Παιδιατρική | Τόμος 66 • Τεύχος 4 • Ιούλιος - Αύγουστος...

ISSN 0377-2551

∞¡∞™∫O¶∏™∂π™∆ÚÔÊÈÎ¤˜ ·ÏÏÂÚÁÈÎ¤˜ ·ÓÙÈ‰Ú¿ÛÂÈ˜ - ¢È·ÁÓˆÛÙÈÎ‹ ÚÔÛ¤ÁÁÈÛË ª. Ã·Ù˙Ë„¿ÏÙË, ª. ∑‹‚·-¶ÂÙÚÔÔ‡ÏÔ˘

∞ÓÙÈ„˘¯ˆÛÈÎ¿ Ê¿ÚÌ·Î· ÛÙËÓ Î‡ËÛË Î·È Á·ÏÔ˘¯›· ¡. ∫·Ì¿˜, ∂. ¶··‚·ÛÈÏÂ›Ô˘

∂ÈÏË„›· Î·È Î‡ËÛË ∂. Ã·Ù˙Ë‰¿ÎË, Ã. °È·ÓÓ·ÎÔÔ‡ÏÔ˘

Eƒ∂À¡∏∆π∫∂™ ∂ƒ°∞™π∂™¢Â›ÎÙÂ˜ ·¯˘Û·ÚÎ›·˜ Î·È ·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ ÛÂ ·È‰È¿ ·ÁÚÔÙÈÎ‹˜ ÔÚÂÈÓ‹˜ ÂÚÈÔ¯‹˜ ÙË˜ ∫Ú‹ÙË˜ π. ªÔÛ¯·Ó‰Ú¤·, Ã. Ã·Ù˙‹˜, π. ª·ÌÌ¿˜, °. ªÂÚÙÛÈ¿˜, ª. §ÈÓ·Ú‰¿ÎË˜, ª. ∫˘ÚÈ·Î¿ÎË˜, §. Ã·Ù˙‹, ¡. ∫·ÚÎ·‚›ÙÛ·˜, ∞. ª·ÚÁÈˆÚ‹˜, ∞. ∫·Ê¿ÙÔ˜

∂›Â‰· Á·ÛÙÚ›ÓË˜, ÌÔÙÈÏ›ÓË˜ Î·È ·ÁÁÂÈÔÂÓÂÚÁÔ‡ ÂÓÙÂÚÈÎÔ‡ ÂÙÈ‰›Ô˘ ÛÂ ÓÂÔÁÓ¿ ‰È·‚ËÙÈÎÒÓ ÌËÙ¤ÚˆÓ ∑. Ã·Ù˙ËÛÙ·Ì·Ù›Ô˘, π. ∫·Ï¤ÁÈ·˜, ∞. °Ô‡Ó·ÚË˜, ™. ™Â‚·ÛÙÈ¿‰Ô˘, ¡. ∞ÏÂÍ›Ô˘, ∂. ∫ˆÛÙ·ÓÙ¤ÏÏÔ˘, Ã. ∫ÒÛÙ·ÏÔ˜

∂Ê·ÚÌÔÁ‹ ÙÔ˘ ıÂÚ·Â˘ÙÈÎÔ‡ ÚˆÙÔÎfiÏÏÔ˘BFM-90 ÛÙËÓ ·È‰ÈÎ‹ ÔÍÂ›· ÏÂÌÊÔ‚Ï·ÛÙÈÎ‹ÏÂ˘¯·ÈÌ›·: ÚÔÁÓˆÛÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ Î·È ·ÔÙÂÏ¤ÛÌ·Ù· º. ∞ı·Ó·ÛÈ¿‰Ô˘, ª. Ã·Ù˙ËÛÙ˘ÏÈ·ÓÔ‡, ª. ∫Ô‡ÚÙË, ∞. ª¤ÓÔ˜, £. ¶··ÁÂˆÚÁ›Ô˘, ª. ™Ù¿ÌÔ˘, ¢. ∫·ÙÚÈÔ‡

REVIEW ARTICLESAdverse reactions to foods - The diagnostic approach M. Hatzipsalti, M. Ziva-Petropoulou

Antipsychotic medications in pregnancy and lactation N. Kambas, E. Papavasiliou

Epilepsy and pregnancy E. Hatzidaki, C. Giannakopoulou

ORIGINAL ARTICLESObesity indices and cardiovascular risk factors in rural dwelling Cretan children J. Moschandreas, C. Hatzis, Y. Mammas, G. Bertsias, M. Linardakis, M. Kiriakakis, L. Hatzi, N. Karkavitsas, A. Margioris, A. Kafatos

Gastrointestinal hormones in neonates of diabetic mothers Z. Hatzistamatiou, J. Kaleyias, A. Gounaris, S. Sevastiadou, N. Alexiou, E. Constantellou, C. Costalos

Application of the BFM-90 therapeutic protocol to childhood acute lymphoblastic leukaemia: prognostic factors and results F. Athanasiadou, M. Hatzistilianou, M. Kourti, A. Benos, T. Papageorgiou, M. Stamou, D. Catriu

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Continuation of table of contents inside title page

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

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°·ÛÙÚÔÔÈÛÔÊ·ÁÈÎ‹ ·ÏÈÓ‰ÚfiÌËÛË ÛÂ ·È‰È¿ ÌÂ ÂÁÎÂÊ·ÏÈÎ‹ ·Ú¿Ï˘ÛË: Û˘¯ÓfiÙËÙ·, ¤ÁÎ·ÈÚË ‰È¿ÁÓˆÛË π. •˘ÓÈ¿˜, Ã. ¶·ÓÙÂÏÈ¿‰Ë˜, ∫. ™‡ÚÔÁÏÔ˘, ¡. ∫·Ú·Ù˙¿˜, µ. ¢ÂÌÂÚÙ˙›‰Ô˘, ∂. ∫·Ú·Ù˙¿, °. ÕÚÛÔ˜

H ·ÌÊÈ‚ÏËÛÙÚÔÂÈ‰Ô¿ıÂÈ· ÙË˜ ÚÔˆÚfiÙËÙ·˜ÛÙË ‰ÂÎ·ÂÙ›· 1990-1999 ∂. ∞Ó·ÛÙ·ÛÈ¿‰Ô˘-∫·Ú·ÁÂˆÚÁÔÔ‡ÏÔ˘, ∞. ∞Ó‰Ú¤Ô˘,Ã. ª·ÛÈ¿ÎÔ˜, ¡. ª¿ÓÔ˜, ∂. ∫Ô‡Ï·ÏË

EN¢π∞º∂ƒOÀ™∂™ ¶∂ƒπ¶∆ø™∂π™∞˘ÙfiÌ·ÙË ‰È¿Ï˘ÛË ¯ÔÏÔÏ›ıÔ˘ ÛÂ ÚfiˆÚÔ ÓÂÔÁÓfi ∞. ∞. ∫·Ú·Ù˙¿, µ. ¡. ¶·‡ÏÔ˘, Ã. ¶. ∫·ÏÔÁÂÚÔÔ‡ÏÔ˘, °. N. ª¿ÚÎÔ˘, ∂. I. ∆ÛÒÙ·, ™. ¶. ª·ÓÙ·Áfi˜

º˘Ì·Ù›ˆÛË ÛÂ ·È‰È¿. ¶ÂÚÈÁÚ·Ê‹ ‰‡Ô ÂÚÈÙÒÛÂˆÓ ÌÂ ∆µ ·Û˘Ó‹ıÔ˘˜ ÂÓÙfiÈÛË˜ Î·È ÚÔ‚ÔÏ‹˜ Ã. §¿ÛÎ·ÚË, °. ∞Ó·ÛÙ·ÛÈ¿‰Ë˜, µ. ¶Ï·ÎÔ‡Ï·, ¢. ∞ÁÁÂÏfiÔ˘ÏÔ˜, °. ¶·Ó·ÁÈˆÙ·ÎfiÔ˘ÏÔ˜, ∫. ¶ÚÔ‡ÓÙ˙Ô˘-∫·ÛÛÈÔ‡

Gastroesophageal reflux in children with cerebral palsy: frequency, early diagnosis I. Xinias, C. Panteliadis, K. Spiroglou, N. Karatzas, V. Demertzidou, E. Karatza, G. Arsos

Retinopathy of prematurity during the decade 1990-1999 E. Anastasiadou-Karageorgopoulou, A. Andreou, H. Basiakos, N. Manos, E. Koulali

CASE REPORTS Spontaneous resolution of cholelithiasis in a premature neonate A. A. Karatza, V. N. Pavlou, C. P. Kalogeropoulou, G. N. Markou, I. I. Tsota, S. P. Mantagos

Tuberculosis in children. Report of two cases with unusual location and presenting symptoms H. Laskari, G. Anastasiadis, V. Plakoula, D. Aggelopoulos, G. Panagiotakopoulos, K. Prountzou-Kassiou

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™˘ÓÂ¯›˙ÔÓÙ·È Continued

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¡∂∞ ∞¶O ∆O ¢π∞¢π∫∆ÀO

∂¶π™∆O§∏ ¶ƒO™ ∆∏ ™À¡∆∞•∏

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™˘ÓÙÔÌÔÁÚ·Ê›Â˜

NEWS FROM THE INTERNET

LETTER TO THE EDITOR

Scheduled Medical Meetings

Abbreviations

321

325

xi

xiv

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

¢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

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πSSN 0377-2551i

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

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

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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

¶·È‰È·ÙÚÈÎ‹ 2003;66:239-246 Paediatriki 2003;66:239-246

239

∆ÚÔÊÈÎ¤˜ ·ÏÏÂÚÁÈÎ¤˜ ·ÓÙÈ‰Ú¿ÛÂÈ˜ - ¢È·ÁÓˆÛÙÈÎ‹ ÚÔÛ¤ÁÁÈÛË ª. Ã·Ù˙Ë„¿ÏÙË, ª. ∑‹‚· - ¶ÂÙÚÔÔ‡ÏÔ˘

Adverse reactions to foods - The diagnostic approach M. Hatzipsalti, M. Ziva - Petropoulou

∞¡∞™∫O¶∏™∏ REVIEW ARTICLE

¶·È‰È·ÙÚÈÎfi ∆Ì‹Ì·, ¶ÂÚÈÊÂÚÂÈ·Îfi °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô“∞ÛÎÏËÈÂ›Ô” µÔ‡Ï·˜, ∞ı‹Ó·

Department of Paediatrics, “Asklipiion” General Hospital,Voula, Athens

∂ÈÛ·ÁˆÁ‹OÈ ·ÓÂÈı‡ÌËÙÂ˜ ·ÓÙÈ‰Ú¿ÛÂÈ˜ ÛÙ· ÙÚfiÊÈÌ· Â›ÙÂ

¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ˆ˜ ·ÏÏÂÚÁÈÎ¤˜, Â›ÙÂ fi¯È, ˘¿Ú-¯Ô˘Ó ·fi ÙËÓ ÂÌÊ¿ÓÈÛË ÙÔ˘ ·ÓıÚÒÔ˘ ÛÙË ÁË, ÂÓÒÂÚÈÁÚ·Ê¤˜ ÙÔ˘˜ ¤¯Ô˘Ó Á›ÓÂÈ Î·È ·fi ÙÔÓ πÔÎÚ¿-ÙË Î·È ÙÔÓ °·ÏËÓfi.

™ÙÈ˜ ·Ú¯¤˜ ÙÔ˘ ·ÈÒÓ· ÙÂÎÌËÚÈÒıËÎÂ ·fi ÙÔÓHamburger ÁÈ· ÚÒÙË ÊÔÚ¿ ÂÚ›ÙˆÛË ˘ÂÚÂ˘·È-ÛıËÛ›·˜ ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜. ™ÙË ‰ÂÎ·ÂÙ›· ÙÔ˘ ’50,fiÌˆ˜, ÂÈ¯ÂÈÚ‹ıËÎÂ ÁÈ· ÚÒÙË ÊÔÚ¿ ‰ÔÎÈÌ·Û›·ÚfiÎÏËÛË˜ ÁÈ· ÙË ‰ÈÂÚÂ‡ÓËÛË Èı·Ó‹˜ ·ÓÂÈı‡ÌË-ÙË˜ ·ÓÙ›‰Ú·ÛË˜ ÛÂ ¿Ì˘ÏÔ Î·Ï·ÌÔÎÈÔ‡ (1).

∞fi ÙfiÙÂ, ·Ú¿ ÙË Û˘ÛÛÒÚÂ˘ÛË ÁÓÒÛÂˆÓ ¿ÓˆÛÂ ı¤Ì·Ù· ·ÏÏÂÚÁ›·˜ ÁÂÓÈÎ¿, ÔÏÏ¿ ·ÎfiÌ· ·ÔÙÂ-ÏÔ‡Ó Â‰›Ô ‰ÈÂÚÂ‡ÓËÛË˜ Î·È ·Ú·Ì¤ÓÔ˘Ó ·‰ÈÂ˘ÎÚ›-

ÓÈÛÙ· fiÛÔÓ ·ÊÔÚ¿ ÛÙÈ˜ ÙÚÔÊÈÎ¤˜ ·ÏÏÂÚÁ›Â˜. OÈ ·ÏÏÂÚÁÈÎ¤˜ ·ÓÙÈ‰Ú¿ÛÂÈ˜ Ô˘ Û˘Ó‰¤ÔÓÙ·È ÌÂ

ÙÚÔÊÈÎ¿ ·ÈÙ›· Â›Ó·È ‰˘Ó·Ùfi Ó· ÚÔ‚¿ÏÏÔ˘Ó ÌÂ ÔÈ-ÎÈÏ›· Û˘ÌÙˆÌ¿ÙˆÓ, Î˘Ú›ˆ˜ ·fi ÙÔ ‰¤ÚÌ·, ÙÔ ·Ó·-ÓÂ˘ÛÙÈÎfi, ÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi ‹/Î·È ÙÔ Î˘ÎÏÔÊÔÚÈ-Îfi. ™˘ÌÙÒÌ·Ù· ·fi ÙÔ ‰¤ÚÌ· Î·È ÙÔ ·Ó·ÓÂ˘ÛÙÈ-Îfi Û˘Ó‰¤ÔÓÙ·È ÌÂ IgE-ÌÂÛÔÏ·‚Ô‡ÌÂÓÂ˜ ÙÚÔÊÈÎ¤˜·ÏÏÂÚÁÈÎ¤˜ ·ÓÙÈ‰Ú¿ÛÂÈ˜, ÂÓÒ ÌÂÌÔÓˆÌ¤Ó· Û˘ÌÙÒ-Ì·Ù· ·fi ÙÔ ÂÙÈÎfi ÚÔÎ·ÏÔ‡ÓÙ·È ·fi ÌË IgE-ÌÂ-ÛÔÏ·‚Ô‡ÌÂÓÂ˜ ·ÓÙÈ‰Ú¿ÛÂÈ˜.

∫·Ù¿ ÙËÓ ÂÍ¤Ù·ÛË ÙˆÓ Èı·ÓÒÓ ÙÚÔÊÈÎÒÓ ·Ï-ÏÂÚÁÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ Â›Ó·È Û˘¯Ó¿ ¯Ú‹ÛÈÌÔ˜ Ô ‰È·-¯ˆÚÈÛÌfi˜ ÛÂ IgE ‹ ÌË IgE-ÌÂÛÔÏ·‚Ô‡ÌÂÓÂ˜ ·ÓÙÈ-‰Ú¿ÛÂÈ˜. ∆Ô ·Ú¯ÈÎfi ÈÛÙÔÚÈÎfi Î·È Ë Ê˘ÛÈÎ‹ ÂÍ¤Ù·ÛËÂ›Ó·È Ô˘ÛÈ·ÛÙÈÎ¿ ·ÚfiÌÔÈ· Î·È ÛÙÔ˘˜ ‰‡Ô Ù‡Ô˘˜,

�¶ÂÚ›ÏË„Ë: OÈ ÙÚÔÊÈÎ¤˜ ·ÏÏÂÚÁÈÎ¤˜ ·ÓÙÈ‰Ú¿ÛÂÈ˜ÚÔ‚¿ÏÏÔ˘Ó ÌÂ ÔÈÎÈÏ›· Û˘ÌÙˆÌ¿ÙˆÓ, Î˘Ú›ˆ˜·fi ÙÔ ‰¤ÚÌ·, ÙÔ ·Ó·ÓÂ˘ÛÙÈÎfi, ÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi‹/Î·È ÙÔ Î˘ÎÏÔÊÔÚÈÎfi. ™˘¯Ó¿, Â›Ó·È ¯Ú‹ÛÈÌÔ˜ Ô ‰È·-¯ˆÚÈÛÌfi˜ ·˘ÙÒÓ ÛÂ IgE Î·È ÌË IgE-ÌÂÛÔÏ·‚Ô‡ÌÂ-ÓÂ˜ ·ÓÙÈ‰Ú¿ÛÂÈ˜. ∞·Ú·›ÙËÙ· ÁÈ· ÙË ‰È·ÁÓˆÛÙÈÎ‹ÚÔÛ¤ÁÁÈÛË ·˘ÙÒÓ Â›Ó·È ¤Ó· Ï‹ÚÂ˜ ÈÛÙÔÚÈÎfi, Ì›·ÏÂÙÔÌÂÚ‹˜ Ê˘ÛÈÎ‹ ÂÍ¤Ù·ÛË Î·È ¤Ó·˜ ÂÈ‰ÈÎfi˜ ÂÚ-Á·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜. ŸÌˆ˜, Ë Gold standard Ì¤-ıÔ‰Ô˜ ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô ·ÓÂÈı‡ÌËÙˆÓ ÙÚÔÊÈÎÒÓ·ÓÙÈ‰Ú¿ÛÂˆÓ Â›Ó·È Ë ‰ÈÏ‹ Ù˘ÊÏ‹ ÂÏÂÁ¯fiÌÂÓË ÌÂÂÈÎÔÓÈÎfi ÙÚfiÊÈÌÔ ‰ÔÎÈÌ·Û›· ÚfiÎÏËÛË˜ (DBPCFC).™ÙÔ ¿ÚıÚÔ ·˘Ùfi Á›ÓÂÙ·È ·Ó·ÛÎfiËÛË ÙË˜ ‰ÈÂıÓÔ‡˜‚È‚ÏÈÔÁÚ·Ê›·˜ fiÛÔÓ ·ÊÔÚ¿ ÛÙÔÓ ÔÚÈÛÌfi, ÛÙËÓ ÎÏÈ-ÓÈÎ‹ ÂÈÎfiÓ·, ·ÏÏ¿ Î˘Ú›ˆ˜ ÛÙËÓ ÂÊ·ÚÌÔÁ‹ ÙË˜DBPCFC ÁÈ· ÙË ‰È¿ÁÓˆÛË ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ ·ÓÙÈ-‰Ú¿ÛÂˆÓ ÛÙ· ÙÚfiÊÈÌ·.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ÙÚÔÊÈÎ‹ ·ÏÏÂÚÁ›·, ‰È¿ÁÓˆÛË, ÙÚÔ-ÊÈÎ‹ ÚfiÎÏËÛË.

�Abstract: Adverse reactions to foods may appearwith a variety of symptoms expressed on the skinand in the respiratory, the digestive and/or thecardiovascular systems. It is often useful todistinguish between IgE and non-IgE mediatedreactions. In order to diagnose food reactions a fullhistory, a careful physical examination and specifictests are necessary. The gold standard method forconfirmation is the double-blind placebo controlledfood challenge (DBPCFC). This article reviews theliterature regarding the definition and the clinicalpresentation of food allergy and in particular, theuse of DBPCFC in its diagnosis.

Key words: adverse reaction to foods, diagnosis,food challenge.

·ÏÏ¿ Ë ÂÚ·ÈÙ¤Úˆ ÂÎÙ›ÌËÛË ‰È·Ê¤ÚÂÈ ÛËÌ·ÓÙÈÎ¿.°È· ÙË ÛˆÛÙ‹ ‰È¿ÁÓˆÛË ··ÈÙÂ›Ù·È Û˘¯Ó¿ ÂÈ‰ÈÎfi˜ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ÚÔ˜ ·Ó›¯ÓÂ˘ÛË ÂÈ‰ÈÎÒÓÙÚÔÊÈÎÒÓ IgE ·ÓÙÈÛˆÌ¿ÙˆÓ, Î·ıÒ˜ Î·È ·fi‰ÂÈÍËÙË˜ ˘ÔıÂÙÈÎ‹˜ ·ÓÙ›‰Ú·ÛË˜ Ì¤Ûˆ ÂÚÈÔÚÈÛÙÈÎ‹˜‰›·ÈÙ·˜ Î·È ÙÚÔÊÈÎÒÓ ÚÔÎÏ‹ÛÂˆÓ.

∫ÏÈÓÈÎ‹ ·ÓÔ¯‹ ÛÂ ÙÚÔÊÈÎ¿ ·ÏÏÂÚÁÈÔÁfiÓ· ·Ó·-Ù‡ÛÛÂÙ·È ÌÂ ÙËÓ ¿ÚÔ‰Ô ÙÔ˘ ¯ÚfiÓÔ˘ ÛÂ ÔÏÏÔ‡˜·ÛıÂÓÂ›˜, ÁÈ’ ·˘Ùfi ¯ÚÂÈ¿˙ÂÙ·È ·Ú·ÎÔÏÔ‡ıËÛË Û˘-¯Ó¿ Î·È ÌÂ ÙÚÔÊÈÎ¤˜ ÚÔÎÏ‹ÛÂÈ˜.

∏ ·Ó¿Ù˘ÍË Ó¤ˆÓ ·ÓÔÛÔÚÚ˘ıÌÈÛÙÈÎÒÓ ÛÙÚ·ÙË-ÁÈÎÒÓ Ô˘ ‚Ú›ÛÎÔÓÙ·È ÛÂ ÂÍ¤ÏÈÍË Èı·ÓÒ˜ Ó· ·Ô-ÙÂÏ¤ÛÂÈ ÈÔ ·ÔÙÂÏÂÛÌ·ÙÈÎ‹ ÚÔÛ¤ÁÁÈÛË ÙÔ˘ ÚÔ-‚Ï‹Ì·ÙÔ˜ Ù· ÂfiÌÂÓ· ¯ÚfiÓÈ·.

OÚÈÛÌÔ› ÂÓ ¯Ú‹ÛÂÈ¶·Ú·Ù›ıÂÓÙ·È, ·Ú¯ÈÎ¿, ÔÈ ÔÚÈÛÌÔ› ÂÓ ¯Ú‹ÛÂÈ ÁÈ·

ÙÈ˜ ÙÚÔÊÈÎ¤˜ ·ÓÂÈı‡ÌËÙÂ˜ ·ÓÙÈ‰Ú¿ÛÂÈ˜ Î·È Ë ÂÚ-ÌËÓÂ›· ÙÔ˘˜ ‚¿ÛÂÈ ÙˆÓ ÚÔÙÂÈÓfiÌÂÓˆÓ ·fi ÙËÓAmerican Academy of Allergy and Immunology (2).

·) ∞ÓÂÈı‡ÌËÙÂ˜ ·ÓÙÈ‰Ú¿ÛÂÈ˜ (Â˘·ÈÛıËÛ›· ÛÂÎ¿ÔÈÔ ÙÚfiÊÈÌÔ): ∂›Ó·È ÁÂÓÈÎfi˜ fiÚÔ˜, ·Ó·ÊÂÚfiÌÂ-ÓÔ˜ ÛÂ Î¿ıÂ ÌË Ê˘ÛÈÔÏÔÁÈÎ‹ ·ÓÙ›‰Ú·ÛË ÌÂÙ¿ ÙËÓÎ·Ù·Ó¿ÏˆÛË Î¿ÔÈÔ˘ ÙÚÔÊ›ÌÔ˘.

‚) ∆ÚÔÊÈÎ‹ ˘ÂÚÂ˘·ÈÛıËÛ›·: ¶ÚÔÛ‰ÈÔÚ›˙ÂÈ ·ÓÔ-ÛÔÏÔÁÈÎ‹ ·¿ÓÙËÛË ÌÂÙ¿ ·fi Î·Ù·Ó¿ÏˆÛË ÙÚÔÊ›-ÌÔ˘. ∂ÌÊ·Ó›˙ÂÙ·È ÛÂ ÔÚÈÛÌ¤ÓÔ˘˜ ·ÛıÂÓÂ›˜ Î·È Â›Ó·È·ÓÂÍ¿ÚÙËÙË ·fi ÙËÓ ÔÛfiÙËÙ· ‹ ÙËÓ „˘¯ÔÏÔÁÈÎ‹Î·Ù¿ÛÙ·ÛË.

Á) ∆ÚÔÊÈÎ‹ ·Ó·Ê˘Ï·Í›·: ∫Ï·ÛÈÎ‹ ·ÓÙ›‰Ú·ÛË˘ÂÚÂ˘·ÈÛıËÛ›·˜ Ù‡Ô˘ I, IgE-ÌÂÛÔÏ·‚Ô‡ÌÂÓË.

‰) ∆ÚÔÊÈÎ‹ ‰˘Û·ÓÂÍ›·: ∂›Ó·È ÁÂÓÈÎfi˜ fiÚÔ˜ ‰È·Ù·-Ú·¯‹˜ ÙË˜ Ê˘ÛÈÔÏÔÁ›·˜ ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ ÌÂÙ¿ ·fiÎ·Ù·Ó¿ÏˆÛË ÙÚÔÊ›ÌÔ˘, ¯ˆÚ›˜ Ó· Û˘Ó‰¤ÂÙ·È ·˘Ù‹ ÌÂ·ÓÔÛÔÏÔÁÈÎfi ÌË¯·ÓÈÛÌfi, ·ÏÏ¿ ÌÂ È‰ÈÔÛ˘ÁÎÚ·ÛÈ·Î¿·›ÙÈ· (ÙÔÍÈÎ¿, Ê·ÚÌ·ÎÔÏÔÁÈÎ¿, ÌÂÙ·‚ÔÏÈÎ¿).

Â) ∆ÔÍÈÎfiÙË˜: ∂›Ó·È ‰Ú¿ÛË ÙÚÔÊ›ÌÔ˘ ÌÂ ¿ÌÂÛÔÙÚfiÔ. ¶ÚÔÎ·ÏÂ›Ù·È ·fi ÙÔÍ›ÓÂ˜ Ô˘ ·Ú¿ÁÔÓÙ·È·fi ÙÔ ›‰ÈÔ ÙÔ ÙÚfiÊÈÌÔ ‹ ·fi ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜ ‹·Ú¿ÛÈÙ· Ô˘ ÂÈÌÔÏ‡ÓÔ˘Ó ÙÔ ÙÚfiÊÈÌÔ.

ÛÙ) ∆ÚÔÊÈÎ‹ È‰ÈÔÛ˘ÁÎÚ·ÛÈ·Î‹ ·ÓÙ›‰Ú·ÛË: ¶Úfi-ÎÂÈÙ·È ÁÈ· ÔÛÔÙÈÎ‹ ·ıÔÏÔÁÈÎ‹ ·ÓÙ›‰Ú·ÛË ÛÂ ÙÚÔ-Ê‹, ¯ˆÚ›˜ ˘ÔÎÂ›ÌÂÓÔ ·ÓÔÛÔÏÔÁÈÎfi ÌË¯·ÓÈÛÌfi.

˙) ∞Ó·Ê˘Ï·ÎÙÔÂÈ‰‹˜ ·ÓÙ›‰Ú·ÛË: ¶ÚÔÛÔÌÔÈ¿˙ÂÈÌÂ ÙËÓ ·Ó·Ê˘Ï·ÎÙÈÎ‹, ·ÏÏ¿ ÔÊÂ›ÏÂÙ·È ÛÙËÓ ·Â-ÏÂ˘ı¤ÚˆÛË ÌÂÛÔÏ·‚ËÙÒÓ ¯ˆÚ›˜ ·ÓÔÛÔÏÔÁÈÎfi ÌË-¯·ÓÈÛÌfi.

Ë) º·ÚÌ·ÎÔÏÔÁÈÎ‹: ∞ÊÔÚ¿ ÛÂ ·ıÔÏÔÁÈÎ‹ ·ÓÙ›-‰Ú·ÛË ÛÂ ÙÚfiÊÈÌÔ ÏfiÁˆ Ê˘ÛÈÎ‹˜ ‡·ÚÍË˜ ‹ ÚÔ-Ûı‹ÎË˜ ÛÂ ·˘Ùfi ¯ËÌÈÎ‹˜ Ô˘Û›·˜, Ë ÔÔ›· ÚÔÎ·ÏÂ›Ê·ÚÌ·ÎÔÏÔÁÈÎÔ‡ Ù‡Ô˘ ·ÓÙ›‰Ú·ÛË.

ı) ªÂÙ·‚ÔÏÈÎ‹ ·ÓÙ›‰Ú·ÛË: ∂›Ó·È ·ÔÙ¤ÏÂÛÌ·ÙË˜ ·ÓÙ›‰Ú·ÛË˜ ÙÔ˘ ÙÚÔÊ›ÌÔ˘ ÛÙÔÓ ÌÂÙ·‚ÔÏÈÛÌfiÙÔ˘ ÍÂÓÈÛÙ‹.

∞ÚÁfiÙÂÚ·, ÙÔ 1995 ‰ËÌÔÛÈÂ‡ıËÎÂ Ë ı¤ÛË ÙË˜∂˘Úˆ·˚Î‹˜ ∞Î·‰ËÌ›·˜ ∞ÏÏÂÚÁÈÔÏÔÁ›·˜ Î·È ∫ÏÈÓÈ-Î‹˜ ∞ÓÔÛÔÏÔÁ›·˜ (3), fiÔ˘ ÚÔÙ¿ıËÎÂ Ó¤· Û˘ÓÙÔ-ÌfiÙÂÚË Ù·ÍÈÓfiÌËÛË, Û‡ÌÊˆÓ· ÌÂ ÙËÓ ÔÔ›· ÔÈ ÙÚÔ-ÊÈÎ¤˜ ·ÓÙÈ‰Ú¿ÛÂÈ˜ ‰È·ÎÚ›ÓÔÓÙ·È ÛÂ ÙÔÍÈÎ¤˜ Î·È ÌËÙÔÍÈÎ¤˜. OÈ ÌË ÙÔÍÈÎ¤˜ ¤¯Ô˘Ó ‹ ‰ÂÓ ¤¯Ô˘Ó ·ÓÔÛÔÏÔ-ÁÈÎfi ÌË¯·ÓÈÛÌfi. O fiÚÔ˜ ÙÚÔÊÈÎ‹ ·ÏÏÂÚÁ›· ¯ÚËÛÈ-ÌÔÔÈÂ›Ù·È ÁÈ· ·ÓÙÈ‰Ú¿ÛÂÈ˜ ÌÂ ·ÓÔÛÔÏÔÁÈÎfi ÌË¯·ÓÈ-ÛÌfi, ÂÓÒ ÁÈ· ÙÈ˜ ˘fiÏÔÈÂ˜ ¯ÚËÛÈÌÔÔÈÂ›Ù·È Ô fiÚÔ˜ÙÚÔÊÈÎ‹ ‰˘Û·ÓÂÍ›·. ∏ ÙÚÔÊÈÎ‹ ·ÏÏÂÚÁ›· ‰È·ÎÚ›ÓÂ-Ù·È ÂÚ·ÈÙ¤Úˆ, Û‡ÌÊˆÓ· ÌÂ ÙËÓ Î·Ù¿Ù·ÍË ÙˆÓ ·ÓÔ-ÛÔÏÔÁÈÎÒÓ ÌË¯·ÓÈÛÌÒÓ Î·Ù¿ Coombs Î·È Gell, ÛÂIgE-ÌÂÛÔÏ·‚Ô‡ÌÂÓÂ˜ ‹ ÌË ÌÂ ÙÔ˘˜ ÏÔÈÔ‡˜ ·ÓÔÛÔ-ÏÔÁÈÎÔ‡˜ Ù‡Ô˘˜. ∏ ÙÚÔÊÈÎ‹ ‰˘Û·ÓÂÍ›· ‰È·ÎÚ›ÓÂÙ·ÈÛÂ Ê·ÚÌ·ÎÔÏÔÁÈÎ‹, ÂÓ˙˘ÌÈÎ‹ Î·È ¿ÁÓˆÛÙË˜ ·ÈÙÈÔ-ÏÔÁ›·˜.

∆Ô 2001 ‰ËÌÔÛÈÂ‡ıËÎÂ ÛÙÔ Allergy ·fi ÂÈÙÚÔ-‹ ÂÈ‰ÈÎÒÓ, ˘fi ÙËÓ ·ÈÁ›‰· ÙÔ˘ EAACI, ÙÚÔÔÔ›Ë-ÛË ÙË˜ ÂÓ ¯Ú‹ÛÂÈ ÔÚÔÏÔÁ›·˜, Ù· Î˘ÚÈfiÙÂÚ· ÛËÌÂ›·ÙË˜ ÔÔ›·˜ Â›Ó·È Ù· ·ÎfiÏÔ˘ı·:

O fiÚÔ˜ “˘ÂÚÂ˘·ÈÛıËÛ›·” ÚÔÙÂ›ÓÂÙ·È Ó· ¯ÚË-ÛÈÌÔÔÈÂ›Ù·È Û·Ó fiÚÔ˜ “ÔÌÚ¤Ï·”, Ô ÔÔ›Ô˜ Î·Ï‡-ÙÂÈ ÛËÌÂ›· Î·È Û˘ÌÙÒÌ·Ù· Ô˘ ‰‡Ó·ÓÙ·È Ó· ·Ó·-·Ú·¯ıÔ‡Ó ÌÂÙ¿ ·fi ¤ÎıÂÛË ÛÂ Î·ıÔÚÈÛÌ¤ÓÔ ÂÚ¤-ıÈÛÌ· Î·È ÛÂ ‰fiÛË ·ÓÂÎÙ‹ ·fi ˘ÁÈ‹ ¿ÙÔÌ·.

O fiÚÔ˜ “·ÏÏÂÚÁ›·” ÂÚÈÏ·Ì‚¿ÓÂÈ ·ÓÙÈ‰Ú¿ÛÂÈ˜˘ÂÚÂ˘·ÈÛıËÛ›·˜, ÛÙÈ˜ ÔÔ›Â˜ ÂÓ¤¯ÂÙ·È ·ÓÔÛÔÏÔÁÈ-Îfi˜ ÌË¯·ÓÈÛÌfi˜.

∆¤ÏÔ˜, ÌÂ ÙÔÓ fiÚÔ “·ÙÔ›·” ‰ËÏÒÓÂÙ·È ÔÈÎÔÁÂ-Ó‹˜ ‹ ·ÙÔÌÈÎ‹ ÚÔ‰È¿ıÂÛË ÚÔ˜ ·Ú·ÁˆÁ‹ IgE·ÓÙÈÛˆÌ¿ÙˆÓ ˆ˜ ·¿ÓÙËÛË ÛÂ ¯·ÌËÏ¤˜ ‰fiÛÂÈ˜ ·Ï-ÏÂÚÁÈÔÁfiÓˆÓ Î·È Î˘Ú›ˆ˜ ÚˆÙÂ˚ÓÒÓ Î·È Ë ·Ó¿Ù˘ÍËÙ˘ÈÎÒÓ Û˘ÌÙˆÌ¿ÙˆÓ fiˆ˜ ¿ÛıÌ·, ÚÈÓÔÂÈÂÊ˘-Î›ÙÈ‰· ‹ ¤Î˙ÂÌ·/‰ÂÚÌ·Ù›ÙÈ‰· (4).

™˘¯ÓfiÙËÙ· - ∫ÏÈÓÈÎ‹ ÂÈÎfiÓ· ŸÛÔÓ ·ÊÔÚ¿ ÛÙË Û˘¯ÓfiÙËÙ· ÙË˜ ÙÚÔÊÈÎ‹˜ ·Ï-

ÏÂÚÁ›·˜, ‰ÂÓ ˘¿Ú¯ÂÈ ÔÌÔÊˆÓ›· Î·È Ù· ·Ó·ÊÂÚfiÌÂ-Ó· ÔÛÔÛÙ¿ Î˘Ì·›ÓÔÓÙ·È ÛÂ ÌÂÁ¿ÏÔ Â‡ÚÔ˜. ∂Ó‰ÂÈ-ÎÙÈÎ¿, ÁÈ· ÙËÓ ·ÏÏÂÚÁ›· ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜ ·Ó·-Ê¤ÚÔÓÙ·È ÔÛÔÛÙ¿ ·fi 0,3% ¤ˆ˜ 7,5%, ÂÓÒ Î·Ù’¿ÏÏÔ˘˜ ¤ˆ˜ 27% (5,6). ∆Ô ÁÂÁÔÓfi˜ ·˘Ùfi Èı·ÓÒ˜ÔÊÂ›ÏÂÙ·È ÛÂ ÌÂıÔ‰ÔÏÔÁÈÎ¿ ·›ÙÈ· Î·È ÛÙÔ Â‡ÚÔ˜ÙˆÓ ÎÏÈÓÈÎÒÓ ÂÎ‰ËÏÒÛÂˆÓ Ô˘ Î¿ıÂ ÊÔÚ¿ ÂÚÈ-Ï·Ì‚¿ÓÔÓÙ·È ÛÙÈ˜ ·ÏÏÂÚÁÈÎ¤˜ ·ÓÙÈ‰Ú¿ÛÂÈ˜. ¶¿-ÓÙˆ˜, ÁÂÓÈÎ¿ Ê·›ÓÂÙ·È fiÙÈ ÔÈ ÙÚÔÊÈÎ¤˜ ·ÏÏÂÚÁ›Â˜Î·Ù·Ï·Ì‚¿ÓÔ˘Ó ÂÍ¤¯Ô˘Û· ı¤ÛË ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ·ÏÏÂÚÁÈÎÒÓ ·ÓÙÈ‰Ú¿ÛÂˆÓ.

™Â ÂÚÁ·Û›· ‰ËÌÔÛÈÂ˘Ì¤ÓË ÛÙÔ Lancet (7), ÔÈYoung Î·È Û˘Ó ·¤ÛÙÂÈÏ·Ó ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ÛÂ20.000 ¿ÙÔÌ· ÁÈ· ÙË ‰ÈÂÚÂ‡ÓËÛË ·ÓÙÈ‰Ú¿ÛÂˆÓ ÛÂ 8ÙÚfiÊÈÌ·. ∞fi ·˘ÙÔ‡˜ Ô˘ ·¿ÓÙËÛ·Ó, 18,5% ıÂˆ-ÚÔ‡ÛÂ fiÙÈ Â›¯Â ‰˘Û·ÓÂÍ›· ÛÂ ·˘Ù¤˜ ÙÈ˜ ÙÚÔÊ¤˜. ªÂ-Ù¿ ·fi ÚfiÎÏËÛË ÌÂ ‰ÈÏ‹ Ù˘ÊÏ‹ Ì¤ıÔ‰Ô ÛÂ 93 ÂÍ


240


241

·˘ÙÒÓ, ÌfiÓÔ ÙÔ 19% ‹Ù·Ó ıÂÙÈÎfi. ∆Ô ·ÔÙ¤ÏÂÛÌ·‰›ÓÂÈ ¤Ó· ÔÛÔÛÙfi Â›ÙˆÛË˜ ÙÚÔÊÈÎ‹˜ ·ÏÏÂÚÁ›·˜1,4% ÛÙ· 8 ‚·ÛÈÎ¿ ÙÚfiÊÈÌ·. ™Â ¿ÏÏË ÂÚÁ·Û›· (8)·fi ÙÔ˘˜ Bock Î·È Martin (1983), ÌÂÏÂÙ‹ıËÎ·Ó 500·È‰È¿ ·fi ÙË Á¤ÓÓËÛË Î·È ÁÈ· ‰È¿ÛÙËÌ· 3 ÂÙÒÓ, ÌÂÏ‹„Ë ÈÛÙÔÚÈÎÔ‡, ÙÚÔÊÈÎ‹ ÚfiÎÏËÛË, ‰ÂÚÌ·ÙÈÎ¤˜‰ÔÎÈÌ·Û›Â˜ Î·È RAST. ™ÙÔ Ù¤ÏÔ˜ ÙˆÓ 3 ÂÙÒÓ, 142(20%) ·fi ·˘Ù¿ Ù· ·È‰È¿ Â›¯·Ó ‡ÔÙÂ˜ ·ÓÙÈ‰Ú¿-ÛÂÈ˜ ÛÂ ÙÚfiÊÈÌ· Î·È ÌfiÓÔ ÛÂ 27 ÂÚÈÙÒÛÂÈ˜ (19%)ÂÈ‚Â‚·ÈÒıËÎÂ ·˘Ùfi ÌÂ ÚfiÎÏËÛË.

∏ ÙÚÔÊÈÎ‹ ·ÏÏÂÚÁ›· ÌÔÚÂ› Ó· ·ÚÔ˘ÛÈ·ÛÙÂ› ÌÂ‰‡Ô ÙÚfiÔ˘˜:

·) ·ÛıÂÓÂ›˜ ÌÂ Û˘ÌÙÒÌ·Ù· ‹ Û˘Ó‰˘·ÛÌfi Û˘-ÌÙˆÌ¿ÙˆÓ Ô˘ ÈÛÙÂ‡Ô˘Ó fiÙÈ ÔÊÂ›ÏÔÓÙ·È ÛÂ ÙÚÔ-ÊÈÎ‹ ·ÏÏÂÚÁ›· Î·È

‚) ·ÛıÂÓÂ›˜ ÌÂ ÂÁÎ·ÙÂÛÙËÌ¤ÓË ‰È¿ÁÓˆÛË Ófi-ÛÔ˘, fiˆ˜ ¿ÛıÌ·, ÚÈÓ›ÙÈ‰·, ·ÙÔÈÎ‹ ‰ÂÚÌ·Ù›ÙÈ‰·Î·È ÎÓ›‰ˆÛË. ¶ÈÛÙÂ‡ÂÙ·È fiÙÈ ¤Ó· ÔÛÔÛÙfi ÂÍ ·˘ÙÒÓı· ¤¯ÂÈ ÙÚÔÊÈÎ‹ ·ÏÏÂÚÁ›· Û·Ó ÚˆÙ·Ú¯ÈÎfi ‹ Û¯ÂÙÈ-˙fiÌÂÓÔ ·›ÙÈÔ ÌÂ ÙË ¯ÚfiÓÈ· ÓfiÛÔ ÙÔ˘.

™ÙÈ˜ ·Ûı¤ÓÂÈÂ˜ Ô˘ ·Ó·Ê¤ÚÂÙ·È fiÙÈ Û¯ÂÙ›˙ÔÓÙ·ÈÌÂ ÙËÓ ÙÚÔÊÈÎ‹ ·ÏÏÂÚÁ›·, ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È Ë ·Ó·-Ê˘Ï·Í›·, Ë ÎÓ›‰ˆÛË/ ÙÔ ·ÁÁÂÈÔÔ›‰ËÌ·, Ë ·ÙÔÈÎ‹‰ÂÚÌ·Ù›ÙÈ‰·, Ë ·ÏÏÂÚÁÈÎ‹ ÚÈÓ›ÙÈ‰· Î·È ÂÈÂÊ˘Î›ÙÈ-‰·, Ë ÔÚÒ‰Ë˜ Ì¤ÛË ˆÙ›ÙÈ‰·, ÙÔ ¿ÛıÌ·, ÙÔ Û‡Ó-‰ÚÔÌÔ Heiner, Ë Á·ÛÙÚÂÓÙÂÚ›ÙÈ‰· ·ÏÏÂÚÁÈÎ‹˜ ·È-ÙÈÔÏÔÁ›·˜, ÔÈ ·ÈÌÔÚÚ·Á›Â˜ ·fi ÙÔ ÂÙÈÎfi, Ë ÂÏÎÒ-‰Ë˜ ÎÔÏ›ÙÈ‰·, ÔÈ ËÌÈÎÚ·Ó›Â˜, Ù· „˘¯ÔÏÔÁÈÎ¿ ÓÔÛ‹-Ì·Ù· Î.¿.

¢È·ÁÓˆÛÙÈÎ¤˜ Ì¤ıÔ‰ÔÈ ∆· ‚·ÛÈÎ¿ fiÚÁ·Ó·-ÛÙfi¯ÔÈ ÛÙËÓ ÙÚÔÊÈÎ‹ ·ÏÏÂÚ-

Á›· Â›Ó·È ÙÔ ‰¤ÚÌ·, ÙÔ ÂÙÈÎfi, ÙÔ ·Ó·ÓÂ˘ÛÙÈÎfi Î·ÈÙÔ Î·Ú‰È·ÁÁÂÈ·Îfi. ∆Ô Û‡ÓÔÏÔ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓÔ˘ ÂÎ‰ËÏÒÓÔÓÙ·È ·fi ·˘Ù¿ Ù· fiÚÁ·Ó· Â›Ó·È Â-ÚÈÔÚÈÛÌ¤ÓÔ Î·È ÌÔÚÂ› Ó· Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ·ÏÏÂÚ-ÁÈÎ‹˜ ‹ ÌË ·ÏÏÂÚÁÈÎ‹˜ Â›‰Ú·ÛË˜.

∏ ·˘ÍËÌ¤ÓË Â˘·ÈÛıËÙÔÔ›ËÛË ÙÔ˘ ÎÔÈÓÔ‡ ÛÙÈ˜ÙÚÔÊÈÎ¤˜ ·ÏÏÂÚÁ›Â˜ Î·È Ë Ï·Óı·ÛÌ¤ÓË Û˘¯Ó¿ ·fi-‰ÔÛË ‰È·ÊfiÚˆÓ ·ı‹ÛÂˆÓ ÛÂ ÙÚÔÊÈÎ‹ ·ÏÏÂÚÁ›·ÂÈ‚¿ÏÏÔ˘Ó ÙÔÓ ÛÎÂÙÈÎÈÛÌfi ÛÙËÓ ÂÎÙ›ÌËÛË Î·È ÙË¯Ú‹ÛË ·ÓÙÈÎÂÈÌÂÓÈÎÒÓ ÎÚÈÙËÚ›ˆÓ ÁÈ· Ó· ÙÂıÂ› Ë ‰È¿-ÁÓˆÛË. ∏ ˘ÂÚ‰È¿ÁÓˆÛË ÙÚÔÊÈÎ‹˜ ·ÏÏÂÚÁ›·˜ Ô‰Ë-ÁÂ› ÛÂ ‰È·ÙÚÔÊÈÎ¤˜ ‰È·Ù·Ú·¯¤˜, ˘ÔıÚÂ„›·, „˘¯Ô-ÏÔÁÈÎ¿ ÚÔ‚Ï‹Ì·Ù· Î·È ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ÛÙËÓ ÔÈÎÔ-Á¤ÓÂÈ·, ÂÓÒ Ë ˘Ô‰È¿ÁÓˆÛË ·Ê‹ÓÂÈ ÙÔÓ ·ÛıÂÓ‹ Ó·˘ÔÊ¤ÚÂÈ Î·È ÌÔÚÂ› Ó· Ô‰ËÁ‹ÛÂÈ ÛÙËÓ ÂÏÏÈ‹ ·Ó¿-Ù˘ÍË Î·È Èı·Ó¿ ÛÂ ÌfiÓÈÌÂ˜ ‚Ï¿‚Â˜.

∏ ‰È·ÁÓˆÛÙÈÎ‹ ÚÔÛ¤ÁÁÈÛË ÛÂ ˘Ô„›· ÙÚÔÊÈ-ÎÒÓ ·ÓÂÈı‡ÌËÙˆÓ ·ÓÙÈ‰Ú¿ÛÂˆÓ ·Ú¯›˙ÂÈ ÌÂ ÏÂÙÔ-ÌÂÚ¤˜ ÈÛÙÔÚÈÎfi Î·È Ê˘ÛÈÎ‹ ÂÍ¤Ù·ÛË.

™ÎÔfi˜ Â›Ó·È Ó· ÚÔÛ‰ÈÔÚÈÛÙÂ› Â¿Ó Ú¿ÁÌ·ÙÈ Ô·ÛıÂÓ‹˜ ·ÚÔ˘Û›·ÛÂ ·ÓÂÈı‡ÌËÙÂ˜ ·ÓÙÈ‰Ú¿ÛÂÈ˜ÛÂ Î¿ÔÈÔ ÙÚfiÊÈÌÔ Î·È Â¿Ó ÛÙËÓ ·ÓÙ›‰Ú·ÛË ·˘Ù‹

ÂÌÏ¤ÎÂÙ·È ·ÓÔÛÔÏÔÁÈÎfi˜ ÌË¯·ÓÈÛÌfi˜. ∂¿Ó ˘¿Ú-¯ÂÈ Ù¤ÙÔÈ· ˘fiÓÔÈ·, Â›Ó·È ¯Ú‹ÛÈÌÔ Ó· Á›ÓÂÈ ÚÔÛ¿-ıÂÈ· ¤ÓÙ·ÍË˜ ÙË˜ ·ÓÙ›‰Ú·ÛË˜ ÛÂ IgE-ÌÂÛÔÏ·‚Ô‡-ÌÂÓË ‹ fi¯È, Î·ıÒ˜ ı· Á›ÓÂÈ ‰È·ÊÔÚÂÙÈÎ‹ ÂÎÙ›ÌËÛËÙÔ˘ ÂÚ·ÈÙ¤Úˆ ÂÏ¤Á¯Ô˘.

∂›ÛË˜, ÛÎfiÈÌÔ Â›Ó·È Ó· Á›ÓÂÈ ‰È·ÊÔÚÈÎ‹ ‰È¿-ÁÓˆÛË ·fi ¿ÏÏ· ·›ÙÈ·, Ù· ÔÔ›· ı· ÌÔÚÔ‡Û·Ó Ó·ÂÎ‰ËÏˆıÔ‡Ó ÌÂ ·ÚfiÌÔÈ· Û˘ÌÙˆÌ·ÙÔÏÔÁ›·.

™ÙÔÓ ¶›Ó·Î· 1 ·Ó·Ê¤ÚÂÙ·È Ì›· ÛÂÈÚ¿ ¿ÏÏˆÓ·ÈÙÈÒÓ Ô˘ ı· Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÔÓÙ·È ˘’ fi„ÈÓ,ÙˆÓ ÔÔ›ˆÓ Ù· Û˘ÌÙÒÌ·Ù· ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙÔÂÙÈÎfi.

™ÙÔÓ ¶›Ó·Î· 2 ·Ó·Ê¤ÚÔÓÙ·È Û˘ÌÙÒÌ·Ù· Ô˘Û˘Ó‹ıˆ˜ ÚÔ¤Ú¯ÔÓÙ·È ·fi Ù· ‰È¿ÊÔÚ· fiÚÁ·Ó·-ÛÙfi¯Ô˘˜ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÙÚÔÊÈÎÒÓ ·ÏÏÂÚÁÈ-ÎÒÓ ·ÓÙÈ‰Ú¿ÛÂˆÓ (9).

§‹„Ë ÈÛÙÔÚÈÎÔ‡°ÂÓÈÎ¤˜ Ô‰ËÁ›Â˜ Ô˘ Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÔÓÙ·È ˘’

fi„ÈÓ Î·Ù¿ ÙË Ï‹„Ë ÙÔ˘ ÈÛÙÔÚÈÎÔ‡ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·ÈÛÙÔÓ ¶›Ó·Î· 3.

ªÂ ‚¿ÛË ÙÔ ·ÙÔÌÈÎfi ÈÛÙÔÚÈÎfi, Ô ÁÈ·ÙÚfi˜ ı·ÚÔÛ·ı‹ÛÂÈ Ó· ÂÚÂ˘Ó‹ÛÂÈ ÙËÓ Èı·ÓfiÙËÙ· ÙË˜ÙÚÔÊÈÎ‹˜ ·ÓÙ›‰Ú·ÛË˜ ÛÙËÚÈ˙fiÌÂÓÔ˜ ÛÙ· Û˘ÌÙÒ-Ì·Ù·, ÙÔÓ ¯ÚfiÓÔ ÙË˜ ·ÓÙ›‰Ú·ÛË˜ Î·È ÙÔ Â›‰Ô˜ ÙÔ˘‡ÔÙÔ˘ ÙÚÔÊ›ÌÔ˘ ÁÈ· ÙËÓ ÚfiÎÏËÛË ÙË˜ ·ÓÙ›‰Ú·-ÛË˜. °È’ ·˘ÙfiÓ ÙÔÓ ÏfiÁÔ Ú¤ÂÈ Ó· ·Ó·˙ËÙËıÔ‡Ó Ù··ÎfiÏÔ˘ı·:

·) Ùo Â›‰Ô˜ ÙÔ˘ ‡ÔÙÔ˘ ÙÚÔÊ›ÌÔ˘ Î·È Ë ÏË-ÊıÂ›Û· ÔÛfiÙËÙ·,

‚) Ô ¯ÚfiÓÔ˜ Ô˘ ¤Ú·ÛÂ ·fi ÙË Ï‹„Ë ÙÔ˘ ÙÚÔ-Ê›ÌÔ˘ ¤ˆ˜ ÙËÓ ÂÎ‰‹ÏˆÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ,

Á) Â¿Ó Ë Ï‹„Ë ÙÔ˘ ‡ÔÙÔ˘ ÙÚÔÊ›ÌÔ˘ ¤¯ÂÈ ÚÔ-Î·Ï¤ÛÂÈ ·ÚfiÌÔÈ· Û˘ÌÙÒÌ·Ù· Î·È ÛÙÔ ·ÚÂÏıfiÓ,

‰) Û˘Ó˘¿Ú¯ÔÓÙÂ˜ ·Ú¿ÁÔÓÙÂ˜ (¿ÛÎËÛË, Î·Ù·-Ó¿ÏˆÛË ·ÏÎÔfiÏ) ÁÈ· ÙËÓ ÂÎ‰‹ÏˆÛË ÙˆÓ Û˘ÌÙˆÌ¿-ÙˆÓ Î·È

Â) ÙÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· Ô˘ ¤Ú·ÛÂ ·fi ÙËÓ ÙÂ-ÏÂ˘Ù·›· ÊÔÚ¿ Ô˘ Û˘Ó¤‚Ë ÙÚÔÊÈÎ‹ ·ÓÙ›‰Ú·ÛË.

∂ÈÏ¤ÔÓ, Ï›Á· ÙÚfiÊÈÌ· Â˘ı‡ÓÔÓÙ·È ÁÈ· ÙÔ Ô-ÛÔÛÙfi ÂÚ›Ô˘ 80-90% ÙˆÓ ‰È·ÈÛÙˆÌ¤ÓˆÓ ·ÓÙÈ-‰Ú¿ÛÂˆÓ (ÌÂ ÂÍ·›ÚÂÛË ÙÔ ÛÙÔÌ·ÙÈÎfi ·ÏÏÂÚÁÈÎfiÛ‡Ó‰ÚÔÌÔ), fiˆ˜ ÙÔ ·˘Áfi, ÙÔ Á¿Ï·, ÔÈ ÍËÚÔ› Î·Ú-Ô›, Ë ÛfiÁÈ·, ÙÔ „¿ÚÈ Î·È Ù· ‰ËÌËÙÚÈ·Î¿ ÛÙ· ·È‰È¿,ÂÓÒ ÛÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜ ÔÈ ·ÓÙ›ÛÙÔÈ¯Â˜ ÙÚÔÊ¤˜ ÂÚÈ-Ï·Ì‚¿ÓÔ˘Ó ÙÔ˘˜ ÍËÚÔ‡˜ Î·ÚÔ‡˜, ÙÔ „¿ÚÈ Î·È Ù·fiÛÙÚ·Î·.

∆Ô ·ÙÔÌÈÎfi ÈÛÙÔÚÈÎfi ¤¯ÂÈ Ùˆ¯‹ ÚÔÁÓˆÛÙÈÎ‹·ÎÚ›‚ÂÈ· ÛÂ ¯ÚfiÓÈ· ÚÔ‚Ï‹Ì·Ù· Û¯ÂÙÈ˙fiÌÂÓ· ÌÂÙÚÔÊÈÎ¤˜ ·ÏÏÂÚÁ›Â˜ (·ÙÔÈÎ‹ ‰ÂÚÌ·Ù›ÙÈ‰·, ¿ÛıÌ·Î·È ·ÏÏÂÚÁÈÎ‹ ËˆÛÈÓÔÊÈÏÈÎ‹ Á·ÛÙÚÂÓÙÂÚ›ÙÈ‰·), ÂÓÒÛÂ ÔÍ¤· ÚÔ‚Ï‹Ì·Ù· (·Ó·Ê˘Ï·Í›· Î·È ÎÓ›‰ˆÛË),ÌÂÙ¿ ÙË Ï‹„Ë ÂÓfi˜ ÙÚÔÊ›ÌÔ˘, Ë ÚÔÁÓˆÛÙÈÎ‹ ÙÔ˘·Í›· Â›Ó·È ˘„ËÏ‹ (10).

∂›ÛË˜, Î·Ù¿ ÙË Ï‹„Ë ÙÔ˘ ÈÛÙÔÚÈÎÔ‡ ı· Ú¤ÂÈ


242

Ó· ·Ó·˙ËÙÔ‡ÓÙ·È Î·È ¿ÏÏ· ÙÚfiÊÈÌ· Ô˘ Î·Ù·Ó·ÏÒ-ıËÎ·Ó ÙÔÓ ›‰ÈÔ ¯ÚfiÓÔ, Î·ıÒ˜ Î·È Èı·Ó¿ “ÂÈÌÔÏ˘-ÛÌ¤Ó·” ÙÚfiÊÈÌ· ·fi “Û˘ÁÎÂÎ·Ï˘Ì¤Ó· ˘ÏÈÎ¿” (9).

º˘ÛÈÎ‹ ÂÍ¤Ù·ÛË∏ ÚÔÛÔ¯‹ Ú¤ÂÈ Ó· ÂÛÙÈ¿˙ÂÙ·È Î˘Ú›ˆ˜ ÛÙÔ

‰¤ÚÌ·, ÛÙÔ ÂÙÈÎfi Î·È ÛÙÔ ·Ó·ÓÂ˘ÛÙÈÎfi, Î·ıÒ˜Â›ÛË˜ ÛÙËÓ ·Ó›¯ÓÂ˘ÛË ·ÙÔÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓÔ˘ Î˘Ú›ˆ˜ ·ÓÂ˘Ú›ÛÎÔÓÙ·È ÛÂ ¿ÙÔÌ· Ô˘ ·ÚÔ˘-ÛÈ¿˙Ô˘Ó IgE-ÌÂÛÔÏ·‚Ô‡ÌÂÓÂ˜ ·ÓÙÈ‰Ú¿ÛÂÈ˜. ∂›-ÛË˜, ÂÎÙÈÌ¿Ù·È Ë ÁÂÓÈÎ‹ Î·Ù¿ÛÙ·ÛË ıÚ¤„Ë˜ ÙÔ˘·ÙfiÌÔ˘ Î·È Ê˘ÛÈÎ¿ ÛËÌÂ›· Ô˘ ˘Ô‰ËÏÒÓÔ˘Ó ÌË·ÏÏÂÚÁÈÎ¤˜ Î·Ù·ÛÙ¿ÛÂÈ˜.

∂ÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ªÂ ÙÔ ÈÛÙÔÚÈÎfi Î·È ÙË Ê˘ÛÈÎ‹ ÂÍ¤Ù·ÛË Ô ÁÈ·-

ÙÚfi˜ ı· Ú¤ÂÈ Ó· ·ÓÙÈÏËÊıÂ› ·Ó Ù· Û˘ÌÙÒÌ·Ù·˘ÔÎÚ‡ÙÔ˘Ó ÙÚÔÊÈÎ‹ ·ÏÏÂÚÁÈÎ‹ ‰È·Ù·Ú·¯‹ Î·È Ó·Èı·ÓÔÏÔÁ‹ÛÂÈ Â¿Ó Â›Ó·È IgE-ÌÂÛÔÏ·‚Ô‡ÌÂÓË ‹ fi¯È.

OÚÈÛÌ¤ÓÂ˜ ÂÚÁ·ÛÙËÚÈ·Î¤˜ ÂÍÂÙ¿ÛÂÈ˜ ÌÔÚÂ› Ó·Â›Ó·È ¯Ú‹ÛÈÌÂ˜ ÛÂ IgE-ÌÂÛÔÏ·‚Ô‡ÌÂÓÂ˜ ‰È·Ù·Ú·-¯¤˜, ÂÓÒ ÛÂ ÌË IgE-ÌÂÛÔÏ·‚Ô‡ÌÂÓÂ˜ Â›Ó·È ÔÏ‡ Â-ÚÈÔÚÈÛÌ¤ÓË˜ ÛËÌ·Û›·˜.

ŒÙÛÈ, ÔÈ ‰ÂÚÌ·ÙÈÎ¤˜ ‰ÔÎÈÌ·Û›Â˜ Î·È Ù· RASTÛÙÈ˜ IgE-ÌÂÛÔÏ·‚Ô‡ÌÂÓÂ˜ ÙÚÔÊÈÎ¤˜ ·ÏÏÂÚÁÈÎ¤˜·ÓÙÈ‰Ú¿ÛÂÈ˜ ‚ÔËıÔ‡Ó ÛÙËÓ ·Ó›¯ÓÂ˘ÛË IgE ·ÓÙÈÛˆ-Ì¿ÙˆÓ ÛÂ ÂÈ‰ÈÎ¿ ÙÚfiÊÈÌ·, ¯ˆÚ›˜ ·˘Ùfi Ó· ÛËÌ·›ÓÂÈfiÙÈ Ù›ıÂÙ·È Ë ‰È¿ÁÓˆÛË ÙË˜ ÎÏÈÓÈÎ‹˜ ÙÚÔÊÈÎ‹˜ ·Ï-ÏÂÚÁ›·˜. OÈ ‰ÂÚÌ·ÙÈÎ¤˜ ‰ÔÎÈÌ·Û›Â˜ ¯ÚËÛÈÌÂ‡Ô˘ÓÛÙËÓ ·Ó›¯ÓÂ˘ÛË ‡ÔÙˆÓ IgE-ÌÂÛÔÏ·‚Ô‡ÌÂÓˆÓÙÚÔÊÈÎÒÓ ·ÏÏÂÚÁÈÒÓ. °ÂÓÈÎ¿, ¿ÓÙˆ˜, ÔÈ ıÂÙÈÎ¤˜‰ÂÚÌ·ÙÈÎ¤˜ ‰ÔÎÈÌ·Û›Â˜ ¤¯Ô˘Ó ÚÔÁÓˆÛÙÈÎ‹ ·Í›· ÌÈ-ÎÚfiÙÂÚË ·fi 50% Û˘ÁÎÚÈÓfiÌÂÓÂ˜ ÌÂ Ù· ·ÔÙÂÏ¤-

ÛÌ·Ù· ÌÂÙ¿ ·fi ÚfiÎÏËÛË. OÈ ·ÚÓËÙÈÎ¤˜ ··ÓÙ‹-ÛÂÈ˜ Û¯Â‰fiÓ ·ÔÎÏÂ›Ô˘Ó ÙÈ˜ IgE-ÌÂÛÔÏ·‚Ô‡ÌÂÓÂ˜·ÓÙÈ‰Ú¿ÛÂÈ˜ (ÚÔÁÓˆÛÙÈÎ‹ ·Í›· ≥95%). ∂ÔÌ¤Óˆ˜,ÂÓÒ ÔÈ ·ÚÓËÙÈÎ¤˜ ‰ÂÚÌ·ÙÈÎ¤˜ ‰ÔÎÈÌ·Û›Â˜ ·ÔÎÏÂ›-Ô˘Ó Û¯Â‰fiÓ ÙÈ˜ IgE-ÌÂÛÔÏ·‚Ô‡ÌÂÓÂ˜ ÙÚÔÊÈÎ¤˜ ·Ï-ÏÂÚÁ›Â˜, ÔÈ ıÂÙÈÎ¤˜ ··ÓÙ‹ÛÂÈ˜ ı¤ÙÔ˘Ó ÌfiÓÔ ÙËÓ˘fiÓÔÈ· ÙË˜ ·ÚÔ˘Û›·˜ ·ÏÏÂÚÁ›·˜. ∂ÓÙÔ‡ÙÔÈ˜, Ì›·ıÂÙÈÎ‹ ‰ÂÚÌ·ÙÈÎ‹ ‰ÔÎÈÌ·Û›· ÌÔÚÂ› Ó· ıÂˆÚËıÂ›‰È·ÁÓˆÛÙÈÎ‹ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ Û˘ÛÙËÌ·ÙÈÎ‹ ·Ó·Ê˘-Ï·ÎÙÈÎ‹ ·ÓÙ›‰Ú·ÛË ÌÂÙ¿ ·fi ÙËÓ Î·Ù·Ó¿ÏˆÛË Û˘-ÁÎÂÎÚÈÌ¤ÓÔ˘ ÙÚÔÊ›ÌÔ˘ (9,10).

ŸÛÔÓ ·ÊÔÚ¿ ÛÙÈ˜ ·ÚÓËÙÈÎ¤˜ ‰ÂÚÌ·ÙÈÎ¤˜ ‰ÔÎÈ-Ì·Û›Â˜ ÌÂ ÂÌÔÚÈÎfi ÂÎ¯‡ÏÈÛÌ·, ÂÊfiÛÔÓ ¤Ú¯ÂÙ·È ÛÂ·ÓÙ›ıÂÛË ÌÂ Û·Ê¤˜ ÈÛÙÔÚÈÎfi, ı· Ú¤ÂÈ Ó· Â·Ó·-Ï·Ì‚¿ÓÔÓÙ·È ÌÂ ÊÚ¤ÛÎÔ ÙÚfiÊÈÌÔ ÚÈÓ ‚ÁÂÈ ÙÔ Û˘-Ì¤Ú·ÛÌ· fiÙÈ ‰ÂÓ ˘¿Ú¯ÂÈ ÙÚÔÊÈÎ‹ ·ÏÏÂÚÁ›·. ∆·RAST, Â›ÛË˜, ·ÓÈ¯ÓÂ‡Ô˘Ó ÂÈ‰ÈÎ¿ IgE ÙÚÔÊÈÎ¿ ·ÓÙÈ-ÛÒÌ·Ù· ÛÙÔÓ ÔÚfi Î·È ¤¯Ô˘Ó ÙÈ˜ ›‰ÈÂ˜ ÂÊ·ÚÌÔÁ¤˜,ÂÓÒ ÚÔÙÈÌÒÓÙ·È ÛÂ ÔÚÈÛÌ¤ÓÂ˜ Î·Ù·ÛÙ¿ÛÂÈ˜, fiˆ˜:·) ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ¤ÓÙÔÓÔ ‰ÂÚÌÔÁÚ·ÊÈÛÌfi, ‚) ÛÂ·ÛıÂÓÂ›˜ ÌÂ ÛÔ‚·Ú¿ ‰ÂÚÌ·ÙÔÏÔÁÈÎ¿ ÚÔ‚Ï‹Ì·Ù·, Á)ÛÂ ·ÛıÂÓÂ›˜ Ô˘ ‰˘ÛÎÔÏÂ‡ÔÓÙ·È Ó· ‰È·Îfi„Ô˘Ó Ù··ÓÙÈÈÛÙ·ÌÈÓÈÎ¿ Î·È ‰) ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ‡ÔÙÂ˜ ·Ô-ÎÏÂÈÛÙÈÎ¿ Â˘·ÈÛıËÛ›Â˜ ÛÂ ÔÚÈÛÌ¤Ó· ÙÚfiÊÈÌ· (9).

¶ÚfiÛÊ·ÙË ÌÂÏ¤ÙË ÙË˜ ÌÂıfi‰Ô˘ CAP-RASTFEIA ÙË˜ Pharmacia ÛÂ ·È‰È¿ ÌÂ ·ÙÔÈÎ‹ ‰ÂÚÌ·Ù›-ÙÈ‰·, ¤‰ÂÈÍÂ fiÙÈ Ô ÔÛÔÙÈÎfi˜ ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÂÈ‰È-ÎÒÓ IgE ÙÚÔÊÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ·ÚÂ›¯Â ·˘ÍËÌ¤ÓËÚÔÁÓˆÛÙÈÎ‹ ·ÎÚ›‚ÂÈ· ÁÈ· ÙÔ Á¿Ï·, ÙÔ ·˘Áfi, ÙÔ ÊÈ-ÛÙ›ÎÈ Î·È ÙÔ „¿ÚÈ, ÛÂ Û¯¤ÛË ÌÂ ÙÈ˜ ‰ÂÚÌ·ÙÈÎ¤˜ ‰ÔÎÈ-Ì·Û›Â˜ (9).

¶›Ó·Î·˜ 1. ™ÂÈÚ¿ ·ÈÙÈÒÓ Ô˘ ı· Ú¤ÂÈ Ó· ÏËÊıÔ‡Ó ˘’ fi„ÈÓ Î·Ù¿ ÙË ‰È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË ·ÏÏÂÚÁÈÎÒÓ ÙÚÔÊÈÎÒÓ ·ÓÙÈ‰Ú¿ÛÂˆÓ

ñ ∞Ó·ÙÔÌÈÎ¤˜ ·ÓˆÌ·Ï›Â˜: ‰È·ÊÚ·ÁÌ·ÙÔÎ‹ÏË, ˘ÏˆÚÈÎ‹ ÛÙ¤ÓˆÛË, ÙÚ·¯ÂÈÔÔÈÛÔÊ·ÁÈÎfi Û˘Ú›ÁÁÈÔ, Ó. Hirsprung ñ ∞ÓÂ¿ÚÎÂÈÂ˜ ÂÓ˙‡ÌˆÓ (ÚˆÙÔ·ıÂ›˜, ‰Â˘ÙÂÚÔ·ıÂ›˜): ·ÓÂ¿ÚÎÂÈ· ‰ÈÛ·Î¯·ÚÈ‰·ÛÒÓ, Á·Ï·ÎÙÔ˙·ÈÌ›·, Ê·ÈÓ˘ÏÔÎÂÙÔÓÔ˘Ú›· ñ ∫·ÎÔ‹ıÂÈÂ˜ ñ ÕÏÏ·: ·ÁÎÚÂ·ÙÈÎ‹ ·ÓÂ¿ÚÎÂÈ·, ¯ÔÏfiÏÈıÔ˜, Á·ÛÙÚÈÎfi ¤ÏÎÔ˜ ñ ¶ÚfiÛıÂÙ· ÙÚÔÊ›ÌˆÓ: Û˘ÓÙËÚËÙÈÎ¿ Î·È ‚ÂÏÙÈˆÙÈÎ¿ ÁÂ‡ÛË˜, ıÂÈÈÎ¿, ªSG-ÓÈÙÚÈÎ¿ ñ ÃÚˆÛÙÈÎ¤˜: Tartazine Î·È ¿ÏÏÂ˜ ·˙Ô¯ÚˆÛÙÈÎ¤˜ ñ ∆ÔÍ›ÓÂ˜: ‚·ÎÙ‹ÚÈ·, Ì‡ÎËÙÂ˜ ñ £·Ï·ÛÛÈÓ¿ - „¿ÚÈ· ñ §ÔÈÌÒÍÂÈ˜: Û·ÏÌÔÓ¤Ï·, ÛÈÁÎ¤ÏÏ·, ÎÔÏÔ‚·ÎÙËÚ›‰ÈÔ, Yersinia, Campylobacter, ·Ú¿ÛÈÙ·, ÈÔ› ñ ∞ÓÙÈÁfiÓ· Ì˘Î‹ÙˆÓ ñ ∆˘¯·›Â˜ ÂÈÌÔÏ‡ÓÛÂÈ˜: Ì¤Ù·ÏÏ·, ÂÓÙÔÌÔÎÙfiÓ·, ·ÓÙÈ‚ÈÔÙÈÎ¿ñ º·ÚÌ·ÎÔÏÔÁÈÎÔ› ·Ú¿ÁÔÓÙÂ˜: Î·ÊÂ˝ÓË, ıÂÔ‚ÚˆÌ›ÓË, ÈÛÙ·Ì›ÓË, ÙÚ˘Ù·Ì›ÓË, ÛÂÚÔÙÔÓ›ÓË, Ù˘Ú·Ì›ÓË

¶›Ó·Î·˜ 2. ™˘ÌÙÒÌ·Ù· ·ÏÏÂÚÁÈÎÒÓ ·ÓÙÈ‰Ú¿ÛÂˆÓ

∞fi ÙÔ ‰¤ÚÌ·: ∫Ó›‰ˆÛË, ·ÁÁÂÈÔÔ›‰ËÌ·, ‰È¿¯˘ÙË ÂÚ˘ıÚfiÙËÙ· - flushing, ÂÚ˘ıËÌ·ÙÒ‰Â˜ ÎÓËÛÌÒ‰Â˜ ÂÍ¿ÓıËÌ·, ·ÙÔ-ÈÎ‹ ‰ÂÚÌ·Ù›ÙÈ‰·

∞fi ÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi: ∫ÓËÛÌfi˜ Î·È Ô›‰ËÌ· ¯ÂÈÏ¤ˆÓ, ÁÏÒÛÛ·˜, ÛÙÔÌ·ÙÈÎÔ‡ ‚ÏÂÓÓÔÁfiÓÔ˘, Ó·˘Ù›·, ÎÔÈÏÈ·Îfi ¿ÏÁÔ˜ ‹ ÎˆÏÈÎfi˜,¤ÌÂÙÔ˜ ‹ reflux, ‰È¿ÚÚÔÈ·

∞fi ÙÔ ·Ó·ÓÂ˘ÛÙÈÎfi: ƒÈÓÈÎ‹ Û˘ÌÊfiÚËÛË, ÚÈÓfiÚÚÔÈ·, ÎÓËÛÌfi˜, Ù¤ÚÓÈÛÌ·, Ï·Ú˘ÁÁÈÎfi Ô›‰ËÌ·, ‚‹¯·˜, ‰˘ÛÊˆÓ›·, Û˘ÚÈÁÌfi˜,Â›ÌÔÓÔ˜ ‚‹¯·˜

∞fi ÙÔ Î·Ú‰È·ÁÁÂÈ·Îfi: ÀfiÙ·ÛË, ˙¿ÏË, shock


243

Œ¯ÂÈ ·Ó·ÊÂÚıÂ› Î·È ÛÂ ÂÏÏËÓÈÎ¤˜ ÌÂÏ¤ÙÂ˜ fiÙÈ Ë›‰È· Ì¤ıÔ‰Ô˜ ÌÔÚÂ› Ó· ÚÔ‚Ï¤„ÂÈ Ù· ·ÔÙÂÏ¤-ÛÌ·Ù· ÙˆÓ ÂÈ‰ÈÎÒÓ ÙÚÔÊÈÎÒÓ ÚÔÎÏ‹ÛÂˆÓ (ÁÈ· ÙÔÁ¿Ï· ·Ó·ÊÂÚfiÌÂÓË ÙÈÌ‹ >95% ÛÂ ıÂÙÈÎfi ·ÔÙ¤ÏÂ-ÛÌ· ÚfiÎÏËÛË˜). ∂›ÛË˜, ·Ó·Ê¤ÚÂÙ·È ˆ˜ ¯Ú‹ÛÈÌËÌ¤ıÔ‰Ô˜ ÛÙË ‰È¿ÎÚÈÛË ÙˆÓ ·È‰ÈÒÓ Ô˘ ı· ·Ô-ÎÙ‹ÛÔ˘Ó ÎÏÈÓÈÎ‹ ·ÓÔ¯‹, ÛÂ Û¯¤ÛË ÌÂ ·˘Ù¿ ÌÂ Â›-ÌÔÓÔ Úfi‚ÏËÌ· (11). ∂›ÛË˜, ¿ÏÏ· ¯·Ú·ÎÙËÚÈÛÙÈÎ¿fiˆ˜ Ù· ˘„ËÏ¿ ‹ ·˘Í·ÓfiÌÂÓ· Â›Â‰· ÂÈ‰ÈÎ‹˜ IgE,Î·ıÒ˜ Î·È ÈÛÙÔÚÈÎfi ·ÓÙ›‰Ú·ÛË˜ ÛÂ ÌÈÎÚ‹ ËÏÈÎ›· Â›-Ó·È ÂÈ‚·Ú˘ÓÙÈÎ¿ fiÛÔÓ ·ÊÔÚ¿ ÛÙÔ ·ÔÙ¤ÏÂÛÌ· ÙˆÓÙÚÔÊÈÎÒÓ ÚÔÎÏ‹ÛÂˆÓ. ∆¤ÏÔ˜, Ô ¤ÏÂÁ¯Ô˜ ÙˆÓ ÂÈ‰È-ÎÒÓ IgE ÙÈÌÒÓ ¯ÚËÛÈÌÂ‡ÂÈ ÁÈ· ÙËÓ ·Ú·ÎÔÏÔ‡ıËÛËÙË˜ ·Ú·ÌÔÓ‹˜ ‹ ÌË ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜ (12). ª›·‰È·ÁÓˆÛÙÈÎ‹ ÚÔÛ¤ÁÁÈÛË ÙË˜ ÙÚÔÊÈÎ‹˜ ·ÏÏÂÚÁ›·˜Ê·›ÓÂÙ·È ÛÙËÓ ∂ÈÎfiÓ· 1.

¢›·ÈÙ· ·ÔÊ˘Á‹˜ - ¢ÔÎÈÌ·Û›Â˜ ÚfiÎÏËÛË˜ ∂ÊfiÛÔÓ ÔÚÈÛÌ¤Ó· ÙÚfiÊÈÌ· ıÂˆÚËıÔ‡Ó ‡ÔÙ·

ÁÈ· ¤ÎÏ˘ÛË ÙÚÔÊÈÎ‹˜ ·ÏÏÂÚÁÈÎ‹˜ ·ÓÙ›‰Ú·ÛË˜,ÂÊ·ÚÌfi˙ÂÙ·È ‰È·ÁÓˆÛÙÈÎ¿ ‰›·ÈÙ· ·ÔÊ˘Á‹˜. °È·ÙËÓ ÂÈÙ˘¯›· ·˘Ù‹˜ ÙË˜ ‰È·‰ÈÎ·Û›·˜ ··ÈÙÂ›Ù·È Ë·ÔÊ˘Á‹ ÙÔ˘ ÛˆÛÙÔ‡ ‹ ÙˆÓ ÛˆÛÙÒÓ ·ÏÏÂÚÁÈÔÁfi-ÓˆÓ. ∂›ÛË˜, ÛËÌ·ÓÙÈÎ‹ Â›Ó·È Ë ÈÎ·ÓfiÙËÙ· ÙÔ˘·ÛıÂÓÔ‡˜ Ó· ‰È·ÙËÚ‹ÛÂÈ Ì›· ‰›·ÈÙ· ÂÏÂ‡ıÂÚË ·fifiÏÂ˜ ÙÈ˜ ‰È·ÊÔÚÂÙÈÎ¤˜ ÌÔÚÊ¤˜ Ô˘ ÌÔÚÂ› Ó· ‚Ú›-ÛÎÂÙ·È ÙÔ ‡ÔÙÔ ÙÚfiÊÈÌÔ, Î·ıÒ˜ Î·È Ë ·Ô˘Û›·¿ÏÏˆÓ ·Ú·ÁfiÓÙˆÓ Ô˘ ı· ÌÔÚÔ‡Û·Ó Ó· ÂÈ‰ÂÈ-ÓÒÛÔ˘Ó Ù· Û˘ÌÙÒÌ·Ù·, fiˆ˜ .¯. Ô Staph. aureusÛ·Ó ÂÈÌfiÏ˘ÓÛË ·ÙÔÈÎ‹˜ ‰ÂÚÌ·Ù›ÙÈ‰·˜, ÔÈ ÈÒÛÂÈ˜ÛÙÔ ¿ÛıÌ· Î·È Ë ‰Â˘ÙÂÚÔ·ı‹˜ ·ÓÂ¿ÚÎÂÈ· Ï·ÎÙ¿-ÛË˜ ÛÂ ‚Ú¤ÊÔ˜ ÌÂ Û‡Ó‰ÚÔÌÔ ÂÓÙÂÚÔÎÔÏ›ÙÈ‰·˜(protein induced) (9).

∞Ó Ù· Û˘ÌÙÒÌ·Ù· ˘Ô¯ˆÚ‹ÛÔ˘Ó ÂÓÒ Ô ·ÛıÂ-Ó‹˜ Â›Ó·È ÛÂ ‰›·ÈÙ· ·ÔÊ˘Á‹˜, ··ÈÙÂ›Ù·È Î¿ÔÈÔ Â›-‰Ô˜ ÙÚÔÊÈÎ‹˜ ÚfiÎÏËÛË˜ ÁÈ· Ó· ÂÈ‚Â‚·ÈˆıÂ› Ë‰È¿ÁÓˆÛË ÙË˜ ÙÚÔÊÈÎ‹˜ ·ÏÏÂÚÁ›·˜, ÂÈ‰ÈÎ¿ ÛÂ ¯Úfi-ÓÈ· ÚÔ‚Ï‹Ì·Ù· fiˆ˜ Ë ·ÙÔÈÎ‹ ‰ÂÚÌ·Ù›ÙÈ‰· Î·ÈÙÔ ¿ÛıÌ·. OÈ ÙÚÔÊÈÎ¤˜ ÚÔÎÏ‹ÛÂÈ˜ Â›Ó·È Ì¤ıÔ‰Ô˜·Ó·ÊÔÚ¿˜ ÁÈ· ÙË ‰È¿ÁÓˆÛË ÙË˜ ÙÚÔÊÈÎ‹˜ ·ÏÏÂÚ-Á›·˜, Î·ıÒ˜ Î·È ÁÈ· ÙËÓ Â·ÓÂÎÙ›ÌËÛË ÙË˜ ÂÓÂÚÁfi-

ÙËÙ·˜ ÙË˜ ÓfiÛÔ˘ Î·È ÙËÓ ·ÂÏÂ˘ı¤ÚˆÛË ÙˆÓ ÂÓÔ-¯ÔÔÈËı¤ÓÙˆÓ ÙÚÔÊ›ÌˆÓ (12).

OÈ ‰ÔÎÈÌ·Û›Â˜ ÚfiÎÏËÛË˜ ·fi ÙÔ ÛÙfiÌ· ‰È·ÎÚ›-ÓÔÓÙ·È ÛÙÈ˜ ·ÓÔÈÎÙ¤˜, fiÔ˘ Ô ÁÈ·ÙÚfi˜ Î·È Ô ·ÛıÂ-Ó‹˜ ÁÓˆÚ›˙Ô˘Ó ÙÔ ÙÚfiÊÈÌÔ, ÛÙÈ˜ ·Ï¤˜ Ù˘ÊÏ¤˜,fiÔ˘ ÌfiÓÔ Ô ÁÈ·ÙÚfi˜ ÁÓˆÚ›˙ÂÈ Î·È ÛÙÈ˜ ‰ÈÏ¤˜ Ù˘-ÊÏ¤˜ ÂÏÂÁ¯fiÌÂÓÂ˜ ÌÂ ÂÈÎÔÓÈÎfi ÙÚfiÊÈÌÔ, fiÔ˘ Ô‡ÙÂÔ ÁÈ·ÙÚfi˜ Ô‡ÙÂ Ô ·ÛıÂÓ‹˜ ÁÓˆÚ›˙Ô˘Ó ÙËÓ Ô˘Û›·.∂›ÛË˜, Ô ·ÛıÂÓ‹˜ ‹ ÔÈ ÁÔÓÂ›˜ ÙÔ˘ Ú¤ÂÈ Ó· Û˘Ì-ÊˆÓ‹ÛÔ˘Ó ÁÈ· ÙË ‰È·‰ÈÎ·Û›· Î·È ÙÔ˘˜ Èı·ÓÔ‡˜ ÎÈÓ-‰‡ÓÔ˘˜. ∞Ú¯ÈÎ¿ Û˘ÓÈÛÙ¿Ù·È ‰›·ÈÙ· ·ÔÊ˘Á‹˜ ÙˆÓ‡ÔÙˆÓ ·ÏÏÂÚÁÈÔÁfiÓˆÓ ÁÈ· 7-14 ËÌ¤ÚÂ˜, fiÙ·Ó ıÂ-ˆÚÂ›Ù·È IgE-ÌÂÛÔÏ·‚Ô‡ÌÂÓË ·ÓÙ›‰Ú·ÛË Î·È ÁÈ· 2-3Ì‹ÓÂ˜ ÛÂ ¿ÏÏÂ˜ ÂÚÈÙÒÛÂÈ˜, È‰›ˆ˜ ÛÂ Á·ÛÙÚÂÓÙÂ-ÚÔÏÔÁÈÎ¿ ÚÔ‚Ï‹Ì·Ù· (13). °È· ÙË ‰ÈÂÓ¤ÚÁÂÈ· ‰ÔÎÈ-Ì·Û›·˜ ÚfiÎÏËÛË˜, ·Ú¯ÈÎ¿, Ô ·ÛıÂÓ‹˜ ‹ ÔÈ ÁÔÓÂ›˜ÙÔ˘ Ú¤ÂÈ Ó· ÂÓËÌÂÚÒÓÔÓÙ·È ÁÈ· ÙË ‰È·‰ÈÎ·Û›· Î·ÈÙÔ˘˜ Èı·ÓÔ‡˜ ÎÈÓ‰‡ÓÔ˘˜ ÙË˜ (15).

∂›ÛË˜, ıÂˆÚÂ›Ù·È ·Ó·ÁÎ·›Ô Ó· ˘¿Ú¯Ô˘Ó Ê¿Ú-Ì·Î· Î·È ÂÍÔÏÈÛÌfi˜ Î·Ù¿ÏÏËÏ· ÁÈ· ÙËÓ ·Ó¿Ù·ÍËÙ˘¯fiÓ ·Ó·Ê˘Ï·Í›·˜, ÂÓÒ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ÈÛÙÔÚÈÎfi·Ó·Ê˘Ï·ÎÙÈÎ‹˜ ·ÓÙ›‰Ú·ÛË˜ Ú¤ÂÈ Ó· ˘¿Ú¯ÂÈ¤ÙÔÈÌË ÚfiÛ‚·ÛË ÛÂ ÊÏ¤‚· Î·È Ë ‰ÔÎÈÌ·Û›· Ó· Á›-ÓÂÙ·È ÛÂ ÓÔÛÔÎÔÌÂ›Ô. ∆¤ÏÔ˜, Ô ·ÛıÂÓ‹˜ Ú¤ÂÈ Ó·Â›Ó·È ˘fi È·ÙÚÈÎ‹ ·Ú·ÎÔÏÔ‡ıËÛË Î·È ÂÎÙ›ÌËÛËÙˆÓ ÏÂÈÙÔ˘ÚÁÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ. ŸÛÔÓ ·ÊÔÚ¿ ÛÙ·Ê¿ÚÌ·Î· Ô˘ Ï·Ì‚¿ÓÂÈ Ô ·ÛıÂÓ‹˜ ÚÈÓ ÙËÓ Úfi-ÎÏËÛË:

·) ÁÈ· ÙÔ ¿ÛıÌ·: Ù· ÂÈÛÓÂfiÌÂÓ·: - ‚2-‰ÈÂÁ¤ÚÙÂ˜ ‚Ú·¯Â›·˜ ‰Ú¿ÛË˜ Î·È ·ÓÙÈ¯ÔÏÈÓÂÚÁÈ-Î¿ Ú¤ÂÈ Ó· ‰È·ÎfiÙÔÓÙ·È 1 ËÌ¤Ú· ÚÈÓ- ‚2-‰ÈÂÁ¤ÚÙÂ˜ Ì·ÎÚ¿˜ ‰Ú¿ÛË˜ Ú¤ÂÈ Ó· ‰È·Îfi-ÙÔÓÙ·È 48 ÒÚÂ˜ ÚÈÓ- ¯ÚˆÌÔÁÏ˘Î›ÓÂ˜, ·ÓÙÈÈÛÙ·ÌÈÓÈÎ¿ Ú¤ÂÈ Ó· ‰È·Îfi-ÙÔÓÙ·È 2-4 ËÌ¤ÚÂ˜ ÚÈÓ - Ù· ·ÓÙÈÈÛÙ·ÌÈÓÈÎ¿ Ì·ÎÚ¿˜ ‰Ú¿ÛË˜ Ú¤ÂÈ Ó· ‰È·-ÎfiÙÔÓÙ·È ÌÂÚÈÎ¤˜ Â‚‰ÔÌ¿‰Â˜ ÚÈÓ- Ù· ÂÈÛÓÂfiÌÂÓ· Î·È Û˘ÛÙËÌ·ÙÈÎ¿ ÛÙÂÚÔÂÈ‰‹ ÌÔ-ÚÂ› Ó· Û˘ÓÂ¯ÈÛÙÔ‡Ó Î·È ÁÈ· ÙËÓ ÂÍ·ÛÊ¿ÏÈÛË Î·Ï‹˜·Ó·ÓÂ˘ÛÙÈÎ‹˜ ÏÂÈÙÔ˘ÚÁ›·˜,

¶›Ó·Î·˜ 3. ™ÙÔÈ¯Â›· Ô˘ Ú¤ÂÈ Ó· ÏËÊıÔ‡Ó ˘’ fi„ÈÓ Î·Ù¿ ÙË Ï‹„Ë ÈÛÙÔÚÈÎÔ‡

ñ ∆Ô ÈÛÙÔÚÈÎfi ÙÔ˘ ·ÛıÂÓÔ‡˜ Â›Ó·È Û˘¯Ó¿ ·Ó·ÎÚÈ‚¤˜ ñ ∏ ÙÚÔÊÈÎ‹ ·ÏÏÂÚÁ›· Â›Ó·È ÈÔ Û˘¯Ó‹ ÛÙ· ÌÈÎÚ¿ ·È‰È¿ Î˘Ú›ˆ˜ ÌÂ ÙË ÌÔÚÊ‹ ·ÙÔÈÎ‹˜ ‰ÂÚÌ·Ù›ÙÈ‰·˜ ñ ™¯ÂÙÈÎ¿ Ï›Á· ÙÚfiÊÈÌ· Â›Ó·È ˘Â‡ı˘Ó· ÁÈ· ÙËÓ ÏÂÈÔÓfiÙËÙ· ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ ·ÓÙÈ‰Ú¿ÛÂˆÓ ñ ªÂ ÂÍ·›ÚÂÛË ÙËÓ ·ÏÏÂÚÁÈÎ‹ ËˆÛÈÓÔÊÈÏÈÎ‹ ÔÈÛÔÊ·Á›ÙÈ‰· ‹ Á·ÛÙÚÂÓÙÂÚ›ÙÈ‰·, Â›Ó·È Û¿ÓÈÔ ¤Ó· ¿ÙÔÌÔ Ó· ·ÓÙÈ‰Ú¿ ÛÂ ÂÚÈÛÛfi-

ÙÂÚ· ·fi 3 ÙÚfiÊÈÌ· ñ ŸÙ·Ó ¤Ó· ·È‰› ÌÂ ÙÚÔÊÈÎ‹ ·ÏÏÂÚÁ›· ·ÓÙÈ‰Ú¿ ÛÂ “Ó¤·” ‹ “ÔÏÏ·Ï¿” ÙÚfiÊÈÌ·, Â›Ó·È Èı·Ófi fiÙÈ Ï·Ì‚¿ÓÂÈ ÌÂ “ÌË Ê·ÓÂÚfi” ÙÚfi-

Ô ÎÔÈÓ¿ ÙÚÔÊÈÎ¿ ·ÏÏÂÚÁÈÔÁfiÓ· ñ ∂ÎÙfi˜ ·fi ÙÈ˜ ·ÏÏÂÚÁ›Â˜ ÙÔ˘ ÂÙÈÎÔ‡, Ù· ÂÚÈÛÛfiÙÂÚ· ÙÚÔÊÈÎ¿ ·ÏÏÂÚÁÈÎ¿ Û˘ÌÙÒÌ·Ù· ÂÌÊ·Ó›˙ÔÓÙ·È ÛÂ Ï›Á· ÏÂÙ¿ ¤ˆ˜ Ï›-

ÁÂ˜ ÒÚÂ˜ ·fi ÙË Ï‹„Ë ÙÔ˘ ÙÚÔÊÈÎÔ‡ ·ÏÏÂÚÁÈÔÁfiÓÔ˘ ñ OÈ ·ÏËıÂ›˜ ÙÚÔÊÈÎ¤˜ ·ÏÏÂÚÁ›Â˜ ÁÂÓÈÎ¿ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÎÏ·ÛÈÎ¿ ÛËÌÂ›· Î·È Û˘ÌÙÒÌ·Ù· Ô˘ ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙÔ ‰¤ÚÌ·, ÙÔ

ÂÙÈÎfi Î·È ÙÔ ·Ó·ÓÂ˘ÛÙÈÎfi ñ ÀÔÎÂÈÌÂÓÈÎ¿ ‹ Û˘ÌÙÒÌ·Ù· ‰È·Ù·Ú·¯ÒÓ Û˘ÌÂÚÈÊÔÚ¿˜ ˆ˜ ÌÔÓ·‰ÈÎ‹ ÂÎ‰‹ÏˆÛË ÙÚÔÊÈÎ‹˜ ·ÏÏÂÚÁ›·˜ Â›Ó·È Û¿ÓÈ· ñ ∞ÓÂÈı‡ÌËÙÂ˜ ·ÓÙÈ‰Ú¿ÛÂÈ˜ ÛÂ ¯ÚˆÛÙÈÎ¤˜ ‹ ÚfiÛıÂÙ· ÙÚÔÊÒÓ Â›Ó·È Û¯ÂÙÈÎ¿ Û¿ÓÈÂ˜


244

‚) ÁÈ· ·ÙÔÈÎ‹ ‰ÂÚÌ·Ù›ÙÈ‰·/ÎÓ›‰ˆÛË: Ú¤ÂÈ Ó·‰È·ÎfiÙÔÓÙ·È Ù· ·ÓÙÈÈÛÙ·ÌÈÓÈÎ¿ Î·È Ù· ÛÙÂÚÔÂÈ‰‹ ‹Ó· ÌÂÈÒÓÂÙ·È Ë ‰fiÛË ÛÙ· ÙÂÏÂ˘Ù·›·,

Á) ÁÈ· ÚÈÓ›ÙÈ‰· Î·È ¿ÛıÌ·: Ú¤ÂÈ Ó· ‰È·ÎfiÙÔ-ÓÙ·È Ù· ·ÔÛ˘ÌÊÔÚËÙÈÎ¿, ÂÓÒ Ù· ÂÈÛÓÂfiÌÂÓ· ÛÙÂ-ÚÔÂÈ‰‹ ÌÔÚÂ› Ó· Û˘ÓÂ¯›˙ÔÓÙ·È.

∏ ‰ÔÎÈÌ·Û›· Ú¤ÂÈ Ó· ·Ú¯›˙ÂÈ ÙÔ Úˆ›, ÌÂÙ¿·fi ÔÏÔÓ‡ÎÙÈ· ÓËÛÙÂ›·, ÍÂÎÈÓÒÓÙ·˜ ÌÂ ‰fiÛË Ô˘‰ÂÓ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ‰ËÌÈÔ˘ÚÁ‹ÛÂÈ Û˘ÌÙÒÌ·Ù·.OÈ ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓÂ˜ ÙÚÔÊ¤˜ ‰È·ÎÚ›ÓÔÓÙ·È ÛÂ:

i) ·˘Ù¤˜ Ô˘ Â›Ó·È ÁÓˆÛÙ¤˜ fiÙÈ Û˘Ó‰¤ÔÓÙ·È ÌÂ·ıÔÏÔÁÈÎ¿ ·ÔÙÂÏ¤ÛÌ·Ù· Î·È ‰È·ÛÙ·˘ÚÔ‡ÌÂÓÂ˜·ÓÙÈ‰Ú¿ÛÂÈ˜,

ii) ·˘Ù¤˜ ÌÂ ÌË ÂÈ‚Â‚·ÈˆÌ¤Ó· ·ÔÙÂÏ¤ÛÌ·Ù·,fiˆ˜ ÊÚÔ‡Ù· Î·È Ï·¯·ÓÈÎ¿ Î·È

iii) ·˘Ù¤˜ ÌÂ Ï›Á· ‰Â‰ÔÌ¤Ó·, ¯ˆÚ›˜ ÂÍ·ÁˆÁ‹ Û˘-ÌÂÚ¿ÛÌ·ÙÔ˜ (.¯. ·ÏÎÔÔÏÔ‡¯· ÔÙ¿).

ªÂÁ·Ï‡ÙÂÚË ÚÔÛÔ¯‹ Ú¤ÂÈ Ó· ‰›ÓÂÙ·È ÛÙËÓÚÒÙË Î·ÙËÁÔÚ›·, ¯ˆÚ›˜ ˘ÔÙ›ÌËÛË ÙˆÓ ¿ÏÏˆÓ‰‡Ô.

∏ ·Ú·ÛÎÂ˘‹ Î·È Ë ÌÔÚÊ‹ ÙË˜ ÙÚÔÊ‹˜, È‰›ˆ˜ÛÙËÓ Ù˘ÊÏ‹ ÚfiÎÏËÛË, ¤¯Ô˘Ó È‰È·›ÙÂÚË ÛËÌ·Û›·,fiÔ˘ ÚÔÙÈÌ¿Ù·È Ë ÌÔÚÊ‹ ÎfiÓÂˆ˜. ∂‡ÎÔÏË ·Ú·-ÛÎÂ˘‹ ÎfiÓÂˆ˜ Á›ÓÂÙ·È ·fi ÙÚÔÊ¤˜ ÍËÚ¤˜ ‹ ·Ê˘‰·-ÙˆÌ¤ÓÂ˜, fiˆ˜ ‰ËÌËÙÚÈ·Î¿, ÍËÚÔ‡˜ Î·ÚÔ‡˜,·Ê˘‰·ÙˆÌ¤ÓÔ Á¿Ï· ‹ ·˘Áfi, ÂÓÒ ÚÔ‚Ï‹Ì·Ù· ÚÔ-Î‡ÙÔ˘Ó ÌÂ Ù· ÊÚÔ‡Ù·, Ù· Ï·¯·ÓÈÎ¿, Ù· ¯fiÚÙ·, Ù·„¿ÚÈ· Î·È Ù· fiÛÙÚ·Î·. ∂›ÛË˜, ÛÂ ÔÚÈÛÌ¤ÓÂ˜ ÙÚÔ-Ê¤˜ ˘¿Ú¯ÂÈ Ë ‰˘Ó·ÙfiÙËÙ· ·Ú·ÛÎÂ˘‹˜ ‚ÈÔÌË¯·ÓÈ-Î¿, ÛÂ Ï˘ÔÊÈÏÔÔÈËÌ¤ÓË ÍËÚ¿ ÛÎfiÓË Î·È ÛÂ ‰È¿ÊÔ-ÚÂ˜ ÔÛfiÙËÙÂ˜ Ô˘ ÌÔÚÔ‡Ó Ó· Û˘ÓÙËÚËıÔ‡Ó ÁÈ·ÂÚÈÛÛfiÙÂÚÔ ¯ÚfiÓÔ. ∏ ÈÔ Û˘ÓËıÈÛÌ¤ÓË Û˘ÛÎÂ˘·-Û›· Â›Ó·È ÛÂ Î¿„Ô˘ÏÂ˜, ÁÈ·Ù› ˘¿Ú¯ÂÈ Ë ‰˘Ó·ÙfiÙËÙ·Ó· Î·Ï˘ÊıÂ› ÌÂÁ¿ÏË ÔÛfiÙËÙ· ÙÚÔÊ‹˜, ÂÓÒ ÛÙ··È‰È¿ Ë Î¿Ï˘„Ë ÌÔÚÂ› Ó· Á›ÓÂÈ ÛÂ ·ÁˆÙ¿, ÛÔ‡-Â˜, ÎÚ¤ÌÂ˜ ÊÚÔ‡ÙˆÓ Î.Ï. ∞ÓÙ›ıÂÙ·, Ë Î¿Ï˘„ËÚ¤ÂÈ Ó· Á›ÓÂÙ·È ÛÂ ˘ÁÚfi ¤Î‰Ô¯Ô ÛÂ ‰‡Ô ÂÚÈÙÒ-ÛÂÈ˜: ·) ÛÙÔ “oral allergy syndrome”, fiÔ˘ ÁÈ· Ó·ÂÎÏ˘ıÂ› ÙÔ Û‡ÌÙˆÌ· Ú¤ÂÈ ÙÔ ·ÓÙÈÁfiÓÔ Ó· ¤ÚıÂÈÛÂ Â·Ê‹ ÌÂ ÙË ÛÙÔÌ·ÙÔÊ·Ú˘ÁÁÈÎ‹ ÎÔÈÏfiÙËÙ· Î·È‚) ÛÙË ‚·ÚÈ¿ ·Ó·Ê˘Ï·ÎÙÈÎ‹ ·ÓÙ›‰Ú·ÛË, ÁÈ·Ù› Ô¤ÏÂÁ¯Ô˜ ÙË˜ ·ÓÙ›‰Ú·ÛË˜ ¯ÚÔÓÈÎ¿ Â›Ó·È ÂÓÙÔÓfiÙÂ-ÚÔ˜, ÂÓÒ ÛÙËÓ Î¿„Ô˘Ï· Ú¤ÂÈ Ó· ÂÚÈÌ¤ÓÔ˘ÌÂ Ó··ÔÚÚÔÊËıÂ›. ™·Ó ÂÈÎÔÓÈÎ‹ ÙÚÔÊ‹ ¯ÚËÛÈÌÔÔÈÂ›Ù·ÈÎ˘Ú›ˆ˜ Ë ‰ÂÍÙÚfi˙Ë, Ô˘ Î·Ï‡ÙÂÙ·È Â‡ÎÔÏ· ÛÂ Î¿-„Ô˘ÏÂ˜ ‹ ¿ÏÏÂ˜ ÙÂ¯ÓÈÎ¤˜. ∏ ·Ú¯ÈÎ‹ ‰fiÛË Â›Ó·È Î·-ÙÒÙÂÚË ·fi ·˘Ù‹ Ô˘ ·Ó·Ì¤ÓÂÙ·È Ó· ÚÔÎ·Ï¤ÛÂÈÛ˘ÌÙÒÌ·Ù· Î·È ‰ÈÏ·ÛÈ¿˙ÂÙ·È ·Ó¿ 15-60 min, ·Ó¿-ÏÔÁ· ÌÂ ÙÔ ÈÛÙÔÚÈÎfi Î·È ÙËÓ ÙÂ¯ÓÈÎ‹ ¯ÔÚ‹ÁËÛË˜(9,15,16).

∞ÓÔÈÎÙ‹ ÚfiÎÏËÛË: ÃÚËÛÈÌÔÔÈÂ›Ù·È: ·) fiÙ·Ó Ë‰ÂÚÌ·ÙÈÎ‹ ‰ÔÎÈÌ·Û›· Â›Ó·È ·ÚÓËÙÈÎ‹ Î·È ÙÔ ÈÛÙÔÚÈÎfiÁÈ· ÙË Û˘ÁÎÂÎÚÈÌ¤ÓË ÙÚÔÊ‹ ·ÌÊ›‚ÔÏÔ, ‚) fiÙ·Ó ÌÂÙË Û˘ÁÎÂÎÚÈÌ¤ÓË ÙÚÔÊ‹ Ù· Û˘ÌÙÒÌ·Ù· ‰ÂÓ ·Ó·-

·Ú¿ÁÔÓÙ·È ÛÙ·ıÂÚ¿, ÒÛÙÂ Î·ÙËÁÔÚËÌ·ÙÈÎ¿ Ó··ÔÌ·ÎÚ‡ÓÔ˘ÌÂ ÙËÓ ‡ÔÙË ÙÚÔÊ‹ Î·È Á) ÁÈ· ÙË ‰È-Â˘ÎÚ›ÓËÛË Ì›·˜ DBPCFC (16).

∞Ï‹ Ù˘ÊÏ‹ ÌÂ ÂÈÎÔÓÈÎfi ¤ÏÂÁ¯Ô: ÃÚËÛÈÌÔÔÈÂ›Ù·ÈÎ˘Ú›ˆ˜ ÚÔ˜ ÂÈ‚Â‚·›ˆÛË ÙË˜ ‰ÈÏ‹˜ Ù˘ÊÏ‹˜ ÌÂ ÂÈ-ÎÔÓÈÎfi ¤ÏÂÁ¯Ô.

¢ÈÏ‹ Ù˘ÊÏ‹ ÌÂ ÂÈÎÔÓÈÎfi ¤ÏÂÁ¯Ô: ¶ÚÔÛ·ÚÌfi˙Â-Ù·È ÛÂ Î¿ıÂ ·ÛıÂÓ‹ ·fi: ·) Ù· Û˘ÌÙÒÌ·Ù·, ‚) ÙÔ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ·fi ÙË Ï‹„Ë ÙË˜ ÙÚÔÊ‹˜ Ì¤¯ÚÈÙËÓ ÂÎ‰‹ÏˆÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ, Á) ÙËÓ ÔÛfiÙËÙ·Ô˘ ··ÈÙÂ›Ù·È ÁÈ· ÙËÓ ÂÎ‰‹ÏˆÛË ÙˆÓ Û˘ÌÙˆÌ¿-ÙˆÓ, ‰) ÙÔ ÈÔ ÚfiÛÊ·ÙÔ ¤ÓÙÔÓÔ ÂÂÈÛfi‰ÈÔ Î·È Â)Â¿Ó ··ÈÙÔ‡ÓÙ·È Î·È ÂÈÚfiÛıÂÙÔÈ ·Ú¿ÁÔÓÙÂ˜(.¯. ¿ÛÎËÛË). ∞Ú¯›˙Ô˘ÌÂ ÌÂ ÙÔ 1/10 ÙË˜ ‰fiÛË˜ Ô˘·Ó·Ê¤ÚÂÙ·È fiÙÈ ·ÚÔ˘Û›·ÛÂ ·ÓÙ›‰Ú·ÛË Î·È ‰ÈÏ·-ÛÈ¿˙Ô˘ÌÂ ÛÂ 15-60 min ·Ó¿ÏÔÁ· ÌÂ ÙÔ ¯ÚÔÓÈÎfi ‰È¿-ÛÙËÌ· ÂÌÊ¿ÓÈÛË˜ Û˘ÌÙˆÌ¿ÙˆÓ Î·È Ì¤¯ÚÈ Ô ·ÛıÂ-Ó‹˜ Ó· ÂÌÊ·Ó›ÛÂÈ Û˘ÌÙÒÌ·Ù· ‹ Ó· ¤¯ÂÈ Î·Ù·Ó·ÏÒ-ÛÂÈ 8-10 g ÍËÚ¿˜ Ï˘ÔÊÈÏÔÔÈËÌ¤ÓË˜ ÙÚÔÊ‹˜ ‹ 60-100 g ˘ÁÚ‹˜ (ÁÈ· 1 ‰fiÛË). ∞Ó Ë DBPCFC Â›Ó·È ·Ú-ÓËÙÈÎ‹, ÂÏ¤Á¯ÂÙ·È ÌÂ ·ÓÔÈÎÙ‹ ÚfiÎÏËÛË. ∂›Ó·È ‰˘-Ó·ÙfiÓ Ó· ¤¯Ô˘ÌÂ ÂÚÈÙÒÛÂÈ˜ ÌÂ ·ÚÓËÙÈÎ‹ ‰ÈÏ‹Ù˘ÊÏ‹ Î·È ıÂÙÈÎ‹ ·ÓÔÈÎÙ‹ ÚfiÎÏËÛË: ·) Â¿Ó ¯ÚËÛÈ-ÌÔÔÈÔ‡ÌÂ ÌÈÎÚfiÙÂÚË ‰fiÛË ·fi ÙËÓ ··ÈÙÔ‡ÌÂÓË,‚) Â¿Ó ÌÂÙ·‚ÏËıÂ› Ë ·ÓÙÈÁÔÓÈÎfiÙËÙ· ÙË˜ ÙÚÔÊ‹˜Î·Ù¿ ÙËÓ ·Ú·ÛÎÂ˘‹ Î·È Á) ÁÈ· „˘¯ÔÏÔÁÈÎÔ‡˜ Ïfi-ÁÔ˘˜ Î·È Ù· Û˘ÌÙÒÌ·Ù·, Ù¤ÏÔ˜, Ó· Â›Ó·È ˘ÔÎÂÈÌÂ-ÓÈÎ¿. ™Â ·ÓÙÈ‰Ú¿ÛÂÈ˜ ÌË IgE-ÌÂÛÔÏ·‚Ô‡ÌÂÓÂ˜, ÔÈÚÔÎÏ‹ÛÂÈ˜ ÌÔÚÂ› Ó· ¯ÚÂÈ·ÛÙÔ‡Ó ‰fiÛÂÈ˜ 0,3-0,6g/kg ÛÂ 1-2 ¯ÔÚËÁ‹ÛÂÈ˜, ÂÓÒ ÛÂ ¿ÏÏÂ˜ ÌË IgE-ÌÂ-ÛÔÏ·‚Ô‡ÌÂÓÂ˜ Ô ·ÛıÂÓ‹˜ ÌÔÚÂ› Ó· ¯ÚÂÈ·ÛÙÂ› ·Ú-ÎÂÙ¤˜ ‰fiÛÂÈ˜ ÛÂ Ì›· ÂÚ›Ô‰Ô 3 ËÌÂÚÒÓ Ì¤¯ÚÈ Ó·ÚÔÎ‡„Ô˘Ó Û˘ÌÙÒÌ·Ù·. ∏ ‰È¿ÚÎÂÈ· ÙÔ˘ ¯ÚfiÓÔ˘·Ú·Ù‹ÚËÛË˜ ÂÍ·ÚÙ¿Ù·È ·fi ÙÔÓ Ù‡Ô ÙË˜ ·ÓÙ›-‰Ú·ÛË˜ (.¯. ÁÂÓÈÎ¿ ¤ˆ˜ 2 ÒÚÂ˜ ÁÈ· ÙÈ˜ IgE-ÌÂÛÔ-Ï·‚Ô‡ÌÂÓÂ˜ ·ÓÙÈ‰Ú¿ÛÂÈ˜, ¤ˆ˜ 4-8 ÒÚÂ˜ ÁÈ· ÙËÓÂÓÙÂÚÔÎÔÏ›ÙÈ‰· ·fi Á¿Ï· ·ÁÂÏ¿‰·˜, 24-48 ÒÚÂ˜ÁÈ· ÙËÓ ÚˆÎÙÔÎÔÏ›ÙÈ‰· Î·È, Ù¤ÏÔ˜, 3-4 ËÌ¤ÚÂ˜ ÁÈ·ÙÈ˜ ÔÏÏ·Ï¤˜ ·ÏÏÂÚÁ›Â˜ ÛÙËÓ ·ÏÏÂÚÁÈÎ‹ ËˆÛÈÓÔ-ÊÈÏÈÎ‹ Á·ÛÙÚÂÓÙÂÚ›ÙÈ‰·). ™ÙÈ˜ ÂÚÈÛÛfiÙÂÚÂ˜ IgE-ÌÂÛÔÏ·‚Ô‡ÌÂÓÂ˜ ·ÓÙÈ‰Ú¿ÛÂÈ˜, ÚÔÎÏ‹ÛÂÈ˜ ÌÂ Ó¤·

§ÂÙÔÌÂÚ¤˜ ÈÛÙÔÚÈÎfi (+) � (+) �

IgE/Th2 ÌÂÛÔÏ¿‚ËÛË ªË IgE/Th2 ÌÂÛÔÏ¿‚ËÛË � �

¢ÂÚÌ·ÙÈÎ¿ tests - CAP-RAST ∂Ó‰ÔÛÎfiËÛË (+) � (-) �

¢›·ÈÙ· ·ÔÊ˘Á‹˜ (-)(-) � (+) �

∆ÚÔÊÈÎ‹ ÚfiÎÏËÛË +

∂È‰ÈÎ‹ ‰›·ÈÙ·

∂ÈÎfiÓ· 1. ¢È·ÁÓˆÛÙÈÎ‹ ÚÔÛ¤ÁÁÈÛË ÙË˜ ÙÚÔÊÈÎ‹˜ ·ÏÏÂÚÁ›·˜.


245

ÙÚfiÊÈÌ· ÌÔÚÔ‡Ó Ó· Á›ÓÔ˘Ó Î¿ıÂ 1-2 ËÌ¤ÚÂ˜, ÂÓÒÁÈ· ÙÈ˜ ÌË IgE-ÌÂÛÔÏ·‚Ô‡ÌÂÓÂ˜ ÔÈ ÚÔÎÏ‹ÛÂÈ˜ ÌÂÓ¤· ÙÚfiÊÈÌ· ¯ÚÂÈ¿˙ÂÙ·È Ó· ¤¯Ô˘Ó ÌÂÛÔ‰È·ÛÙ‹Ì·Ù·3-5 ËÌÂÚÒÓ. ∞·Ú·›ÙËÙË ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË Â›Ó·È Ë¯Ú‹ÛË ·ÓÙÈÎÂÈÌÂÓÈÎÒÓ ÎÚÈÙËÚ›ˆÓ ÙË˜ ·ÓÙ›‰Ú·ÛË˜.ŒÙÛÈ, ÁÈ· ÙÔ ¿ÛıÌ· ıÂˆÚÂ›Ù·È ıÂÙÈÎ‹ Ë ÚfiÎÏËÛËÌÂÙ¿ ·fi ÚÔÎ·ÏÔ‡ÌÂÓË ÙÒÛË ÙË˜ ‚·ÛÈÎ‹˜ ÙÔ˘FEV1 >20%. ™ÙËÓ ÎÓ›‰ˆÛË ÂÊ·ÚÌfi˙ÂÙ·È Ô Î·ÓfiÓ·˜ÙˆÓ 9, ‰È·ÈÚÒÓÙ·˜ ÙÔ ‰¤ÚÌ· ÛÂ 9 ÂÚÈÔ¯¤˜, ÂÓÒ Î¿-ıÂ ÂÚÈÔ¯‹ ‚·ıÌÔÏÔÁÂ›Ù·È ÌÂ ÎÏ›Ì·Î· ·fi 0 ¤ˆ˜ 4·Ó¿ÏÔÁ· ÌÂ ÙËÓ ¤ÓÙ·ÛË ÙÔ˘ ÂÍ·Óı‹Ì·ÙÔ˜. ∏ ·ÙÔÈ-Î‹ ‰ÂÚÌ·Ù›ÙÈ‰· ¤¯ÂÈ ÂÈ‰ÈÎfi ÙÚfiÔ ‚·ıÌÔÏfiÁËÛË˜‰ÂÚÌ·ÙÈÎÒÓ ·ÏÏÔÈÒÛÂˆÓ (‰È¿ÁÓˆÛË ÌÂ Ù· ÎÚÈÙ‹ÚÈ·ÙˆÓ Hanifin Î·È Rajka). °È· ÙË ÚÈÓ›ÙÈ‰· Á›ÓÂÙ·È ÚÈÓÔ-ÌÂÙÚ›· Î·È ÎÏÈÓÈÎ‹ ÂÍ¤Ù·ÛË. ™ÙËÓ ·Ó·Ê˘Ï·ÎÙÈÎ‹·ÓÙ›‰Ú·ÛË ··ÈÙÂ›Ù·È Ì¤ÙÚËÛË ÙË˜ ·ÚÙËÚÈ·Î‹˜ ›Â-ÛË˜, ÛÊ‡ÍÂˆÓ Î·È ∏∫°. ™Â ÈÛÙÔÚÈÎfi ‚·ÚÈ¿˜ ·Ó·Ê˘-Ï·ÎÙÈÎ‹˜ ·ÓÙ›‰Ú·ÛË˜, Ë ÚfiÎÏËÛË Á›ÓÂÙ·È ÌÂ ÔÏ‡ÚÔÛÔ¯‹ Î·È fiÙ·Ó Â›Ó·È ·ÓÂ·ÚÎÂ›˜ ÔÈ ÏÔÈ¤˜ ‰È·-ÁÓˆÛÙÈÎ¤˜ ÂÍÂÙ¿ÛÂÈ˜ (9,15).

¢ÔÎÈÌ·Û›· ÚfiÎÏËÛË˜ ÌÂ ÚfiÛıÂÙ·: ∏ Ï¤ÔÓ·ÍÈfiÈÛÙË Â›Ó·È Ë ‰ÈÏ‹ Ù˘ÊÏ‹ ÚfiÎÏËÛË ÂÏÂÁ¯fiÌÂ-ÓË ÌÂ ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ. ∏ Ô˘Û›· ¯ÔÚËÁÂ›Ù·È ÛÂ Î¿-„Ô˘ÏÂ˜ ÌÂ ÚÔÔ‰Â˘ÙÈÎ¿ ·˘Í·ÓfiÌÂÓÂ˜ ‰fiÛÂÈ˜, ÂÓÒÎ·È ÛÂ ·˘Ù‹ ÙËÓ ÂÚ›ÙˆÛË ı· Ú¤ÂÈ Ó· ˘¿Ú¯ÂÈÂÙÔÈÌfiÙËÙ· ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ Èı·ÓÒÓ Û˘-ÌÙˆÌ¿ÙˆÓ Ô˘ ÌÔÚÂ› Ó· ÚÔÎ‡„Ô˘Ó. °ÂÓÈÎ¿,fiÛÔÓ ·ÊÔÚ¿ ÛÙÔÓ ÚfiÏÔ ÙˆÓ ÚfiÛıÂÙˆÓ ÙˆÓ ÙÚÔ-ÊÒÓ Â›ÙÂ Û˘ÓÙËÚËÙÈÎÒÓ, Â›ÙÂ ‚ÂÏÙÈˆÙÈÎÒÓ ÁÂ‡ÛË˜,‰ÂÓ ˘¿Ú¯Ô˘Ó ÈÛ¯˘Ú¤˜ ÂÓ‰Â›ÍÂÈ˜ ÁÈ· Û˘ÌÌÂÙÔ¯‹ÙÔ˘˜ ÛÂ ˘„ËÏfi ÔÛÔÛÙfi ÛÙÈ˜ ·ÓÂÈı‡ÌËÙÂ˜ ÙÚÔÊÈ-Î¤˜ ·ÓÙÈ‰Ú¿ÛÂÈ˜. ∂ÓÙÔ‡ÙÔÈ˜, Ë ‚ÈÔÌË¯·Ó›· ÙÚÔÊ›-ÌˆÓ, ·ÓÙ·ÔÎÚÈÓfiÌÂÓË ÛÙÔÓ ¤ÓÙÔÓÔ ÚÔ‚ÏËÌ·ÙÈ-ÛÌfi ÙÔ˘ ÎÔÈÓÔ‡ ÛÂ ·˘Ùfi ÙÔ ı¤Ì·, ¤¯ÂÈ ÌÂÈÒÛÂÈ ÙË¯Ú‹ÛË ÙÔ˘˜ ÛÙÔ ÂÏ¿¯ÈÛÙÔ. ∂›ÛË˜, Ë ·Ó·ÁÚ·Ê‹ÛÙË Û˘ÛÎÂ˘·Û›· ÙË˜ ‡·ÚÍË˜ ·˘ÙÒÓ ÙˆÓ Ô˘ÛÈÒÓÂ›Ó·È ÔÏ‡ ¯Ú‹ÛÈÌË ÁÈ· Ù· ¿ÙÔÌ· ÌÂ ÁÓˆÛÙ‹ Â˘·È-ÛıËÛ›·.

™˘ÌÂÚ¿ÛÌ·Ù· ™ÙË ‰ÈÂÚÂ‡ÓËÛË ÙˆÓ ·ÓÂÈı‡ÌËÙˆÓ ·ÓÙÈ‰Ú¿ÛÂ-

ˆÓ, ·ÏÏÂÚÁÈÎÒÓ ‹ ÌË, ÌÂÙ¿ ·fi Ï‹„Ë ÙÚÔÊ›ÌÔ˘, ÙÔÏÂÙÔÌÂÚ¤˜ ·ÙÔÌÈÎfi ÈÛÙÔÚÈÎfi, Ë Ê˘ÛÈÎ‹ ÂÍ¤Ù·ÛË, ÔÂÈ‰ÈÎfi˜ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜, Î·ıÒ˜ Î·È ÔÈ ‰ÂÚ-Ì·ÙÈÎ¤˜ ‰ÔÎÈÌ·Û›Â˜ ¤¯Ô˘Ó Û·Ê‹ ÚfiÏÔ.

∏ ‰ÈÏ‹ Ù˘ÊÏ‹ ÂÏÂÁ¯fiÌÂÓË ÌÂ ÂÈÎÔÓÈÎfi ÙÚfiÊÈÌÔ‰ÔÎÈÌ·Û›· ÚfiÎÏËÛË˜ Â›Ó·È Ë ÈÔ ·ÓÙÈÎÂÈÌÂÓÈÎ‹ Î·È·ÔÙÂÏÂÛÌ·ÙÈÎ‹ Ì¤ıÔ‰Ô˜ ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô ¯ÚfiÓÈˆÓ‰È·Ù·Ú·¯ÒÓ (.¯. ¯ÚfiÓÈ· ÎÓ›‰ˆÛË, ·ÙÔÈÎ‹ ‰ÂÚÌ·-Ù›ÙÈ‰·) Î·È Î¿ıÂ ·ÚÔÍ‡ÓÛÂˆ˜ ‰˘ÓËÙÈÎ¿ Û˘Ó‰ÂfiÌÂ-ÓË˜ ÌÂ ·ÓÂÈı‡ÌËÙË ·ÓÙ›‰Ú·ÛË ÛÂ Ï‹„Ë ÙÚÔÊ›ÌÔ˘.ªÂ ÙÔÓ ÙÚfiÔ ·˘Ùfi, Â›ÛË˜, ÂÏ¤Á¯ÔÓÙ·È Û˘Ó˘¿Ú-¯ÔÓÙÂ˜ ·Ú¿ÁÔÓÙÂ˜ Î·È „˘¯ÔÁÂÓ‹ ·›ÙÈ·. OÈ ÙÚÔÊÈ-Î¤˜ ÚÔÎÏ‹ÛÂÈ˜ ı· Ú¤ÂÈ Ó· Á›ÓÔÓÙ·È ÛÂ È·ÙÚÈÎfi ‹

ÓÔÛÔÎÔÌÂÈ·Îfi ÂÚÈ‚¿ÏÏÔÓ, ÂÈ‰ÈÎ¿ ·Ó ˘¿Ú¯ÂÈ ˘Ô-„›· IgE-ÌÂÛÔÏ·‚Ô‡ÌÂÓË˜ ·ÓÙ›‰Ú·ÛË˜ ‹ ÂÓÙÂÚÔÎÔ-Ï›ÙÈ‰·˜. ¢È·ÁÓˆÛÙÈÎ¿, Â›Ó·È ÛËÌ·ÓÙÈÎ‹ Ë ‰È¿ÎÚÈÛËÙË˜ ÙÚÔÊÈÎ‹˜ ·ÏÏÂÚÁ›·˜ Ù·¯Â›·˜ ¤Ó·ÚÍË˜ (Ù˘ÈÎ‹IgE-ÌÂÛÔÏ·‚Ô‡ÌÂÓË) ·fi Ù· Û‡Ó‰ÚÔÌ· ‚Ú·‰Â›·˜¤Ó·ÚÍË˜, Ù· ÔÔ›· Î˘Ú›ˆ˜ ÔÊÂ›ÏÔÓÙ·È ÛÂ ·ÓÙÈ‰Ú¿-ÛÂÈ˜ ÌÂÛÔÏ·‚Ô‡ÌÂÓÂ˜ ·fi ∆-ÏÂÌÊÔÎ‡ÙÙ·Ú·.

∞·ÈÙÂ›Ù·È ÂÚ·ÈÙ¤Úˆ ¤ÚÂ˘Ó· ÁÈ· ÙË ‚ÂÏÙ›ˆÛËÙˆÓ ÁÓÒÛÂˆÓ ÙÔ˘ È·ÙÚÈÎÔ‡ ÎfiÛÌÔ˘ fiÛÔÓ ·ÊÔÚ¿ÛÙËÓ ·ıÔÊ˘ÛÈÔÏÔÁ›· ÙË˜ ÙÚÔÊÈÎ‹˜ ·ÏÏÂÚÁ›·˜ Î·ÈÛÙË ‰ÈÂ˘ÎÚ›ÓÈÛË ÙË˜ ÙfiÛÔ ÂÓÙ˘ˆÛÈ·Î‹˜ ‰È·ÊÔÚ¿˜ÛÙ· Û˘ÌÙÒÌ·Ù· Î·È ÛÙ· fiÚÁ·Ó·-ÛÙfi¯Ô˘˜ ·Ó¿ÌÂ-Û· ÛÙÔ˘˜ ·ÛıÂÓÂ›˜.

µÈ‚ÏÈÔÁÚ·Ê›·1. Loveless MH. Allergy for corn and its derivatives:

experiments with a masked ingestion test for its diagnosis.J Allergy 1950;21:500-509.

2. Anderson JA, Sogn DD. Adverse reactions to foods:American Academy of Allergy and Immunology Committeeon Adverse Reactions to Foods, National Institute of Allergyand Infectious Diseases, Bethesda, MD: U.S. Department ofHealth and Human Services, Public Health Service,National Institutes of Health, July 1984, 84-2442. p. 4.

3. Bruijnzeel-Koomen C, Ortolani C, Aas K, Bindslev-JensenC, Bjorksten B, Moneret-Vautrin D et al. Adverse reactionsto food. European Academy of Allergology and ClinicalImmunology Subcommittee. Allergy 1995;50:623-635.

4. Johansson SG, Hourihane JO, Bousquet J, Bruijnzeel-Koomen C, Dreborg S, Haahtela T et al. A revisednomenclature for allergy. An EAACI position statementfrom the EAACI nomenclature task force. Allergy2001;56:813-821.

5. Gerrard JW, MacKenzie JW, Goluboff N, Garson JZ,Maningas CS. Cow’s milk allergy: prevalence andmanifestations in an unselected series of newborns. ActaPaediatr Scand 1973;234 (Suppl):S1-S21.

6. Kajosaari M. Food allergy in Finnish children aged 1 to 6years. Acta Paediatr Scand 1982;71:815-819.

7. Young E, Stoneham MD, Petruckevitch A, Barton J, Rona R.A population study of food intolerance. Lancet 1994;343:1127-1130.

8. Bock SA, Martin M. The incidence of adverse reactions tofoods: a continuing study. J Allergy Clin Immunol1983;71:98.

9. Sampson HA. Food allergy. Part 2: diagnosis andmanagement. J Allergy Clin Immunol 1999;103:981-989.

10. Sampson HA. IgE-mediated food intolerance. J Allergy ClinImmunol 1988;81:495-504.

11. æ·ÚÚfi˜ º, •Â··‰¿ÎË ¶, ª·ÓÔ˘Û¿ÎË˜ ª, ∆·Ú·ÓÙ˙‹ §,™˘Ú›ÁÔ˘ ∞, ¶··‰fiÔ˘ÏÔ˜ ¡ Î·È Û˘Ó. ™˘Û¯¤ÙÈÛË ÌÂÙ·Í‡ÙˆÓ ÙÈÌÒÓ ÂÈ‰ÈÎ‹˜ IgE Î·È ÙÔ˘ ·ÔÙÂÏ¤ÛÌ·ÙÔ˜ ÙˆÓ ÂÈ‰ÈÎÒÓÚÔÎÏ‹ÛÂˆÓ ÛÂ ·È‰È¿ ÌÂ ·ÏÏÂÚÁ›· ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰Ô˜(ÂÚ›ÏË„Ë). 4Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ ∞ÏÏÂÚÁÈÔÏÔÁ›·˜ Î·È∫ÏÈÓÈÎ‹˜ ∞ÓÔÛÔÏÔÁ›·˜. ∂ÏÏËÓÈÎ‹ ∞ÏÏÂÚÁÈÔÏÔÁÈÎ‹ Î·È ∫ÏÈÓÈ-Î‹ ∞ÓÔÛÔÏÔÁ›·. ∞ı‹Ó·; 2001, ÙfiÌÔ˜ 8 (Suppl). ÛÂÏ. 4.

12. ¶··‰fiÔ˘ÏÔ˜ ¡, ∫·ÛÛ›ÌÔ˜ ¢, ™˘Ú›ÁÔ˘ ∞ Î·È Û˘Ó. ∞ÛÊ¿-ÏÂÈ· ÙÚÔÊÈÎÒÓ ÚÔÎÏ‹ÛÂˆÓ ÛÂ ·È‰È¿ ÌÂ ıÂÙÈÎfi ÈÛÙÔÚÈÎfi

Î·È ÂÈ‰ÈÎ‹ IgE ÛÙÔ Á¿Ï· Î·È ÙÔ ·˘Áfi. ∂ÏÏËÓÈÎ‹ ∞ÏÏÂÚÁÈÔÏÔ-ÁÈÎ‹ Î·È ∫ÏÈÓÈÎ‹ ∞ÓÔÛÔÏÔÁ›·. 8 (Suppl). ÛÂÏ. 5.

13. Lessof MH. The diagnosis of food intolerance. Clin ExpAllergy 1995;25 (1 Suppl):S14-S15.

14. Carter C. Dietary treatment of food allergy and intolerance.Clin Exp Allergy 1995;25 (1 Suppl):S34-S42.

15. Bock SA, Sampson HA, Atkins FM, Zeiger RS, Lehrer S,Sachs M et al. Double-blind, placebo-controlled foodchallenge (DBPCFC) as an office procedure: a manual. JAllergy Clin Immunol 1988;82:986-997.

16. Metcalfe DD, Sampson HA. Workshop on experimentalmethodology for clinical studies of adverse reactions to

foods and food additives. J Allergy Clin Immunol1990;86:421-442.

17. Lessof MH. Reactions to food additives. Clin Exp Allergy1995;25 (1 Suppl):S27.

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HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 01-10-2002 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛË˜: 04-04-2003

¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ª. Ã·Ù˙Ë„¿ÏÙË ª·ÎÚ˘ÁÈ¿ÓÓË 23-37, ∆.∫. 117 42, ª·ÎÚ˘ÁÈ¿ÓÓË, ∞ı‹Ó· E-mail: [email protected]


247

∞ÓÙÈ„˘¯ˆÛÈÎ¿ Ê¿ÚÌ·Î· ÛÙËÓ Î‡ËÛË Î·È Á·ÏÔ˘¯›· ¡. ∫·Ì¿˜1, ∂. ¶··‚·ÛÈÏÂ›Ô˘2

Antipsychotic medications in pregnancy and lactation N. Kambas1, E. Papavasiliou2


1 °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ∫ÔÚ›ÓıÔ˘, ª·ÈÂ˘Ù‹Ú-°˘Ó·ÈÎÔÏfiÁÔ˜ 2 °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ∫ÔÚ›ÓıÔ˘, ¶·È‰›·ÙÚÔ˜

1 General Hospital of Korinthos, Greece, Obstetrician 2 General Hospital of Korinthos, Greece, Paediatrician

�¶ÂÚ›ÏË„Ë: OÈ „˘¯ˆÛÈÎ¤˜ ‰È·Ù·Ú·¯¤˜ Â›Ó·È Û˘-Ó‹ıÂÈ˜ ÛÂ Á˘Ó·›ÎÂ˜ ÙË˜ ·Ó··Ú·ÁˆÁÈÎ‹˜ ËÏÈÎ›·˜.¶·Ú¿ ÙË ÓÔÛËÚfiÙËÙ¿ ÙÔ˘˜, ˘¿Ú¯ÂÈ Ù¿ÛË Ó· ·Ô-ÊÂ‡ÁÂÙ·È Î·Ù¿ ÙËÓ Î‡ËÛË Ë ¯ÔÚ‹ÁËÛË „˘¯ÔÊ·Ú-Ì¿ÎˆÓ ÏfiÁˆ Èı·Ó‹˜ ÙÂÚ·ÙÔÁfiÓÔ˘ ‰Ú¿ÛË˜ ÛÙÔ¤Ì‚Ú˘Ô. ∏ Î‡ËÛË, fiÌˆ˜, ‰ÂÓ Ê·›ÓÂÙ·È Ó· ÚÔÊ˘-Ï¿ÛÛÂÈ ÙË Á˘Ó·›Î· ·fi ÙËÓ ¤Ó·ÚÍË ‹ ÙËÓ ˘ÔÙÚÔ-‹ ÙˆÓ „˘¯È·ÙÚÈÎÒÓ ·ı‹ÛÂˆÓ. OÈ Î›Ó‰˘ÓÔÈ ÁÈ· ÙËÌËÙ¤Ú·, ÙÔ ¤Ì‚Ú˘Ô Î·È ÙÔ ıËÏ¿˙ÔÓ ÓÂÔÁÓfi ÌÔ-ÚÔ‡Ó Ó· ÌÂÈˆıÔ‡Ó ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÌÔÓÔıÂÚ·-Â˘ÙÈÎ¿ Û¯‹Ì·Ù· ÛÙË ¯·ÌËÏfiÙÂÚË ÈÎ·Ó‹ ‰ÔÛÔÏÔ-Á›·, Î˘Ú›ˆ˜ Ù˘ÈÎÒÓ ·ÓÙÈ„˘¯ˆÛÈÎÒÓ, fiˆ˜ Ë ·ÏÔ-ÂÚÈ‰fiÏË. ™Â ·˘Ù‹ ÙËÓ ·Ó·ÛÎfiËÛË ÂÍÂÙ¿˙ÔÓÙ·È ÔÈÂÈÙÒÛÂÈ˜ ÙˆÓ ·ÓÙÈ„˘¯ˆÛÈÎÒÓ Ô˘ÛÈÒÓ Î·Ù¿ ÙËÓÎ‡ËÛË Î·È ÙË Á·ÏÔ˘¯›·.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: Ê¿ÚÌ·Î·, Î‡ËÛË, ıËÏ·ÛÌfi˜, ·ÓÙÈ-„˘¯ˆÛÈÎ¤˜ Ô˘Û›Â˜.

