Παιδιατρική | Τόμος 70 • Τεύχος 1 • Ιανουάριος -...

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37 √ ÚfiÏÔ˜ ÙˆÓ ·Ù‡ˆÓ ‚·ÎÙËÚ›ˆÓ ÛÙÔÓ ̄ ÚfiÓÈÔ

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42 ¶˘ÚÂÙÈÎÔ› Û·ÛÌÔ›: Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈÎ‹

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70 ∫·Ì‡ÏÂ˜ ÛˆÌ·ÙÈÎ‹˜ ·Ó¿Ù˘ÍË˜

ÙˆÓ ·È‰ÈÒÓ ÙË˜ ̄ ÒÚ·˜ Ì·˜

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75 ∫§π¡π∫√ ∫√Àπ∑

76 ¡∂∞ ∞¶√ ∆√ ¢π∞¢π∫∆À√

Pediatric Blogs

¡. ¶··‰fiÔ˘ÏÔ˜

80 ∂¶π™∆√§∏ ¶ƒ√™ ∆∏ ™À¡∆∞•∏

¶·È‰È·ÙÚÈÎ‹∆fiÌÔ˜ 70 ñ ∆Â‡¯Ô˜ 1 ñ π·ÓÔ˘¿ÚÈÔ˜-ºÂ‚ÚÔ˘¿ÚÈÔ˜ 2007

∫ˆ‰ÈÎfi ̃¢ÈÂ‡ı˘ÓÛË ̃∂ÔÙÂ›· ̃ªª∂: 3889

ISSN 0377-2551

Bimonthly Publication of

the Greek Paediatric Society

President

A. Constantopoulos

Editorial Board

Editor-in-Chief

C. Stefanidis

Members

P. Augoustides-Savvopoulou

H. Antonopoulou

A. Vazeou-Gerasimidi

G. Varlamis

M. Kanariou

∂. Katsarou-Pectasides

A. Kattamis

S. Kitsiou-Tzeli

Ch. Costalos

N. Papadopoulos

∞. Papadopoulou

A. Siamopoulou-Mavridou

M. Tsolia

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Greek Editing

F. Mavroidi

English Editing

S. Nakou

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Contents

REVIEW ARTICLES

1 Mitochondrial disorders in childhood

A. Dinopoulos, A. Papadimitriou

18 High frequency oscillatory ventilation:

How it works

P. Karagianni, N. Nikolaides

ORIGINAL ARTICLES

24 Prevalence of metabolic syndrome in

children and adolescents of Crete and

its relation to diet

M. Linardakis, K. Sarri, G. Bertsias, A. Kafatos, Division of Preventive Medicineand Nutrition

37 The role of mycoplasmal/chlamydial

infection in chronic cough in children

I.M. Velissariou, N.G. Papadopoulos, M. Giannaki, P. Saxoni-Papageorgiou, D.A. Kafetzis

42 Efficacy of intermittent rectal

diazepam prophylaxis for

the prevention of febrile seizures

E. Pavlidou, M. Tzitiridou, E. Kontopoulos, C. Panteliadis

CASE REPORTS

49 Hypochondroplasia with the mutation

N540K of the fibroblast growth factor

receptor 3 – FFGGFFRR33. A case report

V. Aggelakou, G. Niotakis, S. Ilia, A. Bakosi, E. Kokori

54 Nutritional vitamin B12 deficiency in an

infant. Dietary errors of a vegan

V. Aggelakou, M. Orfanou, G. Niotakis, E. Kokori, I. Charoniti

60 Round atelectasis in adolescent

T. Tavladaki, M. Malathraki, G. Drakonakis,I. Saridakis, I. Katsarakis, M. Kladitou,

A. Augenaki, A. Nearchou

PRACTICAL ISSUES

64 Severe protracted diarrhea of

infancy – New aspects

C. Costalos

70 Growth curves for Greek children

A. Kafatos

75 CLINICAL QUIZ

76 NEWS FROM THE INTERNET

Pediatric Blogs

¡. Papadopoulos

80 LETTER TO THE EDITOR

PaediatrikiVolume 70 ñ Number 1 ñ January-February 2007

v™À¡∆∞∫∆π∫∏ E¶π∆ƒ√¶∏ EDITORIAL BOARD

ª¤ÏË ÙË˜ ¢ÈÂıÓÔ‡˜ ™˘ÓÙ·ÎÙÈÎ‹˜ ∂ÈÙÚÔ‹˜ ñ Members of the International Editorial Board

¢ÈÂ˘ı˘ÓÙ‹˜ ™‡ÓÙ·ÍË˜

∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ™ÙÂÊ·Ó›‰Ë˜, ∞ı‹Ó·

ÀÂ‡ı˘ÓÔÈ ™‡ÓÙ·ÍË˜ ∂ÍÂÈ‰ÈÎÂ‡ÛÂˆÓ

∂Ï¤ÓË ∞ÓÙˆÓÔÔ‡ÏÔ˘, ∞ı‹Ó·∞Ó·Ù˘ÍÈ·Î¤˜ ‰È·Ù·Ú·¯¤˜ - ¶ÚÔ‚Ï‹Ì·Ù· Û˘ÌÂÚÈÊÔÚ¿˜

¶ÂÚÛÂÊfiÓË ∞˘ÁÔ˘ÛÙ›‰Ô˘-™·‚‚ÔÔ‡ÏÔ˘, £ÂÛÛ·ÏÔÓ›ÎËKÏËÚÔÓÔÌÈÎ¿ ÌÂÙ·‚ÔÏÈÎ¿ ÓÔÛ‹Ì·Ù·

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

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

ª·Ú›· ∫·Ó¿ÚÈÔ˘, ∞ı‹Ó·∞ÓÔÛÔÏÔÁ›·

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

∞ÓÙÒÓË˜ ∫·ÙÙ¿ÌË˜, ∞ı‹Ó·∞ÈÌ·ÙÔÏÔÁ›· - OÁÎÔÏÔÁ›·

™ÔÊ›· ∫›ÙÛÈÔ˘-∆˙¤ÏË, ∞ı‹Ó·°ÂÓÂÙÈÎ‹

ÃÚ‹ÛÙÔ˜ ∫ÒÛÙ·ÏÔ˜, ∞ı‹Ó·¡ÂÔÁÓÔÏÔÁ›·

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

¡ÈÎfiÏ·Ô˜ ¶··‰fiÔ˘ÏÔ˜, ∞ı‹Ó·∞ÏÏÂÚÁÈÔÏÔÁ›· - ¶ÓÂ˘ÌÔÓÔÏÔÁ›·

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

ª·Ú›˙· ∆ÛÔÏÈ¿, ∞ı‹Ó·§ÔÈÌˆÍÈÔÏÔÁ›·

Editor-in-Chief

Constantinos Stefanidis, Athens

Section Editors

Eleni Antonopoulou, AthensDevelopmental and Behavioral Pediatrics

Persefoni Avgoustidou-Savopoulou, ThessalonikiMetabolic Disorders

Andriani Vazaiou-Gerasimidi, AthensEndocrinology

George Varlamis, ThessalonikiCardiology

Maria Kanariou, AthensImmunology

Eustathia Katsarou-Pektasidou, AthensNeurology

Antonis Kattamis, AthensHaematology - √ncology

Sophia Kitsiou-Tzeli, AthensGenetics

Christos Kostalos, AthensNeonatology

Alexandra Papadopoulou, AthensGastroenterology - Hepatology - Nutrition

Nicos Papadopoulos, AthensAllergology - Pneumonology

Antigoni Siamopoulou-Mavridou, IoanninaRheumatology

Marisa Tsolia, AthensInfectious Diseases

Alexis Arzimanoglou, Paris, France

Ellis D. Avner, Milwaukee, USA

Swati Bhave, New Delhi, India

Alberto Bissot, Panama, Panama

David Branski, Jerusalem, Israel

Francesco Chiarelli, Chieti, Italy

Chok-Wan Chan, Hong Kong, China

Denis Daneman, Toronto, Canada

Jochen Ehrich, Hannover, Germany

Demetrius Ellis, Pittsburgh, USA

Yoshikatsu Eto, Tokyo, Japan

Richard N. Fine, Stony Brook, USA

Margaret C. Fisher, Philadelphia, USA

Raif Geha, Boston, USA

Adenike Grange, Lagos, Nigeria

Judith G. Hall, Vancouver, Canada

Patricia Hamilton, London, UK

Enver Hasanoglu, Ankara, Turkey

Christer Holmberg, Helsinki, Finland

Peter Hoyer, Essen, Germany

Jan Janda, Prague, Czech Republic

Jan Kimpen, Ultrecht, Netherlands

Craig B. Langman, Chicago, USA

John Manis, Boston, USA

Manuel Moya, Alicante, Spain

Hugh O'Brodovich, Toronto, Canada

Ross Petty, Vancouver, Canada

Willem Proesmans, Leuven, Belgium

Jose Ramet, Antwerp, Belgium

Alan Sinaiko, Minneapolis, USA

Nick J. Spencer, Coventry, UK

Alfred Tenore, Udine, Italy

Alkis Togias, Bethesda, USA

Eva Tsalikian, Iowa City, USA

Catherine Weil-Olivier, Paris, France

Max Zach Graz, Austria

Johannes Zschocke, Heidelberg, Germany

vii∂¶π™∆√§∏ ∞¶√ ∆∏ ™À¡∆∞•∏ EDITORIAL

∞Á·ËÙÔ› Û˘Ó¿‰ÂÏÊÔÈ,

™·˜ Â˘¯fiÌ·ÛÙÂ Â˘Ù˘¯ÈÛÌ¤ÓÔ ÙÔÓ Î·ÈÓÔ‡ÚÁÈÔ ¯ÚfiÓÔ Î·È Û·˜ Â˘¯·ÚÈÛÙÔ‡ÌÂ ÁÈ· ÙË Û˘ÓÂ¯‹ Û·˜˘ÔÛÙ‹ÚÈÍË ÛÙÈ˜ ÚÔÛ¿ıÂÈÂ˜ ÁÈ· ·Ó·‚¿ıÌÈÛË ÙË˜ “¶·È‰È·ÙÚÈÎ‹˜”.

π‰È·›ÙÂÚ· Â˘¯·ÚÈÛÙÔ‡ÌÂ ÙÔ˘˜ Û˘ÁÁÚ·ÊÂ›˜, ÙÔ˘˜ ÎÚÈÙ¤˜ ÙˆÓ ÂÚÁ·ÛÈÒÓ Î·È Ù· Ì¤ÏË ÙË˜ ¢ÈÂıÓÔ‡˜™˘ÓÙ·ÎÙÈÎ‹˜ ∂ÈÙÚÔ‹˜. ∏ Û˘ÌÌÂÙÔ¯‹ ÙˆÓ ‰È·ÎÂÎÚÈÌ¤ÓˆÓ ·˘ÙÒÓ Û˘Ó·‰¤ÏÊˆÓ ÛÙËÓ ‰È·‰ÈÎ·Û›·¤Î‰ÔÛË˜ ı· Û˘ÓÙÂÏ¤ÛÂÈ ÛÙÔ Ó· ·ÔÎÙ‹ÛÂÈ Ë “¶·È‰È·ÙÚÈÎ‹” ‰ÈÂıÓ¤˜ Î‡ÚÔ˜. ™·˜ ˘ÂÓı˘Ì›˙Ô˘ÌÂ fiÙÈË ˘Ô‚ÔÏ‹ ÙˆÓ ÂÚÁ·ÛÈÒÓ Û·˜ ÌÔÚÂ› Ó· Á›ÓÂÙ·È Î·È ÛÙ· ∞ÁÁÏÈÎ¿. ∂›ÛË˜ ÌËÓ ÍÂ¯Ó¿ÙÂ, fiÙÈ ÌÔÚÂ›-ÙÂ Ó· ‚ÚÂ›ÙÂ ÙÈ˜ ‰ËÌÔÛÈÂ‡ÛÂÈ˜ ÙË˜ “¶·È‰È·ÙÚÈÎ‹˜” ÛÙËÓ ÈÛÙÔÛÂÏ›‰· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡.

ªÂ ıÂÚÌ¤˜ Â˘¯¤˜

°È· ÙË ™˘ÓÙ·ÎÙÈÎ‹ ∂ÈÙÚÔ‹

∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ™ÙÂÊ·Ó›‰Ë˜¢ÈÂ˘ı˘ÓÙ‹˜ ™‡ÓÙ·ÍË˜

Dear colleagues,

We would like to wish you a Happy New Year. On this occasion, we would like to thank all of youfor supporting the efforts for improvement of “Paediatriki”.

Especially we would like to thank the authors, the reviewers and the members of the InternationalEditorial Board. We believe that the participation of this distinguished group of colleagues willcontribute to our effort for “Paediatriki” to achieve a world-class level. We would like to remind youthat papers may be submitted in English. Finally do not forget that you can find past issues of“Paediatriki” at the web page of the journal.

Warm greetings

√n behalf of the Editorial Board

Constantinos StefanidisEditor-in-Chief

xiii√¢∏°π∂™ ¶ƒ√™ ∆√À™ ™À°°ƒ∞º∂π™

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˜ ™˘ÓÙ·-ÎÙÈÎ‹˜ EÈÙÚÔ‹˜).

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

10. ™‡ÓÙÔÌ· Ó¤·.11. µÚ·¯Â›Â˜ ‰ËÌÔÛÈÂ‡ÛÂÈ˜.12. ∂ÈÛÙÔÏ¤˜ ÚÔ˜ ÙË Û‡ÓÙ·ÍË.13. ¶ÂÚÈÏ‹„ÂÈ˜ ÙË˜ ‚È‚ÏÈÔÁÚ·Ê›·˜.14. ∞Ó·ÎÔÈÓÒÛÂÈ˜ ÚÔÛÂ¯ÒÓ Û˘ÓÂ‰Ú›ˆÓ Î·È ÂÈÛÙËÌÔÓÈ-

ÎÒÓ ÂÎ‰ËÏÒÛÂˆÓ15. ∞Ó·ÊÔÚ¤˜ Î·È ÎÚÈÙÈÎ‹ Ó¤ˆÓ ÂÎ‰fiÛÂˆÓ, ÂÏÏËÓÈÎÒÓ

Î·È Í¤ÓˆÓ, ·È‰È·ÙÚÈÎÔ‡ ÂÓ‰È·Ê¤ÚÔÓÙÔ˜.

H ™˘ÓÙ·ÎÙÈÎ‹ EÈÙÚÔ‹ ‰È·ÙËÚÂ› ÙÔ ‰ÈÎ·›ˆÌ· Ó· ‰Ë-ÌÔÛÈÂ‡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· ÙËÚÂ›Ù·È ËÛÂÈÚ¿ ˘Ô‚ÔÏ‹˜. ∂›ÛË˜, ÌÔÚÂ› Ó· ·ÔÊ·Û›˙ÂÈ ÁÈ· ÙË ‰Ë-ÌÔÛ›Â˘ÛË ÂÚÁ·ÛÈÒÓ Ô˘ ¤¯Ô˘Ó ·ÚÔ˘ÛÈ·ÛÙÂ› ÛÙÔ ÂÙ‹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 ÔÏÈÎ‹ ‹ÌÂÚÈÎ‹ ‰ËÌÔÛ›Â˘ÛË ÂÈÛÙÔÏÒÓ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÛÂ ‰ËÌÔ-ÛÈÂ˘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˜.

ŸÏÂ˜ ÔÈ ÂÚÁ·Û›Â˜ Ú¤ÂÈ Ó· ÌËÓ ¤¯Ô˘Ó ÂÓ Ì¤ÚÂÈ ‹ ÂÍÔÏÔÎÏ‹ÚÔ˘ ‰ËÌÔÛÈÂ˘ıÂ› ‹ ˘Ô‚ÏËıÂ› ÁÈ· ÎÚ›ÛË ÛÂ ¿ÏÏÔÂÚÈÔ‰ÈÎfi. ∂ÈÏ¤ÔÓ, ÛÙËÓ ÂÚÁ·Û›· ı· Ú¤ÂÈ Ó· ·Ó·Ê¤-ÚÔÓÙ·È Ù˘¯fiÓ ÂÈ‰ÔÙ‹ÛÂÈ˜-¯ÔÚËÁ›Â˜ ‹ ¿ÏÏÂ˜ ËÁ¤˜ ˘Ô-ÛÙ‹ÚÈÍË˜. ŸÏÂ˜ ÔÈ ÎÏÈÓÈÎ¤˜ ¤ÚÂ˘ÓÂ˜ Ú¤ÂÈ Ó· ¤¯Ô˘Ó Á›ÓÂÈÌÂÙ¿ ·fi ÏËÚÔÊÔÚËÌ¤ÓË Û˘Ó·›ÓÂÛË ÙˆÓ ÌÂÙÂ¯fiÓÙˆÓ ‹ÙˆÓ ÓÔÌ›ÌˆÓ ÂÎÚÔÛÒˆÓ ÙÔ˘˜, Û‡ÌÊˆÓ· ÌÂ ÙÈ˜ ‰È·ÎË-Ú‡ÍÂÈ˜ ÙÔ˘ EÏÛ›ÓÎÈ Î·È ÙÔ˘ TfiÎÈÔ. E›ÛË˜, Ú¤ÂÈ Ó·¤¯Ô˘Ó ÙËÚËıÂ› ÔÈ Ô‰ËÁ›Â˜ ÁÈ· ÙË ÊÚÔÓÙ›‰· ÂÈÚ·Ì·Ùfi˙ˆ-ˆÓ ÙÔ˘ ∂ıÓÈÎÔ‡ πÓÛÙÈÙÔ‡ÙÔ˘ ÀÁÂ›·˜ ÙˆÓ ∏¶∞ (DHEWPublication, NIH, 80-23). OÈ ÎÏÈÓÈÎ¤˜ ÌÂÏ¤ÙÂ˜ Ú¤ÂÈ Ó·¤¯Ô˘Ó ÂÁÎÚÈıÂ› ·fi ÙËÓ ÂÈÙÚÔ‹ ∏ıÈÎ‹˜ Î·È ¢ÂÔÓÙÔÏÔ-Á›·˜ ÙÔ˘ ¡ÔÛÔÎÔÌÂ›Ô˘.

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·¯ÒÚÈÛË ‰È·ÊËÌ›ÛÂˆÓ ÛÙÔ ÂÚÈÔ‰ÈÎfi ‰ÂÓ ˘Ô‰ËÏÒÓÂÈÔˆÛ‰‹ÔÙÂ ¤ÁÎÚÈÛË ÙˆÓ ÂÚÈÂ¯ÔÌ¤ÓˆÓ ÙÔ˘˜ ·fi ÙËÓEÏÏËÓÈÎ‹ ¶·È‰È·ÙÚÈÎ‹ EÙ·ÈÚÂ›·, ÙË ™˘ÓÙ·ÎÙÈÎ‹ EÈÙÚÔ‹‹ ·fi ÙÔÓ EÎ‰fiÙË ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡.

ŸÏÂ˜ ÔÈ ‰ËÌÔÛÈÂ˘Ì¤ÓÂ˜ ÂÚÁ·Û›Â˜ ıÂˆÚÔ‡ÓÙ·È È‰ÈÔÎÙË-Û›· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ “¶·È‰È·ÙÚÈÎ‹” Î·È Ë ÔÏÈÎ‹ ‹ ÌÂÚÈÎ‹

·Ó·‰ËÌÔÛ›Â˘Û‹ ÙÔ˘˜ ÂÈÙÚ¤ÂÙ·È ÌfiÓÔ ÌÂÙ¿ ·fi ¤ÁÁÚ·ÊË

Û˘ÁÎ·Ù¿ıÂÛË ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡.

µ. ™‡ÓÙ·ÍË ÙˆÓ ∂ÚÁ·ÛÈÒÓŸÏÂ˜ ÔÈ ÂÚÁ·Û›Â˜ Ú¤ÂÈ Ó· ·ÎÔÏÔ˘ıÔ‡Ó “∫ÔÈÓ¤˜ ¶ÚÔ-

‰È·ÁÚ·Ê¤˜ ÁÈ· ÃÂÈÚfiÁÚ·Ê· Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È ÛÂ µÈÔ˚·-

ÙÚÈÎ¿ ¶ÂÚÈÔ‰ÈÎ¿” (Uniform Requirements for Manuscripts

Submitted to Biomedical Journals), ÔÈ ÔÔ›Â˜ ÙÚÔÔÔÈ‹-

ıËÎ·Ó ÚfiÛÊ·Ù· Î·È ‰ËÌÔÛÈÂ‡ÔÓÙ·È ÛÙÈ˜ ‰ÈÂ˘ı‡ÓÛÂÈ˜:

http://www.icmje.org Î·È http://www.icmje.org/icmje.pdf

TÔ 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 Ù˘-

ˆÌ¤ÓÔ ÛÙË ÌÈ· fi„Ë ÏÂ˘ÎÔ‡ ¯·ÚÙÈÔ‡ ÌÂÁ¤ıÔ˘˜ A4

(21x29,7 cm), ÌÂ ‰ÈÏfi ‰È¿ÛÙËÌ· ÌÂÙ·Í‡ ÙˆÓ ÁÚ·ÌÌÒÓ Î·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: ÛÂ-

Ï›‰· Ù›ÙÏÔ˘, ‚Ú·¯‡˜ Ù›ÙÏÔ˜, ÂÚ›ÏË„Ë ÛÙ· ÂÏÏËÓÈÎ¿ Î·È Ù·

·ÁÁÏÈÎ¿, Î·Ù¿ÏÔÁÔ˜ Û˘ÓÙÔÌÔÁÚ·ÊÈÒÓ, ÎÂ›ÌÂÓÔ, Â˘¯·ÚÈ-

ÛÙ›Â˜ Î·ıÒ˜ Î·È ·Ó·ÊÔÚ¿ ÛÂ ÂÈ‰ÔÙ‹ÛÂÈ˜-¯ÔÚËÁ›Â˜ ‹ ¿Ï-

ÏÂ˜ ËÁ¤˜ ˘ÔÛÙ‹ÚÈÍË˜, ‚È‚ÏÈÔÁÚ·Ê›·, ›Ó·ÎÂ˜, ÂÈÎfiÓÂ˜,

Ù›ÙÏÔÈ ÂÈÎfiÓˆÓ. 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·:

ñ ÙÈ˜ ·Ó·ÛÎÔ‹ÛÂÈ˜ ÛÂ 2000-3000 Ï¤ÍÂÈ˜.

ñ ÙÈ˜ ÂÚÂ˘ÓËÙÈÎ¤˜ ÂÚÁ·Û›Â˜ ÛÂ 1500-2500 Ï¤ÍÂÈ˜ Î·È ÙÈ˜

ÂÓ‰È·Ê¤ÚÔ˘ÛÂ˜ ÂÚÈÙÒÛÂÈ˜ ÛÂ 1000-1500 Ï¤ÍÂÈ˜.

ñ ÙÈ˜ ‚Ú·¯Â›Â˜ ‰ËÌÔÛÈÂ‡ÛÂÈ˜ ÛÂ 1000-1500 Ï¤ÍÂÈ˜.

ñ ÙÈ˜ ÂÈÛÙÔÏ¤˜ ÛÂ 250-500 Ï¤ÍÂÈ˜.

™ÂÏ›‰· Ù›ÙÏÔ˘

¶Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ:ñ ÙÔÓ Ù›ÙÏÔ (<14 Ï¤ÍÂÈ˜), Î·ıÒ˜ Î·È ÙÔÓ ‚Ú·¯‡ Ù›ÙÏÔ (<5

Ï¤ÍÂÈ˜) ÙÔ˘ ¿ÚıÚÔ˘. ¢ÂÓ ÂÈÙÚ¤ÔÓÙ·È Û˘ÓÙÌ‹ÛÂÈ˜.

ñ ÙÔ fiÓÔÌ· Î·È ÙÔ ÂÒÓ˘ÌÔ Î¿ıÂ Û˘ÁÁÚ·Ê¤· ÛÙËÓ ÔÓÔ-

Ì·ÛÙÈÎ‹.

ñ 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·ÌÔÓ‹˜

ÙÔ˘/ÙÔ˘˜.

ñ 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˜.

ñ £· Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÔ˘Ï¿¯ÈÛÙÔÓ 200 Ï¤ÍÂÈ˜,

fiÌˆ˜ ‰ÂÓ ı· Ú¤ÂÈ Ó· ˘ÂÚ‚·›ÓÂÈ ÙÈ˜ 250 Ï¤ÍÂÈ˜.

ñ ∏ 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·È Ù·

ÔÓfiÌ·Ù· ÙˆÓ Û˘ÁÁÚ·Ê¤ˆÓ ÛÙ· ·ÁÁÏÈÎ¿. TÔ ÂÚÈÂ¯fiÌÂÓÔ

ÙÔ˘ ·ÁÁÏÈÎÔ‡ ÎÂÈÌ¤ÓÔ˘ Ú¤ÂÈ Ó· Â›Ó·È ‰ÔÌËÌ¤ÓÔ ÛÂ: ÂÈ-

Û·ÁˆÁ‹ (background), Ì¤ıÔ‰ÔÈ (methods), ·ÔÙÂÏ¤ÛÌ·-

Ù· (results) Î·È Û˘ÌÂÚ¿ÛÌ·Ù· (conclusions). H ÂÚ›ÏË-

„Ë ÛÙ· ·ÁÁÏÈÎ¿ ‰ÂÓ Ú¤ÂÈ Ó· ‰È·Ê¤ÚÂÈ ·fi ÙËÓ ·ÓÙ›-

ÛÙÔÈ¯Ë ÛÙ· ÂÏÏËÓÈÎ¿.

K¿Ùˆ ·fi ÙËÓ ÂÏÏËÓÈÎ‹ Î·È ÙËÓ ·ÁÁÏÈÎ‹ ÂÚ›ÏË„Ë ÛËÌÂÈÒ-ÓÔÓÙ·È ÙÚÂÈ˜ ¤ˆ˜ ¤ÓÙÂ Ï¤ÍÂÈ˜ ÎÏÂÈ‰È¿ Ô˘ ı· ¯ÚËÛÈÌÔÔÈËıÔ‡ÓÁÈ· 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‹ ÂÚÈÏ·Ì‚¿ÓÂÈÙ· ÙÂÏÂ˘Ù·›· ‰Â‰ÔÌ¤Ó· ÙË˜ ¤ÚÂ˘Ó·˜ ÛÙÔ Û˘ÁÎÂÎÚÈÌ¤ÓÔ ı¤Ì· ÌÂÙÈ˜ Î˘ÚÈfiÙÂÚÂ˜ ‚È‚ÏÈÔÁÚ·ÊÈÎ¤˜ ·Ú·ÔÌ¤˜ Î·È ÙÔÓ ÛÎÔfi ÙË˜ÂÚÁ·Û›·˜. H ÂÚÈÁÚ·Ê‹ ÙˆÓ ÌÂıfi‰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 Ó· ·Ó·Ê¤ÚÔÓÙ·ÈÌÂ ÏÂÙÔÌ¤ÚÂÈÂ˜ ÔÈ ÛÙ·ÙÈÛÙÈÎ¤˜ Ì¤ıÔ‰ÔÈ ·Ó¿Ï˘ÛË˜ Î·È ·ÍÈÔÏfi-ÁËÛË˜ 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· ÂÚÈÏ·Ì-‚¿ÓÂÈ Ù· Û˘ÌÂÚ¿ÛÌ·Ù· Ô˘ ÚÔÎ‡ÙÔ˘Ó ·fi ÙËÓ ÂÚÁ·Û›·, ÙËÛËÌ·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‡ÓÙÔÌËÂÈÛ·ÁˆÁ‹, ÂÚÈÁÚ·Ê‹ ÙË˜ ÂÚ›ÙˆÛË˜ Î·È ‚Ú·¯Â›· Û˘˙‹ÙËÛË,ÌÂ ¤ÌÊ·ÛË ÛÙË ‰È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË.

T· ˘fiÏÔÈ· ı¤Ì·Ù· ¤¯Ô˘Ó ÂÏÂ‡ıÂÚË ‰ÔÌ‹ Î·Ù¿ ÙËÓ ÎÚ›ÛËÙˆÓ Û˘ÁÁÚ·Ê¤ˆÓ ÙÔ˘˜.

∂˘¯·ÚÈÛÙ›Â˜ ‹ ·Ó·ÁÓˆÚ›ÛÂÈ˜ (·Ó·ÊÔÚ¿ ÛÂ ÂÈ‰ÔÙ‹ÛÂÈ˜-¯Ô-ÚËÁ›Â˜ ‹ ¿ÏÏÂ˜ ËÁ¤˜ ˘ÔÛÙ‹ÚÈÍË˜) ı· Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·ÈÛÙÔ 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¿˙Ô-

ÓÙ·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·È ÛÙÈ˜ ‰ÈÂ˘ı‡ÓÛÂÈ˜:http://www.icmje.org Î·È http://www.icmje.org/icmje.pdf

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

‰ËÌÔÛÈÂ‡ÔÓÙ·È ÛÂ Î¿ıÂ ÙÂ‡¯Ô˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. ™‡ÓıÂÙÔÈ Î·ÈÌ·ÎÚÔÛÎÂÏÂ›˜ fiÚÔÈ Ô˘ Â·Ó·Ï·Ì‚¿ÓÔÓÙ·È Û˘¯Ó¿ ÛÙÔ ÎÂ›ÌÂÓÔÌÔÚÔ‡Ó Ó· ·ÓÙÈÎ·ı›ÛÙ·ÓÙ·È ·fi Û˘ÓÙÔÌÔÁÚ·Ê›Â˜ Ô˘ ÂÂÍË-ÁÔ‡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 ÌfiÓÔ 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¤ÚÔÓÙ·ÈÛÙÔ ÎÂ›ÌÂÓÔ. ™ÙÔ ÎÂ›ÌÂÓÔ, ÔÈ ‚È‚ÏÈÔÁÚ·ÊÈÎ¤˜ ·Ú·ÔÌ¤˜ ·Ó·-Ê¤ÚÔÓÙ·È ÌÂ ·Ú·‚ÈÎÔ‡˜ ·ÚÈıÌÔ‡˜ ÛÂ ·Ú¤ÓıÂÛË. OÈ ‚È‚ÏÈÔÁÚ·-ÊÈÎ¤˜ ·Ú·ÔÌ¤˜ ‰ÂÓ Ú¤ÂÈ Ó· ˘ÂÚ‚·›ÓÔ˘Ó:

ñ ÙÈ˜ 70 ÛÙÈ˜ ·Ó·ÛÎÔ‹ÛÂÈ˜. ñ ÙÈ˜ 30 ÛÙÈ˜ ÂÚÂ˘ÓËÙÈÎ¤˜ ÂÚÁ·Û›Â˜. ñ ÙÈ˜ 12 ÛÙ· Â›Î·ÈÚ· ı¤Ì·Ù· Î·È ÙÈ˜ ÂÓ‰È·Ê¤ÚÔ˘ÛÂ˜ ÂÚÈ-

ÙÒÛÂÈ˜. ñ ÙÈ˜ 5 ÛÙÈ˜ ‚Ú·¯Â›Â˜ ‰ËÌÔÛÈÂ‡ÛÂÈ˜ Î·È ÙÈ˜ ÂÈÛÙÔÏ¤˜.

H Û‡ÓÙ·ÍË ÙˆÓ ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·ÔÌÒÓ Á›ÓÂÙ·ÈÛ‡ÌÊˆÓ· ÌÂ ÙÈ˜ ÚfiÛÊ·Ù· ÙÚÔÔÔÈËÌ¤ÓÂ˜ ÚÔ‰È·ÁÚ·Ê¤˜ ÙË˜International Committee of Medical Journal Editors/ Uniform Re-quirements for Manuscripts Sub-mitted to Biomedical Journals,(http://www.icmje.org Î·È http:// www.icmje.org/icmje.pdf). OÈÛ˘ÓÙÌ‹ÛÂÈ˜ ÙˆÓ Ù›ÙÏˆÓ ÙˆÓ ÂÚÈÔ‰ÈÎÒÓ Á›ÓÔÓÙ·È ÌÂ ‚¿ÛË ÙÔ Cu-mulated Index Medicus [List of Journals Indexed in Index Medicus(http://www.nlm.nih.gov/bsd/uniform_requirements.html)].

¶·Ú·‰Â›ÁÌ·Ù· ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·ÔÌÒÓ

I. ¶∂ƒπO¢π∫∞

AÓ ÔÈ Û˘ÁÁÚ·ÊÂ›˜ Â›Ó·È ¤ˆ˜ ¤ÍÈ, ·Ó·ÁÚ¿ÊÔÓÙ·È fiÏÔÈ, ÂÓÒ ·Ó

Â›Ó·È ÂÙ¿ ‹ ÂÚÈÛÛfiÙÂÚÔÈ, ·Ó·ÁÚ¿ÊÔÓÙ·È ÔÈ ÚÒÙÔÈ ¤ÍÈ Î·È ÚÔ-

ÛÙ›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 neonatal variant. Eur

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™˘ÌÏËÚˆÌ·ÙÈÎfi ÙÂ‡¯Ô˜ ÂÚÈÔ‰ÈÎÔ‡:

Flyvbjerg A. Role of growth hormone, insulin-like growth fac-

tors (IGFs) and IGF-binding proteins in the renal complications

of diabetes. Kidney Int 1997;52 (60 Suppl):S12-S19.

ÃˆÚ›˜ Û˘ÁÁÚ·Ê¤·:

National Institutes of Health Consensus Development

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¶ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù‡Ô˘ ¿ÚıÚÔ˘:

Schreiner GF, Lange L. Ethanol modulation of macrophage

influx in glomerulonephritis [Abstract]. J Am Soc Nephrol

1991;2:562.

Should antileukotriene therapies be used instead of inhaled

corticosteroids in asthma? [Editorial]. Am J Respir Crit Care Med

1998;158:1697-1701.

Laux-End R, Inaebnit D, Gerber HA, Bianchetti MG. Vasculi-

tis associated with levamisole and circulating autoantibodies [Let-

ter]. Arch Dis Child 1996;75:355-356.

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∫ÂÊ¿Ï·ÈÔ ÛÂ ‚È‚Ï›Ô:

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drome. In: Barratt TM, Arner ED, Harmon WE, editors. Pediatric

Nephrology. 4th ed. Baltimore: Lippincott William Wilkins; 1999.

p. 742.

™‡ÁÁÚ·ÌÌ· ‹ ÌÔÓÔÁÚ·Ê›·:

Gorlin RJ, Cohen MM, Levin LS. Syndromes of the head and

neck. 3rd ed. New York: Oxford University Press; 1990.

¢ËÌÔÛ›Â˘ÛË ÛÂ ÙfiÌÔ Ú·ÎÙÈÎÒÓ:

Bauer AW. The two definitions of bacterial resistance. In:

Smith AJ, Rogers CA, eds. Proceedings of the Third International

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¢È‰·ÎÙÔÚÈÎ‹ ‰È·ÙÚÈ‚‹:

¶··‰fiÔ˘ÏÔ˜ Ã. ∏ ıÂÚ·Â›· ÙÔ˘ ÛÙÚ·‚ÈÛÌÔ‡ [‰È‰·ÎÙÔÚÈ-

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

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xiv

xv

IV. ™∆O ¢π∞¢π∫∆ÀOÕÚıÚÔ ÛÂ ÂÚÈÔ‰ÈÎfi:

Abood S. Quality improvement initiative in nursing homes:the ANA acts in an advisory role. Am J Nurs [Internet]. 2002 Jun:Webpage:http://www.nursingworld.org/AJN/2002/june/Wawatch.htm

ªÔÓÔÁÚ·Ê›·:Foley KM, Gelband H, editors. Improving palliative care for

cancer [Monograph, Internet]. Washington: National AcademyPress; 2001. Webpage: http://www.nap.edu/books/0309074029/html

πÛÙÔÛÂÏ›‰Â˜:Cancer-Pain.org [Webpage, Internet]. New York: Association

of Cancer Online Resources, Inc.; 2002: http://www.cancer-pain.org/

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

ÙÔ·ÓÙ›ÁÚ·Ê·). ¶Ú¤ÂÈ Ó· ¤¯Ô˘Ó Ï¿ÙÔ˜ ›ÛÔ ÌÂ ÙÔ Ï¿ÙÔ˜ ÙÔ˘ÌÔÓfiÛÙËÏÔ˘ (7,5 cm) ‹ ÌÂ ÙÔ Ï¿ÙÔ˜ fiÏË˜ ÙË˜ ÛÂÏ›‰·˜ (15,5cm). TÔ Ì¤ÁÈÛÙÔ Ì‹ÎÔ˜ ÙÔ˘˜, Ì·˙› ÌÂ ÙÔ˘˜ Ù›ÙÏÔ˘˜, ‰ÂÓ Ú¤ÂÈ Ó·Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ ·fi 22 cm.

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

ŸÏÔ ÙÔ ·ÂÈÎÔÓÈÛÙÈÎfi ˘ÏÈÎfi (Û¯‹Ì·Ù·, ‰È·ÁÚ¿ÌÌ·Ù·, ÊˆÙÔ-ÁÚ·Ê›Â˜, Î.Ï.) ¯·Ú·ÎÙËÚ›˙ÂÙ·È ˆ˜ ÂÈÎfiÓÂ˜ Î·È ı· Ú¤ÂÈ Ó· Â›-Ó·È ¿ÚÈÛÙË˜ ÔÈfiÙËÙ·˜. ™ÙÔ ›Ûˆ Ì¤ÚÔ˜ ÙˆÓ ÂÈÎfiÓˆÓ Ú¤ÂÈ Ó·ÛËÌÂÈÒÓÂÙ·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¤ÂÈÓ· ·Ó·ÁÓˆÚ›˙ÂÙ·È Ë Ù·˘ÙfiÙËÙ¿ ÙÔ˘˜. OÈ ·ÛıÂÓÂ›˜ ‰ÂÓ Ú¤ÂÈ Ó··Ó·Ê¤ÚÔÓÙ·È ÔÓÔÌ·ÛÙÈÎ¿.

°. ÀÔ‚ÔÏ‹ Î·È ¢ËÌÔÛ›Â˘ÛË ÙˆÓ ∂ÚÁ·ÛÈÒÓŸÏÂ˜ ÔÈ ÂÚÁ·Û›Â˜ Ú¤ÂÈ Ó· ˘Ô‚¿ÏÏÔÓÙ·È ÂÈ˜ ÙÚÈÏÔ‡Ó Î·È

Ó· Û˘ÓÔ‰Â‡ÔÓÙ·È ·fi ‰ÈÛÎ¤Ù· ‹ CD, Î·ıÒ˜ Î·È ·fi ÂÈÛÙÔÏ‹,Ë ÔÔ›· ı· Û˘Ó˘ÔÁÚ¿ÊÂÙ·È ·fi fiÏÔ˘˜ ÙÔ˘˜ Û˘ÁÁÚ·ÊÂ›˜, ÛÙËÓÔÔ›· ı· ‰ËÏÒÓÂÙ·È fiÙÈ Ë ÂÚÁ·Û›· ‰ÂÓ ¤¯ÂÈ ÂÓ Ì¤ÚÂÈ ‹ ÂÍ ÔÏÔ-ÎÏ‹ÚÔ˘ ‰ËÌÔÛÈÂ˘ıÂ› ‹ ˘Ô‚ÏËıÂ› ÁÈ· ÎÚ›ÛË ÛÂ ¿ÏÏÔ ÂÚÈÔ‰ÈÎfiÎ·È fiÙÈ ÔÈ Û˘ÁÁÚ·ÊÂ›˜ ÂÁÎÚ›ÓÔ˘Ó ÙË ‰ËÌÔÛ›Â˘Û‹ ÙË˜ ÛÙÔ ÂÚÈÔ-‰ÈÎfi “¶·È‰È·ÙÚÈÎ‹”. ∂ÈÏ¤ÔÓ, ı· Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È Ù˘¯fiÓÂÈ‰ÔÙ‹ÛÂÈ˜-¯ÔÚËÁ›Â˜ ‹ ¿ÏÏÂ˜ ËÁ¤˜ ˘ÔÛÙ‹ÚÈÍË˜.

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

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

T· ¤ÍÔ‰· ÙˆÓ ÊÈÏÌ Î·È ÙˆÓ ·Ó·Ù‡ˆÓ ‚·Ú‡ÓÔ˘Ó ÙÔ˘˜ Û˘Á-ÁÚ·ÊÂ›˜ Î·È Ú¤ÂÈ Ó· ÏËÚÒÓÔÓÙ·È ÌÂ ÙËÓ ·ÔÛÙÔÏ‹ ÙÔ˘ ÚÒ-ÙÔ˘ ‰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, ÂÊfi-ÛÔÓ ˙ËÙËıÂ› ÂÓÙfi˜ ÂÍ·Ì‹ÓÔ˘, Ù· Û¯‹Ì·Ù· Î·È ÔÈ ÊˆÙÔÁÚ·Ê›Â˜Ô˘ Ù· Û˘ÓÔ‰Â‡Ô˘Ó.

OÈ ÂÚÁ·Û›Â˜ Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È ÚÔ˜ ÎÚ›ÛË ÁÈ· ‰ËÌÔÛ›Â˘ÛËÛÙÔ ÂÚÈÔ‰ÈÎfi “¶·È‰È·ÙÚÈÎ‹” ·ÔÛÙ¤ÏÏÔÓÙ·È ÂÈ˜ ÙÚÈÏÔ‡Ó ÛÙË‰ÈÂ‡ı˘ÓÛË:

™˘ÓÙ·ÎÙÈÎ‹ EÈÙÚÔ‹, EÏÏËÓÈÎ‹ ¶·È‰È·ÙÚÈÎ‹ EÙ·ÈÚÂ›·MÈ¯·Ï·ÎÔÔ‡ÏÔ˘ 92, 115 28 Aı‹Ó·

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

1. 3 ·ÓÙ›ÁÚ·Ê· ÙÔ˘ ÎÂÈÌ¤ÓÔ˘ ÙË˜ ÂÚÁ·Û›·˜, Ù˘ˆÌ¤Ó· Û‡Ì-ÊˆÓ· ÌÂ ÙÈ˜ Ô‰ËÁ›Â˜.

2. ¢ÈÛÎ¤Ù· ‹ CD ÌÂ fiÏÔ ÙÔ ˘ÏÈÎfi ÙË˜ ÂÚÁ·Û›·˜ (ÎÂ›ÌÂÓÔ, ›Ó·ÎÂ˜, ÂÈÎfiÓÂ˜).

3. ∂ÈÛÙÔÏ‹ ˘Ô‚ÔÏ‹˜ Î·È ‰‹ÏˆÛË ÌË ÚÔÁÂÓ¤ÛÙÂÚË˜ ‰ËÌÔ-Û›Â˘ÛË˜ 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· ·ÏÏËÏÔ-

ÁÚ·Ê›·. 5. ¶ÂÚ›ÏË„Ë ÂÏÏËÓÈÎ‹-·ÁÁÏÈÎ‹, ‰ÔÌËÌ¤ÓË ÛÙÈ˜ ÂÍ‹˜ ·Ú·-

ÁÚ¿ÊÔ˘˜: ÂÈÛ·ÁˆÁ‹, Ì¤ıÔ‰ÔÈ, ·ÔÙÂÏ¤ÛÌ·Ù· Î·È Û˘ÌÂÚ¿-ÛÌ·Ù·, Î·ıÒ˜ Î·È Ï¤ÍÂÈ˜ ÎÏÂÈ‰È¿ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈ-ÛÙ‹ ÛÂÏ›‰·).

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

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

ÚËÁ›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˜ ÙÔ ÔÔ›Ô Ó· ‰Â›¯ÓÂÈ

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

ÛÂÏ›‰·) ÂÈ˜ ÙÚÈÏÔ‡Ó.

xvi ™À¡∆√ª√°ƒ∞ºπ∂™ ABBREVIATIONS

Ao

angstrom angstromcal ıÂÚÌ›‰· caloriecm ÂÎ·ÙÔÛÙfi centimetercm2 ÙÂÙÚ·ÁˆÓÈÎfi ÂÎ·ÙÔÛÙfi square centimetercm3 Î˘‚ÈÎfi ÂÎ·ÙÔÛÙfi cubic centimeteroC ‚·ıÌfi˜ ∫ÂÏÛ›Ô˘ degree Celsiusg ÁÚ·ÌÌ¿ÚÈÔ gramh ÒÚ· hourIU ‰ÈÂıÓ‹˜ ÌÔÓ¿‰· international unitkg ¯ÈÏÈfiÁÚ·ÌÌÔ kilograml Ï›ÙÚÔ literm Ì¤ÙÚÔ metermg ¯ÈÏÈfiÁÚ·ÌÌÔ milligrammin ÏÂÙfi minutemm ¯ÈÏÈÔÛÙfiÌÂÙÚÔ millimetermol ÁÚ·ÌÌÔÌfiÚÈÔ molen ·ÚÈıÌfi˜ numberNS ‹ ª™ ÌË ÛËÌ·ÓÙÈÎfi not significantosm ÔÛÌÒÏÈÔ osmole

p Èı·ÓfiÙËÙ· probabilitySD ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË standard deviationSE ÛÙ·ıÂÚfi ÛÊ¿ÏÌ· standard errorsec ‰Â˘ÙÂÚfiÏÂÙÔ secondU ÌÔÓ¿‰· unit

™˘Ó‰˘·˙fiÌÂÓ· ÚÔı¤Ì·Ù· Combining prefixes

tera- (1012) Tgiga- (109) Gmega- (106) Mkilo- (103) khector- (102) hdeca- (101) dadeci- (10-1) dcenti- (10-2) cmilli- (10-3) mmicro- (10-6) Ìnano- (10-9) npico- (10-12) pfemto- (10-15) fatto- (10-18) a

xixINSTRUCTIONS TO AUTHORS

A. General InformationThe Greek Paediatric Society is the owner of “Paedia-

triki”, its official scientific journal, which is distributed to

its members. Its objectives are the publication of paediatric

scientific work and the continuing education of paediatri-

cians. For this purpose, it publishes a variety of articles, and

in particular:

1. Editorials (upon invitation by the Editorial Board).

2. Review articles.

3. Award-winning articles.

4. Original articles.

5. Clinical Quiz.

6. Round tables.

7. Current issues.

8. Issues of healthcare management and education.

9. Case reports.

10. News.

11. Brief reports.

12. Letters to the editor.

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Text

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xx

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ñ 70 in review articles; ñ 30 in original articles; ñ 12 in current issues and case reports; ñ 5 in brief reports and letters.

In listing references follow the recently modified standards ofthe International Committee of Medical Journal Editors/UniformRequirements for Manuscripts Submitted to Biomedical Journals,(http://www.icmje.org and http:// www.icmje.org/icmje.pdf). Ab-breviated names of journals should conform to the Cumulated In-dex Medicus [List of Journals Indexed in Index Medicus (http://www.nlm.nih.gov/bsd/uniform_requirements.html)].

Examples of reference style

I. JOURNALSAll authors are cited if they are six or less; if they are 7 or more,

the first six are cited, followed by “et al”.

Regular edition:Proesmans W. Bartter syndrome and its neonatal variant. Eur

J Pediatr 1997;156:669-679.

Supplement issue:Flyvbjerg A. Role of growth hormone, insulin-like growth fac-

tors (IGFs) and IGF-binding proteins in the renal complicationsof diabetes. Kidney Int 1997;52 (60 Suppl):S12-S19.

No author:National Institutes of Health Consensus Development Con-

ference. Neurofibromatosis conference statement. Arch Neurol1988;45:575-578.

Article type specification:Schreiner GF, Lange L. Ethanol modulation of macrophage in-

flux in glomerulonephritis [Abstract]. J Am Soc Nephrol 1991;2:562.

Should antileukotriene therapies be used instead of inhaledcorticosteroids in asthma? [Editorial]. Am J Respir Crit Care Med1998;158:1697-1701.

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

II. BOOKSChapter in book:

Clark AG, Barratt TM. Steroid-responsive nephrotic syndrome.

In: Barratt TM, Arner ED, Harmon WE, editors. PediatricNephrology. 4th ed. Baltimore: Lippincott William Wilkins; 1999.p. 742.

Book or monograph:Gorlin RJ, Cohen MM, Levin LS. Syndromes of the head and

neck. 3rd ed. New York: Oxford University Press; 1990.

Publication in a volume of proceedings:Bauer AW. The two definitions of bacterial resistance. In:

Smith AJ, Rogers CA, eds. Proceedings of the Third InternationalCongress of Chemotherapy; 1962 May 29-31; New York: Interna-tional Society of Chemotherapy; 1963. p. 484-500.

Doctoral dissertation:Kaplan SJ. Post hospital home health care: the elderly’s access

and utilization [dissertation]. St. Louis (Mo): Washington Univ.;1995.

πππ. CD-ROMAnderson SC, Poulsen KB. Anderson’s electronic atlas of

hematology [CD-ROM]. Philadelphia: Lippincott Williams &Wilkins; 2002.

IV. ON THE INTERNETArticle in journal

Abood S. Quality improvement initiative in nursing homes: theANA acts in an advisory role. Am J Nurs [Internet]. 2002 Jun: Web-page: http://www.nursingworld.org/ AJN/2002/june/Wawatch.htm

MonographFoley KM, Gelband H, editors. Improving palliative care for

cancer [Monograph, Internet]. Washington: National AcademyPress; 2001. Webpage: http://www.nap.edu/books/0309074029/html

WebsitesCancer-Pain.org [Webpage, Internet]. New York: Association

of Cancer Online Resources, Inc.; 2002: http://www.cancer-pain.org/

Tables and FiguresThree copies should be submitted (original plus 2 copies).

Their width should either be equal to the width of one column(7.5 cm) or to the width of the page (15.5 cm). Their maximumlength, titles included, should not exceed 22 cm.

Tables are numbered with Arabic numerals in the order inwhich they appear in the text. They should have a short title andabbreviations should be listed at the bottom. Vertical lines in ta-bles should be avoided.

All illustration material is considered as figures (graphs, pic-tures, etc.). They should be of excellent quality. Also, at the backof every picture, the number of the picture and the name of thefirst author should be noted in pencil, with an arrow showing thetop of the picture. The identity of patients should not be recogniz-able from their pictures nor should their names be stated.

C. Manuscript Submission and PublicationAll manuscripts should be accompanied by a floppy disk or

CD, as well as by a letter, signed by all the authors, in which it isstated that the paper has not been published in part or in whole,or is not under consideration by another journal and that the au-thors accept its publication in “Paediatriki”. Any funding, spon-sorship or other financial support should be acknowledged.

Once the manuscript has been accepted, the corrected version,rewritten according to the reviewers’ recommendations should besubmitted to the Editorial Board accompanied by a floppy disk orCD, containing the paper in Word format, along with a coveringletter specifying in detail the modifications or objections to the re-viewers’ suggestions.

Delay in submission of the modified paper exceeding 30days entails new submission.

Authors will be charged film and reprint expenses, paid upondispatch of the first proof directly to the printer.

Manuscripts of papers which have not been approved for pub-lication are not returned to the author. The accompanying figuresand photographs can be returned upon request within six months.

Manuscripts submitted for review and publication in “Paedi-atriki” should be sent in three copies to the following address:Editorial Board, Greek Paediatric Society92, Michalakopoulou Street, 115 28 Athens, Greece

Before submitting your paper, make sure it contains:1. 3 copies of the text of the paper, printed according to in-

structions.2. A floppy disk or CD with the entire material of the paper

(text, tables, pictures).

3. A covering letter and a statement that the paper has not beenpreviously published.

4. The title page (on a separate page), which includes: a. the title and short title of the paper; b. the name and surname (full name)of the author(s); c. the academic centre(s) of origin; d. the corresponding authors’ name, address and telephone

number; 5. English and Greek abstracts, with the following structure:

background, methods, results and conclusions (double space,separate page) and keywords.

6. List of abbreviations (double space, separate page).7. Text (double space, separate page).8. Acknowledgements and reference to funding, sponsorships

or other financial sources.9. References (double space, separate page).

10. Tables (one per page) in three copies.11. Figures with an arrow at the back showing the top, num-

bered, in two copies.12. Figure titles (double space - on separate pages) in three

copies.

“√È ÂÚ›ÔÏÔÈ ÙË˜ÂÈÚ‹ÓË˜”Diana Marcela Cortes,10 ¯ÚÔÓÒÓ, ∫ÔÏÔÌ‚›·¶·È‰› ÌÂ ÌÂÚÈÎ‹ fiÚ·ÛË

“∆· Ù˘ÊÏ¿ ·È‰È¿˙ˆÁÚ·Ê›˙Ô˘Ó”, ÕÓÓ· §·Ô˘Ù¿ÚË-°ÎÚÈÙ˙¿Ï·, ∞ı‹Ó· 2006

“The patrol of thePeace”, Diana Marcela Cortes,10 years old, ColombiaPartially blind child

“Blind children

paint”, Anna Laoutari-Gritzala,Athens 2006

xxi

1∞¡∞™∫√¶∏™∏ REVIEW ARTICLE

¶·È‰È·ÙÚÈÎ‹ 2007;70:1-17

1 Cincinnati Children’sHospital Medical Center,Dept of PediatricNeurology

2 ¶·ÓÂÈÛÙËÌÈ·Îfi¡ÔÛÔÎÔÌÂ›Ô §¿ÚÈÛ·˜,∆Ì‹Ì· ¡Â˘ÚÔÏÔÁ›·˜

AÏÏËÏÔÁÚ·Ê›·:

∞ÚÁ‡ÚË˜ ¡ÙÈÓfiÔ˘ÏÔ˜[email protected]

1 Cincinnati Children’sHospital Medical Center,Dept of PediatricNeurology

2 University Hospital ofLarissa, Dept ofNeurology

Correspondence:

Argirios [email protected]

ªÈÙÔ¯ÔÓ‰ÚÈ·Î¿ ÓÔÛ‹Ì·Ù· ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜

∞. ¡ÙÈÓfiÔ˘ÏÔ˜1, ∞. ¶··‰ËÌËÙÚ›Ô˘2

¶ÂÚ›ÏË„Ë: ∆· ÌÈÙÔ¯ÔÓ‰ÚÈ·Î¿ ÓÔÛ‹Ì·Ù· ·ÔÙÂÏÔ‡Ó ÌÈ· ÔÌ¿‰· ÛÔÚ·‰ÈÎÒÓ ‹ ÎÏËÚÔÓÔÌÔ‡ÌÂÓˆÓ ÓÔ-ÛËÌ¿ÙˆÓ Ù· ÔÔ›· ÚÔÎ·ÏÔ‡ÓÙ·È ·fi ÌÂÙ·ÏÏ¿ÍÂÈ˜ ÁÔÓÈ‰›ˆÓ ÙÔ˘ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ ‹ ˘ÚËÓÈÎÔ‡ DNA Ô˘Îˆ‰ÈÎÔÔÈÔ‡Ó ÚˆÙÂ˝ÓÂ˜ ··Ú·›ÙËÙÂ˜ ÁÈ· ÙË ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ÌÈÙÔ¯ÔÓ‰Ú›Ô˘. ∏ ÈÔ Û˘¯Ó‹ ‰È·Ù·Ú·¯‹ ·ÊÔ-Ú¿ ÙËÓ ÔÍÂÈ‰ˆÙÈÎ‹ ÊˆÛÊÔÚ˘Ï›ˆÛË Î·È ÔÊÂ›ÏÂÙ·È ÛÂ ·ÓÂ·ÚÎ‹ ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ Û˘ÌÏÂÁÌ¿ÙˆÓ (I-V) ÙË˜·Ó·ÓÂ˘ÛÙÈÎ‹˜ ·Ï˘Û›‰·˜ ÌÂ ·ÔÙ¤ÏÂÛÌ· ÙË ÌÂÈˆÌ¤ÓË ÂÓ‰ÔÎ˘ÙÙ·ÚÈÎ‹ ·Ú·ÁˆÁ‹ ÂÓ¤ÚÁÂÈ·˜. ∂ÈÚÔÛı¤-Ùˆ˜ Ë ÚÔÛ‚ÔÏ‹ ¿ÏÏˆÓ ÏÂÈÙÔ˘ÚÁÈÒÓ ÙÔ˘ ÌÈÙÔ¯ÔÓ‰Ú›Ô˘, fiˆ˜ ÙË˜ ÚˆÙÂ˚ÓÈÎ‹˜ Û‡ÓıÂÛË˜, ÙË˜ ‰È·ÌÂÌ-‚Ú·ÓÈÎ‹˜ ÌÂÙ·ÊÔÚ¿˜, ÙË˜ Û˘Ó·ÚÌÔÏfiÁËÛË˜ ÙˆÓ Û˘ÌÏÂÁÌ¿ÙˆÓ, ÙË˜ Û˘ÓÙ‹ÚËÛË˜ ÙÔ˘ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡DNA ÌÔÚÂ› Ó· ÚÔÎ·Ï¤ÛÔ˘Ó ÌÈÙÔ¯ÔÓ‰ÚÈ·Î‹ ÓfiÛÔ. ¶ÚfiÎÂÈÙ·È ÁÈ· ÔÏ˘Û˘ÛÙËÌ·ÙÈÎ¿ ÓÔÛ‹Ì·Ù· ÌÂ ÂÎ-‰ËÏÒÛÂÈ˜ ·fi ÙÔ ÎÂÓÙÚÈÎfi ÓÂ˘ÚÈÎfi Î·È ÓÂ˘ÚÔÌ˘˚Îfi Û‡ÛÙËÌ·, ÙÔ˘˜ ÔÊı·ÏÌÔ‡˜, ÙËÓ Î·Ú‰È¿, ÙÔ˘˜ ÓÂ-ÊÚÔ‡˜, ÙÔÓ Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ, ÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi Î·È ÂÓ‰ÔÎÚÈÓÈÎfi Û‡ÛÙËÌ·. ∏ ‰È·ÁÓˆÛÙÈÎ‹ ÚÔÛ¤Ï·ÛËÂ›Ó·È ‰‡ÛÎÔÏË ÏfiÁˆ ÙË˜ ¿Ù˘Ë˜ ÎÏÈÓÈÎ‹˜ ÂÈÎfiÓ·˜, ·Ô˘Û›·˜ ·ıÔÁÓˆÌÔÓÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ Î·È ÂÓ‰ÔÁÂÓÒÓÂÚÈÔÚÈÛÌÒÓ ÛÙËÓ ·ÍÈÔÏfiÁËÛË ÙˆÓ ‚ÈÔ¯ËÌÈÎÒÓ Î·È ÌÔÚÈ·ÎÒÓ ÂÍÂÙ¿ÛÂˆÓ. °È· Ù· ·È‰È¿ ¤¯Ô˘Ó ÚÔÙ·ıÂ›ÙÚÔÔÔÈËÌ¤Ó· ‰È·ÁÓˆÛÙÈÎ¿ ÎÚÈÙ‹ÚÈ· Ù· ÔÔ›· ÂÓÛˆÌ·ÙÒÓÔ˘Ó ÎÏÈÓÈÎ¿, ‚ÈÔ¯ËÌÈÎ¿, ÂÓ˙˘ÌÈÎ¿, ÈÛÙÔ·ıÔ-ÏÔÁÈÎ¿ Î·È ÌÔÚÈ·Î¿ ‰Â‰ÔÌ¤Ó·. ∏ ÌÔÚÈ·Î‹ ‰È¿ÁÓˆÛË Ú¤ÂÈ Ó· ·ÔÙÂÏÂ› ÙÔÓ ÙÂÏÈÎfi ÛÙfi¯Ô ÁÈ·Ù› ÌfiÓÔÓ¤ÙÛÈ ÌÔÚÂ› Ó· Â›Ó·È ‰˘Ó·Ù‹ Ë ÁÂÓÂÙÈÎ‹ Û˘Ì‚Ô˘Ï‹ Î·È Î·ıÔ‰‹ÁËÛË. ∞Ó Î·È ·ÈÙÈÔÏÔÁÈÎ‹ ıÂÚ·Â›· ÙˆÓ ÌÈ-ÙÔ¯ÔÓ‰ÚÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ ‰ÂÓ ˘¿Ú¯ÂÈ, ÔÏÏ¿ ‰Â˘ÙÂÚÔ·ı‹ ÚÔ‚Ï‹Ì·Ù· ¯Ú‹˙Ô˘Ó ·ÓÙÈÌÂÙÒÈÛË˜. ∏·Ó·ÛÎfiËÛË ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ÈÔ ÚfiÛÊ·ÙË ÁÓÒÛË Û¯ÂÙÈÎ¿ ÌÂ ÙÔ ÁÂÓÂÙÈÎfi ˘fi‚·ıÚÔ, ·ıÔÁÂÓÂÙÈÎÔ‡˜ÌË¯·ÓÈÛÌÔ‡˜, ÎÏÈÓÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜, ‰È·ÁÓˆÛÙÈÎ‹ ÚÔÛ¤Ï·ÛË Î·È ıÂÚ·Â˘ÙÈÎ‹ ÛÙÚ·ÙËÁÈÎ‹ ÙˆÓ ÌÈÙÔ¯ÔÓ-‰ÚÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ªÈÙÔ¯ÔÓ‰ÚÈ·Î¿ ÓÔÛ‹Ì·Ù·, ÁÂÓÂÙÈÎ‹, ÔÏ˘Û˘ÛÙËÌ·ÙÈÎ¿ ÓÔÛ‹Ì·Ù·, ÁÂÓÂÙÈÎ‹ Î·ıÔ‰‹ÁËÛË.

Mitochondrial disorders in childhood

A. Dinopoulos1, A. Papadimitriou2

Abstract: Mitochondrial disorders are caused by mutations, either sporadic or inherited, in nuclear ormitochondrial DNA genes which encode proteins essential for the mitochondrial function. The mostcommon level of dysfunction is primary or secondary compromise of respiratory chain activity, leading toimpaired oxygen utilization and reduced intracellular energy production. Other mitochondrial functionscan be impaired, such as intergenomic signalling, assembling, transport and mitochondrial motility.Mitochondrial disorders are usually multisystem disorders involving predominantly tissues or organs withhigh oxygen and energy demands, such as skeletal muscle, myocardium, brain, eyes, ears, kidneys,intestines and bone marrow. Several mitochondrial syndromes have been described, but many patientsand particularly children, who meet the morphological, biochemical and/or molecular criteria for amitochondrial disorder, do not fall into a syndrome phenotype. During childhood the clinical and geneticheterogeneity and the absence of “gold standards” makes the diagnostic evaluation challenging.Generally the diagnostic approach has to be individualized and requires an integral approach,incorporating clinical, biochemical, imaging, histological and genetic investigations. Consensus diagnosticcriteria have been proposed for respiratory chain defects in infants and children and, despite somelimitations, they appear to be sensitive in the paediatric population. The diagnostic efforts should aim atthe genetic characterization, because under certain circumstances this may provide the framework forgenetic counselling. Although there is no specific therapy and cure for the mitochondrial diseases, manysecondary problems require specific treatment. This review summarizes present knowledge about thegenetic background, pathogenetic mechanisms, clinical manifestations, diagnostic approach andtherapeutic strategies of mitochondriopathies.

Key words: Mitochondrial disorders, genetics, multisystem disorders, genetic counselling.

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ÚÈÎ‹ ÌÂÌ‚Ú¿ÓË Â›Ó·È ÏÈÈ‰ÈÎ‹ Î·È Â›Ó·È ˘Â‡ı˘ÓË ÁÈ·

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‰·˜, ··Ú·›ÙËÙ· ÁÈ· ÙËÓ ÔÍÂÈ‰ˆÙÈÎ‹ ÊˆÛÊÔÚ˘Ï›ˆÛË,

‚Ú›ÛÎÔÓÙ·È ÛÙÈ˜ ·ÎÚÔÏÔÊ›Â˜ Ô˘ Û¯ËÌ·Ù›˙ÔÓÙ·È ·fi

·Ó·‰ÈÏÒÛÂÈ˜ ÙË˜ ÂÛˆÙÂÚÈÎ‹˜ ÌÂÌ‚Ú¿ÓË˜.

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Â˘ÛË ÙˆÓ Luft et al. Î·È ÙËÓ ÂÚÈÁÚ·Ê‹ ÂÓfi˜ ·ÛıÂ-

ÓÔ‡˜ ÌÂ ˘ÂÚÌÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ ÌÈÙÔ¯ÔÓ‰ÚÈ·Î‹˜

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ÓÂ˘ÛÙÈÎ‹ ·Ï˘Û›‰· ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›· ˘ÔÏÔÁ›˙Â-

Ù·È ÌÂÙ·Í‡ 1/5.000 Î·È 1/11.000 ÁÂÓÓ‹ÛÂÈ˜ (2,3), ÂÓÒ

∂ÈÎfiÓ· 1. ªÂÙ·‚ÔÏÈÎ¤˜ Ô‰Ô› ÛÙÔ ÌÈÙÔ¯fiÓ‰ÚÈÔ: ∞Ó·ÁˆÁÈÎ¿ ÈÛÔ‰‡Ó·Ì· (NADH, FADH2) Û˘ÓÙ›ıÂÓÙ·È ·fi ÙÔ˘˜ ˘‰·Ù¿ÓıÚ·ÎÂ˜ Ì¤Ûˆ ÙÔ˘Î‡ÎÏÔ˘ ÙÔ˘ Krebs Î·È ·fi Ù· ÏÈ·Ú¿ ÔÍ¤· Ì¤Ûˆ ÙË˜ ‚-ÔÍÂ›‰ˆÛË˜ Î·È ÂÈÛ¤Ú¯ÔÓÙ·È ÌÂ ÙË ÌÔÚÊ‹ ËÏÂÎÙÚÔÓ›ˆÓ ÛÂ ‰È·ÊÔÚÂÙÈÎ¿ ÛËÌÂ›· ÙË˜·Ï˘Û›‰·˜. ∏ÏÂÎÙÚfiÓÈ· ·fi NADH (ÁÏÔ˘Ù·ÌÈÎfi, ˘ÚÔÛÙ·Ê˘ÏÈÎfi, 3√∏-‚Ô˘Ù˘ÚÈÎfi ÔÍ‡ Î·È ÏÈ·Ú¿ ÔÍ¤·) ÚÔÛ‰›‰ÔÓÙ·È ÛÙÔ Û‡ÌÏÂÁÌ· I,ËÏÂÎÙÚfiÓÈ· ·fi FADH2 (ÛÔ˘ÎÈÓÈÎfi) ÛÙÔ Û‡ÌÏÂÁÌ· II Î·È ËÏÂÎÙÚfiÓÈ· ·fi FADH2 (ÏÈ·Ú¿ ÔÍ¤·) ·Â˘ıÂ›·˜ ÛÙÔ Û˘Ó¤Ó˙˘ÌÔ Q. ™ÙË Û˘-Ó¤¯ÂÈ· ÌÂ ÙË ‚Ô‹ıÂÈ· ÙÔ˘ Û˘ÓÂÓ˙‡ÌÔ˘ Q Ù· ËÏÂÎÙÚfiÓÈ· ÌÂÙ·Ê¤ÚÔÓÙ·È ·fi Ù· Û˘ÌÏ¤ÁÌ·Ù· π Î·È ππ ÛÙÔ Û‡ÌÏÂÁÌ· πππ Î·È ·ÎÔÏÔ‡ıˆ˜,Ì¤Ûˆ ÙÔ˘ Î˘ÙÔ¯ÚÒÌ·ÙÔ˜ c, ÂÚÓÔ‡Ó ÛÙÔ Û‡ÌÏÂÁÌ· IV. ∏ ÂÓ¤ÚÁÂÈ· Ô˘ ·ÂÏÂ˘ıÂÚÒÓÂÙ·È ·fi ÙË ÚÔ‹ ÙˆÓ ËÏÂÎÙÚÔÓ›ˆÓ Î·Ù¿ Ì‹ÎÔ˜ ÙˆÓÛ˘ÌÏÂÁÌ¿ÙˆÓ π, ππ, πππ, IV ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÁÈ· ÙËÓ ¿ÓÙÏËÛË ÚˆÙÔÓ›ˆÓ ·fi ÙË ıÂÌ¤ÏÈ· Ô˘Û›· ÛÙÔÓ ‰È·ÌÂÌ‚Ú·ÓÈ·Îfi ¯ÒÚÔ Î·È ÙË ‰ËÌÈ-Ô˘ÚÁ›· ËÏÂÎÙÚÔ¯ËÌÈÎ‹˜ ‰È·ÊÔÚ¿˜ ‰˘Ó·ÌÈÎÔ‡ (¢„). ∏ ‰˘Ó·ÌÈÎ‹ ·˘Ù‹ ÂÓ¤ÚÁÂÈ·, ·ÔıËÎÂ˘Ì¤ÓË ˆ˜ ¢„, ¿ÁÂÈ ÙË Û‡ÓıÂÛË ATP ·fi ADPÌ¤Ûˆ ÙÔ˘ Û˘ÌÏ¤ÁÌ·ÙÔ˜ V (ATP Û˘ÓıÂÙ¿ÛË˜), ÌÂ Ù·˘Ùfi¯ÚÔÓË Â·Ó·ÊÔÚ¿ ÙˆÓ ÚˆÙÔÓ›ˆÓ ÛÙË ıÂÌ¤ÏÈ· Ô˘Û›· (6).

∞Ï·Ó›ÓË°·Ï·ÎÙÈÎfi

¶˘ÚÔÛÙ·Ê˘ÏÈÎfi

¶∞ ¶∞-º

∞ÎÂÙ˘ÏÔCoA

NADH

∫ÈÙÚÈÎfi

πÛÔÎÈÙÚÈÎfi

√Í·ÏÔ·ÎÂÙÈÎfi

2-√∏-ÎÂÙÔÁÏ˘Ù·ÚÈÎfi

™Ô˘ÎÈÓ˘ÏÔÛ˘Ó¤Ó˙˘ÌÔ-∞

NADH

NADH

NADHª·ÏÈÎfi

ºÔ˘Ì·ÚÈÎfi

FADH2

FADH2

Û. ππ

Û. π

Û. πππ

Û. V

Û. IV√2

H2√

™˘ÓQ

™Ô˘ÎÈÓÈÎfi

ADP

ATP

H+

H+

∫˘Ùfi¯Ú. c

Tim

¶ÚˆÙÂ˝ÓÂ˜27,19

ATP

ADP

NADH

NAD+

NADH

NAD+

M-CK

ºˆÛÊÔ-ÎÚÂ·Ù›ÓË

∫ÚÂ·Ù›ÓË

∂ÍˆÙÂÚÈÎ‹ ªÈÙÔ¯ÔÓ‰ÚÈ·Î‹

ªÂÌ‚Ú¿ÓË

∂ÛˆÙÂÚÈÎ‹ ªÈÙÔ¯ÔÓ‰ÚÈ·Î‹

ªÂÌ‚Ú¿ÓË

µ-ÔÍÂ›‰ˆÛË ÙˆÓ ÏÈ·ÚÒÓ

ÔÍ¤ˆÓ

∂ÍˆÙÂÚÈÎ‹ ªÈÙÔ¯ÔÓ‰ÚÈ·Î‹

ªÂÌ‚Ú¿ÓË

∞ÓÈfiÓÙ· ATP, ADP

(ADP-ATP-ÙÚ·ÓÛÏÔÎ¿ÛË)

2 ∞. ¡ÙÈÓfiÔ˘ÏÔ˜, ∞. ¶··‰ËÌËÙÚ›Ô˘

Paediatriki 2007;70:1-17

Ë Û˘¯ÓfiÙËÙ· ÌÂÙ·ÏÏ¿ÍÂˆÓ ÙÔ˘ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ DNA

ÛÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜ ÂÎÙÈÌ¿Ù·È 1:8000 (4). ªÈ· Û¯ÂÙÈÎ¿

ÚfiÛÊ·ÙË ÌÂÏ¤ÙË ·fi ÙËÓ ∞˘ÛÙÚ·Ï›·, ‚·ÛÈÛÌ¤ÓË ÛÂ

ÎÚÈÙ‹ÚÈ· ÁÈ· ÙË ‰È¿ÁÓˆÛË, ˘ÔÏÔÁ›˙ÂÈ ÙÔÓ ÂÏ¿¯ÈÛÙÔ

ÂÈÔÏ·ÛÌfi ÙˆÓ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ ÛÙÈ˜

1/7634 ÁÂÓÓ‹ÛÂÈ˜ (5). √È ·ÓˆÙ¤Úˆ Û˘¯ÓfiÙËÙÂ˜ ‰ÂÓ

Ê·›ÓÂÙ·È fiÙÈ ·ÓÙ·ÔÎÚ›ÓÔÓÙ·È ÛÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ·

ÁÈ·Ù›, ÏfiÁˆ ÙË˜ ÂÙÂÚÔÁ¤ÓÂÈ·˜ ÙË˜ ÓfiÛÔ˘, ÌfiÓÔÓ ¤Ó·

ÔÛÔÛÙfi ·ÛıÂÓÒÓ ·Ú·¤ÌÔÓÙ·È ÛÂ ÂÈ‰ÈÎ¿ Î¤ÓÙÚ·

ÁÈ· ÙÂÎÌËÚ›ˆÛË ÙË˜ ‰È¿ÁÓˆÛË˜.

¶·ıÔÁ¤ÓÂÛË ÙˆÓ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ

∆Ô ÌÈÙÔ¯fiÓ‰ÚÈÔ ÂÚÈ¤¯ÂÈ ¤Ó· Î˘ÎÏÈÎfi DNA ÁÔÓÈ-

‰›ˆÌ· ÙÔ ÔÔ›Ô ·ÔÙÂÏÂ› ÙËÓ ‚¿ÛË ÙÔ˘ ‰ÈÎÔ‡ ÙÔ˘

ÁÂÓÂÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ∏ Îˆ‰ÈÎÔÔ›ËÛË ÙˆÓ ÌÈÙÔ-

¯ÔÓ‰ÚÈ·ÎÒÓ ÚˆÙÂ˚ÓÒÓ ‚Ú›ÛÎÂÙ·È ˘fi ÙËÓ ÂÈÚÚÔ‹

‰‡Ô ÁÂÓÂÙÈÎÒÓ Û˘ÛÙËÌ¿ÙˆÓ ÙÔ˘ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ Î·È

ÙÔ˘ ˘ÚËÓÈÎÔ‡. ∆Ô ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi DNA Îˆ‰ÈÎÔÔÈ-

Â› 13 ˘ÔÔÌ¿‰Â˜ ÙË˜ ·Ó·ÓÂ˘ÛÙÈÎ‹˜ ·Ï˘Û›‰·˜ Î·È

Ù· tRNAs Î·È rRNAs ··Ú·›ÙËÙ· ÁÈ· ÙË ÌÂÙ¿ÊÚ·Û‹

ÙÔ˘˜, ÂÓÒ Ô ÌÂÁ·Ï‡ÙÂÚÔ˜ ·ÚÈıÌfi˜ ˘ÔÔÌ¿‰ˆÓ Î·È

ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÒÓ ÚˆÙÂ˚ÓÒÓ Îˆ‰ÈÎÔÔÈÂ›Ù·È ·fi ÙÔ

˘ÚËÓÈÎfi DNA. ∏ ‰ÈÏ‹ ·˘Ù‹ ÁÂÓÂÙÈÎ‹ ÂÈÚÚÔ‹ ÙË˜

·Ó·ÓÂ˘ÛÙÈÎ‹˜ ·Ï˘Û›‰·˜ Â›Ó·È ˘Â‡ı˘ÓË ÁÈ· ÙÔ fiÙÈ

ÛÙ· ÌÈÙÔ¯ÔÓ‰ÚÈ·Î¿ ÓÔÛ‹Ì·Ù· ¤¯Ô˘Ó ÂÚÈÁÚ·ÊÂ›

fiÏÔÈ ÔÈ Ù‡ÔÈ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜. ∏ ÔÌ·Ï‹ ·Ú·Áˆ-

Á‹ ÂÓ¤ÚÁÂÈ·˜ ÛÙÔ ÌÈÙÔ¯fiÓ‰ÚÈÔ ··ÈÙÂ› ÙÔÓ Û˘ÓÙÔÓÈ-

ÛÌfi ÔÏÏÒÓ ÏÂÈÙÔ˘ÚÁÈÒÓ. ªÈÙÔ¯ÔÓ‰ÚÈ·Îfi ÓfiÛËÌ·

ÚÔÎ‡ÙÂÈ fiÙ·Ó Ë ÎÏËÚÔÓÔÌÔ‡ÌÂÓË ‹ ÛÔÚ·‰ÈÎ‹

‚Ï¿‚Ë ÛÙÔ ˘ÚËÓÈÎfi ‹ ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi DNA ÂËÚÂ-

¿ÛÂÈ ¤Ó· ·fi Ù· Â›Â‰· ÏÂÈÙÔ˘ÚÁ›·˜ fiˆ˜ ·Ó·ÁÚ¿-

ÊÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1 (7).

Ã·Ú·ÎÙËÚÈÛÙÈÎfi ÙˆÓ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÒÓ ÓÔÛËÌ¿-

ÙˆÓ Â›Ó·È Ë ÂÙÂÚÔÁ¤ÓÂÈ· ÛÙÔÓ ÎÏÈÓÈÎfi Ê·ÈÓfiÙ˘Ô.

°È· ÙËÓ ÂÍ‹ÁËÛË ÙË˜ Ê·ÈÓÔÙ˘ÈÎ‹˜ ÂÙÂÚÔÁ¤ÓÂÈ·˜

Â›Ó·È ÛËÌ·ÓÙÈÎfi Ó· Î·Ù·ÓÔËıÔ‡Ó ‰‡Ô ‚·ÛÈÎ¤˜ ·Ú-

¯¤˜: Ë ÂÙÂÚÔÏ·ÛÌ›· (heteroplasmy) Î·È Ô Ô˘‰fi˜

Ê·ÈÓÔÙ˘ÈÎ‹˜ ¤ÎÊÚ·ÛË˜ (threshold effect). ∫¿ıÂ

Î‡ÙÙ·ÚÔ ÂÚÈ¤¯ÂÈ ÌÂÁ¿ÏÔ ·ÚÈıÌfi ÌÈÙÔ¯ÔÓ‰Ú›ˆÓ

(Î˘Ì·›ÓÂÙ·È ·fi ÌÂÚÈÎ¤˜ ÂÎ·ÙÔÓÙ¿‰Â˜ Ì¤¯ÚÈ ÌÂÚÈ-

Î¤˜ ¯ÈÏÈ¿‰Â˜) Î·È Î¿ıÂ ÌÈÙÔ¯fiÓ‰ÚÈÔ ÂÚÈ¤¯ÂÈ 2-10

·ÓÙ›ÁÚ·Ê· ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ DNA. ∫·Ù¿ ÙË ÌÈÙˆÙÈ-

Î‹ ‰È·›ÚÂÛË ÙÔ Î‡ÙÙ·ÚÔ ‰›ÓÂÈ ¤Ó·Ó Ù˘¯·›Ô ·ÚÈıÌfi

ÌÈÙÔ¯ÔÓ‰Ú›ˆÓ ÛÙ· ı˘Á·ÙÚÈÎ¿ Î‡ÙÙ·Ú·, Ê·ÈÓfiÌÂÓÔ

Ô˘ ÔÓÔÌ¿˙Ô˘ÌÂ ÌÈÙˆÙÈÎfi ‰È·¯ˆÚÈÛÌfi (mitotic

segregation). ªÂÙ¿ÏÏ·ÍË ÙÔ˘ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ DNA

ÛÙÔ ÚÔÁÔÓÈÎfi Î‡ÙÙ·ÚÔ ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙË ‰Ë-

ÌÈÔ˘ÚÁ›· ‰‡Ô ÏËı˘ÛÌÒÓ ÌÈÙÔ¯ÔÓ‰Ú›ˆÓ ÛÙ· ı˘Á·-

ÙÚÈÎ¿ Î‡ÙÙ·Ú· (∂ÈÎfiÓ· 2), Ê·ÈÓfiÌÂÓÔ Ô˘ ÔÓÔÌ¿˙Â-

Ù·È ÂÙÂÚÔÏ·ÛÌ›· (heteroplasmy). ∫ÏÈÓÈÎ‹ Û˘ÌÙˆ-

Ì·ÙÔÏÔÁ›· ÂÌÊ·Ó›˙ÂÙ·È fiÙ·Ó ÙÔ ÔÛÔÛÙfi ÙˆÓ ÌÈÙÔ-

¯ÔÓ‰Ú›ˆÓ Ô˘ Ê¤ÚÔ˘Ó ÙË ÌÂÙ¿ÏÏ·ÍË ÍÂÂÚ¿ÛÂÈ ¤Ó·Ó

Û˘ÁÎÂÎÚÈÌ¤ÓÔ Ô˘‰fi ÛÙÔ Î‡ÙÙ·ÚÔ (Ô˘‰fi˜ Ê·ÈÓÔÙ˘È-

Î‹˜ ¤ÎÊÚ·ÛË˜/ threshold effect) Î·È Â›Ó·È ÈÎ·Ófi Ó·

ÂËÚÂ¿ÛÂÈ ÙËÓ ÂÓ‰ÔÎ˘ÙÙ¿ÚÈ· ·Ú·ÁˆÁ‹ ÂÓ¤ÚÁÂÈ·˜.

√ Ô˘‰fi˜ ÂÍ·ÚÙ¿Ù·È ·fi ÙÈ˜ ÂÓÂÚÁÂÈ·Î¤˜ ·Ó¿ÁÎÂ˜ ÙÔ˘

ÈÛÙÔ‡ Î·È ·fi ÙÔ Â›‰Ô˜ ÙË˜ ÌÂÙ¿ÏÏ·ÍË˜ (6,8).

∫ÏÈÓÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ & ªÈÙÔ¯ÔÓ‰ÚÈ·Î¿

Û‡Ó‰ÚÔÌ·

ªÈÙÔ¯ÔÓ‰ÚÈ·Î¿ ÓÔÛ‹Ì·Ù· ¤¯Ô˘Ó ÂÚÈÁÚ·ÊÂ› ÛÂ

fiÏÂ˜ ÙÈ˜ ËÏÈÎÈ·Î¤˜ ÔÌ¿‰Â˜. ∏ ÓfiÛÔ˜ ·ÎÔÏÔ˘ıÂ› Û˘-

Ó‹ıˆ˜ ÌÈ· ‚Ú·‰Â›· ÂÍÂÏÈÛÛfiÌÂÓË ÔÚÂ›· ÌÂ ÂÍ¿ÚÛÂÈ˜

ÙË˜ ÓfiÛÔ˘ ˘fi ÙË ÌÔÚÊ‹ ÌÂÙ·‚ÔÏÈÎÒÓ ÎÚ›ÛÂˆÓ Î¿-

Ùˆ ·fi Î·Ù·ÛÙ¿ÛÂÈ˜ stress. ∏ ÂÍ¤ÏÈÍË ÙË˜ ÓfiÛÔ˘

ÌÔÚÂ› Ó· Â›Ó·È Ú·Á‰·›· ÛÙË ÓÂÔÁÓÈÎ‹ ËÏÈÎ›·, ÂÓÒ

˘¿Ú¯ÂÈ ÌÈ· Ù¿ÛË ÛÙ·ıÂÚÔÔ›ËÛË˜ ÌÂÙ¿ ÙÔÓ ÚÒÙÔ

¯ÚfiÓÔ ÙË˜ ˙ˆ‹˜. °ÂÓÈÎfiÙÂÚ· Ë ÔÚÂ›· ÙË˜ ÓfiÛÔ˘

ÂÍ·ÚÙ¿Ù·È ÛÂ ÌÂÁ¿ÏÔ ‚·ıÌfi ·fi ÙÔ Â›‰Ô˜ ÙÔ˘ ÌÈÙÔ-

¯ÔÓ‰ÚÈ·ÎÔ‡ ÓÔÛ‹Ì·ÙÔ˜ Î·È ·fi ÙËÓ ·ÚÔ˘Û›· ‹ fi¯È

ÔÏ˘Û˘ÛÙËÌ·ÙÈÎ‹˜ Û˘ÌÌÂÙÔ¯‹˜. ŸÚÁ·Ó· Î·È ÈÛÙÔ›

ÌÂ ·˘ÍËÌ¤ÓÂ˜ ÂÓÂÚÁÂÈ·Î¤˜ ·Ó¿ÁÎÂ˜ fiˆ˜ ÂÁÎ¤Ê·-

ÏÔ˜, Ì‡Â˜, ·ÌÊÈ‚ÏËÛÙÚÔÂÈ‰‹˜, ÓÂÊÚÈÎ¿ ÛˆÏËÓ¿ÚÈ·

Â›Ó·È ÈÔ Â˘¿ÏˆÙ· ÛÙË ÌÈÙÔ¯ÔÓ‰ÚÈ·Î‹ ‰˘ÛÏÂÈÙÔ˘Ú-

Á›· Î·È ÚÔÛ‚¿ÏÏÔÓÙ·È ÈÔ Û˘¯Ó¿. ™ÙËÓ ·È‰ÈÎ‹ ËÏÈ-

Î›· ÔÈ ÌÈÙÔ¯ÔÓ‰ÚÈÔ¿ıÂÈÂ˜ ÚÔ‚¿ÏÏÔ˘Ó ÛÙËÓ ÏÂÈÔ-

„ËÊ›· ÙˆÓ ÂÚÈÙÒÛÂˆÓ ˆ˜ ¿Ù˘Ë ÂÁÎÂÊ·ÏÔÌ˘Ô-

¿ıÂÈ· ÌÂ ‹ ¯ˆÚ›˜ ÙË Û˘ÌÌÂÙÔ¯‹ ¿ÏÏˆÓ Û˘ÛÙËÌ¿-

ÙˆÓ (¶›Ó·Î·˜ 2). ∆· ÁÓˆÛÙ¿ ÌÈÙÔ¯ÔÓ‰ÚÈ·Î¿ Û‡Ó‰ÚÔ-

Ì· Ô˘ ÂÚÈÁÚ¿ÊÔÓÙ·È Î·ÙˆÙ¤Úˆ ··ÓÙÒÓÙ·È ÈÔ

¶›Ó·Î·˜ 1. ¶·ıÔÁÂÓÂÙÈÎÔ› ÌË¯·ÓÈÛÌÔ› Ô˘ ÂÓ¤¯ÔÓÙ·È ÛÙËÓ ÚfiÎÏËÛË ÚˆÙÔ·ıÒÓ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ

ªÂÙ·ÏÏ¿ÍÂÈ˜ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ DNA ªÂÙ·ÏÏ¿ÍÂÈ˜ ˘ÚËÓÈÎÔ‡ DNA

i. ªÂÙ·ÏÏ¿ÍÂÈ˜ Ô˘ Îˆ‰ÈÎÔÔÈÔ‡Ó i. ¢È·Ù·Ú·¯¤˜ ÛÂ ‰ÔÌÈÎ¿ ÁÔÓ›‰È· ÙË˜ ÔÍÂÈ‰ˆÙÈÎ‹˜ ˘ÔÔÌ¿‰Â˜ ÙˆÓ Û˘ÌÏÂÁÌ¿ÙˆÓ ÊˆÛÊÔÚ˘Ï›ˆÛË˜ ÙË˜ ·Ó·ÓÂ˘ÛÙÈÎ‹˜ ·Ï˘Û›‰·˜ ii. ¢È·Ù·Ú·¯¤˜ ÛÂ ÁÔÓ›‰È· Ô˘ ÂÓ¤¯ÔÓÙ·È ÛÙË Û˘Ó·ÚÌÔÏfiÁËÛË

ii. ªÂÙ·ÏÏ¿ÍÂÈ˜ Ô˘ ÂËÚÂ¿˙Ô˘Ó ÙË (assembly) ÙˆÓ Û˘ÌÏÂÁÌ¿ÙˆÓÌÈÙÔ¯ÔÓ‰ÚÈ·Î‹ ÚˆÙÂ˚ÓÈÎ‹ Û‡ÓıÂÛË iii. ¢È·Ù·Ú·¯¤˜ ÛÙË Û˘ÓÙ‹ÚËÛË ÙÔ˘ mtDNA Î·È ÛÙË (tRNA, rRNA) ‰È·ÁÔÓÈ‰È·Î‹ Û‹Ì·ÓÛË (intergenomic signalling)ñ ™ÔÚ·‰ÈÎ¿ ÂÏÏÂ›ÌÌ·Ù· / ·Ó·‰ÈÏ·ÛÈ·ÛÌÔ› iv. ¢È·Ù·Ú·¯¤˜ ÛÂ ÁÔÓ›‰È· Ô˘ ÂÓ¤¯ÔÓÙ·È ÛÙËÓ ÔÌÔÈfiÛÙ·ÛË Î·È ñ ™ËÌÂÈ·Î¤˜ ÌÂÙ·ÏÏ¿ÍÂÈ˜ ÂÈÛ·ÁˆÁ‹ (import) Û˘ÛÙ·ÙÈÎÒÓ (ÚˆÙÂ˝ÓÂ˜, ADP)

v. ¢È·Ù·Ú·¯¤˜ ÙÔ˘ ÏÈÈ‰ÈÎÔ‡ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ ÙË˜ ÂÛˆÙÂÚÈÎ‹˜ ÌÂÌ‚Ú¿ÓË˜vi. ¢È·Ù·Ú·¯¤˜ ÛÙËÓ ÎÈÓËÙÈÎfiÙËÙ· ÙˆÓ ÌÈÙÔ¯ÔÓ‰Ú›ˆÓ

3ªÈÙÔ¯ÔÓ‰ÚÈ·Î¿ ÓÔÛ‹Ì·Ù· ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜

¶·È‰È·ÙÚÈÎ‹ 2007;70:1-17

Û˘¯Ó¿ ÛÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹, ÂÓÒ fiÙ·Ó ÂÌÊ·ÓÈÛÙÔ‡Ó

ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›· ‰ÂÓ ÂÌÊ·Ó›˙ÔÓÙ·È ÌÂ ÙËÓ ÎÏ·ÛÈ-

Î‹ ÙÔ˘˜ Û˘ÌÙˆÌ·ÙÔÏÔÁ›· (8-14). ÕÏÏÂ˜ Û˘Ó‰ÚÔÌÈ-

Î¤˜ Î·Ù·ÛÙ¿ÛÂÈ˜ ÌÂ ÌÈÙÔ¯ÔÓ‰ÚÈ·Î‹ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·

ÂÚÈÁÚ¿ÊÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 3 (15).

¶ÚÔÔ‰Â˘ÙÈÎ‹ ÂÍˆÙÂÚÈÎ‹ ÔÊı·ÏÌÔÏËÁ›· & ™‡Ó‰ÚÔÌÔ

Kearns-Sayre (Progressive external ophthalmoplegia -

PEO & Kearns-Sayre syndrome). ¶ÚÔÔ‰Â˘ÙÈÎ‹ ÔÊı·Ï-

ÌÔÏËÁ›· Â›Ó·È ¤Ó· ·fi Ù· ÈÔ Û˘¯Ó¿ Û˘ÌÙÒÌ·Ù·

ÛÙ· ÌÈÙÔ¯ÔÓ‰ÚÈ·Î¿ ÓÔÛ‹Ì·Ù·. ¶ÙÒÛË ‚ÏÂÊ¿ÚˆÓ Î·È

ÔÊı·ÏÌÔÏËÁ›· ¯ˆÚ›˜ ‰ÈÏˆ›· (∂ÈÎfiÓ· 3) Â›Ó·È Ù·

·Ú¯ÈÎ¿ Û˘ÌÙÒÌ·Ù· Ù· ÔÔ›· ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙËÓ

fi„ÈÌË ·È‰ÈÎ‹ ‹ ÂÊË‚ÈÎ‹ ËÏÈÎ›· Î·È ÌÔÚÂ› Ó· Û˘Ó-

‰˘¿˙ÔÓÙ·È ÌÂ Ì˘˚Î‹ ·‰˘Ó·Ì›·, ¯ÚfiÓÈ· ÎfiˆÛË Î·È

‰˘Û·ÓÂÍ›· ÛÙËÓ ¿ÛÎËÛË.

∆Ô Û‡Ó‰ÚÔÌÔ Kearns-Sayre Â›Ó·È ÔÏ˘Û˘ÛÙËÌ·-

ÙÈÎfi ÓfiÛËÌ·. √ ·ÎÚÈ‚‹˜ ÔÚÈÛÌfi˜ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Â›-

Ó·È Ë ÂÌÊ¿ÓÈÛË, ÚÈÓ ·fi ÙËÓ ËÏÈÎ›· ÙˆÓ 20 ÂÙÒÓ,

ÔÊı·ÏÌÔÏËÁ›·˜ Î·È ÌÂÏ·Á¯ÚˆÛÙÈÎ‹˜ ·ÌÊÈ‚ÏË-

ÛÙÚÔÂÈ‰Ô¿ıÂÈ·˜ ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ¤Ó· ·fi Ù· Âfi-

ÌÂÓ·: ·) ‰È·Ù·Ú·¯‹ ÙË˜ ·ÁˆÁÈÌfiÙËÙ·˜ ÛÙÔ Î·Ú‰È·Îfi

Ì˘ÔÎ¿Ú‰ÈÔ (conduction block), ‚) ·ÚÂÁÎÂÊ·ÏÈ‰ÈÎ‹

·Ù·Í›·, Á) ·˘ÍËÌ¤ÓË ÚˆÙÂ˝ÓË ÛÙÔ ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô

˘ÁÚfi (∂¡À). ÕÏÏ· ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘

ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ¯·ÌËÏfi ·Ó¿ÛÙËÌ·, ÓÂ˘ÚÔ·ÈÛıËÙË-

ÚÈ·Î‹ ·ÒÏÂÈ· ÙË˜ ·ÎÔ‹˜, ‰È·Ù·Ú·¯‹ ÛÙË ‰È·ÓÔËÙÈ-

Î‹ ÏÂÈÙÔ˘ÚÁ›·, ÛˆÏËÓ·ÚÈ·Î‹ ÓÂÊÚÔ¿ıÂÈ·. ∏ Úfi-

ÁÓˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Kearns-Sayre Â›Ó·È Î·Ù¿ ÔÏ‡

‰˘ÛÌÂÓ¤ÛÙÂÚË ÙË˜ PEO (14).

√È ÂÚÈÛÛfiÙÂÚÔÈ ·ÛıÂÓÂ›˜ ÌÂ Û‡Ó‰ÚÔÌÔ Kearns-

Sayre Î·È PEO ¤¯Ô˘Ó ¤Ó· ÌÔÓ‹ÚÂ˜ ¤ÏÏÂÈÌÌ· ÛÙÔ ÌÈÙÔ-

¯ÔÓ‰ÚÈ·Îfi DNA Î·È Ë ÂÌÊ¿ÓÈÛ‹ ÙÔ˘˜ Â›Ó·È ÛÔÚ·‰È-

Î‹. ™ËÌÂÈ·Î¤˜ ÌÂÙ·ÏÏ¿ÍÂÈ˜ ÛÙÔ ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi DNA

(A3243G) Â›Ó·È ˘Â‡ı˘ÓÂ˜ ÁÈ· ÙÔ Û‡Ó‰ÚÔÌÔ PEO Ô˘

ÌÂÙ·‚È‚¿˙ÂÙ·È ÌÂ ÙÔÓ ÌËÙÚÈÎfi Ù‡Ô ÎÏËÚÔÓÔÌÈÎfiÙË-

Ù·˜. ªÂÙ·ÏÏ¿ÍÂÈ˜ ˘ÚËÓÈÎÒÓ ÁÔÓÈ‰›ˆÓ (ANT1,

POLG1, Twinkle), Ô˘ Ô‰ËÁÔ‡Ó ÛÂ ÔÏÏ·Ï¿ ÂÏÏÂ›Ì-

Ì·Ù· ÛÙÔ ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi DNA Â›Ó·È ˘Â‡ı˘ÓÂ˜ ÁÈ· ÙÔ

ÎÏËÚÔÓÔÌÔ‡ÌÂÓÔ PEO (16-19).

™‡Ó‰ÚÔÌÔ Pearson. ¶·ÚÔ˘ÛÈ¿˙ÂÙ·È Î˘Ú›ˆ˜ ÛÙË ‚ÚÂ-

ÊÈÎ‹ ËÏÈÎ›· Î·È ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÛÈ‰ËÚÔ‚Ï·ÛÙÈÎ‹

¶›Ó·Î·˜ 2. ∫ÏÈÓÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ ·Ó¿ Û˘ÛÙ‹Ì·Ù·

∫¡™ æ˘¯ÔÎÈÓËÙÈÎ‹ Î·ı˘ÛÙ¤ÚËÛË ‹ ˘ÔÛÙÚÔÊ‹, ‰È·ÓÔËÙÈÎ‹ Î·ı˘ÛÙ¤ÚËÛË, ÎÂÓÙÚÈÎ‹ ˘ÔÙÔÓ›· (Û˘Ó‹ıˆ˜Û˘Ó‰˘·ÛÌfi˜ ˘ÔÙÔÓ›·˜ ÙÔ˘ ÎÔÚÌÔ‡ Î·È ˘ÂÚÙÔÓ›·˜ ÙˆÓ ¿ÎÚˆÓ), ·˘ÙÈÛÌfi˜, ·ÚÂÁÎÂÊ·ÏÈ‰ÈÎ‹ ·Ù·Í›·,‰˘ÛÙÔÓ›· Î·È ¿ÏÏÂ˜ ‰˘ÛÎÈÓËÛ›Â˜, ÂÈÏË„›· (Ì˘ÔÎÏÔÓ›Â˜ ‹ ¿ÏÏ· Â›‰Ë Û·ÛÌÒÓ), ÔÏ˘Ì˘ÔÎÏÔÓ›· (ÌËÂÈÏËÙÈÎ‹˜ Ê‡ÛÂˆ˜), ¿Ù˘· ÂÁÎÂÊ·ÏÈÎ¿ ÂÂÈÛfi‰È· (stroke-like events), ˘Ú·ÌÈ‰ÈÎ‹ Û˘Ó‰ÚÔÌ‹ ÌÂÛ·ÛÙÈÎfiÙËÙ·, ÂÍˆ˘Ú·ÌÈ‰ÈÎ‹ Û˘Ó‰ÚÔÌ‹, „‡¯ˆÛË, ËÌÈÎÚ·Ó›·, ÎÒÌ·

¡Â˘ÚÔÌ˘˚Îfi ÀÔÙÔÓ›· (Î˘Ú›ˆ˜ ÛÙ· ‚Ú¤ÊË), Ì˘˚Î‹ ·ÙÚÔÊ›· (ÂÈÎfiÓ· ÓˆÙÈ·›·˜ Ì˘˚Î‹˜ ·ÙÚÔÊ›·˜), Ì˘Ô¿ıÂÈ· (ÛÂ ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿ Î·È ÂÓ‹ÏÈÎÂ˜), Â‡ÎÔÏË ÎfiˆÛË Î·È ‰˘Û·ÓÂÍ›· ÛÙËÓ ¿ÛÎËÛË, Ì˘˚Î¤˜ ÎÚ¿ÌÂ˜ Î·ÈÌ˘·ÏÁ›Â˜, Ú·‚‰ÔÌ˘fiÏ˘ÛË, ÂÚÈÊÂÚÈÎ‹ ÓÂ˘ÚÔ¿ıÂÈ· (Û˘Ó‹ıˆ˜ ·ÍÔÓÈÎ‹ ÌÂ Û˘ÌÌÂÙÔ¯‹ ÙˆÓ ÎÈÓËÙÈÎÒÓ Î·È·ÈÛıËÙÈÎÒÓ ÓÂ‡ÚˆÓ)

√Êı·ÏÌÔ› ∫·Ù·ÚÚ¿¯ÙË˜, ÌÂÏ·Á¯ÚˆÛÙÈÎ‹ ·ÌÊÈ‚ÏËÛÙÚÔÂÈ‰Ô¿ıÂÈ·, ÔÙÈÎ‹ ÓÂ˘ÚÔ¿ıÂÈ·, ·ÙÚÔÊ›· ÔÙÈÎÔ‡ ÓÂ‡ÚÔ˘

∞ÎÔ‹ ¡Â˘ÚÔÂ·ÈÛıËÙËÚÈ·Î‹ ·ÒÏÂÈ· ·ÎÔ‹˜, ˘ÂÚ·ÎÔ˘Û›·

∫·Ú‰È¿ ¢È·Ù·Ú·¯¤˜ ·ÁˆÁÈÌfiÙËÙ·˜, ˘ÂÚÙÚÔÊÈÎ‹ Î·È Û·ÓÈfiÙÂÚ· ‰È·Ù·ÙÈÎ‹ Î·Ú‰ÈÔÌ˘Ô¿ıÂÈ·

°·ÛÙÚÂÓÙÂÚÈÎfi ¶ÚÒÈÌË Ë·ÙÈÎ‹ ·ÓÂ¿ÚÎÂÈ· (Û˘Ó‹ıˆ˜ ÛÂ ‚Ú¤ÊË), ¯ÚfiÓÈ· Ë·ÙÔ¿ıÂÈ·, ÔÍÂ›· Û‡ÛÙËÌ· ÎÂÚ·˘ÓÔ‚fiÏÔ˜ Ë·Ù›ÙÈ‰· Î·È Ó¤ÎÚˆÛË (ÌÂÙ¿ ·fi ¯ÔÚ‹ÁËÛË ‚·ÏÚÔ˚ÎÔ‡ ÔÍ¤Ô˜ ÛÂ Û‡Ó‰ÚÔÌÔ Alper),

„Â˘‰Ô·ÔÊÚ·ÎÙÈÎfi Û‡Ó‰ÚÔÌÔ, ¯ÚfiÓÈÔ ‰È·ÚÚÔ˚Îfi Û‡Ó‰ÚÔÌÔ, ·ÓÂ¿ÚÎÂÈ· ÂÍˆÎÚÈÓÔ‡˜ ÌÔ›Ú·˜ ÙÔ˘·ÁÎÚ¤·ÙÔ˜, Î˘ÎÏÈÎÔ› ¤ÌÂÙÔÈ, ‰È·Ù·Ú·¯‹ ·Ó¿Ù˘ÍË˜ Î·È Î·¯ÂÍ›·

¡ÂÊÚÔ› ™ˆÏËÓ·ÚÈ·Î‹ ·ÓÂ¿ÚÎÂÈ·, Û‡Ó‰ÚÔÌÔ DeToni-Debre-Fanconi, ‰È¿ÌÂÛË ÛˆÏËÓ·ÚÈ·Î‹ ÓÂÊÚ›ÙÈ‰·

∂Ó‰ÔÎÚÈÓÔÏÔÁÈÎfi Ã·ÌËÏfi ·Ó¿ÛÙËÌ·, ÚÒÈÌË ÂÌÊ¿ÓÈÛË Û·Î¯·ÚÒ‰Ô˘˜ ‰È·‚‹ÙË Ù‡Ô˘ 2 (ÂÓËÏ›ÎˆÓ), Û‡ÛÙËÌ· ˘Ô·Ú·ı˘ÚÂÔÈ‰ÈÛÌfi˜, ÔÛÙÂÔfiÚˆÛË, ˘ÔÊ˘ÛÈ·Î‹ ·ÓÂ¿ÚÎÂÈ·

ª˘ÂÏfi˜ ÙˆÓ ÔÛÙÒÓ ™È‰ËÚÔ‚Ï·ÛÙÈÎ‹ ·Ó·ÈÌ›·, Ì˘ÂÏÔ‰˘ÛÏ·ÛÙÈÎfi Û‡Ó‰ÚÔÌÔ



∂ÈÎfiÓ· 2. ∆Ô Ê·ÈÓfiÌÂÓÔ ÙË˜ ÂÙÂÚÔÏ·ÛÌ›·˜ Î·È Ë ·Ú¯‹ ÙÔ˘ Ô˘-‰Ô‡ Ê·ÈÓÔÙ˘ÈÎ‹˜ ¤ÎÊÚ·ÛË˜: √È Ì·‡ÚÔÈ Î‡ÎÏÔÈ ·ÓÙÈÚÔÛˆÂ‡-Ô˘Ó ÌÈÙÔ¯fiÓ‰ÚÈ· Ô˘ Ê¤ÚÔ˘Ó ÙË ÌÂÙ¿ÏÏ·ÍË ÛÙÔ DNA ÙÔ˘˜(mutant) Î·È ÔÈ ÏÂ˘ÎÔ› Î‡ÎÏÔÈ Ê˘ÛÈÔÏÔÁÈÎ¿ ÌÈÙÔ¯fiÓ‰ÚÈ· (wild).ªÂ ÙÔÓ ÌÈÙˆÙÈÎfi ‰È·¯ˆÚÈÛÌfi ÙˆÓ ÌÈÙÔ¯ÔÓ‰Ú›ˆÓ ‰ËÌÈÔ˘ÚÁÂ›Ù·ÈÌÈ· ÌˆÛ·˚Î‹ Î·Ù¿ÛÙ·ÛË ÛÙÔ˘˜ ÈÛÙÔ‡˜, fiÔ˘ ÙÔ ÔÛÔÛÙfi ÙˆÓ ÌÂ-Ù·ÏÏ·ÁÌ¤ÓˆÓ ÌÈÙÔ¯ÔÓ‰Ú›ˆÓ ‰È·Ê¤ÚÂÈ. ∫ÏÈÓÈÎfi˜ Ê·ÈÓfiÙ˘Ô˜ ÂÌ-Ê·Ó›˙ÂÙ·È fiÙ·Ó ÙÔ ÔÛÔÛÙfi ÙˆÓ ÌÂÙ·ÏÏ·ÁÌ¤ÓˆÓ ÌÈÙÔ¯ÔÓ‰Ú›ˆÓ Â›-Ó·È ÈÎ·Ófi Ó· ÂËÚÂ¿ÛÂÈ ÙËÓ ÂÓ‰ÔÎ˘ÙÙ¿ÚÈ· ·Ú·ÁˆÁ‹ ÂÓ¤ÚÁÂÈ·˜.

¶ÚÔÁÔÓÈÎfi Î‡ÙÙ·ÚÔ

£˘Á·ÙÚÈÎ¿ Î‡ÙÙ·Ú·

∫ÏÈÓÈÎ‹ Û˘ÌÙˆÌ·ÙÔÏÔÁ›·√˘

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˜10% 30% 50% 70% 100%

·Ó·ÈÌ›·, ıÚÔÌ‚ÔÂÓ›· Î·È ·ÓÂ¿ÚÎÂÈ· ÙË˜ ÂÍˆÎÚÈ-

ÓÔ‡˜ ÌÔ›Ú·˜ ÙÔ˘ ·ÁÎÚ¤·ÙÔ˜. §ÈÁfiÙÂÚÔ Û˘¯Ó‹ Â›Ó·È Ë

ÓÂÊÚÈÎ‹ ÛˆÏËÓ·ÚÈ·Î‹ ÔÍ¤ˆÛË (20), Ë·ÙÈÎ‹ ·ÓÂ-

¿ÚÎÂÈ· Î·È ‰È·Ù·Ú·¯‹ ÙË˜ ÂÓ‰ÔÎÚÈÓÔ‡˜ ÌÔ›Ú·˜ ÙÔ˘

·ÁÎÚ¤·ÙÔ˜ ÌÂ ÈÓÛÔ˘ÏÈÓÔ-ÂÍ·ÚÙÒÌÂÓÔ Û·Î¯·ÚÒ‰Ë

‰È·‚‹ÙË (21). √È ÂÚÈÛÛfiÙÂÚÔÈ ·ÛıÂÓÂ›˜ ˘ÔÎ‡ÙÔ˘Ó

ÙÔÓ ÚÒÙÔ ¯ÚfiÓÔ ÙË˜ ˙ˆ‹˜, ·ÏÏ¿ ÌÂÚÈÎÔ› ·ÛıÂÓÂ›˜

Ô˘ ¤¯Ô˘Ó ÂÈ˙‹ÛÂÈ ·Ó¤Ù˘Í·Ó ÛÙËÓ ÔÚÂ›· Û‡Ó‰ÚÔ-

ÌÔ Kearns-Sayre. ∂ÚÁ·ÛÙËÚÈ·Î¿ Â˘Ú‹Ì·Ù· ÂÚÈÏ·Ì-

‚¿ÓÔ˘Ó Ì·ÎÚÔÎ˘ÙÙ·ÚÈÎ‹ ·Ó·ÈÌ›·, ·‡ÍËÛË ÙË˜ ·ÈÌÔ-

ÛÊ·ÈÚ›ÓË˜ F, ÛÈ‰ËÚÔ‚Ï¿ÛÙÂ˜ ÛÙË Ì˘ÂÏÈÎ‹ ‚ÈÔ„›·, Á·-

Ï·ÎÙÈÎ‹ ÔÍ¤ˆÛË, ÌÂı˘ÏÔÁÏÔ˘Ù·ÎÔÓÈÎ‹ ÔÍÂÔ˘Ú›·, Î·È

·ÓÂ‡ÚÂÛË ÂÚ˘ıÚÒÓ Ú·Îˆ‰ÒÓ ÈÓÒÓ ÛÙËÓ Ì˘˚Î‹ ‚ÈÔ„›·

(22,23). ∆o Û‡Ó‰ÚÔÌÔ Pearson ¤¯ÂÈ ÂÚÈÁÚ·ÊÂ› ÛÂ

Û˘Ó‰˘·ÛÌfi ÌÂ ÌÂÁ¿ÏË˜ ÎÏ›Ì·Î·˜ ·Ó·Û˘Ó‰˘·ÛÌÔ‡˜

ÙÔ˘ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ DNA (24).

™È‰ËÚÔ‚Ï·ÛÙÈÎ‹ ·Ó·ÈÌ›· ¤¯ÂÈ ÂÚÈÁÚ·ÊÂ› Â›-

ÛË˜ ÌÂ ÙËÓ ÛËÌÂÈ·Î‹ ÌÂÙ¿ÏÏ·ÍË A8344G Î·ıÒ˜ Î·È

ÌÂ ÌÂÙ¿ÏÏ·ÍË ÙÔ˘ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ ÌÂÙ·ÊÔÚ¤· ÛÈ-

‰‹ÚÔ˘ (25).

ª˘ÔÎÏÔÓÈÎ‹ ÂÈÏË„›· ÌÂ ÂÚ˘ıÚ¤˜ Ú·ÎÒ‰ÂÈ˜ ›ÓÂ˜

(Myoclonic Epilepsy with Ragged Red Fibbers). ∆Ô Û‡Ó-

‰ÚÔÌÔ MERRF ··ÓÙ¿Ù·È Û˘Ó‹ıˆ˜ ÛÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜

·ÏÏ¿ Ë Û˘ÌÙˆÌ·ÙÔÏÔÁ›· ÌÔÚÂ› Ó· ·Ú¯›ÛÂÈ ÛÙËÓ

·È‰ÈÎ‹ ËÏÈÎ›·. Ã·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÙËÓ ·ÚÔ˘Û›·

Ì˘ÔÎÏÔÓÈÎÒÓ Û·ÛÌÒÓ, ÂÈÏË„›·˜, ÂÏ·ÊÚ¿˜ Ì˘˚Î‹˜

·‰˘Ó·Ì›·˜ Î·È ·ÚÂÁÎÂÊ·ÏÈ‰ÈÎ‹˜ ·Ù·Í›·˜. ÕÏÏ· ¯·-

Ú·ÎÙËÚÈÛÙÈÎ¿ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ¿ÓÔÈ·,

ÔÙÈÎ‹ ÓÂ˘ÚÔ¿ıÂÈ·, ÓÂ˘ÚÔ·ÈÛıËÙËÚÈ·Î‹ ·ÒÏÂÈ·

·ÎÔ‹˜, ÂÚÈÊÂÚÈÎ‹ ÓÂ˘ÚÔ¿ıÂÈ·, ÔÊı·ÏÌÔÏËÁ›·,

ÔÏÏ·Ï¿ ÏÈÒÌ·Ù· Î.Ï. √ ÓÂ˘ÚÔ·ÂÈÎÔÓÈÛÙÈÎfi˜

¤ÏÂÁ¯Ô˜ Û˘¯Ó¿ ·Ó·‰ÂÈÎÓ‡ÂÈ ÌË ÂÈ‰ÈÎ¿ ÛËÌÂ›· fiˆ˜

ÂÁÎÂÊ·ÏÈÎ‹ Î·È ·ÚÂÁÎÂÊ·ÏÈ‰ÈÎ‹ ·ÙÚÔÊ›·. ∏ ÂÌÊ¿-

ÓÈÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›· Û˘Ó‰˘¿˙Â-

Ù·È ÌÂ ‰˘ÛÌÂÓ¤ÛÙÂÚË ÚfiÁÓˆÛË (26). ™ÙË ‚ÈÔ„›·

ÛÎÂÏÂÙÈÎÔ‡ Ì˘fi˜ Û˘¯Ó¿ ·ÓÂ˘Ú›ÛÎÔÓÙ·È ÂÚ˘ıÚ¤˜ Ú·-

ÎÒ‰ÂÈ˜ ›ÓÂ˜ Î·È ÛÙÔÓ Ì˘˚Îfi ÈÛÙfi Û˘¯Ó‹ Â›Ó·È Ë ·ÓÂ-

¿ÚÎÂÈ· ÙÔ˘ Û˘ÌÏ¤ÁÌ·ÙÔ˜ IV. ™ÙÔ 80% ÙˆÓ ÂÚÈ-

ÙÒÛÂˆÓ ·ÓÈ¯ÓÂ‡ÂÙ·È Ë ÛËÌÂÈ·Î‹ ÌÂÙ¿ÏÏ·ÍË

A8344G (27,28).

ªÈÙÔ¯ÔÓ‰ÚÈ·Î‹ ÂÁÎÂÊ·ÏÔ¿ıÂÈ·, Á·Ï·ÎÙÈÎ‹ ÔÍ¤ˆÛË

Î·È ÂÁÎÂÊ·ÏÈÎ¿ ÂÂÈÛfi‰È· (Mitochondrial encephalo-

pathy, Lactic acidosis and Stroke). ∫ÚÈÙ‹ÚÈ· ÁÈ· ÙË ‰È¿-

ÁÓˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ MELAS ÚÔÙ¿ıËÎ·Ó ·fi ÙÔÓ

Hirano et al. ÌÂÙ¿ ·fi ·Ó·ÛÎfiËÛË 69 ÂÚÈÙÒÛÂˆÓ

(29) Î·È ÂÚÈÏ·Ì‚¿ÓÔ˘Ó: ·) ¿Ù˘Ô ÂÁÎÂÊ·ÏÈÎfi ÂÂÈ-

Ûfi‰ÈÔ ÚÈÓ ·fi ÙËÓ ËÏÈÎ›· ÙˆÓ 40 ÂÙÒÓ, ‚) ÂÁÎÂÊ·ÏÔ-

¿ıÂÈ· ¯·Ú·ÎÙËÚÈ˙fiÌÂÓË ·fi Û·ÛÌÔ‡˜ ‹/Î·È ¿ÓÔÈ·,

Á) Á·Ï·ÎÙÈÎ‹ ÔÍ¤ˆÛË ‹/Î·È ÂÚ˘ıÚ¤˜ Ú·ÎÒ‰ÂÈ˜ ›ÓÂ˜

ÛÙË Ì˘˚Î‹ ‚ÈÔ„›·.

™Ù· ·È‰È¿ ·Ú¯ÈÎ¿ ÌÔÚÂ› Ó· ÚÔ‚¿ÏÂÈ ˆ˜ ¿Ù˘Ë

ÂÁÎÂÊ·ÏÔÌ˘Ô¿ıÂÈ·, ‰È·Ù·Ú·¯‹ ÛÙËÓ ·Ó¿Ù˘ÍË ÌÂ ‹

¯ˆÚ›˜ Á·Ï·ÎÙÈÎ‹ ÔÍ¤ˆÛË, ÂÓÒ Ù· ¯·Ú·ÎÙËÚÈÛÙÈÎ¿

ÂÁÎÂÊ·ÏÈÎ¿ ÂÂÈÛfi‰È· ÂÌÊ·Ó›˙ÔÓÙ·È ·ÚÁfiÙÂÚ·. ∆·

ÂÁÎÂÊ·ÏÈÎ¿ ÂÂÈÛfi‰È· ÚÔ‚¿ÏÔ˘Ó ÌÂ ËÌÈ·ÓÔ„›·,

ËÌÈÎÚ·Ó›· Î·È Û‡Á¯ÚÔÓË ·ÚÔ˘Û›· ÂÛÙÈ·ÎÒÓ Û·-

ÛÌÒÓ Î·È fiÙ·Ó ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›·

˘ÔÙÚÔÈ¿˙Ô˘Ó, Û˘ÓÔ‰Â‡ÔÓÙ·È ·fi ·ÓıÂÎÙÈÎ‹ ÂÛÙÈ·-

Î‹ ÂÈÏË„›· Î·È Ô‰ËÁÔ‡Ó ÛÂ ÂÁÎÂÊ·ÏÈÎ‹ ·ÙÚÔÊ›· Î·È

¿ÓÔÈ· (30). ∞ÂÈÎÔÓÈÛÙÈÎÒ˜ (∂ÈÎfiÓ· 4), Ë ÈÛ¯·ÈÌÈÎ‹

ÂÚÈÔ¯‹ ‰ÂÓ ¤¯ÂÈ Û˘ÁÎÂÎÚÈÌ¤ÓË ·ÁÁÂÈ·Î‹ ·Ó·ÙÔÌÈÎ‹

Î·Ù·ÓÔÌ‹, ÂÓÙÔ›˙ÂÙ·È ÛÙË ‚ÚÂÁÌ·ÙÔ˚ÓÈ·Î‹ ÂÚÈÔ¯‹

Î·È Ë Ì·ÁÓËÙÈÎ‹ Ê·ÛÌ·ÙÔÛÎÔ›· ÚˆÙÔÓ›Ô˘

(1HMRS) ‰Â›¯ÓÂÈ ·È¯Ì‹ Á·Ï·ÎÙÈÎÔ‡ (31). ∞˘ÍËÌ¤ÓÔ

Á·Ï·ÎÙÈÎfi Â›Ó·È Â‡ÚËÌ· ÈÔ Û˘¯Ófi ÛÙÔ ∂¡À ·Ú¿

ÛÙÔÓ ÔÚfi (32). ∂ÈÚfiÛıÂÙ· ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙÔ˘

Û˘Ó‰ÚfiÌÔ˘ ÌÔÚÂ› Ó· Â›Ó·È Ë Ì˘Ô¿ıÂÈ·, Ë Î·Ú‰ÈÔ-

Ì˘Ô¿ıÂÈ·, Ë ÔÙÈÎ‹ ·ÙÚÔÊ›·, Ë ÂÚÈÊÂÚÈÎ‹ ÓÂ˘ÚÔ-

¿ıÂÈ· ·ÍÔÓÈÎÔ‡ Ù‡Ô˘, ÙÔ ¯·ÌËÏfi ·Ó¿ÛÙËÌ·, Ô

Û·Î¯·ÚÒ‰Ë˜ ‰È·‚‹ÙË˜ Î·È Ë ÔÏ˘ÂÓ‰ÔÎÚÈÓÔ¿ıÂÈ·

(33). ∞ÓÂ¿ÚÎÂÈ· ÙÔ˘ Û˘ÌÏ¤ÁÌ·ÙÔ˜ I Â›Ó·È Ë ÈÔ

Û˘¯Ó‹ ·ÓÂ¿ÚÎÂÈ· Î·È ÛÙÔ 80% ÙˆÓ ÂÚÈÙÒÛÂˆÓ

·ÓÂ˘Ú›ÛÎÂÙ·È Ë ÛËÌÂÈ·Î‹ ÌÂÙ¿ÏÏ·ÍË A3243G (14).

¡Â˘ÚÔÁÂÓ‹˜ Ì˘˚Î‹ ·‰˘Ó·Ì›·, ·Ù·Í›·, ÌÂÏ·Á¯ÚˆÛÙÈÎ‹

·ÌÊÈ‚ÏËÛÙÚÔÂÈ‰Ô¿ıÂÈ· & ÌËÙÚÈÎÒ˜ ÎÏËÚÔÓÔÌÔ‡ÌÂÓÔ

∂ÈÎfiÓ· 4. ™‡Ó‰ÚÔÌÔ MELAS: ∂ÁÎ¿ÚÛÈ· ÙÔÌ‹ Flair ·ÎÔÏÔ˘ı›·(10 ÂÙÒÓ). ¶·ıÔÏÔÁÈÎfi Û‹Ì· ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ‚ÚÂÁÌ·ÙÈÎÔ‡-ÈÓÈ·ÎÔ‡ ÏÔ‚Ô‡ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÂÓfi˜ stroke-like ÂÂÈÛÔ‰›Ô˘.™ÙËÓ 1HMRS (Ì·ÎÚ¿ ·ÎÔÏÔ˘ı›·) ÌÂÁ¿ÏË ‰›ÎÔÚÊË ·È¯Ì‹ Á·Ï·-ÎÙÈÎÔ‡ (‚¤ÏÔ˜).


¶·È‰È·ÙÚÈÎ‹ 2007;70:1-17

∂ÈÎfiÓ· 3. ∞ÌÊÔÙÂÚfiÏÂ˘ÚË ‚ÏÂÊ·ÚfiÙˆÛË ÛÂ ·ÛıÂÓ‹ ÌÂ ÂÏ·-ÊÚ¿ ·‰˘Ó·Ì›· Î·È Û‡Ó‰ÚÔÌÔ PEO ·fi ¤ÏÏÂÈÌÌ· ÛÙÔ ÌÈÙÔ¯ÔÓ‰ÚÈ·-Îfi DNA.

Û‡Ó‰ÚÔÌÔ Leigh (Neurogenic muscle weakness, ∞taxia,

and Retinitis Pigmentosa - NARP & Maternal

Inherited Leigh syndrome - MILS). ∆Ô Û‡Ó‰ÚÔÌÔ ÂÌ-

Ê·Ó›˙ÂÙ·È ÌÂ ÔÔÈÔÓ‰‹ÔÙÂ Û˘Ó‰˘·ÛÌfi ÙˆÓ Û˘-

ÌÙˆÌ¿ÙˆÓ ÙÔ˘ ·ÎÚˆÓ˘Ì›Ô˘ ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ Î·-

ı˘ÛÙ¤ÚËÛË ÙË˜ ·Ó¿Ù˘ÍË˜, ÂÈÏË„›·, ¿ÓÔÈ· Î·È ·È-

ÛıËÙËÚÈ·Î‹ ÂÚÈÊÂÚÈÎ‹ ÓÂ˘ÚÔ¿ıÂÈ·. ¶·ÚÂÁÎÂÊ·-

ÏÈ‰ÈÎ‹ ·Ù·Í›· ÎÔÚÌÔ‡ Î·È ¿ÎÚˆÓ Â›Ó·È ÂÌÊ·Ó‹˜,

ÂÓÒ Ë Ì˘˚Î‹ ·‰˘Ó·Ì›· ‰‡ÛÎÔÏ· ·ÓÈ¯ÓÂ‡ÂÙ·È ÏfiÁˆ

ÙË˜ ·Ù·Í›·˜. ∆· ÙÂÓfiÓÙÈ· ·ÓÙ·Ó·ÎÏ·ÛÙÈÎ¿ ·Ô˘ÛÈ¿-

˙Ô˘Ó Î·È ÛÙÔ ËÏÂÎÙÚÔÌ˘ÔÁÚ¿ÊËÌ· ˘¿Ú¯Ô˘Ó Â˘Ú‹-

Ì·Ù· ·ÍÔÓÈÎ‹˜ ·ÈÛıËÙËÚÈ·Î‹˜ ÂÚÈÊÂÚÈÎ‹˜ ÓÂ˘ÚÔ-

¿ıÂÈ·˜. ∂Ú˘ıÚ¤˜ Ú·ÎÒ‰ÂÈ˜ ›ÓÂ˜ ·Ô˘ÛÈ¿˙Ô˘Ó Î·È Ë

·ÓÙ›‰Ú·ÛË ÔÍÂÈ‰¿ÛË˜ ÙÔ˘ Î˘ÙÔ¯ÚÒÌ·ÙÔ˜ (COX) Â›-

Ó·È ıÂÙÈÎ‹ (14). √È ÈÔ ÔÏÏÔ› ·ÛıÂÓÂ›˜ Ê¤ÚÔ˘Ó ÙË

ÛËÌÂÈ·Î‹ ÌÂÙ¿ÏÏ·ÍË T8993G Ô˘ Îˆ‰ÈÎÔÔÈÂ› ÙËÓ

˘ÔÔÌ¿‰· 6 ÙÔ˘ Û˘ÌÏ¤ÁÌ·ÙÔ˜ V (ATP Û˘ÓıÂÙ¿-

ÛË). ∆Ô Û‡Ó‰ÚÔÌÔ ·ÔÙÂÏÂ› ¤Ó· ¿ÚÈÛÙÔ ·Ú¿‰ÂÈÁ-

Ì· Ê·ÈÓÔÙ˘ÈÎ‹˜ ÂÙÂÚÔÁ¤ÓÂÈ·˜ ÏfiÁˆ ÂÙÂÚÔÏ·-

ÛÌ›·˜: ÔÛÔÛÙfi ÌÂÙ·ÏÏ·ÁÌ¤ÓˆÓ ÌÈÙÔ¯ÔÓ‰Ú›ˆÓ

ÛÙÔÓ Ì˘˚Îfi ÈÛÙfi ÌÈÎÚfiÙÂÚÔ ·fi 70% Â›Ó·È ·Û˘-

ÌÙˆÌ·ÙÈÎ‹, ÔÛÔÛÙfi 70-90% ÚÔÎ·ÏÂ› ÓfiÛÔ

NARP Î·È ÔÛÔÛÙfi ÌÂÁ·Ï‡ÙÂÚÔ ·fi 90% ÚÔÎ·ÏÂ›

ÛÔ‚·Úfi Ê·ÈÓfiÙ˘Ô Û˘Ó‰ÚfiÌÔ˘ Leigh (34,35).

™‡Ó‰ÚÔÌÔ Leigh. ∆Ô 1951 Ô Leigh ÂÚÈ¤ÁÚ·„Â ¤Ó·

·È‰› Ô˘ ˘¤Î˘„Â ·fi ˘ÔÍ›· ÛÔ‚·Ú‹ ÂÁÎÂÊ·ÏÔ-

Ì˘Ô¿ıÂÈ· ÌÂ ·ıÔÏÔÁÔ·Ó·ÙÔÌÈÎ¤˜ ·ÓˆÌ·Ï›Â˜ Î˘-

Ú›ˆ˜ ÛÙ· ‚·ÛÈÎ¿ Á¿ÁÁÏÈ·, ÛÙÔÓ ı¿Ï·ÌÔ, ÛÙÔ˘˜ ˘Ô-

ı·Ï¿ÌÈÔ˘˜ ˘Ú‹ÓÂ˜ Î·È ÛÙÔ˘˜ ˘Ú‹ÓÂ˜ ÙÔ˘ ÂÁÎÂÊ·-

ÏÈÎÔ‡ ÛÙÂÏ¤¯Ô˘˜ (36). ∏ ¤Ó·ÚÍË ÙË˜ ÓfiÛÔ˘ ÂÌÊ·Ó›-

˙ÂÙ·È Û˘Ó‹ıˆ˜ ÛÙË ‚ÚÂÊÈÎ‹ ËÏÈÎ›·, ·ÏÏ¿ ÌÔÚÊ¤˜

ÙË˜ ÓfiÛÔ˘ ÌÔÚÂ› Ó· ÚÔ‚¿ÏÔ˘Ó Î·Ù¿ ÙËÓ ÚÒÈÌË

Î·È fi„ÈÌË ÓÂ·ÓÈÎ‹ ËÏÈÎ›·. ™˘Ó‰˘¿˙ÂÙ·È ÌÂ ÌÂÁ¿ÏÔ

Â‡ÚÔ˜ ÓÂ˘ÚÔÏÔÁÈÎÒÓ ÂÎ‰ËÏÒÛÂˆÓ fiˆ˜ „˘¯ÔÎÈÓË-

ÙÈÎ‹ Î·ı˘ÛÙ¤ÚËÛË, ÔÙÈÎ‹ ·ÙÚÔÊ›·, ÔÊı·ÏÌÔÏË-

Á›·, ‚ÏÂÊ·ÚfiÙˆÛË, Ó˘ÛÙ·ÁÌÔÂÈ‰Â›˜ ÎÈÓ‹ÛÂÈ˜, ·Ù·-

Í›·, ÙÚfiÌÔ, ‰˘ÛÙÔÓ›·, ˘Ú·ÌÈ‰ÈÎ‹ Û˘Ó‰ÚÔÌ‹, Ù·¯‡-

ÓÔÈ· Î·È ¿ÓÔÈ· ÎÂÓÙÚÈÎ‹˜ ·ÈÙÈÔÏÔÁ›·˜ (37). ™ÙË

‰È¿ÁÓˆÛË ‚ÔËı¿ Ë ·ÂÈÎfiÓÈÛË ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Î˘-

Ú›ˆ˜ ÌÂ MRI, Ë ÔÔ›· ¤¯ÂÈ ·ÓÙÈÎ·Ù·ÛÙ‹ÛÂÈ ÙËÓ ·-

ıÔÏÔÁÔ·Ó·ÙÔÌÈÎ‹ ‰È¿ÁÓˆÛË. ™ÙËÓ MRI ÂÁÎÂÊ¿ÏÔ˘

¤¯Ô˘ÌÂ ¯·Ú·ÎÙËÚÈÛÙÈÎ¤˜ ·ÏÏÔÈÒÛÂÈ˜ ÛÙ· ‚·ÛÈÎ¿

Á¿ÁÁÏÈ· Î·È ÂÁÎÂÊ·ÏÈÎfi ÛÙ¤ÏÂ¯Ô˜ Î·È ÛÙËÓ 1HMRS

¤¯Ô˘ÌÂ ·È¯Ì‹ Á·Ï·ÎÙÈÎÔ‡ (∂ÈÎfiÓ· 5), Î˘Ú›ˆ˜ ÛÙÔ

·ıÔÏÔÁÈÎfi Û‹Ì· (38-43).

