLondon: W. B. Saunders Company; 1961. ÛÂÏ. 488-490. ™Ë-ÌÂÈÒÓÔ˘ÌÂ, ˆÛÙfiÛÔ, fiÙÈ Ô W. Cullen ‹Ù·Ó ÂÎÂ›ÓÔ˜ Ô˘ ÚÒ-ÙÔ˜ ÚfiÛıÂÛÂ ÙÔ Â›ıÂÙÔ “mellitus” ÛÙËÓ ¿ıËÛË ÙÔ˘ ‰È·-‚‹ÙË. µÏ. Papaspyros NS. The history of diabetes mellitus.Foreword by Lawrence RD: London; 1952. ÛÂÏ. 15.

6. ªÂ ÙÔÓ fiÚÔ “Ô˘ÚÈÎfiÓ Û‡ÛÙËÌ·” ·Ô‰›‰ÂÙ·È Ô fiÚÔ˜ “Ô˘ÚÔ-ÔÈËÙÈÎfiÓ Û‡ÛÙËÌ·”, Ô˘ ÂÈÛ‹¯ıË ÛÙËÓ ÂÏÏËÓÈÎ‹ È·ÙÚÈÎ‹ÔÚÔÏÔÁ›· ·fi ÙÔÓ ∞Ó·ÛÙ¿ÛÈÔ °ÂˆÚÁÈ¿‰Ë. ∞ÓÙÈ·Ó¿ÎÂÈ·. ∂ÓµÈ¤ÓÓË; 1810. ÛÂÏ. 110.

7. Garrison F. An Introduction to the History of Medicine. 4thedition. Reprinted. Philadelphia and London: W.B. SaundersCompany; 1961. ÛÂÏ. 321-322. Morton LT, Moore RJ. AChronology of Medicine and related sciences. Asgate,Aldershot England; 1997. ÛÂÏ.122.

8. Fourcroy AF. ÃËÌÈÎ‹ ÊÈÏÔÛÔÊ›·. ªÂÙ¿ÊÚ·ÛË: £ÂÔ‰ÔÛ›Ô˘∏ÏÈ¿‰Ë, µÈ¤ÓÓË; 1802. ÛÂÏ. 159. ∆Ô ‚È‚Ï›Ô ·˘Ùfi ·ÔÙÂÏÂ› ÙÔÚÒÙÔ ‚È‚Ï›Ô ÃËÌÂ›·˜ ÛÙËÓ ÂÏÏËÓÈÎ‹ ÁÏÒÛÛ· Î·È ÛÙÔ ÔÔ›ÔÎ·Ù·¯ˆÚ›˙ÔÓÙ·È Î·È È·ÙÚÈÎ¤˜ ÁÓÒÛÂÈ˜.

9. ∫ˆÛÙ‹˜ ¡. ∂Á¯ÂÈÚ›‰ÈÔÓ º·ÚÌ·ÎÔÏÔÁ›·˜. ∂Ó ∞ı‹Ó·È˜, ÂÎ ÙË˜Ù˘ÔÁÚ·Ê›·˜ π. ∞ÁÁÂÏÔÔ‡ÏÔ˘; 1855. ÛÂÏ. 774.

10. °ÂˆÚÁÈ¿‰Ë˜ ∞. ∞ÓÙÈ·Ó¿ÎÂÈ·. ∂Ó µÈ¤ÓÓË; 1810. ÛÂÏ. 172. 11. ª·Ó‰·Î¿ÛË˜ £. ŸÌÔÈ· ÙˆÓ ÂÏÏÂÈfiÓÙˆÓ ÔÌÔ›ˆÓ È¿Ì·Ù·.

§ÂÈ„›·; 1757. ∫·Ú·ÌÂÚfiÔ˘ÏÔ˜ ¢. ∏ ÌÂÙ·ÊÔÚ¿ ÙË˜ ÂÈ-ÛÙËÌÔÓÈÎ‹ È·ÙÚÈÎ‹˜ ÁÓÒÛË˜ Ì¤Ûˆ ÙˆÓ ÂÓÙ‡ˆÓ ÂÏÏËÓÈÎÒÓ‚È‚Ï›ˆÓ Î·Ù¿ ÙËÓ ÂÔ¯‹ ÙÔ˘ ¡ÂÔÂÏÏËÓÈÎÔ‡ ¢È·ÊˆÙÈÛÌÔ‡(1745-1821). ∞ı‹Ó·; 1996. ÛÂÏ. 37, 231.

12. ∞ÚÂÙ·›Ô˜. ¶ÂÚ› ·ÈÙ›ˆÓ Î·È ÛËÌÂ›ˆÓ ¯ÚÔÓ›ˆÓ ·ıÒÓ. µÈ‚Ï›ÔÓµ’. ÎÂÊ. 2. “¶ÂÚ› ‰È·‚ËÙ¤ˆ”. ∏ ·fi‰ÔÛË ÛÙË ÓÂÔÂÏÏËÓÈÎ‹ Â›-Ó·È ·fi ÙË ÛÂÈÚ¿ ÙˆÓ ÂÎ‰fiÛÂˆÓ “OÈ ŒÏÏËÓÂ˜”. ·Ú. 393. ∞ı‹-Ó·: ∂Î‰fiÛÂÈ˜ ∫¿ÎÙÔ˜; 1997. ÛÂÏ. 205.

13. ¢ÈÔÓ˘Û›Ô˜ ¶‡ÚÚÔ˜ Ô £ÂÙÙ·Ïfi˜. π·ÙÚÈÎfiÓ ÂÁÎfiÏÈÔÓ. ∆fiÌÔ˜1. ∂Ó ¡·˘Ï›ˆ; 1831. ÛÂÏ. 56-57.

14. ÃÚ‹ÛÙÔ‚ÈÙ˙ §¢. ∆· Ó¤· Ê¿ÚÌ·Î· ‹ ÂÈÙÔÌ‹ ÙˆÓ Î˘ÚÈˆÙ¤ÚˆÓÂÎ ÙˆÓ ÓÂˆÛÙ› ·Ó·Ê·Ó¤ÓÙˆÓ Ó¤ˆÓ ıÂÚ·Â˘ÙÈÎÒÓ ¤ÚÁˆÓ ÌÂ-Ù¿ ÙˆÓ Û˘ÓÙ·ÁÒÓ. ∂Ó ∞ı‹Ó·È˜, ÂÎ ÙÔ˘ Ù˘ÔÁÚ·ÊÂ›Ô˘ °. ™.™Ù·˘Ú›‰Ô˘; 1888. ÛÂÏ. 145, 224, 225, 277.

15. ∫Ô˘Ì·ÓÔ‡‰Ë˜ ™. ™˘Ó·ÁˆÁ‹ Ó¤ˆÓ Ï¤ÍÂˆÓ. ∞ı‹Ó·; 1900.

∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 01-11-2002 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛË˜: 21-02-2003

¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ¢. ∫·Ú·ÌÂÚfiÔ˘ÏÔ˜ªÈÏÙÈ¿‰Ô˘ 3, ∆.∫. 145 62, ∫ËÊÈÛÈ¿

May-June 03 03-06-03 16:55 ™ÂÏ›‰·235

¡∂∞ ∞¶O ∆O ¢π∞¢π∫∆ÀO


236

∂π™∞°ø°π∫O ™∏ª∂πøª∞ ∫ÔÚ›Ó· ¶ÚÔ‡ÓÙ˙Ô˘ - ∫·ÛÛÈÔ‡

∞Á·ËÙÔ› Û˘Ó¿‰ÂÏÊÔÈ, ∆Ô ÂÚÈÔ‰ÈÎfi “¶·È‰È·ÙÚÈÎ‹” Ì¿˜ ¤¯ÂÈ ÛËÌ·‰¤„ÂÈ fiÏÔ˘˜ ÙÔ˘˜ ·Ï·ÈfiÙÂÚÔ˘˜ Î·È ·ÔÙÂÏÂ›

ÛËÌÂ›Ô ·Ó·ÊÔÚ¿˜ ÁÈ· ÙÔ˘˜ Ó¤Ô˘˜ ·È‰È¿ÙÚÔ˘˜. Œ¯ÂÈ ÙË ‰‡Ó·ÌË ÙÔ˘ ÎÏ·ÛÈÎÔ‡ Î·È ÙÔÓ ÚÔÛ·-Ó·ÙÔÏÈÛÌfi ÙÔ˘ ÛÙÔ Ó¤Ô.

™Â ·˘Ùfi ÙÔ ÙÂ‡¯Ô˜ ÂÁÎ·ÈÓÈ¿˙Ô˘ÌÂ Ì›· Ó¤· ÛÂÏ›‰· Ô˘ Ï¤ÁÂÙ·È “¡¤· ·fi ÙÔ ¢È·‰›ÎÙ˘Ô”. ∂›-Ó·È Ì›· ÛÂÏ›‰· Ô˘ ı· ÂÚÈÏ·Ì‚¿ÓÂÈ ÂÓ‰È·Ê¤ÚÔÓÙ· Ó¤· Ô˘ ·ÊÔÚÔ‡Ó ÛÙËÓ ¶·È‰È·ÙÚÈÎ‹ Î·È ÌÂ-Ï¤ÙÂ˜ ÂÓÙÂÏÒ˜ ÚfiÛÊ·ÙÂ˜, ·ÚÎÂÙ¤˜ ÊÔÚ¤˜ ÚÈÓ ·ÎfiÌË ‰ËÌÔÛÈÂ˘ıÔ‡Ó ÛÙ· ·ÓÙ›ÛÙÔÈ¯· ÂÚÈÔ-‰ÈÎ¿. £· ÂÚÈÏ·Ì‚¿ÓÂÈ, Â›ÛË˜, ÏËÚÔÊÔÚ›Â˜ ÁÈ· ÈÛÙÔÛÂÏ›‰Â˜ Î·È ËÏÂÎÙÚÔÓÈÎ¤˜ ‰ÈÂ˘ı‡ÓÛÂÈ˜ÌÂ ·ÓÙÈÎÂ›ÌÂÓÔ ÙËÓ ¶·È‰È·ÙÚÈÎ‹.

∏ ÂÈÌ¤ÏÂÈ· ÙË˜ ÛÂÏ›‰·˜ ı· Â›Ó·È Â˘ı‡ÓË ÙˆÓ: ∫. ¶ÚÔ‡ÓÙ˙Ô˘-∫·ÛÛÈÔ‡ (¶·È‰È¿ÙÚÔ˘), ¡›ÎÔ˘¶··‰fiÔ˘ÏÔ˘ (∞ÏÏÂÚÁÈÔÏfiÁÔ˘) Î·È ª·Ú›·˜ ∏Ï›· (¶·È‰È¿ÙÚÔ˘-°·ÛÙÚÂÓÙÂÚÔÏfiÁÔ˘). ™˘ÓÂÚ-Á¿ÙÂ˜ ÙË˜ ÛÂÏ›‰·˜ ı· Â›Ó·È Î·È ·È‰›·ÙÚÔÈ ÌÂ È‰È·›ÙÂÚÔ ÂÓ‰È·Ê¤ÚÔÓ ÁÈ· ÙÔ ‰È·‰›ÎÙ˘Ô.

∞˘Ù‹ ÙËÓ ÂÔ¯‹, ÙÔ ÂÓ‰È·Ê¤ÚÔÓ fiÏÔ˘ ÙÔ˘ ÎfiÛÌÔ˘ Â›Ó·È ÛÙÚ·ÌÌ¤ÓÔ ÛÙËÓ ÂÈ‰ËÌ›· ÙÔ˘ ™Ô-‚·ÚÔ‡ OÍ¤Ô˜ ∞Ó·ÓÂ˘ÛÙÈÎÔ‡ ™˘Ó‰ÚfiÌÔ˘ (™O∞™). ™Â ·˘Ùfi ÙÔ ÙÂ‡¯Ô˜ ·ÚÔ˘ÛÈ¿˙Ô˘ÌÂ ÙÈ˜ ÙÂ-ÏÂ˘Ù·›Â˜ ÏËÚÔÊÔÚ›Â˜ ÁÈ· ÙÔ Û‡Ó‰ÚÔÌÔ.

£ÂˆÚÔ‡ÌÂ, fiÌˆ˜, ¯Ú¤Ô˜ Ì·˜ ÚÈÓ ¿ÌÂ ÛÙÈ˜ ÏËÚÔÊÔÚ›Â˜, Ó· ·ÔÙ›ÛÔ˘ÌÂ ÊfiÚÔ ÙÈÌ‹˜ÛÙÔÓ π·ÙÚfi-ÕÓıÚˆÔ Carlo Urbani.

O Carlo Urbani ‹Ù·Ó 46 ÂÙÒÓ Î·È ·Ù¤Ú·˜ 3 ·È‰ÈÒÓ. ◊Ù·Ó ÂÈ‰ÈÎfi˜ ÛÙ· ÌÂÙ·‰ÔÙÈÎ¿ ÓÔÛ‹-Ì·Ù· Î·È ¤ı·ÓÂ ÛÙÈ˜ 29 ª·ÚÙ›Ô˘ 2003 ÛÙÔ ∞ÓfiÈ, fiÔ˘ ÂÚÁ·˙fiÙ·Ó Û·Ó ÂÎÚfiÛˆÔ˜ ÙÔ˘ WHOÛÂ ÚÔÁÚ¿ÌÌ·Ù· ‰ËÌfiÛÈ·˜ ˘ÁÂ›·˜.