�Abstract: Psychotic disorders are common inwomen of reproductive age. Despite their morbidity,there has been a tendency to avoid prescribingpsychiatric medications to pregnant womenbecause of possible teratogenic effects on thefetus. Published data suggest that pregnancy doesnot protect women from the onset or relapse ofpsychiatric disorders. The risks of psychoticdisorder and its treatment to the mother, fetus andbreast-feeding infant can be reduced with the use ofmonotherapy at the lowest effective dose, andespecially the use of typical antipsychotic agents,such as haloperidol. In this review, the side effectsof antipsychotic medication during pregnancy andlactation are examined.

Key words: drugs, pregnancy, lactation, antipsy-chotic.

∂ÈÛ·ÁˆÁ‹OÈ ÂÚÈÛÛfiÙÂÚÂ˜ „˘¯È·ÙÚÈÎ¤˜ ·ı‹ÛÂÈ˜ ÛÙÔÓ

Á˘Ó·ÈÎÂ›Ô ÏËı˘ÛÌfi ÂÌÊ·Ó›˙ÔÓÙ·È Î·Ù¿ ÙËÓ ·Ó··-Ú·ÁˆÁÈÎ‹ ËÏÈÎ›· Î·È Î˘Ú›ˆ˜ ÛÙËÓ ÂÚÈÁÂÓÓËÙÈÎ‹ Â-Ú›Ô‰Ô. ¶ÂÚÈÛÛfiÙÂÚÔ ·fi ÙÔ 35% ÙˆÓ ÂÁÎ‡ˆÓ ÛÙÈ˜‰˘ÙÈÎ¤˜ ÎÔÈÓˆÓ›Â˜ Ï·Ì‚¿ÓÂÈ „˘¯ÔÊ¿ÚÌ·Î· (1-3).

∞fi ÚfiÛÊ·Ù· ‰Â‰ÔÌ¤Ó· ¤¯Ô˘Ó ·Ó·ÊÂÚıÂ› Â-ÚÈÙÒÛÂÈ˜ Î·Ù¿ ÙÈ˜ ÔÔ›Â˜ ÙÔ ¤ÓÙÔÓÔ stress ÛÙËÓÂÚ›Ô‰Ô ÙË˜ ÔÚÁ·ÓÔÁ¤ÓÂÛË˜ ÌÔÚÂ› Ó· ÚÔÎ·Ï¤-ÛÂÈ ·‡ÍËÛË ÙÔ˘ ÔÛÔÛÙÔ‡ ÚfiˆÚˆÓ Î·È ÏÈÔ‚·ÚÒÓÓÂÔÁÓÒÓ, ÌÈÎÚÔÎÂÊ·Ï›·, ¯·ÌËÏ‹ ‚·ıÌÔÏfiÁËÛËÛÙËÓ ·ÍÈÔÏfiÁËÛË ÙË˜ ÓÂ˘ÚÔÏÔÁÈÎ‹˜ ·Ó¿Ù˘ÍË˜ Î·È,ÙÔ ÛÔ˘‰·ÈfiÙÂÚÔ fiÏˆÓ, Û˘ÁÁÂÓÂ›˜ ·ÓˆÌ·Ï›Â˜ Î˘-Ú›ˆ˜ ÙˆÓ ÎÚ·ÓÈ·ÎÒÓ ÓÂ˘ÚÈÎÒÓ Ù˘¯ÒÓ (4-6).

¡Â˘ÚÔÏËÙÈÎ¿ ‹ ·ÓÙÈ„˘¯ˆÛÈÎ¿ Ê¿ÚÌ·Î· ∆· ÓÂ˘ÚÔÏËÙÈÎ¿ Ê¿ÚÌ·Î· (ÔÓÔÌ¿˙ÔÓÙ·È Î·È

·ÓÙÈÛ¯È˙ÔÊÚÂÓÈÎ¿, ·ÓÙÈ„˘¯ˆÛÈÎ¿ ‹ ÌÂ›˙ÔÓ· ËÚÂÌÈ-

ÛÙÈÎ¿) ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Î·Ù¿ Î‡ÚÈÔ ÏfiÁÔ ÛÙËÓ·ÓÙÈÌÂÙÒÈÛË ÙË˜ Û¯È˙ÔÊÚ¤ÓÂÈ·˜, Î·ıÒ˜ Â›ÛË˜ ÛÂ‰È¿ÊÔÚÔ˘ Ù‡Ô˘ „˘¯Ô‰ÈÂÁÂÚÙÈÎ¤˜ Î·Ù·ÛÙ¿ÛÂÈ˜,fiˆ˜ Ë Ì·Ó›· Î·È Ù· ·Ú·ÏËÚ‹Ì·Ù·.

∆· ÓÂ˘ÚÔÏËÙÈÎ¿ Ê¿ÚÌ·Î· ÌÔÚÔ‡Ó Ó· Ù·ÍÈÓÔ-ÌËıÔ‡Ó, ‚¿ÛÂÈ ÙË˜ ¯ËÌÈÎ‹˜ ÙÔ˘˜ ‰ÔÌ‹˜, ÛÂ ¤ÓÙÂÎ‡ÚÈÂ˜ Î·ÙËÁÔÚ›Â˜: ·) Ê·ÈÓÔıÂÈ·˙›ÓÂ˜, ‚) ‚Ô˘Ù˘ÚÔ-Ê·ÈÓfiÓÂ˜, Á) ıÂÈÔÍ·Óı¤ÓÈ·, ‰) ‚ÂÓ˙·Ì›‰Â˜ Î·È Â) ‰È-‚ÂÓ˙ÔÍ·˙Â›ÓÂ˜.

∂ÎÙfi˜ ·fi ÙËÓ ·Ú·¿Óˆ Ù·ÍÈÓfiÌËÛË, Ë ÔÔ›·Ô˘ÛÈ·ÛÙÈÎ¿ ‚·Û›˙ÂÙ·È ÛÙË ¯ËÌÈÎ‹ ‰ÔÌ‹ ÙÔ˘ ÌÔÚ›Ô˘,ÌÔÚÂ› Ó· Á›ÓÂÈ Î·È Ì›· Î·Ù¿Ù·ÍË ÙˆÓ ·ÓÙÈ„˘¯ˆÛÈ-ÎÒÓ Û‡ÌÊˆÓ· ÌÂ ÙË ‰Ú¿ÛË ÙÔ˘˜ ÛÙÔ˘˜ D2 ÓÙÔ·ÌÈ-ÓÂÚÁÈÎÔ‡˜ ˘Ô‰Ô¯Â›˜. ªÂ ÙËÓ Ù·ÍÈÓfiÌËÛË ·˘Ù‹¤¯Ô˘ÌÂ ‰‡Ô Î·ÙËÁÔÚ›Â˜: Ù· Ù˘ÈÎ¿ (Ê·ÈÓÔıÂÈ·˙›ÓÂ˜,‚Ô˘Ù˘ÚÔÊ·ÈÓfiÓÂ˜, ÈÌÔ˙›ÓË Î.Ï.) Î·È Ù· ¿Ù˘· ·ÓÙÈ-„˘¯ˆÛÈÎ¿ (ÎÏÔ˙·›ÓË, ÔÏ·Ó˙·›ÓË, ÚÈÛÂÚÈ‰fiÓË).

™ÙËÓ Î‡ËÛË Î·È ÙË Á·ÏÔ˘¯›·, ÔÈ Ê·ÚÌ·ÎÂ˘ÙÈÎ¤˜


248

Ô˘Û›Â˜ Ù·ÍÈÓÔÌÔ‡ÓÙ·È ÛÂ 5 Î·ÙËÁÔÚ›Â˜ ÎÈÓ‰‡ÓÔ˘,Û‡ÌÊˆÓ· ÌÂ ÙËÓ Èı·Ó‹ ÙÔÍÈÎfiÙËÙ· ÙˆÓ Ô˘ÛÈÒÓ ÛÙÔ¤Ì‚Ú˘Ô Î·È ÙÔ ÓÂÔÁÓfi, ·ÓÙ›ÛÙÔÈ¯· (¶›Ó·Î·˜ 1).

∫·Ù¿ ÙËÓ Î‡ËÛË, ·ÎÔÏÔ˘ıÂ›Ù·È Ë Ù·ÍÈÓfiÌËÛËÙÔ˘ ∞ÌÂÚÈÎ·ÓÈÎÔ‡ OÚÁ·ÓÈÛÌÔ‡ ∆ÚÔÊ›ÌˆÓ (FDA).™ÙËÓ Î·ÙËÁÔÚ›· ∞ ·Ó‹ÎÔ˘Ó Ô˘Û›Â˜ ·fiÏ˘Ù· ·ÛÊ·-ÏÂ›˜, ÛÙËÓ Î·ÙËÁÔÚ›· µ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ·ÛÊ·ÏÂ›˜Ô˘Û›Â˜, ÛÙËÓ Î·ÙËÁÔÚ›· C ·Ó‹ÎÔ˘Ó Ô˘Û›Â˜ Û¯ÂÙÈÎ¿·ÛÊ·ÏÂ›˜, ÛÙËÓ Î·ÙËÁÔÚ›· D Èı·ÓfiÓ ÂÈ‚Ï·‚Â›˜Ô˘Û›Â˜ Î·È, Ù¤ÏÔ˜, ÛÙËÓ Î·ÙËÁÔÚ›· X ·Ó‹ÎÔ˘Ó ÔÈ Ô˘-Û›Â˜ Ô˘ Â›Ó·È ·Ô‰Â‰ÂÈÁÌ¤Ó· ÂÈ‚Ï·‚Â›˜.

∫·Ù¿ ÙË Á·ÏÔ˘¯›·, Û‡ÌÊˆÓ· ÌÂ ÙËÓ ¶·ÁÎfi-ÛÌÈ· OÚÁ¿ÓˆÛË ÀÁÂ›·˜, ˘¿Ú¯Ô˘Ó - fiˆ˜ ·Ó·Ê¤-ÚÔÓÙ·È ÛÙÔ ‚È‚Ï›Ô ÙÔ˘ Bennett, 1996 (7) - ÔÈ ·Îfi-ÏÔ˘ıÂ˜ Î·ÙËÁÔÚ›Â˜ ÎÈÓ‰‡ÓÔ˘: L1, L2, L3, L4 Î·ÈL5, ÔÈ ÔÔ›Â˜ ·Ó·Ê¤ÚÔÓÙ·È ÛÂ Ô˘Û›Â˜ ·fiÏ˘Ù··ÛÊ·ÏÂ›˜ (L1), ·ÛÊ·ÏÂ›˜ (L2), Û¯ÂÙÈÎ¿ ·ÛÊ·ÏÂ›˜(L3), Èı·ÓfiÓ ÂÈ‚Ï·‚Â›˜ (L4) Î·È ÂÈ‚Ï·‚Â›˜ (L5),·ÓÙ›ÛÙÔÈ¯·.

∞1. ∆À¶π∫∞ ∞¡∆πæÀÃø™π∫∞º·ÈÓÔıÂÈ·˙›ÓÂ˜ Î·È ıÂÈÔÍ·Óı›ÓÂ˜OÈ Ê·ÈÓÔıÂÈ·˙›ÓÂ˜ Â›Ó·È ÔÈ Ô˘Û›Â˜ ÚÒÙË˜ ÂÎÏÔ-

Á‹˜ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ „˘¯ˆÛÈÎÒÓ Î·Ù·ÛÙ¿-ÛÂˆÓ ÙË˜ ÂÁÎ‡Ô˘. OÈ Ê·ÈÓÔıÂÈ·˙›ÓÂ˜ ¤¯Ô˘Ó ·ÓÙÈ„˘-¯ˆÛÈÎ‹, ·ÓÙÈÌÔ˘ÛÎ·ÚÈÓÈÎ‹ Î·È ·ÓÙÈÂÌÂÙÈÎ‹ ‰Ú¿ÛË.∆· ÂÚÈÛÛfiÙÂÚ· ÓÂ˘ÚÔÏËÙÈÎ¿ Ê¿ÚÌ·Î· ¤¯Ô˘Ó·ÓÙÈÂÌÂÙÈÎ‹ ‰Ú¿ÛË, ÌÂ ÂÍ·›ÚÂÛË ÙË ıÂÈÔÚÈ‰·˙›ÓË. ∏ÚÔÌÂı·˙›ÓË ‰ÂÓ Â›Ó·È Î·Ïfi ·ÓÙÈ„˘¯ˆÛÈÎfi Ê¿ÚÌ·-ÎÔ, ¤¯ÂÈ fiÌˆ˜ ·ÓÙÈÎÓËÛÌÒ‰Ë ‰Ú¿ÛË, ÏfiÁˆ ÙˆÓ·ÓÙÈÛÙ·ÌÈÎÒÓ ÙË˜ È‰ÈÔÙ‹ÙˆÓ.

º¿ÚÌ·Î· fiˆ˜ Ë ÚÔÌ·˙›ÓË, Ë ÏÂ‚ÔÌÂÚÔÌ·˙›-ÓË Î·È Ë ıÂÈÔÚÈ‰·˙›ÓË ¤¯Ô˘Ó ¯ÚËÛÈÌÔÔÈËıÂ› ÌÂ Û¯Â-ÙÈÎ‹ ·ÛÊ¿ÏÂÈ· Î·Ù¿ ÙËÓ Î‡ËÛË.

OÈ Ô˘Û›Â˜ ·˘Ù¤˜ ‰È·ÂÚÓÔ‡Ó Â‡ÎÔÏ· ÙÔÓ Ï·-ÎÔ˘ÓÙÈ·Îfi ÊÚ·ÁÌfi. ∏ Î·Ù·ÓÔÌ‹ Î·È Î˘Ú›ˆ˜ Ô ÌÂ-Ù·‚ÔÏÈÛÌfi˜ ÙÔ˘˜ ÛÙÔ ¤Ì‚Ú˘Ô Î·È ÙÔ ÓÂÔÁÓfi Â›Ó·ÈÂÚÈÛÛfiÙÂÚÔ ·ÚÁfi˜ ÛÂ Û¯¤ÛË ÌÂ ·˘ÙfiÓ ÙË˜ ÌËÙ¤-Ú·˜, ·˘Í¿ÓÔÓÙ·˜ ¤ÙÛÈ ÙËÓ ÙÔÍÈÎfiÙËÙ¿ ÙÔ˘˜, ÏfiÁˆ

¶›Ó·Î·˜ 1. ∆·ÍÈÓfiÌËÛË ÎÈÓ‰‡ÓÔ˘ - ÂÈÙÒÛÂÈ˜ Ô˘ÛÈÒÓ Î·Ù¿ ÙËÓ Î‡ËÛË Î·È ÙË Á·ÏÔ˘¯›·

O˘Û›· ∫·ÙËÁÔÚ›· ÎÈÓ‰‡ÓÔ˘ - ∂ÈÙÒÛÂÈ˜∫‡ËÛË °·ÏÔ˘¯›·

ÃÏˆÚÔÚÔÌ·˙›ÓË C L3- ¡ÂÔÁÓÈÎ‹ Î·Ù·ÛÙÔÏ‹ Î·È Î˘¿ÓˆÛË (14) - ∫·Ù·ÛÙÔÏ‹ (19)- ™‡Ó‰ÚÔÌÔ ·fiÛ˘ÚÛË˜ (15)- ÀÔÙÔÓ›·, Ï‹ı·ÚÁÔ˜, ÈÎÙÂÚÈÎ‹ ¯ÚÔÈ¿ (16)ªÔÚÂ› Ó· ıÂˆÚËıÂ› ·Ú¿ÁˆÓ ÚÒÙË˜ ÂÈÏÔÁ‹˜ Î·Ù¿ ÙËÓ Î‡ËÛË (17)

∞ÏÔÂÚÈ‰fiÏË C L2- ™Â ÂÈÚ·Ì·Ùfi˙ˆ·: ÌÈÎÚÔÌÂÏ›·,·ÓˆÌ·Ï›Â˜ ∫¡™ (20-22) - ¶ÓÂ˘Ì·ÙÈÎ¤˜ Î·È „˘¯ÔÎÈÓËÙÈÎ¤˜ªÔÚÂ› Ó· ıÂˆÚËıÂ› ·Ú¿ÁˆÓ ‰È·Ù·Ú·¯¤˜ (24)ÌÂ ¯·ÌËÏfi ÙÂÚ·ÙÔÁÂÓÂÙÈÎfi Î›Ó‰˘ÓÔ

∫ÏÔ˙·›ÓË C L3- O˘‰ÂÙÂÚÔÂÓ›·, ·ÎÔÎÎÈÔÎ˘ÙÙ·Ú·ÈÌ›· - ∫·Ù·ÛÙÔÏ‹, Û·ÛÌÔ›∞ÓÙÂÓ‰Â›ÎÓ˘Ù·È Î·Ù¿ ÙËÓ Î‡ËÛË - ∫·Ú‰È·ÁÁÂÈ·Î‹ ·ÛÙ¿ıÂÈ·

- ∞ÎÔÎÎÈÔÎ˘ÙÙ·Ú·ÈÌ›·∞ÓÙÂÓ‰Â›ÎÓ˘Ù·È Î·Ù¿ ÙÔÓıËÏ·ÛÌfi (25-27)

ƒÈÛÂÚÈ‰fiÓË C L3∞ÓÙÂÓ‰Â›ÎÓ˘Ù·È Î·Ù¿ ÙËÓ Î‡ËÛË Î·È ÙË Á·ÏÔ˘¯›·, ∞ÓÂ·ÚÎ‹ ÛÙÔÈ¯Â›·ÏfiÁˆ ·ÓÂ·ÚÎÒÓ ÛÙÔÈ¯Â›ˆÓ ÛÙÔÓ ¿ÓıÚˆÔ

OÏ·˙·›ÓË C L3- ¢ÂÓ Ê·›ÓÂÙ·È Ó· ·˘Í¿ÓÂÈ ÙÔ ÔÛÔÛÙfi - ÿÎÙÂÚÔ˜, ˘ÓËÏ›·,

ÙÂÚ·ÙÔÁ¤ÓÂÛË˜ (32) Î·Ú‰ÈÔÌÂÁ·Ï›· (17)™Ô˘ÏÈÚ›‰Ë - ¢ÂÓ ˘¿Ú¯Ô˘Ó ÛÙÔÈ¯Â›· L2

- ¢ÂÓ ·Ó·Ê¤ÚÔÓÙ·È ·ÚÂÓ¤ÚÁÂÈÂ˜ (7)

¶·Ú·ÙËÚ‹ÛÂÈ˜ Â› ÙˆÓ ·ÓÙÈ„˘¯ˆÛÈÎÒÓ:ñ ¶·Ú¿ ÙËÓ Èı·Ó‹ ÂÌÊ¿ÓÈÛË ÂÍˆ˘Ú·ÌÈ‰ÈÎ‹˜ Û˘Ó‰ÚÔÌ‹˜ ÛÙÔ ÓÂÔÁÓfi (Ë ÔÔ›· Â›Ó·È ÂÍ¿ÏÏÔ˘ ÌÈÎÚ‹˜ ‰È¿ÚÎÂÈ·˜), ÊÚfiÓÈÌÔ ı·

‹Ù·Ó Ó· ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Ô˘Û›Â˜ Ù‡Ô˘ ·ÏÔÂÚÈ‰fiÏË˜ ÌÂ ÛÎÔfi Ó· ÂÚÈÔÚÈÛÙÔ‡Ó ÔÈ ·ÓÙÈ¯ÔÏÈÓÂÚÁÈÎ¤˜, ˘ÔÙ·ÛÈÎ¤˜ Î·È·ÓÙÈÈÛÙ·ÌÈÓÈÎ¤˜ ·ÚÂÓ¤ÚÁÂÈÂ˜ ÛÙË ÌËÙ¤Ú·

ñ °È· Ù· ¿Ù˘· ·ÓÙÈ„˘¯ˆÛÈÎ¿ ‰ÂÓ ˘¿Ú¯Ô˘Ó Â·ÚÎ‹ ÛÙÔÈ¯Â›·ñ ¶Ú¤ÂÈ Ó· ·ÔÊÂ‡ÁÔÓÙ·È Ù· depo ÛÎÂ˘¿ÛÌ·Ù·, ÌÂ ÛÎÔfi Ó· ÌÂÈˆıÂ› Ë ÙÔÍÈÎ‹ ‰È¿ÚÎÂÈ¿ ÙÔ˘˜ñ ∆Ô Û‡Ó‰ÚÔÌÔ ÛÙ¤ÚËÛË˜ ‰ÂÓ Ê·›ÓÂÙ·È Ó· Â›Ó·È ÛÔ‚·Ú‹ ·ÚÂÓ¤ÚÁÂÈ· ·˘ÙÒÓ ÙˆÓ Ô˘ÛÈÒÓ


249

ÙË˜ ÌÂÁ·Ï‡ÙÂÚË˜ Û˘ÛÛÒÚÂ˘ÛË˜ ÛÙÔÓ ÂÌ‚Ú˘˚ÎfiÔÚÁ·ÓÈÛÌfi.

¶ÂÚÈÛÛfiÙÂÚ· ‰Â‰ÔÌ¤Ó· ˘¿Ú¯Ô˘Ó ·fi ÙË ¯Ú‹-ÛË ÙÔ˘˜ Î·Ù¿ ÙËÓ ˘ÂÚ¤ÌÂÛË ÙË˜ Î‡ËÛË˜. ¢ÂÓ ÌÔ-ÚÔ‡Ó, fiÌˆ˜, Ó· ÂÍ·¯ıÔ‡Ó ·ÛÊ·Ï‹ Û˘ÌÂÚ¿ÛÌ·Ù·,Î·ı’ fiÙÈ ˆ˜ ·ÓÙÈÂÌÂÙÈÎ¿ ÔÈ ‰ÔÛÔÏÔÁ›Â˜ ÙÔ˘˜ Â›Ó·ÈÛ·ÊÒ˜ ÌÈÎÚfiÙÂÚÂ˜ ·fi ·˘Ù¤˜ ÙˆÓ ·ÓÙÈ„˘¯ˆÛÈÎÒÓÛ¯ËÌ¿ÙˆÓ.

∏ Ì·ÎÚÔ¯ÚfiÓÈ· ¯Ú‹ÛË ÙˆÓ Ê·ÈÓÔıÂÈ·˙ÈÓÒÓ ÌÔ-ÚÂ› Ó· ÚÔÎ·Ï¤ÛÂÈ ‰ÔÛÔÂÍ·ÚÙÒÌÂÓÔ Û‡Ó‰ÚÔÌÔ·fiÛ˘ÚÛË˜ ‹ ·ÚÔ‰ÈÎ‹ ÂÍˆ˘Ú·ÌÈ‰ÈÎ‹ Û˘ÌÙˆÌ·-ÙÔÏÔÁ›· ÛÙÔ ÓÂÔÁÓfi, Ë ÔÔ›· ÌÔÚÂ› Ó· ‰È·ÚÎ¤ÛÂÈÁÈ· ÔÏÏÔ‡˜ Ì‹ÓÂ˜ (8).

∫¿ıÂ ÊÔÚ¿ Ô˘ ÔÈ Ô˘Û›Â˜ ·˘Ù¤˜ ¯ÔÚËÁÔ‡ÓÙ·ÈÛÙËÓ ÂÁÎ˘ÌÔÓÔ‡Û·, Ú¤ÂÈ Ó· ‰›‰ÔÓÙ·È ÔÈ ¯·ÌËÏfiÙÂ-ÚÂ˜ ‰ÔÛÔÏÔÁ›Â˜ Î·È ÁÈ· ÌÈÎÚ¿ ¯ÚÔÓÈÎ¿ ‰È·ÛÙ‹Ì·Ù·.

°È· ÙËÓ ÚfiÏË„Ë ÙˆÓ ÂÍˆ˘Ú·ÌÈ‰ÈÎÒÓ Û˘ÌÙˆ-Ì¿ÙˆÓ ÛÙËÓ Î‡ËÛË, ÌÔÚÂ› Ó· ¯ÔÚËÁËıÂ› ÛÂ Û˘Ó-‰˘·ÛÌfi ÌÂ ÙËÓ ·ÓÙÈ„˘¯ˆÛÈÎ‹ ·ÁˆÁ‹ ¤Ó·˜ ·ÓÙÈ¯ÔÏÈ-ÓÂÚÁÈÎfi˜ ·Ú¿ÁÔÓÙ·˜, fiˆ˜ Â›Ó·È Ë ‚ÈÂÚÈ‰¤ÓË.

∆Ô ÓÂÔÁÓfi Ú¤ÂÈ Ó· ·Ú·ÎÔÏÔ˘ıÂ›Ù·È ÛÙÂÓ¿ÁÈ· Ù˘¯fiÓ ÂÍˆ˘Ú·ÌÈ‰ÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ Î·È Û˘ÌÙˆ-Ì·ÙÔÏÔÁ›· ·fiÛ˘ÚÛË˜.

∞Ó·ÊÔÚ¿ ÛÙË ¯ÏˆÚÔÚÔÌ·˙›ÓË ı· Á›ÓÂÈ ÂÓ Û˘-ÓÂ¯Â›· ·Ó·Ï˘ÙÈÎ¿, Î·ı’ fiÙÈ ˆ˜ ÚfiÙ˘Ô˜ Ê·ÈÓÔıÂÈ-·˙›ÓË ˘¿Ú¯Ô˘Ó ÁÈ’·˘Ù‹Ó ÂÚÈÛÛfiÙÂÚ· ‰Â‰ÔÌ¤Ó·.

ÃÏˆÚÔÚÔÌ·˙›ÓË(∫·ÙËÁÔÚ›· Î‡ËÛË˜ C Î·È Á·ÏÔ˘¯›·˜ L3 - ∂ÌÔ-

ÚÈÎ¿ ÛÎÂ˘¿ÛÌ·Ù·: Largactil, Zuledine Î.¿.) ∫‡ËÛË: OÈ Î‡ÚÈÂ˜ ÂÓ‰Â›ÍÂÈ˜ ÙË˜ ˘‰ÚÔ¯ÏˆÚÈÎ‹˜

¯ÏˆÚÔÚÔÌ·˙›ÓË˜ Â›Ó·È ÔÈ „˘¯ˆÛÈÎ¤˜ Î·Ù·ÛÙ¿ÛÂÈ˜.¢È¤Ú¯ÂÙ·È ÙÔÓ Ï·ÎÔ‡ÓÙ·, fiˆ˜ Î·È ÔÈ ¿ÏÏÂ˜ Ô˘Û›Â˜ÙË˜ Î·ÙËÁÔÚ›·˜ ·˘Ù‹˜. ™Ù· ÂÈÚ·Ì·Ùfi˙ˆ·, ÌÂ ‰Ô-ÛÔÏÔÁÈÎ¿ Û¯‹Ì·Ù· Û·ÊÒ˜ ÌÂÁ·Ï‡ÙÂÚ· ·fi Ù· Û˘-Ó‹ıË Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÛÙÔ ¿ÓıÚˆÔ, ¤¯Ô˘ÓÎ·Ù·ÁÚ·ÊÂ› ÙÂÚ·ÙÔÁfiÓÂ˜ ÂÈÙÒÛÂÈ˜, fiˆ˜ Ï˘Îfi-ÛÙÔÌ·, ·ÓˆÌ·Ï›Â˜ ÎÂÓÙÚÈÎÔ‡ ÓÂ˘ÚÈÎÔ‡ Û˘ÛÙ‹Ì·-ÙÔ˜, ‰È·Ù·Ú·¯¤˜ ÔÚ¿ÛÂˆ˜, Î·ıÒ˜ Â›ÛË˜ Î·È ÛÎÂ-ÏÂÙÈÎ¤˜ ·ÓˆÌ·Ï›Â˜. Œ¯ÂÈ ·Ó·ÊÂÚıÂ› ·ÎfiÌ· ÂÌ‚Ú˘Ô-ÙÔÍÈÎ‹ ‰Ú¿ÛË, Î˘Ú›ˆ˜ ÛÙËÓ ÚÒÈÌË ÂÌ‚Ú˘˚Î‹ Â-Ú›Ô‰Ô, fiˆ˜ ÂÌ‚Ú˘˚Îfi˜ ı¿Ó·ÙÔ˜, ÌÂÈˆÌ¤ÓË ÁÔÓÈÌfi-ÙËÙ· Î·È ‚ÈˆÛÈÌfiÙËÙ· ÙˆÓ ÓÂÔÛÛÒÓ, Î·ıÒ˜ Â›ÛË˜‰È·Ù·Ú·¯¤˜ ÙË˜ Û˘ÌÂÚÈÊÔÚ¿˜ (9-11).

™ÙÔÓ ¿ÓıÚˆÔ ‰ÂÓ ˘¿Ú¯Ô˘Ó Î·ÏÒ˜ ÔÚÁ·ÓˆÌ¤-ÓÂ˜ ÂÈ‰ËÌÈÔÏÔÁÈÎ¤˜ ÌÂÏ¤ÙÂ˜, ÔÈ ÔÔ›Â˜ Ó· ÂÍÂÙ¿-˙Ô˘Ó ÙËÓ Ù˘¯fiÓ ÙÂÚ·ÙÔÁfiÓÔ ‰Ú¿ÛË ÙË˜ ÚÔÁÂÓÓËÙÈ-Î‹˜ ¤ÎıÂÛË˜ ÛÙË ¯ÏˆÚÔÚÔÌ·˙›ÓË.

OÈ ·Ó·ÊÔÚ¤˜ ÚÔ¤Ú¯ÔÓÙ·È ·fi ÌÂÌÔÓˆÌ¤ÓÂ˜Î·Ù·ÁÚ·Ê¤˜ ‹ ·fi ÌÂÏ¤ÙÂ˜ ÛÂ ÌÈÎÚfi ·ÚÈıÌfi Á˘Ó·È-ÎÒÓ, Î˘Ú›ˆ˜ ÌÂÙ¿ ·fi ¯Ú‹ÛË ÙË˜ Ô˘Û›·˜ ˆ˜ ·ÓÙÈÂ-ÌÂÙÈÎfi. º˘ÛÈÎ¿, ÔÈ ‰fiÛÂÈ˜ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ÛÂ ·˘Ù¤˜ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ Â›Ó·È Û·ÊÒ˜ ÌÈÎÚfiÙÂÚÂ˜ ·fi ÙÈ˜¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓÂ˜ ÁÈ· ·ÓÙÈ„˘¯ˆÛÈÎ‹ ‰Ú¿ÛË.À¿Ú¯Ô˘Ó ·ÚÎÂÙ¤˜ ÌÂÏ¤ÙÂ˜ Ô˘ ÂÈ‚Â‚·ÈÒÓÔ˘Ó ÙËÓ

·ÛÊ¿ÏÂÈ· Î·È ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙË˜ ¯ÏˆÚÔ-ÚÔÌ·˙›ÓË˜ fiÙ·Ó ¯ÔÚËÁËıÂ› ÛÂ ¯·ÌËÏ¤˜ ‰fiÛÂÈ˜ ÁÈ·ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ Ó·˘Ù›·˜ Î·È ÙˆÓ ÂÌÂÙÒÓ Î·ı’fiÏË ÙË ‰È¿ÚÎÂÈ· ÙË˜ Î‡ËÛË˜. ™Ù· ›‰È· Û˘ÌÂÚ¿-ÛÌ·Ù· Î·Ù·Ï‹ÁÔ˘Ó Î·È ÔÈ ÌÂÏ¤ÙÂ˜ Ô˘ ¯ÚËÛÈÌÔÔ›-ËÛ·Ó ÙÔ Ê¿ÚÌ·ÎÔ ÁÈ· ·Ó·ÏÁËÛ›·, ·ÌÓËÛ›· ‹ Î·Ù·-ÛÙÔÏ‹ Î·Ù¿ ÙÔÓ ÙÔÎÂÙfi.

Œ¯Ô˘Ó Î·Ù·ÁÚ·ÊÂ› ÂÚÈÙÒÛÂÈ˜ ÌÂ È‰ÈÔÛ˘ÁÎÚ·-ÛÈ·Î‹ ˘fiÙ·ÛË ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË ÙË˜ Ô˘Û›·˜. º˘-ÛÈÎ¿, Ë ·Ú·ÙÂÈÓfiÌÂÓË ˘ÔÙ·ÛÈÎ‹ ÎÚ›ÛË ÌÔÚÂ› Ó·Â›Ó·È ÂÈ‚Ï·‚‹˜ ÁÈ· ÙË ÌËÙ¤Ú· Î·È ÙÔ ¤Ì‚Ú˘Ô. ∆··Ú·¿Óˆ ÚÔ¤Ú¯ÔÓÙ·È ·fi ·Ï·È¤˜ ÌÂÏ¤ÙÂ˜ ÙË˜‰ÂÎ·ÂÙ›·˜ ÙÔ˘ ’60, ÂÚ›Ô‰Ô˜ Î·Ù¿ ÙËÓ ÔÔ›· Ë Ô˘-Û›· Â›¯Â ÌÂÁ·Ï‡ÙÂÚË ¯Ú‹ÛË ·fi ÙË ÛËÌÂÚÈÓ‹(12,13).

∞fi ÙË ÌÂÏ¤ÙË ÙÔ˘ Sobel (1961), Ë ¯ÔÚ‹ÁËÛËÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ÚÔÁÂÓÓËÙÈÎ¿ ÛÂ ˘„ËÏ¤˜ ‰fiÛÂÈ˜(500-600 mg ËÌÂÚËÛ›ˆ˜) ÚÔÎ¿ÏÂÛÂ ÓÂÔÁÓÈÎ‹ Î·-Ù·ÛÙÔÏ‹ Î·È Î˘¿ÓˆÛË (14). Œ¯Ô˘Ó, Â›ÛË˜, ·Ó·-ÊÂÚıÂ› ÓÂ˘ÚÔÏÔÁÈÎ¤˜ ‰È·Ù·Ú·¯¤˜ ÌÂ ÂÍˆ˘Ú·ÌÈ‰È-Î¿ ÎÈÓËÙÈÎ¿ Û˘ÌÙÒÌ·Ù·, fiˆ˜ ˘ÂÚÙÔÓ›·, ÙÚfiÌÔ,‰˘ÛÎÈÓËÛ›·, ‰È¤ÁÂÚÛË, ·‰˘Ó·Ì›· Î·È ÌÂÈˆÌ¤ÓË ‰È¿-ıÂÛË ÁÈ· ıËÏ·ÛÌfi, Î˘Ú›ˆ˜ fiÙ·Ó ÙÔ Ê¿ÚÌ·ÎÔ ¯ÔÚË-ÁËıÂ› ÛÙÔ ÙÚ›ÙÔ ÙÚ›ÌËÓÔ. ∆· Û˘ÌÙÒÌ·Ù· ·˘Ù¿˘·ÁÔÚÂ‡Ô˘Ó ÙËÓ ‡·ÚÍË Û˘Ó‰ÚfiÌÔ˘ ·fiÛ˘ÚÛË˜.∏ Û˘¯ÓfiÙËÙ· ·˘ÙÒÓ ÙˆÓ ·ÓÂÈı‡ÌËÙˆÓ ÂÓÂÚÁÂÈÒÓÂ›Ó·È ¯·ÌËÏ‹ Î·È ÌÈÎÚ‹˜ ‰È¿ÚÎÂÈ·˜, ·Ó Î·È ¤¯Ô˘Ó·Ó·ÊÂÚıÂ› ÂÚÈÙÒÛÂÈ˜ ÌÂ Û˘ÌÙˆÌ·ÙÔÏÔÁ›· Ô˘‰È‹ÚÎÂÛÂ ·ÚÎÂÙÔ‡˜ Ì‹ÓÂ˜. ¶Ú¤ÂÈ Ó· ÛËÌÂÈˆıÂ› fiÙÈ·˘Ù¿ ·Ú·ÙËÚÔ‡ÓÙ·È ÌfiÓÔ ÌÂ ˘„ËÏ¤˜ ‰fiÛÂÈ˜ Î·ÈÛÂ ÂÚ›Ô‰Ô ÎÔÓÙ¿ ÛÙÔÓ ÙÔÎÂÙfi (¿Óˆ ·fi 1200 mgËÌÂÚËÛ›ˆ˜) (15).

OÈ Hammond Î·È Û˘Ó, ÙÔ 1970, ÂÚÈ¤ÁÚ·„·ÓÙËÓ ÂÚ›ÙˆÛË Ì›·˜ ·ÛıÂÓÔ‡˜ Ô˘ Î·Ù·Ó¿ÏˆÛÂÛ˘ÓÔÏÈÎ¿ 8 g ¯ÏˆÚÔÚÔÌ·˙›ÓË˜ ÙÈ˜ ÙÂÏÂ˘Ù·›Â˜ 10ËÌ¤ÚÂ˜ ÙË˜ Î‡ËÛË˜. ∆Ô ÓÂÔÁÓfi Ô˘ ÁÂÓÓ‹ıËÎÂ‹Ù·Ó ˘ÔÙÔÓÈÎfi, ÏËı·ÚÁÈÎfi, ÌÂ ÈÎÙÂÚÈÎ‹ ¯ÚÔÈ¿. ∆··Ú·¿Óˆ ·Ú¤ÌÂÈÓ·Ó ÁÈ· ÂÚ›Ô˘ ÙÚÂÈ˜ Â‚‰ÔÌ¿-‰Â˜ (16).

À¿Ú¯ÂÈ ÌfiÓÔ Ì›· ÌÂÏ¤ÙË Ô˘ Û˘Ó¤‰ÂÛÂ ÙËÓÚÔÁÂÓÓËÙÈÎ‹ ¯ÔÚ‹ÁËÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ÌÂ ÙËÓÂÎÙÚˆÌÂÏ›·. ∫·È ÛÂ ·˘Ù‹, fiÌˆ˜, Ë ¯ÏˆÚÔÚÔÌ·˙›ÓË¯ÔÚËÁ‹ıËÎÂ Ì·˙› ÌÂ ÙË ÌÂÎÏÔ˙›ÓË. ™ÙÈ˜ Û˘Ó‹ıÂÈ˜ ÌÈ-ÎÚ¤˜ ‰fiÛÂÈ˜, Î·ıÒ˜ Â›ÛË˜ Î·È ÛÂ ÌË Û˘ÛÙËÌ·ÙÈÎ‹Ï‹„Ë, Ê·›ÓÂÙ·È Ó· Â›Ó·È ·ÛÊ·Ï‹˜ ÁÈ· ÙÔ ¤Ì‚Ú˘Ô.ª¿ÏÈÛÙ·, Û‡ÌÊˆÓ· ÌÂ ÙËÓ ·Ó·ÛÎfiËÛË ÙˆÓ EliaÎ·È Û˘Ó (1987), ÈÛÙÂ‡ÂÙ·È fiÙÈ Ë ¯ÏˆÚÔÚÔÌ·˙›ÓËÚ¤ÂÈ Ó· Â›Ó·È Ô ıÂÚ·Â˘ÙÈÎfi˜ ·Ú¿ÁˆÓ ÚÒÙË˜ÂÎÏÔÁ‹˜, Â¿Ó ÂÈ‚¿ÏÏÂÙ·È ·ÓÙÈ„˘¯ˆÛÈÎ‹ ·ÁˆÁ‹ Î·-Ù¿ ÙËÓ Î‡ËÛË (17).

¶·Ú¿ Ù·‡Ù·, Ë ¯Ú‹ÛË ÙË˜ Ú¤ÂÈ Ó· ·ÔÊÂ‡ÁÂ-Ù·È ÎÔÓÙ¿ ÛÙÔÓ ÙÔÎÂÙfi, ÏfiÁˆ ÙË˜ È‰ÈÔÛ˘ÁÎÚ·ÛÈ·Î‹˜˘fiÙ·ÛË˜ Ô˘ ÂÈÊ¤ÚÂÈ ÛÙË ÌËÙ¤Ú· Î·È, ˆ˜ ÂÎ ÙÔ‡-ÙÔ˘, ÙË˜ ÂÌ‚Ú˘˚Î‹˜ ‰˘Û¯¤ÚÂÈ·˜.


250

°·ÏÔ˘¯›·: ∏ ¯ÏˆÚÔÚÔÌ·˙›ÓË ·Ó‹ÎÂÈ ÛÙËÓ Î·ÙË-ÁÔÚ›· ÎÈÓ‰‡ÓÔ˘ L3 Î·Ù¿ ÙË Á·ÏÔ˘¯›·. ™˘ÓÂÒ˜, ıÂ-ˆÚÂ›Ù·È “Û¯ÂÙÈÎ¿ ·ÛÊ·Ï‹˜”. ∞ÂÎÎÚ›ÓÂÙ·È ÛÙÔ Á¿-Ï· ÛÂ ÔÏ‡ ÌÈÎÚ¤˜ ÔÛfiÙËÙÂ˜, ÔÈ ÔÔ›Â˜ ‰ÂÓ ÍÂ-ÂÚÓÔ‡Ó ÙÔ 3% ÙË˜ ËÌÂÚ‹ÛÈ·˜ ‰fiÛË˜ ÙË˜ ÌËÙ¤Ú·˜.™˘ÓÈÛÙ¿Ù·È Ë ÛÙÂÓ‹ ·Ú·ÎÔÏÔ‡ıËÛË ÙÔ˘ ÓÂÔÁÓÔ‡ÁÈ· Ù˘¯fiÓ Î·Ù·ÛÙÔÏ‹ (18,19).

µÔ˘Ù˘ÚÔÊ·ÈÓfiÓÂ˜∞ÏÔÂÚÈ‰fiÏË(∫·ÙËÁÔÚ›· Î‡ËÛË˜ C Î·È Á·ÏÔ˘¯›·˜ L2 - ∂ÌÔ-

ÚÈÎ¿ ÛÎÂ˘¿ÛÌ·Ù·: Aloperidin, Sevium) ∫‡ËÛË: ∏ ·ÏÔÂÚÈ‰fiÏË Â›Ó·È Ë Ï¤ÔÓ ÛËÌ·ÓÙÈÎ‹

Ô˘Û›· ·˘Ù‹˜ ÙË˜ ÔÌ¿‰·˜ ÙˆÓ ·ÓÙÈ„˘¯ˆÛÈÎÒÓ Ô˘-ÛÈÒÓ. ¢È¤Ú¯ÂÙ·È ÙÔÓ Ï·ÎÔ˘ÓÙÈ·Îfi ÊÚ·ÁÌfi ÙfiÛÔÛÙ· ÂÈÚ·Ì·Ùfi˙ˆ·, fiÛÔ Î·È ÛÙÔÓ ¿ÓıÚˆÔ. ªÂÏ¤-ÙÂ˜ ÛÂ ÂÈÚ·Ì·Ùfi˙ˆ· ÌÂ ‰ÔÛÔÏÔÁÈÎ¿ Û¯‹Ì·Ù· Û·-ÊÒ˜ ÌÂÁ·Ï‡ÙÂÚ· ·˘ÙÒÓ ÙÔ˘ ·ÓıÚÒÔ˘, ¤‰ÂÈÍ·Ó·˘ÍËÌ¤ÓÔ Î›Ó‰˘ÓÔ ÙÂÚ·ÙÔÁ¤ÓÂÛË˜, Î·Ù·ÁÚ¿ÊÔ-ÓÙ·˜ ÂÚÈÙÒÛÂÈ˜ ÌÂ Ï˘ÎfiÛÙÔÌ·, ÌÈÎÚÔÌÂÏ›·, ·Óˆ-Ì·Ï›Â˜ ÎÂÓÙÚÈÎÔ‡ ÓÂ˘ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Î·È ÎÚ·Ó›-Ô˘ (20-22).

™Â Ì‡Â˜ Î·È Â›Ì˘Â˜ ¤¯ÂÈ Î·Ù·ÁÚ·ÊÂ› ÂÌ‚Ú˘ÔÙÔ-ÍÈÎ‹ ‰Ú¿ÛË, fiˆ˜ ÂÓ‰ÔÌ‹ÙÚÈÔ˜ ı¿Ó·ÙÔ˜, ÌÂÈˆÌ¤ÓË·Ó¿Ù˘ÍË Î·Ù¿ ÙËÓ Î‡ËÛË Î·È ÌÂÙ¿ ·fi ·˘Ù‹Ó, Î·-ıÒ˜ Â›ÛË˜ ‰È·Ù·Ú·¯¤˜ ÙË˜ Û˘ÌÂÚÈÊÔÚ¿˜ (21).

™ÙÔÓ ¿ÓıÚˆÔ ‰ÂÓ ˘¿Ú¯Ô˘Ó Â·ÚÎÒ˜ ÙÂÎÌË-ÚÈˆÌ¤ÓÂ˜ ÌÂÏ¤ÙÂ˜. øÛÙfiÛÔ, Û‡ÌÊˆÓ· ÌÂ ·Ï·ÈfiÙÂ-ÚË ÚÔÔÙÈÎ‹ ÌÂÏ¤ÙË ÙˆÓ van Waes Î·È Û˘Ó (1969),Ë ¯ÔÚ‹ÁËÛË ÌÈÎÚÒÓ ‰fiÛÂˆÓ ÙË˜ ·ÏÔÂÚÈ‰fiÏË˜, 0,6mg ËÌÂÚËÛ›ˆ˜ ˆ˜ ·ÓÙÈÂÌÂÙÈÎfi ‰‡Ô ÊÔÚ¤˜ ÙËÓ ËÌ¤-Ú·, ‰ÂÓ ·‡ÍËÛÂ ÙÔ ÔÛÔÛÙfi ·ÓˆÌ·ÏÈÒÓ ÛÂ Û¯¤ÛËÌÂ ÙÔÓ ÁÂÓÈÎfi ÏËı˘ÛÌfi (23).

∞fi Ù· Ì¤¯ÚÈ Û‹ÌÂÚ· ‰Â‰ÔÌ¤Ó· ÙË˜ ‰ÈÂıÓÔ‡˜‚È‚ÏÈÔÁÚ·Ê›·˜ ‰ÂÓ Ê·›ÓÂÙ·È Ó· ˘¿Ú¯ÂÈ Ì›· Û·Ê‹˜Û¯¤ÛË ÙË˜ ÚÔÁÂÓÓËÙÈÎ‹˜ Ï‹„Ë˜ ÙË˜ ·ÏÔÂÚÈ‰fi-ÏË˜ ÌÂ ÙÈ˜ ÚÔ·Ó·ÊÂÚıÂ›ÛÂ˜ ·ÓˆÌ·Ï›Â˜. ∂ÔÌ¤-Óˆ˜, Ô ÙÂÚ·ÙÔÁÂÓÂÙÈÎfi˜ Î›Ó‰˘ÓÔ˜ ·fi ÙË Ï‹„Ë ÙË˜Ô˘Û›·˜ Â›Ó·È ¯·ÌËÏfi˜. ∏ ÂÁÎ˘ÌÔÓÔ‡Û· ÌÔÚÂ› Ó·Ï¿‚ÂÈ ÙËÓ Ô˘Û›·, ÂÊfiÛÔÓ Ù· ıÂÚ·Â˘ÙÈÎ¿ ÙË˜ ÏÂÔ-ÓÂÎÙ‹Ì·Ù· ˘ÂÚ¤¯Ô˘Ó ÙÔ˘ Èı·ÓÔ‡ ÎÈÓ‰‡ÓÔ˘ ·Óˆ-Ì·ÏÈÒÓ ÙÔ˘ ÓÂÔÁÓÔ‡.

°·ÏÔ˘¯›·: ∞Ó Î·È Ë ·ÏÔÂÚÈ‰fiÏË ·ÂÎÎÚ›ÓÂÙ·ÈÛÂ ÛËÌ·ÓÙÈÎ‹ ÔÛfiÙËÙ· ÛÙÔ Á¿Ï· ÌÂ Ì›· ·Ó·ÏÔÁ›·Á¿Ï·:Ï¿ÛÌ· 0,6-0,7, ÂÓÙÔ‡ÙÔÈ˜ ‰ÂÓ ¤¯Ô˘Ó ·Ó·-ÊÂÚıÂ› ÛËÌ·ÓÙÈÎ¤˜ ·ÚÂÓ¤ÚÁÂÈÂ˜.

™Â ÂÈÚ·Ì·ÙÈÎfi ÛÙ¿‰ÈÔ, ¤¯Ô˘Ó ·Ó·ÊÂÚıÂ› ˘ÓË-Ï›· Î·È ‰È·Ù·Ú·¯¤˜ ÙË˜ ÎÈÓËÙÈÎfiÙËÙ·˜ ÙˆÓ ÓÂÔÁÓÒÓÔ˘ ı‹Ï·˙·Ó ·fi ÌËÙ¤ÚÂ˜ ÛÙÈ˜ ÔÔ›Â˜ ¯ÔÚËÁ‹ıËÎÂË ·ÏÔÂÚÈ‰fiÏË.

∞fi Ù· ‰Â‰ÔÌ¤Ó· ÙÔ˘ Yoshida (1998) ÚÔÎ‡ÙÂÈfiÙÈ Ô ıËÏ·ÛÌfi˜ ÙˆÓ ÓÂÔÁÓÒÓ ·fi ÌËÙ¤ÚÂ˜ Ô˘Ï·Ì‚¿ÓÔ˘Ó ÓÂ˘ÚÔÏËÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜, ÌÔÚÂ›Ó· ÚÔÎ·Ï¤ÛÂÈ ÌÂ›ˆÛË ÙË˜ ÓÂ˘Ì·ÙÈÎ‹˜ Î·È „˘¯Ô-ÎÈÓËÙÈÎ‹˜ ÈÎ·ÓfiÙËÙ¿˜ ÙÔ˘˜ (24).

∏ ∞ÌÂÚÈÎ·ÓÈÎ‹ ∞Î·‰ËÌ›· ¶·È‰È·ÙÚÈÎ‹˜ ıÂˆÚÂ›ÙËÓ ·ÏÔÂÚÈ‰fiÏË Ô˘Û›· ÌÂ ¿ÁÓˆÛÙË ‰Ú¿ÛË ÛÙÔ ÓÂ-ÔÁÓfi, Ô˘ Èı·ÓfiÓ Ó· Â›Ó·È ÂÈ‚Ï·‚‹˜ (19).

∞2. ∞∆À¶∞ ∞¡∆πæÀÃø™π∫∞ ∫ÏÔ˙·›ÓË(∫·ÙËÁÔÚ›· Î‡ËÛË˜ C Î·È Á·ÏÔ˘¯›·˜ L3 - ∂ÌÔ-

ÚÈÎ¿ ÛÎÂ˘¿ÛÌ·Ù·: Leponex) ∫‡ËÛË: ∏ ÎÏÔ˙·›ÓË Â›Ó·È ÙÔ ·Ú¯·ÈfiÙÂÚÔ ¿Ù˘Ô

·ÓÙÈ„˘¯ˆÛÈÎfi, ÙÔ ÔÔ›Ô Â›Ó·È ‰È·ı¤ÛÈÌÔ Ì¤¯ÚÈ Û‹-ÌÂÚ·. ø˜ ¿Ù˘Ô ·ÓÙÈ„˘¯ˆÛÈÎfi ÂÌÊ·Ó›˙ÂÈ ¯·ÌËÏ‹·ÓÙ·ÁˆÓÈÛÙÈÎ‹ Û˘ÁÁ¤ÓÂÈ· ÁÈ· ÙÔ˘˜ ˘Ô‰Ô¯Â›˜ D1Î·È D2 Î·È ˘„ËÏ‹ ·ÓÙ·ÁˆÓÈÛÙÈÎ‹ Û˘ÁÁ¤ÓÂÈ· ÁÈ·ÙÔ˘˜ ÛÂÚÔÙÔÓÈÓÂÚÁÈÎÔ‡˜, ·-·‰ÚÂÓÂÚÁÈÎÔ‡˜ Î·ÈÈÛÙ·ÌÈÓÂÚÁÈÎÔ‡˜ ˘Ô‰Ô¯Â›˜. ∞fi ÙÈ˜ Ì¤¯ÚÈ ÙÒÚ· ÌÂ-Ï¤ÙÂ˜ Ê·›ÓÂÙ·È fiÙÈ Ë ÎÏÔ˙·›ÓË Â›Ó·È ÂÍ›ÛÔ˘, ·Ó fi¯ÈÂÚÈÛÛfiÙÂÚÔ, ·ÔÙÂÏÂÛÌ·ÙÈÎ‹ ÌÂ ÙË ¯ÏˆÚÔÚÔÌ·-˙›ÓË Î·È ÙËÓ ·ÏÔÂÚÈ‰fiÏË. ∞Ó·ÊÂÚfiÌÂÓÂ˜ ·ÓÂÈı‡-ÌËÙÂ˜ ÂÓ¤ÚÁÂÈÂ˜ ·fi ÙË Ï‹„Ë ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Â›Ó·ÈË ÔÚıÔÛÙ·ÙÈÎ‹ ˘fiÙ·ÛË, Ë Ù·¯˘Î·Ú‰›·, Î·ıÒ˜ Î·ÈË ·ÎÔÎÎÈÔÎ˘ÙÙ·Ú·ÈÌ›·, ÁÈ· ÙËÓ ÔÔ›· Ú¤ÂÈ Ó· Á›-ÓÔÓÙ·È Û˘¯ÓÔ› ·ÈÌ·ÙÔÏÔÁÈÎÔ› ¤ÏÂÁ¯ÔÈ.

§fiÁˆ ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÙË˜ ·ÎÔÎÎÈÔÎ˘ÙÙ·Ú·ÈÌ›·˜Î·È ÙÔ˘ ÎfiÛÙÔ˘˜ ÙˆÓ ·ÈÌ·ÙÔÏÔÁÈÎÒÓ ÂÍÂÙ¿ÛÂˆÓ, ËÎÏÔ˙·›ÓË Î·ı›ÛÙ·Ù·È Ê¿ÚÌ·ÎÔ ‰Â‡ÙÂÚË˜ ÂÈÏÔ-Á‹˜. ¶¿Ú· Ù·‡Ù·, ¯ÚËÛÈÌÔÔÈÂ›Ù·È Â˘Ú¤ˆ˜ ÛÂ·ÛıÂÓÂ›˜ Ô˘ ‰ÂÓ ·ÓÙ·ÔÎÚ›ÓÔÓÙ·È ÛÙ· ÎÏ·ÛÈÎ¿·ÓÙÈ„˘¯ˆÛÈÎ¿ Ê¿ÚÌ·Î·.

∏ ÎÏÔ˙·›ÓË, ·ÓÙ›ıÂÙ· ÌÂ ÙÔ˘˜ ¿ÏÏÔ˘˜ ·ÓÙÈ„˘-¯ˆÛÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜, ‰ÂÓ Î·Ù·ÛÙ¤ÏÏÂÈ ÙËÓ ¤ÎÎÚÈ-ÛË ÙË˜ ÚÔÏ·ÎÙ›ÓË˜ Î·È, ˆ˜ ÂÎ ÙÔ‡ÙÔ˘, ‰ÂÓ Ê·›ÓÂ-Ù·È Ó· ‰È·Ù·Ú¿ÛÛÂÈ ÙËÓ ˆÔÚÚËÍ›· Î·È ÙË ÁÔÓÈÌfiÙË-Ù·. ™˘ÓÂÒ˜, Ë Á˘Ó·›Î· Ô˘ Ï·Ì‚¿ÓÂÈ ÙËÓ Ô˘Û›··˘Ù‹, Â›Ó·È ÔÏ‡ Èı·Ófi Ó· ÌÂ›ÓÂÈ ¤ÁÎ˘Ô˜.

∏ ÎÏÔ˙·›ÓË ‰È¤Ú¯ÂÙ·È ÙÔÓ Ï·ÎÔ‡ÓÙ·. ªÂÏ¤ÙÂ˜ÛÂ ÂÈÚ·Ì·Ùfi˙ˆ· ‰ÂÓ ¤‰ÂÈÍ·Ó ·‡ÍËÛË ÙÔ˘ ÔÛÔ-ÛÙÔ‡ ÙÂÚ·ÙÔÁÂÓ¤ÛÂˆÓ Î·È ÂÌ‚Ú˘ÔÙÔÍÈÎfiÙËÙ·˜, ÛÂ‰ÔÛÔÏÔÁÈÎ¿ Û¯‹Ì·Ù· 2-3 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚ· ·fi·˘Ù¿ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÛÙÔÓ ¿ÓıÚˆÔ (25,26).

ª¤¯ÚÈ Û‹ÌÂÚ· ‰ÂÓ ˘¿Ú¯Ô˘Ó ·Ó·ÊÔÚ¤˜ Ô˘ Ó·Û˘Ó‰¤Ô˘Ó ÙËÓ ÚÔÁÂÓÓËÙÈÎ‹ ¤ÎıÂÛË ÛÙËÓ ÎÏÔ˙·›-ÓË ÌÂ Û˘ÁÁÂÓÂ›˜ ·ÓˆÌ·Ï›Â˜.

Ÿˆ˜ ·Ó·Ê¤ÚıËÎÂ, Ë ¯Ú‹ÛË ÙË˜ ÎÏÔ˙·›ÓË˜ÌÔÚÂ› Ó· ÚÔÎ·Ï¤ÛÂÈ Ô˘‰ÂÙÂÚÔÂÓ›· ¤ˆ˜ Î·È·ÎÔÎÎÈÔÎ˘ÙÙ·Ú·ÈÌ›·, Û˘Ó‹ıˆ˜ ÙÔ˘˜ ÚÒÙÔ˘˜ 6 Ì‹-ÓÂ˜ ÙË˜ ıÂÚ·Â›·˜. ∏ ·ÚÂÓ¤ÚÁÂÈ· ·˘Ù‹, ÏfiÁˆ Î·-Ù·ÛÙÔÏ‹˜ ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ, ÌÔÚÂ› Ó· ÂÌÊ·-ÓÈÛÙÂ› Â›ÙÂ ·ÈÊÓÈ‰›ˆ˜, Â›ÙÂ ÛÙ·‰È·Î¿. ø˜ ÂÎ ÙÔ‡ÙÔ˘,ÂÈ‚¿ÏÏÂÙ·È Ô ·ÈÌ·ÙÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙË˜ ÂÁÎ‡Ô˘ÚÈÓ ÙËÓ ¤Ó·ÚÍË ÙË˜ ıÂÚ·Â›·˜, Î¿ıÂ Â‚‰ÔÌ¿‰· ÙÈ˜18 ÚÒÙÂ˜ Â‚‰ÔÌ¿‰Â˜ ÙË˜ ·ÁˆÁ‹˜ Î·È, Î·ÙfiÈÓÙÔ‡ÙÔ˘, Î¿ıÂ 15 ËÌ¤ÚÂ˜ ÁÈ· ¤Ó·Ó ¯ÚfiÓÔ ÛÙÈ˜ ÂÚÈ-ÙÒÛÂÈ˜ Ô˘ ¯ÚÂÈ¿˙ÂÙ·È Ì·ÎÚÔ¯ÚfiÓÈ· ıÂÚ·Â˘ÙÈÎ‹·ÁˆÁ‹.


251

OÈ ·ÛıÂÓÂ›˜ Ô˘ ‰ÂÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·ÈÌ·ÙÔÏÔÁÈ-Î¤˜ ‰È·Ù·Ú·¯¤˜ Î·È Û˘ÓÂ¯›˙Ô˘Ó ÙË Ï‹„Ë ÙÔ˘ Ê·Ú-Ì¿ÎÔ˘ ÁÈ· ÂÚÈÛÛfiÙÂÚÔ ·fi ¤Ó·Ó ¯ÚfiÓÔ, Ú¤ÂÈ Ó·ÂÏ¤Á¯Ô˘Ó Î¿ıÂ Ì‹Ó· ÙÔÓ ·ÚÈıÌfi ÙˆÓ ÏÂ˘ÎÔÎ˘ÙÙ¿-ÚˆÓ Ì¤¯ÚÈ ÙÔ Ù¤ÏÔ˜ ÙË˜ ıÂÚ·Â˘ÙÈÎ‹˜ ·ÁˆÁ‹˜.ŸÙ·Ó ‰È·ÈÛÙˆıÂ› Ë ‰È·Ù·Ú·¯‹, ÂÈ‚¿ÏÏÂÙ·È Ë ‰È·-ÎÔ‹ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘.

Ÿˆ˜ Î·È ÁÈ· ÙÔ˘˜ ÏÔÈÔ‡˜ ·Ú¿ÁÔÓÙÂ˜ ÙÔ˘ ÎÂ-ÓÙÚÈÎÔ‡ ÓÂ˘ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, Û˘ÓÈÛÙ¿Ù·È, fiÔ˘Â›Ó·È ÎÏÈÓÈÎ¿ ÂÊÈÎÙfi, Ë ÌÂ›ˆÛË ÙË˜ ‰fiÛË˜ Î˘Ú›ˆ˜ ÙÔÚÒÙÔ ÙÚ›ÌËÓÔ ÙË˜ Î‡ËÛË˜ ‹ ÙÈ˜ ËÌ¤ÚÂ˜ Ô˘ ÚÔË-ÁÔ‡ÓÙ·È ÙÔ˘ ·Ó·ÌÂÓfiÌÂÓÔ˘ ÙÔÎÂÙÔ‡, ÌÂ ÛÎÔfi Ó·ÚÔÏËÊıÂ› Ë Î·Ù·ÛÙÔÏ‹ Î·È ÙÔ Û‡Ó‰ÚÔÌÔ ·fiÛ˘Ú-ÛË˜ ÙÔ˘ ÓÂÔÁÓÔ‡.

°·ÏÔ˘¯›·: ∏ ¯Ú‹ÛË ÙË˜ ÎÏÔ˙·›ÓË˜ ·ÓÙÂÓ‰Â›-ÎÓ˘Ù·È Î·Ù¿ ÙÔÓ ıËÏ·ÛÌfi. ∏ ÎÏÔ˙·›ÓË ·ÂÎÎÚ›ÓÂ-Ù·È ÛÙÔ Á¿Ï·. ™ÙÔ ÓÂÔÁÓfi ÚÔÎ·ÏÂ› Î·Ù·ÛÙÔÏ‹, ÌÂ›-ˆÛË ÙË˜ ıËÏ·ÛÙÈÎ‹˜ ÂÈı˘Ì›·˜, Û·ÛÌÔ‡˜ Î·È Î·Ú-‰È·ÁÁÂÈ·Î‹ ·ÛÙ¿ıÂÈ·. ª›· ·fi ÙÈ˜ ÛËÌ·ÓÙÈÎfiÙÂÚÂ˜·ÚÂÓ¤ÚÁÂÈÂ˜ Ô˘ ¤¯Ô˘Ó ·Ó·ÊÂÚıÂ› Â›Ó·È Ë ·ÎÔÎÈÔ-Î˘ÙÙ·Ú·ÈÌ›·, Ë ÔÔ›· ÌÔÚÂ› Ó· ı¤ÛÂÈ ÛÂ Î›Ó‰˘ÓÔ ÙË˙ˆ‹ ÙÔ˘ ÓÂÔÁÓÔ‡ ÏfiÁˆ Â˘Î·ÈÚÈ·ÎÒÓ ÏÔÈÌÒÍÂˆÓ(25-27).

ƒÈÛÂÚÈ‰fiÓË (∫·ÙËÁÔÚ›· Î‡ËÛË˜ C Î·È Á·ÏÔ˘¯›·˜ L3 - ∂ÌÔ-

ÚÈÎ¿ ÛÎÂ˘¿ÛÌ·Ù·: Risperdal) ∏ ÚÈÛÂÚÈ‰fiÓË ‰ÂÓ ·ÚÔ˘ÛÈ¿˙ÂÈ ÙÈ˜ ÛÔ‚·Ú¤˜ ·È-

Ì·ÙÈÎ¤˜ ·ÚÂÓ¤ÚÁÂÈÂ˜ ÙË˜ ÎÏÔ˙·›ÓË˜. ÃËÌÈÎ¿, ËÔ˘Û›· ‰ÂÓ Û¯ÂÙ›˙ÂÙ·È ÌÂ Ù· ˘fiÏÔÈ· ·ÓÙÈ„˘¯ˆÛÈÎ¿Ê¿ÚÌ·Î· Î·È Ê·›ÓÂÙ·È Ó· Â›Ó·È ÈÛ¯˘Úfi˜ ·ÓÙ·ÁˆÓÈ-ÛÙ‹˜ ÁÈ· ÙÔ˘˜ 5∏∆2·, 5∏∆7 ÛÂÚÔÙÔÓÈÓÂÚÁÈÎÔ‡˜, ·1,·2-·‰ÚÂÓÂÚÁÈÎÔ‡˜, ∏1-ÈÛÙ·ÌÈÓÈÎÔ‡˜ Î·È ÙÔ˘˜ D2˘Ô‰Ô¯Â›˜. ∞ÓÙ›ıÂÙ·, ·ÚÔ˘ÛÈ¿˙ÂÈ ¯·ÌËÏ‹ Û˘ÁÁ¤-ÓÂÈ· ÁÈ· ÙÔ˘˜ ˘Ô‰Ô¯Â›˜ D1 Î·È D4 ÙË˜ ÓÙÔ·Ì›ÓË˜.

OÈ Ï¤ÔÓ Û˘¯Ó¤˜ ·ÓÂÈı‡ÌËÙÂ˜ ÂÓ¤ÚÁÂÈÂ˜ ·fi ÙË¯Ú‹ÛË ÙË˜ ÚÈÛÂÚÈ‰fiÓË˜ Â›Ó·È ·¸Ó›·, ˙¿ÏË, ¿Á¯Ô˜,Ù·Ú·¯‹, ˘fiÙ·ÛË Î·È ÛÂÍÔ˘·ÏÈÎ‹ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·.

º·›ÓÂÙ·È Ó· ·ÔÙÂÏÂ› ÙÔ Ê¿ÚÌ·ÎÔ ÚÒÙË˜ ÂÎÏÔ-Á‹˜, ·ÎfiÌË Î·È ÛÙÈ˜ ÂÚÈÙÒÛÂÈ˜ Ì·ÓÈÔÎ·Ù·ıÏÈÙÈ-Î‹˜ ‰È·Ù·Ú·¯‹˜, „˘¯ˆÛÈÎ‹˜ Î·Ù¿ıÏÈ„Ë˜ Î.Ï.

∫‡ËÛË: ∂Î ÚÔÔÈÌ›Ô˘, Ú¤ÂÈ Ó· ÂÈÛËÌ¿ÓÔ˘ÌÂfiÙÈ Ë ¯Ú‹ÛË ÙˆÓ ÓÂfiÙÂÚˆÓ ¿Ù˘ˆÓ ·ÓÙÈ„˘¯ˆÛÈÎÒÓ(fiˆ˜ Ë ÏÔÍ·›ÓË Î·È Ë ÔÏ·Ó˙·›ÓË) ‰ÂÓ ÂÓ‰Â›ÎÓ˘-Ù·È Î·Ù¿ ÙËÓ Î‡ËÛË, Î·ıÒ˜ ‰ÂÓ ˘¿Ú¯Ô˘Ó Â·ÚÎ‹‚È‚ÏÈÔÁÚ·ÊÈÎ¿ ‰Â‰ÔÌ¤Ó·.

∞fi Ù· ˘¿Ú¯ÔÓÙ· ‰Â‰ÔÌ¤Ó·, Ë ÚÈÛÂÚÈ‰fiÓË‰È¤Ú¯ÂÙ·È ÙÔÓ Ï·ÎÔ‡ÓÙ·. ™Ù· ÂÈÚ·Ì·Ùfi˙ˆ·, Â›-Ì˘Â˜ Î·È ÎÔ˘Ó¤ÏÈ·, ‰ÂÓ Ê·›ÓÂÙ·È Ó· ¤¯ÂÈ ÙÂÚ·ÙÔÁfi-ÓÔ ‰Ú¿ÛË ÛÂ ‰fiÛÂÈ˜ >2,5 mg/kg per os ÚÈÓ Î·È Î·-Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÚÒÙˆÓ ÛÙ·‰›ˆÓ ÙË˜ Î‡ËÛË˜Î·È 10 mg/kg Î·Ù¿ ÙËÓ ÂÚ›Ô‰Ô ÙË˜ ÔÚÁ·ÓÔÁ¤ÓÂ-ÛË˜. ªÂ ÙË ‰Â‡ÙÂÚË ‰ÔÛÔÏÔÁ›· ·Ú·ÙËÚ‹ıËÎÂ ÌÂ›-ˆÛË ÙÔ˘ ÂÌ‚Ú˘˚ÎÔ‡ ‚¿ÚÔ˘˜ (28).

°È· ÙÔÓ ¿ÓıÚˆÔ ‰ÂÓ ˘¿Ú¯Ô˘Ó Â·ÚÎ‹ ÛÙÔÈ-

¯Â›·. ∞fi ÚfiÛÊ·ÙË ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛË˜, ËÚÔÁÂÓÓËÙÈÎ‹ ¯Ú‹ÛË ÙË˜ Ô˘Û›·˜ ‰ÂÓ ‰ËÌÈÔ‡ÚÁËÛÂ·ÓÂÈı‡ÌËÙÂ˜ ÂÓ¤ÚÁÂÈÂ˜ ÛÙÔ ¤Ì‚Ú˘Ô Î·È ·ÚÁfiÙÂÚ·ÛÙÔ ıËÏ¿˙ÔÓ ÓÂÔÁÓfi (29).

§·Ì‚¿ÓÔÓÙ·˜, fiÌˆ˜, ˘’ fi„ÈÓ ÙËÓ ÂÌ‚Ú˘ÔÙÔÍÈÎ‹‰Ú¿ÛË ÛÙ· ÂÈÚ·Ì·Ùfi˙ˆ·, Û˘ÓÈÛÙ¿Ù·È Ë ¯Ú‹ÛË ÙË˜Ô˘Û›·˜ ÌfiÓÔ fiÔ˘ Ú·ÁÌ·ÙÈÎ¿ ‰ÂÓ ˘¿Ú¯ÂÈ ÂÓ·Ï-Ï·ÎÙÈÎ‹ ıÂÚ·Â˘ÙÈÎ‹ Ï‡ÛË.

°·ÏÔ˘¯›·: ∏ ÚÈÛÂÚÈ‰fiÓË Î·È ÙÔ ·Ú¿ÁˆÁÔ ·˘-Ù‹˜, 9-O∏-ÚÈÛÂÚÈ‰fiÓË, ·ÂÎÎÚ›ÓÔÓÙ·È ÛÙÔ Á¿Ï· ÛÂÛ˘ÁÎÂÓÙÚÒÛÂÈ˜ ÌÂÁ·Ï‡ÙÂÚÂ˜ ‹ ›ÛÂ˜ ·fi ÙÈ˜ Û˘ÁÎÂ-ÓÙÚÒÛÂÈ˜ ÙË˜ Ô˘Û›·˜ ÛÙÔ Ï¿ÛÌ· (25).

ª¤¯ÚÈ Û‹ÌÂÚ· ˘¿Ú¯ÂÈ ÌfiÓÔ Ì›· ÂÚÈÁÚ·Ê‹ Â-Ú›ÙˆÛË˜ ÓÂÔÁÓÔ‡ Ô˘ ÂÎÙ¤ıËÎÂ ÛÙËÓ Ô˘Û›· Î·Ù¿ÙË ‰È¿ÚÎÂÈ· ıËÏ·ÛÌÔ‡ ¯ˆÚ›˜ Ó· ·ÚÔ˘ÛÈ¿ÛÂÈ ·ÓÂ-Èı‡ÌËÙÂ˜ ÂÓ¤ÚÁÂÈÂ˜ (30).

∂ÂÈ‰‹ Ù· ‰Â‰ÔÌ¤Ó· Â›Ó·È ·ÓÂ·ÚÎ‹, ÂÊ’ fiÛÔÓ¯ÔÚËÁÂ›Ù·È Ë Ô˘Û›· ÛÙË ıËÏ¿˙Ô˘Û· ÌËÙ¤Ú·, Û˘ÓÈ-ÛÙ¿Ù·È Ë ÛÙÂÓ‹ ·Ú·ÎÔÏÔ‡ıËÛË ÙÔ˘ ÓÂÔÁÓÔ‡ ÁÈ·Ù˘¯fiÓ ·ÓÂÈı‡ÌËÙÂ˜ ÂÓ¤ÚÁÂÈÂ˜.

OÏ·Ó˙·›ÓË(∫·ÙËÁÔÚ›· Î‡ËÛË˜ C Î·È Á·ÏÔ˘¯›·˜ L3 - ∂ÌÔ-

ÚÈÎ¿ ÛÎÂ˘¿ÛÌ·Ù·: Zyprexa)∏ ÔÏ·Ó˙·›ÓË ·Ó‹ÎÂÈ ÛÙËÓ Î·ÙËÁÔÚ›· ÙˆÓ ¿Ù˘-

ˆÓ ·ÓÙÈ„˘¯ˆÛÈÎÒÓ Î·È ·ÚÔ˘ÛÈ¿˙ÂÈ ¯ËÌÈÎ‹ Û˘ÁÁ¤-ÓÂÈ· ÌÂ ÙËÓ ÎÏÔ˙·›ÓË. Œ¯ÂÈ, Â›ÛË˜, ÙÔÓ ›‰ÈÔ ÌË¯·-ÓÈÛÌfi ‰Ú¿ÛË˜. ∏ Ô˘Û›· ·˘Ù‹, ÛÂ ·ÓÙ›ıÂÛË ÌÂ Ù· ·-Ï·È¿ ·ÓÙÈ„˘¯ˆÛÈÎ¿ Ê¿ÚÌ·Î·, ‰ÂÓ ·˘Í¿ÓÂÈ Ù· Â›-Â‰· ÙË˜ ÚÔÏ·ÎÙ›ÓË˜ Î·È, ˆ˜ ÂÎ ÙÔ‡ÙÔ˘, ‰ÂÓ Ê·›-ÓÂÙ·È Ó· ÂËÚÂ¿˙ÂÈ ÙË ÁÔÓÈÌfiÙËÙ· ÙˆÓ Á˘Ó·ÈÎÒÓ ·˘-ÙÒÓ ÏfiÁˆ ÙË˜ ·Ú·ÙËÚÔ‡ÌÂÓË˜ ·Ú·ÈÔÌËÓfiÚÚÔÈ·˜.¢ÂÓ ÂÌÊ·Ó›˙ÂÈ ÛËÌ·ÓÙÈÎ¤˜ ÂÍˆ˘Ú·ÌÈ‰ÈÎ¤˜ ·ÓÂÈ-ı‡ÌËÙÂ˜ ÂÓ¤ÚÁÂÈÂ˜. ∞fi ÙÈ˜ Ï¤ÔÓ Û˘¯Ó¤˜ ·Ó·ÊÂ-ÚfiÌÂÓÂ˜ ·ÚÂÓ¤ÚÁÂÈÂ˜ Â›Ó·È Ë ˘ÓËÏ›· Î·È Ë ·‡ÍË-ÛË ÙÔ˘ ‚¿ÚÔ˘˜.

∫‡ËÛË: ¢È¤Ú¯ÂÙ·È ÙÔÓ Ï·ÎÔ‡ÓÙ·. ™Ù· ÂÈÚ·Ì·-Ùfi˙ˆ·, ÛÂ ‰fiÛÂÈ˜ ˘„ËÏfiÙÂÚÂ˜ ·˘ÙÒÓ ÙÔ˘ ·ÓıÚÒ-Ô˘, ‰ÂÓ Ê·›ÓÂÙ·È Ó· ¤¯ÂÈ ÙÂÚ·ÙÔÁfiÓÔ ‰Ú¿ÛË. ¶·-ÚÔ˘ÛÈ¿˙ÂÈ, fiÌˆ˜, ·‡ÍËÛË ÙÔ˘ ÔÛÔÛÙÔ‡ ÙˆÓ ÂÓ‰Ô-Ì‹ÙÚÈˆÓ ı·Ó¿ÙˆÓ Î·È ÌÂ›ˆÛË ÙÔ˘ ‚¿ÚÔ˘˜ ÙˆÓ ÂÌ-‚Ú‡ˆÓ (26).

∞fi ÙË ÌÂÏ¤ÙË ÙˆÓ Schenker Î·È Û˘Ó (1999) Ê·›-ÓÂÙ·È fiÙÈ ÙÔ 5-14% ÙË˜ ¯ÔÚËÁÔ‡ÌÂÓË˜ ÔÛfiÙËÙ·˜ÂÚÓ¿ÂÈ ÛÂ ÂÓÂÚÁ‹ ÌÔÚÊ‹ ·fi ÙÔÓ Ï·ÎÔ‡ÓÙ·, ÛÂ‰È¿ÛÙËÌ· 4 ˆÚÒÓ (31).

∞fi ÙËÓ ·Ó¿Ï˘ÛË ÙˆÓ Goldstein Î·È Û˘Ó (2000),ÛÂ 23 ÚÔÔÙÈÎ¤˜ Î·È 9 ·Ó·‰ÚÔÌÈÎ¤˜ ÌÂÏ¤ÙÂ˜ ÌÂÚÔÁÂÓÓËÙÈÎ‹ ¯Ú‹ÛË ÙË˜ Ô˘Û›·˜ ÂÍ‹¯ıËÛ·Ó Ù··ÎfiÏÔ˘ı· ÛÙÔÈ¯Â›·. ∏ ¤Î‚·ÛË ÙˆÓ 23 ÚÔÔÙÈÎÒÓÌÂÏÂÙÒÓ ‹Ù·Ó ˆ˜ ÂÍ‹˜: ·˘ÙfiÌ·ÙÂ˜ ·Ô‚ÔÏ¤˜ ÛËÌÂÈÒıËÎ·Ó ÛÂ ÙÚÂÈ˜ ÂÁÎ‡Ô˘˜ (ÔÛÔÛÙfi 13%) Î·È ÂÓ‰ÔÌ‹ÙÚÈÔ˜ ı¿Ó·ÙÔ˜ ÛÂ Ì›· ¤ÁÎ˘Ô, ÌÂÙ¿ ·fi·˘ÙfiÌ·ÙË Ú‹ÍË ÙˆÓ ˘Ì¤ÓˆÓ ÛÙÈ˜ 37 Â‚‰ÔÌ¿‰Â˜(ÔÛÔÛÙfi 5%). ™ÙËÓ ÂÚ›ÙˆÛË ÙÔ˘ ÂÓ‰ÔÌ‹ÙÚÈÔ˘


252

ı·Ó¿ÙÔ˘, Ë ÌËÙ¤Ú· Â›¯Â ÂÈ‚·Ú˘Ì¤ÓÔ ·ÙÔÌÈÎfi ÈÛÙÔ-ÚÈÎfi (Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË, ıÚÔÌ‚ÔÎ˘ÙÔÂÓ›·, Ë·-Ù›ÙÈ‰· Î·È ¯Ú‹ÛË ÔÏÏÒÓ Ê·ÚÌ¿ÎˆÓ). ¢¤Î· ¤ÍÈ Á˘-Ó·›ÎÂ˜ Â›¯·Ó Ê˘ÛÈÔÏÔÁÈÎfi ÙÔÎÂÙfi (ÔÛÔÛÙfi 80%),ÂÓÒ ¤ÁÈÓÂ Î·È Ì›· Î·ÈÛ·ÚÈÎ‹ ÙÔÌ‹ ÛÙÈ˜ 30 Â‚‰ÔÌ¿-‰Â˜, ÏfiÁˆ ÂÌ‚Ú˘˚Î‹˜ ‰˘Û¯¤ÚÂÈ·˜, ÛÂ ÌËÙ¤Ú· ÌÂÈÛÙÔÚÈÎfi Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË, ˘Ôı˘ÚÂÔÂÈ‰ÈÛÌfiÎ·È ÚÔÂÎÏ·Ì„›·. ¶·Ú¿Ù·ÛË Î˘‹ÛÂˆ˜ ÛËÌÂÈÒıËÎÂÛÂ ‰‡Ô ÂÚÈÙÒÛÂÈ˜. ™Â ·˘Ù‹ ÙËÓ ÔÌ¿‰· ÙˆÓ 23 Á˘-Ó·ÈÎÒÓ, Ë ¯Ú‹ÛË ÙË˜ ÔÏ·Ó˙·›ÓË˜ ‰ÂÓ ·‡ÍËÛÂ Ù·ÔÛÔÛÙ¿ ÙˆÓ ·Ô‚ÔÏÒÓ, ÙˆÓ ÂÓ‰ÔÌ‹ÙÚÈˆÓ ı·Ó¿-ÙˆÓ, ÙË˜ ÚÔˆÚfiÙËÙ·˜ ‹ ÌÂÈ˙fiÓˆÓ ·ÓˆÌ·ÏÈÒÓ ÛÂÛ¯¤ÛË ÌÂ ÙÔÓ ÁÂÓÈÎfi ÏËı˘ÛÌfi (32).

∞fi ÙË ÌÂÏ¤ÙË ÙˆÓ Kirchheiner Î·È Û˘Ó (2000)‰ÂÓ ·Ó·Ê¤ÚÔÓÙ·È ·ÚÂÓ¤ÚÁÂÈÂ˜ ·fi ÙË Ï‹„Ë ÙË˜Ô˘Û›·˜ Î·Ù¿ ÙËÓ Î‡ËÛË (33). ∫·È ·fi Ù· ‰Â‰ÔÌ¤Ó·ÙˆÓ Nagy Î·È Û˘Ó (2001) ‰ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ·-ÚÂÓ¤ÚÁÂÈÂ˜ ·fi ÙËÓ ÚÔÁÂÓÓËÙÈÎ‹ ¤ÎıÂÛË ÛÙËÓ Ô˘-Û›· ÙÔ˘ ÓÂÔÁÓÔ‡, Ë ÌËÙ¤Ú· ÙÔ˘ ÔÔ›Ô˘ ÂÏ¿Ì‚·ÓÂÙËÓ ÔÏ·Ó˙·›ÓË ·fi ÙËÓ 25Ë Â‚‰ÔÌ¿‰· Î‡ËÛË˜ Î·ÈÌ¤¯ÚÈ ÙÔ Ù¤ÏÔ˜ ·˘Ù‹˜. ∆Ô Apgar score ÙÔ˘ ÓÂÔÁÓÔ‡ÛÙÔ 1Ô ÏÂÙfi ‹Ù·Ó 7 Î·È ÛÙÔ 5Ô ÏÂÙfi ‹Ù·Ó 9 (34).

°·ÏÔ˘¯›·: ∞fi Ù· ˘¿Ú¯ÔÓÙ· ÛÙÔÈ¯Â›· ÛÂ ÂÈÚ·-Ì·Ùfi˙ˆ· Ê·›ÓÂÙ·È fiÙÈ Ë ÔÏ·Ó˙·›ÓË ·ÂÎÎÚ›ÓÂÙ·ÈÛÙÔ Á¿Ï· ÙˆÓ Â›Ì˘ˆÓ. ™ÙÔÓ ¿ÓıÚˆÔ ‰ÂÓ ˘¿Ú-¯Ô˘Ó Â·ÚÎ‹ ÛÙÔÈ¯Â›· (32).

OÈ Goldstein Î·È Û˘Ó (2000) ÂÚÈÁÚ¿ÊÔ˘Ó ‰‡ÔÂÚÈÙÒÛÂÈ˜ Ô˘ ÂÎÙ¤ıËÎ·Ó ÛÙËÓ ÔÏ·Ó˙·›ÓË Î·Ù¿ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ıËÏ·ÛÌÔ‡ (32). ™ÙËÓ ÚÒÙË ÂÚ›-ÙˆÛË, Ë ÌËÙ¤Ú· Ô˘ ¤·Û¯Â ·fi ·Ú·ÓÔ˚Î‹ Û¯È-˙ÔÊÚ¤ÓÈ·, ÂÏ¿Ì‚·ÓÂ ÔÏ·Ó˙·›ÓË 10 mg Ì·˙› ÌÂ ÙÚÈ-ÊıÔÚÈÔÂÚ·˙›ÓË Î·È ·ÚÔÍÂÙ›ÓË fiÙ·Ó ÙÔ ÓÂÔÁÓfiÙË˜ ‹Ù·Ó 2 ÌËÓÒÓ. ™Â ·˘Ù‹ ÙËÓ ·Ó·ÊÔÚ¿ ‰ÂÓ ˘‹Ú-¯·Ó ·ÓÂÈı‡ÌËÙÂ˜ ÂÓ¤ÚÁÂÈÂ˜. ™ÙË ‰Â‡ÙÂÚË ÂÚ›-ÙˆÛË, ÙÔ ÓÂÔÁÓfi ·ÚÔ˘Û›·ÛÂ ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi›ÎÙÂÚÔ, ˘ÓËÏ›· Î·È Î·Ú‰ÈÔÌÂÁ·Ï›·. ∏ ÌËÙ¤Ú· ÙÔ˘ÂÏ¿Ì‚·ÓÂ 5 mg ËÌÂÚËÛ›ˆ˜ Î·Ù¿ ÙÔ ÚÒÙÔ Î·È ÙÚ›-ÙÔ ÙÚ›ÌËÓÔ ÙË˜ Î‡ËÛË˜. O ›ÎÙÂÚÔ˜ Î·È Ë ˘ÓËÏ›··Ú¤ÌÂÈÓ·Ó Î·È ÌÂÙ¿ ÙË ‰È·ÎÔ‹ ÙÔ˘ ıËÏ·ÛÌÔ‡.∂ÔÌ¤Óˆ˜, Ù· Û˘ÌÙÒÌ·Ù· ‰ÂÓ ÌÔÚÔ‡Ó Ó· ·Ô-‰ÔıÔ‡Ó ÛÙË Ï‹„Ë ÙË˜ ÔÏ·Ó˙·›ÓË˜ (17,32).

º˘ÛÈÎ¿, ·fi ‰‡Ô ÌfiÓÔ ÂÚÈÙÒÛÂÈ˜ ‰ÂÓ Â›Ó·È‰˘Ó·Ù‹ Ë ÂÍ·ÁˆÁ‹ Û˘ÌÂÚ·ÛÌ¿ÙˆÓ ÁÈ· ÙËÓ ·ÛÊ¿-ÏÂÈ· ÙË˜ Ô˘Û›·˜ Î·Ù¿ ÙÔÓ ıËÏ·ÛÌfi.

ª¤¯ÚÈ ÙË Û˘ÏÏÔÁ‹ Â·ÚÎÒÓ ÛÙÔÈ¯Â›ˆÓ ÁÈ· ÙËÓÔ˘Û›·, Û˘ÓÈÛÙ¿Ù·È Ó· ·ÔÊÂ‡ÁÂÙ·È Ô ıËÏ·ÛÌfi˜ Î·-Ù¿ ÙË ‰È¿ÚÎÂÈ· ·ÁˆÁ‹˜ ÌÂ ÙËÓ ÔÏ·Ó˙·›ÓË Î·È, ÁÂ-ÓÈÎ¿, Ù· ¿ÏÏ· ¿Ù˘· ·ÓÙÈ„˘¯ˆÛÈÎ¿ Ê¿ÚÌ·Î·.

∞fi ÙËÓ ÚfiÛÊ·ÙË ÌÂÏ¤ÙË ÙˆÓ Koren Î·È Û˘Ó(2002) Ê·›ÓÂÙ·È fiÙÈ Ë ·‡ÍËÛË ÙÔ˘ ÔÛÔÛÙÔ‡ ÙˆÓ·ÓˆÌ·ÏÈÒÓ ÙÔ˘ ÓÂ˘ÚÈÎÔ‡ ÛˆÏ‹Ó· ÛÙ· ÓÂÔÁÓ¿ ÙˆÓ·ÛıÂÓÒÓ ÌÂ Û¯È˙ÔÊÚ¤ÓÂÈ· ‰ÂÓ ÔÊÂ›ÏÂÙ·È ÛÙËÓ ·ÓÙÈ-„˘¯ˆÛÈÎ‹ Ô˘Û›·, ·ÏÏ¿ ÛÙËÓ ¤ÏÏÂÈ„Ë Ê˘ÏÏÈÎÔ‡ ÔÍ¤-

Ô˜ Î·È ÛÙËÓ ·¯˘Û·ÚÎ›·. ∞˘ÙÔ› ÔÈ ‰‡Ô Û˘Ì·Ú¿ÁÔ-ÓÙÂ˜ ‹Ù·Ó ·ÚÎÂÙ¿ Û˘¯ÓÔ› ÛÂ ·˘Ù‹ ÙËÓ ÏËı˘ÛÌÈ·Î‹ÔÌ¿‰· (35).

™Ô˘ÏÈÚ›‰Ë (∫·ÙËÁÔÚ›· Á·ÏÔ˘¯›·˜ L2 - ∂ÌÔÚÈÎ¿ ÛÎÂ˘¿-

ÛÌ·Ù·: Dogmatyl, Nufarol, Darleton Î.¿.)∞Ó·ÛÙ¤ÏÏÂÈ ÙÔ˘˜ D2 ÓÙÔ·ÌÈÓÈÎÔ‡˜ ˘Ô‰Ô¯Â›˜,

ÎÂÓÙÚÈÎÔ‡˜ Î·È ÂÚÈÊÂÚÈÎÔ‡˜. ™Â ÌÂÁ¿ÏÂ˜ ‰fiÛÂÈ˜ÚÔÎ·ÏÂ› ¤ÓÙÔÓË ˘ÂÚÚÔÏ·ÎÙÈÓ·ÈÌ›·.

∫‡ËÛË: ¢ÂÓ ˘¿Ú¯Ô˘Ó ‚È‚ÏÈÔÁÚ·ÊÈÎ¿ ‰Â‰ÔÌ¤Ó·.°·ÏÔ˘¯›·: ∏ ÛÔ˘ÏÈÚ›‰Ë Â›Ó·È ¤Ó·˜ ·ÓÙ·ÁˆÓÈ-

ÛÙ‹˜ ÙË˜ ÓÙÔ·Ì›ÓË˜ Î·È, ˆ˜ ÂÎ ÙÔ‡ÙÔ˘, ‰ÈÂÁÂ›ÚÔ-ÓÙ·˜ ÙËÓ ¤ÎÎÚÈÛË ÙË˜ ÚÔÏ·ÎÙ›ÓË˜, ·˘Í¿ÓÂÈ ÙËÓ ·-Ú·ÁˆÁ‹ ÙÔ˘ Á¿Ï·ÎÙÔ˜. ™Â ‰‡Ô ÌÂÏ¤ÙÂ˜, ÔÈ ÌËÙ¤ÚÂ˜ÂÏ¿Ì‚·Ó·Ó 100 mg ÛÔ˘ÏÈÚ›‰Ë˜ ËÌÂÚËÛ›ˆ˜. OÈ Û˘-ÁÎÂÓÙÚÒÛÂÈ˜ ÙË˜ Ô˘Û›·˜ ÛÙÔ Á¿Ï· Î˘Ì¿ÓıËÎ·Ó ·fi0,83 mg/l ¤ˆ˜ 1,97 mg/l. ™‡ÌÊˆÓ· ÌÂ ·˘Ù¤˜ ÙÈ˜ Û˘-ÁÎÂÓÙÚÒÛÂÈ˜, ÙÔ ÓÂÔÁÓfi ı· Ï¿‚ÂÈ ·fi 8,7% ¤ˆ˜ Î·È18% ÙˆÓ ‰fiÛÂˆÓ ÙË˜ ÌËÙ¤Ú·˜. ™Â ·˘Ù¤˜ ÙÈ˜ ÌÂÏ¤-ÙÂ˜ ‰ÂÓ ˘¿Ú¯Ô˘Ó ÛÙÔÈ¯Â›· ÁÈ· Ù˘¯fiÓ ·ÓÂÈı‡ÌËÙÂ˜ÂÓ¤ÚÁÂÈÂ˜ ÛÙ· ÓÂÔÁÓ¿ (7).

∏ÏÂÎÙÚÔÛ·ÛÌÔıÂÚ·Â›· (Electroconvulsivetherapy - ECT)

¢ÂÓ Â›Ó·È Ï›ÁÂ˜ ÔÈ ÊÔÚ¤˜ Ô˘ Ë Ì·ÓÈ·Î‹ ‹ „˘-¯ˆÛÈÎ‹ ¤ÁÎ˘Ô˜ ‰ÂÓ ‰¤¯ÂÙ·È Ó· Ï¿‚ÂÈ ÙË ıÂÚ·Â˘ÙÈ-Î‹ ÙË˜ ·ÁˆÁ‹ ÏfiÁˆ Êfi‚Ô˘ Ù˘¯fiÓ ÙÂÚ·ÙÔÁ¤ÓÂÛË˜ ‹·Ú·ÓÔ˚ÎÒÓ Î·È ··ÙËÏÒÓ ÛÎ¤„ÂˆÓ, .¯. “ÙÔ Ê¿Ú-Ì·ÎÔ Â›Ó·È ‰ËÏËÙ‹ÚÈÔ ÁÈ· ÙÔ ·È‰›”. ™Â ·˘Ù¤˜ ÙÈ˜ Â-ÚÈÙÒÛÂÈ˜ ÌÔÚÂ› Ó· ˘¿ÚÍÔ˘Ó Â˘ÓÔ˚Î¿ ·ÔÙÂÏ¤-ÛÌ·Ù· ·fi ÙË ¯Ú‹ÛË ÙË˜ ECT.

¶ÈÛÙÂ‡ÂÙ·È fiÙÈ Ë ‰Ú¿ÛË ÙË˜ ÔÊÂ›ÏÂÙ·È ÛÙËÓ ·Â-ÏÂ˘ı¤ÚˆÛË ÛËÌ·ÓÙÈÎ‹˜ ÔÛfiÙËÙ·˜ ÓÂ˘ÚÔ‰È·‚È‚·-ÛÙÒÓ, ÓÔÚ·‰ÚÂÓ·Ï›ÓË˜, ÛÂÚÔÙÔÓ›ÓË˜ Î·È ÓÙÔ·Ì›-ÓË˜, ‰È·Ì¤ÛÔ˘ ÙˆÓ ÚÔÎÏËı¤ÓÙˆÓ Û·ÛÌÒÓ.

∏ ECT ·ÔÙÂÏÂ› Ì›· ·ÛÊ·Ï‹ ÂÓ·ÏÏ·ÎÙÈÎ‹ ıÂÚ·-Â˘ÙÈÎ‹ ÚÔÛ¤ÁÁÈÛË, Ë ÔÔ›· ÌÔÚÂ› Î·È Ó· Û˘Ó-‰˘·ÛÙÂ› ÌÂ ÙÔ˘˜ ·ÓÙÈ„˘¯ˆÛÈÎÔ‡˜ Î·È ·ÓÙÈÎ·Ù·ıÏÈ-ÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜.

∏ ËÏÂÎÙÚÔÛ·ÛÌÔıÂÚ·Â›· ÌÔÚÂ› Ó· ÚÔÎ·-Ï¤ÛÂÈ ·ÚÎÂÙ¤˜ ·ÚÂÓ¤ÚÁÂÈÂ˜ Î·Ù¿ ÙËÓ Î‡ËÛË. OÈÂÚÈÛÛfiÙÂÚÂ˜ ·fi ·˘Ù¤˜ ÔÊÂ›ÏÔÓÙ·È ÛÙËÓ ˘ÔÍ›·Î·È ÙËÓ ˘fiÙ·ÛË, ÔÈ ÔÔ›Â˜ ‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È Î·Ù¿ÙËÓ ÂÎÙ¤ÏÂÛË ÙË˜ ÌÂıfi‰Ô˘. ∏ Ì¤ıÔ‰Ô˜ Ê·›ÓÂÙ·È,Â›ÛË˜, Ó· ·ÂÏÂ˘ıÂÚÒÓÂÈ ˆÎ˘ÙÔÎ›ÓË Î·È ¿ÏÏÂ˜ ·Á-ÁÂÈÔ‰Ú·ÛÙÈÎ¤˜ ÔÚÌfiÓÂ˜, fiÔ˘ Ë ÌÂÓ ÚÒÙË ÌÔÚÂ›Ó· ÚÔÎ·Ï¤ÛÂÈ ÚfiˆÚÂ˜ Û˘Û¿ÛÂÈ˜ ÙË˜ Ì‹ÙÚ·˜Î·È ÔÈ ‰Â‡ÙÂÚÂ˜ ·ÈÌÔÚÚ·Á›Â˜ (36-39) (¶›Ó·Î·˜ 2).

™Â Ì›· ‚È‚ÏÈÔÁÚ·ÊÈÎ‹ ·Ó·ÛÎfiËÛË ÙÔ˘ Miller(1994), ¤¯Ô˘Ó Î·Ù·ÁÚ·ÊÂ› Û˘ÓÔÏÈÎ¿ 28 ÂÈÏÔÎ¤˜ ÛÂÂÚÈÛÛfiÙÂÚÂ˜ ·fi 300 ECT Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜Î‡ËÛË˜. ™Â ·˘Ù¤˜ Û˘ÌÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÂÌ‚Ú˘˚Î‹Î·Ú‰È·Î‹ ·ÚÚ˘ıÌ›·, ÎÔÈÏÈ·Îfi ¿ÏÁÔ˜, ÛÙ·ÁÔÓÔÂÈ‰‹˜


253

ÎÔÏÈÎ‹ ·ÈÌfiÚÚÔÈ·, ÚfiˆÚÂ˜ Û˘Û¿ÛÂÈ˜ Î·È Úfiˆ-ÚÔ˜ ÙÔÎÂÙfi˜, Ô ÔÔ›Ô˜ fiÌˆ˜ ÔÊÂÈÏfiÙ·Ó ÛÂ ¿ÏÏË ·È-Ù›·. ™Â 5 ÓÂÔÁÓ¿ ˘‹Ú¯Â Î¿ÔÈ·˜ ÌÔÚÊ‹˜ Û˘ÁÁÂÓ‹˜·ÓˆÌ·Ï›·, Î·Ì›· fiÌˆ˜ ‰ÂÓ Û¯ÂÙ›ÛÙËÎÂ ÌÂ ÙË Ì¤ıÔ-‰Ô. ™ÙËÓ ·ÓˆÙ¤Úˆ ·Ó·ÛÎfiËÛË ·Ó·Ê¤ÚÔÓÙ·È ÙÚÂÈ˜ÂÚÈÙÒÛÂÈ˜ ÂÓ‰ÔÌ‹ÙÚÈÔ˘ ı·Ó¿ÙÔ˘ (40).

™Â ¿ÏÏÂ˜ ‰‡Ô ÂÚÈÙÒÛÂÈ˜ Î·Ù·ÁÚ¿ÊÂÙ·È Ë ·˘ÍË-Ì¤ÓË Û˘¯ÓfiÙËÙ· ÚfiˆÚÔ˘ ÙÔÎÂÙÔ‡ ÌÂÙ¿ ·fi ECT. OÈÚfiˆÚÂ˜ Û˘Û¿ÛÂÈ˜ ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó ÂÈÙ˘¯Ò˜ ÌÂÙÔÎÔÏ˘ÙÈÎ‹ ·ÁˆÁ‹ (6,39). ∞ÓÙ›ıÂÙ·, ÛÂ Ì›· ÂÚ›Ùˆ-ÛË ·ÎÔÏÔ‡ıËÛÂ ·˘ÙfiÌ·ÙË ·Ô‚ÔÏ‹ Î˘‹Ì·ÙÔ˜ 8Â‚‰ÔÌ¿‰ˆÓ ÌÂÙ¿ ÙËÓ 3Ë Û˘ÓÂ‰Ú›· (41).

∞fi Ù· ·Ú·¿Óˆ Ê·›ÓÂÙ·È fiÙÈ ÔÈ Ï¤ÔÓ Û˘¯Ó¤˜·ÚÂÓ¤ÚÁÂÈÂ˜ ÙË˜ ECT Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ Î‡Ë-ÛË˜ Â›Ó·È Ô ÚfiˆÚÔ˜ ÙÔÎÂÙfi˜, ÏfiÁˆ ·‡ÍËÛË˜ ÙˆÓÛ˘Û¿ÛÂˆÓ ÙË˜ Ì‹ÙÚ·˜ Î·È Ë ÎÔÏÈÎ‹ ·ÈÌfiÚÚÔÈ·.Œ¯ÂÈ, Â›ÛË˜, ·Ó·ÊÂÚıÂ› ÚfiˆÚË ·ÔÎfiÏÏËÛËÏ·ÎÔ‡ÓÙ·.

∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÙÚ›ÙÔ˘ ÙÚÈÌ‹ÓÔ˘, ÚÈÓ ÙËÓ¤Ó·ÚÍË ·˘Ù‹˜ ÙË˜ ıÂÚ·Â›·˜, Ú¤ÂÈ Ó· ¯ÔÚËÁÂ›Ù·È·ÓÙÈfiÍÈÓÔ ÁÈ· Ó· ÌÂÙÚÈ¿ÛÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ÓÂ˘ÌÔÓ›·˜·fi ÂÈÛÚfiÊËÛË. ∏ Â·ÚÎ‹˜ ÔÍ˘ÁfiÓˆÛË Î·È Ô ˘Â-Ú·ÂÚÈÛÌfi˜ ÙË˜ ÂÁÎ‡Ô˘ ÚÈÓ, Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Î·È·Ì¤Ûˆ˜ ÌÂÙ¿ ÙËÓ ÂÎÙ¤ÏÂÛË ÙË˜ ECT, Û˘Ì‚¿ÏÏÔ˘ÓÛËÌ·ÓÙÈÎ¿ ÛÙË ÌÂ›ˆÛË ÙË˜ ÂÌ‚Ú˘˚Î‹˜ ‰˘Û¯¤ÚÂÈ·˜ÏfiÁˆ ˘ÔÍ·ÈÌ›·˜ (40,42).

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40. Miller LJ. Use of electroconvulsive therapy duringpregnancy. Hosp Community Psychiatry 1994;45:444-450.

41. Echevarria Moreno M, Martin Munoz J, SanchezValderrabanos J, Vazquez Gutierrez T. Electroconvulsivetherapy in the first trimester of pregnancy. J ECT1998;14:251-254.

42. Walker R, Swartz CM. Electroconvulsive therapy duringhigh-risk pregnancy. Gen Hosp Psychiatry 1994;16:348-353.

43. American Psychiatric Association Committee onElectroconvulsive Therapy. The practice of electrocon-vulsive therapy: recommendations for treatment, training,and privileging. 2nd ed. Washington, DC: AmericanPsychiatric Association Press; 2001.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 04-12-2002HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛË˜: 16-04-2003

¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ¡›ÎÔ˜ ∫·Ì¿˜ ª. ∞ÔÛÙÔÏ›‰Ë 10, ∆.∫. 203 00, §Ô˘ÙÚ¿ÎÈ, ∫fiÚÈÓıÔ˜ E-mail: [email protected]


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∂ÈÏË„›· Î·È Î‡ËÛË∂. Ã·Ù˙Ë‰¿ÎË, Ã. °È·ÓÓ·ÎÔÔ‡ÏÔ˘

Epilepsy and pregnancy E. Hatzidaki, C. Giannakopoulou


¡ÂÔÁÓÔÏÔÁÈÎ‹ ∫ÏÈÓÈÎ‹ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹ÙË˜ Department of Neonatology of the University of Crete

�¶ÂÚ›ÏË„Ë: ∏ ÂÈÏË„›· Â›Ó·È Ì›· ÓÂ˘ÚÔÏÔÁÈÎ‹ ‰È·-Ù·Ú·¯‹ Ô˘ ·ÊÔÚ¿ ÛÙÔ 1% ÂÚ›Ô˘ ÙÔ˘ ÁÂÓÈÎÔ‡ÏËı˘ÛÌÔ‡. ∂›Ó·È Ë Û˘¯ÓfiÙÂÚË ÓÂ˘ÚÔÏÔÁÈÎ‹ ‰È·Ù·-Ú·¯‹ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ Î‡ËÛË˜. ∆Ô 0,3-0,4%ÙˆÓ ÓÂÔÁÓÒÓ ÛÙÈ˜ Ì¤ÚÂ˜ Ì·˜ ÁÂÓÓÈ¤Ù·È ·fi ÂÈÏË-ÙÈÎ¤˜ ÌËÙ¤ÚÂ˜. ∏ ÂÈÏË„›· Û¯ÂÙ›˙ÂÙ·È ÌÂ ·˘ÍËÌ¤ÓËÛ˘¯ÓfiÙËÙ· ÂÈÏÔÎÒÓ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ Î‡Ë-ÛË˜, ÔÈ ÔÔ›Â˜ ·ÂÈÏÔ‡Ó ÙË ˙ˆ‹ ÙfiÛÔ ÙË˜ ÂÁÎ‡Ô˘fiÛÔ Î·È ÙÔ˘ ÓÂÔÁÓÔ‡ ÙË˜. ∏ ·ÓÙÈÂÈÏËÙÈÎ‹ ·ÁˆÁ‹·˘Í¿ÓÂÈ ÙË Û˘¯ÓfiÙËÙ· Û˘ÁÁÂÓÒÓ ·ÓˆÌ·ÏÈÒÓ ÛÙÔ¤Ì‚Ú˘Ô. ™˘ÓÈÛÙ¿Ù·È Ë ¯ÔÚ‹ÁËÛË ÙÔ˘ Î·Ù·ÏÏËÏfiÙÂ-ÚÔ˘ ÛÎÂ˘¿ÛÌ·ÙÔ˜, ÛÙÈ˜ ÌÈÎÚfiÙÂÚÂ˜ ·ÔÙÂÏÂÛÌ·ÙÈ-Î¤˜ ‰fiÛÂÈ˜, ·Ó¿ÏÔÁ· ÌÂ ÙÔÓ Ù‡Ô ÂÈÏË„›·˜ Ô˘ÂÌÊ·Ó›˙ÂÈ Ë ¤ÁÎ˘Ô˜ Î·È ÌÂ ÙÈ˜ ÏÈÁfiÙÂÚÂ˜ ·ÓÂÈı‡-ÌËÙÂ˜ ÂÓ¤ÚÁÂÈÂ˜, ÙfiÛÔ ÁÈ· ÙË Á˘Ó·›Î· fiÛÔ Î·È ÁÈ·ÙÔ ¤Ì‚Ú˘Ô. ™ÙÈ˜ ÂÚÈÛÛfiÙÂÚÂ˜ ÂÚÈÙÒÛÂÈ˜, ÔÈ¤ÁÎ˘Â˜ ÌÂ ÂÈÏË„›· ¤¯Ô˘Ó Ê˘ÛÈÔÏÔÁÈÎ‹ Î‡ËÛË ¯ˆ-Ú›˜ Û˘Ì‚¿Ì·Ù·, ÙÔÎÂÙfi ¯ˆÚ›˜ È‰È·›ÙÂÚ· ÚÔ‚Ï‹Ì·-Ù· Î·È Á¤ÓÓËÛË Ê˘ÛÈÔÏÔÁÈÎÔ‡ ÓÂÔÁÓÔ‡. O Î›Ó‰˘ÓÔ˜Á¤ÓÓËÛË˜ ·È‰ÈÔ‡ ÌÂ Û˘ÁÁÂÓÂ›˜ ·ÓˆÌ·Ï›Â˜ ı· Ú¤-ÂÈ Ó· Á›ÓÂÙ·È ·ÓÙÈÏËÙfi˜ ÙfiÛÔ ·fi ÙËÓ ¤ÁÎ˘Ô fiÛÔÎ·È ·fi ÙÔ ÂÚÈ‚¿ÏÏÔÓ ÙË˜. ∏ ÚÔÂÙÔÈÌ·Û›· Î·È ÔÚÔÁÚ·ÌÌ·ÙÈÛÌfi˜ ÙË˜ Î‡ËÛË˜, Î·ıÒ˜ Î·È Ë ÂÈ-ı·Ú¯ËÌ¤ÓË Î·È ÛˆÛÙ‹ ·Ú·ÎÔÏÔ‡ıËÛË ·fi ÔÌ¿‰·ÂÈ‰ÈÎÒÓ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ¿ ÙË˜, Â›Ó·È ··Ú·›ÙËÙÂ˜ÚÔ¸Ôı¤ÛÂÈ˜ ÁÈ· ÙËÓ ÔÌ·Ï‹ ÂÍ¤ÏÈÍË ÙË˜ Î‡ËÛË˜Î·È ÙÔ˘ ÙÔÎÂÙÔ‡ ¯ˆÚ›˜ ÂÈÏÔÎ¤˜ Î·È ÁÈ· ÙË Á¤ÓÓË-ÛË ÂÓfi˜ Ê˘ÛÈÔÏÔÁÈÎÔ‡ Î·Ù¿ ÙÔ ‰˘Ó·ÙfiÓ ÓÂÔÁÓÔ‡.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ÂÈÏË„›·, Î‡ËÛË.

�Abstract: Epilepsy is a functional neurologicaldisease, which affects about 1% of the generalpopulation. It is the most common of theneurological disorders occurring during pregnancy.About 0.3% to 0.4% of babies nowadays are born toepileptic mothers. There is an association betweenepilepsy and an increased incidence of life-threatening complications during the course ofpregnancy, both to the pregnant woman and to hernewborn infant. Anticonvulsant drugs can increasethe incidence of congenital abnormalities in thefetus. Prescription of the most suitable medication,with the least side effects and in the lowest effectivedosage, is recommended for the benefit of both thepregnant woman and the fetus. In the majority ofcases, pregnancy in epileptic women follows anormal course terminating in a complication-freelabour and delivery and resulting in the birth of ahealthy newborn infant. However, the risk ofcongenital abnormalities in an infant born to anepileptic mother must be taken into considerationby the mother to be and her family. Careful planningand preparation for pregnancy and disciplined,accurate monitoring by specialized personnelduring its course are vital prerequisites for itsuneventful evolvement and the uncomplicateddelivery of a healthy newborn.

Key words: epilepsy, pregnancy.

∂ÈÛ·ÁˆÁ‹O fiÚÔ˜ ÂÈÏË„›· ·Ó·Ê¤ÚÂÙ·È ÛÙË ¯ÚfiÓÈ· ‰È·Ù·-

Ú·¯‹ Î·Ù¿ ÙËÓ ÔÔ›· ·Ú·ÙËÚÔ‡ÓÙ·È ÛÙÂÚÂfiÙ˘·Â·Ó·Ï·Ì‚·ÓfiÌÂÓ· ÂÂÈÛfi‰È· ‰È·Ù·Ú·¯‹˜ ÙË˜ Û˘-ÓÂ›‰ËÛË˜, ÙË˜ Û˘ÌÂÚÈÊÔÚ¿˜, ÙÔ˘ Û˘Ó·ÈÛı‹Ì·ÙÔ˜,ÙË˜ ÎÈÓËÙÈÎfiÙËÙ·˜ ‹ ÙË˜ ·ÈÛıËÙÈÎfiÙËÙ·˜. ∏ ÂÈÏË-

„›· Â›Ó·È Ì›· ÓÂ˘ÚÔÏÔÁÈÎ‹ ‰È·Ù·Ú·¯‹ Ô˘ ·ÊÔÚ¿ÛÙÔ 1% ÂÚ›Ô˘ ÙÔ˘ ÁÂÓÈÎÔ‡ ÏËı˘ÛÌÔ‡ (1,2). ∂›-Ó·È Ë Û˘¯ÓfiÙÂÚË ÓÂ˘ÚÔÏÔÁÈÎ‹ ‰È·Ù·Ú·¯‹ Î·Ù¿ ÙË‰È¿ÚÎÂÈ· ÙË˜ Î‡ËÛË˜. ™‹ÌÂÚ·, ÙÔ 0,3-0,5% ÙˆÓ ÓÂ-ÔÁÓÒÓ ÁÂÓÓÈ¤Ù·È ·fi ÂÈÏËÙÈÎ¤˜ ÌËÙ¤ÚÂ˜ (3). ∏Î‡ËÛË ÌÔÚÂ› Ó· ÂÈÙÂ›ÓÂÈ ÙË Û˘ÌÙˆÌ·ÙÔÏÔÁ›· ÙË˜

ÂÈÏËÙÈÎ‹˜ ÂÁÎ‡Ô˘ ‹ Ó· Â·Ó·‰Ú·ÛÙËÚÈÔÔÈ‹ÛÂÈÙËÓ ÂÈÏËÙÈÎ‹ ‰Ú·ÛÙËÚÈfiÙËÙ· (1). ∏ ·ÓÙÈÂÈÏËÙÈ-Î‹ ·ÁˆÁ‹ ·˘Í¿ÓÂÈ ÙË Û˘¯ÓfiÙËÙ· Û˘ÁÁÂÓÒÓ ·ÓˆÌ·-ÏÈÒÓ ÛÙÔ ¤Ì‚Ú˘Ô (4-6). °È· ÙËÓ Î·Ù¿ ÙÔ ‰˘Ó·ÙfiÓÏËÚ¤ÛÙÂÚË È·ÙÚÈÎ‹ Î·È ÓÔÛËÏÂ˘ÙÈÎ‹ ÊÚÔÓÙ›‰· ·˘-ÙÒÓ ÙˆÓ ÂÁÎ‡ˆÓ Á˘Ó·ÈÎÒÓ Î·È ÙˆÓ ÓÂÔÁÓÒÓ ÙÔ˘˜, ËÛ˘ÁÎÚfiÙËÛË ÔÌ¿‰·˜ ·ÔÙÂÏÔ‡ÌÂÓË˜ ·fi Ì·ÈÂ˘Ù‹-Ú·-Á˘Ó·ÈÎÔÏfiÁÔ, ÓÂ˘ÚÔÏfiÁÔ, ÁÂÓÂÙÈÛÙ‹, ÓÂÔÁÓÔÏfi-ÁÔ Î·È ÂÎ·È‰Â˘Ì¤ÓÔ ÓÔÛËÏÂ˘ÙÈÎfi ÚÔÛˆÈÎfi ıÂˆ-ÚÂ›Ù·È ··Ú·›ÙËÙË (7).

∂È‰Ú¿ÛÂÈ˜ ÙˆÓ ÔÚÌÔÓÒÓ ÙÔ˘ Ê‡ÏÔ˘ ÛÙËÓ ÂÈÏËÙÈÎ‹‰Ú·ÛÙËÚÈfiÙËÙ·

OÈ ÛÙÂÚÔÂÈ‰Â›˜ ÔÚÌfiÓÂ˜ Ô˘ ·Ú¿ÁÔÓÙ·È ·fi Ù·ÂÈÓÂÊÚ›‰È· Î·È ÙÈ˜ ÁÔÓ¿‰Â˜, Î·ıÒ˜ Î·È Ù· ÂÙ›‰È·Ô˘ ·Ú¿ÁÔÓÙ·È ·fi ÙËÓ ˘fiÊ˘ÛË, Ê·›ÓÂÙ·È fiÙÈ¤¯Ô˘Ó ÓÂ˘ÚÔÁÂÓ‹ ‰Ú¿ÛË Î·È ÌÔÚÔ‡Ó Ó· ÚÔÎ·Ï¤-ÛÔ˘Ó ÂÈÏËÙÈÎ‹ ÎÚ›ÛË. ∆· ÔÈÛÙÚÔÁfiÓ·, ·ÎfiÌ· Î·ÈÛÂ Ê˘ÛÈÔÏÔÁÈÎ¿ Â›Â‰· ÛÙÔ ·›Ì·, ¤¯Ô˘Ó Û˘Û¯ÂÙÈ-ÛÙÂ› ÌÂ ÚfiÎÏËÛË ÂÈÏËÙÈÎÒÓ ÎÚ›ÛÂˆÓ, ÂÓÒ Ë ¤Ï-ÏÂÈ„‹ ÙÔ˘˜ ‰ÂÓ Ê·›ÓÂÙ·È Ó· ¤¯ÂÈ ÚÔÛÙ·ÙÂ˘ÙÈÎ‹‰Ú¿ÛË. ∏ ÚÔÁÂÛÙÂÚfiÓË Ê·›ÓÂÙ·È Ó· ¤¯ÂÈ Î·Ù·-ÛÙ·ÏÙÈÎ¤˜ È‰ÈfiÙËÙÂ˜ Î·È Ó· ÂÚÈÔÚ›˙ÂÈ ÙËÓ ÂÈÏËÙÈ-Î‹ ‰Ú·ÛÙËÚÈfiÙËÙ·. ∏ Û˘¯ÓfiÙËÙ· ÙˆÓ ÂÈÏËÙÈÎÒÓÎÚ›ÛÂˆÓ ·ÚÔ˘ÛÈ¿˙ÂÈ ıÂÙÈÎ‹ Û˘Û¯¤ÙÈÛË ÌÂ ÙË Û¯¤ÛËÔÈÛÙÚ·‰ÈfiÏË˜ ÚÔ˜ ÙËÓ ÚÔÁÂÛÙÂÚfiÓË, Ë ÔÔ›· ÔÈ-Î›ÏÏÂÈ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ Á˘Ó·ÈÎÂ›Ô˘ Î‡ÎÏÔ˘. ∏Û˘¯ÓfiÙÂÚË ÂÌÊ¿ÓÈÛË ÂÈÏËÙÈÎÒÓ ÎÚ›ÛÂˆÓ ÚÈÓ ÙËÓ¤ÌÌËÓÔ Ú‡ÛË ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙÂ› ÌÂ ÙËÓ ÙÒÛË ÙˆÓÂÈ¤‰ˆÓ ÙË˜ ÚÔÁÂÛÙÂÚfiÓË˜, ÂÓÒ ÛÙË Ì¤ÛË ÙÔ˘Î‡ÎÏÔ˘ ÌÂ ÙËÓ ·‡ÍËÛË ÙˆÓ ÔÈÛÙÚÔÁfiÓˆÓ (1,8,9).

∂ÈÏË„›· Î·È ÂÊË‚Â›· ™Â ÌÂÚÈÎ¤˜ ÂÚÈÙÒÛÂÈ˜, Ë ‰È¿ÁÓˆÛË ÙË˜ ÂÈÏË-

„›·˜ Ù›ıÂÙ·È Ï·Óı·ÛÌ¤Ó· ÌÂ Û¯ÂÙÈÎ‹ Â˘ÎÔÏ›·. ª¤-¯ÚÈ Î·È ÙÔ 10% ÙˆÓ ÂÊ‹‚ˆÓ Ô˘ ıÂˆÚÂ›Ù·È fiÙÈ ¿-Û¯Ô˘Ó ·fi ÂÈÏË„›·, ÛÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ· ¤¯ÂÈ ¿Ï-ÏË ÓfiÛÔ Ô˘ ÌÈÌÂ›Ù·È ÙËÓ ÎÏÈÓÈÎ‹ ÚÔ‚ÔÏ‹ ÙË˜(10,11). ∏ “Ù·Ì¤Ï·”, fiÌˆ˜, ·˘Ù‹˜ ÙË˜ ÓfiÛÔ˘ ÁÈ·Î¿ıÂ ¿ÓıÚˆÔ Î·È È‰È·›ÙÂÚ· ÁÈ· ÙÈ˜ ÓÂ·Ú¤˜ ¤ÊË‚Â˜·ÔÙÂÏÂ› ¤Ó· ÛËÌ·ÓÙÈÎfi ÂÌfi‰ÈÔ, ÙfiÛÔ ÛÙËÓ ÚÔ-ÛˆÈÎ‹ Î·È ÔÈÎÔÁÂÓÂÈ·Î‹ ˙ˆ‹ fiÛÔ Î·È ÛÙËÓ Â·Á-ÁÂÏÌ·ÙÈÎ‹ ·ÔÎ·Ù¿ÛÙ·ÛË. ª‹ˆ˜, ÏÔÈfiÓ, Â›Ó·ÈÎ·ÈÚfi˜ ÁÈ· Â·ÓÂÎÙ›ÌËÛË ·fi ÙÔ˘˜ ÂÈ‰ÈÎÔ‡˜ Î·È ÁÈ·Ì›· Ó¤· ÚÔÛ¿ıÂÈ· Â›Ï˘ÛË˜ ÙÔ˘ Ù˘¯fiÓ ‰È·ÁÓˆ-ÛÙÈÎÔ‡ ÁÚ›ÊÔ˘; ∂›Ó·È fiÓÙˆ˜ ÂÈÏË„›· ‹ Ì‹ˆ˜ Î¿-ÔÈ· ¿ÏÏË ÓfiÛÔ˜ Ô˘ ÌÈÌÂ›Ù·È ÙËÓ ÎÏÈÓÈÎ‹ ÙË˜ ÚÔ-‚ÔÏ‹; ∏ Ê·ÚÌ·ÎÂ˘ÙÈÎ‹ ·ÁˆÁ‹ Â›Ó·È ··Ú·›ÙËÙË ‹ÌÔÚÂ› ‰˘ÓËÙÈÎ¿ Ó· ‰È·ÎÔÂ› (10);

∏ ÂÈÏË„›· ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙÂ› ÌÂ ·¯˘Û·ÚÎ›·, ¯·-ÌËÏfiÙÂÚÔ ·Ó¿ÛÙËÌ· Î·È Î·ı˘ÛÙÂÚËÌ¤ÓË ÂÌÌËÓ·Ú-¯‹ (10). ∏ ÁÔÓÈÌfiÙËÙ· ÙˆÓ Á˘Ó·ÈÎÒÓ Ô˘ ¿Û¯Ô˘Ó·fi ÂÈÏË„›· Ê·›ÓÂÙ·È Ó· ÌÂÈÒÓÂÙ·È ÛËÌ·ÓÙÈÎ¿. ∆fi-ÛÔ Ë Û˘¯ÓfiÙËÙ· ÙˆÓ ·ÓˆÔÚÚËÎÙÈÎÒÓ Î‡ÎÏˆÓ, fiÛÔ

Î·È Ë Â›ÙˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ÔÏ˘Î˘ÛÙÈÎÒÓ ˆÔ-ıËÎÒÓ Â›Ó·È ·˘ÍËÌ¤ÓÂ˜ ÛÂ Û¯¤ÛË ÌÂ ÙÔÓ ÁÂÓÈÎfiÏËı˘ÛÌfi (1,10,12,13). ∏ ¯ÔÚ‹ÁËÛË ·ÓÙÈÂÈÏËÙÈ-ÎÒÓ Ê·ÚÌ¿ÎˆÓ ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙÂ› ÌÂ ·˘ÍËÌ¤ÓÔ Ô-ÛÔÛÙfi ·ÔÙ˘¯›·˜ ÙË˜ ·ÓÙÈÛ˘ÏÏËÙÈÎ‹˜ ·ÁˆÁ‹˜, ËÔÔ›· ÔÊÂ›ÏÂÙ·È ÛÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ Ë·ÙÈÎÒÓÂÓ˙‡ÌˆÓ ·fi ÙÔ ·ÓÙÈÂÈÏËÙÈÎfi Î·È ÛÙÔÓ ÂÓÈÛ¯˘Ì¤-ÓÔ Î·Ù·‚ÔÏÈÛÌfi ÙˆÓ ÂÍˆÁÂÓÒÓ ÔÚÌÔÓÒÓ (5,7,14). ∏Î·Ú‚·Ì·˙Â›ÓË, Ë Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË, Ë Ê·ÈÓ˘ÙÔ˝ÓËÎ·È Ë ÚÈÌÈ‰fiÓË ¤¯Ô˘Ó Ù¤ÙÔÈÔ˘ Â›‰Ô˘˜ ‰Ú¿ÛË. Œ¯Ô-ÓÙ·˜ ÌÈÎÚ‹ ‹ Î·ıfiÏÔ˘ ‰Ú¿ÛË ÛÙËÓ Â·ÁˆÁ‹ ÂÓ˙‡-ÌˆÓ, ÙÔ ‚·ÏÚÔ˚Îfi ÔÍ‡, ÔÈ ‚ÂÓ˙Ô‰È·˙Â›ÓÂ˜, Ë ‚ÈÎ·-Ì·ÙÚ›ÓË Î·È Ë Ï·ÌÔÙÚÈÁ›ÓË ‰ÂÓ ¤¯Ô˘Ó Û˘Û¯ÂÙÈÛÙÂ›ÌÂ ·˘ÍËÌ¤ÓÔ ÔÛÔÛÙfi ·ÔÙ˘¯›·˜ (5,7,14,15). ∞Îfi-Ì· Î·È ˘„ËÏ¤˜ ‰fiÛÂÈ˜ ·ÓÙÈÛ˘ÏÏËÙÈÎÒÓ ÛÂ Û˘Ó‰˘·-ÛÌfi ‰ÂÓ ÂÍ·ÛÊ·Ï›˙Ô˘Ó ÙËÓ ·ÓÙÈÛ˘ÏÏËÙÈÎ‹ ÚÔ-ÛÙ·Û›·, ÂÓÒ Ë ÛˆÛÙ‹ ÂÓËÌ¤ÚˆÛË ÙË˜ ·ÛıÂÓÔ‡˜ ıÂ-ˆÚÂ›Ù·È ÌÂ›˙ÔÓÔ˜ ÛËÌ·Û›·˜ (15,16).

∂È‰Ú¿ÛÂÈ˜ ÙË˜ Î‡ËÛË˜ ÛÙËÓ ÂÈÏË„›·∏ Û˘¯ÓfiÙËÙ· ÙˆÓ ÎÚ›ÛÂˆÓ ·˘Í¿ÓÂÙ·È Î·Ù¿ ÙË

‰È¿ÚÎÂÈ· ÙË˜ Î‡ËÛË˜ ÛÙÈ˜ ÂÈÏËÙÈÎ¤˜ ¤ÁÎ˘Â˜. ∆·ÔÛÔÛÙ¿ ÔÈÎ›ÏÏÔ˘Ó ÛÙÈ˜ ‰È¿ÊÔÚÂ˜ ÌÂÏ¤ÙÂ˜ Î·È·Ó·Ê¤ÚÔÓÙ·È ·fi 8% ¤ˆ˜ 46%. ™˘Ó‹ıˆ˜ ·Ú·ÙË-ÚÂ›Ù·È ÛÂ ¿ÙÔÌ· ÌÂ ·˘ÍËÌ¤ÓË ÂÈÏËÙÈÎ‹ ‰Ú·ÛÙË-ÚÈfiÙËÙ· Î·È ·ÓÂ·ÚÎ‹ Ú‡ıÌÈÛË ÛÙËÓ ÚÔ ÙË˜ Î‡Ë-ÛË˜ ÂÚ›Ô‰Ô ÙË˜ ˙ˆ‹˜ ÙÔ˘˜ (10,12). ∞˘Ù‹ Ë ·˘ÍË-Ì¤ÓË Û˘¯ÓfiÙËÙ· Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ Î‡ËÛË˜ ¤¯ÂÈÛ˘Û¯ÂÙÈÛÙÂ› ÌÂ ‰È¿ÊÔÚÔ˘˜ ·Ú¿ÁÔÓÙÂ˜, fiˆ˜ ÌÂÈ-ˆÌ¤ÓË ·ÔÚÚfiÊËÛË ÙÔ˘ ·ÓÙÈÂÈÏËÙÈÎÔ‡ Ê·ÚÌ¿-ÎÔ˘ ÂÍ·ÈÙ›·˜ ÙË˜ ˘ÂÚ¤ÌÂÛË˜, ‰È·Ù·Ú·¯¤˜ ‡ÓÔ˘,ÂÓ‰Â¯fiÌÂÓË ÌÂ›ˆÛË ÙˆÓ ¯ÔÚËÁÔ‡ÌÂÓˆÓ ‰fiÛÂˆÓ Î·ÈÛÎÂ˘·ÛÌ¿ÙˆÓ Î·È ÌÂ›ˆÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙÔ˘ Ê·Ú-Ì¿ÎÔ˘ ÛÙÔ Ï¿ÛÌ· (10,17). ∏ ¤ÁÎ˘Ô˜ ‚Ú›ÛÎÂÙ·È ÛÂ·˘ÍËÌ¤ÓÔ Î›Ó‰˘ÓÔ Ó· ÂÎ‰ËÏÒÛÂÈ ÂÈÏËÙÈÎ‹ ÎÚ›ÛËÎ·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÙÔÎÂÙÔ‡ ÛÙÔ 1-2% ÙˆÓ ÂÚÈ-ÙÒÛÂˆÓ ‹ ÛÙÈ˜ ÂfiÌÂÓÂ˜ 24 ÒÚÂ˜ (Â›ÛË˜ ÛÂ Ô-ÛÔÛÙfi 1-2%). ∞ÓÙÈı¤Ùˆ˜, ÂÚÈÛÛfiÙÂÚÂ˜ ·fi ÙÔ50% ÙˆÓ ÂÁÎ‡ˆÓ ÌÂ ÂÈÏË„›· ·Ó·Ê¤ÚÔ˘Ó Î·Ï‡ÙÂÚËÚ‡ıÌÈÛË Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ Î‡ËÛË˜, Ë ÔÔ›· ¤¯ÂÈÛ˘Û¯ÂÙÈÛÙÂ› ÌÂ ÙËÓ ÂÚÈÔÚÈÛÌ¤ÓË ‰Ú·ÛÙËÚÈfiÙËÙ·,ÙÈ˜ ÔÚÌÔÓÈÎ¤˜ ·ÏÏ·Á¤˜ Î·È ÁÂÓÈÎfiÙÂÚ· ÌÂ ÙË ÌÂÁ·-Ï‡ÙÂÚË ÂÈı·Ú¯›· ÙÔ˘˜ (2,10,18). O Î›Ó‰˘ÓÔ˜“status epilepticus” Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ Î‡ËÛË˜ Â›-Ó·È ÌÈÎÚfiÙÂÚÔ˜ ÙÔ˘ 1% (2,10). ™Â Ì›· Ù¤ÙÔÈ· ÂÚ›-ÙˆÛË, Ô Î›Ó‰˘ÓÔ˜ ÂÓ‰ÔÌ‹ÙÚÈÔ˘ ı·Ó¿ÙÔ˘ ÌÔÚÂ› Ó··Ó¤ÏıÂÈ ÛÂ ÔÛÔÛÙfi ¤ˆ˜ Î·È 50%, ÂÓÒ ·Ú¿ÏÏËÏ··˘Í¿ÓÂÙ·È ‰Ú·Ì·ÙÈÎ¿ Ô Î›Ó‰˘ÓÔ˜ ÂÈÛÚfiÊËÛË˜ ÙË˜ÌËÙ¤Ú·˜ Î·È Ë ÌËÙÚÈÎ‹ ıÓËÙfiÙËÙ·. ™·Ó Èı·Ófi˜ÌË¯·ÓÈÛÌfi˜ ÚfiÎÏËÛË˜ ÂÓ‰ÔÌ‹ÙÚÈÔ˘ ı·Ó¿ÙÔ˘ÙÔ˘ ÂÌ‚Ú‡Ô˘ ¤¯ÂÈ ÚÔÙ·ıÂ› Ë ÂÌ‚Ú˘˚Î‹ ·ÛÊ˘Í›·,Û·Ó Û˘Ó¤ÂÈ· ÙË˜ ÔÍ¤ˆÛË˜ Î·È ÙË˜ ˘ÔÍ›·˜ ÙË˜ÌËÙ¤Ú·˜, Ë ÌÂÈˆÌ¤ÓË ·ÈÌ·ÙÈÎ‹ ·ÚÔ¯‹ ÛÙËÓ ÂÌ-‚Ú˘ÔÏ·ÎÔ˘ÓÙÈ·Î‹ ÌÔÓ¿‰· Î·È Ë ·ÔÎfiÏÏËÛË ÙÔ˘


256

257


Ï·ÎÔ‡ÓÙ· Ô˘ ÌÔÚÂ› Ó· Û˘Ì‚Â› Î·Ù¿ ÙË ‰È¿ÚÎÂÈ·ÂÓfi˜ ·Ú·ÙÂÙ·Ì¤ÓÔ˘ ÂÂÈÛÔ‰›Ô˘ Û·ÛÌÒÓ (7,19).