∆Ô Û‡Ó‰ÚÔÌÔ Leigh Â›Ó·È ‚ÈÔ¯ËÌÈÎ¿ Î·È ÁÂÓÂÙÈ-

Î¿ ÂÙÂÚÔÁÂÓ‹˜ ÓfiÛÔ˜ Î·È ÌÔÚÂ› Ó· ÂÌÊ·ÓÈÛÙÂ› Ïfi-

Áˆ ‰È·Ù·Ú·¯‹˜ ‰È·ÊfiÚˆÓ ÂÓ˙˘ÌÈÎÒÓ Û˘ÌÏÂÁÌ¿ÙˆÓ

Ô˘ Îˆ‰ÈÎÔÔÈÔ‡ÓÙ·È Â›ÙÂ ·fi ÙÔ ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi Â›-

ÙÂ ·fi ÙÔ ˘ÚËÓÈÎfi DNA (¶›Ó·Î·˜ 4).

ªÈÙÔ¯ÔÓ‰ÚÈ·Î‹ ÓÂ˘ÚÔ-Á·ÛÙÚÂÓÙÂÚÈÎ‹ ÂÁÎÂÊ·ÏÔ-

Ì˘Ô¿ıÂÈ· (Mitochondrial Neuro-Gastro-Intestinal

Encephalomyopathy - MNGIE). ∆o Û‡Ó‰ÚÔÌÔ ¯·Ú·-

ÎÙËÚ›˙ÂÙ·È ·fi ‰˘ÛÎÈÓËÙÈÎfiÙËÙ· ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈ-

ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÌÂ „Â˘‰Ô·ÔÊÚ¿ÍÂÈ˜, Î·¯ÂÍ›·,

ÚÔÔ‰Â˘ÙÈÎ‹ ÂÍˆÙÂÚÈÎ‹ ÔÊı·ÏÌÔÏËÁ›·, ÔÏ˘ÓÂ˘-

ÚÔ¿ıÂÈ· Î·È ÏÂ˘ÎÔÂÁÎÂÊ·ÏÔ¿ıÂÈ· (44). ™ÙË ‚ÚÂ-

ÊÈÎ‹ ËÏÈÎ›· Ë ÓfiÛÔ˜ ÚÔ‚¿ÏÂÈ ÌÂ Û˘ÌÙÒÌ·Ù· ·fi

ÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi (Á·ÛÙÚÔ¿ÚÂÛË, ‰˘ÛÊ·Á›·, „Â˘-

‰Ô·fiÊÚ·ÍË) (45). ∏ ÎÈÓËÙÈÎÔ-·ÈÛıËÙËÚÈ·Î‹ ÂÚÈ-

ÊÂÚÈÎ‹ ÓÂ˘ÚÔ¿ıÂÈ· Â›Ó·È ÂÏ·ÊÚ¿˜ ÌÔÚÊ‹˜ Î·È ·Ô-

Ì˘ÂÏÈÓˆÙÈÎÔ‡ ¯·Ú·ÎÙ‹Ú·. ªÂÙ·‚È‚¿˙ÂÙ·È ÌÂ ÙÔÓ

˘ÔÏÂÈfiÌÂÓÔ ÛˆÌ·ÙÈÎfi Ù‡Ô ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜

Î·È ÔÊÂ›ÏÂÙ·È ÛÂ ÌÂÙ¿ÏÏ·ÍË ÙÔ˘ ÁÔÓÈ‰›Ô˘ ÙË˜ ı˘ÌÈ‰È-

ÓÔÊˆÛÊˆÚ˘Ï¿ÛË˜ (thymidine phosphorylase), ÂÓ˙‡-

ÌÔ˘ ··Ú·›ÙËÙÔ˘ ÁÈ· ÙÔÓ Û¯ËÌ·ÙÈÛÌfi ÓÔ˘ÎÏÂÔÙÈ-

‰›ˆÓ. ∏ ‰È·Ù¿Ú·ÍË ÙË˜ ÈÛÔÚÚÔ›·˜ ÛÙË ‰ÂÍ·ÌÂÓ‹

ÓÔ˘ÎÏÂÔÙÈ‰›ˆÓ ÚÔÎ·ÏÂ› ÔÏÏ·Ï¿ ÂÏÏÂ›ÌÌ·Ù· ÛÙÔ

ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi DNA (46).

∫ÏËÚÔÓÔÌÔ‡ÌÂÓË ÔÙÈÎ‹ ÓÂ˘Ú›ÙÈ‰· ÙÔ˘ Leber

(Leber’s Hereditary Optic Neuropathy - LHON). ∏

ÔÙÈÎ‹ ÓÂ˘Ú›ÙÈ‰· ÙÔ˘ Leber ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi

˘ÔÍ›· ÂÌÊ¿ÓÈÛË ÛÔ‚·Ú‹˜ ·ÌÊÔÙÂÚfiÏÂ˘ÚË˜

·ÒÏÂÈ·˜ ÙË˜ fiÚ·ÛË˜ Ô˘ ·Ú·ÙËÚÂ›Ù·È Î˘Ú›ˆ˜

ÛÙÔ˘˜ ¿ÚÚÂÓÂ˜ ËÏÈÎ›·˜ 11-30 ÂÙÒÓ. √ Ì¤ÛÔ˜ ¯ÚfiÓÔ˜

·Ó¿ÌÂÛ· ÛÙËÓ ÚÔÛ‚ÔÏ‹ ÙˆÓ ‰‡Ô ÔÊı·ÏÌÒÓ Â›Ó·È

8 Â‚‰ÔÌ¿‰Â˜ Î·È Ë ÚÔÔ‰Â˘ÙÈÎ‹ ÂÈ‰Â›ÓˆÛË ÙË˜

fiÚ·ÛË˜ Á›ÓÂÙ·È ÛÂ 1-6 Â‚‰ÔÌ¿‰Â˜ (47). √È ·ÛıÂÓÂ›˜

·Ú·ÔÓÔ‡ÓÙ·È ÁÈ· “ı¿Ì‚ˆÌ·” ÙË˜ fiÚ·ÛË˜ Ô˘

ÛÙËÓ ÂÚÈÌÂÙÚÈÎ‹ Ì¤ÙÚËÛË ÙˆÓ ÔÙÈÎÒÓ Â‰›ˆÓ

·ÓÙÈÛÙÔÈ¯Â› ÛÂ ‰ÈÂ‡Ú˘ÓÛË ÙÔ˘ Ù˘ÊÏÔ‡ ÛËÌÂ›Ô˘ Î·È

·ÒÏÂÈ· ÙË˜ ÎÂÓÙÚÈÎ‹˜ fiÚ·ÛË˜. ¶fiÓÔ˜ Î·Ù¿ ÙË

‰È¿ÚÎÂÈ· ÙˆÓ ÔÊı·ÏÌÈÎÒÓ ÎÈÓ‹ÛÂˆÓ Û¿ÓÈ· ÂÌÊ·-

Ó›˙ÂÙ·È, ÁÂÁÔÓfi˜ Ô˘ ‚ÔËı¿ ÛÙË ‰È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆ-

ÛË ·fi ÙËÓ ÂÒ‰˘ÓË ÔÙÈÎ‹ ÓÂ˘Ú›ÙÈ‰· Ô˘ ·Ú·-

ÙËÚÂ›Ù·È ÛÂ ÊÏÂÁÌÔÓÒ‰ÂÈ˜ Î·Ù·ÛÙ¿ÛÂÈ˜. ø¯ÚfiÙËÙ·

ÙÔ˘ ÔÙÈÎÔ‡ ‰›ÛÎÔ˘ ÂÌÊ·Ó›˙ÂÙ·È ÌÂÙ¿ ÙËÓ ÂÁÎ·Ù¿-

ÛÙ·ÛË ÙË˜ ·ÒÏÂÈ·˜ fiÚ·ÛË˜. √È ÂÚÈÛÛfiÙÂÚÔÈ

·ÛıÂÓÂ›˜ Ê¤ÚÔ˘Ó ÔÌÔÈÔÏ·ÛÌÈÎ¤˜ ÛËÌÂÈ·Î¤˜ ÌÂ-

Ù·ÏÏ¿ÍÂÈ˜ ÙÔ˘ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ DNA Ô˘ Îˆ‰ÈÎÔ-

ÔÈÂ› ‰ÔÌÈÎ¤˜ ˘ÔÔÌ¿‰Â˜ ÙÔ˘ Û˘ÌÏ¤ÁÌ·ÙÔ˜ I

∂ÈÎfiÓ· 5. ™‡Ó‰ÚÔÌÔ Leigh: ∆2 ·ÎÔÏÔ˘ı›· ÂÁÎ¿ÚÛÈ· ÙÔÌ‹. √ÌÔ-ÁÂÓ¤˜ ˘„ËÏfi Û‹Ì· ÛÙÔ Ú·‚‰ˆÙfi ÛÒÌ· ÌÂ ÛÙÈÎÙ¤˜ ÂÚÈÔ¯¤˜ ¯·-ÌËÏÔ‡ Û‹Ì·ÙÔ˜ Èı·ÓfiÓ ÏfiÁˆ ·˘ÍËÌ¤ÓˆÓ ÂÚÈ·ÁÁÂÈ·ÎÒÓ ¯Ò-ÚˆÓ. ™ÙË Ì·ÁÓËÙÈÎ‹ Ê·ÛÌ·ÙÔÛÎÔ›· ·Ú·ÙËÚÂ›Ù·È (1HMRS‚Ú·¯Â›· ·ÎÔÏÔ˘ı›·) ÌÂÁ¿ÏË ·È¯Ì‹ Á·Ï·ÎÙÈÎÔ‡ (‚¤ÏÔ˜) (6).



°·Ï·ÎÙÈÎfi: ‰ÈÎfiÚ˘ÊË·È¯Ì‹

(ND1, ND4, ND6). ∞ÔÎ·Ù¿ÛÙ·ÛË ÙË˜ fiÚ·ÛË˜ Â›-

Ó·È ÔÏ‡ Û¿ÓÈ· fiÙ·Ó ÔÈ ·ÛıÂÓÂ›˜ Ê¤ÚÔ˘Ó ÙË ÌÂ-

Ù¿ÏÏ·ÍË G11778A, ·ÏÏ¿ Û¯ÂÙÈÎ¿ Û˘¯Ó‹ ÛÂ ·ÛıÂ-

ÓÂ›˜ ÌÂ ÙË ÌÂÙ¿ÏÏ·ÍË T14484C (48). ÕÏÏÂ˜ ÓÂ˘ÚÔ-

ÏÔÁÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ Â›Ó·È Û¿ÓÈÂ˜ (49).

™‡Ó‰ÚÔÌÔ ÔÛÔÙÈÎ‹˜ ÌÂ›ˆÛË˜ ÙÔ˘ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡

DNA (Mitochondrial DNA depletion syndrome

(MDS). ∞ÔÙÂÏÔ‡Ó ·Ûı¤ÓÂÈÂ˜ ÙË˜ ‚ÚÂÊÈÎ‹˜ ËÏÈ-

Î›·˜ Ô˘ ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÙÔ˘˜ Â›Ó·È ÔÛÔÙÈÎ‹ ‰È·-

Ù·Ú·¯‹ ÙÔ˘ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ DNA ÏfiÁÔ˘ ÂÏ¿ÙÙˆ-

ÛË˜ ÙË˜ ‰ÂÍ·ÌÂÓ‹˜ ÙˆÓ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÒÓ ‰ÂÔÍ˘ÚÈ-

‚ÔÓÔ˘ÎÏÂÔÙÈ‰›ˆÓ (dNTPs) ··Ú·›ÙËÙˆÓ ÁÈ· ÙË

Û‡ÓıÂÛË ÙÔ˘ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ DNA. À¿Ú¯Ô˘Ó ‰‡Ô

¤Ó˙˘Ì· Ô˘ ÂÏ¤Á¯Ô˘Ó ·˘Ù‹ ÙË ‰ÂÍ·ÌÂÓ‹. ∏ ÎÈÓ¿ÛË

ÙË˜ ‰ÂÔÍ˘ÁÔ˘·ÓÔÛ›ÓË˜ (dGK) ÌÂÙ·ÏÏ¿ÍÂÈ˜ ÙË˜

ÔÔ›·˜ Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÙÔÓ Ë·ÙÔÂÁÎÂÊ·ÏÈÎfi Ù‡Ô

Î·È Ë ÎÈÓ¿ÛË ÙË˜ ı˘ÌÈ‰›ÓË˜ (TK2) ÌÂÙ·ÏÏ¿ÍÂÈ˜ ÙË˜

ÔÔ›·˜ Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÙÔÓ Ì˘Ô·ıËÙÈÎfi Ù‡Ô (50).

ªËÙÚÈÎÒ˜ ÎÏËÚÔÓÔÌÔ‡ÌÂÓË ÓÂ˘ÚÔ·ÈÛıËÙËÚÈ·Î‹ ·Ò-

ÏÂÈ· ·ÎÔ‹˜ (Maternal Inherited Hearing Loss - MIHL).

∆· ÙÚÈ¯ˆÙ¿ Î‡ÙÙ·Ú· ÙÔ˘ ÎÔ¯Ï›· Â›Ó·È ·ÚÎÂÙ¿ Â˘·›-

ÛıËÙ· ÛÙË ‰È·Ù·Ú·¯‹ ÙË˜ ÌÈÙÔ¯ÔÓ‰ÚÈ·Î‹˜ ·Ú·Áˆ-

Á‹˜ ÂÓ¤ÚÁÂÈ·˜. ∏ ÛËÌÂÈ·Î‹ ÌÂÙ·ÏÏ¿ÍË, Û˘Ó‹ıˆ˜ ÛÂ

ÔÌÔÈÔÏ·ÛÌ›·, ÛÙË ı¤ÛË G1555A ÙÔ˘ ÌÈÙÔ¯ÔÓ‰ÚÈ·-

ÎÔ‡ DNA Â›Ó·È Û˘¯Ófi Â‡ÚËÌ· ÓÂ˘ÚÔ·ÈÛıËÙËÚÈ·Î‹˜

·ÒÏÂÈ·˜ ·ÎÔ‹˜. ∂ÈÚÔÛı¤Ùˆ˜, ¿ÙÔÌ· Ô˘ Ê¤ÚÔ˘Ó

ÙË ÌÂÙ¿ÏÏ·ÍË C1494T Â›Ó·È Â˘·›ÛıËÙ· ÛÙËÓ ÚfiÎÏË-

ÛË ·ÒÏÂÈ·˜ ·ÎÔ‹˜ ÌÂÙ¿ ·fi ¤ÎıÂÛË ÛÙÈ˜ ·ÌÈÓÔÁÏ˘-

ÎÔÛ›‰Â˜ (51,52).

ªÈÙÔ¯ÔÓ‰ÚÈ·Î‹ Ì˘ÔÎ·Ú‰ÈÔ¿ıÂÈ·. √È ÈÔ Û˘¯Ó¤˜

Î·Ú‰È·Î¤˜ ·ÓˆÌ·Ï›Â˜ Â›Ó·È ÔÈ ‰È·Ù·Ú·¯¤˜ ·ÁˆÁÈÌfi-

ÙËÙ·˜ Ô˘ Â›Ó·È ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘

Kearns-Sayre Î·È Ë ˘ÂÚÙÚÔÊÈÎ‹ Î·Ú‰ÈÔÌ˘Ô¿ıÂÈ·

(53). ∏ ‰È·Ù·ÙÈÎ‹ Î·Ú‰ÈÔÌ˘Ô¿ıÂÈ· Â›Ó·È ÏÈÁfiÙÂÚÔ

Û˘¯Ó‹. °ÂÓÂÙÈÎ¤˜ ‚Ï¿‚Â˜ Ô˘ Û˘Ó‰˘¿˙ÔÓÙ·È ÌÂ ÙËÓ

·ÚÔ˘Û›· Î·Ú‰ÈÔÌ˘Ô¿ıÂÈ·˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó:


¶·È‰È·ÙÚÈÎ‹ 2007;70:1-17

¶›Ó·Î·˜ 3. ™‡Ó‰ÚÔÌ· ÌÂ ÚˆÙÔ·ı‹ ‹ ‰Â˘ÙÂÚÔ·ı‹ ÌÈÙÔ¯ÔÓ‰ÚÈ·Î‹ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·

¡fiÛËÌ· / ∫ÏËÚÔÓÔÌÈÎfiÙËÙ· ∫ÏÈÓÈÎÔÂÚÁ·ÛÙËÚÈ·Îfi˜ Ê·ÈÓfiÙ˘Ô˜ °ÂÓÂÙÈÎ‹ ‚Ï¿‚Ë / ªË¯·ÓÈÛÌfi˜

∞Ù·Í›· ÙÔ˘ Freidreich / À™ ∞Ù·Í›·, ·Ô˘Û›· ÙÂÓfiÓÙÈˆÓ ªÂÙ·ÏÏ¿ÍÂÈ˜ (GAA repeat expansion) ·ÓÙ·Ó·ÎÏ·ÛÙÈÎÒÓ, ÛËÌÂ›Ô Babinski, ÛÙÔ ÁÔÓ›‰ÈÔ ÙË˜ ÊÚ·Ù·Í›ÓË˜ (FRDA1)/Î·Ú‰ÈÔÌ˘Ô¿ıÂÈ·, ‰È·‚‹ÙË˜, ÔÙÈÎ‹ ·ÙÚÔÊ›·

™‡Ó‰ÚÔÌÔ Menkes / ºÀ ∂ÈÏË„›·, „˘¯ÔÛˆÌ·ÙÈÎ‹ Î·ı˘ÛÙ¤ÚËÛË, ªÂÙ·ÏÏ¿ÍÂÈ˜ ÛÙÔ ÁÔÓ›‰ÈÔ ATP7A Ô˘ ·ÓˆÌ·Ï›Â˜ ÙÚÈ¯ÒÓ ÎÂÊ·Ï‹˜, ÔÛÙÈÎ‹ Îˆ‰ÈÎÔÔÈÂ› ÙÔÓ ATPase ÌÂÙ·ÊÔÚ¤· Â˘ıÚ·˘ÛÙfiÙËÙ·, ÂÁÎÂÊ·ÏÈÎ‹ ·ÙÚÔÊ›·, ¯·ÏÎÔ‡

∞Ù·Í›· ÛÈ‰ËÚÔ‚Ï·ÛÙÈÎ‹ AÙ·Í›· ÛÈ‰ËÚÔ‚Ï·ÛÙÈÎ‹ ·Ó·ÈÌ›· ªÂÙ·ÏÏ¿ÍÂÈ˜ ÛÙÔ ÁÔÓ›‰ÈÔ ABC7 Ô˘ ·Ó·ÈÌ›· / ºÀ Îˆ‰ÈÎÔÔÈÂ› ÙÔÓ ÌÂÙ·ÊÔÚ¤· ÛÈ‰‹ÚÔ˘ ÛÙÔ

ÌÈÙÔ¯fiÓ‰ÚÈÔ™‡Ó‰ÚÔÌÔ ÎÒÊˆÛË˜-‰˘ÛÙÔÓ›·˜ ∫ÒÊˆÛË, ‰˘ÛÙÔÓ›·, Î·Ù·ÚÚ¿ÎÙË˜, ªÂÙ·ÏÏ¿ÍÂÈ˜ ÛÙÔ ÁÔÓ›‰ÈÔ DDP1/(Mohr-Tranebjaerg) / ºÀ ‰˘ÛÊ·Á›· TIMM8A Ô˘ Îˆ‰ÈÎÔÔÈÂ› ÙÔÓ

ÚˆÙÂ˚ÓÈÎfi ÌÂÙ·ÊÔÚ¤· ∫ÏËÚÔÓÔÌÔ‡ÌÂÓË Û·ÛÙÈÎ‹ ™·ÛÙÈÎ‹ ·Ú·ÏËÁ›· ªÂÙ·ÏÏ¿ÍÂÈ˜ ÛÙÔ SPG7 ÁÔÓ›‰ÈÔ Ô˘ ·Ú·ÏËÁ›· / À™ Îˆ‰ÈÎÔÔÈÂ› Ì›· ÌÂÙ·ÏÏÔÚˆÙÂ¿ÛË™‡Ó‰ÚÔÌÔ Barth / ºÀ Ã·ÌËÏfi ·Ó¿ÛÙËÌ·, Î·Ú‰ÈÔÌ˘Ô¿ıÂÈ·, ªÂÙ·ÏÏ¿ÍÂÈ˜ ÛÙÔ ÁÔÓ›‰ÈÔ ÙË˜

Ô˘‰ÂÙÂÚÔÂÓ›· Î·È Ù·Ê·˙›ÓË˜ Ô˘ ÚÔÎ·ÏÂ› ‰È·Ù·Ú·¯¤˜ 3-ÌÂı˘ÏÁÏÔ˘Ù·ÎÔÓÈÎ‹ ÔÍÂÔ˘Ú›· ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙË˜ Î·Ú‰ÈÔÏÈ›ÓË˜ ÛÙË

ÌÈÙÔ¯ÔÓ‰ÚÈ·Î‹ ÌÂÌ‚Ú¿ÓË™‡Ó‰ÚÔÌÔ Alper / À™ - ™ÔÚ·‰ÈÎ‹ ∞Ù·Í›·, Ì˘ÔÎÏÔÓÈÎ‹ ÂÈÏË„›·, ªÂÙ·ÏÏ¿ÍÂÈ˜ ÛÙÔ ÁÔÓ›‰ÈÔ POLG1

Ë·ÙÔ¿ıÂÈ· (ÌÔÚÂ› Ó· ÂÌÊ·ÓÈÛÙÂ› Â›Ó·È ˘Â‡ı˘ÓÂ˜ ÁÈ· ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ ÌÂÙ¿ ·fi ¯ÔÚ‹ÁËÛË ‚·ÏÚÔ˚ÎÔ‡ ÔÍ¤Ô˜). Û˘Ó‰ÚfiÌÔ˘ Alper ÌÂ Ë·ÙÔ¿ıÂÈ·¶ÚÔÔ‰Â˘ÙÈÎ‹ ÂÁÎÂÊ·ÏÈÎ‹ ·ÙÚÔÊ›· Î·È ÓÂ˘ÚÔÂÎÊ‡ÏÈÛË

Charcot-Marie-Tooth type 2A ∞ÍÔÓÈÎÔ‡ Ù‡Ô˘ ÔÏ˘ÓÂ˘ÚÔ¿ıÂÈ· ªÂÙ·ÏÏ¿ÍÂÈ˜ ÛÙÔ ÁÔÓ›‰ÈÔ MFN2 Ô˘Îˆ‰ÈÎÔÔÈÂ› ÙË ÌÈÙÔÛ˘ÓÙËÍ›ÓË 2, ÚˆÙÂ˝ÓË··Ú·›ÙËÙË ÁÈ· ÙËÓ ÎÈÓËÙÈÎfiÙËÙ· ÙˆÓÌÈÙÔ¯ÔÓ‰Ú›ˆÓ

∞ÓÂ¿ÚÎÂÈ· Û˘ÓÂÓ˙‡ÌÔ˘ Q10 ñ ª˘Ô¿ıÂÈ· (ÂÚ˘ıÚ¤˜ Ú·ÎÒ‰ÂÈ˜ ›ÓÂ˜), Ã·ÌËÏ¿ Â›Â‰· ÔÏÈÎÔ‡ Q10 ÛÙÔ˘˜ Ì˘ÔÛÊ·ÈÚÈÓÔ˘Ú›·, Ì˘˜, Ê˘ÛÈÔÏÔÁÈÎ‹ ‰Ú·ÛÙÈÎfiÙËÙ· ·ÚÂÁÎÂÊ·ÏÈ‰ÈÎ‹ ·Ù·Í›· Û˘ÌÏÂÁÌ¿ÙˆÓ I, II, III, IV ·ÏÏ¿

ñ ™Ô‚·Ú‹ ÂÁÎÂÊ·ÏÔÌ˘Ô¿ıÂÈ· Î·È ÂÏ·ÙÙˆÌ¤ÓË ‰Ú·ÛÙÈÎfiÙËÙ· ÓÂÊÚÈÎ‹ ·ÓÂ¿ÚÎÂÈ· ÙˆÓ I-III Î·È II-III.

ÕÁÓˆÛÙË ÁÂÓÂÙÈÎ‹ ‚Ï¿‚Ë

À™: ÀÔÏÂÈfiÌÂÓÔ ™ˆÌ·ÙÈÎfi, ∂™: ∂ÈÎÚ·ÙÔ‡Ó ™ˆÌ·ÙÈÎfi, ºÀ: º˘ÏÔÛ‡Ó‰ÂÙÔ ÀÔÏÂÈfiÌÂÓÔ

i. ™ËÌÂÈ·Î¤˜ ÌÂÙ·ÏÏ¿ÍÂÈ˜ ÛÙÔ ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi

DNA (54)

ii. ªÂÙ·ÏÏ¿ÍÂÈ˜ ÙÔ˘ ˘ÚËÓÈÎÔ‡ DNA Ô˘ Îˆ‰È-

ÎÔÔÈÔ‡Ó ‰ÔÌÈÎ¤˜ ÌÔÓ¿‰Â˜ ÙÔ˘ Û˘ÌÏ¤ÁÌ·ÙÔ˜ I

(NDUFS2, NDUFV2) (55)

iii. ∞ÓÂ¿ÚÎÂÈ· ÙÔ˘ Î˘ÙÔ¯ÚÒÌ·ÙÔ˜ b (56)

iv. ªÂÙ¿ÏÏ·ÍË ÛÙÔ SCO2 ÁÔÓ›‰ÈÔ Ô˘ Îˆ‰ÈÎÔ-

ÔÈÂ› ÚˆÙÂ˝ÓË ··Ú·›ÙËÙË ÁÈ· ÙË Û˘Ó·ÚÌÔÏfiÁËÛË

ÙÔ˘ Û˘ÌÏ¤ÁÌ·ÙÔ˜ IV (57)

v. ¶ÔÛÔÙÈÎ‹ ÌÂ›ˆÛË ÙÔ˘ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ DNA

(58).

ªÈÙÔ¯ÔÓ‰ÚÈ·Î‹ Ì˘Ô¿ıÂÈ· Î·È ‰˘Û·ÓÂÍ›· ÛÙËÓ ¿ÛÎË-

ÛË (Isolated myopathy and exercise intolerance). ¶ÔÏ-

Ï¤˜ ÊÔÚ¤˜ Ì˘˚Î‹ ·‰˘Ó·Ì›· ÌÔÚÂ› Ó· Â›Ó·È ÙÔ ÌfiÓÔ

ÎÏÈÓÈÎfi Â‡ÚËÌ·. ∏ ÔÚÂ›· Â›Ó·È ·ÚÁ‹ Î·È ÚÔÔ‰Â˘ÙÈ-

Î‹ Î·È Û˘Ó‹ıˆ˜ ·ÊÔÚ¿ ÙÈ˜ ÂÁÁ‡˜ Ì˘˚Î¤˜ ÔÌ¿‰Â˜. ∏

Û˘ÌÙˆÌ·ÙÔÏÔÁ›· ÂÚÈÏ·Ì‚¿ÓÂÈ ÌÂÈˆÌ¤ÓË ·ÓÙÔ¯‹

ÛÙËÓ ¿ÛÎËÛË, ¯ÚfiÓÈ· ÎfiˆÛË, Ì˘˚Î¿ ¿ÏÁË Î·È Û·-

Ó›ˆ˜ ÂÂÈÛfi‰È· Ú·‚‰ÔÌ˘fiÏ˘ÛË˜ (59,60). ∏ Î·Ù¿ÛÙ·-

ÛË Â›Ó·È ÁÂÓÂÙÈÎÒ˜ ÂÙÂÚÔÁÂÓ‹˜ Î·È ¤¯ÂÈ Û˘Ó‰˘·ÛÙÂ›

ÌÂ: ·) ÛËÌÂÈ·Î¤˜ ÌÂÙ·ÏÏ¿ÍÂÈ˜ ÙÔ˘ ÁÔÓÈ‰›Ô˘ Ô˘ Îˆ-

‰ÈÎÔÔÈÂ› ÙÔ Î˘Ùfi¯ÚˆÌ· b, ‚) ¤ÏÏÂÈÌÌ· ÙÔ˘ ÌÈÙÔ¯ÔÓ-

‰ÚÈ·ÎÔ‡ DNA Î·È Á) ÌÂ ÂÚÈÙÒÛÂÈ˜ ÔÛÔÙÈÎ‹˜ ÌÂ›-

ˆÛË˜ (depletion) ÙÔ˘ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ DNA (14).

¢È·ÁÓˆÛÙÈÎ‹ ÚÔÛ¤ÁÁÈÛË Î·È ÎÚÈÙ‹ÚÈ·

∏ ‰˘ÛÎÔÏ›· ÛÙË ‰È·ÁÓˆÛÙÈÎ‹ ÚÔÛ¤Ï·ÛË ÙˆÓ

ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ ÔÊÂ›ÏÂÙ·È ÛÙË ÁÂÓÂÙÈ-

Î‹ Î·È Ê·ÈÓÔÙ˘ÈÎ‹ ÂÙÂÚÔÁ¤ÓÂÈ· Î·È ÛÙËÓ ·Ô˘Û›·

ÂÈ‰ÈÎÒÓ ‰È·ÁÓˆÛÙÈÎÒÓ ÙÂ¯ÓÈÎÒÓ. ∏ ÎÏËÚÔÓÔÌÈÎfiÙË-

Ù· ÔÈÎ›ÏÂÈ Î·È ÛÙÈ˜ ÂÚÈÛÛfiÙÂÚÂ˜ ÂÚÈÙÒÛÂÈ˜ ÙÔ

ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi Â›Ó·È ·ÚÓËÙÈÎfi. ™Ù· ·È‰È¿ Ë

‰È¿ÁÓˆÛË Â›Ó·È ·ÎfiÌË ÈÔ ‰‡ÛÎÔÏË ÁÈ·Ù›: ·) Ù· ÎÏÈ-

ÓÈÎ¿ ÌÈÙÔ¯ÔÓ‰ÚÈ·Î¿ Û‡Ó‰ÚÔÌ· Â›Ó·È Û¿ÓÈ·, ‚) Ù·

Â˘Ú‹Ì·Ù· ·fi ÙË Ì˘˚Î‹ ‚ÈÔ„›· ÛÙËÓ ÏÂÈÔ„ËÊ›·

ÙÔ˘˜ Â›Ó·È ¿Ù˘· Î·È Á) Ô ‚ÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ ‰ÂÓ

Â›Ó·È ¿ÓÙ· ·ÔÎ·Ï˘ÙÈÎfi˜ (61). ∏ ÚÔÛ¤ÁÁÈÛË

·ÛıÂÓÔ‡˜ ÌÂ ˘Ô„›· ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ ÓÔÛ‹Ì·ÙÔ˜

Ú¤ÂÈ Ó· ÂÍ·ÙÔÌÈÎÂ‡ÂÙ·È Î·È ··ÈÙÂ› ÙËÓ Ù·˘Ùfi-

¯ÚÔÓË ·ÍÈÔÏfiÁËÛË ÎÏÈÓÈÎÒÓ, ÓÂ˘ÚÔ·ÂÈÎÔÓÈÛÙÈÎÒÓ,

‚ÈÔ¯ËÌÈÎÒÓ, ÈÛÙÔ·ıÔÏÔÁÈÎÒÓ Î·È ÁÂÓÂÙÈÎÒÓ ÏË-

ÚÔÊÔÚÈÒÓ. °È· ÙËÓ Â˘ÎÔÏfiÙÂÚË Î·ÙËÁÔÚÈÔÔ›ËÛË

Î·È ‰È¿ÁÓˆÛË ÙˆÓ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ

¤¯Ô˘Ó ÚÔÙ·ıÂ› Î·È ÙÚÔÔÔÈËıÂ› ÁÈ· Ù· ·È‰È¿

‰È·ÁÓˆÛÙÈÎ¿ ÎÚÈÙ‹ÚÈ· (¶›Ó·Î·˜ 5) (62). ∆· ‰È·ÁÓˆ-

ÛÙÈÎ¿ ÎÚÈÙ‹ÚÈ· ‚ÔËıÔ‡Ó ÒÛÙÂ Ó· Ù·ÍÈÓÔÌËıÂ› Ô

·ÛıÂÓ‹˜ ·Ó¿ÏÔÁ· ÌÂ ÙË ‰È·ÁÓˆÛÙÈÎ‹ ‚Â‚·ÈfiÙËÙ·

(“ÔÚÈÛÙÈÎ‹”, “Èı·Ó‹”, “‰˘Ó·Ù‹”) Ó· Ê¤ÚÂÈ ÌÈÙÔ-

¯ÔÓ‰ÚÈ·Îfi ÓfiÛËÌ·.

µÈÔ¯ËÌÈÎ‹ ÌÂÏ¤ÙË

∏ ·ÓˆÌ·Ï›· ÙË˜ ÔÍÂÈ‰ˆÙÈÎ‹˜ ÊˆÛÊÔÚ˘Ï›ˆÛË˜

ÚÔÎ·ÏÂ› ¿ÌÂÛË Î·È ¤ÌÌÂÛË ‰È·Ù·Ú·¯‹ ‰È·ÊfiÚˆÓ ÌÂ-

Ù·‚ÔÏÈÎÒÓ Ô‰ÒÓ fiˆ˜ ÙË˜ ÁÏ˘ÎfiÏ˘ÛË˜, ÙÔ˘ ÌÂÙ·‚Ô-

ÏÈÛÌÔ‡ ˘ÚÔÛÙ·Ê˘ÏÈÎÔ‡ ÔÍ¤Ô˜, ÙÔ˘ Î‡ÎÏÔ˘ ÙÔ˘

Krebs Î·È ÙÔ˘ Î·Ù·‚ÔÏÈÛÌÔ‡ ÚˆÙÂ˚ÓÒÓ. ÕÌÂÛË Û˘-

Ó¤ÂÈ· ÙˆÓ ‰È·Ù·Ú·¯ÒÓ ·˘ÙÒÓ Â›Ó·È Ë ·‡ÍËÛË ÛÙÔÓ

ÔÚfi Î·È ∂¡À ÙÔ˘ Á·Ï·ÎÙÈÎÔ‡ Î·È ˘ÚÔÛÙ·Ê˘ÏÈÎÔ‡

(·‡ÍËÛË ÙÔ˘ ÏfiÁÔ˘ Á·Ï·ÎÙÈÎfi/˘ÚÔÛÙ·Ê˘ÏÈÎfi ¿Óˆ

·fi 20) Î·È ÙË˜ ·Ï·Ó›ÓË˜. ™ÙÔÓ ÔÚfi ¤¯Ô˘ÌÂ Â›ÛË˜



¶›Ó·Î·˜ 4. ∂Ó˙˘ÌÈÎ¤˜ ‰È·Ù·Ú·¯¤˜ Î·È ÌÂÙ·ÏÏ¿ÍÂÈ˜ ÙÔ˘ ˘ÚËÓÈÎÔ‡ ‹ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ DNA Ô˘ Û˘Ó‰˘¿˙ÔÓÙ·È ÌÂ Û‡Ó‰ÚÔÌÔ Leigh

ªÂÙ·ÏÏ¿ÍÂÈ˜ ˘ÚËÓÈÎÔ‡ DNA (˘ÔÏÂÈfiÌÂÓË ÎÏËÚÔÓÔÌÈÎfiÙËÙ·)

ñ ªÂÙ·ÏÏ¿ÍÂÈ˜ ÁÔÓÈ‰›ˆÓ Ô˘ ÂÓ¤¯ÔÓÙ·È ÛÙË Û˘Ó·ÚÌÔÏfiÁËÛË ÙÔ˘ Û˘ÌÏ¤ÁÌ·ÙÔ˜ IV (Î˘ÙÔ¯ÚˆÌÈÎ‹˜ ÔÍÂÈ‰¿ÛË˜ COX) Ô˘Î˘Ú›ˆ˜ ·ÊÔÚ¿ ÙÔ SURF1 ÁÔÓ›‰ÈÔ Î·È ÈÔ Û¿ÓÈ· ÙÔ SCO2 (ÂÁÎÂÊ·ÏÔ¿ıÂÈ·, ˘ÂÚÙÚÔÊÈÎ‹ Î·Ú‰ÈÔÌ˘Ô¿ıÂÈ·) Î·È SCO1ÁÔÓ›‰È· (57,77)

ñ ªÂÙ·ÏÏ¿ÍÂÈ˜ ÁÔÓÈ‰›ˆÓ Ô˘ ·ÊÔÚÔ‡Ó ‰ÔÌÈÎ¤˜ ˘ÔÔÌ¿‰Â˜ ÙÔ˘ Û˘ÌÏ¤ÁÌ·ÙÔ˜ I (NDUFS1, NDUFS8, NDUFS4, NDUFS7,NDUFS2, NDUFV2) (78)

ñ ªÂÙ¿ÏÏ·ÍË SDHA ÁÔÓÈ‰›Ô˘ ÙÔ˘ Û˘ÌÏ¤ÁÌ·ÙÔ˜ ππ (79)

ñ ªÂÙ¿ÏÏ·ÍË BSC1 ÁÔÓÈ‰›Ô˘ Ô˘ Û˘ÌÌÂÙ¤¯ÂÈ ÛÙË Û˘Ó·ÚÌÔÏfiÁËÛË (chaperone) ÙÔ˘ Û˘ÌÏ¤ÁÌ·ÙÔ˜ πππ (80)

ªÂÙ·ÏÏ¿ÍÂÈ˜ ÙÔ˘ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ DNA

ñ ªÂÙ·ÏÏ¿ÍÂÈ˜ ÁÔÓÈ‰›ˆÓ ÙË˜ ATP Û˘ÓıÂÙ¿ÛË˜ (NARP/Leigh) A8344G (tRNALys) G8363A

ñ ªÂÙ·ÏÏ¿ÍÂÈ˜ ÛÙ· ÁÔÓ›‰È· ND3 ‹ ND5 Ô˘ Îˆ‰ÈÎÔÔÈÔ‡Ó ‰ÔÌÈÎ¤˜ ÌÔÓ¿‰Â˜ ÙÔ˘ Û˘ÌÏ¤ÁÌ·ÙÔ˜ π (81,82)

ñ ªÂÙ·ÏÏ¿ÍÂÈ˜ ÛÙÔ COXIII ÁÔÓ›‰ÈÔ ÙÔ˘ Û˘ÌÏ¤ÁÌ·ÙÔ˜ IV

¶ÔÛÔÙÈÎ‹ ÌÂ›ˆÛË ÙÔ˘ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ DNA

ñ ¶ÔÏÏ·Ï‹ Û˘ÌÏÂÁÌ·ÙÈÎ‹ ·ÓÂ¿ÚÎÂÈ· (83)

ÕÏÏˆÓ ÂÓ˙˘ÌÈÎÒÓ ·ÓÂ·ÚÎÂÈÒÓ

ñ ∞ÓÂ¿ÚÎÂÈ· ˘ÚÔÛÙ·Ê˘ÏÈÎ‹˜ ·Ê˘‰ÚÔÁÔÓ¿ÛË˜ (E1a, E3, E3BP, ÚÔÛÊ¿Ùˆ˜ E1b)

ñ ∞ÓÂ¿ÚÎÂÈ· ‚ÈÔÙÈÓÈ‰¿ÛË˜ (ÔÏÏ·Ï‹ ·ÓÂ¿ÚÎÂÈ· Î·Ú‚ÔÍ˘Ï·ÛÒÓ) (84)

ñ ∞ÓÂ¿ÚÎÂÈ· ˘ÚÔÛÙ·Ê˘ÏÈÎ‹˜ Î·Ú‚ÔÍ˘Ï¿ÛË˜

·‡ÍËÛË ÙˆÓ ÎÂÙÔÓÔÛˆÌ¿ÙˆÓ È‰È·›ÙÂÚ· ÌÂÙ¿ ÙË Ï‹„ËÙÚÔÊ‹˜ (·Ú¿‰ÔÍË ÎÂÙÔÓ·ÈÌ›·). ∏ ÊˆÛÊÔÎÈÓ¿ÛË ÙË˜ÎÚÂ·Ù›ÓË˜ (CPK) Â›Ó·È Û˘Ó‹ıˆ˜ Ê˘ÛÈÔÏÔÁÈÎ‹ ‹ ÂÏ·-ÊÚ¿ ·˘ÍËÌ¤ÓË ÛÂ ÌÂÚÈÎ¤˜ ÌÈÙÔ¯ÔÓ‰ÚÈ·Î¤˜ Ì˘Ô¿ıÂÈ-Â˜. √ÚÈÛÌ¤Ó· ÌÈÙÔ¯ÔÓ‰ÚÈ·Î¿ ÓÔÛ‹Ì·Ù· ÚÔÛ‚¿ÏÔ˘ÓÙÔ ‹·Ú ÌÂ ‰È·Ù·Ú·¯‹ ÙˆÓ Ë·ÙÈÎÒÓ ÂÓ˙‡ÌˆÓ Î·È ¿Ï-Ï· ÙÔ˘˜ ÓÂÊÚÔ‡˜ ÌÂ ÂÌÊ¿ÓÈÛË ÓÂÊÚÈÎ‹˜ ÛˆÏËÓ·ÚÈ·-Î‹˜ ÔÍ¤ˆÛË˜ (De-Toni-Fabre-Fanconi). ∏ ·Ó·ÈÌ›·ÌÔÚÂ› Ó· Â›Ó·È Â›ÙÂ ÚˆÙÔ·ı‹˜ (ÛÈ‰ËÚÔ‚Ï·ÛÙÈÎ‹·Ó·ÈÌ›·) Â›ÙÂ ‰Â˘ÙÂÚÔ·ı‹˜ ÏfiÁˆ ÓÂÊÚÔ¿ıÂÈ·˜. ¢˘-ÛÙ˘¯Ò˜, ÙÔ ‚ÈÔ¯ËÌÈÎfi ÌÂÙ·‚ÔÏÈÎfi screening ‰ÂÓ Â›Ó·È¿ÓÙ· ·ÔÎ·Ï˘ÙÈÎfi, Î·È Ù· ‰È·ÁÓˆÛÙÈÎ¿ Ï¿ıË Â›Ó·ÈÛ˘¯Ó¿ (13,63). √ ¶›Ó·Î·˜ 6 ÂÚÈÁÚ¿ÊÂÈ ÙÔÓ ‚ÈÔ¯ËÌÈ-Îfi ÌÂÙ·‚ÔÏÈÎfi ¤ÏÂÁ¯Ô Ô˘ Û˘ÓÈÛÙ¿Ù·È Â› ˘Ô„›·˜ÓÔÛ‹Ì·ÙÔ˜ ÌÂ ÌÈÙÔ¯ÔÓ‰ÚÈ·Î‹ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·.

πÛÙÔ·ıÔÏÔÁ›· Ì˘˚ÎÔ‡ ÈÛÙÔ‡

∆Ô ÈÛÙÔÏÔÁÈÎfi Û‹Ì· Î·Ù·ÙÂı¤Ó ÙˆÓ ÌÈÙÔ¯ÔÓ‰ÚÈÔ-·ıÂÈÒÓ Â›Ó·È ÔÈ ÂÚ˘ıÚ¤˜ Ú·ÎÒ‰ÂÈ˜ ›ÓÂ˜ (ragged redfibers) Ô˘ ·ÓÈ¯ÓÂ‡ÔÓÙ·È ÌÂ ÙË ¯ÚÒÛË Gomori-trichrome (∂ÈÎfiÓ· 6·) Î·È ÙË ¯ÚÒÛË ÛÔ˘ÎÈÓÈÎ‹˜ ·Ê˘-‰ÚÔÁÔÓ¿ÛË˜ (∂ÈÎfiÓ· 6‚). √È ÂÚ˘ıÚ¤˜ Ú·ÎÒ‰ÂÈ˜ ›ÓÂ˜Û¯ËÌ·Ù›˙ÔÓÙ·È ·fi ÙÔÓ ÔÏÏ·Ï·ÛÈ·ÛÌfi Î·È ÙË Û˘-ÁÎ¤ÓÙÚˆÛË ˘ÔÛ·ÚÎËÏÂÈÌÌ·ÙÈÎÒÓ ÌÈÙÔ¯ÔÓ‰Ú›ˆÓ Î·ÈÙËÓ ÂÎÊ‡ÏÈÛË ÙˆÓ Ì˘˚ÎÒÓ ÈÓÒÓ. √È ÈÛÙÔÏÔÁÈÎ¤˜ ·˘Ù¤˜·ÏÏÔÈÒÛÂÈ˜ ·Ú·ÙËÚÔ‡ÓÙ·È Î˘Ú›ˆ˜ ÛÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜Î·È Û˘¯ÓfiÙÂÚ· ÛÂ ÌÈÙÔ¯ÔÓ‰ÚÈ·Î¿ ÓÔÛ‹Ì·Ù· ·fi ÌÂ-Ù·ÏÏ¿ÍÂÈ˜ ÙÔ˘ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ DNA. ∂Ú˘ıÚ¤˜ Ú·ÎÒ-‰ÂÈ˜ ›ÓÂ˜ Û·Ó›ˆ˜ ·ÓÈ¯ÓÂ‡ÔÓÙ·È ÛÙË ‚ÚÂÊÈÎ‹ Î·È ·È-‰ÈÎ‹ ËÏÈÎ›·, ÂÓÒ ÈÔ Û˘¯Ófi Â‡ÚËÌ· Â›Ó·È Ë ·ÚÔ˘Û›·˘ÔÛ·ÚÎËÏÂÈÌÌ·ÙÈÎÒÓ Û˘ÛÛˆÚÂ‡ÛÂˆÓ (64). ∏ ·ÓÙ›-‰Ú·ÛË ÙË˜ ÔÍÂÈ‰¿ÛË˜ ÙÔ˘ Î˘ÙÔ¯ÚÒÌ·ÙÔ˜ (COX) ÔÈ-Î›ÏÂÈ. ÕÏÏÂ˜ ÌË ÂÈ‰ÈÎ¤˜ ÈÛÙÔ·ıÔÏÔÁÈÎ¤˜ ·ÏÏÔÈÒÛÂÈ˜Â›Ó·È Û˘¯Ó¤˜ ·ÏÏ¿ ÌË ‰È·ÁÓˆÛÙÈÎ¤˜ (65).

∏ ·Ó¿Ï˘ÛË ÌÂ ËÏÂÎÙÚÔÓÈÎfi ÌÈÎÚÔÛÎfiÈÔ ÌÔÚÂ›Ó· ·ÓÈ¯ÓÂ‡ÛÂÈ ‰ÔÌÈÎ¤˜ ·ÓˆÌ·Ï›Â˜ fiˆ˜ ·Ú·ÎÚ˘-ÛÙ·ÏÏÈÎ¿ ¤ÁÎÏÂÈÛÙ·, ˘ÂÚÌÂÁ¤ıË ÌÈÙÔ¯fiÓ‰ÚÈ·, ÌÈÙÔ-¯fiÓ‰ÚÈ· ÌÂ ·ÏÏÔÈÒÛÂÈ˜ ÙˆÓ ·ÎÚÔÏÔÊÈÒÓ, ·˘ÍËÌ¤ÓËÔÈÎÈÏÔÌÔÚÊ›· ÙˆÓ ÌÈÙÔ¯ÔÓ‰Ú›ˆÓ Î·È ˘ÔÛ·ÚÎÂÈ-ÏËÌÌ·ÙÈÎ¤˜ Î·È ÂÓ‰ÔÌ˘Ô˚ÓÈ‰È·Î¤˜ Û˘ÛÛˆÚÂ‡ÛÂÈ˜ ÌÈ-ÙÔ¯ÔÓ‰Ú›ˆÓ. ∏ ·ÚÔ˘Û›· ·Ú·ÎÚ˘ÛÙ·ÏÏÈÎÒÓ ¤ÁÎÏÂÈ-

ÛÙˆÓ Î·È Û˘ÛÛˆÚÂ‡ÛÂÈ˜ ·ıÔÏÔÁÈÎÒÓ ÌÈÙÔ¯ÔÓ‰Ú›ˆÓ

Â›Ó·È ÂÈ‰ÈÎÔ› ‰ÔÌÈÎÔ› ‰Â›ÎÙÂ˜ ÌÈÙÔ¯ÔÓ‰ÚÈÔ¿ıÂÈ·˜

(∂ÈÎfiÓ· 7 ) ·ÏÏ¿ ‰ÂÓ ·ÓÈ¯ÓÂ‡ÔÓÙ·È ¿ÓÙ·.

∂Ó˙˘Ì·ÙÈÎ‹ Ì¤ÙÚËÛË Î·È ÔÍÂÈ‰ˆÙÈÎfi˜

¤ÏÂÁ¯Ô˜ ÛÙÔ˘˜ ÈÛÙÔ‡˜

∏ ÂÓ˙˘ÌÈÎ‹ ·Ó¿Ï˘ÛË ÚÔÙÈÌ¿Ù·È Ó· Á›ÓÂÙ·È ÛÂ

ÊÚ¤ÛÎÔ Ì˘˚Îfi ÈÛÙfi, ÂÂÈ‰‹ Ù· ÌÈÙÔ¯fiÓ‰ÚÈ· ·Ú·Ì¤-

ÓÔ˘Ó ·Î¤Ú·È· Î·È ¤ÙÛÈ ÌÔÚÂ› Ó· ÌÂÙÚËıÂ› Ô ‚·ıÌfi˜

ÔÍÂ›‰ˆÛË˜ Î·È Ë ·Ú·ÁˆÁ‹ ATP. ∏ Ì¤ÙÚËÛË ÙË˜

ÔÍÂÈ‰ˆÙÈÎ‹˜ ÈÎ·ÓfiÙËÙ·˜ ÛÂ ÊÚ¤ÛÎ· Ì˘˚Î¿ ÌÈÙÔ¯fiÓ-

‰ÚÈ· Á›ÓÂÙ·È Â›ÙÂ ÌÂ ÔÏ·ÚÔÁÚ·ÊÈÎ‹ Ì¤ıÔ‰Ô Â›ÙÂ ÌÂ

Ú·‰ÈÔ¯ËÌÈÎ‹ Ì¤ıÔ‰Ô (6). ∆Ô Úfi‚ÏËÌ· ÌÂ ÙË ‰ÈÂÚÂ‡-

ÓËÛË ÛÂ ÊÚ¤ÛÎÔ ÈÛÙfi Â›Ó·È fiÙÈ ÙÔ ‰Â›ÁÌ· Ú¤ÂÈ Ó·

ÊÙ¿ÛÂÈ ÛÙÔ ÂÚÁ·ÛÙ‹ÚÈÔ Ì¤Û· ÛÂ 2-3 ÒÚÂ˜ ·fi ÙË ‚ÈÔ-

„›· Î·È Ë ‰ÔÎÈÌ·Û›· Á›ÓÂÙ·È ÌfiÓÔ ÛÂ Ï›Á· ÂÍÂÈ‰ÈÎÂ˘-

Ì¤Ó· ÂÚÁ·ÛÙ‹ÚÈ·. ∞Ó Ë ÂÍ¤Ù·ÛË ÛÂ ÊÚ¤ÛÎÔ ÈÛÙfi ‰ÂÓ

Â›Ó·È ‰˘Ó·Ù‹, ÙÔ ‰Â›ÁÌ· Ú¤ÂÈ Ó· Î·Ù·„‡¯ÂÙ·È ·Ì¤-

Ûˆ˜ ÛÂ ˘ÁÚfi ¿˙ˆÙÔ, ¯ˆÚ›˜ Ì¤ÛÔ, Î·È Ó· Ê˘Ï¿ÛÛÂÙ·È

ÛÙÔ˘˜ -80ÔC. ªÂÙ·ÊÔÚ¿ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ÛÙÔ ÂÚÁ·ÛÙ‹-

ÚÈÔ Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÌÂ ÍËÚfi ¿ÁÔ. ™ÙËÓ ÂÚ›ÙˆÛË

·˘Ù‹ Ë Ì¤ÙÚËÛË ÙË˜ ‰Ú·ÛÙÈÎfiÙËÙ·˜ ÙˆÓ ·Ó·ÓÂ˘ÛÙÈ-

ÎÒÓ ÂÓ˙‡ÌˆÓ Á›ÓÂÙ·È ÛÂ ÔÌÔÁÂÓÔÔÈËÌ¤ÓÔ ˘ÏÈÎfi ÙÔ˘

ÈÛÙÔ‡ ÌÂ ÙË Ì¤ıÔ‰Ô ÙË˜ Ê·ÛÌ·ÙÔÊˆÙÔÌÂÙÚ›·˜ (66).

∞ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜

∂› ÎÏÈÓÈÎ‹˜ ÂÁÎÂÊ·ÏÔÌ˘Ô¿ıÂÈ·˜ Ô ÓÂ˘ÚÔ·ÂÈ-

ÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ Â›Ó·È ··Ú·›ÙËÙÔ˜ ÁÈ·Ù› ÌÔÚÂ›

∂ÈÎfiÓ· 7. ¶·Ú·ÎÚ˘ÛÙ·ÏÏÈÎ¿ ¤ÁÎÏÂÈÛÙ· ÛÙÔÓ ‰È·ÌÂÌ‚Ú·ÓÈÎfi¯ÒÚÔ ÙˆÓ ÌÈÙÔ¯ÔÓ‰Ú›ˆÓ ˘fi ÙË ÌÔÚÊ‹ “¯ÒÚÔ˘ ÛÙ¿ıÌÂ˘ÛË˜(parking lot)” ‚¤ÏÔ˜.

∂ÈÎfiÓ· 6. ·) ÃÚÒÛË Gomori Trichrome: ÂÚ˘ıÚ¤˜ Ú·ÎÒ‰ÂÈ˜ ›ÓÂ˜(ÏÂ˘Îfi ‚¤ÏÔ˜) Î·È ˘ÔÛ·ÚÎËÏÂÈÌÌ·ÙÈÎ¤˜ Û˘ÛÛˆÚÂ‡ÛÂÈ˜ ÌÈÙÔ-¯ÔÓ‰Ú›ˆÓ (Ì·‡Ú· ‚¤ÏË) ‚) ÃÚÒÛË SDH “Î˘·Ó¤˜ Ú·ÎÒ‰ÂÈ˜ ›ÓÂ˜”(ÂÚ˘ıÚfi ‚¤ÏÔ˜).

· ‚


¶·È‰È·ÙÚÈÎ‹ 2007;70:1-17

Ó· ‰ÒÛÂÈ ÏËÚÔÊÔÚ›Â˜ ÔÈ ÔÔ›Â˜ Ó· Î·ÙÂ˘ı‡ÓÔ˘Ó ÙË

‰È·ÁÓˆÛÙÈÎ‹ ÚÔÛ¤ÁÁÈÛË. √ Ì·ÁÓËÙÈÎfi˜ ·ÂÈÎÔÓÈÛÙÈ-

Îfi˜ Û˘ÓÙÔÓÈÛÌfi˜ ÚÔÙÈÌ¿Ù·È, ÂÓÒ Ë ·ÍÔÓÈÎ‹ ÙÔÌÔ-

ÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ ÌÔÚÂ› Ó· ·ÂÈÎÔÓ›ÛÂÈ Î·Ï‡ÙÂÚ·

ÙÈ˜ Èı·Ó¤˜ ·Û‚ÂÛÙÔÔÈ‹ÛÂÈ˜ ÛÙ· ‚·ÛÈÎ¿ Á¿ÁÁÏÈ·

(67). π‰È·›ÙÂÚ· ÛÙÈ˜ ÂÚÈÙÒÛÂÈ˜ Û˘Ó‰ÚfiÌÔ˘ Leigh,

Û˘ÌÌÂÙÚÈÎfi ·ıÔÏÔÁÈÎfi Û‹Ì· ·ÓÂ˘Ú›ÛÎÂÙ·È ÛÙ· ‚·-

ÛÈÎ¿ Á¿ÁÁÏÈ· (∂ÈÎfiÓ· 5) ·ÏÏ¿ Î·È ¿ÏÏÔ˘˜ ÂÁÎÂÊ·ÏÈ-

ÎÔ‡˜ ˘Ú‹ÓÂ˜ (˘Ôı·Ï¿ÌÈÔ˘˜, Ì¤Ï·ÈÓ· Ô˘Û›·, Ê·È¿

Ô˘Û›· ÙÔ˘ ˘‰Ú·ÁˆÁÔ‡ ÙÔ˘ Sylvious Î·È ˘Ú‹ÓÂ˜ ÙÔ˘

ÛÙÂÏ¤¯Ô˘˜). Ã·Ú·ÎÙËÚÈÛÙÈÎ‹ ÂÈÎfiÓ· ÏÂ˘ÎÔ‰˘ÛÙÚÔ-

Ê›·˜ ¤¯Ô˘ÌÂ ÛÙÔ Û‡Ó‰ÚÔÌÔ Kearns-Sayre (∂ÈÎfiÓ· 8).

¶ÚÔÛ‚ÔÏ‹ ÙË˜ ÏÂ˘Î‹˜ Ô˘Û›·˜ ¤¯Ô˘ÌÂ Â›ÛË˜ ÛÙÔ

Û‡Ó‰ÚÔÌÔ MNGIE Î·È Û‡Ó‰ÚÔÌÔ Leigh (41,68). ∂ÁÎÂ-

Ê·ÏÈÎ‹ Î·È ·ÚÂÁÎÂÊ·ÏÈ‰ÈÎ‹ ÊÏÔÈÒ‰Ë˜ ·ÙÚÔÊ›· Â›-

Ó·È Û˘¯Ófi Â‡ÚËÌ·, Î·Ù¿ Î·ÓfiÓ· ‚Ú›ÛÎÂÙ·È ÛÙÔ Û‡Ó-

‰ÚÔÌÔ Alper, ÂÓÒ Û·Ó›ˆ˜ ··ÓÙ¿Ù·È ÛÙÔ Û‡Ó‰ÚÔÌÔ

Leigh (31,39,41,69).



¶›Ó·Î·˜ 5. ∆ÚÔÔÔÈËÌ¤Ó· ÎÚÈÙ‹ÚÈ· ÂÓËÏ›ÎˆÓ ÁÈ· ÙË ‰È¿ÁÓˆÛË ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ

ªÂ›˙ÔÓ· ∫ÚÈÙ‹ÚÈ·

∫ÏÈÓÈÎ‹ ÂÎ‰‹ÏˆÛË¶Ï‹ÚË˜ ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· ÌÈÙÔ¯ÔÓ‰ÚÈ·Î‹˜ ÂÁÎÂÊ·ÏÔÌ˘Ô¿ıÂÈ·˜*‹ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· Ô˘ ÏËÚÔ› ÙÚÂÈ˜ ÚÔ¸Ôı¤ÛÂÈ˜:ñ ¶ÔÏ˘Û˘ÛÙËÌ·ÙÈÎ‹ Û˘ÌÙˆÌ·ÙÔÏÔÁ›· ÌÂ ÙË Û˘ÌÌÂÙÔ¯‹

ÙÔ˘Ï¿¯ÈÛÙÔÓ ÙÚÈÒÓ ÔÚÁ·ÓÈÎÒÓ Û˘ÛÙËÌ¿ÙˆÓ (∫¡™, Ì˘˚Îfi,Î·Ú‰È·ÁÁÂÈ·Îfi, ÓÂÊÚÈÎfi, Á·ÛÙÚÂÓÙÂÚÈÎfi, Ë·ÙÈÎfi, ÂÓ‰ÔÎÚÈÓÈÎfi,·ÈÌ·ÙÔÏÔÁÈÎfi) ‹ ÔÚÁ¿ÓˆÓ (·ÎÔ‹, fiÚ·ÛË, ‰˘ÛÌÔÚÊ›·)

ñ ¶ÚÔÔ‰Â˘ÙÈÎ‹ ÎÏÈÓÈÎ‹ ÔÚÂ›· ÌÂ ÂÍ¿ÚÛÂÈ˜ ‹ ÔÈÎÔÁÂÓÂÈ·ÎfiÈÛÙÔÚÈÎfi ÌÂ Èı·Ó‹ ÌÈÙÔ¯ÔÓ‰ÚÈÔ¿ıÂÈ·

ñ ∞ÔÎÏÂÈÛÌfi˜ ¿ÏÏˆÓ ÌÂÙ·‚ÔÏÈÎÒÓ ‹ ÓÂ˘ÚÔÂÎÊ˘ÏÈÛÙÈÎÒÓÓÔÛËÌ¿ÙˆÓ

πÛÙÔ·ıÔÏÔÁ›·>2% ÂÚ˘ıÚÒÓ Ú·Îˆ‰ÒÓ ÈÓÒÓ ÛÂ ÛÎÂÏÂÙÈÎfi Ì˘˚Îfi ÈÛÙfi

∂Ó˙˘ÌÔÏÔÁ›·**ñ >2% COX-·ÚÓËÙÈÎ¤˜ ›ÓÂ˜ (<50 ÂÙÒÓ)ñ >5% COX-·ÚÓËÙÈÎ¤˜ ›ÓÂ˜ (>50 ÂÙÒÓ)ñ <20% ‰Ú·ÛÙÈÎfiÙËÙ· ÂÓ˙˘ÌÈÎÔ‡ Û˘ÌÏ¤ÁÌ·ÙÔ˜ ÙË˜

·Ó·ÓÂ˘ÛÙÈÎ‹˜ ·Ï˘Û›‰·˜ ÛÂ ÈÛÙfiñ <30% ‰Ú·ÛÙÈÎfiÙËÙ· ÂÓ˙˘ÌÈÎÔ‡ Û˘ÌÏ¤ÁÌ·ÙÔ˜ ÙË˜

·Ó·ÓÂ˘ÛÙÈÎ‹˜ ·Ï˘Û›‰·˜ ÛÂ Î˘ÙÙ·ÚÈÎ‹ ÁÚ·ÌÌ‹ñ <30% ‰Ú·ÛÙÈÎfiÙËÙ· ÂÓ˙˘ÌÈÎÔ‡ Û˘ÌÏ¤ÁÌ·ÙÔ˜ ÙË˜

·Ó·ÓÂ˘ÛÙÈÎ‹˜ ·Ï˘Û›‰·˜ ÛÂ ‰‡Ô ÈÛÙÔ‡˜§ÂÈÙÔ˘ÚÁÈÎ¤˜ ‰ÔÎÈÌ·Û›Â˜

ªÂÈˆÌ¤ÓË Û˘ÓıÂÙÈÎ‹ ÈÎ·ÓfiÙËÙ· ATP ÛÂ ÈÓÔ‚Ï¿ÛÙÂ˜ (>3ÛÙ·ıÂÚ¤˜ ·ÔÎÏÂ›ÛÂÈ˜ ÙË˜ Ì¤ÛË˜ ÙÈÌ‹˜)

ªÔÚÈ·Î¿ Â˘Ú‹Ì·Ù·∆·˘ÙÔÔ›ËÛË ÌÂÙ¿ÏÏ·ÍË˜ ÛÂ ˘ÚËÓÈÎfi ‹ ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi DNA·‰È·ÌÊÈÛ‚‹ÙËÙË˜ ·ıÔÁÂÓÂÙÈÎfiÙËÙ·˜

* ∫ÏÈÓÈÎ‹ ÚÔ‚ÔÏ‹ Ù˘ÈÎ‹ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ (Leigh, Alper, Pearson’s, Kearns-Sayre, MELAS, MERRF, NARP, MNGIE, LHON)

** ∂Ó˙˘ÌÈÎ‹ ‰Ú·ÛÙÈÎfiÙËÙ· ·ÓÙÈÚÔÛˆÂ‡ÂÈ ÔÛÔÛÙÈ·›· ·Ó·ÏÔÁ›· ÛÂ Û¯¤ÛË ÌÂ ÙË Ê˘ÛÈÔÏÔÁÈÎ‹ Ì¤ÛË ÙÈÌ‹

∂Ï¿ÛÛÔÓ· ∫ÚÈÙ‹ÚÈ·

∫ÏÈÓÈÎ‹ ÂÎ‰‹ÏˆÛË∫ÏÈÓÈÎ‹ Û˘ÌÙˆÌ·ÙÔÏÔÁ›· Û˘Ì‚·Ù‹ ÌÂ ÌÈÙÔ¯ÔÓ‰ÚÈ·Î‹ÂÁÎÂÊ·ÏÔÌ˘Ô¿ıÂÈ·*

πÛÙÔ·ıÔÏÔÁ›·ñ 1-2% ÂÚ˘ıÚÒÓ Ú·Îˆ‰ÒÓ ÈÓÒÓ (ËÏÈÎ›· 30-50 ÂÙÒÓ)ñ √ÔÈ·‰‹ÔÙÂ ·ÚÔ˘Û›· ÂÚ˘ıÚÒÓ Ú·Îˆ‰ÒÓ ÈÓÒÓ (<30

ÂÙÒÓ)ñ >2% ˘ÔÛ·ÚÎÂÈÏËÌ·ÙÈÎ¤˜ ÌÈÙÔ¯ÔÓ‰ÚÈ·Î¤˜

Û˘ÛÛˆÚÂ‡ÛÂÈ˜ (<16 ÂÙÒÓ)ñ ∂ÎÙÂÙ·Ì¤ÓÂ˜ ÌÈÙÔ¯ÔÓ‰ÚÈ·Î¤˜ ·ÏÏÔÈÒÛÂÈ˜ ÛÙÔ

ËÏÂÎÙÚÔÓÈÎfi ÌÈÎÚÔÛÎfiÈÔ ∂Ó˙˘ÌÔÏÔÁ›·

ñ 20-30% ‰Ú·ÛÙÈÎfiÙËÙ· ÂÓ˙˘ÌÈÎÔ‡ Û˘ÌÏ¤ÁÌ·ÙÔ˜ ÙË˜·Ó·ÓÂ˘ÛÙÈÎ‹˜ ·Ï˘Û›‰·˜ ÛÂ ÈÛÙfi

ñ 30-40% ‰Ú·ÛÙÈÎfiÙËÙ· ÂÓ˙˘ÌÈÎÔ‡ Û˘ÌÏ¤ÁÌ·ÙÔ˜ ÙË˜·Ó·ÓÂ˘ÛÙÈÎ‹˜ ·Ï˘Û›‰·˜ ÛÂ Î˘ÙÙ·ÚÈÎ‹ ÁÚ·ÌÌ‹

ñ 30-40% ‰Ú·ÛÙÈÎfiÙËÙ· ÂÓ˙˘ÌÈÎÔ‡ Û˘ÌÏ¤ÁÌ·ÙÔ˜ ÙË˜·Ó·ÓÂ˘ÛÙÈÎ‹˜ ·Ï˘Û›‰·˜ ÛÂ ‰‡Ô ÈÛÙÔ‡˜

§ÂÈÙÔ˘ÚÁÈÎ¤˜ ‰ÔÎÈÌ·Û›Â˜ñ ªÂÈˆÌ¤ÓË Û˘ÓıÂÙÈÎ‹ ÈÎ·ÓfiÙËÙ· ATP ÛÂ ÈÓÔ‚Ï¿ÛÙÂ˜

(2-3 ÛÙ·ıÂÚ¤˜ ·ÔÎÏ›ÛÂÈ˜ ·fi ÙË Ì¤ÛË)ªÔÚÈ·Î¿ Â˘Ú‹Ì·Ù·

∆·˘ÙÔÔ›ËÛË ÌÂÙ¿ÏÏ·ÍË˜ ÛÂ ˘ÚËÓÈÎfi ‹ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎfiDNA Èı·Ó‹˜ ·ıÔÁÂÓÂÙÈÎfiÙËÙ·˜

ªÂÙ·‚ÔÏÈÎ¤˜ ‰È·Ù·Ú·¯¤˜ŒÓ·˜ ‹ ÂÚÈÛÛfiÙÂÚÔÈ ÌÂÙ·‚ÔÏÈÎÔ› ‰Â›ÎÙÂ˜ ‰È·Ù·Ú·¯‹˜ÙË˜ ·Ó·ÓÂ˘ÛÙÈÎ‹˜ ·Ï˘Û›‰·˜

* ∆· ÎÚÈÙ‹ÚÈ· ÁÈ· ÂÓ‹ÏÈÎÂ˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Û˘ÌÌÂÙÔ¯‹ ÙÔÓÂ˘ÚÈÎÔ‡ ‹ Ì˘˚ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ™Ù· ·È‰È¿ Û˘ÌÙÒÌ·-Ù· fiˆ˜ ÓÂÔÁÓÈÎfi˜ ı¿Ó·ÙÔ˜, ÓÂÔÁÓÈÎ‹ ˘ÔÙÔÓ›·, ÛÔ‚·-Ú‹ Î·ı˘ÛÙ¤ÚËÛË ·Ó¿Ù˘ÍË˜, ÓÂÔÁÓÈÎ‹ ˘ÂÚÙÔÓ›· ıÂˆ-ÚÔ‡ÓÙ·È ÎÏÈÓÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ ÌÈÙÔ¯ÔÓ‰ÚÈÔ¿ıÂÈ·˜

∂ÈÎfiÓ· 8. ™‡Ó‰ÚÔÌÔ Kearns-Sayre: ∂ÁÎ¿ÚÛÈ· ÙÔÌ‹ ∆2 ·ÎÔÏÔ˘-ı›· (11 ÂÙÒÓ). ∂ÎÙÂÙ·Ì¤ÓË Û˘ÌÌÂÙÔ¯‹ ÙË˜ ˘ÔÊÏÔÈÒ‰Ô˘˜ ÏÂ˘-Î‹˜ Ô˘Û›·˜ (ÎfiÎÎÈÓÔ ‚¤ÏÔ˜). ¶·ıÔÏÔÁÈÎfi ˘„ËÏfi ∆2 Û‹Ì· ·Ú·-ÙËÚÂ›Ù·È ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ Ê·ÎÔÂÈ‰Ô‡˜ ˘Ú‹Ó· (6).

∏ 1HMRS ÌÔÚÂ› Ó· ‰ÒÛÂÈ ¯Ú‹ÛÈÌÂ˜ in vivo ÌÂÙ·-‚ÔÏÈÎ¤˜ ÏËÚÔÊÔÚ›Â˜ Î·È Ë ·ÚÔ˘Û›· ·È¯Ì‹˜ Á·Ï·-ÎÙÈÎÔ‡ ÛÙËÓ 1HMRS ÌÔÚÂ› Ó· ÂÚÈÏ·Ì‚¿ÓÂÙ·È ·˘-ÙfiÓÔÌ· ˆ˜ ¤Ï·ÛÛÔÓ ÎÚÈÙ‹ÚÈÔ ÛÙÔ Û¯‹Ì· ÎÚÈÙËÚ›ˆÓ(MAC) (70). Ã·ÌËÏ‹ ÙÈÌ‹ ¡∞∞ Â›Ó·È Û˘¯Ófi Â‡ÚËÌ··ÏÏ¿ ‰ÂÓ ·ÔÙÂÏÂ› ÂÈ‰ÈÎfi ÌÂÙ·‚ÔÏÈÎfi ‰Â›ÎÙË (41).

°ÂÓÂÙÈÎfi˜ ¤ÏÂÁ¯Ô˜

∏ ÁÂÓÂÙÈÎ‹ ÚÔÛ¤Ï·ÛË ÙˆÓ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÒÓÓÔÛËÌ¿ÙˆÓ Â›Ó·È ‰··ÓËÚ‹ ‰È·‰ÈÎ·Û›· Î·È ··ÈÙÂ›ÂÍÂÈ‰ÈÎÂ˘Ì¤ÓÔ ÂÚÁ·ÛÙ‹ÚÈÔ. ŸÙ·Ó ¤¯Ô˘ÌÂ Ù˘ÈÎfiÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi Ê·ÈÓfiÙ˘Ô, ÙfiÙÂ Ô ¤ÏÂÁ¯Ô˜ ÙˆÓ ÎÔÈ-ÓÒÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ ÛÙÔ ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi DNA Ú¤ÂÈÓ· Á›ÓÂÙ·È ÚÈÓ ÙËÓ ÂÊ·ÚÌÔÁ‹ Ì˘˚Î‹˜ ‚ÈÔ„›·˜.∞ÚÓËÙÈÎfi ·ÔÙ¤ÏÂÛÌ· ÌÂÈÒÓÂÈ ÙËÓ Èı·ÓfiÙËÙ· ÌÈ-ÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ ÓÔÛ‹Ì·ÙÔ˜ ·ÏÏ¿ ‰ÂÓ ÙÔ ·ÔÎÏÂ›ÂÈ,ÁÈ·Ù› ÌÂÙ·ÏÏ¿ÍÂÈ˜ ÙÔ˘ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ DNA ‰ÂÓÂÎÊÚ¿˙ÔÓÙ·È ÛÂ fiÏÔ˘˜ ÙÔ˘˜ ÈÛÙÔ‡˜. ∂ÏÏÂ›ÌÌ·Ù·ÛÙÔ ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi DNA ÂÎÊÚ¿˙ÔÓÙ·È Î·Ï‡ÙÂÚ·ÛÙÔÓ Ì˘˚Îfi ÈÛÙfi ·Ú¿ ÛÙ· ÏÂ˘ÎÔÎ‡ÙÙ·Ú· (ÂÍ·›ÚÂÛË·ÔÙÂÏÂ› ÙÔ Û‡Ó‰ÚÔÌÔ Pearson). ŸÙ·Ó ÎÏÈÓÈÎ¿, ‚ÈÔ-¯ËÌÈÎ¿ Î·È ÈÛÙÔ·ıÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù· Â›Ó·È Û˘Ì‚·-Ù¿ ÌÂ ÌÈÙÔ¯ÔÓ‰ÚÈÔ¿ıÂÈ· Î·È ÔÈ ÎÔÈÓ¤˜ ÌÂÙ·ÏÏ¿ÍÂÈ˜ÛÙÔ ÌÈÙÔ¯fiÓ‰ÚÈ· DNA ·Ô˘ÛÈ¿˙Ô˘Ó, ÙfiÙÂ Ô ÂÚ·È-Ù¤Úˆ ÁÂÓÂÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ú¤ÂÈ Ó· ÂÍ·ÙÔÌÈÎÂ‡ÂÙ·È.∏ ·ÔÎˆ‰ÈÎÔÔ›ËÛË ÙˆÓ ·ÏÏËÏÔ˘¯ÈÒÓ ÙÔ˘ ÌÈÙÔ-¯ÔÓ‰ÚÈ·ÎÔ‡ DNA (sequencing) Û˘ÓÈÛÙ¿Ù·È ÌÂ ÛÎÔ-fi ÙËÓ ·ÓÂ‡ÚÂÛË ÌË ÎÔÈÓÒÓ ‹ ·ÎfiÌË Î·È Ó¤ˆÓ ÌÂ-

Ù·ÏÏ¿ÍÂˆÓ. ∏ ·ÓÂ‡ÚÂÛË ÌÈ·˜ Ó¤·˜ ÌÂÙ¿ÏÏ·ÍË˜ ‰ÂÓÛËÌ·›ÓÂÈ fiÙÈ ·˘Ù‹ Â›Ó·È ··Ú·›ÙËÙ· ·ıÔÏÔÁÈÎ‹Î·È Ë ÂÚÌËÓÂ›· ı· Ú¤ÂÈ Ó· Á›ÓÂÙ·È ·fi ÂÍÂÈ‰È-ÎÂ˘Ì¤Ó· Î¤ÓÙÚ·.

™Ù· ·È‰È¿ ÈÛÙÂ‡ÂÙ·È fiÙÈ Ë ÏÂÈÔ„ËÊ›· ÙˆÓ ÌÈ-ÙÔ¯ÔÓ‰ÚÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ ÚÔÎ·ÏÂ›Ù·È ·fi ÌÂÙ·Ï-Ï¿ÍÂÈ˜ ÛÙÔ ˘ÚËÓÈÎfi DNA. ∏ ·fiÊ·ÛË ÁÈ· ÙÔ ÔÈ·ÁÂÓÂÙÈÎ‹ Î·ÙÂ‡ı˘ÓÛË ı· ·ÎÔÏÔ˘ı‹ÛÔ˘ÌÂ Â›Ó·È ·Ô-Ù¤ÏÂÛÌ· ÚÔÛÂÎÙÈÎ‹˜ ·Ó¿Ï˘ÛË˜ ÙÔ˘ ÎÏÈÓÈÎÔ‡ Ê·È-ÓÔÙ‡Ô˘, ÈÛÙÔ·ıÔÏÔÁ›·˜, ÂÓ˙˘ÌÈÎ‹˜ ·ÓÂ¿ÚÎÂÈ·˜Î·È ÙÔ˘ ÓÂ˘ÚÔ·ÂÈÎÔÓÈÛÙÈÎÔ‡ ÂÏ¤Á¯Ô˘. °È· ·Ú¿-‰ÂÈÁÌ·, ÛÂ ·ÛıÂÓ‹ ÌÂ Û‡Ó‰ÚÔÌÔ Leigh Î·È ·ÚÓËÙÈÎ‹·ÓÙ›‰Ú·ÛË COX ÛÙË Ì˘˚Î‹ ‚ÈÔ„›·, ··Ú·›ÙËÙË Â›Ó·ÈË ·Ó›¯ÓÂ˘ÛË ÌÂÙ·ÏÏ¿ÍÂˆÓ ÛÙÔ ÁÔÓ›‰ÈÔ SURF1. ¶·-ÚÔ˘Û›· Î˘ÛÙÈÎ‹˜ ÏÂ˘ÎÔÂÁÎÂÊ·ÏÔ¿ıÂÈ·˜ ÛÂ ·ÛıÂÓ‹ÌÂ ·ÓÂ¿ÚÎÂÈ· ÙÔ˘ Û˘ÌÏ¤ÁÌ·ÙÔ˜ π Ì¿˜ Î·ÙÂ˘ı‡ÓÂÈÚÔ˜ ÌÂÙ·ÏÏ¿ÍÂÈ˜ ÛÙÔ ÁÔÓ›‰ÈÔ NDUFV1. ∞ÛıÂÓ‹˜ÌÂ Î·Ú‰ÈÔÌ˘Ô¿ıÂÈ· Î·È ·ÚÓËÙÈÎ‹ ·ÓÙ›‰Ú·ÛË COXÌ¿˜ Î·ÙÂ˘ı‡ÓÂÈ ÛÙÔ ÁÔÓ›‰ÈÔ SCO2 Î·È ·ÛıÂÓ‹˜ ÌÂÂÁÎÂÊ·ÏÔ¿ıÂÈ·, ÓÂÊÚÈÎ‹ ÛˆÏËÓ·ÚÈ·Î‹ ‚Ï¿‚Ë Î·È·ÚÓËÙÈÎ‹ ·ÓÙ›‰Ú·ÛË COX Ì¿˜ Î·ÙÂ˘ı‡ÓÂÈ ÛÙÔ ÁÔÓ›-‰ÈÔ COX10. √ Î·Ù¿ÏÔÁÔ˜ ÙˆÓ ˘Â‡ı˘ÓˆÓ ÌÂÙ·ÏÏ¿-ÍÂˆÓ ÁÈ· ÚˆÙÔ·ı‹ ÌÈÙÔ¯ÔÓ‰ÚÈ·Î‹ ÓfiÛÔ Û˘ÓÂ¯Ò˜·˘Í¿ÓÂÙ·È Î·È ÙÔ ¢È·‰›ÎÙ˘Ô ·ÔÙÂÏÂ› ÙËÓ Î·Ï‡ÙÂÚËËÁ‹ ÏËÚÔÊfiÚËÛË˜ (mitomap.org). √È ¶›Ó·ÎÂ˜ 7Î·È 8 ÂÚÈÁÚ¿ÊÔ˘Ó ÁÓˆÛÙ¤˜ ·ıÔÏÔÁÈÎ¤˜ ÌÂÙ·ÏÏ¿-ÍÂÈ˜ ÛÙÔ ˘ÚËÓÈÎfi ‹ ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi DNA ·ÓÙÈÛÙÔ›-¯ˆ˜ (6,8,14,33,71).


¶·È‰È·ÙÚÈÎ‹ 2007;70:1-17

¶›Ó·Î·˜ 6. ¶ÚÔÙÂÈÓfiÌÂÓÔ ÌÂÙ·‚ÔÏÈÎfi ÚÔÊ›Ï Â› ˘Ô„›· ÂÓÂÚÁÂÈ·Î‹˜ ‰È·Ù·Ú·¯‹˜

¢ÂÈÁÌ·ÙÔÏË„›· ÓËÛÙÂ›·˜ ¢ÂÈÁÌ·ÙÔÏË„›· ÌÂÙ¿ Ê·ÁËÙfi(8 ÒÚÂ˜ ÛÂ ·È‰È¿, 4-5 ÒÚÂ˜ ÛÂ ‚Ú¤ÊË) (1-2 ÒÚÂ˜ ÌÂÙ¿ ·fi Î·Ïfi ÁÂ‡Ì·)

√Úfi˜ √Úfi˜°Ï˘Îfi˙Ë, ÓÂÊÚÈÎ‹/Ë·ÙÈÎ‹ ÏÂÈÙÔ˘ÚÁ›·, Á·Ï·ÎÙÈÎfi, °Ï˘Îfi˙Ë, Á·Ï·ÎÙÈÎfi, ˘ÚÔÛÙ·Ê˘ÏÈÎfi, ÎÂÙÔÓÔÛÒÌ·Ù·, ·ÌÈÓÔÍ¤·˘ÚÔÛÙ·Ê˘ÏÈÎfi, ÎÂÙÔÓÔÛÒÌ·Ù·, ·ÌÈÓÔÍ¤·, Ô˘ÚÈÎfi ÔÍ‡, ÔÏÈÎ‹ Î·ÚÓÈÙ›ÓË, ·ÎÂÙ˘ÏÔÎ·ÚÓÈÙ›ÓÂ˜, ÂÏÂ‡ıÂÚ· ÏÈ·Ú¿ ÔÍ¤·, ·ÌÌˆÓ›·, CPK, ‰Â›ÁÌ· ÚÔ˜ ·Ôı‹ÎÂ˘ÛË

√‡Ú· √‡Ú·°ÂÓÈÎ‹ Ô‡ÚˆÓ, ÎÂÙÔÓÔÛÒÌ·Ù·, ÔÚÁ·ÓÈÎ¿ ÔÍ¤· Î·È °ÂÓÈÎ‹ Ô‡ÚˆÓ, ÎÂÙÔÓÔÛÒÌ·Ù·, ÔÚÁ·ÓÈÎ¿ ÔÍ¤· Î·È ÔÚÔÙÈÎfi, ÔÚÔÙÈÎfi, ·ÌÈÓÔÍ¤· Ô‡ÚˆÓ, ‰Â›ÁÌ· ÚÔ˜ ·Ôı‹ÎÂ˘ÛË ·ÌÈÓÔÍ¤· Ô‡ÚˆÓ

∂¡À°Ï˘Îfi˙Ë, ÚˆÙÂ˝ÓË, Á·Ï·ÎÙÈÎfi, ˘ÚÔÛÙ·Ê˘ÏÈÎfi, ·ÌÈÓÔÍ¤·, ‰Â›ÁÌ· ÚÔ˜ ·Ôı‹ÎÂ˘ÛË

¶ÂÚÈÔÚÈÛÌÔ›ñ ∂Ó˙˘Ì·ÙÈÎ¿ Î·È ÁÂÓÂÙÈÎ¿ ·Ô‰Â‰ÂÈÁÌ¤ÓÂ˜ ÌÈÙÔ¯ÔÓ‰ÚÈÔ¿ıÂÈÂ˜ ÌÔÚÂ› Ó· ¤¯Ô˘Ó Ê˘ÛÈÔÏÔÁÈÎfi Á·Ï·ÎÙÈÎfi ÔÍ‡ Î·È ¿ÏÏÔ˘˜

‚ÈÔ¯ËÌÈÎÔ‡˜ ‰Â›ÎÙÂ˜ ÛÙÔÓ ÔÚfi. ñ ™Â ÂÚ›Ô‰Ô ‡ÊÂÛË˜ Î·È ·Ô˘Û›·˜ ÌÂÙ·‚ÔÏÈÎÔ‡ stress, Ô ‚ÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÌÔÚÂ› Ó· Â›Ó·È Ê˘ÛÈÔÏÔÁÈÎfi˜.ñ ŒÓÙÔÓÔ ÎÏ¿Ì· (È‰È·›ÙÂÚ· ÛÙ· ·È‰È¿), Ë ÂÊ·ÚÌÔÁ‹ ÂÚ›ÛÊÈÍË˜ (tourniquet) ÁÈ· ÙË ÊÏÂ‚ÔÎ¤ÓÙËÛË ÌÔÚÂ› Ê˘ÛÈÔÏÔÁÈÎ¿ Ó·

ÂËÚÂ¿ÛÔ˘Ó ÙË Û˘ÁÎ¤ÓÙÚˆÛË ÙÔ˘ Á·Ï·ÎÙÈÎÔ‡ ÛÙÔÓ ÔÚfi. ∏ ·Ï·Ó›ÓË ÔÚÔ‡ Î·È ÙÔ Á·Ï·ÎÙÈÎfi ÔÍ‡ ÛÙÔ ∂¡À ÂËÚÂ¿˙ÔÓÙ·È ÛÂÌÈÎÚfiÙÂÚÔ ‚·ıÌfi.

ñ ∂ÁÁ‡˜ ÛˆÏËÓ·ÚÈ·Î‹ ‚Ï¿‚Ë ÂÏ·ÙÙÒÓÂÈ ÙË Û˘ÁÎ¤ÓÙÚˆÛË Á·Ï·ÎÙÈÎÔ‡ ÛÙÔÓ ÔÚfi ·ÏÏ¿ ÙËÓ ·˘Í¿ÓÂÈ ÛÙ· Ô‡Ú·.ñ ∏ ·ÚÔ˘Û›· Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË ÂÌÔ‰›˙ÂÈ ÙËÓ Â›ÛÔ‰Ô ÙÔ˘ ˘ÚÔÛÙ·Ê˘ÏÈÎÔ‡ ÛÙÔÓ Î‡ÎÏÔ ÙÔ˘ ÎÈÙÚÈÎÔ‡ ÔÍ¤Ô˜ ÌÂ

·ÔÙ¤ÏÂÛÌ· ÙËÓ ·˘ÍËÌ¤ÓË ·Ú·ÁˆÁ‹ Á·Ï·ÎÙÈÎÔ‡.ñ ∏ Ì¤ÙÚËÛË ÙÔ˘ Á·Ï·ÎÙÈÎÔ‡ ÛÙÔ ∂¡À Â›Ó·È ÈÔ Â˘·›ÛıËÙË Î·È ÂÈ‰ÈÎ‹ Ì¤ıÔ‰Ô˜ Î·È Û˘ÓÈÛÙ¿Ù·È.

£ÂÚ·Â›· Î·È ÁÂÓÂÙÈÎ‹ Î·ıÔ‰‹ÁËÛË

£ÂÚ·Â›·

¢˘ÛÙ˘¯Ò˜ ·ÔÙÂÏÂÛÌ·ÙÈÎ‹ ·ÈÙÈÔÏÔÁÈÎ‹ ıÂÚ·-

Â›· ÙˆÓ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ ‰ÂÓ ˘¿Ú¯ÂÈ

Î·È Ë ıÂÚ·Â›· ÂÚÈÔÚ›˙ÂÙ·È ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ

Û˘ÌÙˆÌ¿ÙˆÓ, ˘ÔÛÙ‹ÚÈÍË ÙˆÓ ÔÚÁ¿ÓˆÓ ‹ Û˘ÛÙË-

Ì¿ÙˆÓ Ô˘ Û˘ÌÌÂÙ¤¯Ô˘Ó Î·È ·ÔÊ˘Á‹ ÂÈÏÔÎÒÓ

·fi ·Ó·ËÚ›Â˜ ÙË˜ ÓfiÛÔ˘ (72,73).

¢È·ÈÙËÙÈÎ¿ Ì¤ÙÚ·. ™˘ÓÈÛÙ¿Ù·È Ë ·ÔÊ˘Á‹ ·Ú·ÙÂ-

Ù·Ì¤ÓË˜ ÓËÛÙÂ›·˜ Î·È Ë Î·Ï‹ ÂÓ˘‰¿ÙˆÛË, È‰È·›ÙÂÚ·

fiÙ·Ó ÙÔ ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi ÓfiÛËÌ· Û˘ÓÔ‰Â‡ÂÙ·È ·fi

˘ÔÁÏ˘Î·ÈÌ›·. ∏ ÎÂÙÔÁÂÓ‹˜ ‰›·ÈÙ· Û˘ÓÈÛÙ¿Ù·È ÛÂ

·ÓÂ¿ÚÎÂÈ· ÙË˜ ˘ÚÔÛÙ·Ê˘ÏÏÈÎ‹˜ ·Ê˘‰ÚÔÁÔÓ¿ÛË˜

ÂÓÒ ÌÔÚÂ› Ó· Â›Ó·È ‚ÔËıËÙÈÎ‹ ÛÂ ·ÓÂ¿ÚÎÂÈ· ÙÔ˘

Û˘ÌÏ¤ÁÌ·ÙÔ˜ I ÌÂ ·ÓıÂÎÙÈÎ‹ ÂÈÏË„›·. ™ËÌ·ÓÙÈÎ‹

Â›Ó·È Ë ‰È·Ù‹ÚËÛË ‰È·ÈÙËÙÈÎÔ‡ ÈÛÔ˙˘Á›Ô˘ ÌÂ Úfi-

ÛÏË„Ë fiÏˆÓ ÙˆÓ ··Ú·›ÙËÙˆÓ ‚ÈÙ·ÌÈÓÒÓ Î·È È¯ÓÔ-

ÛÙÔÈ¯Â›ˆÓ ÂÂÈ‰‹ ÔÈ ·ÛıÂÓÂ›˜ ÌÂ ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi Ófi-

ÛËÌ· Â›Ó·È È‰È·›ÙÂÚ· ÂÈÚÚÂ‹˜ ÛÂ ·ÓÂ¿ÚÎÂÈÂ˜.

º˘ÛÈÎÔıÂÚ·Â›·. ∏ Ê˘ÛÈÎ‹ ¿ÛÎËÛË Ú¤ÂÈ Ó· ÂÓ-

ı·ÚÚ‡ÓÂÙ·È Î·È Î·Ïfi Â›Ó·È Ó· Á›ÓÂÙ·È ÚÔÁÚ·ÌÌ·ÙÈ-

ÛÌ¤Ó· ˘fi ÙËÓ Â›‚ÏÂ„Ë ÙÔ˘ Ê˘ÛÈÎÔıÂÚ·Â˘Ù‹ Î·È

·ÊÔ‡ ¤¯ÂÈ ·ÔÎÏÂÈÛÙÂ› ˘ÔÎÏÈÓÈÎ‹ Î·Ú‰ÈÔ¿ıÂÈ·. ∏

Ê˘ÛÈÎÔıÂÚ·Â›· ‚ÔËı¿ÂÈ ÛÙËÓ ÚfiÏË„Ë ÙˆÓ Û˘-

ÁÎ¿Ì„ÂˆÓ, ÛÎÔÏ›ˆÛË˜ Î·È ÛÙËÓ ÚfiÏË„Ë ÙË˜ ÔÛÙÂ-

ÔfiÚˆÛË˜. ∏ ˘ÂÚ‚ÔÏÈÎ‹ ¿ÛÎËÛË Î·Ïfi Â›Ó·È Ó·



¶›Ó·Î·˜ 7. ªÂÙ·ÏÏ¿ÍÂÈ˜ ÙÔ˘ ˘ÚËÓÈÎÔ‡ DNA ˘Â‡ı˘ÓÂ˜ ÁÈ· ÚˆÙÔ·ı‹ ÌÈÙÔ¯ÔÓ‰ÚÈ·Î‹ ÓfiÛÔ

°ÔÓ›‰ÈÔ ªÈÙÔ¯ÔÓ‰ÚÈ·Î‹ ‚Ï¿‚Ë ∫ÏËÚÔÓÔÌÈÎfiÙËÙ· / ∫ÏÈÓÈÎfi˜ Ê·ÈÓfiÙ˘Ô˜

ªÂÙ·ÏÏ¿ÍÂÈ˜ Ô˘ Îˆ‰ÈÎÔÔÈÔ‡Ó ‰ÔÌÈÎ¤˜ ÌÔÓ¿‰Â˜ Û˘ÌÏÂÁÌ¿ÙˆÓNDUFS1 ™‡ÌÏÂÁÌ· π À™ / ÂÁÎÂÊ·ÏÔ¿ıÂÈ·NDUFS2 »NDUFS4 » À™ / ¶ÔÏ˘Û˘ÛÙËÌ·ÙÈÎ‹ ÓfiÛÔ˜NDUFS7 » À™ / LeighNDUFS8 » À™ / LeighNDUFV1 » À™ / §Â˘ÎÔÂÁÎÂÊ·ÏÔ¿ıÂÈ· / Ì˘ÔÎÏÔÓ›·SDHA ™‡ÌÏÂÁÌ· ππ À™ / LeighSDHB » ∂™ ‹ ™ÔÚ·‰ÈÎ‹ / º·ÈÔ¯ÚˆÌÔÎ‡ÙÙˆÌ·, ÙÚ·¯ËÏÈÎfi ·Ú·Á·ÁÁÏ›ˆÌ·SDHD Î·È SDHC » ∫ÏËÚÔÓÔÌÈÎfi ·Ú·Á·ÁÁÏ›ˆÌ·UQCRB ™‡ÌÏÂÁÌ· πππ ÀÔÎ·ÏÈ·ÈÌ›·, Á·Ï·ÎÙÈÎ‹ ÔÍ¤ˆÛË

ªÂÙ·ÏÏ¿ÍÂÈ˜ Ô˘ Îˆ‰ÈÎÔÔÈÔ‡Ó ÚˆÙÂ˝ÓÂ˜ Û˘Ó·ÚÌÔÏfiÁËÛË˜ Û˘ÌÏÂÁÌ¿ÙˆÓSURF1 ™‡ÌÏÂÁÌ· πV À™ / LeighSCO1 » À™ / ∏·ÙÔ¿ıÂÈ·SCO2 » À™ / µÚÂÊÈÎ‹ Î·Ú‰ÈÔÌ˘Ô¿ıÂÈ·COX10 » À™ / §Â˘ÎÔÂÁÎÂÊ·ÏÔ¿ıÂÈ·, ÓÂÊÚÈÎ‹ ÛˆÏËÓ·ÚÈ·Î‹ ‚Ï¿‚ËCOX15 » À™ / ÀÂÚÙÚÔÊÈÎ‹ Î·Ú‰ÈÔÌ˘Ô¿ıÂÈ·LRPPRC » À™ / LeighBCS1L ™‡ÌÏÂÁÌ· πII À™ / ∂ÁÎÂÊ·ÏÔÌ˘Ô¿ıÂÈ·, Ë·ÙÈÎ‹ ·ÓÂ¿ÚÎÂÈ·, ÓÂÊÚÈÎ‹ ÛˆÏËÓ·ÚÈ·Î‹

‚Ï¿‚ËATP12 ™‡ÌÏÂÁÌ· V À™ / ∂ÁÎÂÊ·ÏÔ¿ıÂÈ·

ªÂÙ·ÏÏ¿ÍÂÈ˜ Ô˘ Îˆ‰ÈÎÔÔÈÔ‡Ó ÚˆÙÂ˝ÓÂ˜ ··Ú·›ÙËÙÂ˜ ÁÈ· ÙË ‰È·Ù‹ÚËÛË ÙÔ˘ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ DNATwinkle ¶ÔÏÏ·Ï¿ ÂÏÏÂ›ÌÌ·Ù· À™ ‹ ∂™ / ¶ÚÔÔ‰Â˘ÙÈÎ‹ ÔÊı·ÏÌÔÏËÁ›· (PEO)

ÛÙÔ ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi DNAPOLG1 À™ / ™‡Ó‰ÚÔÌÔ Alpers Thymidine ¶ÔÏÏ·Ï¿ ÂÏÏÂ›ÌÌ·Ù· ‹ À™ / ªÈÙÔ¯ÔÓ‰ÚÈ·Î‹ ÓÂ˘ÚÔ-Á·ÛÙÚÂÓÙÂÚÈÎ‹ phosphorylase ÔÛÔÙÈÎ‹ ÌÂ›ˆÛË ÙÔ˘ ÂÁÎÂÊ·ÏÔÌ˘Ô¿ıÂÈ· (MNGIE)

ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ DNATK2 ¶ÔÛÔÙÈÎ‹ ÌÂ›ˆÛË ÙÔ˘ µÚÂÊÈÎ‹ Û˘ÁÁÂÓ‹˜ Ì˘Ô¿ıÂÈ· ÌÂ ‹ ¯ˆÚ›˜

ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ DNA Û‡Ó‰ÚÔÌÔ De Toni-Fanconi DGUOK ¶ÔÛÔÙÈÎ‹ ÌÂ›ˆÛË µÚÂÊÈÎ‹ Ë·ÙÔ¿ıÂÈ· Î·È ÂÁÎÂÊ·ÏÔÌ˘Ô¿ıÂÈ·

ÙÔ˘ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ DNA

ªÂÙ·ÏÏ¿ÍÂÈ˜ Ô˘ Îˆ‰ÈÎÔÔÈÔ‡Ó ÚˆÙÂ˝ÓÂ˜ ÌÂÙ·ÊÔÚÂ›˜DDP1/TIMM8A ºÀ / ∫ÒÊˆÛË ‰˘ÛÙÔÓ›· (Û‡Ó‰ÚÔÌÔ Mohr-Tranebjaerg)ANT1 ¶ÔÏÏ·Ï¿ ÂÏÏÂ›ÌÌ·Ù· À™ ‹ ∂™ / ¶ÚÔÔ‰Â˘ÙÈÎ‹ ÔÊı·ÏÌÔÏËÁ›· (PEO)

ÛÙÔ ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi DNA

ÕÏÏÂ˜ ÌÂÙ·ÏÏ¿ÍÂÈ˜Tafazzin ºÀ / ™‡Ó‰ÚÔÌÔ Barth

À™: ÀÔÏÂÈfiÌÂÓÔ ™ˆÌ·ÙÈÎfi, ∂™: ∂ÈÎÚ·ÙÔ‡Ó ™ˆÌ·ÙÈÎfi, ºÀ: º˘ÏÔÛ‡Ó‰ÂÙÔ ÀÔÏÂÈfiÌÂÓÔ

·ÔÊÂ‡ÁÂÙ·È ÁÈ·Ù› ·ÊÂÓfi˜ ˘¿Ú¯ÂÈ Î›Ó‰˘ÓÔ˜ Ú·‚‰Ô-

Ì˘fiÏ˘ÛË˜ Î·È Î›Ó‰˘ÓÔ˜ Î·Ú‰È·Î‹˜ ‚Ï¿‚Ë˜, ·ÊÂÙ¤-

ÚÔ˘ ÌÔÚÂ› Ó· ·˘Í‹ÛÂÈ ÙÔ ÔÛÔÛÙfi ÙˆÓ ·ıÔÏÔÁÈ-

ÎÒÓ ÌÈÙÔ¯ÔÓ‰Ú›ˆÓ.

º·ÚÌ·ÎÂ˘ÙÈÎ‹ Î·È ·Ó·ÏËÚˆÌ·ÙÈÎ‹ ıÂÚ·Â›·. ∏

¯ÔÚ‹ÁËÛË Û˘ÓÂÓ˙‡ÌÔ˘ Q10 (4-10 mg/kg/ËÌ¤Ú·) ‹

¿ÏÏÔ˘ ·Ó¿ÏÔÁÔ˘ (idebenone 90-200 mg/ËÌ¤Ú·) Û˘-

ÓÈÛÙ¿Ù·È, ·Ó Î·È ‰ÂÓ ˘¿Ú¯Ô˘Ó Ù˘¯·ÈÔÔÈËÌ¤ÓÂ˜

ÌÂÏ¤ÙÂ˜ Ô˘ Ó· ·Ô‰ÂÈÎÓ‡Ô˘Ó ÙËÓ Â˘ÂÚÁÂÙÈÎ‹ ÙÔ˘˜

‰Ú¿ÛË. ∏ ¯ÔÚ‹ÁËÛË ‚ÈÙ·ÌÈÓÒÓ Â›Ó·È ··Ú·›ÙËÙË

fiˆ˜ ‚ÈÙ·Ì›ÓË C (100-1000 mg/ËÌ¤Ú·), ıÈ·Ì›ÓË

(50-200 mg/ËÌ¤Ú·), ÚÈ‚ÔÊÏ·‚›ÓË (50-200 mg/ËÌ¤-

Ú·), ÂÓÒ ¿ÏÏÂ˜ ‚ÈÙ·Ì›ÓÂ˜ (D, E) ¯ÔÚËÁÔ‡ÓÙ·È ·Ó¿

ÂÚ›ÙˆÛË. ∏ ¯ÔÚ‹ÁËÛË L-Î·ÚÓÈÙ›ÓË˜ (25-50

mg/kg/ËÌ¤Ú·) Â›Ó·È ·ÌÊÈÏÂÁfiÌÂÓË ·ÏÏ¿ ÁÂÓÈÎÒ˜

Û˘ÓÈÛÙ¿Ù·È ÛÂ ÂÚÈÙÒÛÂÈ˜ Ô˘ ¤¯Ô˘ÌÂ ·Ô‰Â‰ÂÈÁ-

Ì¤ÓË ·ÓÂ¿ÚÎÂÈ·. ™Â ÂÈ‰ÈÎ¤˜ ÂÚÈÙÒÛÂÈ˜ fiˆ˜

ÛÔ‚·ÚÔ‡˜ Û˘ÁÁÂÓÔ‡˜ Á·Ï·ÎÙÈÎ‹˜ ÔÍ¤ˆÛË˜ ¤¯ÂÈ

¯ÚËÛÈÌÔÔÈËıÂ› ÙÔ ‰È¯ÏˆÚÔ·ÎÂÙÔÙÈÎfi ÔÍ‡ (DCA)

Î·È ÛÂ ÂÚÈÙÒÛÂÈ˜ ÂÁÎÂÊ·ÏÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ ÛÂ

Û‡Ó‰ÚÔÌÔ MELAS Ë L-·ÚÁÈÓ›ÓË (74,75).

∆Ô ‚·ÏÚÔ˚Îfi ÔÍ‡ Î·Ïfi Â›Ó·È Ó· ·ÔÊÂ‡ÁÂÙ·È

ÁÈ·Ù› È‰È·›ÙÂÚ· ÛÙÔ Û‡Ó‰ÚÔÌÔ Alper ÌÔÚÂ› Ó· Â¿-

ÁÂÈ ÎÂÚ·˘ÓÔ‚fiÏÔ Ë·ÙÈÎ‹ Ó¤ÎÚˆÛË. ∞ÓÙÈÂÈÏËÙÈ-

Î¿ fiˆ˜ ÙÔÈÚ·Ì¿ÙË Î·È ˙ÔÓÈÛ·Ì›‰Ë ÌÔÚÂ› Ó·

ÂÈ‰ÂÈÓÒÛÔ˘Ó ÙË ÌÂÙ·‚ÔÏÈÎ‹ ÔÍ¤ˆÛË Î·È Ú¤ÂÈ

Ó· ¯ÔÚËÁÔ‡ÓÙ·È ÌÂ ÚÔÛÔ¯‹ Î·È ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ

‰ÈÙÙ·ÓıÚ·ÎÈÎ¿. ÕÏÏ· Ê¿ÚÌ·Î· ÙÔÍÈÎ¿ ÁÈ· Ù· ÌÈÙÔ-

¯fiÓ‰ÚÈ· Â›Ó·È ·ÓÙÈ‚ÈÔÙÈÎ¿ fiˆ˜ ÔÈ ·ÌÈÓÔÁÏ˘ÎÔÛ›-

‰Â˜ (Î›Ó‰˘ÓÔ˜ ·ÒÏÂÈ· ·ÎÔ‹˜) Î·È Ë ¯ÏˆÚ·ÌÊÂÓÈ-

ÎfiÏË, ÈÔÛÙ·ÙÈÎ¿ (AZT) Î·È ·ÓÙÈ·Ú·ÛÈÙÈÎ¿ fiˆ˜ Ë

ÌÂÙÚÔÓÈ‰·˙fiÏË.


¶·È‰È·ÙÚÈÎ‹ 2007;70:1-17

¶›Ó·Î·˜ 8. º·ÈÓÔÙ˘ÈÎ‹ ¤ÎÊÚ·ÛË ·ıÔÁfiÓˆÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ ÙÔ˘ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ DNA (ÌÂ ¤ÓÙÔÓ· ÁÚ¿ÌÌ·Ù· ·Ó·ÁÚ¿ÊÔÓÙ·È ÔÈ ÈÔ Û˘¯Ó¤˜ÌÂÙ·ÏÏ¿ÍÂÈ˜)

∫ÏÈÓÈÎfi˜ º·ÈÓfiÙ˘Ô˜ °ÔÓ›‰ÈÔ ªÂÙ·ÏÏ¿ÍÂÈ˜

MELAS tRNA ñ {3243, 3252, 3260, 5814}A>G, {1642, 583}G>A, {3271, 3291}T>C

ñ ŒÏÏÂÈÌÌ· (deletion)ND5 (Û‡ÌÏÂÁÌ· π) ñ 13513G>A, 13514A>GCyt b (Û‡ÌÏÂÁÌ· IIπ) ñ 14787del4COX III (Û‡ÌÏÂÁÌ· πV) ñ 9957T>C

MELAS/Ó¤ÎÚˆÛË ND5 (Û‡ÌÏÂÁÌ· π) ñ 3308T>CÚ·‚‰ˆÙÔ‡ ÛÒÌ·ÙÔ˜MELAS/MERRF tRNA ñ {8356,7512}T>CMERRF ñ 8344A>G, 8363G>APEO ñ ŒÏÏÂÈÌÌ· (deletion)

ñ {3243, 5692, 3251}A>G, {4309, 5703, 12315, 4298, 8342}G>APEO/ÔÏ˘Û˘ÛÙËÌ·ÙÈÎ‹ ñ 3256C>TÓfiÛÔ˜PEO/‰È·‚‹ÙË˜, ·Ù·Í›· ñ {3264, 12311}T>Cª˘Ô¿ıÂÈ· ñ {3288, 3302, 3243, 12320}A>G, 5521G>A, 15990C>T

{618, 3250, 4409}T>CCyt b (Û‡ÌÏÂÁÌ· III) ñ {14846, 15059, 15084, 15150, 15168, 15242, 15615, 15723, 15762}G>A,

15197T>C ñ 15498del24

ÀÂÚÙÚÔÊÈÎ‹ tRNA ñ {3243, 3254, 3260, 4269, 4295, 4300, 8296}A>G, {3303, Î·Ú‰ÈÔÌ˘Ô¿ıÂÈ· 4320} C>T, 9997T>C, 8363 G>A

Cyt b (Û‡ÌÏÂÁÌ· IIπ) ñ 15243G>A¡Â˘ÚÔ·ÈÛıËÙËÚÈ·Î‹ tRNA ñ {3243, 7445}A>G, {7510, 7511, 7512}T>C, 12258G>A·ÒÏÂÈ· ·ÎÔ‹˜ ñ 7472-insC

rRNA ñ delT961Cn, 1095T>C, 1555A>GNARP/MILS tRNA ñ {1624, 1644}C>T, 8344A>G, 8363G>A, 5537-insT

ATPase 6 (Û‡ÌÏÂÁÌ· V) ñ 8993A>G, {8851, 9171}T>CND6 (Û‡ÌÏÂÁÌ· π) ñ 14459 G>ACOX III (Û‡ÌÏÂÁÌ· πV) ñ 9537 insC

LHON / ND1 (Û‡ÌÏÂÁÌ· π) ñ {3460, 5244, 7444, 9438, 9804, 13708, 15257, 15812}G>A, 4917A>G ,{3394, 4160, 4216, 9101}T>C

ND4 (Û‡ÌÏÂÁÌ· π) ñ 11778G>A (ÏÂ˘ÎÔÂÁÎÂÊ·ÏÔ¿ıÂÈ·), 10663T>CND6 (Û‡ÌÏÂÁÌ· π) ñ 14482G>A, 14484T>C, 14495A>G

LHON / ¢˘ÛÙÔÓ›· ñ 11696, 14459 (‚Ï¿‚Ë ÛÙ· ‚·ÛÈÎ¿ Á¿ÁÁÏÈ·), 14596∫™™ / Pearson tRNA ñ ∂ÏÏÂ›ÌÌ·Ù·

ñ ∞Ó·‰ÈÏ·ÛÈ·ÛÌÔ›

ÀÔÛÙËÚÈÎÙÈÎ‹ ıÂÚ·Â›·.

i. ∞ÓÙÈÌÂÙÒÈÛË ÙˆÓ Û·ÛÌÒÓ ÌÂ ·ÓÙÈÂÈÏËÙÈ-

Î‹ ·ÁˆÁ‹. ¢ÂÓ ˘¿Ú¯ÂÈ Î¿ÔÈÔ ÂÈ‰ÈÎfi ·ÓÙÈÂÈÏËÙÈ-

Îfi Ê¿ÚÌ·ÎÔ. ∞fi Ù· ÓÂfiÙÂÚ· ·ÓÙÈÂÈÏËÙÈÎ¿ Ë Ï·-

ÌÔÙÚÈÁ›ÓË Î·È Ë ÏÂ‚ÂÙÈÚ·ÎÂÙ¿ÌË ‰ÂÓ ÚÔÎ·ÏÔ‡Ó ÌÂ-

Ù·‚ÔÏÈÎ‹ ‰È·Ù·Ú·¯‹ Î·È Â›Ó·È Î·Ï¿ ·ÓÂÎÙ¿.

ii. ∞ÓÙÈÌÂÙÒÈÛË ÙÔ˘ Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË Î·È

¿ÏÏˆÓ ÂÓ‰ÔÎÚÈÓÔ·ıÂÈÒÓ.

iii. ÀÔÛÙËÚÈÎÙÈÎ‹ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ Ì˘ÔÎ·Ú‰ÈÔ-

¿ıÂÈ·˜ (ACE ·Ó·ÛÙÔÏÂ›˜, ‰ÈÔ˘ÚËÙÈÎ¿ Î.Ï.) Î·È ·Ú-

Ú˘ıÌÈÒÓ (Ê¿ÚÌ·Î· ‹ ‚ËÌ·ÙÔ‰fiÙË˜).

iv. ŒÁÎ·ÈÚË ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ Û˘ÁÁÂÓÔ‡˜ Î·Ù·Ú-

Ú¿¯ÙË Î·È Ë ‚ÏÂÊ·ÚÔÏ·ÛÙÈÎ‹ Û˘ÓÈÛÙ¿Ù·È fiÙ·Ó

¤¯Ô˘ÌÂ ÛÔ‚·Ú‹ ‚ÏÂÊ·ÚfiÙˆÛË.

v. ∞ÓÙÈÌÂÙÒÈÛË ÙË˜ ‚·ÚËÎÔ˝·˜ ÌÂ ·ÎÔ˘ÛÙÈÎ¿ ‹

·Ó ¯ÚÂÈ·ÛÙÂ›, ÎÔ¯ÏÈ·Î¿ ÂÌÊ˘ÙÂ‡Ì·Ù·.

vi. ∞ÓÙÈÌÂÙÒÈÛË ÓÂÊÚÈÎ‹˜ ÓfiÛÔ˘ Î·È ÙË˜ Û˘ÓÔ-

‰Ô‡ ·Ó·ÈÌ›·˜.

∞ÓÙÈÌÂÙÒÈÛË ÌÂÙ·‚ÔÏÈÎ‹˜ ÎÚ›ÛË˜. ∏ ·ÓÙÈÌÂÙÒÈÛË

ÙˆÓ ÎÚ›ÛÂˆÓ Â›Ó·È Û˘ÌÙˆÌ·ÙÈÎ‹ Î·È ÂÚÈÏ·Ì‚¿ÓÂÈ

Î·Ï‹ ÂÓ˘‰¿ÙˆÛË, ‰ÈfiÚıˆÛË ÙË˜ ˘ÔÁÏ˘Î·ÈÌ›·˜ Î·È

ÛˆÛÙ‹ Ú‡ıÌÈÛË ÙË˜ ÔÍÂÔ‚·ÛÈÎ‹˜ ÈÛÔÚÚÔ›·˜. ™ËÌ·-

ÓÙÈÎfi˜ Â›Ó·È Ô ¤ÏÂÁ¯Ô˜ ÙË˜ Ë·ÙÈÎ‹˜ Î·È È‰È·›ÙÂÚ· ÙË˜

ÓÂÊÚÈÎ‹˜ ÏÂÈÙÔ˘ÚÁ›·˜ fiÙ·Ó ¤¯Ô˘ÌÂ Û˘ÓÔ‰fi Ú·‚‰Ô-

Ì˘fiÏ˘ÛË. ∏ ¯ÔÚ‹ÁËÛË ‰ÈÙÙ·ÓıÚ·ÎÈÎÒÓ ÛÂ ÂÚÈÙÒ-

ÛÂÈ˜ Á·Ï·ÎÙÈÎ‹˜ ÔÍ¤ˆÛË˜ ÂÈ‚¿ÏÏÂÙ·È. ∞Ó Ë Á·Ï·ÎÙÈ-

Î‹ ÔÍ¤ˆÛË Â›Ó·È ÛÔ‚·Ú‹, ÙfiÙÂ ÌÔÚÔ‡ÌÂ Ó· ¯ÔÚËÁ‹-

ÛÔ˘ÌÂ ‰È¯ÏˆÚÔ·ÎÂÙÔÙÈÎfi ÔÍ‡ DCA (25 mg/kg/day)

(76). ∏ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ Û·ÛÌÒÓ Ô˘ ÔÏÏ¤˜ ÊÔ-

Ú¤˜ ÂÈÏ¤ÎÔ˘Ó ÌÈ· ÎÚ›ÛË Á›ÓÂÙ·È ÌÂ ÂÓ‰ÔÊÏ¤‚È· ‹

·fi ÙÔ ÔÚıfi ¯ÔÚ‹ÁËÛË ‚ÂÓ˙Ô‰È·˙ÂÈÓÒÓ, ÂÓÒ ·fi

ÚÔÛˆÈÎ‹ ÂÌÂÈÚ›·, Ë ¯ÔÚ‹ÁËÛË Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË˜

ÌÔÚÂ› Ó· Â›Ó·È ‚ÔËıËÙÈÎ‹.

°ÂÓÂÙÈÎ‹ Î·ıÔ‰‹ÁËÛË

™ËÌÂÈ·Î¤˜ ÌÂÙ·ÏÏ¿ÍÂÈ˜ ÛÙÔ ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi DNA. √

Î›Ó‰˘ÓÔ˜ ÙË˜ ÌËÙ¤Ú·˜ ÌÂ ÛËÌÂÈ·Î‹ ÌÂÙ¿ÏÏ·ÍË ÛÙÔ

ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi DNA Ó· ÌÂÙ·‚È‚¿ÛÂÈ ÙË ÓfiÛÔ ÛÙ·

·È‰È¿ ÂÍ·ÚÙ¿Ù·È ·fi ÙÔ Â›Â‰Ô ÙË˜ ÂÙÂÚÔÏ·-

ÛÌ›·˜ ÙË˜ ÌÂÙ¿ÏÏ·ÍË˜ ÛÙÔ˘˜ ÈÛÙÔ‡˜. √ Î›Ó‰˘ÓÔ˜ ·˘-

Í¿ÓÂÙ·È ÌÂ ÙÔ ÔÛÔÛÙfi ÂÙÂÚÔÏ·ÛÌ›·˜ ÛÙÔ˘˜ ÈÛÙÔ‡˜

Î·È ‰ÂÓ ˘¿Ú¯ÂÈ ¤Ó· ÂÏ¿¯ÈÛÙÔ Â›Â‰Ô ÂÙÂÚÔÏ·-

ÛÌ›·˜ Î¿Ùˆ ÙÔ˘ ÔÔ›Ô˘ Ô Î›Ó‰˘ÓÔ˜ ÌÂÙ·‚›‚·ÛË˜ Ó·

··ÏÂ›ÊÂÙ·È. ÕÚÚÂÓÂ˜ ÌÂ ÌÂÙ·ÏÏ¿ÍÂÈ˜ ÛÙÔ ÌÈÙÔ¯ÔÓ-

‰ÚÈ·Îfi DNA ÂÍ·ÈÚÂÙÈÎ¿ Û¿ÓÈ· ÌÔÚÂ› Ó· ÌÂÙ·‚È-

‚¿ÛÔ˘Ó ÙË ÓfiÛÔ.

∞Ó·Û˘Ó‰˘·ÛÌÔ› ÛÙÔ ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi DNA. √È ÂÚÈÛ-

ÛfiÙÂÚÂ˜ ÂÚÈÙÒÛÂÈ˜ ÌÂ ÌÔÓ‹ÚÂ˜ ¤ÏÏÂÈÌÌ· ÛÙÔ ÌÈ-

ÙÔ¯ÔÓ‰ÚÈ·Îfi DNA Â›Ó·È ÛÔÚ·‰ÈÎ¤˜ (4). √ Î›Ó‰˘ÓÔ˜

ÂÌÊ¿ÓÈÛË˜ ÙË˜ ÓfiÛÔ˘ ÛÙÔ ·È‰› ‰ÂÓ ·˘Í¿ÓÂÙ·È ÌÂ

ÙËÓ ËÏÈÎ›· ÙË˜ ÌËÙ¤Ú·˜. ªËÙ¤ÚÂ˜ ÌÂ ÌÔÓ‹ÚÂ˜ ¤Ï-

ÏÂÈÌÌ· Î·È Û‡Ó‰ÚÔÌÔ Kearn-Sayre ‹ PEO ¤¯Ô˘Ó Î›Ó-

‰˘ÓÔ 4% Ó· ÌÂÙ·‚È‚¿ÛÔ˘Ó ÙË ÓfiÛÔ.

ªÂÙ·ÏÏ¿ÍÂÈ˜ ÛÙÔ ˘ÚËÓÈÎfi DNA. ∏ ÁÂÓÂÙÈÎ‹ ÙˆÓ

ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ ·fi ÌÂÙ¿ÏÏ·ÍË ÛÙÔ

˘ÚËÓÈÎfi DNA ·ÎÔÏÔ˘ıÂ› ÙÔ˘˜ ÌÂÓ‰¤ÏÈÔ˘˜ Î·Ófi-

ÓÂ˜ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜ Î·È ÛÂ ·˘Ù¤˜ ÙÈ˜ ÂÚÈÙÒ-

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À„›Û˘¯ÓÔ˜ ·ÂÚÈÛÌfi˜ ÌÂ Ù·Ï·ÓÙÒÛÂÈ˜: ªË¯·ÓÈÛÌÔ› ÏÂÈÙÔ˘ÚÁ›·˜

¶. ∫·Ú·ÁÈ¿ÓÓË, ¡. ¡ÈÎÔÏ·˝‰Ë˜

¶ÂÚ›ÏË„Ë: O ˘„›Û˘¯ÓÔ˜ ·ÂÚÈÛÌfi˜ ÌÂ Ù·Ï·ÓÙÒÛÂÈ˜ (À∞∆) ·ÔÙÂÏÂ› ¤Ó·Ó ÂÓ·ÏÏ·ÎÙÈÎfi ÙÚfiÔ ÌË¯·ÓÈ-ÎÔ‡ ·ÂÚÈÛÌÔ‡, Ô ÔÔ›Ô˜ ¯ÚËÛÈÌÔÔÈÂ› ÌÈÎÚÔ‡˜ ·Ó·ÓÂfiÌÂÓÔ˘˜ fiÁÎÔ˘˜ ·¤Ú·, Û˘¯Ó¿ ÌÈÎÚfiÙÂÚÔ˘˜ ·fiÙÔÓ ·Ó·ÙÔÌÈÎ¿ ÓÂÎÚfi ¯ÒÚÔ Î·È ÂÍ·ÈÚÂÙÈÎ¿ ÁÚ‹ÁÔÚÔ˘˜ ·Ó·ÓÂ˘ÛÙÈÎÔ‡˜ Ú˘ıÌÔ‡˜, ¤Ú·Ó ÙÔ˘ Ê˘ÛÈÔ-ÏÔÁÈÎÔ‡, ÁÈ· ÙËÓ ÂÍ·ÛÊ¿ÏÈÛË ÙË˜ ÔÍ˘ÁfiÓˆÛË˜ Î·È ÙÔ˘ ·ÂÚÈÛÌÔ‡ ÙˆÓ ÓÂÔÁÓÒÓ. ∞ÚÎÂÙ¤˜ ÂÈÚ·Ì·ÙÈÎ¤˜ÌÂÏ¤ÙÂ˜ ¤‰ÂÈÍ·Ó fiÙÈ ÙÔ ÔÁÎfiÙÚ·˘Ì· Ì¿ÏÏÔÓ ·Ú¿ ÙÔ ‚·ÚfiÙÚ·˘Ì· Â›Ó·È Ë ·Ú¯ÈÎ‹ ·ÈÙ›· ÙË˜ ÔÍÂ›·˜ÓÂ˘ÌÔÓÈÎ‹˜ ‚Ï¿‚Ë˜ Ô˘ ÚÔÎ·ÏÂ›Ù·È ·fi ÙÔ Û˘Ì‚·ÙÈÎfi ·ÂÚÈÛÌfi (™∞). π‰È·›ÙÂÚ· ÁÈ· ÙËÓ ÚfiÎÏËÛË·˘Ù‹˜ ÙË˜ ‚Ï¿‚Ë˜ ·Ô‰Â›¯ıËÎÂ fiÙÈ ÛËÌ·ÓÙÈÎfiÙÂÚÔ ÚfiÏÔ ‰È·‰Ú·Ì·Ù›˙Ô˘Ó ÔÈ ‰È·Î˘Ì¿ÓÛÂÈ˜ ÙÔ˘ fiÁÎÔ˘ÙˆÓ ÓÂ˘ÌfiÓˆÓ ÂÍ·ÈÙ›·˜ ÙË˜ ÚÔÎ·ıÔÚÈÛÌ¤ÓË˜ ÂÚÈÔ‰ÈÎfiÙËÙ·˜ ÙÔ˘ ™∞, ·Ú¿ ÔÈ ÌÂÙ·‚ÔÏ¤˜ ÛÙÈ˜ È¤-ÛÂÈ˜ ÙˆÓ ·ÂÚÔÊfiÚˆÓ Ô‰ÒÓ. ∆Ô ÁÂÁÔÓfi˜ fiÙÈ Î·Ù¿ ÙÔÓ À∞∆, Ô fiÁÎÔ˜ ÙˆÓ ÓÂ˘ÌfiÓˆÓ ·Ú·Ì¤ÓÂÈ Û¯ÂÙÈ-Î¿ ÛÙ·ıÂÚfi˜ ÌÂ ÌÈÎÚ¤˜ ÌfiÓÔ ‰È·Î˘Ì¿ÓÛÂÈ˜, ı· ÌÔÚÔ‡ÛÂ ıÂˆÚËÙÈÎ¿ Ó· ‰ÈÎ·ÈÔÏÔÁ‹ÛÂÈ ÙË ¯Ú‹ÛË ÙÔ˘,ÒÛÙÂ Ó· ÚÔÛÙ·Ù¤„ÂÈ ÙÔÓ ·ÓÒÚÈÌÔ ÓÂÔÁÓÈÎfi ÓÂ‡ÌÔÓ· ·fi ‚Ï¿‚Ë. Œ¯ÂÈ ¯ÚËÛÈÌÔÔÈËıÂ› Î˘Ú›ˆ˜ ˆ˜ıÂÚ·Â›· ‰È¿ÛˆÛË˜ ÛÂ ÙÂÏÂÈfiÌËÓ· ‹ ÌÂÁ¿Ï· ÚfiˆÚ· ÌÂ ÛÔ‚·Ú‹ ·Ó·ÓÂ˘ÛÙÈÎ‹ ·ÓÂ¿ÚÎÂÈ· Î·È ·-Ú·Ì¤ÓÔ˘Û· ÓÂ˘ÌÔÓÈÎ‹ ˘¤ÚÙ·ÛË Î·È ˆ˜ ·Ú¯ÈÎ‹ ıÂÚ·Â˘ÙÈÎ‹ ÂÈÏÔÁ‹ ÛÂ ÚfiˆÚ· ÌÂ ÛÔ‚·Úfi Û‡Ó-‰ÚÔÌÔ ·Ó·ÓÂ˘ÛÙÈÎ‹˜ ‰˘Û¯¤ÚÂÈ·˜ Î·È ÛÙ· Û‡Ó‰ÚÔÌ· ‰È·Ê˘Á‹˜ ·¤Ú·. √È ·fi„ÂÈ˜ Û¯ÂÙÈÎ¿ ÌÂ ÙÈ˜ ÂÓ-‰Â›ÍÂÈ˜ ÂÊ·ÚÌÔÁ‹˜ ÙÔ˘ Â›Ó·È ·ÎfiÌË ·ÓÙÈÎÚÔ˘fiÌÂÓÂ˜. ™ÙËÓ ·ÚÔ‡Û· ·Ó·ÛÎfiËÛË ı· ÂÚÈÁÚ·ÊÔ‡Ó ÔÈ·Ú¯¤˜ ÏÂÈÙÔ˘ÚÁ›·˜, Ë Ê˘ÛÈÔÏÔÁ›· ÙË˜ ÔÍ˘ÁfiÓˆÛË˜ Î·È ÙÔ˘ ·ÂÚÈÛÌÔ‡ Î·È ÔÈ ÌË¯·ÓÈÛÌÔ› ·ÓÙ·ÏÏ·Á‹˜·ÂÚ›ˆÓ ÛÂ ·˘Ùfi ÙÔ ÌÔÓÙ¤ÏÔ ÌË¯·ÓÈÎÔ‡ ·ÂÚÈÛÌÔ‡.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: À„›Û˘¯ÓÔ˜ ·ÂÚÈÛÌfi˜ ÌÂ Ù·Ï·ÓÙÒÛÂÈ˜, ÔÍ˘ÁfiÓˆÛË, ·ÂÚÈÛÌfi˜, ·ÓÙ·ÏÏ·Á‹ ·ÂÚ›ˆÓ.

High frequency oscillatory ventilation: How it works

P. Karagianni, N. Nikolaides

Abstract: High frequency oscillatory ventilation (HFOV) is an alternative mode of mechanicalventilation that uses small tidal volumes, usually smaller than the anatomically dead space andextremely rapid respiratory rates, above the normal, in order to achieve the oxygenation and ventilationof neonates. Several experimental studies showed that volutrauma rather than barotrauma is the initialcause of acute pulmonary damage, caused by conventional ventilation (CV). It was proved that thefluctuations of the lung volume due to the time cycled of conventional ventilation and not the pressurechanges in the airway tracts play important role for this damage. During the application of HFOV, thelung volume remains relatively constant with only small fluctuations. This could theoretically justify itsuse in order to protect the immature neonatal lung from damage. It has been used mainly as rescuetherapy in full term or near term neonates with serious respiratory insufficiency and persistentpulmonary hypertension and also as an initial therapy in premature neonates with serious respiratorydistress and air leak syndromes. Opinions regarding the indication of its application are stillcontroversial. This review describes the operational principles of HFOV and the relevant physiology andmechanisms of gas exchange during this mode of mechanical ventilation.

Key words: High frequency oscillatory ventilation, oxygenation, ventilation, mechanisms of gas exchange.