O Carlo Urbani ‹Ù·Ó Ô ÚÒÙÔ˜ ÁÈ·ÙÚfi˜ Ô˘ ·Ú·Ù‹ÚËÛÂ ÙËÓ È‰È·ÈÙÂÚfiÙËÙ· ÙË˜ Ó¤·˜ ·Ûı¤-ÓÂÈ·˜ ÛÂ ¤Ó·Ó ∞ÌÂÚÈÎ·Ófi ÂÈ¯ÂÈÚËÌ·Ù›·, ÛÂ ¡ÔÛÔÎÔÌÂ›Ô ÙÔ˘ ∞ÓfiÈ. Ã¿ÚË ÛÂ ·˘Ù‹ ÙËÓ ÚÒÈÌË·Ó·ÁÓÒÚÈÛË ÙË˜ ÓfiÛÔ˘, ÂÓÂÚÁÔÔÈ‹ıËÎÂ ÔÏ‡ ÁÚ‹ÁÔÚ· Ô ·ÁÎfiÛÌÈÔ˜ ÌË¯·ÓÈÛÌfi˜ ÂÈÙ‹ÚË-ÛË˜, ÌÂ ·ÔÙ¤ÏÂÛÌ· Ó· ÏËÊıÔ‡Ó ¤ÁÎ·ÈÚ· Ì¤ÙÚ· ·Ó·ÎÔ‹˜ ÙË˜ ÂÍ¿ÏˆÛË˜ ÙË˜ ÓfiÛÔ˘ Î·È ËÂÈ‰ËÌ›· ÛÙÔ ∞ÓfiÈ ÙÒÚ· Ó· ÂÏ¤Á¯ÂÙ·È.

O Carlo Urbani ‹ÚÂ ÙÔ Ù˘¯›Ô ÙË˜ π·ÙÚÈÎ‹˜ ·fi ÙÔ ¶·ÓÂÈÛÙ‹ÌÈÔ ÙË˜ ∞ÁÎfiÓ· ÛÙËÓ πÙ·Ï›·Î·È ¤Î·ÓÂ ÌÂÙ·Ù˘¯È·Î¤˜ ÛÔ˘‰¤˜ ÛÙËÓ ÂÏÔÓÔÛ›· Î·È Ù· ·Ú·ÛÈÙÈÎ¿ ÓÔÛ‹Ì·Ù·. ◊Ù·Ó ÂÈ‰ÈÎfi˜ÙÚÔÈÎÒÓ ÓfiÛˆÓ ÛÙ· ·È‰È¿. ∂›ÛË˜, ‹Ù·Ó ¶ÚfiÂ‰ÚÔ˜ ÙˆÓ “°È·ÙÚÒÓ ¯ˆÚ›˜ Û‡ÓÔÚ·” ÙË˜ πÙ·-Ï›·˜. O ı¿Ó·Ùfi˜ ÙÔ˘ Û˘ÁÎÏfiÓÈÛÂ ÙËÓ ·ÁÎfiÛÌÈ· È·ÙÚÈÎ‹ ÎÔÈÓfiÙËÙ· Î·È Â·Ó¤ÊÂÚÂ ÛÙË Û˘ÓÂ›-‰ËÛË fiÏˆÓ Ì·˜ ·Í›Â˜ Ô˘ Ú¤ÂÈ Ó· ¯·Ú·ÎÙËÚ›˙Ô˘Ó ÙÔÓ ÁÈ·ÙÚfi: ÚÔÛ‹ÏˆÛË ÛÙÔ Î·ı‹ÎÔÓ,·ÓÈ‰ÈÔÙ¤ÏÂÈ·, ·˘ÙÔı˘Û›·, ·ÓıÚˆÈÛÌfi˜. ™ÙËÓ ÙÂÏÂ˘Ù·›· “Ú¿ÍË ÙÔ˘ ‰Ú¿Ì·ÙÔ˜” ÚÔÛ¤ÊÂÚÂÙËÓ ˘¤ÚÙ·ÙË ı˘Û›·: ∆∏ ∑ø∏ ∆OÀ.

∆Ë ÛËÌÂÚÈÓ‹ ÂÔ¯‹, ·ÁÎfiÛÌÈ·, ¤¯Ô˘Ó ÂÎÏÂ›„ÂÈ ÔÈ ËÁ¤ÙÂ˜ Î·È Ù· ÚfiÙ˘· ÛÂ fiÏ· Ù· Â›-Â‰·. O Carlo Urbani Â›Ó·È Ô ÈÔ Û‡Á¯ÚÔÓÔ˜ “º¿ÚÔ˜” ÛÂ fiÏË ÂÎÂ›ÓË ÙË ÛÂÈÚ¿ ÙˆÓ ·ÓıÚÒˆÓÙË˜ πÛÙÔÚ›·˜ ÙË˜ π·ÙÚÈÎ‹˜ Ô˘ ÊˆÙ›˙Ô˘Ó ÙÔ ‰‡Û‚·ÙÔ ÌÔÓÔ¿ÙÈ ÙÔ˘ ∞ÓıÚˆÈÛÌÔ‡. ¢ÂÓ ı· ÍÂ-¯·ÛÙÂ› ÔÙ¤ ÁÈ·Ù›, ÁÈ· Ó· ı˘ÌËıÔ‡ÌÂ Î·È ÙÔÓ ÔÈËÙ‹, “fiÏÔ ÙÔ ÛÎÔÙ¿‰È ÙÔ˘ ÎfiÛÌÔ˘ ‰ÂÓ ÌÔÚÂ›Ó· Û‚‹ÛÂÈ ÙÔ Êˆ˜ ÂÓfi˜ ÌÈÎÚÔ‡ ÎÂÚÈÔ‡”. ¶fiÛÔ Ì¿ÏÏÔÓ ÂÓfi˜ “º¿ÚÔ˘”.