∂È‰Ú¿ÛÂÈ˜ ÙË˜ ÂÈÏË„›·˜ ÛÙËÓ Î‡ËÛË™ÙÈ˜ ÂÚÈÛÛfiÙÂÚÂ˜ ÂÚÈÙÒÛÂÈ˜, ÔÈ ¤ÁÎ˘Â˜ ÌÂ

ÂÈÏË„›· ¤¯Ô˘Ó Ê˘ÛÈÔÏÔÁÈÎ‹ Î‡ËÛË ¯ˆÚ›˜ Û˘Ì‚¿-Ì·Ù·, ÙÔÎÂÙfi ¯ˆÚ›˜ È‰È·›ÙÂÚ· ÚÔ‚Ï‹Ì·Ù· Î·È Á¤Ó-ÓËÛË Ê˘ÛÈÔÏÔÁÈÎÔ‡ ÓÂÔÁÓÔ‡. ∂ÓÙÔ‡ÙÔÈ˜, Ë ÂÈÏË„›·¤¯ÂÈ Û˘Û¯ÂÙÈÛÙÂ› ÌÂ ·˘ÍËÌ¤ÓË Û˘¯ÓfiÙËÙ· Ì·ÈÂ˘ÙÈ-ÎÒÓ ÂÈÏÔÎÒÓ fiˆ˜ ÙÔÍÈÓ·ÈÌ›·, ÚÔÂÎÏ·Ì„›·, ÂÓ-‰ÔÌ‹ÙÚÈÔ ı¿Ó·ÙÔ, ·ÔÎfiÏÏËÛË Ï·ÎÔ‡ÓÙ·, Úfiˆ-ÚÔ ÙÔÎÂÙfi, ÂÓ‰ÔÌ‹ÙÚÈ· Î·ı˘ÛÙ¤ÚËÛË ·Ó¿Ù˘ÍË˜,¯·ÌËÏfi Apgar score Î·È ·˘ÍËÌ¤ÓË ÂÚÈÁÂÓÓËÙÈÎ‹ıÓËÛÈÌfiÙËÙ· (17,20). ∞fi ÙÔ˘˜ Nelson Î·È Û˘Ó ¤¯ÂÈ·Ó·ÊÂÚıÂ› ·˘ÍËÌ¤ÓÔ˜ Î›Ó‰˘ÓÔ˜ ÂÓ‰ÔÌ‹ÙÚÈÔ˘ ı·Ó¿-ÙÔ˘, ÌÈÎÚÔÎÂÊ·Ï›·˜ Î·È ‰È·ÓÔËÙÈÎ‹˜ Î·ı˘ÛÙ¤ÚËÛË˜ÛÙ· ·È‰È¿ ÙˆÓ ÌËÙ¤ÚˆÓ ÌÂ ÂÈÏË„›· ÛÂ Û¯¤ÛË ÌÂÙÔÓ ÁÂÓÈÎfi ÏËı˘ÛÌfi (21).

O Î›Ó‰˘ÓÔ˜ ÂÌÊ¿ÓÈÛË˜ ÂÈÏË„›·˜ ÛÙ· ·È‰È¿ ÙˆÓÌËÙ¤ÚˆÓ ÌÂ ÂÈÏË„›· ÂÍ·ÚÙ¿Ù·È ·fi ÙËÓ ‡·ÚÍË˘ÔÎÂ›ÌÂÓË˜ ·ıÔÏÔÁ›·˜, ·ÏÏ¿ Î·È ·fi ÙË ÌÔÚÊ‹ÙË˜. ™ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ È‰ÈÔ·ıÔ‡˜ ÁÂÓÈÎÂ˘Ì¤ÓË˜ ÂÈ-ÏË„›·˜, Ô Î›Ó‰˘ÓÔ˜ ÁÈ· ÙÔ ·È‰› ÌÂ ¤Ó·Ó ¿Û¯ÔÓÙ·Û˘ÁÁÂÓ‹ ·’ ‚·ıÌÔ‡ ·Ó¤Ú¯ÂÙ·È ÛÂ 5-20%, ÂÓÒ Â¿Ó˘¿Ú¯ÂÈ Î·È ‰Â‡ÙÂÚÔ˜ ·’ ‚·ıÌÔ‡ Û˘ÁÁÂÓ‹˜ ·Ó¤Ú¯Â-Ù·È ÛÙÔ 25%. ŒÙÛÈ, ÁÈ· Ì›· ÌËÙ¤Ú· ÌÂ È‰ÈÔ·ı‹ ÁÂ-ÓÈÎÂ˘Ì¤ÓË ÂÈÏË„›·, Ô Î›Ó‰˘ÓÔ˜ Á¤ÓÓËÛË˜ ·È‰ÈÔ‡ÌÂ ÙËÓ ›‰È· ÓfiÛÔ Â›Ó·È 9-12% (22).

Œ¯ÂÈ ·Ó·ÊÂÚıÂ› fiÙÈ Ù· ·È‰È¿ ÂÈÏËÙÈÎÒÓ ÌËÙ¤-ÚˆÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Û˘¯ÓfiÙÂÚ· ¯·ÌËÏfi ‰È·ÓÔËÙÈÎfiËÏ›ÎÔ. ¢ÂÓ Â›Ó·È fiÌˆ˜ ÍÂÎ·ı·ÚÈÛÌ¤ÓÔ Î·Ù¿ fiÛÔÓ·˘Ùfi ÔÊÂ›ÏÂÙ·È ‹ fi¯È ÛÙËÓ Â›‰Ú·ÛË ÙÔ˘ ·ÓÙÈÂÈÏË-ÙÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘ (23). ∏ ÂÌÊ¿ÓÈÛË ÂÈÏËÙÈÎÒÓÎÚ›ÛÂˆÓ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ Î‡ËÛË˜, ÁÂÓÂÙÈÎÔ› ·-Ú¿ÁÔÓÙÂ˜ ‹ ÙÔ ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎfi Â›Â‰Ô ÙË˜ ÔÈ-ÎÔÁ¤ÓÂÈ·˜ ÌÔÚÔ‡Ó Ó· ‰È·‰Ú·Ì·Ù›ÛÔ˘Ó ÈÛ¯˘ÚfiÙ·ÙÔÚfiÏÔ (23,24). ŒÓ· ·Ú·ÙÂÙ·Ì¤ÓÔ ·ÛÊ˘ÎÙÈÎfi ÂÂÈ-Ûfi‰ÈÔ ÛÙ· Ï·›ÛÈ· ÂÈÏËÙÈÎ‹˜ ÎÚ›ÛË˜ Î·Ù¿ ÙË‰È¿ÚÎÂÈ· ÙË˜ Î‡ËÛË˜ ÌÔÚÂ› Ó· ¤¯ÂÈ Î·Ù·ÛÙÚÔÊÈÎ¤˜Û˘Ó¤ÂÈÂ˜ ÁÈ· ÙÔÓ ÂÁÎ¤Ê·ÏÔ ÙÔ˘ ÂÌ‚Ú‡Ô˘. ∂›Ó·ÈÁÓˆÛÙfi fiÙÈ ÙÔ ÌÔÚÊˆÙÈÎfi, ÙÔ ÎÔÈÓˆÓÈÎfi Î·È ÙÔ ÔÈÎÔ-ÓÔÌÈÎfi Â›Â‰Ô ÙˆÓ ·ÙfiÌˆÓ ÌÂ ÂÈÏË„›· ÌÔÚÂ› Ó·Â›Ó·È ¯·ÌËÏfiÙÂÚÔ ·fi ·˘Ùfi ÙÔ˘ ÁÂÓÈÎÔ‡ ÏËı˘-ÛÌÔ‡. ∞˘Ù‹ Ë ‰È·ÊÔÚÔÔ›ËÛË ÌÔÚÂ› Ó· ·Ô‰ÔıÂ›·ÊÂÓfi˜ ÌÂÓ ÛÙËÓ ›‰È· ÙË ÓfiÛÔ Î·È ÛÙËÓ ÂÓ‰Â¯fiÌÂÓË‡·ÚÍË Î¿ÔÈÔ˘ ‚·ıÌÔ‡ ÔÚÁ·ÓÈÎ‹˜ ‰˘ÛÏÂÈÙÔ˘Ú-Á›·˜, ·ÊÂÙ¤ÚÔ˘ ‰Â ÛÙ· fiÚÈ· Ô˘ ı¤ÙÂÈ Ë ›‰È· Ë Ófi-ÛÔ˜, Ë ÔÈÎÔÁ¤ÓÂÈ· Î·È Ë ÎÔÈÓˆÓ›· ÁÂÓÈÎfiÙÂÚ· ÛÙÔÛ˘ÁÎÂÎÚÈÌ¤ÓÔ ¿ÙÔÌÔ. ¢ÂÓ Â›Ó·È Ï›ÁÂ˜ ÔÈ ÂÚÈÙÒÛÂÈ˜Ô˘ ÂÈÏËÙÈÎ¿ ¿ÙÔÌ· ·Ó·ÁÎ¿˙ÔÓÙ·È ·fi ÙÔ ÎÔÈÓˆÓÈ-Îfi Û‡ÓÔÏÔ Ó· ÂÚÈÔÚ›ÛÔ˘Ó ÙÈ˜ ‰Ú·ÛÙËÚÈfiÙËÙ¤˜ ÙÔ˘˜.¢˘ÛÎÔÏÂ‡ÔÓÙ·È Ó· ÂÚÁ·ÛÙÔ‡Ó, Ó· Û˘Ó·Ó·ÛÙÚ·ÊÔ‡ÓÙÔ˘˜ Û˘ÓÔÌËÏ›ÎÔ˘˜ ÙÔ˘˜, Ó· ·ÔÎÙ‹ÛÔ˘Ó ‰ÈÎ‹ ÙÔ˘˜ÔÈÎÔÁ¤ÓÂÈ· Î·È Ó· ˙‹ÛÔ˘Ó ÙËÓ Î·ıËÌÂÚÈÓfiÙËÙ· (26).

º·ÚÌ·ÎÔÎÈÓËÙÈÎ‹ ÙˆÓ ·ÓÙÈÂÈÏËÙÈÎÒÓ ÛÙËÓ Î‡ËÛË ∏ ÌÂÈˆÌ¤ÓË Û˘ÁÎ¤ÓÙÚˆÛË ÙˆÓ ·ÓÙÈÂÈÏËÙÈÎÒÓ

ÛÙÔ Ï¿ÛÌ· Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ Î‡ËÛË˜ ·ÓÙ·Ó·-ÎÏ¿ ÙË ÌÂÈˆÌ¤ÓË ·ÔÚÚfiÊËÛË, ÙËÓ ·‡ÍËÛË ÙÔ˘fiÁÎÔ˘ ÙÔ˘ Ï¿ÛÌ·ÙÔ˜ Ô˘ ÊÙ¿ÓÂÈ Ì¤¯ÚÈ ÙÔ 50%, ÙËÌÂÈˆÌ¤ÓË ‰ÂÛÌÂ˘ÙÈÎ‹ ÈÎ·ÓfiÙËÙ· ÙˆÓ ÏÂ˘ÎˆÌ·ÙÈÓÒÓÎ·È ÙËÓ ·˘ÍËÌ¤ÓË ·¤ÎÎÚÈÛË. ¢È·ÊÔÚÔÔÈÂ›Ù·È Ùfi-ÛÔ ÙÔ ‰ÂÛÌÂ˘Ì¤ÓÔ ÌÂ ÙË ÏÂ˘ÎˆÌ·Ù›ÓË, fiÛÔ Î·È ÙÔÂÏÂ‡ıÂÚÔ ÛÙËÓ Î˘ÎÏÔÊÔÚ›· ·ÓÙÈÂÈÏËÙÈÎfi (5,27).O ÙfiÓÔ˜ ÙÔ˘ ÛÙÔÌ¿¯Ô˘ Î·È Ë ÎÈÓËÙÈÎfiÙËÙ¿ ÙÔ˘ Â›Ó·ÈÌÂÈˆÌ¤Ó· Î·Ù¿ ÙËÓ Î‡ËÛË, ÌÂ ·ÔÙ¤ÏÂÛÌ· ÙËÓ Î·-ı˘ÛÙÂÚËÌ¤ÓË Î¤ÓˆÛË ÙÔ˘ ÛÙÔÌ¿¯Ô˘. ∏ Ó·˘Ù›· Î·ÈÔÈ ¤ÌÂÙÔÈ Ô˘ Û˘Ì‚·›ÓÔ˘Ó È‰È·›ÙÂÚ· ÛÙÔ ÚÒÙÔ ÙÚ›-ÌËÓÔ, ‰˘ÛÎÔÏÂ‡Ô˘Ó ·ÎfiÌ· ÂÚÈÛÛfiÙÂÚÔ ÙËÓ Úfi-ÛÏË„Ë, ·ÏÏ¿ Î·È ÙËÓ ·ÔÚÚfiÊËÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘.O fiÁÎÔ˜ ÙÔ˘ Ï¿ÛÌ·ÙÔ˜ ·˘Í¿ÓÂÙ·È Î·Ù¿ 50%, ÂÓÒÙÔ ÎÏ¿ÛÌ· ÂÍÒıËÛË˜ Î·Ù¿ 30%, ·Ú¿ÁÔÓÙÂ˜ Ô˘Û˘ÓÂÈÛÊ¤ÚÔ˘Ó ÛÙË ÌÂ›ˆÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ·ÓÙÈÂ-ÈÏËÙÈÎÒÓ ÛÙËÓ ¤ÁÎ˘Ô. ™Ù· ÚÔ¯ˆÚËÌ¤Ó· ÛÙ¿‰È·ÙË˜ Î‡ËÛË˜, Ù· Â›Â‰· ÙË˜ ÏÂ˘ÎˆÌ·Ù›ÓË˜ ÌÂÈÒÓÔ-ÓÙ·È, ÌÂ ·ÔÙ¤ÏÂÛÌ· ÙË ÌÂ›ˆÛË ÙÔ˘ ‰ÂÛÌÂ˘Ì¤ÓÔ˘Î·È ÙËÓ ·‡ÍËÛË ÙÔ˘ ÂÏÂ‡ıÂÚÔ˘ Î·È ‰È·ı¤ÛÈÌÔ˘ ÁÈ·‚ÈÔÌÂÙ·Û¯ËÌ·ÙÈÛÌfi Î·È ·¤ÎÎÚÈÛË ÎÏ¿ÛÌ·ÙÔ˜ ÙÔ˘·ÓÙÈÂÈÏËÙÈÎÔ‡. ∏ Î‡ËÛË Â›Ó·È ÁÓˆÛÙfi fiÙÈ ÂËÚÂ¿-˙ÂÈ ÙÔ ÌÂÙ·‚ÔÏÈÛÌfi Î·È ÙË ‰Ú·ÛÙËÚÈfiÙËÙ· ÙˆÓ Ë·-ÙÈÎÒÓ ÂÓ˙‡ÌˆÓ. ∏ ·‡ÍËÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙË˜ Î˘ÎÏÔ-ÊÔÚÔ‡Û·˜ ÚÔÁÂÛÙÂÚfiÓË˜ Â¿ÁÂÈ Ù· Ë·ÙÈÎ¿ ÌÈ-ÎÚÔÛˆÌÈ·Î¿ ¤Ó˙˘Ì·, ÂÓÒ Ù· ÔÈÛÙÚÔÁfiÓ· ‰ÚÔ˘Ó·Ó·ÛÙ·ÏÙÈÎ¿ (5,27,28).

°ÂÓÈÎ¿, Â›Ó·È ÁÓˆÛÙfi fiÙÈ Ì›· ÙÒÛË ÙÔ˘ ÂÈ¤-‰Ô˘ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ÛÙÔÓ ÔÚfi ÌÔÚÂ› Ó· Â·Ó·‰Ú·-ÛÙËÚÈÔÔÈ‹ÛÂÈ ÙËÓ ÂÈÏËÙÈÎ‹ ‰Ú·ÛÙËÚÈfiÙËÙ· Î·ÈÓ· ÚÔÎ·Ï¤ÛÂÈ Û·ÛÌÔ‡˜. ∂ÓÙÔ‡ÙÔÈ˜, Ë ÙÒÛË ÙÔ˘ÔÏÈÎÔ‡ ÂÈ¤‰Ô˘ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ÛÙÔÓ ÔÚfi ‰ÂÓ ÛË-Ì·›ÓÂÈ ··Ú·›ÙËÙ· Î·È ÙÒÛË ÙÔ˘ ÂÏÂ‡ıÂÚÔ˘ ÙÌ‹-Ì·ÙÔ˜, Ô˘ Ô˘ÛÈ·ÛÙÈÎ¿ Â›Ó·È Î·È ÙÔ ‰Ú·ÛÙÈÎfi(27,28). ∏ Î·Ú‚·Ì·˙Â›ÓË ·ÔÚÚÔÊ¿Ù·È ·ÚÁ¿, ‰Â-ÛÌÂ‡ÂÙ·È ÌÂ ÙË ÏÂ˘ÎˆÌ·Ù›ÓË ÛÙÔ 70-80% Î·È ÌÂÙ·-‚ÔÏ›˙ÂÙ·È ÛÙÔ ‹·Ú (27,29). ∏ Ê·ÈÓ˘ÙÔ˝ÓË ‰ÂÛÌÂ‡Â-Ù·È ÌÂ ÙË ÏÂ˘ÎˆÌ·Ù›ÓË ÛÙÔ 90-93% Î·È ÌÂÙ·‚ÔÏ›˙Â-Ù·È, Â›ÛË˜, ·fi ÙÔ ‹·Ú (27,30). ∆Ô ‚·ÏÚÔ˚Îfi·ÔÚÚÔÊ¿Ù·È ÁÚ‹ÁÔÚ· Î·È ‰ÂÛÌÂ‡ÂÙ·È ÌÂ ÙË ÏÂ˘-ÎˆÌ·Ù›ÓË ÛÙÔ 88-92% (27). ∏ Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË, Ù·ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, ‰ÂÓ ‚Ú›ÛÎÂÙ·È ÛÙËÓ ÚÒÙË ÁÚ·Ì-Ì‹, ·ÊÔ‡ ¤¯ÂÈ ÂÓÔ¯ÔÔÈËıÂ› ÁÈ· Î·Ù·ÛÙÔÏ‹ Î·È Ì·-ıËÛÈ·Î¤˜ ‰˘ÛÎÔÏ›Â˜. Œ¯ÂÈ Î·Ï‹ ·ÔÚÚfiÊËÛË ·fiÙÔ ÛÙfiÌ· Î·È ‰ÂÛÌÂ‡ÂÙ·È ÌÂ ÙË ÏÂ˘ÎˆÌ·Ù›ÓË ÛÙÔ50%. ªÂÙ·‚ÔÏ›˙ÂÙ·È, Â›ÛË˜, ·fi ÙÔ ‹·Ú. ∂¿ÁÂÈÙ· ÌÈÎÚÔÛˆÌÈ·Î¿ Ë·ÙÈÎ¿ ¤Ó˙˘Ì· ÌÂ ÙÔÓ ›‰ÈÔ ÌË¯·-ÓÈÛÌfi fiˆ˜ Ë Ê·ÈÓ˘ÙÔ˝ÓË Î·È Ë Î·Ú‚·Ì·˙Â›ÓË,ÂËÚÂ¿˙ÔÓÙ·˜ ÙÔ ıÂÚ·Â˘ÙÈÎfi ·ÔÙ¤ÏÂÛÌ· ÙˆÓ¿ÏÏˆÓ Ê·ÚÌ¿ÎˆÓ. ¡ÂÔÁÓ¿ Ô˘ ÁÂÓÓ‹ıËÎ·Ó ·fiÌËÙ¤ÚÂ˜ Ô˘ ¤·ÈÚÓ·Ó Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË ÌÔÚÂ› Ó·ÂÌÊ·Ó›ÛÔ˘Ó Û‡Ó‰ÚÔÌÔ ÛÙ¤ÚËÛË˜. ¢Â‰ÔÌ¤ÓÔ˘ ÙÔ˘


258

Ì·ÎÚÔ‡ ¯ÚfiÓÔ˘ ËÌÈ˙ˆ‹˜ (Ì¤¯ÚÈ Î·È 100 ÒÚÂ˜), Ë·Ú·ÎÔÏÔ‡ıËÛË ÙÔ˘ ÓÂÔÁÓÔ‡ ·fi ÙËÓ 7Ë ËÌ¤Ú·˙ˆ‹˜ Î·È ÁÈ· ÙÔ˘Ï¿¯ÈÛÙÔÓ 2-6 Â‚‰ÔÌ¿‰Â˜ Â›Ó·È ··-Ú·›ÙËÙË (5). ∆· Ó¤· ·ÓÙÈÂÈÏËÙÈÎ¿ Ê¿ÚÌ·Î·, fiˆ˜Ë ÔÍ˘Î·Ú‚·Ì·˙Â›ÓË, Ë ÙÔÈÚ·Ì¿ÙË Î·È Ë ÊÂÏÌ·-Ì¿ÙË ‰ÂÛÌÂ‡ÔÓÙ·È ·fi ÙË ÏÂ˘ÎˆÌ·Ù›ÓË ÛÂ ÌÈÎÚfiÙÂ-ÚÂ˜ ÔÛfiÙËÙÂ˜, ÂÓÒ Ë ‚ÈÎ·Ì·ÙÚ›ÓË Î·È Ë ÁÎ·Ì·-ÂÓÙ›ÓË ‰ÂÓ ‰ÂÛÌÂ‡ÔÓÙ·È Î·ıfiÏÔ˘. ∞ÂÎÎÚ›ÓÔÓÙ·È·fi Ù· ÓÂÊÚ¿ Î·È ‰ÂÓ Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ·Ú·ÁˆÁ‹ ÂÓ-‰È¿ÌÂÛˆÓ ÙÔÍÈÎÒÓ ÌÂÙ·‚ÔÏÈÙÒÓ ÙÔ˘ ÔÍÂÈ‰ˆÙÈÎÔ‡ÌË¯·ÓÈÛÌÔ‡. ¶ÚÔÙÂ›ÓÔÓÙ·È Û·Ó ÌÔÓÔıÂÚ·Â›· Î·Ù¿ÙË ‰È¿ÚÎÂÈ· ÙË˜ Î‡ËÛË˜, ¯ˆÚ›˜ Ó· ˘¿Ú¯ÂÈ ÈÎ·ÓÔ-ÔÈËÙÈÎfi˜ ·ÚÈıÌfi˜ ÌÂÏÂÙÒÓ Ô˘ Ó· ÂÁÁ˘¿Ù·È ÙËÓ·ÛÊ·Ï‹ ¯ÔÚ‹ÁËÛ‹ ÙÔ˘˜ (5).

∆ÂÚ·ÙÔÁfiÓÔ˜ ‰Ú¿ÛË ·ÓÙÈÂÈÏËÙÈÎÒÓ ∏ ÂÈÏË„›· ÙË˜ ÂÁÎ‡Ô˘ ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙÂ› ·fi

ÙÔ˘˜ ÂÚÂ˘ÓËÙ¤˜ ÌÂ ·˘ÍËÌ¤ÓË Â›ÙˆÛË Û˘ÁÁÂÓÒÓ·ÓˆÌ·ÏÈÒÓ ÙÔ˘ ÂÌ‚Ú‡Ô˘ (10,31). ∂›Ó·È ÁÓˆÛÙfi fiÙÈÛÙÈ˜ ·ÓÂÙ˘ÁÌ¤ÓÂ˜ ¯ÒÚÂ˜ Û˘ÁÁÂÓÂ›˜ ·ÓˆÌ·Ï›Â˜ ÂÌ-Ê·Ó›˙ÔÓÙ·È ÛÙÔ 3% ÂÚ›Ô˘ ÙÔ˘ ÁÂÓÈÎÔ‡ ÏËı˘-ÛÌÔ‡. ™ÙÈ˜ ÂÁÎ‡Ô˘˜ ÌÂ ÂÈÏË„›·, ·ÎfiÌ· Î·È ÛÙÈ˜ Â-ÚÈÙÒÛÂÈ˜ ÂÎÂ›ÓÂ˜ Ô˘ ‰ÂÓ ‚Ú›ÛÎÔÓÙ·È ÛÂ ·ÓÙÈÂÈ-ÏËÙÈÎ‹ ·ÁˆÁ‹, Ô Î›Ó‰˘ÓÔ˜ Á¤ÓÓËÛË˜ ÓÂÔÁÓÔ‡ ÌÂÛ˘ÁÁÂÓ‹ ·ÓˆÌ·Ï›· Ê·›ÓÂÙ·È Ó· Â›Ó·È ·˘ÍËÌ¤ÓÔ˜(10). ∏ ÙÂÚ·ÙÔÁ¤ÓÂÛË ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙÂ› ÌÂ ÙÔÓ ·ÚÈı-Ìfi ÙˆÓ ·ÓÙÈÂÈÏËÙÈÎÒÓ Ô˘ ¯ÔÚËÁÔ‡ÓÙ·È, ÙËÓ ËÏÈ-Î›· ÙË˜ Î‡ËÛË˜, ÙË Ê·ÚÌ·ÎÔÎÈÓËÙÈÎ‹ ÙÔ˘ Û˘ÁÎÂÎÚÈ-Ì¤ÓÔ˘ ÛÎÂ˘¿ÛÌ·ÙÔ˜, ÂÓÒ ÌÂÚÈÎÔ› ÂÚÂ˘ÓËÙ¤˜ ˘Ô-ÛÙËÚ›˙Ô˘Ó fiÙÈ Û˘Ì‚·›ÓÂÈ ÛÂ ÁÂÓÂÙÈÎ¿ ÚÔ‰È·ÙÂıÂÈ-Ì¤Ó· ¿ÙÔÌ· (10,32). ∏ ‚Ï·ÙÈÎ‹ Â›‰Ú·ÛË Û˘Ì‚·›-ÓÂÈ ÛÙËÓ ÏÂÈÔ„ËÊ›· ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÛÙ· ·Ú¯ÈÎ¿ÛÙ¿‰È·, fiÙ·Ó Ë Î‡ËÛË ‰ÂÓ ¤¯ÂÈ Á›ÓÂÈ ·ÎfiÌ· ·ÓÙÈÏË-Ù‹ ·fi ÙË Ì¤ÏÏÔ˘Û· ÌËÙ¤Ú· Î·È ÙÔ ÂÚÈ‚¿ÏÏÔÓÙË˜. ∂›Ó·È, ÏÔÈfiÓ, ÚÔÊ·Ó¤˜ fiÙÈ Î¿ıÂ ·Ú¤Ì‚·ÛËÌÂ ÙÚÔÔÔ›ËÛË ‹ ·ÎfiÌ· Î·È ‰È·ÎÔ‹ ÙË˜ ıÂÚ·-Â˘ÙÈÎ‹˜ ·ÁˆÁ‹˜, Ë ÔÔ›· ı· Ú·ÁÌ·ÙÔÔÈËıÂ›¤ÛÙˆ Î·È ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË ÁÓˆÛÙÔÔ›ËÛË ÙË˜ Î‡Ë-ÛË˜, ‰ÂÓ ·Ú¤¯ÂÈ È‰È·›ÙÂÚË ÚÔÛÙ·Û›· ÁÈ· ÙÔ ¤Ì-‚Ú˘Ô (10). ∏ ¤ÎıÂÛË ÙÔ˘ ÂÌ‚Ú‡Ô˘ ÛÙÔ ·ÓÙÈÂÈÏË-ÙÈÎfi Ê·ÚÌ·ÎÂ˘ÙÈÎfi ÛÎÂ‡·ÛÌ· ÙÈ˜ ÚÒÙÂ˜ 7 Â‚‰Ô-Ì¿‰Â˜ ÙË˜ Î‡ËÛË˜ ÚÔÎ·ÏÂ› ÌÂ›˙ÔÓÂ˜ ÌÔÚÊÔÏÔÁÈ-Î¤˜ ·ÓˆÌ·Ï›Â˜, ÂÓÒ ÛÂ ÈÔ ÚÔ¯ˆÚËÌ¤Ó· ÛÙ¿‰È·ÙË˜ Î‡ËÛË˜ ÌÔÚÂ› Ó· ÚÔÎ·Ï¤ÛÂÈ ÂÏ¿ÛÛÔÓÂ˜ ·Óˆ-Ì·Ï›Â˜ (7). OÈ Û˘ÁÁÂÓÂ›˜ ·ÓˆÌ·Ï›Â˜ ¤¯Ô˘Ó Û˘Û¯ÂÙÈ-ÛÙÂ› ÌÂ ÙË ¯Ú‹ÛË ÔÏÏÒÓ ·ÓÙÈÂÈÏËÙÈÎÒÓ Ê·ÚÌ¿-ÎˆÓ. ªÂ›˙ÔÓÂ˜ ·ÓˆÌ·Ï›Â˜ ¤¯Ô˘Ó ·Ó·ÊÂÚıÂ› ·fi ÙÔÓÂ˘ÚÈÎfi (·ÓÂÁÎÂÊ·Ï›·, ÂÁÎÂÊ·ÏÔÎ‹ÏË, ÌËÓÈÁÁÔ-Ì˘ÂÏÔÎ‹ÏË, ‰ÈÛ¯È‰‹˜ Ú¿¯Ë) Î·È ÙÔ Ô˘ÚÔÔÈÔÁÂÓÓË-ÙÈÎfi Û‡ÛÙËÌ·, Î·ıÒ˜ Î·È ¯ÂÈÏÂÔÛ¯ÈÛÙ›Â˜, ˘ÂÚˆ˚Ô-Û¯ÈÛÙ›Â˜ Î·È Û˘ÁÁÂÓÂ›˜ Î·Ú‰ÈÔ¿ıÂÈÂ˜. ∂ÎÙfi˜ fiÌˆ˜·fi ÙÈ˜ ÌÂ›˙ÔÓÂ˜, ¤¯Ô˘Ó ·Ó·ÊÂÚıÂ› Î·È ÂÏ¿ÛÛÔÓÂ˜·ÓˆÌ·Ï›Â˜ ÛÙ· ÓÂÔÁÓ¿ ·˘ÙÒÓ ÙˆÓ ÌËÙ¤ÚˆÓ, Î˘Ú›ˆ˜

·fi Ù· Ì¿ÙÈ· (˘ÂÚÙÂÏˆÚÈÛÌfi˜), ÙÔ ÛÙfiÌ· (ÌÈÎÚÔ-ÛÙÔÌ›·), Ù· ·˘ÙÈ¿ (¯·ÌËÏ‹ ÚfiÛÊ˘ÛË), ÙË Ì‡ÙË (ÌÈ-ÎÚ‹ Ì‡ÙË, Î·ı›˙ËÛË ÙË˜ ‚¿ÛË˜) Î·È Ù· ‰¿ÎÙ˘Ï·(˘ÔÏ·Û›· ÙˆÓ ¿ˆ Ê·Ï¿ÁÁˆÓ) (7,10,33). ∂ÏÏÂ›Ì-Ì·Ù· ÓÂ˘ÚÈÎÔ‡ ÛˆÏ‹Ó· Û˘Ì‚·›ÓÔ˘Ó fiÙ·Ó Ô ‚Ï·ÙÈ-Îfi˜ ·Ú¿ÁÔÓÙ·˜ ‰Ú¿ÛÂÈ ÌÂÙ·Í‡ ÙË˜ 21Ë˜ Î·È 28Ë˜ËÌ¤Ú·˜ ·fi ÙËÓ ÚÒÙË ËÌ¤Ú· ÙË˜ ÙÂÏÂ˘Ù·›·˜ ¤Ì-ÌËÓË˜ Ú‡ÛË˜, ¯ÂÈÏÂÔÛ¯ÈÛÙ›· fiÙ·Ó ‰Ú¿ÛÂÈ ÚÈÓ ÙËÓ35Ë, ˘ÂÚˆ˚ÔÛ¯ÈÛÙ›· ÚÈÓ ÙËÓ 70‹, ÂÓÒ Û˘ÁÁÂÓ‹˜Î·Ú‰ÈÔ¿ıÂÈ· ÚÈÓ ÙËÓ 42Ë ËÌ¤Ú· (5).

ŸÛÔÓ ·ÊÔÚ¿ ÛÙÔÓ ÌË¯·ÓÈÛÌfi ÚfiÎÏËÛË˜ ‚Ï¿-‚Ë˜, ‰ÂÓ Â›Ó·È Â·ÚÎÒ˜ ‰ÈÂ˘ÎÚÈÓÈÛÌ¤ÓÔ˜. º·›ÓÂÙ·È,fiÌˆ˜, Ó· ÚÔÎ·ÏÂ›Ù·È Ì¤Ûˆ ÂÓ‰È¿ÌÂÛˆÓ ÌÂÙ·‚ÔÏÈ-ÙÒÓ Î·È fi¯È ÌÂ ¿ÌÂÛË ‰Ú¿ÛË ÙÔ˘ Ê·ÚÌ·ÎÂ˘ÙÈÎÔ‡·Ú¿ÁÔÓÙ·. ∏ ·Ú·ÁˆÁ‹ ÙÔÍÈÎÒÓ ÂÏÂ‡ıÂÚˆÓ ÚÈ˙ÒÓÔÍ˘ÁfiÓÔ˘, fiˆ˜ Â›ÛË˜ Î·È Ë ˘ÔÍ›· Ô˘ ÚÔÎ·-ÏÂ›Ù·È ·fi ÙË ÌÂ›ˆÛË ÙË˜ Î·Ú‰È·Î‹˜ Û˘¯ÓfiÙËÙ·˜¤¯Ô˘Ó ÂÓÔ¯ÔÔÈËıÂ›. ∆Ô ¤Ó˙˘ÌÔ ˘‰ÚÔÏ¿ÛË ÙÔ˘ ÂÔ-ÍÂÈ‰›Ô˘ ¤¯ÂÈ Û·Ó ÚfiÏÔ ÙÔ˘ ÙËÓ ÂÍÔ˘‰ÂÙ¤ÚˆÛË ÙˆÓÙÔÍÈÎÒÓ ÂÓ‰È¿ÌÂÛˆÓ ÌÂÙ·‚ÔÏÈÙÒÓ ÙÔ˘ ÔÍÂÈ‰ˆÙÈÎÔ‡ÌÂÙ·‚ÔÏÈÛÌÔ‡. ∏ ‰Ú·ÛÙËÚÈfiÙËÙ¿ ÙÔ˘ ÌÔÚÂ› Ó· ÌÂ-ÙÚËıÂ› ÛÙ· Î‡ÙÙ·Ú· ÙÔ˘ ·ÌÓÈ·ÎÔ‡ ˘ÁÚÔ‡. º·›ÓÂÙ·ÈÓ· ÂÏ¤Á¯ÂÙ·È ·fi ‰‡Ô ·ÏÏËÏfiÌÔÚÊ· ÁÔÓ›‰È· Î·ÈÂÎÊÚ¿˙ÂÙ·È ÛÂ ÙÚÂÈ˜ Ê·ÈÓfiÙ˘Ô˘˜ ÌÂ ¯·ÌËÏ‹, Ì¤-ÙÚÈ· Î·È ˘„ËÏ‹ ÂÓ˙˘ÌÈÎ‹ ‰Ú·ÛÙËÚÈfiÙËÙ·. ÕÙÔÌ· ÌÂ¯·ÌËÏ‹ ÂÓ˙˘ÌÈÎ‹ ‰Ú·ÛÙËÚÈfiÙËÙ· Â›Ó·È ÔÌÔ˙˘ÁÒÙÂ˜ÙÔ˘ ˘ÔÏÂÈfiÌÂÓÔ˘ ·ÏÏËÏ›Ô˘. ŒÌ‚Ú˘· ÌÂ ¯·ÌËÏ‹ÂÓ˙˘ÌÈÎ‹ ‰Ú·ÛÙËÚÈfiÙËÙ· ¤¯Ô˘Ó ÌÂÈˆÌ¤ÓË ÈÎ·ÓfiÙË-Ù· Î¿ı·ÚÛË˜ ÙˆÓ ÙÔÍÈÎÒÓ ·˘ÙÒÓ ÌÂÙ·‚ÔÏÈÙÒÓ Î·È‚Ú›ÛÎÔÓÙ·È ÛÂ ·˘ÍËÌ¤ÓÔ Î›Ó‰˘ÓÔ ·Ó¿Ù˘ÍË˜ Û˘Á-ÁÂÓÒÓ ·ÓˆÌ·ÏÈÒÓ (7,10,34).

∏ ·ÓÂ¿ÚÎÂÈ· ÙÔ˘ Ê˘ÏÈÎÔ‡ ÔÍ¤Ô˜ ‰Ú· Û˘ÓÂÚÁÈ-Î¿ ÛÙËÓ ÙÂÚ·ÙÔÁ¤ÓÂÛË. ∆Ô Ê˘ÏÈÎfi ÔÍ‡ Î·È Ë ‚ÈÙ·Ì›-ÓË µ12 Â›Ó·È Û˘Ó¤Ó˙˘Ì· ÙË˜ Û˘ÓıÂÙ¿ÛË˜ ÙË˜ ÌÂıÂÈ-ÔÓ›ÓË˜, ¤Ó˙˘ÌÔ ÎÚÈÙÈÎ‹˜ ÛËÌ·Û›·˜ ÁÈ· ÙË ‚ÈÔÛ‡ÓıÂ-ÛË ÙÔ˘ DNA. Ã·ÌËÏ¿ Â›Â‰· Ê˘ÏÈÎÔ‡ ÔÍ¤Ô˜ ¤¯Ô˘ÓÛ˘Û¯ÂÙÈÛÙÂ› ÌÂ ·˘ÍËÌ¤ÓÔ Î›Ó‰˘ÓÔ Û˘ÁÁÂÓÒÓ ·Óˆ-Ì·ÏÈÒÓ (7,35). ∞ÓÙÈÂÈÏËÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ fiˆ˜ÙÔ ‚·ÏÚÔ˚Îfi Î·È Ë Ê·ÈÓ˘ÙÔ˝ÓË ¤¯ÂÈ ‚ÚÂıÂ› fiÙÈ ‰È·-Ù·Ú¿ÛÛÔ˘Ó ÙÔ ÌÂÙ·‚ÔÏÈÛÌfi ÙÔ˘ Ê˘ÏÈÎÔ‡ ÔÍ¤Ô˜ ÛÙÔ¤Ì‚Ú˘Ô. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ Î‡ËÛË˜, ÔÈ Û˘ÁÎÂ-ÓÙÚÒÛÂÈ˜ ÙÔ˘ Ê˘ÏÈÎÔ‡ ÔÍ¤Ô˜ ÌÂÈÒÓÔÓÙ·È Î·È Ë ıÂ-Ú·Â›· ÌÂ ·ÓÙÈÂÈÏËÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜ fiˆ˜ ÙÔ‚·ÏÚÔ˚Îfi ‰Ú· ÂÓÈÛ¯˘ÙÈÎ¿ ÛÂ ·˘ÙÔ‡ ÙÔ˘ Ù‡Ô˘ ÙË‰È·Ù·Ú·¯‹ (7,36).

À‰·ÓÙÔ˝ÓÂ˜ ∏ ¯Ú‹ÛË ÙÔ˘˜ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ Î‡ËÛË˜ ¤¯ÂÈ

Û˘Û¯ÂÙÈÛÙÂ› ÌÂ ·˘ÍËÌ¤ÓË Â›ÙˆÛË ¯ÂÈÏÂÔÛ¯ÈÛÙ›·˜Î·È ˘ÂÚˆ˚ÔÛ¯ÈÛÙ›·˜, ·ÓˆÌ·Ï›Â˜ Ó˘¯ÈÒÓ, ˘ÔÏ·-Û›· Ê·Ï¿ÁÁˆÓ Î·È ÎÚ·ÓÈÔÚÔÛˆÈÎ¤˜ ‰˘ÛÏ·Û›Â˜.∏ ̄ Ú‹ÛË ÙÔ˘˜ ÛÂ Á˘Ó·›ÎÂ˜ ·Ó··Ú·ÁˆÁÈÎ‹˜ ËÏÈÎ›·˜ı· Ú¤ÂÈ Ó· ·Ôı·ÚÚ‡ÓÂÙ·È, ÂÓÒ ·ÓÙÂÓ‰Â›ÎÓ˘Ù·ÈÎ·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ Î‡ËÛË˜ (10,37). ∏ ¯Ú‹ÛË ÙË˜

Ê·ÈÓ˘ÙÔ˝ÓË˜ Û·Ó ÌÔÓÔıÂÚ·Â›· ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙÂ› ÌÂÚfiÎÏËÛË ‰È·Ù·Ú·¯ÒÓ ÛÙÔ ¤Ì‚Ú˘Ô, ÔÈ ÔÔ›Â˜ Ù·ÍÈ-ÓÔÌÔ‡ÓÙ·È Û·Ó “Û‡Ó‰ÚÔÌÔ ˘‰·ÓÙÔ˝ÓË˜”. ∆Ô Û‡Ó-‰ÚÔÌÔ ·˘Ùfi ÂÚÈÏ·Ì‚¿ÓÂÈ Î·ı˘ÛÙ¤ÚËÛË ·Ó¿Ù˘-ÍË˜ ÙfiÛÔ ÛÙËÓ ÂÓ‰ÔÌ‹ÙÚÈ·, fiÛÔ Î·È ÛÙËÓ ÂÍˆÌ‹-ÙÚÈ· ˙ˆ‹, ÌÈÎÚÔÎÂÊ·Ï›·, ‰È·ÓÔËÙÈÎ‹ Î·ı˘ÛÙ¤ÚËÛË,ÎÚ·ÓÈÔÚÔÛˆÈÎ¤˜ ‰˘ÛÏ·Û›Â˜ ÌÂ Û˘¯ÓfiÙÂÚÔ ÙÔÓ˘ÂÚÙÂÏˆÚÈÛÌfi Î·È ˘ÔÏ·Û›Â˜ Ê·Ï¿ÁÁˆÓ Î·È Ó˘-¯ÈÒÓ (10,38).

µ·Ú‚ÈÙÔ˘ÚÈÎ¿ (Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË, ÚÈÌÈ‰fiÓË) ∏ ¯Ú‹ÛË ÙÔ˘˜ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ Î‡ËÛË˜ ¤¯ÂÈ

Û˘Û¯ÂÙÈÛÙÂ› ÌÂ Û˘ÁÁÂÓÂ›˜ Î·Ú‰ÈÔ¿ıÂÈÂ˜, ‰˘ÛÌÔÚ-Ê›Â˜ Î·È ÎÚ·ÓÈÔÚÔÛˆÈÎ¤˜ ‰˘ÛÏ·Û›Â˜ (10).

µ·ÏÚÔ˚Îfi∏ ¯Ú‹ÛË ÙÔ˘ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ Î‡ËÛË˜ ¤¯ÂÈ

Û˘Û¯ÂÙÈÛÙÂ› ÌÂ ‰˘ÛÌÔÚÊ›Â˜ ÙÔ˘ ÓÂÔÁÓÔ‡ Î·È ‰È·-ÓÔËÙÈÎ‹ Î·ı˘ÛÙ¤ÚËÛË. O Î›Ó‰˘ÓÔ˜ ‡·ÚÍË˜ ÂÏ-ÏÂÈÌÌ¿ÙˆÓ ÙÔ˘ ÓÂ˘ÚÈÎÔ‡ ÛˆÏ‹Ó· ÂÌÊ·Ó›˙ÂÙ·È Ó· Â›-Ó·È 1-2% ÛÂ Û¯¤ÛË ÌÂ 0,2-0,5% ÙÔ˘ ÁÂÓÈÎÔ‡ ÏËı˘-ÛÌÔ‡. ∂›ÛË˜, ¤¯ÂÈ ·Ó·ÊÂÚıÂ› ·˘ÍËÌ¤ÓË Â›ÙˆÛËÛ˘ÁÁÂÓÒÓ Î·Ú‰ÈÔ·ıÂÈÒÓ Î·È ·ÓˆÌ·ÏÈÒÓ ·fi ÙÔÔ˘ÚÔÔÈÔÁÂÓÓËÙÈÎfi. ∏ ¯Ú‹ÛË ÙÔ˘ ‚·ÏÚÔ˚ÎÔ‡ ·fiÁ˘Ó·›ÎÂ˜ ·Ó··Ú·ÁˆÁÈÎ‹˜ ËÏÈÎ›·˜ ı· Ú¤ÂÈ Ó··Ôı·ÚÚ‡ÓÂÙ·È, ÂÓÒ Ë ¯Ú‹ÛË ÙÔ˘ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ·ÙË˜ Î‡ËÛË˜ ·ÓÙÂÓ‰Â›ÎÓ˘Ù·È. ∂›Ó·È ›Ûˆ˜ ÙÔ ÌfiÓÔ·ÓÙÈÂÈÏËÙÈÎfi ÁÈ· ÙÔ ÔÔ›Ô ¤¯ÂÈ ˘ÔÛÙËÚÈ¯ÙÂ› fiÙÈ ËÙÂÚ·ÙÔÁfiÓÔ˜ ‰Ú¿ÛË Î·È ÔÈ ÁÂÓÈÎfiÙÂÚÂ˜ ÂÈÙÒÛÂÈ˜Ô˘ ¤¯ÂÈ ÛÙÔ Î‡ËÌ· Â›Ó·È ‰ÔÛÔÂÍ·ÚÙÒÌÂÓÂ˜(10,12,33).

∫·Ú‚·Ì·˙Â›ÓË £ÂˆÚÂ›Ù·È ÙÔ ·ÓÙÈÂÈÏËÙÈÎfi Ê¿ÚÌ·ÎÔ ÌÂ ÙË ÌÈ-

ÎÚfiÙÂÚÔ˘ ‚·ıÌÔ‡ ÙÂÚ·ÙÔÁfiÓÔ ‰Ú¿ÛË. ∂ÓÙÔ‡ÙÔÈ˜,ÚfiÛÊ·Ù· ‰ËÌÔÛÈÂ˘Ì¤ÓÂ˜ ÌÂÏ¤ÙÂ˜ ¤¯Ô˘Ó Û˘Û¯ÂÙ›-ÛÂÈ ÙËÓ Î·Ú‚·Ì·˙Â›ÓË ÌÂ Û˘ÁÁÂÓÂ›˜ ‰È·Ì·ÚÙ›Â˜ÛÙÔÓ ›‰ÈÔ ‚·ıÌfi ÌÂ Ù· ‚·Ú‚ÈÙÔ˘ÚÈÎ¿ Î·È ÙË Ê·ÈÓ˘-ÙÔ˝ÓË. OÈ ·Ó·ÊÔÚ¤˜, fiÌˆ˜, Â›Ó·È ÂÚÈÔÚÈÛÌ¤ÓÂ˜ Î·ÈÔ ·ÚÈıÌfi˜ ÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ ÌÈÎÚfi˜. Œ¯ÂÈ Û˘Û¯ÂÙÈ-ÛÙÂ› ÌÂ ·‡ÍËÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ‡·ÚÍË˜ ÂÏÏÂ›ÌÌ·ÙÔ˜ÛÙÔ ÓÂ˘ÚÈÎfi ÛˆÏ‹Ó· ÛÙÔ 0,9%, ÌÂ ÌÂ›ˆÛË ÙË˜ ÂÚÈ-Ì¤ÙÚÔ˘ ÎÂÊ·Ï‹˜, ÙÔ˘ ‚¿ÚÔ˜ Î·È ÙÔ˘ Ì‹ÎÔ˘˜ ÛÒÌ·-ÙÔ˜ ÛÙË Á¤ÓÓËÛË, ÌÂ ‰˘ÛÌÔÚÊ›Â˜, ˘ÔÛ·‰›·, ‚Ô˘-‚ˆÓÔÎ‹ÏË Î·È ‰È·ÓÔËÙÈÎ‹ Î·ı˘ÛÙ¤ÚËÛË ÛÙÔ 20%ÙˆÓ ·È‰ÈÒÓ (10,12, 39).

§·ÌÔÙÚÈÁ›ÓË, ‚ÈÎ·Ì·ÙÚ›ÓË, ÁÎ·Ì·ÂÓÙ›ÓË™‡ÌÊˆÓ· ÌÂ ÌÂÏ¤ÙÂ˜ ÛÂ ˙Ò·, ‰ÂÓ ¤¯Ô˘Ó Û˘Û¯Â-

ÙÈÛÙÂ› ÌÂ ÙÂÚ·ÙÔÁfiÓÔ ‰Ú¿ÛË. ∂ÓÙÔ‡ÙÔÈ˜, Ô ÚfiÏÔ˜ÙÔ˘˜ ÛÙÔÓ ¿ÓıÚˆÔ ‰ÂÓ ¤¯ÂÈ Â·ÎÚÈ‚Ò˜ ‰ÈÂÚÂ˘ÓË-ıÂ›, ÌÂ ‚¿ÛË Î·È ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·ÈÛÂ ıÂÚ·Â˘ÙÈÎ¿ ÚˆÙfiÎÔÏÏ· Ô˘ ÂÚÈÏ·Ì‚¿ÓÔ˘ÓÂÚÈÛÛfiÙÂÚ· ÙÔ˘ ÂÓfi˜ ÛÎÂ˘¿ÛÌ·Ù·. ™‡ÌÊˆÓ· ÌÂÙËÓ ˘ËÚÂÛ›· ÙÚÔÊ›ÌˆÓ Î·È Ê·ÚÌ¿ÎˆÓ ÙˆÓ ∏ÓˆÌ¤-ÓˆÓ ¶ÔÏÈÙÂÈÒÓ ÙË˜ ∞ÌÂÚÈÎ‹˜, ÔÈ Ô˘Û›Â˜ ·˘Ù¤˜ ‰ÂÓıÂˆÚÔ‡ÓÙ·È ·ıÒÂ˜ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ Î‡ËÛË˜ Î·È

Ë ¯Ú‹ÛË ÙÔ˘˜ ÚÔÙÂ›ÓÂÙ·È ÌfiÓÔ ÛÙÈ˜ ÂÚÈÙÒÛÂÈ˜ÂÎÂ›ÓÂ˜ Ô˘ ÙÔ fiÊÂÏÔ˜ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚÔ ·fi ÙÔÓÎ›Ó‰˘ÓÔ Ô˘ ·ÔÚÚ¤ÂÈ ·fi ÙË ¯Ú‹ÛË ÙÔ˘˜ (7,10).

∞ÓÙÈÌÂÙÒÈÛË ÙË˜ Ì¤ÏÏÔ˘Û·˜ ÌËÙ¤Ú·˜ ÌÂ ÂÈÏË„›·∂›Ó·È ÁÓˆÛÙfi fiÙÈ Ë ·ÓÙÈÂÈÏËÙÈÎ‹ ·ÁˆÁ‹ ÛÙÈ˜

ÂÚÈÛÛfiÙÂÚÂ˜ ÂÚÈÙÒÛÂÈ˜ ‰ÂÓ ·ÔÙÂÏÂ› ·ÈÙÈÔÏÔÁÈ-Î‹, ·ÏÏ¿ ÌfiÓÔ Û˘ÌÙˆÌ·ÙÈÎ‹ ıÂÚ·Â˘ÙÈÎ‹ ÚÔÛ¤Á-ÁÈÛË. ™Ùfi¯Ô˜ ÙË˜ Â›Ó·È Ë ÂÍ·ÛÊ¿ÏÈÛË ÛÙËÓ ·ÛıÂÓ‹Ì›·˜ ˙ˆ‹˜ ¯ˆÚ›˜ ÂÂÈÛfi‰È· Û·ÛÌÒÓ ‹ ÙÔ˘Ï¿¯È-ÛÙÔÓ ÌÂ ÙËÓ Î·Ù¿ ÙÔ ‰˘Ó·ÙfiÓ ÏÈÁfiÙÂÚÔ Û˘¯Ó‹ ÂÌ-Ê¿ÓÈÛ‹ ÙÔ˘˜. ™Â Ì›· ·ÛıÂÓ‹ Ô˘ Â›Ó·È ÂÏÂ‡ıÂÚËÂÂÈÛÔ‰›ˆÓ Ù· ÙÂÏÂ˘Ù·›· 2-5 ¯ÚfiÓÈ·, ÌÂ Ê˘ÛÈÔÏÔÁÈ-Îfi ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ· Î·È Ê˘ÛÈÔÏÔÁÈÎ‹ÓÂ˘ÚÔÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË, Ë ‰È·ÎÔ‹ ÙË˜ ·ÁˆÁ‹˜ ı·Ú¤ÂÈ Ó· Û˘˙ËÙÂ›Ù·È ÛÔ‚·Ú¿ (7,14). ∂¿Ó Ë Û˘Ó¤¯È-ÛË ÙË˜ ·ÁˆÁ‹˜ ÎÚÈıÂ› ··Ú·›ÙËÙË, Û˘ÓÈÛÙ¿Ù·È Ë ¯Ô-Ú‹ÁËÛË ÙÔ˘ Î·Ù·ÏÏËÏfiÙÂÚÔ˘ ÛÎÂ˘¿ÛÌ·ÙÔ˜ ·Ó¿ÏÔ-Á· ÌÂ ÙÔÓ Ù‡Ô ÂÈÏË„›·˜, ÌÂ ÙÈ˜ Î·Ù¿ ÙÔ ‰˘Ó·ÙfiÓÏÈÁfiÙÂÚÂ˜ ·ÓÂÈı‡ÌËÙÂ˜ ÂÓ¤ÚÁÂÈÂ˜, ÙfiÛÔ ÁÈ· ÙË Á˘-Ó·›Î· fiÛÔ Î·È ÁÈ· ÙÔ ¤Ì‚Ú˘Ô, ¯ÔÚËÁÔ‡ÌÂÓÔ˘ ÛÙÈ˜¯·ÌËÏfiÙÂÚÂ˜ ·ÔÙÂÏÂÛÌ·ÙÈÎ¤˜ ‰fiÛÂÈ˜. ∏ ¯Ú‹ÛËÂÓfi˜ ÌfiÓÔ ÛÎÂ˘¿ÛÌ·ÙÔ˜, Â¿Ó Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈ-Î‹, Â›Ó·È Û·ÊÒ˜ ·ÛÊ·Ï¤ÛÙÂÚË Î·È ÚÔÙÈÌfiÙÂÚË·fi ÙË ¯Ú‹ÛË Ê·ÚÌ¿ÎˆÓ ÛÂ Û˘Ó‰˘·ÛÌfi (7,31). ∏·Ú·ÎÔÏÔ‡ıËÛË Ú¤ÂÈ Ó· ·Ú¯›˙ÂÈ ÙÔ˘Ï¿¯ÈÛÙÔÓ¤Ó· ÙÚ›ÌËÓÔ ÚÈÓ ÙË Û‡ÏÏË„Ë, ÂÓÒ Ë Û˘ÌÏËÚˆÌ·-ÙÈÎ‹ ¯ÔÚ‹ÁËÛË Ê˘ÏÈÎÔ‡ ıÂˆÚÂ›Ù·È ÌÂ›˙ÔÓÔ˜ ÛËÌ·-Û›·˜. ∏ Á˘Ó·›Î· ÂÓı·ÚÚ‡ÓÂÙ·È Ó· ‰È·Îfi„ÂÈ ÙÔ Î¿-ÓÈÛÌ·, Ó· ¤¯ÂÈ ÈÛÔÚÚÔËÌ¤ÓÔ ‰È·ÈÙÔÏfiÁÈÔ Î·È Ó·ÎÔÈÌ¿Ù·È ·ÚÎÂÙ¿. ∂¿Ó Ë ıÂÚ·Â›· ‰ÂÓ ÌÔÚÂ› Ó·‰È·ÎÔÂ›, ÚÔÙÈÌ¿Ù·È Ë ÌÔÓÔıÂÚ·Â›· ÌÂ ÙÔÓ ·Ú¿-ÁÔÓÙ· Ô˘ ÂÌÊ·Ó›˙ÂÈ ÙËÓ ·ıˆfiÙÂÚË Û˘ÌÂÚÈÊÔÚ¿ÛÙÔ ¤Ì‚Ú˘Ô. ÃÔÚËÁÂ›Ù·È ÛÙÈ˜ ÌÈÎÚfiÙÂÚÂ˜ Â·ÚÎÂ›˜ÁÈ· ¤ÏÂÁ¯Ô ‰fiÛÂÈ˜, ÙÌËÌ·ÙÈÎ¿ ÛÙ· ÌÂÛÔ‰È·ÛÙ‹Ì·Ù·ÙË˜ ËÌ¤Ú·˜, ÌÂ ÛÙfi¯Ô ÙË ‰È·Ù‹ÚËÛË ÙˆÓ ÂÈ¤‰ˆÓÙÔ˘ ÔÚÔ‡ ÛÙ· ¯·ÌËÏfiÙÂÚ· ·ÔÙÂÏÂÛÌ·ÙÈÎ¿ ÁÈ·¤ÏÂÁ¯Ô ÙˆÓ ÎÚ›ÛÂˆÓ fiÚÈ·. ∂¿Ó Â›Ó·È ‰˘Ó·Ùfi, Ë ¯Ô-Ú‹ÁËÛË ‚·ÏÚÔ˚ÎÔ‡ Î·È Î·Ú‚·Ì·˙Â›ÓË˜ ÛÙÈ˜¤ÁÎ˘Â˜ ÌÂ ÈÛÙÔÚÈÎfi ÂÏÏÂÈÌÌ¿ÙˆÓ ÙÔ˘ ÓÂ˘ÚÈÎÔ‡ Ûˆ-Ï‹Ó· Ú¤ÂÈ Ó· ·ÔÊÂ‡ÁÂÙ·È. ∂¿Ó ¯ÔÚËÁÂ›Ù·È Ê·È-Ó˘ÙÔ˝ÓË Î·È ‚·ÏÚÔ˚Îfi, Û˘ÓÈÛÙ¿Ù·È fiÔ˘ Â›Ó·È ‰˘Ó·-Ù‹ Ë Ì¤ÙÚËÛË ÙÔ˘ ÂÏÂ‡ıÂÚÔ˘ - Î·È fi¯È ÌfiÓÔ ÙÔ˘ ÔÏÈ-ÎÔ‡ - Ê·ÚÌ¿ÎÔ˘ ÛÙÔÓ ÔÚfi (5,7,10). ∏ ∞ÌÂÚÈÎ·ÓÈÎ‹∞Î·‰ËÌ›· ¡Â˘ÚÔÏÔÁ›·˜ ÚÔÙÂ›ÓÂÈ ·Ú·ÎÔÏÔ‡ıËÛËÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ·ÓÙÈÂÈÏËÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ ÚÈÓÙË Û‡ÏÏË„Ë, ÛÙËÓ ·Ú¯‹ Î¿ıÂ ÙÚÈÌ‹ÓÔ˘ Î‡ËÛË˜, ÛÙË‰È¿ÚÎÂÈ· ÙÔ˘ ÙÂÏÂ˘Ù·›Ô˘ Ì‹Ó· ÙË˜ Î‡ËÛË˜, Î·ıÒ˜Î·È ÙËÓ fiÁ‰ÔË Â‚‰ÔÌ¿‰· ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi (16).

∂›Ó·È ÁÓˆÛÙfi fiÙÈ Ë Ó·˘Ù›· Î·È ÔÈ ¤ÌÂÙÔÈ Ù·Ï·È-ˆÚÔ‡Ó ÙÔ 50-90% ÙˆÓ ÂÁÎ‡ˆÓ. ™ÙÔ 1,3% ÂÚ›Ô˘, ËÎÏÈÓÈÎ‹ ÚÔ‚ÔÏ‹ Â›Ó·È È‰È·›ÙÂÚ· ¤ÓÙÔÓË, ÌÂ ˘ÂÚ¤ÌÂÛË,ÎÂÙÔÓÔ˘Ú›· Î·È ·ÒÏÂÈ· ‚¿ÚÔ˘˜. ∏ ‰È·Ù·Ú·¯‹ ÛÙË


259


260

Ï‹„Ë Î·È ÙËÓ ·ÔÚÚfiÊËÛË ÙˆÓ ·ÓÙÈÂÈÏËÙÈÎÒÓÂÍ·ÚÙ¿Ù·È ·fi ÙËÓ ¤ÓÙ·ÛË ÙË˜ Û˘ÌÙˆÌ·ÙÔÏÔÁ›·˜Î·È ÛÂ ÌÂÚÈÎ¤˜ ÂÚÈÙÒÛÂÈ˜ ÌÔÚÂ› Ó· ÂÈÊ¤ÚÂÈ·ÒÏÂÈ· ÙÔ˘ ÂÏ¤Á¯Ô˘ ÙˆÓ ÂÈÏËÙÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ,ÌÂ fiÏÂ˜ ÙÈ˜ ‰˘Û¿ÚÂÛÙÂ˜ Û˘Ó¤ÂÈÂ˜ ÁÈ· ÙËÓ ¤ÁÎ˘ÔÎ·È ÙÔ ¤Ì‚Ú˘Ô. Œ¯Ô˘Ó ‰ÔÎÈÌ·ÛÙÂ› ‰È¿ÊÔÚÔÈ Ê·ÚÌ·-ÎÂ˘ÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ fiˆ˜ ÌÂÙÔÎÏÔÚ·Ì›‰Ë, Ú·ÓÈ-ÙÈ‰›ÓË, ‰ÈÊ·ÈÓ˘‰Ú·Ì›ÓË, ÚÔÌÂı·˙›ÓË Î·È ¿ÏÏÔÈ, ÌÂ¿ÏÏÔÙÂ ¿ÏÏ· ·ÔÙÂÏ¤ÛÌ·Ù·. ¶·ÚÂÓÙÂÚÈÎ‹ ¯ÔÚ‹ÁË-ÛË ˘ÁÚÒÓ Î·È ËÏÂÎÙÚÔÏ˘ÙÈÎÒÓ ‰È·Ï˘Ì¿ÙˆÓ ÌÔÚÂ›Ó· ¯ÚÂÈ·ÛÙÂ› ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÂÚÈÙÒÛÂˆÓÔ˘ ‰ÂÓ ·ÓÙ·ÔÎÚ›ÓÔÓÙ·È ÛÙ· ˆ˜ ¿Óˆ (7,40).

∏ ¤ÏÏÂÈ„Ë ÙÔ˘ Ê˘ÏÈÎÔ‡ ÔÍ¤Ô˜ ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙÂ›ÌÂ ·˘ÍËÌ¤ÓÔ Î›Ó‰˘ÓÔ Û˘ÁÁÂÓÒÓ ·ÓˆÌ·ÏÈÒÓ. ∏ Û˘-ÌÏËÚˆÌ·ÙÈÎ‹ ¯ÔÚ‹ÁËÛ‹ ÙÔ˘ ÛÂ ÌË ÂÈÏËÙÈÎ¤˜Á˘Ó·›ÎÂ˜ ¤¯ÂÈ ‚ÚÂıÂ› fiÙÈ ÌÂÈÒÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ Á¤ÓÓË-ÛË˜ ÓÂÔÁÓÔ‡ ÌÂ ¤ÏÏÂÈÌÌ· ÛÙÔ ÓÂ˘ÚÈÎfi ÛˆÏ‹Ó· Î·-Ù¿ 60-100% (7,41). ŸÛÔÓ ·ÊÔÚ¿ ÛÙÈ˜ Á˘Ó·›ÎÂ˜ Ô˘Ï·Ì‚¿ÓÔ˘Ó ·ÓÙÈÂÈÏËÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜, ‰ÂÓ˘¿Ú¯ÂÈ ·ÎfiÌ· Â·ÚÎ‹˜ ‚È‚ÏÈÔÁÚ·ÊÈÎ‹ ÙÂÎÌËÚ›ˆ-ÛË (7). ∆Ô ∫¤ÓÙÚÔ ∂Ï¤Á¯Ô˘ ¡ÔÛËÌ¿ÙˆÓ ÙˆÓ ∏Óˆ-Ì¤ÓˆÓ ¶ÔÏÈÙÂÈÒÓ ÙË˜ ∞ÌÂÚÈÎ‹˜ ÚÔÙÂ›ÓÂÈ ÙË Û˘-ÌÏËÚˆÌ·ÙÈÎ‹ ¯ÔÚ‹ÁËÛË 0,4 mg/ËÌ¤Ú· Ê˘ÏÈÎÔ‡ÔÍ¤Ô˜ ÛÂ Î¿ıÂ Á˘Ó·›Î· ·Ó··Ú·ÁˆÁÈÎ‹˜ ËÏÈÎ›·˜,ÌÂ ÛÙfi¯Ô ÙË ÌÂ›ˆÛË ÙÔ˘ Î›Ó‰˘ÓÔ˘ Á¤ÓÓËÛË˜ ÓÂÔ-ÁÓÔ‡ ÌÂ ÂÏÏÂ›ÌÌ·Ù· ÛÙÔ ÓÂ˘ÚÈÎfi ÛˆÏ‹Ó·. ∞˘Ù‹ Ë‰fiÛË Ê·›ÓÂÙ·È Ó· Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈÎ‹ ÁÈ· ÚˆÙÔ-ÁÂÓ‹ ÚfiÏË„Ë (42). ∆Ô 1996, ÙÔ ∞ÌÂÚÈÎ·ÓÈÎfi ∫ÔÏ¤-ÁÈÔ ª·ÈÂ˘Ù‹ÚˆÓ °˘Ó·ÈÎÔÏfiÁˆÓ ÚfiÙÂÈÓÂ ÙË ¯ÔÚ‹-ÁËÛË 4 mg ËÌÂÚËÛ›ˆ˜ Ê˘ÏÈÎÔ‡ ÔÍ¤Ô˜ ÙÚÂÈ˜ Ì‹ÓÂ˜ÚÈÓ ·fi ÙË Û‡ÏÏË„Ë Î·È ÛÂ fiÏË ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ÚÒÙÔ˘ ÙÚÈÌ‹ÓÔ˘, ÛÂ Î¿ıÂ Á˘Ó·›Î· Ô˘ ÛÙÔ ·-ÚÂÏıfiÓ Â›¯Â Ì›· Î‡ËÛË ÂÌ‚Ú‡Ô˘ ÌÂ ¤ÏÏÂÈÌÌ· ÛÙÔÓÂ˘ÚÈÎfi ÛˆÏ‹Ó· Î·È ÂÈı˘ÌÂ› Ó· ÌÂ›ÓÂÈ ¤ÁÎ˘Ô˜, ÂÎ-ÊÚ¿˙ÔÓÙ·˜ ÙËÓ ¿Ô„Ë fiÙÈ Ë ›‰È· ÚÔÏËÙÈÎ‹ ‰fiÛËÊ·›ÓÂÙ·È Ó· Â›Ó·È Ë ÂÓ‰Â‰ÂÈÁÌ¤ÓË Î·È ÁÈ· ÙÈ˜ Á˘Ó·›-ÎÂ˜ Ô˘ ‚Ú›ÛÎÔÓÙ·È ˘fi ıÂÚ·Â›· ÌÂ ·ÓÙÈÂÈÏËÙÈ-ÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜ (19).

∞ÓÂ¿ÚÎÂÈ· ‚ÈÙ·Ì›ÓË˜ ∫ ¤¯ÂÈ ·Ó·ÊÂÚıÂ› ÛÂ ÓÂÔ-ÁÓ¿ ÌËÙ¤ÚˆÓ ˘fi ·ÓÙÈÂÈÏËÙÈÎ‹ ·ÁˆÁ‹ Î·Ù¿ ÙË‰È¿ÚÎÂÈ· ÙË˜ Î‡ËÛË˜. ™˘Ì‚·›ÓÂÈ Û˘Ó‹ıˆ˜ ÙÔ ÚÒ-ÙÔ 24ˆÚÔ ÙË˜ ˙ˆ‹˜, ÌÔÚÂ› Ó· Â›Ó·È ÛÔ‚·Ú‹, ·ÊÔ-Ú¿ Î˘Ú›ˆ˜ ÛÙÔ ‰¤ÚÌ·, ÙÔÓ ÂÁÎ¤Ê·ÏÔ, ÙÔÓ ˘Â˙ˆÎfi-Ù· Î·È ÙÔ ÂÚÈÙfiÓ·ÈÔ. ∏ ·‰Ú·ÓÔÔ›ËÛË ÙË˜ ‚ÈÙ·Ì›-ÓË˜ ∫, ÂÍ·ÈÙ›·˜ ÙË˜ Â·ÁˆÁ‹˜ ÙˆÓ Ë·ÙÈÎÒÓ ÂÓ˙‡-ÌˆÓ ·fi Ù· ·ÓÙÈÂÈÏËÙÈÎ¿, ¤¯ÂÈ Û·Ó Û˘Ó¤ÂÈ· ÙËÌÂ›ˆÛË ÙˆÓ ·Ú·ÁfiÓÙˆÓ ππ, VII, πÃ Î·È Ã Î·È ÙËÓ ·È-ÌÔÚÚ·ÁÈÎ‹ ‰È¿ıÂÛË ÙÔ˘ ÓÂÔÁÓÔ‡. ™˘ÓÈÛÙ¿Ù·È Ë ¯Ô-Ú‹ÁËÛË 1 mg ‚ÈÙ·Ì›ÓË˜ ∫ ÛÙÔ ÓÂÔÁÓfi ÁÈ· ÚfiÏË„Ë·ÈÌÔÚÚ·ÁÈÎ‹˜ ÓfiÛÔ˘, ÂÓÒ Â¿Ó ‰È·ÈÛÙˆıÂ› ·ÓÂ¿Ú-ÎÂÈ· ÙˆÓ ·Ú·ÁfiÓÙˆÓ ‹ÍË˜, Û˘ÓÈÛÙ¿Ù·È Ë ¯ÔÚ‹ÁË-ÛË ÊÚ¤ÛÎÔ˘ Î·ÙÂ„˘ÁÌ¤ÓÔ˘ Ï¿ÛÌ·ÙÔ˜. ™˘ÌÏË-ÚˆÌ·ÙÈÎ‹ ·fi ÙÔ ÛÙfiÌ· ¯ÔÚ‹ÁËÛË 20 mg ËÌÂÚË-

Û›ˆ˜ ÛÙËÓ ¤ÁÎ˘Ô ÙÔÓ ÙÂÏÂ˘Ù·›Ô Ì‹Ó· ÙË˜ Î‡ËÛË˜,Ê·›ÓÂÙ·È Ó· ÚÔÏ·Ì‚¿ÓÂÈ ÙËÓ ·ÓÂ¿ÚÎÂÈ· ÙË˜ ‚ÈÙ·-Ì›ÓË˜ ∫ ÛÙÔ ÓÂÔÁÓfi, ·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ‰ÂÓ ‰È¤Ú-¯ÂÙ·È Â‡ÎÔÏ· ÙÔÓ Ï·ÎÔ‡ÓÙ· (7,10).

¶ÚÔÁÂÓÓËÙÈÎfi˜ ¤ÏÂÁ¯Ô˜O Î›Ó‰˘ÓÔ˜ Á¤ÓÓËÛË˜ ·È‰ÈÔ‡ ÌÂ Û˘ÁÁÂÓÂ›˜

·ÓˆÌ·Ï›Â˜ ı· Ú¤ÂÈ Ó· Á›ÓÂÙ·È ·ÓÙÈÏËÙfi˜ ÙfiÛÔ·fi ÙËÓ ¤ÁÎ˘Ô, fiÛÔ Î·È ·fi ÙÔ ÂÚÈ‚¿ÏÏÔÓ ÙË˜.ÀÂÚË¯ÔÁÚ·ÊÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙÔ˘ ÂÌ‚Ú‡Ô˘ ÙË 18Ë-22Ë Â‚‰ÔÌ¿‰· ÙË˜ Î‡ËÛË˜ ı· ‰ÒÛÂÈ ÏËÚÔÊÔÚ›Â˜ÁÈ· ÙËÓ ÂÓ‰Â¯fiÌÂÓË ‡·ÚÍË Û˘ÁÁÂÓÒÓ ·ÓˆÌ·ÏÈÒÓÛÙÔ ¤Ì‚Ú˘Ô. ∂ÈÚfiÛıÂÙÂ˜ ÏËÚÔÊÔÚ›Â˜ ÁÈ· ÙËÓ‡·ÚÍË ÂÏÏÂÈÌÌ¿ÙˆÓ ÙÔ˘ ÓˆÙÈ·›Ô˘ ÛˆÏ‹Ó· ı· ‰Ò-ÛÂÈ Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙË˜ · ÂÌ‚Ú˘˚Î‹˜ ÚˆÙÂ˝ÓË˜ÛÙÔÓ ÔÚfi ÙË˜ ÌËÙ¤Ú·˜ ÙË 15Ë ¤ˆ˜ 22Ë Â‚‰ÔÌ¿‰·ÙË˜ Î‡ËÛË˜. ¶ÚÔÙÂ›ÓÂÙ·È, Â›ÛË˜, Ë ‰ÈÂÓ¤ÚÁÂÈ··ÌÓÈÔÎ¤ÓÙËÛË˜ Î·Ù¿ ÙËÓ 16Ë Â‚‰ÔÌ¿‰· Î‡ËÛË˜, ÌÂÛÎÔfi ÙË Ì¤ÙÚËÛË ÙË˜ · ÂÌ‚Ú˘˚Î‹˜ ÚˆÙÂ˝ÓË˜ ÛÙÔ·ÌÓÈ·Îfi ˘ÁÚfi, Ë ÔÔ›· ‚Ú›ÛÎÂÙ·È ·˘ÍËÌ¤ÓË ÛÙËÓÏÂÈÔ„ËÊ›· ÙˆÓ ÂÚÈÙÒÛÂˆÓ Ô˘ ¤¯Ô˘Ó ¤ÏÏÂÈÌÌ·ÙÔ˘ ÓˆÙÈ·›Ô˘ ÛˆÏ‹Ó· (17,19). ∏ ÚÔÁÂÓÓËÙÈÎ‹ ‰È¿-ÁÓˆÛË Ù˘¯fiÓ Û˘ÁÁÂÓÒÓ ·ÓˆÌ·ÏÈÒÓ ·Ú¤¯ÂÈ ÛÙÔ˘˜ÁÔÓÂ›˜ ÙËÓ ÂÈÏÔÁ‹ ÙË˜ ‰È·ÎÔ‹˜ ÙË˜ Î‡ËÛË˜ ÛÙÈ˜ÂÚÈÙÒÛÂÈ˜ Ô˘ ‰ÂÓ ÂÈ‰¤¯ÔÓÙ·È ıÂÚ·Â˘ÙÈÎ‹ ·-Ú¤Ì‚·ÛË, ‰›ÓÂÈ ÂÚÈıÒÚÈ· ·Ô‰Ô¯‹˜ ÙÔ˘ ÚÔ‚Ï‹-Ì·ÙÔ˜ Î·È ÂÈÙÚ¤ÂÈ ÙËÓ ÔÚÁ¿ÓˆÛË ÏËÚ¤ÛÙÂÚË˜Î·È Î·Ù·ÏÏËÏfiÙÂÚË˜ ÂÚÈÁÂÓÓËÙÈÎ‹˜ ÊÚÔÓÙ›‰·˜.∂ÓÙÔ‡ÙÔÈ˜, Â›Ó·È ¯Ú‹ÛÈÌÔ Ó· ÂÓËÌÂÚÒÓÂÙ·È ÙfiÛÔ Ë¤ÁÎ˘Ô˜, fiÛÔ Î·È ÙÔ ÂÚÈ‚¿ÏÏÔÓ ÙË˜ ÁÈ· ÙÈ˜ ·‰˘Ó·-Ì›Â˜ ÙÔ˘ ÚÔÁÂÓÓËÙÈÎÔ‡ ÂÏ¤Á¯Ô˘, fiÛÔÓ ·ÊÔÚ¿ÛÙËÓ ·Ó›¯ÓÂ˘ÛË fiÏˆÓ ÙˆÓ ÂÓ‰Â¯fiÌÂÓˆÓ ÚÔ‚ÏËÌ¿-ÙˆÓ, Ë ÎÏÈÓÈÎ‹ ¤ÎÊÚ·ÛË ÙˆÓ ÔÔ›ˆÓ ÌÔÚÂ› Ó· Á›ÓÂÈ·ÓÙÈÏËÙ‹ ·ÚÁfiÙÂÚ·, fiˆ˜ ÁÈ· ·Ú¿‰ÂÈÁÌ· Ë ‰È·-ÓÔËÙÈÎ‹ Î·ı˘ÛÙ¤ÚËÛË (1,17).

∆ÔÎÂÙfi˜∏ ÏÂÈÔ„ËÊ›· ÙˆÓ ÂÈÏËÙÈÎÒÓ ÂÁÎ‡ˆÓ ÔÏÔÎÏË-

ÚÒÓÂÈ ÙËÓ ÂÁÎ˘ÌÔÛ‡ÓË ÌÂ ¤Ó·Ó ·ÛÊ·Ï‹ Î·È ¯ˆÚ›˜È‰È·›ÙÂÚ· ÚÔ‚Ï‹Ì·Ù· Î·È Û˘Ì‚¿Ì·Ù· ÎÔÏÈÎfi ÙÔ-ÎÂÙfi. ŸÌˆ˜, ÔÛÔÛÙfi 1-2% ÙˆÓ ÂÈÏËÙÈÎÒÓÂÁÎ‡ˆÓ ı· ‚ÈÒÛÂÈ ÙËÓ ÂÌÂÈÚ›· Ì›·˜ ÂÈÏËÙÈÎ‹˜ÎÚ›ÛË˜ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÙÔÎÂÙÔ‡, ÂÓÒ 1-2%,Â›ÛË˜, ı· ¤¯ÂÈ ·Ó¿ÏÔÁË ÂÌÂÈÚ›· ÙÔ 1Ô 24ˆÚÔ ÌÂ-Ù¿ ÙÔÓ ÙÔÎÂÙfi (2,10). °›ÓÂÙ·È, ÏÔÈfiÓ, ·ÓÙÈÏËÙfi fi-ÛÔ ÛËÌ·ÓÙÈÎ‹ ÁÈ· ÙËÓ ÙÂÏÈÎ‹ ¤Î‚·ÛË Â›Ó·È Ë Ï‹„ËÙË˜ ·ÁˆÁ‹˜ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÙÔÎÂÙÔ‡, fiˆ˜Â›ÛË˜ Î·È Ë ‰È·Ù‹ÚËÛË ÙˆÓ ÂÈ¤‰ˆÓ ÛÂ ıÂÚ·Â˘-ÙÈÎ¿ Â›Â‰· Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ Î‡ËÛË˜. ∫·Ù¿ ÙË‰È¿ÚÎÂÈ· ÙÔ˘ ÙÔÎÂÙÔ‡, Ë ¯ÔÚ‹ÁËÛË ·ÓÙÈÂÈÏËÙÈÎ‹˜·ÁˆÁ‹˜ Û˘ÓÂ¯›˙ÂÙ·È. ŸÏ· Ù· ·ÓÙÈÂÈÏËÙÈÎ¿ ÛÎÂ˘¿-ÛÌ·Ù· ÌÔÚÔ‡Ó Ó· ¯ÔÚËÁËıÔ‡Ó, ·Ó ÎÚÈıÂ› ÛÎfiÈÌÔ,ÌÂ ÚÈÓÔÁ·ÛÙÚÈÎfi Î·ıÂÙ‹Ú·, ÂÓÒ Ë Ê·ÈÓ˘ÙÔ˝ÓË, ÙÔ‚·ÏÚÔ˚Îfi ÔÍ‡, Ë ‰È·˙Â¿ÌË, Ë ÎÏÔÓ·˙Â¿ÌË Î·È Ë

Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË ÌÔÚÔ‡Ó Ó· ¯ÔÚËÁËıÔ‡Ó Î·È ·-ÚÂÓÙÂÚÈÎ¿ (2,10,19). ™ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ ÂÎÂ›ÓÂ˜ Ô˘Â›ÎÂÈÙ·È ÚfiˆÚÔ˜ ÙÔÎÂÙfi˜ Î·È ·ÔÊ·ÛÈÛÙÂ› Ë ¯Ô-Ú‹ÁËÛË ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰ÒÓ ÛÙËÓ ¤ÁÎ˘Ô ÌÂ ÛÙfi¯ÔÙËÓ ˆÚ›Ì·ÓÛË ÙˆÓ ÓÂ˘ÌfiÓˆÓ ÙÔ˘ ÂÌ‚Ú‡Ô˘, Î·ÏfiÂ›Ó·È Ó· Ï·Ì‚¿ÓÂÙ·È ˘’ fi„ÈÓ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ë ¯Ô-Ú‹ÁËÛË Ê·ÈÓ˘ÙÔ˝ÓË˜, Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË˜, Î·Ú‚·Ì·-˙Â›ÓË˜ Î·È ÚÈÌÈ‰fiÓË˜, Â¿ÁÔÓÙ·˜ Ù· Ë·ÙÈÎ¿ ÌÈ-ÎÚÔÛˆÌÈ·Î¿ ¤Ó˙˘Ì·, Î·ıÈÛÙ¿ ··Ú·›ÙËÙË ÙË ¯ÔÚ‹-ÁËÛË ÌÂÁ·Ï‡ÙÂÚˆÓ ‰fiÛÂˆÓ ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰ÒÓ(10,43).

∏ ÂÓ‰ÔÊÏ¤‚È· ¯ÔÚ‹ÁËÛË ÏÔÚ·˙Â¿ÌË˜ ÌÔÚÂ›Ó· ¯ÚËÛÈÌÔÔÈËıÂ› Û·Ó ÔÍÂ›· ·ÓÙÈÌÂÙÒÈÛË ÂÈÏË-ÙÈÎ‹˜ ÎÚ›ÛË˜ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÙÔÎÂÙÔ‡. ∂¿ÓÙ· ÂÂÈÛfi‰È· Û·ÛÌÒÓ Â·Ó·Ï·Ì‚¿ÓÔÓÙ·È ‹ Ë Â›-ÙÔÎÔ˜ Â›Ó·È ÛÂ “status epilepticus”, Û˘ÓÈÛÙ¿Ù·È Ë‰ÈÂÓ¤ÚÁÂÈ· ÂÂ›ÁÔ˘Û·˜ Î·ÈÛ·ÚÈÎ‹˜ ÙÔÌ‹˜. ∏ ÂÚÈÔ-¯ÈÎ‹ ÂÈÛÎÏËÚ›‰ÈÔ˜ ·Ó·ÈÛıËÛ›· ÚÔÙÂ›ÓÂÙ·È ÌÂ ÛÎÔ-fi Ó· ÂÚÈÔÚÈÛÙÂ› Î·Ù¿ ÙÔ ‰˘Ó·ÙfiÓ ÙÔ ÂÒ‰˘ÓÔÂÚ¤ıÈÛÌ·. ∏ ‰ÈÂÓ¤ÚÁÂÈ· Î·ÈÛ·ÚÈÎ‹˜ ÙÔÌ‹˜ Û·Ó Ù·-ÎÙÈÎ‹ ÚÔ˘Ù›Ó·˜ Ì¿ÏÏÔÓ ‰ÂÓ ÚÔÙÂ›ÓÂÙ·È, ÂÓÒ ıÂˆ-ÚÂ›Ù·È Â˘ÂÚÁÂÙÈÎ‹ ÛÙÈ˜ ÂÚÈÙÒÛÂÈ˜ Ô˘ Ë Ú‡ıÌÈÛËÙË˜ ÂÈÏËÙÈÎ‹˜ ÂÁÎ‡Ô˘ ‰ÂÓ Â›Ó·È ÈÎ·ÓÔÔÈËÙÈÎ‹ Î·È¤¯Ô˘Ó ·Ó·ÊÂÚıÂ› ÎÚ›ÛÂÈ˜ Î·Ù¿ ÙËÓ ÙÂÏÂ˘Ù·›· Â‚‰Ô-Ì¿‰· ÚÈÓ ÙÔÓ ÙÔÎÂÙfi. ∂›Ó·È ÁÓˆÛÙfi fiÙÈ Ë ¯ÔÚ‹ÁËÛË·ÓÙÈÂÈÏËÙÈÎÒÓ ÛÙËÓ Â›ÙÔÎÔ ÌÔÚÂ› Ó· ÚÔÎ·Ï¤-ÛÂÈ Î·Ù·ÛÙÔÏ‹ ÛÙÔ ¤Ì‚Ú˘Ô. ∏ ·ÚÔ˘Û›·, ÏÔÈfiÓ,ÛÙËÓ ·›ıÔ˘Û· ÙÔÎÂÙÔ‡ È·ÙÚÔ‡ ÈÎ·ÓÔ‡ ÛÙËÓ ·Ó¿ÓË„ËÙÔ˘ ÓÂÔÁÓÔ‡, ıÂˆÚÂ›Ù·È ··Ú·›ÙËÙË. °È· ÏfiÁÔ˘˜·ÛÊ·ÏÂ›·˜, Ë ‰ÈÂÓ¤ÚÁÂÈ· ÙÔ˘ ÙÔÎÂÙÔ‡ Û˘ÓÈÛÙ¿Ù·È Ó·Á›ÓÂÙ·È ÛÂ ÂÚÈÁÂÓÓËÙÈÎfi Î¤ÓÙÚÔ, ÙÔ ÔÔ›Ô Â›Ó·È ÈÎ·-Ófi Ó· ·ÓÙÈÌÂÙˆ›ÛÂÈ ÙËÓ Â›ÙÔÎÔ, fiÛÔÓ ·ÊÔÚ¿ ÛÂ ÂÓ-‰Â¯fiÌÂÓË ·Ó·ÁÎ·ÈfiÙËÙ· ÂÂ›ÁÔ˘Û·˜ Î·ÈÛ·ÚÈÎ‹˜ ÙÔ-Ì‹˜, Î·ıÒ˜ Î·È ÙÔ ÓÂÔÁÓfi ÙË˜ (2,10).

£ËÏ·ÛÌfi˜∏ ·ÓÙÈÂÈÏËÙÈÎ‹ ·ÁˆÁ‹ ÛÙË ÌËÙ¤Ú· ‰ÂÓ ıÂˆ-

ÚÂ›Ù·È ·ÓÙ¤Ó‰ÂÈÍË ÁÈ· ÙÔÓ ÌËÙÚÈÎfi ıËÏ·ÛÌfi. ŸÏ·Û¯Â‰fiÓ Ù· ·ÓÙÈÂÈÏËÙÈÎ¿ Ê¿ÚÌ·Î· ·ÂÎÎÚ›ÓÔÓÙ·È·fi ÙÔ ÌËÙÚÈÎfi Á¿Ï·. ∆Ô Û˘ÓÔÏÈÎfi ÔÛfi ÙÔ˘ Ê·Ú-Ì¿ÎÔ˘ Ô˘ Ï·Ì‚¿ÓÂÈ ÙÔ ÓÂÔÁÓfi ‹ ÙÔ ‚Ú¤ÊÔ˜ ÌÂ ÙÔıËÏ·ÛÌfi Â›Ó·È Û·ÊÒ˜ ÌÈÎÚfiÙÂÚÔ ·fi ·˘Ùfi Ô˘ ÌÂ-Ù·Ê¤ÚÂÙ·È Ì¤Ûˆ ÙÔ˘ Ï·ÎÔ‡ÓÙ· Î·Ù¿ ÙË ‰È¿ÚÎÂÈ·ÙË˜ Î‡ËÛË˜ (7,10,17,44). ∂ÓÙÔ‡ÙÔÈ˜, ÂÂÈ‰‹ Ô ÌÂÙ·-‚ÔÏÈÛÌfi˜ ÙˆÓ Ê·ÚÌ¿ÎˆÓ Î·È Ë ·¤ÎÎÚÈÛ‹ ÙÔ˘˜ ÙÈ˜ÚÒÙÂ˜ ËÌ¤ÚÂ˜ ÙË˜ ˙ˆ‹˜ Â›Ó·È ·ÓÂ·ÚÎ‹, Ë Â·Ó·-Ï·Ì‚·ÓfiÌÂÓË ÚfiÛÏË„Ë ·fi ÙÔ ÌËÙÚÈÎfi Á¿Ï· ÌÔ-ÚÂ› ‰˘ÓËÙÈÎ¿ Ó· ¤¯ÂÈ ·ıÚÔÈÛÙÈÎ‹ ‰Ú¿ÛË. ∆Ô Û˘ÓÔÏÈ-Î¿ ·ıÚÔÈ˙fiÌÂÓÔ ÔÛfi ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ÂÍ·ÚÙ¿Ù·È·fi ÙË Û˘¯ÓfiÙËÙ· Î·È ÙÔÓ Û˘ÓÔÏÈÎfi fiÁÎÔ ÙˆÓ ËÌÂ-Ú‹ÛÈˆÓ ÁÂ˘Ì¿ÙˆÓ, ÙËÓ ËÏÈÎ›· ÙÔ˘ ‚Ú¤ÊÔ˘˜, ÙËÓ Î·-Ù¿ÛÙ·ÛË ÙË˜ ˘ÁÂ›·˜ ÙÔ˘ Î·È ·fi ÙË Ï‹„Ë ¿ÏÏˆÓÊ·ÚÌ·ÎÂ˘ÙÈÎÒÓ Ô˘ÛÈÒÓ Ô˘ Ù˘¯fiÓ ÂËÚÂ¿˙Ô˘Ó ÙËÓ

·ÔÚÚfiÊËÛË, ÙË ‚ÈÔ‰È·ıÂÛÈÌfiÙËÙ· ‹ ÙÔÓ ÌÂÙ·‚ÔÏÈ-ÛÌfi Î·È ÙËÓ ·¤ÎÎÚÈÛ‹ ÙÔ˘ (10). OÈ Û˘ÁÎÂÓÙÚÒÛÂÈ˜ÙÔ˘˜ ÛÙÔ ÌËÙÚÈÎfi Á¿Ï· ÔÈÎ›ÏÏÔ˘Ó ·fi 10% ¤ˆ˜100% ÙˆÓ Û˘ÁÎÂÓÙÚÒÛÂÒÓ ÙÔ˘ ÛÙÔ ÌËÙÚÈÎfi Ï¿-ÛÌ·. ªÂ ‰Â‰ÔÌ¤ÓË ÙË ¯·ÌËÏfiÙÂÚË ‰ÂÛÌÂ˘ÙÈÎ‹ ÈÎ·-ÓfiÙËÙ· ÙˆÓ ÚˆÙÂ˚ÓÒÓ ÙÔ˘ ÓÂÔÁÓÔ‡ Î·È ÙÔÓ Ì·ÎÚfi-ÙÂÚÔ ¯ÚfiÓÔ ËÌÈ˙ˆ‹˜ ÛÙÔ Ï¿ÛÌ· ÛÂ Û¯¤ÛË ÌÂ ÙËÌËÙ¤Ú· ÙÔ˘, Ë ‰Ú·ÛÙÈÎ‹ Û˘ÁÎ¤ÓÙÚˆÛË ÙÔ˘ Ê·ÚÌ¿-ÎÔ˘ ÌÔÚÂ› Ó· Â›Ó·È ·˘ÍËÌ¤ÓË (17). ŒÙÛÈ, ÛÙÈ˜ ÂÚÈ-ÙÒÛÂÈ˜ Ô˘ Ë ÌËÙ¤Ú· Ï·Ì‚¿ÓÂÈ ÚÈÌÈ‰fiÓË, Ê·ÈÓÔ-‚·Ú‚ÈÙ¿ÏË ‹ ‚ÂÓ˙Ô‰È·˙Â›ÓÂ˜, ÙÔ ÓÂÔÁÓfi ÌÔÚÂ›‰˘ÓËÙÈÎ¿ Ó· Â›Ó·È ÛÂ Î·Ù·ÛÙÔÏ‹ Î·È Ó· ·ÚÔ˘ÛÈ¿˙ÂÈ‰˘ÛÎÔÏ›Â˜ ÛÙË Û›ÙÈÛË. ™ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ ÂÎÂ›ÓÂ˜Ô˘ Ù· ÛËÌÂ›· Î·Ù·ÛÙÔÏ‹˜ Â›Ó·È È‰È·›ÙÂÚ· ¤ÓÙÔÓ·,Û˘ÓÈÛÙ¿Ù·È Ë ‰È·ÎÔ‹ ÙÔ˘ ıËÏ·ÛÌÔ‡. ∏ Ê·ÈÓÔ‚·Ú-‚ÈÙ¿ÏË Î·È Ë ÚÈÌÈ‰fiÓË ÚÔÎ·ÏÔ‡Ó ÛËÌÂ›· Î·Ù·-ÛÙÔÏ‹˜ ÛÙÔ ‚Ú¤ÊÔ˜, ·ÊÔ‡ Ë ·¤ÎÎÚÈÛ‹ ÙÔ˘˜ ·fiÙÔ ÌËÙÚÈÎfi Á¿Ï· Â›Ó·È ÛËÌ·ÓÙÈÎ‹. ∏ Ù·ÎÙÈÎ‹ ÎÏÈÓÈÎ‹ÂÎÙ›ÌËÛË Î·È Ë ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙÔ˘Ê·ÚÌ¿ÎÔ˘ ÛÙÔÓ ÔÚfi ÙÔ˘ ‚Ú¤ÊÔ˘˜ ÎÚ›ÓÔÓÙ·È ··-Ú·›ÙËÙ· (2,17). ∏ Ê·ÈÓ˘ÙÔ˝ÓË ·ÂÎÎÚ›ÓÂÙ·È ÛÙÔ ÌË-ÙÚÈÎfi Á¿Ï· ÛÂ ÌÈÎÚ¤˜ ÔÛfiÙËÙÂ˜. ∆· Â›Â‰· ÛÙÔÓÔÚfi ÙˆÓ ‚ÚÂÊÒÓ Ô˘ ıËÏ¿˙Ô˘Ó ·fi ÌËÙ¤ÚÂ˜ Ô˘‚Ú›ÛÎÔÓÙ·È ÛÂ ÌÔÓÔıÂÚ·Â›· ÌÂ Ê·ÈÓ˘ÙÔ˝ÓË Â›Ó·È¯·ÌËÏ¿ Î·È ‰ÂÓ ˘¿Ú¯ÂÈ ·ÓÙ¤Ó‰ÂÈÍË ÁÈ· ÙÔÓ ÌËÙÚÈ-Îfi ıËÏ·ÛÌfi (44). ∏ ıÂÚ·Â›· ÙË˜ ÌËÙ¤Ú·˜ ÌÂ Î·Ú-‚·Ì·˙Â›ÓË ‹ ‚·ÏÚÔ˚Îfi Â›Ó·È ·ÛÊ·Ï‹˜ ÁÈ· ÙÔ ‚Ú¤-ÊÔ˜ Ô˘ ıËÏ¿˙ÂÈ. OÈ ÔÛfiÙËÙÂ˜ Ô˘ ÂÚÓÔ‡Ó ÛÙÔÌËÙÚÈÎfi Á¿Ï· Î·È ·ÔÚÚÔÊÔ‡ÓÙ·È ·fi ÙÔ ‚Ú¤ÊÔ˜Â›Ó·È ÌÈÎÚ¤˜ Î·È Û˘Ó‹ıˆ˜ ·ÛÊ·ÏÂ›˜. ŸÛÔÓ ·ÊÔÚ¿ÛÙ· Ó¤· ·ÓÙÈÂÈÏËÙÈÎ¿ ‚ÈÎ·Ì·ÙÚ›ÓË, Ï·ÌÔÙÚÈÁ›ÓË,ÁÎ·Ì·ÂÓÙ›ÓË Î·È ÊÂÏÌ·Ì¿ÙË, ‰ÂÓ ˘¿Ú¯Ô˘Ó ·Ú-ÎÂÙ¤˜ ÌÂÏ¤ÙÂ˜ Ô˘ Ó· ÂÁÁ˘ÒÓÙ·È ÙËÓ ·ÛÊ·Ï‹ ¯Ú‹-ÛË ÙÔ˘˜ ·fi ÙË ÌËÙ¤Ú· Ô˘ ıËÏ¿˙ÂÈ. ∏ ¯Ú‹ÛË ÙË˜ÊÂÏÌ·Ì¿ÙË˜ Û˘ÓÈÛÙ¿Ù·È Ó· ·ÔÊÂ‡ÁÂÙ·È ·fi ÙËıËÏ¿˙Ô˘Û· ÌËÙ¤Ú· ÂÍ·ÈÙ›·˜ ÙˆÓ ·ÈÌ·ÙÔÏÔÁÈÎÒÓ·ÓÂÈı‡ÌËÙˆÓ ÂÓÂÚÁÂÈÒÓ ÙË˜, ÔÈ ÔÔ›Â˜ ‰ÂÓ Â›Ó·È··Ú·›ÙËÙ· ¿ÌÂÛ· Û¯ÂÙÈ˙fiÌÂÓÂ˜ ÌÂ Ù· Â›Â‰· ÙÔ˘Ê·ÚÌ¿ÎÔ˘ ÛÙÔ Ï¿ÛÌ· (10).

∏ ÂÈÏË„›· Â›Ó·È Ë Û˘¯ÓfiÙÂÚË ÓÂ˘ÚÔÏÔÁÈÎ‹ ‰È·-Ù·Ú·¯‹ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ Î‡ËÛË˜. ¢ÂÓ Â›Ó·È,fiÌˆ˜, Ï›ÁÂ˜ ÔÈ ÂÚÈÙÒÛÂÈ˜ Ô˘ ÙÔ ÌÔÚÊˆÙÈÎfi Â›-Â‰Ô ÙË˜ ÂÁÎ‡Ô˘ ÌÂ ÂÈÏË„›· ‰ÂÓ ÙË˜ ÂÈÙÚ¤ÂÈ Ó·ÁÓˆÛÙÔÔÈ‹ÛÂÈ ÙÔ Úfi‚ÏËÌ¿ ÙË˜, Ë ÔÔ›· ·ÓÙÈÌÂ-Ùˆ›˙ÂÈ ÙÔ ÂÓ‰Â¯fiÌÂÓÔ ÙË˜ ÂÚÈıˆÚÈÔÔ›ËÛË˜ ÌÂÙÚfiÌÔ. ™ÙÔ ÛËÌÂ›Ô ·˘Ùfi, fiÌˆ˜, ÔÈ Û˘Ó¤ÂÈÂ˜ ‰ÂÓ Â›-Ó·È Ï›ÁÂ˜, Ô‡ÙÂ ·Û‹Ì·ÓÙÂ˜ ÙfiÛÔ ÁÈ· ÙËÓ ›‰È· fiÛÔÎ·È ÁÈ· ÙÔ ÓÂÔÁÓfi ÙË˜. ÃÚ¤Ô˜ ÙË˜ ÎÔÈÓˆÓ›·˜ Â›Ó·È Ë˘ÔÛÙ‹ÚÈÍË ·˘ÙÒÓ ÙˆÓ ·ÙfiÌˆÓ ÛÂ fiÏÔ˘˜ ÙÔ˘˜ ÙÔ-ÌÂ›˜ Î·È Ë ‰È·Ù‹ÚËÛË ÙˆÓ ·ÚÂ¯fiÌÂÓˆÓ ˘ËÚÂÛÈÒÓ˘ÁÂ›·˜ ÛÂ ˘„ËÏfi Â›Â‰Ô. ∏ ÚÔÂÙÔÈÌ·Û›· Î·È ÔÚÔÁÚ·ÌÌ·ÙÈÛÌfi˜ ÙË˜ Î‡ËÛË˜, Î·ıÒ˜ Î·È Ë ÂÈ-ı·Ú¯ËÌ¤ÓË Î·È ÛˆÛÙ‹ ·Ú·ÎÔÏÔ‡ıËÛË ·fi ÔÌ¿‰·


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ÂÈ‰ÈÎÒÓ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ¿ ÙË˜ Â›Ó·È ··Ú·›ÙËÙÂ˜ÚÔ¸Ôı¤ÛÂÈ˜ ÁÈ· ÙËÓ ÔÌ·Ï‹ ÂÍ¤ÏÈÍË ÙË˜ Î‡ËÛË˜ Î·ÈÙÔ˘ ÙÔÎÂÙÔ‡ ¯ˆÚ›˜ ÂÈÏÔÎ¤˜, Î·ıÒ˜ Î·È ÁÈ· ÙË Á¤Ó-ÓËÛË ÂÓfi˜ Ê˘ÛÈÔÏÔÁÈÎÔ‡ Î·Ù¿ ÙÔ ‰˘Ó·ÙfiÓ ÓÂÔÁÓÔ‡.

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∫ÏÈÓÈÎ‹ ¶ÚÔÏËÙÈÎ‹˜ π·ÙÚÈÎ‹˜ Î·È ¢È·ÙÚÔÊ‹˜ ∆ÔÌ¤·˜ ∫ÔÈÓˆÓÈÎ‹˜ π·ÙÚÈÎ‹˜, ∆Ì‹Ì· π·ÙÚÈÎ‹˜ ™¯ÔÏ‹ ∂ÈÛÙËÌÒÓ ÀÁÂ›·˜ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹ÙË˜, ∏Ú¿ÎÏÂÈÔ ∫Ú‹ÙË˜

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

�¶ÂÚ›ÏË„Ë: ∏ ¤ÁÎ·ÈÚË ·ÓÂ‡ÚÂÛË ÙˆÓ ·Ú·Áfi-ÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ ·fi ÙËÓ ·È‰È-Î‹ ·ÎfiÌ· ËÏÈÎ›· ÌÂÈÒÓÂÈ ÙËÓ Èı·ÓfiÙËÙ· ÙˆÓ Î·Ú-‰È·ÁÁÂÈ·ÎÒÓ ÂÂÈÛÔ‰›ˆÓ. ™Ùfi¯ÔÈ ÙË˜ ·ÚÔ‡Û·˜ ÌÂ-Ï¤ÙË˜ ‹Ù·Ó Ó· ÂÚÂ˘ÓËıÂ› Ë Û˘Û¯¤ÙÈÛË ‰È·ÊfiÚˆÓ‰ÂÈÎÙÒÓ ·¯˘Û·ÚÎ›·˜ ÌÂ ÚÔ‰È·ıÂÛÈÎÔ‡˜ ·-Ú¿ÁoÓÙÂ˜ ÁÈ· Î·Ú‰È·ÁÁÂÈ·Î‹ ÓfiÛÔ ÛÂ ·È‰È¿ ÚÔ-Û¯ÔÏÈÎ‹˜ Î·È Û¯ÔÏÈÎ‹˜ ËÏÈÎ›·˜ Î·È Ó· ÂÎÙÈÌËıÂ› ÔÂÈÔÏ·ÛÌfi˜ ÙË˜ ·¯˘Û·ÚÎ›·˜, ÙË˜ ˘ÂÚ¯ÔÏËÛÙÂ-ÚÔÏ·ÈÌ›·˜ Î·È ÙË˜ ˘ÂÚÈÓÛÔ˘ÏÈÓ·ÈÌ›·˜. ™ˆÌ·ÙÔÌÂ-ÙÚ‹ÛÂÈ˜ Î·È ‚ÈÔ¯ËÌÈÎ¤˜ ÌÂÙÚ‹ÛÂÈ˜ Ú·ÁÌ·ÙÔÔÈ‹-ıËÎ·Ó ÛÂ 178 ·fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ 201 ·È‰ÈÒÓ ÙÔ˘¢‹ÌÔ˘ ƒÔ‡‚· (99 ·ÁfiÚÈ·, 102 ÎÔÚ›ÙÛÈ·) ËÏÈÎ›·˜ 4-15 ÂÙÒÓ. §‹„Ë ˘Ô‰fiÚÈÔ˘ Ï›Ô˘˜ ¤ÁÈÓÂ ÛÂ 111 ·È-‰È¿. ∏ Û‡ÁÎÚÈÛË ÙˆÓ ‰ÂÈÎÙÒÓ ·¯˘Û·ÚÎ›·˜ ¤ÁÈÓÂ ÌÂÙË ¯Ú‹ÛË ÙË˜ ÔÏÏ·Ï‹˜ ÛÙ·ÙÈÛÙÈÎ‹˜ ·ÏÈÓ‰ÚfiÌË-ÛË˜. ¶¤ÓÙÂ ÛÙÔ˘˜ 6 ‰Â›ÎÙÂ˜ ·¯˘Û·ÚÎ›·˜ ·ÚÔ˘-Û›·˙·Ó ·ÚÓËÙÈÎ‹ Û˘Û¯¤ÙÈÛË ÌÂ ÙËÓ HDL-¯ÔÏËÛÙÂ-ÚfiÏË Î·È ıÂÙÈÎ‹ Û˘Û¯¤ÙÈÛË ÌÂ ÙË Û˘ÁÎ¤ÓÙÚˆÛË ÙÚÈ-ÁÏ˘ÎÂÚÈ‰›ˆÓ Î·È ÙÔÓ ÏfiÁÔ ÔÏÈÎ‹˜ ¯ÔÏËÛÙÂÚfiÏË˜ÚÔ˜ HDL-¯ÔÏËÛÙÂÚfiÏË. ∏ ÂÚ›ÌÂÙÚÔ˜ Ì¤ÛË˜(¶ª), ÙÔ ÛˆÌ·ÙÈÎfi ‚¿ÚÔ˜ (™µ), Ô ‰Â›ÎÙË˜ Ì¿˙·˜ÛÒÌ·ÙÔ˜ (¢ª™), ÙÔ ¿ıÚÔÈÛÌ· ÙˆÓ ‰ÂÚÌ·ÙÈÎÒÓ Ù˘-¯ÒÓ (A¢¶) Î·È Ô ÏfiÁÔ˜ ÂÚÈÌ¤ÙÚÔ˘ Ì¤ÛË˜ ÚÔ˜ ‡„Ô˜ ÛÒÌ·ÙÔ˜ (¶ªÀ) Û˘Û¯ÂÙ›˙ÔÓÙ·Ó ıÂÙÈÎ¿ÌÂ Ù· Â›Â‰· ÙË˜ ÈÓÛÔ˘Ï›ÓË˜ (p<0,0005 ÁÈ· fiÏÔ˘˜ÙÔ˘˜ ‰Â›ÎÙÂ˜). ¢ÂÓ ‚Ú¤ıËÎÂ ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹Û˘Û¯¤ÙÈÛË ÙÔ˘ ÔÛÔÛÙÔ‡ ÎÔÚÂÛÌ¤ÓÔ˘, ÌÔÓÔ·ÎfiÚÂ-ÛÙÔ˘ ‹ ÔÏ˘·ÎfiÚÂÛÙÔ˘ ˘Ô‰fiÚÈÔ˘ Ï›Ô˘˜ ÌÂ ÙÔ˘˜ ÚÔ‰È·ıÂÛÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜. ÃÚËÛÈÌÔÔÈÒ-ÓÙ·˜ ‰ÈÂıÓÒ˜ Î·ıÔÚÈÛÌ¤Ó· fiÚÈ·, ÙÔ 32% ÙˆÓ ·È-‰ÈÒÓ ÎÚ›ıËÎÂ ˘¤Ú‚·ÚÔ Î·È ÙÔ 9% ÙÔ˘ Û˘ÓfiÏÔ˘ ÎÚ›ıËÎÂ ·¯‡Û·ÚÎÔ. ∆Ô 19% ÙˆÓ ·È‰ÈÒÓ ·ÚÔ˘-Û›·˙Â ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· (TC >200 mg/dL), ÙÔ

�Abstract: The risk of cardiovascular disease(CVD) is reduced by the early detection ofpredisposing factors. The aims of this study were toinvestigate the relationships between variousobesity indices and cardiovascular disease riskfactors and to estimate the prevalence of obesity,hypercholesteraemia and hyperinsulinaemia in arural population of children. Complete anthro-pometric and biochemical measurements wereobtained in 178 of the 201 children (99 boys, 102girls) aged between 4 and 15 years living in amountainous rural community in Crete. Adiposetissue samples were taken from 111 children. Usingmultiple regression techniques, five of the sixobesity indices considered were found to benegatively related to HDL and positively related totriglyceride concentration and the total cholesterol(TC) to HDL ratio. Waist circumference, bodyweight, body mass index (BMI), the sum of fourskinfolds and waist to height ratio were positivelyrelated to insulin concentration (p<0.0005 in allcases). No statistically significant relationship wasfound between the risk factors and the precentageof saturated, monounsaturated or polyunsaturatedadipose fat. Using IOTF criteria, 32% of the childrenwere overweight and 9% obese; 19% of the childrenhad hypercholesteraemia (TC >200 mg/dL), 7%hyperinsulaemia (insulin >17 ÌIU/mol) and 32%increased arterial blood pressure (>95thpercentile), while 29% had at least 2 risk factors.The findings of this study indicate an increasedprevalence of obesity and other CVD risk factors inchildren living in rural Crete. Waist circumferenceappears to be as closely related as BMI to other risk


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∂ÈÛ·ÁˆÁ‹™ÙË ÌÂÏ¤ÙË ÙˆÓ ∂Ù¿ ÃˆÚÒÓ Ô˘ ¿Ú¯ÈÛÂ ÙÔ

1960, Ô ·Ó‰ÚÈÎfi˜ ·ÁÚÔÙÈÎfi˜ ÏËı˘ÛÌfi˜ ÙË˜ ∫Ú‹-ÙË˜ ¯·Ú·ÎÙËÚÈ˙fiÙ·Ó ·fi ÙË ÌÈÎÚfiÙÂÚË 25ÂÙ‹ ıÓË-ÛÈÌfiÙËÙ· ·fi ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ, ÛÂ Û‡ÁÎÚÈÛË ÌÂÙÔ˘˜ ˘fiÏÔÈÔ˘˜ 15 ÏËı˘ÛÌÔ‡˜ ÙË˜ ÌÂÏ¤ÙË˜ (1).∏ ÔÌ·‰ÔÔÈËÌ¤ÓË (pooled) ÂÈÎÈÓ‰˘ÓfiÙËÙ· ı·Ó¿-ÙÔ˘ ·fi Î·Ú‰È·ÁÁÂÈ·Îfi ÓfiÛËÌ· Û¯ÂÙ›ÛÙËÎÂ, ÌÂÙ·-Í‡ ¿ÏÏˆÓ, ÌÂ ÙË Û˘ÛÙÔÏÈÎ‹ ·ÚÙËÚÈ·Î‹ ›ÂÛË, ÙÔÓ‰Â›ÎÙË Ì¿˙·˜ ÛÒÌ·ÙÔ˜ Î·È ÙË Û˘ÁÎ¤ÓÙÚˆÛË ¯ÔÏË-ÛÙÂÚfiÏË˜ ÔÚÔ‡ (2). O ¯·ÌËÏfi˜ ‰Â›ÎÙË˜ ıÓËÛÈÌfiÙË-Ù·˜ ÙÔ˘ ÏËı˘ÛÌÔ‡ ÙË˜ ∫Ú‹ÙË˜ Û¯ÂÙ›ÛÙËÎÂ, Â›-ÛË˜, ÌÂ ÙËÓ ·Ú·‰ÔÛÈ·Î‹ ÎÚËÙÈÎ‹ ‰›·ÈÙ·, Ô˘ ÂÚÈ-Â›¯Â ¯·ÌËÏ‹ ÂÚÈÂÎÙÈÎfiÙËÙ· ÎÔÚÂÛÌ¤ÓˆÓ ÏÈ·ÚÒÓÔÍ¤ˆÓ Î·È ˘„ËÏ‹ ÂÚÈÂÎÙÈÎfiÙËÙ· ÌÔÓÔ·ÎfiÚÂÛÙˆÓÏÈ·ÚÒÓ ÔÍ¤ˆÓ (1). ™‹ÌÂÚ·, Ë Ù˘ÈÎ‹ ‰›·ÈÙ· ÛÙËÓ∫Ú‹ÙË ‰È·Ê¤ÚÂÈ ·ÚÎÂÙ¿ ·fi ·˘Ù‹Ó ÙÔ˘ 1960, ÌÂ

·˘ÍËÌ¤ÓË ÚfiÛÏË„Ë ÎÔÚÂÛÌ¤ÓˆÓ ÏÈ·ÚÒÓ ÔÍ¤ˆÓÙfiÛÔ ÛÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜, fiÛÔ Î·È ÛÙ· ·È‰È¿ Î·È ÙÔ˘˜ÂÊ‹‚Ô˘˜ (3,4). ∏ ·˘ÍËÌ¤ÓË ÚfiÛÏË„Ë ÎÔÚÂÛÌ¤ÓˆÓÏÈ·ÚÒÓ ÔÍ¤ˆÓ ÛÙË ‰È·ÙÚÔÊ‹ (Î·È ÈÔ Û˘ÁÎÂÎÚÈÌ¤-Ó· ·˘Ù¿ ÌÂ 12-16 ¿ÙÔÌ· ¿ÓıÚ·Î·) Û¯ÂÙ›˙ÂÙ·È ÌÂ·˘ÍËÌ¤Ó· Â›Â‰· ¯ÔÏËÛÙÂÚfiÏË˜ Ï¿ÛÌ·ÙÔ˜ Î·È·˘ÍËÌ¤ÓË Â›ÙˆÛË ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ (5). ∏ Úfi-ÛÏË„Ë Ï›Ô˘˜ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÌÂÁ¿ÏˆÓ ¯ÚÔÓÈÎÒÓÂÚÈfi‰ˆÓ ·ÓÙ·Ó·ÎÏ¿Ù·È ·fi ÙË Û‡ÛÙ·ÛË ÙÔ˘ ˘Ô-‰fiÚÈÔ˘ Ï›Ô˘˜ (6-8).

ÕÏÏÔÈ ÛÔ‚·ÚÔ› ·Ú¿ÁÔÓÙÂ˜ ıÓËÛÈÌfiÙËÙ·˜ ·fiÎ·Ú‰È·ÁÁÂÈ·Î¿ ÓÔÛ‹Ì·Ù· Ô˘ ¤¯Ô˘Ó ‚ÚÂıÂ› ÛÂÏËı˘ÛÌÈ·Î¤˜ ÔÌ¿‰Â˜ Â›Ó·È Ë ·ÓÙ›ÛÙ·ÛË ÛÙË ‰Ú¿-ÛË ÙË˜ ÈÓÛÔ˘Ï›ÓË˜, Ë ÌË-·ÓÔ¯‹ ÛÙË ÁÏ˘Îfi˙Ë Î·È ÔÛ·Î¯·ÚÒ‰Ë˜ ‰È·‚‹ÙË˜ Ù‡Ô˘ 2 (9,10). ∆· Â›Â‰·ÈÓÛÔ˘Ï›ÓË˜ Ï¿ÛÌ·ÙÔ˜ ÌÂÙ¿ ·fi ÓËÛÙÂ›· ¤¯Ô˘Ó¯ÚËÛÈÌÔÔÈËıÂ› ÛÂ ÂÈ‰ËÌÈÔÏÔÁÈÎ¤˜ ÌÂÏ¤ÙÂ˜ ÁÈ·ÙËÓ ·Ó›¯ÓÂ˘ÛË Ù˘¯fiÓ ·ÓÙ›ÛÙ·ÛË˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÛÙË‰Ú¿ÛË ÙË˜ ÈÓÛÔ˘Ï›ÓË˜ (11). ∏ ·¯˘Û·ÚÎ›·, Ë ÔÔ›··ÔÙÂÏÂ› ·ÓÂÍ¿ÚÙËÙÔ ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘, ¤¯ÂÈÛ˘Û¯ÂÙÈÛÙÂ› ÌÂ ÙËÓ ·ÚÔ˘Û›· ÙˆÓ ˘fiÏÔÈˆÓ ÚÔ-‰È·ıÂÛÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË Î·Ú-‰È·ÁÁÂÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ (12).

¶ÚÔÔÙÈÎ¤˜ ÌÂÏ¤ÙÂ˜ ÌÂÁ¿ÏË˜ ‰È¿ÚÎÂÈ·˜ ¤¯Ô˘Ó‰Â›ÍÂÈ fiÙÈ ·È‰È¿ ÌÂ Î·Ù’ ÂÍ·ÎÔÏÔ‡ıËÛË ˘„ËÏ‹ ·Ú-ÙËÚÈ·Î‹ ›ÂÛË ¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚÔ Î›Ó‰˘ÓÔ Ó· Á›-ÓÔ˘Ó ˘ÂÚÙ·ÛÈÎÔ› ˆ˜ ÂÓ‹ÏÈÎÂ˜ Î·È fiÙÈ ¿Óˆ ·fi ÙÔ80% ÙÔÓ ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ ÂÍ·ÎÔÏÔ˘ıÂ› Ó· Â›-Ó·È ·¯‡Û·ÚÎÔ ÛÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹ (13). ™Â Û¯¤ÛË ÌÂ¿ÏÏÂ˜ Â˘Úˆ·˚Î¤˜ ¯ÒÚÂ˜, ÔÈ ¯ÒÚÂ˜ ÙË˜ ÓfiÙÈ·˜ Î·È·Ó·ÙÔÏÈÎ‹˜ ∂˘ÚÒË˜ ¤¯Ô˘Ó Ù· ÌÂÁ·Ï‡ÙÂÚ· ÔÛÔ-ÛÙ¿ ·È‰ÈÎ‹˜ ·¯˘Û·ÚÎ›·˜ (14). °È· ÙËÓ ÂÎÙ›ÌËÛËÙÔ˘ ‚·ıÌÔ‡ ·¯˘Û·ÚÎ›·˜ ÛÙ· ·È‰È¿ Î·È ÙÔ˘˜ ÂÓ‹-ÏÈÎÂ˜ ¯ÚËÛÈÌÔÔÈÂ›Ù·È Î·Ù¿ Î·ÓfiÓ· Ô ‰Â›ÎÙË˜ Ì¿-˙·˜ ÛÒÌ·ÙÔ˜ (¢ª™). π‰È·›ÙÂÚË ÛËÌ·Û›· ·ÚÔ˘ÛÈ¿-˙ÂÈ Î·È Ô ˘ÔÏÔÁÈÛÌfi˜ ‰ÂÈÎÙÒÓ ·¯˘Û·ÚÎ›·˜ fiˆ˜Ë ÂÚ›ÌÂÙÚÔ˜ Ì¤ÛË˜, Ë ÂÚ›ÌÂÙÚÔ˜ Ì¤ÛË˜ ÚÔ˜

7% ˘ÂÚÈÓÛÔ˘ÏÈÓ·ÈÌ›· (>17 ÌIU/mol), ÙÔ 32% ·˘-ÍËÌ¤Ó· Â›Â‰· ·ÚÙËÚÈ·Î‹˜ ›ÂÛË˜ (>95Ë ÂÎ·ÙÔ-ÛÙÈ·›· ı¤ÛË), ÂÓÒ ÙÔ 29% ÙˆÓ Ì·ıËÙÒÓ Û˘ÁÎ¤-ÓÙÚˆÓÂ ÙÔ˘Ï¿¯ÈÛÙÔÓ 2 ·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘. ∏ ÌÂ-Ï¤ÙË ·Ó·‰ÂÈÎÓ‡ÂÈ ÙËÓ ·˘ÍËÌ¤ÓË Û˘¯ÓfiÙËÙ· ·¯˘-Û·ÚÎ›·˜ Î·È ¿ÏÏˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÛÂ ·È-‰È¿ ÙË˜ ÔÚÂÈÓ‹˜ ∫Ú‹ÙË˜. ∏ Ì¤ÙÚËÛË ÙË˜ ¶ª ÂÌÊ·-Ó›˙ÂÙ·È Ó· Â›Ó·È ÂÍ›ÛÔ˘ ÈÛ¯˘Úfi˜ ‰Â›ÎÙË˜ fiˆ˜ Ô¢ª™, ÁÂÁÔÓfi˜ Ô˘ Î·ıÈÛÙ¿ ·Ó·ÁÎ·›· ÙËÓ Â¤ÎÙ·ÛËÌ›·˜ ÙfiÛÔ ·Ï‹˜ Ì¤ÙÚËÛË˜ ÛÙËÓ ÎÏÈÓÈÎ‹ Ú¿ÍË.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘, ·¯˘Û·Ú-Î›·, ÈÓÛÔ˘Ï›ÓË, ÏÈÔÚˆÙÂ˝ÓÂ˜, ÁÏ˘ÎÔ˙˘ÏÈˆÌ¤ÓË ·È-ÌÔÛÊ·ÈÚ›ÓË HbA1c, ˘Ô‰fiÚÈÔ Ï›Ô˜, ‰Â›ÎÙÂ˜HOMA.

factors, a finding which supports the incorporationof this simple measurement in clinical practice.

Key words: risk factors, obesity, insulin,lipoproteins, glycosylated haemoglobin HbA1c,adipose fat, ∏Oª∞ indices.

™˘ÓÙÔÌÔÁÚ·Ê›Â˜ ∞¢¶ ÕıÚÔÈÛÌ· ÙˆÓ ‰ÂÚÌ·ÙÈÎÒÓ Ù˘¯ÒÓ ¢∂ ¢È¿ÛÙËÌ· ÂÌÈÛÙÔÛ‡ÓË˜ ¢ª™ ¢Â›ÎÙË˜ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ ª∆ ª¤ÛË ÙÈÌ‹ ¶ª ¶ÂÚ›ÌÂÙÚÔ˜ Ì¤ÛË˜ ¶ªÀ §fiÁÔ˜ ÂÚÈÌ¤ÙÚÔ˘ Ì¤ÛË˜ ÚÔ˜

‡„Ô˜ ÛÒÌ·ÙÔ˜ ¶ªπ §fiÁÔ˜ ÂÚÈÌ¤ÙÚÔ˘ Ì¤ÛË˜ ÚÔ˜

ÂÚ›ÌÂÙÚÔ ÈÛ¯›ˆÓ ™µ ™ˆÌ·ÙÈÎfi ‚¿ÚÔ˜ ∆∞ ∆˘ÈÎ‹ ·fiÎÏÈÛË TG ∆ÚÈÁÏ˘ÎÂÚ›‰È· TC OÏÈÎ‹ ¯ÔÏËÛÙÂÚfiÏË HDL-¯ÔÏËÛÙÂÚfiÏË §ÈÔÚˆÙÂ˝ÓË ˘„ËÏ‹˜

˘ÎÓfiÙËÙ·˜ LDL-¯ÔÏËÛÙÂÚfiÏË §ÈÔÚˆÙÂ˝ÓË ¯·ÌËÏ‹˜

˘ÎÓfiÙËÙ·˜ IRHOMA ¢Â›ÎÙË˜ ·ÓÙ›ÛÙ·ÛË˜ ÛÙËÓ

ÈÓÛÔ˘Ï›ÓË SECRHOMA ¢Â›ÎÙË˜ ÙË˜ ÏÂÈÙÔ˘ÚÁ›·˜

ÙˆÓ ‚-Î˘ÙÙ¿ÚˆÓ ÙÔ˘ ·ÁÎÚ¤·ÙÔ˜


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‡„Ô˜ ÛÒÌ·ÙÔ˜ Î·È Ë ÂÚ›ÌÂÙÚÔ˜ Ì¤ÛË˜ ÚÔ˜ ÂÚ›-ÌÂÙÚÔ ÈÛ¯›ˆÓ, ÁÈ· ÙÔÓ Î·ıÔÚÈÛÌfi ÙË˜ ÂÓ‰ÔÎÔÈÏÈ·-Î‹˜ ÂÓ·fiıÂÛË˜ Ï›Ô˘˜ (ÎÂÓÙÚÈÎ‹ ·¯˘Û·ÚÎ›·), ËÔÔ›· Û˘ÓÔ‰Â‡ÂÙ·È ·fi ˘„ËÏfiÙÂÚÔ Î›Ó‰˘ÓÔ Î·Ú-‰È·ÁÁÂÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ, ˘¤ÚÙ·ÛË˜ Î·È Û·Î¯·ÚÒ-‰Ô˘˜ ‰È·‚‹ÙË Ù‡Ô˘ 2, Û˘ÁÎÚÈÙÈÎ¿ ÌÂ ÙËÓ ÂÚÈÊÂ-ÚÈÎ‹ ·¯˘Û·ÚÎ›· (15). °È· ÙÔÓ ·È‰ÈÎfi ÏËı˘ÛÌfi,˘¿Ú¯ÂÈ ÌÂÁ¿ÏË Û˘˙‹ÙËÛË ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·-Ê›· Û¯ÂÙÈÎ¿ ÌÂ ÙÔ ÔÈÔ˜ ‰Â›ÎÙË˜ ÚÔ‚Ï¤ÂÈ Î·Ï‡-ÙÂÚ· ÙËÓ ·ÚÔ˘Û›· ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÁÈ· Î·Ú-‰È·ÁÁÂÈ·Î¿ ÓÔÛ‹Ì·Ù· (16-18). ™Ùfi¯ÔÈ ÙË˜ ·ÚÔ‡-Û·˜ ÌÂÏ¤ÙË˜ Â›Ó·È: ·) Ó· ÂÚÂ˘ÓËıÂ› Ë Û˘Û¯¤ÙÈÛË‰È¿ÊÔÚˆÓ ‰ÂÈÎÙÒÓ ·¯˘Û·ÚÎ›·˜ ÌÂ ÙÈ˜ ÏÈÔÚˆ-ÙÂ˝ÓÂ˜ ÙÔ˘ ÔÚÔ‡, ÙË ÁÏ˘Îfi˙Ë, ÙËÓ ÈÓÛÔ˘Ï›ÓË, ÙË ÁÏ˘-ÎÔ˙˘ÏÈˆÌ¤ÓË ·ÈÌÔÛÊ·ÈÚ›ÓË HbA1c Î·È ÙËÓ ·ÚÙËÚÈ·-Î‹ ›ÂÛË ÛÂ ·È‰È¿ ÚÔÛ¯ÔÏÈÎ‹˜ Î·È Û¯ÔÏÈÎ‹˜ ËÏÈ-Î›·˜ Î·È ‚) Ó· ÂÎÙÈÌËıÂ› Ô ÂÈÔÏ·ÛÌfi˜ ÙË˜ ·¯˘-Û·ÚÎ›·˜, ÙË˜ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·˜, ÙË˜ ˘ÂÚÈÓ-ÛÔ˘ÏÈÓ·ÈÌ›·˜ Î·È ÙË˜ ·˘ÍËÌ¤ÓË˜ ·ÚÙËÚÈ·Î‹˜ ›Â-ÛË˜ ÛÂ ·È‰È¿ Ì›·˜ ıÂˆÚÔ‡ÌÂÓË˜ ·Ú·‰ÔÛÈ·Î‹˜ÔÚÂÈÓ‹˜ ÂÚÈÔ¯‹˜ ÙË˜ ∫Ú‹ÙË˜.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ¶ÏËı˘ÛÌfi˜∏ ÌÂÏ¤ÙË Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ ÛÂ ÔÚÂÈÓ‹ ÂÚÈÔ¯‹ ÙË˜ ÎÂ-

ÓÙÚÈÎ‹˜ ∫Ú‹ÙË˜, ÛÙË ÓfiÙÈ· ÏÂ˘Ú¿ ÙÔ˘ æËÏÔÚÂ›ÙË. ™˘ÌÌÂ-ÙÂ›¯·Ó fiÏ· Ù· ·È‰È¿ ÙÔ˘ ÓËÈ·ÁˆÁÂ›Ô˘ (ËÏÈÎ›·˜ 4-5 ÂÙÒÓ),‰ËÌÔÙÈÎÔ‡ (6-11 ÂÙÒÓ) Î·È Á˘ÌÓ·Û›Ô˘ (12-15 ÂÙÒÓ) ÙÔ˘ ¢‹-ÌÔ˘ ƒÔ‡‚·, ÂÓfi˜ ‰‹ÌÔ˘ ÌÂ Û˘ÓÔÏÈÎfi ÏËı˘ÛÌfi 2830 ·Ùfi-ÌˆÓ (ÛÙÔÈ¯Â›· ·ÔÁÚ·Ê‹˜ ÏËı˘ÛÌÔ‡ 1991). ∆Ô Û¯ÔÏÂ›Ô‚Ú›ÛÎÂÙ·È ÛÙÔ ¯ˆÚÈfi °¤ÚÁÂÚË, ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ÛÙËÓ ÂÚÈÔ¯‹ÙÔ˘ ƒÔ‡‚·, ÌÂ ÏËı˘ÛÌfi 2110 Î·ÙÔ›ÎˆÓ. ÕÏÏ· ¯ˆÚÈ¿ ÛÙËÓÂÚÈÔ¯‹ Â›Ó·È Ô ¶·Ó·ÛÛfi˜ (395 Î¿ÙÔÈÎÔÈ) Î·È Ë ¡‡‚ÚÈÙÔ˜(325 Î¿ÙÔÈÎÔÈ).

∆· ÛÙÔÈ¯Â›· Ô˘ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ·ÔÙÂÏÔ‡Ó Ì¤ÚÔ˜ ÙÔ˘ÚÔÁÚ¿ÌÌ·ÙÔ˜ ∞ÁˆÁ‹˜ ÀÁÂ›·˜ ÛÙËÓ ·ÁÚÔÙÈÎ‹ ÂÚÈÔ¯‹ ÙÔ˘ƒÔ‡‚·, Ô˘ ‰ÈÂÎÂÚ·ÈÒÓÂÙ·È ·fi ÙËÓ ÂÚÂ˘ÓËÙÈÎ‹ ÔÌ¿‰· ÙË˜∫ÏÈÓÈÎ‹˜ ¶ÚÔÏËÙÈÎ‹˜ π·ÙÚÈÎ‹˜ Î·È ¢È·ÙÚÔÊ‹˜ ÙÔ˘ ∆Ì‹Ì·-ÙÔ˜ π·ÙÚÈÎ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹ÙË˜. ∏ ÌÂıÔ‰ÔÏÔÁ›· ÙË˜ ·-Ú¤Ì‚·ÛË˜ Â›Ó·È ·ÚfiÌÔÈ· ÌÂ ·˘Ù‹Ó Ô˘ ÂÊ·ÚÌfiÛÙËÎÂ ÛÙÔÙÚ¤¯ÔÓ ÚfiÁÚ·ÌÌ· ÛÂ ‰Â›ÁÌ· ÙˆÓ ‰ËÌÔÙÈÎÒÓ Û¯ÔÏÂ›ˆÓ Î·ÈÁ˘ÌÓ·Û›ˆÓ ÙË˜ ∫Ú‹ÙË˜ (19). ∆· ÛÙÔÈ¯Â›· Ô˘ ·Ó·Ï‡ıËÎ·ÓÁÈ· ÙËÓ ·ÚÔ‡Û· ÂÚÁ·Û›· Û˘ÏÏ¤¯ıËÎ·Ó ÛÙÔ ‰È¿ÛÙËÌ· ÌÂÙ·-Í‡ π·ÓÔ˘·Ú›Ô˘ Î·È ºÂ‚ÚÔ˘·Ú›Ô˘ 2001 Î·È ÔÈ ÌÂÙÚ‹ÛÂÈ˜ Ï‹-ÊıËÎ·Ó ÚÈÓ ÙËÓ ¤Ó·ÚÍË ÙË˜ ·Ú¤Ì‚·ÛË˜. ™ÙÔ Û¯ÔÏÂ›Ô ÙË˜ÂÚÈÔ¯‹˜ ÊÔÈÙÔ‡Û·Ó Û˘ÓÔÏÈÎ¿ 201 Ì·ıËÙ¤˜ (86% ·fi ÙË°¤ÚÁÂÚË, 9% ·fi ÙË ¡‡‚ÚÈÙÔ Î·È 5% ·fi ÙÔÓ ¶·Ó·ÛÛfi).∂ÓËÌÂÚˆÙÈÎ¿ ÁÚ¿ÌÌ·Ù·-Û˘ÌÊˆÓËÙÈÎ¿ Û˘ÁÎ·Ù¿ıÂÛË˜ ÁÈ· ÙËÛ˘ÌÌÂÙÔ¯‹ ÛÙË ÌÂÏ¤ÙË ‰fiıËÎ·Ó ÚÔ˜ ˘ÔÁÚ·Ê‹ ÛÙÔ˘˜ ÁÔ-ÓÂ›˜ ÙˆÓ ·È‰ÈÒÓ. ∆ÂÏÈÎ¿, 192 ·È‰È¿ Û˘ÌÌÂÙÂ›¯·Ó ÛÙÈ˜ ÂÍÂ-Ù¿ÛÂÈ˜ (96% Û˘ÌÌÂÙÔ¯‹) Î·È ÔÈ ÛÙ·ÙÈÛÙÈÎ¤˜ ·Ó·Ï‡ÛÂÈ˜ Ú·Á-Ì·ÙÔÔÈ‹ıËÎ·Ó ÛÙ· 178 ·È‰È¿, ÁÈ· Ù· ÔÔ›· ˘‹Ú¯·Ó Ï‹-ÚË ÛˆÌ·ÙÔÌÂÙÚÈÎ¿ Î·È ‚ÈÔ¯ËÌÈÎ¿ ÛÙÔÈ¯Â›·. ∏ ËÏÈÎ›· ÙˆÓ Ì·-ıËÙÒÓ ‹Ù·Ó 4-15 ¤ÙË.

