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

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∞ƒ£ƒ√ ™À¡∆∞•∏™

165 Long term outcomes of children with cancer

G.A. Levitt

∞¡∞™∫O¶∏™∂π™

167 Surviving childhood cancer: long-term

outcomes

M. Servitzoglou

174 √ ·ÓÔÛÔÊ·ÈÓfiÙ˘Ô˜ ÙˆÓ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ

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184 ™˘ÁÁÂÓÂ›˜ ‰È·Ì·ÚÙ›Â˜ ÓÂ˘ÌfiÓˆÓ:

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199 ∏ ÈÓÙÂÚÏÂ˘Î›ÓË-8 (IL-8) ÙˆÓ Ô‡ÚˆÓ ̂ ˜

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217 ¶ÔÛÔÙÈÎfi˜ ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙË˜

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221 ∞ÍÈÔÏfiÁËÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ Ô˘ÚÔÏÔ›ÌˆÍË˜

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247 ™À¡∆√ª∞ ¶∞π¢π∞∆ƒπ∫∞ ¡∂∞

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249 ¡∂∞ ∞¶√ ∆√ ¢π∞¢π∫∆À√

πÛÙÔÛÂÏ›‰Â˜ ÁÈ· ÙÈ˜ ¶ÚˆÙÔ·ıÂ›˜

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¶·È‰È·ÙÚÈÎ‹∆fiÌÔ˜ 70 ñ ∆Â‡¯Ô˜ 3 ñ ª¿ÈÔ˜-πÔ‡ÓÈÔ˜ 2007

∫ˆ‰ÈÎfi ̃¢ÈÂ‡ı˘ÓÛË ̃∂ÔÙÂ›· ̃ªª∂: 3889

ISSN 0377-2551

Pediatri May-Jun 07 24-05-07 17:57 ™ÂÏ›‰·1

Bimonthly Publication of

the Greek Paediatric Society

President

A. Constantopoulos

Editorial Board

Editor-in-Chief

C. Stefanidis

Members

S. Andronikou

P. Augoustides-Savvopoulou

A. Vazeou-Gerasimidi

G. Varlamis

M. Galanakis

L. Thomaidou

M. Kanariou

∂. Katsarou-Pectasides

A. Kattamis

S. Kitsiou-Tzeli

∞. Papadopoulou

N. Papadopoulos

A. Siamopoulou-Mavridou

M. Tsolia

Manuscript Editing

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English Editing

S. Nakou

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K. Griveas

Publishing Coordinator

SCIENTIFIC PUBLICATIONS Ltd

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Contents

EDITORIAL COMMENTARY

165 Long term outcomes of children with

cancer

G.A. Levitt

REVIEW ARTICLES

167 Surviving childhood cancer: long-term

outcomes

M. Servitzoglou

174 Peripheral blood lymphocyte

immunophenotype in paediatric clinical

practice

F. Tzifi, M. Tzanoudaki, M. Kanariou

184 Congenital lung malformations:

pathogenesis, diagnostic approach and

long-term outcome

K.N. Priftis, N.P. Douridas, M.B. Anthracopoulos

ORIGINAL ARTICLES

192 Investigation of type-1/type-2 immune

imbalance in steroid sensitive nephritic

syndrome - No relationship with atopy

N. Printza, F. Papachristou, V. Tzimouli, A. Taparkou, F. Kanakoudi-Tsakalidou

199 Urine interleukin-8 as a marker of

vesicoureteral reflux in children aged |

under 1 year

M. Bitsori, E. Galanakis, E. Dimitriou, C. Giannakopoulou, N.A. Karkavitsas, M. Kalmanti

205 Secular trends during early 1990s and

2000s of body measurements, blood

pressure, glucose and serum lipids in

children of Crete, Greece

M. Linardakis, G. Bertsias, K. Sarri, A. Kafatos

217 Quantitative determination of C-reactive

protein in the blood of neonates -

Comparative study of two methods

H. Chatziioannidis, A. Naoum, G. Mitsiakos, C. Tsakalidis, D.G. Goulis, N. Nikolaidis

221 Estimating the risk of urinary tract infection

in febrile infants aged 15-90 days with no

apparent focus of infection

S. Fouzas, A. Fasouli, D. Adamidis, K. Tzelepis, I. Bakopoulou, A. Papadopoulou, D. Zafirakopoulos

CASE REPORTS

227 Opsoclonus-myoclonus-ataxia syndrome

in a patient with neuroblastoma: Case

report and review of the literature

N. Katzilakis, E. Mandadakis, A. Savidou, P. Vorgia, M. Raissaki, E. Steiakaki, M. Kalmanti

232 An infant with autoimmune neutropenia

F. Stripeli, J.P. Panagiotou, E. Dimitriou, E. Koemtzidou, T. Anastasiou, A. Constantopoulos

PRACTICAL ISSUE

237 Clinical and laboratory investigation of

children with neutropenia

A. Makis, N. Chaliassos

246 CLINICAL QUIZ

M. Emboriadou, A. Tragiannidis, G. Tzouvelekis,L. Fidani, I. Costopoulos, F. Athanassiadou

247 PAEDIATRIC NEWS IN BRIEF

E. Galanakis

249 NEWS FROM THE INTERNET

M. Kanariou

PaediatrikiVolume 70 ñ Number 3 ñ May-June 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

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

¶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›·

∂ÌÌ·ÓÔ˘‹Ï °·Ï·Ó¿ÎË˜, ∏Ú¿ÎÏÂÈÔ∏ıÈÎ‹ Î·È ¢ÂÔÓÙÔÏÔÁ›·

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

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‹

∞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

Stella Andronikou, IoanninaNeonatology

Persefoni Avgoustides-Savvopoulou, ThessalonikiMetabolic Disorders

Andriani Vazaiou-Gerasimidi, AthensEndocrinology

George Varlamis, ThessalonikiCardiology

Emmanouil Galanakis, HeraklionEthics and Deontology

Loretta Thomaidou, AthensDevelopmental Pediatrics

Maria Kanariou, AthensImmunology

Eustathia Katsarou-Pektasides, AthensNeurology

Antonis Kattamis, AthensHaematology - √ncology

Sophia Kitsiou-Tzeli, AthensGenetics

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


x √¢∏°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‡ ¤Ú-ÁÔ˘ 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¤ˆÓ ÁÈ·ÙËÓ ·Ó·ÁÎ·ÈfiÙËÙ· ÙË˜ Ù·¯Â›·˜ ‰ËÌÔÛ›Â˘ÛË˜. ∏ ∂ÈÙÚÔ‹™‡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˚·ÙÚÈ-

Î¿ ¶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 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.

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¯fi-

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

ÛÂ: ÂÈÛ·ÁˆÁ‹ (background), Ì¤ıÔ‰ÔÈ (methods), ·ÔÙÂ-

Ï¤ÛÌ·Ù· (results) Î·È Û˘ÌÂÚ¿ÛÌ·Ù· (conclusions). H Â-

Ú›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 ÛË-

ÌÂÈÒÓÔÓÙ·È ÙÚÂÈ˜ ¤ˆ˜ ¤ÓÙÂ Ï¤ÍÂÈ˜ ÎÏÂÈ‰È¿ Ô˘ ı· ¯ÚËÛÈ-

ÌÔÔÈËıÔ‡Ó ÁÈ· ÙÔ ıÂÌ·ÙÈÎfi Â˘ÚÂÙ‹ÚÈÔ.

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

ÌÂıfi‰Ô˘˜, ·ÔÙÂÏ¤ÛÌ·Ù· Î·È Û˘˙‹ÙËÛË. H ÂÈÛ·ÁˆÁ‹


xii

ÂÚÈÏ·Ì‚¿ÓÂÈ Ù· ÙÂÏÂ˘Ù·›· ‰Â‰ÔÌ¤Ó· ÙË˜ ¤ÚÂ˘Ó·˜ ÛÙÔ Û˘ÁÎÂ-ÎÚÈÌ¤ÓÔ ı¤Ì· ÌÂ ÙÈ˜ 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·È ÌÂ ÏÂÙÔÌ¤ÚÂÈÂ˜ ÔÈ ÛÙ·ÙÈÛÙÈÎ¤˜ Ì¤ıÔ-‰ÔÈ ·Ó¿Ï˘ÛË˜ Î·È ·ÍÈÔÏfiÁËÛË˜ ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ. T· ·Ô-ÙÂÏ¤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˘ ÚÔ-Î‡ÙÔ˘Ó ·fi ÙËÓ ÂÚÁ·Û›·, ÙË ÛËÌ·Û›· Ô˘ ÌÔÚÂ› Ó· ¤¯Ô˘ÓÎ·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˜ 40 ÛÙÈ˜ ÂÚÂ˘ÓËÙÈÎ¤˜ ÂÚÁ·Û›Â˜. ñ ÙÈ˜ 20 ÛÙ· Â›Î·ÈÚ· ı¤Ì·Ù· Î·È ÙÈ˜ ÂÓ‰È·Ê¤ÚÔ˘ÛÂ˜

ÂÚÈÙÒÛÂÈ˜. ñ ÙÈ˜ 10 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 Submitted 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 Medi-cus(http://www.nlm.nih.gov/bsd/uniform_requirements.html)].

¶·Ú·‰Â›ÁÌ·Ù· ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·ÔÌÒÓI. ¶∂ƒπO¢π∫∞

AÓ ÔÈ Û˘ÁÁÚ·ÊÂ›˜ Â›Ó·È ¤ˆ˜ ¤ÍÈ, ·Ó·ÁÚ¿ÊÔÓÙ·È fiÏÔÈ, ÂÓÒ ·ÓÂ›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·ÛËÛÙËÓ 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. EurJ Pediatr 1997;156:669-679.

™˘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 ofdiabetes. Kidney Int 1997;52 (60 Suppl):S12-S19.

ÃˆÚ›˜ Û˘ÁÁÚ·Ê¤·:

National Institutes of Health Consensus DevelopmentConference. Neurofibromatosis conference statement. ArchNeurol 1988;45:575-578.

¶ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù‡Ô˘ ¿ÚıÚÔ˘:

Schreiner GF, Lange L. Ethanol modulation of macrophageinflux in glomerulonephritis [Abstract]. J Am Soc Nephrol1991;2:562.

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

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II. µπµ§π∞

∫ÂÊ¿Ï·ÈÔ ÛÂ ‚È‚Ï›Ô:

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™‡ÁÁÚ·ÌÌ· ‹ ÌÔÓÔÁÚ·Ê›·:

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¢ËÌÔÛ›Â˘ÛË ÛÂ ÙfiÌÔ Ú·ÎÙÈÎÒÓ:

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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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πππ. CD-ROM

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IV. ™∆O ¢π∞¢π∫∆ÀO

ÕÚıÚÔ 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


xiv

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˜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˜.

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··ÔÛÙ¤ÏÏÂÙ·È ÛÂ ËÏÂÎÙÚÔÓÈÎ‹ ÌÔÚÊ‹ Î·È ÛÂ ·Ú¯Â›· ˘„ËÏ‹˜ ·Ó¿-Ï˘ÛË˜. ™Â ÂÚ›ÙˆÛË Ô˘ ·˘Ùfi ‰ÂÓ Â›Ó·È ‰˘Ó·Ùfi, ÙÔ ˘ÏÈÎfi ı··ÔÛÙ¤ÏÏÂÙ·È Ù·¯˘‰ÚÔÌÈÎÒ˜ Î·È ÛÙÔ ›Ûˆ Ì¤ÚÔ˜ ÙˆÓ ÂÈÎfiÓˆÓ ı·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· ·ÔÛÙ¤ÏÏÔÓÙ·È ÛÙËÓ ËÏÂÎÙÚÔ-

ÓÈÎ‹ ‰ÈÂ‡ı˘ÓÛË ÙË˜ ÂÙ·ÈÚÂ›·˜ ([email protected]). ™Â ÍÂ¯ˆ-ÚÈÛÙfi Ì‹Ó˘Ì· ı· ‰ËÏÒÓÂÙ·È fiÙÈ Ë ÂÚÁ·Û›· ‰ÂÓ ¤¯ÂÈ ÂÓ Ì¤ÚÂÈ ‹ ÂÍÔÏÔÎÏ‹ÚÔ˘ ‰ËÌÔÛÈÂ˘ıÂ› ‹ ˘Ô‚ÏËıÂ› ÁÈ· ÎÚ›ÛË ÛÂ ¿ÏÏÔ ÂÚÈÔ‰È-Îfi Î·È fiÙÈ ÔÈ Û˘ÁÁÚ·ÊÂ›˜ ÂÁÎÚ›ÓÔ˘Ó ÙË ‰ËÌÔÛ›Â˘Û‹ ÙË˜ ÛÙÔ Â-ÚÈÔ‰ÈÎfi “¶·È‰È·ÙÚÈÎ‹”. ∂ÈÏ¤ÔÓ, ı· Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È Ù˘-¯fiÓ ÂÈ‰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 ÎÂ›ÌÂÓÔ Ú¤ÂÈ Ó· ˘Ô‚¿ÏÂÙ·È ÛÙË™˘ÓÙ·ÎÙÈÎ‹ EÈÙÚÔ‹, Ì¤Ûˆ e-mail Ô˘ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ÂÚ-Á·Û›· ÛÂ ÚfiÁÚ·ÌÌ· Word. ™Â ÍÂ¯ˆÚÈÛÙfi ·Ú¯Â›Ô ı· ÂÚÈÏ·Ì‚¿-ÓÂÙ·È ÂÈÛÙÔÏ‹ fiÔ˘ ı· ·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· 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.

¶ÚÈÓ ·ÔÛÙÂ›ÏÂÙÂ ËÏÂÎÙÚÔÓÈÎ¿ ÙËÓ ÂÚÁ·Û›· Û·˜, ‚Â-‚·ÈˆıÂ›ÙÂ fiÙÈ ÙÔ ·Ú¯Â›Ô ÂÚÈÏ·Ì‚¿ÓÂÈ:

1. ™ÂÏ›‰· Ù›ÙÏÔ˘ Ô˘ ÂÚÈ¤¯ÂÈ: ·. 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, ËÏÂÎÙÚÔÓÈÎ‹ ‰ÈÂ‡ı˘ÓÛË Î·È ÙËÏ¤Êˆ-

ÓÔ Û˘ÁÁÚ·Ê¤· ÁÈ· ·ÏÏËÏÔÁÚ·Ê›·. 2. ¶ÂÚ›ÏË„Ë ÂÏÏËÓÈÎ‹-·ÁÁÏÈÎ‹ (200-250 Ï¤ÍÂÈ˜), ‰ÔÌËÌ¤ÓË

ÛÙÈ˜ ÂÍ‹˜ ·Ú·ÁÚ¿ÊÔ˘˜: ÂÈÛ·ÁˆÁ‹, Ì¤ıÔ‰ÔÈ, ·ÔÙÂÏ¤ÛÌ·-Ù· Î·È Û˘ÌÂÚ¿ÛÌ·Ù·.

3. §¤ÍÂÈ˜ ÎÏÂÈ‰È¿.4. ∫·Ù¿ÏÔÁÔ Û˘ÓÙÔÌÔÁÚ·ÊÈÒÓ.5. ∫Â›ÌÂÓÔ.6. ∂˘¯·ÚÈÛÙ›Â˜ ‹ ·Ó·ÁÓˆÚ›ÛÂÈ˜ (·Ó·ÊÔÚ¿ ÛÂ ÂÈ‰ÔÙ‹ÛÂÈ˜-¯Ô-

ÚËÁ›Â˜ ‹ ¿ÏÏÂ˜ ËÁ¤˜ ˘ÔÛÙ‹ÚÈÍË˜).7. µÈ‚ÏÈÔÁÚ·Ê›·.8. ¶›Ó·ÎÂ˜ (Ô Î·ı¤Ó·˜ ÛÂ ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·).9. ∂ÈÎfiÓÂ˜ (Ë Î·ıÂÌ›· ÛÂ ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·).

10. ∆›ÙÏÔ˘˜ ÂÈÎfiÓˆÓ.

“∏ ÕÓÔÈÍË”Regla de la C. Alfonso

Rames, 15 ÂÙÒÓ, ∫Ô‡‚·∆˘ÊÏfi ·È‰›

“∆· Ù˘ÊÏ¿ ·È‰È¿

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“Spring”, Regla de la C. Alfonso

Rames, 15 years old, CubaBlind child

“Blind children paint”, Anna Laoutari-Gritzala,Athens 2006


Long term outcomes of children with cancer

G. A. Levitt

165EDITORIAL COMMENTARY ∞ƒ£ƒ√ ™À¡∆∞•∏™

Great Ormond Street Hospitalfor Children, NHS Trust Great Ormond St., London, UK

Correspondence:

Gill A. [email protected] Ormond Street Hospitalfor Children, NHS Trust Great Ormond St.,London WCIN3JH, UK

¶·È‰È·ÙÚÈÎ‹ 2007;70:165-166

˘·ÓÈÔ‡-Ï¿ÛÌ·-ˆ· ‰ÂÓÌÂÏ¤ÙÂ˜‹ÛË ÙÔ˘ÌËÙ¤Ú·˜›· ÌfiÓÔÓ·Ì¤ÓÂ-Ú¤ÂÈ Ôª∏∆∂™Â˜ Ô˘

ÂÁ¯fiÌÂ-˙›ÏË ÛÂ: ∞˘Í‹-. Ÿˆ˜¿ÓıËÌ·

Ù· Û˘-‰È·ÎÔ-ÓËÏ›·

˜. ∞ÈÌÔ-ÓÈ·. ¡Â-%), Â-ÊÂÚıÂ›Í›·, ·Á-Ó‰ÚÔÌÔÙÂ˜ ·-ˆÛÈÓÔ-

ÂÙ·È Î˘-Î‹˜ ÏÂÈ-ProcefÙˆÓ 12ÛÂ Û˘-

È· ˘„Ë-Ô‰ËÁ›Â˜5 ∂Àƒø¶∂. ¶√-

Children diagnosed with a malignancy priorto the 1980’s had a dismal outlook but over thelast three decades the long-term survival rateshave substantially improved. More than 75% ofchildren with cancer in the western world canexpect to reach adulthood, in real terms 1 in 715young adults will have experienced cancer by theyear 2010 (1).

This success has been achieved by the im-proved supportive care and the use of multi-modality treatments, surgery, intensive chemo-therapy and radiotherapy. Unfortunately pre-sent day cancer treatments do not target cancercells alone but cause damage to normal tissues.The extent of the damage and the number of or-gans involved depends on many factors includ-ing the treatment intensity, scheduling andcombinations, age and gender of the patient (2).A number of studies including large epidemio-logical studies have shown an increased risk ofearly mortality, an eleven times greater risk ofdeath compared to that expected for the generalpopulation five years from diagnosis. The mainculprit was disease relapse but 20% was due totreatment related effects (3,4). Further studieshave suggested that 60% of survivors sufferchronic conditions (5,6). A third of patientshave moderate or severe compromise with a sig-nificant proportion with more than one organsystem affected.

The paper in this edition, “Surviving child-hood cancer: long-term outcome”, highlights thediversity of late sequelae and the variable onset ofproblems. The damage occurs at the time of treat-ment but clinically relevant effects may presentmany years later. Platinium or Ifosfamide relatedrenal dysfunction tends to be evident at the end oftreatment and may remain static, however an-thracycline cardiotoxicity is progressive and clini-cally relevant symptoms can present many yearslater. Gonadotoxic treatment prescribed to pre-pubertal patients will not be evident until pubertyor until fertility is tested.

Space limitations for the review did not allowfor a full appreciation of the less common prob-lems such as osteoporosis, renal or sensory im-pairment but these are no less important, partic-ularly when they are in combination with otherproblems.

This review carries an important message,drawing attention to a wider audience bothwithin paediatric and adult practice, on theneeds of long-term survivors of childhood can-cer. It clearly shows the problems they may pre-sent related to their previous medical history andthe variable time of onset after cure has been es-tablished. History taking is vital to assist in mak-ing the correct diagnosis and apportioning acause. In addition, this review makes the case forproviding subspecialist expertise to maximizethe survivors’ wellbeing. Normal life events suchas pregnancy may be compromised by the cancertreatments, abdominal radiation increasing therisk of prematurity, extra workload for the heartthat has received a significant dose of anthracy-clines; this information needs to reach the physi-cians dealing with these patients (7).

The paper touches on the development offollow-up guidelines. The importance of theguidelines is to improve the long-term outcomesof these patients by detecting sequelae at an ear-ly stage, when treatment can be maximized. Anumber of surveillance guidelines have beenpublished which can be adapted to produce afollow-up programme for individual patientsbased on the therapy received and the risks of de-veloping a problem (8-10). Unfortunately muchof the guidance is not evidence-based but never-theless it is based on expert sensible opinion.

All countries successfully treating childhoodcancer should invest in a follow-up programme.The “where, how, by whom”, is very much de-pendent on the local health care organization butshould incorporate a provision for transition toadult care for these childhood cancer survivorsrequiring ongoing monitoring or treatment.

The guidance is straightforward and the sur-veillance can be delivered by paediatricians andprimary care physicians with explicit referralpathways when abnormalities are encountered.This becomes important as the numbers increaseand the care of the patients by their oncologistmay not be appropriate and therefore differentmodels of care need to be explored.

Work with long-term survivors shows thatmany wish to take control of their own follow-up, but they require solid information on thetreatment that they received and the risks of late


sequelae. This information can also be used to discusshealthy life-style issues, appropriate employment,which will be vital to improve the long-term quality ofsurvival. These information packages should be pro-vided by well-informed health workers as patients en-ter adulthood and should be an integral part of fol-low-up.

Long-term cancer survivors in many cases requireconsiderable input from health professionals so thatthey can obtain the best possible quality of life and en-able them to contribute to their community. Curealone is not sufficient.

References

1. Campbell J, Wallace WHB, Bhatti LA, Stockton DL, RapsonT, Brewster DH. Childhood Cancer in Scotland: Trends inincidence, mortality and survival 1975-1999. NHS ScotlandInformation and Statistics Division. Edinburgh. 2004.

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

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

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166 G.A. Levitt

Paediatriki 2007;70:165-166


Surviving childhood cancer: long-term outcomes

M. Servitzoglou

Abstract: Childhood cancer survivors constitute a rapidly expanding population with special healthcareneeds. The disease, in conjunction with the highly intensive therapy, results in numerous side effectsthat can present long after the completion of treatment. Survivors are susceptible to high morbidity andearly mortality, due mainly to complications, ranging from second malignancies to heart dysfunction.Second malignancies are frequently found at sites of prior radiation and include breast cancer, thyroidcancer and soft tissue sarcomas. Some chemotherapy agents, such as alkylating agents andtopoisomerase II inhibitors, can cause acute myeloid leukaemia and myelodysplastic syndromes. Failurein linear growth is noted after cranial radiotherapy for brain tumour and leukaemia. Abnormal thyroidfunction is observed following neck irradiation. Pelvic irradiation and exposure to alkylating agents aresignificant risk factors for sub- or infertility in both sexes. Cardiac dysfunction is progressive and morefrequently presents as cardiomyopathy related to anthracyclines, with adjuvant chest irradiation beingan independent factor. Impaired neurocognitive performance is classically reported in children withbrain tumours and leukaemia. The use of cranial irradiation and even the use of intrathecalchemotherapy alone for leukaemia can cause permanent damage, especially to younger children. Therecent development of specific guidelines for the follow-up of childhood cancer survivors is an attemptto improve their long-term quality of life, ensuring the early detection and management ofcomplications. The best model for follow-up and transition of care to the adult setting is yet to bedecided.

Key words: Cancer, children, outcomes.

167REVIEW ARTICLE ∞¡∞™∫√¶∏™∏

Great Ormond Street Hospitalfor Children, NHS Trust London, UK

Correspondence:

Marina [email protected] Great Ormond Street Hospitalfor Children, NHS TrustGreat Ormond St., London WC1N 3JHUnited Kingdom

¶·È‰È·ÙÚÈÎ‹ 2007;70:167-173

Introduction

The treatment for paediatric malignancieshas improved so remarkably that the overall curerate has increased to 75% (1). This high cure rateis attributed to the effective combination ofchemotherapy, radiotherapy and surgery. Overthe past few decades, more aggressive multidrugregimens, together with novel therapies, have ledto the current, impressive survival rates. Youngindividuals cured from cancer are currently anexpanding population with special healthcareneeds and distinctive characteristics. It is antici-pated that at present, 1 individual in 1000 is achildhood cancer survivor but this prevalence isas high as 1 in 570 among young adults aged be-tween 20 and 34 years (2).

Obviously, effective therapies can cause se-vere toxicity and the balance between cure andtreatment-induced morbidity is extremely fine.Complications may emerge long after the com-pletion of treatment, which together with thenormal aging process, make childhood cancersurvivors susceptible to various health problems.It appears that up to 60-70% of survivors devel-op at least one medical disability as a result oftheir disease or, more frequently, of their treat-ment (3). Survivors can develop problems suchas endocrine dysfunction, neurological deficit,

cardiovascular or pulmonary compromise, renalimpairment, gastrointestinal dysfunction, osteo-porosis, and hearing or visual loss. The mini-mization of long-term morbidity without com-promising the efficacy of treatment for affectedchildren is now the focus of attention. In the pre-sent article the more important of these late ef-fects are briefly described.

Late endocrine effects

Growth

Linear growth is significantly impaired inspecific groups of childhood cancer survivors.Nearly 40% of brain tumour and 10% ofleukaemia survivors are below the 5th percentilefor height (4-6). Additionally, there are childrenwho, although they remain above the 5th per-centile, experience significant drops on the stan-dardized curves and their final height is lowerthan that predicted according to their growthprior to cancer diagnosis.

The strongest risk factors for adult shortstature seem to be younger age at diagnosis andcraniospinal irradiation treatment involving thehypothalamic-pituitary axis, with a dose-responsefashion (4). Whole-brain irradiation of up to 18-24 Gy, as used in older protocols for children withleukaemia, even though it is a relatively low dose,


can cause a reduction in the final height, but the impact

in growth is much more severe with doses above 30 Gy.

Recent protocols for acute lymphoblastic and myeloid

leukaemia do not include cranial irradiation. Younger

age at diagnosis and, possibly, female sex are addition-

al negative prognostic factors.

Treatment effects on growth are multifactorial

and include growth hormone deficiency, spinal short-

ening due to direct inhibition of vertebral growth,

precocious puberty, latent hypothyroidism, and poor

nutrition. Fifty percent to 80% of children treated

with craniospinal radiation for brain tumours will ex-

perience growth failure (7). Even children who have

not received irradiation as part of their leukaemia

treatment have deficient growth hormone (GH) lev-

els, but the long-term effect on final height is still un-

clear (8-10). Results have recently improved after the

introduction of GH therapy, but the presence of con-

comitant endocrinopathies and the use of increased

doses of spinal irradiation can reduce the benefit. On

the other hand, male gender, younger bone age at the

start of GH treatment and conventional higher doses

of GH maximize the chances of successful therapy.

Obesity has been described in specific groups of

childhood cancer survivors (4,8,11). On the basis of

body mass index (BMI) female sex, young age at diag-

nosis and cranial irradiation are factors that have been

associated with obesity risk in leukaemia survivors

(11). In a recent study on individuals treated for brain

tumours, 60% of subjects who were treated with cra-

nial irradiation, compared with 20% of those who were

not, had two or more of the 5 components of the meta-

bolic syndrome. Cranial irradiation was strongly relat-

ed to GH deficiency, and lower insulin-like growth fac-

tor 1 (IGF-1), higher fasting insulin, abdominal obesi-

ty, and dyslipidaemia, particularly in women (8).

Thyroid function

Abnormal thyroid function is anticipated after

neck irradiation for primary malignancies. Also, the

use of Busulphan in conditioning for stem cell trans-

plantation and of iodide-containing contrast material,

such as 131-I-metaiodobenzylguanidine (MIBG), for

neuroblastoma, are considered additional risk factors

for the development of thyroid disorders (12). Sur-

vivors develop clinical or laboratory signs of deranged

thyroid function after a period of 2 to 16 years (mean

7 years), usually after doses higher than 15 Gy. The

percentage can be as high as 30 to 90% for individuals

treated for Hodgkin disease or head and neck tumours

(4,13). In a report from the Childhood Cancer Sur-

vivorship Study (CCSS) study, compared to their

healthy siblings the survivors’ relative risk was 17.1 for

hypothyroidism, 8 for hyperthyroidism and 27 for

thyroid nodules (14). Radiation dosage higher than 25

Gy, older age at primary diagnosis and female sex were

independent risk factors for the development of hy-

pothyroidism. There is evidence that the risk of thy-

roid dysfunction is cumulative after the combination

of chemotherapy and cervical spine radiotherapy.

Gonadal function

i) Males

Chemotherapy, in the form of alkylating agents,

especially in high doses, can cause decreased sper-

matogenesis, while irradiation may also inhibit pu-

bertal development. Testicular irradiation can result

in decreased testicular volume and sperm production,

with concurrent elevated levels of follicle-stimulating

hormone (FSH) and reduced inhibin B levels. The ef-

fect is obviously dose-dependent, as doses of up to 3

Gy cause transient azoospermia for up to 5 years but

after 6 Gy, the damage appears to be irreversible

(15,16). Total body irradiation (TBI), as part of con-

ditioning for bone marrow transplantation (BMT),

causes permanent invariable azoospermia. Despite

previous evidence for impaired spermatogenesis,

sperm DNA studies have shown that cancer survivors

have normal DNA integrity (17). However, further

studies are needed to evaluate the extent of DNA ab-

normalities in survivors. In addition, the type of can-

cer also has a very strong influence on sperm func-

tion. Leydig cells are less radiosensitive than Sertoli /

germ cells, but still the effect is dose-dependent and

inversely related to age at treatment, with prepubertal

males being more vulnerable to permanent damage.

Direct radiation with doses higher than 20 Gy could

cause delayed sexual maturation, while doses lower

than 12 Gy usually allow pubertal progression, even

with dysfunctional Leydig cells, normal testosterone

and elevated luteinizing hormone (LH) (16).

ii) Females

Cranial irradiation, inclusive of the area of hypo-

thalamus and pituitary can result in delayed puberty

with doses higher than 24 Gy, whilst lower doses are

more commonly related with precocious puberty

(18). Primary ovarian failure is not as common as

premature menopause and has been reported in asso-

ciation with older age at diagnosis, previous Hodgkin

disease, abdominal or pelvic irradiation and exposure

to alkylating agents (19). However, it should be men-

tioned that female gonadal function is less affected by

alkylating agents than male gonadal function. The

ovarian and concurrent uterine impairment, when

the pelvis is included in the radiation field, increases

168 M. Servitzoglou



the risk of miscarriages, fetal death and low birth

weight in subsequent pregnancies (20,21). In a recent

report from CCSS, up to 30% of survivors treated with

alkylating agents plus abdominopelvic radiation had

premature menopause, with attained age and Hodgkin

lymphoma being significant risk factors independent

of the actual doses of drugs and radiation (22).

Late cardiovascular effects

Cardiac dysfunction is chronic and progressive in

childhood cancer survivors. Typically, cardiomyopa-

thy is related with the use of anthracyclines. Progres-

sive reduction in ventricular mass and wall thickening

are associated with worsening contractility and in-

creasing afterload (23). Doses higher than 300 mg/m2

place survivors at increased risk of toxicity. The risk of

cardiac failure or severe abnormalities increases with

anthracycline dose, adjuvant chest irradiation and

time since treatment. The proportion of affected sur-

vivors in follow-up longer than 15 years is higher than

30% (23-25).

Development of coronary artery disease has been

reported following chest irradiation in percentage up

to 10% (26). Also, there is evidence of increased rela-

tive risk of stroke in Hodgkin survivors previously

treated with mantle irradiation, possibly due to

carotid artery or cardiac valvular disease (27).

Late neurocognitive effects

Children treated for leukaemia, non-Hodgkin

lymphoma and brain tumours are susceptible to neu-

rocognitive disorders of variable severity, mainly be-

cause of the use of cranial irradiation. Damage is more

prominent for children diagnosed at a younger age,

when the brain, especially the cortical and subcortical

white matter, is still developing (28,29). Even

chemotherapy-only regimens, including high-dose

frequently administered methotrexate, are associated

with cognitive dysfunction, which can be progressive

over at least a decade (4). Treatment for acute lym-

phocytic leukaemia (ALL), with or without central

nervous system (CNS) irradiation, can lead to smaller

white-matter volumes that are directly associated

with impaired neurocognitive performance (30,31).

Other risk factors are perioperative morbidity, large-

volume high-dose cranial irradiation, supra-tentorial

brain tumour and leukoencephalopathy. Survivors

may develop lower verbal and performance IQ, diffi-

culties in information processing, maintenance of

concentration and attention, memory deficits and

impaired fine motor and visual-spatial skills (32,33).

It has been reported that survivors of leukaemia, CNS

tumours, non-Hodgkin lymphoma, and neuroblas-

toma were significantly less likely to finish high school

compared with their siblings, unless they received ad-

ditional support (34).

Another feature of neurological effects is the in-

creased rate of neurosensory impairment. Survivors

of brain tumours, compared to their sibling compari-

son group, were found to be at elevated risk for hear-

ing impairments, legal blindness in one or both eyes,

cataract, and double vision. Radiation exposure of

greater than 50 Gy to the posterior fossa was associat-

ed with a higher likelihood of developing hearing im-

pairment. Children receiving at least 50 Gy to the

frontal brain regions had a moderately elevated risk

for motor problems (35).

Apart from the type of cancer and treatment, fac-

tors such as age at diagnosis or gender have been sug-

gested as independent variables for the development

of neurocognitive problems in survivors. Girls treated

for ALL, with intravenous and intrathecal chemother-

apy only, have been reported to have significantly

lower verbal and/or nonverbal IQ scores, compared

to boys (36,37).

Second malignancies

Survivors have a 6-fold relative risk, compared

with the normal population, of developing a second

malignancy, due in part to the mutating action of

chemotherapy and irradiation and in part to the ge-

netic predisposition of the individual for cancer

(38,39). The risk for second malignancy increases

with time and is relatively higher in those individuals

who have been treated for Hodgkin disease, those

who received high doses of epipophyllotoxins, alky-

lating agents or radiotherapy, and those with familial

cancer syndromes such as hereditary retinoblastoma

or Li Fraumeni, and also in females, mainly because of

the higher occurrence of breast cancer. A recent Sur-

veillance Epidemiology and End Results (SEER) re-

port has provided evidence that patients treated in re-

cent years for brain tumours carry a greater risk of

second malignancy, due to the increasing intensity of

treatment (40).

Characteristically, breast cancer can occur in fe-

males following mantle or chest irradiation for

Hodgkin disease, where it is probably the most com-

mon second malignancy (41). The cumulative inci-

dence by the age of 40 years for female survivors treat-

ed with irradiation can be as high as 17%. The risk be-

gins to increase approximately 8 years after treatment

and is higher if radiotherapy was administered before

adulthood (42). Also documented was an increasing

occurrence of thyroid cancer and of epithelial neo-

plasms common in adults, such as colon and lung

169Surviving childhood cancer

¶·È‰È·ÙÚÈÎ‹ 2007;70:167-173


cancer, at a younger age than expected in the general

population.

Thyroid cancer has been reported in survivors who

received radiotherapy not only for Hodgkin disease,

but also for ALL, brain tumours and after TBI for BMT.

For Hodgkin disease survivors, the risk can be up to 18

times that of general population. The risk increased

with radiation doses of up to 20-29 Gy and for individ-

uals treated before they reached 10 years of age (43).

Secondary bone tumours are not particularly high

among survivors of childhood cancer, apart from those

treated for bilateral retinoblastoma, Ewing sarcoma

and soft tissue sarcomas where the cumulative proba-

bility at 20 years could reach 7.4% (44,45). Local radio-

therapy and alkylating agents are independent risk fac-

tors, both increasing with cumulative exposure.

Soft tissue sarcoma (STS) is one of the most fre-

quent second cancers occurring during the first 20

years following treatment for a solid cancer in child-

hood. The risk increases with the square of the dose of

radiation to the site of STS development and with the

administration of Procarbazine (46). On the other

hand, survivors of STS in childhood are at increased

risk for developing second malignancy in the form of

(acute myelogenous leukaemia) AML, cutaneous

melanoma, breast cancer and bone or STS, while can-

cers of the oral cavity are prominent. The risk is high-

er when they have received combination of

chemotherapy and radiotherapy (47).

Secondary AML and myelodysplastic syndromes

can occur 5-10 years following treatment for child-

hood cancer and are classically associated with the use

of alkylating agents and topoisomerase II inhibitors.

For the former, the relationship is dose-dependent

and is frequently associated with abnormalities in

chromosomes 5 or 7 (48). For topoisomerase II in-

hibitors, the latency period is shorter and cytogenetic

examination often reveals abnormalities in chromo-

some 11q23 (49).

Late psychosocial effects

The milestone study of Koocher and O’Malley

highlighted the fact that childhood cancer survivors

are prone to psychological difficulties of sufficient

severity to affect their long-term quality of life (50,51).

The results have been inconsistent, but they all point

to certain vulnerable subgroups, such as brain tumour

survivors, who are at greater risk for psychosocial mal-

adjustment, and who have fewer friends and signifi-

cantly more behavioural problems (52-54).

There is evidence that the cohort of childhood

cancer survivors is susceptible to psychosocial prob-

lems, such as high anxiety prevalence or lowered self-

esteem (55-57). Factors such as older age at diagnosis

or disfiguration and body changes have been suggest-

ed as risk factors, as in these cases the normal matura-

tion process and transition to independence are dis-

rupted. More recently, it has been reported that sur-

vivors, due to the devastating experience of the dis-

ease and its treatment, manifest symptoms similar to

post-traumatic stress disorder, especially when enter-

ing adulthood, in a percentage as high as 20% (58-60).

Nevertheless, it should be emphasized that there is al-

so a tendency to consider childhood cancer not only a

source of distress, but also as an incentive to accelerat-

ed maturation and enhanced emotional development,

leading to deeper appreciation for life and wiser

choices of life priorities (61-62).

Conclusion

The increasing population of childhood cancer

survivors is prone to a variety of disorders in many dif-

ferent systems, resulting from the disease itself and the

aggressive treatment. Some of these problems such as

anthracycline induced cardiomyopathy, can develop

many years after therapy, while others, such as neu-

rocognitive or endocrine complications, may appear

during treatment and persist. Possible psychosocial

difficulties can remain for many years, while the risk

for secondary malignancies increases with time.

Consequently, it is important for healthcare

providers to anticipate and detect these problems as

early as possible in order to minimize their effects on

the quality of life of survivors. Surprisingly, it was on-

ly recently that specific recommendations for the pre-

vention and management of the cancer and treatment

related complications have been developed in an at-

tempt to improve the health of these individuals. The

entire process has been delayed by the evolution of

cancer therapies, the long latent period for the devel-

opment of many late effects and the unspecified addi-

tional effect of aging on individuals treated in child-

hood for cancer (63,64). The aim of these guidelines is

to provide long-tem monitoring of survivors’ health,

ensuring the early detection of complications (65-67).

Moreover, because of the low incidence of disease, the

majority of doctors, especially those involved in the

health care of adults, are unfamiliar with childhood

cancer and the treatment-related risks of survivors. In

view of the particular needs of survivors, the best

model for long-term follow-up, especially in case of

emergencies, has raised many discussions and is far

from being established. Their care needs to be

smoothly transmitted from the paediatric to the adult

setting in a way that the new health provider can have

the opportunity to know the patient, identify his/her

170 M. Servitzoglou



medical, psychological and social needs and organize

the appropriate monitoring plan. Otherwise, patients

might have to move abruptly into an adult healthcare

setting, when they have already developed severe

problems, for example a second malignancy, compli-

cating further the already difficult situation.

Childhood cancer survivors are a rapidly growing

population with unique characteristics and special

healthcare needs, who are at high risk for late effects

that could impair their long-term quality of life. They

need to be closely monitored for the rest of their life

for presentation of all the possible complications so

that the disease- and treatment-related morbidity and

mortality can be minimized.

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¶·È‰È·ÙÚÈÎ‹ 2007;70:167-173


174 ∞¡∞™∫√¶∏™∏ REVIEW ARTICLE


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§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ∫˘ÙÙ·ÚÔÌÂÙÚ›· ÚÔ‹˜, ·ÓÔÛÔÊ·ÈÓfiÙ˘Ô˜, ÏÂÌÊÔÎ‡ÙÙ·Ú·, ·È‰È·ÙÚÈÎ‹.

Peripheral blood lymphocyte immunophenotype in paediatric

clinical practice

F. Tzifi, M. Tzanoudaki, M. Kanariou

Abstract: Flow cytometry is used for rapid evaluation of the peripheral blood lymphocytesubpopulations and investigation of immune system disorders. The immunophenotype study ofperipheral blood lymphocytes is now used routinely in paediatric clinical practice. Scientific research inimmunology has led to the identification of lymphocyte surface or cytoplasmic molecules with a rangeof functions that have been elucidated to a variable degree. These molecules, which are expressed atcertain stages of haemopoiesis, are used as markers for identifying lymphocyte populations andsubpopulations according to their cell line, maturational stage and function. They are detected usingmonoclonal antibodies in conjunction with fluorochromes in the flow cytometry system. ∆hey are usefulfor the diagnosis of immunodeficiencies, the follow up of infectious, rheumatic and immunologicaldisease and the classification of leukaemias and lymphomas. In view of the vast body of relevantinformation, it is important for paediatricians to be familiar with the basic markers that characterize thelymphocyte populations and to know how to make a rough interpretation of the immunophenotyperesults. The purpose of this review is to provide an answer to these questions and to enhance the use offlow cytometry for screening, diagnosis and follow up of immunological diseases.

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

∆Ì‹Ì· ∞ÓÔÛÔÏÔÁ›·˜-πÛÙÔÛ˘Ì‚·ÙfiÙËÙ·˜,¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó·

AÏÏËÏÔÁÚ·Ê›·:

ª·Ú›· ∫·Ó¿ÚÈÔ˘ [email protected] ∆Ì‹Ì· ∞ÓÔÛÔÏÔÁ›·˜-πÛÙÔÛ˘Ì‚·ÙfiÙËÙ·˜, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·” £Ë‚ÒÓ &¶··‰È·Ì·ÓÙÔÔ‡ÏÔ˘, ∆.∫. 115 27, ∞ı‹Ó·

Department of Immunologyand Histocompatibility,“Aghia Sophia” Children’sHospital, Athens

Correspondence:

Maria Kanariou [email protected] Department of Immunologyand Histocompatibility, “Aghia Sophia” Children’sHospital Thivon & Papadiaman-dopoulou St., 115 27, Athens

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ÛÙÔ‡Ó ÛÙ· Î‡ÙÙ·Ú· ÌfiÚÈ· Ô˘ ÂÎÊÚ¿˙ÔÓÙ·È ·fi ·˘-

Ù¿ Î·È Ù· ÔÔ›· ‰ÈÂıÓÒ˜ ÔÓÔÌ¿˙ÔÓÙ·È ˆ˜ CDs

(Clusters of differentiation), ̄ ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ‰Â ̂ ˜

‰Â›ÎÙÂ˜ ÚÔÛ‰ÈÔÚÈÛÌÔ‡ ÙˆÓ ‰È·ÊfiÚˆÓ ÏËı˘ÛÌÒÓ

ÙˆÓ ÏÂ˘ÎÔÎ˘ÙÙ¿ÚˆÓ (2). ™Â ¤Ó·Ó ·ÓÔÛÔÊ·ÈÓfiÙ˘Ô

∂ÈÎfiÓ· 1. ∆· Â›‰Ë ÙˆÓ ‚·ÛÈÎÒÓ ÏÂÌÊÔÎ˘ÙÙ·ÚÈÎÒÓ ÏËı˘ÛÌÒÓ Î·È ˘ÔÏËı˘ÛÌÒÓ ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜. ∞ÂÈÎÔÓ›˙ÔÓÙ·È ÔÈ ˘Ô-‰È·ÈÚ¤ÛÂÈ˜ ÙˆÓ ÏËı˘ÛÌÒÓ Î·È fi¯È Ù· ÂÍÂÏÈÎÙÈÎ¿ ÙÔ˘˜ ÛÙ¿‰È·.

∆-ÏÂÌÊÔÎ‡ÙÙ·Ú·CD3+CD16-CD56-

¡∫∆-Î‡ÙÙ·Ú·CD3+CD16+CD56+

¡∫- Î‡ÙÙ·Ú·CD3-CD16+/CD56+

µ-ÏÂÌÊÔÎ‡ÙÙ·Ú·CD19+CD20+

CD5+

¶ÚÒÈÌ·CD5-

ÒÚÈÌ·

TCR·‚+

CD4+CD8-

‚ÔËıËÙÈÎ¿

CD4+ CD45RA+

·Úı¤Ó·CD4+ CD45RO+

ÌÓËÌÔÓÈÎ¿CD8+ CD45RO+

ÌÓËÌÔÓÈÎ¿

CD8+ CD45RA+

·Úı¤Ó· ‹ ·ÓÔÛÔ‰Ú·ÛÙÈÎ¿

CD4 CD8+

Î˘ÙÙ·ÚÔÙÔÍÈÎ¿

TCRÁ‰+

CD4-CD8-

CD4-CD8+dim CD8-

CD8+dim CD8-

§ÂÌÊÔÎ‡ÙÙ·Ú·FSdim SSdim CD45bright

175√ ·ÓÔÛÔÊ·ÈÓfiÙ˘Ô˜ ÙˆÓ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜

¶·È‰È·ÙÚÈÎ‹ 2007;70:174-183


ÚÔÛ‰ÈÔÚ›˙ÂÙ·È ·Ú¯ÈÎ¿ ÙÔ ÔÛÔÛÙfi ÙˆÓ ∆-, µ- Î·È ¡∫-

Î˘ÙÙ¿ÚˆÓ Î·È ÂÌÌ¤Ûˆ˜ Ô ·fiÏ˘ÙÔ˜ ·ÚÈıÌfi˜ ÙÔ˘˜.

ŸÌˆ˜, ÁÈ· ÙËÓ Î·Ù·ÓfiËÛË Î·È ÛˆÛÙ‹ ·ÍÈÔÏfiÁËÛË ÙˆÓ

Î˘ÙÙ·ÚÈÎÒÓ ÏËı˘ÛÌÒÓ Î·ıÔÚÈÛÙÈÎfi ÚfiÏÔ ·›˙ÂÈ Ë

ÁÓÒÛË ÙË˜ ‚·ÛÈÎ‹˜ ·ÓÔÛÔ·¿ÓÙËÛË˜ (∂ÈÎfiÓ· 2).

∆-ÏÂÌÊÔÎ‡ÙÙ·Ú·

∆· ∆-ÏÂÌÊÔÎ‡ÙÙ·Ú· (CD3+) ·›˙Ô˘Ó ÎÂÓÙÚÈÎfi Úfi-

ÏÔ ÛÙËÓ Â›ÎÙËÙË ·ÓÔÛÈ·Î‹ ·¿ÓÙËÛË Â›ÙÂ ˆ˜ ‚ÔËıË-

ÙÈÎ¿/Â·ÁˆÁÈÎ¿ Î‡ÙÙ·Ú· (CD4+) Â›ÙÂ ̂ ˜ Î˘ÙÙ·ÚÔÙÔÍÈ-

Î¿/Î·Ù·ÛÙ·ÏÙÈÎ¿ Î‡ÙÙ·Ú· (CD8+). ∆· ∆-ÏÂÌÊÔÎ‡ÙÙ·-

Ú· ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ÙËÓ ·ÚÔ˘Û›· ÙÔ˘ Û˘ÌÏ¤Á-

Ì·ÙÔ˜ ÙÔ˘ ·ÓÙÈÁÔÓÈÎÔ‡ ˘Ô‰Ô¯¤· (TCR), Ô˘ ‰ËÌÈ-

Ô˘ÚÁÂ›Ù·È ·fi ‰‡Ô ·Ï˘Û›‰Â˜, ÔÈ ÔÔ›Â˜ Û¯ËÌ·Ù›˙Ô˘Ó

ÙÔ ÂÙÂÚÔ‰ÈÌÂÚ¤˜ ·‚ ‹ ÙÔ Á‰ Ô˘ Û˘Ó‰¤ÂÙ·È ÌÂ ÙÔ ÌfiÚÈÔ

CD3. ∂ÔÌ¤Óˆ˜, ·Ó¿ÏÔÁ· ÌÂ ÙË ‰ÔÌ‹ ÙÔ˘ ˘Ô‰Ô¯¤·,

‰È·ÎÚ›ÓÔÓÙ·È ÛÂ ‰‡Ô ÏËı˘ÛÌÔ‡˜, ÙÔÓ CD3+ TCR·‚+

Î·È ÙÔÓ CD3+ TCRÁ‰+ (4,5).

∆· ÌfiÚÈ· Ô˘ ÂÏ¤Á¯ÔÓÙ·È ÛÙ· ∆-ÏÂÌÊÔÎ‡ÙÙ·Ú·

ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜ ÛÙËÓ Î·ı’ ËÌ¤Ú· ÎÏÈÓÈÎ‹

Ú¿ÍË Â›Ó·È Ù· ·ÎfiÏÔ˘ı·:

∞Ú¯ÈÎfi˜ ¤ÏÂÁ¯Ô˜:

CD3: ∆Ô CD3 ÂÎÊÚ¿˙ÂÙ·È ·ÔÎÏÂÈÛÙÈÎ¿ ÛÙ· ∆-

ÏÂÌÊÔÎ‡ÙÙ·Ú· Î·È ÙÈ˜ ÚÔÁÔÓÈÎ¤˜ ÌÔÚÊ¤˜ ÙÔ˘˜.

¶·›˙ÂÈ Û˘ÓÂÚÁÈÎfi ÚfiÏÔ ÛÙË ÌÂÙ·‚›‚·ÛË ÌËÓ‡Ì·ÙÔ˜

·fi ÙÔÓ ·ÓÙÈÁÔÓÈÎfi ˘Ô‰Ô¯¤· ÙÔ˘ ∆ Î˘ÙÙ¿ÚÔ˘

(TCR). ∂ÔÌ¤Óˆ˜, Ù· Î‡ÙÙ·Ú· Ô˘ ÂÎÊÚ¿˙Ô˘Ó CD3

ÚÔÛ‰ÈÔÚ›˙Ô˘Ó ÙÔÓ Û˘ÓÔÏÈÎfi ·ÚÈıÌfi ÙˆÓ ∆-ÏÂÌÊÔ-

Î˘ÙÙ¿ÚˆÓ (6).

CD4: ∆Ô ÌfiÚÈÔ CD4 ÂÎÊÚ¿˙ÂÙ·È ˆ˜ Û˘Ó˘Ô‰Ô¯¤-

·˜ ÛÙËÓ ÂÈÊ¿ÓÂÈ· ÙˆÓ ‚ÔËıËÙÈÎÒÓ ∆-ÏÂÌÊÔÎ˘ÙÙ¿-

ÚˆÓ, Ù· ÔÔ›· ·Ó·ÁÓˆÚ›˙Ô˘Ó ·ÓÙÈÁfiÓ· Ô˘ ·ÚÔ˘-

ÛÈ¿˙ÔÓÙ·È Û˘Ó‰Â‰ÂÌ¤Ó· ÌÂ ÌfiÚÈ· MHC II ÙˆÓ APC.

∞˘Í¿ÓÂÈ ÙËÓ ·ÏÏËÏÂ›‰Ú·ÛË ÙÔ˘ TCR ÌÂ ÙÔ APC,

·›˙ÂÈ Û˘ÓÂÚÁÈÎfi ÚfiÏÔ ÛÙË ÌÂÙ¿‰ÔÛË ÌËÓ˘Ì¿ÙˆÓ

Î·È ÛÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ ‚ÔËıËÙÈÎÒÓ CD4+ ÏÂÌ-

ÊÔÎ˘ÙÙ¿ÚˆÓ. ∆· ‚ÔËıËÙÈÎ¿ ∆-ÏÂÌÊÔÎ‡ÙÙ·Ú·

(CD3+CD4+CD8-) ·ÔÙÂÏÔ‡Ó ÙÔ 50-60% ÙˆÓ Û˘ÓÔÏÈ-

ÎÒÓ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜, Ù·

‰Â ÂÓÂÚÁÔÔÈËÌ¤Ó· CD4+ Î‡ÙÙ·Ú·, ·Ó¿ÏÔÁ· ÌÂ ÙÈ˜

Î˘ÙÙ·ÚÔÎ›ÓÂ˜ Ô˘ ·Ú¿ÁÔ˘Ó, ‰È·ÎÚ›ÓÔÓÙ·È ÛÂ ‰‡Ô

˘ÔÎ·ÙËÁÔÚ›Â˜: Th1 Î·È Th2. ŒÓ·˜ ¿ÏÏÔ˜ ÚfiÏÔ˜ ÙˆÓ

CD4+ Î˘ÙÙ¿ÚˆÓ Â›Ó·È Ë Û˘ÌÌÂÙÔ¯‹ ÙÔ˘˜ ÛÙË ‰È·ÊÔ-

ÚÔÔ›ËÛË ÙˆÓ µ-ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ (7,8).

CD8: √ ‰Â›ÎÙË˜ CD8 Â›Ó·È ÁÏ˘ÎÔÚˆÙÂ˝ÓË Ô˘

ÂÎÊÚ¿˙ÂÙ·È ˆ˜ Û˘Ó˘Ô‰Ô¯¤·˜ ÛÙËÓ ÂÈÊ¿ÓÂÈ· ÙˆÓ

Î·Ù·ÛÙ·ÏÙÈÎÒÓ/Î˘ÙÙ·ÚÔÙÔÍÈÎÒÓ ∆-ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ,

Ù· ÔÔ›· ·Ó·ÁÓˆÚ›˙Ô˘Ó Î·È Û˘Ó‰¤ÔÓÙ·È ÌÂ Î‡ÙÙ·Ú·

Ô˘ ÂÎÊÚ¿˙Ô˘Ó ÂÓ‰ÔÁÂÓ‹, .¯. ÈÈÎ¿, ·ÓÙÈÁfiÓ· Û˘Ó‰Â-

‰ÂÌ¤Ó· ÌÂ ÌfiÚÈ· MHC π. £ÂˆÚÂ›Ù·È ˆ˜ Û˘Ó˘Ô‰Ô¯¤-

·˜ fiÙ·Ó ÛÙË Û‡Ó‰ÂÛË ÌÂ ÙÔ ·ÓÙÈÁfiÓÔ-MHC Û˘ÌÌÂÙ¤-

¯ÂÈ Î·È Ô TCR, ÂÓÒ Â¿Ó Ô TCR ‰ÂÓ Û˘ÌÌÂÙ¤¯ÂÈ, ÏÂÈ-

ÙÔ˘ÚÁÂ› ˆ˜ ÌfiÚÈÔ ÚÔÛÎfiÏÏËÛË˜ (7). ∆· Î˘ÙÙ·ÚÔÙÔ-

ÍÈÎ¿ ∆-ÏÂÌÊÔÎ‡ÙÙ·Ú· (CD3+CD4-CD8+) ·›˙Ô˘Ó,

ªË ÂÈ‰ÈÎ‹ ·ÓÔÛ›·

∂›ÎÙËÙË

·ÓÔÛ›·

∞ÓÙÈÁfiÓ·

HLA ÌfiÚÈÔ

APS ÂÓ‰ÔÎ˘ÙÙ¿ÚˆÛË

·ÓÙÈÁÔÓÔÂÂÍÂÚÁ·Û›·

·ÓÙÈÁÔÓÔ·ÚÔ˘Û›·ÛË

∞ÓÙÈÁfiÓ·-ı˘ÌÔ·ÓÂÍ¿ÚÙËÙ·

BCR

µ-ÏÂÌÊÔÎ‡ÙÙ·ÚÔ

TCR

˘Ô‰Ô¯¤·˜ §ÂÌÊÔÎ›ÓÂ˜

§ÂÌÊÔÎ›ÓÂ˜

∆-ÏÂÌÊÔÎ‡ÙÙ·Ú·

∂ÓÂÚÁÔÔÈËÌ¤ÓÔ

∆-ÏÂÌÊÔÎ‡ÙÙ·ÚÔ

∞ÓÙÈÛÒÌ·Ù·

∂ÈÎfiÓ· 2. ∞‰Ú‹ ·ÂÈÎfiÓÈÛË ÙË˜ ·ÓÔÛÔ·¿ÓÙËÛË˜ (3).

176 º. ∆˙ÈÊ‹ Î·È Û˘Ó.



Â›ÛË˜, ÚfiÏÔ ÛÙËÓ ·fiÚÚÈ„Ë ÙˆÓ ÌÔÛ¯Â˘Ì¿ÙˆÓ Î·È

ÛÙËÓ Î·Ù·ÛÙÚÔÊ‹ ÙˆÓ Î·ÚÎÈÓÈÎÒÓ Î˘ÙÙ¿ÚˆÓ (7).

™˘ÌÏËÚˆÌ·ÙÈÎfi˜ ¤ÏÂÁ¯Ô˜:

TCR·‚: √ ¯·Ú·ÎÙËÚÈÛÙÈÎfi˜ ·ÓÙÈÁÔÓÈÎfi˜ ˘Ô‰Ô-

¯¤·˜ ÛÙËÓ ÏÂÈÔÓfiÙËÙ· (>90%) ÙˆÓ ∆-ÏÂÌÊÔÎ˘ÙÙ¿-

ÚˆÓ ·ÔÙÂÏÂ›Ù·È ·fi ‰‡Ô ‰È·ÌÂÌ‚Ú·ÓÈÎ¤˜ ÔÏ˘Â-

ÙÈ‰ÈÎ¤˜ ·Ï˘Û›‰Â˜, ÙËÓ · Î·È ÙË ‚. AÓ·ÁÓˆÚ›˙ÂÈ ·ÓÙÈ-

ÁfiÓ· Û˘Ó‰Â‰ÂÌ¤Ó· ÌÂ ÌfiÚÈ· ÙÔ˘ ÌÂ›˙ÔÓÔ˜ Û˘ÌÏ¤Á-

Ì·ÙÔ˜ ÈÛÙÔÛ˘Ì‚·ÙfiÙËÙ·˜, ·ÚÔ˘ÛÈ·˙fiÌÂÓ· ·fi Ù·

·ÓÙÈÁÔÓÔ·ÚÔ˘ÛÈ·ÛÙÈÎ¿ Î‡ÙÙ·Ú· (9).

TCRÁ‰: ¶ÂÚ›Ô˘ ÛÙÔ 5% fiÏˆÓ ÙˆÓ ∆-ÏÂÌÊÔÎ˘Ù-

Ù¿ÚˆÓ, Ô TCR ·ÔÙÂÏÂ›Ù·È ·fi Á Î·È ‰ ·Ï˘Û›‰Â˜. ∆·

TCRÁ‰+ Î‡ÙÙ·Ú· Â›Ó·È Î˘Ú›ˆ˜ CD3+CD4-CD8- Î‡Ù-

Ù·Ú· Î·È ‰ÂÓ ·Ó·ÁÓˆÚ›˙Ô˘Ó Ô‡ÙÂ Û˘Ó‰¤ÔÓÙ·È ÌÂ

·ÓÙÈÁfiÓ· Ô˘ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ì¤Ûˆ ÙÔ˘ ÌÂ›˙ÔÓÔ˜

Û˘ÌÏ¤ÁÌ·ÙÔ˜ ÈÛÙÔÛ˘Ì‚·ÙfiÙËÙ·˜. √ ÚfiÏÔ˜ ÙÔ˘˜

‰ÂÓ ¤¯ÂÈ Ï‹Úˆ˜ ‰ÈÂ˘ÎÚÈÓÈÛÙÂ› (10-12).

CD45: ∆Ô ÌfiÚÈÔ ·˘Ùfi Â›Ó·È ÁÓˆÛÙfi ˆ˜ ÎÔÈÓfi ÏÂ˘-

ÎÔÎ˘ÙÙ·ÚÈÎfi ·ÓÙÈÁfiÓÔ Î·È ÔÈ ‰È¿ÊÔÚÂ˜ ÈÛÔÌÔÚÊ¤˜

ÙÔ˘ ÂÎÊÚ¿˙ÔÓÙ·È ÛÂ fiÏ· Ù· ¿ˆÚ· Î·È ÒÚÈÌ· ÏÂ˘ÎÔ-

Î‡ÙÙ·Ú·. £ÂˆÚÂ›Ù·È fiÙÈ ·›˙ÂÈ ÚfiÏÔ ÛÙËÓ ÂÓÂÚÁÔ-

Ô›ËÛË ÙˆÓ ∆-ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ Î·È ¯ÚËÛÈÌÔÔÈÂ›Ù·È

ÛÙÔÓ ‰È·¯ˆÚÈÛÌfi ÙˆÓ ÏÂ˘ÎÒÓ ·fi ÙÔ˘˜ ÂÚ˘ıÚÔ‚Ï¿-

ÛÙÂ˜. ∆· ÂÚÈÛÛfiÙÂÚ· ·Úı¤Ó· Î‡ÙÙ·Ú· ÂÎÊÚ¿˙Ô˘Ó

ÙË CD45R∞ ÈÛÔÌÔÚÊ‹ ÙÔ˘, Ù· ‰Â ÌÓËÌÔÓÈÎ¿ Î‡ÙÙ·-

Ú· Î˘Ú›ˆ˜ ÙË CD45R√ (13,14).

HLA-DR (Human leukocyte antigen-DR): ªfiÚÈÔ

ÙÔ˘ ÌÂ›˙ÔÓÔ˜ Û˘ÌÏ¤ÁÌ·ÙÔ˜ ÈÛÙÔÛ˘Ì‚·ÙfiÙËÙ·˜ Ù¿-

ÍË˜ ππ, ÙÔ ÔÔ›Ô ÛÙ·ıÂÚ¿ ÂÎÊÚ¿˙ÂÙ·È ÛÙ· µ Î·È ÛÙ·

‰ÈÂÁÂÚÌ¤Ó· ∆-ÏÂÌÊÔÎ‡ÙÙ·Ú·. ™ÙËÓ Î·ıËÌÂÚÈÓ‹ ÎÏÈ-

ÓÈÎ‹ Ú¿ÍË ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ÙÔ

CD3 ÁÈ· ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙˆÓ ‰ÈÂÁÂÚÌ¤ÓˆÓ ∆-ÏÂÌ-

ÊÔÎ˘ÙÙ¿ÚˆÓ (15).

CD25: ∆Ô CD25 ·ÔÙÂÏÂ› Â›ÙÔÔ ÙË˜ · ·Ï˘Û›-

‰·˜ ÙÔ˘ ˘Ô‰Ô¯¤· ÙË˜ ÈÓÙÂÚÏÂ˘Î›ÓË˜ 2 (IL-2). π‰È·›-

ÙÂÚÔ ÂÓ‰È·Ê¤ÚÔÓ ¤¯Ô˘Ó Ù· Ú˘ıÌÈÛÙÈÎ¿ CD4+CD25+

Î‡ÙÙ·Ú· (Treg), Ù· ÔÔ›· ·›˙Ô˘Ó ÛËÌ·ÓÙÈÎfi ÚfiÏÔ

ÛÙËÓ ÔÌÔÈfiÛÙ·ÛË ÙÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜,

Ë ‰Â ‰È·Ù·Ú·¯‹ ÙÔ˘˜ Û˘Û¯ÂÙ›˙ÂÙ·È ÌÂ ÙËÓ ÂÌÊ¿ÓÈÛË

·˘ÙÔ¿ÓÔÛˆÓ ÓÔÛËÌ¿ÙˆÓ. ∂ÂÈ‰‹ ÙÔ ÌfiÚÈÔ CD25 ‰ÂÓ

ÂÎÊÚ¿˙ÂÙ·È ·ÔÎÏÂÈÛÙÈÎ¿ ÛÙ· Ú˘ıÌÈÛÙÈÎ¿, ·ÏÏ¿ Î·È

ÛÙ· ÂÓÂÚÁÔÔÈËÌ¤Ó· ∆-ÏÂÌÊÔÎ‡ÙÙ·Ú·, ÂÎÎÚÂÌÂ› Ë

Â‡ÚÂÛË ÂÈ‰ÈÎÒÓ ÌÔÚ›ˆÓ Ô˘ Ó· Ù·˘ÙÔÔÈÔ‡Ó Ù· Ú˘ı-

ÌÈÛÙÈÎ¿ Î‡ÙÙ·Ú· (16,17).

CD69: ∆Ô ÌfiÚÈÔ ·˘Ùfi Â›Ó·È ÁÓˆÛÙfi Î·È ̂ ˜ Â·Áˆ-

ÁÈÎfi ÌfiÚÈÔ ÂÓÂÚÁÔÔ›ËÛË˜ (Activation inducer

molecule - AIM), ÂÎÊÚ¿˙ÂÙ·È ÛÂ ÂÓÂÚÁÔÔÈËÌ¤Ó·

ÏÂ˘ÎÔÎ‡ÙÙ·Ú·, fiˆ˜ ∆- Î·È µ-ÏÂÌÊÔÎ‡ÙÙ·Ú·, ¡∫-

Î‡ÙÙ·Ú·, Ô˘‰ÂÙÂÚfiÊÈÏ·, ‚·ÛÂfiÊÈÏ· Î·È ËˆÛÈÓfiÊÈÏ·

Î·È Èı·ÓÒ˜ ·›˙ÂÈ ÚfiÏÔ ÛÙË ÌÂÙ¿‰ÔÛË ÌËÓ˘Ì¿ÙˆÓ

ÌÂÙ·Í‡ ‰È·ÊfiÚˆÓ ÂÈ‰ÒÓ Î˘ÙÙ¿ÚˆÓ (18,19).

∂ÍÂÈ‰ÈÎÂ˘Ì¤ÓÔ˜ ¤ÏÂÁ¯Ô˜:

CD40L: ªfiÚÈÔ Û˘Ó‰È¤ÁÂÚÛË˜ Ô˘ ‚Ú›ÛÎÂÙ·È ÛÙË

ÌÂÌ‚Ú¿ÓË ÙˆÓ ‚ÔËıËÙÈÎÒÓ ∆-ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ Î·È

Û˘Ó‰¤ÂÙ·È ÌÂ ÙÔ CD40 ÙˆÓ µ-ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ. ∂›Ó·È

ÛËÌ·ÓÙÈÎfi ÁÈ· ÙÔÓ ÔÏÏ·Ï·ÛÈ·ÛÌfi ÙˆÓ µ-ÏÂÌÊÔ-

Î˘ÙÙ¿ÚˆÓ Î·È ÁÈ· ÙËÓ ÈÛÔÙ˘ÈÎ‹ ÌÂÙ·ÛÙÚÔÊ‹

(switching) ·fi ÙËÓ ·ÓÔÛÔÛÊ·ÈÚ›ÓË IgM ÛÂ IgG, IgA

‹ IgE (20).

CD2: ∂›Ó·È ·fi Ù· ÚÒÙ· ÌfiÚÈ· Ô˘ ÂÎÊÚ¿˙ÔÓÙ·È

ÛÙ· ÏÂÌÊÔÎ‡ÙÙ·Ú· Ô˘ ÂÈÛ¤Ú¯ÔÓÙ·È ÛÙÔÓ ı‡ÌÔ ·‰¤Ó·

Î·È ÂÎÊÚ¿˙ÂÙ·È ·fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ ∆-ÏÂÌÊÔÎ˘ÙÙ¿-

ÚˆÓ. ∂›Ó·È ÌfiÚÈÔ ÚÔÛÎfiÏÏËÛË˜ Î·È ÂÈÏ¤ÔÓ ·›˙ÂÈ

ÚfiÏÔ ÛÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ ∆-ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ.

∂›ÛË˜, ÙÔ CD2 ÂÎÊÚ¿˙ÂÙ·È ÛÙ· ¡∫-Î‡ÙÙ·Ú· (21,22).

CD7: ¶ÚfiÎÂÈÙ·È ÁÈ· ÚˆÙÂ˝ÓË Ô˘ ·Ó‹ÎÂÈ ÛÙËÓ

˘ÂÚÔÈÎÔÁ¤ÓÂÈ· ÙˆÓ ·ÓÔÛÔÛÊ·ÈÚÈÓÒÓ ÌÂ ¿ÁÓˆÛÙË

ÏÂÈÙÔ˘ÚÁ›· Î·È ÂÎÊÚ¿˙ÂÙ·È ÛÂ ı˘ÌÔÎ‡ÙÙ·Ú·, ¡∫- Î·È

∆-ÏÂÌÊÔÎ‡ÙÙ·Ú·. ÃÚËÛÈÌÔÔÈÂ›Ù·È ˆ˜ ‰Â›ÎÙË˜ ÁÈ·

ÙË ‰È¿ÁÓˆÛË ÙË˜ ÔÍÂ›·˜ T-ÏÂÌÊÔÎ˘ÙÙ·ÚÈÎ‹˜ ÏÂ˘¯·È-

Ì›·˜. ∂›Ó·È Èı·Ófi Ó· ·›˙ÂÈ ÚfiÏÔ ÛÙË Ú‡ıÌÈÛË ÙË˜

ÔÓÙÔÁ¤ÓÂÛË˜ ÙˆÓ ¡∫∆- Î·È ÙˆÓ Ú˘ıÌÈÛÙÈÎÒÓ ∆-ÏÂÌ-

ÊÔÎ˘ÙÙ¿ÚˆÓ (23).

µ-ÏÂÌÊÔÎ‡ÙÙ·Ú·

∆· µ-ÏÂÌÊÔÎ‡ÙÙ·Ú· ·ÔÙÂÏÔ‡Ó ÙÔ 10-20% ÙÔ˘

ÔÏÈÎÔ‡ ·ÚÈıÌÔ‡ ÙˆÓ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ ÙÔ˘ ÂÚÈÊÂÚÈ-

ÎÔ‡ ·›Ì·ÙÔ˜. ∏ ·ÍÈÔÏfiÁËÛË ÙË˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘˜ Á›-

ÓÂÙ·È ÌÂ ÙË Ì¤ÙÚËÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ·ÓÔÛÔÛÊ·È-

ÚÈÓÒÓ (IgG, IgM, IgA) Î·È ÙË˜ ·ÓÙÈÛˆÌ·ÙÈÎ‹˜ ·¿-

ÓÙËÛË˜, ÂÓÒ Ë Ì¤ÙÚËÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙÔ˘˜ Á›ÓÂÙ·È ÌÂ

ÙË Ì¤ıÔ‰Ô ÙË˜ Î˘ÙÙ·ÚÔÌÂÙÚ›·˜ ÚÔ‹˜.

∆· ÌfiÚÈ· Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ˆ˜ ‰Â›ÎÙÂ˜ ÙˆÓ

µ-ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ ÛÂ ¤Ó·Ó ·ÓÔÛÔÊ·ÈÓfiÙ˘Ô Â›Ó·È

Ù· ·ÎfiÏÔ˘ı·:

∞Ú¯ÈÎfi˜ ¤ÏÂÁ¯Ô˜:

CD19: ¶ÚfiÎÂÈÙ·È ÁÈ· ÌfiÚÈÔ ÂÈÊ·ÓÂ›·˜ Û¯Â‰fiÓ

fiÏˆÓ ÙˆÓ µ-ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ Î·È ·›˙ÂÈ Û˘ÓÂÚÁÈÎfi

ÚfiÏÔ ÛÙËÓ ÂÓÂÚÁÔÔ›ËÛË ·˘ÙÒÓ (24,25).

CD20: ¶ÚˆÙÂ˝ÓË Ô˘ ÂÎÊÚ¿˙ÂÙ·È ÛÂ fiÏ· Ù· ÒÚÈ-

Ì· µ-ÏÂÌÊÔÎ‡ÙÙ·Ú· Î·È Ë ¤ÎÊÚ·Û‹ ÙÔ˘ ÛÙ·Ì·Ù¿

ÛÙÔ ÛÙ¿‰ÈÔ ÙË˜ ‰È·ÊÔÚÔÔ›ËÛË˜ ÙÔ˘ µ-ÏÂÌÊÔÎ˘Ù-

Ù¿ÚÔ˘ ÛÂ Ï·ÛÌ·ÙÔÎ‡ÙÙ·ÚÔ. ¶·›˙ÂÈ ÚfiÏÔ ÛÙËÓ

ÂÓÂÚÁÔÔ›ËÛË ‹ ÙË Ú‡ıÌÈÛË ÙˆÓ µ-ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ

Î·È ·ÔÙÂÏÂ› ‰›·˘ÏÔ ÈfiÓÙˆÓ ·Û‚ÂÛÙ›Ô˘. ∆· ÂÚÈÛ-

ÛfiÙÂÚ· µ-ÏÂÌÊÔÎ‡ÙÙ·Ú· Ô˘ ÌÂÙÚÒÓÙ·È ÛÙÔ ÂÚÈ-

ÊÂÚÈÎfi ·›Ì· Û˘ÓÂÎÊÚ¿˙Ô˘Ó Î·È ÙÔ CD19 Î·È ÙÔ

CD20 ÌfiÚÈÔ (26-28).

∂ÍÂÈ‰ÈÎÂ˘Ì¤ÓÔ˜ ¤ÏÂÁ¯Ô˜:

CD5: H ¤ÎÊÚ·ÛË ÙÔ˘ CD5 ÛÙ· µ-ÏÂÌÊÔÎ‡ÙÙ·Ú·

ÌÂÏÂÙ¿Ù·È ÛÙËÓ Î·ıËÌÂÚÈÓ‹ Ú¿ÍË, È‰›ˆ˜ ÛÙÔ Ï·›-

ÛÈÔ ÙË˜ ÌÂÏ¤ÙË˜ ÙË˜ ·˘ÙÔ·ÓÔÛ›·˜ Î·È ÙˆÓ ÌÂÙ·ÌÔ-

Û¯Â‡ÛÂˆÓ, fiÔ˘ Â›Ó·È Î·È ·˘ÍËÌ¤ÓË. ¶ÚfiÎÂÈÙ·È ÁÈ·

‰È·ÌÂÌ‚Ú·ÓÈÎ‹ ÁÏ˘ÎÔÚˆÙÂ˝ÓË Ô˘ Ê˘ÛÈÔÏÔÁÈÎ¿

˘¿Ú¯ÂÈ ÛÙ· ∆-ÏÂÌÊÔÎ‡ÙÙ·Ú· Î·È ›Ûˆ˜ ·›˙ÂÈ ÚfiÏÔ

ÛÙËÓ ·ÏÏËÏÂ›‰Ú·ÛË ÌÂÙ·Í‡ ∆- Î·È µ-Î˘ÙÙ¿ÚˆÓ. ∆Ô


¶·È‰È·ÙÚÈÎ‹ 2007;70:174-183


ÌfiÚÈÔ ·˘Ùfi ‹Ù·Ó ÁÓˆÛÙfi fiÙÈ ÂÎÊÚ¿˙ÂÙ·È ÛÂ Î·ÎÔ‹ıË

µ-ÏÂÌÊÔÎ‡ÙÙ·Ú· Î·È ·ÚÁfiÙÂÚ· ‚Ú¤ıËÎÂ fiÙÈ ˘¿Ú¯ÂÈ

ÛÂ ÌÈÎÚfi ÔÛÔÛÙfi Ê˘ÛÈÔÏÔÁÈÎÒÓ µ-ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ,

ÛÙ· ÔÔ›· ÌÂÏÂÙ¿Ù·È Ô È‰È·›ÙÂÚÔ˜ ÚfiÏÔ˜ ÙÔ˘ (30,31).

CD23: ∆Ô ÌfiÚÈÔ ·˘Ùfi Â›Ó·È ˘Ô‰Ô¯¤·˜ ¯·ÌËÏ‹˜

Û˘ÁÁ¤ÓÂÈ·˜ ÁÈ· ÙËÓ IgE ·ÓÔÛÔÛÊ·ÈÚ›ÓË (FcÂRIIb) Î·È

‰Ú· ˆ˜ Ú˘ıÌÈÛÙ‹˜ ÙˆÓ Û˘ÁÎÂÓÙÚÒÛÂÒÓ ÙË˜ (29).

¡∫-Î‡ÙÙ·Ú·

∆· ¡∫-Î‡ÙÙ·Ú· ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ÙËÓ ÈÎ·Ófi-

ÙËÙ¿ ÙÔ˘˜ Ó· Î·Ù·ÛÙÚ¤ÊÔ˘Ó Î‡ÙÙ·Ú· ÛÙfi¯Ô˘˜, ¯ˆ-

Ú›˜ ÙËÓ ·Ó¿ÁÎË ÚÔËÁÔ‡ÌÂÓË˜ ¤ÎıÂÛË˜ ÛÂ ·ÓÙÈÁfiÓÔ

Î·È ·ÔÙÂÏÔ‡Ó ÛËÌ·ÓÙÈÎfi ÎÔÌÌ¿ÙÈ ÙË˜ Ê˘ÛÈÎ‹˜ ·ÓÔ-

Û›·˜. ∂ÈÏ¤ÔÓ, Ù· ¡∫-Î‡ÙÙ·Ú· Â›Ó·È Ì›· ‚·ÛÈÎ‹

ËÁ‹ Î˘ÙÙ·ÚÔÎÈÓÒÓ, ÔÈ ÔÔ›Â˜ Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÙËÓ

¤Ó·ÚÍË ·ÓÔÛÔÏÔÁÈÎÒÓ ··ÓÙ‹ÛÂˆÓ ÌÂÙ¿ ·fi Î¿-

ÔÈÔ ·ÓÙÈÁÔÓÈÎfi ÂÚ¤ıÈÛÌ· (32). √È ‰Â›ÎÙÂ˜ ÂÈÊ·ÓÂ›-

·˜ ÙˆÓ ¡∫-Î˘ÙÙ¿ÚˆÓ Â›Ó·È ÔÈ ÂÍ‹˜:

CD16: ¶ÚfiÎÂÈÙ·È ÁÈ· ˘Ô‰Ô¯¤· ÙÔ˘ Fc ÙÌ‹Ì·ÙÔ˜

ÙË˜ IgG Ô˘ Â›Ó·È ˘Â‡ı˘ÓÔ˜ ÁÈ· ÙËÓ ÂÍ·ÚÙÒÌÂÓË

·fi ·ÓÙÈÛÒÌ·Ù· Î˘ÙÙ·ÚÔÙÔÍÈÎfiÙËÙ·. ∂ÎÙfi˜ ·fi Ù·

¡∫-Î‡ÙÙ·Ú·, ÙÔ CD16 ÌfiÚÈÔ ÂÎÊÚ¿˙ÂÙ·È ÛÂ Ì·ÎÚÔ-

Ê¿Á· Î·È Ô˘‰ÂÙÂÚfiÊÈÏ· (33).

CD56: ∂ÎÊÚ¿˙ÂÙ·È ÛÂ ¡∫-Î‡ÙÙ·Ú·, ÛÂ ÌÂÚÈÎ¿ ∆-

Î·È µ-Î‡ÙÙ·Ú· Î·È ÛÂ ÂÁÎÂÊ·ÏÈÎ¿ Î‡ÙÙ·Ú· (ÈÛfiÙ˘-

Ô˜ ÙÔ˘ ·ÓıÚÒÈÓÔ˘ ÌÔÚ›Ô˘ ÓÂ˘ÚÔÎ˘ÙÙ·ÚÈÎ‹˜ ÚÔ-

ÛÎfiÏÏËÛË˜). ™ÙËÓ Î˘ÙÙ·ÚÔÌÂÙÚ›· ÚÔ‹˜ ‰È·-

ÎÚ›ÓoÓÙ·È ‰‡Ô ÏËı˘ÛÌÔ› CD3-CD56+: Ô CD56dim, ÛÂ

ÔÛÔÛÙfi 90%, Ô ÔÔ›Ô˜ Â›Ó·È CD16+ Î·È ‰Ú· Î˘Ú›ˆ˜

Î˘ÙÙ·ÚÔÙÔÍÈÎ¿ Î·È Ô CD56bright, ÛÂ ÔÛÔÛÙfi 10%, Ô

ÔÔ›Ô˜ Â›Ó·È CD56+CD16- Î·È ÂÎÎÚ›ÓÂÈ Î˘ÙÙ·ÚÔÎ›ÓÂ˜

Ô˘ ÂÓÂÚÁÔÔÈÔ‡Ó Ù· ÌÔÓÔÎ‡ÙÙ·Ú· (33).