µ’ ¡ÂÔÁÓÔÏÔÁÈÎ‹ ∫ÏÈÓÈÎ‹ Î·È∂ÓÙ·ÙÈÎ‹ ¡ÔÛËÏÂ›· ¡ÂÔÁÓÒÓ∞.¶.£., °.¶.¡. “¶··ÁÂˆÚÁ›Ô˘”,£ÂÛÛ·ÏÔÓ›ÎË˜


∫·Ú·ÁÈ¿ÓÓË ¶·Ú·ÛÎÂ˘‹[email protected]µ’ ¡ÂÔÁÓÔÏÔÁÈÎ‹ ∫ÏÈÓÈÎ‹ Î·È∂ÓÙ·ÙÈÎ‹ ¡ÔÛËÏÂ›· ¡ÂÔÁÓÒÓ∞.¶.£., °.¶.¡. “¶··ÁÂˆÚÁ›Ô˘”¶ÂÚÈÊÂÚÂÈ·Î‹ Ô‰fi˜, ¡. ∂˘Î·Ú›·∆.∫. 564 03, £ÂÛÛ·ÏÔÓ›ÎË

2nd NICU and NeonatologyDepartment of the AristotleUniversity of Thessaloniki,G.P.N. “Papageorgiou”,Thessaloniki

Correspondence:

Karagianni [email protected] NICU and NeonatologyDepartment of AristotleUniversity of Thessaloniki.G.P.N. “Papageorgiou”Ring road Nea Efkarpia, 546 03, Thessaloniki

™˘ÓÙÔÌÔÁÚ·Ê›Â˜

À∞∆ Y„›Û˘¯ÓÔ˜ ·ÂÚÈÛÌfi˜ ÌÂ Ù·Ï·ÓÙÒÛÂÈ˜(HFOV)

™∞ ™˘Ì‚·ÙÈÎfi˜ ·ÂÚÈÛÌfi˜ Vt ∞Ó·ÓÂfiÌÂÓÔ˜ fiÁÎÔ˜ ·¤Ú·™∞¢ ™‡Ó‰ÚÔÌÔ ·Ó·ÓÂ˘ÛÙÈÎ‹˜ ‰˘Û¯¤ÚÂÈ·˜ Pa-w ª¤ÛË ›ÂÛË ·ÂÚ·ÁˆÁÒÓ¢ƒ ¢È·ÊÔÚ¿ ›ÂÛË˜ Ù·Ï¿ÓÙˆÛË˜ Amplitude ∂‡ÚÔ˜ Ù·Ï¿ÓÙˆÛË˜f ™˘¯ÓfiÙËÙ·

√ ˘„›Û˘¯ÓÔ˜ ·ÂÚÈÛÌfi˜ ÌÂ Ù·Ï·ÓÙÒÛÂÈ˜(High frequency oscillatory ventilation, HFOV)·ÔÙÂÏÂ› ¤Ó·Ó ÂÓ·ÏÏ·ÎÙÈÎfi ÙÚfiÔ ÌË¯·ÓÈÎÔ‡·ÂÚÈÛÌÔ‡ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ·Ó·ÓÂ˘-ÛÙÈÎ‹˜ ·ÓÂ¿ÚÎÂÈ·˜ ÛÙ· ÓÂÔÁÓ¿. ∆Ô Î‡ÚÈÔ ¯·Ú·-ÎÙËÚÈÛÙÈÎfi ÙÔ˘ Â›Ó·È fiÙÈ ¯ÚËÛÈÌÔÔÈÂ› ÌÈÎÚÔ‡˜·Ó·ÓÂfiÌÂÓÔ˘˜ fiÁÎÔ˘˜ ·¤Ú· (Vt, tidal volume),Û˘¯Ó¿ ÌÈÎÚfiÙÂÚÔ˘˜ ·fi ÙÔÓ ·Ó·ÙÔÌÈÎ¿ ÓÂÎÚfi¯ÒÚÔ Î·È ÔÏ‡ ÁÚ‹ÁÔÚÔ˘˜ ·Ó·ÓÂ˘ÛÙÈÎÔ‡˜

Ú˘ıÌÔ‡˜ (·fi 2,5 ¤ˆ˜ 30 Hz) ÁÈ· ÙËÓ ÂÍ·ÛÊ¿ÏÈÛË

ÙË˜ ÔÍ˘ÁfiÓˆÛË˜ Î·È ÙÔ˘ ·ÂÚÈÛÌÔ‡ ÛÙ· ÓÂÔÁÓ¿ (1-3).

∆· ÚÒÙ· ÂÈÚ¿Ì·Ù· Û¯ÂÙÈÎ¿ ÌÂ ÙÈ˜ ·Ú¯¤˜ ÏÂÈ-

ÙÔ˘ÚÁ›·˜ ÙÔ˘ ˘„›Û˘¯ÓÔ˘ ·ÂÚÈÛÌÔ‡ ÌÂ Ù·Ï·ÓÙÒÛÂÈ˜

(À∞∆) ÍÂÎ›ÓËÛ·Ó ÙÔ 1915 ·fi ÙÔÓ Henderson (4), ·Ï-

Ï¿ Ô ÚÒÙÔ˜ ·Ó·ÓÂ˘ÛÙ‹Ú·˜ ˘„ËÏ‹˜ Û˘¯ÓfiÙËÙ·˜

Î·Ù·ÛÎÂ˘¿ÛÙËÎÂ ·fi ÙÔÓ Emmerson ÙÔ 1959. √È

Lunkenheimer Î·È Û˘Ó. ÙÔ 1972, ·¤‰ÂÈÍ·Ó ÛÂ ÂÈÚ·-

Ì·ÙÈÎ‹ ÌÂÏ¤ÙË fiÙÈ Ë Ù·Ï¿ÓÙˆÛË ÌÈÎÚÒÓ fiÁÎˆÓ ·¤Ú·

ÛÙÔ˘˜ ·ÂÚ·ÁˆÁÔ‡˜ ÙˆÓ ÂÈÚ·Ì·Ùfi˙ˆˆÓ ‰È·ÙËÚÔ‡ÛÂ

ÙÔ ·ÚÙËÚÈ·Îfi ‰ÈÔÍÂ›‰ÈÔ ÙÔ˘ ¿ÓıÚ·Î· ÛÂ Ê˘ÛÈÔÏÔÁÈÎ¿

Â›Â‰· (5). ∞ÚÁfiÙÂÚ· ·Ô‰Â›¯ıËÎÂ fiÙÈ ·Ó ¯ÚËÛÈÌÔ-

ÔÈËıÔ‡Ó ·Ó·ÓÂfiÌÂÓÔÈ fiÁÎÔÈ ÌÈÎÚfiÙÂÚÔÈ ·fi ÙÔÓ

·Ó·ÙÔÌÈÎ¿ ÓÂÎÚfi ¯ÒÚÔ, ÌÔÚÂ› Ó· ‰È·ÙËÚËıÂ› Ô Î˘-

„ÂÏÈ‰ÈÎfi˜ ·ÂÚÈÛÌfi˜ ÛÂ ÈÎ·ÓÔÔÈËÙÈÎ¿ Â›Â‰· (6,7).

∏ ÚÒÙË ÎÏÈÓÈÎ‹ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ À∞∆ ÛÂ ÓÂÔÁÓ¿

Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ ·fi ÙÔ˘˜ Marchak Î·È Û˘Ó. (8).

√ À∞∆ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ ·Ú¯ÈÎ¿ ÌÂ ÙËÓ ÂÔ›ıË-

ÛË fiÙÈ ÏfiÁˆ ÙˆÓ È‰È·›ÙÂÚˆÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ÙÔ˘

ÌÔÚÂ› Ó· ‚ÂÏÙÈÒÛÂÈ ÙËÓ ·ÓÙ·ÏÏ·Á‹ ÙˆÓ ·ÂÚ›ˆÓ ÛÂ

ÓÂÔÁÓ¿ ÌÂ ÛÔ‚·Ú‹ ·Ó·ÓÂ˘ÛÙÈÎ‹ ·ÓÂ¿ÚÎÂÈ·, ·ÏÏ¿

Î·È Ó· ÌÂÈÒÛÂÈ ÙÈ˜ ÔÍÂ›Â˜ ‹ ¯ÚfiÓÈÂ˜ ÂÈÏÔÎ¤˜ Ô˘

ÔÊÂ›ÏÔÓÙ·È ÛÙËÓ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ÌË¯·ÓÈÎÔ‡ ·ÂÚÈÛÌÔ‡.

∞ÚÎÂÙ¤˜ ÂÈÚ·Ì·ÙÈÎ¤˜ ÌÂÏ¤ÙÂ˜ ¤‰ÂÈÍ·Ó fiÙÈ ÙÔ ÔÁÎfi-

ÙÚ·˘Ì· Ì¿ÏÏÔÓ ·Ú¿ ÙÔ ‚·ÚfiÙÚ·˘Ì· Â›Ó·È Ë ·Ú¯ÈÎ‹

·ÈÙ›· ÙË˜ ÔÍÂ›·˜ ÓÂ˘ÌÔÓÈÎ‹˜ ‚Ï¿‚Ë˜ Ô˘ ÚÔÎ·ÏÂ›-

Ù·È ·fi ÙÔÓ Û˘Ì‚·ÙÈÎfi ·ÂÚÈÛÌfi (™∞) (9-12). π‰È·›ÙÂ-

Ú· ÁÈ· ÙËÓ ÚfiÎÏËÛË ·˘Ù‹˜ ÙË˜ ‚Ï¿‚Ë˜ ·Ô‰Â›¯ıËÎÂ

fiÙÈ ÛËÌ·ÓÙÈÎfiÙÂÚÔ ÚfiÏÔ ‰È·‰Ú·Ì·Ù›˙Ô˘Ó ÔÈ ‰È·Î˘-

Ì¿ÓÛÂÈ˜ ÙÔ˘ fiÁÎÔ˘ ÙˆÓ ÓÂ˘ÌfiÓˆÓ ÂÍ·ÈÙ›·˜ ÙË˜ ÚÔ-

Î·ıÔÚÈÛÌ¤ÓË˜ ÂÚÈÔ‰ÈÎfiÙËÙ·˜ (time cycled) ÙÔ˘ ™∞,

·Ú¿ ÔÈ ÌÂÙ·‚ÔÏ¤˜ ÛÙÈ˜ È¤ÛÂÈ˜ ÙˆÓ ·ÂÚÔÊfiÚˆÓ

Ô‰ÒÓ. ∆Ô ÁÂÁÔÓfi˜ fiÙÈ Î·Ù¿ ÙÔÓ À∞∆, Ô fiÁÎÔ˜ ÙˆÓ

ÓÂ˘ÌfiÓˆÓ ·Ú·Ì¤ÓÂÈ Û¯ÂÙÈÎ¿ ÛÙ·ıÂÚfi˜ ÌÂ ÌÈÎÚ¤˜

ÌfiÓÔ ‰È·Î˘Ì¿ÓÛÂÈ˜, ı· ÌÔÚÔ‡ÛÂ ıÂˆÚËÙÈÎ¿ Ó· ‰È-

Î·ÈÔÏÔÁ‹ÛÂÈ ÙË ¯Ú‹ÛË ÙÔ˘, ÒÛÙÂ Ó· ÚÔÛÙ·Ù¤„ÂÈ ÙÔÓ

·ÓÒÚÈÌÔ ÓÂÔÁÓÈÎfi ÓÂ‡ÌÔÓ· ·fi ‚Ï¿‚Ë (13).

∂ÈÏ¤ÔÓ ¤¯ÂÈ ÙÔ ÏÂÔÓ¤ÎÙËÌ·, ÂÊfiÛÔÓ ÂÊ·ÚÌÔ-

ÛÙÂ› Ë Î·Ù¿ÏÏËÏË ÛÙÚ·ÙËÁÈÎ‹, Ó· ÂÙ‡¯ÂÈ ÈÔ ÔÌÔÈ-

ÔÁÂÓ‹ ¤ÎÙ˘ÍË ÙÔ˘ ÓÂ‡ÌÔÓ·, ÌÂ›ˆÛË ÙˆÓ ÂÓ‰Ô-

ÓÂ˘ÌÔÓÈÎÒÓ ‰È·Ê˘ÁÒÓ, Ù·¯‡ÙÂÚË ‚ÂÏÙ›ˆÛË ÛÙË

Û¯¤ÛË ·ÂÚÈÛÌÔ‡-·ÈÌ¿ÙˆÛË˜ Î·È ÙË˜ ÔÍ˘ÁfiÓˆÛË˜.

ªÂ ÙËÓ Ù·¯‡ÙÂÚË ‚ÂÏÙ›ˆÛË ÛÙËÓ ÔÍ˘ÁfiÓˆÛË ÌÂÈÒ-

ÓÂÙ·È Ô ¯ÚfiÓÔ˜ ¯ÔÚ‹ÁËÛË˜ √2, ¿Ú· Î·È Ë ¤ÎıÂÛË ÙÔ˘

ÓÂ‡ÌÔÓ· ÛÙÈ˜ ÂÏÂ‡ıÂÚÂ˜ Ú›˙Â˜ ÙÔ˘ Ô˘ ÂÓÔ¯ÔÔÈ-

Ô‡ÓÙ·È ÁÈ· ÚfiÎÏËÛË ÓÂ˘ÌÔÓÈÎ‹˜ ‚Ï¿‚Ë˜ (14).

∞Ú¯¤˜ ÏÂÈÙÔ˘ÚÁ›·˜ - ·Ú¿ÌÂÙÚÔÈ

√ ˘„›Û˘¯ÓÔ˜ ·Ó·ÓÂ˘ÛÙ‹Ú·˜ ÏÂÈÙÔ˘ÚÁÂ› Û·Ó

·ÓÙÏ›· ÌÂ ÈÛÙfiÓÈ (¤Ì‚ÔÏÔ) ‹ Ù·Ï·ÓÙÔ‡ÌÂÓ· ‰È·-

ÊÚ¿ÁÌ·Ù·, Ù· ÔÔ›· ¿ÏÏÔÓÙ·È ÌÂ Û˘¯ÓfiÙËÙ· 400-

2400 ·Ó·ÓÔÒÓ ÛÙÔ ÏÂÙfi (15). ∫·Ù¿ ÙË ÏÂÈÙÔ˘ÚÁ›·

ÙÔ˘ À∞∆ Ë ÂÈÛÓÔ‹ Î·È Ë ÂÎÓÔ‹ Â›Ó·È ÂÓÂÚÁËÙÈÎ¤˜.

√È Ù·Ï·ÓÙˆÙ¤˜ ·Ú¿ÁÔ˘Ó Î·È ‰È·Ó¤ÌÔ˘Ó ÌÂÁ¿ÏÔ˘˜

fiÁÎÔ˘˜ ·¤Ú·. ™˘ÓÂ¯‹˜ Î·È ÚÔÎ·ıÔÚÈÛÌ¤ÓË (ÛÂ

l/min) ÚÔ‹ ·¤Ú· ‰ÈÔ¯ÂÙÂ‡ÂÙ·È ÌÂ Ù·¯‡ Ú˘ıÌfi ·fi

Ì›· ËÁ‹, Ë ÔÔ›· ·Ú¿ÁÂÈ ‹ ·Ú¤¯ÂÈ ÂÓ¤ÚÁÂÈ· ÛÙÈ˜

Ù·Ï·ÓÙÒÛÂÈ˜. ŒÓ· ÂÏÂÁ¯fiÌÂÓÔ ÛËÌÂ›Ô ‰È·ÚÚÔ‹˜ ‹

¯·ÌËÏ‹˜ ‰È¿‚·ÛË˜ Ê›ÏÙÚÔ ÂÈÙÚ¤ÂÈ ÛÙÔÓ ·¤Ú· Ó·

ÂÍ¤Ú¯ÂÙ·È ·fi ÙÔ Û‡ÛÙËÌ· (16).

¶ÂÚÈÛÛfiÙÂÚÔ ·fi fiÏÔ˘˜ ¤¯ÂÈ ¯ÚËÛÈÌÔÔÈËıÂ› Ô

SensorMedics 3100A (SensorMedics, Corp Yorba

Linda, CA) (17). √ Û˘ÁÎÂÎÚÈÌ¤ÓÔ˜ ·Ó·ÓÂ˘ÛÙ‹Ú·˜

Ê¤ÚÂÈ ÛÊÚ·ÁÈÛÌ¤ÓÔ ¤Ì‚ÔÏÔ ÌÂ Ú˘ıÌÈ˙fiÌÂÓË ÌÂÙ·-

Î›ÓËÛË fiÁÎÔ˘, ÚÔÎ·ÏÒÓÙ·˜ Ù·Ï·ÓÙÒÛÂÈ˜ ÛÙÈ˜ ·Â-

ÚÔÊfiÚÔ˘˜ Ô‰Ô‡˜. ∏ Û˘¯ÓfiÙËÙ· (frequency-f) Ú˘ı-

Ì›˙ÂÙ·È ÌÂÙ·Í‡ 180-900 ·Ó·ÓÔ¤˜ ÙÔ ÏÂÙfi (3-

15Hz), Ë Ì¤ÛË ›ÂÛË ·ÂÚ·ÁˆÁÒÓ (mean airway

pressure - Pa-w) ·fi 3-45 cm H2O Î·È Ô ÂÈÛÓÂ˘ÛÙÈ-

Îfi˜ ¯ÚfiÓÔ˜ (inspiratory time - π∆) Â›Ó·È ÌÂÙ·‚·Ï-

ÏfiÌÂÓÔ˜ Ì¤¯ÚÈ ÙÔ 50% ÙÔ˘ Û˘ÓÔÏÈÎÔ‡ ·Ó·ÓÂ˘ÛÙÈ-

ÎÔ‡ Î‡ÎÏÔ˘. ∏ ‰È·ÊÔÚ¿ ›ÂÛË˜ Ù·Ï¿ÓÙˆÛË˜ (¢ƒ) ‹

Â‡ÚÔ˜ Ù·Ï¿ÓÙˆÛË˜ (amplitude) Î·ıÔÚ›˙ÂÈ ÙÔÓ ·Ó·-

ÓÂfiÌÂÓÔ fiÁÎÔ Î·È Ú˘ıÌ›˙ÂÙ·È ¤ˆ˜ 90 cmH2O. ∏

ÚÔ‹ (flow) Ú˘ıÌ›˙ÂÙ·È ·fi 6-20 lt/min ÁÈ· Ù· ÌÈ-

ÎÚfiÙÂÚ· ÙˆÓ 1000 gr Î·È Ù· ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿

·ÓÙ›ÛÙÔÈ¯·. ∆Ô ÎÏ¿ÛÌ· ÂÈÛÓÂfiÌÂÓÔ˘ √2 (Fraction

of inspired √xygen - Fi√2) Ú˘ıÌ›˙ÂÙ·È fiˆ˜ Î·È ÛÂ

fiÏÔ˘˜ ÙÔ˘˜ ·Ó·ÓÂ˘ÛÙ‹ÚÂ˜. √ ·Ó·ÓÂ˘ÛÙ‹Ú·˜

SensorMedics 3100A ¯ÚËÛÈÌÔÔÈÂ› ÙÔ ËÏÂÎÙÚÔÌ·-

ÁÓËÙÈÎ¿ Î·ıÔ‰ËÁÔ‡ÌÂÓÔ ‰È¿ÊÚ·ÁÌ· ÁÈ· ÙËÓ ·Ú·-

ÁˆÁ‹ ›ÂÛË˜ ËÌÈÙÔÓÔÂÈ‰Ô‡˜ ÌÔÚÊ‹˜ Ì¤Û· ÛÙÔ Î‡-

ÎÏˆÌ· ÙÔ˘ ·Ó·ÓÂ˘ÛÙ‹Ú·, Ë ÔÔ›· ÂÊ·ÚÌfi˙ÂÙ·È

ÛÙÔÓ ÂÓ‰ÔÙÚ·¯ÂÈ·Îfi ÛˆÏ‹Ó·. ∏ Î›ÓËÛË Ù·Ï¿ÓÙˆ-

ÛË˜ ÙÔ˘ ‰È·ÊÚ¿ÁÌ·ÙÔ˜ ÚÔÎ·ÏÂ› ÂÓÂÚÁËÙÈÎ¤˜ ÂÈ-

ÛÓÂ˘ÛÙÈÎ¤˜ Î·È ÂÎÓÂ˘ÛÙÈÎ¤˜ Ê¿ÛÂÈ˜, ÔÈ ÔÔ›Â˜

Î·ÙÂ˘ı‡ÓÔ˘Ó ÙÔ Ì›ÁÌ· ÙˆÓ ·ÂÚ›ˆÓ ÌÂÙ·Í‡ ÙÔ˘ Î˘-

ÎÏÒÌ·ÙÔ˜ ÙÔ˘ ·Ó·ÓÂ˘ÛÙ‹Ú· Î·È ÙˆÓ ÓÂ˘ÌÔÓÈ-

ÎÒÓ Î˘„ÂÏ›‰ˆÓ ÙÔ˘ ·ÛıÂÓ‹.

∏ ‰È·ÊÔÚ¿ ›ÂÛË˜ ˘ÔÏÔÁ›˙ÂÙ·È ÛÙËÓ ˘Ô‰Ô¯‹

ÙÔ˘ ÂÓ‰ÔÙÚ·¯ÂÈ·ÎÔ‡ ÛˆÏ‹Ó· ˆ˜ ¢ƒ Î·È Î·ıÔÚ›˙ÂÈ

ÙÔÓ ·Ó·ÓÂfiÌÂÓÔ fiÁÎÔ Ô˘ Êı¿ÓÂÈ ÛÙÔÓ ·ÛıÂÓ‹ ÛÂ

Î¿ıÂ ·Ó·ÓÔ‹. ∫¿ıÂ ÌÂÙ·‚ÔÏ‹ ÛÙËÓ ¢ƒ ÂËÚÂ¿˙ÂÈ

Î·È ÙÔÓ ·ÂÚÈÛÌfi ÙÔ˘ ÓÂÔÁÓÔ‡. ∏ Ì¤ÛË ›ÂÛË ÙˆÓ ·Â-

ÚÔÊfiÚˆÓ Ô‰ÒÓ ‰È¤ÂÙ·È ·fi ÙÔÓ Ú˘ıÌfi ÚÔ‹˜ ·¤Ú·

Ì¤Û· ÛÙÔ Î‡ÎÏˆÌ· Î·È ÙËÓ ·ÓÙ›ÛÙ·ÛË ÚÔ˜ ÙËÓ ÂÎ-

ÓÂ˘ÛÙÈÎ‹ ÏÂ˘Ú¿ ÙÔ˘ Î˘ÎÏÒÌ·ÙÔ˜. ∆Ô Â‡ÚÔ˜ Ù·-

Ï¿ÓÙˆÛË˜ (amplitude) ÙË˜ ‰È·ÊÔÚ¿˜ ›ÂÛË˜ (¢P),

Ô˘ ·Ú¿ÁÂÙ·È ·fi ÙÔ ‰È¿ÊÚ·ÁÌ· Î·È Ë Ì¤ÛË ›ÂÛË

ÙˆÓ ·ÂÚ·ÁˆÁÒÓ, ÌÔÚÔ‡Ó Ó· Ú˘ıÌÈÛÙÔ‡Ó ·ÓÂÍ¿Ú-

ÙËÙ·. ÕÚ·, ÌÔÚÔ‡ÌÂ Ó· ¤¯Ô˘ÌÂ ÙËÓ ›‰È· ›ÂÛË ÌÂ

‰È·ÊÔÚÂÙÈÎfi Â‡ÚÔ˜ Ù·Ï¿ÓÙˆÛË˜ (17).

√Í˘ÁfiÓˆÛË Î·È ·ÂÚÈÛÌfi˜

∏ Ê˘ÛÈÔÏÔÁ›· ÙË˜ ·ÓÙ·ÏÏ·Á‹˜ ·ÂÚ›ˆÓ ÌÂ ÙÔÓ À∞∆

ÛÂ Û‡ÁÎÚÈÛË ÌÂ ™∞ Â›Ó·È ÂÍ·ÈÚÂÙÈÎ¿ ÈÔ Û‡ÓıÂÙË. ∏

19À„›Û˘¯ÓÔ˜ ·ÂÚÈÛÌfi˜ ÌÂ Ù·Ï·ÓÙÒÛÂÈ˜

¶·È‰È·ÙÚÈÎ‹ 2007;70:18-23

·ÏÏËÏÂ›‰Ú·ÛË ÙˆÓ ·Ú·ÁfiÓÙˆÓ Ô˘ ÂËÚÂ¿˙Ô˘Ó

ÙËÓ ·ÓÙ·ÏÏ·Á‹ ·ÂÚ›ˆÓ ÛÙÔÓ À∞∆ ¤¯ÂÈ ÌÂÏÂÙËıÂ› ·fi

·ÚÎÂÙÔ‡˜ ÂÚÂ˘ÓËÙ¤˜ (18-21).

·. √Í˘ÁfiÓˆÛË

∏ ÔÍ˘ÁfiÓˆÛË ÛÙÔÓ À∞∆ ÂÍ·ÚÙ¿Ù·È ·fi ÙË Ì¤ÛË

›ÂÛË ·ÂÚ·ÁˆÁÒÓ (Pa-w). √È ÂÚÈÛÛfiÙÂÚÂ˜ ·Ó·ÓÂ˘-

ÛÙÈÎ¤˜ ·ı‹ÛÂÈ˜ ÙˆÓ ÓÂÔÁÓÒÓ Â›Ó·È Î˘Ú›ˆ˜ ÂÚÈÔÚÈ-

ÛÙÈÎÔ‡ Ù‡Ô˘. ∏ ‚·ÛÈÎ‹ ·Ú¯‹ ÙË˜ ÂÈı˘ÌËÙ‹˜ ÔÍ˘Áfi-

ÓˆÛË˜ ÛÙÔÓ À∞∆ Â›Ó·È Ë Â›ÙÂ˘ÍË Î·È ‰È·Ù‹ÚËÛË ÙË˜

‚¤ÏÙÈÛÙË˜ ¤ÎÙ˘ÍË˜ ÙˆÓ ÓÂ˘ÌfiÓˆÓ (optimal lung

inflation) ÌÂ ÙËÓ ÂÈÛÙÚ¿ÙÂ˘ÛË ÂÚÈÛÛfiÙÂÚˆÓ Î˘„Â-

Ï›‰ˆÓ, ¯ˆÚ›˜ ˘ÂÚ‰È¿Ù·ÛË ÙˆÓ ÓÂ˘ÌfiÓˆÓ (22). √È

˙ÒÓÂ˜ ÙË˜ ¤ÎÙ˘ÍË˜ ÙˆÓ ÓÂ˘ÌfiÓˆÓ ÛÙÔÓ À∞∆ ·ÂÈ-

ÎÔÓ›˙ÔÓÙ·È ÛÙËÓ ∂ÈÎfiÓ· 1. ™ÙË ˙ÒÓË ∞, Ô ÓÂ‡ÌÔÓ·˜

˘Ô-ÂÎÙ‡ÛÛÂÙ·È, ÂÓÒ Ë ·‡ÍËÛË ÙÔ˘ Â‡ÚÔ˘˜ Ù·Ï·-

ÓÙÒÛÂˆÓ ÂÈÊ¤ÚÂÈ ÌfiÓÔ ÌÈÎÚ¤˜ ·ÏÏ·Á¤˜ ÛÙÔÓ fiÁÎÔ

ÙÔ˘. ∫ÏÈÓÈÎ¿, ÂÎÊÚ¿˙ÂÙ·È ÌÂ ˘„ËÏ¤˜ ··ÈÙ‹ÛÂÈ˜ ÛÂ

ÔÍ˘ÁfiÓÔ Î·È ÂÚÈÔÚÈÛÌ¤ÓÂ˜ ‰ÔÓ‹ÛÂÈ˜ ÙÔ˘ ıˆÚ·ÎÈÎÔ‡

ÙÔÈ¯ÒÌ·ÙÔ˜. ∏ ˙ÒÓË µ ·ÔÙÂÏÂ› ÙËÓ ÂÚÈÔ¯‹ ÙË˜ ‚¤Ï-

ÙÈÛÙË˜ ¤ÎÙ˘ÍË˜. ∂ÊfiÛÔÓ Ô ÓÂ‡ÌÔÓ·˜ ¤¯ÂÈ ÂÎÙ˘-

¯ıÂ› ÌÂ ˘„ËÏ‹ Pa-w, Ë ÓÂ˘ÌÔÓÈÎ‹ ·ÁÁÂÈ·Î‹ ·ÓÙ›ÛÙ·-

ÛË ÌÂÈÒÓÂÙ·È Î·È ÙfiÙÂ, ÌÈÎÚfiÙÂÚ· Â‡ÚË Ù·Ï¿ÓÙˆÛË˜

Ô‰ËÁÔ‡Ó ÛÂ ÌÂÁ·Ï‡ÙÂÚÂ˜ ·ÏÏ·Á¤˜ ÛÙÔÓ fiÁÎÔ. ∫ÏÈÓÈÎ¿,

ÂÎÊÚ¿˙ÂÙ·È ÌÂ ÙÒÛË ÙˆÓ ··ÈÙ‹ÛÂˆÓ ÛÂ ÔÍ˘ÁfiÓÔ

Î·È Î·Ï¤˜ ‰ÔÓ‹ÛÂÈ˜ ÙÔ˘ ıˆÚ·ÎÈÎÔ‡ ÙÔÈ¯ÒÌ·ÙÔ˜. ∏ ̇ Ò-

ÓË ° ·ÓÙ·Ó·ÎÏ¿ ÙËÓ ˘ÂÚ‰È¿Ù·ÛË ÙÔ˘ ÓÂ‡ÌÔÓ·. ∫·È

ÛÙË ˙ÒÓË ·˘Ù‹ ÌÔÚÂ› Ó· ··ÈÙËıÂ› ÌÂÁ·Ï‡ÙÂÚÔ Â‡-

ÚÔ˜ Ù·Ï¿ÓÙˆÛË˜ ÁÈ· Ó· ÚÔÎ·Ï¤ÛÂÈ ·ÏÏ·Á¤˜ ÛÙÔÓ

fiÁÎÔ, ÂÓÒ Ô ˘ÂÚ‰È·ÙÂÙ·Ì¤ÓÔ˜ ÓÂ‡ÌÔÓ·˜ ÌÔÚÂ› Ó·

ÂËÚÂ¿ÛÂÈ ÙËÓ Î·Ú‰È·Î‹ ·ÚÔ¯‹, ÏfiÁˆ ÌÂ›ˆÛË˜ ÙË˜

ÊÏÂ‚ÈÎ‹˜ Â·Ó·ÊÔÚ¿˜. ∞˘Ùfi ·ÔÙÂÏÂ› Î·È ÙÔ ÈÔ ÂÈ-

Î›Ó‰˘ÓÔ ÛËÌÂ›Ô ÛÙË ̄ Ú‹ÛË ÙÔ˘. ∂›Ó·È ‰‡ÛÎÔÏÔ Ó· ·Ó·-

ÁÓˆÚÈÛıÂ› ÎÏÈÓÈÎ¿, ÁÈ·Ù› ÔÈ ··ÈÙ‹ÛÂÈ˜ ÛÂ ÔÍ˘ÁfiÓÔ ‰È·-

ÙËÚÔ‡ÓÙ·È ·Ú¯ÈÎ¿ ¯·ÌËÏ¤˜ Î·È Ë ÌÂ›ˆÛË ÙˆÓ ‰ÔÓ‹ÛÂ-

ˆÓ ÌÔÚÂ› Ó· ÌËÓ ·ÍÈÔÏÔÁËıÂ›. ∏ ·ÎÙÈÓÔÁÚ·Ê›· ıÒ-

Ú·ÎÔ˜ ·Ú·Ì¤ÓÂÈ ÙÔ ·ÛÊ·Ï¤ÛÙÂÚÔ Ì¤ÛÔÓ ÂÎÙ›ÌËÛË˜

ÙË˜ ¤ÎÙ˘ÍË˜. ∏ ˙ÒÓË ¢, Ù¤ÏÔ˜, ·ÓÙÈÎ·ÙÔÙÚ›˙ÂÈ ÙÔÓ

‚¤ÏÙÈÛÙÔ fiÁÎÔ ÁÈ· ÙËÓ ·Ô‰¤ÛÌÂ˘ÛË ·fi ÙÔÓ ·Ó·-

ÓÂ˘ÛÙ‹Ú·. ™Ùfi¯Ô˜ Â›Ó·È Ë ÌÂÙ¿ÙˆÛË ÙˆÓ ÓÂ˘Ìfi-

ÓˆÓ ·fi ÙÔ ÛËÌÂ›Ô µ ÛÙÔ ÛËÌÂ›Ô ¢, ·ÔÊÂ‡ÁÔÓÙ·˜ ÙË

˙ÒÓË °. ∂ÊfiÛÔÓ ÂÈÙÂ˘¯ıÂ› Ë ‰È·Ù‹ÚËÛË ÙË˜ ‚¤ÏÙÈ-

ÛÙË˜ ¤ÎÙ˘ÍË˜ ÙˆÓ ÓÂ˘ÌfiÓˆÓ Î·È ÙÔ˘ ·ÂÚÈÛÌÔ‡ ÌÂ

ÛÙ·‰È·Î¤˜ ÌÂÈÒÛÂÈ˜ ÙË˜ Pa-w ÌÔÚÔ‡ÌÂ Ó· ˘ÔÛÙËÚ›-

ÍÔ˘ÌÂ ÙÔ ÓÂÔÁÓfi ÌÂ ¯·ÌËÏ‹ Pa-w. ∂¿Ó fiÌˆ˜ Ë Pa-w ÌÂÈ-

ˆıÂ› ¿Ú· ÔÏ‡, ˘¿Ú¯ÂÈ Î›Ó‰˘ÓÔ˜ Ó· ·˘ÍËıÔ‡Ó Î·È

¿ÏÈ ÔÈ ··ÈÙ‹ÛÂÈ˜ ÛÂ ÔÍ˘ÁfiÓÔ (∂ÈÎfiÓ· 1).

‚. ∞ÂÚÈÛÌfi˜

∏ Ô˘ÛÈ·ÛÙÈÎ‹ ‰È·ÊÔÚ¿ ÛÙËÓ ·Ô‚ÔÏ‹ ‰ÈÔÍÂÈ‰›Ô˘

ÙÔ˘ ¿ÓıÚ·Î· ÌÂÙ·Í‡ ™∞ Î·È À∞∆, Â›Ó·È fiÙÈ Ô ™∞

·Ô‰›‰ÂÈ ·Ó·ÓÂˆÌ¤ÓÔ ·¤Ú· ÛÙÈ˜ Î˘„ÂÏ›‰Â˜ ÌfiÓÔ ÌÂ

ÙÔ Ê·ÈÓfiÌÂÓÔ ÙË˜ ÔÁÎÒ‰Ô˘˜ ÚÔ‹˜ (bulk flow), ÂÓÒ Ô

À∞∆ ÚÔÎ·ÏÂ› ÙfiÛÔ ÔÁÎÒ‰Ë ÚÔ‹, fiÛÔ Î·È Ì›ÍË. ∞˘-Ù‹ Ë ‰˘Ó·ÙfiÙËÙ· ·Ó¿ÌÈÍË˜ ÙÔ˘ ·¤Ú· ÌÂÙ·Í‡ ÙˆÓ·ÓÒÙÂÚˆÓ ·ÂÚ·ÁˆÁÒÓ Î·È ÙˆÓ Î˘„ÂÏ›‰ˆÓ Î¿ÓÂÈ ÙÔÓÀ∞∆ ÂÚÈÛÛfiÙÂÚÔ ·ÔÙÂÏÂÛÌ·ÙÈÎfi.

™ÙÔÓ ™∞ o ·ÂÚÈÛÌfi˜, ‰ËÏ·‰‹ Ë ·ÔÌ¿ÎÚ˘ÓÛË ÙÔ˘‰ÈÔÍÂÈ‰›Ô˘ ÙÔ˘ ¿ÓıÚ·Î·, Â›Ó·È ·Ó¿ÏÔÁÔ˜ ÙË˜ Û˘¯Ófi-ÙËÙ·˜ Â› ÙÔÓ ·Ó·ÓÂfiÌÂÓÔ fiÁÎÔ (VECO2 = f x Vt ).∞ÓÙÈı¤Ùˆ˜ ÛÙÔÓ À∞∆ Ë ·ÔÌ¿ÎÚ˘ÓÛË ÙÔ˘ ‰ÈÔÍÂÈ‰›Ô˘ÙÔ˘ ¿ÓıÚ·Î· ÚÔÛ‰ÈÔÚ›˙ÂÙ·È ·fi ÙËÓ ÂÍ›ÛˆÛË VECO2

= fa x Vtb ‹ fa x amplitudeb), fiÔ˘ a Î˘Ì·›ÓÂÙ·È ·fi

0,75 ¤ˆ˜ 1,24 Î·È b ·fi 1,5 ¤ˆ˜ 2,2. ª›· ·fi ÙÈ˜ ÂÈ-ÙÒÛÂÈ˜ ·˘Ù‹˜ ÙË˜ Û¯¤ÛË˜ Â›Ó·È fiÙÈ ÛÙÔÓ À∞∆, ÌÈÎÚ¤˜·ÏÏ·Á¤˜ ÛÙÔÓ ·Ó·ÓÂfiÌÂÓÔ fiÁÎÔ ¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚËÂ›‰Ú·ÛË ÛÙÔÓ ·ÂÚÈÛÌfi ·’ fi,ÙÈ ÔÈ ÌÈÎÚ¤˜ ·ÏÏ·Á¤˜ÛÙË Û˘¯ÓfiÙËÙ· (17,22). À„ËÏfiÙÂÚ· Â‡ÚË Ù·Ï¿ÓÙˆÛË˜·˘Í¿ÓÔ˘Ó ÙÔÓ ·Ó·ÓÂfiÌÂÓÔ fiÁÎÔ Î·È, ˆ˜ Â·ÎfiÏÔ˘-ıÔ, ÙËÓ ·ÔÌ¿ÎÚ˘ÓÛË ÙÔ˘ CO2. ∞ÓÙÈı¤Ùˆ˜ Ë ·‡ÍËÛËÙË˜ Û˘¯ÓfiÙËÙ·˜ Ô‰ËÁÂ› ÛÙÔ ·Ú¿‰ÔÍÔ Ê·ÈÓfiÌÂÓÔ ÙË˜ÌÂ›ˆÛË˜ ÙË˜ ·Ô‚ÔÏ‹˜ ÙÔ˘ CO2 (23) Î·È ÛÂ ÛËÌ·ÓÙÈ-Î‹ ÌÂ›ˆÛË ÙÔ˘ Vt. ∆Ô ·Ú·¿Óˆ ÈÛ¯‡ÂÈ ÛÙÔÓSensorMedics, ·Ó Ë ¢ƒ ·Ú·Ì¤ÓÂÈ ÛÙ·ıÂÚ‹. À¿Ú-¯Ô˘Ó HFOV Ô˘ ‰È·ÙËÚÔ‡Ó ÛÙ·ıÂÚfi Vt ·ÓÂÍ¿ÚÙËÙ··fi ÙË Û˘¯ÓfiÙËÙ· (Hummingbird). ∞˘Ù‹ Ë Û‡ÓıÂÙËÛ¯¤ÛË ÌÂÙ·Í‡ Û˘¯ÓfiÙËÙ·˜ Î·È CO2 ÂÍËÁÂ› ÁÈ·Ù› Ë Û˘-¯ÓfiÙËÙ· ‰ÂÓ Â›Ó·È Ë ÚˆÙ·Ú¯ÈÎ‹ ·Ú¿ÌÂÙÚÔ˜ fiÙ·Óı¤ÏÔ˘ÌÂ Ó· ‚ÂÏÙÈÒÛÔ˘ÌÂ ÙÔÓ ·ÂÚÈÛÌfi ÛÙÔÓ À∞∆ (24).

ªË¯·ÓÈÛÌÔ› ÌÂÙ·ÊÔÚ¿˜ Î·È ·ÓÙ·ÏÏ·Á‹˜

·ÂÚ›ˆÓ

√È ÌË¯·ÓÈÛÌÔ› ÌÂ ÙÔ˘˜ ÔÔ›Ô˘˜ Ô À∞∆ ‚ÂÏÙÈÒ-ÓÂÈ ÙËÓ ·Ó¿ÌÈÍË ÙÔ˘ ·¤Ú· ÌÂÙ·Í‡ ÙˆÓ ·ÓÒÙÂÚˆÓ·ÂÚ·ÁˆÁÒÓ Î·È ÙˆÓ Î˘„ÂÏ›‰ˆÓ Â›Ó·È ÂÍ·ÈÚÂÙÈÎ¿Û‡ÓıÂÙÔÈ. §ÂÙÔÌÂÚ‹˜ ·Ó¿Ï˘ÛË ÙˆÓ ÌË¯·ÓÈÛÌÒÓ·˘ÙÒÓ ÂÚÈÁÚ¿ÊÂÙ·È ÛÙËÓ ÎÏ·ÛÈÎ‹ ÂÚÁ·Û›· ÙÔ˘Chang (22) Î·È ÈÔ ÚfiÛÊ·Ù· ÙË˜ Pillow (25).

§ÀÃ

√°

∫√

™ (

ml)

¶π∂™∏ (cmH2O)

¢

∞

µ

°

∂ÈÎfiÓ· 1. ∑ÒÓÂ˜ ÙË˜ ¤ÎÙ˘ÍË˜ ÙˆÓ ÓÂ˘ÌfiÓˆÓ ÛÙÔÓ À∞∆: ∑ÒÓË∞: ˘Ô¤ÎÙ˘ÍË. ∑ÒÓË B: ‚¤ÏÙÈÛÙË ¤ÎÙ˘ÍË. ∑ÒÓË °: ˘ÂÚ‰È¿Ù·-ÛË. ∑ÒÓË ¢: ‚¤ÏÙÈÛÙË ¤ÎÙ˘ÍË Î·Ù¿ ÙÔÓ ·ÔÁ·Ï·ÎÙÈÛÌfi. §ÀÃ:§ÂÈÙÔ˘ÚÁÈÎ‹ ˘ÔÏÂÈfiÌÂÓË ¯ˆÚËÙÈÎfiÙËÙ·, À∞∆: À„›Û˘¯ÓÔ˜ ·ÂÚÈ-ÛÌfi˜ ÌÂ Ù·Ï·ÓÙÒÛÂÈ˜.

20 ¶. ∫·Ú·ÁÈ¿ÓÓË, ¡. ¡ÈÎÔÏ·˝‰Ë˜


·. ªÂÙ·ÊÔÚ¿ (Convection)

ªÂÙ¿ ·fi Ï›ÁÔ˘˜ ·Ó·ÓÂ˘ÛÙÈÎÔ‡˜ Î‡ÎÏÔ˘˜ Ù·-

Ï¿ÓÙˆÛË˜, Ù· ÌfiÚÈ· ·¤Ú· Ô˘ ·Ú¯ÈÎ¿ ‹Ù·Ó ÛÙÔ Î¤-

ÓÙÚÔ ÙÔ˘ ·ÂÚ·ÁˆÁÔ‡ ÂÎÙÔÍÂ‡ÔÓÙ·È ÚÔ˜ Ù· ÚfiÛˆ,

ÛÙÔ Ì¤ÛÔÓ ÙˆÓ ‰‡Ô ÂÚÈÊÂÚÈÎÒÓ ·ÂÚ·ÁˆÁÒÓ Î·È Ù·

ÌfiÚÈ·, Ô˘ ‹Ù·Ó ·Ú¯ÈÎ¿ ÛÙËÓ ÂÚÈÊ¤ÚÂÈ· ÎÔÓÙ¿ ÛÙÈ˜

ÏÂ˘Ú¤˜ ÙÔ˘ Î‡ÚÈÔ˘ ·ÂÚ·ÁˆÁÔ‡, ÌÂÙ·ÎÈÓÔ‡ÓÙ·È

ÚÔ˜ Ù· ›Ûˆ ‹ ·Â˘ıÂ›·˜ ÛÙËÓ ÙÚ·¯Â›·. Œ¯ÂÈ ˘Ô-

ÏÔÁÈÛÙÂ› fiÙÈ ÛÂ Î¿ıÂ Î‡ÎÏÔ Û˘Ì‚·›ÓÂÈ ·ÓÙ·ÏÏ·Á‹ ·Â-

Ú›ˆÓ ÌÂ ÌÂÙ·ÊÔÚ¿ Î·Ù¿ 5% (26).

‚. ∂·˘Í·ÓfiÌÂÓË ‰È¿¯˘ÛË (Augmented

diffusion)

™ÙÔ˘˜ ·ÂÚ·ÁˆÁÔ‡˜ ‹ ÛÙ· ÛËÌÂ›· ÙÔ˘ ‰È¯·ÛÌÔ‡,

Û˘Ì‚·›ÓÂÈ ‰Â˘ÙÂÚÔ·ı‹˜ ·Ó¿ÌÈÍË ÙÔ˘ ·¤Ú·, Ë ÔÔ›·

·Ê’ ÂÓfi˜ ÌÂÓ Ô‰ËÁÂ› ÛÂ ÏÂ˘ÚÈÎ‹ ·Ó¿ÌÈÍË ÙˆÓ ·Â-

Ú›ˆÓ ·ÏÏ¿, ·Ê’ ÂÙ¤ÚÔ˘ ÂÌÔ‰›˙ÂÈ ÙËÓ Î·Ù¿ Ì‹ÎÔ˜

ÌÂÙ·ÊÔÚ¿ ÙÔ˘˜. ∏ ·ÏÌÈÎ‹ Î›ÓËÛË ÙˆÓ ÙÔÈ¯ˆÌ¿ÙˆÓ

ÙˆÓ ‚ÚfiÁ¯ˆÓ ÌÔÚÂ› Ó· ·Ó·ÛÙÚ¤„ÂÈ ÙË ÚÔ‹ ÙÔ˘ ·¤-

Ú·, ·˘Í¿ÓÔÓÙ·˜ ¤ÙÛÈ ÙË ‰È·ÊÔÚ¿ ÛÙË Û˘ÁÎ¤ÓÙÚˆÛË

ÌÂÙ·Í‡ ÙˆÓ ‰‡Ô ·ÂÚ›ˆÓ. ∞˘Ùfi ÚÔÎ·ÏÂ› ÌÂÁ·Ï‡ÙÂÚË

Î·Ù¿ Ì‹ÎÔ˜ ÌÂÙ·Î›ÓËÛË ÙÔ˘ ·¤Ú·.

Á. ƒÔ‹ ÌÂÁ¿ÏÔ˘ fiÁÎÔ˘ (Bulk flow)

∂›Ó·È ÁÂÓÈÎ¿ ·Ô‰ÂÎÙfi fiÙÈ Ô À∞∆ ÏÂÈÙÔ˘ÚÁÂ› ÌÂ

·Ó·ÓÂfiÌÂÓÔ˘˜ fiÁÎÔ˘˜ ·¤Ú· Ô˘ Â›Ó·È ÂÚ›Ô˘

ÈÛÔ‰‡Ó·ÌÔÈ ÌÂ ÙÔÓ fiÁÎÔ ÙÔ˘ ·Ó·ÙÔÌÈÎ¿ ÓÂÎÚÔ‡ ¯Ò-

ÚÔ˘. øÛÙfiÛÔ ÛÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ·, ÌÂÚÈÎ¤˜ Î˘„Â-

Ï›‰Â˜ ‚Ú›ÛÎÔÓÙ·È ÈÔ ÎÔÓÙ¿, ·’ fiÙÈ Î¿ÔÈÂ˜ ¿ÏÏÂ˜,

ÛÙ· ·ÓÒÙÂÚ· ÙÌ‹Ì·Ù· ÙÔ˘ ·ÂÚ·ÁˆÁÔ‡. ŒÙÛÈ, Ô ·ÂÚÈ-

ÛÌfi˜ ÌÂ ·Ó·ÓÂfiÌÂÓÔ˘˜ fiÁÎÔ˘˜ ·¤Ú· Ô˘ ÚÔÛÂÁ-

Á›˙Ô˘Ó ÙÔÓ fiÁÎÔ ÙÔ˘ ÓÂÎÚÔ‡ ¯ÒÚÔ˘, ‰›ÓÂÈ ÛÙËÓ

Ú·ÁÌ·ÙÈÎfiÙËÙ· ÊÚ¤ÛÎÔ ·¤Ú· ÛÂ Î¿ÔÈÂ˜ “ÏËÛÈ¤-

ÛÙÂÚÂ˜” Î˘„ÂÏ›‰Â˜.

‰. º·ÈÓfiÌÂÓÔ Pendelluft

O ÁÂÚÌ·ÓÈÎfi˜ fiÚÔ˜ Pendelluft ‹ Î·Ù¿ ÚÔÛ¤ÁÁÈ-

ÛË “·ÈˆÚÔ‡ÌÂÓÔ˜ ·¤Ú·˜”, ‰ËÏÒÓÂÈ ¤Ó·Ó ÛËÌ·ÓÙÈÎfi

ÌË¯·ÓÈÛÌfi ·ÓÙ·ÏÏ·Á‹˜ ·ÂÚ›ˆÓ ÛÙÔÓ À∞∆. ¶ÚfiÎÂÈ-

Ù·È ÁÈ· ÌÂÙ·Î›ÓËÛË ÙÔ˘ ·¤Ú· ÌÂÙ·Í‡ “·Ú·ÎÂ›ÌÂ-

ÓˆÓ” ÌÔÓ¿‰ˆÓ ÙÔ˘ ÓÂ‡ÌÔÓ· Î·È fi¯È ÌÂÙ·Í‡ ÙˆÓ

·ÓÒÙÂÚˆÓ ·ÂÚ·ÁˆÁÒÓ Î·È ÙˆÓ Î˘„ÂÏ›‰ˆÓ.

∂ÂÈ‰‹ Ë ÛÙ·ıÂÚ¿ ¯ÚfiÓÔ˘ (Tc, time constant)

ÈÛÔ‡Ù·È ÌÂ ÙÔ ÁÈÓfiÌÂÓÔ ÙË˜ ·ÓÙ›ÛÙ·ÛË˜ (Resistance)

Â› ÙËÓ Â˘ÂÓ‰ÔÙfiÙËÙ· (Compliance), (∆c=RxC)

˘¿Ú¯Ô˘Ó ÌÈÎÚ¤˜ ‰È·ÊÔÚ¤˜ ÛÙÈ˜ ÙÈÌ¤˜ ÛÂ ‰È·ÊÔÚÂÙÈ-

Î¤˜ Î˘„ÂÏ›‰Â˜. ∫·ıÒ˜ ÔÈ ·Ó·ÓÂ˘ÛÙÈÎ¤˜ Û˘¯ÓfiÙË-

ÙÂ˜ ·˘Í¿ÓÔ˘Ó Î·È ÔÈ ¯ÚfiÓÔÈ ÂÈÛÓÔ‹˜ Î·È ÂÎÓÔ‹˜

Á›ÓÔÓÙ·È ÌÈÎÚÔ› ÛÂ Û¯¤ÛË ÌÂ ÙËÓ ∆c, ‰ÂÓ ˘¿Ú¯ÂÈ

Ï¤ÔÓ Â·ÚÎ‹˜ ¯ÚfiÓÔ˜ ÁÈ· ÙÈ˜ Î˘„ÂÏÈ‰ÈÎ¤˜ È¤ÛÂÈ˜

Ó· ÂÍÈÛÔÚÚÔËıÔ‡Ó ÌÂ ÙÈ˜ È¤ÛÂÈ˜ ÙˆÓ ·ÓÒÙÂÚˆÓ

·ÂÚ·ÁˆÁÒÓ. ∂¿Ó ÔÈ Û˘¯ÓfiÙËÙÂ˜ ·˘ÍËıÔ‡Ó ·ÎfiÌË Â-

ÚÈÛÛfiÙÂÚÔ Î·È ·ÓÙ›ÛÙÔÈ¯· ÌÂÈˆıÔ‡Ó ÔÈ ¯ÚfiÓÔÈ ÂÎ-

ÓÔ‹˜ Î·È ÂÈÛÓÔ‹˜, ÙfiÙÂ ÌÔÚÂ› Ó· ˘¿ÚÍÔ˘Ó ÛÙÈÁ-

Ì¤˜ ÙÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡ Î‡ÎÏÔ˘ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ·

ÙˆÓ ÔÔ›ˆÓ ˘¿Ú¯ÂÈ ÌÈ· ÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿ ÛÙËÓ

›ÂÛË (gradient) ÌÂÙ·Í‡ ÙˆÓ ·Ú·ÎÂ›ÌÂÓˆÓ Î˘„ÂÏ›-

‰ˆÓ. ™ÙÈ˜ ¯ÚÔÓÈÎ¤˜ ·˘Ù¤˜ ÛÙÈÁÌ¤˜, Ô ·¤Ú·˜ ı· Ú¤ÂÈ

Ì¿ÏÏÔÓ ·fi ÙË Ì›· Î˘„ÂÏ›‰· ÛÙËÓ ¿ÏÏË, ·Ú¿ ·fi

ÙÔÓ ·ÂÚ·ÁˆÁfi ÚÔ˜ ÙÈ˜ Î˘„ÂÏ›‰Â˜. ¶Ú·ÁÌ·ÙÈÎ¿, Ë

Â·ÚÎ‹˜ Û˘ÓÙfiÌÂ˘ÛË ÙˆÓ ¯ÚfiÓˆÓ ÂÈÛÓÔ‹˜ Î·È ÂÎ-

ÓÔ‹˜ ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÔÈ ÁÂÈÙÔÓÈÎ¤˜ Î˘„ÂÏ›‰Â˜

Ó· Ô‰ËÁÔ‡ÓÙ·È ÂÎÙfi˜ Ê¿ÛË˜, ÛÂ Û¯¤ÛË ÌÂ ÙÈ˜ ¿ÏÏÂ˜.

ŸÙ·Ó ·˘Ùfi Û˘Ì‚·›ÓÂÈ, Ë ‰È·ÓÔÌ‹ Û¯ÂÙÈÎ¿ ÌÈÎÚÒÓ

fiÁÎˆÓ ÚÔ˜ ÙÔ˘˜ ·ÓÒÙÂÚÔ˘˜ ·ÂÚ·ÁˆÁÔ‡˜ Ô‰ËÁÂ› ÛÂ

“Ì›ÍË ·¤Ú·” ·Ó¿ÌÂÛ· ÛÙÈ˜ Î˘„ÂÏ›‰Â˜ ·˘Ù¤˜. ∞˘Ùfi˜

Â›Ó·È Ô ÌË¯·ÓÈÛÌfi˜ ÙÔ˘ “·ÈˆÚÔ‡ÌÂÓÔ˘ ·¤Ú·” Ô˘

ÌÂÙ·ÎÈÓÂ›Ù·È ÌÂÙ·Í‡ ÙˆÓ ·Ú·ÎÂ›ÌÂÓˆÓ Î˘„ÂÏ›‰ˆÓ

Î·È ÌÔÚÂ› Ó· Â·˘Í¿ÓÂÈ ÙËÓ ·Ó¿ÌÈÍ‹ ÙÔ˘ ÛÙÔ˘˜ ·Â-

Ú·ÁˆÁÔ‡˜ (25,27).

Â. ∞Û‡ÌÌÂÙÚÂ˜ Î·Ù·ÙÔÌ¤˜ Ù·¯˘Ù‹ÙˆÓ

(Asymmetric velocity profiles)

ŸÙ·Ó ÛÙÔÓ Î˘ÎÏÔÊÔÚÔ‡ÓÙ· ·¤Ú· Î¿ÔÈÔ˘ ·Áˆ-

ÁÔ‡ ÂÊ·ÚÌfi˙ÂÙ·È ·fiÙÔÌË ›ÂÛË, Ô ·¤Ú·˜ ‰ÂÓ ÂÈ-

Ù·¯‡ÓÂÈ ÔÌÔÈfiÌÔÚÊ·. √ ·¤Ú·˜ Ô˘ ‚Ú›ÛÎÂÙ·È ÛÙÔ

Î¤ÓÙÚÔ ÙÔ˘ ·ÁˆÁÔ‡ ÎÈÓÂ›Ù·È ÌÂ Ù·¯‡ÙËÙ· ÌÂÁ·Ï‡ÙÂ-

ÚË ·fi ÂÎÂ›ÓË ÙÔ˘ ·¤Ú· ÛÙËÓ ÂÚÈÊ¤ÚÂÈ· ÙÔ˘ ÛˆÏ‹-

Ó·. ∏ ‰È·ÊÔÚ¿ ÌÂÙ·Í‡ ÙÔ˘ ·Ó‡ÛÌ·ÙÔ˜ Ù·¯‡ÙËÙ·˜

ÙÔ˘ ·¤Ú· ÛÙÔ Î¤ÓÙÚÔ ÙÔ˘ ·ÁˆÁÔ‡ Î·È ÙË˜ Ù·¯‡ÙËÙ·˜

ÛÙËÓ ÂÚÈÊ¤ÚÂÈ· ‹ Ë ·Û˘ÌÌÂÙÚ›· ÛÙËÓ Î·Ù·ÓÔÌ‹

ÙˆÓ Ù·¯˘Ù‹ÙˆÓ, ÂÍ·ÚÙ¿Ù·È ·fi ÔÏÏ·ÏÔ‡˜ ·Ú¿-

ÁÔÓÙÂ˜, ÛÙÔ˘˜ ÔÔ›Ô˘˜ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È Ë ‰È¿ÌÂ-

ÙÚÔ˜ ÙÔ˘ ·ÁˆÁÔ‡ Î·È Ë ÂÊ·ÚÌÔ˙fiÌÂÓË ›ÂÛË. ŸÙ·Ó

ÂÊ·ÚÌfi˙ÂÙ·È Í·ÊÓÈÎ¿ ÛÙÔÓ ·¤Ú· ˘„ËÏ‹ ›ÂÛË ÛÙÔÓ

·ÓÒÙÂÚÔ ·ÂÚ·ÁˆÁfi, Ô ·¤Ú·˜ ÛÙÔ Î¤ÓÙÚÔ ÙÔ˘ Ù·ÍÈ-

‰Â‡ÂÈ ÌÂ ÌÂÁ·Ï‡ÙÂÚË Ù·¯‡ÙËÙ· Î·È ÂÔÌ¤Óˆ˜ ‚·ı‡-

ÙÂÚ· Ì¤Û· ÛÙÔÓ ÓÂ‡ÌÔÓ·, ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙËÓ ÂÚ›-

ÙˆÛË Ô˘ Ë ÂÊ·ÚÌÔÁ‹ ÙË˜ ›ÂÛË˜ Á›ÓÂÙ·È ·ÚÁ¿

(fiˆ˜ ÛÙÔÓ ™∞) (28).

∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÂÎÓÔ‹˜, Ô ·¤Ú·˜ ÂÈÙ·¯‡-

ÓÂÈ ÚÔ˜ ÙÔ ÂÍˆÙÂÚÈÎfi ÙˆÓ Î˘„ÂÏ›‰ˆÓ Î·È Ë ÔÚÂ›·

ÙÔ˘ ·ÓÙÈÛÙÚ¤ÊÂÙ·È. ∂ÂÈ‰‹, Ë ‰È¿ÌÂÙÚÔ˜ ÙÔ˘ ·ÂÚ·-

ÁˆÁÔ‡ Â›Ó·È ÌÈÎÚfiÙÂÚË ÛÙË ‰È¿ÚÎÂÈ· ÙË˜ ÂÎÓÔ‹˜

·fi ÂÎÂ›ÓË ÙË˜ ÂÈÛÓÔ‹˜, Ô ‚·ıÌfi˜ ·Û˘ÌÌÂÙÚ›·˜

ÙˆÓ Î·Ù·ÙÔÌÒÓ Ù·¯‡ÙËÙ·˜ Â›Ó·È ÌÈÎÚfiÙÂÚÔ˜ ÛÙËÓ

ÂÎÓÔ‹. ŒÙÛÈ ÂÍËÁÂ›Ù·È ÁÈ·Ù› Ù· ‰È·Ó‡ÛÌ·Ù· Ù‹˜

ÚÔ˜ Ù· ÂÌÚfi˜ (ÂÈÛÓÂ˘ÛÙÈÎ‹˜) Î·È ÙË˜ ·Ó¿ÛÙÚÔ-

ÊË˜ (ÂÎÓÂ˘ÛÙÈÎ‹˜) Ù·¯‡ÙËÙ·˜ ÂÓfi˜ Ï‹ÚÔ˘˜ Î‡-

ÎÏÔ˘ À∞∆ ‰ÂÓ ·ÏÏËÏÔ·Ó·ÈÚÔ‡ÓÙ·È, ÂÈÛÙÚ¤ÊÔÓÙ·˜

fiÏÔ ÙÔÓ ·¤Ú· ÛÙËÓ ·Ú¯ÈÎ‹ ÙÔ˘ ı¤ÛË.

ÛÙ. ¢È·ÛÔÚ¿ Ù‡Ô˘ Taylor

(Taylor-type dispersion)

ª›· ·fi ÙÈ˜ Û˘Ó¤ÂÈÂ˜ ÙˆÓ ·Û‡ÌÌÂÙÚˆÓ Î·Ù·ÓÔ-

ÌÒÓ Ù·¯‡ÙËÙ·˜ Â›Ó·È fiÙÈ o ·Ó·ÓÂˆÌ¤ÓÔ˜ ·¤Ú·˜ ÛÙÔ


¶·È‰È·ÙÚÈÎ‹ 2007;70:18-23

Î¤ÓÙÚÔ ÙˆÓ ·ÂÚ·ÁˆÁÒÓ ÂÚÈ‚¿ÏÏÂÙ·È ·fi ·¤Ú· ÙÔ˘

ÚÔËÁÔ‡ÌÂÓÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡ Î‡ÎÏÔ˘, ÛÙËÓ ÂÚÈ-

Ê¤ÚÂÈ·. À¿Ú¯ÂÈ ‰ËÏ·‰‹ ‰È·ÊÔÚ¿ Û˘ÁÎ¤ÓÙÚˆÛË˜,

·fi ÙÔ Î¤ÓÙÚÔ ÚÔ˜ ÙËÓ ÂÚÈÊ¤ÚÂÈ· ÙfiÛÔ ÁÈ· ÙÔ √2

fiÛÔ Î·È ÁÈ· ÙÔ CO2. ∂ÂÈ‰‹ Ë ·Ó¿ÌÈÍË Û˘Ì‚·›ÓÂÈ ÛÂ

Î¿ıÂ ÂÚ›ÙˆÛË fiÔ˘ ˘¿Ú¯ÂÈ Ë ‰È·ÊÔÚ¿ ÛÙË Û˘-

ÁÎ¤ÓÙÚˆÛË √2 Î·È CO2, ·˘Ùfi Ô‰ËÁÂ› ÛÂ ·ÎÙÈÓˆÙ‹

‰È¿¯˘ÛË ·fi ÙÔÓ ·ÂÚ·ÁˆÁfi ÚÔ˜ ÙÔ Î¤ÓÙÚÔ Î·È ·fi

ÙÔ Î¤ÓÙÚÔ ÚÔ˜ ÙËÓ ÂÚÈÊ¤ÚÂÈ·. ∞˘Ù‹ Ë ‰È¿¯˘ÛË,

Ô˘ ÚÔÎ·ÏÂ›Ù·È ·fi ÙÔÓ Û˘Ó‰˘·ÛÌfi ÙˆÓ ·ÍÔÓÈÎÒÓ

·Û‡ÌÌÂÙÚˆÓ ·Ó˘ÛÌ¿ÙˆÓ Ù·¯‡ÙËÙ·˜ Î·È ÙË˜ ·ÎÙÈÓˆ-

Ù‹˜ ÎÏ›ÛË˜ Û˘ÁÎ¤ÓÙÚˆÛË˜, ÔÓÔÌ¿˙ÂÙ·È ‰È·ÛÔÚ¿

Ù‡Ô˘ Taylor.

˙. ÕÏÏÔÈ ÌË¯·ÓÈÛÌÔ› ·ÓÙ·ÏÏ·Á‹˜ ·ÂÚ›ˆÓ

Ÿˆ˜ ÛÙÔÓ ™∞, ¤ÙÛÈ Î·È ÛÙÔÓ À∞∆, Ë ÌÔÚÈ·Î‹

‰È¿¯˘ÛË (molecular diffusion) Û˘ÌÌÂÙ¤¯ÂÈ ÛÙËÓ ·Ó¿-

ÌÈÍË ÙˆÓ ·ÂÚ›ˆÓ, ·ÎÚÈ‚Ò˜ ‰›Ï· ·fi ÙËÓ Î˘„ÂÏÈ‰È-

Î‹ ÂÈÊ¿ÓÂÈ·. ∂›ÛË˜, ¤Ó· ÌÈÎÚfi ÙÌ‹Ì· ÙˆÓ ÏËÛÈ¤-

ÛÙÂÚˆÓ ÛÙÔ˘˜ ·ÂÚ·ÁˆÁÔ‡˜ Î˘„ÂÏ›‰ˆÓ ·ÂÚ›˙ÂÙ·È

·Â˘ıÂ›·˜ (direct alveolar ventilation). ŒÙÛÈ, Ë

·ÓÙ·ÏÏ·Á‹ ·ÂÚ›ˆÓ Á›ÓÂÙ·È fiˆ˜ Î·È ÛÙÔÓ ™∞.

™ÙÚ·ÙËÁÈÎ¤˜ ·ÂÚÈÛÌÔ‡

∏ ÚÔÙÂÈÓfiÌÂÓË ÛÙÚ·ÙËÁÈÎ‹ ¯Ú‹ÛË˜ ÙÔ˘ À∞∆

ÛÙËÚ›˙ÂÙ·È ÛÙË ‰È·Ù‹ÚËÛË ÙÔ˘ “‚¤ÏÙÈÛÙÔ˘” fiÁÎÔ˘

ÙˆÓ ÓÂ˘ÌfiÓˆÓ ÛÂ ÛÙÂÓ¿ Ï·›ÛÈ·, ·Ó¿ÌÂÛ· ÛÙËÓ

·ÔÊ˘Á‹ ·ÙÂÏÂÎÙ·Û›·˜ Î·È ˘ÂÚ‰È¿Ù·ÛË˜, ÚÔÎÂÈ-

Ì¤ÓÔ˘ Ó· “·Ô‰ÂÛÌÂ˘ÙÂ›” Û‡ÓÙÔÌ· ÙÔ ÓÂÔÁÓfi ·fi

ÙÔÓ ÌË¯·ÓÈÎfi ·ÂÚÈÛÌfi (9,29,30). ÃÚËÛÈÌÔÔÈÒÓÙ·˜

ÙËÓ Ù·ÎÙÈÎ‹ ÙÔ˘ “˘„ËÏÔ‡ fiÁÎÔ˘ ÙˆÓ ÓÂ˘ÌfiÓˆÓ”,

ÂÊ·ÚÌfi˙ÂÙ·È Û˘ÓÂ¯‹˜ ‰È·Ù·ÙÈÎ‹ ›ÂÛË, ˘„ËÏfiÙÂÚË

·fi ÙËÓ ›ÂÛË ‰È¿ÓÔÈÍË˜ ÙˆÓ Î˘„ÂÏ›‰ˆÓ, ÌÂ ·ÔÙ¤-

ÏÂÛÌ· ÙË ÛÙÚ·ÙÔÏfiÁËÛË ÙˆÓ ·ÙÂÏÂÎÙ·ÙÈÎÒÓ Î˘„Â-

Ï›‰ˆÓ Î·È ÙËÓ Î·Ï‡ÙÂÚË ¤ÎÙ˘ÍË ÙˆÓ ÓÂ˘ÌfiÓˆÓ

(31). ∞˘Ù¤˜ ÔÈ Ô‰ËÁ›Â˜ ·Â˘ı‡ÓÔÓÙ·È ÛÙÔ ÚfiˆÚÔ

ÓÂÔÁÓfi Ô˘ ¿Û¯ÂÈ Î˘Ú›ˆ˜ ·fi ÙËÓ ·ÙÂÏÂÎÙ·ÙÈÎ‹

ÓfiÛÔ ÙˆÓ ÓÂ˘ÌfiÓˆÓ. √È Ô‰ËÁ›Â˜ fiÌˆ˜, Ú¤ÂÈ Ó·

ÂÍ·ÙÔÌÈÎÂ‡ÔÓÙ·È Î·È Ó· ‰È·ÊÔÚÔÔÈÔ‡ÓÙ·È ·Ó¿ÏÔÁ·

ÌÂ ÙËÓ ÚˆÙÔ·ı‹ ÓÂ˘ÌÔÓÈÎ‹ ÓfiÛÔ (21,32-34). ∂›-

Ó·È ÛËÌ·ÓÙÈÎfi Ô ÓÂÔÁÓÔÏfiÁÔ˜ Ó· ·ÍÈÔÏÔÁÂ› ÚÔÛÂ-

ÎÙÈÎ¿ ÙËÓ ÓÂ˘ÌÔÓÈÎ‹ ·ıÔÊ˘ÛÈÔÏÔÁ›· Î¿ıÂ ·ÛıÂ-

Ó‹ Î·È Ó· Î·ıÔÚ›˙ÂÈ ÙÔ˘˜ ÌË¯·ÓÈÛÌÔ‡˜ Ô˘ Â˘ı‡ÓÔ-

ÓÙ·È ÁÈ· ÙË ÌË Â·ÚÎ‹ ·ÓÙ·ÏÏ·Á‹ ÙˆÓ ·ÂÚ›ˆÓ. ªfi-

ÓÔ ÙfiÙÂ ÌÔÚÂ› Ó· Û¯Â‰È·ÛÙÂ› Ë Î·Ï‡ÙÂÚË ÛÙÚ·ÙËÁÈ-

Î‹ ·ÂÚÈÛÌÔ‡ Ô˘ ı· Â›Ó·È Ë Î·Ù·ÏÏËÏfiÙÂÚË ÁÈ· Î¿-

ıÂ ÓÂÔÁÓfi. ∏ ÔÚÂ›· ÙË˜ ÓfiÛÔ˘ Ú¤ÂÈ Ó· Â·Ó·ÍÈÔ-

ÏÔÁÂ›Ù·È Û˘¯Ó¿ Î·È Ó· ÙÚÔÔÔÈÂ›Ù·È ·Ó·ÏfiÁˆ˜ Ë

ÛÙÚ·ÙËÁÈÎ‹ ÙÔ˘ ·ÂÚÈÛÌÔ‡ (34).

™˘Ì¤Ú·ÛÌ·

∏ Î·Ï‡ÙÂÚË Î·Ù·ÓfiËÛË ÙÔ˘ ÙÚfiÔ˘ Î·È ÙˆÓ ÌË-

¯·ÓÈÛÌÒÓ ÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘ ˘„›Û˘¯ÓÔ˘ ·ÂÚÈÛÌÔ‡ Î·-

ıÒ˜ Î·È ·ÍÈÔÏfiÁËÛË ÙË˜ ÓÂ˘ÌÔÓÈÎ‹˜ ·ıÔÊ˘ÛÈÔÏÔ-Á›·˜ ÙÔ˘ Î¿ıÂ ÓÂÔÁÓÔ‡ ı· ‚ÔËıÔ‡ÛÂ ÛÙËÓ ·ÔÙÂÏÂ-ÛÌ·ÙÈÎfiÙÂÚË ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘. √È ÂÍÂÏ›ÍÂÈ˜ ÛÙÔÓ ÙÔ-Ì¤· ÙÔ˘ ÌË¯·ÓÈÎÔ‡ ·ÂÚÈÛÌÔ‡ ·ÔÙÂÏÔ‡Ó ÚfiÎÏËÛËÁÈ· ÙÔ˘˜ ÓÂÔÁÓÔÏfiÁÔ˘˜. ∏ ÛˆÛÙ‹ ÂÈÏÔÁ‹ ÙÔ˘ ÌÔÓÙ¤-ÏÔ˘ ı· Ú¤ÂÈ Ó· Â›Ó·È ÂÍ·ÙÔÌÈÎÂ˘Ì¤ÓË ÁÈ· Î¿ıÂ ÓÂ-ÔÁÓfi. ∏ ·Ó¿Ù˘ÍË ÙË˜ ÙÂ¯ÓÔÏÔÁ›·˜ Û·ÊÒ˜ Â›Ó·È ·Ï-Ì·ÙÒ‰Ë˜, ‰ÂÓ ı· Ú¤ÂÈ fiÌˆ˜ Ó· ·Ú·‚Ï¤ÂÙ·È ËÎÏÈÓÈÎ‹ ÂÎÙ›ÌËÛË Î·È Ë ÂÌÂÈÚ›· ÛÙË ¯Ú‹ÛË ÂÓfi˜ ÌË-¯·Ó‹Ì·ÙÔ˜, ÁÈ·Ù› ·ÏÔ‡ÛÙ·Ù· ¤Ó· Û‡Á¯ÚÔÓÔ ÌË¯¿ÓË-Ì· Èı·ÓÒ˜ Ó· Â›Ó·È ÂÈÎ›Ó‰˘ÓÔ ÁÈ· ÙÔÓ ·ÛıÂÓ‹, Â¿Ó‰ÂÓ ¤¯Ô˘ÌÂ Î·Ù·ÓÔ‹ÛÂÈ Ï‹Úˆ˜ ÙÔ˘˜ ÌË¯·ÓÈÛÌÔ‡˜ÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘.


1. Boros SJ, Mammel MC, Coleman JM, Lewallen PK, Gor-don MJ, Bing DR, et al. Neonatal high-frequency jet venti-lation: four years’ experience. Pediatrics 1985;75:657-663.

2. Roithmair A, Hultzsch W, Lipowsky G, Reinhardt D. Air-way pressure measurements during high-frequency posi-tive pressure ventilation in extremely low birth weightneonates. Crit Care Med 1994;22 (9 Suppl):S71-S76.

3. Truog WE. High Frequency Oscillatory Ventilation. In:Spitzer AR, editor. Intensive Care of Fetus and Neonate. StLouis, MO: Mosby - Yearbook Publishing Company; 1996.p. 584-593.

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5. Lunkenheimer PP, Rafflenbeul W, Keller H, Frank I, Dick-hut HH, Fuhrmann C. Application of transtracheal pres-sure oscillations as a modification of “diffusing respira-tion”. Br J Anaesth 1972;44:627.

6. Drazen JM, Kamm RD, Slutsky AS. High frequency venti-lation. Physiol Rev 1984;64:505-543.

7. Boynton BR, Vilanueva D, Hammond MD, Vreeland PN,Buckley B, Frantz ID 3rd. Effect of mean airway pressureon gas exchange during high-frequency oscillatory venti-lation. J Appl Physiol 1991; 70:701-707.

8. Marchak BE, Thompson WK, Duffy P, Miyaki T, BryanMH, Bryan AC, et al. Treatment of RDS by high-frequen-cy oscillatory ventilation: a preliminary report. J Pediatr1981;99:287-292.

9. Delemos RA, Coalson JJ, Gerstmann DR, Null DM Jr,Ackerman NB, Escobedo MB, et al. Ventilatory manage-ment of infant baboons with hyaline membrane disease:the use of high frequency ventilation. Pediatr Res 1987;21:594-602.

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¶·È‰È·ÙÚÈÎ‹ 2007;70:18-23

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Past, present and future. Clin Perinatol 2001;28:579-607.

24 ∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞ ORIGINAL ARTICLE


ªÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ ÛÂ ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ ÙË˜ ∫Ú‹ÙË˜

ÛÂ Û¯¤ÛË ÌÂ ÙË ‰È·ÙÚÔÊ‹ ÙÔ˘˜

ª. §ÈÓ·Ú‰¿ÎË˜, ∫. ™·ÚÚ‹, °. ªÂÚÙÛÈ¿˜, ∞. ∫·Ê¿ÙÔ˜, √Ì¿‰· ∫ÏÈÓÈÎ‹˜ ¶ÚÔÏËÙÈÎ‹˜ π·ÙÚÈÎ‹˜ Î·È ¢È·ÙÚÔÊ‹˜*

¶ÂÚ›ÏË„Ë

∂ÈÛ·ÁˆÁ‹: ™ÎÔfi˜ ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ Â›Ó·È Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙË˜ Û˘¯ÓfiÙËÙ·˜ ÂÌÊ¿ÓÈÛË˜ ÙÔ˘ ªÂÙ·-‚ÔÏÈÎÔ‡ ™˘Ó‰ÚfiÌÔ˘ (ªÂÙ™˘Ó) ÛÂ ·È‰È¿ & ÂÊ‹‚Ô˘˜ ÙË˜ ∫Ú‹ÙË˜ ÛÂ Û¯¤ÛË ÌÂ ÙË ‰È·ÙÚÔÊ‹ ÙÔ˘˜.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ∂ÈÏ¤¯ıËÎ·Ó 1209 ·È‰È¿ Î·È ¤ÊË‚ÔÈ. ÀÔÏÔÁ›ÛÙËÎÂ Ë Û˘¯ÓfiÙËÙ· Û˘Ó‡·ÚÍË˜ ÙÚÈÒÓ‹ ÂÚÈÛÛÔÙ¤ÚˆÓ ·Ú·ÁfiÓÙˆÓ ÙÔ˘ ªÂÙ™˘Ó Î·È Û˘Û¯ÂÙ›ÛÙËÎÂ ÌÂ ÙÔÓ ¢Â›ÎÙË ÀÁÈÂÈÓ‹˜ ¢È·ÙÚÔÊ‹˜ (¢À¢), ÔÔÔ›Ô˜ ·ÍÈÔÏÔÁÂ› Î·È Ù·ÍÈÓÔÌÂ› ÙË ‰È·ÙÚÔÊ‹ Î¿ıÂ ·ÙfiÌÔ˘ ÛÂ ÎÏ›Ì·Î· ·fi 1-100. ¢È·ÙÚÔÊ‹ ÌÂ ‚·ıÌÔ-ÏÔÁ›· <51 ıÂˆÚÂ›Ù·È “·ÓÂ·ÚÎ‹˜”, ·fi 51-80 fiÙÈ “¯ÚÂÈ¿˙ÂÙ·È ‚ÂÏÙ›ˆÛË” Î·È ·fi 81-100 “Î·Ï‹”.

∞ÔÙÂÏ¤ÛÌ·Ù·: √ ÂÈÔÏ·ÛÌfi˜ ÙÔ˘ ªÂÙ™˘Ó ‚Ú¤ıËÎÂ 3,9% (4,2% ÛÙ· ·ÁfiÚÈ·, 3,6% ÛÙ· ÎÔÚ›ÙÛÈ·). ∏Ì¤ÛË ‚·ıÌÔÏÔÁ›· ÙÔ˘ ¢À¢ ‹Ù·Ó 58,7 ÌÂ 58,4 ÛÙ· ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ ÌÂ ªÂÙ™˘Ó ¤Ó·ÓÙÈ 59,8 ÛÂ ÂÎÂ›Ó·¯ˆÚ›˜ ·Ú¿ÁÔÓÙÂ˜ ªÂÙ™˘Ó (p>0,05). ∆Ô 36% ÙˆÓ ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ ÌÂ ªÂÙ™˘Ó, Â›¯Â ‰È·ÙÚÔÊ‹ “·ÓÂ-·ÚÎ‹” Î·È 5% “Î·Ï‹”, ¤Ó·ÓÙÈ 28% Î·È 8% ·ÓÙ›ÛÙÔÈ¯·, ÂÎÂ›ÓˆÓ ¯ˆÚ›˜ ·Ú¿ÁÔÓÙÂ˜ ªÂÙ™˘Ó (p=0,026).∂›ÛË˜, Ù· ·È‰È¿ - ¤ÊË‚ÔÈ ÌÂ ªÂÙ™˘Ó, ¤Ó·ÓÙÈ ÂÎÂ›ÓˆÓ ¯ˆÚ›˜ ·Ú¿ÁÔÓÙÂ˜ ªÂÙ™˘Ó, Â›¯·Ó ˘„ËÏfiÙÂÚ· Ô-ÛÔÛÙ¿ ÌÂ ·ÓÂ·ÚÎ‹ Ï‹„Ë Ê˘ÏÈÎÔ‡ ÔÍ¤Ô˜ (55% ¤Ó·ÓÙÈ 53%, p=0,010) Î·È ‚ÈÙ·Ì›ÓË˜ ∞ (45% ¤Ó·ÓÙÈ 43%,p=0,023). ™Ù· ·¯‡Û·ÚÎ· ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜, Ô Î›Ó‰˘ÓÔ˜ Ó· ·Ó·Ù‡ÍÔ˘Ó ªÂÙ™˘Ó ‚Ú¤ıËÎÂ 85 ÊÔÚ¤˜ÌÂÁ·Ï‡ÙÂÚÔ˜ ÛÂ Û¯¤ÛË ÌÂ Ù· Ê˘ÛÈÔÏÔÁÈÎ¿ (95% ¢∂: 33-219, p<0,001). ∆· ·È‰È¿ Î·È ¤ÊË‚ÔÈ ÌÂ ªÂÙ™˘ÓÂ›¯·Ó Â›ÛË˜ 30% ¯·ÌËÏfiÙÂÚË Èı·ÓfiÙËÙ· ÁÈ· Î·Ï‹ Î·Ú‰ÈÔ·Ó·ÓÂ˘ÛÙÈÎ‹ ·ÓÙÔ¯‹ ÛÂ Û¯¤ÛË ÌÂ ÂÎÂ›Ó·¯ˆÚ›˜ ·Ú¿ÁÔÓÙÂ˜ ªÂÙ™˘Ó (OR=0,70, 95% ¢∂: 0,49-0,99, p=0,042).

™˘ÌÂÚ¿ÛÌ·Ù·: ∞fi Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ‰È·ÈÛÙÒÓÂÙ·È fiÙÈ Ë ÚˆÙÔÁÂÓ‹˜ ÚfiÏË„Ë Î·È ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ªÂÙ™˘Ó ÌÔÚÂ› Ó· ÂÈÙÂ˘¯ıÂ› ÌfiÓÔ ÌÂ Î·Ù¿ÏÏËÏË ·ÁˆÁ‹ ˘ÁÂ›·˜ ·Â˘ı˘ÓfiÌÂÓË ÛÙ· ·È‰È¿ Î·È ÛÙÈ˜ ÔÈ-ÎÔÁ¤ÓÂÈ¤˜ ÙÔ˘˜, ¤ÙÛÈ ÒÛÙÂ Ó· ÙÔ˘˜ ‰ÔıÂ› Ë ‰˘Ó·ÙfiÙËÙ· Ó· Î¿ÓÔ˘Ó Î·Ï‡ÙÂÚÂ˜ ÂÈÏÔÁ¤˜ ÛÙË ‰È·ÙÚÔÊ‹, ÛÙËÛˆÌ·ÙÈÎ‹ ¿ÛÎËÛË Î·È ÁÂÓÈÎfiÙÂÚ· ÛÙÔÓ ÙÚfiÔ ˙ˆ‹˜ ÙÔ˘˜.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ªÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ, ‰È·ÙÚÔÊ‹, ‰Â›ÎÙË˜ ˘ÁÈÂÈÓ‹˜ ‰È·ÙÚÔÊ‹˜, ·¯˘Û·ÚÎ›·, ÏÈÔÚˆÙÂ˝ÓÂ˜.

Prevalence of metabolic syndrome in children and adolescents of

Crete and its relation to diet

M. Linardakis, K. Sarri, G. Bertsias, A. Kafatos, Division of Preventive Medicine and Nutrition*

Abstract

Background: The aim of this study was to determine the prevalence of the metabolic syndrome (MetSyn)in children and adolescents of Crete, and to explore its association with dietary intake.

Methods: The study included 1209 children and adolescents. The prevalence of MetSyn was examinedand associated with the USDA Healthy Eating Index (HEI), which classifies the dietary intake ofindividuals, providing a score of 1-100. The scores indicate respectively: <51 a “poor” diet, 51-80 a dietthat “needs improvement”, and >80 a “good” diet.

Results: The rate of MetSyn in the children and adolescents was 3.9% (4.2% of boys, 3.6% of girls). Theoverall mean HEI score was 58.7 (58.4 in children and adolescents with MetSyn and 59.8 in risk-freeindividuals, p>0.05). Of the children and adolescents with MetSyn, 36% had a “poor” diet and only5% had a “good” diet according to the HEI score, while the respective rates in risk-free individuals were28% and 8% (p=0.026). Inadequate intakes of folate (55% vs 53%, p=0.010) and vitamin A (45% vs43%, p=0.023) were also more common in children and adolescents with MetSyn. Compared to theirnon-obese counterparts, obese children and adolescents had an 85 times higher risk for MetSyn (95%CI: 33-219, p<0.001). The children and adolescents with MetSyn were 30% less likely to have goodcardiorespiratory fitness (OR=0.70, 95% CI: 0.49-0.99, p=0.042) than those with no risk factors.

Conclusions: Primary prevention of MetSyn could be achieved when appropriate health and nutritionintervention is initiated early in childhood, aimed at behaviour modification in children, parents andteachers, for better health choices in nutrition and physical activity.

Key words: Metabolic syndrome, nutrition, healthy eating index, obesity, serum lipids.

¶·ÓÂÈÛÙ‹ÌÈÔ ∫Ú‹ÙË˜, ∆Ì‹Ì· π·ÙÚÈÎ‹˜, ∆ÔÌ¤·˜ ∫ÔÈÓˆÓÈÎ‹˜ π·ÙÚÈÎ‹˜,∫ÏÈÓÈÎ‹ ¶ÚÔÏËÙÈÎ‹˜π·ÙÚÈÎ‹˜ Î·È ¢È·ÙÚÔÊ‹˜,∏Ú¿ÎÏÂÈÔ ∫Ú‹ÙË˜


ª·ÓfiÏË˜ §ÈÓ·Ú‰¿ÎË˜ [email protected] ¢È·ÛÙ·‡ÚˆÛË µÔ‡ÙÂ˜ -™Ù·˘Ú¿ÎÈ· ∆.∫. 710 03, ∆.£.: 2208,∏Ú¿ÎÏÂÈÔ ∫Ú‹ÙË˜

* Ã. Ã·Ù˙‹˜, ™. ºÏÔ˘Ú‹, π. ªÔÛ¯·Ó‰Ú¤·, º. ªÂÚ‚·Ó¿ÎË, ª. ∫˘ÚÈ·Î¿ÎË˜, °. ∆ÛÈÌÈÓfi˜, C. Codrington, °. ª·Ì·Ï¿ÎÈ˜

University of Crete, Faculty of Medicine,Department of SocialMedicine, Division of PreventiveMedicine and Nutrition,Heraklion, Crete

Correspondence:

Manolis Linardakis [email protected] Voutes-Stavrakia Junction, 71 003, Po. Box: 2208, Herakleion, Crete

* H. Hatzis, S. Flouri, I. Moschandrea, F. Bervanaki,M. Kiriakakis, G. Tsibinos, C. Codrington, G. Mamalakis

25ªÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ ÛÂ ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜

¶·È‰È·ÙÚÈÎ‹ 2007;70:24-36

™˘ÓÙÔÌÔÁÚ·Ê›Â˜

ªÂÙ™˘Ó ªÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ

¢ª™ ¢Â›ÎÙË˜ Ì¿˙·˜ ÛÒÌ·ÙÔ˜

HDL-C ÃÔÏËÛÙÂÚfiÏË ÙˆÓ ˘„ËÏ‹˜ ˘ÎÓfiÙËÙ·˜

ÏÈÔÚˆÙÂ˚ÓÒÓ

LDL-C ÃÔÏËÛÙÂÚfiÏË ÙˆÓ ¯·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜

ÏÈÔÚˆÙÂ˚ÓÒÓ

¢À¢ ¢Â›ÎÙË˜ ˘ÁÈÂÈÓ‹˜ ‰È·ÙÚÔÊ‹˜

USDA United States Department of Agriculture

∏™¶ ∏ÌÂÚ‹ÛÈ· Û˘ÓÈÛÙÒÌÂÓË ÔÛfiÙËÙ·

RDA Recommended dietary allowances

ª™ ™Ù·ÙÈÛÙÈÎÒ˜ ÌË ÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿

ANCOVA ∞Ó¿Ï˘ÛË Û˘Ó‰È·Î‡Ì·ÓÛË˜

OR Odds ratio

NHANES III 3rd National Health and Nutrition

Examination Survey

∂ÈÛ·ÁˆÁ‹

ŒÓ· ·fi Ù· ÌÂÁ·Ï‡ÙÂÚ· Û‡Á¯ÚÔÓ· ÚÔ‚Ï‹Ì·Ù·

ÙË˜ ‰ËÌfiÛÈ·˜ ˘ÁÂ›·˜ ·ÔÙÂÏÂ› ÙÔ ÌÂÙ·‚ÔÏÈÎfi Û‡Ó-

‰ÚÔÌÔ (ªÂÙ™˘Ó) ‹ Û‡Ó‰ÚÔÌÔ Ã, ·ÊÔ‡ Î·ıÔÚ›˙ÂÙ·È

·fi ÙË Û˘ÁÎ¤ÓÙÚˆÛË ÙÚÈÒÓ ‹ ÂÚÈÛÛfiÙÂÚˆÓ ·Ú·-

ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË Î·Ú‰È·ÁÁÂÈ·ÎÒÓ

Î·È ¿ÏÏˆÓ ¯ÚfiÓÈˆÓ ÓÔÛËÌ¿ÙˆÓ (1-3).

™‹ÌÂÚ·, ·Ú¿ ÙÔ˘˜ ‰È·ÊÔÚÂÙÈÎÔ‡˜ ÔÚÈÛÌÔ‡˜

Ô˘ ¤¯Ô˘Ó ‰ÔıÂ›, ¤¯ÂÈ Á›ÓÂÈ ·Ô‰ÂÎÙfi fiÙÈ ªÂÙ™˘Ó

˘Ê›ÛÙ·Ù·È fiÙ·Ó Û˘Ó˘¿Ú¯Ô˘Ó ÙÚÂÈ˜ ‹ ÂÚÈÛÛfiÙÂÚÔÈ

·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ (2-4), fiˆ˜ ·˘ÍËÌ¤ÓË ÙÈÌ‹

Û·Î¯¿ÚÔ˘ ÔÚÔ‡ ·›Ì·ÙÔ˜ ˆ˜ ‰Â›ÎÙË˜ ˘ÂÚÁÏ˘Î·È-

Ì›·˜ ‹ Û·Î¯·ÚÒ‰Ô˘˜ ‰È·‚‹ÙË Ù‡Ô˘ 2, ¯·ÌËÏ‹

HDL ¯ÔÏËÛÙÂÚfiÏË, ˘ÂÚÙÚÈÁÏ˘ÎÂÚÈ‰·ÈÌ›·, ·˘ÍË-

Ì¤ÓË Û˘ÛÙÔÏÈÎ‹ Î·È ‰È·ÛÙÔÏÈÎ‹ ·ÚÙËÚÈ·Î‹ ›ÂÛË

ˆ˜ ‰Â›ÎÙÂ˜ ˘¤ÚÙ·ÛË˜ Î·È, Ù¤ÏÔ˜, ·˘ÍËÌ¤ÓË ÂÚ›-

ÌÂÙÚÔ˜ Ì¤ÛË˜ ˆ˜ ‰Â›ÎÙË˜ ÎÂÓÙÚÈÎ‹˜ ·¯˘Û·ÚÎ›·˜.

∏ Û˘Ó¤ÚÁÂÈ· ÙˆÓ ·Ú·ÁfiÓÙˆÓ ·˘ÙÒÓ Ô‰ËÁÂ›

ÛÙËÓ ·Ó¿Ù˘ÍË ·ıËÚÔÛÎÏËÚˆÙÈÎÒÓ Ï·ÎÒÓ Î·È, Î·-

Ù¿ Û˘Ó¤ÂÈ·, ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ ‹ ÁÂÓÈÎfiÙÂÚ· Î·Ú-

‰È·ÁÁÂÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ (1-7). ∂ÎÙÈÌ‹ıËÎÂ ‰Â ·fi

ÙË ÌÂÏ¤ÙË NHANES 1999-2000, fiÙÈ ÂÚ›Ô˘ 47 ÂÎ·-

ÙÔÌÌ‡ÚÈ· ∞ÌÂÚÈÎ·ÓÒÓ ¤¯Ô˘Ó ªÂÙ™˘Ó, Î·ıÒ˜ Î·È

ÂÚÈÛÛfiÙÂÚÔÈ ·fi 2 ÂÎ·ÙÔÌÌ‡ÚÈ· ¤ÊË‚ÔÈ (8-10).

∏ ·ÚÔ˘Û›· ÈÓÒ‰Ô˘˜ Ï¿Î·˜ ÂÍÂÏ›ÛÛÂÙ·È ÛÂ

·ıËÚÔÛÎÏ‹ÚˆÛË ·fi ÙËÓ ·È‰ÈÎ‹ Î·È ÂÊË‚ÈÎ‹ ·Îfi-

Ì· ËÏÈÎ›· (11,12). ∞ÔÙÂÏÂ› Û˘Ó¤ÂÈ· Û˘Ó‰˘·ÛÌÔ‡

ÙË˜ Î·Î‹˜ ‰È·ÙÚÔÊ‹˜, ÙË˜ ·ÓÂ·ÚÎÔ‡˜ ¿ÛÎËÛË˜ Î·È

ÙË˜ ·¯˘Û·ÚÎ›·˜, Ô˘ fiˆ˜ ·Ó·Ê¤ÚÂÙ·È ÛÂ ÌÂÏ¤ÙË

ÛÙÈ˜ ∏¶∞ (13), ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙÔ˘Ï¿¯ÈÛÙÔÓ

300.000 ı·Ó¿ÙÔ˘˜ ÂÙËÛ›ˆ˜ Î·È ÂÚ›Ô˘ 99 ‰ÈÛ. ‰Ô-

Ï¿ÚÈ· ÂÙ‹ÛÈÔ ÔÈÎÔÓÔÌÈÎfi ÎfiÛÙÔ˜.

∞Ó Î·È Ë ·ıÔÁ¤ÓÂÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ‰ÂÓ ¤¯ÂÈ

Ï‹Úˆ˜ Î·Ù·ÓÔËıÂ›, Â›Ó·È ÁÓˆÛÙ‹ Ë Û¯¤ÛË ÙÔ˘ ÌÂ

ÁÂÓÂÙÈÎÔ‡˜ Î·È ÂÚÈ‚·ÏÏÔÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜,

fiˆ˜ Ë Î·ıÈÛÙÈÎ‹ ˙ˆ‹ Î·È Ë ‰˘ÙÈÎÔ‡ Ù‡Ô˘ ‰È·ÙÚÔ-

Ê‹ (14), ÛÙÔÈ¯Â›· Ô˘ ·ÔÙÂÏÔ‡Ó Â›ÛË˜ ‚·ÛÈÎfi

¿ÍÔÓ· ÙË˜ Û˘ÓÔÏÈÎ‹˜ ·ÓÙÈÌÂÙÒÈÛ‹˜ ÙÔ˘ (15).

™ÙË ¯ÒÚ· Ì·˜ ‰ÂÓ ¤¯ÂÈ ·ÎfiÌË ÌÂÏÂÙËıÂ› Ë Û˘-

¯ÓfiÙËÙ· ÙÔ˘ ªÂÙ™˘Ó ÛÙÔÓ ·È‰ÈÎfi Î·È ÂÊË‚ÈÎfi

ÏËı˘ÛÌfi, Î·ıÒ˜ Î·È Ë Û¯¤ÛË ÙÔ˘ ÌÂ ÙË ‰È·ÙÚÔÊ‹.

∏ ·ÏÏ·Á‹ ÙˆÓ ‰È·ÈÙËÙÈÎÒÓ Û˘ÓËıÂÈÒÓ ÛÙÈ˜ ÙÂÏÂ˘-

Ù·›Â˜ ‰ÂÎ·ÂÙ›Â˜ Î·È ÁÂÓÈÎfiÙÂÚ· ÙÔ˘ ÙÚfiÔ˘ ˙ˆ‹˜

ÙˆÓ Û‡Á¯ÚÔÓˆÓ ∫ÚËÙÈÎÒÓ (16,17), ÙÔÓ›˙ÂÈ ÙÔ È‰È·›ÙÂ-

ÚÔ ÂÓ‰È·Ê¤ÚÔÓ Ô˘ ¤¯ÂÈ Ë ÌÂÏ¤ÙË ÙË˜ ·ÚÔ˘Û›·˜

ÙÔ˘ ªÂÙ™˘Ó ÛÂ ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ ÙË˜ ∫Ú‹ÙË˜ Î·È

Ë Û¯¤ÛË ÙÔ˘ ÌÂ ÙË ‰È·ÙÚÔÊ‹ ÙÔ˘˜.

™ÙËÓ ·ÚÔ‡Û· ¤ÚÂ˘Ó· ÌÂÏÂÙ‹ıËÎÂ Ô ÂÈÔÏ·-

ÛÌfi˜ ÙÔ˘ ªÂÙ™˘Ó ÛÂ ‰Â›ÁÌ· ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ ÙË˜

∫Ú‹ÙË˜ Î·È Ë Û¯¤ÛË ÙÔ˘ ÌÂ ÙË ‰È·ÙÚÔÊ‹ ÙÔ˘˜, ·ÏÏ¿

Î·È ÌÂ ¿ÏÏÔ˘˜ ·Ú¿ÁÔÓÙÂ˜ fiˆ˜ Â›Ó·È Ë ÛˆÌ·ÙÈÎ‹

¿ÛÎËÛË, Ë Û˘ÓÔÏÈÎ‹ ÏÈÈ‰·ÈÌÈÎ‹ ÂÈÎfiÓ·, ÙÔ Î¿ÓÈÛÌ·

(ÛÙÔ˘˜ ÂÊ‹‚Ô˘˜), Î·ıÒ˜ Î·È Ë Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛË˜

ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ÛÙ· ·¯‡Û·ÚÎ· ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ

∏ ÌÂÏ¤ÙË Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ ÛÂ ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ ÙË˜

∫Ú‹ÙË˜ Î·Ù¿ Ù· ¤ÙË 2001-2003. ∞Ú¯ÈÎ¿ Û˘ÌÌÂÙÂ›¯·Ó 1381

·È‰È¿-¤ÊË‚ÔÈ, ·fi ÙÔ˘˜ ÔÔ›Ô˘˜ 172 ·ÚÓ‹ıËÎ·Ó Ó· Û˘ÌÌÂ-

Ù¿Û¯Ô˘Ó ÛÙÈ˜ ÛˆÌ·ÙÔÌÂÙÚ‹ÛÂÈ˜ ‹ Î·È ÛÙËÓ ·ÈÌÔÏË„›·. ∆ÂÏÈ-

Î¿, 1209 ·È‰È¿-¤ÊË‚ÔÈ (545 ·ÁfiÚÈ· Î·È 677 ÎÔÚ›ÙÛÈ·), ËÏÈ-

Î›·˜ 3 ¤ˆ˜ 17ó ÂÙÒÓ, Â›¯·Ó Ï‹ÚË ÛÙÔÈ¯Â›· Î·È Û˘ÌÂÚÈÏ‹-

ÊıËÛ·Ó ÛÙÈ˜ ·Ó·Ï‡ÛÂÈ˜. ∂›¯·Ó Û˘ÌÌÂÙ¿Û¯ÂÈ ÛÂ ÌÂÏ¤ÙÂ˜ Û˘Á-

¯ÚÔÓÈÎ‹˜ ‹ Î·È ‰È·¯ÚÔÓÈÎ‹˜ ·Ú·ÎÔÏÔ‡ıËÛË˜ ÙË˜ ∫ÏÈÓÈÎ‹˜

¶ÚÔÏËÙÈÎ‹˜ π·ÙÚÈÎ‹˜ Î·È ¢È·ÙÚÔÊ‹˜ (¶›Ó·Î·˜ 1) Î·È ÚÔ-

¤Ú¯ÔÓÙ·È ·fi ¤ÓÙÂ ‰È·ÊÔÚÂÙÈÎ¤˜ ÂÚÈÔ¯¤˜ ÙˆÓ ¡ÔÌÒÓ Ã·-

Ó›ˆÓ Î·È ∏Ú·ÎÏÂ›Ô˘.

∆ÔÓ π·ÓÔ˘¿ÚÈÔ ÙÔ˘ 2001, Ë ∫ÏÈÓÈÎ‹ ÍÂÎ›ÓËÛÂ ÛÙ· Û¯ÔÏÂ›·

ÙË˜ ËÌÈÔÚÂÈÓ‹˜ ÂÚÈÔ¯‹˜ ÙÔ˘ ¢‹ÌÔ˘ ƒÔ‡‚· ∏Ú·ÎÏÂ›Ô˘ ¶Úfi-

ÁÚ·ÌÌ· ¶ÚÔ·ÁˆÁ‹˜ ÙË˜ ÀÁÂ›·˜, ·fi ÙÔ ÔÔ›Ô ÛÙËÓ ·ÚÔ‡Û·

ÌÂÏ¤ÙË ¤¯Ô˘Ó Û˘ÌÂÚÈÏËÊıÂ› Û˘ÓÔÏÈÎ¿ 188 Ì·ıËÙ¤˜ (18).

¢Ò‰ÂÎ· ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙÔ ÓËÈ·ÁˆÁÂ›Ô, 108 ·fi Ù· ‰ËÌÔ-

ÙÈÎ¿ Î·È 68 ·fi ÙÔ Á˘ÌÓ¿ÛÈÔ.

∞fi ÙËÓ ÙÂÏÂ˘Ù·›· ·ÍÈÔÏfiÁËÛË (2001-2002) ÂÍ·ÂÙÔ‡˜

ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÂÎ·È‰Â˘ÙÈÎ‹˜ ·Ú¤Ì‚·ÛË˜, Ô˘ ¿Ú¯ÈÛÂ

ÛÙËÓ ÚÒÙË Ù¿ÍË ÙˆÓ ‰ËÌÔÙÈÎÒÓ Û¯ÔÏÂ›ˆÓ ÙË˜ ∫Ú‹ÙË˜ ÙÔ

Û¯ÔÏÈÎfi ¤ÙÔ˜ 1992-1993 (19,20), ÂÈÏ¤¯ıËÎ·Ó 246 Ì·ıËÙ¤˜

·fi ÙÔ ¡ÔÌfi Ã·Ó›ˆÓ (ÔÌ¿‰· ÂÏ¤Á¯Ô˘).

∆ËÓ ¿ÓÔÈÍË ÙÔ˘ 2003, Ë ∫ÏÈÓÈÎ‹ ÛÂ Û˘ÓÂÚÁ·Û›· ÌÂ ÙÔÓ ¢‹-

ÌÔ ÃÂÚÛÔÓ‹ÛÔ˘ ¿Ú¯ÈÛÂ ¶ÚfiÁÚ·ÌÌ· ¶ÚÔ·ÁˆÁ‹˜ ÙË˜ ÀÁÂ›·˜

Î·È ∞Ó¿Ù˘ÍË˜ ÙˆÓ ·È‰ÈÒÓ ÛÂ ÂÙ¿ ÓËÈ·ÁˆÁÂ›·. ∞fi ·˘Ù¿,

Ô ‚ÚÂÊÔÓËÈ·Îfi˜ ÛÙ·ıÌfi˜, ÙÔ 1Ô & 2Ô ¡ËÈ·ÁˆÁÂ›Ô Î·È ÙÔ

¡ËÈ·ÁˆÁÂ›Ô ÃÂÚÛÔÓ‹ÛÔ˘ ÚÔ¤Ú¯ÔÓÙ·Ó ·fi ÙËÓ ÂÚÈÔ¯‹

ÙÔ˘ §ÈÌ¤Ó· ÃÂÚÛÔÓ‹ÛÔ˘, ÂÓÒ Â›ÛË˜ Û˘ÌÂÚÈÏ‹ÊıËÎ·Ó Ù·

ÓËÈ·ÁˆÁÂ›· ∫Ô˘ÙÔ˘ÏÔ˘Ê·Ú›Ô˘, ∞Ó¿ÏË„Ë˜ Î·È °ˆÓÈÒÓ ¶Â-

‰È¿‰Ô˜. ø˜ ÚÒÙË Ê¿ÛË ˘ÏÔÔ›ËÛË˜ ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ Î·-

ıÔÚ›ÛÙËÎÂ Ô ¤ÏÂÁ¯Ô˜ Î·È Ë ÂÎÙ›ÌËÛË ÙÔ˘ ÂÈ¤‰Ô˘ ˘ÁÂ›·˜ ÙˆÓ

·È‰ÈÒÓ, ·fi Ù· ÔÔ›· Û˘ÌÌÂÙÂ›¯·Ó 89 ÛÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË.

¶·ÚfiÌÔÈ·, ÙÔ 2002-2003, ¿Ú¯ÈÛÂ ¶ÚfiÁÚ·ÌÌ· ÕıÏËÛË˜

Î·È ¢È·ÙÚÔÊ‹˜ ÛÂ Û¯ÔÏÂ›· ÙË˜ ÂÚÈÔ¯‹˜ ¢ÂÈÏÈÓÒÓ ÙÔ˘ ¢‹ÌÔ˘

∏Ú·ÎÏÂ›Ô˘, fiÔ˘ Û˘ÌÌÂÙÂ›¯Â ÙÔ 30fi & 45Ô ¡ËÈ·ÁˆÁÂ›Ô, ÙÔ

33Ô & 45Ô ¢ËÌÔÙÈÎfi, ÙÔ ∞ıÏËÙÈÎfi 8Ô & 9Ô °˘ÌÓ¿ÛÈÔ Î·È ÙÔ 7Ô

& 10Ô §‡ÎÂÈÔ. ∂›ÛË˜, Û˘ÌÌÂÙÂ›¯·Ó ÙÔ ¡ËÈ·ÁˆÁÂ›Ô, ¢ËÌÔ-

ÙÈÎfi Î·È °˘ÌÓ¿ÛÈÔ Î·È ÙÔ˘ ¢‹ÌÔ˘ ∆˘Ï›ÛÛÔ˘. ∏ ÚÒÙË Ê¿ÛË

ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÔÏÔÎÏËÚÒıËÎÂ ÙÔ ‰È¿ÛÙËÌ· ·fi ÙÔÓ ¢Â-

Î¤Ì‚ÚÈÔ 2002 ¤ˆ˜ ÙÔÓ ∞Ú›ÏÈÔ 2003. ™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË

Û˘ÌÌÂÙÂ›¯·Ó Û˘ÓÔÏÈÎ¿ 686 ·È‰È¿.

ªÂÙÚ‹ÛÂÈ˜

√È ÌÂÙÚ‹ÛÂÈ˜ Î·È ÔÈ ÎÏÈÓÈÎ¤˜ ÂÍÂÙ¿ÛÂÈ˜ ·ÊÔÚÔ‡Ó ÛÙËÓ

Î·Ù·ÁÚ·Ê‹ ÙË˜ Û˘Ó‹ıÂÈ·˜ Î·Ó›ÛÌ·ÙÔ˜ (ÛÙÔ˘˜ ÂÊ‹‚Ô˘˜),

ÛÙË Ì¤ÙÚËÛË ÙˆÓ ÛˆÌ·ÙÔÌÂÙÚÈÎÒÓ ÌÂÁÂıÒÓ, ÙË˜ ·ÚÙËÚÈ·-

Î‹˜ ›ÂÛË˜, ÙÔ˘ Û·Î¯¿ÚÔ˘ ÔÚÔ‡ ·›Ì·ÙÔ˜ Î·È ÙˆÓ ÏÈÔÚˆ-

ÙÂ˚ÓÒÓ, ÛÙËÓ ·ÍÈÔÏfiÁËÛË ÙË˜ Ê˘ÛÈÎ‹˜ Î·Ù¿ÛÙ·ÛË˜ Î·È ÛÙË

Ï‹„Ë Î·È Î·Ù·ÁÚ·Ê‹ ‰È·ÈÙËÙÈÎÔ‡ ÈÛÙÔÚÈÎÔ‡. °È· ÙË Û˘ÌÌÂ-

ÙÔ¯‹, ÔÈ ÁÔÓÂ›˜ ÙˆÓ ·È‰ÈÒÓ Î·È ÙˆÓ ÂÊ‹‚ˆÓ ˘¤ÁÚ·Ê·Ó

Û˘ÌÊˆÓËÙÈÎfi ·Ô‰Ô¯‹˜, ·ÊÔ‡ Â›¯·Ó ÂÓËÌÂÚˆıÂ› ÁÚ·ÙÒ˜

ÁÈ· ÙË ‰È·‰ÈÎ·Û›· Î·È ÙÔ Â›‰Ô˜ ÙˆÓ ÌÂÙÚ‹ÛÂˆÓ.

∏ ÎÏÈÓÈÎ‹ ÂÍ¤Ù·ÛË ¤ÁÈÓÂ ÛÙ· ÓËÈ·ÁˆÁÂ›· Î·È Ù· Û¯Ô-

ÏÂ›·, ·ÊÔ‡ ÚÔËÁ‹ıËÎÂ Û¯ÂÙÈÎ‹ ¤ÁÎÚÈÛË ÙˆÓ ¶ÚÔÁÚ·ÌÌ¿-

ÙˆÓ ∞ÁˆÁ‹˜ Î·È ¶ÚÔ·ÁˆÁ‹˜ ÙË˜ ÀÁÂ›·˜ ·fi ÙÔ ¶·È‰·ÁˆÁÈÎfi

πÓÛÙÈÙÔ‡ÙÔ Î·È ÙÔ ÀÔ˘ÚÁÂ›Ô ¶·È‰Â›·˜. °È· fiÏÂ˜ ÙÈ˜ ÌÂÏ¤ÙÂ˜

ÚÔËÁ‹ıËÎÂ, Â›ÛË˜, ¤ÁÎÚÈÛË ·fi ÙËÓ ÂÈÙÚÔ‹ ∏ıÈÎ‹˜ Î·È

¢ÂÔÓÙÔÏÔÁ›·˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹ÙË˜.

∂ÚˆÙËÌ·ÙÔÏfiÁÈÔ

°È· ÙË Û˘Ó‹ıÂÈ· ÙÔ˘ Î·Ó›ÛÌ·ÙÔ˜ ‰fiıËÎÂ ÂÚˆÙËÌ·ÙÔÏfi-

ÁÈÔ ÛÙÔ˘˜ ÂÊ‹‚Ô˘˜, ÙÔ ÔÔ›Ô Û˘ÌÏ‹ÚˆÓ·Ó ÌfiÓÔÈ ÙÔ˘˜, Û‡Ì-

ÊˆÓ· ÌÂ ÙÈ˜ ··Ú·›ÙËÙÂ˜ Ô‰ËÁ›Â˜. À‹Ú¯·Ó ¤ÓÙÂ ÂÚˆÙ‹ÛÂÈ˜,

·ÓÔÈÎÙÔ‡ Î·È ÎÏÂÈÛÙÔ‡ Ù‡Ô˘, ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË ÙË˜ ·ÍÈÔÈ-

ÛÙ›·˜ ÙˆÓ ··ÓÙ‹ÛÂˆÓ (21). ø˜ Î·ÓÈÛÙ¤˜ ıÂˆÚ‹ıËÎ·Ó fiÛÔÈ

Î¿ÓÈ˙·Ó ÂÚÈÛÛfiÙÂÚÔ ·fi ¤Ó· ÙÛÈÁ¿ÚÔ ÙËÓ ËÌ¤Ú·, ÁÈ· ‰È¿-

ÛÙËÌ· ÌÂÁ·Ï‡ÙÂÚÔ ÙˆÓ ÙÚÈÒÓ Û˘ÓÂ¯fiÌÂÓˆÓ ÌËÓÒÓ.

™ˆÌ·ÙÔÌÂÙÚ‹ÛÂÈ˜

™Â 1209 ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ ÌÂÙÚ‹ıËÎÂ ÙÔ ‚¿ÚÔ˜, ÙÔ

‡„Ô˜ (ÛÂ ‡ÙÈ· ı¤ÛË ÁÈ· ·È‰È¿ ËÏÈÎ›·˜ <6 ÂÙÒÓ) Î·È Ë ÂÚ›-

ÌÂÙÚÔ˜ Ì¤ÛË˜ Î·È ÏÂÎ¿ÓË˜, ÂÓÒ ÂÎÙÈÌ‹ıËÎ·Ó ÔÈ ‰Â›ÎÙÂ˜ Â-

ÚÈÌ¤ÙÚÔ˘ Ì¤ÛË˜ ÚÔ˜ ÏÂÎ¿ÓË, ÂÚÈÌ¤ÙÚÔ˘ Ì¤ÛË˜ ÚÔ˜ ‡„Ô˜

Î·È Ô ¢Â›ÎÙË˜ ª¿˙·˜ ™ÒÌ·ÙÔ˜ (¢ª™) ˆ˜ ÎÈÏ¿ ÚÔ˜ ÙÔ ‡„Ô˜

ÛÂ Ì¤ÙÚ· ÛÙÔ ÙÂÙÚ¿ÁˆÓÔ (kg/m2). ¶Ï‹ÚË˜ ÂÚÈÁÚ·Ê‹ ÙˆÓ ÌÂ-

ıfi‰ˆÓ Ì¤ÙÚËÛË˜ ·Ó·Ê¤ÚÂÙ·È ÛÂ ÚÔËÁÔ‡ÌÂÓÂ˜ ‰ËÌÔÛÈÂ˘Ì¤-

ÓÂ˜ ÌÂÏ¤ÙÂ˜ (19,22).

°È· ÙÔÓ Î·ıÔÚÈÛÌfi ÙˆÓ ˘¤Ú‚·ÚˆÓ Î·È ·¯‡Û·ÚÎˆÓ ·È-

‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ, ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ô ‰È·¯ˆÚÈÛÌfi˜ ÙÔ˘ ¢ª™,

Ô˘ ·ÓÙÈÛÙÔÈ¯Â› ÛÂ fiÚÈ· ≤25 kg/m2, 25,1 kg/m2 ¤ˆ˜ 30 kg/m2

Î·È ≥30 kg/m2 (23).

ª¤ÙÚËÛË ·ÚÙËÚÈ·Î‹˜ ›ÂÛË˜ ·›Ì·ÙÔ˜

∏ ·ÚÙËÚÈ·Î‹ ›ÂÛË ÌÂÙÚ‹ıËÎÂ ÛÂ 1209 ·È‰È¿ Î·È ÂÊ‹-

‚Ô˘˜, ÛÂ Î·ıÈÛÙ‹ ı¤ÛË Î·È ÌÂÙ¿ ·fi ·Ó¿·˘ÛË 5-10 ÏÂÙÒÓ,

ÌÂ ˘‰Ú·ÚÁ˘ÚÈÎfi ÛÊ˘ÁÌÔÌ·ÓfiÌÂÙÚÔ Î·Ù¿ÏÏËÏÔ ÛÂ Ì¤ÁÂıÔ˜

ÂÚÈ¯ÂÈÚ›‰Ô˜, Î·Ï‡ÙÔÓÙ·˜ ÙÔ 50-75% ÙË˜ ÂÚÈÌ¤ÙÚÔ˘ ÙÔ˘

‰ÂÍÈÔ‡ ‚Ú·¯›ÔÓ·. O ÚÒÙÔ˜ Î·È ¤ÌÙÔ˜ ÙfiÓÔ˜ Korotkoff

·ÔÙ¤ÏÂÛ·Ó, ·ÓÙÈÛÙÔ›¯ˆ˜, ÙË Û˘ÛÙÔÏÈÎ‹ Î·È ‰È·ÛÙÔÏÈÎ‹ ·Ú-

ÙËÚÈ·Î‹ ›ÂÛË, Ô˘ ÌÂÙÚ‹ıËÎ·Ó ÙÚÂÈ˜ ÊÔÚ¤˜ ÌÂ ÌÂÛÔ‰È¿ÛÙË-

Ì· 1-2 ÏÂÙÒÓ Î·È ÂÏ‹ÊıË Ô Ì¤ÛÔ˜ fiÚÔ˜ ÙˆÓ ÌÂÙÚ‹ÛÂˆÓ

(ÚˆÙfiÎÔÏÏÔ MONICA) (18).

§‹„Ë ·›Ì·ÙÔ˜ Î·È ‚ÈÔ¯ËÌÈÎ¤˜ ·Ó·Ï‡ÛÂÈ˜

∞ÈÌÔÏË„›· Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ ÛÂ 1209 ·È‰È¿ Î·È ÂÊ‹-

‚Ô˘˜ ÙÈ˜ ÚÒÙÂ˜ ÚˆÈÓ¤˜ ÒÚÂ˜, ÛÂ ‡ÙÈ· ı¤ÛË, ÌÂÙ¿ ·fi

12ˆÚË ÓËÛÙÂ›·.

∂Ï‹ÊıËÛ·Ó ‰Â›ÁÌ·Ù· ÙˆÓ 10 ml ÛÂ ÛˆÏËÓ¿ÚÈ· ¯ˆÚ›˜

·ÓÙÈËÎÙÈÎfi ÁÈ· ÙÔÓ ‰È·¯ˆÚÈÛÌfi ÙÔ˘ ÔÚÔ‡ Î·È ÙÔÔıÂÙ‹ıË-

Î·Ó ÛÂ ÊÔÚËÙfi „˘ÁÂ›Ô ÌÂ ·ÁÔÎ‡ÛÙÂ˜, ÒÛÙÂ Ó· ‰È·ÙËÚË-

ıÔ‡Ó ÛÂ ıÂÚÌÔÎÚ·Û›· 3-4ÔC. ªÂÙ·Ê¤ÚıËÎ·Ó ÂÓÙfi˜ 2-4

ˆÚÒÓ ÛÙ· ÂÚÁ·ÛÙ‹ÚÈ· ÙË˜ ∫ÏÈÓÈÎ‹˜ Î·È ·Ì¤Ûˆ˜ Ê˘ÁÔÎÂ-

ÓÙÚ‹ıËÎ·Ó ÛÂ 4000 rpm ÁÈ· 15 ÏÂÙ¿, ÂÓÒ ÛÂ Ï·ÛÙÈÎ¿ Ûˆ-

ÏËÓ¿ÚÈ· Eppendorf ‰È·¯ˆÚ›ÛÙËÎÂ Ô ÔÚfi˜. ¶ÂÚÈÛÛfiÙÂÚÂ˜ ÏÂ-

ÙÔÌ¤ÚÂÈÂ˜ ÁÈ· ÙÔÓ ˘ÔÏÔÁÈÛÌfi ÙÔ˘ Û·Î¯¿ÚÔ˘ Î·È ÙˆÓ ‚ÈÔ-

¯ËÌÈÎÒÓ ‰ÂÈÎÙÒÓ (ÔÏÈÎ‹ ¯ÔÏËÛÙÂÚfiÏË, ÙÚÈÁÏ˘ÎÂÚÈ‰›·,

HDL-C, LDL-C) Î·È ÙˆÓ ·ıËÚˆÌ·ÙÈÎÒÓ ‰ÂÈÎÙÒÓ (ÔÏÈÎ‹ ¯Ô-

ÏËÛÙÂÚfiÏË ÚÔ˜ HDL-C Î·È LDL-C ÚÔ˜ HDL-C) ·Ó·Ê¤-

ÚÔÓÙ·È ÛÂ ¿ÏÏÂ˜ ‰ËÌÔÛÈÂ˘Ì¤ÓÂ˜ ÌÂÏ¤ÙÂ˜ (18-22).

ŒÏÂÁ¯Ô˜ Ê˘ÛÈÎ‹˜ Î·Ù¿ÛÙ·ÛË˜

∏ Ê˘ÛÈÎ‹ Î·Ù¿ÛÙ·ÛË Î·È Ë Î·Ú‰ÈÔ·Ó·ÓÂ˘ÛÙÈÎ‹ ·ÓÙÔ¯‹

ÂÏ¤Á¯ıËÎ·Ó ÛÂ 433 ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ ÌÂ ÙÔ ·Ï›Ó‰ÚÔÌÔ

ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜ (20). ∆· ·È‰È¿ Î·È ÔÈ ¤ÊË‚ÔÈ Û¯ËÌ¿ÙÈ˙·Ó

ÔÌ¿‰Â˜ ÙˆÓ 5 ·ÙfiÌˆÓ Î·È Î·ÏÔ‡ÓÙ·Ó Ó· ‰È·Ó‡ÛÔ˘Ó Ì›· ·fi-

ÛÙ·ÛË 20 Ì¤ÙÚˆÓ ÌÂÙ·Í‡ ‰‡Ô ÁÚ·ÌÌÒÓ, fiÛÔ ÙÔ ‰˘Ó·ÙfiÓ ÈÔ

ÔÏÏ¤˜ ÊÔÚ¤˜. √ Ú˘ıÌfi˜ ÁÈ· ÙËÓ Ù·¯‡ÙËÙ· ‰ÈÓfiÙ·Ó ·fi ¤Ó·

Ì·ÁÓËÙÔÊˆÓËÌ¤ÓÔ Ë¯ËÙÈÎfi Û‹Ì·, ÙÔ˘ ÔÔ›Ô˘ Ô Ú˘ıÌfi˜ ÛÙ·-

‰È·Î¿ ·˘Í·ÓfiÙ·Ó. ∏ Û˘ÌÏ‹ÚˆÛË Û˘ÁÎÂÎÚÈÌ¤ÓÔ˘ ·ÚÈıÌÔ‡

‰È·‰ÚÔÌÒÓ ·ÓÙÈÛÙÔÈ¯Ô‡ÛÂ ÛÂ ¤Ó· ÛÙ¿‰ÈÔ. ø˜ ÙÂÏÈÎ‹ ‚·ıÌÔ-

ÏÔÁ›· Î·Ù·ÁÚ¿ÊËÎ·Ó Ù· ÛÙ¿‰È· Ô˘ Î·Ù¿ÊÂÚ·Ó Ó· ‰È·Ó‡-

ÛÔ˘Ó Ù· ·È‰È¿-¤ÊË‚ÔÈ Û˘ÓÂ¯fiÌÂÓ· Î·È Ì¤Û· ÛÙÔÓ Ú˘ıÌfi

Ô˘ Â¤‚·ÏÂ ÙÔ Ë¯ËÙÈÎfi Û‹Ì·.

¢È·ÈÙËÙÈÎfi ÈÛÙÔÚÈÎfi

∏ Ï‹„Ë ‰È·ÈÙËÙÈÎÔ‡ ÈÛÙÔÚÈÎÔ‡ ÙÂÏÂ˘Ù·›Ô˘ 24ÒÚÔ˘ ¤ÁÈ-

ÓÂ ÌÂ Û˘Ó¤ÓÙÂ˘ÍË ·fi ‰È·ÈÙÔÏfiÁÔ ÛÂ 1124 ·È‰È¿ Î·È ÂÊ‹-

‚Ô˘˜. ∫·Ù¿ ÙË ‰È·‰ÈÎ·Û›· ÙˆÓ Û˘ÓÂÓÙÂ‡ÍÂˆÓ, ÁÈ· ÙÔÓ ÚÔÛ-

‰ÈÔÚÈÛÌfi ÙË˜ ÔÛfiÙËÙ·˜ Î·Ù·Ó¿ÏˆÛË˜ ÙÚÔÊ›ÌˆÓ (ÛÂ ÁÚ·Ì-

Ì¿ÚÈ·), ·ÚÔ˘ÛÈ¿˙ÔÓÙ·Ó ÌÔÓÙ¤Ï· ÙÚÔÊ›ÌˆÓ, ÂÓÒ ÁÈ· Ù·

·È‰È¿ ËÏÈÎ›·˜ ÌÈÎÚfiÙÂÚË˜ ÙˆÓ 8 ÂÙÒÓ, Ë Ï‹„Ë ÙÔ˘ ÈÛÙÔÚÈ-

ÎÔ‡ ¤ÁÈÓÂ Î·È ÌÂ ÙË Û˘ÓÂÚÁ·Û›· ÙˆÓ ÁÔÓ¤ˆÓ. ∏ ·Ó¿Ï˘ÛË ÙˆÓ

‰È·ÈÙÔÏÔÁ›ˆÓ ¤ÁÈÓÂ ·fi ÙËÓ ∏ÏÂÎÙÚÔÓÈÎ‹ µ¿ÛË ∆ÚÔÊ›ÌˆÓ

ÙË˜ ∫ÏÈÓÈÎ‹˜ (24).

¶›Ó·Î·˜ 1. ¶ÂÚÈÁÚ·ÊÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ ÌÂÏ¤ÙË˜ ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘

√Ì¿‰Â˜ ÌÂÏ¤ÙË˜ ¡* ª¤ÙÚËÛË ·Ú·ÁfiÓÙˆÓ ∞ÁfiÚÈ· ∫ÔÚ›ÙÛÈ· ∏ÏÈÎ›· ŒÙÔ˜ (% Û˘ÌÌ.) ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘** ÂÍ¤Ù·ÛË˜

ª·ıËÙ¤˜ ¢‹ÌÔ˘ ƒÔ‡‚· 192 (94) 188 89 99 4-16 2001ª·ıËÙ¤˜ Ã·Ó›ˆÓ 303 (68) 246 103 143 14-17 2002¡‹È· ¢‹ÌÔ˘ ÃÂÚÛÔÓ‹ÛÔ˘ 110 (63) 89 46 43 3-7 2003¡‹È· Î·È Ì·ıËÙ¤˜ 779 (67) 686 304 382 3-17,5 2003¢ÂÈÏÈÓÒÓ ∏Ú·ÎÏÂ›Ô˘ & ¢‹ÌÔ˘ ∆˘Ï›ÛÛÔ˘™‡ÓÔÏÔ 1381 1209 542 667 3-17ó

* ¶·È‰È¿ Ô˘ Û˘ÌÌÂÙÂ›¯·Ó ÛÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë ÌÂÏ¤ÙË Î·È ÔÛÔÛÙfi Û˘ÌÌÂÙÔ¯‹˜ ÙÔ˘˜ (ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ Ì·ıËÙÒÓ ÛÙ· Û¯ÔÏÂ›· ÙÔ˘˜) ** ¶·È‰È¿ Ô˘ Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË

26 ª. §ÈÓ·Ú‰¿ÎË˜ Î·È Û˘Ó.


°È· ÙËÓ ·ÍÈÔÏfiÁËÛË ÙË˜ ‰È·ÙÚÔÊ‹˜, ˘ÔÏÔÁ›ÛÙËÎ·Ó Ù·

ÚÔÛÏ·Ì‚·ÓfiÌÂÓ· ıÚÂÙÈÎ¿ Û˘ÛÙ·ÙÈÎ¿, Î·ıÒ˜ Î·È 16 ÔÌ¿-

‰Â˜ Î·Ù·Ó¿ÏˆÛË˜ ÙÚÔÊ›ÌˆÓ. ∂›ÛË˜, ÂÎÙÈÌ‹ıËÎ·Ó Ô ¢Â›ÎÙË˜

ÀÁÈÂÈÓ‹˜ ¢È·ÙÚÔÊ‹˜ (¢À¢) (25,26) Î·È Ù· ÔÛÔÛÙ¿ ·ÓÂ·Ú-

ÎÔ‡˜ ıÚ¤„Ë˜ ·fi ÙÈ˜ ËÌÂÚ‹ÛÈÂ˜ Û˘ÓÈÛÙÒÌÂÓÂ˜ ÔÛfiÙËÙÂ˜

(∏™¶) ÚfiÛÏË„Ë˜ ıÚÂÙÈÎÒÓ Û˘ÛÙ·ÙÈÎÒÓ.