™ˆÌ·ÙÔÌÂÙÚ‹ÛÂÈ˜OÈ ¤ÍÈ ‰Â›ÎÙÂ˜ ·¯˘Û·ÚÎ›·˜ Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÛÙËÓ

·ÚÔ‡Û· ÌÂÏ¤ÙË ‹Ù·Ó Ë ÂÚ›ÌÂÙÚÔ˜ Ì¤ÛË˜ (¶ª), ÙÔ ÛˆÌ·ÙÈ-Îfi ‚¿ÚÔ˜ (™µ), Ô ¢ª™, Ô ÏfiÁÔ˜ ÂÚÈÌ¤ÙÚÔ˘ Ì¤ÛË˜ ÚÔ˜‡„Ô˜ ÛÒÌ·ÙÔ˜ (¶ªÀ), Ô ÏfiÁÔ˜ ÂÚÈÌ¤ÙÚÔ˘ Ì¤ÛË˜ ÚÔ˜ Â-Ú›ÌÂÙÚÔ ÈÛ¯›ˆÓ (¶ªπ) Î·È ÙÔ ¿ıÚÔÈÛÌ· ÙˆÓ ‰ÂÚÌ·ÙÈÎÒÓ Ù˘-¯ÒÓ (∞¢¶). OÈ ÂÚ›ÌÂÙÚÔÈ Ì¤ÛË˜ Î·È ÈÛ¯›ˆÓ ÌÂÙÚ‹ıËÎ·Ó ÌÂÏ·ÛÙÈÎ‹ Ù·ÈÓ›· ÚÔ˜ ÙÔ ÏËÛÈ¤ÛÙÂÚÔ ¯ÈÏÈÔÛÙfiÌÂÙÚÔ. ∆Ô ™µÌÂÙÚ‹ıËÎÂ ÌÂ ÙË ‚Ô‹ıÂÈ· ËÏÂÎÙÚÔÓÈÎÔ‡ ˙˘ÁÔ‡ Â‰¿ÊÔ˘˜(Seca alpha) ÌÂ ·ÎÚ›‚ÂÈ· 100 g. ∏ Ì¤ÙÚËÛË Ú·ÁÌ·ÙÔÔÈ‹-ıËÎÂ ¯ˆÚ›˜ ˘Ô‰‹Ì·Ù· Î·È ÌÂ ÂÏ·ÊÚ‡ ÚÔ˘¯ÈÛÌfi. ™Â ·È‰È¿ËÏÈÎ›·˜ 6 ÂÙÒÓ Î·È ¿Óˆ, Ë Ì¤ÙÚËÛË ÙÔ˘ ‡„Ô˘˜ ÛÒÌ·ÙÔ˜ ¤ÁÈ-ÓÂ ÛÂ fiÚıÈ· ÛÙ¿ÛË, ¯ˆÚ›˜ ˘Ô‰‹Ì·Ù·, ÌÂ ÙÔ˘˜ ÒÌÔ˘˜ ÛÂ ı¤-ÛË ·Ó¿·˘ÛË˜ Î·È Ù· ¿Óˆ ¿ÎÚ· Ó· ·ÈˆÚÔ‡ÓÙ·È ÂÏÂ‡ıÂÚ·.°È· ÙÔ ÛÎÔfi ·˘Ùfi ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ ·Ó·ÛÙËÌfiÌÂÙÚÔ, ÚÔ-Û·ÚÌÔÛÌ¤ÓÔ ÛÂ ›ÛÈÔ ÙÔ›¯Ô, ÙÔ ÔÔ›Ô Û¯ËÌ¿ÙÈ˙Â ÔÚı‹ ÁˆÓ›·ÌÂ ÙÔ ¿ÙˆÌ·. O ˘ÔÏÔÁÈÛÌfi˜ ÙÔ˘ ‡„Ô˘˜ ¤ÁÈÓÂ ÛÙÔ ÏËÛÈ¤-ÛÙÂÚÔ 0,5 cm. ™Â ·È‰È¿ ÌÈÎÚfiÙÂÚ· ÙˆÓ 6 ÂÙÒÓ, ÙÔ Ì‹ÎÔ˜ ÙÔ˘ÛÒÌ·ÙÔ˜ ÌÂÙÚ‹ıËÎÂ ÛÂ ‡ÙÈ· ı¤ÛË, ¿Óˆ ÛÂ Û·Ó›‰È ÂÈ‰ÈÎ‹˜Î·Ù·ÛÎÂ˘‹˜. O ¢ª™ ˘ÔÏÔÁ›ÛÙËÎÂ ‰È·ÈÚÒÓÙ·˜ ÙÔ ™µ (kg) ÌÂÙÔ ÙÂÙÚ¿ÁˆÓÔ ÙÔ˘ ‡„Ô˘˜ ÛÒÌ·ÙÔ˜ (m2). ∆Ô ¿¯Ô˜ ÙˆÓ ‰ÂÚ-Ì·ÙÈÎÒÓ Ù˘¯ÒÓ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ÙÚÈÎ¤Ê·ÏÔ˘, ‰ÈÎ¤Ê·ÏÔ˘, ÙË˜ˆÌÔÏ¿ÙË˜ Î·È ÙÔ˘ Ï·ÁÔÓ›Ô˘ ÌÂÙÚ‹ıËÎÂ ÌÂ Lange SkinfoldCaliper, ÂÍ·ÛÊ·Ï›˙ÔÓÙ·˜ fiÙÈ Ô ÂÍÂÙ·˙fiÌÂÓÔ˜ ‹Ù·Ó ÛÂ fiÚıÈ·ÛÙ¿ÛË ÌÂ Ù· ¿Óˆ ¿ÎÚ· ÛÂ ı¤ÛË ·Ó¿·˘ÛË˜ ÛÙ· Ï¿ÁÈ· ÙÔ˘ÎÔÚÌÔ‡.

ª¤ÙÚËÛË ÙË˜ ·ÚÙËÚÈ·Î‹˜ ›ÂÛË˜ ∏ Ì¤ÙÚËÛË ÙË˜ ·ÚÙËÚÈ·Î‹˜ ›ÂÛË˜ Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ

ÌÂ ÙÔÓ ÂÍÂÙ·˙fiÌÂÓÔ Î·ıÈÛÙfi Î·È ÌÂÙ¿ ·fi ·Ó¿·˘ÛË 5-10min. ÃÚËÛÈÌÔÔÈ‹ıËÎÂ ˘‰Ú·ÚÁ˘ÚÈÎfi ÛÊ˘ÁÌÔÌ·ÓfiÌÂÙÚÔ ÌÂÎ·Ù¿ÏÏËÏÔ Ì¤ÁÂıÔ˜ ÂÚÈ¯ÂÈÚ›‰·˜, ÒÛÙÂ Ó· Î·Ï‡ÙÂÈ ÙÔ 50-75% ÙË˜ ÂÚÈÌ¤ÙÚÔ˘ ÙÔ˘ ‰ÂÍÈÔ‡ ‚Ú·¯›ÔÓ·. ∫·Ù·ÁÚ¿ÊËÎÂ ËÛ˘ÛÙÔÏÈÎ‹ ·ÚÙËÚÈ·Î‹ ›ÂÛË Î·È Ë ‰È·ÛÙÔÏÈÎ‹ Î·Ù¿ ÙËÓ ¤-ÌÙË Ê¿ÛË. ∏ ·ÚÙËÚÈ·Î‹ ›ÂÛË ÌÂÙÚ‹ıËÎÂ ÙÚÂÈ˜ ÊÔÚ¤˜ Î·È˘ÔÏÔÁ›ÛÙËÎÂ Ô Ì¤ÛÔ˜ fiÚÔ˜ (ÚˆÙfiÎÔÏÏÔ MONICA study).

¢Â›ÁÌ·Ù· ÏÈÒ‰Ô˘˜ ÈÛÙÔ‡¢Â›ÁÌ·Ù· ˘Ô‰fiÚÈÔ˘ Ï›Ô˘˜ ÂÏ‹ÊıËÛ·Ó ·fi ÙÔ ¿Óˆ ¤Íˆ

ÙÂÙ·ÚÙËÌfiÚÈÔ ÙÔ˘ ÁÏÔ˘ÙÔ‡, ÌÂ ‚ÂÏfiÓ· Û˘Ó‰Â‰ÂÌ¤ÓË ÛÂ Ûˆ-ÏËÓ¿ÚÈÔ ÎÂÓÔ‡ ÙˆÓ 10 ml. ∏ ÂÚÈÔ¯‹ Ï‹„Ë˜ ˘Ô‰fiÚÈÔ˘ Ï›-Ô˘˜ Â›¯Â ÚÔËÁÔ˘Ì¤Óˆ˜ ·ÔÏ˘Ì·ÓıÂ› ÌÂ ÔÈÓfiÓÂ˘Ì· Î·È¤ÂÈÙ· Â›¯Â „ÂÎ·ÛÙÂ› ÌÂ ÙÔÈÎfi ·Ó·ÈÛıËÙÈÎfi (¯ÏˆÚÈÔ‡¯Ô ·È-ı‡ÏÈÔ). OÈ ‰È·‰ÈÎ·Û›Â˜ Ï‹„Ë˜ Î·È ·Ó¿Ï˘ÛË˜ ‹Ù·Ó ·˘Ù¤˜ ÙˆÓBeynen Î·È Katan (20). ∆· ‰Â›ÁÌ·Ù· ·ÔıËÎÂ‡ÙËÎ·Ó, ¤ˆ˜fiÙÔ˘ ·Ó·Ï˘ıÔ‡Ó, ÛÂ ıÂÚÌÔÎÚ·Û›· -80ÔC.

¶ÔÛfiÙËÙ· 3-10 mg ˘Ô‰fiÚÈÔ˘ Ï›Ô˘˜ ÌÂÙ·Ê¤ÚıËÎÂ ÛÂ‰ÔÎÈÌ·ÛÙÈÎfi ÛˆÏ‹Ó· borosilicate 12 ml Î·È ·Ì¤Ûˆ˜ ÚÔÛÙ¤-ıËÎÂ 1 ml ÌÂı·ÓÔÏÈÎÔ‡ ‰È·Ï‡Ì·ÙÔ˜ ¡·O∏ 1¡. ∆Ô ‰È¿Ï˘Ì·ıÂÚÌ¿ÓıËÎÂ ÛÂ ˘‰·ÙfiÏÔ˘ÙÚÔ ÛÙÔ˘˜ 80ÔC ÁÈ· 10 min, „‡-¯ıËÎÂ Î·È Î·ÙfiÈÓ ÚÔÛÙ¤ıËÎ·Ó 2 ml ÌÂı·ÓÔÏÈÎÔ‡ ‰È·Ï‡Ì·-ÙÔ˜ ÙÚÈÊıÔÚÈÔ‡¯Ô˘ ‚ÚˆÌ›Ô˘ 14% (BF3 14% methanol). ∞ÎÔ-ÏÔ‡ıËÛÂ ı¤ÚÌ·ÓÛË ÛÂ ˘‰·ÙfiÏÔ˘ÙÚÔ ÁÈ· 4 min, „‡ÍË Î·ÈÚÔÛı‹ÎË 3 ml ÎÔÚÂÛÌ¤ÓÔ˘ ˘‰·ÙÈÎÔ‡ ‰È·Ï‡Ì·ÙÔ˜ ¡·Cl Î·È1 ml ÂÍ·Ó›Ô˘ (C6H14). ∆Ô ÌÂ›ÁÌ· Ô˘ ÚÔ¤Î˘„Â ·Ó·ÎÈÓ‹ıËÎÂÈÛ¯˘Ú¿ ÁÈ· 2-3 min Î·È Ë ÔÚÁ·ÓÈÎ‹ Ê¿ÛË (Ô˘ ÂÚÈ¤¯ÂÈ ÙÔ˘


267

ÌÂı˘ÏÂÛÙ¤ÚÂ˜ FAME) ÌÂÙ·Ê¤ÚıËÎÂ ÛÂ ÊÈ·Ï›‰ÈÔ ÁÈ· ·Ó¿Ï˘-ÛË ÛÂ ·¤ÚÈÔ ¯ÚˆÌ·ÙÔÁÚ¿ÊÔ (SHIMADZU GC-17A), Ô˘ Â›-Ó·È ÂÍÔÏÈÛÌ¤ÓÔ˜ ÌÂ ÎÔÏÒÓ· ÙÚÈ¯ÔÂÈ‰Ô‡˜ SP-2560 Ì‹ÎÔ˘˜100 m x 0,25 Ìm x 0,2 Ìm film thickness (SUPELCO). °È·ÙËÓ Ù·˘ÙÔÔ›ËÛË ÙˆÓ ·Ó·ÏˆÌ¤ÓˆÓ Ô˘ÛÈÒÓ (FAME), ¯ÚËÛÈ-ÌÔÔÈ‹ıËÎÂ Ë ˘¿Ú¯Ô˘Û· ‚È‚ÏÈÔÁÚ·Ê›· ·fi ÙËÓ ÈÛÙÔÛÂÏ›-‰· ÙË˜ SUPELCO Î·È ‰È¿Ï˘Ì· ÚfiÙ˘ˆÓ FAME(SUPELCO). ∞fi ÙÈ˜ ÔÛfiÙËÙÂ˜ ÙˆÓ ÏÈ·ÚÒÓ ÔÍ¤ˆÓ Ô˘ÚÔÛ‰ÈÔÚ›ÛÙËÎ·Ó (ÎÔÚÂÛÌ¤Ó·, ÌÔÓÔ·ÎfiÚÂÛÙ·, ÔÏ˘·ÎfiÚÂ-ÛÙ·, trans, ˆÌ¤Á·-3 Î·È ˆÌ¤Á·-6 ÏÈ·Ú¿ ÔÍ¤·), ˘ÔÏÔÁ›-ÛÙËÎ·Ó Ù· ÔÛÔÛÙ¿ ÁÈ· Î¿ıÂ ¤Ó· ÍÂ¯ˆÚÈÛÙ¿ ˆ˜ ÚÔ˜ ÙÔ Û‡-ÓÔÏÔ ÙˆÓ 39 ÏÈ·ÚÒÓ ÔÍ¤ˆÓ.

§‹„Ë ·›Ì·ÙÔ˜ Î·È ‚ÈÔ¯ËÌÈÎ¤˜ ·Ó·Ï‡ÛÂÈ˜°È· ÙÈ˜ ‚ÈÔ¯ËÌÈÎ¤˜ ·Ó·Ï‡ÛÂÈ˜, ¤ÁÈÓÂ Ï‹„Ë 10 ml ÊÏÂ‚ÈÎÔ‡

·›Ì·ÙÔ˜ ÌÂÙ¿ ·fi ÔÏÔÓ‡¯ÙÈ· 12ˆÚË ÓËÛÙÂ›·. ∆· ‰Â›ÁÌ·Ù·ÌÂÙ·Ê¤ÚıËÎ·Ó ÛÂ 3,5-4 ÒÚÂ˜ ·fi ÙËÓ ·Ú¯‹ ÙË˜ Ï‹„Ë˜ ÛÙÔ∂ÚÁ·ÛÙ‹ÚÈÔ ¢È·ÙÚÔÊ‹˜ ÙÔ˘ ∆Ì‹Ì·ÙÔ˜ π·ÙÚÈÎ‹˜ ¶·ÓÂÈÛÙË-Ì›Ô˘ ∫Ú‹ÙË˜ ÌÂ ÊÔÚËÙfi „˘ÁÂ›Ô ÌÂ ·ÁÔÎ‡ÛÙÂÈ˜, ÒÛÙÂ Ó·‰È·ÙËÚËıÔ‡Ó ÛÂ ıÂÚÌÔÎÚ·Û›· 3-4ÔC. ∆Ô ·›Ì· Ê˘ÁÔÎÂÓÙÚ‹-ıËÎÂ ÛÂ 4000 rpm ÁÈ· 15 min Î·È Ô ÔÚfi˜ Î·Ù·ÓÂÌfiÙ·Ó ÛÂÏ·ÛÙÈÎ¿ ÛˆÏËÓ¿ÚÈ· Eppendorf. O ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ ÙÚÈ-ÁÏ˘ÎÂÚÈ‰›ˆÓ (TG), ÙË˜ ÔÏÈÎ‹˜ ¯ÔÏËÛÙÂÚfiÏË˜ (TC), ÙË˜ ÏÈÔ-ÚˆÙÂ˝ÓË˜ ˘„ËÏ‹˜ ˘ÎÓfiÙËÙ·˜ (HDL-¯ÔÏËÛÙÂÚfiÏË) Î·È ÙË˜ÏÈÔÚˆÙÂ˝ÓË˜ ¯·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜ (LDL-¯ÔÏËÛÙÂÚfiÏË) ¤ÁÈ-ÓÂ ÙËÓ ›‰È· ËÌ¤Ú· ÌÂ ÙË Û˘ÏÏÔÁ‹ ÙˆÓ ‰ÂÈÁÌ¿ÙˆÓ, ÌÂ ÌÂıfi-‰Ô˘˜ Ô˘ ‹‰Ë ¤¯Ô˘Ó ‰ËÌÔÛÈÂ˘ıÂ› (19). ÀÔÏÔÁ›ÛÙËÎÂ Ô Ïfi-ÁÔ˜ TC ÚÔ˜ HDL-¯ÔÏËÛÙÂÚfiÏË (TC/HDL). ∆ËÓ ›‰È· ËÌ¤Ú·,Â›ÛË˜, ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ ÔÚfi˜ ·fi ÙÔ ·›Ì· ÁÈ· ÙÔÓ ÚÔÛ-‰ÈÔÚÈÛÌfi ÙˆÓ ÂÈ¤‰ˆÓ ÁÏ˘Îfi˙Ë˜ ÌÂ ÙË Ì¤ıÔ‰Ô ÙË˜ ÂÍÔÎ˘-Ó¿ÛË˜ ÌÂ ÂÈ‰ÈÎfi ·˘ÙÔ-·Ó·Ï˘Ù‹ AU-640 (OlympusInstruments) Î·È Ê˘ÛÈÔÏÔÁÈÎfi Â‡ÚÔ˜ ÙÈÌÒÓ 70-115 mg/dL.ÃÚËÛÈÌÔÔÈ‹ıËÎ·Ó ‰Â›ÁÌ·Ù· ÔÏÈÎÔ‡ ·›Ì·ÙÔ˜ ÌÂ ·ÓÙÈËÎÙÈÎfi(EDTA) ÁÈ· ÙË Ì¤ÙÚËÛË ÙË˜ ÁÏ˘ÎÔ˙˘ÏÈˆÌ¤ÓË˜ ·ÈÌÔÛÊ·ÈÚ›ÓË˜(HbA1c). O ÔÛÔÙÈÎfi˜ ÚÔÛ‰ÈÔÚÈÛÌfi˜ ¤ÁÈÓÂ ÌÂ ˘ÁÚ‹ ¯ÚˆÌ·-ÙÔÁÚ·Ê›· ˘„ËÏ‹˜ ·fi‰ÔÛË˜ (HPLC, HiAUTOAIC HA 8140,Ê˘ÛÈÔÏÔÁÈÎfi Â‡ÚÔ˜ ÙÈÌÒÓ HbA1c: 3-6%). ∏ ÈÓÛÔ˘Ï›ÓË ÚÔÛ-‰ÈÔÚ›ÛÙËÎÂ ÔÛÔÙÈÎ¿ ÌÂ ÙË Ì¤ıÔ‰Ô RIA (InsulinImmunoradiometric assay kit Diasorin s.r.l.), ÌÂ Ê˘ÛÈÔÏÔÁÈÎfiÂ‡ÚÔ˜ 3-17 ÌIU/ml.

∂ÚˆÙËÌ·ÙÔÏfiÁÈÔ ÁÔÓ¤ˆÓ ∑ËÙ‹ıËÎÂ ·fi ÙÔ˘˜ ÁÔÓÂ›˜ Ó· Û˘ÌÏËÚÒÛÔ˘Ó ¤Ó· Û‡-

ÓÙÔÌÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ, Ô˘ ÂÚÈÂÏ¿Ì‚·ÓÂ ÂÚˆÙ‹ÛÂÈ˜ ÁÈ· ÙÔ™µ Î·È ÙÔ ‡„Ô˜ ÙÔ˘ Î¿ıÂ ÁÔÓ¤·, Î·ıÒ˜ Î·È ÁÈ· ÙËÓ ·ÚÔ˘Û›··ÚÙËÚÈ·Î‹˜ ˘¤ÚÙ·ÛË˜, Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË ‹ ‰È·‚‹ÙË Î‡Ë-ÛË˜. ∞ÎfiÌ·, ÚˆÙ‹ıËÎ·Ó ÔÈ ÁÔÓÂ›˜ ÁÈ· Ù˘¯fiÓ ÂÂÈÛfi‰ÈÔ ÂÌ-ÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘ Î·Ù¿ ÙÔ ·ÚÂÏıfiÓ. O ¢ª™ ÙÔ˘Î¿ıÂ ÁÔÓ¤· ˘ÔÏÔÁ›ÛÙËÎÂ ÌÂ ÙË ‰È·›ÚÂÛË ÙÔ˘ ·Ó·ÊÂÚfiÌÂÓÔ˘‚¿ÚÔ˘˜ ÌÂ ÙÔ ÙÂÙÚ¿ÁˆÓÔ ÙÔ˘ ·Ó·ÊÂÚfiÌÂÓÔ˘ ‡„Ô˘˜.

™Ù·ÙÈÛÙÈÎ¤˜ Ì¤ıÔ‰ÔÈ O ‚·ıÌfi˜ Û˘Û¯¤ÙÈÛË˜ ÙˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÁÈ·

Î·Ú‰È·ÁÁÂÈ·Î‹ ÓfiÛÔ ÌÂ ÙÔ˘˜ ‰Â›ÎÙÂ˜ ·¯˘Û·ÚÎ›·˜ ÌÂÏÂÙ‹-ıËÎÂ ÌÂ ÙÔ˘˜ Û˘ÓÙÂÏÂÛÙ¤˜ Û˘Û¯¤ÙÈÛË˜ ÙÔ˘ Pearson. ∆ÈÌ¤˜p<0,05 ıÂˆÚ‹ıËÎ·Ó ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ¤˜ ÛÙÈ˜ Û˘Û¯ÂÙ›-ÛÂÈ˜ ÌÂÙ·‚ÏËÙÒÓ. ∂Ê·ÚÌfiÛÙËÎ·Ó ÙÂ¯ÓÈÎ¤˜ ÔÏÏ·Ï‹˜ ·-

ÏÈÓ‰ÚfiÌËÛË˜ (multiple regression), ÒÛÙÂ Ó· ÂÎÙÈÌËıÂ› Ô ‚·ı-Ìfi˜ ÛÙÔÓ ÔÔ›Ô ÔÈ ·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ ÂÍ·ÚÙÒÓÙ·È ·fiÙÔ˘˜ ÂÍÂÙ·˙fiÌÂÓÔ˘˜ ‰Â›ÎÙÂ˜ ·¯˘Û·ÚÎ›·˜, Ï·Ì‚¿ÓÔÓÙ·˜ ˘’fi„ÈÓ ÙËÓ ËÏÈÎ›· Î·È ÙÔ Ê‡ÏÔ ÙˆÓ Ì·ıËÙÒÓ. OÈ Î·Ù·ÓÔÌ¤˜ ÙÈ-ÌÒÓ ÙË˜ ÈÓÛÔ˘Ï›ÓË˜, ÙÔ˘ ™µ, ÙË˜ ¶ª, ÙÔ˘ ∞¢¶, ÙÔ ¶ªÀ, ÙˆÓÂÈ¤‰ˆÓ TG Î·È ÙÔ˘ ÏfiÁÔ˘ TC ÚÔ˜ HDL-¯ÔÏËÛÙÂÚfiÏË ÂÌ-Ê¿ÓÈÛ·Ó ıÂÙÈÎ‹ ÏÔÍfiÙËÙ· Î·È, ¤ÙÛÈ, ÙÚÔÔÔÈ‹ıËÎ·Ó ÛÂ ÏÔ-Á·ÚÈıÌÈÎ‹ ÎÏ›Ì·Î· ÚÈÓ ¯ÚËÛÈÌÔÔÈËıÔ‡Ó ÛÙÈ˜ ·Ó·Ï‡ÛÂÈ˜.

∂ÎÙÈÌ‹ÛÂÈ˜ ÙË˜ ·ÓÙ›ÛÙ·ÛË˜ ÛÙËÓ ÈÓÛÔ˘Ï›ÓË Î·È ÙË˜ ÏÂÈ-ÙÔ˘ÚÁ›·˜ ÙˆÓ ‚-Î˘ÙÙ¿ÚˆÓ ÙÔ˘ ·ÁÎÚ¤·ÙÔ˜ ˘ÔÏÔÁ›ÛÙËÎ·ÓÌÂ ÙÈ˜ ÂÍÈÛÒÛÂÈ˜ ∏Oª∞ (¤¯ÔÓÙ·˜ ÚÒÙ· ÌÂÙ·ÙÚ¤„ÂÈ ÙÈ˜ ÌÂ-ÙÚ‹ÛÂÈ˜ ÙË˜ ÁÏ˘Îfi˙Ë˜ ÛÂ mmol/l):

IRHOMA = (ÈÓÛÔ˘Ï›ÓË Â› ÁÏ˘Îfi˙Ë) ‰È¿ 22,5 Î·È SECRHOMA = (ÈÓÛÔ˘Ï›ÓË Â› 20) ‰È¿ (ÁÏ˘Îfi˙Ë ÌÂ›ÔÓ 3,5),

·ÓÙÈÛÙÔ›¯ˆ˜ (21). ∫·È ÔÈ ‰‡Ô ‰Â›ÎÙÂ˜ ¯ÚÂÈ¿ÛÙËÎ·Ó ÁÈ· ÙÈ˜ ·Ó·Ï‡ÛÂÈ˜ ÌÂÙ·-

ÙÚÔ‹ ÛÂ ÏÔÁ·ÚÈıÌÈÎ‹ ÎÏ›Ì·Î·.

∞ÔÙÂÏ¤ÛÌ·Ù·Ã·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙÔ˘ ÏËı˘ÛÌÔ‡ ÌÂÏ¤ÙË˜∆· ·ÔÙÂÏ¤ÛÌ·Ù· ÙˆÓ ÛˆÌ·ÙÔÌÂÙÚÈÎÒÓ Î·È ‚ÈÔ-

¯ËÌÈÎÒÓ ÌÂÙÚ‹ÛÂˆÓ ÁÈ· Ù· ·ÁfiÚÈ· Î·È Ù· ÎÔÚ›ÙÛÈ·Ô˘ Û˘ÌÌÂÙÂ›¯·Ó ÛÙË ÌÂÏ¤ÙË ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÙÔÓ¶›Ó·Î· 1. ∏ Ì¤ÛË ÙÈÌ‹ ÙÔ˘ ¢ª™ ÙˆÓ ·ÁÔÚÈÒÓ ‹Ù·Ó18,5 kg/m2 [Ù˘ÈÎ‹ ·fiÎÏÈÛË (∆∞) 3,5], Û¯ÂÙÈÎ¿ ÌÈ-ÎÚfiÙÂÚË ·fi ·˘Ù‹ ÙˆÓ ÎÔÚÈÙÛÈÒÓ Ô˘ ‹Ù·Ó 19,7kg/m2 (∆∞ 3,9, p<0,05). ∏ Ì¤ÛË ÙÈÌ‹ ÙÔ˘ ¢ª™ ÛÙ··ÁfiÚÈ· ËÏÈÎ›·˜ <10 ÂÙÒÓ (fiÔ˘ Ù· 10 ¤ÙË ‹Ù·Ó Ë‰È¿ÌÂÛË ËÏÈÎ›· ÛÙÔ ‰Â›ÁÌ· ÌÂÏ¤ÙË˜) ‹Ù·Ó 17,4kg/m2 (∆∞ 3,2), ÂÓÒ ÛÂ ·˘Ù¿ ËÏÈÎ›·˜ ≥10 ÂÙÒÓ ‹Ù·Ó19,4 kg/m2 (∆∞ 3,5). OÈ ·ÓÙ›ÛÙÔÈ¯Â˜ ÙÈÌ¤˜ ÛÙ· ÎÔÚ›-ÙÛÈ· ‹Ù·Ó 18,1 kg/m2 (∆∞ 3,0) Î·È 20,9 kg/m2 (∆∞4,1). ™ËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿ ˘‹Ú¯Â ÌÂÙ·Í‡ ·ÁÔÚÈÒÓÎ·È ÎÔÚÈÙÛÈÒÓ ÛÙÔ ∞¢¶ (Ì¤ÛÂ˜ ÙÈÌ¤˜ ÛÂ ·ÁfiÚÈ· 37,1mm, ∆∞ 23,9 Î·È ÛÂ ÎÔÚ›ÙÛÈ· 50,6 mm, ∆∞ 34,5,p<0,0001) Î·È ÙÔ ¶ªπ, fiÔ˘ ÁÈ· ÙÔ ¶ªπ ÔÈ ÙÈÌ¤˜ ÛÙ·ÎÔÚ›ÙÛÈ· ‹Ù·Ó ÌÈÎÚfiÙÂÚÂ˜ ·fi ·˘Ù¤˜ ÙˆÓ ·ÁÔÚÈÒÓ.™Ù·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ¤˜ ‰È·ÊÔÚ¤˜ ÌÂÙ·Í‡ ÙˆÓ ‰‡ÔÊ‡ÏˆÓ ÂÓÙÔ›ÛÙËÎ·Ó Î·È ÛÂ ¿ÏÏÂ˜ ÌÂÙ·‚ÏËÙ¤˜fiˆ˜ ÈÓÛÔ˘Ï›ÓË, HDL-¯ÔÏËÛÙÂÚfiÏË, TC/HDL, TG,Û˘ÛÙÔÏÈÎ‹ ·ÚÙËÚÈ·Î‹ ›ÂÛË, ÁÏ˘Îfi˙Ë, πRHOMA Î·ÈSECRHOMA (¶›Ó·Î·˜ 1). ™Â ‰‡Ô ÎÔÚ›ÙÛÈ· ˘‹ÚÍ·Ó·ÎÚ·›Â˜ ÙÈÌ¤˜ (extreme values) ÙË˜ SECRHOMA (-2016 Î·È 3402), ÔÈ ÔÔ›Â˜ ·Ê·ÈÚ¤ıËÎ·Ó ÚÈÓ Á›ÓÂÈ ËÛÙ·ÙÈÛÙÈÎ‹ ÂÂÍÂÚÁ·Û›·.

ŸÏ· Ù· ·È‰È¿ Â›¯·Ó Â›Â‰· ÁÏ˘ÎÔ˙˘ÏÈˆÌ¤ÓË˜·ÈÌÔÛÊ·ÈÚ›ÓË˜ ÂÓÙfi˜ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÔÚ›ˆÓ, ÂÓÒÌfiÓÔ 1 Â›¯Â Â›Â‰· ÁÏ˘Îfi˙Ë˜ (ÔÚÈ·Î¿) ¿Óˆ ·fiÙÔ ·ÓÒÙÂÚÔ Ê˘ÛÈÔÏÔÁÈÎfi, ÌÂ ÙÈÌ‹ 117 mg/dL (·ÏÏ¿Ë Û˘ÁÎ¤ÓÙÚˆÛË ÙË˜ HbA1c ÛÙÔ ·›Ì· ÙË˜ Û˘ÁÎÂÎÚÈ-Ì¤ÓË˜ ÂÙ¿¯ÚÔÓË˜ Ì·ı‹ÙÚÈ·˜ ‹Ù·Ó 4,6%, ‰ËÏ·‰‹ÂÚ›Ô˘ ÛÙË ‰È¿ÌÂÛÔ ÙˆÓ ¿ÏÏˆÓ ÙÈÌÒÓ). ∆¤ÛÛÂÚ··È‰È¿ Â›¯·Ó Â›Â‰· ÁÏ˘Îfi˙Ë˜ ¯·ÌËÏfiÙÂÚ· ·fi ÙÔÎ·ÙÒÙÂÚÔ fiÚÈÔ ÙˆÓ 70 mg/dL (ÌÂ ÙÈÌ¤˜ ÌÂÙ·Í‡ 60


268

Î·È 70 mg/dL). ¢ÂÎ·ÙÚ›· ÎÔÚ›ÙÛÈ· ·fi Ù· 178 ·È-‰È¿ Â›¯·Ó Â›Â‰· ÈÓÛÔ˘Ï›ÓË˜ >17 ÌIU/ml. ™Â 4 ·È-‰È¿, Ù· Â›Â‰· ÈÓÛÔ˘Ï›ÓË˜ ‹Ù·Ó <3 ÌIU/ml. ∆Ô 55%(¡=98) ÙˆÓ ·È‰ÈÒÓ Â›¯Â Â›Â‰· TC >170 mg/dLÎ·È 34 ·fi ·˘Ù¿ (35%, 19% Û˘ÓfiÏÔ˘ ‰Â›ÁÌ·ÙÔ˜) Â›-¯·Ó ÙÈÌ¤˜ >200 mg/dL (ÔÚÈ·Î¿ ·˘ÍËÌ¤Ó· Î·È ·˘ÍË-Ì¤Ó· Â›Â‰·: 22, 23 ·ÓÙÈÛÙÔ›¯ˆ˜). ∂ÈÏ¤ÔÓ, 35·È‰È¿ (20%) Â›¯·Ó ÙÈÌ¤˜ LDL-¯ÔÏËÛÙÂÚfiÏË˜ >130mg/dL (·˘ÍËÌ¤Ó· Â›Â‰·, 22). ¶ÂÓ‹ÓÙ· ¤ÍÈ ·È‰È¿(32%) Â›¯·Ó ÙÈÌ¤˜ Û˘ÛÙÔÏÈÎ‹˜ ·ÚÙËÚÈ·Î‹˜ ›ÂÛË˜¿Óˆ ·fi ÙËÓ 95Ë ÂÎ·ÙÔÛÙÈ·›· ı¤ÛË ÙÈÌÒÓ ÛÂ ·È-‰È¿ ÛÙÈ˜ ∏.¶.∞. ‚¿ÛÂÈ ËÏÈÎ›·˜ Î·È Ê‡ÏÔ˘, ÂÓÒ 17·È‰È¿ (10%) Â›¯·Ó ÙÈÌ¤˜ ‰È·ÛÙÔÏÈÎ‹˜ ·ÚÙËÚÈ·Î‹˜›ÂÛË˜ ¿Óˆ ·fi Ù· ·ÓÙ›ÛÙÔÈ¯· fiÚÈ· (24). ŸÛÔÓ·ÊÔÚ¿ ÛÙËÓ Ù·˘Ùfi¯ÚÔÓË ·ÚÔ˘Û›· ·¯˘Û·ÚÎ›·˜,˘ÂÚÈÓÛÔ˘ÏÈÓ·ÈÌ›·˜ (>17 ÌIU/ml), ˘ÂÚ¯ÔÏËÛÙÂÚÔ-Ï·ÈÌ›·˜ (>200 mg/dL) Î·È ·˘ÍËÌ¤ÓË˜ Û˘ÛÙÔÏÈÎ‹˜·ÚÙËÚÈ·Î‹˜ ›ÂÛË˜ (>95Ë ÂÎ·ÙÔÛÙÈ·›· ı¤ÛË), 51·fi Ù· 178 ·È‰È¿ Â›¯·Ó ÙÔ˘Ï¿¯ÈÛÙÔÓ 2 ·fi ÙÔ˘˜ 4·Ú¿ÁÔÓÙÂ˜, 7 ·È‰È¿ (5 ·ÁfiÚÈ·, 2 ÎÔÚ›ÙÛÈ·) Â›¯·Ó3 Î·È 2 ·È‰È¿ (ÎÔÚ›ÙÛÈ·) Â›¯·Ó Î·È ÙÔ˘˜ 4 ·Ú¿ÁÔ-

ÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘. O ·ÚÈıÌfi˜ ÙˆÓ ÎÔÚÈÙÛÈÒÓ ÌÂ ÙÔ˘Ï¿-¯ÈÛÙÔÓ 2 ·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚÔ˜ÙÔ˘ ·Ó·ÌÂÓfiÌÂÓÔ˘, ÛÂ Û¯¤ÛË ÌÂ ÙÔÓ ·ÚÈıÌfi ÙˆÓ·ÁÔÚÈÒÓ (34 ÎÔÚ›ÙÛÈ· ·ÓÙ› ÙÔ˘ ÚÔ‚ÏÂfiÌÂÓÔ˘ 26,¯2=6,91, df=1, p=0,009).

™ÙÔÓ ¶›Ó·Î· 2 ·Ó·ÁÚ¿ÊÔÓÙ·È Ù· ·ÔÙÂÏ¤ÛÌ·Ù·ÙË˜ ·Ó¿Ï˘ÛË˜ ÙÔ˘ ˘Ô‰fiÚÈÔ˘ Ï›Ô˘˜ Î·Ù¿ Ê‡ÏÔ.À‹Ú¯Â Ì›· ÌÈÎÚ‹, ·ÏÏ¿ ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ ‰È·-ÊÔÚ¿ ÛÙËÓ ·ÚÔ˘Û›· ÎÔÚÂÛÌ¤ÓˆÓ ÏÈ·ÚÒÓ ÔÍ¤ˆÓÌÂÙ·Í‡ ·ÁÔÚÈÒÓ Î·È ÎÔÚÈÙÛÈÒÓ (‰È¿ÌÂÛÂ˜ ÙÈÌ¤˜:23,2% ÁÈ· Ù· ·ÁfiÚÈ·, 22,0% ÁÈ· Ù· ÎÔÚ›ÙÛÈ·, p<0,05),·ÏÏ¿ ‰ÂÓ ·Ú·ÙËÚ‹ıËÎÂ Î·Ì›· ¿ÏÏË ‰È·ÊÔÚ¿ ÌÂÙ·Í‡ÙˆÓ Ê‡ÏˆÓ ÛÙË Û‡ÛÙ·ÛË ÙÔ˘ ˘Ô‰fiÚÈÔ˘ Ï›Ô˘˜.

∆· ÛÙÔÈ¯Â›· ·fi ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi È·ÙÚÈÎfi ÈÛÙÔÚÈ-Îfi Î·È Ù· ·Ó·ÊÂÚfiÌÂÓ· ·ÓıÚˆÔÌÂÙÚÈÎ¿ ‰Â‰ÔÌ¤-Ó· ÙˆÓ ÁÔÓ¤ˆÓ ÙˆÓ Ì·ıËÙÒÓ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÙÔÓ¶›Ó·Î· 3. OÈ ·Ù¤ÚÂ˜ ÙˆÓ Ì·ıËÙÒÓ ÂÌÊ·Ó›ÛÙËÎ·Ó˘¤Ú‚·ÚÔÈ (25<¢ª™<30 kg/m2) Î·Ù¿ 56% Î·È ·-¯‡Û·ÚÎÔÈ (¢ª™ ≥30 kg/m2) Î·Ù¿ 20%. ∆· ·ÓÙ›ÛÙÔÈ-¯· ÔÛÔÛÙ¿ ÛÙÈ˜ ÌËÙ¤ÚÂ˜ ‹Ù·Ó 36% Î·È 17%. ÃÚË-ÛÈÌÔÔÈÒÓÙ·˜ ‰ÈÂıÓÒ˜ Î·ıÔÚÈÛÌ¤Ó· fiÚÈ· ÙÔ˘ ¢ª™

¶›Ó·Î·˜ 1. ™ˆÌ·ÙÔÌÂÙÚ‹ÛÂÈ˜, ÏÈÔÚˆÙÂ˝ÓÂ˜ ÔÚÔ‡ Î·È ‚ÈÔ¯ËÌÈÎ¤˜ ·Ó·Ï‡ÛÂÈ˜ ÛÂ 178 Ì·ıËÙ¤˜ ÔÚÂÈÓ‹˜ ÂÚÈÔ¯‹˜ ÙË˜ ∫Ú‹ÙË˜ ÌÂ ‚¿-ÛË ÙÔ Ê‡ÏÔ

∞ÁfiÚÈ· (n=87) ∫ÔÚ›ÙÛÈ· (n=91) ™‡ÓÔÏÔ (n=178)ª∆ (∆∞) ¢È¿ÌÂÛÔ˜ ª∆ (∆∞) ¢È¿ÌÂÛÔ˜ ª∆ (∆∞) ¢È¿ÌÂÛÔ˜

∏ÏÈÎ›· (¤ÙË) 10 (3,1) 10 10 (2,9) 10 10 (3,0) 10B¿ÚÔ˜ (kg) 36,6 (13,9) 33,6 40,2 (15,5) 38,0 38,4 (14,8) 35,9⁄„Ô˜ (cm) 138 (17,7) 139 140 (16,6) 140 139 (17,1) 139¢ª™* (kg/m2) 18,5 (3,5) 17,7 19,7 (3,9) 18,9 19,1 (3,8) 18,2∞¢¶** (mm) 37,1 (23,9) 28,0 50,6 (24,5) 46,0 44,0 (25,1) 34,5¶ª (cm) 63,2 (9,5) 61,0 63,9 (10,0) 63,0 63,6 (9,9) 61,8¶ªπ** 0,9 (0,05) 0,9 0,8 (0,05) 0,8 0,8 (0,1) 0,8™˘ÛÙÔÏÈÎ‹ ∞¶* (mmHg) 111,4 (9,0) 110,0 114,3 (10,3) 112,3 112,9 (9,8) 110,7¢È·ÛÙÔÏÈÎ‹ ∞¶ (mmHg) 67,3 (7,3) 67,3 68,4 (7,4) 68,0 67,9 (7,4) 68,0HbA1c (%) 4,5 (0,3) 4,5 4,5 (0,1) 4,5 4,5 (0,3) 4,5TC (mg/dL) 174,7 (27,8) 175,0 178,4 (28,6) 178,0 176,6 (28,2) 177,5HDL-¯ÔÏËÛÙÂÚfiÏË***(mg/dL) 58,2 (13,8) 56,0 52,8 (13,1) 51,0 55,5 (13,7) 54,0LDL-¯ÔÏËÛÙÂÚfiÏË (mg/dL) 104,3 (24,0) 104,0 111,3 (25,4) 105,0 107,9 (24,9) 104,0TC/HDL*** 3,1 (0,8) 2,9 3,5 (0,9) 3,3 3,3 (0,9) 3,2TG***(mg/dL) 61,8 (26,0) 58,0 72,0 (29,0) 66,0 66,8 (28,0) 62,0πÓÛÔ˘Ï›ÓË** (ÌIU/ml) 7,0 (3,2) 7,7 10,9 (9,1) 6,1 9,0 (5,2) 7,8°Ï˘Îfi˙Ë* (mg/dL) 85,0 (7,2) 85,0 82,1 (8,1) 82,0 83,5 (7,8) 83,0§ÂÈÙÔ˘ÚÁ›· ‚-Î˘ÙÙ¿ÚˆÓ (SECR∏Oª∞)** 127,1 (72,2) 109 214,0 (159,4) 162,0 172,2 (132,4) 132,0∞ÓÙ›ÛÙ·ÛË ÛÙËÓ ÈÓÛÔ˘Ï›ÓË (IR∏Oª∞)**** 1,5 (0,7) 1,3 2,1 (1,3) 1,8 1,8 (1,1) 1,6

ª.∆.: ª¤ÛË ÙÈÌ‹∆.∞.: ∆˘ÈÎ‹ ·fiÎÏÈÛË

* p<0,05 ‰È·ÊÔÚ¿ ÌÂÙ·Í‡ ÙˆÓ ‰‡Ô Ê‡ÏˆÓ, Mann-Whitney test** p<0,0001 ‰È·ÊÔÚ¿ ÌÂÙ·Í‡ ÙˆÓ ‰‡Ô Ê‡ÏˆÓ, Mann-Whitney test

*** p<0,01 ‰È·ÊÔÚ¿ ÌÂÙ·Í‡ ÙˆÓ ‰‡Ô Ê‡ÏˆÓ, Mann-Whitney test**** p<0,001 ‰È·ÊÔÚ¿ ÌÂÙ·Í‡ ÙˆÓ ‰‡Ô Ê‡ÏˆÓ, Mann-Whitney test


269

ÁÈ· ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙË˜ ·¯˘Û·ÚÎ›·˜ ÛÙ· ·È‰È¿·Ó¿ ËÏÈÎ›· (ÌÈÛ¿ ¤ÙË) Î·È Ê‡ÏÔ, 58 ·È‰È¿ (33% ÙˆÓ178 ·È‰ÈÒÓ ÌÂ Ï‹ÚÂÈ˜ ÌÂÙÚ‹ÛÂÈ˜) ÎÚ›ıËÎ·Ó ˘¤Ú-‚·Ú· Î·È, ·fi ·˘Ù¿ Ù· ·È‰È¿, Ù· 16 (9% ÙÔ˘ Û˘Ófi-ÏÔ˘) ÎÚ›ıËÎ·Ó ·¯‡Û·ÚÎ· (25). OÈ 58 ˘¤Ú‚·ÚÔÈÎ·È ·¯‡Û·ÚÎÔÈ Ì·ıËÙ¤˜ Â›¯·Ó ÛÙ·ÙÈÛÙÈÎ¿ ˘„ËÏfi-ÙÂÚÂ˜ ÙÈÌ¤˜ Û˘ÛÙÔÏÈÎ‹˜ Î·È ‰È·ÛÙÔÏÈÎ‹˜ ·ÚÙËÚÈ·-Î‹˜ ›ÂÛË˜, LDL-¯ÔÏËÛÙÂÚfiÏË˜, ÏfiÁÔ˘ TC/HDL,TG Î·È ÈÓÛÔ˘Ï›ÓË˜ ÛÂ Û¯¤ÛË ÌÂ ÙÔ˘˜ Ì·ıËÙ¤˜ Ê˘-ÛÈÔÏÔÁÈÎÔ‡ ‚¿ÚÔ˘˜.

™˘Û¯ÂÙ›ÛÂÈ˜ ‰ÂÈÎÙÒÓ ·¯˘Û·ÚÎ›·˜ ÌÂ ÏÈÔÚˆ-ÙÂ˝ÓÂ˜ ÔÚÔ‡, ·ÚÙËÚÈ·Î‹ ›ÂÛË, Û˘ÁÎ¤ÓÙÚˆÛË ÈÓÛÔ˘-Ï›ÓË˜, Â›Â‰· ÁÏ˘Îfi˙Ë˜ ÓËÛÙÂ›·˜ Î·È ÙÈÌ¤˜ HbA1c

¶¤ÓÙÂ ·fi ÙÔ˘˜ 6 ‰Â›ÎÙÂ˜ ·¯˘Û·ÚÎ›·˜ ·ÚÔ˘-Û›·Û·Ó ÛÙ·ÙÈÛÙÈÎÒ˜ ÛËÌ·ÓÙÈÎ‹ ·ÚÓËÙÈÎ‹ Û˘Û¯¤ÙÈÛË ÌÂ ÙÈ˜ ÙÈÌ¤˜ HDL-¯ÔÏËÛÙÂÚfiÏË˜ (¢ª™r=-0,27, p<0,0005, ¶ªÀ r=-0,28, p<0,0005, ∞¢¶ r=-0,25, p=0,001, ¶ª r=-0,24, p=0,001, ™µr=-0,17, p=0,023) Î·È ıÂÙÈÎ‹ Û¯¤ÛË ÌÂ ÙÔ ÏfiÁÔTC/HDL (¢ª™ r=0,34, ¶ªÀ r=0,36, ∞¢¶ r=0,35,

¶ª r=0,30, fiÏ· p<0,0005 Î·È ™µ r=-0,19,p=0,01). ∫·Ó¤Ó·˜ ·fi ÙÔ˘˜ ‰Â›ÎÙÂ˜ ‰ÂÓ Û¯ÂÙÈ˙fiÙ·ÓÌÂ Ù· Â›Â‰· TC. OÈ ‰Â›ÎÙÂ˜ ¶ªÀ Î·È ∞¢¶ ÂÌÊ¿-ÓÈÛ·Ó ıÂÙÈÎ‹ Û˘Û¯¤ÙÈÛË ÌÂ ÙËÓ LDL-¯ÔÏËÛÙÂÚfiÏË(r=0,21, p=0,006 Î·È r=0,19, p=0,013, ·ÓÙ›ÛÙÔÈ-¯·). OÈ Û¯¤ÛÂÈ˜ ÌÂÙ·Í‡ ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ Î·È ÙˆÓ‰ÂÈÎÙÒÓ ·¯˘Û·ÚÎ›·˜ ÛÙÈ˜ ÌÔÓÔÌÂÙ·‚ÏËÙ¤˜ Û˘Û¯Â-Ù›ÛÂÈ˜ ÂÈ‚Â‚·ÈÒıËÎ·Ó Î·È ÛÙÈ˜ ·Ó·Ï‡ÛÂÈ˜ ÔÏÏ·-Ï‹˜ ·ÏÈÓ‰ÚfiÌËÛË˜, ÌÂ ·Ú¿ÏÏËÏÔ ¤ÏÂÁ¯Ô ÁÈ·ÙËÓ ËÏÈÎ›· Î·È ÙÔ Ê‡ÏÔ (¶›Ó·Î·˜ 4). ∫·È ÔÈ 6 ‰Â›ÎÙÂ˜Û¯ÂÙ›˙ÔÓÙ·Ó ÌÂ ÙËÓ HDL-¯ÔÏËÛÙÂÚfiÏË, ·Ú’ fiÏÔÔ˘ ÙÔ 89-93% ÙË˜ ‰È·Î‡Ì·ÓÛË˜ ÙˆÓ ÙÈÌÒÓ ÙË˜ ‰ÂÓÌÔÚÔ‡ÛÂ Ó· ÚÔ‚ÏÂÊıÂ›.

OÈ ‰Â›ÎÙÂ˜ ¶ª, ™µ, ¢ª™ Î·È ∞¢¶ ÂÌÊ¿ÓÈÛ·ÓÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ ıÂÙÈÎ‹ Û˘Û¯¤ÙÈÛË ÌÂ ÙË Û˘-ÛÙÔÏÈÎ‹ ·ÚÙËÚÈ·Î‹ ›ÂÛË (r=0,51, 0,58, 0,50, 0,40,·ÓÙ›ÛÙÔÈ¯·, p<0,0005 ÛÂ fiÏÂ˜ ÙÈ˜ ÂÚÈÙÒÛÂÈ˜) Î·È,Â›ÛË˜, ÛÂ ÌÈÎÚfiÙÂÚÔ ‚·ıÌfi, ÌÂ ÙË ‰È·ÛÙÔÏÈÎ‹ ›Â-ÛË (r=0,32 ÌÂ p<0,0005, 0,37 ÌÂ p<0,0005, r=0,29ÌÂ p<0,0005 Î·È 0,19 ÌÂ p=0,012, ·ÓÙ›ÛÙÔÈ¯·). ∏

¶›Ó·Î·˜ 2. ™‡ÓıÂÛË ˘Ô‰fiÚÈÔ˘ Ï›Ô˘˜ ÛÂ ÏÈ·Ú¿ ÔÍ¤· ÛÂ 111 Ì·ıËÙ¤˜ ÔÚÂÈÓ‹˜ ÂÚÈÔ¯‹˜ ÙË˜ ∫Ú‹ÙË˜ Î·Ù¿ Ê‡ÏÔ*

∫·ÙËÁÔÚ›· ∞ÁfiÚÈ· (n=46) ∫ÔÚ›ÙÛÈ· (n=65) ™‡ÓÔÏÔ (n=111)ÏÈ·ÚÒÓ ÔÍ¤ˆÓ**

ª¤ÛË ÙÈÌ‹ ¢È¿ÌÂÛÔ˜ ª¤ÛË ÙÈÌ‹ ¢È¿ÌÂÛÔ˜ ª¤ÛË ÙÈÌ‹ ¢È¿ÌÂÛÔ˜% (∆∞) % % (∆∞) % % (∆∞) %

∫ÔÚÂÛÌ¤Ó· *** 23,6 (3,5) 23,2 22,1 (2,5) 22,0 22,7 (3,0) 22,8ªÔÓÔ·ÎfiÚÂÛÙ· 60,2 (3,9) 60,6 61,7 (2,5) 61,8 61,1 (3,2) 61,1¶ÔÏ˘·ÎfiÚÂÛÙ· 13,4 (0,9) 13,4 13,6 (1,0) 13,5 13,5 (1,0) 13,5Trans 1,6 (0,4) 1,6 1,5 (0,3) 1,5 1,5 (0,3) 1,5øÌ¤Á·-3 0,80 (0,13) 0,79 0,77 (0,12) 0,74 0,78 (0,12) 0,78øÌ¤Á·-6 12,5 (0,9) 12,6 12,7 (1,0) 12,7 12,6 (0,9) 12,6

* ∞fi Ù· 178 ·È‰È¿ ÌÂ Ï‹ÚË ‰Â‰ÔÌ¤Ó· ÛÙÈ˜ ÛˆÌ·ÙÔÌÂÙÚÈÎ¤˜ Î·È ‚ÈÔ¯ËÌÈÎ¤˜ ÌÂÙÚ‹ÛÂÈ˜, 111 Û˘ÌÊÒÓËÛ·Ó Ó· Ú·ÁÌ·ÙÔÔÈËıÂ›Ï‹„Ë ‰Â›ÁÌ·ÙÔ˜ ˘Ô‰fiÚÈÔ˘ Ï›Ô˘˜

** % ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ÏÈ·ÚÒÓ ÔÍ¤ˆÓ *** p<0,05 ‰È·ÊÔÚ¿ ÌÂÙ·Í‡ ÙˆÓ ‰‡Ô Ê‡ÏˆÓ, Mann-Whitney test

¶›Ó·Î·˜ 3. ∞·ÓÙ‹ÛÂÈ˜ ÙˆÓ ÁÔÓ¤ˆÓ ÙˆÓ Ì·ıËÙÒÓ ÛÙÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ˘ÁÂ›·˜ (n=86*)

ªËÙ¤Ú· ¶·Ù¤Ú·˜n (%) n (%)

Œ¯ÂÈ ˘¤ÚÙ·ÛË 3 (4) 5 (6)Œ¯ÂÈ Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË 1 (1) 0∂›¯Â ‰È·‚‹ÙË Î‡ËÛË˜ 2 (2) -Œ¯ÂÈ ˘ÔÛÙÂ› ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘ 0 1 (1)À¤Ú‚·ÚÔ˜** 31 (36) 48 (56)¶·¯‡Û·ÚÎÔ˜*** 15 (17) 17 (20)

ª¤ÛË ÙÈÌ‹ (∆∞)µ¿ÚÔ˜ (kg) 68,4 (10,7) 81,8 (12,0)⁄„Ô˜ (cm) 161,9 (6,6) 172,7 (7,1)¢ª™ (kg/m2) 26,2 (4,1) 27,4 (3,6)

* ∆· ÂÚˆÙËÌ·ÙÔÏfiÁÈ· Û˘ÌÏËÚÒıËÎ·Ó ·fi 86 ÁÔÓÂ›˜ Ô˘ ·ÓÙÈÛÙÔÈ¯Ô‡Ó ÛÂ 157 ·È‰È¿ ** 25<¢ª™<30 kg/m2

*** ¢ª™ >30 kg/m2


¶ªÀ ‰ÂÓ ·ÚÔ˘Û›·ÛÂ Û˘Û¯¤ÙÈÛË ÌÂ ÙË Û˘ÛÙÔÏÈÎ‹‹ ÙË ‰È·ÛÙÔÏÈÎ‹ ·ÚÙËÚÈ·Î‹ ›ÂÛË, ÂÓÒ Ë ¶ªπ ÂÌ-Ê¿ÓÈÛÂ ·ÚÓËÙÈÎ‹ Û¯¤ÛË ÌfiÓÔ ÌÂ ÙË Û˘ÛÙÔÏÈÎ‹ ›Â-ÛË (r=-0,28, p<0,0005).

OÈ ‰Â›ÎÙÂ˜ ¶ª, ™µ, ¢ª™, ∞¢¶ Î·È ¶ªÀ ÂÌÊ¿ÓÈ-Û·Ó ıÂÙÈÎ‹ Û˘Û¯¤ÙÈÛË ÌÂ Ù· Â›Â‰· ÈÓÛÔ˘Ï›ÓË˜ ÓË-ÛÙÂ›·˜ (r=0,59, 0,65, 0,63, 0,57 Î·È 0,21, ·ÓÙ›ÛÙÔÈ-¯·, p<0,0005 ÁÈ· ÙÈ˜ ÚÒÙÂ˜ 4 ÌÂÙ·‚ÏËÙ¤˜ Î·Èp=0,005 ÁÈ· ÙËÓ ¶ªÀ). ∞ÓÙ›ıÂÙ·, Ë ¶ªπ ÂÌÊ¿ÓÈÛÂ ·ÚÓËÙÈÎ‹ Û¯¤ÛË ÌÂ ÙÈ˜ ÙÈÌ¤˜ ÈÓÛÔ˘Ï›ÓË˜(r=-0,36, p<0,0005). OÈ 5 ‰Â›ÎÙÂ˜ ÌÂ ÙË ıÂÙÈÎ‹ Û˘-Û¯¤ÙÈÛË ÚÔ˜ Ù· Â›Â‰· ÈÓÛÔ˘Ï›ÓË˜, ‰È·Ù‹ÚËÛ·ÓÙË Û¯¤ÛË ·˘Ù‹ Î·È ÌÂÙ¿ ·fi ¤ÏÂÁ¯Ô ÁÈ· ËÏÈÎ›· Î·ÈÊ‡ÏÔ (ÛÂ fiÏ· Ù· 5 ÌÔÓÙ¤Ï· ·ÏÈÓ‰ÚfiÌËÛË˜ Â›¯·ÓÚÔ‚ÏÂÙÈÎ‹ ‰‡Ó·ÌË ÂÚ›Ô˘ ÛÙÔ 50%, ¶›Ó·Î·˜ 4).∞ÓÙ›ıÂÙ·, Ë Û¯¤ÛË ÙË˜ ¶ªπ ÌÂ ÙÈ˜ ÙÈÌ¤˜ ÈÓÛÔ˘Ï›ÓË˜¯¿ıËÎÂ ÌÂÙ¿ ·fi ÙÔÓ ¤ÏÂÁ¯Ô ÁÈ· ËÏÈÎ›· Î·È Ê‡ÏÔ.

OÈ ‰Â›ÎÙÂ˜ ¶ª, ™µ, ∞¢¶ Î·È ¢ª™ ·ÚÔ˘Û›·Û·ÓÛÙ·ÙÈÛÙÈÎÒ˜ ÛËÌ·ÓÙÈÎ‹ ·ÚÓËÙÈÎ‹ Û¯¤ÛË ÌÂ Ù· Â›-Â‰· ÁÏ˘Îfi˙Ë˜ (r=-0,24 ÌÂ p=0,002, r=-0,22 ÌÂp=0,004, r=-0,21 ÌÂ p=0,005 Î·È r=-0,19 ÌÂp=0,01, ·ÓÙ›ÛÙÔÈ¯·). ∆Ô ∞¢¶, Ë ¶ª Î·È Ë ¶ªÀ ÂÌ-Ê¿ÓÈÛ·Ó ıÂÙÈÎ‹ Û˘Û¯¤ÙÈÛË ÌÂ ÙÈ˜ Û˘ÁÎÂÓÙÚÒÛÂÈ˜HbA1c (r=0,18, 0,15 Î·È 0,14, Î·È ÛÙÈ˜ ÙÚÂÈ˜ ÂÚÈ-ÙÒÛÂÈ˜ 0,01<p≤0,05). ªÂÙ¿ ·fi ¤ÏÂÁ¯Ô ÁÈ· ÙËÓËÏÈÎ›· Î·È ÙÔ Ê‡ÏÔ, Î·Ó¤Ó·˜ ·fi ÙÔ˘˜ ‰Â›ÎÙÂ˜ ‰ÂÓÂ›¯Â Û˘Û¯¤ÙÈÛË ÌÂ ÙË ÁÏ˘Îfi˙Ë Î·È ÌfiÓÔ ÙÔ ∞¢¶Û¯ÂÙÈ˙fiÙ·Ó ÌÂ ÙÈ˜ ÙÈÌ¤˜ HbA1c (·Ú¿ÁÔÓÙ·˜ ·ÏÈÓ-‰ÚfiÌËÛË˜ 0,13 Î·È 95% ‰È¿ÛÙËÌ· ÂÌÈÛÙÔÛ‡ÓË˜0,03-0,23, p=0,011) (¶›Ó·Î·˜ 4).

OÈ ‰Â›ÎÙÂ˜ ¶ª, ™µ, ¢ª™, ∞¢¶ Î·È ¶ªÀ ÂÌÊ¿ÓÈ-Û·Ó ıÂÙÈÎ‹ Û˘Û¯¤ÙÈÛË Î·È ÌÂ ÙËÓ ÂÎÙÈÌÒÌÂÓË ÏÂÈ-ÙÔ˘ÚÁ›· ÙˆÓ ‚-Î˘ÙÙ¿ÚˆÓ SECRHOMA (r=0,62, 0,67,0,63, 0,58 Î·È 0,20, ·ÓÙ›ÛÙÔÈ¯·, p<0,0005 ÁÈ· ÙÈ˜ÚÒÙÂ˜ 4 ÌÂÙ·‚ÏËÙ¤˜ Î·È p=0,004 ÁÈ· ÙËÓ ¶ªÀ)Î·È ÌÂ ÙËÓ ·ÓÙ›ÛÙ·ÛË ÛÙËÓ ÈÓÛÔ˘Ï›ÓË πRHOMA(r=0,56, 0,62, 0,60, 0,54 Î·È 0,18, ·ÓÙ›ÛÙÔÈ¯·,p<0,0005 ÁÈ· ÙÈ˜ ÚÒÙÂ˜ 4 ÌÂÙ·‚ÏËÙ¤˜ Î·Èp=0,006 ÁÈ· ÙË ¶ªÀ). ∞ÓÙ›ıÂÙ·, Ë ¶ªπ ÂÌÊ¿ÓÈÛÂ·ÚÓËÙÈÎ‹ Û¯¤ÛË Î·È ÌÂ ÙÔ˘˜ ‰‡Ô ‰Â›ÎÙÂ˜(SECRHOMA r=-0,37, p<0,0005 Î·È IRHOMAr=-0,35, p<0,0005). OÈ 5 ‰Â›ÎÙÂ˜ ÌÂ ÙË ıÂÙÈÎ‹ Û˘-Û¯¤ÙÈÛË ÚÔ˜ Ù· Â›Â‰· ÈÓÛÔ˘Ï›ÓË˜, ‰È·Ù‹ÚËÛ·ÓÙË Û¯¤ÛË ·˘Ù‹ Î·È ÌÂÙ¿ ·fi ¤ÏÂÁ¯Ô ÁÈ· ËÏÈÎ›· Î·ÈÊ‡ÏÔ (Ë ‰‡Ó·ÌË ÙË˜ Úfi‚ÏÂ„Ë˜ ‹Ù·Ó ÌÂÙ·Í‡ 33%Î·È 45% ÛÙ· ÌÔÓÙ¤Ï· IRHOMA Î·È 48% ÌÂ 55% ÛÙ·ÌÔÓÙ¤Ï· SECRHOMA, ¶›Ó·Î·˜ 4). ∞ÓÙ›ıÂÙ·, Ë Û¯¤ÛËÙË˜ ¶ªπ ÌÂ ÙÈ˜ ÙÈÌ¤˜ ÈÓÛÔ˘Ï›ÓË˜ ¯¿ıËÎÂ ÌÂÙ¿ ·fiÙÔÓ ¤ÏÂÁ¯Ô ÁÈ· ËÏÈÎ›· Î·È Ê‡ÏÔ.

™˘Û¯ÂÙ›ÛÂÈ˜ Û‡ÛÙ·ÛË˜ ˘Ô‰fiÚÈÔ˘ Ï›Ô˘˜ ÌÂ·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· Î·Ú‰È·ÁÁÂÈ·Î¿ ÓÔÛ‹Ì·Ù·

OÈ Û¯¤ÛÂÈ˜ ÌÂÙ·Í‡ ÏÈ·ÚÒÓ ÔÍ¤ˆÓ ÙÔ˘ ÏÈÒ-‰Ô˘˜ ÈÛÙÔ‡ Î·È ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ·¤‚ËÛ·Ó ÛÂ

ÁÂÓÈÎ¤˜ ÁÚ·ÌÌ¤˜ ÌË-ÈÛ¯˘Ú¤˜. ∆Ô ÔÛÔÛÙfi ÙˆÓtrans ÏÈ·ÚÒÓ ÔÍ¤ˆÓ ÛÙÔÓ ÏÈÒ‰Ë ÈÛÙfi ÂÌÊ¿ÓÈÛÂıÂÙÈÎ‹ Û˘Û¯¤ÙÈÛË ÌÂ ÙËÓ HDL-¯ÔÏËÛÙÂÚfiÏË Î·È ·Ú-ÓËÙÈÎ‹ ÌÂ Ù· Â›Â‰· TG (r=0,19, p=0,039 Î·È r=-0,286, p=0,004, ·ÓÙ›ÛÙÔÈ¯·). ¶·Ú¿ÏÏËÏ·, ˘‹ÚÍÂÌ›· ıÂÙÈÎ‹ Û¯¤ÛË ÌÂÙ·Í‡ ÙÔ˘ ÔÛÔÛÙÔ‡ ÌÔÓÔ·Îfi-ÚÂÛÙˆÓ ÏÈ·ÚÒÓ ÔÍ¤ˆÓ Î·È ÙˆÓ Û˘ÁÎÂÓÙÚÒÛÂˆÓTG (r=0,199, p=0,033). ∆Ô ÔÛÔÛÙfi ÙˆÓ ÔÏ˘·Îfi-ÚÂÛÙˆÓ ÏÈ·ÚÒÓ ÔÍ¤ˆÓ ÛÙÔ ˘Ô‰fiÚÈÔ Ï›Ô˜ Û¯ÂÙÈ-˙fiÙ·Ó ıÂÙÈÎ¿ ÌÂ ÙË Û˘ÛÙÔÏÈÎ‹ ·ÚÙËÚÈ·Î‹ ›ÂÛË(r=0,20, p=0,031) Î·È ÈÔ ÂÈ‰ÈÎ¿, Ù· ˆÌ¤Á·-3 ÂÌ-Ê¿ÓÈÛ·Ó ÈÛ¯˘Ú‹ Û˘Û¯¤ÙÈÛË ÌÂ ÙË Û˘ÛÙÔÏÈÎ‹(r=0,24, p=0,009) Î·È ÙË ‰È·ÛÙÔÏÈÎ‹ ·ÚÙËÚÈ·Î‹›ÂÛË (r=0,21, p=0,025).

∏ ÂÚÈÂÎÙÈÎfiÙËÙ· ÙÔ˘ ÏÈÒ‰Ô˘˜ ÈÛÙÔ‡ ÛÂ ÎÔÚÂ-ÛÌ¤Ó· ÏÈ·Ú¿ ÔÍ¤· ÂÌÊ¿ÓÈÛÂ ÈÛ¯˘Ú‹ ·ÚÓËÙÈÎ‹ Û¯¤-ÛË ÌÂ Ù· Â›Â‰· ÈÓÛÔ˘Ï›ÓË˜ (r=-0,338, p<0,001)Î·È ÌÂ ÙË ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ ‚-Î˘ÙÙ¿ÚˆÓ (r=0,35,p<0,0001), ÂÓÒ Ù· ÌÔÓÔ·ÎfiÚÂÛÙ· ÏÈ·Ú¿ ÔÍ¤· ·-ÚÔ˘Û›·Û·Ó ıÂÙÈÎ‹ Û¯¤ÛË ÌÂ ÙËÓ ÈÓÛÔ˘Ï›ÓË(r=0,286, p=0,002). ∂ÈÚfiÛıÂÙ·, ıÂÙÈÎ‹ Û˘Û¯¤ÙÈ-ÛË ˘‹Ú¯Â Î·È ÌÂÙ·Í‡ ÙˆÓ ˆÌ¤Á·-3 ÏÈ·ÚÒÓ ÔÍ¤ˆÓÎ·È: ·) ÙË˜ ÈÓÛÔ˘Ï›ÓË˜ (r=0,206, p=0,002), ‚) ÙË˜ÏÂÈÙÔ˘ÚÁ›·˜ ÙˆÓ ‚-Î˘ÙÙ¿ÚˆÓ (r=0,21, p=0,014) Î·ÈÁ) ÙË˜ Û¯ÂÙÈÎ‹˜ ·ÓÙ›ÛÙ·ÛË˜ ÛÙËÓ ÈÓÛÔ˘Ï›ÓË(r=0,20, p=0,018). ∫·Ì›· Ì¤ÙÚËÛË ‰ÂÓ Û¯ÂÙÈ˙fiÙ·ÓÌÂ ÙË ÁÏ˘Îfi˙Ë ÓËÛÙÂ›·˜ ÂÎ ‰È·ÙÚÔÊ‹˜ ‹ ÙË Û˘ÁÎ¤-ÓÙÚˆÛË ÙË˜ HbA1c. ∏ ·Ó¿Ï˘ÛË ÌÂ ÔÏÏ·Ï‹ ·-ÏÈÓ‰ÚfiÌËÛË ¤‰ÂÈÍÂ ˆ˜ ÙÔ ÔÛÔÛÙfi ÙˆÓ ˆÌ¤Á·-3ÏÈ·ÚÒÓ ÔÍ¤ˆÓ ÛÙÔ ÏÈÒ‰Ë ÈÛÙfi ÂÚÌ‹ÓÂ˘Â Ì¤ÚÔ˜ÙË˜ ‰È·Î‡Ì·ÓÛË˜ ÛÙÈ˜ ÙÈÌ¤˜ ÙˆÓ LDL-¯ÔÏËÛÙÂÚfiÏËÎ·È TC/HDL, ÂÓÒ Ù· trans ÏÈ·Ú¿ ÔÍ¤· ÚÔ¤‚ÏÂ·ÓÌ¤ÚÔ˜ ·fi ÙË ‰È·Î‡Ì·ÓÛË ÙˆÓ ÂÈ¤‰ˆÓ TG (¶›Ó·-Î·˜ 5). ∞fi ÙÈ˜ ÂÊ·ÚÌÔÁ¤˜ ·ÏÈÓ‰ÚfiÌËÛË˜ ‰ÂÓÚÔ¤Î˘„·Ó ÛËÌ·ÓÙÈÎ¤˜ Û˘Û¯ÂÙ›ÛÂÈ˜ ÌÂÙ·Í‡ ÙÔ˘ÔÛÔÛÙÔ‡ ÙˆÓ ÎÔÚÂÛÌ¤ÓˆÓ, ÌÔÓÔ·ÎfiÚÂÛÙˆÓ Î·ÈÔÏ˘·ÎfiÚÂÛÙˆÓ ÏÈ·ÚÒÓ ÔÍ¤ˆÓ Î·È ÙˆÓ ÎÏ·ÛÈÎÒÓ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘.

™˘˙‹ÙËÛË∏ ÌÂÏ¤ÙË ·˘Ù‹ ·ÔÙÂÏÂ› Ì›· ÚÔÛ¿ıÂÈ· Û˘-

Û¯¤ÙÈÛË˜ ÙˆÓ ‰È·ÊfiÚˆÓ ‰ÂÈÎÙÒÓ ·¯˘Û·ÚÎ›·˜ ÌÂÙÔ Û‡ÓÔÏÔ ÙˆÓ Î‡ÚÈˆÓ ÚÔ‰È·ıÂÛÈÎÒÓ ·Ú·ÁfiÓÙˆÓÁÈ· ·Ó¿Ù˘ÍË Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ ÛÙ· ·È-‰È¿. OÈ ‰Â›ÎÙÂ˜ ·¯˘Û·ÚÎ›·˜ ‚Ú¤ıËÎ·Ó Ó· ÂÚÌË-ÓÂ‡Ô˘Ó ÙË ‰È·Î‡Ì·ÓÛË ÙˆÓ ÙÈÌÒÓ ÈÓÛÔ˘Ï›ÓË˜ (40-50%) Î·È Û˘ÛÙÔÏÈÎ‹˜ ·ÚÙËÚÈ·Î‹˜ ›ÂÛË˜ (¤ˆ˜35%) ÂÚÈÛÛfiÙÂÚÔ ·fi ·˘Ù¤˜ ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ(7-11%). ∆· ·ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜Î·Ù·Ï‹ÁÔ˘Ó ÛÙÔ fiÙÈ Ë ¶ªπ ‰ÂÓ Û¯ÂÙ›˙ÂÙ·È ÙfiÛÔ ÛÙÂ-Ó¿ ÌÂ ÙÔ˘˜ ·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· Î·Ú‰È·ÁÁÂÈ·-Î¿ ÓÔÛ‹Ì·Ù·, fiÛÔ ÔÈ ¿ÏÏÔÈ ‰Â›ÎÙÂ˜ ·¯˘Û·ÚÎ›·˜. ∏¶ªπ Â›Ó·È Ô ÌfiÓÔ˜ ‰Â›ÎÙË˜ Ô˘ ‰ÂÓ Û¯ÂÙ›˙ÂÙ·È ÌÂ

270


271

¶›Ó·Î·˜ 4. ∞ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ ·Ó¿Ï˘ÛË˜ ÔÏÏ·Ï‹˜ ÛÙ·ÙÈÛÙÈÎ‹˜ ·ÏÈÓ‰ÚfiÌËÛË˜ ÁÈ· ÙË Û¯¤ÛË ‰ÂÈÎÙÒÓ ·¯˘Û·ÚÎ›·˜ ÌÂ ·Ú¿ÁÔ-ÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· Î·Ú‰È·ÁÁÂÈ·Î¿ ÓÔÛ‹Ì·Ù·*

∂Í·ÚÙÒÌÂÓË ∞ÓÂÍ¿ÚÙËÙË R** ™˘ÓÙÂÏÂÛÙ‹˜ t ÛÙ·ÙÈÛÙÈÎ‹ p-valueÌÂÙ·‚ÏËÙ‹ ÌÂÙ·‚ÏËÙ‹** ·ÏÈÓ‰ÚfiÌËÛË˜ ·Ó¿Ï˘ÛË

(95% ‰È¿ÛÙËÌ· ÂÌÈÛÙÔÛ‡ÓË˜)

πÓÛÔ˘Ï›ÓË*** ™µ*** 0,52 1,25 (0,98 ¤ˆ˜ 1,52) 9,08 <0,0005¶ª*** 0,46 1,93 (1,40 ¤ˆ˜ 2,46) 7,22 <0,0005¢ª™ 0,50 0,08 (0,06 ¤ˆ˜ 0,09) 8,45 <0,0005¶ªÀ*** 0,40 1,71 (1,09 ¤ˆ˜ 2,34) 5,04 <0,0005∞¢¶*** 0,48 0,49 (0,37 ¤ˆ˜ 0,61) 7,89 <0,0005

§ÂÈÙÔ˘ÚÁ›· ‚-Î˘ÙÙ¿ÚˆÓ (SECR∏Oª∞)*** ™µ*** 0,55 1,30 (1,00 ¤ˆ˜ 1,59) 8,69 <0,0005

¶ª*** 0,53 2,21 (1,65 ¤ˆ˜ 2,77) 7,82 <0,0005¢ª™ 0,54 0,08 (0,06 ¤ˆ˜ 0,10) 8,24 <0,0005¶ªÀ*** 0,48 2,04 (1,38 ¤ˆ˜ 2,71) 6,04 <0,0005∞¢¶*** 0,54 0,53 (0,40 ¤ˆ˜ 0,66) 7,99 <0,0005

∞ÓÙ›ÛÙ·ÛË ÛÙËÓ ÈÓÛÔ˘Ï›ÓË (πR∏Oª∞)*** ™µ*** 0,45 1,22 (0,92 ¤ˆ˜ 1,52) 8,10 <0,0005

¶ª*** 0,38 1,83 (1,25 ¤ˆ˜ 2,41) 6,25 <0,0005¢ª™ 0,42 0,07 (0,05 ¤ˆ˜ 0,92) 7,46 <0,0005¶ªÀ*** 0,33 1,58 (0,91 ¤ˆ˜ 2,26) 4,61 <0,0005∞¢¶*** 0,41 0,47 (0,34 ¤ˆ˜ 0,60) 6,90 <0,0005

HbA1c ∞¢¶*** 0,04 0,13 (0,03 ¤ˆ˜ 0,23) 2,58 0,011LDL-¯ÔÏËÛÙÂÚfiÏË ¶ª*** 0,06 41,1 (9,9 ¤ˆ˜ 72,4) 2,60 0,010

¢ª™ 0,05 1,27 (0,19 ¤ˆ˜ 2,35) 2,31 0,022¶ªÀ*** 0,06 47,3 (12,6 ¤ˆ˜ 82,1) 2,69 0,008∞¢¶*** 0,05 8,3 (0,8 ¤ˆ˜ 15,8) 2,19 0,030

HDL-¯ÔÏËÛÙÂÚfiÏË ™µ*** 0,07 -11,9 (-20,8 ¤ˆ˜ -3,0) -2,63 0,009¶ª*** 0,10 -30,2 (-46,5 ¤ˆ˜ -13,9) -3,65 <0,0005¢ª™ 0,10 -1,01 (-1,57 ¤ˆ˜ -0,44) -3,52 0,001¶ªπ 0,08 -68,2 (-111,9 ¤ˆ˜ -24,5) -3,08 0,002¶ªÀ*** 0,11 -36,9 (-54,9 ¤ˆ˜ -18,4) -3,96 <0,0005∞¢¶*** 0,07 -4,9 (-8,8 ¤ˆ˜ -0,9) -2,43 0,016

TC/HDL ™µ*** 0,14 0,34 (0,18 ¤ˆ˜ 0,51) 4,08 <0,0005¶ª*** 0,19 0,78 (0,49 ¤ˆ˜ 1,07) 5,34 <0,0005¢ª™ 0,18 0,03 (0,02 ¤ˆ˜ 0,04) 4,90 <0,0005¶ªπ 0,12 1,34 (0,58 ¤ˆ˜ 2,20) 3,38 0,001¶ªÀ*** 0,20 0,89 (0,57 ¤ˆ˜ 1,21) 5,51 <0,0005∞¢¶*** 0,15 0,15 (0,08 ¤ˆ˜ 0,22) 4,14 <0,0005

TG ™µ*** 0,19 0,64 (0,39 ¤ˆ˜ 0,90) 5,03 <0,0005¶ª*** 0,21 1,24 (0,79 ¤ˆ˜ 1,69) 5,43 <0,0005¢ª™ 0,17 0,04 (0,02 ¤ˆ˜ 0,05) 4,53 <0,0005¶ªÀ*** 0,17 1,19 (0,68 ¤ˆ˜ 1,70) 4,58 <0,0005∞¢¶*** 0,20 0,29 (0,18 ¤ˆ˜ 0,40) 5,33 <0,0005

™˘ÛÙÔÏÈÎ‹ ∞¶ ™µ*** 0,35 19,10 (13,45 ¤ˆ˜ 24,74) 6,68 <0,0005¶ª*** 0,29 27,28 (16,62 ¤ˆ˜ 37,95) 5,05 <0,0005¢ª™ 0,30 1,00 (0,64 ¤ˆ˜ 1,36) 5,41 <0,0005¶ªÀ*** 0,23 19,59 (7,23 ¤ˆ˜ 31,94) 3,13 0,002∞¢¶*** 0,27 5,94 (3,37 ¤ˆ˜ 8,51) 4,57 <0,0005

¢È·ÛÙÔÏÈÎ‹ ∞¶ ™µ*** 0,15 10,15 (5,27 ¤ˆ˜ 15,03) 4,11 <0,0005¶ª*** 0,11 13,18 (4,18 ¤ˆ˜ 22,19) 2,89 0,004¢ª™ 0,11 0,42 (0,11 ¤ˆ˜ 0,73) 2,66 0,008

* n=178. ¶·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÌfiÓÔ ÔÈ ‰Â›ÎÙÂ˜ ·¯˘Û·ÚÎ›·˜ ÁÈ· ÙÔ˘˜ ÔÔ›Ô˘˜ ‚Ú¤ıËÎ·Ó ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ¤˜ Û˘Û¯ÂÙ›ÛÂÈ˜ ÌÂ ÙËÓÂÍ·ÚÙËÌ¤ÓË ÌÂÙ·‚ÏËÙ‹. ¢ÂÓ ˘‹Ú¯·Ó Û˘Û¯ÂÙ›ÛÂÈ˜ ÌÂÙ·Í‡ ÙˆÓ ‰ÂÈÎÙÒÓ ·¯˘Û·ÚÎ›·˜ Î·È ÙË˜ ÁÏ˘Îfi˙Ë˜ ‹ ÙË˜ ÔÏÈÎ‹˜ ¯ÔÏËÛÙÂ-ÚfiÏË˜

** ¶¤Ú·Ó ÙÔ˘ ‰Â›ÎÙË ·¯˘Û·ÚÎ›·˜, ÙÔ Ê‡ÏÔ Î·È Ë ËÏÈÎ›· ÂÚÈÂÏ‹ÊıËÛ·Ó ÛÂ Î¿ıÂ ·Ó¿Ï˘ÛË ·ÏÈÓ‰ÚfiÌËÛË˜ *** ™Â ÎÏ›Ì·Î· Ê˘ÛÈÎÔ‡ ÏÔÁ¿ÚÈıÌÔ˘


ÙËÓ ÈÓÛÔ˘Ï›ÓË (ÌÂÙ¿ ·fi ¤ÏÂÁ¯Ô ÁÈ· ÙËÓ ËÏÈÎ›· Î·ÈÙÔ Ê‡ÏÔ ÛÙËÓ ÔÏ˘ÌÂÙ·‚ÏËÙ‹ ·Ó¿Ï˘ÛË). ∏ ¶ª, Ë¶ªÀ Î·È Ô ¢ª™ ·ÚÔ˘Û›·˙·Ó ÙËÓ ÈÛ¯˘ÚfiÙÂÚË Û˘-Û¯¤ÙÈÛË ÌÂ Ù· Â›Â‰· ÏÈÔÚˆÙÂ˚ÓÒÓ. ∆Ô ™µ Â›¯ÂÛÙÂÓfiÙÂÚË Û¯¤ÛË ÌÂ ÙË Û˘ÛÙÔÏÈÎ‹ Î·È ‰È·ÛÙÔÏÈÎ‹·ÚÙËÚÈ·Î‹ ›ÂÛË ·fi ÙÔ˘˜ ¿ÏÏÔ˘˜ ‰Â›ÎÙÂ˜. ¶ÚÔË-ÁÔ‡ÌÂÓÂ˜ ÌÂÏ¤ÙÂ˜ ÛÙÔÓ ·È‰ÈÎfi ÏËı˘ÛÌfi ¤¯Ô˘ÓÂ›ÛË˜ ‰Â›ÍÂÈ ÙË ıÂÙÈÎ‹ Û¯¤ÛË ÌÂÙ·Í‡ ÎÂÓÙÚÈÎ‹˜·¯˘Û·ÚÎ›·˜ Î·È ÂÈ¤‰ˆÓ TC, TG, LDL-¯ÔÏËÛÙÂ-ÚfiÏË, Î·ıÒ˜ Î·È ÙËÓ ·ÚÓËÙÈÎ‹ Û¯¤ÛË ÌÂ ÙÈ˜ ÙÈÌ¤˜HDL-¯ÔÏËÛÙÂÚfiÏË˜ (26,27). ∏ ÌÂÏ¤ÙË BogalusaHeart Study ÛÙÈ˜ ∏.¶.∞. (ÌÂ 2996 ·È‰È¿ ËÏÈÎ›·˜ 5-17 ÂÙÒÓ) Î·È ¿ÏÏÂ˜ ÂÚÁ·Û›Â˜ Î·Ù·Ï‹ÁÔ˘Ó ÛÙÔ ›‰ÈÔÛ˘Ì¤Ú·ÛÌ· ÌÂ ÙËÓ ·ÚÔ‡Û·, ‰ËÏ·‰‹ fiÙÈ ›Ûˆ˜ Ë¶ª ·ÔÙÂÏÂ› ÙÔÓ Î·Ï‡ÙÂÚÔ ‰Â›ÎÙË Î·Ù·ÓÔÌ‹˜ Ï›-Ô˘˜ ÁÈ· ÙËÓ ÂÓÙfiÈÛË ÙˆÓ ·È‰ÈÒÓ ÌÂ ‰˘ÛÌÂÓ‹ Û˘-ÁÎ¤ÓÙÚˆÛË ÏÈÔÚˆÙÂ˚ÓÒÓ Î·È ÈÓÛÔ˘Ï›ÓË˜ Î·È ÙËÓ˘¤ÚÙ·ÛË (16,18,28).

ªÂ ‚¿ÛË ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙË˜ Û‡ÛÙ·ÛË˜ ÙÔ˘˘Ô‰fiÚÈÔ˘ Ï›Ô˘˜, ÙÔ ÔÛÔÛÙfi ÙˆÓ ÎÔÚÂÛÌ¤ÓˆÓÏÈ·ÚÒÓ ÔÍ¤ˆÓ ÛÙ· ·ÁfiÚÈ· ‹Ù·Ó 23,6% (95% ¢∂:22,6-24,6%). ™Â ÌÂÏ¤ÙË Ô˘ Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ ÛÂ·ÁfiÚÈ· ËÏÈÎ›·˜ 8-16 ÂÙÒÓ ÛÂ ·ÁÚÔÙÈÎ‹ ÂÚÈÔ¯‹ ÙË˜∫Ú‹ÙË˜ ÛÙÈ˜ ·Ú¯¤˜ ÙË˜ ‰ÂÎ·ÂÙ›·˜ ÙÔ˘ 1980, ÙÔ·ÓÙ›ÛÙÔÈ¯Ô ÔÛÔÛÙfi ‹Ù·Ó 20,3% (95% ¢∂: 19,3-21,3%) (29). ∆Ô ÁÂÁÔÓfi˜ ·˘Ùfi ÌÔÚÂ› Ó· ·Ô‰ÔıÂ›ÛÙËÓ ·ÏÏ·Á‹ ÙˆÓ ‰È·ÙÚÔÊÈÎÒÓ Û˘ÓËıÂÈÒÓ Ô˘¤¯Ô˘Ó ·Ú·ÙËÚËıÂ› ÛÙËÓ ∫Ú‹ÙË ÙÈ˜ ÙÂÏÂ˘Ù·›Â˜ ‰Â-Î·ÂÙ›Â˜ (4).

™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË, Ë Û‡ÛÙ·ÛË ÙÔ˘ ˘Ô‰fi-ÚÈÔ˘ Ï›Ô˘˜ ‚Ú¤ıËÎÂ fiÙÈ ‰ÂÓ ·ÔÙÂÏÂ› ÈÛ¯˘Úfi ‰Â›-ÎÙË ÁÈ· Ù· Â›Â‰· ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ ÙÔ˘ Ï¿-ÛÌ·ÙÔ˜. ∆Ô ÁÂÁÔÓfi˜ ·˘Ùfi Û˘ÌÊˆÓÂ› ÌÂ Ù· ·ÔÙÂ-Ï¤ÛÌ·Ù· ÚfiÛÊ·ÙË˜ ÌÂÏ¤ÙË˜ ÛÂ ·È‰È¿ ËÏÈÎ›·˜ 12ÂÙÒÓ ·fi ÙËÓ ∫Ú‹ÙË, Ë ÔÔ›· ¤‰ÂÈÍÂ ˆ˜ ÔÈ ‰Â›ÎÙÂ˜

·¯˘Û·ÚÎ›·˜ ·ÔÙÂÏÔ‡Ó ÈÛ¯˘ÚfiÙÂÚÔ˘˜ ‰Â›ÎÙÂ˜ ÁÈ·Ù· Â›Â‰· ÏÈÔÚˆÙÂ˚ÓÒÓ ÛÂ Û¯¤ÛË ÌÂ ÙË Û‡ÛÙ·-ÛË ÙÔ˘ ˘Ô‰fiÚÈÔ˘ Ï›Ô˘˜ ·fi ÙË ÁÏÔ˘ÙÈ·›· ÂÚÈÔ-¯‹ (30). ∆Ô ˘Ô‰fiÚÈÔ Ï›Ô˜ ÙË˜ ÂÚÈÔ¯‹˜ ·˘Ù‹˜·ÚÔ˘ÛÈ¿˙ÂÈ ÌÈÎÚfiÙÂÚÔ ‚·ıÌfi ÏÈfiÏ˘ÛË˜ ÛÂ Û¯¤-ÛË ÌÂ ·˘Ùfi ÙË˜ ÎÔÈÏÈ·Î‹˜ ¯ÒÚ·˜ (31), fiˆ˜ ·Ó·-Ê¤ÚÂÙ·È Î·È ·fi ÙÔ˘˜ Mamalakis Î·È Û˘Ó (32). ∏ ÏÈ-fiÏ˘ÛË ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·‡ÍËÛË ÙË˜ Ë·-ÙÈÎ‹˜ Û‡ÓıÂÛË˜ ÏÈÔÚˆÙÂ˚ÓÒÓ Î·È ÙËÓ ·‡ÍËÛË ÙË˜Û˘ÁÎ¤ÓÙÚˆÛ‹˜ ÙÔ˘˜ ÛÙÔ Ï¿ÛÌ·. ªÂÏ¤ÙË ÛÂ ·È-‰È¿ ËÏÈÎ›·˜ 11-18 ÂÙÒÓ ¤‰ÂÈÍÂ fiÙÈ Ë Û‡ÛÙ·ÛË ÙÔ˘˘Ô‰fiÚÈÔ˘ Ï›Ô˘˜ ÙË˜ ÎÔÈÏÈ·Î‹˜ ÂÚÈÔ¯‹˜ ·ÔÙÂ-ÏÂ› Î·Ï‡ÙÂÚÔ ‰Â›ÎÙË ÁÈ· Ù· Â›Â‰· ÙˆÓ ÏÈÔÚˆ-ÙÂ˚ÓÒÓ ÙÔ˘ Ï¿ÛÌ·ÙÔ˜ ·’ fi,ÙÈ ·˘Ù‹ ÙË˜ ÁÏÔ˘ÙÈ·›·˜ÂÚÈÔ¯‹˜ (32). ∏ Â›‰Ú·ÛË ÙË˜ Û‡ÛÙ·ÛË˜ ÙÔ˘ ˘Ô-‰fiÚÈÔ˘ Ï›Ô˘˜ ÛÙ· ÏÈ›‰È· ÙÔ˘ Ï¿ÛÌ·ÙÔ˜ ‰ÂÓ ¤¯ÂÈÚÔÛ‰ÈÔÚÈÛÙÂ› ·ÎfiÌ· (33), ÂÓÒ ÔÈ Û¯ÂÙÈÎ¤˜ ÌÂÏ¤ÙÂ˜Â›Ó·È Û¿ÓÈÂ˜. °È· ·È‰ÈÎÔ‡˜ ÏËı˘ÛÌÔ‡˜, ÂÎÙfi˜ÙˆÓ ÚÔ·Ó·ÊÂÚfiÌÂÓˆÓ ÌÂÏÂÙÒÓ, ‰ÂÓ Ê·›ÓÂÙ·È Ó·˘¿Ú¯Ô˘Ó ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›· ÌÂÏ¤ÙÂ˜ Û˘-Û¯¤ÙÈÛË˜ ÙË˜ Û‡ÛÙ·ÛË˜ ÙÔ˘ ˘Ô‰fiÚÈÔ˘ Ï›Ô˘˜ ÌÂÙ· Â›Â‰· ÏÈÔÚˆÙÂ˚ÓÒÓ. ∆· ·ÔÙÂÏ¤ÛÌ·Ù· Ì›·˜ÌÂÏ¤ÙË˜ ÛÂ ·¯‡Û·ÚÎ· ÂÓ‹ÏÈÎ· ¿ÙÔÌ· ÛÙËÓ πÛ·-Ó›· ¤‰ÂÈÍ·Ó fiÙÈ ‰ÂÓ ˘‹Ú¯Â Û˘Û¯¤ÙÈÛË ÎÔÚÂÛÌ¤ÓˆÓÏÈ·ÚÒÓ ÔÍ¤ˆÓ ÌÂ Ù· ÏÈ›‰È· ÙÔ˘ Ï¿ÛÌ·ÙÔ˜, ÂÓÒ˘‹Ú¯Â ·ÚÓËÙÈÎ‹ Û˘Û¯¤ÙÈÛË ÙˆÓ ˆÌ¤Á·-3 ÏÈ·ÚÒÓÔÍ¤ˆÓ ÙÔ˘ ˘Ô‰fiÚÈÔ˘ Ï›Ô˘˜ ÌÂ Ù· ÙÚÈÁÏ˘ÎÂÚ›‰È·ÙÔ˘ Ï¿ÛÌ·ÙÔ˜ Î·È ıÂÙÈÎ‹ Û˘Û¯¤ÙÈÛË ÌÂ ÙËÓ HDL,ÁÂÁÔÓfi˜ Ô˘ ÔÈ Û˘ÁÁÚ·ÊÂ›˜ ¯·Ú·ÎÙËÚ›˙Ô˘Ó ˆ˜ ·-ÚfiÌÔÈÔ Â‡ÚËÌ· ÌÂ ·˘Ùfi ¿ÏÏˆÓ ÂÈ‰ËÌÈÔÏÔÁÈÎÒÓÌÂÏÂÙÒÓ ÛÙË ™ÎˆÙ›·, ºÈÓÏ·Ó‰›· Î·È πÙ·Ï›· (33).

À¿Ú¯ÂÈ, ÛÂ ÌÂÁ¿ÏÔ ‚·ıÌfi, ·ÏÏËÏÔÂÈÎ¿Ï˘„ËÌÂÙ·Í‡ ÙˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÛÙÂÊ·ÓÈ·›·ÓfiÛÔ Î·È ·˘ÙÒÓ ÁÈ· ‰È·‚‹ÙË Ù‡Ô˘ 2 (34). ∆· ÙÂ-ÏÂ˘Ù·›· ¯ÚfiÓÈ·, Ë ˘ÂÚÈÓÛÔ˘ÏÈÓ·ÈÌ›· ÂÓÔ¯ÔÔÈÂ›Ù·È

¶›Ó·Î·˜ 5. ∞ÔÙÂÏ¤ÛÌ·Ù· ·Ó¿Ï˘ÛË˜ ÔÏÏ·Ï‹˜ ·ÏÈÓ‰ÚfiÌËÛË˜ ÁÈ· ÙË Û¯¤ÛË Û‡ÓıÂÛË˜ ÙÔ˘ ˘Ô‰fiÚÈÔ˘ Ï›Ô˘˜ ÌÂ ÙÔ˘˜ ·Ú¿ÁÔ-ÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· Î·Ú‰È·ÁÁÂÈ·Î¿ ÓÔÛ‹Ì·Ù·*

∂Í·ÚÙËÌ¤ÓË ∞ÓÂÍ¿ÚÙËÙË R** ™˘ÓÙÂÏÂÛÙ‹˜ t ÛÙ·ÙÈÛÙÈÎ‹ p-valueÌÂÙ·‚ÏËÙ‹ ÌÂÙ·‚ÏËÙ‹ ·ÏÈÓ‰ÚfiÌËÛË˜ ·Ó¿Ï˘ÛË

(ÏÈ·Ú¿ ÔÍ¤·)** (95% ‰È¿ÛÙËÌ· ÂÌÈÛÙÔÛ‡ÓË˜)

§ÂÈÙÔ˘ÚÁ›· ‚-Î˘ÙÙ¿ÚˆÓ (SECR∏Oª∞)*** ∫ÔÚÂÛÌ¤Ó· 0,31 -0,86 (-1,65 ¤ˆ˜ -0,08) -2,18 0,031øÌ¤Á·-3*** 0,31 0,70 (0,08 ¤ˆ˜ 1,33) 2,22 0,028

∞ÓÙ›ÛÙ·ÛË ÛÙËÓ ÈÓÛÔ˘Ï›ÓË (πR∏Oª∞)*** øÌ¤Á·-3*** 0,27 0,65 (0,03 ¤ˆ˜ 1,26) 2,08 0,040LDL-¯ÔÏËÛÙÂÚfiÏË øÌ¤Á·-3*** 0,08 33,7 (0,0 ¤ˆ˜ 67,4) 1,98 0,050TC/HDL øÌ¤Á·-3*** 0,08 0,33 (0,01 ¤ˆ˜ 0,65) 2,02 0,046TG Trans*** 0,11 -0,46 (-0,81 ¤ˆ˜ -0,12) -2,66 0,009

* n=117. ¶·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÌfiÓÔ ÔÈ ÔÌ¿‰Â˜ ÙˆÓ ÏÈ·ÚÒÓ ÔÍ¤ˆÓ ÁÈ· ÙÈ˜ ÔÔ›Â˜ ‚Ú¤ıËÎ·Ó ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ¤˜ Û˘Û¯ÂÙ›ÛÂÈ˜ ÌÂ ÙËÓÂÍ·ÚÙËÌ¤ÓË ÌÂÙ·‚ÏËÙ‹. ¢ÂÓ ˘‹Ú¯·Ó Û˘Û¯ÂÙ›ÛÂÈ˜ ÌÂÙ·Í‡ ÙˆÓ ÔÌ¿‰ˆÓ ÙˆÓ ÏÈ·ÚÒÓ ÔÍ¤ˆÓ Î·È ÙËÓ HbA1c, ÙË ÁÏ˘Îfi˙Ë, ÙËÓ ÈÓ-ÛÔ˘Ï›ÓË, ÙËÓ ÔÏÈÎ‹ ¯ÔÏËÛÙÂÚfiÏË, ÙËÓ HDL-¯ÔÏËÛÙÂÚfiÏË, ÙË Û˘ÛÙÔÏÈÎ‹ ‹ ÙË ‰È·ÛÙÔÏÈÎ‹ ·ÚÙËÚÈ·Î‹ ›ÂÛË

** ∂ÎÙfi˜ ·fi ÙËÓ Î·ÙËÁÔÚ›· ÏÈ·ÚÒÓ ÔÍ¤ˆÓ, ÙÔ Ê‡ÏÔ Î·È Ë ËÏÈÎ›· ÂÚÈÂÏ‹ÊıËÛ·Ó ÛÂ Î¿ıÂ ÛÙ·ÙÈÛÙÈÎ‹ ·Ó¿Ï˘ÛË ·ÏÈÓ‰ÚfiÌËÛË˜ *** ™Â ÎÏ›Ì·Î· Ê˘ÛÈÎÔ‡ ÏÔÁ¿ÚÈıÌÔ˘

272

fiÏÔ Î·È Û˘¯ÓfiÙÂÚ· ÁÈ· ÙËÓ ÚfiÎÏËÛË ÛÔ‚·ÚÒÓ ·Á-ÁÂÈ·ÎÒÓ ·ı‹ÛÂˆÓ ÏfiÁˆ ·ıËÚÔÛÎÏ‹Ú˘ÓÛË˜. ªÂ-Á¿ÏÂ˜ ÚÔÔÙÈÎ¤˜ ÏËı˘ÛÌÈ·Î¤˜ ÌÂÏ¤ÙÂ˜ ˘ÔÛÙË-Ú›˙Ô˘Ó ˆ˜ Ë ˘ÂÚÈÓÛÔ˘ÏÈÓ·ÈÌ›· Û˘ÓÔ‰Â‡ÂÙ·È ·fi·˘ÍËÌ¤ÓÔ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛË˜ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘(35). ™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË, fiÏÔÈ ÔÈ ‰Â›ÎÙÂ˜ ·¯˘-Û·ÚÎ›·˜, ÂÎÙfi˜ ·fi ÙËÓ ¶ªπ, ·ÚÔ˘Û›·Û·Ó ıÂÙÈÎ‹Û˘Û¯¤ÙÈÛË ÌÂ Ù· Â›Â‰· ÈÓÛÔ˘Ï›ÓË˜ ÛÙÔ Ï¿ÛÌ·.ªÂ ‚¿ÛË ·˘Ùfi ÙÔ ÛÙÔÈ¯Â›Ô Î·È ‰Â‰ÔÌ¤ÓÔ˘ fiÙÈ Ì¤¯ÚÈÛÙÈÁÌ‹˜ ‰ÂÓ Û˘ÓÈÛÙ¿Ù·È Ë Ì¤ÙÚËÛË ÈÓÛÔ˘Ï›ÓË˜ Ï¿-ÛÌ·ÙÔ˜ ÛÙ· Ï·›ÛÈ· ÙË˜ ÚˆÙÔÁÂÓÔ‡˜ ÚfiÏË„Ë˜ÁÈ· ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ, ·Ó·‰ÂÈÎÓ‡ÂÙ·È Ë ÛËÌ·Û›· ÙˆÓÛˆÌ·ÙÔÌÂÙÚÈÎÒÓ ‰ÂÈÎÙÒÓ ÛÙÔÓ ÂÓÙÔÈÛÌfi ·È‰ÈÒÓÌÂ ˘ÂÚÈÓÛÔ˘ÏÈÓ·ÈÌ›·.

™Â ·¯‡Û·ÚÎ· ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜, ¤Ó·˜ ·Ú¿-ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ‰È·Ù·Ú·¯‹ ÛÙËÓ Î·Ì‡ÏË ·ÓÔ-¯‹˜ ÁÏ˘Îfi˙Ë˜ Â›Ó·È Ë ˘ÂÚÈÓÛÔ˘ÏÈÓ·ÈÌ›· ÌÂÙ¿ ·fiÓËÛÙÂ›· (35). ™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË, ·fi ÙÈ˜ 13 Ì·-ı‹ÙÚÈÂ˜ ÌÂ ·˘ÍËÌ¤Ó· Â›Â‰· ÈÓÛÔ˘Ï›ÓË˜ (ËÏÈÎ›·˜7-14 ÂÙÒÓ), ÔÈ 10 Ù·ÍÈÓÔÌ‹ıËÎ·Ó ˆ˜ ˘¤Ú‚·ÚÂ˜ ‚¿-ÛÂÈ ÙˆÓ ÙÈÌÒÓ ÙË˜ International Obesity Task Force(πOTF, 25) Î·È 3 ·fi ·˘Ù¤˜ ÎÚ›ıËÎ·Ó ·¯‡Û·ÚÎÂ˜.∫·Ì‡ÏË ·ÓÔ¯‹˜ ÁÏ˘Îfi˙Ë˜ ¤ÁÈÓÂ ÛÂ 7 ÎÔÚ›ÙÛÈ·, ·Ï-Ï¿ ‰ÂÓ ÚÔ¤Î˘„·Ó ÂÓ‰Â›ÍÂÈ˜ ÁÈ· ÌË-·ÓÔ¯‹ ÛÙË ÁÏ˘-Îfi˙Ë (fiÏ· Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ‹Ù·Ó ÂÓÙfi˜ ÙˆÓ Ê˘ÛÈÔ-ÏÔÁÈÎÒÓ ÔÚ›ˆÓ). OÈ ÂÎÙÈÌ‹ÛÂÈ˜ ÙË˜ ·ÓÙ›ÛÙ·ÛË˜ ÛÙËÓÈÓÛÔ˘Ï›ÓË Î·È ÙË˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÙˆÓ ‚-Î˘ÙÙ¿ÚˆÓ ÙÔ˘·ÁÎÚ¤·ÙÔ˜ (∏Oª∞) Â›¯·Ó ÛÙÂÓ‹ ıÂÙÈÎ‹ Û˘Û¯¤ÙÈÛËÌÂ ÙÔ˘˜ ‰Â›ÎÙÂ˜ ·¯˘Û·ÚÎ›·˜ Î·È ÂÈ‰ÈÎ¿ ÌÂ ÙÔ ™µ,ÙÔÓ ¢ª™ Î·È ÙËÓ ¶ª. OÈ Û˘Û¯ÂÙ›ÛÂÈ˜ ÌÂÙ·Í‡ ÙˆÓ‰ÂÈÎÙÒÓ ∏Oª∞ Î·È ÙÔ˘ ‚¿ÚÔ˘˜ Î·È ÙÔ˘ ¢ª™ ¤¯Ô˘Ó‚ÚÂıÂ› Î·È ÛÂ ÌÂÏ¤ÙÂ˜ ÛÂ ·È‰È¿ ÙË˜ πÓ‰›·˜, ÙË˜∞ÌÂÚÈÎ‹˜ Î·È ÙË˜ ¡fiÙÈ·˜ ∞ÊÚÈÎ‹˜ Î·È Û¯ÂÙ›˙ÔÓÙ·ÈÂ›ÛË˜ ÌÂ ÙÔÓ Ú˘ıÌfi ÌÂÙ·‚ÔÏ‹˜ ÙÔ˘ ‚¿ÚÔ˘˜(weight velocity), fiÔ˘ ÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛË˜ ¤¯ÂÈ·ÚÓËÙÈÎ‹ Û˘Û¯¤ÙÈÛË ÌÂ ÙÔÓ ‰Â›ÎÙË πRHOMA (36-38).∆Ô Û˘Ì¤Ú·ÛÌ· Ì›·˜ ÌÂÏ¤ÙË˜ ÛÂ ·È‰È¿ ÙË˜∞ÁÁÏ›·˜ ËÏÈÎ›·˜ 10-11 ÂÙÒÓ ‹Ù·Ó fiÙÈ Ë ·¯˘Û·ÚÎ›·Â›Ó·È ÈÔ Î·ıÔÚÈÛÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÁÈ· ÙÔ Â›Â‰ÔÙË˜ ·ÓÙ›ÛÙ·ÛË˜ ÛÙËÓ ÈÓÛÔ˘Ï›ÓË ·’ fi,ÙÈ ÙÔ Ì¤ÁÂıÔ˜Î·Ù¿ ÙË Á¤ÓÓËÛË (39). ∏ ÂÏ¿ÙÙˆÛË ÙÔ˘ ‚¿ÚÔ˘˜ ÌÂ·‡ÍËÛË ÙË˜ ÛˆÌ·ÙÈÎ‹˜ ¿ÛÎËÛË˜ Î·È Ë ÛˆÛÙ‹ ‰È·-ÙÚÔÊ‹ ÌÔÚÔ‡Ó Ó· Î·ı˘ÛÙÂÚ‹ÛÔ˘Ó ‹ ·ÎfiÌ· Ó·ÛÙ·Ì·Ù‹ÛÔ˘Ó ÙËÓ ÂÌÊ¿ÓÈÛË Û·Î¯·ÚÒ‰Ô˘˜ ‰È·‚‹-ÙË Ù‡Ô˘ 2 (35).

OÈ ÙÈÌ¤˜ ÙË˜ ÁÏ˘ÎÔ˙˘ÏÈˆÌ¤ÓË˜ ·ÈÌÔÛÊ·ÈÚ›ÓË˜HbA1c ·ÓÙÈÎ·ÙÔÙÚ›˙Ô˘Ó Ù· Â›Â‰· ÁÏ˘Îfi˙Ë˜ ÛÙÔ·›Ì· ÁÈ· ÌÂÁ·Ï‡ÙÂÚË ¯ÚÔÓÈÎ‹ ÂÚ›Ô‰Ô ÛÂ Û¯¤ÛË ÌÂÙÈ˜ ÙÈÌ¤˜ ÁÏ˘Îfi˙Ë˜ ÓËÛÙÂ›·˜. O ÌfiÓÔ˜ ‰Â›ÎÙË˜ ·-¯˘Û·ÚÎ›·˜ Ô˘ Û˘Û¯ÂÙ›ÛÙËÎÂ ÌÂ Ù· Â›Â‰· ÁÏ˘-ÎÔ˙˘ÏÈˆÌ¤ÓË˜ ·ÈÌÔÛÊ·ÈÚ›ÓË˜ ‹Ù·Ó ÙÔ ∞¢¶. ¶·Úfi-ÌÔÈ· ·ÔÙÂÏ¤ÛÌ·Ù· ‚Ú¤ıËÎ·Ó ÛÂ ÌÂÏ¤ÙË ÛÂ 1610·È‰È¿ ËÏÈÎ›·˜ 6-16 ÂÙÒÓ ÛÙËÓ ∆˙·Ì¿ÈÎ·, fiÔ˘ Ë

‰ÂÚÌ·ÙÈÎ‹ Ù˘¯‹ ÙÚÈÎ¤Ê·ÏÔ˘ ‹Ù·Ó Ô ÌfiÓÔ˜ ‰Â›ÎÙË˜·¯˘Û·ÚÎ›·˜ (¯ÚËÛÈÌÔÔÈÒÓÙ·˜ Î·È ÙÔ ÛˆÌ·ÙÈÎfi‚¿ÚÔ˜ Î·È ÙÔ ‚·ÚÔ˜/‡„Ô˜3 ˆ˜ ‰Â›ÎÙÂ˜, ponderalindex) Ô˘ Û˘Û¯ÂÙ›ÛÙËÎÂ ÌÂ Ù· Â›Â‰· ·ÈÌÔÛÊ·È-Ú›ÓË˜ HbA1c (40). øÛÙfiÛÔ, Ë Û¯ÂÙÈÎ‹ ·Ô˘Û›· ‰Â-‰ÔÌ¤ÓˆÓ Û¯ÂÙÈÎ¿ ÌÂ ÙË ÁÏ˘ÎÔ˙˘ÏÈˆÌ¤ÓË ·ÈÌÔÛÊ·È-Ú›ÓË ÛÙ· ·È‰È¿ Î·È ÙË Û¯¤ÛË ÙË˜ ÌÂ ÚÔ‰È·ıÂÛÈ-ÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜ ÁÈ· Î·Ú‰È·ÁÁÂÈ·Î¿ ÓÔÛ‹Ì·Ù·,Î·ıÈÛÙ¿ ·Ó·ÁÎ·›· ÙËÓ Ú·ÁÌ·ÙÔÔ›ËÛË ·ÓÙ›ÛÙÔÈ-¯ˆÓ ÌÂÏÂÙÒÓ ÛÙÔ Ì¤ÏÏÔÓ.

O Û‡Á¯ÚÔÓÔ˜ ÙÚfiÔ˜ ˙ˆ‹˜, Ë ÂÚÈÔÚÈÛÌ¤ÓË Ê˘-ÛÈÎ‹ ‰Ú·ÛÙËÚÈfiÙËÙ· Î·È Ë ÛÙ¿ÛË ÙˆÓ ÁÔÓ¤ˆÓ ÛÂı¤Ì·Ù· ‰È·ÙÚÔÊ‹˜ ·ÔÙÂÏÔ‡Ó ‚·ÛÈÎÔ‡˜ ·Ú¿ÁÔ-ÓÙÂ˜ ‰È·ÌfiÚÊˆÛË˜ ÙË˜ Û˘ÌÂÚÈÊÔÚ¿˜ ÙˆÓ ·È‰ÈÒÓÁ‡Úˆ ·fi Û˘Ó‹ıÂÈÂ˜ ˘ÁÂ›·˜. π‰È·›ÙÂÚ· ÛËÌ·ÓÙÈÎfi˜ÛÙËÓ ÂÎ‰‹ÏˆÛË ÙË˜ ·È‰ÈÎ‹˜ ·¯˘Û·ÚÎ›·˜ Ê·›ÓÂ-Ù·È Ô ÙÚfiÔ˜ ‰È·ÙÚÔÊ‹˜ Î·È ÔÈ Û˘Ó‹ıÂÈÂ˜ ÙË˜ ÔÈÎÔ-Á¤ÓÂÈ·˜ (41). øÛÙfiÛÔ, Ì›· ÛÂÈÚ¿ ·fi ÌÂÏ¤ÙÂ˜ ÛÂ ‰›-‰˘ÌÔ˘˜ Î·È ˘ÈÔıÂÙËÌ¤Ó· ·È‰È¿ ¤¯Ô˘Ó ·Ô‰ÒÛÂÈ ÙËÛ˘Û¯¤ÙÈÛË ÙË˜ ·¯˘Û·ÚÎ›·˜ ÙˆÓ ÁÔÓ¤ˆÓ ÌÂ ÂÎÂ›ÓËÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜ Î·È ÛÂ ÁÂÓÂÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜(42,43), fiˆ˜ ·Ó·Ê¤ÚÂÙ·È Î·È ·fi ÙÔ˘˜ MamalakisÎ·È Û˘Ó (17). ™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË, ˘‹ÚÍÂ ıÂÙÈÎ‹Û˘Û¯¤ÙÈÛË ÌÂÙ·Í‡ ÙÔ˘ ¢ª™ ÙÔ˘ ·È‰ÈÔ‡ Î·È ÙÔ˘·Ù¤Ú· Î·È ÛÂ ÌÈÎÚfiÙÂÚÔ ‚·ıÌfi ÙË˜ ÌËÙ¤Ú·˜, ÌÂÙ¿·fi ¤ÏÂÁ¯Ô ÁÈ· ÙËÓ ËÏÈÎ›· Î·È ÙÔ Ê‡ÏÔ ÙÔ˘ ·È‰ÈÔ‡(r=0,24, p=0,004 ÁÈ· ÙÔÓ ·Ù¤Ú·, r=0,20, p=0,016ÁÈ· ÙË ÌËÙ¤Ú·). ∏ ∂ÈÎfiÓ· 1 ·ÂÈÎÔÓ›˙ÂÈ ÙË Û¯¤ÛË ÌÂ-Ù·Í‡ ÙË˜ ·¯˘Û·ÚÎ›·˜ ÙˆÓ ·È‰ÈÒÓ Î·È ÙˆÓ ·Ù¤-ÚˆÓ ÙÔ˘˜. πÛ¯˘Ú‹ ÛÙ·ÙÈÛÙÈÎ¿ Û˘Û¯¤ÙÈÛË ·ÚÔ˘ÛÈ¿-ÛÙËÎÂ Î·È ÌÂÙ·Í‡ ¶ªÀ ÙÔ˘ ·È‰ÈÔ‡ Î·È ¢ª™ ÙÔ˘·Ù¤Ú· (r=0,40, p<0,0001), ÌÂÙ·Í‡ ∞¢¶ Î·È ¢ª™ÙÔ˘ ·Ù¤Ú· (r=0,25, p=0,002) Î·È ÌÂÙ·Í‡ ¶ªπ Î·È¢ª™ ÙÔ˘ ·Ù¤Ú· (r=0,23, p=0,006). O ÌÔÓ·‰ÈÎfi˜‰Â›ÎÙË˜ ·¯˘Û·ÚÎ›·˜ Ô˘ Û¯ÂÙÈ˙fiÙ·Ó ÌÂ ÙÔÓ ‰Ë-ÏÔ‡ÌÂÓÔ ¢ª™ ÙË˜ ÌËÙ¤Ú·˜ ‹Ù·Ó ÙÔ ™µ ÙÔ˘ ·È‰ÈÔ‡(r=0,18, p=0,03). ª›· ÛÂÈÚ¿ ·fi ÌÂÏ¤ÙÂ˜ ÛÂ ‰È¿-ÊÔÚÔ˘˜ ÏËı˘ÛÌÔ‡˜ ÂÓËÏ›ÎˆÓ ¤¯ÂÈ ‰Â›ÍÂÈ fiÙÈ Ë¯Ú‹ÛË ·˘ÙÔ-·Ó·ÊÂÚfiÌÂÓˆÓ (self-reported) ÙÈÌÒÓÙÔ˘ ‚¿ÚÔ˘˜ Î·È ÙÔ˘ ‡„Ô˘˜ ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙËÓ˘ÔÂÎÙ›ÌËÛË ÙÔ˘ ¢ª™ Î·È ÙÔ˘ ÂÈÔÏ·ÛÌÔ‡ ÙË˜·¯˘Û·ÚÎ›·˜. ∞˘Ù‹ Ë ‰È·ÊÔÚ¿ ÌÂÙ·Í‡ ÙÔ˘ ¢ª™Ô˘ ¤¯ÂÈ ˘ÔÏÔÁÈÛÙÂ› ·fi ÌÂÙÚ‹ÛÂÈ˜ Î·È ÙÔ˘ ¢ª™Ô˘ ¤¯ÂÈ ÂÎÙÈÌËıÂ› ·fi ·Ó·ÊÂÚfiÌÂÓÂ˜ ÙÈÌ¤˜ Â›Ó·ÈÌÂÁ·Ï‡ÙÂÚË ÛÙÈ˜ Á˘Ó·›ÎÂ˜ ·’ fi,ÙÈ ÛÙÔ˘˜ ¿Ó‰ÚÂ˜(44-46). ∂ÔÌ¤Óˆ˜, ˘¿Ú¯ÂÈ ÂÚ›ÙˆÛË ÛÙËÓ ·-ÚÔ‡Û· ÂÚÁ·Û›· Ó· ¤¯Ô˘Ó ˘ÔÂÎÙÈÌËıÂ› ÔÈ Ú·ÁÌ·-ÙÈÎ¤˜ Û˘Û¯ÂÙ›ÛÂÈ˜ Î·È ÂÈ‰ÈÎ¿ ·˘Ù¤˜ ÌÂÙ·Í‡ ÙÔ˘¢ª™ ÌËÙ¤Ú·˜ Î·È ÙˆÓ ‰ÂÈÎÙÒÓ ·¯˘Û·ÚÎ›·˜ ÙˆÓ·È‰ÈÒÓ ÙÔ˘˜.

ŒÓ· ¿ÏÏÔ ÛËÌ·ÓÙÈÎfi Â‡ÚËÌ· ÙË˜ ·ÚÔ‡Û·˜ ÂÚ-Á·Û›·˜ Â›Ó·È fiÙÈ ÛÙÔÓ ÏËı˘ÛÌfi Ô˘ ÌÂÏÂÙ‹ıËÎÂ,·ÓÙÈÚÔÛˆÂ˘ÙÈÎfi˜ ÙˆÓ ·È‰ÈÎÒÓ ÏËı˘ÛÌÒÓ ÛÂ


273


274

·ÁÚÔÙÈÎ¤˜ ÂÚÈÔ¯¤˜ ÙË˜ ∫Ú‹ÙË˜, ˘¿Ú¯ÂÈ ˘„ËÏfiÔÛÔÛÙfi ˘¤Ú‚·ÚˆÓ Î·È ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ.¶ÚÔËÁÔ‡ÌÂÓÂ˜ ÌÂÏ¤ÙÂ˜ ÛÙËÓ ∂ÏÏ¿‰· Î·È ÛÂ ¿ÏÏÂ˜Â˘Úˆ·˚Î¤˜ ¯ÒÚÂ˜ ‰Â›¯ÓÔ˘Ó fiÙÈ Ù· Â›Â‰· ÙË˜·È‰ÈÎ‹˜ ·¯˘Û·ÚÎ›·˜ Â›Ó·È ˘„ËÏfiÙÂÚ· ÛÙÈ˜ ·ÁÚÔ-ÙÈÎ¤˜ ÛÂ Û¯¤ÛË ÌÂ ÙÈ˜ ·ÛÙÈÎ¤˜ ÂÚÈÔ¯¤˜. ™Â Úfi-ÛÊ·ÙË ÌÂÏ¤ÙË 90.997 ·È‰ÈÒÓ ËÏÈÎ›·˜ 6-7 ÂÙÒÓ Î·È106.284 ÂÊ‹‚ˆÓ ËÏÈÎ›·˜ 13-14 ÂÙÒÓ ÛÙËÓ πÛ·Ó›·,‚Ú¤ıËÎÂ fiÙÈ Ë Èı·ÓfiÙËÙ· Ó· Â›Ó·È ¤Ó· ·È‰› ˘¤Ú-‚·ÚÔ ‹Ù·Ó ˘„ËÏfiÙÂÚË ÛÙÈ˜ ·ÁÚÔÙÈÎ¤˜ ·Ú¿ ÛÙÈ˜·ÛÙÈÎ¤˜ ÂÚÈÔ¯¤˜ ÙË˜ ¯ÒÚ·˜ (47). To 33% ÙˆÓ ·È-‰ÈÒÓ ÙË˜ ÌÂÏ¤ÙË˜ Ì·˜ ‹Ù·Ó ˘¤Ú‚·ÚÔ Î·È Û˘ÓÔÏÈÎ¿˘‹Ú¯Â ÔÛÔÛÙfi 9% ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ, ÂÓÒ ÛÂÌ›· ÚfiÛÊ·ÙË ÌÂÏ¤ÙË ÛÙËÓ fiÏË ÙË˜ £ÂÛÛ·ÏÔÓ›-ÎË˜ ÛÂ 2458 ·È‰È¿ ËÏÈÎ›·˜ 6-17 ÂÙÒÓ ‚Ú¤ıËÎÂ Ô-ÛÔÛÙfi 22% Î·È 4% ˘¤Ú‚·ÚˆÓ Î·È ·¯‡Û·ÚÎˆÓ·È‰ÈÒÓ, ·ÓÙ›ÛÙÔÈ¯· (¯ÚËÛÈÌÔÔÈÒÓÙ·˜ Ù· ›‰È· IOTFÎÚÈÙ‹ÚÈ· ÙÔ˘ ¢ª™) (48). ™ÙËÓ ÚÔ·Ó·ÊÂÚfiÌÂÓË ÌÂ-Ï¤ÙË, Ì¿ÏÈÛÙ·, ·Ó·Ê¤ÚÂÙ·È fiÙÈ ÙÈ˜ ÙÂÏÂ˘Ù·›Â˜ ‰ÂÎ·-ÂÙ›Â˜ ÛÙËÓ ∂ÏÏ¿‰· ˘¿Ú¯ÂÈ ·‡ÍËÛË ÛÙÔÓ ÂÈÔÏ·-ÛÌfi ÙˆÓ ˘¤Ú‚·ÚˆÓ Î·È ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ.

™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË ‚Ú¤ıËÎÂ fiÙÈ 29% ÙˆÓ Ì·-ıËÙÒÓ Â›¯Â ÙÔ˘Ï¿¯ÈÛÙÔÓ 2 ·fi ÙÔ˘˜ 4 ‚·ÛÈÎÔ‡˜ ·-Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· Î·Ú‰È·ÁÁÂÈ·Î¿ ÓÔÛ‹Ì·Ù·(·¯˘Û·ÚÎ›·, ˘ÂÚÈÓÛÔ˘ÏÈÓ·ÈÌ›·, ˘ÂÚ¯ÔÏËÛÙÂÚÔ-Ï·ÈÌ›· Î·È Û˘ÛÙÔÏÈÎ‹ ˘¤ÚÙ·ÛË). ª¿ÏÈÛÙ·, Ù· ÎÔÚ›-ÙÛÈ· ÂÌÊ·Ó›ÛÙËÎ·Ó ÂÚÈÛÛfiÙÂÚÔ ÂÈÚÚÂ‹ ÛÙËÓ·ÚÔ˘Û›· ÔÏÏ·ÏÒÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÛÂÛ¯¤ÛË ÌÂ Ù· ·ÁfiÚÈ· (¯2-·Ó¿Ï˘ÛË, p=0,009). ™Â ÌÂ-Ï¤ÙË Ô˘ Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ ÛÂ 7054 ·È‰È¿ ËÏÈ-Î›·˜ 11-12 ÂÙÒÓ ÛÙËÓ ∫‡ÚÔ, ÙÔ 18% ÙˆÓ ·ÁÔÚÈÒÓÎ·È ÙÔ 15% ÙˆÓ ÎÔÚÈÙÛÈÒÓ (p<0,001) Û˘ÁÎ¤ÓÙÚˆÓÂ2 ·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ (ÂÎ ÙˆÓ 4: Û˘ÛÙÔÏÈÎ‹ ˘¤Ú-Ù·ÛË, ·¯˘Û·ÚÎ›·, ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· Î·È ÌÂÈˆ-Ì¤ÓË Ê˘ÛÈÎ‹ Î·Ù¿ÛÙ·ÛË), ÂÓÒ 5,3% Î·È 3,2% ·ÓÙ›-ÛÙÔÈ¯· Â›¯Â ¿Óˆ ·fi 3 ÚÔ‰È·ıÂÛÈÎÔ‡˜ ·Ú¿ÁÔ-ÓÙÂ˜ (49). ™Â ÚfiÛÊ·ÙË ÌÂÏ¤ÙË ÛÙÔ ∫¤ÓÙÚÔ ÀÁÂ›·˜ÙË˜ ·ÁÚÔÙÈÎ‹˜ ÂÚÈÔ¯‹˜ ÙÔ˘ Ã¿Ú·Î·, ÛÙÔÓ ÓÔÌfi∏Ú·ÎÏÂ›Ô˘, 150 ·È‰ÈÒÓ ËÏÈÎ›·˜ 12-13 ¯ÚÔÓÒÓ, ÙÔ14% ÙˆÓ ·ÁÔÚÈÒÓ Î·È ÙÔ 20% ÙˆÓ ÎÔÚÈÙÛÈÒÓ ·-ÚÔ˘Û›·ÛÂ Û˘ÛÙÔÏÈÎ‹ ·ÚÙËÚÈ·Î‹ ›ÂÛË ÙÔ˘Ï¿¯ÈÛÙÔÓ120 mmHg Î·È 15% ÙˆÓ ·È‰ÈÒÓ ÎÚ›ıËÎÂ ˘¤Ú‚·-ÚÔ (Î·È/‹ ·¯‡Û·ÚÎÔ, fiÔ˘ ÔÈ Û˘ÁÁÚ·ÊÂ›˜ ¯ÚËÛÈ-ÌÔÔ›ËÛ·Ó ˆ˜ ÎÚÈÙ‹ÚÈÔ ÙÔÓ ¢ª™ >21 kg/m2) (50).

À‹Ú¯·Ó Î¿ÔÈÔÈ ÂÚÈÔÚÈÛÌÔ› ÛÙËÓ ·ÚÔ‡Û·ÌÂÏ¤ÙË. ª›· ·‰˘Ó·Ì›· ·ÔÙÂÏÂ› ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÔÈÛ˘ÌÌÂÙ¤¯ÔÓÙÂ˜ Û¯ÂÙ›˙ÔÓÙ·Ó ÛÂ Î¿ÔÈÔ ‚·ıÌfi ÁÂÓÂ-ÙÈÎ¿ ÌÂÙ·Í‡ ÙÔ˘˜. ªfiÓÔ 40 ·fi Ù· 178 ·È‰È¿ ‰ÂÓÂ›¯·Ó Î¿ÔÈÔÓ ·‰ÂÚÊfi ‹ ·‰ÂÚÊ‹ Ó· Û˘ÌÌÂÙ¤¯ÂÈÛÙÔ ÚfiÁÚ·ÌÌ·. £· ‹Ù·Ó È‰È·›ÙÂÚ· ÂÓ‰È·Ê¤ÚÔÓ Ó·ÂÎÙÈÌ‹ÛÂÈ Î·ÓÂ›˜ ÛÂ ÁÂÓÂÙÈÎfi Â›Â‰Ô ÙËÓ Â›‰Ú·ÛËÁÓˆÛÙÒÓ ÁÔÓÈ‰›ˆÓ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È ÌÂ Î·Ú‰È·ÁÁÂÈ-·Îfi Î›Ó‰˘ÓÔ (.¯. ÁÔÓfiÙ˘Ô˜ ApoE). ¶·Ú¿ÏÏËÏ·, Ô

·ÚÈıÌfi˜ ÙˆÓ Ì·ıËÙÒÓ ‹Ù·Ó Û¯ÂÙÈÎ¿ ÌÈÎÚfi˜ Î·È ÙÔËÏÈÎÈ·Îfi Â‡ÚÔ˜ ÌÂÁ¿ÏÔ. ∏ ËÏÈÎ›· ‚Ú¤ıËÎÂ Ó· ·-ÚÔ˘ÛÈ¿˙ÂÈ ıÂÙÈÎ‹ Û˘Û¯¤ÙÈÛË ÌÂ ÙËÓ ÈÓÛÔ˘Ï›ÓË, ÙËÓ·ÚÙËÚÈ·Î‹ ›ÂÛË Î·È ÙÔ˘˜ ‰Â›ÎÙÂ˜ ·¯˘Û·ÚÎ›·˜(ÂÓÒ ‰ÂÓ ˘‹Ú¯Â Û˘Û¯¤ÙÈÛË ÌÂ ÙÈ˜ ÏÈÔÚˆÙÂ˝ÓÂ˜,ÙË ÁÏ˘Îfi˙Ë Î·È ÙËÓ HbA1c), ·ÏÏ¿ ÛÙ· ÌÔÓÙ¤Ï· ·-ÏÈÓ‰ÚfiÌËÛË˜ Â›¯Â ÏËÊıÂ› ˘’ fi„ÈÓ Ë ËÏÈÎ›· (ˆ˜Û˘ÌÌÂÙ·‚ÏËÙ‹). ∂·Ó·Ï‹ÊıËÎ·Ó, fiÌˆ˜, ÔÈ ÛÙ·ÙÈ-ÛÙÈÎ¤˜ ·Ó·Ï‡ÛÂÈ˜ ÛÂ ‰‡Ô ÔÌ¿‰Â˜ Ì·ıËÙÒÓ (Î¿Ùˆ·fi ÙË ‰È¿ÌÂÛË ËÏÈÎ›· ÙˆÓ 10 ÂÙÒÓ Î·È ¿Óˆ ·fi·˘Ù‹ ÙËÓ ËÏÈÎ›·) Î·È ‰ÂÓ ÂÓÙÔ›ÛÙËÎ·Ó ‰È·ÊÔÚ¤˜ÛÙ· ·ÔÙÂÏ¤ÛÌ·Ù·. ∂›ÛË˜, ÌÂ ‚¿ÛË ÙÔÓ ÌÈÎÚfi·ÚÈıÌfi ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜, ·ÔÊÂ‡¯ıËÎÂ Ë ¯ÚËÛÈÌÔ-Ô›ËÛË ÔÚ›ˆÓ ÌÂ ‚¿ÛË ÂÎ·ÙÔÛÙÈ·›Â˜ ı¤ÛÂÈ˜ (ÙÔ˘‰Â›ÁÌ·ÙÔ˜), ÚÔÎÂÈÌ¤ÓÔ˘ Ó· ÂÎÙÈÌËıÂ› Ë ·ÚÔ˘Û›··¯˘Û·ÚÎ›·˜. ŒÓ·˜ ¿ÏÏÔ˜ ÂÚÈÔÚÈÛÌfi˜ ÙË˜ ÌÂÏ¤-ÙË˜ ‹Ù·Ó fiÙÈ ‰ÂÓ ÂÎÙÈÌ‹ıËÎÂ ÙÔ ÛÙ¿‰ÈÔ ÁÂÓÓËÙÈÎ‹˜·Ó¿Ù˘ÍË˜ Î·Ù¿ Tanner ÛÙ· ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿.∂›ÛË˜, ÛÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË ÙÔÌ‹˜ ‰ÂÓ ˘‹Ú¯·ÓÌÂÙÚ‹ÛÂÈ˜ ÛˆÌ·ÙÈÎ‹˜ ¿ÛÎËÛË˜ ‹ Û˘ÁÎÂÎÚÈÌ¤ÓÔÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ÁÈ· ÙË Ê˘ÛÈÎ‹ ‰Ú·ÛÙËÚÈfiÙËÙ· ÙÔ˘Î¿ıÂ ·È‰ÈÔ‡.