NKT-ÏÂÌÊÔÎ‡ÙÙ·Ú·

∆· ¡∫∆-ÏÂÌÊÔÎ‡ÙÙ·Ú· ÂÎÊÚ¿˙Ô˘Ó ÙfiÛÔ ‰Â›ÎÙÂ˜

∆-ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ (CD3, TCR), fiÛÔ Î·È ¡∫-Î˘ÙÙ¿-

ÚˆÓ (CD16). º·›ÓÂÙ·È Ó· ÂÌÏ¤ÎÔÓÙ·È ÛÙË Ú‡ıÌÈÛË

ÙË˜ ·ÓÔÛÈ·Î‹˜ ·¿ÓÙËÛË˜. ∆ÂÏÂ˘Ù·›·, ¤¯ÂÈ ‰ÔıÂ›

ÛËÌ·Û›· ÛÙËÓ ÔÌÔÈfiÙËÙ¿ ÙÔ˘˜ ÌÂ Ù· CD4+CD25+

Ú˘ıÌÈÛÙÈÎ¿ ÏÂÌÊÔÎ‡ÙÙ·Ú· (34).

™Â ·ÎfiÌË ÈÔ ÂÍÂÈ‰ÈÎÂ˘Ì¤ÓÂ˜ ‹ ·‰ÈÂ˘ÎÚ›ÓÈÛÙÂ˜

ÂÚÈÙÒÛÂÈ˜, ÂÏ¤Á¯ÔÓÙ·È ÂÚ·ÈÙ¤Úˆ ‰Â›ÎÙÂ˜ ÙˆÓ

ÏÂÌÊÔÎ˘ÙÙ·ÚÈÎÒÓ ÏËı˘ÛÌÒÓ, ÔÈ ÔÔ›ÔÈ Û˘Ì‚¿Ï-

ÏÔ˘Ó ÛÙË ‰È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË.

∏ ·Ó¿ÁÓˆÛË ÙË˜ ·¿ÓÙËÛË˜ ÙÔ˘

·ÓÔÛÔÊ·ÈÓfiÙ˘Ô˘

°È· ÙËÓ Î·Ù·ÓfiËÛË ÙÔ˘ ÙÚfiÔ˘ ·ÚÔ˘Û›·ÛË˜

ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ Î·È ÙËÓ Ù·ÍÈÓfiÌËÛË ÙˆÓ ‰Â‰Ô-

Ì¤ÓˆÓ, ı· ÌÔÚÔ‡Û·Ó Ó· ·ÎÔÏÔ˘ıËıÔ‡Ó Ù· ·Ú·Î¿-

Ùˆ ‚‹Ì·Ù·:

·) ∂Ï¤Á¯ÂÙ·È Ë ÁÂÓÈÎ‹ ÂÍ¤Ù·ÛË ·›Ì·ÙÔ˜ ÙÔ˘ ·ÛıÂ-

ÓÔ‡˜. ∂ÎÙfi˜ ·fi ÙË ÁÂÓÈÎfiÙÂÚË ·ÈÌ·ÙÔÏÔÁÈÎ‹ ÂÈÎfiÓ·,

È‰È·›ÙÂÚ· ÂÓ‰È·Ê¤ÚÂÈ Ô ·fiÏ˘ÙÔ˜ ·ÚÈıÌfi˜ ÙˆÓ ÏÂÌ-

ÊÔÎ˘ÙÙ¿ÚˆÓ, ‰Â‰ÔÌ¤ÓÔ˘ fiÙÈ Ë ÏÂÌÊÔÂÓ›· ·ÔÙÂÏÂ›

‚·ÛÈÎfi ‰È·ÁÓˆÛÙÈÎfi ÎÚÈÙ‹ÚÈÔ ÙˆÓ ·ÓÔÛÔ·ÓÂ·ÚÎÂÈ-

ÒÓ (37). ∂›ÛË˜, ı· Ú¤ÂÈ Ó· ÂÏ¤Á¯ÂÙ·È Ì‹ˆ˜ Ì›·

Ù˘¯fiÓ ·fiÎÏÈÛË ÙÔ˘ ÔÛÔÛÙÔ‡ ÂÓfi˜ ÏËı˘ÛÌÔ‡ ·fi

ÙÔ Ê˘ÛÈÔÏÔÁÈÎfi ·ÔÙÂÏÂ› ·ÏÒ˜ ·ÚÈıÌËÙÈÎ‹ Ï¿ÓË,

ÏfiÁˆ ÙË˜ ÌÂÙ·‚ÔÏ‹˜ ÂÓfi˜ ¿ÏÏÔ˘ ÏËı˘ÛÌÔ‡.

‚) ∞Ó·ÁÓˆÚ›˙ÂÙ·È Ô ÂÎ¿ÛÙÔÙÂ ÏËı˘ÛÌfi˜ ÁÈ· ÙÔÓ

ÔÔ›Ô ‰›ÓÔÓÙ·È Ù· ·ÔÙÂÏ¤ÛÌ·Ù·. ∂ÎÙfi˜ ·fi ÙÔ˘˜ ‚·-

ÛÈÎÔ‡˜ ÏËı˘ÛÌÔ‡˜ ÙˆÓ ÔÔ›ˆÓ Ô Û˘Ì‚ÔÏÈÛÌfi˜ Â›Ó·È

·Ïfi˜ (CD3+, CD4+, CD8+, CD19+/20+, CD16+/56+),

ÛÙËÓ ·¿ÓÙËÛË ·Ó·Ê¤ÚÔÓÙ·È Î·È ‰È¿ÊÔÚÔÈ ˘ÔÏË-

ı˘ÛÌÔ› ÙÔ˘˜, ÛÙËÓ ÔÓÔÌ·ÙÔÏÔÁ›· ÙˆÓ ÔÔ›ˆÓ ·Ó·ÁÚ¿-

ÊÂÙ·È ÚÒÙÔ˜ Ô ‚·ÛÈÎfi˜ ÏËı˘ÛÌfi˜ fiÔ˘ ·Ó‹ÎÔ˘Ó.

°È· ·Ú¿‰ÂÈÁÌ·, Ë ¤ÎÊÚ·ÛË CD3+CD4+ Û˘Ì‚ÔÏ›˙ÂÈ Ù·

∆-ÏÂÌÊÔÎ‡ÙÙ·Ú· Ô˘ ÂÎÊÚ¿˙Ô˘Ó ÙÔ CD4 ÌfiÚÈÔ.

Á) √È ÙÈÌ¤˜ ÙˆÓ ‰È·ÊfiÚˆÓ ÏËı˘ÛÌÒÓ ÂÏ¤Á¯Ô-

ÓÙ·È ÌÂ ‚¿ÛË Ù· Ê˘ÛÈÔÏÔÁÈÎ¿ ÁÈ· ÙËÓ ËÏÈÎ›· ÙÔ˘ ·È-

‰ÈÔ‡ Â›Â‰·, Ï·Ì‚¿ÓÔÓÙ·˜ ˘’ fi„ÈÓ ÙËÓ Â›‰Ú·ÛË

ÙË˜ ÂıÓÈÎfiÙËÙ·˜, Ë ÔÔ›· ÛÂ ÔÚÈÛÌ¤ÓÂ˜ ÂÚÈÙÒÛÂÈ˜

Â›Ó·È ÛËÌ·ÓÙÈÎ‹ (35,36) (¶›Ó·ÎÂ˜ 1 Î·È 2).

‰) ÀÔÏÔÁ›˙ÂÙ·È Ô ÏfiÁÔ˜ CD4+/CD8+, Ô ÔÔ›Ô˜

Ú¤ÂÈ Ó· Â›Ó·È >1 (36).

Â) ÀÔÏÔÁ›˙ÂÙ·È Ô ÏfiÁÔ˜ CD4+CD45RA+/

CD4+CD45RO+, Ô ÔÔ›Ô˜ Â›Ó·È ·ÓÙÈÛÙÚfiÊˆ˜ ·Ó¿ÏÔÁÔ˜

ÙË˜ ËÏÈÎ›·˜ Î·È ÛÙ· ·È‰È¿ Ú¤ÂÈ Ó· Â›Ó·È >1 (36).

ÛÙ) ªÂ ·Ï¤˜ ·ÚÈıÌËÙÈÎ¤˜ Ú¿ÍÂÈ˜ ÌÔÚÂ› Ó·

ÂÏÂÁ¯ıÂ› Ë ‡·ÚÍË ·ıÔÏÔÁÈÎÒÓ ÏËı˘ÛÌÒÓ. √È ‚·-

ÛÈÎfiÙÂÚÂ˜ ÂÚÈÁÚ¿ÊÔÓÙ·È ·Ú·Î¿Ùˆ Î·È ·ÊÔÚÔ‡Ó

ÛÙ· ÔÛÔÛÙ¿ ÙˆÓ ÏËı˘ÛÌÒÓ:

i) CD3+ + CD19+ + CD16+ ≈ 100

∆Ô ¿ıÚÔÈÛÌ· ÙˆÓ Î˘ÚÈfiÙÂÚˆÓ ÏÂÌÊÔÎ˘ÙÙ·ÚÈÎÒÓ

˘ÔÏËı˘ÛÌÒÓ ı· Ú¤ÂÈ Ó· Î·Ï‡ÙÂÈ ÙÔ Û‡ÓÔÏÔ

ÙˆÓ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ (100%) (38). ∏ Î˘ÚÈfiÙÂÚË ·ÈÙ›·

·fiÎÏÈÛË˜ ÚÔ˜ Ù· Î¿Ùˆ Â›Ó·È Ë ‡·ÚÍË ÂÚ˘ıÚÔ-

‚Ï·ÛÙÒÓ, ÔÈ ÔÔ›ÔÈ ÂÎÏ·Ì‚¿ÓÔÓÙ·È ·fi ÙÔÓ ·Ó·Ï˘Ù‹

ˆ˜ ÏÂÌÊÔÎ‡ÙÙ·Ú·, Ê·ÈÓfiÌÂÓÔ Û˘¯Ófi ÛÂ ÓÂÔÁÓ¿ Î·È

ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ·ÈÌÔÛÊ·ÈÚÈÓÔ¿ıÂÈÂ˜. ŸÔÙÂ ÚÔÎ‡-

ÙÂÈ ÙÔ Úfi‚ÏËÌ· ·˘Ùfi, Â›ÙÂ ÂÏ¤Á¯ÂÙ·È Ô ‰Â›ÎÙË˜

CD45, Ô ÔÔ›Ô˜ Â›Ó·È ¯·Ú·ÎÙËÚÈÛÙÈÎfi˜ ÙË˜ ÏÂ˘Î‹˜

ÛÂÈÚ¿˜ Î·È fi¯È ÙˆÓ ÂÚ˘ıÚÔ‚Ï·ÛÙÒÓ, Â›ÙÂ Á›ÓÂÙ·È

ÂÍ·Ú¯‹˜ ‰È·ÊÔÚÂÙÈÎ‹ Î·ÙÂÚÁ·Û›· ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜

(1,39). ∂¿Ó ·ÔÎÏÂÈÛÙÂ› ÙÔ ÂÓ‰Â¯fiÌÂÓÔ ‡·ÚÍË˜

ÂÚ˘ıÚÔ‚Ï·ÛÙÒÓ, ÙfiÙÂ Èı·ÓfiÙ·Ù· ÚfiÎÂÈÙ·È ÁÈ· ·-

ıÔÏÔÁÈÎfi ÏËı˘ÛÌfi. ™Â ÂÚ›ÙˆÛË ˘¤ÚÌÂÙÚË˜ ·‡-

ÍËÛË˜ ÙÔ˘ ÏËı˘ÛÌÔ‡ ÙˆÓ ¡∫∆-Î˘ÙÙ¿ÚˆÓ ı· ·Ú·-

ÙËÚËıÂ› ·‡ÍËÛË ÙÔ˘ ÂÓ ÏfiÁˆ ·ıÚÔ›ÛÌ·ÙÔ˜.

ii) CD4+ + CD8+ ≈ CD3+-TCRÁ‰+

ŸÏ· Ù· Ê˘ÛÈÔÏÔÁÈÎ¿ TCR·‚+ Î‡ÙÙ·Ú· ÂÎÊÚ¿-

˙Ô˘Ó ÛÙËÓ ÂÈÊ¿ÓÂÈ¿ ÙÔ˘˜ Â›ÙÂ ÙÔÓ CD4 Â›ÙÂ ÙÔÓ

CD8 ‰Â›ÎÙË, ÂÓÒ Ù· ÂÚÈÛÛfiÙÂÚ· TCRÁ‰+ Û˘¯Ó¿ ‰ÂÓ

ÂÎÊÚ¿˙Ô˘Ó Î·Ó¤Ó·Ó ·fi ÙÔ˘˜ ‰‡Ô (38).

∂¿Ó CD4++CD8+>CD3+-TCRÁ‰+, ·Ú¯ÈÎ¿ Ú¤ÂÈ

178 º. ∆˙ÈÊ‹ Î·È Û˘Ó.



Ó· ÂÏÂÁ¯ıÂ› ÙÔ ÂÓ‰Â¯fiÌÂÓÔ ÙË˜ ¤ÎÊÚ·ÛË˜ ÙÔ˘ CD8

Â›ÙÂ ÛÙ· TCRÁ‰+ ÏÂÌÊÔÎ‡ÙÙ·Ú· (‰ËÏ·‰‹ ˘„ËÏÔ‡

ÔÛÔÛÙÔ‡ CD3+CD8+TCRÁ‰+ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ) (40),

Â›ÙÂ ÛÙ· ¡∫-Î‡ÙÙ·Ú· (˘„ËÏÔ‡ ÔÛÔÛÙÔ‡ CD3-

CD8+CD16+) (32) Î·È ÛÙË Û˘Ó¤¯ÂÈ·, Ë Èı·ÓfiÙËÙ·

‡·ÚÍË˜ ·ıÔÏÔÁÈÎÔ‡ ÏËı˘ÛÌÔ‡ ‰ÈÏ¿ ıÂÙÈÎÒÓ

CD3+CD4+CD8+ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ.

∂¿Ó CD4++CD8+<CD3+-TCRÁ‰+, ̆ Ê›ÛÙ·Ù·È ÙÔ ÂÓ-

‰Â¯fiÌÂÓÔ ‡·ÚÍË˜ Â›ÙÂ ·ıÔÏÔÁÈÎÔ‡ ÏËı˘ÛÌÔ‡ ‰È-

Ï¿ ·ÚÓËÙÈÎÒÓ CD3+TCR·‚+CD4-CD8- ÏÂÌÊÔÎ˘ÙÙ¿-

ÚˆÓ ‹ ÌÂÁ¿ÏÔ˘ ÔÛÔÛÙÔ‡ ¡∫∆-Î˘ÙÙ¿ÚˆÓ (34).

∂¿Ó ÛÙËÓ ·¿ÓÙËÛË ‰ÂÓ ·Ó·Ê¤ÚÂÙ·È ÙÔ ÔÛÔÛÙfi

ÙˆÓ TCRÁ‰+ Î˘ÙÙ¿ÚˆÓ, ÙfiÙÂ ÙÔ ¿ıÚÔÈÛÌ· ÙˆÓ CD4+

Î·È ÙˆÓ CD8+ ı· Ú¤ÂÈ Ó· Â›Ó·È Ï›ÁÔ ÌÈÎÚfiÙÂÚÔ ·fi

ÂÎÂ›ÓÔ ÙˆÓ CD3+.

√È ÏÂÌÊÔÎ˘ÙÙ·ÚÈÎÔ› ˘ÔÏËı˘ÛÌÔ› ÙÔ˘

ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜ ÛÙÈ˜ ÚˆÙÔ·ıÂ›˜

·ÓÔÛÔ·ÓÂ¿ÚÎÂÈÂ˜

ªÂÙ¿ ÙËÓ ·Ó¿ÁÓˆÛË ÙÔ˘ ·ÔÙÂÏ¤ÛÌ·ÙÔ˜, ÛÂÈÚ¿

¤¯ÂÈ Ë ·ÍÈÔÏfiÁËÛË ÙˆÓ ÏÂÌÊÔÎ˘ÙÙ·ÚÈÎÒÓ ÏËı˘-

ÛÌÒÓ, Ë ÔÔ›· Á›ÓÂÙ·È ¿ÓÙ· ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ÙËÓ

¶›Ó·Î·˜ 2. ∞fiÏ˘ÙÂ˜ ÙÈÌ¤˜ (·ÚÈıÌfi˜ Î˘ÙÙ¿ÚˆÓ 10-3/Ìl) ÙˆÓ ˘ÔÏËı˘ÛÌÒÓ ÙˆÓ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ ˘ÁÈÒÓ ·È‰ÈÒÓ. ∫·Ù·ÓÔÌ‹ Î·Ù¿ ËÏÈÎ›· ÛÙËÏÂ˘Î‹ Ê˘Ï‹ (36).

ÀÔÏËı˘ÛÌfi˜ 0-3 ÌËÓÒÓ 3-6 ÌËÓÒÓ 6-12 ÌËÓÒÓ 1-2 ÂÙÒÓ 2-6 ÂÙÒÓ 6-12 ÂÙÒÓ 12-18 ÂÙÒÓ

CD3+ 3,68 3,93 3,93 3,55 2,39 1,82 1,48(2,5-5,5) (2,5-5,6) (1.9-5,9) (2,1-6,2) (1,4-3,7) (1,2-2,6) (1,0-2,2)

CD4+ 2,61 2,85 2,67 2,16 1,38 0,98 0,84(1,6-4,0) (1,8-4,0) (1,4-4,3) (1,3-3,4) (0,7-2,2) (0,65-1,5) (0,53-1,3)

CD8+ 0,98 1,05 1,04 1,04 0,84 0,68 0,53(0,56-1,7) (0,59-1,6) (0,5-1,7) (0,62-2) (0,49-1,3) (0,37-1,1) (0,33-0,92)

CD4+CD45RA+ 2,27 2,32 2,21 1,65 0,98 0,57 0,4(1,2-3,7) (1,3-3,7) (1,1-3,7) (1,0-2,9) (0,43-1,5) (0,32-1,0) (0,23-0,77)

CD4+CD45RO+ 0,32 0,33 0,34 0,4 0,36 0,35 0,38(0,06-0,9) (0,12-0,63) (0,16-0,8) (0,21-0,85) (0,22-0,66) (0,23-0,63) (0,24-0,7)

CD4+HLA-DR+ 0,1 0,15 0,12 0,13 0,09 0,07 0,06(0,04-0,18) (0,06-0,28) (0,05-0,26) (0,07-0,28) (0,05-0,18) (0,04-0,12) (0,03-1)

CD8+HLA-DR+ 0,05 0,08 0,09 0,18 0,14 0,09 0,07(0,02-0,16) (0,03-0,17) (0,04-0,29) (0,06-0,6) (0,07-0,42) (0,04-0,27) (0,03-0,18)

CD19+ 0,73 1,55 1,52 1,31 0,75 0,48 0,3(0,3-2,0) (0,43-3) (0,61-2,6) (0,72-2,6) (0,39-1,4) (0,27-0,86) (0,11-0,57)

CD16+/CD56+ 0,42 0,42 0,4 0,36 0,3 0,23 0,3(0,17-1,1) (0,17-0,83) (0,16-0,95) (0,18-0,92) (0,13-0,72) (0,1-0,48) (0,11-0,57)

¶›Ó·Î·˜ 1. ∂Î·ÙÔÛÙÈ·›Â˜ ·Ó·ÏÔÁ›Â˜ (%) ÙˆÓ ˘ÔÏËı˘ÛÌÒÓ ÙˆÓ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ ˘ÁÈÒÓ ·È‰ÈÒÓ. ∫·Ù·ÓÔÌ‹ Î·Ù¿ ËÏÈÎ›· ÛÙË ÏÂ˘Î‹ Ê˘Ï‹ (36).

ÀÔÏËı˘ÛÌfi˜ 0-3 ÌËÓÒÓ 3-6 ÌËÓÒÓ 6-12 ÌËÓÒÓ 1-2 ÂÙÒÓ 2-6 ÂÙÒÓ 6-12 ÂÙÒÓ 12-18 ÂÙÒÓ

CD3+ 73% 66% 65% 65% 66% 69% 73%(53-84) (51-77) (49-76) (53-75) (56-75) (60-76) (56-84)

CD4+ 52% 46% 46% 41% 38% 37% 41%(35-64) (35-56) (31-56) (32-51) (28-47) (31-47) (31-52)

CD8+ 18% 16% 17% 20% 23% 25% 26%(12-28) (12-23) (12-24) (14-30) (16-30) (18-35) (18-35)

CD4+CD45RA+ 90% 90% 86% 81% 71% 59% 53%(64-95) (77-94) (64-93) (63-91) (53-86) (46-77) (33-66)

CD4+CD45RO+ 10% 8% 9% 12% 16% 21% 28%(02-22) (03-16) (05-18) (07-20) (09-26) (13-30) (18-38)

CD4+HLA-DR+ 3% 5% 5% 6% 7% 6% 7%(02-06) (02-10) (02-11) (02-11) (03-12) (03-13) (04-11)

CD8+HLA-DR+ 5% 7% 10% 16% 16% 12% 12%(02-20) (03-17) (04-27) (06-33) (07-37) (06-29) (05-25)

CD19+ 15% 25% 24% 25% 21% 18% 14%(06-32) (11-41) (14-37) (16-35) (14-33) (13-27) (06-23)

CD16+/CD56+ 8% 6% 7% 7% 9% 9% 9%(04-18) (03-14) (03-15) (03-15) (04-17) (04-17) (03-22)


¶·È‰È·ÙÚÈÎ‹ 2007;70:174-183


ÎÏÈÓÈÎ‹ Î·È ÂÚÁ·ÛÙËÚÈ·Î‹ ÂÈÎfiÓ·. ∏ ÌÂÏ¤ÙË ÙˆÓÏÂÌÊÔÎ˘ÙÙ·ÚÈÎÒÓ ÏËı˘ÛÌÒÓ Û˘Ì‚¿ÏÏÂÈ ÛÙË ‰È¿-ÁÓˆÛË ÙˆÓ ÚˆÙÔ·ıÒÓ ·ÓÔÛÔ·ÓÂ·ÚÎÂÈÒÓ Î·ÈÛÙËÓ Ù·ÍÈÓfiÌËÛ‹ ÙÔ˘˜. ¶·Ú·Î¿Ùˆ ·Ó·Ê¤ÚÔÓÙ·È ÔÈ¯·Ú·ÎÙËÚÈÛÙÈÎfiÙÂÚÂ˜ ‰È·Ù·Ú·¯¤˜ ÙˆÓ ÏÂÌÊÔÎ˘Ù-Ù·ÚÈÎÒÓ ÏËı˘ÛÌÒÓ ÛÙÈ˜ Î˘ÚÈfiÙÂÚÂ˜ ·ÓÔÛÔ·ÓÂ-¿ÚÎÂÈÂ˜ (37,41-43), ÌÂ ‚¿ÛË ÙË ‰ÈÂıÓÒ˜ ÈÛ¯‡Ô˘Û·Ù·ÍÈÓfiÌËÛË (41) (∂ÈÎfiÓ· 3).

™ËÌ·ÓÙÈÎ‹ ÌÂ›ˆÛË ∆- Î·È µ-ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ: ∏ ‚·-ÚÈ¿ Û˘Ó‰˘·ÛÌ¤ÓË ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ· (SCID) ÌÂ ÂÎ-ÛÂÛËÌ·ÛÌ¤ÓË ÌÂ›ˆÛË Î·È ÙˆÓ ‰‡Ô ·˘ÙÒÓ ÏËı˘-ÛÌÒÓ ÔÊÂ›ÏÂÙ·È Û˘ÓËı¤ÛÙÂÚ· ÛÂ ‰È·Ù·Ú·¯‹ ÛÙÔÂ›Â‰Ô ÙÔ˘ ·Ó·Û˘Ó‰˘·ÛÌÔ‡ ÙˆÓ ÁÔÓÈ‰›ˆÓ ÙÔ˘ TCRÎ·È ÙˆÓ ·ÓÔÛÔÛÊ·ÈÚÈÓÒÓ Î·È Î˘Ú›ˆ˜ ÛÂ ÌÂÙ·ÏÏ¿ÍÂÈ˜ÙˆÓ ÁÔÓÈ‰›ˆÓ ÙˆÓ ÂÓ˙‡ÌˆÓ RAG1 ‹ RAG2. ™ÙËÓ ·ÓÂ-¿ÚÎÂÈ· ÙË˜ ··ÌÈÓ¿ÛË˜ ÙË˜ ·‰ÂÓÔÛ›ÓË˜ (ADA ·ÓÂ-¿ÚÎÂÈ·), ÂËÚÂ¿˙ÔÓÙ·È Î·È ÔÈ ‰‡Ô ·˘Ù¤˜ Î˘ÙÙ·ÚÈ-Î¤˜ ÛÂÈÚ¤˜, ·ÏÏ¿ Ë ÌÂ›ˆÛ‹ ÙÔ˘˜ Â›Ó·È ÚÔÔ‰Â˘ÙÈÎ‹.

™ËÌ·ÓÙÈÎ‹ ÌÂ›ˆÛË ÙˆÓ ∆-ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ ÌÂ Ê˘ÛÈÔ-

ÏÔÁÈÎ¿ ‹ ·˘ÍËÌ¤Ó· µ-ÏÂÌÊÔÎ‡ÙÙ·Ú·: ™ÙËÓ ÂÚ›ÙˆÛË

·˘Ù‹ ı· Ú¤ÂÈ Ó· ÂÏ¤Á¯ÂÙ·È Ô ·ÚÈıÌfi˜ ÙˆÓ ¡∫-Î˘Ù-

Ù¿ÚˆÓ. ™˘Ó‰˘·ÛÌ¤ÓË ÌÂ›ˆÛË ÙˆÓ ∆- Î·È ÙˆÓ ¡∫-Î˘Ù-

Ù¿ÚˆÓ Û˘ÓËı¤ÛÙÂÚ· ÔÊÂ›ÏÂÙ·È ÛÂ ‰È·Ù·Ú·¯‹ ÙË˜ ÎÔÈ-

Ó‹˜ Á-·Ï˘Û›‰·˜ ÙˆÓ ˘Ô‰Ô¯¤ˆÓ ÙˆÓ IL-4, IL-7, IL-9

Î·È IL-15 ‹ ÛÂ ÌÂÙ·ÏÏ¿ÍÂÈ˜ ÙÔ˘ ÁÔÓÈ‰›Ô˘ ÙË˜ ÎÈÓ¿ÛË˜

Jak3. ªÂÌÔÓˆÌ¤ÓË ÂÍ·Ú¯‹˜ ÌÂ›ˆÛË ÙˆÓ ∆-ÏÂÌÊÔÎ˘Ù-

Ù¿ÚˆÓ ÌÔÚÂ› Ó· ÔÊÂ›ÏÂÙ·È ÛÂ ÁÂÓÂÙÈÎ¤˜ ‰È·Ù·Ú·¯¤˜

ÙÔ˘ ˘Ô‰Ô¯¤· ÙË˜ IL-7, ÙÔ˘ CD45 ‹ ÙË˜ ‰ ·Ï˘Û›‰·˜

ÙÔ˘ CD3. ¶ÚÔÔ‰Â˘ÙÈÎ‹ ÌÂ›ˆÛË ÙˆÓ ∆-ÏÂÌÊÔÎ˘ÙÙ¿-

ÚˆÓ ·Ú·ÙËÚÂ›Ù·È Î·È ÛÙËÓ ·ÓÂ¿ÚÎÂÈ· PNP, ÛÙÔ Û‡Ó-

‰ÚÔÌÔ Wiskott-Aldrich Î·È ÛÙËÓ ·Ù·Í›·-ÙËÏ·ÁÁÂÈÂ-

ÎÙ·Û›·. ™ÙÔ Û‡Ó‰ÚÔÌÔ Di George, ÙÔ ÔÔ›Ô Û˘¯Ó¿ Â-

ÚÈÏ·Ì‚¿ÓÂÈ Î·È ÔÈÎ›ÏÔ˘ ‚·ıÌÔ‡ ‰È·Ù·Ú·¯‹ ÙË˜ ·Ó¿-

Ù˘ÍË˜ ÙÔ˘ ı‡ÌÔ˘, ·Ú·ÙËÚÂ›Ù·È ÔÈÎ›ÏÔ˘ ‚·ıÌÔ‡

ÌÂÌÔÓˆÌ¤ÓË ÌÂ›ˆÛË ÙˆÓ ˆÚ›ÌˆÓ ∆-ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ,

ÌÂ Ù¿ÛË ÁÈ· ÚÔÔ‰Â˘ÙÈÎ‹ ÔÏÈÁÔÎÏˆÓÈÎ‹ ·‡ÍËÛË (42).

ª˘ÂÏfi˜

£‡ÌÔ˜

XLA (·ÓÂ¿ÚÎÂÈ· Btk)

·) SCID ÌÂ ÌÂÙ¿ÏÏ·ÍË

ÛÙÔ RAG ÁÔÓ›‰ÈÔ

‚) ™‡Ó‰ÚÔÌÔ √ª∂¡

¢ÈÎÙ˘ˆÙ‹

¢˘ÛÁÂÓÂÛ›·

·Ú¯¤ÁÔÓÔ

·ÈÌÔÔÈËÙÈÎfi

Î‡ÙÙ·ÚÔ

§ÂÌÊÈÎfi

ÚÔÁÔÓÈÎfi

Î‡ÙÙ·ÚÔ/

HLA-DR,

CD34,

CD117

Pro-B Î‡ÙÙ·ÚÔ,

Tdt, CD34,

CD10, cCD79a

¶ÚÔı˘ÌÔ-

Î‡ÙÙ·ÚÔ

Tdt, CD34,

CD44∞ÓÒÚÈÌÔ

ı˘ÌÔÎ‡ÙÙ·ÚÔ

pre-TCR,

Tdt, CD44,

CD25, CD4

ÒÚÈÌÔ

ı˘ÌÔÎ‡ÙÙ·ÚÔ,

CD4

TCR CD3

ÒÚÈÌÔ

ı˘ÌÔÎ‡ÙÙ·ÚÔ

CD8 TCR

CD3

ÎÔÈÓfi

ı˘ÌÔ-

Î‡ÙÙ·ÚÔ,

Tdt, cCD3,

CD4/CD8

∞ÓÒÚÈÌÔ

ı˘ÌÔÎ‡ÙÙ·ÚÔ,

pre-TCR,

Tdt, CD25,

CD4


ÛÙÔ RAG ÁÔÓ›‰ÈÔ

‚) ™‡Ó‰ÚÔÌÔ DiGeorge


ÙË˜ ÎÔÈÓ‹˜ Á ·Ï˘Û›‰·˜

‚) SCID ÌÂ Jak3

ÌÂÙ¿ÏÏ·ÍË

∞ÓÂ¿ÚÎÂÈ· ÙË˜ ‚ ·Ï˘Û›‰·˜ ÙÔ˘

˘Ô‰Ô¯¤· ÙË˜ IL 12 ∞ÓÂ¿ÚÎÂÈ· ÙÔ˘

˘Ô‰Ô¯¤· ÙË˜ π¡FÁ

∞ÓÂ¿ÚÎÂÈ· ÙÔ˘

HLA-II ‹ Û‡Ó‰ÚÔÌÔ

ÙÔ˘ Á˘ÌÓÔ‡

ÏÂÌÊÔÎ˘ÙÙ¿ÚÔ˘

·) ∞ÓÂ¿ÚÎÂÈ· ADA,

PNP

‚) ∞ÓÂ¿ÚÎÂÈ· ZAP70

Pre-B2 Î‡ÙÙ·ÚÔ,

CD10, CD19,

pre-BCR

Pre-B1 Î‡ÙÙ·ÚÔ, Tdt,

CD34, CD10, cCD79a,

CD19

™‡Ó‰ÚÔÌÔ À¤Ú-IgM

IgM

IgG

IgA

IgE

πg∞ ·ÓÂ¿ÚÎÂÈ·

ÚÒÈÌÔ

µ-Î‡ÙÙ·ÚÔ

CD10/

CD19

¶ÂÚÈÊÂÚÈÎfi ∞›Ì· Î·È§ÂÌÊÈÎfi˜ πÛÙfi˜

ÂÓ‰È¿ÌÂÛÔ

µ-Î‡ÙÙ·ÚÔ,

CD19, CD20

ÒÚÈÌÔ

µ-Î‡ÙÙ·ÚÔ,

CD19, CD20

·ÓÔÛÔ‚Ï¿ÛÙË

CD19, CD20Ï·ÛÌ·ÙÔÎ‡ÙÙ·ÚÔ

IL-12RIL-12

INFÁRINFÁ

‚ÔËıËÙÈÎfi

∆-Î‡ÙÙ·ÚÔ

CD4CD3 APS

HLA-II

Î˘ÙÙ·ÚÔÙÔÍÈÎfi

Î·Ù·ÛÙ·ÏÙÈÎfi

∆-Î‡ÙÙ·ÚÔ CD8 CD3

∂ÈÎfiÓ· 3. √È Î˘ÚÈfiÙÂÚÂ˜ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈÂ˜ Ô˘ ·Ú·ÙËÚÔ‡ÓÙ·È ÏfiÁˆ ÁÂÓÂÙÈÎÔ‡ ÂÏÏÂ›ÌÌ·ÙÔ˜ ÛÙË ‰È·‰ÈÎ·Û›· ‰È·ÊÔÚÔÔ›ËÛË˜ Î·È ÂÍ¤-ÏÈÍË˜ ÙÔ˘ ÏÂÌÊÔÎ˘ÙÙ¿ÚÔ˘ ÛÙÔÓ Ì˘ÂÏfi Î·È ÛÙÔÓ ı‡ÌÔ (36).SCID: µ·ÚÈ¿ ™˘Ó‰˘·ÛÌ¤ÓË ∞ÓÔÛÔ·ÓÂ¿ÚÎÂÈ· (Severe Combined Immunodeficiency), XLA: º˘ÏÔÛ‡Ó‰ÂÙË ̆ ÔÁ·ÌÌ·ÛÊ·ÈÚÈÓ·ÈÌ›·, Btk:T˘ÚÔÛÈÓÈÎ‹ ÎÈÓ¿ÛË Bruton (Bruton tyrosine kinase), PNP: ¶Ô˘ÚÈÓÈÎ‹ ÊˆÛÊÔÚ˘Ï¿ÛË (Purine phoshorylase), ADA: ∞·ÌÈÓ¿ÛË ÙË˜ ·‰Â-ÓÔÛ›ÓË˜ (Adenosine deaminase), Jak3: ∫ÈÓ¿ÛË Ô˘ Û˘Ó‰¤ÂÙ·È ÌÂ ÙËÓ Á ·Ï˘Û›‰· Î·È ÛÂ ·ÓÂ¿ÚÎÂÈ· ÙË˜ ÎÈÓ¿ÛË˜ ·˘Ù‹˜ ÂÌÊ·Ó›˙ÂÙ·È ˘Ô-ÏÂÈfiÌÂÓÔ ·˘ÙÔÛˆÌ·ÙÈÎfi SCID, RAG: °ÔÓ›‰È· ÂÓÂÚÁÔÔ›ËÛË˜ ·Ó·Û˘Ó‰˘·ÛÌÔ‡ (Recombination-activating genes), ZAP70: ∆˘ÚÔÛÈÓÈÎ‹ÎÈÓ¿ÛË Ô˘ Û˘Ó‰¤ÂÙ·È ÌÂ ÙËÓ ˙ ·Ï˘Û›‰· ÙÔ˘ TCR Û˘ÌÏ¤ÁÌ·ÙÔ˜ Î·È Â›Ó·È ÛËÌ·ÓÙÈÎ‹ ÁÈ· ÙËÓ ÚÒÈÌË ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ ÏÂÌÊÔÎ˘ÙÙ¿-ÚˆÓ, IL-1: πÓÙÂÚÏÂ˘Î›ÓË 1, INF-Á: πÓÙÂÚÊÂÚfiÓË Á, INF-ÁR: ÀÔ‰Ô¯¤·˜ ÙË˜ INF-Á, Pre-TCR: ¶Úfi‰ÚÔÌË ÌÔÚÊ‹ ÙÔ˘ TCR Î·Ù¿ ÙËÓ ˆÚ›-Ì·ÓÛË ÙˆÓ ∆ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ, Tdt: ∆ÂÏÈÎ‹ ‰ÂÔÍ˘ÚÈ‚ÔÓÔ˘ÎÏÂÔÙÈ‰ÈÎ‹ ÙÚ·ÓÛÊÂÚ¿ÛË (terminal deoxyribonucleotidyl transferase)

180 º. ∆˙ÈÊ‹ Î·È Û˘Ó.



ªÂÌÔÓˆÌ¤ÓË ¤ÏÏÂÈ„Ë ÙˆÓ CD4+ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ ·-Ú·¤ÌÂÈ ÛÂ ·ÓÂ¿ÚÎÂÈ· ÙˆÓ ÌÔÚ›ˆÓ MHC Ù¿ÍË˜ ππ,ÂÓÒ ÌÂÌÔÓˆÌ¤ÓË ¤ÏÏÂÈ„Ë ÙˆÓ CD8+ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ ÌÔ-ÚÂ› Ó· ÔÊÂ›ÏÂÙ·È ÛÂ ‰È·Ù·Ú·¯‹ ÙË˜ ÌÂÙ¿‰ÔÛË˜ Û‹Ì·-ÙÔ˜ Ì¤Ûˆ ÙÔ˘ TCR (·ÓÂ¿ÚÎÂÈ· ÙˆÓ ÌÔÚ›ˆÓ CD8,ZAP-70, TAP-1 ‹ TAP-2) (41). ™Â ·‡ÍËÛË ÙˆÓ ‰ÈÏ¿·ÚÓËÙÈÎÒÓ CD3+TCR·‚+CD4-CD8- ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓı· Ú¤ÂÈ Ó· ‰ÈÂÚÂ˘Ó¿Ù·È Î·È Ë Èı·ÓfiÙËÙ· ·˘ÙÔ¿ÓÔ-ÛÔ˘ ÏÂÌÊÔ¸ÂÚÏ·ÛÙÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ (1).

ªÂÌÔÓˆÌ¤ÓË Ì¤¯ÚÈ ÌË‰ÂÓÈÛÌÔ‡ ÌÂ›ˆÛË ÙˆÓ µ-ÏÂÌ-ÊÔÎ˘ÙÙ¿ÚˆÓ ·Ú·ÙËÚÂ›Ù·È ÛÙËÓ ÁÔÓÈ‰È·Î‹ ‰È·Ù·Ú·¯‹ÙË˜ ÎÈÓ¿ÛË˜ Btk (Ê˘ÏÔÛ‡Ó‰ÂÙË ·Á·ÌÌ·ÛÊ·ÈÚÈÓ·ÈÌ›·,ÓfiÛÔ˜ ÙÔ˘ Bruton), ÌÔÚÂ›, fiÌˆ˜, Ó· ÔÊÂ›ÏÂÙ·È Î·È ÛÂ·˘ÙÔÛˆÌ·ÙÈÎÒ˜ ÎÏËÚÔÓÔÌÔ‡ÌÂÓÂ˜ ÌÂÙ·ÏÏ¿ÍÂÈ˜ (44).ªÈÎÚ‹ ÌÂ›ˆÛË ÙˆÓ µ-ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ ÌÔÚÂ› Ó· ·-Ú·ÙËÚËıÂ› ÛÂ ÂÚÈÙÒÛÂÈ˜ ÎÔÈÓ‹˜ ÔÈÎ›ÏË˜ ·ÓÔÛÔ·-ÓÂ¿ÚÎÂÈ·˜ (45), ÂÓÒ ÛÂ ·ÓÂ¿ÚÎÂÈÂ˜ ˘ÔÙ¿ÍÂˆÓ ÙˆÓ·ÓÔÛÔÛÊ·ÈÚÈÓÒÓ ÌÔÚÂ› Ó· ·Ú·ÙËÚËıÂ› ·‡ÍËÛË ÙˆÓ·ÓÒÚÈÌˆÓ µ-ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ. £· Ú¤ÂÈ, fiÌˆ˜, Ó·ÙÔÓÈÛÙÂ› fiÙÈ Ê˘ÛÈÔÏÔÁÈÎ¿ Â›Â‰· µ-ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ‰ÂÓ ·ÔÎÏÂ›Ô˘Ó ÙËÓ ‡·ÚÍË Û˘Ó‰ÚfiÌÔ˘ ˘¤Ú-IgM,ÎÔÈÓ‹˜ ÔÈÎ›ÏË˜ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·˜ ‹ ¿ÏÏË˜ ·ÓÙÈÛˆ-Ì·ÙÈÎ‹˜ ·ÓÂ¿ÚÎÂÈ·˜. ∂›ÛË˜, ÛÙËÓ ·ÚÔ‰ÈÎ‹ ˘Ô-Á·ÌÌ·ÛÊ·ÈÚÈÓ·ÈÌ›· ÙˆÓ ‚ÚÂÊÒÓ, Ù· Î˘ÎÏÔÊÔÚÔ‡ÓÙ·µ-Î‡ÙÙ·Ú· Â›Ó·È ÛÂ Ê˘ÛÈÔÏÔÁÈÎ¿ Â›Â‰· (43,46).

∞Ó·ÊÔÚÈÎ¿ ÌÂ ÙËÓ ÎÔÈÓ‹ ÔÈÎ›ÏË ·ÓÔÛÔ·ÓÂ¿Ú-ÎÂÈ·, Ë ÔÔ›· ·ÔÙÂÏÂ› Ì›· ÂÙÂÚÔÁÂÓ‹ ÔÌ¿‰· Û¯ÂÙÈÎ¿Û˘¯ÓÒÓ ÓÔÛËÌ¿ÙˆÓ ÌÂ ÎÔÈÓfi ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÙËÓ·‰˘Ó·Ì›· ˆÚ›Ì·ÓÛË˜ ÙˆÓ µ-ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ ÛÂ Â›-Â‰Ô ‚Ï·ÛÙÈÎÔ‡ Î¤ÓÙÚÔ˘ Î·È, Û˘ÓÂÒ˜, ÙËÓ ÌÂÈˆÌ¤ÓË·Ú·ÁˆÁ‹ ·ÓÔÛÔÛÊ·ÈÚÈÓÒÓ, ı· Ú¤ÂÈ Ó· ÛËÌÂÈˆıÂ›fiÙÈ Û˘¯Ó¿ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÌÂ›ˆÛË ÙÔ˘ ·ÚÈıÌÔ‡ÙˆÓ CD4+TCR·‚+ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ Î·È È‰È·›ÙÂÚ· ÙˆÓ·Úı¤ÓˆÓ CD4+CD45RA+, ¯ˆÚ›˜, fiÌˆ˜, ·˘Ùfi ÙÔ Â‡-ÚËÌ· Ó· ·ÔÙÂÏÂ› ‰È·ÁÓˆÛÙÈÎfi ÎÚÈÙ‹ÚÈÔ (45).

¶·Ú¿ÁÔÓÙÂ˜ Ô˘ ÂËÚÂ¿˙Ô˘Ó ÙÈ˜ ÙÈÌ¤˜ ÙˆÓ

ÏÂÌÊÔÎ˘ÙÙ·ÚÈÎÒÓ ÏËı˘ÛÌÒÓ ÛÙÔ

ÂÚÈÊÂÚÈÎfi ·›Ì·

∆Ô ·ÔÙ¤ÏÂÛÌ· ÙÔ˘ ·ÓÔÛÔÊ·ÈÓfiÙ˘Ô˘ ÙˆÓ ÏÂÌ-ÊÔÎ˘ÙÙ¿ÚˆÓ ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜ ÌÔÚÂ› Ó·ÂËÚÂ·ÛÙÂ› ·fi Ì›· ÏËıÒÚ· ·Ú·ÁfiÓÙˆÓ:

™‹„Ë: ¶ÔÏÏ¿ ·È‰È¿ Ô˘ ÂÏ¤Á¯ÔÓÙ·È ÁÈ· ·ÓÔÛÔ·-ÓÂ¿ÚÎÂÈ· ¤¯Ô˘Ó ÈÛÙÔÚÈÎfi ÚfiÛÊ·ÙˆÓ ‚·Ú¤ˆÓ ÏÔÈ-ÌÒÍÂˆÓ ‹ ÛËÙÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ. ∂›Ó·È Û˘¯Ó‹ Ë ·Ó¿-ÁÎË ‰ÈÂÚÂ‡ÓËÛË˜ ·È‰ÈÒÓ ÌÂ ‚·ÚÈ¿ ÎÏÈÓÈÎ‹ ÂÈÎfiÓ·,Î˘Ú›ˆ˜ ÏfiÁˆ ÙË˜ ¤ÏÏÂÈ„Ë˜ ÙÔ˘ ̄ ÚÔÓÈÎÔ‡ ÂÚÈıˆÚ›Ô˘.∏ Û‹„Ë, fiÌˆ˜, ÌÔÚÂ› Ó· ÂÈÊ¤ÚÂÈ ÛËÌ·ÓÙÈÎfiÙ·ÙÂ˜ÌÂÙ·‚ÔÏ¤˜ ÛÙÔ˘˜ ÏÂÌÊÔÎ˘ÙÙ·ÚÈÎÔ‡˜ ÏËı˘ÛÌÔ‡˜,·ÎfiÌË Î·È ‰‡Ô Ì‹ÓÂ˜ ÌÂÙ¿ ÙËÓ ·Ó¿ÚÚˆÛË, fiˆ˜ ÙÒ-ÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ CD4+ Î·È ÏÈÁfiÙÂÚÔ ÙˆÓ CD8+

ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ ÛÙÔ ÂÚÈÊÂÚÈÎfi ·›Ì· (47), ·Ú¯ÈÎ‹Ì¤¯ÚÈ ÌË‰ÂÓÈÛÌÔ‡ ÌÂ›ˆÛË Î·È ·ÎÔÏÔ‡ıˆ˜ ·‡ÍËÛËÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ¡∫-Î˘ÙÙ¿ÚˆÓ, ·‡ÍËÛË ÙˆÓ µ-ÏÂÌ-

ÊÔÎ˘ÙÙ¿ÚˆÓ Î·È ·‡ÍËÛË ÙˆÓ CD3+HLADR+ ‰ÈÂÁÂÚ-

Ì¤ÓˆÓ ∆-ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ (48).

HIV ÏÔ›ÌˆÍË: ∏ ÚÔÔ‰Â˘ÙÈÎ‹ ÌÂ›ˆÛË ÙÔ˘ ·fiÏ˘-

ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ CD4+ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ (Î‡ÚÈÔ˜ ‰Â›-

ÎÙË˜ ·Ú·ÎÔÏÔ‡ıËÛË˜ ÙˆÓ ·ÛıÂÓÒÓ) Î·È Ë ·˘ÍËÌ¤-

ÓË ¤ÎÊÚ·ÛË ÙˆÓ ‰ÂÈÎÙÒÓ ‰È¤ÁÂÚÛË˜ (HLA-DR Î·È

CD38) ÛÙ· CD8+ ∆-ÏÂÌÊÔÎ‡ÙÙ·Ú· (‰Â›ÎÙË˜ ÂÈÎÂ›-

ÌÂÓË˜ ·‡ÍËÛË˜ ÙÔ˘ ÈÈÎÔ‡ ÊÔÚÙ›Ô˘) Â›Ó·È ÔÈ Î˘ÚÈfiÙÂ-

ÚÂ˜ ‰È·Ù·Ú·¯¤˜ ÛÙËÓ HIV ÏÔ›ÌˆÍË (49). ∆· ÔÚÔ·Ú-

ÓËÙÈÎ¿ ÓÂÔÁÓ¿ ÌÂ HIV+ ÌËÙ¤Ú· ÌÔÚÂ› Ó· ·ÚÔ˘ÛÈ¿-

˙Ô˘Ó ·Ó¿ÏÔÁÂ˜ ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ·ÓÔÛÔÊ·ÈÓfiÙ˘Ô˘,

Ô˘ ÌÔÚÂ› Ó· ‰È·ÙËÚËıÔ‡Ó Ì¤¯ÚÈ ÙË Û˘ÌÏ‹ÚˆÛË

ÙÔ˘ ÚÒÙÔ˘ ¤ÙÔ˘˜ (50).

∫ÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹-·ÓÔÛÔÎ·Ù·ÛÙ·ÏÙÈÎ¿: ∆· ·ÓÔÛÔÎ·-

Ù·ÛÙ·ÏÙÈÎ¿ Î·È Ù· ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹ Ô˘ ¯ÔÚËÁÔ‡-

ÓÙ·È ÏfiÁˆ ÙˆÓ ·˘ÙÔ¿ÓÔÛˆÓ ÂÎ‰ËÏÒÛÂˆÓ ÔÚÈÛÌ¤ÓˆÓ

·ÓÔÛÔ·ÓÂ·ÚÎÂÈÒÓ ÂËÚÂ¿˙Ô˘Ó È‰È·›ÙÂÚ· ÙÔÓ ·ÓÔÛÔ-

Ê·ÈÓfiÙ˘Ô. ∏ ÏÂÌÊÔÂÓ›· Ô˘ ÚÔÎ·ÏÂ›Ù·È ·fi Ù·

ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹, ÔÊÂ›ÏÂÙ·È ÂÚÈÛÛfiÙÂÚÔ ÛÙË ÌÂ›ˆ-

ÛË ÙˆÓ CD4+ Î·È ÏÈÁfiÙÂÚÔ ÛÙË ÌÂ›ˆÛË ÙˆÓ CD8+ ÏÂÌ-

ÊÔÎ˘ÙÙ¿ÚˆÓ. ∏ ÌÂ›ˆÛË ·˘Ù‹, Ì¿ÏÈÛÙ·, ·ÊÔÚ¿ Î˘Ú›ˆ˜

ÛÙÔ˘˜ ÏËı˘ÛÌÔ‡˜ ÙˆÓ ÂÓÂÚÁÔÔÈËÌ¤ÓˆÓ Î˘ÙÙ¿ÚˆÓ

(CD3+CD4+CD69+, CD3+ CD8+CD69+) (51). ø˜ Û˘Ó¤-

ÂÈ· ÙˆÓ ·Ú·¿Óˆ, ·Ó·ÛÙÚ¤ÊÂÙ·È Ô ÏfiÁÔ˜

CD4+/CD8+ Î·È Ë ·Ó·ÛÙÚÔÊ‹ ·˘Ù‹ ‰È·ÚÎÂ› ÁÈ· ÌÂÁ¿ÏÔ

¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·, ÏfiÁˆ ÙÔ˘ ÌÂÈˆÌ¤ÓÔ˘ Ú˘ıÌÔ‡ ·Ô-

Î·Ù¿ÛÙ·ÛË˜ ÙˆÓ CD4+ (28,2 ËÌ¤ÚÂ˜) ÛÂ Û¯¤ÛË ÌÂ Ù·

CD8+ (12,6 ËÌ¤ÚÂ˜) ÏÂÌÊÔÎ‡ÙÙ·Ú· (52). ∂ÔÌ¤Óˆ˜,

Û˘ÓÈÛÙ¿Ù·È Ë ‰ÈÂÍ·ÁˆÁ‹ ÙÔ˘ Ù˘¯fiÓ ÂÓ‰ÂÈÎÓ˘fiÌÂÓÔ˘

ÂÏ¤Á¯Ô˘ ÙÔ˘ ·ÓÔÛÔÊ·ÈÓfiÙ˘Ô˘ ÚÈÓ ·fi ÙË ¯ÔÚ‹ÁË-

ÛË ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰ÒÓ ‹ ¿ÏÏË˜ ·ÓÔÛÔÙÚÔÔÔÈËÙÈ-

Î‹˜ ıÂÚ·Â›·˜.

√È ÏÂÌÊÔÎ˘ÙÙ·ÚÈÎÔ› ˘ÔÏËı˘ÛÌÔ› ÂËÚÂ¿˙Ô-

ÓÙ·È Î·È ·fi ¿ÏÏÂ˜ Î·Ù·ÛÙ¿ÛÂÈ˜. ¶·Ú·Î¿Ùˆ ·Ó·Ê¤-

ÚÔÓÙ·È ÔÈ ÛËÌ·ÓÙÈÎfiÙÂÚÂ˜ ·fi ·˘Ù¤˜ ·Ó¿ ÏÂÌÊÔÎ˘Ù-

Ù·ÚÈÎfi ˘ÔÏËı˘ÛÌfi:

∆-ÏÂÌÊÔÎ‡ÙÙ·Ú· CD4+: ¶ÙˆÙÈÎ‹ Ù¿ÛË ÙÔ˘˜ ¤¯ÂÈ

Î·Ù·ÁÚ·ÊÂ› ÛÂ ‚·ÎÙËÚÈ·Î¤˜ ÏÔÈÌÒÍÂÈ˜ (53), ÏfiÁˆ

ÙË˜ ÌÂÙ·Ó¿ÛÙÂ˘Û‹˜ ÙÔ˘˜ ÛÙ· ÏÂÌÊÈÎ¿ fiÚÁ·Ó·.

CD8+: ∏ Èı·ÓfiÙÂÚË ·ÈÙ›· ·‡ÍËÛË˜ ·ÚÈıÌÔ‡ ÙˆÓ

CD8+ Â›Ó·È ÔÈ ÏÔÈÌÒÍÂÈ˜ (ÈÔÁÂÓÂ›˜, ‚·ÎÙËÚÈ·Î¤˜). ™Â

·˘Ù¤˜ ·Ô‰›‰ÂÙ·È Î·È Û˘¯Ó‹ ·‡ÍËÛË ÙˆÓ CD8+ ÛÙ·

ÔÏ˘ÌÂÙ·ÁÁÈ˙fiÌÂÓ· ¿ÙÔÌ· (54).

CD3HLADR: ∂ÎÙfi˜ ·fi ÙÈ˜ ÏÔÈÌÒÍÂÈ˜, Ù· ‰ÈÂÁÂÚ-

Ì¤Ó· ∆-ÏÂÌÊÔÎ‡ÙÙ·Ú· ·˘Í¿ÓÔÓÙ·È Î·È ÛÂ ¿ÏÏÂ˜ Â-

ÚÈÙÒÛÂÈ˜ ‰È¤ÁÂÚÛË˜ ÙÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡ (·˘ÙÔ¿-

ÓÔÛ· ÓÔÛ‹Ì·Ù·, ÌÂÙ·ÌÔÛ¯Â‡ÛÂÈ˜, ÔÏ˘ÌÂÙ·ÁÁÈ˙fi-

ÌÂÓ· ¿ÙÔÌ·) (55).

TCRÁ‰: ∏ ·‡ÍËÛË ÙˆÓ TCRÁ‰ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ

Û˘Ó‹ıˆ˜ Û˘Ó·ÓÙ¿Ù·È ÛÂ ÏÔÈÌÒÍÂÈ˜ ·fi ÂÓ‰ÔÎ˘ÙÙ¿-

ÚÈÔ˘˜ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜ (ÂÚËÙÔ˚Ô‡˜, Ì˘ÎÔ‚·ÎÙË-

Ú›‰ÈÔ ÙË˜ Ê˘Ì·Ù›ˆÛË˜). √È ÙÈÌ¤˜ ÙÔ˘˜ Â›Ó·È, Â›ÛË˜,

Û˘¯Ó¿ ·˘ÍËÌ¤ÓÂ˜ ÛÂ ·˘ÙÔ¿ÓÔÛ· ÓÔÛ‹Ì·Ù· (56).


¶·È‰È·ÙÚÈÎ‹ 2007;70:174-183


µ-ÏÂÌÊÔÎ‡ÙÙ·Ú·: ∏ Û˘ÓËı¤ÛÙÂÚË, Ï¤ÔÓ, ·ÈÙ›·

ÌË‰ÂÓÈÛÌÔ‡ ÙˆÓ CD19+CD20+ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ Â›Ó·È

Ë ¯ÔÚ‹ÁËÛË ·ÓÙÈ-CD20 ıÂÚ·Â›·˜. ∞˘ÍËÙÈÎ‹ Ù¿ÛË

¤¯ÂÈ ·Ú·ÙËÚËıÂ› ÛÂ ÏÔÈÌÒÍÂÈ˜ (57), ·ÏÏ¿ ÛÂ ˘ÂÚ-

‚ÔÏÈÎ‹ ·‡ÍËÛ‹ ÙÔ˘˜ ı· Ú¤ÂÈ Ó· ·ÔÎÏÂÈÛÙÂ› Î¿-

ÔÈ· ÏÂÌÊÔÎ˘ÙÙ·ÚÈÎ‹ Î·ÎÔ‹ıÂÈ·, ÌÂ ÙÔÓ ¤ÏÂÁ¯Ô

‡·ÚÍË˜ ÌÔÓÔÎÏˆÓÈÎfiÙËÙ·˜ Î ‹ Ï ·Ï˘Û›‰ˆÓ. π‰È·›-

ÙÂÚÔ ÂÓ‰È·Ê¤ÚÔÓ ¤¯Ô˘Ó ÔÈ ‰È·Î˘Ì¿ÓÛÂÈ˜ ÙˆÓ

CD19+CD5+, ÛÙÔ Ï·›ÛÈÔ Î˘Ú›ˆ˜ ÙË˜ ÚÔÛ¿ıÂÈ·˜

ÂÍÂ‡ÚÂÛË˜ ÚÔÁÓˆÛÙÈÎÒÓ ‰ÂÈÎÙÒÓ ÙˆÓ ·˘ÙÔ¿ÓÔÛˆÓ

ÓÔÛËÌ¿ÙˆÓ, fiˆ˜ ÛÙÔÓ Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË Ù‡Ô˘ π

(50). ŸÌˆ˜, Ë ·ÍÈÔÏfiÁËÛË ÙˆÓ CD19+CD5+ ÛÙ· ‚Ú¤-

ÊË Â›Ó·È ‰˘Û¯ÂÚ‹˜, ÏfiÁˆ ÙÔ˘ Ê˘ÛÈÔÏÔÁÈÎ¿ ·˘ÍËÌ¤-

ÓÔ˘ ·ÚÈıÌÔ‡ ÙÔ˘˜ (58).

¡∫-Î‡ÙÙ·Ú·: ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÙÈ˜ Ù·¯‡ÙÂÚÂ˜ ‰È·Î˘-

Ì¿ÓÛÂÈ˜, ÏfiÁˆ ÙË˜ ·Ó·Î·Ù·ÓÔÌ‹˜ ÙˆÓ Î˘ÎÏÔÊÔÚÔ‡-

ÓÙˆÓ (ÌÂÙÚÔ‡ÌÂÓˆÓ) Î·È ÙˆÓ ÚÔÛÎÔÏÏËÌ¤ÓˆÓ ÛÙ·

·ÁÁÂÈ·Î¿ ÙÔÈ¯ÒÌ·Ù· (ÌË ÌÂÙÚÔ‡ÌÂÓˆÓ) ¡∫-ÏÂÌÊÔ-

Î˘ÙÙ¿ÚˆÓ Ô˘ ÚÔÎ·ÏÂ›Ù·È ·fi ‰È¿ÊÔÚÔ˘˜ ·Ú¿ÁÔ-

ÓÙÂ˜, fiˆ˜ Ë ˘ÂÚ¤ÎÎÚÈÛË Î·ÙÂ¯ÔÏ·ÌÈÓÒÓ (59,60).

™¯ÔÏÈ·ÛÌfi˜

£· Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÂÙ·È ˘fi„Ë fiÙÈ Ù· ·ÔÙÂ-

Ï¤ÛÌ·Ù· ÙˆÓ ‰È·ÊfiÚˆÓ ÂÚÁ·ÛÙËÚ›ˆÓ ‰ÂÓ Â›Ó·È ¿-

ÓÙÔÙÂ Û˘ÁÎÚ›ÛÈÌ·, È‰›ˆ˜ ˆ˜ ÚÔ˜ ÙÔ˘˜ ÌÈÎÚÔ‡ ·ÚÈı-

ÌÔ‡ ˘ÔÏËı˘ÛÌÔ‡˜ (36).

∏ ÂÈÏÔÁ‹ ÙˆÓ Î·Ù¿ÏÏËÏˆÓ ÚÔ˜ ¤ÏÂÁ¯Ô ‰ÂÈ-

ÎÙÒÓ ˘·ÁÔÚÂ‡ÂÙ·È ·fi ÙËÓ ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· ÙÔ˘

·ÛıÂÓÔ‡˜, ÛËÌÂ›Ô ÛÙÔ ÔÔ›Ô Â›Ó·È È‰È·›ÙÂÚ· ÛËÌ·-

ÓÙÈÎ‹ Ë Û˘ÓÂÚÁ·Û›· ÙˆÓ ÎÏÈÓÈÎÒÓ ÌÂ ÙÔ ÂÚÁ·ÛÙ‹ÚÈÔ.

∞˘Ùfi fiÌˆ˜ Ô˘ ı· Ú¤ÂÈ Ó· ÙÔÓÈÛÙÂ› Â›Ó·È fiÙÈ

Ë ÌÂÏ¤ÙË ÙˆÓ ÏÂÌÊÔÎ˘ÙÙ·ÚÈÎÒÓ ÏËı˘ÛÌÒÓ ÙÔ˘

ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜ ı· Ú¤ÂÈ Ó· ‰ÈÂÓÂÚÁÂ›Ù·È ÁÈ·

Ó· ··ÓÙ‹ÛÂÈ Û˘ÁÎÂÎÚÈÌ¤Ó· ÂÚˆÙ‹Ì·Ù· (Î˘Ú›ˆ˜

ÁÈ· ÙË ‰È¿ÁÓˆÛË ·ÓÔÛÔ·ÓÂ·ÚÎÂÈÒÓ) Î·È ‰ÂÓ ¤¯ÂÈ

Î·Ó¤Ó· ÚfiÏÔ ˆ˜ ‰ÔÎÈÌ·Û›· ÂÏ¤Á¯Ô˘ ÙÔ˘ ÁÂÓÈÎÔ‡

ÏËı˘ÛÌÔ‡, ‰ÈfiÙÈ ÔÈ ÏÂÌÊÔÎ˘ÙÙ·ÚÈÎÔ› ÏËı˘ÛÌÔ›

ÂËÚÂ¿˙ÔÓÙ·È ·fi ¿Ú· ÔÏÏÔ‡˜ ·Ú¿ÁÔÓÙÂ˜ Î·È

Ë Ù˘¯·›· Â‡ÚÂÛË Ì›·˜ ·fiÎÏÈÛ‹˜ ÙÔ˘˜ ·fi ÙÈ˜ ·Ó·-

ÌÂÓfiÌÂÓÂ˜ ÙÈÌ¤˜ ÌÔÚÂ› Ó· ·Ú·Ï·Ó‹ÛÂÈ ÙË ‰È·-

ÁÓˆÛÙÈÎ‹ ÛÎ¤„Ë.

∂˘¯·ÚÈÛÙ›Â˜

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184 ∞¡∞™∫√¶∏™∏ REVIEW ARTICLE


™˘ÁÁÂÓÂ›˜ ‰È·Ì·ÚÙ›Â˜ ÓÂ˘ÌfiÓˆÓ: ·ıÔÁ¤ÓÂÈ·, ‰È·ÁÓˆÛÙÈÎ‹

ÚÔÛ¤ÁÁÈÛË Î·È ·ÒÙÂÚË ¤Î‚·ÛË

∫. ¡. ¶Ú›ÊÙË˜1, ¶. ¡. ¢Ô˘Ú›‰·˜1, ª. B. ∞ÓıÚ·ÎfiÔ˘ÏÔ˜2

¶ÂÚ›ÏË„Ë: √È Û˘ÁÁÂÓÂ›˜ ‰È·Ì·ÚÙ›Â˜ ÙÔ˘ ÓÂ‡ÌÔÓ· ·ÔÙÂÏÔ‡Ó ÌÈ· ·Û˘Ó‹ıË ·ÏÏ¿ È‰È·›ÙÂÚ· ÂÓ‰È·Ê¤-ÚÔ˘Û· ÔÌ¿‰· ÓÔÛËÌ¿ÙˆÓ Ô˘ ÌÔÚÂ› Ó· ·ÓÈ¯ÓÂ˘ıÔ‡Ó ÔÏ‡ ¤ÁÎ·ÈÚ·, ÛÙÔ Ï·›ÛÈÔ ÚÔÁÂÓÓËÙÈÎÔ‡ ÂÏ¤Á-¯Ô˘ Î·Ù¿ ÙËÓ ÂÓ‰ÔÌ‹ÙÚÈ· ÂÚ›Ô‰Ô ‹ ·ÎfiÌ· fi„ÈÌ·, ÛÂ Ù˘¯·›Ô ¤ÏÂÁ¯Ô ÛÙËÓ ÂÓ‹ÏÈÎÔ ˙ˆ‹. ∏ ·ıÔÁ¤ÓÂÈ·ÙˆÓ ‰È·Ì·ÚÙÈÒÓ Û˘Ó‰¤ÂÙ·È ¿ÌÂÛ· ÌÂ ÙËÓ ·Ó·ÙÔÌÈÎ‹ ı¤ÛË Î·È ÙË Ê¿ÛË Î·Ù¿ ÙËÓ ÔÔ›· Û˘Ì‚·›ÓÂÈ Ë ‰È·-Ù·Ú·¯‹ ÛÙË ‰È·‰ÈÎ·Û›· ·Ó¿Ù˘ÍË˜ ÙÔ˘ ÓÂ‡ÌÔÓ· Î·Ù¿ ÙËÓ ÂÓ‰ÔÌ‹ÙÚÈ· ÂÚ›Ô‰Ô. ∏ ‰È·ÁÓˆÛÙÈÎ‹ ÚÔ-Û¤ÁÁÈÛË Û˘Ó·ÚÙ¿Ù·È ¿ÌÂÛ· ÌÂ ÙË ÁÓÒÛË Î·È ÙËÓ ÒÚÈÌË ÎÏÈÓÈÎ‹ ÛÎ¤„Ë. ∞Ó Î·È Ë ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· Û¯ÂÙ›˙ÂÙ·ÈÌÂ ÙËÓ ËÏÈÎ›· ÙÔ˘ ·ÛıÂÓÔ‡˜, Û˘Ó‹ıˆ˜ Â›Ó·È ÌË ÂÈ‰ÈÎ‹ Î·È ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ÙË Û·ÓÈfiÙËÙ· ÙˆÓ Û˘ÁÁÂ-ÓÒÓ ‰È·Ì·ÚÙÈÒÓ ÙÔ˘ ÓÂ‡ÌÔÓ· Â›Ó·È ··Ú·›ÙËÙÔ ÂÎ Ì¤ÚÔ˘˜ ÙÔ˘ ÎÏÈÓÈÎÔ‡ ÁÈ·ÙÚÔ‡ Ó· ̆ ¿Ú¯ÂÈ ̆ „ËÏfi˜ ‰Â›-ÎÙË˜ ˘Ô„›·˜. √ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ÌÂ ÙËÓ ÔÚı‹ ¯Ú‹ÛË ÙË˜ Û‡Á¯ÚÔÓË˜ ÙÂ¯ÓÔÏÔÁ›·˜, Û˘Ó‹ıˆ˜, Ô‰Ë-ÁÂ› ÛÂ ·ÎÚÈ‚Â›˜ ‰È·ÁÓÒÛÂÈ˜. ∏ ÚfiÁÓˆÛË ÙˆÓ Û˘ÁÁÂÓÒÓ ‰È·Ì·ÚÙÈÒÓ ÙˆÓ ÓÂ˘ÌfiÓˆÓ ÂÍ·ÚÙ¿Ù·È ·fi ÙÔÂ›‰Ô˜ Î·È ÙËÓ ¤ÎÙ·ÛË ÙË˜ ‚Ï¿‚Ë˜, Î·ıÒ˜ Â›ÛË˜ ÙËÓ ‡·ÚÍË ‹ ÌË Û˘ÓÔ‰ÒÓ ·ÓˆÌ·ÏÈÒÓ. ø˜ ÚÔ˜ ÙÔÓ ̄ Úfi-ÓÔ ÙË˜ Èı·Ó‹˜ ¯ÂÈÚÔ˘ÚÁÈÎ‹˜ ·Ú¤Ì‚·ÛË˜, ÂÊfiÛÔÓ ‰ÂÓ ˘¿Ú¯ÂÈ ·Ó¿ÁÎË ÂÂ›ÁÔ˘Û·˜ ·ÓÙÈÌÂÙÒÈÛË˜,ÔÏÏ¤˜ ‚Ï¿‚Â˜ ÌÔÚÔ‡Ó Ó· ·ÓÙÈÌÂÙˆÈÛıÔ‡Ó Û˘ÓÙËÚËÙÈÎ¿ ÒÛÙÂ Ó· ÂÈÏÂÁÂ› ·ÚÁfiÙÂÚ· Ô Î·Ù·ÏÏËÏfiÙÂÚÔ˜¯ÚfiÓÔ˜ ÁÈ· ÙËÓ Â¤Ì‚·ÛË. ∆Ô fiÊÂÏÔ˜ ÙË˜ ·ÓÙÈÚÚÔÈÛÙÈÎ‹˜ ·‡ÍËÛË˜ ÙÔ˘ ·ÚÈıÌÔ‡ ‹ ÙË˜ ‰ÔÌ‹˜ ÙˆÓ Î˘„Â-Ï›‰ˆÓ ÌÂÙ¿ ·fi ÓÂ˘ÌÔÓÂÎÙÔÌ‹ ÛÂ ÌÈÎÚ‹ ËÏÈÎ›· ‰ÂÓ ¤¯ÂÈ ÂÈ‚Â‚·ÈˆıÂ›.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ∫˘ÛÙÈÎ‹ ·‰ÂÓÔÌ·ÙÔÂÈ‰‹˜ ‰˘ÛÏ·Û›·, ÏÔ‚ÂÎÙÔÌ‹, ÓÂ˘ÌÔÓÈÎfi ·fiÏ˘Ì·, Û˘ÁÁÂÓ¤˜ ÏÔ‚Ò‰Â˜ ÂÌÊ‡-

ÛËÌ·, ÙÚ·¯ÂÈÔÔÈÛÔÊ·ÁÈÎfi Û˘Ú›ÁÁÈÔ, ˘ÔÏ·Û›· ÓÂ‡ÌÔÓ·.

Congenital lung malformations: pathogenesis, diagnostic approach

and long-term outcome

K. N. Priftis1, N. P. Douridas1, M. B. Anthracopoulos2

Abstract: Congenital lung malformations constitute an infrequent but intriguing group of diseases, someof which are diagnosed prenatally while others remain asymptomatic for many years and are incidentalfindings during adulthood. The pathogenesis is determined by the anatomical location of the lesion andthe timing of the intrauterine insult during embryonic lung development. The diagnostic approach isdependent on the expertise and clinical skills of the physician. Clinical manifestations of congenital lungmalformations depend on the age of the patient, and in most instances are non-specific. In view of theirrareness a high index of suspicion is required for the diagnosis of these clinical entities. Rational use ofcurrent imaging and endoscopic techniques can provide an accurate diagnosis. The prognosis of a specificcongenital lung malformation depends on the nature and the size of the lesion and the presence orabsence of associated developmental defects. With regard to the timing of surgical intervention, ifemergency surgery is not required, congenital malformations can be managed conservatively, andprogrammed surgical resection can be undertaken at a later point in time. The occurrence of post-pneumonectomy compensatory lung growth, when surgical intervention takes place early in life, has notbeen confirmed.

Key words: Congenital lobar emphysema, cystic adenomatoid malformation, lobectomy, pulmonary

hypoplasia, pulmonary sequestration, tracheo-oesophageal fistula.

1 ∞ÏÏÂÚÁÈÔÏÔÁÈÎfi ∆Ì‹Ì·,°ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô¶·›‰ˆÓ ¶ÂÓÙ¤ÏË˜

2 ¶·È‰ÔÓÂ˘ÌÔÓÔÏÔÁÈÎ‹ªÔÓ¿‰·, ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹¶·ÓÂÈÛÙËÌ›Ô˘ ¶·ÙÚÒÓ


∫ÒÛÙ·˜ ¡. ¶Ú›ÊÙË˜[email protected]∞ÏÏÂÚÁÈÔÏÔÁÈÎfi ∆Ì‹Ì·,°ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ¶ÂÓÙ¤ÏË˜T.K. 152 36, ¶. ¶ÂÓÙ¤ÏË

1 Department ofAllergology, Children’sGeneral Hospital of Penteli

2 Paediatric PneumonologyUnit, University of PatrasPaediatric Clinic

Correspondence:

Kostas N. [email protected] Department,Children’s General Hospitalof Penteli 152 36, P. Penteli, Greece

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ÚÔ˘ ¯ÚfiÓÔ˘ ÁÈ· ÙËÓ Â¤Ì‚·ÛË.

¶ÚfiÛÊ·Ù· ÂÎ‰fiıËÎÂ ÙfiÌÔ˜ Ô˘ ·Ó·Ê¤ÚÂÙ·È ·Ô-

ÎÏÂÈÛÙÈÎ¿ ÛÙÈ˜ Û˘ÁÁÂÓÂ›˜ ‰È·Ì·ÚÙ›Â˜ ÙÔ˘ ÓÂ‡ÌÔÓ·

(1). √ ·Ó·ÁÓÒÛÙË˜ ·Ú·¤ÌÂÙ·È ÛÂ ·˘ÙfiÓ ÁÈ· ·Ó·-

Ï˘ÙÈÎfiÙÂÚË ÂÓËÌ¤ÚˆÛË ·Ó¿ ¿ıËÛË (2). ™ÙÔ ÎÂ›ÌÂÓÔ

Ô˘ ·ÎÔÏÔ˘ıÂ› ·ÚÔ˘ÛÈ¿˙ÂÙ·È Û˘ÓÔÙÈÎ¿ Ë ·ıÔÁ¤-

ÓÂÈ·, Ë ‰È·ÁÓˆÛÙÈÎ‹ ÚÔÛ¤ÁÁÈÛË Î·È Ë ·ÒÙÂÚË

¤Î‚·ÛË ÙˆÓ Û˘ÁÁÂÓÒÓ ‰È·Ì·ÚÙÈÒÓ ÙÔ˘ ÓÂ‡ÌÔÓ·.

∆·ÍÈÓfiÌËÛË Î·È ÂÌ‚Ú˘ÔÁ¤ÓÂÛË

∏ Î·Ù¿Ù·ÍË ÌÈ·˜ Û˘ÁÁÂÓÔ‡˜ ‰È·Ì·ÚÙ›·˜ ÙÔ˘

ÓÂ‡ÌÔÓ· Ô˘ ·ÊÔÚ¿ ·ÔÎÏÂÈÛÙÈÎ¿ ÛÂ ÌÈ· ·Ó·ÙÔÌÈ-

Î‹ ‰ÔÌ‹, fiˆ˜ Â›Ó·È Ë Û˘ÁÁÂÓ‹˜ ÛÙ¤ÓˆÛË ‚ÚfiÁ¯Ô˘ ‹

Ë ‚ÚÔÁ¯ÔÁÂÓ‹˜ Î‡ÛÙË, Â›Ó·È Û¯ÂÙÈÎ¿ ·Ï‹. ŸÙ·Ó

fiÌˆ˜, Ë Û˘ÁÁÂÓ‹˜ ‰È·Ì·ÚÙ›· ÂÚÈÏ·Ì‚¿ÓÂÈ ÂÚÈÛÛfi-

ÙÂÚÂ˜ Û˘ÓÈÛÙÒÛÂ˜, fiˆ˜ ÓÂ˘ÌÔÓÈÎfi ·Ú¤Á¯˘Ì· Î·È

·ÁÁÂ›·, ÌÂ ·ÓÙÈÚÔÛˆÂ˘ÙÈÎfi ·Ú¿‰ÂÈÁÌ· ÙÔ ÓÂ˘-

ÌÔÓÈÎfi ·fiÏ˘Ì·, Ë Î·Ù¿Ù·ÍË Î·È Ë Î·Ù·ÓfiËÛË ÙË˜

ÂÌ‚Ú˘ÔÁ¤ÓÂÛË˜ ÙË˜ ‚Ï¿‚Ë˜ ÌÔÚÂ› Ó· ·ÔÙÂÏÂ›

Ú·ÁÌ·ÙÈÎ¿ ÔÏ‡ÏÔÎË ‰È·‰ÈÎ·Û›·.

¶·Ï·ÈfiÙÂÚË Î·Ù¿Ù·ÍË ·fi ÙÔ American College

of Chest Physicians ·ÚÎÂ›Ù·È ÛÂ ·Ï‹ ·Ú¿ıÂÛË, ¯ˆ-

Ú›˜ ·ıÔÁÂÓÂÙÈÎ‹ ÂÚÌËÓÂ›· (3). ∞ÎfiÌË Î·È Û‹ÌÂÚ·

fiÌˆ˜, ·Ú¿ ÙÈ˜ ‰È¿ÊÔÚÂ˜ ıÂˆÚ›Â˜ Ô˘ ¤¯Ô˘Ó ÚÔÙ·-

ıÂ› (4-6), ‰ÂÓ ˘¿Ú¯ÂÈ ÈÎ·ÓÔÔÈËÙÈÎ‹ ÔÚÈÔı¤ÙËÛË

Î·È Î·Ù¿Ù·ÍË ÙˆÓ Û˘ÁÁÂÓÒÓ ‰È·Ì·ÚÙÈÒÓ ÙÔ˘ ÓÂ‡-

ÌÔÓ· ÌÂ ‚¿ÛË ÙËÓ ·Ó·ÙÔÌ›· Î·È ÙËÓ ·ıÔÁ¤ÓÂÈ· (7).

∆Ô 1984, ÛÙËÓ ÂÚ›ÊËÌË ‰È¿ÏÂÍ‹ ÙË˜ ÂÈ˜ ÌÓ‹ÌËÓ

ÙÔ˘ Tudor Edwards (Tudor Edwards memorial

lecture), Ë Lynne Reid ·Ó·Ê¤ÚıËÎÂ ÛÙÔ˘˜ “ÙÚÂÈ˜ Ófi-

ÌÔ˘˜” Ô˘ ‰È¤Ô˘Ó ÙËÓ ÂÍ¤ÏÈÍË ÙÔ˘ ÓÂ‡ÌÔÓ· (8):

1) √È ‰È·ÎÏ·‰ÒÛÂÈ˜ ÙÔ˘ ‚ÚÔÁ¯ÈÎÔ‡ ‰¤Ó‰ÚÔ˘

¤¯Ô˘Ó Î·ıÔÚÈÛıÂ› ÚÈÓ ·fi ÙÔ Ù¤ÏÔ˜ ÙË˜ 16Ë˜ ÂÌ-

‚Ú˘˚Î‹˜ Â‚‰ÔÌ¿‰·˜.

2) ∏ ‰È¿Ï·ÛË ÙˆÓ Î˘„ÂÏ›‰ˆÓ ·Ú¯›˙ÂÈ ÙËÓ 24Ë ÂÌ-

‚Ú˘˚Î‹ Â‚‰ÔÌ¿‰· Î·È Û˘ÓÂ¯›˙ÂÙ·È ÌÂÙ¿ ÙË Á¤ÓÓËÛË.

3) ∆· “ÚÔ-‚ÔÙÚ˘‰È·Î¿ ·ÁÁÂ›·” (ÚÈÓ ÙÔ ‚ÔÙÚ‡-

‰ÈÔ ‹ ÚˆÙÔÁÂÓ¤˜ ÓÂ˘ÌÔÓÈÎfi ÏÔ‚›‰ÈÔ, pre-acinar

vessels) ·ÎÔÏÔ˘ıÔ‡Ó ÙË ‰ËÌÈÔ˘ÚÁ›· ÙˆÓ ·ÂÚ·ÁˆÁÒÓ,

ÂÓÒ Ù· “ÂÓ‰Ô-‚ÔÙÚ˘‰È·Î¿ ·ÁÁÂ›·” (intra-acinar

vessels) ·ÎÔÏÔ˘ıÔ‡Ó ÂÎÂ›ÓË ÙˆÓ Î˘„ÂÏ›‰ˆÓ.

√È “ÓfiÌÔÈ” ·˘ÙÔ› ¤¯Ô˘Ó ÂÈ‚Â‚·ÈˆıÂ› ·fi ÙÈ˜ Â-

ÚÈÁÚ·ÊÂ›ÛÂ˜ ÎÏÈÓÈÎ¤˜ ÂÚÈÙÒÛÂÈ˜.