√ ¢À¢ (¶›Ó·Î·˜ 2) ·ÔÙÂÏÂ› Ì¤ıÔ‰Ô ÔÈÔÙÈÎ‹˜ ·ÍÈÔÏfiÁË-

ÛË˜ ÙË˜ ËÌÂÚ‹ÛÈ·˜ ‰È·ÙÚÔÊ‹˜ ·ÙfiÌˆÓ ËÏÈÎ›·˜ ¿Óˆ ÙˆÓ 2 ÂÙÒÓ

Î·È ÂÎÙÈÌ¿Ù·È ·fi ‰È·ÈÙÔÏfiÁÈÔ Î·Ù·ÁÚ·Ê‹˜ ÙÂÏÂ˘Ù·›Ô˘

24ÒÚÔ˘ (25,26). Œ¯ÂÈ Û¯Â‰È·ÛÙÂ› ·fi ÙÔ USDA ÌÂ ‚¿ÛË ÙÈ˜ ‰È-

·ÈÙËÙÈÎ¤˜ Ô‰ËÁ›Â˜ Ô˘ ·Â˘ı‡ÓÔÓÙ·È ÚÔ˜ ÙÔ˘˜ ∞ÌÂÚÈÎ·ÓÔ‡˜

(27), ÂÊ·ÚÌfi˙ÂÙ·È fiÌˆ˜ Î·È ÛÂ ÌÂÛÔÁÂÈ·ÎÔ‡˜ ÏËı˘ÛÌÔ‡˜

(28) Î·È ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙÂ› ÌÂ ÙÔ˘˜ ‚ÈÔÏÔÁÈÎÔ‡˜ ‰Â›ÎÙÂ˜ ÙˆÓ ÏÈ-

ÔÚˆÙÂ˚ÓÒÓ Î·È ÙËÓ ·¯˘Û·ÚÎ›· (29,30). √ ¢À¢ ·ÔÙÂÏÂ›

‰È·‚¿ıÌÈÛË ‚·ıÌÔÏÔÁ›·˜ ÛÂ ÎÏ›Ì·Î· ÌÂ ¯Â›ÚÈÛÙË ÙÈÌ‹ 0 Î·È

¿ÚÈÛÙË 100. ∆ÈÌ¤˜ <51 ·ÍÈÔÏÔÁÔ‡Ó ÙË ‰È·ÙÚÔÊ‹ ˆ˜ “·ÓÂ·Ú-

Î‹”, 51-80 ‰ËÏÒÓÔ˘Ó fiÙÈ “¯ÚÂÈ¿˙ÂÙ·È ‚ÂÏÙ›ˆÛË” Î·È ÙÈÌ¤˜ 81-

100 ¯·Ú·ÎÙËÚ›˙Ô˘Ó ÙË ‰È·ÙÚÔÊ‹ ˆ˜ “Î·Ï‹”. ∏ ‚·ıÌÔÏÔÁ›·

ÚÔÎ‡ÙÂÈ ·fi ÙÔ ¿ıÚÔÈÛÌ· ‰¤Î· Û˘ÓÈÛÙˆÛÒÓ, ÔÈ ÔÔ›Â˜ ¯ˆ-

Ú›˙ÔÓÙ·È ÛÂ ÙÚÂÈ˜ Î‡ÚÈÂ˜ ÔÌ¿‰Â˜ Î·È ÂÓ¤¯Ô˘Ó ‰È·‚·ıÌÈÛÌ¤ÓË

‚·ıÌÔÏÔÁ›· ÌÂ ¯Â›ÚÈÛÙË ÙÈÌ‹ 0 Î·È ¿ÚÈÛÙË 10.

∏ ÚÒÙË Î‡ÚÈ· ÔÌ¿‰· ·ÊÔÚ¿ ÛÙËÓ Î·Ù·Ó¿ÏˆÛË ÙÚÔÊ›ÌˆÓ

Î·È ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÈ˜ Û˘ÓÈÛÙÒÛÂ˜: ‰ËÌËÙÚÈ·Î¿ („ˆÌ›, Ú‡˙È,

‰ËÌËÙÚÈ·Î¿, ˙˘Ì·ÚÈÎ¿), Ï·¯·ÓÈÎ¿, ÊÚÔ‡Ù·, Á·Ï·ÎÙÔÎÔÌÈÎ¿

(Á¿Ï·, ÁÈ·Ô‡ÚÙÈ, Ù˘Ú›) Î·È ÎÚ¤·˜ (ÎÚ¤·˜, Ô˘ÏÂÚÈÎ¿, ÍËÚ¿ Ê·-

ÛfiÏÈ·, „¿ÚÈ, ·˘Á¿, ÍËÚÔ› Î·ÚÔ›). ∏ ‰Â‡ÙÂÚË ·ÊÔÚ¿ ÛÙËÓ Úfi-

ÛÏË„Ë ıÚÂÙÈÎÒÓ Û˘ÛÙ·ÙÈÎÒÓ Î·È ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÈ˜ Û˘ÓÈÛÙÒ-

ÛÂ˜: ÔÏÈÎfi Î·È ÎÔÚÂÛÌ¤ÓÔ Ï›Ô˜ ˆ˜ ÔÛÔÛÙ¿ ÂÓ¤ÚÁÂÈ·˜, ¯ÔÏË-

ÛÙÂÚfiÏË ÙÚÔÊ‹˜ Î·È Ó¿ÙÚÈÔ. ∆¤ÏÔ˜, Ë ÙÚ›ÙË ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ

Î·Ù·Ó¿ÏˆÛË ÔÈÎÈÏ›·˜ ÙÚÔÊ›ÌˆÓ Î·È ˘ÔÏÔÁ›˙ÂÙ·È ·fi ‰È·-

ÊÔÚÂÙÈÎ¿ ˆ˜ ÚÔ˜ ÙÔ Â›‰Ô˜ ÙÔ˘˜ ÙÚfiÊÈÌ·.

∏ ·fi‰ÔÛË ‚·ıÌÔÏÔÁ›·˜ ·fi 0 ¤ˆ˜ 10 ‰È·Ê¤ÚÂÈ ÛÂ Î¿ıÂ

Ì›· Û˘ÓÈÛÙÒÛ· Î·È Â›Ó·È ·Ó¿ÏÔÁË ÙˆÓ ÌÂÚ›‰ˆÓ, Ô˘ ˘ÔÏÔÁ›-

˙ÔÓÙ·È ÛÂ ÁÚ·ÌÌ¿ÚÈ·, ÙˆÓ ÔÚ›ˆÓ ÚfiÛÏË„Ë˜ ıÚÂÙÈÎÒÓ Û˘-

ÛÙ·ÙÈÎÒÓ Î·È ÙÔ˘ ·ÚÈıÌÔ‡ Î·Ù·Ó¿ÏˆÛË˜ ‰È·ÊÔÚÂÙÈÎÒÓ ÙÚÔ-

Ê›ÌˆÓ ÛÙÈ˜ ÙÚÂÈ˜ Î‡ÚÈÂ˜ ÔÌ¿‰Â˜, ·ÓÙÈÛÙÔ›¯ˆ˜. ¶ÈÔ Û˘ÁÎÂÎÚÈ-

Ì¤Ó·, ÛÙËÓ ÚÒÙË Î‡ÚÈ· ÔÌ¿‰·, Ë ¯Â›ÚÈÛÙË ÙÈÌ‹ 0 ·Ô‰›‰ÂÙ·È

ÛÙË ÌË‰ÂÓÈÎ‹ Î·Ù·Ó¿ÏˆÛË ÌÂÚ›‰ˆÓ. ∆Ô ¿ÚÈÛÙ· 10, ·ÓÙÈÛÙÔÈ-

¯Â› ÛÂ Î·Ù·Ó¿ÏˆÛË 6-11 ÌÂÚ›‰ˆÓ ‰ËÌËÙÚÈ·ÎÒÓ, 3-5 Ï·¯·ÓÈ-

ÎÒÓ, 2-4 ÊÚÔ‡ÙˆÓ, 2-3 Á·Ï·ÎÙÔÎÔÌÈÎÒÓ Î·È 2-3 ÎÚ¤·ÙÔ˜. √È

ÌÂÚ›‰Â˜ ·˘Ù¤˜ Î·ıÔÚ›˙ÔÓÙ·È Î·È Â›Ó·È ·Ó¿ÏÔÁÂ˜ ·fi ÙËÓ Î·-

Ù¿ Ê‡ÏÔ Î·È ËÏÈÎ›· ËÌÂÚ‹ÛÈ· Û˘ÓÈÛÙÒÌÂÓË ÂÓ¤ÚÁÂÈ· Î·È Î·-

Ù·Ó¿ÏˆÛË ÙÚÔÊ›ÌˆÓ (¶›Ó·Î·˜ 2) (25). ™ÙË ‰Â‡ÙÂÚË Î‡ÚÈ·

ÔÌ¿‰·, ¯Â›ÚÈÛÙË ÙÈÌ‹ 0 ·Ô‰›‰ÂÙ·È ÛÙËÓ ÚfiÛÏË„Ë ÔÏÈÎÔ‡

Ï›Ô˘˜ ≥45% ÙË˜ ÚÔÛÏ·Ì‚·ÓfiÌÂÓË˜ ÂÓ¤ÚÁÂÈ·˜, ÎÔÚÂÛÌ¤-

ÓÔ˘ Ï›Ô˘˜ ≥15%, ¯ÔÏËÛÙÂÚfiÏË˜ ÙÚÔÊ‹˜ ≥450 mg Î·È Ó·ÙÚ›-

Ô˘ ≥4800 mg. ÕÚÈÛÙ· 10 ·Ô‰›‰ÂÙ·È ÛÙËÓ ÚfiÛÏË„Ë ÔÏÈÎÔ‡

Ï›Ô˘˜ ≤30% ÙË˜ ÂÓ¤ÚÁÂÈ·˜, ÎÔÚÂÛÌ¤ÓÔ˘ Ï›Ô˘˜ <10%, ¯Ô-

ÏËÛÙÂÚfiÏË˜ ÙÚÔÊ‹˜ ≤300 mg Î·È Ó·ÙÚ›Ô˘ ≤2400 mg. ∆¤ÏÔ˜,

ÛÙËÓ ÙÚ›ÙË Î‡ÚÈ· ÔÌ¿‰·, ¯Â›ÚÈÛÙË ÙÈÌ‹ 0 ·Ô‰›‰ÂÙ·È fiÙ·Ó Ë

Î·Ù·Ó¿ÏˆÛË ‰ÂÓ ˘ÂÚ‚·›ÓÂÈ Ù· ÙÚ›· ‰È·ÊÔÚÂÙÈÎ¿ Â›‰Ë ÙÚÔ-

Ê›ÌˆÓ, ÂÓÒ ¿ÚÈÛÙË 10 fiÙ·Ó Ë Î·Ù·Ó¿ÏˆÛË Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË

‹ ›ÛË ÙˆÓ 8 ‰È·ÊÔÚÂÙÈÎÒÓ ÙÚÔÊ›ÌˆÓ.

∫·È ÛÙÈ˜ ‰¤Î· Û˘ÓÈÛÙÒÛÂ˜ ÙÔ˘ ¢À¢, Ë ‚·ıÌÔÏÔÁ›· ÁÈ· ÙÈ˜

ÂÓ‰È¿ÌÂÛÂ˜ ÙÈÌ¤˜ ÙË˜ ¯Â›ÚÈÛÙË˜ Î·È ÙË˜ ¿ÚÈÛÙË˜ ˘ÔÏÔÁ›˙ÂÙ·È

·Ó·ÏÔÁÈÎ¿.

∆¤ÏÔ˜, ·fi ÙÈ˜ ∏™¶ ÚfiÛÏË„Ë˜ ÙˆÓ ıÚÂÙÈÎÒÓ Û˘ÛÙ·ÙÈ-

ÎÒÓ (31), ˘ÔÏÔÁ›ÛÙËÎ·Ó, ·Ó¿ Ê‡ÏÔ Î·È ËÏÈÎ›·, Ù· fiÚÈ· ÙÔ˘

67%, Ô˘ Î·ıÔÚ›˙Ô˘Ó ÙËÓ ·ÓÂ·ÚÎ‹ ıÚ¤„Ë.

ŸÚÈ· ·Ú·ÁfiÓÙˆÓ ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘

™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó fiÚÈ· ÙˆÓ ·-

Ú·ÁfiÓÙˆÓ ªÂÙ™˘Ó Ô˘ Î·ıÔÚ›˙ÔÓÙ·È ·fi ÙÔ Ê‡ÏÔ Î·È ÙËÓ

ËÏÈÎ›· (2,32). ∆· fiÚÈ· ÙˆÓ ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ Î·È ÙË˜ ÂÚÈÌ¤-

ÙÚÔ˘ Ì¤ÛË˜ ·ÊÔÚÔ‡Ó ÙËÓ 90‹ ÂÎ·ÙÔÛÙÈ·›· ı¤ÛË Î·È ÙË 10Ë

ÁÈ· ÙËÓ HDL-C (32). ∂›ÛË˜, ÂÂÈ‰‹ Ë Û˘ÛÙÔÏÈÎ‹ Î·È ‰È·ÛÙÔ-

ÏÈÎ‹ ·ÚÙËÚÈ·Î‹ ›ÂÛË Û˘ÓÂÎÙÈÌÒÓÙ·È ˆ˜ ¤Ó·˜ ÎÔÈÓfi˜ ·Ú¿-

ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘, ˆ˜ ·ıÔÏÔÁÈÎ‹ ıÂˆÚ‹ıËÎÂ Ë ˘¤Ú‚·ÛË

ÙÔ˘ ÔÚ›Ô˘, Â›ÙÂ ÙË˜ Û˘ÛÙÔÏÈÎ‹˜ Â›ÙÂ ÙË˜ ‰È·ÛÙÔÏÈÎ‹˜. ∆· fiÚÈ·

·˘Ù¿ ·ÊÔÚÔ‡Û·Ó ÛÙËÓ ÂÈÏÔÁ‹ ÙË˜ 90‹˜ ÂÎ·ÙÔÛÙÈ·›·˜ ı¤ÛË˜

Ô˘ ·ÓÙÈÛÙÔÈ¯Â› ÛÙËÓ 50‹ ÂÎ·ÙÔÛÙÈ·›· ı¤ÛË ÙÔ˘ ·Ó·ÛÙ‹Ì·-

ÙÔ˜ (2,33). ∆¤ÏÔ˜, ˆ˜ fiÚÈÔ ÁÈ· ÙÔ Û¿Î¯·ÚÔ ÔÚÔ‡ ·›Ì·ÙÔ˜ Î·-

ıÔÚ›ÛÙËÎ·Ó Ù· 100 mg/dl (2).

™Ù·ÙÈÛÙÈÎ‹ ·Ó¿Ï˘ÛË

°È· ÙË ÛÙ·ÙÈÛÙÈÎ‹ ·Ó¿Ï˘ÛË ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ ÙÔ ÚfiÁÚ·Ì-

Ì· SPSS 12.0. ÃÚËÛÈÌÔÔÈ‹ıËÎ·Ó Ì¤ıÔ‰ÔÈ ·Ó¿Ï˘ÛË˜ ÛÂ ÛÙÚˆ-

Ì·ÙÔÔÈËÌ¤Ó· ‰Â‰ÔÌ¤Ó·, ÂÏ¤Á¯ÔÓÙ·˜ Î·È ÁÈ· ÙËÓ Â›‰Ú·ÛË

Û˘Á¯˘ÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ (34), Î·ıÒ˜ ÙÔ ‰Â›ÁÌ· ÌÂÏ¤ÙË˜ ‰È·-

¯ˆÚ›ÛÙËÎÂ ÛÂ ÔÌ¿‰Â˜ ËÏÈÎÈÒÓ, fiˆ˜ 3-6, 6ó-10, 10ó-14 Î·È

14ó-17ó ÂÙÒÓ.

ªÂ ÙÔÓ ¤ÏÂÁ¯Ô χ2 (Chi-square test) ÂÏ¤Á¯ıËÎÂ Ë ‡·ÚÍË

‰È·ÊÔÚ¿˜ ÛÙËÓ Î·Ù·ÓÔÌ‹ ÙÔ˘ ·ÚÈıÌÔ‡ Û˘ÁÎ¤ÓÙÚˆÛË˜ ·Ú·-

ÁfiÓÙˆÓ ªÂÙ™˘Ó ˆ˜ ÚÔ˜ ÙÔ Ê‡ÏÔ Î·È ÙÈ˜ ∏™¶ ÚfiÛÏË„Ë˜

ıÚÂÙÈÎÒÓ Û˘ÛÙ·ÙÈÎÒÓ, Î·ıÒ˜ Î·È Ë ‡·ÚÍË ÁÚ·ÌÌÈÎ‹˜ Ù¿-

ÛË˜ (linear trend) ˆ˜ ÚÔ˜ ÙÈ˜ ÔÌ¿‰Â˜ ËÏÈÎÈÒÓ Î·È ÙÔÓ ·ÚÈı-

Ìfi Û˘ÁÎ¤ÓÙÚˆÛË˜ ·Ú·ÁfiÓÙˆÓ ªÂÙ™˘Ó.

ªÂ ÙÔÓ ¤ÏÂÁ¯Ô Student t (equal variances not assumed)

ÂÏ¤Á¯ıËÎÂ Ë ‰È·ÊÔÚÔÔ›ËÛË ÙË˜ ‚·ıÌÔÏÔÁ›·˜ ÙˆÓ Û˘ÓÈÛÙˆ-

ÛÒÓ Î·È ÙÔ˘ ¢À¢ ÛÙ· ‰‡Ô Ê‡Ï· ÌÂÙ·Í‡ ÙˆÓ ËÏÈÎÈÒÓ 3-6 Î·È

14ó-17ó ÂÙÒÓ. ¶·ÚÔÌÔ›ˆ˜, ÌÂ ÙÔÓ ¤ÏÂÁ¯Ô Mann-Whitney

¤ÁÈÓÂ Û‡ÁÎÚÈÛË ÙË˜ Î·Ù·Ó¿ÏˆÛË˜ ÙÚÔÊ›ÌˆÓ ÌÂÙ·Í‡ ·È‰ÈÒÓ

Î·È ÂÊ‹‚ˆÓ ¯ˆÚ›˜ ·Ú¿ÁÔÓÙÂ˜ ªÂÙ™˘Ó Î·È ÂÎÂ›ÓˆÓ ÌÂ

ªÂÙ™˘Ó.

ªÂ ÙË Ì¤ıÔ‰Ô ·Ó¿Ï˘ÛË˜ Û˘Ó‰È·Î‡Ì·ÓÛË˜ (ANCOVA)

ÂÎÙÈÌ‹ıËÎÂ Ë ‡·ÚÍË ÁÚ·ÌÌÈÎ‹˜ Ù¿ÛË˜ (linear trend) ÛÙËÓ

ÚfiÛÏË„Ë ıÚÂÙÈÎÒÓ Û˘ÛÙ·ÙÈÎÒÓ Î·È ÛÙË ‚·ıÌÔÏÔÁ›· ÙÔ˘

¢À¢ Î·È ÙˆÓ Û˘ÓÈÛÙˆÛÒÓ ÙÔ˘, ˆ˜ ÚÔ˜ ÙÔÓ ·ÚÈıÌfi Û˘ÁÎ¤-

ÓÙÚˆÛË˜ ·Ú·ÁfiÓÙˆÓ ªÂÙ™˘Ó. ø˜ Û˘ÌÌÂÙ·‚ÏËÙ¤˜ ¯ÚËÛÈÌÔ-

ÔÈ‹ıËÎ·Ó ÙÔ Ê‡ÏÔ, Ë ËÏÈÎ›· Î·È Ô ¢ª™, ÂÓÒ Ë ÂÙÂÚÔÁ¤ÓÂÈ·

ÂÏ¤Á¯ıËÎÂ ÌÂ ÙË Ì¤ıÔ‰Ô Levene (Levene’s test).

∆¤ÏÔ˜, ÁÈ· ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ ÌÂ ªÂÙ™˘Ó, ÂÎÙÈÌ‹ıËÎ·Ó

ÌÂ ÙË Ì¤ıÔ‰Ô ·Ó¿Ï˘ÛË˜ ÏÔÁÈÛÙÈÎ‹˜ ·ÏÈÓ‰ÚfiÌËÛË˜ (Logistic

linear regression), ÔÈ ÏfiÁÔÈ Û˘ÌÏËÚˆÌ·ÙÈÎÒÓ Èı·ÓÔÙ‹ÙˆÓ ‹

Û¯ÂÙÈÎÔ› Î›Ó‰˘ÓÔÈ (Odds Ratio) Î·È Ù· 95% ¢È·ÛÙ‹Ì·Ù· ∂ÌÈ-

ÛÙÔÛ‡ÓË˜. ∏ ÂÎÙ›ÌËÛË ÔÚ›ÛÙËÎÂ ˆ˜ ÚÔ˜ ÂÎÂ›Ó· Ù· ·È‰È¿ Î·È

ÙÔ˘˜ ÂÊ‹‚Ô˘˜ Ô˘ ‰ÂÓ ¤¯Ô˘Ó ·Ú¿ÁÔÓÙÂ˜ ªÂÙ™˘Ó, ÂÓÒ ˆ˜

Û˘ÌÌÂÙ·‚ÏËÙ¤˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÙÔ Ê‡ÏÔ Î·È Ë ËÏÈÎ›·.

ø˜ ÛÙ·ÙÈÛÙÈÎÒ˜ ÌË ÛËÌ·ÓÙÈÎ¤˜ ‰È·ÊÔÚ¤˜ (ª™) ÔÚ›ÛÙËÎ·Ó

Ù· Â›Â‰· ÌÂ p>0,05.

∞ÔÙÂÏ¤ÛÌ·Ù·

Ÿˆ˜ Ê·›ÓÂÙ·È ÛÙÔÓ ¶›Ó·Î· 3, ÛÙË Û˘¯ÓfiÙËÙ·

ÂÌÊ¿ÓÈÛË˜ ·Ú·ÁfiÓÙˆÓ ªÂÙ™˘Ó ‰ÂÓ ‚Ú¤ıËÎÂ ÛÙ·

·ÁfiÚÈ· ÛËÌ·ÓÙÈÎ‹ Ù¿ÛË ·‡ÍËÛË˜ ·Ó¿ÏÔÁ· ÌÂ ÙËÓ

ËÏÈÎ›·. ªÂ ªÂÙ™˘Ó ‚Ú¤ıËÎÂ ÔÛÔÛÙfi 2,5% ÛÙÈ˜

ËÏÈÎ›Â˜ 3-6 ÂÙÒÓ Î·È 4,6% ÛÙÈ˜ ËÏÈÎ›Â˜ 14ó-17ó

ÂÙÒÓ, ÂÓÒ ÛÙ· ÎÔÚ›ÙÛÈ· ‹Ù·Ó 2,9% Î·È 3%, ·ÓÙ›ÛÙÔÈ-

¯·. ™Ù· ÎÔÚ›ÙÛÈ·, ˆÛÙfiÛÔ, ‹Ù·Ó ÛËÌ·ÓÙÈÎ‹ Ë ‰È·ÊÔ-

ÚÔÔ›ËÛË ÛÙËÓ Î·Ù·ÓÔÌ‹ ÙÔ˘˜ ÛÙÈ˜ ÔÌ¿‰Â˜ ËÏÈÎÈÒÓ

ˆ˜ ÚÔ˜ ÙË Û˘¯ÓfiÙËÙ· ÙˆÓ ·Ú·ÁfiÓÙˆÓ ªÂÙ™˘Ó

(p<0,05).


¶·È‰È·ÙÚÈÎ‹ 2007;70:24-36

™˘ÓÔÏÈÎ¿, Ô ÂÈÔÏ·ÛÌfi˜ ÙÔ˘ ªÂÙ™˘Ó ‹Ù·Ó

3,9% ÛÙ· ·È‰È¿ Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜ (4,2% ÛÙ· ·ÁfiÚÈ·

Î·È 3,9% ÛÙ· ÎÔÚ›ÙÛÈ·, ª™).

™‡ÌÊˆÓ· ÌÂ ÙÔÓ ¶›Ó·Î· 4, ÛËÌ·ÓÙÈÎ¤˜ ‰È·ÊÔÚ¤˜

‚Ú¤ıËÎ·Ó ÛÙ· ‰‡Ô Ê‡Ï·, ÌÂÙ·Í‡ ÙˆÓ ËÏÈÎÈÒÓ 3-6 Î·È

14ó-17ó ÂÙÒÓ, ÛÙË ‚·ıÌÔÏÔÁ›· ÚfiÛÏË„Ë˜ ÎÔÚÂ-

ÛÌ¤ÓÔ˘ Ï›Ô˘˜ (·ÁfiÚÈ·: 2,0 ¤Ó·ÓÙÈ 3,9, p<0,001, ÎÔ-

Ú›ÙÛÈ·: 2,2 ¤Ó·ÓÙÈ 3,9, p<0,001), Ó·ÙÚ›Ô˘ (·ÁfiÚÈ·: 9,9

¤Ó·ÓÙÈ 7,8, p<0,001, ÎÔÚ›ÙÛÈ·: 9,8 ¤Ó·ÓÙÈ 9,2,

p<0,001) Î·È ÛÙÔÓ ¢À¢ (·ÁfiÚÈ·: 62,8 ¤Ó·ÓÙÈ 57,8,

p<0,01, ÎÔÚ›ÙÛÈ·: 61,5 ¤Ó·ÓÙÈ 57,5, p<0,05). ∂›ÛË˜,

ÛËÌ·ÓÙÈÎ¿ ÌÂÁ·Ï‡ÙÂÚË ‚·ıÌÔÏÔÁ›· ‚Ú¤ıËÎÂ ÛÙ·

·ÁfiÚÈ· ÌÂÙ·Í‡ ÙˆÓ ËÏÈÎÈÒÓ 3-6 Î·È 14ó-17ó ÂÙÒÓ,

ÛÙËÓ Î·Ù·Ó¿ÏˆÛË ÊÚÔ‡ÙˆÓ (5,8 ¤Ó·ÓÙÈ 4,2, p<0,05),

Á·Ï·ÎÙÔÎÔÌÈÎÒÓ (9,9 ¤Ó·ÓÙÈ 8,6, p<0,001) Î·È ÔÈÎÈ-

Ï›·˜ ÙÚÔÊ›ÌˆÓ (4,8 ¤Ó·ÓÙÈ 6,2, p<0,01).

∏ Û˘ÓÔÏÈÎ‹ Ì¤ÛË ‚·ıÌÔÏÔÁ›· ÙÔ˘ ¢À¢ ‚Ú¤ıËÎÂ

58,7, ÌÂ ÙË ‰È·ÙÚÔÊ‹ ÙË˜ ÏÂÈÔÓfiÙËÙ·˜ ÙˆÓ ·È‰ÈÒÓ

Î·È ÂÊ‹‚ˆÓ Ó· Ù·ÍÈÓÔÌÂ›Ù·È ÛÙËÓ Î·ÙËÁÔÚ›· “¯ÚÂÈ¿-

˙ÂÙ·È ‚ÂÏÙ›ˆÛË”.

¢ÂÓ ‚Ú¤ıËÎÂ ÛËÌ·ÓÙÈÎ‹ Ù¿ÛË ÌÂÙ·‚ÔÏ‹˜ ÌÂ ÙËÓ

·‡ÍËÛË ÙˆÓ ·Ú·ÁfiÓÙˆÓ ÙÔ˘ ªÂÙ™˘Ó ÛÙËÓ Úfi-

ÛÏË„Ë ıÚÂÙÈÎÒÓ Û˘ÛÙ·ÙÈÎÒÓ, ÛÙËÓ Î·Ù·Ó¿ÏˆÛË

ÙÚÔÊ›ÌˆÓ, ÛÙÔÓ ¢À¢ Î·È ÛÙÈ˜ Û˘ÓÈÛÙÒÛÂ˜ ÙÔ˘ (‰Â-

‰ÔÌ¤Ó· ‰ÂÓ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÂ ›Ó·Î·). øÛÙfiÛÔ,

Ù· ·È‰È¿ Î·È ÔÈ ¤ÊË‚ÔÈ ¯ˆÚ›˜ ·Ú¿ÁÔÓÙÂ˜

ªÂÙ™˘Ó, ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÂÎÂ›Ó· ÌÂ ªÂÙ™˘Ó, Â›¯·Ó

ÌÈÎÚfiÙÂÚË Ï‹„Ë ÎÔÚÂÛÌ¤ÓˆÓ ÏÈ·ÚÒÓ ÔÍ¤ˆÓ (31,9

g ¤Ó·ÓÙÈ 34,8 g, ª™) Î·È Î·Ù·Ó¿ÏˆÛË ÎÚ¤·ÙÔ˜ (115

g ¤Ó·ÓÙÈ 146 g, ª™), ÂÓÒ ‚Ú¤ıËÎ·Ó ÌÂ ÌÂÁ·Ï‡ÙÂÚË

Î·Ù·Ó¿ÏˆÛË ÊÚÔ‡ÙˆÓ Î·È Ï·¯·ÓÈÎÒÓ (299 g ¤Ó·ÓÙÈ

244 g, ª™).



¶›Ó·Î·˜ 2. ∫ÚÈÙ‹ÚÈ· Î·È ‚·ıÌÔÏfiÁËÛË Û˘ÓÈÛÙˆÛÒÓ ÙÔ˘ ¢Â›ÎÙË ÀÁÈÂÈÓ‹˜ ¢È·ÙÚÔÊ‹˜ (25)

∫ÚÈÙ‹ÚÈ· ‚·ıÌÔÏfiÁËÛË˜∂Ï¿¯ÈÛÙË (ÌË‰¤Ó) ª¤ÁÈÛÙË (‰¤Î·)

1. √Ì¿‰· ‰ËÌËÙÚÈ·ÎÒÓ 0 ÌÂÚ›‰Â˜ 6-11 ÌÂÚ›‰Â˜(„ˆÌ›, Ú‡˙È, ‰ËÌËÙÚÈ·Î¿, ˙˘Ì·ÚÈÎ¿)

2. §·¯·ÓÈÎ¿ 0 ÌÂÚ›‰Â˜ 3-5 ÌÂÚ›‰Â˜3. ºÚÔ‡Ù· 0 ÌÂÚ›‰Â˜ 2-4 ÌÂÚ›‰Â˜4. √Ì¿‰· Á·Ï·ÎÙÔÎÔÌÈÎÒÓ 0 ÌÂÚ›‰Â˜ 2-3 ÌÂÚ›‰Â˜

(Á¿Ï·, ÁÈ·Ô‡ÚÙÈ, Ù˘Ú›)5. √Ì¿‰· ÎÚ¤·ÙÔ˜ 0 ÌÂÚ›‰Â˜ 2-3 ÌÂÚ›‰Â˜

(ÎÚ¤·˜, Ô˘ÏÂÚÈÎ¿, ÍËÚ¿ Ê·ÛfiÏÈ·, „¿ÚÈ, ·˘Á¿, ÍËÚÔ› Î·ÚÔ›)

6. √ÏÈÎfi Ï›Ô˜ ≥45% ÙË˜ ÂÓ¤ÚÁÂÈ·˜ ≤30% ÙË˜ ÂÓ¤ÚÁÂÈ·˜(% ÂÓ¤ÚÁÂÈ·˜)

7. ∫ÔÚÂÛÌ¤ÓÔ Ï›Ô˜ ≥15% ÙË˜ ÂÓ¤ÚÁÂÈ·˜ <10% ÙË˜ ÂÓ¤ÚÁÂÈ·˜(% ÂÓ¤ÚÁÂÈ·˜)

8. ÃÔÏËÛÙÂÚfiÏË ÙÚÔÊ‹˜ ≥450 mg ≤300 mg9. ¡¿ÙÚÈÔ ≥4800 mg ≤2400 mg10. ¶ÔÈÎÈÏ›· ÙÚÔÊ›ÌˆÓ ≤3 ‰È·ÊÔÚÂÙÈÎ¿ Â›‰Ë ÙÚÔÊ›ÌˆÓ ≥8 ‰È·ÊÔÚÂÙÈÎ¿ Â›‰Ë ÙÚÔÊ›ÌˆÓ

[

™˘ÓÈÛÙÒÌÂÓË ÂÓ¤ÚÁÂÈ· & Û˘ÓÈÛÙÒÌÂÓÂ˜ ÌÂÚ›‰Â˜ ÙÚÔÊ›ÌˆÓ ·Ó¿ ËÌ¤Ú· (USDA, 1996)

∏ÏÈÎ›· ∂Ó¤ÚÁÂÈ· (kcal) ¢ËÌËÙÚÈ·Î¿ §·¯·ÓÈÎ¿ ºÚÔ‡Ù· °·Ï·ÎÙÔÎÔÌÈÎ¿ ∫Ú¤·˜

™˘ÓÈÛÙÒÌÂÓÂ˜ ÌÂÚ›‰Â˜ ·Ó¿ ËÌ¤Ú·

¶·È‰È¿ 2-3 1300 6 3 2 2 24-6 1800 7 3,3 2,3 2 2,1

7-10 2000 7,8 3,7 2,7 2 2,3∞ÁfiÚÈ· 11-14 2500 9,9 4,5 3,5 3 2,6

15-18 3000 11 5 4 3 2,8∫ÔÚ›ÙÛÈ· 11-24 2200 9 4 3 3 2,4

[

ÕıÚÔÈÛÌ· 10 Û˘ÓÈÛÙˆÛÒÓ Î·È Ù·ÍÈÓfiÌËÛË

¢Â›ÎÙË˜ ÀÁÈÂÈÓ‹˜ ¢È·ÙÚÔÊ‹˜<51 51-80 >80

∞ÓÂ·ÚÎ‹˜ ÃÚÂÈ¿˙ÂÙ·È ‚ÂÏÙ›ˆÛË ∫·Ï‹

* √È Û˘ÓÈÛÙÒÛÂ˜ Î·È Ô ¢Â›ÎÙË˜ ÀÁÈÂÈÓ‹˜ ¢È·ÙÚÔÊ‹˜ ÂÎÙÈÌÒÓÙ·È ·fi ‰È·ÈÙÔÏfiÁÈÔ 24ÒÚÔ˘ ** ∏ ‚·ıÌÔÏfiÁËÛË ÌÂÙ·Í‡ ÙË˜ ÂÏ¿¯ÈÛÙË˜ Î·È Ì¤ÁÈÛÙË˜ ÙÈÌ‹˜ (0 ¤ˆ˜ 10) ÂÎÙÈÌ¿Ù·È ·Ó·ÏÔÁÈÎ¿

¶›Ó·Î·˜ 4. ª¤ÛË ‚·ıÌÔÏÔÁ›· Û˘ÓÈÛÙˆÛÒÓ Î·È ¢Â›ÎÙË ÀÁÈÂÈÓ‹˜ ¢È·ÙÚÔÊ‹˜ ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ ˆ˜ ÚÔ˜ ÙÔ Ê‡ÏÔ Î·È ÙÈ˜ ÔÌ¿‰Â˜ ËÏÈÎÈÒÓ

∏ÏÈÎ›· (¤ÙË)

3-6 6ó-10 10ó-14 14ó-17ó ™‡ÓÔÏÔ

™˘ÓÈÛÙÒÛÂ˜ & ‰Â›ÎÙË˜ º‡ÏÔ ª¤ÛË ÙÈÌ‹ ± ∆˘ÈÎ‹ ·fiÎÏÈÛË

1. √Ì¿‰· ‰ËÌËÙÚÈ·ÎÒÓ ∞ÁfiÚÈ· 6,4±3,6 7,3±3,1 6,1±3,1 5,7±2,8 6,2±3,1(„ˆÌ›, Ú‡˙È, ‰ËÌËÙÚÈ·Î¿, ˙˘Ì·ÚÈÎ¿) ∫ÔÚ›ÙÛÈ· 6,0±3,5 6,6±3,2 5,4±3,1 5,7±3,3 5,8±3,3

2. §·¯·ÓÈÎ¿ ∞ÁfiÚÈ· 3,4±3,7 2,5±3,4 2,3±3,1 3,0±3,1 2,8±3,3∫ÔÚ›ÙÛÈ· 3,1±3,6 2,9±3,6 2,4±3,2 2,8±3,3 2,7±3,3

3. ºÚÔ‡Ù· ∞ÁfiÚÈ· 5,8±4,7* 4,9±4,6 4,2±4,6 4,2±4,4 4,6±4,6∫ÔÚ›ÙÛÈ· 6,0±4,5 5,0±4,8 5,0±4,8 4,3±4,6 4,8±4,72

4. √Ì¿‰· Á·Ï·ÎÙÔÎÔÌÈÎÒÓ ∞ÁfiÚÈ· 9,9±0,6*** 9,5±2,0 8,7±2,7 8,6±3,0 9,0±2,6(Á¿Ï·, ÁÈ·Ô‡ÚÙÈ, Ù˘Ú›) ∫ÔÚ›ÙÛÈ· 9,8±1,4 9,2±2,6 7,4±3,8 7,4±3,9 7,9±3,6

5. √Ì¿‰· ÎÚ¤·ÙÔ˜ ∞ÁfiÚÈ· 8,7±3,2 7,8±3,8 8,4±3,4 8,2±3,5 8,2±3,5(ÎÚ¤·˜, Ô˘ÏÂÚÈÎ¿, ÍËÚ¿ Ê·ÛfiÏÈ·, ∫ÔÚ›ÙÛÈ· 8,1±3,8 8,4±3,4 7,7±3,9 7,3±4,1 7,7±3,9„¿ÚÈ, ·˘Á¿, ÍËÚÔ› Î·ÚÔ›)

6. √ÏÈÎfi Ï›Ô˜ ∞ÁfiÚÈ· 3,0±2,9 2,9±3,3 3,7±3,6 3,2±3,4 3,3±3,4(% ÂÓ¤ÚÁÂÈ·˜) ∫ÔÚ›ÙÛÈ· 3,5±3,0 2,8±3,2 3,0±3,5 3,8±3,8 3,4±3,6

7. ∫ÔÚÂÛÌ¤ÓÔ Ï›Ô˜ ∞ÁfiÚÈ· 2,0±2,9*** 3,1±3,6 3,6±3,7 3,9±3,9 3,4±3,7(% ÂÓ¤ÚÁÂÈ·˜) ∫ÔÚ›ÙÛÈ· 2,2±3,0*** 2,2±3,3 3,8±3,9 3,9±4,0 3,4±3,8

8. ÃÔÏËÛÙÂÚfiÏË ÙÚÔÊ‹˜ ∞ÁfiÚÈ· 8,9±2,8*** 8,0±3,6 7,8±3,8 6,9±4,2 7,6±3,9∫ÔÚ›ÙÛÈ· 8,3±3,3 9,1±2,5 8,6±3,0 8,6±3,2 8,6±3,0

9. ¡¿ÙÚÈÔ ∞ÁfiÚÈ· 9,9±0,2*** 9,6±1,4 8,6±2,5 7,8±3,0 8,7±2,5∫ÔÚ›ÙÛÈ· 9,8±0,6*** 9,6±1,3 9,6±1,4 9,2±2,0 9,5±1,6

10. ¶ÔÈÎÈÏ›· ÙÚÔÊ›ÌˆÓ ∞ÁfiÚÈ· 4,8±3,1** 4,7±3,1 5,6±3,4 6,2±3,3 5,6±3,3∫ÔÚ›ÙÛÈ· 4,6±3,3 4,4±3,1 4,5±3,1 4,3±3,1 4,4±3,1

¢Â›ÎÙË˜ ÀÁÈÂÈÓ‹˜ ¢È·ÙÚÔÊ‹˜ ∞ÁfiÚÈ· 62,8±12,7** 60,3±14,3 59,0±11,9 57,8±12,2 59,3±12,7∫ÔÚ›ÙÛÈ· 61,5±13,5* 60,2±12,6 57,4±13,0 57,5±14,7 58,3±13,7

∆· ‰È·ÈÙÔÏfiÁÈ· ·fi Ù· ÔÔ›· ÚÔ¤Ú¯ÔÓÙ·È ÔÈ ·Ú·¿Óˆ ÂÎÙÈÌ‹ÛÂÈ˜ ·Ó¤Ú¯ÔÓÙ·È ÛÂ 1124 ÛÂ Û‡ÓÔÏÔ 1209 ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ. ∏ Î·Ù·ÓÔÌ‹ ÙÔ˘˜ (¡) ÛÙÈ˜ ·Ú·¿Óˆ ÔÌ¿‰Â˜ ËÏÈÎÈÒÓ Â›Ó·È ·ÓÙ›ÛÙÔÈ¯· ÛÙ· ·ÁfiÚÈ·: 66, 95,151 Î·È 191 Î·È ÛÙ· ÎÔÚ›ÙÛÈ·: 53, 103,209 Î·È 256. # ŒÏÂÁ¯Ô˜ Student t test (equal variances not assumed) ÌÂÙ·Í‡ ÙˆÓ ËÏÈÎÈÒÓ 3-6 Î·È 14ó-17ó: * p≤0,05, ** p≤0,01,*** p≤0,001

¶›Ó·Î·˜ 3. ¶·È‰È¿ Î·È ¤ÊË‚ÔÈ ÌÂ ‹ ¯ˆÚ›˜ ·Ú¿ÁÔÓÙÂ˜ ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ ÛÂ Û¯¤ÛË ÌÂ ÙÔ Ê‡ÏÔ Î·È ÙËÓ ËÏÈÎ›·

∏ÏÈÎ›· (¤ÙË)

3-6 6ó-10 10ó-14 14ó-17ó ™‡ÓÔÏÔ

¡ (%)

∞ÁfiÚÈ· ™‡ÓÔÏÔ 81 113 152 196 542¶·Ú¿ÁÔÓÙÂ˜

0 43 (53,1) 42 (37,2) 63 (41,4) 80 (40,8) 228 (42,1)1 29 (35,8) 48 (42,5) 65 (42,8) 81 (41,3) 223 (41,1)2 7 (8,6) 15 (13,3) 20 (13,2) 26 (13,3) 68 (12,5)

≥3 2 (2,5) 8 (7,1) 4 (2,6) 9 (4,6) 23 (4,2)∫ÔÚ›ÙÛÈ·* ™‡ÓÔÏÔ 68 120 215 264 667

¶·Ú¿ÁÔÓÙÂ˜0 41 (60,3) 49 (40,8) 63 (29,3) 128 (48,5) 281 (42,1)1 19 (27,9) 48 (40,0) 116 (54,0) 106 (40,2) 289 (43,3)2 6 (8,8) 19 (15,8) 26 (12,1) 22 (8,3) 73 (10,9)

≥3 2 (2,9) 4 (3,3) 10 (4,7) 8 (3,0) 24 (3,6)

* ŒÏÂÁ¯Ô˜ χ2 (p<0,05) ** ŒÏÂÁ¯Ô˜ χ2 ÁÈ· ÁÚ·ÌÌÈÎ‹ Ù¿ÛË (p value for linear trend): p<0,05


¶·È‰È·ÙÚÈÎ‹ 2007;70:24-36

ªÂ ÙËÓ ·‡ÍËÛË ÙÔ˘ ·ÚÈıÌÔ‡ ·Ú·ÁfiÓÙˆÓ ªÂÙ™˘Ó

(¶›Ó·Î·˜ 5), ·˘Í¿ÓÔÓÙ·È ÛËÌ·ÓÙÈÎ¿ Ù· ÔÛÔÛÙ¿ ÙˆÓ

·È‰ÈÒÓ Î·È ÙˆÓ ÂÊ‹‚ˆÓ ÌÂ ·ÓÂ·ÚÎ‹ Ï‹„Ë ÚˆÙÂ˚-

ÓÒÓ (Ï‹„Ë <67% ÙÔ˘ RDA) ·fi 4% ÛÂ 11%

(p=0,027), Ì·ÁÓËÛ›Ô˘ ·fi 45% ÛÂ 61% (p=0,018),

Ê˘ÏÈÎÔ‡ ÔÍ¤Ô˜ ·fi 53% ÛÂ 55% (p=0,010) Î·È ‚ÈÙ·-

Ì›ÓË˜ ∞ ·fi 43% ÛÂ 45% (p=0,023).

∞ÓÙ›ıÂÙ·, ‰ÂÓ ÌÂÙ·‚¿ÏÏÂÙ·È ÛËÌ·ÓÙÈÎ¿ Ë ‚·ıÌÔ-

ÏÔÁ›· ÙÔ˘ ¢À¢ Î·È ÙˆÓ Û˘ÓÈÛÙˆÛÒÓ ÙÔ˘ ÌÂ ÙËÓ ·‡-

ÍËÛË ÙÔ˘ ·ÚÈıÌÔ‡ ·Ú·ÁfiÓÙˆÓ ªÂÙ™˘Ó (‰Â‰ÔÌ¤Ó·

‰ÂÓ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÂ ›Ó·Î·). ¶·È‰È¿ Î·È ¤ÊË‚ÔÈ

¯ˆÚ›˜ ·Ú¿ÁÔÓÙÂ˜ ªÂÙ™˘Ó, ÛÂ Û¯¤ÛË ÌÂ ÂÎÂ›Ó· ÌÂ

ªÂÙ™˘Ó, ‚Ú¤ıËÎ·Ó ÌÂ ˘„ËÏfiÙÂÚË ‚·ıÌÔÏÔÁ›· ÛÙËÓ

Î·Ù·Ó¿ÏˆÛË ‰ËÌËÙÚÈ·ÎÒÓ (6,1 ¤Ó·ÓÙÈ 5,6, ª™),

ÊÚÔ‡ÙˆÓ (5,1 ¤Ó·ÓÙÈ 4,4, ª™) Î·È ÛÙÔÓ ¢À¢ (59,8

¤Ó·ÓÙÈ 58,4, ª™).

∏ Î·Ù·ÓÔÌ‹ ÙˆÓ ·ÁÔÚÈÒÓ Î·È ÙˆÓ ÎÔÚÈÙÛÈÒÓ ˆ˜

ÚÔ˜ ÙÈ˜ Î·ÙËÁÔÚ›Â˜ ÙÔ˘ ¢À¢ (¶›Ó·Î·˜ 6) ‰ÂÓ ‰È·-

ÊÔÚÔÔÈÂ›Ù·È, Â›ÛË˜, ÛËÌ·ÓÙÈÎ¿. ¶ÔÛÔÛÙfi ÌfiÏÈ˜

6% ÙˆÓ ·ÁÔÚÈÒÓ Â›¯Â “Î·Ï‹” ‰È·ÙÚÔÊ‹ Î·È 27%

“·ÓÂ·ÚÎ‹”, ÂÓÒ ÛÙ· ÎÔÚ›ÙÛÈ· ÔÛÔÛÙfi 7% Â›¯Â

“Î·Ï‹” Î·È 32% “·ÓÂ·ÚÎ‹” ‰È·ÙÚÔÊ‹. øÛÙfiÛÔ, ÙÔ

ÔÛÔÛÙfi ÙˆÓ ·È‰ÈÒÓ Î·È ÙˆÓ ÂÊ‹‚ˆÓ ÌÂ “Î·Ï‹”

‰È·ÙÚÔÊ‹ ·fi 10% ÛÙÈ˜ ËÏÈÎ›Â˜ 3-6 ÂÙÒÓ, ÌÂÈÒÓÂÙ·È

ÛËÌ·ÓÙÈÎ¿ ÛÂ 7% ÛÙÈ˜ ËÏÈÎ›Â˜ ÙˆÓ 14ó-17ó ÂÙÒÓ,

ÂÓÒ ÌÂ “·ÓÂ·ÚÎ‹” ‰È·ÙÚÔÊ‹ ·˘Í¿ÓÂÙ·È ·fi 24%

ÛÂ 32% (p=0,019). ∂ÈÏ¤ÔÓ, ÙÔ 36% ÙˆÓ ·È‰ÈÒÓ

Î·È ÂÊ‹‚ˆÓ ÌÂ ªÂÙ™˘Ó, Â›¯Â “·ÓÂ·ÚÎ‹” ‰È·ÙÚÔÊ‹

Î·È ÙÔ 5% “Î·Ï‹”, ¤Ó·ÓÙÈ 28% Î·È 8%, ·ÓÙ›ÛÙÔÈ¯·,

ÂÎÂ›ÓˆÓ ¯ˆÚ›˜ ·Ú¿ÁÔÓÙÂ˜ ªÂÙ™˘Ó (p=0,026).

√ Û¯ÂÙÈÎfi˜ Î›Ó‰˘ÓÔ˜ (Odds Ratio) (¶›Ó·Î·˜ 7)

ÁÈ· ªÂÙ™˘Ó ‚Ú¤ıËÎÂ Ó· ·˘Í¿ÓÂÙ·È Î·Ù¿ 3,16 ÊÔÚ¤˜

ÁÈ· Ù· ·È‰È¿ Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜ ÌÂ ·˘ÍËÌ¤Ó· Â›Â-

‰· LDL-C (95% ¢∂: 1,59-6,29, p=0,001), Î·Ù¿ 71,2

ÊÔÚ¤˜ ÁÈ· fiÛ· ¤¯Ô˘Ó ·˘ÍËÌ¤Ó· Â›Â‰· ·ıËÚˆÌ·ÙÈ-

ÎÔ‡ ‰Â›ÎÙË ÔÏÈÎ‹˜ ÚÔ˜ ∏DL-C (95% ¢∂: 19,5-

260,1, p<0,001) Î·È Î·Ù¿ 84,8 ÊÔÚ¤˜ ÁÈ· fiÛ· Â›Ó·È

·¯‡Û·ÚÎ· (¢ª™ >30 kg/m2) (95% ¢∂: 32,7-219,4,

p<0,001). ∂›ÛË˜, ·È‰È¿ Î·È ¤ÊË‚ÔÈ ÌÂ ªÂÙ™˘Ó

‚Ú¤ıËÎ·Ó Ó· ¤¯Ô˘Ó ÛËÌ·ÓÙÈÎ¿ ÌÂÈˆÌ¤ÓÂ˜ Èı·ÓfiÙË-

ÙÂ˜ (Î·Ù¿ 30%) ÁÈ· Î·Ï‹ Î·Ú‰ÈÔ·Ó·ÓÂ˘ÛÙÈÎ‹ ·ÓÙÔ-

¯‹ (95% ¢∂: 0,49-0,99, p<0,042).

∆Ô 85% ÙˆÓ ·È‰ÈÒÓ Î·È ÙˆÓ ÂÊ‹‚ˆÓ ÌÂ

ªÂÙ™˘Ó (∂ÈÎfiÓ· 1) ˘ÂÚ‚·›ÓÂÈ Ù· fiÚÈ· ÙË˜ 90‹˜

ÂÎ·ÙÔÛÙÈ·›·˜ ı¤ÛË˜ ÙË˜ Û˘ÛÙÔÏÈÎ‹˜ ›ÂÛË˜ Î¿ÙÈ

Ô˘ ·ÔÙÂÏÂ› ÙÔÓ ÈÔ Û˘¯Ófi ·Ú¿ÁÔÓÙ· ªÂÙ™˘Ó.

∞ÎÔÏÔ˘ıÔ‡Ó Ù· ·˘ÍËÌ¤Ó· ÙÚÈÁÏ˘ÎÂÚ›‰È· Î·È Ë ¯·-

ÌËÏ‹ HDL-C.

™Â 243 ÂÊ‹‚Ô˘˜ ËÏÈÎ›·˜ 15-17 ÂÙÒÓ, ÔÛÔÛÙfi

12% ‚Ú¤ıËÎÂ Ó· Â›Ó·È Î·ÓÈÛÙ¤˜ (‰Â‰ÔÌ¤Ó· ‰ÂÓ

·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÂ ›Ó·Î·) (13% ·ÁfiÚÈ· Î·È 11%

ÎÔÚ›ÙÛÈ·, χ2 ¤ÏÂÁ¯Ô˜, ª™). øÛÙfiÛÔ, ‰ÂÓ Û¯ÂÙ›˙ÂÙ·È

ÛËÌ·ÓÙÈÎ¿ ÙÔ Î¿ÓÈÛÌ· ÌÂ ÙÔÓ ÂÈÔÏ·ÛÌfi ÙÔ˘

ªÂÙ™˘Ó.

∆¤ÏÔ˜, ÌÂ ‚¿ÛË ÙÔÓ ¢ª™, ÙÔ 23,2% ÙˆÓ ·È‰ÈÒÓ

Î·È ÂÊ‹‚ˆÓ ‚Ú¤ıËÎÂ ÌÂ ·˘ÍËÌ¤ÓÔ ‚¿ÚÔ˜ Î·È ÙÔ 9,9%

ÌÂ ·¯˘Û·ÚÎ›· (‰Â‰ÔÌ¤Ó· ‰ÂÓ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÂ

›Ó·Î·). ªÂ ·˘ÍËÌ¤ÓÔ ‚¿ÚÔ˜ ‚Ú¤ıËÎÂ ÙÔ 25% ÙˆÓ

·ÁÔÚÈÒÓ Î·È ÙÔ 21% ÙˆÓ ÎÔÚÈÙÛÈÒÓ Î·È ÌÂ ·¯˘Û·Ú-

Î›· ÔÛÔÛÙfi 12% Î·È 9%, ·ÓÙ›ÛÙÔÈ¯· (χ2 ¤ÏÂÁ¯Ô˜,

¶›Ó·Î·˜ 5. ¶ÔÛÔÛÙ¿ ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ Ô˘ ÚÔÛÏ·Ì‚¿ÓÔ˘Ó ıÚÂÙÈÎ¿ Û˘ÛÙ·ÙÈÎ¿ ÏÈÁfiÙÂÚÔ ·fi 67% ÙË˜ ËÌÂÚ‹ÛÈ·˜ Û˘ÓÈÛÙÒÌÂÓË˜ Ô-ÛfiÙËÙ·˜ (RDA) ÛÂ Û¯¤ÛË ÌÂ ÙËÓ ·ÚÔ˘Û›· ·Ú·ÁfiÓÙˆÓ ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘

¶·Ú¿ÁÔÓÙÂ˜ ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘

0 1 2 ≥3

<67% RDA ¡ (%) p*

ª·ÎÚÔıÚÂÙÈÎ¿ ∂Ó¤ÚÁÂÈ· 106 (22) 127 (26) 35 (27) 14 (32) ª™¶ÚˆÙÂ˝ÓÂ˜ 19 (4) 26 (5) 9 (7) 5 (11) 0,027

ÿÓÂ˜ 362 (77) 382 (80) 109 (83) 34 (77) ª™ª¤Ù·ÏÏ· & È¯ÓÔÛÙÔÈ¯Â›· ∞Û‚¤ÛÙÈÔ 239 (51) 253 (53) 67 (51) 25 (57) ª™

™›‰ËÚÔ˜ 103 (22) 108 (23) 30 (23) 12 (27) ª™ª·ÁÓ‹ÛÈÔ 208 (45) 238 (51) 66 (51) 27 (61) 0,018ºÒÛÊÔÚÔ˜ 140 (31) 166 (36) 45 (35) 19 (44) ª™º˘ÏÈÎfi ÔÍ‡ 252 (53) 310 (65) 86 (66) 24 (55) 0,010

µÈÙ·Ì›ÓÂ˜ µÈÙ·Ì›ÓË ∞ 202 (43) 232 (48) 74 (56) 20 (45) 0,023µÈÙ·Ì›ÓË ∂ 304 (64) 308 (64) 87 (67) 27 (61) ª™µÈÙ·Ì›ÓË C 96 (20) 125 (26) 38 (29) 7 (16) ª™µÈÙ·Ì›ÓË µ1 20 (4) 22 (5) 9 (7) 0 ª™µÈÙ·Ì›ÓË µ2 17 (4) 16 (3) 5 (4) 4 (9) ª™µÈÙ·Ì›ÓË µ6 58 (12) 68 (14) 22 (17) 9 (20) ª™µÈÙ·Ì›ÓË µ12 103 (22) 102 (21) 33 (25) 13 (30) ª™

¡È·Û›ÓË 66 (14) 82 (17) 28 (22) 7 (16) ª™

* ŒÏÂÁ¯Ô˜ χ2 ÁÈ· ÁÚ·ÌÌÈÎ‹ Ù¿ÛË (p value for linear trend)



p=0,024). ∂›ÛË˜, ÌÂ ·¯˘Û·ÚÎ›· ‚Ú¤ıËÎÂ ÙÔ 51%ÙˆÓ ·È‰ÈÒÓ Î·È ÙˆÓ ÂÊ‹‚ˆÓ ÌÂ ªÂÙ™˘Ó, ¤Ó·ÓÙÈ8% ÂÎÂ›ÓˆÓ ÌÂ 0-2 ·Ú¿ÁÔÓÙÂ˜ ªÂÙ™˘Ó (p<0,001).

™˘˙‹ÙËÛË

™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË, ÔÛÔÛÙfi 3,9% ÙˆÓ ·È-

‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ ÙË˜ ∫Ú‹ÙË˜ ‚Ú¤ıËÎÂ ÌÂ ÙÚÂÈ˜ ‹

ÂÚÈÛÛfiÙÂÚÔ˘˜ ·Ú¿ÁÔÓÙÂ˜ ªÂÙ™˘Ó (4,2% ÛÙ·

·ÁfiÚÈ·, 3,6% ÛÙ· ÎÔÚ›ÙÛÈ·). ∏ ‚·ıÌÔÏÔÁ›· ÙÔ˘ ¢À¢

‰ÂÓ ‰È¤ÊÂÚÂ ÛËÌ·ÓÙÈÎ¿ ·fi ÙË ‚·ıÌÔÏÔÁ›· ÙˆÓ

·È‰ÈÒÓ Î·È ÙˆÓ ÂÊ‹‚ˆÓ ÌÂ Î·ıfiÏÔ˘ ‹ ÏÈÁfiÙÂÚÔ˘˜

·Ú¿ÁÔÓÙÂ˜ ªÂÙ™˘Ó. øÛÙfiÛÔ, Ë ·ÍÈÔÏfiÁËÛË ÙË˜

‰È·ÙÚÔÊ‹˜ ÙÔ˘˜ ¤‰ÂÈÍÂ fiÙÈ ¤¯Ô˘Ó ÛÂ ÛËÌ·ÓÙÈÎ¿ ÌÂ-

Á·Ï‡ÙÂÚÔ ÔÛÔÛÙfi “·ÓÂ·ÚÎ‹” ‰È·ÙÚÔÊ‹ Î·È ÛÂ ÌÈ-

ÎÚfiÙÂÚÔ “Î·Ï‹”. ∂›ÛË˜, ÛÂ ÔÛÔÛÙfi 64% fiÏˆÓ

ÙˆÓ ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ ÙË˜ ÌÂÏ¤ÙË˜, ·ÓÂÍ·ÚÙ‹Ùˆ˜

‰ËÏ·‰‹ ÙË˜ ·ÚÔ˘Û›·˜ ‹ ÌË ·Ú·ÁfiÓÙˆÓ ªÂÙ™˘Ó,

‚Ú¤ıËÎÂ fiÙÈ Ë ‰È·ÙÚÔÊ‹ “¯ÚÂÈ¿˙ÂÙ·È ‚ÂÏÙ›ˆÛË”.

∞ÎfiÌË, Ù· ·È‰È¿ Î·È ÔÈ ¤ÊË‚ÔÈ ÌÂ ÙÚÂÈ˜ ‹ ÂÚÈÛÛfi-

ÙÂÚÔ˘˜ ·Ú¿ÁÔÓÙÂ˜ ªÂÙ™˘Ó Î·Ù·Ó·ÏÒÓÔ˘Ó ÌÈÎÚfi-

ÙÂÚË ÔÛfiÙËÙ· ÊÚÔ‡ÙˆÓ Î·È Ï·¯·ÓÈÎÒÓ, ÂÓÒ Â›¯·Ó

ÛËÌ·ÓÙÈÎ¿ ÌÂÁ·Ï‡ÙÂÚ· ÔÛÔÛÙ¿ ·ÓÂ·ÚÎÔ‡˜ Ï‹-

„Ë˜ ÚˆÙÂ˚ÓÒÓ, Ê˘ÏÈÎÔ‡ ÔÍ¤Ô˜ Î·È ‚ÈÙ·Ì›ÓË˜ ∞.

∂ÈÔÏ·ÛÌfi˜ ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘

§›ÁÂ˜ ¤ÚÂ˘ÓÂ˜ ·ÁÎÔÛÌ›ˆ˜ ¤¯Ô˘Ó ÌÂÏÂÙ‹ÛÂÈ ÙÔ

ªÂÙ™˘Ó ÛÙËÓ ·È‰ÈÎ‹ Î·È ÂÊË‚ÈÎ‹ ËÏÈÎ›· (35). √

ÂÈÔÏ·ÛÌfi˜ ÙÔ˘, ˆÛÙfiÛÔ, ÂÎÙÈÌ¿Ù·È ÌÂÙ·Í‡ 4%

Î·È 5% (36).

∞fi ÙË ÌÂÏ¤ÙË NHANES 1999-2000 ÙˆÓ ∏¶∞, ÛÂ

¤ÊË‚Ô˘˜ ËÏÈÎ›·˜ 12-19 ÂÙÒÓ (10), ‚Ú¤ıËÎÂ fiÙÈ 6,4%

Â›¯Â ªÂÙ™˘Ó (9,1% Ù· ·ÁfiÚÈ· Î·È 3,7% Ù· ÎÔÚ›ÙÛÈ·)

Î·È fiÙÈ ÂÚÈÛÛfiÙÂÚÔÈ ·fi ‰‡Ô ÂÎ·ÙÔÌÌ‡ÚÈ· ¤ÊË‚ÔÈ

63

75

83

42

83

13

61

57

52

44

87

39

0 10 20 30 40 50 60 70 80 90 100

¶ÔÛÔÛÙfi ·È‰ÈÒÓ / ÂÊ‹‚ˆÓ (%)

¶·

Ú¿

ÁÔ

ÓÙ

Â˜ ª

ÂÙ·

‚Ô

ÏÈÎ

Ô‡

™˘

Ó‰

Úfi

ÌÔ

˘

¶ÂÚ. ª¤ÛË˜

HDL-C

∆ÚÈÁÏ˘ÎÂÚ›‰È·

¢È·ÛÙÔÏÈÎ‹ ∞¶

™˘ÛÙÔÏÈÎ‹ ∞¶

™¿Î¯·ÚÔ

∞ÁfiÚÈ·

∫ÔÚ›ÙÛÈ·

∂ÈÎfiÓ· 1. ¶ÔÛÔÛÙ¿ ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ ÌÂ ÌÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ Ô˘ ˘ÂÚ‚·›ÓÔ˘Ó Ù· fiÚÈ· (cut offs) ÙˆÓ ·Ú·ÁfiÓÙˆÓ ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘.


¶·È‰È·ÙÚÈÎ‹ 2007;70:24-36

¶›Ó·Î·˜ 6. ∞ÚÈıÌfi˜ Î·È ÔÛÔÛÙ¿ ·È‰ÈÒÓ ÌÂ ‚·ıÌÔÏÔÁ›· ¢À¢“·ÓÂ·ÚÎ‹”, “¯ÚÂÈ¿˙ÂÙ·È ‚ÂÏÙ›ˆÛË” Î·È “Î·Ï‹” ÛÂ Û¯¤ÛË ÌÂ ÙÔÊ‡ÏÔ, ÙËÓ ËÏÈÎ›· Î·È ÙËÓ ·ÚÔ˘Û›· ·Ú·ÁfiÓÙˆÓ ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó-‰ÚfiÌÔ˘

¢Â›ÎÙË˜ ÀÁÈÂÈÓ‹˜ ¢È·ÙÚÔÊ‹˜

∞ÓÂ·ÚÎ‹˜ ÃÚÂÈ¿˙ÂÙ·È ∫·Ï‹ (<51) ‚ÂÏÙ›ˆÛË (>80)

(51-80)

¡ (%) p*

º‡ÏÔ∞ÁfiÚÈ· 139 (27) 336 (67) 28 (6)∫ÔÚ›ÙÛÈ· 197 (32) 382 (61) 42 (7) ª™*™‡ÓÔÏÔ 336 (30) 718 (64) 70 (6)

∏ÏÈÎ›· 3-6 28 (24) 79 (66) 12 (10)6ó-10 52 (26) 130 (66) 16 (8)

0,019**10ó-14 113 (31) 234 (65) 13 (4)14ó-17ó 143 (32) 275 (62) 29 (7)

¶·Ú¿ÁÔÓÙÂ˜ ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘0 131 (28) 303 (64) 38 (8)1 144 (30) 311 (65) 23 (5)

0,026**2 45 (35) 78 (60) 7 (5)≥3 16 (36) 26 (59) 2 (5)

* ŒÏÂÁ¯Ô˜ χ2

** ŒÏÂÁ¯Ô˜ χ2 ÁÈ· ÁÚ·ÌÌÈÎ‹ Ù¿ÛË (p value for linear trend)

¤¯Ô˘Ó ªÂÙ™˘Ó. ™ÙË ÌÂÏ¤ÙË NHANES πππ 1988-1992,Ô ÂÈÔÏ·ÛÌfi˜ ‹Ù·Ó ÌÈÎÚfiÙÂÚÔ˜ Î·È ÚÔÛ¤ÁÁÈ˙Â ÙÔ4,2% (10), ÂÓÒ ·fi ÙËÓ Bogalusa Heart Study, ÛÂ ·È-‰È¿ Î·È ÂÊ‹‚Ô˘˜ ËÏÈÎ›·˜ 8-17 ÂÙÒÓ, Î·Ù¿ ÙÔ ‰È¿ÛÙË-Ì· 1978-1996, ‚Ú¤ıËÎÂ 3,6% (37).

™Â ¿ÏÏË ÌÂÏ¤ÙË ÛÙÈ˜ ∏¶∞, ÙÔ 1999, ÛÂ 439 ·¯‡-Û·ÚÎ· ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ ‚Ú¤ıËÎÂ ÂÈÔÏ·ÛÌfi˜ªÂÙ™˘Ó 50% (38). ™ÙÔÓ ∫·Ó·‰¿, ÙËÓ ›‰È· ÂÚ›Ô‰Ô,ÛÂ ·ÓÙÈÚÔÛˆÂ˘ÙÈÎfi ‰Â›ÁÌ· 2244 ·È‰ÈÒÓ Î·È ÂÊ‹-‚ˆÓ, ËÏÈÎ›·˜ 9, 13 Î·È 16 ÂÙÒÓ, Ô ÂÈÔÏ·ÛÌfi˜ ÙÔ˘Û˘Ó‰ÚfiÌÔ˘ ·ÓÙ›ÛÙ·ÛË˜ ÛÙËÓ ÈÓÛÔ˘Ï›ÓË ‚Ú¤ıËÎÂ11,5% (39).

¶·¯˘Û·ÚÎ›·

∏ ·¯˘Û·ÚÎ›· ·ÔÙÂÏÂ› Î‡ÚÈÔ ÁÓÒÚÈÛÌ· ÙÔ˘ªÂÙ™˘Ó Î·È Û˘ÓÔ‰Â‡ÂÙ·È Û˘¯Ó¿ ·fi ¿ÏÏÔ˘˜ ·Ú¿-ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘, fiˆ˜ Â›Ó·È Ù· ·˘ÍËÌ¤Ó· ÏÈ›‰È·ÔÚÔ‡ ·›Ì·ÙÔ˜, ÙÔ Û¿Î¯·ÚÔ Î·È Ô Û·Î¯·ÚÒ‰Ë˜ ‰È·‚‹-ÙË˜ Ù‡Ô˘ 2 (40).

™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË, ÔÛÔÛÙfi 33% fiÏˆÓ ÙˆÓ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ ‚Ú¤ıËÎÂ Ó· Â›Ó·È ˘¤Ú‚·Ú· Î·È·¯‡Û·ÚÎ· Û‡ÌÊˆÓ· ÌÂ ÙÔÓ ¢ª™, ÂÓÒ ÙÔ 51% ÂÎÂ›-ÓˆÓ ÌÂ ªÂÙ™˘Ó ‹Ù·Ó ·¯‡Û·ÚÎ·. ªÂ ÎÂÓÙÚÈÎ‹ ·¯˘-Û·ÚÎ›· ‚Ú¤ıËÎÂ ÙÔ 62% ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ ÌÂªÂÙ™˘Ó. ∂ÈÏ¤ÔÓ, Ù· ·¯‡Û·ÚÎ· ·È‰È¿ Î·È ÔÈ ¤ÊË-‚ÔÈ ‚Ú¤ıËÎ·Ó Ó· ¤¯Ô˘Ó 85 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚÔ Î›Ó‰˘ÓÔÓ· ·Ó·Ù‡ÍÔ˘Ó ªÂÙ™˘Ó, ÛÂ Û¯¤ÛË ÌÂ Ù· Ê˘ÛÈÔÏÔÁÈÎ¿.

∞fi ÙË ÌÂÏ¤ÙË NHANES 1999-2000 (10), ÙÔ 32%ÙˆÓ ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ, Û‡ÌÊˆÓ· ÌÂÙÔÓ ¢ª™, ‚Ú¤ıËÎÂ Ó· ¤¯Ô˘Ó ªÂÙ™˘Ó (36).

™ÙË ‰ÂÎ·ÂÙ›· ÙÔ˘ 1990, Ô ÂÈÔÏ·ÛÌfi˜ ˘¤Ú‚·-ÚˆÓ Î·È ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ ËÏÈÎ›·˜ 5-17 ÂÙÒÓÚÔÛÂÁÁ›˙ÂÈ ·ÁÎÔÛÌ›ˆ˜ ÙÔ 10%, ÌÂ ÙËÓ ∞ÌÂÚÈÎ‹Î·È ÙËÓ ∂˘ÚÒË Ó· ˘ÂÚ‚·›ÓÔ˘Ó ÙÔ 20% (34). ™ÙËÓ

∂ÏÏ¿‰· ‹Ù·Ó 23% Î·È ÛÙÈ˜ ∏¶∞ 26% (41), ÂÓÒÛÙËÓ πÙ·Ï›· ‚Ú¤ıËÎÂ ÙÔ ˘„ËÏfiÙÂÚÔ ÔÛÔÛÙfi(36%) (42).

ªÂÏ¤ÙË ÏËı˘ÛÌÈ·Î‹˜ Ù¿ÛË˜ ÛÂ ·ÁfiÚÈ· ÙË˜∫Ú‹ÙË˜ ËÏÈÎ›·˜ 9-16 ÂÙÒÓ, ¤‰ÂÈÍÂ fiÙÈ Î·Ù¿ ÙÔ ‰È¿-ÛÙËÌ· 1982-2002, ·˘Í‹ıËÎ·Ó Ù· ˘¤Ú‚·Ú· Î·È ·-¯‡Û·ÚÎ· ·fi 20% ÛÂ 40% (43).

∏ ÚfiÏË„Ë ÙË˜ ·¯˘Û·ÚÎ›·˜ ı· Ú¤ÂÈ Ó· ·Ú¯›-˙ÂÈ ·fi ÙË ‚ÚÂÊÈÎ‹ ËÏÈÎ›· (40). √ ıËÏ·ÛÌfi˜, Ë ·-Ú·‰ÔÛÈ·Î‹ ÂÏÏËÓÈÎ‹ ‰È·ÙÚÔÊ‹ Î·È Ë ¿ÛÎËÛË Â›Ó·È·ÔÙÂÏÂÛÌ·ÙÈÎ¿ Ì¤Û· ÚfiÏË„Ë˜ Î·È ·ÓÙÈÌÂÙÒÈ-ÛË˜ ÙË˜ ·¯˘Û·ÚÎ›·˜ Î·È ÙÔ˘ ªÂÙ™˘Ó. ªÂ ·˘ÙfiÓÙÔÓ ÙÚfiÔ ÌÔÚÂ› Ó· ÌÂÈˆıÂ› Ô Î›Ó‰˘ÓÔ˜ ÁÈ· Î·Ú‰È·-Î¿ ÓÔÛ‹Ì·Ù· Î·Ù¿ 35-55% (40,42,44-46).

§ÈÔÚˆÙÂ˝ÓÂ˜ Î·È Û¿Î¯·ÚÔ ÔÚÔ‡ ·›Ì·ÙÔ˜

™Ù· ·È‰È¿ Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜ ÌÂ ªÂÙ™˘Ó, ÔÛÔ-ÛÙfi 68% ‚Ú¤ıËÎÂ ÌÂ ·˘ÍËÌ¤Ó· Â›Â‰· ÙÚÈÁÏ˘ÎÂ-ÚÈ‰›ˆÓ, 66% ÌÂ ¯·ÌËÏ‹ HDL-C, ÂÓÒ Â›¯·Ó ÂÚ›Ô˘3,2 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚÔ Î›Ó‰˘ÓÔ ÁÈ· ·ıÔÏÔÁÈÎ¿Â›Â‰· LDL-C.

∆· ˘„ËÏ¿ Â›Â‰· ÏÈÔÚˆÙÂ˚ÓÒÓ Î·È Û·Î¯¿-ÚÔ˘, fiˆ˜ Î·È Ë ·¯˘Û·ÚÎ›·, Û¯ÂÙ›˙ÔÓÙ·È ¿ÌÂÛ· ÌÂÙË ‰È·ÙÚÔÊ‹ Î·È ÙË ÛˆÌ·ÙÈÎ‹ ¿ÛÎËÛË. ∏ ÔÏÈÎ‹ ¯Ô-ÏËÛÙÂÚfiÏË ·˘Í¿ÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ÁÈ· ¤ÌÊÚ·ÁÌ· ÙÔ˘Ì˘ÔÎ·Ú‰›Ô˘ Î·Ù¿ 2,4 ÊÔÚ¤˜, ÂÓÒ Ë ÛˆÛÙ‹ ‰È·ÙÚÔ-Ê‹, ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ¿ÏÏÔ˘˜ ·Ú¿ÁÔÓÙÂ˜, Û˘Ì‚¿Ï-ÏÂÈ ÛËÌ·ÓÙÈÎ¿ ÛÙË ÌÂ›ˆÛ‹ ÙË˜ (47). ÕÙÔÌ· ÌÂ ˘„Ë-Ï¿ Â›Â‰· ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ Î·È ¯·ÌËÏ‹ HDL-CÚ¤ÂÈ Ó· Ï·Ì‚¿ÓÔ˘Ó ÌÈÎÚ¤˜ ÔÛfiÙËÙÂ˜ ÎÔÚÂÛÌ¤-ÓˆÓ ÏÈ·ÚÒÓ ÔÍ¤ˆÓ Î·È ¯ÔÏËÛÙÂÚfiÏË˜ ÙÚÔÊ‹˜, Ó·ÂÚÈÔÚ›˙Ô˘Ó ÙËÓ ÂÓ¤ÚÁÂÈ· Ô˘ Ï·Ì‚¿ÓÔ˘Ó ·Ó¿ÏÔÁ·ÌÂ ÙÔ ‚¿ÚÔ˜ ÙÔ˘˜ Î·È Ó· ¤¯Ô˘Ó Î·ıËÌÂÚÈÓ‹ ÛˆÌ·ÙÈ-Î‹ ¿ÛÎËÛË ÌÂ Ì¤ÙÚÈÔ ÚÔ˜ ¤ÓÙÔÓÔ Ú˘ıÌfi (47).

¶›Ó·Î·˜ 7. ∂ÎÙ›ÌËÛË ‰ÂÈÎÙÒÓ Û¯ÂÙÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘ (Odds Ratio) ‰È·ÊfiÚˆÓ ·Ú·ÁfiÓÙˆÓ ÛÂ ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ ÌÂ ÌÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ ÛÂÛ¯¤ÛË ÌÂ ·È‰È¿ ¯ˆÚ›˜ ·Ú¿ÁÔÓÙÂ˜ ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘

¡ OR (95% ‰È¿ÛÙËÌ· ÂÌÈÛÙÔÛ‡ÓË˜) p-value#

√ÏÈÎ‹ ¯ÔÏËÛÙÂÚfiÏË* 556 1,58 (0,70-3,57) ª™LDL ¯ÔÏËÛÙÂÚfiÏË** 556 3,16 (1,59-6,29) 0,001∞ıËÚˆÌ·ÙÈÎfi˜ ‰Â›ÎÙË˜ ÔÏÈÎ‹˜ 556 71,2 (19,5-260,1) <0,001¯ÔÏËÛÙÂÚfiÏË˜ ÚÔ˜ HDL-C***∞ıËÚˆÌ·ÙÈÎfi˜ ‰Â›ÎÙË˜ 556 47,4 (9,4-239,5) <0,001LDL-C ÚÔ˜ HDL-C$

¢Â›ÎÙË˜ ª¿˙·˜ 25-30$$ 556 7,32 (3,07-14,47)<0,001™ÒÌ·ÙÔ˜ (kg/m2) >30 556 84,8 (32,7-219,4)<0,001¶·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜ 181 0,70 (0,49-0,99) 0,042∫¿ÓÈÛÌ· ∫·ÓÈÛÙ¤˜ 106 0,98 (0,11-8,97) ª™

∏ ·Ó¿Ï˘ÛË ·ÊÔÚ¿ ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ Ô˘ ‰ÂÓ ¤¯Ô˘Ó ·Ú¿ÁÔÓÙÂ˜ ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ (ÌË‰¤Ó ·Ú¿ÁÔÓÙÂ˜) ÛÂ Û¯¤ÛË ÌÂÂÎÂ›Ó· ÌÂ ÌÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ (ÙÚÂÈ˜ ‹ ÂÚÈÛÛfiÙÂÚÔ˘˜ ·Ú¿ÁÔÓÙÂ˜). # ∞Ó¿Ï˘ÛË ÏÔÁÈÛÙÈÎ‹˜ ·ÏÈÓ‰ÚfiÌËÛË˜ (logistic linearregression analysis): ˆ˜ Û˘ÌÌÂÙ·‚ÏËÙ¤˜ ÂÏ¤Á¯Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÙÔ Ê‡ÏÔ Î·È Ë ËÏÈÎ›· * √ÏÈÎ‹ ¯ÔÏËÛÙÂÚfiÏË >200 mg/dl, ** LDL ¯ÔÏËÛÙÂÚfiÏË >130 mg/dl, *** ∞ıËÚˆÌ·ÙÈÎfi˜ ‰Â›ÎÙË˜ ÔÏÈÎ‹˜ ¯ÔÏËÛÙÂÚfiÏË˜ ÚÔ˜HDL >5,00, $ ∞ıËÚˆÌ·ÙÈÎfi˜ ‰Â›ÎÙË˜ LDL ¯ÔÏËÛÙÂÚfiÏË˜ ÚÔ˜ HDL >4,00, $$ ∆· fiÚÈ· ÙÔ˘ ¢ª™ Î·ıÔÚ›˙ÔÓÙ·È ·fi ÙÔ˘˜ ColeÎ·È Û˘Ó, 2000 (23)



™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË, ÙÔ ·˘ÍËÌ¤ÓÔ Û¿Î¯·ÚÔ,

ˆ˜ ¤Ó‰ÂÈÍË ‰È·Ù·Ú·¯‹˜ ÙË˜ Û·Î¯·Ú·ÈÌÈÎ‹˜ Î·Ì‡-

ÏË˜, ·ÚÔ˘ÛÈ¿˙ÂÈ ÙË ¯·ÌËÏfiÙÂÚË Û˘¯ÓfiÙËÙ· ÂÌÊ¿-

ÓÈÛË˜ (26%) ÛÂ Û¯¤ÛË ÌÂ ÙÔ˘˜ ˘fiÏÔÈÔ˘˜ Ù¤ÛÛÂÚÈ˜

·Ú¿ÁÔÓÙÂ˜.

∏ Î·Ù¿ÏÏËÏË ‰È·ÙÚÔÊ‹ Î·È Ë ÛˆÌ·ÙÈÎ‹ ¿ÛÎËÛË

Â›Ó·È Ù· ÌÔÓ·‰ÈÎ¿ Ì¤Û· ÁÈ· ÙËÓ ·‡ÍËÛË ÙË˜ Â˘·È-

ÛıËÛ›·˜ ÛÙË ‰Ú¿ÛË ÙË˜ ÈÓÛÔ˘Ï›ÓË˜. ŒÙÛÈ ÂÏ·ÙÙÒÓÔ-

ÓÙ·È Ù· Â›Â‰· Û·Î¯¿ÚÔ˘, ÂÓÒ ÌÂ ÙËÓ ·ÓÙÈÎ·Ù¿ÛÙ·-

ÛË ÙÔ˘ ÎÔÚÂÛÌ¤ÓÔ˘ Ï›Ô˘˜ ÌÂ ÌÔÓÔ·ÎfiÚÂÛÙÔ ·fi

ÂÏ·ÈfiÏ·‰Ô, ·˘Í¿ÓÂÙ·È Ë Â˘·ÈÛıËÛ›· ÙˆÓ ÈÛÙÒÓ ÛÙË

‰Ú¿ÛË ÙË˜ ÈÓÛÔ˘Ï›ÓË˜, ÌÂ Û˘Ó¤ÂÈ· ÙËÓ ÂÏ¿ÙÙˆÛË

ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÁÈ· Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË Ù‡Ô˘ 2

(3,15). ∂›ÛË˜, Ë Î·Ù·Ó¿ÏˆÛË ÙÚÔÊ›ÌˆÓ ÌÂ ˘„ËÏfi

ÁÏ˘Î·ÈÌÈÎfi ‰Â›ÎÙË Û¯ÂÙ›˙ÂÙ·È ÌÂ ·‡ÍËÛË ÙÔ˘ ÎÈÓ‰‡-

ÓÔ˘ ÁÈ· Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË Ù‡Ô˘ 2 (48). ™ÙË ÌÂ-

Ï¤ÙË Framingham, ÛÂ ÂÓ‹ÏÈÎÂ˜ ÌÂ ªÂÙ™˘Ó ‚Ú¤ıËÎÂ

¯·ÌËÏfiÙÂÚË Î·Ù·Ó¿ÏˆÛË ‰ËÌËÙÚÈ·ÎÒÓ ÌÂ ‰È·ÈÙËÙÈ-

Î¤˜ ›ÓÂ˜, ÛÂ Û¯¤ÛË ÌÂ ¿ÙÔÌ· ¯ˆÚ›˜ ªÂÙ™˘Ó. √ ÂÈ-

ÔÏ·ÛÌfi˜ ÙÔ˘ ªÂÙ™˘Ó Û¯ÂÙÈ˙fiÙ·Ó ıÂÙÈÎ¿ ÌÂ ÙËÓ

·‡ÍËÛË ÙÔ˘ ÁÏ˘Î·ÈÌÈÎÔ‡ ‰Â›ÎÙË ÙˆÓ ÙÚÔÊ›ÌˆÓ Ô˘

Î·Ù·Ó¿ÏˆÓ·Ó (49).

∞ÚÙËÚÈ·Î‹ ›ÂÛË ·›Ì·ÙÔ˜

∏ ˘¤ÚÙ·ÛË Â›¯Â ÙË ÌÂÁ·Ï‡ÙÂÚË Û˘¯ÓfiÙËÙ· ÂÌ-

Ê¿ÓÈÛË˜ ÌÂ ÔÛÔÛÙfi 96% ÛÙ· ·È‰È¿ Î·È ÙÔ˘˜ ÂÊ‹-

‚Ô˘˜ ÌÂ ªÂÙ™˘Ó. √ ÂÈÔÏ·ÛÌfi˜ ÙË˜ ıÂˆÚÂ›Ù·È ·Ú-

ÎÂÙ¿ ˘„ËÏfi˜ ÛÙÈ˜ ·ÓÂÙ˘ÁÌ¤ÓÂ˜ ¯ÒÚÂ˜ Î·È ÚÔÛÂÁÁ›-

˙ÂÈ ÙÔ 30% ÙÔ˘ ÂÓ‹ÏÈÎÔ˘ ÏËı˘ÛÌÔ‡, ÂÓÒ ÙÔ ÁÂÁÔÓfi˜

fiÙÈ Ë ˘¤ÚÙ·ÛË ‰ÈÏ·ÛÈ¿˙ÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ÁÈ· Î·Ú‰ÈÔ-

¿ıÂÈ· (15) Î·Ù·‰ÂÈÎÓ‡ÂÈ ÙËÓ ·Ó·ÁÎ·ÈfiÙËÙ· ÁÈ·

¤ÁÎ·ÈÚË ÌË Ê·ÚÌ·ÎÂ˘ÙÈÎ‹ ·ÓÙÈÌÂÙÒÈÛË, ÌÂ ‚ÂÏÙ›ˆ-

ÛË ÙÔ˘ ÙÚfiÔ˘ ˙ˆ‹˜, ‰È·ÙÚÔÊ‹˜ Î·È ¿ıÏËÛË˜ (50,51).

∏ ÌÂ›ˆÛË ÙÔ˘ ÛˆÌ·ÙÈÎÔ‡ ‚¿ÚÔ˘˜, Ë ÂÚÈÔÚÈÛÌ¤ÓË

Î·Ù·Ó¿ÏˆÛË ·Ï·ÙÈÔ‡, Ë ¯Ú‹ÛË ÌfiÓÔ ÂÏ·ÈÔÏ¿‰Ô˘, Ë

·˘ÍËÌ¤ÓË Ï‹„Ë Î·Ï›Ô˘ ·fi Ï·¯·ÓÈÎ¿, ÊÚÔ‡Ù·,

fiÛÚÈ· Î·È ·Ó¿Ï·ÙÔ˘˜ ÍËÚÔ‡˜ Î·ÚÔ‡˜, Î·ıÒ˜ Î·È Ë

Î·ıËÌÂÚÈÓ‹ Ì¤ÙÚÈ· ÚÔ˜ ¤ÓÙÔÓË ÛˆÌ·ÙÈÎ‹ ¿ÛÎËÛË,

·ÔÙÂÏÔ‡Ó Î‡ÚÈÂ˜ ÌÂıfi‰Ô˘˜ ÌË Ê·ÚÌ·ÎÂ˘ÙÈÎ‹˜ ·ÓÙÈ-

ÌÂÙÒÈÛË˜ (50).

º˘ÛÈÎ‹ ¿ÛÎËÛË

∏ ¤ÏÏÂÈ„Ë ÛˆÌ·ÙÈÎ‹˜ ¿ÛÎËÛË˜ Û¯ÂÙ›˙ÂÙ·È ÛÙÂÓ¿

ÌÂ ÙÔ ªÂÙ™˘Ó, Î·ıÒ˜ ·˘Í¿ÓÂÙ·È Ô Î›Ó‰˘ÓÔ˜ ÁÈ· Û·Î-

¯·ÚÒ‰Ë ‰È·‚‹ÙË, ·¯˘Û·ÚÎ›·, ˘¤ÚÙ·ÛË Î·È ‰˘ÛÏÈ-

È‰·ÈÌ›· (15).

™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË, Ù· ·È‰È¿ Î·È ÔÈ ¤ÊË‚ÔÈ ÌÂ

ªÂÙ™˘Ó ‚Ú¤ıËÎ·Ó ÌÂ ÛËÌ·ÓÙÈÎ¿ ¯·ÌËÏfiÙÂÚÂ˜ Èı·-

ÓfiÙËÙÂ˜ (Î·Ù¿ 30%) Ó· ¤¯Ô˘Ó Î·Ï‹ Î·Ú‰ÈÔ·Ó·ÓÂ˘-

ÛÙÈÎ‹ ·ÓÙÔ¯‹. √È Ribeiro Î·È Û˘Ó (52) ·Ó·Ê¤ÚÔ˘Ó

(·fi ÌÂÏ¤ÙË ÛÙËÓ ¶ÔÚÙÔÁ·Ï›·) fiÙÈ ·ÁfiÚÈ· ËÏÈÎ›·˜ 8-

15 ÂÙÒÓ, ÌÂ ¯·ÌËÏ¿ Â›Â‰· ÛˆÌ·ÙÈÎ‹˜ ¿ÛÎËÛË˜, Â›-

¯·Ó ÂÚÈÛÛfiÙÂÚÔ˘˜ ·Ú¿ÁÔÓÙÂ˜ ªÂÙ™˘Ó. ∞ÎfiÌË,

·fi ÌÂÏ¤ÙË ÂÓËÏ›ÎˆÓ ÙË˜ ∞ÙÙÈÎ‹˜, fiÛÔÈ ‰‹ÏˆÓ·Ó fiÙÈ

·ÛÎÔ‡ÓÙ·Ó ÌÂ Ì¤ÙÚÈ· ¤ÓÙ·ÛË ‚Ú¤ıËÎ·Ó ÌÂ 25% ¯·-

ÌËÏfiÙÂÚÔ Î›Ó‰˘ÓÔ ÁÈ· ·Ó¿Ù˘ÍË ªÂÙ™˘Ó (53).

∫¿ÓÈÛÌ·

∆Ô Î¿ÓÈÛÌ·, ·Ó Î·È ‰ÂÓ ÂÚÈÏ·Ì‚¿ÓÂÙ·È Ï¤ÔÓ

ÛÙÔ ªÂÙ™˘Ó (5), ·ÔÙÂÏÂ› ÚˆÙÂ‡ÔÓÙ· ·ıËÚÔÁfiÓÔ

·Ú¿ÁÔÓÙ· Î·È ‰Ú· ÛÂ Û˘Ó¤ÚÁÂÈ· ÌÂ ÙÔ˘˜ ̆ fiÏÔÈÔ˘˜.

¢ÂÓ ‚Ú¤ıËÎÂ ÛÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË Ó· Û¯ÂÙ›˙Â-

Ù·È ÌÂ ÙËÓ ·ÚÔ˘Û›· ªÂÙ™˘Ó, ·Ú’ fiÏÔ Ô˘ ÔÛÔ-

ÛÙfi 12% ÙˆÓ ÂÊ‹‚ˆÓ ‰‹ÏˆÓ·Ó Î·ÓÈÛÙ¤˜. ∆Ô Î¿-

ÓÈÛÌ· Ô˘ ·Ú¯›˙ÂÈ Û˘Ó‹ıˆ˜ ·fi ÙËÓ ÂÊË‚ÈÎ‹ ËÏÈ-

Î›·, ·ÔÙÂÏÂ› ÙÔ ÛÔ‚·ÚfiÙÂÚÔ Úfi‚ÏËÌ· ‰ËÌfiÛÈ·˜

˘ÁÂ›·˜ ·ÁÎÔÛÌ›ˆ˜ (13). ∞˘Í¿ÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ÁÈ·

Î·Ú‰ÈÔ¿ıÂÈ· Î·Ù¿ 2,5 ÊÔÚ¤˜ (48), ÂÓÒ Â˘ı‡ÓÂÙ·È

ÁÈ· ÙÔ 13% fiÏˆÓ ÙˆÓ ı·Ó¿ÙˆÓ Î·È ÁÈ· ÂÚ›Ô˘ 19-23

“¯·Ì¤Ó·” ¯ÚfiÓÈ· ˙ˆ‹˜ (54).

∏ ÛËÌ·Û›· ÙË˜ ÂÎ·È‰Â˘ÙÈÎ‹˜ ·Ú¤Ì‚·ÛË˜ ÛÙË

‰È·ÎÔ‹ ‹ ÙËÓ ÂÏ¿ÙÙˆÛË ÙÔ˘ Î·Ó›ÛÌ·ÙÔ˜ ·Ó·‰Â›-

¯ÙËÎÂ ·fi Û¯ÂÙÈÎ¿ ÚÔÁÚ¿ÌÌ·Ù· Ô˘ ÂÊ·ÚÌfiÛÙË-

Î·Ó ÛÂ Û¯ÔÏÂ›· ÙË˜ ∫Ú‹ÙË˜ (19,55).

¢È·ÙÚÔÊ‹ Î·È ÌÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ

™‡ÌÊˆÓ· ÌÂ ÙÔÓ ¢À¢, Ë ‰È·ÙÚÔÊ‹ ÙˆÓ 2/3 ÙˆÓ

·È‰ÈÒÓ Î·È ÙˆÓ ÂÊ‹‚ˆÓ “¯ÚÂÈ¿˙ÂÙ·È ‚ÂÏÙ›ˆÛË”, ÙÔ

1/3 ¤¯ÂÈ “·ÓÂ·ÚÎ‹” ‰È·ÙÚÔÊ‹ Î·È ÂÏ¿¯ÈÛÙÔ ÔÛÔ-

ÛÙfi (6%) ¤¯ÂÈ “Î·Ï‹”.

√ ¢À¢, ˆ˜ Ì¤ıÔ‰Ô˜ ÔÈÔÙÈÎ‹˜ ·ÍÈÔÏfiÁËÛË˜ ÙË˜

ËÌÂÚ‹ÛÈ·˜ ‰È·ÙÚÔÊ‹˜, ˘ÔÏÔÁ›˙ÂÙ·È ·fi ÙÔÓ Û˘Ó-

‰˘·ÛÌfi ÙË˜ Ï‹„Ë˜ ıÚÂÙÈÎÒÓ Û˘ÛÙ·ÙÈÎÒÓ Î·È Î·Ù·-

Ó¿ÏˆÛË˜ ÙÚÔÊ›ÌˆÓ. ∂Ê·ÚÌfi˙ÂÙ·È ÛÂ ¯ÒÚÂ˜ Î·È ÏË-

ı˘ÛÌÔ‡˜ ÌÂ ‰È·ÊÔÚÂÙÈÎ¤˜ ‰È·ÈÙËÙÈÎ¤˜ Û˘Ó‹ıÂÈÂ˜,

fiˆ˜ Ë πÛ·Ó›· (28), ÂÚÈÔ¯‹ ÌÂ ÙËÓ ÔÔ›· Ë ∂ÏÏ¿-

‰· ¤¯ÂÈ ÎÔÈÓ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÁÓˆÚ›ÛÌ·Ù·, ÛÙÔ Ï·›-

ÛÈÔ È‰›ˆ˜ ÙË˜ ·Ó·ÊÂÚfiÌÂÓË˜ ÌÂÛÔÁÂÈ·Î‹˜ ‰È·ÙÚÔ-

Ê‹˜. øÛÙfiÛÔ, Ô ¢À¢ Ú¤ÂÈ Ó· ·Ó·ÓÂÒÓÂÙ·È, Ó· ÙÚÔ-

ÔÔÈÂ›Ù·È Î·È Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ÂÎÙÈÌ‹ÛÂÈ˜ Î·È ÁÈ·

ÙËÓ Î·Ù·Ó¿ÏˆÛË ÌË ˘ÁÈÂÈÓÒÓ ÙÚÔÊ›ÌˆÓ (25,56).

™ÙÈ˜ ∏¶∞, Ù· ·È‰È¿ Î·È ÔÈ ¤ÊË‚ÔÈ Î·Ù¿ Ù· ¤ÙË

1999-2000, Â›¯·Ó ‚·ıÌÔÏÔÁ›· ¢À¢ 62,8, Ô˘ Â›Ó·È

ÛËÌ·ÓÙÈÎ¿ ˘„ËÏfiÙÂÚË ·fi ÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë ÙË˜ ·-

ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ (¤ÏÂÁ¯Ô˜ Student, 62,8 ¤Ó·ÓÙÈ 58,7,

p<0,001), ÌÂ ÔÛÔÛÙfi 16% Ó· ¤¯ÂÈ “·ÓÂ·ÚÎ‹” ‰È·-

ÙÚÔÊ‹ Î·È 10% “Î·Ï‹” (25). ™ÙËÓ πÛ·Ó›· ÂÎÙÈÌ‹-

ıËÎÂ fiÙÈ ·È‰È¿ ËÏÈÎ›·˜ 6-7 ÂÙÒÓ Â›¯·Ó ‚·ıÌÔÏÔÁ›·

64,6, ÌÂ 3,7% Ó· ¤¯ÂÈ “·ÓÂ·ÚÎ‹” ‰È·ÙÚÔÊ‹ Î·È

1,6% “Î·Ï‹” (28).

°È· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Î·È ÙË ıÂÚ·Â›· ÙÔ˘

ªÂÙ™˘Ó, Ë ‰È·ÙÚÔÊ‹ Ú¤ÂÈ Ó· Â›Ó·È ¯·ÌËÏ‹ ÛÂ ÎÔ-

ÚÂÛÌ¤Ó· ÏÈ·Ú¿ ÔÍ¤· Î·È ÏÔ‡ÛÈ· ÛÂ ‰È·ÈÙËÙÈÎ¤˜

›ÓÂ˜ - ·fi ÙÚfiÊÈÌ· Ô˘ ¤¯Ô˘Ó ¯·ÌËÏfi ÁÏ˘Î·ÈÌÈÎfi

‰Â›ÎÙË - Î·È ÌÔÓÔ·ÎfiÚÂÛÙ· ÏÈ·Ú¿ ÔÍ¤· Ô˘ ÚÔ¤Ú-

¯ÔÓÙ·È ·fi ÙÔ ÂÏ·ÈfiÏ·‰Ô (46). ∏ ÓËÛÙÂÈ·Î‹ ‰›·ÈÙ·


¶·È‰È·ÙÚÈÎ‹ 2007;70:24-36

Ô˘ Î·ıÔÚ›˙ÂÙ·È ·fi ÙÔ˘˜ Î·ÓfiÓÂ˜ ÙË˜ √Úıfi‰ÔÍË˜∂ÏÏËÓÈÎ‹˜ ∂ÎÎÏËÛ›·˜ (40,57-59) ‚Ú¤ıËÎÂ Ó· ¤¯ÂÈÙËÓ ˘„ËÏfiÙÂÚË ÂÚÈÂÎÙÈÎfiÙËÙ· ÛÂ Û‡ÓıÂÙÔ˘˜ ˘‰·-Ù¿ÓıÚ·ÎÂ˜ ÌÂ ¯·ÌËÏfi ÁÏ˘Î·ÈÌÈÎfi ‰Â›ÎÙË, Ú¿ÁÌ·Ô˘ Û˘Ó¿‰ÂÈ ÌÂ ÙÈ˜ ‚·ÛÈÎ¤˜ Ô‰ËÁ›Â˜ Ô˘ ·ÊÔÚÔ‡ÓÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ªÂÙ™˘Ó (46,60). ∂ÈÏ¤ÔÓ,·fi ÙÔ˘˜ Davy Î·È Melby (60) ÂÈ‚Â‚·ÈÒÓÂÙ·È fiÙÈ‰È·ÙÚÔÊ‹ ˘„ËÏ‹ ÛÂ Û‡ÓıÂÙÔ˘˜ ˘‰·Ù¿ÓıÚ·ÎÂ˜ Î·È¯·ÌËÏ‹ ÛÂ ÏÈ·Ú¿, ÌÂÈÒÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ÁÈ· ¯ÚfiÓÈÂ˜·Ûı¤ÓÂÈÂ˜, ÂÓÒ Ë Ï‹„Ë ‰È·ÈÙËÙÈÎÒÓ ÈÓÒÓ, fiˆ˜ Î·-ıÔÚ›˙ÂÙ·È ·fi ÙÔ American Dietetic Association, Â›-Ó·È Â˘ÂÚÁÂÙÈÎ‹ ÁÈ· ÙËÓ ÚfiÏË„Ë Î·È ·ÓÙÈÌÂÙÒÈÛËÙÔ˘ ªÂÙ™˘Ó, ·ÊÔ‡ Ô‰ËÁÂ› ÛÙË ÌÂ›ˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ıÚÔÌ‚ÔÁ¤ÓÂÛË˜.

™˘ÌÂÚ¿ÛÌ·Ù·

∞Ó Î·È Ë Û˘¯ÓfiÙËÙ· ÙÔ˘ ªÂÙ™˘Ó ‚Ú¤ıËÎÂ ¯·ÌË-ÏfiÙÂÚË ÛÂ Û¯¤ÛË ÌÂ ¿ÏÏÂ˜ ‰ÈÂıÓÂ›˜ ÌÂÏ¤ÙÂ˜, Ë ·ÓË-Û˘¯›· ÁÈ· ˘„ËÏ‹ Â›ÙˆÛ‹ ÙÔ˘ ÛÙÔÓ ÎÚËÙÈÎfi ·È-‰ÈÎfi Î·È ÂÊË‚ÈÎfi ÏËı˘ÛÌfi ·Ú·Ì¤ÓÂÈ, ·ÊÔ‡ ‚Ú¤-ıËÎ·Ó ÛÂ ˘„ËÏ‹ Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛË˜ ÔÚÈÛÌ¤ÓÂ˜Û˘ÓÈÛÙÒÛÂ˜ ÙÔ˘, fiˆ˜ Ë ·˘ÍËÌ¤ÓË ·ÚÙËÚÈ·Î‹ ›Â-ÛË Î·È Ë ·¯˘Û·ÚÎ›·. ∏ ÏÂÈÔÓfiÙËÙ· ÙˆÓ ·È‰ÈÒÓÂ›¯Â ‰È·ÙÚÔÊ‹ Ô˘ “¯ÚÂÈ¿˙ÂÙ·È ‚ÂÏÙ›ˆÛË”, ÂÓÒ‹Ù·Ó ÔÏ‡ ¯·ÌËÏfi ÙÔ ÔÛÔÛÙfi ÙˆÓ ·È‰ÈÒÓ Î·ÈÙˆÓ ÂÊ‹‚ˆÓ ÌÂ “Î·Ï‹” ÔÈÔÙÈÎÒ˜ ‰È·ÙÚÔÊ‹. ∆fiÛÔË “·ÓÂ·ÚÎ‹˜” ‰È·ÙÚÔÊ‹ fiÛÔ Î·È ·˘Ù‹ Ô˘ “¯ÚÂÈ-¿˙ÂÙ·È ‚ÂÏÙ›ˆÛË”, ÔÊÂ›ÏÔÓÙ·È Î˘Ú›ˆ˜ ÛÙË ¯·ÌËÏ‹Î·Ù·Ó¿ÏˆÛË ÊÚÔ‡ÙˆÓ, Ï·¯·ÓÈÎÒÓ Î·È ÔÛÚ›ˆÓ,ÂÓÒ ˘„ËÏ‹ ‹Ù·Ó Ë Ï‹„Ë ÎÔÚÂÛÌ¤ÓÔ˘ Ï›Ô˘˜ Î·ÈÎÚ¤·ÙÔ˜.

∏ ÚˆÙÔÁÂÓ‹˜ ÚfiÏË„Ë Â›Ó·È Ô ·ÔÙÂÏÂÛÌ·ÙÈ-ÎfiÙÂÚÔ˜ ÙÚfiÔ˜ ÂÏ¿ÙÙˆÛË˜ ÙË˜ Û˘¯ÓfiÙËÙ·˜ ÂÌÊ¿-ÓÈÛË˜ ÙÔ˘ ªÂÙ™˘Ó (36). ∫·Ù¿ÏÏËÏ· ÂÎ·È‰Â˘ÙÈÎ¿ÚÔÁÚ¿ÌÌ·Ù· Ô˘ Â˘·ÈÛıËÙÔÔÈÔ‡Ó Ù· ·È‰È¿ ÛÂı¤Ì·Ù· ˘ÁÂ›·˜ Î·È ‰È·ÙÚÔÊ‹˜, ÌÔÚÔ‡Ó Ó· Û˘Ì‚¿Ï-ÏÔ˘Ó ÒÛÙÂ Ó· Á›ÓÔÓÙ·È Î·Ï‡ÙÂÚÂ˜ ÂÈÏÔÁ¤˜ fiÛÔÓ·ÊÔÚ¿ ÛÙË ‰È·ÙÚÔÊ‹ Î·È ÛÙËÓ ·‡ÍËÛË ÙË˜ ÛˆÌ·ÙÈ-Î‹˜ ¿ÛÎËÛË˜.

∂˘¯·ÚÈÛÙ›Â˜

∂˘¯·ÚÈÛÙÔ‡ÌÂ ıÂÚÌ¿ ÁÈ· ÙË ¯ÚËÌ·ÙÔ‰fiÙËÛË ÙË˜ ÌÂÏ¤-

ÙË˜, ÙË °ÂÓÈÎ‹ °Ú·ÌÌ·ÙÂ›· ∞ıÏËÙÈÛÌÔ‡, ÙÔ ÀÔ˘ÚÁÂ›Ô ¶·È-

‰Â›·˜ Î·È £ÚËÛÎÂ˘Ì¿ÙˆÓ, ÙËÓ ÂÙ·ÈÚÂ›· Kellogg’s, Î·ıÒ˜ Î·È

ÙÈ˜ ‰ËÌÔÙÈÎ¤˜ ·˘ÙÔ‰ÈÔÈÎ‹ÛÂÈ˜ ÙˆÓ ¢‹ÌˆÓ ƒÔ‡‚· Î·È ÃÂÚÛÔ-

Ó‹ÛÔ˘ ∏Ú·ÎÏÂ›Ô˘. ∂›ÛË˜, Û˘Ó¤‚·Ï·Ó ·ÔÙÂÏÂÛÌ·ÙÈÎ¿ ÔÈ

Û˘ÓÂÚÁ¿ÙÂ˜: ª·Ú›· ªÈÙÛÒÚË, πˆ¿ÓÓ· ∞ÔÛÙÔÏ¿ÎË, ∞ÁÁÂ-

ÏÈÎ‹ ¶··‰¿ÎË Î·È ¢ËÌ‹ÙÚË˜ ∞ı·Ó·ÛfiÔ˘ÏÔ˜.


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37∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞ ORIGINAL ARTICLE

¶·È‰È·ÙÚÈÎ‹ 2007;70:37-41

√ ÚfiÏÔ˜ ÙˆÓ ¿Ù˘ˆÓ ‚·ÎÙËÚ›ˆÓ ÛÙÔÓ ¯ÚfiÓÈÔ ‚‹¯·

ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜

π.ª. µÂÏÈÛÛ·Ú›Ô˘, ¡.°. ¶··‰fiÔ˘ÏÔ˜, M. ∆ÛÔÏÈ¿, ª. °È·ÓÓ¿ÎË, º. ™·ÍÒÓË-¶··ÁÂˆÚÁ›Ô˘, ¢.∞. ∫·ÊÂÙ˙‹˜

¶ÂÚ›ÏË„Ë: ™ÎÔfi˜ ÙË˜ ÌÂÏ¤ÙË˜ Â›Ó·È Ë ‰ÈÂÚÂ‡ÓËÛË ÙÔ˘ ÚfiÏÔ˘ ÙÔ˘ Ì˘ÎÔÏ¿ÛÌ·ÙÔ˜ Î·È ÙÔ˘ ¯Ï·Ì˘‰›Ô˘ÙË˜ ÓÂ˘ÌÔÓ›·˜ ÛÙÔÓ ·È‰ÈÎfi ÏËı˘ÛÌfi ÌÂ ¯ÚfiÓÈÔ ‹/Î·È ˘ÔÙÚÔÈ¿˙ÔÓÙ· ‚‹¯· Î·È Ë ·ÍÈÔÏfiÁËÛË ÙË˜ÎÏÈÓÈÎ‹˜ ·¿ÓÙËÛË˜ ÙˆÓ ·ÛıÂÓÒÓ ·˘ÙÒÓ ÛÙËÓ ·Ó¿ÏÔÁË ıÂÚ·Â›·. ∂Í‹ÓÙ· ÂÙ¿ ·È‰È¿, ·fi 2,5 ¤ˆ˜ 16ÂÙÒÓ, ÌÂ ¯ÚfiÓÈÔ ‹ ˘ÔÙÚÔÈ¿˙ÔÓÙ· ‚‹¯· Û˘ÌÂÚÈÂÏ‹ÊıËÛ·Ó ÛÙË ÌÂÏ¤ÙË. ∞ÓÙÈÛÒÌ·Ù· ÁÈ· Mycoplasma

pneumoniae (M. pneumoniae) Î·È Chlamydia pneumoniae (C. pneumoniae) ·ÓÈ¯ÓÂ‡ıËÎ·Ó ÛÂ ‰Â›ÁÌ· ÔÚÔ‡ÙˆÓ ·ÛıÂÓÒÓ ·˘ÙÒÓ ÌÂ ‰‡Ô Â˘Ú¤ˆ˜ ‰È·‰Â‰ÔÌ¤ÓÂ˜ ÌÂıfi‰Ô˘˜, ÙËÓ ELISA (enzyme-linkedimmunosorbent assay) Î·È ÙÔÓ ¤ÌÌÂÛÔ ·ÓÔÛÔÊıÔÚÈÛÌfi (IFA). √È ·ÛıÂÓÂ›˜ ÌÂ ıÂÙÈÎ¿ ·ÓÙÈÛÒÌ·Ù· IgMÁÈ· M. pneumoniae ‹ C. pneumoniae Î·È ·ÓÂ·ÚÎ‹ ·ÓÙ·fiÎÚÈÛË ÛÙËÓ ·ÓÙÈ·ÛıÌ·ÙÈÎ‹ ·ÁˆÁ‹, ¤Ï·‚·ÓÎÏ·ÚÈıÚÔÌ˘Î›ÓË ·fi ÙÔ ÛÙfiÌ·. ∂›ÎÔÛÈ ·ÛıÂÓÂ›˜ (29,9%) ¤·Û¯·Ó ·fi ÔÍÂ›· Ì˘ÎÔÏ·ÛÌ·ÙÈÎ‹ ÏÔ›ÌˆÍËÎ·È 4 (6,0%) ·fi ÔÍÂ›· ¯Ï·Ì˘‰È·Î‹ ÏÔ›ÌˆÍË, ÂÓÒ ¤Ó· ·È‰› Â›¯Â Ù·˘Ùfi¯ÚÔÓ· Î·È ÙÈ˜ ‰‡Ô ÏÔÈÌÒÍÂÈ˜. ∞fiÙÔ˘˜ 23 ÔÚÔıÂÙÈÎÔ‡˜ ·ÛıÂÓÂ›˜, ÔÈ 9 (39,1%) ¤·Û¯·Ó ·fi ÔÍÂ›· Ì˘ÎÔÏ·ÛÌ·ÙÈÎ‹/¯Ï·Ì˘‰È·Î‹ ÏÔ›ÌˆÍËÌfiÓÔ, ÂÓÒ ÔÈ ˘fiÏÔÈÔÈ 14 (60,8%) ·fi Û˘Ó‰˘·ÛÌfi ¿ÛıÌ·ÙÔ˜ ‹/Î·È ÚÈÓ›ÙÈ‰·˜/·Ú·ÚÚÈÓÔÎÔÏ›ÙÈ‰·˜. ∏¯ÔÚ‹ÁËÛË ÎÏ·ÚÈıÚÔÌ˘Î›ÓË˜ Ê·›ÓÂÙ·È ˆ˜ ‹Ù·Ó ·ÔÙÂÏÂÛÌ·ÙÈÎ‹ ÛÙËÓ ÂÍ¿ÏÂÈ„Ë ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÛÙ·15 ·È‰È¿ (65,2%), ÂÓÒ 8 ·ÛıÂÓÂ›˜ (34,7%) ‚ÂÏÙÈÒıËÎ·Ó ¯ˆÚ›˜ Ï‹„Ë Ì·ÎÚÔÏÈ‰ÒÓ. ∏ ÔÍÂ›· Ì˘ÎÔÏ·-ÛÌ·ÙÈÎ‹/¯Ï·Ì˘‰È·Î‹ ÏÔ›ÌˆÍË Â›Ó·È Û˘¯Ó‹ ÛÙ· ·È‰È¿ ÌÂ ¯ÚfiÓÈÔ ‹ ˘ÔÙÚÔÈ¿˙ÔÓÙ· ‚‹¯· Î·È Ê·›ÓÂÙ·ÈfiÙÈ ·ÓÙ·ÔÎÚ›ÓÂÙ·È Î·Ï¿ ÛÙË ¯ÔÚ‹ÁËÛË ÎÏ·ÚÈıÚÔÌ˘Î›ÓË˜.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ÕÙ˘Ë ÏÔ›ÌˆÍË, Ì˘ÎfiÏ·ÛÌ·, ·È‰È¿, ¯ÚfiÓÈÔ˜ ‚‹¯·˜.

The role of mycoplasmal/chlamydial infection in chronic cough in

children

I.M. Velissariou, N.G. Papadopoulos, M. Giannaki, P. Saxoni-Papageorgiou, D.A. Kafetzis

Abstract

Objectives: The aim of this study was to assess the role of recent mycoplasmal/chlamydial infection inchildren with a chronic cough, and to evaluate the clinical response to treatment with clarithromycin.

Methods: Sixty-seven children, aged 2.5 to 16 years, with chronic or recurrent cough were enrolled inthe study. A serum sample from each child was processed for Mycoplasma pneumoniae and Chlamydia

pneumoniae antibody status, using two widely approved methods, the enzyme-linked immunosorbentassay (ELISA) and the immunofluorescence assay (IFA). Clarithromycin was prescribed for children withpositive IgM M. pneumoniae and/or C. pneumoniae antibodies, according to their response to anti-asthmatic treatment.

Results: Twenty patients (29.9%) had evidence of recent mycoplasmal infection and 4 (6.0%) of recentchlamydial infection, with one child having both mycoplasmal and chlamydial infection. Of the 23 positivepatients, 9 (39.1%) had recent mycoplasmal/chlamydial infection only, while in 14 (60.8%) the atypicalbacterial infection was in addition to asthma or rhino-sinusitis. Clarithromycin treatment was effective indiminishing symptoms in 15 (65.2%) children, while 8 patients (34.7%) improved without it.

Conclusions: Chronic or recurrent cough in children is commonly due to recent mycoplasmal/chlamydial infection and tends to respond well to clarithromycin.

Key words: Atypical respiratory infection, mycoplasma, chronic cough.

2Ë ¶·ÓÂÈÛÙËÌÈ·Î‹¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹,¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞ÁÏ·˝· ∫˘ÚÈ·ÎÔ‡”, £Ë‚ÒÓÎ·È §Â‚·‰Â›·˜, ∞ı‹Ó·


πˆ¿ÓÓ· ª. µÂÏÈÛÛ·Ú›Ô˘, [email protected]∞ÌÊÈÙÚ›ÙË˜ 3, ¶·Ï·Èfiº¿ÏËÚÔ, ∆.∫. 175 61, ∞ı‹Ó·

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

Correspondence:

Ioanna M. Velissariou, [email protected], Amphitritis St., 175 61, Athens, Greece

∂ÈÛ·ÁˆÁ‹

∆Ô Ì˘ÎfiÏ·ÛÌ· Î·È ÙÔ ¯Ï·Ì‡‰ÈÔ ÙË˜ ÓÂ˘-

ÌÔÓ›·˜ ·ÔÙÂÏÔ‡Ó ÁÓˆÛÙÔ‡˜ ·ÈÙÈÔÏÔÁÈÎÔ‡˜ ·-

Ú¿ÁÔÓÙÂ˜ ¿Ù˘Ë˜ ÓÂ˘ÌÔÓ›·˜ ÛÂ ·È‰È¿ Û¯ÔÏÈ-

Î‹˜ ËÏÈÎ›·˜, ·ÏÏ¿ Î·È ÛÂ ÓÂ·ÚÔ‡˜ ÂÓ‹ÏÈÎÂ˜

(1,2). ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, ‰ÈÂÍ¿ÁÔÓÙ·È ÌÂÏ¤-

ÙÂ˜ Ô˘ ÛÙfi¯Ô ¤¯Ô˘Ó Ó· ·ÔÛ·ÊËÓ›ÛÔ˘Ó ÙËÓ

Èı·Ó‹ Û¯¤ÛË ÌÂÙ·Í‡ ‚ÚÔÁ¯ÈÎ‹˜ ˘ÂÚ··ÓÙË-

ÙÈÎfiÙËÙ·˜ Î·È ÈÔÁÂÓÒÓ ‹ Ì˘ÎÔÏ·ÛÌ·ÙÈÎÒÓ

ÏÔÈÌÒÍÂˆÓ (1,3,4).

√ ¯ÚfiÓÈÔ˜ ‚‹¯·˜ ·ÔÙÂÏÂ› Û¯ÂÙÈÎ¿ Û˘¯Ófi Û‡-

ÌÙˆÌ· ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜, ÚÔÎ·ÏÒÓÙ·˜ ÛËÌ·-

ÓÙÈÎÔ‡ ‚·ıÌÔ‡ ÂÓfi¯ÏËÛË ÛÙÔÓ ¿Û¯ÔÓÙ·, ÌÂ ·Ô-

Ù¤ÏÂÛÌ· ·˘ÍËÌ¤ÓË ·ÓËÛ˘¯›· ÙˆÓ ÁÔÓ¤ˆÓ Î·È Û˘-

¯Ó¤˜ ·Ô˘Û›Â˜ ·fi ÙÔ Û¯ÔÏÂ›Ô (5). ŸÛÔÓ ·ÊÔÚ¿ ÙËÓ

·ÈÙÈÔÏÔÁ›· ÙÔ˘, Ï¤ÁÂÙ·È fiÙÈ ÔÔÈ·‰‹ÔÙÂ ¿ıËÛË

ÙÔ˘ ÓÂ‡ÌÔÓ· ÌÔÚÂ› Ó· ÚÔÎ·Ï¤ÛÂÈ ¯ÚfiÓÈÔ ‹ ˘Ô-

ÙÚÔÈ¿˙ÔÓÙ· ‚‹¯· ÛÙ· ·È‰È¿, ·Ó Î·È ÔÈ Û˘¯ÓfiÙÂÚÂ˜

·ÈÙ›Â˜ Â›Ó·È ÙÔ ¿ÛıÌ·, Ë ÚÈÓ›ÙÈ‰·, Ë ·Ú·ÚÚÈÓÔÎÔÏ-

›ÙÈ‰·, ÔÈ ÏÔÈÌÒÍÂÈ˜ ÙÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡ Î·È ÔÈ ·Ó·-

ÙÔÌÈÎ¤˜ ·ÓˆÌ·Ï›Â˜ ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡

(5,6). √ ÔÚÈÛÌfi˜ ÙÔ˘ ¯ÚfiÓÈÔ˘ ‚‹¯·, Â›ÛË˜, ÔÈÎ›-

ÏÂÈ, ·Ó Î·È ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ ÂÚÂ˘ÓËÙ¤˜ ıÂˆÚÔ‡Ó

¯ÚfiÓÈÔ ÙÔÓ ‚‹¯· Ô˘ ‰È·ÚÎÂ› ÂÚÈÛÛfiÙÂÚÔ ·fi 3

Â‚‰ÔÌ¿‰Â˜ (5,6).

∆fiÛÔ ÔÈ Ì˘ÎÔÏ·ÛÌ·ÙÈÎ¤˜, fiÛÔ Î·È ÔÈ ¯Ï·Ì˘‰È·-

Î¤˜ ÏÔÈÌÒÍÂÈ˜ ÙÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡ ÂÎ‰ËÏÒÓÔÓÙ·È

ÔÏ‡ Û˘¯Ó¿ ÌÂ ‚‹¯·. øÛÙfiÛÔ, Ë ÌÂÁ·Ï‡ÙÂÚË ‰˘ÛÎÔ-

Ï›· ÛÙË Û˘Û¯¤ÙÈÛË Ì˘ÎÔÏ·ÛÌ·ÙÈÎ‹˜/¯Ï·Ì˘‰È·Î‹˜

ÏÔ›ÌˆÍË˜ Î·È ¯ÚfiÓÈÔ˘ ‚‹¯· ÛÙ· ·È‰È¿ ¤ÁÎÂÈÙ·È ÛÙ·

ÌË ÂÈ‰ÈÎ¿, Û˘¯Ó¿ Û˘ÌÙÒÌ·Ù· Î·È ÛÙËÓ ÂÚÈÏÔÎfi-

ÙËÙ· ÙË˜ ‚·ÎÙËÚÈÔÏÔÁÈÎ‹˜ ‰È¿ÁÓˆÛË˜ (7-10).

√ ÛÎÔfi˜ ÙË˜ ÌÂÏ¤ÙË˜ ·˘Ù‹˜ ‹Ù·Ó Ó· Î·ıÔÚÈÛÙÂ›

fiÛÔ Û˘¯Ó¿ Û¯ÂÙ›˙ÔÓÙ·È ÔÈ Ì˘ÎÔÏ·ÛÌ·ÙÈÎ¤˜/¯Ï·-

Ì˘‰È·Î¤˜ ÏÔÈÌÒÍÂÈ˜ ÙÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡ ÌÂ ¯ÚfiÓÈÔ

‚‹¯· ÛÙ· ·È‰È¿ Î·È Î·Ù¿ fiÛÔ ·ÓÙ·ÔÎÚ›ÓÔÓÙ·È

ÛÙËÓ ·ÈÙÈÔÏÔÁÈÎ‹ ıÂÚ·Â›·.


∞ÛıÂÓÂ›˜

∆Ô ¿ÚıÚÔ ·˘Ùfi ·ÔÙÂÏÂ› Ì¤ÚÔ˜ Ì›·˜ ÚÔÔÙÈÎ‹˜ ÌÂÏ¤ÙË˜

67 ·È‰ÈÒÓ ÌÂ ¯ÚfiÓÈÔ ‹ ˘ÔÙÚÔÈ¿˙ÔÓÙ· ‚‹¯·, Ù· ÔÔ›· ·-

ÚÔ˘ÛÈ¿ÛÙËÎ·Ó ÛÙ· ∂ÍˆÙÂÚÈÎ¿ π·ÙÚÂ›· ÙÔ˘ ¡ÔÛÔÎÔÌÂ›Ô˘ ¶·›-

‰ˆÓ “∞ÁÏ·˝· ∫˘ÚÈ·ÎÔ‡” ÛÙÔ ‰È¿ÛÙËÌ· ÂÓfi˜ ¤ÙÔ˘˜. √È ·ÛıÂ-

ÓÂ›˜ ·˘ÙÔ› ·ÎÔÏÔ‡ıËÛ·Ó ¤Ó·Ó ‰È·ÁÓˆÛÙÈÎfi Î·È ıÂÚ·Â˘ÙÈÎfi

·ÏÁfiÚÈıÌÔ, Ô ÔÔ›Ô˜ ÂÚÈÂÏ¿Ì‚·ÓÂ ÂÓ‰ÂÏÂ¯‹ ¤ÏÂÁ¯Ô ÙË˜

·Ó·ÓÂ˘ÛÙÈÎ‹˜ ÏÂÈÙÔ˘ÚÁ›·˜ (Ù·Ï·ÓÙÔÛÈÌÂÙÚ›· Î·È ÛÈÚÔÌ¤-

ÙÚËÛË ÚÈÓ Î·È ÌÂÙ¿ ·fi ‚ÚÔÁ¯Ô‰È·ÛÙÔÏ‹ Î·È ‚ÚÔÁ¯ÈÎ‹ Úfi-

ÎÏËÛË ·‰ÂÓÔÛ›ÓË˜, fiÔ˘ ¯ÚÂÈ¿ÛÙËÎÂ) Î·È ·ÚÔ˘ÛÈ¿˙ÂÙ·È ·Ï-

ÏÔ‡. ø˜ ¯ÚfiÓÈÔ˜ ‚‹¯·˜ ÔÚ›ÛÙËÎÂ Ô ‚‹¯·˜ ÌÂ ‰È¿ÚÎÂÈ· ¿Óˆ

ÙˆÓ 3 Û˘ÓÂ¯ÒÓ Â‚‰ÔÌ¿‰ˆÓ, ÂÓÒ ˆ˜ ˘ÔÙÚÔÈ¿˙ˆÓ, Ô ‚‹¯·˜

‰È¿ÚÎÂÈ·˜ ÙÔ˘Ï¿¯ÈÛÙÔÓ 2 Â‚‰ÔÌ¿‰ˆÓ Ô˘ ·ÚÔ˘ÛÈ¿˙ÂÈ ÙÔ˘-

Ï¿¯ÈÛÙÔÓ 3 ÂÂÈÛfi‰È· Î·ı’ ¤ÙÔ˜. ∞ÛıÂÓÂ›˜ ¿Û¯ÔÓÙÂ˜ ·fi

ÁÓˆÛÙ¤˜ ·ı‹ÛÂÈ˜ Ô˘ ÚÔÎ·ÏÔ‡Ó ¯ÚfiÓÈÔ ‚‹¯·, fiˆ˜ Ë ÈÓÔ-

Î˘ÛÙÈÎ‹ ÓfiÛÔ˜, Ë ‚ÚÔÁ¯ÔÓÂ˘ÌÔÓÈÎ‹ ‰˘ÛÏ·Û›·, ‚ÚÔÁ¯ÈÂ-

ÎÙ·Û›Â˜, Î.Ï., ·ÔÎÏÂ›ÛÙËÎ·Ó ·fi ÙË ÌÂÏ¤ÙË, fiˆ˜ Î·È ·È-

‰È¿ ÌÂ Ù˘ÈÎfi ÈÛÙÔÚÈÎfi Î·È Û˘ÌÙˆÌ·ÙÔÏÔÁ›· ¿ÛıÌ·ÙÔ˜ (Û˘-

ÚÈÁÌfi˜, ·Ú¿Ù·ÛË ÂÎÓÔ‹˜), ‹ ÌÂ ·ÎÙÈÓÔÁÚ·ÊÈÎ¿ Â˘Ú‹Ì·Ù·

ÏÔ‚Ò‰Ô˘˜ ÓÂ˘ÌÔÓ›·˜.

∏ ¤ÚÂ˘Ó· ÂÁÎÚ›ıËÎÂ ·fi ÙËÓ ∂ÈÙÚÔ‹ ¢ÂÔÓÙÔÏÔÁ›·˜ ÙÔ˘

¡ÔÛÔÎÔÌÂ›Ô˘, ÂÓÒ ¤ÁÁÚ·ÊË Û˘ÁÎ·Ù¿ıÂÛË Û˘ÌÌÂÙÔ¯‹˜ ˙ËÙ‹-

ıËÎÂ ·fi fiÏÔ˘˜ ÙÔ˘˜ ÎË‰ÂÌfiÓÂ˜ ÙˆÓ ·ÛıÂÓÒÓ.

∫·Ù¿ ÙËÓ Â›ÛÔ‰Ô ÛÙË ÌÂÏ¤ÙË, fiÏ· Ù· ·È‰È¿ Î·È ÔÈ ÁÔÓÂ›˜

ÙÔ˘˜ Û˘ÌÏ‹ÚˆÛ·Ó ¤Ó· ÏÂÙÔÌÂÚ¤˜ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ fiÛÔÓ

·ÊÔÚ¿ ÙË ‰È¿ÚÎÂÈ· Î·È ÙËÓ ¤ÓÙ·ÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ, ÂÓÒ

·ÎÔÏÔ‡ıËÛÂ Ê˘ÛÈÎ‹ ÂÍ¤Ù·ÛË Î·È Ì¤ÙÚËÛË ÙˆÓ ·ÓıÚˆÔÌÂÙÚÈ-

ÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ. √ ¤ÏÂÁ¯Ô˜ ÙË˜ ·ÙÔ›·˜ ÂÚÈÂÏ¿Ì‚·ÓÂ

‰ÂÚÌ·ÙÈÎ¤˜ ‰ÔÎÈÌ·Û›Â˜ Ó˘ÁÌÔ‡ ÛÂ 8 ÎÔÈÓ¿ ·ÏÏÂÚÁÈÔÁfiÓ· (ÂÏÈ¿,

·ÚÈÂÙ¿ÚÈ·, ·ÏÙÂÚÓ¿ÚÈ·, ÔÈÎÈ·Î‹ ÛÎfiÓË, Ì›ÁÌ· ÁÚ·ÛÈ‰ÈÒÓ, Á¿-

Ù·, ÛÎ‡ÏÔ˜ Î·È Ì›ÁÌ· ‰¤ÓÙÚˆÓ) (11), ÂÓÒ Ô ¤ÏÂÁ¯Ô˜ ·ÓÙÈÛˆÌ¿-

ÙˆÓ ÁÈ· M. pneumoniae Î·È C. pneumoniae ¤ÁÈÓÂ ÛÂ ÌÔÓfi ‰Â›Á-

Ì· ÔÚÔ‡.

∞Ó›¯ÓÂ˘ÛË ·ÓÙÈÛˆÌ¿ÙˆÓ ÁÈ· M. pneumoniae Î·È C.

pneumoniae

™ÙË ÌÂÏ¤ÙË ·˘Ù‹ ÂÊ·ÚÌfiÛÙËÎ·Ó ‰‡Ô Â˘Ú¤ˆ˜ ‰È·‰Â‰ÔÌ¤-

ÓÂ˜ Ì¤ıÔ‰ÔÈ ·Ó›¯ÓÂ˘ÛË˜ ·ÓÙÈÛˆÌ¿ÙˆÓ, Ë ELISA Î·È Ô ¤ÌÌÂ-

ÛÔ˜ ·ÓÔÛÔÊıÔÚÈÛÌfi˜. ∞Í›˙ÂÈ Ó· ÛËÌÂÈˆıÂ› fiÙÈ ¤Ó·˜ ÌÂÁ¿ÏÔ˜

·ÚÈıÌfi˜ ·ÛıÂÓÒÓ Î·ÙÔÈÎÔ‡ÛÂ ÂÎÙfi˜ ∞ıËÓÒÓ, ÌÂ ·ÔÙ¤ÏÂÛÌ·

Ó· ÌËÓ Â›Ó·È ¿ÓÙ· ÂÊÈÎÙ‹ Ë Ï‹„Ë ‰Â‡ÙÂÚÔ˘ ‰Â›ÁÌ·ÙÔ˜ ÔÚÔ‡,

ÔfiÙÂ Ë ·Ó›¯ÓÂ˘ÛË ÙˆÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ÂÚÈÔÚ›ÛÙËÎÂ ÛÂ ¤Ó·

ÌfiÓÔ ‰Â›ÁÌ·. ¢È¿ÁÓˆÛË ÔÍÂ›·˜ Ì˘ÎÔÏ·ÛÌ·ÙÈÎ‹˜ ‹ ¯Ï·Ì˘-

‰È·Î‹˜ ÏÔ›ÌˆÍË˜ Ù¤ıËÎÂ ÛÙÈ˜ ÂÚÈÙÒÛÂÈ˜ fiÔ˘ Î·È ÔÈ ‰‡Ô

Ì¤ıÔ‰ÔÈ ¤‰ÈÓ·Ó Û·ÊÒ˜ ıÂÙÈÎfi ·ÔÙ¤ÏÂÛÌ·. £ÂÙÈÎÔ› Ù›ÙÏÔÈ

IgM ·ÓÙÈÛˆÌ¿ÙˆÓ ÁÈ· Ì˘ÎfiÏ·ÛÌ· ‹ ¯Ï·Ì‡‰ÈÔ ÙË˜ ÓÂ˘ÌÔ-

Ó›·˜ ıÂˆÚ‹ıËÎ·Ó ÂÓ‰ÂÈÎÙÈÎÔ› ÚfiÛÊ·ÙË˜ ¿Ù˘Ë˜ ÏÔ›ÌˆÍË˜.