O ¢ª™ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ ÛÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙËÁÈ· Ó· ÂÓÙÔÈÛÙÔ‡Ó Ù· ˘¤Ú‚·Ú· Î·È ·¯‡Û·ÚÎ··È‰È¿, ‰ÈfiÙÈ Â›Ó·È ¤Ó·˜ ‰Â›ÎÙË˜ ÁÈ· ÙÔÓ ÔÔ›Ô˘¿Ú¯Ô˘Ó ‰ÈÂıÓ‹ ÎÚÈÙ‹ÚÈ· Î·È ¯ÚËÛÈÌÔÔÈÂ›Ù·È Û˘-¯Ó¿ ÛÂ ‰ËÌÔÛÈÂ˘Ì¤ÓÂ˜ ÌÂÏ¤ÙÂ˜. ¢ÂÓ ˘¿Ú¯ÂÈ,fiÌˆ˜, Î¿ÔÈÔ˜ ÔÚÈÛÌfi˜ ÙË˜ ·¯˘Û·ÚÎ›·˜ ÛÙ· ·È-‰È¿ Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜, Ô ÔÔ›Ô˜ Ó· Â›Ó·È ÁÂÓÈÎ¿·Ô‰ÂÎÙfi˜ (51), fiˆ˜ ·Ó·Ê¤ÚÂÙ·È Î·È ·fi ÙÔ˘˜Mamalakis Î·È Û˘Ó (30). øÛÙfiÛÔ, Ô ÔÚÈÛÌfi˜ Ú¤ÂÈÓ· ¤¯ÂÈ Û¯¤ÛË ÌÂ ÙÔ˘˜ ‰Â›ÎÙÂ˜ ÓÔÛËÚfiÙËÙ·˜ Î·ÈıÓËÛÈÌfiÙËÙ·˜ (52), ÔÈ ÔÔ›ÔÈ Û˘Û¯ÂÙ›˙ÔÓÙ·È ¿ÌÂÛ·ÛÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜ ÌÂ ÙËÓ ·ÚÔ˘Û›· ÙˆÓ ·Ú·ÁfiÓÙˆÓ

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ÎÈÓ‰‡ÓÔ˘ Ô˘ ÂÚÂ˘Ó‹ıËÎ·Ó ÛÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË.ª›· ÂÍ‹ÁËÛË ÁÈ· ÙËÓ Èı·Ó‹ ·‰˘Ó·Ì›· ÙÔ˘ ¢ª™ Â›-Ó·È fiÙÈ ·È‰È¿ ÌÂ ÙÔÓ ›‰ÈÔ ¢ª™ ÌÔÚÂ› Ó· ¤¯Ô˘Ó ÌÂ-Á¿ÏÂ˜ ‰È·ÊÔÚ¤˜ ÛÙÔ Û˘ÓÔÏÈÎfi Ï›Ô˜ ÛÒÌ·ÙÔ˜.∞Ó·¿ÓÙËÙÔ ·Ú·Ì¤ÓÂÈ ÙÔ ÂÚÒÙËÌ· ·Ó Ë ¶ª Â›Ó·ÈÙÔ˘Ï¿¯ÈÛÙÔÓ ÙfiÛÔ Î·Ïfi˜ ‰Â›ÎÙË˜ fiÛÔ Ô ¢ª™ ÁÈ·ÙËÓ ÂÓÙfiÈÛË ÙË˜ ·È‰ÈÎ‹˜ Î·È ÂÊË‚ÈÎ‹˜ ·¯˘Û·Ú-Î›·˜. Ÿˆ˜ ‰È·ÈÛÙÒıËÎÂ ÛÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË, Ë¶ª Â›Ó·È ¤Ó·˜ ‰Â›ÎÙË˜ ÌÂ ÂÍ›ÛÔ˘ ÛÙÂÓ‹ Û¯¤ÛË ÌÂÙÔ˘˜ ¿ÏÏÔ˘˜ ·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ ÛÙ· ·È‰È¿,fiˆ˜ Ô ¢ª™, ÂÓÒ Â›Ó·È Û¯ÂÙÈÎ¿ Â‡ÎÔÏÔ Ó· ÌÂÙÚËıÂ›Ë ¶ª ÌÂ ·ÎÚ›‚ÂÈ·.

™˘ÓÔ„›˙ÔÓÙ·˜, Ë ÂÓ‰ÔÎÔÈÏÈ·Î‹ ÂÓ·fiıÂÛË Ï›-Ô˘˜ (fiˆ˜ Ê·›ÓÂÙ·È ·fi ÙËÓ ¶ª) ÛÙÔÓ ·È‰ÈÎfiÏËı˘ÛÌfi Û¯ÂÙ›˙ÂÙ·È ÌÂ ‰˘ÛÌÂÓ‹ ÂÈÎfiÓ·, fiÛÔÓ·ÊÔÚ¿ ÛÙÔ˘˜ ·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÛÙÂÊ·ÓÈ·›·ÓfiÛÔ. ∏ ·Ï‹ Ì¤ÙÚËÛË ÙË˜ ¶ª ‹Ù·Ó ÂÍ›ÛÔ˘ ÈÛ¯˘Ú‹ˆ˜ ‰Â›ÎÙË˜, fiˆ˜ Ô ¢ª™, ÁÂÁÔÓfi˜ Ô˘ ÛËÌ·›ÓÂÈ fiÙÈı· ÌÔÚÔ‡ÛÂ Ó· ÂÂÎÙ·ıÂ› ÛÙËÓ ÎÏÈÓÈÎ‹ Ú¿ÍË. OÏËı˘ÛÌfi˜ Ô˘ ÌÂÏÂÙ‹ıËÎÂ, ·Ú¿ ÙÔÓ ÌÈÎÚfi ·ÚÈı-Ìfi ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜, ıÂˆÚÂ›Ù·È ·ÓÙÈÚÔÛˆÂ˘ÙÈÎfi˜ÙÔ˘ ·È‰ÈÎÔ‡ ·ÁÚÔÙÈÎÔ‡ ÏËı˘ÛÌÔ‡ ÙË˜ ∫Ú‹ÙË˜. ∏ÌÂÏ¤ÙË ·Ó·‰ÂÈÎÓ‡ÂÈ ÙËÓ ·˘ÍËÌ¤ÓË Û˘¯ÓfiÙËÙ· ·-¯˘Û·ÚÎ›·˜, ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·˜ Î·È ˘ÂÚÈÓÛÔ˘-ÏÈÓ·ÈÌ›·˜ ÛÙ· ·È‰È¿ ÙË˜ ÔÚÂÈÓ‹˜ ÂÚÈÔ¯‹˜ ÙÔ˘ƒÔ‡‚·, Ô˘ ˘ÔÙ›ıÂÙ·È fiÙÈ ‰È·ÙËÚÂ› ÙÔÓ ·Ú·‰Ô-ÛÈ·Îfi ÙÚfiÔ ˙ˆ‹˜ Î·È ‰È·ÙÚÔÊ‹˜. ∆· ÛÙÔÈ¯Â›· ÙË˜ÌÂÏ¤ÙË˜ Î·ıÈÛÙÔ‡Ó ·Ó·ÁÎ·›· ÙËÓ ¤ÁÎ·ÈÚË ·Ó›¯ÓÂ˘-ÛË ÙˆÓ ‚·ÛÈÎÒÓ ·˘ÙÒÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ Î·Ù¿ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÚÒÙˆÓ ¯ÚfiÓˆÓ ˙ˆ‹˜.

∂˘¯·ÚÈÛÙ›Â˜ ∂˘¯·ÚÈÛÙÔ‡ÌÂ ÙÔÓ ¢‹ÌÔ ƒÔ‡‚· ÁÈ· ÙË ¯ÚËÌ·ÙÔ‰fiÙËÛË

ÙË˜ ÌÂÏ¤ÙË˜. ∂˘¯·ÚÈÛÙÔ‡ÌÂ, Â›ÛË˜, ÙÈ˜ ÂÚÂ˘Ó‹ÙÚÈÂ˜ Î. ∫·-ÙÂÚ›Ó· ™·ÚÚ‹ Î·È Î. πÁÓ·ÓÙ›· ∫ˆÊˆÔ‡ÏÔ˘, ÙËÓ ·È‰›·ÙÚÔ Î.ª·Ú›· ªÈÙÛÒÚË Î·È ÙË ÁÚ·ÌÌ·Ù¤· Î. ™ÔÊ›· ºÏÔ˘Ú‹. ¶ÔÏ-Ï¤˜ Â˘¯·ÚÈÛÙ›Â˜ Î·È ÛÙÔ˘˜ ‰·ÛÎ¿ÏÔ˘˜ Î·È Î·ıËÁËÙ¤˜ ÙÔ˘Û¯ÔÏÂ›Ô˘ ÛÙÔ ƒÔ‡‚·, ÙËÓ Î. °ÂˆÚÁ›· ∫·„¿ÏË ÛÙÔ ¢‹ÌÔ ÙÔ˘ƒÔ‡‚· Î·È ‚Â‚·›ˆ˜ fiÏÔ˘˜ ÙÔ˘˜ Ì·ıËÙ¤˜ Î·È ÙÔ˘˜ ÁÔÓÂ›˜ÙÔ˘˜ ÁÈ· ÙËÓ ¤ÓıÂÚÌË Û˘ÌÌÂÙÔ¯‹ ÙÔ˘˜ ÛÙË ÌÂÏ¤ÙË.

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Gastrointestinal hormones in neonates of diabetic mothers Z. Hatzistamatiou1, J. Kaleyias1, A. Gounaris2, S. Sevastiadou1, N. Alexiou2, E. Constantellou3, C. Costalos1


1 ªÔÓ¿‰· ∂ÓÙ·ÙÈÎ‹˜ ¡ÔÛËÏÂ›·˜ ¡ÂÔÁÓÒÓ, ¶ÂÚÈÊÂÚÂÈ·Îfi °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô “∞ÏÂÍ¿Ó‰Ú·”, ∞ı‹Ó·

2 ªÔÓ¿‰· ∂ÓÙ·ÙÈÎ‹˜ ¡ÔÛËÏÂ›·˜ ¡ÂÔÁÓÒÓ, ¶ÂÚÈÊÂÚÂÈ·Îfi°ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô “ÕÁÈÔ˜ ¶·ÓÙÂÏÂ‹ÌˆÓ”, ¶ÂÈÚ·È¿˜

3 ∂Ó‰ÔÎÚÈÓÔÏÔÁÈÎfi ∂ÚÁ·ÛÙ‹ÚÈÔ, ¶ÂÚÈÊÂÚÂÈ·Îfi °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô “ÕÁÈÔ˜ ¶·ÓÙÂÏÂ‹ÌˆÓ”, ¶ÂÈÚ·È¿˜

1 NICU, General District Hospital “Alexandra”, Athens

2 NICU, General District Hospital “Agios Panteleimon”, Piraeus

3 Laboratory of Endocrinology, General District Hospital “Agios Panteleimon”, Piraeus

�¶ÂÚ›ÏË„Ë: OÈ Á·ÛÙÚÂÓÙÂÚÈÎ¤˜ ÔÚÌfiÓÂ˜ ÛÂ ÓÂÔ-ÁÓ¿ ‰È·‚ËÙÈÎÒÓ ÌËÙ¤ÚˆÓ (¡¢ª) ‰ÂÓ ¤¯Ô˘Ó ÌÂÏÂÙË-ıÂ›. ™ÎÔfi˜ ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ ‹Ù·Ó Ó· ÚÔÛ-‰ÈÔÚ›ÛÂÈ ÙÈ˜ Á·ÛÙÚÂÓÙÂÚÈÎ¤˜ ÔÚÌfiÓÂ˜ ÛÂ ·˘Ù¿ Ù·ÓÂÔÁÓ¿. ¶ÚÔÛ‰ÈÔÚ›ÛÙËÎ·Ó Ù· Â›Â‰· ÙË˜ Á·ÛÙÚ›-ÓË˜, ÙË˜ ÌÔÙÈÏ›ÓË˜ Î·È ÙÔ˘ ·ÁÁÂÈÔÂÓÂÚÁÔ‡ ÂÓÙÂÚÈ-ÎÔ‡ ÂÙÈ‰›Ô˘ ÌÂ Â˘·›ÛıËÙÂ˜ Ú·‰ÈÔ·ÓÔÛÔÂÓ˙˘ÌÈ-Î¤˜ ÌÂıfi‰Ô˘˜ ÛÂ: ·) 22 ÓÂÔÁÓ¿ ‰È·‚ËÙÈÎÒÓ ÌËÙ¤-ÚˆÓ Î·È ‚) 20 ˘ÁÈ‹ ÓÂÔÁÓ¿ ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË Á¤ÓÓË-ÛË Î·È ÌÂÙ¿ ·fi ÙÚÂÈ˜ ËÌ¤ÚÂ˜ ÂÓÙÂÚÈÎ‹˜ Û›ÙÈÛË˜ÚÔÁÂ˘Ì·ÙÈÎ¿. ∆· Â›Â‰· ÙË˜ Á·ÛÙÚ›ÓË˜ (pg/ml)ÛÙÔ Ï¿ÛÌ· ÛÙË Á¤ÓÓËÛË ‹Ù·Ó 69±25 ÛÙ· ¡¢ª Î·È78±21 ÛÙÔ˘˜ Ì¿ÚÙ˘ÚÂ˜ (p=ns) Î·È ÌÂÙ¿ ÙËÓ ÂÓÙÂ-ÚÈÎ‹ Û›ÙÈÛË 82±21 Î·È 96±28, ·ÓÙ›ÛÙÔÈ¯· (p=ns).∆· Â›Â‰· ÙË˜ ÌÔÙÈÏ›ÓË˜ (pmol/l) ‹Ù·Ó 72±15 ÛÙ·¡¢ª Î·È 57±24 ÛÙÔ˘˜ Ì¿ÚÙ˘ÚÂ˜ (p<0,05) Î·È ÌÂ-Ù¿ ÙËÓ ÂÓÙÂÚÈÎ‹ Û›ÙÈÛË 90±33 Î·È 60±30, ·ÓÙ›ÛÙÔÈ-¯· (p<0,05). ∆· Â›Â‰· ÙÔ˘ ·ÁÁÂÈÔÂÓÂÚÁÔ‡ ÂÓÙÂ-ÚÈÎÔ‡ ÂÙÈ‰›Ô˘ (pg/ml) ‹Ù·Ó 12±5 ÛÙ· ¡¢ª Î·È12±7 ÛÙÔ˘˜ Ì¿ÚÙ˘ÚÂ˜ (p=ns) Î·È ÌÂÙ¿ ÙËÓ ÂÓÙÂÚÈ-Î‹ Û›ÙÈÛË 10±6 Î·È 9±6, ·ÓÙ›ÛÙÔÈ¯· (p=ns). ∆·¡¢ª Â›¯·Ó ˘„ËÏfiÙÂÚ· Â›Â‰· ÌÔÙÈÏ›ÓË˜ ÛÙË Á¤Ó-ÓËÛË Î·È ÌÂÙ¿ ÙËÓ ÂÓÙÂÚÈÎ‹ Û›ÙÈÛË ÛÂ Û¯¤ÛË ÌÂÙÔ˘˜ Ì¿ÚÙ˘ÚÂ˜. ∆· ·ÔÙÂÏ¤ÛÌ·Ù· ·˘Ù¿ ÌÔÚÂ› Ó··ÔÙÂÏ¤ÛÔ˘Ó ÙË ‚¿ÛË ÁÈ· ÂÚ·ÈÙ¤Úˆ ·ÍÈÔÏfiÁËÛËÙˆÓ Á·ÛÙÚÂÓÙÂÚÈÎÒÓ ÔÚÌÔÓÒÓ ÛÂ ¡¢ª.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ÓÂÔÁÓ¿ ‰È·‚ËÙÈÎÒÓ ÌËÙ¤ÚˆÓ, Á·-ÛÙÚÂÓÙÂÚÈÎ¤˜ ÔÚÌfiÓÂ˜, Á·ÛÙÚ›ÓË, ÌÔÙÈÏ›ÓË, ·ÁÁÂÈÔ-ÂÓÂÚÁfi ÂÓÙÂÚÈÎfi ÂÙ›‰ÈÔ.

�Abstract: There is no information ongastrointestinal hormones in infants of diabeticmothers (IDMs). The objective of the study was tomeasure gastrointestinal hormones in IDMs. Usingsensitive radioimmunoassays plasma concentrationsof gastrin, motilin and VIP have been measured andcompared in: a) 22 neonates of diabetic mothers andb) 20 healthy neonates at birth and prepradially afterthree days of enteral feeding. Plasma concentrationsof gastrin (pg/ml) at birth were 69±25 in IDMs and78±21 in controls (p=ns) and after enteral feedingwere 82±21 and 96±28 respectively (p=ns). Plasmaconcentrations of motilin (pmol/l) at birth were72±15 in IDMs and 57±24 in controls (p<0.05) andafter enteral feeding were 90±33 and 60±30respectively (p<0.05). Plasma concentrations of VIP(pg/ml) at birth were 12±5 in IDMs and 12±7 incontrols (p=ns) and after enteral feeding were 10±6and 9±6 respectively (p=ns). These findingssuggest that IDM have higher concentration ofmotilin at birth and after enteral feeding compared tohealthy neonates while, the levels of gastrin and VIPare similar to controls. These findings form a basisfor further assessment of gastrointestinal peptides inIDM.

Key words: gastrointestinal hormones, infants ofdiabetic mothers, gastrin, motilin, VIP.


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∂ÈÛ·ÁˆÁ‹OÈ Á·ÛÙÚÂÓÙÂÚÈÎ¤˜ ÔÚÌfiÓÂ˜ Â›Ó·È ÂÙ›‰È· Ô˘

·Ú¿ÁÔÓÙ·È ÛÙÔÓ Á·ÛÙÚÂÓÙÂÚÈÎfi ÛˆÏ‹Ó· Î·È ÛÙÔ¿ÁÎÚÂ·˜ Î·È ÂËÚÂ¿˙Ô˘Ó Î˘Ú›ˆ˜ ÙË ÏÂÈÙÔ˘ÚÁ›·ÙˆÓ ÔÚÁ¿ÓˆÓ ÙÔ˘ ÂÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ∆· Â›Â-‰· ÙˆÓ Á·ÛÙÚÂÓÙÂÚÈÎÒÓ ÔÚÌÔÓÒÓ ¤¯Ô˘Ó ÌÂÏÂÙËıÂ›ÛÂ ÙÂÏÂÈfiÌËÓ· Î·È ÚfiˆÚ· ÓÂÔÁÓ¿ (1-3). ∞ÍÈÔÛË-ÌÂ›ˆÙÂ˜ ·ÏÏ·Á¤˜ ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ Á·ÛÙÚÂÓÙÂÚÈ-ÎÒÓ ÔÚÌÔÓÒÓ Û˘Ì‚·›ÓÔ˘Ó ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË ÙË˜ÂÓÙÂÚÈÎ‹˜ Û›ÙÈÛË˜. OÈ Lucas Î·È Û˘Ó (1) ÌÂÏ¤ÙËÛ·ÓÙ· Â›Â‰· ÙË˜ ÌÔÙÈÏ›ÓË˜, ÙË˜ Á·ÛÙÚ›ÓË˜ Î·È ÙÔ˘ÂÓÙÂÚÔÁÏ˘Î·ÁfiÓÔ˘ ÛÂ ÓÂÔÁ¤ÓÓËÙ· Î·Ù¿ ÙË ‰È¿Ú-ÎÂÈ· ÙˆÓ 24 ÚÒÙˆÓ ËÌÂÚÒÓ ˙ˆ‹˜ Î·È Î·Ù¤ÏËÍ·ÓfiÙÈ Ë ÂÓÙÂÚÈÎ‹ Û›ÙÈÛË ˘ÚÔ‰ÔÙÂ› ÙËÓ ¤ÎÎÚÈÛË ÙˆÓÔÚÌÔÓÒÓ ·˘ÙÒÓ. ∆· Â›Â‰· ÙË˜ Á·ÛÙÚ›ÓË˜ ÛÙÔ ·›-Ì· ÙÔ˘ ÔÌÊ¿ÏÈÔ˘ ÏÒÚÔ˘ Â›Ó·È ÂÓÙ·Ï¿ÛÈ· ·fiÂÎÂ›Ó· ÙˆÓ ÂÓËÏ›ÎˆÓ Î·È ·˘Í¿ÓÔÓÙ·È ·ÎfiÌ· ÂÚÈÛ-ÛfiÙÂÚÔ ÌÂÙ¿ ÙÔ ÚÒÙÔ ÁÂ‡Ì· (1,4). ∆· Â›Â‰· ÙË˜ÌÔÙÈÏ›ÓË˜ ÛÙÔ ·›Ì· ÙÔ˘ ÔÌÊ¿ÏÈÔ˘ ÏÒÚÔ˘ Â›Ó·È ¯·-ÌËÏ¿, ·ÏÏ¿ ·˘Í¿ÓÔÓÙ·È ÛËÌ·ÓÙÈÎ¿ ÙË 2Ë Â‚‰ÔÌ¿‰·˙ˆ‹˜ (1). ∆· Â›Â‰· ÙÔ˘ ·ÁÁÂÈÔÂÓÂÚÁÔ‡ ÂÓÙÂÚÈÎÔ‡ÂÙÈ‰›Ô˘ (VIP) Â›Ó·È ·˘ÍËÌ¤Ó· Î·Ù¿ ÙË Á¤ÓÓËÛË Î·È·ÎÔÏÔ˘ıÔ‡Ó ÙˆÙÈÎ‹ ÔÚÂ›· (5,6).

∆· Â›Â‰· ÙˆÓ Á·ÛÙÚÂÓÙÂÚÈÎÒÓ ÔÚÌÔÓÒÓ ¤¯Ô˘ÓÌÂÏÂÙËıÂ› ÛÂ ÓÂÔÁÓ¿ ÌÂ ÎÂ¯ÚˆÛÌ¤ÓÔ ·ÌÓÈ·Îfi ˘ÁÚfi(7), ÛÙÔ˘˜ ÎÔÏÈÎÔ‡˜ ÙÔ˘ 1Ô˘ ÙÚÈÌ‹ÓÔ˘ (8), ÛÂ ¿Û¯Ô-ÓÙ· ÚfiˆÚ· ÓÂÔÁÓ¿ ÌÂ ÂÏ¿¯ÈÛÙË ÂÓÙÂÚÈÎ‹ Û›ÙÈÛË(minimal enteric feeding) (9), ÛÂ ÓÂÔÁÓ¿ ÌÂ ›ÎÙÂÚÔ ˘fiÊˆÙÔıÂÚ·Â›· (10) Î·È ÛÂ ÚfiˆÚ· ÓÂÔÁÓ¿ ÌËÙ¤ÚˆÓÔ˘ ¤Ï·‚·Ó ÚÔÁÂÓÓËÙÈÎ¿ ÎÔÚÙÈÎÔÂÈ‰‹ (11). ∆· Â›Â-‰· ÙˆÓ ÔÚÌÔÓÒÓ ·˘ÙÒÓ ‰ÂÓ ¤¯Ô˘Ó Ì¤¯ÚÈ Û‹ÌÂÚ· ÌÂ-ÏÂÙËıÂ› ÛÂ ÓÂÔÁÓ¿ ‰È·‚ËÙÈÎÒÓ ÌËÙ¤ÚˆÓ.

OÈ Á·ÛÙÚÂÓÙÂÚÈÎ¤˜ ‰È·Ù·Ú·¯¤˜ Â›Ó·È Û˘Ó‹ıÂÈ˜ÛÂ ·ÛıÂÓÂ›˜ ÌÂ Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË (12). ¶ÚfiÛÊ·-ÙÂ˜ ÌÂÏ¤ÙÂ˜ ¤‰ÂÈÍ·Ó fiÙÈ Ë ˘ÂÚÁÏ˘Î·ÈÌ›· ÂËÚÂ¿˙ÂÈÙË Á·ÛÙÚÈÎ‹ Î¤ÓˆÛË Î·È ÙËÓ ÎÈÓËÙÈÎfiÙËÙ· ÙÔ˘ ÂÓÙ¤-ÚÔ˘ ÛÂ ¿Û¯ÔÓÙÂ˜ ·fi ‰È·‚‹ÙË, ·ÏÏ¿ Î·È ÛÂ ˘ÁÈÂ›˜(12,13). ™Â ÂÈÚ·Ì·ÙÈÎfi ÌÔÓÙ¤ÏÔ ˘ÂÚÈÓÛÔ˘ÏÈÓ·È-Ì›·˜, Ù· Â›Â‰· ÙË˜ ÌÔÙÈÏ›ÓË˜ ‚Ú¤ıËÎ·Ó ÛËÌ·ÓÙÈ-Î¿ ÌÂÈˆÌ¤Ó· (13). ∆Ô 53% ÙˆÓ ÂÓËÏ›ÎˆÓ ÌÂ ™¢ ·-ÚÔ˘ÛÈ¿˙ÂÈ Î·ı˘ÛÙ¤ÚËÛË ÙË˜ Á·ÛÙÚÈÎ‹˜ Î¤ÓˆÛË˜Î·Ù¿ ÙËÓ ˘ÂÚÁÏ˘Î·ÈÌ›·, ÂÓÒ ·ÓÙ›ıÂÙ· ÂÈÙ·¯‡ÓÂ-Ù·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ˘ÔÁÏ˘Î·ÈÌ›·˜. OÈ LamÎ·È Û˘Ó ¤‰ÂÈÍ·Ó fiÙÈ Ë ÔÍÂ›· ˘ÂÚÁÏ˘Î·ÈÌ›· ÌÂÈÒÓÂÈÙËÓ ¤ÎÎÚÈÛË ÙÔ˘ Á·ÛÙÚÈÎÔ‡ ÔÍ¤Ô˜ Î·È ÙËÓ ·ÂÏÂ˘ı¤-ÚˆÛË ÙÔ˘ ·ÁÎÚÂ·ÙÈÎÔ‡ ÔÏ˘ÂÙÈ‰›Ô˘ (14). OÈ µ·-˙·›Ô˘ Î·È Û˘Ó ¤‰ÂÈÍ·Ó fiÙÈ Ù· Â›Â‰· ÙË˜ ÌÔÙÈÏ›ÓË˜ Î·ÈÙË˜ ÓÂ˘ÚÔÙÂÓÛ›ÓË˜ ÛÙ· ‰È·‚ËÙÈÎ¿ ·È‰È¿ ‹Ù·Ó ¯·ÌË-ÏfiÙÂÚ· ÛÂ Û¯¤ÛË ÌÂ ÙÔ˘˜ ˘ÁÈÂ›˜ Ì¿ÚÙ˘ÚÂ˜, ÂÓÒ Ù·

Â›Â‰· ÁÏ˘Î·ÁfiÓË˜ ‹Ù·Ó ˘„ËÏfiÙÂÚ· (15).∏ Á·ÛÙÚ›ÓË ·Ú¿ÁÂÙ·È ·fi Ù· G-Î‡ÙÙ·Ú· ÙÔ˘

¿ÓÙÚÔ˘ ÙÔ˘ ÛÙÔÌ¿¯Ô˘. ¢ÈÂÁÂ›ÚÂÈ ÙËÓ ¤ÎÎÚÈÛË Èfi-ÓÙˆÓ ˘‰ÚÔÁfiÓÔ˘ ·fi Ù· Î·Ï˘Ù‹ÚÈ· Î‡ÙÙ·Ú· ÙÔ˘ÛÙÔÌ¿¯Ô˘ Î·È ¤¯ÂÈ ÙÚÔÊÈÎ‹ ‰Ú¿ÛË ÛÙÔÓ Á·ÛÙÚÈÎfi‚ÏÂÓÓÔÁfiÓÔ (16). ∫·Ù¿ ÙË ÓÂÔÁÓÈÎ‹ ÂÚ›Ô‰Ô, Â›Ó·ÈÎÔÈÓ¿ ·Ô‰ÂÎÙfi fiÙÈ Ù· Â›Â‰· ÙË˜ Á·ÛÙÚ›ÓË˜ Â›Ó·ÈÛËÌ·ÓÙÈÎ¿ ˘„ËÏfiÙÂÚ· ÛÂ Û¯¤ÛË ÌÂ ·˘Ù¿ ÙˆÓ ÂÓË-Ï›ÎˆÓ (17). OÈ Lucas Î·È Û˘Ó (1) ¤‰ÂÈÍ·Ó fiÙÈ ÙÈ˜ ÚÒ-ÙÂ˜ 3-6 ÒÚÂ˜ ˙ˆ‹˜ Ù· Â›Â‰· ÙË˜ Á·ÛÙÚ›ÓË˜ ÌÂÈÒ-ÓÔÓÙ·È ÛÂ ÂÎÂ›Ó· ÙˆÓ ÂÓËÏ›ÎˆÓ, fiÌˆ˜, ÌÂÙ¿ ÙÔ ÚÒ-ÙÔ ÁÂ‡Ì· ÛËÌÂÈÒÓÂÙ·È ˘ÂÚÁ·ÛÙÚÈÓ·ÈÌ›·, Ë ÔÔ›·‰È·ÙËÚÂ›Ù·È ÛÂ fiÏË ÙË ÓÂÔÁÓÈÎ‹ ÂÚ›Ô‰Ô (18).

∏ ÌÔÙÈÏ›ÓË ·Ú¿ÁÂÙ·È ·fi ÂÓ‰ÔÎÚÈÓÈÎ¿ Î‡ÙÙ·Ú·ÙÔ˘ ‰ˆ‰ÂÎ·‰·ÎÙ‡ÏÔ˘ Î·È ÙË˜ Ó‹ÛÙÈ‰·˜ Î·È ·˘Í¿ÓÂÈÙËÓ ÎÈÓËÙÈÎfiÙËÙ· ÙÔ˘ ÛÙÔÌ¿¯Ô˘ Î·È ÙÔ˘ ÂÓÙ¤ÚÔ˘,ÂÓÒ ÂÓÂÚÁÔÔÈÂ› Î·È ÙËÓ ·˘ÙfiÌ·ÙË ÎÈÓËÙÈÎfiÙËÙ· Î·-Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ¿ÌÂÛË˜ ÂÚÈÁÂÓÓËÙÈÎ‹˜ ÂÚÈfi-‰Ô˘ (1,19). ∆· Â›Â‰· ÙË˜ ÌÔÙÈÏ›ÓË˜ ÛÙË ÓÂÔÁÓÈÎ‹ËÏÈÎ›· Â›Ó·È ˘„ËÏ¿ Î·È ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÚÔÁÂ˘Ì·ÙÈ-Î‹ ·‡ÍËÛË (1,20).

∆Ô ·ÁÁÂÈÔÂÓÂÚÁfi ÂÓÙÂÚÈÎfi ÂÙ›‰ÈÔ ·Ú¿ÁÂÙ·ÈÛÙÈ˜ ÓÂ˘ÚÈÎ¤˜ ·ÔÏ‹ÍÂÈ˜ ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ÛˆÏ‹Ó· Î·ÈÂËÚÂ¿˙ÂÈ ÙËÓ ÎÈÓËÙÈÎfiÙËÙ· Î·È ÙËÓ ·ÈÌ¿ÙˆÛË ÙÔ˘ÂÓÙ¤ÚÔ˘ (5). ∆· Â›Â‰· ÙÔ˘ VIP Â›Ó·È ˘„ËÏ¿ ÙÈ˜ÚÒÙÂ˜ ËÌ¤ÚÂ˜ ˙ˆ‹˜ Î·È ÛÙË Û˘Ó¤¯ÂÈ· ·ÚÔ˘ÛÈ¿-˙Ô˘Ó ÙˆÙÈÎ‹ ÔÚÂ›· (5,6).

§·Ì‚¿ÓÔÓÙ·˜ ˘’ fi„ÈÓ fiÙÈ Ë ˘ÂÚÁÏ˘Î·ÈÌ›· ÂË-ÚÂ¿˙ÂÈ Ù· Â›Â‰· ÙˆÓ Á·ÛÙÚÂÓÙÂÚÈÎÒÓ ÔÚÌÔÓÒÓ,Î·ıÒ˜ Â›ÛË˜ fiÙÈ Ù· ÓÂÔÁÓ¿ ‰È·‚ËÙÈÎÒÓ ÌËÙ¤ÚˆÓ‚Ú›ÛÎÔÓÙ·È ÛÂ ÂÚÈfi‰Ô˘˜ ˘ÂÚÁÏ˘Î·ÈÌ›·˜ Î·Ù¿ ÙË‰È¿ÚÎÂÈ· ÙË˜ ÂÁÎ˘ÌÔÛ‡ÓË˜, ‰ÈÂÚÂ˘Ó‹ıËÎÂ Ë Èı·Ó‹Â›‰Ú·ÛË ÙÔ˘ ‰È·‚‹ÙË Î‡ËÛË˜ ÛÙ· Â›Â‰· ÙÚÈÒÓÁ·ÛÙÚÂÓÙÂÚÈÎÒÓ ÔÚÌÔÓÒÓ (Á·ÛÙÚ›ÓË˜, ÌÔÙÈÏ›ÓË˜Î·È VIP) ÛÙË ÓÂÔÁÓÈÎ‹ ËÏÈÎ›·.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈÀÏÈÎfi ÙË˜ ÌÂÏ¤ÙË˜ ·ÔÙ¤ÏÂÛ·Ó ÓÂÔÁÓ¿ ÌËÙ¤ÚˆÓ ÌÂ Û·Î-

¯·ÚÒ‰Ë ‰È·‚‹ÙË Î‡ËÛË˜ ‹ Ù‡Ô˘ π Ô˘ ÁÂÓÓ‹ıËÎ·Ó ÛÙÔ Ì·È-Â˘Ù‹ÚÈÔ “∞ÏÂÍ¿Ó‰Ú·” Î·È ÛÙÔ °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ¡›Î·È·˜,Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ¯ÚÔÓÈÎ‹˜ ÂÚÈfi‰Ô˘ ·fi ÙÔÓ ª¿ÈÔ 1999Ì¤¯ÚÈ Î·È ÙÔÓ ¢ÂÎ¤Ì‚ÚÈÔ 1999. ∫ÚÈÙ‹ÚÈ· ·ÔÎÏÂÈÛÌÔ‡ ·fi ÙËÌÂÏ¤ÙË ‹Ù·Ó ÔÈ Û˘ÁÁÂÓÂ›˜ ‹ ¯ÚˆÌÔÛˆÌÈÎ¤˜ ·ÓˆÌ·Ï›Â˜ Î·ÈÚˆÙÔ·ı‹ ÓÔÛ‹Ì·Ù· ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ø˜Ì¿ÚÙ˘ÚÂ˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÓÂÔÁÓ¿ Ô˘ ÁÂÓÓ‹ıËÎ·Ó ÙËÓ›‰È· ¯ÚÔÓÈÎ‹ ÂÚ›Ô‰Ô ÛÙ· ÚÔ·Ó·ÊÂÚı¤ÓÙ· ÓÔÛÔÎÔÌÂ›·, ÔÈÌËÙ¤ÚÂ˜ ÙˆÓ ÔÔ›ˆÓ Â›¯·Ó Ù·ÎÙÈÎ‹ Ì·ÈÂ˘ÙÈÎ‹ ·Ú·ÎÔÏÔ‡ıË-ÛË Î·È ‰ÂÓ Â›¯·Ó Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË.

∏ ÌÂÏ¤ÙË ‹Ù·Ó ÚÔ‰ÚÔÌÈÎ‹. ∞fi Î¿ıÂ ÓÂÔÁÓfi ‰È·‚ËÙÈÎ‹˜ÌËÙ¤Ú·˜ Î·È ·fi ÙÔÓ ·ÓÙ›ÛÙÔÈ¯Ô Ì¿ÚÙ˘Ú· Ï·Ì‚·ÓfiÙ·Ó 1 ml·›Ì·ÙÔ˜ ·fi ÂÚÈÊÂÚÈÎ‹ ÊÏ¤‚· ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË(Ê¿ÛË π) Î·È ÌÂÙ¿ ·fi 3 ËÌ¤ÚÂ˜ Ï‹ÚÔ˘˜ ÂÓÙÂÚÈÎ‹˜ Û›ÙÈÛË˜ÚÔÁÂ˘Ì·ÙÈÎ¿ (Ê¿ÛË ππ).

O ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ ÂÈ¤‰ˆÓ Á·ÛÙÚ›ÓË˜, ÌÔÙÈÏ›ÓË˜ Î·È

™˘ÓÙÔÌÔÁÚ·Ê›Â˜¡¢ª ¡ÂÔÁÓ¿ ‰È·‚ËÙÈÎÒÓ ÌËÙ¤ÚˆÓVIP Vassoactive intestinal peptide

(·ÁÁÂÈÔÂÓÂÚÁfi ÂÓÙÂÚÈÎfi ÂÙ›‰ÈÔ)


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VIP ¤ÁÈÓÂ ÌÂ ·ÓÔÛÔÂÓ˙˘ÌÈÎ‹ Ì¤ıÔ‰Ô (RIA) ÛÙÈ˜ Ê¿ÛÂÈ˜ π Î·È ππ.∆· ·ÓÙÈ‰Ú·ÛÙ‹ÚÈ· Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÁÈ· ÙÔÓ ÚÔÛ‰ÈÔ-ÚÈÛÌfi ÙË˜ Á·ÛÙÚ›ÓË˜, ÙË˜ ÌÔÙÈÏ›ÓË˜ Î·È ÙÔ˘ VIP ‹Ù·Ó ·ÓÙ›-ÛÙÔÈ¯·: ·) Diagnostic Products Corporation, Los Angeles,USA, ‚) EuroDiagnostica AB, Sweden Î·È Á) Inc Star ScienceTechnology and Research Inc Star MN, USA.

∏ ÛÙ·ÙÈÛÙÈÎ‹ ·Ó¿Ï˘ÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ¤ÁÈÓÂ ÌÂ ÙË‰ÔÎÈÌ·Û›· t-test. ø˜ fiÚÈÔ ÛÙ·ÙÈÛÙÈÎ‹˜ ÛËÌ·ÓÙÈÎfiÙËÙ·˜ ıÂˆ-Ú‹ıËÎÂ Ë ÙÈÌ‹ p<0,05.

∞ÔÙÂÏ¤ÛÌ·Ù· Ã·Ú·ÎÙËÚÈÛÙÈÎ¿ ÓÂÔÁÓÒÓ ∂›ÎÔÛÈ ‰‡Ô ÓÂÔÁÓ¿ (ÔÌ¿‰· ∞) ÌËÙ¤ÚˆÓ ÌÂ ‰È·-

‚‹ÙË (17/22 ÌÂ ‰È·‚‹ÙË Î‡ËÛË˜ Î·È 5/22 ÌÂ ™¢ Ù‡-Ô˘ π) Î·È 20 ÓÂÔÁÓ¿ ÌË ‰È·‚ËÙÈÎÒÓ ÌËÙ¤ÚˆÓ (ÔÌ¿-‰· µ) Û˘ÌÂÚÈÂÏ‹ÊıËÛ·Ó ÛÙË ÌÂÏ¤ÙË. ∆Ô Ì¤ÛÔ µ°(±SD) ÙˆÓ ÓÂÔÁÓÒÓ ÙË˜ ÔÌ¿‰·˜ ∞ ‹Ù·Ó 2790 g(±900 g) Î·È ÙË˜ ÔÌ¿‰·˜ B 3150 g (±500 g)(p=ns). ∏ Ì¤ÛË ¢∫ (±SD) ÙˆÓ ÓÂÔÁÓÒÓ ÙË˜ ÔÌ¿‰·˜∞ ‹Ù·Ó 36 (±2,1) Â‚‰ÔÌ¿‰Â˜ Î·È ÙË˜ ÔÌ¿‰·˜ µ 38,5(±1,6) Â‚‰ÔÌ¿‰Â˜ (p=ns).

∂›Â‰· Á·ÛÙÚ›ÓË˜ - ÌÔÙÈÏ›ÓË˜ - VIP ∆· Â›Â‰· ÙË˜ Á·ÛÙÚ›ÓË˜ (pg/ml), ÙË˜ ÌÔÙÈÏ›-

ÓË˜ (pmol/l) Î·È ÙÔ˘ VIP (pg/ml) ÛÙ· ¡¢ª Î·È ÛÙÔ˘˜Ì¿ÚÙ˘ÚÂ˜ Î·È ÛÙÈ˜ ‰‡Ô Ê¿ÛÂÈ˜ ÙË˜ ÌÂÏ¤ÙË˜ Ê·›ÓÔ-ÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1.

·) °·ÛÙÚ›ÓË (∂ÈÎfiÓ· 1)º¿ÛË π: ∆· Â›Â‰· Á·ÛÙÚ›ÓË˜ (±SD) (pg/ml)

·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË ‹Ù·Ó ¯·ÌËÏfiÙÂÚ· ÛÙËÓ

ÔÌ¿‰· ÙˆÓ ÓÂÔÁÓÒÓ ‰È·‚ËÙÈÎÒÓ ÌËÙ¤ÚˆÓ [69 (±25)pg/ml] ÛÂ Û¯¤ÛË ÌÂ ÙËÓ ÔÌ¿‰· ÂÏ¤Á¯Ô˘ [78 (±21)pg/ml], ¯ˆÚ›˜ fiÌˆ˜ Ë ‰È·ÊÔÚ¿ ·˘Ù‹ Ó· Â›Ó·È ÛÙ·ÙÈ-ÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ (p=ns).

º¿ÛË ππ: ∆· Â›Â‰· Á·ÛÙÚ›ÓË˜ (±SD) (pg/ml)ÌÂÙ¿ ·fi 3 ËÌ¤ÚÂ˜ ÂÓÙÂÚÈÎ‹˜ Û›ÙÈÛË˜ ‹Ù·Ó 82pg/ml (±21) ÛÙËÓ ÔÌ¿‰· ∞ Î·È 96 pg/ml (±28) ÛÙËÓÔÌ¿‰· ÂÏ¤Á¯Ô˘ (p=ns).

∆· Â›Â‰· ÙË˜ Á·ÛÙÚ›ÓË˜ Î·È ÛÙÈ˜ ‰‡Ô ÔÌ¿‰Â˜‹Ù·Ó ˘„ËÏfiÙÂÚ· ÛÙË Ê¿ÛË ππ, ¯ˆÚ›˜ fiÌˆ˜ Ë ‰È·ÊÔ-Ú¿ ·˘Ù‹ Ó· Â›Ó·È ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹.

‚) ªÔÙÈÏ›ÓË (∂ÈÎfiÓ· 2) º¿ÛË π: ∆· Â›Â‰· ÌÔÙÈÏ›ÓË˜ (±SD) (pmol/l)

·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË ‹Ù·Ó ˘„ËÏfiÙÂÚ· ÛÙËÓ

¶›Ó·Î·˜ 1. ∂›Â‰· Á·ÛÙÚ›ÓË˜, ÌÔÙÈÏ›ÓË˜ Î·È VIP ÛÂ ÓÂÔÁÓ¿‰È·‚ËÙÈÎÒÓ ÌËÙ¤ÚˆÓ (ÔÌ¿‰· ∞) Î·È ÛÙÔ˘˜ Ì¿ÚÙ˘ÚÂ˜ (ÔÌ¿‰· µ)

OÚÌfiÓË ¡ÂÔÁÓ¿ ª¿ÚÙ˘ÚÂ˜ p-value‰È·‚ËÙÈÎÒÓ

ÌËÙ¤ÚˆÓ¡=22 N=20

°·ÛÙÚ›ÓË (pg/ml) (Ì¤ÛË ÙÈÌ‹±SD)º¿ÛË π 69±25 78±21 nsº¿ÛË ππ 82±21 96±28 ns

ªÔÙÈÏ›ÓË (pmol/l)(Ì¤ÛË ÙÈÌ‹±SD)º¿ÛË π 72±15 57±24 <0,05º¿ÛË ππ 90±33 60±30 <0,05

VIP (pg/ml) (Ì¤ÛË ÙÈÌ‹±SD)º¿ÛË π 12±5 12±7 nsº¿ÛË ππ 10±6 9±6 ns

∂ÈÎfiÓ· 1. ∂›Â‰· Á·ÛÙÚ›ÓË˜ (pg/ml) ÛÙ· ÓÂÔÁÓ¿ ‰È·‚ËÙÈÎÒÓ ÌËÙ¤ÚˆÓ (ÔÌ¿‰· ∞) Î·È ÛÙÔ˘˜ Ì¿ÚÙ˘ÚÂ˜ (ÔÌ¿‰· µ) ÌÂÙ¿ ÙË Á¤ÓÓËÛË(Ê¿ÛË π) Î·È ÌÂÙ¿ ÙËÓ ÂÓÙÂÚÈÎ‹ Û›ÙÈÛË (Ê¿ÛË ππ).

140

120

100

80

60

40

20

0

OÌ¿‰· ∞ - º¿ÛË π

69 82 78 96

OÌ¿‰· ∞ - º¿ÛË ππ

OÌ¿‰· µ - º¿ÛË ππ

pg/m

l

OÌ¿‰· µ - º¿ÛË π


281

∂ÈÎfiÓ· 2. ∂›Â‰· ÌÔÙÈÏ›ÓË˜ (pmol/l) ÛÙ· ÓÂÔÁÓ¿ ‰È·‚ËÙÈÎÒÓ ÌËÙ¤ÚˆÓ (ÔÌ¿‰· ∞) Î·È ÛÙÔ˘˜ Ì¿ÚÙ˘ÚÂ˜ (ÔÌ¿‰· µ) ÌÂÙ¿ ÙË Á¤ÓÓË-ÛË (Ê¿ÛË π) Î·È ÌÂÙ¿ ·fi ÂÓÙÂÚÈÎ‹ Û›ÙÈÛË (Ê¿ÛË ππ).

140

120

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40

20

0

OÌ¿‰· ∞ - º¿ÛË π

72 90 57 60



pmol

/l


ÔÌ¿‰· ÙˆÓ ÓÂÔÁÓÒÓ ‰È·‚ËÙÈÎÒÓ ÌËÙ¤ÚˆÓ [72 (±15)pmol/l] ÛÂ Û¯¤ÛË ÌÂ ÙËÓ ÔÌ¿‰· ÂÏ¤Á¯Ô˘ [57 (±24)pmol/l ] Î·È Ë ‰È·ÊÔÚ¿ ·˘Ù‹ ‹Ù·Ó ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·-ÓÙÈÎ‹ (p<0,05).

º¿ÛË ππ: ∆· Â›Â‰· ÌÔÙÈÏ›ÓË˜ (±SD) (pmol/l)ÌÂÙ¿ ·fi 3 ËÌ¤ÚÂ˜ ÂÓÙÂÚÈÎ‹˜ Û›ÙÈÛË˜ ‹Ù·Ó ÛËÌ·-ÓÙÈÎ¿ ˘„ËÏfiÙÂÚ· ÛÙËÓ ÔÌ¿‰· ∞ [90 (±33) pmol/l]ÛÂ Û¯¤ÛË ÌÂ ÙËÓ ÔÌ¿‰· ÂÏ¤Á¯Ô˘ [60 (±30) pmol/l](p<0,05).

∆· Â›Â‰· ÙË˜ ÌÔÙÈÏ›ÓË˜ ·˘Í‹ıËÎ·Ó ÛËÌ·ÓÙÈÎ¿ÛÙËÓ ÔÌ¿‰· ∞ ÌÂÙ¿ ÙËÓ ÂÓÙÂÚÈÎ‹ Û›ÙÈÛË (p<0,05),ÂÓÒ ÛÙËÓ ÔÌ¿‰· µ ‰ÂÓ ÛËÌÂÈÒıËÎÂ ÙÚÔÔÔ›ËÛË(p=ns).

Á) VIP (∂ÈÎfiÓ· 3) º¿ÛË π: ∆· Â›Â‰· ÙÔ˘ VIP (±SD) (pg/ml) ·Ì¤-

Ûˆ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË ‹Ù·Ó ·ÚfiÌÔÈ· Î·È ÛÙÈ˜ ‰‡ÔÔÌ¿‰Â˜ [12 (±5) pg/ml ÛÙËÓ ÔÌ¿‰· ∞ Î·È 12 (±7)pg/ml ÛÙËÓ ÔÌ¿‰· B] (p=ns).

º¿ÛË ππ: ∆· Â›Â‰· ÙÔ˘ VIP (±SD) (pg/ml) ÌÂÙ¿·fi 3 ËÌ¤ÚÂ˜ ÂÓÙÂÚÈÎ‹˜ Û›ÙÈÛË˜ ‹Ù·Ó ·ÚfiÌÔÈ· Î·ÈÛÙÈ˜ ‰‡Ô ÔÌ¿‰Â˜ [10 (±6) pg/ml ÛÙËÓ ÔÌ¿‰· ∞ Î·È9 (±6) pg/ml ÛÙËÓ ÔÌ¿‰· µ] (p=ns).

∆· Â›Â‰· ÙÔ˘ VIP ‰ÂÓ ÙÚÔÔÔÈ‹ıËÎ·Ó ÌÂÙ¿ÙËÓ ÂÓÙÂÚÈÎ‹ Û›ÙÈÛË ÛÂ Î·Ì›· ·fi ÙÈ˜ ‰‡Ô ÔÌ¿‰Â˜.

™˘˙‹ÙËÛË ªÂÏÂÙ‹ıËÎ·Ó Ù· Â›Â‰· ÙË˜ Á·ÛÙÚ›ÓË˜, ÙË˜ ÌÔ-

ÙÈÏ›ÓË˜ Î·È ÙÔ˘ ·ÁÁÂÈÔÂÓÂÚÁÔ‡ ÂÓÙÂÚÈÎÔ‡ ÂÙÈ‰›Ô˘ÛÂ ÓÂÔÁÓ¿ ‰È·‚ËÙÈÎÒÓ ÌËÙ¤ÚˆÓ Î·È ÛÂ Ì¿ÚÙ˘ÚÂ˜,

·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË Î·È ÌÂÙ¿ ·fi 3 ËÌ¤ÚÂ˜ÂÓÙÂÚÈÎ‹˜ Û›ÙÈÛË˜. ∆· ÓÂÔÁÓ¿ ‰È·‚ËÙÈÎÒÓ ÌËÙ¤ÚˆÓÂ›¯·Ó ÛËÌ·ÓÙÈÎ¿ ˘„ËÏfiÙÂÚ· Â›Â‰· ÌÔÙÈÏ›ÓË˜, ¯·-ÌËÏfiÙÂÚ· Â›Â‰· Á·ÛÙÚ›ÓË˜ Î·È ›‰È· Â›Â‰· VIPÛÙË Á¤ÓÓËÛË, ÛÂ Û¯¤ÛË ÌÂ ÙÔ˘˜ Ì¿ÚÙ˘ÚÂ˜. ªÂÙ¿ ÙËÓ¤Ó·ÚÍË ÙË˜ ÂÓÙÂÚÈÎ‹˜ Û›ÙÈÛË˜, Ù· Â›Â‰· ÙË˜ Á·-ÛÙÚ›ÓË˜ ·ÚÔ˘Û›·Û·Ó ¿ÓÔ‰Ô Î·È ÛÙÈ˜ ‰‡Ô ÔÌ¿‰Â˜,Ù· Â›Â‰· ÙË˜ ÌÔÙÈÏ›ÓË˜ ·˘Í‹ıËÎ·Ó ÛËÌ·ÓÙÈÎ¿ ÛÙ·ÓÂÔÁÓ¿ ‰È·‚ËÙÈÎÒÓ ÌËÙ¤ÚˆÓ, ÂÓÒ Ù· Â›Â‰· ÙÔ˘ VIP‰ÂÓ ÙÚÔÔÔÈ‹ıËÎ·Ó.

∆· Â›Â‰· ÙˆÓ Á·ÛÙÚÂÓÙÂÚÈÎÒÓ ÔÚÌÔÓÒÓ ÛÙËÓÂÔÁÓÈÎ‹ ËÏÈÎ›· Â›Ó·È ˘„ËÏfiÙÂÚ· ÛÂ Û¯¤ÛË ÌÂ ·˘Ù¿ÙˆÓ ÂÓËÏ›ÎˆÓ. ¶Èı·Ó¤˜ ·ÈÙ›Â˜ ÁÈ· Ù· ˘„ËÏfiÙÂÚ·Â›Â‰· ÙˆÓ ÔÚÌÔÓÒÓ ÛÙË ÓÂÔÁÓÈÎ‹ ËÏÈÎ›· Â›Ó·È ÙÔÛ¯ÂÙÈÎ¿ ÌÂÁ·Ï‡ÙÂÚÔ Ì¤ÁÂıÔ˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘, Ù· ÌÈ-ÎÚ¿ ÌÂÛÔ‰È·ÛÙ‹Ì·Ù· Ô˘ ÌÂÛÔÏ·‚Ô‡Ó ·Ó¿ÌÂÛ·ÛÙ· ÁÂ‡Ì·Ù· Î·È Ô ÌÂÁ¿ÏÔ˜ fiÁÎÔ˜ ÚÔÛÏ·Ì‚·Ófi-ÌÂÓˆÓ ˘ÁÚÒÓ (Ë Î·Ù·Ó¿ÏˆÛË Á¿Ï·ÎÙÔ˜ ·fi ¤Ó· ÓÂ-ÔÁÓfi 2 Â‚‰ÔÌ¿‰ˆÓ ·ÓÙÈÛÙÔÈ¯Â› ÛÂ 10-20 l ÛÙÔ˘˜ÂÓËÏ›ÎÔ˘˜) (1). ∏ ÂÓÙÂÚÈÎ‹ Û›ÙÈÛË ˘ÚÔ‰ÔÙÂ› ÙËÓ ¤Î-ÎÚÈÛË ÙˆÓ Á·ÛÙÚÂÓÙÂÚÈÎÒÓ ÔÚÌÔÓÒÓ, ÔÈ ÔÔ›Â˜ Ì¤-Ûˆ ÂÓ‰ÔÎÚÈÓÈÎ‹˜, ·Ú·ÎÚÈÓÈÎ‹˜ Î·È ÓÂ˘ÚÔÂÎÎÚÈÙÈ-Î‹˜ ‰Ú¿ÛË˜ ÂËÚÂ¿˙Ô˘Ó ÙËÓ ·Ó¿Ù˘ÍË Î·È ÙËÓ ÎÈ-ÓËÙÈÎfiÙËÙ· ÙÔ˘ ÂÓÙ¤ÚÔ˘ (1-3).

OÈ Bjornsson Î·È Û˘Ó ÌÂÏ¤ÙËÛ·Ó ÙËÓ Â›‰Ú·ÛËÙË˜ ÔÍÂ›·˜ ˘ÂÚÁÏ˘Î·ÈÌ›·˜ ÛÙËÓ ÎÈÓËÙÈÎfiÙËÙ· ÙÔ˘ÂÓÙ¤ÚÔ˘ Î·È Î·Ù¤ÏËÍ·Ó ÛÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ Ë ˘ÂÚ-ÁÏ˘Î·ÈÌ›· ÌÂÈÒÓÂÈ ÙËÓ ÎÈÓËÙÈÎfiÙËÙ· ÙÔ˘ ÛÙÔÌ¿¯Ô˘,ÙÔ˘ ‰ˆ‰ÂÎ·‰·ÎÙ‡ÏÔ˘ Î·È ÙË˜ Ó‹ÛÙÈ‰·˜ (12). OÈ

Barnett Î·È Owyang ¤‰ÂÈÍ·Ó fiÙÈ Ë ˘ÂÚÁÏ˘Î·ÈÌ›· Î·-Ù·ÛÙ¤ÏÏÂÈ Ù· Â›Â‰· ÙË˜ ÌÔÙÈÏ›ÓË˜ Î·È ·Ó·ÛÙ¤ÏÏÂÈÙËÓ ÎÈÓËÙÈÎfiÙËÙ· ÙÔ˘ ÛÙÔÌ¿¯Ô˘ (21).

OÈ Á·ÛÙÚÂÓÙÂÚÈÎ¤˜ ÔÚÌfiÓÂ˜ ¤¯Ô˘Ó ÂÎÙÂÓÒ˜ ÌÂ-ÏÂÙËıÂ› ÛÙË ÓÂÔÁÓÈÎ‹ ËÏÈÎ›· ÙfiÛÔ ÛÂ Ê˘ÛÈÔÏÔÁÈÎ¿ÙÂÏÂÈfiÌËÓ· Î·È ÚfiˆÚ· ÓÂÔÁÓ¿ (1-3,5,6), fiÛÔ Î·ÈÛÂ ¿ÏÏÂ˜ Î·Ù·ÛÙ¿ÛÂÈ˜ (4,7-11). ∏ ·ÚÔ‡Û· ÌÂÏ¤ÙËÂ›Ó·È Ë ÚÒÙË ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›· Ô˘ ÌÂÏ¤-ÙËÛÂ Ù· Â›Â‰· ÙˆÓ Á·ÛÙÚÂÓÙÂÚÈÎÒÓ ÔÚÌÔÓÒÓ ÛÂÓÂÔÁÓ¿ ‰È·‚ËÙÈÎÒÓ ÌËÙ¤ÚˆÓ.

∆· Â›Â‰· ÙË˜ Á·ÛÙÚ›ÓË˜ ‹Ù·Ó ÂÏ·ÊÚ¿ ¯·ÌË-ÏfiÙÂÚ· ÛÙ· ¡¢ª ÛÂ Û¯¤ÛË ÌÂ ÙÔ˘˜ Ì¿ÚÙ˘ÚÂ˜, ¯ˆ-Ú›˜ fiÌˆ˜ Ë ‰È·ÊÔÚ¿ ·˘Ù‹ Ó· Â›Ó·È ÛÙ·ÙÈÛÙÈÎ¿ ÛË-Ì·ÓÙÈÎ‹. ªÂÙ¿ ·fi ÙËÓ ÂÓÙÂÚÈÎ‹ Û›ÙÈÛË Î·È ÛÙÈ˜ ‰‡ÔÔÌ¿‰Â˜ Ù· Â›Â‰· ÙË˜ Á·ÛÙÚ›ÓË˜ ·˘Í‹ıËÎ·Ó. ∏˘ÂÚÁ·ÛÙÚÈÓ·ÈÌ›· ÙË˜ ÓÂÔÁÓÈÎ‹˜ ËÏÈÎ›·˜ Î·È Ë Â›-Ù·ÛË ·˘Ù‹˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË ÙË˜ ÂÓÙÂÚÈÎ‹˜ Û›ÙÈÛË˜Â›Ó·È ÛÙ·ıÂÚfi Â‡ÚËÌ· ÛÂ fiÏÂ˜ ÙÈ˜ ÌÂÏ¤ÙÂ˜ Ô˘·ÊÔÚÔ‡Ó ÛÙÈ˜ Á·ÛÙÚÂÓÙÂÚÈÎ¤˜ ÔÚÌfiÓÂ˜ ÛÙË ÓÂÔÁÓÈ-Î‹ ËÏÈÎ›·. Ã·ÌËÏ¿ Â›Â‰· Á·ÛÙÚ›ÓË˜ ‰È·›ÛÙˆÛ·ÓÔÈ Shulman Î·È Kanarek ÛÂ ÓÂÔÁÓ¿ ÂÍ·ÈÚÂÙÈÎ¿ ¯·-ÌËÏÔ‡ ‚¿ÚÔ˘˜ Ô˘ ‰ÂÓ ÛÈÙ›˙ÔÓÙ·Ó ÂÓÙÂÚÈÎ¿ (4). ∏Á·ÛÙÚ›ÓË ¤¯ÂÈ ÙÚÔÊÈÎ‹ ‰Ú¿ÛË ÛÙÔ ¤ÓÙÂÚÔ Î·È Â›Ó·ÈÎÔÈÓ¿ ·Ô‰ÂÎÙfi fiÙÈ Ë ¤ÁÎ·ÈÚË ¤Ó·ÚÍË ÙË˜ ÂÓÙÂÚÈÎ‹˜Û›ÙÈÛË˜ Â›Ó·È ··Ú·›ÙËÙË ÁÈ· ÙËÓ ˆÚ›Ì·ÓÛË ÙÔ˘ Â-ÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜.

∆· ¡¢ª Â›¯·Ó ÛËÌ·ÓÙÈÎ¿ ˘„ËÏfiÙÂÚ· Â›Â‰·ÌÔÙÈÏ›ÓË˜ ÛÂ Û¯¤ÛË ÌÂ ÙÔ˘˜ Ì¿ÚÙ˘ÚÂ˜ Î·È Ë ‰È·ÊÔ-Ú¿ ·˘Ù‹ ‰È·ÙËÚ‹ıËÎÂ Î·È ÌÂÙ¿ ÙËÓ ÂÓÙÂÚÈÎ‹ Û›ÙÈÛË.

À„ËÏ¿ Â›Â‰· ÌÔÙÈÏ›ÓË˜ ¤¯Ô˘Ó ‰È·ÈÛÙˆıÂ› ÛÂ ÓÂ-ÔÁÓ¿ ÌÂ ÎÂ¯ÚˆÛÌ¤ÓÔ ·ÌÓÈ·Îfi ˘ÁÚfi Î·È ÛÂ ‚Ú¤ÊËÌÂ ÎÔÏÈÎÔ‡˜ ÚÒÙÔ˘ ÙÚÈÌ‹ÓÔ˘ (7,8). ∆· ˘„ËÏ¿ Â›-Â‰· ÙË˜ ÌÔÙÈÏ›ÓË˜ ‰ÂÓ Û˘Û¯ÂÙ›ÛÙËÎ·Ó ÌÂ ‰È·Ù·Ú·-¯¤˜ ·fi ÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi Û‡ÛÙËÌ· ÙˆÓ ÌÂÏÂÙËı¤-ÓÙˆÓ ÓÂÔÁÓÒÓ.

∆· Â›Â‰· ÙÔ˘ VIP ‹Ù·Ó ·ÚfiÌÔÈ· Î·È ÛÙÈ˜ ‰‡ÔÔÌ¿‰Â˜ Î·È ‰ÂÓ ÙÚÔÔÔÈ‹ıËÎ·Ó ÌÂÙ¿ ÙËÓ ÂÓÙÂÚÈÎ‹Û›ÙÈÛË. ∆· Â›Â‰· ÙÔ˘ VIP Â›Ó·È ·˘ÍËÌ¤Ó· ÛÙË Á¤Ó-ÓËÛË Î·È ·˘Í¿ÓÔÓÙ·È ·ÎfiÌ· ÂÚÈÛÛfiÙÂÚÔ Î·Ù¿ ÙË‰È¿ÚÎÂÈ· ÙË˜ ÓÂÔÁÓÈÎ‹˜ ÂÚÈfi‰Ô˘, ÌÂ ÎÔÚ‡ÊˆÛË ÙË‰Â‡ÙÂÚË Â‚‰ÔÌ¿‰· ˙ˆ‹˜ (5). OÈ °Ô‡Ó·ÚË˜ Î·È Û˘Ó‰È·›ÛÙˆÛ·Ó ·˘ÍËÌ¤Ó· Â›Â‰· ÙÔ˘ VIP ÛÂ ÓÂÔÁÓ¿ÌÂ ›ÎÙÂÚÔ ˘fi ÊˆÙÔıÂÚ·Â›· (10).

∆· ·ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ ı·ÌÔÚÔ‡Û·Ó Ó· ·ÔÙÂÏ¤ÛÔ˘Ó ÙË ‚¿ÛË ÁÈ· ÙËÓ ·ÍÈÔ-ÏfiÁËÛË ÙË˜ ·ıÔÊ˘ÛÈÔÏÔÁ›·˜ ÙˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ·fi ÙÔ ÂÙÈÎfi Û‡ÛÙËÌ· ÙˆÓ ÓÂÔÁÓÒÓ ‰È·‚ËÙÈÎÒÓÌËÙ¤ÚˆÓ ÛÂ Û¯¤ÛË ÌÂ ÙÈ˜ Á·ÛÙÚÂÓÙÂÚÈÎ¤˜ ÔÚÌfiÓÂ˜.∞·ÈÙÂ›Ù·È, fiÌˆ˜, ÂÚ·ÈÙ¤Úˆ ¤ÚÂ˘Ó· ÚÔÎÂÈÌ¤ÓÔ˘Ó· ‰ÈÂ˘ÎÚÈÓÈÛÙÂ› Ë ÎÏÈÓÈÎ‹ ÛËÌ·Û›· ÙˆÓ ·ÔÙÂÏÂ-ÛÌ¿ÙˆÓ ·˘ÙÒÓ.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Lucas A, Adrian TE, Christofides N, Bloom SR, Aynsley-

Green A. Plasma motilin, gastrin, and enteroglucagon andfeeding in the human newborn. Arch Dis Child1980;55:673-677.

2. Lucas A, Bloom SR, Aynsley-Green A. Development of gut


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∂ÈÎfiÓ· 3. ∂›Â‰· VIP (mg/dl) ÛÙ· ÓÂÔÁÓ¿ ‰È·‚ËÙÈÎÒÓ ÌËÙ¤ÚˆÓ (ÔÌ¿‰· ∞) Î·È ÛÙÔ˘˜ Ì¿ÚÙ˘ÚÂ˜ (ÔÌ¿‰· µ) ÌÂÙ¿ ÙË Á¤ÓÓËÛË (Ê¿-ÛË π) Î·È ÌÂÙ¿ ·fi ÂÓÙÂÚÈÎ‹ Û›ÙÈÛË (Ê¿ÛË ππ).

20

18

16

14

12

10

8

6

4

2

0

OÌ¿‰· ∞ - º¿ÛË π

12 10 12 9



mg/

dl



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hormone responses to feeding in neonates. Arch Dis Child1980;55:678-682.

3. Lucas A, Bloom SR, Aynsley-Green A. Postnatal surges inplasma gut hormones in term and preterm neonates. BiolNeonate 1982;41:63-67.

4. Shulman DI, Kanarek K. Gastrin, motilin, insulin, and insulin-like growth factor-I concentrations in very-low-birth-weightinfants receiving enteral or parenteral nutrition. J ParenterEnteral Nutr 1993;17:130-133.

5. Grisoni ER, Kalhan SC. Plasma vasoactive intestinalpolypeptide in the newborn infant. J Pediatr GastroenterolNutr 1990;10:185-188.

6. Lucas A, Bloom SR, Aynsley-Green A. Vasoactive intestinalpeptide (VIP) in preterm and term neonates. Acta PaediatrScand 1982;71:71-74.

7. Mahmoud EL, Benirschke K, Vaucher YE, Poitras P. Motilinlevels in term neonates who have passed meconium priorto birth. J Pediatr Gastroenterol Nutr 1988;7:95-99.

8. Lothe L, Ivarsson SA, Lindberg T. Motilin, vasoactiveintestinal peptide and gastrin in infantile colic. Acta PaediatrScand 1987;76:316-320.

9. Ordaz-Jimenez MR, Fernandez-Celis JM, Rivera-Rosas S,Serrano-Camargo C, Ballesteros-del-Olmo JC, Estrada-Flores JV. Gastrointestinal hormones during minimal enteralfeeding of sick premature infants. Rev Invest Clin1998;50:37-42.

10. Gounaris A, Alexiou N, Costalos C, Daniilidou M, BakoleasV, Constantellou E. Gut hormone levels in neonates underphototherapy. Early Hum Dev 1998;51:57-60.

11. Gounaris A, Sevastiadou S, Bora C, Theodoraki M,Hatzistamatiou Z, Constantellou E et al. Antenatalcorticosteroids and GI peptides in the newborn [abstract].European Society for Pediatric Research; 2000 September23-27; Rodos, Greece; 2000. p. 246.

12. Bjornsson ES, Urbanavicius V, Eliasson B, Attvall S, SmithU, Abrahamsson H. Effects of hyperglycemia oninterdigestive gastrointestinal motility in humans. Scand JGastroenterol 1994;29:1096-1104.

13. Eliasson B, Bjornsson E, Urbanavicius V, Andersson H,

Fowelin J, Attvall S et al. Hyperinsulinaemia impairsgastrointestinal motility and slows carbohydrate absorption.Diabetologia 1995;38:79-85.

14. Lam WF, Masclee AA, De Boer SY, Lamers CB.Hyperglycaemia reduces gastrin-stimulated gastric acidsecretion in humans. Eur J Clin Invest 1998;28:826-830.

15. Vazeou A, Papadopoulou A, Pergantou E, Kitsiou E,Batrsocas C. Gastrointestinal regulatory peptides inchildren with IDDM: does the glycemic control matter?Diabetologia 1997;40 (Suppl 1):508.

16. Johnson LR. New aspects of the trophic action ofgastrointestinal hormones. Gastroenterology 1977;72:788-792.

17. Rogers IM, Davidson DC, Lawrence J, Ardill J, BuchananKD. Neonatal secretion of gastrin and glucagon. Arch DisChild 1974;49:796-801.

18. von Berger L, Henrichs I, Raptis S, Heinze E, Jonatha W,Teller WM et al. Gastrin concentration in plasma of theneonate at birth and after the first feeding. Pediatrics1976;58:264-267.

19. Pearse AG, Polak JM, Bloom SR, Adams C, Dryburgh JR,Brown JC. Enterochromaffin cells of the mammalian smallintestine as the source of motilin. Virchows Arch B CellPathol 1974;16:111-120.

20. Lucas A, Bloom SR, Aynsley-Green A. Metabolic andendocrine events at the time of the first feed of humanmilk in preterm and term infants. Arch Dis Child 1978;53:731-736.

21. Barnett JL, Owyang C. Serum glucose concentration asa modulator of interdigestive gastric motility. Gastro-enterology 1988;94:739-744.


¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: πˆÛ‹Ê ∫·Ï¤ÁÈ·˜ Õıˆ 31 & OÚˆÔ‡, ∆.∫. 262 26, ¶¿ÙÚ· E-mail: [email protected]


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∂Ê·ÚÌÔÁ‹ ÙÔ˘ ıÂÚ·Â˘ÙÈÎÔ‡ ÚˆÙÔÎfiÏÏÔ˘ BFM-90 ÛÙËÓ ·È‰ÈÎ‹ ÔÍÂ›·ÏÂÌÊÔ‚Ï·ÛÙÈÎ‹ ÏÂ˘¯·ÈÌ›·: ÚÔÁÓˆÛÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ Î·È ·ÔÙÂÏ¤ÛÌ·Ù· º. ∞ı·Ó·ÛÈ¿‰Ô˘1, ª. Ã·Ù˙ËÛÙ˘ÏÈ·ÓÔ‡1, ª. ∫Ô‡ÚÙË1, ∞. ª¤ÓÔ˜2, £. ¶··ÁÂˆÚÁ›Ô˘1, ª. ™Ù¿ÌÔ˘1, ¢. ∫·ÙÚÈÔ‡1

Application of the BFM-90 therapeutic protocol to childhood acute lymphoblastic leukaemia: prognostic factors and results F. Athanasiadou1, M. Hatzistilianou1, M. Kourti1, A. Benos2, T. Papageorgiou1, M. Stamou1, D. Catriu1


�¶ÂÚ›ÏË„Ë: ™ÎÔfi˜ ÙË˜ ·ÚÔ‡Û·˜ ÂÚÁ·Û›·˜ Â›Ó·ÈË ·Ó·‰ÚÔÌÈÎ‹ ÌÂÏ¤ÙË ÙË˜ ÂÈ‚›ˆÛË˜ ·È‰ÈÒÓ ÌÂÔÍÂ›· ÏÂÌÊÔ‚Ï·ÛÙÈÎ‹ ÏÂ˘¯·ÈÌ›· Ô˘ ¤Ï·‚·Ó ıÂÚ·-Â›· ÌÂ ‚¿ÛË ÙÔ ÚˆÙfiÎÔÏÏÔ BFM-90 Î·È Ë ·ÍÈÔÏfi-ÁËÛË ÙÔ˘ ÚfiÏÔ˘ Î·ıÈÂÚˆÌ¤ÓˆÓ ÚÔÁÓˆÛÙÈÎÒÓ ·-Ú·ÁfiÓÙˆÓ ÛÙÔ Ï·›ÛÈÔ ÙË˜ ÂÊ·ÚÌÔÁ‹˜ ÙÔ˘ ·ÓˆÙ¤-Úˆ ÚˆÙÔÎfiÏÏÔ˘. ™ÙË ÌÂÏ¤ÙË Û˘ÌÂÚÈÂÏ‹ÊıËÛ·Ó70 ·È‰È¿ (39 ·ÁfiÚÈ· Î·È 31 ÎÔÚ›ÙÛÈ·) ÌÂ ‰È¿ÌÂÛËËÏÈÎ›· Ù· 4,6 ¤ÙË (Â‡ÚÔ˜: 3 Ì‹ÓÂ˜-15 ¤ÙË), Ù· ÔÔ›·ÓÔÛËÏÂ‡ÙËÎ·Ó ÛÙË µ’ ¶·ÓÂÈÛÙËÌÈ·Î‹ ¶·È‰È·ÙÚÈÎ‹∫ÏÈÓÈÎ‹ ÙÔ˘ ÓÔÛÔÎÔÌÂ›Ô˘ ∞Ã∂¶∞ Î·Ù¿ ÙÔ ¯ÚÔÓÈÎfi‰È¿ÛÙËÌ· π·ÓÔ˘·Ú›Ô˘ 1993-¢ÂÎÂÌ‚Ú›Ô˘ 1999. O‰È¿ÌÂÛÔ˜ ¯ÚfiÓÔ˜ ·Ú·Ù‹ÚËÛË˜ ‹Ù·Ó 53 Ì‹ÓÂ˜ (Â‡-ÚÔ˜: 14 ËÌ¤ÚÂ˜-97 Ì‹ÓÂ˜) Î·È Ë Èı·ÓfiÙËÙ· ÂÏÂ‡-ıÂÚË˜ ÓfiÛÔ˘ ÂÈ‚›ˆÛË˜ ÛÂ ÚÒÙË ‡ÊÂÛË (event-free survival - EFS) ‹Ù·Ó 77,46% (CI: 70-86%). ∏ È-ı·ÓfiÙËÙ· Û˘ÓÔÏÈÎ‹˜ ÂÈ‚›ˆÛË˜ (overall survival -OS) ‹Ù·Ó 82,61% (CI: 74-90%). ™Â Û˘ÓÂ¯È˙fiÌÂÓËÏ‹ÚË ‡ÊÂÛË ‚Ú›ÛÎÔÓÙ·È 58 ·ÛıÂÓÂ›˜, ÂÓÒ 12 Î·Ù¤-ÏËÍ·Ó. ÀÔÙÚÔ‹ ·ÚÔ˘Û›·Û·Ó 8 ·ÛıÂÓÂ›˜, 6 ÛÙÔÓÌ˘ÂÏfi Î·È 2 ÛÙÔ˘˜ fiÚ¯ÂÈ˜, ÂÓÒ ÛÂ ‰Â‡ÙÂÚË Ï‹ÚË‡ÊÂÛË Â˘Ú›ÛÎÔÓÙ·È 3 ·ÛıÂÓÂ›˜ (‰È¿ÌÂÛÔ˜ ¯ÚfiÓÔ˜:14 Ì‹ÓÂ˜, Â‡ÚÔ˜: 6-23 Ì‹ÓÂ˜). ¢˘ÛÌÂÓ‹ Â›‰Ú·ÛËÛÙËÓ Èı·ÓfiÙËÙ· EFS ÌÂ ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ ‰È·-ÊÔÚ¿ (p log-rank ≤0,05) Â›¯·Ó: Ë ËÏÈÎ›· ≤3 ¤ÙË, Ô·ÚÈıÌfi˜ ÙˆÓ ÏÂ˘ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ (WBC≥50x109/L), Ë ÙÈÌ‹ ÙË˜ LDH (≥1000 IU/L), Ë Ë·ÙÔ-ÌÂÁ·Ï›· (≥3 cm), Ë ÛÏËÓÔÌÂÁ·Ï›· (≥3 cm) Î·È ËÎ·Ù¿Ù·ÍË Î·Ù¿ NCI (National Cancer Institute, US)ÛÙËÓ ÔÌ¿‰· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘. ∏ Cox-regression·Ó¿Ï˘ÛË ·ÔÎ¿Ï˘„Â fiÙÈ ÈÛ¯˘ÚfiÙÂÚÔ˜ ‰˘ÛÌÂÓ‹˜ÚÔÁÓˆÛÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ‹Ù·Ó Ô ·ÚÈıÌfi˜ ÙˆÓÏÂ˘ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ (WBC ≥50x109/L). ∆· ·ÔÙÂ-Ï¤ÛÌ·Ù· ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ ÎÚ›ÓÔÓÙ·È ÔÏ‡

�Abstract: The aim of this study is to perform aretrospective analysis of survival of children withnewly diagnosed acute lymphoblastic leukaemia(ALL) who were treated according to the BFM-90protocol in the 2nd University Department ofPediatrics at AHEPA General Hospital and toanalyze the value of established prognostic factors.Seventy children (39 male and 31 female) with amedian age of 4.6 years (range: 3 months-15years)were included in this study. The median observationtime was 53 months (range: 14 days-97 months)and the estimate of probability of event-free survival,pEFS, was 77.46% (CI: 70-86%), and that of overallsurvival, pOS, was 82.61% (CI: 74-90%). At the timeof collecting the data, 58 patients were incontinuous complete remission and 12 patients haddied. Relapse occurred in 8 patients, 6 in the bonemarrow and 2 in the testes, and 3 patients achievedsecond remission for a median time of 14 months(range: 6-23 months). The following variables wereadversely associated with EFS: age ≤3 years, WBCcount ≥50x109/L, LDH value ≥1000 IU/L,hepatomegaly, splenomegaly, and NCI (NationalCancer Institute, US) classification in the high-riskgroup. In the Cox regression analysis, WBC count≥50x109/L emerged as the most significant adverseprognostic factor. The results of this study appear tobe in concordance with other reports frominternational study groups. This can be attributed tothe high compliance to standardized protocol-based treatment.

1 µ’ ¶·ÓÂÈÛÙËÌÈ·Î‹ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹, ∞.¶.£., £ÂÛÛ·ÏÔÓ›ÎË 2 ∂ÚÁ·ÛÙ‹ÚÈÔ ÀÁÈÂÈÓ‹˜, ∆Ì‹Ì· π·ÙÚÈÎ‹˜ ∞.¶.£., £ÂÛÛ·ÏÔÓ›ÎË

1 2nd Paediatric Clinic of Aristotelion University, Thessaloniki 2 Department of Hygiene, Aristotelion University of Thessaloniki


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∂ÈÛ·ÁˆÁ‹ ∏ ÔÍÂ›· ÏÂÌÊÔ‚Ï·ÛÙÈÎ‹ ÏÂ˘¯·ÈÌ›· (O§§) Â›Ó·È Ë

Û˘¯ÓfiÙÂÚË Î·ÎÔ‹ıË˜ ÓÂÔÏ·ÛÌ·ÙÈÎ‹ ÓfiÛÔ˜ ÙË˜·È‰ÈÎ‹˜ ËÏÈÎ›·˜. ∞ÔÙÂÏÂ› ÙÔ 25-30% fiÏˆÓ ÙˆÓ·È‰ÈÎÒÓ ÓÂÔÏ·ÛÈÒÓ, ÌÂ Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛË˜ 3-4ÂÚÈÙÒÛÂÈ˜ ÂÙËÛ›ˆ˜ ·Ó¿ 100.000 ·È‰È¿ ËÏÈÎ›·˜Î¿Ùˆ ÙˆÓ 15 ÂÙÒÓ (1,2). ∂›Ó·È ÓfiÛËÌ· ÌÂ Â˘Ú‡ Î·ÈÂÙÂÚÔÁÂÓ¤˜ Ê¿ÛÌ· ÙfiÛÔ ˆ˜ ÚÔ˜ ÙÔÓ ·ÈÌ·ÙÔÏÔÁÈ-Îfi, fiÛÔ Î·È ˆ˜ ÚÔ˜ ÙÔÓ ÎÏÈÓÈÎfi Ê·ÈÓfiÙ˘Ô. ∂È-Ï¤ÔÓ, Û‹ÌÂÚ· Ù· ÔÛÔÛÙ¿ Ì·ÎÚÔ¯ÚfiÓÈ·˜ ÂÈ‚›ˆ-ÛË˜ ÙˆÓ ·È‰ÈÒÓ ÌÂ O§§ ÍÂÂÚÓÔ‡Ó ÙÔ 70% (20). ∆ÔÂ›ÙÂ˘ÁÌ· ·˘Ùfi ÌÔÚÂ› Ó· ·Ô‰ÔıÂ›: ·) ÛÙËÓ ÚÔ-Ê‡Ï·ÍË ÙÔ˘ ∫¡™, ‚) ÛÙË Û˘Ó‰˘·ÛÌ¤ÓË ¯Ú‹ÛË ¯Ë-ÌÂÈÔıÂÚ·Â˘ÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ, Á) ÛÙËÓ Î·Ù¿Ù·ÍËÙˆÓ ·ÛıÂÓÒÓ ÛÂ ÔÌ¿‰Â˜ ÎÈÓ‰‡ÓÔ˘ ÌÂ ‚¿ÛË ÚÔ-ÁÓˆÛÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜ Î·È ‰) ÛÙËÓ ÂÓÙ·ÙÈÎÔÔ›Ë-ÛË ÙË˜ ıÂÚ·Â›·˜ ÌÂ ‚¿ÛË ÙÔÓ Î›Ó‰˘ÓÔ ˘ÔÙÚÔ‹˜.

™ÎÔfi˜ ÙË˜ ÂÚÁ·Û›·˜ Â›Ó·È Ë ·Ó·‰ÚÔÌÈÎ‹ ÌÂÏ¤ÙËÙË˜ ÂÈ‚›ˆÛË˜ ÙˆÓ ·È‰ÈÒÓ ÌÂ O§§ Î·È Ë ·ÍÈÔÏfiÁËÛËÙÔ˘ ÚfiÏÔ˘ Î·ıÈÂÚˆÌ¤ÓˆÓ ÚÔÁÓˆÛÙÈÎÒÓ ·Ú·Áfi-ÓÙˆÓ ÛÙÔ Ï·›ÛÈÔ ÙË˜ ÂÊ·ÚÌÔÁ‹˜ Û‡Á¯ÚÔÓˆÓ ÂÓÙ·ÙÈ-ÎÒÓ ¯ËÌÂÈÔıÂÚ·Â˘ÙÈÎÒÓ ÚˆÙÔÎfiÏÏˆÓ.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ªÂÏÂÙ‹ıËÎ·Ó ·Ó·‰ÚÔÌÈÎ¿ ÔÈ Ê¿ÎÂÏÔÈ ÙˆÓ ·È‰ÈÒÓ ÌÂ

ÔÍÂ›· ÏÂÌÊÔ‚Ï·ÛÙÈÎ‹ ÏÂ˘¯·ÈÌ›· Ô˘ ÓÔÛËÏÂ‡ÙËÎ·Ó ÛÙË µ’¶·ÓÂÈÛÙËÌÈ·Î‹ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ÙÔ˘ ÓÔÛÔÎÔÌÂ›Ô˘∞Ã∂¶∞ Î·È ¤Ï·‚·Ó ıÂÚ·Â›· ÌÂ ‚¿ÛË ÙÔ ÚˆÙfiÎÔÏÏÔ BFM-90 (Berlin-Frankfurt-Münster), Î·Ù¿ ÙÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· π·-ÓÔ˘·Ú›Ô˘ 1993-¢ÂÎÂÌ‚Ú›Ô˘ 1999 (¶›Ó·Î·˜ 1) (∂ÈÎfiÓ· 1). ∞fiÙË ÌÂÏ¤ÙË ÂÍ·ÈÚ¤ıËÎ·Ó 1 ·ÛıÂÓ‹˜ ÌÂ ÒÚÈÌË B-O§§ Î·È 1·ÛıÂÓ‹˜ Ô˘ ÚÔÛ‹ÏıÂ ÌÂ ˘ÔÙÚÔ‹ O§§.

°È· Î¿ıÂ ·È‰› Û˘ÌÏËÚˆÓfiÙ·Ó ÂÈ‰ÈÎfi ÚˆÙfiÎÔÏÏÔ, ÛÙÔÔÔ›Ô ˘‹Ú¯·Ó ‰ËÌÔÁÚ·ÊÈÎ¿ ÎÏÈÓÈÎ¿ Î·È ÂÚÁ·ÛÙËÚÈ·Î¿ ÛÙÔÈ-¯Â›· Î·Ù¿ ÙËÓ ·Ú¯ÈÎ‹ ‰È¿ÁÓˆÛË ÙË˜ ÓfiÛÔ˘.

∆· ‰ËÌÔÁÚ·ÊÈÎ¿ Î·È ÎÏÈÓÈÎ¿ ÛÙÔÈ¯Â›· ÂÚÈÂÏ¿Ì‚·Ó·Ó ÙÔÔÓÔÌ·ÙÂÒÓ˘ÌÔ ÙÔ˘ ·È‰ÈÔ‡, ÙÔÓ ÙfiÔ ‰È·ÌÔÓ‹˜ ÙÔ˘, ÙÔ Ê‡-ÏÔ, ÙËÓ ËÌÂÚÔÌËÓ›· Á¤ÓÓËÛË˜, ÙËÓ ËÌÂÚÔÌËÓ›· ÂÈÛ·ÁˆÁ‹˜ÛÙË ÎÏÈÓÈÎ‹, ÙËÓ ËÌÂÚÔÌËÓ›· ‰È¿ÁÓˆÛË˜ ÙË˜ ÓfiÛÔ˘ Î·È ¤Ó·Ú-ÍË˜ ÙË˜ ıÂÚ·Â›·˜, Ù· ÎÏÈÓÈÎ¿ ÛËÌÂ›· Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹, ÙËÓÙ˘¯fiÓ ‡·ÚÍË Ë·ÙÔÌÂÁ·Ï›·˜, ÛÏËÓÔÌÂÁ·Ï›·˜, ÏÂÌÊ·‰ÂÓÔ-¿ıÂÈ·˜, ÙË Û˘ÌÌÂÙÔ¯‹ ‹ ÌË ÙˆÓ fiÚ¯ÂˆÓ Î·È ÙË ‰È‹ıËÛË ‹ ÌËÙÔ˘ ÎÂÓÙÚÈÎÔ‡ ÓÂ˘ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ∆· ÂÚÁ·ÛÙËÚÈ·Î¿ Â˘-Ú‹Ì·Ù· Ô˘ ·ÍÈÔÏÔÁ‹ıËÎ·Ó Î·Ù¿ ÙË ‰È¿ÁÓˆÛË ÙË˜ ÓfiÛÔ˘

‹Ù·Ó Ô ·ÚÈıÌfi˜ ÙˆÓ ÏÂ˘ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ, Ë ÙÈÌ‹ ÙË˜ ·ÈÌÔ-ÛÊ·ÈÚ›ÓË˜, Ô ·ÚÈıÌfi˜ ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ Î·È Ë ÙÈÌ‹ ÙË˜ LDH.∂ÈÏ¤ÔÓ, Û˘ÌÏËÚˆÓfiÙ·Ó Ë ÌÔÚÊÔÏÔÁÈÎ‹ Î·È ·ÓÔÛÔÏÔÁÈÎ‹Ù·ÍÈÓfiÌËÛË ÙÔ˘ ÓÔÛ‹Ì·ÙÔ˜, Î·ıÒ˜ Â›ÛË˜ Î·È ÛÙÔÈ¯Â›· Ô˘·ÊÔÚÔ‡Û·Ó ÛÙËÓ ÔÚÂ›· ÙË˜ ÓfiÛÔ˘, fiˆ˜ Ë Ù˘¯fiÓ ˘ÔÙÚÔ-‹, Ô ¯ÚfiÓÔ˜ Î·È Ë ı¤ÛË ÂÌÊ¿ÓÈÛ‹˜ ÙË˜, Ô ı¿Ó·ÙÔ˜, Ô ¯Úfi-ÓÔ˜ Î·È Ë ·ÈÙ›· ı·Ó¿ÙÔ˘, Ô ¯ÚfiÓÔ˜ ‰È·ÎÔ‹˜ ÙË˜ ıÂÚ·Â›·˜Î·È Ë ÙÂÏÂ˘Ù·›· Â›ÛÎÂ„Ë ÁÈ· Â·Ó¤ÏÂÁ¯Ô.

OÈ ·ÛıÂÓÂ›˜, ÛÙË Û˘Ó¤¯ÂÈ·, Ù·ÍÈÓÔÌ‹ıËÎ·Ó ÛÂ ‰È¿ÊÔÚÂ˜Î·ÙËÁÔÚ›Â˜ ·Ó¿ÏÔÁ· ÌÂ Ù· ÂÚÁ·ÛÙËÚÈ·Î¿ Î·È ÎÏÈÓÈÎ¿ ¯·Ú·-ÎÙËÚÈÛÙÈÎ¿ ÙÔ˘˜ Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹. ¶ÚÈÓ ÙËÓ ¤Ó·ÚÍË ÙË˜ ıÂ-Ú·Â›·˜ Â›¯Â ÚÔËÁËıÂ› Ë Î·Ù¿Ù·Í‹ ÙÔ˘˜ ÛÂ ÔÌ¿‰Â˜ ÎÈÓ‰‡ÓÔ˘ÌÂ ‚¿ÛË Ù· ÎÚÈÙ‹ÚÈ· ÙÔ˘ BFM-90 (6): ·) ÔÌ¿‰· ‚·ÛÈÎÔ‡ ÎÈÓ‰‡-ÓÔ˘ (SR): BFM-RF <0,8 Î·È ‚Ï¿ÛÙÂ˜ <1.000/ÌL ÛÙÔ ÂÚÈÊÂÚÈ-Îfi ·›Ì· ÙËÓ 8Ë ËÌ¤Ú· Î·È fi¯È ∆-O§§ Î·È ÌË Û˘ÌÌÂÙÔ¯‹ ÙÔ˘∫¡™, ‚) ÔÌ¿‰· ÂÓ‰È¿ÌÂÛÔ˘ ÎÈÓ‰‡ÓÔ˘ (MR): ‚Ï¿ÛÙÂ˜ <1.000/ÌLÛÙÔ ÂÚÈÊÂÚÈÎfi ·›Ì· ÙËÓ 8Ë ËÌ¤Ú· Î·È BFM-RF ≥0,8 ‹ BFM-RF<0,8 Î·È Û˘ÌÌÂÙÔ¯‹ ÙÔ˘ ∫¡™ ‹ ∆-O§§ Î·È Á) ÔÌ¿‰· ˘„ËÏÔ‡ ÎÈÓ-‰‡ÓÔ˘ (HR): ‚Ï¿ÛÙÂ˜ ≥1.000/ÌL ÛÙÔ ÂÚÈÊÂÚÈÎfi ·›Ì· ÙËÓ 8ËËÌ¤Ú· ‹ ‚Ï¿ÛÙÂ˜ <1.000/ÌL ÛÙÔ ÂÚÈÊÂÚÈÎfi ·›Ì· ÙËÓ 8Ë ËÌ¤-Ú·, ·ÏÏ¿ ≥5% ‚Ï¿ÛÙÂ˜ ÛÙÔÓ Ì˘ÂÏfi ÙËÓ 33Ë ËÌ¤Ú·.

[BFM-RF (Risk-factor) = 0,2 x log (·ÚÈıÌfi˜ ‚Ï·ÛÙÒÓ/ÌL+1) + 0,06 x ‹·Ú (cm ˘fi ÙÔ ÏÂ˘ÚÈÎfi ÙfiÍÔ) + 0,04 xÛÏ‹Ó·˜ (cm ˘fi ÙÔ ÏÂ˘ÚÈÎfi ÙfiÍÔ)] (6).

∂ÈÏ¤ÔÓ, ÁÈ· ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË ¤ÁÈÓÂ Î·Ù¿Ù·ÍË ÙˆÓ·ÛıÂÓÒÓ ÛÂ ÔÌ¿‰Â˜ ÎÈÓ‰‡ÓÔ˘ ÌÂ ‚¿ÛË Ù· ÎÚÈÙ‹ÚÈ· Î·Ù¿ NCI(18): ·) ‚·ÛÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘: WBC <50x109/L Î·È ËÏÈÎ›· 1 ¤ˆ˜ <10¤ÙË Î·È ‚) ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘: WBC ≥50x109/L ‹ ËÏÈÎ›· ≥10 ÂÙÒÓ.

¢È¿ÁÓˆÛË ∏ ‰È¿ÁÓˆÛË ÙË˜ ÔÍÂ›·˜ ÏÂÌÊÔ‚Ï·ÛÙÈÎ‹˜ ÏÂ˘¯·ÈÌ›·˜ ¤ÁÈÓÂ

ÌÂ Î˘ÙÙ·ÚÔÌÔÚÊÔÏÔÁÈÎ‹ Î·È ÈÛÙÔ¯ËÌÈÎ‹ ÂÍ¤Ù·ÛË ÂÈ¯ÚÈÛÌ¿ÙˆÓ·›Ì·ÙÔ˜ Î·È Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ. °È· ÙË ‰È¿ÁÓˆÛË ÙË˜ ÔÍÂ›·˜ÏÂÌÊÔ‚Ï·ÛÙÈÎ‹˜ ÏÂ˘¯·ÈÌ›·˜ ‹Ù·Ó ··Ú·›ÙËÙË Ë ‡·ÚÍË ≥25%‚Ï·ÛÙÒÓ ÛÙÔÓ Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ. ∏ Û˘ÌÌÂÙÔ¯‹ ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ÓÂ˘ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÔÚ›ÛÙËÎÂ ˆ˜ Ë ‡·ÚÍË ≥5 ‚Ï¿ÛÙÂ˜/ÌLÌË ·ÈÌ·ÙËÚÔ‡ ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô˘ ˘ÁÚÔ‡ ‹ Ë ÏÂ˘¯·ÈÌÈÎ‹ ‰È‹ıË-ÛË ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ ÌÂÙ¿ ·fi ·ÍÔÓÈÎ‹ ‹ Ì·ÁÓËÙÈÎ‹ ÙÔÌÔÁÚ·Ê›·.™Â fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓÂ›˜ ÁÈÓfiÙ·Ó ÔÊı·ÏÌÔÏÔÁÈÎfi˜ Î·È Ë¯ÔÎ·Ú-‰ÈÔÁÚ·ÊÈÎfi˜ ¤ÏÂÁ¯Ô˜.

OÈ ·ÓÔÛÔÏÔÁÈÎÔ› ‰Â›ÎÙÂ˜ ÁÈ· ÙÔÓ Î·ıÔÚÈÛÌfi ÙÔ˘ ·ÓÔÛÔ-Ê·ÈÓfiÙ˘Ô˘ ıÂˆÚÔ‡ÓÙ·Ó ıÂÙÈÎÔ› ÂÊfiÛÔÓ ÂÎÊÚ¿˙ÔÓÙ·Ó ÛÂ≥20% ÙˆÓ ÏÂ˘¯·ÈÌÈÎÒÓ Î˘ÙÙ¿ÚˆÓ. ∏ ÔÍÂ›· ÏÂÌÊÔ‚Ï·ÛÙÈÎ‹ÏÂ˘¯·ÈÌ›· Ù·ÍÈÓÔÌ‹ıËÎÂ ÛÂ ÚÔ-ÚÔ-µ ÂÊfiÛÔÓ ‹Ù·Ó TdT+,HLA-DR+, CD19+, ÛÂ ÚÔ-µ ÂÊfiÛÔÓ ‹Ù·Ó TdT+/-, HLA-DR+/-

ÈÎ·ÓÔÔÈËÙÈÎ¿ Î·È Â›Ó·È ÛÂ Ï‹ÚË ·ÓÙÈÛÙÔÈ¯›· ÌÂ Ù·‰ÈÂıÓ‹ ‰Â‰ÔÌ¤Ó·. ∞˘Ùfi ÌÔÚÂ› Ó· ·Ô‰ÔıÂ› ÛÙËÓÂÊ·ÚÌÔÁ‹ Î·È Ù‹ÚËÛË Î·ıÈÂÚˆÌ¤ÓˆÓ ‰ÈÂıÓÒÓ Úˆ-ÙÔÎfiÏÏˆÓ.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ·È‰ÈÎ‹ ÔÍÂ›· ÏÂÌÊÔ‚Ï·ÛÙÈÎ‹ ÏÂ˘-¯·ÈÌ›·, ÚˆÙfiÎÔÏÏÔ BFM-90, ÚÔÁÓˆÛÙÈÎÔ› ·Ú¿-ÁÔÓÙÂ˜.

Key words: childhood acute lymphoblasticleukaemia, BFM-90 protocol, prognostic factors.


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¶›Ó·Î·˜ 1. ¶ÚˆÙfiÎÔÏÏÔ BFM-90

º¿ÚÌ·ÎÔ ¢fiÛË (/m2) ∏Ì¤ÚÂ˜

º¿ÛË ÂÊfi‰Ô˘¶ÚˆÙfiÎÔÏÏÔ π¶ÚÂ‰ÓÈ˙fiÓË (per os) 60 mg 1-28µÈÓÎÚÈÛÙ›ÓË (IV) 1,5 mg 8, 15, 22, 29¢·Ô˘ÓÔÚÔ˘‚ÈÎ›ÓË (IV) 30 mg 8, 15, 22, 29L-∞Û·Ú·ÁÈÓ¿ÛË (IV) 10.000 IU 12, 15, 18, 21, 24, 27, 30, 33ªÂıÔÙÚÂÍ¿ÙË (IT) 12 mg 1, 15, 29∫˘ÎÏÔÊˆÛÊ·Ì›‰Ë (IV) 1000 mg 36, 64∫˘Ù·Ú·‚›ÓË (IV) 75 mg 38-41, 45-48, 52-55, 59-626-ªÂÚÎ·ÙÔÔ˘Ú›ÓË 60 mg 36-64ªÂıÔÙÚÂÍ¿ÙË (IT) 12 mg 45, 59

º¿ÛË Â‰Ú·›ˆÛË˜ (ÛÂ SRG & MRG)¶ÚˆÙfiÎÔÏÏÔ M6-ªÂÚÎ·ÙÔÔ˘Ú›ÓË 25 mg 1-56ªÂıÔÙÚÂÍ¿ÙË 5 g/m2 8, 22, 36, 50MÂıÔÙÚÂÍ¿ÙË (IT) 12 mg 8, 22, 36, 50

¶ÚˆÙfiÎÔÏÏÔ M-AL-∞Û·Ú·ÁÈÓ¿ÛË (IM) 25.000 IU 10, 24, 38, 52

º¿ÛË Â·ÓÂÊfi‰Ô˘ (ÛÂ SRG & MRG)¶ÚˆÙfiÎÔÏÏÔ II¢ÂÍ·ÌÂı·˙fiÓË (per os) 10 mg 1-21µÈÓÎÚÈÛÙ›ÓË (IV) 1,5 mg 8, 15, 22, 29¢ÔÍÔÚÔ˘‚ÈÎ›ÓË (IV) 30 mg 8, 15, 22, 29L-AÛ·Ú·ÁÈÓ¿ÛË (IV) 10.000 IU 8, 11, 15, 18∫˘ÎÏÔÊˆÛÊ·Ì›‰Ë (IV) 1000 mg 36∫˘Ù·Ú·‚›ÓË (IV) 75 mg 38-41, 45-486-£ÈÔÁÔ˘·Ó›ÓË (orally) 60 mg 36-49ªÂıÔÙÚÂÍ¿ÙË (IT) 12 mg 38, 45

∂ÓÙ·ÙÈÎ‹ Â·ÓÂ‰Ú·›ˆÛË (HRG ÌfiÓÔ)™ÙÔÈ¯Â›Ô HR-1¢ÂÍ·ÌÂı·˙fiÓË (per os) 20 mg 1-56-MÂÚÎ·ÙÔÔ˘Ú›ÓË 100 mg 1-5µÈÓÎÚÈÛÙ›ÓË (IV) 1,5 mg 1, 5ªÂıÔÙÚÂÍ¿ÙË 5 g 1∫˘Ù·Ú·‚›ÓË 2 g 5L-AÛ·Ú·ÁÈÓ¿ÛË (IM) 25.000 IU 6ªÂıÔÙÚÂÍ¿ÙË/Î˘Ù·Ú·‚›ÓË/ÚÂ‰ÓÈ˙fiÓË (IT) 12 mg/30 mg/10 mg 1

™ÙÔÈ¯Â›Ô HR-2¢ÂÍ·ÌÂı·˙fiÓË (per os) 20 mg 1-5£ÈÔÁÔ˘·Ó›ÓË (per os) 100 mg 1-5µÈÓ‰ÂÛ›ÓË (IV) 3 mg 1ªÂıÔÙÚÂÍ¿ÙË 5 g 1πÊÔÛÊ·Ì›‰Ë 400 mg 1-5¢·Ô˘ÓÔÚÔ˘‚ÈÎ›ÓË 50 mg 5L-∞Û·Ú·ÁÈÓ¿ÛË (IM) 25.000 IU 6MÂıÔÙÚÂÍ¿ÙË/Î˘Ù·Ú·‚›ÓË/ÚÂ‰ÓÈ˙fiÓË (IT) 12 mg/30 mg/10 mg 1

™ÙÔÈ¯Â›Ô HR-3¢ÂÍ·ÌÂı·˙fiÓË 20 mg 1-5∫˘Ù·Ú·‚›ÓË 2 g 1, 2∂ÙÔÔÛ›‰Ë 150 mg 3-5L-AÛ·Ú·ÁÈÓ¿ÛË (IM) 25.000 IU 6ªÂıÔÙÚÂÍ¿ÙË/Î˘Ù·Ú·‚›ÓË/ÚÂ‰ÓÈ˙fiÓË (IT) 12 mg/30 mg/10 mg 5

CD10+, CD19+ Î·È cyIg+ (Î˘ÙÙ·ÚÔÏ·ÛÌ·ÙÈÎ‹), ÛÂ ÒÚÈÌË µ-O§§ ÂÊfiÛÔÓ ‹Ù·Ó TdT+, HLA-DR+, CD19+, CD22+, cyIg+ Î·ÈsIg+ (ÂÈÊ·ÓÂÈ·Î‹), ÛÂ ∆-O§§ ÂÊfiÛÔÓ ‹Ù·Ó TdT+, CD2+,cyCD3+, CD7+ Î·È ÛÂ ‰ÈÊ·ÈÓÔÙ˘ÈÎ‹ O§§ ÂÊfiÛÔÓ ˘‹Ú¯ÂÙ·˘Ùfi¯ÚÔÓË ¤ÎÊÚ·ÛË ÛÂ ÙÔ˘Ï¿¯ÈÛÙÔÓ 20% ÙˆÓ ÏÂÌÊÔ‚Ï·-ÛÙÒÓ ÂÓfi˜ ‹ ÂÚÈÛÛfiÙÂÚˆÓ ·ÓÙÈÁfiÓˆÓ ÙË˜ Ì˘ÂÏÈÎ‹˜ ÛÂÈÚ¿˜(CD13, CD33, CD65s).

™Ù·ÙÈÛÙÈÎ‹ ·Ó¿Ï˘ÛËOÈ ‰È·ÊÔÚ¤˜ ÙˆÓ ÎÏÈÓÈÎÒÓ Î·È ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ·Ú·Ì¤-

ÙÚˆÓ ·Ó¿ÌÂÛ· ÛÙÈ˜ ˘ÔÎ·ÙËÁÔÚ›Â˜ ÙˆÓ ·ÛıÂÓÒÓ ÌÂÏÂÙ‹ıË-Î·Ó ÌÂ ÙË ‰ÔÎÈÌ·Û›· ¯2 Î·È ÙÔ Mann Whitney U test. ∏ ÂÎÙ›ÌË-ÛË ÙË˜ Û˘ÓÔÏÈÎ‹˜ ÂÈ‚›ˆÛË˜ (overall survival - OS) Î·È ÙË˜ ÂÈ-‚›ˆÛË˜ ¯ˆÚ›˜ ÓfiÛÔ ÛÂ ÚÒÙË ‡ÊÂÛË (event-free survival - EFS)¤ÁÈÓÂ ÌÂ ÙË Ì¤ıÔ‰Ô Kaplan-Meier, Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ Ùo˘


287

Ù˘ÈÎÔ‡ ÛÊ¿ÏÌ·ÙÔ˜ (standard error - SE) Î·È 95% ‰È·ÛÙ‹Ì·-ÙÔ˜ ·ÍÈÔÈÛÙ›·˜ (confidence interval - CI) (3).

∏ Û˘ÓÔÏÈÎ‹ ÂÈ‚›ˆÛË ˘ÔÏÔÁ›ÛÙËÎÂ ·fi ÙËÓ ËÌÂÚÔÌËÓ›·‰È¿ÁÓˆÛË˜ ¤ˆ˜ ÙËÓ ËÌÂÚÔÌËÓ›· ÙË˜ ÙÂÏÂ˘Ù·›·˜ Â›ÛÎÂ„Ë˜ÁÈ· Â·Ó¤ÏÂÁ¯Ô ‹ ÙËÓ ËÌÂÚÔÌËÓ›· ı·Ó¿ÙÔ˘. ∏ ÂÈ‚›ˆÛË ¯ˆ-Ú›˜ ÓfiÛÔ ÛÂ ÚÒÙË ‡ÊÂÛË ˘ÔÏÔÁ›ÛÙËÎÂ ·fi ÙËÓ ËÌÂÚÔÌË-Ó›· ÙË˜ ‰È¿ÁÓˆÛË˜ Ì¤¯ÚÈ ÙËÓ ËÌÂÚÔÌËÓ›· ÙË˜ ÙÂÏÂ˘Ù·›·˜ Â›-ÛÎÂ„Ë˜ ÁÈ· ¤ÏÂÁ¯Ô ‹ Ì¤¯ÚÈ ÙËÓ ËÌÂÚÔÌËÓ›· Ô˘ ˘‹Ú¯Â Û˘Ì-‚¿Ó. ø˜ Û˘Ì‚¿Ó ÔÚ›ÛÙËÎÂ Ë ·ÔÙ˘¯›· Â›ÙÂ˘ÍË˜ Ï‹ÚÔ˘˜‡ÊÂÛË˜ (ÚfiˆÚÔ˜ ı¿Ó·ÙÔ˜ ‹ ·ÓıÂÎÙÈÎ‹ ÏÂ˘¯·ÈÌ›·), Ë ˘Ô-ÙÚÔ‹ Î·È Ô ı¿Ó·ÙÔ˜ ÛÙË ‰È¿ÚÎÂÈ· ÙË˜ Ï‹ÚÔ˘˜ ‡ÊÂÛË˜. OÈ·ÛıÂÓÂ›˜ Ù·ÍÈÓÔÌ‹ıËÎ·Ó ÛÂ ‰È¿ÊÔÚÂ˜ ÔÌ¿‰Â˜ ·Ó¿ÏÔÁ· ÌÂÙÔ˘˜ ÚÔÁÓˆÛÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜ Ô˘ ÂÍ¤ÊÚ·˙·Ó Î·Ù¿ ÙËÓËÌÂÚÔÌËÓ›· ÙË˜ ‰È¿ÁÓˆÛË˜, ÔÈ ÔÔ›ÔÈ ‹Ù·Ó: ËÏÈÎ›· (<1 ¤ÙÔ˘˜,1-6 ÂÙÒÓ, ≥6 ÂÙÒÓ Î·È ≤3/>3 ÂÙÒÓ), Ê‡ÏÔ, Ë·ÙÔÌÂÁ·Ï›· Î·ÈÛÏËÓÔÌÂÁ·Ï›· (</≥3 cm ˘fi ÙÔ ÏÂ˘ÚÈÎfi ÙfiÍÔ), Û˘ÌÌÂÙÔ-¯‹ ÙˆÓ ÏÂÌÊ·‰¤ÓˆÓ, ÙÔ˘ ∫¡™, ÙˆÓ fiÚ¯ÂˆÓ, o ·ÚÈıÌfi˜ ÙˆÓÏÂ˘ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ (WBC <10x109/L, 10-25x109/L, 25-50x109/L 50-100x109/L, >100x109/L), Ë ÙÈÌ‹ ÙË˜ ·ÈÌÔÛÊ·ÈÚ›-ÓË˜ (Hb </≥10 g/dl), o ·ÚÈıÌfi˜ ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ(</≥100.000/mm3), Ë ÙÈÌ‹ ÙË˜ LDH (</≥1000 IU/L), Ô ·ÓÔ-ÛÔÊ·ÈÓfiÙ˘Ô˜ (ÚÔ-ÚÔ-B, ÚÔ-B, T-O§§, ‰ÈÊ·ÈÓÔÙ˘ÈÎ‹O§§, ·‰È·ÊÔÚÔÔ›ËÙË O§§) Î·È Ë Ù·ÍÈÓfiÌËÛË Î·Ù¿ NCI.

OÈ ‰È·ÊÔÚ¤˜ ÛÙ· ÔÛÔÛÙ¿ ÂÈ‚›ˆÛË˜ ÌÂÙ·Í‡ ÙˆÓ ‰È·Êfi-ÚˆÓ Î·ÙËÁÔÚÈÒÓ ÙˆÓ ·ÛıÂÓÒÓ ÂÎÙÈÌ‹ıËÎ·Ó ÌÂ ÙÔ 2-sidedlog-rank test (4). ∏ ÚÔÁÓˆÛÙÈÎ‹ ·Í›· ÙˆÓ ÎÏÈÓÈÎÒÓ Î·È ÂÚÁ·-ÛÙËÚÈ·ÎÒÓ ÌÂÙ·‚ÏËÙÒÓ ÙˆÓ ·ÛıÂÓÒÓ ·ÍÈÔÏÔÁ‹ıËÎÂ ÌÂ ÙËÓ·Ó¿Ï˘ÛË Cox-regression (5). °È· ÙËÓ ·Ó¿Ï˘ÛË ·˘Ù‹ Û˘ÌÂ-ÚÈÂÏ‹ÊıËÛ·Ó ÌfiÓÔ ÔÈ ·Ú¿ÌÂÙÚÔÈ Ô˘ Â›¯·Ó ÛÙ·ÙÈÛÙÈÎ¿ ÛË-Ì·ÓÙÈÎ‹ Â›‰Ú·ÛË ÛÙËÓ EFS (p log-rank <0,05). ∏ ÛÙ·ÙÈÛÙÈÎ‹ÂÂÍÂÚÁ·Û›· ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ ¤ÁÈÓÂ ÌÂ ÙÔ ·Î¤ÙÔ “SPSS forwindows” (version 10.0).

∞ÔÙÂÏ¤ÛÌ·Ù·∫ÏÈÓÈÎ¿ Î·È ÂÚÁ·ÛÙËÚÈ·Î¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿∞fi ÙÔ˘˜ 70 ·ÛıÂÓÂ›˜ ÙË˜ ÌÂÏ¤ÙË˜, 39 (55,7%)

‹Ù·Ó ·ÁfiÚÈ· Î·È 31 (44,2%) ÎÔÚ›ÙÛÈ·, ËÏÈÎ›·˜ 3 ÌË-ÓÒÓ ¤ˆ˜ Î·È 15 ÂÙÒÓ. ŒÓ·˜ ÂÎ ÙˆÓ ·ÛıÂÓÒÓ ‹Ù·Ó‚Ú¤ÊÔ˜, 46 Â›¯·Ó ËÏÈÎ›· 1-<6 ÂÙÒÓ Î·È 23 ≥6 ÂÙÒÓ,ÌÂ ‰È¿ÌÂÛË ËÏÈÎ›· Ù· 4,5 ¤ÙË. O ‰È¿ÌÂÛÔ˜ ·ÚÈıÌfi˜ÙˆÓ ÏÂ˘ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ ‹Ù·Ó 11,7x109/L (Â‡ÚÔ˜:0,13x109/L-185,8x109/L), ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ49.000/mm3 (Â‡ÚÔ˜: 8000/mm3-480.000/mm3), ÙË˜ÙÈÌ‹˜ ÙË˜ ·ÈÌÔÛÊ·ÈÚ›ÓË˜ 7,3 g/dl (Â‡ÚÔ˜: 3,5 g/dl-16,9 g/dl) Î·È ÙË˜ ÙÈÌ‹˜ ÙË˜ LDH 827 IU/L (Â‡ÚÔ˜:62 IU/L-5210 IU/L).

ªÂ ‚¿ÛË ÙËÓ Ù·ÍÈÓfiÌËÛË ÙˆÓ ·ÛıÂÓÒÓ ÛÂ ÔÌ¿-‰Â˜ ÎÈÓ‰‡ÓÔ˘ Û‡ÌÊˆÓ· ÌÂ Ù· ÎÚÈÙ‹ÚÈ· Ô˘ ÔÚ›˙ÂÈÙÔ ÚˆÙfiÎÔÏÏÔ BFM-90, 36 (51,4%) ·ÛıÂÓÂ›˜ ·Ó‹-Î·Ó ÛÙËÓ ÔÌ¿‰· ‚·ÛÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘ (standard-risk)Î·È 34 (48,6%) ÛÙËÓ ÔÌ¿‰· ÂÓ‰È¿ÌÂÛÔ˘ ÎÈÓ‰‡ÓÔ˘(medium-risk). ªÂ ‚¿ÛË ÙËÓ Î·Ù¿Ù·ÍË ÙˆÓ ·ÛıÂÓÒÓÛÂ ÔÌ¿‰Â˜ ÎÈÓ‰‡ÓÔ˘ Û‡ÌÊˆÓ· ÌÂ Ù· ÎÚÈÙ‹ÚÈ· NCI,41 (58,6%) ·ÛıÂÓÂ›˜ ÂÎÏ‹ÚˆÓ·Ó Ù· ÎÚÈÙ‹ÚÈ· ÙË˜ÔÌ¿‰·˜ ‚·ÛÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘ Î·È 29 (41,4%) ÙË˜ ÔÌ¿-‰·˜ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘. ∫·Ó¤Ó·˜ ·ÛıÂÓ‹˜ Î·Ù¿ ÙË‰È¿ÁÓˆÛË ‰ÂÓ Â›¯Â ‰È‹ıËÛË ÙÔ˘ ∫¡™ ‹ ÙˆÓ fiÚ¯ÂˆÓ.∏ Î·Ù¿Ù·Í‹ ÙÔ˘˜ ÛÂ ‰È¿ÊÔÚÂ˜ ÔÌ¿‰Â˜ ÛÂ Û¯¤ÛË ÌÂÙ· ÂÚÁ·ÛÙËÚÈ·Î¿ Î·È ÎÏÈÓÈÎ¿ Â˘Ú‹Ì·Ù· Î·È Ë ·ÓÙ›-ÛÙÔÈ¯Ë ÔÛÔÛÙÈ·›· Î·Ù·ÓÔÌ‹ ÙÔ˘˜ Û˘ÓÔ„›˙ÔÓÙ·ÈÛÙÔÓ ¶›Ó·Î· 2. ™ÙËÓ ∂ÈÎfiÓ· 2 Ê·›ÓÔÓÙ·È ÔÈ ÔÛÔÛÙÈ-·›Â˜ ·Ó·ÏÔÁ›Â˜ ÙˆÓ Î˘Ú›·Ú¯ˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÙˆÓ·ÛıÂÓÒÓ Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘˜.

∞ÍÈÔÛËÌÂ›ˆÙÔ Â›Ó·È fiÙÈ ÔÈ ·ÛıÂÓÂ›˜ ÌÂ ˘„ËÏfi

º¿ÛË ÂÊfi‰Ô˘

I M II

II

12 Gy*

12 Gy*HR1

HR2

HR3

HR2

HR3

HR2

HR3

HR1

HR1

M

M-A

I R

IA

OÌ¿‰· ‚·ÛÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘

OÌ¿‰· ÂÓ‰È¿ÌÂÛÔ˘ ÎÈÓ‰‡ÓÔ˘

OÌ¿‰· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘

∂‚‰ÔÌ¿‰Â˜0 5 11 21 28 30 104

º¿ÛË Â‰Ú·›ˆÛË˜ º¿ÛË Â·ÓÂÊfi‰Ô˘ º¿ÛË Û˘ÓÙ‹ÚËÛË˜

∂ÈÎfiÓ· 1. º¿ÛÂÈ˜ ıÂÚ·Â›·˜ ÚˆÙÔÎfiÏÏÔ˘ BFM-90.


288

·ÚÈıÌfi ÏÂ˘ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ WBC ≥50x109/L ·ÚÔ˘-Û›·˙·Ó ÛÙ·ÙÈÛÙÈÎÒ˜ ÛËÌ·ÓÙÈÎ¿ ˘„ËÏfiÙÂÚË ÙÈÌ‹ ÙË˜LDH (≥1000 IU/L) (∂ÈÎfiÓ· 3) Î·È ÛÙ·ÙÈÛÙÈÎÒ˜ ÛËÌ·ÓÙÈ-Î¿ ˘„ËÏfiÙÂÚ· ÔÛÔÛÙ¿ ÛÏËÓÔÌÂÁ·Ï›·˜ (p<0,05).

∞ÔÙÂÏ¤ÛÌ·Ù· ıÂÚ·Â›·˜O ‰È¿ÌÂÛÔ˜ ¯ÚfiÓÔ˜ ·Ú·Ù‹ÚËÛË˜ ÁÈ· ÙÔ Û‡ÓÔ-

ÏÔ ÙˆÓ ·ÛıÂÓÒÓ ‹Ù·Ó 53 Ì‹ÓÂ˜ (Â‡ÚÔ˜: 14 ËÌ¤ÚÂ˜-97 Ì‹ÓÂ˜). H Èı·ÓfiÙËÙ· EFS ‹Ù·Ó 77,14% (CI: 69-86%) Î·È Ë Èı·ÓfiÙËÙ· OS ‹Ù·Ó 82,35% (CI: 74-90%) (∂ÈÎfiÓÂ˜ 4 Î·È 5).

∆· ıÂÚ·Â˘ÙÈÎ¿ ·ÔÙÂÏ¤ÛÌ·Ù· ÙÔ˘ Û˘ÓfiÏÔ˘ÙˆÓ ·ÛıÂÓÒÓ Û˘ÓÔ„›˙ÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 3. ŒÓ·˜·ÛıÂÓ‹˜ Â›¯Â ÚfiˆÚÔ ı¿Ó·ÙÔ ÙÈ˜ ÚÒÙÂ˜ ËÌ¤ÚÂ˜ÙË˜ ıÂÚ·Â›·˜, ÂÓÒ Û˘ÓÔÏÈÎ¿ 3 ·ÛıÂÓÂ›˜ Î·Ù¤ÏË-Í·Ó ÛÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÚÒÙˆÓ 5 Â‚‰ÔÌ¿‰ˆÓ ÙË˜ ıÂ-Ú·Â›·˜ ÂÊfi‰Ô˘. ∞ÈÙ›· ı·Ó¿ÙÔ˘, fiˆ˜ ·˘Ù‹ Î·Ù·-ÁÚ·ÊfiÙ·Ó ÛÙ· ÈÛÙÔÔÈËÙÈÎ¿ ı·Ó¿ÙÔ˘, ‹Ù·Ó Ë ·È-ÌÔÚÚ·Á›·. ªÂÙ¿, fiÌˆ˜, ·fi ÏÂÙÔÌÂÚ‹ ·Ó¿Ï˘ÛËÙˆÓ Ê‡ÏÏˆÓ ÓÔÛËÏÂ›·˜ ‰È·ÈÛÙÒıËÎÂ fiÙÈ ·˘Ù‹ ‹Ù·ÓÙÔ ÙÂÏÈÎfi ·ÔÙ¤ÏÂÛÌ· ‚·ÚÈ¿˜ Ì˘ÂÏÈÎ‹˜ ·Ï·Û›·˜ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ·Ú·ÙÂÙ·Ì¤ÓË Ô˘‰ÂÙÂÚÔÂÓ›·Î·È Û˘Ó˘¿Ú¯Ô˘Û· ÏÔ›ÌˆÍË.

ÀÔÙÚÔ‹ ·ÚÔ˘Û›·Û·Ó 8 ·ÛıÂÓÂ›˜, 6 ÛÙÔÓÌ˘ÂÏfi Î·È 2 ÛÙÔ˘˜ fiÚ¯ÂÈ˜. ¢ÂÓ ˘‹Ú¯·Ó ‰È·ÊÔÚ¤˜ÛÂ Û¯¤ÛË ÌÂ ÙÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÂÌÊ¿ÓÈÛË˜ ÙË˜˘ÔÙÚÔ‹˜, Î·ıÒ˜ 4 ·ÛıÂÓÂ›˜ ·ÚÔ˘Û›·Û·Ó ˘Ô-ÙÚÔ‹ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ıÂÚ·Â›·˜ Î·È 4 Ì¤Û·ÛÙÔÓ ÚÒÙÔ ¯ÚfiÓÔ ·fi ÙËÓ ÔÏÔÎÏ‹ÚˆÛ‹ ÙË˜. ∆ÚÂÈ˜·ÛıÂÓÂ›˜ ·Ú·Ì¤ÓÔ˘Ó ÛÂ ‰Â‡ÙÂÚË Ï‹ÚË ‡ÊÂÛËÁÈ· ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· Ô˘ Î˘Ì·›ÓÂÙ·È ·fi 6 ¤ˆ˜ 23Ì‹ÓÂ˜ (‰È¿ÌÂÛÔ˜ ¯ÚfiÓÔ˜: 14 Ì‹ÓÂ˜), ÂÓÒ 5 ·ÛıÂ-ÓÂ›˜ Î·Ù¤ÏËÍ·Ó (ÛÂ ‰È¿ÛÙËÌ· ·fi 2 ¤ˆ˜ 6 Ì‹ÓÂ˜·fi ÙËÓ ¤Ó·ÚÍË ÙË˜ ıÂÚ·Â›·˜).

∫·Ù·‚ÔÏ‹31% ∞Ó·ÈÌ›·

36,6%

∂Î¯˘ÌÒÛÂÈ˜ÂÙ¤¯ÂÈÂ˜

21,1%∞ÚıÚ·ÏÁ›·

22,5%

¶˘ÚÂÙfi˜31%

∞ÓÔÚÂÍ›·-Î·Ù·‚ÔÏ‹18,3%

∂ÈÎfiÓ· 2. ∫·Ù·ÓÔÌ‹ (%) ÙˆÓ ·ÛıÂÓÒÓ Û‡ÌÊˆÓ· ÌÂ Ù· Î˘-Ú›·Ú¯· Û˘ÌÙÒÌ·Ù· Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹.

¶›Ó·Î·˜ 2. ∫·Ù·ÓÔÌ‹ (%) ÙˆÓ ·ÛıÂÓÒÓ Û‡ÌÊˆÓ· ÌÂ Ù· ÎÏÈ-ÓÈÎ¿ Î·È ÂÚÁ·ÛÙËÚÈ·Î¿ Â˘Ú‹Ì·Ù· ÂÈÛ·ÁˆÁ‹˜

ªÂÙ·‚ÏËÙ‹ ∞ÚÈıÌfi˜ ¶ÔÛÔÛÙfi ·ÛıÂÓÒÓ ·ÛıÂÓÒÓ (%)

ñ ∞ÚÈıÌfi˜ ÏÂ˘ÎÒÓ (x109/L)<10 32/70 45,810-25 14/70 2025-50 8/70 11,450-100 8/70 11,4≥100 8/70 11,4

ñ ∞ÈÌÔÛÊ·ÈÚ›ÓË (g/dl)≤10 57/70 81,4>10 13/70 18,6

ñ ∞ÈÌÔÂÙ¿ÏÈ· (/mm3)<100.000 57/70 81,4≥100.000 13/70 18,6

ñ LDH<1.000 40/66 60,6≥1.000 26/66 39,4

ñ ∏·ÙÔÌÂÁ·Ï›·<3 cm (˘fi ÏÂ˘ÚÈÎfi ÙfiÍÔ) 44/70 62,6≥3 cm 26/70 37,4

ñ ™ÏËÓÔÌÂÁ·Ï›·<3 cm (˘fi ÏÂ˘ÚÈÎfi ÙfiÍÔ) 42/70 60≥3 cm 28/70 40

ñ §ÂÌÊ·‰ÂÓÈÎ‹ ‰ÈfiÁÎˆÛË∞Ô˘Û›· 28/68 41,2¶·ÚÔ˘Û›· 40/68 58,8

ñ ∞ÓÔÛÔÊ·ÈÓfiÙ˘Ô˜¶ÚÔ-ÚÔ-µ 7/70 10¶ÚÔ-µ 60/70 85,8∆-O§§ 1/70 1,4¢ÈÊ·ÈÓÔÙ˘ÈÎ‹ O§§ 1/70 1,4∞‰È·ÊÔÚÔÔ›ËÙË O§§ 1/70 1,4 ∂ÈÎfiÓ· 3. ¢È¿ÁÚ·ÌÌ· ‰È·ÛÔÚ¿˜ ÙˆÓ ÙÈÌÒÓ ÙË˜ LDH ÛÂ Û¯¤-

ÛË ÌÂ ÙÔÓ ·ÚÈıÌfi ÏÂ˘ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ.

6000

5000

4000

3000

2000

1000

050.000 100.000 150.000 200.000

WBC

p<0,05

LDH

(IU

/L)


289

¶ÚÔÁÓˆÛÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜™ÙÔÓ ¶›Ó·Î· 4 ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ù· ıÂÚ·Â˘ÙÈÎ¿

·ÔÙÂÏ¤ÛÌ·Ù· Î·È Ë Èı·ÓfiÙËÙ· EFS ÛÂ Û¯¤ÛË ÌÂÙÈ˜ ÎÏÈÓÈÎ¤˜ Î·È ÂÚÁ·ÛÙËÚÈ·Î¤˜ ·Ú·Ì¤ÙÚÔ˘˜.Ÿˆ˜ ÚÔÎ‡ÙÂÈ, ‰˘ÛÌÂÓ‹ Â›‰Ú·ÛË ÛÙËÓ Èı·Ófi-ÙËÙ· EFS ÌÂ ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿ (p log-rank ≤0,05) Â›¯·Ó: Ô ·ÚÈıÌfi˜ ÙˆÓ ÏÂ˘ÎÒÓ ·ÈÌÔÛÊ·È-Ú›ˆÓ WBC ≥50x109/L, Ë ÙÈÌ‹ ÙË˜ LDH ≥1000 IU/L, ËËÏÈÎ›· (≤3 ÂÙÒÓ), Ë Ë·ÙÔÌÂÁ·Ï›· (≥3 cm), Ë ÛÏË-ÓÔÌÂÁ·Ï›· (≥3 cm) Î·È Ë Ù·ÍÈÓfiÌËÛË Î·Ù¿ NCI ÛÙËÓÔÌ¿‰· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ (∂ÈÎfiÓÂ˜ 6-11). OÈ ÌÂÙ·-‚ÏËÙ¤˜ Ô˘ ‚Ú¤ıËÎÂ fiÙÈ Â›¯·Ó ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹Â›‰Ú·ÛË ÛÙË Èı·ÓfiÙËÙ· EFS (p log-rank <0,05),Û˘ÌÂÚÈÂÏ‹ÊıËÛ·Ó ÛÙËÓ ·Ó¿Ï˘ÛË Cox regression.∞˘Ù‹ ·ÔÎ¿Ï˘„Â fiÙÈ ÈÛ¯˘ÚfiÙÂÚÔ˜ ‰˘ÛÌÂÓ‹˜ ÚÔ-ÁÓˆÛÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ‹Ù·Ó Ô ·ÚÈıÌfi˜ ÙˆÓ ÏÂ˘ÎÒÓ·ÈÌÔÛÊ·ÈÚ›ˆÓ, WBC ≥50x109/L (¶›Ó·Î·˜ 5).

™˘˙‹ÙËÛË ªÂ Ù· Û‡Á¯ÚÔÓ· ıÂÚ·Â˘ÙÈÎ¿ ÚˆÙfiÎÔÏÏ·, Ù·

ÔÛÔÛÙ¿ ÂÈ‚›ˆÛË˜ ÙˆÓ ·ÛıÂÓÒÓ ÌÂ ·È‰ÈÎ‹ O§§Ô˘ ÂÈ‚ÈÒÓÔ˘Ó ÂÏÂ‡ıÂÚÔÈ ÓfiÛÔ˘ (pEFS) Î˘Ì·›ÓÔ-ÓÙ·È ·fi 63% ¤ˆ˜ 83% (6-16). °È· ÙÔ˘˜ ·ÛıÂÓÂ›˜ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜, ÙÔ ÔÛÔÛÙfi EFS ‹Ù·Ó77,14% (CI: 69-86%) Î·È ÙÔ ÔÛÔÛÙfi OS ‹Ù·Ó82,35% (CI: 74-90%). ∆· ·ÔÙÂÏ¤ÛÌ·Ù· ·˘Ù¿ Â›Ó·ÈÛÂ ·fiÏ˘ÙË ·ÓÙÈÛÙÔÈ¯›· ÌÂ Ù· ‰ËÌÔÛÈÂ˘Ì¤Ó· ·Ô-

ÙÂÏ¤ÛÌ·Ù· ·fi ÙËÓ ÔÏ˘ÎÂÓÙÚÈÎ‹ ÌÂÏ¤ÙË ÙÔ˘BFM-90 Ô˘ ‹Ù·Ó 78,1±1% Î·È 85±1%, ·ÓÙ›ÛÙÔÈ-¯· (6). ∆· ·ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ÎÚ›ÓÔÓÙ·È ÔÏ‡ ÈÎ·ÓÔÔÈËÙÈÎ¿ Î·È Â›Ó·È ÛÂ Ï‹ÚË·ÓÙÈÛÙÔÈ¯›· ÌÂ Ù· ‰ÈÂıÓ‹ ‰Â‰ÔÌ¤Ó·. ∞˘Ùfi ÌÔÚÂ›Ó· ·Ô‰ÔıÂ› ÛÙËÓ ÈÛÙ‹ ÂÊ·ÚÌÔÁ‹ Î·È Ù‹ÚËÛË Î·-ıÈÂÚˆÌ¤ÓˆÓ ‰ÈÂıÓÒÓ ÚˆÙÔÎfiÏÏˆÓ. Ÿˆ˜ Â›Ó·ÈÁÓˆÛÙfi, Ë O§§ ıÂˆÚÂ›Ù·È ÙÔ ÚfiÙ˘Ô ÓfiÛËÌ·ÂÊ·ÚÌÔÁ‹˜ ÂÈÙ˘¯ËÌ¤ÓˆÓ ıÂÚ·Â˘ÙÈÎÒÓ ·ÚÂÌ-‚¿ÛÂˆÓ, Ì¤Ûˆ Â˘Ú¤ˆÓ Ù˘¯·ÈÔÔÈËÌ¤ÓˆÓ ÎÏÈÓÈÎÒÓÌÂÏÂÙÒÓ, ÌÂ ·ÔÙ¤ÏÂÛÌ· ÙË ÛËÌ·ÓÙÈÎ‹ ·‡ÍËÛË ÙË˜ÂÈ‚›ˆÛË˜ ÙˆÓ ·ÛıÂÓÒÓ. ∂›Ó·È ÔÏ‡ ÛËÌ·ÓÙÈÎfi ÛÙË

∂ÈÎfiÓ· 4. Kaplan-Meier ÂÎÙ›ÌËÛË ÙË˜ OS ÁÈ· ÙÔ Û‡ÓÔÏÔ ÙˆÓ·ÛıÂÓÒÓ.

∂ÈÎfiÓ· 5. Kaplan-Meier ÂÎÙ›ÌËÛË ÙË˜ EFS ÁÈ· ÙÔ Û‡ÓÔÏÔ ÙˆÓ·ÛıÂÓÒÓ.

1,0

0,8

0,6

0,4

0,2

0

1,0

0,8

0,6

0,4

0,2

00 20 40 60 80 100 0 20 40 60 80 100

ª‹ÓÂ˜ ª‹ÓÂ˜

p O

S

p E

FS

¶›Ó·Î·˜ 3. ∞ÔÙÂÏ¤ÛÌ·Ù· ıÂÚ·Â›·˜

∞ÔÙÂÏ¤ÛÌ·Ù· ¡ (/70)

ñ ÀÔÙÚÔ‹™ÙË ‰È¿ÚÎÂÈ· ÙË˜ ıÂÚ·Â›·˜ 4ªÂÙ¿ ÙÔ ¤Ú·˜ ÙË˜ ıÂÚ·Â›·˜ 4ª˘ÂÏfi˜ 6ŸÚ¯ÂÈ˜ 2™‡ÓÔÏÔ 8

ñ £¿Ó·ÙÔÈ¶ÚfiˆÚÔ˜ ı¿Ó·ÙÔ˜ 1™ÙË Ê¿ÛË ÂÊfi‰Ô˘ 4™ÙË Ê¿ÛË Â·ÓÂÊfi‰Ô˘ 2ªÂÙ¿ ·fi ˘ÔÙÚÔ‹ 5™‡ÓÔÏÔ 12

ñ ™˘ÓÂ¯È˙fiÌÂÓË Ï‹ÚË˜ ‡ÊÂÛË 58


290

¯ÒÚ· Ì·˜, Ë ÔÔ›· ÏfiÁˆ ÙÔ˘ ÌÈÎÚÔ‡ ·ÚÈıÌÔ‡ ·ÛıÂ-ÓÒÓ ‰ÂÓ ÌÔÚÂ› Ó· Û˘ÌÌÂÙ¤¯ÂÈ ÛÙÔÓ Û¯Â‰È·ÛÌfi Ó¤-ˆÓ ıÂÚ·Â˘ÙÈÎÒÓ ÛÙÚ·ÙËÁÈÎÒÓ, Ó· ˘ÈÔıÂÙÔ‡ÓÙ·È‰ÈÂıÓ‹ ÚˆÙfiÎÔÏÏ· ÌÂ ·Ô‰Â‰ÂÈÁÌ¤ÓË ˘„ËÏ‹ ·Ô-ÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Î·È ¯·ÌËÏ‹ ÙÔÍÈÎfiÙËÙ·.