May-June 03 03-06-03 16:55 ™ÂÏ›‰·236

237

¡∂∞ ∞¶O ∆O ¢π∞¢π∫∆ÀO


¡∂∞™Ô‚·Úfi OÍ‡ ∞Ó·ÓÂ˘ÛÙÈÎfi ™‡Ó‰ÚÔÌÔ (™O∞™) - Severe Acute Respiratory Syndrome (SARS) ¡›ÎÔ˜ ¶··‰fiÔ˘ÏÔ˜, ∞ÏÏÂÚÁÈÔÏfiÁÔ˜

∆Ô ™Ô‚·Úfi OÍ‡ ∞Ó·ÓÂ˘ÛÙÈÎfi ™‡Ó‰ÚÔÌÔ (Severe Acute Respiratory Syndrome - SARS)ÚˆÙÔÂÌÊ·Ó›ÛÙËÎÂ ÛÙËÓ ∫›Ó· ÚÈÓ ·fi Ï›ÁÔ˘˜ Ì‹ÓÂ˜. Œ¯Ô˘Ó ÚÔ˜ ÙÔ ·ÚfiÓ ÚÔÛ‚ÏËıÂ› ÙÔ˘-Ï¿¯ÈÛÙÔÓ 2600 ¿ÙÔÌ·, ÂÎ ÙˆÓ ÔÔ›ˆÓ ÂÚ›Ô˘ 100 ¤¯Ô˘Ó Âı¿ÓÂÈ. ¶˘Ú‹ÓÂ˜ ÙË˜ ÂÈ‰ËÌ›·˜ Â›-Ó·È Ë ∫›Ó·, ÙÔ ÃÔÓÁÎ-∫ÔÓÁÎ, Ë ™ÈÁÎ·Ô‡ÚË Î·È ÙÔ µÈÂÙÓ¿Ì, ·ÏÏ¿ ¤Ó·˜ ‰Â‡ÙÂÚÔ˜ ı‡Ï·Î·˜ ¤¯ÂÈ‰ËÌÈÔ˘ÚÁËıÂ› ÛÙÔÓ ∫·Ó·‰¿ Î·È ÛÙÈ˜ ∏.¶.∞. ·fi ¿ÙÔÌ· Ô˘ ÚÔÛ‚Ï‹ıËÎ·Ó Î·Ù¿ ÙË ‰È¿ÚÎÂÈ·Ù·ÍÈ‰ÈÒÓ ÛÙËÓ Õˆ ∞Ó·ÙÔÏ‹. ∆Ô Û‡Ó‰ÚÔÌÔ ·ÚÔ˘ÛÈ¿˙ÂÈ ·Ú¯ÈÎ¿ ˘„ËÏfi ˘ÚÂÙfi Î·È ÁÂÓÈÎ¿ Û˘-ÌÙÒÌ·Ù· (Ì˘·ÏÁ›Â˜, ÎÂÊ·Ï·ÏÁ›·, Î·ÎÔ˘¯›·), ÁÈ· Ó· ÂÌÊ·Ó›ÛÂÈ 2-7 ËÌ¤ÚÂ˜ ·ÚÁfiÙÂÚ· Û˘-ÌÙÒÌ·Ù· ·fi ÙÔ ·Ó·ÓÂ˘ÛÙÈÎfi, Î˘Ú›ˆ˜ ÍËÚfi ‚‹¯· Î·È ÛÙ·‰È·Î¿ ÂÈ‰ÂÈÓÔ‡ÌÂÓË ‰‡ÛÓÔÈ·Ô˘ ÌÔÚÂ› Ó· ÊÙ¿ÛÂÈ Ì¤¯ÚÈ ÙÔ ÛËÌÂ›Ô ÙË˜ ·Ó·ÓÂ˘ÛÙÈÎ‹˜ ·ÓÂ¿ÚÎÂÈ·˜. O ¯ÚfiÓÔ˜ ÂÒ·ÛË˜ÙÔ˘ ÏÔÈÌÔÁfiÓÔ˘ ·Ú¿ÁÔÓÙ· Â›Ó·È 2-10 ËÌ¤ÚÂ˜. O ÙÚfiÔ˜ ÌÂÙ¿‰ÔÛË˜ Ê·›ÓÂÙ·È Ó· Á›ÓÂÙ·È ÌÂÛÙ·ÁÔÓ›‰È·, ¯ÚÂÈ¿˙ÂÙ·È fiÌˆ˜ Û¯ÂÙÈÎ¿ ÛÙÂÓ‹ Â·Ê‹ ÌÂ ÙÔÓ ·ÛıÂÓ‹: Â›Ó·È ÛËÌ·ÓÙÈÎfi ÙÔ ÁÂÁÔ-Ófi˜ fiÙÈ ¤¯ÂÈ ÓÔÛ‹ÛÂÈ ÌÂÁ¿ÏÔ˜ ·ÚÈıÌfi˜ È·ÙÚÒÓ Ô˘ ÓÔÛ‹ÏÂ˘·Ó ¿Û¯ÔÓÙÂ˜ ·fi SARS. ∆Ô ·›ÙÈÔÙË˜ ÓfiÛÔ˘ ÌÔÈ¿˙ÂÈ Ó· Â›Ó·È ¤Ó·˜ Ó¤Ô˜ Èfi˜ ÎÔÚfiÓ·, ·Ó Î·È Û˘Û¯ÂÙ›ÛÂÈ˜ ¤¯Ô˘Ó Á›ÓÂÈ Î·È ÌÂ ÌÂÙ·-ÓÂ˘ÌÔÓÔ˚fi Î·È ·Ú·Ì˘ÍÔ˚fi. °›ÓÔÓÙ·È ÌÂÁ¿ÏÂ˜ ÚÔÛ¿ıÂÈÂ˜ ÁÈ· ÙË ‰ËÌÈÔ˘ÚÁ›· ‰È·ÁÓˆÛÙÈÎÔ‡ÙÂÛÙ, ·Ú¿ÏÏËÏ· ÌÂ ÙËÓ ÂÈ‚Â‚·›ˆÛË ÙÔ˘ ·ÈÙÈÔÏÔÁÈÎÔ‡ ·Ú¿ÁÔÓÙ·. ∏ ıÂÚ·Â›· Â›Ó·È ·ÏÒ˜˘ÔÛÙËÚÈÎÙÈÎ‹. ∏ ¶OÀ Û˘ÛÙ‹ÓÂÈ ÙËÓ ·ÔÊ˘Á‹ Ù·ÍÈ‰ÈÒÓ ÚÔ˜ ÙÈ˜ ÂÚÈÔ¯¤˜ Ô˘ ¤¯Ô˘Ó ÏËÁÂ›.