√È Clements Î·È Warner ÛÂ ÙÚ›· ‰È·‰Ô¯ÈÎ¿ ¿ÚıÚ·

Ô˘ ‰ËÌÔÛÈÂ‡ıËÎ·Ó ÙÔ 1987 ÛÙÔ ›‰ÈÔ ÙÂ‡¯Ô˜ ÙÔ˘ Â-

ÚÈÔ‰ÈÎÔ‡ Thorax (9-11), ÂÈÛ‹Á·Á·Ó ÙËÓ ¤ÓÓÔÈ· “‰È·-

Ù·Ú·¯‹ ·Ó·ÛÙfiÌˆÛË˜” (malinosculation) ÚÔÎÂÈÌ¤-

ÓÔ˘ Ó· ÂÚÌËÓÂ‡ÛÔ˘Ó Î·È Ó· Î·Ù·Ù¿ÍÔ˘Ó ÙÔ Û‡ÓÔÏÔ

ÙˆÓ Û˘ÁÁÂÓÒÓ ‰È·Ì·ÚÙÈÒÓ ÙÔ˘ ÓÂ‡ÌÔÓ·, ·ÏÒÓ Î·È

Û‡ÓıÂÙˆÓ. ªÂ ‚¿ÛË ÙËÓ ̆ fiıÂÛË Ô˘ ‰È·Ù‡ˆÛ·Ó, Ë

Ê˘ÛÈÔÏÔÁÈÎ‹ ·Ó·ÛÙfiÌˆÛË (inosculation) ÙˆÓ ‰È·Êfi-

ÚˆÓ Û˘ÛÙËÌ¿ÙˆÓ ÛˆÏ‹ÓˆÓ (·ÁˆÁÒÓ) ÙÔ˘ ÓÂ‡ÌÔÓ· -

·ÂÚ·ÁˆÁÒÓ, ·ÚÙËÚÈÒÓ, ÊÏÂ‚ÒÓ Î·È ÏÂÌÊ·ÁÁÂ›ˆÓ-

Ô‰ËÁÂ› ÛÙË ‰È¿Ï·ÛË ÙÔ˘ Ê˘ÛÈÔÏÔÁÈÎÔ‡ ÓÂ‡ÌÔÓ·.

µ¿ÛË ÙˆÓ Û˘ÁÁÂÓÒÓ ‰È·Ì·ÚÙÈÒÓ ÙÔ˘ ÓÂ‡ÌÔÓ·, ÏÈÁfi-

ÙÂÚÔ ‹ ÂÚÈÛÛfiÙÂÚÔ Û‡ÓıÂÙˆÓ ·ÔÙÂÏÂ› Ë ‰È·Ù·Ú·¯‹

·Ó·ÛÙfiÌˆÛË˜ ÂÓfi˜ ‹ ÂÚÈÛÛÔÙ¤ÚˆÓ ·fi Ù· ·Ú·¿-

Óˆ Û˘ÛÙ‹Ì·Ù· ÛˆÏ‹ÓˆÓ (malinosculation). √ ̄ ÚfiÓÔ˜

‰Ú¿ÛË˜ ÙÔ˘ ‚Ï·ÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· Î·ıÔÚ›˙ÂÈ Â¿Ó Ë

‰È·Ì·ÚÙ›· ı· Â›Ó·È ÂÓ‰Ô- ‹ ÂÍˆ-ÓÂ˘ÌÔÓÈÎ‹.

™˘ÓÔÙÈÎ¿, ÔÈ ‰È¿ÊÔÚÂ˜ Û˘ÁÁÂÓÂ›˜ ‰È·Ì·ÚÙ›Â˜

ÌÔÚÔ‡Ó Ó· Ù·ÍÈÓÔÌËıÔ‡Ó ˆ˜ ÂÍ‹˜:

1. ¢È·Ù·Ú·¯‹ ‰È¿Ï·ÛË˜ ÙÔ˘ ·ÂÚ·ÁˆÁÔ‡ Î·È ÙˆÓ ·Á-

ÁÂ›ˆÓ Ô˘ ÙÔÓ ·Ú‰Â‡Ô˘Ó Ô‰ËÁÂ› ÛÂ ·ÁÂÓÂÛ›· ‹ ̆ ÔÏ·-

Û›· ÓÂ‡ÌÔÓ·, ÏÔ‚Ô‡ ‹ ÙÌ‹Ì·ÙÔ˜, ·Ó·ÏfiÁˆ˜ ÙÔ˘ Â›-

‰Ô˘˜, ÙË˜ ¤ÓÙ·ÛË˜ Î·È ÙË˜ ¯ÚÔÓÈÎ‹˜ ÛÙÈÁÌ‹˜ Ô˘ ÂÎ-

‰ËÏÒıËÎÂ ÙÔ ‚Ï·ÙÈÎfi ÂÚ¤ıÈÛÌ·.

2. ¶ÂÚÈÔÚÈÛÌ¤ÓË Î·È ÂÓÙÔÈÛÌ¤ÓË ‰È·Ù·Ú·¯‹ ‰È¿-

Ï·ÛË˜ ÂÚÈÊÂÚÈÎÔ‡ ‚ÚfiÁ¯Ô˘ Ô˘ ·ÎÔÏÔ˘ıÂ›Ù·È ·fi

Ê˘ÛÈÔÏÔÁÈÎ‹ ÂÚ·ÈÙ¤Úˆ ·Ó¿Ù˘ÍË, ÌÔÚÂ› Ó· Ô‰Ë-

Á‹ÛÂÈ ÛÂ ÛÙ¤ÓˆÛË ‚ÚfiÁ¯Ô˘, ‚ÚÔÁ¯ÔÁÂÓ‹ Î‡ÛÙË ‹ ‰˘-

ÛÏ·Û›· ¯fiÓ‰ÚÔ˘ ÌÂ ·ÔÙ¤ÏÂÛÌ· ÙÚ·¯ÂÈÔ-/‚ÚÔÁ¯Ô-

Ì·Ï¿Î˘ÓÛË ‹ Û˘ÁÁÂÓ¤˜ ÏÔ‚Ò‰Â˜ ÂÌÊ‡ÛËÌ·.

3. ™Â Û¿ÓÈÂ˜ ÂÚÈÙÒÛÂÈ˜ ‰È·Ù·Ú¿ÛÛÂÙ·È Ë ‰È¿-

Ï·ÛË ÓÂ˘ÌÔÓÈÎ‹˜ ·ÚÙËÚ›·˜ ¯ˆÚ›˜ ·ÓÙ›ÛÙÔÈ¯Ë ‰È·Ù·-

Ú·¯‹ ÙË˜ ·Ó¿Ù˘ÍË˜ ÙÔ˘ ‚ÚfiÁ¯Ô˘, ÒÛÙÂ ÙÔ Ê˘ÛÈÔÏÔ-

ÁÈÎfi ‚ÚÔÁ¯ÔÓÂ˘ÌÔÓÈÎfi ÙÌ‹Ì· Ó· ·Ú‰Â‡ÂÙ·È ·fi

·ÓÒÌ·ÏË ·ÚÙËÚ›· ÙË˜ Û˘ÛÙËÌ·ÙÈÎ‹˜ Î˘ÎÏÔÊÔÚ›·˜.

4. ∆Ô ‚Ï·ÙÈÎfi ÂÚ¤ıÈÛÌ· ÚÔÎ·ÏÂ› ‰È·Ù·Ú·¯‹ ÙË˜

‰È¿Ï·ÛË˜ ÙÔ˘ ·ÚÂÁ¯‡Ì·ÙÔ˜ Î·È ÙË˜ ·ÚÙËÚ›·˜ ÌÂ Û˘Ó¤-

ÂÈ· ÙÔ “ÎÏ·ÛÈÎfi” ·fiÏ˘Ì· (sequestration), ÙÈ˜ Û˘Á-

ÁÂÓÂ›˜ Î‡ÛÙÂÈ˜ ÌÂ ·ÓÒÌ·ÏË Û˘ÛÙËÌ·ÙÈÎ‹ ·ÁÁÂ›ˆÛË

Î·È Èı·ÓfiÓ ÙË Û˘ÁÁÂÓ‹ Î˘ÛÙÈÎ‹ ‚ÚÔÁ¯ÂÎÙ·Û›·.

5. ∆¤ÏÔ˜, Â¿Ó ‰È·Ù·Ú·¯ıÂ› Ë ·Ó¿Ù˘ÍË ÙÔ˘ ·ÂÚ·Áˆ-

ÁÔ‡ ¯ˆÚ›˜ Û˘ÓÔ‰fi ‰È·Ù·Ú·¯‹ ÙË˜ ·ÚÙËÚÈ·Î‹˜ ¿Ú‰Â˘-

ÛË˜, ÌÔÚÂ› Ó· ÚÔÎ‡„ÂÈ ÓÂ˘ÌÔÓÈÎ‹ Î‡ÛÙË, ·fi-

Ï˘Ì· ÌÂ Ê˘ÛÈÔÏÔÁÈÎ‹ ¿Ú‰Â˘ÛË (·fi ÓÂ˘ÌÔÓÈÎ‹ ·Ú-

ÙËÚ›·), Î˘ÛÙÈÎ‹ ·‰ÂÓÔÌ·ÙÔÂÈ‰‹˜ ‰È·Ì·ÚÙ›· ‹ Û˘ÁÁÂ-

Ó¤˜ ÏÔ‚Ò‰Â˜ ÂÌÊ‡ÛËÌ·.

∏ ‰È¿Ï·ÛË ÙÔ˘ ÊÏÂ‚ÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ¤¯ÂÈ ‰ÈÂ-

ÚÂ˘ÓËıÂ› ÏÈÁfiÙÂÚÔ. ™Â ÔÔÈ·‰‹ÔÙÂ ·fi ÙÈ˜ ·Ú·-

¿Óˆ ÂÚÈÙÒÛÂÈ˜ ÌÔÚÂ› Ó· Û˘Ó˘¿Ú¯ÂÈ ‰È·Ù·Ú·¯‹

185™˘ÁÁÂÓÂ›˜ ‰È·Ì·ÚÙ›Â˜ ÓÂ˘ÌfiÓˆÓ

¶·È‰È·ÙÚÈÎ‹ 2007;70:184-191


ÙË˜ ÊÏÂ‚ÈÎ‹˜ ·ÚÔ¯¤ÙÂ˘ÛË˜. √È ·ÓÒÌ·ÏÂ˜ ÊÏ¤‚Â˜

(·Ú·ÏÏ·Á‹ Û˘Ó‰ÚfiÌÔ˘ Scimitar) ÌÔÚÂ› Ó· Î·Ù·-

Ï‹ÁÔ˘Ó ÛÙÔÓ ‰ÂÍÈfi ÎfiÏÔ, ÛÙËÓ ¿Óˆ ‹ Î¿Ùˆ ÎÔ›ÏË

ÊÏ¤‚· Î·È ÂÓ›ÔÙÂ ÛÙÔÓ ·ÚÈÛÙÂÚfi ÎfiÏÔ.

¢È·ÁÓˆÛÙÈÎ‹ ÚÔÛ¤ÁÁÈÛË

∏ ·ıÔÏÔÁ›· ÙÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜

ÂÎÊÚ¿˙ÂÙ·È ÌÂ ÂÚÈÔÚÈÛÌ¤ÓÔ Ê¿ÛÌ· Û˘ÌÙˆÌ¿ÙˆÓ

Î·È ÛËÌÂ›ˆÓ, ÔÈ Û˘Ó‰˘·ÛÌÔ› ÙˆÓ ÔÔ›ˆÓ (ÎÏÈÓÈÎ‹ ÂÈ-

ÎfiÓ·) Û¿ÓÈ· ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·ÍÈÔÛËÌÂ›ˆÙË ÂÈ‰ÈÎfi-

ÙËÙ·. ∞Ó¿ÏÔÁÔ Úfi‚ÏËÌ· ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ù· ·Ú·-

ÎÏÈÓÈÎ¿ ÂÚÁ·ÛÙËÚÈ·Î¿ ÂÚÁ·ÏÂ›· ÚÒÙË˜ ÁÚ·ÌÌ‹˜

(·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·Î·, ÛÈÚÔÌÂÙÚ›·, ÔÍ˘ÌÂÙÚ›·, ·¤-

ÚÈ· ·›Ì·ÙÔ˜, ÁÂÓÈÎ¤˜ ·ÈÌ·ÙÔÏÔÁÈÎ¤˜ ÂÍÂÙ¿ÛÂÈ˜). ∫·-

Ù¿ Û˘Ó¤ÂÈ·, ÙÔ “ÊÙˆ¯fi ÏÂÍÈÏfiÁÈÔ” ÙË˜ ·ıÔÏÔÁ›·˜

ÙÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ

ÙË Û·ÓÈfiÙËÙ· ÙˆÓ Û˘ÁÁÂÓÒÓ ‰È·Ì·ÚÙÈÒÓ ÙÔ˘ ÓÂ‡-

ÌÔÓ·, Î·ıÈÛÙÔ‡Ó ··Ú·›ÙËÙÔ ÙÔÓ ˘„ËÏfi ‰Â›ÎÙË

˘Ô„›·˜ ÂÎ Ì¤ÚÔ˘˜ ÙÔ˘ ÎÏÈÓÈÎÔ‡ ÁÈ·ÙÚÔ‡ ÚÔÎÂÈÌ¤-

ÓÔ˘ Ó· Ô‰ËÁËıÂ› ÛÙË ‰È¿ÁÓˆÛ‹ ÙÔ˘˜.

∏ Û˘ÁÁÂÓ‹˜ ‰È·Ì·ÚÙ›· ÙÔ˘ ÓÂ‡ÌÔÓ· ÌÔÚÂ› Ó·

Â›Ó·È ÁÓˆÛÙ‹ ‹‰Ë ·fi ÙÔÓ ÚÔÁÂÓÓËÙÈÎfi ¤ÏÂÁ¯Ô, Ó·

ÂÎ‰ËÏˆıÂ› ˆ˜ ÂÂ›ÁÔ˘Û· Î·Ù¿ÛÙ·ÛË ÛÙÈ˜ ÚÒÙÂ˜

ÛÙÈÁÌ¤˜ ÙË˜ ˙ˆ‹˜ ‹ Ó· ·ÚÔ˘ÛÈ·ÛıÂ› ·ÚÁfiÙÂÚ· (ÓÂÔ-

ÁÓÈÎ‹, fi„ÈÌË ‚ÚÂÊÈÎ‹, ·È‰ÈÎ‹ ËÏÈÎ›·, ÂÊË‚Â›·, ÂÓ‹-

ÏÈÎÔ ˙ˆ‹). ∂Ó›ÔÙÂ ÔÈ Û˘ÁÁÂÓÂ›˜ ‰È·Ì·ÚÙ›Â˜ ·Ú·Ì¤-

ÓÔ˘Ó ·Û˘ÌÙˆÌ·ÙÈÎ¤˜ Î·È ·ÔÙÂÏÔ‡Ó Ù˘¯·›Ô ·ÎÙÈ-

ÓÔÁÚ·ÊÈÎfi Â‡ÚËÌ·. Ÿ¯È Û¿ÓÈ· Ù¤ÏÔ˜, Û˘ÓÔ‰Â‡ÔÓÙ·È

·fi ‰È·Ì·ÚÙ›Â˜ ¿ÏÏˆÓ Û˘ÛÙËÌ¿ÙˆÓ -Û˘¯ÓfiÙÂÚ· ÙÔ˘

Î·Ú‰È·ÁÁÂÈ·ÎÔ‡ ·ÏÏ¿ Î·È ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡, Ì˘Ô-

ÛÎÂÏÂÙÈÎÔ‡, Ô˘ÚÔÔÈÔÁÂÓÓËÙÈÎÔ‡- ‹ ·ÔÙÂÏÔ‡Ó Û˘-

ÛÙ·ÙÈÎ¿ ÛÙÔÈ¯Â›· Û˘Ó‰ÚfiÌˆÓ, ÌÂ ·ÔÙ¤ÏÂÛÌ· Ó· ÂÎ-

‰ËÏÒÓÔÓÙ·È ÌÂ Û˘ÌÙˆÌ·ÙÔÏÔÁ›· ÂÎÙfi˜ ÙÔ˘ ·Ó·-

ÓÂ˘ÛÙÈÎÔ‡ (7,12-14).

¶ÚÔÁÂÓÓËÙÈÎ‹ ‰È¿ÁÓˆÛË Î·È ÂÎ‰ËÏÒÛÂÈ˜ ÛÙÔ

ÓÂÔÁ¤ÓÓËÙÔ Î·È ÛÙÔ˘˜ ÚÒÙÔ˘˜ Ì‹ÓÂ˜ ̇ ˆ‹˜

√È Û˘ÁÁÂÓÂ›˜ ·ÓˆÌ·Ï›Â˜ ÙÔ˘ ÓÂ‡ÌÔÓ· ÌÔÚÂ› Ó·

ÂÎ‰ËÏˆıÔ‡Ó ‹‰Ë ·fi ÙËÓ ÂÓ‰ÔÌ‹ÙÚÈÔ ˙ˆ‹ Î·È Ó·

ÂÓÙÔÈÛıÔ‡Ó ÌÂ ÙËÓ ˘ÂÚË¯ÔÁÚ·ÊÈÎ‹ ÂÍ¤Ù·ÛË ÙÔ˘

ÂÌ‚Ú‡Ô˘. ∆Ô ÔÏÈÁÔ¸‰Ú¿ÌÓÈÔ Â›Ó·È ÙÔ ‰Â‡ÙÂÚÔ ÛÂ Û˘¯Ófi-

ÙËÙ· ·›ÙÈÔ ÙË˜ ·Ï·Û›·˜ ‹ ˘ÔÏ·Û›·˜ ÙÔ˘ ÓÂ‡ÌÔ-

Ó·. ¶ÔÏ˘˘‰Ú¿ÌÓÈÔ ÌÔÚÂ› Ó· ÚÔÎ·Ï¤ÛÂÈ Ë ·ÙÚËÛ›·

ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘, È‰È·›ÙÂÚ· fiÙ·Ó Û˘ÓÔ‰Â‡ÂÙ·È ·fi ÙÚ·-

¯ÂÈÔÔÈÛÔÊ·ÁÈÎfi Û˘Ú›ÁÁÈÔ Î·È ÔÔÈ·‰‹ÔÙÂ ¯ˆÚÔÎ·-

Ù·ÎÙËÙÈÎ‹ ÂÓ‰ÔıˆÚ·ÎÈÎ‹ ‚Ï¿‚Ë, fiÙ·Ó ·˘Ù‹ Ô‰ËÁÂ› ÛÂ

ÛÔ‚·Ú‹ ÌÂ›ˆÛË ÙÔ˘ fiÁÎÔ˘ ÙˆÓ ÓÂ˘ÌfiÓˆÓ, ·ÊÔ‡ Ê˘-

ÛÈÔÏÔÁÈÎ¿ ÂÚÈ¤¯Ô˘Ó ÙÔ ÂÓ‰ÔÓÂ˘ÌÔÓÈÎfi ˘ÁÚfi, ·Ó¿-

ÏÔÁÔ ÙÔ˘ ·ÌÓÈ·ÎÔ‡ (Û˘ÁÁÂÓ‹˜ ‰È·ÊÚ·ÁÌ·ÙÔÎ‹ÏË, Â˘-

ÌÂÁ¤ıË˜ ‚ÚÔÁ¯ÔÁÂÓ‹˜ Î‡ÛÙË, Î˘ÛÙÈÎ‹ ·‰ÂÓÔÌ·ÙÔÂÈ-

‰‹˜ ‰˘ÛÏ·Û›·, Â˘Ì¤ÁÂıÂ˜ ·fiÏ˘Ì·) (15).

¶ÔÏÏ¤˜ Û˘ÁÁÂÓÂ›˜ ‰È·Ì·ÚÙ›Â˜ ÙÔ˘ ÓÂ‡ÌÔÓ· ÂÎ-

‰ËÏÒÓÔÓÙ·È ˆ˜ ÂÂ›ÁÔÓÙ· ·Ó·ÓÂ˘ÛÙÈÎ¿ ÂÚÈÛÙ·ÙÈÎ¿

ÌÂ ·Ó·ÓÂ˘ÛÙÈÎ‹ ‰˘Û¯¤ÚÂÈ·, ÛËÌ·ÓÙÈÎ‹ ·‡ÍËÛË ÙÔ˘

¤ÚÁÔ˘ ·Ó·ÓÔ‹˜ ‹/Î·È Î˘¿ÓˆÛË (¶›Ó·Î·˜ 1) (3).

∆Ô ÈÛÙÔÚÈÎfi ‰‡ÛÎÔÏÔ˘ ÙÔÎÂÙÔ‡ ı¤ÙÂÈ ˘Ô„›· ÙÚ·˘-

Ì·ÙÈÎ‹˜ ·Ú¿Ï˘ÛË˜ ÙÔ˘ ÊÚÂÓÈÎÔ‡ ÓÂ‡ÚÔ˘ Î·È Ë

·Ó·ÓÂ˘ÛÙÈÎ‹ ‰˘Û¯¤ÚÂÈ· Ô˘ Û˘ÓÔ‰Â‡ÂÙ·È ·fi

·‰˘Ó·Ì›· ‰È·ÚÚÈÓÈÎ‹˜ ‰È¿‚·ÛË˜ ÙÔ˘ ÚÈÓÔÁ·ÛÙÚÈÎÔ‡ Î·-

ıÂÙ‹Ú· ˘Ô‰ËÏÒÓÂÈ ·ÌÊÔÙÂÚfiÏÂ˘ÚË ·ÙÚËÛ›· ÚÈÓÈ-

ÎÒÓ ¯Ô·ÓÒÓ.

∫·Ù¿ ÙËÓ ÎÏÈÓÈÎ‹ ÂÍ¤Ù·ÛË ÙÔ˘ ÓÂÔÁ¤ÓÓËÙÔ˘, Ë

·Ô˘Û›· ·Ó·ÓÂ˘ÛÙÈÎÒÓ ‹¯ˆÓ ÛÙÔ ¤Ó· ‹ Î·È ÛÙ· ‰‡Ô

ËÌÈıˆÚ¿ÎÈ· ı¤ÙÂÈ ˙‹ÙËÌ· Èı·Ó‹˜ ÂÙÂÚfiÏÂ˘ÚË˜

·Ï·Û›·˜/˘ÔÏ·Û›·˜ (ÌÔÚÂ› Ó· Û˘ÓÔ‰Â‡ÂÙ·È ·fi

ÂÈ¤‰ˆÛË Î·È ÂÏ·ÙÙˆÌ¤ÓË ÎÈÓËÙÈÎfiÙËÙ· Û‡ÛÙÔÈ¯·,

Û˘ÁÁÂÓ‹ Î·Ú‰ÈÔ¿ıÂÈ· Î·È ·ÓˆÌ·Ï›Â˜ ÚÔÛÒÔ˘),

Û˘ÁÁÂÓÔ‡˜ ÏÔ‚Ò‰Ô˘˜ ÂÌÊ˘Û‹Ì·ÙÔ˜, Û˘ÁÁÂÓÔ‡˜ ‰È·-

ÊÚ·ÁÌ·ÙÔÎ‹ÏË˜ (85% ÛÙÔ ·ÚÈÛÙÂÚfi ËÌÈıˆÚ¿ÎÈÔ),

ÌÂÁ¿ÏË˜ ¯ˆÚÔÎ·Ù·ÎÙËÙÈÎ‹˜ ‚Ï¿‚Ë˜ (Û˘ÁÁÂÓ‹˜ ‰È·-

ÊÚ·ÁÌ·ÙÔÎ‹ÏË, Û˘ÁÁÂÓ‹˜ ÌÂÛÔıˆÚ·ÎÈÎ‹ ‹ ·ÚÂÁ-

¯˘Ì·ÙÈÎ‹ Î‡ÛÙË, Î˘ÛÙÈÎ‹ ·‰ÂÓÔÌ·ÙÔÂÈ‰‹˜ ‰˘ÛÏ·-

Û›·, ÔÏ‡ ÌÂÁ¿ÏÔ ·fiÏ˘Ì·) ‹ Û·ÓÈfiÙÂÚ·, ÂÎÛÂÛË-

Ì·ÛÌ¤ÓË˜ ‰È¿Ù·ÛË˜ ÙË˜ ÎÔÈÏÈ¿˜, ÔfiÙÂ ‰ÈÂÚÂ˘Ó¿Ù·È

ÙÔ ·›ÙÈÔ ÙË˜ ‰È¿Ù·ÛË˜.

∞ÎÚfi·ÛË ÂÓÙÂÚÈÎÒÓ ‹¯ˆÓ ÛÙÔ ·ÚÈÛÙÂÚfi ËÌÈıˆÚ¿ÎÈÔ

Ô˘ Û˘ÓÔ‰Â‡ÂÙ·È ·fi ÛÎ·ÊÔÂÈ‰‹ ÎÔÈÏÈ¿ Î·ÙÂ˘ı‡ÓÔ˘Ó

ÙË ‰È·ÁÓˆÛÙÈÎ‹ ÛÎ¤„Ë ÚÔ˜ ÙË Û˘ÁÁÂÓ‹ ‰È·ÊÚ·ÁÌ·-

ÙÔÎ‹ÏË. ™ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ ·˘Ù¤˜, Ô ·ÂÚÈÛÌfi˜ ÌÂ ·ÛÎfi

Î·È Ì¿ÛÎ· ÌÔÚÂ› Ó· ÂÈ‰ÂÈÓÒÛÂÈ ÙËÓ ÎÏÈÓÈÎ‹ ÂÈÎfiÓ·

186 ∫. ¡. ¶Ú›ÊÙË˜ Î·È Û˘Ó.


¶›Ó·Î·˜ 1. ™˘ÁÁÂÓÂ›˜ ‰È·Ì·ÚÙ›Â˜ ÙÔ˘ ÓÂ‡ÌÔÓ· Ô˘ ÌÔÚÂ› Ó·ÂÎ‰ËÏˆıÔ‡Ó ˆ˜ ÂÂ›ÁÔÓÙ· ÂÚÈÛÙ·ÙÈÎ¿ ÛÙÔ ÓÂÔÁ¤ÓÓËÙÔ

ñ ∞ÙÚËÛ›· ÚÈÓÈÎÒÓ ¯Ô·ÓÒÓñ ∞˘¯ÂÓÈÎ¤˜ Ì¿˙Â˜ (ÏÂÌÊ·ÁÁÂ›ˆÌ·, ·ÈÌ·ÁÁÂ›ˆÌ·, Û˘ÁÁÂÓ‹˜

‚ÚÔÁ¯ÔÎ‹ÏË, Î‡ÛÙË ı˘ÚÂÔÁÏˆÛÛÈÎÔ‡ fiÚÔ˘, ‚Ú·Á¯È·Î‹Î‡ÛÙË)

ñ ÀÂÚÁÏˆÙÙÈ‰ÈÎ‹ Û‡ÓÙËÍË Ï¿Ú˘ÁÁ·, ·ÏËı‹˜ Ï·Ú˘ÁÁÈÎ‹ÌÂÌ‚Ú¿ÓË, Ï·Ú˘ÁÁÈÎ‹ Î‡ÛÙË, ‰˘ÛÏ·Û›· ÎÚÈÎÔÂÈ‰Ô‡˜¯fiÓ‰ÚÔ˘, ·Ú¿Ï˘ÛË ÊˆÓËÙÈÎÒÓ ¯ÔÚ‰ÒÓ

ñ ∞ÁÁÂÈ·Îfi˜ ‰·ÎÙ‡ÏÈÔ˜ (Û¿ÓÈÔ, ÛÂ ·ÎÚ·›Â˜ ÂÚÈÙÒÛÂÈ˜)ñ ∫‡ÛÙÂÈ˜ Î·È fiÁÎÔÈ ÌÂÛÔıˆÚ·Î›Ô˘ (Â˘ÌÂÁ¤ıÂÈ˜, Â›

ÛËÌ·ÓÙÈÎ‹˜ ·fiÊÚ·ÍË˜)ñ ∞ÙÚËÛ›· ÔÈÛÔÊ¿ÁÔ˘ ÌÂ ‹ ¯ˆÚ›˜ ÙÚ·¯ÂÈÔÔÈÛÔÊ·ÁÈÎfi

Û˘Ú›ÁÁÈÔñ µÚÔÁ¯ÔÁÂÓÂ›˜ Î‡ÛÙÂÈ˜ (Â˘ÌÂÁ¤ıÂÈ˜, Â› ÛËÌ·ÓÙÈÎ‹˜

·fiÊÚ·ÍË˜)ñ ∫˘ÛÙÈÎ‹ ·‰ÂÓÔÌ·ÙÔÂÈ‰‹˜ ‰˘ÛÏ·Û›· (75% ÂÎ‰‹ÏˆÛË ÛÙÔ

ÓÂÔÁ¤ÓÓËÙÔ)ñ ™˘ÁÁÂÓ¤˜ ÏÔ‚Ò‰Â˜ ÂÌÊ‡ÛËÌ· (50% ÂÎ‰‹ÏˆÛË ÛÙÔÓ ÚÒÙÔ

Ì‹Ó· ˙ˆ‹˜)ñ ¶ÓÂ˘ÌÔÓÈÎfi ·fiÏ˘Ì· (Û¿ÓÈÔ, ÂÊfiÛÔÓ È‰È·›ÙÂÚ·

Â˘Ì¤ÁÂıÂ˜)ñ ∞ÁÂÓÂÛ›·/˘ÔÏ·Û›· ÓÂ‡ÌÔÓ·ñ ¶ÓÂ˘ÌÔıÒÚ·Î·˜ (Û˘Ó¤ÂÈ· Ú‹ÍË˜ Î˘ÛÙÈÎÔ‡ Û¯ËÌ·ÙÈÛÌÔ‡)ñ ™˘ÁÁÂÓ‹˜ ÏÂÌÊ·ÁÁÂÈÂÎÙ·Û›·, ¯˘ÏÔıÒÚ·Î·˜ñ ¢˘ÛÏ·Û›Â˜ ıˆÚ·ÎÈÎÔ‡ ÙÔÈ¯ÒÌ·ÙÔ˜ñ ∂ÎÛÂÛËÌ·ÛÌ¤ÓË ‰È¿Ù·ÛË ÙË˜ ÎÔÈÏÈ¿˜ (ÔÈÎ›ÏË˜

·ÈÙÈÔÏÔÁ›·˜)


ÏfiÁˆ ‰È¿Ù·ÛË˜ ÙÔ˘ ÛÙÔÌ¿¯Ô˘ Ô˘ ‚Ú›ÛÎÂÙ·È ÛÙË ıˆ-

Ú·ÎÈÎ‹ ÎÔÈÏfiÙËÙ·. ∏ Î·Ú‰È·Î‹ ÛÎÈ¿ ·ˆıÂ›Ù·È ÚÔ˜

Ù· ‰ÂÍÈ¿.

∫ÏÈÓÈÎ¿ ÛËÌ·ÓÙÈÎfi˜ ÓÂ˘ÌÔıÒÚ·Î·˜ ÌÔÚÂ› Ó· Â›Ó·È

Û˘Ó¤ÂÈ· Û˘ÁÁÂÓÔ‡˜ ÏÔ‚Ò‰Ô˘˜ ÂÌÊ˘Û‹Ì·ÙÔ˜ ‹ ÔÔÈ-

·Û‰‹ÔÙÂ Â˘ÌÂÁ¤ıÔ˘˜ Û˘ÁÁÂÓÔ‡˜ Î˘ÛÙÈÎ‹˜ ·ÓˆÌ·-

Ï›·˜. ∞‰˘Ó·Ì›· Û›ÙÈÛË˜ ÌÂ ÓÈÁÌÔÓ‹ Î·È Èı·Ó‹ ÂÈÛÚfiÊË-

ÛË, ÌÂ ·Ú¿ÏÏËÏË ·‰˘Ó·Ì›· ÚÔÒıËÛË˜ ÙÔ˘ ÚÈÓÔÁ·-

ÛÙÚÈÎÔ‡ Î·ıÂÙ‹Ú· ÛÙÔÓ ÔÈÛÔÊ¿ÁÔ, ·Ú·¤ÌÂÈ ÛÂ

ÙÚ·¯ÂÈÔÔÈÛÔÊ·ÁÈÎfi Û˘Ú›ÁÁÈÔ ÌÂ ·ÙÚËÛ›· ÔÈÛÔÊ¿ÁÔ˘

(Û˘¯ÓfiÙÂÚÔ˜ Ù‡Ô˜), Ô˘ ÌÔÚÂ› Ó· ÂÈ‚Â‚·ÈˆıÂ›

·ÎÙÈÓÔÁÚ·ÊÈÎ¿ ·fi ÙËÓ ÔÚÂ›· ÙÔ˘ ÚÈÓÔÁ·ÛÙÚÈÎÔ‡

Î·ıÂÙ‹Ú· ‹ ÌÂ ÙË ¯Ú‹ÛË ÛÎÈ·ÁÚ·ÊÈÎÔ‡ ˘ÏÈÎÔ‡.

ÕÏÏÂ˜ Û˘ÁÁÂÓÂ›˜ ‰È·Ì·ÚÙ›Â˜ Ô˘ ÚÔ‚¿ÏÏÔ˘Ó ˆ˜

ÂÂ›ÁÔ˘ÛÂ˜ Î·Ù·ÛÙ¿ÛÂÈ˜ ÛÙÔ ÓÂÔÁ¤ÓÓËÙÔ ÂÚÈÏ·Ì‚¿-

ÓÔ˘Ó ÙÈ˜ ÛÔ‚·Ú¤˜ ‰˘ÛÏ·Û›Â˜ ÙÔ˘ Ï¿Ú˘ÁÁ· Î·È ÙË˜

ÙÚ·¯Â›·˜ (Ï‹ÚË˜ Û‡ÓÙËÍË ÙˆÓ ˘ÂÚÁÏˆÙÙÈ‰ÈÎÒÓ

·Ó·ÙÔÌÈÎÒÓ ÌÔÚ›ˆÓ, ·ÏËıÂ›˜ Ï·Ú˘ÁÁÈÎ¤˜ ÌÂÌ‚Ú¿-

ÓÂ˜, Ï·Ú˘ÁÁÈÎ¤˜ Î‡ÛÙÂÈ˜, ‰˘ÛÏ·Û›· ÎÚÈÎÔÂÈ‰Ô‡˜

¯fiÓ‰ÚÔ˘, ·ÌÊÔÙÂÚfiÏÂ˘ÚË ·Ú¿Ï˘ÛË ÊˆÓËÙÈÎÒÓ

¯ÔÚ‰ÒÓ), ÙÈ˜ Ì¿˙Â˜ ·˘¯ÂÓÈÎ‹˜ ÌÔ›Ú·˜ (ÏÂÌÊ·ÁÁÂ›ˆ-

Ì·, ·ÈÌ·ÁÁÂ›ˆÌ·, Û˘ÁÁÂÓ‹˜ ‚ÚÔÁ¯ÔÎ‹ÏË, ÌÂÁ¿ÏÂ˜

‚Ú·Á¯È·Î¤˜ Î‡ÛÙÂÈ˜ ‹ Î‡ÛÙÂÈ˜ ı˘ÚÂÔÁÏˆÛÛÈÎÔ‡ fi-

ÚÔ˘) Û·Ó›ˆ˜ ÙÈ˜ ·ÎÚ·›Â˜ ÌÔÚÊ¤˜ ·ÁÁÂÈ·ÎÔ‡ ‰·ÎÙ˘-

Ï›Ô˘ (·ÁÎ‡ÏË ·ÚÈÛÙÂÚ¿˜ ÓÂ˘ÌÔÓÈÎ‹˜ ·ÚÙËÚ›·˜ ÌÂ

ÛÙ¤ÓˆÛË ÙÚ·¯Â›·˜ ÏfiÁˆ Ï‹ÚˆÓ ¯fiÓ‰ÚÈÓˆÓ ‰·ÎÙ˘-

Ï›ˆÓ, ring-sling syndrome) Î·È Ù· ÂÏÏÂ›ÌÌ·Ù· ÙÔ˘

ıˆÚ·ÎÈÎÔ‡ ÙÔÈ¯ÒÌ·ÙÔ˜ (ÛÙÂÚÓÈÎ‹ Û¯ÈÛÙ›·, ·Ô˘Û›·

ÙÌËÌ¿ÙˆÓ ÏÂ˘ÚÒÓ Î.Ï.) (7,12-14,16).

µÏ¿‚Â˜ ÛÙÔ Â›Â‰Ô ÙË˜ ÁÏˆÙÙ›‰·˜ ÌÔÚÂ› Ó·

Û˘ÓÔ‰Â‡ÔÓÙ·È ·fi ·ÊˆÓ›· ‹ ‚Ú·¯Ófi Î·È ·‰‡Ó·ÌÔ ÎÏ¿-

Ì·. ∏ ·Ó·ÓÂ˘ÛÙÈÎ‹ ‰˘Û¯¤ÚÂÈ· ÏfiÁˆ ÂÍˆıˆÚ·ÎÈÎ‹˜

·fiÊÚ·ÍË˜ ÙÔ˘ ·ÂÚ·ÁˆÁÔ‡ ÚÔÎ·ÏÂ› ÚˆÙ›ÛÙˆ˜ ÂÈ-

ÛÓÂ˘ÛÙÈÎfi Î·È Èı·ÓfiÓ ‰ÈÊ·ÛÈÎfi ÛÈÁÌfi, ·Ó Î·È ·˘Ùfi

ÙÔ ÎÏÈÓÈÎfi ÛËÌÂ›Ô ÂÎ‰ËÏÒÓÂÙ·È Û˘Ó‹ıˆ˜ ·ÚÁfiÙÂÚ·,

Î·Ù¿ ÙÔ˘˜ ÚÒÙÔ˘˜ Ì‹ÓÂ˜ ÙË˜ ˙ˆ‹˜. √ ·ÁÁÂÈ·Îfi˜

‰·ÎÙ‡ÏÈÔ˜ Ô˘ ÂÎ‰ËÏÒÓÂÙ·È ÓˆÚ›˜ Û˘ÓÔ‰Â‡ÂÙ·È ·fi

ÌÔÓÔÊˆÓÈÎfi ‹ Û˘¯Ó¿ ‰ÈÊ·ÛÈÎfi Û˘ÚÈÁÌfi (ÂÓ‰ÔıˆÚ·-

ÎÈÎ‹ ·fiÊÚ·ÍË ÙÚ·¯Â›·˜) Î·ıÒ˜ Î·È ·fi ÚÔ‚Ï‹Ì·-

Ù· Û›ÙÈÛË˜, ÛÈÂÏfiÚÚÔÈ· Î·È ÂÈÎfiÓ· ÔÈÛıfiÙÔÓÔ˘. ∏ ÛÔ‚·-

Ú‹ ÙÚ·¯ÂÈÔÌ·Ï¿Î˘ÓÛË ÏfiÁˆ ·ÁÁÂÈ·ÎÔ‡ ‰·ÎÙ˘Ï›Ô˘ ‹

Ë ·Ú·ÌÔÓ‹ ÙË˜ ÌÂÙ¿ ‰ÈfiÚıˆÛË ÙÚ·¯ÂÈÔÔÈÛÔÊ·ÁÈ-

ÎÔ‡ Û˘ÚÈÁÁ›Ô˘ Î·È ÔÈ ÂÈÛÚÔÊ‹ÛÂÈ˜ ÔÈÎ›ÏË˜ ·ÈÙÈÔÏÔ-

Á›·˜ (ÙÚ·¯ÂÈÔÔÈÛÔÊ·ÁÈÎfi Û˘Ú›ÁÁÈÔ, Ï·Ú˘ÁÁÈÎ‹ Û¯È-

ÛÌ‹, ·Û˘Ó¤ÚÁÂÈ· Ì˘ÒÓ Î·Ù¿ÔÛË˜, Á·ÛÙÚÔÔÈÛÔÊ·ÁÈ-

Î‹ ·ÏÈÓ‰ÚfiÌËÛË) ÌÔÚÂ› Ó· ÂÎ‰ËÏˆıÔ‡Ó ÌÂ ÂÂÈ-

Ûfi‰È· ¿ÓÔÈ·˜ Î·È ‚Ú·‰˘Î·Ú‰›·˜.

∏ Û˘ÁÁÂÓ‹˜ ÏÂÌÊ·ÁÁÂÈÂÎÙ·Û›· ÂÎ‰ËÏÒÓÂÙ·È ÌÂ

·Ó·ÓÂ˘ÛÙÈÎ‹ ‰˘Û¯¤ÚÂÈ· Î·È Î˘¿ÓˆÛË ·fi ÙÈ˜ ÚÒÙÂ˜

ÒÚÂ˜ ˙ˆ‹˜, ÂÓÒ ÙÔ ·Ó·ÓÂ˘ÛÙÈÎfi „Èı‡ÚÈÛÌ· ·ÎÔ‡-

ÁÂÙ·È ·ÚÔÛ‰fiÎËÙ· Ê˘ÛÈÔÏÔÁÈÎfi.

∏ ÂÂ›ÁÔ˘Û· ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·Î· ÌÔÚÂ› Ó·

‚ÔËı‹ÛÂÈ ÛËÌ·ÓÙÈÎ¿ ÛÙË ‰ÈÂ˘ÎÚ›ÓÈÛË ÙˆÓ ·ÓˆÙ¤Úˆ

Û˘ÁÁÂÓÒÓ ·ÓˆÌ·ÏÈÒÓ. ™Â Î¿ıÂ ÂÚ›ÙˆÛË, ÚÔ¤¯ÂÈ

Ë Î·Ú‰ÈÔ·Ó·ÓÂ˘ÛÙÈÎ‹ ÛÙ·ıÂÚÔÔ›ËÛË ÙÔ˘ ¿Û¯Ô-

ÓÙÔ˜ ÓÂÔÁÓÔ‡, Ô˘ ÌÔÚÂ› Ó· ··ÈÙ‹ÛÂÈ ÂÓÙ·ÙÈÎ‹

ıÂÚ·Â›· Î·È ÌË¯·ÓÈÎ‹ ˘ÔÛÙ‹ÚÈÍË. ÿÛˆ˜ ¯ÚÂÈ·ÛıÂ›

ÂÂ›ÁÔ˘Û· ¯ÂÈÚÔ˘ÚÁÈÎ‹ ·ÓÙÈÌÂÙÒÈÛË (.¯. ÙÚ·¯ÂÈÔ-

ÛÙÔÌ›·) ÚÔÎÂÈÌ¤ÓÔ˘ Ó· ·ÚıÂ›, ¤ÛÙˆ ÚÔÛˆÚÈÓ¿, ÙÔ

·›ÙÈÔ Ô˘ ‰È·Î˘‚Â‡ÂÈ ÙË ‚·ÙfiÙËÙ· ÙÔ˘ ·ÂÚ·ÁˆÁÔ‡.

√ ÂÚ·ÈÙ¤Úˆ ¤ÏÂÁ¯Ô˜ ÌÔÚÂ› Ó· ÂÚÈÏ¿‚ÂÈ ÛÂÈÚ¿

·ÂÈÎÔÓÈÛÙÈÎÒÓ ÌÂıfi‰ˆÓ (‚·ÚÈÔ‡¯Ô ÁÂ‡Ì·, ·ÍÔÓÈÎ‹

Î·È Ì·ÁÓËÙÈÎ‹ ÙÔÌÔÁÚ·Ê›·, ˘ÂÚË¯ÔÁÚ¿ÊËÌ·, ·Á-

ÁÂÈÔÁÚ·Ê›· Î.Ï., Ô˘ ‰ÈÂ˘ÎÚÈÓ›˙Ô˘Ó ÙË ‚Ï¿‚Ë ·Ó·-

ÙÔÌÈÎ¿). ∏ ‚ÚÔÁ¯ÔÛÎfiËÛË ÌÂ ÙÔ Â‡Î·ÌÙÔ ‹/Î·È

¿Î·ÌÙÔ ‚ÚÔÁ¯ÔÛÎfiÈÔ ·Ó·‰ÂÈÎÓ‡ÂÈ ÙÈ˜ Û˘Ó¤ÂÈÂ˜

ÙË˜ Û˘ÁÁÂÓÔ‡˜ ‰È·Ì·ÚÙ›·˜ ÛÙÔÓ ·ÂÚ·ÁˆÁfi (ÂÓ‰Ô·˘-

ÏÈÎ¿ ·›ÙÈ· ÛÙ¤ÓˆÛË˜, ÂÍˆÙÂÚÈÎ‹ Û˘Ì›ÂÛË, ‰˘Ó·ÌÈ-

Î‹ ÛÙ¤ÓˆÛË Â› Ï·Ú˘ÁÁÔ-ÙÚ·¯ÂÈÔ-‚ÚÔÁ¯ÔÌ·Ï¿Î˘Ó-

ÛË˜), ÂÓÒ ÙÔ ‚ÚÔÁ¯ÔÎ˘„ÂÏÈ‰ÈÎfi ¤ÎÏ˘Ì· ÌÔÚÂ› Ó·

ÙÂÎÌËÚÈÒÛÂÈ ÂÈÛÚfiÊËÛË ‹ ·ÈÌÔÚÚ·Á›· (7,12-14,17).

§fiÁˆ Û˘¯Ó‹˜ Û˘Ó‡·ÚÍË˜ Û˘ÁÁÂÓÔ‡˜ Î·Ú‰ÈÔ¿-

ıÂÈ·˜, Ú¤ÂÈ Ó· Á›ÓÂÙ·È ˘ÂÚË¯ÔÎ·Ú‰ÈÔÁÚ·ÊÈÎfi˜

¤ÏÂÁ¯Ô˜. ™ÙËÓ ÂÚ›ÙˆÛË ·ÔÏ‡Ì·ÙÔ˜ ‹ Û·Ó›ˆ˜,

Û˘ÁÁÂÓÔ‡˜ Î‡ÛÙË˜ ÌÂ Û˘ÛÙËÌ·ÙÈÎ‹ ·ÁÁÂ›ˆÛË Î·È ÌÂ-

Á¿ÏË ‰È·Ê˘Á‹ ·fi ÙËÓ ·ÚÈÛÙÂÚ‹ ÚÔ˜ ÙË ‰ÂÍÈ¿ Î˘-

ÎÏÔÊÔÚ›·, ÚÒÙË ÂÎ‰‹ÏˆÛË ÙË˜ Û˘ÁÁÂÓÔ‡˜ ÓÂ˘ÌÔ-

ÓÈÎ‹˜ ‰È·Ì·ÚÙ›·˜ ÌÔÚÂ› Ó· Â›Ó·È Î·Ú‰È·Î‹ ·ÓÂ¿Ú-

ÎÂÈ· (7,12-14).

∂Î‰ËÏÒÛÂÈ˜ ÛÙËÓ fi„ÈÌË ‚ÚÂÊÈÎ‹ ËÏÈÎ›· Î·È ÛÙ·

ÚÒÙ· 2-3 ¤ÙË ̇ ˆ‹˜

∫·Ù¿ ÙËÓ ÂÚ›Ô‰Ô ·˘Ù‹ ¤¯Ô˘Ó Ï¤ÔÓ ÂÎ‰ËÏˆıÂ›

ÔÈ ÂÚÈÛÛfiÙÂÚÂ˜ ·fi ÙÈ˜ ÎÏÈÓÈÎ¿ ÛËÌ·ÓÙÈÎ¤˜ Û˘ÁÁÂ-

ÓÂ›˜ ‰È·Ì·ÚÙ›Â˜ ÙÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ∏

fi„ÈÌË ÂÎ‰‹ÏˆÛË Û˘ÁÁÂÓÔ‡˜ ‰È·Ì·ÚÙ›·˜ Â›Ó·È Ì¿Ï-

ÏÔÓ Û˘Ó¤ÂÈ· ÂÚÈÔÚÈÛÌ¤ÓÔ˘ ÌÂÁ¤ıÔ˘˜ ÙË˜ ‚Ï¿‚Ë˜

·Ú¿ ÙË˜ ›‰È·˜ ÙË˜ Ê‡ÛË˜ ÙË˜. ™ÙÔÓ ¶›Ó·Î· 2 ·Ó·Ê¤-

ÚÔÓÙ·È ÔÈ Û˘ÁÁÂÓÂ›˜ ‰È·Ì·ÚÙ›Â˜ ÔÈ ÔÔ›Â˜ Î·Ù’ ÂÍÔ¯‹Ó

··Û¯ÔÏÔ‡Ó ÙÔÓ ÁÈ·ÙÚfi ÌÂÙ¿ ÙÔ˘˜ ÚÒÙÔ˘˜ Ì‹ÓÂ˜

˙ˆ‹˜ Î·È Ì¤¯ÚÈ ÙËÓ ÚÒÈÌË ÚÔÛ¯ÔÏÈÎ‹ ËÏÈÎ›·.

¶Ú¤ÂÈ Ó· Á›ÓÂÙ·È ‰È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË ÙÔ˘ ÛÈÁ-

ÌÔ‡ (stridor) Î·È ÙÔ˘ Û˘ÚÈÁÌÔ‡ (wheezing). √ ÚÒÙÔ˜

Â›Ó·È Î˘Ú›ˆ˜ ÂÈÛÓÂ˘ÛÙÈÎfi˜ ÌÔÓÔÊˆÓÈÎfi˜ ÌÔ˘ÛÈÎfi˜

‹¯Ô˜, ÏfiÁˆ ÂÍˆıˆÚ·ÎÈÎ‹˜ ÛÙ¤ÓˆÛË˜ ÙÔ˘ ·ÂÚ·Áˆ-

ÁÔ‡. O ‰Â‡ÙÂÚÔ˜ Â›Ó·È ÚˆÙ›ÛÙˆ˜ ÂÎÓÂ˘ÛÙÈÎfi˜ ÌÔ-

ÓÔÊˆÓÈÎfi˜ ‹ ÔÏ˘ÊˆÓÈÎfi˜ -·Ó·ÏfiÁˆ˜ ÙË˜ ÂÓÙfiÈ-

ÛË˜- ÌÔ˘ÛÈÎfi˜ ‹¯Ô˜ Î·È ÔÊÂ›ÏÂÙ·È ÛÂ ÂÓ‰ÔıˆÚ·ÎÈÎ‹

ÛÙ¤ÓˆÛË ÙˆÓ ·ÂÚ·ÁˆÁÒÓ (18). ¶¿ÓÙˆ˜, ÚfiÎÂÈÙ·È

ÁÈ· ÂÍ·ÈÚÂÙÈÎ¿ Û˘¯Ó¿ ·Ó·ÓÂ˘ÛÙÈÎ¿ Û˘ÌÙÒÌ·Ù·

·˘Ù‹˜ ÙË˜ ËÏÈÎ›·˜ Ô˘ ÌÔÚÂ› Ó· ÔÊÂ›ÏÔÓÙ·È ÛÂ Û˘-

Ó‹ıÂÈ˜ ·ı‹ÛÂÈ˜. ¶ÔÏ‡ Û˘¯Ó¿ Ù· ·ÎÚÔ·ÛÙÈÎ¿ Â˘Ú‹-

Ì·Ù· ÙË˜ Û˘ÁÁÂÓÔ‡˜ ‰È·Ì·ÚÙ›·˜ ÂÈ‰ÂÈÓÒÓÔÓÙ·È ÌÂ-

Ù¿ ·fi ÏÔ›ÌˆÍË ÙÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡ (.¯. Ï·Ú˘ÁÁÔ-

Ì·Ï¿Î˘ÓÛË, ÙÚ·¯ÂÈÔÌ·Ï¿Î˘ÓÛË) Î·È ·˘Ùfi ÌÔÚÂ›

Ó· ÂÚÈÏ¤ÍÂÈ ÂÚÈÛÛfiÙÂÚÔ ÙË ‰È¿ÁÓˆÛË. ™˘¯Ó¿ Ë


¶·È‰È·ÙÚÈÎ‹ 2007;70:184-191


ÙÚ·¯ÂÈÔÌ·Ï¿Î˘ÓÛË “·ÓÙÈÌÂÙˆ›˙ÂÙ·È” Â› Ì·ÎÚfiÓ

ÌÂ ·ÓÙÈ·ÛıÌ·ÙÈÎ‹ ·ÁˆÁ‹ ÚÔÙÔ‡ ‰È·ÁÓˆÛıÂ› ‹

·ÏÒ˜ ÛÙ·Ì·Ù‹ÛÂÈ Ó· ¤¯ÂÈ ÎÏÈÓÈÎ‹ ÛËÌ·Û›· (7,12-

14,18,19).

™˘¯Ófi Û‡ÌÙˆÌ· ÙË˜ Ï·Ú˘ÁÁÔ-ÙÚ·¯ÂÈÔ-‚ÚÔÁ¯Ô-

Ì·Ï¿Î˘ÓÛË˜ Î·È ÙˆÓ ‰È·ÊfiÚˆÓ Û˘ÁÁÂÓÒÓ ‰È·Ì·Ú-

ÙÈÒÓ Ô˘ È¤˙Ô˘Ó ÂÍˆÙÂÚÈÎ¿ ÙÔÓ ·ÂÚ·ÁˆÁfi Â›Ó·È Î·È

Ô ¯ÚfiÓÈÔ˜ ‹ ˘ÔÙÚÔÈ¿˙ˆÓ ‚‹¯·˜. ™˘Ó‹ıÂÈ˜ ·Ó·ÓÂ˘-

ÛÙÈÎ¤˜ ·ı‹ÛÂÈ˜ ÙË˜ ‚ÚÂÊÈÎ‹˜ ËÏÈÎ›·˜, fiˆ˜ Ë ÔÍÂ›·

‚ÚÔÁ¯ÈÔÏ›ÙÈ‰·, ÌÔÚÂ› Ó· ÂÎ‰ËÏˆıÔ‡Ó ÌÂ ·Û˘Ó‹ıÈÛÙË

‚·Ú‡ÙËÙ· fiÙ·Ó Û˘Ó˘¿Ú¯ÂÈ Û˘ÁÁÂÓ‹˜ ‰È·Ì·ÚÙ›· ÙÔ˘

ÓÂ‡ÌÔÓ· (.¯. Û˘ÁÁÂÓ‹˜ ‰È·ÊÚ·ÁÌ·ÙÔÎ‹ÏË, Û˘ÁÁÂ-

Ó¤˜ ÏÔ‚Ò‰Â˜ ÂÌÊ‡ÛËÌ·, Û˘ÌÙˆÌ·ÙÈÎ¤˜ Î˘ÛÙÈÎ¤˜

‰È·Ì·ÚÙ›Â˜).

∂Ó›ÔÙÂ, Ë Û˘ÁÁÂÓ‹˜ ‰È·Ì·ÚÙ›· ÌÔÚÂ› Ó· ÂÎ‰ËÏÒ-

ÓÂÙ·È ˆ˜ ˘ÔÙÚÔÈ¿˙Ô˘Û· ÓÂ˘ÌÔÓ›· ÛÙËÓ ›‰È· ¿ÓÙÔ-

ÙÂ ·Ó·ÙÔÌÈÎ‹ ı¤ÛË (¯ Û˘ÁÁÂÓ‹˜ Î‡ÛÙË, Î˘ÛÙÈÎ‹

·‰ÂÓÔÌ·ÙÔÂÈ‰‹˜ ‰˘ÛÏ·Û›·, ·fiÏ˘Ì·) ‹ ˆ˜ ÌÂÙ·-

Ó·ÛÙÂ˘ÙÈÎ‹ ÓÂ˘ÌÔÓ›·/·ÙÂÏÂÎÙ·Û›· (.¯. Û˘ÁÁÂÓÂ›˜

‚ÚÔÁ¯ÂÎÙ·Û›Â˜, Á·ÛÙÚÔÔÈÛÔÊ·ÁÈÎ‹ ·ÏÈÓ‰ÚfiÌËÛË

ÌÂ ÂÈÛÚfiÊËÛË ˆ˜ ÌÂÙÂÁ¯ÂÈÚËÙÈÎ‹ ÂÈÏÔÎ‹ ‰ÈfiÚıˆ-

ÛË˜ ·ÙÚËÛ›·˜ ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘).

™ÙËÓ ËÏÈÎÈ·Î‹ ·˘Ù‹ ÔÌ¿‰· Ë ·ÈÌfiÙ˘ÛË ˆ˜ Û‡-

ÌÙˆÌ· Û·Ó›˙ÂÈ.

√ÚÈÛÌ¤ÓÂ˜ Û˘ÁÁÂÓÂ›˜ ‚Ï¿‚Â˜ ÌÔÚÂ› Ó· ·Ó·Î·-

Ï˘ÊıÔ‡Ó Ù˘¯·›· ÛÂ ·ÎÙÈÓÔÁÚ·ÊÈÎfi ¤ÏÂÁ¯Ô Ô˘ ¤ÁÈÓÂ

ÁÈ· ¿ÏÏÔ ÏfiÁÔ (18,19).

∂› ˘Ô„›·˜ Û˘ÁÁÂÓÔ‡˜ ‰È·Ì·ÚÙ›·˜ Ë ÂÚÁ·ÛÙË-

ÚÈ·Î‹ ÚÔÛ¤ÁÁÈÛË Â›Ó·È ·ÚfiÌÔÈ· ÌÂ ·˘Ù‹Ó Ô˘ Â-

ÚÈÁÚ¿ÊËÎÂ ÁÈ· ÙÈ˜ ÌÈÎÚfiÙÂÚÂ˜ ËÏÈÎ›Â˜.

∂Î‰ËÏÒÛÂÈ˜ ÛÙËÓ fi„ÈÌË ÚÔÛ¯ÔÏÈÎ‹, ·È‰ÈÎ‹ Î·È

ÂÊË‚ÈÎ‹ ËÏÈÎ›·

√È ÎÏÈÓÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ ÙË˜ ËÏÈÎÈ·Î‹˜ ·˘Ù‹˜

ÔÌ¿‰·˜ Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 3 (7,12-14,18,19).

™ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ·È‰› Î·È ÛÙÔÓ ¤ÊË‚Ô, fiˆ˜ ÂÍ¿Ï-

ÏÔ˘ Î·È ÛÙÔÓ ÂÓ‹ÏÈÎÔ, ÔÏ‡ Û˘¯Ó¿ Ë ‰È¿ÁÓˆÛË ÙË˜

Û˘ÁÁÂÓÔ‡˜ ‰È·Ì·ÚÙ›·˜ Á›ÓÂÙ·È ÌÂ ·ÊÔÚÌ‹ Ù˘¯·›Ô ·ÎÙÈ-

ÓÔÁÚ·ÊÈÎfi Â‡ÚËÌ·. ∫ÏÈÓÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ ÙˆÓ Û˘ÁÁÂ-

ÓÒÓ ‰È·Ì·ÚÙÈÒÓ ÛÙÈ˜ ÌÂÁ·Ï‡ÙÂÚÂ˜ ËÏÈÎ›Â˜ ·ÔÙÂ-

ÏÔ‡Ó ÔÈ ˘ÔÙÚÔÈ¿˙Ô˘ÛÂ˜ ‹ ¯ÚfiÓÈÂ˜ ÏÔÈÌÒÍÂÈ˜ ÙÔ˘ Î·ÙÒ-

ÙÂÚÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡ Î·È Û·ÓÈfiÙÂÚ· Ë ·ÈÌfiÙ˘ÛË ‹ Ô

·ÈÊÓ›‰ÈÔ˜ ÓÂ˘ÌÔıÒÚ·Î·˜. ÀÔ„›· Û˘ÁÁÂÓÔ‡˜ ‰È·-

Ì·ÚÙ›·˜ ÌÔÚÂ› Ó· ÙÂıÂ› ·fi Ù· Â˘Ú‹Ì·Ù· ÙÔ˘ ÏÂÈ-

ÙÔ˘ÚÁÈÎÔ‡ ÂÏ¤Á¯Ô˘ ÙˆÓ ÓÂ˘ÌfiÓˆÓ (.¯. ÌË ÌÂÙ·-

‚·ÏÏfiÌÂÓË ·fiÊÚ·ÍË ÏfiÁˆ ÂÍˆÁÂÓÔ‡˜ Û˘Ì›ÂÛË˜

ÙÔ˘ ·ÂÚ·ÁˆÁÔ‡ ·ÛıÂÓÔ‡˜ ÌÂ Û˘ÚÈÁÌfi ‹ ÂÚÈÔÚÈÛÙÈÎ‹

ÓÂ˘ÌÔÓÔ¿ıÂÈ· ÏfiÁˆ ¯ÚfiÓÈ·˜ ÂÈÛÚfiÊËÛË˜ ÌÂÙ¿

‰ÈfiÚıˆÛË ÙÚ·¯ÂÈÔÔÈÛÔÊ·ÁÈÎÔ‡ Û˘ÚÈÁÁ›Ô˘) (19).

∏ Î˘ÛÙÈÎ‹ ·‰ÂÓÔÌ·ÙÔÂÈ‰‹˜ ‰˘ÛÏ·Û›· ÚÔ‰È·-

ı¤ÙÂÈ ÛÂ Î·ÎÔ‹ıË ÂÍ·ÏÏ·Á‹ ÛÙËÓ ÂÓ‹ÏÈÎÔ ˙ˆ‹, ÁÈ’ ·˘-

Ùfi ¿ÏÏˆÛÙÂ, ÂÓ‰Â›ÎÓ˘Ù·È Ë ¯ÂÈÚÔ˘ÚÁÈÎ‹ ÂÍ·›ÚÂÛË,

·ÎfiÌË Î·È Â› ·Û˘ÌÙˆÌ·ÙÈÎ‹˜ ‚Ï¿‚Ë˜ (19). ∫·-

ÎÔ‹ıË˜ ÂÍ·ÏÏ·Á‹ ¤¯ÂÈ ÂÚÈÁÚ·ÊÂ› Î·È ÛÂ ÂÚÈÙÒ-

ÛÂÈ˜ ‚ÚÔÁ¯ÔÁÂÓÔ‡˜ Î‡ÛÙË˜ (20).

¶ÚfiÁÓˆÛË Î·È ·ÒÙÂÚÂ˜ Û˘Ó¤ÂÈÂ˜

∏ ÚfiÁÓˆÛË ÙˆÓ Û˘ÁÁÂÓÒÓ ‰È·Ì·ÚÙÈÒÓ ÙˆÓ ÓÂ˘-

ÌfiÓˆÓ ÂÍ·ÚÙ¿Ù·È ·fi ÙÔ Â›‰Ô˜ Î·È ÙËÓ ¤ÎÙ·ÛË ÙË˜

‚Ï¿‚Ë˜, Î·ıÒ˜ Â›ÛË˜ ÙËÓ ‡·ÚÍË ‹ ÌË Û˘ÓÔ‰ÒÓ

·ÓˆÌ·ÏÈÒÓ. £· ÂÍ·ÚÙËıÂ› ·fi ÙÔÓ ¯ÚfiÓÔ ÙË˜ Èı·-

Ó‹˜ ¯ÂÈÚÔ˘ÚÁÈÎ‹˜ ·Ú¤Ì‚·ÛË˜, ·fi ÙËÓ ¤ÎÙ·ÛË ÙÔ˘

·Ê·ÈÚÔ‡ÌÂÓÔ˘ ÓÂ˘ÌÔÓÈÎÔ‡ ·ÚÂÁ¯‡Ì·ÙÔ˜, ·fi ÙÈ˜

ÂÓ·ÔÌÂ›Ó·ÛÂ˜ ·Ó·ÙÔÌÈÎ¤˜ ·ÓˆÌ·Ï›Â˜, ·fi ÙÈ˜ ÂÈ-

ÏÔÎ¤˜ ÙÔ˘ ÌË¯·ÓÈÎÔ‡ ·ÂÚÈÛÌÔ‡ Ô˘ ›Ûˆ˜ ·ÚÔ˘ÛÈ·-

ÛıÔ‡Ó, ·fi ÙËÓ ÈÎ·ÓfiÙËÙ· Î·È ÂÌÂÈÚ›· ÙÔ˘ ¯ÂÈÚÔ˘Ú-

ÁÔ‡ Î·È Ù¤ÏÔ˜, ·fi ÙËÓ ·ÓÙÈÚÚÔÈÛÙÈÎ‹ ·Ó¿Ù˘ÍË ÙÔ˘

ÓÂ˘ÌÔÓÈÎÔ‡ ÈÛÙÔ‡ ÌÂÙ¿ ÙËÓ ÂÎÙÔÌ‹ ÙË˜ ‚Ï¿‚Ë˜.

188 ∫. ¡. ¶Ú›ÊÙË˜ Î·È Û˘Ó.


¶›Ó·Î·˜ 3. ∂Î‰ËÏÒÛÂÈ˜ Û˘ÁÁÂÓÔ‡˜ ‰È·Ì·ÚÙ›·˜ ÙÔ˘ ÓÂ‡ÌÔÓ· Î·Ù¿ÙËÓ fi„ÈÌË ÚÔÛ¯ÔÏÈÎ‹, ÙËÓ ·È‰ÈÎ‹ Î·È ÙËÓ ÂÊË‚ÈÎ‹ ËÏÈÎ›·

ñ ∆˘¯·›Ô ·ÎÙÈÓÔÁÚ·ÊÈÎfi Â‡ÚËÌ·ñ ÀÔÙÚÔÈ¿˙Ô˘Û· ÓÂ˘ÌÔÓ›·/·ÙÂÏÂÎÙ·Û›· ‹ ·fiÛÙËÌ·

(Û˘ÁÁÂÓ‹˜ Î‡ÛÙË, Î˘ÛÙÈÎ‹ ·‰ÂÓÔÌ·ÙÔÂÈ‰‹˜ ‰È·Ì·ÚÙ›·,·fiÏ˘Ì·)

ñ ™˘¯Ó¤˜ ‹ ¯ÚfiÓÈÂ˜ ÏÔÈÌÒÍÂÈ˜ ·fi ÙÔ Î·ÙÒÙÂÚÔ·Ó·ÓÂ˘ÛÙÈÎfi (Û˘ÁÁÂÓÂ›˜ ‚ÚÔÁ¯ÂÎÙ·Û›Â˜, Û‡Ó‰ÚÔÌÔMounier-Kuhn, Û‡Ó‰ÚÔÌÔ Williams-Campbell, ÙÚ·¯ÂÈ·ÎfiÂÎÎfiÏˆÌ·)

ñ ∞ÈÌfiÙ˘ÛË (Û˘ÁÁÂÓ‹˜ Î‡ÛÙË, Î˘ÛÙÈÎ‹ ·‰ÂÓÔÌ·ÙÔÂÈ‰‹˜‰È·Ì·ÚÙ›·, ·fiÏ˘Ì·, ‚ÚÔÁ¯ÂÎÙ·Û›Â˜)

ñ ∞ÈÊÓ›‰ÈÔ˜ ÓÂ˘ÌÔıÒÚ·Î·˜ (Î˘ÛÙÈÎ¤˜ ‰È·Ì·ÚÙ›Â˜)ñ ∞ÔÎÔÚÂÛÌfi˜ ·ÈÌÔÛÊ·ÈÚ›ÓË˜, Î˘¿ÓˆÛË, ÏËÎÙÚÔ‰·ÎÙ˘Ï›·

(·ÚÙËÚÈÔÊÏÂ‚Ò‰Ë˜ ÂÈÎÔÈÓˆÓ›·)ñ ™ÈÚÔÌÂÙÚÈÎfi Â‡ÚËÌ· Î·Ù¿ ÙË ‰ÈÂÚÂ‡ÓËÛË Û˘ÚÈÁÌÔ‡,

ÂÚÈÔÚÈÛÙÈÎ‹ ÓfiÛÔ˜ ÌÂÙ¿ ÂÁ¯ÂÈÚËÙÈÎ‹ ‰ÈfiÚıˆÛËÙÚ·¯ÂÈÔÔÈÛÔÊ·ÁÈÎÔ‡ Û˘ÚÈÁÁ›Ô˘

ñ ™˘ÁÁÂÓÂ›˜ ‰˘ÛÏ·Û›Â˜ ÛÔÓ‰˘ÏÈÎ‹˜ ÛÙ‹ÏË˜ (Û˘ÁÁÂÓ‹˜ÛÎÔÏ›ˆÛË, Û˘ÁÁÂÓ‹˜ Î‡ÊˆÛË), ÛÎÔÏ›ˆÛË ÌÂÙ¿ıˆÚ·ÎÔÙÔÌ‹ (.¯. ‰ÈfiÚıˆÛË ÙÚ·¯ÂÈÔÔÈÛÔÊ·ÁÈÎÔ‡Û˘ÚÈÁÁ›Ô˘)

¶›Ó·Î·˜ 2. ™˘ÁÁÂÓÂ›˜ ‰È·Ì·ÚÙ›Â˜ ÙÔ˘ ÓÂ‡ÌÔÓ· Ô˘ Û˘Ó‹ıˆ˜ ÂÎ-‰ËÏÒÓÔÓÙ·È ÌÂÙ¿ ÙÔ˘˜ ÚÒÙÔ˘˜ Ì‹ÓÂ˜ Î·È Ì¤¯ÚÈ Ù· 2-3 ÚÒÙ· ¤ÙË˙ˆ‹˜

ñ ª¿˙Â˜ (ÏÂÌÊ·ÁÁÂ›ˆÌ·, ·ÈÌ·ÁÁÂ›ˆÌ·, Î‡ÛÙË ı˘ÚÂÔ-ÁÏˆÛÛÈÎÔ‡ fiÚÔ˘, ‚Ú·Á¯È·Î‹ Î‡ÛÙË, Ï·Ú˘ÁÁÈÎ‹ Î‡ÛÙË)

ñ ∂ÙÂÚfiÏÂ˘ÚË ·Ú¿Ï˘ÛË, ¿ÚÂÛË ÊˆÓËÙÈÎÒÓ ¯ÔÚ‰ÒÓñ §·Ú˘ÁÁÔ-ÙÚ·¯ÂÈÔ-‚ÚÔÁ¯ÔÌ·Ï¿Î˘ÓÛË (Û˘¯Ó‹)ñ ∞ÁÁÂÈ·Îfi˜ ‰·ÎÙ‡ÏÈÔ˜ (Û˘¯ÓfiÙÂÚË ÛÙË Û˘ÁÎÂÎÚÈÌ¤ÓË

ËÏÈÎÈ·Î‹ ÔÌ¿‰·)ñ ∫‡ÛÙÂÈ˜ Î·È fiÁÎÔÈ ÌÂÛÔıˆÚ·Î›Ô˘ñ ∆Ú·¯ÂÈÔÔÈÛÔÊ·ÁÈÎfi Û˘Ú›ÁÁÈÔ Ù‡Ô˘-∏ñ µÚÔÁ¯ÔÁÂÓÂ›˜ Î‡ÛÙÂÈ˜ (·fiÊÚ·ÍË, ÏÔÈÌÒÍÂÈ˜)ñ ∫˘ÛÙÈÎ‹ ·‰ÂÓÔÌ·ÙÔÂÈ‰‹˜ ‰˘ÛÏ·Û›· (ÌÈÎÚfi Û¯ÂÙÈÎ¿

ÔÛÔÛÙfi)ñ ™˘ÁÁÂÓ¤˜ ÏÔ‚Ò‰Â˜ ÂÌÊ‡ÛËÌ· (ÌÈÎÚ‹ ‰È¿Ù·ÛË)ñ ¶ÓÂ˘ÌÔÓÈÎfi ·fiÏ˘Ì· ñ ÀÔÏ·Û›· ÓÂ‡ÌÔÓ· (ÌÈÎÚÔ‡ ‚·ıÌÔ‡)


™ÙËÓ Ú¿ÍË ˘¿Ú¯Ô˘Ó ÔÈ ÂÍ‹˜ Î·ÙËÁÔÚ›Â˜ ·ÛıÂ-

ÓÒÓ (21):

1) √È ·ÛıÂÓÂ›˜ Ô˘ ¯ÂÈÚÔ˘ÚÁ‹ıËÎ·Ó ·Ì¤Ûˆ˜ ÌÂ-

Ù¿ ÙË Á¤ÓÓËÛË. ∆¤ÙÔÈÔÈ Â›Ó·È Î˘Ú›ˆ˜ ÔÈ ·ÛıÂÓÂ›˜ ÌÂ

Û˘ÁÁÂÓ‹ ‰È·ÊÚ·ÁÌ·ÙÔÎ‹ÏË Î·È ·ÙÚËÛ›· ÔÈÛÔÊ¿ÁÔ˘.

2) √È ·ÛıÂÓÂ›˜ Ô˘ ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È Û˘ÓÙËÚËÙÈ-

Î¿ Î·È ÛÙÔ˘˜ ÔÔ›Ô˘˜ ·Ó·‚¿ÏÏÂÙ·È Ë ¯ÂÈÚÔ˘ÚÁÈÎ‹

‰ÈfiÚıˆÛË, ÂÊfiÛÔÓ Ë Î·Ù¿ÛÙ·Û‹ ÙÔ˘˜ ÙÔ ÂÈÙÚ¤ÂÈ.

¶·Ú¿‰ÂÈÁÌ· Â›Ó·È ÔÈ ·ÛıÂÓÂ›˜ ÌÂ Î˘ÛÙÈÎ¤˜ ·ÓˆÌ·Ï›Â˜.

3) √È ·ÛıÂÓÂ›˜ ÛÙÔ˘˜ ÔÔ›Ô˘˜ Ë ‰È¿ÁÓˆÛË Á›ÓÂÙ·È

ÛÂ ÌÂÁ¿ÏË ËÏÈÎ›·, Û˘Ó‹ıˆ˜ Ù˘¯·›·, Ô˘ ÌÔÚÂ› Ó·

¤¯Ô˘Ó ‹‰Ë ÂÁÎ·ÙÂÛÙËÌ¤ÓÂ˜ ÂÈÏÔÎ¤˜.

ŸÛÔÓ ·ÊÔÚ¿ ÛÙË Ì·ÎÚÔ¯ÚfiÓÈ· ÔÚÂ›· ÙˆÓ ·Ú·-

¿Óˆ ·ÛıÂÓÒÓ Ô˘ ¯ÂÈÚÔ˘ÚÁ‹ıËÎ·Ó ‹ ‰ÂÓ ¯ÂÈÚÔ˘Ú-

Á‹ıËÎ·Ó, Ù›ıÂÓÙ·È Ù· ÂÍ‹˜ ‰‡Ô ÂÚˆÙ‹Ì·Ù·:

·) ∂›Ó·È Ë ·Ó¿Ù˘ÍË ÙÔ˘ ̆ fiÏÔÈÔ˘ ̆ ÁÈÔ‡˜ ÓÂ‡-

ÌÔÓ· ÌÔÚÊÔÏÔÁÈÎ¿ Î·È ÏÂÈÙÔ˘ÚÁÈÎ¿ Ê˘ÛÈÔÏÔÁÈÎ‹;

‚) ™Â ÔÈÔ ‚·ıÌfi ÂËÚÂ¿˙ÂÙ·È Ë ÂÔ˘ÏˆÙÈÎ‹ ÈÎ·-

ÓfiÙËÙ· ÙÔ˘ ÓÂ‡ÌÔÓ· ·fi ÙËÓ ËÏÈÎ›· ÙÔ˘ ·ÛıÂÓÔ‡˜;

∆· ·Ú·¿Óˆ ÂÚˆÙ‹Ì·Ù· ‰ÂÓ ··Û¯ÔÏÔ‡Ó ÌfiÓÔ

ÙÔÓ ÓÂ˘ÌÔÓÔÏfiÁÔ ÂÓËÏ›ÎˆÓ, ·ÊÔ‡ ·˘Ùfi˜ ‰È·ÈÛÙÒ-

ÓÂÈ ÙÈ˜ ·ÒÙÂÚÂ˜ Û˘Ó¤ÂÈÂ˜ ÙË˜ Û˘ÁÁÂÓÔ‡˜ ‚Ï¿‚Ë˜ ‹

ÙË˜ ¯ÂÈÚÔ˘ÚÁÈÎ‹˜ Â¤Ì‚·ÛË˜, ·ÏÏ¿ Î·È ÙÔÓ ·È‰›·-

ÙÚÔ, ÙÔÓ ·È‰ÔÓÂ˘ÌÔÓÔÏfiÁÔ ‹ ÙÔÓ ·È‰Ô¯ÂÈÚÔ˘ÚÁfi

Ô˘ ÚÔÛ·ıÂ› Ó· ÂÈÏ¤ÍÂÈ ÙÔÓ Î·Ù·ÏÏËÏfiÙÂÚÔ ̄ Úfi-

ÓÔ ÙË˜ ¯ÂÈÚÔ˘ÚÁÈÎ‹˜ ·ÓÙÈÌÂÙÒÈÛË˜ ÙË˜ Û˘ÁÁÂÓÔ‡˜

‰È·Ì·ÚÙ›·˜.

∂¿Ó Ë ·ÓÙÈÚÚÔÈÛÙÈÎ‹ ·‡ÍËÛË Î·È ·Ó¿Ù˘ÍË Â›Ó·È

ÌÂÁ·Ï‡ÙÂÚË ÛÙÈ˜ ÌÈÎÚfiÙÂÚÂ˜ ËÏÈÎ›Â˜, Ë ÂÎÙÔÌ‹ ÙË˜

‚Ï¿‚Ë˜ Ú¤ÂÈ Ó· Á›ÓÂÈ fiÛÔ ÙÔ ‰˘Ó·ÙfiÓ ÓˆÚ›ÙÂÚ·,

ÒÛÙÂ Ó· ÂÈÙÂ˘¯ıÂ› Ë Ì¤ÁÈÛÙË ·ÔÎ·Ù¿ÛÙ·ÛË. ∂¿Ó

‰ÂÓ ÂÍ·ÚÙ¿Ù·È ·fi ÙË ËÏÈÎ›·, Ë Â¤Ì‚·ÛË ÌÔÚÂ› Ó·

·Ó·‚ÏËıÂ› ÒÛÙÂ Ó· ÂÍ·ÛÊ·ÏÈÛıÔ‡Ó ÔÈ Î·Ï‡ÙÂÚÂ˜

ÚÔ¸Ôı¤ÛÂÈ˜, ÂÊfiÛÔÓ Ë Û˘ÓÙËÚËÙÈÎ‹ ·ÓÙÈÌÂÙÒÈ-

ÛË ‰ÂÓ Â›Ó·È ÂÈÛÊ·Ï‹˜.

™·ÊÂ›˜ ··ÓÙ‹ÛÂÈ˜ ÛÙ· ·Ú·¿Óˆ ÂÚˆÙ‹Ì·Ù·

Ê·›ÓÂÙ·È fiÙÈ ‰ÂÓ ˘¿Ú¯Ô˘Ó ÚÔ˜ ÙÔ ·ÚfiÓ, ÏfiÁˆ ÙË˜

ÔÏ˘ÏÔÎfiÙËÙ·˜ ÙÔ˘ ı¤Ì·ÙÔ˜ (21). ™ÙË ‚È‚ÏÈÔÁÚ·-

Ê›· ˘¿Ú¯Ô˘Ó ÌÂÏ¤ÙÂ˜ ÌÂ ·ÓÙÈÎÚÔ˘fiÌÂÓ· ·ÔÙÂÏ¤-

ÛÌ·Ù·. ™Â ·Ï·ÈfiÙÂÚË ÂÚÂ˘ÓËÙÈÎ‹ ÂÚÁ·Û›· ‰È·È-

ÛÙÒıËÎÂ ÌÂ›ˆÛË ÙˆÓ ÓÂ˘ÌÔÓÈÎÒÓ fiÁÎˆÓ Î·È ÙË˜

‰È·¯˘ÙÈÎ‹˜ ÈÎ·ÓfiÙËÙ·˜ ·Ó¿ÏÔÁË ÚÔ˜ ÙËÓ ¤ÎÙ·ÛË

ÙÔ˘ ÂÎÙ·Ì¤ÓÙÔ˜ ÓÂ˘ÌÔÓÈÎÔ‡ ÈÛÙÔ‡ (22). ™Â ¿ÏÏÂ˜

ÌÂÏ¤ÙÂ˜ fiÌˆ˜, ·Ó·Ê¤ÚÂÙ·È fiÙÈ ÔÚÈÛÌ¤ÓÔÈ ‰Â›ÎÙÂ˜

ÚÔÛÂÁÁ›˙Ô˘Ó Ù· “Ê˘ÛÈÔÏÔÁÈÎ¿” Â›Â‰·, ˘Ô‰ËÏÒ-

ÓÔÓÙ·˜ ÙËÓ ·ÓÙÈÚÚÔÈÛÙÈÎ‹ ÈÎ·ÓfiÙËÙ· ÙÔ˘ ÂÓ·Ô-

ÌÂ›Ó·ÓÙ· ÓÂ‡ÌÔÓ· (23,24). º˘ÛÈÔÏÔÁÈÎ¤˜ ÏÂÈÙÔ˘Ú-

ÁÈÎ¤˜ ‰ÔÎÈÌ·Û›Â˜ ‰È·ÈÛÙÒıËÎ·Ó ÌÂÙ¿ ÏÔ‚ÂÎÙÔÌ‹

ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ Û˘ÁÁÂÓÔ‡˜ ÏÔ‚Ò‰Ô˘˜ ÂÌ-

Ê˘Û‹Ì·ÙÔ˜ ÛÙË ‚ÚÂÊÈÎ‹ ËÏÈÎ›·, ·Ó Î·È ÔÈ ·ÛıÂÓÂ›˜

Ô˘ Â›¯·Ó ˘ÔÛÙÂ› ·Ê·›ÚÂÛË ÌÂÁ·Ï‡ÙÂÚˆÓ ÏÔ‚ÒÓ

Â›¯·Ó ÌÂÁ·Ï‡ÙÂÚÂ˜ ÙÈÌ¤˜ ÓÂ˘ÌÔÓÈÎÒÓ fiÁÎˆÓ (25).