ÃÚËÛÈÌÔÔÈ‹ıËÎÂ Ë ELISA ÙË˜ NovaTec Immuno-

diagnostica, Dietzenbach, GmBH, Germany (·ÚÈıÌfi˜ ÚÔ˚fi-

ÓÙÔ˜ CHLG0510) ÁÈ· ·ÓÙÈÛÒÌ·Ù· IgG Î·È IgM, ÙfiÛÔ ÙÔ˘ Ì˘-

ÎÔÏ¿ÛÌ·ÙÔ˜, fiÛÔ Î·È ÙÔ˘ ¯Ï·Ì˘‰›Ô˘ ÙË˜ ÓÂ˘ÌÔÓ›·˜, ÌÂ Ì¤-

ÙÚÈ· Â˘·ÈÛıËÛ›· (<70%) Î·È Î·Ï‹ ÂÈ‰ÈÎfiÙËÙ· (70-90%) Î·È ÁÈ·

ÙÔ˘˜ ‰‡Ô ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜ (12).

∆· ·ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ ÌÂıfi‰Ô˘ ·˘Ù‹˜ ÂÎÊÚ¿˙ÔÓÙ·È ÛÂ

ÌÔÓ¿‰Â˜ NovaTec (NTU), ˆ˜ ÂÍ‹˜: ·ÌÊ›‚ÔÏË ˙ÒÓË: 9-11

¡∆U, ·ÚÓËÙÈÎfi ·ÔÙ¤ÏÂÛÌ·: <9 NTU, ıÂÙÈÎfi ·ÔÙ¤ÏÂÛÌ·:

>11 NTU.

∞Ó¿ÏÔÁË ‰È·ÁÓˆÛÙÈÎ‹ ·ÎÚ›‚ÂÈ· ÂÈÙ˘Á¯¿ÓÂÙ·È Î·È ÌÂ ÙÔÓ

·ÓÔÛÔÊıÔÚÈÛÌfi ÙË˜ Biognost, Zagreb, Croatia (antibody

assay E0001), ÁÈ· IgG Î·È IgM Î·È ÙˆÓ ‰‡Ô ÌÈÎÚÔÔÚÁ·ÓÈÛÌÒÓ

(13). ∏ Ì¤ıÔ‰Ô˜ ·˘Ù‹ ÂÊ·ÚÌfiÛÙËÎÂ ÂÈÎÔ˘ÚÈÎ¿ ÚÔ˜ ÙËÓ

ELISA, ÁÈ· ÙËÓ ÂÈ‚Â‚·›ˆÛË ÙˆÓ ıÂÙÈÎÒÓ Î·È ·ÚÓËÙÈÎÒÓ

·ÔÙÂÏÂÛÌ¿ÙˆÓ Î·È ÁÈ· ÙË ‰È·ÏÂ‡Î·ÓÛË ÙË˜ ·ÌÊ›‚ÔÏË˜ ˙Ò-

ÓË˜. ∞Ó Î·È ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ ÂÚÂ˘ÓËÙ¤˜ ‰ÂÓ ‚·Û›˙Ô˘Ó ÙË ‰È¿-

ÁÓˆÛË ÛÙÔÓ IFA, ˆÛÙfiÛÔ Ë Ì¤ıÔ‰Ô˜ ·˘Ù‹ ¤¯ÂÈ 70% Â˘·È-

ÛıËÛ›· Î·È 70-90% ÂÈ‰ÈÎfiÙËÙ· Î·È ÁÈ· ÙÔ˘˜ ‰‡Ô ÌÈÎÚÔÔÚÁ·-

ÓÈÛÌÔ‡˜ (12,13). ∂Í¿ÏÏÔ˘, ˘¿Ú¯Ô˘Ó ÂÚÂ˘ÓËÙ¤˜ Ô˘ ıÂˆ-

ÚÔ‡Ó ÙÔÓ ·ÓÔÛÔÊıÔÚÈÛÌfi ˆ˜ ÙË Ì¤ıÔ‰Ô ÂÎÏÔÁ‹˜ ÁÈ· ÙË ‰È¿-

ÁÓˆÛË ÙÔ˘ C. pneumoniae (14). £ÂÙÈÎfi˜ ıÂˆÚÂ›Ù·È Ô Ù›ÙÏÔ˜

>1/160 ÁÈ· ÔÔÈ·‰‹ÔÙÂ Ù¿ÍË ·ÓÔÛÔÛÊ·ÈÚÈÓÒÓ.

£ÂÚ·Â˘ÙÈÎfi ÚˆÙfiÎÔÏÏÔ

∏ ·Ú¯ÈÎ‹ ıÂÚ·Â˘ÙÈÎ‹ ÚÔÛ¤ÁÁÈÛË ÁÈ· fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂ-

ÓÂ›˜, ·ÓÂÍ¿ÚÙËÙ· ·fi Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÙˆÓ ÂÍÂÙ¿ÛÂˆÓ, Û˘Ó›-

ÛÙ·Ù·È ÛÂ ·ÓÙÈ·ÛıÌ·ÙÈÎ‹ ·ÁˆÁ‹ ÁÈ· 3 Â‚‰ÔÌ¿‰Â˜ (Û˘Ó‰˘·-

ÛÌfi˜ ÂÈÛÓÂfiÌÂÓÔ˘ ‚2 ‰ÈÂÁ¤ÚÙË Ì·ÎÚ¿˜ ‰È¿ÚÎÂÈ·˜ ‰Ú¿ÛË˜ Î·È

ÛÙÂÚÔÂÈ‰Ô‡˜ ÛÂ ‰fiÛË ·Ó¿ÏÔÁË ÚÔ˜ ÙËÓ ËÏÈÎ›·, ÁÈ· Ì¤ÙÚÈÔ,

ÂÈÌ¤ÓÔÓ ¿ÛıÌ·). ∫·Ù¿ ÙËÓ Â·ÓÂÍ¤Ù·ÛË, ÔÈ ÂÚÂ˘ÓËÙ¤˜ ·ÍÈÔ-

ÏÔÁÔ‡Û·Ó ÙËÓ ÎÏÈÓÈÎ‹ ·ÓÙ·fiÎÚÈÛË ÛÙË ıÂÚ·Â›·, ÛÂ Û˘Ó-

‰˘·ÛÌfi ÌÂ Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÙˆÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ÙˆÓ M.

pneumoniae Î·È C. pneumoniae. √È ·ÛıÂÓÂ›˜ ÂÎÂ›ÓÔÈ Ô˘ ‰ÂÓ

·Ó¤ÊÂÚ·Ó ÛËÌ·ÓÙÈÎ‹ ‚ÂÏÙ›ˆÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÌÂ ÙËÓ

·ÓÙÈ·ÛıÌ·ÙÈÎ‹ ·ÁˆÁ‹ Î·È ÙˆÓ ÔÔ›ˆÓ Ù· ·ÓÙÈÛÒÌ·Ù· ‹Ù·Ó

ÂÓ‰ÂÈÎÙÈÎ¿ ÔÍÂ›·˜ Ì˘ÎÔÏ·ÛÌ·ÙÈÎ‹˜/¯Ï·Ì˘‰È·Î‹˜ ÏÔ›ÌˆÍË˜,

·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó ÛÙË Û˘Ó¤¯ÂÈ· ÌÂ ¯ÔÚ‹ÁËÛË ÎÏ·ÚÈıÚÔÌ˘Î›-

ÓË˜ ·fi ÙÔ ÛÙfiÌ·, ÛÂ ‰fiÛË 15 mg/kg/ËÌ¤Ú· ÁÈ· 21 ËÌ¤ÚÂ˜.

∂›ÛË˜, ÔÈ ·ÛıÂÓÂ›˜ Ô˘ Â›¯·Ó ÛÙÔÈ¯Â›· ¿ÛıÌ·ÙÔ˜ ÛÙÔÓ ÏÂÈ-

ÙÔ˘ÚÁÈÎfi ¤ÏÂÁ¯Ô ÙË˜ ·Ó·ÓÔ‹˜, Î·ıÒ˜ Î·È ·ÓÙÈÛÒÌ·Ù· ÂÓ‰ÂÈ-

ÎÙÈÎ¿ ÔÍÂ›·˜ Ì˘ÎÔÏ·ÛÌ·ÙÈÎ‹˜/¯Ï·Ì˘‰È·Î‹˜ ÏÔ›ÌˆÍË˜, ¤Ï·-

‚·Ó ·ÓÙÈ·ÛıÌ·ÙÈÎ‹ ·ÁˆÁ‹ ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ÎÏ·ÚÈıÚÔÌ˘Î›ÓË,

38 π.ª. µÂÏÈÛÛ·Ú›Ô˘ Î·È Û˘Ó.


ÂÓÒ ÂÎÂ›ÓÔÈ Ô˘ Â›¯·Ó Â˘Ú‹Ì·Ù· ÚÈÓ›ÙÈ‰·˜/·Ú·ÚÚÈÓÔÎÔÏ›-ÙÈ‰·˜ ÛÙËÓ ·ÎÙÈÓÔÁÚ·Ê›· ·Ú·ÚÚÈÓ›ˆÓ ÎfiÏˆÓ Î·È ÔÍÂ›· ÏÔ›-ÌˆÍË ·fi ¿Ù˘· ÌÈÎÚfi‚È·, ¤Ï·‚·Ó ÎÏ·ÚÈıÚÔÌ˘Î›ÓË Î·È ÙÔÈ-Î¿ ÛÙÂÚÔÂÈ‰‹. ∆ÚÂÈ˜ Â‚‰ÔÌ¿‰Â˜ ·ÚÁfiÙÂÚ·, ÔÈ ·ÛıÂÓÂ›˜ Â·ÓÂ-ÎÙÈÌ‹ıËÎ·Ó Î·È Ë ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘˜ ·ÎÔÏÔ‡ıˆ˜, ÂÍ·ÙÔÌÈ-ÎÂ‡ÙËÎÂ.


∂Í‹ÓÙ· ÂÙ¿ ·È‰È¿ Û˘ÌÌÂÙÂ›¯·Ó ÛÙË ÌÂÏ¤ÙË·˘Ù‹, ·fi 2,5 ¤ˆ˜ 16 ÂÙÒÓ, ÌÂ Ì¤ÛË ËÏÈÎ›· Ù· 7 ¤ÙË.∆ÚÈ¿ÓÙ· ‰‡Ô (47,8%) ‹Ù·Ó ·ÁfiÚÈ· Î·È 35 (52,2%)ÎÔÚ›ÙÛÈ·. ™·Ú¿ÓÙ· ‰‡Ô ·ÛıÂÓÂ›˜ (62,7%) ¤·Û¯·Ó·fi ¯ÚfiÓÈÔ Î·È 25 (37,3%) ·fi ˘ÔÙÚÔÈ¿˙ÔÓÙ·‚‹¯·. ™·Ú¿ÓÙ· ÙÚ›· ·È‰È¿ (64,2%) Î·ÙÔÈÎÔ‡Û·ÓÛÙËÓ ∞ı‹Ó·, 23 (34,3%) ÛÂ ËÌÈ·ÛÙÈÎ¤˜ Î·È ·ÁÚÔÙÈ-Î¤˜ ÂÚÈÔ¯¤˜, ÂÓÒ ¤Ó· (1,5%) Î·ÙÔÈÎÔ‡ÛÂ ÛÙËÓ ∫‡-ÚÔ. ŸÏ· ‹Ù·Ó Ï‹Úˆ˜ ÂÌ‚ÔÏÈ·ÛÌ¤Ó· ÁÈ· ÙËÓ ËÏÈ-Î›· ÙÔ˘˜ Î·È ÛÂ Î·Ó¤Ó· ‰ÂÓ ·ÓÂ‚Ú¤ıËÎ·Ó ÛËÌÂ›·˘ÔÛÈÙÈÛÌÔ‡.

∏ ‰È¿ÁÓˆÛË ÙË˜ ÔÍÂ›·˜ Ì˘ÎÔÏ·ÛÌ·ÙÈÎ‹˜ ‹¯Ï·Ì˘‰È·Î‹˜ ÏÔ›ÌˆÍË˜ ·Ô‰fiıËÎÂ ÌfiÓÔ ÛÙÔ˘˜·ÛıÂÓÂ›˜ ÌÂ ıÂÙÈÎfi Ù›ÙÏÔ IgM ·ÓÙÈÛˆÌ¿ÙˆÓ, ÂÓÒ ÔÈÙ›ÙÏÔÈ ÙˆÓ IgG ·ÓÔÛÔÛÊ·ÈÚÈÓÒÓ ‰ÂÓ ·Ó¤‰ÂÈÍ·Ó ÂÈ-ÚfiÛıÂÙÂ˜ ÂÚÈÙÒÛÂÈ˜ ¿Ù˘Ë˜ ÏÔ›ÌˆÍË˜. ™ÙÔÓ¶›Ó·Î· 1, ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ù· Û˘ÁÎÂÓÙÚˆÙÈÎ¿ ·Ô-ÙÂÏ¤ÛÌ·Ù· ÙˆÓ ·ÓÔÛÔÛÊ·ÈÚÈÓÒÓ ÙˆÓ ·ÛıÂÓÒÓ Î·ÈÁÈ· ÙÔ˘˜ ‰‡Ô ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜.

∞fi ÙÔ˘˜ 67 ·ÛıÂÓÂ›˜ ÙË˜ ÌÂÏ¤ÙË˜, ÔÈ 20(29,9%) ¤·Û¯·Ó ·fi ÔÍÂ›· Ì˘ÎÔÏ·ÛÌ·ÙÈÎ‹ ÏÔ›-ÌˆÍË Î·È ÔÈ 4 (6,0%) ·fi ¯Ï·Ì˘‰È·Î‹ ÏÔ›ÌˆÍË,ÂÓÒ ¤Ó·˜ ·ÛıÂÓ‹˜ Â›¯Â Ù·˘Ùfi¯ÚÔÓ·, ÔÍÂ›· Ì˘ÎÔ-Ï·ÛÌ·ÙÈÎ‹ Î·È ¯Ï·Ì˘‰È·Î‹ ÏÔ›ÌˆÍË. ∫·Ó¤Ó·˜ ‰ÂÓ·ÚÔ˘Û›·˙Â ÛÙÔÈ¯Â›· ÂÍ·Óı‹Ì·ÙÔ˜, ·ÚıÚ›ÙÈ‰·˜, ·È-ÌÔÏ˘ÙÈÎ‹˜ ·Ó·ÈÌ›·˜ ‹ ¿ÏÏˆÓ ÂÎ‰ËÏÒÛÂˆÓ ÏÔ›Ìˆ-ÍË˜ ·fi ¿Ù˘·.

∆· ·ÔÙÂÏ¤ÛÌ·Ù· Ô˘ ·Ú·Ù›ıÂÓÙ·È ÛÙË Û˘Ó¤-¯ÂÈ·, ·Ó·Ê¤ÚÔÓÙ·È ÌfiÓÔ ÛÙÔ˘˜ 23 ÔÚÔıÂÙÈÎÔ‡˜·ÛıÂÓÂ›˜ ÁÈ· Ì˘ÎfiÏ·ÛÌ· ‹ ¯Ï·Ì‡‰È·.

∞fi ÙÔ˘˜ 23 ·˘ÙÔ‡˜ ·ÛıÂÓÂ›˜, ÔÈ 9 (39,1%) ¤·-Û¯·Ó ·fi ÔÍÂ›· Ì˘ÎÔÏ·ÛÌ·ÙÈÎ‹/ ¯Ï·Ì˘‰È·Î‹ ÏÔ›-ÌˆÍË ÌfiÓÔ. ™ÙÔ˘˜ ˘fiÏÔÈÔ˘˜ 14 (60,8%) ·ÓÂ‚Ú¤ıË-Î·Ó ÂÚÈÛÛfiÙÂÚÂ˜ ·fi Ì›· ·ÈÙ›Â˜ ÁÈ· ÙÔÓ ‚‹¯· ÙÔ˘˜.√È 6 ¤·Û¯·Ó Î·È ·fi ¿ÛıÌ· (ÌÂ ‚¿ÛË Ù· ·ÔÙÂÏ¤-ÛÌ·Ù· ÙˆÓ ÏÂÈÙÔ˘ÚÁÈÎÒÓ ‰ÔÎÈÌ·ÛÈÒÓ ÙË˜ ·Ó·ÓÔ‹˜Î·È ÙËÓ ·ÓÙ·fiÎÚÈÛË ÛÙËÓ ·ÓÙÈ·ÛıÌ·ÙÈÎ‹ ·ÁˆÁ‹), ÔÈ

7 Â›¯·Ó Î·È ÚÈÓ›ÙÈ‰·/ ·Ú·ÚÚÈÓÔÎÔÏ›ÙÈ‰· (ÌÂ ‚¿ÛË

ÙËÓ ‡·ÚÍË ÚÈÓÈÎ‹˜ Û˘ÌÊfiÚËÛË˜, ÔÓÔÎÂÊ¿ÏÔ˘, Â˘-

·ÈÛıËÛ›·˜ ÛÙËÓ „ËÏ¿ÊËÛË ÙˆÓ ·Ú·ÚÚÈÓ›ˆÓ ÎfiÏˆÓ

Î·È ˘ÁÚ·ÂÚÈÎÔ‡ ÂÈ¤‰Ô˘ ÛÙËÓ ·ÎÙÈÓÔÁÚ·Ê›· ·Ú·Ú-

ÚÈÓ›ˆÓ), ÂÓÒ ¤Ó·˜ ÂÌÊ¿ÓÈ˙Â Î·È ˘ÂÚÙÚÔÊ›· ÙˆÓ ·‰Â-

ÓÔÂÈ‰ÒÓ ÂÎ‚Ï·ÛÙ‹ÛÂˆÓ (Ô˘ ‰È·ÈÛÙÒıËÎÂ ÌÂÙ¿ ·fi

·Ú·ÔÌ‹ ÙÔ˘ ·ÛıÂÓÔ‡˜ ÛÂ ˆÙÔÚÈÓÔÏ·Ú˘ÁÁÔÏfiÁÔ).

∏ Ì¤ÛË ËÏÈÎ›· ÙˆÓ ·È‰ÈÒÓ ‹Ù·Ó 7,3 ¤ÙË (±3,1) Î·È Ë

Ì¤ÛË ‰È¿ÚÎÂÈ· ÙÔ˘ ‚‹¯· ÚÈÓ ÙËÓ Â›ÛÔ‰fi ÙÔ˘˜ ÛÙË ÌÂ-

Ï¤ÙË, 60,4 ËÌ¤ÚÂ˜ (±22,5). ™¯Â‰fiÓ fiÏÔÈ ÔÈ ·ÛıÂÓÂ›˜

(97%) ıÂˆÚÔ‡Û·Ó ÙÔÓ ‚‹¯· ˆ˜ ÙÔ ÈÔ ÂÓÔ¯ÏËÙÈÎfi Û‡-

ÌÙˆÌ· Ô˘ ÂÌÊ¿ÓÈ˙·Ó.

∞fi Ù· 23 ·È‰È¿, Ù· 10 (43,3%) Â›¯·Ó ÙÔ˘Ï¿¯È-

ÛÙÔÓ Ì›· ıÂÙÈÎ‹ ‰ÂÚÌ·ÙÈÎ‹ ‰ÔÎÈÌ·Û›· Ó˘ÁÌÔ‡, Î·È ˆ˜

ÂÎ ÙÔ‡ÙÔ˘ ıÂˆÚ‹ıËÎ·Ó ·ÙÔÈÎ¿. √È ÁÔÓÂ›˜ ÙˆÓ ·È-

‰ÈÒÓ ·˘ÙÒÓ ·Ó¤ÊÂÚ·Ó ·ÚfiÌÔÈ· ÂÂÈÛfi‰È· ‚‹¯· Î·È

ÛÙÔ ·ÚÂÏıfiÓ, Ù· ÔÔ›· Â›¯·Ó ·Ô‰ÔıÂ› ÛÂ ‚ÚÔÁ¯›ÙÈ-

‰· ‹ ÓÂ˘ÌÔÓ›·, ÂÓÒ 7 ·fi Ù· ·È‰È¿ ·˘Ù¿ Â›¯·Ó ̄ ÚÂÈ-

·ÛÙÂ› ÓÔÛËÏÂ›· ÛÂ ·Ó¿ÏÔÁÂ˜ ÂÚÈÙÒÛÂÈ˜. ∞˘Ù¿ Ù·

·È‰È¿, Î·ıÒ˜ Î·È ¤Ó· ·fi Ù· ˘fiÏÔÈ· (Û‡ÓÔÏÔ 11

·ÛıÂÓÂ›˜ - 47,8%) ·Ó¤ÊÂÚ·Ó ÂÔ¯È·Î‹ ‰È·Î‡Ì·ÓÛË

ÛÙÔÓ ‚‹¯· ÙÔ˘˜, ÌÂ ¤Í·ÚÛË ÙÔ˘˜ ¯ÂÈÌÂÚÈÓÔ‡˜ Ì‹ÓÂ˜.

Ÿˆ˜ ·Ó·Ê¤ÚıËÎÂ ÚÔËÁÔ˘Ì¤Óˆ˜, Î·È ÔÈ 23

·ÛıÂÓÂ›˜ ¤Ï·‚·Ó ·ÓÙÈ·ÛıÌ·ÙÈÎ‹ ·ÁˆÁ‹ ˆ˜ ÚÒÙÔ

‚‹Ì· ·ÓÙÈÌÂÙÒÈÛË˜. ∫·Ù¿ ÙÔÓ Â·Ó¤ÏÂÁ¯Ô, Ô ‚‹¯·˜

Â›¯Â ˘Ô¯ˆÚ‹ÛÂÈ ÂÓÙÂÏÒ˜ ÛÙÔ˘˜ 8 ·ÛıÂÓÂ›˜ (34,7%),

ÔfiÙÂ ‰ÂÓ ¯ÔÚËÁ‹ıËÎÂ ÎÏ·ÚÈıÚÔÌ˘Î›ÓË. ∆ÚÂÈ˜ ·fi

·˘ÙÔ‡˜ Â›¯·Ó ÛÙÔÈ¯Â›· ·fiÊÚ·ÍË˜ Î·Ù¿ ÙÈ˜ ‰ÔÎÈÌ·-

Û›Â˜ ÏÂÈÙÔ˘ÚÁÈÎÔ‡ ÂÏ¤Á¯Ô˘ ÙË˜ ·Ó·ÓÔ‹˜, ÔfiÙÂ Û˘-

Ó¤¯ÈÛ·Ó ÙËÓ ·ÓÙÈ·ÛıÌ·ÙÈÎ‹ ·ÁˆÁ‹, ÂÓÒ ÔÈ ˘fiÏÔÈÔÈ

5 Â›¯·Ó Â˘Ú‹Ì·Ù· ·Ú·ÚÚÈÓÔÎÔÏ›ÙÈ‰·˜ ÛÙËÓ ·ÎÙÈ-

ÓÔÁÚ·Ê›· ·Ú·ÚÚÈÓ›ˆÓ ÎfiÏˆÓ, ÔfiÙÂ Û˘Ó¤¯ÈÛ·Ó

ÙËÓ ·ÁˆÁ‹ ÙÔ˘˜ ÌÂ ÙÔÈÎ‹ ¯Ú‹ÛË ÚÈÓÈÎÔ‡ ÛÙÂÚÔÂÈ-

‰Ô‡˜ Î·È ¿ÏÏË˜ ·ÓÙÈ‚›ˆÛË˜ ·fi ÙÔ ÛÙfiÌ·.

√È ˘fiÏÔÈÔÈ 15 ·ÛıÂÓÂ›˜ (65,2%) ‰ÂÓ ‚ÂÏÙÈÒ-

ıËÎ·Ó ÌÂ ÙËÓ ·ÓÙÈ·ÛıÌ·ÙÈÎ‹ ıÂÚ·Â›·, ÔfiÙÂ ¤Ï·-

‚·Ó ÎÏ·ÚÈıÚÔÌ˘Î›ÓË ÛÂ ‰Â‡ÙÂÚÔ ¯ÚfiÓÔ. √ÎÙÒ ¤Ï·-

‚·Ó ÌfiÓÔ ÎÏ·ÚÈıÚÔÌ˘Î›ÓË, ÂÓÒ 5 Â›¯·Ó Â˘Ú‹Ì·Ù·

·fiÊÚ·ÍË˜ Î·Ù¿ ÙË Ù·Ï·ÓÙÔÛÈÌÂÙÚ›· Î·È ÙË ÛÈÚÔ-

Ì¤ÙÚËÛË, ÔfiÙÂ ¤Ï·‚·Ó ÎÏ·ÚÈıÚÔÌ˘Î›ÓË Î·È ·ÓÙÈ·-

ÛıÌ·ÙÈÎ¿ Î·È 2 Â›¯·Ó ·ıÔÏÔÁÈÎ‹ ·ÎÙÈÓÔÁÚ·Ê›·

·Ú·ÚÚÈÓ›ˆÓ, ÔfiÙÂ ¤Ï·‚·Ó ÎÏ·ÚÈıÚÔÌ˘Î›ÓË Î·È

ÙÔÈÎfi ÚÈÓÈÎfi ÛÙÂÚÔÂÈ‰¤˜.

∫·Ù¿ ÙËÓ Â·ÓÂÍ¤Ù·ÛË, Ô ‚‹¯·˜ Â›¯Â ˘Ô¯ˆÚ‹-

ÛÂÈ ÛÂ fiÏ· Ù· ·È‰È¿ ÂÎÙfi˜ ·fi ¤Ó·. ∆Ô ·È‰› ·˘Ùfi

¤·ÈÚÓÂ ÌfiÓÔ ÎÏ·ÚÈıÚÔÌ˘Î›ÓË, ˆÛÙfiÛÔ Â›¯Â ¤Ó·Ó

˘ÔÏÂÈÌÌ·ÙÈÎfi ‚‹¯· ÛÙÈ˜ 3 Â‚‰ÔÌ¿‰Â˜ ıÂÚ·Â›·˜.

°È· ÙÔÓ ÏfiÁÔ ·˘Ùfi, ·ÔÊ·Û›ÛÙËÎÂ Ë Û˘Ó¤¯ÈÛË ÙË˜

·ÁˆÁ‹˜ ÁÈ· ¿ÏÏÂ˜ 3 Â‚‰ÔÌ¿‰Â˜, ÔfiÙÂ Î·È Ô ‚‹¯·˜

˘Ô¯ÒÚËÛÂ.

√ ¶›Ó·Î·˜ 2 ÂÚÈÁÚ¿ÊÂÈ ÙË ıÂÚ·Â˘ÙÈÎ‹ ÚÔÛ¤Á-

ÁÈÛË Î·È ·¿ÓÙËÛË fiÏˆÓ ÙˆÓ ·ÛıÂÓÒÓ ÌÂ ÔÍÂ›· Ì˘-

ÎÔÏ·ÛÌ·ÙÈÎ‹/ ¯Ï·Ì˘‰È·Î‹ ÏÔ›ÌˆÍË.

39ª˘ÎfiÏ·ÛÌ· Î·È ¯ÚfiÓÈÔ˜ ‚‹¯·˜

¶·È‰È·ÙÚÈÎ‹ 2007;70:37-41

¶›Ó·Î·˜ 1. ∞ÔÙÂÏ¤ÛÌ·Ù· ·ÓÔÛÔÛÊ·ÈÚÈÓÒÓ ÁÈ· M. pneumoniae /C. pneumoniae

∞ÓÔÛÔÛÊ·ÈÚ›ÓÂ˜ ¶ÂÚÈÛÙ·ÙÈÎ¿ (%) Â› 67 ·ÛıÂÓÒÓ

M. pneumoniae IgG 32 (47,8%)M. pneumoniae IgM 20 (29,9%)C. pneumoniae IgG 1 (1,5%)C. pneumoniae IgM 4 (6,0%)

™˘˙‹ÙËÛË

∏ ÌÂÏ¤ÙË ·˘Ù‹ ÂÈ¯Â›ÚËÛÂ Ó· ·ÍÈÔÏÔÁ‹ÛÂÈ ÙÔÓÚfiÏÔ ÙÔ˘ Ì˘ÎÔÏ¿ÛÌ·ÙÔ˜ Î·È ÙÔ˘ ¯Ï·Ì˘‰›Ô˘ ÙË˜ÓÂ˘ÌÔÓ›·˜ ÛÙÔÓ ¯ÚfiÓÈÔ Î·È ˘ÔÙÚÔÈ¿˙ÔÓÙ· ‚‹¯·ÙÔ˘ ·È‰ÈÎÔ‡ ÏËı˘ÛÌÔ‡, Î·ıÒ˜ Î·È ÙËÓ ·ÔÙÂÏÂ-ÛÌ·ÙÈÎfiÙËÙ· ÙË˜ ıÂÚ·Â›·˜ ÙÔ˘˜ ÌÂ Ì·ÎÚÔÏ›‰Â˜.

∏ Ì·ÎÚ¿ ‰È¿ÚÎÂÈ· ÙÔ˘ ‚‹¯· (Ì¤ÛË ‰È¿ÚÎÂÈ· 2 Ì‹-ÓÂ˜), ·ÎfiÌË Î·È fiÙ·Ó Ë ¤ÓÙ·ÛË ‰ÂÓ ‹Ù·Ó ÌÂÁ¿ÏË, Ê¿-ÓËÎÂ Ó· ÎÔ˘Ú¿˙ÂÈ ÙÔ˘˜ ·ÛıÂÓÂ›˜ Î·È ÙÔ˘˜ Û˘ÁÁÂÓÂ›˜ÙÔ˘˜. ÕÏÏˆÛÙÂ, Û¯Â‰fiÓ fiÏÔÈ ÔÈ ÁÔÓÂ›˜ (97%) ·Ó¤ÊÂ-Ú·Ó fiÙÈ Ô ‚‹¯·˜ ‹Ù·Ó ÙÔ ÈÔ ÂÓÔ¯ÏËÙÈÎfi Û‡ÌÙˆÌ·ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜.

√ ÚfiÏÔ˜ ÙË˜ ÔÍÂ›·˜ Ì˘ÎÔÏ·ÛÌ·ÙÈÎ‹˜/¯Ï·Ì˘-‰È·Î‹˜ ÏÔ›ÌˆÍË˜ ÛÂ ·È‰È¿ ÌÂ ·ÚÔÍ‡ÓÛÂÈ˜ ¿ÛıÌ·-ÙÔ˜ ‰ÈÂÚÂ˘Ó‹ıËÎÂ ÚfiÛÊ·Ù·. √ÍÂ›· Ì˘ÎÔÏ·ÛÌ·-ÙÈÎ‹ ÏÔ›ÌˆÍË ·ÓÂ‚Ú¤ıËÎÂ ÛÙÔ 20% ÙˆÓ ·ÚÔÍ‡Ó-ÛÂˆÓ ¿ÛıÌ·ÙÔ˜, ÂÓÒ ÔÍÂ›· ¯Ï·Ì˘‰È·Î‹ ÏÔ›ÌˆÍËÛÙÔ 3,4% ÙˆÓ ÂÚÈÙÒÛÂˆÓ. ∂ÈÏ¤ÔÓ, ÙÔ ÔÛÔÛÙfiÔÍÂ›·˜ Ì˘ÎÔÏ·ÛÌ·ÙÈÎ‹˜ ÏÔ›ÌˆÍË˜ ÛÙÔ ÚÒÙÔÂÂÈÛfi‰ÈÔ ¿ÛıÌ·ÙÔ˜ Êı¿ÓÂÈ ÙÔ 50% (15). ∏ ÌÂÏ¤ÙË·˘Ù‹ ·Ó¤‰ÂÈÍÂ ·Ú·Ï‹ÛÈ· ÔÛÔÛÙ¿ ÔÍÂ›·˜ Ì˘ÎÔ-Ï·ÛÌ·ÙÈÎ‹˜/¯Ï·Ì˘‰È·Î‹˜ ÏÔ›ÌˆÍË˜ (34,3%) ÛÂÂÚÈÙÒÛÂÈ˜ ¯ÚfiÓÈÔ˘ ‹ ˘ÔÙÚÔÈ¿˙ÔÓÙÔ˜ ‚‹¯·,¯ˆÚ›˜ ÚÔËÁËıÂ›Û· ‰È¿ÁÓˆÛË ¿ÛıÌ·ÙÔ˜. ¶Ú¤ÂÈ,ˆÛÙfiÛÔ Ó· ·Ó·ÊÂÚıÂ› fiÙÈ 6 ·È‰È¿ (26%) ÌÂ ıÂÙÈÎ¿IgM ·ÓÙÈÛÒÌ·Ù· ÁÈ· M. pneumoniae, ÂÌÊ¿ÓÈÛ·ÓÛÙË Û˘Ó¤¯ÂÈ· ÛÙÔÈ¯Â›· ¿ÛıÌ·ÙÔ˜ ÛÙÈ˜ ‰ÔÎÈÌ·Û›Â˜ÏÂÈÙÔ˘ÚÁÈÎÔ‡ ÂÏ¤Á¯Ô˘ ÙË˜ ·Ó·ÓÔ‹˜. ∂›ÛË˜, ·Í›-˙ÂÈ Ó· ÛËÌÂÈˆıÂ› fiÙÈ ¿ÏÏÂ˜ ÌÂÏ¤ÙÂ˜ ·È‰ÈÒÓ ÌÂ¯ÚfiÓÈÔ ‹ ˘ÔÙÚÔÈ¿˙ÔÓÙ· ‚‹¯·, ·Ó¤‰ÂÈÍ·Ó ÌÈÎÚfi-

ÙÂÚÔ ÔÛÔÛÙfi ÏÔÈÌÒÍÂˆÓ ·fi ¿Ù˘· ·’ fi,ÙÈ Ë ‰È-Î‹ Ì·˜ (6,16).

∞ÍÈÔÛËÌÂ›ˆÙÔ Â›Ó·È ÙÔ ÁÂÁÔÓfi˜ fiÙÈ 10 ·ÛıÂÓÂ›˜(43,4%) ÌÂ ÔÍÂ›· Ì˘ÎÔÏ·ÛÌ·ÙÈÎ‹ ÏÔ›ÌˆÍË, ·Ó¤ÊÂ-Ú·Ó ·Ó¿ÏÔÁ· ÂÂÈÛfi‰È· ‚‹¯· ÛÙÔ ·ÚÂÏıfiÓ, ÂÓÒ ÔÈ 7·fi ·˘ÙÔ‡˜ (30,4%) ¯ÚÂÈ¿ÛÙËÎ·Ó ÓÔÛËÏÂ›·. ∆Ô ÁÂÁÔ-Ófi˜ ·˘Ùfi ˘ÔÛÙËÚ›˙ÂÈ ÙËÓ ¿Ô„Ë fiÙÈ ÙÔ M.pneumoniae ÌÔÚÂ› Ó· ÏÂÈÙÔ˘ÚÁÂ› ˆ˜ ÂÎÏ˘ÙÈÎfi ·›ÙÈÔ˘ÔÙÚÔÈ¿˙ÔÓÙÔ˜ Û˘ÚÈÁÌÔ‡ Î·È ‚‹¯· (15). √È ›‰ÈÔÈ 10·ÛıÂÓÂ›˜ (43,4%) ‹Ù·Ó Î·È ·ÙÔÈÎÔ›. ∞˘Ùfi ÙÔ ÔÛÔ-ÛÙfi ·ÙÔ›·˜ ÛÂ ·È‰È¿ ÌÂ ¿Ù˘Ë ÏÔ›ÌˆÍË Â›Ó·È ·Ó¿-ÏÔÁÔ ÙÔ˘ ÔÛÔÛÙÔ‡ Ô˘ ·Ó·Ê¤ÚÂÙ·È ·ÏÏÔ‡ (15).

Ÿˆ˜ Ê·›ÓÂÙ·È Î·È ÛÙÔÓ ¶›Ó·Î· 1, 32 ·fi Ù· 67·È‰È¿ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó (47,8%) Â›¯·Ó ıÂÙÈÎ¿ ·ÓÙÈ-ÛÒÌ·Ù· IgG ÁÈ· M. pneumoniae Î·È ¤Ó· ·È‰› (1,5%)Â›¯Â ıÂÙÈÎ¿ IgG ÁÈ· C. pneumoniae. ŸÏÔÈ ÔÈ ·ÛıÂÓÂ›˜Ô˘ Â›¯·Ó ıÂÙÈÎ¿ IgM ·ÓÙÈÛÒÌ·Ù· ÁÈ· Ì˘ÎfiÏ·ÛÌ·,Â›¯·Ó Â›ÛË˜ ıÂÙÈÎ¿ Î·È IgG ·ÓÙÈÛÒÌ·Ù· ÁÈ· ÙÔÓ ›‰ÈÔÌÈÎÚÔÔÚÁ·ÓÈÛÌfi. ∆Ô ˘„ËÏfi ÔÛÔÛÙfi ÙˆÓ ıÂÙÈÎÒÓIgG ·ÓÙÈÛˆÌ¿ÙˆÓ ÙÔ˘ Ì˘ÎÔÏ¿ÛÌ·ÙÔ˜ (47,8%)˘Ô‰ÂÈÎÓ‡ÂÈ fiÙÈ Ë Â·Ê‹ ÌÂ Ì˘ÎfiÏ·ÛÌ· ÙË˜ ÓÂ˘-ÌÔÓ›·˜ Â›Ó·È ·ÚÎÂÙ¿ Û˘¯Ó‹ ÛÙ· ·È‰È¿ Î·È Ú¤ÂÈ Ó··Ó·˙ËÙÂ›Ù·È ÛÂ fiÏÂ˜ ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ ·Ú·ÙÂÙ·Ì¤-ÓË˜ Û˘ÌÙˆÌ·ÙÔÏÔÁ›·˜ ·fi ÙÔ ·Ó·ÓÂ˘ÛÙÈÎfi.

¶Ú¤ÂÈ, Â›ÛË˜, Ó· ·Ó·ÊÂÚıÂ› fiÙÈ ¤Ó· ÛËÌ·ÓÙÈÎfiÔÛÔÛÙfi ·È‰ÈÒÓ ÌÂ ÔÍÂ›· Ì˘ÎÔÏ·ÛÌ·ÙÈÎ‹/ ¯Ï·-Ì˘‰È·Î‹ ÏÔ›ÌˆÍË, Â›¯Â Ù·˘Ùfi¯ÚÔÓ· Î·È ¿ÏÏÂ˜ ·ÈÙ›Â˜ÁÈ· ÙÔÓ ‚‹¯· ÙÔ˘, Î˘Ú›ˆ˜ ¿ÛıÌ· ‹ ÚÈÓ›ÙÈ‰·/ ·Ú·Ú-ÚÈÓÔÎÔÏ›ÙÈ‰·. ∏ Û˘Ó‡·ÚÍË Ì˘ÎÔÏ·ÛÌ·ÙÈÎ‹˜ÏÔ›ÌˆÍË˜ Î·È ¿ÛıÌ·ÙÔ˜ ÛÙÔÓ ›‰ÈÔ ·ÛıÂÓ‹, ÌÔÚÂ› Ó·

¶›Ó·Î·˜ 2. ™¯ËÌ·ÙÈÎ‹ ·ÔÙ‡ˆÛË ÙË˜ ıÂÚ·Â˘ÙÈÎ‹˜ ÚÔÛ¤ÁÁÈÛË˜ ÙˆÓ ÔÍ¤ˆÓ Ì˘ÎÔÏ·ÛÌ·ÙÈÎÒÓ/¯Ï·Ì˘‰È·ÎÒÓ ÏÔÈÌÒÍÂˆÓ

3 ·È‰È¿ (13,0%)8 ·È‰È¿ (34,7%) ·ÓÙÈ·ÛıÌ·ÙÈÎ¿‚ÂÏÙ›ˆÛË

5 ·È‰È¿ (21,7%)ÚÈÓÈÎfi ÛÙÂÚÔÂÈ‰¤˜+ ·ÓÙÈ‚›ˆÛË

23 ·È‰È¿ (100,0%)(M. pneumoniae IgM +‹ C. pneumoniae IgM+)˘fi ·ÓÙÈ·ÛıÌ·ÙÈÎ‹ ·ÁˆÁ‹

8 ·È‰È¿ (34,7%)ÎÏ·ÚÈıÚÔÌ˘Î›ÓË

15 ·È‰È¿ (65,2%)fi¯È ‚ÂÏÙ›ˆÛË

5 ·È‰È¿ (21,7%)ÎÏ·ÚÈıÚÔÌ˘Î›ÓË+ ·ÓÙÈ·ÛıÌ·ÙÈÎ¿

2 ·È‰È¿ (8,6%)ÎÏ·ÚÈıÚÔÌ˘Î›ÓË+ ÚÈÓÈÎfi ÛÙÂÚÔÂÈ‰¤˜

40 π.ª. µÂÏÈÛÛ·Ú›Ô˘ Î·È Û˘Ó.


·Ô‰ÔıÂ› ÛÙËÓ È‰ÈfiÙËÙ· ÙÔ˘ M. pneumoniae Ó· ÚÔ-Î·ÏÂ› ‚ÚÔÁ¯ÈÎ‹ ˘ÂÚ··ÓÙËÙÈÎfiÙËÙ· Â› Ì·ÎÚfi¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· (1,3,4).

∏ ¯ÔÚ‹ÁËÛË ÎÏ·ÚÈıÚÔÌ˘Î›ÓË˜ ·fi ÙÔ ÛÙfiÌ· ÁÈ· 3Â‚‰ÔÌ¿‰Â˜ Ê·›ÓÂÙ·È Ó· Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈÎ‹ ÛÙËÌÂ›ˆÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÙˆÓ ·È‰ÈÒÓ ÌÂ ÔÍÂ›· Ì˘-ÎÔÏ·ÛÌ·ÙÈÎ‹/ ¯Ï·Ì˘‰È·Î‹ ÏÔ›ÌˆÍË, ·Ó Î·È 8 ·ÛıÂ-ÓÂ›˜ (34,7%) ‚ÂÏÙÈÒıËÎ·Ó ¯ˆÚ›˜ ÂÈ‰ÈÎ‹ ıÂÚ·Â›·.ÿÛˆ˜, ÏÔÈfiÓ, Ó· ‹Ù·Ó ÏÔÁÈÎfi Ó· ‰ÔÎÈÌ¿ÛÂÈ Î·ÓÂ›˜ ÙË¯ÔÚ‹ÁËÛË ÎÏ·ÚÈıÚÔÌ˘Î›ÓË˜ ÛÂ ·È‰È¿ ÌÂ ¯ÚfiÓÈÔ ‚‹-¯· Ô˘ ‰ÂÓ ·ÓÙ·ÔÎÚ›ıËÎ·Ó ÛÙËÓ ·ÓÙÈ·ÛıÌ·ÙÈÎ‹·ÁˆÁ‹. ∆ÔÓ›˙Ô˘ÌÂ, ˆÛÙfiÛÔ, fiÙÈ ··ÈÙÔ‡ÓÙ·È ÌÂÁ·Ï‡-ÙÂÚÂ˜ ÌÂÏ¤ÙÂ˜ ÁÈ· Ó· ÙÂÎÌËÚÈÒÛÔ˘Ó ·˘Ù‹ ÙËÓ ˘fiıÂ-ÛË, Î·ıÒ˜ Î·È Û‡ÁÎÚÈÛË ·ÛıÂÓÒÓ-Ì·ÚÙ‡ÚˆÓ. ∂›ÛË˜,‰ÂÓ ÌÔÚÂ› Ó· ·ÁÓÔËıÂ› ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ô ¯ÚfiÓÈÔ˜ ‚‹-¯·˜ Î·È ÔÈ ÏÔÈÌÒÍÂÈ˜ ·fi ¿Ù˘· Â›Ó·È Û˘¯Ó¿ ·˘ÙÔ-È¿-ÛÈÌÂ˜ ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›·, ÂÔÌ¤Óˆ˜ Â›Ó·È ÔÏ‡ ‰‡-ÛÎÔÏÔ Ó· ÂÎÙÈÌËıÂ› Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙˆÓ ıÂ-Ú·ÂÈÒÓ, ‰Â‰ÔÌ¤ÓÔ˘ fiÙÈ ÔÈ ·ÛıÂÓÂ›˜ ÌÔÚÂ› Ó· ‚ÂÏ-ÙÈˆıÔ‡Ó ÌÂ ÙÔ ¤Ú·ÛÌ· ÙÔ˘ ¯ÚfiÓÔ˘ Î·È ¯ˆÚ›˜ ·ÁˆÁ‹.

™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, Ë ÔÍÂ›· Ì˘ÎÔÏ·ÛÌ·ÙÈÎ‹/¯Ï·-Ì˘‰È·Î‹ ÏÔ›ÌˆÍË Â›Ó·È Û¯ÂÙÈÎ¿ Û˘¯Ó‹ ÛÙ· ·È‰È¿ ÌÂ¯ÚfiÓÈÔ ‹ ˘ÔÙÚÔÈ¿˙ÔÓÙ· ‚‹¯· Î·È ÙÂ›ÓÂÈ Ó· ·ÓÙ·-ÔÎÚ›ÓÂÙ·È Î·Ï¿ ÛÙË ıÂÚ·Â›· ÌÂ ÎÏ·ÚÈıÚÔÌ˘Î›ÓË.∆Ô ˘„ËÏfi ÔÛÔÛÙfi ·ÛıÂÓÒÓ ÌÂ ıÂÙÈÎ¿ IgM ·ÓÙÈÛÒ-Ì·Ù· ÁÈ· Ì˘ÎfiÏ·ÛÌ·, ˘ÔÁÚ·ÌÌ›˙ÂÈ ÙÔ ÁÂÁÔÓfi˜ fiÙÈÔÈ ÏÔÈÌÒÍÂÈ˜ ·˘Ù¤˜ Ú¤ÂÈ Ó· ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·ÈÂÁÎ·›Úˆ˜, ÚÔÎÂÈÌ¤ÓÔ˘ Ó· ·ÔÊÂ‡ÁÂÙ·È Ë ‚ÚÔÁ¯ÈÎ‹˘ÂÚ··ÓÙËÙÈÎfiÙËÙ· Ô˘ ÌÔÚÂ› Ó· Ô‰ËÁ‹ÛÂÈ ÛÂÂÈÌÔÓ‹ ÙÔ˘ ‚‹¯·.


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41ª˘ÎfiÏ·ÛÌ· Î·È ¯ÚfiÓÈÔ˜ ‚‹¯·˜

¶·È‰È·ÙÚÈÎ‹ 2007;70:37-41

42 ∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞ ORIGINAL ARTICLE


1 3Ë ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹πÔÎÚ¿ÙÂÈÔ˘ ¡ÔÛÔÎÔÌÂ›Ô˘,∞ÚÈÛÙÔÙ¤ÏÂÈÔ ¶·ÓÂÈÛÙ‹ÌÈÔ£ÂÛÛ·ÏÔÓ›ÎË˜

2 1Ë ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹πÔÎÚ¿ÙÂÈÔ˘ ¡ÔÛÔÎÔÌÂ›Ô˘,∞ÚÈÛÙÔÙ¤ÏÂÈÔ ¶·ÓÂÈÛÙ‹ÌÈÔ£ÂÛÛ·ÏÔÓ›ÎË˜


ÃÚ‹ÛÙÔ˜ ¶. ¶·ÓÙÂÏÈ¿‰Ë˜,[email protected]∫·ıËÁËÙ‹˜ ¶·È‰È·ÙÚÈÎ‹˜∫. ¶·Ï·Ì¿ 4,∆.∫. 551 33, £ÂÛÛ·ÏÔÓ›ÎË

1 3rd Department ofPediatrics, “Ippokration”Hospital, Aristotle Universityof Thessaloniki

2 1st Department ofPediatrics, “Ippokration”Hospital, Aristotle Universityof Thessaloniki

Correspondence:

Christos P. Panteliadis,[email protected] Professor of Pediatrics4, K. Palama St.,551 33, Thessaloniki

¶˘ÚÂÙÈÎÔ› Û·ÛÌÔ›: ∂›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈÎ‹ Ë ‰È·ÏÂ›Ô˘Û·

ÚÔÊ‡Ï·ÍË ÌÂ ‰È·˙Â¿ÌË;

∂. ¶·˘Ï›‰Ô˘1, ª. ∆˙ËÙËÚ›‰Ô˘1, ∂. ∫ÔÓÙfiÔ˘ÏÔ˜2, Ã. ¶·ÓÙÂÏÈ¿‰Ë˜1

¶ÂÚ›ÏË„Ë

∂ÈÛ·ÁˆÁ‹: ∂ÎÙÈÌ‹ıËÎÂ Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙË˜ ‰È·ÏÂ›Ô˘Û·˜ ÚÔÊ‡Ï·ÍË˜ ÌÂ ‰È·˙Â¿ÌË ·fi ÙÔ ÔÚ-ıfi ÛÙËÓ ÚfiÏË„Ë ÙˆÓ ˘ÚÂÙÈÎÒÓ Û·ÛÌÒÓ (¶™).

ª¤ıÔ‰ÔÈ: ¶ÚfiÎÂÈÙ·È ÁÈ· ÚÔÔÙÈÎ‹ Ù˘¯·ÈÔÔÈËÌ¤ÓË ÌÂÏ¤ÙË ÛÂ 139 ·È‰È¿ (77 ÎÔÚ›ÙÛÈ· Î·È 62 ·ÁfiÚÈ·),Ô˘ Â›¯·Ó ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ¶™. ∆· ·È‰È¿ ¯ˆÚ›ÛÙËÎ·Ó ÛÂ ‰‡Ô ÔÌ¿‰Â˜: ÙËÓ ÔÌ¿‰· (∞) Ô˘ ¤Ï·‚Â ÚÔ-Ê‡Ï·ÍË (n=68) Î·È ÙËÓ ÔÌ¿‰· (µ) ¯ˆÚ›˜ ÚÔÊ‡Ï·ÍË (n=71). ∆· ·È‰È¿ Î·È ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ·Ú¤ÌÂÈ-Ó·Ó ÛÂ ·Ú·ÎÔÏÔ‡ıËÛË ÁÈ· 3 ¯ÚfiÓÈ·. ∆· ÎÚÈÙ‹ÚÈ· ÂÈÛ·ÁˆÁ‹˜ ÛÙË ÌÂÏ¤ÙË ‹Ù·Ó: ÂÏÂ‡ıÂÚÔ ·ÙÔÌÈÎfi ÈÛÙÔ-ÚÈÎfi ·‡ÚÂÙˆÓ Û·ÛÌÒÓ, Ê˘ÛÈÔÏÔÁÈÎ‹ „˘¯ÔÎÈÓËÙÈÎ‹ ·Ó¿Ù˘ÍË, Ó· ÌËÓ ¤¯ÂÈ ¯ÔÚËÁËıÂ› ·ÓÙÈÂÈÏËÙÈÎ‹·ÁˆÁ‹ Î·È ËÏÈÎ›· ¤Ó·ÚÍË˜ ÌÂÙ·Í‡ 6 ÌËÓÒÓ Î·È 3 ÂÙÒÓ. ∏ Î¿ıÂ ÔÌ¿‰· Ù·ÍÈÓÔÌ‹ıËÎÂ ÛÂ ÙÚÂÈ˜ ˘ÔÔÌ¿-‰Â˜, ·Ó¿ÏÔÁ· ÌÂ ÙÔÓ ‚·ıÌfi ÎÈÓ‰‡ÓÔ˘ ˘ÔÙÚÔ‹˜. ø˜ ·Ú¿ÁÔÓÙÂ˜ ÂÈÎÈÓ‰˘ÓfiÙËÙ·˜ ıÂˆÚ‹ıËÎ·Ó: Ë ËÏÈ-Î›· ¤Ó·ÚÍË˜ ≤15 ÌËÓÒÓ, ÙÔ ÈÛÙÔÚÈÎfi ÂÈÏË„›·˜ ÛÂ Û˘ÁÁÂÓ‹ ·’ ‚·ıÌÔ‡, ÙÔ ÈÛÙÔÚÈÎfi ¶™ ÛÂ Û˘ÁÁÂÓ‹ ·’‚·ıÌÔ‡, ÙÔ ÂÈÏÂÁÌ¤ÓÔ ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ¶™ Î·È ÔÈ Û˘¯Ó¤˜ ÂÌ‡ÚÂÙÂ˜ ÏÔÈÌÒÍÂÈ˜. ∆ËÓ ÚÒÙË ËÌ¤Ú· ÙÔ˘˘ÚÂÙÔ‡ ¯ÔÚËÁ‹ıËÎÂ ‰È·˙Â¿ÌË 0,33 mg/kg µ™/8ˆÚÔ Î·È ÙË ‰Â‡ÙÂÚË 0,33 mg/kg µ™/12ˆÚÔ, Î·È ÔÙ¤¿Óˆ ·fi 7,5 mg/‰fiÛË. ™Â fiÏ· Ù· ·È‰È¿ ¤ÁÈÓÂ ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ· ÌfiÏÈ˜ ·˘Ú¤ÙËÛ·Ó, ÌÂÙ¿ ÙÔÚÒÙÔ ÂÂÈÛfi‰ÈÔ ¶™.

∞ÔÙÂÏ¤ÛÌ·Ù·: ™ÙÔ Ù¤ÏÔ˜ ÙˆÓ 3 ÂÙÒÓ ·Ú·ÎÔÏÔ‡ıËÛË˜, Ë Û˘¯ÓfiÙËÙ· ˘ÔÙÚÔÒÓ ÛÙËÓ ÔÌ¿‰· Ô˘ ‰ÂÓ ¤Ï·-‚Â ‰È·˙Â¿ÌË ‹Ù·Ó 83% ÁÈ· Ù· ̆ „ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘, 55% ÛÙ· ÂÓ‰È·Ì¤ÛÔ˘ Î·È 46% ÛÙ· ̄ ·ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ·È-‰È¿. ™Ù· ·È‰È¿ ÌÂ ÚÔÊ‡Ï·ÍË ÔÈ Û˘¯ÓfiÙËÙÂ˜ ̆ ÔÙÚÔ‹˜ ÌÂÈÒıËÎ·Ó ÛÂ fiÏÂ˜ ÙÈ˜ ÔÌ¿‰Â˜ ÎÈÓ‰‡ÓÔ˘: 38%, 35%Î·È 33% ·ÓÙ›ÛÙÔÈ¯·.

™˘ÌÂÚ¿ÛÌ·Ù·: ∏ ‰È·ÏÂ›Ô˘Û· ÚÔÊ‡Ï·ÍË ÌÂ ‰È·˙Â¿ÌË ·fi ÙÔ ÔÚıfi ÌÂÈÒÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ˘ÔÙÚÔ‹˜È‰È·›ÙÂÚ· ÛÙ· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ·È‰È¿, ·ÚÎÂ› Ó· ¯ÔÚËÁÂ›Ù·È ¤ÁÎ·ÈÚ· Î·È Â·ÚÎÒ˜.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ¢È·˙Â¿ÌË, ÚÔÊ‡Ï·ÍË ˘ÚÂÙÈÎÒÓ Û·ÛÌÒÓ.

Efficacy of intermittent rectal diazepam prophylaxis for

the prevention of febrile seizures

E. Pavlidou1, M. Tzitiridou1, E. Kontopoulos2, C. Panteliadis1

Abstract

Objectives: The aim of this study was to assess the efficacy of intermittent rectal diazepam prophylaxisfor the prevention of febrile seizures (FS).

Methods: This was a prospective randomized trial of 139 children (77 females, 62 males), who hadexperienced a first episode of FS. The children were allocated to two groups: group (A), which receivedintermittent rectal diazepam prophylaxis (n=68), and group (B) without prophylaxis (n=71). The childrenin both groups were monitored for 36 months. The inclusion criteria were: no personal history of afebrileseizures, normal neurodevelopment, no previous anticonvulsant therapy, and age between 6 months and3 years. The children in each group were stratified into low, intermediate and high risk according toclinical factors: age at onset ≤15 months, epilepsy in first degree relatives, FS in first degree relatives, a firstcomplex FS and increased febrile episodes. Diazepam was administered rectally at a dose of 0.33 mg/kgBW/8 hours on the first day of a febrile illness and 0.33 mg/kgBW/12 hours the second day, maximum7.5 mg/dose. All children had an EEG recording after the first FS as soon as they were afebrile.

Results: The 36-month recurrence rates for the no prophylaxis group were 83% in high-risk, 55% inintermediate and 46% in low-risk patients. For the prophylaxis group the recurrence rates were lowerin all risk groups: 38%, 35% and 33% respectively.

Conclusions: Intermittent rectal diazepam prophylaxis reduces the recurrence rate of FS, especially forhigh-risk children, provided that adequate doses are given early in the febrile illness.

Key words: Diazepam, febrile seizure prophylaxis.

∂ÈÛ·ÁˆÁ‹

∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ‰ËÌÔÛÈÂ‡ıËÎ·Ó ÔÏÏ¤˜ÂÚÁ·Û›Â˜ Ô˘ ·ÊÔÚÔ‡Û·Ó ÙË ıÂÚ·Â›·, ÚÔÊ‡Ï·ÍËÎ·È ÚfiÁÓˆÛË ÙˆÓ ˘ÚÂÙÈÎÒÓ Û·ÛÌÒÓ (¶™) (1,2).∞fi ÙÈ˜ ÌÂÏ¤ÙÂ˜ ·˘Ù¤˜ ÚÔ¤Î˘„·Ó ÔÏÏ¿ Ó¤· ÛÙÔÈ-¯Â›· Û¯ÂÙÈÎ¿ ÌÂ ÙËÓ ÎÏËÚÔÓÔÌÈÎ‹ ÂÈ‚¿Ú˘ÓÛË ‹ÚÔ‰È¿ıÂÛË ÙˆÓ ¶™ (3,4). ∏ ¿Ô„Ë fiÙÈ ÔÈ ·ÏÔ›¶™ Â›Ó·È Î·ÏÔ‹ıÂÈ˜ Î·È Û¿ÓÈ· ··ÈÙÔ‡Ó ıÂÚ·Â›·ÈÛ¯‡ÂÈ Î·È Û‹ÌÂÚ·. øÛÙfiÛÔ, Â›Ó·È Èı·Ófi ÛÂ ¤Ó· ÌÈ-ÎÚfi ÔÛÔÛÙfi ·È‰ÈÒÓ Ó· ÚÔÎÏËıÔ‡Ó ÂÈÏËÙÈÎ¤˜(Î˘Ú›ˆ˜ ÂÛÙÈ·Î¤˜) ÎÚ›ÛÂÈ˜.

∏ ‰È·ÏÂ›Ô˘Û· ÚÔÊ‡Ï·ÍË ÌÂ ‰È·˙Â¿ÌË ·fiÙÔ ÛÙfiÌ·, ˘ÔÁÏÒÛÛÈ· ‹ ÙÔ ÔÚıfi (˘ÔÎÏ˘ÛÌfi) ¤¯ÂÈÁ›ÓÂÈ ı¤Ì· ¤ÚÂ˘Ó·˜ ·fi ÔÏÏÔ‡˜ Û˘ÁÁÚ·ÊÂ›˜ Ù· ÙÂ-ÏÂ˘Ù·›· 20 ¯ÚfiÓÈ·. √È ‰È¿ÊÔÚÂ˜ ÌÂÏ¤ÙÂ˜ ÂÈÎÂÓÙÚÒ-ıËÎ·Ó ÛÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙË˜ ‰È·ÏÂ›Ô˘Û·˜ÚÔÊ‡Ï·ÍË˜ ÌÂ ‰È·˙Â¿ÌË Î·È ÙËÓ Â›‰Ú·Û‹ ÙË˜ÛÙËÓ ˘ÔÙÚÔ‹ ÙˆÓ ¶™, ÂÓÒ ˆ˜ ÌÂÈÔÓ¤ÎÙËÌ· ıÂˆ-ÚÂ›Ù·È Ë ¯ÔÚ‹ÁËÛË ÂÓfi˜ Ê·ÚÌ¿ÎÔ˘ ÛÂ ÌÈÎÚ¿ ·È‰È¿ÁÈ· ÌÈ· Î·ÏÔ‹ıË Î·Ù¿ÛÙ·ÛË (5). √È ÌÂÏ¤ÙÂ˜ ·˘Ù¤˜¤‰ÂÈÍ·Ó fiÙÈ Ë ‰È·˙Â¿ÌË Ú¤ÂÈ Ó· ¯ÔÚËÁÂ›Ù·È ÛÂÂÈÏÂÁÌ¤ÓÂ˜ ÂÚÈÙÒÛÂÈ˜, fiˆ˜ ÛÂ ·È‰È¿ ÌÂ ·Ú·-ÙÂÙ·Ì¤ÓÔ˘˜ Û·ÛÌÔ‡˜, ÂÛÙÈ·Î¤˜ ÎÚ›ÛÂÈ˜ Î·È ÛÂ ·È-‰È¿ ÌÂ ·ÚÎÂÙÔ‡˜ ·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ (6,7). ™ÎÔ-fi˜ ÙË˜ ÌÂÏ¤ÙË˜ Ì·˜ Â›Ó·È Ó· ÂÎÙÈÌËıÂ› Ë ·ÔÙÂÏÂ-ÛÌ·ÙÈÎfiÙËÙ· ÙË˜ ‰È·ÏÂ›Ô˘Û·˜ ÚÔÊ‡Ï·ÍË˜ ÌÂ ‰È·-˙Â¿ÌË, ÛÂ Û˘Û¯¤ÙÈÛË ÌÂ ÙÔÓ Î›Ó‰˘ÓÔ ˘ÔÙÚÔ‹˜.°È· ÙÔÓ ÏfiÁÔ ·˘Ùfi, ÌÂÏÂÙ‹Û·ÌÂ ¤Ó· ÌÂÁ¿ÏÔ ‰Â›ÁÌ··È‰ÈÒÓ Î·È Ë ‰È¿ÚÎÂÈ· ·Ú·ÎÔÏÔ‡ıËÛË˜ ‹Ù·Ó ÙÔ˘-Ï¿¯ÈÛÙÔÓ 3 ¯ÚfiÓÈ·.


∏ ¤ÚÂ˘Ó· ¤ÁÈÓÂ ÛÂ ÔÌ¿‰· 145 ·È‰ÈÒÓ ÌÂ ÚÒÙÔ ÂÂÈÛfi-‰ÈÔ ¶™ Î·È Â›Ó·È ÚÔÔÙÈÎ‹, ÂÏÂÁ¯fiÌÂÓË Î·È Ù˘¯·ÈÔÔÈËÌ¤-ÓË. ∞fi ÙË ÌÂÏ¤ÙË ·ÔÎÏÂ›ÛÙËÎ·Ó 6 ·È‰È¿ ÏfiÁˆ ‰˘ÛÎÔÏÈÒÓ·Ú·ÎÔÏÔ‡ıËÛË˜. ∆· ˘fiÏÔÈ· 139 ·È‰È¿ ·Ú¤ÌÂÈÓ·Ó ÛÂ·Ú·ÎÔÏÔ‡ıËÛË ÁÈ· ‰È¿ÛÙËÌ· 3 ¯ÚfiÓˆÓ. ∆· ·È‰È¿ ¯ˆÚ›ÛÙË-Î·Ó ÛÂ ‰‡Ô ÔÌ¿‰Â˜: ÙËÓ ÔÌ¿‰· ∞ Ô˘ ¤Ï·‚Â ÚÔÊ‡Ï·ÍË ÌÂ‰È·˙Â¿ÌË Î·È ÙËÓ ÔÌ¿‰· µ (Ì·ÚÙ‡ÚˆÓ) Ô˘ ‰ÂÓ ¤Ï·‚Â ·Áˆ-Á‹. ∫¿ıÂ ·È‰› Ù˘¯·›· Î·Ù·¯ˆÚ‹ıËÎÂ ÛÙËÓ ÔÌ¿‰· ∞ ‹ µ (ÌÔ-Ó¤˜ Î·È ˙˘Á¤˜ Ì¤ÚÂ˜ ·ÓÙ›ÛÙÔÈ¯·) Î·È Ô ˘Â‡ı˘ÓÔ˜ ÁÈ· ÙËÓ ·-Ú·ÎÔÏÔ‡ıËÛË ÁÈ·ÙÚfi˜ ‰ÂÓ ÁÓÒÚÈ˙Â ÙËÓ Ù˘¯·ÈÔÔ›ËÛË. √È ‰‡ÔÔÌ¿‰Â˜ ‹Ù·Ó Û˘ÁÎÚ›ÛÈÌÂ˜ fiÛÔÓ ·ÊÔÚ¿ Ù· ‰ËÌÔÁÚ·ÊÈÎ¿ Î·ÈÎÏÈÓÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙÔ˘˜ (¶›Ó·Î·˜ 1).

∏ ÔÌ¿‰· ∞ (ÔÌ¿‰· ÚÔÊ‡Ï·ÍË˜) ·ÔÙÂÏÂ›Ù·È ·fi 68·È‰È¿ Î·È Ë ÔÌ¿‰· µ (Ì·ÚÙ‡ÚˆÓ, ¯ˆÚ›˜ ÚÔÊ‡Ï·ÍË) ·fi 71·È‰È¿. ∆· ÎÚÈÙ‹ÚÈ· ÂÈÛ·ÁˆÁ‹˜ ÛÙË ÌÂÏ¤ÙË Â›Ó·È: ÂÏÂ‡ıÂÚÔ·ÙÔÌÈÎfi ÈÛÙÔÚÈÎfi ·‡ÚÂÙˆÓ Û·ÛÌÒÓ, Ê˘ÛÈÔÏÔÁÈÎ‹ „˘¯ÔÎÈ-ÓËÙÈÎ‹ ·Ó¿Ù˘ÍË, Ó· ÌËÓ ¤¯ÂÈ ¯ÔÚËÁËıÂ› ·ÓÙÈÂÈÏËÙÈÎ‹·ÁˆÁ‹ Î·È Ë ËÏÈÎ›· ¤Ó·ÚÍË˜ Ó· Â›Ó·È ÌÂÙ·Í‡ 6 ÌËÓÒÓ Î·È 3ÂÙÒÓ. √È ¶™ ÔÚ›ÛÙËÎ·Ó ‚¿ÛÂÈ ÙË˜ ÔÌÔÊˆÓ›·˜ ÙÔ˘ NationalInstitutes of Health. ™‡ÌÊˆÓ· ÌÂ ÙËÓ ÔÔ›·, ˆ˜ ¶™ ÔÚ›˙ÔÓÙ·ÈÔÈ Û·ÛÌÔ› Ô˘ Û˘Ì‚·›ÓÔ˘Ó ÛÂ ‚Ú¤ÊË Î·È ·È‰È¿ ËÏÈÎ›·˜ ·fi3 ÌËÓÒÓ ¤ˆ˜ 5 ÂÙÒÓ, Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÙÔÓ ˘ÚÂÙfi ·ÏÏ¿ ‰ÂÓ˘¿Ú¯ÂÈ ¤Ó‰ÂÈÍË ÂÓ‰ÔÎÚ¿ÓÈ·˜ ÏÔ›ÌˆÍË˜ ‹ ¿ÏÏË˜ ÔÚÈÛÌ¤ÓË˜·ÈÙ›·˜, Ô‡ÙÂ ÈÛÙÔÚÈÎfi ÚÔËÁÔ‡ÌÂÓÔ˘ ÂÂÈÛÔ‰›Ô˘ ·‡ÚÂÙˆÓÛ·ÛÌÒÓ (8).

√È ÁÔÓÂ›˜ ÙˆÓ ·È‰ÈÒÓ ÂÓËÌÂÚÒıËÎ·Ó ÏÂÙÔÌÂÚÒ˜ Û¯Â-

ÙÈÎ¿ ÌÂ ÙË Ê‡ÛË Î·È ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ¶™ Î·È ¤‰ˆÛ·Ó

ÙË Û˘ÁÎ·Ù¿ıÂÛ‹ ÙÔ˘˜ ÁÈ· ÙË ÌÂÏ¤ÙË. ∂ÈÏ¤ÔÓ, ÔÈ ÁÔÓÂ›˜

ÙË˜ ÔÌ¿‰·˜ ∞ ‹Ú·Ó ÚÔÊÔÚÈÎ¤˜ Î·È ÁÚ·Ù¤˜ Ô‰ËÁ›Â˜ Û¯Â-

ÙÈÎ¿ ÌÂ ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ÎÏ‡ÛÌ·ÙÔ˜ ‰È·˙Â¿ÌË˜ ·fi ÙÔ

ÔÚıfi Î·È ÏËÚÔÊÔÚ‹ıËÎ·Ó ÁÈ· ÙÈ˜ Èı·Ó¤˜ ·ÚÂÓ¤ÚÁÂÈÂ˜. ∏

ÚÔÊ‡Ï·ÍË ÂÊ·ÚÌfiÛÙËÎÂ ÙÈ˜ ‰‡Ô ÚÒÙÂ˜ ËÌ¤ÚÂ˜ ÙÔ˘ ˘ÚÂ-

ÙÔ‡ Î·È fiÙ·Ó Ë ıÂÚÌÔÎÚ·Û›· ÛÒÌ·ÙÔ˜ ·fi ÙÔ ÔÚıfi ‹Ù·Ó

>38ÔC. ∞Ó¿ÏÔÁ· ÌÂ ÙÔ ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜ ¯ÔÚËÁ‹ıËÎÂ ÙËÓ

ÚÒÙË Ì¤Ú· ÙÔ˘ ˘ÚÂÙÔ‡ 0,33 mg/kg µ™/8ˆÚÔ Î·È ÙË ‰Â‡-

ÙÂÚË 0,33 mg/kg µ™/12ˆÚÔ Î·È fi¯È ¿Óˆ ·fi 7,5 mg/‰fiÛË.

¶ÚÔÎÂÈÌ¤ÓÔ˘ Ó· ·ÔÊÂ˘¯ıÂ› ·ÓÂÈı‡ÌËÙË Î·Ù·ÛÙÔÏ‹ ·fi

ÙË Û˘ÛÛÒÚÂ˘ÛË ÙË˜ ‰È·˙Â¿ÌË˜, ‰fiıËÎ·Ó ÙÔ Ì¤ÁÈÛÙÔ 5 Û˘-

ÓÂ¯Â›˜ ‰fiÛÂÈ˜ ÛÂ Î¿ıÂ ÂÌ‡ÚÂÙË ÏÔ›ÌˆÍË, Û‡ÌÊˆÓ· ÌÂ ÙÔ

·Ú·¿Óˆ Û¯‹Ì·.

¶ÚÔÊ›Ï ÎÈÓ‰‡ÓÔ˘ ˘ÔÙÚÔ‹˜ ¤ÁÈÓÂ ÛÂ Î¿ıÂ ·È‰› ÙË˜ ÌÂ-

Ï¤ÙË˜ ÚÈÓ ·fi ÙËÓ ¤Ó·ÚÍË ÙË˜ ıÂÚ·Â›·˜ Î·È ÔÈ ÁÔÓÂ›˜ ÂÓË-

ÌÂÚÒıËÎ·Ó ÁÈ· ÙËÓ ÂÓ‰Â¯fiÌÂÓË ˘ÔÙÚÔ‹ ÙˆÓ ¶™ (¯·ÌËÏfi˜,

ÂÓ‰È¿ÌÂÛÔ˜ ‹ ˘„ËÏfi˜ Î›Ó‰˘ÓÔ˜). ∂ÂÈ‰‹ Ù· ˘„ËÏÔ‡, ÂÓ‰È·-

Ì¤ÛÔ˘ ‹ ¯·ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ·È‰È¿ ·ÓÙ·ÔÎÚ›ÓÔÓÙ·È ‰È·ÊÔ-

ÚÂÙÈÎ¿ ÛÙË ‰È·ÏÂ›Ô˘Û· ÚÔÊ‡Ï·ÍË ÌÂ ‰È·˙Â¿ÌË, Ë Î¿ıÂ

ÔÌ¿‰· Ù·ÍÈÓÔÌ‹ıËÎÂ ÛÂ ÙÚÂÈ˜ ˘ÔÔÌ¿‰Â˜, ·Ó¿ÏÔÁ· ÌÂ ÙÔÓ

‚·ıÌfi ÎÈÓ‰‡ÓÔ˘ ˘ÔÙÚÔ‹˜. ∆Ô ÚÔÊ›Ï ÂÈÎÈÓ‰˘ÓfiÙËÙ·˜

Î·ıÔÚ›ÛÙËÎÂ ‚¿ÛÂÈ ÙˆÓ ÎÏÈÓÈÎÒÓ ÎÚÈÙËÚ›ˆÓ ·fi ÙÔ ÈÛÙÔÚÈÎfi.

√È ÚÔÁÓˆÛÙÈÎÔ› ‰Â›ÎÙÂ˜ ˘ÔÙÚÔ‹˜ ÙˆÓ ¶™, Ô˘ ¯ÚËÛÈÌÔ-

ÔÈ‹ıËÎ·Ó Î·È ÛÙË ‰ÈÎ‹ Ì·˜ ÌÂÏ¤ÙË, ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÙÔÓ

¶›Ó·Î· 2. ∆· ·È‰È¿ Ô˘ Â›¯·Ó ·fi ÌË‰¤Ó ¤ˆ˜ ¤Ó·Ó ·Ú¿ÁÔ-

ÓÙ· ÎÈÓ‰‡ÓÔ˘ Î·Ù·ÓÂÌ‹ıËÎ·Ó ÛÙ· ¯·ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘, ÂÎÂ›Ó·

ÌÂ ‰‡Ô ·Ú¿ÁÔÓÙÂ˜ ÛÙ· ÂÓ‰È·Ì¤ÛÔ˘ Î·È ÂÎÂ›Ó· ÌÂ ÙÚÂÈ˜ ¤ˆ˜

¤ÓÙÂ ÛÙ· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘.

∏ ÌÂÏ¤ÙË ÛÙÈ˜ ‰‡Ô ÔÌ¿‰Â˜ ¿Ú¯ÈÛÂ ÌÂÙ¿ ÙÔ ÚÒÙÔ ÂÂÈÛfi-

‰ÈÔ ¶™ ·fi ÙÔ ÙÌ‹Ì· ¶·È‰È·ÙÚÈÎ‹˜ ¡Â˘ÚÔÏÔÁ›·˜ (ÎÏÈÓÈÎ‹ Î·È

ÂÍˆÙÂÚÈÎ¿ È·ÙÚÂ›·). ŸÏ· Ù· ·È‰È¿ Â›¯·Ó ÂÏÂ‡ıÂÚÔ ÚÔÁÂÓÓË-

ÙÈÎfi Î·È ÂÚÈÁÂÓÓËÙÈÎfi ÈÛÙÔÚÈÎfi, Ê˘ÛÈÔÏÔÁÈÎ‹ „˘¯ÔÎÈÓËÙÈÎ‹

·Ó¿Ù˘ÍË Î·È Î·Ó¤Ó· ‰ÂÓ Â›¯Â ÎÏÈÓÈÎ¤˜ ‹ ÂÚÁ·ÛÙËÚÈ·Î¤˜ ÂÓ-

‰Â›ÍÂÈ˜ ÂÎÊ˘ÏÈÛÙÈÎÔ‡ ÓÔÛ‹Ì·ÙÔ˜ ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ ÓÂ˘ÚÈÎÔ‡ Û˘-

ÛÙ‹Ì·ÙÔ˜ (∫¡™).

™Â fiÏ· ¤ÁÈÓÂ ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ· (∏∂°), ÌfiÏÈ˜

·˘Ú¤ÙËÛ·Ó, ÌÂÙ¿ ÙÔ ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ¶™ Î·È ·Ú·ÎÔÏÔ˘-

ı‹ıËÎ·Ó ÁÈ· ÙÔ˘Ï¿¯ÈÛÙÔÓ 3 ¯ÚfiÓÈ·. ∏ ÙÂÏÈÎ‹ Â·ÓÂÎÙ›ÌËÛË

¤ÁÈÓÂ ÛÙËÓ ËÏÈÎ›· ÙˆÓ 3-6 ÂÙÒÓ, Ì¤ÛË ËÏÈÎ›· 4,8±1,2 ÂÙÒÓ.

∫¿ıÂ 4 Ì‹ÓÂ˜ ˘‹Ú¯Â Â·Ê‹ ÌÂ ÙÔ˘˜ ÁÔÓÂ›˜ ÙˆÓ ·È‰ÈÒÓ

ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô ÂÊ·ÚÌÔÁ‹˜ ÙÔ˘ ÚˆÙÔÎfiÏÏÔ˘ Î·È ÙËÓ ·ÔÊ˘-

Á‹ Ï·ıÒÓ. ∂›ÛË˜, ÛÂ Î¿ıÂ ÂÌ‡ÚÂÙÔ ÂÂÈÛfi‰ÈÔ ˘‹Ú¯Â ÍÂ-

¯ˆÚÈÛÙ‹ ÙËÏÂÊˆÓÈÎ‹ ÂÈÎÔÈÓˆÓ›· ÌÂ ÙÔ˘˜ ÁÔÓÂ›˜ ÁÈ· Ó· Û˘-

ÁÎÂÓÙÚˆıÔ‡Ó fiÏÂ˜ ÔÈ ··Ú·›ÙËÙÂ˜ ÏËÚÔÊÔÚ›Â˜ Û¯ÂÙÈÎ¿ ÌÂ

ÙÔÓ ˘ÚÂÙfi, ÙÔ˘˜ Û·ÛÌÔ‡˜ Î·È ÙÈ˜ Èı·Ó¤˜ ·ÓÂÈı‡ÌËÙÂ˜

ÂÓ¤ÚÁÂÈÂ˜.

™Ù·ÙÈÛÙÈÎ‹ ·Ó¿Ï˘ÛË

∏ ÛÙ·ÙÈÛÙÈÎ‹ ·Ó¿Ï˘ÛË ÌÂÙ·Í‡ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ¤ÁÈÓÂ Û‡Ì-

ÊˆÓ· ÌÂ ÙÔ Pearson Chi-Square Test (™˘ÓÂ¯‹˜ ¢ÈfiÚıˆÛË Î·Ù¿

Yates). ™Ù·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ¤˜ ıÂˆÚ‹ıËÎ·Ó ÔÈ ÙÈÌ¤˜ ÙÔ˘

P<0,05.


∏ ÔÌ¿‰· ÚÔÊ‡Ï·ÍË˜ (n=68) ·ÔÙÂÏÂ›ÙÔ ·fi 39

ÎÔÚ›ÙÛÈ· Î·È 29 ·ÁfiÚÈ· Î·È Ë ËÏÈÎ›· ¤Ó·ÚÍË˜ Î˘Ì·È-

ÓfiÙ·Ó ·fi 6 ¤ˆ˜ 36 Ì‹ÓÂ˜ (Ì¤ÛË ËÏÈÎ›·±SD, 15±7).

™˘ÓÔÏÈÎ¿ 54/68 ÂÌÊ¿ÓÈÛ·Ó ÚÒÙÔ ÂÂÈÛfi‰ÈÔ

·ÏÒÓ ¶™, ÂÓÒ 14/68 Â›¯·Ó ·ÚÔ˘ÛÈ¿ÛÂÈ ÛÙÔ ÚÒÙÔ

43¶˘ÚÂÙÈÎÔ› Û·ÛÌÔ›

¶·È‰È·ÙÚÈÎ‹ 2007;70:42-48

ÂÂÈÛfi‰ÈÔ ÂÈÏÂÁÌ¤ÓÔ˘˜ ¶™ Î·È ·fi ·˘Ù¿ 3 ÂÌÊ¿-

ÓÈÛ·Ó ÂÛÙÈ·Î‹ ÛËÌÂÈÔÏÔÁ›·, ÂÓÒ 12 Â›¯·Ó ˘ÔÙÚÔ‹

ÛÙÔ ›‰ÈÔ ÂÌ‡ÚÂÙÔ. ∏ ‰È¿ÚÎÂÈ· ÙˆÓ ÎÚ›ÛÂˆÓ ‹Ù·Ó ÛÂ

65 ·È‰È¿ ÌÈÎÚfiÙÂÚË ·fi 10 ÏÂÙ¿. ™Â 3 ÂÚÈÙÒ-

ÛÂÈ˜ ÔÈ Û·ÛÌÔ› Â›¯·Ó ‰È¿ÚÎÂÈ· >15 ÏÂÙ¿, ·fi ÙÈ˜

ÔÔ›Â˜ ‰‡Ô ÂÎ‰ËÏÒıËÎ·Ó ÌÂ ÙË ÌÔÚÊ‹ ˘ÚÂÙÈÎÔ‡

status epilepticus (>30 ÏÂÙ¿). ™˘ÓÔÏÈÎ¿ 30 ·È‰È¿

ÙË˜ ÔÌ¿‰·˜ ∞ Â›¯·Ó ËÏÈÎ›· ¤Ó·ÚÍË˜ ¿Óˆ ÙˆÓ 15 ÌË-

ÓÒÓ, ÂÓÒ 38 ‹Ù·Ó ÌÈÎÚfiÙÂÚ· (¶›Ó·Î·˜ 1).

∏ ÔÌ¿‰· ÙˆÓ Ì·ÚÙ‡ÚˆÓ (n=71) ·ÔÙÂÏÂ›ÙÔ ·fi

38 ÎÔÚ›ÙÛÈ· Î·È 33 ·ÁfiÚÈ· Î·È Ë ËÏÈÎ›· ¤Ó·ÚÍË˜ Î˘-

Ì·ÈÓfiÙ·Ó ·fi 6 ¤ˆ˜ 36 Ì‹ÓÂ˜ (Ì¤ÛË ËÏÈÎ›·±SD,

15±8). ¶ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ·ÏÒÓ ¶™ ÂÌÊ¿ÓÈÛ·Ó

59/71 ·È‰È¿ Î·È 12/71 Â›¯·Ó ÂÈÏÂÁÌ¤ÓÔ. ™·ÛÌÔ›

‰È¿ÚÎÂÈ·˜ 1-5 ÏÂÙ¿ Î·Ù·ÁÚ¿ÊËÎ·Ó ÛÂ 68/71 ·ÛıÂ-

ÓÂ›˜, ‰‡Ô Â›¯·Ó ˘ÚÂÙÈÎfi status epilepticus, ÂÓÒ 10/71

Â›¯·Ó Î·È ‰Â‡ÙÂÚÔ ÂÂÈÛfi‰ÈÔ ÛÙÔ ›‰ÈÔ ÂÌ‡ÚÂÙÔ.

∂ÛÙÈ·ÎÔ› ¶™ ·Ú·ÙËÚ‹ıËÎ·Ó ÛÂ Ù¤ÛÛÂÚÈ˜ ·ÛıÂÓÂ›˜.

∆ÚÈ¿ÓÙ· ¤Ó· ·È‰È¿ ‹Ù·Ó ËÏÈÎ›·˜ ÌÂÁ·Ï‡ÙÂÚ· ·fi

15 ÌËÓÒÓ Î·È 40 ÌÈÎÚfiÙÂÚ· (¶›Ó·Î·˜ 1).

ªÂÙ·Í‡ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ‰ÂÓ ˘‹Ú¯·Ó ÛËÌ·ÓÙÈ-Î¤˜ ‰È·ÊÔÚ¤˜ fiÛÔÓ ·ÊÔÚ¿ ÙÔ Ê‡ÏÔ, ÙËÓ ËÏÈÎ›· ¤Ó·Ú-ÍË˜, ÙË ÌÔÚÊ‹ Î·È ÙË ‰È¿ÚÎÂÈ· Û·ÛÌÒÓ. £ÂÙÈÎfi ÔÈ-ÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÂÈÏË„›·˜ ÛÂ Û˘ÁÁÂÓ‹ ·ã ‚·ı-ÌÔ‡ ˘‹Ú¯Â ÛÂ 6 ·ÛıÂÓÂ›˜ ÙË˜ ÔÌ¿‰·˜ ∞ Î·È ÛÂ 8 ÙË˜ÔÌ¿‰·˜ µ, ÂÓÒ ÈÛÙÔÚÈÎfi ¶™ ÛÂ Û˘ÁÁÂÓ‹ ·ã ‚·ıÌÔ‡Â›¯·Ó 21/68 ·È‰È¿ ÙË˜ ÔÌ¿‰·˜ ∞ Î·È 21/71 ÙË˜ ÔÌ¿-‰·˜ µ. ∏ ÓÂ˘ÚÔÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË Î·È Ë „˘¯ÔÎÈÓËÙÈÎ‹·Ó¿Ù˘ÍË ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ¤˜ ÛÂ fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂ-ÓÂ›˜. ∆· ∏∂° fiÏˆÓ ÙˆÓ ·È‰ÈÒÓ (ÔÌ¿‰· ∞ Î·È µ)‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ¿, ÂÎÙfi˜ ·fi Ì›· ÂÚ›ÙˆÛË fiÔ˘Î·Ù·ÁÚ¿ÊËÎ·Ó Û·ÊÂ›˜ ·ÚÔÍ˘ÓÙÈÎ¤˜ ÂÎÊÔÚÙ›ÛÂÈ˜·ÚÈÛÙÂÚ¿ Î·È Ù¿ÛË ÁÂÓ›ÎÂ˘ÛË˜. ∆Ô ·È‰› ·Ó‹ÎÂ ÛÙËÓÔÌ¿‰· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ¯ˆÚ›˜ ÚÔÊ‡Ï·ÍË Î·È ÂÌ-Ê¿ÓÈÛÂ Û˘ÓÔÏÈÎ¿ 6 ˘ÔÙÚÔ¤˜.

ŸÏ· Ù· ·È‰È¿ ÙË˜ ÌÂÏ¤ÙË˜ Â›¯·Ó ÙÔ˘Ï¿¯ÈÛÙÔÓ¤ÍÈ ÂÌ‡ÚÂÙ· ÂÂÈÛfi‰È· Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ 3¯ÚfiÓˆÓ ·Ú·ÎÔÏÔ‡ıËÛË˜ Î·È Ô Û˘ÓÔÏÈÎfi˜ ·ÚÈıÌfi˜ÙˆÓ ÂÌ‡ÚÂÙˆÓ Î·Ù·ÛÙ¿ÛÂˆÓ ‹Ù·Ó 443 ÁÈ· ÙËÓÔÌ¿‰· ∞ Î·È 485 ÁÈ· ÙË µ. ∆· ·›ÙÈ· ÙÔ˘ ˘ÚÂÙÔ‡ ÛÙÈ˜ÂÚÈÛÛfiÙÂÚÂ˜ ÂÚÈÙÒÛÂÈ˜ ‹Ù·Ó ÈÔÁÂÓÂ›˜ ÏÔÈÌÒÍÂÈ˜ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡. ∏ ıÂÚÌÔÎÚ·Û›· ÛÙÔÚÒÙÔ ÂÂÈÛfi‰ÈÔ ¶™ Î˘Ì·›ÓÔÓÙ·Ó ÛÙ· ·È‰È¿ ˘fiÚÔÊ‡Ï·ÍË ÌÂÙ·Í‡ 37,5ÔC Î·È 40ÔC (Ì¤ÛË ÙÈÌ‹38,5ÔC) Î·È ÛÙËÓ ÔÌ¿‰· ¯ˆÚ›˜ ÚÔÊ‡Ï·ÍË ÌÂÙ·Í‡37,6ÔC Î·È 41ÔC (Ì¤ÛË ÙÈÌ‹ 38,8ÔC). øÛÙfiÛÔ, ÛÙÈ˜˘ÔÙÚÔ¤˜ Ë ıÂÚÌÔÎÚ·Û›· Â›¯Â ‰È·Î‡Ì·ÓÛË ·fi38ÔC ¤ˆ˜ 39,5ÔC (Ì¤ÛË ÙÈÌ‹ 39ÔC). ∏ ÏÂÈÔÓfiÙËÙ·

¶›Ó·Î·˜ 2. ¶ÚÔÁÓˆÛÙÈÎÔ› ‰Â›ÎÙÂ˜ ˘ÔÙÚÔ‹˜ ˘ÚÂÙÈÎÒÓ Û·ÛÌÒÓ

ñ ∏ÏÈÎ›· ¤Ó·ÚÍË˜ ≤15 ÌËÓÒÓñ √ÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ¶™ ÛÂ Û˘ÁÁÂÓ‹ ·ã ‚·ıÌÔ‡ñ √ÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÂÈÏË„›·˜ ÛÂ Û˘ÁÁÂÓ‹ ·ã ‚·ıÌÔ‡ñ ∂ÈÏÂÁÌ¤ÓÔ ÙÔ ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ¶™ñ ™˘¯Ó¤˜ ÂÌ‡ÚÂÙÂ˜ ÏÔÈÌÒÍÂÈ˜ (·È‰ÈÎfi˜ ÛÙ·ıÌfi˜)

44 ∂. ¶·˘Ï›‰Ô˘ Î·È Û˘Ó.


¶›Ó·Î·˜ 1. µ·ÛÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙˆÓ ÔÌ¿‰ˆÓ ∞ Î·È µ

√Ì¿‰· A (n=68) √Ì¿‰· B (n=71)

¢ËÌÔÁÚ·ÊÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿£‹ÏÂ· 39 (57%) 38 (54%)∏ÏÈÎ›· ¤Ó·ÚÍË˜ a* 15 (6-36) 15 (6-36)√ÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ¶™* 21 (31%) 21 (30%)√ÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÂÈÏË„›·˜* 6 (9%) 8 (11%)æ˘¯ÔÎÈÓËÙÈÎ‹ Î·ı˘ÛÙ¤ÚËÛË ∫·Ó¤Ó· ∫·Ó¤Ó·¶·È‰ÈÎfi˜ ÛÙ·ıÌfi˜* 21 (31%) 24 (34%)¶Ï‹ÚË˜ ÂÌ‚ÔÏÈ·ÛÙÈÎ‹ Î¿Ï˘„Ëb 56 (82%) 59 (83%)Ã·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙÔ˘ ·Ú¯ÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘∏ÏÈÎ›· ¤Ó·ÚÍË˜ a* 15 (6-36) 15 (6-36)>15 ÌËÓÒÓ 30 (44%) 31 (44%)≤15 ÌËÓÒÓ 38 (56%) 40 (56%)¶™∂c* 2 (3%) 2 (3%)∂ÈÏÂÁÌ¤ÓÔÈ ¶™ (ÂÛÙÈ·ÎÔ›)* 3 (4%) 4 (6%)∂ÈÏÂÁÌ¤ÓÔÈ ¶™(˘ÔÙÚÔ¤˜ ÛÙÔ ›‰ÈÔ ÂÌ‡ÚÂÙÔ)* 12 (18%) 10 (14%)∂ÈÏÂÁÌ¤ÓÔÈ ¶™ (≥15 ÏÂÙ¿ ‰È¿ÚÎÂÈ·)* 1 (2%) 1 (2%)£ÂÚÌÔÎÚ·Û›· ÔÚıÔ‡ (ÔC) 38,5 (37-40oC) 38,8 (37-41oC)µ·ıÌfi˜ ÎÈÓ‰‡ÓÔ˘ ˘ÔÙÚÔ‹˜0-1 (Ã·ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘) 27 (40%) 28 (39%)2 (ªÂÛ·›Ô˘ ÎÈÓ‰‡ÓÔ˘) 20 (29%) 20 (28%)3-5 (À„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘) 21 (31%) 23 (32%)

a ™Â Ì‹ÓÂ˜, b ™‡ÌÊˆÓ· ÌÂ ÙÔ ∂ıÓÈÎfi ¶ÚfiÁÚ·ÌÌ· ∂Ì‚ÔÏÈ·ÛÌÔ‡, c ¶˘ÚÂÙÈÎfi status epilepticus (‰È¿ÚÎÂÈ· >30 ÏÂÙ¿), * ¶·Ú¿ÁÔ-ÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ˘ÔÙÚÔ‹ ÙˆÓ ¶™, fiˆ˜ Û˘˙ËÙ‹ıËÎ·Ó ÛÙÔ “ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ”.

ÙˆÓ ˘ÔÙÚÔÒÓ ÛÙÈ˜ ‰‡Ô ÔÌ¿‰Â˜ ·ÚÔ˘ÛÈ¿ÛÙËÎÂ

ÙÈ˜ ÚÒÙÂ˜ 24 ÒÚÂ˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË ÙÔ˘ ˘ÚÂÙÔ‡.

™˘ÓÔÏÈÎ¿ ÛÙË ‰È¿ÚÎÂÈ· ÙË˜ ÌÂÏ¤ÙË˜ ÛÙËÓ ÔÌ¿‰·

∞ Ô˘ ¤Ï·‚Â ‰È·˙Â¿ÌË, ˘‹Ú¯·Ó 38 ˘ÔÙÚÔ¤˜

Î·È 103 ÛÙËÓ ÔÌ¿‰· µ ÙˆÓ Ì·ÚÙ‡ÚˆÓ. ∆Ô˘˜ ÚÒ-

ÙÔ˘˜ 6 Ì‹ÓÂ˜ ÙË˜ ÌÂÏ¤ÙË˜ ‰ÂÎ·¤ÓÙÂ ·ÛıÂÓÂ›˜ ·fi

ÙËÓ ÔÌ¿‰· ∞ (22%) Î·È ÂÈÎÔÛÈÙ¤ÛÛÂÚÈ˜ ·fi ÙËÓ

ÔÌ¿‰· µ (34%) Â›¯·Ó ÙÔ˘Ï¿¯ÈÛÙÔÓ Ì›· ˘ÔÙÚÔ‹.

∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÚÒÙÔ˘ ¯ÚfiÓÔ˘ ·Ú·ÎÔÏÔ‡-

ıËÛË˜ 20/68 ·È‰È¿ Ô˘ ‹Ú·Ó ÚÔÊ‡Ï·ÍË (29%)

Î·È 33/71 Ô˘ ‰ÂÓ ‹Ú·Ó ÚÔÊ‡Ï·ÍË (46%) ˘Ô-

ÙÚÔ›·Û·Ó. ∆Ú›· ¯ÚfiÓÈ· ÌÂÙ¿ ÙËÓ Ù˘¯·ÈÔÔ›ËÛË, Ë

·ıÚÔÈÛÙÈÎ‹ Û˘¯ÓfiÙËÙ· ÙË˜ ÚÒÙË˜ ˘ÔÙÚÔ‹˜ ÙˆÓ

¶™ ‹Ù·Ó 60% ÛÙËÓ ÔÌ¿‰· ÙˆÓ Ì·ÚÙ‡ÚˆÓ Î·È 35%

ÛÙËÓ ÔÌ¿‰· ÙË˜ ‰È·˙Â¿ÌË˜. ∞˘Ùfi ‰Â›¯ÓÂÈ fiÙÈ ÛË-

ÌÂÈÒıËÎÂ ÌÂ›ˆÛË 25% ÛÙËÓ ÔÌ¿‰· ∞ Ô˘ ¤Ï·‚Â ÙËÓ

ÚÔÊ‡Ï·ÍË (¶›Ó·Î·˜ 3). ™ÙËÓ ÔÌ¿‰· ÙË˜ ‰È·˙Â¿-

ÌË˜ 7/68 ·È‰È¿ Â›¯·Ó Û˘ÓÔÏÈÎ¿ 15 ˘ÔÙÚÔ¤˜,

15/68 Ì›· ˘ÔÙÚÔ‹, ÌfiÓÔ ‰‡Ô ·È‰È¿ Ù¤ÛÛÂÚÈ˜,

ÂÓÒ 44/68 ‰ÂÓ ÂÌÊ¿ÓÈÛ·Ó ˘ÔÙÚÔ‹. ™ÙËÓ ÔÌ¿‰·

Ô˘ ‰ÂÓ ¤Ï·‚Â ÚÔÊ‡Ï·ÍË, 22/71 ·ÛıÂÓÂ›˜ Â›¯·Ó

Û˘ÓÔÏÈÎ¿ 73 ˘ÔÙÚÔ¤˜, 20/71 Ì›· Î·È 1 ·È‰› Â›¯Â

10. ∏ Û˘¯ÓfiÙËÙ· ÙË˜ ˘ÔÙÚÔ‹˜ ÌÂÈˆÓfiÙ·Ó ÌÂ ÙËÓ

·‡ÍËÛË ÙË˜ ËÏÈÎ›·˜ ÙˆÓ ·È‰ÈÒÓ, ÂÈ‰ÈÎfiÙÂÚ· ÌÂÙ¿

ÙÔÓ 2Ô ¯ÚfiÓÔ ÙË˜ ˙ˆ‹˜.

™ÙËÓ ÔÌ¿‰· µ, Ë Û˘¯ÓfiÙËÙ· ˘ÔÙÚÔ‹˜ ÛÙÔ Ù¤-

ÏÔ˜ ÙË˜ ·Ú·ÎÔÏÔ‡ıËÛË˜ ÙˆÓ ÙÚÈÒÓ ¯ÚfiÓˆÓ ‹Ù·Ó

46% ÁÈ· Ù· ¯·ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ·È‰È¿, 55% ÁÈ· Ù·

ÂÓ‰È·Ì¤ÛÔ˘ Î·È 83% ÁÈ· Ù· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ (∂ÈÎfi-

Ó· 1). ∞ÓÙ›ıÂÙ·, ÛÙËÓ ÔÌ¿‰· ∞ Ë Û˘¯ÓfiÙËÙ· ÙË˜

˘ÔÙÚÔ‹˜ ÁÈ· ÙÔ ›‰ÈÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÌÂÈÒıËÎÂ

ÛÂ 33% ÛÙ· ¯·ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘, 35% ÛÙ· ÂÓ‰È·Ì¤ÛÔ˘

Î·È 38% ÛÙ· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ·È‰È¿ (∂ÈÎfiÓ· 2).

ªÂ ÙË ¯Ú‹ÛË ÙË˜ ‰È·˙Â¿ÌË˜ ·Ú·ÙËÚ‹ıËÎÂ ÌÂ›ˆ-

ÛË ÙË˜ Û˘¯ÓfiÙËÙ·˜ ˘ÔÙÚÔ‹˜ Î·Ù¿ 45% ÛÙ· ·È-

‰È¿ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ Î·È ÌfiÓÔ 13% Î·È 20% ·ÓÙ›-

ÛÙÔÈ¯·, ÛÙ· ¯·ÌËÏÔ‡ Î·È ÂÓ‰È¿ÌÂÛÔ˘ ÎÈÓ‰‡ÓÔ˘. ∏

‰È·ÏÂ›Ô˘Û· ÚÔÊ‡Ï·ÍË ÌÂ ‰È·˙Â¿ÌË ÌÂ›ˆÛÂ ÙË

Û˘¯ÓfiÙËÙ· ˘ÔÙÚÔ‹˜ ÛËÌ·ÓÙÈÎ¿ ÛÙ· ˘„ËÏÔ‡ ÎÈÓ-

‰‡ÓÔ˘ ·È‰È¿ (p=0,005, ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ ‰È·-

ÊÔÚ¿), ÂÓÒ ÛÙ· ¯·ÌËÏÔ‡ (p=0,412, ÛÙ·ÙÈÛÙÈÎ¿ ÌË

ÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿) Î·È ÛÙ· ÌÂÛ·›Ô˘ ÎÈÓ‰‡ÓÔ˘

(p=0,341, ÛÙ·ÙÈÛÙÈÎ¿ ÌË ÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿) Â›¯Â

¯·ÌËÏ‹ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· (¶›Ó·Î·˜ 3).

√È ·ÓÂÈı‡ÌËÙÂ˜ ÂÓ¤ÚÁÂÈÂ˜ Ô˘ ·Ú·ÙËÚ‹ıËÎ·Ó

ÛÙËÓ ÔÌ¿‰· ∞ (14%), fiˆ˜ ˘ÓËÏ›· Î·È Â˘ÂÚÂıÈÛÙfi-

ÙËÙ·, ‹Ù·Ó ‹ÈÂ˜ Î·È ·ÚÔ‰ÈÎ¤˜, ÂÓÒ Ì·ÎÚÔÚfiıÂ-

ÛÌÂ˜ ·ÓÂÈı‡ÌËÙÂ˜ ÂÓ¤ÚÁÂÈÂ˜ ‰ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó

ÛÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÙÚÈÒÓ ¯ÚfiÓˆÓ.

¶ÚÔ‚Ï‹Ì·Ù· ÂÏÏÈÔ‡˜ Û˘ÌÌfiÚÊˆÛË˜ ‹ ÂÊ·ÚÌÔ-

Á‹˜ ÙË˜ ÌÂÏ¤ÙË˜ ‰ÂÓ ÛËÌÂÈÒıËÎ·Ó, ‰ÈfiÙÈ ˘‹Ú¯Â Û˘-

¯Ó‹ Â·Ê‹ ÌÂ ÙÔ˘˜ ÁÔÓÂ›˜ ÁÈ· ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙˆÓ

Ô‰ËÁÈÒÓ. ™Â 14 ÂÚÈÙÒÛÂÈ˜ Ë ˘ÔÙÚÔ‹ ÙˆÓ ¶™ Û˘-

Ó¤‚Ë ÌÂ ÙËÓ ¿ÓÔ‰Ô ÙÔ˘ ˘ÚÂÙÔ‡. √È 6 ·fi ·˘Ù¤˜

·Ó‹Î·Ó ÛÂ ·È‰È¿ ÙË˜ ÔÌ¿‰·˜ ∞, ÛÙ· ÔÔ›· ÔÈ ÁÔÓÂ›˜

‰ÂÓ ÚfiÏ·‚·Ó Ó· ¯ÔÚËÁ‹ÛÔ˘Ó ¤ÁÎ·ÈÚ· ÙÔ Ê¿ÚÌ·ÎÔ.

∞fi Ù· ·È‰È¿ ·˘Ù¿ 1 ·Ó‹ÎÂ ÛÙËÓ ˘ÔÔÌ¿‰· ˘„ËÏÔ‡

™˘¯ÓfiÙËÙ· ˘ÔÙÚÔ‹˜ ÛÂ Û¯¤ÛË ÌÂ

ÙÔÓ ‚·ıÌfi ÎÈÓ‰‡ÓÔ˘ ÛÙËÓ ÔÌ¿‰· µ

0 6 12 18 24 30 36

ª‹ÓÂ˜ ÌÂÙ¿ ÙÔ 1Ô ÂÂÈÛfi‰ÈÔ ¶™

™˘

¯Ófi

ÙËÙ·

˘

ÔÙÚ

Ô

‹˜

(%)

Ã·ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘

∂Ó‰È·Ì¤ÛÔ˘ ÎÈÓ‰‡ÓÔ˘

À„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘

0

20

40

60

100

80

∂ÈÎfiÓ· 1. ™˘¯ÓfiÙËÙ· ˘ÔÙÚÔ‹˜ ÛÂ Û¯¤ÛË ÌÂ ÙÔÓ ‚·ıÌfi ÎÈÓ‰‡-ÓÔ˘ ÛÙËÓ ÔÌ¿‰· µ.

¶›Ó·Î·˜ 3. ™‡ÁÎÚÈÛË ÙˆÓ Û˘¯ÓÔÙ‹ÙˆÓ ˘ÔÙÚÔ‹˜ ÛÙ· ·È‰È¿ ¯·ÌËÏÔ‡, ÌÂÛ·›Ô˘ Î·È ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ˘ÔÙÚÔ‹˜ ÙˆÓ ÔÌ¿‰ˆÓ ∞ Î·È µ(·Ú·ÎÔÏÔ‡ıËÛË 3 ¯ÚfiÓˆÓ)

ÀÔÙÚÔ‹ √Ì¿‰· µ √Ì¿‰· ∞ Exact Sig. (2-sided)

Ã·ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ Ÿ¯È 15 18 p=0,412¡·È 13 9 NS

™‡ÓÔÏÔ 28 27ªÂÛ·›Ô˘ ÎÈÓ‰‡ÓÔ˘ Ÿ¯È 9 13 p=0,341

¡·È 11 7 NS™‡ÓÔÏÔ 20 20

À„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ Ÿ¯È 4 13 p=0,005¡·È 19 8 S

™‡ÓÔÏÔ 23 21

NS: ªË ™ËÌ·ÓÙÈÎfi, S: ™ËÌ·ÓÙÈÎfi


¶·È‰È·ÙÚÈÎ‹ 2007;70:42-48

ÎÈÓ‰‡ÓÔ˘, 3 ÛÙËÓ ÂÓ‰È·Ì¤ÛÔ˘ Î·È 2 ÛÙË ¯·ÌËÏÔ‡ ÎÈÓ-

‰‡ÓÔ˘. °È· ÙË ÛˆÛÙfiÙÂÚË ·Ó¿Ï˘ÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿-

ÙˆÓ ÙË˜ ÌÂÏ¤ÙË˜, ÔÈ Û˘ÁÎÂÎÚÈÌ¤ÓÂ˜ ˘ÔÙÚÔ¤˜ ‰ÂÓ

Î·Ù·ÌÂÙÚ‹ıËÎ·Ó. ªÂÙ¿ ÙËÓ ˘ÔÙÚÔ‹ ÔÈ ÁÔÓÂ›˜ ¤Ï·-

‚·Ó Ô‰ËÁ›Â˜ Ó· Û˘ÓÂ¯›ÛÔ˘Ó Î·ÓÔÓÈÎ¿ ÙÔ ÚˆÙfiÎÔÏÏÔ

ÙË˜ ÚÔÊ‡Ï·ÍË˜.

™˘˙‹ÙËÛË

∏ ‰È·ÏÂ›Ô˘Û· ÚÔÊ‡Ï·ÍË ÌÂ ‰È·˙Â¿ÌË ÂÊ·Ú-

ÌfiÛÙËÎÂ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ·fi ÔÏÏÔ‡˜ ÂÚÂ˘ÓË-

Ù¤˜ ÛÙËÓ ∂˘ÚÒË Î·È ÙËÓ π·ˆÓ›· (6,9). ∏ ‰È·˙Â¿-

ÌË ÌÔÚÂ› Ó· ¯ÔÚËÁËıÂ› ·fi ÙÔ ÛÙfiÌ·, ˘ÔÁÏÒÛÛÈ·

Î·È ·fi ÙÔ ÔÚıfi (10,11). ∏ ÚÈÓÈÎ‹ ¯ÔÚ‹ÁËÛË ‰È·˙Â-

¿ÌË˜ ‰ÂÓ ¤¯ÂÈ ¯ÚËÛÈÌÔÔÈËıÂ› ·ÎfiÌË ÁÈ· ÙË ‰È·-

ÏÂ›Ô˘Û· ÚÔÊ‡Ï·ÍË ÙˆÓ ¶™ (12). ™ÙË ÌÂÏ¤ÙË Ì·˜

ÂÈÏ¤Í·ÌÂ ÙË ‰È·˙Â¿ÌË ·fi ÙÔ ÔÚıfi, ÁÈ·Ù› Â›Ó·È Â‡-

ÎÔÏË Ë ¯Ú‹ÛË ÙË˜, ÊÙ¿ÓÂÈ ÁÚ‹ÁÔÚ· ÛÂ ˘„ËÏ¿ ıÂÚ·-

Â˘ÙÈÎ¿ Â›Â‰· ÛÙÔÓ ÔÚfi (<10 ÏÂÙ¿) Î·È Ë Ì¤ÁÈ-

ÛÙË Û˘ÁÎ¤ÓÙÚˆÛ‹ ÙË˜ ÂÈÙ˘Á¯¿ÓÂÙ·È ÛÂ 30 Ì¤¯ÚÈ 60

ÏÂÙ¿ (10). √È Minagawa Î·È Û˘Ó. ÌÂÏ¤ÙËÛ·Ó ÙË

Ê·ÚÌ·ÎÔÎÈÓËÙÈÎ‹ ÙË˜ ‰È·˙Â¿ÌË˜ ·fi ÙÔ ÔÚıfi ÛÂ

Â·Ó·Ï·Ì‚·ÓfiÌÂÓÂ˜ ‰fiÛÂÈ˜. ™Â 6 ‚Ú¤ÊË ÌÂ ÂÌ‡ÚÂ-

ÙË ÏÔ›ÌˆÍË ¯ÔÚ‹ÁËÛ·Ó ‰È·˙Â¿ÌË ÛÂ ‰‡Ô ‰fiÛÂÈ˜

ÙˆÓ 0,5 mg/kg ·fi ÙÔ ÔÚıfi, ÌÂ ÌÂÛÔ‰È¿ÛÙËÌ· 8

ˆÚÒÓ Î·È ¤‰ÂÈÍ·Ó fiÙÈ ÂÈÙÂ‡¯ıËÎ·Ó ıÂÚ·Â˘ÙÈÎ¿

Â›Â‰· ÛÙÔ Ï¿ÛÌ· ÛÂ 30 ÏÂÙ¿ ·fi ÙË ¯ÔÚ‹ÁËÛË

Î·È ‰È·ÙËÚ‹ıËÎ·Ó ÁÈ· 24 ÒÚÂ˜ (13).

∏ ËÏÈÎ›· ¤Ó·ÚÍË˜ ÙË˜ ÌÂÏ¤ÙË˜ Ì·˜, Û‡ÌÊˆÓ· ÌÂ

Ù· ÎÚÈÙ‹ÚÈ·, Î˘Ì·ÈÓfiÙ·Ó ·fi 6 Ì‹ÓÂ˜ ¤ˆ˜ 3 ¯ÚfiÓÈ·

ÎÈ ·˘Ùfi ÁÈ·Ù› ÙÔ 90% ÂÚ›Ô˘ ÙˆÓ ·È‰ÈÒÓ Ô˘ ÂÌ-

Ê·Ó›˙Ô˘Ó ¶™ Â›Ó·È Î¿Ùˆ ÙˆÓ 3 ÂÙÒÓ. ∞˘Ùfi ÛËÌ·›ÓÂÈ

fiÙÈ ·È‰È¿ Ô˘ ¤¯Ô˘Ó ÙÔ ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ¶™ ÛÂ ÌÈ-

ÎÚ‹ ËÏÈÎ›·, ¤¯Ô˘Ó ÂÚÈÛÛfiÙÂÚÔ ¯ÚfiÓÔ ÁÈ· Ó· ÂÌÊ·-

Ó›ÛÔ˘Ó ˘ÔÙÚÔ‹ ÛÂ Û¯¤ÛË ÌÂ Ù· ÌÂÁ·Ï‡ÙÂÚË˜ ËÏÈ-

Î›·˜. √È Offringa Î·È Û˘Ó. (1994) ÛÂ ÌÈ· ÌÂÙ·-·Ó¿Ï˘-

ÛË 5 ÌÂÏÂÙÒÓ ·Û¯ÔÏ‹ıËÎ·Ó ÌÂ ÙÔÓ Î›Ó‰˘ÓÔ ˘ÔÙÚÔ-

‹˜ ÛÂ Û¯¤ÛË ÌÂ ÙËÓ ËÏÈÎ›· ¤Ó·ÚÍË˜ Î·È ‚Ú‹Î·Ó ˆ˜

ÔÈ ¶™ ÂÏ·ÙÙÒÓÔÓÙ·Ó Û˘ÓÂ¯Ò˜ ÌÂ ÙËÓ ¿ÚÔ‰Ô ÙË˜

ËÏÈÎ›·˜ ·fi 12 ¤ˆ˜ 42 ÌËÓÒÓ (14).

∞fi ÙË ‚È‚ÏÈÔÁÚ·Ê›· ÁÓˆÚ›˙Ô˘ÌÂ, fiÙÈ Ô Î›Ó‰˘ÓÔ˜

ÂÌÊ¿ÓÈÛË˜ ˘ÔÙÚÔ‹˜ ÙˆÓ ¶™ ÙÔÓ ÚÒÙÔ ¯ÚfiÓÔ Î˘-

Ì·›ÓÂÙ·È ÌÂÙ·Í‡ 29 Î·È 42,5%, Î·Ù¿ Ì¤ÛÔÓ fiÚÔ 35%

(15). ∏ ‰ÈÎ‹ Ì·˜ ÌÂÏ¤ÙË ¤‰ÂÈÍÂ ˆ˜ Ë Û˘ÓÔÏÈÎ‹ Û˘-

¯ÓfiÙËÙ· ˘ÔÙÚÔÒÓ ÛÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÙÚÈÒÓ ¯ÚfiÓˆÓ

‹Ù·Ó 60% ÛÙËÓ ÔÌ¿‰· Ô˘ ‰ÂÓ ¯ÔÚËÁ‹ıËÎÂ ‰È·˙Â¿-

ÌË Î·È 35% ÛÙËÓ ÔÌ¿‰· Ô˘ ¤Ï·‚Â ÙÔ Ê¿ÚÌ·ÎÔ. ∫·-

Ù¿ ÙË ÁÓÒÌË Ì·˜ ÔÈ ˘„ËÏÔ› ·ÚÈıÌÔ› ˘ÔÙÚÔ‹˜ Ô˘

‚Ú‹Î·ÌÂ Î·È ÛÙÈ˜ ‰‡Ô ÔÌ¿‰Â˜ ÔÊÂ›ÏÔÓÙ·È ÛÂ ‰‡Ô Ïfi-

ÁÔ˘˜: ·) ÛÙË ÌÂÁ¿ÏË ‰È¿ÚÎÂÈ· ·Ú·ÎÔÏÔ‡ıËÛË˜ (3

¯ÚfiÓÈ·) ÌÂ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·‡ÍËÛË ÙË˜ Èı·ÓfiÙËÙ·˜

ÂÌÊ¿ÓÈÛË˜ ˘ÔÙÚÔÒÓ Î·È ‚) ÛÙË ÌÈÎÚ‹ ËÏÈÎ›· ¤Ó·Ú-

ÍË˜ ÙˆÓ ¶™ (<15 ÌËÓÒÓ) ÛÙÔ 60% ÂÚ›Ô˘ ÙˆÓ ·È-

‰ÈÒÓ ÛÂ Î¿ıÂ ÔÌ¿‰·. ™ÙÈ˜ ¿ÏÏÂ˜ ÌÂÏ¤ÙÂ˜ ÙË˜ ‚È‚ÏÈÔ-

ÁÚ·Ê›·˜ ÙÔ ÔÛÔÛÙfi ÙˆÓ ·È‰ÈÒÓ ÌÂ ËÏÈÎ›· Î¿Ùˆ ÙˆÓ

15 ÌËÓÒÓ ‰ÂÓ ‹Ù·Ó ÛÂ Î·Ì›· ÂÚ›ÙˆÛË ÙfiÛÔ ˘„ËÏfi

(11,12,14). √È ÂÚÈÛÛfiÙÂÚÂ˜ ÌÂÏ¤ÙÂ˜, Û˘ÌÂÚÈÏ·Ì‚·-

ÓÔÌ¤ÓË˜ Î·È ÙË˜ ‰ÈÎ‹˜ Ì·˜, Û˘ÌÊˆÓÔ‡Ó fiÙÈ Ë ÌÈÎÚ‹

ËÏÈÎ›· ¤Ó·ÚÍË˜ Â›Ó·È Ô ÈÔ ÛËÌ·ÓÙÈÎfi˜ ÚÔÁÓˆÛÙÈÎfi˜

·Ú¿ÁÔÓÙ·˜ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ˘ÔÙÚÔÒÓ (16-18).

°È· Ó· ÂÎÙÈÌ‹ÛÔ˘ÌÂ ÙÔÓ Î›Ó‰˘ÓÔ ˘ÔÙÚÔ‹˜ Î·-

Ï‡ÙÂÚ·, ˘ÈÔıÂÙ‹Û·ÌÂ ¤Ó·Ó ÚÔÁÓˆÛÙÈÎfi ‰Â›ÎÙË ‚·ÛÈ-

ÛÌ¤ÓÔ ÛÂ ¤ÓÙÂ ·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘. °È· Ú·ÎÙÈ-

ÎÔ‡˜ ÏfiÁÔ˘˜ fiÏÔÈ ÔÈ ·Ú¿ÁÔÓÙÂ˜ ıÂˆÚ‹ıËÎ·Ó ˆ˜

¤¯Ô˘Ó ÙËÓ ›‰È· ÚÔÁÓˆÛÙÈÎ‹ ·Í›·. ∞ÏÏ¿ Î·È ÁÂÓÂÙÈÎÔ›

Î·È ÎÔÈÓˆÓÈÎÔ-ÔÈÎÔÓÔÌÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ ÌÔÚÔ‡Ó Â›-

ÛË˜ Ó· ÂËÚÂ¿ÛÔ˘Ó ÙÔÓ Ù‡Ô, ÙÔÓ ·ÚÈıÌfi, ÙËÓ ·ÏÏË-

ÏÂ›‰Ú·ÛË Î·È ÙËÓ ÈÛ¯‡ ÙˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘. ∏

ÌÂÏ¤ÙË Ì·˜ ‰Â›¯ÓÂÈ fiÙÈ Ë ÚÔÊ‡Ï·ÍË ÌÂ ‰È·˙Â¿ÌË

Â› ˘ÚÂÙÔ‡ ÚÔÛÊ¤ÚÂÈ ÈÎ·ÓÔÔÈËÙÈÎfi ¤ÏÂÁ¯Ô ÙˆÓ

˘ÔÙÚÔÒÓ ÛÙ· ·È‰È¿ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ Î·È fi¯È ÛÙ·

·È‰È¿ ÌÂ ¯·ÌËÏfi ‹ ÌÂÛ·›Ô Î›Ó‰˘ÓÔ ˘ÔÙÚÔ‹˜. ∆·

·ÔÙÂÏ¤ÛÌ·Ù¿ Ì·˜ ÂÈ‚Â‚·ÈÒÓÔ˘Ó ÙË ÌÂÏ¤ÙË ÙÔ˘

Knudsen (1985b), Ô ÔÔ›Ô˜ ÌÂ ÙÔ ›‰ÈÔ ÚÔÊ›Ï ÂÈÎÈÓ-

‰˘ÓfiÙËÙ·˜, ˘ÔÏfiÁÈÛÂ ÙË Û˘¯ÓfiÙËÙ· ˘ÔÙÚÔ‹˜ ÙˆÓ

¶™ ÛÂ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· 18 ÌËÓÒÓ. ÃÔÚ‹ÁËÛÂ ‰È·˙Â-

¿ÌË ·fi ÙÔ ÔÚıfi 0,5 mg/kg ÛÂ ‰‡Ô ‰fiÛÂÈ˜ ÛÙË ‰È¿Ú-

ÎÂÈ· ÂÌ˘Ú¤ÙÔ˘ ÓÔÛ‹Ì·ÙÔ˜, Ì¤¯ÚÈ Ô ˘ÚÂÙfi˜ Ó· ¤-

ÛÂÈ Î¿Ùˆ ·fi 38,5ÔC. ∆· Û˘ÌÂÚ¿ÛÌ·Ù· ÙË˜ ÌÂÏ¤ÙË˜

¤‰ÂÈÍ·Ó fiÙÈ Ë ‰È·ÏÂ›Ô˘Û· ¯ÔÚ‹ÁËÛË ‰È·˙Â¿ÌË˜ Â›-

Ó·È ·Ó·ÔÙÂÏÂÛÌ·ÙÈÎ‹ ÛÙ· ÔÏ‡ ¯·ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘

·È‰È¿ (Î·Ó¤Ó·˜ ·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘), ¤¯ÂÈ Ì¤ÙÚÈ·

·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÛÙ· ÌÂÛ·›Ô˘ ÎÈÓ‰‡ÓÔ˘ Î·È Â›Ó·È

ÂÍ·ÈÚÂÙÈÎ¿ ·ÔÙÂÏÂÛÌ·ÙÈÎ‹ ÛÙ· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘.

™˘ÁÎÂÎÚÈÌ¤Ó·, ÛÙËÓ ÔÌ¿‰· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ‚Ú‹ÎÂ

fiÙÈ Ë Û˘¯ÓfiÙËÙ· ˘ÔÙÚÔ‹˜ ÌÂÈÒıËÎÂ ·fi 75-100%

ÛÂ 10-15% ÌÂ ÙËÓ ÚÔÊ‡Ï·ÍË (17).

46 ∂. ¶·˘Ï›‰Ô˘ Î·È Û˘Ó.


™˘¯ÓfiÙËÙ· ˘ÔÙÚÔ‹˜ ÛÂ Û¯¤ÛË ÌÂ

ÙÔÓ ‚·ıÌfi ÎÈÓ‰‡ÓÔ˘ ÛÙËÓ ÔÌ¿‰· ∞

0 6 12 18 24 30 36

ª‹ÓÂ˜ ÌÂÙ¿ ÙÔ 1Ô ÂÂÈÛfi‰ÈÔ ¶™

™˘

¯Ófi

ÙËÙ·

˘

ÔÙÚ

Ô

‹˜

(%)

Ã·ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘

∂Ó‰È·Ì¤ÛÔ˘ ÎÈÓ‰‡ÓÔ˘

À„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘

0

20

40

60

80

100

∂ÈÎfiÓ· 2. ™˘¯ÓfiÙËÙ· ˘ÔÙÚÔ‹˜ ÛÂ Û¯¤ÛË ÌÂ ÙÔÓ ‚·ıÌfi ÎÈÓ‰‡-ÓÔ˘ ÛÙËÓ ÔÌ¿‰· ∞.

∏ ‰ÈÎ‹ Ì·˜ ÌÂÏ¤ÙË ¤¯ÂÈ ÌÂÁ·Ï‡ÙÂÚÔ ¯ÚfiÓÔ ·Ú·-

ÎÔÏÔ‡ıËÛË˜ (36 Ì‹ÓÂ˜ ·ÓÙ› 18) Î·È ·ÓÂÈı‡ÌËÙÂ˜

ÂÓ¤ÚÁÂÈÂ˜ ·Ú·ÙËÚ‹ıËÎ·Ó ÛÂ ÌÈÎÚfiÙÂÚÔ ÔÛÔÛÙfi,

ÏfiÁˆ ÙË˜ ¯ÔÚ‹ÁËÛË˜ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ÌfiÓÔ ÁÈ· ‰‡Ô

ËÌ¤ÚÂ˜ (3 ‰fiÛÂÈ˜ ÙËÓ ÚÒÙË ËÌ¤Ú· Î·È 2 ÙË ‰Â‡ÙÂ-

ÚË) ÛÙË ‰È¿ÚÎÂÈ· ÙË˜ ÂÌ‡ÚÂÙË˜ ÏÔ›ÌˆÍË˜. ™ÙÔ ›‰ÈÔ

Û˘Ì¤Ú·ÛÌ· Ô‰ËÁ‹ıËÎ·Ó Î·È ÔÈ Û˘ÁÁÚ·ÊÂ›˜ ÙË˜ ·-

Ú·¿Óˆ ÌÂÏ¤ÙË˜ (Knudsen, 1985b), ÔÈ ÔÔ›ÔÈ ¿ÏÏ·-

Í·Ó ÙÔ Û¯‹Ì· ÚÔÊ‡Ï·ÍË˜ ÛÂ Ù¤ÛÛÂÚÈ˜ ‰fiÛÂÈ˜.

∞fi ÙËÓ ¿ÏÏË ÌÂÚÈ¿, ·ÓÙÈÎÚÔ˘fiÌÂÓ· ·ÔÙÂÏ¤-

ÛÌ·Ù· ÚÔÎ‡ÙÔ˘Ó ·fi ÙÈ˜ ÌÂÏ¤ÙÂ˜ ÙˆÓ Uhari Î·È

Û˘Ó. (1995) Î·È ÙˆÓ Autret Î·È Û˘Ó. (1990), ÙˆÓ ÔÔ›-

ˆÓ ÔÈ ¤ÚÂ˘ÓÂ˜ ¤‰ÂÈÍ·Ó ˆ˜ ‰ÂÓ ÂÈÙÂ‡¯ıËÎÂ ÛËÌ·ÓÙÈ-

Îfi˜ ¤ÏÂÁ¯Ô˜ ÙˆÓ ÎÚ›ÛÂˆÓ (11,19). ŸÌˆ˜, ÛÙË ÌÂÏ¤ÙË

ÙˆÓ Uhari Î·È Û˘Ó. (1995) Ê·›ÓÂÙ·È fiÙÈ Ë ¯·ÌËÏ‹ ‰fi-

ÛË ÙË˜ ‰È·˙Â¿ÌË˜, ·Ú¯ÈÎ¿ ·fi ÙÔ ÔÚıfi Î·È ·ÎÔÏÔ‡-

ıˆ˜ ·fi ÙÔ ÛÙfiÌ· (0,2 mg/kg ÙÚÂÈ˜ ÊÔÚ¤˜/ËÌ¤Ú·)

‹Ù·Ó ˘Â‡ı˘ÓË ÁÈ· ÙËÓ ¤ÏÏÂÈ„Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙË-

Ù·˜. ∏ ÌÂÏ¤ÙË ÙˆÓ Autret Î·È Û˘Ó. (1990) ·ÚÔ˘Û›·˙Â

ÛÔ‚·Ú¿ ÚÔ‚Ï‹Ì·Ù· Û˘ÌÌfiÚÊˆÛË˜ ÛÙÔ Û¯‹Ì· ÚÔ-

Ê‡Ï·ÍË˜, ·ÊÔ‡ ÌfiÓÔ ¤Ó· ÛÙ· 15 ·È‰È¿ ÌÂ ˘ÔÙÚÔ‹

¤Ï·‚·Ó ÙË ‰È·˙Â¿ÌË Û‡ÌÊˆÓ· ÌÂ ÙÈ˜ Ô‰ËÁ›Â˜. ™Â ÌÈ·

ÚfiÛÊ·ÙË ÌÂÏ¤ÙË ÙˆÓ Okumura Î·È Û˘Ó. (2004) ‰ÈÂ-

ÚÂ˘Ó‹ıËÎÂ Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙË˜ ÚÔÊ˘Ï·ÎÙÈ-

Î‹˜ ·ÁˆÁ‹˜ ÛÂ ·È‰È¿ ÌÂ ¶™, ÛÙ· ÔÔ›· ÙÔ ∏∂° Î·-

Ù¤ÁÚ·„Â ÂÈÏËÙÈÎ‹ ‰Ú·ÛÙËÚÈfiÙËÙ·. ∆· ·ÔÙÂÏ¤-

ÛÌ·Ù· ÙË˜ ÌÂÏ¤ÙË˜ ÙÔ˘˜ ¤‰ÂÈÍ·Ó ˆ˜ Ë ‰È·ÏÂ›Ô˘Û·

ÚÔÊ‡Ï·ÍË ÌÂ ‰È·˙Â¿ÌË ‰ÂÓ Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈÎ‹

ÛÙË ÌÂ›ˆÛË ÙË˜ Û˘¯ÓfiÙËÙ·˜ ˘ÔÙÚÔÒÓ ÙˆÓ ¶™.

øÛÙfiÛÔ, Ô ·ÚÈıÌfi˜ ÙˆÓ ·È‰ÈÒÓ Ô˘ ÌÂÏ¤ÙËÛ·Ó ‰ÂÓ

‹Ù·Ó ÈÎ·ÓÔÔÈËÙÈÎ¿ ÌÂÁ¿ÏÔ˜ (10/43 ¤Ï·‚·Ó ‰È·ÏÂ›-

Ô˘Û· ÚÔÊ‡Ï·ÍË ‰È·˙Â¿ÌË˜), Ô‡ÙÂ ·Ó·Ê¤ÚÔ˘Ó ÙÔ

Û¯‹Ì· ¯ÔÚ‹ÁËÛË˜ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ (20).

™Â ¿ÏÏÂ˜ ÌÂÏ¤ÙÂ˜ Ê¿ÓËÎÂ fiÙÈ Ë ‰È·ÏÂ›Ô˘Û· ¯Ô-

Ú‹ÁËÛË ‰È·˙Â¿ÌË˜ ·fi ÙÔ ÛÙfiÌ· ÌÂÈÒÓÂÈ ÛËÌ·ÓÙÈ-

Î¿ ÙÔ ÔÛÔÛÙfi ˘ÔÙÚÔÒÓ (21,22). ™ÙÈ˜ ÌÂÏ¤ÙÂ˜ ·˘-

Ù¤˜ Î·Ù·ÁÚ¿ÊËÎ·Ó ÔÈ ›‰ÈÂ˜ ·ÚÂÓ¤ÚÁÂÈÂ˜, fiˆ˜

ÛÙÔ˘˜ ‰ÈÎÔ‡˜ Ì·˜ ·ÛıÂÓÂ›˜, ·ÏÏ¿ ÛÂ ÌÂÁ·Ï‡ÙÂÚÔ Ô-

ÛÔÛÙfi. ∞˘Ùfi ÌÔÚÂ› Ó· ÔÊÂ›ÏÂÙ·È ÛÙË ÌÂÁ·Ï‡ÙÂÚË

‰È¿ÚÎÂÈ· ¯ÔÚ‹ÁËÛË˜ ‰È·˙Â¿ÌË˜. √È ·ÓÂÈı‡ÌËÙÂ˜

ÂÓ¤ÚÁÂÈÂ˜ ÛÙË ‰ÈÎ‹ Ì·˜ ¤ÚÂ˘Ó· ‹Ù·Ó ‹ÈÂ˜, ·ÚÔ‰È-

Î¤˜ Î·È ÛÂ Î·Ì›· ÂÚ›ÙˆÛË ‰ÂÓ ‹Ù·Ó ÛÔ‚·Ú¤˜.