∏ ¯ÚËÛÈÌÔÔ›ËÛË ‰È·ÊfiÚˆÓ ÚÔÁÓˆÛÙÈÎÒÓ ·-Ú·ÁfiÓÙˆÓ ÁÈ· ÙÔÓ Î·ıÔÚÈÛÌfi ÙË˜ ıÂÚ·Â›·˜ ¤¯ÂÈ·Ó·ÌÊ›‚ÔÏ· Û˘Ì‚¿ÏÂÈ ÛÙË ‚ÂÏÙ›ˆÛË ÙˆÓ ıÂÚ·Â˘-ÙÈÎÒÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ Î·È ÛÙËÓ ÂÏ¿ÙÙˆÛË ÙˆÓ ·Ò-ÙÂÚˆÓ ÂÈÏÔÎÒÓ. ™ËÌ·ÓÙÈÎ¤˜ ÚÔÛ¿ıÂÈÂ˜ ¤¯Ô˘ÓÁ›ÓÂÈ ÁÈ· ÙË ı¤ÛÈÛË ÔÌfiÊˆÓ· ·Ô‰ÂÎÙÒÓ ÚÔÁÓˆ-ÛÙÈÎÒÓ ÎÚÈÙËÚ›ˆÓ ÁÈ· ÙËÓ ·È‰ÈÎ‹ O§§. ∞˘Ù¿ Ù· ÎÚÈ-Ù‹ÚÈ· Â›Ó·È ··Ú·›ÙËÙ· ÁÈ· ÙË Û‡ÁÎÚÈÛË ÙˆÓ ·ÔÙÂ-ÏÂÛÌ¿ÙˆÓ ‰È·ÊfiÚˆÓ ıÂÚ·Â˘ÙÈÎÒÓ ÚˆÙÔÎfiÏÏˆÓ·fi ‰È·ÊÔÚÂÙÈÎ¤˜ ÔÌ¿‰Â˜ ÌÂÏ¤ÙË˜.

™ÙË ƒÒÌË, ÙÔ 1985, ¤ÁÈÓÂ Ë ÚÒÙË ÛÔ‚·Ú‹ ÚÔ-Û¿ıÂÈ· ÌÂ ÙË ÌÔÚÊ‹ Û˘ÛÙ¿ÛÂˆÓ ÁÈ· ÙËÓ Î·ÙËÁÔ-ÚÈÔÔ›ËÛË ÙË˜ ·È‰ÈÎ‹˜ O§§ ÛÂ 2 ÔÌ¿‰Â˜ ÎÈÓ‰‡ÓÔ˘,ÙËÓ ÔÌ¿‰· ‚·ÛÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘ (standard risk - SR)

Î·È ÙËÓ ÔÌ¿‰· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ (high risk - HR),Û‡ÌÊˆÓ· ÌÂ ÙÔÓ ·ÚÈıÌfi ÙˆÓ ÏÂ˘ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓÎ·È ÙËÓ ËÏÈÎ›· Î·Ù¿ ÙË ‰È¿ÁÓˆÛË (17). ∞ÚÁfiÙÂÚ·, ÙÔ1993, ÙÔ NCI Û˘ÌÊÒÓËÛÂ ÌÂ Ù· ÎÚÈÙ‹ÚÈ· ÙË˜ ƒÒÌË˜Î·È ıÂÛ›ÛÙËÎ·Ó Ù· ÎÔÈÓ¿ ÎÚÈÙ‹ÚÈ· NCπ (18).

™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË, ÔÈ ·ÛıÂÓÂ›˜ Ô˘ ÏËÚÔ‡-Û·Ó Ù· ÎÚÈÙ‹ÚÈ· ÙË˜ ÔÌ¿‰·˜ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ Î·Ù¿NCI Â›¯·Ó ÛÙ·ÙÈÛÙÈÎÒ˜ ÛËÌ·ÓÙÈÎ¿ ¯·ÌËÏfiÙÂÚË È-ı·ÓfiÙËÙ· ∂FS ÛÂ Û¯¤ÛË ÌÂ ÙÔ˘˜ ·ÛıÂÓÂ›˜ ÙË˜ ÔÌ¿-‰·˜ ‚·ÛÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘, ÌÂ Èı·ÓfiÙËÙ· EFS65,52±7% Î·È 85,37±5%, ·ÓÙ›ÛÙÔÈ¯·. ∆· ·ÔÙÂÏ¤-ÛÌ·Ù· ·˘Ù¿ ÌÔÚÔ‡Ó Ó· Û˘ÁÎÚÈıÔ‡Ó Î·È Û˘ÌÊˆ-ÓÔ‡Ó ÌÂ ·˘Ù¿ ¿ÏÏˆÓ ÂÚÂ˘ÓËÙÒÓ, fiˆ˜ ·˘Ù¿ ÙÔ˘BFM-90 Û‡ÌÊˆÓ· ÌÂ Ù· ÔÔ›· ÁÈ· ÙËÓ ÔÌ¿‰· ‚·ÛÈ-ÎÔ‡ ÎÈÓ‰‡ÓÔ˘ Ë Èı·ÓfiÙËÙ· EFS ‹Ù·Ó 86±1% (6)Î·È ÌÂ Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÙˆÓ ·ÛıÂÓÒÓ ÌÂ µ-O§§Ô˘ ¤Ï·‚·Ó ıÂÚ·Â›· ÌÂ Ù· ÚˆÙfiÎÔÏÏ· POG(Alinc-14) (Pediatric Oncology Group) ‹ CCG(Children’s Cancer Group) (CCG 100 Î·È CCG-

¶›Ó·Î·˜ 4. ¶ÚÔÁÓˆÛÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ Î·È Èı·ÓfiÙËÙ· ÂÏÂ‡ıÂÚË˜ ÓfiÛÔ˘ ÂÈ‚›ˆÛË˜ (EFS)

ªÂÙ·‚ÏËÙ‹ ∞ÚÈıÌfi˜ ·ÛıÂÓÒÓ (%) ∂FS (SE) P (log-rank)

ñ ™‡ÓÔÏÔ 70 77,14% (4)∞ÁfiÚÈ· 39/70 (55,7) 76,92% (6) 0,97∫ÔÚ›ÙÛÈ· 31/70 (44,3) 77,42% (6)

ñ ∏ÏÈÎ›· (¤ÙË)≤3 18/70 61,11% (9) 0,04>3 52/70 82,69% (4)

ñ NCI ÔÌ¿‰Â˜ ÎÈÓ‰‡ÓÔ˘µ·ÛÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘ 41/70 (58,6) 85,37% (5) 0,05À„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ 29/70 (41,4) 65,52% (7)

ñ ∞ÓÔÛÔÊ·ÈÓfiÙ˘Ô˜¶ÚÔ-ÚÔ-µ 7/70 (10) 71,43% (7) 0,0000¶ÚÔ-µ 60/70 (85,7) 81,67% (4)ÕÏÏÔ* 3/70 (4,3) 0

ñ ∞ÚÈıÌfi˜ ÏÂ˘ÎÒÓ (x109/L)<50 54/70 (77,1) 85,19% (4) 0,002≥50 16/70 (22,9) 50% (13)

ñ ∞ÈÌÔÛÊ·ÈÚ›ÓË (g/dl)≤10 57/70 (81,4) 80,7% (5) 0,14>10 13/70 (18,6) 61,54% (11)

ñ ∞ÈÌÔÂÙ¿ÏÈ· (/mm3)<100.000 57/70 (81,4) 75,44% (13) 0,45≥100.000 13/70 (18,6) 84,62% (9)

ñ LDH (IU/L)<1000 40/66 (60,6) 82,5% (5) 0,05≥1000 26/66 (39,4) 65,38% (7)

ñ ∏·ÙÔÌÂÁ·Ï›·<3 cm 44/70 (62,6) 84,09% (5) 0,05≥3 cm 26/70 (37,4) 65,38% (8)

ñ ™ÏËÓÔÌÂÁ·Ï›·<3 cm 42/70 (60) 88,1% (4) 0,01≥3 cm 28/70 (40) 60,7% (7)

ñ §ÂÌÊ·‰ÂÓÈÎ‹ ‰ÈfiÁÎˆÛË∞Ô˘Û›· 28/68 (41,2) 82,14% (6) 0,5¶·ÚÔ˘Û›· 40/68 (58,9) 75% (5)

* T-O§§, ‰ÈÊ·ÈÓÔÙ˘ÈÎ‹ O§§, ·‰È·ÊÔÚÔÔ›ËÙË O§§

1800) Ô˘ Â›¯·Ó 80,3% Èı·ÓfiÙËÙ· ÙÂÙÚ·ÂÙÔ‡˜ EFS(18). ∞ÓÙÈÛÙÔ›¯ˆ˜, Û˘ÁÎÚ›ÛÈÌ· Â›Ó·È Î·È Ù· ·ÔÙÂÏ¤-ÛÌ·Ù· ÁÈ· ÙËÓ ÔÌ¿‰· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ·fi ÙÔBFM-90 Î·È CCG/POG Ô˘ ‹Ù·Ó 64±2% Î·È 63,9%,·ÓÙ›ÛÙÔÈ¯· (6,18).

O ·ÚÈıÌfi˜ ÙˆÓ ÏÂ˘ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ Â›Ó·È ¤Ó·˜·Ó·ÁÓˆÚÈÛÌ¤ÓÔ˜ ÚÔÁÓˆÛÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜. ™‡Ì-ÊˆÓ· ÌÂ Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜,ÔÈ ·ÛıÂÓÂ›˜ ÌÂ ·ÚÈıÌfi ÏÂ˘ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ WBC≥50x109/L Â›¯·Ó ÛÙ·ÙÈÛÙÈÎ¿ ‰˘ÛÌÂÓ¤ÛÙÂÚË ¤Î‚·ÛËÛÂ Û¯¤ÛË ÌÂ ÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ WBC <50x109/L ÌÂÈı·ÓfiÙËÙ· EFS 85,19±4% Î·È 50±13%, ·ÓÙ›ÛÙÔÈ-¯·. ™ÙËÓ Cox regression ·Ó¿Ï˘ÛË, Ô ·ÚÈıÌfi˜ ÙˆÓÏÂ˘ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ WBC ≥50x109/L ·Ó·‰Â›¯ÙËÎÂˆ˜ Ô ÈÔ ÛËÌ·ÓÙÈÎfi˜ ‰˘ÛÌÂÓ‹˜ ·Ú¿ÁÔÓÙ·˜ ÁÈ· ÙËÓÂÏÂ‡ıÂÚË ÓfiÛÔ˘ ÂÈ‚›ˆÛË Î·È Ê¿ÓËÎÂ fiÙÈ ÔÈ ·ÛıÂ-ÓÂ›˜ ÌÂ WBC ≥50x109/L Â›¯·Ó 2,78 ÊÔÚ¤˜ ÌÂÁ·Ï‡-ÙÂÚÔ Î›Ó‰˘ÓÔ ÁÈ· ˘ÔÙÚÔ‹ ‹ ı¿Ó·ÙÔ (Û¯ÂÙÈÎfi˜ Î›Ó-‰˘ÓÔ˜: 2,78, 95% CI: 1,12-8,2) ÛÂ Û¯¤ÛË ÌÂ ÙÔ˘˜·ÛıÂÓÂ›˜ ÌÂ WBC <50x109/L.

¢ÂÓ ˘¿Ú¯ÂÈ ·fiÏ˘ÙË ÔÌÔÊˆÓ›· ÌÂÙ·Í‡ ÙˆÓÂÚÂ˘ÓËÙÒÓ ÁÈ· ÙÔÓ Î·ıÔÚÈÛÌfi ÙÔ˘ ÎÚ›ÛÈÌÔ˘ ·ÚÈı-ÌÔ‡ ÙˆÓ ÏÂ˘ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ ÁÈ· ÙËÓ Î·Ù¿Ù·ÍËÙˆÓ ·ÛıÂÓÒÓ ÛÂ ÔÌ¿‰Â˜ ÎÈÓ‰‡ÓÔ˘. ¶ÈÔ Û˘ÁÎÂÎÚÈÌ¤-Ó·, ÔÚÈÛÌ¤ÓÂ˜ ÔÌ¿‰Â˜, fiˆ˜ Ë ÔÌ¿‰· ÙÔ˘ St Jude’sResearch Hospital (SJCRH) (13), Û˘ÌÂÚÈÏ·Ì‚¿-ÓÔ˘Ó Ù· ·È‰È¿ ÌÂ ·ÚÈıÌfi ÏÂ˘ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ≥25x109/L ÛÙËÓ ÔÌ¿‰· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘. ÕÏÏÂ˜

ÔÌ¿‰Â˜, fiˆ˜ Ë ÔÌ¿‰· ÙÔ˘ Nordic Society ofPediatric Hematology and Oncology (NOPHO) (16)Î·È Ë ÔÌ¿‰· ÙÔ˘ CCG (8), Î·Ù·Ù¿ÛÛÔ˘Ó ÛÂ ÔÌ¿‰·˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ Ù· ·È‰È¿ ÌÂ ·ÚÈıÌfi ÏÂ˘ÎÒÓ ·ÈÌÔ-ÛÊ·ÈÚ›ˆÓ ≥50x109/L, ÂÓÒ ÔÈ ÔÌ¿‰Â˜ POG (12) Î·ÈDFCI (Dana Farber Cancer Institute) (15) ¯ÚËÛÈÌÔÔÈ-Ô‡Ó ˆ˜ ÎÚÈÙ‹ÚÈÔ ÙÔÓ ·ÚÈıÌfi ÙˆÓ ÏÂ˘ÎÒÓ ·ÈÌÔÛÊ·È-Ú›ˆÓ ≥100x109/L ÁÈ· ÙËÓ Ù·ÍÈÓfiÌËÛË ÙˆÓ ·È‰ÈÒÓ ÛÂÔÌ¿‰· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ Î·È ÙË ıÂÚ·Â›· ÙÔ˘˜ ÌÂ ÈÔÂÓÙ·ÙÈÎ¿ Î·È ÂÈıÂÙÈÎ¿ Û¯‹Ì·Ù· ıÂÚ·Â›·˜.

∆Ô ˘„ËÏfi ÊÔÚÙ›Ô ÙÔ˘ fiÁÎÔ˘ Û˘Û¯ÂÙ›˙ÂÙ·È ÎÏÈÓÈ-Î¿ ÌÂ ÙËÓ Ë·ÙÔÌÂÁ·Ï›·, ÙË ÛÏËÓÔÌÂÁ·Ï›· Î·È ÙËÏÂÌÊ·‰ÂÓÈÎ‹ ‰ÈfiÁÎˆÛË. ∏ ‡·ÚÍË Ë·ÙÔÌÂÁ·Ï›·˜‹ ÛÏËÓÔÌÂÁ·Ï›·˜ Â›Ó·È ‰‡Ô ÚÔÁÓˆÛÙÈÎÔ› ·Ú¿-ÁÔÓÙÂ˜ Ô˘ Â›Ó·È ÂÓÛˆÌ·ÙˆÌ¤ÓÔÈ ÛÂ ·ÚÎÂÙ¿ ıÂÚ·-Â˘ÙÈÎ¿ ÚˆÙfiÎÔÏÏ· ÌÂ ÙË ÌÔÚÊ‹ ÙÔ˘ BFM-RF,fiˆ˜ ÈÛ¯‡ÂÈ ÁÈ· ÙÈ˜ ÔÌ¿‰Â˜ BFM (6), AIEOP (ItalianAssociation of Pediatric Hematology and Oncology)(7) Î·È DCLSG (Dutch Childhood Leukemia StudyGroup) (10). ÕÏÏÂ˜ ÔÌ¿‰Â˜, fiˆ˜ Ë NOPHO (16), ËDFCI (15), Ë CCG (8) Î·È Ë POG (12), Â›ÛË˜ Û˘-ÌÂÚÈÏ·Ì‚¿ÓÔ˘Ó ·˘ÙÔ‡˜ ÙÔ˘˜ ·ÛıÂÓÂ›˜ ÛÂ ÔÌ¿‰·˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘.

™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË, ÔÈ ·ÛıÂÓÂ›˜ ÌÂ Ë·ÙÔÌÂ-Á·Ï›· ‹ ÛÏËÓÔÌÂÁ·Ï›· (≥3 cm ˘fi ÙÔ ÏÂ˘ÚÈÎfiÙfiÍÔ) Â›¯·Ó ÛÙ·ÙÈÛÙÈÎÒ˜ ÛËÌ·ÓÙÈÎ¿ ÌÈÎÚfiÙÂÚ· ÔÛÔ-ÛÙ¿ EFS ÌÂ ÙÈÌ¤˜ 65,38±8% Î·È 60,7±7%, ·ÓÙ›ÛÙÔÈ-¯·, ÛÂ Û¯¤ÛË ÌÂ ÙÔ˘˜ ·ÛıÂÓÂ›˜ ¯ˆÚ›˜ Ë·ÙÔÌÂÁ·Ï›·


291

∂ÈÎfiÓ· 6. Kaplan-Meier ÂÎÙ›ÌËÛË ÙË˜ EFS ÛÂ Û¯¤ÛË ÌÂ ÙÔÓ·ÚÈıÌfi ÏÂ˘ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ.

∂ÈÎfiÓ· 7. Kaplan-Meier ÂÎÙ›ÌËÛË ÙË˜ EFS ÛÂ Û¯¤ÛË ÌÂ Ù·ÎÚÈÙ‹ÚÈ· NCI.

1,0

0,8

0,6

0,4

0,2

0

1,0

0,8

0,6

0,4

0,2

00 20 40 60 80 100 0 20 40 60 80 100


p E

FS

p E

FS

WBC<50.000/ÌL NCI, ‚·ÛÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘

NCI, ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘

p=0,05

WBC≥50.000/ÌL

p=0,002


292

‹ ÛÏËÓÔÌÂÁ·Ï›· ÌÂ EFS 84,09±5% Î·È 88,1±4%,·ÓÙ›ÛÙÔÈ¯·. ∞Ó Î·È ÔÈ ·ÛıÂÓÂ›˜ ÌÂ ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ·Â›¯·Ó ÌÈÎÚfiÙÂÚË Èı·ÓfiÙËÙ· EFS (ÙÈÌ‹: 75±5%) ÛÂÛ¯¤ÛË ÌÂ ÙÔ˘˜ ·ÛıÂÓÂ›˜ ¯ˆÚ›˜ ÏÂÌÊ·‰ÂÓÈÎ‹ Û˘Ì-ÌÂÙÔ¯‹ (ÙÈÌ‹: 82,14±6%), Ë ‰È·ÊÔÚ¿ ‹Ù·Ó ÛÙ·ÙÈÛÙÈ-Î¿ ÌË ÛËÌ·ÓÙÈÎ‹. ∆· ·ÔÙÂÏ¤ÛÌ·Ù· ·˘Ù¿ Â›Ó·È Û˘-ÁÎÚ›ÛÈÌ· ÌÂ Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ·fi ÙËÓ ÔÌ¿‰· BFM-90 ÛÂ Û¯¤ÛË ÌÂ ÙËÓ ‡·ÚÍË Ë·ÙÔÌÂÁ·Ï›·˜ ‹ ÛÏË-ÓÔÌÂÁ·Ï›·˜ Ô˘ ‹Ù·Ó 71±1% Î·È 68±2% (6).

∏ ÙÈÌ‹ ÙË˜ LDH ÛÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË Â›¯Â ÛË-Ì·ÓÙÈÎ‹ ÚÔÁÓˆÛÙÈÎ‹ ·Í›· ÁÈ· ÙËÓ ÂÈ‚›ˆÛË ÙˆÓ·ÛıÂÓÒÓ. OÈ ·ÛıÂÓÂ›˜ ÌÂ ÙÈÌ‹ LDH ≥1000 IU/L Â›-¯·Ó ÛÙ·ÙÈÛÙÈÎÒ˜ ÛËÌ·ÓÙÈÎ¿ ÌÈÎÚfiÙÂÚÔ ÔÛÔÛÙfiEFS ÛÂ Û¯¤ÛË ÌÂ ÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ ÙÈÌ‹ LDH <1000IU/L, ÌÂ Èı·ÓfiÙËÙ· EFS 65,38±7% Î·È 84,09±5%,·ÓÙ›ÛÙÔÈ¯·. ∂ÈÏ¤ÔÓ, ˘‹Ú¯Â ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈ-Î‹ Û˘Û¯¤ÙÈÛË ÙË˜ ÙÈÌ‹˜ ÙË˜ LDH ÌÂ ÙÔÓ ·ÚÈıÌfi ÙˆÓÏÂ˘ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ. ∞˘Ù¿ Ù· ·ÔÙÂÏ¤ÛÌ·Ù· Â›Ó·ÈÛÂ Û˘ÌÊˆÓ›· ÌÂ Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÙˆÓ Pui Î·È Û˘Ó,ÛÙË ÌÂÏ¤ÙË ÙˆÓ ÔÔ›ˆÓ Ë LDH Â›¯Â ÛÙ·ÙÈÛÙÈÎ¿ ÛË-Ì·ÓÙÈÎ‹ Û˘Û¯¤ÙÈÛË ÌÂ ÙÔÓ ·ÚÈıÌfi ÙˆÓ ÏÂ˘ÎÒÓ ·ÈÌÔ-ÛÊ·ÈÚ›ˆÓ Î·È ‰˘ÛÌÂÓ‹ ÚÔÁÓˆÛÙÈÎ‹ ·Í›· ÁÈ· ÙËÓÂÏÂ‡ıÂÚË ÓfiÛÔ˘ ÂÈ‚›ˆÛË (19).

O ·ÚÈıÌfi˜ ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ Î·È Ë ÙÈÌ‹ ÙË˜ ·È-ÌÔÛÊ·ÈÚ›ÓË˜ ‰ÂÓ Â›¯·Ó ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ Â›-‰Ú·ÛË ÛÙËÓ Èı·ÓfiÙËÙ· EFS. ∞˘Ùfi Â›Ó·È ÛÂ Û˘ÌÊˆ-Ó›· ÌÂ ÙÈ˜ Û‡Á¯ÚÔÓÂ˜ ÌÂÏ¤ÙÂ˜, ÛÙÈ˜ ÔÔ›Â˜ ÙfiÛÔ Ô·ÚÈıÌfi˜ ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ, fiÛÔ Î·È Ë ÙÈÌ‹ ÙË˜ ·È-

ÌÔÛÊ·ÈÚ›ÓË˜ ‰ÂÓ Û˘ÌÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÛÙ· ıÂÚ·-Â˘ÙÈÎ¿ ÚˆÙfiÎÔÏÏ· ÁÈ· ÙËÓ Ù·ÍÈÓfiÌËÛË ÙˆÓ ·ÛıÂ-ÓÒÓ ÛÂ ÔÌ¿‰Â˜ ÎÈÓ‰‡ÓÔ˘ (20).

ŸÛÔÓ ·ÊÔÚ¿ ÛÙÔ Ê‡ÏÔ, Ù· ÔÛÔÛÙ¿ ÙË˜ ÂÏÂ‡-ıÂÚË˜ ÓfiÛÔ˘ ÂÈ‚›ˆÛË˜ ‰ÂÓ Â›¯·Ó ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·-ÓÙÈÎ‹ ‰È·ÊÔÚ¿ ·Ó¿ÌÂÛ· ÛÙ· ·ÁfiÚÈ· Î·È Ù· ÎÔÚ›ÙÛÈ·,ÌÂ ÙÈÌ¤˜ 76,92±6% Î·È 78,13±6%, ·ÓÙ›ÛÙÔÈ¯·. ∆··ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ Û˘ÌÊˆÓÔ‡ÓÌÂ Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÙˆÓ Steinherz Î·È Û˘Ó (21) Î·ÈGustafsson Î·È Û˘Ó (22) ·fi ÙÈ˜ ÔÌ¿‰Â˜ CCG Î·ÈNOPHO ·ÓÙ›ÛÙÔÈ¯·, ÛÙÈ˜ ÔÔ›Â˜ ‰ÂÓ ˘‹Ú¯Â ‰È·ÊÔ-Ú¿ ÛÙËÓ ÂÈ‚›ˆÛË ÛÂ Û¯¤ÛË ÌÂ ÙÔ Ê‡ÏÔ. ∞ÓÙ›ıÂÙ·,fiÌˆ˜, Û‡ÌÊˆÓ· ÌÂ Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ ÔÌ¿‰·˜BFM-90, Ù· ·ÁfiÚÈ· Â›¯·Ó ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ¿ ‰˘-ÛÌÂÓ¤ÛÙÂÚË ¤Î‚·ÛË ÛÂ Û¯¤ÛË ÌÂ Ù· ÎÔÚ›ÙÛÈ· (6).

™‡ÌÊˆÓ· ÌÂ Ù· ‰ËÌÔÛÈÂ˘Ì¤Ó· ·ÔÙÂÏ¤ÛÌ·Ù·ÙÔ˘ BFM-90, ·ÓÂÍ¿ÚÙËÙÔ˜ ‰˘ÛÌÂÓ‹˜ ÚÔÁÓˆÛÙÈÎfi˜·Ú¿ÁÔÓÙ·˜ ‹Ù·Ó Ë ËÏÈÎ›· <1 ¤ÙÔ˘˜ ‹ >6 ÂÙÒÓ (6).°È· ÙÔ˘˜ ·ÛıÂÓÂ›˜ ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ ‰ÂÓ˘‹Ú¯Â ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿ ÛÙËÓ Èı·-ÓfiÙËÙ· EFS ÌÂ ‚¿ÛË ÙËÓ ËÏÈÎ›· ÙˆÓ 6 ÂÙÒÓ. ∂ÈÏ¤-ÔÓ, ÛÂ ·ÓÙ›ıÂÛË ÌÂ ÙÈ˜ Û‡Á¯ÚÔÓÂ˜ ÌÂÏ¤ÙÂ˜ fiÔ˘ Ë‚ÚÂÊÈÎ‹ O§§ ·Ó·ÁÓˆÚ›˙ÂÙ·È ˆ˜ ÍÂ¯ˆÚÈÛÙ‹ ‚ÈÔÏÔÁÈ-Î‹ ÔÓÙfiÙËÙ· ÌÂ ‰˘ÛÌÂÓ‹ ÚfiÁÓˆÛË (23), ÛÙËÓ ·-ÚÔ‡Û· ÌÂÏ¤ÙË ˘‹Ú¯Â 1 ‚Ú¤ÊÔ˜ Ô˘ ‚Ú›ÛÎÂÙ·È ÛÂÛ˘ÓÂ¯È˙fiÌÂÓË Ï‹ÚË ‡ÊÂÛË. ∞Í›˙ÂÈ Ó· ÛËÌÂÈˆıÂ› fiÙÈÔ ·ÚÈıÌfi˜ ·˘Ùfi˜ ‰ÂÓ ÂÈÙÚ¤ÂÈ Û˘ÁÎÚ›ÛÂÈ˜ Î·È ‰ÂÓ‚ÔËı¿ ÛÙËÓ ÂÍ·ÁˆÁ‹ ·ÛÊ·ÏÒÓ Û˘ÌÂÚ·ÛÌ¿ÙˆÓ.

∂ÈÎfiÓ· 8. Kaplan-Meier ÂÎÙ›ÌËÛË ÙË˜ EFS ÛÂ Û¯¤ÛË ÌÂ ÙËÓË·ÙÔÌÂÁ·Ï›·.

∂ÈÎfiÓ· 9. Kaplan-Meier ÂÎÙ›ÌËÛË ÙË˜ EFS ÛÂ Û¯¤ÛË ÌÂ ÙËÛÏËÓÔÌÂÁ·Ï›·.

1,0

0,8

0,6

0,4

0,2

0

1,0

0,8

0,6

0,4

0,2

00 20 40 60 80 100 0 20 40 60 80 100


p E

FS

p E

FS

◊·Ú <3 cm ™Ï‹Ó·˜ <3 cm

™Ï‹Ó·˜ ≥3 cm

p=0,01

◊·Ú ≥3 cm

p=0,05

∞Ó·Ï‡ÔÓÙ·˜, fiÌˆ˜, ÙËÓ Èı·ÓfiÙËÙ· ∂FS ÌÂ ‚¿ÛËÙËÓ ËÏÈÎ›· ÙˆÓ 3 ÂÙÒÓ ‰È·ÈÛÙÒıËÎÂ fiÙÈ ÔÈ ·ÛıÂÓÂ›˜ËÏÈÎ›·˜ ≤3 ÂÙÒÓ Â›¯·Ó ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ¿ ÌÈÎÚfi-ÙÂÚË Èı·ÓfiÙËÙ· EFS (61,11±9%) ÛÂ Û¯¤ÛË ÌÂÙÔ˘˜ ·ÛıÂÓÂ›˜ ËÏÈÎ›·˜ >3 ÂÙÒÓ (Èı·ÓfiÙËÙ· EFS82,69±4%).

∆Ô ÔÛÔÛÙfi ÚfiˆÚË˜ ıÓËÙfiÙËÙ·˜ (earlymortality rate) ÚÈÓ ÙËÓ 33Ë ËÌ¤Ú· ıÂÚ·Â›·˜ ‹Ù·Ó4,2% (4/70), ÙÔ ÔÔ›Ô Â›Ó·È ·ÚÎÂÙ¿ ˘„ËÏfi ÛÂ Û¯¤ÛËÌÂ ¿ÏÏÂ˜ Û‡Á¯ÚÔÓÂ˜ ÌÂÏ¤ÙÂ˜ ÛÙÈ˜ ÔÔ›Â˜ Î˘Ì·›ÓÂ-Ù·È ·fi 1% ¤ˆ˜ 2,5% (6,24,25). Ÿˆ˜ ÚÔ¤Î˘„ÂÌÂÙ¿ ·fi ÏÂÙÔÌÂÚ‹ ·Ó¿Ï˘ÛË ÙˆÓ Ê‡ÏÏˆÓ ÓÔÛË-ÏÂ›·˜ ÙˆÓ ·ÛıÂÓÒÓ, Ë ·ÈÌÔÚÚ·Á›· Ô˘ Î·Ù·ÁÚ¿ÊÂ-Ù·È ˆ˜ Ë Î‡ÚÈ· ·ÈÙ›· ı·Ó¿ÙÔ˘, ‹Ù·Ó Ë Û˘Ó¤ÂÈ· ‚·-ÚÈ¿˜ Ì˘ÂÏÈÎ‹˜ ·Ï·Û›·˜ ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ·Ú·ÙÂ-Ù·Ì¤ÓË Ô˘‰ÂÙÂÚÔÂÓ›· ÌÂÙ¿ ·fi ¯ËÌÂÈÔıÂÚ·Â›·Î·È Û˘Ó˘¿Ú¯Ô˘Û· ÏÔ›ÌˆÍË. ∆Ô Â‡ÚËÌ· ·˘Ùfi ÂÊÈ-ÛÙ¿ ÙËÓ ÚÔÛÔ¯‹ ÛÙË ‚ÂÏÙ›ˆÛË ÙË˜ ·ÚÂ¯fiÌÂÓË˜˘ÔÛÙËÚÈÎÙÈÎ‹˜ ıÂÚ·Â›·˜, È‰È·›ÙÂÚ· ÛÙÔÓ ÙÔÌ¤·ÙË˜ ·ÓÙÈÌÂÙÒÈÛË˜ ÙË˜ ıÚÔÌ‚ÔÂÓ›·˜ ÌÂÙ¿ ·fi ¯Ë-ÌÂÈÔıÂÚ·Â›·, ÌÂ ¤ÁÎ·ÈÚË ·Ú¤Ì‚·ÛË ÁÈ· ÌÂÙ¿ÁÁÈ-ÛË ·ÈÌÔÂÙ·Ï›ˆÓ.

∂›Ó·È ·ÍÈÔÛËÌÂ›ˆÙÔ fiÙÈ Ë ÏÂÈÔ„ËÊ›· ÙˆÓ ı·Ó¿-ÙˆÓ Ô˘ ÛËÌÂÈÒıËÎ·Ó ‹Ù·Ó Î·Ù¿ ÙË Ê¿ÛË ÂÊfi‰Ô˘‹ Â·ÓÂÊfi‰Ô˘. ∂›Ó·È ÁÓˆÛÙfi fiÙÈ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ··˘ÙÒÓ ÙˆÓ Ê¿ÛÂˆÓ ıÂÚ·Â›·˜ Ù· Û¯‹Ì·Ù· Â›Ó·È·ÚÎÂÙ¿ ÂÓÙ·ÙÈÎ¿ Î·È, Î·Ù¿ Û˘Ó¤ÂÈ·, ·ÚÎÂÙ¿ ÙÔÍÈ-Î¿. ∞˘Ùfi Ê¤ÚÓÂÈ ÛÙËÓ ÂÈÊ¿ÓÂÈ· ÙÔÓ Û‡Á¯ÚÔÓÔ ÚÔ-

‚ÏËÌ·ÙÈÛÌfi ÙˆÓ ÂÚÂ˘ÓËÙÒÓ ÁÈ· ÙËÓ ·Ó·Î¿Ï˘„Ë Ó¤-ˆÓ ÚÔÁÓˆÛÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ Ô˘ ı· ÂÓÛˆÌ·Ùˆ-ıÔ‡Ó ÛÙ· ıÂÚ·Â˘ÙÈÎ¿ ÚˆÙfiÎÔÏÏ·, ÒÛÙÂ Ë ·‡ÍË-ÛË ÙÔ˘ ÚÔÛ‰fiÎÈÌÔ˘ ÂÈ‚›ˆÛË˜ ÙˆÓ ·È‰ÈÒÓ ÌÂO§§ Ó· Û˘Ó‰˘¿˙ÂÙ·È Î·È ÌÂ ÌÂ›ˆÛË ÙË˜ ¿ÌÂÛË˜ ‹·ÒÙÂÚË˜ ÙÔÍÈÎfiÙËÙ·˜ ÙË˜ ¯ÔÚËÁÔ‡ÌÂÓË˜ ·ÁˆÁ‹˜.

◊‰Ë ÛÙÈ˜ Û‡Á¯ÚÔÓÂ˜ ÌÂÏ¤ÙÂ˜ ·ÍÈÔÏÔÁÂ›Ù·È ËÚÔÁÓˆÛÙÈÎ‹ ·Í›· ÙË˜ ·Ó›¯ÓÂ˘ÛË˜ Î·È ÔÛÔÙÈÎÔ-Ô›ËÛË˜ ÙË˜ ÂÏ¿¯ÈÛÙË˜ ˘ÔÏÂÈÌÌ·ÙÈÎ‹˜ ÓfiÛÔ˘.Ÿˆ˜ ÚÔÎ‡ÙÂÈ, Ë ·ÓÔÛÔÊ·ÈÓÔÙ˘ÈÎ‹ Î·È ÌÔÚÈ·Î‹ÂÎÙ›ÌËÛË ÙË˜ ÔÚÂ›·˜ ÙË˜ ˘ÔÌÈÎÚÔÛÎÔÈÎ‹˜ ÂÏ¿-¯ÈÛÙË˜ ˘ÔÏÂÈÌÌ·ÙÈÎ‹˜ ÓfiÛÔ˘ Ê·ÓÂÚÒÓÂÈ fiÙÈ Ë ·Ú-Á‹ ÂÍ·Ê¿ÓÈÛË ÙˆÓ ÓÂÔÏ·ÛÌ·ÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ Â›Ó·ÈÛËÌÂ›Ô ·˘ÍËÌ¤ÓÔ˘ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ˘ÔÙÚÔ‹ ÙË˜ Ófi-ÛÔ˘ (26,27). ∂ÈÏ¤ÔÓ, Ë ÌÂÏ¤ÙË ÙˆÓ ÁÂÓÂÙÈÎÒÓ Ô-Ï˘ÌÔÚÊÈÛÌÒÓ ÌÂÙ·‚ÔÏÈÎÒÓ ÂÓ˙‡ÌˆÓ ı· ÚÔÛÊ¤ÚÂÈ¯Ú‹ÛÈÌÂ˜ ÏËÚÔÊÔÚ›Â˜ ÁÈ· ÙËÓ ÂÍ·ÙÔÌ›ÎÂ˘ÛË ÙˆÓ


293

∂ÈÎfiÓ· 10. Kaplan-Meier ÂÎÙ›ÌËÛË ÙË˜ EFS ÛÂ Û¯¤ÛË ÌÂ ÙËÓÙÈÌ‹ ÙË˜ LDH.

∂ÈÎfiÓ· 11. Kaplan-Meier ÂÎÙ›ÌËÛË ÙË˜ EFS ÛÂ Û¯¤ÛË ÌÂ ÙËÓËÏÈÎ›·.

1,0

0,8

0,6

0,4

0,2

0

1,0

0,8

0,6

0,4

0,2

00 20 40 60 80 100 0 20 40 60 80 100


p E

FS

p E

FS

LDH<1000 IU/L ∏ÏÈÎ›· >3 ÂÙÒÓ

∏ÏÈÎ›· ≤3 ÂÙÒÓ

p log-rank=0,04

LDH≥1000 IU/L

p=0,05

¶›Ó·Î·˜ 5. ∞ÔÙÂÏ¤ÛÌ·Ù· Cox-regression ·Ó¿Ï˘ÛË˜

ªÂÙ·‚ÏËÙ‹ 95% CI ™¯ÂÙÈÎfi˜ pÎ›Ó‰˘ÓÔ˜

ñ ∏ÏÈÎ›· (<3 ÂÙÒÓ) 0,53-4,56 1,56 0,4ñ ∞ÚÈıÌfi˜ ÏÂ˘ÎÒÓ

·ÈÌÔÛÊ·ÈÚ›ˆÓ(≥50x109/L) 1,12-8,2 2,78 0,04

ñ ™ÏËÓÔÌÂÁ·Ï›· 0,92-8,1 2,68 0,06(≥3 cm)


294

Ê·ÚÌ·ÎÂ˘ÙÈÎÒÓ ‰fiÛÂˆÓ ÙˆÓ ¯ÔÚËÁÔ‡ÌÂÓˆÓ Ê·Ú-Ì¿ÎˆÓ (28).

ªÂ ÙËÓ ·ÏÌ·ÙÒ‰Ë ÚfiÔ‰Ô Ô˘ ·Ú·ÙËÚÂ›Ù·È Ù·ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÛÙÔÓ ÙÔÌ¤· ÙË˜ ÌÔÚÈ·Î‹˜ ÁÂÓÂÙÈ-Î‹˜ ÌÂ ÙËÓ ·ÔÙ‡ˆÛË ÙÔ˘ ÁÔÓÈ‰È·ÎÔ‡ ¯¿ÚÙË ÙË˜ÓfiÛÔ˘ Î¿ıÂ ·ÛıÂÓ‹ ÌÂ ÙÈ˜ ÌÂıfi‰Ô˘˜ ÙˆÓ DNA ÌÈ-ÎÚÔÛ˘ÛÙÔÈ¯ÈÒÓ (DNA microarrays), ı· Â›Ó·È ÂÊÈÎÙfiÓ· Î·ÙÂ˘ı‡ÓÂÙ·È Ë ıÂÚ·Â›· ÛÙÔ˘˜ ‰È¿ÊÔÚÔ˘˜ ÁÂ-ÓÂÙÈÎÔ‡˜ ˘ÔÙ‡Ô˘˜ ÙË˜ ÏÂ˘¯·ÈÌ›·˜ Î·È Ó· ÚÔ-Û·ÚÌfi˙ÂÙ·È Ë ‰È¿ÚÎÂÈ¿ ÙË˜ ÛÙÔ ÁÂÓÂÙÈÎfi ÔÚÙÚ¤ÙÔÙÔ˘ Î¿ıÂ ·ÛıÂÓ‹ (29,30).

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Gastroesophageal reflux in children with cerebral palsy: frequency, early diagnosis I. Xinias1, C. Panteliadis1, K. Spiroglou1, N. Karatzas2, V. Demertzidou1, E. Karatza1, G. Arsos2


�¶ÂÚ›ÏË„Ë: ∏ Á·ÛÙÚÔÔÈÛÔÊ·ÁÈÎ‹ ·ÏÈÓ‰ÚfiÌËÛË(°O¶) ·Ó·Ê¤ÚÂÙ·È Û˘¯Ó¿ ÛÂ ·È‰È¿ ÌÂ ÂÁÎÂÊ·ÏÈÎ‹·Ú¿Ï˘ÛË (∂¶). ™ÎÔfi˜ ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜‹Ù·Ó Ë ‰ÈÂÚÂ‡ÓËÛË ÙË˜ Û˘¯ÓfiÙËÙ·˜, ÙË˜ ‚·Ú‡ÙËÙ·˜Î·È ÙˆÓ ÂÈÏÔÎÒÓ ÙË˜ °O¶ ÛÂ ·È‰È¿ ÌÂ ÂÁÎÂÊ·ÏÈ-Î‹ ·Ú¿Ï˘ÛË ÌÈÎÚfiÙÂÚ· ÙˆÓ 5 ÂÙÒÓ, Î·ıÒ˜ Î·È Ë·Ó·˙‹ÙËÛË ÙË˜ Û¯¤ÛË˜ ÙË˜ °O¶ ÌÂ Û˘ÁÎÂÎÚÈÌ¤ÓÂ˜ÌÔÚÊ¤˜ ∂¶. ŒÓ·˜ ÂÈÏ¤ÔÓ ÛÙfi¯Ô˜ ‹Ù·Ó Ë ‰ÈÂÚÂ‡-ÓËÛË ÙË˜ ·Ó·ÁÎ·ÈfiÙËÙ·˜ Î·È ÙË˜ ·ÍÈÔÈÛÙ›·˜ ÂÓfi˜ÌË ÂÂÌ‚·ÙÈÎÔ‡ screening test ÛÙË Û˘ÁÎÂÎÚÈÌ¤ÓËÏËı˘ÛÌÈ·Î‹ ÔÌ¿‰·. ™ÙË ÌÂÏ¤ÙË Û˘ÌÂÚÈÂÏ‹ÊıË-Û·Ó 52 ·È‰È¿ ÌÂ ∂¶, Ù· ÔÔ›· ‰ÈÂÚÂ˘Ó‹ıËÎ·Ó ÁÈ·°O¶ ÌÂ 24ˆÚË pH-ÌÂÙÚ›·, ˘ÂÚË¯ÔÁÚ¿ÊËÌ· Î·ÈÛÈÓıËÚÔÁÚ¿ÊËÌ· ÛÙÔÌ¿¯Ô˘-ÔÈÛÔÊ¿ÁÔ˘. O ¤ÏÂÁ-¯Ô˜ ÂÚÈÂÏ¿Ì‚·ÓÂ ·ÎfiÌË ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·Î·,·ÍÔÓÈÎ‹ ‹ Ì·ÁÓËÙÈÎ‹ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘, ËÏÂ-ÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ· (∏∂°) Î·È ·ÈÌ·ÙÔÏÔÁÈÎfi Î·È‚ÈÔ¯ËÌÈÎfi ¤ÏÂÁ¯Ô. ∞fi Ù· ·È‰È¿ ÙË˜ ÌÂÏ¤ÙË˜, ÙÔ44,2% (23/52) Â›¯Â °O¶ ‰È·ÁÓˆÛÌ¤ÓË ÌÂ pH-ÌÂÙÚ›·.¢ÂÓ ‚Ú¤ıËÎÂ Û¯¤ÛË ÌÂÙ·Í‡ ÙË˜ ÂÌÊ¿ÓÈÛË˜ °O¶ Î·ÈÙˆÓ Û·ÛÙÈÎÒÓ ‹ ÌË Û·ÛÙÈÎÒÓ ÌÔÚÊÒÓ ÙË˜ ∂¶,fiˆ˜ Â›ÛË˜ ‰ÂÓ ‚Ú¤ıËÎÂ Û¯¤ÛË ÌÂÙ·Í‡ °O¶ Î·ÈÊ‡ÏÔ˘. ™Ô‚·ÚÔ‡ ‚·ıÌÔ‡ °O¶ ‰È·ÈÛÙÒıËÎÂ ÛÙÔ52,2% (12/23 ·È‰È¿) Î·È Ì¤ÙÚÈÔ˘ ‚·ıÌÔ‡ ÛÙÔ ˘fi-ÏÔÈÔ 47,8% (11/23 ·È‰È¿). OÈ Û˘¯ÓfiÙÂÚÂ˜ ÂÈÏÔ-Î¤˜ ÙË˜ °O¶ ‹Ù·Ó Ë ÛÈ‰ËÚÔÂÓ›· (56,5%), Ë ·Ó·ÈÌ›·(47,8%), Ë Î·Î‹ ıÚ¤„Ë (34,8%), ÔÈ ˘ÔÙÚÔÈ¿˙Ô˘ÛÂ˜ÏÔÈÌÒÍÂÈ˜ ÙÔ˘ Î·ÙÒÙÂÚÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡ (26%) Î·ÈÙÔ ¯·ÌËÏfi ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜ (26%). ∆Ô ˘ÂÚË¯ÔÁÚ¿-ÊËÌ· ÙË˜ Á·ÛÙÚÔÔÈÛÔÊ·ÁÈÎ‹˜ Û˘Ì‚ÔÏ‹˜ ‹Ù·Ó ıÂÙÈ-Îfi ÁÈ· °O¶ ÛÙÔ 53,8% ÙˆÓ ÂÚÈÙÒÛÂˆÓ (28/52 ·È-‰È¿). ™Â Û¯¤ÛË ÌÂ ÙËÓ pH-ÌÂÙÚ›·, Ë Â˘·ÈÛıËÛ›· Î·È ËÂÈ‰ÈÎfiÙËÙ· ÙÔ˘ ˘ÂÚË¯ÔÁÚ·Ê‹Ì·ÙÔ˜ ‹Ù·Ó 82,1% Î·È

�Abstract: The aims of this study were toinvestigate the frequency, severity and complica-tions of gastroesophageal reflux (GOR) in childrenunder 5 years with cerebral palsy (CP), to evaluatethe need for a reliable, non-invasive GOR-screeningtest in this population group, in which GOR iscommon, and to investigate a possible relationshipbetween GOR and CP type. Fifty-two children withCP were investigated for GOR by 24-hour pH moni-toring, ultrasonography (U/S) and scintigraphy. Theexamination also included chest X-ray, CT or MRI ofthe brain, EEG and various blood tests. GOR waspH-metrically diagnosed in 23/52 patients (44.2%)and was rated severe in 12/23 (52.2%) andmoderate in 11/23 (47.8%). GOR occurrence didnot differ significantly between spastic and non-spastic forms of CP or between males and females.The most frequent complications of GOR were irondeficiency (56.5%), anaemia (47.8%), malnutrition(34.8%), low body weight (26%) and recurrent lowerrespiratory tract infections (26%). U/S findings wereconsistent with GOR in 28/52 patients (53.8%).Compared to pH-metry, U/S sensitivity andspecificity were 82.1% and 68.96%, respectively.Scintigraphy performed in 19 pH-metry- and U/S-GOR positive patients was positive in only 9/19(47.4%). The study confirms that moderate or severeGOR is common in children with CP, frequentlyleading to complications, but not influenced by sexor CP type. U/S may be used as a screening test, firstat age 12-16 months and then six-monthly, to ensuretimely diagnosis of GOR in children with CP.Confirmatory investigation by 24-hour pH monitoring

∞ÚÈÛÙÔÙ¤ÏÂÈÔ ¶·ÓÂÈÛÙ‹ÌÈÔ £ÂÛÛ·ÏÔÓ›ÎË˜, π·ÙÚÈÎ‹ ™¯ÔÏ‹,πÔÎÚ¿ÙÂÈÔ ¡ÔÛÔÎÔÌÂ›Ô £ÂÛÛ·ÏÔÓ›ÎË˜ 1 °’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ 2 ∂ÚÁ·ÛÙ‹ÚÈÔ ¶˘ÚËÓÈÎ‹˜ π·ÙÚÈÎ‹˜

Aristotelion University of Thessaloniki, Medical School,Ippokration Hospital, Thessaloniki 1 3rd Paediatric Clinic 2 Laboratory of Nuclear Medicine

∂ÈÛ·ÁˆÁ‹ ∏ Û¯¤ÛË ÂÁÎÂÊ·ÏÈÎ‹˜ ·Ú¿Ï˘ÛË˜ (∂¶) Î·È Á·-

ÛÙÚÔÔÈÛÔÊ·ÁÈÎ‹˜ ·ÏÈÓ‰ÚfiÌËÛË˜ (°O¶) ·Ó·Ê¤Ú-ıËÎÂ ÁÈ· ÚÒÙË ÊÔÚ¿ ·fi ÙÔ˘˜ Abrahams Î·ÈBurkitt ÙÔ 1970, ÔÈ ÔÔ›ÔÈ ‚Ú‹Î·Ó ·ÏÈÓ‰ÚfiÌËÛË ÌÂ24ˆÚË pH-ÌÂÙÚ›· ÛÙÔ 75% ÙˆÓ ·È‰ÈÒÓ Ô˘ ÌÂÏ¤-ÙËÛ·Ó (1). ∆· ·ÔÙÂÏ¤ÛÌ·Ù· ·˘Ù¿ ÂÈ‚Â‚·ÈÒıËÎ·Ó·ÚÁfiÙÂÚ· Î·È ·fi ¿ÏÏÔ˘˜ Û˘ÁÁÚ·ÊÂ›˜, ÔÈ ÔÔ›ÔÈ·Ó·Ê¤ÚÔ˘Ó Û˘¯ÓfiÙËÙ· °O¶ ÛÂ ·È‰È¿ ÌÂ ÂÁÎÂÊ·ÏÈ-Î‹ ·Ú¿Ï˘ÛË ÛÂ ÔÛÔÛÙfi 26-91% (2-6), ¤Ó·ÓÙÈ 2-5% ÛÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi (7).

∏ °O¶ ÛÂ ·È‰È¿ ÌÂ ∂¶ Â›Ó·È Â›ÎÙËÙË, ·Ú·ÙË-ÚÂ›Ù·È Û˘Ó‹ıˆ˜ ÌÂÙ¿ ÙÔ ÚÒÙÔ ¤ÙÔ˜ ÙË˜ ˙ˆ‹˜ (8)Î·È ¤¯ÂÈ ·Ô‰ÔıÂ› ÛÂ ‰È¿ÊÔÚÔ˘˜ ·Ú¿ÁÔÓÙÂ˜ Ô˘‰ÚÔ˘Ó ·˘ÙfiÓÔÌ· ‹ Û˘ÓÂÚÁÈÎ¿ (9).

OÈ Î˘ÚÈfiÙÂÚÂ˜ Ì¤ıÔ‰ÔÈ Ô˘ ˘¿Ú¯Ô˘Ó ÁÈ· ÙÔÓ¤ÏÂÁ¯Ô ÙË˜ °O¶ Â›Ó·È ÙÔ ÔÈÛÔÊ·ÁÔÁÚ¿ÊËÌ·, ÙÔ˘ÂÚË¯ÔÁÚ¿ÊËÌ·, ÙÔ ÛÈÓıËÚÔÁÚ¿ÊËÌ·, Ë ÔÈÛÔ-Ê·ÁÔÛÎfiËÛË, Ë Ì·ÓÔÌÂÙÚ›· Î·È Ë 24ˆÚË pH-ÌÂ-ÙÚ›· (10). OÈ ·Ú·¿Óˆ Ì¤ıÔ‰ÔÈ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·ÓÙ· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÌÂ ·ÓÙÈÎÚÔ˘fiÌÂÓ··ÔÙÂÏ¤ÛÌ·Ù·. ∏ Â˘·ÈÛıËÛ›· Î·È Ë ÂÍÂÈ‰›ÎÂ˘ÛËÙË˜ Î¿ıÂ ÌÂıfi‰Ô˘ ‰È·Ê¤ÚÂÈ, ·ÏÏ¿ ¯ˆÚ›˜ ·ÌÊÈÛ‚‹-ÙËÛË ÙÔ “¯Ú˘Ûfi ÚfiÙ˘Ô” Â›Ó·È Ë pH-ÌÂÙÚ›·, ËÔÔ›· ·ÔÙÂÏÂ› ÂÍ¤Ù·ÛË ·Ó·ÊÔÚ¿˜ (10,11). ¶·Ú’fiÏ· ·˘Ù¿, Ë ·Ó·ÁÎ·ÈfiÙËÙ· Î·È Ë ·ÍÈÔÈÛÙ›· Ì›·˜ ÌËÂÂÌ‚·ÙÈÎ‹˜ ÂÍ¤Ù·ÛË˜ ‰È·ÏÔÁ‹˜ ‰ÂÓ ¤¯Ô˘Ó ÌÂÏÂ-ÙËıÂ› Ì¤¯ÚÈ Û‹ÌÂÚ·.

™ÎÔfi˜ ÙË˜ ÂÚÁ·Û›·˜ ‹Ù·Ó Ó· ÌÂÏÂÙËıÂ› Ë Û˘-¯ÓfiÙËÙ· Î·È ÔÈ ÂÈÙÒÛÂÈ˜ ÙË˜ °O¶ ÛÂ ·È‰È¿ ÌÂ ∂¶ÌÈÎÚfiÙÂÚ· ÙˆÓ 5 ÂÙÒÓ Î·È Ó· ‰ÈÂÚÂ˘ÓËıÔ‡Ó Ë ·Ó·-

ÁÎ·ÈfiÙËÙ· Î·È Ë ·ÍÈÔÈÛÙ›· Ì›·˜ ÌË ÂÂÌ‚·ÙÈÎ‹˜ÂÍ¤Ù·ÛË˜ ‰È·ÏÔÁ‹˜ ÛÙË Û˘ÁÎÂÎÚÈÌ¤ÓË ÏËı˘ÛÌÈ·-Î‹ ÔÌ¿‰·.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ™ÙË ÌÂÏ¤ÙË Û˘ÌÂÚÈÂÏ‹ÊıËÛ·Ó 52 ·È‰È¿ (32 ·ÁfiÚÈ· Î·È 20

ÎÔÚ›ÙÛÈ·) ËÏÈÎ›·˜ 1-5 ÂÙÒÓ ÌÂ ‰È¿ÁÓˆÛË ÂÁÎÂÊ·ÏÈÎ‹˜ ·Ú¿Ï˘-ÛË˜ (¶›Ó·Î·˜ 1). ŸÏ· Ù· ·È‰È¿ ·ÚÔ˘Û›·˙·Ó ‰È¿ÊÔÚ· ¿Ù˘·Û˘ÌÙÒÌ·Ù·, ‡ÔÙ· ÁÈ· ÓfiÛÔ ·fi °O¶ (°O¶¡), fiˆ˜ ÂÌ¤-ÙÔ˘˜, Î·ı˘ÛÙ¤ÚËÛË ÛˆÌ·ÙÈÎ‹˜ ·Ó¿Ù˘ÍË˜, ÏÔÈÌÒÍÂÈ˜ Î·ÙÒÙÂ-ÚÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Î.Ï. ¶·È‰È¿ Î¿Ùˆ ÙˆÓ 12 ÌË-ÓÒÓ ‰ÂÓ ÂÚÈÏ‹ÊıËÎ·Ó ÛÙË ÌÂÏ¤ÙË, ‰ÈfiÙÈ ÚÈÓ ·fi ÙËÓ ËÏÈÎ›··˘Ù‹ ‰ÂÓ Â›Ó·È Û·Ê‹˜ Ë ÌÔÚÊ‹ ÙË˜ ∂¶ Î·È ÂÂÈ‰‹ Ë °O¶ Â›Ó·ÈÂ›ÎÙËÙË Î·È ÂÌÊ·Ó›˙ÂÙ·È ·ÚÁfiÙÂÚ· ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›·, Èı·-ÓfiÙÂÚ· ÌÂÙ¿ ÙÔ 1Ô ¤ÙÔ˜ ÙË˜ ˙ˆ‹˜ (8). ∂·ÓÂÎÙ›ÌËÛË ÙÔ˘ Ù‡Ô˘ÙË˜ ∂¶ ÛÙ· 52 ·È‰È¿ ¤ÁÈÓÂ ÌÂÙ¿ ·fi 2 ¯ÚfiÓÈ·.

™Â Î¿ıÂ ·ÛıÂÓ‹ Ï‹ÊıËÎÂ Ï‹ÚÂ˜ ÈÛÙÔÚÈÎfi (·ÙÔÌÈÎfi, ÔÈ-ÎÔÁÂÓÂÈ·Îfi, Î‡ËÛË˜, ÂÚÈÁÂÓÓËÙÈÎfi, ‚ÚÂÊÈÎ‹˜ ËÏÈÎ›·˜), ÌÂÈ‰È·›ÙÂÚË ¤ÌÊ·ÛË ÛÂ Û˘ÌÙÒÌ·Ù· Î·È ÂÈÏÔÎ¤˜ Èı·Ó‹˜°O¶¡. ŒÁÈÓÂ ÎÏÈÓÈÎ‹ Î·È ÓÂ˘ÚÔÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË ÁÈ· ÙÔÓ Î·ıÔ-ÚÈÛÌfi ÙË˜ ÌÔÚÊ‹˜ ÙË˜ ∂¶, ÙË˜ Î·Ù¿ÛÙ·ÛË˜ ıÚ¤„Ë˜ Î·È ÙˆÓÛˆÌ·ÙÔÌÂÙÚÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ. ™Â fiÏ· Ù· ·È‰È¿ ¤ÁÈÓÂ 24ˆÚËpH-ÌÂÙÚ›·, ˘ÂÚË¯ÔÁÚ¿ÊËÌ· Á·ÛÙÚÔÔÈÛÔÊ·ÁÈÎ‹˜ Û˘Ì‚Ô-Ï‹˜, ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ· (∏∂°), ·ÍÔÓÈÎ‹ ‹ Ì·ÁÓËÙÈÎ‹ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ (CT/MRI), ·Ï‹ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·-Î· Î·È ÁÂÓÈÎ‹ ÂÍ¤Ù·ÛË ·›Ì·ÙÔ˜, ÛÈ‰‹ÚÔ˘, ÊÂÚÚÈÙ›ÓË˜ Î·È ÏÂ˘-ÎˆÌ¿ÙˆÓ ÔÚÔ‡. ™ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ Ô˘ Ô ·ÛıÂÓ‹˜ Ï¿Ì‚·ÓÂÎ¿ÔÈ· Ê¿ÚÌ·Î·, ¤ÁÈÓÂ ÚÔÛˆÚÈÓ‹ ‰È·ÎÔ‹ ·˘ÙÒÓ, ÒÛÙÂ Ó·ÌËÓ ÂËÚÂ·ÛÙÂ› Ô ÙfiÓÔ˜ ÙÔ˘ Î·ÙÒÙÂÚÔ˘ ÔÈÛÔÊ·ÁÈÎÔ‡ ÛÊÈÁÎÙ‹Ú· (∫O™). °È· ÙËÓ pH-ÌÂÙÚ›· ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ ÊÔ-ÚËÙ‹ Û˘ÛÎÂ˘‹ Î·Ù·ÁÚ·Ê‹˜ ÙË˜ ÂÙ·ÈÚÂ›·˜ Synectics Medical

68,96%, ·ÓÙ›ÛÙÔÈ¯·. ™ÈÓıËÚÔÁÚ¿ÊËÌ· ÛÙÔÌ¿¯Ô˘-ÔÈÛÔÊ¿ÁÔ˘ ¤ÁÈÓÂ ÛÂ 19 ·È‰È¿ Ô˘ Â›¯·Ó Ù·˘Ùfi¯ÚÔ-Ó· ıÂÙÈÎfi ˘ÂÚË¯ÔÁÚ¿ÊËÌ· Î·È pH-ÌÂÙÚ›· Î·È ‚Ú¤-ıËÎÂ ıÂÙÈÎfi ÌfiÓÔ ÛÙÔ 47,4% ÙˆÓ ÂÚÈÙÒÛÂˆÓ (9/19·È‰È¿). ∏ °O¶ ÛÂ ·È‰È¿ ÌÂ ∂¶ Â›Ó·È Û˘¯Ó‹ Î·È ÛÙËÓÏÂÈÔ„ËÊ›· ÙˆÓ ÂÚÈÙÒÛÂˆÓ Â›Ó·È Ì¤ÙÚÈ· ‹ ‚·ÚÈ¿,ÌÂ Û˘Ó¤ÂÈ· ÙË Û˘¯Ó‹ ÂÌÊ¿ÓÈÛË ÛÔ‚·ÚÒÓ ÂÈÏÔ-ÎÒÓ. ¢ÂÓ Ê·›ÓÂÙ·È Ó· ˘¿Ú¯ÂÈ Û¯¤ÛË ÙË˜ °O¶ ÌÂ Û˘-ÁÎÂÎÚÈÌ¤ÓË ÌÔÚÊ‹ ∂¶ ‹ ÌÂ ÙÔ Ê‡ÏÔ. ∆Ô ˘ÂÚË¯Ô-ÁÚ¿ÊËÌ· ÙË˜ Á·ÛÙÚÔÔÈÛÔÊ·ÁÈÎ‹˜ Û˘Ì‚ÔÏ‹˜ Â›Ó·È·ÍÈfiÈÛÙÔ Î·È ıÂˆÚÂ›Ù·È ·Ó·ÁÎ·›Ô Û·Ó screeningtest. £· Ú¤ÂÈ Ó· ÂÊ·ÚÌfi˙ÂÙ·È ÛÂ ·È‰È¿ ÌÂ ∂¶, ·Ú-¯ÈÎ¿ ÛÙËÓ ËÏÈÎ›· ÙˆÓ 12-16 ÌËÓÒÓ Î·È ·ÚÁfiÙÂÚ· Â-ÚÈÔ‰ÈÎ¿ Î¿ıÂ 6 Ì‹ÓÂ˜ ÁÈ· ¤ÁÎ·ÈÚË ·ÔÎ¿Ï˘„Ë ÙË˜°O¶. ™Â ıÂÙÈÎ¤˜ ÂÚÈÙÒÛÂÈ˜, Ë ‰È¿ÁÓˆÛË ı· Ú¤ÂÈÓ· ÂÈ‚Â‚·ÈÒÓÂÙ·È ÌÂ 24ˆÚË pH-ÌÂÙÚ›·. ∆Ô ÛÈÓıË-ÚÔÁÚ¿ÊËÌ· ÛÙÔÌ¿¯Ô˘-ÔÈÛÔÊ¿ÁÔ˘ ‰ÂÓ ÂÓ‰Â›ÎÓ˘Ù·ÈÁÈ· ÙË ‰ÈÂÚÂ‡ÓËÛË ÙË˜ °O¶ ÛÙËÓ ∂¶.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ÂÁÎÂÊ·ÏÈÎ‹ ·Ú¿Ï˘ÛË, Á·ÛÙÚÔÔÈÛÔ-Ê·ÁÈÎ‹ ·ÏÈÓ‰ÚfiÌËÛË, screening (ÚÔÛ˘ÌÙˆÌ·ÙÈ-Îfi˜ ¤ÏÂÁ¯Ô˜).

should be applied in U/S-positive cases.Scintigraphy is not indicated for screening GOR inCP patients.

Key words: cerebral palsy, gastroesophagealreflux, screening.


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298

(Digitrapper Mk III) ÌÂ ‰ÈÎ¿Ó·ÏÔ ËÏÂÎÙÚfi‰ÈÔ Î·Ù·ÁÚ·Ê‹˜. ∏ ÙÔ-Ôı¤ÙËÛË ÙÔ˘ ËÏÂÎÙÚÔ‰›Ô˘ ÁÈÓfiÙ·Ó ‰È¿ ÙË˜ ÚÈÓÈÎ‹˜ Ô‰Ô‡ Î·È Ë·fiÛÙ·ÛË ÚÈÓfi˜-∫O™ (L) ˘ÔÏÔÁ›ÛÙËÎÂ Û‡ÌÊˆÓ· ÌÂ ÙÔÓ Î·Ófi-Ó· ÙÔ˘ Strobel (11-13): L (cm) = [(0,252 x ‡„Ô˜) +5] x 0,87.

∂È‚Â‚·›ˆÛË ÙË˜ ÛˆÛÙ‹˜ ı¤ÛË˜ ÙÔ˘ ËÏÂÎÙÚÔ‰›Ô˘, ÂÚ›-Ô˘ 3-4 cm ¿Óˆ ·fi ÙË Á·ÛÙÚÔÔÈÛÔÊ·ÁÈÎ‹ Û˘Ì‚ÔÏ‹, ÁÈÓfi-Ù·Ó pH-ÌÂÙÚÈÎ¿ Î·È ÌfiÓÔ Â› ·ÌÊÈ‚ÔÏÈÒÓ ·ÎÙÈÓÔÛÎÔÈÎ¿. ∏‰È¿ÚÎÂÈ· ÙË˜ Î·Ù·ÁÚ·Ê‹˜ ‹Ù·Ó 24 ÒÚÂ˜, ¯ˆÚ›˜ Ó· Á›ÓÂÈ ·Ï-Ï·Á‹ ÛÙÈ˜ Û˘Ó‹ıÂÈ˜ ‰Ú·ÛÙËÚÈfiÙËÙÂ˜ ÙÔ˘ ·ÛıÂÓ‹. OÈ ÙÈÌ¤˜ÙÔ˘ ÔÈÛÔÊ·ÁÈÎÔ‡ pH ·ÔıËÎÂ‡ÔÓÙ·Ó ÛÙË ÌÓ‹ÌË Î¿ıÂ 6 sec,ÂÓÒ ÂÂÈÛfi‰È· ·ÏÈÓ‰ÚfiÌËÛË˜ ıÂˆÚÔ‡ÓÙ·Ó ·˘Ù¿ ÌÂ ‰È¿ÚÎÂÈ·ÌÂÁ·Ï‡ÙÂÚË ÙˆÓ 15 sec (14). ŸÍÈÓË ·ÏÈÓ‰ÚfiÌËÛË ıÂˆÚÔ‡-ÓÙ·Ó Ë ÙÈÌ‹ ÙÔ˘ pH ≤4, ÂÓÒ ·ÏÎ·ÏÈÎ‹ fiÙ·Ó ‹Ù·Ó ≥8. ∆· ÎÚÈ-Ù‹ÚÈ· Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÁÈ· ÙË ‰È¿ÁÓˆÛË ÙË˜ °O¶ Ê·›-ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2 (8,15).

∞ÎÔÏÔ‡ıËÛÂ Doppler ÙË˜ Á·ÛÙÚÔÔÈÛÔÊ·ÁÈÎ‹˜ Û˘Ì‚ÔÏ‹˜ÌÂ ·ÛÚfiÌ·˘ÚË Û˘ÛÎÂ˘‹ ˘ÂÚ‹¯ˆÓ. ∆· ÂÂÈÛfi‰È· °O¶ Ô˘·Ú·ÙËÚ‹ıËÎ·Ó ıÂˆÚ‹ıËÎ·Ó ·ıÔÏÔÁÈÎ¿ Û‡ÌÊˆÓ· ÌÂ Ù·‰ÈÂıÓ‹ ÎÚÈÙ‹ÚÈ·, ·Ó¿ÏÔÁ· ÌÂ ÙÔÓ fiÁÎÔ Î·È ÙË ‰È¿ÚÎÂÈ· ÙË˜·ÏÈÓ‰ÚfiÌËÛË˜ ÙÔ˘ Á·ÛÙÚÈÎÔ‡ ÂÚÈÂ¯ÔÌ¤ÓÔ˘ (16).

™Ù· ·È‰È¿ Ô˘ ·ÚÔ˘Û›·˙·Ó °O¶ ·Ô‰Â‰ÂÈÁÌ¤ÓË ÌÂ24ˆÚË pH-ÌÂÙÚ›· Î·È ˘ÂÚË¯ÔÁÚ¿ÊËÌ· ÙË˜ Á·ÛÙÚÔÔÈÛÔÊ·-ÁÈÎ‹˜ Û˘Ì‚ÔÏ‹˜, ÁÈÓfiÙ·Ó Ú·‰ÈÔ˚ÛÔÙÔÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÌÂ ÛÈÓ-ıËÚÔÁÚ¿ÊËÌ· ÛÙÔÌ¿¯Ô˘-ÔÈÛÔÊ¿ÁÔ˘.

∆Ô ÛÈÓıËÚÔÁÚ¿ÊËÌ· ÁÈÓfiÙ·Ó ÌÂ Ú·‰ÈÔÂÈÛËÌ·ÛÌ¤ÓÔÁ¿Ï· ÛÙ·ıÂÚ‹˜ Û‡ÓıÂÛË˜ ÌÂÙ¿ ·fi 8-12 ÒÚÂ˜ ÓËÛÙÂ›·˜. ∆ÔÁ¿Ï· ÂÈÛËÌ·ÈÓfiÙ·Ó ÌÂ ÎÔÏÏÔÂÈ‰¤˜ ÙÔ˘ ÙÂ¯ÓËÙ›Ô˘ 99 (99mTccolloid) Î·È Ë ÔÛfiÙËÙ· ˘ÔÏÔÁÈ˙fiÙ·Ó Û‡ÌÊˆÓ· Î·È ÌÂ ÚÔË-ÁÔ‡ÌÂÓÂ˜ ÌÂÏ¤ÙÂ˜ ÛÙ· 300 ml/1,73 m2 (13). ™ÙËÓ Ú¿ÍË, Ë ÌÈ-Û‹ ÙË˜ ˘ÔÏÔÁÈÛıÂ›Û·˜ ÔÛfiÙËÙ·˜ Á¿Ï·ÎÙÔ˜ ÂÈÛËÌ·ÈÓfiÙ·ÓÌÂ ÙÔ Ú·‰ÈÔ˚ÛfiÙÔÔ, ÂÓÒ Ë ˘fiÏÔÈË ÌÈÛ‹ ÔÛfiÙËÙ· ‰ÂÓÂÈÛËÌ·ÈÓfiÙ·Ó. ∆Ô ÂÈÛËÌ·ÛÌ¤ÓÔ Á¿Ï· ¯ÔÚËÁÔ‡ÓÙ·Ó ÛÙÔ·È‰› ·fi ÙÔ ÛÙfiÌ· ‹ ÌÂ ÚÈÓÔÁ·ÛÙÚÈÎfi Î·ıÂÙ‹Ú·. ∞ÎÔÏÔ‡-ıˆ˜, ¯ÔÚËÁÔ‡ÓÙ·Ó Ë ÌË ÂÈÛËÌ·ÛÌ¤ÓË ÔÛfiÙËÙ· Á¿Ï·ÎÙÔ˜,ÚÔÎÂÈÌ¤ÓÔ˘ Ó· ÍÂÏ˘ıÂ› ÙÔ ÛÙfiÌ·, Ô Ê¿Ú˘ÁÁ·˜ Î·È Ô ÔÈÛÔ-Ê¿ÁÔ˜ ·fi Ù· ˘ÔÏÂ›ÌÌ·Ù· ÙÔ˘ Ú·‰ÈÔ˚ÛÔÙfiÔ˘. ∆Ô ·È‰›·ÎÈÓËÙÔÔÈÔ‡ÓÙ·Ó ÌÂ ‰È¿ÊÔÚÔ˘˜ ÙÚfiÔ˘˜ (Û¿ÎÔÈ ¿ÌÌÔ˘,ÈÌ¿ÓÙÂ˜) Î·È ·ÎÔÏÔ˘ıÔ‡Û·Ó Ï‹„ÂÈ˜ ÌÂ ÙË Á-Î¿ÌÂÚ· ÛÂ ·ÚÈ-ÛÙÂÚ‹ ÚfiÛıÈ· ÏÔÍ‹ ı¤ÛË (LAO). ∏ ‰È¿ÚÎÂÈ· ÙË˜ Ï‹„Ë˜‹Ù·Ó 1 ÒÚ·.

O ‰Â›ÎÙË˜ ·ÏÈÓ‰ÚfiÌËÛË˜ ˘ÔÏÔÁÈ˙fiÙ·Ó ·fi ÙÔÓ Ù‡Ô(17): RI (%) = [(Eso)-(Bgr) / (SÔ)] x 100 (So: Á·ÛÙÚÈÎ‹ ‰Ú·-ÛÙËÚÈfiÙËÙ· ÛÙËÓ ·Ú¯‹ ÙË˜ ÌÂÏ¤ÙË˜, Eso: ÔÈÛÔÊ·ÁÈÎ‹ ‰Ú·-ÛÙËÚÈfiÙËÙ·, Bgr: ‰Ú·ÛÙËÚÈfiÙËÙ· ÛÙÔ Background).

™Â ·È‰È¿ Î·È ÂÓ‹ÏÈÎÂ˜ ¯ˆÚ›˜ ·ÏÈÓ‰ÚfiÌËÛË, ÔÈ ÙÈÌ¤˜ ÙÔ˘RI Î˘Ì·›ÓÔÓÙ·È ·fi 0,1-5,0% (17-19). ∏ ÔÈÔÙÈÎ‹ ÂÎÙ›ÌËÛË ÁÈ-ÓfiÙ·Ó ·Ú·ÎÔÏÔ˘ıÒÓÙ·˜ ÛÂ cine mode ÙÔ Û‡ÓÔÏÔ ÙË˜ ÌÂÏ¤-ÙË˜ Î·È Î·ıÔÚ›˙ÔÓÙ·˜ ÙÔÓ ·ÚÈıÌfi, ÙÔ ‡„Ô˜ ÙˆÓ ÂÂÈÛÔ‰›ˆÓ·ÏÈÓ‰ÚfiÌËÛË˜ (Â¿Ó Ë °O¶ ¤Êı·ÓÂ ÛÙÔÓ ·ÓÒÙÂÚÔ ÔÈÛÔÊ¿-ÁÔ) Î·È ÙËÓ Î·ı˘ÛÙÂÚËÌ¤ÓË Î¿ı·ÚÛË ÙÔ˘ Ú·‰ÈÔÊ·ÚÌ¿ÎÔ˘·fi ÙÔÓ ÔÈÛÔÊ¿ÁÔ (20).

™Ù·ÙÈÛÙÈÎ‹ ·Ó¿Ï˘ÛË ∏ ÛÙ·ÙÈÛÙÈÎ‹ ·Ó¿Ï˘ÛË ¤ÁÈÓÂ ÌÂ ÙË ‚Ô‹ıÂÈ· ËÏÂÎÙÚÔÓÈÎÔ‡

˘ÔÏÔÁÈÛÙ‹, ÛÙÔ ÏÂÈÙÔ˘ÚÁÈÎfi Û‡ÛÙËÌ· Windows 98 Î·È ÌÂ ÙÔ

ÛÙ·ÙÈÛÙÈÎfi ÚfiÁÚ·ÌÌ· GraphPad InStat. ¶ÚÔÎÂÈÌ¤ÓÔ˘ ÁÈ·Û˘ÁÎÚ›ÛÂÈ˜ ÌÂÙ·Í‡ ‰È·ÊfiÚˆÓ ÔÌ¿‰ˆÓ, ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë‰ÔÎÈÌ·Û›· x2. °È· ÙË Û‡ÁÎÚÈÛË ÙˆÓ ËÏÈÎÈÒÓ ÌÂÙ·Í‡ ÙˆÓ ‰È·-ÊfiÚˆÓ ÌÔÚÊÒÓ ∂¶ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë ÌË ·Ú·ÌÂÙÚÈÎ‹ Ì¤-ıÔ‰Ô˜ Mann-Whitney. ™Ù·ÙÈÛÙÈÎ‹ ÛËÌ·ÓÙÈÎfiÙËÙ· ÁÈÓfiÙ·Ó ‰Â-ÎÙ‹ ÁÈ· ÙÈÌ¤˜ p<0,05.

¶›Ó·Î·˜ 1. ™ÙÔÈ¯Â›· ÙˆÓ ·ÛıÂÓÒÓ ÙË˜ ÌÂÏ¤ÙË˜

ŸÓÔÌ· ∏ÏÈÎ›· ªÔÚÊ‹ ∂¶ º‡ÏÔ °O¶

¶. ¢. 20 ÌËÓÒÓ ™·ÛÙÈÎ‹ ÕÚÚÂÓ Ÿ¯È°. ∞. 22 ÌËÓÒÓ ∞Ù·ÍÈÎ‹ ÕÚÚÂÓ Ÿ¯Èµ. ∞. 12 ÌËÓÒÓ ∞Ù·ÍÈÎ‹ ÕÚÚÂÓ Ÿ¯È∆. ∫. 21 ÌËÓÒÓ ™·ÛÙÈÎ‹ ÕÚÚÂÓ Ÿ¯È∫. ∞. 18 ÌËÓÒÓ ™·ÛÙÈÎ‹ ÕÚÚÂÓ Ÿ¯È¶. ∞. 13 ÌËÓÒÓ ™·ÛÙÈÎ‹ ÕÚÚÂÓ Ÿ¯Èª. ∂. 20 ÌËÓÒÓ ™·ÛÙÈÎ‹ ÕÚÚÂÓ Ÿ¯Èµ. °. 12 ÌËÓÒÓ ∞Ù·ÍÈÎ‹ ÕÚÚÂÓ Ÿ¯È∆. ª. 2 6/12 ÂÙÒÓ ™·ÛÙÈÎ‹ ÕÚÚÂÓ Ÿ¯È∆. ¡. 3 5/12 ÂÙÒÓ ªÈÎÙ‹ ÕÚÚÂÓ Ÿ¯È™. ¡. 3 1/12 ÂÙÒÓ ™·ÛÙÈÎ‹ ÕÚÚÂÓ Ÿ¯È¶. ¶. 4 1/12 ÂÙÒÓ ªÈÎÙ‹ ÕÚÚÂÓ Ÿ¯È∫. ¶. 3 6/12 ÂÙÒÓ ªÈÎÙ‹ ÕÚÚÂÓ Ÿ¯È°. °. 2 2/12 ÂÙÒÓ ™·ÛÙÈÎ‹ ÕÚÚÂÓ Ÿ¯È°. ∞. 16 ÌËÓÒÓ ™·ÛÙÈÎ‹ ÕÚÚÂÓ Ÿ¯È¢. º. 3 3/12 ÂÙÒÓ ™·ÛÙÈÎ‹ ÕÚÚÂÓ Ÿ¯È™. ¶. 2 6/12 ÂÙÒÓ ™·ÛÙÈÎ‹ ÕÚÚÂÓ Ÿ¯Èª. ∞. 12 ÌËÓÒÓ ™·ÛÙÈÎ‹ ÕÚÚÂÓ Ÿ¯È∞. ∞. 3 6/12 ÂÙÒÓ ™·ÛÙÈÎ‹ ÕÚÚÂÓ ¡·È∆. °. 3 1/12 ÂÙÒÓ ™·ÛÙÈÎ‹ ÕÚÚÂÓ ¡·È¶. ™. 4 ÂÙÒÓ ªÈÎÙ‹ ÕÚÚÂÓ ¡·È¡. ∫. 20 ÌËÓÒÓ ™·ÛÙÈÎ‹ ÕÚÚÂÓ ¡·È°. ∞. 4 3/12 ÂÙÒÓ ™·ÛÙÈÎ‹ ÕÚÚÂÓ ¡·È∫. ™. 5 2/12 ÂÙÒÓ ™·ÛÙÈÎ‹ ÕÚÚÂÓ ¡·Èƒ. ¶. 3 3/12 ÂÙÒÓ ™·ÛÙÈÎ‹ ÕÚÚÂÓ ¡·È∞. ∞. 4 1/12 ÂÙÒÓ ™·ÛÙÈÎ‹ ÕÚÚÂÓ ¡·È∆. ª. 2 6/12 ÂÙÒÓ ªÈÎÙ‹ ÕÚÚÂÓ ¡·È∆. ∫. 4 1/12 ÂÙÒÓ ∞Ù·ÍÈÎ‹ ÕÚÚÂÓ ¡·È¶. ¶. 2 7/12 ÂÙÒÓ ªÈÎÙ‹ ÕÚÚÂÓ ¡·È∫. ∫. 3 1/12 ÂÙÒÓ ∞Ù·ÍÈÎ‹ ÕÚÚÂÓ ¡·È¢. ∫. 3 1/12 ÂÙÒÓ ™·ÛÙÈÎ‹ ÕÚÚÂÓ ¡·È∫. ª. 5 6/12 ÂÙÒÓ ™·ÛÙÈÎ‹ ÕÚÚÂÓ ¡·È∫. §. 2 9/12 ÂÙÒÓ ∞Ù·ÍÈÎ‹ £‹Ï˘ Ÿ¯È¡. ¶. 4 10/12 ÂÙÒÓ ªÈÎÙ‹ £‹Ï˘ Ÿ¯È∫. ƒ. 2 2/12 ÂÙÒÓ ªÈÎÙ‹ £‹Ï˘ Ÿ¯È¶. ¶. 3 4/12 ÂÙÒÓ ªÈÎÙ‹ £‹Ï˘ Ÿ¯È∂. £. 22 ÌËÓÒÓ ∂Íˆ˘Ú·ÌÈ‰ÈÎ‹ £‹Ï˘ Ÿ¯È∞. ∂. 5 3/12 ÂÙÒÓ ™·ÛÙÈÎ‹ £‹Ï˘ Ÿ¯È§. Ã. 19 ÌËÓÒÓ ™·ÛÙÈÎ‹ £‹Ï˘ Ÿ¯È∫. µ. 19 ÌËÓÒÓ ∞Ù·ÍÈÎ‹ £‹Ï˘ Ÿ¯Èª. °. 5 2/12 ÂÙÒÓ ™·ÛÙÈÎ‹ £‹Ï˘ Ÿ¯È¶. ∫. 3 3/12 ÂÙÒÓ ªÈÎÙ‹ £‹Ï˘ Ÿ¯È∫. ™. 5 1/12 ÂÙÒÓ ªÈÎÙ‹ £‹Ï˘ Ÿ¯È∆. ∆. 21 ÌËÓÒÓ ™·ÛÙÈÎ‹ £‹Ï˘ ¡·È∫. ∫. 5 1/12 ÂÙÒÓ ∂Íˆ˘Ú·ÌÈ‰ÈÎ‹ £‹Ï˘ ¡·Èª. ∫. 4 1/12 ÂÙÒÓ ™·ÛÙÈÎ‹ £‹Ï˘ ¡·È™. π. 19 ÌËÓÒÓ ªÈÎÙ‹ £‹Ï˘ ¡·È∂. ∫. 4 ÂÙÒÓ ™·ÛÙÈÎ‹ £‹Ï˘ ¡·È¶. ∫. 3 2/12 ÂÙÒÓ ∞Ù·ÍÈÎ‹ £‹Ï˘ ¡·È∫. ∆. 2 3/12 ÂÙÒÓ ™·ÛÙÈÎ‹ £‹Ï˘ ¡·È¶. ¡. 2 6/12 ÂÙÒÓ ™·ÛÙÈÎ‹ £‹Ï˘ ¡·È∞. ∂. 5 3/12 ÂÙÒÓ ™·ÛÙÈÎ‹ £‹Ï˘ ¡·È

∞ÔÙÂÏ¤ÛÌ·Ù· ∞fi ÙÔ˘˜ 52 ·ÛıÂÓÂ›˜ ÌÂ ∂¶, ÔÈ 32 (61,5%) Â›-

¯·Ó Û·ÛÙÈÎ‹ ÌÔÚÊ‹ Î·È Û˘ÁÎÂÎÚÈÌ¤Ó· 18 Â›¯·ÓÛ·ÛÙÈÎ‹ ÙÂÙÚ·ÏËÁ›·, 8 Û·ÛÙÈÎ‹ ËÌÈÏËÁ›· Î·È 6Û·ÛÙÈÎ‹ ‰ÈÏËÁ›·. OÈ ˘fiÏÔÈÔÈ 20 ·ÛıÂÓÂ›˜(38,5%) Â›¯·Ó ÌË Û·ÛÙÈÎ‹ ÌÔÚÊ‹ ∂¶, ·fi ÙÔ˘˜ÔÔ›Ô˘˜ 12 Â›¯·Ó ÌÈÎÙ‹, 6 ·Ù·ÍÈÎ‹ Î·È 2 ‰˘ÛÎÈÓËÙÈ-Î‹-ÂÍˆ˘Ú·ÌÈ‰ÈÎ‹ ÌÔÚÊ‹. ™ÙÔ 19,2% ÙˆÓ ·È‰ÈÒÓÙË˜ ÌÂÏ¤ÙË˜ ˘‹Ú¯Â ÈÛÙÔÚÈÎfi ÚÔˆÚfiÙËÙ·˜ ÌÂ‰È¿ÚÎÂÈ· Î‡ËÛË˜ <38 Â‚‰ÔÌ¿‰Â˜ Î·È ÙÔ ˘fiÏÔÈÔ80,8% ‹Ù·Ó ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿. ∏ Î·Ù·ÓÔÌ‹ ÙˆÓ‰È·ÊfiÚˆÓ ÌÔÚÊÒÓ ÙË˜ ÂÁÎÂÊ·ÏÈÎ‹˜ ·Ú¿Ï˘ÛË˜, ËÛ˘¯ÓfiÙËÙ· Î·È Ë ‚·Ú‡ÙËÙ· ÙË˜ °O¶ ÌÂ pH-ÌÂÙÚ›·Î·È Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÙÔ˘ ˘ÂÚË¯ÔÁÚ·Ê‹Ì·ÙÔ˜Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 3. °·ÛÙÚÔÔÈÛÔÊ·ÁÈÎ‹ ·ÏÈÓ-‰ÚfiÌËÛË ÌÂ 24ˆÚË pH-ÌÂÙÚ›· ‰È·ÈÛÙÒıËÎÂ ÛÂ Ô-ÛÔÛÙfi 44,2% (23/52 ·È‰È¿), ÂÓÒ ÌÂ ÙÔ ˘ÂÚË¯Ô-ÁÚ¿ÊËÌ· ÙÔ ÔÛÔÛÙfi ·˘Ùfi ·ÓÂÚ¯fiÙ·Ó ÛÂ 53,8%(28/52). °·ÛÙÚÔÔÈÛÔÊ·ÁÈÎ‹ ·ÏÈÓ‰ÚfiÌËÛË ÂÈ‚Â-‚·ÈˆÌ¤ÓË Î·È ÌÂ ÙÈ˜ ‰‡Ô ÌÂıfi‰Ô˘˜ ‰È·ÈÛÙÒıËÎÂÛÂ 19 ·È‰È¿ (36,5%). ∆Ô ˘ÂÚË¯ÔÁÚ¿ÊËÌ· ÛÂ Û¯¤-ÛË ÌÂ ÙËÓ pH-ÌÂÙÚ›· Â›¯Â Â˘·ÈÛıËÛ›· 82,1%, ÂÓÒ ËÂÈ‰ÈÎfiÙËÙ· ·ÓÂÚ¯fiÙ·Ó ÛÙÔ 68,96% (¶›Ó·Î·˜ 4). ∏ıÂÙÈÎ‹ ÚÔÁÓˆÛÙÈÎ‹ ·Í›· (PPV), Ë ·ÚÓËÙÈÎ‹ ÚÔ-ÁÓˆÛÙÈÎ‹ ·Í›· (NPV) Î·È Ë ‰È·ÁÓˆÛÙÈÎ‹ ·ÎÚ›‚ÂÈ·(accuracy) Ê·›ÓÔÓÙ·È, Â›ÛË˜, ÛÙÔÓ ¶›Ó·Î· 4.

™‡ÌÊˆÓ· ÌÂ ÌÂÏ¤ÙÂ˜ (5,11), Ô ‚·ıÌfi˜ (‚·Ú‡ÙË-Ù·) ÙË˜ °O¶ Î·ıÔÚ›˙ÂÙ·È ·Ó¿ÏÔÁ· ÌÂ ÙÔÓ ‰Â›ÎÙË·ÏÈÓ‰ÚfiÌËÛË˜ (¢¶), Ô ÔÔ›Ô˜ Â›Ó·È ÙÔ ÔÛÔÛÙfiÙÔ˘ ¯ÚfiÓÔ˘ Î·Ù·ÁÚ·Ê‹˜ Ô˘ ÙÔ pH ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘Â›Ó·È ÌÈÎÚfiÙÂÚÔ ·fi 4. ∏ °O¶ ıÂˆÚÂ›Ù·È ‹È· fiÙ·ÓÔ ¢¶ Â›Ó·È 5-10% (ÙÔ˘ Û˘ÓÔÏÈÎÔ‡ ¯ÚfiÓÔ˘ Î·Ù·ÁÚ·-Ê‹˜), Ì¤ÙÚÈ· fiÙ·Ó Â›Ó·È 10-20%, ÂÓÒ ÛÔ‚·Ú‹ ıÂˆ-ÚÂ›Ù·È fiÙ·Ó Ô ¢¶ Â›Ó·È >20%. ∞fi Ù· 23 ·È‰È¿ ÌÂıÂÙÈÎ‹ pH-ÌÂÙÚ›·, ÛÔ‚·Ú‹ °O¶ Â›¯Â ÙÔ 52,1%(12/23 ·È‰È¿), Ì¤ÙÚÈ· ÙÔ 47,8% (11/23), ÂÓÒ ‹È·°O¶ ‰ÂÓ ‰È·ÈÛÙÒıËÎÂ ÛÂ Î·Ó¤Ó· ·È‰› ÙË˜ ÌÂÏ¤-ÙË˜ (¶›Ó·Î·˜ 3).

™ÈÓıËÚÔÁÚ¿ÊËÌ· ÛÙÔÌ¿¯Ô˘-ÔÈÛÔÊ¿ÁÔ˘ ¤ÁÈÓÂÛÂ 19 ·ÛıÂÓÂ›˜ Ô˘ Â›¯·Ó Ù·˘Ùfi¯ÚÔÓ· ıÂÙÈÎ‹ pH-ÌÂÙÚ›· Î·È ˘ÂÚË¯ÔÁÚ¿ÊËÌ·. ∞fi ·˘ÙÔ‡˜, ÙÔ47,4% (9/19) Â›¯Â Â˘Ú‹Ì·Ù· ·ıÔÏÔÁÈÎ‹˜ °O¶ Î·ÈÛÙÔÓ Ú·‰ÈÔ˚ÛÔÙÔÈÎfi ¤ÏÂÁ¯Ô. ¶ÔÛÔÛÙfi 36,8%(7/19) Â›¯Â ·ÏÈÓ‰ÚÔÌ‹ÛÂÈ˜ Î·Ù¿ ÙË ‰ÈÂÓ¤ÚÁÂÈ· ÙÔ˘ÛÈÓıËÚÔÁÚ·Ê‹Ì·ÙÔ˜, ·ÏÏ¿ Ô ‰Â›ÎÙË˜ ·ÏÈÓ‰Úfi-ÌËÛË˜ (Reflux Index) ‰ÂÓ ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚÔ˜ ÙÔ˘ 5%ÁÈ· Ó· ıÂˆÚËıÔ‡Ó ·ıÔÏÔÁÈÎ¤˜. ∆¤ÏÔ˜, ÙÔ 15,8%(3/19 ·È‰È¿) ‰ÂÓ Â›¯Â ·ÏÈÓ‰ÚÔÌ‹ÛÂÈ˜ Î·Ù¿ ÙË‰È¿ÚÎÂÈ· ÙÔ˘ ÛÈÓıËÚÔÁÚ·ÊÈÎÔ‡ ÂÏ¤Á¯Ô˘.

∏ Û˘¯ÓfiÙËÙ· ÙË˜ Á·ÛÙÚÔÔÈÛÔÊ·ÁÈÎ‹˜ ·ÏÈÓ-‰ÚfiÌËÛË˜ (·Ô‰Â‰ÂÈÁÌ¤ÓË ÌÂ pH-ÌÂÙÚ›·) ÛÙ· ‰‡ÔÊ‡Ï· ‹Ù·Ó 43,8% (14/32) ÁÈ· Ù· ·ÁfiÚÈ· Î·È 45%


299

¶›Ó·Î·˜ 2. ∫ÚÈÙ‹ÚÈ· ‰È¿ÁÓˆÛË˜ °O¶ Î·Ù¿ ÙË ‰ÈÂÓ¤ÚÁÂÈ· 24ˆÚË˜ pH-ÌÂÙÚ›·˜* (8,15)

ñ ¢Â›ÎÙË˜ ·ÏÈÓ‰ÚfiÌËÛË˜ (¢¶): ¶ÔÛÔÛÙfi Û˘ÓÔÏÈÎÔ‡ ¯ÚfiÓÔ˘ Ô˘ ÙÔ pH ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘ Â›Ó·È ÌÈÎÚfiÙÂÚÔ ÙÔ˘ 4 (Ê˘ÛÈÔÏÔÁÈÎ¤˜ÙÈÌ¤˜ Ì¤¯ÚÈ 5% ÙÔ˘ Û˘ÓÔÏÈÎÔ‡ ¯ÚfiÓÔ˘ Î·Ù·ÁÚ·Ê‹˜**)

ñ ∞ÚÈıÌfi˜ ÂÂÈÛÔ‰›ˆÓ ÌÂ ‰È¿ÚÎÂÈ· ÌÂÁ·Ï‡ÙÂÚË ·fi 5 ÏÂÙ¿ (·ıÔÏÔÁÈÎfi˜ fiÙ·Ó ÛËÌÂÈÒÓÔÓÙ·È >7 ÂÂÈÛfi‰È·/24ˆÚÔ) ñ ∫¿ı·ÚÛË ÔÍ¤Ô˜. ø˜ Î¿ı·ÚÛË ÔÍ¤Ô˜ ÔÚ›˙ÂÙ·È ÙÔ ËÏ›ÎÔ ÙË˜ Û˘ÓÔÏÈÎ‹˜ ‰È¿ÚÎÂÈ·˜ (ÛÂ ÏÂÙ¿) ÙˆÓ ÂÂÈÛÔ‰›ˆÓ °O¶ ÌÂ pH ÌÈ-

ÎÚfiÙÂÚÔ ÙÔ˘ 4 ‰È¿ ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÂÂÈÛÔ‰›ˆÓ °O¶ (·ıÔÏÔÁÈÎ‹ ıÂˆÚÂ›Ù·È fiÙ·Ó Â›Ó·È >4 ÏÂÙ¿) ñ ªÂÁ·Ï‡ÙÂÚÔ ÛÂ ‰È¿ÚÎÂÈ· ÂÂÈÛfi‰ÈÔ (·ıÔÏÔÁÈÎfi fiÙ·Ó Â›Ó·È >20 ÏÂÙ¿) ñ ¶ÔÛÔÛÙfi ÂÂÈÛÔ‰›ˆÓ >5 ÏÂÙ¿ (·ıÔÏÔÁÈÎfi fiÙ·Ó Â›Ó·È >12%) ñ ™˘¯ÓfiÙËÙ· ·ÏÈÓ‰ÚÔÌ‹ÛÂˆÓ (·ıÔÏÔÁÈÎfi fiÙ·Ó Â›Ó·È >1,5 ÂÂÈÛfi‰ÈÔ/ÒÚ·)

* ∆· ·Ú·¿Óˆ ÎÚÈÙ‹ÚÈ· ÈÛ¯‡Ô˘Ó ÁÈ· ÌÂÙÚ‹ÛÂÈ˜ ¿Óˆ ·fi 16 ÒÚÂ˜. °È· Ó· ÙÂıÂ› Ë ‰È¿ÁÓˆÛË °O¶, Ú¤ÂÈ Ó· Â›Ó·È ·ıÔÏÔÁÈ-Î¿ ÙÔ˘Ï¿¯ÈÛÙÔÓ 2 ·fi Ù· ÎÚÈÙ‹ÚÈ·

** ◊È· ıÂˆÚÂ›Ù·È Ë °O¶ fiÙ·Ó Ô ¢¶ Â›Ó·È 5-10% (ÙÔ˘ Û˘ÓÔÏÈÎÔ‡ ¯ÚfiÓÔ˘ Î·Ù·ÁÚ·Ê‹˜), Ì¤ÙÚÈ· ÌÂÙ·Í‡ 10-20%, ÂÓÒ ÛÔ‚·Ú‹ ıÂ-ˆÚÂ›Ù·È fiÙ·Ó Ô ¢¶ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚÔ˜ ÙÔ˘ 20%

¶›Ó·Î·˜ 3. µ·Ú‡ÙËÙ· °O¶ ÛÙÈ˜ ‰È¿ÊÔÚÂ˜ ÌÔÚÊ¤˜ ∂¶ Î·Ù¿ ÙËÓ 24ˆÚË pH-ÌÂÙÚ›· ÛÂ Û‡ÁÎÚÈÛË ÌÂ ˘ÂÚË¯ÔÁÚ¿ÊËÌ·

∆‡Ô˜ ∂¶ (n) µ·ıÌfi˜ °O¶ £ÂÙÈÎ¿ Â˘Ú‹Ì·Ù·◊ÈÔ˜ ª¤ÙÚÈÔ˜ ™Ô‚·Úfi˜ pH-ÌÂÙÚ›· ÀÂÚË¯ÔÁÚ¿ÊËÌ·

™·ÛÙÈÎ‹ ÙÂÙÚ·ÏËÁ›· (18) 0 3 5 8 7™·ÛÙÈÎ‹ ‰ÈÏËÁ›· (6) 0 2 1 3 4™·ÛÙÈÎ‹ ËÌÈÏËÁ›· (8) 0 2 2 4 5∂Íˆ˘Ú·ÌÈ‰ÈÎ‹ (2) 0 1 0 1 1∞Ù·ÍÈÎ‹ (6) 0 1 2 3 4ªÈÎÙ‹ (12) 0 2 2 4 7™‡ÓÔÏÔ (52) 0 11 12 23 28

n: ·ÚÈıÌfi˜ ·ÛıÂÓÒÓ °O¶: Á·ÛÙÚÔÔÈÛÔÊ·ÁÈÎ‹ ·ÏÈÓ‰ÚfiÌËÛË ∂¶: ÂÁÎÂÊ·ÏÈÎ‹ ·Ú¿Ï˘ÛË O ‚·ıÌfi˜ ÙË˜ °O¶ Î·ıÔÚ›ÛÙËÎÂ Û‡ÌÊˆÓ· ÌÂ Ù· ‰ÈÂıÓ‹ ÎÚÈÙ‹ÚÈ· Ô˘ ÈÛ¯‡Ô˘Ó ÁÈ· ÙËÓ 24ˆÚË pH-ÌÂÙÚ›·


300

(9/20) ÁÈ· Ù· ÎÔÚ›ÙÛÈ· (p=0,59). ∏ Û˘¯ÓfiÙËÙ· ÙË˜ °O¶ ÛÙÈ˜ Û·ÛÙÈÎ¤˜ ÌÔÚÊ¤˜

‹Ù·Ó 46,9% (15/32) Î·È ÛÙÈ˜ ÌË Û·ÛÙÈÎ¤˜ ÌÔÚÊ¤˜40% (8/20), ‰È·ÊÔÚ¿ ÛÙ·ÙÈÛÙÈÎ¿ ÌË ÛËÌ·ÓÙÈÎ‹(p=0,59). ∏ ËÏÈÎ›· ÌÂÙ·Í‡ Û·ÛÙÈÎÒÓ Î·È ÌË Û·ÛÙÈ-ÎÒÓ ÌÔÚÊÒÓ ∂¶ ‰ÂÓ ‰È¤ÊÂÚÂ, Â›ÛË˜, ÛËÌ·ÓÙÈÎ¿(p=0,698). OÈ Û˘¯ÓfiÙÂÚÂ˜ ÂÈÏÔÎ¤˜ ÛÙ· 23 ·È‰È¿Ô˘ Â›¯·Ó °O¶ ÛÙËÓ pH-ÌÂÙÚ›· ‹Ù·Ó Ë ÛÈ‰ËÚÔÂÓ›·(56,5%), Ë Î·Î‹ ıÚ¤„Ë (34,8%), Ë ·Ó·ÈÌ›· (47,8%), ÔÈ˘ÔÙÚÔÈ¿˙Ô˘ÛÂ˜ ÏÔÈÌÒÍÂÈ˜ ÙÔ˘ Î·ÙÒÙÂÚÔ˘ ·Ó·-ÓÂ˘ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ (26%) Î·È Ë ÛÙ·ÛÈÌfiÙËÙ·ÙÔ˘ ‚¿ÚÔ˘˜ (26%) (¶›Ó·Î·˜ 5). §ÈÁfiÙÂÚÔ Û˘¯Ó¤˜ ÂÈ-ÏÔÎ¤˜ ‹Ù·Ó Ë ˘ÔÏÂ˘ÎˆÌ·ÙÈÓ·ÈÌ›·, Ë ÛÙ·ÛÈÌfiÙËÙ·ÙÔ˘ ‡„Ô˘˜ Î·È Ë ·ıÔÏÔÁÈÎ‹ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·Î·ÌÂ ‚ÚÔÁ¯ÂÎÙ·Û›Â˜ Î·È ÂÈÎfiÓ· ÓÂ˘ÌÔÓÈÎ‹˜ ›ÓˆÛË˜.∞ÓÙ›ıÂÙ·, ·È‰È¿ ¯ˆÚ›˜ °O¶ (n=33) Â›¯·Ó ÂÎ‰ËÏÒ-ÛÂÈ˜ Ô˘ ·Ú·¤ÌÔ˘Ó ÛÂ °O¶ ÂÈÏÔÎ¤˜ ÛÂ ÌÈÎÚfi-ÙÂÚ· ÔÛÔÛÙ¿ (¶›Ó·Î·˜ 5).

™˘˙‹ÙËÛË ™‡ÌÊˆÓ· Î·È ÌÂ ÚÔËÁÔ‡ÌÂÓÂ˜ ÌÂÏ¤ÙÂ˜ (3-

5,21,22), Ë Û˘¯ÓfiÙËÙ· ÙË˜ °O¶ ÛÙËÓ ∂¶ ·ÚÔ˘ÛÈ¿-˙ÂÈ Â˘ÚÂ›Â˜ ‰È·Î˘Ì¿ÓÛÂÈ˜ (25-91%), ÂÓÒ ·Ó·Ê¤ÚÂ-Ù·È ¯·ÌËÏfiÙÂÚË (8%) ÛÂ Ê˘ÛÈÔÏÔÁÈÎ¿ ¿ÙÔÌ· (23).OÈ Bohmer Î·È Û˘Ó (24) ÛÂ ÚfiÛÊ·ÙË ÌÂÏ¤ÙË ÙÔ˘˜·Ó·Ê¤ÚÔ˘Ó Û˘¯ÓfiÙËÙ· °O¶ 55,3% ÛÂ ÓÔËÙÈÎ¿ Î·-ı˘ÛÙÂÚËÌ¤Ó· ·È‰È¿ Ô˘ ‚Ú›ÛÎÔÓÙ·È ÛÂ È‰Ú‡Ì·Ù·,ÂÓÒ ÔÈ Del Giudice Î·È Û˘Ó (1999) ·Ó·Ê¤ÚÔ˘Ó Û˘-¯ÓfiÙËÙ· ÙË˜ °O¶ ÛÂ ·È‰È¿ ÌÂ ∂¶ 91% (6). OÈRavelli Î·È Milla (5) ‰ÈÂÓÂÚÁÒÓÙ·˜ 24ˆÚË pH-ÌÂÙÚ›·ÛÂ 50 ·ÛıÂÓÂ›˜ ÌÂ ÂÌ¤ÙÔ˘˜ Î·È ‚Ï¿‚Ë ÙÔ˘ ∫¡™, ‰È¤-ÁÓˆÛ·Ó °O¶ ÛÂ ÔÛÔÛÙfi 58%. ™ÙË ÌÂÏ¤ÙË ÙˆÓReyes Î·È Û˘Ó (4), ÔÈ ÔÔ›ÔÈ Â›ÛË˜ ÂÊ¿ÚÌÔÛ·Ó24ˆÚË pH-ÌÂÙÚ›· ÛÂ ·È‰È¿ ÌÂ ∂¶, Ë Û˘¯ÓfiÙËÙ··ÓÂÚ¯fiÙ·Ó ÛÂ 70% Î·È Ë °O¶ ‹Ù·Ó Û˘¯ÓfiÙÂÚË ÛÙ··ÁfiÚÈ· (43%) ÛÂ Û¯¤ÛË ÌÂ Ù· ÎÔÚ›ÙÛÈ· (22%), ¯ˆÚ›˜Ó· ÌÔÚÂ› Ó· ‰ÔıÂ› Î¿ÔÈ· ÂÍ‹ÁËÛË. ™ÙËÓ ·ÚÔ‡Û·ÌÂÏ¤ÙË, Ë Û˘¯ÓfiÙËÙ· ÙË˜ °O¶ (·Ô‰Â‰ÂÈÁÌ¤ÓË ÌÂ24ˆÚË pH-ÌÂÙÚ›·) ‹Ù·Ó 44,2%. ¢È·ÊÔÚ¿ Û˘¯ÓfiÙË-Ù·˜ ÙË˜ °O¶ ÌÂÙ·Í‡ ·ÁÔÚÈÒÓ (43,8%) Î·È ÎÔÚÈÙÛÈÒÓ

(45%) ‰ÂÓ ‰È·ÈÛÙÒıËÎÂ (p>0,05). ∆· Â˘Ú‹Ì·Ù·ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ ‰ÂÓ ‰È·Ê¤ÚÔ˘Ó ÛËÌ·ÓÙÈÎ¿·fi ·˘Ù¿ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· Î·È‰Â›¯ÓÔ˘Ó fiÙÈ Ë Û˘¯ÓfiÙËÙ· ÙË˜ °O¶ ÛÙ· ·È‰È¿ ÌÂ∂¶ Â›Ó·È ·˘ÍËÌ¤ÓË. ∆· ¯·ÌËÏfiÙÂÚ· ÔÛÔÛÙ¿ ÙË˜·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ ¤Ó·ÓÙÈ ÙˆÓ ˘„ËÏfiÙÂÚˆÓ ÙË˜ ‚È-‚ÏÈÔÁÚ·Ê›·˜ (¤ˆ˜ 90%), ›Ûˆ˜ Ó· ÔÊÂ›ÏÔÓÙ·È ÛÙÔ ÁÂ-ÁÔÓfi˜ fiÙÈ ÙÔ ˘ÏÈÎfi ÙË˜ ÚÒÙË˜ ·ÔÙÂÏÔ‡ÓÙ·Ó ·fi·È‰È¿ ËÏÈÎ›·˜ ¤ˆ˜ 5 ¯ÚfiÓˆÓ Î·È ÚÔÊ·ÓÒ˜ ‰ÂÓ Â›-¯Â ÂÎ‰ËÏˆıÂ› ·ÎfiÌË Ë °O¶.

∏ Â˘·ÈÛıËÛ›· ÙˆÓ ÌÂıfi‰ˆÓ ‰È¿ÁÓˆÛË˜ ÙË˜ °O¶·Ó·Ê¤ÚÂÙ·È ÛÂ ·ÚÎÂÙ¤˜ ÌÂÏ¤ÙÂ˜. §·Ì‚¿ÓÔÓÙ·˜ ˆ˜ÂÍ¤Ù·ÛË ·Ó·ÊÔÚ¿˜ ÙËÓ pH-ÌÂÙÚ›·, ÙÔ ˘ÂÚË¯ÔÁÚ¿-ÊËÌ· ·Ó·Ê¤ÚÂÙ·È Ó· ¤¯ÂÈ Â˘·ÈÛıËÛ›· ¤ˆ˜ 87%(16,25,26). ¶ÚfiÛÊ·Ù· (1997), ÔÈ Hirsch Î·È Û˘Ó (25)ÂÊ·ÚÌfi˙ÔÓÙ·˜ ¤Á¯ÚˆÌÔ ˘ÂÚË¯ÔÁÚ¿ÊËÌ· ÛÂ 84·È‰È¿, ‰È·›ÛÙˆÛ·Ó ·ÎfiÌ· ÌÂÁ·Ï‡ÙÂÚË Â˘·ÈÛıË-Û›· ÙˆÓ ˘ÂÚ‹¯ˆÓ ÁÈ· ÙËÓ ·ÔÎ¿Ï˘„Ë °O¶ (94%).™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË, ÙÔ ˘ÂÚË¯ÔÁÚ¿ÊËÌ· ‹Ù·ÓıÂÙÈÎfi ÛÂ ÔÛÔÛÙfi 53,8% ÙˆÓ ·ÛıÂÓÒÓ. §·Ì‚¿ÓÔ-ÓÙ·˜ ˘’ fi„ÈÓ Û·Ó “¯Ú˘Ûfi ÚfiÙ˘Ô” ÙËÓ pH-ÌÂÙÚ›·,Ë Â˘·ÈÛıËÛ›· ÙÔ˘ ˘ÂÚË¯ÔÁÚ·Ê‹Ì·ÙÔ˜ ‹Ù·Ó 82,1%(19/23 ·È‰È¿ ÌÂ ıÂÙÈÎ‹ pH-ÌÂÙÚ›· Â›¯·Ó Î·È ıÂÙÈÎfi˘ÂÚË¯ÔÁÚ¿ÊËÌ·). ∏ ÂÈ‰ÈÎfiÙËÙ· ÙÔ˘ ˘ÂÚË¯ÔÁÚ·-Ê‹Ì·ÙÔ˜ ÛÂ Û¯¤ÛË ÌÂ ÙËÓ pH-ÌÂÙÚ›· ‹Ù·Ó 68,96%.™‡ÌÊˆÓ· Î·È ÌÂ ¿ÏÏÂ˜ ÌÂÏ¤ÙÂ˜, Ë ÂÈ‰ÈÎfiÙËÙ· ÙÔ˘˘ÂÚË¯ÔÁÚ·Ê‹Ì·ÙÔ˜ ÛÂ Û¯¤ÛË ÌÂ ÙËÓ pH-ÌÂÙÚ›··Ó¤Ú¯ÂÙ·È ÛÙÔ 58% Î·È ÌÔÚÂ› Ó· ·˘ÍËıÂ› ÛËÌ·ÓÙÈ-Î¿ fiÙ·Ó, ÛÂ ¿ÙÔÌ· ¯ˆÚ›˜ ÎÏÈÓÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜, ÔÈ‰È·ÈÛÙˆÌ¤ÓÂ˜ ·ÏÈÓ‰ÚÔÌ‹ÛÂÈ˜ ıÂˆÚËıÔ‡Ó Û·ÊÒ˜·ıÔÏÔÁÈÎ¤˜ (16).

∏ Â˘·ÈÛıËÛ›· ÙÔ˘ ÛÈÓıËÚÔÁÚ·Ê‹Ì·ÙÔ˜ ÁÈ· ÙË‰È¿ÁÓˆÛË °O¶ ÔÈÎ›ÏÏÂÈ ·Ó¿ÌÂÛ· ÛÙÈ˜ ‰È¿ÊÔÚÂ˜ÌÂÏ¤ÙÂ˜ Î·È Î˘Ì·›ÓÂÙ·È ·fi 14-90% (27). ™‡ÌÊˆÓ·ÌÂ ¿ÏÏÔ˘˜ ÌÂÏÂÙËÙ¤˜, Ë Â˘·ÈÛıËÛ›· ÙÔ˘ ÛÈÓıËÚÔ-ÁÚ·Ê‹Ì·ÙÔ˜ ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙËÓ pH-ÌÂÙÚ›· Î˘Ì·›-ÓÂÙ·È ·fi 75% ¤ˆ˜ 100%, ÂÓÒ Ë ÂÈ‰ÈÎfiÙËÙ· ·Ó¤Ú¯ÂÙ·È ÛÂ ÔÛÔÛÙfi 90% (20,28,29). OÈ ·Ú¿ÁÔ-ÓÙÂ˜ Ô˘ ÂËÚÂ¿˙Ô˘Ó ÙËÓ Â˘·ÈÛıËÛ›· Â›Ó·È Ô fiÁÎÔ˜Î·È Ë Û‡ÓıÂÛË ÙÔ˘ ÁÂ‡Ì·ÙÔ˜, Ë Û˘ÁÎ¤ÓÙÚˆÛË ÙÔ˘

¶›Ó·Î·˜ 4. ∞ÍÈÔÏfiÁËÛË ÙÔ˘ ˘ÂÚË¯ÔÁÚ·Ê‹Ì·ÙÔ˜ (ÛÂ Û¯¤ÛË ÌÂ ÙËÓ pH-ÌÂÙÚ›·) ÛÙË ‰È¿ÁÓˆÛË ÙË˜ °O¶ ÛÂ ·È‰È¿ ÌÂ ∂¶

TP FP TN FN Se Sp Ac PPV NPV(19) (9) (20) (4) 82,1% 68,96% 75,0% 67,86% 83,3%

(23/28) (20/29) (39/52) (19/28) (20/24)

TP (true positive): ÔÚıÒ˜ ıÂÙÈÎ¿ FP (false positive): „Â˘‰Ò˜ ıÂÙÈÎ¿ TN (true negative): ÔÚıÒ˜ ·ÚÓËÙÈÎ¿ FN (false negative): „Â˘‰Ò˜ ·ÚÓËÙÈÎ¿ Se (sensitivity): Â˘·ÈÛıËÛ›· Sp (specificity): ÂÈ‰ÈÎfiÙËÙ· Ac (accuracy): ‰È·ÁÓˆÛÙÈÎ‹ ·ÎÚ›‚ÂÈ· PPV (positive predictive value): ıÂÙÈÎfi˜ ÚÔÁÓˆÛÙÈÎfi˜ ‰Â›ÎÙË˜ NPV (negative predictive value): ·ÚÓËÙÈÎfi˜ ÚÔÁÓˆÛÙÈÎfi˜ ‰Â›ÎÙË˜ ™ÙÈ˜ ·ÚÂÓı¤ÛÂÈ˜ ·Ó·Ê¤ÚÂÙ·È Ô ·ÚÈıÌfi˜ ÙˆÓ ·È‰ÈÒÓ

Ú·‰ÈÔÊ·ÚÌ¿ÎÔ˘, Ë Â˘·ÈÛıËÛ›· ÙË˜ Á-camera, ËÂÍ·Ûı¤ÓËÛË ÙË˜ ·ÎÙÈÓÔ‚ÔÏ›·˜, Ô fiÁÎÔ˜ Î·È Ë ‰È¿Ú-ÎÂÈ· ÙË˜ ·ÏÈÓ‰ÚfiÌËÛË˜. ™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË,·È‰È¿ ÌÂ ıÂÙÈÎ‹ pH-ÌÂÙÚ›· Î·È ˘ÂÚË¯ÔÁÚ¿ÊËÌ·(n=19) Â›¯·Ó ıÂÙÈÎfi ÛÈÓıËÚÔÁÚ¿ÊËÌ· ÛÂ ÔÛÔ-ÛÙfi 47,4% (9/19 ·È‰È¿), ÂÓÒ ÙÔ 36,8% (7/19 ·È-‰È¿) Â›¯Â ·ÏÈÓ‰ÚfiÌËÛË, ·ÏÏ¿ ÛÙ· fiÚÈ· ÙÔ˘ Ê˘ÛÈÔ-ÏÔÁÈÎÔ‡ (RI <5%).

O ‚·ıÌfi˜ (‚·Ú‡ÙËÙ·) ÙË˜ °O¶ ÛÙ· ·È‰È¿ ÌÂÂÁÎÂÊ·ÏÈÎ‹ ·Ú¿Ï˘ÛË ÔÈÎ›ÏÏÂÈ. OÈ Gustafsson Î·ÈTibbling ‚Ú‹Î·Ó Ì¤ÙÚÈÔ˘ Î·È ÛÔ‚·ÚÔ‡ ‚·ıÌÔ‡ °O¶ÛÙÔ 61% ÙˆÓ ·È‰ÈÒÓ ÌÂ ·ÏÈÓ‰ÚfiÌËÛË (ÛÔ‚·Ú‹ÌÔÚÊ‹ ÛÙÔ 22% Î·È Ì¤ÙÚÈ· ÛÙÔ 39%) (30). ¶·Úfi-ÌÔÈ· ÔÛÔÛÙ¿ ·Ó·Ê¤ÚÔ˘Ó Î·È ÔÈ Ravelli Î·È Milla, ÔÈÔÔ›ÔÈ ‚Ú‹Î·Ó Ì¤ÙÚÈ· Î·È ÛÔ‚·Ú‹ ÌÔÚÊ‹ °O¶ ÛÙÔ68% ÙˆÓ ·ÛıÂÓÒÓ ÌÂ ·ÏÈÓ‰ÚfiÌËÛË (5). ™ÙËÓ ·-ÚÔ‡Û· ÌÂÏ¤ÙË, Ì¤ÙÚÈÔ˘ Î·È ÛÔ‚·ÚÔ‡ ‚·ıÌÔ‡ °O¶‚Ú¤ıËÎÂ ÛÙÔ 100% ÙˆÓ ·È‰ÈÒÓ ÌÂ ·ÏÈÓ‰ÚfiÌËÛË(Ì¤ÙÚÈ· ÛÙÔ 47,8%, ÛÔ‚·Ú‹ ÛÙÔ 52,2%, ÂÓÒ ‰ÂÓ‚Ú¤ıËÎÂ ‹È·), ¤Ó·ÓÙÈ 61% Î·È 68% ÙˆÓ ÚÔ·Ó·ÊÂ-ÚfiÌÂÓˆÓ ÌÂÏÂÙÒÓ. °È· ÙË ‰È·ÊÔÚ¿ ·˘Ù‹ ‰ÂÓ ‹Ù·Ó‰˘Ó·Ùfi Ó· ‰ÔıÂ› Û·Ê‹˜ ÂÍ‹ÁËÛË. ÿÛˆ˜ Ó· ÔÊÂ›ÏÂ-Ù·È ÛÙÔ fiÙÈ ÛÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ‰ÈÎ¿Ó·ÏÔ ËÏÂÎÙÚfi‰ÈÔ Î·Ù·ÁÚ·Ê‹˜, ÙÔ ÔÔ›Ô ·˘Í¿-ÓÂÈ ÙËÓ Â˘·ÈÛıËÛ›· ÙË˜ pH-ÌÂÙÚ›·˜.

¢È·ÊÔÚ¤˜, fiÌˆ˜, ˘¿Ú¯Ô˘Ó Î·È ÛÙËÓ ÂÌÊ¿ÓÈÛËÙË˜ °O¶ ÛÙÈ˜ Ù¤ÛÛÂÚÈ˜ ÌÔÚÊ¤˜ ∂¶. OÈ Reyes Î·ÈÛ˘Ó ·Ó·Ê¤ÚÔ˘Ó fiÙÈ ‰ÂÓ ‚Ú‹Î·Ó Î·Ì›· Û¯¤ÛË ÌÂÙ·-Í‡ °O¶ Î·È Î¿ÔÈ·˜ Û˘ÁÎÂÎÚÈÌ¤ÓË˜ ÌÔÚÊ‹˜ ∂¶ (ÛÂ·È‰È¿ ËÏÈÎ›·˜ 0,6-11,8 ÂÙÒÓ), Ô‡ÙÂ ÌÂÙ·Í‡ ÙÔ˘ ‚·ı-ÌÔ‡ ÙË˜ ·Ó·ËÚ›·˜ Î·È ÙË˜ ÂÌÊ¿ÓÈÛË˜ °O¶ (4).∞ÓÙ›ıÂÙ·, ¿ÏÏÂ˜ ÌÂÏ¤ÙÂ˜ ·Ó·Ê¤ÚÔ˘Ó ÌÂÁ·Ï‡ÙÂÚËÛ˘¯ÓfiÙËÙ· ÙË˜ °O¶ ÛÙÈ˜ Û·ÛÙÈÎ¤˜ ÌÔÚÊ¤˜ ∂¶. OÈSondheimer Î·È Û˘Ó (3), ÛÂ 15 ·È‰È¿ ÌÂ ‚Ï¿‚Ë ÙÔ˘∫¡™ Î·È °O¶ (ËÏÈÎ›·˜ 14±0,9 ÂÙÒÓ), ‚Ú‹Î·Ó fiÙÈ ÙÔ75% ÙË˜ ·ÏÈÓ‰ÚfiÌËÛË˜ ·Ú·ÙËÚ‹ıËÎÂ ÛÙÈ˜ Û·-ÛÙÈÎ¤˜ ÌÔÚÊ¤˜, ÂÓÒ ÔÈ Ravelli Î·È Milla (5) Ô˘ ÌÂ-Ï¤ÙËÛ·Ó 50 ·È‰È¿ ÌÂ ∂¶ (ËÏÈÎ›·˜ 4 ÌËÓÒÓ-15,5ÂÙÒÓ), ·Ó·Ê¤ÚÔ˘Ó Û˘¯ÓfiÙËÙ· °O¶ ÛÙÈ˜ Û·ÛÙÈÎ¤˜ÌÔÚÊ¤˜ ÛÂ ÔÛÔÛÙfi 46%. ™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË, Ë

Û˘¯ÓfiÙËÙ· ÙË˜ °O¶ (Û‡ÌÊˆÓ· ÌÂ Ù· ·ÔÙÂÏ¤ÛÌ·-Ù· ÙË˜ pH-ÌÂÙÚ›·˜) ÛÙÈ˜ Û·ÛÙÈÎ¤˜ ÌÔÚÊ¤˜ ·ÓÂÚ-¯fiÙ·Ó ÛÂ ÔÛÔÛÙfi 46,9% (15/32 ·È‰È¿), ÂÓÒ ÛÙÈ˜ÌË Û·ÛÙÈÎ¤˜ ÛÂ 40% (8/20 ·È‰È¿).

OÈ Û˘¯ÓfiÙÂÚÂ˜ ÂÈÏÔÎ¤˜ ÙË˜ °O¶ ÛÂ ·È‰È¿ ÌÂ∂¶ Â›Ó·È ÛÙÂÓÒÛÂÈ˜ ÙÔ˘ ÂÙÈÎÔ‡, ÔÈÛÔÊ¿ÁÔ˜ Ù‡Ô˘Barett, Ô˘ ıÂˆÚÂ›Ù·È ÚÔÎ·ÚÎÈÓˆÌ·ÙÒ‰Ë˜ Î·Ù¿-ÛÙ·ÛË, ÛÈ‰ËÚÔÂÓÈÎ‹ ·Ó·ÈÌ›·, ·ÈÌÔÚÚ·Á›· ·fi ÙÔÂÙÈÎfi Î·È ÓÂ˘ÌÔÓ›· ·fi ÂÈÛÚfiÊËÛË (3,6,21,22).OÈ ÂÈÏÔÎ¤˜ ·˘Ù¤˜, ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ÙÈ˜ ‰˘ÛÎÔÏ›Â˜Î·Ù¿ÔÛË˜ Ô˘ ˘¿Ú¯Ô˘Ó, Ô‰ËÁÔ‡Ó ÛÂ Î·ı˘ÛÙÂÚË-Ì¤ÓË ·Ó¿Ù˘ÍË Î·È ıÚ¤„Ë Î·È ÂËÚÂ¿˙Ô˘Ó ·ÚÓËÙÈÎ¿Ù· ÔÏÏ·Ï¿ ıÂÚ·Â˘ÙÈÎ¿ Ì¤ÙÚ·.

OÈ ÂÈÏÔÎ¤˜ ÙË˜ °O¶ ÛÙËÓ ∂¶ ‰ÂÓ ÌÂÏÂÙ‹ıËÎ·ÓÛÙÂÓ¿ Ì¤¯ÚÈ Û‹ÌÂÚ·, ›Ûˆ˜ ÂÍ·ÈÙ›·˜ Î·È ÙˆÓ ¿ÏÏˆÓÛÔ‚·ÚÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ Ô˘ ¤¯Ô˘Ó Ù· ·È‰È¿ ÌÂ ∂¶.

™ÙË ÌÂÏ¤ÙË ÙˆÓ Drvaric Î·È Û˘Ó ÛÂ 52 ·ÛıÂÓÂ›˜ÌÂ ∂¶, ·Ó·Ê¤ÚÂÙ·È Û˘¯ÓfiÙËÙ· °O¶ 62%, ÙÔ 79%ÙÔ˘ ÔÔ›Ô˘ (41/52 ·È‰È¿) ‹Ù·Ó Î¿Ùˆ ·fi ÙËÓ 3ËÂÎ·ÙÔÛÙÈ·›· ı¤ÛË (∂£) ˆ˜ ÚÔ˜ ÙÔ ‚¿ÚÔ˜, ÙÔ 32%Â›¯Â ¯·ÌËÏfiÙÂÚË ÏÂ˘ÎˆÌ·Ù›ÓË ·fi ÙÔ Ê˘ÛÈÔÏÔÁÈÎfi(<3,8 g/dl), ÂÓÒ ˘ÔÚˆÙÂ˚Ó·ÈÌ›· ·Ú·ÙËÚ‹ıËÎÂÛÙÔ 8% (31). øÛÙfiÛÔ, ÛÂ ·˘Ù‹ ÙË ÌÂÏ¤ÙË ‰ÂÓ ¤ÁÈÓÂÛ˘Û¯¤ÙÈÛË ÙˆÓ Â˘ÚËÌ¿ÙˆÓ ·˘ÙÒÓ ÌÂ ÙËÓ ·ÚÔ˘Û›·‹ ÌË °O¶. OÈ Reyes Î·È Û˘Ó, ÛÂ 23 ·È‰È¿ ÌÂ ∂¶,‚Ú‹Î·Ó ÛÔ‚·Ú¿ ÚÔ‚Ï‹Ì·Ù· ‰È·ÙÚÔÊ‹˜ (‰˘ÛÎÔ-Ï›Â˜ Ì¿ÛËÛË˜, ‰˘ÛÎ·Ù·ÔÛ›· Î·È ÂÌ¤ÙÔ˘˜) ÛÙÔ70%, ÛÙ·ÛÈÌfiÙËÙ· ÛˆÌ·ÙÈÎ‹˜ ·Ó¿Ù˘ÍË˜ ÛÙÔ 52%Î·È ·Ó·ÈÌ›· ÛÙÔ 31% ÙˆÓ ·È‰ÈÒÓ (4). ™ÙËÓ ›‰È· ÂÚ-Á·Û›·, ˘ÔÙÚÔÈ¿˙Ô˘ÛÂ˜ ÏÔÈÌÒÍÂÈ˜ ÙÔ˘ Î·ÙÒÙÂÚÔ˘·Ó·ÓÂ˘ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ·Ó·Ê¤ÚÔÓÙ·Ó ÛÙÔ31%, ÂÓÒ °O¶ ·Ô‰Â‰ÂÈÁÌ¤ÓË ÌÂ 24ˆÚË pH-ÌÂÙÚ›·‚Ú¤ıËÎÂ ÛÙÔ 70% ÙˆÓ ·ÛıÂÓÒÓ. ∆· ÚÔ‚Ï‹Ì·Ù·‰È·ÙÚÔÊ‹˜ ÛÙË Û˘ÁÎÂÎÚÈÌ¤ÓË ÌÂÏ¤ÙË ‰ÂÓ ‹Ù·Ó Û˘-¯ÓfiÙÂÚ· ÛÙ· ·È‰È¿ ÌÂ °O¶ ÛÂ Û‡ÁÎÚÈÛË ÌÂ ·˘Ù¿¯ˆÚ›˜ °O¶. ∞˘Ù¿ Ù· ·ÔÙÂÏ¤ÛÌ·Ù· Ô‰‹ÁËÛ·Ó ÛÙÔÛ˘Ì¤Ú·ÛÌ· fiÙÈ Ë Î·Î‹ ıÚ¤„Ë ·fi ÌfiÓË ÙË˜ ‰ÂÓÛ¯ÂÙÈ˙fiÙ·Ó ··Ú·›ÙËÙ· ÌÂ °O¶, ·ÏÏ¿ ÔÊÂÈÏfiÙ·ÓÎ·È ÛÂ ¿ÏÏÔ˘˜ ·Ú¿ÁÔÓÙÂ˜.

∞ÓÙ›ıÂÙ·, ÔÈ Ravelli Î·È Milla ·Ó·Ê¤ÚÔ˘Ó ÔÏ‡


301

¶›Ó·Î·˜ 5. ∂ÈÏÔÎ¤˜ °O¶ ÛÂ ·È‰È¿ ÌÂ ∂¶ Î·È ·Ô‰Â‰ÂÈÁÌ¤ÓË ·ÏÈÓ‰ÚfiÌËÛË (n=23) Î·È ÛÂ ·È‰È¿ ¯ˆÚ›˜ °O¶ (n=33)

∂ÈÏÔÎ‹ ∞ÛıÂÓÂ›˜ ÌÂ °O¶ ∞ÛıÂÓÂ›˜ ¯ˆÚ›˜ °O¶n (%) n (%)

∫·Î‹ ıÚ¤„Ë* 8 (34,8) 2 (6)ÀÔÙÚÔÈ¿˙Ô˘ÛÂ˜ ÓÂ˘ÌÔÓ›Â˜ 6 (26) 4 (12,1)∞Ó·ÈÌ›· 11 (47,8) 5 (15,1)™È‰ËÚÔÂÓ›· 13 (56,5) 7 (21,2)ÀÔÏÂ˘ÎˆÌ·ÙÈÓ·ÈÌ›· 4 (17,3) 4 (12,1)µ¿ÚÔ˜ ÛÒÌ·ÙÔ˜ <3Ë ∂£ 6 (26) 8 (24,2)⁄„Ô˜ ÛÒÌ·ÙÔ˜ <3Ë ∂£ 4 (17,3) 6 (18,1)¶·ıÔÏÔÁÈÎ‹ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·Î· 5 (21,7) 3 (9)

n: ·ÚÈıÌfi˜ ·ÛıÂÓÒÓ * ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜ <10Ë ÂÎ·ÙÔÛÙÈ·›· ı¤ÛË (∂£) Î·È ÏÂ˘ÎˆÌ·Ù›ÓË ÔÚÔ‡ <2,5 g/l ‹ ·Ó·ÈÌ›·


302

˘„ËÏ¿ ÔÛÔÛÙ¿ (92%) ÛÙ·ÛÈÌfiÙËÙ·˜ ÛˆÌ·ÙÈÎ‹˜·Ó¿Ù˘ÍË˜ ÛÂ ·È‰È¿ ÌÂ ∂¶ Î·È °O¶ (5). ™Â ÌÂÏ¤ÙËÔ˘ ÂÚÈÂÏ¿Ì‚·ÓÂ 32 ·È‰È¿ ÌÂ ∂¶ Î·È „˘¯ÔÎÈÓËÙÈ-Î‹ Î·ı˘ÛÙ¤ÚËÛË, ÙÔ 80% ·ÚÔ˘Û›·˙Â °O¶ ·Ô‰Â-‰ÂÈÁÌ¤ÓË ÌÂ 24ˆÚË pH-ÌÂÙÚ›·, ÙÔ 47% ÙÔ˘ ÔÔ›Ô˘(13/32) Â›¯Â ÛÈ‰ËÚÔÂÓ›· Î·È ÙÔ 16% (5/32) ·Ó·ÈÌ›·(30). ∆Ô 9% (3/32) ·ÚÔ˘Û›·˙Â ÓÂ˘ÌÔÓÈÎ¤˜ ÂÛÙ›Â˜ÛÙËÓ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·Î·, ÂÓÒ ˘ÔÙÚÔÈ¿˙Ô˘ÛÂ˜ÓÂ˘ÌÔÓ›Â˜ ·Ó·Ê¤ÚÔÓÙ·Ó ÛÂ 3 ·È‰È¿ (9%).

™Â ·ÓÙ›ıÂÛË ÌÂ ¿ÏÏÂ˜ ÌÂÏ¤ÙÂ˜, ÛÙËÓ ·ÚÔ‡Û·ÂÚÁ·Û›· ÌÂÏÂÙ‹ıËÎ·Ó ÔÈ ÂÈÏÔÎ¤˜ ÙË˜ °O¶ ÛÂÛ¯¤ÛË ÌÂ ÙËÓ ·ÚÔ˘Û›· ·Ô‰Â‰ÂÈÁÌ¤ÓË˜ ·ÏÈÓ‰Úfi-ÌËÛË˜. ŒÙÛÈ, ÛÙ· ·È‰È¿ ÌÂ °O¶ (n=23) Î·Î‹ ıÚ¤-„Ë ·Ú·ÙËÚ‹ıËÎÂ ÛÂ ÔÛÔÛÙfi 34,8%, ÛÈ‰ËÚÔÂÓ›·ÛÙÔ 56,5%, ·Ó·ÈÌ›· ÛÙÔ 47,8%, ˘ÔÙÚÔÈ¿˙Ô˘ÛÂ˜ÏÔÈÌÒÍÂÈ˜ ÙÔ˘ Î·ÙÒÙÂÚÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·-ÙÔ˜ ÛÙÔ 26% Î·È ÛÙ·ÛÈÌfiÙËÙ· ‚¿ÚÔ˘˜ ÛÙÔ 26%. §È-ÁfiÙÂÚÔ Û˘¯Ó¤˜ ÂÈÏÔÎ¤˜ ‹Ù·Ó Ë ˘ÔÏÂ˘ÎˆÌ·ÙÈÓ·È-Ì›·, Ë ÛÙ·ÛÈÌfiÙËÙ· ‡„Ô˘˜ Î·È Ë ·ıÔÏÔÁÈÎ‹ ·ÎÙÈ-ÓÔÁÚ·Ê›· ıÒÚ·Î· ÌÂ ‚ÚÔÁ¯ÂÎÙ·Û›Â˜ Î·È ÂÈÎfiÓ·ÓÂ˘ÌÔÓÈÎ‹˜ ›ÓˆÛË˜ (¶›Ó·Î·˜ 5). ∞ÓÙ›ıÂÙ·, Ù· ·È-‰È¿ ¯ˆÚ›˜ °O¶ Â›¯·Ó ÏÈÁfiÙÂÚÔ Û˘¯Ó¿ ÂÎ‰ËÏÒÛÂÈ˜Ô˘ ·Ú·¤ÌÔ˘Ó ÛÂ °O¶¡.