√È ÌÂÁ·Ï‡ÙÂÚÂ˜ ÙÈÌ¤˜ ÓÂ˘ÌÔÓÈÎÒÓ fiÁÎˆÓ ‰ÂÓ ˘Ô-

‰ËÏÒÓÔ˘Ó ··Ú·›ÙËÙ· Î·Ï‡ÙÂÚË ÏÂÈÙÔ˘ÚÁÈÎ‹ ÈÎ·-

ÓfiÙËÙ·, ‰ÈfiÙÈ ·˘Ùfi ÌÔÚÂ› Ó· ·ÔÙÂÏÂ› Û˘Ó¤ÂÈ· ÙË˜

“˘ÂÚ‰È¿Ù·ÛË˜” ÙÔ˘ ÓÂ‡ÌÔÓ·, ·Ê‹ÓÔ˘Ó fiÌˆ˜

·ÓÔÈ¯Ùfi ÙÔ ÂÓ‰Â¯fiÌÂÓÔ ÙÔ Ì¤ÁÂıÔ˜ ÙË˜ ·ÓÙÈÚÚÔÈ-

ÛÙÈÎ‹˜ ·¿ÓÙËÛË˜ ÙÔ˘ ÓÂ‡ÌÔÓ· Ó· ÂÍ·ÚÙ¿Ù·È ·fi

ÙËÓ ¤ÎÙ·ÛË ÙË˜ ÏÔ‚ÂÎÙÔÌ‹˜.

∞ÓÙ›ÛÙÔÈ¯Â˜ ÌÂÏ¤ÙÂ˜ ÛÂ ÂÈÚ·Ì·Ùfi˙ˆ· ¤‰ÂÈÍ·Ó

fiÙÈ Ô ÓÂ‡ÌÔÓ·˜ Ô˘ Ì¤ÓÂÈ ÌÂÙ¿ ÙËÓ ÂÎÙÔÌ‹, ÎÂÚ‰›-

˙ÂÈ ÛÂ fiÁÎÔ Î·È ‚¿ÚÔ˜ Î·È fiÙÈ ·˘Ù‹ Ë ·¿ÓÙËÛË Û˘Ì-

‚·›ÓÂÈ ·ÓÂÍ¿ÚÙËÙ· ·fi ÙËÓ ËÏÈÎ›· (26). ¶¿ÏÈ fiÌˆ˜,

Ë ·‡ÍËÛË ÙÔ˘ ÓÂ‡ÌÔÓ· ÛÂ fiÁÎÔ Î·È ‚¿ÚÔ˜ ‰ÂÓ ÛË-

Ì·›ÓÂÈ ··Ú·›ÙËÙ· ÛËÌ·ÓÙÈÎ‹ ·‡ÍËÛË ÙÔ˘ ÏÂÈÙÔ˘Ú-

ÁÈÎÔ‡ ÓÂ˘ÌÔÓÈÎÔ‡ ÈÛÙÔ‡, ·ÊÔ‡ Ô ÓÂ‡ÌÔÓ·˜ Â›Ó·È

fiÚÁ·ÓÔ Ô˘ Ú¤ÂÈ Ó· ÚÔÛ·ÚÌfi˙ÂÙ·È ÛÙÔÓ fiÁÎÔ

·ÏÌÔ‡ È‰È·›ÙÂÚ· ÛÂ Û˘Óı‹ÎÂ˜ Ì¤ÁÈÛÙË˜ ÎfiˆÛË˜.

ŒÙÛÈ, ÙÔ ‚·ÛÈÎfi ÂÚÒÙËÌ· Â›Ó·È ·Ó Ë ·‡ÍËÛË ÙË˜

Ì¿˙·˜ ÙÔ˘ ÓÂ˘ÌÔÓÈÎÔ‡ ÈÛÙÔ‡ ÌÂÙ¿ ÂÎÙÔÌ‹ Ì¤ÚÔ˘˜

ÙÔ˘ ÓÂ‡ÌÔÓ· ÔÊÂ›ÏÂÙ·È ÛÂ Û¯ËÌ·ÙÈÛÌfi Ó¤ˆÓ Î˘„Â-

Ï›‰ˆÓ ‹ ÛÂ ÌÂÁ¤ı˘ÓÛË ÙˆÓ ‹‰Ë ˘·Ú¯Ô˘ÛÒÓ. ™ÙË

Û˘Ó¤¯ÂÈ· ÚÔÎ‡ÙÂÈ ÙÔ ÂÚÒÙËÌ· ·Ó ÔÈ “ÌÂÁ·Ï‡ÙÂ-

ÚÂ˜” Î˘„ÂÏ›‰Â˜ ÈÛÔ‰˘Ó·ÌÔ‡Ó ÌÂ ÙÈ˜ “ÂÚÈÛÛfiÙÂÚÂ˜”

Î˘„ÂÏ›‰Â˜ (26,27). £· ÌÔÚÔ‡ÛÂ Ó· ÈÛ¯˘ÚÈÛÙÂ› Î·-

ÓÂ›˜ fiÙÈ Ë ÏÂÈÙÔ˘ÚÁÈÎ‹ ·Ó·ÓÂ˘ÛÙÈÎ‹ ÂÈÊ¿ÓÂÈ· ÙˆÓ

Î˘„ÂÏ›‰ˆÓ ÌÔÚÂ› Ó· ·˘ÍËıÂ› ¯ˆÚ›˜ ÙË ‰ËÌÈÔ˘ÚÁ›·

Ó¤ˆÓ, ·ÏÏ¿ ÌÂ ÙËÓ Â¤ÎÙ·ÛË ÙˆÓ Î˘„ÂÏÈ‰ÈÎÒÓ fi-

ÚˆÓ Î·È Û¿ÎˆÓ, Ô˘ ·ÎÔÏÔ˘ıÂ›Ù·È ·fi ÂÈÌ‹Î˘ÓÛË

ÙˆÓ Î˘„ÂÏÈ‰ÈÎÒÓ ÙÔÈ¯ˆÌ¿ÙˆÓ ÌÂ ÙÂÏÈÎfi ·ÔÙ¤ÏÂ-

ÛÌ· ÙËÓ “·Ó·ÚÚ›¯ËÛË” ÛÂ Ê˘ÛÈÔÏÔÁÈÎ¿ ÏÂÈÙÔ˘ÚÁÈÎ¿

Â›Â‰· (28). ∂ÎÂ› Ô˘ Ë ˘¿Ú¯Ô˘Û· ‚È‚ÏÈÔÁÚ·Ê›·

Û˘ÌÊˆÓÂ› Â›Ó·È fiÙÈ Ë ·‡ÍËÛË ÙÔ˘ ÓÂ˘ÌÔÓÈÎÔ‡ ÈÛÙÔ‡

ÌÂÙ¿ ÙËÓ ÓÂ˘ÌÔÓÂÎÙÔÌ‹, ·ÊÔÚ¿ Î˘Ú›ˆ˜ ÛÙÔ ·Ú¤Á-

¯˘Ì· Î·È ÏÈÁfiÙÂÚÔ ÙÔ ‰›ÎÙ˘Ô ÙˆÓ ·ÂÚ·ÁˆÁÒÓ, Ë ·‡-

ÍËÛË ÙÔ˘ ÔÔ›Ô˘ Â›Ó·È ·Ó·ÏÔÁÈÎ¿ ÌÈÎÚfiÙÂÚË ÂÎÂ›ÓË˜

ÙÔ˘ ·ÚÂÁ¯‡Ì·ÙÔ˜ (29,30).

ŸÛÔÓ ·ÊÔÚ¿ ÛÙÔ ÂÚÒÙËÌ· Â¿Ó ·˘ÙÔ› ÔÈ ÌË¯·ÓÈ-

ÛÌÔ› ÂÍ·ÚÙÒÓÙ·È ·fi ÙËÓ ËÏÈÎ›· ÙÔ˘ ·ÛıÂÓÔ‡˜ Î·Ù¿

ÙËÓ ÔÔ›· Á›ÓÂÙ·È Ë ÂÎÙÔÌ‹, ÌÂÏ¤ÙÂ˜ ÛÂ ÂÈÚ·Ì·Ùfi-

˙ˆ· Ô˘ ˘¤ÛÙËÛ·Ó ÓÂ˘ÌÔÓÂÎÙÔÌ‹ ÛÂ ‰È·ÊÔÚÂÙÈ-

Î¤˜ ËÏÈÎ›Â˜ ‰È·›ÛÙˆÛ·Ó fiÙÈ ÛÂ ÔÏ‡ ÓÂ·Ú¿ ÂÈÚ·-

Ì·Ùfi˙ˆ· ̆ ‹ÚÍÂ ÔÏÏ·Ï·ÛÈ·ÛÌfi˜ ÙˆÓ Î˘„ÂÏ›‰ˆÓ,

ÛÙ· ÌÂÁ·Ï‡ÙÂÚ· Î˘ÚÈ·Ú¯Ô‡ÛÂ Ë ÂÈÌ‹Î˘ÓÛË ÙˆÓ Î˘-

„ÂÏÈ‰ÈÎÒÓ fiÚˆÓ Î·È ÙˆÓ ÙÔÈ¯ˆÌ¿ÙˆÓ, ÂÓÒ ÛÙ· ÂÓ‹-

ÏÈÎ· ˙Ò· ˘‹Ú¯Â ˘ÂÚ¤ÎÙ˘ÍË ÙÔ˘ ·ÚÂÁ¯‡Ì·ÙÔ˜

(31). ∞˘Ùfi ÙÔ ÈÛÙÔÏÔÁÈÎfi Â‡ÚËÌ· ÙÔ˘ Î˘„ÂÏÈ‰ÈÎÔ‡

ÔÏÏ·Ï·ÛÈ·ÛÌÔ‡ ÌÂÙ¿ ÓÂ˘ÌÔÓÂÎÙÔÌ‹ ÛÙ· ÔÏ‡

ÓÂ·Ú¿ ÂÈÚ·Ì·Ùfi˙ˆ· ‰ÂÓ ˘Ô‰ËÏÒÓÂÈ ˘Ô¯ÚÂˆÙÈÎ¿

ÂÎÙÂÙ·Ì¤ÓË ·ÓÙÈÚÚÔÈÛÙÈÎ‹ ·‡ÍËÛË ÙÔ˘ ÂÓ·ÔÌÂ›-

Ó·ÓÙ· ÓÂ‡ÌÔÓ·. √ ÔÏÏ·Ï·ÛÈ·ÛÌfi˜ ÙˆÓ Î˘„ÂÏ›-

‰ˆÓ Ê˘ÛÈÔÏÔÁÈÎ¿ ÂÂÎÙÂ›ÓÂÙ·È ¯ÚÔÓÈÎ¿ Î·È ÛÙË ÌÂ-

Ù·-ÓÂÔÁÓÈÎ‹ ÂÚ›Ô‰Ô ÁÈ· ÌÂÚÈÎ¿ Â›‰Ë ˙ÒˆÓ, fiˆ˜

ÛÙ· ÔÓÙ›ÎÈ·, ÂÓÒ ÛÙÔ˘˜ ·ÓıÚÒÔ˘˜ ·˘Ù‹ Ë ‰È·‰È-

Î·Û›· ÙË˜ ·‡ÍËÛË˜ ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ Î˘„ÂÏ›‰ˆÓ Û˘-

ÓÂ¯›˙ÂÙ·È ÂÚ›Ô˘ Ì¤¯ÚÈ Ù· 2 ¯ÚfiÓÈ· (24-34).


¶·È‰È·ÙÚÈÎ‹ 2007;70:184-191


™˘ÓÂÒ˜, Ô ÔÏÏ·Ï·ÛÈ·ÛÌfi˜ ÙˆÓ Î˘„ÂÏ›‰ˆÓÛÂ ÓÂ˘ÌÔÓÂÎÙÔÌËı¤ÓÙ· ÂÈÚ·Ì·Ùfi˙ˆ·, ÌÔÚÂ› Ó·Â›Ó·È ÙÔ ·ÔÙ¤ÏÂÛÌ· ÙË˜ ·ÓÙÈÚÚÔÈÛÙÈÎ‹˜ ·‡ÍËÛË˜ÛÂ ÌÈ· ÚÔÛ¿ıÂÈ· ·ÔÎ·Ù¿ÛÙ·ÛË˜ ÙÔ˘ ·ÔÏÂÛı¤-ÓÙÔ˜ ÈÛÙÔ‡ ‹ Ó· Â›Ó·È Ì¤ÚÔ˜ ÙË˜ Ê˘ÛÈÔÏÔÁÈÎ‹˜ ‰È·‰ÈÎ·Û›·˜ ·‡ÍËÛË˜ Ô˘ Û˘Ì‚·›ÓÂÈ ·ÓÂÍ¿ÚÙËÙ··fi ÙËÓ ÓÂ˘ÌÔÓÂÎÙÔÌ‹. ¶ÈÛÙÂ‡ÂÙ·È fiÙÈ Ì¿ÏÏÔÓ˘¿Ú¯ÂÈ ÁÂÓÂÙÈÎ¿ ÚÔÎ·ıÔÚÈÛÌ¤ÓÔ fiÚÈÔ Î˘ÙÙ·ÚÈ-ÎÔ‡ ÔÏÏ·Ï·ÛÈ·ÛÌÔ‡ Ô˘ ·ÊÔÚ¿ ÛÙËÓ ·‡ÍËÛËÙÔ˘ ÓÂ‡ÌÔÓ· Î·È ÙÔ fiÚÈÔ ·˘Ùfi ˘Ê›ÛÙ·Ù·È, ·Û¯¤Ùˆ˜Â¿Ó Ô ÓÂ‡ÌÔÓ·˜ ˘¤ÛÙË ÂÎÙÔÌ‹ ‹ fi¯È ÛÂ ÌÈÎÚ‹ËÏÈÎ›· (21).

∞fi Ù· ·Ú·¿Óˆ ‰ÂÓ ÚÔÎ‡ÙÂÈ ÌÂ Â·ÚÎ‹ Û·-Ê‹ÓÂÈ· ÙÔ fiÊÂÏÔ˜ ÙË˜ ·ÓÙÈÚÚÔÈÛÙÈÎ‹˜ ·‡ÍËÛË˜,ÛÙÔÓ ·ÚÈıÌfi ‹ ÛÙË ‰ÔÌ‹ ÙˆÓ Î˘„ÂÏ›‰ˆÓ ÌÂÙ¿ ·fiÓÂ˘ÌÔÓÂÎÙÔÌ‹ ÛÂ ÌÈÎÚ‹ ËÏÈÎ›·. °È· ÙÔÓ ÎÏÈÓÈÎfiÁÈ·ÙÚfi ÙÔ Î‡ÚÈÔ ÎÚÈÙ‹ÚÈÔ Ê·›ÓÂÙ·È Ó· ·Ú·Ì¤ÓÂÈ ËÎ·Ù¿ÛÙ·ÛË Î·È Ë ÈÂÚ¿Ú¯ËÛË ÙˆÓ ·Ó·ÁÎÒÓ ÙÔ˘ Î¿ıÂ·ÛıÂÓÔ‡˜. ∂ÊfiÛÔÓ ‰ÂÓ ˘¿Ú¯ÂÈ ÂÂ›ÁÔ˘Û· ·Ó¿ÁÎË¯ÂÈÚÔ˘ÚÁÈÎ‹˜ ·ÓÙÈÌÂÙÒÈÛË˜ ÙË˜ Û˘ÁÁÂÓÔ‡˜ ‰È·Ì·Ú-Ù›·˜ ÙÔ˘ ÓÂ‡ÌÔÓ· ÛÂ ÌÈÎÚ‹ ËÏÈÎ›·, ÔÏÏ¤˜ ‚Ï¿‚Â˜ÌÔÚÔ‡Ó Ó· ·ÓÙÈÌÂÙˆÈÛıÔ‡Ó Û˘ÓÙËÚËÙÈÎ¿ ÒÛÙÂ Ó·ÂÈÏÂÁÂ› Ô Î·Ù·ÏÏËÏfiÙÂÚÔ˜ ¯ÚfiÓÔ˜ ÁÈ· ÙËÓ Â¤Ì‚·-ÛË Î·È ·˘Ùfi ¯ˆÚ›˜ ÛËÌ·ÓÙÈÎfi Î›Ó‰˘ÓÔ Ó· ¯·ıÂ› Î¿-ÔÈ· Â˘Î·ÈÚ›· ·ÓÙÈÚÚÔÈÛÙÈÎ‹˜ ·‡ÍËÛË˜. √È ·Ó·-ÓÂ˘ÛÙÈÎ¤˜ ÂÊÂ‰ÚÂ›Â˜ ÙÔ˘ ÂÓ‹ÏÈÎÔ˘ Ô˘ ¯ÂÈÚÔ˘ÚÁ‹-ıËÎÂ ÛÙË ‚ÚÂÊÈÎ‹ ‹ ·È‰ÈÎ‹ ËÏÈÎ›· Î·ıÔÚ›˙ÔÓÙ·ÈÂÚÈÛÛfiÙÂÚÔ ·fi ÙËÓ ¤ÎÙ·ÛË ÙË˜ ÂÎÙÔÌ‹˜ ·Ú¿ ·fiÙËÓ ËÏÈÎ›· Ô˘ ¤ÁÈÓÂ Ë Â¤Ì‚·ÛË.


1. ∞ÓıÚ·ÎfiÔ˘ÏÔ˜ ª, ¶Ú›ÊÙË˜ ∫, ÂÈÌ. ™˘ÁÁÂÓÂ›˜‰È·Ì·ÚÙ›Â˜ ·Ó·ÓÂ˘ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ªÔÓÔÁÚ·Ê›·¶·È‰È·ÙÚÈÎ‹˜ ¶ÓÂ˘ÌÔÓÔÏÔÁ›·˜. ∆Â‡¯Ô˜ 3, ∞ı‹Ó·; 2004.

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Quiz

1. ¶ÔÈÔ ·fi Ù· ·Ú·Î¿Ùˆ ÂÎ‰ËÏÒÓÂÙ·È Û˘Ó‹ıˆ˜ ÛÙÈ˜ ÚÒÙÂ˜ ÒÚÂ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË;·. ∞ÁÁÂÈ·Îfi˜ ‰·ÎÙ‡ÏÈÔ˜‚. ™˘ÁÁÂÓ‹˜ ‚ÚÔÁ¯ÂÎÙ·Û›·Á. ™˘ÁÁÂÓ‹˜ ‰È·ÊÚ·ÁÌ·ÙÔÎ‹ÏË‰. ¶ÓÂ˘ÌÔÓÈÎfi ·fiÏ˘Ì·Â. ∆Ú·¯ÂÈÔÔÈÛÔÊ·ÁÈÎfi Û˘Ú›ÁÁÈÔ ÌÂ ·ÙÚËÛ›· Ù‡Ô˘ ∏

2. ∏ ‰È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË ÂÈÛÓÂ˘ÛÙÈÎÔ‡ ÛÈÁÌÔ‡ Î·È/‹ ÂÎÓÂ˘ÛÙÈÎÔ‡ ÌÔÓÔÊˆÓÈÎÔ‡ Û˘ÚÈÁÌÔ‡ ÛÙ· 2-3 ÚÒÙ·¤ÙË ˙ˆ‹˜ Ú¤ÂÈ Ó· ÂÚÈÏ¿‚ÂÈ:·. ∆Ë ÌÂÙ·ÙÚ·˘Ì·ÙÈÎ‹ ÛÙ¤ÓˆÛË ÌÂÙ¿ ·fi ‰È·ÛˆÏ‹ÓˆÛË‚. ∆Ë Á·ÛÙÚÔÔÈÛÔÊ·ÁÈÎ‹ ·ÏÈÓ‰ÚfiÌËÛË Î·È ÂÈÛÚfiÊËÛËÁ. ∆ËÓ ÂÈÛÚfiÊËÛË Í¤ÓÔ˘ ÛÒÌ·ÙÔ˜‰. ∆ÔÓ ·ÁÁÂÈ·Îfi ‰·ÎÙ‡ÏÈÔÂ. ŸÏ· Ù· ·Ú·¿Óˆ

3. ¶ÔÈÔ ·fi Ù· ·Ú·Î¿Ùˆ Â›Ó·È ·ÏËı¤˜;·. µÏ¿‚Â˜ ÛÙÔ Â›Â‰Ô ÙË˜ ÁÏˆÙÙ›‰·˜ Û˘Ó‹ıˆ˜ ‰ÂÓ Û˘ÓÔ‰Â‡ÔÓÙ·È ·fi ·ÊˆÓ›· ‹ ‚Ú·¯Ófi ÎÏ¿Ì·‚. ∆Ô Û˘ÁÁÂÓ¤˜ ÏÔ‚Ò‰Â˜ ÂÌÊ‡ÛËÌ· Û˘Ó‰˘¿˙ÂÙ·È ÌÂ ·˘ÍËÌ¤ÓË Èı·ÓfiÙËÙ· Î·ÎÔ‹ıÔ˘˜ ÂÍ·ÏÏ·Á‹˜ Î·Ù¿

ÙËÓ ÂÓ‹ÏÈÎÔ ˙ˆ‹Á. √ ·ÁÁÂÈ·Îfi˜ ‰·ÎÙ‡ÏÈÔ˜ ÌÔÚÂ› Ó· ÂÎ‰ËÏˆıÂ› ˆ˜ “ÔÈÛıfiÙÔÓÔ˜” Î·Ù¿ ÙÔ˘˜ ÚÒÙÔ˘˜ Ì‹ÓÂ˜ ÙË˜ ˙ˆ‹˜‰. ∆Ô ÓÂ˘ÌÔÓÈÎfi ·fiÏ˘Ì· Û˘Ó‹ıˆ˜ ÂÎ‰ËÏÒÓÂÙ·È ÌÂ ÓÂ˘ÌÔıÒÚ·Î· Î·Ù¿ ÙÔ˘˜ ÚÒÙÔ˘˜ Ì‹ÓÂ˜ ÙË˜ ˙ˆ‹˜Â. ∏ ·Ï·Û›· ÙÔ˘ ÓÂ‡ÌÔÓ· ÂÎ‰ËÏÒÓÂÙ·È ÌÂ ÔÏ˘˘‰Ú¿ÌÓÈÔ

4. ∏ ‰ÈfiÚıˆÛË ÙÚ·¯ÂÈÔÔÈÛÔÊ·ÁÈÎÔ‡ Û˘ÚÈÁÁ›Ô˘ ÌÔÚÂ› Ó· Û˘ÓÔ‰Â‡ÂÙ·È ·fi:·. ¢È·Ù·Ú·¯‹ ÙË˜ ·‡ÍËÛË˜‚. ™˘ÌÙˆÌ·ÙÔÏÔÁ›· Á·ÛÙÚÔÔÈÛÔÊ·ÁÈÎ‹˜ ·ÏÈÓ‰ÚfiÌËÛË˜ Á. ¢˘ÛÎÔÏ›· Î·Ù¿ ÙËÓ Î·Ù¿ÔÛË, È‰›ˆ˜ ÛÙÂÚÂÒÓ ÙÚÔÊÒÓ‰. ™˘ÌÙˆÌ·ÙÔÏÔÁ›· ÙÚ·¯ÂÈÔÌ·Ï¿Î˘ÓÛË˜Â. ŸÏ· Ù· ·Ú·¿Óˆ

5. ¶ÔÈÔ ·fi Ù· ·Ú·Î¿Ùˆ ÈÛ¯‡ÂÈ ÁÈ· ÙË ¯ÂÈÚÔ˘ÚÁÈÎ‹ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ Û˘ÁÁÂÓÒÓ ‰È·Ì·ÚÙÈÒÓ ÙÔ˘ ÓÂ‡ÌÔÓ·;·. √È ·Ó·ÓÂ˘ÛÙÈÎ¤˜ ÂÊÂ‰ÚÂ›Â˜ ÙˆÓ ÂÓËÏ›ÎˆÓ Î·ıÔÚ›˙ÔÓÙ·È Î˘Ú›ˆ˜ ·fi ÙËÓ ËÏÈÎ›· Ô˘ ¤ÁÈÓÂ Ë ÂÎÙÔÌ‹‚. √È Û˘ÁÁÂÓÂ›˜ ‰È·Ì·ÚÙ›Â˜ ¯ÚÂÈ¿˙ÔÓÙ·È Î·Ù¿ Î·ÓfiÓ· ¿ÌÂÛË Â¤Ì‚·ÛËÁ. ∏ ·‡ÍËÛË ÙÔ˘ ÓÂ˘ÌÔÓÈÎÔ‡ ÈÛÙÔ‡ ÌÂÙ¿ ÙËÓ ÓÂ˘ÌÔÓÂÎÙÔÌ‹ ·ÊÔÚ¿ Î˘Ú›ˆ˜ ÙÔ ‰›ÎÙ˘Ô ÙˆÓ ·ÂÚ·ÁˆÁÒÓ

Î·È ÏÈÁfiÙÂÚÔ ÙÔ ·Ú¤Á¯˘Ì·‰. ¶ÂÈÚ·Ì·ÙÈÎ¿ ‰Â‰ÔÌ¤Ó· ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ Ë ÌÂÙÂÁ¯ÂÈÚËÙÈÎ‹ ·‡ÍËÛË ÙÔ˘ ÓÂ‡ÌÔÓ· Û˘ÓÂ¿ÁÂÙ·È ÛËÌ·-

ÓÙÈÎ‹ ·‡ÍËÛË ÙÔ˘ ÏÂÈÙÔ˘ÚÁÈÎÔ‡ ÓÂ˘ÌÔÓÈÎÔ‡ ÈÛÙÔ‡Â. ∫·Ó¤Ó· ·fi Ù· ·Ú·¿Óˆ

√È ÛˆÛÙ¤˜ ··ÓÙ‹ÛÂÈ˜ ÛÙË ÛÂÏ›‰· 204


192 ∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞ ORIGINAL ARTICLE


¢ÈÂÚÂ‡ÓËÛË ÙË˜ ‰È·Ù·Ú·¯‹˜ ÛÙËÓ ÈÛÔÚÚÔ›· ÌÂÙ·Í‡ Ù‡Ô˘-1

Î·È Ù‡Ô˘-2 ·ÓÔÛÈ·Î‹˜ ·¿ÓÙËÛË˜ ÛÙÔ ÎÔÚÙÈÎÔÂ˘·›ÛıËÙÔ

ÓÂÊÚˆÛÈÎfi Û‡Ó‰ÚÔÌÔ - ∞Ô˘Û›· Û¯¤ÛË˜ ÚÔ˜ ·ÙÔ›·

¡. ¶Ú›ÓÙ˙·, º. ¶··¯Ú‹ÛÙÔ˘, µ. ∆˙ÈÌÔ‡ÏË, Õ. ∆·¿ÚÎÔ˘, º. ∫·Ó·ÎÔ‡‰Ë - ∆Û·Î·Ï›‰Ô˘

¶ÂÚ›ÏË„Ë

∂ÈÛ·ÁˆÁ‹: ™ÎÔfi˜ ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ ‹Ù·Ó Ë ÚÔÔÙÈÎ‹ ÌÂÏ¤ÙË ÙˆÓ ·ÓÔÛÔÏÔÁÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓÙÔ˘ ÎÔÚÙÈÎÔÂ˘·›ÛıËÙÔ˘ ÓÂÊÚˆÛÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ (∫∂¡™) ÛÙËÓ ÂÓÂÚÁfi Ê¿ÛË ÙË˜ ÓfiÛÔ˘ Û˘ÁÎÚÈÙÈÎ¿ ÌÂ ÙËÊ¿ÛË ‡ÊÂÛË˜ Î·È ÌÂ Ù· Â˘Ú‹Ì·Ù· ˘ÁÈÒÓ ·È‰ÈÒÓ Î·È Ë Û˘Û¯¤ÙÈÛË ÙˆÓ Â˘ÚËÌ¿ÙˆÓ ÌÂ ÙËÓ ·ÙÔ›·. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ªÂÏÂÙ‹ıËÎ·Ó 20 ·È‰È¿, ËÏÈÎ›·˜ 3-14 ÂÙÒÓ, ÌÂ ∫∂¡™ Î·È 20 ˘ÁÈ‹ ·È‰È¿ (Ì¿ÚÙ˘ÚÂ˜).∆· 12/20 ·È‰È¿ ÌÂ ∫∂¡™ ÌÂÏÂÙ‹ıËÎ·Ó ÛÂ ÂÓÂÚÁfi Ê¿ÛË, ÛÂ Ê¿ÛË ‡ÊÂÛË˜ ˘fi ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹ Î·È ÛÂÊ¿ÛË ‡ÊÂÛË˜ ¯ˆÚ›˜ ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹ (8/12). ™Â 8 ÂÈÏ¤ÔÓ ·È‰È¿ ÌÂ ∫∂¡™, Ô ¤ÏÂÁ¯Ô˜ ¤ÁÈÓÂ ÌfiÓÔ ÛÂÊ¿ÛË ‡ÊÂÛË˜ ¯ˆÚ›˜ ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹. ¶ÚÔÛ‰ÈÔÚ›ÛÙËÎ·Ó Ô ‚·ÛÈÎfi˜ ·ÓÔÛÔÊ·ÈÓfiÙ˘Ô˜ µ Î·È ∆ Î˘ÙÙ¿-ÚˆÓ, Ù· ÔÛÔÛÙ¿ ÙˆÓ CD23+, CD3+/CD69+/INF-Á+ Î·È CD3+/CD69+/IL-4+ Î˘ÙÙ¿ÚˆÓ Î·È Ù· Â›Â‰·ÛÙÔÓ ÔÚfi ÙˆÓ IgE, INF-Á, IL-4, IL-13 Î·È IL-18. ∞ÔÙÂÏ¤ÛÌ·Ù·: πÛÙÔÚÈÎfi ·ÙÔ›·˜ ·ÚÔ˘Û›·˙·Ó 4/20 ·È‰È¿ ÌÂ ∫∂¡™ Î·È 3/20 Ì¿ÚÙ˘ÚÂ˜. T· ÔÛÔÛÙ¿ÙˆÓ CD19+, CD23+ µ Î˘ÙÙ¿ÚˆÓ, ÙˆÓ CD3+/CD69+/IL-4+ T Î˘ÙÙ¿ÚˆÓ, Î·ıÒ˜ Î·È Ù· Â›Â‰· ÙˆÓ IgE, IL-4, IL-13 Î·È IL-18 ‹Ù·Ó ÛËÌ·ÓÙÈÎ¿ ·˘ÍËÌ¤Ó· ÛÙËÓ ÂÓÂÚÁfi Ê¿ÛË ÙË˜ ÓfiÛÔ˘ Û˘ÁÎÚÈÙÈÎ¿ ÌÂ ÙË Ê¿ÛË ‡ÊÂ-ÛË˜ ˘fi Î·È ¯ˆÚ›˜ ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹ Î·È ÌÂ ÙÔ˘˜ Ì¿ÚÙ˘ÚÂ˜ (p<0,05). ∞ÓÙ›ıÂÙ·, ÙÔ ÔÛÔÛÙfi ÙˆÓCD3+/CD69+/INF-Á+ T Î˘ÙÙ¿ÚˆÓ ‹Ù·Ó ÛËÌ·ÓÙÈÎ¿ ÂÏ·ÙÙˆÌ¤ÓÔ ÛÂ fiÏÂ˜ ÙÈ˜ Ê¿ÛÂÈ˜ ÙË˜ ÓfiÛÔ˘ ÛÂ Û¯¤ÛË ÌÂÙÔ˘˜ Ì¿ÚÙ˘ÚÂ˜ (p<0,05). ¢È·ÈÛÙÒıËÎÂ ıÂÙÈÎ‹ Û˘Û¯¤ÙÈÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙË˜ IgE ÌÂ Ù· Â›Â‰· Î˘Ú›ˆ˜ÙË˜ πL-13, fiˆ˜ Î·È ÙˆÓ IL-4 Î·È πL-18, ·ÏÏ¿ fi¯È ÌÂ ÙÔ ÈÛÙÔÚÈÎfi ·ÙÔ›·˜. ™˘ÌÂÚ¿ÛÌ·Ù·: ™Ù· ·È‰È¿ ÌÂ ÂÓÂÚÁfi ∫∂¡™ ˘ÂÚ¤¯ÂÈ Ë ·ÓÔÛÈ·Î‹ ·¿ÓÙËÛË Ù‡Ô˘-2, Ë ÔÔ›· Èı·ÓfiÓÓ· ÔÊÂ›ÏÂÙ·È ÛÙËÓ ·˘ÍËÌ¤ÓË ¤ÎÎÚÈÛË Î·È Û˘ÓÂÚÁÈÎ‹ ‰Ú¿ÛË ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ IL-13 Î·È IL-18 Î·È fi¯È ÛÂÌË¯·ÓÈÛÌfi ·ÙÔ›·˜.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ∫ÔÚÙÈÎÔÂ˘·›ÛıËÙÔ ÓÂÊÚˆÛÈÎfi Û‡Ó‰ÚÔÌÔ, Ù‡Ô˘-1/Ù‡Ô˘-2 Î˘ÙÙ·ÚÔÎ›ÓÂ˜.

Investigation of type-1/type-2 immune imbalance in steroid sensitive

nephrotic syndrome - No relationship with atopy

N. Printza, F. Papachristou, V. Tzimouli, A. Taparkou, F. Kanakoudi - Tsakalidou

Abstract

Background: The purpose of this prospective study was to investigate the immune disturbances indifferent stages of primary steroid sensitive nephrotic syndrome (SSNS) and identify whether there is arelationship of the findings with atopy. Methods: Twenty children with SSNS, aged 3-14 years, were studied; 12/20 both in active stage beforetreatment initiation and in remission still on steroid treatment; 8/12 in remission off steroids as well.Eight additional children with previously treated primary SSNS were studied only in remission offsteroids. Data were compared with those obtained from 20 age-matched controls. The followingparameters were assessed: basic B and T cell populations, percentages of CD23+, CD3+/CD69+/INF-Á+cells and CD3+/CD69+/IL-4+ as well as serum levels of IgE, INF-Á, IL-4, IL-13 and IL-18. Results: Atopic disease was recorded in 4/20 nephrotic children and in 3/20 controls. Percentages ofCD23+ and CD19+ B cells, CD3+/CD69+/IL-4+ T cells and serum levels of IgE, IL-4, IL-13 and IL-18 weresignificantly higher in the active stage of SSNS compared with the remission stage on steroids, remissionoff steroids and controls (p<0.05). On the contrary, percentage of CD3+/CD69+/INF-Á+ T cells wassignificantly lower in patients during different disease stages compared with controls (p<0.05). In theactive disease stage, serum IgE concentrations were significantly correlated mainly with serum IL-13 aswell as IL-4 and IL-18 levels but not with history of atopy. Conclusions: These findings suggest that the type-2 immune response found in active SSNS may be theresult of synergistic action of increased IL-13 and IL-18 produced during this disease stage and not to anatopy induced mechanism.

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

∞’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ∞¶£,πÔÎÚ¿ÙÂÈÔ ¡ÔÛÔÎÔÌÂ›Ô,£ÂÛÛ·ÏÔÓ›ÎË


¡ÈÎÔÏ¤Ù· ¶Ú›ÓÙ˙· [email protected] ∫ˆÓÛÙ·ÓÙÈÓÔ˘fiÏÂˆ˜ 49 ∞’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ∞¶£ πÔÎÚ¿ÙÂÈÔ ¡ÔÛÔÎÔÌÂ›Ô,£ÂÛÛ·ÏÔÓ›ÎË

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

1st Paediatric Department,Hippokration GeneralHospital, Thessaloniki

Correspondence:

Nikoleta Printza [email protected] 49 Konstantinoupoleos Str. 1st Paediatric Department Hippokration GeneralHospital


∂ÈÛ·ÁˆÁ‹

ªÂ ÙÔÓ fiÚÔ ÓÂÊÚˆÛÈÎfi Û‡Ó‰ÚÔÌÔ (¡™) ̄ ·Ú·ÎÙË-

Ú›˙ÔÓÙ·È ÛÂÈÚ·Ì·ÙÔ¿ıÂÈÂ˜ ÌÂ ÛÔ‚·Ú‹ ÚˆÙÂ˚ÓÔ˘-

Ú›·, Ô˘ ÚÔÎ·ÏÂ› ˘ÔÏÂ˘ÎˆÌ·ÙÈÓÂ·ÈÌ›· (<2,5

g/dl), ˘ÂÚ¯ÔÏËÛÙÂÚÈÓ·ÈÌ›· Î·È Û˘Ó‹ıˆ˜ Ô›‰ËÌ· (1).

∫ÏÈÓÈÎ¿, ·Ó¿ÏÔÁ· ÌÂ ÙËÓ ·¿ÓÙËÛ‹ ÙÔ˘ ÛÙË ıÂÚ·-

Â›· ÌÂ ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹, ÙÔ ¡™ ‰È·ÎÚ›ÓÂÙ·È ÛÂ

ÎÔÚÙÈÎÔÂ˘·›ÛıËÙÔ (∫∂¡™), Ô˘ ·ÔÙÂÏÂ› ÙÔ 45-

80% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÛÙ· ·È‰È¿ Î·È ÛÂ ÎÔÚÙÈÎÔ·Ó-

ıÂÎÙÈÎfi (2-4).

∏ ·ÎÚÈ‚‹˜ ·ıÔÁ¤ÓÂÛË ÙÔ˘ ∫∂¡™ ‰ÂÓ ¤¯ÂÈ Ï‹-

Úˆ˜ ‰ÈÂ˘ÎÚÈÓÈÛÙÂ›, fiÌˆ˜ ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙÂ› ÌÂ ‰È·Ù·-

Ú·¯‹ ÙË˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÙˆÓ ∆ Î˘ÙÙ¿ÚˆÓ. ∆Ô 1974 Ô

Shalhoud RJ ‰È·Ù‡ˆÛÂ ÚÒÙÔ˜ ÙËÓ ˘fiıÂÛË fiÙÈ ÛÂ

ÂÓÂÚÁfi ∫∂¡™ ¤Ó·˜ ÎÏÒÓÔ˜ ∆ Î˘ÙÙ¿ÚˆÓ ·Ú¿ÁÂÈ Ì›·

“ÏÂÌÊÔÎ›ÓË” Ô˘ Â›Ó·È ÙÔÍÈÎ‹ ÁÈ· ÙË ‚·ÛÈÎ‹ ÌÂÌ-

‚Ú¿ÓË ÙÔ˘ ÛÂÈÚ¿Ì·ÙÔ˜, Â›ÙÂ ¿ÌÂÛ· ‹ ¤ÌÌÂÛ·, Ì¤Ûˆ

ÂÓÂÚÁÔÔ›ËÛË˜ ÙˆÓ ÌÂÛ·ÁÁÂÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ. ∏

¿Ô„Ë ·˘Ù‹ ‚·Û›ÛÙËÎÂ ÛÙÈ˜ ÂÍ‹˜ ÎÏÈÓÈÎ¤˜ ·Ú·ÙË-

Ú‹ÛÂÈ˜: ·) ˘‹Ú¯Â ‡ÊÂÛË ÙË˜ ÓfiÛÔ˘ ÛÂ ÏÔÈÌÒÍÂÈ˜

Ô˘ ÚÔÎ·ÏÔ‡Ó ·ÓÔÛÔÎ·Ù·ÛÙÔÏ‹, fiˆ˜ Ë ÈÏ·Ú¿, ‚)

Ù· ·È‰È¿ ÌÂ ¡™ Â›¯·Ó Â˘·ÈÛıËÛ›· ÛÂ ÓÂ˘ÌÔÓÈÔÎÔÎ-

ÎÈÎ¤˜ Î·È ¿ÏÏÂ˜ ÌÈÎÚÔ‚È·Î¤˜ ÏÔÈÌÒÍÂÈ˜ Î·È Á) Ù· ·È-

‰È¿ ÌÂ ¡™ ··ÓÙÔ‡Û·Ó ÛÙË ıÂÚ·Â›· ÌÂ ÛÙÂÚÔÂÈ‰‹

Î·È Î˘ÎÏÔÊˆÛÊ·Ì›‰Ë, Ê¿ÚÌ·Î· Ô˘ Î·Ù·ÛÙ¤ÏÏÔ˘Ó

ÙËÓ Î˘ÙÙ·ÚÈÎ‹ ·ÓÔÛ›· (5). ™ÙÈ˜ ÂfiÌÂÓÂ˜ ‰ÂÎ·ÂÙ›Â˜,

Ë ·ÎÚÈ‚‹˜ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ÙˆÓ ∆ Î˘ÙÙ¿ÚˆÓ Î·È Ô Úfi-

ÏÔ˜ ÙÔ˘˜ ÛÙËÓ ·ıÔÁ¤ÓÂÛË ÙÔ˘ ∫∂¡™ ·ÔÙ¤ÏÂÛÂ

·ÓÙÈÎÂ›ÌÂÓÔ ·ÚÎÂÙÒÓ ÂÚÂ˘ÓÒÓ (6-15). ∫·Ù¿ Ù· ÙÂ-

ÏÂ˘Ù·›· ¯ÚfiÓÈ·, ‰È·Ù˘ÒıËÎÂ Ë ¿Ô„Ë fiÙÈ Ù· ∆ Î‡Ù-

Ù·Ú· ÂÌÏ¤ÎÔÓÙ·È ÛÙËÓ ·ıÔÁ¤ÓÂÛË ÙÔ˘ ∫∂¡™ Ì¤-

Ûˆ ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ Ô˘ ·Ú¿ÁÔ˘Ó (7,9,10,12).

ªÂ ‚¿ÛË ÙÈ˜ ·Ú·ÁfiÌÂÓÂ˜ Î˘ÙÙ·ÚÔÎ›ÓÂ˜, Ù· ∆

Î‡ÙÙ·Ú· ‰È·ÎÚ›ÓÔÓÙ·È ÛÂ Ù‡Ô˘-1 Î·È Ù‡Ô˘-2. ∆·

Ù‡Ô˘-1 ∆ Î‡ÙÙ·Ú· Ù˘ÈÎ¿ ·Ú¿ÁÔ˘Ó ÈÓÙÂÚÏÂ˘Î›ÓË-

2 (IL-2), ÙÔÓ ·Ú¿ÁÔÓÙ· Ó¤ÎÚˆÛË˜ ÙˆÓ fiÁÎˆÓ (TNF)

Î·È ÈÓÂÚÊÂÚfiÓË-Á (πNF-Á), ‰ËÏ·‰‹ Î˘ÙÙ·ÚÔÎ›ÓÂ˜ ÌÂ

Î˘ÙÙ·ÚÔÙÔÍÈÎ‹ Î·È ÊÏÂÁÌÔÓÒ‰Ë ‰Ú¿ÛË. ∆· Ù‡Ô˘-2

∆ Î‡ÙÙ·Ú· ·Ú¿ÁÔ˘Ó IL-4, IL-5, IL-9, IL-10 Î·È IL-

13, ‰ËÏ·‰‹ Î˘ÙÙ·ÚÔÎ›ÓÂ˜ Ô˘ Û˘Ó‰¤ÔÓÙ·È ÌÂ ÙË

Ú‡ıÌÈÛË ÈÛ¯˘ÚÒÓ ·ÓÔÛÈ·ÎÒÓ ··ÓÙ‹ÛÂˆÓ ÛÂ ·ÓÙÈÁfi-

Ó· Î·È ·ÏÏÂÚÁÈÔÁfiÓ·. √È ÚfiÛÊ·ÙÂ˜ ÌÂÏ¤ÙÂ˜ Û¯ÂÙÈÎ¿

ÌÂ ÙËÓ Ù·˘ÙÔÔ›ËÛË ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ Ô˘ ÂÎÎÚ›-

ÓÔÓÙ·È ÛÙÔ ∫∂¡™ ¤‰ÂÈÍ·Ó ·ÔÙÂÏ¤ÛÌ·Ù· Ô˘ Û˘¯Ó¿

‹Ù·Ó ·ÓÙÈÎÚÔ˘fiÌÂÓ· (16).

∏ ˘ÂÚÔ¯‹ ÙË˜ ·ÓÔÛÈ·Î‹˜ ·¿ÓÙËÛË˜ Ù‡Ô˘-2,

fiˆ˜ ÚÔ¤Î˘„Â ·fi ÔÚÈÛÌ¤ÓÂ˜ ÌÂÏ¤ÙÂ˜ (16), ÛÂ

Û˘Ó‰˘·ÛÌfi ÌÂ Ù· ·˘ÍËÌ¤Ó· Â›Â‰· ÙË˜ ·ÓÔÛÔ-

ÛÊ·ÈÚ›ÓË˜ ∂ (πgE) Ô˘ ‚Ú¤ıËÎ·Ó ÛÂ ÂÓÂÚÁfi ∫∂¡™

(15,17), Ô‰‹ÁËÛ·Ó ÛÙË Û‡Ó‰ÂÛË ÙÔ˘ ∫∂¡™ ÌÂ ÙËÓ

·ÙÔ›·. ¶·Ú’ fiÏ· ·˘Ù¿, ÎÏÈÓÈÎ¤˜ ·Ú·ÙËÚ‹ÛÂÈ˜

(18,19) Î·ıÒ˜ Î·È ÂÚÁ·ÛÙËÚÈ·Î¿ ‰Â‰ÔÌ¤Ó· (20) ¤ıÂ-

Û·Ó ÛÂ ·ÌÊÈÛ‚‹ÙËÛË ÙËÓ ·Ú·¿Óˆ ˘fiıÂÛË.

™ÎÔfi˜ ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ ‹Ù·Ó Ë ÚÔÔÙÈ-Î‹ ‰ÈÂÚÂ‡ÓËÛË ÙˆÓ ·ÓÔÛÔÏÔÁÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ ÛÙ··È‰È¿ ÌÂ ∫∂¡™ ÛÙÈ˜ ‰È·ÊÔÚÂÙÈÎ¤˜ Ê¿ÛÂÈ˜ ÙË˜ Ófi-ÛÔ˘, ÛÂ Û‡ÁÎÚÈÛË ÌÂ ˘ÁÈ‹ ·È‰È¿, ÌÂ ÂÈÎ¤ÓÙÚˆÛËÛÙËÓ Ù·˘ÙÔÔ›ËÛË ÙÔ˘ Ù‡Ô˘ ÙË˜ ·ÓÔÛÈ·Î‹˜ ·¿-ÓÙËÛË˜ (1 ‹ 2) Ô˘ ˘ÂÚÈÛ¯‡ÂÈ ÛÂ ÂÓÂÚÁfi Ê¿ÛË ÙË˜ÓfiÛÔ˘ Î·È ÛÙË Û¯¤ÛË ÙË˜ ÌÂ ·ÙÔ›·.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ

ªÂÏÂÙ‹ıËÎ·Ó 20 ·È‰È¿ (7 ·ÁfiÚÈ· Î·È 13 ÎÔÚ›ÙÛÈ·), ËÏÈ-Î›·˜ 3-14 ÂÙÒÓ, ÌÂ ∫∂¡™. ∆· 12/20 ·È‰È¿ ÌÂÏÂÙ‹ıËÎ·Ó ·ÊÂ-Ófi˜ ÛÂ ÂÓÂÚÁfi Ê¿ÛË ÙË˜ ÓfiÛÔ˘ (3/12 ÛÙÔ ÚÒÙÔ ÂÂÈÛfi‰ÈÔ∫∂¡™ Î·È 9/12 ÛÂ ˘ÔÙÚÔ‹ ÙË˜ ÓfiÛÔ˘), ÚÈÓ ÙËÓ ¤Ó·ÚÍË ÙË˜·ÁˆÁ‹˜ ÌÂ ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹, ·ÊÂÙ¤ÚÔ˘ ÛÂ Ê¿ÛË ‡ÊÂÛË˜ Î·ÈÂÓÒ Ï¿Ì‚·Ó·Ó ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹. ∞fi ·˘Ù¿ Ù· 12 ·È‰È¿, 8ÌÂÏÂÙ‹ıËÎ·Ó Î·È ÛÂ Ê¿ÛË ‡ÊÂÛË˜ ¯ˆÚ›˜ ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹ (6Ì‹ÓÂ˜ ÌÂÙ¿ ÙË ‰È·ÎÔ‹). ™Â 8/20 ·È‰È¿ ÌÂ ∫∂¡™, Ô ¤ÏÂÁ¯Ô˜¤ÁÈÓÂ ÌfiÓÔ ÛÂ Ê¿ÛË ‡ÊÂÛË˜ ̄ ˆÚ›˜ ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹. ∫·È ÔÈ 12·ÛıÂÓÂ›˜, ÔÈ ÔÔ›ÔÈ ÌÂÏÂÙ‹ıËÎ·Ó ÛÂ Ê¿ÛË ‡ÊÂÛË˜ ˘fi ÎÔÚÙÈ-ÎÔÛÙÂÚÔÂÈ‰‹, Ï¿Ì‚·Ó·Ó ÙËÓ ›‰È· ‰fiÛË ÚÂ‰ÓÈ˙fiÓË˜ (40 mg/m2

·Ó¿ 48ˆÚÔ). ∏ ‰È¿ÁÓˆÛË ÙÔ˘ ∫∂¡™ Î·È ÙË˜ ˘ÔÙÚÔ‹˜ ‚·Û›-ÛÙËÎÂ ÛÙ· ‰ÈÂıÓ‹ ÎÚÈÙ‹ÚÈ· (6) Î·È Ô Î·ıÔÚÈÛÌfi˜ ÙË˜ ÎÔÚÙÈÎÔ-Â˘·ÈÛıËÛ›·˜ ¤ÁÈÓÂ ÌÂ ‚¿ÛË ÙËÓ ·Ú¯ÈÎ‹ ·¿ÓÙËÛË ÙÔ˘ ÓÂÊÚˆ-ÛÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ ÛÙ· ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹ ÂÓÙfi˜ 4 Â‚‰ÔÌ¿‰ˆÓ.

∆ËÓ ÔÌ¿‰· Ì·ÚÙ‡ÚˆÓ ·ÔÙ¤ÏÂÛ·Ó 20 ˘ÁÈ‹ ·È‰È¿, ËÏÈ-Î›·˜ 2,5-14 ÂÙÒÓ, Ô˘ ÚÔÛ‹Ïı·Ó ÛÙÔ ∞ÈÌ·ÙÔÏÔÁÈÎfi ∂ÚÁ·-ÛÙ‹ÚÈÔ ÙË˜ ∞’ ¶·È‰È·ÙÚÈÎ‹˜ ∫ÏÈÓÈÎ‹˜ ÁÈ· ¤ÏÂÁ¯Ô Û˘ÁÁÂÓÔ‡˜·ÈÌÔÏ˘ÙÈÎ‹˜ ·Ó·ÈÌ›·˜ Î·È ¯ÚËÛ›ÌÂ˘Û·Ó ˆ˜ ÔÌ¿‰· ˘ÁÈÒÓ Ì·Ú-Ù‡ÚˆÓ ÁÈ· ÙË Û‡ÁÎÚÈÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ÌÂ ÂÎÂ›Ó· ÙˆÓ·ÛıÂÓÒÓ. ∞ÈÌÔÏË„›· Î·È ¤ÏÂÁ¯Ô˜ ÙˆÓ ·ÓÔÛÔÏÔÁÈÎÒÓ ·Ú·-Ì¤ÙÚˆÓ ÛÙÔ˘˜ Ì¿ÚÙ˘ÚÂ˜ Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó Ì›· ÊÔÚ¿.

∞ÓÔÛÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜

™Â fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓÂ›˜ Î·È ÙÔ˘˜ Ì¿ÚÙ˘ÚÂ˜ ÌÂÏÂÙ‹ıËÎ·ÓÔÈ ·ÎfiÏÔ˘ıÂ˜ ·ÓÔÛÔÏÔÁÈÎ¤˜ ·Ú¿ÌÂÙÚÔÈ: ‚·ÛÈÎfi˜ ·ÓÔÛÔÛÔ-Ê·ÈÓfiÙ˘Ô˜, ÏfiÁÔ˜ CD4+/CD8+ ∆ Î˘ÙÙ¿ÚˆÓ, CD25+ T Î‡Ù-Ù·Ú·, CD23+ B Î‡ÙÙ·Ú·, ÔÛÔÛÙfi CD3+/CD69+/INF-Á+ Î·ÈCD3+/CD69+/IL-4+ T Î˘ÙÙ¿ÚˆÓ Î·È Û˘ÁÎÂÓÙÚÒÛÂÈ˜ ÛÙÔÓÔÚfi ÙˆÓ πgE, INF-Á, IL-4, IL-13 Î·È IL-18.

·) ¶ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙÔ˘ ‚·ÛÈÎÔ‡ ·ÓÔÛÔÊ·ÈÓfiÙ˘Ô˘ °È· ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙˆÓ ÂÈÊ·ÓÂÈ·ÎÒÓ ÌÔÚ›ˆÓ ÙˆÓ

ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ (‚·ÛÈÎfi˜ ·ÓÔÛÔÊ·ÈÓfiÙ˘Ô˜) ÂÊ·ÚÌfiÛÙËÎÂÙÚÈÏfi˜ ¿ÌÂÛÔ˜ ·ÓÔÛÔÊıÔÚÈÛÌfi˜ ÌÂ ÙË ‚Ô‹ıÂÈ· Î·Ù¿ÏÏËÏˆÓÌÔÓÔÎÏˆÓÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ÙˆÓ ÂÙ·ÈÚÂÈÒÓ COULTER(Miami, Florida) Î·È IMMUNOTECH (Hamburg, Germany)Û˘Ó‰Â‰ÂÌ¤ÓˆÓ ÌÂ ÊıÔÚ›˙Ô˘ÛÂ˜ ̄ ÚˆÛÙÈÎ¤˜, fiˆ˜ ÈÛÔıÂÈÔÎ˘·-ÓÈÎ‹ ÊÏÔ˘ÚÂÛÎÂ˝ÓË (FITC): CD3, CD4, CD8, CD23, Ê˘ÎÔÂ-Ú˘ıÚ›ÓË (PE): CD4, CD19, CD25 Î·È Ê˘ÎÔÂÚ˘ıÚ›ÓË-Î˘·Ó›ÓË5 (PE-Cy5): CD45.

∆· ÔÛÔÛÙ¿ ÙˆÓ µ Î˘ÙÙ¿ÚˆÓ (CD19+), ÙˆÓ ÂÓÂÚÁÔÔÈË-Ì¤ÓˆÓ µ Î˘ÙÙ¿ÚˆÓ Ô˘ ÂÎÊÚ¿˙Ô˘Ó ÙÔÓ ˘Ô‰Ô¯¤· ππ ÙË˜ IgE(CD23+), ÙˆÓ ÂÓÂÚÁÔÔÈËÌ¤ÓˆÓ ∆ Î˘ÙÙ¿ÚˆÓ Ô˘ ÂÎÊÚ¿˙Ô˘ÓÙÔÓ ˘Ô‰Ô¯¤· ÙË˜ IL-2 (CD25+) Î·È ÔÈ ˘ÔÏËı˘ÛÌÔ› ÙˆÓ ∆Î˘ÙÙ¿ÚˆÓ (CD3+/CD4+ Î·È CD3+/CD8+) ÚÔÛ‰ÈÔÚ›ÛÙËÎ·ÓÛÙÔÓ Î˘ÙÙ·ÚÔÌÂÙÚËÙ‹ ÚÔ‹˜ EPICS-XL ÙË˜ ÂÙ·ÈÚÂ›·˜COULTER, ÌÂÙ¿ ·fi Î·Ù¿ÏÏËÏË ÂÂÍÂÚÁ·Û›· ÁÈ· Ï‡ÛË ÙˆÓÂÚ˘ıÚÒÓ ÛÙË Û˘ÛÎÂ˘‹ multi Q-PREP ÌÂ ÙË ‚Ô‹ıÂÈ· ÙÔ˘Immunoprep Reagent System.

T· ·ÔÙÂÏ¤ÛÌ·Ù· ÂÎÊÚ¿˙ÔÓÙ·È ̂ ˜ ÔÛÔÛÙfi ıÂÙÈÎÒÓ Î˘Ù-Ù¿ÚˆÓ (‰ËÏ·‰‹ % ÔÛÔÛÙfi ÙˆÓ Î˘ÙÙ¿ÚˆÓ Ô˘ ÂÎÊÚ¿˙Ô˘ÓÙÔÓ Û˘ÁÎÂÎÚÈÌ¤ÓÔ ÂÈÊ·ÓÂÈ·Îfi ‰Â›ÎÙË).

193∞ÓÔÛÈ·Î‹ ·¿ÓÙËÛË ÛÙÔ ÎÔÚÙÈÎÔÂ˘·›ÛıËÙÔ ÓÂÊÚˆÛÈÎfi Û‡Ó‰ÚÔÌÔ

¶·È‰È·ÙÚÈÎ‹ 2007;70:192-198


‚) EÓ‰ÔÎ˘ÙÙ¿ÚÈÔ˜ ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ INF-Á

Î·È IL-4

∏ ÂÓ‰ÔÎ˘ÙÙ¿ÚÈ· ·Ú·ÁˆÁ‹ ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ π¡F-Á Î·È

IL-4 ÌÂÙÚ‹ıËÎÂ ÛÂ ÂÚÈÊÂÚÈÎfi ·›Ì· ÌÂ Î˘ÙÙ·ÚÔÌÂÙÚ›· ÚÔ‹˜.

ÃÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÌÔÓÔÎÏˆÓÈÎ¿ ·ÓÙÈÛÒÌ·Ù· ÛÂ ÛËÌ·ÛÌ¤Ó·

ÌÂ Ù· Î·Ù¿ÏÏËÏ· ÊıÔÚÈÔ¯ÚÒÌ·Ù·: CD3 (PE-Cy5), CD69

(FITC) (Beckman, COULTER, Maiami, Florida), Î·ıÒ˜ Î·È

·ÓÙÈ-IL-4 PE Î·È ·ÓÙÈ-INF-Á ƒ∂ (R&D Systems, Abingon,

United Kingdom).

ŒÁÈÓÂ ÌË ÂÈ‰ÈÎ‹ ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÌÂ ÂÛÙ¤Ú·

ÙË˜ ÊÔÚÌfiÏË˜ PMA (phorbol-12-mystrate-13-acetate) Î·È

ÈÔÓÔÌ˘Î›ÓË (iomycin) ÙË˜ ÂÙ·ÈÚÂ›·˜ SIGMA. ªÂÙ¿ ·fi ÌË ÂÈ-

‰ÈÎ‹ ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÌÂ PMA Î·È ÂÂÍÂÚÁ·Û›·

ÌÂ Î·Ù¿ÏÏËÏ· ·ÓÙÈ‰Ú·ÛÙ‹ÚÈ· (intra-prep kit, Beckman,

Coulter), ÌÂÙÚ‹ıËÎÂ Ë ¤ÓÙ·ÛË ÙÔ˘ ÊıÔÚÈÛÌÔ‡ ÙˆÓ Î˘ÙÙ¿ÚˆÓ

Ô˘ ¤¯Ô˘Ó ‰ÂÛÌÂ‡ÛÂÈ ÙÔ ÂÈ‰ÈÎfi ·ÓÙ›ÛˆÌ· ÁÈ· ÙËÓ INF-Á Î·È

ÙËÓ IL-4 ÌÂ ÙË Ì¤ıÔ‰Ô ÙÔ˘ ÙÚÈÏÔ‡ ¿ÌÂÛÔ˘ ·ÓÔÛÔÊıÔÚÈÛÌÔ‡

ÛÙÔÓ Î˘ÙÙ·ÚÔÌÂÙÚËÙ‹ ÚÔ‹˜ Coulter EPIX XL.

∏ ÂÈÏÔÁ‹ ÙÔ˘ ÏËı˘ÛÌÔ‡ ÙˆÓ ∆ Î˘ÙÙ¿ÚˆÓ ¤ÁÈÓÂ ÌÂ ÙÔ

CD3+ PE-Cy5 (Fluorescence channel 3, FL3) Î·È ÙËÓ ·Ú¿ÌÂ-

ÙÚÔ ÙÔ˘ Ï¿ÁÈÔ˘ ÛÎÂ‰·ÛÌÔ‡ (Sidescatter, SSC). ™ÙË Û˘Ó¤¯ÂÈ·,

ÌÂ ÙË ‚Ô‹ıÂÈ· ÙˆÓ ·Ú·Ì¤ÙÚˆÓ FL1 (Fluorescence channel 1)

ÁÈ· ÙÔ CD9 Î·È FL2 (Fluorescence channel 2) ÁÈ· ÙËÓ INF-Á ‹

IL-4, ÚÔÛ‰ÈÔÚ›ÛÙËÎÂ ÙÔ ÔÛÔÛÙfi ÙˆÓ ÂÓÂÚÁÔÔÈËÌ¤ÓˆÓ ∆

Î˘ÙÙ¿ÚˆÓ (CD3+CD69+) Ô˘ ·Ú¿ÁÔ˘Ó ÙÈ˜ ·ÓÙ›ÛÙÔÈ¯Â˜ Î˘Ù-

Ù·ÚÔÎ›ÓÂ˜.

°È· ÙËÓ ÂÍ·›ÚÂÛË ÙÔ˘ ÌË ÂÈ‰ÈÎÔ‡ Û‹Ì·ÙÔ˜ ·fi ÙËÓ ·Ó¿Ï˘-

ÛË, ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ ÈÛÔÙ˘ÈÎfi ‰Â›ÁÌ· ÂÏ¤Á¯Ô˘, Î·ıÒ˜ Î·È

‰Â›ÁÌ· ¯ˆÚ›˜ ÙËÓ ÚÔÛı‹ÎË ÂÓÂÚÁÔÔÈËÙ‹ ƒª∞.

∆· ·ÔÙÂÏ¤ÛÌ·Ù· ÂÎÊÚ¿˙ÔÓÙ·È ˆ˜ ÙÔ % ÔÛÔÛÙfi ÙˆÓ

ÂÓÂÚÁÔÔÈËÌ¤ÓˆÓ Î˘ÙÙ¿ÚˆÓ CD3+ CD69+ Ô˘ ·Ú¿ÁÔ˘Ó

INF-Á ‹ IL-4.

Á) ª¤ÙÚËÛË ÙˆÓ Û˘ÁÎÂÓÙÚÒÛÂˆÓ ÙË˜ πgE ÛÙÔÓ ÔÚfi

∆· Â›Â‰· ÙË˜ IgE ÌÂÙÚ‹ıËÎ·Ó ÛÙÔÓ ÔÚfi ÌÂ ÙËÓ ÙÂ¯ÓÈÎ‹

ÙË˜ ÎÈÓËÙÈÎ‹˜ ÓÂÊÂÏÔÌÂÙÚ›·˜ Î·È ÂÈ‰ÈÎfiÙÂÚ· ÌÂ ÙËÓ ÙÂ¯ÓÈÎ‹

ÙË˜ ÂÓ›Û¯˘ÛË˜ ÌÂ ÂÈ‰ÈÎ¿ ÛˆÌ·Ù›‰È· latex (Particle enhanced

nephelometry) ÌÂ ÓÂÊÂÏfiÌÂÙÚÔ µ¡∞ (Behring Nephelometry

Analyzer) BN100 ÙË˜ ÂÙ·ÈÚÂ›·˜ Behring. °È· ÙÈ˜ ÌÂÙÚ‹ÛÂÈ˜

¯ÚËÛÈÌÔÔÈ‹ıËÎÂ ÙÔ ÂÈ‰ÈÎfi ·ÓÙÈ‰Ú·ÛÙ‹ÚÈÔ ÙË˜ ÂÙ·ÈÚÂ›·˜

Behring Ô˘ ·ÔÙÂÏÂ›Ù·È ·fi ÛˆÌ·Ù›‰È· ÔÏ˘ÛÙ˘ÚÂÓ›Ô˘ ÂÈ-

Î·Ï˘ÙfiÌÂÓ· ÌÂ ÌÔÓÔÎÏˆÓÈÎ¿ ·ÓÙÈÛÒÌ·Ù· IgE Î·È ÚfiÙ˘Ô˜

·ÓÙÈÔÚfi˜ ÙË˜ ›‰È·˜ ÂÙ·ÈÚÂ›·˜ (IgE-standard) ÁÈ· ÙË ‰ËÌÈÔ˘Ú-

Á›· Î·Ì‡ÏË˜ ·Ó·ÊÔÚ¿˜.

‰) ¶ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ Û˘ÁÎÂÓÙÚÒÛÂˆÓ ÛÙÔÓ ÔÚfi ÙˆÓ Î˘ÙÙ·ÚÔ-

ÎÈÓÒÓ INF-Á, IL-4, IL-13 Î·È IL-18

∆· Â›Â‰· ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ INF-Á, IL-4, IL-13 Î·È IL-

18 ÛÙÔÓ ÔÚfi ÌÂÙÚ‹ıËÎ·Ó ÌÂ ·ÓÔÛÔÂÓ˙˘ÌÈÎ‹ Ì¤ıÔ‰Ô ELISA

(R&D Systems, UK) Û‡ÌÊˆÓ· ÌÂ ÙÈ˜ Ô‰ËÁ›Â˜ ÙË˜ ·Ú·ÛÎÂ˘¿-

ÛÙÚÈ·˜ ÂÙ·ÈÚÂ›·˜. ∆· fiÚÈ· Â˘·ÈÛıËÛ›·˜ ÙˆÓ ÌÂÙÚ‹ÛÂˆÓ ÙˆÓ

INF-Á, IL-4, IL-13 Î·È IL-18 Â›Ó·È 13,8 pg/ml, 6,6 pg/ml, 14,3

pg/ml Î·È 12,5 pg/ml, ·ÓÙ›ÛÙÔÈ¯·.

™Ù·ÙÈÛÙÈÎ‹ ·Ó¿Ï˘ÛË

∏ ÛÙ·ÙÈÛÙÈÎ‹ ÂÂÍÂÚÁ·Û›· ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ¤ÁÈÓÂ ÌÂ

ÙË ̄ Ú‹ÛË ÙÔ˘ ÛÙ·ÙÈÛÙÈÎÔ‡ ·Î¤ÙÔ˘ SPSS ¤Î‰ÔÛË 11.5. °È· fiÏÂ˜

ÙÈ˜ ·Ú·Ì¤ÙÚÔ˘˜ ˘ÔÏÔÁ›ÛÙËÎÂ Ë ‰È¿ÌÂÛË ÙÈÌ‹ Î·È Ë ‰È·Î‡-

Ì·ÓÛË. °È· ÙËÓ Î·Ù¿ ˙Â‡ÁË ·Ó¿Ï˘ÛË ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë ÌË

·Ú·ÌÂÙÚÈÎ‹ ‰ÔÎÈÌ·Û›· Wilcoxon signed-rank test Î·È ÁÈ· ÙË

Û‡ÁÎÚÈÛË ÙˆÓ ‰È¿ÌÂÛˆÓ ÙÈÌÒÓ ÙˆÓ ·Ú·Ì¤ÙÚˆÓ Ë ÌË ·Ú·ÌÂ-

ÙÚÈÎ‹ ‰ÔÎÈÌ·Û›· Mann-Whitney rank test. ∏ Û˘Û¯¤ÙÈÛË (r) ¤ÁÈ-

ÓÂ ÌÂ ÙË ‰ÔÎÈÌ·Û›· Spearman’s coefficient of correlation. ∏

ÛÙ·ÙÈÛÙÈÎ‹ ÛËÌ·ÓÙÈÎfiÙËÙ· ÔÚ›ÛÙËÎÂ ÛÙÔ Â›Â‰Ô p<0,05.

∞ÔÙÂÏ¤ÛÌ·Ù·

πÛÙÔÚÈÎfi ·ÏÏÂÚÁ›·˜

πÛÙÔÚÈÎfi ·ÙÔ›·˜ ·ÚÔ˘Û›·˙·Ó 4/20 ·È‰È¿ ÌÂ

∫∂¡™ (2 ·È‰È¿ ÌÂ ¿ÛıÌ·, 1 ·È‰› ÌÂ ·ÙÔÈÎ‹ ‰ÂÚ-

Ì·Ù›ÙÈ‰· Î·È 1 ·È‰› ÌÂ ¿ÛıÌ· Î·È ·ÙÔÈÎ‹ ‰ÂÚÌ·Ù›-

ÙÈ‰·) Î·È 3/20 Ì¿ÚÙ˘ÚÂ˜ (1 ·È‰› ÌÂ ¿ÛıÌ·, 1 ·È‰›

ÌÂ ·ÙÔÈÎ‹ ‰ÂÚÌ·Ù›ÙÈ‰· Î·È 1 ·È‰› ÌÂ ¿ÛıÌ· Î·È

·ÙÔÈÎ‹ ‰ÂÚÌ·Ù›ÙÈ‰·).

ÀÔÏËı˘ÛÌÔ› ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ

∆· ÔÛÔÛÙ¿ ÙˆÓ ˘ÔÏËı˘ÛÌÒÓ CD3+ fiˆ˜ Î·È

CD25+, CD4+ Î·È CD8+ ∆ Î˘ÙÙ¿ÚˆÓ ÛÙ· ·È‰È¿ ÌÂ

∫∂¡™ Î·Ù¿ ÙËÓ ÂÓÂÚÁfi Ê¿ÛË ÙË˜ ÓfiÛÔ˘ Î·È Î·Ù¿ ÙË

Ê¿ÛË ‡ÊÂÛË˜ ˘fi Î·È ¯ˆÚ›˜ ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹, ‹Ù·Ó

Û˘ÁÎÚ›ÛÈÌ· ÌÂ ·˘Ù¿ ÙˆÓ Ì·ÚÙ‡ÚˆÓ. ™ÙËÓ Î·Ù¿ ˙Â‡ÁË

·Ó¿Ï˘ÛË ÙˆÓ 12 ·È‰ÈÒÓ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó ÙfiÛÔ ÛÂ

ÂÓÂÚÁfi Ê¿ÛË, fiÛÔ Î·È ÛÂ Ê¿ÛË ‡ÊÂÛË˜ ˘fi ÎÔÚÙÈÎÔ-

ÛÙÂÚÔÂÈ‰‹, ‚Ú¤ıËÎÂ fiÙÈ Ô ÏfiÁÔ˜ CD4+/CD8+ ∆ Î˘Ù-

Ù¿ÚˆÓ ‹Ù·Ó ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ¿ ¯·ÌËÏfiÙÂÚÔ˜ ÛÙËÓ

ÂÓÂÚÁfi Ê¿ÛË ÙË˜ ÓfiÛÔ˘ (p=0,017). ∞˘Ùfi ÔÊÂÈÏfiÙ·Ó

ÛÂ ·‡ÍËÛË ÙÔ˘ ÔÛÔÛÙÔ‡ ÙˆÓ CD8+ ∆ Î˘ÙÙ¿ÚˆÓ.

∆Ô ÔÛÔÛÙfi ÙˆÓ CD19+ µ Î˘ÙÙ¿ÚˆÓ ‹Ù·Ó ÛËÌ·-

ÓÙÈÎ¿ ·˘ÍËÌ¤ÓÔ ÛÙËÓ ÂÓÂÚÁfi Ê¿ÛË ÙË˜ ÓfiÛÔ˘ (‰È¿ÌÂ-

ÛÔ˜: 17,12, ‰È·Î‡Ì·ÓÛË: 12,22-24,54) ÛÂ Û¯¤ÛË ÌÂ ÙË

Ê¿ÛË ‡ÊÂÛË˜ ÙfiÛÔ ˘fi ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹ (‰È¿ÌÂÛÔ˜:

14,16, ‰È·Î‡Ì·ÓÛË: 10,23-18,3 Î·È p<0,0001), fiÛÔ Î·È

¯ˆÚ›˜ ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹ (‰È¿ÌÂÛÔ˜: 13,92, ‰È·Î‡Ì·Ó-

ÛË: 10,8-17,4 Î·È p=0,035), Î·ıÒ˜ Î·È ÌÂ ÙÔ˘˜ Ì¿ÚÙ˘-

ÚÂ˜ (‰È¿ÌÂÛÔ˜: 13,78, ‰È·Î‡Ì·ÓÛË: 10,2-16,8 Î·È

p=0,022). ∂›ÛË˜, ÙÔ ÔÛÔÛÙfi ÙˆÓ µ Î˘ÙÙ¿ÚˆÓ Ô˘

ÂÎÊÚ¿˙Ô˘Ó ÙÔÓ ˘Ô‰Ô¯¤· ÙË˜ IgE (CD23+) ‹Ù·Ó ÛË-

Ì·ÓÙÈÎ¿ ·˘ÍËÌ¤ÓÔ ÛÙËÓ ÂÓÂÚÁfi Ê¿ÛË ÙË˜ ÓfiÛÔ˘ (‰È¿-

ÌÂÛÔ˜: 3,62, ‰È·Î‡Ì·ÓÛË: 1,80-11) Û˘ÁÎÚÈÙÈÎ¿ ÌÂ ÙË

Ê¿ÛË ‡ÊÂÛË˜ ˘fi ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹ (‰È¿ÌÂÛÔ˜: 2,02,

‰È·Î‡Ì·ÓÛË: 1,21-8,53 Î·È p=0,002) Î·È ¯ˆÚ›˜ ÎÔÚÙÈ-

ÎÔÛÙÂÚÔÂÈ‰‹ (‰È¿ÌÂÛÔ˜: 1,43, ‰È·Î‡Ì·ÓÛË: 0,44-8,06

Î·È p=0,012), Î·ıÒ˜ Î·È ÌÂ ÙËÓ ÔÌ¿‰· ÙˆÓ Ì·ÚÙ‡ÚˆÓ

(‰È¿ÌÂÛÔ˜: 1,13, ‰È·Î‡Ì·ÓÛË: 0,37-6,53 Î·È p<0,001).

EÓ‰ÔÎ˘ÙÙ¿ÚÈÔ˜ ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ

Î˘ÙÙ·ÚÔÎÈÓÒÓ INF-Á Î·È IL-4

ø˜ ÚÔ˜ ÙËÓ ÂÓ‰ÔÎ˘ÙÙ¿ÚÈ· ·Ú·ÁˆÁ‹ Î˘ÙÙ·ÚÔ-

ÎÈÓÒÓ, ÙÔ ÔÛÔÛÙfi ÙˆÓ CD3+/CD69+/INF-Á ∆ Î˘Ù-

Ù¿ÚˆÓ (Ù‡Ô˘-1 Î‡ÙÙ·Ú·) ‹Ù·Ó ÔÏ‡ ÂÏ·ÙÙˆÌ¤ÓÔ

ÛÙ· ·È‰È¿ ÌÂ ∫∂¡™ ÛÂ fiÏÂ˜ ÙÈ˜ Ê¿ÛÂÈ˜ ÙË˜ ÓfiÛÔ˘

(‰È¿ÌÂÛÔ˜: 10,85, ‰È·Î‡Ì·ÓÛË: 8,47-16,49) ÛÂ Û¯¤ÛË

ÌÂ ÙÔ˘˜ Ì¿ÚÙ˘ÚÂ˜ (‰È¿ÌÂÛÔ˜: 23,85, ‰È·Î‡Ì·ÓÛË:

13,4-28,7 Î·È p<0,0001).

∞ÓÙ›ıÂÙ·, ÙÔ ÔÛÔÛÙfi ÙˆÓ CD3+/CD69+/IL4+ ∆

Î˘ÙÙ¿ÚˆÓ (Ù‡Ô˘-2 Î‡ÙÙ·Ú·) ‹Ù·Ó ÛËÌ·ÓÙÈÎ¿ ·˘ÍË-

Ì¤ÓÔ, fi¯È ÌfiÓÔ Î·Ù¿ ÙËÓ ÂÓÂÚÁfi Ê¿ÛË ÙË˜ ÓfiÛÔ˘

(‰È¿ÌÂÛÔ˜: 19,59, ‰È·Î‡Ì·ÓÛË: 13,68-26,29), ·ÏÏ¿ Î·È

Î·Ù¿ ÙË Ê¿ÛË ‡ÊÂÛË˜ ÙfiÛÔ ˘fi ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹

194 ¡. ¶Ú›ÓÙ˙· Î·È Û˘Ó.



(‰È¿ÌÂÛÔ˜: 15,158, ‰È·Î‡Ì·ÓÛË: 10,43-19,63 Î·È

p=0,015), fiÛÔ Î·È ¯ˆÚ›˜ ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹ (‰È¿ÌÂ-

ÛÔ˜: 11,68, ‰È·Î‡Ì·ÓÛË: 7,57-14,56 Î·È p=0,004) Û˘-

ÁÎÚÈÙÈÎ¿ ÌÂ ÙÔ˘˜ Ì¿ÚÙ˘ÚÂ˜ (‰È¿ÌÂÛÔ˜: 2,14, ‰È·Î‡-

Ì·ÓÛË: 1,25-5,63 Î·È p<0,0001).

∂›Â‰· ÛÙÔÓ ÔÚfi ÙË˜ πgE

Ÿˆ˜ Ê·›ÓÂÙ·È ÛÙÔÓ ¶›Ó·Î· 1, Ù· Â›Â‰· ÙË˜

IgE ÛÙÔÓ ÔÚfi ÛÙ· ·È‰È¿ ÌÂ ∫∂¡™ ‹Ù·Ó ÛËÌ·ÓÙÈÎ¿

·˘ÍËÌ¤Ó· ÛÙËÓ ÂÓÂÚÁfi Ê¿ÛË ÙË˜ ÓfiÛÔ˘ (‰È¿ÌÂÛÔ˜:

230 IU/ml, ‰È·Î‡Ì·ÓÛË: 84-2100 IU/ml) ÛÂ Û¯¤ÛË ÌÂ

ÙË Ê¿ÛË ‡ÊÂÛË˜, ÙfiÛÔ ˘fi ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹ (‰È¿-

ÌÂÛÔ˜: 102 IU/ml, ‰È·Î‡Ì·ÓÛË: 19-1000 IU/ml Î·È

p=0,002), (∂ÈÎfiÓ· 1), fiÛÔ Î·È ¯ˆÚ›˜ ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ-

‰‹ (‰È¿ÌÂÛÔ˜: 57 IU/ml, ‰È·Î‡Ì·ÓÛË:18-759 IU/ml

Î·È p=0,012), Î·ıÒ˜ Î·È ÌÂ ÙÔ˘˜ Ì¿ÚÙ˘ÚÂ˜ (‰È¿ÌÂ-

ÛÔ˜: 27 IU/ml, ‰È·Î‡Ì·ÓÛË: 5-125 IU/ml Î·È

p<0,0001). ¢ÂÓ ‰È·ÈÛÙÒıËÎÂ ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹

Û˘Û¯¤ÙÈÛË ÌÂÙ·Í‡ ÙˆÓ ÙÈÌÒÓ ÙË˜ IgE Î·È ÙË˜ ·ÚÔ˘-

Û›·˜ ·ÙÔ›·˜ (p>0,05).