ŒÁÎ·ÈÚË ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ¿ÛıÌ·ÙÔ˜ ¡›ÎÔ˜ ¶··‰fiÔ˘ÏÔ˜, ∞ÏÏÂÚÁÈÔÏfiÁÔ˜

∏ ¤ÁÎ·ÈÚË ¯ÔÚ‹ÁËÛË ÚÔÊ˘Ï·ÎÙÈÎ‹˜ ıÂÚ·Â›·˜ ÁÈ· ÙÔ ¿ÛıÌ· Ê·›ÓÂÙ·È Ó· ¤¯ÂÈ ÛËÌ·ÓÙÈÎ¿Î·Ï‡ÙÂÚ· ·ÔÙÂÏ¤ÛÌ·Ù· ·fi ÙËÓ Î·ı˘ÛÙÂÚËÌ¤ÓË ¯ÔÚ‹ÁËÛË. ∞Ó Î·È ·ÚÎÂÙ¤˜ ÌÂÏ¤ÙÂ˜ ÛÙÔ ·-ÚÂÏıfiÓ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ Ë ‰˘Ó·ÙfiÙËÙ· ‚ÂÏÙ›ˆÛË˜ ÙË˜ ·Ó·ÓÂ˘ÛÙÈÎ‹˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÛÙ· ·È‰È¿ÌÂ ÙË ¯ÔÚ‹ÁËÛË ÂÈÛÓÂfiÌÂÓˆÓ ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰ÒÓ Â›Ó·È ·ÓÙÈÛÙÚfiÊˆ˜ ·Ó¿ÏÔÁË ÙÔ˘ ¯ÚfiÓÔ˘·fi ÙËÓ ¤Ó·ÚÍË ÙË˜ ÓfiÛÔ˘, Ë ÌÂÏ¤ÙË START, ÙË˜ ÔÔ›·˜ ÙÔ ÚÒÙÔ Ì¤ÚÔ˜ ‰ËÌÔÛÈÂ‡ıËÎÂ ÛÙÈ˜29-03-2003 ÛÙÔ Lancet, ·ÔÙÂÏÂ› ÙË ÌÂÁ·Ï‡ÙÂÚË Ù˘¯·ÈÔÔÈËÌ¤ÓË ÌÂÏ¤ÙË Û¯ÂÙÈÎ¿ ÌÂ ÙË ıÂÚ·-Â›· ÙÔ˘ ¿ÛıÌ·ÙÔ˜, ÂÚÈÏ·Ì‚¿ÓÔÓÙ·˜ ÂÚÈÛÛfiÙÂÚÔ˘˜ ·fi 7000 ·ÛıÂÓÂ›˜, fiÏˆÓ ÙˆÓ ËÏÈÎÈÒÓ.∆· ·ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ START ¤‰ÂÈÍ·Ó fiÙÈ ¿ÙÔÌ· ÌÂ ‹ÈÔ Â›ÌÔÓÔ ¿ÛıÌ·, Ô˘ Â›¯Â ‰È·ÁÓˆÛÙÂ›ÏÈÁfiÙÂÚÔ ·fi 2 ¯ÚfiÓÈ· Î·È ¤Ï·‚·Ó ‚Ô˘‰ÂÛÔÓ›‰Ë ÂÈÏ¤ÔÓ ¿ÏÏˆÓ ıÂÚ·ÂÈÒÓ, Â›¯·Ó ÛËÌ·ÓÙÈÎ‹‚ÂÏÙ›ˆÛË ÛÂ fiÏÂ˜ Û¯Â‰fiÓ ÙÈ˜ ·Ú·Ì¤ÙÚÔ˘˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÙË˜ ÓfiÛÔ˘.

º·›ÓÂÙ·È fiÙÈ Ù· ÚÒÙ· ¯ÚfiÓÈ· ÂÌÊ¿ÓÈÛË˜ ÙÔ˘ ¿ÛıÌ·ÙÔ˜ Â›Ó·È ÔÏ‡ ÛËÌ·ÓÙÈÎ¿ ÛÙËÓ ·ÓÙÈ-ÌÂÙÒÈÛ‹ ÙÔ˘, ÁÂÁÔÓfi˜ ÙÔ ÔÔ›Ô ‰›ÓÂÈ ·ÎfiÌË ÌÂÁ·Ï‡ÙÂÚË ‚·Ú‡ÙËÙ· ÛÙÔ ÚfiÏÔ ÙˆÓ ·È‰È¿ÙÚˆÓÛÙËÓ ÚfiÏË„Ë Î·È ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ÓfiÛÔ˘.

Lancet 2003;361:1071-1076

May-June 03 03-06-03 16:56 ™ÂÏ›‰·237

238

¡∂∞ ∞¶O ∆O ¢π∞¢π∫∆ÀO


PediatricLinx.com - www.pediatriclinx.com

°È· fiÛÔ˘˜ ‰ÂÓ ÌÔÚÔ‡Ó Ó· Ì¤ÓÔ˘Ó ›Ûˆ Ô‡ÙÂ Ì›· Â‚‰ÔÌ¿‰· ÛÙËÓ ÂÓËÌ¤ÚˆÛ‹ ÙÔ˘˜, ÙÔPediatricLinx ›Ûˆ˜ Ó· ·ÔÙÂÏÂ› ÙËÓ È‰·ÓÈÎ‹ Ï‡ÛË. ∏ ÔÌ¿‰· ·˘Ù‹˜ ÙË˜ ÈÛÙÔÛÂÏ›‰·˜ ·Ô‰ÂÏ-ÙÈÒÓÂÈ ÙÔ Û‡ÓÔÏÔ Û¯Â‰fiÓ ÙˆÓ ÂÈÛÙËÌÔÓÈÎÒÓ ÂÚÈÔ‰ÈÎÒÓ ·È‰È·ÙÚÈÎ‹˜ Î·È Û¯ÂÙÈ˙fiÌÂÓˆÓ ÂÈ‰È-ÎÔÙ‹ÙˆÓ Î·È ·Ú·ı¤ÙÂÈ ÙÔÓ Ù›ÙÏÔ Î·È Ù· Û˘ÌÂÚ¿ÛÌ·Ù·, ÌÂ Ú˘ıÌfi ·Ó·Ó¤ˆÛË˜ 2-3 ÊÔÚ¤˜ ÙËÓÂ‚‰ÔÌ¿‰·. ŒÙÛÈ, ÌÔÚÂ› Î·ÓÂ›˜ Ó· Ú›¯ÓÂÈ Ì›· Ì·ÙÈ¿ ÛÙÔÓ ÙÂÚ¿ÛÙÈÔ ·˘Ùfi fiÁÎÔ ÙˆÓ ÏËÚÔÊÔ-ÚÈÒÓ Î·È, Â¿Ó Î¿ÙÈ ÙÔÓ ÂÓ‰È·Ê¤ÚÂÈ È‰È·›ÙÂÚ·, Ó· Û˘Ó‰¤ÂÙ·È ÌÂ ÙÔÓ ‰È·‰ÈÎÙ˘·Îfi ÙfiÔ ÙÔ˘ Û˘-ÁÎÂÎÚÈÌ¤ÓÔ˘ ÂÚÈÔ‰ÈÎÔ‡, fiÔ˘ ˘¿Ú¯ÂÈ Ë Ï‹ÚË˜ ÂÚ›ÏË„Ë Î·È, Â›ÙÂ ‰ˆÚÂ¿Ó Â›ÙÂ Ì¤Ûˆ Û˘Ó-‰ÚÔÌ‹˜, ÙÔ Ï‹ÚÂ˜ ¿ÚıÚÔ.