ÕÏÏÔÈ Û˘ÁÁÚ·ÊÂ›˜ ÚÔ‚ÏËÌ·Ù›˙ÔÓÙ·È ÌÂ ÙËÓ

ÚÔÊ˘Ï·ÎÙÈÎ‹ ¯ÔÚ‹ÁËÛË ‰È·˙Â¿ÌË˜, ÂÂÈ‰‹ ÊÔ-

‚Ô‡ÓÙ·È Ì‹ˆ˜ ÙÔ˘˜ ‰È·Ê‡ÁÂÈ Ë ‰È¿ÁÓˆÛË ÛÔ‚·Ú‹˜

˘ÔÎÂ›ÌÂÓË˜ ÓfiÛÔ˘ (.¯. ÌËÓÈÁÁ›ÙÈ‰·˜ ‹ ÂÁÎÂÊ·Ï›-

ÙÈ‰·˜) (5,23). ŸÛÔÓ ·ÊÔÚ¿ fiÌˆ˜, ÛÙ· ·È‰È¿ ËÏÈ-

Î›·˜ Î¿Ùˆ ÙˆÓ 18 ÌËÓÒÓ ÌÂ ¶™, ÛÙË ‰È·ÁÓˆÛÙÈÎ‹

Ì·˜ ÛÎ¤„Ë Ì·›ÓÂÈ ·˘ÙÔÌ¿Ùˆ˜ Î·È Ë Èı·Ó‹ ÏÔ›Ìˆ-

ÍË ÙÔ˘ ∫¡™. ™Â ‡ÔÙÂ˜ ÂÚÈÙÒÛÂÈ˜ Á›ÓÂÙ·È Î·Ù¿

Î·ÓfiÓ· ÔÛÊ˘ÔÓˆÙÈ·›· ·Ú·Î¤ÓÙËÛË (√¡¶). ™ÙË

ÌÂÏ¤ÙË Ì·˜ ¤ÁÈÓÂ √¡¶ ÛÂ ‰¤Î· ·È‰È¿ ÁÈ· ‰È·ÁÓˆ-

ÛÙÈÎÔ‡˜ ÏfiÁÔ˘˜ Î·È ‹Ù·Ó fiÏÂ˜ ·ÚÓËÙÈÎ¤˜.

∆· Î‡ÚÈ· ÂÚˆÙ‹Ì·Ù· Ô˘ ÚÔ‚ÏËÌ·Ù›˙Ô˘Ó ÙÔ˘˜

ÂÚÈÛÛfiÙÂÚÔ˘˜ ÂÚÂ˘ÓËÙ¤˜ Â›Ó·È Î·Ù¿ fiÛÔÓ ÔÈ ¶™

ÌÔÚÔ‡Ó Ó· ‚Ï¿„Ô˘Ó ÙÔÓ ÂÁÎ¤Ê·ÏÔ, Î·È È‰›ˆ˜ ÙÔÓ

·ÓÒÚÈÌÔ, ‹ ·ÎfiÌË Î·È Ó· ÚÔÎ·Ï¤ÛÔ˘Ó ı¿Ó·ÙÔ ÙˆÓ

ÓÂ˘ÚÈÎÒÓ Î˘ÙÙ¿ÚˆÓ Î·È ˆ˜ ÂÎ ÙÔ‡ÙÔ˘ ÂÈ‚¿ÏÏÂÙ·È Ë

ÚfiÏË„‹ ÙÔ˘˜ (24,25). ∞ÓÙ›ıÂÙÂ˜ ÚÔ˜ ·˘Ù‹Ó ÙËÓ

¿Ô„Ë Â›Ó·È ÔÈ ÌÂÏ¤ÙÂ˜ ÙˆÓ Verity Î·È Û˘Ó. (1991,

1998) (26,27). √È Morell Î·È Û˘Ó. ÛÂ ÂÈÚ·Ì·ÙÈÎfi ÌÔ-

ÓÙ¤ÏÔ ¤‰ÂÈÍ·Ó ˆ˜ ÔÈ Û·ÛÌÔ› (Î¿Ùˆ ·fi Û˘Óı‹ÎÂ˜

˘ÚÂÙÔ‡) Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÚÔÎ·Ï¤ÛÔ˘Ó ·˘ÍËÌ¤ÓË

Â˘·ÈÛıËÛ›· ÛÙË Á¤ÓÂÛË ÙˆÓ Û·ÛÌÒÓ ÂÓÂÚÁÔÔÈÒ-

ÓÙ·˜ ÌË¯·ÓÈÛÌÔ‡˜ ÛÙÔÓ ÂÁÎ¤Ê·ÏÔ (28).

ªÂÏ¤ÙÂ˜ ·Ó·Ê¤ÚÔ˘Ó fiÙÈ ÔÈ ˘ÔÙÚÔÈ¿˙ÔÓÙÂ˜

Û·ÛÌÔ› Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ·˘ÍËÌ¤ÓÔ Î›Ó‰˘ÓÔ Â·Îfi-

ÏÔ˘ıË˜ ÂÈÏË„›·˜ (24,25). ∞ÓÙ›ıÂÙ· ÔÈ Berg Î·È

Shinnar (1994a) ¤‰ÂÈÍ·Ó ˆ˜ Ô Î›Ó‰˘ÓÔ˜ Î·Ù¿ÏËÍË˜

ÛÂ ÂÈÏË„›· ÛÂ ·È‰È¿ ÌÂÙ¿ ·fi ¶™ Â›Ó·È ¯·ÌËÏfi˜

(29). ÕÏÏÔÈ ¿ÏÈ ·Ó·Ê¤ÚÔÓÙ·È ÛÂ ÌÂÁ·Ï‡ÙÂÚ· ÔÛÔ-

ÛÙ¿ ÂÌÊ¿ÓÈÛË˜ ÂÈÏË„›·˜ ÛÂ ·È‰È¿ ÌÂ ˘„ËÏfi Î›Ó-

‰˘ÓÔ ˘ÔÙÚÔ‹˜ ÙˆÓ ¶™. ¶ÈÔ ·Ó·Ï˘ÙÈÎ¿ ÙÔÓ›˙Ô˘Ó

ˆ˜ Ù· ˘ÔÙÚÔÈ¿˙ÔÓÙ· ÂÂÈÛfi‰È· ¶™ ·ÔÙÂÏÔ‡Ó

ÛËÌ·ÓÙÈÎfi ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ Â·ÎfiÏÔ˘-

ıË ÂÌÊ¿ÓÈÛË ÂÈÏË„›·˜. ∏ Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛË˜

ÂÈÏË„›·˜ ÛÙ· ·È‰È¿ ÌÂ ¤Ó· ·Ïfi ÂÂÈÛfi‰ÈÔ ¶™ Î·È

¯ˆÚ›˜ Î·Ó¤Ó·Ó ¿ÏÏÔ ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ˘ÔÏÔÁ›-

ÛÙËÎÂ ÂÚ›Ô˘ ÛÂ 1%, ÂÓÒ ÛÙ· ·È‰È¿ ÌÂ Ù¤ÛÛÂÚ· ‹

ÂÚÈÛÛfiÙÂÚ· ÂÂÈÛfi‰È· ¶™ ÛÙÔ ÈÛÙÔÚÈÎfi ÙÔ˘˜ Ô Î›Ó-

‰˘ÓÔ˜ ·˘Ùfi˜ ·Ó¤Ú¯ÂÙ·È ÛÂ 4% (19,25,30,31).

°ÂÓÈÎ¿, ÔÈ ÁÈ·ÙÚÔ› ı· Ú¤ÂÈ Ó· Î·ıËÛ˘¯¿˙Ô˘Ó

ÙÔ˘˜ ÁÔÓÂ›˜ Î·È Ó· ÙÔ˘˜ ‰È·‚Â‚·ÈÒÓÔ˘Ó ÁÈ· ÙËÓ Î·-

Ï‹ ÔÚÂ›· ÙˆÓ ¶™. ™‡ÌÊˆÓ· ÌÂ ÌÈ· ÚfiÛÊ·ÙË

¤ÚÂ˘Ó·, Ë ÛˆÛÙ‹ ÂÓËÌ¤ÚˆÛË ÙˆÓ ÁÔÓÈÒÓ ÙÔ‡˜ ÂÌ„˘-

¯ÒÓÂÈ Î·È ÌÂÈÒÓÂÈ ÙÔ ¿Á¯Ô˜ ÙÔ˘˜ (32). ∫·Ù¿ ÙËÓ ¿Ô-

„‹ Ì·˜, Ë Î·Ù·ÏÏËÏfiÙÂÚË ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ¶™ Â-

ÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ÚfiÏË„Ë ÙˆÓ ˘ÔÙÚÔÒÓ ÌfiÓÔ

ÛÙÔ˘˜ ÏËı˘ÛÌÔ‡˜ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘. ∞˘Ùfi ÌÔÚÂ›

Ó· Á›ÓÂÈ ·ÔÙÂÏÂÛÌ·ÙÈÎ¿ ÌÂ ÙË ‰È·ÏÂ›Ô˘Û· ¯ÔÚ‹-

ÁËÛË ‰È·˙Â¿ÌË˜ ·fi ÙÔ ÔÚıfi, ·ÚÎÂ› Ó· ‰›ÓÂÙ·È

¤ÁÎ·ÈÚ· Î·È ÛˆÛÙ¿ ÛÙËÓ ¤Ó·ÚÍË ÙÔ˘ ˘ÚÂÙÔ‡.


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3. Hirose S, Mitsudome A, Okada M, Kaneko S; Epilepsy Ge-

netic Study Group Japan. Genetic of idiopathic epilepsies.

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4. Winawer M, Hesdorffer D. Turning on the heat: the search

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5. American Academy of Pediatrics. Practice parameter:

Long-term treatment of the child with simple febrile

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6. Pavlidou E, Tzitiridou M, Panteliadis C. Effectiveness of

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8. National Institutes of Health. Febrile Seizures: Consensusdevelopment conference summary. National Institutes ofHealth 1980;3. Webpage: http://consensus.nih.gov/PREVIOUSSTATEMENTS.htm

9. Aksu F, Tzitiridou M. Febrile Seizures. In: Panteliadis C andKorinthenberg R, editors. Paediatric Neurology. 3rd edi-tion. Stuttgart: Thieme International; 2005. p. 523.

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13. Minagawa K, Miura H, Mizuno S, Shirai H. Pharmacoki-netics of rectal diazepam in the prevention of recurrentfebrile convulsions. Brain Dev 1986;8:53-59.

14. Offringa M, Bossuyt P, Lubsen J, Ellenberg JH, Nelson KB,Knudsen FU, et al. Risk factors for seizure recurrence in chil-dren with febrile seizures: A pooled analysis of individual pa-tient data from five studies. J Pediatr 1994;124:574-584.

15. Berg A. Recurrent febrile seizures. In: Baram T and ShlomoS, editors. Febrile Seizures. 1st edition. California: Academ-ic Press; 2002. p.37.

16. Pavlidou E, Tzitiridou M, Kontopoulos E, Panteliadis C.Modified Prognostic Factors for Febrile Seizure Recur-rences. European Journal of Paediatric Neurology 2005;3-4:203-204.

17. Knudsen FU. Recurrence risk after first febrile seizure andeffect of short term diazepam prophylaxis. Arch Dis Child1985;60:1045-1049.

18. Van Stuijvenberg M, Steyerberg E, Derksen-Lubsen G, MollH. Temperature, age and recurrence of febrile seizure. ArchPediatr Adolesc Med 1998;152:1170-1175.

19. Autret E, Billard C, Bertrand P, Motte J, Pouplard E,Jonville AP. Double-blind randomized trial of diazepamversus placebo for prevention of recurrence of febrileseizures. J Pediatr 1990;117:440-494.

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23. Waruiru C, Appleton R. Febrile Seizures: an update. ArchDis Child 2004;84:751-756.

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48 ∂. ¶·˘Ï›‰Ô˘ Î·È Û˘Ó.


49∂¡¢π∞º∂ƒ√À™∞ ¶∂ƒπ¶∆ø™∏ CASE REPORT

¶·È‰È·ÙÚÈÎ‹ 2007;70:49-53

ÀÔ¯ÔÓ‰ÚÔÏ·Û›· ÌÂ ÌÂÙ¿ÏÏ·ÍË ¡540∫ ÛÙÔÓ ˘Ô‰Ô¯¤· 3

ÙÔ˘ ·˘ÍËÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ÙˆÓ ÈÓÔ‚Ï·ÛÙÒÓ - FGFR3.


µ. ∞ÁÁÂÏ¿ÎÔ˘, °. ¡ÈˆÙ¿ÎË˜, ™. ∏Ï›·, ™. ª¿ÎˆÛË, ∂. ∫fiÎÔÚË

¶ÂÚ›ÏË„Ë: ∏ ˘Ô¯ÔÓ‰ÚÔÏ·Û›· (ªπª 146000) Â›Ó·È ·˘ÙÔÛˆÌ·ÙÈÎ‹ ÂÈÎÚ·ÙËÙÈÎ‹ ÛÎÂÏÂÙÈÎ‹ ‰˘ÛÏ·-Û›· ÌÂ Û˘¯ÓfiÙËÙ· 1:30.000 ÛÙÔÓ ÁÂÓÈÎfi ÏËı˘ÛÌfi. ™˘¯Ó¿, ÔÏÏ¤˜ ÂÚÈÙÒÛÂÈ˜ ‰È·ÊÂ‡ÁÔ˘Ó ÙË˜ ‰È¿-ÁÓˆÛË˜ ‹ ıÂˆÚÔ‡ÓÙ·È Ï·Óı·ÛÌ¤Ó· ˆ˜ ÂÚÈÙÒÛÂÈ˜ ÔÈÎÔÁÂÓÔ‡˜ ‚Ú·¯˘ÛˆÌ›·˜, ÂÂÈ‰‹ ÔÈ ÎÏÈÓÈÎ¤˜ ÂÎ‰Ë-ÏÒÛÂÈ˜ Â›Ó·È ‹ÈÂ˜. ∏ ‰È¿ÁÓˆÛË ÌÔÚÂ› Ó· Á›ÓÂÈ Î·ı˘ÛÙÂÚËÌ¤Ó· (ÛÙ· 2-4 ¯ÚfiÓÈ·), fiÙ·Ó ‰È·ÈÛÙÒÓÂÙ·ÈfiÙÈ ÙÔ ·È‰› ÛÙ·ıÂÚ¿ ‚Ú›ÛÎÂÙ·È Î¿Ùˆ ·fi ÙËÓ 3Ë ∂.£., ÂÓÒ Ë ÚÔÛÂÎÙÈÎ‹ ·ÓÙÈÎÂÈÌÂÓÈÎ‹ ÂÍ¤Ù·ÛË ·ÔÎ·-Ï‡ÙÂÈ ÙË ÚÈ˙ÔÌÂÏÈÎ‹ ‚Ú¿¯˘ÓÛË ÙˆÓ ¿ÎÚˆÓ. ™Ù· ÎÏÈÓÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ‹È· ‚Ú·¯˘-ÛˆÌ›·, ÎÔÓÙ¿ ¿ÎÚ·, ÏfiÚ‰ˆÛË ÙË˜ ÔÛÊ˘˚Î‹˜ ÌÔ›Ú·˜ ÙË˜ ÛÔÓ‰˘ÏÈÎ‹˜ ÛÙ‹ÏË˜, ÎÔÓÙ¤˜ Î·È Ï·ÙÂÈ¤˜ ·Ï¿-ÌÂ˜ Î·È ¤ÏÌ·Ù·, ÚÔ¤¯ÔÓ Ì¤ÙˆÔ Î·È ·Ô‡Û· ‹ ‹È· Ì·ÎÚÔÎÂÊ·Ï›·. ¶ÚfiÛÊ·Ù· ‚Ú¤ıËÎÂ fiÙÈ ÛÙÔ 70%ÂÚ›Ô˘ ÙˆÓ ·ÛıÂÓÒÓ ÌÂ ˘Ô¯ÔÓ‰ÚÔÏ·Û›· ˘¿Ú¯ÂÈ ÌÂÙ¿ÏÏ·ÍË ÛÙÔ ÁÔÓ›‰ÈÔ ÙÔ˘ ˘Ô‰Ô¯¤· 3 ÙÔ˘ ·˘-ÍËÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ÙˆÓ ÈÓÔ‚Ï·ÛÙÒÓ (FGFR3), Ô˘ ‚Ú›ÛÎÂÙ·È ÛÙÔ ¯ÚˆÌfiÛˆÌ· 4p16.3. ¶ÂÚÈÁÚ¿ÊÔ˘ÌÂÎÔÚ›ÙÛÈ ËÏÈÎ›·˜ 7ó ÂÙÒÓ, ÌÂ ‰˘Û·Ó¿ÏÔÁÔ ÎÔÓÙfi ·Ó¿ÛÙËÌ·, Î·È ÌÂ ÎÏÈÓÈÎ¿ Î·È ·ÎÙÈÓÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù·Û˘Ì‚·Ù¿ ÌÂ ÙË ‰È¿ÁÓˆÛË ÙË˜ ˘Ô¯ÔÓ‰ÚÔÏ·Û›·˜. ∏ ÌÔÚÈ·Î‹ ÁÂÓÂÙÈÎ‹ ·Ó¿Ï˘ÛË ¤‰ÂÈÍÂ fiÙÈ Ë ·ÛıÂÓ‹˜ Â›-Ó·È ÂÙÂÚÔ˙˘ÁÒÙË˜ ÁÈ· ÙË ÌÂÙ¿ÏÏ·ÍË C1620A ÛÙÔ ¯ÚˆÌfiÛˆÌ· 4p16.3, Ô˘ Ô‰ËÁÂ› ÛÙËÓ ·ÓÙÈÎ·Ù¿ÛÙ·ÛË¡540∫ ÛÙÔÓ FGFR3 Î·È ·ÓÙÈÚÔÛˆÂ‡ÂÈ ÙËÓ ÈÔ Û˘¯Ó‹ ÌÂÙ¿ÏÏ·ÍË ÛÙËÓ ˘Ô¯ÔÓ‰ÚÔÏ·Û›·.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ÀÔ¯ÔÓ‰ÚÔÏ·Û›·, ÛÎÂÏÂÙÈÎ‹ ‰˘ÛÏ·Û›·, FGFR3, ‰˘Û·Ó¿ÏÔÁÔ ÎÔÓÙfi ·Ó¿ÛÙËÌ·, ·˘ÍËÙÈÎ‹ ÔÚÌfiÓË.

Hypochondroplasia with the mutation N540K of the fibroblast

growth factor receptor 3 - FGFR3. A case report

V. Aggelakou, G. Niotakis, S. Ilia, S. Bakosi, E. Kokori

Abstract: Hypochondroplasia (MIM 146000) is an autosomal dominant skeletal dysplasia affecting 1in 30,000 individuals. It is not uncommon for many cases to be overlooked or misdiagnosed as beingfamilial short stature, since the clinical manifestations may be mild, and the diagnosis is often delayed(2-4 years). Suspicions arise when the child is noted to “fall off the growth curve”, and a carefulexamination reveals the rhizomelic shortening. Clinical features of hypochondroplasia include mildshort stature, micromelia, lumbar lordosis, short broad hands and feet, a large forehead and absent ormild macrocephaly. Recently, it has been reported that almost 70% of patients with hypochondroplasiacarry a gene mutation encoding for the receptor 3 of the fibroblast growth factor (FGFR3) onchromosome 4q16.3. The case is described of a 7ó year-old girl who presented with disproportionalshort stature and clinical and radiological findings consistent with hypochondroplasia. Moleculargenetic analysis confirmed that the patient was heterozygous for the C1620A mutation resulting inN540K substitution in FGFR3, the most common mutation in hypochondroplasia.

Key words: Hypochondroplasia, skeletal dysplasia, FGFR3, disproportional short stature, growth hormone.

∞’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹µÂÓÈ˙¤ÏÂÈÔ˘ ¡ÔÛÔÎÔÌÂ›Ô˘,∏Ú¿ÎÏÂÈÔ ∫Ú‹ÙË˜


µ·ÛÈÏÈÎ‹ ∞ÁÁÂÏ¿ÎÔ˘[email protected]°Ô‡ÚÓÂ˜ ∆ÂÌ¤ÓÔ˘˜∆.∫. 71 500∏Ú¿ÎÏÂÈÔ ∫Ú‹ÙË˜

1st Pediatric Clinic, VenizeleioHospital, Herakleion, Crete

Correspondence:

Vassiliki Aggelakou [email protected] Temenous71 500, Herakleion, Crete

∂ÈÛ·ÁˆÁ‹

∏ ˘Ô¯ÔÓ‰ÚÔÏ·Û›· (ÀÃ) ·Ó‹ÎÂÈ ÛÙËÓ ÔÌ¿-‰· ÙË˜ ·¯ÔÓ‰ÚÔÏ·Û›·˜ ÌÂ ‚¿ÛË ÌÈ· Ó¤· ·Ó·ıÂ-ˆÚËÌ¤ÓË ‰ÈÂıÓ‹ ÔÓÔÌ·ÙÔÏÔÁ›· Î·È Ù·ÍÈÓfiÌËÛË(1), Ì·˙› ÌÂ ÙËÓ ·¯ÔÓ‰ÚÔÏ·Û›· Î·È ÙË ı·Ó·ÙÔ-ÙÚÔÊÈÎ‹ ‰˘ÛÏ·Û›· Î·È ÌÂÙ·‚È‚¿˙ÂÙ·È ÌÂ ÙÔÓ·˘ÙÔÛˆÌ·ÙÈÎfi ÂÈÎÚ·ÙËÙÈÎfi ¯·Ú·ÎÙ‹Ú·. ∏ ÁÂ-ÓÂÙÈÎ‹ ‰È·Ù·Ú·¯‹ ·ÊÔÚ¿ ÌÂÙ·ÏÏ¿ÍÂÈ˜ ÛÙÔ ÁÔÓ›-‰ÈÔ ÙÔ˘ ˘Ô‰Ô¯¤· 3 ÙÔ˘ ·˘ÍËÙÈÎÔ‡ ·Ú¿ÁÔÓÙ·

ÙˆÓ ÈÓÔ‚Ï·ÛÙÒÓ (FGFR 3) (∂ÈÎfiÓ· 1), Ô˘ ‚Ú›-

ÛÎÂÙ·È ÛÙÔ ¯ÚˆÌfiÛˆÌ· 4p16.3 (2). √È ÂÚÈÛÛfi-

ÙÂÚÂ˜ ÌÂÙ·ÏÏ¿ÍÂÈ˜ Â›Ó·È Ù˘¯·›Â˜ (de novo), ÂÓÒ

˘¿Ú¯ÂÈ ÌÂÁ¿ÏË Ê·ÈÓÔÙ˘ÈÎ‹ ÔÈÎÈÏÔÌÔÚÊ›·

ÙË˜ ÀÃ ÏfiÁˆ ÙÔ˘ Â›‰Ô˘˜ ÙˆÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ (2). ∏

Û˘¯ÓfiÙËÙ· ˘ÔÏÔÁ›˙ÂÙ·È ÛÂ 1:30.000 ÛÙÔÓ ÁÂÓÈÎfi

ÏËı˘ÛÌfi. ∫ÏÈÓÈÎ¿ ·Ú·ÙËÚÂ›Ù·È ‹È· ‚Ú·¯˘-

ÛˆÌ›· (‡„Ô˜ 145-165 cm ÛÙ· ·ÁfiÚÈ· Î·È 133-150

cm ÛÙ· ÎÔÚ›ÙÛÈ·), ÎÔÓÙ¿ ¿ÎÚ·, ÚÔ¤¯ÔÓ Ì¤ÙˆÔ,

·Ô‡Û· ‹ ‹È· Ì·ÎÚÔÎÂÊ·Ï›·, ÏfiÚ‰ˆÛË ÙË˜ ÔÛÊ˘˚-

Î‹˜ ÌÔ›Ú·˜ ÙË˜ ÛÔÓ‰˘ÏÈÎ‹˜ ÛÙ‹ÏË˜ Î·È ÎÔÓÙ¿ Î·È

Ï·ÙÈ¿ ÌÂÙ·Î¿ÚÈ· Î·È Ê¿Ï·ÁÁÂ˜ (3). ∆· ·ÎÙÈÓÔÏÔÁÈ-

Î¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÌÂÈˆÌ¤ÓË ‰È·˘¯Â-

ÓÈÎ‹ ·fiÛÙ·ÛË ÛÙÔ˘˜ Î·ÙÒÙÂÚÔ˘˜ ÔÛÊ˘˚ÎÔ‡˜ ÛÔÓ-

‰‡ÏÔ˘˜, Â˘Ú¤· Î·È ÎÔÓÙ¿ Ì·ÎÚ¿ ÔÛÙ¿, ÌÂÙ·Î¿ÚÈ· Î·È

Ê¿Ï·ÁÁÂ˜, Î·ıÒ˜ Î·È Â˘Ú‡ Î·È ÎÔÓÙfi ·˘¯¤Ó· ÙÔ˘ ÌË-

ÚÈ·›Ô˘, ÂÓÒ ÙÔ Ì‹ÎÔ˜ ÙË˜ ÂÚfiÓË˜ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚÔ

ÙË˜ ÎÓ‹ÌË˜ (4).

¶·ÚÔ˘ÛÈ¿˙Ô˘ÌÂ ÂÚ›ÙˆÛË ˘Ô¯ÔÓ‰ÚÔÏ·Û›·˜

ÌÂ ÌÂÙ¿ÏÏ·ÍË ¡540∫ ÛÙÔÓ FGFR 3, ÛÙËÓ ÔÔ›· Ë ‰È¿-

ÁÓˆÛË Ù¤ıËÎÂ Î·ı˘ÛÙÂÚËÌ¤Ó· ÛÂ ËÏÈÎ›· 7,5 ÂÙÒÓ, ÌÂ

ÛÎÔfi Ó· Â˘·ÈÛıËÙÔÔÈ‹ÛÔ˘ÌÂ ÙÔ˘˜ Û˘Ó·‰¤ÏÊÔ˘˜

·È‰È¿ÙÚÔ˘˜, ÒÛÙÂ Ó· ·Ó·ÁÓˆÚ›˙Ô˘Ó ¤ÁÎ·ÈÚ· ÙË ÓfiÛÔ

Î·È Ó· ÌÔÚÔ‡Ó Ó· ̇ ËÙ‹ÛÔ˘Ó ÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë ÁÂÓÂÙÈÎ‹

ÙÂÎÌËÚ›ˆÛË. ∏ ÂÚ›ÙˆÛË Â›Ó·È Ë ÚÒÙË Ô˘ ‰ËÌÔ-

ÛÈÂ‡ÂÙ·È ÛÙËÓ ÚÔÛÈÙ‹ ÂÏÏËÓÈÎ‹ ‚È‚ÏÈÔÁÚ·Ê›·.

¶ÂÚÈÁÚ·Ê‹ ÂÚÈÛÙ·ÙÈÎÔ‡

¶ÚfiÎÂÈÙ·È ÁÈ· ÎÔÚ›ÙÛÈ ËÏÈÎ›·˜ 7ó ÂÙÒÓ Ô˘ Ó

ÔÛËÏÂ‡ıËÎÂ ÁÈ· ÏÔ›ÌˆÍË ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·Ó·ÓÂ˘-

ÛÙÈÎÔ‡. ™ÙÔ ·ÙÔÌÈÎfi ·Ó·ÌÓËÛÙÈÎfi ÙË˜ ·Ó·Ê¤ÚÂÙ·È

fiÙÈ ÁÂÓÓ‹ıËÎÂ ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ÙÔÎÂÙfi, ÌÂÙ¿ ·fi ÙÂ-

ÏÂÈfiÌËÓË Î‡ËÛË ÌÂ ‚¿ÚÔ˜ 2.930 g (25Ë ∂.£.), Ì‹ÎÔ˜

46 cm (3Ë ∂.£.) Î·È ÂÚ›ÌÂÙÚÔ ÎÂÊ·Ï‹˜ 34 cm (50‹

∂.£.). ™Â ËÏÈÎ›· 3 ÂÙÒÓ ÙÔ ‡„Ô˜ ‹Ù·Ó 81 cm (-4 SD

·fi 50‹ ∂.£.), ÙÔ ‚¿ÚÔ˜ 11,5 kg (-2 SD ·fi 50‹

∂.£.) Î·È Ë ÂÚ›ÌÂÙÚÔ˜ ÎÂÊ·Ï‹˜ 48 cm (-2 SD ·fi

50 ‹ ∂.£.), ÂÓÒ ‰ÂÓ ˘¿Ú¯Ô˘Ó ¿ÏÏÂ˜ Î·Ù·ÁÂÁÚ·ÌÌ¤-

ÓÂ˜ ÌÂÙÚ‹ÛÂÈ˜. §fiÁˆ ÙË˜ ÌÂÁ¿ÏË˜ ·fiÎÏÈÛË˜ ÙÔ˘

‡„Ô˘˜ ·fi ÙË Ì¤ÛË ÙÈÌ‹ ÁÈ· ÙËÓ ËÏÈÎ›· ÙË˜, ¤ÁÈÓÂ

ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ Ô˘ ·¤ÎÏÂÈÛÂ Ù· ¯ÚfiÓÈ·

ÓÔÛ‹Ì·Ù· Î·È ÙËÓ ¤ÏÏÂÈ„Ë ·˘ÍËÙÈÎ‹˜ ÔÚÌfiÓË˜, ÂÓÒ

Èı·ÓÔÏÔÁ‹ıËÎÂ Î¿ÔÈ· ÌÔÚÊ‹ ÛÎÂÏÂÙÈÎ‹˜ ‰˘-

ÛÏ·Û›·˜, ¯ˆÚ›˜ fiÌˆ˜ Ó· Á›ÓÂÈ ÂÚ·ÈÙ¤Úˆ ¤ÏÂÁ¯Ô˜.

∏ „˘¯ÔÎÈÓËÙÈÎ‹ ÂÍ¤ÏÈÍË ÙË˜ ·ÛıÂÓÔ‡˜ ‹Ù·Ó ÔÌ·Ï‹,

ÌÂ Î·Ï‹ Û¯ÔÏÈÎ‹ Â›‰ÔÛË. √È ÁÔÓÂ›˜ Î·È Ô ·‰ÂÏÊfi˜

ÙË˜ ¤¯Ô˘Ó Ê˘ÛÈÔÏÔÁÈÎfi ‚¿ÚÔ˜, ‡„Ô˜ Î·È ÂÚ›ÌÂÙÚÔ

ÎÂÊ·Ï‹˜, ¯ˆÚ›˜ ‰˘Û·Ó·ÏÔÁ›· ÎÔÚÌÔ‡-¿ÎÚˆÓ.

∏ ·ÓÙÈÎÂÈÌÂÓÈÎ‹ ÂÍ¤Ù·ÛË Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙË˜

ÛÙËÓ ÎÏÈÓÈÎ‹ ·ÔÎ¿Ï˘„Â ˘ÔÏÂÈfiÌÂÓË ÛˆÌ·ÙÈÎ‹

·Ó¿Ù˘ÍË Î·È ‰˘Û·Ó¿ÏÔÁÔ ÎÔÓÙfi ·Ó¿ÛÙËÌ· ÌÂ ÎÔ-

ÓÙ¿ ¿Óˆ Î·È Î¿Ùˆ ¿ÎÚ· [‡„Ô˜: 102,5 cm (-6 SD ·fi

50‹ ∂.£.), ‚¿ÚÔ˜: 18 kg (-2,5 SD ·fi 50‹ ∂.£.), Â-

Ú›ÌÂÙÚÔ˜ ÎÂÊ·Ï‹˜: 50 cm (-2 SD ·fi 50‹ ∂.£.), Î·-

ıÈÛÙfi ‡„Ô˜: 59 cm, ¿ÓÔÈÁÌ· ¯ÂÚÈÒÓ: 96 cm, ·Ó·ÏÔÁ›·

¿Óˆ/Î¿Ùˆ ÙÌ‹Ì·ÙÔ˜ ÙÔ˘ ÛÒÌ·ÙÔ˜: 1,35 (Ê.Ù. ÁÈ· ÙËÓ

ËÏÈÎ›·: 1,06), ‰È·ÊÔÚ¿ ·ÓÔ›ÁÌ·ÙÔ˜ ¯ÂÚÈÒÓ - ‡„Ô˜: -

0,65 (Ê.Ù.: -2) Î·È ÏfiÁÔ˜ Î·ıÈÛÙÔ‡ ‡„Ô˘˜ / Û˘ÓÔÏÈÎfi

‡„Ô˜: 0,575 (+3 SD ·fi 50‹ ∂.£.)]. ∆· ‰¿ÎÙ˘Ï¿ ÙË˜

‹Ù·Ó ÎÔÓÙ¿ Î·È Ï·ÙÈ¿, ÂÓÒ ·Ú·ÙËÚ‹ıËÎÂ ‹È·

ÏfiÚ‰ˆÛË ÙË˜ ÔÛÊ˘˚Î‹˜ ÌÔ›Ú·˜ ÙË˜ ÛÔÓ‰˘ÏÈÎ‹˜

ÛÙ‹ÏË˜. ¢ÂÓ ÂÌÊ¿ÓÈ˙Â ‰˘ÛÌÔÚÊÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿

ÛÙÔ ÚfiÛˆÔ Î·È ÛÙÔ ÎÚ·Ó›Ô (∂ÈÎfiÓ· 2). ∏ ÔÛÙÈÎ‹

ËÏÈÎ›· ‹Ù·Ó Û˘Ì‚·Ù‹ ÌÂ ÙË ¯ÚÔÓÔÏÔÁÈÎ‹. ∆· ·ÎÙÈ-

ÓÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù· ·ÊÔÚÔ‡Û·Ó ÎÔÓÙ¿ Î·È Ê·Ú‰È¿

ÌÂÙ·Î¿ÚÈ· Î·È Ê¿Ï·ÁÁÂ˜ ¿Óˆ ¿ÎÚˆÓ, ÌÂ›ˆÛË ÙË˜

‰È·˘¯ÂÓÈÎ‹˜ ·fiÛÙ·ÛË˜ ·fi ÙÔÓ √1 ¤ˆ˜ ÙÔÓ √5

ÛfiÓ‰˘ÏÔ, ÎÔÓÙfi Î·È Â˘Ú‡ ·˘¯¤Ó· ÌËÚÈ·›Ô˘ ÔÛÙÔ‡,

‹È· ÂÏ·Ù˘ÛÌ¤Ó· Î·È ÎÔÓÙ¿ Ï·ÁfiÓÈ· ÔÛÙ¿ ÌÂ ÂÈ-

¤‰ˆÛË ÙË˜ ÔÚÔÊ‹˜ ÙË˜ ÎÔÙ‡ÏË˜, ÂÚfiÓË ÌÂÁ·Ï‡-

ÙÂÚË ÙË˜ ÎÓ‹ÌË˜ Î·È Ù¤ÏÔ˜, ÎÔÓÙ¿ Î·È Ê·Ú‰È¿ Ì·-

ÎÚ¿ ÔÛÙ¿ ÙˆÓ Î¿Ùˆ ¿ÎÚˆÓ (∂ÈÎfiÓ· 3).

√ ˘fiÏÔÈÔ˜ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ‹Ù·Ó Ê˘-

ÛÈÔÏÔÁÈÎfi˜ fiˆ˜ Î·È Ô ¤ÏÂÁ¯Ô˜ ı˘ÚÂÔÂÈ‰Ô‡˜ Î·È

·Ú·ı˘ÚÂÔÂÈ‰ÒÓ ·‰¤ÓˆÓ [·Ú·ıÔÚÌfiÓË: 31 pg/ml

(Ê.Ù. 1-43), TSH: 1,90 IU/ml (Ê.Ù. 0,4-4), FT3: 5,4

pmol/L (Ê.Ù. 2,2-6,2), FT4 18,2 pmol/L (Ê.Ù. 10,2-

24,4)], Ë ¤ÎÎÚÈÛË ·˘ÍËÙÈÎ‹˜ ÔÚÌfiÓË˜ ÌÂ ‰ÔÎÈÌ·-

Û›Â˜ ‡ÓÔ˘ Î·È ¿ÛÎËÛË˜, Î·ıÒ˜ Î·È ÔÈ ÙÈÌ¤˜ ÙÔ˘

·˘ÍËÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· IGF-1 Î·È ÙË˜ ÚˆÙÂ˝ÓË˜

IGF-BP3.

ªÂ ‚¿ÛË Ù· ·ÓˆÙ¤Úˆ ÎÏÈÓÈÎÔÂÚÁ·ÛÙËÚÈ·Î¿ Â˘Ú‹-

Ì·Ù· Ô˘ Û˘ÓËÁÔÚÔ‡Û·Ó ˘¤Ú ÙË˜ ÀÃ, ‰Â›ÁÌ· ·›Ì·-

ÙÔ˜ ÂÛÙ¿ÏË ÁÈ· ÌÔÚÈ·Îfi ÁÔÓÈ‰È·Îfi ¤ÏÂÁ¯Ô ÛÙÔ ∂˘Úˆ-

·˚Îfi ¢›ÎÙ˘Ô ™ÎÂÏÂÙÈÎÒÓ ¢˘ÛÏ·ÛÈÒÓ (European

Skeletal Dysplasia Network: www.esdn.org) Î·È ‰È·È-

ÛÙÒıËÎÂ fiÙÈ Ë ·ÛıÂÓ‹˜ Â›Ó·È ÂÙÂÚÔ˙˘ÁÒÙË˜ ÁÈ· ÙË

50 µ. ∞ÁÁÂÏ¿ÎÔ˘ Î·È Û˘Ó.


TD I TD II HCH ACH TD I

COOH

TK2 TK1TM Ig III Ig II A

Ig I S

NH2

∂ÈÎfiÓ· 1. ™¯ËÌ·ÙÈÎ‹ ·Ú¿ÛÙ·ÛË ÙË˜ ÚˆÙÂ˚ÓÈÎ‹˜ ‰ÔÌ‹˜ ÙÔ˘ FGFR-3 Î·È ÙË˜ ı¤ÛË˜ ÙˆÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ Ô˘ ÚÔÎ·ÏÔ‡Ó ÙÚÂÈ˜ ÛÎÂÏÂÙÈ-Î¤˜ ‰˘ÛÏ·Û›Â˜: ·¯ÔÓ‰ÚÔÏ·Û›· (ACH), ˘Ô¯ÔÓ‰ÚÔÏ·Û›· (HCH) Î·È ı·Ó·ÙÔÙÚÔÊÈÎ‹ ¯ÔÓ‰ÚÔ‰˘ÛÏ·Û›· Ù‡Ô˘ π Î·È ππ (TD I, TD II).TM: ‰È·ÌÂÌ‚Ú·ÓÈÎfi ÙÌ‹Ì·. ∆∫1, ∆∫2: ÙÌ‹Ì·Ù· ÎÈÓ¿ÛË Ù˘ÚÔÛ›ÓË˜ 1 Î·È 2. Ig π, Ig II, Ig III: ÙÌ‹Ì·Ù· Ô˘ ÌÔÈ¿˙Ô˘Ó ÌÂ ·ÓÔÛÔÛÊ·ÈÚ›ÓË.

ÌÂÙ¿ÏÏ·ÍË C1620A ÛÙÔ ÁÔÓ›‰ÈÔ ÙÔ˘ FGFR3. ∏ ÌÂ-

Ù¿ÏÏ·ÍË ·˘Ù‹ Ô˘ Ô‰ËÁÂ› ÛÙËÓ ·ÓÙÈÎ·Ù¿ÛÙ·ÛË

¡540∫ ÛÙÔÓ FGFR3 ·ÔÙÂÏÂ› ÙËÓ ÈÔ Û˘¯Ó‹ Î·È ÛÔ-

‚·Ú‹ ÌÂÙ¿ÏÏ·ÍË ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ˘Ô¯ÔÓ‰ÚÔÏ·Û›·.

√ ÁÔÓÈ‰È·Îfi˜ ¤ÏÂÁ¯Ô˜ ÙË˜ ÔÈÎÔÁ¤ÓÂÈ·˜ ‹Ù·Ó ·ÚÓËÙÈ-

Îfi˜ ÁÈ· ÙË ÌÂÙ¿ÏÏ·ÍË.

™˘˙‹ÙËÛË

∏ ÀÃ Â›Ó·È Ë ËÈfiÙÂÚË ÌÔÚÊ‹ ÛÎÂÏÂÙÈÎ‹˜ ‰˘-

ÛÏ·Û›·˜ ÛÙËÓ ÔÌ¿‰· ÙË˜ ·¯ÔÓ‰ÚÔÏ·Û›·˜ (5,6),

Î·È ÔÊÂ›ÏÂÙ·È Û˘Ó‹ıˆ˜ ÛÂ ÌÂÙ·ÏÏ¿ÍÂÈ˜ ÛÙÔÓ

FGFR3 (6,7). √ FGFR3 Â›Ó·È ÌÈ· ÁÏ˘ÎÔÚˆÙÂ˝ÓË

Ô˘ ·Ó‹ÎÂÈ ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ· ÙˆÓ ˘Ô‰Ô¯¤ˆÓ ÙË˜

Ù˘ÚÔÛÈÓÈÎ‹˜ ÎÈÓ¿ÛË˜ (∆∫). ∏ ·¯ÔÓ‰ÚÔÏ·Û›· ÚÔ-

Î·ÏÂ›Ù·È ·fi ÛËÌÂÈ·Î¤˜ ÌÂÙ·ÏÏ¿ÍÂÈ˜ ÛÙÔ ‰È·ÌÂÌ-

‚Ú·ÓÈÎfi ÙÌ‹Ì· ÙÔ˘ FGFR3, ÂÓÒ Ë ÀÃ, fiˆ˜ Î·È Ë

ı·Ó·ÙÔÙÚÔÊÈÎ‹ ‰˘ÛÏ·Û›·, ·fi ÌÂÙ·ÏÏ¿ÍÂÈ˜ ÛÙË

‰ÔÌ‹ ÙË˜ ∆∫1, TK2 ·ÏÏ¿ Î·È ¿ÏÏˆÓ ÙÌËÌ¿ÙˆÓ ÙÔ˘

FGFR3 (∂ÈÎfiÓ· 1) (7). ∏ ÌÂÁ¿ÏË ÎÏÈÓÈÎ‹ ÂÙÂÚÔÁ¤-

ÓÂÈ· ÙˆÓ ÚÔ·Ó·ÊÂÚı¤ÓÙˆÓ ÓÔÛËÌ¿ÙˆÓ ÔÊÂ›ÏÂÙ·È

ÛÙË ‰È·ÊÔÚÂÙÈÎ‹˜ ‚·Ú‡ÙËÙ·˜ ‰È·Ù·Ú·¯‹ ÙË˜ ÏÂÈ-

ÙÔ˘ÚÁÈÎfiÙËÙ·˜ ÙÔ˘ FGFR3 Ô˘ ÚÔÎ·ÏÔ‡Ó ÔÈ ‰È¿-

ÊÔÚÂ˜ ÌÂÙ·ÏÏ¿ÍÂÈ˜ (7). ™ÙÔ 70% ÙˆÓ ÂÚÈÙÒÛÂˆÓ

ÀÃ ¤¯Ô˘Ó Ù·˘ÙÔÔÈËıÂ› ÂÓÓ¤· ÌÂÙ·ÏÏ¿ÍÂÈ˜ ÁÈ· ÙËÓ

∆∫1 ÛÙÔ ÁÔÓ›‰ÈÔ ÙÔ˘ FGFR3, ÔÈ ÔÔ›Â˜ ÚÔÎ·ÏÔ‡Ó

ÂÙ¿ ‰È·ÊÔÚÂÙÈÎ¤˜ ·ÓÙÈÎ·Ù·ÛÙ¿ÛÂÈ˜ ·ÌÈÓÔÍ¤ˆÓ

(2,8), ÌÂ ÈÔ Û˘¯Ó‹ ÌÂÙ¿ÏÏ·ÍË ÙË ¡540∫ Ô˘ ·ÓÙÈ-

ÚÔÛˆÂ‡ÂÈ ÂÚ›Ô˘ ÙÔ 50% fiÏˆÓ ÙˆÓ ÌÂÙ·ÏÏ¿ÍÂ-

ˆÓ ÙÔ˘ FGFR3 ÛÙËÓ YX (2). ™ÙÔ ˘fiÏÔÈÔ 30% ÙˆÓÂÚÈÙÒÛÂˆÓ ÀÃ, ‰ÂÓ ¤¯ÂÈ ‚ÚÂıÂ› Ë ÁÔÓÈ‰È·Î‹ ‰È·-Ù·Ú·¯‹. ™Â ÔÏÏ¤˜ ÌÂÏ¤ÙÂ˜ ¤¯ÂÈ Á›ÓÂÈ ÚÔÛ¿ıÂÈ·Ê·ÈÓÔÙ˘ÈÎ‹˜-ÁÔÓÔÙ˘ÈÎ‹˜ Û˘Û¯¤ÙÈÛË˜ (2,4,9,10)(¶›Ó·Î·˜ 1). √È ·ÛıÂÓÂ›˜ ÌÂ ÙËÓ ¡540∫ ÌÂÙ¿ÏÏ·ÍËÙÂ›ÓÔ˘Ó Ó· ¤¯Ô˘Ó ÔÏ‡ ÎÔÓÙfi ·Ó¿ÛÙËÌ· Î·È ÌÂÁ·-Ï‡ÙÂÚË ‰˘Û·Ó·ÏÔÁ›· ÎÔÚÌÔ‡-¿ÎÚˆÓ ÛÂ Û¯¤ÛË ÌÂ¿ÏÏÂ˜ ÌÂÙ·ÏÏ¿ÍÂÈ˜, ÂÓÒ Ë Ì·ÎÚÔÎÂÊ·Ï›· ÌÔÈ¿˙ÂÈÓ· Â›Ó·È ÛÔ‚·ÚfiÙÂÚË ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ÙËÓ ∫650¡ Î·È∫650Q ÌÂÙ¿ÏÏ·ÍË (4,9,10). ∆ÂÏÂ˘Ù·›· ¤¯Ô˘Ó ÂÚÈ-ÁÚ·ÊÂ› ÙÚÂÈ˜ ÂÚÈÙÒÛÂÈ˜ ÔÈÎÔÁÂÓÂÈÒÓ ÙˆÓ ÔÔ›ˆÓÙ· Ì¤ÏË Â›¯·Ó ‡„Ô˜ ÂÓÙfi˜ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÔÚ›ˆÓ, ·Ï-Ï¿ ÌÂ Ì¤ÙÚÈ· ‰˘Û·Ó·ÏÔÁ›· ÎÔÚÌÔ‡ Î·È ¿ÎÚˆÓ, Ì·-ÎÚÔÎÂÊ·Ï›·, ÚÔ¤¯ÔÓ Ì¤ÙˆÔ, Î·ı›˙ËÛË ÙË˜ Ú›˙·˜ÙË˜ Ì‡ÙË˜, Â˘Ú‡ ıÒÚ·Î· Î·È ÏfiÚ‰ˆÛË ÙË˜ ÔÛÊ˘˚-Î‹˜ ÌÔ›Ú·˜ ÙË˜ ™™, ·ÎÙÈÓÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù· Û˘Ì‚·-Ù¿ ÌÂ ÀÃ, ÂÓÒ Î·È ÛÙÈ˜ ÙÚÂÈ˜ ÔÈÎÔÁ¤ÓÂÈÂ˜ ·ÓÈ¯ÓÂ‡-ÙËÎÂ Ë ÌÂÙ¿ÏÏ·ÍË ¡540S (2,8). ∂›ÛË˜, ‹È· Ê·È-ÓÔÙ˘ÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÀÃ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ¿ÙÔÌ·ÌÂ ÙË ÌÂÙ¿ÏÏ·ÍË I538V (11), ÛÙ· ÔÔ›· ÙÔ ‡„Ô˜ Î·ÈË ÂÚ›ÌÂÙÚÔ˜ ÎÂÊ·Ï‹˜ Â›Ó·È ÂÓÙfi˜ ÙˆÓ Ê˘ÛÈÔÏÔÁÈ-ÎÒÓ ÔÚ›ˆÓ, ÂÓÒ Ë ·Ó·ÏÔÁ›· Î·ıÈÛÙfi ‡„Ô˜/Û˘ÓÔÏÈÎfi‡„Ô˜ Â›Ó·È ·ıÔÏÔÁÈÎ‹. ∫·Ù¿ Û˘Ó¤ÂÈ·, ¿ÙÔÌ· ÌÂÙÈ˜ ÌÂÙ·ÏÏ¿ÍÂÈ˜ ¡540S Î·È I538V ÌÔÚÂ› Ó· ‰È·Ê‡-ÁÔ˘Ó ÙË˜ ‰È¿ÁÓˆÛË˜. ∂ÎÙfi˜ ·fi ÙÈ˜ ÌÂÙ·ÏÏ¿ÍÂÈ˜ÛÙËÓ ∆∫1, ÚfiÛÊ·Ù· ‰ËÌÔÛÈÂ‡ıËÎÂ ÂÚ›ÙˆÛË ÀÃ

51ÀÔ¯ÔÓ‰ÚÔÏ·Û›· ÌÂ ÌÂÙ¿ÏÏ·ÍË ¡540∫ ÛÙÔÓ FGFR3

¶·È‰È·ÙÚÈÎ‹ 2007;70:49-53

∂ÈÎfiÓ· 2. ∏ ·ÛıÂÓ‹˜ ÛÂ ËÏÈÎ›· 10 ÂÙÒÓ.∂ÈÎfiÓ· 3. ∞ÎÙÈÓÔÁÚ·ÊÈÎ¿ Â˘Ú‹Ì·Ù·: ∞. ∫ÔÓÙ‹ Î·È Ï·ÙÈ¿ ÎÓ‹ÌËÎ·È ÂÚfiÓË Ì·ÎÚ‡ÙÂÚË ÙË˜ ÎÓ‹ÌË˜. µ. ¢È·˘¯ÂÓÈÎ‹ ·fiÛÙ·ÛËÛÙÔ˘˜ Î·ÙÒÙÂÚÔ˘˜ ÔÛÊ˘˚ÎÔ‡˜ ÛÔÓ‰‡ÏÔ˘˜ ÌÈÎÚfiÙÂÚË ·fi ÙÔ˘˜·ÓÒÙÂÚÔ˘˜. °. µÚ·¯¤· Î·È Ï·ÙÈ¿ ÌÂÙ·Î¿ÚÈ· Î·È Ê¿Ï·ÁÁÂ˜. ¢.∫ÔÓÙfi˜ Î·È Ï·Ù‡˜ ·˘¯¤Ó·˜ ÌËÚÈ·›Ô˘, ÎÔÓÙ¿ Î·È Ï·ÙÈ¿ Ï·ÁfiÓÈ·.

∞ µ

° ¢

ÌÂ ÙË ÛËÌÂÈ·Î‹ ÌÂÙ¿ÏÏ·ÍË ¡328π ÛÙÔ ÂÍˆÎ˘ÙÙ¿ÚÈÔ

·ÓÔÛÔÛÊ·ÈÚÈÓÈÎfi ÌfiÚÈÔ Ig III ÙÔ˘ FGFR3. ∏ ÌÂÙ¿Ï-

Ï·ÍË ·˘Ù‹ ¤¯ÂÈ ˆ˜ Û˘Ó¤ÂÈ· ÙË ‰È·Ù·Ú·¯‹ ÙË˜ ÁÏ˘-

ÎÔ˙˘Ï›ˆÛË˜ Î·È Ê·›ÓÂÙ·È Ó· ·›˙ÂÈ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ

ÛÙË Ê˘ÛÈÔÏÔÁÈÎ‹ ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ˘Ô‰Ô¯¤· (12).

∆· Ê·ÈÓÔÙ˘ÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙÔ˘ ·ÛıÂÓÔ‡˜

‹Ù·Ó Ù· ÎÏ·ÛÈÎ¿ ÙË˜ ÀÃ.

¶ÔÏÏÔ› ·ÛıÂÓÂ›˜ ÌÂ ÀÃ ÂÌÊ·Ó›˙Ô˘Ó „˘¯ÔÎÔÈÓˆ-

ÓÈÎ¿ ÚÔ‚Ï‹Ì·Ù· ÏfiÁˆ ÙË˜ ÌÂÈˆÌ¤ÓË˜ ·˘ÙÔÂÎÙ›ÌË-

Û‹˜ ÙÔ˘˜, ·ÏÏ¿ Î·È ÙÔ˘ ÎÔÈÓˆÓÈÎÔ‡ ·ÔÎÏÂÈÛÌÔ‡

Ô˘ Û˘¯Ó¿ Û˘Ì‚·›ÓÂÈ ÛÂ ¿ÙÔÌ· ÌÂ ÛˆÌ·ÙÈÎ¿ ÂÏ-

ÏÂ›ÌÌ·Ù·. °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi ¤¯ÂÈ ÂÈ¯ÂÈÚËıÂ› Ë ·‡-

ÍËÛË ÙÔ˘ ‡„Ô˘˜ ÙˆÓ ·ÛıÂÓÒÓ ÌÂ ÙË ¯ÔÚ‹ÁËÛË ·˘-

ÍËÙÈÎ‹˜ ÔÚÌfiÓË˜ Î·È ÙË ¯ÂÈÚÔ˘ÚÁÈÎ‹ ÂÈÌ‹Î˘ÓÛË

ÙˆÓ ÔÛÙÒÓ ÌÂÙ¿ ÙËÓ Û‡ÁÎÏÂÈÛË ÙˆÓ ÂÈÊ‡ÛÂˆÓ (13-

15). √È ÌÂÏ¤ÙÂ˜ fiÌˆ˜ ¯ÔÚ‹ÁËÛË˜ ·˘ÍËÙÈÎ‹˜ ÔÚÌfi-

ÓË˜ Â›Ó·È ÂÚÈÔÚÈÛÌ¤ÓÂ˜ ÛÂ ÌÈÎÚfi ·ÚÈıÌfi ·ÛıÂÓÒÓ

Î·È ÁÈ· Û‡ÓÙÔÌÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ·Ú·ÎÔÏÔ‡ıË-

ÛË˜. √È ÂÚÈÛÛfiÙÂÚÔÈ Û˘ÁÁÚ·ÊÂ›˜ Û˘ÌÊˆÓÔ‡Ó fiÙÈ

Ù· ·ÔÙÂÏ¤ÛÌ·Ù· Â›Ó·È Î·Ï‡ÙÂÚ· fiÙ·Ó Ë ·˘ÍËÙÈÎ‹

ÔÚÌfiÓË ¯ÔÚËÁËıÂ› ÛÙËÓ ‹‚Ë, ÂÂÈ‰‹ ÔÈ ·ÛıÂÓÂ›˜ ÌÂ

ÀÃ ‰ÂÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÙËÓ Ù˘ÈÎ‹ Ù·¯Â›· ·Ó¿Ù˘ÍË

ÙË˜ ‹‚Ë˜ (pubertal growth spurt) Ô˘ ·Ú·ÙËÚÂ›Ù·È

ÛÙ· Ê˘ÛÈÔÏÔÁÈÎ¿ ·È‰È¿, Û˘ÓÂÒ˜ Ë ·˘ÍËÙÈÎ‹ ÔÚ-

ÌfiÓË ÛÂ ‰fiÛË ˘„ËÏfiÙÂÚË ·fi ÙË Û˘Ó‹ıË Ô˘ ‰›‰Â-

Ù·È ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ·ÓÂ¿ÚÎÂÈ· ÙË˜ ˘fiÊ˘ÛË˜, ÌÔ-

ÚÂ› Ó· ‰Ú¿ÛÂÈ ·Ó·ÏËÚÒÓÔÓÙ·˜ ·˘Ùfi ÙÔ ¤ÏÏÂÈÌÌ·

(3,13). (3). ∞Ó Î·È ÁÂÓÈÎ¿ ‰ÂÓ ¤¯Ô˘Ó ·Ú·ÙËÚËıÂ›

·ÓÂÈı‡ÌËÙÂ˜ ‰Ú¿ÛÂÈ˜ ÛÙ· ÔÛÙ¿, fiˆ˜ ÂÈÙ¿¯˘ÓÛË

ÙË˜ ÔÛÙÈÎ‹˜ ËÏÈÎ›·˜ ‹ ÂÈ‰Â›ÓˆÛË ÙË˜ ‰˘Û·Ó·ÏÔ-

Á›·˜ ÎÔÚÌÔ‡-¿ÎÚˆÓ (3,13), ˆÛÙfiÛÔ, Â›Ó·È ··Ú·›ÙË-

ÙÂ˜ ÂÚ·ÈÙ¤Úˆ ÌÂÏ¤ÙÂ˜. ŸÛÔÓ ·ÊÔÚ¿ ÙË ¯ÂÈÚÔ˘ÚÁÈ-

Î‹ ÂÈÌ‹Î˘ÓÛË ÙˆÓ ÔÛÙÒÓ, Ô˘ ·ÔÙÂÏÂ› ÌÈ· ÂÂÌ-

‚·ÙÈÎ‹, ÂÈÎ›Ó‰˘ÓË, ÂÚ›ÏÔÎË Î·È Ì·ÎÚÔ¯ÚfiÓÈ·

‰È·‰ÈÎ·Û›·, Ë ÂÈÏÔÁ‹ ÙË˜ ı· Ú¤ÂÈ Ó· ·ÔÊ·Û›˙Â-

Ù·È ÌÂ ÌÂÁ¿ÏË ÂÚ›ÛÎÂ„Ë. ™Â ÚfiÛÊ·ÙË ÌÂÏ¤ÙË 20

·ÛıÂÓÒÓ ÌÂ ÀÃ Ô˘ ˘Ô‚Ï‹ıËÎ·Ó ÛÂ ÂÈÌ‹Î˘ÓÛË

ÔÛÙÒÓ, ÌÂÙ¿ ÙËÓ ÂÈÌ‹Î˘ÓÛË ÙÔ˘ ÌËÚÈ·›Ô˘ Î·È ÙË˜

ÎÓ‹ÌË˜, ÛÙÔ Û‡ÓÔÏfi ÙÔ˘˜ ÍÂ¤Ú·Û·Ó Ù· 150 cm Î·È

·Ú¿ ÙÔ fiÙÈ ÂÌÊ·Ó›ÛıËÎ·Ó ‰È¿ÊÔÚÂ˜ ÂÈÏÔÎ¤˜ ÛÙÔ

46% ÙˆÓ ·ÛıÂÓÒÓ, ‰ÂÓ ·Ú¤ÌÂÈÓ·Ó ÌfiÓÈÌÂ˜ ‚Ï¿‚Â˜

(15). ∂ÈÛËÌ·›ÓÂÙ·È ·fi ÙÔ˘˜ Û˘ÁÁÚ·ÊÂ›˜ fiÙÈ Ë ıÂ-

ÙÈÎ‹ Â›‰Ú·ÛË ÙË˜ ·‡ÍËÛË˜ ÙÔ˘ ‡„Ô˘˜ ÛÙËÓ ÔÈfi-

ÙËÙ· ˙ˆ‹˜ ÙˆÓ ·ÛıÂÓÒÓ, Ô˘ ·ÊÔÚÔ‡ÛÂ ÙËÓ ·ÓÂ-

Í·ÚÙËÛ›· ÙÔ˘˜, ÙËÓ ·˘ÙÔÂÎÙ›ÌËÛ‹ ÙÔ˘˜ Î·È ÙË ‚ÂÏ-

Ù›ˆÛË ÙˆÓ ÎÔÈÓˆÓÈÎÒÓ ÙÔ˘˜ Û¯¤ÛÂˆÓ, ÍÂ¤Ú·ÛÂ Î·-

Ù¿ ÔÏ‡ ÙÔ ÎfiÛÙÔ˜ ÛÂ ¯Ú‹Ì·Ù· Î·È ¯ÚfiÓÔ Ô˘ ··È-

Ù‹ıËÎÂ (15).

∏ ÚÔÁÂÓÓËÙÈÎ‹ ‰È¿ÁÓˆÛË ÙË˜ ÀÃ ÌÂ ÙË ¯Ú‹ÛË

˘ÂÚ‹¯ˆÓ ÌÔÚÂ› Â‡ÎÔÏ· Ó· ‰È·Ê‡ÁÂÈ ÛÂ ÂÚÈÙÒ-

ÛÂÈ˜ ·Ô˘Û›·˜ ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÈÛÙÔÚÈÎÔ‡. √È ·Ó·ÊÔ-

Ú¤˜ ÚÔÁÂÓÓËÙÈÎ‹˜ ‰È¿ÁÓˆÛË˜ ÙË˜ ÀÃ ÛÙË ‚È‚ÏÈÔ-

ÁÚ·Ê›· Â›Ó·È Ï›ÁÂ˜ (5,16,17). ™ÙÈ˜ ÂÚÈÛÛfiÙÂÚÂ˜ Â-

ÚÈÙÒÛÂÈ˜ Ë ˘ÂÚË¯ÔÁÚ·ÊÈÎ‹ ‰È¿ÁÓˆÛË ¤ÁÈÓÂ ÛÙÔ

‰Â‡ÙÂÚÔ ÙÚ›ÌËÓÔ ÙË˜ Î‡ËÛË˜, ÌÂÙ·Í‡ 23Ë˜-26Ë˜

Â‚‰ÔÌ¿‰·˜ Î‡ËÛË˜, ÌÂ ÛÙ·ıÂÚfi Â‡ÚËÌ· ÙÔ ÌÈÎÚfi

Ì‹ÎÔ˜ ÙÔ˘ ÌËÚÈ·›Ô˘ ÔÛÙÔ‡ ÛÂ Û¯¤ÛË ÌÂ ÙËÓ ·ÌÊÈ-

‚ÚÂÁÌ·ÙÈÎ‹ ‰È¿ÌÂÙÚÔ, ÙËÓ ÂÚ›ÌÂÙÚÔ ÙË˜ ÎÔÈÏ›·˜

Î·È ÙÔ Ì‹ÎÔ˜ ÙÔ˘ ¿ÎÚÔ˘ Ô‰fi˜, ÂÓÒ ·Ô˘Û›·˙·Ó ¿Ï-

Ï· ÛÔ‚·Ú¿ ·ıÔÏÔÁÈÎ¿ ˘ÂÚË¯ÔÁÚ·ÊÈÎ¿ Â˘Ú‹Ì·Ù·

(5,16). ™ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ ·˘Ù¤˜ Ô ÚÔÁÂÓÓËÙÈÎfi˜ ÁÔ-

ÓÈ‰È·Îfi˜ ¤ÏÂÁ¯Ô˜ ÌÔÚÂ› Ó· Û˘Ì‚¿ÏÂÈ ÛÙË ‰È¿ÁÓˆÛË.

ŸÌˆ˜, ÏfiÁˆ ÙˆÓ Èı·ÓÒÓ ÎÈÓ‰‡ÓˆÓ ÙË˜ ·ÌÓÈÔ·Ú·-

Î¤ÓÙËÛË˜ Î·È ÂÂÈ‰‹ Ë ÀÃ ‰ÂÓ Â›Ó·È ı·Ó·ÙËÊfiÚÔ˜

·Ûı¤ÓÂÈ·, ÚÔÙÂ›ÓÂÙ·È Ë ·ÌÓÈÔ·Ú·Î¤ÓÙËÛË Ó· Á›ÓÂ-

Ù·È ÌfiÓÔ fiÙ·Ó Ë ÀÃ Â›Ó·È ‰È·ÁÓˆÛÌ¤ÓË ÛÙÔÓ ¤Ó· ‹

Î·È ÛÙÔ˘˜ ‰‡Ô ÁÔÓÂ›˜ (16).

™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, Ë ÀÃ Â›Ó·È ÌÈ· ÓfiÛÔ˜ Ô˘ ÌÔ-

ÚÂ› Ó· ‰È·Ê‡ÁÂÈ ÙË˜ ‰È¿ÁÓˆÛË˜, ·Ó ‰ÂÓ ˘¿Ú¯ÂÈ ıÂÙÈ-

Îfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi. °È· ÙËÓ ¤ÁÎ·ÈÚË ‰È¿ÁÓˆÛË

··ÈÙÂ›Ù·È ÏÂÙÔÌÂÚ‹˜ ÎÏÈÓÈÎ‹ ÂÍ¤Ù·ÛË Î·È ÁÓÒÛË

ÙˆÓ ÎÏÈÓÈÎÒÓ Î·È ·ÎÙÈÓÔÏÔÁÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ Ô˘ Û˘-

ÓÔ‰Â‡Ô˘Ó ÙË ÓÔÛÔÏÔÁÈÎ‹ ·˘Ù‹ ÔÓÙfiÙËÙ·, ÚÔ¸Ôı¤-

ÛÂÈ˜ Ô˘ ··ÈÙÔ‡ÓÙ·È ÁÈ· ÙËÓ ·Ó·˙‹ÙËÛË ÙË˜ Û˘ÁÎÂ-

ÎÚÈÌ¤ÓË˜ ÁÔÓÈ‰È·Î‹˜ ‰È·Ù·Ú·¯‹˜. ∏ ÚÔÁÂÓÓËÙÈÎ‹

‰È¿ÁÓˆÛË Â›Ó·È ‰˘Ó·Ù‹ ÌÂ ÙË ¯Ú‹ÛË ˘ÂÚ‹¯ˆÓ Î·È

ÁÔÓÈ‰È·Îfi ¤ÏÂÁ¯Ô. ™Â ÂÚÈÙÒÛÂÈ˜ ÌÂ ÛÔ‚·Ú‹ ‚Ú·¯˘-

ÛˆÌ›· Â›Ó·È ‰˘Ó·Ù‹ ÙfiÛÔ Ë ¯Ú‹ÛË ·˘ÍËÙÈÎ‹˜ ÔÚÌfi-

ÓË˜ ÛÙËÓ ÂÊË‚Â›·, fiÛÔ Î·È Ë ¯ÂÈÚÔ˘ÚÁÈÎ‹ ÂÈÌ‹Î˘Ó-

ÛË ÙˆÓ ÔÛÙÒÓ ÌÂÙ¿ ÙËÓ Û‡ÁÎÏÂÈÛË ÙˆÓ ÂÈÊ‡ÛÂˆÓ.

∂˘¯·ÚÈÛÙ›Â˜

∂˘¯·ÚÈÛÙÔ‡ÌÂ ÙËÓ ÔÌ¿‰· ÂÈ‰ÈÎÒÓ ÙÔ˘ ∂˘Úˆ·˚ÎÔ‡ ¢È-

ÎÙ‡Ô˘ ™ÎÂÏÂÙÈÎÒÓ ¢˘ÛÏ·ÛÈÒÓ Ô˘ Ì·˜ ‚Ô‹ıËÛÂ ÛÙËÓ ÎÏÈ-

ÓÈÎ‹ Î·È ÁÂÓÂÙÈÎ‹ ‰È¿ÁÓˆÛË. ∂›ÛË˜, Â˘¯·ÚÈÛÙÔ‡ÌÂ ÙÔ ∂Ó‰Ô-

ÎÚÈÓÔÏÔÁÈÎfi ∆Ì‹Ì· Î·È ÙÔ ∞ÎÙÈÓÔÏÔÁÈÎfi ∂ÚÁ·ÛÙ‹ÚÈÔ ÙÔ˘ µÂ-

ÓÈ˙¤ÏÂÈÔ˘ ¡ÔÛÔÎÔÌÂ›Ô˘ ÁÈ· ÙË Û˘Ì‚ÔÏ‹ ÙÔ˘˜ ÛÙË ‰È¿ÁÓˆÛË.

¶›Ó·Î·˜ 1. ™˘Û¯¤ÙÈÛË ÙˆÓ ‰È·ÊfiÚˆÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ ÛÙÔÓ FGFR-3 ÌÂ ÙÔ ‡„Ô˜ Î·È ÙËÓ ÂÚ›ÌÂÙÚÔ ÎÂÊ·Ï‹˜ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ˘Ô¯ÔÓ‰ÚÔÏ·Û›·

ª¤ÛÔ ‡„Ô˜ ¶ÂÚ›ÌÂÙÚÔ˜ ÎÂÊ·Ï‹˜ µÈ‚ÏÈÔÁÚ·Ê›·

N328I -2,5 SD +2 SD Winterpacht et al, 2000N540K -3,25 ±1 SD +1,72 ± 1,1 SD Matsui et al, 1998N540T -2,5 SD +2,5 SD Deutz-Terlow et al, 1998N540S -1,5 SD +0,5 ¤ˆ˜ 3 SD Mortier et al, 2000I538V -1,8 SD +0,81 SD Grigelioniene et al, 1997K650N, K650Q 1,87 SD ± 0,99 SD +2,48 ± 1,65 SD Bellus et al, 2000




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M, Vigone MC, et al. Comparison of clinical-radiological

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1998;133:99-102.

11. Grigelioniene G, Hagenas L, Eklof O, Neumeyer L, Haereid

PE, Anvret M. A novel missense mutation Ile538Val in the

fibroblast growth factor receptor 3 in hypochondroplasia.

Mutations in brief no. 122. Hum Mutat 1998;11:333.

12. Winterpacht A, Hilbert K, Stelzer C, Schweikardt T, Deck-

er H, Segerer H, et al. A novel mutation in FGFR 3 dis-

rupts a putative N-glycosylation site and results in

hypochondroplasia. Physiol Genomics 2000;2:9-12.

13. Tanaka N, Katsumata N, Horikawa R, Tanaka T. The com-

parison of the effects of short-term growth hormone treat-

ment in patients with achondroplasia and with hypochon-

droplasia. Endocr J 2003;50:69-75.

14. Kanazawa H, Tanaka H, Inoue M, Yamanaka Y, Namba

N, Seino Y. Efficacy of growth hormone therapy for pa-

tients with skeletal dysplasia. J Bone Miner Metab 2003;21:

307-310.

15. Aldegheri R, Dall’Oca C. Limb lengthening in short stature

patients. J Pediatr Orthop B 2001;10:238-247.

16. Huggins MJ, Mernagh JR, Steele L, Smith JR, Nowaczyk

MJ. Prenatal sonographic diagnosis of hypochondroplasia

in a high-risk fetus. Am J Med Genet 1999;87:226-229.

17. Karadimas C, Sifakis S, Valsamopoulos P, Makatsoris C,

Velissariou V, Petersen MB, et al. Prenatal diagnosis of

hypochondroplasia: report of two cases. Am J Med Genet

A 2006;140:998-1003.

53ÀÔ¯ÔÓ‰ÚÔÏ·Û›· ÌÂ ÌÂÙ¿ÏÏ·ÍË ¡540∫ ÛÙÔÓ FGFR3

¶·È‰È·ÙÚÈÎ‹ 2007;70:49-53

54 ∂¡¢π∞º∂ƒ√À™∞ ¶∂ƒπ¶∆ø™∏ CASE REPORT


™ÈÙÈÔÁÂÓ‹˜ ·ÓÂ¿ÚÎÂÈ· ‚ÈÙ·Ì›ÓË˜ µ12 ÛÂ ‚Ú¤ÊÔ˜.

∆· ÛÈÙÈÛÙÈÎ¿ Ï¿ıË ÙˆÓ ¯ÔÚÙÔÊ¿ÁˆÓ

µ. ∞ÁÁÂÏ¿ÎÔ˘, ª. OÚÊ·ÓÔ‡, °. ¡ÈˆÙ¿ÎË˜, ∂. ∫fiÎÔÚË, π. Ã·ÚˆÓ›ÙË

¶ÂÚ›ÏË„Ë: ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ·ÓÂ¿ÚÎÂÈ·˜ ‚ÈÙ·Ì›ÓË˜ µ12 ÛÂ ı‹Ï˘ ‚Ú¤ÊÔ˜ ËÏÈÎ›·˜ 12 ÌËÓÒÓ,Ô˘ ÁÂÓÓ‹ıËÎÂ Î·È ı‹Ï·ÛÂ ·fi ÌËÙ¤Ú· ·ÔÎÏÂÈÛÙÈÎ¿ ¯ÔÚÙÔÊ¿ÁÔ. ∆· Û˘ÌÙÒÌ·Ù· Î·Ù¿ ÙËÓ ÂÈÛ·Áˆ-Á‹ ÙÔ˘ ‹Ù·Ó ·ÓÔÚÂÍ›·, ·ÓÂ·ÚÎ‹˜ ÚfiÛÏË„Ë ‚¿ÚÔ˘˜, ¤ÌÂÙÔÈ, ·¿ıÂÈ· Î·È Ì˘˚Î‹ ˘ÔÙÔÓ›·. ∆Ô ‚Ú¤-ÊÔ˜ ı‹Ï·˙Â ·ÔÎÏÂÈÛÙÈÎ¿ Ì¤¯ÚÈ ÙËÓ ËÏÈÎ›· ÙˆÓ 8,5 ÌËÓÒÓ, fiÙ·Ó ¿Ú¯ÈÛ·Ó Ó· ÚÔÛÙ›ıÂÓÙ·È ÛÙË ‰È·-ÙÚÔÊ‹ ÙÔ˘ ÌÈÎÚ¤˜ ÔÛfiÙËÙÂ˜ ·fi Á¿Ï· ÛfiÁÈ·˜, ÊÚÔ‡Ù· Î·È Ï·¯·ÓÈÎ¿. ∏ ·ÓÔÚÂÍ›· ‹Ù·Ó ÙÔ ÚÒÙÔ Û‡-ÌÙˆÌ· Ô˘ ÂÌÊ·Ó›ÛÙËÎÂ ÛÂ ËÏÈÎ›· 6 ÌËÓÒÓ. ™ÙËÓ ËÏÈÎ›· ÙˆÓ 9 ÌËÓÒÓ ÚÔÛÙ¤ıËÎ·Ó ¤ÌÂÙÔÈ Î·È ·Ò-ÏÂÈ· ‚¿ÚÔ˘˜. ∏ „˘¯ÔÎÈÓËÙÈÎ‹ ÂÍ¤ÏÈÍË ÙÔ˘ ‚Ú¤ÊÔ˘˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ‹ Î·Ù¿ ÙÔ˘˜ ÚÒÙÔ˘˜ Ì‹ÓÂ˜ ÙË˜˙ˆ‹˜. ™ÙËÓ ËÏÈÎ›· ÙˆÓ 10 ÌËÓÒÓ ÂÌÊ·Ó›ÛÙËÎ·Ó ÛËÌÂ›· „˘¯ÔÎÈÓËÙÈÎ‹˜ Î·ı˘ÛÙ¤ÚËÛË˜ Î·È Ë ÌËÙ¤Ú·ÂÚÈÁÚ¿ÊÂÈ ÙÔ ‚Ú¤ÊÔ˜ Û·Ó ÏÈÁfiÙÂÚÔ ˙ˆËÚfi Î·È ÌÂ ÛÙ·‰È·Î¿ ·˘Í·ÓfiÌÂÓË ·¿ıÂÈ·. ∆· ÂÚÁ·ÛÙËÚÈ·Î¿Â˘Ú‹Ì·Ù· ¤‰ÂÈÍ·Ó ÛÔ‚·Ú‹ ÌÂÁ·ÏÔ‚Ï·ÛÙÈÎ‹ ·Ó·ÈÌ›·. ∆· Â›Â‰· ‚ÈÙ·Ì›ÓË˜ µ12 ÛÙÔÓ ÔÚfi ÙÔ˘ ‚Ú¤ÊÔ˘˜Î·È ÙË˜ ÌËÙ¤Ú·˜ ‹Ù·Ó ¯·ÌËÏ¿. ∆Ô ‚Ú¤ÊÔ˜ ·ÓÙ·ÔÎÚ›ıËÎÂ Î·Ï¿ ÛÙË ¯ÔÚ‹ÁËÛË ‚ÈÙ·Ì›ÓË˜ µ12 fiÛÔÓ·ÊÔÚ¿ ÛÙ· ÁÂÓÈÎ¿ Û˘ÌÙÒÌ·Ù·, ÙÈ˜ ·ÈÌ·ÙÔÏÔÁÈÎ¤˜ ‰È·Ù·Ú·¯¤˜, ÙËÓ ˘ÔÙÔÓ›· Î·È ÙËÓ „˘¯ÔÎÈÓËÙÈÎ‹ÂÍ¤ÏÈÍË.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ÃÔÚÙÔÊ·Á›·, ·ÔÎÏÂÈÛÙÈÎ¿ ¯ÔÚÙÔÊ¿ÁÔÈ, ·ÓÂ¿ÚÎÂÈ· ‚ÈÙ·Ì›ÓË˜ µ12, ‰È·ÙÚÔÊ‹, ‚Ú¤ÊË.

Nutritional vitamin B12 deficiency in an infant. Dietary errors of

a vegan

V. Aggelakou, M. Orfanou, G. Niotakis, H. Kokori, I. Charoniti

Abstract: The case is reported of vitamin B12 deficiency in a twelve month-old female infant born to andbreastfed by a strictly vegan mother. The infant presented with anorexia, failure to thrive, vomiting,apathy and muscular hypotonia. She had been exclusively breast fed up to the age of 8.5 months, whensmall amounts of soya milk, vegetables and fruits were added to her diet. The first symptom was reducedappetite, which presented at the age of 6 months, followed by vomiting and weight loss at the age of 9months. The psychomotor development was normal during the first months of life, but around 10 monthsof age signs of psychomotor delay were noted and the mother described the baby as being less activeand increasingly apathetic. Laboratory tests revealed severe megaloblastic anaemia. Low levels of serumvitamin B12 were found in both the infant and her mother. The infant responded well to vitamin B12

administration, with improvement in the general symptoms and in the haematologic manifestations,muscular hypotonia and psychomotor development.

Key words: Vegetarianism, vegan, vitamin B12 deficiency, infant, nutrition.

∞’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹,µÂÓÈ˙¤ÏÂÈÔ ¡ÔÛÔÎÔÌÂ›Ô∏Ú·ÎÏÂ›Ô˘, ∫Ú‹ÙË


∞ÁÁÂÏ¿ÎÔ˘ µ·ÛÈÏÈÎ‹ [email protected] °Ô‡ÚÓÂ˜ ∆ÂÌ¤ÓÔ˘˜ ∆.∫. 715 00, ∏Ú¿ÎÏÂÈÔ ∫Ú‹ÙË˜

1st Paediatric Clinic,Venizelion General Hospital of Heraklion, Crete

Correspondence:

V. Aggelakou [email protected] Gournes Temenous 715 00, Heraklion, Crete

∂ÈÛ·ÁˆÁ‹

∆· Î‡ÚÈ· ·›ÙÈ· ·ÓÂ¿ÚÎÂÈ·˜ ‚ÈÙ·Ì›ÓË˜ µ12

(∞µµ12) ÛÙ· ·È‰È¿ ‰È·ÈÚÔ‡ÓÙ·È ÛÂ ÙÚÂÈ˜ Î·ÙË-ÁÔÚ›Â˜: ÌÂÈˆÌ¤ÓË ÚfiÛÏË„Ë, ·ÓÒÌ·ÏË ·ÔÚ-ÚfiÊËÛË Î·È ÂÓ‰ÔÁÂÓÂ›˜ ‰È·Ù·Ú·¯¤˜ ÙË˜ ÌÂÙ·-ÊÔÚ¿˜ Î·È ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙË˜ ‚ÈÙ·Ì›ÓË˜ µ12

(µµ12 ) (¶›Ó·Î·˜ 1, ∂ÈÎfiÓ· 1) (1). ∞Ó Î·È Ë∞µµ12 ÛÙ· ·È‰È¿ ÛÙÈ˜ ·ÓÂÙ˘ÁÌ¤ÓÂ˜ ¯ÒÚÂ˜ÌÔÚÂ› Ó· ÔÊÂ›ÏÂÙ·È ÛÂ ÂÈ‰ÈÎ¤˜ ‰›·ÈÙÂ˜ (.¯.·ÛıÂÓÂ›˜ ÌÂ Ê·ÈÓ˘ÏÎÂÙÔÓÔ˘Ú›· ‹ ÁÏ˘ÎÔÁÔÓ›·ÛËIb) ‹ ÛÂ ÂËÚÂ·ÛÌ¤ÓË ·ÔÚÚfiÊËÛË (.¯. ÎÔÈ-ÏÈÔÎ¿ÎË ‹ ¯ÂÈÚÔ˘ÚÁÈÎ¤˜ ÂÂÌ‚¿ÛÂÈ˜ ÛÙÔ ÛÙÔ-Ì¿¯È ‹ ÙÔ ¤ÓÙÂÚÔ), ÔÈ ÂÚÈÛÛfiÙÂÚÂ˜ ÂÚÈÙÒ-

ÛÂÈ˜ ∞µµ12 Ô˘ ÂÚÈÁÚ¿ÊÔÓÙ·È ÛÙË ‚È‚ÏÈÔÁÚ·-Ê›· ·ÊÔÚÔ‡Ó ÛÂ ıËÏ¿˙ÔÓÙ· ‚Ú¤ÊË ÌËÙ¤ÚˆÓ ÌÂ∞µµ12 (2). ∏ ∞µµ12 ÙˆÓ ıËÏ·˙Ô˘ÛÒÓ ÌËÙ¤ÚˆÓÛ˘Ó‹ıˆ˜ ÔÊÂ›ÏÂÙ·È ÛÂ ·˘ÛÙËÚ‹ ¯ÔÚÙÔÊ·Á›·(veganism), Ë ÔÔ›· ·ÔÎÏÂ›ÂÈ Ï‹Úˆ˜ Ù· ÙÚfi-ÊÈÌ· ˙ˆÈÎ‹˜ ÚÔ¤ÏÂ˘ÛË˜ (ÎÚ¤·˜, „¿ÚÈ, ·˘Á¿,Á¿Ï· Î·È ¿ÏÏ· ˙ˆÈÎ¿ ÚÔ˚fiÓÙ·) ·fi ÙË ‰È·ÙÚÔ-Ê‹ (2). ∏ ¯ÔÚÙÔÊ·Á›· (vegetarianism) Â›Ó·È ÛÈ-ÙÈÛÙÈÎ‹ Ú·ÎÙÈÎ‹ ÛÂ ÔÏÏ¤˜ ÂÚÈÔ¯¤˜ ÙÔ˘Ï·Ó‹ÙË, fiˆ˜ Ë πÓ‰›·, ÙÔ ªÂÍÈÎfi, Ë ∫ÂÓÙÚÈ-Î‹ Î·È ¡fiÙÈ· ∞ÌÂÚÈÎ‹ Î·È ÔÚÈÛÌ¤ÓÂ˜ ÂÚÈÔ¯¤˜ÙË˜ ∞ÊÚÈÎ‹˜ (3). √ ÊÈÏfiÛÔÊÔ˜ ¶˘ı·ÁfiÚ·˜‹Ù·Ó ·fi ÙÔ˘˜ ÚÒÙÔ˘˜ ˘ÔÛÙËÚÈÎÙ¤˜ ÙË˜

¯ÔÚÙÔÊ·Á›·˜ ÛÙË ¢‡ÛË (4). ™ÙÈ˜ ‰ÂÎ·ÂÙ›Â˜ ÙÔ˘ 1960

Î·È 1970 ¿Ú¯ÈÛÂ Ó· ·˘Í¿ÓÂÙ·È ÙÔ ÔÛÔÛÙfi ÙˆÓ ¯ÔÚ-

ÙÔÊ¿ÁˆÓ ÛÙËÓ ∂˘ÚÒË Î·È ÙÈ˜ ∏¶∞ ÏfiÁˆ ıÚËÛÎÂ˘-

ÙÈÎÒÓ, ÊÈÏÔÛÔÊÈÎÒÓ Î·È ÔÈÎÔÏÔÁÈÎÒÓ ÂÔÈı‹ÛÂˆÓ,

·ÏÏ¿ Î·È ÁÈ· ÏfiÁÔ˘˜ ‚ÂÏÙ›ˆÛË˜ ÙË˜ ˘ÁÂ›·˜ (4). ¶·-

Ú¿ÏÏËÏ·, Ê·›ÓÂÙ·È Ó· ·˘Í¿ÓÂÈ Î·È ÙÔ ÔÛÔÛÙfi ÙˆÓ

·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ Ô˘ ·ÎÔÏÔ˘ıÔ‡Ó ¯ÔÚÙÔÊ·ÁÈÎ‹

‰È·ÙÚÔÊ‹, Û˘Ó‹ıˆ˜ ÏfiÁˆ ¯ÔÚÙÔÊ·Á›·˜ ÙˆÓ ÁÔÓ¤ˆÓ

(5). ∏ ÌË ÈÛÔÚÚÔËÌ¤ÓË ¯ÔÚÙÔÊ·ÁÈÎ‹ ‰È·ÙÚÔÊ‹

ÌÔÚÂ› Ó· Ô‰ËÁ‹ÛÂÈ ÛÂ ÌÂÈˆÌ¤ÓË ÚfiÛÏË„Ë ÂÓ¤Ú-

ÁÂÈ·˜, ÚˆÙÂ˚ÓÒÓ, ‚ÈÙ·ÌÈÓÒÓ (Î˘Ú›ˆ˜ µ12 Î·È D) Î·È

È¯ÓÔÛÙÔÈ¯Â›ˆÓ fiˆ˜ Fe, Ca Î·È Zn (4). ∏ ∞µµ12 Â›Ó·È

Û˘¯Ó‹ ÛÙÔ˘˜ ·˘ÛÙËÚ¿ ¯ÔÚÙÔÊ¿ÁÔ˘˜ (vegan) (3). ∏

‰È¿ÁÓˆÛ‹ ÙË˜ ÌÔÚÂ› Ó· ‰È·Ê‡ÁÂÈ ‹ Ó· Î·ı˘ÛÙÂÚ‹-

ÛÂÈ ÂÂÈ‰‹ Ù· Û˘ÌÙÒÌ·Ù¿ ÙË˜ ‰ÂÓ Â›Ó·È ÂÈ‰ÈÎ¿. √È

Û˘ÓËı¤ÛÙÂÚÂ˜ ÂÎ‰ËÏÒÛÂÈ˜ ÙË˜ ∞µµ12 ÂÚÈÏ·Ì‚¿-

ÓÔ˘Ó Á·ÛÙÚÂÓÙÂÚÈÎ¤˜ ‰È·Ù·Ú·¯¤˜ Î·È ÓÂ˘ÚÔÏÔÁÈÎ¿

Û˘ÌÙÒÌ·Ù·, Ù· ÔÔ›· ÌÔÚÂ› Ó· Â›Ó·È ·ÚÔ‰ÈÎ¿ ‹

ÌfiÓÈÌ· (6-9).


£‹Ï˘ ‚Ú¤ÊÔ˜, ËÏÈÎ›·˜ 12 ÌËÓÒÓ, ÚÔÛÎÔÌ›ÛÙËÎÂ

ÛÙËÓ ÎÏÈÓÈÎ‹ ÏfiÁˆ ·ÓÔÚÂÍ›·˜, ÓˆıÚfiÙËÙ·˜, ÂÌ¤ÙˆÓ,

ˆ¯ÚÔÎ›ÙÚÈÓË˜ ¯ÚÔÈ¿˜ ‰¤ÚÌ·ÙÔ˜ Î·È ·ÒÏÂÈ·˜ ‚¿ÚÔ˘˜.

√È ÁÔÓÂ›˜ ÙÔ˘ Â›Ó·È ·˘ÛÙËÚÒ˜ ¯ÔÚÙÔÊ¿ÁÔÈ ·fi

20ÂÙ›·˜ ÏfiÁˆ ıÚËÛÎÂ˘ÙÈÎÒÓ ÂÔÈı‹ÛÂˆÓ. ∆Ô ‚Ú¤-

ÊÔ˜ Â›Ó·È ÙÔ ÚÒÙÔ ·È‰› ÙË˜ ÔÈÎÔÁ¤ÓÂÈ·˜. °ÂÓÓ‹ıË-

ÎÂ ÌÂÙ¿ ·fi Ê˘ÛÈÔÏÔÁÈÎ‹ ÙÂÏÂÈfiÌËÓË Î‡ËÛË, ÌÂ Ê˘-

ÛÈÔÏÔÁÈÎfi ÙÔÎÂÙfi Î·È ÌÂ ‚¿ÚÔ˜ Á¤ÓÓËÛË˜ 3820 g. ∆Ô

‚Ú¤ÊÔ˜ ÙÚÂÊfiÙ·Ó ·ÔÎÏÂÈÛÙÈÎ¿ ÌÂ ÌËÙÚÈÎfi ıËÏ·-

ÛÌfi ¤ˆ˜ ÙËÓ ËÏÈÎ›· ÙˆÓ 8,5 ÌËÓÒÓ, ÂÓÒ ÛÙË Û˘Ó¤¯ÂÈ·

ÚÔÛÙ¤ıËÎ·Ó ÛÙË ‰È·ÙÚÔÊ‹ ÙÔ˘ Á¿Ï· ÛfiÁÈ·˜, Ê˘ÙÈ-

Î¤˜ ÙÚÔÊ¤˜ Î·È ÊÚÔ‡Ù·, ·fi Ù· ÔÔ›· ÂÏ¿Ì‚·ÓÂ

ÂÏ¿¯ÈÛÙÂ˜ ÔÛfiÙËÙÂ˜. ∆Ô ‚Ú¤ÊÔ˜ Â›¯Â Ê˘ÛÈÔÏÔÁÈÎ‹

ÛˆÌ·ÙÈÎ‹ ·Ó¿Ù˘ÍË Ì¤¯ÚÈ ÙËÓ ËÏÈÎ›· ÙˆÓ 6 ÌËÓÒÓ.

∞fi ·˘Ù‹ ÙËÓ ËÏÈÎ›· ·ÚÔ˘Û›·ÛÂ ÌÂÈˆÌ¤ÓË fiÚÂÍË,

ÂÓÒ ·fi ÙÔÓ ¤Ó·ÙÔ Ì‹Ó· Î·ıËÌÂÚÈÓÔ‡˜ ÂÌ¤ÙÔ˘˜ (1-

2 ËÌÂÚËÛ›ˆ˜) Î·È ·ÒÏÂÈ· ‚¿ÚÔ˘˜. ™‡ÌÊˆÓ· ÌÂ ÙÈ˜

ÏËÚÔÊÔÚ›Â˜ ÙˆÓ ÁÔÓ¤ˆÓ, Î·Ù¿ ÙÔ˘˜ ÚÒÙÔ˘˜ Ì‹ÓÂ˜

ÙË˜ ˙ˆ‹˜ ÙÔ ‚Ú¤ÊÔ˜ Â›¯Â ÔÌ·Ï‹ „˘¯ÔÎÈÓËÙÈÎ‹ ÂÍ¤ÏÈ-

ÍË. ™Â ËÏÈÎ›· 10 ÌËÓÒÓ, ÙÔ ‚Ú¤ÊÔ˜ ÌÔÚÔ‡ÛÂ Ó· Î¿-

ıÂÙ·È ÛÙ·ıÂÚ¿ Î·È Ó· ÛÙ¤ÎÂÙ·È fiÚıÈÔ ÎÚ·ÙÒÓÙ·˜

¤ÈÏ·, Ó· È¿ÓÂÈ ·ÓÙÈÎÂ›ÌÂÓÔ ÌÂ ‰Â›ÎÙË-·ÓÙ›¯ÂÈÚ·,

Ó· Û˘Ó‰˘¿˙ÂÈ ‰‡Ô Û˘ÏÏ·‚¤˜, ÂÓÒ Ë ·ÓÙ›ÏË„Ë Î·È Ë

55™ÈÙÈÔÁÂÓ‹˜ ·ÓÂ¿ÚÎÂÈ· ‚ÈÙ·Ì›ÓË˜ µ12 ÛÂ ‚Ú¤ÊÔ˜

¶·È‰È·ÙÚÈÎ‹ 2007;70:54-59

¶›Ó·Î·˜ 1. ∞›ÙÈ· ·ÓÂ¿ÚÎÂÈ·˜ ‚ÈÙ·Ì›ÓË˜ µ12 ÛÙ· ·È‰È¿

ªÂÈˆÌ¤ÓË ÚfiÛÏË„Ë ñ ÃÔÚÙÔÊ·ÁÈÎ‹ ‰›·ÈÙ· ñ £ËÏ¿˙ÔÓÙ· ‚Ú¤ÊË ·fi ÌËÙ¤ÚÂ˜ ÌÂ ·ÓÂ¿ÚÎÂÈ· µµ12 ÏfiÁˆ

Î·ÎÔ‹ıÔ˘˜ ·Ó·ÈÌ›·˜, ¯ÔÚÙÔÊ·ÁÈÎ‹˜ ‰›·ÈÙ·˜, ÂÁ¯Â›ÚËÛË˜·Ú¿Î·Ì„Ë˜ ÙÔ˘ ÛÙÔÌ¿¯Ô˘, Ï‹„Ë˜ ·Ó·ÛÙÔÏ¤ˆÓ ÙË˜·ÓÙÏ›·˜ ÚˆÙÔÓ›ˆÓ

ñ ÕÏÏÂ˜ ‰›·ÈÙÂ˜, .¯. ÌË ÛˆÛÙ‹ ‰›·ÈÙ· ÛÂ Ê·ÈÓ˘ÏÎÂÙÔÓÔ˘Ú›· ∞ÓÒÌ·ÏË ·ÔÚÚfiÊËÛË ñ ∞Ô˘Û›·/‰˘ÛÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ÂÓ‰ÔÁÂÓ‹ ·Ú¿ÁÔÓÙ· Ô˘

·Ú¿ÁÂÙ·È ·fi Ù· ÙÔÈ¯ˆÌ·ÙÈÎ¿ Î‡ÙÙ·Ú· ÙÔ˘ ÛÙÔÌ¿¯Ô˘,ÏfiÁˆ: - ∞Ê·›ÚÂÛË˜ ÙÔ˘ ÛÙÔÌ¿¯Ô˘- ∞˘ÙÔ¿ÓÔÛË˜ Î·ÎÔ‹ıÔ˘˜ ·Ó·ÈÌ›·˜

ñ ªÂÈˆÌ¤ÓË ÔÛfiÙËÙ· Á·ÛÙÚÈÎÔ‡ ÔÍ¤Ô˜ - ¶·Ú·ÙÂÙ·Ì¤ÓË ıÂÚ·Â›· ÌÂ ·Ó·ÛÙÔÏÂ›˜ ÙË˜ ·ÓÙÏ›·˜

ÚˆÙÔÓ›ˆÓñ ¶·ÁÎÚÂ·ÙÈÎ‹ ·ÓÂ¿ÚÎÂÈ· ñ ∞ÓÙ·ÁˆÓÈÛÌfi˜ ÁÈ· µµ12 ÛÙÔ ¤ÓÙÂÚÔ

- ¶·Ú·ÛÈÙÈÎ¤˜ ÏÔÈÌÒÍÂÈ˜ - ÀÂÚ·Ó¿Ù˘ÍË ‚·ÎÙËÚÈ‰›ˆÓ

ñ ¢È·Ù·Ú·¯‹ ÙË˜ ·ÔÚÚfiÊËÛË˜ Î·Ù¿ Ì‹ÎÔ˜ ÙÔ˘ ÂÈÏÂÔ‡ - ¡fiÛÔ˜ Crohn - ∫ÔÈÏÈÔÎ¿ÎË - ÃÂÈÚÔ˘ÚÁÈÎ¤˜ ÂÂÌ‚¿ÛÂÈ˜ ÛÙÔÓ ÂÈÏÂfi - ∞ÓˆÌ·Ï›· ÙÔ˘ ˘Ô‰Ô¯¤· ÛÙÔÓ ÂÈÏÂfi

(ÓfiÛÔ˜ Imerslund-Grasbeck) ∂Ó‰ÔÁÂÓÂ›˜ ‰È·Ù·Ú·¯¤˜ ÙË˜ ÌÂÙ·ÊÔÚ¿˜ Î·È ÙÔ˘ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙË˜ µµ12

ñ ¢È·Ù·Ú·¯‹ ÛÙË ÌÂÙ·ÊÔÚ¿ - ∞ÓÂ¿ÚÎÂÈ· ÙÚ·ÓÛÎÔ‚·Ï·Ì›ÓË˜ ππ - ∞ÓÂ¿ÚÎÂÈ· ÙˆÓ R-binder ÚˆÙÂ˚ÓÒÓ

ñ ¢È·Ù·Ú·¯‹ ÌÂÙ·‚ÔÏÈÛÌÔ‡ - ∞ÓÂ¿ÚÎÂÈ· ·‰ÂÓÔÛ˘ÏÎÔ‚·Ï·Ì›ÓË˜:

ÓfiÛÔ˜ cblA Î·È cblµ- ∞ÓÂ¿ÚÎÂÈ· ÌÂı˘ÏÎÔ‚·Ï·Ì›ÓË˜:

ÓfiÛÔ˜ cblE Î·È cblG - ™˘Ó‰˘·ÛÌ¤ÓË ·ÓÂ¿ÚÎÂÈ· ·‰ÂÓÔÛ˘ÏÎÔ‚·Ï·Ì›ÓË˜ Î·È

ÌÂı˘ÏÎÔ‚·Ï·Ì›ÓË˜: cblC, cblD Î·È cblF

∂ÈÎfiÓ· 1. ∞ÔÚÚfiÊËÛË Î·È ÌÂÙ·‚ÔÏÈÛÌfi˜ ÙË˜ ‚ÈÙ·Ì›ÓË˜ µ12.

™ÙfiÌ·∂ÏÂ‡ıÂÚË µ12 ÌÔÚÂ› Ó· ·ÔÚÚÔÊËıÂ› ˘ÔÁÏÒÛÛÈ·

◊·Ú∏ µ12 ·ÔıËÎÂ‡ÂÙ·È Î·È ÂÎÎÚ›ÓÂÙ·È ÛÙÔ ¤ÓÙÂÚÔ ÌÂ ÙË ¯ÔÏ‹ ·fi fiÔ˘ Î·È Â·Ó·ÚÚÔÊ¿Ù·È

∞›Ì·∏ ÙÚ·ÓÛÎÔ‚·Ï·Ì›ÓË ππ ÌÂÙ·-Ê¤ÚÂÈ ÙË µ12 ÛÙÔ˘˜ ÈÛÙÔ‡˜fiÔ˘ ¯ÚËÛÈÌÔÔÈÂ›Ù·È Î·ÈÛÙÔ ‹·Ú fiÔ˘ ·ÔıËÎÂ‡Â-Ù·È ÛÙËÓ ÙÚ·ÓÛÎÔ‚·Ï·Ì›ÓËπππ

™ÙÔÌ¿¯Èñ ŒÓ˙˘Ì· Î·È ÔÍ¤· ·ÔÛ˘Ó‰¤Ô˘Ó

ÙË µ12 ·fi ÙÈ˜ ÚˆÙÂ˝ÓÂ˜

ñ R-ÚˆÙÂ˝ÓÂ˜ ‰ÂÛÌÂ‡Ô˘Ó ÙË µ12

ñ ŒÎÎÚÈÛË ÙÔ˘ ÂÓ‰ÔÁÂÓ‹·Ú¿ÁÔÓÙ· (IF)

∞ÓÒÙÂÚÔ ÏÂÙfi ¤ÓÙÂÚÔñ R-ÚˆÙÂ˝ÓÂ˜ ·Ô‰ÂÛÌÂ‡Ô˘Ó

ÙË µ12

ñ IF ‰ÂÛÌÂ‡ÂÈ ÙË µ12

∫·ÙÒÙÂÚÔ ÏÂÙfi ¤ÓÙÂÚÔ∆Ô Û‡ÌÏÂÁÌ· IF- µ12 Û˘Ó‰¤ÂÙ·ÈÛÙÔÓ IF- µ12 ˘Ô‰Ô¯¤· ÛÙ·ÂÓÙÂÚÈÎ¿ Î‡ÙÙ·Ú·

∂ÓÙÂÚÈÎ¿ Î‡ÙÙ·Ú·∏ µ12 Û˘Ó‰¤ÂÙ·È ÛÙËÓÙÚ·ÓÛÎÔ‚·Ï·Ì›ÓË ππ

ÎÔÈÓˆÓÈÎfiÙËÙ· ‹Ù·Ó Û˘Ì‚·Ù¤˜ ÌÂ ÙËÓ ËÏÈÎ›· ÙÔ˘.

∞fi ÙËÓ ËÏÈÎ›· ÙˆÓ 10 ÌËÓÒÓ, Ë Î·Ù¿ÛÙ·ÛË ÙÔ˘ ‚Ú¤-

ÊÔ˘˜ ·ÚÔ˘Û›·ÛÂ ÛÙ·‰È·Î‹ ÂÈ‰Â›ÓˆÛË ÌÂ ÓˆıÚfi-

ÙËÙ·, ÌÂÈˆÌ¤ÓË ÎÈÓËÙÈÎfiÙËÙ·, ·‰˘Ó·Ì›· Ó· ÛÙ¤ÎÂÙ·È

ÁÈ· ·ÚÎÂÙ‹ ÒÚ· fiÚıÈÔ, ÂÓÒ ·Ú¿ÏÏËÏ· ÙÔ ·È‰› ÛÙ·-

Ì¿ÙËÛÂ Ó· ¯·ÌÔÁÂÏ¿ Î·È ·ÚÔ˘Û›·ÛÂ ¤ÓÙÔÓË ˆ¯ÚÔ-

Î›ÙÚÈÓË ¯ÚÔÈ¿ ‰¤ÚÌ·ÙÔ˜, ÛÙÔÌ·Ù›ÙÈ‰· Î·È ‰˘ÛÎÔÏ›·

ÛÙË Û›ÙÈÛË.

∫·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô ÙÔ ‚Ú¤-

ÊÔ˜ ‹Ù·Ó ÛÂ ÂËÚÂ·ÛÌ¤ÓË ÁÂÓÈÎ‹ Î·Ù¿ÛÙ·ÛË, Óˆ-

ıÚfi Î·È Â›¯Â ÌÂÈˆÌ¤ÓË ıÚ¤„Ë. ∆Ô ‚¿ÚÔ˜ ‹Ù·Ó 7300

g (<3Ë ∂.£.), ÂÓÒ ÙÔ Ì‹ÎÔ˜ Î·È Ë ÂÚ›ÌÂÙÚÔ˜ ÎÂÊ·-

Ï‹˜ ‹Ù·Ó ÛÙËÓ 50‹ ∂.£. Î·È ÌÂÙ·Í‡ 25Ë˜-50‹˜ ∂.£.,

·ÓÙ›ÛÙÔÈ¯·. ∂›¯Â ˆ¯ÚÔÎ›ÙÚÈÓË ¯ÚÔÈ¿ ‰¤ÚÌ·ÙÔ˜, Ë ·Ú-

ÙËÚÈ·Î‹ ›ÂÛË ‹Ù·Ó 95/51 mmHg Î·È Ë Î·Ú‰È·Î‹

Û˘¯ÓfiÙËÙ· 163 ÛÊ‡ÍÂÈ˜/min. ∞fi ÙËÓ ·‰Ú‹ ÓÂ˘ÚÔ-

ÏÔÁÈÎ‹ ÂÎÙ›ÌËÛË ·ÚÔ˘Û›·˙Â ÁÂÓÈÎÂ˘Ì¤ÓË Ì˘˚Î‹

˘ÔÙÔÓ›·, ÂÓÒ ·fi Ù· ˘fiÏÔÈ· Û˘ÛÙ‹Ì·Ù· ‰ÂÓ Â›-

¯Â ·ıÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù·. ∞fi ÙË ÁÂÓÈÎ‹ ÂÍ¤Ù·ÛË

·›Ì·ÙÔ˜ ‰È·ÈÛÙÒıËÎÂ ÛÔ‚·Ú‹ ·Ó·ÈÌ›· ÌÂ Hb: 5,2

g/dl, Ht: 15,2%, Ì¤ÛÔ fiÁÎÔ ÂÚ˘ıÚÒÓ (MCV): 109 fl,

Ì¤ÛË ÔÛfiÙËÙ· ·ÈÌÔÛÊ·ÈÚ›ÓË˜ (MCH): 37,6 pg,

ÏÂ˘Î¿ ·ÈÌÔÛÊ·›ÚÈ·: 6,72 K/Ìl, ·ÈÌÔÂÙ¿ÏÈ·: 207

K/Ìl Î·È ‰ÈÎÙ˘ÔÂÚ˘ıÚÔÎ‡ÙÙ·Ú·: 4,3%. ∏ ÌÔÚÊÔÏÔ-

Á›· ÙˆÓ ÂÚ˘ıÚÒÓ ¤‰ÂÈÍÂ ·ÓÈÛÔÎ˘ÙÙ¿ÚˆÛË, ÔÈÎÈÏÔ-

Î˘ÙÙ¿ÚˆÛË, Ì·ÎÚÔÎ˘ÙÙ¿ÚˆÛË, ‚·ÛÂfiÊÈÏË ÛÙ›ÍË Î·È

‰·ÎÚ˘ÔÎ‡ÙÙ·Ú·, ÛÙÔÈ¯Â›· Ô˘ Û˘ÓËÁÔÚÔ‡Ó ˘¤Ú

ÌÂÁ·ÏÔ‚Ï·ÛÙÈÎ‹˜ ·Ó·ÈÌ›·˜. √ ˘fiÏÔÈÔ˜ ÂÚÁ·ÛÙË-

ÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍÂ: ÁÏ˘Îfi˙Ë: 83 mg/dl, Ô˘Ú›·: 19

mg/dl, ÎÚÂ·ÙÈÓ›ÓË: 0,3 mg/dl, Na: 142 mEq/L, K: 4,4

mEq/L, Cl: 102 mEq/L, Ca: 8,9 mg/dl, Ph: 4,6 mg/dl,

Mg: 2,4 mg/dl, ÔÏÈÎ¿ ÏÂ˘ÎÒÌ·Ù· ÔÚÔ‡: 5,6 g/dl, ·Ï-

‚Ô˘Ì›ÓË: 3,7 g/dl, oÏÈÎ‹ ¯ÔÏÂÚ˘ıÚ›ÓË: 2,7 mg/dl,

¿ÌÂÛË ¯ÔÏÂÚ˘ıÚ›ÓË: 0,7 mg/dl, SGOT: 44U/L,

SGPT: 14U/L, Û›‰ËÚÔ˜ ÔÚÔ‡: 156 Ìg/dl, ÊÂÚÚÈÙ›ÓË

ÔÚÔ‡: 116 ng /ml, ‰ÔÎÈÌ·Û›· ‰ÚÂ¿ÓˆÛË˜ ·ÚÓËÙÈÎ‹,

¿ÌÂÛË Coombs ·ÚÓËÙÈÎ‹, Â¿ÚÎÂÈ· ÙÔ˘ ÂÓ˙‡ÌÔ˘

G6PD, Â›Â‰· ÙÔ˘ ‰È·Ï˘ÙÔ‡ ˘Ô‰Ô¯¤· ÙË˜ ÙÚ·Ó-

ÛÊÂÚ›ÓË˜ (sTfR): 2,32 mg/l (Ê.Ù.: 0,83-1,76 mg/l),

Ê˘ÏÏÈÎfi ÔÍ‡: 17 ng /ml (Ê.Ù.: 5-17,5 ng/ml), ‚ÈÙ·Ì›-

ÓË µ12 ÔÚÔ‡: 102 pg/ml (Ê.Ù.: 120-970 pg/ml), LDH:

1460 πU/L, Ï‹ÚË ¤ÏÂÁ¯Ô ËÎÙÈÎfiÙËÙ·˜ Ê˘ÛÈÔÏÔÁÈ-

Îfi. ŒÁÈÓÂ ‚·ÚÈÔ‡¯Ô ÁÂ‡Ì·, Ô˘ ¤‰ÂÈÍÂ Ê˘ÛÈÔÏÔÁÈÎfi

ÛÙfiÌ·¯Ô Î·È ‰ˆ‰ÂÎ·‰¿ÎÙ˘ÏÔ. ∏ ÌËÙ¤Ú· ÙÔ˘ ‚Ú¤-

ÊÔ˘˜ Â›¯Â: ∏b: 12,6 g/dl, Ht: 37,9%, MCV: 87,9 fl,

MCH: 29,3 pg, ÏÂ˘Î¿ ·ÈÌÔÛÊ·›ÚÈ·: 6,80 K/Ìl Î·È

PLT: 287 K/Ìl, ‚ÈÙ·Ì›ÓË µ12: 112 pg/ml. ∆o ‚Ú¤ÊÔ˜

ÌÂÙ·ÁÁ›ÛÙËÎÂ ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ÌÂ 90

ml Û˘Ì˘ÎÓˆÌ¤ÓˆÓ ÂÚ˘ıÚÒÓ. §fiÁˆ ÙË˜ ¿ÚÓËÛË˜

Ï‹„Ë˜ ÙÚÔÊ‹˜ ÂÙ¤ıË ÚÈÓÔÁ·ÛÙÚÈÎfi˜ Î·ıÂÙ‹Ú·˜ Î·È

ÛÈÙÈ˙fiÙ·Ó ÌÂ ÌÂÚÈÎÒ˜ ˘‰ÚÔÏ˘Ì¤ÓÔ Á¿Ï·. ÃÔÚËÁ‹ıË-

ÎÂ ÂÓ‰ÔÌ˘˚ÎÒ˜ ˘‰ÚÔÍ˘ÎÔ‚·Ï·Ì›ÓË ÛÂ ‰fiÛË 250 Ìg

Î¿ıÂ 2 ËÌ¤ÚÂ˜ Â› 2 Â‚‰ÔÌ¿‰Â˜ Î·È ÛÙË Û˘Ó¤¯ÂÈ·

250 Ìg ·Ó¿ Â‚‰ÔÌ¿‰·. ∂›ÛË˜, ¯ÔÚËÁ‹ıËÎÂ Û›‰ËÚÔ˜

per os ÛÂ ‰fiÛË 3 mg/kg/24 h. ∞fi ÙÈ˜ ÚÒÙÂ˜ ËÌ¤ÚÂ˜

ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË ÙË˜ ıÂÚ·Â›·˜, ÙÔ ‚Ú¤ÊÔ˜ ·ÚÔ˘-

Û›·ÛÂ ‚ÂÏÙ›ˆÛË ÙÔ˘ Ì˘˚ÎÔ‡ ÙfiÓÔ˘ Î·È ÙË˜ ÎÈÓËÙÈÎfi-

ÙËÙ¿˜ ÙÔ˘. ÕÚ¯ÈÛÂ Ó· ¯·ÌÔÁÂÏ¿ Î·È Ó· ·›˙ÂÈ ÌÂ

ÙÔ˘˜ ÔÈÎÂ›Ô˘˜ ÙÔ˘. √ ÚÈÓÔÁ·ÛÙÚÈÎfi˜ Î·ıÂÙ‹Ú·˜

·Ê·ÈÚ¤ıËÎÂ Î·È ÙÔ ·È‰› ¿Ú¯ÈÛÂ Ó· ÛÈÙ›˙ÂÙ·È ·fi ÙÔ

ÛÙfiÌ·, ÌÂ ÛÙ·‰È·Î‹ ‚ÂÏÙ›ˆÛË ÙË˜ fiÚÂÍ‹˜ ÙÔ˘ Î·È

ÙË˜ ÚfiÛÏË„Ë˜ ‚¿ÚÔ˘˜. ¶¤ÓÙÂ Â‚‰ÔÌ¿‰Â˜ ÂÚ›Ô˘

·fi ÙËÓ ¤Ó·ÚÍË ÙË˜ ıÂÚ·Â›·˜ ÌÂ ˘‰ÚÔÍ˘ÎÔ‚·Ï·-

Ì›ÓË, Ë ÁÂÓÈÎ‹ ÂÍ¤Ù·ÛË ·›Ì·ÙÔ˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ‹

Î·È ÔÈ ÙÈÌ¤˜ ÙË˜ µµ12 ÛÙÔÓ ÔÚfi ‹Ù·Ó >1000 pg/ml. ∆Ô

·È‰› ¿Ú¯ÈÛÂ Ó· ÛÈÙ›˙ÂÙ·È ÌÂ ‰È·ÙÚÔÊ‹ Ô˘ ÂÚÈÂ-

Ï¿Ì‚·ÓÂ Á·Ï·ÎÙÔÎÔÌÈÎ¿ ÚÔ˚fiÓÙ·, ·ÏÏ¿ fi¯È „¿ÚÈ

Î·È ÎÚ¤·˜ (ÏfiÁˆ ¿ÚÓËÛË˜ ÙˆÓ ÁÔÓ¤ˆÓ). ∆Ô ‚¿ÚÔ˜

Â·Ó‹ÏıÂ ÛÂ Â›Â‰· ¿Óˆ ÙË˜ 50‹˜ ∂.£. ÁÈ· ÙËÓ

ËÏÈÎ›· ÙÔ˘ ·È‰ÈÔ‡. ™Â ËÏÈÎ›· 14 ÌËÓÒÓ ÂÚ·ÙÔ‡-

ÛÂ Î·ÓÔÓÈÎ¿ Î·È ¿Ú¯ÈÛÂ Ó· Ï¤ÂÈ 2-3 Ï¤ÍÂÈ˜ ÌÂ ¤ÓÓÔÈ·.

∏ ·ÓÙ›ÏË„Ë Î·È Ë ÎÔÈÓˆÓÈÎfiÙËÙ¿ ÙÔ˘ ‹Ù·Ó Ê˘ÛÈÔ-

ÏÔÁÈÎ¤˜. ∏ ·Ú·ÎÔÏÔ‡ıËÛË ÙÔ˘ ·È‰ÈÔ‡ Û˘ÓÂ¯›-

ÛÙËÎÂ Ì¤¯ÚÈ ÙËÓ ËÏÈÎ›· ÙˆÓ 16 ÌËÓÒÓ, ÔfiÙÂ Ë ÔÈ-

ÎÔÁ¤ÓÂÈ· ÌÂÙ·ÎfiÌÈÛÂ ÛÙÔ ÂÍˆÙÂÚÈÎfi.

™˘˙‹ÙËÛË

∏ µµ12 ‰ÂÓ ·Ú¿ÁÂÙ·È ÛÙÔÓ ·ÓıÚÒÈÓÔ ÔÚÁ·ÓÈ-

ÛÌfi Î·È ËÁ¤˜ ÙË˜ Â›Ó·È ·ÔÎÏÂÈÛÙÈÎ¿ ÔÈ ˙ˆÈÎ¤˜ ÙÚÔ-

Ê¤˜, fiˆ˜ ÙÔ ÎÚ¤·˜, ÙÔ „¿ÚÈ, Ù· ·˘Á¿ Î·È Ù· Á·Ï·-

ÎÙÔÎÔÌÈÎ¿ ÚÔ˚fiÓÙ·. √È ËÌÂÚ‹ÛÈÂ˜ ·Ó¿ÁÎÂ˜ ÛÂ µµ12

ÛÙ· ‚Ú¤ÊË ˘ÔÏÔÁ›˙ÔÓÙ·È ÛÂ 0,4 Ìg, ÛÙ· ·È‰È¿ ËÏÈ-

Î›·˜ 1-8 ÂÙÒÓ ÛÂ 1,1 Ìg, ÛÙ· ·È‰È¿ ËÏÈÎ›·˜ 9-13

ÂÙÒÓ ÛÂ 1,8 Ìg, ÛÙÔ˘˜ ÂÊ‹‚Ô˘˜ Î·È ÂÓ‹ÏÈÎÂ˜ ÛÂ 2,4

Ìg, ÂÓÒ ÛÙÈ˜ ÂÁÎ‡Ô˘˜ Î·È ıËÏ¿˙Ô˘ÛÂ˜ Á˘Ó·›ÎÂ˜ ÔÈ

·Ó¿ÁÎÂ˜ ·˘Í¿ÓÔÓÙ·È ÛÂ 2,8 Ìg (3). ∆· Ë·ÙÈÎ¿ ·Ô-

ı¤Ì·Ù· ÙˆÓ ÂÓËÏ›ÎˆÓ Ô˘ Î·Ù·Ó·ÏÒÓÔ˘Ó ˙ˆÈÎ¤˜

ÙÚÔÊ¤˜ Â›Ó·È ÂÚ›Ô˘ 3-5 mg µ12 , ÂÓÒ Î·Ù¿ ÙË Á¤Ó-

ÓËÛË ˘¿Ú¯Ô˘Ó ÌÈÎÚ¿ ·Ôı¤Ì·Ù·, ÂÚ›Ô˘ 25Ìg.

∆· ·Ôı¤Ì·Ù· ·˘Ù¿ Â›Ó·È ÌÈÎÚfiÙÂÚ· Â¿Ó Ë ÌËÙ¤Ú·

ÙÔ˘ ÓÂÔÁÓÔ‡ ¤¯ÂÈ ∞µµ12 ÛÙË ‰È¿ÚÎÂÈ· ÙË˜ Î‡ËÛË˜

(7). ∂¿Ó ÏËÊıÔ‡Ó ˘’ fi„ÈÓ ÔÈ ËÌÂÚ‹ÛÈÂ˜ ·Ó¿ÁÎÂ˜

ÙˆÓ ÂÓËÏ›ÎˆÓ ÛÂ µµ12 ÛÂ Û¯¤ÛË ÌÂ Ù· ·Ôı¤Ì·Ù¿

ÙÔ˘˜, ÌÔÚÂ› Ó· Á›ÓÂÈ Î·Ù·ÓÔËÙfi ÁÈ·Ù› ·˘ÛÙËÚÒ˜

¯ÔÚÙÔÊ¿ÁÔÈ ÂÓ‹ÏÈÎÂ˜ Î·ı˘ÛÙÂÚÔ‡Ó ÔÏÏ¿ ¯ÚfiÓÈ· Ó·

ÂÌÊ·Ó›ÛÔ˘Ó Û˘ÌÙÒÌ·Ù· ∞µµ12 ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË

¯ÔÚÙÔÊ·ÁÈÎ‹˜ ‰›·ÈÙ·˜. ∆· ÓÂÔÁÓ¿, ·ÓÙ›ıÂÙ·, ÏfiÁˆ

ÙˆÓ ÌÈÎÚÒÓ ·ÔıÂÌ¿ÙˆÓ ÙÔ˘˜ ÛÂ µµ12 , ÂÌÊ·Ó›˙Ô˘Ó

Û˘ÌÙÒÌ·Ù· ·ÓÂ¿ÚÎÂÈ·˜ Ì¤Û· ÛÂ Ï›ÁÔ˘˜ Ì‹ÓÂ˜,

ÛÙËÓ ÂÚ›ÙˆÛË Ô˘ Ë ÚfiÛÏË„Ë ‰ÂÓ Î·Ï‡ÙÂÈ ÙÈ˜

ËÌÂÚ‹ÛÈÂ˜ ·Ó¿ÁÎÂ˜ ÛÂ µµ12 (7). ™˘Ó‹ıˆ˜, ∞µµ12 ÂÌ-

Ê·Ó›˙Ô˘Ó Ù· ‚Ú¤ÊË Ô˘ ıËÏ¿˙Ô˘Ó ·ÔÎÏÂÈÛÙÈÎ¿ ÁÈ·

ÌÂÁ¿ÏÔ ‰È¿ÛÙËÌ· ·fi ·˘ÛÙËÚÒ˜ ¯ÔÚÙÔÊ¿ÁÔ˘˜ ÌË-

Ù¤ÚÂ˜, ÛÙÈ˜ ÔÔ›Â˜ ‰ÂÓ ¯ÔÚËÁÂ›Ù·È Û˘ÌÏËÚˆÌ·ÙÈÎ¿

µµ12. ∆· Â›Â‰· µµ12 ÛÙÔ ÌËÙÚÈÎfi Á¿Ï· ¤¯Ô˘Ó

ÁÚ·ÌÌÈÎ‹ Û˘Û¯¤ÙÈÛË ÌÂ ·˘Ù¿ ÙÔ˘ Ï¿ÛÌ·ÙÔ˜ Î·È



ÛÙÈ˜ ·˘ÛÙËÚÒ˜ ¯ÔÚÙÔÊ¿ÁÔ˘˜ ÌËÙ¤ÚÂ˜ ·˘Ù¿ ·ÓÂ˘Ú›-

ÛÎÔÓÙ·È ÔÏ‡ ¯·ÌËÏ¿ (1,2).

∆· Î‡ÚÈ· ÎÏÈÓÈÎ¿ Û˘ÌÙÒÌ·Ù· ÙË˜ Aµµ12 ÂÍËÁÔ‡-

ÓÙ·È ÏfiÁˆ ÙË˜ ÂÌÏÔÎ‹˜ ÙË˜ µµ12 ÛÂ ÛËÌ·ÓÙÈÎ¤˜ ÌÂ-

Ù·‚ÔÏÈÎ¤˜ ·ÓÙÈ‰Ú¿ÛÂÈ˜ (1) (∂ÈÎfiÓ· 1). ∏ µµ12 Â›Ó·È

Û˘Ó¤Ó˙˘ÌÔ ·Ó·ÁÎ·›Ô ÁÈ· ÙË ÌÂı˘Ï›ˆÛË ÙË˜ ÔÌÔÎ˘-

ÛÙÂ˝ÓË˜ ÛÂ ÌÂıÂÈÔÓ›ÓË, ÙË ÌÂÙ·ÙÚÔ‹ ÙÔ˘ ÌÂı˘ÏÌ·-

ÏÔÓ˘Ï-Û˘ÓÂÓ˙‡ÌÔ˘ ∞ ÛÂ ÛÔ˘ÎÈÓ˘Ï-Û˘Ó¤Ó˙˘ÌÔ ∞ Î·È

ÁÈ· ÙË Û‡ÓıÂÛË ÙÔ˘ ÙÂÙÚ·¸‰ÚÔÊ˘ÏÏÈÎÔ‡ ÔÍ¤Ô˜ ·fi

ÙÔ ÌÂı˘ÏÙÂÙÚ·¸‰ÚÔÊ˘ÏÏÈÎfi ÔÍ‡. ™Â ·ÛıÂÓÂ›˜ ÌÂ

Aµµ12 ·ıÚÔ›˙ÔÓÙ·È Úfi‰ÚÔÌÂ˜ Ô˘Û›Â˜, fiˆ˜ ÔÌÔÎ˘-

ÛÙÂ˝ÓË Î·È ÌÂı˘ÏÌ·ÏÔÓÈÎfi ÔÍ‡, ÔÈ ÔÔ›Â˜ ÌÔÚÂ› Ó·

ÚÔÛ‰ÈÔÚÈÛÙÔ‡Ó ÛÙÔÓ ÔÚfi Î·È ·ÔÙÂÏÔ‡Ó ÚÒÈÌÔ˘˜

Î·È ·ÍÈfiÈÛÙÔ˘˜ ‰Â›ÎÙÂ˜ Aµµ12 (1). ∏ ÌÂıÂÈÔÓ›ÓË Î·È

ÙÔ ÙÂÙÚ·¸‰ÚÔÊ˘ÏÏÈÎfi Â›Ó·È ··Ú·›ÙËÙÂ˜ Ô˘Û›Â˜ ÁÈ·

ÙË Û‡ÓıÂÛË DNA Î·È Ë ·ÓÂ¿ÚÎÂÈ¿ ÙÔ˘˜ Ô‰ËÁÂ› ÛÂ

‰È·Ù·Ú·¯¤˜ ÛÂ fiÏ· Ù· Ù·¯¤ˆ˜ ‰È·ÈÚÔ‡ÌÂÓ· Î‡ÙÙ·Ú·,

fiˆ˜ Â›Ó·È Ù· ·ÈÌÔÔÈËÙÈÎ¿ Î·È Ù· Î‡ÙÙ·Ú· ÙÔ˘ Á·-

ÛÙÚÂÓÙÂÚÈÎÔ‡ ‚ÏÂÓÓÔÁfiÓÔ˘. ªÂÁ·ÏÔ‚Ï·ÛÙÈÎ‹ ·Ó·È-

Ì›·, ÁÏˆÛÛ›ÙÈ‰· Î·È ÌÂÚÈÎ‹ ·ÙÚÔÊ›· ÙˆÓ Ï·¯ÓÒÓ Â›-

Ó·È Û˘¯Ó¤˜ ÂÎ‰ËÏÒÛÂÈ˜ ÙË˜ ∞µµ12 (9). ÕÏÏË ÌÂÙ·‚Ô-

ÏÈÎ‹ ·ÓÙ›‰Ú·ÛË Ô˘ ÂÍ·ÚÙ¿Ù·È ·fi ÙË µµ12 Â›Ó·È Ë

ÌÂÙ·ÙÚÔ‹ ÙÔ˘ ÌÂı˘ÏÌ·ÏÔÓÈÎÔ‡-CoA ÛÂ ÛÔ˘ÎÈÓ˘Ï-

CoA. ∏ ·ÓÂ·ÚÎ‹˜ ÌÂÙ·ÙÚÔ‹ ÙÔ˘ ÌÂı˘ÏÌ·ÏÔÓÈ-

ÎÔ‡-CoA Ô‰ËÁÂ› ÛÂ ·‡ÍËÛË ÙË˜ Úfi‰ÚÔÌË˜ Ô˘Û›·˜

ÚÔÈÔÓ˘Ï-CoA. ∏ ¿ıÚÔÈÛË ÌÂı˘ÏÌ·ÏÔÓÈÎÔ‡-CoA

Î·È ÚÔÈÔÓ˘Ï-CoA Ô‰ËÁÂ› ÛÂ Û‡ÓıÂÛË ·ÓÒÌ·ÏˆÓ

·Ï˘Û›‰ˆÓ ÏÈ·ÚÒÓ ÔÍ¤ˆÓ, ÔÈ ÔÔ›Â˜ Ô‰ËÁÔ‡Ó ÛÂ ÂÓ-

ÛˆÌ¿ÙˆÛË ÌÂÁ¿ÏˆÓ ÔÛÔÙ‹ÙˆÓ ·Û˘Ó‹ıÈÛÙˆÓ ÏÈ·-

ÚÒÓ ÔÍ¤ˆÓ C15 Î·È C17 ÛÙÔ ÙÔ›¯ˆÌ· ÙˆÓ ÓÂ‡ÚˆÓ. ∆Ô

·ÔÙ¤ÏÂÛÌ· Â›Ó·È ·ÔÌ˘ÂÏ›ÓˆÛË, ·ÍÔÓÈÎ‹ ÂÎÊ‡ÏÈÛË

Î·È ı¿Ó·ÙÔ˜ ÓÂ˘ÚÒÓˆÓ (7,8). ∆· ÓÂ˘ÚÔÏÔÁÈÎ¿ Â˘Ú‹-

Ì·Ù· ÛÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜ ·ÊÔÚÔ‡Ó Î˘Ú›ˆ˜ ÛÙÔ ÂÚÈÊÂÚÈ-

Îfi ÓÂ˘ÚÈÎfi Û‡ÛÙËÌ·, ÂÓÒ ÛÙ· ‚Ú¤ÊË ÛÙÔ ÎÂÓÙÚÈÎfi

ÓÂ˘ÚÈÎfi Û‡ÛÙËÌ· Î·È ·Ô‰›‰ÔÓÙ·È Î˘Ú›ˆ˜ ÛÙÈ˜ ·Óˆ-

Ù¤Úˆ ÌÂÙ·‚ÔÏÈÎ¤˜ ‰È·Ù·Ú·¯¤˜ (1), ¯ˆÚ›˜ fiÌˆ˜ Ó·

·ÔÎÏÂ›ÔÓÙ·È Î·È ¿ÏÏÔÈ ÌË¯·ÓÈÛÌÔ› (7,9). ∏ ·‡ÍËÛË

ÙË˜ ÔÌÔÎ˘ÛÙÂ˝ÓË˜ ıÂˆÚÂ›Ù·È ·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘

ÁÈ· ·ÔÊÚ·ÎÙÈÎ‹ ·ÁÁÂÈÔ¿ıÂÈ·, Û˘ÁÁÂÓ‹ Î·Ú‰ÈÔ¿-

ıÂÈ·, ÓfiÛÔ Alzheimer Î·È „˘¯ÒÛÂÈ˜ (2,3).