∂›Â‰· ÛÙÔÓ ÔÚfi ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ π¡F-Á, IL-4,

IL-13 Î·È IL-18

™ÙÔÓ ¶›Ó·Î· 1 ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Û˘ÓÔÙÈÎ¿ Ù·

·ÔÙÂÏ¤ÛÌ·Ù· ·Ó·ÊÔÚÈÎ¿ ÌÂ Ù· Â›Â‰· ÛÙÔÓ ÔÚfi

ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ π¡F-Á, IL-4, IL-13 Î·È IL-18 .∆·Â›Â‰· ÙË˜ INF-Á ÛÙÔÓ ÔÚfi, ÛÂ Û˘ÌÊˆÓ›· ÌÂ ·˘Ù¿·fi ÙËÓ ÂÓ‰ÔÎ˘ÙÙ¿ÚÈ· ÂÎÙ›ÌËÛË, ‹Ù·Ó ÔÏ‡ ÂÏ·Ù-ÙˆÌ¤Ó· ÛÙ· ·È‰È¿ ÌÂ ∫∂¡™ ÛÂ ÂÓÂÚÁfi Ê¿ÛË ÛÂ Û¯¤-ÛË ÌÂ ÙÔ˘˜ Ì¿ÚÙ˘ÚÂ˜. ∞ÓÙ›ıÂÙ·, ÙË˜ IL-4 ‹Ù·Ó ÛËÌ·-ÓÙÈÎ¿ ·˘ÍËÌ¤Ó· fi¯È ÌfiÓÔ Î·Ù¿ ÙËÓ ÂÓÂÚÁfi Ê¿ÛË ÙË˜ÓfiÛÔ˘, ·ÏÏ¿ Î·È Î·Ù¿ ÙË Ê¿ÛË ‡ÊÂÛË˜ ÙfiÛÔ ˘fiÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹, fiÛÔ Î·È ¯ˆÚ›˜ ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹Û˘ÁÎÚÈÙÈÎ¿ ÌÂ ÙÔ˘˜ Ì¿ÚÙ˘ÚÂ˜.

∆· Â›Â‰· ÙË˜ IL-13 ÛÙÔÓ ÔÚfi ÙˆÓ ·È‰ÈÒÓ ÌÂ∫∂¡™ ‹Ù·Ó Â›ÛË˜ ÛËÌ·ÓÙÈÎ¿ ·˘ÍËÌ¤Ó· ÛÙËÓ ÂÓÂÚÁfi

¶›Ó·Î·˜ 1. ∂›Â‰· ÛÙÔÓ ÔÚfi, ‰È¿ÌÂÛË ÙÈÌ‹ Î·È ‰È·Î‡Ì·ÓÛË, ÙË˜ IgE Î·È ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ INF-Á, IL4, IL-13 Î·È IL-18 ÛÙ· ·È‰È¿ ÌÂ∫∂¡™ Î·È ÛÙÔ˘˜ Ì¿ÚÙ˘ÚÂ˜

∂›Â‰· ∂ÓÂÚÁfi˜ Ê¿ÛË ⁄ÊÂÛË ˘fi ⁄ÊÂÛË ¯ˆÚ›˜ ª¿ÚÙ˘ÚÂ˜ÛÙÔÓ ÔÚfi ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹ ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹

IgE (IU/ml)¢È¿ÌÂÛÔ˜ 2301 102 57 27¢È·Î‡Ì·ÓÛË 84-2100 19-1005 18-759 5-125INF-Á (pg/ml)¢È¿ÌÂÛÔ˜ 14,822 21,95 24,2 19,23¢È·Î‡Ì·ÓÛË 13,7-27,37 13,92-34,45 16,9-35,56 13,96-32,27IL-4 (pg/ml)¢È¿ÌÂÛÔ˜ 583 30,33 21,76 12,4¢È·Î‡Ì·ÓÛË 17,8-194 12,13-72,04 10,8-51,65 6,43-33,53IL-13 (pg/ml)¢È¿ÌÂÛÔ˜ 75,694 41,03 37 14,6¢È·Î‡Ì·ÓÛË 20-187 13,7-134 12-88 14,2-19,2IL-18(pg/ml)¢È¿ÌÂÛÔ˜ 1613,755 926,75 670 214,8¢È·Î‡Ì·ÓÛË 521-4090 455-1291 394-1136 78,3-386,8

1 p=0,002, p=0,012, p<0,0001 ÁÈ· Û‡ÁÎÚÈÛË ÌÂÙ·Í‡ ÂÓÂÚÁÔ‡ Ê¿ÛË˜ ÛÂ Û¯¤ÛË ÌÂ Ê¿ÛË ‡ÊÂÛË˜ ˘fi ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹, Ê¿ÛË‡ÊÂÛË˜ ¯ˆÚ›˜ ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹ Î·È Ì¿ÚÙ˘ÚÂ˜, ·ÓÙ›ÛÙÔÈ¯·

2 p<0,0001, p<0,0001, p=0,019 ÁÈ· Û‡ÁÎÚÈÛË ÌÂÙ·Í‡ ÂÓÂÚÁÔ‡ Ê¿ÛË˜ ÛÂ Û¯¤ÛË ÌÂ Ê¿ÛË ‡ÊÂÛË˜ ˘fi ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹, Ê¿ÛË‡ÊÂÛË˜ ¯ˆÚ›˜ ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹ Î·È Ì¿ÚÙ˘ÚÂ˜, ·ÓÙ›ÛÙÔÈ¯·

3 p<0,0001, p<0,0001, p<0,0001 ÁÈ· Û‡ÁÎÚÈÛË ÌÂÙ·Í‡ ÂÓÂÚÁÔ‡ Ê¿ÛË˜ ÛÂ Û¯¤ÛË ÌÂ Ê¿ÛË ‡ÊÂÛË˜ ˘fi ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹, Ê¿ÛË‡ÊÂÛË˜ ¯ˆÚ›˜ ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹ Î·È Ì¿ÚÙ˘ÚÂ˜, ·ÓÙ›ÛÙÔÈ¯·



0

500

1000

1500

2000

2500

1 2

∂ÓÂÚÁfi˜ Ê¿ÛË ¡™. ⁄ÊÂÛË ˘fi ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹

IgE

(IU

/ml)

∂ÈÎfiÓ· 1. √È Î·Ù¿ ˙Â‡ÁË ÙÈÌ¤˜ ÙË˜ πgE ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ ∫∂¡™ÛÂ ÂÓÂÚÁfi Ê¿ÛË Î·È ÛÂ Ê¿ÛË ‡ÊÂÛË˜ ˘fi ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹.


¶·È‰È·ÙÚÈÎ‹ 2007;70:192-198


Ê¿ÛË ÙË˜ ÓfiÛÔ˘ Û˘ÁÎÚÈÙÈÎ¿ ÌÂ ÙË Ê¿ÛË ‡ÊÂÛË˜, Ùfi-ÛÔ ˘fi ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹, fiÛÔ Î·È ¯ˆÚ›˜ ÎÔÚÙÈÎÔ-ÛÙÂÚÔÂÈ‰‹ Î·ıÒ˜ Î·È ÌÂ ÙÔ˘˜ Ì¿ÚÙ˘ÚÂ˜. ∆Ô ›‰ÈÔ ‚Ú¤-ıËÎÂ Î·È ÁÈ· Ù· Â›Â‰· ÙË˜ IL-18 Ô˘ ‹Ù·Ó ÔÏ‡·˘ÍËÌ¤Ó· Î·Ù¿ ÙËÓ ÂÓÂÚÁfi Ê¿ÛË ÙË˜ ÓfiÛÔ˘ Û˘ÁÎÚÈ-ÙÈÎ¿ ÌÂ ÙÔ˘˜ Ì¿ÚÙ˘ÚÂ˜. ∆· Â›Â‰· ÂÏ·ÙÙÒÓÔÓÙ·ÓÛËÌ·ÓÙÈÎ¿ Î·Ù¿ ÙË Ê¿ÛË ‡ÊÂÛË˜ ˘fi Î·È ¯ˆÚ›˜ ÎÔÚ-ÙÈÎÔÛÙÂÚÔÂÈ‰‹, ·ÏÏ¿ ·Ú¤ÌÂÓ·Ó ÛËÌ·ÓÙÈÎ¿ ·˘ÍËÌ¤-Ó· ÛÂ Û¯¤ÛË ÌÂ ·˘Ù¿ ÙˆÓ Ì·ÚÙ‡ÚˆÓ (p<0,01).

™˘Û¯ÂÙ›ÛÂÈ˜

¶Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó Û˘Û¯ÂÙ›ÛÂÈ˜: ·) ÙˆÓ ÂÈ-¤‰ˆÓ ÙË˜ IgE ÙÔ˘ ÔÚÔ‡ ÌÂ ÙÔ ÔÛÔÛÙfi ÙˆÓ CD23+B Î˘ÙÙ¿ÚˆÓ, fiÔ˘ ‚Ú¤ıËÎÂ ÛËÌ·ÓÙÈÎ‹ ıÂÙÈÎ‹ Û˘-Û¯¤ÙÈÛË ÌÂÙ·Í‡ ÙˆÓ ÂÈ¤‰ˆÓ ÙË˜ IgE ÙÔ˘ ÔÚÔ‡ Î·ÈÙˆÓ CD23+ B Î˘ÙÙ¿ÚˆÓ (r=0,773 Î·È p<0,0001)Î·È, ‚) ÙˆÓ ÂÈ¤‰ˆÓ ÙË˜ IgE ÙÔ˘ ÔÚÔ‡ ÌÂ Ù· Â›Â-‰· ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ πL-13, IL-4 Î·È πL-18 ÛÂ ÂÓÂÚÁfiÊ¿ÛË ÙË˜ ÓfiÛÔ˘, fiÔ˘ ˘‹Ú¯Â ÛËÌ·ÓÙÈÎ‹ ıÂÙÈÎ‹ Û˘-Û¯¤ÙÈÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙË˜ IgE ÙÔ˘ ÔÚÔ‡ Î˘Ú›ˆ˜ ÌÂ Ù·Â›Â‰· ÙË˜ πL-13 (r=0,628 Î·È p<0,05) Î·È ÏÈÁfiÙÂÚ·ÌÂ ·˘Ù¿ ÙË˜ IL-4 Î·È ÙË˜ πL-18 (r=0,459 Î·È p<0,05,r=0,502 Î·È p<0,05, ·ÓÙ›ÛÙÔÈ¯·) (∂ÈÎfiÓÂ˜ 2, 3, 4).

™˘˙‹ÙËÛË

™ÙËÓ ·ÚÔ‡Û· ÚÔÔÙÈÎ‹ ÌÂÏ¤ÙË ¤ÁÈÓÂ ÚÔÛ¿-ıÂÈ· Ó· ‰ÈÂÚÂ˘ÓËıÔ‡Ó ÔÈ ·ÓÔÛÔÏÔÁÈÎ¤˜ ‰È·Ù·Ú·¯¤˜Ô˘ ·Ú·ÙËÚÔ‡ÓÙ·È ÛÙ· ·È‰È¿ ÌÂ ÚˆÙÔ·ı¤˜∫∂¡™ Î·È Ó· Û˘Û¯ÂÙÈÛÙÔ‡Ó ·˘Ù¤˜ ÌÂ ÙËÓ ·ÙÔ›·. ∆·Î‡ÚÈ· Â˘Ú‹Ì·Ù· ÙË˜ ÌÂÏ¤ÙË˜ ‹Ù·Ó Ù· ·ÎfiÏÔ˘ı·: Ù··È‰È¿ ÌÂ ∫∂¡™, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙË Ê¿ÛË ÙË˜ ÓfiÛÔ˘,Â›¯·Ó Ê˘ÛÈÔÏÔÁÈÎfi ÙfiÛÔ ÙÔÓ ·fiÏ˘ÙÔ ·ÚÈıÌfi ÙˆÓ ÏÂÌ-ÊÔÎ˘ÙÙ¿ÚˆÓ, ÙˆÓ ∆ Î˘ÙÙ¿ÚˆÓ, ÙˆÓ CD4+ ∆ Î˘ÙÙ¿ÚˆÓ

Î·È ÙˆÓ CD8+ ∆ Î˘ÙÙ¿ÚˆÓ, fiÛÔ Î·È ÙÔÓ ÏfiÁÔCD4+/CD8+ ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙÔ˘˜ Ì¿ÚÙ˘ÚÂ˜. √ ÏfiÁÔ˜CD4+/CD8+ ∆ Î˘ÙÙ¿ÚˆÓ, ·Ú’ fiÏÔ Ô˘ ‹Ù·Ó Ì¤Û·ÛÙ· fiÚÈ· ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÙÈÌÒÓ, ‚Ú¤ıËÎÂ ÛËÌ·-ÓÙÈÎ¿ ¯·ÌËÏfiÙÂÚÔ˜ ÛÙËÓ ÂÓÂÚÁfi Ê¿ÛË ÙË˜ ÓfiÛÔ˘ ÛÂÛ‡ÁÎÚÈÛË ÌÂ ÙË Ê¿ÛË ‡ÊÂÛË˜ ˘fi ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ-‰‹. ∞˘Ùfi ÔÊÂÈÏfiÙ·Ó ÛÂ ·‡ÍËÛË ÙÔ˘ ÔÛÔÛÙÔ‡ ÙˆÓCD8+ ∆ Î˘ÙÙ¿ÚˆÓ. ∆Ô ÔÛÔÛÙfi ÙˆÓ ÂÓÂÚÁÔÔÈËÌ¤-ÓˆÓ ∆ Î˘ÙÙ¿ÚˆÓ ÛÙËÓ Î˘ÎÏÔÊÔÚ›· ÙˆÓ ·È‰ÈÒÓ ÌÂ∫∂¡™ ‚È‚ÏÈÔÁÚ·ÊÈÎ¿ ·Ó·Ê¤ÚÂÙ·È fiÙÈ Û˘Ó‹ıˆ˜ Â›Ó·ÈÛÙ· Ê˘ÛÈÔÏÔÁÈÎ¿ fiÚÈ· (10-12), fiˆ˜ Î·È ÛÙËÓ ·-ÚÔ‡Û· ÌÂÏ¤ÙË, ÛÙËÓ ÔÔ›· ‰ÂÓ ˘‹Ú¯Â ÌÂÙ·‚ÔÏ‹ÙˆÓ CD25+ Î˘ÙÙ¿ÚˆÓ ÛÂ Î·Ì›· Ê¿ÛË ÙË˜ ÓfiÛÔ˘.

2.000,00

1.500,00

1.000,00

500,00

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40,00 80,00 120,00 160,00

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IgE

IU

/ml

IL-13 (pg/ml)

r=0,628

p<0,05

∂ÈÎfiÓ· 2. ™˘Û¯¤ÙÈÛË ÌÂÙ·Í‡ ÙˆÓ ÂÈ¤‰ˆÓ ÙË˜ IgE ÙÔ˘ ÔÚÔ‡ ÌÂÙ· Â›Â‰· ÙË˜ πL-13 ÛÙ· ·È‰È¿ ÌÂ ÂÓÂÚÁfi ∫∂¡™.

r=0,459

p<0,05

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✟

✟

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✟

✟✟✟✟

✟ ✟✟ ✟✟✟✟

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2.000,00

1.500,00

1.000,00

500,00

0,00

50,00 100,00 150,00 200,00

IgE

IU

/ml

IL-4 (pg/ml)


✟

✟

✟

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✟

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r=0,502

p<0,052.000,00

1.500,00

1.000,00

500,00

0,00

1.000,00 2.000,00 3.000,00 4.000,00

IgE

IU

/ml

IL-18 (pg/ml)


196 ¡. ¶Ú›ÓÙ˙· Î·È Û˘Ó.



∞ÓÙ›ıÂÙ·, ÙÔ ÔÛÔÛÙfi ÙˆÓ CD19+ Î·È CD23+ µ Î˘Ù-

Ù¿ÚˆÓ ‚Ú¤ıËÎÂ ÛËÌ·ÓÙÈÎ¿ ·˘ÍËÌ¤ÓÔ ÛÙËÓ ·ÚÔ‡Û·

ÌÂÏ¤ÙË ÛÙËÓ ÂÓÂÚÁfi Ê¿ÛË ÙË˜ ÓfiÛÔ˘, Û˘ÁÎÚÈÙÈÎ¿ ÌÂ

ÙÈ˜ Ê¿ÛÂÈ˜ ‡ÊÂÛË˜ Î·È ÌÂ ÙÔ˘˜ Ì¿ÚÙ˘ÚÂ˜. ∂ÈÏ¤ÔÓ,

ÙÔ ·˘ÍËÌ¤ÓÔ ÔÛÔÛÙfi ÙˆÓ CD23+ µ Î˘ÙÙ¿ÚˆÓ ÛÙËÓ

ÂÓÂÚÁfi Ê¿ÛË ÙË˜ ÓfiÛÔ˘ ·ÚÔ˘Û›·˙Â ÛËÌ·ÓÙÈÎ‹ Û˘-

Û¯¤ÙÈÛË ÌÂ Ù· Â›ÛË˜ ·˘ÍËÌ¤Ó· Â›Â‰· ÙË˜ IgE ÛÙÔÓ

ÔÚfi, ·ÓÂÍ·ÚÙ‹Ùˆ˜ ÙÔ˘ ÈÛÙÔÚÈÎÔ‡ ·ÙÔ›·˜. ∆· ÈÔ

ÂÓÙ˘ˆÛÈ·Î¿ Â˘Ú‹Ì·Ù· ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜, fiÛÔÓ

·ÊÔÚ¿ ÛÙËÓ ÂÓ‰ÔÎ˘ÙÙ¿ÚÈ· Û‡ÓıÂÛË ÙˆÓ Î˘ÙÙ·ÚÔÎÈ-

ÓÒÓ Î·È Ù· Â›Â‰¿ ÙÔ˘˜ ÛÙÔÓ ÔÚfi, ‹Ù·Ó Ù· ÂÍ‹˜: ·È-

‰È¿ ÌÂ ∫∂¡™ ÛÂ fiÏÂ˜ ÙÈ˜ Ê¿ÛÂÈ˜ ÙË˜ ÓfiÛÔ˘ ·ÚÔ˘Û›·-

˙·Ó ·˘ÍËÌ¤Ó· ÔÛÔÛÙ¿ CD3+/CD69+/IL-4+ ∆ Î˘Ù-

Ù¿ÚˆÓ (Ù‡Ô˘-2), ÌÂÈˆÌ¤Ó· ÔÛÔÛÙ¿ CD3+/CD69+/

INF-Á ∆ Î˘ÙÙ¿ÚˆÓ (Ù‡Ô˘-1), ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ·˘ÍË-

Ì¤Ó· Â›Â‰· ÛÙÔÓ ÔÚfi ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ IL-4, IL-13

Î·È IL-18 Î·È ·˘ÍËÌ¤Ó· Â›Â‰· IgE, Â˘Ú‹Ì·Ù· Ô˘

Û˘ÓËÁÔÚÔ‡Ó ÁÈ· ·ÓÔÛÈ·Î‹ ·¿ÓÙËÛË Ù‡Ô˘-2. À‹Ú-

¯Â, Â›ÛË˜, ÛËÌ·ÓÙÈÎ¿ ıÂÙÈÎ‹ Û˘Û¯¤ÙÈÛË ÙˆÓ ÂÈ¤-

‰ˆÓ ÙÔ˘ ÔÚÔ‡ ÙË˜ IgE Î˘Ú›ˆ˜ ÌÂ ·˘Ù¿ ÙË˜ πL-13, ·ÏÏ¿

Î·È ÙË˜ IL-4 Î·È ÙË˜ πL-18.

™¯ÂÙÈÎ¿ ÌÂ ÙÔÓ ·ÓÔÛÔÊ·ÈÓfiÙ˘Ô ÙˆÓ µ Î·È ∆ Î˘Ù-

Ù¿ÚˆÓ ÛÙ· ·È‰È¿ ÌÂ ÂÓÂÚÁfi ∫∂¡™, Ù· ·ÔÙÂÏ¤ÛÌ·-

Ù· ÙˆÓ ‰È·ÊfiÚˆÓ ÌÂÏÂÙÒÓ Â›Ó·È ·ÓÙÈÎÚÔ˘fiÌÂÓ· (7-

10,16). ™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË, Ù· ÌfiÓ· ·ıÔÏÔÁÈÎ¿

Â˘Ú‹Ì·Ù· ‹Ù·Ó ÙÔ ·˘ÍËÌ¤ÓÔ ÔÛÔÛÙfi ÙˆÓ CD19+

Î·È CD23+ µ Î˘ÙÙ¿ÚˆÓ. ø˜ ÚÔ˜ ÙÔÓ ÏfiÁÔ

CD4+/CD8+ ∆ Î˘ÙÙ¿ÚˆÓ, ÛÂ ÂÓÂÚÁfi Ê¿ÛË ÙË˜ ÓfiÛÔ˘

ÌÔÚÂ› Ó· Â›Ó·È ÂÏ·ÙÙˆÌ¤ÓÔ˜, ÂÓÒ ÛÙËÓ ‡ÊÂÛË ÔÈ ÙÈ-

Ì¤˜ Â·Ó¤Ú¯ÔÓÙ·È ÛÙÔ Ê˘ÛÈÔÏÔÁÈÎfi (8,10), fiˆ˜

‚Ú¤ıËÎÂ Î·È ÛÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË.

T· ·ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ Û˘ÁÎÂÎÚÈÌ¤ÓË˜ ÌÂÏ¤ÙË˜,

·Ó·ÊÔÚÈÎ¿ ÌÂ ÙÈ˜ ·Ú·ÁfiÌÂÓÂ˜ Î˘ÙÙ·ÚÔÎ›ÓÂ˜ ‰Â›-

¯ÓÔ˘Ó fiÙÈ ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ ∫∂¡™ ˘¿Ú¯ÂÈ ‰È·Ù·-

Ú·ÁÌ¤ÓË ÈÛÔÚÚÔ›· ÙË˜ Ù‡Ô˘-1 ÚÔ˜ Ù‡Ô-2 ·ÓÔ-

ÛÈ·Î‹˜ ·¿ÓÙËÛË˜ ÌÂ ˘ÂÚÔ¯‹ ÙË˜ Ù‡Ô˘-2 (·ÓÙ› ÙË˜

Ù‡Ô˘-1, Ô˘ Û˘Ì‚·›ÓÂÈ ÛÂ ˘ÁÈ‹ ¿ÙÔÌ· Î·È fiˆ˜ ‚Ú¤-

ıËÎÂ ÛÙÔ˘˜ Ì¿ÚÙ˘ÚÂ˜ ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜), fiˆ˜

·˘Ù‹ ÂÎÊÚ¿˙ÂÙ·È Î˘Ú›ˆ˜ ·fi ÙËÓ ·˘ÍËÌ¤ÓË Û‡ÓıÂÛË

ÙˆÓ Î˘Ù·ÚÔÎÈÓÒÓ IL-4 Î·È IL-13 Î·È ÙË ÌÂÈˆÌ¤ÓË Û‡Ó-

ıÂÛË ÙË˜ INF-Á. ∞Ó·ÊÔÚÈÎ¿ ÌÂ ÙËÓ IL-4, Ù· ·ÔÙÂÏ¤-

ÛÌ·Ù· ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ Û˘ÌÊˆÓÔ‡Ó ÌÂ ·˘Ù¿

ÙˆÓ Neuhaus Î·È Û˘Ó (14) Î·È Cho Î·È Û˘Ó (15), ÔÈ

ÔÔ›ÔÈ ‚Ú‹Î·Ó ·˘ÍËÌ¤Ó· Â›Â‰· ÙË˜ IL-4 ÛÙÔÓ ÔÚfi.

∞ÓÙ›ıÂÙ·, ÔÈ Stachowski Î·È Û˘Ó (21) ÛÂ ÂÓÂÚÁfi Ê¿ÛË

ÙÔ˘ ∫∂¡™ ·Ú·Ù‹ÚËÛ·Ó ÌÂÈˆÌ¤Ó· Â›Â‰· ÙË˜ IL-4,

Èı·ÓÒ˜ ÁÈ·Ù› ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ ‰È·ÊÔÚÂÙÈÎ‹ ÙÂ¯ÓÈ-

Î‹, Ë ÔÔ›· ‰ÂÓ ÌÂÙÚ¿ÂÈ ¿ÌÂÛ· Ù· Î‡ÙÙ·Ú· Ô˘ ·Ú¿-

ÁÔ˘Ó IL-4, fiˆ˜ ¤ÁÈÓÂ ÛÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË. ™ÙËÓ

·ÚÔ‡Û· ÌÂÏ¤ÙË ‰È·ÈÛÙÒıËÎÂ ÛÂ fiÏÂ˜ ÙÈ˜ Ê¿ÛÂÈ˜

ÙÔ˘ ∫∂¡™ ·Ú·ÁˆÁ‹ Î˘ÙÙ·ÚÔÎÈÓÒÓ Ô˘ ¯·Ú·ÎÙËÚ›-

˙Ô˘Ó ÙËÓ Ù‡Ô˘-2 ·ÓÔÛÈ·Î‹ ·¿ÓÙËÛË. ∆· Â˘Ú‹Ì·Ù·

·˘Ù¿ ÂÓÈÛ¯‡ÔÓÙ·È Î·È ·fi ÙËÓ ·ÓÂ‡ÚÂÛË ÌÂÈˆÌ¤ÓË˜

ÂÓ‰ÔÎ˘ÙÙ¿ÚÈ·˜ Û‡ÓıÂÛË˜ ÙË˜ INF-Á (Î˘ÙÙ·ÚÔÎ›ÓË ÙË˜

Ù‡Ô˘-1 ·ÓÔÛÈ·Î‹˜ ·¿ÓÙËÛË˜). ™Â ÚÔËÁÔ‡ÌÂÓÂ˜

ÌÂÏ¤ÙÂ˜, ÔÈ Yap Î·È Û˘Ó (13) ‚Ú‹Î·Ó ÛÙÔ˘˜ ·ÛıÂÓÂ›˜

ÌÂ ÂÓÂÚÁfi ∫∂¡™, ÌÂ ÙË ¯Ú‹ÛË ËÌÈÔÛÔÙÈÎ‹˜ PCR ÙÂ-

¯ÓÈÎ‹˜, ·˘ÍËÌ¤ÓË ¤ÎÊÚ·ÛË ÙÔ˘ mRNA ÙË˜ IL-13, Ùfi-

ÛÔ ÛÙ· CD4+ fiÛÔ Î·È ÛÙ· CD8+ ∆ ÏÂÌÊÔÎ‡ÙÙ·Ú· ÛÂ

Û‡ÁÎÚÈÛË ÌÂ ÙÔ˘˜ ·ÛıÂÓÂ›˜ Ô˘ ‚Ú›ÛÎÔÓÙ·È ÛÂ Ê¿ÛË

‡ÊÂÛË˜ ÙË˜ ÓfiÛÔ˘ Î·È ÌÂ ÙÔ˘˜ ˘ÁÈÂ›˜ Ì¿ÚÙ˘ÚÂ˜. ∏ IL-

13, Û‡ÌÊˆÓ· ÌÂ ÙÔ˘˜ Û˘ÁÁÚ·ÊÂ›˜, Èı·ÓfiÙ·Ù· ‰Ú·

ÛÙ· ÌÔÓÔÎ‡ÙÙ·Ú·, Â¿ÁÔÓÙ·˜ ÙËÓ ·Ú·ÁˆÁ‹ ÂÓfi˜

˘ÔıÂÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· Ô˘ ·˘Í¿ÓÂÈ ÙËÓ ·ÁÁÂÈ·Î‹

‰È·ÂÚ·ÙfiÙËÙ· (vascular permeability factor) Î·È Û˘Ì-

‚¿ÏÏÔÓÙ·˜ ¤ÙÛÈ ÛÙËÓ ÂÌÊ¿ÓÈÛË ÙË˜ ÚˆÙÂ˚ÓÔ˘Ú›·˜.

¢ÂÓ Â›Ó·È ÁÓˆÛÙfi˜ Ô ÌË¯·ÓÈÛÌfi˜ Ô˘ Û˘ÓÙÂÏÂ› ÛÙËÓ

·˘ÍËÌ¤ÓË ¤ÎÊÚ·ÛË ÙË˜ IL-13 ÛÙ· ¿ÙÔÌ· ÌÂ ÂÓÂÚÁfi

∫∂¡™, Ê·›ÓÂÙ·È fiÌˆ˜ fiÙÈ ‰ÂÓ Û¯ÂÙ›˙ÂÙ·È ÌÂ ÁÂÓÂÙÈÎfi

˘fiÛÙÚˆÌ·, ÙÔ˘Ï¿¯ÈÛÙÔÓ fiÛÔÓ ·ÊÔÚ¿ ÛÙÔ˘˜ ÁÓˆ-

ÛÙÔ‡˜ Ì¤¯ÚÈ Û‹ÌÂÚ· ÔÏ˘ÌÔÚÊÈÛÌÔ‡˜ ÙÔ˘ ÁÔÓÈ‰›Ô˘

ÙË˜ IL-13 (22), Ô‡ÙÂ Î·È ÌÂ ÔÏ˘ÌÔÚÊÈÛÌÔ‡˜ ÙˆÓ ÁÔ-

ÓÈ‰›ˆÓ Ô˘ Îˆ‰ÈÎÔÔÈÔ‡Ó ÙÔ˘˜ ‰È·ÌÂÌ‚Ú·ÓÈÎÔ‡˜

˘Ô‰Ô¯Â›˜ ÙË˜ IL-4 Î·È ÙË˜ IL-13 (23,24).

π‰È·›ÙÂÚÔ ÂÓ‰È·Ê¤ÚÔÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ù· ·ÔÙÂ-

Ï¤ÛÌ·Ù· ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ Û¯ÂÙÈÎ¿ ÌÂ Ù· ·˘ÍË-

Ì¤Ó· Â›Â‰· ÙË˜ IL-18 ÛÂ fiÏÂ˜ ÙÈ˜ Ê¿ÛÂÈ˜ ÙÔ˘

∫∂¡™, È‰È·›ÙÂÚ· ‰Â ÛÙËÓ ÂÓÂÚÁfi Ê¿ÛË, ÛÂ Û‡ÁÎÚÈÛË

ÌÂ ÙÔ˘˜ Ì¿ÚÙ˘ÚÂ˜. ∏ IL-18 ·ÔÙÂÏÂ› Ì›· Î˘ÙÙ·ÚÔÎ›-

ÓË Ô˘ ¿ÏÏÔÙÂ Â¿ÁÂÈ ÙËÓ Ù‡Ô˘ π Î·È ¿ÏÏÔÙÂ ÙËÓ

Ù‡Ô˘ ππ ·ÓÔÛÈ·Î‹ ·¿ÓÙËÛË Î·È Ë ‰Ú¿ÛË ÙË˜ ÛÂ Î¿-

ıÂ ÂÚ›ÙˆÛË ÂÍ·ÚÙ¿Ù·È ·fi ÙÔ ÂÚÈ‚¿ÏÏÔÓ ÙˆÓ

Î˘ÙÙ·ÚÔÎÈÓÒÓ ÛÙÔ ÔÔ›Ô ‰Ú· (25). ∂›ÛË˜, ÛÂ ÂÈÚ·-

Ì·ÙÈÎ¿ ÌÔÓÙ¤Ï· Ê¿ÓËÎÂ fiÙÈ Ë IL-18 ˆ˜ ÌÔÓ·‰ÈÎfi˜

·Ú¿ÁÔÓÙ·˜ ÌÔÚÂ› Ó· Â¿ÁÂÈ ÙËÓ ·Ú·ÁˆÁ‹ ÙË˜ IL-

4 Î·È ÙË˜ IL-13 ·fi Ù· Ì·ÛÙÔÎ‡ÙÙ·Ú· Î·È Ù· ‚·ÛÂfi-

ÊÈÏ·, ·˘Í¿ÓÔÓÙ·˜ Ù· Â›Â‰· ÙË˜ πgE, Î·ıÒ˜ Â›ÛË˜

fiÙÈ Ë Î·ıËÌÂÚÈÓ‹ ¯ÔÚ‹ÁËÛ‹ ÙË˜ ÚÔÎ·ÏÂ› ‰ÔÛÔÂ-

Í·ÚÙÒÌÂÓË ·‡ÍËÛË ÙË˜ IgE Â¿ÁÔÓÙ·˜ ÙËÓ ·ÂÏÂ˘-

ı¤ÚˆÛË ÙË˜ IL-4 ·fi Ù· ∆ Î‡ÙÙ·Ú· (25). ∞Ó·ÊÔÚÈÎ¿

ÌÂ ÙÔ ∫∂¡™, ÛÂ ÚÔËÁÔ‡ÌÂÓË ÌÂÏ¤ÙË ÔÈ Matsumoto

Î·È Û˘Ó (26) ‚Ú‹Î·Ó ·˘ÍËÌ¤Ó· Â›Â‰· ÙË˜ IL-18 ÛÂ

ÂÓ‹ÏÈÎÂ˜ ÌÂ ÂÓÂÚÁfi ∫∂¡™. ª¤¯ÚÈ Û‹ÌÂÚ· ‰ÂÓ ˘¿Ú-

¯Ô˘Ó ÂÚÈÛÛfiÙÂÚ· ‰Â‰ÔÌ¤Ó· Û¯ÂÙÈÎ¿ ÌÂ ÙÔÓ ÚfiÏÔ

ÙË˜ IL-18 ÛÙËÓ ·ıÔÁ¤ÓÂÈ· ÙÔ˘ ∫∂¡™.

™Â ÔÚÈÛÌ¤ÓÂ˜ ÌÂÏ¤ÙÂ˜ (16,20), fiˆ˜ Î·È ÛÙËÓ ·-

ÚÔ‡Û·, ¤¯ÂÈ Ê·ÓÂ› fiÙÈ Ù· Â›Â‰· ÙË˜ IgE ÌÔÚÂ› Ó·

Â›Ó·È ·˘ÍËÌ¤Ó· ÛÙ· ·È‰È¿ ÌÂ ÎÔÚÙÈÎÔÂ˘·›ÛıËÙÔ ÓÂ-

ÊÚˆÛÈÎfi Û‡Ó‰ÚÔÌÔ ÛÂ ÔÛÔÛÙfi ¤ˆ˜ 60%, È‰È·›ÙÂÚ·

ÛÙËÓ ÂÓÂÚÁfi Ê¿ÛË ÙË˜ ÓfiÛÔ˘. ∆· ·˘ÍËÌ¤Ó· Â›Â‰·

ıÂˆÚ‹ıËÎ·Ó ·Ú¯ÈÎ¿ ˆ˜ ‰Â›ÎÙË˜ ·ÚÔ˘Û›·˜ ·ÙÔ›·˜

ÛÙ· ·È‰È¿ ·˘Ù¿ (18,19). ∂›ÛË˜, ¿ÏÏÔÈ ÂÚÂ˘ÓËÙ¤˜

¤‰ÂÈÍ·Ó fiÙÈ ÛÂ ·È‰È¿ ÌÂ ∫∂¡™ ˘¿Ú¯ÂÈ ·˘ÍËÌ¤ÓË

¤ÎÊÚ·ÛË ÙÔ˘ CD23+, ÂÈÊ·ÓÂÈ·ÎÔ‡ ÌÔÚ›Ô˘ Ô˘ Â›-

Ó·È Ô ˘Ô‰Ô¯¤·˜ II ÙË˜ IgE ÛÙ· µ Î‡ÙÙ·Ú· (15). ™Â

ÌÂÙ·ÁÂÓ¤ÛÙÂÚÂ˜ ÌÂÏ¤ÙÂ˜ ‚Ú¤ıËÎÂ fiÙÈ ·˘ÍËÌ¤Ó·


¶·È‰È·ÙÚÈÎ‹ 2007;70:192-198


Â›Â‰· IgE Î·È ·˘ÍËÌ¤ÓÔ ÔÛÔÛÙfi CD23+ Î˘ÙÙ¿-ÚˆÓ Â›¯·Ó ÙfiÛÔ Ù· ·ÏÏÂÚÁÈÎ¿ fiÛÔ Î·È Ù· ÌË ·ÏÏÂÚÁÈÎ¿·È‰È¿ ÌÂ ÂÓÂÚÁfi ∫∂¡™ (20). ªÂ Ù· Â˘Ú‹Ì·Ù· ÙˆÓ·Ú·¿Óˆ ÌÂÏÂÙÒÓ Â›Ó·È Û˘Ì‚·Ù¿ Î·È Ù· ·ÔÙÂÏ¤-ÛÌ·Ù· ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜, Û‡ÌÊˆÓ· ÌÂ Ù· ÔÔ›·Ë ·˘ÍËÌ¤ÓË IgE ‰ÂÓ Û¯ÂÙÈ˙fiÙ·Ó ÌÂ ÙÔ ÈÛÙÔÚÈÎfi ·ÙÔ-›·˜ ÛÙ· ·È‰È¿ ÌÂ ∫∂¡™. √È Cheung Î·È Û˘Ó (20)‚Ú‹Î·Ó fiÙÈ Ë ·˘ÍËÌ¤ÓË ·Ú·ÁˆÁ‹ ÙË˜ IgE ÛÙ· ·È‰È¿ÌÂ ∫∂¡™ Û˘Û¯ÂÙÈ˙fiÙ·Ó ÌÂ ·˘ÍËÌ¤ÓË ·Ú·ÁˆÁ‹ ÙË˜IL-13. ™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË ‚Ú¤ıËÎÂ, Â›ÛË˜, ÛÙ·ÙÈ-ÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ Û˘Û¯¤ÙÈÛË ÌÂÙ·Í‡ ÙË˜ IgE Î˘Ú›ˆ˜ ÌÂÙËÓ IL-13. º·›ÓÂÙ·È, ÏÔÈfiÓ, fiÙÈ Ë ·‡ÍËÛË ÙË˜ IgE·ÔÙÂÏÂ› Èı·ÓfiÙ·Ù· ¤Ó· ÂÈÊ·ÈÓfiÌÂÓÔ, ÏfiÁˆ ÙË˜Ù‡Ô˘-2 ·ÓÔÛÈ·Î‹˜ ·¿ÓÙËÛË˜ Ô˘ ˘ÂÚÈÛ¯‡ÂÈ ÛÙËÓÂÓÂÚÁfi Ê¿ÛË ÙÔ˘ ∫∂¡™.

™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, Ù· Â˘Ú‹Ì·Ù· ÙË˜ ·ÚÔ‡Û·˜ÌÂÏ¤ÙË˜ ‰Â›¯ÓÔ˘Ó fiÙÈ ÛÙ· ·È‰È¿ ÌÂ ÂÓÂÚÁfi ∫∂¡™˘ÂÚ¤¯ÂÈ Ë ·ÓÔÛÈ·Î‹ ·¿ÓÙËÛË Ù‡Ô˘-2, Ë ÔÔ›· Â›-Ó·È Èı·Ófi Ó· Â¿ÁÂÙ·È ·fi ÙË Û˘ÓÂÚÁÈÎ‹ ‰Ú¿ÛË ÙˆÓÎ˘ÙÙ·ÚÔÎÈÓÒÓ IL-18 Î·È IL-13. ∏ ·‡ÍËÛË ÙË˜ IgE, ËÔÔ›· ·Ú·ÙËÚÂ›Ù·È ÛÂ ÂÓÂÚÁfi Ê¿ÛË ÙË˜ ÓfiÛÔ˘, Ê·›-ÓÂÙ·È fiÙÈ ‰ÂÓ Û¯ÂÙ›˙ÂÙ·È ÌÂ ÌË¯·ÓÈÛÌfi ·ÙÔ›·˜, ·ÏÏ¿·ÔÙÂÏÂ› ·ÔÙ¤ÏÂÛÌ· ‹ ÂÈÊ·ÈÓfiÌÂÓÔ ÙË˜ Ù‡Ô˘-2·ÓÔÛÈ·Î‹˜ ·¿ÓÙËÛË˜. ªÂÏÏÔÓÙÈÎ¤˜ ÌÂÏ¤ÙÂ˜ ı· Ú›-ÍÔ˘Ó ÂÚÈÛÛfiÙÂÚÔ Êˆ˜ ÛÙ· ·›ÙÈ· ‹/Î·È ÛÙÔ˘˜ ÌË¯·-ÓÈÛÌÔ‡˜ Ô˘ ÚÔÎ·ÏÔ‡Ó ·˘Ù‹ ÙË ÛËÌ·ÓÙÈÎ‹ ·‡ÍËÛËÙˆÓ Ù‡Ô˘-2 Î˘ÙÙ·ÚÔÎÈÓÒÓ.


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21. Stachowski J, Barth C, Michalkiewicz J, Krynicki T, Jar-molinski T, Runowski D et al. Th1/Th2 balance andCD45-positive T cell subsets in primary nephrotic syn-drome. Pediatr Nephrol 2000;14:779-785.

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198 ¡. ¶Ú›ÓÙ˙· Î·È Û˘Ó.



199∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞ ORIGINAL ARTICLE

¶·È‰È·ÙÚÈÎ‹ 2007;70:199-204

∏ ÈÓÙÂÚÏÂ˘Î›ÓË-8 (IL-8) ÙˆÓ Ô‡ÚˆÓ ˆ˜ ‰È·ÁÓˆÛÙÈÎfi˜ ‰Â›ÎÙË˜

ÙË˜ Î˘ÛÙÂÔÔ˘ÚËÙËÚÈÎ‹˜ ·ÏÈÓ‰ÚfiÌËÛË˜ ÛÂ ·È‰È¿ ËÏÈÎ›·˜

Î¿Ùˆ ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜

ª. ªÈÙÛÒÚË1, ∂. °·Ï·Ó¿ÎË˜1, ∂. ¢ËÌËÙÚ›Ô˘1, Ã. °È·ÓÓ·ÎÔÔ‡ÏÔ˘2, ¡.∞. ∫·ÚÎ·‚›ÙÛ·˜3, ª. ∫·ÏÌ·ÓÙ‹1

¶ÂÚ›ÏË„Ë

∂ÈÛ·ÁˆÁ‹: ∏ ‰È¿ÁÓˆÛË ÙË˜ Î˘ÛÙÂÔÔ˘ÚËÙËÚÈÎ‹˜ ·ÏÈÓ‰ÚfiÌËÛË˜ (∫√¶) ‚·Û›˙ÂÙ·È ÛÂ ÂÂÌ‚·ÙÈÎ¤˜ ·ÂÈ-ÎÔÓÈÛÙÈÎ¤˜ ÌÂıfi‰Ô˘˜ Ô˘ Û˘ÓÂ¿ÁÔÓÙ·È ·ÎÙÈÓÔ‚ÔÏ›· Î·È ÛËÌ·ÓÙÈÎfi ÎfiÛÙÔ˜. √ ÛÎÔfi˜ ÙË˜ ·ÚÔ‡Û·˜ ÌÂ-Ï¤ÙË˜ ‹Ù·Ó Ë ÂÎÙ›ÌËÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙË˜ ÈÓÙÂÚÏÂ˘Î›ÓË˜ 8 (IL-8) ÛÙ· Ô‡Ú·, ˆ˜ ÌË ÂÂÌ‚·ÙÈÎÔ‡ ‰Â›ÎÙË∫√¶ ÛÂ ·È‰È¿ ËÏÈÎ›·˜ Î¿Ùˆ ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ªÂÏÂÙ‹ıËÎ·Ó ÔÈ Û˘ÁÎÂÓÙÚÒÛÂÈ˜ ÙË˜ IL-8 ÛÙ· Ô‡Ú· 69 ‚ÚÂÊÒÓ ËÏÈÎ›·˜ ÂÓfi˜ ÌËÓfi˜¤ˆ˜ ÂÓfi˜ ¤ÙÔ˘˜. ∞fi ·˘Ù¿, 37 Â›¯·Ó ÂÈ‚Â‚·ÈˆÌ¤ÓË ∫√¶ ¯ˆÚ›˜ ÚfiÛÊ·ÙË Ô˘ÚÔÏÔ›ÌˆÍË (ÔÌ¿‰· ∞), 13Â›¯·Ó ·Ó·ÌÓËÛÙÈÎfi ·Ô‰Ú·ÌÔ‡Û·˜ Ô˘ÚÔÏÔ›ÌˆÍË˜ ·ÏÏ¿ fi¯È ∫√¶ (ÔÌ¿‰· µ) Î·È Ù· ˘fiÏÔÈ· 19 ‹Û·ÓÂÏÂ‡ıÂÚ· ·Ó·ÌÓËÛÙÈÎÔ‡ ÁÓˆÛÙ‹˜ ÔÍÂ›·˜ ‹ ¯ÚfiÓÈ·˜ ÓfiÛÔ˘ Ô˘ ı· ÌÔÚÔ‡ÛÂ Ó· ÂËÚÂ¿ÛÂÈ ÙË ÓÂÊÚÈÎ‹ÏÂÈÙÔ˘ÚÁ›· (ÔÌ¿‰· °). √È ÙÈÌ¤˜ IL-8 ÌÂÙÚ‹ıËÎ·Ó ÌÂ ELISA Î·È ÌÂÏÂÙ‹ıËÎ·Ó ÌÂÙ¿ ·fi ·Ó·ÁˆÁ‹ ÛÙËÓ ÙÈÌ‹ÙË˜ ÎÚÂ·ÙÈÓ›ÓË˜ ÙˆÓ Ô‡ÚˆÓ.

∞ÔÙÂÏ¤ÛÌ·Ù·: ∆· ‚Ú¤ÊË ÙË˜ ÔÌ¿‰·˜ ∞ Â›¯·Ó ÛËÌ·ÓÙÈÎ¿ ·˘ÍËÌ¤Ó· Â›Â‰· IL-8 ÛÙ· Ô‡Ú· ÛÂ Û¯¤ÛË Ùfi-ÛÔ ÌÂ Ù· ‚Ú¤ÊË ÙË˜ ÔÌ¿‰·˜ µ (p=0,0491) fiÛÔ Î·È ÌÂ ÂÎÂ›Ó· ÙË˜ ÔÌ¿‰·˜ ° (p=0,0095). ∆ÈÌ¤˜ IL-8/ÎÚÂ·-ÙÈÓ›ÓË˜ Ô‡ÚˆÓ >5 mg/Ìmol Â›¯·Ó Â˘·ÈÛıËÛ›· 73% Î·È ÂÈ‰ÈÎfiÙËÙ· 56% ÛÙË ‰È¿ÁÓˆÛË ÙË˜ ∫√¶.

™˘ÌÂÚ¿ÛÌ·Ù·: ∏ ·ÚÔ˘Û›· ·˘ÍËÌ¤ÓˆÓ ÂÈ¤‰ˆÓ IL-8 ÛÙ· Ô‡Ú· ‚ÚÂÊÒÓ ÌÂ ∫√¶ ÌÂÙ¿ ÙËÓ ·Ô‰ÚÔÌ‹ÙË˜ ÂÓÂÚÁÔ‡ ÏÔ›ÌˆÍË˜, ˘Ô‰ÂÈÎÓ‡ÂÈ Û˘ÓÂ¯È˙fiÌÂÓË ÊÏÂÁÌÔÓÒ‰Ë ‰È·‰ÈÎ·Û›· Î·È ÌÔÚÂ› Ó· ¯ÚËÛÈÌÂ‡ÛÂÈˆ˜ ÌË ÂÂÌ‚·ÙÈÎfi˜ ‰Â›ÎÙË˜ ÈÎ·ÓÔÔÈËÙÈÎ‹˜ Â˘·ÈÛıËÛ›·˜ Î·È ÂÈ‰ÈÎfiÙËÙ·˜ ÁÈ· ÙÔÓ ·Ú¯ÈÎfi ·ÓÈ¯ÓÂ˘ÙÈÎfi ¤ÏÂÁ-¯Ô ÙË˜ ∫√¶.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ¢È·ÁÓˆÛÙÈÎ¤˜ ‰ÔÎÈÌ·Û›Â˜, ÈÓÙÂÚÏÂ˘Î›ÓË-8, Î˘ÛÙÂÔÔ˘ÚËÙËÚÈÎ‹ ·ÏÈÓ‰ÚfiÌËÛË, Ô˘ÚÔÏÔ›ÌˆÍË.

Urine interleukin-8 as a marker of vesicoureteral reflux in children

aged under 1 year

M. µitsori1, E. Galanakis1, E. Dimitriou1, C. Giannakopoulou2, N.A. Karkavitsas3, M. Kalmanti1

Abstract

Background: Diagnosis of vesicoureteral reflux (VUR) is based on imaging modalities that are associatedwith radiation, invasiveness and expense. The aim of this study was to assess the urine levels of IL-8 as anon-invasive marker of VUR in children aged under 1 year.

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

Results: The infants in group A had higher urine IL-8 levels than those in groups B (p=0.0491) and C(p=0.0095). Urine IL-8/creatinine concentrations of >5 mg/Ìmol had a sensitivity of 73% and a specificityof 56% for diagnosing VUR.

Conclusions: The findings of this study suggest that urinary IL-8 levels remain increased in infants withVUR after acute UTI has resolved, pointing to an ongoing inflammatory process. Increased urinary IL-8levels may serve as non-invasive marker of adequate sensitivity and specificity for an initial screening forVUR in young infants.

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

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

1 ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹,°ÂÓÈÎfi ¶·ÓÂÈÛÙËÌÈ·Îfi¡ÔÛÔÎÔÌÂ›Ô ∏Ú·ÎÏÂ›Ô˘

2 ¡ÂÔÁÓÔÏÔÁÈÎ‹ ∫ÏÈÓÈÎ‹,°ÂÓÈÎfi ¶·ÓÂÈÛÙËÌÈ·Îfi¡ÔÛÔÎÔÌÂ›Ô ∏Ú·ÎÏÂ›Ô˘

3 ∆Ì‹Ì· ¶˘ÚËÓÈÎ‹˜π·ÙÚÈÎ‹˜, ¶·ÓÂÈÛÙËÌÈ·Îfi°ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô∏Ú·ÎÏÂ›Ô˘


∂ÌÌ·ÓÔ˘‹Ï °·Ï·Ó¿ÎË˜, [email protected]∆ÔÌ¤·˜ ªËÙ¤Ú·˜ ¶·È‰ÈÔ‡,∆Ì‹Ì· π·ÙÚÈÎ‹˜, ¶·ÓÂÈÛÙ‹ÌÈÔ ∫Ú‹ÙË˜, ∆.£. 2208, T.K. 71003, ∏Ú¿ÎÏÂÈÔ

1 Paediatrics Department,University GeneralHospital of Heraklion,Crete

2 Neonatal Department,University GeneralHospital of Heraklion,Crete

3 Nuclear MedicineDepartment, UniversityGeneral Hospital ofHeraklion, Crete

Correspondence:

Emmanouil Galanakis, [email protected] of Crete, Faculty of MedicineDivision of Mother andChild Medicine, PO Box 2208, 71003, Heraklion, Crete


∂ÈÛ·ÁˆÁ‹

∏ Î˘ÛÙÂÔÔ˘ÚËÙËÚÈÎ‹ ·ÏÈÓ‰ÚfiÌËÛË (∫√¶) Â›-

Ó·È Û˘¯Ófi Â‡ÚËÌ· ÛÂ ·È‰È¿ ÌÂ Ô˘ÚÔÏÔÈÌÒÍÂÈ˜, ÛÂ

ÓÂÔÁÓ¿ ÌÂ ÚÔÁÂÓÓËÙÈÎ‹ ˘‰ÚÔÓ¤ÊÚˆÛË Î·È ÛÂ Û˘Á-

ÁÂÓÂ›˜ ·Û¯fiÓÙˆÓ ·fi ∫√¶ (1). ∏ ¤ÁÎ·ÈÚË ‰È¿ÁÓˆ-

Û‹ ÙË˜, ÚÈÓ ÙÔ ÚÒÙÔ ÂÂÈÛfi‰ÈÔ Ô˘ÚÔÏÔ›ÌˆÍË˜ - ·Ó

ÚfiÎÂÈÙ·È ÁÈ· ∫√¶ ÌÂÁ¿ÏÔ˘ ‚·ıÌÔ‡ - Â›Ó·È È‰È·›ÙÂ-

Ú· ÛËÌ·ÓÙÈÎ‹ ÁÈ· ÙËÓ ÚfiÏË„Ë ÙË˜ ÓÂÊÚÔ¿ıÂÈ·˜

·fi ·ÏÈÓ‰ÚfiÌËÛË, Ë ÔÔ›· ıÂˆÚÂ›Ù·È ¤Ó· ·fi Ù·

ÛËÌ·ÓÙÈÎfiÙÂÚ· ·›ÙÈ· ˘¤ÚÙ·ÛË˜ Î·È ÓÂÊÚÈÎ‹˜ ·ÓÂ-

¿ÚÎÂÈ·˜ ÛÙ· ·È‰È¿ (2,3). ∏ ∫√¶ Â˘ÓÔÂ› ÙËÓ ·ÓÈ-

Ô‡Û· ÏÔ›ÌˆÍË Î·È ÙË ÌÂÙ·ÊÔÚ¿ ÙË˜ ÂÓ‰ÔÎ˘ÛÙÈÎ‹˜

›ÂÛË˜ ÛÙÔ˘˜ ÓÂÊÚÔ‡˜, ˆÛÙfiÛÔ ÔÈ ·ÎÚÈ‚Â›˜ ÌË¯·ÓÈ-

ÛÌÔ› Ô˘ Ô‰ËÁÔ‡Ó ·fi ÙËÓ ∫√¶ Î·È ÙËÓ Ô˘ÚÔÏÔ›-

ÌˆÍË ÛÙË ÓÂÊÚÈÎ‹ ·ÚÂÁ¯˘Ì·ÙÈÎ‹ ‚Ï¿‚Ë Î·È ÙË

¯ÚfiÓÈ· ÓÂÊÚÈÎ‹ ÓfiÛÔ ‰ÂÓ Â›Ó·È ·ÎfiÌË Ï‹Úˆ˜ Î·Ù·-

ÓÔËÙÔ› (4-6). ∏ ·Ó›¯ÓÂ˘ÛË ÙË˜ ∫√¶ Î·È ÙË˜ ÓÂÊÚÈ-

Î‹˜ Ô˘Ï‹˜ ‚·Û›˙ÂÙ·È Â› ÙÔ˘ ·ÚfiÓÙÔ˜ ÛÂ ÂÂÌ‚·ÙÈ-

Î¤˜ ·ÂÈÎÔÓÈÛÙÈÎ¤˜ ÌÂıfi‰Ô˘˜ Ô˘ ÂÈ‚·Ú‡ÓÔ˘Ó ÙÔÓ

·ÛıÂÓ‹ ÌÂ ·ÎÙÈÓÔ‚ÔÏ›· Î·È ¤¯Ô˘Ó ˘ÔÏÔÁ›ÛÈÌÔ Îfi-

ÛÙÔ˜ (1,6-7). ∂ÂÈ‰‹ ÛËÌ·ÓÙÈÎfi˜ ·ÚÈıÌfi˜ ·È‰ÈÒÓ

˘Ô‚¿ÏÏÂÙ·È ÛÂ ÂÎÙÂÙ·Ì¤ÓÔ ·ÂÈÎÔÓÈÛÙÈÎfi ¤ÏÂÁ¯Ô,

Ë ·ÓÂ‡ÚÂÛË ÌË ÂÂÌ‚·ÙÈÎÒÓ ÌÂıfi‰ˆÓ ·Ó›¯ÓÂ˘ÛË˜

ÙË˜ ∫√¶ ı· ‰ÈÂ˘ÎfiÏ˘ÓÂ ÛËÌ·ÓÙÈÎ¿ ÙË ‰È·ÁÓˆÛÙÈÎ‹

ÙË˜ ÚÔÛ¤ÁÁÈÛË. √È ‰Â›ÎÙÂ˜ ·˘ÙÔ› ı· ÌÔÚÔ‡Û·Ó Ó·

·Ô‰ÂÈ¯ÙÔ‡Ó ¯Ú‹ÛÈÌÔÈ Î·È ÁÈ· ÙÔÓ ÚÔÏËÙÈÎfi ¤ÏÂÁ-

¯Ô, ÛÙÔÓ ÔÔ›Ô Û˘ÓÈÛÙ¿Ù·È Ó· ˘Ô‚ÏËıÔ‡Ó Ù· ·‰¤Ï-

ÊÈ· Î·È Ù· ·È‰È¿ ÙˆÓ ·ÙfiÌˆÓ ÌÂ ∫√¶, Î·ıÒ˜ Î·È Ù·

‚Ú¤ÊË ÛÙ· ÔÔ›· ¤¯ÂÈ ‰È·ÁÓˆÛÙÂ› ˘‰ÚÔÓ¤ÊÚˆÛË

ÚÔÁÂÓÓËÙÈÎ¿ (2,8).

∆Ô ÂÈı‹ÏÈÔ ÙÔ˘ Ô˘ÚÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜,

ÂÎÙfi˜ ÙÔ˘ fiÙÈ ·ÔÙÂÏÂ› Ê˘ÛÈÎfi ÊÚ·ÁÌfi ¤Ó·ÓÙÈ ÙˆÓ

ÌÈÎÚÔÔÚÁ·ÓÈÛÌÒÓ, ‰È·‰Ú·Ì·Ù›˙ÂÈ Î·È ÂÓÂÚÁfi ·Ì˘ÓÙÈ-

Îfi ÚfiÏÔ ÌÂ ÙËÓ ·Ú·ÁˆÁ‹ ̄ ËÌÂÈÔÎÈÓÒÓ Î·È Î˘ÙÙ·ÚÔ-

ÎÈÓÒÓ, Ô˘ Ú˘ıÌ›˙Ô˘Ó ÙËÓ ·ÓÙ›‰Ú·ÛË ÛÙË ÏÔ›ÌˆÍË

(9). ∏ ÊÏÂÁÌÔÓÒ‰Ë˜ ·˘Ù‹ ‰È·‰ÈÎ·Û›· ‰È·‰Ú·Ì·Ù›˙ÂÈ

ÌÂ ÙË ÛÂÈÚ¿ ÙË˜ ÎÂÓÙÚÈÎfi ÚfiÏÔ ÛÙË ‰ËÌÈÔ˘ÚÁ›· ÓÂ-

ÊÚÈÎ‹˜ ·ÚÂÁ¯˘Ì·ÙÈÎ‹˜ ‚Ï¿‚Ë˜. ¶ÔÏ‡ Ï›Á· Â›Ó·È

ÁÓˆÛÙ¿ ÁÈ· ÙÔÓ ÚfiÏÔ ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ ÌÂÙ¿ ÙËÓ

·Ô‰ÚÔÌ‹ ÙË˜ ÔÍÂ›·˜ ÏÔ›ÌˆÍË˜ (6,10-15). ∞Ó·˙ËÙÒ-

ÓÙ·˜ ÌË ÂÂÌ‚·ÙÈÎÔ‡˜ ‰Â›ÎÙÂ˜ ∫√¶, ÚÔÛ‰ÈÔÚ›Û·-

ÌÂ ÙÈ˜ Û˘ÁÎÂÓÙÚÒÛÂÈ˜ ÛÙ· Ô‡Ú· ÙË˜ Î˘ÙÙ·ÚÔÎ›ÓË˜-

¯ËÌÂÈÔÎ›ÓË˜ ÈÓÙÂÚÏÂ˘Î›ÓË˜-8 (IL-8) ÛÂ ‚Ú¤ÊË ÌÂ ·-

ÏÈÓ‰ÚfiÌËÛË ¯ˆÚ›˜ ÚfiÛÊ·ÙË Ô˘ÚÔÏÔ›ÌˆÍË. ∏ IL-8,

ÚÔ-ÊÏÂÁÌÔÓÒ‰Ë˜ ‰È·ÌÂÛÔÏ·‚ËÙ‹˜ Î·È ¯ËÌÂÈÔÙ·-

ÎÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÙˆÓ Ô˘‰ÂÙÂÚfiÊÈÏˆÓ, ·Ú¿ÁÂÙ·È

·fi Ù· ÂÈıËÏÈ·Î¿ Î‡ÙÙ·Ú· ÙÔ˘ Ô˘ÚÔÔÈËÙÈÎÔ‡ ˆ˜

·¿ÓÙËÛË ÛÂ ÊÏÂÁÌÔÓÒ‰Ë ÂÚÂı›ÛÌ·Ù·. √ Ú˘ıÌÈÛÙÈ-

Îfi˜ ÙË˜ ÚfiÏÔ˜ ÛÙË ‰È·‰ÚÔÌ‹ ÙË˜ ÔÍÂ›·˜ ÏÔ›ÌˆÍË˜

ÙÔ˘ Ô˘ÚÔÔÈËÙÈÎÔ‡ ¤¯ÂÈ ÂÈÛËÌ·ÓıÂ› ·fi ÌÂÏ¤ÙÂ˜

ÌÂ ÚÔÎÏËÙ‹ ˘ÂÏÔÓÂÊÚ›ÙÈ‰·, Û‡ÌÊˆÓ· ÌÂ ÙÈ˜

ÔÔ›Â˜ ÂÈÚ·Ì·Ùfi˙ˆ· ÌÂ Â·ÁfiÌÂÓË ·‰˘Ó·Ì›· ·-

Ú·ÁˆÁ‹˜ IL-8 ·ÚÔ˘Û›·Û·Ó ·˘ÍËÌ¤ÓË ‚·Ú‡ÙËÙ·

ÏÔ›ÌˆÍË˜ Î·È ÛÔ‚·Ú¤˜ ÓÂÊÚÈÎ¤˜ ·ÚÂÁ¯˘Ì·ÙÈÎ¤˜

‚Ï¿‚Â˜ (16). ∞˘ÍËÌ¤Ó· Â›Â‰· IL-8 ¤¯Ô˘Ó ‹‰Ë ‰È·-

ÈÛÙˆıÂ› ÛÙ· Ô‡Ú· ·ÛıÂÓÒÓ ÌÂ ÔÍÂ›· Ô˘ÚÔÏÔ›ÌˆÍË

(8,12-13,15,17-21).


∞ÛıÂÓÂ›˜

∆· Â›Â‰· IL-8 ÚÔÛ‰ÈÔÚ›ÛÙËÎ·Ó ÛÙ· Ô‡Ú· 69 ‚ÚÂÊÒÓ

ËÏÈÎ›·˜ 1 ÌËÓfi˜ ¤ˆ˜ 1 ¤ÙÔ˘˜. ŸÏ· Ù· ·È‰È¿ Ô˘ Û˘ÌÂÚÈÏ‹-

ÊıËÎ·Ó ÛÙË ÌÂÏ¤ÙË ‹Ù·Ó ÂÏÂ‡ıÂÚ· Ô˘ÚÔÏÔ›ÌˆÍË˜ ÁÈ· ÙÚÂÈ˜

ÙÔ˘Ï¿¯ÈÛÙÔÓ Â‚‰ÔÌ¿‰Â˜, fiˆ˜ Î·ıÔÚ›ÛÙËÎÂ ·fi ÙËÓ ÎÏÈÓÈÎ‹

ÙÔ˘˜ ÂÈÎfiÓ·, ÙÈ˜ Ê˘ÛÈÔÏÔÁÈÎ¤˜ ÙÈÌ¤˜ ÙˆÓ ÏÂ˘ÎÒÓ ·ÈÌÔÛÊ·È-

Ú›ˆÓ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜, ÙË˜ Ù·¯‡ÙËÙ·˜ Î·ı›˙ËÛË˜ ÂÚ˘-

ıÚÒÓ Î·È C-·ÓÙÈ‰ÚÒÛ·˜ ÚˆÙÂ˝ÓË˜ Î·ıÒ˜ Î·È ·fi ÙË Ê˘ÛÈÔ-

ÏÔÁÈÎ‹ ÌÈÎÚÔÛÎÔÈÎ‹ ÂÍ¤Ù·ÛË Î·È Î·ÏÏÈ¤ÚÁÂÈ· Ô‡ÚˆÓ (11-

13). ∏ ‰È¿ÁÓˆÛË ÙË˜ Ô˘ÚÔÏÔ›ÌˆÍË˜ ‚·Û›ÛÙËÎÂ ÛÙËÓ ·ÚÔ˘-

Û›· ‚·ÎÙËÚÈÔ˘Ú›·˜, Ë ÔÔ›· ÔÚ›ÛÙËÎÂ ˆ˜ ÔÔÈ·‰‹ÔÙÂ ·Ó¿-

Ù˘ÍË ‚·ÎÙËÚ›ˆÓ ÛÂ Î·ÏÏÈ¤ÚÁÂÈ· ‰Â›ÁÌ·ÙÔ˜ Ô‡ÚˆÓ ·fi ˘Â-

ÚË‚ÈÎ‹ ·Ú·Î¤ÓÙËÛË, ÌÔÓÔ·Ó¿Ù˘ÍË ÙÔ˘Ï¿¯ÈÛÙÔÓ 105 ‚·-

ÎÙËÚ›ˆÓ/ml ÛÂ Î·ÏÏÈ¤ÚÁÂÈ· ‰‡Ô ‰È·‰Ô¯ÈÎÒÓ ‰ÂÈÁÌ¿ÙˆÓ Ô‡-

ÚˆÓ ‹ ·Ó¿Ù˘ÍË ÙÔ˘Ï¿¯ÈÛÙÔÓ 104 ‚·ÎÙËÚ›ˆÓ/ml ÛÂ Î·ÏÏÈ¤Ú-

ÁÂÈ· ‰Â›ÁÌ·ÙÔ˜ Ô‡ÚˆÓ ·fi Î·ıÂÙËÚÈ·ÛÌfi ÙË˜ Î‡ÛÙË˜. ∆·

‚Ú¤ÊË Ù·ÍÈÓÔÌ‹ıËÎ·Ó ÛÂ 3 ÔÌ¿‰Â˜: ÔÌ¿‰· ∞, ‚Ú¤ÊË ÌÂ ·Ô-

‰Â‰ÂÈÁÌ¤ÓË ∫√¶ (37 ‚Ú¤ÊË ËÏÈÎ›·˜ 0,13 ¤ˆ˜ 0,99 ÂÙÒÓ, ‰È¿-

ÌÂÛË ÙÈÌ‹ 0,36), ÔÌ¿‰· µ, ‚Ú¤ÊË ÌÂ ·Ó·ÌÓËÛÙÈÎfi Ô˘ÚÔÏÔ›-

ÌˆÍË˜, ·ÏÏ¿ ·ÚÓËÙÈÎfi ¤ÏÂÁ¯Ô ÁÈ· ∫√¶ (13 ‚Ú¤ÊË ËÏÈÎ›·˜

0,24 ¤ˆ˜ 0,70 ÂÙÒÓ, ‰È¿ÌÂÛË ÙÈÌ‹ 0,39), Î·È ÔÌ¿‰· °, ‚Ú¤ÊË

¯ˆÚ›˜ ·Ó·ÌÓËÛÙÈÎfi ÁÓˆÛÙ‹˜ ÔÍÂ›·˜ ‹ ¯ÚfiÓÈ·˜ Î·Ù¿ÛÙ·ÛË˜

Ô˘ ı· ÌÔÚÔ‡ÛÂ Ó· ÂËÚÂ¿ÛÂÈ ÙË ÓÂÊÚÈÎ‹ ÏÂÈÙÔ˘ÚÁ›· (19

‚Ú¤ÊË ËÏÈÎ›·˜ 0,08 ¤ˆ˜ 0,96 ÂÙÒÓ, ‰È¿ÌÂÛË ÙÈÌ‹ 0,28). ∏ ÌÂ-

Ï¤ÙË ÂÁÎÚ›ıËÎÂ ·fi ÙËÓ ∂ÈÙÚÔ‹ ¢ÂÔÓÙÔÏÔÁ›·˜ ÙÔ˘ ∂È-

ÛÙËÌÔÓÈÎÔ‡ ™˘Ì‚Ô˘Ï›Ô˘ ÙÔ˘ ¡ÔÛÔÎÔÌÂ›Ô˘.

∂ÚÂ˘ÓËÙÈÎfi ÚˆÙfiÎÔÏÏÔ

∆· ‰Â›ÁÌ·Ù· ·fi Ù· ‚Ú¤ÊË ÙˆÓ ÔÌ¿‰ˆÓ ∞ Î·È µ Û˘ÁÎÂ-

ÓÙÚÒıËÎ·Ó Î·Ù¿ ÙË ‰ÈÂÓ¤ÚÁÂÈ· ÙÔ˘ ·ÂÈÎÔÓÈÛÙÈÎÔ‡ ÂÏ¤Á¯Ô˘

ÌÂÙ¿ ·fi ·Ô‰Â‰ÂÈÁÌ¤ÓË Ô˘ÚÔÏÔ›ÌˆÍË ‹ ÌÂÙ¿ ·fi ‰È·›-

ÛÙˆÛË ÚÔÁÂÓÓËÙÈÎ‹˜ ˘‰ÚÔÓ¤ÊÚˆÛË˜. ∆Ô ˘ÂÚË¯ÔÁÚ¿ÊËÌ·

ÓÂÊÚÒÓ ¤ÁÈÓÂ Î·Ù¿ ÙËÓ ÚÒÙË Â‚‰ÔÌ¿‰· ·fi ÙË ‰È¿ÁÓˆÛË

ÙË˜ Ô˘ÚÔÏÔ›ÌˆÍË˜. ∏ ·ÚÔ˘Û›· Î·È Ô ‚·ıÌfi˜ ∫√¶ ÚÔÛ‰ÈÔ-

Ú›ÛÙËÎ·Ó ÌÂ ÎÏ·ÛÈÎ‹ ·ÓÈÔ‡Û· Î˘ÛÙÂÔ-Ô˘ÚËıÚÔÁÚ·Ê›· Î·Ù¿

ÙËÓ Ô‡ÚËÛË, Ô˘ Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ 6-8 Â‚‰ÔÌ¿‰Â˜ ÌÂÙ¿ ÙË

ÏÔ›ÌˆÍË. ∏ ·ÏÈÓ‰ÚfiÌËÛË ‚·ıÌÔÏÔÁ‹ıËÎÂ ·fi 0-V Û‡ÌÊˆ-

Ó· ÌÂ ÙË ¢ÈÂıÓ‹ ∂ÈÙÚÔ‹ ÁÈ· ÙË ªÂÏ¤ÙË ÙË˜ ¶·ÏÈÓ‰ÚfiÌË-

ÛË˜ (International Reflux Study Committee) (1,22). ™Â ÂÚ›-

ÙˆÛË ·ÌÊÔÙÂÚfiÏÂ˘ÚË˜ ·ÏÈÓ‰ÚfiÌËÛË˜, ·Ó·Ê¤ÚÂÙ·È Ô

·ÓÙ›ÛÙÔÈ¯Ô˜ ·ıÚÔÈÛÙÈÎfi˜ ·ÚÈıÌfi˜. ∏ ·ÚÔ˘Û›· Î·È ÙÔ Ì¤ÁÂ-

ıÔ˜ ÙˆÓ ÓÂÊÚÈÎÒÓ ·ÚÂÁ¯˘Ì·ÙÈÎÒÓ ‚Ï·‚ÒÓ ÚÔÛ‰ÈÔÚ›ÛÙËÎÂ

3-6 Ì‹ÓÂ˜ ÌÂÙ¿ ÙË ÏÔ›ÌˆÍË ÌÂ ÛÈÓıËÚÔÁÚ¿ÊËÌ· ÌÂ ‰ÈÌÂÚ-

Î·ÙÔÛÔ˘ÎÎÈÓÈÎfi ÔÍ‡ ÛËÌ·ÛÌ¤ÓÔ ÌÂ ÙÂ¯Ó‹ÙÈÔ 99m (DMSA).

ø˜ ÓÂÊÚÈÎ‹ ·ÚÂÁ¯˘Ì·ÙÈÎ‹ ‚Ï¿‚Ë ÔÚ›ÛÙËÎÂ ÙÔ ÂÛÙÈ·Îfi ‹ Ô-

Ï˘ÂÛÙÈ·Îfi ¤ÏÏÂÈÌÌ· Ï‹ÚˆÛË˜ ‹ Ë Û¯ÂÙÈÎ‹ ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ·

Î¿Ùˆ ·fi 45%. ∏ ÓÂÊÚÈÎ‹ Ô˘Ï‹ ÔÚ›ÛÙËÎÂ ˆ˜ ¤ÏÏÂÈÌÌ· ÛÙÔ

Ê˘ÛÈÔÏÔÁÈÎfi ÓÂÊÚÈÎfi ÂÚ›ÁÚ·ÌÌ· (1,23). ∏ ÔÌ¿‰· ° ÂÚÈÂ-

Ï¿Ì‚·ÓÂ ‚Ú¤ÊË ÂÏÂ‡ıÂÚ· ·Ó·ÌÓËÛÙÈÎÔ‡ Ô˘ÚÔÏÔ›ÌˆÍË˜ ‹ ¿Ï-

ÏË˜ ÁÓˆÛÙ‹˜ ˘ÔÎÂ›ÌÂÓË˜ Î·Ù¿ÛÙ·ÛË˜ Ô˘ ı· ÌÔÚÔ‡ÛÂ Ó·

ÂËÚÂ¿ÛÂÈ ÙË ÓÂÊÚÈÎ‹ ÏÂÈÙÔ˘ÚÁ›·.

¶ÚÔÛ‰ÈÔÚÈÛÌfi˜ IL-8

™ÙË ÌÂÏ¤ÙË ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ˘ÔÏÂÈÌÌ·ÙÈÎ¿ ‰Â›ÁÌ·Ù·

Ô‡ÚˆÓ ·fi ·˘Ù¿ Ô˘ Â›¯·Ó ÏËÊıÂ› ÁÈ· ÙÔÓ Û˘Ó‹ıË ¤ÏÂÁ¯Ô

200 ª. ªÈÙÛÒÚË Î·È Û˘Ó.



ÙˆÓ ‚ÚÂÊÒÓ. ∆· ‰Â›ÁÌ·Ù· Î·Ù·„‡¯ıËÎ·Ó ÛÙÔ˘˜ -70ÔC ¯ˆÚ›˜ÚÔËÁÔ‡ÌÂÓË Ê˘ÁÔÎ¤ÓÙÚËÛË Î·È ·Ô„‡¯ıËÎ·Ó ÚÈÓ ÙÔÓÚÔÛ‰ÈÔÚÈÛÌfi ÙË˜ IL-8. √È Û˘ÁÎÂÓÙÚÒÛÂÈ˜ ÙË˜ IL-8 ÌÂÙÚ‹ıË-Î·Ó ÌÂ ÔÛÔÙÈÎ‹ Ì¤ıÔ‰Ô ELISA (quantitative sandwichenzyme-linked immunosorbent assay, R&D systems,Abingdon, UK). ŸÏÂ˜ ÔÈ ÌÂÙÚ‹ÛÂÈ˜ ¤ÁÈÓ·Ó ÂÈ˜ ‰ÈÏÔ‡Ó. ™‡Ì-ÊˆÓ· ÌÂ ÙÔÓ Î·Ù·ÛÎÂ˘·ÛÙ‹, ÙÔ Î·ÙÒÙÂÚÔ fiÚÈÔ ·Ó›¯ÓÂ˘ÛË˜ÁÈ· ÙËÓ IL-8 ‹Ù·Ó <10 pg/mL. ¶ÚÔÎÂÈÌ¤ÓÔ˘ Ó· ·ÔÊÂ˘¯ıÔ‡ÓÂÈ‰Ú¿ÛÂÈ˜ ÙË˜ Û˘Ì‡ÎÓˆÛË˜ ÙˆÓ Ô‡ÚˆÓ ÛÙËÓ ÙÈÌ‹ ÙË˜ IL-8,Ù· Â›Â‰· IL-8 ÂÎÊÚ¿ÛÙËÎ·Ó ˆ˜ ÏfiÁÔ˜ IL-8/ ÎÚÂ·ÙÈÓ›ÓË Ô‡-ÚˆÓ (pg/Ìmol ÎÚÂ·ÙÈÓ›ÓË˜) (6,11,17).

™Ù·ÙÈÛÙÈÎ‹

°È· ÙËÓ ·Ó¿Ï˘ÛË ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÔÈ ÌË ·Ú·ÌÂÙÚÈÎ¤˜‰ÔÎÈÌ·Û›Â˜ Kruskal-Wallis Î·È Mann-Whitney Î·È Ë ‰ÔÎÈÌ·-Û›· Û˘Û¯¤ÙÈÛË˜ Spearman. ™Â fiÏÂ˜ ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ ÂÊ·ÚÌfi-ÛÙËÎÂ ÙÔ Û˘Ì‚·ÙÈÎfi Â›Â‰Ô ÛËÌ·ÓÙÈÎfiÙËÙ·˜ p<0,05.


∆· ‚Ú¤ÊË ÛÙÈ˜ ÔÌ¿‰Â˜ ∞ Î·È µ ‹Ù·Ó ÂÏÂ‡ıÂÚ· Ô˘-ÚÔÏÔ›ÌˆÍË˜ ÁÈ· ‰È¿ÛÙËÌ· 3 ¤ˆ˜ 48 (‰È¿ÌÂÛË ÙÈÌ‹ 5)Â‚‰ÔÌ¿‰ˆÓ Î·È 3 ¤ˆ˜ 10,3 (‰È¿ÌÂÛË ÙÈÌ‹ 5) Â‚‰ÔÌ¿-‰ˆÓ, ·ÓÙ›ÛÙÔÈ¯·, ÚÈÓ ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙË˜ IL-8.¢ÂÓ ·Ú·ÙËÚ‹ıËÎÂ ÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿ ˆ˜ ÚÔ˜ ÙÔÓÂÏÂ‡ıÂÚÔ Ô˘ÚÔÏÔ›ÌˆÍË˜ ¯ÚfiÓÔ ·Ó¿ÌÂÛ· ÛÙÈ˜ ‰‡ÔÔÌ¿‰Â˜ (p=0,460). ∆· 35 ·fi Ù· 37 ‚Ú¤ÊË ÙË˜ ÔÌ¿-‰·˜ ∞ Â›¯·Ó ·ÚÔ˘ÛÈ¿ÛÂÈ ÂÂÈÛfi‰ÈÔ Ô˘ÚÔÏÔ›ÌˆÍË˜ÚÈÓ ÙË ‰È·›ÛÙˆÛË ÙË˜ ∫√¶. ™Â 2 ‚Ú¤ÊË ËÏÈÎ›·˜ 3ÌËÓÒÓ, Ë ∫√¶ Â›¯Â ‰È·ÁÓˆÛıÂ› ÛÙ· Ï·›ÛÈ· ‰ÈÂÚÂ‡-ÓËÛË˜ ÚÔÁÂÓÓËÙÈÎ‹˜ ˘‰ÚÔÓ¤ÊÚˆÛË˜ Î·È Î·Ó¤Ó·ÂÂÈÛfi‰ÈÔ Ô˘ÚÔÏÔ›ÌˆÍË˜ ‰ÂÓ Â›¯Â ÙÂÎÌËÚÈˆıÂ› ¤ˆ˜ÙÔÓ ¯ÚfiÓÔ ÙË˜ ÌÂÏ¤ÙË˜. ™ÙËÓ ÔÌ¿‰· ∞, Ë ·ÏÈÓ‰Úfi-ÌËÛË ‹Ù·Ó ‰ÂÍÈ¿ ÛÂ 10 ‚Ú¤ÊË, ·ÚÈÛÙÂÚ¿ ÛÂ 10 Î·È·ÌÊÔÙÂÚfiÏÂ˘ÚË ÛÂ 17. ¡ÂÊÚÈÎ‹ ·ÚÂÁ¯˘Ì·ÙÈÎ‹‚Ï¿‚Ë ÙÂÎÌËÚÈÒıËÎÂ ÛÂ 20 ‚Ú¤ÊË ÙË˜ ÔÌ¿‰·˜ ∞ Î·ÈÛÂ Î·Ó¤Ó· ·fi Ù· ‚Ú¤ÊË ÙË˜ ÔÌ¿‰·˜ µ.