¢›ÓÂÙ·È, Â›ÛË˜, Ë ‰˘Ó·ÙfiÙËÙ· Ó· ÁÚ·ÊÙÂ› Î¿ÔÈÔ˜ Û˘Ó‰ÚÔÌËÙ‹˜ ÛÙÔ newsletter ·˘ÙÔ‡ ÙÔ˘ÙfiÔ˘, ÔfiÙÂ fiÏÂ˜ ÔÈ ·Ú·¿Óˆ ÏËÚÔÊÔÚ›Â˜ Î·Ù·Êı¿ÓÔ˘Ó ÌÂ ÙÔ ËÏÂÎÙÚÔÓÈÎfi Ù·¯˘‰ÚÔÌÂ›Ô.

¶ÚÔÛÔ¯‹! O ÙfiÔ˜ ·˘Ùfi˜ ·Â˘ı‡ÓÂÙ·È ÛÙÔ˘˜ ·ÔÊ·ÛÈÛÌ¤ÓÔ˘˜ Î·È ‰È„·ÛÌ¤ÓÔ˘˜ ÁÈ· ÁÓÒ-ÛË Û˘Ó·‰¤ÏÊÔ˘˜.

∆˘¯·ÈÔÔÈËÌ¤ÓË Û˘ÁÎÚÈÙÈÎ‹ ÌÂÏ¤ÙË ¤‰ÂÈÍÂ fiÙÈ ¤Ó· “‚Ú·¯‡” Û¯‹Ì· ÂÌ‚ÔÏÈ·ÛÌÔ‡ Î·Ù¿ ÙË˜ Ë·-Ù›ÙÈ‰·˜ µ (3 ‰fiÛÂÈ˜ ÛÂ ¯ÚfiÓÔ 0, 10 Î·È 21 ËÌ¤ÚÂ˜) ‰ËÌÈÔ˘ÚÁÂ› ÚÔÛÙ·ÙÂ˘ÙÈÎ¿ ·ÓÙÈÛÒÌ·Ù· (anti-HBs) Ù·¯‡ÙÂÚ· ·’ fiÙÈ ÙÔ ÎÏ·ÛÈÎfi Û¯‹Ì· (3 ‰fiÛÂÈ˜ ÛÂ ¯ÚfiÓÔ 0, 1 Î·È 6 Ì‹ÓÂ˜), ÂÓÒ Ô ‚·ıÌfi˜ ·ÓÔ-ÛÔÏÔÁÈÎ‹˜ ÚÔÛÙ·Û›·˜ Î·È ÛÙ· ‰‡Ô Û¯‹Ì·Ù· Â›Ó·È Ô ›‰ÈÔ˜ ÌÂÙ¿ ·fi 1 ¯ÚfiÓÔ.

™˘ÓÂÒ˜, ÙÔ ‚Ú·¯‡ ·˘Ùfi Û¯‹Ì· ı· ÌÔÚÔ‡ÛÂ Ó· ¯ÔÚËÁËıÂ› ÛÂ ·È‰È¿ Ô˘ ÚfiÎÂÈÙ·È Ó· Ù·-ÍÈ‰¤„Ô˘Ó ÛÂ ÂÓ‰ËÌÈÎ¤˜ ÂÚÈÔ¯¤˜ Î·È ‰ÂÓ Â›¯·Ó Â·ÚÎ‹ ¯ÚfiÓÔ ÁÈ· Ó· Û˘ÌÏËÚÒÛÔ˘Ó ÙÔ ÎÏ·ÛÈÎfiÚfiÁÚ·ÌÌ· ÂÌ‚ÔÏÈ·ÛÌÔ‡ ‹ ÚfiÎÂÈÙ·È Ó· Ï¿‚Ô˘Ó ÌÂÙ¿ÁÁÈÛË ·›Ì·ÙÔ˜ Î·È ·Ú·ÁÒÁˆÓ ·›Ì·ÙÔ˜.

Pediatr Int 2002;44:663-665

µÚ·¯‡ ÚfiÁÚ·ÌÌ· ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÁÈ· Ë·Ù›ÙÈ‰· µ ÛÙ· ·È‰È¿ ¢‹ÌËÙÚ· §È·ÓÔ‡, ¶·È‰›·ÙÚÔ˜

∏§∂∫∆ƒO¡π∫∂™ ¢π∂À£À¡™∂π™

∞ÌÂÚÈÎ·ÓÈÎ‹ ∞Î·‰ËÌ›· ¶·È‰È·ÙÚÈÎ‹˜ - www.aap.org

∏ ÈÛÙÔÛÂÏ›‰· ÙË˜ ∞ÌÂÚÈÎ·ÓÈÎ‹˜ ∞Î·‰ËÌ›·˜ ¶·È‰È·ÙÚÈÎ‹˜ ·ÔÙÂÏÂ› ÛËÌÂ›Ô ·Ó·ÊÔÚ¿˜.¶ÂÚÈÏ·Ì‚¿ÓÂÈ Ù· ÈÔ ÚfiÛÊ·Ù· ·È‰È·ÙÚÈÎ¿ Ó¤·, ÏËÚÔÊÔÚ›Â˜ Û¯ÂÙÈÎ¿ ÌÂ Ù· ÚÔÙÂÈÓfiÌÂÓ·Û¯‹Ì·Ù· ÂÌ‚ÔÏÈ·ÛÌÒÓ, ÏËÚÔÊÔÚ›Â˜ ÁÈ· ÙÈ˜ ‰È¿ÊÔÚÂ˜ ÂÎÛÙÚ·ÙÂ›Â˜ Ô˘ ÔÚÁ·ÓÒÓÂÈ Ë ∞Î·-‰ËÌ›·, ‰ÂÏÙ›· Ù‡Ô˘, ÏËÚÔÊÔÚ›Â˜ ÁÈ· ÁÔÓÂ›˜, ÂÈ‰ÈÎ¤˜ ÂÎ‰fiÛÂÈ˜ Î·È ¿ÏÏ·. ∂Ó‰È·Ê¤ÚÔÓ ·-ÚÔ˘ÛÈ¿˙ÂÈ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÛÙÈ˜ ÂÚÈÛÛfiÙÂÚÂ˜ ÂÚÈÙÒÛÂÈ˜ ÔÈ Ô‰ËÁ›Â˜ Â›Ó·È ÏÈÙ¤˜, Û˘ÁÎÂÎÚÈ-Ì¤ÓÂ˜ Î·È ‰ÔÌËÌ¤ÓÂ˜, ¤ÙÛÈ ÒÛÙÂ ÌÔÚÂ› Î·ÓÂ›˜ Â‡ÎÔÏ· Ó· ÙÈ˜ ÌÂÙ·Ê¤ÚÂÈ, ·ÊÔ‡ ÙÈ˜ ÌÂÙ·-ÊÚ¿ÛÂÈ, ÛÙËÓ Î·ıËÌÂÚÈÓ‹ ÙÔ˘ Ú·ÎÙÈÎ‹.