∏ ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· ÛÙ· ‚Ú¤ÊË ÌÂ ∞µµ12 Ô˘ ÂÚÈ-

ÁÚ¿ÊÔÓÙ·È ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· ·ÎÔÏÔ˘ıÂ› ¤Ó· ÛÙ·ıÂ-

Úfi ÌÔÓÙ¤ÏÔ. ∏ ÂÌÊ¿ÓÈÛË Û˘ÌÙˆÌ¿ÙˆÓ ·Ú¯›˙ÂÈ Û˘-

Ó‹ıˆ˜ ÛÙËÓ ËÏÈÎ›· ÙˆÓ 4-15 ÌËÓÒÓ, ÌÂÙ¿ ·fi Ì›·

ÂÚ›Ô‰Ô Ê˘ÛÈÔÏÔÁÈÎ‹˜ ·Ó¿Ù˘ÍË˜. ∆· ÚÒÙ· Û˘-

ÌÙÒÌ·Ù· Â›Ó·È ·ÓÔÚÂÍ›·, Â˘ÂÚÂıÈÛÙfiÙËÙ·, ·¿-

ıÂÈ·, ¤ÌÂÙÔÈ, ·‰‡Ó·ÌÔ ÎÏ¿Ì· Î·È Î·ı˘ÛÙ¤ÚËÛË ‹

·ÏÈÓ‰ÚfiÌËÛË ÛÙËÓ „˘¯ÔÎÈÓËÙÈÎ‹ ·Ó¿Ù˘ÍË. ∏ Ûˆ-

Ì·ÙÈÎ‹ ·Ó¿Ù˘ÍË ·Ú¯›˙ÂÈ Ó· ˘ÔÏÂ›ÂÙ·È, ÂÚÈÏ·Ì-

‚·ÓÔÌ¤ÓË˜ Î·È ÙË˜ ÂÚÈÌ¤ÙÚÔ˘ ÎÂÊ·Ï‹˜, Û˘¯Ó¿

˘¿Ú¯ÂÈ ˆ¯ÚfiÙËÙ· ‰¤ÚÌ·ÙÔ˜ Î·È ÁÏˆÛÛ›ÙÈ‰·, ÂÓÒ

ÌÔÚÂ› Ó· ÂÌÊ·ÓÈÛÙÔ‡Ó ÓÂ˘ÚÔÏÔÁÈÎ¿ Û˘ÌÙÒÌ·Ù·,

fiˆ˜ ˘ÔÙÔÓ›·, ÌÂÈˆÌ¤Ó· ÙÂÓfiÓÙÈ· ·ÓÙ·Ó·ÎÏ·ÛÙÈÎ¿

Î·È ¯ÔÚÈÔ·ıÂÙˆÛÈÎ¤˜ ÎÈÓ‹ÛÂÈ˜ Î·È, ÛÂ ÌÂÚÈÎ¤˜ ÂÚÈ-

ÙÒÛÂÈ˜, ÎÒÌ· Ë ·Ó·ÓÂ˘ÛÙÈÎ‹ ·ÓÂ¿ÚÎÂÈ· (9). √È

ÏÔÈ¤˜ ÎÏÈÓÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ ÙË˜ ∞µµ12 ·Ó·Ê¤ÚÔÓÙ·È

ÛÙÔÓ ¶›Ó·Î· 2 (1).

∏ ÁÂÓÈÎ‹ ÂÍ¤Ù·ÛË ·›Ì·ÙÔ˜ ÛÙ· ·È‰È¿ Û˘Ó‹ıˆ˜

·ÔÎ·Ï‡ÙÂÈ ·‡ÍËÛË ÙÔ˘ MCV Î·È MCH, ÂÓÒ Ù·

Â›Â‰· ÙË˜ Hb ÔÈÎ›ÏÏÔ˘Ó. ÕÏÏÔ Û˘¯Ófi Â‡ÚËÌ· ÛÙË

ÁÂÓÈÎ‹ ·›Ì·ÙÔ˜ Â›Ó·È Ë ˘ÂÚÎ·Ù¿ÙÌËÛË ÙÔ˘ ˘Ú‹Ó·

ÙˆÓ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ. √È ÌËÙ¤ÚÂ˜ ÙˆÓ ·Û¯fiÓÙˆÓ

‚ÚÂÊÒÓ Û˘Ó‹ıˆ˜ ‰ÂÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ì·ÎÚÔÎ˘ÙÙ·ÚÈ-

Î‹ ·Ó·ÈÌ›· Î·È Ù· Â›Â‰· ÙË˜ µµ12 Â›Ó·È ÛÙ· Î·ÙÒ-

ÙÂÚ· Ê˘ÛÈÔÏÔÁÈÎ¿ Â›Â‰·. °ÂÓÈÎ¿, ÔÈ ·˘ÛÙËÚÒ˜

¯ÔÚÙÔÊ¿ÁÔÈ ÂÓ‹ÏÈÎÂ˜ Û¿ÓÈ· ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÌÂÁ·ÏÔ-

‚Ï·ÛÙÈÎ‹ ·Ó·ÈÌ›·. ∆Ô ·Ú·¿Óˆ Û˘Ì‚·›ÓÂÈ ÏfiÁˆ

ÙˆÓ ˘„ËÏÒÓ ·ÔıÂÌ¿ÙˆÓ ÙÔ˘˜ ÛÂ Ê˘ÏÏÈÎfi ÔÍ‡, Ô˘

ÔÊÂ›ÏÂÙ·È ÛÙËÓ Â·ÚÎ‹ ÚfiÛÏË„Ë Ê˘ÙÈÎÒÓ ÙÚÔÊÒÓ,

·ÏÏ¿ Î·È ÛÙËÓ ¿ıÚÔÈÛË Ê˘ÏÏÈÎÔ‡ ÔÍ¤Ô˜ ÛÙÔ˘˜ ÈÛÙÔ‡˜

ÏfiÁˆ ÙË˜ ÌË ÌÂÙ·ÙÚÔ‹˜ ÙÔ˘ ÛÂ ÙÂÙÚ·¸‰ÚÔÊ˘ÏÏÈÎfi

ÔÍ‡ (∂ÈÎfiÓ· 2). ∫·Ù’ ·˘ÙfiÓ ÙÔÓ ÙÚfiÔ Û˘ÁÎ·Ï‡ÙÂ-

Ù·È Ë Ì·ÎÚÔÎ˘ÙÙ¿ÚˆÛË Ô˘ ·Ú·ÙËÚÂ›Ù·È ÛÙËÓ

∞µµ12. ∏ ÛÈ‰ËÚÔÂÓ›·, Ô˘ Â›Ó·È Û˘¯Ó‹ ÛÂ fiÏÂ˜ ÙÈ˜

ÌÔÚÊ¤˜ ¯ÔÚÙÔÊ·ÁÈÎ‹˜ ‰›·ÈÙ·˜, Â›Ó·È ¤Ó·˜ ¿ÏÏÔ˜ Ïfi-

ÁÔ˜ Ô˘ Û˘¯Ó¿ Û˘ÁÎ·Ï‡ÙÂÈ ÙË Ì·ÎÚÔÎ˘ÙÙ¿ÚˆÛË,

Ô‰ËÁÒÓÙ·˜ ÌÂÚÈÎ¤˜ ÊÔÚ¤˜ Ì¿ÏÈÛÙ· ÛÂ ÌÈÎÚÔÎ˘ÙÙ¿-

ÚˆÛË (10,11). ™ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ ·˘Ù¤˜, Ë Ì¤ÙÚËÛË

ÙÔ˘ ªª∞ ı¤ÙÂÈ ÙË ‰È¿ÁÓˆÛË ÙË˜ ∞µµ12. ™˘¯Ó¿ ÂÚÁ·-

ÛÙËÚÈ·Î¿ Â˘Ú‹Ì·Ù· ÙË˜ ∞µµ12 ÛÙ· ·È‰È¿ Â›Ó·È Ë ·‡-

ÍËÛË ÙË˜ ¤ÌÌÂÛË˜ ¯ÔÏÂÚ˘ıÚ›ÓË˜ Î·È ÙË˜ Á·Ï·ÎÙÈÎ‹˜

‰Â¸‰ÚÔÁÂÓ¿ÛË˜ (LDH) ÛÙÔÓ ÔÚfi, Ô˘ ·ÓÙ·Ó·ÎÏÔ‡Ó

ÙË ÌË ·Ô‰ÔÙÈÎ‹ ÂÚ˘ıÚÔÔ›ËÛË Î·È Î·Ù·ÛÙÚÔÊ‹

ÙˆÓ Úfi‰ÚÔÌˆÓ ÌÔÚÊÒÓ ÙˆÓ ÂÚ˘ıÚÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ

ÛÙÔÓ Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ. ™ÙËÓ ·ÂÈÎfiÓÈÛË ÙÔ˘ ∫¡™ ÌÂ

Ì·ÁÓËÙÈÎ‹ ÙÔÌÔÁÚ·Ê›· (MRI), ·ÓÂ˘Ú›ÛÎÂÙ·È Û˘¯Ó¿

ÂÁÎÂÊ·ÏÈÎ‹ ·ÙÚÔÊ›· Î·È Î·ı˘ÛÙ¤ÚËÛË ÛÙË Ì˘ÂÏ›Óˆ-

ÛË (1,7,9). ∆Ô ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ· (HE°)

ÌÔÚÂ› Ó· ‰Â›ÍÂÈ ‰È¿¯˘ÙË ÂÈ‚Ú¿‰˘ÓÛË ‹ ·Ô˘Û›·

ÙÔ˘ ‚·ÛÈÎÔ‡ Ú˘ıÌÔ‡ (1,7,9).

∏ ‰È¿ÁÓˆÛË ÙË˜ ∞µµ12 ÌÔÚÂ› Ó· Î·ı˘ÛÙÂÚ‹ÛÂÈ

‹ Ó· ‰È·Ê‡ÁÂÈ ÏfiÁˆ ¤ÏÏÂÈ„Ë˜ ÂÈ‰ÈÎÒÓ Û˘ÌÙˆÌ¿-

ÙˆÓ. ∏ Ì¤ÙÚËÛË ÙË˜ µµ12 ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ÙÔÓ

ÚÔÛ‰ÈÔÚÈÛÌfi ÙˆÓ ÂÈ¤‰ˆÓ ÙÔ˘ ªª∞ Î·È ÙË˜ ÔÏÈ-

Î‹˜ ÔÌÔÎ˘ÛÙÂ˝ÓË˜ ÛÙÔÓ ÔÚfi ıÂˆÚÂ›Ù·È fiÙÈ ·ÔÙÂ-

ÏÔ‡Ó ··Ú·›ÙËÙÂ˜ ÂÍÂÙ¿ÛÂÈ˜ Ô˘ ı¤ÙÔ˘Ó ÙË ‰È¿-

ÁÓˆÛË fiÙ·Ó ˘¿Ú¯Ô˘Ó Û˘ÌÙÒÌ·Ù· Ù· ÔÔ›· ÂÚÈ-

ÁÚ¿ÊÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2, ·ÏÏ¿ Î·È Î·Ù·ÛÙ¿ÛÂÈ˜

Ô˘ Û˘ÓÔ‰Â‡ÔÓÙ·È ·fi ∞µµ12 , fiˆ˜ Ê·›ÓÔÓÙ·È ÛÙÔÓ

¶›Ó·Î· 1 (1,12). ∏ ‰È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË ÌÂÙ·Í‡ ÙË˜

ÛÈÙÈÔÁÂÓÔ‡˜ ¤ÏÏÂÈ„Ë˜ µµ12 Î·È ÙˆÓ ÂÓ‰ÔÁÂÓÒÓ ‰È·-

Ù·Ú·¯ÒÓ ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙË˜ µµ12 Â›Ó·È ÛËÌ·ÓÙÈ-

Î‹, È‰È·›ÙÂÚ· ÛÙË ‚ÚÂÊÈÎ‹ ËÏÈÎ›·. ∆Ô ÈÛÙÔÚÈÎfi

Â·ÚÎÔ‡˜ ÚfiÛÏË„Ë˜ µµ12 ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ Ê˘-

ÛÈÔÏÔÁÈÎ¿ ‹ Î·È ·˘ÍËÌ¤Ó· Â›Â‰· µµ12 Î·È ªª∞

ÛÙÔÓ ÔÚfi ÙÔ˘ ‚Ú¤ÊÔ˘˜ Ô˘ ·ÚÔ˘ÛÈ¿˙ÂÈ ÎÏÈÓÈÎ¤˜


¶·È‰È·ÙÚÈÎ‹ 2007;70:54-59

ÂÎ‰ËÏÒÛÂÈ˜ Û˘Ì‚·Ù¤˜ ÌÂ ∞µµ12 , Û˘ÓËÁÔÚÔ‡Ó ˘¤ÚÂÓ‰ÔÁÂÓÔ‡˜ ‰È·Ù·Ú·¯‹˜ ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙË˜µµ12 (1).

∏ ÎÏÈÓÈÎ‹ ·ÓÙ·fiÎÚÈÛË Û¯Â‰fiÓ fiÏˆÓ ÙˆÓ ‚ÚÂ-

ÊÒÓ ÌÂ ÛÈÙÈÔÁÂÓ‹ ¤ÏÏÂÈ„Ë µµ12 ÛÙË ¯ÔÚ‹ÁËÛË µµ12

Â›Ó·È ıÂ·Ì·ÙÈÎ‹ ÛÂ fi,ÙÈ ·ÊÔÚ¿ ÛÙ· ÁÂÓÈÎ¿ Û˘ÌÙÒ-

Ì·Ù·, ÛÙÈ˜ Á·ÛÙÚÂÓÙÂÚÈÎ¤˜ Î·È ·ÈÌ·ÙÔÏÔÁÈÎ¤˜ ‰È·-

Ù·Ú·¯¤˜, ÛÙË ÛˆÌ·ÙÈÎ‹ ·Ó¿Ù˘ÍË, ·ÏÏ¿ Î·È ÛÂ ÔÚÈ-

ÛÌ¤Ó· ÓÂ˘ÚÔÏÔÁÈÎ¿ Û˘ÌÙÒÌ·Ù·, fiˆ˜ Ë ˘ÔÙÔÓ›·

(1,6-9). ∆· Â˘Ú‹Ì·Ù· ÛÙËÓ MRI Î·È ÙÔ ∏∂° Û˘Ó‹-

ıˆ˜ ·ÔÎ·ı›ÛÙ·ÓÙ·È (1,7,9), ¯ˆÚ›˜ ˆÛÙfiÛÔ Ó· ÌÔ-

ÚÂ› Ó· ·ÔÎÏÂÈÛÙÂ› Ë ·Ú·ÌÔÓ‹ ÓÂ˘ÚÔ·Ó·Ù˘ÍÈ·-

ÎÒÓ ·ıÔÏÔÁÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ. ∆¤ÙÔÈ· Â˘Ú‹Ì·Ù· Â›-

Ó·È Ë ÓÔËÙÈÎ‹ ˘ÛÙ¤ÚËÛË, ÔÈ ‰È·Ù·Ú·¯¤˜ ‚¿‰ÈÛË˜ ‹ Ë

ÂÈÏË„›· (10). √ Î›Ó‰˘ÓÔ˜ ·Ú·ÌÔÓ‹˜ ÌfiÓÈÌˆÓ

ÓÂ˘ÚÔÏÔÁÈÎÒÓ ÂÎ‰ËÏÒÛÂˆÓ Û˘Û¯ÂÙ›˙ÂÙ·È ÌÂ ÙË ÛÔ-

‚·ÚfiÙËÙ· ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Î·Ù¿ ÙË ‰È¿ÁÓˆÛË,

·ÏÏ¿ Î·È ÌÂ ÙËÓ Î·ı˘ÛÙ¤ÚËÛË ÙË˜ ‰È¿ÁÓˆÛË˜ Î·È

ÙË˜ ¤Ó·ÚÍË˜ ıÂÚ·Â›·˜ (1,7,10). ªÂÏ¤ÙË ÛÂ ÂÊ‹-

‚Ô˘˜ Ô˘ ÛÙË ‚ÚÂÊÈÎ‹ Î·È ÚÒÙË ·È‰ÈÎ‹ ËÏÈÎ›·

ÛÈÙ›ÛÙËÎ·Ó ÌÂ ·ÌÈÁÒ˜ ¯ÔÚÙÔÊ·ÁÈÎ‹ ‰›·ÈÙ· Î·È ÛÙË

Û˘Ó¤¯ÂÈ· ¿Ú¯ÈÛ·Ó Ó· Î·Ù·Ó·ÏÒÓÔ˘Ó ˙ˆ˚Î¤˜ ÙÚÔÊ¤˜,

·Ú¤¯ÂÈ ÔÏ‡ ÛËÌ·ÓÙÈÎ¤˜ ÏËÚÔÊÔÚ›Â˜ (13). ™ÙË

ÌÂÏ¤ÙË ·˘Ù‹ Ê·›ÓÂÙ·È fiÙÈ ÔÈ ·ÓÂÈı‡ÌËÙÂ˜ ÂÈ‰Ú¿-

ÛÂÈ˜ ÙË˜ ∞µµ12 ÛÙÔ˘˜ ¯ÔÚÙÔÊ¿ÁÔ˘˜ ÌÔÚÂ› Ó· ÌËÓ

ÂÚÈÔÚ›˙ÔÓÙ·È ÌfiÓÔ ÛÙË ‚ÚÂÊÈÎ‹ ËÏÈÎ›·, ·ÏÏ¿ Ó·

ÂÂÎÙÂ›ÓÔÓÙ·È Î·È ÛÙËÓ ÂÊË‚ÈÎ‹ ËÏÈÎ›·. ∏ ·ÏÏ·Á‹

ÙË˜ ‰È·ÙÚÔÊ‹˜ ·fi ·ÌÈÁÒ˜ ¯ÔÚÙÔÊ·ÁÈÎ‹ ÛÂ ‰›·ÈÙ·

Ô˘ ÂÚÈ¤¯ÂÈ ·˘Á¿, Á·Ï·ÎÙÔÎÔÌÈÎ¿ ‹ Î·È ÎÚ¤·˜ ‰ÂÓ

Â›Ó·È ÈÎ·Ó‹ ÁÈ· ÙË ‰È·Ù‹ÚËÛË ÙË˜ Â¿ÚÎÂÈ·˜ µµ12

Â¿Ó Î·Ù·Ó·ÏÒÓÔÓÙ·È Ì¤ÙÚÈÂ˜ ÔÛfiÙËÙÂ˜ ˙ˆ˚ÎÒÓ

ÙÚÔÊÒÓ Î·È ÌÔÚÂ› Ó· Ô‰ËÁ‹ÛÂÈ ÛÂ ÁÓˆÛÙÈÎ¤˜ Î·È

„˘¯ÔÎÈÓËÙÈÎ¤˜ ‰È·Ù·Ú·¯¤˜.

™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, ˘¿Ú¯Ô˘Ó ÔÏÏ¤˜ ÂÓ‰Â›ÍÂÈ˜

fiÙÈ Ë ∞µµ12 Â›Ó·È ·ÈÙ›· ÛËÌ·ÓÙÈÎ‹˜ ÓÔÛËÚfiÙËÙ·˜

ÛÙËÓ ÔÌ¿‰· ÙˆÓ ·˘ÛÙËÚÒ˜ ¯ÔÚÙÔÊ¿ÁˆÓ ·ÙfiÌˆÓ Î·È

·ÊÔÚ¿ ÛÂ fiÏÂ˜ ÙÈ˜ ËÏÈÎ›Â˜, ÌÂ ÌÂÁ¿ÏË Èı·ÓfiÙËÙ·

ªÂı˘ÏÙÂÙÚ·¸‰ÚÔÊ˘ÏÏÈÎfi ∆ÂÙÚ·¸‰ÚÔÊ˘ÏÏÈÎfi

√ÌÔÎ˘ÛÙÂ˝ÓË ªÂıÂÈÔÓ›ÓË

L-ªÂı˘ÏÌ·ÏÔÓ˘Ï-CoA ™Ô˘ÎÈÓ˘Ï-CoA

ªÂı˘ÏÙÚ·ÓÛÊÂÚ¿ÛË

ªÂı˘ÏÎÔ‚·Ï·Ì›ÓË

µÈÙ·Ì›ÓË µ12 (ÎÔ‚·Ï·Ì›ÓË)

5ã-∞‰ÂÓÔÛ˘ÏÎÔ‚·Ï·Ì›ÓË

ªÂı˘ÏÌ·ÏÔÓ˘Ï-CoA ÌÔ˘Ù¿ÛË

∂ÈÎfiÓ· 2. ∏ ‚ÈÙ·Ì›ÓË µ12 Â›Ó·È Û˘Ó¤Ó˙˘ÌÔ ÁÈ· ÙË ÌÂı˘Ï›ˆÛË ÙË˜ ÔÌÔÎ˘ÛÙÂ˝ÓË˜ ÛÂ ÌÂıÂÈÔÓ›ÓË, ÙË ÌÂÙ·ÙÚÔ‹ ÙÔ˘ ÌÂı˘ÏÌ·ÏÔÓ˘Ï-Û˘ÓÂÓ˙‡ÌÔ˘ ∞ ÛÂ ÛÔ˘ÎÈÓ˘Ï-Û˘Ó¤Ó˙˘ÌÔ ∞ Î·È ÙË ÌÂÙ·ÙÚÔ‹ ÙÔ˘ ÌÂı˘ÏÙÂÙÚ·¸‰ÚÔÊ˘ÏÏÈÎÔ‡ ÔÍ¤Ô˜ ÛÂ ÙÂÙÚ·¸‰ÚÔÊ˘ÏÏÈÎfi ÔÍ‡.

¶›Ó·Î·˜ 2. ∫ÏÈÓÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ ·ÓÂ¿ÚÎÂÈ·˜ ‚ÈÙ·Ì›ÓË˜ µ12 ÛÙ··È‰È¿

°ÂÓÈÎ¿ Û˘ÌÙÒÌ·Ù· ∞‰˘Ó·Ì›·∂‡ÎÔÏË ÎfiˆÛË ∞ÓÔÚÂÍ›·∞ÓÂ·ÚÎ‹˜ ·‡ÍËÛË∂˘ÂÚÂıÈÛÙfiÙËÙ·

¡Â˘ÚÔÏÔÁÈÎ¿/„˘¯È·ÙÚÈÎ¿ Û˘ÌÙÒÌ·Ù· ∞Ó·Ù˘ÍÈ·Î‹ Î·ı˘ÛÙ¤ÚËÛË ‹ ·ÏÈÓ‰ÚfiÌËÛË¶·Ú·ÈÛıËÛ›Â˜ÀÔÙÔÓ›·ÃÔÚÈÔ·ıÂÙˆÛÈÎ¤˜ ÎÈÓ‹ÛÂÈ˜ ™·ÛÌÔ›∞Ù·Í›·∫ÒÌ·∞ÒÏÂÈ· ÌÓ‹ÌË˜ ∞ÏÏ·Á‹ ÙË˜ ÚÔÛˆÈÎfiÙËÙ·˜ ªÂ›ˆÛË ÙˆÓ Û¯ÔÏÈÎÒÓ ÂÈ‰fiÛÂˆÓ ∫·Ù¿ıÏÈ„Ë

∞ÈÌ·ÙÔÏÔÁÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ ª·ÎÚÔÎ˘ÙÙ¿ÚˆÛË ∞Ó·ÈÌ›· ÀÂÚÎ·Ù¿ÙÌËÛË ÙÔ˘ ˘Ú‹Ó· ÙˆÓ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ §Â˘ÎÔÂÓ›· £ÚÔÌ‚ÔÂÓ›· ¶·ÓÎ˘ÙÙ·ÚÔÂÓ›·

ÕÏÏÂ˜ ÂÎ‰ËÏÒÛÂÈ˜ °ÏˆÛÛ›ÙÈ‰· À¤Ú¯ÚˆÛË ‰¤ÚÌ·ÙÔ˜ ŒÌÂÙÔÈ›/‰È¿ÚÚÔÈ· ÿÎÙÂÚÔ˜ ∫·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ·



Ó· Ô‰ËÁ‹ÛÂÈ ÛÂ ÌfiÓÈÌÂ˜ ·ıÔÏÔÁÈÎ¤˜ ÓÂ˘ÚÔÏÔÁÈÎ¤˜Î·È ·Ó·Ù˘ÍÈ·Î¤˜ ÂÎ‰ËÏÒÛÂÈ˜. √È Ê˘ÛÈÔÏÔÁÈÎ¤˜ ÙÈ-Ì¤˜ µµ12 Î·È Ë ·Ô˘Û›· ·Ó·ÈÌ›·˜ ‰ÂÓ ·ÔÎÏÂ›Ô˘ÓÙËÓ ·ÓÂ¿ÚÎÂÈ· ÙË˜ µµ12. √È ·˘ÛÙËÚÒ˜ ¯ÔÚÙÔÊ¿ÁÔÈÌËÙ¤ÚÂ˜ Ú¤ÂÈ Ó· Â›Ó·È ÂÓËÌÂÚˆÌ¤ÓÂ˜ ÁÈ· ÙË ÛË-Ì·Û›· ÙË˜ Â·ÚÎÔ‡˜ ÚfiÛÏË„Ë˜ µµ12 Î·Ù¿ ÙË ‰È¿Ú-ÎÂÈ· ÙË˜ ÂÁÎ˘ÌÔÛ‡ÓË˜ Î·È ÙÔ˘ ıËÏ·ÛÌÔ‡. ™Â ‚Ú¤-ÊË ·˘ÛÙËÚÒ˜ ¯ÔÚÙÔÊ¿ÁˆÓ ÌËÙ¤ÚˆÓ Ô˘ ÙÚ¤ÊÔ-ÓÙ·È ·ÔÎÏÂÈÛÙÈÎ¿ ÌÂ ÌËÙÚÈÎfi Á¿Ï·, Ú¤ÂÈ Ó· ¯Ô-ÚËÁÂ›Ù·È Û˘ÌÏ‹ÚˆÌ· µµ12. ŸÙ·Ó ˘¿Ú¯ÂÈ ˘Ô„›·∞µµ12 ÛÂ ‚Ú¤ÊÔ˜, Ë Ï‹„Ë ÏÂÙÔÌÂÚÔ‡˜ ‰È·ÙÚÔÊÈ-ÎÔ‡ ÈÛÙÔÚÈÎÔ‡ ÂÎ Ì¤ÚÔ˘˜ ÙË˜ ÌËÙ¤Ú·˜ Î·È ÙÔ˘ ‚Ú¤-ÊÔ˘˜, ·ÏÏ¿ Î·È Ô ¤ÏÂÁ¯Ô˜ ÁÈ· Î·ÎÔ‹ıË ·Ó·ÈÌ›· ÙË˜ÌËÙ¤Ú·˜ ıÂˆÚÔ‡ÓÙ·È ··Ú·›ÙËÙ·. ∏ ¤ÁÎ·ÈÚË ‰È¿-ÁÓˆÛË Î·È ıÂÚ·Â›· ÙË˜ ∞µµ12 ÛÙ· ‚Ú¤ÊË Â›Ó·È··Ú·›ÙËÙË ÁÈ· ÙËÓ ·ÔÙÚÔ‹ ÌfiÓÈÌˆÓ ÓÂ˘ÚÔÏÔÁÈ-ÎÒÓ ‰È·Ù·Ú·¯ÒÓ.


1. Rasmussen SA, Fernhoff PM, Scanlon KS. Vitamin B12 defi-ciency in children and adolescents. J Pediatr 2001;138:10-17.

2. Asok A. Vegetarianism and vitamin B12 (cobalamin) defi-ciency. Am J Clin Nutr 2003;78:3-6.

3. Stabler SP, Allen RH. Vitamin B12 deficiency as a world-wide problem. Annu Rev Nutr 2004;24:299-326.

4. Sanders TA. Vegetarian diets and children. Pediatr ClinNorth Am 1995;42:955-965.

5. Hebbelinck M, Clarys P, De Malsche A. Growth, develop-

ment, and physical fitness of Flemish vegetarian children,

adolescents, and young adults. Am J Clin Nutr 1999;70 (3

Suppl):S579-S585.

6. Centers for Disease Control and Prevention (CDC). Neu-

rologic impairment in children associated with maternal

dietary deficiency of cobalamin - Georgia, 2001. MMWR

2003;52:61-64.

7. von Schenck U, Bender-Gotze C, Koletzko B. Persistence

of neurological damage induced by dietary vitamin B12 de-

ficiency in infancy. Arch Dis Child 1997;77:137-139.

8. Graham SM, Arvela OM, Wise GA. Long-term neurolog-

ic consequences of nutritional vitamin B12 deficiency in in-

fants. J Pediatr 1992;121:710-714.

9. Codazzi D, Sala F, Parini R, Langer M. Coma and respira-

tory failure in a child with severe vitamin B(12) deficien-

cy. Pediatr Crit Care Med 2005;6:483-485.

10. Weiss R, Fogelman Y, Bennett M. Severe vitamin B12 defi-

ciency in an infant associated with a maternal deficiency

and a strict vegetarian diet. J Pediatr Hematol Oncol 2004;

26:270-271.

11. Obeid R, Geisel J, Schorr H, Hubner U, Herrmann W. The

impact of vegetarianism on some haematological parame-

ters. Eur J Haematol 2002;69:275-279.

12. Roschitz B, Plecko B, Huemer M, Biebl A, Foerster H,

Sperl W. Nutritional infantile vitamin B12 deficiency:

pathobiochemical considerations in seven patients. Arch

Dis Child Fetal Neonatal Ed 2005;90:F281-F282.

13. van Dusseldorp M, Schneede J, Refsum H, Ueland PM,

Thomas CM, de Boer E et al. Risk of persistent cobalamin

deficiency in adolescents fed a macrobiotic diet in early

life. Am J Clin Nutr 1999;69:664-671.


¶·È‰È·ÙÚÈÎ‹ 2007;70:54-59

60 ∂¡¢π∞º∂ƒ√À™∞ ¶∂ƒπ¶∆ø™∏ CASE REPORT


¢ÈÛÎÔÂÈ‰‹˜ ·ÙÂÏÂÎÙ·Û›· ÛÂ ¤ÊË‚Ô

£. ∆·‚Ï·‰¿ÎË1, ª. ª·Ï·ıÚ¿ÎË1, °. ¢Ú·ÎˆÓ¿ÎË˜2, π. ™·ÚÈ‰¿ÎË˜3, π. ∫·ÙÛ·Ú¿ÎË˜1, ª. ∫Ï·‰›ÙÔ˘1,

∞. ∞˘ÁÂÓ¿ÎË1, ∞. ¡Â¿Ú¯Ô˘1

¶ÂÚ›ÏË„Ë: ∏ ‰ÈÛÎÔÂÈ‰‹˜ ·ÙÂÏÂÎÙ·Û›· Â›Ó·È ¤Ó· È‰È·›ÙÂÚÔ Â›‰Ô˜ ÂÚÈÊÂÚÈÎ‹˜ ÓÂ˘ÌÔÓÈÎ‹˜ Û‡ÌÙ˘ÍË˜, ËÔÔ›· ÌÈÌÂ›Ù·È ÓÂfiÏ·ÛÌ· ÛÙËÓ ÂÚÈÊ¤ÚÂÈ· ÙÔ˘ ÓÂ‡ÌÔÓ· ‹ ÌÂÛÔıËÏ›ˆÌ·. ∞Ó·Ù‡ÛÛÂÙ·È ˆ˜ ·ÔÙ¤ÏÂ-ÛÌ· ·ıÔÏÔÁÈÎ‹˜ Î·Ù¿ÛÙ·ÛË˜ ÙÔ˘ ˘Â˙ˆÎfiÙ·. ™˘Ó·ÓÙ¿Ù·È Ù˘¯·›· Î·È Û¿ÓÈ· ÛÂ ·Û˘ÌÙˆÌ·ÙÈÎfi ÂÓ‹ÏÈ-Î· Î·È ·ÎfiÌ· ÈÔ Û¿ÓÈ· ÛÂ ·È‰È¿. ¶·ÚfiÌÔÈÂ˜ ÂÚÈÙÒÛÂÈ˜ ‰ÂÓ ¤¯Ô˘Ó ·Ó·ÊÂÚıÂ› ÛÙË ‚È‚ÏÈÔÁÚ·Ê›·.¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ÂÊ‹‚Ô˘, ËÏÈÎ›·˜ ‰ÂÎ·ÙÚÈÒÓ ÂÙÒÓ, ÌÂ ‰ÂÎ·ÙÈÎ‹ ˘ÚÂÙÈÎ‹ Î›ÓËÛË, ÏÂ˘ÚÈÙÈÎ‹Û˘ÏÏÔÁ‹, ‰ÈÛÎÔÂÈ‰‹ ·ÙÂÏÂÎÙ·Û›· Î·È ÔÚÈ·Î¿ ‰ÈÔÁÎˆÌ¤ÓÔ ÂÚÈ‚ÚÔÁ¯ÈÎfi ÏÂÌÊ·‰¤Ó· ÛÙËÓ ·ÍÔÓÈÎ‹ ÙÔÌÔ-ÁÚ·Ê›· ıÒÚ·ÎÔ˜. √ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ÁÈ· Ê˘Ì·Ù›ˆÛË ‹Ù·Ó ·ÚÓËÙÈÎfi˜ ÁÈ· ÙÔÓ ›‰ÈÔ Î·È ÙÔ ÂÚÈ-‚¿ÏÏÔÓ ÙÔ˘, ÂÓÒ Ô Ù›ÙÏÔ˜ ·ÓÙÈÛˆÌ¿ÙˆÓ ÁÈ· Ì˘ÎfiÏ·ÛÌ· (‰‡Ô ‰Â›ÁÌ·Ù·), ‹Ù·Ó Û˘Ì‚·Ùfi˜ ÌÂ ÏÔ›ÌˆÍË·fi Ì˘ÎfiÏ·ÛÌ·. ∏ ‰ÈÛÎÔÂÈ‰‹˜ ·ÙÂÏÂÎÙ·Û›· ÙÔ˘ ·ÛıÂÓÔ‡˜ ·Ô‰fiıËÎÂ ÛÂ ÏÂ˘ÚÈÙÈÎ‹ Û˘ÏÏÔÁ‹ Î·È ·˘-Ù‹ ÛÂ Ì˘ÎÔÏ·ÛÌ·ÙÈÎ‹ ÓÂ˘ÌÔÓ›·.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ¢ÈÛÎÔÂÈ‰‹˜ ·ÙÂÏÂÎÙ·Û›·, Ì˘ÎÔÏ·ÛÌ·ÙÈÎ‹ ÓÂ˘ÌÔÓ›·, ¤ÊË‚Ô˜.

Round atelectasis in adolescent

T. Tavladaki1, M. Malathraki1, G. Drakonakis2, I. Saridakis3, I. Katsarakis1, M. Kladitou1, A. Augenaki1,

A. Nearchou1

Abstract: Round atelectasis is a special type of peripheral lung collapse that can mimic a peripherallung tumour or a mesothelioma. It develops as a result of pleural disease. It is a rare incidental findingin asymptomatic adults and even rarer in children, for whom there are no published reports. The caseof a thirteen year-old adolescent male is described, who presented with a low grade fever and thefindings of pleural effusion, round atelectasis and a slightly enlarged peribronchial lymph node onthoracic computed tomography. The laboratory investigation for tuberculosis was negative for thepatient and his environment; however antibody titers for mycoplasma (two samples) were positive.The round atelectasis was therefore attributed to pleural effusion due to mycoplasma pneumonia.

Key words: Round atelectasis, mycoplasma pneumonia, adolescent.

1 ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹, °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô™ËÙÂ›·˜, ∫Ú‹ÙË

2 ¶ÓÂ˘ÌÔÓÔÏÔÁÈÎ‹ ∫ÏÈÓÈÎ‹,°ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô™ËÙÂ›·˜, ∫Ú‹ÙË

3 ∞ÎÙÈÓÔÏÔÁÈÎfi ∆Ì‹Ì·, °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô™ËÙÂ›·˜, ∫Ú‹ÙË


£ÂÔÓ‡ÌÊË ∆·‚Ï·‰¿ÎË [email protected] ∂ıÓÈÎ‹˜ ∞ÓÙ›ÛÙ·ÛË˜ 9 ∆.∫. 724 00, ¡Â¿ÔÏË§·ÛÈı›Ô˘ ∫Ú‹ÙË˜

1 Paediatric Clinic, GeneralHospital of Sitia, Crete

2 Pneumonology Clinic,General Hospital of Sitia,Crete

3 Department of Radiology,General Hospital of Sitia,Crete

Correspondence:

Theonymfi Tavladaki [email protected] 9, Ethnikis Antistasis St. 724 00 Neapoli, Lasithi,Crete

∂ÈÛ·ÁˆÁ‹

∏ ‰ÈÛÎÔÂÈ‰‹˜ ·ÙÂÏÂÎÙ·Û›· (folded lung ‹

atelectatic pseudotumor ‹ Blesousky’s syndrome)

Â›Ó·È ÌÈ· ·Û˘Ó‹ıÈÛÙË ÌÔÚÊ‹ ÂÚÈÊÂÚÈÎ‹˜ ·ÙÂÏÂ-

ÎÙ·Û›·˜. ∞Ó·ÊÔÚÈÎ¿ ÌÂ ÙËÓ ·ıÔÁ¤ÓÂÛ‹ ÙË˜

¤¯Ô˘Ó ·Ó·Ù˘¯ıÂ› ‰‡Ô ‚·ÛÈÎ¤˜ ıÂˆÚ›Â˜ (2,3).

™‡ÌÊˆÓ· ÌÂ ÙËÓ ÚÒÙË, Ë Â·ÓÂÈÏËÌÌ¤ÓË ¤ÎıÂ-

ÛË ÛÂ ·Ì›·ÓÙÔ ÚÔÎ·ÏÂ› ÌÈ· ÚÔÔ‰Â˘ÙÈÎ‹ ÈÓÒ‰Ë

·ÓÙ›‰Ú·ÛË ÙÔ˘ ˘Â˙ˆÎfiÙ·. ªÂ ÙËÓ ˆÚ›Ì·ÓÛË

ÙË˜ ·ÓÙ›‰Ú·ÛË˜ ·˘Ù‹˜, Ô ÈÓÒ‰Ë˜ ÈÛÙfi˜ Û˘ÚÚÈ-

ÎÓÒÓÂÙ·È Î·È ˆıÂ› ÙÌ‹Ì·Ù· ÙÔ˘ ˘ÔÎÂ›ÌÂÓÔ˘

ÓÂ‡ÌÔÓ· ÛÂ Û‡ÌÙ˘ÍË (2,3).

∏ ‰Â‡ÙÂÚË ıÂˆÚ›· ÂÎÙÈÌ¿ fiÙÈ Ë ‰ÈÛÎÔÂÈ‰‹˜

·ÙÂÏÂÎÙ·Û›· ÌÔÚÂ› Ó· ·Ó·Ù˘¯ıÂ› ÌÂÙ¿ ·fi

›ÂÛË ÛÂ ÌÈ· ÂÚÈÊÂÚÈÎ‹ ı¤ÛË ÙÔ˘ ÓÂ‡ÌÔÓ·

ÏfiÁˆ Î¿ÔÈ·˜ ÏÂ˘ÚÈÙÈÎ‹˜ Û˘ÏÏÔÁ‹˜, ÌÂ ·Ô-

Ù¤ÏÂÛÌ· ÙÔ ÓÂ˘ÌÔÓÈÎfi ·Ú¤Á¯˘Ì· Ó· Û˘-

ÌÙ‡ÛÛÂÙ·È Î·È Ó· ÂÁÎÏˆ‚›˙ÂÙ·È Ì¤Û· ÛÙË Û˘Ï-

ÏÔÁ‹. ªÔÚÂ› Ó· ·Ú·Ì¤ÓÂÈ ÂÁÎÏˆ‚ÈÛÌ¤ÓÔ, Ïfi-

Áˆ ÙË˜ ·Ó¿Ù˘ÍË˜ Û˘ÌÊ‡ÛÂˆÓ, ÌÂÙ¿ ÙËÓ ˘Ô-

¯ÒÚËÛ‹ ÙË˜ (1-3,7,8).

™˘Ó‹ıˆ˜ ÂÓÙÔ›˙ÂÙ·È ÛÙ· Ô›ÛıÈ· ÙÌ‹Ì·Ù·

ÙˆÓ Î¿Ùˆ ÏÔ‚ÒÓ, ·ÏÏ¿ ÌÔÚÂ› Ó· ÂÓÙÔÈÛÙÂ›

Î·È ÛÂ ¿ÏÏÂ˜ ı¤ÛÂÈ˜ ÙˆÓ ÓÂ˘ÌfiÓˆÓ. ™˘¯ÓfiÙÂ-

ÚË Â›Ó·È Ë ÂÙÂÚfiÏÂ˘ÚË ÂÓÙfiÈÛË, ·Ó Î·È

¤¯Ô˘Ó ·Ó·ÊÂÚıÂ› ·ÌÊÔÙÂÚfiÏÂ˘ÚÂ˜ ÂÓÙÔ›-

ÛÂÈ˜ (1,2,7).

™ÙËÓ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ Ê·›ÓÂÙ·È

ÛÙÚÔÁÁ˘Ï‹ ‹ ÛÊËÓÔÂÈ‰‹˜ ÛÎ›·ÛË, ‰È·Ì¤ÙÚÔ˘ 4-

7 cm, Ô˘ Û¯ËÌ·Ù›˙ÂÈ ÔÍÂ›Â˜ ÁˆÓ›Â˜ ÌÂ ÙÔÓ ˘Â-

˙ˆÎfiÙ·. ™˘¯Ó¿ Û˘Ó˘¿Ú¯Ô˘Ó ˘Â˙ˆÎÔÙÈÎ‹ ¿-

¯˘ÓÛË Î·È ÏÂ˘ÚÈÙÈÎ‹ Û˘ÏÏÔÁ‹ (3,6).

™ÙËÓ ·ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ ‰È·ÎÚ›-

ÓÂÙ·È: ·) ÛÙÚÔÁÁ˘Ï‹ ‹ ÛÊËÓÔÂÈ‰‹˜ ‹ ÂÏÏÂÈ„Ô-

ÂÈ‰‹˜ Ì¿˙· Ô˘ Û˘Ó¤¯ÂÙ·È ÌÂ ÌÈ· ‰È¿¯˘ÙË ˘Â-

˙ˆÎÔÙÈÎ‹ ¿¯˘ÓÛË ÌÂ ‹ ¯ˆÚ›˜ Û˘ÓÔ‰¤˜ Â·-

Û‚ÂÛÙÒÛÂÈ˜, ‚) ‚ÚÔÁ¯Ô·ÁÁÂÈ·Î‹ ‰ÔÌ‹ Ô˘ ÂÈ-

Û¤Ú¯ÂÙ·È ÛÙ· fiÚÈ· ÙË˜ Ì¿˙·˜, ·Ó·Ê¤ÚÂÙ·È ˆ˜

61¢ÈÛÎÔÂÈ‰‹˜ ·ÙÂÏÂÎÙ·Û›· ÛÂ ¤ÊË‚Ô

¶·È‰È·ÙÚÈÎ‹ 2007;70:60-63

“ÛËÌÂ›Ô Ô˘Ú¿˜ ÎÔÌ‹ÙË” Î·È ·ÔÙÂÏÂ› ¯·Ú·ÎÙËÚÈ-

ÛÙÈÎfi Â‡ÚËÌ·, Á) ·ÂÚÔ‚ÚÔÁ¯fiÁÚ·ÌÌ· ‹ ·ÎÙÈÓÔ‰È·-

Ê·ÓÂ›˜ ÎÂÓÙÚÈÎ¤˜ ÂÚÈÔ¯¤˜ Ô˘ Èı·ÓfiÓ ÂÚÈ¤¯Ô-

ÓÙ·È Ì¤Û· ÛÙË Ì¿˙·, ÏfiÁˆ ˘ÔÏÂÈÌÌ·ÙÈÎÔ‡ ·ÂÚÈ-

ÛÌÔ‡ ÙÔ˘ ·ÙÂÏÂÎÙ·ÙÈÎÔ‡ ÓÂ˘ÌÔÓÈÎÔ‡ ÈÛÙÔ‡ Î·È ‰)

·Ó·ÏËÚˆÌ·ÙÈÎfi˜ ˘ÂÚ·ÂÚÈÛÌfi˜ ÙÔ˘ ·Ú·ÎÂ›ÌÂ-

ÓÔ˘ ÓÂ˘ÌÔÓÈÎÔ‡ ÈÛÙÔ‡ (4-6).

À¿Ú¯ÂÈ ÏËıÒÚ· ·ÎÙÈÓÔÏÔÁÈÎÒÓ ·Ú·ÏÏ·ÁÒÓ

fiÛÔÓ ·ÊÔÚ¿ ÛÙÔ Ì¤ÁÂıÔ˜, ÙÔ Û¯‹Ì·, ÙË ı¤ÛË Î·È ÙË

ÌÔÚÊÔÏÔÁ›·. ™˘Ó‹ıˆ˜ ·Ú·Ì¤ÓÂÈ ÛÙ¿ÛÈÌË, ·ÏÏ¿

ÌÔÚÂ› Ó· ˘ÔÛÙÚ·ÊÂ› ‹ Î·È Ó· ÂÍ·ÏÂÈÊıÂ› Ï‹Úˆ˜.

∏ ‰È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÔ ÌÂÛÔıË-

Ï›ˆÌ· Î·È ÙÔ ‚ÚÔÁ¯ÔÁÂÓ¤˜ Î·ÚÎ›ÓˆÌ·.

∏ ‰È¿ÁÓˆÛË ı· ÛÙËÚÈ¯ıÂ› ÛÙÔ˘˜ È‰È·›ÙÂÚÔ˘˜

·ÎÙÈÓÔÏÔÁÈÎÔ‡˜ ¯·Ú·ÎÙ‹ÚÂ˜ ÙË˜ ‰ÈÛÎÔÂÈ‰Ô‡˜ ·ÙÂ-

ÏÂÎÙ·Û›·˜, ÛÙË Û˘ÓÔÏÈÎ‹ ÎÏÈÓÈÎÔÂÚÁ·ÛÙËÚÈ·Î‹ ÂÈ-

ÎfiÓ· Î·È ÛÙËÓ Â·ÓÂÎÙ›ÌËÛË. ™Â ·ÌÊ›‚ÔÏÂ˜ ÂÚÈ-

ÙÒÛÂÈ˜ ÌÔÚÂ› Ó· ··ÈÙËıÂ› Î·È ‚ÈÔ„›·.


¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ÂÊ‹‚Ô˘ ËÏÈÎ›·˜ 13

ÂÙÒÓ, Ô ÔÔ›Ô˜ - 30 ËÌ¤ÚÂ˜ ÚÈÓ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ -

·ÚÔ˘Û›·ÛÂ ‰‡Ô ÂÂÈÛfi‰È· ÔÍ¤Ô˜ ¿ÏÁÔ˘˜ ÛÙÔ Úfi-

ÛıÈÔ Î·È Ô›ÛıÈÔ ·ÚÈÛÙÂÚfi ËÌÈıˆÚ¿ÎÈÔ Î·È ¤Ó· ˘-

ÚÂÙÈÎfi Î‡Ì· ¤ˆ˜ 38ÔC. ∆· Û˘ÌÙÒÌ·Ù· ·Ô‰fiıËÎ·Ó

ÛÂ ÈÔÁÂÓ‹ ÏÔ›ÌˆÍË. ∂›ÎÔÛÈ ËÌ¤ÚÂ˜ ·ÚÁfiÙÂÚ· ·ÚÔ˘-

Û›·ÛÂ ‰ÂÎ·ÙÈÎ‹ ˘ÚÂÙÈÎ‹ Î›ÓËÛË Î·Ù¿ ÙÈ˜ ·ÔÁÂ˘-

Ì·ÙÈÓ¤˜ Î·È ‚Ú·‰ÈÓ¤˜ ÒÚÂ˜.

∞fi ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈÎ‹ ÂÍ¤Ù·ÛË ÙˆÓ Û˘ÛÙËÌ¿-

ÙˆÓ ·ÚÔ˘Û›·ÛÂ ÌÂ›ˆÛË ·Ó·ÓÂ˘ÛÙÈÎÔ‡ „Èı˘Ú›-

ÛÌ·ÙÔ˜ ÛÙÔ ·ÚÈÛÙÂÚfi Ì¤ÛÔ ÓÂ˘ÌÔÓÈÎfi Â‰›Ô.

∞fi ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ·Ó·Ê¤ÚÂÙ·È ‚ÚÔÁ-

¯ÈÎfi ¿ÛıÌ· ·fi ÙË ÌËÙÚÈÎ‹ ÁÈ·ÁÈ¿, ÂÓÒ ·fi ÙÔ ·ÙÔ-

ÌÈÎfi ÈÛÙÔÚÈÎfi ·Ó·Ê¤ÚÂÙ·È ÚÔˆÚfiÙËÙ· (34 Â‚‰ÔÌ¿-

‰ˆÓ Î‡ËÛË, 1900 g ‚¿ÚÔ˜ Á¤ÓÓËÛË˜) Î·È ÁÈ· ÙÔÓ Ïfi-

ÁÔ ·˘Ùfi ÓÔÛËÏÂ‡ÙËÎÂ ÛÂ ÙÌ‹Ì· ÚÔÒÚˆÓ. ™Â ‚ÚÂÊÈ-

Î‹ ËÏÈÎ›· ÓÔÛËÏÂ‡ÙËÎÂ ÁÈ· ‚ÚÔÁ¯ÈÔÏ›ÙÈ‰· Î·È ÛÙË

Û˘Ó¤¯ÂÈ· Â›¯Â ‹ÈÂ˜ ÎÚ›ÛÂÈ˜ ‚ÚÔÁ¯ÈÎÔ‡ ¿ÛıÌ·ÙÔ˜.

∆· Â˘Ú‹Ì·Ù· ·fi ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô Î·-

Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ‹Ù·Ó Ù· ·ÎfiÏÔ˘ı·: ™ÙËÓ ·ÎÙÈÓÔ-

ÁÚ·Ê›· ıÒÚ·ÎÔ˜ ·Ú·ÙËÚ‹ıËÎÂ ÏÂ˘ÚÈÙÈÎ‹ Û˘ÏÏÔ-

Á‹ ·ÚÈÛÙÂÚÔ‡ Î¿Ùˆ ÏÔ‚Ô‡ (∂ÈÎfiÓ· 1). °ÂÓÈÎ‹ ·›Ì·-

ÙÔ˜: §Â˘Î¿: 10.000 ÎÎ¯ (¶: 27%, §ÂÌÊ: 62%, ª:

7%), Ht: 40%, Hb: 13,2 g%, Plt: 366.000. µÈÔ¯ËÌÈÎ¿:

O˘Ú›·: 32 mg%, ∫ÚÂ·ÙÈÓ›ÓË: 1 mg%, SGOT: 29,

SGPT: 14, ALP: 454, LDH: 375, ™¿Î¯·ÚÔ: 97 mg%. ∏

∆∫∂ ‹Ù·Ó 55 mm/1 h. CRP: 45 mg/l. WIDAL: (-),

WRIGHT: (-). Mantoux: 15 mm (ÂÌ‚ÔÏÈ·ÛÌfi˜ ÌÂ

µCG ÚÔ 18Ì‹ÓÔ˘). ∆· Â˘Ú‹Ì·Ù· ·fi ÙË ÁÂÓÈÎ‹ Ô‡-

ÚˆÓ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ¿ Î·È Ë Î·ÏÏÈ¤ÚÁÂÈ· Ô‡ÚˆÓ ÁÈ·

µ. Koch (3 ‰Â›ÁÌ·Ù·) ‹Ù·Ó ·ÚÓËÙÈÎ‹. °·ÛÙÚÈÎfi ˘ÁÚfi

(¿ÌÂÛÔ Î·È Î·ÏÏÈÂÚÁÂÈ·, 3 ‰Â›ÁÌ·Ù·): ·ÚÓËÙÈÎ‹.

∆Ô ˘ÁÚfi ·Ú·Î¤ÓÙËÛË˜ ıÒÚ·ÎÔ˜ ‹Ù·Ó ÔÚÔ·ÈÌ·-

ÙËÚfi, ÌÂ ÔÚÚÒ‰Ë ¯ÚÔÈ¿ Î·È ‰È·˘Á‹ fi„Ë ÌÂ ›˙ËÌ·.∞fi ÙË ÁÂÓÈÎ‹ ÂÍ¤Ù·ÛË: ∫‡ÙÙ·Ú·: WBC: 7400/ÎÎ¯(¶: 50%, §: 47%, ª: 3%), RBC: 15000, ™¿Î¯·ÚÔ:115 mg/dl, §Â‡ÎˆÌ·: 4,9 g/dl, LDH: 1605 IU/L,∞Ì˘Ï¿ÛË: 29 u/l. ∏ Î·ÏÏÈ¤ÚÁÂÈ· ÁÈ· ÎÔÈÓ¿ ÌÈÎÚfi‚È·‹Ù·Ó ÛÙÂ›Ú·. ∞fi ÙËÓ Î˘ÙÙ·ÚÔÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË ‰ÂÓ·Ú·ÙËÚ‹ıËÎ·Ó ÓÂÔÏ·ÛÌ·ÙÈÎ¿ Î‡ÙÙ·Ú·, Ô‡ÙÂ Ê˘-Ì¿ÙÈ·, ÂÓÒ ÛËÌÂÈÒÓÂÙ·È Ë ·ÚÔ˘Û›· ËˆÛÈÓÔÊ›ÏˆÓÛÙÔ Â›¯ÚÈÛÌ·.

∆Ô U/S Î·Ú‰È¿˜ ¤‰ÂÈÍÂ ÂÏÂ‡ıÂÚÔ ÂÚÈÎ¿Ú‰ÈÔ. ∏ ·ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ ¤‰ÂÈÍÂ ˘fi˘-

ÎÓË ˘Â˙ˆÎÔÙÈÎ‹ Û˘ÏÏÔÁ‹ ˘ÁÚÔ‡ Î·Ù¿ ÙË Ú·¯È·›··Ú·ÛÔÓ‰˘ÏÈÎ‹ Î·È ¤Íˆ Ï¿ÁÈ· ÂÈÊ¿ÓÂÈ· ÙÔ˘ Î·-ÙÒÙÂÚÔ˘ ·ÚÈÛÙÂÚÔ‡ ËÌÈıˆÚ·Î›Ô˘ ÌÂ Û˘ÌÌÂÙÔ¯‹ ÙÔ˘Î·ÙÒÙÂÚÔ˘ ÙÌ‹Ì·ÙÔ˜ ÙË˜ Û‡ÛÙÔÈ¯Ô˘ ÌÂ›˙ÔÓÔ˜ ÌÂÛÔ-ÏÔ‚›Ô˘ Û¯ÈÛÌ‹˜. ™ÙÔ ¤Íˆ ‚·ÛÈÎfi ÙÌ‹Ì· ÙÔ˘ ·ÚÈÛÙÂ-ÚÔ‡ Î¿Ùˆ ÓÂ˘ÌÔÓÈÎÔ‡ ÏÔ‚Ô‡ ·Ó·‰ÂÈÎÓ‡ÂÙ·È ÛÊË-ÓÔÂÈ‰Ô‡˜ Û¯‹Ì·ÙÔ˜ ÌÈÎÚ‹ ·ÚÂÁ¯˘Ì·ÙÈÎ‹ ‚Ï¿‚Ë, ËÔÔ›· ÏËÚÔ› ÔÏÏ¿ ÂÎ ÙˆÓ ·ÂÈÎÔÓÈÛÙÈÎÒÓ ÎÚÈÙË-Ú›ˆÓ ÌÈÎÚ‹˜ ‰ÈÛÎÔÂÈ‰Ô‡˜ ·ÙÂÏÂÎÙ·Û›·˜, ÂÓÙfi˜ ÙˆÓÔÚ›ˆÓ ÙË˜ ÔÔ›·˜ ·Ó·‰ÂÈÎÓ‡ÔÓÙ·È ÌfiÏÈ˜ ˘ÔÛËÌ·È-ÓfiÌÂÓÂ˜ ÛˆÏËÓÔÂÈ‰Â›˜ ‰ÔÌ¤˜ ÌÂ ·¤Ú· Ô˘ ·ÓÙÈÚÔ-ÛˆÂ‡Ô˘Ó ÔÚÈ·Î¿ ‰È·ÙÂÙ·Ì¤ÓÔ˘˜ ‚ÚfiÁ¯Ô˘˜ (∂ÈÎfi-ÓÂ˜ 2 Î·È 3).

∂Î ÙÔ˘ ÏÔÈÔ‡ ÂÏ¤Á¯Ô˘ ·Ó·Ê¤ÚÂÙ·È Ë ·ÚÔ˘Û›·ÌÈÎÚÔ‡ ˘ÔÛÙÚfiÁÁ˘ÏÔ˘ ÌÔÚÊÒÌ·ÙÔ˜ ‰È·Ì¤ÙÚÔ˘ 1,2cm ÛÙÔ ·ÚÈÛÙÂÚfi ¯Â›ÏÔ˜ ÙÔ˘ Ô›ÛıÈÔ˘ ÌÂÛÔıˆÚ·Î›-Ô˘ ‰›Ï· ·fi ÙÔÓ ÔÈÛÔÊ¿ÁÔ. ∂›ÛË˜, ‰›‰ÂÙ·È Ë ÂÓÙ‡-ˆÛË ÔÚÈ·Î‹˜ ·ÔÛÙÚÔÁÁ‡ÏˆÛË˜ ÙË˜ ·ÚÈÛÙÂÚ‹˜ÓÂ˘ÌÔÓÈÎ‹˜ ‡ÏË˜, ÛÙÔ ‡„Ô˜ ÙË˜ ·ÚÈÛÙÂÚ‹˜ ÓÂ˘-ÌÔÓÈÎ‹˜ ·ÚÙËÚ›·˜. ∆· ÙÂÏÂ˘Ù·›· Â˘Ú‹Ì·Ù· ¤ıÂÛ·ÓÙËÓ ˘fiÓÔÈ· ÌÈÎÚÔ‡ ÌÂÛÔıˆÚ·ÎÈÎÔ‡ Î·È Èı·ÓÒ˜ÔÚÈ·Î¿ ‰ÈÔÁÎˆÌ¤ÓÔ˘ ·ÚÈÛÙÂÚÔ‡ ÂÚÈ‚ÚÔÁ¯ÈÎÔ‡ ÏÂÌ-Ê·‰¤Ó·.

√˘‰¤Ó ·ıÔÏÔÁÈÎfi ·ÓÂ˘Ú¤ıË ·fi ÙÔÓ ¤ÏÂÁ¯ÔÙˆÓ ˘fiÏÔÈˆÓ ÓÂ˘ÌÔÓÈÎÒÓ Â‰›ˆÓ.

∂ÈÎfiÓ· 1. ∞ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹. ¶ÏÂ˘ÚÈÙÈ-Î‹ Û˘ÏÏÔÁ‹ ·ÚÈÛÙÂÚ¿.

√ ·ÛıÂÓ‹˜ ·ÓÙÈÌÂÙˆ›ÛÙËÎÂ ÌÂ ÎÔÚÙÈ˙fiÓË Î·È

·ÓÙÈÊ˘Ì·ÙÈÎ‹ ·ÁˆÁ‹ Ì¤¯ÚÈ Ó· ÔÏÔÎÏËÚˆıÂ› Ô ÂÚÁ·-

ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ÁÈ· ÙÔÓ ›‰ÈÔ Î·È ÙÔ ÂÚÈ‚¿ÏÏÔÓ

ÙÔ˘ Î·È ÛÙË Û˘Ó¤¯ÂÈ· ¤Ï·‚Â Ì·ÎÚÔÏ›‰Ë (15

mg/kg/24h) ÛÂ ‰‡Ô ‰fiÛÂÈ˜ ÁÈ· 15 ËÌ¤ÚÂ˜. ∫·Ù¿ ÙË

‰È¿ÚÎÂÈ· ÙË˜ ÓÔÛËÏÂ›·˜ ÙÔ˘ ·Ú¤ÌÂÈÓÂ ÛÂ ¿ÚÈÛÙË

ÁÂÓÈÎ‹ Î·Ù¿ÛÙ·ÛË, Û˘Ó¤¯È˙Â fiÌˆ˜ ‰ÂÎ·ÙÈÎ‹ ˘ÚÂÙÈ-

Î‹ Î›ÓËÛË ÁÈ· ¤ÓÙÂ ËÌ¤ÚÂ˜ Î·Ù¿ ÙÈ˜ ·ÔÁÂ˘Ì·ÙÈ-

Ó¤˜ ÒÚÂ˜. ªÂÙ¿ ÙËÓ ¤Ó·ÚÍË ıÂÚ·Â›·˜, ˘‹ÚÍÂ

·ÎÚÔ·ÛÙÈÎÒ˜ ÚÔÔ‰Â˘ÙÈÎ‹ ‚ÂÏÙ›ˆÛË ÙˆÓ Â˘ÚËÌ¿-

ÙˆÓ ·fi ÙÔÓ ıÒÚ·Î·, ÂÓÒ ·ÔÎ·Ù¿ÛÙ·ÛË ÙÔ˘ ·Ó·-

ÓÂ˘ÛÙÈÎÔ‡ „Èı˘Ú›ÛÌ·ÙÔ˜ ˘‹ÚÍÂ ÌÂÙ¿ ÙË ‰¤Î·ÙË

ËÌ¤Ú· ÙË˜ ÓÔÛËÏÂ›·˜ ÙÔ˘. √ ¤ÏÂÁ¯Ô˜ ÙÔ˘ ÂÚÈ‚¿Ï-

ÏÔÓÙÔ˜ ÙÔ˘ ÂÊ‹‚Ô˘ ÁÈ· Ê˘Ì·Ù›ˆÛË ‹Ù·Ó ·ÚÓËÙÈÎfi˜,

ÂÓÒ ÙÔ ÚÒÙÔ ‰Â›ÁÌ· ÈÔÏÔÁÈÎÔ‡ ÂÏ¤Á¯Ô˘ Ê·›ÓÂÙ·È

ÛÙÔÓ ¶›Ó·Î· 1.

√ ¤ÊË‚Ô˜ Û˘Ó¤¯ÈÛÂ Ó· ·Ú·ÎÔÏÔ˘ıÂ›Ù·È ÎÏÈÓÈÎ¿

Î·È ÂÚÁ·ÛÙËÚÈ·Î¿ ÛÙ· ÂÍˆÙÂÚÈÎ¿ È·ÙÚÂ›· ÙË˜ ÎÏÈÓÈ-

Î‹˜. ŒÏ·‚Â ·ÓÙÈÊ˘Ì·ÙÈÎ‹ ·ÁˆÁ‹ ÁÈ· Û˘ÓÔÏÈÎfi ‰È¿-

ÛÙËÌ· 20 ËÌÂÚÒÓ. ∏ ÂÍ·Ê¿ÓÈÛË ÙË˜ ·ÙÂÏÂÎÙ·Û›·˜

‰È·ÈÛÙÒıËÎÂ ·ÎÙÈÓÔÏÔÁÈÎ¿ ‰‡Ô Ì‹ÓÂ˜ ÌÂÙ¿ ÙË ‰È¿-

ÁÓˆÛ‹ ÙË˜ Î·È ¤ÎÙÔÙÂ Ô ¤ÊË‚Ô˜ ·Ú·Ì¤ÓÂÈ ÛÂ ¿ÚÈ-

ÛÙË ÁÂÓÈÎ‹ Î·Ù¿ÛÙ·ÛË. ∏ ÏÂ˘ÚÈÙÈÎ‹ Û˘ÏÏÔÁ‹ ·Ô-

‰fiıËÎÂ ÛÂ ÓÂ˘ÌÔÓ›· ·fi Ì˘ÎfiÏ·ÛÌ· Î·È Ë ‰ÈÛÎÔ-

ÂÈ‰‹˜ ·ÙÂÏÂÎÙ·Û›· ÛÙËÓ ‡·ÚÍË ÂÍÈ‰ÚÒÌ·ÙÔ˜.

™˘˙‹ÙËÛË

∏ ‰ÈÛÎÔÂÈ‰‹˜ ·ÙÂÏÂÎÙ·Û›· Â›Ó·È Ì›· ·Û˘Ó‹ıÈÛÙË

ÌÔÚÊ‹ ÂÚÈÊÂÚÈÎ‹˜ ·ÙÂÏÂÎÙ·Û›·˜. ∞Ó·Ù‡ÛÛÂÙ·È

ˆ˜ ·ÔÙ¤ÏÂÛÌ· ·ıÔÏÔÁÈÎ‹˜ Î·Ù¿ÛÙ·ÛË˜ ÙÔ˘ ˘Â-

˙ˆÎfiÙ·. √È ÂÚÈÛÛfiÙÂÚÂ˜ ÂÚÈÙÒÛÂÈ˜ ¤¯Ô˘Ó ·Ô-

‰ÔıÂ› ÛÂ ÂÈÛÓÔ‹ ·ÌÈ¿ÓÙÔ˘, ·ÏÏ¿ ¤¯Ô˘Ó ·Ó·ÊÂÚıÂ›

Î·È ÔÏÏ¤˜ ¿ÏÏÂ˜ ·ÈÙ›Â˜, fiˆ˜ ÓÂ˘ÌÔÓÈÎ‹ Û˘ÏÏÔÁ‹

(ÂÍ›‰ÚˆÌ· ‹ ‰È›‰ÚˆÌ·) Î·È ÙÚ·‡Ì·. ∏ ‰ÈÛÎÔÂÈ‰‹˜

·ÙÂÏÂÎÙ·Û›· ÌÔÚÂ› Ó· ‰È·ÁÓˆÛÙÂ› ·fi ÏËıÒÚ·

·ÎÙÈÓÔÏÔÁÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ.

™ÙËÓ ÂÚ›ÙˆÛË ÙÔ˘ ·ÛıÂÓÔ‡˜ Ô˘ ·ÚÔ˘ÛÈ¿˙Â-

Ù·È, ˘¿Ú¯Ô˘Ó ÔÏÏ¿ ·fi Ù· ÎÚÈÙ‹ÚÈ· ÙË˜ ‰ÈÛÎÔÂÈ-

‰Ô‡˜ ·ÙÂÏÂÎÙ·Û›·˜, fiÛÔÓ ·ÊÔÚ¿: ·) ÛÙËÓ ÂÓÙfiÈÛË:

Â›Ó·È Û˘Ó‹ıˆ˜ ÂÙÂÚfiÏÂ˘ÚË Î·È Î·Ù·Ï·Ì‚¿ÓÂÈ Ù·

Ô›ÛıÈ· ÙÌ‹Ì·Ù· ÙˆÓ Î¿Ùˆ ÏÔ‚ÒÓ, ‚) ÛÙËÓ ·ÈÙÈÔÏÔ-

Á›·: ÏÂ˘ÚÈÙÈÎ‹ Û˘ÏÏÔÁ‹, fiˆ˜ Ê·›ÓÂÙ·È ÛÙËÓ ·ÎÙÈÓÔ-

ÁÚ·Ê›· ıÒÚ·ÎÔ˜ ·ÚÈÛÙÂÚ¿ Î·È Á) ÛÙÔ Û¯‹Ì·: ÛÊËÓÔÂÈ-

‰‹˜ Ì¿˙·, fiˆ˜ Ê·›ÓÂÙ·È ÛÙËÓ ·ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›·

Ô˘ Û˘Ó¤¯ÂÙ·È ÌÂ ÌÈ· ‰È¿¯˘ÙË ̆ Â˙ˆÎÔÙÈÎ‹ ¿¯˘ÓÛË.

¶›Ó·Î·˜ 1. ¶ÚÒÙÔ ‰Â›ÁÌ· ÈÔÏÔÁÈÎÔ‡ ÂÏ¤Á¯Ô˘

IgM IgG

Echo (1Ô ‰Â›ÁÌ·) (±) (-)Coxsakie (-) (-)Mycoplasm (1Ô ‰Â›ÁÌ·) 2,1 o.d. (max 2 o.d.) 3 o.d. (max 2 o.d.)

(optical density) (optical density)Chlamydia (-) (-)Mycoplasm (2Ô ‰Â›ÁÌ·-2 Â‚‰ÔÌ¿‰Â˜ ·ÚÁfiÙÂÚ·) (-) 3 o.d. (max 2 o.d.)

(optical density)Echo (2Ô ‰Â›ÁÌ·) (-) (-)

∂ÈÎfiÓ· 3. ∞ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹.™Ù· fiÚÈ· ÙË˜ ·ÏÏÔ›ˆÛË˜ ·Ó·‰ÂÈÎÓ‡ÔÓÙ·È ÔÚÈ·Î¿ ‰È·ÙÂÙ·Ì¤ÓÔÈ‚ÚfiÁ¯ÔÈ. ¢È·Ê·›ÓÂÙ·È Ë ¯·Ú·ÎÙËÚÈÛÙÈÎ‹ “Ô˘Ú¿ ÎÔÌ‹ÙË”.

∂ÈÎfiÓ· 2. ∞ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹.™ÊËÓÔÂÈ‰Ô‡˜ Û¯‹Ì·ÙÔ˜ ‰ÈÛÎÔÂÈ‰‹˜ ·ÙÂÏÂÎÙ·Û›·. ™˘ÓÂ¯È˙fiÌÂÓËÌÂ ÙÔÓ ˘Â˙ˆÎfiÙ·, Û˘Ó˘¿Ú¯ÂÈ ˘Â˙ˆÎÔÙÈÎ‹ ¿¯˘ÓÛË Î·ÈÏÂ˘ÚÈÙÈÎ‹ Û˘ÏÏÔÁ‹.

62 £. ∆·‚Ï·‰¿ÎË Î·È Û˘Ó.


63¢ÈÛÎÔÂÈ‰‹˜ ·ÙÂÏÂÎÙ·Û›· ÛÂ ¤ÊË‚Ô

¶·È‰È·ÙÚÈÎ‹ 2007;70:60-63

∂›ÛË˜, ÛÙËÓ ·ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›· ·ÂÈÎÔÓ›˙ÂÙ·ÈË ‚ÚÔÁ¯Ô·ÁÁÂÈ·Î‹ ‰ÔÌ‹ Ô˘ ÂÈÛ¤Ú¯ÂÙ·È ÛÙ· fiÚÈ·ÙË˜ Ì¿˙·˜ Î·È ·Ó·Ê¤ÚÂÙ·È ˆ˜ “ÛËÌÂ›Ô Ô˘Ú¿˜ ÎÔÌ‹-ÙË”, ÙÔ ÔÔ›Ô ·ÔÙÂÏÂ› ¯·Ú·ÎÙËÚÈÛÙÈÎfi Â‡ÚËÌ· ÙË˜‰ÈÛÎÔÂÈ‰Ô‡˜ ·ÙÂÏÂÎÙ·Û›·˜.

∆· Ì˘ÎÔÏ¿ÛÌ·Ù· Â›Ó·È ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ›, ÔÚÈ-ÛÌ¤Ó· Â›‰Ë ÂÎ ÙˆÓ ÔÔ›ˆÓ Â›Ó·È ·ıÔÁfiÓ· ÁÈ· ÙÔÓ¿ÓıÚˆÔ. ∫ÏÈÓÈÎ¿ Û˘Ó‹ıˆ˜ ÚÔ‚¿ÏÏÔ˘Ó ˆ˜ ÏÔ›Ìˆ-ÍË ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ‹ ˆ˜ÓÂ˘ÌÔÓ›·. ∏ ÓÂ˘ÌÔÓ›· ÂÌÊ·Ó›˙ÂÙ·È Î˘Ú›ˆ˜ ÛÂÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜.

∏ ÏÂ˘ÚÈÙÈÎ‹ Û˘ÏÏÔÁ‹ Î·È Ë ·ıÔÏÔÁÈÎ‹ Î·Ù¿-ÛÙ·ÛË ÙÔ˘ ˘Â˙ˆÎfiÙ· Â›¯Â ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙËÓ·Ó¿Ù˘ÍË ‰ÈÛÎÔÂÈ‰Ô‡˜ ·ÙÂÏÂÎÙ·Û›·˜, fiˆ˜ Ê·›ÓÂ-Ù·È ÛÙËÓ ·ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›· ıÒÚ·ÎÔ˜.


1. Szydlowski GW, Cohn HE, Steiner RM, Edie RN. Round-

ed atelectasis: a pulmonary pseudotumor. Ann Thorac Surg1992;53:817-821.

2. Hanke R, Kretzschmar R. Round atelectasis. SeminRoentgenol 1980;15:174-182.

3. Fraser R, Muller N, Colman N, Pare P. Fraser and Pare’sdiagnosis of diseases of the chest. 4th edition. Philadelphia,PA: WB Saunders Company; 1999. p. 513-522.

4. Doyle TC, Lawler GA. CT features of rounded atelectasis ofthe lung. Am J Roentgenol 1984;143:225-228.

5. McHugh K, Blaquiere RM. CT features of rounded atelec-tasis. Am J Roentgenol 1989;153:257-260.

6. Roach HD, Davies GJ, Attanoos R, Crane M, Adams H,Phillips S. Asbestos: when the dust settles an imaging re-view of asbestos-related disease. Radiographics 2002;22:167-184.

7. Medford ARL, Darby M, Maskell NA. Rounded atelectasismimicking a lung cancer. J R Col Physicians Edinb 2005;35:123-125.

8. Woodring Jh. Pleural effusion is a cause of round atelec-tasis of the lung. J Ky Med Assoc 2000;98:527-532.

64 ¶ƒ∞∫∆π∫√ £∂ª∞ PRACTICAL ISSUE


¶°¡∞ ∞ÏÂÍ¿Ó‰Ú·, ¡ÂÔÁÓÔÏÔÁÈÎfi ∆Ì‹Ì·


Ã. ∫ÒÛÙ·ÏÔ˜[email protected]∞ÚÙ¤ÌÈ‰Ô˜ 130, ∆.∫. 175 62, ¶. º¿ÏËÚÔ

Department of NeonatalMedicine, Alexandra RegionalGeneral Hospital, Athens,Greece

Correspondence:

C. [email protected], Artemidos St.,175 62 P. Faliro, Athens, Greece

µÚÂÊÈÎ‹ ÛÔ‚·Ú‹ ·Ú·ÙÂÈÓfiÌÂÓË ‰È¿ÚÚÔÈ· -

¡ÂfiÙÂÚÂ˜ ·fi„ÂÈ˜


¶ÂÚ›ÏË„Ë: ø˜ ÛÔ‚·Ú‹ ·Ú·ÙÂÈÓfiÌÂÓË ‰È¿ÚÚÔÈ· ıÂˆÚÔ‡ÌÂ Î¿ıÂ ‰È·ÚÚÔ˚Îfi ÂÂÈÛfi‰ÈÔ ÙÔ ÔÔ›Ô ‰È·Ú-ÎÂ› ÂÚÈÛÛfiÙÂÚÔ ·fi 15 ËÌ¤ÚÂ˜ Î·È Â›Ó·È ·ÚÎÔ‡ÓÙˆ˜ ÛÔ‚·Úfi ÒÛÙÂ Ó· ··ÈÙÂ› ıÂÚ·Â›· ÌÂ ·ÚÂÓÙÂÚÈ-Î‹ ‰È·ÙÚÔÊ‹. ¶ÚfiÎÂÈÙ·È ÁÈ· ‚·ÚÈ¿ ¿ıËÛË ÙË˜ ÔÔ›·˜ Ë ıÓËÙfiÙËÙ· Î˘Ì·›ÓÂÙ·È ÌÂÙ·Í‡ 5-47%. §ÔÈÌÒ-‰ÂÈ˜ ·Ú¿ÁÔÓÙÂ˜ Î·È ÙÚÔÊÈÎ¤˜ ·ÏÏÂÚÁ›Â˜ ·ÔÙÂÏÔ‡Ó ÙÈ˜ ÈÔ Û˘¯Ó¤˜ ·ÈÙ›Â˜ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘. ¶ÚÔÁÓˆÛÙÈÎ¿ÛËÌÂ›· Ô˘ ÚÔ‰È·ÁÚ¿ÊÔ˘Ó Î·Î‹ ¤Î‚·ÛË, ·ÔÙÂÏÔ‡Ó Ù· ·ÎfiÏÔ˘ı·: ¯·ÌËÏfi ‚¿ÚÔ˜ Á¤ÓÓËÛË˜, ıÂÙÈÎfi ÔÈ-ÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi, ÚÒÈÌË ¤Ó·ÚÍË, ÎÔÈÓˆÓÈÎ‹ Ù¿ÍË, Î·È ÌË Ï‹„Ë ÌËÙÚÈÎÔ‡ Á¿Ï·ÎÙÔ˜. ∏ ÂÈÛ·ÁˆÁ‹ Ó¤-ˆÓ ‰È·ÁÓˆÛÙÈÎÒÓ ÌÂıfi‰ˆÓ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· Â¤ÙÚÂ„Â ÙË ‰È¿ÁÓˆÛË Ó¤ˆÓ ·ı‹ÛÂˆÓ ÔÈ ÔÔ›Â˜ ÚÔ-Î·ÏÔ‡Ó ·Ú·ÙÂÈÓfiÌÂÓË ‰È¿ÚÚÔÈ·, fiˆ˜ Â›Ó·È Ë Û˘ÁÁÂÓ‹˜ „Â˘‰Ô·fiÊÚ·ÍË, Ë ÓfiÛÔ˜ ÙˆÓ ÌÈÎÚÔÏ·¯ÓÈ·-ÎÒÓ ÂÁÎÏÂ›ÛÙˆÓ, Ë ÂÓÙÂÚÔ¿ıÂÈ· ÌÂ ı˘Û¿ÓÔ˘˜, Ë ·˘ÙÔ¿ÓÔÛË ÂÓÙÂÚÔ¿ıÂÈ·, ÙÔ Û‡Ó‰ÚÔÌÔ ·ÓÔÛÔÏÔÁÈÎ‹˜‰˘ÛÚ˘ıÌ›·˜, ÔÏ˘ÂÓ‰ÔÎÚÈÓÔ¿ıÂÈ·˜, ÂÓÙÂÚÔ¿ıÂÈ·˜ Î·È Ê˘ÏÔÛ‡Ó‰ÂÙË˜ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜ (IPEX), Ë ÂÈ-Ì¤ÓÔ˘Û· ÂÏÎÒ‰Ë˜ ÎÔÏ›ÙÈ‰·, ÔÈ ‰È·Ù·Ú·¯¤˜ ÁÏ˘ÎÔ˙˘Ï›ˆÛË˜, Î·ıÒ˜ Î·È ÂÓÙÂÚÔ¿ıÂÈÂ˜ ·fi Ó¤· ÏÔÈÌÒ‰Ë·›ÙÈ·. √È Ó¤Â˜ ·˘Ù¤˜ ·ı‹ÛÂÈ˜ ·ÔÙÂÏÔ‡Ó ÙÔ ·ÓÙÈÎÂ›ÌÂÓÔ ÙË˜ ·ÚÔ‡Û·˜ ·Ó·ÛÎfiËÛË˜. ∞Ó Î·È ÁÈ· ÙÈ˜ Â-ÚÈÛÛfiÙÂÚÂ˜ ·fi ·˘Ù¤˜, ÂÎÙfi˜ ·fi ÙÈ˜ ÏÔÈÌÒ‰ÂÈ˜, ‰ÂÓ ˘¿Ú¯ÂÈ ÂÈ‰ÈÎ‹ ıÂÚ·Â›·, Ë ÚÒÈÌË ‰È¿ÁÓˆÛË Ô‰Ë-ÁÂ› ÛÂ Î·Ï‡ÙÂÚË ÂÎÙ›ÌËÛË ÙË˜ ÚfiÁÓˆÛË˜ Î·È ‰›ÓÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· ÁÈ· ÙËÓ ·ÚÔ¯‹ ÁÂÓÂÙÈÎÒÓ Û˘Ì‚Ô˘-ÏÒÓ ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ·. Àfi ‰ÔÎÈÌ‹ ‚Ú›ÛÎÔÓÙ·È Û‹ÌÂÚ· Ó¤· ıÂÚ·Â˘ÙÈÎ¿ Ì¤Û· ˘fi ÌÔÚÊ‹ ·˘ÍËÙÈÎÒÓ, ‚ÈÔ-ÏÔÁÈÎÒÓ Î·È ·ÓÙÈÊÏÂÁÌÔÓˆ‰ÒÓ ·Ú·ÁfiÓÙˆÓ Î·ıÒ˜ Î·È ıÚÂÙÈÎÒÓ Ô˘ÛÈÒÓ.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ÃÚfiÓÈ· ‰È¿ÚÚÔÈ·, ÂÓÙÂÚÔ¿ıÂÈ·, ÓÂÔÁÓfi.

Severe protracted diarrhÔea of infancy - New aspects

C. Costalos

Abstract: Severe protracted diarrhoea of infancy is defined as diarrhoea lasting for more than 15 days,severe enough to necessitate parenteral nutrition. It is a serious disease with a mortality rate ranging from5 to 47%. Infectious agents and trophic allergies account for most of the cases. Poor prognostic factorsinclude low birth weight, positive family history, early onset, atopy, low social class and absence of breastfeeding. The availability of novel diagnostic tools in recent years has expanded understanding of theaetiology and pathophysiology of protracted diarrhoea, resulting in the identification of a number of newdiarrhoeal disease entities, which are discussed in this review. These include congenital pseudo-obstruction, familial microvillus inclusion disease, tufting enteropathy, autoimmune enteropathy, immunedysregulation, polyendocrinopathy, enteropathy, X-linked syndrome (IPEX) and persistent ulcerativecolitis, as well as disorders of glucoprotein glycosylation. New infective enteropathogens have also beenidentified. Although definitive treatment for severe protracted diarrhoea is available only in the case ofinfectious agents, early identification of these diseases permits improved counseling of parents about thelong-term prognosis and therapeutic options, and allows better assessment of the potential risk forsubsequent affected siblings. New forms of management are currently under way, with the use of enteralgrowth factors, biologic and anti-inflammatory agents and nutrients.

Key words: Enteropathies, chronic intractable diarrhoea, newborn infant.

∂ÈÛ·ÁˆÁ‹

ø˜ ·Ú·ÙÂÈÓfiÌÂÓË ÛÔ‚·Ú‹ ‰È¿ÚÚÔÈ· (¶™¢) ÔÚ›-

˙ÂÙ·È Ë ‰È¿ÚÚÔÈ· Ë ÔÔ›· ·Ú·ÙÂ›ÓÂÙ·È ¤Ú·Ó

ÙˆÓ 15 ËÌÂÚÒÓ Î·È Â›Ó·È ·ÚÎÔ‡ÓÙˆ˜ ÛÔ‚·Ú‹

ÒÛÙÂ Ó· ··ÈÙÂ› ÂÈ‰ÈÎ‹ ‰È·ÈÙËÙÈÎ‹ ·ÓÙÈÌÂÙÒÈÛË

Î·È Û˘¯Ó¿ ·ÚÂÓÙÂÚÈÎ‹ ‰È·ÙÚÔÊ‹ (1). ∆Ô ı¤Ì·

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¯ÚfiÓÈ· ÛÙË Á·ÛÙÚÂÓÙÂÚÔÏÔÁ›· ¤ÊÂÚ·Ó ÙÔ ı¤Ì·

Î·È ¿ÏÈ ÛÙÔ ÚÔÛÎ‹ÓÈÔ. ∏ ¯ÚËÛÈÌÔÔ›ËÛË ÙÔ˘

ËÏÂÎÙÚÔÓÈÎÔ‡ ÌÈÎÚÔÛÎÔ›Ô˘, ·ÓÔÛÔ˚ÛÙÔ¯ËÌÈ-

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Î·È ÙÔÓ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛ‹˜ ÙË˜ ÛÂ ÌÂÙ·ÁÂÓ¤ÛÙÂÚË

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ÂÚÓ¿ÂÈ ÙË 1 ÂÚ›ÙˆÛË/100.000 ÁÂÓÓ‹ÛÂÈ˜ (2), Ë

ıÓËÙfiÙËÙ¿ ÙË˜ Â›Ó·È ÔÏ‡ ˘„ËÏ‹ (5-47%) (1) Î·È Ë

ÔÈÎÔÓÔÌÈÎ‹ ÂÈ‚¿Ú˘ÓÛË ÙÂÚ¿ÛÙÈ·.

§fiÁˆ ÙÔ˘ ÌÂÁ¿ÏÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ·ı‹ÛÂˆÓ ÔÈ

ÔÔ›Â˜ ÚÔÎ·ÏÔ‡Ó ¶™¢, Ë ·Ó·ÛÎfiËÛË ı· ·Ó·ÊÂÚ-

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ÁfiÓÔ˘˜ ·Ú¿ÁÔÓÙÂ˜ ÔÈ ÔÔ›ÔÈ ÚÔÎ·ÏÔ‡Ó ¶™¢.

∆· Î˘ÚÈfiÙÂÚ· ·›ÙÈ· ¶™¢ ÂÚÈÁÚ¿ÊÔÓÙ·È ÛÙÔÓ ¶›-

Ó·Î· 1 (3). ø˜ ÂÈ‚·Ú˘ÓÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ ÁÈ· ¶™¢

·Ó·Ê¤ÚÔÓÙ·È ÔÈ ÂÍ‹˜: ¯·ÌËÏfi ‚¿ÚÔ˜ Á¤ÓÓËÛË˜, ÌË

Ï‹„Ë ÌËÙÚÈÎÔ‡ Á¿Ï·ÎÙÔ˜, ·ÙÔÈÎ‹ ÚÔ‰È¿ıÂÛË,

ÚÒÈÌË ¤Ó·ÚÍË ÙË˜ ÓfiÛÔ˘ (ÓˆÚ›ÙÂÚ· ·fi ÙÔÓ 1Ô Ì‹-

Ó· ˙ˆ‹˜), ¯·ÌËÏ‹ ÎÔÈÓˆÓÈÎ‹ Ù¿ÍË, Î·È ÚÔÛ‚ÔÏ‹

Î·È ¿ÏÏÔ˘ Ì¤ÏÔ˘˜ ÙË˜ ÔÈÎÔÁ¤ÓÂÈ·˜ ·fi ¶™¢ (3).

∞. ™˘ÁÁÂÓ‹˜ „Â˘‰Ô·fiÊÚ·ÍË

∂ÌÊ·Ó›˙ÂÙ·È Î·Ù¿ ÙË ÓÂÔÁÓÈÎ‹ ÂÚ›Ô‰Ô ÌÂ ÛË-

ÌÂ›· ÂÓÙÂÚÈÎ‹˜ ·fiÊÚ·ÍË˜: ¤ÌÂÙÔ, ‰È¿Ù·ÛË ÎÔÈÏÈ¿˜,

·Ô˘Û›· ÎÂÓÒÛÂˆÓ, ¯ˆÚ›˜ fiÌˆ˜ ·Ó·ÙÔÌÈÎfi ÎÒÏ˘Ì·

(4). ™˘Ó‹ıˆ˜ ÂÌÊ·Ó›˙ÂÙ·È ÛÔÚ·‰ÈÎ¿, ¤¯Ô˘Ó ÂÚÈ-

ÁÚ·ÊÂ› fiÌˆ˜ ÂÚÈÙÒÛÂÈ˜ ÔÈ ÔÔ›Â˜ ÎÏËÚÔÓÔÌÔ‡-

ÓÙ·È ÌÂ ÂÈÎÚ·ÙÔ‡ÓÙ· ‹ ˘ÔÏÂÈfiÌÂÓÔ ¯·Ú·ÎÙ‹Ú·.

√ÊÂ›ÏÂÙ·È Û˘Ó‹ıˆ˜ ÛÂ ·ÓÒÌ·ÏË ·Ó¿Ù˘ÍË ÙÔ˘ ÏÂ›-

Ô˘ Ì˘˚ÎÔ‡ ¯ÈÙÒÓ· ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ÙÔÈ¯ÒÌ·ÙÔ˜ ‹ ÛÂ

·ÙÂÏ‹ ·Ó¿Ù˘ÍË ÙÔ˘ ·˘ÙfiÓÔÌÔ˘ ÓÂ˘ÚÈÎÔ‡ Ï¤ÁÌ·-

ÙÔ˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘ (4). ∂› ÚÔÛ‚ÔÏ‹˜ ÙÔ˘ Ì˘˚ÎÔ‡ ¯È-

ÙÒÓ· ·Ú·ÙËÚÂ›Ù·È ·ÓÙÈÎ·Ù¿ÛÙ·ÛË ÙÔ˘ ÂÈÌ‹ÎÔ˘˜

Ì˘˚ÎÔ‡ ¯ÈÙÒÓ· ÌÂ ÈÓÒ‰Ë ÈÛÙfi. ™Â ÓÂ˘ÚÔÏÔÁÈÎ‹ ‚Ï¿-

‚Ë ·Ú·ÙËÚÂ›Ù·È ÌÂ›ˆÛË ÙˆÓ Á·ÁÁÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ.

™Â ÌÂÚÈÎ¤˜ ÂÚÈÙÒÛÂÈ˜ ·Ó·Ê¤ÚÔÓÙ·È ·ÓˆÌ·Ï›Â˜

ÛÙ· Î‡ÙÙ·Ú· ÙÔ˘ Cajal, ÂÓÒ ÛÂ ¿ÏÏÂ˜ ÂÚÈÙÒÛÂÈ˜,

·ÓˆÌ·Ï›Â˜ ÛÙ· ÌÈÙÔ¯fiÓ‰ÚÈ· ÙˆÓ ÂÓÙÂÚÈÎÒÓ Î˘ÙÙ¿-

ÚˆÓ (5).

™ÙÔ 50% ÙˆÓ ÚÔÛ‚Â‚ÏËÌ¤ÓˆÓ ·È‰ÈÒÓ Ù· Û˘-

ÌÙÒÌ·Ù· ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÔ˘˜ ÙÚÂÈ˜ ÚÒÙÔ˘˜ Ì‹ÓÂ˜

˙ˆ‹˜. ∆· 2/3 ÙˆÓ ÂÚÈÙÒÛÂˆÓ ·ÊÔÚÔ‡Ó ÛÂ ÚfiˆÚ·

‚Ú¤ÊË. ™ÙÔ 40% ÙˆÓ ÂÚÈÙÒÛÂˆÓ Û˘Ó˘¿Ú¯ÂÈ ·ÓÒ-

Ì·ÏË ÂÚÈÛÙÚÔÊ‹ ÙÔ˘ ÂÓÙ¤ÚÔ˘. ∏ ‰˘ÛÎÔÈÏÈfiÙËÙ·

·ÔÙÂÏÂ› ÙËÓ ÈÔ Û˘¯Ó‹ ÂÎ‰‹ÏˆÛË, ÂÓÒ Ë ‰È¿ÚÚÔÈ·

ÂÌÊ·Ó›˙ÂÙ·È ÛÙÔ 30-40% ÙˆÓ ÂÚÈÙÒÛÂˆÓ. ™˘ÌÌÂ-

ÙÔ¯‹ ÙÔ˘ Ô˘ÚÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ·Ú·ÙËÚÂ›Ù·È

Û˘¯Ó¿ Î·È ÂÎ‰ËÏÒÓÂÙ·È ÌÂ Û˘¯Ó¤˜ Ô˘ÚÔÏÔÈÌÒÍÂÈ˜. ∏

‰È¿ÁÓˆÛË Ù›ıÂÙ·È ÌÂ Ì·ÓÔÌÂÙÚÈÎfi ¤ÏÂÁ¯Ô ÙË˜ ÎÈÓËÙÈ-

ÎfiÙËÙ·˜ ÙÔ˘ ÂÙÈÎÔ‡, ÂÓÒ ÙÂÏÂ˘Ù·›· ¯ÚËÛÈÌÔÔÈÔ‡-

ÓÙ·È Î·È ÛÈÓıËÚÔÁÚ·ÊÈÎ¤˜ Ì¤ıÔ‰ÔÈ ÌÂ Ú·‰ÈÔ˚ÛfiÙÔ-

·. (6). ∏ ‰È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË ı· Á›ÓÂÈ ·fi ÙË ÓfiÛÔ

ÙÔ˘ Hirschprung. ™Â ·ÓÙ›ıÂÛË fiÌˆ˜, ÌÂ ÙÔ Û˘ÁÁÂÓ¤˜

ÌÂÁ¿ÎÔÏÔ, Ë ÎÈÓËÙÈÎfiÙËÙ· ÙÔ˘ ÔÚıÔ‡ Î·È ÙÔ˘ Úˆ-

ÎÙÔ‡ Â›Ó·È Ê˘ÛÈÔÏÔÁÈÎ‹. ∏ ÙÂÏÈÎ‹ ‰È¿ÁÓˆÛË Á›ÓÂÙ·È

ÌÂ ÈÛÙÔÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ‚ÏÂÓÓÔÁfiÓÔ˘

ÌÂÙ¿ ·fi ‚ÈÔ„›·. ∏ ıÂÚ·Â›· Û˘Ó›ÛÙ·Ù·È ÛÂ ¯ÔÚ‹ÁË-

ÛË ÚÔÎÈÓËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ .¯. ·ÓÙ·ÁˆÓÈÛÙÒÓ ÙË˜

5-˘‰ÚÔÍ˘ÙÚ˘Ù·Ì›ÓË˜ (ÛÈÛ·Ú›‰Ë), ‹ ÌÂ Ù· ÓÂfiÙÂÚ·

Ê¿ÚÌ·Î· alosetron (·ÓÙ·ÁˆÓÈÛÙ‹˜ ÙˆÓ ˘Ô‰Ô¯¤ˆÓ

ÙË˜ 5-∏∆3) ‹ tegaserod (Û˘Ó·ÁˆÓÈÛÙ‹˜ ÙˆÓ ˘Ô‰Ô¯¤-

ˆÓ ÙË˜ 5-∏∆4). ™Â ÛÔ‚·Ú¤˜ ÂÚÈÙÒÛÂÈ˜ Á›ÓÂÙ·È ÎÔ-

ÏÂÎÙÔÌ‹ ‹ ÂÈÏÂÔÛÙÔÌ›· (7,8).

µ. ¡fiÛÔ˜ ÌÈÎÚÔÏ·¯ÓÈ·ÎÒÓ ÂÁÎÏÂ›ÛÙˆÓ

¶ÚfiÎÂÈÙ·È ÁÈ· ÛÔ‚·Ú‹ ‰È·ÚÚÔ˚Î‹ Û˘Ó‰ÚÔÌ‹ ÌÂ

˘‰·ÚÂ›˜ ÎÂÓÒÛÂÈ˜ Î·È ÙÂÚ¿ÛÙÈÂ˜ ·ÒÏÂÈÂ˜ ËÏÂÎÙÚÔ-

Ï˘ÙÒÓ ÛÙ· ÎfiÚ·Ó·, Ë ÔÔ›· ÂÌÊ·Ó›˙ÂÙ·È ·fi ÙÈ˜

ÚÒÙÂ˜ ËÌ¤ÚÂ˜ ˙ˆ‹˜ Î·È ·ÔÙÂÏÂ› ÙË Û˘¯ÓfiÙÂÚË ·È-

Ù›· ¶™¢ ÙË˜ ÓÂÔÁÓÈÎ‹˜ ÂÚÈfi‰Ô˘ ÌÂÙ¿ ÙË ÏÔÈÌÒ‰Ë ·È-

ÙÈÔÏÔÁ›· (9,10). ∂›Ó·È ·ÁÓÒÛÙÔ˘ ·ÈÙÈÔÏÔÁ›·˜ Î·È Èı·-

ÓfiÓ ÎÏËÚÔÓÔÌÂ›Ù·È ÌÂ ÛˆÌ·ÙÈÎ¿ ̆ ÔÏÂÈfiÌÂÓÔ ̄ ·Ú·-

ÎÙ‹Ú·. ∏ ‰È¿ÁÓˆÛË Ù›ıÂÙ·È ÌÂ ‚ÈÔ„›· ÙÔ˘ ÂÓÙ¤ÚÔ˘, Ë

ÔÔ›· ‰Â›¯ÓÂÈ ·ÙÚÔÊ›· ÙˆÓ Ï·¯ÓÒÓ. ™ÙÔ ËÏÂÎÙÚÔÓÈÎfi

ÌÈÎÚÔÛÎfiÈÔ, Ù· Î‡ÙÙ·Ú· ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ‚ÏÂÓÓÔÁfi-

ÓÔ˘ Û˘ÁÎÂÓÙÚÒÓÔÓÙ·È Î·Ù¿ ÛˆÚÔ‡˜ Î·È ‰Â›¯ÓÔ˘Ó ÎÂ-

ÓÔÙfiÈ· ÙÔ˘ Î˘ÙÙ·ÚÔÏ¿ÛÌ·ÙÔ˜. ∏ „˘ÎÙÚÔÂÈ‰‹˜ ·-

Ú˘Ê‹ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ¤¯ÂÈ ·Û·Ê‹ fiÚÈ· (11). ∞ÓÔÛÔ-

¯ÚˆÌ·ÙÈÛÌfi˜ ÁÈ· “‚ÈÏÏ›ÓË”, ¤Ó· ÌÈÎÚÔÓËÌ·ÙÒ‰Â˜ Û˘-

ÛÙ·ÙÈÎfi ÙˆÓ ÌÈÎÚÔÏ·¯ÓÒÓ ·ÔÎ·Ï‡ÙÂÈ ÙËÓ ·ÚÔ˘-

Û›· Î˘ÙÙ·ÚÈÎÒÓ ÂÁÎÏÂ›ÛÙˆÓ ·ÔÙÂÏÔ‡ÌÂÓˆÓ ·fi

·ÓÒÌ·ÏÂ˜ ÌÈÎÚÔÏ¿¯ÓÂ˜ ÔÈ ÔÔ›Â˜ Ê¤ÚÔ˘Ó „˘ÎÙÚÔÂÈ-

‰‹ ·Ú˘Ê‹, ÌÂÌ‚Ú¿ÓË, ÌÈÎÚÔÓËÌ¿ÙÈ·, ÓËÌ·ÙÈÒ‰Â˜

ÂÚ›‚ÏËÌ· (12). ∆· ¤ÁÎÏÂÈÛÙ· ·˘Ù¿ ·ÓÂ˘Ú›ÛÎÔÓÙ·È

Î·È ÛÂ ¿ÏÏ· ÂÈıËÏÈ·Î¿ Î‡ÙÙ·Ú· ÙfiÛÔ ÙÔ˘ ÂÙÈÎÔ‡

(ÛÙÔÌ¿¯È, ¯ÔÏË‰fi¯Ô˜ Î‡ÛÙË, ÎfiÏÔÓ), fiÛÔ Î·È ÛÙ· ÓÂ-

ÊÚÈÎ¿ ÛˆÏËÓ¿ÚÈ· (11). ∂›ÛË˜ ·ÓÈ¯ÓÂ‡ÔÓÙ·È Ê˘Û·ÏÈ-

‰Ò‰Ë ÛˆÌ¿ÙÈ· Ù· ÔÔ›· ÂÚÈ¤¯Ô˘Ó ÎÔÎÎÈÒ‰Â˜ ˘ÏÈÎfi

¿ÁÓˆÛÙË˜ ÚÔ¤ÏÂ˘ÛË˜.

∏ ·ÈÙÈÔÏÔÁ›· ÙË˜ ÓfiÛÔ˘ Â›Ó·È ¿ÁÓˆÛÙË. ¶Èı·ÓÔ-

ÏÔÁÂ›Ù·È ‰È·Ù·Ú·¯‹ ÛÙË ÌÂÙ·ÊÔÚ¿ ÚˆÙÂ˚ÓÒÓ ··-

Ú·›ÙËÙˆÓ ÁÈ· ÙË ‰ÔÌ‹ ÙÔ˘ Î˘ÙÙ·ÚÔÏ¿ÛÌ·ÙÔ˜ ÙˆÓ

ÂÓÙÂÚÈÎÒÓ Î˘ÙÙ¿ÚˆÓ. ªÂ ‚¿ÛË ÙË ıÂˆÚ›· ·˘Ù‹, ÔÈ

Ê˘Û·Ï›‰Â˜ ÔÈ ÔÔ›Â˜ ·Ú·ÙËÚÔ‡ÓÙ·È ÛÙÔ ËÏÂÎÙÚÔÓÈ-

Îfi ÌÈÎÚÔÛÎfiÈÔ ÚÔ¤Ú¯ÔÓÙ·È ·fi Ù· ÛˆÌ¿ÙÈ· ÙÔ˘

65µÚÂÊÈÎ‹ ·Ú·ÙÂÈÓfiÌÂÓË ‰È¿ÚÚÔÈ·

¶·È‰È·ÙÚÈÎ‹ 2007;70:64-69

¶›Ó·Î·˜ 1. ™˘¯ÓfiÙÂÚ· ·›ÙÈ· ÛÔ‚·Ú‹˜ ·Ú·ÙÂÈÓfiÌÂÓË˜ ‰È¿ÚÚÔÈ·˜ÛÂ 38 ‚Ú¤ÊË (3)

∂ÓÙÂÚÈÎ‹ ÏÔ›ÌˆÍË 18∆ÚÔÊÈÎ‹ ·ÏÏÂÚÁ›· 8∞˘ÙÔ¿ÓÔÛË ÂÓÙÂÚÔ¿ıÂÈ· 2¡fiÛÔ˜ ÌÈÎÚÔÏ·¯ÓÈ·ÎÒÓ ÂÁÎÏÂ›ÛÙˆÓ 2∫ÔÈÏÈÔÎ¿ÎË 1HˆÛÈÓÔÊÈÏÈÎ‹ ÂÓÙÂÚÔ¿ıÂÈ· 1§ÂÌÊ·ÁÁÈÂÎÙ·Û›· 1æÂ˘‰Ô·fiÊÚ·ÍË 1¡Â˘ÚÔ‰˘ÛÏ·Û›· 1ÕÁÓˆÛÙ· ·›ÙÈ· 3

Golgi ·’ fiÔ˘ ÌÂÙ·Ó·ÛÙÂ‡Ô˘Ó ÚÔ˜ ÙËÓ ÂÈÊ¿ÓÂÈ·

ÙÔ˘ Î˘ÙÙ¿ÚÔ˘ ÌÂÙ·Ê¤ÚÔÓÙ·˜ Û˘ÛÙ·ÙÈÎ¿ ··Ú·›ÙËÙ·

ÁÈ· ÙË ‰fiÌËÛË ÙË˜ „˘ÎÙÚÔÂÈ‰Ô‡˜ ·Ú˘Ê‹˜. ™ÙËÓ

¿ıËÛË ·˘Ù‹ Ë ÔÚÂ›· ÙˆÓ Ê˘Û·Ï›‰ˆÓ ·Ó·ÎfiÙÂÙ·È

Î·È ÔÈ Ê˘Û·Ï›‰Â˜ Î·Ù·ÎÚ·ÙÔ‡ÓÙ·È ÛÙÔ Î˘ÙÙ·ÚfiÏ·-

ÛÌ· ÙÔ˘ Î˘ÙÙ¿ÚÔ˘ fiÔ˘ Î·È ‰ËÌÈÔ˘ÚÁÔ‡Ó ·ıÔÏÔÁÈ-

Î¿ ÌÈÎÚÔÏ·¯ÓÒ‰Ë ¤ÁÎÏÂÈÛÙ· (9,13). ŒÓ· ¿ÏÏÔ ¯·Ú·-

ÎÙËÚÈÛÙÈÎfi ÙË˜ ¿ıËÛË˜ Â›Ó·È Ë ·ÚÔ˘Û›· ·ÓÙÈÛˆ-

Ì¿ÙˆÓ Î·Ù¿ ÙÔ˘ Î·ÚÎÈÓÔÂÌ‚Ú˘˚ÎÔ‡ (CEA) Î·È ÙÔ˘

ÏÂ˘¯·ÈÌÈÎÔ‡ (CD10) ·ÓÙÈÁfiÓÔ˘ (12).

¢ÂÓ ˘¿Ú¯ÂÈ ÂÈ‰ÈÎ‹ ıÂÚ·Â›· ÁÈ· ÙË ÓfiÛÔ. ÃÚË-

ÛÈÌÔÔÈÔ‡ÓÙ·È ‰È¿ÊÔÚ· ·ÓÙÈÂÎÎÚÈÙÈÎ¿ Ê¿ÚÌ·Î·

.¯. ·ÓıÚ·ÎÈÎfi Ï›ıÈÔ (14) Î·È ÛˆÌ·ÙÔÛÙ·Ù›ÓË (15).

∏ Û›ÙÈÛË Á›ÓÂÙ·È ·ÚÂÓÙÂÚÈÎ¿ Ì¤¯ÚÈ˜ fiÙÔ˘ ‚ÚÂıÂ› ÙÔ

Î·Ù¿ÏÏËÏÔ ÌfiÛ¯Â˘Ì· ÂÓÙ¤ÚÔ˘ ÁÈ· ÌÂÙ·ÌfiÛ¯Â˘ÛË.

°. ∂ÓÙÂÚÔ¿ıÂÈ· ÌÂ ı˘Û¿ÓÔ˘˜

∂ÌÊ·Ó›˙ÂÙ·È Î·Ù¿ ÙÔ˘˜ ÚÒÙÔ˘˜ Ì‹ÓÂ˜ ˙ˆ‹˜ ÌÂ

¯ÚfiÓÈ· ˘‰·Ú‹ ‰È¿ÚÚÔÈ· Î·È Î·ı˘ÛÙ¤ÚËÛË ÛÙË ÛˆÌ·-

ÙÈÎ‹ ·Ó¿Ù˘ÍË. √ÚÈÛÌ¤Ó· ‚Ú¤ÊË ÂÌÊ·Ó›˙Ô˘Ó Î·È

‰˘ÛÌÔÚÊÈÎfi ÚfiÛˆÔ. ¶·Ú·ÙËÚÂ›Ù·È Û˘¯ÓfiÙÂÚ· ÛÂ

¿ÙÔÌ· Ì·ÏÙ¤˙ÈÎË˜ Î·Ù·ÁˆÁ‹˜ (16). º·›ÓÂÙ·È fiÙÈ

ÔÊÂ›ÏÂÙ·È ÛÂ ·ÓˆÌ·Ï›Â˜ ÛÙËÓ ¤ÎÊÚ·ÛË Î˘ÙÙ·ÚÈÎÒÓ

ÌÔÚ›ˆÓ ÚÔÛÎfiÏÏËÛË˜. ∞Ó·Ê¤ÚÔÓÙ·È ‰È·Ù·Ú·¯¤˜

ÛÙËÓ Î·Ù·ÓÔÌ‹ ÙË˜ ¿ÏÊ·2/‚‹Ù·1 ÈÓÙÂÁÎÚ›ÓË˜ Î·È

‰ÔÌÈÎ¤˜ ÌÂÙ·‚ÔÏ¤˜ ÛÙ· ‰ÂÛÌÔÛˆÌ¿ÙÈ· ÙÔ˘ ÂÓÙ¤ÚÔ˘

(17,18). ™Â ÔÓÙ›ÎÈ· ¿Û¯ÔÓÙ· ·fi ÙË ÓfiÛÔ ‚Ú¤ıË-

Î·Ó Â›ÛË˜ ÌÂÈˆÌ¤Ó· Â›Â‰· ÙÔ˘ ˘Ô‰Ô¯¤· Ù‡Ô˘

2 ÙÔ˘ ÌÂÙ·ÙÚÂÙÈÎÔ‡ ·˘ÍËÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ‚. √È

·ÓˆÌ·Ï›Â˜ ·˘Ù¤˜ Ô‰ËÁÔ‡Ó ÛÂ ‰È·Ù·Ú·¯¤˜ ˆ˜ ÚÔ˜

ÙË Û‡ÛÙ·ÛË ÙË˜ ‚·ÛÈÎ‹˜ ÌÂÌ‚Ú¿ÓË˜ Î·È Î˘Ú›ˆ˜ ÙË˜

Ï·ÌÈÓ›ÓË˜ Î·È ÙË˜ ÚˆÙÂÔÁÏ˘Î¿ÓË˜ ÙˆÓ ÂÈıËÏÈ·-

ÎÒÓ Î˘ÙÙ¿ÚˆÓ ÙÔ˘ ÂÓÙ¤ÚÔ˘, ÌÂ Û˘Ó¤ÂÈ· Ó· ˘Ê›ÛÙ·-

ÓÙ·È ·fiÙˆÛË (19). ∏ ‚ÈÔ„›· ÙÔ˘ ÂÓÙ¤ÚÔ˘ ‰Â›¯ÓÂÈ

ÔÏÈÎ‹ ‹ ÌÂÚÈÎ‹ ·ÙÚÔÊ›· ÙˆÓ Ï·¯ÓÒÓ, ˘ÂÚÏ·Û›·

ÎÚ˘ÙÒÓ Î·È ·‡ÍËÛË ÙˆÓ ÊÏÂÁÌÔÓˆ‰ÒÓ Î˘ÙÙ¿ÚˆÓ

ÛÙÔ ¯fiÚÈÔ. Ã·Ú·ÎÙËÚÈÛÙÈÎfi Â‡ÚËÌ· ·ÔÙÂÏÂ› Ë ·Û‡-

ÓÙ·ÎÙË Û˘ÛÛÒÚÂ˘ÛË ÂÈıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ ÌÂ ‰Ë-

ÌÈÔ˘ÚÁ›· “ı˘Û¿ÓˆÓ” ÏfiÁˆ ÙÔ˘ fiÙÈ Ë Î˘ÙÙ·ÚÈÎ‹ ÙÔ˘˜

ÌÂÌ‚Ú¿ÓË Â›Ó·È ÛÙÚÔÁÁ˘ÏÂÌ¤ÓË ÛÙËÓ ÎÔÚ˘Ê‹, ÒÛÙÂ

ÙÔ ÂÈıËÏÈ·Îfi Î‡ÙÙ·ÚÔ Ó· ÚÔÛÔÌÔÈ¿˙ÂÈ ÌÂ ÛÙ·Áfi-

Ó· ‰·ÎÚ‡Ô˘ (16). ¢ÂÓ ˘¿Ú¯ÂÈ ÂÈ‰ÈÎ‹ ıÂÚ·Â›· Î·È Ë

ÌfiÓË ‰È¤ÍÔ‰Ô˜ ÛÙËÓ ÂÚ›ÙˆÛË ·˘Ù‹ Â›Ó·È Ë ÌÂÙ·-

ÌfiÛ¯Â˘ÛË ÂÓÙ¤ÚÔ˘.

¢. ∞˘ÙÔ¿ÓÔÛË ÂÓÙÂÚÔ¿ıÂÈ·

√ÊÂ›ÏÂÙ·È ÛÙËÓ ‡·ÚÍË ·ÓÙÈÛˆÌ¿ÙˆÓ Î·Ù¿ ·ÓÙÈ-

ÁfiÓˆÓ ÙˆÓ ÂÓÙÂÚÔÎ˘ÙÙ¿ÚˆÓ. ∆Ô ·˘ÙÔ·ÓÙÈÁfiÓÔ ÙÔ

ÔÔ›Ô ÚÔÎ·ÏÂ› ÙËÓ ·ÓÔÛÔÏÔÁÈÎ‹ ·¿ÓÙËÛË ÔÓÔÌ¿-

˙ÂÙ·È MCC2 Î·È Î·ıÔÚ›˙ÂÙ·È ·fi ÁÔÓ›‰ÈÔ ÛÙÔ ¯Úˆ-

ÌfiÛˆÌ· 19p13. ∏ ÓfiÛÔ˜ Û˘¯Ó¿ Û˘ÓÔ‰Â‡ÂÙ·È ·fi

ÂÍˆ-ÂÓÙÂÚÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ ·˘ÙÔ·ÓÔÛ›·˜ (9). ∏ ‚ÈÔ-

„›· ÂÓÙ¤ÚÔ˘ ‰Â›¯ÓÂÈ ·ÙÚÔÊ›· ÙˆÓ Ï·¯ÓÒÓ Î·È ‰È‹ıË-

ÛË ÙÔ˘ ¯ÔÚ›Ô˘ ÌÂ ∆ ÏÂÌÊÔÎ‡ÙÙ·Ú·, Î·ıÒ˜ Î·È ˘ÂÚ-

Ï·Û›· ÙˆÓ ÎÚ˘ÙÒÓ. ∂›ÛË˜ ·Ú·ÙËÚÂ›Ù·È ‰ÂÎ·-

Ï¿ÛÈ· ·‡ÍËÛË CD-3 ıÂÙÈÎÒÓ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ ÛÙÔ

ÂÈı‹ÏÈÔ Î·È ÛÙÔ ¯fiÚÈÔ ÙÔ˘ ÏÂÙÔ‡ Î·È ÙÔ˘ ·¯¤Ô˜

ÂÓÙ¤ÚÔ˘ (21,22).

∏ ıÂÚ·Â›· Û˘Ó›ÛÙ·Ù·È ÛÙË ¯ÔÚ‹ÁËÛË ·ÓÔÛÔÎ·-

Ù·ÛÙ·ÏÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ .¯. ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰ÒÓ,

Î˘ÎÏÔÛÔÚ›ÓË˜, Î˘ÎÏÔÊˆÛÊ·Ì›‰Ë˜, tacrolimus, Î·È

ÙÔ˘ Ó¤Ô˘ ·Ú¿ÁÔÓÙ· infliximab ÙÔ ÔÔ›Ô ·Ó·ÛÙ¤ÏÏÂÈ

ÙË ‰Ú¿ÛË ÙÔ˘ ∆¡F (23).

∂. ™‡Ó‰ÚÔÌÔ ·ÓÔÛÔÏÔÁÈÎ‹˜ ‰˘ÛÚ˘ıÌ›·˜,

ÔÏ˘ÂÓ‰ÔÎÚÈÓÔ¿ıÂÈ·˜, ÂÓÙÂÚÔ¿ıÂÈ·˜ Î·È

Ê˘ÏÔÛ‡Ó‰ÂÙË˜ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜ (IPEX)

∏ ÔÓÔÌ·Û›· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ÚÔ¤Ú¯ÂÙ·È ·fi ÙÔ

·ÎÚˆÓ‡ÌÈÔ ÙˆÓ ‰È·Ù·Ú·¯ÒÓ ÙÈ˜ ÔÔ›Â˜ ÚÔÎ·ÏÂ›

(Immune dysregulation, Polyendocrino-pathy,

Enteropathy, X-linked syndrome) ‰ËÏ·‰‹ ·ÓÔÛÔÏÔ-

ÁÈÎ‹ ‰˘ÛÚ˘ıÌ›·, ÔÏ˘ÂÓ‰ÔÎÚÈÓÔ¿ıÂÈ·, ÂÓÙÂÚÔ¿-

ıÂÈ· Î·È Ê˘ÏÔÛ‡Ó‰ÂÙË ÎÏËÚÔÓÔÌÈÎfiÙËÙ· (24,25).

Ã·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ‰È‹ıËÛË ÙÔ˘ ¯ÔÚ›Ô˘ ÌÂ

ÂÓÂÚÁÔÔÈËÌ¤Ó· ∆ ÏÂÌÊÔÎ‡ÙÙ·Ú· Î·ıÒ˜ Î·È ·fi

·ÙÚÔÊ›· ÙˆÓ Ï·¯ÓÒÓ. ¶ÚÔÎ·ÏÂ›Ù·È ·fi ÌÂÙ¿ÏÏ·ÍË

ÙÔ˘ ÁÔÓÈ‰›Ô˘ FOXP3 (ÛÎ·ÚÊ›ÓË) Ë ÔÔ›· Û¯ÂÙ›˙ÂÙ·È

ÌÂ ÙÔÓ ÔÏÏ·Ï·ÛÈ·ÛÌfi ÙˆÓ CD4+ T ÏÂÌÊÔÎ˘ÙÙ¿-

ÚˆÓ (26). ∂ÎÙfi˜ ·fi ‰È·ÚÚÔ˚Îfi Û‡Ó‰ÚÔÌÔ, Ù· ¿-

Û¯ÔÓÙ· ¿ÙÔÌ· ÂÌÊ·Ó›˙Ô˘Ó Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË, ı˘-

ÚÂÔÂÈ‰Ô¿ıÂÈ·, È¯ı‡ˆÛË, ·ÈÌÔÏ˘ÙÈÎ‹ ·Ó·ÈÌ›·. ∏ Ófi-

ÛÔ˜ ·ÓÙÈÌÂÙˆ›˙ÂÙ·È ÌÂ Î˘ÙÙ·ÚÔÛÙ·ÙÈÎ¿.

™Ù. ∂ÈÌ¤ÓÔ˘Û· ÂÏÎÒ‰Ë˜ ÎÔÏ›ÙÈ‰·

¶ÚfiÎÂÈÙ·È ÁÈ· ÔÏ‡ Û¿ÓÈ· ÓÔÛÔÏÔÁÈÎ‹ ÔÓÙfiÙË-

Ù· Ë ÔÔ›· Èı·ÓfiÓ ÎÏËÚÔÓÔÌÂ›Ù·È ÌÂ ÙÔÓ ˘ÔÏÂÈ-

fiÌÂÓÔ ¯·Ú·ÎÙ‹Ú·. ∆· ÎÚÈÙ‹ÚÈ· ‰È¿ÁÓˆÛË˜ Â›Ó·È:

Û˘ÁÁÂÓÈÎ‹ Û¯¤ÛË ÙˆÓ ÁÔÓ¤ˆÓ, Î·È ÂÎ‰ËÏÒÛÂÈ˜ ·fi

ÙÔ ÛÙfiÌ· Î·È ÙËÓ ÂÚÈÚˆÎÙÈÎ‹ ÂÚÈÔ¯‹ (ÂÍÂÏÎÒ-

ÛÂÈ˜, ÊÏÂÁÌÔÓ‹, Û˘Ú›ÁÁÈ·) (27,28). ∂ÎÙfi˜ ·fi ÙË

‰È¿ÚÚÔÈ·, Ë ¿ıËÛË Û˘ÓÔ‰Â‡ÂÙ·È ·fi ‚ÏÂÓÓÔ·ÈÌÔÚ-

Ú·ÁÈÎ¤˜ ÎÂÓÒÛÂÈ˜. ∫·Ù¿ ÙËÓ ÂÓ‰ÔÛÎfiËÛË ‹ ÙË ‚ÈÔ-

„›· ·Ú·ÙËÚÂ›Ù·È ÂÈÎfiÓ· ÎÔÏ›ÙÈ‰·˜ ÌÂ ‰È·ÙÔÈ¯ˆÌ·-

ÙÈÎ¿ ¤ÏÎË ÛÂ Û¯‹Ì· ÊÏ·ÛÎÈÔ‡ ÌÂ ÂÈÎÚÂÌ¿ÌÂÓ· ¯Â›-

ÏË, Î·ıÒ˜ Î·È ·ÔÛÙËÌ¿ÙÈ· ÎÚ˘ÙÒÓ. ∏ ÈÛÙÔÏÔÁÈÎ‹

ÂÈÎfiÓ· ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ‰È‹ıËÛË ÙÔ˘ ¯ÔÚ›Ô˘ ·fi

ÊÏÂÁÌÔÓÒ‰Ë Î‡ÙÙ·Ú·. ™Â ÛÔ‚·Ú¤˜ ÌÔÚÊ¤˜ ˘¿Ú¯ÂÈ

ÂÎÙÂÙ·Ì¤ÓË ·Ó¿Ù˘ÍË ÎÔÎÎÈÒ‰Ô˘˜ ÈÛÙÔ‡ Î·È Û¯ËÌ·-

ÙÈÛÌfi˜ „Â˘‰ÔÔÏ˘fi‰ˆÓ. ∂ÎÙfi˜ ·fi ÙÔ ÎfiÏÔÓ ·-

Ú·ÙËÚÂ›Ù·È Û˘ÌÌÂÙÔ¯‹ Î·È ÙÔ˘ ÏÂÙÔ‡ ÂÓÙ¤ÚÔ˘ ÌÂ

ÌÂ›ˆÛË ÙË˜ Û¯¤ÛË˜ Ï·¯ÓÒÓ/ÎÚ˘ÙÒÓ.

∂ÎÙfi˜ ·fi ÙËÓ ÂÓ‰ÔÛÎfiËÛË Î·È ÙË ‚ÈÔ„›·, Ë

‰È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË ÙË˜ ÓfiÛÔ˘ Î·È ÁÂÓÈÎ¿ ÙˆÓ

ÊÏÂÁÌÔÓˆ‰ÒÓ ·ı‹ÛÂˆÓ ÙÔ˘ ÂÓÙ¤ÚÔ˘ ·fi ÙÈ˜ ÂÎ-

ÎÚÈÙÈÎÔ‡ Ù‡Ô˘ ÂÓÙÂÚÔ¿ıÂÈÂ˜ ÌÔÚÂ› Ó· Á›ÓÂÈ ÌÂ

ÂÍ¤Ù·ÛË ÛÙ· ÎfiÚ·Ó· ÁÈ· ÙËÓ ·Ó›¯ÓÂ˘ÛË ÙË˜ Ô˘Û›·˜

66 Ã. ∫ÒÛÙ·ÏÔ˜


Î·ÏÚÔÙÂÎÙ›ÓË˜. ¶ÚfiÎÂÈÙ·È ÁÈ· ÚˆÙÂ˝ÓË Ô˘ ‰Â-

ÛÌÂ‡ÂÈ ÙÔ ·Û‚¤ÛÙÈÔ Î·È ÙÔÓ „Â˘‰¿ÚÁ˘ÚÔ ÛÙ· Ô˘‰Â-

ÙÂÚfiÊÈÏ· ÔÏ˘ÌÔÚÊÔ‡ÚËÓ· ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ÙÔÈ¯Ò-

Ì·ÙÔ˜. ∏ ÚˆÙÂ˝ÓË ·˘Ù‹ ·Ú·Ì¤ÓÂÈ ¿ıÈÎÙË ÛÙ· Îfi-

Ú·Ó· Ì¤¯ÚÈ Î·È 7 ËÌ¤ÚÂ˜ ÌÂÙ¿ ÙËÓ ·Ô‚ÔÏ‹ ÙË˜

(29). ∏ ·ÚÔ˘Û›· ÙË˜ ˘Ô‰ËÏÒÓÂÈ ÊÏÂÁÌÔÓ‹ ÙÔ˘

ÂÓÙ¤ÚÔ˘. ÕÏÏÔÈ ‰Â›ÎÙÂ˜ ÊÏÂÁÌÔÓ‹˜ Â›Ó·È Ë ·ÚÔ˘Û›·

ÙÔ˘ ·Ú¿ÁÔÓÙ· ÊÏÂÁÌÔÓ‹˜ TNF, Ë ÂÎÙ›ÌËÛË ÙÔ˘

·Ô‚·ÏÏfiÌÂÓÔ˘ ÛÙ· ÎfiÚ·Ó· ÌÔÓÔÍÂÈ‰›Ô˘ ÙÔ˘ ·˙Ò-

ÙÔ˘ (30) Î·È Ì¤ÙÚËÛË ÙÔ˘ ÂÓ˙‡ÌÔ˘ ÂÏ·ÛÙ¿ÛË ÛÙ·

ÎfiÚ·Ó· (31).

∏ ıÂÚ·Â›· Û˘Ó›ÛÙ·Ù·È ÛÂ ˘ÊÔÏÈÎ‹ ÎÔÏÂÎÙÔÌ‹

Î·È ÛÂ ¯ÔÚ‹ÁËÛË Î˘ÙÙ·ÚÔÛÙ·ÙÈÎÒÓ. ¶·Ú·ÙËÚÂ›Ù·È

fiÌˆ˜ Û˘¯Ó¿, ·Ó¿Ù˘ÍË ÏÂÌÊˆÌ¿ÙˆÓ (32). ¶ÚfiÛÊ·-

Ù· ‰ÔÎÈÌ¿ÛÙËÎ·Ó ÌÂ ÂÈÙ˘¯›·, ÛÂ ÂÓ‹ÏÈÎÂ˜ fiÌˆ˜,

ÔÚÈÛÌ¤Ó· Ó¤· Ê¿ÚÌ·Î· .¯. Ô ·ÓÙ·ÁˆÓÈÛÙ‹˜ ÙÔ˘

∆¡F infliximab Î·È ÔÈ ·ÓÙ·ÁˆÓÈÛÙ¤˜ ÙˆÓ ˘Ô‰Ô¯¤ˆÓ

ÙË˜ IL-2 daclizumab, basiliximab, visilizumab (33).

∑. ¢È·Ù·Ú·¯¤˜ ÁÏ˘ÎÔ˙˘Ï›ˆÛË˜ ÙˆÓ

¡-ÁÏ˘ÎÔÚˆÙÂ˚ÓÒÓ

∆· ‚Ú¤ÊË ÌÂ ÙËÓ ¿ıËÛË ·˘Ù‹ ÂÌÊ·Ó›˙Ô˘Ó ÂÎÙfi˜

·fi Â›ÌÔÓË ‰È¿ÚÚÔÈ· Î·È ‰˘ÛÌÔÚÊÈÎ¿ ¯·Ú·ÎÙËÚÈ-

ÛÙÈÎ¿ (ÌÈÎÚÔÁÓ·ı›·, ·ÓÒÌ·ÏË Î·Ù·ÓÔÌ‹ ÙÔ˘ ˘Ô‰fi-

ÚÈÔ˘ Ï›Ô˘˜, ÌÈÎÚÔÛÙÔÌ›·), Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›·,

Ë·ÙÔ¿ıÂÈ·, ıÚÔÌ‚ÔÂÓ›·, ˘ÂÚÛÏËÓÈÛÌfi, Î·Ù·Ú-

Ú¿ÎÙË, ÌÂÏ·Á¯ÚˆÌ·ÙÈÎ‹ ·ÌÊÈ‚ÏËÛÙÚÔÂÈ‰Ô¿ıÂÈ·,

Î·ıÒ˜ Î·È ¯·ÌËÏ¿ Â›Â‰· ÁÏ˘ÎÔÚˆÙÂ˚ÓÒÓ .¯.

·ÙÔÛÊ·ÈÚ›ÓË˜, ÙÚ·ÓÛÊÂÚ›ÓË˜, ı˘ÚÂÔÙÚfiÔ˘ ÔÚÌfi-

ÓË˜. ∏ ‰È¿ÁÓˆÛË Ù›ıÂÙ·È ÌÂ ËÏÂÎÙÚÔÊfiÚËÛË ÙË˜

ÙÚ·ÓÛÊÂÚÚ›ÓË˜. ¢ÂÓ ˘¿Ú¯ÂÈ ÂÈ‰ÈÎ‹ ıÂÚ·Â›· ÁÈ· ÙË

Û˘ÁÎÂÎÚÈÌ¤ÓË ¿ıËÛË. ™Â ÔÚÈÛÌ¤ÓÂ˜ ÌÔÚÊ¤˜ ¤¯ÂÈ ‰Ô-

ÎÈÌ·ÛÙÂ› Ë ¯ÔÚ‹ÁËÛË Ì·ÓÓfi˙Ë˜ ·fi ÙÔ ÛÙfiÌ· (34).