√È ÙÈÌ¤˜ ÎÚÂ·ÙÈÓ›ÓË˜ Ô‡ÚˆÓ ‰ÂÓ ‰È¤ÊÂÚ·Ó ÛËÌ·-ÓÙÈÎ¿ ÌÂÙ·Í‡ ÙˆÓ ÔÌ¿‰ˆÓ ∞, µ Î·È ° (‰È¿ÌÂÛÂ˜ ÙÈÌ¤˜1,06, 1,5 Î·È 1,15 Ìmol/mL ·ÓÙ›ÛÙÔÈ¯·, p=0,070). √È‰È¿ÌÂÛÂ˜ ÙÈÌ¤˜ IL-8/ÎÚÂ·ÙÈÓ›ÓË (pg/Ìmol) ‹Ù·Ó16,97 (0,00-3.874) ÛÙËÓ ÔÌ¿‰· ∞, 4,47 (0,01-386)ÛÙËÓ ÔÌ¿‰· µ Î·È 4,19 (0,00-55,6) ÛÙËÓ ÔÌ¿‰· ° (∂È-ÎfiÓ· 1). √È ÙÈÌ¤˜ IL-8/ÎÚÂ·ÙÈÓ›ÓË ‹Ù·Ó ÛËÌ·ÓÙÈÎ¿˘„ËÏfiÙÂÚÂ˜ ÛÙËÓ ÔÌ¿‰· ∞ ÙfiÛÔ ÛÂ Û¯¤ÛË ÌÂ ÙËÓÔÌ¿‰· µ (p=0,0491) fiÛÔ Î·È ÛÂ Û¯¤ÛË ÌÂ ÙËÓ ÔÌ¿‰·° (p=0,0095), ¯ˆÚ›˜ Ó· ·Ú·ÙËÚËıÂ› ÛËÌ·ÓÙÈÎ‹ ‰È·-ÊÔÚ¿ ÌÂÙ·Í‡ ÙË˜ ÔÌ¿‰·˜ µ Î·È ÙË˜ ÔÌ¿‰·˜ °(p=0,759). ™ÙËÓ ÔÌ¿‰· ∞ ‰ÂÓ Î·Ù·‰Â›¯ÙËÎ·Ó ÛËÌ·-ÓÙÈÎ¤˜ Û˘Û¯ÂÙ›ÛÂÈ˜ ·fi ÙËÓ ·Ó¿Ï˘ÛË ÙˆÓ ÙÈÌÒÓ IL-8/ÎÚÂ·ÙÈÓ›ÓË ÛÂ Û¯¤ÛË ÌÂ ÙËÓ ·ÚÔ˘Û›· ÓÂÊÚÈÎ‹˜ ·-ÚÂÁ¯˘Ì·ÙÈÎ‹˜ ‚Ï¿‚Ë˜ (p=0,272), ÓÂÊÚÈÎ‹˜ Ô˘Ï‹˜(p=0,266), ‹ ÌÂ ÙÔÓ ‚·ıÌfi ÙË˜ ·ÏÈÓ‰ÚfiÌËÛË˜(Spearman r=-0,049, p=0,775) ‹ ÙÔÓ ¯ÚfiÓÔ Ô˘ ÌÂÛÔ-Ï¿‚ËÛÂ ·fi ÙËÓ ÙÂÏÂ˘Ù·›· Ô˘ÚÔÏÔ›ÌˆÍË (Spearmanr=-0,091, p=0,601).

™ÙËÓ ∂ÈÎfiÓ· 2 ·ÚÔ˘ÛÈ¿˙ÂÙ·È Ë Î·Ì‡ÏË Ù‡Ô˘

ROC (receiver-operator curve) Ô˘ ÚÔ¤Î˘„Â ·fi

ÙËÓ ·ÂÈÎfiÓÈÛË ÙË˜ Â˘·ÈÛıËÛ›·˜ Î·È ÙË˜ ÂÈ‰ÈÎfiÙËÙ·˜

ÛÂ ‰È·ÊÔÚÂÙÈÎ¤˜ ÙÈÌ¤˜ ÙÔ˘ ÏfiÁÔ˘ IL-8/ÎÚÂ·ÙÈÓ›ÓË

ÛÙ· Ô‡Ú·. ∞fi ÙËÓ Î·Ì‡ÏË ÚÔÎ‡ÙÂÈ fiÙÈ ÛÙËÓ ÙÈÌ‹

5 pg/Ìmol ÙÔ˘ ÏfiÁÔ˘ IL-8/ÎÚÂ·ÙÈÓ›ÓË, Ë Â˘·ÈÛıËÛ›·

·˘ÙÔ‡ ÙÔ˘ ‰Â›ÎÙË ÛÙË ‰È¿ÁÓˆÛË ÙË˜ ∫√¶ Â›Ó·È 73%

Î·È Ë ÂÈ‰ÈÎfiÙËÙ· Â›Ó·È 56%. °È· ÙËÓ ›‰È· ÙÈÌ‹ IL-

8/ÎÚÂ·ÙÈÓ›ÓË, Ë ıÂÙÈÎ‹ ÚÔÁÓˆÛÙÈÎ‹ ·Í›· ˘ÔÏÔÁ›-

ÛÙËÎÂ ÛÂ 66% Î·È Ë ·ÚÓËÙÈÎ‹ ÚÔÁÓˆÛÙÈÎ‹ ·Í›· ÛÂ

64%. ªÂ ÙÔÓ ‰È·ÁÓˆÛÙÈÎfi Ô˘‰fi ÛÙËÓ ÙÈÌ‹ 10

pg/Ìmol ÙÔ˘ ÏfiÁÔ˘ IL-8/ÎÚÂ·ÙÈÓ›ÓË ÛÙ· Ô‡Ú·, Ë Â˘-

·ÈÛıËÛ›· ·˘ÙÔ‡ ÙÔ˘ ‰Â›ÎÙË ÛÙË ‰È¿ÁÓˆÛË ÙË˜ ∫√¶

Â›Ó·È 62%, Ë ÂÈ‰ÈÎfiÙËÙ· Â›Ó·È 69%, Ë ıÂÙÈÎ‹ ÚÔÁÓˆ-

ÛÙÈÎ‹ ·Í›· 70% Î·È Ë ·ÚÓËÙÈÎ‹ ÚÔÁÓˆÛÙÈÎ‹ ·Í›·

61%. ∏ ¯Ú‹ÛË ˘„ËÏfiÙÂÚˆÓ ÙÈÌÒÓ ÙÔ˘ ÏfiÁÔ˘ IL-

8/ÎÚÂ·ÙÈÓ›ÓË ·˘Í¿ÓÂÈ ÙËÓ ÂÈ‰ÈÎfiÙËÙ· ·ÏÏ¿ ÌÂÈÒÓÂÈ

Ú·Á‰·›· ÙËÓ Â˘·ÈÛıËÛ›·. ∂Ó‰ÂÈÎÙÈÎ¿ ÁÈ· ÙÈÌ¤˜ IL-

8/ÎÚÂ·ÙÈÓ›ÓË 100 pg/Ìmol, Ë ÂÈ‰ÈÎfiÙËÙ· ·˘Í‹ıËÎÂ

ÛÙÔ 97%, ·ÏÏ¿ Ë Â˘·ÈÛıËÛ›· ÌÂÈÒıËÎÂ ÛÙÔ 27%.

™˘˙‹ÙËÛË

∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÙÔ ÂÚÂ˘ÓËÙÈÎfi ÂÓ‰È·Ê¤ÚÔÓ

Û¯ÂÙÈÎ¿ ÌÂ ÙËÓ ∫√¶ ÛÙÚ¤ÊÂÙ·È ÛÙËÓ ·Ó·˙‹ÙËÛË ÌÂ-

ıfi‰ˆÓ ·Ó·ÁÓÒÚÈÛË˜ ÙˆÓ ·È‰ÈÒÓ Ô˘ ·Ó‹ÎÔ˘Ó ÛÙËÓ

201IL-8 Î·È Î˘ÛÙÂÔÔ˘ÚËÙËÚÈÎ‹ ·ÏÈÓ‰ÚfiÌËÛË

¶·È‰È·ÙÚÈÎ‹ 2007;70:199-204

∞ µ °0

100

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300

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500

1100

1200

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3800

3900

™˘

ÁÎ

ÂÓÙ

ÚÒ

ÛÂÈ

˜ IL

-8/Î

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∂ÈÎfiÓ· 1. ™˘ÁÎÂÓÙÚÒÛÂÈ˜ IL-8/ÎÚÂ·ÙÈÓ›ÓË ÛÙ· Ô‡Ú· ‚ÚÂÊÒÓ ÌÂ·Ô‰Â‰ÂÈÁÌ¤ÓË ∫√¶ (ÔÌ¿‰· ∞), ‚ÚÂÊÒÓ ÌÂ ·Ó·ÌÓËÛÙÈÎfi Ô˘ÚÔ-ÏÔ›ÌˆÍË˜ ·ÏÏ¿ ¯ˆÚ›˜ ∫√¶ (ÔÌ¿‰· µ) Î·È ‚ÚÂÊÒÓ ÌÂ ÂÏÂ‡ıÂÚÔ·Ó·ÌÓËÛÙÈÎfi ·ı‹ÛÂˆÓ ÙÔ˘ Ô˘ÚÔÔÈËÙÈÎÔ‡ (ÔÌ¿‰· °).


Î·ÙËÁÔÚ›· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ∫√¶, ÓÂÊÚÈÎ‹ ·-

ÚÂÁ¯˘Ì·ÙÈÎ‹ ‚Ï¿‚Ë Î·È ÓÂÊÚÔ¿ıÂÈ· ·fi ·ÏÈÓ-

‰ÚfiÌËÛË. √ Û˘Ó‰˘·ÛÌfi˜ ÎÏÈÓÈÎÒÓ Î·È ·ÏÒÓ ÂÚÁ·-

ÛÙËÚÈ·ÎÒÓ ·Ú·Ì¤ÙÚˆÓ Â›¯Â Ì¤ÙÚÈ· ÌfiÓÔ ·ÔÙÂÏ¤-

ÛÌ·Ù· ÛÙËÓ Î·ÙÂ‡ı˘ÓÛË ·˘Ù‹ (24). ∆ÂÏÂ˘Ù·›·, ÔÈ

ÂÚÂ˘ÓËÙÈÎ¤˜ ÚÔÛ¿ıÂÈÂ˜ ÂÛÙÈ¿˙ÔÓÙ·È ÛÙÔ˘˜ ‰Â›-

ÎÙÂ˜ Î·È ÙÔ˘˜ ÌÂÛÔÏ·‚ËÙ¤˜ ÙË˜ ÊÏÂÁÌÔÓ‹˜. ∏ ÚÔ-

Î·ÏÛÈÙÔÓ›ÓË (PCT), ¤Ó·˜ ·fi ÙÔ˘˜ ÙÂÏÂ˘Ù·›· ·Ó·-

ÁÓˆÚÈÛı¤ÓÙÂ˜ ‰Â›ÎÙÂ˜ ÊÏÂÁÌÔÓ‹˜, ÌÂÏÂÙ‹ıËÎÂ ÛÂ

‚Ú¤ÊË Î·È Ó‹È· ÌÂ ÚÒÙÔ ÂÂÈÛfi‰ÈÔ Ô˘ÚÔÏÔ›ÌˆÍË˜

Î·È Ù· Â›Â‰¿ ÙË˜ ‚Ú¤ıËÎ·Ó ·˘ÍËÌ¤Ó· ÛÙÔÓ ÔÚfi

·È‰ÈÒÓ ÌÂ ∫√¶ (25,26), fiÌˆ˜, ‰ÂÓ ˘¿Ú¯Ô˘Ó ÛÙÔÈ-

¯Â›· ÁÈ· ÙË Û˘ÌÂÚÈÊÔÚ¿ ÙÔ˘ Û˘ÁÎÂÎÚÈÌ¤ÓÔ˘ ‰Â›ÎÙË

ÛÂ ·È‰È¿ ÌÂ ∫√¶ ¯ˆÚ›˜ Ô˘ÚÔÏÔ›ÌˆÍË. ∏ ÌÂÏ¤ÙË

Î˘ÙÙ·ÚÔÎÈÓÒÓ Î·È ÌÂÛÔÏ·‚ËÙÒÓ, fiˆ˜ Ë ÈÓÙÂÚÏÂ˘-

Î›ÓË-6 (IL-6) Î·È Ô ˘Ô‰Ô¯¤·˜ ÙÔ˘ ·Ú¿ÁÔÓÙ· Ó¤-

ÎÚˆÛË˜ ÙÔ˘ fiÁÎÔ˘ 1 (TNF-1) ‰ÂÓ Î·Ù¤‰ÂÈÍÂ È‰È·›ÙÂ-

ÚË ÌÂÙ·‚ÔÏ‹ ÛÂ ·È‰È¿ ÌÂ ∫√¶ ¯ˆÚ›˜ ÚfiÛÊ·ÙË

ÔÍÂ›· ÏÔ›ÌˆÍË (5). ∏ ·ÚÔ‡Û· ÌÂÏ¤ÙË ˘Ô‰ÂÈÎÓ‡ÂÈ

fiÙÈ ·ÎfiÌ· Î·È ¯ˆÚ›˜ ÚfiÛÊ·ÙË Ô˘ÚÔÏÔ›ÌˆÍË, Ù·

Â›Â‰· ÙË˜ IL-8 ÛÙ· Ô‡Ú· ·Ú·Ì¤ÓÔ˘Ó ˘„ËÏfiÙÂÚ·

ÛÙ· ‚Ú¤ÊË ÌÂ ∫√¶ Û˘ÁÎÚÈÙÈÎ¿ ÌÂ Ù· ‚Ú¤ÊË ÌÂ ·Ó·-

ÌÓËÛÙÈÎfi Ô˘ÚÔÏÔ›ÌˆÍË˜ ¯ˆÚ›˜ ∫√¶ Î·È Ù· ‚Ú¤ÊË

ÙË˜ ÔÌ¿‰·˜ ÂÏ¤Á¯Ô˘. ∞˘ÍËÌ¤Ó· Â›Â‰· IL-8 ÛÙ·

Ô‡Ú· ¤¯Ô˘Ó ÂÚÈÁÚ·ÊÂ› ÛÂ ·È‰È¿ ÌÂ ‰È¿ÊÔÚÂ˜ ÓÂ-

ÊÚÈÎ¤˜ ÊÏÂÁÌÔÓÒ‰ÂÈ˜ ‰È·Ù·Ú·¯¤˜, Û˘ÌÂÚÈÏ·Ì‚·-

ÓÔÌ¤ÓË˜ ÙË˜ Ô˘ÚÔÏÔ›ÌˆÍË˜ (6,10,12-15), Î·È Ë ÙÈÌ‹

200 pg/ml ¤¯ÂÈ ÚÔÙ·ıÂ› ˆ˜ ·ÍÈfiÈÛÙÔ˜ ‰Â›ÎÙË˜ ÁÈ·

ÙË ‰È¿ÁÓˆÛË Ô˘ÚÔÏÔ›ÌˆÍË˜ (15). ∏ ·¤ÎÎÚÈÛË ÙË˜

IL-8 ÛÙ· Ô‡Ú· ÌÂÈÒÓÂÙ·È ÁÚ‹ÁÔÚ· ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË

ÙË˜ ·ÓÙÈ‚ÈÔÙÈÎ‹˜ ·ÁˆÁ‹˜ (27), Â‡ÚËÌ· Ô˘ ÂÈ‚Â-

‚·ÈÒıËÎÂ Î·È ÛÙËÓ ÔÌ¿‰· µ ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜.

∆· ·ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ ÌÂÏ¤ÙË˜ ˘Ô‰ÂÈÎÓ‡Ô˘Ó Â-

Ú·ÈÙ¤Úˆ fiÙÈ ÙÈÌ¤˜ IL-8/ÎÚÂ·ÙÈÓ›ÓË ÌÂÁ·Ï‡ÙÂÚÂ˜ ÙˆÓ

5-10 pg/Ìmol ¤¯Ô˘Ó ÈÎ·ÓÔÔÈËÙÈÎ‹ Â˘·ÈÛıËÛ›· Î·È

ÂÈ‰ÈÎfiÙËÙ· ÛÙË ‰È¿ÁÓˆÛË ÙË˜ ∫√¶. À„ËÏfiÙÂÚÂ˜ ÙÈ-

Ì¤˜ ·˘Í¿ÓÔ˘Ó ÙËÓ ÂÈ‰ÈÎfiÙËÙ·, ÌÂÈÒÓÔÓÙ·˜ fiÌˆ˜ ÛË-

Ì·ÓÙÈÎ¿ ÙËÓ Â˘·ÈÛıËÛ›·. Œ¯Ô˘Ó ‹‰Ë ÂÚÈÁÚ·ÊÂ› ·˘-

ÍËÌ¤Ó· Â›Â‰· IL-8 ÛÙ· Ô‡Ú· ·È‰ÈÒÓ ÌÂ ∫√¶ Î·È

ÓÂÊÚÈÎ¤˜ Ô˘Ï¤˜ ¯ˆÚ›˜ ÚfiÛÊ·ÙË Ô˘ÚÔÏÔ›ÌˆÍË

(9,14). ∆· Â˘Ú‹Ì·Ù· ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ ÂÈ‚Â-

‚·ÈÒÓÔ˘Ó fiÙÈ ˘¿Ú¯Ô˘Ó ÛËÌ·ÓÙÈÎ¤˜ ‰È·ÊÔÚ¤˜ ÌÂÙ·-

Í‡ ‚ÚÂÊÒÓ ÌÂ ∫√¶ Î·È ‚ÚÂÊÒÓ ÌÂ ·Ó·ÌÓËÛÙÈÎfi Ô˘-

ÚÔÏÔ›ÌˆÍË˜ ·ÏÏ¿ fi¯È ∫√¶ ‹ ‚ÚÂÊÒÓ ¯ˆÚ›˜ ·Ó·ÌÓË-

ÛÙÈÎfi ÓfiÛÔ˘ ÙÔ˘ Ô˘ÚÔÔÈËÙÈÎÔ‡, Î·È ˘Ô‰ÂÈÎÓ‡Ô˘Ó

ÙÈ˜ ·˘ÍËÌ¤ÓÂ˜ ÙÈÌ¤˜ IL-8/ÎÚÂ·ÙÈÓ›ÓË ÙˆÓ Ô‡ÚˆÓ ˆ˜

·ÍÈfiÈÛÙÔ ‰È·ÁÓˆÛÙÈÎfi ‰Â›ÎÙË ÙË˜ ∫√¶. ¢Â‰ÔÌ¤ÓÔ˘

fiÙÈ Ù· ‚Ú¤ÊË ÙË˜ ÔÌ¿‰·˜ ∞ ÂÌÊ¿ÓÈ˙·Ó ·ÚÂÁ¯˘Ì·ÙÈ-

Î‹ ‚Ï¿‚Ë/ÓÂÊÚÈÎ‹ Ô˘Ï‹ ÛÂ Û·ÊÒ˜ ÌÂÁ·Ï‡ÙÂÚË Û˘-

¯ÓfiÙËÙ· ·fi Ù· ‚Ú¤ÊË ÙË˜ ÔÌ¿‰·˜ µ, Ë ·˘ÍËÌ¤ÓË

IL-8 ı· ÌÔÚÔ‡ÛÂ ÂÓ‰Â¯ÔÌ¤Óˆ˜ Ó· ·Ô‰ÔıÂ› ÛÙËÓ

·ÚÂÁ¯˘Ì·ÙÈÎ‹ ‚Ï¿‚Ë Ì¿ÏÏÔÓ ·Ú¿ ÛÙËÓ Î˘ÛÙÂÔ-

Ô˘ÚËÙËÚÈÎ‹ ·ÏÈÓ‰ÚfiÌËÛË. øÛÙfiÛÔ, ÛÙ· ‚Ú¤ÊË ÙË˜

ÔÌ¿‰·˜ ∞ ‰ÂÓ ‰È·ÈÛÙÒıËÎÂ Û¯¤ÛË ÙˆÓ ÂÈ¤‰ˆÓ

IL-8 ÌÂ ÙËÓ ‡·ÚÍË ‹ ÌË ·ÚÂÁ¯˘Ì·ÙÈÎ‹˜ ‚Ï¿‚Ë˜.

√ˆÛ‰‹ÔÙÂ, ÌÂÏ¤ÙÂ˜ ÌÂ ÌÂÁ·Ï‡ÙÂÚÔ ÏËı˘ÛÌfi ı·

‹Ù·Ó ÔÏ‡ÙÈÌÂ˜ ÁÈ· ÙËÓ ÂÍ·ÁˆÁ‹ ÔÚÈÛÙÈÎÒÓ Û˘ÌÂ-

Ú·ÛÌ¿ÙˆÓ Û¯ÂÙÈÎ¿ ÌÂ ·˘Ùfi ÙÔ ÔÏ‡ ÂÓ‰È·Ê¤ÚÔÓ

ÂÚÒÙËÌ·.

∆· Â˘Ú‹Ì·Ù· ÙË˜ ÌÂÏ¤ÙË˜ ·Ô‰ÂÈÎÓ‡Ô˘Ó ÂÈÏ¤-

ÔÓ fiÙÈ Ë ÊÏÂÁÌÔÓÒ‰Ë˜ ‰È·‰ÈÎ·Û›· ÂÍ·ÎÔÏÔ˘ıÂ› Ó·

˘Ê›ÛÙ·Ù·È ÛÙËÓ ∫√¶ Î·È ÌÂÙ¿ ÙËÓ ·Ô‰ÚÔÌ‹ ÙË˜

Ô˘ÚÔÏÔ›ÌˆÍË˜, ÛÂ ·ÓÙ›ıÂÛË ÌÂ ÙËÓ ¿Ô„Ë fiÙÈ Ë ·-

ÏÈÓ‰ÚfiÌËÛË Ô‡ÚˆÓ ÛÙÂ›ÚˆÓ ÌÈÎÚÔ‚›ˆÓ ‰ÂÓ ‰ËÌÈÔ˘Ú-

ÁÂ› ÓÂÊÚÈÎ‹ ‚Ï¿‚Ë (3). ∏ ·‡ÍËÛË ÙË˜ IL-8 ÛÙ· ·È-

‰È¿ ÌÂ ∫√¶ Ê·›ÓÂÙ·È Ó· Â›Ó·È ÓÂÊÚÈÎ‹˜ Î·È fi¯È Û˘-

ÛÙËÌ·ÙÈÎ‹˜ ÚÔ¤ÏÂ˘ÛË˜, ·ÊÔ‡ Ù· Â›Â‰· IL-8 ÛÙÔÓ

ÔÚfi ·È‰ÈÒÓ ÌÂ ∫√¶ ¯ˆÚ›˜ Ô˘ÚÔÏÔ›ÌˆÍË ¤¯Ô˘Ó

·Ó·ÊÂÚıÂ› Ê˘ÛÈÔÏÔÁÈÎ¿ (13,20). ∏ ·‡ÍËÛË ·˘Ù‹ ‰ÂÓ

ı· ÌÔÚÔ‡ÛÂ Ó· ·Ô‰ÔıÂ› ÛÂ ˘ÔÏÂÈfiÌÂÓË ÊÏÂÁ-

ÌÔÓ‹ ÏfiÁˆ ÙË˜ ÚÔËÁËıÂ›Û·˜ Ô˘ÚÔÏÔ›ÌˆÍË˜, Î·ıÒ˜

‰ÂÓ ·Ú·ÙËÚ‹ıËÎÂ ÛÂ ·È‰È¿ ÌÂ ÚÔËÁËıÂ›Û· Ô˘ÚÔ-

ÏÔ›ÌˆÍË ¯ˆÚ›˜ ∫√¶. ∂ÈÏ¤ÔÓ, Â›Ó·È ÂÓ‰È·Ê¤ÚÔÓ

fiÙÈ ÌÂÙ·Í‡ fiÏˆÓ ÙˆÓ ·È‰ÈÒÓ ÙË˜ ÌÂÏ¤ÙË˜, Ë ‰Â‡ÙÂ-

ÚË ˘„ËÏfiÙÂÚË ÙÈÌ‹ IL-8 ·Ú·ÙËÚ‹ıËÎÂ ÛÂ ¤Ó· ‚Ú¤-

ÊÔ˜ ÌÂ ÚÔÁÂÓÓËÙÈÎ‹ ‰È¿ÁÓˆÛË ∫√¶ Î·È ¯ˆÚ›˜

ÈÛÙÔÚÈÎfi Ô˘ÚÔÏÔ›ÌˆÍË˜. ∏ ¯ÚfiÓÈ· ÊÏÂÁÌÔÓÒ‰Ë˜

Î˘ÙÙ·ÚÈÎ‹ ‰È‹ıËÛË Ô˘ Û¯ÂÙ›˙ÂÙ·È ÂÚÈÛÛfiÙÂÚÔ ÌÂ

ÙË ÓÂÊÚÔ¿ıÂÈ· ÙË˜ ·ÏÈÓ‰ÚfiÌËÛË˜ ·Ú¿ ÌÂ ÙËÓ

›‰È· ÙËÓ ·ÏÈÓ‰ÚfiÌËÛË, ·ÔÙÂÏÂ› ÂÓ‰Â¯ÔÌ¤Óˆ˜ ÌÈ·

ÂÍ‹ÁËÛË ÁÈ· Ù· ·˘ÍËÌ¤Ó· Â›Â‰· IL-8 ÛÙ· ·È‰È¿

ÌÂ ∫√¶, Ô˘ ÌÔÚÂ› Ó· Â›Ó·È ·ÓÂÍ¿ÚÙËÙ· ·fi ÙÔÓ

‚·ıÌfi ÙË˜ ·ÏÈÓ‰ÚfiÌËÛË˜.



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∂ÈÎfiÓ· 2. ∂˘·ÈÛıËÛ›· Î·È ÂÈ‰ÈÎfiÙËÙ· ÙÈÌÒÓ IL-8/ÎÚÂ·ÙÈÓ›ÓË Ô‡-ÚˆÓ (pg/Ìmol) ÁÈ· ÙË ‰È¿ÁÓˆÛË ÙË˜ ∫√¶ ÛÂ ‚Ú¤ÊË ¯ˆÚ›˜ Úfi-ÛÊ·ÙË Ô˘ÚÔÏÔ›ÌˆÍË.


∏ ÌÂÏ¤ÙË ÂÈÎÂÓÙÚÒıËÎÂ ÛÙ· ÌÈÎÚ¿ ‚Ú¤ÊË, ÂÂÈ-‰‹ ·˘Ù‹ Ë ËÏÈÎÈ·Î‹ ÔÌ¿‰· ·ÓÙÈÌÂÙˆ›˙ÂÈ ·˘ÍËÌ¤ÓÔÎ›Ó‰˘ÓÔ ·Ó¿Ù˘ÍË˜ ÓÂÊÚÈÎ‹˜ ‚Ï¿‚Ë˜ (1). ∏ ·Ó›-¯ÓÂ˘ÛË ∫√¶, ¯ÚfiÓÈ·˜ ˘ÂÏÔÓÂÊÚ›ÙÈ‰·˜ Î·È ÓÂÊÚÈ-Î‹˜ Ô˘Ï‹˜ ‚·Û›˙ÂÙ·È Û‹ÌÂÚ· ÛÂ ·ÂÈÎÔÓÈÛÙÈÎ¤˜ ÌÂ-ıfi‰Ô˘˜, fiˆ˜ Ù· Ú·‰ÈÔ˚ÛfiÙÔ· Î·È Ë Î˘ÛÙÂÔÔ˘ÚË-ıÚÔÁÚ·Ê›·, Ô˘ Û˘ÓÂ¿ÁÔÓÙ·È ¤ÎıÂÛË ÛÂ ·ÎÙÈÓÔ‚Ô-Ï›·, ÂÂÌ‚·ÙÈÎfiÙËÙ· Î·È ÛËÌ·ÓÙÈÎfi ÎfiÛÙÔ˜. ∏ ¯Ú‹-ÛË ÌË ÂÂÌ‚·ÙÈÎÒÓ ÌÂıfi‰ˆÓ ı· Â›¯Â ·Ó·ÌÊ›‚ÔÏ·ÛËÌ·ÓÙÈÎ¿ ÔÊ¤ÏË. ∆Ô ˘ÂÚË¯ÔÁÚ¿ÊËÌ· Â›Ó·È Ì›·ÔÏ‡ÙÈÌË ÌË ÂÂÌ‚·ÙÈÎ‹ Ì¤ıÔ‰Ô˜ ÁÈ· ÙË ‰ÈÂ˘ÎÚ›ÓÈ-ÛË ÙË˜ ·Ó·ÙÔÌ›·˜ ÙÔ˘ Ô˘ÚÔÔÈËÙÈÎÔ‡, ˆÛÙfiÛÔ Â›Ó·ÈÁÓˆÛÙ‹ Ë ¯·ÌËÏ‹ ÙÔ˘ Â˘·ÈÛıËÛ›· ÛÙË ‰È¿ÁÓˆÛË ÙË˜∫√¶, ÌÂ ·ÔÙ¤ÏÂÛÌ· ÙÔÓ ÂÚÈÔÚÈÛÌfi ÙË˜ ¯Ú‹ÛË˜ÙÔ˘ ˆ˜ ·ÓÈ¯ÓÂ˘ÙÈÎ‹˜ ÌÂıfi‰Ô˘ (28).

√ ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙË˜ IL-8 ÛÙ· Ô‡Ú· Ê·›ÓÂÙ·È Ó··ÔÙÂÏÂ› ˘ÔÛ¯fiÌÂÓÔ ÌË ÂÂÌ‚·ÙÈÎfi ‰È·ÁÓˆÛÙÈÎfi‰Â›ÎÙË ÁÈ· ÙËÓ ∫√¶ ÛÙ· ÌÈÎÚ¿ ‚Ú¤ÊË. √ ‰Â›ÎÙË˜ ·˘-Ùfi˜ ‰ÂÓ Â›Ó·È ¯ˆÚ›˜ ÂÚÈÔÚÈÛÌÔ‡˜. ∆· Â›Â‰· ÙË˜IL-8 ÌÔÚÂ› Ó· ‚ÚÂıÔ‡Ó ·˘ÍËÌ¤Ó· ÛÙÔ Ï·›ÛÈÔ ¯ÂÈ-ÚÔ˘ÚÁÈÎÒÓ ¯ÂÈÚÈÛÌÒÓ ÛÙÔ Ô˘ÚÔÔÈËÙÈÎfi Û‡ÛÙËÌ·,¿ÏÏË˜ ·ıÔÏÔÁÈÎ‹˜ Î·Ù¿ÛÙ·ÛË˜ ÙÔ˘ Ô˘ÚÔÔÈËÙÈÎÔ‡Û˘ÛÙ‹Ì·ÙÔ˜, ÎÔÏ›ÙÈ‰·˜/Ô˘ÚËıÚ›ÙÈ‰·˜ (14), ‹ Ô˘ÚÔ-ÏÔ›ÌˆÍË˜ Ô˘ ‰ÂÓ ·ÓÈ¯ÓÂ‡ÙËÎÂ. ¶Èı·ÓfiÓ, ÙÔ ÙÂÏÂ˘-Ù·›Ô ÂÓ‰Â¯fiÌÂÓÔ ÂÍËÁÂ› ÙËÓ ·˘ÍËÌ¤ÓË Û˘ÁÎ¤ÓÙÚˆÛËIL-8 ÛÂ ¤Ó· ‚Ú¤ÊÔ˜ ÙË˜ ¯ˆÚ›˜ ∫√¶ ÔÌ¿‰·˜ µ (∂ÈÎfi-Ó· 1). ∆¤ÏÔ˜, Ë ÌÂÏ¤ÙË ÂÚÈ¤Ï·‚Â ÌfiÓÔ ‚Ú¤ÊË, Û˘ÓÂ-Ò˜ Â›Ó·È ·ÌÊ›‚ÔÏÔ Î·Ù¿ fiÛÔ Ù· Â˘Ú‹Ì·Ù¿ ÙË˜ÈÛ¯‡Ô˘Ó ÁÈ· ÌÂÁ·Ï‡ÙÂÚ· Ó‹È· Î·È ·È‰È¿. ¶·Ú¿ÙÔ˘˜ ÂÚÈÔÚÈÛÌÔ‡˜ ·˘ÙÔ‡˜, Ë Ì¤ÙÚËÛË ÙË˜ IL-8 ÛÙ·Ô‡Ú· ÌÂÙ¿ ÙËÓ ·Ô‰ÚÔÌ‹ ÙË˜ Ô˘ÚÔÏÔ›ÌˆÍË˜ ÌÔÚÂ›Ó· ÚÔÛÊ¤ÚÂÈ Ô˘ÛÈÒ‰Ë ‰È·ÁÓˆÛÙÈÎ‹ ‚Ô‹ıÂÈ· ˆ˜ ·ÓÈ-¯ÓÂ˘ÙÈÎ‹ Ì¤ıÔ‰Ô˜ Î·Ù¿ ÙËÓ ·Ó·ÁÓÒÚÈÛË ‚ÚÂÊÒÓÔ˘ ·Ó‹ÎÔ˘Ó ÛÙËÓ Î·ÙËÁÔÚ›· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÁÈ·∫√¶, ÌÂ ·ÒÙÂÚÔ ÛÎÔfi ÙËÓ ·˘ÛÙËÚfiÙÂÚË ÂÈÏÔÁ‹ÙˆÓ ·È‰ÈÒÓ Ô˘ ı· ˆÊÂÏËıÔ‡Ó ·fi ÙË ‰ÈÂÓ¤ÚÁÂÈ·ÙË˜ Î˘ÛÙÂÔÔ˘ÚËıÚÔÁÚ·Ê›·˜.


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™ˆÛÙ¤˜ ··ÓÙ‹ÛÂÈ˜ ÙÔ˘ Quiz ÁÈ· ÙÔ ¿ÚıÚÔ “™˘ÁÁÂÓÂ›˜ ‰È·Ì·ÚÙ›Â˜ ÓÂ˘ÌfiÓˆÓ”

1. ¶ÔÈÔ ·fi Ù· ·Ú·Î¿Ùˆ ÂÎ‰ËÏÒÓÂÙ·È Û˘Ó‹ıˆ˜ ÛÙÈ˜ ÚÒÙÂ˜ ÒÚÂ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË;Á. ™˘ÁÁÂÓ‹˜ ‰È·ÊÚ·ÁÌ·ÙÔÎ‹ÏË

2. ∏ ‰È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË ÂÈÛÓÂ˘ÛÙÈÎÔ‡ ÛÈÁÌÔ‡ Î·È/‹ ÂÎÓÂ˘ÛÙÈÎÔ‡ ÌÔÓÔÊˆÓÈÎÔ‡ Û˘ÚÈÁÌÔ‡ ÛÙ· 2-3 ÚÒÙ·¤ÙË ˙ˆ‹˜ Ú¤ÂÈ Ó· ÂÚÈÏ¿‚ÂÈ:Â. ŸÏ· Ù· ·Ú·¿Óˆ (ÙË ÌÂÙ·ÙÚ·˘Ì·ÙÈÎ‹ ÛÙ¤ÓˆÛË ÌÂÙ¿ ·fi ‰È·ÛˆÏ‹ÓˆÛË, ÙË Á·ÛÙÚÔÔÈÛÔÊ·ÁÈÎ‹ ·-

ÏÈÓ‰ÚfiÌËÛË Î·È ÂÈÛÚfiÊËÛË, ÙËÓ ÂÈÛÚfiÊËÛË Í¤ÓÔ˘ ÛÒÌ·ÙÔ˜, ÙÔÓ ·ÁÁÂÈ·Îfi ‰·ÎÙ‡ÏÈÔ)

3. ¶ÔÈÔ ·fi Ù· ·Ú·Î¿Ùˆ Â›Ó·È ·ÏËı¤˜;Á. √ ·ÁÁÂÈ·Îfi˜ ‰·ÎÙ‡ÏÈÔ˜ ÌÔÚÂ› Ó· ÂÎ‰ËÏˆıÂ› ˆ˜ "ÔÈÛıfiÙÔÓÔ˜" Î·Ù¿ ÙÔ˘˜ ÚÒÙÔ˘˜ Ì‹ÓÂ˜ ÙË˜ ˙ˆ‹˜

4. ∏ ‰ÈfiÚıˆÛË ÙÚ·¯ÂÈÔÔÈÛÔÊ·ÁÈÎÔ‡ Û˘ÚÈÁÁ›Ô˘ ÌÔÚÂ› Ó· Û˘ÓÔ‰Â‡ÂÙ·È ·fi:Â. ŸÏ· Ù· ·Ú·¿Óˆ (‰È·Ù·Ú·¯‹ ÙË˜ ·‡ÍËÛË˜, Û˘ÌÙˆÌ·ÙÔÏÔÁ›· Á·ÛÙÚÔÔÈÛÔÊ·ÁÈÎ‹˜ ·ÏÈÓ‰ÚfiÌËÛË˜,

‰˘ÛÎÔÏ›· Î·Ù¿ ÙËÓ Î·Ù¿ÔÛË, È‰›ˆ˜ ÛÙÂÚÂÒÓ ÙÚÔÊÒÓ, Û˘ÌÙˆÌ·ÙÔÏÔÁ›· ÙÚ·¯ÂÈÔÌ·Ï¿Î˘ÓÛË˜)

5. ¶ÔÈÔ ·fi Ù· ·Ú·Î¿Ùˆ ÈÛ¯‡ÂÈ ÁÈ· ÙË ¯ÂÈÚÔ˘ÚÁÈÎ‹ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ Û˘ÁÁÂÓÒÓ ‰È·Ì·ÚÙÈÒÓ ÙÔ˘ ÓÂ‡ÌÔÓ·;Â. ∫·Ó¤Ó· ·fi Ù· ·Ú·¿Óˆ (ÔÈ ·Ó·ÓÂ˘ÛÙÈÎ¤˜ ÂÊÂ‰ÚÂ›Â˜ ÙˆÓ ÂÓËÏ›ÎˆÓ Î·ıÔÚ›˙ÔÓÙ·È Î˘Ú›ˆ˜ ·fi ÙËÓ

ËÏÈÎ›· Ô˘ ¤ÁÈÓÂ Ë ÂÎÙÔÌ‹ - ÔÈ Û˘ÁÁÂÓÂ›˜ ‰È·Ì·ÚÙ›Â˜ ¯ÚÂÈ¿˙ÔÓÙ·È Î·Ù¿ Î·ÓfiÓ· ¿ÌÂÛË Â¤Ì‚·ÛË - Ë ·‡-ÍËÛË ÙÔ˘ ÓÂ˘ÌÔÓÈÎÔ‡ ÈÛÙÔ‡ ÌÂÙ¿ ÙËÓ ÓÂ˘ÌÔÓÂÎÙÔÌ‹ ·ÊÔÚ¿ Î˘Ú›ˆ˜ ÙÔ ‰›ÎÙ˘Ô ÙˆÓ ·ÂÚ·ÁˆÁÒÓ Î·È ÏÈ-ÁfiÙÂÚÔ ÙÔ ·Ú¤Á¯˘Ì· - ÂÈÚ·Ì·ÙÈÎ¿ ‰Â‰ÔÌ¤Ó· ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ Ë ÌÂÙÂÁ¯ÂÈÚËÙÈÎ‹ ·‡ÍËÛË ÙÔ˘ ÓÂ‡ÌÔ-Ó· Û˘ÓÂ¿ÁÂÙ·È ÛËÌ·ÓÙÈÎ‹ ·‡ÍËÛË ÙÔ˘ ÏÂÈÙÔ˘ÚÁÈÎÔ‡ ÓÂ˘ÌÔÓÈÎÔ‡ ÈÛÙÔ‡)


ªÂÙ·‚ÔÏ‹ ÛˆÌ·ÙÔÌÂÙÚÈÎÒÓ ÌÂÁÂıÒÓ, ·ÚÙËÚÈ·Î‹˜ ›ÂÛË˜,

Û·Î¯¿ÚÔ˘ Î·È ÏÈÈ‰›ˆÓ ÔÚÔ‡ ·›Ì·ÙÔ˜ ·È‰ÈÒÓ ÙË˜ ∫Ú‹ÙË˜

ÌÂÙ·Í‡ ÙˆÓ ¯ÚÔÓÈÎÒÓ ÂÚÈfi‰ˆÓ 1989-1993 Î·È 1999-2003

ª. §ÈÓ·Ú‰¿ÎË˜, °. ªÂÚÙÛÈ¿˜, ∫. ™·ÚÚ‹, ∞. ∫·Ê¿ÙÔ˜

¶ÂÚ›ÏË„Ë

∂ÈÛ·ÁˆÁ‹: ™ÎÔfi˜ ÙË˜ ÌÂÏ¤ÙË˜ ‹Ù·Ó Ë ÂÎÙ›ÌËÛË ÙË˜ ÌÂÙ·‚ÔÏ‹˜ ÙˆÓ ÛˆÌ·ÙÔÌÂÙÚ‹ÛÂˆÓ, ÙË˜ ·ÚÙËÚÈ·Î‹˜›ÂÛË˜ (∞¶), ÙÔ˘ Û·Î¯¿ÚÔ˘ Î·È ÙˆÓ ÏÈÈ‰›ˆÓ ÔÚÔ‡ ·›Ì·ÙÔ˜ ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ ÙË˜ ∫Ú‹ÙË˜, ÌÂÙ·Í‡ ÙˆÓÂÙÒÓ 1989-1993 Î·È 1999-2003.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ªÂÏÂÙ‹ıËÎ·Ó ‰‡Ô ·ÓÙÈÚÔÛˆÂ˘ÙÈÎ¿ ‰Â›ÁÌ·Ù· ·È‰ÈÒÓ ËÏÈÎ›·˜ 5-15 ÂÙÒÓ, ·fi ÙÈ˜ÂÚÈfi‰Ô˘˜ 1989-1993 (¡=987) Î·È 1999-2003 (¡=891). ¶ÚÔ‹Ïı·Ó ·fi ÏËı˘ÛÌfi 5337 ·È‰ÈÒÓ 12 ÌÂ-ÏÂÙÒÓ Ô˘ ‰ÈÂÍ‹¯ıËÛ·Ó ÛÙÈ˜ ‰‡Ô ÂÚÈfi‰Ô˘˜ ·fi ÙËÓ ∫ÏÈÓÈÎ‹ ¶ÚÔÏËÙÈÎ‹˜ π·ÙÚÈÎ‹˜ Î·È ¢È·ÙÚÔÊ‹˜ ÙÔ˘¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹ÙË˜. ªÂÙÚ‹ıËÎ·Ó ÙÔ ‚¿ÚÔ˜, ÙÔ ‡„Ô˜, ÔÈ ‰ÂÚÌ·ÙÈÎ¤˜ Ù˘¯¤˜, Ë ÂÚ›ÌÂÙÚÔ˜ ·ÚÈÛÙÂÚÔ‡‚Ú·¯›ÔÓ·, Ë ∞¶, ÙÔ Û¿Î¯·ÚÔ Î·È Ù· ÏÈ›‰È· ÔÚÔ‡ ·›Ì·ÙÔ˜. ÀÔÏÔÁ›ÛÙËÎÂ Î·È Ô ÂÈÔÏ·ÛÌfi˜ ÙÔ˘ ÌÂÙ·‚Ô-ÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ (ªÂÙ™˘Ó) ˆ˜ Ë Û˘ÁÎ¤ÓÙÚˆÛË ÙÚÈÒÓ ‹ ÂÚÈÛÛfiÙÂÚˆÓ ·fi ÙÔ˘˜ ¤ÓÙÂ ·Ú¿ÁÔÓÙÂ˜: ·˘-ÍËÌ¤ÓÔ Û¿Î¯·ÚÔ, ·˘ÍËÌ¤ÓË ∞¶, ˘ÂÚÙÚÈÁÏ˘ÎÂÚÈ‰·ÈÌ›·, ¯·ÌËÏ‹ HDL ¯ÔÏËÛÙÂÚfiÏË Î·È ·¯˘Û·ÚÎ›·.

∞ÔÙÂÏ¤ÛÌ·Ù·: ªÂÙ·Í‡ ÙˆÓ ÂÚÈfi‰ˆÓ 1989-1993 Î·È 1999-2003 ‚Ú¤ıËÎÂ ÛËÌ·ÓÙÈÎ‹ Ì¤ÛË ·‡ÍËÛË ÙÔ˘‚¿ÚÔ˘˜ Î·Ù¿ 4 kg, ÙÔ˘ ‡„Ô˘˜ Î·Ù¿ 3,3 cm, ÙÔ˘ ‰Â›ÎÙË Ì¿˙·˜ ÛÒÌ·ÙÔ˜ Î·Ù¿ 0,92 kg/m2 Î·È ÙÔ˘ ·ıÚÔ›-ÛÌ·ÙÔ˜ ÙÂÛÛ¿ÚˆÓ ‰ÂÚÌ·ÙÈÎÒÓ Ù˘¯ÒÓ Î·Ù¿ 13,2 mm (p<0,001). √ ÂÈÔÏ·ÛÌfi˜ ÙˆÓ ˘¤Ú‚·ÚˆÓ ·È-‰ÈÒÓ ·˘Í‹ıËÎÂ ·fi 21,3% ÛÂ 24,7% (p<0,001) Î·È ÙË˜ ·¯˘Û·ÚÎ›·˜ ·fi 5,4% ÛÂ 10,4% (p<0,001). ∆ÔÔÛÔÛÙfi ÙˆÓ ·È‰ÈÒÓ ÌÂ ·˘ÍËÌ¤ÓË ÔÏÈÎ‹ ¯ÔÏËÛÙÂÚfiÏË ·Ú¤ÌÂÈÓÂ ·ÌÂÙ¿‚ÏËÙÔ ÛÙÔ 15,9%, ÂÓÒ ÂÎÂ›ÓˆÓÌÂ ·˘ÍËÌ¤ÓË LDL-C ÌÂÈÒıËÎÂ ·fi 18,8% ÛÂ 17,1% (p=0,006). ™˘ÓÔÏÈÎ¿, ÙÔ 4,5% ÙˆÓ ·È‰ÈÒÓ ‚Ú¤ıËÎÂÙÔ 1989-1993 ÌÂ ÙÚÂÈ˜ ‹ ÂÚÈÛÛfiÙÂÚÔ˘˜ ·Ú¿ÁÔÓÙÂ˜ ÙÔ˘ ªÂÙ™˘Ó ¤Ó·ÓÙÈ 5,6% ÙÔ 1999-2003 (p>0,05).

™˘ÌÂÚ¿ÛÌ·Ù·: ™ËÌ·ÓÙÈÎ‹ ·‡ÍËÛË ‰È·ÈÛÙÒÓÂÙ·È ÛÙÔ˘˜ ‰Â›ÎÙÂ˜ ·¯˘Û·ÚÎ›·˜ ÙˆÓ ·È‰ÈÒÓ ÙË˜ ∫Ú‹ÙË˜ÛÙËÓ ÂÚ›Ô‰Ô ÌÂÙ·Í‡ 1989-1993 Î·È 1999-2003. ¢ÂÓ ‚Ú¤ıËÎÂ, ˆÛÙfiÛÔ, ·Ó¿ÏÔÁË ÛËÌ·ÓÙÈÎ‹ ÌÂÙ·‚ÔÏ‹ÛÙËÓ ·ÚÙËÚÈ·Î‹ ›ÂÛË, ÛÙÔ Û¿Î¯·ÚÔ Î·È Ù· ÏÈ›‰È· ÔÚÔ‡ ·›Ì·ÙÔ˜, ·ÏÏ¿ ÌÈÎÚ‹ ·‡ÍËÛË ÛÙÔÓ ÂÈÔÏ·ÛÌfiÙÔ˘ ªÂÙ™˘Ó. ∆· ·ÔÙÂÏ¤ÛÌ·Ù· ‰Â›¯ÓÔ˘Ó fiÙÈ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ·¯˘Û·ÚÎ›·˜ ÎÚ›ÓÂÙ·È ·Ó·ÁÎ·›· ËÂÊ·ÚÌÔÁ‹ ÂıÓÈÎ‹˜ ÔÏÈÙÈÎ‹˜ ÁÈ· ÙËÓ ÚÔ·ÁˆÁ‹ ÙË˜ ˘ÁÂ›·˜ ÙˆÓ ·È‰ÈÒÓ.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ¶ÏËı˘ÛÌÈ·Î‹ Ù¿ÛË, ·È‰È¿, ÛˆÌ·ÙÔÌÂÙÚ‹ÛÂÈ˜, ÏÈ›‰È· ÔÚÔ‡ ·›Ì·ÙÔ˜, ÌÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ.

Secular trends during early 1990s and 2000s of body measurements,

blood pressure, glucose and serum lipids in children of Crete, Greece

M. Linardakis, G. Bertsias, K. Sarri, A. Kafatos

Abstract

Background: This study aimed at assessing secular changes in anthropometric measurements, bloodpressure, glucose, and serum lipids in children and adolescents in Crete between 1989-1993 and1999-2003.

Methods: Two representative samples of children aged 5-15 years were studied during the time periods1989-1993 (N=987) and 1999-2003 (N=891). The study samples came from a population of 5,337children who participated in a series of 12 studies conducted by the same study team. Body weight andheight, skin fold thickness, blood pressure, glucose, and serum lipids were measured, and body massindex (BMI) was derived. The prevalence of metabolic syndrome (MetSyn) was estimated as theclustering of three or more cardiovascular disease risk factors such as hyperglycaemia, high bloodpressure, hypertriglyceridaemia, low HDL cholesterol and obesity.

Results: Between 1989-1993 and 1999-2003 there was a significant increase in body weight (by 4 kg),height (by 3.3 cm), BMI (by 0.92 kg/m2), and the sum of skin folds (by 13.2 mm) (p<0.001). Theprevalence of overweight children increased from 21.3% to 24.7% (p<0.001) and obesity from 5.4% to10.4% (p<0.001). The percentage of children with increased total cholesterol remained unchanged, whilethat of children with elevated LDL-C decreased from 18.8% to 17.1% (p=0.006). Overall, 4.5% of childrenhad ≥3 risk factors for MetSyn in 1989-1993, compared to 5.6% in 1999-2003 (p>0.05).


¶·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˜

University of Crete, Facultyof Medicine, Department ofSocial Medicine, Division ofPreventive Medicine andNutrition, Heraklion, Crete

Correspondence:

Manolis Linardakis [email protected] Voutes-Stavrakia Junction710 03, Po Box 2208, heraklion, Crete

¶·È‰È·ÙÚÈÎ‹ 2007;70:205-216


206 ª. §ÈÓ·Ú‰¿ÎË˜ Î·È Û˘Ó.


Conclusions: A significant increase in obesity indices was found in children in Crete between 1989-1993and 1999-2003, but with no significant changes in blood pressure or blood glucose or serum lipid levels.A small increase was also found in the prevalence of the MetSyn. These results highlight the need for im-plementation of national health promotion policies focusing on childhood obesity in Greece.

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


¢ª™ ¢Â›ÎÙË˜ Ì¿˙·˜ ÛÒÌ·ÙÔ˜

∞¢¶ ÕıÚÔÈÛÌ· 4 ‰ÂÚÌ·ÙÈÎÒÓ Ù˘¯ÒÓ

¶∞µ ¶ÂÚ›ÌÂÙÚÔ˜ ·ÚÈÛÙÂÚÔ‡ ‚Ú·¯›ÔÓ·

™∞¶ ™˘ÛÙÔÏÈÎ‹ ·ÚÙËÚÈ·Î‹ ›ÂÛË

¢∞¶ ¢È·ÛÙÔÏÈÎ‹ ·ÚÙËÚÈ·Î‹ ›ÂÛË

∞¶ ∞ÚÙËÚÈ·Î‹ ›ÂÛË

GLU ™¿Î¯·ÚÔ

TC √ÏÈÎ‹ ¯ÔÏËÛÙÂÚfiÏË

TG ∆ÚÈÁÏ˘ÎÂÚ›‰È·

HDL-C ÃÔÏËÛÙÂÚfiÏË ÙˆÓ ˘„ËÏ‹˜ ˘ÎÓfiÙËÙ·˜

ÏÈÔÚˆÙÂ˚ÓÒÓ

LDL-C ÃÔÏËÛÙÂÚfiÏË ÙˆÓ ¯·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜

ÏÈÔÚˆÙÂ˚ÓÒÓ

∂£ ∂Î·ÙÔÛÙÈ·›· ı¤ÛË

OR Odds ratio

∂ÈÛ·ÁˆÁ‹

T· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, ·ÚÎÂÙ¤˜ ÌÂÏ¤ÙÂ˜ ÛÂ

·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ Î·Ù·‰ÂÈÎÓ‡Ô˘Ó ÙË Ú·Á‰·›·

ÌÂÙ·‚ÔÏ‹ ÙˆÓ ÛˆÌ·ÙÔÌÂÙÚÈÎÒÓ ÙÔ˘˜ ÌÂÁÂıÒÓ,

Ô˘ ¤¯ÂÈ ˆ˜ Û˘Ó¤ÂÈ· ÙËÓ ÂÈ‰ËÌÈÎ‹ ¤Í·ÚÛË

ÙË˜ ·¯˘Û·ÚÎ›·˜ (1-3). √ ÂÈÔÏ·ÛÌfi˜ ·˘ÍË-

Ì¤ÓÔ˘ ‚¿ÚÔ˘˜ Î·È ·¯˘Û·ÚÎ›·˜ ·È‰ÈÒÓ ËÏÈ-

Î›·˜ 5-17 ÂÙÒÓ, ˘ÔÏÔÁ›˙ÂÙ·È ·ÁÎÔÛÌ›ˆ˜ ÛÙÔ

10% ÛÙË ‰ÂÎ·ÂÙ›· ÙÔ˘ 1990. ∆ËÓ ÚÒÙË ı¤ÛË

Î·Ù¤¯Ô˘Ó ÔÈ ∏¶∞ ÌÂ 36% Î·È ·ÎÔÏÔ˘ıÂ› Ë Â˘-

Úˆ·˚Î‹ ‹ÂÈÚÔ˜ ÌÂ 20% (1,2,4).

√ ·ÈÙÈÔÏÔÁÈÎfi˜ ÌË¯·ÓÈÛÌfi˜ ÙË˜ ·¯˘Û·ÚÎ›·˜

ıÂˆÚÂ›Ù·È ÔÏ˘·Ú·ÁÔÓÙÈÎfi˜ ·Ó Î·È ‰ÂÓ ¤¯ÂÈ

Ï‹Úˆ˜ Î·Ù·ÓÔËıÂ›. ∂ÎÙfi˜ ·fi ÙÔÓ ÚˆÙÂ‡Ô-

ÓÙ· ÚfiÏÔ Ô˘ Î·Ù¤¯Ô˘Ó Ë ·ÓÈÛÔÚÚÔ›· ÚÔ-

ÛÏ·Ì‚·ÓfiÌÂÓË˜ - Î·Ù·Ó·ÏÈÛÎfiÌÂÓË˜ ÂÓ¤ÚÁÂÈ·˜

Î·È Ë ¤ÏÏÂÈ„Ë ÛˆÌ·ÙÈÎ‹˜ ¿ÛÎËÛË˜, ÛËÌ·ÓÙÈÎfi

ÚfiÏÔ ‰È·‰Ú·Ì·Ù›˙Ô˘Ó ÂÚÈ‚·ÏÏÔÓÙÈÎÔ›, ÎÔÈÓˆÓÈ-

ÎÔ›, ÔÏÈÙÈÛÌÈÎÔ›, Î·ıÒ˜ Î·È ‚ÈÔÏÔÁÈÎÔ› ·Ú¿ÁÔ-

ÓÙÂ˜ (2,5).

∏ ÂÈ‰ËÌÈÎ‹ ¤Í·ÚÛË ÙË˜ ·¯˘Û·ÚÎ›·˜ ¿Ú-

¯ÈÛÂ ÙË ‰ÂÎ·ÂÙ›· ÙÔ˘ 1960 ÁÈ· ÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜

Î·È ÙË ‰ÂÎ·ÂÙ›· ÙÔ˘ 1980 ÁÈ· Ù· ·È‰È¿ (5). ∏

·‡ÍËÛË ÙÔ˘ ÛˆÌ·ÙÈÎÔ‡ Ï›Ô˘˜ Û˘ÓÔ‰Â‡ÂÙ·È

·fi ¿ÏÏÔ˘˜ ·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ¯ÚfiÓÈ·

ÓÔÛ‹Ì·Ù·, fiˆ˜ ˘¤ÚÙ·ÛË, ·˘ÍËÌ¤ÓÔ Û¿Î¯·-

ÚÔ ÔÚÔ‡ ·›Ì·ÙÔ˜ (GLU), ˘ÂÚÏÈÈ‰·ÈÌ›· ‹ Î·È

¯·ÌËÏ‹ HDL ¯ÔÏËÛÙÂÚfiÏË, ÂÓÒ Ô Û˘Ó‰˘·-ÛÌfi˜ ÙÔ˘˜ (ÙÚÂÈ˜ ‹ ÂÚÈÛÛfiÙÂÚÔÈ ·Ú¿ÁÔÓÙÂ˜)Î·ıÔÚ›˙ÂÈ ÙÔ ÌÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ (ªÂÙ™˘Ó)(6-10).

ªÂ ÂÓ‰È·Ê¤ÚÔÓ Ù›ıÂÙ·È, ÂÔÌ¤Óˆ˜, ÙÔ ÂÚÒ-ÙËÌ· Â¿Ó Ë ÌÂÙ·‚ÔÏ‹ ÙË˜ ·¯˘Û·ÚÎ›·˜ ÛÙ··È‰È¿ Î·È ÛÙÔ˘˜ ÂÊ‹‚Ô˘˜ Û˘ÓÔ‰Â‡ÂÙ·È ·fi·Ó¿ÏÔÁË ÌÂÙ·‚ÔÏ‹ ÛÙ· ÏÈ›‰È· ÔÚÔ‡ ·›Ì·ÙÔ˜,ÛÙÔ GLU Î·È ÛÙËÓ ·ÚÙËÚÈ·Î‹ ›ÂÛË (∞¶). √ J.Eisenmann ÛÂ ·Ó·ÛÎfiËÛË, ÙÔ 2003, ÛÂ ÌÂÏ¤-ÙÂ˜ ·È‰ÈÒÓ ÙˆÓ ∏¶∞ Î·È ÙÔ˘ ∫·Ó·‰¿ (11),ÙÔÓ›˙ÂÈ fiÙÈ “·Ú¿ ÙËÓ ÂÈ‰ËÌÈÎ‹ ·‡ÍËÛË ÙË˜·¯˘Û·ÚÎ›·˜ ÙÈ˜ ÙÂÏÂ˘Ù·›Â˜ ‰ÂÎ·ÂÙ›Â˜, ˘¿Ú-¯Ô˘Ó ÂÓ‰Â›ÍÂÈ˜ ÁÈ· ·ÓÙ›ıÂÙË ·ÏÏ·Á‹ ÛÙ· Â›-Â‰· ÙˆÓ ÏÈÈ‰›ˆÓ Î·È ÙË˜ ·ÚÙËÚÈ·Î‹˜ ›Â-ÛË˜”. ø˜ Î·ıÔÚÈÛÙÈÎ‹ ·Ó·Ê¤ÚÂÈ ÙËÓ Â›‰Ú·ÛËÎ·È ¿ÏÏˆÓ ·Ú·ÁfiÓÙˆÓ, fiˆ˜ Ë ÛˆÌ·ÙÈÎ‹¿ÛÎËÛË, Ô Û‡Á¯ÚÔÓÔ˜ ÙÚfiÔ˜ ˙ˆ‹˜, Ë ‰È·ÙÚÔ-Ê‹, ÙÔ stress Î·È Ë ‰È·Ù·Ú·¯‹ Î·È ·ÔÚ‡ıÌÈÛËÙÔ˘ ¿ÍÔÓ· ˘Ôı·Ï¿ÌÔ˘-˘fiÊ˘ÛË˜ Î·È ÂÈÓÂ-ÊÚÈ‰›ˆÓ.

øÛÙfiÛÔ, ÛÙËÓ ÏËı˘ÛÌÈ·Î‹ Ù¿ÛË (seculartrend) ÁÈ· ·‡ÍËÛË ÙˆÓ ÛˆÌ·ÙÔÌÂÙÚÈÎÒÓ ÌÂÁÂ-ıÒÓ, Ï·Ì‚¿ÓÔÓÙ·È ˘’ fi„ÈÓ Î·È ¿ÏÏÔÈ ·Ú¿ÁÔ-ÓÙÂ˜, fiˆ˜ .¯. Ë ÌÂÙ·‚ÔÏ‹ ÛÙÈ˜ ÎÔÈÓˆÓÈÎo-ÔÈÎÔÓÔÌÈÎ¤˜ Û˘Óı‹ÎÂ˜ Î·È ÛÙÔÓ ÙfiÔ Î·ÙÔÈ-Î›·˜ (12).

™ÎÔfi˜ ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ ‹Ù·Ó Ë ÂÎÙ›-ÌËÛË ÙË˜ ÌÂÙ·‚ÔÏ‹˜ ÙˆÓ ÛˆÌ·ÙÔÌÂÙÚÈÎÒÓ ÌÂ-ÁÂıÒÓ, ÙË˜ ∞¶, ÙÔ˘ GLU Î·È ÙˆÓ ÏÈÈ‰›ˆÓ ·È-‰ÈÒÓ ÙË˜ ∫Ú‹ÙË˜, ËÏÈÎ›·˜ 5-15 ÂÙÒÓ, ÌÂÙ·Í‡ÙˆÓ ¯ÚÔÓÈÎÒÓ ÂÚÈfi‰ˆÓ 1989-1993 Î·È 1999-2003, Î·ıÒ˜ Î·È Ë ÂÎÙ›ÌËÛË ÙË˜ ÌÂÙ·‚ÔÏ‹˜ ÙÔ˘ÂÈÔÏ·ÛÌÔ‡ ÙÔ˘ ªÂÙ™˘Ó.


¶ÂÚÈÔ¯‹ ÌÂÏ¤ÙË˜

∏ ÌÂÏ¤ÙË Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ ÛÂ ·È‰È¿ ÙË˜ ∫Ú‹-ÙË˜ Ô˘ Û˘ÌÌÂÙÂ›¯·Ó ÛÂ ÌÂÏ¤ÙÂ˜ ÙË˜ ∫ÏÈÓÈÎ‹˜ ¶ÚÔÏË-ÙÈÎ‹˜ π·ÙÚÈÎ‹˜ Î·È ¢È·ÙÚÔÊ‹˜, ÙË˜ π·ÙÚÈÎ‹˜ ™¯ÔÏ‹˜ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹ÙË˜.

√ ÌfiÓÈÌÔ˜ ÏËı˘ÛÌfi˜ ÙÔ˘ ÓËÛÈÔ‡ ·˘Í‹ıËÎÂ ÙË ‰Â-Î·ÂÙ›· ÙÔ˘ 1990 ·fi 540.054 ÛÂ 594.368 Î·ÙÔ›ÎÔ˘˜ ‹9,1%. ∆Ô 2001, ÙÔ 46% ÙÔ˘ ÏËı˘ÛÌÔ‡ ‹Ù·Ó ·ÛÙÈÎfi˜,


42% ·ÁÚÔÙÈÎfi˜ Î·È 12% ËÌÈ·ÛÙÈÎfi˜. ∆Ô Î·Ù¿ ÎÂÊ·Ï‹Ó ∞∂¶

ÙˆÓ ∫ÚËÙÈÎÒÓ ·˘Í‹ıËÎÂ Î·Ù¿ 41% (ÛÙÔÈ¯Â›· ∂™À∂).

¶ÏËı˘ÛÌfi˜ ÌÂÏ¤ÙË˜

ªÂÏÂÙ‹ıËÎ·Ó ‰‡Ô ·ÓÙÈÚÔÛˆÂ˘ÙÈÎ¿ ‰Â›ÁÌ·Ù· 1878

·È‰ÈÒÓ ËÏÈÎ›·˜ 5-15 ÂÙÒÓ ·fi fiÏË ÙËÓ ∫Ú‹ÙË.

∆Ô ÚÒÙÔ ‰Â›ÁÌ· ·ÔÙÂÏÔ‡Ó 987 ·È‰È¿ (491 ·ÁfiÚÈ·).

∂ÈÏ¤¯ıËÎ·Ó ·fi 2785 Ô˘ Û˘ÌÌÂÙÂ›¯·Ó ÛÂ ¤ÍÈ ÌÂÏ¤ÙÂ˜, ÔÈ

ÔÔ›Â˜ Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó ·fi ÙËÓ ∫ÏÈÓÈÎ‹, Î·Ù¿ ÙË ¯ÚÔ-

ÓÈÎ‹ ÂÚ›Ô‰Ô 1989-1993 Î·È ·ÊÔÚÔ‡Û·Ó ¶ÚÔÁÚ¿ÌÌ·Ù· ∞Áˆ-

Á‹˜ Î·È ¶ÚÔ·ÁˆÁ‹˜ ÙË˜ ÀÁÂ›·˜ ÁÈ· ÙË ÛˆÌ·ÙÈÎ‹ ·Ó¿Ù˘ÍË

Î·È ÙËÓ ÚfiÏË„Ë ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÁÈ· Î·Ú‰È·ÁÁÂÈ·Î‹

ÓfiÛÔ (13-18). ¶·ÚfiÌÔÈ·, ÌÂ ·ÓÙÈÛÙÔ›¯ÈÛË (ˆ˜ ÚÔ˜ Ê‡ÏÔ-

ËÏÈÎ›·-ÂÚÈÔ¯‹ Î·ÙÔÈÎ›·˜) ÂÈÏ¤¯ıËÎÂ ÙÔ ‰Â‡ÙÂÚÔ ‰Â›ÁÌ·

ÙˆÓ 891 ·È‰ÈÒÓ (442 ·ÁfiÚÈ·) ·fi Û‡ÓÔÏÔ 2572 Ô˘ Û˘ÌÌÂ-

ÙÂ›¯·Ó ÛÂ ¤ÍÈ ·Ó¿ÏÔÁÂ˜ ÌÂÏ¤ÙÂ˜, ÔÈ ÔÔ›Â˜ Ú·ÁÌ·ÙÔÔÈ‹ıË-

Î·Ó Î·Ù¿ ÙË ¯ÚÔÓÈÎ‹ ÂÚ›Ô‰Ô 1999-2003 (9,19-21). ∏ ÂÈÏÔ-

Á‹ ÙÔ˘˜ ÛÙÈ˜ ‰Ò‰ÂÎ· ÌÂÏ¤ÙÂ˜ ‹Ù·Ó Ù˘¯·›·-ÔÏ˘ÛÙ·‰È·Î‹.

∞Ú¯ÈÎ¿, ÂÈÏ¤¯ıËÎ·Ó Ù˘¯·›· ÔÈ ÂÚÈÔ¯¤˜ ÌÂÏ¤ÙË˜ (·ÁÚÔÙÈ-

Î¤˜-·ÛÙÈÎ¤˜-ËÌÈ·ÛÙÈÎ¤˜) Î·È ÂÓ Û˘ÓÂ¯Â›·, Ù· Û¯ÔÏÂ›· ÛÙ·

ÔÔ›· ·Ó‹Î·Ó fiÏ· Ù· ·È‰È¿. ∏ ÂÈÏÔÁ‹ ÙÔ˘˜, ̂ ÛÙfiÛÔ, ÁÈ· ÙË

Û˘ÁÎÚfiÙËÛË Î·È ·ÓÙÈÛÙÔ›¯ÈÛË ÙˆÓ ‰‡Ô ‰ÂÈÁÌ¿ÙˆÓ ‹Ù·Ó Ù˘-

¯·›· Î·È Î·ıÔÚ›ÛÙËÎÂ ·fi ÙË Û‡ÓıÂÛË (Î·Ù¿ Ê‡ÏÔ-ËÏÈÎ›·-

ÂÚÈÔ¯‹ Î·ÙÔÈÎ›·˜) ÙÔ˘ ˘ÔÏÔÁÈ˙fiÌÂÓÔ˘ ·È‰ÈÎÔ‡ ÎÚËÙÈÎÔ‡

ÏËı˘ÛÌÔ‡ ËÏÈÎ›·˜ 5-15 ÂÙÒÓ, fiˆ˜ ÂÎÙÈÌ‹ıËÎÂ ·fi ÙËÓ

∂™À∂ ÁÈ· Ù· ¤ÙË 1989 Î·È 1999.

ªÂÙÚ‹ÛÂÈ˜

√È ÌÂÙÚ‹ÛÂÈ˜ ·ÊÔÚÔ‡Û·Ó ÛÙ· ÛˆÌ·ÙÔÌÂÙÚÈÎ¿ ÌÂÁ¤ıË,

ÙËÓ ∞¶, Î·ıÒ˜ Î·È ÛÙË Ï‹„Ë ÔÚÔ‡ ·›Ì·ÙÔ˜ ÁÈ· ÙË Ì¤ÙÚËÛË

ÙÔ˘ GLU Î·È ÙˆÓ ÏÈÈ‰›ˆÓ. ∏ Û˘ÌÌÂÙÔ¯‹ ÙˆÓ ·È‰ÈÒÓ ¤ÁÈÓÂ

ÌÂÙ¿ ·fi ¤ÁÁÚ·ÊË Û˘ÁÎ·Ù¿ıÂÛË ÙˆÓ ÁÔÓ¤ˆÓ ÙÔ˘˜ Î·È ·ÊÔ‡

ÚÔËÁ‹ıËÎÂ ÁÚ·Ù‹ ÂÓËÌ¤ÚˆÛË ÁÈ· ÙË ‰È·‰ÈÎ·Û›· Î·È Ù· Â›-

‰Ë ÙˆÓ ÌÂÙÚ‹ÛÂˆÓ. √È ÌÂÙÚ‹ÛÂÈ˜ ¤ÁÈÓ·Ó ÛÙ· Î·Ù¿ ÙfiÔ˘˜

Û¯ÔÏÂ›·, ÌÂÙ¿ ·fi Û¯ÂÙÈÎ‹ ¤ÁÎÚÈÛË ÙˆÓ ¶ÚÔÁÚ·ÌÌ¿ÙˆÓ

∞ÁˆÁ‹˜ Î·È ¶ÚÔ·ÁˆÁ‹˜ ÙË˜ ÀÁÂ›·˜ Î·È ÙˆÓ ·ÍÈÔÏÔÁ‹ÛÂÒÓ

ÙÔ˘˜ ·fi ÙÔ ¶·È‰·ÁˆÁÈÎfi πÓÛÙÈÙÔ‡ÙÔ Î·È ÙÔ ÀÔ˘ÚÁÂ›Ô ¶·È-

‰Â›·˜. ŒÁÎÚÈÛË, Â›ÛË˜, ÚÔËÁ‹ıËÎÂ Î·È ·fi ÙËÓ ∂ÈÙÚÔ‹

∏ıÈÎ‹˜ Î·È ¢ÂÔÓÙÔÏÔÁ›·˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹ÙË˜.

™ˆÌ·ÙÔÌÂÙÚ‹ÛÂÈ˜

√È ÛˆÌ·ÙÔÌÂÙÚ‹ÛÂÈ˜ ·ÊÔÚÔ‡Û·Ó ÛÙÔ ‚¿ÚÔ˜, ÙÔ ‡„Ô˜, ÙÈ˜

‰ÂÚÌ·ÙÈÎ¤˜ Ù˘¯¤˜ ̂ ÌÔÏ¿ÙË˜, Ï·ÁÔÓ›Ô˘, ‰ÈÎÂÊ¿ÏÔ˘, ÙÚÈÎÂ-

Ê¿ÏÔ˘ Î·È ÛÙËÓ ÂÚ›ÌÂÙÚÔ ·ÚÈÛÙÂÚÔ‡ ‚Ú·¯›ÔÓ· (¶∞µ), ÂÓÒ

˘ÔÏÔÁ›ÛÙËÎÂ Ô ¢ª™ Î·È ÙÔ ¿ıÚÔÈÛÌ· ÙˆÓ 4 ‰ÂÚÌ·ÙÈÎÒÓ

Ù˘¯ÒÓ. ¶Ï‹ÚË˜ ÂÚÈÁÚ·Ê‹ ÙˆÓ ÌÂıfi‰ˆÓ-ÌÂÙÚ‹ÛÂˆÓ ·Ó·-

Ê¤ÚÂÙ·È ÛÂ ÚÔËÁÔ‡ÌÂÓÂ˜ ‰ËÌÔÛÈÂ˘Ì¤ÓÂ˜ ÌÂÏ¤ÙÂ˜ (9,19,20).

°È· ÙÔÓ Î·ıÔÚÈÛÌfi ÙˆÓ ˘¤Ú‚·ÚˆÓ Î·È ·¯‡Û·ÚÎˆÓ ·È-

‰ÈÒÓ, ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó Ù· Î·Ù¿ Ê‡ÏÔ Î·È ËÏÈÎ›· fiÚÈ·,

fiˆ˜ ÔÚ›˙ÔÓÙ·È ·fi ÙÔÓ International Obesity Task Force

(IOTF) (1).

√ ·ÚÈıÌfi˜ ÙˆÓ ·È‰ÈÒÓ Ô˘ ÌÂÙÚ‹ıËÎ·Ó ‰È·Ê¤ÚÂÈ ·fi

Ì¤ÙÚËÛË ÛÂ Ì¤ÙÚËÛË. øÛÙfiÛÔ, Ë Û˘ÌÌÂÙÔ¯‹ ÚÔÛÂÁÁ›˙ÂÈ ÙÔ

99% Î·È ÛÙÈ˜ ‰‡Ô ¯ÚÔÓÈÎ¤˜ ÂÚÈfi‰Ô˘˜, ÌÂ ÂÍ·›ÚÂÛË ÙË Ì¤-

ÙÚËÛË ÙˆÓ ‰ÂÚÌ·ÙÈÎÒÓ Ù˘¯ÒÓ. ŸÛ· ·È‰È¿ Â›¯·Ó Ì¤ÙÚËÛË

¶∞µ Â›¯·Ó ÌÂÙÚËıÂ› ÛÂ ÙÔ˘Ï¿¯ÈÛÙÔÓ Ì›· ·fi ÙÈ˜ ‰ÂÚÌ·ÙÈÎ¤˜

Ù˘¯¤˜.

ª¤ÙÚËÛË ·ÚÙËÚÈ·Î‹˜ ›ÂÛË˜ ·›Ì·ÙÔ˜

∏ ∞¶ ÌÂÙÚ‹ıËÎÂ ÛÂ 928 ·È‰È¿ (94%) ÙÔ 1989-1993 Î·È

ÛÂ 563 ·È‰È¿ (63%) ÙÔ 1999-2003, ÛÂ Î·ıÈÛÙ‹ ı¤ÛË Î·È ÌÂ-

Ù¿ ·fi ·Ó¿·˘ÛË 5-10 ÏÂÙÒÓ. ∏ Ì¤ÙÚËÛË ¤ÁÈÓÂ ÌÂ ˘‰Ú·Ú-

Á˘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¤ÏÂ-

Û·Ó ÙË Û˘ÛÙÔÏÈÎ‹ (™∞¶) Î·È ‰È·ÛÙÔÏÈÎ‹ (¢∞¶) ∞¶, ·ÓÙ›-

ÛÙÔÈ¯·. ∞˘Ù¤˜ ÌÂÙÚ‹ıËÎ·Ó ÙÚÂÈ˜ ÊÔÚ¤˜ ÌÂ ÌÂÛÔ‰È¿ÛÙËÌ·

ÂÓfi˜ ÌÂ ‰‡Ô ÏÂÙÒÓ Î·È ÂÎÙÈÌ‹ıËÎÂ Ô Ì¤ÛÔ˜ fiÚÔ˜, fiˆ˜

ÔÚ›˙ÂÙ·È ÛÙÔ ÚˆÙfiÎÔÏÏÔ MONICA (9,21).

ø˜ ·ıÔÏÔÁÈÎ¿ fiÚÈ· ÂÏ‹ÊıËÛ·Ó ÔÈ Î·Ù¿ Ê‡ÏÔ-ËÏÈÎ›·

90¤˜ ÂÎ·ÙÔÛÙÈ·›Â˜ ı¤ÛÂÈ˜ (∂.£.) ÙË˜ ™∞¶ Î·È ¢∞¶, Ô˘ ·ÓÙÈ-

ÛÙÔÈ¯Ô‡Ó ÛÙËÓ 50‹ ∂.£. ÙÔ˘ ‡„Ô˘˜ ·È‰ÈÒÓ ÙˆÓ ∏¶∞ (23).

§‹„Ë ·›Ì·ÙÔ˜ Î·È ‚ÈÔ¯ËÌÈÎ¤˜ ·Ó·Ï‡ÛÂÈ˜

∏ ·ÈÌÔÏË„›· Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ ÚˆÈÓ¤˜ ÒÚÂ˜, ÌÂÙ¿

·fi 12ˆÚË ÓËÛÙÂ›· Î·È ÛÂ ‡ÙÈ· ı¤ÛË. ¢Â›ÁÌ·Ù· ·›Ì·ÙÔ˜

ÙˆÓ 10 ml ÂÏ‹ÊıËÛ·Ó ÛÂ ÛˆÏËÓ¿ÚÈ· ¯ˆÚ›˜ ·ÓÙÈËÎÙÈÎfi ÁÈ·

ÙÔÓ ‰È·¯ˆÚÈÛÌfi ÙÔ˘ ÔÚÔ‡. ∞Ì¤Ûˆ˜ ÌÂÙ¿, ÁÈ· ÙË Û˘ÓÙ‹ÚËÛ‹

ÙÔ˘˜ ÛÂ ¯·ÌËÏ‹ ıÂÚÌÔÎÚ·Û›· (3-4ÔC), ÙÔÔıÂÙ‹ıËÎ·Ó ÛÂ

ÊÔÚËÙfi „˘ÁÂ›Ô ÌÂ ·ÁÔÎ‡ÛÙÂ˜ Î·È ÌÂÙ·Ê¤ÚıËÎ·Ó ÂÓÙfi˜ 4

ˆÚÒÓ ÛÙ· ÂÚÁ·ÛÙ‹ÚÈ· ÙË˜ ∫ÏÈÓÈÎ‹˜ (9,17-20).

∆Ô GLU ÌÂÙÚ‹ıËÎÂ ÛÂ 410 ·È‰È¿ (42%) ÙÔ 1989-1993

Î·È ÛÂ 633 ·È‰È¿ (71%) ÙÔ 1999-2003, ÂÓÒ Ù· ÏÈ›‰È·: ÔÏÈÎ‹

¯ÔÏËÛÙÂÚfiÏË (TC), ÙÚÈÁÏ˘ÎÂÚ›‰È· (TG), HDL-C, LDL-C Î·È

Ë ÂÎÙ›ÌËÛË ÙÔ˘ ·ıËÚˆÌ·ÙÈÎÔ‡ ‰Â›ÎÙË TC:HDL-C, ÛÂ 591

·È‰È¿ (60%) ÙÔ 1989-1993 Î·È ÛÂ 826 ·È‰È¿ (93%) ÙÔ

1999-2003.

ø˜ ·ıÔÏÔÁÈÎ¿ fiÚÈ· ÂÏ‹ÊıËÛ·Ó Ù· 100 mg/dl ÛÙÔ GLU

(6), Ù· 180 Î·È 200 mg/dl ÛÙËÓ TC, Ù· 110 Î·È 130 mg/dl ÛÙËÓ

LDL-C Î·È ÙÔ 4,00 ÛÙÔÓ ‰Â›ÎÙË TC:HDL-C. ™Ù· TG Î·È ÙËÓ

HDL-C ÂÏ‹ÊıËÛ·Ó ÔÈ Î·Ù¿ Ê‡ÏÔ-ËÏÈÎ›· 90‹ & 10Ë ∂.£.

·ÓÙ›ÛÙÔÈ¯·, 6000 ÂÚ›Ô˘ ÌÂÙÚ‹ÛÂˆÓ ÛÂ ·È‰È¿ ÙË˜ ∫Ú‹ÙË˜

(9). ™ÙËÓ ÂÎÙ›ÌËÛË ÙË˜ Û˘ÁÎ¤ÓÙÚˆÛË˜ ·Ú·ÁfiÓÙˆÓ ªÂÙ™˘Ó

ÂÚÈÂÏ‹ÊıËÛ·Ó ¤ÓÙÂ ‰Â›ÎÙÂ˜, fiˆ˜: ¢ª™ (·¯˘Û·ÚÎ›·),

∞¶ (™∞¶ ‹/Î·È ¢∞¶ ≥90‹ ∂.£.), GLU (≥100 mg/dl), TG

(≥90‹ ∂.£.) Î·È HDL-C (≤10Ë ∂.£.).