™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, Ë Û˘¯ÓfiÙËÙ· ÙË˜ °O¶ ÛÙ··È‰È¿ ÌÂ ∂¶ Â›Ó·È ·˘ÍËÌ¤ÓË Î·È ÛÙËÓ ÏÂÈÔ„ËÊ›·ÙˆÓ ÂÚÈÙÒÛÂˆÓ Ì¤ÙÚÈÔ˘ ¤ˆ˜ ÛÔ‚·ÚÔ‡ ‚·ıÌÔ‡,ÌÂ ·ÔÙ¤ÏÂÛÌ· Ó· ÚÔÎ·ÏÂ› Û˘¯Ó¿ ÛÔ‚·Ú¤˜ ÂÈ-ÏÔÎ¤˜. ŒÙÛÈ, Ë ¤ÁÎ·ÈÚË ‰È¿ÁÓˆÛË Î·È ·ÓÙÈÌÂÙÒÈ-ÛË ÙË˜ ·ÏÈÓ‰ÚfiÌËÛË˜ ÎÚ›ÓÂÙ·È ··Ú·›ÙËÙË ÛÂ fiÏ·Ù· ·È‰È¿ ÌÂ ∂¶. ™‡ÌÊˆÓ· ÌÂ Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÙË˜·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜, ÛÂ Î¿ıÂ ·È‰› ÌÂ ∂¶ Ú¤ÂÈ Ó·Á›ÓÂÙ·È ¤ÏÂÁ¯Ô˜ ÁÈ· °O¶ (screening test) ÌÂ ˘ÂÚË-¯ÔÁÚ¿ÊËÌ·, ·Ú¯ÈÎ¿ ÛÙËÓ ËÏÈÎ›· ÙˆÓ 12-16 ÌËÓÒÓÎ·È ÌÂÙ¿ ÂÚÈÔ‰ÈÎ¿ Î¿ıÂ 6 Ì‹ÓÂ˜ Î·È Ì¤¯ÚÈ ÙË Û¯Ô-ÏÈÎ‹ ËÏÈÎ›·. ∏ Â˘·ÈÛıËÛ›· ÙÔ˘ ˘ÂÚË¯ÔÁÚ·Ê‹Ì·ÙÔ˜ÛÙË ‰È¿ÁÓˆÛË ÙË˜ °O¶ Â›Ó·È ˘„ËÏ‹ (>80%) Î·È ÛÂÛ˘Ó¿ÚÙËÛË ÌÂ ÙÔÓ ÌË ÂÂÌ‚·ÙÈÎfi ÙË˜ ¯·Ú·ÎÙ‹Ú·,·ÏÏ¿ Î·È ÙËÓ ·Ô˘Û›· ·ÎÙÈÓÔ‚ÔÏ›·˜, Î·ı›ÛÙ·Ù·È ·Ú-¯ÈÎ¿ Ì¤ıÔ‰Ô˜ ÂÎÏÔÁ‹˜ ÛÙÔ screening ÙˆÓ ·È‰ÈÒÓÌÂ ∂¶. ∏ pH-ÌÂÙÚ›·, ÏfiÁˆ ÙÔ˘ ÂÂÌ‚·ÙÈÎÔ‡ ÙË˜ ¯·-Ú·ÎÙ‹Ú·, ·ÏÏ¿ Î·È ÙÔ˘ ˘„ËÏfiÙÂÚÔ˘ ÎfiÛÙÔ˘˜, ı·Ú¤ÂÈ Ó· ÂÊ·ÚÌfi˙ÂÙ·È ÌfiÓÔ ÛÙÈ˜ ÂÚÈÙÒÛÂÈ˜ ÌÂıÂÙÈÎ¿ ˘ÂÚË¯ÔÁÚ·ÊÈÎ¿ Â˘Ú‹Ì·Ù·.

∞ÓÙ›ıÂÙ·, ÙÔ ÛÈÓıËÚÔÁÚ¿ÊËÌ· ÛÙÔÌ¿¯Ô˘-ÔÈÛÔ-Ê¿ÁÔ˘ ¤¯ÂÈ ÌÈÎÚfiÙÂÚË Â˘·ÈÛıËÛ›· ÛÙËÓ ·ÔÎ¿Ï˘„Ë°O¶ (~50%), ¤¯ÂÈ ÌÂÁ·Ï‡ÙÂÚÔ ÎfiÛÙÔ˜, ··ÈÙÂ› ·ÎÈ-ÓËÙÔÔ›ËÛË ÙÔ˘ ·ÛıÂÓÔ‡˜ Î·È ÂÎı¤ÙÂÈ ÛÂ ÈÔÓ›˙Ô˘Û··ÎÙÈÓÔ‚ÔÏ›·. °È· ·˘ÙÔ‡˜ ÙÔ˘˜ ÏfiÁÔ˘˜, ‰ÂÓ Ú¤ÂÈÓ· ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÛÙË ‰È·ÁÓˆÛÙÈÎ‹ ÚÔÛ¤ÁÁÈÛËÙË˜ °O¶ ÛÂ ·È‰È¿ ÌÂ ∂¶.

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12. Strobel CT, Byrne WJ, Ament ME, Euler AR. Correlation ofesophageal lengths in children with height: application tothe Tuttle test without prior esophageal manometry. JPediatr 1979;94:81-84.

13. Roy C. Gastroesophageal reflux. In: Pediatric ClinicalGastroenterology. 4th ed. New York: Arnold SilvermannMosby; 1995. p. 163-170.

14. Emde C, Garner A, Blum AL. Technical aspects ofintraluminal pH-metry in man: current status andrecommendations. Gut 1987;28:1177-1188.

15. Sondheimer JM. Gastroesophageal reflux in children.Clinical presentation and diagnostic evaluation. GastrointestEndosc Clin N Am 1994;4:55-74.

16. Westra SJ, Wolf BH, Staalman CR. Ultrasound diagnosis ofgastroesophageal reflux and hiatal hernia in infants andyoung children. J Clin Ultrasound 1990;18:477-485.

17. Fisher RS, Malmud LS, Roberts GS, Lobis IF. Gastroeso-phageal (GE) scintiscanning to detect and quantitate GEreflux. Gastroenterology 1976;70:301-308.

18. Martins JC, Isaacs PE, Sladen GE, Maisey MN, Edwards S.Gastroesophageal reflux scintigraphy compared with pHprobe monitoring. Nucl Med Commun 1984;5:201-204.

19. Kaul B, Halvorsen T, Petersen H, Grette K, Myrvold HE.Gastroesophageal reflux disease. Scintigraphic,endoscopic, and histologic considerations. Scand JGastroenterol 1986;21:134-138.

20. Blumhagen JD, Rudd TG, Christie DL. Gastroesophageal reflux in children: radionuclide gastroesophagography. AmJ Roentgenol 1980;135:1001-1004.

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and Barrett’s esophagus in developmentally disabledpatients. Am J Gastroenterol 1986;81:519-523.

23. Vandenplas Y, Goyvaerts H, Helven R, Sacre L.Gastroesophageal reflux, as measured by 24-hour pHmonitoring, in 509 healthy infants screened for risk ofsudden infant death syndrome. Pediatrics 1991;88:834-840.

24. Bohmer CJ, Niezen-de Boer MC, Klinkenberg-Knol EC,Tuynman HA, Voskuil JH, Deville WL et al.Gastroesophageal reflux disease in intellectually disabledindividuals: leads for diagnosis and the effect of omeprazoletherapy. Am J Gastroenterol 1997;92:1475-1479.

25. Hirsch W, Preiss U, Kedar R. Color coded Dopplerultrasound in diagnosis of gastroesophageal reflux. KlinPadiatr 1997;209:6-10.

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27. Ott DJ. Gastroesophageal reflux disease. Radiol Clin NorthAm 1994;32:1147-1166.

28. Heyman S, Kirkpatrick JA, Winter HS, Treves S. An

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¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∫ÏÂÔÌ¤ÓË˜ ™‡ÚÔÁÏÔ˘ °’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ∞.¶.£. πÔÎÚ¿ÙÂÈÔ ¡ÔÛÔÎÔÌÂ›Ô £ÂÛÛ·ÏÔÓ›ÎË˜ ∫ˆÓÛÙ·ÓÙÈÓÔ˘fiÏÂˆ˜ 46, ∆.∫. 546 42, £ÂÛÛ·ÏÔÓ›ÎË E-mail: [email protected]


304

H ·ÌÊÈ‚ÏËÛÙÚÔÂÈ‰Ô¿ıÂÈ· ÙË˜ ÚÔˆÚfiÙËÙ·˜ ÛÙË ‰ÂÎ·ÂÙ›· 1990-1999 ∂. ∞Ó·ÛÙ·ÛÈ¿‰Ô˘ - ∫·Ú·ÁÂˆÚÁÔÔ‡ÏÔ˘1, ∞. ∞Ó‰Ú¤Ô˘1, Ã. ª·ÛÈ¿ÎÔ˜2, ¡. ª¿ÓÔ˜1, ∂. ∫Ô‡Ï·ÏË2

Retinopathy of prematurity during the decade 1990-1999 E. Anastasiadou - Karageorgopoulou1, A. Andreou1, H. Basiakos2, N. Manos1, E. Koulali2


�¶ÂÚ›ÏË„Ë: ™ÎÔfi˜ ÙË˜ ÌÂÏ¤ÙË˜ Â›Ó·È Ó· Î·Ù·-ÁÚ·ÊÂ› Ë Û˘¯ÓfiÙËÙ·, Ë ·ÓÙÈÌÂÙÒÈÛË Î·È Ë ¤Î‚·ÛËÙË˜ ·ÌÊÈ‚ÏËÛÙÚÔÂÈ‰Ô¿ıÂÈ·˜ ÙË˜ ÚÔˆÚfiÙËÙ·˜(∞Ù¶) ÛÂ fiÏ· Ù· ÓÂÔÁÓ¿ ÌÂ ‚¿ÚÔ˜ Á¤ÓÓËÛË˜ (µ°)<1500 g, Ô˘ ÓÔÛËÏÂ‡ıËÎ·Ó Î·È Â¤˙ËÛ·Ó, ÛÙÔ ¡Â-ÔÁÓÔÏÔÁÈÎfi ÙÌ‹Ì· ÙÔ˘ ∂™À ÙÔ˘ πÔÎÚ¿ÙÂÈÔ˘ ¡Ô-ÛÔÎÔÌÂ›Ô˘ £ÂÛÛ·ÏÔÓ›ÎË˜ Î·Ù¿ ÙË ‰ÂÎ·ÂÙ›· 1990-1999. ∏ ‰ÂÎ·ÂÙ›· ‰È·ÈÚ¤ıËÎÂ ÛÂ ‰‡Ô ÂÚÈfi‰Ô˘˜: ∞(1990-1994) Î·È µ (1995-1999). ∆· ÓÂÔÁÓ¿, Â›ÛË˜,¯ˆÚ›ÛÙËÎ·Ó ÛÂ ‰‡Ô Î·ÙËÁÔÚ›Â˜ ·Ó¿ÏÔÁ· ÌÂ ÙÔ µ°(501-1000 g Î·È 1001-1500 g), ÔÈ ÔÔ›Â˜ Û˘ÁÎÚ›ıË-Î·Ó ÌÂÙ·Í‡ ÙÔ˘˜ fiÛÔÓ ·ÊÔÚ¿ ÛÙË Û˘¯ÓfiÙËÙ· Î·È ÙË‚·Ú‡ÙËÙ· ÙË˜ ∞Ù¶. ∫·Ù¿ ÙËÓ ∞ ÂÚ›Ô‰Ô, ∞Ù¶ ·-ÚÔ˘Û›·Û·Ó 24 (37,5%) ·fi Ù· 64 ÓÂÔÁÓ¿ ÌÂ µ° 501-1000 g Ô˘ Â¤˙ËÛ·Ó Î·È 22 (8,5%) ·fi Ù· 258 ÓÂ-ÔÁÓ¿ ÌÂ µ° 1001-1500 g (p<0,0001). ∆Ô Ì¤ÛÔ µ°ÙË˜ ÚÒÙË˜ Î·ÙËÁÔÚ›·˜ ‹Ù·Ó 865±93 g (‰È·Î‡Ì·Ó-ÛË 670-1000) Î·È Ë ‰È¿ÚÎÂÈ· Î‡ËÛË˜ (¢∫) ‹Ù·Ó26,7±1,3 (‰È·Î‡Ì·ÓÛË 25-29 Â‚‰ÔÌ¿‰Â˜). ∆Ô Ì¤ÛÔµ° ÙË˜ ‰Â‡ÙÂÚË˜ Î·ÙËÁÔÚ›·˜ ‹Ù·Ó 1348±230 g(‰È·Î‡Ì·ÓÛË 1001-1500 g) Î·È Ë ¢∫ ‹Ù·Ó 30±2,3(‰È·Î‡Ì·ÓÛË 26-32 Â‚‰ÔÌ¿‰Â˜). ∞Ù¶ I-II ÛÙ·‰›Ô˘ Â›-¯·Ó 15 (23,5%) ÓÂÔÁÓ¿ ÌÂ µ° 501-1000 g Î·È 19(7,3%) ÌÂ µ° 1001-1500 g (p<0,0001), ÂÓÒ ∞Ù¶ III-V ÛÙ·‰›Ô˘ Â›¯·Ó 9 (14%) Î·È 3 (1,2%) ÓÂÔÁÓ¿, ·ÓÙ›-ÛÙÔÈ¯· (p<0,0001). ∫·Ù¿ ÙË µ ÂÚ›Ô‰Ô, ∞Ù¶ ·-ÚÔ˘Û›·Û·Ó 42 (37,8%) ·fi Ù· 111 ÓÂÔÁÓ¿ ÌÂ µ°501-1000 g Î·È 24 (6,5%) ·fi Ù· 364 ÓÂÔÁÓ¿ ÌÂ µ°1001-1500 g (p<0,001). ∆Ô Ì¤ÛÔ µ° ÙË˜ ÚÒÙË˜ Î·-ÙËÁÔÚ›·˜ ‹Ù·Ó 853,7±95,8 g (‰È·Î‡Ì·ÓÛË 615-1000g) Î·È Ë ¢∫ ‹Ù·Ó 26,7±1,6 (‰È·Î‡Ì·ÓÛË 24-30 Â‚‰Ô-Ì¿‰Â˜). ∆Ô Ì¤ÛÔ µ° ÙË˜ ‰Â‡ÙÂÚË˜ Î·ÙËÁÔÚ›·˜ ‹Ù·Ó1260±210 g (‰È·Î‡Ì·ÓÛË 1020-1450 g) Î·È Ë ¢∫‹Ù·Ó 28,5±2,6 (‰È·Î‡Ì·ÓÛË 26-34 Â‚‰ÔÌ¿‰Â˜). AÙ¶π-ππ ÛÙ·‰›Ô˘ ·ÚÔ˘Û›·Û·Ó 30 (27%) ÓÂÔÁÓ¿ ÌÂ

�Abstract: The aim of the study was to record theincidence, the treatment and the outcome ofretinopathy of prematurity (ROP) during the decade1990-1999, in the Neonatal Department ofIppokration General Hospital of Thessaloniki. All theneonates with birth weight (BW) ≤1500 g, who wereadmitted and survived in the department during thedecade 1990-1999 were included. The decade wasdivided in 2 periods: period A (1990-1994) and periodB (1995-1999) and the infants were also divided in 2groups according to the BW (501-1000 g and 1001-1500 g), which were compared between each other.During the period A 24 (37.5%) infants developedROP from 64 infants with BW 501-1000 g whosurvived and 22 (8.52%) from 258 infants with BW1001-1500 g (p<0.0001). For the first group, themean BW of the affected infants was 865±93 g(range 670-1000 g) and mean gestational age (GA)26.7±1.3 (range 25-29 weeks). For the secondgroup, the mean BW of the affected infants was1348±230 g (range 1060-1500 g) and mean GA30±2.3 (range 26-32 weeks). Fifteen (23.5%) infants,with BW 501-1000 g, and 19 (7.3%), with BW 1001-1500 g, had ROP stages I and II (p<0.0001), while 9(14%) and 3 (1.2%) from the corresponding groupshad severe ROP stages III-V, with or without plusdisease (p<0.0001). During the period B 42 (37.8%)infants developed ROP from 111 with BW 501-1000 gwho survived and 24 (6.59%) from 364 infants withBW 1001-1500 g (p<0.001). For the first group themean BW of the affected infants was 853.7±95.8 g(range 615-1000 g) and the GA 24-30 weeks(x=26.7±1.5). For the second group, the mean BWof the affected infants was 1260±210 g (range 1020-1450 g) and the GA 28.5±2.6 (range 26-34 weeks).

1 ª∂¡¡ ∂™À πÔÎÚ¿ÙÂÈÔ °¶¡£, £ÂÛÛ·ÏÔÓ›ÎË 2 OÊı·ÏÌÔÏÔÁÈÎ‹ ∫ÏÈÓÈÎ‹ πÔÎÚ¿ÙÂÈÔ˘ °¶¡£,

£ÂÛÛ·ÏÔÓ›ÎË

1 Division of Neonatology, Ippokration General Hospital,Thessaloniki

2 Ophthalmologic Clinic, Ippokration General Hospital,Thessaloniki


305

∂ÈÛ·ÁˆÁ‹∏ ·ÌÊÈ‚ÏËÛÙÚÔÂÈ‰Ô¿ıÂÈ· ÙË˜ ÚÔˆÚfiÙËÙ·˜

(∞Ù¶), ÁÓˆÛÙ‹ ·fi ÙÔ 1942 ÌÂ ÙÔ fiÓÔÌ· ÔÈÛıÔÊ·-ÎÈÎ‹ ÈÓÔÏ·Û›·, Â›Ó·È Ì›· ÂÍÂÏÈÎÙÈÎ‹ ¿ıËÛË Ô˘·ÊÔÚ¿ ÛÂ ÚfiˆÚ· ÓÂÔÁÓ¿ Î·È ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi·ÓÒÌ·ÏË ·Ó¿Ù˘ÍË ÙˆÓ ·ÌÊÈ‚ÏËÛÙÚÔÂÈ‰ÈÎÒÓ ·Á-ÁÂ›ˆÓ (1,2). ∆˘ÈÎ¿, ÚÔÛ‚¿ÏÏÂÈ ÚfiˆÚ·, ÔÏ‡ ¯·-ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛË˜ ÓÂÔÁÓ¿ ÛÙ· ÔÔ›· ¯ÔÚË-Á‹ıËÎÂ ÔÍ˘ÁfiÓÔ Î·È, Û¿ÓÈ·, ÙÂÏÂÈfiÌËÓ·, Ê˘ÛÈÔÏÔ-ÁÈÎÔ‡ ‚¿ÚÔ˘˜ ÓÂÔÁÓ¿, Ô˘ ‰ÂÓ ÂÎÙ¤ıËÎ·Ó ÛÂ ¯ÔÚ‹-ÁËÛË ÔÍ˘ÁfiÓÔ˘. ∞ÚÎÂÙÔ› ·Ú¿ÁÔÓÙÂ˜ ¤¯Ô˘Ó Û˘Ó‰Â-ıÂ› ÌÂ ÙËÓ ·ÈÙÈÔÏÔÁ›· ÙË˜ (2,3).

∏ ÛÙ·‰ÈÔÔ›ËÛË ÙË˜ ∞Ù¶ ¤ÁÈÓÂ Û‡ÌÊˆÓ· ÌÂ ÙË‰ÈÂıÓ‹ Ù·ÍÈÓfiÌËÛË, ·Ó¿ÏÔÁ· ÌÂ ÙËÓ ÂÓÙfiÈÛË, ÙËÓ¤ÎÙ·ÛË Î·È ÙË ‚·Ú‡ÙËÙ· ÙˆÓ ‚Ï·‚ÒÓ (2). ∏ ÂÓÙfiÈ-ÛË ÙˆÓ ‚Ï·‚ÒÓ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÙË ˙ÒÓË ÙÔ˘·ÌÊÈ‚ÏËÛÙÚÔÂÈ‰Ô‡˜ ÛÙËÓ ÔÔ›· ÂÓÙÔ›˙ÔÓÙ·È. ∫·-ıÔÚ›ÛÙËÎ·Ó ÙÚÂÈ˜ ˙ÒÓÂ˜ Î˘ÎÏÈÎ¤˜, ÔÌfiÎÂÓÙÚÂ˜ ÌÂÎ¤ÓÙÚÔ ÙË ıËÏ‹. ∏ ¤ÎÙ·ÛË ÙˆÓ ‚Ï·‚ÒÓ ÂÍ·ÚÙ¿Ù·È·fi ÙÔÓ ·ÚÈıÌfi ÙˆÓ ˆÚÒÓ ÛÙÈ˜ ÔÔ›Â˜ ÂÎÙÂ›ÓÔÓÙ·È.∫¿ıÂ ÒÚ· Â›Ó·È ¤Ó·˜ ·fi ÙÔ˘˜ ‰Ò‰ÂÎ· Î˘ÎÏÈÎÔ‡˜ÙÔÌÂ›˜, ÙfiÍÔ˘ 30 ÌÔÈÚÒÓ, ÛÙÔ˘˜ ÔÔ›Ô˘˜ ‰È·ÈÚÂ›Ù·ÈÔ ·ÌÊÈ‚ÏËÛÙÚÔÂÈ‰‹˜. ∏ ÂÓÙfiÈÛË Î·È Ë ¤ÎÙ·ÛË ÙˆÓ‚Ï·‚ÒÓ Î·ıÔÚ›˙Ô˘Ó ÙË ‚·Ú‡ÙËÙ· ÙË˜ ¿ıËÛË˜, ËÔÔ›· ‰È·ÎÚ›ÓÂÙ·È ÛÂ ¤ÓÙÂ ÛÙ¿‰È·. ∆· ÛÙ¿‰È· πππ-VıÂˆÚÔ‡ÓÙ·È ‚·ÚÈ¿˜ ÌÔÚÊ‹˜ ∞Ù¶. ∏ ·ÔÎfiÏÏËÛËÙÔ˘ ·ÌÊÈ‚ÏËÛÙÚÔÂÈ‰Ô‡˜ ¯·Ú·ÎÙËÚ›˙ÂÈ Ù· ÛÙ¿‰È· IVÎ·È V. ∏ ‰È¿Ù·ÛË Î·È Ë ÔÊÈÔÂÈ‰‹˜ ÔÚÂ›· ÙˆÓ ·Á-ÁÂ›ˆÓ ÙÔ˘Ï¿¯ÈÛÙÔÓ ÂÓfi˜ ÙÂÙ·ÚÙËÌÔÚ›Ô˘ ÙÔ˘ Ô›ÛıÈ-Ô˘ fiÏÔ˘ ¯·Ú·ÎÙËÚ›˙ÂÈ ÙÔ ÛÙ¿‰ÈÔ ÌÂ ÙÔ ÚfiıÂÌ·Û˘Ó (+) (plus (+) disease). ∞˘Ù‹ ‰ÈÂ˘ÎÚÈÓ›˙ÂÈ Â-Ú·ÈÙ¤Úˆ ÙË ‚·Ú‡ÙËÙ· ÙË˜ ∞Ù¶ ‰ÈfiÙÈ, Î·Ù¿ Î·ÓfiÓ·,ÚÔËÁÂ›Ù·È ÙË˜ ·ÔÎfiÏÏËÛË˜ ÙÔ˘ ·ÌÊÈ‚ÏËÛÙÚÔÂÈ-‰Ô‡˜. ∆Ô ÛÙ¿‰ÈÔ III plus, ÛÙÔ ÔÔ›Ô ÔÈ ‚Ï¿‚Â˜ ˘ÂÚ-‚·›ÓÔ˘Ó ÛÂ ¤ÎÙ·ÛË ¤ÓÙÂ Û˘ÓÂ¯Â›˜ ‹ ÔÎÙÒ ·Û˘ÓÂ-¯Â›˜ ÒÚÂ˜ Î·È ÂÓÙÔ›˙ÔÓÙ·È ÛÙË ˙ÒÓË 1 ‹ 2, Î·ıÔÚ›-˙ÂÙ·È Û·Ó Ô˘‰fi˜ (threshold) ∞Ù¶ Î·È ·ÔÙÂÏÂ› ¤Ó-‰ÂÈÍË ÁÈ· ¿ÌÂÛË ÂÊ·ÚÌÔÁ‹ ÎÚ˘ÔËÍ›·˜ ‹ ÊˆÙÔË-Í›·˜ (4). ∆Ô ÚÔËÁÔ‡ÌÂÓÔ ÛÙ¿‰ÈÔ, ÙÔ ÚÔ-Ô˘‰ÈÎfi

(pre-threshold), Â›Ó·È ÏÈÁfiÙÂÚÔ ÛÔ‚·Úfi. ∏ Û˘¯ÓfiÙËÙ· ÙË˜ ∞Ù¶ ÁÈ· ÓÂÔÁÓ¿ ‚¿ÚÔ˘˜ <1,5

kg, Î˘Ì·›ÓÂÙ·È ·fi 12% ¤ˆ˜ 78% (5,6). ∏ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ∞Ù¶ ÔÈÎ›ÏÏÂÈ ·Ó¿ÏÔÁ· ÌÂ ÙÔ

ÛÙ¿‰ÈÔ ÛÙÔ ÔÔ›Ô ‚Ú›ÛÎÂÙ·È Ë ¿ıËÛË. ™Ù· ÚÒÙ· 2ÛÙ¿‰È· ‰ÂÓ Û˘ÓÈÛÙ¿Ù·È Î·Ì›· ·Ú¤Ì‚·ÛË, ‰ÈfiÙÈ ÔÈ È-ı·ÓfiÙËÙÂ˜ ·˘ÙfiÌ·ÙË˜ ˘ÔÛÙÚÔÊ‹˜ Â›Ó·È Î·Ï¤˜(5,7,8). ™ÙÔ ÔÚÈ·Îfi 3+ ÛÙ¿‰ÈÔ Î·È ÂÊfiÛÔÓ ÔÈ ‚Ï¿‚Â˜˘ÂÚ‚·›ÓÔ˘Ó ÛÂ ¤ÎÙ·ÛË ÙÈ˜ 5 Û˘ÓÂ¯Â›˜ ÒÚÂ˜ ‹ ÙÈ˜ 8·Û˘ÓÂ¯Â›˜ ÛÙË ˙ÒÓË π ‹ ππ, Û˘ÓÈÛÙ¿Ù·È Ë ¿ÌÂÛË (ÂÓÙfi˜72 ˆÚÒÓ) ÎÚ˘ÔËÍ›· ‹ ÊˆÙÔËÍ›· ÙË˜ ·Ó¿ÁÁÂÈ·˜ Â-ÚÈÔ¯‹˜ ÙÔ˘ ·ÌÊÈ‚ÏËÛÙÚÔÂÈ‰Ô‡˜ (7).

™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË ÂÚÈÁÚ¿ÊÔÓÙ·È Ë Û˘¯Ófi-ÙËÙ· Î·È Ë ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ∞Ù¶ ÛÙÔ Û˘ÁÎÂÎÚÈÌ¤-ÓÔ ÓÔÛÔÎÔÌÂ›Ô Î·È ·Ó·Ê¤ÚÔÓÙ·È Ù· ÓÂfiÙÂÚ· ‰Â‰Ô-Ì¤Ó· ÁÈ· ·˘Ù‹ ÙËÓ ¿ıËÛË.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ∏ ·ÚÔ‡Û· ÌÂÏ¤ÙË ·ÊÔÚ¿ ÛÙË ‰ÂÎ·ÂÙ›· 1990-1999 Î·È Â-

ÚÈÏ·Ì‚¿ÓÂÈ fiÏ· Ù· ÚfiˆÚ· ÓÂÔÁÓ¿ ÌÂ µ° ≤1500 g Ô˘ ÓÔÛË-ÏÂ‡ıËÎ·Ó ÛÙÔ ¡ÂÔÁÓÔÏÔÁÈÎfi ÙÌ‹Ì· Î·È ÂÈ‚›ˆÛ·Ó. ∆· Úfiˆ-Ú· ÓÂÔÁÓ¿ ÌÂ µ° >1500 g Î·È Ù· ÙÂÏÂÈfiÌËÓ· ÂÍÂÙ¿˙ÔÓÙ·ÓÔÊı·ÏÌÔÏÔÁÈÎ¿ ÁÈ· ∞Ù¶ ÌfiÓÔÓ fiÙ·Ó ˘‹Ú¯·Ó ÁÓˆÛÙÔ›, ÂÈ‚·-Ú˘ÓÙÈÎÔ› ÁÈ· ∞Ù¶, ·Ú¿ÁÔÓÙÂ˜. ∏ ‰ÂÎ·ÂÙ›· ‰È·ÈÚ¤ıËÎÂ ÛÂ ‰‡ÔÂÚÈfi‰Ô˘˜: ÙËÓ ∞ Ô˘ ÂÚÈÏ·Ì‚¿ÓÂÈ Ù· ¤ÙË 1990-1994 Î·È ÙË µÔ˘ ÂÚÈÏ·Ì‚¿ÓÂÈ Ù· ¤ÙË 1995-1999. ™Â Î¿ıÂ ÂÚ›Ô‰Ô ‰È·ÎÚ›Ó·-ÌÂ ‰‡Ô Î·ÙËÁÔÚ›Â˜ ÓÂÔÁÓÒÓ: Ì›· Ô˘ ÂÚÈÏ·Ì‚¿ÓÂÈ fiÏ· Ù· ÓÂÔ-ÁÓ¿ ÌÂ µ° 501-1000 g Î·È Ì›· ¿ÏÏË Ô˘ ÂÚÈÏ·Ì‚¿ÓÂÈ fiÏ· Ù· ÓÂ-ÔÁÓ¿ ÌÂ µ° 1001-1500 g. ™Â Î¿ıÂ ÂÚ›Ô‰Ô ¯ˆÚÈÛÙ¿, ÔÈ ‰‡Ô Î·-ÙËÁÔÚ›Â˜ µ° Û˘ÁÎÚ›ıËÎ·Ó ÌÂÙ·Í‡ ÙÔ˘˜ ˆ˜ ÚÔ˜ ÙË Û˘¯ÓfiÙËÙ·ÙË˜ ∞Ù¶. ŒÁÈÓÂ, Â›ÛË˜, Û‡ÁÎÚÈÛË ÙˆÓ ‰‡Ô Î·ÙËÁÔÚÈÒÓ µ° ÌÂ-Ù·Í‡ ÙˆÓ ‰‡Ô ÂÚÈfi‰ˆÓ, ˆ˜ ÚÔ˜ ÙÔ˘˜ ›‰ÈÔ˘˜ ·Ú¿ÁÔÓÙÂ˜.

∂ÎÙfi˜ ·fi ÙËÓ ÚÔˆÚfiÙËÙ·, ¿ÏÏÔÈ ÁÓˆÛÙÔ›, ÂÈ‚·Ú˘ÓÙÈÎÔ›ÁÈ· ∞Ù¶, ·Ú¿ÁÔÓÙÂ˜ Ô˘ ˘‹Ú¯·Ó ÛÙ· ÓÂÔÁÓ¿, ‰ÂÓ ÂÏ¤Á¯ıË-Î·Ó ÛÙ·ÙÈÛÙÈÎ¿.

™‡ÌÊˆÓ· ÌÂ ÙÔ ÚˆÙfiÎÔÏÏÔ ÙË˜ ÎÏÈÓÈÎ‹˜, fiÏ· Ù· ÓÂÔÁÓ¿Ô˘ Â¤˙ËÛ·Ó, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙË ¢∫, ÂÍÂÙ¿ÛÙËÎ·Ó Î·Ù¿ ÙË‰È¿ÚÎÂÈ· ÙË˜ ÓÔÛËÏÂ›·˜ ÙÔ˘˜ ‹ ÛÙ· ÂÍˆÙÂÚÈÎ¿ È·ÙÚÂ›· ÌÂ ¤Ì-ÌÂÛË ÔÊı·ÏÌÔÛÎfiËÛË ÁÈ· ÚÒÙË ÊÔÚ¿ ÛÂ ËÏÈÎ›· Î·Ù¿ Ì¤ÛÔ

µ° 501-1000 g Î·È 20 (5,5%) ÓÂÔÁÓ¿ ÌÂ µ° 1001-1500 g (p<0,0001), ÂÓÒ ∞Ù¶ πππ-V ÛÙ·‰›Ô˘ ·ÚÔ˘-Û›·Û·Ó 12 (10,8%) Î·È 4 (1,1%) ÓÂÔÁÓ¿, ·ÓÙ›ÛÙÔÈ¯·(p<0,0001). ∏ Û‡ÁÎÚÈÛË ÙˆÓ ‰‡Ô ÂÚÈfi‰ˆÓ, fiÛÔÓ·ÊÔÚ¿ ÛÙË Û˘¯ÓfiÙËÙ· Î·È ‚·Ú‡ÙËÙ· ÙË˜ ∞Ù¶ ÛÙÈ˜‰‡Ô Î·ÙËÁÔÚ›Â˜ µ°, ¤‰ÂÈÍÂ ÌË ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈ-Î‹ ‰È·ÊÔÚ¿ (p>0,01).

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ∞Ù¶, Û˘¯ÓfiÙËÙ·, ·ÓÙÈÌÂÙÒÈÛË.

Thirty (27%) infants with BW 501-1000 g and 20(5.5%) with BW 1001-1500 g had ROP stages I andII while 12 (10.8%) and 4 (1.1%) from thecorresponding groups had severe ROP stages III-V,with or without plus disease (p<0.0001). Thecomparison between the two periods didn’t showstatistically significant differences (p>0.01)between the periods A and B for the neonates withBW <1000 g, 1001-1500 g totally and for the twocategories (stages I and II, stage ≥III).

Key words: ROP, incidence, treatment.


306

fiÚÔ 4-5 Â‚‰ÔÌ¿‰ˆÓ ˙ˆ‹˜. ∆· ÚfiˆÚ· ÓÂÔÁÓ¿ ÌÂ ¢∫ ≤25Â‚‰ÔÌ¿‰Â˜ ÂÍÂÙ¿˙ÔÓÙ·Ó ÁÈ· ÚÒÙË ÊÔÚ¿ ÛÂ ÌÂÙ·-ÂÌÌËÓÔÚ-ÚÔ˚Î‹ ËÏÈÎ›· 31-32 Â‚‰ÔÌ¿‰ˆÓ, ÂÓÒ Ù· ÚfiˆÚ· ÌÂ ¢∫ 31-32Â‚‰ÔÌ¿‰Â˜ ÂÍÂÙ¿˙ÔÓÙ·Ó ÛÂ ËÏÈÎ›· 34-35 Â‚‰ÔÌ¿‰ˆÓ. OÈ Âfi-ÌÂÓÂ˜ ÔÊı·ÏÌÔÛÎÔ‹ÛÂÈ˜ Ú·ÁÌ·ÙÔÔÈÔ‡ÓÙ·Ó ·Ó¿ÏÔÁ· ÌÂ Ù··Ú¯ÈÎ¿ Â˘Ú‹Ì·Ù·. ŸÙ·Ó ‰ÂÓ ˘‹Ú¯Â ∞Ù¶ Î·È Ë ·ÁÁÂ›ˆÛË ÙÔ˘·ÌÊÈ‚ÏËÛÙÚÔÂÈ‰Ô‡˜ ‰ÂÓ ‹Ù·Ó Ï‹ÚË˜, Ë ÔÊı·ÏÌÔÛÎfiËÛËÂ·Ó·Ï·Ì‚·ÓfiÙ·Ó Î¿ıÂ 1-2 Â‚‰ÔÌ¿‰Â˜, Ì¤¯ÚÈ Ï‹ÚÔ˘˜ ·ÁÁÂ›-ˆÛË˜. ∏ ÂÍ¤Ù·ÛË ÙÔ˘ ‚˘ıÔ‡ ÙˆÓ ÓÂÔÁÓÒÓ ÁÈÓfiÙ·Ó ·fi ÔÊı·Ï-Ì›·ÙÚÔ ÂÍÔÈÎÂÈˆÌ¤ÓÔ ÛÙË ¯Ú‹ÛË ÙÔ˘ ¤ÌÌÂÛÔ˘ ÔÊı·ÏÌÔÛÎÔ›-Ô˘ Î·È ¤ÌÂÈÚÔ ÛÙÈ˜ È‰È·ÈÙÂÚfiÙËÙÂ˜ ÙÔ˘ ·ÌÊÈ‚ÏËÛÙÚÔÂÈ‰Ô‡˜ÙˆÓ ÚÔÒÚˆÓ. ÃÚËÛÈÌÔÔÈ‹ıËÎÂ Ë Ì¤ıÔ‰Ô˜ ÙË˜ ‰ÈfiÊı·ÏÌË˜¤ÌÌÂÛË˜ ÔÊı·ÏÌÔÛÎfiËÛË˜ ÌÂÙ¿ ·fi Ï‹ÚË Ì˘‰Ú›·ÛË, ‰ÈfiÙÈ‰›ÓÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· ·Ú·Ù‹ÚËÛË˜ ÙË˜ ·ÒÙÂÚË˜ ÂÚÈÊ¤ÚÂÈ·˜ÙÔ˘ ·ÌÊÈ‚ÏËÛÙÚÔÂÈ‰Ô‡˜, fiÔ˘ ÂÌÊ·Ó›˙ÔÓÙ·È Û˘Ó‹ıˆ˜ ÔÈ ÂÎ‰Ë-ÏÒÛÂÈ˜ ÙË˜ ¿ıËÛË˜. °È· ÙË Ì˘‰Ú›·ÛË ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÎÔÏ-Ï‡ÚÈ· Ê·ÈÓ˘ÏÂÊÚ›ÓË˜ 2,5%, Î˘ÎÏÔÂÓÙÔÏ¿ÙË˜ 0,2% Î·È ÙÚÔÈ-Î·Ì›‰Ë˜ 1%, ÛÂ ‰È¿ÊÔÚÂ˜ ·Ó·ÏÔÁ›Â˜, Ô˘ ÂÓÛÙ·Ï¿˙ÔÓÙ·ÓÙÚÂÈ˜ ÊÔÚ¤˜ ·Ó¿ 10 ÏÂÙ¿ Î·È ·ÎÔÏÔ˘ıÔ‡ÛÂ Ë ÂÍ¤Ù·ÛË ÌÂÙ¿·fi 30 ÏÂÙ¿. ∏ ÂÍ¤Ù·ÛË ÁÈÓfiÙ·Ó ÌÂ Û˘Ó·›ÛıËÛË fiÙÈ ·ÔÙÂÏÂ›Ì›· Ù·Ï·ÈˆÚ›· ÁÈ· Ù· ÓÂÔÁÓ¿ Î·È fiÙÈ ‰ÂÓ Â›Ó·È ¿ÌÔÈÚË Û˘Ì‚·-Ì¿ÙˆÓ. ◊Ù·Ó Û‡ÓÙÔÌË (<1,5 min) Î·È fiÔ˘ ‹Ù·Ó ‰˘Ó·Ùfi ÁÈÓfi-Ù·Ó ¯ˆÚ›˜ ¯Ú‹ÛË ÂÚÁ·ÏÂ›ˆÓ, .¯. ‚ÏÂÊ·ÚÔ‰È·ÛÙÔÏ¤· ‹ ÛÎÏË-ÚÈÎÔ‡ ÂÓÙ˘ˆÙ‹.

ŸÏ· Ù· ÓÂÔÁÓ¿ ÓÔÛËÏÂ‡ıËÎ·Ó ÛÂ ÂÚÈ‚¿ÏÏÔÓ ÌÂ Û˘ÓËıÈ-ÛÌ¤ÓÔ ËÏÈ·Îfi Êˆ˜ ÙËÓ ËÌ¤Ú· Î·È Û¯ÂÙÈÎ¿ ¤ÓÙÔÓÔ, ÊıÔÚ›˙ÔÓÊˆ˜ ÙÔ ‚Ú¿‰˘, ÌÂ ÂÓ·ÏÏ·ÛÛfiÌÂÓÂ˜ ÂÚÈfi‰Ô˘˜ ¯·ÌËÏÔ‡ ÊˆÙÈ-ÛÌÔ‡. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÊˆÙÔıÂÚ·Â›·˜, Ù· Ì¿ÙÈ· ‹Ù·Ó¿ÓÙÔÙÂ Î·Ï˘ÌÌ¤Ó·. °ÈÓfiÙ·Ó ÚÔÛ¿ıÂÈ· ÒÛÙÂ Ô ÎÔÚÂÛÌfi˜ÙÔ˘ ·ÚÙËÚÈ·ÎÔ‡ ·›Ì·ÙÔ˜ ÛÂ ÔÍ˘ÁfiÓÔ Ó· ‰È·ÙËÚÂ›Ù·È Î¿Ùˆ ·fi92-95%. ™Â Î·Ó¤Ó· ÓÂÔÁÓfi ‰ÂÓ ¯ÔÚËÁ‹ıËÎÂ ‚ÈÙ·Ì›ÓË ∂ ÚÔÊ˘-Ï·ÎÙÈÎ¿ ‹ ıÂÚ·Â˘ÙÈÎ¿. ∏ ÛÙ·‰ÈÔÔ›ËÛË ÙË˜ ∞Ù¶ ¤ÁÈÓÂ Û‡Ì-

ÊˆÓ· ÌÂ ÙË ‰ÈÂıÓ‹ Ù·ÍÈÓfiÌËÛË (2). O ¯ÚfiÓÔ˜ Â·ÓÂÍ¤Ù·ÛË˜Î·ıÔÚÈ˙fiÙ·Ó ·fi Ù· Â˘Ú‹Ì·Ù· ÙË˜ ÙÂÏÂ˘Ù·›·˜ ÂÍ¤Ù·ÛË˜. ∂¿Ó˘‹Ú¯Â ·ÓˆÚÈÌfiÙËÙ· ÙˆÓ ·ÁÁÂ›ˆÓ, ·ÏÏ¿ fi¯È ∞Ù¶, Ë Â·ÓÂÍ¤-Ù·ÛË ÁÈÓfiÙ·Ó ÌÂÙ¿ ·fi 4 Â‚‰ÔÌ¿‰Â˜. ∂¿Ó Ë ∞Ù¶ ·ÊÔÚÔ‡ÛÂÛÙÈ˜ ˙ÒÓÂ˜ π ‹ ππ Î·È ‹Ù·Ó ÛÙ·‰›Ô˘ 2+ ‹ 3, Ë ÂÍ¤Ù·ÛË Â·Ó·-Ï·Ì‚·ÓfiÙ·Ó ÌÂÙ¿ ·fi 1 Â‚‰ÔÌ¿‰·. ¡ÂÔÁÓ¿ ÌÂ ·Ô‰Ú·ÌÔ‡Û·∞Ù¶ Â·ÓÂÍÂÙ¿˙ÔÓÙ·Ó ÌÂÙ¿ ·fi 3 Ì‹ÓÂ˜.

°È· ÙË Û‡ÁÎÚÈÛË ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë ÛÙ·ÙÈÛÙÈÎ‹ Ì¤ıÔ‰Ô˜¯2 Î·È Ë ‰ÔÎÈÌ·Û›· Fisher’s exact.

∞ÔÙÂÏ¤ÛÌ·Ù·∆ËÓ ÂÚ›Ô‰Ô ∞ ÓÔÛËÏÂ‡ıËÎ·Ó 173 ÓÂÔÁÓ¿ ÌÂ µ°

≤1000 g Î·È Â¤˙ËÛ·Ó 64 (37%), Ô˘ Â›¯·Ó µ° 670-1000 g (¯=865±93) Î·È ¢∫ 25-29 Â‚‰ÔÌ¿‰Â˜(¯=26,7±1,3). ∆ËÓ ›‰È· ÂÚ›Ô‰Ô ÓÔÛËÏÂ‡ıËÎ·Ó Î·È348 ÓÂÔÁÓ¿ ÌÂ µ° 1001-1500 g Î·È Â¤˙ËÛ·Ó 258(74,1%), ÌÂ µ° 1060-1500 g (x=1348±230) Î·È ¢∫26-32 Â‚‰ÔÌ¿‰Â˜ (¯=30±2,3) (¶›Ó·Î·˜ 1).

∞fi Ù· 64 ÓÂÔÁÓ¿ ÌÂ µ° ≤1000 g Ô˘ Â¤˙ËÛ·Ó,24 (37,5%) ·ÚÔ˘Û›·Û·Ó ∞Ù¶. ∞fi ·˘Ù¿, 15(23,5%) Â›¯·Ó ∞Ù¶ π-ππ ÛÙ·‰›Ô˘ Î·È 9 (14%) Â›¯·Ó ‚·-ÚÈ¿ ∞Ù¶ πππ-V ÛÙ·‰›Ô˘, ÌÂ ‹ ¯ˆÚ›˜ plus disease. ∞fiÙ· 9 ÓÂÔÁÓ¿ ÌÂ ‚·ÚÈ¿ ∞Ù¶, 3 Â›¯·Ó ∞Ù¶ III ÛÙ·‰›Ô˘Î·È 6 Â›¯·Ó ∞Ù¶ ≥πππ+. ∞fi Ù· 258 ÓÂÔÁÓ¿ ÌÂ µ°1001-1500 g Ô˘ Â¤˙ËÛ·Ó, 22 (8,5%) ·ÚÔ˘Û›·Û·Ó∞Ù¶. ∞fi ·˘Ù¿, 19 (7,5%) Â›¯·Ó ∞Ù¶ I-II ÛÙ·‰›Ô˘ Î·È3 (1,2%) Â›¯·Ó ‚·ÚÈ¿ ∞Ù¶ πππ-V ÛÙ·‰›Ô˘ ÌÂ ‹ ¯ˆÚ›˜plus disease. ∞fi Ù· 3 ÓÂÔÁÓ¿ ÌÂ ‚·ÚÈ¿ ∞Ù¶, 1 Â›¯Â∞Ù¶ πππ ÛÙ·‰›Ô˘ Î·È 2 Â›¯·Ó ∞Ù¶ ≥πππ+. ŸÏ· Ù· ÓÂÔ-ÁÓ¿ ÌÂ ∞Ù¶ π-ππ ÛÙ·‰›Ô˘, Î·ıÒ˜ Î·È Ù· 4 ÓÂÔÁÓ¿ ÌÂ∞Ù¶ III ÛÙ·‰›Ô˘ Â›¯·Ó ·˘ÙfiÌ·ÙË ˘ÔÛÙÚÔÊ‹ ÙË˜∞Ù¶ ÌÂ Î·Ï‹ ÌÂÙ¤ÂÈÙ· ·Ó¿Ù˘ÍË ÙË˜ fiÚ·ÛË˜. ∞fi

¶›Ó·Î·˜ 1. ¡ÂÔÁÓ¿ ÌÂ ∞Ù¶ ·Ó¿ÏÔÁ· ÌÂ ÙÔ µ° Î·È ÙË ¢∫

¶ÂÚ›Ô‰Ô˜ ∞: 1990-1994µ° (g)±SD ¢∫ (Â‚‰.) ∞Ù¶* (%) π &ππ ÛÙ¿‰ÈÔ µ·ÚÈ¿ ≥πππ ÛÙ¿‰ÈÔ £ÂÚ·Â›·

¡Ô (%)** ¡Ô (%)**

≤1000 26,7±1,3 24/64 (37,5) 15 (23,5) 9 (14) 2 ÎÚ˘ÔËÍ›·/1 Laser865±93

1001-1500 30±2,3 22/258 (8,5)*** 19 (7,5)*** 3 (1,2)***1348±230

¶ÂÚ›Ô‰Ô˜ µ: 1995-1999µ° (g)±SD ¢∫ (Â‚‰.) ∞Ù¶* (%) π &ππ ÛÙ¿‰ÈÔ µ·ÚÈ¿ ≥πππ ÛÙ¿‰ÈÔ £ÂÚ·Â›·

¡Ô (%) ¡Ô (%)

≤1000 26,7±1,5 42/111 (37,8)# 30 (27)# 12 (10,8)# 8 ÎÚ˘ÔËÍ›·853,7±95,8

1001-1500 28,5±2,6 24/364 (6,6)***# 20 (5,5)***# 4 (1,1)***# 3 ÎÚ˘ÔËÍ›·1260±210

* ™˘ÓÔÏÈÎfi˜ ·ÚÈıÌfi˜ ÓÂÔÁÓÒÓ ÌÂ ∞Ù¶/·ÚÈıÌfi˜ ÓÂÔÁÓÒÓ Ô˘ Â¤˙ËÛ·Ó ** AÚÈıÌfi˜ ÓÂÔÁÓÒÓ ÌÂ ∞Ù¶ (% ÙˆÓ ÓÂÔÁÓÒÓ Ô˘ ÂÈ‚›ˆÛ·Ó)*** p<0,0001 ÌÂÙ·Í‡ ÙË˜ Ì›·˜ Î·ÙËÁÔÚ›·˜ µ° (≤1000 g) ¤Ó·ÓÙÈ ÙË˜ ¿ÏÏË˜ (1001-1500 g) ÙË˜ ›‰È·˜ ÂÚÈfi‰Ô˘ ÁÈ· ÙÔ Û‡ÓÔÏÔ ÙË˜

∞Ù¶ Î·È Ù· ‰‡Ô ÛÙ¿‰È¿ ÙË˜ # p>0,1 ÌÂÙ·Í‡ Î¿ıÂ Î·ÙËÁÔÚ›·˜ µ° (≤1000 g, 1001-1500 g) ÙË˜ ÂÚÈfi‰Ô˘ ∞ ÚÔ˜ ÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë ÙË˜ ÂÚÈfi‰Ô˘ µ ÁÈ· ÙÔ Û‡-

ÓÔÏÔ ÙË˜ ∞Ù¶ Î·È Ù· ‰‡Ô ÛÙ¿‰È·

Ù· 6 ÓÂÔÁÓ¿ ÌÂ ∞Ù¶ ≥πππ+ Î·È µ° ≤1000 g, 3 ÂÏ¤Á-¯ıËÎ·Ó ÌÂ Î·ı˘ÛÙ¤ÚËÛË ÏfiÁˆ ‚·ÚÈ¿˜ ÁÂÓÈÎ‹˜ Î·-Ù¿ÛÙ·ÛË˜, Â›¯·Ó ∞Ù¶ V ÛÙ·‰›Ô˘ ¿ÌÊˆ Î·È·Ó¤Ù˘Í·Ó ¿ÚÈÛÙË fiÚ·ÛË ·fi ÙÔÓ ¤Ó· ÔÊı·ÏÌfi Î·ÈÌÂÈˆÌ¤ÓË ·fi ÙÔÓ ¿ÏÏÔ. ∞fi Ù· 2 ÓÂÔÁÓ¿ ÌÂ ∞Ù¶≥πππ+ Î·È µ° 1001-1500 g, ÛÙÔ ¤Ó· ‰ÂÓ ‹Ù·Ó ÂÊÈÎÙfi˜Ô ¤ÏÂÁ¯Ô˜ ÙÔ˘ ‚˘ıÔ‡ ÁÈ· 6 Â‚‰ÔÌ¿‰Â˜ ÏfiÁˆ ·ÈÌÔÚ-Ú·ÁÈÒÓ ÛÙÔ ˘·ÏÔÂÈ‰¤˜ Î·È fiÙ·Ó ·˘Ùfi Î·Ù¤ÛÙË ‰˘Ó·-Ùfi, Ë ÚfiÁÓˆÛË ÁÈ· ÙËÓ fiÚ·ÛË ‹Ù·Ó Ùˆ¯‹. ∆Ô ¿ÏÏÔÂÏ¤Á¯ıËÎÂ ÌÂ Î·ı˘ÛÙ¤ÚËÛË ÏfiÁˆ ‚·ÚÈ¿˜ ÁÂÓÈÎ‹˜Î·Ù¿ÛÙ·ÛË˜, ·ÏÏ¿ ·Ó¤Ù˘ÍÂ ÈÎ·ÓÔÔÈËÙÈÎ‹ fiÚ·ÛË.

™Â 2 ÓÂÔÁÓ¿ ÌÂ µ° ≤1000 g ¤ÁÈÓÂ ÎÚ˘ÔËÍ›· Î·È¤Ó· ÙË˜ ›‰È·˜ Î·ÙËÁÔÚ›·˜ ıÂÚ·Â‡ıËÎÂ ÌÂ Laser.∞fi Ù· 2 ÓÂÔÁÓ¿ Ô˘ ˘Â‚Ï‹ıËÛ·Ó ÛÂ ÎÚ˘ÔËÍ›·, 1Î·Ù¤ÏËÍÂ ·fi ·›ÙÈ· Ô˘ ‰ÂÓ Â›¯·Ó Û¯¤ÛË ÌÂ ÙËÓ ¿-ıËÛË Î·È 1 ·ÚÔ˘Û›·ÛÂ ˘ÔÛÙÚÔÊ‹ ÙË˜ ∞Ù¶ ÌÂ Î·-Ï‹ ÌÂÙ¤ÂÈÙ· ·Ó¿Ù˘ÍË ÙË˜ fiÚ·ÛË˜. ∆Ô ÓÂÔÁÓfi Ô˘·ÓÙÈÌÂÙˆ›ÛÙËÎÂ ÌÂ Laser ·Ú¤ÌÂÈÓÂ Ù˘ÊÏfi. ™˘ÓÔ-ÏÈÎ¿, ˘‹ÚÍÂ ¤Ó· Ù˘ÊÏfi ÓÂÔÁÓfi ÌÂ µ° ≤1000 g (Ô-ÛÔÛÙfi 1,55% Â› ÙˆÓ ÂÈ‚ÈˆÛ¿ÓÙˆÓ ÌÂ ‚·ÚÈ¿ ∞Ù¶).

∆ËÓ µ ÂÚ›Ô‰Ô ÓÔÛËÏÂ‡ıËÎ·Ó 196 ÓÂÔÁÓ¿ ÌÂ µ°501-1000 g Î·È Â¤˙ËÛ·Ó 111 (56,5%), Ô˘ Â›¯·Óµ° 615-1000 g (¯=853,7±95,8) Î·È ¢∫ 24-30 Â‚‰Ô-Ì¿‰Â˜ (¯=26,7±1,5). ∆ËÓ ›‰È· ÂÚ›Ô‰Ô ÓÔÛËÏÂ‡ıË-Î·Ó Î·È 415 ÓÂÔÁÓ¿ ÌÂ µ° 1001-1500 g Î·È Â¤˙Ë-Û·Ó 364 (87,7%), Ô˘ Â›¯·Ó µ° 1020-1450 g(¯=1260±210) Î·È ¢∫ 26-34 Â‚‰ÔÌ¿‰Â˜(¯=28,5±2,6) (¶›Ó·Î·˜ 1).

∞fi Ù· 111 ÓÂÔÁÓ¿ ÌÂ µ° ≤1000 g Ô˘ Â¤˙Ë-Û·Ó, 42 (37,8%) ·ÚÔ˘Û›·Û·Ó ∞Ù¶. ∞fi ·˘Ù¿, 30(27%) Â›¯·Ó ∞Ù¶ π-ππ ÛÙ·‰›Ô˘ Î·È 12 (10,8%) Â›¯·Ó‚·ÚÈ¿ ∞Ù¶ πππ-V ÛÙ·‰›Ô˘ ÌÂ ‹ ¯ˆÚ›˜ plus disease.∞fi Ù· 12 ÓÂÔÁÓ¿ ÌÂ ‚·ÚÈ¿ ∞Ù¶, 3 Â›¯·Ó ∞Ù¶ πππ ÛÙ·-‰›Ô˘ Î·È ˘ÔÛÙÚÔÊ‹ ÙË˜ ∞Ù¶ Î·È 9 Â›¯·Ó ∞Ù¶ ≥πππ+.∞fi Ù· 9 ÓÂÔÁÓ¿ ÌÂ ∞Ù¶ ≥πππ+ Î·È µ° <1001 g, 1 Â›-¯Â ˘ÔÛÙÚÔÊ‹ ÙË˜ ∞Ù¶ ·fi ÙÔÓ ¤Ó· ÔÊı·ÏÌfi ÌÂÎ·Ï‹ ·Ó¿Ù˘ÍË ÙË˜ fiÚ·ÛË˜ Û‡ÛÙÔÈ¯· Î·È Ù· ˘fi-ÏÔÈ· 8 ¯ÂÈÚÔ˘ÚÁ‹ıËÎ·Ó. ∞fi Ù· 364 ÓÂÔÁÓ¿ ÌÂ µ°1001-1500 g Ô˘ Â¤˙ËÛ·Ó, 24 (6,6%) ·ÚÔ˘Û›·-Û·Ó ∞Ù¶. ∞fi ·˘Ù¿, 20 (5,5%) Â›¯·Ó ∞Ù¶ I-II ÛÙ·‰›-Ô˘ Î·È 4 (1,1%) Â›¯·Ó ‚·ÚÈ¿ ∞Ù¶ III-V ÛÙ·‰›Ô˘ ÌÂ ‹¯ˆÚ›˜ plus disease. ™Â ÎÚ˘ÔËÍ›· ˘Â‚Ï‹ıËÛ·Ó 8·fi Ù· 12 ÓÂÔÁÓ¿ ÌÂ ‚·ÚÈ¿ ∞Ù¶ Î·È µ° ≤1000 g Î·È3 ·fi Ù· 4 ÓÂÔÁÓ¿ ÌÂ ‚·ÚÈ¿ ∞Ù¶ Î·È µ° 1001-1500g. ªÂÙ¿ ÙËÓ ÎÚ˘ÔËÍ›·, 1 ·fi Ù· 8 ÓÂÔÁÓ¿ ÌÂ µ°≤1000 g Î·Ù¤ÏËÍÂ ·fi ·›ÙÈ· Ô˘ ‰ÂÓ Â›¯·Ó Û¯¤ÛËÌÂ ÙËÓ ¿ıËÛË, 2 Â›¯·Ó Î·Î‹ ÚfiÁÓˆÛË, 1 Â›¯Â·Û‹Ì·ÓÙË ‚ÂÏÙ›ˆÛË, ÂÓÒ Ù· ˘fiÏÔÈ· 4 ·ÚÔ˘Û›·-Û·Ó ˘ÔÛÙÚÔÊ‹ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÙË˜ ∞Ù¶. ∞fiÙ· 3 ÓÂÔÁÓ¿ ÌÂ µ° 1001-1500 g Ô˘ ˘Ô‚Ï‹ıËÎ·ÓÛÂ ÎÚ˘ÔËÍ›·, ˘ÔÛÙÚÔÊ‹ ·Ú·ÙËÚ‹ıËÎÂ ÛÙ· 2Î·È ·ÔÎfiÏÏËÛË ÙÔ˘ ·ÌÊÈ‚ÏËÛÙÚÔÂÈ‰Ô‡˜ ÛÂ 1. ŒÓ·ÓÂÔÁÓfi ÙË˜ ›‰È·˜ Î·ÙËÁÔÚ›·˜ ‚¿ÚÔ˘˜ Â›¯Â ∞Ù¶ ππ

ÛÙ·‰›Ô˘ ÛÙÔÓ ¤Ó· ÔÊı·ÏÌfi Î·È πππ ÛÙ·‰›Ô˘ ÛÙÔÓ ¿Ï-ÏÔ Ô˘ ÂÍÂÏ›¯ıËÎÂ ÛÂ ÂÚÈÊÂÚÈÎ‹ ·ÔÎfiÏÏËÛË ÙÔ˘·ÌÊÈ‚ÏËÛÙÚÔÂÈ‰Ô‡˜ ÏfiÁˆ ÌË Ù‹ÚËÛË˜ ÙÔ˘ Ù·ÎÙÈ-ÎÔ‡ Â·ÓÂÏ¤Á¯Ô˘ ·fi ÙÔ˘˜ ÁÔÓÂ›˜. ∏ fiÚ·ÛË ÙÔ˘ÓÂÔÁÓÔ‡ ·Ó·Ù‡¯ıËÎÂ ¿ÚÈÛÙ·. ™˘ÓÔÏÈÎ¿, ˘‹ÚÍ·Ó3 Ù˘ÊÏ¿ ÓÂÔÁÓ¿ ÌÂ µ° ≤1000 g (ÔÛÔÛÙfi 2,7% Â›ÙˆÓ ÂÈ‚ÈˆÛ¿ÓÙˆÓ ÌÂ ‚·ÚÈ¿ ∞Ù¶).

∞ÌÊÈ‚ÏËÛÙÚÔÂÈ‰Ô¿ıÂÈ· ÙË˜ ÚÔˆÚfiÙËÙ·˜ ÛÙË˙ÒÓË 1 ‹ plus disease Â›¯·Ó 2 ÓÂÔÁÓ¿ ÌÂ µ° ≤1000g ÙËÓ ∞ ÂÚ›Ô‰Ô Î·È 2 ÙËÓ µ ÂÚ›Ô‰Ô Î·È 1 ÓÂÔÁÓfiÌÂ µ° 1001-1500 g ÙËÓ ∞ Î·È 2 ÓÂÔÁÓ¿ ÙËÓ µ ÂÚ›Ô-‰Ô. ∞Ù¶ ÌÂ ¤ÎÙ·ÛË ÂÚÈÛÛfiÙÂÚË ·fi 6 ÒÚÂ˜ Â›¯·ÓÙËÓ ∞ ÂÚ›Ô‰Ô 10 ÓÂÔÁÓ¿ ÌÂ µ° ≤1000 g Î·È 1 ÌÂµ° 1001-1500 g Î·È ÙË µ ÂÚ›Ô‰Ô 15 ÓÂÔÁÓ¿ ÌÂ µ°≤1000 g Î·È 6 ÌÂ µ° 1001-1500 g.

™Â Î¿ıÂ ÂÚ›Ô‰Ô, Ù· ÓÂÔÁÓ¿ ÌÂ µ° ≤1000 g, ÛÂÛ¯¤ÛË ÌÂ Ù· ÓÂÔÁÓ¿ ÌÂ µ° 1001-1500 g, Â›¯·Ó ÛÙ·-ÙÈÛÙÈÎ¿ ÌÂÁ·Ï‡ÙÂÚË Û˘¯ÓfiÙËÙ· (p<0,0001) ÛÙÔ Û‡-ÓÔÏÔ ÙË˜ ∞Ù¶ Î·È ÛÙÈ˜ Î·ÙËÁÔÚ›Â˜ ÛÙ·‰›ˆÓ ÙË˜ (¶›-Ó·Î·˜ 1). ªÂÙ·Í‡ ÙˆÓ ‰‡Ô ÂÚÈfi‰ˆÓ ‰ÂÓ ˘‹Ú¯·ÓÛËÌ·ÓÙÈÎ¤˜ (p>0,1) ‰È·ÊÔÚ¤˜ ÛÙË Û˘¯ÓfiÙËÙ· Î·È‚·Ú‡ÙËÙ· ÙË˜ ∞Ù¶ (ÔÏÈÎ‹ Î·È ·Ó¿ ÛÙ¿‰È·) Î·Ù¿ ÙËÛ‡ÁÎÚÈÛË ÙˆÓ ·ÓÙ›ÛÙÔÈ¯ˆÓ Î·ÙËÁÔÚÈÒÓ µ°.

™ÙËÓ Î·ÙËÁÔÚ›· ÙˆÓ ÓÂÔÁÓÒÓ ÌÂ µ° >1500 gÔ˘ ÂÍÂÙ¿ÛÙËÎ·Ó ÔÊı·ÏÌÔÛÎÔÈÎ¿, ‚Ú¤ıËÎ·Ó Ìfi-ÓÔ 7 ÓÂÔÁÓ¿ ÌÂ ∞Ù¶, ÛÙ·‰›Ô˘ π Î·È ππ, ÂÓÒ ÛÙË Î·ÙË-ÁÔÚ›· ÙˆÓ ÙÂÏÂÈfiÌËÓˆÓ ÓÂÔÁÓÒÓ ‰ÂÓ ‚Ú¤ıËÎÂ Î·-Ó¤Ó· ÌÂ ∞Ù¶. ∏ ¢∫ ÙˆÓ 7 ÓÂÔÁÓÒÓ Î˘Ì·ÈÓfiÙ·Ó ·fi32 ¤ˆ˜ 36 Â‚‰ÔÌ¿‰Â˜.

™˘˙‹ÙËÛË ∏ ∞Ù¶ ··ÓÙ¿ ÛÂ ÓÂÔÁÓ¿ ÌÂ µ° <1500 g Î·È Î˘-

Ú›ˆ˜ ÛÂ ÓÂÔÁÓ¿ ÌÂ µ° <1000 g. O ÌÔÓ·‰ÈÎfi˜ ÛË-Ì·ÓÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÁÈ· ÙËÓ ∞Ù¶ ·Ú·Ì¤ÓÂÈ Ë ÌÂ-Á¿ÏË ·ÓˆÚÈÌfiÙËÙ· (5). ™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË, ÛÔ-‚·Ú‹ ∞Ù¶ ·ÚÔ˘ÛÈ¿ÛÙËÎÂ ÌfiÓÔ ÛÂ ÓÂÔÁÓ¿ ÌÂ µ°<1500 g Î·È ‹Ù·Ó ÛËÌ·ÓÙÈÎ¿ Û˘¯ÓfiÙÂÚË ÛÙ· ÌÈÎÚfi-ÙÂÚ· Î·È ÈÔ ·ÓÒÚÈÌ· ÓÂÔÁÓ¿. ∏ Û˘¯ÓfiÙËÙ· ÙË˜∞Ù¶ ÛÂ ÓÂÔÁÓ¿ ÌÂ µ° <1,5 kg Î˘Ì·›ÓÂÙ·È ·fi 12%¤ˆ˜ 78% (5,6). ∏ Û˘¯ÓfiÙËÙ· Î·È Ë ‚·Ú‡ÙËÙ· ÙË˜∞Ù¶ ÛÙ· ÂÚÈÛÙ·ÙÈÎ¿ Ô˘ ÂÍÂÙ¿ÛÙËÎ·Ó Î·È ÁÈ· ÙÈ˜‰‡Ô Î·ÙËÁÔÚ›Â˜ µ° Â›Ó·È ·ÚfiÌÔÈÂ˜ ÌÂ ·˘Ù¤˜ ÂÚ-Á·ÛÈÒÓ ·fi ÚÔËÁÌ¤ÓÂ˜ ˘ÁÂÈÔÓÔÌÈÎ¿ ¯ÒÚÂ˜(2,3,6,9,10). ∏ ·‡ÍËÛË ÙË˜ ÂÈ‚›ˆÛË˜ ÙˆÓ ÓÂÔÁÓÒÓÌÂ µ° <1500 g ÙË µ ÂÚ›Ô‰Ô Â›¯Â Û·Ó ·ÔÙ¤ÏÂÛÌ·Î·È ÙËÓ ·‡ÍËÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÓÂÔÁÓÒÓ ÌÂ ∞Ù¶.∏ ÔÛÔÛÙÈ·›· ·Ó·ÏÔÁ›·, fiÌˆ˜, ·Ú¤ÌÂÈÓÂ Ë ›‰È·.ªÂÚÈÎ¤˜ ÚfiÛÊ·ÙÂ˜ ¤ÚÂ˘ÓÂ˜ ‰Â›¯ÓÔ˘Ó fiÙÈ Ë Û˘-¯ÓfiÙËÙ· ÙË˜ ∞Ù¶ Ô˘ Û¯ÂÙ›˙ÂÙ·È ÌÂ ÙÔ µ° ÂÏ·ÙÙÒ-ÓÂÙ·È, ·Ó Î·È ‰ÂÓ Â›Ó·È Î·Ï¿ Î·Ù·ÓÔËÙfi ÁÈ·Ù› Û˘Ì-‚·›ÓÂÈ ·˘Ùfi (11).

¶·Ú¿ÁÔÓÙÂ˜ Ô˘ ¤¯Ô˘Ó Û˘Ó‰ÂıÂ› ÌÂ ∞Ù¶ ÛÙ· ÔÏ‡ ÚfiˆÚ· ÓÂÔÁÓ¿ Â›Ó·È Ë ·Ú·ÙÂÙ·Ì¤ÓË,


307


308

·ÓÂÍ¤ÏÂÁÎÙË ¯ÔÚ‹ÁËÛË ÔÍ˘ÁfiÓÔ˘ Î·È Ë ·ÛÙ·ı‹˜ÓÂÔÁÓÈÎ‹ ÔÚÂ›·, Ô˘ ˘Ô‰ËÏÒÓÂÙ·È ·fi ÙË ‰È¿Ú-ÎÂÈ· ÙÔ˘ ÌË¯·ÓÈÎÔ‡ ·ÂÚÈÛÌÔ‡, ÙËÓ ÓÂ˘ÌÔÓÈÎ‹ ‰È·-Ê˘Á‹ ·¤Ú·, ÙËÓ ÂÓ‰ÔÎÔÈÏÈ·Î‹ ÂÁÎÂÊ·ÏÈÎ‹ ·ÈÌÔÚÚ·-Á›·, ÙË Û‹„Ë, ÙÔ shock Î.¿. OÈ ·ÓˆÙ¤Úˆ ·Ú¿ÁÔ-ÓÙÂ˜ ˘‹Ú¯·Ó ÛÙËÓ ÏÂÈÔÓfiÙËÙ· ÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜, ·ÏÏ¿ ‰ÂÓ Î·Ù¤ÛÙË ‰˘Ó·Ù‹ ËÛÙ·ÙÈÛÙÈÎ‹ ÙÔ˘˜ ÂÂÍÂÚÁ·Û›·. ∆· ÓÂÔÁÓ¿ ÌÂ ∞Ù¶·ÚÔ˘ÛÈ¿˙Ô˘Ó Û˘¯ÓfiÙÂÚ· ÛÔ‚·Ú¤˜ ˘ÔÏÂÈÌÌ·ÙÈÎ¤˜‚Ï¿‚Â˜, fiˆ˜ ÂÁÎÂÊ·ÏÈÎ‹ ·Ú¿Ï˘ÛË Î·È „˘¯ÔÎÈÓË-ÙÈÎ‹ ˘ÛÙ¤ÚËÛË (12,13).

∏ ‰È¿ÚÎÂÈ· ÙÔ˘ ¯ÔÚËÁÔ‡ÌÂÓÔ˘ ÔÍ˘ÁfiÓÔ˘ Â›Ó·È ËÈÔ Û˘ÓÂ‹˜ ·ÓÂÍ¿ÚÙËÙË È·ÙÚÈÎ‹ ·Ú¿ÌÂÙÚÔ˜ Ô˘Û˘Ó‰¤ÂÙ·È ÌÂ ÙËÓ ∞Ù¶. ∏ ÂÏÂÁ¯fiÌÂÓË ¯ÔÚ‹ÁËÛË ÙÔ˘ÔÍ˘ÁfiÓÔ˘ ÂÚÈfiÚÈÛÂ ÛËÌ·ÓÙÈÎ¿ ÙË Û˘¯ÓfiÙËÙ· ÙË˜¿ıËÛË˜ ÌÂÙ¿ ÙÔ 1953 (7), ·ÏÏ¿ Ë ∞Ù¶ Â·ÓÂÌÊ·-Ó›ÛÙËÎÂ Î·Ù¿ ÙË ‰ÂÎ·ÂÙ›· ÙÔ˘ 1970, fiÙ·Ó Ë ÂÈ‚›ˆ-ÛË ÙˆÓ ·Ú¿ ÔÏ‡ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ ÓÂÔÁÓÒÓ ¿Ú¯È-ÛÂ Ó· ·˘Í¿ÓÂÙ·È (14). ∏ ·‡ÍËÛË ·˘Ù‹ Û˘ÓÂ¯›ÛÙËÎÂÌ¤¯ÚÈ ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎ‹ ÂÊ·ÚÌÔÁ‹ ÙË˜ ÎÚ˘ÔıÂ-Ú·Â›·˜ (4). ¶ÚfiÛÊ·ÙË ÌÂÏ¤ÙË ¤¯ÂÈ ‰Â›ÍÂÈ fiÙÈ ÛÂ ÓÂ-ÔÁÓ¿ ÌÂ ¢∫ <28 Â‚‰ÔÌ¿‰Â˜, Ë ¯ÔÚ‹ÁËÛË ÔÍ˘ÁfiÓÔ˘ÙÈ˜ ÚÒÙÂ˜ 8 Â‚‰ÔÌ¿‰Â˜ ˙ˆ‹˜, ÛÂ ÔÛfiÙËÙ· ·ÚÎÂ-Ù‹ Ó· ‰È·ÙËÚ‹ÛÂÈ ‰È·‰ÂÚÌÈÎfi ÎÔÚÂÛÌfi ÔÍ˘ÁfiÓÔ˘88-98%, Û˘ÓÔ‰Â‡ÙËÎÂ ÌÂ ÛÔ‚·Ú‹ ∞Ù¶ Ô˘ ¯ÚÂÈ·˙fi-Ù·Ó ÎÚ˘ÔıÂÚ·Â›· 4 ÊÔÚ¤˜ ÈÔ Û˘¯Ó¿ ÛÂ Û‡ÁÎÚÈÛËÌÂ ÓÂÔÁÓ¿ Ô˘ ¤Ï·‚·Ó ÔÍ˘ÁfiÓÔ ·ÚÎÂÙfi ÁÈ· ‰È·Ù‹-ÚËÛË ‰È·‰ÂÚÌÈÎÔ‡ ÎÔÚÂÛÌÔ‡ 70-90% (15). ∏ ‰È·Ù‹-ÚËÛË ¯·ÌËÏfiÙÂÚÔ˘ ÎÔÚÂÛÌÔ‡ ‰ÂÓ Û˘ÓÔ‰Â˘fiÙ·Ó·fi ·‡ÍËÛË ÙË˜ ıÓËÛÈÌfiÙËÙ·˜ ‹ ÙË˜ ÂÁÎÂÊ·ÏÈÎ‹˜·Ú¿Ï˘ÛË˜. O Û˘ÓÂ¯‹˜ ¤ÏÂÁ¯Ô˜ ÙÔ˘ ¯ÔÚËÁÔ‡ÌÂ-ÓÔ˘ ÔÍ˘ÁfiÓÔ˘ Î·È Ë ‰ÈfiÚıˆÛË ÙË˜ ˘ÂÚÔÍ›·˜ ÛÂÛ¯¤ÛË ÌÂ ÙÔÓ ÂÚÈÔ‰ÈÎfi ¤ÏÂÁ¯Ô ‰ÂÓ ¤‰ÂÈÍÂ Ó· ¤¯ÂÈÛËÌ·ÓÙÈÎ‹ Â›‰Ú·ÛË ÛÙË Û˘¯ÓfiÙËÙ· ÙË˜ ∞Ù¶ (16).

∏ ¯ÔÚ‹ÁËÛË ˘„ËÏfiÙÂÚˆÓ ˘ÎÓÔÙ‹ÙˆÓ ÔÍ˘Áfi-ÓÔ˘ (ÎÔÚÂÛÌfi˜ ÔÍ˘ÁfiÓÔ˘ >94%), fiÙ·Ó Ë ∞Ù¶ ¤¯ÂÈÊı¿ÛÂÈ ÛÙÔ ÚÔ-Ô˘‰ÈÎfi ÛÙ¿‰ÈÔ, ‰ÂÓ ÂÈ‰ÂÈÓÒÓÂÈ ÙÈ˜‚Ï¿‚Â˜ ÙÔ˘ ·ÌÊÈ‚ÏËÛÙÚÔÂÈ‰Ô‡˜ Î·È ÌÔÚÂ› Ó· ¤¯ÂÈ·Ó·ÛÙ·ÏÙÈÎ‹ ‰Ú¿ÛË ÛÙËÓ ÂÍ¤ÏÈÍË ÚÔ˜ ÙÔ Ô˘‰ÈÎfiÛÙ¿‰ÈÔ (17,18). ∏ ¯ÔÚ‹ÁËÛË, fiÌˆ˜, ˘„ËÏfiÙÂÚˆÓ˘ÎÓÔÙ‹ÙˆÓ ÔÍ˘ÁfiÓÔ˘ ÛÙÈ˜ ÂÚÈÙÒÛÂÈ˜ ·˘Ù¤˜ ‰ÂÓÛ˘ÓÈÛÙ¿Ù·È ÏfiÁˆ ÙÔ˘ ·˘ÍËÌ¤ÓÔ˘ ÎÈÓ‰‡ÓÔ˘ ‚Ï¿‚Ë˜ÙˆÓ ÓÂ˘ÌfiÓˆÓ (17).

™ÙË ‚·Ú‡ÙËÙ· ÙË˜ ∞Ù¶ Ê·›ÓÂÙ·È fiÙÈ ÛËÌ·ÓÙÈÎfiÚfiÏÔ ‰È·‰Ú·Ì·Ù›˙ÂÈ Î·È Ë Ê˘Ï‹. ¡ÂÔÁÓ¿ ∞ÊÚÔ·ÌÂ-ÚÈÎ·ÓÒÓ Â›Ó·È ÏÈÁfiÙÂÚÔ Èı·Ófi Ó· ·Ó·Ù‡ÍÔ˘Ó ‚·-ÚÈ¿ ∞Ù¶ (19). ™Â ÔÚÈÛÌ¤ÓÂ˜ ÂÚÈÙÒÛÂÈ˜ ‚·ÚÈ¿˜∞Ù¶ Ô˘ ‰ÂÓ ‰ÈÎ·ÈÔÏÔÁÔ‡ÓÙ·Ó ·fi ÙË ¢∫, ‚Ú¤ıËÎÂfiÙÈ ˘‹Ú¯Â ÁÂÓÂÙÈÎ‹ ‚Ï¿‚Ë (7).

∏ Û‹„Ë ·fi Candida ¤¯ÂÈ ÂÓÔ¯ÔÔÈËıÂ› Û·Ó¤Ó·˜ ·ÓÂÍ¿ÚÙËÙÔ˜ ·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ·Ó¿-Ù˘ÍË ‚·ÚÈ¿˜ ∞Ù¶ (19,20), ¯ˆÚ›˜ ·˘Ùfi Ó· ¤¯ÂÈ ÂÈ-‚Â‚·ÈˆıÂ› ·fi ¿ÏÏÂ˜ ÂÚÁ·Û›Â˜ (21).

∞ÓÙÈÎÚÔ˘fiÌÂÓ· ·ÔÙÂÏ¤ÛÌ·Ù· ¤¯Ô˘Ó ‰ËÌÔÛÈÂ˘-

ıÂ› Î·È fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ Â›‰Ú·ÛË ÙˆÓ ÎÔÚÙÈÎÔ-ÛÙÂÚÔÂÈ‰ÒÓ ÛÙËÓ ·Ó¿Ù˘ÍË ‹ ÚÔÊ‡Ï·ÍË ·fi ‚·-ÚÈ¿ ∞Ù¶, fiÙ·Ó ·˘Ù¿ ¯ÔÚËÁÔ‡ÓÙ·È ÚÔÁÂÓÓËÙÈÎ¿ ‹ÌÂÙ·ÁÂÓÓËÙÈÎ¿ ÁÈ· ÙË ıÂÚ·Â›· ÙË˜ ¯ÚfiÓÈ·˜ ÓÂ˘-ÌÔÓÔ¿ıÂÈ·˜ (19-22). ¶ÚfiÛÊ·ÙË ÌÂÙ·-·Ó¿Ï˘ÛË¤‰ÂÈÍÂ fiÙÈ Ù· ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹ Ô˘ ¯ÔÚËÁÔ‡ÓÙ·ÈÌÂÙ·ÁÂÓÓËÙÈÎ¿ ‰ÂÓ ¤¯Ô˘Ó ÛËÌ·ÓÙÈÎ‹ Â›‰Ú·ÛË ÛÙËÛ˘¯ÓfiÙËÙ· Î·È ‚·Ú‡ÙËÙ· ÙË˜ ∞Ù¶ (23).

¢ÂÓ ˘¿Ú¯ÂÈ Î¿ÔÈÔ˜ ·Ô‰Â‰ÂÈÁÌ¤ÓÔ˜ ÙÚfiÔ˜ÚÔÊ‡Ï·ÍË˜ ÙˆÓ ÓÂÔÁÓÒÓ ·fi ÙËÓ ÚÔÛ‚ÔÏ‹ ·fi∞Ù¶. ∏ Û¯¤ÛË ÌÂÙ·Í‡ ¢∫ Î·È Û˘¯ÓfiÙËÙ·˜ ∞Ù¶ Î·ıÈ-ÛÙ¿ Û·Ê¤˜ fiÙÈ Ô ÈÔ ·ÔÙÂÏÂÛÌ·ÙÈÎfi˜ ÙÚfiÔ˜ Úfi-ÏË„Ë˜ ÙË˜ ·ÒÏÂÈ·˜ fiÚ·ÛË˜ ·fi ∞Ù¶ Â›Ó·È Ë ÂÏ¿Ù-ÙˆÛË ÙˆÓ ÚfiˆÚˆÓ ÁÂÓÓ‹ÛÂˆÓ. ∞fi ÙËÓ ¿ÏÏË ÌÂ-ÚÈ¿, Ë ‚ÂÏÙ›ˆÛË ÙˆÓ ÙÂ¯ÓÈÎÒÓ Î·È Ú·ÎÙÈÎÒÓ Ô˘ÂÍ·ÛÊ·Ï›˙Ô˘Ó ÂÚÈÛÛfiÙÂÚÔ ÛÙ·ıÂÚ‹ Î·È ÌË ÂÂÈÛÔ-‰È·Î‹ ÔÚÂ›· ÛÙ· ÓÂÔÁÓ¿, ¤¯ÂÈ Û·Ó ·ÔÙ¤ÏÂÛÌ· Ó·ÂÚÈÔÚ›˙ÂÙ·È Ë ÂÌÊ¿ÓÈÛË ÙË˜ ∞Ù¶ ÛÙ· ÈÔ ÌÈÎÚ¿ Î·È·ÓÒÚÈÌ· ÓÂÔÁÓ¿ (11,24). ∆¤ÙÔÈÂ˜ Ú·ÎÙÈÎ¤˜ Â›Ó·È ËÚÔÁÂÓÓËÙÈÎ‹ ¯ÔÚ‹ÁËÛË ÎÔÚÙÈ˙fiÓË˜, Ë ÚÔÊ˘Ï·ÎÙÈ-Î‹ ¯ÔÚ‹ÁËÛË ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· Î·ÈÈÓ‰ÔÌÂı·Î›ÓË˜ Î·È ¿ÏÏÂ˜ ÌÈÎÚfiÙÂÚÂ˜ ·ÚÂÌ‚¿ÛÂÈ˜.

∏ Ê·ÚÌ·ÎÔÏÔÁÈÎ‹ ÚÔÊ‡Ï·ÍË ÁÈ· ∞Ù¶ ‚·Û›˙Â-Ù·È ÛÙËÓ ˘fiıÂÛË fiÙÈ Ë ÙÚ·˘Ì·ÙÈÎ‹ ‚Ï¿‚Ë ÙˆÓ ·Ì-ÊÈ‚ÏËÛÙÚÔÂÈ‰ÈÎÒÓ ÙÚÈ¯ÔÂÈ‰ÈÎÒÓ ·ÁÁÂ›ˆÓ Â›Ó·È Úˆ-ÙÔÁÂÓÒ˜ ÔÍÂÈ‰ˆÙÈÎ‹. ∞fi ÙËÓ ÚÔÊ˘Ï·ÎÙÈÎ‹ ¯ÔÚ‹-ÁËÛË Ê·ÚÌ·ÎÂ˘ÙÈÎÒÓ Ô˘ÛÈÒÓ, È‰È·›ÙÂÚ· ¤¯ÂÈ ÌÂÏÂ-ÙËıÂ› Ë ¯ÔÚ‹ÁËÛË ‚ÈÙ·Ì›ÓË˜ ∂ ·fi ÔÏÏ¿ Î¤ÓÙÚ·,¯ˆÚ›˜ Ó· ·Ô‰ÂÈ¯ıÂ› fiÙÈ ¤¯ÂÈ Î¿ÔÈ· Â˘ÂÚÁÂÙÈÎ¿·ÔÙÂÏ¤ÛÌ·Ù· (7). §›ÁÂ˜ ÂÚÁ·Û›Â˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈË ÈÓÔÛÈÙfiÏË Î·È Ë D ÂÓÈÎÈÏÏ·Ì›ÓË ÂÏ·ÙÙÒÓÔ˘Ó ÙËÛ˘¯ÓfiÙËÙ· ÙË˜ ∞Ù¶, ·ÏÏ¿ ··ÈÙÔ‡ÓÙ·È ÂÚÈÛÛfiÙÂ-ÚÂ˜ Î·È ÈÔ Ï‹ÚÂÈ˜ ÌÂÏ¤ÙÂ˜ ÁÈ· Ó· ÂÈ‚Â‚·ÈˆıÔ‡Ó·˘Ù¿ Ù· ·ÔÙÂÏ¤ÛÌ·Ù· (25,26). ∏ ÚÔÊ‡Ï·ÍË ·fiÙÔ Êˆ˜ ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜, ÙÔ ÔÔ›Ô ¤¯ÂÈ ÂÓÔ¯Ô-ÔÈËıÂ› fiÙÈ ÌÔÚÂ› Ó· ÚÔÎ·Ï¤ÛÂÈ ÔÍÂÈ‰ˆÙÈÎ‹ ‚Ï¿‚ËÙˆÓ ÙÚÈ¯ÔÂÈ‰ÒÓ, ‰ÂÓ ¤¯ÂÈ ‰Â›ÍÂÈ fiÙÈ ÂÏ·ÙÙÒÓÂÈ ÙË Û˘-¯ÓfiÙËÙ· ÙË˜ ∞Ù¶ (27).

∏ ∞Ù¶ Êı¿ÓÂÈ ÙÔ ÚÔ-Ô˘‰ÈÎfi ÛÙ¿‰ÈÔ Î·Ù¿ Ì¤ÛÔfiÚÔ ÛÂ ÌÂÙ·-ÂÌÌËÓÔÚÚÔ˚Î‹ ËÏÈÎ›· Î‡ËÛË˜ 36 Â‚‰Ô-Ì¿‰ˆÓ Î·È ÔÙ¤ ÚÈÓ ÙËÓ 31Ë Â‚‰ÔÌ¿‰·. O Ô˘‰fi˜ÙË˜ ∞Ù¶ ¤¯ÂÈ ¤Ó·ÚÍË ÂÚ›Ô˘ 1 Â‚‰ÔÌ¿‰· ·ÚÁfiÙÂ-Ú· Î·È Ì¤ÛË ËÏÈÎ›· 37 Â‚‰ÔÌ¿‰Â˜ Î·È ‰ÂÓ ·Ú·ÙË-ÚÂ›Ù·È ÚÈÓ ÙÈ˜ 32 Â‚‰ÔÌ¿‰Â˜ ÌÂÙ¿ ÙË Û‡ÏÏË„Ë (28).∏ ¤Ó·ÚÍË Î·È Ù· ÁÂÁÔÓfiÙ· ÙË˜ ∞Ù¶ Û˘Ì‚·›ÓÔ˘Ó ÛÂ¯ÚÔÓÈÎ‹ Û˘Û¯¤ÙÈÛË ÌÂ ÙË ÌÂÙ·-ÂÌÌËÓÔÚÚÔ˚Î‹ ËÏÈÎ›·Î·È fi¯È ÌÂ ÙË ¯ÚÔÓÔÏÔÁÈÎ‹ ËÏÈÎ›·. ∞˘Ùfi Û˘ÓÂ¿ÁÂÙ·ÈfiÙÈ Ë ∞Ù¶ ÂÓÂÚÁÔÔÈÂ›Ù·È fiÙ·Ó Ô ·ÌÊÈ‚ÏËÛÙÚÔÂÈ‰‹˜Êı¿ÛÂÈ ¤Ó·Ó ÔÚÈÛÌ¤ÓÔ ‚·ıÌfi ˆÚÈÌfiÙËÙ·˜ Î·È fi¯ÈfiÙ·Ó ÂÚ¿ÛÂÈ ¤Ó·˜ ÔÚÈÛÌ¤ÓÔ˜ ·ÚÈıÌfi˜ ËÌÂÚÒÓ ‹Â‚‰ÔÌ¿‰ˆÓ ÌÂÙ¿ ÙË ‚Ï¿‚Ë ÛÙ· ·Ó·Ù˘ÛÛfiÌÂÓ· ·Á-ÁÂ›· ÙÔ˘ ·ÌÊÈ‚ÏËÛÙÚÔÂÈ‰Ô‡˜.

∏ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ∞Ù¶ ÔÈÎ›ÏÏÂÈ ·Ó¿ÏÔÁ· ÌÂ ÙÔÛÙ¿‰ÈÔ ÛÙÔ ÔÔ›Ô ‚Ú›ÛÎÂÙ·È Ë ¿ıËÛË. ™Ù· ÚÒÙ· 2

ÛÙ¿‰È· ‰ÂÓ Û˘ÓÈÛÙ¿Ù·È Î·Ì›· ·Ú¤Ì‚·ÛË, ‰ÈfiÙÈ ÔÈÈı·ÓfiÙËÙÂ˜ ·˘ÙfiÌ·ÙË˜ ˘ÔÛÙÚÔÊ‹˜ Â›Ó·È Î·Ï¤˜(5,7,8), fiˆ˜ Û˘Ó¤‚Ë Î·È ÛÙ· ÂÚÈÛÙ·ÙÈÎ¿ ÙË˜ ·-ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜.

™ÙÔ ÔÚÈ·Îfi 3+ ÛÙ¿‰ÈÔ Î·È ÂÊfiÛÔÓ ÔÈ ‚Ï¿‚Â˜˘ÂÚ‚·›ÓÔ˘Ó ÛÂ ¤ÎÙ·ÛË ÙÈ˜ 5 Û˘ÓÂ¯Â›˜ ÒÚÂ˜ ‹ 8·Û˘ÓÂ¯Â›˜ ÛÙË ˙ÒÓË π ‹ ππ, Û˘ÓÈÛÙ¿Ù·È Ë ¿ÌÂÛË(ÂÓÙfi˜ 72 ˆÚÒÓ) ÎÚ˘ÔËÍ›· ‹ ÊˆÙÔËÍ›· ÙË˜ ·Ó¿Á-ÁÂÈ·˜ ÂÚÈÔ¯‹˜ ÙÔ˘ ·ÌÊÈ‚ÏËÛÙÚÔÂÈ‰Ô‡˜ (7). ∏ÎÚ˘ÔıÂÚ·Â›· ÂÏ·ÙÙÒÓÂÈ ÙËÓ Ùˆ¯‹ ¤Î‚·ÛË ·fi51,4% ÛÂ 31,1%. ∞Ó ‰ÂÓ Á›ÓÂÈ ıÂÚ·Â›·, Û˘Ì‚·›ÓÂÈ·ÔÎfiÏÏËÛË ÙÔ˘ ·ÌÊÈ‚ÏËÛÙÚÔÂÈ‰Ô‡˜ ÛÂ ÂÚ›Ô˘50% ÙˆÓ ÂÚÈÙÒÛÂˆÓ (7,10). µ·ÚÈ¿ ∞Ù¶ Ô˘ ¯ÚÂÈ-¿˙ÂÙ·È ıÂÚ·Â›· Â›Ó·È ÔÏ‡ ÏÈÁfiÙÂÚÔ Û˘¯Ó‹ ÛÙ· ÓÂ-ÔÁÓ¿ ÌÂ ¢∫ >29 Â‚‰ÔÌ¿‰Â˜, ÌÂ ·ÔÙ¤ÏÂÛÌ· ÛÙÈ˜∏¶∞ ÔÈ Ô‰ËÁ›Â˜ ÁÈ· ˘Ô¯ÚÂˆÙÈÎfi ÔÊı·ÏÌÔÏÔÁÈÎfi¤ÏÂÁ¯Ô Ó· ·ÊÔÚÔ‡Ó ÌfiÓÔ ÛÂ ÓÂÔÁÓ¿ ÌÂ ¢∫ <28Â‚‰ÔÌ¿‰Â˜ ‹ µ° <1500 g. ™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË˘‹ÚÍ·Ó ÌfiÓÔ 2 ÓÂÔÁÓ¿ ÌÂ ¢∫ >29 Â‚‰ÔÌ¿‰Â˜ Î·È‚·ÚÈ¿ ∞Ù¶ Ô˘ ¯ÚÂÈ¿ÛÙËÎÂ ıÂÚ·Â›· Î·Ù¿ ÙË µ Â-Ú›Ô‰Ô. °È· Ù· ÚfiˆÚ· ÌÂ ¢∫ >28 Â‚‰ÔÌ¿‰Â˜,ÔÊı·ÏÌÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ Á›ÓÂÙ·È fiÙ·Ó ˘¿Ú¯Ô˘Ó˘Ô„›Â˜ fiÙÈ ‚Ú›ÛÎÔÓÙ·È ÛÂ ˘„ËÏfi Î›Ó‰˘ÓÔ ÁÈ· ∞Ù¶Î·Ù¿ ÙËÓ ÂÎÙ›ÌËÛË ÙÔ˘ ÓÂÔÁÓÔÏfiÁÔ˘ (7). ∏ ·Ú·-Ù‹ÚËÛË fiÙÈ ·Ú¿ ÙËÓ ¤ÁÎ·ÈÚË Â¤Ì‚·ÛË ÛÙÔ Ô˘‰È-Îfi ÛÙ¿‰ÈÔ ÛËÌ·ÓÙÈÎfi˜ ·ÚÈıÌfi˜ ÓÂÔÁÓÒÓ ı· ·Ú·-ÌÂ›ÓÔ˘Ó Ù˘ÊÏ¿, ¤¯ÂÈ ÚÔÎ·Ï¤ÛÂÈ ÙËÓ ¤Ó·ÚÍË Ì›·˜ÔÏ˘ÎÂÓÙÚÈÎ‹˜ ÌÂÏ¤ÙË˜, fiÔ˘ Ë ıÂÚ·Â›· ·Ú¯›˙ÂÈÛÙÔ ÚÔ-Ô˘‰ÈÎfi ·ÓÙ› ÛÙÔ Ô˘‰ÈÎfi ÛÙ¿‰ÈÔ. OÈ ÚÔ-Û¿ıÂÈÂ˜ ‰È¿ÛˆÛË˜ ÙÔ˘ ·ÌÊÈ‚ÏËÛÙÚÔÂÈ‰‹ ÌÂÙ¿ ÙËÓ·ÔÎfiÏÏËÛË Â›Ó·È Û˘¯Ó¿ ·ÔÁÔËÙÂ˘ÙÈÎ¤˜ (7). ™ÙËÌÂÏ¤ÙË Ì·˜, ÙËÓ ÂÚ›Ô‰Ô 1990-1994 ÙÔ 25% ÙˆÓ ÓÂ-ÔÁÓÒÓ ÌÂ ‚·ÚÈ¿ ∞Ù¶ III-V ÛÙ·‰›Ô˘ ·ÓÙÈÌÂÙˆ›ÛÙËÎÂÌÂ ÎÚ˘ÔËÍ›· ‹ Laser ¤Ó·ÓÙÈ ÙÔ˘ 68% ÙË˜ ÂÚÈfi‰Ô˘1995-1999. ∏ ‰È·ÊÔÚ¿ ÛÙ· ÔÛÔÛÙ¿ ÙË˜ ¯ÂÈÚÔ˘ÚÁÈ-Î‹˜ ·ÓÙÈÌÂÙÒÈÛË˜ ÔÊÂ›ÏÂÙ·È ·ÊÂÓfi˜ ÛÙÔ fiÙÈ ÙËÓÚÒÙË ÂÚ›Ô‰Ô ÙÔ 30% ÙˆÓ ÓÂÔÁÓÒÓ ÌÂ ‚·ÚÈ¿ ∞Ù¶ÂÏ¤Á¯ıËÎÂ ÌÂ Î·ı˘ÛÙ¤ÚËÛË, ·ÊÂÙ¤ÚÔ˘ ÙË ‰Â‡ÙÂÚËÂÚ›Ô‰Ô ÂÚÈÛÛfiÙÂÚ· ÓÂÔÁÓ¿ Â›¯·Ó ∞Ù¶ III+.

µ·ÚÈ¿ ∞Ù¶ Ô˘ ÚÔÎ·ÏÂ› Ù‡ÊÏˆÛË ··ÓÙ¿ ÛÂÔÛÔÛÙfi 2-11% ÙˆÓ ÂÈ‚ÈˆÛ¿ÓÙˆÓ ÓÂÔÁÓÒÓ ÌÂ µ°<1000 g. ¶ÔÛÔÛÙfi 50% ÙˆÓ ÂÈ‚ÈˆÛ¿ÓÙˆÓ ·fi ‚·-ÚÈ¿ ∞Ù¶ ÌÂ Ù‡ÊÏˆÛË ¤¯ÂÈ „˘¯ÔÎÈÓËÙÈÎ‹ Î·ı˘ÛÙ¤-ÚËÛË (8). ™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË ˘‹ÚÍÂ 1 Ù˘ÊÏfi·È‰› ÌÂ µ° ≤1000 g Î·Ù¿ ÙËÓ ÂÚ›Ô‰Ô ∞ (1,55%Â› ÙˆÓ ÂÈ‚ÈˆÛ¿ÓÙˆÓ) Î·È 3 ÌÂ µ° ≤1000 g Î·Ù¿ ÙËµ ÂÚ›Ô‰Ô (2,7% Â› ÙˆÓ ÂÈ‚ÈˆÛ¿ÓÙˆÓ). ∫·È Ù· 3Ù˘ÊÏ¿ ·È‰È¿ ÙË˜ µ ÂÚÈfi‰Ô˘ ¤¯Ô˘Ó ‚·ÚÈ¿ „˘¯ÔÎÈ-ÓËÙÈÎ‹ Î·ı˘ÛÙ¤ÚËÛË ÔÊÂÈÏfiÌÂÓË ÛÂ ÂÚÈÎÔÈÏÈ·Î‹ÏÂ˘ÎÔÌ·Ï·Î›· ‹ ÂÁÎÂÊ·ÏÈÎ‹ ·ÙÚÔÊ›·.

O ÔÊı·ÏÌÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙˆÓ ·È‰ÈÒÓ ÌÂ∞Ù¶ Ú¤ÂÈ Ó· Û˘ÓÂ¯›˙ÂÙ·È ÂÚÈÔ‰ÈÎ¿ ÁÈ· ·ÚÎÂÙ¿¯ÚfiÓÈ· ÁÈ· ÙËÓ ¤ÁÎ·ÈÚË ‰È¿ÁÓˆÛË Î·È ·ÓÙÈÌÂÙÒÈÛË

·ÒÙÂÚˆÓ ÂÈÏÔÎÒÓ, fiˆ˜ Ë ·ÔÎfiÏÏËÛË ÙÔ˘ ·Ì-ÊÈ‚ÏËÛÙÚÔÂÈ‰Ô‡˜, Ë ˘„ËÏ‹ Ì˘ˆ›·, Ô ÛÙÚ·‚ÈÛÌfi˜,Ë ·Ì‚Ï˘ˆ›· Î.¿. (7).

¶·Ú¿ ÙÈ˜ ÌÂÁ¿ÏÂ˜ ÚÔfi‰Ô˘˜ Ô˘ ¤¯Ô˘Ó ÛËÌÂÈ-ˆıÂ› Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÛÙËÓ ·ıÔÁ¤ÓÂÈ· Î·È ıÂ-Ú·Â›· ÙË˜ ∞Ù¶, ˘¿Ú¯Ô˘Ó ·ÎfiÌ· ÔÏÏ¿ Ô˘ Ú¤-ÂÈ Ó· ÌÂÏÂÙËıÔ‡Ó.

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2. Committee for the Classification of Retinopathy ofPrematurity. An international classification of retinopathy ofprematurity. Arch Ophthalmol 1984;102:1130-1134.

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18. McClead RE, McGregor ML, Bremer D, Cole C, Fellows R,Phelps D et al. HOPE-ROP (High Oxygen Percentage inRetinopathy of prematurity) Study: ROP outcome in infantswith prethreshold ROP and SpO2 >94% in room air. PediatrRes 2000;2457:415A.

19. Saunders RA, Donahue ML, Christmann LM, Pakalnis AV,Tung B, Hardy RJ et al. Racial variation in retinopathy ofprematurity. Arch Ophthalmol 1997;115;604-608.

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∞˘ÙfiÌ·ÙË ‰È¿Ï˘ÛË ¯ÔÏÔÏ›ıÔ˘ ÛÂ ÚfiˆÚÔ ÓÂÔÁÓfi∞. ∞. ∫·Ú·Ù˙¿1, µ. ¡. ¶·‡ÏÔ˘1, Ã. ¶. ∫·ÏÔÁÂÚÔÔ‡ÏÔ˘2, °. N. ª¿ÚÎÔ˘1, ∂. I. ∆ÛÒÙ·2, ™. ¶. ª·ÓÙ·Áfi˜1

Spontaneous resolution of cholelithiasis in a premature neonate A. A. Karatza1, V. N. Pavlou1, C. P. Kalogeropoulou2, G. N. Markou1, I. I. Tsota2, S. P. Mantagos1

∂¡¢π∞º∂ƒOÀ™∞ ¶∂ƒπ¶∆ø™∏ CASE REPORT

1 ªÔÓ¿‰· ∂ÓÙ·ÙÈÎ‹˜ ¡ÔÛËÏÂ›·˜ ¡ÂÔÁÓÒÓ, ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ ¶·ÙÚÒÓ

2 ∫ÏÈÓÈÎfi ∂ÚÁ·ÛÙ‹ÚÈÔ ∞ÎÙÈÓÔÏÔÁ›·˜, ¶·ÓÂÈÛÙ‹ÌÈÔ ¶·ÙÚÒÓ

1 Department of Paediatrics, Neonatal Intensive Care Unit,University of Patras

2 Department of Radiology, University of Patras

∂ÈÛ·ÁˆÁ‹∏ ¯ÔÏÔÏÈı›·ÛË Â›Ó·È Û¿ÓÈÔ Â‡ÚËÌ· ÛÙ· ÓÂÔÁÓ¿

Î·È Ù· ‚Ú¤ÊË. ¶ÚÔ‰È·ıÂÛÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ ıÂˆÚÔ‡-ÓÙ·È Ë ÚÔˆÚfiÙËÙ·, Ë Û‹„Ë, Ë ·ÈÌfiÏ˘ÛË, Ë ÔÏÈÎ‹·ÚÂÓÙÂÚÈÎ‹ ‰È·ÙÚÔÊ‹, Ë ¯ÂÈÚÔ˘ÚÁÈÎ‹ ÂÎÙÔÌ‹ ÙÔ˘ÂÈÏÂÔ‡ Î·È Ë ¯ÚfiÓÈ· ıÂÚ·Â›· ÌÂ ‰ÈÔ˘ÚËÙÈÎ¿. ¶ÂÚÈ-ÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ·Û˘ÌÙˆÌ·ÙÈÎÔ‡ ÚfiˆÚÔ˘ÓÂÔÁÓÔ‡ ÌÂ ÏÈı›·ÛË ¯ÔÏË‰fi¯Ô˘ Î‡ÛÙË˜, ÛÙÔ ÔÔ›Ô

·Ú·ÙËÚ‹ıËÎÂ ·˘ÙfiÌ·ÙË ‰È¿Ï˘ÛË ÙÔ˘ ¯ÔÏÔÏ›ıÔ˘Î·È ·Ô˘Û›· ÙÔ˘ ÛÙÔÓ ˘ÂÚË¯ÔÁÚ·ÊÈÎfi Â·Ó¤ÏÂÁ-¯Ô ÛÙÔÓ 3Ô Ì‹Ó· ÙË˜ ˙ˆ‹˜.

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛË˜ ¡ÂÔÁÓfi ı‹Ï˘, ËÏÈÎ›·˜ Î‡ËÛË˜ 28 Â‚‰ÔÌ¿‰ˆÓ, ÌÂ

‚¿ÚÔ˜ Á¤ÓÓËÛË˜ 1020 g, ÁÂÓÓ‹ıËÎÂ ·fi ÌËÙ¤Ú·ÚˆÙÔÙfiÎÔ ËÏÈÎ›·˜ 19 ÂÙÒÓ, ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ÙÔÎÂÙfi

�¶ÂÚ›ÏË„Ë: ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ÚfiˆÚÔ˘ÓÂÔÁÓÔ‡ 28 Â‚‰ÔÌ¿‰ˆÓ ÌÂ ÏÈı›·ÛË ¯ÔÏË‰fi¯Ô˘ Î‡-ÛÙË˜. ∆Ô ÓÂÔÁÓfi ÂÌÊ¿ÓÈÛÂ Â·ÓÂÈÏËÌÌ¤Ó· ÂÂÈÛfi-‰È· ÛË„·ÈÌ›·˜ Î·È ÁÂÓÈÎÂ˘Ì¤ÓË˜ Ì˘ÎËÙ›·ÛË˜ ·fiCandida albicans. ÃÚÂÈ¿ÛÙËÎÂ ÌË¯·ÓÈÎ‹ ˘ÔÛÙ‹ÚÈ-ÍË ÙË˜ ·Ó·ÓÔ‹˜ ÁÈ· 40 ËÌ¤ÚÂ˜ Î·È ¤Ï·‚Â ·ÚÂ-ÓÙÂÚÈÎ‹ ‰È·ÙÚÔÊ‹ ÙÔ ›‰ÈÔ ‰È¿ÛÙËÌ·. ∆Ô 11Ô 24ˆÚÔÂÌÊ¿ÓÈÛÂ ·ÔÊÚ·ÎÙÈÎfi ›ÎÙÂÚÔ Î·È ÙÔ 18Ô 24ˆÚÔ·‡ÍËÛË ÙˆÓ Ë·ÙÈÎÒÓ ÂÓ˙‡ÌˆÓ ÌÂ Ì¤ÁÈÛÙÂ˜ ÙÈÌ¤˜ÙÔ 29Ô 24ˆÚÔ ˙ˆ‹˜, Ô˘ Û˘Ì›ÙÂÈ ÌÂ ÙËÓ ¤Ó·ÚÍËÛ›ÙÈÛË˜. ∆Ô ˘ÂÚË¯ÔÁÚ¿ÊËÌ· ¿Óˆ ÎÔÈÏ›·˜, ¤Ó·ÓÌ‹Ó· ·ÚÁfiÙÂÚ·, ·Ó¤‰ÂÈÍÂ ˘ÂÚË¯ÔÁÂÓ¤˜ ÌfiÚÊˆÌ·ÛÙË ¯ÔÏË‰fi¯Ô Î‡ÛÙË (¯ÔÏfiÏÈıÔ˜), ¯ˆÚ›˜ Â˘Ú‹Ì·Ù··fi Ù· ÏÔÈ¿ fiÚÁ·Ó·. ∆Ô ÓÂÔÁÓfi ·Ú¤ÌÂÈÓÂ ·Û˘-ÌÙˆÌ·ÙÈÎfi Î·È ÂÍ‹ÏıÂ ·fi ÙË ÌÔÓ¿‰· ÙÔ 100fi24ˆÚÔ ˙ˆ‹˜, ÌÂ ‹È· ·˘ÍËÌ¤ÓÂ˜ ÙÈÌ¤˜ Ë·ÙÈÎÒÓ ÂÓ-˙‡ÌˆÓ Î·È ¯ÔÏÂÚ˘ıÚ›ÓË˜. O Â‚‰ÔÌ·‰È·›Ô˜ Â·Ó¤-ÏÂÁ¯Ô˜ ¤‰ÂÈÍÂ Ê˘ÛÈÔÏÔÁÈÎfi Ë·ÙÈÎfi ·Ú¤Á¯˘Ì· Î·È·Ô˘Û›· Ï›ıÔ˘ ÛÙË ¯ÔÏË‰fi¯Ô Î‡ÛÙË ‹ ÛÙ· ¯ÔÏËÊfi-Ú· ÙÔ 108Ô 24ˆÚÔ ˙ˆ‹˜. ∂ÂÈ‰‹ ÔÈ ÓÂÔÁÓÈÎÔ› ¯ÔÏfi-ÏÈıÔÈ ¤¯Ô˘Ó Î·ÏÔ‹ıË ÔÚÂ›· Î·È Û˘¯Ó¿ ‰È·Ï‡ÔÓÙ·È·˘ÙfiÌ·Ù·, ÛÙ· ÓÂÔÁÓ¿ Ô˘ ·Ú·Ì¤ÓÔ˘Ó ·Û˘ÌÙˆ-Ì·ÙÈÎ¿ Û˘ÓÈÛÙ¿Ù·È Û˘ÓÙËÚËÙÈÎ‹ ·ÓÙÈÌÂÙÒÈÛË Î·ÈÙ·ÎÙÈÎ‹ ˘ÂÚË¯ÔÁÚ·ÊÈÎ‹ ·Ú·ÎÔÏÔ‡ıËÛË.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ¯ÔÏÔÏÈı›·ÛË, ÓÂÔÁÓfi, ÚÔˆÚfiÙËÙ·.

�Abstract: The case is presented of a neonateborn prematurely at 28 weeks of gestation withcholelithiasis. The infant had repeated episodes ofsepsis and generalized infection due to Candidaalbicans and required mechanical ventilation andparenteral nutrition for 40 consecutive days.Cholestasis was noted on day 11 and elevation ofthe hepatic enzymes on day 18, with maximumconcentrations on day 29 when oral feeds wereinitiated. Ultrasonography of the upper abdomenshowed an echodense mass within the gallbladder(gallstone) one month later, with no pathologicalfindings in any other organs. The neonate remainedasymptomatic and was discharged on day 100 withslightly increased serum levels hepatic enzymesand bilirubin. Weekly follow-up showed normalappearance of the liver with no stones in thegallbladder or biliary tree at 108 days of life. Asneonatal gallstones follow a benign course andoften dissolve spontaneously, conservativemanagement with periodic ultrasonographic follow-up of asymptomatic neonates is suggested.

Key words: cholelithiasis, neonate, prematurity.


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Î·È ·˘ÙfiÌ·ÙË Ú‹ÍË ˘Ì¤ÓˆÓ ‰È¿ÚÎÂÈ·˜ 2 ˆÚÒÓ. ∏ ÌË-Ù¤Ú· ÂÌÊ¿ÓÈÛÂ Û˘Û¿ÛÂÈ˜ 5 ËÌ¤ÚÂ˜ ÚÈÓ ÙÔÓ ÙÔÎÂ-Ùfi. °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi, ÙË˜ ¯ÔÚËÁ‹ıËÎÂ ÙÔÎfiÏ˘ÛË ÌÂÈÛÔÍÔ˘Ú›ÓË, 2 ‰fiÛÂÈ˜ Betamethasone Î·ÈCefuroxime acetil ÏfiÁˆ ÏÂ˘ÎÔÎ˘ÙÙ¿ÚˆÛË˜ Î·È ıÂÙÈ-Î‹˜ CRP. ∆Ô ·ÌÓÈ·Îfi ˘ÁÚfi ‹Ù·Ó ÂÏ·ÊÚ¿ ÎÂ¯ÚˆÛÌ¤-ÓÔ Î·È ÙÔ Apgar score ‹Ù·Ó 8 ÛÙÔ 1Ô Î·È 5Ô ÏÂÙfi.

∞Ì¤Ûˆ˜ ÌÂÙ¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ÛÙË ª∂¡, ¯ÚÂÈ-¿ÛÙËÎÂ ÌË¯·ÓÈÎ‹ ˘ÔÛÙ‹ÚÈÍË ÙË˜ ·Ó·ÓÔ‹˜ Î·È ¯Ô-ÚËÁ‹ıËÎ·Ó 2 ‰fiÛÂÈ˜ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔ-ÓÙ·. ∆¤ıËÎÂ ÛÂ ·ÁˆÁ‹ ÌÂ Ampicilline Î·ÈTobramycin. ∂ÂÈ‰‹ ÙÔ 3Ô 24ˆÚÔ ·ÚÔ˘Û›·ÛÂ ‰È·-Ù·Ú·¯¤˜ ÛÙË ıÂÚÌÔÚÚ‡ıÌÈÛË, ˘ÂÚÁÏ˘Î·ÈÌ›· Î·ÈÌÂÙ·‚ÔÏÈÎ‹ ÔÍ¤ˆÛË, Ë ·ÁˆÁ‹ ÙÚÔÔÔÈ‹ıËÎÂ ÛÂAztreonam, Piperacillin-Tazobactam Î·ÈClindamycin. ∆Ô 5Ô 24ˆÚÔ ‰È·ÈÛÙÒıËÎÂ ÔÊı·ÏÌ›·Î·È ÛÙËÓ Î·ÏÏÈ¤ÚÁÂÈ· ÙÔ˘ ÔÊı·ÏÌÈÎÔ‡ ÂÎÎÚ›Ì·ÙÔ˜·Ó·Ù‡¯ıËÎÂ Candida albicans. ∆Ô 9Ô 24ˆÚÔ ÂÌ-Ê¿ÓÈÛÂ ˘fiÛÎÏËÚË ÎÔÈÏ›· ÌÂ ‰È·ÁÚ·Ê‹ ÂÓÙÂÚÈÎÒÓÂÏ›ÎˆÓ. ¶Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ-¯Ô˜ ÏÔ›ÌˆÍË˜ Î·È Ë ·ÁˆÁ‹ ÙÚÔÔÔÈ‹ıËÎÂ ÛÂMeropenem Î·È Teicoplanin.

∆Ô 11Ô 24ˆÚÔ ÂÌÊ¿ÓÈÛÂ ·ÔÊÚ·ÎÙÈÎfi ›ÎÙÂÚÔ(¯ÔÏÂÚ˘ıÚ›ÓË ÔÏÈÎ‹ 11,4 mg/dl Î·È ¿ÌÂÛË 6,1mg/dl). øÛÙfiÛÔ, ÂÂÈ‰‹ ÛÙËÓ ˘ÂÚË‚ÈÎ‹ Î·ÏÏÈ¤Ú-ÁÂÈ· Ô‡ÚˆÓ Î·È ÙÚ·¯ÂÈÔÛˆÏ‹Ó· ·ÔÌÔÓÒıËÎÂCandida albicans, ÂÓÒ Ë Î·ÏÏÈ¤ÚÁÂÈ· ·›Ì·ÙÔ˜ ‹Ù·ÓÛÙÂ›Ú·, ÛÙËÓ ·ÁˆÁ‹ ÚÔÛÙ¤ıËÎÂ ÏÈÔÛˆÌÈÎ‹ ·ÌÊÔ-ÙÂÚÈÎ›ÓË µ. ¢‡Ô ËÌ¤ÚÂ˜ ·ÚÁfiÙÂÚ· ·ÔÌÔÓÒıËÎÂCandida albicans, ÙfiÛÔ ÛÙËÓ Î·ÏÏÈ¤ÚÁÂÈ· ·›Ì·ÙÔ˜fiÛÔ Î·È ÛÙËÓ ˘ÂÚË‚ÈÎ‹ Î·ÏÏÈ¤ÚÁÂÈ· Ô‡ÚˆÓ, ÔfiÙÂÚÔÛÙ¤ıËÎÂ Î·È Fluconazole. ∏ ‰ÈÏ‹ ·ÓÙÈÌ˘ÎËÙÈ·-ÛÈÎ‹ ·ÁˆÁ‹ ¯ÔÚËÁ‹ıËÎÂ ÁÈ· 30 ËÌ¤ÚÂ˜.

O ˘ÂÚË¯ÔÁÚ·ÊÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ ÙÔ10Ô 24ˆÚÔ ˙ˆ‹˜ ·Ó¤‰ÂÈÍÂ ˘ÔÂÂÓ‰˘Ì·ÙÈÎ‹ ·ÈÌÔÚ-Ú·Á›· 1Ô˘ ‚·ıÌÔ‡ ·ÚÈÛÙÂÚ¿. ∂·Ó·ÏËÙÈÎfi ˘ÂÚË-¯ÔÁÚ¿ÊËÌ· ÙÔ 18Ô 24ˆÚÔ ¤‰ÂÈÍÂ ˘ÔÂÂÓ‰˘Ì·ÙÈÎ‹·ÈÌÔÚÚ·Á›· 2Ô˘ ‚·ıÌÔ‡ ¿ÌÊˆ, fiˆ˜ Î·È ‰‡Ô ˘fi-˘ÎÓÔ˘˜ Û¯ËÌ·ÙÈÛÌÔ‡˜ ÌÂ Ë¯ÔÁÂÓ‹ ¿Ïˆ ÛÙËÓ ÂÚÈÔ-¯‹ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ı·Ï¿ÌÔ˘ (Èı·Ó¿ Ì˘ÎËÙÈ·ÛÈÎ¿·ÔÛÙËÌ¿ÙÈ·). ∂›ÛË˜, ·fi ÙËÓ ›‰È· ËÌ¤Ú· ·Ú·ÙË-Ú‹ıËÎÂ ·‡ÍËÛË ÙˆÓ ÙÚ·ÓÛ·ÌÈÓ·ÛÒÓ, ÌÂ Ì¤ÁÈÛÙÂ˜ ÙÈ-Ì¤˜ ÙÔ 29Ô 24ˆÚÔ ˙ˆ‹˜ (SGOT: 760 U/L, SGPT: 472U/L, LDH: 664 U/L), ÔfiÙÂ ¿Ú¯ÈÛÂ Î·È Ë Û›ÙÈÛË. ∆Ô 1Ô˘ÂÚË¯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜-‹·ÙÔ˜, ÙÔ ÔÔ›Ô ¤ÁÈÓÂ ÙË18Ë ËÌ¤Ú· ˙ˆ‹˜, ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi. ¢ÂÓ ˘‹Ú¯Â·ÛÎËÙÈÎfi ˘ÁÚfi, “Ï¿ÛË” ÛÙË ¯ÔÏË‰fi¯Ô Î‡ÛÙË ‹ ‰È¿-Ù·ÛË ·˘Ù‹˜.

∆Ô 24Ô 24ˆÚÔ ˙ˆ‹˜ ÂÌÊ¿ÓÈÛÂ ÂÎ Ó¤Ô˘ ˆ¯ÚÔÁ·È-Ò‰Â˜ ¯ÚÒÌ·, ‰È¿Ù·ÛË ÎÔÈÏ›·˜ ÌÂ ‰È·ÁÚ·Ê‹ ÂÓÙÂÚÈ-ÎÒÓ ÂÏ›ÎˆÓ Î·È ·‡ÍËÛË ÙˆÓ ·Ó·ÓÂ˘ÛÙÈÎÒÓ ·Ó·-ÁÎÒÓ. ŒÙÛÈ, ÛÙÔ ‰ÈÏfi ·ÓÙÈÌ˘ÎËÙÈ·ÛÈÎfi Û¯‹Ì· ÚÔ-ÛÙ¤ıËÎ·Ó Vancomycin Î·È Netilmicin.

ÃÚÂÈ¿ÛÙËÎÂ ·Ó·ÓÂ˘ÛÙÈÎ‹ ˘ÔÛÙ‹ÚÈÍË ÁÈ· 40

ËÌ¤ÚÂ˜, ‰È¿ÛÙËÌ· Î·Ù¿ ÙÔ ÔÔ›Ô ¤Ï·‚Â ·ÚÂÓÙÂÚÈ-Î‹ ‰È·ÙÚÔÊ‹, Î·ıÒ˜ Î·È ÔÏÏ·Ï¤˜ ÌÂÙ·ÁÁ›ÛÂÈ˜ ·›-Ì·ÙÔ˜ (13 Û˘ÓÔÏÈÎ¿).

O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ÙË˜ ·Ú·ÙÂÙ·Ì¤ÓË˜¯ÔÏfiÛÙ·ÛË˜ ÂÚÈ¤Ï·‚Â Û˘ÁÁÂÓÂ›˜ ÏÔÈÌÒÍÂÈ˜, ÈÔÁÂ-ÓÂ›˜ Ë·Ù›ÙÈ‰Â˜, ·ÌÈÓÔÍÂfiÁÚ·ÌÌ· ÔÚÔ‡ Î·È Ô‡ÚˆÓ,·1-·ÓÙÈıÚ˘„›ÓË, ÙÂÛÙ È‰ÚÒÙ·, ·˘ÙÔ·ÓÙÈÛÒÌ·Ù· Î·Èmantoux, Ù· ÔÔ›· ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ¿. O ¤ÏÂÁ¯Ô˜ı˘ÚÂÔÂÈ‰ÈÎ‹˜ ÏÂÈÙÔ˘ÚÁ›·˜ ‹Ù·Ó Û˘Ì‚·Ùfi˜ ÌÂ ˘Ô-ı˘ÚÂÔÂÈ‰ÈÛÌfi (∆4: 6,6 Ìg/dl, ∆3: 0,90 ng/ml, TSH:0,80 mIU/ml), Ô ÔÔ›Ô˜ ·Ô‰fiıËÎÂ ÛÙËÓ ÚÔˆÚfi-ÙËÙ·, ÛÙË ÏÔ›ÌˆÍË Î·È ÙË ÁÂÓÈÎfiÙÂÚ· ÂËÚÂ·ÛÌ¤ÓËÎ·Ù¿ÛÙ·ÛË ÙÔ˘ ÓÂÔÁÓÔ‡. ∆Ô ˘ÂÚË¯ÔÁÚ¿ÊËÌ· ÎÔÈ-Ï›·˜ ÙÔ 72Ô 24ˆÚÔ ·Ó¤‰ÂÈÍÂ ˘ÂÚË¯ÔÁÂÓ¤˜ ÌfiÚÊˆ-Ì· ÂÓÙfi˜ ÙË˜ ¯ÔÏË‰fi¯Ô˘ Î‡ÛÙÂˆ˜ ‰È·ÛÙ¿ÛÂˆÓ 1,0x 0,5 cm, ¯ˆÚ›˜ Â˘Ú‹Ì·Ù· ·fi Ù· ÏÔÈ¿ fiÚÁ·Ó· ÙË˜¿Óˆ ÎÔÈÏ›·˜ (∂ÈÎfiÓ· 1). ¢ÂÓ Û˘Ó˘‹Ú¯Â ÓÂÊÚÔÏÈı›·-ÛË Î·È Ô Ï›ıÔ˜ ÙË˜ ¯ÔÏË‰fi¯Ô˘ Î‡ÛÙÂˆ˜ ‰ÂÓ ‹Ù·ÓÔÚ·Ùfi˜ ÛÙËÓ ·Ï‹ ·ÎÙÈÓÔÁÚ·Ê›· ÎÔÈÏ›·˜. ∂·Ó·ÏË-ÙÈÎfi ˘ÂÚË¯ÔÁÚ¿ÊËÌ· ÙÔ 92Ô 24ˆÚÔ ¤‰ÂÈÍÂ ‰È¿-Ù·ÛË ÙˆÓ ÂÓ‰ÔË·ÙÈÎÒÓ ¯ÔÏËÊfiÚˆÓ, ¯ˆÚ›˜ Ó· ÌÔ-ÚÂ› Ó· ·Ó·‰ÂÈ¯ıÂ› ÎÒÏ˘Ì· ÛÙÔÓ ¯ÔÏË‰fi¯Ô fiÚÔ (∂È-ÎfiÓ· 2). ∂·ÓÂÏ¤Á¯ıËÎÂ Ô ¯ÔÏfiÏÈıÔ˜, fiˆ˜ Î·È Ë˘ÎÓ‹ ¯ÔÏ‹ ÂÓÙfi˜ ÙË˜ ¯ÔÏË‰fi¯Ô˘ Î‡ÛÙÂˆ˜. ∏ Ú·‰È-Ô˚ÛÔÙÔÈÎ‹ ¯ÔÏ·ÁÁÂÈÔÁÚ·Ê›· (HIDA) ·Ó¤‰ÂÈÍÂ ÈÎ·-ÓÔÔÈËÙÈÎ‹ ÚfiÛÏË„Ë ÙÔ˘ Ú·‰ÈÔÊ·ÚÌ¿ÎÔ˘ ·fi ÙÔ‹·Ú Î·È Î·ı˘ÛÙÂÚËÌ¤ÓË ·¤ÎÎÚÈÛ‹ ÙÔ˘ ÛÙÔ ¤ÓÙÂ-ÚÔ, ÂÓÒ Ë ¯ÔÏË‰fi¯Ô˜ Î‡ÛÙË ‰ÂÓ ·ÂÈÎÔÓ›ÛÙËÎÂ ·Îfi-Ì· Î·È ÛÙÈ˜ Î·ı˘ÛÙÂÚËÌ¤ÓÂ˜ Ï‹„ÂÈ˜ (ÌÂÙ¿ ·fi 8ÒÚÂ˜) (∂ÈÎfiÓ· 3).

∆Ô ÓÂÔÁÓfi ·Ú¤ÌÂÈÓÂ ·Û˘ÌÙˆÌ·ÙÈÎfi Î·È ÂÍ‹ÏıÂ·fi ÙË ÌÔÓ¿‰· ÙÔ 100fi 24ˆÚÔ ˙ˆ‹˜, ÌÂ ÂÏ·ÊÚ¿·˘ÍËÌ¤ÓÂ˜ ÙÈÌ¤˜ Ë·ÙÈÎÒÓ ÂÓ˙‡ÌˆÓ (SGOT: 220U/L, SGPT: 132 U/L, ÁGT: 104 U/L, ALP: 1077 U/L),¯ÔÏÂÚ˘ıÚ›ÓË˜ (ÔÏÈÎ‹: 6,31 mg/dl Î·È ¿ÌÂÛË: 3,32mg/dl) Î·È Ê˘ÛÈÔÏÔÁÈÎ‹ ËÎÙÈÎfiÙËÙ· (P∆: 14,4’’,PTT: 40,1’’).

O Â·Ó¤ÏÂÁ¯Ô˜, Ì›· Â‚‰ÔÌ¿‰· ·ÚÁfiÙÂÚ·, ¤‰ÂÈÍÂÊ˘ÛÈÔÏÔÁÈÎfi Ë·ÙÈÎfi ·Ú¤Á¯˘Ì·, ·Ô˘Û›· Ï›ıÔ˘ÛÙË ¯ÔÏË‰fi¯Ô Î‡ÛÙË ‹ ÛÙ· ¯ÔÏËÊfiÚ·, ÂÓÒ ÔÈ ÙÈÌ¤˜ÙˆÓ Ë·ÙÈÎÒÓ ÂÓ˙‡ÌˆÓ Î·È ÙË˜ ¯ÔÏÂÚ˘ıÚ›ÓË˜ ‰È·ÙË-Ú‹ıËÎ·Ó ÛÂ ·ÚfiÌÔÈ· Â›Â‰· ÌÂ ÂÎÂ›Ó· ÙË˜ ÂÍfi-‰Ô˘ ·fi ÙË ÌÔÓ¿‰· (∂ÈÎfiÓ· 4). OÈ ÁÔÓÂ›˜ ·ÚÓ‹ıË-Î·Ó ‰È·ÁÓˆÛÙÈÎ‹ ‚ÈÔ„›· ‹·ÙÔ˜.

™˘˙‹ÙËÛË ™˘ÁÎÂÎÚÈÌ¤ÓÔÈ ·Ú¿ÁÔÓÙÂ˜ ¤¯Ô˘Ó Û˘Û¯ÂÙÈÛÙÂ›

ÌÂ ÙËÓ ÂÌÊ¿ÓÈÛË ¯ÔÏÔÏÈı›·ÛË˜ ÛÙ· ÓÂÔÁÓ¿ Î·È Ù·‚Ú¤ÊË (1,2). ÃÔÏfiÏÈıÔÈ ·Ú·ÙËÚÔ‡ÓÙ·È Û˘ÓËı¤ÛÙÂ-Ú· ÛÙ· ¿ÚÚˆÛÙ·, ÚfiˆÚ· ÓÂÔÁÓ¿ Ô˘ ‰È·Ó‡Ô˘ÓÂÚÈfi‰Ô˘˜ ·Ú·ÙÂÙ·Ì¤ÓË˜ ÓËÛÙÂ›·˜, ÌÂ ·ÔÙ¤ÏÂ-ÛÌ· ·ÊÂÓfi˜ ÌÂÓ Ó· ÌËÓ ‰ÈÂÁÂ›ÚÂÙ·È Ë Û˘ÛÙ·ÏÙÈÎfi-ÙËÙ· ÙË˜ ¯ÔÏË‰fi¯Ô˘ Î‡ÛÙË˜ ÏfiÁˆ ¤ÏÏÂÈ„Ë˜ ÂÓÙÂÚÈ-Î‹˜ Û›ÙÈÛË˜ Î·È ·ÊÂÙ¤ÚÔ˘ Ó· ˘ÔÛÙËÚ›˙ÔÓÙ·È ÌÂ


313

ÔÏÈÎ‹ ·ÚÂÓÙÂÚÈÎ‹ ‰È·ÙÚÔÊ‹ ÁÈ· ÌÂÁ¿Ï· ¯ÚÔÓÈÎ¿‰È·ÛÙ‹Ì·Ù·. ∏ ·ıÔÁ¤ÓÂÈ· ÙË˜ ¯ÔÏfiÛÙ·ÛË˜ Ô˘ÔÊÂ›ÏÂÙ·È ÛÂ ·ÚÂÓÙÂÚÈÎ‹ ‰È·ÙÚÔÊ‹ Â›Ó·È ¿ÁÓˆÛÙË,Èı·ÓfiÙ·Ù· fiÌˆ˜ Â›Ó·È ÔÏ˘·Ú·ÁÔÓÙÈÎ‹. Œ¯Ô˘ÓÂÓÔ¯ÔÔÈËıÂ› Ë ·ÓˆÚÈÌfiÙËÙ· ÙË˜ ÂÓÙÂÚÔË·ÙÈÎ‹˜Î˘ÎÏÔÊÔÚ›·˜ ÙˆÓ ÚÔÒÚˆÓ, Ë ‰È·Ù·Ú·¯‹ ÙÔ˘ ÔÚ-ÌÔÓÈÎÔ‡ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ ÙÔ˘ ÂÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜,Ô˘ Û˘ÓÂ¿ÁÂÙ·È Ë ·Ú·ÙÂÙ·Ì¤ÓË ÓËÛÙÂ›·, Ô Èı·-Ófi˜ ÙÔÍÈÎfi˜ ÚfiÏÔ˜ ÙÔ˘ ‰È·Ï‡Ì·ÙÔ˜ ÙˆÓ ·ÌÈÓÔÍ¤ˆÓÎ·È Ë ¤ÏÏÂÈ„Ë Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ··Ú·›ÙËÙˆÓ Û˘ÛÙ·-ÙÈÎÒÓ ·fi ÙËÓ ÙÂ¯ÓËÙ‹ ‰È·ÙÚÔÊ‹ (1). ™˘¯Ó¿ Û˘Ó˘-¿Ú¯Ô˘Ó Î·È ¿ÏÏÔÈ ÂÈ‚·Ú˘ÓÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ ÁÈ·ÙË ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ‹·ÙÔ˜, fiˆ˜ Â·ÓÂÈÏËÌÌ¤Ó·ÂÂÈÛfi‰È· Û‹„Ë˜, ¤ÎıÂÛË ÛÂ ÙÔÍÈÎ¿ Ê¿ÚÌ·Î· Î·ÈÂÂÈÛfi‰È· ˘fiÙ·ÛË˜ ‹ shock (2). ∂ÓÙÔ‡ÙÔÈ˜, Ë ¯Ô-ÏfiÛÙ·ÛË ·fi ·ÚÂÓÙÂÚÈÎ‹ ‰È·ÙÚÔÊ‹ ·Ú·Ì¤ÓÂÈ‰È¿ÁÓˆÛË ÂÍ ·ÔÎÏÂÈÛÌÔ‡ Î·È Ù· ÚÔÛ‚Â‚ÏËÌ¤Ó·ÓÂÔÁÓ¿ Ú¤ÂÈ Ó· ‰ÈÂÚÂ˘ÓÒÓÙ·È ÁÈ· Ù˘¯fiÓ ‡·ÚÍË

ıÂÚ·Â‡ÛÈÌˆÓ ·ÈÙ›ˆÓ ¯ÔÏfiÛÙ·ÛË˜. OÈ Û˘¯Ó¤˜ ÌÂÙ·ÁÁ›ÛÂÈ˜ ·›Ì·ÙÔ˜, ÔÈ ÔÔ›Â˜ Û˘ÓÂ-

¿ÁÔÓÙ·È ·˘ÍËÌ¤ÓÔ ÊÔÚÙ›Ô ¯ÔÏÂÚ˘ıÚ›ÓË˜ (3), ÔÈ¯ÂÈÚÔ˘ÚÁÈÎ¤˜ ·ı‹ÛÂÈ˜ ÙÔ˘ ÂÈÏÂÔ‡ (2,4), Ë Ì·ÎÚÔ-¯ÚfiÓÈ· ıÂÚ·Â›· ÌÂ ÊÔ˘ÚÔÛÂÌ›‰Ë (5), fiˆ˜ Î·È Ë·Ê˘‰¿ÙˆÛË Î·È Ë Û˘Ó‡·ÚÍË Û˘ÁÁÂÓÒÓ ·ÓˆÌ·-ÏÈÒÓ ÙˆÓ ¯ÔÏËÊfiÚˆÓ (4), ¤¯Ô˘Ó Û˘Ó‰˘·ÛÙÂ› Â›ÛË˜ÌÂ ·˘ÍËÌ¤ÓË Â›ÙˆÛË ÓÂÔÁÓÈÎ‹˜ ¯ÔÏfiÛÙ·ÛË˜ Î·È¯ÔÏÔÏÈı›·ÛË˜. ∏ ¯ÔÏÔÏÈı›·ÛË Â›Ó·È Û˘ÓËı¤ÛÙÂÚËÛÙ· ¿ÚÚÂÓ· ÛÂ Û¯¤ÛË ÌÂ Ù· ı‹ÏÂ· ÓÂÔÁÓ¿ Î·È Û˘-¯Ó¿ ÌÔÚÂ› Ó· ÌË Û˘ÓÔ‰Â‡ÂÙ·È ·fi Î¿ÔÈÔÓ ·Ú¿-ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ (4).