∏. §ÔÈÌÒ‰Ë ·›ÙÈ·

∂ÎÙfi˜ ·fi Ù· ÁÓˆÛÙ¿ ÏÔÈÌÒ‰Ë ·›ÙÈ· Ù· ÔÔ›·

ÚÔÎ·ÏÔ‡Ó ·Ú·ÙÂÈÓfiÌÂÓË ‰È¿ÚÚÔÈ·, Ë ÚfiÔ‰Ô˜ Ë

ÔÔ›· ¤¯ÂÈ Û˘ÓÙÂÏÂÛÙÂ› Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÛÙË ÌÈ-

ÎÚÔ‚ÈÔÏÔÁ›· Î·È Ë ¯ÚËÛÈÌÔÔ›ËÛË ÙË˜ ·Ï˘ÛÈ‰ˆÙ‹˜

·ÓÙ›‰Ú·ÛË˜ ÙË˜ ÔÏ˘ÌÂÚ¿ÛË˜ (PCR) Î·È ÙÔ˘ ËÏÂ-

ÎÙÚÔÓÈÎÔ‡ ÌÈÎÚÔÛÎÔ›Ô˘, Î·Ù¤ÛÙËÛÂ ‰˘Ó·Ù‹ ÙËÓ

·Ó›¯ÓÂ˘ÛË Ó¤ˆÓ ÏÔÈÌÔÁfiÓˆÓ ·Ú·ÁfiÓÙˆÓ ÔÈ ÔÔ›ÔÈ

ÚÔÎ·ÏÔ‡Ó ÂÓÙÂÚÈÎ¤˜ ÏÔÈÌÒÍÂÈ˜ ÂÈ‰ÈÎ¿ ÛÂ ·ÓÔÛÔÎ·-

Ù·ÛÙ·ÏÌ¤Ó· ¿ÙÔÌ· Î·ıÒ˜ Î·È ÛÂ ÚfiˆÚ· ‹ ‰˘ÛÙÚÔ-

ÊÈÎ¿ ‚Ú¤ÊË. ªÈ· Ó¤· ÔÌ¿‰· ÎÔÏÔ‚·ÎÙËÚÈ‰›ˆÓ

(enteroaggregative E. coli) ¤¯ÂÈ ·Ó·‰ÂÈ¯ıÂ› ˆ˜ ‚·ÛÈÎfi

·›ÙÈÔ ¶™¢, fiˆ˜ Î·È ÈÔ› (ÌÂÁ·ÏÔÎ˘ÙÙ·ÚÔ˚fi˜, Î·È Ô

Èfi˜ ∏πV) (35,36). √ ÌË¯·ÓÈÛÌfi˜ ÌÂ ÙÔÓ ÔÔ›Ô Ô HIV

ÚÔÎ·ÏÂ› ÂÓÙÂÚÔ¿ıÂÈ· Â›Ó·È Ì¤Ûˆ ‰Â˘ÙÂÚÔÁÂÓÒÓ

ÏÔÈÌÒÍÂˆÓ ÌÂ ‚·ÎÙËÚ›‰È·, ÚˆÙfi˙ˆ·, Î·È ·Ú¿ÛÈÙ·

ÏfiÁˆ ÙË˜ ·ÓÔÛÔÏÔÁÈÎ‹˜ ·ÓÂ¿ÚÎÂÈ·˜. ∏ ¤ÎÏ˘ÛË

ÊÏÂÁÌÔÓˆ‰ÒÓ ÌÂÛÔÏ·‚ËÙÒÓ Î·È Ë Î·¯ÂÍ›· Ë ÔÔ›·

Û˘Ó‹ıˆ˜ Û˘ÓÔ‰Â‡ÂÙ·È ·fi ¤ÏÏÂÈ„Ë ··Ú·›ÙËÙˆÓ

È¯ÓÔÛÙÔÈ¯Â›ˆÓ .¯. ÙÔ˘ „Â˘‰·ÚÁ‡ÚÔ˘, Û˘Ì‚¿ÏÏÔ˘Ó

Â›ÛË˜ ÛËÌ·ÓÙÈÎ¿ ÛÙË ‰È·ÈÒÓÈÛË ÙË˜ ÂÓÙÂÚÈÎ‹˜ ‚Ï¿-

‚Ë˜ (37).

∂ÎÙfi˜ ·fi ÙÔ˘˜ ·Ú·¿Óˆ ÏÔÈÌÔÁfiÓÔ˘˜ ·Ú¿-

ÁÔÓÙÂ˜ ÙˆÓ ÔÔ›ˆÓ Ô ÚfiÏÔ˜ ÛÙËÓ ÚfiÎÏËÛË ¶™¢ Â›-

Ó·È ·Ô‰Â‰ÂÈÁÌ¤ÓÔ˜, Ë ÂÊ·ÚÌÔÁ‹ Û‡Á¯ÚÔÓˆÓ ÌÂıfi-

‰ˆÓ ·ÔÎ¿Ï˘„Â ÙËÓ ·ÚÔ˘Û›· Î·È Ï‹ıÔ˘˜ Ó¤ˆÓ ÌÈ-

ÎÚÔÔÚÁ·ÓÈÛÌÒÓ ÛÙÔÓ ÂÙÈÎfi ÛˆÏ‹Ó· fiˆ˜ ÈÒÓ

(astrovirus, calicivirus, torovirus, coronavirus) (38),

Î·ıÒ˜ Î·È ·Ú·Û›ÙˆÓ (ÎÚ˘ÙÔÛÔÚ›‰È·, Î˘ÎÏfiÛÔ-

Ú·, ÈÛfiÛÔÚ·) (39). O ÚfiÏÔ˜ fiÏˆÓ ·˘ÙÒÓ ÙˆÓ ·Ú·-

ÁfiÓÙˆÓ ÛÙËÓ ÚfiÎÏËÛË ¶™¢ Ì¤ÓÂÈ Ó· ‰ÈÂ˘ÎÚÈÓÈÛıÂ›.

∏ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÂÓÙÂÚÈÎÒÓ ÏÔÈÌÒÍÂˆÓ Á›ÓÂÙ·È

ÌÂ ÙË ¯Ú‹ÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ, ·ÓÙÈ-ÈÈÎÒÓ Î·È ·ÓÙÈ·Ú·-

ÛÈÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ. ªÂÁ¿ÏÔ ÂÓ‰È·Ê¤ÚÔÓ ·ÚÔ˘ÛÈ¿-

˙ÂÈ Î·È Ë ÚÔÛ¿ıÂÈ· ÁÈ· ÙË ‰ËÌÈÔ˘ÚÁ›· ÂÌ‚ÔÏ›ˆÓ

Î·Ù¿ ÔÏÏÒÓ ÂÓÙÂÚÈÎÒÓ ·ıÔÁfiÓˆÓ (40,41).

∂È‰ÈÎ‹ ıÂÚ·Â›· ÁÈ· ÙÈ˜ ·Ú·¿Óˆ ·ı‹ÛÂÈ˜,

ÏËÓ ·˘ÙÒÓ ÔÈ ÔÔ›Â˜ ÔÊÂ›ÏÔÓÙ·È ÛÂ ÏÔÈÌÒ‰Ë ·›-

ÙÈ·, ‰ÂÓ ˘¿Ú¯ÂÈ. µÚ›ÛÎÔÓÙ·È, fiÌˆ˜, ÛÂ ÂÍ¤ÏÈÍË ‰È¿-

ÊÔÚÂ˜ Ó¤Â˜ ÌÔÚÊ¤˜ ıÂÚ·Â›·˜ .¯. ·˘ÍËÙÈÎÔ› ·-

Ú¿ÁÔÓÙÂ˜ -ÂÈ‰ÂÚÌÈÎfi˜ ·˘ÍËÙÈÎfi˜ ·Ú¿ÁˆÓ (42-

44), ÂÚ˘ıÚÔÔÈËÙ›ÓË (45), ÈÓÛÔ˘Ï›ÓË (46)- ÔÈ ÔÔ›-

Â˜ ÚÔ¿ÁÔ˘Ó ÙËÓ ·Ó¿Ï·ÛË ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ÂÈıËÏ›-

Ô˘ Î·È Èı·ÓÒ˜ ÛÙÔ Ì¤ÏÏÔÓ ı· Û˘ÓÙÂÏ¤ÛÔ˘Ó ÛÙËÓ

Ï¤ÔÓ ·ÔÙÂÏÂÛÌ·ÙÈÎ‹ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ¶™¢.

ªÂÁ¿ÏÔ ÂÓ‰È·Ê¤ÚÔÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Î·È ‚ÈÔÏÔÁÈÎÔ›

·Ú¿ÁÔÓÙÂ˜ (ÚÔ‚ÈÔÙÈÎ¿, ÚÂ‚ÈÔÙÈÎ¿) ÔÈ ÔÔ›ÔÈ

Â˘Ô‰ÒÓÔ˘Ó ÙËÓ ·Ó¿Ù˘ÍË Ê˘ÛÈÔÏÔÁÈÎ‹˜ ¯ÏˆÚ›‰·˜

ÛÙÔ ¤ÓÙÂÚÔ ·ÏÏ¿ ¤¯Ô˘Ó Î·È ·ÓÙÈÊÏÂÁÌÔÓÒ‰ÂÈ˜ È‰Èfi-

ÙËÙÂ˜ (47-49). ∂›ÛË˜ ÂÚÂ˘Ó¿Ù·È Î·È Ô ÚfiÏÔ˜ ıÚÂ-

ÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ÔÈ ÔÔ›ÔÈ Â›Ó·È ··Ú·›ÙËÙÔÈ

ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ‚ÏÂÓÓÔÁfiÓÔ˘. ∂‰Ò

˘¿ÁÔÓÙ·È Ù· ÓÔ˘ÎÏÂÔÙ›‰È·, Ù· ÔÏ˘·ÎfiÚÂÛÙ· ÏÈ-

·Ú¿ ÔÍ¤·, Ë ÁÏÔ˘Ù·Ì›ÓË, Ë ·ÚÁÈÓ›ÓË Î.¿. (50-52).

¢È¿ÊÔÚ· È¯ÓÔÛÙÔÈ¯Â›· ¤¯Ô˘Ó Â›ÛË˜ ÎÚÈıÂ› ··Ú·›-

ÙËÙ· ÁÈ· ÙË ÛˆÛÙ‹ ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ‚ÏÂÓ-

ÓÔÁfiÓÔ˘, fiˆ˜ Ô „Â˘‰¿ÚÁ˘ÚÔ˜. ∏ ¤ÏÏÂÈ„Ë ÛÈ‰‹-

ÚÔ˘ ¤¯ÂÈ ‚ÚÂıÂ› fiÙÈ ·˘Í¿ÓÂÈ ÙË ‰È·ÂÚ·ÙfiÙËÙ· ÙÔ˘

ÂÓÙ¤ÚÔ˘ ÛÂ ·ıÔÁfiÓÔ˘˜ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜ Î·È

Ô‰ËÁÂ› ÛÂ ¶™¢ (41). ™Â Î¿ıÂ ÂÚ›ÙˆÛË, Ô ÌËÙÚÈ-

Îfi˜ ıËÏ·ÛÌfi˜ ·ÔÙÂÏÂ› ÛËÌ·ÓÙÈÎfi Ì¤ÛÔ ÚfiÏË„Ë˜

Î·È ıÂÚ·Â›·˜ ÙË˜ ¶™¢ ÏfiÁˆ ÙˆÓ ·ÓÙÈÌÈÎÚÔ‚È·ÎÒÓ

Î·È ·ÓÙÈÊÏÂÁÌÔÓˆ‰ÒÓ È‰ÈÔÙ‹ÙˆÓ ÙÔ˘ Á˘Ó·ÈÎÂ›Ô˘

Á¿Ï·ÎÙÔ˜ Î·ıÒ˜ Î·È ÙˆÓ ·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ

ÙÔ˘˜ ÔÔ›Ô˘˜ ÂÚÈ¤¯ÂÈ (53).


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¶·È‰È·ÙÚÈÎ‹ 2007;70:64-69

70 ¶ƒ∞∫∆π∫√ £∂ª∞ PRACTICAL ISSUE


∂ÈÛ·ÁˆÁ‹

∞·Ú·›ÙËÙÔ ÂÚÁ·ÏÂ›Ô ÁÈ· Î¿ıÂ ·È‰›·ÙÚÔ

Î·È ÁÔÓÈfi ÁÈ· ÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË ÙË˜ ÔÚÂ›-

·˜ ÙË˜ ÛˆÌ·ÙÈÎ‹˜ ·Ó¿Ù˘ÍË˜ ÙÔ˘ ·È‰ÈÔ‡ ·fi

ÙË Á¤ÓÓËÛË ¤ˆ˜ Î·È ÙËÓ ÔÏÔÎÏ‹ÚˆÛ‹ ÙË˜ Â›Ó·È

ÔÈ Î·Ì‡ÏÂ˜ ·Ó¿Ù˘ÍË˜.

∫·Ì‡ÏÂ˜ ÛˆÌ·ÙÈÎ‹˜ ·Ó¿Ù˘ÍË˜ ÙˆÓ ·È‰ÈÒÓ ÙË˜ ¯ÒÚ·˜ Ì·˜

∞. ∫·Ê¿ÙÔ˜

¶ÂÚ›ÏË„Ë: ∞·Ú·›ÙËÙÔ ÂÚÁ·ÏÂ›Ô Î¿ıÂ ·È‰›·ÙÚÔ˘ Î·È ÁÔÓÈÔ‡ Â›Ó·È ÔÈ Î·Ì‡ÏÂ˜ ·Ó¿Ù˘ÍË˜ ÁÈ· ÙËÓ·Ú·ÎÔÏÔ‡ıËÛË ÙË˜ ÛˆÌ·ÙÈÎ‹˜ ·Ó¿Ù˘ÍË˜ ÙÔ˘ ·È‰ÈÔ‡ ·fi ÙË Á¤ÓÓËÛË ¤ˆ˜ Î·È ÙËÓ ÔÏÔÎÏ‹ÚˆÛ‹ ÙË˜.™ÙÔ ‚È‚ÏÈ¿ÚÈÔ ˘ÁÂ›·˜ ÙÔ˘ ·È‰ÈÔ‡ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÁÈ· ÔÏÏ¿ ¯ÚfiÓÈ· ·fi ÙÔ ÀÔ˘ÚÁÂ›Ô ÀÁÂ›·˜, ÔÈÎ·Ì‡ÏÂ˜ ·Ó¿Ù˘ÍË˜ ÙÔ˘ πÓÛÙÈÙÔ‡ÙÔ˘ ÀÁÂ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡ (πÀ¶) ÁÈ· ·È‰È¿ 6-18 ÂÙÒÓ Î·È ÂÎÂ›ÓÂ˜ ÙˆÓ∏¶∞ ÁÈ· ·È‰È¿ ÚÔÛ¯ÔÏÈÎ‹˜ ËÏÈÎ›·˜. ∆Ô 2003 Ó¤Â˜ Î·Ì‡ÏÂ˜ ·Ó¿Ù˘ÍË˜ ÂÌÊ·Ó›ÛıËÎ·Ó ÛÙ· ‚È‚ÏÈ¿-ÚÈ· ˘ÁÂ›·˜ Ô˘ ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙËÓ ∞’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ÙÔ˘ ¡ÔÛÔÎÔÌÂ›Ô˘ ∞Á›· ™ÔÊ›· (∞’ ¶∫¶∞).™¯ÂÙÈÎ‹ ‰ËÌÔÛ›Â˘ÛË ·Ó¤ÊÂÚÂ fiÙÈ ÙÔ ‰Â›ÁÌ· ÚÔÂÚ¯fiÙ·Ó ·fi ÙËÓ ÂÚÈÔ¯‹ ∞ıËÓÒÓ ¯ˆÚ›˜ Ó· ‰›‰ÔÓÙ·ÈÏËÚÔÊÔÚ›Â˜ ·Ó ÚfiÎÂÈÙ·È ÁÈ· Î·ÓÔÓÈÎ¿, ÌÈÎÚ¿ ‹ ÌÂÁ¿Ï· ÁÈ· ÙËÓ ËÏÈÎ›· ÙË˜ Î˘‹ÛÂˆ˜ ‚Ú¤ÊË, ıËÏ¿-˙ÔÓÙ· ‹ ÌË Î·ıÒ˜ Î·È ÁÈ· ÙÈ˜ ÌÂıfi‰Ô˘˜ Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó. √ ¶·ÁÎfiÛÌÈÔ˜ √ÚÁ·ÓÈÛÌfi˜ ÀÁÂ›·˜(WHO) ¯ÚËÛÈÌÔÔ›ËÛÂ ÙÈ˜ Î·Ì‡ÏÂ˜ ·Ó¿Ù˘ÍË˜ ÙˆÓ ∏¶∞ (CDC 2000) Ô˘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ‰Â‰ÔÌ¤-Ó· ·fi Ù¤ÛÛÂÚÈ˜ ÂıÓÈÎ¤˜ ‰ÂÈÁÌ·ÙÔÏË„›Â˜ ·È‰ÈÒÓ ÌÂÙ·Í‡ 1963 Î·È 1990 Î·È ÙÈ˜ ÚÔÛ¿ÚÌÔÛÂ ÁÈ· ¯Ú‹-ÛË ·fi ¯ÒÚÂ˜ ÔÈ ÔÔ›Â˜ ‰ÂÓ ‰È·ı¤ÙÔ˘Ó Î·Ì‡ÏÂ˜ ·Ó¿Ù˘ÍË˜. ¢ÂÓ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë ÂıÓÈÎ‹ ÌÂÏ¤ÙËÙÔ˘ 1994 ÁÈ· ·È‰È¿ ¿Óˆ ÙˆÓ 6 ÂÙÒÓ ÏfiÁˆ ¤Í·ÚÛË˜ ÙË˜ ·¯˘Û·ÚÎ›·˜. ∏ Û‡ÁÎÚÈÛË ÙˆÓ Î·Ì˘ÏÒÓ ÙÔ˘CDC-WHO Î·È ÙË˜ ∞’ ¶∫¶∞ ·ÔÎ·Ï‡ÙÂÈ fiÙÈ ÔÈ ÂÏÏËÓÈÎ¤˜ Î·Ì‡ÏÂ˜ ·Ó¿Ù˘ÍË˜ ‚Ú›ÛÎÔÓÙ·È ÔÏ‡ ˘„Ë-ÏfiÙÂÚ· ÁÈ· fiÏÂ˜ ÙÈ˜ ÌÂÙÚ‹ÛÂÈ˜. ø˜ ·ÔÙ¤ÏÂÛÌ·, ÔÏÏ¿ ·È‰È¿ ‚Ú›ÛÎÔÓÙ·È Ó· ¤¯Ô˘Ó ·ÓÂ·ÚÎ‹ ·Ó¿-Ù˘ÍË Û‡ÌÊˆÓ· ÌÂ ÙÈ˜ Î·Ì‡ÏÂ˜ ÙË˜ ∞’ ¶∫¶∞, ÂÓÒ Â›Ó·È ÛÙ· Ê˘ÛÈÔÏÔÁÈÎ¿ fiÚÈ· ÌÂ ‚¿ÛË ÂÎÂ›ÓÂ˜ ÙÔ˘CDC. ∞ÓÙ›ıÂÙ·, Á›ÓÂÙ·È ˘ÔÂÎÙ›ÌËÛË ÙˆÓ ˘¤Ú‚·ÚˆÓ Î·È ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ. √È Î·Ì‡ÏÂ˜ ÙË˜ ∞’¶∫¶∞ Ô˘ ‚Ú›ÛÎÔÓÙ·È Û‹ÌÂÚ· ÛÙ· ‚È‚ÏÈ¿ÚÈ· ˘ÁÂ›·˜ ı· Ú¤ÂÈ ¿ÌÂÛ· Ó· ·ÓÙÈÎ·Ù·ÛÙ·ıÔ‡Ó ·fi ÙÈ˜Î·Ì‡ÏÂ˜ ÙÔ˘ πÀ¶. °È· ·È‰È¿ ÚÔÛ¯ÔÏÈÎ‹˜ ËÏÈÎ›·˜ ˘¿Ú¯Ô˘Ó Û‹ÌÂÚ· ÌÂÙÚ‹ÛÂÈ˜ ·’ fiÏË ÙË ¯ÒÚ· Ô˘ÂÈÙÚ¤Ô˘Ó ÙË ‰ËÌÈÔ˘ÚÁ›· Î·Ï‡ÙÂÚˆÓ Î·Ì˘ÏÒÓ ·Ó¿Ù˘ÍË˜.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ∫·Ì‡ÏÂ˜ ·Ó¿Ù˘ÍË˜, ·È‰È¿, ·¯˘Û·ÚÎ›·, ˘ÔıÚÂ„›·, ·ÓÙÈÚÔÛˆÂ˘ÙÈÎfi ÂıÓÈÎfi ‰Â›ÁÌ·.

Growth curves for Greek children

A. Kafatos

Abstract: Physical growth curves enable paediatricians and parents to monitor the pattern of childgrowth from birth onwards. Growth curves should be derived from large, nationally representativesamples. In 1981, the Institute of Child Health (ICH) in Athens conducted a national study and createdgrowth curves for children aged 6-17 years in Greece. Up until the end of 2003 the Greek children’shealth booklet contained US Centers for Disease Control (CDC) curves for preschool children and theICH growth curves for children over the age of 6 years. In 2003, the Greek Ministry of Health replacedthese with curves constructed by the A’ Paediatric Clinic of the University of Athens (APCUA), whichare based on children living in Athens, but for which very little information about sampling proceduresis available. For preschool children it is stated that children were measured in private clinics and healthcentres, without details of birth weight, the presence of illness or the number of measurements takenon each child. Comparing the APCUA growth curves with CDC-WHO curves for international use andwith the ICH curves, the APCUA curves overestimate the proportion of children with stunted growth atevery age while underestimating the proportions of overweight and obese children. From the aboveobservations, it is apparent that the growth curves presently in use by the Ministry of Health should bereplaced by the original ICH curves for children over the age of 6 years. The ICH growth curves are themost appropriate, since the children in the representative national sample were measured in 1981,before the present epidemic of obesity started. For preschool children, other data are available for moreappropriate growth curves.

Key words: Growth curves, children, overweight, obese, underweight, national representative sample.

¶·ÓÂÈÛÙ‹ÌÈÔ ∫Ú‹ÙË˜, ∆Ì‹Ì· π·ÙÚÈÎ‹˜, ∆ÔÌ¤·˜∫ÔÈÓˆÓÈÎ‹˜ π·ÙÚÈÎ‹˜, ∫ÏÈÓÈÎ‹ ¶ÚÔÏËÙÈÎ‹˜ π·ÙÚÈÎ‹˜Î·È ¢È·ÙÚÔÊ‹˜


∞ÓÙÒÓË˜ ∫·Ê¿ÙÔ˜[email protected]¢È·ÛÙ·‡ÚˆÛË µÔ‡ÙÂ˜ -™Ù·˘Ú¿ÎÈ·,∆.∫. 71 003, ∆.£.: 2208,∏Ú¿ÎÏÂÈÔ ∫Ú‹ÙË˜

University of Crete, MedicalSchool, Department of SocialMedicine, Clinic of PreventiveMedicine and Nutrition

Correspondence:

Antonis [email protected] Junction, 71 003, Po. Box: 2208, Herakleion, Crete

¢ÂÓ ˘¿Ú¯ÂÈ ·ÌÊÈ‚ÔÏ›· fiÙÈ ÔÈ Î·Ì‡ÏÂ˜ ·Ó¿-

Ù˘ÍË˜ Ú¤ÂÈ Ó· Â›Ó·È Î·Ù¿ÏÏËÏ· Û¯Â‰È·ÛÌ¤ÓÂ˜

Î·È Ó· ‚·Û›˙ÔÓÙ·È ÛÂ ÌÂÙÚ‹ÛÂÈ˜ ·ÓÙÈÚÔÛˆÂ˘ÙÈ-

ÎÔ‡ ÂıÓÈÎÔ‡ ‰Â›ÁÌ·ÙÔ˜ ˘ÁÈÒÓ ·È‰ÈÒÓ.

√È ∏¶∞ ‹Ù·Ó Ë ÚÒÙË ̄ ÒÚ· Ô˘ ‰ËÌÈÔ‡ÚÁËÛÂ Î·-

Ì‡ÏÂ˜ ·Ó¿Ù˘ÍË˜ ÌÂ ÂıÓÈÎ¤˜ ‰ÂÈÁÌ·ÙÔÏË„›Â˜ (¶›Ó·-

Î·˜ 1) Î·È ·ÎÔÏÔ‡ıËÛ·Ó ÔÈ µÚÂÙ·ÓÔ› (¶›Ó·Î·˜ 2).

√ ¶·ÁÎfiÛÌÈÔ˜ √ÚÁ·ÓÈÛÌfi˜ ÀÁÂ›·˜ (WHO) ¯ÚË-

ÛÈÌÔÔ›ËÛÂ ÙÈ˜ ·ÌÂÚÈÎ·ÓÈÎ¤˜ Î·Ì‡ÏÂ˜ ·Ó¿Ù˘ÍË˜

Ô˘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ‰Â‰ÔÌ¤Ó· ·fi Ù¤ÛÛÂÚÈ˜ ÂıÓÈ-

Î¤˜ ‰ÂÈÁÌ·ÙÔÏË„›Â˜ ·È‰ÈÒÓ ÛÙÈ˜ ∏¶∞ (fiÏÂ˜ ÔÈ

ÂıÓÈÎfiÙËÙÂ˜) ÌÂÙ·Í‡ 1963 Î·È 1990 Î·È ¤ÓÙÂ Û˘-

ÌÏËÚˆÌ·ÙÈÎ¤˜ ÌÂÏ¤ÙÂ˜ Î·È ÙÈ˜ ÚÔÛ¿ÚÌÔÛÂ ÁÈ·

¯Ú‹ÛË ·fi ¯ÒÚÂ˜ ÔÈ ÔÔ›Â˜ ‰ÂÓ ‰È·ı¤ÙÔ˘Ó ‰ÈÎ¤˜

ÙÔ˘˜ Î·Ì‡ÏÂ˜ ·Ó¿Ù˘ÍË˜ (CDC 2000) (¢ÂÓ ¯ÚË-

ÛÈÌÔÔÈ‹ıËÎÂ Ë ÂıÓÈÎ‹ ÌÂÏ¤ÙË ÙˆÓ ∏¶∞ ÙÔ˘ 1994

ÁÈ· ·È‰È¿ ¿Óˆ ÙˆÓ 6 ÂÙÒÓ ÏfiÁˆ ÂÈ‰ËÌÈÎ‹˜ ¤Í·Ú-

ÛË˜ ÙË˜ ·¯˘Û·ÚÎ›·˜).

∏ ¯ÒÚ· Ì·˜ ¯ÚËÛÈÌÔÔ›ËÛÂ Ì¤¯ÚÈ ÙÔ 2003 ÙÈ˜

Î·Ì‡ÏÂ˜ ·Ó¿Ù˘ÍË˜ ÙˆÓ ∏¶∞ (CDC) ÁÈ· ·È‰È¿

ÚÔÛ¯ÔÏÈÎ‹˜ ËÏÈÎ›·˜ Î·È ÁÈ· ÙÈ˜ ËÏÈÎ›Â˜ 6-18 ÂÙÒÓ

ÙÈ˜ Î·Ì‡ÏÂ˜ ·Ó¿Ù˘ÍË˜ ÙÔ˘ πÓÛÙÈÙÔ‡ÙÔ˘ ÀÁÂ›·˜

ÙÔ˘ ¶·È‰ÈÔ‡.

∏ Ï¤ÔÓ ÛÔ‚·Ú‹ ÚÔÛ¿ıÂÈ· ‰ËÌÈÔ˘ÚÁ›·˜ Î·-

Ì˘ÏÒÓ ·Ó¿Ù˘ÍË˜ ÁÈ· ·È‰È¿ Û¯ÔÏÈÎ‹˜ ËÏÈÎ›·˜

‹Ù·Ó ÂÎÂ›ÓË ÙÔ˘ πÓÛÙÈÙÔ‡ÙÔ˘ ÀÁÂ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡

ÙÔ 1981 (7).

√È Î·Ì‡ÏÂ˜ ÙÔ˘ πÀ¶ ¤ÁÈÓ·Ó ÛÂ Ú¿ÁÌ·ÙÈ ·ÓÙÈ-

ÚÔÛˆÂ˘ÙÈÎfi ‰Â›ÁÌ· 27.000 ·È‰ÈÒÓ ËÏÈÎ›·˜ 6-18

ÂÙÒÓ ·’ fiÏË ÙË ¯ÒÚ· ÙÔ 1981. ∞˘Ù‹ ‹Ù·Ó Ë Ï¤ÔÓ

Î·Ù¿ÏÏËÏË ¯ÚÔÓÈÎ‹ ÂÚ›Ô‰Ô˜ Ó· Á›ÓÔ˘Ó Î·Ì‡ÏÂ˜

·Ó¿Ù˘ÍË˜ ÁÈ·Ù› ‰ÂÓ Â›¯Â ·Ú¯›ÛÂÈ ·ÎfiÌ· Ë ÂÈ‰ËÌ›·

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ÙÔÓ ÙfiÙÂ ÚfiÂ‰ÚÔ ÙÔ˘ ™‡ÚÔ ¢ÔÍÈ¿‰Ë ÁÈ· ÙËÓ ÙÂ-

Ú¿ÛÙÈ·˜ ÛËÌ·Û›·˜ ÚÔÛÊÔÚ¿ ÙÔ˘, fiˆ˜ ·Ô‰ÂÈ-

ÎÓ‡ÂÙ·È Û‹ÌÂÚ·.

™Â ÚfiÛÊ·ÙË ‰ËÌÔÛ›Â˘ÛË (9) Ê·›ÓÂÙ·È Ë ÌÂÁ¿-

ÏË ·‡ÍËÛË ÙÔ˘ ‚¿ÚÔ˘˜ ÙˆÓ ·È‰ÈÒÓ ·fi ÙÔ 1982

Ì¤¯ÚÈ ÙÔ 2002 ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙËÓ ÔÏ‡ ÌÈÎÚ‹ ·‡-

ÍËÛË ÙÔ˘ ·Ó·ÛÙ‹Ì·ÙÔ˜ Î·Ù¿ ÙËÓ ›‰È· ¯ÚÔÓÈÎ‹ Â-

Ú›Ô‰Ô (¶›Ó·Î·˜ 3).

√ ¶›Ó·Î·˜ 4 Û˘ÓÔ„›˙ÂÈ ÙÈ˜ ÌÂÏ¤ÙÂ˜ Ô˘ ¤ÁÈÓ·Ó

ÛÙË ¯ÒÚ· Ì·˜ ÁÈ· ‰ËÌÈÔ˘ÚÁ›· Î·Ì˘ÏÒÓ ·Ó¿Ù˘-

ÍË˜ ÙˆÓ ·È‰ÈÒÓ (7,11,12,14).

∆Ô 2003 ÂÌÊ·Ó›ÛÙËÎ·Ó Ó¤Â˜ Î·Ì‡ÏÂ˜ ·Ó¿Ù˘ÍË˜

ÛÙ· ‚È‚ÏÈ¿ÚÈ· ˘ÁÂ›·˜ ÙÔ˘ ÀÔ˘ÚÁÂ›Ô˘ ÀÁÂ›·˜ Ô˘

ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙËÓ ∞ã ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ÙÔ˘

¡ÔÛÔÎÔÌÂ›Ô˘ ∞Á›· ™ÔÊ›·. ∞ÚÁfiÙÂÚ· ÙÔ 2004, Û¯ÂÙÈÎ‹

‰ËÌÔÛ›Â˘ÛË ·Ó¤ÊÂÚÂ fiÙÈ ÙÔ ‰Â›ÁÌ· ÚÔ¤Ú¯ÔÓÙ·Ó ·fi

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ÊÔÚ›Â˜ ·Ó ÚfiÎÂÈÙ·È ÁÈ· ·È‰È¿ ÌÈÎÚ¿ ‹ ÌÂÁ¿Ï· ÁÈ·

ÙËÓ ËÏÈÎ›· Î˘‹ÛÂˆ˜, ıËÏ¿˙ÔÓÙ· ‹ ÌË Î·ıÒ˜ Î·È ÁÈ·

ÙÈ˜ ÌÂıfi‰Ô˘˜ Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó (1-3).

™ÙË ÌÂÏ¤ÙË ·˘Ù‹ Ù· 10.000 ÂÚ›Ô˘ ·È‰È¿ Î·È

¤ÊË‚ÔÈ Ô˘ ÌÂÙÚ‹ıËÎ·Ó, Èı·ÓfiÓ Ó· ÌËÓ ·ÓÙÈÚÔ-

ÛˆÂ‡Ô˘Ó Î·Ó Ù· ·È‰È¿ ÙË˜ ÂÚÈÔ¯‹˜ ∞ıËÓÒÓ ÁÈ·-

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Ì·ÙÔ˜ ÛÙÈ˜ ‰‡Ô ‰ËÌÔÛÈÂ‡ÛÂÈ˜ ÙË˜ ›‰È·˜ ∫ÏÈÓÈÎ‹˜ (1-

3). √‡ÙÂ ÂÚÈÁÚ¿ÊÂÙ·È ÙÔ ‰Â›ÁÌ· ÚÔÛ¯ÔÏÈÎ‹˜ ËÏÈ-

Î›·˜ Ô˘ Ï‹ÊıËÎÂ ·fi È‰ÈˆÙÈÎ¤˜ ÎÏÈÓÈÎ¤˜, È‰ÈˆÙÈÎ¿

È·ÙÚÂ›· Î·È Î¤ÓÙÚ· ˘ÁÂ›·˜. ¶Ò˜ ÂÂÏ¤ÁËÛ·Ó; ∞Ô-

ÎÏÂ›ÛÙËÎ·Ó Ù· ¿ÚÚˆÛÙ· ·È‰È¿; ¢ÂÓ ·Ó·Ê¤ÚÔÓÙ·È Ù·

ÎÚÈÙ‹ÚÈ· ÂÈÏÔÁ‹˜ ÙˆÓ ·È‰ÈÒÓ, Ô‡ÙÂ ·Ó·Ê¤ÚÂÙ·È

Ô˘ ‚Ú›ÛÎÔÓÙ·È Ù· È·ÙÚÂ›· Î·È Î¤ÓÙÚ· ˘ÁÂ›·˜ Î·È fi-

Û· ·fi ·˘Ù¿ Û˘ÌÌÂÙÂ›¯·Ó ÛÙË ÌÂÏ¤ÙË.

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ÓÔ‡ÚÁÈÔ ·È‰›. ∞Ó ‰ÂÓ Û˘Ó¤‚·ÈÓÂ ·˘Ùfi, fiÛ· ·È‰È¿

ÂÍÂÙ¿ÛıËÎ·Ó Â·ÓÂÈÏËÌÌ¤Ó· - ‰È·¯ÚÔÓÈÎ¿;

¶›Ó·Î·˜ 1. ªÂÏ¤ÙÂ˜ ÙˆÓ ∏¶∞ ÁÈ· Î·Ì‡ÏÂ˜ ·Ó¿Ù˘ÍË˜ (4)

ŒÙÔ˜ ªÂÏ¤ÙË ∏ÏÈÎ›· ¶·È‰È¿

1963-65 NHES II ∂ıÓÈÎ‹ 6-11 ÂÙÒÓ 36321966-70 NHES III -//- 12-17 ÂÙÒÓ 32231971-74 NHANES I -//- 1-18 ÂÙÒÓ 36591976-80 NHANES II -//- 6 ÌËÓÒÓ-18 ÂÙÒÓ 39211988-94 NHANES III -//- 2 ÌËÓÒÓ-18 ÂÙÒÓ 36981960-94 ¶¤ÓÙÂ Û˘ÌÏËÚˆÌ·ÙÈÎ¤˜ ÌÂÏ¤ÙÂ˜ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ‚ÚÂÊÒÓ >23000

71∫·Ì‡ÏÂ˜ ÛˆÌ·ÙÈÎ‹˜ ·Ó¿Ù˘ÍË˜ ÛÙËÓ ∂ÏÏ¿‰·

¶·È‰È·ÙÚÈÎ‹ 2007;70:70-74

¶›Ó·Î·˜ 2. µÚÂÙ·ÓÈÎ¤˜ Î·Ì‡ÏÂ˜ ·Ó¿Ù˘ÍË˜ (5,6)

ñ ∫·Ì‡ÏÂ˜ Tanner-Whitehouse 1966

ñ ∞ËÚ¯·ÈˆÌ¤ÓÂ˜ ÏfiÁˆ ÙË˜ ·‡ÍËÛË˜ ‡„Ô˘˜ ÙÈ˜ ÙÂÏÂ˘Ù·›Â˜‰ÂÎ·ÂÙ›Â˜

ñ ∫·Ì‡ÏÂ˜ Buckler-Tanner ÚÔÛ·ÚÌfiÛÙËÎ·Ó ÙÔ 1999 Î·È¤Ï·‚·Ó ˘’ fi„ÈÓ ÙËÓ ·‡ÍËÛË ‚¿ÚÔ˘˜ - ‡„Ô˘˜

ñ ∫·Ì‡ÏÂ˜ UK 90 - ÚÔ¤Î˘„·Ó ·fi ÙÈ˜ ÚÔËÁËıÂ›ÛÂ˜ÌÂÏ¤ÙÂ˜. Œ¯Ô˘Ó ÌÂÁ¿ÏË ·ÍÈÔÈÛÙ›· Û˘ÁÎÚÈÓfiÌÂÓÂ˜ ÌÂ ÙÈ˜·Ï·ÈfiÙÂÚÂ˜ (ËÏÈÎ›Â˜ 2-20 ¤ÙË). ™ÙËÓ ÂÊË‚Â›·‰È·ÛÙ·˘ÚÒÓÔÓÙ·È Û˘Ó‹ıˆ˜ ÔÈ ÂÎ·ÙÔÛÙÈ·›Â˜ ı¤ÛÂÈ˜ ÏfiÁˆÌÂÁ¿ÏˆÓ ‰È·ÊÔÚÒÓ ÛÙËÓ ËÏÈÎ›· ¤Ó·ÚÍË˜ ÙË˜ ÂÚÈfi‰Ô˘Ù·¯Â›·˜ ·Ó¿Ù˘ÍË˜ (growth spurt). ÃÚËÛÈÌÔÔÈ‹ıËÎ·Ó‰Â‰ÔÌ¤Ó· Ì¤¯ÚÈ ÙÔ 1990 ÏfiÁˆ ÙË˜ ÂÈ‰ËÌ›·˜ ·¯˘Û·ÚÎ›·˜ÙËÓ ÙÂÏÂ˘Ù·›· ‰ÂÎ·ÂÙ›·

ñ √È ‚ÚÂÙ·ÓÈÎ¤˜ Î·Ì‡ÏÂ˜ ·Ó·ÊÔÚ¿˜ [UK 90] ÁÈ· ¢ª™¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ‰ÈÂıÓÒ˜ ÁÈ· ÂÎÙ›ÌËÛË ÙˆÓ ˘¤Ú‚·ÚˆÓÎ·È ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ (IOTF)

™ÙÔ ›‰ÈÔ ¿ÚıÚÔ ÂÈÛËÌ·›ÓÂÙ·È Ë ÌÂÁ¿ÏË ·‡ÍËÛË

ÙÔ˘ ‚¿ÚÔ˘˜ ·ÁÔÚÈÒÓ Î·È ÎÔÚÈÙÛÈÒÓ Ù· ÙÂÏÂ˘Ù·›· 20

¯ÚfiÓÈ·.

Ÿˆ˜ Ê·›ÓÂÙ·È ÛÙÈ˜ ∂ÈÎfiÓÂ˜ 1 & 2 ÔÈ Î·Ì‡ÏÂ˜

·˘Ù¤˜ ÙÈ˜ ∞’ ¶·È‰È·ÙÚÈÎ‹˜ ∫ÏÈÓÈÎ‹˜ ˘ÔÙÈÌÔ‡Ó Ù·

Ì¤ÁÈÛÙ· ÙÔÓ ·ÚÈıÌfi ÙˆÓ ·È‰ÈÒÓ ÌÂ ·˘ÍËÌ¤ÓÔ ‚¿-

ÚÔ˜ Î·È ·¯˘Û·ÚÎ›· Î·È ˘ÂÚÂÎÙÈÌÔ‡Ó ÙÔÓ ·ÚÈıÌfi

ÙˆÓ ·È‰ÈÒÓ ÌÂ ·ÓÂ·ÚÎ‹ ·Ó¿Ù˘ÍË.

√ ‰Â›ÎÙË˜ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ (¢ª™) ÙfiÛÔ ÛÙ· ·Áfi-

ÚÈ· fiÛÔ Î·È ÛÙ· ÎÔÚ›ÙÛÈ· ÙË˜ 3Ë˜ ∂.£. ÙË˜ ∞’ ¶·È-

‰È·ÙÚÈÎ‹˜ ∫ÏÈÓÈÎ‹˜ ·ÓÙÈÛÙÔÈ¯Â› ÛÙË 10Ë ÙÔ˘ CDC

ÂÓÒ Ë 97Ë ∂.£. Â›Ó·È ÔÏ‡ ÈÔ ¿Óˆ ·fi ÙËÓ 97Ë

ÙˆÓ Î·Ì˘ÏÒÓ ÙÔ˘ CDC ÛÙÈ˜ ∏¶∞. ∆Ô ›‰ÈÔ ·Ú·-

ÙËÚÂ›Ù·È Î·È ÛÙËÓ 50‹ ∂.£.. °È’ ·˘ÙfiÓ ·ÎÚÈ‚Ò˜ ÙÔÓ

ÏfiÁÔ ˘ÔÙÈÌ¿Ù·È ÙÔ ÔÛÔÛÙfi ·¯˘Û·ÚÎ›·˜ ÌÂ ‚¿ÛË

ÙÈ˜ Î·Ì‡ÏÂ˜ ÙË˜ ∞’ ¶·È‰È·ÙÚÈÎ‹˜ ∫ÏÈÓÈÎ‹˜, ÂÓÒ

˘ÂÚÂÎÙÈÌ¿Ù·È ÙÔ ÔÛÔÛÙfi ÙˆÓ ·È‰ÈÒÓ ÌÂ ·ÓÂ-

·ÚÎ‹ ·Ó¿Ù˘ÍË Î·È ˘ÔıÚÂ„›·.

™ÙË ‰ËÌÔÛ›Â˘ÛË ÙË˜ ∞’ ¶·È‰È·ÙÚÈÎ‹˜ ∫ÏÈÓÈÎ‹˜

ÙÔÓ›˙ÂÙ·È fiÙÈ ·ıÔÏÔÁÈÎ¿ ·˘ÍËÌ¤ÓÔ ¢ª™ Î·È ·-

¯˘Û·ÚÎ›· ¤¯Ô˘Ó fiÛ· ·ÁfiÚÈ· Â›Ó·È ¿Óˆ ·fi ÙËÓ

50‹ ∂.£. ÙˆÓ Î·Ì˘ÏÒÓ ÙÔ˘˜ (∂ÈÎfiÓ· 3) ‹ ¿Óˆ

·fi ÙËÓ 75Ë ∂.£. ÁÈ· Ù· ÎÔÚ›ÙÛÈ·, Û‡ÌÊˆÓ· ÌÂ Ù·

ÎÚÈÙ‹ÚÈ· ÙÔ˘ IOTF (International Obesity Task

Force) (8).

√È Î·Ì‡ÏÂ˜ fiÌˆ˜, ÙË˜ ∞’ ¶·È‰È·ÙÚÈÎ‹˜ ∫ÏÈÓÈ-

Î‹˜ ‰ËÌÈÔ˘ÚÁÔ‡Ó Û‡Á¯˘ÛË ÛÙÔ˘˜ ·È‰›·ÙÚÔ˘˜ Î·È

ÁÔÓÂ›˜ ÁÈ·Ù› Ê˘ÛÈÔÏÔÁÈÎ¿ ıÂˆÚÔ‡ÓÙ·È Ù· ·ÁfiÚÈ·

Ô˘ Â›Ó·È Î¿Ùˆ ÙË˜ 50‹˜ ∂.£. Î·È Î¿Ùˆ ÙË˜ 75Ë˜ ÁÈ·

Ù· ÎÔÚ›ÙÛÈ·.

∞ÓÙ›ıÂÙ· ÔÈ Î·Ì‡ÏÂ˜ ·Ó¿Ù˘ÍË˜ ÙÔ˘ πÀ¶ Ô˘

¤ÁÈÓ·Ó ÛÂ ·ÓÙÈÚÔÛˆÂ˘ÙÈÎfi ‰Â›ÁÌ· ÂÏÏËÓÈÎÔ‡

ÏËı˘ÛÌÔ‡ ËÏÈÎ›·˜ 6-18 ÂÙÒÓ Î·È ÛÂ Î·Ù¿ÏÏËÏË

¯ÚÔÓÈÎ‹ ÛÙÈÁÌ‹ (1981), ÚÈÓ ‰ËÏ·‰‹ ÙËÓ ¤Ó·ÚÍË

ÙË˜ ÂÈ‰ËÌ›·˜ ÙË˜ ·¯˘Û·ÚÎ›·˜, ·ÓÙÈÛÙÔÈ¯Ô‡Ó

Ï‹Úˆ˜ ÛÙÈ˜ ·ÓÙ›ÛÙÔÈ¯Â˜ ÂÎ·ÙÔÛÙÈ·›Â˜ ı¤ÛÂÈ˜ ÙˆÓ

Î·Ì˘ÏÒÓ ÙÔ˘ CDC (ÔÈ ÙÈÌ¤˜ ÙˆÓ ÂÎ·ÙÔÛÙÈ·›ˆÓ

ı¤ÛÂˆÓ ÙÔ˘ ‚¿ÚÔ˘˜ Î·È ÙÔ˘ ·Ó·ÛÙ‹Ì·ÙÔ˜ ÙˆÓ ·È-

‰ÈÒÓ ÛÙÈ˜ ‰È¿ÊÔÚÂ˜ ËÏÈÎ›Â˜ ‰ÂÓ ‰È¤ÊÂÚ·Ó ÛËÌ·ÓÙÈ-

Î¿ - ANOVA, p>0,05).

ŸÛÔÓ ·ÊÔÚ¿ ÙÈ˜ Î·Ì‡ÏÂ˜ ·Ó¿Ù˘ÍË˜ Î·Ù¿ ÙË

‚ÚÂÊÈÎ‹ ËÏÈÎ›·, Ë ∞’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ¯ÚËÛÈÌÔ-

Ô›ËÛÂ 139 ·ÁfiÚÈ· Î·È ·ÚfiÌÔÈÔ ·ÚÈıÌfi ÎÔÚÈÙÛÈÒÓ.

∞Ó ÌÂÙÚ‹ıËÎ·Ó ÌfiÓÔ Ì›· ÊÔÚ¿ (‰Â›ÁÌ· ÙÔÌ‹˜),

Â›Ó·È ÂÍ·ÈÚÂÙÈÎ¿ ÌÈÎÚfi ‰Â›ÁÌ· ÁÈ· Ó· ·ÚÔ˘ÛÈ·ÛıÂ›

ˆ˜ ·ÓÙÈÚÔÛˆÂ˘ÙÈÎfi ÁÈ· ÂıÓÈÎ¤˜ Î·Ì‡ÏÂ˜. ∏ Â-

ÚÈÁÂÓÓËÙÈÎ‹ ÌÂÏ¤ÙË ∫Ú‹ÙË˜ ÌÂ 1.200 ÂÚ›Ô˘ ˘ÁÈ‹

·È‰È¿ ‰È·¯ÚÔÓÈÎ‹˜ ·Ú·ÎÔÏÔ‡ıËÛË˜ ÁÈ· 6 ¯ÚfiÓÈ·

(11), Â›Ó·È ÔÏ‡ ÈÔ ÏÔÁÈÎfi ‰Â›ÁÌ·, ÂÓÙÔ‡ÙÔÈ˜ ‰ÂÓ

ÈÛ¯˘ÚÈ˙fiÌ·ÛÙÂ ˆ˜ ÌÔÚÂ› Ó· ¯ÚËÛÈÌÔÔÈËıÂ› ÁÈ·

ÂıÓÈÎ¤˜ Î·Ì‡ÏÂ˜ ·Ó¿Ù˘ÍË˜.

™˘ÌÂÚ¿ÛÌ·Ù·

∆Ô ÂÍ·ÈÚÂÙÈÎ¿ ÛÔ‚·Úfi Úfi‚ÏËÌ· ÙË˜ ·¯˘Û·Ú-

Î›·˜ Ô˘ ¤¯ÂÈ ¿ÚÂÈ ÂÈ‰ËÌÈÎ¤˜ ‰È·ÛÙ¿ÛÂÈ˜ ˘ÔÙÈ-

Ì¿Ù·È ·fi ÙÈ˜ ˘¿Ú¯Ô˘ÛÂ˜ Û‹ÌÂÚ· Î·Ì‡ÏÂ˜ ·Ó¿-

Ù˘ÍË˜ ÛÙ· ‚È‚ÏÈ¿ÚÈ· ˘ÁÂ›·˜ ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘

¶›Ó·Î·˜ 3. ™ˆÌ·ÙÔÌÂÙÚ‹ÛÂÈ˜ Î·È ÔÛÔÛÙ¿ ˘¤Ú‚·ÚˆÓ Î·È ·-¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ ÙË˜ ∫Ú‹ÙË˜, ËÏÈÎ›·˜ 9 ÌÂ 17 ÂÙÒÓ ÙÔ 1982 Î·È2002 (9)

1982 2002 ∞ÏÏ·Á‹ (¡=528) (¡=620)

ª¤ÛË ∆ÈÌ‹ %

µ¿ÚÔ˜ (kg) 45,8 50,2 9,6⁄„Ô˜ (cm) 150,8 152,5 1,1¢ª™ (kg/m2) 19,4 21,0 8,2

%º˘ÛÈÔÏÔÁÈÎ¿ 79 60À¤Ú‚·Ú· 16,5 27¶·¯‡Û·ÚÎ· 4,2 12,7À¤Ú‚·Ú· & ¶·¯‡Û·ÚÎ· 20,6 39,7

¶›Ó·Î·˜ 4. ªÂÏ¤ÙÂ˜ ÛÙËÓ ∂ÏÏ¿‰· ÁÈ· Î·Ì‡ÏÂ˜ ·Ó¿Ù˘ÍË˜

πÓÛÙÈÙÔ‡ÙÔ ÀÁÂ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡ ∂ıÓÈÎ¿ ÚfiÙ˘· ·Ó¿Ù˘ÍË˜¶·È‰È·ÙÚÈÎ‹ 1986;49:1-15 ∂ıÓÈÎ‹ ‰ÂÈÁÌ·ÙÔÏË„›· ÛÂ 230 Û¯ÔÏÂ›· - ÕÓÔÈÍË 1981∏ÏÈÎ›· 6-18 ÂÙÒÓ, 27.000 ·È‰È¿

¶·ÓÂÈÛÙ‹ÌÈÔ £ÂÛÛ·ÏÔÓ›ÎË˜ - ∆Ô Ê˘ÛÈÔÏÔÁÈÎfi ·È‰›. ¶ÚfiÙ˘· ÛÙÔÈ¯Â›· ·Ó¿Ù˘ÍË˜ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ £ÂÛÛ·ÏÔÓ›ÎË, 1990

1148 ¡ÂÔÁÓ¿ 0-30 ÌËÓÒÓ, ∞ı‹Ó·, 1984-19853419 ·È‰È¿ 3-6 ÂÙÒÓ, µÚÂÊÔÓËÈ·ÎÔ›-¶·È‰ÈÎÔ› ÛÙ·ıÌÔ› 7926 ·È‰È¿ 6-17 ÂÙÒÓ, ‰Â›ÁÌ· 38 Û¯ÔÏÂ›ˆÓ

¶·ÓÂÈÛÙ‹ÌÈÔ ∫Ú‹ÙË˜ - ∫·Ì‡ÏÂ˜ ÛˆÌ·ÙÈÎ‹˜ ·Ó¿Ù˘ÍË˜ ·È‰ÈÒÓ ‚ÚÂÊÈÎ‹˜ Î·È ÚÔÛ¯ÔÏÈÎ‹˜ ËÏÈÎ›·˜ ∫ÏÈÓÈÎ‹ ¶ÚÔÏËÙÈÎ‹˜ Ô˘ ÚÔ¤Î˘„·Ó ·fi ‰È·¯ÚÔÓÈÎ‹ ·Ú·ÎÔÏÔ‡ıËÛ‹ ÙÔ˘˜π·ÙÚÈÎ‹˜ & ¢È·ÙÚÔÊ‹˜ ¶·È‰È·ÙÚÈÎ‹ 2000;63:391-407

1142 ·È‰È¿ 0-6 ÂÙÒÓ, ∫Ú‹ÙË, 1988-1995, ‰È¿ÚÎÂÈ· 7 ¯ÚfiÓÈ·ÀÁÂ›·, ‰È·ÙÚÔÊ‹ & ·Ó¿Ù˘ÍË ·È‰ÈÒÓ ÚÔÛ¯ÔÏÈÎ‹˜ ËÏÈÎ›·˜Ã·ÓÈ¿, 20046663 ·È‰È¿ ËÏÈÎ›·˜ 5 ¤ˆ˜ 17,5 ÂÙÒÓ, 1987-2004

72 ∞. ∫·Ê¿ÙÔ˜


ÀÔ˘ÚÁÂ›Ô˘ ÀÁÂ›·˜. √È Î·Ì‡ÏÂ˜ ·˘Ù¤˜ ‰ÂÓ ¤ÁÈÓ·Ó

ÛÂ Î·Ù¿ÏÏËÏÔ ÏËı˘ÛÌÈ·Îfi ‰Â›ÁÌ· Ô‡ÙÂ ÙËÓ Î·-

Ù¿ÏÏËÏË ¯ÚÔÓÈÎ‹ ÂÚ›Ô‰Ô.

∆Ô πÀ¶ ¤Î·ÓÂ ÂÍ·ÈÚÂÙÈÎ¿ ÛÔ˘‰·›Ô ¤ÚÁÔ ÙÔ

1981 ÌÂ ÙË ‰ËÌÈÔ˘ÚÁ›· Î·Ì˘ÏÒÓ ·Ó¿Ù˘ÍË˜ ·fi

·ÓÙÈÚÔÛˆÂ˘ÙÈÎfi ‰Â›ÁÌ· 27.000 ·È‰ÈÒÓ ËÏÈÎ›·˜

6-18 ¯ÚfiÓˆÓ ·’ fiÏË ÙË ¯ÒÚ·. √È Î·Ì‡ÏÂ˜ ·˘Ù¤˜

‹Ù·Ó ÛÙ· ‚È‚ÏÈ¿ÚÈ· ˘ÁÂ›·˜ ÙÔ˘ ·È‰ÈÔ‡ Ì¤¯ÚÈ ÙÔ Ù¤-

ÏÔ˜ ÙÔ˘ 2003. √È Î·Ì‡ÏÂ˜ ·˘Ù¤˜ ı· Ú¤ÂÈ Ó·

Â·Ó¤ÏıÔ˘Ó ¿ÌÂÛ·, ·ÊÔ‡ ÂÈÛ·¯ıÔ‡Ó Ù· ‰Â‰ÔÌ¤Ó·

ÙˆÓ 27.000 ·È‰ÈÒÓ ÛÙÔ˘˜ ˘ÔÏÔÁÈÛÙ¤˜ Î·È ÌÂ Û‡Á-

¯ÚÔÓÂ˜ ÌÂıfi‰Ô˘˜ ‚ÈÔÛÙ·ÙÈÛÙÈÎ‹˜ Á›ÓÔ˘Ó Í·Ó¿ ÔÈ

Î·Ì‡ÏÂ˜ ·Ó¿Ù˘ÍË˜.

¶ÚÈÓ ·fi 25 ¯ÚfiÓÈ· ‰ÂÓ Ú·ÁÌ·ÙÔÔÈÂ›ÙÔ Ë Ì¤-

ÙÚËÛË ÙË˜ ÂÚÈÌ¤ÙÚÔ˘ Ì¤ÛË˜. ™‹ÌÂÚ· fiÌˆ˜, ıÂˆ-

ÚÂ›Ù·È ÂÍ·ÈÚÂÙÈÎ¿ ÛÔ˘‰·›· Ì¤ÙÚËÛË ÁÈ· ÙËÓ ÂÎÙ›ÌË-

ÛË ÙË˜ ÎÂÓÙÚÈÎ‹˜ ·¯˘Û·ÚÎ›·˜. ∏ ¤Î‰ÔÛË ÙÔ˘ ¶·-

ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹ÙË˜ “ÀÁÂ›·, ‰È·ÙÚÔÊ‹ Î·È ·Ó¿Ù˘-

ÍË ·È‰ÈÒÓ ÚÔÛ¯ÔÏÈÎ‹˜ ËÏÈÎ›·˜” ÙÔ 2004 (14), Â-

ÚÈÏ·Ì‚¿ÓÂÈ Î·Ì‡ÏÂ˜ ÂÚÈÌ¤ÙÚÔ˘ Ì¤ÛË˜, fiˆ˜ Î·È

ÔÈ ‰ËÌÔÛÈÂ‡ÛÂÈ˜ ÙˆÓ ™¿‚‚· Î·È Û˘Ó. (13), ÛÂ ·ÓÙÈ-

ÚÔÛˆÂ˘ÙÈÎfi ‰Â›ÁÌ· ·È‰ÈÒÓ ÙË˜ ∫‡ÚÔ˘.

¶ÏËı˘ÛÌÈ·Î¤˜ ÔÌ¿‰Â˜ ·È‰ÈÒÓ ·ÎfiÌ· ·fi ÙËÓ

ÚÔÛ¯ÔÏÈÎ‹ ËÏÈÎ›·, ‚Ú¤ıËÎ·Ó Ó· ¤¯Ô˘Ó ‰ÈÏ¿ÛÈ·

Â›Â‰· ÈÓÛÔ˘Ï›ÓË˜ ÛÂ ÂÎÂ›Ó· Ô˘ Â›¯·Ó ÂÚ›ÌÂÙÚÔ

Ì¤ÛË˜ ¿Óˆ ·fi ÙËÓ 85Ë ∂.£. ÛÂ Û‡ÁÎÚÈÛË Ì’ ·˘Ù¿

Ô˘ ‹Ù·Ó Î¿Ùˆ ·fi ÙËÓ 15Ë ∂.£. (10). °È’ ·˘Ùfi ÌÂ

Ó¤· ÂıÓÈÎ‹ ‰ÂÈÁÌ·ÙÔÏË„›· ·È‰ÈÒÓ fiÏË˜ ÙË˜ ¯ÒÚ·˜

Ô˘ ı· ÛÙÔ¯Â‡ÂÈ ÛÙËÓ ÂÎÙ›ÌËÛË ÙÔ˘ ÂÈ¤‰Ô˘ ˘ÁÂ›·˜,

ıÚ¤„Ë˜ Î·È ·Ó¿Ù˘ÍË˜, Ë ÂÚ›ÌÂÙÚÔ˜ Ì¤ÛË˜ Ú¤ÂÈ

™¯ËÌ·ÙÈÎ‹ Û‡ÁÎÚÈÛË. ª™ Î·Ì˘ÏÒÓ ·Ó¿Ù˘ÍË˜ ∞’ ¶∫¶∞ Î·ÈÔÚ›ˆÓ ˘¤Ú‚·ÚˆÓ Î·È ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ ‚¿ÛË ÙÔ˘ IOTF

¢ª™ 30 kg/m 2

¢ª™ 25 kg/m 2

¢ª™ - ∞ÁfiÚÈ·

∂ÈÎfiÓ· 3. ™¯ËÌ·ÙÈÎ‹ Û‡ÁÎÚÈÛË Î·Ì˘ÏÒÓ ¢ª™ ·ÁÔÚÈÒÓ ·fiCDC Î·È ∞’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ∞ıËÓÒÓ.

3%

50%

97%

™¯ËÌ·ÙÈÎ‹ Û‡ÁÎÚÈÛË. ª™ Î·Ì˘ÏÒÓ ·Ó¿Ù˘ÍË˜CDC Î·È ∞’ ¶·È‰È·ÙÚÈÎ‹˜ ∫ÏÈÓÈÎ‹˜ ∞ıËÓÒÓ

∂ÈÎfiÓ· 1. ∫·Ì‡ÏÂ˜ ¢ª™ ÎÔÚÈÙÛÈÒÓ ·fi CDC Î·È ∞’ ¶·È‰È·-ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ∞ıËÓÒÓ.

97%

50%

3%

™¯ËÌ·ÙÈÎ‹ Û‡ÁÎÚÈÛË. ª™ Î·Ì˘ÏÒÓ ·Ó¿Ù˘ÍË˜CDC Î·È ∞’ ¶·È‰È·ÙÚÈÎ‹˜ ∫ÏÈÓÈÎ‹˜ ∞ıËÓÒÓ

∂ÈÎfiÓ· 2. ∫·Ì‡ÏÂ˜ ¢ª™ ·ÁÔÚÈÒÓ ·fi CDC Î·È ∞’ ¶·È‰È·ÙÚÈ-Î‹ ∫ÏÈÓÈÎ‹ ∞ıËÓÒÓ.

73∫·Ì‡ÏÂ˜ ÛˆÌ·ÙÈÎ‹˜ ·Ó¿Ù˘ÍË˜ ÛÙËÓ ∂ÏÏ¿‰·

¶·È‰È·ÙÚÈÎ‹ 2007;70:70-74

Ó· ÂÚÈÏ·Ì‚¿ÓÂÙ·È ÛÙÈ˜ ÌÂÙÚ‹ÛÂÈ˜. √È Î·Ì‡ÏÂ˜ Â-ÚÈÌ¤ÙÚÔ˘ Ì¤ÛË˜ Ú¤ÂÈ Ó· ÌÔ˘Ó ÛÙ· ‚È‚ÏÈ¿ÚÈ·˘ÁÂ›·˜ ÙÔ˘ ·È‰ÈÔ‡ ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË ÙÔ˘ ‚·ıÌÔ‡ ÎÂ-ÓÙÚÈÎ‹˜ ·¯˘Û·ÚÎ›·˜.


1. ÃÈÒÙË˜ ¢, ∆Û›ÊÙË˜ °, Ã·Ù˙ËÛ˘ÌÂÒÓ ª, ª·ÓÈ¿ÙË-ÃÚËÛÙ›-‰Ë ª, ∫Ú›ÎÔ˜ •, ¢¿ÎÔ˘-µÔ˘ÙÂÙ¿ÎË ∞. ∞Ó¿ÛÙËÌ· Î·È Ûˆ-Ì·ÙÈÎfi ‚¿ÚÔ˜ ÂÏÏËÓÔ·›‰ˆÓ ËÏÈÎ›·˜ 0-18 ÂÙÒÓ (2000-2001): Û‡ÁÎÚÈÛË ÌÂ ‰Â‰ÔÌ¤Ó· ÌÂÏ¤ÙË˜ 1978-1979. ¢ÂÏÙ›Ô∞’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹˜ 2003;50:136-156.

2. ÃÈÒÙË˜ ¢, ∫Ú›ÎÔ˜ •, ∆Û›ÊÙË˜ °, Ã·Ù˙ËÛ˘ÌÂÒÓ ª, ª·ÓÈ¿-ÙË-ÃÚËÛÙ›‰Ë ª, ¢¿ÎÔ˘-µÔ˘ÙÂÙ¿ÎË ∞. ¢Â›ÎÙË˜ Ì¿˙·˜ ÛÒ-Ì·ÙÔ˜ (BMI) Î·È ÔÛÔÛÙfi ·¯˘Û·ÚÎ›·˜ ÛÂ ¿ÙÔÌ· ÙË˜ Â˘-Ú‡ÙÂÚË˜ ÂÚÈÔ¯‹˜ ∞ıËÓÒÓ, ËÏÈÎ›·˜ 0-18 ÂÙÒÓ. ¢ÂÏÙ›Ô Õ¶·È‰È·ÙÚÈÎ‹˜ ∫ÏÈÓÈÎ‹˜ 2004;51:139-154.

3. ÃÚÔ‡ÛÔ˜ °¶. ¶·È‰ÈÎ‹ ·¯˘Û·ÚÎ›· ÛÙËÓ ∂ÏÏ¿‰·. ¶·È‰È·-ÙÚÈÎ‹ £ÂÚ·Â˘ÙÈÎ‹ ∂ÓËÌ¤ÚˆÛË 2003; 225-234.

4. National Center for Health Statistics. [Webpage, Internet].Growth Charts for the United States: Methods andDevelopment, CDC 2000:http://www.cdc.gov/growthcharts

5. Cole TJ, Freeman JV, Preece MA. Body mass indexreference curves for the UK, 1990. Arch Dis Child1995;73(1):25-29.

6. Cameron N. British growth charts for height and weightwith recommendations concerning their use in axiologicalassessment. Ann Hum Biol 2002; 29(1):1-10.

7. ª·Ù˙·ÁÚÈÒÙË-ªÂ˚ÌÂÚ›‰Ë ª, ¶·ÓÙ·˙›‰Ë˜ ¡, ¢ÔÍÈ¿‰Ë˜ ™,ƒ·Ê·‹Ï ª. ∂ıÓÈÎ¿ ÚfiÙ˘· ·Ó¿Ù˘ÍË˜: µ¿ÚÔ˜ Î·È ‡„Ô˜·È‰ÈÎÔ‡ ÏËı˘ÛÌÔ‡ ÛÙËÓ ∂ÏÏ¿‰·. ¶·È‰È·ÙÚÈÎ‹ 1986;49:1-15.

8. Lobstein T, Baur L, Uauy R; IASO International ObesityTaskForce. Obesity in children and young people: a crisis inpublic health. Report to the WHO. Obes Rev 2004; 5(1Suppl):S4-S104.

9. Magkos F, Manios Y, Christakis G, Kafatos AG. Seculartrends in cardiovascular risk factors among school-agedboys from Crete, Greece, 1982-2002. Eur J Clin Nutr 2005;59:1-7.

10. ªÔÛ¯·Ó‰Ú¤· I, Ã·Ù˙‹˜ X, ª·ÌÌ¿˜ I, ªÂÚÙÛÈ¿˜ °, §È-Ó·Ú‰¿ÎË˜ ª, ∫˘ÚÈ·Î¿ÎË˜ ª, et al. ¢Â›ÎÙÂ˜ ·¯˘Û·ÚÎ›·˜Î·È ·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ ÛÂ ·È‰È¿ ·ÁÚÔÙÈÎ‹˜ ÔÚÂÈÓ‹˜ÂÚÈÔ¯‹˜ ÙË˜ ∫Ú‹ÙË˜. ¶·È‰È·ÙÚÈÎ‹ 2003;66:264-277.

11. §ÈÓ·Ú‰¿ÎË˜ ª, ªÔÛ¯·Ó‰Ú¤· I, ∫·Ê¿ÙÔ˜ ∞. ∫·Ì‡ÏÂ˜ÛˆÌ·ÙÈÎ‹˜ ·Ó¿Ù˘ÍË˜ ·È‰ÈÒÓ ‚ÚÂÊÈÎ‹˜ Î·È ÚÔÛ¯ÔÏÈ-Î‹˜ ËÏÈÎ›·˜ ÙË˜ ∫Ú‹ÙË˜ Ô˘ ÚÔ¤Î˘„·Ó ·fi ‰È·¯ÚÔÓÈÎ‹·Ú·ÎÔÏÔ‡ıËÛ‹ ÙÔ˘˜. ¶·È‰È·ÙÚÈÎ‹ 2000;63:391-407.

12. ∞˚‚¿˙Ë˜ µ. ∆Ô Ê˘ÛÈÔÏÔÁÈÎfi ·È‰› - ¶ÚfiÙ˘· ÛÙÔÈ¯Â›··Ó¿Ù˘ÍË˜. £ÂÛÛ·ÏÔÓ›ÎË 1990.

13. Savva SC, Kourides Y, Tornaritis M, Epiphaniou-Savva M,Tafouna P, Kafatos A. Reference growth curves for Cypriotchildren 6 to 17 years of age. Obes Res 2001;9:754-762.

14. ∫·Ê¿ÙÔ˜ ∞. ÀÁÂ›·, ¢È·ÙÚÔÊ‹ Î·È ·Ó¿Ù˘ÍË ·È‰ÈÒÓ ÚÔ-Û¯ÔÏÈÎ‹˜ ËÏÈÎ›·˜. ¡ÔÌ·Ú¯È·Î‹ ∞˘ÙÔ‰ÈÔ›ÎËÛË Ã·Ó›ˆÓ -¶·ÓÂÈÛÙ‹ÌÈÔ ∫Ú‹ÙË˜, ÂÎ‰fiÙÂ˜. Ã·ÓÈ¿: 2004.

74 ∞. ∫·Ê¿ÙÔ˜


“√ÓÂÈÚÂ‡ÔÌ·È ÙËÓ∂ÈÚ‹ÓË”,Lina Maria Ocampo,

12 ¯ÚÔÓÒÓ, ∫ÔÏÔÌ‚›·¶·È‰› ÌÂ ÌÂÚÈÎ‹ fiÚ·ÛË

“∆· Ù˘ÊÏ¿ ·È‰È¿˙ˆÁÚ·Ê›˙Ô˘Ó”, ÕÓÓ· §·Ô˘Ù¿ÚË-°ÎÚÈÙ˙¿Ï·, ∞ı‹Ó· 2006

“Dreaming with thePeace”, Lina Maria Ocampo,

12 years old, ColombiaPartially blind child

“Blind children

paint”, Anna Laoutari-Gritzala,Athens 2006

¡ÂÊÚÔÏÔÁÈÎfi ∆Ì‹Ì·,¡ÔÛÔÎÔÌÂ›Ô˘ ¶·›‰ˆÓ “¶. Î·È ∞. ∫˘ÚÈ·ÎÔ‡”


K. ™ÙÂÊ·Ó›‰Ë˜[email protected]¡ÂÊÚÔÏÔÁÈÎfi ∆Ì‹Ì·,¡ÔÛÔÎÔÌÂ›Ô˘ ¶·›‰ˆÓ “¶. Î·È ∞. ∫˘ÚÈ·ÎÔ‡”

75∫§π¡π∫√ ∫√Àπ∑

¶·È‰È·ÙÚÈÎ‹ 2006;69:75,78-79

K. ™ÙÂÊ·Ó›‰Ë˜, µ. ∞ÛÎËÙ‹

∞ÁfiÚÈ ËÏÈÎ›·˜ 8 ÂÙÒÓ ·ÚÔ˘Û›·ÛÂ Ì·ÎÚÔÛÎÔÈ-Î‹ ·ÈÌ·ÙÔ˘Ú›·, ‰È·ÚÎÂ›·˜ ‰‡Ô ËÌÂÚÒÓ Î·È ÛÙË Û˘-Ó¤¯ÂÈ· ÂÈÌ¤ÓÔ˘Û· ÌÈÎÚÔÛÎÔÈÎ‹ ·ÈÌ·ÙÔ˘Ú›·. ∆Ô·ÙÔÌÈÎfi ÈÛÙÔÚÈÎfi ‹Ù·Ó ÂÏÂ‡ıÂÚÔ. ¢ÂÓ ·Ó·Ê¤ÚıËÎÂÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÓÂÊÚÔ¿ıÂÈ·˜ ‹ ¿ÏÏÔ˘¯ÚfiÓÈÔ˘ ÓÔÛ‹Ì·ÙÔ˜. ∞fi ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈÎ‹ ÂÍ¤Ù·-ÛË ‰È·ÈÛÙÒıËÎÂ ‡„Ô˜ Î·È ‚¿ÚÔ˜ ÛÙËÓ 50‹ ÂÎ·ÙÔ-ÛÙÈ·›· ı¤ÛË, Ê˘ÛÈÔÏÔÁÈÎ‹ ·ÚÙËÚÈ·Î‹ ›ÂÛË Î·È Î·-Ù¿ Û˘ÛÙ‹Ì·Ù· ÂÍ¤Ù·ÛË ¯ˆÚ›˜ ·ıÔÏÔÁÈÎ¿ Â˘Ú‹Ì·-Ù·, ÂÎÙfi˜ ·fi ÙËÓ ‡·ÚÍË ÎÈÚÛÔÎ‹ÏË˜ ·ÚÈÛÙÂÚ¿. ∏ÁÂÓÈÎ‹ ·›Ì·ÙÔ˜ Î·È Ô ‚ÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ (Ô˘Ú›·,ÎÚÂ·ÙÈÓ›ÓË, Ô˘ÚÈÎfi ÔÍ‡, ÁÏ˘Îfi˙Ë, ·Û‚¤ÛÙÈÔ, Î¿ÏÈÔ,Ó¿ÙÚÈÔ, pH Î·È ‰ÈÙÙ·ÓıÚ·ÎÈÎ¿) ‰ÂÓ ¤‰ÂÈÍ·Ó ·ıÔ-ÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù·. √ ¤ÏÂÁ¯Ô˜ ËÎÙÈÎfiÙËÙ·˜ ‹Ù·ÓÊ˘ÛÈÔÏÔÁÈÎfi˜. ∆· Â˘Ú‹Ì·Ù· ·fi ÙË ÁÂÓÈÎ‹ Ô‡ÚˆÓ‹Ù·Ó: ÂÈ‰ÈÎfi ‚¿ÚÔ˜ 1020, ÏÂ‡ÎˆÌ· ·ÚÓËÙÈÎfi, ·ÈÌÔ-

ÛÊ·ÈÚ›ÓË +++ Î·È ÂÚ˘ıÚÔÎ‡ÙÙ·Ú· 15-20/ÔÙÈÎfiÂ‰›Ô. ¢ÂÓ ‰È·ÈÛÙÒıËÎ·Ó ‰‡ÛÌÔÚÊ· ÂÚ˘ıÚÔÎ‡Ù-Ù·Ú· ÛÙËÓ ÂÍ¤Ù·ÛË ÙÔ˘ È˙‹Ì·ÙÔ˜ ÙˆÓ Ô‡ÚˆÓ ÌÂ ÌÈ-ÎÚÔÛÎfiÈÔ ·ÓÙÈı¤ÙˆÓ Ê¿ÛÂˆÓ. √ ÏfiÁÔ˜ ·Û‚ÂÛÙ›Ô˘Ô‡ÚˆÓ/ÎÚÂ·ÙÈÓ›ÓË Ô‡ÚˆÓ, Ô˘ÚÈÎfi ÔÍ‡ Ô‡ÚˆÓ/ÎÚÂ·-ÙÈÓ›ÓË Ô‡ÚˆÓ Î·È ÔÍ·ÏÈÎfi ÔÍ‡ Ô‡ÚˆÓ/ÎÚÂ·ÙÈÓ›ÓËÔ‡ÚˆÓ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜. ∆Ô ˘ÂÚË¯ÔÁÚ¿ÊËÌ·Ô˘ÚÔÔÈËÙÈÎÔ‡ ¤‰ÂÈÍÂ Ê˘ÛÈÔÏÔÁÈÎfi Ì¤ÁÂıÔ˜ Î·ÈË¯ÔÁ¤ÓÂÈ· ÓÂÊÚÒÓ ¯ˆÚ›˜ ‰È¿Ù·ÛË ÙÔ˘ ˘ÂÏÔÎ·Ï˘-ÎÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ‹ Î·È ÙˆÓ Ô˘ÚËÙ‹ÚˆÓ.

™Â ËÏÈÎ›· 9 ÂÙÒÓ ÙÔ ·È‰› ·ÚÔ˘Û›·ÛÂ 2Ë ÊÔÚ¿Ì·ÎÚÔÛÎÔÈÎ‹ ·ÈÌ·ÙÔ˘Ú›·. ™ÙËÓ Î˘ÛÙÂÔÛÎfiËÛË‰È·ÈÛÙÒıËÎÂ ·ÈÌ·ÙÔ˘Ú›· ÌfiÓÔ ·fi ÙÔÓ ·ÚÈÛÙÂÚfiÔ˘ÚËÙ‹Ú·. ™ÙÔ ˘ÂÚË¯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜ ‰È·È-ÛÙÒıËÎÂ ÛËÌ·ÓÙÈÎ‹ ‰È¿Ù·ÛË ÙË˜ ·ÚÈÛÙÂÚ¿˜ ÓÂÊÚÈ-Î‹˜ ÊÏ¤‚·˜ (∂ÈÎfiÓ· 1).

∏ ·¿ÓÙËÛË ·ÎÔÏÔ˘ıÂ› ÛÙË ÛÂÏ›‰· 78

∂ÈÎfiÓ· 1. ∂ÁÎ¿ÚÛÈ· ÙÔÌ‹ ˘ÂÚË¯ÔÁÚ·Ê‹Ì·ÙÔ˜ ÎÔÈÏ›·˜ (1: ¿Óˆ ÌÂÛÂÓÙ¤ÚÈÔ˜ ·ÚÙËÚ›·, 2: ·ÔÚÙ‹, 3: ÓÂÊÚÈÎ‹ ÊÏ¤‚·).

¶Èı·Ó¤˜ ‰È·ÁÓÒÛÂÈ˜:1. IgA ÓÂÊÚÔ¿ıÂÈ·2. ¡ÂfiÏ·ÛÌ· ÓÂÊÚÔ‡3. ¡ÂÊÚÔÏÈı›·ÛË 4. ™‡Ó‰ÚÔÌÔ Î·Ú˘ÔıÚ·‡ÛÙË

76 ¡∂∞ ∞¶√ ∆√ ¢π∞¢π∫∆À√


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


¡›ÎÔ˜ ¶··‰fiÔ˘ÏÔ˜E-mail: [email protected]

¡›ÎÔ˜ ¶··‰fiÔ˘ÏÔ˜, ¶·È‰›·ÙÚÔ˜, ∞ÏÏÂÚÁÈÔÏfiÁÔ˜

Pediatric Blogs

T· ÙÂÏÂ˘Ù·›· ‰‡Ô ¯ÚfiÓÈ· ¤Ó· Ó¤Ô Ê·ÈÓfiÌÂÓÔ ÂÌÊ·Ó›ÛÙËÎÂ Î·È‹ÚÂ ÛËÌ·ÓÙÈÎ¤˜ ‰È·ÛÙ¿ÛÂÈ˜ ÛÙÔ ‰È·‰›ÎÙ˘Ô: Ù· blogs (Û‡ÓÙÌËÛËÙÔ˘ web-logs) ·ÔÙÂÏÔ‡Ó ‰È·‰ÈÎÙ˘·Î¿ ËÌÂÚÔÏfiÁÈ·-ÛËÌÂÈˆÌ·Ù¿-ÚÈ·, Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÁÈ· ÙËÓ Î·Ù·ÁÚ·Ê‹ Î·È ÙËÓ Ù·ÍÈÓfiÌË-ÛË ÙˆÓ ÛÎ¤„ÂˆÓ ÙÔ˘ Û˘ÓÙ¿ÎÙË, ÌÂ ‚¿ÛË ÙËÓ ËÌÂÚÔÌËÓ›· Î·È ÙËÓÒÚ· Ô˘ Î·Ù·¯ˆÚÔ‡ÓÙ·È.

™ËÌ·ÓÙÈÎ‹ ÒıËÛË ÛÙËÓ ÂÍ¿ÏˆÛË ÙÔ˘˜ ·ÔÙ¤ÏÂÛ·Ó Ù· ÁÂÁÔ-ÓfiÙ· ÙË˜ 11Ë˜ ™ÂÙÂÌ‚Ú›Ô˘ 2001, fiÙ·Ó ÔÏÏÔ› ·ÏÔ› ¯Ú‹ÛÙÂ˜¤ÓÈˆÛ·Ó ÙËÓ ·Ó¿ÁÎË Ó· ÌÔ˘Ó ÛÙÔ ‰È·‰›ÎÙ˘Ô ÚÔÎÂÈÌ¤ÓÔ˘ Ó· ÂÓË-ÌÂÚˆıÔ‡Ó, Ó· ÌÔÈÚ·ÛÙÔ‡Ó ÙÈ˜ ÛÎ¤„ÂÈ˜ Î·È Ù· Û˘Ó·ÈÛı‹Ì·Ù¿ ÙÔ˘˜,Î·ıÒ˜ Î·È Ó· ÚÔ‚Ô‡Ó ÛÙÔÓ Û¯ÔÏÈ·ÛÌfi ÙˆÓ ÁÂÁÔÓfiÙˆÓ.

™‹ÌÂÚ· Ù· weblogs ˘¿Ú¯Ô˘Ó ÛÂ ‰È¿ÊÔÚÂ˜ ·Ú·ÏÏ·Á¤˜. °È·¤Ó·Ó ·Ïfi ¯Ú‹ÛÙË, ÙÔ weblog ÌÔÚÂ› Ó· Â›Ó·È ¤Ó·˜ ÙÚfiÔ˜ ÁÈ· Ó·

ÂÎÊÚ¿ÛÂÈ ÙÈ˜ ÚÔÛˆÈÎ¤˜ ÙÔ˘ ·fi„ÂÈ˜ Û¯ÂÙÈÎ¿ ÌÂ ÙËÓ ÂÈÎ·ÈÚfiÙËÙ·, ÌÂ ı¤Ì·Ù· Â·ÁÁÂÏÌ·ÙÈÎ¿ ‹ÚÔÛˆÈÎ¿, ÂÓÒ ÁÈ· ÌÈ· ÂÙ·ÈÚÂ›· ÌÔÚÂ› Ó· Â›Ó·È ¤Ó· Ì¤ÛÔ Û˘ÏÏÔÁÈÎ‹˜ Î·Ù·ÁÚ·Ê‹˜ ÛÎ¤„ÂˆÓ, ˘Ô-‰Â›ÍÂˆÓ Î·È ÂÈÛËÌ¿ÓÛÂˆÓ, ÂÍ·ÏÂ›ÙÔÓÙ·˜ ¤ÙÛÈ ÙËÓ ·Ó¿ÁÎË ·ÔÛÙÔÏ‹˜ e-mail.

∞Ó ı¤ÏÂÙÂ ÌÔÚÂ›ÙÂ ÎÈ ÂÛÂ›˜, ¯ˆÚ›˜ È‰È·›ÙÂÚÂ˜ ÙÂ¯ÓÈÎ¤˜ ÁÓÒÛÂÈ˜ Ó· ÍÂÎÈÓ‹ÛÂÙÂ Ó· ÁÚ¿ÊÂÙÂ ¤Ó·blog. ∂ÈÛÎÂÊıÂ›ÙÂ ÙÔ www.blogger.com, fiÔ˘ ˘¿Ú¯Ô˘Ó ÙfiÛÔ Ù· Ì¤Û· fiÛÔ Î·È ÔÈ ··Ú·›ÙËÙÂ˜ ÏË-ÚÔÊÔÚ›Â˜ Û¯ÂÙÈÎ¿ ÌÂ ÙË ÊÈÏÔÛÔÊ›· ÙˆÓ blogs.

∞Ó ¿ÏÈ, ı¤ÏÂÙÂ Ó· ‰È·‚¿ÛÂÙÂ ‹ Ó· ÌÔÈÚ·ÛÙÂ›ÙÂ ÛÎ¤„ÂÈ˜ ¿ÏÏˆÓ Û˘Ó·‰¤ÏÊˆÓ ‹ ·ÛıÂÓÒÓ, ˘¿Ú-¯ÂÈ ÙÂÚ¿ÛÙÈ· ÔÈÎÈÏ›·, ÌÔÚÂ›ÙÂ fiÌˆ˜ Ó· ÍÂÎÈÓ‹ÛÂÙÂ ·fi Ù· ·Ú·Î¿Ùˆ:

Medicine World - http://medicineworld.org/news/pediatric-news.html

™ÙËÓ ÈÛÙÔÛÂÏ›‰· Medicine World Ô ÂÈÛÎ¤ÙË˜ ¤¯ÂÈ ÚfiÛ‚·-ÛË ÛÂ ÏËıÒÚ· ¿ÚıÚˆÓ ÛÙÔÓ ÙÔÌ¤· ÙˆÓ Pediatric News, Ù· ÔÔ›·Î·Ù·Ù¿ÛÛÔÓÙ·È ÌÂ ¯ÚÔÓÔÏÔÁÈÎ‹ ÛÂÈÚ¿. ∂ÈÚfiÛıÂÙ· ÙÔ site ÚÔ-ÛÊ¤ÚÂÈ ÛÙÔÓ ÂÈÛÎ¤ÙË ÙË ‰˘Ó·ÙfiÙËÙ· Ó· ·Ó·ÁÓÒÛÂÈ ÔÏÏ¤˜ÂÚÈÙÒÛÂÈ˜ Û¯ÂÙÈÎ¤˜ ÌÂ ÎÔÈÓ¿ ÚÔ‚Ï‹Ì·Ù· ÙË˜ ·È‰ÈÎ‹˜ ËÏÈ-Î›·˜ Ù· ÔÔ›· ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÌÂ ¤Ó·Ó È‰È·›ÙÂÚ· ÁÏ·Ê˘Úfi ÂÚÈ-ÁÚ·ÊÈÎfi ÙÚfiÔ. ÕÚıÚ· fiˆ˜ “¡¤· ∂Ï›‰· ÁÈ· Ù· ·È‰È¿ Ô˘ ¿-Û¯Ô˘Ó ·fi §Â˘¯·ÈÌ›·”, fiÔ˘ ·Ó·ÎÔÈÓÒÓÂÙ·È Ë ÂÊ·ÚÌÔÁ‹ Ó¤ˆÓ‚ÂÏÙÈˆÌ¤ÓˆÓ ÙÂ¯ÓÈÎÒÓ ÁÈ· ÌÂÙ·ÌÔÛ¯Â‡ÛÂÈ˜ ÚÔÁÔÓÈÎÒÓ Î˘ÙÙ¿-ÚˆÓ ÛÂ ·È‰È¿, ‹ ¿ÚıÚ· Ô˘ ·ÊÔÚÔ‡Ó ÂÚÈÛÛfiÙÂÚÔ ˙ËÙ‹Ì·Ù·

„˘¯ÔÏÔÁÈÎ‹˜ Ê‡ÛÂˆ˜ fiˆ˜ “∞ÓÙÈÌÂÙˆ›˙ÔÓÙ·˜ Ù· ·È‰È¿ ÌÂ ÂÓÔ‡ÚËÛË” Â›Ó·È ÌÂÚÈÎ¿ ÌfiÓÔ ·fi ·˘-Ù¿ Ô˘ ÌÔÚÂ› Î·ÓÂ›˜ Ó· ÂÓÙÔ›ÛÂÈ ÛÙÔ Û˘ÁÎÂÎÚÈÌ¤ÓÔ blog. ∆Ô site ‰›ÓÂÈ ÙËÓ Â˘Î·ÈÚ›· ÛÂ Î¿ıÂ·È‰›·ÙÚÔ Ó· ÂÁÁÚ·ÊÂ› ˆ˜ Ì¤ÏÔ˜ Î·È Ó· ‰ËÌÔÛÈÂ‡ÛÂÈ ÙÔ ¿ÚıÚÔ ÙÔ˘ ·ÏÏ¿ Ù·˘Ùfi¯ÚÔÓ· ·Ó·Ê¤ÚÂÈfiÙÈ Ù· ¿ÚıÚ· Ú¤ÂÈ Ó· ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ˆ˜ ËÁ‹ ÚÔÛˆÈÎ‹˜ ÏËÚÔÊfiÚËÛË˜ Î·È fi¯È ˆ˜ ‚¿-ÛË È·ÙÚÈÎÒÓ ÂÊ·ÚÌÔÁÒÓ.

77NEWS FROM THE INTERNET

¶·È‰È·ÙÚÈÎ‹ 2007;70:76-77

WebMD - http://blogs.webmd.com/healthy-children/

∆ËÓ ÂÍ¿ÏˆÛË ÙˆÓ blogs ¤¯Ô˘Ó ·Ó·Î·Ï‡„ÂÈ Î·È ¯ÚËÛÈÌÔ-ÔÈÔ‡Ó Î·È ÌÂÁ¿Ï·, ÔÚÁ·ÓˆÌ¤Ó· sites, fiˆ˜ .¯. ÙÔ webMD,ÛÙÔ ÔÔ›Ô ÔÈ ÛÎ¤„ÂÈ˜ /ÛËÌÂÈÒÛÂÈ˜ ÚÔ¤Ú¯ÔÓÙ·È ·fi ÂÈ‰ÈÎÔ‡˜.∞Ó Î·È Ë ÚÔÛ¤ÁÁÈÛË ·˘Ù‹ ÌÂÈÒÓÂÈ ÙÔÓ ·˘ıÔÚÌËÙÈÛÌfi ÙˆÓblogs, ˘¿Ú¯ÂÈ ÌÂÁ·Ï‡ÙÂÚË ÛÈÁÔ˘ÚÈ¿ Û¯ÂÙÈÎ¿ ÌÂ ÙË ÌË-·˘ı·È-ÚÂÛ›· ÙË˜ ÏËÚÔÊÔÚ›·˜

Your Child’s Health - http://yourchildshealth.blogspot.com/2006_12_01_archive.html

∫·È ¤Ó· ·Ú¿‰ÂÈÁÌ· blog ·fi ·È‰›·ÙÚÔ: Î·ÏÔÛÙËÌ¤ÓË,Â˘¯¿ÚÈÛÙË Î·È ‰ËÌÈÔ˘ÚÁÈÎ‹, Ë ÚÔÛˆÈÎ‹ ÈÛÙÔÛÂÏ›‰· ÙË˜Dr Gwenn ÔÓÔÌ¿˙ÂÙ·È “Your Child’s Health” Î·È ·ÔÙÂÏÂ›¤Ó· blog ÁÈ· ÙÈ˜ Û‡Á¯ÚÔÓÂ˜ ÔÈÎÔÁ¤ÓÂÈÂ˜ ÌÂ ÂÓ‰È·Ê¤ÚÔÓÙ·Ó¤·, Û¯ÔÏÈ·ÛÌÔ‡˜ Î·È ÛÎ¤„ÂÈ˜.

∏ ·È‰›·ÙÚÔ˜ ÂÎı¤ÙÂÈ ÙË˜ È‰¤Â˜ ÙË˜ Î·È ÌÔÈÚ¿˙ÂÙ·È ÙÈ˜ÂÌÂÈÚ›Â˜ ÙË˜ ÌÂ ÙÔ˘˜ ÁÔÓÂ›˜ ÂÍ˘ËÚÂÙÒÓÙ·˜ Ù·˘Ùfi¯ÚÔÓ·¤Ó·Ó ‰È·‰Ú·ÛÙÈÎfi ÛÎÔfi.

∆›ÙÏÔÈ ¿ÚıÚˆÓ fiˆ˜ “¢È·ÙÚÔÊÈÎ¤˜ ·ÏÏÂÚÁ›Â˜”, “£¤Ì·Ù·Û¯ÂÙÈÎ¿ ÌÂ Ù· Ó‹È·”, “¢È·ÛÎ¤‰·ÛË Î·È ·ÛÊ¿ÏÂÈ· ÛÙÈ˜ ‰Ú·ÛÙË-ÚÈfiÙËÙÂ˜ ÂÎÙfi˜ ÛÈÙÈÔ‡” ‹ “∏ ˘ÁÂ›· ÙˆÓ ÂÊ‹‚ˆÓ”, Î¿ÓÔ˘Ó ÙËÓ

¤ÚÂ˘Ó· ÈÔ Â‡ÎÔÏË Î·È Ú·ÎÙÈÎ‹. ∆Ô site ¤¯ÂÈ ·ÎfiÌË ÛÂ ÛÙ‹ÏË ·Ú¯ÂÈÔıÂÙËÌ¤Ó· Ù· ÚÔËÁÔ‡ÌÂÓ·blogs ·ÏÏ¿ Î·È Ï›ÛÙ· ÌÂ links ¿ÏÏˆÓ ¯Ú‹ÛÈÌˆÓ ÈÛÙÔÛÂÏ›‰ˆÓ (∞ÌÂÚÈÎ·ÓÈÎ‹ ∞Î·‰ËÌ›· ¶·È‰È¿ÙÚˆÓ,™‡Á¯ÚÔÓË ¶·È‰È·ÙÚÈÎ‹ Î.¿). ∏ Û˘ÁÎÂÎÚÈÌ¤ÓË ÈÛÙÔÛÂÏ›‰· ÚÔÛÊ¤ÚÂÈ ÌÈ· Â˘¯¿ÚÈÛÙË ·Ó¿ÁÓˆÛË‰È·ÓıÈÛÌ¤ÓË ÌÂ ÂÈÎfiÓÂ˜ Î·È ÏÔ‡ÛÈ· ÁÚ·ÊÈÎ¿, ÂÓÒ ·Ú¿ÏÏËÏ· ˘¿Ú¯ÂÈ ‰˘Ó·ÙfiÙËÙ· ÂÈÎÔÈÓˆ-Ó›·˜, ·Ú¿ıÂÛË˜ Û¯ÔÏ›ˆÓ ‹ Î·È ÂÓÂÚÁÔ‡ Û˘ÌÌÂÙÔ¯‹˜ ÛÙËÓ ·ÚıÚÔÁÚ·Ê›·.

∞˜ ÛËÌÂÈˆıÂ› fiÙÈ Ë ·ÍÈÔÈÛÙ›· ÙˆÓ ÏËÚÔÊÔÚÈÒÓ ÛÙ· blogs ‰ÂÓ ÂÏ¤Á¯ÂÙ·È ·fi Î·Ó¤Ó·Ó ÎÈ ¤ÙÛÈ, ÂÓÒÌÔÚÂ› Ó· ·ÔÙÂÏ¤ÛÔ˘Ó Â˘¯¿ÚÈÛÙÔ ·Ó¿ÁÓˆÛÌ·, ı· Ú¤ÂÈ Ó· Á›ÓÂÙ·È Û·Ê¤˜ fiÙÈ ‰ÂÓ ¤¯Ô˘Ó ÛÂ Î·Ì›·

ÂÚ›ÙˆÛË ÚfiÏÔ È·ÙÚÈÎ‹˜ ÁÓÒÌË˜ ‹ Û˘Ì‚Ô˘Ï‹˜!

CLINICAL QUIZ78

Paediatriki 2007;70:75,78-79

∫ÏÈÓÈÎfi QUIZ

∞¶∞¡∆∏™∏

∏ ‰È¿ÁÓˆÛË ‹Ù·Ó Û‡Ó‰ÚÔÌÔ ÙÔ˘ Î·Ú˘Ô-

ıÚ·‡ÛÙË (nutcracker), Ë ÔÔ›· ‚·Û›ÛıËÎÂ ÛÙ·

Ù˘ÈÎ¿ Â˘Ú‹Ì·Ù· ÙË˜ ˘ÔÙÚÔÈ¿˙Ô˘Û·˜ Ì·-

ÎÚÔÛÎÔÈÎ‹˜ ·ÈÌ·ÙÔ˘Ú›·˜ ÌfiÓÔ ·fi ÙÔÓ ·ÚÈ-

ÛÙÂÚfi Ô˘ÚËÙ‹Ú·, ÌÈÎÚÔÛÎÔÈÎ‹˜ ·ÈÌ·ÙÔ˘Ú›·˜

ÌÂ ÈÛÔÌÔÚÊÈÎ¿ ÂÚ˘ıÚÔÎ‡ÙÙ·Ú· ÛÙËÓ ÂÍ¤Ù·ÛË

ÙÔ˘ È˙‹Ì·ÙÔ˜ Ô‡ÚˆÓ ÌÂ ÌÈÎÚÔÛÎfiÈÔ ·ÓÙÈı¤ÙˆÓ

Ê¿ÛÂˆÓ, ÛÙËÓ ÎÈÚÛÔÎ‹ÏË Î·È ÂÈ‚Â‚·ÈÒıËÎÂ

ÌÂ ÙÔ ¯·Ú·ÎÙËÚÈÛÙÈÎfi Â‡ÚËÌ· ‰È¿Ù·ÛË ÙË˜ ·ÚÈ-

ÛÙÂÚ‹˜ ÓÂÊÚÈÎ‹˜ ÊÏ¤‚·˜ ÛÙËÓ ÂÁÎ¿ÚÛÈ· ÙÔÌ‹

ÙÔ˘ ˘ÂÚË¯ÔÁÚ·Ê‹Ì·ÙÔ˜ ÎÔÈÏ›·˜ (∂ÈÎfiÓ· 2).

∆Ô Û‡Ó‰ÚÔÌÔ ÙÔ˘ Î·Ú˘ÔıÚ·‡ÛÙË Â›Ó·È ·Ô-

Ù¤ÏÂÛÌ· Û˘Ì›ÂÛË˜ ÙË˜ ·ÚÈÛÙÂÚ‹˜ ÓÂÊÚÈÎ‹˜

ÊÏ¤‚·˜ ·fi ÙËÓ ·ÔÚÙ‹ Î·È ÙËÓ ¿Óˆ ÌÂÛÂÓÙ¤ÚÈ·

·ÚÙËÚ›·, Ô˘ ÏÂÈÙÔ˘ÚÁÔ‡Ó Û·Ó Ù· ‰‡Ô ÛÎ¤ÏË

ÂÓfi˜ Î·Ú˘ÔıÚ·‡ÛÙË (1). ∆Ô Û‡Ó‰ÚÔÌÔ ·˘Ùfi

ÔÊÂ›ÏÂÙ·È ÛÂ ·ÓÒÌ·ÏË ‰È·ÎÏ¿‰ˆÛË ÙË˜ ¿Óˆ ÌÂ-

ÛÂÓÙ¤ÚÈ·˜ ·ÚÙËÚ›·˜ ·fi ÙËÓ ·ÔÚÙ‹ ‹ ÛÙËÓ

ÂÏ¿ÙÙˆÛË ÙË˜ ÁˆÓ›·˜ Ô˘ Û¯ËÌ·Ù›˙ÂÙ·È ·fi ÙÈ˜

‰‡Ô ·˘Ù¤˜ ·ÚÙËÚ›Â˜ (1,2) (∂ÈÎfiÓ· 3). ∏ ÁˆÓ›·

·˘Ù‹ ÂÏ·ÙÙÒÓÂÙ·È ·ÎfiÌË ÂÚÈÛÛfiÙÂÚÔ ÛÙËÓ fiÚ-

ıÈ· ı¤ÛË Î·È ¤ÙÛÈ ÌÔÚÂ› Ó· ÂÍËÁËıÂ› Î·È Ë ÂÌ-

Ê¿ÓÈÛË ÔÚıÔÛÙ·ÙÈÎ‹˜ ÏÂ˘ÎˆÌ·ÙÔ˘Ú›·˜ ÛÂ

·ÛıÂÓÂ›˜ ÌÂ ÙÔ Û‡Ó‰ÚÔÌÔ ·˘Ùfi (3) ‹ Ë ÂÌÊ¿ÓÈ-

ÛË ÙˆÓ ÂÂÈÛÔ‰›ˆÓ Ì·ÎÚÔÛÎÔÈÎ‹˜ ·ÈÌ·ÙÔ˘-

Ú›·˜ ÌÂÙ¿ ·fi ¿ÛÎËÛË. ∏ ·‡ÍËÛË ÙË˜ ›ÂÛË˜

ÛÙËÓ ·ÚÈÛÙÂÚ‹ ÓÂÊÚÈÎ‹ ÊÏ¤‚· ‰ËÌÈÔ˘ÚÁÂ› ·-

Ú¿ÏÂ˘ÚË ÊÏÂ‚ÈÎ‹ Î˘ÎÏÔÊÔÚ›· Î·È ÚÔÎ·ÏÂ›

·ÏÈÓ‰ÚfiÌËÛË ·›Ì·ÙÔ˜ ÛÙËÓ ¤Ûˆ ÛÂÚÌ·ÙÈÎ‹

ÊÏ¤‚· Î·È ÂÌÊ¿ÓÈÛË ÎÈÚÛÔÎ‹ÏË˜, Î·ıÒ˜ Î·È ÌÈ-

ÎÚÔÚ‹ÍÂÈ˜ ÙˆÓ ÊÏÂ‚ÒÓ ÌÂ ÏÂÙfi ÙÔ›¯ˆÌ· ÙÔ˘

·Ô¯ÂÙÂ˘ÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ŒÙÛÈ ÂÍËÁÂ›Ù·È Î·ÈË ÂÌÊ¿ÓÈÛË ·ÈÌ·ÙÔ˘Ú›·˜ ÌÂ ÂÚ˘ıÚÔÎ‡ÙÙ·Ú· ÌÂÌÔÚÊÔÏÔÁ›· ·Ó¿ÏÔÁË ÂÎÂ›ÓˆÓ ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡·›Ì·ÙÔ˜ (ÈÛÔÌÔÚÊÈÎ¿) (4). ∆· Ù˘ÈÎ¿ Â˘Ú‹Ì·Ù·ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Â›Ó·È Ë ·Û˘ÌÙˆÌ·ÙÈÎ‹ ÌÈÎÚÔ-ÛÎÔÈÎ‹, ÌË ÛÂÈÚ·Ì·ÙÈÎ‹ ·ÈÌ·ÙÔ˘Ú›· ÌÂ ‹ ¯ˆ-Ú›˜ ÔÚıÔÛÙ·ÙÈÎ‹ ÏÂ˘ÎˆÌ·ÙÔ˘Ú›· Î·È Ë ·ÈÊÓ›‰È·ÂÌÊ¿ÓÈÛË ÂÂÈÛÔ‰›ˆÓ Ì·ÎÚÔÛÎÔÈÎ‹˜ ·ÈÌ·ÙÔ˘-Ú›·˜ Û˘Ó‹ıˆ˜ ÌÈÎÚ‹˜ ‰È¿ÚÎÂÈ·˜, Ù· ÔÔ›· ‰ÂÓÛ¯ÂÙ›˙ÔÓÙ·È ÌÂ ÏÔÈÌÒÍÂÈ˜ ÙÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡,ÛÂ ·ÓÙ›ıÂÛË ÌÂ ÙËÓ IgA ÓÂÊÚÔ¿ıÂÈ·. ∞ÎfiÌËÌÂÚÈÎÔ› ·ÛıÂÓÂ›˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÎÔÈÏÈ·Î¿ ¿ÏÁË‹ ¿ÏÁË ÛÙËÓ ÔÛÊ˘˚Î‹ ¯ÒÚ·, fiÌˆ˜ Û˘Ó‹ıˆ˜ ‰ÂÓ‰È·ÈÛÙÒÓÔÓÙ·È ÛÔ‚·Ú¤˜ ‰È·Ù·Ú·¯¤˜. ∆Ô Û‡Ó-‰ÚÔÌÔ ‰ÂÓ ·ÔÙÂÏÂ› ÌÈ· ÎÏËÚÔÓÔÌÈÎ‹ ÓfiÛÔ Î·ÈË ÂÌÊ¿ÓÈÛ‹ ÙÔ˘ ÛÂ Ì¤ÏË ÙË˜ ›‰È·˜ ÔÈÎÔÁ¤ÓÂÈ·˜Â›Ó·È Û¿ÓÈ·. ¶ÚfiÛÊ·Ù· ¤¯ÂÈ ÂÚÈÁÚ·ÊÂ› ÛÂ ‰‡Ô·‰¤ÏÊÈ· (5). ∆Ô Û‡Ó‰ÚÔÌÔ ÙÔ˘ Î·Ú˘ÔıÚ·‡ÛÙËÚ¤ÂÈ Ó· ‰È·ÎÚ›ÓÂÙ·È ·fi ÙÔ Ê·ÈÓfiÌÂÓÔ ÙÔ˘Î·Ú˘ÔıÚ·‡ÛÙË, ‰ËÏ·‰‹ ÙËÓ ·Û˘ÌÙˆÌ·ÙÈÎ‹‰È¿Ù·ÛË ÙË˜ ÓÂÊÚÈÎ‹˜ ÊÏ¤‚·˜, Ô˘ Û˘Ó‹ıˆ˜ Â›-Ó·È Ù˘¯·›Ô Â‡ÚËÌ· (6).

∏ ÚÒÙË ÂÚÈÁÚ·Ê‹ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ¤ÁÈÓÂÙÔ 1972 ·fi ÙÔÓ De Schepper ÛÂ ‰‡Ô ·ÛıÂÓÂ›˜ÌÂ ÂÈÌ¤ÓÔ˘Û· “È‰ÈÔ·ı‹” ·ÈÌ·ÙÔ˘Ú›· Î·È ‰È¿-Ù·ÛË ÙË˜ ·ÚÈÛÙÂÚ‹˜ ÓÂÊÚÈÎ‹˜ ÊÏ¤‚·˜ (7). ∆·ÂfiÌÂÓ· ¯ÚfiÓÈ· ÂÚÈÁÚ¿ÊËÎ·Ó ÔÏÏÔ› ·ÛıÂ-ÓÂ›˜ ÌÂ ÙÔ Û‡Ó‰ÚÔÌÔ ·˘Ùfi, ÔÈ ÔÔ›ÔÈ Û˘Ó‹ıˆ˜Â›¯·Ó Î·ÏÔ‹ıË ÔÚÂ›· Î·È Ê¿ÓËÎÂ fiÙÈ ÙÔ Û‡Ó-‰ÚÔÌÔ ·˘Ùfi ‹Ù·Ó ÔÏ‡ ÈÔ Û˘¯Ófi ·’ fi,ÙÈ ·Ú¯È-Î¿ ıÂˆÚÔ‡ÓÙ·Ó. ŒÙÛÈ ÛÂ ÌÈ· ÂÈ‰ËÌÈÔÏÔÁÈÎ‹

∂ÈÎfiÓ· 2. ªË¯·ÓÈÛÌfi˜ ÚfiÎÏËÛË˜ ‚Ï¿‚Ë˜ ÛÙÔ Û‡Ó‰ÚÔÌÔÙÔ˘ Î·Ú˘ÔıÚ·‡ÛÙË.

∂ÈÎfiÓ· 3. ∏ ÔÚÂ›· ÙË˜ ÓÂÊÚÈÎ‹˜ ÊÏ¤‚·˜ ÌÂÙ·Í‡ ¿ÓˆÌÂÛÂÓÙÂÚ›Ô˘ ·ÚÙËÚ›·˜ Î·È ·ÔÚÙ‹˜.

ÕÓˆ ÌÂÛÂÓÙ¤ÚÈ··ÚÙËÚ›·

ŒÛˆ ÛÂÚÌ·ÙÈÎ‹ÊÏ¤‚·

ŒÛˆ ÛÂÚÌ·ÙÈÎ‹ ÊÏ¤‚·

∞ÔÚÙ‹

¡ÂÊÚÈÎ‹ ÊÏ¤‚·

ÕÓˆ ÌÂÛÂÓÙ¤ÚÈ· ·ÚÙËÚ›·

¡ÂÊÚÈÎ‹ÊÏ¤‚·

∞ÔÚÙ‹

∞ÚÈÛÙÂÚfi˜ ÓÂÊÚfi˜

∞ÚÈÛÙÂÚfi˜ÓÂÊÚfi˜

79CLINICAL QUIZ

¶·È‰È·ÙÚÈÎ‹ 2007;70:75,78-79

ÌÂÏ¤ÙË ·fi ÙËÓ ∫ÔÚ¤· ÛÂ 1044 ·È‰È¿ ÌÂ ·ÈÌ·ÙÔ˘-Ú›· ‹/Î·È ÏÂ˘ÎˆÌ·ÙÔ˘Ú›·, ÙÔ Û‡Ó‰ÚÔÌÔ ·˘Ùfi ‰È·-ÁÓÒÛÙËÎÂ ÛÂ 65 ·È‰È¿, ·ÓÙÈÚÔÛˆÂ‡ÔÓÙ·˜ ÙÔ Û˘-¯ÓfiÙÂÚÔ ·ıÔÏÔÁÈÎfi Â‡ÚËÌ· ÛÙÔ ˘ÂÚË¯ÔÁÚ¿ÊËÌ·ÓÂÊÚÒÓ ÌÂ ‹ ¯ˆÚ›˜ Doppler (8). ™Â ¿ÏÏË ÌÂÏ¤ÙË ÛÂ52 ·È‰È¿ ÌÂ ÌÈÎÚÔÛÎÔÈÎ‹ ·ÈÌ·ÙÔ˘Ú›· ‰È·ÈÛÙÒıË-Î·Ó ÛÙÔ ˘ÂÚË¯ÔÁÚ¿ÊËÌ· ÓÂÊÚÒÓ ÌÂ Doppler Â˘Ú‹-Ì·Ù· Ô˘ ÏËÚÔ‡Û·Ó Ù· ‰È·ÁÓˆÛÙÈÎ¿ ÎÚÈÙ‹ÚÈ· ÙÔ˘Û˘Ó‰ÚfiÌÔ˘ ÛÙÔ 33% ÙˆÓ ·ÛıÂÓÒÓ (9). øÛÙfiÛÔ, ‰ÂÓ˘¿Ú¯ÂÈ ÔÌÔÊˆÓ›· ÁÈ· ÙÔ Ò˜ Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÌÂ·ÍÈÔÈÛÙ›· Ë ‰È¿ÁÓˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘. ∏ ÓÂÊÚÈÎ‹ÊÏÂ‚ÔÁÚ·Ê›·, ÌÂ Ù·˘Ùfi¯ÚÔÓË Ì¤ÙÚËÛË ÙˆÓ È¤ÛÂˆÓÛÙËÓ Î¿Ùˆ ÎÔ›ÏË Î·È ÙË ÓÂÊÚÈÎ‹ ÊÏ¤‚· ıÂˆÚÂ›Ù·È ËÈÔ ·ÍÈfiÈÛÙË Ì¤ıÔ‰Ô˜. ŸÌˆ˜ Ë ÙÂ¯ÓÈÎ‹ ·˘Ù‹ Â›Ó·È·ÚÂÌ‚·ÙÈÎ‹ Î·È Ë ÂÊ·ÚÌÔÁ‹ ÙË˜ ÛÙ· ·È‰È¿ ‰˘Û¯Â-Ú‹˜. ∏ ‰È¿ÁÓˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘, ·ÎfiÌ· Î·È ÛÙ· ·Ú-¯ÈÎ¿ ÛÙ¿‰È·, ÌÔÚÂ› Ó· Á›ÓÂÈ Î·È ÌÂ ·Ïfi ˘ÂÚË¯Ô-ÁÚ¿ÊËÌ· ‹ ˘ÂÚË¯ÔÁÚ¿ÊËÌ· Doppler, ÌÂ ·ÍÔÓÈÎ‹ÙÔÌÔÁÚ·Ê›· ‹ ÌÂ Ì·ÁÓËÙÈÎ‹ ·ÁÁÂÈÔÁÚ·Ê›· (10). ∆·Â˘Ú‹Ì·Ù· ÛÙËÓ ÂÍ¤Ù·ÛË ÙÔ˘ È˙‹Ì·ÙÔ˜ Ô‡ÚˆÓ ÌÂ ÌÈ-ÎÚÔÛÎfiÈÔ ·ÓÙÈı¤ÙˆÓ Ê¿ÛÂˆÓ ‰ÂÓ Â›Ó·È ¿ÓÙÔÙÂ·ÍÈfiÈÛÙ· ÁÈ· ÙË ‰È¿ÎÚÈÛË ÙË˜ ÛÂÈÚ·Ì·ÙÈÎ‹˜, ·fiÙË ÌË ÛÂÈÚ·Ì·ÙÈÎ‹ ·ÈÌ·ÙÔ˘Ú›·. ∂›Ó·È ÂÓ‰È·Ê¤ÚÔÓfiÙÈ ¤¯Ô˘Ó ÂÚÈÁÚ·ÊÂ› ·ÛıÂÓÂ›˜ ÌÂ ÌÈÎÚÔÛÎÔÈÎ‹ ·È-Ì·ÙÔ˘Ú›· Î·È Ù˘ÈÎ¿ ˘ÂÚË¯ÔÁÚ·ÊÈÎ¿ Â˘Ú‹Ì·Ù·ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘, Ô˘ ÛÙË ‰È¿ÚÎÂÈ· ÙË˜ ·Ú·ÎÔÏÔ‡-ıËÛ‹˜ ÙÔ˘˜ ‰È·ÁÓÒÛıËÎÂ IgA ÓÂÊÚÔ¿ıÂÈ· (11).

∞Û˘ÌÊˆÓ›· ˘¿Ú¯ÂÈ Î·È ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛËÙÔ˘ Û˘Ó‰ÚfiÌÔ˘. ∂Ó‰Â›ÍÂÈ˜ ÁÈ· ¯ÂÈÚÔ˘ÚÁÈÎ‹ ·ÓÙÈÌÂ-ÙÒÈÛË Â›Ó·È Ë ÛÔ‚·Ú‹ ·ÈÌ·ÙÔ˘Ú›· Ô˘ ÚÔÎ·ÏÂ›·Ó·ÈÌ›·, ÛÔ‚·Ú¿ ÎÔÈÏÈ·Î¿ ¿ÏÁË ‹ ¿ÏÁË ÛÙËÓ ÔÛÊ˘˚-Î‹ ¯ÒÚ· (10,12). ŸÌˆ˜ ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ ·ÛıÂÓÂ›˜ÌÔÚÔ‡Ó Ó· ·ÓÙÈÌÂÙˆÈÛıÔ‡Ó ÌÂ Ì·ÎÚÔ¯ÚfiÓÈ· ·-Ú·ÎÔÏÔ‡ıËÛË, ‰Â‰ÔÌ¤ÓÔ˘ fiÙÈ Ë ÚfiÁÓˆÛË ÙÔ˘ Û˘Ó-‰ÚfiÌÔ˘ Û˘Ó‹ıˆ˜ Â›Ó·È Î·Ï‹. ™Â ÚfiÛÊ·ÙË ‰ËÌÔÛ›-Â˘ÛË ·Ó·Ê¤ÚÂÙ·È fiÙÈ ÌfiÓÔ 15 ·fi Ù· 20 ·È‰È¿ ÌÂÛ‡Ó‰ÚÔÌÔ ÙÔ˘ Î·Ú˘ÔıÚ·‡ÛÙË Û˘Ó¤¯È˙·Ó Ó· ·ÚÔ˘-ÛÈ¿˙Ô˘Ó ·ÈÌ·ÙÔ˘Ú›· ÌÂÙ¿ ·fi 0,5-3,5 ¯ÚfiÓÈ· (10).ŒÙÛÈ Û‹ÌÂÚ· Â›Ó·È ÁÂÓÈÎ¿ ·Ô‰ÂÎÙfi fiÙÈ Ë ¤ÁÎ·ÈÚË

‰È¿ÁÓˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Â›Ó·È ÔÏ‡ ÛËÌ·ÓÙÈÎ‹ ÁÈ·

Ó· ·ÔÊÂ‡ÁÔÓÙ·È ÔÈ ÂÚÈÙÙ¤˜ ÂÍÂÙ¿ÛÂÈ˜.

µÈ‚ÏÈoÁÚ·Ê›·

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Yalcinkaya F, Arikan N. The “nutcracker phenomenon”

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80 ∂¶π™∆√§H ¶ƒ√™ ∆∏ ™À¡∆∞•∏ LETTER TO THE EDITOR

Paediatriki 2007;70:80

∞Á·ËÙÔ› Î‡ÚÈÔÈ,

ªÂ ¯·Ú¿ Û·˜ ·Ó·ÎÔÈÓÒÓÔ˘ÌÂ fiÙÈ ÙÔ Ó¤Ô ÙÌ‹Ì· ÙË˜µã ¶·È‰È·ÙÚÈÎ‹˜ ∫ÏÈÓÈÎ‹˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıË-ÓÒÓ, ªÔÓ¿‰· ∂ÊË‚ÈÎ‹˜ ÀÁÂ›·˜ (ª.∂.À.) “∞§§∞∑ø”,¿Ú¯ÈÛÂ Ó· ÏÂÈÙÔ˘ÚÁÂ› ·fi 15-10-2006, ÛÙÔ ¶·Ú¿ÚÙËÌ·ÙÔ˘ ¡ÔÛÔÎÔÌÂ›Ô˘ ¶·›‰ˆÓ “¶·Ó. & ∞ÁÏ·˝· ∫˘ÚÈ·-ÎÔ‡”, ªÂÛÔÁÂ›ˆÓ 24 ÛÙÔÓ 6Ô fiÚÔÊÔ (¶Ù¤Ú˘Á· ∂Ï¤ÓË˜¢·Ï·ÎÔ‡Ú·).

∆Ô ∆Ì‹Ì· ÂÈÛÎ¤ÙÔÓÙ·È ¤ÊË‚ÔÈ ËÏÈÎ›·˜ 11-19ÂÙÒÓ Î·È Ë ÔÈÎÔÁ¤ÓÂÈ¿ ÙÔ˘˜, ÁÈ· Û˘˙‹ÙËÛË Î·È Â›Ï˘-ÛË ıÂÌ¿ÙˆÓ Ô˘ ÙÔ˘˜ ··Û¯ÔÏÔ‡Ó:

ñ ∂Ó‰ÔÎÚÈÓÔÏÔÁÈÎ¿ñ µ¿ÚÔ˘˜ ÛÒÌ·ÙÔ˜ñ ¢È·ÙÚÔÊ‹˜ñ ÕÛÎËÛË˜ ñ ¢ÂÚÌ·ÙÔÏÔÁÈÎ¿ ñ °˘Ó·ÈÎÔÏÔÁÈÎ¿ñ æ˘¯ÔÏÔÁÈÎ¿ñ £¤Ì·Ù· Û¯ÔÏÈÎ‹˜ Â›‰ÔÛË˜ ñ ¢˘ÛÏÂÈÙÔ˘ÚÁ›· ÔÈÎÔÁ¤ÓÂÈ·˜, Û˘Ì‚Ô˘ÏÂ˘ÙÈÎ‹ Î.Ï.√È ˘ËÚÂÛ›Â˜ ·Ú¤¯ÔÓÙ·È ·fi ÂÈ‰ÈÎÔ‡˜ ÛÂ ı¤Ì·Ù·

ÂÊË‚ÈÎ‹˜ ˘ÁÂ›·˜, ¯ˆÚ›˜ ÔÈÎÔÓÔÌÈÎ‹ ÂÈ‚¿Ú˘ÓÛË, Î·ÈÛÂ ÒÚÂ˜ Ô˘ ÂÍ˘ËÚÂÙÔ‡Ó ¿ÓÙ· ÙÔ ÚfiÁÚ·ÌÌ· ÙˆÓÂÓ‰È·ÊÂÚÔÌ¤ÓˆÓ (·ÔÁÂ‡Ì·Ù·).

Ÿˆ˜ fiÏÔÈ ÁÓˆÚ›˙Ô˘ÌÂ, Ë ÂÊË‚Â›· Â›Ó·È ÌÈ· “È‰È·›ÙÂÚË” ËÏÈÎ›·. ∞ÔÙÂÏÂ› ÌÈ· ÌÂÙ·‚·ÙÈÎ‹ ÂÚ›Ô‰Ô,ÌÂÙ·Í‡ ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜ Î·È ÙË˜ ÂÓËÏÈÎ›ˆÛË˜. √ ¤ÊË‚Ô˜ ‰ÂÓ Â›Ó·È Ô‡ÙÂ ·È‰›, Ô‡ÙÂ ÂÓ‹ÏÈÎ·˜ Î·È·ÚÔ˘ÛÈ¿˙ÂÈ È‰È·ÈÙÂÚfiÙËÙÂ˜ Î·È Û˘ÁÎÂÎÚÈÌ¤ÓÂ˜ ·Ó¿ÁÎÂ˜. ∏ ËÏÈÎ›· ·˘Ù‹ Â›Ó·È ÁÂÌ¿ÙË ÚˆÙfiÁÓˆÚÂ˜Î·È Û˘Ó·Ú·ÛÙÈÎ¤˜ ÂÌÂÈÚ›Â˜, ·ÏÏ¿ Î·È ‰˘ÛÎÔÏ›Â˜, ¿Á¯Ô˜ Î·È ÔÚÈÛÌ¤ÓÂ˜ ÊÔÚ¤˜ Î›Ó‰˘ÓÔ. §fiÁˆ ÙË˜ Ûˆ-Ì·ÙÈÎ‹˜ Î·È „˘¯ÔÏÔÁÈÎ‹˜ ·ÛÙ¿ıÂÈ·˜ Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÈ ÙÔÓ ¤ÊË‚Ô, ÌÔÚÂ› Ó· ·Ó·‰˘ıÔ‡Ó ‰È¿ÊÔÚ· ÚÔ-‚Ï‹Ì·Ù· ‹ Ó· ÂÈ‰ÂÈÓˆıÔ‡Ó Ù· ‹‰Ë ˘¿Ú¯ÔÓÙ·. ∂ÈÏ¤ÔÓ, Ë ÔÈÎÔÁ¤ÓÂÈ· ÌÔÈ¿˙ÂÈ Û˘¯Ó¿ ·Ì‹¯·ÓË, ÁÂÌ¿-ÙË ‰¤Ô˜ ÌÚÔÛÙ¿ ÛÂ ·˘Ùfi ÙÔÓ Î·Ù·ÈÁÈÛÌfi ÛˆÌ·ÙÈÎÒÓ Î·È „˘¯ÔÏÔÁÈÎÒÓ ÌÂÙ·‚ÔÏÒÓ. √ ¤ÊË‚Ô˜ Î·È Ë ÔÈ-ÎÔÁ¤ÓÂÈ¿ ÙÔ˘ ¤¯Ô˘Ó ·Ó¿ÁÎË ·fi “Ê¿ÚÔ˘˜” ÛÙÈ˜ Û‡Á¯ÚÔÓÂ˜ ÎÔÈÓˆÓ›Â˜.

™ÙËÓ ∂ÏÏ¿‰· ‰ÂÓ ˘¿Ú¯Ô˘Ó ·ÚÎÂÙ¤˜ ‰ÔÌ¤˜ ÁÈ· ÙËÓ ÂÊË‚ÈÎ‹ ËÏÈÎ›·, ÌÂ ·ÔÙ¤ÏÂÛÌ· ÔÈ ¤ÊË‚ÔÈ Ó··Ú·ÌÂÏÔ‡ÓÙ·È Î·È Ó· ÂÎÙ›ıÂÓÙ·È ÛÂ ÎÈÓ‰‡ÓÔ˘˜. ∏ ·Ó¿ÁÎË ‰ËÌÈÔ˘ÚÁ›·˜ ÌÈ·˜ Ó¤·˜ ‰ÔÌ‹˜ ÁÈ· ÙËÓ ÂÊË-‚ÈÎ‹ ËÏÈÎ›· ˘·ÁÔÚÂ‡ÂÙ·È ·fi ÙË ÁÂÓÈÎfiÙÂÚË ¤ÏÏÂÈ„Ë ‰ÔÌÒÓ ÁÈ· ÙË ÊÚÔÓÙ›‰· ÙˆÓ ∂ÏÏ‹ÓˆÓ ÂÊ‹‚ˆÓ,Î·ıÒ˜ Î·È ·fi ÙËÓ ·ÓÂ·ÚÎ‹ Î·Ù·ÁÚ·Ê‹ Î·È ÌÂÏ¤ÙË ÙˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ ÙË˜ ËÏÈÎ›·˜ ·˘Ù‹˜.

°È· ÂÚÈÛÛfiÙÂÚÂ˜ ÏËÚÔÊÔÚ›Â˜ Î·È Ú·ÓÙÂ‚Ô‡ ÔÈ ÂÓ‰È·ÊÂÚfiÌÂÓÔÈ ÌÔÚÔ‡Ó Ó· ·Â˘ı‡ÓÔÓÙ·È ÛÙË ªÔ-Ó¿‰· ∂ÊË‚ÈÎ‹˜ ÀÁÂ›·˜ (ª.∂.À.) Î·ıËÌÂÚÈÓ¿ 10:00-14:00, ÛÙÔ ÙËÏ¤ÊˆÓÔ 210-7710824.

ªÂ ÙÈÌ‹,

√ ¢ÈÂ˘ı˘ÓÙ‹˜ ∏ ∂ÈÛÙËÌÔÓÈÎ‹ ÀÂ‡ı˘ÓË ∞Ó‰Ú¤·˜ ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜ ÕÚÙÂÌÈ˜ ∆Û›ÙÛÈÎ·

∫·ıËÁËÙ‹˜ - ¢ÈÂ˘ı˘ÓÙ‹˜ ¶·È‰›·ÙÚÔ˜ - ∂ÊË‚ÈÎ‹ π·ÙÚÈÎ‹µ’ ¶·È‰È·ÙÚÈÎ‹˜ ∫ÏÈÓÈÎ‹˜ ¢È‰¿ÎÙˆÚ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ

xxiii¶ƒ√™∂Ã∏ ™À¡∂¢ƒπ∞

10-11 ºÂ‚ÚÔ˘·Ú›Ô˘ 2007 ™ÂÌÈÓ¿ÚÈÔ ¢È·Ù·Ú·¯‹ ∂ÏÏÂÈÌÌ·ÙÈÎ‹˜ £ÂÛÛ·ÏÔÓ›ÎË

¶ÚÔÛÔ¯‹˜ – ÀÂÚÎÈÓËÙÈÎfiÙËÙ·

MÔ˘ÛÂ›Ô ∞ıÏËÙÈÛÌÔ‡ £ÂÛÛ·ÏÔÓ›ÎË˜ ¶ÏËÚÔÊÔÚ›Â˜: Diaskepsis - ª·Ù›Ó· ∆Û¿ÌË∆ËÏ./Fax: 2310 230 459∂-mail: [email protected]: www.diaskepsis.gr

17 ºÂ‚ÚÔ˘·Ú›Ô˘ 2007 3Ë ∂ÈÛÙËÌÔÓÈÎ‹ ∏ÌÂÚ›‰· °¡¶∞ ∞ı‹Ó·

“¶. & ∞. ∫˘ÚÈ·ÎÔ‡” “¶·È‰ÈÎfi ∞Ù‡¯ËÌ·”

¢ÈÔÚÁ¿ÓˆÛË: ∂ÈÛÙËÌÔÓÈÎfi ™˘Ì‚Ô‡ÏÈÔ ÙÔ˘ ¡ÔÛÔÎÔÌÂ›Ô˘AÌÊÈı¤·ÙÚÔ “∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ¶··‰¿ÙÔ˜”NÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”£Ë‚ÒÓ & §Â‚·‰Â›·˜, ∞ÌÂÏfiÎËÔÈ ∆ËÏ.: 210 7726000

28 ºÂ‚ÚÔ˘·Ú›Ô˘ - Current Concepts in Paediatric Orthopaedics London,

2 ª·ÚÙ›Ô˘ 2007 Royal Institute of British Architects United Kingdom

Contact: Deborah EastwoodTel.: 020 8909 5758 Fax: 020 8954 4566 E-mail: [email protected] Website: http://www.bscos.com

8-11 ª·ÚÙ›Ô˘ 2007 Pediatric Anesthesiology 2007 Phoenix, AZ,

Contact: Society for Pediatric Anesthesia United States

Tel.: 804-282-9780Fax: 804-282-0090E-mail: [email protected]

31 ª·ÚÙ›Ô˘ 2007 5Ë ∂ÈÛÙËÌÔÓÈÎ‹ ∏ÌÂÚ›‰· ∂˘ÚˆÎÏÈÓÈÎ‹˜ ¶·›‰ˆÓ ∞ı‹Ó·

∞›ıÔ˘Û· Olympia•ÂÓÔ‰Ô¯Â›Ô Royal Olympic¶ÏËÚÔÊÔÚ›Â˜: FIRSTEVENT ∂¶∂∆ËÏ.: 210 8228950Fax: 210 8228901

E-mail: [email protected]

16-18 ∞ÚÈÏ›Ô˘ 2007 The 7th Annual International Riyadh, Saudi

Neonatology Symposium Arabia

Contact: Saleh Al-Alaiyan, MDTel.: 00-96-614-427-762Fax: 00-96-614-427-784E-mail: [email protected]

25-28 ∞ÚÈÏ›Ô˘ 2007 18th Annual Congress of the European Society Brugge,

for Paediatric Urology (ESPU) Belgium

HALL Ambassadeur, Oud-Sint Jan, ZonnekemeersWebsite: www.espu2007.com/

xxiv

2-4 ª·˝Ô˘ 2007 25th European Congress for Pediatric Porto,

Infectious Diseases Portugal

Centro de Congressos e Exposiço~esContact: Kenes International / ESPID 200717, Rue du Cendrier, PO Box 1726CH-1211 Geneva 1, Switzerland Tel: +41 22 908 0488 Fax: +41 22 732 2850E-mail: [email protected]: www.kenes.com/espid/

2-5 ª·˝Ô˘ 2007 15th TRANSMED: 15th European / Cairo,

Mediterranean Congress about Egypt

Mother & Child Health

Contact: Kamel BARGAOUITel.: 33-607-686-118Fax: 33-143-839-985E-mail: [email protected]

9-12 ª·˝Ô˘ 2007 40th Annual meeting of the European Society Barcelona,

for Paediatric Gastroenterology, Hepatology Spain

and Nutrition (ESPGHAN)

Catalunya Congress PalaceContact: ESPGHAN 2007 C/o Colloquium 12, rue de la Croix Faubin 75557 Paris Cedex 11 - France Tel.: 33 (0) 1 44 64 15 15 Fax: 33 (0) 1 44 64 15 16 E-mail: [email protected]

25-27 ª·˝Ô˘ 2007 45Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ ™ÈıˆÓ›·,

™˘ÓÂ‰ÚÈ·Îfi ∫¤ÓÙÚÔ Porto Carras “Olympic” Ã·ÏÎÈ‰ÈÎ‹˜

¶ÏËÚÔÊÔÚ›Â˜: AC&C International S.A. ∆ËÏ.: 210 6889 100Fax: 210 6844 777 ∂-mail: [email protected]: www.pediatric2007.gr

3-7 πÔ˘Ó›Ô˘ 2007 44th Annual Meeting of the European Society Barcelona,

of Pediatric Radiology Spain

Contact: Viajes Iberia CongresosFontanella 21-23, 4o1a

08010 Barcelona, SpainTel.: +34 93 510 1005Fax: +34 93 510 1009E-mail: [email protected]: www.espr2007.info/

25-30 ∞˘ÁÔ‡ÛÙÔ˘ 2007 25th International Congress of Pediatrics ∞ı‹Ó·

ª¤Á·ÚÔ ªÔ˘ÛÈÎ‹˜ ∞ıËÓÒÓ∞C&C International, PCOTel: 210 68 89 100Fax: 210 68 44 777E-mail: [email protected]: www.icp2007.gr

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