™Ù·ÙÈÛÙÈÎ‹ ·Ó¿Ï˘ÛË

°È· ÙËÓ ·Ó¿Ï˘ÛË ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ, ÂÎÙfi˜ ·fi ÙË ÛÙÚˆÌ·-

ÙÔÔÈËÌ¤ÓË Ù˘¯·›· ÂÈÏÔÁ‹ ÙˆÓ ·È‰ÈÒÓ ÛÂ Î¿ıÂ ÂÚ›Ô‰Ô

(Î·Ù¿ Ê‡ÏÔ-ËÏÈÎ›·-ÂÚÈÔ¯‹ Î·ÙÔÈÎ›·˜), ·ÎÔÏÔ‡ıËÛÂ ËÏÈÎÈ·-

Î‹ ÔÌ·‰ÔÔ›ËÛË Î·È ¤ÏÂÁ¯Ô˜ ·˘ÙÒÓ ÙˆÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ

ÙˆÓ ·È‰ÈÒÓ, ÌÂÙ·Í‡ ÙˆÓ ‰‡Ô ‰ÂÈÁÌ¿ÙˆÓ. ∏ ÔÌ·‰ÔÔ›ËÛË

·ÊÔÚÔ‡ÛÂ ÛÙÈ˜ ËÏÈÎ›Â˜ 5-9,9 ÂÙÒÓ Î·È 10-15 ÂÙÒÓ Î·È ¯ÚËÛÈ-

ÌÔÔÈ‹ıËÎ·Ó ÔÈ Ì¤ıÔ‰ÔÈ Student t Î·È χ2 (¶›Ó·Î·˜ 1). ªÂÙ·-

Í‡ ÙˆÓ ¯ÚÔÓÈÎÒÓ ÂÚÈfi‰ˆÓ ‰ÂÓ ‚Ú¤ıËÎÂ ÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿

ÛÙËÓ Î·Ù·ÓÔÌ‹ ÙˆÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ÙˆÓ ÂÈÏÂÁÌ¤ÓˆÓ ·È-

‰ÈÒÓ, ·Ú¿ ÌfiÓÔ ÛÙËÓ ÂÚÈÔ¯‹ Î·ÙÔÈÎ›·˜ ÙÔ˘˜ (·ÁÚÔÙÈÎ‹:

47,8% ¤Ó·ÓÙÈ 42,9%, ·ÓÙ›ÛÙÔÈ¯·, p=0,011), Î·ıÒ˜ ·ÏÏ¿˙ÂÈ

‰È·¯ÚÔÓÈÎ¿ Ë Î·Ù·ÓÔÌ‹ ÙÔ˘ Û˘ÓÔÏÈÎÔ‡ ÏËı˘ÛÌÔ‡ ˆ˜ ÚÔ˜

ÙËÓ ÂÚÈÔ¯‹ Î·ÙÔÈÎ›·˜.

ªÂ ÙÈ˜ ›‰ÈÂ˜ ÌÂıfi‰Ô˘˜ ÂÏ¤Á¯ıËÎ·Ó ·ÎfiÌË ÔÈ Î·Ù·ÓÔÌ¤˜

ˆ˜ ÚÔ˜ Ê‡ÏÔ-ËÏÈÎ›·-ÂÚÈÔ¯‹ Î·ÙÔÈÎ›·˜ (·ÔÙÂÏ¤ÛÌ·Ù·

‰ÂÓ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÂ ›Ó·Î·) ÁÈ· Ù· ·È‰È¿ Ô˘ Â›¯·Ó ÏÈ-

ÁfiÙÂÚÂ˜ ÌÂÙÚ‹ÛÂÈ˜ (ÌÈÎÚfi Ú˘ıÌfi Û˘ÌÌÂÙÔ¯‹˜). ¢ÂÓ ‚Ú¤ıË-

Î·Ó, ˆÛÙfiÛÔ, ÛËÌ·ÓÙÈÎ¤˜ ‰È·ÊÔÚ¤˜ ÛÙËÓ Î·Ù·ÓÔÌ‹ ÙÔ˘˜.

ªÂ ÙË Ì¤ıÔ‰Ô Student t (equal variances not assumed)

ÂÏ¤Á¯ıËÎ·Ó ·ÎfiÌË ÔÈ ÌÂÙ·‚ÔÏ¤˜ ÙˆÓ ÌÂÙÚ‹ÛÂˆÓ ÛÂ Î¿ıÂ Ê‡-

ÏÔ, ÌÂÙ·Í‡ ÙˆÓ ‰‡Ô ¯ÚÔÓÈÎÒÓ ÂÚÈfi‰ˆÓ. ªÂ ÙË χ2 ÂÏ¤Á¯ıËÎÂ

ÛÙÈ˜ ‰‡Ô ÂÚÈfi‰Ô˘˜ Ô ÂÈÔÏ·ÛÌfi˜ ÙË˜ ·¯˘Û·ÚÎ›·˜ Î·È ÙˆÓ

˘„ËÏÒÓ ÂÈ¤‰ˆÓ ÙË˜ ∞¶, ÙÔ˘ GLU Î·È ÙˆÓ ÏÈÈ‰›ˆÓ.

ªÂ ÙËÓ ·Ó¿Ï˘ÛË ÏÔÁÈÛÙÈÎ‹˜ ·ÏÈÓ‰ÚfiÌËÛË˜ (logistic linear

regression) ˘ÔÏÔÁ›ÛÙËÎ·Ó ÔÈ ‰Â›ÎÙÂ˜ Û¯ÂÙÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘

(Odds ratio) Î·È Ù· 95% ‰È·ÛÙ‹Ì·Ù· ÂÌÈÛÙÔÛ‡ÓË˜ ÛÙÈ˜ ‰‡Ô

207ªÂÙ·‚ÔÏ‹ ÛˆÌ·ÙÔÌÂÙÚ‹ÛÂˆÓ, ·ÚÙËÚÈ·Î‹˜ ›ÂÛË˜ Î·È ‰ÂÈÎÙÒÓ ÔÚÔ‡ ·›Ì·ÙÔ˜ ·È‰ÈÒÓ

¶·È‰È·ÙÚÈÎ‹ 2007;70:205-216


ÂÚÈfi‰Ô˘˜, ÁÈ· ·ÁfiÚÈ· Î·È ÎÔÚ›ÙÛÈ· ÌÂ ·˘ÍËÌ¤Ó· Â›Â‰·

¢ª™, ·ÚÙËÚÈ·Î‹˜ ›ÂÛË˜, GLU Î·È ÏÈÈ‰›ˆÓ Î·È ÌÂ Û˘ÌÌÂ-

Ù·‚ÏËÙ‹ ÂÏ¤Á¯Ô˘ ÙËÓ ËÏÈÎ›·.

ªÂ ÙË ¯Ú‹ÛË ÔÏ˘ˆÓ˘ÌÈÎÔ‡ ÌÔÓÙ¤ÏÔ˘ 3Ô˘ ‚·ıÌÔ‡

·ÂÈÎÔÓ›ÛÙËÎÂ ÛÂ ÙÚÈÛ‰È¿ÛÙ·ÙË ÌÔÚÊ‹ ÌÂ ÙËÓ ·‡ÍËÛË ÙË˜

ËÏÈÎ›·˜, Ë Û˘Û¯¤ÙÈÛË ÙÔ˘ ¢ª™ ÌÂ ÙËÓ TC Î·È HDL-C. ∆¤ÏÔ˜,

ÌÂ ÙÔ ‰È¿ÁÚ·ÌÌ· ladder ·ÂÈÎÔÓ›ÛÙËÎÂ Ë Û¯ÂÙÈÎ‹ ÌÂÙ·‚ÔÏ‹

ÌÂÙ·Í‡ ÙˆÓ ‰‡Ô ÂÚÈfi‰ˆÓ ÙÔ˘ ÂÈÔÏ·ÛÌÔ‡ ÙˆÓ ˘„ËÏÒÓ

ÂÈ¤‰ˆÓ: ÙÔ˘ ¢ª™, ÙË˜ ·ÚÙËÚÈ·Î‹˜ ›ÂÛË˜, ÙÔ˘ GLU Î·È

ÙˆÓ ÏÈÈ‰›ˆÓ.


ªÂÙ·Í‡ ÙˆÓ ÂÚÈfi‰ˆÓ 1989-1993 Î·È 1999-2003,ÙÔ ‚¿ÚÔ˜ ÙˆÓ ·ÁÔÚÈÒÓ (¶›Ó·Î·˜ 2) ·˘Í‹ıËÎÂ Î·Ù¿4,3 kg ‹ 11,4% (p<0,001), ÙÔ ‡„Ô˜ Î·Ù¿ 4 cm ‹ 2,9%(p<0,001), Ô ¢ª™ Î·Ù¿ 0,92 kg/m2 ‹ 4,9%(p<0,001), ÙÔ ∞¢¶ Î·Ù¿ 12,2 mm (p<0,001) Î·È Ë¶∞µ Î·Ù¿ 1,8 mm (p<0,001). ∏ ™∞¶ ·˘Í‹ıËÎÂ Î·-Ù¿ 6,7 mmHg (p<0,001) ÛÙÈ˜ ËÏÈÎ›Â˜ 10,0-15,0 ÂÙÒÓ,ÂÓÒ ÌÂÈÒıËÎ·Ó Ë ¢∞¶ Î·Ù¿ 8,9 mmHg (p<0,001),ÙÔ GLU Î·Ù¿ 2,9 mg/dl (p<0,001) Î·È Ë LDL-C Î·Ù¿4,4 mg/dl (p=0,036).

™Ù· ÎÔÚ›ÙÛÈ· (¶›Ó·Î·˜ 3) ÙÔ ‚¿ÚÔ˜ ·˘Í‹ıËÎÂÎ·Ù¿ 3,6 kg ‹ 9,4% (p<0,001), ÙÔ ‡„Ô˜ Î·Ù¿ 2,5 cm‹ 1,8% (p<0,001), Ô ¢ª™ Î·Ù¿ 1,02 kg/m2 ‹ 5,4%(p<0,001), ÙÔ ∞¢¶ Î·Ù¿ 14,2 mm (p<0,001) Î·È Ë¶∞µ Î·Ù¿ 1,5 mm (p<0,001). ∏ ™∞¶ ·˘Í‹ıËÎÂ Î·-Ù¿ 2,5 mmHg (p=0,020), ÂÓÒ ÌÂ›ˆÛË - fiˆ˜ ÛÙ··ÁfiÚÈ· - ‚Ú¤ıËÎÂ ÛÙË ¢∞¶ 5,6 mmHg (p=0,020) Î·ÈÛÙÔ GLU 4,1 mg/dl (p<0,001).

√ ÂÈÔÏ·ÛÌfi˜ ÙˆÓ ˘¤Ú‚·ÚˆÓ ·ÁÔÚÈÒÓ (¶›Ó·-

Î·˜ 4) ·˘Í‹ıËÎÂ Î·Ù¿ 18,8% ·fi ÙÔ 1989-1993 ÛÙÔ

1999-2003 Î·È Î·Ù¿ 82% ÙˆÓ ·¯‡Û·ÚÎˆÓ (·fi

20,7% ÛÂ 24,6% Î·È ·fi 5,0% ÛÂ 9,1%, ·ÓÙ›ÛÙÔÈ¯·,

p=0,011) Î·È ÛÙ· ÎÔÚ›ÙÛÈ· Î·Ù¿ 13,8% Î·È 96,6%,

·ÓÙ›ÛÙÔÈ¯· (·fi 21,8 ÛÂ 24,8% Î·È ·fi 5,9 ÛÂ

11,6%, ·ÓÙ›ÛÙÔÈ¯·, p=0,002). ™˘ÓÔÏÈÎ¿, Ô ÂÈÔÏ·-

ÛÌfi˜ ˘¤Ú‚·ÚˆÓ ·È‰ÈÒÓ ·˘Í‹ıËÎÂ ·fi 21,3% ÛÂ

24,7% (p<0,001) Î·È ÙˆÓ ·¯‡Û·ÚÎˆÓ ·fi 5,4%

ÛÙÔ 10,4% (p<0,001).

∆· ÔÛÔÛÙ¿ ·ÁÔÚÈÒÓ Î·È ÎÔÚÈÙÛÈÒÓ ÌÂ ˘„ËÏ‹

™∞¶ ·˘Í‹ıËÎ·Ó Î·Ù¿ 48,4% (p=0,001) Î·È 72,2%

(p<0,001), ÂÓÒ ÌÂÈÒıËÎ·Ó ÛÙË ¢∞¶ Î·Ù¿ 57,5%

(p<0,001) Î·È 28,9% (p<0,001), ·ÓÙ›ÛÙÔÈ¯·. ™ËÌ·-

ÓÙÈÎ‹ ÌÂ›ˆÛË ‚Ú¤ıËÎÂ Î·È ÛÙ· ÎÔÚ›ÙÛÈ· ÌÂ LDL-C

ÌÂÙ·Í‡ 111-130 mg/dl (ÌÂ›ˆÛË Î·Ù¿ 30,4%,

p=0,015). ∂›ÛË˜, fiÏ· Ù· ·È‰È¿ ·Ú¤ÌÂÈÓ·Ó ÌÂ ·˘-

ÍËÌ¤ÓË TC ÛÙÔ 15,9% (p>0,05), ÂÓÒ ÂÎÂ›ÓˆÓ ÌÂ ·˘-

ÍËÌ¤ÓË LDL-C ÌÂÈÒıËÎ·Ó ·fi 18,8% ÛÂ 17,1%

(p=0,006), ·ÓÙ›ÛÙÔÈ¯· (·ÔÙÂÏ¤ÛÌ·Ù· ‰ÂÓ ·ÚÔ˘-

ÛÈ¿˙ÔÓÙ·È ÛÙÔÓ ›Ó·Î·).

™ÙÔÓ Û˘Ó‰˘·ÛÌfi ·Ú·ÁfiÓÙˆÓ ÙÔ˘ ªÂÙ™˘Ó, ‰ÂÓ

‚Ú¤ıËÎÂ ÛËÌ·ÓÙÈÎ‹ ÌÂÙ·‚ÔÏ‹ ÛÙÔ ÔÛÔÛÙfi ÙˆÓ

·È‰ÈÒÓ ÌÂ ÙÚÂÈ˜ ‹ ÂÚÈÛÛfiÙÂÚÔ˘˜ ·Ú¿ÁÔÓÙÂ˜. ™˘-

ÁÎÂÎÚÈÌ¤Ó·, ÙÔ 4,5% fiÏˆÓ ÙˆÓ ·È‰ÈÒÓ ‚Ú¤ıËÎÂ ÙÔ

1989-1993 ÌÂ ªÂÙ™˘Ó ¤Ó·ÓÙÈ 5,6% ÙÔ 1999-2003.

∆¤ÏÔ˜, ÛÙÔÓ ¶›Ó·Î· 5 ÔÈ ‰Â›ÎÙÂ˜ Û¯ÂÙÈÎÔ‡ ÎÈÓ-

‰‡ÓÔ˘ (Odds Ratio) ¤‰ÂÈÍ·Ó ÁÈ· ÙËÓ ÂÚ›Ô‰Ô 1999-

2003 ÛÂ Û¯¤ÛË ÌÂ ÙËÓ ÂÚ›Ô‰Ô 1989-1993, Ù· ·Áfi-

ÚÈ· Ó· ¤¯Ô˘Ó 2,06 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚÔ Î›Ó‰˘ÓÔ ÁÈ·

208 ª. §ÈÓ·Ú‰¿ÎË˜ Î·È Û˘Ó.


¶›Ó·Î·˜ 1. Ã·Ú·ÎÙËÚÈÛÙÈÎ¿ Î·È ‰È·ÊÔÚ¤˜ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ÙˆÓ 1878 ·È‰ÈÒÓ ÙË˜ ∫Ú‹ÙË˜, ËÏÈÎ›·˜ 5 ¤ˆ˜ 15 ÂÙÒÓ, ÛÙÈ˜ ÂÚÈfi‰Ô˘˜ 1989-1993Î·È 1999-2003

1989-1993 1999-2003

N (%) p-value*

∞ÁfiÚÈ· 491 (49,7) 442 (49,6) 0,952∫ÔÚ›ÙÛÈ· 496 (50,3) 449 (50,4)

5,0-9,9 ÂÙÒÓ 458 (46,4) 383 (43,0) 0,13710,0-15,0 ÂÙÒÓ 429 (53,6) 508 (57,0)

∞ÁÚÔÙÈÎ‹ 472 (47,8) 382 (42,9) 0,011∏ÌÈ·ÛÙÈÎ‹ 66 (6,7) 89 (10,0)∞ÛÙÈÎ‹ 449 (46,5) 420 (47,1)

ª¤ÛË ËÏÈÎ›· ± ∆∞ (¡) p-value**

∏ÏÈÎ›· (¤ÙË) ∞ÁfiÚÈ· 10,4±2,7 (491) 10,5±2,7 (442) 0,298∫ÔÚ›ÙÛÈ· 10,4±2,8 (496) 10,5±2,9 (449) 0,330

™‡ÓÔÏÔ 10,4±2,8 (987) 10,5±2,8 (891) 0,609

5,0-9,9 ∞ÁfiÚÈ· 7,8±1,5 (224) 7,8±1,6 (183) 0,809∫ÔÚ›ÙÛÈ· 7,8±1,4 (234) 7,7±1,5 (200) 0,523

10,0-15,0 ∞ÁfiÚÈ· 12,6±1,1 (267) 12,5±1,3 (259) 0,471∫ÔÚ›ÙÛÈ· 12,7±1,3 (262) 12,7±1,4 (249) 0,954

* ŒÏÂÁ¯Ô˜ χ2, ** ŒÏÂÁ¯Ô˜ Student t


·¯˘Û·ÚÎ›· (95% ¢∂: 1,21-3,49, p=0,008) Î·È Ù· ÎÔ-

Ú›ÙÛÈ· 2,31 ÊÔÚ¤˜ (95% ¢∂: 1,42-3,76, p=0,001). √

Î›Ó‰˘ÓÔ˜ ÁÈ· ˘„ËÏ‹ ™∞¶ ‚Ú¤ıËÎÂ 1,81 ÊÔÚ¤˜ ÌÂÁ·-

Ï‡ÙÂÚÔ˜ ÛÙ· ·ÁfiÚÈ· (p<0,001) Î·È 2,39 ÛÙ· ÎÔÚ›ÙÛÈ·

(p<0,001). ∞ÓÙ›ıÂÙ·, ÌÂÈˆÌ¤ÓË Èı·ÓfiÙËÙ· ÁÈ· ˘„Ë-

Ï‹ ¢∞¶ ‚Ú¤ıËÎÂ Î·Ù¿ 75% ÛÙ· ·ÁfiÚÈ· (p<0,001)

Î·È 46% ÛÙ· ÎÔÚ›ÙÛÈ· (p<0,001). ∂›ÛË˜, ÌÂÈˆÌ¤ÓË

Èı·ÓfiÙËÙ· ÁÈ· ˘„ËÏ¿ Â›Â‰· GLU ‚Ú¤ıËÎÂ ÙÔ

1999-2003 ÛÙ· ÎÔÚ›ÙÛÈ· Î·Ù¿ 56% (p=0,025).

∂ÈÏ¤ÔÓ, Ù· ·ÁfiÚÈ· ÙË˜ ÂÚÈfi‰Ô˘ 1999-2003

‚Ú¤ıËÎ·Ó ÛÂ Û¯¤ÛË ÌÂ ÂÎÂ›Ó· ÙË˜ 1989-1993, ÌÂ

ÌÂÈˆÌ¤ÓË Èı·ÓfiÙËÙ· Î·Ù¿ 57% (p=0,098) Ó· ·Ó·-

Ù‡ÍÔ˘Ó ªÂÙ™˘Ó, ÂÓÒ ÛÙ· ÎÔÚ›ÙÛÈ· Ô Î›Ó‰˘ÓÔ˜

‹Ù·Ó 2,69 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚÔ˜ (p=0,064). ∆Ô 1989-

1993 ÌfiÏÈ˜ ÙÔ 14,3% ÙˆÓ ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ

‚Ú¤ıËÎÂ ÌÂ ªÂÙ™˘Ó, ÂÓÒ ÙÔ 1999-2003 ÙÔ 37,3%

(p<0,001) (·ÔÙÂÏ¤ÛÌ·Ù· ‰ÂÓ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È

ÛÙÔÓ ›Ó·Î·). ∂ÈÏ¤ÔÓ, ÛÙ· ·¯‡Û·ÚÎ· ·È‰È¿ Ô

Î›Ó‰˘ÓÔ˜ Ó· ·Ó·Ù‡ÍÔ˘Ó ªÂÙ™˘Ó ‹Ù·Ó 3,89 ÙÔ

1989-1993 (95% ¢∂: 0,38-20,15, p>0,05), Î·ıÒ˜ ÙÔ

1999-2003 ·˘Í‹ıËÎÂ ÂÙ¿ ÊÔÚ¤˜ Î·È ·Ó‹ÏıÂ ÛÙÔ

27,08 (95% ¢∂: 10,77-69,99, p<0,001).


¶·È‰È·ÙÚÈÎ‹ 2007;70:205-216

¶›Ó·Î·˜ 2. ∂›Â‰· ÛˆÌ·ÙÔÌÂÙÚÈÎÒÓ ÌÂÁÂıÒÓ, ·ÚÙËÚÈ·Î‹˜ ›ÂÛË˜ Î·È ÏÈÈ‰›ˆÓ ÔÚÔ‡ ·›Ì·ÙÔ˜ ·ÁÔÚÈÒÓ ÙË˜ ∫Ú‹ÙË˜, ËÏÈÎ›·˜ 5-15 ÂÙÒÓ, ÌÂ-Ù·Í‡ ÙˆÓ ¯ÚÔÓÈÎÒÓ ÂÚÈfi‰ˆÓ 1989-1993 Î·È 1999-2003

1989-1993 1999-2003 ªÂÙ·‚ÔÏ‹

ª¤ÙÚËÛË ∏ÏÈÎ›· ¡ ª¤ÛË ÙÈÌ‹ (∆∞) ¡ ª¤ÛË ÙÈÌ‹ (∆∞) p-value

µ¿ÚÔ˜ (kg) 5,0-9,9 220 27,7 (6,4) 181 30,2 (9,3) 2,5 0,00310,0-15,0 259 46,4 (11,5) 258 50,6 (13,0) 4,2 <0,001

™‡ÓÔÏÔ 479 37,8 (13,4) 439 42,2 (15,4) 4,3 <0,001⁄„Ô˜ (cm) 5,0-9,9 220 126,8 (9,8) 181 128,1 (10,3) 1,3 0,187

10,0-15,0 258 151,6 (9,3) 258 155,4 (12,4) 3,9 <0,001™‡ÓÔÏÔ 478 140,2 (15,6) 439 144,2 (17,8) 4,0 <0,001

¢ª™ (kg/m2) 5,0-9,9 220 17,07 (2,49) 181 18,00 (3,23) 0,93 0,00210,0-15,0 258 20,01 (3,49) 258 20,69 (3,65) 0,67 0,033

™‡ÓÔÏÔ 478 18,66 (3,39) 439 19,58 (3,72) 0,92 <0,001∞¢¶ (mm) 5,0-9,9 131 33,6 (18,5) 181 47,5 (24,2) 13,9 <0,001

10,0-15,0 170 43,5 (23,8) 258 54,3 (28,9) 10,8 <0,001™‡ÓÔÏÔ 301 39,2 (22,2) 439 51,5 (27,3) 12,2 <0,001

¶∞µ (mm) 5,0-9,9 200 19,3 (2,3) 181 20,4 (3,3) 1,2 <0,00110,0-15,0 181 22,9 (3,7) 258 24,4 (3,4) 1,6 <0,001

™‡ÓÔÏÔ 381 21,0 (3,5) 439 22,8 (3,9) 1,8 <0,001™∞¶ (mmHg) 5,0-9,9 208 105,1 (10,9) 128 102,7 (15,8) -2,4 0,129

10,0-15,0 256 111,8 (11,7) 135 118,5 (11,0) 6,7 <0,001™‡ÓÔÏÔ 464 108,8 (11,8) 263 110,8 (15,6) 2,0 0,070

¢∞¶ (mmHg) 5,0-9,9 208 71,8 (10,9) 128 65,1 (11,0) -6,7 <0,00110,0-15,0 256 74,0 (9,3) 135 63,1 (12,9) -10,9 <0,001

™‡ÓÔÏÔ 464 73,0 (10,1) 263 64,1 (12,0) -8,9 <0,001GLU (mg/dl) 5,0-9,9 45 85,0 (10,8) 163 87,1 (8,8) 2,1 0,229

10,0-15,0 162 91,8 (7,7) 148 87,6 (9,7) -4,2 <0,001™‡ÓÔÏÔ 207 90,3 (8,9) 311 87,4 (9,2) -2,9 <0,001

TC (mg/dl) 5,0-9,9 102 175,5 (29,5) 166 172,8 (25,6) -2,7 0,44510,0-15,0 188 171,2 (31,3) 241 166,2 (29,4) -5,0 0,093

™‡ÓÔÏÔ 290 172,7 (30,7) 407 168,9 (20,1) -3,8 0,094TG (mg/dl) 5,0-9,9 97 61,5 (30,1) 166 55,7 (21,0) -5,9 0,091

10,0-15,0 171 66,1 (32,5) 241 66,2 (29,0) 0,1 0,989™‡ÓÔÏÔ 268 64,5 (31,7) 407 61,9 (26,6) -2,6 0,270

HDL-C (mg/dl) 5,0-9,9 101 53,3 (13,4) 166 54,3 (11,8) 1,0 0,53010,0-15,0 187 52,9 (12,6) 241 51,4 (13,3) -1,5 0,250

™‡ÓÔÏÔ 288 53,0 (12,9) 407 52,6 (12,8) -0,4 0,673LDL-C (mg/dl) 5,0-9,9 102 110,9 (28,7) 166 107,1 (23,6) -3,6 0,254

10,0-15,0 188 106,6 (28,6) 241 101,5 (25,3) -2,6 0,054™‡ÓÔÏÔ 290 108,0 (28,6) 407 103,7 (24,8) -4,4 0,036

¢Â›ÎÙË˜ TC:HDL 5,0-9,9 101 3,47 (0,97) 166 3,30 (0,81) -0,13 0,14610,0-15,0 187 3,40 (1,00) 241 3,40 (0,89) 0,00 0,932

™‡ÓÔÏÔ 288 3,43 (0,99) 407 3,36 (0,86) -0,07 0,340

Student t test (equal variances not assumed)


∞fi ÙËÓ ∂ÈÎfiÓ· 1 ‰È·ÈÛÙÒÓÂÙ·È fiÙÈ ÙÔ 1999-

2003 ÛÂ Û¯¤ÛË ÌÂ ÙÔ 1989-1993, Ë ÂÈÊ¿ÓÂÈ· ÙˆÓ ÙÈ-

ÌÒÓ ÙÔ˘ ¢ª™ ÙÂ›ÓÂÈ Ó· ·˘Í¿ÓÂÙ·È ÌÂ ÙËÓ ·‡ÍËÛË

ÙË˜ ËÏÈÎ›·˜ Î·È ÙË˜ TC. ∞ÓÙ›ıÂÙ·, ÌÈÎÚ¤˜ ÙÈÌ¤˜

HDL-C (∂ÈÎfiÓ· 2) ·ÓÙÈÛÙÔÈ¯Ô‡Ó ÛÂ ˘„ËÏfiÙÂÚÂ˜ ÙÈ-

Ì¤˜ ÙÔ˘ ¢ª™.

∞fi ÙËÓ ∂ÈÎfiÓ· 3 ‰È·ÈÛÙÒÓÂÙ·È ·‡ÍËÛË ÙÔ˘ ÂÈ-

ÔÏ·ÛÌÔ‡ ÙˆÓ ̆ ¤Ú‚·ÚˆÓ Î·È ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ

(¢ª™) Î·È ÙË˜ ·˘ÍËÌ¤ÓË˜ ·ÚÙËÚÈ·Î‹˜ ›ÂÛË˜, ÛÙ·-

ıÂÚÔÔ›ËÛË ÙÔ˘ ÂÈÔÏ·ÛÌÔ‡ ÙË˜ ·˘ÍËÌ¤ÓË˜ TC

Î·ıÒ˜ Î·È ÌÂ›ˆÛË ÙÔ˘ ÂÈÔÏ·ÛÌÔ‡ ÌÂ ·˘ÍËÌ¤ÓÔ

GLU Î·È ÌÂ ¯·ÌËÏ‹ HDL-C. °ÂÓÈÎ¿, ÌÈÎÚ‹ ·‡ÍËÛË

‰È·ÈÛÙÒÓÂÙ·È Î·È ÛÙÔÓ ÂÈÔÏ·ÛÌfi ÙÔ˘ ªÂÙ™˘Ó.

™˘˙‹ÙËÛË

∆· ÛˆÌ·ÙÔÌÂÙÚÈÎ¿ ÌÂÁ¤ıË ·È‰ÈÒÓ ÙË˜ ∫Ú‹ÙË˜,

fiˆ˜ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË, ·˘Í‹-

ıËÎ·Ó ÛËÌ·ÓÙÈÎ¿ ÂÓÙfi˜ ÙÔ˘ ‚Ú·¯¤Ô˜ ‰È·ÛÙ‹Ì·ÙÔ˜

ÌÂÙ·Í‡ 1989-1993 Î·È 1999-2003.

∆Ô Ì¤ÛÔ ‚¿ÚÔ˜ ·˘Í‹ıËÎÂ Î·Ù¿ 4 kg ‹ 10,4% (4,3

kg ÛÙ· ·ÁfiÚÈ· Î·È 3,6 kg ÛÙ· ÎÔÚ›ÙÛÈ·) ÌÂ ·Ú¿ÏÏË-

ÏË ·‡ÍËÛË ÙÔ˘ ‡„Ô˘˜ Î·Ù¿ 3,3 cm ‹ 2,4% (4 cm ÛÙ·

210 ª. §ÈÓ·Ú‰¿ÎË˜ Î·È Û˘Ó.


¶›Ó·Î·˜ 3. ∂›Â‰· ÛˆÌ·ÙÔÌÂÙÚÈÎÒÓ ÌÂÁÂıÒÓ, ·ÚÙËÚÈ·Î‹˜ ›ÂÛË˜ Î·È ÏÈÈ‰›ˆÓ ÔÚÔ‡ ·›Ì·ÙÔ˜ ÎÔÚÈÙÛÈÒÓ ÙË˜ ∫Ú‹ÙË˜, ËÏÈÎ›·˜ 5-15 ÂÙÒÓ,ÌÂÙ·Í‡ ÙˆÓ ¯ÚÔÓÈÎÒÓ ÂÚÈfi‰ˆÓ 1989-1993 Î·È 1999-2003

1989-1993 1999-2003 ªÂÙ·‚ÔÏ‹

ª¤ÙÚËÛË ∏ÏÈÎ›· ¡ ª¤ÛË ÙÈÌ‹ (∆∞) ¡ ª¤ÛË ÙÈÌ‹ (∆∞) p-value

µ¿ÚÔ˜ (kg) 5,0-9,9 230 27,8 (7,5) 198 30,4 (7,4) 2,6 0,004

10,0-15,0 247 47,9 (10,8) 249 50,9 (11,9) 2,9 0,004™‡ÓÔÏÔ 477 38,2 (13,7) 447 41,8 (15,1) 3,6 <0,001

⁄„Ô˜ (cm) 5,0-9,9 230 126,7 (9,8) 198 126,9 (9,9) 0,2 0,81210,0-15,0 247 152,1 (8,3) 249 154,5 (8,3) 2,5 0,001

™‡ÓÔÏÔ 477 139,8 (15,6) 447 142,3 (16,5) 2,5 0,020¢ª™ (kg/m2) 5,0-9,9 230 17,07 (2,75) 198 18,36 (3,75) 1,30 <0,001

10,0-15,0 247 20,55 (3,57) 249 21,12 (3,84) 0,60 0,088™‡ÓÔÏÔ 477 18,87 (3,64) 447 19,90 (4,03) 1,02 <0,001

∞¢¶ (mm) 5,0-9,9 134 34,0 (20,3) 199 55,1 (26,3) 18,1 <0,00110,0-15,0 167 50,6 (21,0) 248 61,7 (25,1) 11,1 <0,001

™‡ÓÔÏÔ 301 44,5 (21,8) 447 58,8 (25,8) 14,2 <0,001¶∞µ (mm) 5,0-9,9 205 19,7 (20,9) 198 20,9 (3,5) 1,2 <0,001

10,0-15,0 177 23,4 (3,1) 249 24,6 (3,3) 1,2 <0,001™‡ÓÔÏÔ 382 21,4 (3,5) 447 22,9 (3,9) 1,5 <0,001

™∞¶ (mmHg) 5,0-9,9 217 103,9 (11,1) 159 102,0 (15,0) -1,9 0,17410,0-15,0 247 111,0 (11,3) 141 119,4 (10,0) 8,4 <0,001

™‡ÓÔÏÔ 464 107,7 (11,8) 300 110,1 (15,6) 2,5 0,020¢∞¶ (mmHg) 5,0-9,9 217 69,7 (10,3) 159 66,7 (10,9) -3,0 0,007

10,0-15,0 247 75,8 (7,9) 141 67,5 (11,8) -8,3 <0,001™‡ÓÔÏÔ 464 72,9 (9,6) 300 67,0 (11,3) -5,6 <0,001

GLU (mg/dl) 5,0-9,9 58 83,6 (10,1) 173 85,4 (8,3) 1,8 0,11210,0-15,0 145 91,4 (8,6) 149 84,7 (8,7) -6,8 <0,001

™‡ÓÔÏÔ 303 89,2 (9,7) 322 85,1 (8,5) -4,1 <0,001TC (mg/dl) 5,0-9,9 119 180,4 (32,2) 177 173,2 (30,6) -7,2 0,057

10,0-15,0 182 170,4 (28,6) 242 174,6 (34,9) 4,2 0,174™‡ÓÔÏÔ 301 174,3 (30,5) 419 174,0 (33,2) -0,3 0,888

TG (mg/dl) 5,0-9,9 113 63,9 (25,4) 176 63,7 (26,5) -0,3 0,93410,0-15,0 168 70,0 (30,9) 242 74,8 (31,5) 4,9 0,120

™‡ÓÔÏÔ 281 67,5 (28,9) 418 70,1 (30,0) 2,6 0,252HDL-C (mg/dl) 5,0-9,9 119 52,7 (12,3) 177 52,1 (11,9) -0,6 0,698

10,0-15,0 181 53,5 (15,1) 242 52,5 (12,9) -1,0 0,475™‡ÓÔÏÔ 300 53,2 (14,0) 419 52,3 (12,4) -0,9 0,413

LDL-C (mg/dl) 5,0-9,9 119 115,6 (29,6) 176 108,3 (28,0) -7,3 0,03510,0-15,0 182 104,3 (28,1) 242 107,2 (30,5) 2,9 0,315

™‡ÓÔÏÔ 301 108,8 (29,2) 418 107,7 (29,5) -1,0 0,614¢Â›ÎÙË˜ TC:HDL 5,0-9,9 119 3,59 (1,00) 177 3,45 (0,84) -0,14 0,201

10,0-15,0 181 3,39 (0,94) 242 3,50 (1,07) 0,11 0,300™‡ÓÔÏÔ 300 3,47 (0,96) 419 3,48 (0,98) 0,01 0,958

Student t test (equal variances not assumed)


·ÁfiÚÈ· Î·È 2,5 cm ÛÙ· ÎÔÚ›ÙÛÈ·). ø˜ Û˘Ó¤ÂÈ·, fiÌˆ˜,

ÙË˜ ÌÂÁ·Ï‡ÙÂÚË˜ ·‡ÍËÛË˜ ÙÔ˘ ‚¿ÚÔ˘˜, Ô ¢ª™ ·˘Í‹-

ıËÎÂ Î·Ù¿ 0,97 kg/m2 ‹ 5,2%, ÌÂ ÙË ÌÂÁ·Ï‡ÙÂÚË ·‡ÍË-

ÛË Ó· ‰È·ÈÛÙÒÓÂÙ·È ÛÙ· ÎÔÚ›ÙÛÈ· ÌÂ ÔÛÔÛÙfi 5,4%.

∞fi ÌÂÏ¤ÙË ÛÂ ·ÁfiÚÈ· ÙË˜ ∫Ú‹ÙË˜ ËÏÈÎ›·˜ 9-15

ÂÙÒÓ (22) Î·È ÁÈ· ‰È¿ÛÙËÌ· ÌÂÁ·Ï‡ÙÂÚÔ ·fi ·˘Ùfi

ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ (1982 ¤ˆ˜ 2002), ‚Ú¤ıËÎÂ

·‡ÍËÛË 4,4 kg (9,6%) ÛÙÔ ‚¿ÚÔ˜, 1,7 cm (1,1%) ÛÙÔ

‡„Ô˜ Î·È 1,64 kg/m2 (8,4%) ÛÙÔÓ ¢ª™. ∂›ÛË˜ ·fi

ÙË Û‡ÁÎÚÈÛË ÙË˜ 50Ë˜ ∂.£. ÙÔ˘ ‚¿ÚÔ˘˜ Î·È ÙÔ˘

‡„Ô˘˜ ÙˆÓ ·È‰ÈÒÓ (∂ÈÎfiÓ· 4) ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤-

ÙË˜ Î·È ÙˆÓ ·È‰ÈÒÓ ÙË˜ ÌÂÏ¤ÙË˜ ÙÔ˘ πÓÛÙÈÙÔ‡ÙÔ˘

ÀÁÂ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡ (24), ‰È·ÈÛÙÒÓÂÙ·È Ë ÌÂÁ·Ï‡-

ÙÂÚË ·‡ÍËÛË ÙÔ˘ ‚¿ÚÔ˘˜ Î·È ÌÈÎÚfiÙÂÚË ÙÔ˘ ‡„Ô˘˜

ÛÂ fiÏÂ˜ Û¯Â‰fiÓ ÙÈ˜ ËÏÈÎ›Â˜ ÙˆÓ ·È‰ÈÒÓ, ÁÈ· ÙËÓ Â-

Ú›Ô‰Ô 1999-2003.

™Â ÌÂÏ¤ÙË ·ÁÔÚÈÒÓ ËÏÈÎ›·˜ 6-15 ÂÙÒÓ ÙË˜ ™·Ú·-

ÁfiÛ· (25), ÌÂÙ·Í‡ ÙˆÓ ÂÙÒÓ 1980 Î·È 1995, ‚Ú¤ıË-

Î·Ó ÌÈÎÚfiÙÂÚÂ˜ ·˘Í‹ÛÂÈ˜, ÛÂ Û¯¤ÛË ÌÂ ÙËÓ ·ÚÔ‡Û·

ÌÂÏ¤ÙË, ÛÙÔ ‚¿ÚÔ˜ (3,4 kg ‹ 9,9%), ÛÙÔ ‡„Ô˜ (3,9

cm ‹ 2,8%) Î·È ÛÙÔÓ ¢ª™ (0,64 kg/m2 ‹ 3,6%).

øÛÙfiÛÔ, Ù· ·ÁfiÚÈ· ÙË˜ ™·Ú·ÁfiÛ· Â›¯·Ó, ÙÔ 1995, ÛÂ

Û¯¤ÛË ÌÂ Ù· ·ÁfiÚÈ· ·Ó¿ÏÔÁË˜ ËÏÈÎ›·˜ ÙË˜ ∫Ú‹ÙË˜

ÙË˜ ÂÚÈfi‰Ô˘ 1989-1993, ÛËÌ·ÓÙÈÎ¿ ÌÈÎÚfiÙÂÚÔ ‡„Ô˜

(139,2 ¤Ó·ÓÙÈ 141,4 cm, p=0,001, ·ÓÙ›ÛÙÔÈ¯·) Î·È

¢ª™ (18,2 ¤Ó·ÓÙÈ 18,7 kg/m2, p=0,001, ·ÓÙ›ÛÙÔÈ¯·).


¶·È‰È·ÙÚÈÎ‹ 2007;70:205-216

¶›Ó·Î·˜ 4. ∂ÈÔÏ·ÛÌfi˜ ˘ÂÚ‚ÔÏÈÎÔ‡ ‚¿ÚÔ˘˜ Î·È ·¯˘Û·ÚÎ›·˜, ·˘ÍËÌ¤ÓË˜ ·ÚÙËÚÈ·Î‹˜ ›ÂÛË˜, Û·Î¯¿ÚÔ˘ Î·È ÏÈÈ‰›ˆÓ ÔÚÔ‡ ·›Ì·ÙÔ˜ ·È-‰ÈÒÓ ÙË˜ ∫Ú‹ÙË˜, ÌÂÙ·Í‡ ÙˆÓ ÂÚÈfi‰ˆÓ 1989-1993 Î·È 1999-2003

∞ÁfiÚÈ· ∫ÔÚ›ÙÛÈ·

1989-1993 1999-2003 ¶ÔÛÔÛÙÈ·›· 1989-1993 1999-2003 ¶ÔÛÔÛÙÈ·›·

ª¤ÙÚËÛË ŸÚÈ· ¡ (%) ÌÂÙ·‚ÔÏ‹ ¡ (%) ÌÂÙ·‚ÔÏ‹

¢ª™ º˘ÛÈÔÏÔÁÈÎ¿ 355 (74,3) 291 (66,3) -9,7 345 (72,3) 284 (63,5) -12,2À¤Ú‚·Ú· 99 (20,7) 108 (24,6) 18,8 104 (21,8) 111 (24,8) 13,8¶·¯‡Û·ÚÎ· 24 (5,0) 40 (9,1) 82,0 28 (5,9) 52 (11,6) 96,6

p-value* 0,011 0,002™∞¶ <90 ∂.£. 350 (75,4) 167 (63,5) -15,8 349 (75,2) 172 (57,3) -23,8

≥90 ∂.£. 114 (24,6) 96 (36,5) 48,4 115 (24,8) 128 (42,7) 72,2p-value 0,001 <0,001

¢∞¶ <90 ∂.£. 252 (54,3) 212 (80,6) 48,4 260 (56,0) 206 (68,7) 22,7≥90 ∂.£. 212 (45,7) 51 (19,4) -57,5 204 (44,0) 94 (31,3) -28,9

p-value <0,001 <0,001GLU <100 mg/dl 188 (90,8) 283 (91,0) 0,2 182 (89,7) 308 (95,7) 6,7

≥100 19 (9,2) 28 (9,0) -2,2 21 (10,3) 14 (4,3) -58,3p-value 0,946 0,007

TC <180 mg/dl 169 (58,3) 268 (65,8) 12,9 179 (59,5) 256 (61,1) 2,7180-200 79 (27,2) 88 (21,6) -20,6 70 (23,3) 83 (19,8) -15,0>200 42 (14,5) 51 (12,5) -13,8 52 (17,3) 80 (19,1) 10,4

p-value 0,119 0,504TG <90 ∂.£. 230 (85,8) 361 (88,7) 3,3 248 (88,3) 362 (86,6) -2,0

≥90 ∂.£. 38 (14,2) 46 (11,3) -25,7 33 (11,7) 56 (13,4) 12,7p-value 0,268 0,520

HDL-C ≥10 ∂.£. 251 (87,2) 366 (89,9) 3,0 260 (86,7) 371 (88,5) 2,0<10 ∂.£. 37 (12,8) 41 (10,1) -26,7 40 (13,3) 48 (11,5) -15,7

p-value 0,254 0,449LDL-C ≤110 mg/dl 155 (53,4) 245 (60,2) 12,7 156 (51,8) 256 (61,2) 18,1

111-113 83 (28,6) 100 (24,6) -14,0 86 (28,6) 83 (19,9) -30,4>130 52 (17,9) 62 (15,2) -15,1 59 (19,6) 79 (18,9) -3,6

p-value 0,206 0,015¢Â›ÎÙË˜ TC:HDL ≤4,00 232 (80,6) 33,2 (81,6) 1,2 234 (78,0) 338 (80,7) 3,5

>4,00 56 (19,4) 75 (18,4) -5,2 66 (22,0) 81 (19,3) -12,3p-value 0,736 0,382

™˘Ó‰˘·ÛÌfi˜ 0 69 (38,8) 95 (39,7) 2,3 66 (37,3) 90 (32,4) -15,1·Ú·ÁfiÓÙˆÓ 1-2 98 (55,1) 135 (56,5) 2,5 106 (59,9) 168 (60,4) 0,8ÎÈÓ‰‡ÓÔ˘** ≥3 11 (6,2) 9 (3,8) -63,2 5 (2,8) 20 (7,2) 61,1

p-value 0,522 0,104

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


¶·È‰È¿ ÂÚÈfi‰Ô˘1989-1993

¢ª

™

√ÏÈÎ‹ ¯ÔÏËÛÙÂÚfiÏË (mg/dl)

∏ÏÈÎ›· (¤ÙË)

29,4

27,5

26,0

24,6

23,3

21,9

20,6

19,2

17,9

16,5

15,2

13,9

12,5

11,2

141312111098765

350325

300275

250225

200175

150125

10075

50

¶·È‰È¿ ÂÚÈfi‰Ô˘1999-2003

¢ª

™

√ÏÈÎ‹ ¯ÔÏËÛÙÂÚfiÏË (mg/dl)

∏ÏÈÎ›· (¤ÙË)

30,0

28,7

27,3

25,9

24,6

23,2

21,8

20,4

19,1

17,7

16,4

15,0

13,7

12,3

11,0

141312111098765

400375

350325

300275

250225

200175

150125

10075

50

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

212 ª. §ÈÓ·Ú‰¿ÎË˜ Î·È Û˘Ó.


¶›Ó·Î·˜ 5. ¢Â›ÎÙÂ˜ Û¯ÂÙÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘ (Odds Ratio) ¢ª™, ·ÚÙËÚÈ·Î‹˜ ›ÂÛË˜ Î·È ÏÈÈ‰›ˆÓ ÔÚÔ‡ ·›Ì·ÙÔ˜ ·È‰ÈÒÓ ÙË˜ ∫Ú‹ÙË˜, Î·Ù¿ ÙË¯ÚÔÓÈÎ‹ ÂÚ›Ô‰Ô 1999-2003 ÛÂ Û¯¤ÛË ÌÂ ÙËÓ ÂÚ›Ô‰Ô 1989-1993

∞ÁfiÚÈ· ∫ÔÚ›ÙÛÈ·

ª¤ÙÚËÛË ŸÚÈ· ¡ √R (95% ¢∂) p* ¡ √R (95% ¢∂) p*

¢ª™ º˘ÛÈÔÏÔÁÈÎ¿ 646 1,00 629 1,00À¤Ú‚·Ú· 207 1,32 (0,96-1,80) 0,087 215 1,29 (0,95-1,77) 0,104¶·¯‡Û·ÚÎ· 64 2,06 (1,21-3,49) 0,008 80 2,31 (1,42-3,76) 0,001

™∞¶ <90 ∂.£. 517 1,00 521 1,00≥90 ∂.£. 210 1,81 (1,30-2,52) <0,001 243 2,39 (1,74-3,27) <0,001

¢∞¶ <90 ∂.£. 464 1,00 466 1,00≥90 ∂.£. 263 0,25 (0,17-0,36) <0,001 298 0,54 (0,40-0,74) <0,001

GLU <100 mg/dl 471 1,00 490 1,00≥100 47 0,95 (0,50-1,79) 0,870 35 0,44 (0,22-0,90) 0,025

TC <180 437 1,00 435 1,00180-200 167 0,70 (0,48-1,00) 0,049 153 0,84 (0,58-1,21) 0,350>200 93 0,76 (0,48-1,20) 0,240 132 1,09 (0,73-1,63) 0,666

TG <90 ∂.£. 591 1,00 610 1,00≥90 ∂.£. 84 0,77 (0,49-1,22) 0,265 89 1,16 (0,74-1,84) 0,519

HDL-C ≥10 ∂.£. 617 1,00 631 1,00<10 ∂.£. 78 0,76 (0,47-1,22) 0,253 88 0,86 (0,55-1,34) 0,496

LDL-C ≤110 mg/dl 400 1,00 412 1,00111-113 183 0,76 (0,53-1,08) 0,124 169 0,59 (0,41-0,85) 0,005>130 114 0,75 (0,49-1,14) 0,179 138 0,83 (0,56-1,23) 0,352

¢Â›ÎÙË˜ TC:HDL ≤4,00 564 1,00 572 1,00>4,00 131 0,94 (0,64-1,39) 0,742 147 0,85 (0,59-1,23) 0,388

™˘Ó‰˘·ÛÌfi˜ 0 164 1,00 156 1,00·Ú·ÁfiÓÙˆÓ 1-2 233 0,88 (0,57-1,34) 0,543 274 1,10 (0,73-1,66) 0,636ÎÈÓ‰‡ÓÔ˘** ≥3 20 0,43 (0,16-1,17) 0,098 25 2,69 (0,95-7,65) 0,064

* §ÔÁÈÛÙÈÎ‹ ·Ó¿Ï˘ÛË ·ÏÈÓ‰ÚfiÌËÛË˜ (ˆ˜ Û˘ÌÌÂÙ·‚ÏËÙ‹ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë ËÏÈÎ›·), ** √ Û˘Ó‰˘·ÛÌfi˜ ·Ú·ÁfiÓÙˆÓÎÈÓ‰‡ÓÔ˘ ·ÊÔÚ¿ ÛÙÔÓ ¢ª™, ÛÙËÓ ·ÚÙËÚÈ·Î‹ ›ÂÛË, ÛÙÔ GLU, ÛÙËÓ HDL-C Î·È ÛÙ· TG


∂›ÛË˜, ·fi ÌÂÏ¤ÙË ÛÂ ·È‰È¿ ÙË˜ ∆Ô˘ÚÎ›·˜ (26),·Ó¿ÏÔÁË˜ ËÏÈÎ›·˜ Î·È ¯ÚÔÓÈÎ‹˜ ÂÚÈfi‰Ô˘ ÌÂ ÙËÓ·ÚÔ‡Û· ÌÂÏ¤ÙË, ‚Ú¤ıËÎ·Ó ÌÂÁ·Ï‡ÙÂÚÂ˜ ·˘Í‹ÛÂÈ˜ÛÙÔ ‚¿ÚÔ˜ (4,4 kg) Î·È ÛÙÔ ‡„Ô˜ (3,9 cm), ÂÓÒ ÌÂÏ¤-ÙË ÛÂ ¤ÊË‚Ô˘˜ 15-18 ÂÙÒÓ ÙË˜ ºÈÓÏ·Ó‰›·˜ (31),¤‰ÂÈÍÂ ·‡ÍËÛË 4,8% ÛÙÔÓ ¢ª™ ÌÂÙ·Í‡ ÙˆÓ ÂÙÒÓ1980 Î·È 1992.

∞fi ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË ‚Ú¤ıËÎÂ Â›ÛË˜ fiÙÈ ÙÔÔÛÔÛÙfi ÙˆÓ ˘¤Ú‚·ÚˆÓ Î·È ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ·˘Í‹ıËÎÂ Î·Ù¿ 31,5% (·fi 26,7% ·Ó‹Ïı·Ó ÛÂ

35,1%), ÌÂ Î˘ÚÈfiÙÂÚÔ fiÌˆ˜, ÙÔÓ ‰ÈÏ·ÛÈ·ÛÌfi ÙˆÓ·¯‡Û·ÚÎˆÓ (·fi 5,4 ÛÂ 10,4%). ¶·Ú¿ÏÏËÏ·, ·fiÙÔ˘˜ Magkos Î·È Û˘Ó (22) ·Ó·Ê¤ÚıËÎÂ ·‡ÍËÛË ÙÔ˘ÂÈÔÏ·ÛÌÔ‡ ÙˆÓ ˘¤Ú‚·ÚˆÓ ·ÁÔÚÈÒÓ ÙË˜ ∫Ú‹ÙË˜Î·Ù¿ 63% Î·È ÙˆÓ ·¯‡Û·ÚÎˆÓ Î·Ù¿ 202% ÌÂÙ·Í‡ÙˆÓ ÂÙÒÓ 1982 Î·È 2002, ÂÓÒ ÛÂ ÌÂÏ¤ÙË ÙÔ 2002 ÛÂ2458 ·È‰È¿ ÙË˜ £ÂÛÛ·ÏÔÓ›ÎË˜ (27), ËÏÈÎ›·˜ 6-17ÂÙÒÓ, ‚Ú¤ıËÎÂ ÂÈÔÏ·ÛÌfi˜ ˘¤Ú‚·ÚˆÓ 22,2% Î·È·¯‡Û·ÚÎˆÓ 4,1% Î·È ·‡ÍËÛË ÙÔ˘ ¢ª™ Î·Ù¿ 5%ÂÚ›Ô˘ ·fi ÙÔ 1982. ªÂÙ·Í‡ ÙˆÓ ÂÙÒÓ 1985 Î·È1995, ‚Ú¤ıËÎÂ Â›ÛË˜ ÛÂ ·È‰È¿ ÙË˜ ∞˘ÛÙÚ·Ï›·˜(28), ËÏÈÎ›·˜ 2-18 ÂÙÒÓ, 50% ·‡ÍËÛË ÙˆÓ ˘¤Ú‚·-ÚˆÓ ·È‰ÈÒÓ (·fi 10% ·Ó‹Ïı·Ó ÛÂ 15,4%) Î·È276% ÙˆÓ ·¯‡Û·ÚÎˆÓ (·fi 1,3% ÛÙÔ 4,9%), ÌÂ3,28 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚÔ Î›Ó‰˘ÓÔ ÙÔ 1995 ÁÈ· ·Ó¿-Ù˘ÍË ·¯˘Û·ÚÎ›·˜. ¶·ÚfiÌÔÈ·, ·fi ÌÂÏ¤ÙË ÁÈ· ÙËÌÂÙ·‚ÔÏ‹ ÙÔ˘ ¢ª™ ÛÂ ·ÓÙÈÚÔÛˆÂ˘ÙÈÎfi ‰Â›ÁÌ··È‰ÈÒÓ ÙÔ˘ ∫·Ó·‰¿ (29), ËÏÈÎ›·˜ 7-13 ÂÙÒÓ, ‚Ú¤-ıËÎÂ fiÙÈ Ù· ˘¤Ú‚·Ú· ·È‰È¿ ·˘Í‹ıËÎ·Ó ÌÂÙ·Í‡ÙˆÓ ÂÙÒÓ 1981 Î·È 1996 ·fi 15% ÛÂ 21,2% Î·È˘ÂÚ‰ÈÏ·ÛÈ¿ÛÙËÎ·Ó Ù· ·¯‡Û·ÚÎ· (·fi 5% ÛÂ12,7%), ÌÂ ÙÔ Û‡ÓÔÏÔ ÙˆÓ ˘¤Ú‚·ÚˆÓ Î·È ·¯‡Û·Ú-ÎˆÓ Ó· ·Ó¤Ú¯ÂÙ·È ÙÔ 1996 ÛÂ 38,9%.

∆· ·Ú·¿Óˆ Â˘Ú‹Ì·Ù· ·ÔÙÂÏÔ‡Ó ÈÛ¯˘Ú¤˜ ÂÓ-‰Â›ÍÂÈ˜ ÙË˜ ·‡ÍËÛË˜ ÙÔ˘ ˘ÂÚ‚ÔÏÈÎÔ‡ ‚¿ÚÔ˘˜ Î·ÈÙË˜ ·¯˘Û·ÚÎ›·˜, ·ÎfiÌ· Î·È ÂÓÙfi˜ ‚Ú·¯¤ˆÓ ¯ÚÔÓÈ-ÎÒÓ ÂÚÈfi‰ˆÓ. ¶·Ú¿ÏÏËÏ·, Î·Ù·‰ÂÈÎÓ‡ÂÙ·È fiÙÈ Ù·˘¤Ú‚·Ú· ·È‰È¿ ·˘Í¿ÓÔ˘Ó ÙÔ ‚¿ÚÔ˜ ÙÔ˘˜ Û˘ÓÂ¯Ò˜,ÌÂ ·ÔÙ¤ÏÂÛÌ· Ó· ·˘Í¿ÓÂÙ·È ‰È·ÚÎÒ˜ Ë ·È‰ÈÎ‹ ·-¯˘Û·ÚÎ›·. °È· ·Ú¿‰ÂÈÁÌ·, ÛÙË ÌÂÏ¤ÙË NHANES1999-2002 ÙˆÓ ∏¶∞ (30), ÌÂÙ·Í‡ ÙˆÓ ÂÙÒÓ 1999-2000 Î·È 2001-2002, ‚Ú¤ıËÎÂ ÌÂÁ·Ï‡ÙÂÚË ·‡ÍËÛËÎ·Ù¿ 10% ÙˆÓ ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ (·fi 15%·Ó‹Ïı·Ó ÛÂ 16,5%) ÛÂ Û¯¤ÛË ÌÂ ÙËÓ ·‡ÍËÛË Î·Ù¿

¢ª

™

HDL-C (mg/dl)∏

ÏÈÎ›·

(¤ÙË)

30,5

28,9

27,4

25,9

24,4

22,9

21,5

20,0

18,5

17,0

15,6

14,1

12,6

11,2141312111098765

130115

10085

7055

4025

10

¶·È‰È¿ ÂÚÈfi‰Ô˘

1989-1993

¢ª

™

HDL-C (mg/dl)∏

ÏÈÎ›·

(¤ÙË)

30,5

28,9

27,4

25,9

24,4

22,9

21,5

20,0

18,5

17,0

15,6

14,1

12,6

11,2141312111098765

130115

10085

7055

4025

10

¶·È‰È¿ ÂÚÈfi‰Ô˘

1999-2003

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

ªÂÙ

·‚

ÔÏ

‹ Â

È

ÔÏ

·Û

ÌÔ

‡

˘ÂÚ‚ÔÏÈÎfi ‚¿ÚÔ˜

& ·¯˘Û·ÚÎ›·

·ÚÙËÚÈ·Î‹ ›ÂÛË

GLUTCTG

HDL-CLDL-CTC:HDL-CÛ˘Ó‰˘·ÛÌfi˜ ·Ú·ÁfiÓÙˆÓ

1989-1993 1999-2003

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

∂ÈÎfiÓ· 3. ™¯ÂÙÈÎ‹ ÌÂÙ·‚ÔÏ‹ ÙÔ˘ ÂÈÔÏ·ÛÌÔ‡ ÙˆÓ ˘„ËÏÒÓ ÂÈ-¤‰ˆÓ ÙÔ˘ ¢ª™, ÙË˜ ·ÚÙËÚÈ·Î‹˜ ›ÂÛË˜, ÙÔ˘ GLU Î·È ÙˆÓ ÏÈÈ-‰›ˆÓ ·È‰ÈÒÓ ÙË˜ ∫Ú‹ÙË˜ ËÏÈÎ›·˜ 5-15 ÂÙÒÓ, ÌÂÙ·Í‡ ÙˆÓ ¯ÚÔÓÈ-ÎÒÓ ÂÚÈfi‰ˆÓ 1989-1993 Î·È 1999-2003.


¶·È‰È·ÙÚÈÎ‹ 2007;70:205-216


5,4% ÙˆÓ ˘¤Ú‚·ÚˆÓ (·fi 29,9% ·Ó‹Ïı·Ó ÛÂ31,5%).

∂Ó‰È·Ê¤ÚÔÓ, fiÌˆ˜, ·ÚÔ˘ÛÈ¿˙ÂÈ Ë Û˘Û¯¤ÙÈÛËÙË˜ ·‡ÍËÛË˜ ÙÔ˘ ‚¿ÚÔ˘˜ ÙˆÓ ·È‰ÈÒÓ ÌÂ ÙË ÌÂÙ·-‚ÔÏ‹ ¿ÏÏˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ¯ÚfiÓÈ· ÓÔ-Û‹Ì·Ù·. ∞Ó Î·È ÛÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË Ë ™∞¶ ÙˆÓ·È‰ÈÒÓ ÙË˜ ÂÚÈfi‰Ô˘ 1999-2003 ‚Ú¤ıËÎÂ ·˘ÍËÌ¤-ÓË Î·Ù¿ 2%, ÛÂ Û¯¤ÛË ÌÂ ÂÎÂ›ÓË ÙË˜ ÂÚÈfi‰Ô˘1989-1993, ÌË ÛËÌ·ÓÙÈÎ‹ ÌÂ›ˆÛË ‚Ú¤ıËÎÂ ÛÙ· Â›-Â‰· ÙÔ˘ GLU, ÙË˜ TC, ÙË˜ HDL-C Î·È ÙË˜ LDL-CÎ·Ù¿ 3,9%, 1,2%, 0,7% Î·È 2,5%, ·ÓÙ›ÛÙÔÈ¯·. ™Â ÌÂ-Ï¤ÙË ÂÊ‹‚ˆÓ ÙË˜ ºÈÓÏ·Ó‰›·˜ (31), ·Ó·Ê¤ÚÔÓÙ·ÈÌÂÁ·Ï‡ÙÂÚÂ˜ ÌÂÈÒÛÂÈ˜ ÌÂÙ·Í‡ 1980 Î·È 1992 ÛÙËÓTC, ÛÙËÓ HDL-C Î·È ÙËÓ LDL-C Î·Ù¿ -8,5%, -19,2% Î·È -7,5%, ·ÓÙ›ÛÙÔÈ¯·. √È ·ÏÏ·Á¤˜ ·˘Ù¤˜·ÔÙÂÏÔ‡Ó Û˘Ó¤ÂÈ· ÙË˜ ÂıÓÈÎ‹˜ ÔÏÈÙÈÎ‹˜ Ô˘·ÎÔÏÔ˘ıÂ›Ù·È ·fi ÙÈ˜ ·Ú¯¤˜ ÙÔ˘ 1970, ÌÂ Î‡ÚÈÔ

ÛÙfi¯Ô ÙË ÌÂ›ˆÛË ÙˆÓ ÂÈ¤‰ˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡-ÓÔ˘ ÁÈ· Î·Ú‰È·ÁÁÂÈ·Î¿ ÓÔÛ‹Ì·Ù·, Ì¤Ûˆ ÙË˜ ÌÂ›ˆ-ÛË˜ Î·Ù·Ó¿ÏˆÛË˜ ÎÔÚÂÛÌ¤ÓÔ˘ Ï›Ô˘˜, Ó·ÙÚ›Ô˘ Î·ÈÙËÓ ·‡ÍËÛË Î·Ù·Ó¿ÏˆÛË˜ ÊÚÔ‡ÙˆÓ Î·È Ï·¯·ÓÈÎÒÓ(32). ∞ÓÙ›ıÂÙ·, ÔÈ Magkos Î·È Û˘Ó (22) ·Ó·Ê¤ÚÔ˘ÓÛËÌ·ÓÙÈÎ¤˜ ·˘Í‹ÛÂÈ˜ ÛÙ· ÏÈ›‰È· ÔÚÔ‡ ·›Ì·ÙÔ˜·ÁÔÚÈÒÓ ÙË˜ ∫Ú‹ÙË˜, ÌÂ Î˘ÚÈfiÙÂÚË ÙËÓ ·˘ÍËÌ¤ÓËLDL-C Î·Ù¿ 25,3%.

™˘ÓÔÙÈÎ¿ Î·È ÛÂ Û¯¤ÛË ÌÂ Ù· ·Ú·¿Óˆ ·Ô-ÙÂÏ¤ÛÌ·Ù·, Ô Û˘Ó‰˘·ÛÌfi˜ ·Ú·ÁfiÓÙˆÓ ªÂÙ™˘Ó‚Ú¤ıËÎÂ ·˘ÍËÌ¤ÓÔ˜ ÛÙ· ·È‰È¿ ÙË˜ ·ÚÔ‡Û·˜ ÌÂ-Ï¤ÙË˜ Î·Ù¿ 24% ÂÓÙfi˜ ÙˆÓ ‰‡Ô ÂÚÈfi‰ˆÓ (·fi4,5% ·Ó‹ÏıÂ ÛÂ 5,6%). ∞fi Ù· ·È‰È¿, fiÌˆ˜, ÌÂªÂÙ™˘Ó, ÔÛÔÛÙfi ÌfiÏÈ˜ 14,3% ‹Ù·Ó ·¯‡Û·ÚÎ· ÙÔ1989-1993, ÂÓÒ ˘ÂÚ‰ÈÏ·ÛÈ¿ÛÙËÎ·Ó ÙÔ 1999-2003Î·È ·Ó‹Ïı·Ó ÛÙÔ 37,3%. ™Ù· ·¯‡Û·ÚÎ· ·È‰È¿, ÔÎ›Ó‰˘ÓÔ˜ Ó· ·Ó·Ù‡ÍÔ˘Ó ªÂÙ™˘Ó ÙÔ 1989-1993

214 ª. §ÈÓ·Ú‰¿ÎË˜ Î·È Û˘Ó.


170

165

160

155

150

145

140

135

130

125

120

115

⁄„Ô˜ ∞ÁÔÚÈÒÓ

∏ÏÈÎ›· (¯ÚfiÓÈ·)

∂Î

·Ù

ÔÛ

Ù¿

1989-93

1999

-03

πÀ¶

7 8 9 10 11 12 13 14 15

165

160

155

150

145

140

135

130

125

120

115

⁄„Ô˜ ∫ÔÚÈÙÛÈÒÓ


∂Î

·Ù

ÔÛ

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1989-93

1999-03

πÀ¶

7 8 9 10 11 12 13 14 15

60

55

50

45

40

35

30

25

20

µ¿ÚÔ˜ ∫ÔÚÈÙÛÈÒÓ


∫ÈÏ

¿

7 8 9 10 11 12 13 14 15

IY¶1999-0

3

1989-93

∂ÈÎfiÓ· 4. ™¯ËÌ·ÙÈÎ‹ Û‡ÁÎÚÈÛË 50‹˜ ∂.£. ‚¿ÚÔ˘˜ Î·È ‡„Ô˘˜ ·È‰ÈÒÓ ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ Î·È ÙÔ˘ πÓÛÙÈÙÔ‡ÙÔ˘ ÀÁÂ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡(πÀ¶).

60

55

50

45

40

35

30

25

20

µ¿ÚÔ˜ ∞ÁÔÚÈÒÓ


∫ÈÏ

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1999-03

1989-93

IY¶

7 8 9 10 11 12 13 14 15



¶·È‰È·ÙÚÈÎ‹ 2007;70:205-216

‹Ù·Ó 3,89 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚÔ˜ ¤Ó·ÓÙÈ ÙˆÓ Ê˘ÛÈÔÏÔ-

ÁÈÎÒÓ, Î·ıÒ˜ ÙÔ 1999-2003 Ô Î›Ó‰˘ÓÔ˜ ·˘Ùfi˜ ‹Ù·Ó

ÂÙ¿ ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚÔ˜ (27,08). ¢È·ÈÛÙÒÓÂÙ·È,

ÏÔÈfiÓ, fiÙÈ ·Ó Î·È ÙÔ ªÂÙ™˘Ó ·ÔÙÂÏÂ› Û˘Ó¿ÚÙËÛË

ÙË˜ ‰˘Ó·ÌÈÎ‹˜ ÙˆÓ Û˘ÓÈÛÙˆÛÒÓ ÙÔ˘, ÂÓÙÔ‡ÙÔÈ˜, ÌÂ-

Ù·‚¿ÏÏÂÙ·È Î·Ù¿ Î‡ÚÈÔ ÏfiÁÔ Û‡ÌÊˆÓ· ÌÂ ÙË ÌÂÙ·-

‚ÔÏ‹ ÙË˜ ·¯˘Û·ÚÎ›·˜.

™ÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›· ‰ÂÓ Î·Ù·ÁÚ¿ÊÂÙ·È Ë

‰È·¯ÚÔÓÈÎ‹ Ù¿ÛË ÙÔ˘ ªÂÙ™˘Ó ÛÂ ·È‰È¿ Î·È ÂÊ‹-

‚Ô˘˜, ·Ú¿ ÙË ‰ÈÂÚÂ‡ÓËÛË ÙÔ˘ ÂÈÔÏ·ÛÌÔ‡ ÙÔ˘

ÛÙ· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·. ™Â ·È‰È¿ ÙË˜ ∫Ú‹ÙË˜, ËÏÈ-

Î›·˜ 3-18 ÂÙÒÓ, ÛÙÔ ‰È¿ÛÙËÌ· 2001-2003 (9), ‚Ú¤-

ıËÎÂ fiÙÈ ÂÚ›Ô˘ 4% Â›¯·Ó ªÂÙ™˘Ó, ·fi Ù· ÔÔ›·

Ù· ‰‡Ô ÙÚ›Ù· ‹Ù·Ó ·¯‡Û·ÚÎ·. ∂›ÛË˜, ÛÂ ·¯‡-

Û·ÚÎ· ·È‰È¿ ÙË˜ πÙ·Ï›·˜ ËÏÈÎ›·˜ 6-14 ÂÙÒÓ (33),

ÙÔ 38% Â›¯Â ·ÚÔ˘Û›· ÙÔ˘Ï¿¯ÈÛÙÔÓ ÙÚÈÒÓ ·Ú·Áfi-

ÓÙˆÓ ªÂÙ™˘Ó, ÂÓÒ ‚Ú¤ıËÎ·Ó Ó· ¤¯Ô˘Ó ÛËÌ·ÓÙÈÎ¿

˘„ËÏfiÙÂÚ· Â›Â‰· ÈÓÛÔ˘Ï›ÓË˜, C-·ÓÙÈ‰ÚÒÛ·˜

ÚˆÙÂ˝ÓË˜ Î·È ÌÂÁ·Ï‡ÙÂÚË ·ÓÂÏ·ÛÙÈÎfiÙËÙ· Î·Úˆ-

ÙÈ‰ÈÎ‹˜ ·ÚÙËÚ›·˜ (carotid artery stiffness).

¶·Ú¿ ÙÈ˜ ·Ú·¿Óˆ ·Ó·ÊÔÚ¤˜ Î·È Û˘ÁÎÚ›ÛÂÈ˜,

ÛÙË ‰È·¯ÚÔÓÈÎ‹ Û‡ÁÎÚÈÛË ·ÔÙÂÏÂÛÌ¿ÙˆÓ ı· Ú¤ÂÈ

Ó· Ï·Ì‚¿ÓÂÙ·È ˘’ fi„ÈÓ ÙÔ Ì¤ÁÂıÔ˜ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜, Ë

·ÓÙÈÚÔÛˆÂ˘ÙÈÎfiÙËÙ·, Ë Ì¤ıÔ‰Ô˜ ‰ÂÈÁÌ·ÙÔÏË-

„›·˜, ÔÈ ÌÂıÔ‰ÔÏÔÁÈÎÔ› ÂÚÈÔÚÈÛÌÔ› ‹ ‰È·ÊÔÚ¤˜, Î·-

ıÒ˜ Î·È Ë ÌÂÙ·‚ÏËÙfiÙËÙ· ÙˆÓ ÌÂÙÚ‹ÛÂˆÓ (11). ∞Ó

Î·È Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÙˆÓ ÂÚÈÛÛfiÙÂÚˆÓ ÌÂÏÂÙÒÓ,

fiˆ˜ Î·È ÙË˜ ·ÚÔ‡Û·˜, ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·ÓÙÈÎÚÔ˘fi-

ÌÂÓ· ·ÔÙÂÏ¤ÛÌ·Ù·, ÛËÌ·ÓÙÈÎfi ÛÙÔÈ¯Â›Ô ·ÔÙÂÏÂ› Ë

‰È·›ÛÙˆÛË ÙÔ˘ Eisenmann (11) fiÙÈ ·Ó Î·È ÛÙ·ÙÈÛÙÈ-

ÎÒ˜ ÔÈ ‰È·ÊÔÚÔÔÈ‹ÛÂÈ˜ Â›Ó·È ÛËÌ·ÓÙÈÎ¤˜ Î·È ·ÓÙ›-

ıÂÙÂ˜, ˆÛÙfiÛÔ ˆ˜ ÎÏÈÓÈÎ¿ Â˘Ú‹Ì·Ù· ‰ÂÓ ·ÔÙÂÏÔ‡Ó

ÔˆÛ‰‹ÔÙÂ ·ÍÈfiÏÔÁÂ˜ ÌÂÙ·‚ÔÏ¤˜. ∏ ¿Ô„Ë ·˘Ù‹

ÂÓÈÛ¯‡ÂÙ·È ÂÚÈÛÛfiÙÂÚÔ Â¿Ó ÙÔ ‰È¿ÛÙËÌ· ÌÂÏ¤ÙË˜

Â›Ó·È ‚Ú·¯Â›· ÂÚ›Ô‰Ô˜ Î·È ·Ó Ï·Ì‚¿ÓÂÙ·È ˘’ fi„ÈÓ

Ô ÚfiÏÔ˜ ÙË˜ ÂÓ‰Â¯fiÌÂÓË˜ Â›‰Ú·ÛË˜ ‹ ÌÂÙ·‚ÔÏ‹˜

¿ÏÏˆÓ Û˘Ì·Ú·ÁfiÓÙˆÓ, fiˆ˜ ÔÈ ‰È·ÈÙËÙÈÎ¤˜ Û˘Ó‹-

ıÂÈÂ˜ Î·È Ë ÛˆÌ·ÙÈÎ‹ ¿ÛÎËÛË, Ô˘ ˆÛÙfiÛÔ ‰ÂÓ ÂÎÙÈ-

Ì‹ıËÎ·Ó ÛÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË.

™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, Î·Ù¿ ÙËÓ ÙÂÏÂ˘Ù·›· ‰ÂÎ·ÂÙ›·

‰È·ÈÛÙÒÓÂÙ·È ÛËÌ·ÓÙÈÎ‹ ·‡ÍËÛË ÛÙÔ˘˜ ‰Â›ÎÙÂ˜

·¯˘Û·ÚÎ›·˜ ÙˆÓ ·È‰ÈÒÓ ÙË˜ ∫Ú‹ÙË˜. ∏ ¤ÏÏÂÈ„Ë

ÛˆÛÙÒÓ ÂÈÏÔÁÒÓ ÛÙË ‰È·ÙÚÔÊ‹, Ô ÂÚÈÔÚÈÛÌfi˜

ÙË˜ ÛˆÌ·ÙÈÎ‹˜ ¿ÛÎËÛË˜, Ë ˘ÈÔı¤ÙËÛË ÂÈ‚Ï·‚ÒÓ

ÁÈ· ÙËÓ ˘ÁÂ›· Û˘ÓËıÂÈÒÓ fiˆ˜ ÙÔ Î¿ÓÈÛÌ· Î·È Ë

Î·Ù·Ó¿ÏˆÛË ÔÈÓÔÓÂ‡Ì·ÙÔ˜, ·ÔÙÂÏÔ‡Ó ÌÂÚÈÎ¤˜

·Ú·Ì¤ÙÚÔ˘˜ Ô˘ Û˘ÓÂÈÛÊ¤ÚÔ˘Ó ÛÙÈ˜ ·ÚÓËÙÈÎ¤˜

ÌÂÙ·‚ÔÏ¤˜ ÙˆÓ ‰ÂÈÎÙÒÓ ˘ÁÂ›·˜. ¢Â‰ÔÌ¤ÓË˜ ÙË˜ ·Ô-

ÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ ÙË˜ ÂÊ·ÚÌÔÁ‹˜ ÚÔÁÚ·ÌÌ¿ÙˆÓ

ÂÎ·È‰Â˘ÙÈÎ‹˜ ·Ú¤Ì‚·ÛË˜ ÛÂ Ì·ıËÙ¤˜ (17,18,21),

ÎÚ›ÓÔÓÙ·È ·Ó·ÁÎ·›· Ô Û¯Â‰È·ÛÌfi˜ Î·È Ë ÂÊ·ÚÌÔÁ‹

ÂıÓÈÎ‹˜ ÔÏÈÙÈÎ‹˜ ÁÈ· ÙËÓ ÚÔ·ÁˆÁ‹ ÙË˜ ˘ÁÂ›·˜ Î·È

ÙËÓ ÚfiÏË„Ë ÛÂ ·ÚfiÌÔÈÔ Ï·›ÛÈÔ ‰Ú¿ÛË˜.

∂˘¯·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, ÙÔ ¶·È‰·ÁˆÁÈÎfi πÓÛÙÈÙÔ‡ÙÔ, ÙËÓ ÂÙ·È-ÚÂ›· Kellogg’s, Î·ıÒ˜ Î·È ÙÈ˜ ‰ËÌÔÙÈÎ¤˜ ·˘ÙÔ‰ÈÔÈÎ‹ÛÂÈ˜ ÙˆÓ¢‹ÌˆÓ ∞Á. ¡ÈÎÔÏ¿Ô˘, ƒÔ‡‚·, ÃÂÚÛÔÓ‹ÛÔ˘ Î·È ∏Ú·ÎÏÂ›Ô˘.∂›ÛË˜, Û˘Ó¤‚·Ï·Ó ·ÔÙÂÏÂÛÌ·ÙÈÎ¿ ÔÈ Û˘ÓÂÚÁ¿ÙÂ˜: ÃÚ‹ÛÙÔ˜Ã·Ù˙‹˜, ∂ÈÚ‹ÓË ª¿ÚÎ·Ù˙Ë, πˆ¿ÓÓ· ªÔÛ¯·Ó‰Ú¤·, ªÈ¯¿ÏË˜∫˘ÚÈ·Î¿ÎË˜, ™ÔÊ›· ºÏÔ˘Ú‹, ª·Ú›· ªÈÙÛÒÚË, πˆ¿ÓÓ·∞ÔÛÙÔÏ¿ÎË, ºÚfiÛˆ ªÂÚ‚·Ó¿ÎË Î·È Caroline Codrington.


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13. §˘‰¿ÎË ∂, ∫·Ê¿ÙÔ˜ ∞, ∫Ô˘Ó¿ÏË ¢, ∞ÔÛÙÔÏ¿ÎË π. ¢È·È-ÙËÙÈÎ¤˜ Û˘Ó‹ıÂÈÂ˜, Ê˘ÛÈÎ‹ ‰Ú·ÛÙËÚÈfiÙËÙ· Î·È ÏÈ›‰È·ÔÚÔ‡ ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ ËÏÈÎ›·˜ 12-14 ¯ÚfiÓˆÓ. ¶·È-‰È·ÙÚÈÎ‹ 1994;57:330-347.

14. ∫·Ê¿ÙÔ˜ ∞, ∫ˆÓÛÙ·ÓÙÈÓ¿ÎÔ˜ ¶, ¶··‰¿ÎË˜ ∂, £ÂÔ‰Ò-ÚÔ˘ Ã. ŒÏÂÁ¯Ô˜ ·ÂÚfi‚È·˜ ÈÎ·ÓfiÙËÙ·˜ ·¯‡Û·ÚÎˆÓ ·È-‰ÈÒÓ ËÏÈÎ›·˜ 12-14 ¯ÚfiÓˆÓ. ¶·È‰È·ÙÚÈÎ‹ 1992;55:249-257.

15. ªÈÙÛÒÚË ª, ¡Â¿Ú¯Ô˘ ∞, ∫·˙Ì·Ù˙‹ µ, ª·Ï·ıÚ¿ÎËª, ∫ÔÏ˘‰¿ÎË-™˘ÚÈ‰¿ÎË ª, ƒÂÌÂÏ¿ÎË˜ µ Î·È Û˘Ó.


216 ª. §ÈÓ·Ú‰¿ÎË˜ Î·È Û˘Ó.


∞Ó¿Ù˘ÍË Î·È ‰È·ÈÙËÙÈÎ¤˜ Û˘Ó‹ıÂÈÂ˜ ·È‰ÈÒÓ Û¯ÔÏÈÎ‹˜ËÏÈÎ›·˜ ÛÙËÓ Â·Ú¯›· ™ËÙÂ›·˜. ¶·È‰È·ÙÚÈÎ‹ 1995;58:326-335.

16. ™ÈÔÓ‰ÒÚË ª, ∫Ô˘Ó¿ÏË ¢, ÃÂÈÏ·‰¿ÎË º, ∫·ÓÙÈ‰¿ÎË ∂,∫·Ê¿ÙÔ˜ ∞. ¶ÚfiÛÏË„Ë Ì·ÎÚÔıÚÂÙÈÎÒÓ Û˘ÛÙ·ÙÈÎÒÓ·fi ·È‰È¿ ÙË˜ ∫Ú‹ÙË˜, ËÏÈÎ›·˜ 7 Î·È 12-14 ÂÙÒÓ. ¢È·-ÙÚÔÊ‹-¢È·ÈÙÔÏÔÁ›· 1992;4:23-30.

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18. Manios Y, Kafatos A, Mamalakis G. The effects of a healtheducation intervention initiated at first grade over a 3 yearperiod: physical activity and fitness indices. Health EducRes 1998;13:593-606.

19. Moschandreas JA, Kafatos A. Calcium intake in relation todiet and health indicators in Cretan primary and high schoolpupils, Greece. Int J Vitam Nutr Res 2002;72:264-277.