∆Ô ÓÂÔÁÓfi Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È ÂÌÊ¿ÓÈÛÂ ·ÚÎÂ-ÙÔ‡˜ ·fi ÙÔ˘˜ ÚÔ·Ó·ÊÂÚı¤ÓÙÂ˜ ÚÔ‰È·ıÂÛÈÎÔ‡˜·Ú¿ÁÔÓÙÂ˜ ÁÈ· ·Ó¿Ù˘ÍË ¯ÔÏfiÛÙ·ÛË˜, Û˘ÌÂÚÈ-Ï·Ì‚·ÓÔÌ¤ÓË˜ Î·È ÙË˜ ıÂÚ·Â›·˜ ÌÂ ·ÌÊÔÙÂÚÈÎ›ÓËµ, Ë ÔÔ›· ¤¯ÂÈ ‰˘ÓËÙÈÎ¿ ÙÔÍÈÎ‹ ‰Ú¿ÛË ÛÙËÓ ÂÎÎÚÈ-ÙÈÎ‹ ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ‹·ÙÔ˜ (6). Œ¯Ô˘Ó ÂÚÈÁÚ·ÊÂ›Û¿ÓÈÂ˜ ÂÚÈÙÒÛÂÈ˜ ·ÛıÂÓÒÓ ÌÂ Ì˘ÎËÙ›·ÛË ·fiCandida Î·È ·ÔÊÚ·ÎÙÈÎfi ›ÎÙÂÚÔ, ÔÊÂÈÏfiÌÂÓÔ ÛÂ·fiÊÚ·ÍË ÙˆÓ ¯ÔÏËÊfiÚˆÓ ·fi Ì˘Î‹ÏÈ· (7). ∞˘Ùfi‰ÂÓ ÈÛ¯‡ÂÈ ÛÙË Û˘ÁÎÂÎÚÈÌ¤ÓË ÂÚ›ÙˆÛË, ‰Â‰ÔÌ¤-ÓÔ˘ fiÙÈ ÙÔ ˘ÂÚË¯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜ ‰ÂÓ ·Ó¤‰ÂÈÍÂ·ıÔÏÔÁ›· ·fi ÙÔ ‹·Ú ‹ Ù· ¯ÔÏËÊfiÚ· ÛÙË Ê¿ÛËÙË˜ ÂÓÂÚÁ‹˜ Î·ÓÙÈÓÙ›·ÛË˜.

∏ ÓÂÔÁÓÈÎ‹ ¯ÔÏÔÏÈı›·ÛË Â›Ó·È Û¿ÓÈÔ ÓfiÛËÌ·.∂ÓÙÔ‡ÙÔÈ˜, Ë ÁÂÓ›ÎÂ˘ÛË ÙË˜ ¯Ú‹ÛË˜ ÙˆÓ ˘ÂÚ‹¯ˆÓ¤¯ÂÈ ·˘Í‹ÛÂÈ ÙËÓ ·Ó›¯ÓÂ˘Û‹ ÙË˜, ·ÎfiÌ· Î·È ÛÂ ·Û˘ÌÙˆÌ·ÙÈÎÔ‡˜ ·ÛıÂÓÂ›˜ (8). OÈ Ï›ıÔÈ ÛÙË ¯ÔÏË-‰fi¯Ô Î‡ÛÙË ¤¯Ô˘Ó ÂÚÈÁÚ·ÊÂ› ˆ˜ Ù˘¯·›Ô ˘ÂÚË¯Ô-ÁÚ·ÊÈÎfi Â‡ÚËÌ· ÛÂ ·ÓıÚÒÈÓ· ¤Ì‚Ú˘· Î·È Û˘Ó‹-ıˆ˜ ÂÍ·Ê·Ó›˙ÔÓÙ·È ¯ˆÚ›˜ ıÂÚ·Â›· (9). ¶·ÚfiÌÔÈ·Â›Ó·È Ë Ê˘ÛÈÎ‹ ÈÛÙÔÚ›· Î·È ÙˆÓ ÓÂÔÁÓÈÎÒÓ ¯ÔÏÔÏ›-ıˆÓ, ÔÈ ÔÔ›ÔÈ ÁÂÓÈÎ¿ ¤¯Ô˘Ó Î·ÏÔ‹ıË ÔÚÂ›· Î·È Û˘-¯Ó¿ ‰È·Ï‡ÔÓÙ·È ·˘ÙfiÌ·Ù· (4,10,11). °È· ÙÔÓ ÏfiÁÔ·˘Ùfi, ÛÙÈ˜ ÂÚÈÙÒÛÂÈ˜ Ô˘ Ù· ÓÂÔÁÓ¿ ·Ú·Ì¤ÓÔ˘Ó

∂ÈÎfiÓ· 1 (·, ‚). ÀÂÚË¯ÔÁÚ¿ÊËÌ· ¿Óˆ ÎÔÈÏ›·˜ (72Ô 24ˆÚÔ). ∂ÈÌ‹ÎË˜ ÙÔÌ‹ ÛÙÔ Â›Â‰Ô ÙË˜ ¯ÔÏË‰fi¯Ô˘ Î‡ÛÙÂˆ˜. ∞Ó·ÁÓˆÚ›-˙ÂÙ·È ˘ÂÚË¯ÔÁÂÓ‹˜ ¯ÔÏfiÏÈıÔ˜ (‚¤ÏÔ˜) ÂÈÌ‹ÎÔ˘˜ ‰È·Ì¤ÙÚÔ˘ 1 cm Ô˘ ‰ËÌÈÔ˘ÚÁÂ› ·ÎÔ˘ÛÙÈÎ‹ ÛÎÈ¿.

· ‚

∂ÈÎfiÓ· 2. ÀÂÚË¯ÔÁÚ¿ÊËÌ· ¿Óˆ ÎÔÈÏ›·˜ (92Ô 24ˆÚÔ). §›ıÔ˜ÛÙË ¯ÔÏË‰fi¯Ô Î‡ÛÙË Î·È ‰È¿Ù·ÛË ÂÓ‰ÔË·ÙÈÎÒÓ ¯ÔÏËÊfiÚˆÓ(‚¤ÏÔ˜).


314

·Û˘ÌÙˆÌ·ÙÈÎ¿, Û˘ÓÈÛÙ¿Ù·È Û˘ÓÙËÚËÙÈÎ‹ ·ÓÙÈÌÂÙÒ-ÈÛË Î·È Ù·ÎÙÈÎfi˜ ˘ÂÚË¯ÔÁÚ·ÊÈÎfi˜ ¤ÏÂÁ¯Ô˜ (11).¶·Ú’ fiÏ· ·˘Ù¿, ÔÈ ·ÛıÂÓÂ›˜ Ú¤ÂÈ Ó· ·Ú·ÎÔÏÔ˘-ıÔ‡ÓÙ·È ÛÙÂÓ¿ ÁÈ· ÂÎ‰‹ÏˆÛË ÏÔ›ÌˆÍË˜, Ï‹ÚÔ˘˜·fiÊÚ·ÍË˜ ‹ ÚÔÔ‰Â˘ÙÈÎ‹˜ Ë·ÙÈÎ‹˜ ‰˘ÛÏÂÈÙÔ˘Ú-Á›·˜. À¿Ú¯ÂÈ ÂÚÈÔÚÈÛÌ¤ÓË ÂÌÂÈÚ›· fiÛÔÓ ·ÊÔÚ¿ÛÙË ¯Ú‹ÛË ÙÔ˘ Ô˘ÚÛÔ‰ÂÔÍ˘¯ÔÏÈÎÔ‡ ÔÍ¤Ô˜ ÛÙ· ÓÂÔ-ÁÓ¿, ÂÓÒ o ÚfiÏÔ˜ ÙÔ˘ ÛÙË ÓÂÔÁÓÈÎ‹ ¯ÔÏÔÏÈı›·ÛË Â›-Ó·È ·ÌÊ›‚ÔÏÔ˜ (12,13). OÈ Û˘ÌÙˆÌ·ÙÈÎ¤˜ ÂÚÈÙÒ-ÛÂÈ˜ ¯ÔÏÔÏÈı›·ÛË˜ Î·È ¯ÔÏË‰Ô¯ÔÏÈı›·ÛË˜ ·ÓÙÈÌÂÙˆ-›˙ÔÓÙ·È ÌÂ ¯ÂÈÚÔ˘ÚÁÈÎ¤˜ ÌÂıfi‰Ô˘˜ ‹ ÌÂ ÌÂıfi‰Ô˘˜ÂÂÌ‚·ÙÈÎ‹˜ ·ÎÙÈÓÔÏÔÁ›·˜ (4,10,14,15).

µÈ‚ÏÈÔÁÚ·Ê›· 1. Farrell MK, Balistreri WF. Parenteral nutrition and

hepatobiliary dysfunction. Clin Perinatol 1986;13:197-212.

2. McEvoy CF, Suchy FJ. Biliary tract disease in children.Pediatr Clin North Am 1996;43:75-98.

3. Jeffrey I, Lund RJ, Whitelaw A. Cholelithiasis in a preterminfant. Pediatr Pathol 1984;2:207-213.

4. St-Vil D, Yazbeck S, Luks FI, Hancock BJ, Filiatrault D,Youssef S. Cholelithiasis in newborns and infants. J PediatrSurg 1992;27:1305-1307.

5. Blickman JG, Herrin JT, Cleveland RH, Jaramillo D.Coexisting nephrolithiasis and cholelithiasis in prematureinfants. Pediatr Radiol 1991;21:363-364.

6. Gaeta GB, Utili R, Adinolfi LE, Tripodi MF, Esposito V. Effectsof amphotericin B on the excretory function and the colloidclearance capacity of the perfused rat liver. J Hepatol1989;8:344-350.

7. Carstensen H, Nilsson KO, Nettelblad SC, Cederlund CG,Hildell J. Common bile duct obstruction due to anintraluminal mass of candidiasis in a previously healthychild. Pediatrics 1986;77:858-861.

8. Citak EC, Ergenekon E, Alpaslan HG, Atalay Y, Koc E,Zengin A. Asymptomatic neonatal cholelithiasis. Indian JPediatr 2001;68:91-93.

9. Stringer MD, Lim P, Cave M, Martinez D, Lilford RJ. Fetalgallstones. J Pediatr Surg 1996;31:1589-1591.

10. Debray D, Pariente D, Gauthier F, Myara A, Bernard O.Cholelithiasis in infancy: a study of 40 cases. J Pediatr1993;122:385-391.

11. Haddad S, Hage G, Sukkarieh A, Ghorayeb Z, Atallah N.Spontaneous resolution of cholelithiasis in an infant. J MedLiban 1996;44:230-232.

12. Levine A, Maayan A, Shamir R, Dinari G, Sulkes J, Sirotta L.Parenteral nutrition-associated cholestasis in pretermneonates: evaluation of ursodeoxycholic acid treatment. JPediatr Endocrinol Metab 1999;12:549-553.

13. Maruyama K, Koizumi T. Choledocholithiasis in an infant ofextremely low birthweight. J Paediatr Child Health2002;38:204-205.

∂ÈÎfiÓ· 4. ÀÂÚË¯ÔÁÚ¿ÊËÌ· ¿Óˆ ÎÔÈÏ›·˜ (108Ô 24ˆÚÔ). ∏ ¯Ô-ÏË‰fi¯Ô˜ Î‡ÛÙË (‚¤ÏÔ˜) ÂÏ¤Á¯ÂÙ·È ÎÂÓ‹ Ï›ıÔ˘.

∂ÈÎfiÓ· 3 (·, ‚). ƒ·‰ÈÔ˚ÛÔÙÔÈÎ‹ ¯ÔÏ·ÁÁÂÈÔÁÚ·Ê›· ÌÂ Tc-99m Mebrofenin. ·) ∫·Ù¿ Ù· ÚÒÙ· 30 ÏÂÙ¿ ·Ú·ÙËÚÂ›Ù·È ÈÎ·ÓÔÔÈËÙÈÎ‹ ÚfiÛÏË„Ë ÙÔ˘ Ú·‰ÈÔÊ·ÚÌ¿ÎÔ˘ ·fi ÙÔ ‹·Ú. ‚) §‹„ÂÈ˜ 75 ÏÂÙ¿, 4 Î·È 8 ÒÚÂ˜ ÌÂÙ¿ ÙËÓ ¤Á¯˘ÛË. ™ËÌÂÈÒıËÎÂ Î·ı˘ÛÙÂÚËÌ¤ÓË ·¤ÎÎÚÈÛË ÙÔ˘ Ú·‰ÈÔÊ·ÚÌ¿ÎÔ˘ ÌÂ ·Ó›¯ÓÂ˘ÛËÚ·‰ÈÔÛËÌ·ÛÌ¤ÓË˜ ¯ÔÏ‹˜ ÛÙÈ˜ ÂÓÙÂÚÈÎ¤˜ ¤ÏÈÎÂ˜ 4 ÒÚÂ˜ ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË (Î¿Ùˆ ·ÚÈÛÙÂÚ¿). ∏ ¯ÔÏË‰fi¯Ô˜ Î‡ÛÙË ‰ÂÓ ·ÂÈÎÔÓ›-ÛÙËÎÂ ÛÙÈ˜ Î·ı˘ÛÙÂÚËÌ¤ÓÂ˜ Ï‹„ÂÈ˜ ÌÂÙ¿ ·fi 8 ÒÚÂ˜ (Î¿Ùˆ ‰ÂÍÈ¿).

· ‚

14. Ishitani MB, Shaul DB, Padua EA, McAlpin CA.Choledocholithiasis in a premature neonate. J Pediatr1996;128:853-855.

15. Asabe K, Handa N. Infant cholelithiasis: report of a case.Surg Today 1997;27:71-75.


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¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ™Ù¤Ê·ÓÔ˜ ¶. ª·ÓÙ·Áfi˜ ªÔÓ¿‰· ∂ÓÙ·ÙÈÎ‹˜ ¡ÔÛËÏÂ›·˜ ¡ÂÔÁÓÒÓ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ ¶·ÙÚÒÓ ∆.∫. 265 04, ƒ›Ô, ¶¿ÙÚ· E-mail: [email protected]


316

∂ÈÛ·ÁˆÁ‹OÈ ËÏÈÎ›Â˜ 5-14 ÂÙÒÓ Û˘¯Ó¿ ·ÔÎ·ÏÔ‡ÓÙ·È “Â˘-

ÓÔÔ‡ÌÂÓË ËÏÈÎ›· ÙË˜ Ê˘Ì·Ù›ˆÛË˜”, ÁÈ·Ù› Â›Ó·È Ë ËÏÈ-ÎÈ·Î‹ ÔÌ¿‰· ÌÂ ÙË ÌÈÎÚfiÙÂÚË Â›ÙˆÛË ÙË˜ ÓfiÛÔ˘‰ÈÂıÓÒ˜. ∂ÈÏ¤ÔÓ, Ë Ê˘Ì·Ù›ˆÛË ÛÙ· ·È‰È¿ ÂÌÊ·-Ó›˙ÂÙ·È Û˘¯ÓfiÙÂÚ· Û·Ó ÚˆÙÔ·ı‹˜ ÓÂ˘ÌÔÓÈÎ‹Ê˘Ì·Ù›ˆÛË ÌÂ ‰ÈÔÁÎˆÌ¤ÓÔ˘˜ ÙÔ˘˜ ÂÈ¯ÒÚÈÔ˘˜ ÏÂÌ-

Ê·‰¤ÓÂ˜ Î·È ›Ûˆ˜ Î¿ÔÈÔ˘ ‚·ıÌÔ‡ ·ÚÂÁ¯˘Ì·ÙÈÎ‹‚Ï¿‚Ë. ∏ ÂÍˆÓÂ˘ÌÔÓÈÎ‹ Ê˘Ì·Ù›ˆÛË ÛÙ· ·È‰È¿‰ÂÓ Â›Ó·È Û˘¯Ó‹. ¶ÈÔ Û˘¯Ó¿ ·Ú·ÙËÚÂ›Ù·È ÛÂ ·Ó·-Ù˘ÛÛfiÌÂÓÂ˜ ¯ÒÚÂ˜, fiÔ˘ Ë ‰È¿ÁÓˆÛË ÙË˜ ÓfiÛÔ˘Î·ı˘ÛÙÂÚÂ› Î·È ··ÓÙ¿Ù·È ÌÂ Û˘Ó‡·ÚÍË ‹ fi¯È ÓÂ˘-ÌÔÓÈÎ‹˜ ÓfiÛÔ˘.

OÈ ‰‡Ô ÂÚÈÙÒÛÂÈ˜ Ô˘ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ·ÊÔÚÔ‡Ó

º˘Ì·Ù›ˆÛË ÛÂ ·È‰È¿. ¶ÂÚÈÁÚ·Ê‹ ‰‡Ô ÂÚÈÙÒÛÂˆÓ ÌÂ ∆µ ·Û˘Ó‹ıÔ˘˜ ÂÓÙfiÈÛË˜ Î·È ÚÔ‚ÔÏ‹˜ Ã. §¿ÛÎ·ÚË, °. ∞Ó·ÛÙ·ÛÈ¿‰Ë˜, µ. ¶Ï·ÎÔ‡Ï·, ¢. ∞ÁÁÂÏfiÔ˘ÏÔ˜, °. ¶·Ó·ÁÈˆÙ·ÎfiÔ˘ÏÔ˜, ∫. ¶ÚÔ‡ÓÙ˙Ô˘ - ∫·ÛÛÈÔ‡

Tuberculosis in children. Report of two cases with unusual location and presenting symptoms H. Laskari, G. Anastasiadis, V. Plakoula, D. Aggelopoulos, G. Panagiotakopoulos, K. Prountzou - Kassiou

∂¡¢π∞º∂ƒOÀ™∞ ¶∂ƒπ¶∆ø™∏ CASE REPORT

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

1st Paediatric Clinic, “Aghia Sophia” Children’s Hospital,Athens

�¶ÂÚ›ÏË„Ë: ¶ÂÚÈÁÚ¿ÊÔÓÙ·È ‰‡Ô ÂÚÈÙÒÛÂÈ˜ ·È-‰ÈÒÓ ÌÂ Ê˘Ì·Ù›ˆÛË ·Û˘Ó‹ıÔ˘˜ ÂÓÙfiÈÛË˜ Î·È ÚÔ-‚ÔÏ‹˜. °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi ˘‹Ú¯·Ó ‰È·ÁÓˆÛÙÈÎ¤˜‰˘ÛÎÔÏ›Â˜. ∏ ÚÒÙË ÂÚ›ÙˆÛË (·ÁfiÚÈ 11 ÂÙÒÓ)‹Ù·Ó Ê˘Ì·Ù›ˆÛË ÌÂ ÂÈÓ¤ÌËÛË Î·È ÙÔ˘ ÂÙÈÎÔ‡,Ô˘ ÂÌÊ¿ÓÈ˙Â Û˘ÌÙˆÌ·ÙÔÏÔÁ›· ·fi ÙÔ Û˘ÁÎÂÎÚÈ-Ì¤ÓÔ Û‡ÛÙËÌ·. ∞˘Ùfi Û˘ÓÂÙ¤ÏÂÛÂ Ó· ÓÔÛËÏÂ˘ÙÂ› Ô·ÛıÂÓ‹˜ Û·Ó ÂÚÈÛÙ·ÙÈÎfi ÂÌ‡ÚÂÙË˜ Á·ÛÙÚÂÓÙÂÚ›-ÙÈ‰·˜ Î·Ù¿ ÙËÓ ÚÒÙË ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ÛÂ ÓÔÛÔÎÔÌÂ›Ô,¯ˆÚ›˜ Ó· ÙÂıÂ› ·Ú¯ÈÎ¿ ÛÙÔ˘˜ ‰È·ÊÔÚÔ‰È·ÁÓˆÛÙÈ-ÎÔ‡˜ Û˘ÏÏÔÁÈÛÌÔ‡˜ Ë Èı·Ó‹ ‰È¿ÁÓˆÛË ÙË˜ ∆µ ÂÓÙÂ-Ú›ÙÈ‰·˜. O ·ÛıÂÓ‹˜ ÙË˜ ‰Â‡ÙÂÚË˜ ÂÚ›ÙˆÛË˜ (ÎÔ-Ú›ÙÛÈ 10 ÂÙÒÓ) Â›¯Â ÈÛÙÔÚÈÎfi, Û˘ÌÙˆÌ·ÙÔÏÔÁ›·, ÂÚ-Á·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô Î·È ¯ÂÈÚÔ˘ÚÁÈÎ¿ Â˘Ú‹Ì·Ù· Ô˘·Ú¤ÂÌ·Ó ÛÂ ‡·ÚÍË Â¯ÈÓfiÎÔÎÎÔ˘ Î‡ÛÙÂˆ˜ ÓÂ‡-ÌÔÓ·. ªÂÙ¿ ÙË Û˘ÌÏ‹ÚˆÛË ÙÔ˘ ÂÏ¤Á¯Ô˘ Ê¿ÓËÎÂfiÙÈ ÚfiÎÂÈÙ·È ÁÈ· Ê˘Ì·Ù›ˆÛË Î·È ÛÙÈ˜ ‰‡Ô ÂÚÈÙÒ-ÛÂÈ˜. OÈ ÂÚÈÙÒÛÂÈ˜ ·˘Ù¤˜ ÂÚÈÁÚ¿ÊÔÓÙ·È ÛÙËÓ ·-ÚÔ‡Û· ÌÂÏ¤ÙË, Î·ıÒ˜ Ë Ê˘Ì·Ù›ˆÛË ÂÍ·ÎÔÏÔ˘ıÂ› Ó·˘¿Ú¯ÂÈ ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›· ÌÂ ·Ó·ÊÂÚfiÌÂÓË ·‡ÍË-ÛË ÙË˜ Â›ÙˆÛ‹˜ ÙË˜ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·. ™Ùfi¯Ô˜Â›Ó·È Ó· ÙÔÓÈÛÙÂ› fiÙÈ Ë ÓfiÛÔ˜ ·ÓÂ˘Ú›ÛÎÂÙ·È Î·È ÛÂ ÌËÙ˘ÈÎ¤˜ ÌÔÚÊ¤˜ Î·È fiÙÈ Â›Ó·È ÛÎfiÈÌÔ Ó· Û˘ÌÂÚÈ-Ï·Ì‚¿ÓÂÙ·È ÛÙË ‰È·ÁÓˆÛÙÈÎ‹ Û˘ÏÏÔÁÈÛÙÈÎ‹, ÒÛÙÂ Ó·Â›Ó·È ‰˘Ó·Ù‹ Ë ¤ÁÎ·ÈÚË ‰È¿ÁÓˆÛ‹ ÙË˜.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: Ê˘Ì·Ù›ˆÛË, ·È‰È¿, ÂÓ‰ÔÎÔÈÏÈ·Î‹,Ù‡Ô˘ ÂÓËÏ›ÎÔ˘.

�Abstract: Two cases of tuberculosis (TB) in childrenare reported. The location of the disease and thepresenting symptoms were unusual for their age,causing diagnostic difficulties. The first case was thatof an eleven year-old boy who had TB withinvolvement of the abdomen and the gastrointestinalsystem. The presenting symptoms from the gastro-intestinal system resulted in a diagnosis after his firsthospital admission of “acute gastroenteritis”, with noreference to TB in the differential diagnosis. Thesecond case was that of a ten year-old girl whosehistory, symptoms and laboratory results referred to“echinococcosis of the lung”. Following completion ofthe investigation it became obvious that both werecases of TB. TB continues to be observed in children,with an increasing incidence in recent years. Thesecases are reported in order to emphasize that thedisease may present atypically and a high index ofsuspicion is required to make an early diagnosis.

Key words: tuberculosis, children, intraabdominal,adult type.

ÛÂ ·È‰È¿ ËÏÈÎ›·˜ 11 Î·È 10 ÂÙÒÓ. ™ÙËÓ ÚÒÙË ˘‹Ú-¯Â Î·È ÂÍˆÓÂ˘ÌÔÓÈÎ‹ Ê˘Ì·Ù›ˆÛË (Ê˘Ì·Ù›ˆÛË Â-ÙÈÎÔ‡ Î·È Ê˘Ì·ÙÈÒ‰Ë˜ ÂÚÈÙÔÓ›ÙÈ‰·). ∆Ô ‰Â‡ÙÂÚÔ·È‰› Â›¯Â ÓÂ˘ÌÔÓÈÎ‹ Ê˘Ì·Ù›ˆÛË, ·ÏÏ¿ ÌÂ ÂÓÙfiÈ-ÛË ÛÙÔ ‰ÂÍÈfi Î¿Ùˆ ÓÂ˘ÌÔÓÈÎfi ÏÔ‚fi Î·È Û¯ËÌ·ÙÈ-ÛÌfi ÛËÏ·›Ô˘ ÛÙËÓ ›‰È· ÂÚÈÔ¯‹, ÂÓÙfiÈÛË Î·È ‚Ï¿-‚Ë ·Û˘Ó‹ıÈÛÙË ÛÂ ·È‰ÈÎ‹ ËÏÈÎ›·.

∏ Û·ÓÈfiÙËÙ· ·˘ÙÒÓ ÙˆÓ ‰‡Ô ÂÚÈÙÒÛÂˆÓ, ÔÈ‰È·ÊÔÚÔ‰È·ÁÓˆÛÙÈÎ¤˜ ‰˘ÛÎÔÏ›Â˜ Ô˘ ·ÚÔ˘Û›·˙·ÓÎ·È Ë ÎÔÈÓˆÓÈÎ‹ ‰È¿ÛÙ·ÛË ÙË˜ ‰Â‡ÙÂÚË˜ (Â›¯Â ÌÔ-Ï˘ÓıÂ› ÌÂ Ì˘ÎÔ‚·ÎÙËÚ›‰ÈÔ ÌÂÁ¿ÏÔ Ì¤ÚÔ˜ ÙÔ˘ ÏË-ı˘ÛÌÔ‡ ÂÓfi˜ ÌÈÎÚÔ‡ ÓËÛÈÔ‡) ·ÔÙ¤ÏÂÛ·Ó ÙÈ˜ ·ÈÙ›Â˜ÂÚÈÁÚ·Ê‹˜ ÙÔ˘˜.

¶ÂÚÈÁÚ·Ê‹ ÂÚÈÙÒÛÂˆÓ¶ÂÚ›ÙˆÛË ÚÒÙË∞ÁfiÚÈ ËÏÈÎ›·˜ 11 ÂÙÒÓ ÚÔÛ‹ÏıÂ ÛÂ Â·Ú¯È·Îfi

ÓÔÛÔÎÔÌÂ›Ô ÌÂ ˘ÚÂÙfi, ÂÌ¤ÙÔ˘˜ Î·È ‰È·ÚÚÔ˚Î¤˜ ÎÂ-ÓÒÛÂÈ˜. ¡ÔÛËÏÂ‡ÙËÎÂ Û·Ó ÂÚÈÛÙ·ÙÈÎfi ÌÈÎÚÔ‚È·-Î‹˜ Á·ÛÙÚÂÓÙÂÚ›ÙÈ‰·˜ ÌÂ Èı·Ó‹ ·ÈÙ›· ÙË Û·ÏÌÔÓ¤-Ï· (‰ÂÓ ·ÔÌÔÓÒıËÎÂ ÙÔ ÌÈÎÚfi‚ÈÔ ÛÙÈ˜ Î·ÏÏÈ¤ÚÁÂÈ-Â˜) Î·È ¯ÔÚËÁ‹ıËÎÂ ¯ÏˆÚ·ÌÊÂÓÈÎfiÏË. ŒÌÂÈÓÂ ·‡-ÚÂÙÔ Î·È ÂÍ‹ÏıÂ, ·ÏÏ¿ ÌÂÙ¿ ·fi 6 ËÌ¤ÚÂ˜ Ô ˘ÚÂ-Ùfi˜ ˘ÔÙÚÔ›·ÛÂ Î·È ¤ÁÈÓÂ Â·ÓÂÈÛ·ÁˆÁ‹ ÙÔ˘.

™ÙÔÓ ¤ÏÂÁ¯Ô Ô˘ ·ÎÔÏÔ‡ıËÛÂ ‰È·ÈÛÙÒıËÎÂ ÛÙËÓ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·Î· ‡·ÚÍË ÏÂ˘ÚÈÙÈÎÔ‡ ˘ÁÚÔ‡·ÚÈÛÙÂÚ¿ Î·È ÛÂ CT ÎÔÈÏ›·˜ ·ÛÎÈÙÈÎfi ˘ÁÚfi, ‰ÈfiÁÎˆÛË·ÁÎÚ¤·ÙÔ˜ Î·È Ô›‰ËÌ· ÂÓÙÂÚÈÎÒÓ ÂÏ›ÎˆÓ.

∏ Mantoux ¤‰ÂÈÍÂ ‰È‹ıËÛË ‰È·Ì¤ÙÚÔ˘ 5 mm Î·ÈË ÂÍ¤Ù·ÛË ÙÔ˘ ·ÛÎÈÙÈÎÔ‡ ˘ÁÚÔ‡ 800 ÏÂ˘ÎÔÎ‡ÙÙ·Ú··Ó¿ ÙÂÙÚ·ÁˆÓÈÎfi ¯ÈÏÈÔÛÙfi ÌÂ ÏÂÌÊÔÎ‡ÙÙ·Ú· 95%Î·È ÏÂ‡ÎˆÌ· 3 g%. ∏ Î˘ÙÙ·ÚÔÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË ‹Ù·Ó·ÚÓËÙÈÎ‹ ÁÈ· Î·ÎÔ‹ıË Î‡ÙÙ·Ú·. ªÂ Èı·Ó‹ ÙË ‰È¿-ÁÓˆÛË Ê˘Ì·ÙÈÒ‰Ô˘˜ ÏÔ›ÌˆÍË˜ ¯ÔÚËÁ‹ıËÎÂ π¡∏Î·È RIF. ªÂÙ¿ ·fi Ì›· Â‚‰ÔÌ¿‰·, ÂÂÈ‰‹ Ô ˘ÚÂÙfi˜Û˘ÓÂ¯È˙fiÙ·Ó, ¤ÁÈÓÂ ‰È·ÎÔ‹ ÙË˜ ·ÓÙ›-∆µ ·ÁˆÁ‹˜ Î·È·Ú·ÔÌ‹ ÙÔ˘ ·ÛıÂÓ‹ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô ÁÈ· ÂÚ·È-Ù¤Úˆ ¤ÏÂÁ¯Ô.

∫·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ÛÙËÓ ÎÏÈÓÈÎ‹, ÙÔ ·È‰›¤·Û¯Â Î·È ‹Ù·Ó ˆ¯Úfi, Â›¯Â ‰È·ÙÂÙ·Ì¤ÓË ÎÔÈÏÈ¿ Î·ÈıÂÚÌÔÎÚ·Û›· 38oC. ∆Ô ‹·Ú ‹Ù·Ó „ËÏ·ÊËÙfi 2 cm,Ô ÛÏ‹Ó·˜ 1 cm Î·È Ë ·ÚÙËÚÈ·Î‹ ›ÂÛË ‹Ù·Ó 100/70mmHg. ¢ÂÓ ‰È·ÈÛÙÒıËÎ·Ó ÔÈ‰‹Ì·Ù· ‹ „ËÏ·ÊËÙÔ›ÏÂÌÊ·‰¤ÓÂ˜. ∆Ô ·ÙÔÌÈÎfi Î·È ÎÏËÚÔÓÔÌÈÎfi ·Ó·ÌÓË-ÛÙÈÎfi ‹Ù·Ó ÂÏÂ‡ıÂÚ·.

O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍÂ ·ÈÌÔÛÊ·ÈÚ›ÓË11 g/dL, ·ÈÌ·ÙÔÎÚ›ÙË 33%, ÏÂ˘Î¿ ·ÈÌÔÛÊ·›ÚÈ·18.000/mm3 ÌÂ ÔÏ˘ÌÔÚÊÔ‡ÚËÓ· 76%, ÏÂÌÊÔ-Î‡ÙÙ·Ú· 17% Î·È ÌÔÓÔ‡ÚËÓ· 4%. ∏ TKE ‹Ù·Ó 11mm ÙËÓ 1Ë ÒÚ·. OÈ ËÏÂÎÙÚÔÏ‡ÙÂ˜ ÔÚÔ‡, Ë Ô˘Ú›·, ËÎÚÂ·ÙÈÓ›ÓË, Ë ·Ì˘Ï¿ÛË ÔÚÔ‡ Î·È Ô‡ÚˆÓ, Ù· ÔÏÈÎ¿ÏÂ˘ÎÒÌ·Ù·, ÔÈ ÏÂ˘ÎˆÌ·Ù›ÓÂ˜ Î·È Ë ÁÂÓÈÎ‹ ÂÍ¤Ù·ÛËÔ‡ÚˆÓ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ¿.

∏ Mayer ÎÔÚ¿ÓˆÓ ‹Ù·Ó ·ÚÓËÙÈÎ‹, Ë ÁÏ˘Îfi˙Ë108 mg/dl, Ë SGOT 38 U/L, Ë SGPT 65 U/L, Ë ÁGT73 U/L Î·È Ë ¯ÔÏÂÚ˘ıÚ›ÓË Î·È ·ÏÎ·ÏÈÎ‹ ÊˆÛÊ·Ù¿-ÛË ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ¤˜. OÈ ÔÚÔ·ÓÙÈ‰Ú¿ÛÂÈ˜ WidalÎ·È Wright ‹Ù·Ó ·ÚÓËÙÈÎ¤˜. O ¤ÏÂÁ¯Ô˜ ÁÈ· Ë·Ù›ÙÈ‰·Î·È HIV ÏÔ›ÌˆÍË ‹Ù·Ó ·ÚÓËÙÈÎfi˜, Ë ‰ÂÚÌÔ·ÓÙ›‰Ú·-ÛË Mantoux ¤‰ÂÈÍÂ ¿ÏÈ ‰È‹ıËÛË 5 mm Î·È Ë Î·-Ì‡ÏË ·ÓÔ¯‹˜ ÁÏ˘Îfi˙Ë˜ ‹Ù·Ó ·ıÔÏÔÁÈÎ‹. ∏ CTıÒÚ·Î· Î·È ÎÔÈÏ›·˜ (∂ÈÎfiÓ· 1) ¤‰ÂÈÍÂ ‰È¿Ù·ÛË ˘-ÏÒÓ, ÏÂ˘ÚÈÙÈÎfi ˘ÁÚfi ·ÚÈÛÙÂÚ¿ Î·È ·ÙÂÏÂÎÙ·Û›·ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ Î¿Ùˆ ÏÔ‚Ô‡ ÙÔ˘ ÓÂ‡ÌÔÓ·. À‹Ú¯ÂÌÂ›ˆÛË ÙË˜ ÔÛfiÙËÙ·˜ ÙÔ˘ ·ÛÎÈÙÈÎÔ‡ ˘ÁÚÔ‡ Î·ÈÌÂ›ˆÛË ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙÔ˘ ·ÁÎÚ¤·ÙÔ˜ Î·È ÙÔ˘ ÔÈ-‰‹Ì·ÙÔ˜ ÙˆÓ ÂÓÙÂÚÈÎÒÓ ÂÏ›ÎˆÓ Û˘ÁÎÚÈÙÈÎ¿ ÌÂ ÙËÓ1Ë CT. O ¤ÏÂÁ¯Ô˜ ÙÔ˘ ÏÂ˘ÚÈÙÈÎÔ‡ ˘ÁÚÔ‡ ¤‰ÂÈÍÂ720 ÏÂ˘Î¿/mm2 ÌÂ 97% ÏÂÌÊÔÎ‡ÙÙ·Ú·, Ï›Á· ÂÚ˘-ıÚ¿, ÂÓÒ ‹Ù·Ó ·ÚÓËÙÈÎfi˜ ÁÈ· ‚·Î›ÏÔ˘˜ Koch. ªÂÈı·Ó¤˜ ‰È·ÁÓÒÛÂÈ˜ ÙËÓ ∆µ ÏÔ›ÌˆÍË, ¿ÏÏË ¯ÚÔÓ›-˙Ô˘Û· ÊÏÂÁÌÔÓ‹ ‹ Î·ÎÔ‹ıÂÈ·, ÍÂÎ›ÓËÛÂ ·ÓÙ›-∆µ·ÁˆÁ‹ (2 ËÌ¤ÚÂ˜ ÌÂÙ¿ ÙË ‰È·ÎÔ‹ ÙË˜) ÌÂ INH, RIFÎ·È ˘Ú·˙ÈÓ·Ì›‰Ë. °Ú‹ÁÔÚ·, Ë ÁÂÓÈÎ‹ Î·Ù¿ÛÙ·ÛËÙÔ˘ ·ÛıÂÓ‹ ‚ÂÏÙÈÒıËÎÂ, ¤ÌÂÈÓÂ ·‡ÚÂÙÔ˜ ÌÂÙ¿ ·fiÌ›· Â‚‰ÔÌ¿‰· ıÂÚ·Â›·˜ Î·È Ë ‰È¿Ù·ÛË ÙË˜ ÎÔÈÏÈ¿˜˘Ô¯ÒÚËÛÂ. ™ÙÔÓ Â·Ó¤ÏÂÁ¯Ô ÌÂ ·/· ıÒÚ·ÎÔ˜ Î·ÈU/S ÎÔÈÏ›·˜ ÌÂÙ¿ ·fi 20 ËÌ¤ÚÂ˜ ‰ÂÓ ·Ú·ÙËÚ‹ıËÎ·ÓÏÂ˘ÚÈÙÈÎfi ‹ ·ÛÎÈÙÈÎfi ˘ÁÚfi, ÂÓÒ Ë ‰ÈfiÁÎˆÛË ÙÔ˘ ·-ÁÎÚ¤·ÙÔ˜ Â›¯Â ÂÚ·ÈÙ¤Úˆ ˘Ô¯ÒÚËÛË. ∏ ÁÏ˘Îfi˙Ë Î·ÈÙ· Ë·ÙÈÎ¿ ¤Ó˙˘Ì· ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ¿, Ë ÁGT ·Ú¤ÌÂ-ÓÂ ÔÚÈ·Î¿ ·˘ÍËÌ¤ÓË, ÂÓÒ ˘‹Ú¯Â Ë ‰È¿Ù·ÛË ÙˆÓ ˘-ÏÒÓ Î·È Ë ·ÙÂÏÂÎÙ·Û›· ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ÓÂ‡ÌÔÓ·. ¢‡ÔÌ‹ÓÂ˜ ÌÂÙ¿, Ë ‰È¿Ù·ÛË ÙˆÓ ˘ÏÒÓ Î·È Ë ·ÙÂÏÂÎÙ·Û›·Â¤ÌÂÓ·Ó. ªÂÙ¿ ·fi Û˘ÓÔÏÈÎ‹ ·ÓÙ›-∆µ ·ÁˆÁ‹ 18 ÌË-ÓÒÓ (ÙÔ˘˜ ÚÒÙÔ˘˜ 2 Ì‹ÓÂ˜ Ù· ÙÚ›· ÚÔ·Ó·ÊÂÚı¤ÓÙ·Ê¿ÚÌ·Î· Î·È ÛÙË Û˘Ó¤¯ÂÈ· π¡∏ Î·È RIF), ÙÔ ·È‰› Â›¯Â·Ó·ÚÚÒÛÂÈ Ï‹Úˆ˜. ∏ ÂÛÙ›· ÌÂÙ¿‰ÔÛË˜ ÙË˜ ÏÔ›Ìˆ-ÍË˜ ‰ÂÓ ¤ÁÈÓÂ ‰˘Ó·Ùfi Ó· ÂÓÙÔÈÛÙÂ›.


317

∂ÈÎfiÓ· 1. CT ÎÔÈÏÈ¿˜ Î·È ıÒÚ·Î·: ·) ·ÙÂÏÂÎÙ·Û›· ·ÚÈÛÙÂÚÔ‡Î¿Ùˆ ÏÔ‚Ô‡, ‚) ·ÛÎÈÙÈÎfi ˘ÁÚfi, Á) ‰ÈfiÁÎˆÛË ·ÁÎÚ¤·ÙÔ˜ Î·È‰) Ô›‰ËÌ· ÂÓÙÂÚÈÎÒÓ ÂÏ›ÎˆÓ.

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318

¶ÂÚ›ÙˆÛË ‰Â‡ÙÂÚË∫ÔÚ›ÙÛÈ ËÏÈÎ›·˜ 10 ÂÙÒÓ ÚÔÛ‹ÏıÂ ÛÙËÓ ÎÏÈÓÈÎ‹

ÌÂ ˘ÚÂÙfi, ‚‹¯· Î·È ÂÈÁ·ÛÙÚ·ÏÁ›· ·fi ÙÚÈËÌ¤ÚÔ˘,ÂÓÒ 36 ÒÚÂ˜ ÚÔ ÙË˜ ÂÈÛ·ÁˆÁ‹˜ ÙÔ˘ ·ÚÔ˘Û›·ÛÂÂÂÈÛfi‰ÈÔ Ô˘ ¤ÌÔÈ·˙Â ÌÂ “˘‰·Ù¤ÌÂÛË”. ◊Ù·Ó ÙÔ 2Ô·È‰› ˘ÁÈÒÓ ÁÔÓ¤ˆÓ Î·È ÙÔ ·ÙÔÌÈÎfi Î·È ÎÏËÚÔÓÔÌÈÎfiÈÛÙÔÚÈÎfi ÙË˜ ‹Ù·Ó ÂÏÂ‡ıÂÚ·. ∏ ÔÈÎÔÁ¤ÓÂÈ· Î·ÙÔÈ-ÎÔ‡ÛÂ ÛÂ ÌÈÎÚfi ÓËÛ› Î·È Ë ÌÂÙ·ÊÔÚ¿ ÙË˜ ÛÙÔ ÓÔÛÔ-ÎÔÌÂ›Ô ¤ÁÈÓÂ ÌÂÙ¿ ·fi Û‡ÛÙ·ÛË ÙÔ˘ ·ÁÚÔÙÈÎÔ‡ ÁÈ·-ÙÚÔ‡. ∏ ÁÂÓÈÎ‹ Î·Ù¿ÛÙ·ÛË ‹Ù·Ó Î·Ï‹. ™ÙËÓ ·ÎÚfi·-ÛË ÙˆÓ ÓÂ˘ÌfiÓˆÓ ‚Ú¤ıËÎ·Ó ‰È¿¯˘ÙÔÈ Ú˘Á¯¿˙Ô-ÓÙÂ˜, ·¯Â›˜ Î·È ÏÂÙÔ› ˘ÁÚÔ› ÚfiÁ¯ÔÈ ÛÙÔÓ ‰ÂÍÈfiÓÂ‡ÌÔÓ·, ÂÓÒ ·fi Ù· ¿ÏÏ· Û˘ÛÙ‹Ì·Ù· ‰ÂÓ ˘‹Ú-¯·Ó ·ıÔÏÔÁÈÎ¿ ÎÏÈÓÈÎ¿ Â˘Ú‹Ì·Ù·. O ÂÚÁ·ÛÙËÚÈ·-Îfi˜ ¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍÂ Hb 11,6 g/dl, ÏÂ˘Î¿ 12.270/mm3

ÌÂ ÔÏ˘ÌÔÚÊÔ‡ÚËÓ· 65%, ÏÂÌÊÔÎ‡ÙÙ·Ú· 22%,ÌÔÓÔ‡ÚËÓ· 2%, ËˆÛÈÓfiÊÈÏ· 2%, ·ÈÌÔÂÙ¿ÏÈ·541.000/mm3, TKE 27 mm Î·È CRP 12 g/l.

O ·‰Úfi˜ ‚ÈÔ¯ËÌÈÎfi˜, Ë·ÙÈÎfi˜ Î·È Ô ¤ÏÂÁ¯Ô˜ ÓÂ-ÊÚÈÎ‹˜ ÏÂÈÙÔ˘ÚÁ›·˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎÔ›. ™ÙËÓ ·/·ıÒÚ·Î· (∂ÈÎfiÓ· 2) ‰È·ÈÛÙÒıËÎÂ ‡ÎÓˆÛË Î·Ù¿ ÙÔ¤Íˆ ÙÌ‹Ì· ÙÔ˘ ‰ÂÍÈÔ‡ Ì¤ÛÔ˘ ÓÂ˘ÌÔÓÈÎÔ‡ ÏÔ‚Ô‡,ÂÓÙfi˜ ÙË˜ ÔÔ›·˜ ÚÔ‚·ÏÏfiÙ·Ó ÛÙÚÔÁÁ˘Ïfi ÌfiÚÊˆ-Ì· ÌÂ Û·Ê‹ fiÚÈ· ˘ÂÚ‰È·‡Á·ÛË˜. ∏ ÂÈÎfiÓ· ‹Ù·ÓÛ˘Ì‚·Ù‹ ÌÂ Ú·ÁÂ›Û· Î·È ÂÈÌÔÏ˘ÓıÂ›Û· Î‡ÛÙËÓÂ‡ÌÔÓ·. ™‡ÌÊˆÓ· ÌÂ ÙÔÓ ˘fiÏÔÈÔ ¤ÏÂÁ¯Ô, ÙÔU/S ÎÔÈÏ›·˜ Î·È ÓÂÊÚÒÓ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi, Ù· Ù‡Â-Ï· Î·È ÙÔ ‚ÚÔÁ¯ÈÎfi ¤ÎÎÚÈÌ· ‹Ù·Ó ·ÚÓËÙÈÎfi ÁÈ· ‚-Koch, Ù· ·ÓÙÈÂ¯ÈÓÔÎÔÎÎÈÎ¿ ·ÓÙÈÛÒÌ·Ù· ıÂÙÈÎ¿ ÛÂ¤Ó· ÂÚÁ·ÛÙ‹ÚÈÔ, ÂÓÒ ‚Ú¤ıËÎ·Ó ·ÚÓËÙÈÎ¿ ÛÂ ‰‡Ô¿ÏÏ·, Ë CT ıÒÚ·Î· ‹Ù·Ó ¯ˆÚ›˜ ‰ÈÔÁÎˆÌ¤ÓÔ˘˜ ÏÂÌ-Ê·‰¤ÓÂ˜, Ë ‰ÂÚÌÔ·ÓÙ›‰Ú·ÛË Mantoux ¤‰ÂÈÍÂ ‰È‹ıË-ÛË 14 mm (Â›¯Â ÚÔËÁËıÂ› BCG ÚÔ ÙÚÈÂÙ›·˜). ∆Ô·È‰› ·ÓÙÈÌÂÙˆ›ÛÙËÎÂ ÌÂ ·ÓÙÈÂÏÌÈÓıÈÎ‹ Î·È ·ÓÙÈÌÈ-ÎÚÔ‚È·Î‹ ·ÁˆÁ‹ (·Ï‚ÂÓ‰·˙fiÏË Î·È ÎÂÊÔ˘ÚÔÍ›ÌË).

O ˘ÚÂÙfi˜ ·Ú¯ÈÎ¿ ˘Ô¯ÒÚËÛÂ, ÛÙË Û˘Ó¤¯ÂÈ·fiÌˆ˜ ˘ÔÙÚÔ›·ÛÂ, ÌÂ Ù·˘Ùfi¯ÚÔÓË ÂÈ‰Â›ÓˆÛË ÙË˜ÁÂÓÈÎ‹˜ Î·Ù¿ÛÙ·ÛË˜ Î·È ·‡ÍËÛË ÙˆÓ ‰ÂÈÎÙÒÓ ÏÔ›-ÌˆÍË˜. ªÂ Û˘ÓÂ¯È˙fiÌÂÓË ıÂÚ·Â˘ÙÈÎ‹ ·ÁˆÁ‹ (ÎÂ-ÊÔÙ·Í›ÌË, ÎÏÈÓ‰·Ì˘Î›ÓË Î·È ·Ï‚ÂÓ‰·˙fiÏË), ·Ú·ÙË-Ú‹ıËÎÂ Ó¤· ‚ÂÏÙ›ˆÛË Î·È ·ÚÁfiÙÂÚ· ÂÎ Ó¤Ô˘ ˘Ô-ÙÚÔ‹. ™Â Î·ÈÓÔ‡ÚÈ· ·/· ıÒÚ·Î· ‰È·ÈÛÙÒıËÎÂ“˘‰Ú·ÂÚÈÎfi Â›Â‰Ô ÛÙËÓ Î‡ÛÙË ÙÔ˘ ‰ÂÍÈÔ‡ Î¿ÙˆÏÔ‚Ô‡” Î·È ÙÔ ·È‰› ¯ÂÈÚÔ˘ÚÁ‹ıËÎÂ ÌÂ ÛÎÔfi ÙËÓÂÎÙÔÌ‹ ÙË˜ Î‡ÛÙÂˆ˜.

™ÙËÓ Â¤Ì‚·ÛË ‚Ú¤ıËÎÂ “ÊÏÂÁÌ·›ÓÔ˘Û· ·Ú·-ÛÈÙÈÎ‹ Î‡ÛÙË ÛÙËÓ ÎÔÚ˘Ê‹ ÙÔ˘ ‰ÂÍÈÔ‡ Î¿Ùˆ ÏÔ‚Ô‡”Î·È ¤ÁÈÓÂ ÂÎÙÔÌ‹ ÙË˜. ∆Ô ·È‰› Û˘Ó¤¯ÈÛÂ Ó· Â›Ó·ÈÂÌ‡ÚÂÙÔ Î·È ÌÂÙ¿ ÙËÓ Â¤Ì‚·ÛË. ∏ ÈÛÙÔÏÔÁÈÎ‹ ÂÍ¤-Ù·ÛË ÙÔ˘ ÙÂÌ·¯›Ô˘ ÙÔ˘ ÓÂ‡ÌÔÓ· Ô˘ ÂÍ·ÈÚ¤ıËÎÂ¤‰ˆÛÂ Â˘Ú‹Ì·Ù· “Û˘Ì‚·Ù¿ ÌÂ ÎÔÎÎ›ˆÌ· Ê˘Ì·Ù›ˆ-ÛË˜”. ªÂÙ¿ Ù· ÈÛÙÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù·, ¯ÔÚËÁ‹ıËÎÂÛÙË ÌÈÎÚ‹ ·ÛıÂÓ‹ ·ÓÙ›-∆µ ·ÁˆÁ‹ (ÌÂ π¡∏, RIF Î·È

˘Ú·˙ÈÓ·Ì›‰Ë), ÛÙËÓ ÔÔ›· ·ÓÙ·ÔÎÚ›ıËÎÂ ÌÂ ÚÔ-Ô‰Â˘ÙÈÎ‹ ‚ÂÏÙ›ˆÛË ÙË˜ ÁÂÓÈÎ‹˜ ÙË˜ Î·Ù¿ÛÙ·ÛË˜ Î·È·˘ÚÂÍ›·. ∏ ËÁ‹ ÌfiÏ˘ÓÛË˜ ‹Ù·Ó Ì¤ÏÔ˜ ÙË˜ Â˘Ú‡-ÙÂÚË˜ ÔÈÎÔÁ¤ÓÂÈ·˜, ·ÙÂÏÒ˜ ıÂÚ·Â˘Ì¤ÓÔ, ÌÂ ÁÓˆ-ÛÙ‹ ÙË ÓfiÛÔ. ∆Ô ÁÂÁÔÓfi˜ ‰ÂÓ Â›¯Â ÁÓˆÛÙÔÔÈËıÂ›ÛÙÔ ¡ÔÛÔÎÔÌÂ›Ô, ÁÈ· ÏfiÁÔ˘˜ ÎÔÈÓˆÓÈÎÔ‡˜, ·Ú¿ ÙÈ˜ÂÚˆÙ‹ÛÂÈ˜ Î·Ù¿ ÙË Ï‹„Ë ÙÔ˘ ÈÛÙÔÚÈÎÔ‡ ÙÔ˘ ·È‰ÈÔ‡Î·È ÙË˜ ÔÈÎÔÁ¤ÓÂÈ·˜.

∏ ·ÛıÂÓ‹˜ ÂÍ‹ÏıÂ ·fi ÙÔ ¡ÔÛÔÎÔÌÂ›Ô ÌÂ Ô‰Ë-Á›Â˜ ÁÈ· Û˘Ó¤¯ÈÛË ÙË˜ ·ÁˆÁ‹˜ Î·È ÂÚÈÔ‰ÈÎÔ‡˜ Â·-Ó¤ÏÂÁ¯Ô˘˜. ªÂÙ¿ ÙË Û˘ÌÏ‹ÚˆÛË 2 ÌËÓÒÓ ıÂÚ·Â›-·˜, Ë ˘Ú·˙ÈÓ·Ì›‰Ë ‰ÈÂÎfiË. ∞fi ÙÔÓ 5Ô Ì‹Ó· ·ÓÙ›-∆µ ·ÁˆÁ‹˜, ÙÔ ıÂÚ·Â˘ÙÈÎfi Û¯‹Ì· ¿ÏÏ·ÍÂ ÏfiÁˆ ÂÌ-Ê¿ÓÈÛË˜ ÛËÌ·ÓÙÈÎ‹˜ Ë·ÙÔÙÔÍÈÎfiÙËÙ·˜, ÌË ‚ÂÏÙÈÔ‡-ÌÂÓË˜ ÌÂÙ¿ ·fi ÌÂ›ˆÛË ÙË˜ ‰fiÛË˜ ÙË˜ RIF. ∏ ·Áˆ-Á‹ Û˘ÓÂ¯›ÛÙËÎÂ ÌÂ ∂ªµ Î·È π¡∏ ÁÈ· ¿ÏÏÔ˘˜ 14 Ì‹-ÓÂ˜. ªÂÙ¿ ·fi Û˘ÓÔÏÈÎ‹ ·ÁˆÁ‹ 19 ÌËÓÒÓ Î·È Û˘Ó¤-¯ÈÛË ÙË˜ ·Ú·ÎÔÏÔ‡ıËÛË˜ ÁÈ· ¿ÏÏÔ˘˜ 18 Ì‹ÓÂ˜ ‰ÂÓ˘‹Ú¯·Ó ÚÔ‚Ï‹Ì·Ù· ÎÏÈÓÈÎ¿ ‹ ÂÚÁ·ÛÙËÚÈ·Î¿. ™ÙÔ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÙË˜ ıÂÚ·Â›·˜ Î·È ÙË˜ ÌÂÙ¤ÂÈÙ··Ú·ÎÔÏÔ‡ıËÛË˜ ÛÂ Û˘ÓÂÚÁ·Û›· ÌÂ ÓÔÛÔÎÔÌÂ›·ÂÓËÏ›ÎˆÓ, ÂÏ¤Á¯ıËÎÂ ÙÔ ÂÚÈ‚¿ÏÏÔÓ ÙË˜ ·ÛıÂÓÔ‡˜·ÏÏ¿ Î·È ÙÔ Û‡ÓÔÏÔ ÙˆÓ Î·ÙÔ›ÎˆÓ ÙÔ˘ ÌÈÎÚÔ‡ ÓËÛÈ-Ô‡. ∂ÓÙÔ›ÛÙËÎ·Ó Î·È ¿ÏÏÔÈ ¿Û¯ÔÓÙÂ˜ ·fi ∆µ Î·ÈÚÔÁÚ·ÌÌ·Ù›ÛÙËÎÂ Ë ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘˜.

™˘˙‹ÙËÛË∏ Â›ÙˆÛË ÙË˜ Ê˘Ì·Ù›ˆÛË˜ ÁÂÓÈÎ¿, ·ÏÏ¿ Î·È

ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›· ÂÈ‰ÈÎfiÙÂÚ·, ·Ó·Ê¤ÚÂÙ·È fiÙÈ ·˘-Í¿ÓÂÙ·È ‰ÈÂıÓÒ˜ (1,2). ∞˘Ùfi Á›ÓÂÙ·È È‰È·›ÙÂÚ· ·ÓÙÈ-ÏËÙfi ÛÂ ÏËı˘ÛÌÔ‡˜ ÌÂÙ·Ó·ÛÙÒÓ, ·ÙfiÌˆÓ ÌÂ ÎÔÈ-ÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎ¿ ÚÔ‚Ï‹Ì·Ù· Î·È ÛÂ ·ÛıÂÓÂ›˜ ÌÂHIV ÏÔ›ÌˆÍË. £ÂˆÚÂ›Ù·È fiÙÈ Ù· ¿ÙÔÌ· ‚ÚÂÊÈÎ‹˜ ‹ÌÂÙ·-ÂÊË‚ÈÎ‹˜ ËÏÈÎ›·˜ ‰È·ÙÚ¤¯Ô˘Ó ÙÔÓ ˘„ËÏfiÙÂÚÔÎ›Ó‰˘ÓÔ (1). OÈ ‰‡Ô ·ÛıÂÓÂ›˜ ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜‰ÂÓ Û˘ÌÂÚÈÏ·Ì‚¿ÓÔÓÙ·Ó ÛÂ ·˘Ù¤˜ ÙÈ˜ ÔÌ¿‰Â˜. ∏·ıÔÁ¤ÓÂÛË ÙË˜ ÂÍˆÓÂ˘ÌÔÓÈÎ‹˜, Î·È ‰Ë ÎÔÈÏÈ·Î‹˜,

∂ÈÎfiÓ· 2. ¶‡ÎÓˆÛË ‰ÂÍÈÔ‡ Ì¤ÛÔ˘ ÏÔ‚Ô‡ Î·È, ÂÓÙfi˜ ·˘Ù‹˜,ÛÙÚÔÁÁ˘Ïfi ÌfiÚÊˆÌ· ÌÂ Û·Ê‹ fiÚÈ· ˘ÂÚ‰È·‡Á·ÛË˜.

Ê˘Ì·Ù›ˆÛË˜ Ô˘ Â›¯·ÌÂ ÛÙËÓ 1Ë ÂÚ›ÙˆÛË Â›Ó·ÈÔÈÎ›ÏË. ∏ Ê˘Ì·ÙÈÒ‰Ë˜ ÂÚÈÙÔÓ›ÙÈ‰· ÛÙËÓ ·È‰ÈÎ‹ËÏÈÎ›· Â›Ó·È Û¿ÓÈ· Î·È ÌÔÚÂ› Ó· ÂÌÊ·ÓÈÛÙÂ› ‰Â˘-ÙÂÚÔ·ıÒ˜ ÏfiÁˆ ·ÈÌ·ÙÔÁÂÓÔ‡˜ ‰È·ÛÔÚ¿˜ ·fiÂÓÂÚÁ‹ ÓÂ˘ÌÔÓÈÎ‹ ÓfiÛÔ ‹ ÎÂ¯ÚÔÂÈ‰‹ Ê˘Ì·Ù›ˆÛË.∂›ÛË˜, ÌÔÚÂ› Ó· ÂÎ‰ËÏˆıÂ› Â¿Ó ˘¿ÚÍÂÈ Â·ÓÂ-ÓÂÚÁÔÔ›ËÛË ·ÏÈ¿˜ Ê˘Ì·ÙÈÒ‰Ô˘˜ ÂÛÙ›·˜ ÛÙÔ Â-ÚÈÙfiÓ·ÈÔ ‹ ¿ÏÏË ÂÓ‰ÔÎÔÈÏÈ·Î‹ ÂÛÙ›· (1,3-5,10). ∏Ê˘Ì·ÙÈÒ‰Ë˜ ÂÓÙÂÚ›ÙÈ‰·, Ô˘ ÚÔÊ·ÓÒ˜ ÂÍ·ÈÙ›·˜ÙË˜ Ô ÌÈÎÚfi˜ ·ÛıÂÓ‹˜ ÚÔÛ‹ÏıÂ ÛÙÔ ÚÒÙÔ ÓÔÛÔ-ÎÔÌÂ›Ô, Û˘Ó·ÓÙ¿Ù·È Â›ÛË˜ ÛÂ ·ÈÌ·ÙÔÁÂÓ‹ ‰È·ÛÔ-Ú¿ ‹ Î·Ù¿ÔÛË ÊÏÂÁÌÔÓˆ‰ÒÓ ÂÎÎÚ›ÛÂˆÓ ·fi ÙÔ·Ó·ÓÂ˘ÛÙÈÎfi ÛÙË Ê¿ÛË ÙË˜ ÚˆÙÔ·ıÔ‡˜ ÓÂ˘-ÌÔÓÈÎ‹˜ ÓfiÛÔ˘.

∫ÏÈÓÈÎ¿, Ë ÂÓ‰ÔÎÔÈÏÈ·Î‹ Ê˘Ì·Ù›ˆÛË ÌÔÚÂ› Ó·ÌÈÌËıÂ› Î·È ¿ÏÏÂ˜ ·ıÔÏÔÁÈÎ¤˜ Î·Ù·ÛÙ¿ÛÂÈ˜, ÂÓÒÛÂ Î¿ÔÈÂ˜ ·fi ·˘Ù¤˜ ÌÔÚÂ› Ó· Û˘Ó˘¿Ú¯Ô˘Ó Â˘-Ú‹Ì·Ù· ·fi ÙÔ ·Ó·ÓÂ˘ÛÙÈÎfi (5). ∫¿ÔÈ· ·ÎÙÈÓÔ-ÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù·, Â¿Ó ˘¿Ú¯Ô˘Ó, ‚ÔËıÔ‡Ó ÛÙË ‰È¿-ÁÓˆÛË ÙË˜ ÂÓ‰ÔÎÔÈÏÈ·Î‹˜ Ê˘Ì·Ù›ˆÛË˜, fiˆ˜ Ë ¿-¯˘ÓÛË ÙÔ˘ ÙÔÈ¯ÒÌ·ÙÔ˜ ÂÓÙÂÚÈÎÒÓ ÂÏ›ÎˆÓ ÛÙËÓ ÂÈÏÂ-ÔÙ˘ÊÏÈÎ‹ ‚·Ï‚›‰· ‹ Ë ·ÓÂ‡ÚÂÛË ÂÏÎÒÓ ÛÙÔÓ ÂÓÙÂ-ÚÈÎfi ÛˆÏ‹Ó· (6,9). ∏ ·ÓÂ‡ÚÂÛË ·ÛÎ›ÙË ‹ ‰ÈfiÁÎˆ-ÛË˜ ÌÂÛÂÓÙ¤ÚÈˆÓ ÏÂÌÊ·‰¤ÓˆÓ ÛÙÔÓ ˘ÂÚË¯ÔÁÚ·-ÊÈÎfi ¤ÏÂÁ¯Ô Û˘ÓËÁÔÚÂ›, Â›ÛË˜, ˘¤Ú ÙË˜ Û˘ÁÎÂ-ÎÚÈÌ¤ÓË˜ ‰È¿ÁÓˆÛË˜.

O ¤ÏÂÁ¯Ô˜ ÙÔ˘ ·ÛÎÈÙÈÎÔ‡ ˘ÁÚÔ‡ ‚ÔËı¿ÂÈ ‰È·-ÁÓˆÛÙÈÎ¿, ·ÏÏ¿ ¯ÚÂÈ¿˙ÔÓÙ·È Î·È ÈÔ ÂÈ‰ÈÎÔ› ¯ÂÈÚÈ-ÛÌÔ›, fiˆ˜ ÂÓ‰ÔÛÎfiËÛË Î·È Ï‹„Ë ‚ÈÔ„›·˜ ÂÓÙ¤-ÚÔ˘ ‹ ÂÚÂ˘ÓËÙÈÎ‹ Ï··ÚÔÙÔÌ›· (2,5). ∫·Ù¿ ÙË ‰È·-ÁÓˆÛÙÈÎ‹ ·ÍÈÔÏfiÁËÛË ÙˆÓ ‰‡Ô Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ Â-ÚÈÙÒÛÂˆÓ, Ë Û˘Ì‚·Ù‹ Î·È ÌÂ ∆µ Û˘Ó‡·ÚÍË Â˘ÚË-Ì¿ÙˆÓ ·fi ÙÔ ·Ó·ÓÂ˘ÛÙÈÎfi, Ù· ÂÚÁ·ÛÙËÚÈ·Î¿ Â˘-Ú‹Ì·Ù· ÙÔ˘ ÏÂ˘ÚÈÙÈÎÔ‡ ˘ÁÚÔ‡ Î·È Ë ˘¿Ú¯Ô˘Û·ÎÏÈÓÈÎ‹ Î·È ·ÂÈÎÔÓÈÛÙÈÎ‹ ÂÈÎfiÓ· ÙË˜ ÎÔÈÏ›·˜ ÈÛ¯˘-ÚÔÔÈÔ‡Û·Ó ÙËÓ Èı·ÓfiÙËÙ· ‰Â˘ÙÂÚÔ·ıÔ‡˜ ∆µÏÔ›ÌˆÍË˜ ·fi ÚˆÙÔ·ı‹ ÂÛÙ›· ÛÙÔÓ ÓÂ‡ÌÔÓ· ‹ÂÓ‰ÔÎÔÈÏÈ·Î¿.

∏ ‰ÂÚÌÔ·ÓÙ›‰Ú·ÛË Mantoux, Ô˘ Î·È ÛÙËÓ Â·-Ó¿ÏË„Ë ¤‰ÂÈÍÂ ‰È‹ıËÛË ÌfiÓÔ 5 mm, ‰ÂÓ ıÂˆÚ‹ıË-ÎÂ ÌË Û˘Ì‚·Ù‹ ÌÂ ÙË ‰È¿ÁÓˆÛË ÙË˜ ∆µ ÏÔ›ÌˆÍË˜.∂›Ó·È ÁÓˆÛÙfi fiÙÈ ÙÔ 10% ÙˆÓ ·È‰ÈÒÓ ÌÂ ·Ô‰Â-‰ÂÈÁÌ¤ÓË (ÌÂ Î·ÏÏÈ¤ÚÁÂÈ·) ∆µ ÏÔ›ÌˆÍË Î·È ÌË ·ÓÔ-ÛÔÎ·ÙÂÛÙ·ÏÌ¤Ó· ‰ÂÓ ·ÓÙÈ‰Ú¿ ¿ÌÂÛ· ÛÙË ‰ÂÚÌÔ·-ÓÙ›‰Ú·ÛË Mantoux (5TU ·fi PPD). ¶·Ú¿ÁÔÓÙÂ˜fiˆ˜ Ë ÓÂ·Ú‹ ËÏÈÎ›· ÙÔ˘ ÂÏÂÁ¯fiÌÂÓÔ˘ ·ÙfiÌÔ˘, ËÎ·Î‹ ıÚ¤„Ë, ¿ÏÏÂ˜ ÈÔÁÂÓÂ›˜ ÏÔÈÌÒÍÂÈ˜ (ÂÈ‰ÈÎ¿ ÈÏ·-Ú¿, ·ÓÂÌÔ‚ÏÔÁÈ¿ Î·È ÁÚ›Ë) Î·È Ë ‚·ÚÈ¿ ÂÎÙÂÙ·Ì¤ÓËÊ˘Ì·ÙÈÒ‰Ë˜ ÏÔ›ÌˆÍË, ÌÔÚÔ‡Ó Ó· ÌÂÈÒÛÔ˘Ó ÙËÓ·ÓÙÈ‰Ú·ÛÙÈÎfiÙËÙ· ÛÙÔ ‰ÂÚÌ·ÙÈÎfi test ÌÂ Ê˘Ì·Ù›ÓË.£ÂˆÚ‹ıËÎÂ fiÙÈ Ô ÌÈÎÚfi˜ ·ÛıÂÓ‹˜ ÂÓ¤ÈÙÂ ÛÙËÓÙÂÏÂ˘Ù·›· Î·ÙËÁÔÚ›· ·˘ÙÒÓ ÙˆÓ ·È‰ÈÒÓ. ŒÙÛÈ,Â·Ó·¯ÔÚËÁ‹ıËÎÂ Ù·¯‡Ù·Ù· ·ÓÙ›-∆µ ·ÁˆÁ‹ ÌÂ

ÙÚ›· Ê¿ÚÌ·Î· (π¡∏, RIF, ˘Ú·˙ÈÓ·Ì›‰Ë), ÂÓÒ Ù·˘-Ùfi¯ÚÔÓ· Û˘ÓÂ¯È˙fiÙ·Ó Ô ÂÚ·ÈÙ¤Úˆ ¤ÏÂÁ¯Ô˜(3,6,7,9,10).

∏ 2Ë ÂÚ›ÙˆÛË ·ÊÔÚÔ‡ÛÂ ÛÂ ÎÔÚ›ÙÛÈ ÌÂ ÓÂ˘-ÌÔÓÈÎ‹ ∆µ. ¶·Ú’ fiÙÈ ÙÔ ·È‰› ‹Ù·Ó 10 ÂÙÒÓ, ÙÔ ÂÚÈ-ÛÙ·ÙÈÎfi ·ÊÔÚÔ‡ÛÂ ÛÂ Ê˘Ì·Ù›ˆÛË Ù‡Ô˘ ÂÓËÏ›ÎÔ˘.∆Ô ÈÛÙÔÚÈÎfi, Ë ·ÎÙÈÓÔÏÔÁÈÎ‹ ÂÈÎfiÓ·, Ô ÙfiÔ˜ Î·È ÔÈÛ˘Óı‹ÎÂ˜ ‰È·‚›ˆÛË˜ Û˘ÓËÁÔÚÔ‡Û·Ó ÁÈ· ‡·ÚÍËÂ¯ÈÓfiÎÔÎÎÔ˘ Î‡ÛÙÂˆ˜ ÛÙÔÓ ÓÂ‡ÌÔÓ·. ∂ÈÏ¤ÔÓ, ÔÂÌ‚ÔÏÈ·ÛÌfi˜ ÌÂ µCG Ô˘ Â›¯Â ÚÔËÁËıÂ› ÌÔÚÔ‡-ÛÂ Ó· ‰ÈÎ·ÈÔÏÔÁ‹ÛÂÈ ÙËÓ ‡·ÚÍË ıÂÙÈÎ‹˜ MantouxÌÂ ‰È¿ÌÂÙÚÔ 1,4 cm (10). ∆¤ÏÔ˜, ÔÈ ÁÔÓÂ›˜ ·¤ÎÚ˘-„·Ó fiÙÈ ˘‹Ú¯·Ó ÛÙËÓ Â˘Ú‡ÙÂÚË ÔÈÎÔÁ¤ÓÂÈ¿ ÙÔ˘˜¿Û¯ÔÓÙÂ˜ ·fi Ê˘Ì·Ù›ˆÛË (ıÂ›Ô˜, ÁÈ·ÁÈ¿) - Î·È Ì¿-ÏÈÛÙ· ·ÙÂÏÒ˜ ıÂÚ·Â˘Ì¤ÓÔÈ. ¢ÂÓ ‹ıÂÏ·Ó, fiˆ˜ Â›-·Ó, Ó· Á›ÓÂÈ ÁÓˆÛÙfi ÛÙË ÌÈÎÚ‹ Â·Ú¯È·Î‹ ÎÔÈÓˆÓ›·Ô˘ ˙Ô‡Û·Ó. ŸÏ· Ù· ·Ú·¿Óˆ Û˘ÓÂÙ¤ÏÂÛ·Ó ÛÙËÓÎ·ı˘ÛÙ¤ÚËÛË ÙË˜ ‰È¿ÁÓˆÛË˜. O ¤ÏÂÁ¯Ô˜ ·ÓÙÈÂ¯È-ÓÔÎÔÎÎÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ‰ÂÓ ‚Ô‹ıËÛÂ, Î·ıÒ˜ ÌÂ-Ù¿ ÙËÓ ·ÓÂ‡ÚÂÛË ıÂÙÈÎÒÓ ·Ú¯ÈÎ¿ Î·È ÙËÓ Ù·˘Ùfi¯ÚÔ-ÓË ·ÚÓËÙÈÎ‹ ·¿ÓÙËÛË ·fi ¿ÏÏÔ ÂÚÁ·ÛÙ‹ÚÈÔ,ÂÛÙ¿ÏË ÛÂ 3Ô ÂÚÁ·ÛÙ‹ÚÈÔ ·›Ì· ÁÈ· Â·Ó¿ÏË„Ë ÙË˜ÂÍ¤Ù·ÛË˜, Ë ÔÔ›· ‹Ù·Ó ·ÚÓËÙÈÎ‹. O ¤ÏÂÁ¯Ô˜ ÙˆÓ·ÓÙÈÂ¯ÈÓÔÎÔÎÎÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ Î·È ÛÙ· ÙÚ›· ÂÚÁ·-ÛÙ‹ÚÈ· ¤ÁÈÓÂ ÌÂ ÙË Ì¤ıÔ‰Ô ÙË˜ ¤ÌÌÂÛË˜ ·ÈÌÔÛ˘-ÁÎfiÏÏËÛË˜, Ë ÔÔ›· ¤¯ÂÈ Èı·ÓfiÙËÙÂ˜ „Â˘‰Ò˜ ıÂÙÈ-ÎÔ‡ ·ÔÙÂÏ¤ÛÌ·ÙÔ˜. ∆ÂÏÈÎ¿, Ë ÂÍ¤ÏÈÍË ÙÔ˘ ·È‰ÈÔ‡Ô‰‹ÁËÛÂ ÛÂ ¯ÂÈÚÔ˘ÚÁÈÎ‹ Â¤Ì‚·ÛË Î·È ÂÍ·›ÚÂÛËÙÔ˘ ¿Û¯ÔÓÙÔ˜ ÓÂ˘ÌÔÓÈÎÔ‡ ÈÛÙÔ‡. ∏ ÈÛÙÔÏÔÁÈÎ‹ÂÍ¤Ù·ÛË ¤‰ÂÈÍÂ ÎÔÎÎ›ˆÌ· Ê˘Ì·Ù›ˆÛË˜. ∆Ô ·È‰›·ÓÙ·ÔÎÚ›ıËÎÂ ÛÙËÓ ·ÁˆÁ‹ Î·È ÛÙËÓ ÙÂÏÂ˘Ù·›·Â·ÓÂÍ¤Ù·Û‹ ÙÔ˘, 18 Ì‹ÓÂ˜ ÌÂÙ¿ ÙÔ Ù¤ÏÔ˜ ÙË˜ Ê·Ú-Ì·ÎÂ˘ÙÈÎ‹˜ ·ÁˆÁ‹˜, ‹Ù·Ó ÂÏÂ‡ıÂÚÔ ÓfiÛÔ˘ Î·È ÛÂÎ·Ï‹ Î·Ù¿ÛÙ·ÛË.

O ÂÓÙÔÈÛÌfi˜ ÙË˜ ËÁ‹˜ ÌfiÏ˘ÓÛË˜ ÌÂ ÙÔ Ì˘ÎÔ-‚·ÎÙËÚ›‰ÈÔ ‹Ù·Ó Ë ·ÈÙ›· Ó· ÂÏÂÁ¯ıÔ‡Ó ÔÈ Î¿ÙÔÈÎÔÈÙÔ˘ ÓËÛÈÔ‡ Î·È Ó· ·ÓÙÈÌÂÙˆÈÛÙÔ‡Ó ıÂÚ·Â˘ÙÈÎ¿ ÔÈ¿Û¯ÔÓÙÂ˜ ·fi ∆µ.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Starke JR, Munoz G. Tuberculosis. In: Nelson Textbook of

Pediatrics. 16th ed. Philadelphia: WB Saunders Company;2000. p. 885-897.

2. Starke JR, Jacobs RF, Jereb J. Resurgence of tuberculosisin children. J Pediatr 1992;120:839-855.

3. Marshall JB. Tuberculosis of the gastrointestinal tract andperitoneum. Am J Gastroenterol 1993;88:989-999.

4. Lingenfelser T, Zak J, Marks IN, Steyn E, Halkett J, Price SK.Abdominal tuberculosis: still a potentially lethal disease. AmJ Gastroenterol 1993;88:744-750.

5. Paul CR, Rabah R, Rao RB. Unusual presentation of intra-abdominal tuberculosis. Clin Pediatr 1996;35:597-599.

6. Singh MM, Bhargava AN, Jain KP. Tuberculous peritonitis.An evaluation of pathogenetic mechanisms, diagnosticprocedures and therapeutic measures. N Engl J Med


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1969;281:1091-1094. 7. ¢ÂÏËÁÈÒÚÁË˜ ¢, °ÎÈÔ‡Ú‰· ∞. º˘Ì·ÙÈÒ‰Ë˜ ÂÚÈÙÔÓ›ÙÈ˜ ÛÂ

·ÁfiÚÈ ËÏÈÎ›·˜ 10 ÂÙÒÓ. ¢ÂÏÙ ∞’ ¶·È‰ ∫ÏÈÓ ¶·ÓÂ ∞ıËÓÒÓ1981;28:246-252.

8. ºÔ˘Û¤ÎË-Ã·Ù˙ËÁÂˆÚÁ›Ô˘ ∞, £ÂÔ‰ˆÚ›‰Ô˘-¶··ÁÚËÁÔÚ›Ô˘ª, ª·ÚÎfiÛÔÁÏÔ˘ ¢, §È¿Ë-∞‰·Ì›‰Ô˘ ∂, ¶··ÓÈÎÔÏ¿Ô˘ ∞,∑Ô˘ÌÔ˘Ï¿ÎË˜ ¢. º˘Ì·ÙÈÒ‰Ë˜ ÂÓÙÂÚ›ÙÈ˜ ÛÂ ·È‰› ÌÂ ¯ÚfiÓÈ·ÎÔÎÎÈˆÌ·ÙÒ‰Ë ÓfiÛÔ. ¶·È‰È·ÙÚÈÎ‹ 1994;57:617-621.

9. Leder RA, Low VH. Tuberculosis of the abdomen. RadiolClin North Am 1995;33:691-705.

10. Hussey G, Chisholm T, Kibel M. Miliary tuberculosis inchildren: a review of 94 cases. Pediatr Infect Dis J1991;10:832-836.

11. Starke JR, Correa AG. Management of mycobacterialinfection and disease in children. Pediatr Infect Dis J1995;14:455-469.

12. O’Brien RJ, Long MW, Cross FS, Lyle MA, Snider DE Jr.Hepatotoxicity from isoniazid and rifampin among childrentreated for tuberculosis. Pediatrics 1983;72:491-499.

13. Golditz GA, Brewer TF, Berkey CS, Wilson ME, Burdick E,Fineberg HV et al. Efficacy of BCG vaccine in the preventionof tuberculosis. Meta-analysis of the published literature.JAMA 1994;271:698-702.


¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: §¿ÛÎ·ÚË Ã·Ú¿ Õıˆ 5, ªÂÏ›ÛÛÈ·

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¡∂∞∫ÏÈÓÈÎ‹ ÂÈÎfiÓ· Î·È ¤Î‚·ÛË ÙÔ˘ ™Ô‚·ÚÔ‡ OÍ¤Ô˜ ∞Ó·ÓÂ˘ÛÙÈÎÔ‡ ™˘Ó‰ÚfiÌÔ˘ (™O∞™ ‹ SARS)ÛÙ· ·È‰È¿ ∫ÔÚ›Ó· ¶ÚÔ‡ÓÙ˙Ô˘ - ∫·ÛÛÈÔ‡, ¶·È‰›·ÙÚÔ˜

¶ÚfiÎÂÈÙ·È ÁÈ· Ì›· ·Ó·ÊÔÚ¿ ÁÈ·ÙÚÒÓ ·fi ÙÔ Hong Kong Ô˘ ‰ËÌÔÛÈÂ‡ÙËÎÂ ÛÙÔ ‰È·‰›ÎÙ˘ÔÛÙÔ Lancet ÛÙÈ˜ 29 ∞ÚÈÏ›Ô˘ 2003 Î·È ·ÊÔÚ¿ ÛÙËÓ ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· ÙˆÓ ·È‰ÈÒÓ ˆ˜ ·ÛıÂÓÒÓ ÌÂSARS, ÛÙË ıÂÚ·Â›· Î·È ÙËÓ ¤Î‚·ÛË ÙË˜ ÓfiÛÔ˘ ÛÂ 10 ·È‰È¿ Ô˘ ÓÔÛËÏÂ‡ÙËÎ·Ó ÛÙ· ÓÔÛÔÎÔ-ÌÂ›· Prince of Wales Î·È Princess Margaret ÙÔ˘ Hong Kong ·fi 13 ¤ˆ˜ 28 ª·ÚÙ›Ô˘ 2003. ¢¤-Î· ·È‰È¿ ËÏÈÎ›·˜ ·fi 1,5 ¤ˆ˜ 16,5 ÂÙÒÓ ÂÈÛ‹¯ıËÛ·Ó ÌÂ ˘Ô„›· SARS.

¶·Ú·ÙËÚ‹ıËÎ·Ó ‰‡Ô ÍÂ¯ˆÚÈÛÙ¤˜ ÎÏÈÓÈÎ¤˜ ÂÈÎfiÓÂ˜ ·Ó¿ÏÔÁ· ÌÂ ÙËÓ ËÏÈÎ›·. OÈ ¤ÊË‚ÔÈ ÂÌ-Ê¿ÓÈÛ·Ó ˘ÚÂÙfi, ‚‹¯·, Î·ÎÔ˘¯›·, Ì˘·ÏÁ›Â˜, ÊÚ›ÎÈ· Î·È Ú›ÁÔ˜ (Û·Ó ·˘Ù¿ ÙˆÓ ÂÓËÏ›ÎˆÓ), ÂÓÒ Ù·ÌÈÎÚfiÙÂÚ· ·È‰È¿ ÂÌÊ¿ÓÈÛ·Ó Î˘Ú›ˆ˜ ‚‹¯·, ÚÈÓÈÎ‹ Î·Ù·ÚÚÔ‹, ˘ÚÂÙfi Î·È ‚‹¯·.

ŸÏ· Ù· ·È‰È¿ ÏËÚÔ‡Û·Ó Ù· ÎÚÈÙ‹ÚÈ· ÙÔ˘ WHO ÁÈ· ÙË ‰È¿ÁÓˆÛË ÙÔ˘ SARS Î·È fiÏ· Â›¯·Ó¤ÚıÂÈ ÛÂ Â·Ê‹ ÌÂ ¿Û¯ÔÓÙÂ˜ ÂÓ‹ÏÈÎÂ˜.

∂ÓÓ¤· ·fi Ù· 10 ·È‰È¿ Â›¯·Ó ·ıÔÏÔÁÈÎ‹ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ ÛÙËÓ ÂÈÛ·ÁˆÁ‹. ∆Ô Î‡-ÚÈÔ Â‡ÚËÌ· ÛÙÈ˜ ·ÎÙÈÓÔÁÚ·Ê›Â˜ ıÒÚ·ÎÔ˜ ‹Ù·Ó ‰È¿Û·ÚÙÂ˜ ıÔÏÂÚfiÙËÙÂ˜, ÂÓÒ 4 ·fi Ù· 5 ÌÈ-ÎÚfiÙÂÚ· ·È‰È¿ Â›¯·Ó ÙÌËÌ·ÙÈÎ‹ ‡ÎÓˆÛË Î·È 2 ÌÂÁ·Ï‡ÙÂÚ· (¤ÊË‚ÔÈ) Â›¯·Ó ·ÌÊÔÙÂÚfiÏÂ˘ÚËıÔÏÂÚfiÙËÙ· ÙˆÓ Î¿Ùˆ ÏÔ‚ÒÓ. ™Â ¤Ó·Ó ·ÛıÂÓ‹, Ë ‡ÎÓˆÛË ‰È·ÁÓÒÛÙËÎÂ ÌfiÓÔ ÌÂ ·ÍÔÓÈÎ‹ ÙÔ-ÌÔÁÚ·Ê›· ˘„ËÏ‹˜ Â˘ÎÚ›ÓÂÈ·˜.

§ÂÌÊÔÂÓ›· (0,3-3,0 x 10 G/L) Â›¯·Ó fiÏÔÈ ÔÈ ·ÛıÂÓÂ›˜, Î˘Ú›ˆ˜ ÌÂÙ·Í‡ ÙË˜ 3Ë˜ Î·È 7Ë˜ ËÌ¤-Ú·˜ ÙË˜ ÓfiÛÔ˘. ™Â Î·Ó¤Ó·Ó ·ÛıÂÓ‹ ‰ÂÓ ‚Ú¤ıËÎ·Ó ¿ÏÏ· ·ıÔÁfiÓ·, ÈÔ› ‹ Ì‡ÎËÙÂ˜. ÕÏÏ· ÂÚÁ·-ÛÙËÚÈ·Î¿ Â˘Ú‹Ì·Ù· ÂÚÈÂÏ¿Ì‚·Ó·Ó ÌÂÙÚ›ˆ˜ ¯·ÌËÏ¿ ·ÈÌÔÂÙ¿ÏÈ·, ˘„ËÏ‹ LDH Î·È ˘„ËÏ‹ ALT(alanine aminotransferase). O ÎÔÚˆÓÔ˚fi˜ ·ÔÌÔÓÒıËÎÂ ÛÂ Î·ÏÏÈ¤ÚÁÂÈ· ÛÂ 2 ·ÛıÂÓÂ›˜ Î·È ËPCR Î·Ù¤‰ÂÈÍÂ ÙÔÓ Èfi ÛÂ 4 ·fi Ù· 6 ·È‰È¿ Ô˘ ÂÏ¤Á¯ıËÎ·Ó.

™Â fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓÂ›˜ ¯ÔÚËÁ‹ıËÎ·Ó ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹, ·ÓÙÈ-ÈÈÎ¿ Ê¿ÚÌ·Î· Î·È ·ÓÙÈ‚ÈÔÙÈ-Î¿. ™˘ÁÎÂÎÚÈÌ¤Ó·, ¯ÔÚËÁ‹ıËÎ·Ó ÂÓ‰ÔÊÏ¤‚È· ÎÂÊÔ˘ÚÔÍ›ÌË, ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜ ÎÏ·ÚÈıÚÔÌ˘Î›-ÓË, ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜ ÚÈÌ·‚ÈÚ›ÓË ÛÂ ‰fiÛË 40 mg/kg/ËÌ¤Ú· ‰È·ÈÚÂÌ¤ÓË ÛÂ 2 ‹ 3 ‰fiÛÂÈ˜. ∂¿ÓÔ ˘ÚÂÙfi˜ Â¤ÌÂÓÂ ÌÂÙ¿ 48 ÒÚÂ˜, ÛÙËÓ ·ÁˆÁ‹ Û˘ÌÂÚÈÏ·Ì‚·ÓfiÙ·Ó ÚÂ‰ÓÈ˙ÔÏfiÓË ·fi ÙÔ˘ÛÙfiÌ·ÙÔ˜. ∂Ó‰ÔÊÏ¤‚È· ÚÈÌ·‚ÈÚ›ÓË, ÛÂ ‰fiÛË 20 mg/kg/ËÌ¤Ú·, ¯ÔÚËÁ‹ıËÎÂ ÛÂ ·ÛıÂÓÂ›˜ ÌÂÌ¤ÙÚÈ· Û˘ÌÙÒÌ·Ù· Î·È ÔÏ‡ ˘„ËÏfi ˘ÚÂÙfi Ì·˙› ÌÂ ˘‰ÚÔÎÔÚÙÈ˙fiÓË 2 mg/kg/6 ÒÚÂ˜ ·Ì¤Ûˆ˜ÌÂÙ¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘˜.

™Â ·ÛıÂÓÂ›˜ ÌÂ Â›ÌÔÓÔ ˘ÚÂÙfi Î·È ÚÔÔ‰Â˘ÙÈÎ‹ ÂÈ‰Â›ÓˆÛË, ÎÏÈÓÈÎ‹ ‹ ·ÎÙÈÓÔÏÔÁÈÎ‹, ¯Ô-ÚËÁ‹ıËÎÂ ıÂÚ·Â›· ÌÂ ÌÂı˘ÏÚÂ‰ÓÈ˙ÔÏfiÓË (10-20 mg/kg) ÛÂ ÒÛÂÈ˜. ∏ ıÂÚ·Â›· ·˘Ù‹ ¯ÔÚË-Á‹ıËÎÂ ÛÂ 1 ÌÈÎÚfi ·È‰› Î·È 4 ÂÊ‹‚Ô˘˜. ™Â ‰‡Ô ËÌ¤ÚÂ˜, Ô ˘ÚÂÙfi˜ Â›¯Â ˘Ô¯ˆÚ‹ÛÂÈ ÛÂ fiÏÔ˘˜ÙÔ˘˜ ·ÛıÂÓÂ›˜, ÂÎÙfi˜ ·fi ¤Ó·Ó.

ªfiÓÔ 3 ·ÛıÂÓÂ›˜ ¯ÚÂÈ¿ÛÙËÎ·Ó ·Ó·ÓÂ˘ÛÙÈÎ‹ ˘ÔÛÙ‹ÚÈÍË ÌÂ ÔÍ˘ÁfiÓÔ (maxim 50%), Ì¿-ÛÎ·, BiPAP ‹ IPPV.

ª¤¯ÚÈ ·˘Ù‹ ÙËÓ ·Ó·ÊÔÚ¿ Î·Ó¤Ó· ·È‰› ‰ÂÓ Î·Ù¤ÏËÍÂ. OÈ Û˘ÁÁÚ·ÊÂ›˜ Û˘ÌÂÚ·›ÓÔ˘Ó, Û‡Ì-ÊˆÓ· ÌÂ Ù· Ì¤¯ÚÈ ÙÒÚ· ÛÙÔÈ¯Â›·, fiÙÈ Ù· ·È‰È¿ ·Ó·Ù‡ÛÛÔ˘Ó Ì›· ËÈfiÙÂÚË ÌÔÚÊ‹ ÙË˜ ÓfiÛÔ˘Î·È ÏÈÁfiÙÂÚÔ ÂÈıÂÙÈÎ‹ ÎÏÈÓÈÎ‹ ÔÚÂ›· ÛÂ Û¯¤ÛË ÌÂ ÙÔ˘˜ ÂÊ‹‚Ô˘˜ Î·È ÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜.

Lancet 2003;361:1701-1703

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∞ÏÏÂÚÁÈÎ‹ Â˘·ÈÛıËÙÔÔ›ËÛË: Ó¤Â˜ Èı·Ó¤˜ ËÁ¤˜ ¡›ÎÔ˜ ¶··‰fiÔ˘ÏÔ˜, ∞ÏÏÂÚÁÈÔÏfiÁÔ˜

∏ ÙÚÔÊÈÎ‹ ·ÏÏÂÚÁ›· ·ÔÙÂÏÂ› Û˘¯Ófi Úfi‚ÏËÌ· ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜, ÂÓÒ ÔÏÏ¤˜ ÊÔÚ¤˜Û¯ÂÙ›˙ÂÙ·È ÌÂ ¤ÓÙÔÓÂ˜ ·Ó·Ê˘Ï·ÎÙÈÎ¤˜ ·ÓÙÈ‰Ú¿ÛÂÈ˜. OÈ Û˘Óı‹ÎÂ˜ ¤ÎıÂÛË˜ ÛÙÈ˜ ÙÚÔÊ¤˜ Ô˘Ô‰ËÁÔ‡Ó ÛÂ ·ÏÏÂÚÁÈÎ‹ Â˘·ÈÛıËÙÔÔ›ËÛË Â›Ó·È ·ÎfiÌË ·ÙÂÏÒ˜ Î·Ù·ÓÔËÙ¤˜.

™Â Ì›· ÚfiÛÊ·ÙË ÌÂÏ¤ÙË ‰ËÌÔÛÈÂ˘Ì¤ÓË ÛÙÔ New England Journal of Medicine, Ë ÔÌ¿‰· ÙÔ˘Gideon Lack ÂÓÙfiÈÛÂ Ì¤Û· ·fi Ì›· ÔÌ¿‰· 14.000 ·È‰ÈÒÓ, 50 ÂÚ›Ô˘ ·È‰È¿ ÌÂ ·ÏÏÂÚÁ›· ÛÙÔÊÈÛÙ›ÎÈ, Ë ÔÔ›· ˆ˜ ÁÓˆÛÙfiÓ Â›Ó·È Û˘¯Ó‹ ÛÙÈ˜ ·ÁÁÏÔÛ·ÍÔÓÈÎ¤˜ ¯ÒÚÂ˜ Î·È ÌÔÚÂ› Ó· ·Ô‚Â› ÌÔÈ-Ú·›·. ∆· ·È‰È¿ ·˘Ù¿ ÛÙËÓ ÏÂÈÔÓfiÙËÙ¿ ÙÔ˘˜ ¤·Û¯·Ó Î·È ·fi ·ÙÔÈÎ‹ ‰ÂÚÌ·Ù›ÙÈ‰·.

™˘ÁÎÚ›ÓÔÓÙ·˜ Ù· ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ¤ÎıÂÛË˜ ÙˆÓ ·È‰ÈÒÓ ·˘ÙÒÓ ÌÂ ·È‰È¿ ÌÂ ·ÙÔÈÎ‹ ‰ÂÚ-Ì·Ù›ÙÈ‰· ¯ˆÚ›˜ ·ÏÏÂÚÁ›· ÛÙÔ ÊÈÛÙ›ÎÈ Î·È Ê˘ÛÈÔÏÔÁÈÎ¿ ·È‰È¿, ‰È·›ÛÙˆÛÂ fiÙÈ Ë ‰È·ÙÚÔÊ‹ ÙË˜ÌËÙ¤Ú·˜ ‰ÂÓ ·ÔÙÂÏÂ› ÂÈ‚·Ú˘ÓÙÈÎfi ·Ú¿ÁÔÓÙ·, fiˆ˜ ÂıÂˆÚÂ›ÙÔ ·Ï·ÈfiÙÂÚ·. ∞ÓÙ›ıÂÙ·, fiÏ·Û¯Â‰fiÓ Ù· ·È‰È¿ ÌÂ ·ÏÏÂÚÁ›· ÛÙÔ ÊÈÛÙ›ÎÈ Â›¯·Ó ÂÎÙÂıÂ› ÛÂ ‚ÚÂÊÈÎ‹ ËÏÈÎ›· ÛÂ Î·ÏÏ˘ÓÙÈÎ¤˜ ÎÚ¤-ÌÂ˜ Ô˘ ÂÚÈÂ›¯·Ó ·Ú·¯È‰¤Ï·ÈÔ (ÊÈÛÙÈÎ¤Ï·ÈÔ). £ÂÙÈÎ‹, Â›ÛË˜, Û˘Û¯¤ÙÈÛË ˘‹Ú¯Â Î·È ÌÂ ÙË¯Ú‹ÛË Á¿Ï·ÎÙÔ˜ ÛfiÁÈ·˜ Ù· 2 ÚÒÙ· ¯ÚfiÓÈ· ÙË˜ ˙ˆ‹˜.

∆Ô Û˘Ì¤Ú·ÛÌ· Â›Ó·È fiÙÈ Ë ¤ÎıÂÛË ÛÂ ·ÏÏÂÚÁÈÔÁÔÓÈÎ¤˜ ÚˆÙÂ˝ÓÂ˜ Ì¤Ûˆ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ ÛÂ·È‰È¿ ÌÂ ÊÏÂÁÌ·›ÓÔÓ ‰¤ÚÌ·, ÌÔÚÂ› Ó· Ô‰ËÁ‹ÛÂÈ ÛÂ ·ÏÏÂÚÁÈÎ‹ Â˘·ÈÛıËÙÔÔ›ËÛË Î·È ÙÚÔÊÈ-Î‹ ·ÏÏÂÚÁ›·. ∂›ÛË˜, ÛÙËÓ ·ÏÏÂÚÁ›· ·˘Ù‹ ÌÔÚÂ› ›Ûˆ˜ Ó· Ô‰ËÁËıÂ› Î·ÓÂ›˜ Ì¤Ûˆ ‰È·ÛÙ·˘-ÚÔ‡ÌÂÓË˜ ·ÓÙ›‰Ú·ÛË˜ ÌÂ ÙË ÛfiÁÈ·, ·Ó Î·È ·˘Ùfi ¯ÚÂÈ¿˙ÂÙ·È ÂÚ·ÈÙ¤Úˆ ‰ÈÂÚÂ‡ÓËÛË. ∏ ¯Ú‹ÛËÎ·ÏÏ˘ÓÙÈÎÒÓ ÛÎÂ˘·ÛÌ¿ÙˆÓ ÛÙËÓ ·ÙÔÈÎ‹ ‰ÂÚÌ·Ù›ÙÈ‰· Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÌÂ Ï‹ÚË Î·È ÏÂÙÔ-ÌÂÚ‹ Î·Ù·ÓfiËÛË ÙË˜ Û‡ÛÙ·Û‹˜ ÙÔ˘˜, ÂÓÒ ÛÙÈ˜ ÌÈÎÚ¤˜ ËÏÈÎ›Â˜ Î·Ïfi ı· ‹Ù·Ó Ó· ·ÔÊÂ‡ÁÂÙ·ÈË ¯Ú‹ÛË ÛÎÂ˘·ÛÌ¿ÙˆÓ Ô˘ ÂÚÈ¤¯Ô˘Ó ÂÎ¯˘Ï›ÛÌ·Ù· Èı·Ó¿ ·ÏÏÂÚÁÈÔÁfiÓˆÓ ÚˆÙÂ˚ÓÒÓ.

New Engl J Med 2003;348:977-985

∏ ·¯˘Û·ÚÎ›· ÙË˜ ÌËÙ¤Ú·˜ ·˘Í¿ÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ÁÈ· Û˘ÁÁÂÓÂ›˜ ·ÓˆÌ·Ï›Â˜ ÛÙÔ ¤Ì‚Ú˘Ô∫ÔÚ›Ó· ¶ÚÔ‡ÓÙ˙Ô˘ - ∫·ÛÛÈÔ‡, ¶·È‰›·ÙÚÔ˜

OÈ Watkins ML Î·È Û˘Ó ‰ËÌÔÛÈÂ‡Ô˘Ó ÛÙÔ Pediatrics ÙÔ˘ ª·˝Ô˘ Ì›· ÌÂÏ¤ÙË ÙË˜ Û˘Û¯¤ÙÈÛË˜ÙË˜ ·¯˘Û·ÚÎ›·˜ ÙË˜ ÌËÙ¤Ú·˜ Î·È ÙˆÓ Û˘ÁÁÂÓÒÓ ·ÓˆÌ·ÏÈÒÓ ÛÙÔ ¤Ì‚Ú˘Ô.

À¿Ú¯Ô˘Ó ÚÔËÁÔ‡ÌÂÓÂ˜ ÌÂÏ¤ÙÂ˜ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔ ı¤Ì· Î·È Î˘Ú›ˆ˜ ÛÙË Û˘Û¯¤ÙÈÛËÙË˜ ·¯˘Û·ÚÎ›·˜ ÙË˜ ÌËÙ¤Ú·˜ ÌÂ ·ÓˆÌ·Ï›Â˜ ÙÔ˘ ÓˆÙÈ·›Ô˘ ÛˆÏ‹Ó·.

™Â ·˘Ù‹ ÙË ÌÂÏ¤ÙË, Ô ‰Â›ÎÙË˜ ÛˆÌ·ÙÈÎ‹˜ Ì¿˙·˜ (µªπ) ÚÈÓ ÙËÓ ÂÁÎ˘ÌÔÛ‡ÓË ÂÏ‹ÊıË ˘’fi„ÈÓ ÛÂ ÌËÙ¤ÚÂ˜ ÓÂÔÁÓÒÓ ÌÂ Î·È ¯ˆÚ›˜ Û˘ÁÁÂÓÂ›˜ ·ÓˆÌ·Ï›Â˜ Ô˘ ÁÂÓÓ‹ıËÎ·Ó ·fi ÙÔÓ π·ÓÔ˘-¿ÚÈÔ 1993 ¤ˆ˜ ÙÔÓ ∞‡ÁÔ˘ÛÙÔ 1997.

OÈ ÌËÙ¤ÚÂ˜ ¯ˆÚ›ÛÙËÎ·Ó ÛÂ 3 ÔÌ¿‰Â˜: ·) ÌÂ ÛÔ‚·Ú‹ ·¯˘Û·ÚÎ›· (µªπ >35), ‚) ÌÂ Ì¤ÙÚÈ··¯˘Û·ÚÎ›· (µªπ=25-29,9) Î·È Á) ÌÂ Î·ÓÔÓÈÎfi ‚¿ÚÔ˜ (µªπ=18,5-24,9).

™˘ÁÎÚÈÙÈÎ¿, Ù· ÓÂÔÁ¤ÓÓËÙ· ÙˆÓ ·¯‡Û·ÚÎˆÓ ÌËÙ¤ÚˆÓ Â›¯·Ó 3,5 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚË Èı·-ÓfiÙËÙ· Ó· ¤¯Ô˘Ó ·ÓˆÌ·Ï›Â˜ ÓˆÙÈ·›Ô˘ ÛˆÏ‹Ó·, 3,3 ÊÔÚ¤˜ Ó· ¤¯Ô˘Ó ÔÌÊ·ÏÔÎ‹ÏË, 2 ÊÔÚ¤˜ Ó·¤¯Ô˘Ó ·ÓˆÌ·Ï›· ÙÔ˘ Î·Ú‰È·ÁÁÂÈ·ÎÔ‡ Î·È 2 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚË Èı·ÓfiÙËÙ· Ó· ¤¯Ô˘Ó ÔÏÏ·-Ï¤˜ Û˘ÁÁÂÓÂ›˜ ·ÓˆÌ·Ï›Â˜. ŸÛÔ ÛÔ‚·ÚfiÙÂÚË ‹Ù·Ó Ë ·¯˘Û·ÚÎ›· ÙfiÛÔ ÌÂÁ·Ï‡ÙÂÚÔ˜ ‹Ù·Ó ÔÎ›Ó‰˘ÓÔ˜ Û˘ÁÁÂÓÒÓ ·ÓˆÌ·ÏÈÒÓ.

323

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ø˜ Èı·ÓÔ› ÌË¯·ÓÈÛÌÔ› ÚfiÎÏËÛË˜ Û˘ÁÁÂÓÒÓ ·ÓˆÌ·ÏÈÒÓ ·Ó·Ê¤ÚÔÓÙ·È: ·) ÌÂÙ·‚ÔÏÈÎ¤˜‰È·Ù·Ú·¯¤˜, fiˆ˜ ˘ÂÚÁÏ˘Î·ÈÌ›·, ˘ÂÚÈÓÛÔ˘ÏÈÓÈÛÌfi˜ Î·È ·˘ÍËÌ¤Ó· Â›Â‰· ÔÈÛÙÚÔÁfiÓˆÓ (ÂÈ-‰ÈÎ¿ Ô ˘ÂÚÈÓÛÔ˘ÏÈÓÈÛÌfi˜ Â›Ó·È ÁÓˆÛÙfi˜ ·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ·ÓˆÌ·Ï›Â˜ ÙÔ˘ ÓˆÙÈ·›Ô˘ÛˆÏ‹Ó·) Î·È ‚) ÔÈ ·˘ÍËÌ¤ÓÂ˜ ·Ó¿ÁÎÂ˜ ÙˆÓ ·¯‡Û·ÚÎˆÓ ÌËÙ¤ÚˆÓ ÛÂ ÔÚÈÛÌ¤Ó· È¯ÓÔÛÙÔÈ¯Â›· Î·È‚ÈÙ·Ì›ÓÂ˜, fiˆ˜ .¯. ÙÔ Ê˘ÏÏÈÎfi ÔÍ‡, ÁÓˆÛÙfi ÁÈ· ÙËÓ ÚÔÊ˘Ï·ÎÙÈÎ‹ ÙÔ˘ ‰Ú¿ÛË ÛÂ Û˘ÁÁÂÓÂ›˜·ÓˆÌ·Ï›Â˜ ÙÔ˘ ÓˆÙÈ·›Ô˘ ÛˆÏ‹Ó·.

∏ Ú·ÎÙÈÎ‹ ·Í›· ·˘Ù‹˜ ÙË˜ ·Ú·Ù‹ÚËÛË˜ ÁÈ· ÙÔ˘˜ ·È‰È¿ÙÚÔ˘˜ Û˘Ó›ÛÙ·Ù·È ÛÙÔ ÁÂÁÔÓfi˜fiÙÈ ·Ú·ÎÔÏÔ˘ıÔ‡Ó ·È‰È¿ Ô˘ Ù· ‚Ï¤Ô˘Ó Ì·˙› ÌÂ ÙÈ˜ ÌËÙ¤ÚÂ˜ ÙÔ˘˜, ÔÈ ÔÔ›Â˜ Èı·ÓfiÓ ı··ÔÎÙ‹ÛÔ˘Ó Î·È ¿ÏÏ· ·È‰È¿. ™˘ÓÂÒ˜, ¤¯Ô˘Ó ÙËÓ Â˘Î·ÈÚ›· Ó· ÂÓËÌÂÚÒÛÔ˘Ó ÙÈ˜ ÌËÙ¤ÚÂ˜ ÁÈ·ÙÔ˘˜ ÎÈÓ‰‡ÓÔ˘˜ Ô˘ ‰È·ÙÚ¤¯ÂÈ ÙÔ ÌÂÏÏÔÓÙÈÎfi ¤Ì‚Ú˘fi ÙÔ˘˜ ·fi ÙËÓ ·¯˘Û·ÚÎ›· ÙÔ˘˜ Î·È Ó·ÙÈ˜ ÂÓı·ÚÚ‡ÓÔ˘Ó Ó· ¯¿ÛÔ˘Ó ‚¿ÚÔ˜ ÚÈÓ ÙËÓ ÂfiÌÂÓË ÂÁÎ˘ÌÔÛ‡ÓË ÙÔ˘˜.

Pediatrics 2003;111:1152

Human metapneumovirus: ¤Ó·˜ Ó¤Ô˜ Èfi˜, Û˘¯Ófi ·›ÙÈÔ ·Ó·ÓÂ˘ÛÙÈÎÒÓ ÏÔÈÌÒÍÂˆÓ ÛÙ· ·È‰È¿∂ÈÚ‹ÓË ∫ÔÓÙÔfi‰Ë, ¶·È‰›·ÙÚÔ˜

OÈ ÏÔÈÌÒÍÂÈ˜ ÙÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡ ·ÔÙÂÏÔ‡Ó ·ÁÎfiÛÌÈ· ÙË 2Ë ·ÈÙ›· ı·Ó¿ÙÔ˘ ÛÙ· ·È‰È¿ËÏÈÎ›·˜ ÌÈÎÚfiÙÂÚË˜ ÙˆÓ 5 ÂÙÒÓ. ∞Ó Î·È Ô RSV Î·È ÔÈ ÈÔ› ÙË˜ ÁÚ›Ë˜ Î·È ·Ú·ÁÚ›Ë˜ Â˘ı‡ÓÔÓÙ·ÈÁÈ· ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ÙˆÓ ÏÔÈÌÒÍÂˆÓ ÙÔ˘ Î·ÙÒÙÂÚÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡ (‚ÚÔÁ¯ÈÔÏ›ÙÈ‰·,ÓÂ˘ÌÔÓ›·), Ë ·ÈÙÈÔÏÔÁ›· ÛÙÔ 15-34% ÙˆÓ ÏÔÈÌÒÍÂˆÓ ·˘ÙÒÓ ·Ú·Ì¤ÓÂÈ ·‰ÈÂ˘ÎÚ›ÓÈÛÙË.

¶ÚfiÛÊ·Ù·, ÛÙÈ˜ ∫¿Ùˆ ÃÒÚÂ˜, Ù·˘ÙÔÔÈ‹ıËÎÂ ¤Ó·˜ ¿ÁÓˆÛÙÔ˜ ÏÔÈÌÔÁfiÓÔ˜ ·Ú¿ÁÔÓÙ·˜Ô˘ Â›¯Â ·ÔÌÔÓˆıÂ› Ù· ÙÂÏÂ˘Ù·›· 20 ¯ÚfiÓÈ· ·fi 28 ‚Ú¤ÊË Î·È ·È‰È¿ ÌÂ ÏÔ›ÌˆÍË ÙÔ˘ ·Ó·-ÓÂ˘ÛÙÈÎÔ‡. ¶ÚfiÎÂÈÙ·È ÁÈ· ÙÔ ÚÒÙÔ ·ıÔÁfiÓÔ ÁÈ· ÙÔ˘˜ ·ÓıÚÒÔ˘˜ ÛÙ¤ÏÂ¯Ô˜ ÈÔ‡ ÙË˜ ÔÈÎÔ-Á¤ÓÂÈ·˜ ÙˆÓ metapneumovirus. O Èfi˜ ·˘Ùfi˜, Ô ÔÔ›Ô˜ ÔÓÔÌ¿ÛÙËÎÂ Human metapneumovirus(hMPV), ·ÓÈ¯ÓÂ‡ıËÎÂ ÛÙË Û˘Ó¤¯ÂÈ· ÛÙËÓ ∞˘ÛÙÚ·Ï›·, ÛÙÔÓ ∫·Ó·‰¿ Î·È ÛÙÔ ∏ÓˆÌ¤ÓÔ µ·Û›ÏÂÈÔ.∆Ô˘˜ ¯ÂÈÌÂÚÈÓÔ‡˜ Ì‹ÓÂ˜ ÙˆÓ ÂÙÒÓ 2001-2002, ÂÎÔÓ‹ıËÎÂ ÛÙÔ Connecticut ÙˆÓ ∏.¶.∞. ÌÂÏ¤-ÙË ÌÂ ÛÎÔfi ÙË ‰ÈÂÚÂ‡ÓËÛË ÙË˜ Û˘¯ÓfiÙËÙ·˜ Î·È ÙË˜ ÎÏÈÓÈÎ‹˜ ÚÔ‚ÔÏ‹˜ ÙË˜ ÏÔ›ÌˆÍË˜ ·fi ÙÔÓÈfi ·˘Ùfi ÛÙ· ·È‰È¿ ËÏÈÎ›·˜ <5 ÂÙÒÓ ÛÂ ·˘Ù‹ ÙËÓ ÂÚÈÔ¯‹. O Èfi˜ ·Ó·˙ËÙ‹ıËÎÂ ÌÂ ÌÔÚÈ·Î¤˜ ÙÂ-¯ÓÈÎ¤˜ (PCR) ÛÙ· ·Ó·ÓÂ˘ÛÙÈÎ¿ ÂÎÎÚ›Ì·Ù· ·È‰ÈÒÓ Ô˘ ·ÚÔ˘Û›·˙·Ó Û˘ÌÙÒÌ·Ù· ·Ó·ÓÂ˘-ÛÙÈÎ‹˜ ÏÔ›ÌˆÍË˜ Î·È ÛÙ· ÔÔ›· ‰ÂÓ ·ÓÈ¯ÓÂ‡ÔÓÙ·Ó ÌÂ ÙË Ì¤ıÔ‰Ô ÙÔ˘ ·ÓÔÛÔÊıÔÚÈÛÌÔ‡ Ù· ·ÓÙÈ-ÁfiÓ· ÙˆÓ ÈÒÓ RSV, ÁÚ›Ë˜, ·Ú·ÁÚ›Ë˜ Î·È ·‰ÂÓÔ˚ÒÓ.

™ÙË ÌÂÏ¤ÙË ·˘Ù‹ ‰È·ÈÛÙÒıËÎÂ fiÙÈ Ë hMPV ·ÔÙÂÏÂ› Û˘¯Ófi ·›ÙÈÔ ÙˆÓ ÏÔÈÌÒÍÂˆÓ ÙÔ˘ ·ÓÒ-ÙÂÚÔ˘ Î·È Î·ÙÒÙÂÚÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡ (6,4% ÙˆÓ ÂÚÈÙÒÛÂˆÓ, fiÔ˘ ‰ÂÓ ·ÓÈ¯ÓÂ‡ÂÙ·È ¿ÏÏÔ ·›-ÙÈÔ). ¢È·ÈÛÙÒıËÎÂ, Â›ÛË˜, fiÙÈ ÔÈ ÌÈÛÔ› ÂÚ›Ô˘ ·ÛıÂÓÂ›˜ ·fi ÙÔ˘˜ ¿Û¯ÔÓÙÂ˜ ·fi ÏÔ›ÌˆÍË·fi ÙÔÓ hMPV, ÂÌÊ¿ÓÈ˙·Ó Û˘ÌÙÒÌ·Ù· ‚ÚÔÁ¯ÈÔÏ›ÙÈ‰·˜ Î·È ·ÚÎÂÙÔ› ·fi ·˘ÙÔ‡˜ (>30%) ·-ÚÔ˘Û›·˙·Ó ˘ÔÍ·ÈÌ›·. OÈ Û˘ÁÁÚ·ÊÂ›˜ ÂÈÛËÌ·›ÓÔ˘Ó ÙÔÓ Èı·Ó¿ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÙÔ˘ ÈÔ‡ ·˘ÙÔ‡ÛÙËÓ ÂÈ‰ËÌÈÔÏÔÁ›· ÙË˜ ‚ÚÔÁ¯ÈÔÏ›ÙÈ‰·˜.

Pediatrics 2003;111:1407-1410

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∏§∂∫∆ƒO¡π∫∂™ ¢π∂À£À¡™∂π™∏ ¡ÂÔÁÓÔÏÔÁ›· ÛÙÔ ÚÔÛÎ‹ÓÈÔNeonatology on the web - www.neonatology.org

ŸÙ·Ó ·Ó·˙ËÙÂ› Î·ÓÂ›˜ Û˘ÁÎÂÓÙÚˆÌ¤ÓÂ˜ ÏËÚÔÊÔÚ›Â˜ Û¯ÂÙÈÎ¿ ÌÂ ÙË ÓÂÔÁÓÔÏÔÁ›·, ÙÔneonatology.org Â›Ó·È Ì›· ·fi ÙÈ˜ ÏËÚ¤ÛÙÂÚÂ˜ ËÁ¤˜. ¢ËÌÈÔ˘ÚÁ‹ıËÎÂ ·fi ÙËÓ È·ÙÚÈÎ‹ ÔÌ¿-‰· ÙÔ˘ Cedars-Sinai Medical Center ÛÙÔ Los Angeles Î·È ÂÚÈÏ·Ì‚¿ÓÂÈ ÌÂÁ¿ÏÔ ·ÚÈıÌfi ¿Ú-ıÚˆÓ, ·˘ÙÔÌ·ÙÔÔÈËÌ¤ÓˆÓ ·ÏÁÔÚ›ıÌˆÓ Î·È ·Ó·ÊÔÚÒÓ Ô˘ ÍÂÎÈÓÔ‡Ó ·fi ÙËÓ ÈÛÙÔÚ›· ÙË˜ ¡Â-ÔÁÓÔÏÔÁ›·˜ Î·È ÊÙ¿ÓÔ˘Ó Ì¤¯ÚÈ ÚfiÛÊ·Ù· ÚÔÁÚ¿ÌÌ·Ù· ÁÈ· PDAs. ∏ ·ÈÛıËÙÈÎ‹ Î·È Ô ‰ÔÌÈÎfi˜Û¯Â‰È·ÛÌfi˜ ÙË˜ ÛÂÏ›‰·˜ ‰ÂÓ ¤¯Ô˘Ó Ó· ÂÈ‰Â›ÍÔ˘Ó Î¿ÙÈ È‰È·›ÙÂÚÔ Î·È Ì¿ÏÏÔÓ ı· ÌÔÚÔ‡Û·Ó Ó·¯·Ú·ÎÙËÚÈÛÙÔ‡Ó ˆ˜ “·Ï·È¿˜ Ìfi‰·˜”, ·ÏÏ¿ ·˘Ùfi Î·ıfiÏÔ˘ ‰ÂÓ ÂÌÔ‰›˙ÂÈ ÙËÓ ÚÔÛ¤ÁÁÈÛËÛÙËÓ ÏËÚÔÊÔÚ›·. ∂Ó‰È·Ê¤ÚÔÓ ¤¯ÂÈ, Â›ÛË˜, ÙÔ virtual tour, Ì›· ÙÚÈÛ‰È¿ÛÙ·ÙË ÂÚÈ‹ÁËÛË ÛÂÌ›· ÂÈÎÔÓÈÎ‹ ÌÔÓ¿‰· ÓÂÔÁÓÒÓ. ∏ ·Ó·Ó¤ˆÛË ÙˆÓ ÛÂÏ›‰ˆÓ Â›Ó·È Ù·ÎÙÈÎ‹ Î·È ¤ÙÛÈ ÌÔÚÂ› Ó· Â›Ó·ÈÎ·ÓÂ›˜ ‚¤‚·ÈÔ˜ fiÙÈ ÔÈ ÏËÚÔÊÔÚ›Â˜ Ô˘ ı· Ï¿‚ÂÈ ·fi ÙÔ ËÏÂÎÙÚÔÓÈÎfi ·˘Ùfi Û‡ÁÁÚ·ÌÌ· ·Ó·-ÊÔÚ¿˜ ı· Â›Ó·È ·ÎÚÈ‚Â›˜ Î·È Â›Î·ÈÚÂ˜.

∞ÏÔÔÈËÌ¤ÓË ÂÈÛÙ‹ÌË ChildHealthMonitor - www.childhealthmonitor.org

¶ÚÔÛ·ıÒÓÙ·˜ Ó· ÈÛÔÚÚÔ‹ÛÂÈ ÌÂÙ·Í‡ ÙË˜ ˘ÂÚ‚ÔÏ‹˜ Î·È ÙË˜ ·ÏÔ˚ÎfiÙËÙ·˜ ÙˆÓ Î·Ù·-Ó·ÏˆÙÈÎÒÓ ÂÓÙ‡ˆÓ Î·È ÙË˜ ÂÍÂÈ‰›ÎÂ˘ÛË˜ Î·È ÛÙ·ÙÈÛÙÈÎ‹˜ ÚÔÛ¤ÁÁÈÛË˜ ÙˆÓ ÂÈÛÙËÌÔÓÈÎÒÓ Â-ÚÈÔ‰ÈÎÒÓ, Ë ÔÌ¿‰· ÙÔ˘ ChildHealthMonitor ·Ú·ÎÔÏÔ˘ıÂ› Î·È ·Ó·Ê¤ÚÂÈ ÙËÓ ·È‰È·ÙÚÈÎ‹ ‚È-‚ÏÈÔÁÚ·Ê›· ÌÂ ·ÏÔÔÈËÌ¤ÓÔ ÙÚfiÔ, ÒÛÙÂ Ó· Á›ÓÂÙ·È Î·Ù·ÓÔËÙ‹ Î·È ·fi ÌË ÂÈ‰ÈÎÔ‡˜. ¶ÂÚÈ¤-¯ÂÈ, Â›ÛË˜, Û˘ÏÏÔÁ¤˜ ¿ÚıÚˆÓ Û¯ÂÙÈÎÒÓ ÌÂ ÙÈ˜ Û˘¯ÓfiÙÂÚÂ˜ ·È‰È·ÙÚÈÎ¤˜ ÔÓÙfiÙËÙÂ˜. ∂›Ó·È ¤Ó·Î·Ïfi ·Ú¿‰ÂÈÁÌ· ÂÌÔÚÈÎÔ‡ ÙfiÔ˘, fiÔ˘ - ¯ˆÚ›˜ È‰È·›ÙÂÚÂ˜ ˘ÂÚ‚ÔÏ¤˜ - ·Ú¤¯ÔÓÙ·È ÂÂ-ÍÂÚÁ·ÛÌ¤ÓÂ˜ ÏËÚÔÊÔÚ›Â˜ ÛÂ ÌÔÚÊ‹ Ô˘ ı· ÌÔÚÔ‡ÛÂ Î·ÓÂ›˜ Ó· ¯ÚËÛÈÌÔÔÈ‹ÛÂÈ ÁÈ· ÙËÓÂÓËÌ¤ÚˆÛË ÙˆÓ ÁÔÓ¤ˆÓ ÙˆÓ ·ÛıÂÓÒÓ ÙÔ˘.

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£· ‹ıÂÏ· Ó· Û˘Á¯·ÚÒ ÂÛ¿˜ ÚÔÛˆÈÎ¿ Î·È fiÏ· Ù· Ì¤ÏË ÙÔ˘ ¢.™. ÙË˜ ∂ÏÏËÓÈÎ‹˜ ¶·È‰È·ÙÚÈÎ‹˜ ∂Ù·ÈÚÂ›-·˜ ÁÈ· ÙËÓ Î·Ù¿ ÁÂÓÈÎ‹ ÔÌÔÏÔÁ›· ÂÈÙ˘¯›· ÙÔ˘ 41Ô˘ ¶·ÓÂÏÏ‹ÓÈÔ˘ ¶·È‰È·ÙÚÈÎÔ‡ ™˘ÓÂ‰Ú›Ô˘.

£· ‹ıÂÏ·, Â›ÛË˜, Ó· Û·˜ ‰ËÏÒÛˆ ÙËÓ ·ÒÏÂÈ· ÙÔ˘ Poster ÌÔ˘ ÌÂ ·ÚÈıÌfi P140 Î·È Ù›ÙÏÔ: “°ÂÓÂÙÈÎ‹ Î·-ıÔ‰‹ÁËÛË ÛÂ ÚÔ‚Ï‹Ì·Ù· ÙË˜ ÚÔÁÂÓÓËÙÈÎ‹˜ Î˘ÙÙ·ÚÔÁÂÓÂÙÈÎ‹˜ ‰È¿ÁÓˆÛË˜ ÌÂ ·ÌÓÈÔÎ¤ÓÙËÛË”, ÌÂ Û˘Á-ÁÚ·ÊÂ›˜ ÙÔ˘˜ Î.Î. Ã. Ã·Ù˙ËÛÂ‚·ÛÙÔ‡-§Ô˘Î›‰Ô˘ Î·È ∫. ª·ÏÙ˙‹ (∂ÚÁ·ÛÙ‹ÚÈÔ ∫˘ÙÙ·ÚÔÁÂÓÂÙÈÎ‹˜ ÙË˜ ∞’ ¶·È-‰È·ÙÚÈÎ‹˜ ∫ÏÈÓÈÎ‹˜ ∞.¶.£., °¶¡ πÔÎÚ¿ÙÂÈÔ £ÂÛÛ·ÏÔÓ›ÎË˜) Î·È §. ºÏˆÚÂÓÙ›Ó-∞Ú¿Ú (Alfa Lab, ∫¤ÓÙÚÔ ªÔ-ÚÈ·Î‹˜ µÈÔÏÔÁ›·˜ Î·È ∫˘ÙÙ·ÚÔÁÂÓÂÙÈÎ‹˜ ¢È¿ÁÓˆÛË˜, ∞ı‹Ó·).

™˘ÁÎÂÎÚÈÌ¤Ó·, ÙËÓ ∫˘ÚÈ·Î‹ 19-06-2003 Î·È ÒÚ· 19:00 ·Ú¤Ï·‚· ·fi ÙÔÓ ¯ÒÚÔ ÙˆÓ ·Ó·ÚÙËÌ¤ÓˆÓ ·Ó·-ÎÔÈÓÒÛÂˆÓ ÙÔ ¤Ó· ·fi Ù· Poster ÌÔ˘ ÌÂ ·ÚÈıÌfi PO67, ‰ÂÓ ˘‹Ú¯Â fiÌˆ˜ ÙÔ Poster ÌÂ ·ÚÈıÌfi P140, ÙÔÔÔ›Ô ÂÚÈÂÏ¿Ì‚·ÓÂ ÂÈÎfiÓ· Û¿ÓÈÔ˘ Î·Ú˘fiÙ˘Ô˘ Î·È ÊˆÙÔÁÚ·Ê›Â˜ ‰‡Ô Ê˘ÛÈÔÏÔÁÈÎÒÓ ·È‰ÈÒÓ ÛÂ Á˘·ÏÈ-ÛÙÂÚfi ÊˆÙÔÁÚ·ÊÈÎfi ¯·ÚÙ› Î·È ÛÂ ‰È·ÛÙ¿ÛÂÈ˜ ¯·ÚÙÈÔ‡ ∞4 (‚Ï. Î·ÙˆÙ¤Úˆ).

£· ‹ıÂÏ· Ó· Û·˜ ·Ú·Î·Ï¤Ûˆ Ó· ‰ËÌÔÛÈÂ‡ÛÂÙÂ ÙËÓ ÂÚ›ÙˆÛË ÌÂ ÙÔÓ Î·Ú˘fiÙ˘Ô ˆ˜ ·ÂÈÎÔÓÈÛÙÈÎ‹ ÁÈ·Ó· Î·ÙÔ¯˘ÚÒÛˆ ÙÔ ¤ÚÁÔ ÌÔ˘. ∂›ÛË˜, ·Ó Û˘ÌÊˆÓÂ›ÙÂ, Ó· ‰ËÌÔÛÈÂ‡ÛÂÙÂ ÙËÓ ÂÈÛÙÔÏ‹ ÌÔ˘ ÚÔ˜ ·ÔÊ˘Á‹Ó·ÚfiÌÔÈˆÓ ÂÂÈÛÔ‰›ˆÓ ÛÙÔ Ì¤ÏÏÔÓ.

™·˜ Â˘¯·ÚÈÛÙÒ Î·È ÂÏ›˙ˆ ÛÙËÓ ·Ô‰Ô¯‹ ÙË˜ ÚfiÙ·Û‹˜ ÌÔ˘.

£ÂÛÛ·ÏÔÓ›ÎË, 02-07-2003ªÂ ÙÈÌ‹

Ã. Ã·Ù˙ËÛÂ‚·ÛÙÔ‡-§Ô˘Î›‰Ô˘

°ÂÓÂÙÈÎ‹ Î·ıÔ‰‹ÁËÛË ÛÂ ÚÔ‚Ï‹Ì·Ù· ÙË˜ ÚÔÁÂÓÓËÙÈÎ‹˜ Î˘ÙÙ·ÚÔÁÂÓÂÙÈÎ‹˜ ‰È¿ÁÓˆÛË˜ ÌÂ ·ÌÓÈÔÎ¤ÓÙËÛË

∂¶π™∆O§∏ ¶ƒO™ ∆∏ ™À¡∆∞•∏ LETTER TO THE EDITOR

∂ÈÎfiÓ· 1. º˘ÛÈÔÏÔÁÈÎfi ·ÁfiÚÈ 2,5ÂÙÒÓ. O Î·Ú˘fiÙ˘fi˜ ÙÔ˘ ÛÙ· Î‡Ù-Ù·Ú· ÙÔ˘ ·ÌÓÈ·Îo‡ ˘ÁÚÔ‡ ÙÔ˘‹Ù·Ó: 46,ÃÀ/47,ÃÀ, +20 ÛÂ ·Ó·ÏÔ-Á›· 27/12 (¶ÂÚ›ÙˆÛË ·/· 1).


∂ÈÎfiÓ· 2. º˘ÛÈÔÏÔÁÈÎfi ı‹Ï˘ 1 ¤ÙÔ˘˜. O Î·-Ú˘fiÙ˘fi˜ ÙÔ˘ ÛÙ· Î‡ÙÙ·Ú· ÙÔ˘ ·ÌÓÈ·ÎÔ‡˘ÁÚÔ‡ ÙÔ˘ ‹Ù·Ó: 45,ÃÃ,der(14;21)(q10;q10)de novo (¶ÂÚ›ÙˆÛË ·/· 3).

326

∫·Ù¿ ·Ú¤ÎÎÏÈÛË ÙˆÓ ·Ú¯ÒÓ ÙÔ˘ ¶ÂÚÈÔ‰ÈÎÔ‡, ‰ËÌÔÛÈÂ‡ÔÓÙ·È ÔÈ ˆ˜ ¿Óˆ ÊˆÙÔÁÚ·Ê›Â˜ ÏfiÁˆ ÙÔ˘ ·Ù˘¯Ô‡˜Û˘Ì‚¿ÓÙÔ˜ ÙË˜ ·ÒÏÂÈ·˜ ÙÔ˘ Poster.

O ¢ÈÂ˘ı˘ÓÙ‹˜ ™‡ÓÙ·ÍË˜

∫·ıËÁËÙ‹˜ ™Ù·‡ÚÔ˜ Ã·˚‰¿˜

∂ÈÎfiÓ· 3. ∫·Ú˘fiÙ˘Ô˜ ÙÔ˘ ÂÌ‚Ú‡Ô˘: 47,ÃÀ,+mar de novo. ŒÁÈÓÂ ÂÚ·ÈÙ¤Úˆ ¤ÏÂÁ¯Ô˜ ÌÂ ÙÂ¯ÓÈÎ‹ FISH ÚÔÎÂÈÌ¤ÓÔ˘ Ó· ÚÔÛ-‰ÈÔÚÈÛÙÂ› Ë ¯ÚˆÌÔÛˆÌÈÎ‹ ÚÔ¤ÏÂ˘ÛË ÙÔ˘ ‰Â›ÎÙË ·˘ÙÔ‡ (mar). À‚ÚÈ‰ÈÛÌfi˜ ÌÂ ·ÓÈ¯ÓÂ˘Ù¤˜ ÙË˜ ÂÚÈÔ¯‹˜ alpha satellite ÁÈ· Ù· ¯Úˆ-ÌÔÛÒÌ·Ù· 13/21, 14/22 Î·È 15 ·Ó·ÁÓÒÚÈÛ·Ó ÙÔ ¯ÚˆÌÔÛˆÌÈÎfi ‰Â›ÎÙË Ô˘ ¤¯ÂÈ ·ÓÈ¯ÓÂ˘ÙÂ› ÛÙÔÓ Î·Ú˘fiÙ˘Ô ÙÔ˘ ÂÌ‚Ú‡Ô˘ ·˘ÙÔ‡ˆ˜ ÚÔÂÚ¯fiÌÂÓÔ ·fi Ù· ¯ÚˆÌÔÛÒÌ·Ù· 13 ‹ 21. OÈ ÁÔÓÂ›˜ Â¤ÏÂÍ·Ó ÙË Û˘Ó¤¯ÈÛË ÙË˜ Î‡ËÛË˜ Î·È ÁÂÓÓ‹ıËÎÂ ¤Ó· Ê˘ÛÈÔÏÔÁÈÎfi·ÁfiÚÈ (¶ÂÚ›ÙˆÛË ·/· 8).


xi

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]

1-4 OÎÙˆ‚Ú›Ô˘ 2003 TRANSMED 2003: 11th European Lisboa, PortugalMediterranean Obstetrics, Perinatology & Paediatrics Meeting¶ÏËÚÔÊÔÚ›Â˜: Kamel BARGAOUITel.: +33 607 686 118Fax: +33 743 839 985E-mail: [email protected]

5-7 OÎÙˆ‚Ú›Ô˘ 2003 2nd International Symposium Prague, on Perinatal and Developmental Medicine Czech Republic¶ÏËÚÔÊÔÚ›Â˜: Milos Cerny M.D.Tel.: 42 0 257 272 350Fax: 42 0 257 214 550E-mail: [email protected]

10-12 OÎÙˆ‚Ú›Ô˘ 2003 4th International Pediatric Cardiovascular Atlanta, GA,Symposium: Heart Failure in Pediatrics United States¶ÏËÚÔÊÔÚ›Â˜: Jane Darrish Tel.: 404 929 8645 Fax: 404 315 2885 E-mail: [email protected]

¶PO™EXH ™YNE¢PIA

xii

19-22 OÎÙˆ‚Ú›Ô˘ 2003 Europaediatrics 2003 Prague, ¶ÏËÚÔÊÔÚ›Â˜: Kenes International Czech Republic Tel.: +41 22 908 0488 Fax: +41 22 732 2850 E-mail: [email protected] Website: www.kenes.com/europaediatrics2003

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]

9-12 ºÂ‚ÚÔ˘·Ú›Ô˘ 2004 15th International Congress Paris, France on anti-Cancer Treatment¶ÏËÚÔÊÔÚ›Â˜: T.C.O. Tel.: (33-1) 42 94 87 32 Fax: (33-1) 42 94 87 33 Website: www.icact.com 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

xiv

™˘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

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™YNTOMO°PAºIE™ ABBREVIATIONS

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TGMkhdadcmÌnpfa

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