°È· ÙÔ˘˜ ÓÂfiÙÂÚÔ˘˜, ˘¿Ú¯Ô˘Ó ÏËÚÔÊÔÚ›Â˜ Û¯ÂÙÈÎ¿ ÌÂ Â˘Î·ÈÚ›Â˜ ·ÓÂ‡ÚÂÛË˜ ÂÚÁ·Û›·˜ÛÙÈ˜ ∏.¶.∞., ˘ÔÙÚÔÊ›Â˜ Î.Ï. ¶·Ú¤¯ÔÓÙ·È, Â›ÛË˜, ‰ˆÚÂ¿Ó Ì·ı‹Ì·Ù· Û˘ÓÂ¯È˙fiÌÂÓË˜ ·È-‰È·ÙÚÈÎ‹˜ ÂÎ·›‰Â˘ÛË˜ on-line, links ÁÈ· Ù· ÂÚÈÔ‰ÈÎ¿ ÙË˜ ∞Î·‰ËÌ›·˜, fiˆ˜ ÙÔ Pediatrics Î·ÈÙÔ Pediatrics in Review Î·È ÔÏÏ¿ ¿ÏÏ·.

∞Í›˙ÂÈ Ó· ÙÔ ÂÚÈÏ¿‚ÂÙÂ ÛÙ· favorites!

May-June 03 03-06-03 16:56 ™ÂÏ›‰·238

xi

30 ª·˝Ô˘ 2003 5Ë ∏ÌÂÚ›‰· ¶·È‰È·ÙÚÈÎ‹˜ ∂ÓÙ·ÙÈÎ‹˜ £ÂÚ·Â›·˜ ∞ı‹Ó· “OÍ¤· Î·È ÃÚfiÓÈ· ¡Â˘ÚÔÏÔÁÈÎ¿ ¶ÚÔ‚Ï‹Ì·Ù·”ÃˆÚ¤ÌÂÈÔ ∂ÚÂ˘ÓËÙÈÎfi ∂ÚÁ·ÛÙ‹ÚÈÔ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”¶ÏËÚÔÊÔÚ›Â˜: ∞Ó·ÛÙ¿ÛÈÔ˜ Ã·Ù˙‹˜ ª.∂.£. ¡ÔÛÔÎÔÌÂ›Ô˘ ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”∆ËÏ. & fax: 210-74 88 686

8-12 πÔ˘Ó›Ô˘ 2003 15th European Immunology Congress ƒfi‰Ô˜ ∂ÏÏËÓÈÎ‹ ∂Ù·ÈÚÂ›· ∞ÓÔÛÔÏÔÁ›·˜ ¶ÏËÚÔÊÔÚ›Â˜: Amphitrion Holidays ∆ËÏ.: +3 210-900 6000 Fax: +3 210-9249 836 E-mail: [email protected]

12-14 πÔ˘Ó›Ô˘ 2003 “2nd Caring in the skies” ∞ı‹Ó· ¶ÏËÚÔÊÔÚ›Â˜: Triaena Tours & Congress ∆ËÏ.: +3 210-7499 300 Fax: +3 210-7705 752 E-mail: [email protected]

12-15 πÔ˘Ó›Ô˘ 2003 8th Congress of the European Lyon, FranceHematology Association ¶ÏËÚÔÊÔÚ›Â˜: Eurocongres Conference ManagementTel.: +31 20 679 3411 Fax: +31 20 673 7306 E-mail: [email protected]

13-15 πÔ˘Ó›Ô˘ 2003 41Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ ƒfi‰Ô˜ ¶ÏËÚÔÊÔÚ›Â˜: C & C International S.A. ∆ËÏ.: 210 - 68 89 100 Fax: 210 - 68 44 777 E-mail: [email protected]

16-17 πÔ˘Ó›Ô˘ 2003 2nd International Medical Toronto, Canadaand Genetic Congress on Schwachman Diamond Syndrome ¶ÏËÚÔÊÔÚ›Â˜: ¢Ú ∂Ï¤ÓË æÈ¿¯Ô˘-Leonard E-mail: [email protected]

¶PO™EXH ™YNE¢PIA

May-June 03 03-06-03 16:56 ™ÂÏ›‰·241

xii

12-18 πÔ˘Ï›Ô˘ 2003 ÃπÃ Congress of the International Birmingham, UKSociety on Thrombosis and Haemostasis ¶ÏËÚÔÊÔÚ›Â˜: Concorde Services Tel.: +44 20 8743 3106 Fax: +44 20 8743 1010 E-mail: [email protected]

12-13 ™ÂÙÂÌ‚Ú›Ô˘ 2003 Erasmus Workshop on Molecular Rotterdam, The Therapeutics in Acute Leukemia Netherlands ¶ÏËÚÔÊÔÚ›Â˜: Erasmus Workshop LeukemiaTel.: +31 (0)10 4087669 Fax: +31 (0)10 4089462 E-mail: [email protected] Website: www.eur.nl/fgg/emco

18-21 ™ÂÙÂÌ‚Ú›Ô˘ 2003 28th UMEMPS Congress Marrakech, Secretariat: Dr S. Afif - Pr. M. Oumlil Morocco Tel. & Fax: +212 22 22 6386 E-mail: [email protected]

20-23 ¡ÔÂÌ‚Ú›Ô˘ 2003 14th European Congress on Pediatric ∞ı‹Ó·and Neonatal Intensive Care Astir Palace Hotel ¶ÏËÚÔÊÔÚ›Â˜: ZITA Congress E-mail: [email protected]

10-13 πÔ˘Ó›Ô˘ 2004 9th Congress of the European Geneva, Hematology Association Switzerland ¶ÏËÚÔÊÔÚ›Â˜: Eurocongres Conference Management Tel.: +31 20 679 3411 Fax: +31 20 673 7306 E-mail: [email protected]: www.eurocongres.com/eha2004

¶PO™EXH ™YNE¢PIA

May-June 03 03-06-03 16:56 ™ÂÏ›‰·242

xv

™˘ÓÙÔÌÔÁÚ·Ê›Â˜AIDS

AMP, ADP, ATP

ATPasecalCSF ‹ ENYCNS ‹ ∫¡™cmCoAcmÑcm2

cAMPÆCCRPDNAECG ‹ ∏∫°EEG ‹ ∏∂°ELISA

ESR ‹ ∆∫∂EDTAgHctHbHLA

IgICU ‹ ª∂£IUi.m. ‹ ∂.ª.i.p. ‹ ∂.¶.i.v. ‹ ∂.º.LlogmolªW ‹ MBMCHMCVmRNAmminnNNS ‹ ª™Ôsm%PCRpHPCO2PO2p

EÏÏËÓÈÎÔ› fiÚÔÈÛ‡Ó‰ÚÔÌÔ Â›ÎÙËÙË˜ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·˜

ÌÔÓÔ-, ‰È-, ÙÚÈÊˆÛÊÔÚÈÎ‹ ·‰ÂÓÔÛ›ÓË

ÙÚÈÊˆÛÊ·Ù¿ÛË ÙË˜ ·‰ÂÓÔÛ›ÓË˜ıÂÚÌ›‰·ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚfiÎÂÓÙÚÈÎfi ÓÂ˘ÚÈÎfi Û‡ÛÙËÌ·ÂÎ·ÙÔÛÙfiÛ˘Ó¤Ó˙˘ÌÔ ∞Î˘‚ÈÎfi ÂÎ·ÙÔÛÙfi ÙÂÙÚ·ÁˆÓÈÎfi ÂÎ·ÙÔÛÙfiÎ˘ÎÏÈÎfi AMP‚·ıÌfi˜ KÂÏÛ›Ô˘C-·ÓÙÈ‰ÚÒÛ· ÚˆÙÂ˝ÓË‰ÂÔÍ˘ÚÈ‚Ô˙ÔÓÔ˘ÎÏÂ˚ÓÈÎfi ÔÍ‡ËÏÂÎÙÚÔÎ·Ú‰ÈÔÁÚ¿ÊËÌ·ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ·¤Ó˙˘ÌÔ-Û˘Ó‰¤ÙË˜ ·ÓÔÛÔÚÔÛÚfiÊËÛË˜ÚÔÛ‰ÈÔÚÈÛÌfi˜Ù·¯‡ÙËÙ· Î·ıÈ˙‹ÛÂˆ˜ ÂÚ˘ıÚÒÓÂı˘ÏÂÓÔ‰È·ÌÈÓÔÙÂÙÚ·ÔÍÂ˚Îfi ÔÍ‡ÁÚ·ÌÌ¿ÚÈo·ÈÌ·ÙÔÎÚ›ÙË˜·ÈÌÔÛÊ·ÈÚ›ÓË·ÓÙÈÁfiÓÔ ÈÛÙÔÛ˘Ì‚·ÙfiÙËÙ·˜

·ÓÔÛÔÛÊ·ÈÚ›ÓËÌÔÓ¿‰· ÂÓÙ·ÙÈÎ‹˜ ıÂÚ·Â›·˜‰ÈÂıÓ‹˜ ÌÔÓ¿‰·ÂÓ‰ÔÌ˘˚Î¿ÂÓ‰ÔÂÚÈÙÔÓ·˚Î¿ÂÓ‰ÔÊÏ¤‚È·Ï›ÙÚÔ(·)ÏÔÁ¿ÚÈıÌÔ˜ÁÚ·ÌÌÔÌfiÚÈÔÌÔÚÈ·Îfi ‚¿ÚÔ˜Ì¤ÛË ·ÈÌÔÛÊ·ÈÚ›ÓË ÂÚ˘ıÚÒÓÌ¤ÛÔ˜ fiÁÎÔ˜ ÂÚ˘ıÚÒÓ ·ÁÁÂÏÈÔÊfiÚÔ˜ RNAÌ¤ÙÚÔÏÂÙfi·ÚÈıÌfi˜ ÓÂ˘ÙÒÓÈÔÌË ÛËÌ·ÓÙÈÎfiÔÛÌÒÏÈÔÂ› ÙÔÈ˜ ÂÎ·Ùfi·Ï˘ÛÈ‰ˆÙ‹ ·ÓÙ›‰Ú·ÛË ÔÏ˘ÌÂÚ¿ÛË˜Û˘ÁÎ¤ÓÙÚˆÛË ÈfiÓÙˆÓ ˘‰ÚÔÁfiÓÔ˘ÌÂÚÈÎ‹ Ù¿ÛË CO2ÌÂÚÈÎ‹ Ù¿ÛË ÔÍ˘ÁfiÓÔ˘Èı·ÓfiÙËÙ·

AÁÁÏÈÎÔ› fiÚÔÈacquired immunodeficiencysyndromeadenosine 5mono-, di-,triphosphateadenosine triphosphatasecaloriecerebrospinal fluidcentral nervous systemcentimetercoenzyme Acubic centimetersquare centimetercyclic AMPdegree(s) CelsiusC-reactive proteindeoxyribonucleic acidelectrocardiogramelectroencephalogramenzyme-linked immunoabsorbentassayerythrocyte sedimentation rateethylenediaminetetracetategramhaematocrithaemoglobin(human) histocompatibilityleucocyte antigenimmunoglobulinintensive care unitinternational Unitintramuscularintraperitonealintravenousliterlogarithmmolemolecular weightmean corpuscular haemoglobinmean corpuscular volumemessenger RNAmeterminutenumber newtonnot significantosmolepercent polymerase chain reactionpotentia hydrogeniicarbon dioxide pressureoxygen pressureprobability

™YNTOMO°PAºIE™ ABBREVIATIONS

May-June 03 03-06-03 16:56 ™ÂÏ›‰·245

xvi

EÏÏËÓÈÎÔ› fiÚÔÈ™˘ÓÙÔÌÔÁÚ·Ê›Â˜

p.o.RIARNARDSsecs.c. ‹ À.¢.SDSEU

™˘Ó‰˘·˙fiÌÂÓ· ÚÔı¤Ì·Ù·

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

·fi ÙÔ ÛÙfiÌ·Ú·‰ÈÔ·ÓÔÛÔ·ÔÚÚÔÊËÙÈÎ‹ ‰ÔÎÈÌ·Û›·ÚÈ‚ÔÓÔ˘ÎÏÂ˚ÓÈÎfi ÔÍ‡Û‡Ó‰ÚÔÌÔ ·Ó·ÓÂ˘ÛÙÈÎ‹˜ ‰˘Û¯¤ÚÈ·˜‰Â˘ÙÂÚfiÏÂÙÔ˘Ô‰fiÚÈ·ÛÙ·ıÂÚ‹ ·fiÎÏÈÛËÛÙ·ıÂÚfi ÛÊ¿ÏÌ·ÌÔÓ¿‰·

Combining prefixes

TGMkhdadcmÌnpfa

by mouthradioimmunoassayribonucleic acidrespiratory distress syndromesecondsubcutaneousstandard deviationstandard errorunit

AÁÁÏÈÎÔ› fiÚÔÈ

May-June 03 03-06-03 16:56 ™ÂÏ›‰·246

Παιδιατρική | Τόμος 66 • Τεύχος 3 • Μάιος - Ιούνιος 2003

Documents

Transcript of Παιδιατρική | Τόμος 66 • Τεύχος 3 • Μάιος - Ιούνιος 2003