20. ªÔÛ¯·Ó‰Ú¤· I, Ã·Ù˙‹˜ X, ª·ÌÌ¿˜ I, ªÂÚÙÛÈ¿˜ °, §ÈÓ·Ú-‰¿ÎË˜ ª, ∫˘ÚÈ·Î¿ÎË˜ § Î·È Û˘Ó. ¢Â›ÎÙÂ˜ ·¯˘Û·ÚÎ›·˜ Î·È·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ ÛÂ ·È‰È¿ ·ÁÚÔÙÈÎ‹˜ ÔÚÂÈÓ‹˜ Â-ÚÈÔ¯‹˜ ÙË˜ ∫Ú‹ÙË˜. ¶·È‰È·ÙÚÈÎ‹ 2003;66:264-277.

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¶·È‰È·ÙÚÈÎ‹ 2007;70:217-220

¶ÔÛÔÙÈÎfi˜ ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙË˜ C-·ÓÙÈ‰ÚÒÛ·˜ ÚˆÙÂ˝ÓË˜ ÛÙÔ

·›Ì· ÓÂÔÁÓÒÓ - ™˘ÁÎÚÈÙÈÎ‹ ÌÂÏ¤ÙË ‰‡Ô ÌÂıfi‰ˆÓ

∏. Ã·Ù˙ËÈˆ·ÓÓ›‰Ë˜, ∞. ¡·Ô‡Ì, °. MËÙÛÈ¿ÎÔ˜, Ã. ∆Û·Î·Ï›‰Ë˜, ¢. °. °Ô˘Ï‹˜, ¡. ¡ÈÎÔÏ·˝‰Ë˜

¶ÂÚ›ÏË„Ë

∂ÈÛ·ÁˆÁ‹: ∏ ıÔÏˆÛÈÌÂÙÚÈÎ‹ (£√§) Ì¤ıÔ‰Ô˜ Ì¤ÙÚËÛË˜ ÙË˜ C-·ÓÙÈ‰ÚÒÛ·˜ ÚˆÙÂ˝ÓË˜ (CRP) ¯·Ú·ÎÙËÚ›-˙ÂÙ·È ·fi ÌÂÁ¿ÏË Ú·ÎÙÈÎfiÙËÙ·, Î·ıÒ˜ ‰ÂÓ ··ÈÙÂ›Ù·È ÂÚÁ·ÛÙ‹ÚÈÔ, ‰ÈÂÓÂÚÁÂ›Ù·È ÌÂ Ï‹„Ë ÔÏ‡ ÌÈÎÚ‹˜ Ô-ÛfiÙËÙ·˜ ÙÚÈ¯oÂÈ‰ÈÎÔ‡ ·›Ì·ÙÔ˜ Î·È ÙÔ ·ÔÙ¤ÏÂÛÌ· Â›Ó·È ‰È·ı¤ÛÈÌÔ ÛÂ ÔÏ‡ ÌÈÎÚfi ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·. ™ÎÔ-fi˜ ÙË˜ ÂÚÁ·Û›·˜ ‹Ù·Ó Ë Û‡ÁÎÚÈÛË ÙË˜ ·ÍÈÔÈÛÙ›·˜ ÙË˜ £√§ ÌÂıfi‰Ô˘ Ì¤ÙÚËÛË˜ ÙË˜ CRP ÌÂ ·˘Ù‹ ÙË˜ ÓÂ-ÊÂÏÔÌÂÙÚÈÎ‹˜ ÌÂıfi‰Ô˘ (¡∂º).

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ∏ ÌÂÏ¤ÙË ÂÍ¤Ù·ÛÂ 163 ‰Â›ÁÌ·Ù· Ï‹ÚÔ˘˜ ·›Ì·ÙÔ˜ ·fi 79 ÓÂÔÁÓ¿, Ù· ÔÔ›· ÓÔÛË-ÏÂ‡ıËÎ·Ó ÛÙË µ’ ªÔÓ¿‰· ∂ÓÙ·ÙÈÎ‹˜ ¡ÔÛËÏÂ›·˜ ¡ÂÔÁÓÒÓ ÙÔ˘ A.¶.£. ∏ CRP ÌÂÙÚ‹ıËÎÂ ÛÂ 97 ‰Â›ÁÌ·Ù··›Ì·ÙÔ˜ Î·ıÈÂÚˆÌ¤ÓË˜ ·Ú·ÎÔÏÔ‡ıËÛË˜ (65 ÓÂÔÁÓ¿, ÔÌ¿‰· ∞) Î·È ÛÂ 66 ‰Â›ÁÌ·Ù· ·›Ì·ÙÔ˜ ÓÂÔÁÓÒÓ ÌÂÎÏÈÓÈÎ‹ ÂÈÎfiÓ· ‡ÔÙË ÁÈ· ÏÔ›ÌˆÍË (43 ÓÂÔÁÓ¿, ÔÌ¿‰· µ). √ £√§ ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙË˜ CRP ‰ÈÂÓÂÚÁ‹ıË-ÎÂ ÛÙËÓ ÎÏÈÓÈÎ‹ ·fi ÙÔ ÚÔÛˆÈÎfi ÙË˜ ÌÔÓ¿‰·˜ Î·È ¤ÁÈÓÂ ÌÂ ÙËÓ ÙÂ¯ÓÈÎ‹ Quick Read System, ÂÓÒ Ô ¡∂ºÌÂ ÓÂÊÂÏfiÌÂÙÚÔ ÙË˜ ÂÙ·ÈÚÂ›·˜ µeckman ÛÙÔ ÂÚÁ·ÛÙ‹ÚÈÔ ÙÔ˘ ÓÔÛÔÎÔÌÂ›Ô˘.

∞ÔÙÂÏ¤ÛÌ·Ù·: ¢È·ÈÛÙÒıËÎÂ ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿ ÌÂÙ·Í‡ ÙˆÓ ÂÈ¤‰ˆÓ CRP ÌÂ ÙË £√§ Î·È¡∂º Ì¤ıÔ‰Ô (18,7±22,6 mg/l ¤Ó·ÓÙÈ 14,9±20,7 mg/l, ·ÓÙ›ÛÙÔÈ¯·, p<0,001). √È £√§ Î·È ¡∂º Ì¤ıÔ‰ÔÈ‚Ú›ÛÎÔÓÙ·Ó ÛÂ ÈÛ¯˘Ú¿ ıÂÙÈÎ‹ Û˘Û¯¤ÙÈÛË (r2=0,8935, p<0,001). ™ÙËÓ ·Ó¿Ï˘ÛË Bland-Altman ‰È·ÈÛÙÒ-ıËÎÂ ˘ÂÚÂÎÙ›ÌËÛË ÙË˜ CRP ÌÂ ÙË £√§ Ì¤ıÔ‰Ô ÛÂ Û¯¤ÛË ÌÂ ÙË ¡∂º ÛÙËÓ ÂÚÈÔ¯‹ ÙÈÌÒÓ Ì¤¯ÚÈ 40 mg/l.ªÂ Ô˘‰fi Ù· 11 mg/l, Ë Â˘·ÈÛıËÛ›· Î·È Ë ÂÈ‰ÈÎfiÙËÙ· ÙË˜ £√§ ÌÂıfi‰Ô˘ ‹Ù·Ó 93% Î·È 55%, ·ÓÙ›ÛÙÔÈ¯·ÛÂ Û¯¤ÛË ÌÂ ÙË ıÂÙÈÎ‹ ·ÈÌÔÎ·ÏÏÈ¤ÚÁÂÈ·.

™˘ÌÂÚ¿ÛÌ·Ù·: √ ÁÚ‹ÁÔÚÔ˜ ˘ÔÏÔÁÈÛÌfi˜ ÙË˜ CRP ÌÂ ÙË £√§ Ì¤ıÔ‰Ô Ê·›ÓÂÙ·È ˆ˜ Â›Ó·È ·ÍÈfiÈÛÙÔ˜,Î·ıÒ˜ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ˘„ËÏ‹ Â˘·ÈÛıËÛ›· Î·È ·ÚÓËÙÈÎ‹ ÚÔÁÓˆÛÙÈÎ‹ ·Í›·.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: C-·ÓÙÈ‰ÚÒÛ· ÚˆÙÂ˝ÓË, ıÔÏˆÛÈÌÂÙÚÈÎ‹ Ì¤ıÔ‰Ô˜, ÓÂÊÂÏÔÌÂÙÚ›·.

Quantitative determination of C-reactive protein in the blood of

neonates - Comparative study of two methods

H. Chatziioannidis, A. Naoum, G. Mitsiakos, C. Tsakalidis, D. G. Goulis, N. Nikolaidis

Abstract

Background: The turbidometric (TUR) method of measurement of C-reactive protein (CRP) is character-ized by practicality, since it can be carried out at the bedside, it requires a very small quantity of blood andthe result is available within a very short period of time. The aim of this study was to compare the TURmethod of CRP measurement with that of nephelometry (NEP).

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

Results: A statistically significant difference was observed between the mean CRP levels measured bythe TUR and NEP methods (18.7±22.6 mg/l versus 14.9±20.7 mg/l respectively, p<0.001). The TUR andNEP methods were found to have a strong positive correlation (r2=0.945, p<0.001). On Bland-Altmananalysis a CRP over-estimate was noted with the TUR method compared with the NEP, for levels of upto 40 mg/l. With a threshold of 11 mg/l the sensitivity and specificity of the TUR method were 93% and55% respectively, compared to positive blood culture.

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

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

µ’ ªÔÓ¿‰· ∂ÓÙ·ÙÈÎ‹˜¡ÔÛËÏÂ›·˜ ¡ÂÔÁÓÒÓ ∞¶£,°¶¡ “¶··ÁÂˆÚÁ›Ô˘”,£ÂÛÛ·ÏÔÓ›ÎË


∏. Ã·Ù˙ËÈˆ·ÓÓ›‰Ë˜[email protected]∫·ÈÛ·ÚÂ›·˜ 52, T.K. 54454, £ÂÛÛ·ÏÔÓ›ÎË

2nd Unit of NeonatalIntensive Care, AristotleUniversity of Thessaloniki,General Hospital“Papageorgiou”,Thessaloniki

Correspondence:

H. [email protected], Kesarias St., 54454 Thessaloniki


218 ∏. Ã·Ù˙ËÈˆ·ÓÓ›‰Ë˜ Î·È Û˘Ó.


∂ÈÛ·ÁˆÁ‹

√È ÚˆÙÂ˝ÓÂ˜ ÔÍÂ›·˜ Ê¿ÛË˜, fiˆ˜ Ë C-·ÓÙÈ‰ÚÒÛ·ÚˆÙÂ˝ÓË (C-reactive protein, CRP), Ë ·1-ÔÍ˘ÁÏ˘ÎÔ-ÚˆÙÂ˝ÓË, ÙÔ ∞-·Ì˘ÏÔÂÈ‰¤˜ ÙÔ˘ ÔÚÔ‡, Ë ÛÂÚÔ˘ÏÔ-Ï·ÛÌ›ÓË, Ù· C3 Î·È C4 ÎÏ¿ÛÌ·Ù· ÙÔ˘ Û˘ÌÏËÚÒÌ·-ÙÔ˜, Ë ·1-·ÓÙÈıÚ˘„›ÓË, Ë ·ÙÔÛÊ·ÈÚ›ÓË Î·È ÙÔ ÈÓˆ‰Ô-ÁfiÓÔ ÔÓÔÌ¿ÛıËÎ·Ó ¤ÙÛÈ ÁÈ·Ù› Ë ·‡ÍËÛ‹ ÙÔ˘˜ Á›ÓÂÙ·ÈÙ·¯‡Ù·Ù·, Û˘¯Ó¿ ÚÈÓ ÔÏÔÎÏËÚˆıÂ› Ë ÎÏÈÓÈÎ‹ Î·È ÂÚ-Á·ÛÙËÚÈ·Î‹ ÂÈÎfiÓ· ÙË˜ ·ıÔÏÔÁÈÎ‹˜ ‰ÈÂÚÁ·Û›·˜ Ô˘ÚÔÎ¿ÏÂÛÂ ÙËÓ ·Ú·ÁˆÁ‹ ÙÔ˘˜. ∂ÔÌ¤Óˆ˜, Ë ‰˘Ó·-ÙfiÙËÙ· ÁÚ‹ÁÔÚÔ˘ Î·È Â‡ÎÔÏÔ˘ ÚÔÛ‰ÈÔÚÈÛÌÔ‡ ÙˆÓÂÈ¤‰ˆÓ ÙÔ˘˜ ‰ÈÂ˘ÎÔÏ‡ÓÂÈ ÔÏ‡ ÙË ‰È¿ÁÓˆÛË ·ÏÏ¿Î·È ÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË ÙfiÛÔ ÙˆÓ ÂÓËÏ›ÎˆÓ, fiÛÔ Î·ÈÙˆÓ ÓÂÔÁÓÒÓ (1). ∏ CRP ıÂˆÚÂ›Ù·È Ë Î˘ÚÈfiÙÂÚË ÂÎ-ÚfiÛˆÔ˜ ÙˆÓ ÚˆÙÂ˚ÓÒÓ ÔÍÂ›·˜ Ê¿ÛË˜ Î·ıÒ˜ ·˘-Í¿ÓÂÙ·È Ù·¯‡ÙÂÚ· Î·È ÂÚÈÛÛfiÙÂÚÔ ·fi ÙÈ˜ ¿ÏÏÂ˜,Â·Ó¤Ú¯ÂÙ·È ‰Â ÛÙ· Ê˘ÛÈÔÏÔÁÈÎ¿ Â›Â‰· ÔÏ‡ ÁÚ‹-ÁÔÚ· ÌÂÙ¿ ÙËÓ ¿ÚÛË ÙÔ˘ ·ÈÙ›Ô˘ Ô˘ ÚÔÎ¿ÏÂÛÂ ÙËÓ·‡ÍËÛ‹ ÙË˜. Œ¯ÂÈ ÌÔÚÈ·Îfi ‚¿ÚÔ˜ 106 kDa ÂÚ›Ô˘Î·È ‚Ú›ÛÎÂÙ·È ËÏÂÎÙÚÔÊÔÚËÙÈÎ¿ ÛÙËÓ ÂÚÈÔ¯‹ ÙˆÓÁ-ÛÊ·ÈÚÈÓÒÓ (2). ∏ CRP ıÂˆÚÂ›Ù·È Â˘·›ÛıËÙÔ˜ ‰Â›-ÎÙË˜ ÏÔ›ÌˆÍË˜, ·ÏÏ¿ ÌË ÂÈ‰ÈÎfi˜, Î·ıÒ˜ ·˘Í¿ÓÂÙ·È ÛÂÊÏÂÁÌÔÓÒ‰ÂÈ˜ Î·Ù·ÛÙ¿ÛÂÈ˜, ˘ÔÍ›·, Ì·ÈÂ˘ÙÈÎ¤˜ Î·-ÎÒÛÂÈ˜, ÂÚÈÁÂÓÓËÙÈÎ‹ ·ÛÊ˘Í›· Î·È ÂÈÛÚfiÊËÛË ÌË-ÎˆÓ›Ô˘ (3).

™ÙË ªÔÓ¿‰· ∂ÓÙ·ÙÈÎ‹˜ ¡ÔÛËÏÂ›·˜ ¡ÂÔÁÓÒÓ(ª∂¡¡) ÙË˜ µã ¡ÂÔÁÓÔÏÔÁÈÎ‹˜ ∫ÏÈÓÈÎ‹˜ ∞.¶.£.¯ÚËÛÈÌÔÔÈÂ›Ù·È ÌÈ· ıÔÏˆÛÈÌÂÙÚÈÎ‹ Ì¤ıÔ‰Ô˜ ÚÔÛ-‰ÈÔÚÈÛÌÔ‡ ÙË˜ CRP Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÌÂÁ¿ÏËÚ·ÎÙÈÎfiÙËÙ·, Î·ıÒ˜ ÂÎÙÂÏÂ›Ù·È ÛÙËÓ ›‰È· ÙË ªÔÓ¿-‰· ÌÂ Ï‹„Ë ÔÏ‡ ÌÈÎÚ‹˜ ÔÛfiÙËÙ·˜ ÙÚÈ¯ÔÂÈ‰ÈÎÔ‡ ·›-Ì·ÙÔ˜ Î·È ÙÔ ·ÔÙ¤ÏÂÛÌ· Â›Ó·È ‰È·ı¤ÛÈÌÔ ÛÂ ÔÏ‡ÌÈÎÚfi ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·.

™ÎÔfi˜ ·˘Ù‹˜ ÙË˜ ÌÂÏ¤ÙË˜ ‹Ù·Ó Ë Û‡ÁÎÚÈÛË ÙË˜ıÔÏˆÛÈÌÂÙÚÈÎ‹˜ ÌÂıfi‰Ô˘ (£√§) ÌÂ ÙÔÓ ÎÏ·ÛÈÎfiÙÚfiÔ ÚÔÛ‰ÈÔÚÈÛÌÔ‡ ÙË˜ CRP ÌÂ ÓÂÊÂÏfiÌÂÙÚÔ(¡∂º).


∏ ÌÂÏ¤ÙË ‹Ù·Ó ·Ó·‰ÚÔÌÈÎ‹. ¶ÂÚÈ¤Ï·‚Â 163 ‰Â›ÁÌ·Ù·Ï‹ÚÔ˘˜ ·›Ì·ÙÔ˜ ·fi 79 ÓÂÔÁÓ¿, Ù· ÔÔ›· ÓÔÛËÏÂ‡ıËÎ·ÓÛÙË ª∂¡¡, ·fi ÙÔÓ ∞Ú›ÏÈÔ ¤ˆ˜ ÙÔÓ ™ÂÙ¤Ì‚ÚÈÔ 2004.

∏ CRP ÌÂÙÚ‹ıËÎÂ ÛÂ 97 ‰Â›ÁÌ·Ù· ·›Ì·ÙÔ˜ ˆ˜ ÚÔ˘Ù›Ó·(√Ì¿‰· ∞: n=65) Î·È ÛÂ 66 ‰Â›ÁÌ·Ù· ·›Ì·ÙÔ˜ ÓÂÔÁÓÒÓ ÌÂ ÎÏÈ-ÓÈÎ‹ ÂÈÎfiÓ· ‡ÔÙË ÁÈ· ÏÔ›ÌˆÍË (OÌ¿‰· µ, n=43). ∂ÈÎfiÓ·‡ÔÙË ÁÈ· ÏÔ›ÌˆÍË ıÂˆÚ‹ıËÎÂ Ë ·ÚÔ˘Û›· ÙÔ˘Ï¿¯ÈÛÙÔÓ ‰‡Ô‹ ÂÚÈÛÛÔÙ¤ÚˆÓ ÎÏÈÓÈÎÒÓ ÛËÌÂ›ˆÓ ·fi: (·) ÙÔ ÓÂ˘ÚÈÎfi Û‡-ÛÙËÌ· (˘ÔÙÔÓ›·, Ï‹ı·ÚÁÔ˜, Û·ÛÌÔ›), (‚) ÙÔ ·Ó·ÓÂ˘ÛÙÈÎfiÛ‡ÛÙËÌ· (·Ó·ÓÂ˘ÛÙÈÎ‹ ‰˘Û¯¤ÚÂÈ·, ¿ÓÔÈ·, Ù·¯‡ÓÔÈ·, Î˘¿-ÓˆÛË), (Á) ÙÔ Î·Ú‰È·ÁÁÂÈ·Îfi Û‡ÛÙËÌ· (‚Ú·‰˘Î·Ú‰›·, Ù·¯˘-Î·Ú‰›·, ˘fiÙ·ÛË), (‰) ÙÔ ÂÙÈÎfi Û‡ÛÙËÌ· (‰˘Û·ÓÂÍ›· ÛÙËÛ›ÙÈÛË, ÌÂÙÂˆÚÈÛÌfi˜) Î·È Â) ÙË ıÂÚÌÔÚ‡ıÌÈÛË (˘ÔıÂÚÌ›·,˘ÂÚıÂÚÌ›·). ∆· Â›Â‰· ÙË˜ CRP ÚÔÛ‰ÈÔÚ›ÛıËÎ·Ó ÙfiÛÔ ÌÂÙË £√§ Ì¤ıÔ‰Ô, fiÛÔ Î·È ÌÂ ÙË ¡∂º, ˆ˜ Ì¤ıÔ‰Ô ·Ó·ÊÔÚ¿˜ ÛÂfiÏ· Ù· ‰Â›ÁÌ·Ù·. ∂ÈÚfiÛıÂÙ·, Î·ÏÏÈ¤ÚÁÂÈÂ˜ ·›Ì·ÙÔ˜, Ô˘¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ˆ˜ ‰Â‡ÙÂÚË Ì¤ıÔ‰Ô˜ ·Ó·ÊÔÚ¿˜, ÂÏ‹ÊıË-

Û·Ó ÛÂ 37 ÂÚÈÙÒÛÂÈ˜ ·fi 28 ÓÂÔÁÓ¿ ÙË˜ ÔÌ¿‰·˜ ∞ Î·È ÛÂ 45ÂÚÈÙÒÛÂÈ˜ ·fi 34 ÓÂÔÁÓ¿ ÙË˜ ÔÌ¿‰·˜ µ.

√ £√§ ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙË˜ CRP ¤ÁÈÓÂ ÌÂ ÙËÓ ÙÂ¯ÓÈÎ‹Quick Read System (√RION Diagnostica, Espoo, Finland).¶ÚfiÎÂÈÙ·È ÁÈ· Ù·¯Â›· Ì¤ıÔ‰Ô ‰È¿ÚÎÂÈ·˜ 2,5 ÏÂÙÒÓ, Ô˘ ÛÙË-Ú›˙ÂÙ·È ÛÙË Û‡Ó‰ÂÛË ÙË˜ CRP ÌÂ ÌÔÓÔÎÏˆÓÈÎfi ·ÓÙ›ÛˆÌ·, ÌÂÙÔ ÔÔ›Ô ÂÂÓ‰‡ÂÈ ÌÈÎÚÔÛˆÌ·Ù›‰È· latex. ∏ ÌÂÙ·‚ÔÏ‹ ÙË˜ ıÔ-ÏÂÚfiÙËÙ·˜ ÌÂÙ¿ ÙË Û‡Ó‰ÂÛË ÌÂÙÚ¿Ù·È ÌÂ ÂÈ‰ÈÎfi fiÚÁ·ÓÔ. √fiÁÎÔ˜ ÙÔ˘ ·›Ì·ÙÔ˜ Ô˘ ··ÈÙÂ›Ù·È Â›Ó·È 20 Ìl Î·È ÙÔ Â‡ÚÔ˜ Ì¤-ÙÚËÛË˜ ‚Ú›ÛÎÂÙ·È ÌÂÙ·Í‡ 8 Î·È 160 mg/l. ™‡ÌÊˆÓ· ÌÂ ÙÔÓ Î·-Ù·ÛÎÂ˘·ÛÙ‹, Ë Ì¤ıÔ‰Ô˜ ¤¯ÂÈ Û˘ÓÙÂÏÂÛÙ‹ ÌÂÙ·‚ÏËÙfiÙËÙ·˜ÛÙËÓ ›‰È· Ì¤ÙÚËÛË (within-assay CV) 4,9% Î·È ÛÂ Â·Ó·Ï·Ì-‚·ÓfiÌÂÓÂ˜ ÌÂÙÚ‹ÛÂÈ˜ (between-assay CV) 8,3%.

√ ¡∂º ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙË˜ CRP (ÌÂ Ï‹„Ë ÔÚÔ‡ ·›Ì·-ÙÔ˜) ¤ÁÈÓÂ ÌÂ ÓÂÊÂÏfiÌÂÙÚÔ ÙË˜ ÂÙ·ÈÚÂ›·˜ Beckman (within-assay CV 2,6% Î·È between-assay CV 3,0%) ÛÙÔ ‚ÈÔ¯ËÌÈÎfiÂÚÁ·ÛÙ‹ÚÈÔ. √ ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙË˜ CRP ÁÈÓfiÙ·Ó ÛÙËÓ ›‰È· ·È-ÌÔÏË„›· Ù·˘Ùfi¯ÚÔÓ· Î·È ÌÂ ÙÈ˜ ‰‡Ô ÌÂıfi‰Ô˘˜. ∏ ÂÂÍÂÚÁ·-Û›· ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ ¤ÁÈÓÂ ÌÂ ÙË ¯Ú‹ÛË ÙÔ˘ SPSS 11.5 forWindows (SPSS Inc., Chicago, Ill). ∆· ·ÔÙÂÏ¤ÛÌ·Ù· ÂÎÊÚ¿-ÛÙËÎ·Ó ˆ˜ Ì¤ÛÂ˜ ÙÈÌ¤˜ ÌÂ ÙÈ˜ ÛÙ·ıÂÚ¤˜ ÙÔ˘˜ ·ÔÎÏ›ÛÂÈ˜(x±SD). °È· ÙË Û‡ÁÎÚÈÛË ÙˆÓ ÙÈÌÒÓ ÙË˜ CRP ÌÂÙ·Í‡ ÙË˜£√§ Î·È ¡∂º ÌÂıfi‰Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë ÌË ·Ú·ÌÂÙÚÈ-Î‹ Ì¤ıÔ‰Ô˜ Wilcoxon Signed Rank test Î·È Ë ·Ó¿Ï˘ÛË Bland-Altman, ÂÓÒ ÁÈ· ÙË Û‡ÁÎÚÈÛË ÙˆÓ ÔÛÔÛÙÈ·›ˆÓ ·Ó·ÏÔÁÈÒÓ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë ·ÎÚÈ‚‹˜ ‰ÔÎÈÌ·Û›· Fisher (Fisher’s exacttest). ∆¤ÏÔ˜, ÚÔÛ‰ÈÔÚ›ÛıËÎ·Ó Î·Ì‡ÏÂ˜ ROC (ReceiverOperative Characteristics) ÙfiÛÔ ÁÈ· ÙË £√§, fiÛÔ Î·È ÁÈ· ÙË¡∂º Ì¤ıÔ‰Ô, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÙËÓ Î·ÏÏÈ¤ÚÁÂÈ· ·›Ì·ÙÔ˜ ˆ˜Ì¤ıÔ‰Ô ·Ó·ÊÔÚ¿˜. TÈÌ‹ p ÌÈÎÚfiÙÂÚË ·fi 0,05 ÔÚ›ÛÙËÎÂ ˆ˜ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ ÛÂ fiÏÂ˜ ÙÈ˜ ‰ÔÎÈÌ·Û›Â˜.


∞. ™‡ÁÎÚÈÛË ÙÈÌÒÓ CRP ÌÂ £√§ Î·È ¡∂º Ì¤ıÔ‰Ô

¢È·ÈÛÙÒıËÎÂ ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿ÌÂÙ·Í‡ ÙˆÓ ÂÈ¤‰ˆÓ CRP ÌÂ £√§ Î·È ¡∂º ÌÂıfi-‰Ô˘˜ (18,7±22,6 mg/l ¤Ó·ÓÙÈ 14,9±20,7 mg/l, ·ÓÙ›-ÛÙÔÈ¯·, Wilcoxon Signed Rank test, p<0,001).

√È £√§ Î·È ¡∂º Ì¤ıÔ‰ÔÈ ‚Ú›ÛÎÔÓÙ·Ó ÛÂ ÈÛ¯˘Ú‹ıÂÙÈÎ‹ Û˘Û¯¤ÙÈÛË (Spearman’s rho, r2=0,945,p<0,001). ™ÙÔ ÁÚ¿ÊËÌ· ‰È·ÛÔÚ¿˜ Ë Â˘ıÂ›· ·ÏÈÓ-‰ÚfiÌËÛË˜ ÌÂÙ·Í‡ ÙˆÓ ‰‡Ô ÌÂıfi‰ˆÓ ÚÔÛ‰ÈÔÚÈÛÌÔ‡ÙË˜ CRP ‰Â›¯ÓÂÈ ÙË ıÂÙÈÎ‹ Û¯¤ÛË (∂ÈÎfiÓ· 1).

™ÙËÓ ·Ó¿Ï˘ÛË Bland-Altman ‰È·ÈÛÙÒÓÂÙ·È ˘Â-ÚÂÎÙ›ÌËÛË ÙË˜ CRP ÌÂ ÙË £√§ Ì¤ıÔ‰Ô ÛÂ Û¯¤ÛË ÌÂ ÙË¡∂º Ì¤ıÔ‰Ô ÛÙËÓ ÂÚÈÔ¯‹ ÙÈÌÒÓ Ì¤¯ÚÈ 40 mg/l („Â˘-‰Ò˜ ıÂÙÈÎ¤˜ ÙÈÌ¤˜) (∂ÈÎfiÓ· 2).

µ. ™‡ÁÎÚÈÛË £√§ Î·È ¡∂º ÌÂıfi‰ˆÓ ÌÂ ÙËÓ

Î·ÏÏÈ¤ÚÁÂÈ· ·›Ì·ÙÔ˜

™ÙËÓ ÔÌ¿‰· ∞ Ë CRP ‚Ú¤ıËÎÂ ·˘ÍËÌ¤ÓË (>10mg/l) ÛÂ 45 ‰Â›ÁÌ·Ù· ÌÂ ÙË £√§ Ì¤ıÔ‰Ô Î·È ÛÂ 15‰Â›ÁÌ·Ù· ÌÂ ÙË ¡∂º Ì¤ıÔ‰Ô, ÂÓÒ ÛÙËÓ ÔÌ¿‰· µ ÛÂ36 Î·È 18, ·ÓÙ›ÛÙÔÈ¯·. ™Ë„·ÈÌ›· ÌÂ ıÂÙÈÎ‹ Î·ÏÏÈ¤Ú-ÁÂÈ· ·›Ì·ÙÔ˜ ‰È·ÈÛÙÒıËÎÂ ÛÂ 6 ÓÂÔÁÓ¿ ÙË˜ ÔÌ¿‰·˜∞ Î·È 8 ÓÂÔÁÓ¿ ÙË˜ ÔÌ¿‰·˜ µ.

ÀÔÏÔÁ›ÛıËÎÂ fiÙÈ Ë CRP-£√§ ¤¯ÂÈ Â˘·ÈÛıËÛ›·93% (13/14) Î·È ÂÈ‰ÈÎfiÙËÙ· 56% (38/68) ¤Ó·ÓÙÈ ÙË˜


Î·ÏÏÈ¤ÚÁÂÈ·˜, ÂÓÒ Ë CRP-¡∂º 72% (10/14) Î·È

82% (56/68), ·ÓÙ›ÛÙÔÈ¯·. H ıÂÙÈÎ‹ ÚÔÁÓˆÛÙÈÎ‹

·Í›· (PPV) ÙË˜ CRP-£√§ Â›Ó·È 30% (13/43) Î·È Ë

·ÚÓËÙÈÎ‹ ÚÔÁÓˆÛÙÈÎ‹ ·Í›· (NPV) 97% (38/39),

ÂÓÒ ÙË˜ CRP-¡∂º 46% (10/22) Î·È 94% (56/60),

·ÓÙ›ÛÙÔÈ¯·.

√ ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙË˜ CRP ÌÂ £√§ Î·È ¡∂º ÌÂ-

ıfi‰Ô˘˜ ‰ÂÓ ·ÚÔ˘Û›·˙Â ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ ‰È·-

ÊÔÚ¿ ̂ ˜ ÚÔ˜ ÙËÓ Â˘·ÈÛıËÛ›·, PPV Î·È NPV. ∞ÓÙ›ıÂ-

Ù·, ˆ˜ ÚÔ˜ ÙËÓ ÂÈ‰ÈÎfiÙËÙ· ‚Ú¤ıËÎÂ ÛÙ·ÙÈÛÙÈÎ¿ ÛË-

Ì·ÓÙÈÎ‹ ‰È·ÊÔÚ¿ (Fisher’s exact test, p<0,001).

°. ¶ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ô˘‰Ô‡ £√§ ÌÂıfi‰Ô˘ ÛÂ Û¯¤ÛË

ÌÂ ÙËÓ Î·ÏÏÈ¤ÚÁÂÈ· ·›Ì·ÙÔ˜

∂Ê·ÚÌfi˙ÔÓÙ·˜ ÙË ‰È·‰ÈÎ·Û›· ROC ÁÈ· ÙË £√§

Ì¤ıÔ‰Ô Î·È ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÙËÓ Î·ÏÏÈ¤ÚÁÂÈ· ·›Ì·-

ÙÔ˜ ˆ˜ Ì¤ıÔ‰Ô ·Ó·ÊÔÚ¿˜ (Area Under Curve=

0,782), ‰È·ÈÛÙÒıËÎÂ fiÙÈ Ô ‚¤ÏÙÈÛÙÔ˜ Ô˘‰fi˜ ÙË˜

£√§ ÌÂıfi‰Ô˘ ˆ˜ ÚÔ˜ ÙË ‰È¿ÁÓˆÛË ÌÈ·˜ ÏÔ›ÌˆÍË˜

Â›Ó·È Ù· 11 mg/l (∂ÈÎfiÓ· 3). ™ÙÔÓ Ô˘‰fi ·˘Ùfi, Ë Â˘·È-

ÛıËÛ›· Î·È Ë ÂÈ‰ÈÎfiÙËÙ· ÙË˜ £√§ ÌÂıfi‰Ô˘ Â›Ó·È 93%

Î·È 55%, ·ÓÙ›ÛÙÔÈ¯·. ŒÓ·Ó ÂÓ·ÏÏ·ÎÙÈÎfi Ô˘‰fi ·ÔÙÂ-

ÏÔ‡Ó Ù· 14 mg/l. ™ÙÔÓ Ô˘‰fi ·˘Ùfi, Ë Â˘·ÈÛıËÛ›· Î·È Ë

ÂÈ‰ÈÎfiÙËÙ· ÙË˜ £√§ ÌÂıfi‰Ô˘ Â›Ó·È 71% Î·È 63%,

·ÓÙ›ÛÙÔÈ¯·.

™˘˙‹ÙËÛË

∏ Ì¤ÙÚËÛË ÙË˜ CRP ÛÂ ÊÏÂÁÌÔÓÒ‰ÂÈ˜ Î·Ù·ÛÙ¿-

ÛÂÈ˜ ÌÔÚÂ› Ó· ¯ÚËÛÈÌÔÔÈËıÂ› ˆ˜ Â˘·›ÛıËÙÔ˜ ‰Â›-

ÎÙË˜ ÙË˜ ÓfiÛÔ˘, ÙË˜ ·ÓÙ·fiÎÚÈÛË˜ ÛÙË ıÂÚ·Â›· ·Ï-

Ï¿ Î·È ÙË˜ ÏÔ›ÌˆÍË˜ ÙÔ˘ ÓÂÔÁÓÔ‡ (4). ∏ ÂÎÙ›ÌËÛË

ÙË˜ CRP Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ ¯Ú‹ÛÈÌË ÛÙË ‰È¿ÁÓˆÛË

ÙË˜ ÏÔ›ÌˆÍË˜ ÌÂÙ¿ ·fi Â·Ó·Ï·Ì‚·ÓfiÌÂÓÂ˜ ÌÂÙÚ‹-

ÛÂÈ˜ (5). °ÓˆÚ›˙ÔÓÙ·˜ fiÙÈ ·˘Í¿ÓÂÙ·È ÌÂÙ¿ ·fi 4 ¤ˆ˜ 6

ÒÚÂ˜ ·fi ÙËÓ ¤Ó·ÚÍË ÙË˜ ÓfiÛÔ˘, ı· Ú¤ÂÈ Ó· ‰ÈÂ-

ÓÂÚÁÂ›Ù·È ÙÔ˘Ï¿¯ÈÛÙÔÓ Ì›· ‰Â‡ÙÂÚË Ì¤ÙÚËÛË ÌÂÙ¿

·fi ÌÂÚÈÎ¤˜ ÒÚÂ˜, È‰È·›ÙÂÚ· ·Ó Ë ÚÒÙË Ì¤ÙÚËÛË

¤‰ˆÛÂ ÔÚÈ·Îfi ·ÔÙ¤ÏÂÛÌ· (2,6).

∏ ¡∂º Â›Ó·È Ë Ì¤ıÔ‰Ô˜ ÂÎÏÔÁ‹˜ ÁÈ· ÙË Ì¤ÙÚËÛË

ÙË˜ CRP ÁÈ·Ù› Â›Ó·È Â˘·›ÛıËÙË Î·È ·ÎÚÈ‚‹˜ (7). ∞·È-

ÙÂ› fiÌˆ˜ ÂÍÔÏÈÛÌfi Î·È ÂÈ‰ÈÎ¿ ÂÎ·È‰Â˘Ì¤ÓÔ ÚÔÛˆ-

ÈÎfi Î·È ÔÚÁ·ÓˆÌ¤ÓÔ ÂÚÁ·ÛÙ‹ÚÈÔ. ∂ÈÚfiÛıÂÙ·,

ÔÏÏ¤˜ ÊÔÚ¤˜ Ô ¯ÚfiÓÔ˜ Ô˘ ··ÈÙÂ›Ù·È ÁÈ· ÙËÓ ·Ú·-

Ï·‚‹ ÙÔ˘ ·ÔÙÂÏ¤ÛÌ·ÙÔ˜ ÌÔÚÂ› Ó· Â›Ó·È ÛËÌ·ÓÙÈÎfi˜

ÁÈ· ÙÈ˜ ·ÔÊ¿ÛÂÈ˜ Ô˘ Ú¤ÂÈ Ó· ÏËÊıÔ‡Ó ÛÂ ÓÂÔÁÓ¿

ÌÂ Î›Ó‰˘ÓÔ ÛË„·ÈÌ›·˜. ∞fi ÙËÓ ¿ÏÏË ÌÂÚÈ¿, Ë ÂÊ·Ú-

ÌÔÁ‹ ÙË˜ £√§ ÌÂıfi‰Ô˘ Â›Ó·È Ù·¯‡Ù·ÙË (·ÔÙ¤ÏÂÛÌ·

0 20 40 60 80 100 120 140 160 180

ª¤ÛÔ˜ fiÚÔ˜ CRP £√§ Î·È ¡∂º ÌÂıfi‰ˆÓ

¢È¿

ÊÔ

Ú·

CR

P £

√§

Î·

È ¡

∂º

ÌÂı

fi‰

ˆÓ

-30

-20

-10

0

10

20

30

40

50

∂ÈÎfiÓ· 2. ∞Ó¿Ï˘ÛË Bland-Altman ÙˆÓ ÙÈÌÒÓ ÙË˜ CRP ÌÂ ¡∂ºÎ·È £√§ Ì¤ıÔ‰Ô.

1 - ∂È‰ÈÎfiÙËÙ·

1,00,80,50,30,0

∂˘

·ÈÛ

ıË

Û›·

1,0

0,8

0,5

0,3

0,0

∂ÈÎfiÓ· 3. ROC Î·Ì‡ÏË ÙË˜ £√§ ÌÂıfi‰Ô˘ ÚÔÛ‰ÈÔÚÈÛÌÔ‡ ÙË˜CRP, ÌÂ ÙËÓ Î·ÏÏÈ¤ÚÁÂÈ· ·›Ì·ÙÔ˜ ˆ˜ Ì¤ıÔ‰Ô ·Ó·ÊÔÚ¿˜.

219™‡ÁÎÚÈÛË ‰˘Ô ÌÂıfi‰ˆÓ ÚÔÛ‰ÈÔÚÈÛÌÔ‡ ÙË˜ CRP

¶·È‰È·ÙÚÈÎ‹ 2007;70:217-220

y = 0,864 x - 1,213

R2 = 0,8935

20 140 40 60 80 100 120 1600CRP - ¡∂º (mg/l)

180

160

140

120

CR

P -

£√

§ (

mg/

l)

100

80

60

40

20

0

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


ÛÂ 3 ÏÂÙ¿), ¯ˆÚ›˜ Ó· ··ÈÙÂ› ÂÈ‰ÈÎfi ÂÍÔÏÈÛÌfi Î·ÈÂÍÂÈ‰ÈÎÂ˘Ì¤ÓÔ ÚÔÛˆÈÎfi, ·ÏÏ¿ ‰ÂÓ Â›Ó·È ·fiÏ˘Ù·ÙÂÎÌËÚÈˆÌ¤ÓË Î·ıÒ˜ ÔÈ ÌÂÏ¤ÙÂ˜ Û‡ÁÎÚÈÛË˜ ¡∂º Î·È£√§ ÌÂıfi‰ˆÓ Â›Ó·È ÂÚÈÔÚÈÛÌ¤ÓÂ˜ (1,7,8). ™ÙËÓ ÂÚ-Á·Û›· ÙˆÓ Imad E. Makhoul Î·È S. Esposito ÛÂ ÓÂÔÁÓ¿Î·È ·È‰È¿ ·ÓÙ›ÛÙÔÈ¯·, ·ÍÈÔÏÔÁ‹ıËÎÂ Ë Ì¤ÙÚËÛË ÙË˜CRP ÌÂ £√§ Ì¤ıÔ‰Ô ˆ˜ ÈÛÔ‰‡Ó·ÌË ÙË˜ ¡∂º ÌÂıfi-‰Ô˘, ÂÓÒ ÛÂ ·˘Ù‹ ÙË˜ °È·ÓÓ¿ÎÔ˘ ª. Î·È Û˘Ó. ‰È·È-ÛÙÒÓÂÙ·È Î·Ï‹ Û˘ÌÊˆÓ›· ÌÂÙÚ‹ÛÂˆÓ ÌÂÙ·Í‡ ÙˆÓ‰‡Ô ÌÂıfi‰ˆÓ.

™ÙË ÌÂÏ¤ÙË ·˘Ù‹ Û˘ÁÎÚ›ıËÎÂ Ë £√§ Ì¤ıÔ‰Ô˜ÚÔÛ‰ÈÔÚÈÛÌÔ‡ ÙË˜ CRP ÌÂ ·˘Ù‹ ÙË˜ ¡∂º Î·È ‰È·È-ÛÙÒıËÎÂ ÈÛ¯˘Ú‹ ıÂÙÈÎ‹ ÁÚ·ÌÌÈÎ‹ Û˘Û¯¤ÙÈÛË. ¶·Ú¿ÙË Û˘Û¯¤ÙÈÛË ·˘Ù‹, ÔÈ Ì¤ÛÔÈ fiÚÔÈ ÙˆÓ ÙÈÌÒÓ ÙˆÓ ‰‡ÔÌÂıfi‰ˆÓ ‰È¤ÊÂÚ·Ó ÛËÌ·ÓÙÈÎ¿, ÌÂ ÙË £√§ Ì¤ıÔ‰Ô Ó·ÂÌÊ·Ó›˙ÂÈ ˘„ËÏfiÙÂÚÂ˜ ÙÈÌ¤˜. °È’ ·˘Ùfi ÙÔÓ ÛÎÔfiÂÊ·ÚÌfiÛ·ÌÂ ÙËÓ ·Ó¿Ï˘ÛË Î·Ù¿ Bland-Altman, fiÔ˘Û˘ÁÎÚ›ÓÔÓÙ·È ÔÈ ‰È·ÊÔÚ¤˜ ÙˆÓ ÙÈÌÒÓ ÙˆÓ ‰‡Ô ÌÂıfi-‰ˆÓ ÌÂ ÙÔÓ Ì¤ÛÔ fiÚÔ ÙÔ˘˜ ÛÂ fiÏÔ ÙÔ Ê¿ÛÌ· ÙÈÌÒÓ ÙË˜CRP. ∞fi ÙËÓ ·Ó¿Ï˘ÛË ·˘Ù‹ ‰È·ÈÛÙÒıËÎÂ fiÙÈ ÁÈ· ÙÈ-Ì¤˜ CRP ÌÈÎÚfiÙÂÚÂ˜ ·fi 40 mg/l, Ë ¡∂º Ì¤ıÔ‰Ô˜ Û˘-ÛÙËÌ·ÙÈÎ¿ ˘ÂÚÂÎÙÈÌÔ‡ÛÂ Ù· ·ÔÙÂÏ¤ÛÌ·Ù·.

π‰È·›ÙÂÚ· ¤¯ÂÈ ··Û¯ÔÏ‹ÛÂÈ ÙË ‚È‚ÏÈÔÁÚ·Ê›· ËÛ˘ÁÎ¤ÓÙÚˆÛË ÙË˜ CRP ¿Óˆ ·fi ÙËÓ ÔÔ›· Ë ÏÔ›Ìˆ-ÍË ıÂˆÚÂ›Ù·È ‚·ÎÙËÚÈ·Î‹. ∫·Ù¿ ÙÔ˘˜ ÂÚÈÛÛfiÙÂÚÔ˘˜ÂÚÂ˘ÓËÙ¤˜ ÙÔ fiÚÈÔ Ù›ıÂÙ·È ÛÙ· 20 mg/l. ∫·Ù’ ¿ÏÏÔ˘˜ÙÔ fiÚÈÔ ÙˆÓ 40 mg/l ·˘Í¿ÓÂÈ ÙËÓ Â˘·ÈÛıËÛ›· Î·È ÙËÓÂÈ‰ÈÎfiÙËÙ· ÙË˜ ÌÂıfi‰Ô˘ (6). ™ÙË ‰ÈÎ‹ Ì·˜ ÌÂÏ¤ÙË,ÛÙË ROC ·Ó¿Ï˘ÛË ÁÈ· ÙË £√§ Ì¤ıÔ‰Ô, ˆ˜ ‚¤ÏÙÈÛÙÔ˜Ô˘‰fi˜ ̂ ˜ ÚÔ˜ ÙË ‰È¿ÁÓˆÛË ÙË˜ ÏÔ›ÌˆÍË˜ ÛÂ Û‡ÁÎÚÈ-ÛË ÌÂ ÙË ıÂÙÈÎ‹ Î·ÏÏÈ¤ÚÁÂÈ· ·›Ì·ÙÔ˜ ‚Ú¤ıËÎÂ ÙÈÌ‹CRP 11 mg/l. ™ÙÔÓ Ô˘‰fi ·˘Ùfi ˘‹Ú¯Â Â˘·ÈÛıËÛ›·93% Î·È ÂÈ‰ÈÎfiÙËÙ· 55%. ŸÙ·Ó Ô Ô˘‰fi˜ ÙÔÔıÂÙ‹ıË-ÎÂ ÛÙ· 14 mg/l, Ë Â˘·ÈÛıËÛ›· Î·È Ë ÂÈ‰ÈÎfiÙËÙ· ÙË˜£√§ ÌÂıfi‰Ô˘ ‹Ù·Ó 71% Î·È 63%, ·ÓÙ›ÛÙÔÈ¯·. £Âˆ-ÚÔ‡ÌÂ fiÙÈ ÛÙÔ ÎÏÈÓÈÎfi Â›Â‰Ô ı· Ú¤ÂÈ Ó· ÂÊ·ÚÌfi-˙ÂÙ·È Ô Ô˘‰fi˜ ÙˆÓ 11 mg/l Î·ıÒ˜ Â›Ó·È ÚÔÙÈÌfiÙÂÚËË ¤Ó·ÚÍË ıÂÚ·Â›·˜ ÛÂ ·Ô˘Û›· ÛË„·ÈÌ›·˜ ·fi ÙÈ˜Û˘Ó¤ÂÈÂ˜ ÌË ¯ÔÚËÁÔ‡ÌÂÓË˜ ·ÁˆÁ‹˜ ÛÂ ÓÂÔÁÓfi ÌÂ·ÚÔ˘Û›· ÛÔ‚·Ú‹˜ ÏÔ›ÌˆÍË˜ (2).

∏ ·ÚÓËÙÈÎ‹ ÚÔÁÓˆÛÙÈÎ‹ ·Í›· (NPV) Î·È ÌÂ ÙÈ˜‰‡Ô ÌÂıfi‰Ô˘˜ Î˘Ì¿ÓıËÎÂ ÛÂ ˘„ËÏ¿ Â›Â‰·. ∏

˘„ËÏ‹ NPV ÛËÌ·›ÓÂÈ fiÙÈ ·Ó ÙÔ ·ÔÙ¤ÏÂÛÌ· ÙË˜ ÂÍ¤-Ù·ÛË˜ Â›Ó·È ·ÚÓËÙÈÎfi, Ë Èı·ÓfiÙËÙ· ‡·ÚÍË˜ ÏÔ›Ìˆ-ÍË˜ Â›Ó·È ÌÈÎÚ‹. ∆Ô ÁÂÁÔÓfi˜ ·˘Ùfi ‚ÔËı¿ ÛÙÔÓ ·Ô-ÎÏÂÈÛÌfi ÙË˜ ÏÔ›ÌˆÍË˜ ÌÂ Â·ÎfiÏÔ˘ıÔ ÙËÓ ÂÏ¿ÙÙˆÛËÙË˜ ¯Ú‹ÛË˜ ÙˆÓ ·ÓÙÈ‚ÈÔÙÈÎÒÓ (9).

™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, ÛÙ· ÓÔÛÔÎÔÌÂÈ·Î¿ ÂÚÁ·ÛÙ‹ÚÈ·,·ÎfiÌË ÎÈ ·Ó ‰È·Ù›ıÂÙ·È ÓÂÊÂÏfiÌÂÙÚÔ, ¯ÚÂÈ¿˙ÂÙ·È Ó·˘¿Ú¯ÂÈ Î·È ÌÈ· ¿ÏÏË ·ÏÔ‡ÛÙÂÚË Î·È Ù·¯‡ÙÂÚË ÙÂ-¯ÓÈÎ‹. √ ÁÚ‹ÁÔÚÔ˜ ˘ÔÏÔÁÈÛÌfi˜ ÙË˜ CRP ÌÂ ÙË £√§Ì¤ıÔ‰Ô ¯ˆÚ›˜ ·ÈÌÔÏË„›· ÛÂ ÙÚÈ¯ÔÂÈ‰ÈÎfi ·›Ì· Ê·›ÓÂ-Ù·È ˆ˜ Â›Ó·È ·ÍÈfiÈÛÙÔ˜, Î·ıÒ˜ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi˘„ËÏ‹ Â˘·ÈÛıËÛ›· Î·È ·ÚÓËÙÈÎ‹ ÚÔÁÓˆÛÙÈÎ‹ ·Í›·.∏ £√§ Ì¤ıÔ‰Ô˜ ·Ó·Ì¤ÓÂÙ·È Ó· Ô‰ËÁ‹ÛÂÈ ÛÂ ÂÏ¿ÙÙˆ-ÛË ÙÔ˘ ÎfiÛÙÔ˘˜ ÓÔÛËÏÂ›·˜ Î·ıÒ˜ ÂÚÈÔÚ›˙ÂÈ ÛËÌ·-ÓÙÈÎ¿ ÙÈ˜ ÂÚÁ·ÛÙËÚÈ·Î¤˜ ÂÍÂÙ¿ÛÂÈ˜ Î·È, ÙÔ ÛËÌ·ÓÙÈÎfi-ÙÂÚÔ, Ô‰ËÁÂ› ÛÂ ÏÔÁÈÎ‹ ¯ÔÚ‹ÁËÛË ÙˆÓ ·ÓÙÈ‚ÈÔÙÈÎÒÓ.


1. Makhoul IR, Smolkin T, Zinder O, Diamond E, ∆amir A,Sujov P. Fast bedside measurement of blood count and C-reactive protein in neonates with suspected late-onsetsespsis. Acta Paediatr 2005;94:960-963.

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

3. ∆·Ú·ÓÙ˙‹ ¶, ∫Ô˘ÎÔ˘ÏÔÌ¿ÙË-ºÚ¿ÁÎÔ˘ ∂., ∫Ô˘Ú¿ÎË˜ °.∏ C-·ÓÙÈ‰ÚÒÛ· ÚˆÙÂ˝ÓË (CRP) ÛÙË ‰È¿ÁÓˆÛËÓÂÔÁÓÈÎÒÓ ÏÔÈÌÒÍÂˆÓ. ¶·È‰È·ÙÚÈÎ‹ 1989;52:226-230.

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

5. Hengst JM. The role of C-reactive protein in the evalua-tion and management of infants with suspected sepsis.Adv Neonatal Care 2003;3:3-13.

6. °È·ÓÓ¿ÎË-æÈÓ¿ÎË ª. C-·ÓÙÈ‰ÚÒÛ· ÚˆÙÂ˝ÓË. ªÈÎÚÔ‚ÈÔ-ÏÔÁ›· Î·È ∂ÚÁ·ÛÙËÚÈ·Î‹ ¢È·ÁÓˆÛÙÈÎ‹ 1990;5:211-217.

7. °È·ÓÓ¿ÎË ª, µÔ˘Ó¿ÙÛÔ˘ ª, ∆ÛÈÏ¿ÎÔ˘ ™. ∞ÍÈÔÏfiÁËÛË‰‡Ô ÁÚ‹ÁÔÚˆÓ ÙÂ¯ÓÈÎÒÓ ÔÛÔÙÈÎÔ‡ ÚÔÛ‰ÈÔÚÈÛÌÔ‡ ÙË˜CRP ÛÂ Ï‹ÚÂ˜ ·›Ì·. ªÈÎÚÔ‚ÈÔÏÔÁ›· Î·È ∂ÚÁ·ÛÙËÚÈ·Î‹¢È·ÁÓˆÛÙÈÎ‹ 2001;6:177-181.

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

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

220 ∏. Ã·Ù˙ËÈˆ·ÓÓ›‰Ë˜ Î·È Û˘Ó.



∞ÍÈÔÏfiÁËÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ Ô˘ÚÔÏÔ›ÌˆÍË˜ ÛÂ ÂÌ‡ÚÂÙ· ‚Ú¤ÊË

¯ˆÚ›˜ ÂÌÊ·Ó‹ ÂÛÙ›· ÏÔ›ÌˆÍË˜

™. ºÔ‡˙·˜, ∞. º·ÛÔ˘Ï‹, ¢. ∞‰·Ì›‰Ë˜, ∫. ∆˙ÂÏ¤Ë˜, π. ª·ÎÔÔ‡ÏÔ˘, ∞. ¶··‰ÔÔ‡ÏÔ˘, ¢. ∑·ÊÂÈÚ·ÎfiÔ˘ÏÔ˜

¶ÂÚ›ÏË„Ë

∂ÈÛ·ÁˆÁ‹: √È Ô˘ÚÔÏÔÈÌÒÍÂÈ˜ ·ÔÙÂÏÔ‡Ó Û˘¯Ófi ·›ÙÈÔ ÌÈÎÚÔ‚È·Î‹˜ ÓfiÛÔ˘ ÛÙË ‚ÚÂÊÈÎ‹ ËÏÈÎ›·. ™ÎÔfi˜ ÙË˜ÌÂÏ¤ÙË˜ ‹Ù·Ó Ë ·ÍÈÔÏfiÁËÛË ÙˆÓ ˘ÔÛÊ·ÈÚ›ˆÓ ÛÙË ÌÈÎÚÔÛÎÔÈÎ‹ ÂÍ¤Ù·ÛË Ô‡ÚˆÓ, ÙˆÓ ÏÂ˘ÎÒÓ ÛÙË ÁÂÓÈ-Î‹ ÂÍ¤Ù·ÛË ·›Ì·ÙÔ˜, ÙË˜ ∆∫∂ Î·È ÙË˜ CRP, ÚÔÎÂÈÌ¤ÓÔ˘ Ó· ÂÎÙÈÌËıÂ› Ô Î›Ó‰˘ÓÔ˜ Ô˘ÚÔÏÔ›ÌˆÍË˜ ÛÂ ÂÌ‡-ÚÂÙ· ‚Ú¤ÊË ¯ˆÚ›˜ ÂÌÊ·Ó‹ ÂÛÙ›· ÏÔ›ÌˆÍË˜.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ªÂÏÂÙ‹ıËÎ·Ó ·Ó·‰ÚÔÌÈÎ¿ 115 ‚Ú¤ÊË ËÏÈÎ›·˜ 15-90 ËÌÂÚÒÓ Ô˘ ÂÈÛ‹¯ıËÛ·Ó ÁÈ·¤ÏÂÁ¯Ô ˘ÚÂÙÔ‡ ¯ˆÚ›˜ ÂÌÊ·Ó‹ ÂÛÙ›·. ™Â fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓÂ›˜ Â›¯Â Á›ÓÂÈ Ï‹ÚË˜ ¤ÏÂÁ¯Ô˜ ÛË„·ÈÌ›·˜: Î·Ï-ÏÈ¤ÚÁÂÈ· ·›Ì·ÙÔ˜, ÁÂÓÈÎ‹ Î·È Î·ÏÏÈ¤ÚÁÂÈ· Ô‡ÚˆÓ, ÁÂÓÈÎ‹ Î·È Î·ÏÏÈ¤ÚÁÂÈ· ∂¡À. °È· ÙËÓ Î¿ıÂ ÂÚÁ·ÛÙËÚÈ·-Î‹ ·Ú¿ÌÂÙÚÔ Î·ıÔÚ›ÛÙËÎ·Ó Ë Â˘·ÈÛıËÛ›·, Ë ÂÈ‰ÈÎfiÙËÙ·, Ë ıÂÙÈÎ‹ Î·È ·ÚÓËÙÈÎ‹ ÚÔÁÓˆÛÙÈÎ‹ ·Í›·, ÔÈ·Ó·ÏÔÁ›Â˜ Èı·ÓÔÙ‹ÙˆÓ (LR), Î·ıÒ˜ Î·È Ë Û˘ÓÔÏÈÎ‹ ·fi‰ÔÛË ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÙÈ˜ Î·Ì‡ÏÂ˜ ROC.

∞ÔÙÂÏ¤ÛÌ·Ù·: ∏ Û˘¯ÓfiÙËÙ· Ô˘ÚÔÏÔ›ÌˆÍË˜ ‹Ù·Ó 23,5%. ∏ ˘Ô˘Ú›· ‹Ù·Ó Ë ÌfiÓË ·Ú¿ÌÂÙÚÔ˜ ÌÂ Î·Ï‹‰È·ÎÚÈÙÈÎ‹ ÈÎ·ÓfiÙËÙ· (AUC: 0,825). √ ·ÚÈıÌfi˜ ˘ÔÛÊ·ÈÚ›ˆÓ >10 ÎÔ ·ÚÔ˘Û›·ÛÂ Â˘·ÈÛıËÛ›· 56%, ÂÈ‰È-ÎfiÙËÙ· 99%, ÂÍ·ÈÚÂÙÈÎ‹ ıÂÙÈÎ‹ LR (48,9) Î·È ·Û‹Ì·ÓÙË ·ÚÓËÙÈÎ‹ LR (0,45). ∆· ÏÂ˘Î¿ ·ÈÌÔÛÊ·›ÚÈ·(>15.000/ÌL ‹ <5.000/ÌL) Â›¯·Ó 78% Â˘·ÈÛıËÛ›·, 76% ÂÈ‰ÈÎfiÙËÙ· Î·È ·Û‹Ì·ÓÙÂ˜ ·Ó·ÏÔÁ›Â˜ Èı·ÓÔÙ‹ÙˆÓ(ıÂÙÈÎ‹ LR 3,26 Î·È ·ÚÓËÙÈÎ‹ LR 0,29). °È· ÙËÓ ∆∫∂ Î·È ÙË CRP Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ‰ÂÓ ‹Ù·Ó ÈÎ·ÓÔÔÈËÙÈÎ¿. √Û˘Ó‰˘·ÛÌfi˜ ˘ÔÛÊ·ÈÚ›ˆÓ Î·È ÏÂ˘ÎÒÓ ı· Ô‰ËÁÔ‡ÛÂ ÛÂ ·ÔÙ˘¯›· ‰È¿ÁÓˆÛË˜ 3 Ô˘ÚÔÏÔÈÌÒÍÂˆÓ (11%).

™˘ÌÂÚ¿ÛÌ·Ù·: ∫·Ó¤Ó·˜ ·fi ÙÔ˘˜ ÂÚÁ·ÛÙËÚÈ·ÎÔ‡˜ ‰Â›ÎÙÂ˜ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó ‰ÂÓ ·Ô‰Â›¯ıËÎÂ ÈÎ·Ófi˜Ó· ÚÔ‚Ï¤„ÂÈ ÌÂ ·ÛÊ¿ÏÂÈ· ÙÔ ·ÔÙ¤ÏÂÛÌ· ÙË˜ Î·ÏÏÈ¤ÚÁÂÈ·˜ Ô‡ÚˆÓ. ∏ ·ÓÂ‡ÚÂÛË >10 ˘ÔÛÊ·ÈÚ›ˆÓ ÎÔÛÙË ÌÈÎÚÔÛÎÔÈÎ‹ ÂÍ¤Ù·ÛË Ô‡ÚˆÓ Î·ÙÂ˘ı‡ÓÂÈ ÚÔ˜ ÙËÓ Èı·ÓfiÙËÙ· Ô˘ÚÔÏÔ›ÌˆÍË˜, ·ÏÏ¿ Ë ¤ÏÏÂÈ„Ë ˘-Ô˘Ú›·˜ ‰ÂÓ ·ÔÎÏÂ›ÂÈ ÙË ÓfiÛÔ. ∞ÎfiÌ· Î·È Ô Û˘Ó‰˘·ÛÌfi˜ ˘ÔÛÊ·ÈÚ›ˆÓ ÌÂ ÙÔÓ ·ÚÈıÌfi ÙˆÓ ÏÂ˘ÎÒÓ ‰ÂÓ·ÔÎÏÂ›ÂÈ ÙËÓ Èı·ÓfiÙËÙ· Ô˘ÚÔÏÔ›ÌˆÍË˜.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: √˘ÚÔÏÔ›ÌˆÍË, ˘Ô˘Ú›·, ÌÈÎÚÔÛÎÔÈÎ‹ Ô‡ÚˆÓ, Î·ÏÏÈ¤ÚÁÂÈ· Ô‡ÚˆÓ, ÂÌ‡ÚÂÙ· ‚Ú¤ÊË.

Estimating the risk of urinary tract infection in febrile infants aged

15-90 days with no apparent focus of infection

S. Fouzas, A. Fasouli, D. Adamidis, K. Tzelepis, I. Bakopoulou, A. Papadopoulou, D. Zafirakopoulos

∞bstract

Background: Urinary tract infection (UTI) is a common cause of bacterial disease in infancy. The aim ofthis study was to assess the usefulness of microscopic urinalysis, peripheral white blood cell count(WBC), CRP and ESR, for estimating the risk of UTI in febrile infants without a focus of infection.

Methods: The records of 115 infants aged 15-90 days, hospitalized for investigation of fever with noapparent focus, were evaluated retrospectively. All the patients had undergone a full sepsisinvestigation: blood culture, urine microscopy and culture, CSF microscopy, biochemistry and culture.The sensitivity, specificity, positive and negative predictive value, likelihood ratio (LR) and overall testperformance were determined for each of the laboratory parameters, using ROC curves.

Results: The incidence of UTI was 23.5%. Pyuria was the only parameter with good discriminationability (AUC: 0.825). Pyuria of >10 WBCs/hpf had 56% sensitivity, 99% specificity, an exceptionalpositive LR (48.9) and insignificant negative LR (0.45). A WBC count of >15,000/ÌL or <5,000/ÌL, had78% sensitivity, 76% specificity and insignificant likelihood ratios (positive LR 3.26 and negative LR0.29). The findings for ESR and CRP were not satisfactory indicators. Use of a combination of pyuria andWBC count would have led to misdiagnosis in 3 cases of UTI (11%).

Conclusions: None of the tested laboratory parameters can safely predict the results of the urine culture.Pyuria of >10 WBCs/hpf points to the possibility of UTI but the absence of pyuria cannot rule out thedisease. Even the use of the combination of pyuria and peripheral WBC count does not eliminate thepossibility of UTI.

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


¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ °ÂÓÈÎÔ‡¡ÔÛÔÎÔÌÂ›Ô˘ •¿ÓıË˜


™ˆÙ‹ÚË˜ ºÔ‡˙·˜ [email protected] ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ °.¡. •¿ÓıË˜ ∆.∫. 671 00, ¡Â¿ÔÏË •¿ÓıË˜

Paediatric Clinic, General Hospital, Xanthi

Correspondence:

Sotiris Fouzas [email protected] Paediatric Clinic, General Hospital, Xanthi 671 00, Neapoli, Xanthi

¶·È‰È·ÙÚÈÎ‹ 2007;70:221-226



∆∫∂ ∆·¯‡ÙËÙ· Î·ı›˙ËÛË˜ ÂÚ˘ıÚÒÓ

CRP ∞ÓÙÈ‰ÚÒÛ· ÚˆÙÂ˝ÓË C

√¡¶ √ÛÊ˘ÔÓˆÙÈ·›· ·Ú·Î¤ÓÙËÛË

∂¡À ∂ÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚfi

LR ∞Ó·ÏÔÁ›· Èı·ÓÔÙ‹ÙˆÓ

ROC curve ∫·Ì‡ÏË ROC

AUC ¶ÂÚÈÔ¯‹ Î¿Ùˆ ·fi ÙËÓ Î·Ì‡ÏË

∂ÈÛ·ÁˆÁ‹

√È Ô˘ÚÔÏÔÈÌÒÍÂÈ˜ ·ÔÙÂÏÔ‡Ó ÙË Û˘¯ÓfiÙÂÚË ·ÈÙ›·

ÌÈÎÚÔ‚È·Î‹˜ ÏÔ›ÌˆÍË˜ Î·Ù¿ ÙË ÓÂÔÁÓÈÎ‹ Î·È ÚÒÙË

‚ÚÂÊÈÎ‹ ËÏÈÎ›·. ∏ ¤ÁÎ·ÈÚË ‰È¿ÁÓˆÛË Î·Ù¿ ÙËÓ ÎÚ›ÛÈ-

ÌË ·˘Ù‹ ÂÚ›Ô‰Ô Â›Ó·È ÛËÌ·ÓÙÈÎ‹, ·ÊÂÓfi˜ ÁÈ·Ù› ÌÔ-

ÚÂ› Ó· Û˘Ó˘¿Ú¯ÂÈ ·Ó·ÙÔÌÈÎ‹ ·ÓˆÌ·Ï›· ÙÔ˘ Ô˘ÚÔ-

ÔÈËÙÈÎÔ‡, ·ÊÂÙ¤ÚÔ˘ ÁÈ·Ù› Ë ÔÍÂ›· ˘ÂÏÔÓÂÊÚ›ÙÈ‰·

Â›Ó·È ‰˘Ó·Ùfi Ó· ÚÔÎ·Ï¤ÛÂÈ ·ÒÏÂÈ· ÓÂÊÚÈÎÔ‡

ÈÛÙÔ‡, ‰ËÌÈÔ˘ÚÁ›· Ô˘ÏÒÓ Î·È ¤ÎÙˆÛË ÙË˜ ÓÂÊÚÈÎ‹˜

ÏÂÈÙÔ˘ÚÁ›·˜. ∂ÈÏ¤ÔÓ, ¤Ó· ÛËÌ·ÓÙÈÎfi ÔÛÔÛÙfi ‚ÚÂ-

ÊÒÓ ·ÚÔ˘ÛÈ¿˙ÂÈ ‰È·ÛÔÚ¿ ÙË˜ ÓfiÛÔ˘ Î·È ÂÈÎ›Ó‰˘-

ÓË ÁÈ· ÙË ˙ˆ‹ ÁÂÓÈÎÂ˘Ì¤ÓË ÏÔ›ÌˆÍË (1-3).

∏ Î·ÏÏÈ¤ÚÁÂÈ· Ô‡ÚˆÓ ·Ú·Ì¤ÓÂÈ Ë ÈÔ ·ÍÈfiÈÛÙË

Ì¤ıÔ‰Ô˜ ÁÈ· ÙË ‰È¿ÁÓˆÛË ÙË˜ Ô˘ÚÔÏÔ›ÌˆÍË˜, ¤¯Ô-

ÓÙ·˜ fiÌˆ˜ ÙÔ ÌÂÈÔÓ¤ÎÙËÌ· ÙË˜ Î·ı˘ÛÙ¤ÚËÛË˜ ÙˆÓ

·ÔÙÂÏÂÛÌ¿ÙˆÓ. ŒÙÛÈ, ¤¯Ô˘Ó ·Ó·˙ËÙËıÂ› ÂÚÁ·ÛÙË-

ÚÈ·ÎÔ› ‰Â›ÎÙÂ˜ Ô˘ ı· ÌÔÚÔ‡Û·Ó ¿ÌÂÛ· Ó· ÚÔ‚Ï¤-

„Ô˘Ó ÙÔ ·ÔÙ¤ÏÂÛÌ· ÙË˜ Î·ÏÏÈ¤ÚÁÂÈ·˜, ÁÂÁÔÓfi˜ ÌÂ

È‰È·›ÙÂÚË ÛËÌ·Û›· ÛÙËÓ ÂÚ›ÙˆÛË ‚ÚÂÊÒÓ ÌÂ Ô˘-

ÚÔÏÔ›ÌˆÍË, fiÔ˘ Ë Û˘ÌÙˆÌ·ÙÔÏÔÁ›· ‰ÂÓ Â›Ó·È ÂÈ-

‰ÈÎ‹ Î·È Ë ¤ÁÎ·ÈÚË ıÂÚ·Â˘ÙÈÎ‹ ·Ú¤Ì‚·ÛË Â›Ó·È

Ô˘ÛÈÒ‰Ë˜. ∏ ·Ï‹ ÌÈÎÚÔÛÎÔÈÎ‹ ÂÍ¤Ù·ÛË ÙˆÓ Ô‡-

ÚˆÓ ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ‰È¿ÊÔÚÔ˘˜ ‚ÈÔ¯ËÌÈÎÔ‡˜ ‰Â›-

ÎÙÂ˜ (ÓÈÙÚÒ‰Ë, ÂÛÙÂÚ¿ÛË ÏÂ˘ÎÔÎ˘ÙÙ¿ÚˆÓ), Î·ıÒ˜

Î·È Ì¤ıÔ‰ÔÈ ÂÓÈÛ¯˘Ì¤ÓË˜ ·Ó¿Ï˘ÛË˜ Ô‡ÚˆÓ ¤¯Ô˘Ó

·ÍÈÔÏÔÁËıÂ› ÛÂ ÛËÌ·ÓÙÈÎfi ·ÚÈıÌfi ÌÂÏÂÙÒÓ. ∏ ·Ô-

ÙÂÏÂÛÌ·ÙÈÎfiÙËÙ¿ ÙÔ˘˜, ˆÛÙfiÛÔ, Â›Ó·È ÂÚÈÔÚÈÛÌ¤ÓË,

Î˘Ú›ˆ˜ ÂÍ·ÈÙ›·˜ ÙË˜ ·‰˘Ó·Ì›·˜ ·ÔÎÏÂÈÛÌÔ‡ ÙË˜ Ófi-

ÛÔ˘ (3-12). ¶·Ú’ fiÏ· ·˘Ù¿, ÛÙËÓ Î·ıËÌÂÚÈÓ‹ ÎÏÈÓÈÎ‹

Ú¿ÍË Ë ˘Ô„›· Ô˘ÚÔÏÔ›ÌˆÍË˜, ·ÎfiÌ· Î·È Ë ·fi-

Ê·ÛË ÁÈ· Î·ÏÏÈ¤ÚÁÂÈ·, ‚·Û›˙ÔÓÙ·È Û˘¯Ó¿ ÛÙ· ·ÔÙÂ-

Ï¤ÛÌ·Ù· ÙË˜ ÁÂÓÈÎ‹˜ ÂÍ¤Ù·ÛË˜ Ô‡ÚˆÓ (3,7,9,11,12).

∂ÈÏ¤ÔÓ, Ô ·ÚÈıÌfi˜ ˘ÔÛÊ·ÈÚ›ˆÓ ÛÙË ÌÈÎÚÔÛÎÔÈ-

Î‹ Ô‡ÚˆÓ ·ÔÙÂÏÂ› ‚·ÛÈÎfi ÎÚÈÙ‹ÚÈÔ ÛÙ· ÚˆÙfiÎÔÏ-

Ï· ÂÎÙ›ÌËÛË˜ ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÛÔ‚·Ú‹˜ ÌÈÎÚÔ‚È·Î‹˜

ÓfiÛÔ˘ ÛÂ ÂÌ‡ÚÂÙ· ‚Ú¤ÊË ¯ˆÚ›˜ ÂÌÊ·Ó‹ ÂÛÙ›· ÏÔ›-

ÌˆÍË˜ (13-15), ·Ó Î·È Ë Û¯ÂÙÈÎ‹ ·‰˘Ó·Ì›· ·˘ÙÒÓ

ÙˆÓ ÚˆÙÔÎfiÏÏˆÓ ÛÙÔÓ ·ÔÎÏÂÈÛÌfi ÙË˜ Ô˘ÚÔÏÔ›-

ÌˆÍË˜ ¤¯ÂÈ ·Ó·ÁÓˆÚÈÛÙÂ› (16-18).

™ÎÔfi˜ ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ ‹Ù·Ó Ë ·ÍÈÔÏfiÁË-

ÛË ÙÔ˘ ·ÚÈıÌÔ‡ ˘ÔÛÊ·ÈÚ›ˆÓ ÛÙË ÁÂÓÈÎ‹ Ô‡ÚˆÓ, ÙÔ˘

·ÚÈıÌÔ‡ ÏÂ˘ÎÒÓ ÛÙË ÁÂÓÈÎ‹ ·›Ì·ÙÔ˜, ÙË˜ ∆∫∂ Î·È

ÙË˜ CRP, ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ Ô˘ÚÔÏÔ›-

ÌˆÍË˜ ÛÂ ÂÌ‡ÚÂÙ· ‚Ú¤ÊË ËÏÈÎ›·˜ 15-90 ËÌÂÚÒÓ

¯ˆÚ›˜ ÂÌÊ·Ó‹ ÂÛÙ›· ÏÔ›ÌˆÍË˜.


ªÂÏÂÙ‹ıËÎ·Ó ·Ó·‰ÚÔÌÈÎ¿ ÔÈ Ê¿ÎÂÏÔÈ ‚ÚÂÊÒÓ ËÏÈÎ›·˜

15-90 ËÌÂÚÒÓ Ô˘ ÂÈÛ‹¯ıËÛ·Ó ÛÙËÓ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ Î·-

Ù¿ ÙË ¯ÚÔÓÈÎ‹ ÂÚ›Ô‰Ô 01/06/2001 Î·È 31/05/2005 ÁÈ· ¤ÏÂÁ¯Ô

˘ÚÂÙÔ‡ (ıÂÚÌÔÎÚ·Û›· ÔÚıÔ‡ >38ÔC), ¯ˆÚ›˜ ÂÌÊ·Ó‹ ÂÛÙ›·

ÏÔ›ÌˆÍË˜.

™Â fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓÂ›˜ Â›¯Â Á›ÓÂÈ Ï‹ÚË˜ ¤ÏÂÁ¯Ô˜ ÛË„·È-

Ì›·˜: ÁÂÓÈÎ‹ ·›Ì·ÙÔ˜, ∆∫∂, CRP, Î·ÏÏÈ¤ÚÁÂÈ· ·›Ì·ÙÔ˜, ÁÂÓÈÎ‹

Î·È Î·ÏÏÈ¤ÚÁÂÈ· Ô‡ÚˆÓ, √¡¶ ÁÈ· ÁÂÓÈÎ‹ ∂¡À, Û¿Î¯·ÚÔ, ÏÂ‡-

ÎˆÌ·, ¯ÚÒÛË Î·Ù¿ Gram Î·È Î·ÏÏÈ¤ÚÁÂÈ· ∂¡À Î·È, Î·Ù¿ Â-

Ú›ÙˆÛË, ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ Î·È Î·ÏÏÈ¤ÚÁÂÈ· ÎÔÚ¿ÓˆÓ.

ŸÏ· Ù· ‰Â›ÁÌ·Ù· Ô‡ÚˆÓ Â›¯·Ó ÏËÊıÂ› ÌÂ ˘ÂÚË‚ÈÎ‹ ·Ú·Î¤-

ÓÙËÛË ÙË˜ Ô˘ÚÔ‰fi¯Ô˘ Î‡ÛÙË˜. ∞fi ÙË ÌÂÏ¤ÙË ·ÔÎÏÂ›ÛÙË-

Î·Ó 3 ‚Ú¤ÊË Ô˘ Â›¯·Ó Ï¿‚ÂÈ ·ÓÙÈ‚ÈÔÙÈÎ‹ ·ÁˆÁ‹ ÚÈÓ ÙËÓ ÂÈ-

Û·ÁˆÁ‹ ÙÔ˘˜ Î·È 16 ‚Ú¤ÊË Ô˘ ‰ÂÓ ÔÏÔÎÏ‹ÚˆÛ·Ó ÙÔÓ ÚÔÎ·-

ıÔÚÈÛÌ¤ÓÔ ¤ÏÂÁ¯Ô ÛË„·ÈÌ›·˜.

°È· ÙËÓ ·ÍÈÔÏfiÁËÛË ÙˆÓ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ‰ÂÈÎÙÒÓ Î·ıÔÚ›-

ÛÙËÎ·Ó Ë Â˘·ÈÛıËÛ›·, Ë ÂÈ‰ÈÎfiÙËÙ·, Ë ıÂÙÈÎ‹ Î·È ·ÚÓËÙÈÎ‹ ÚÔ-

ÁÓˆÛÙÈÎ‹ ·Í›·, Î·ıÒ˜ Î·È ÔÈ ·Ó·ÏÔÁ›Â˜ Èı·ÓÔÙ‹ÙˆÓ. √È ·Ó·ÏÔ-

Á›Â˜ Èı·ÓÔÙ‹ÙˆÓ (likelihood ratios - LR), ıÂÙÈÎ‹ ‹ ·ÚÓËÙÈÎ‹

(LR + ‹ LR -), ÂÎÊÚ¿˙Ô˘Ó ÙËÓ Èı·ÓfiÙËÙ· Ë ‰ÔÎÈÌ·Û›· Ó· Â›Ó·È

ıÂÙÈÎ‹ ‹ ·ÚÓËÙÈÎ‹ ÛÙÔ˘˜ ¿Û¯ÔÓÙÂ˜ ÛÂ Û¯¤ÛË ÌÂ ÙËÓ Èı·ÓfiÙË-

Ù· Ë ‰ÔÎÈÌ·Û›· Ó· Â›Ó·È ·ÓÙ›ÛÙÔÈ¯· ıÂÙÈÎ‹ ‹ ·ÚÓËÙÈÎ‹ ÛÙÔ˘˜ ÌË

¿Û¯ÔÓÙÂ˜. √È ·Ó·ÏÔÁ›Â˜ Èı·ÓÔÙ‹ÙˆÓ ıÂˆÚÔ‡ÓÙ·È ÔÈ ÈÔ ·ÍÈfi-

ÈÛÙÔÈ ‰Â›ÎÙÂ˜ ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË ÙË˜ ‰È·ÁÓˆÛÙÈÎ‹˜ ·Í›·˜ Ì›·˜

‰ÔÎÈÌ·Û›·˜. ™ËÌ·ÓÙÈÎ¤˜ ÁÈ· ÙËÓ ÎÏÈÓÈÎ‹ Ú¿ÍË ıÂˆÚÔ‡ÓÙ·È ÙÈ-

Ì¤˜ ÌÂÁ·Ï‡ÙÂÚÂ˜ ÙÔ˘ 10 ÁÈ· ÙË ıÂÙÈÎ‹ Î·È ÌÈÎÚfiÙÂÚÂ˜ ÙÔ˘ 0,1

ÁÈ· ÙËÓ ·ÚÓËÙÈÎ‹ ·Ó·ÏÔÁ›· Èı·ÓÔÙ‹ÙˆÓ (19,20).

∏ Û˘ÓÔÏÈÎ‹ ·fi‰ÔÛË ÙË˜ Î¿ıÂ ‰ÔÎÈÌ·Û›·˜ ·ÍÈÔÏÔÁ‹ıËÎÂ

¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÙÈ˜ Î·Ì‡ÏÂ˜ ROC (Receiver operating

characteristics). √È Î·Ì‡ÏÂ˜ ROC Â›Ó·È ÁÚ·ÊÈÎ¤˜ ·Ú·ÛÙ¿-

ÛÂÈ˜ ÙË˜ Â˘·ÈÛıËÛ›·˜ ÛÂ Û¯¤ÛË ÌÂ ÙËÓ ÂÈ‰ÈÎfiÙËÙ·. ∞fi ÙÔ ÂÌ-

‚·‰fiÓ ÙË˜ ÂÚÈÔ¯‹˜ ÌÂÙ·Í‡ ÙË˜ Î·Ì‡ÏË˜ Î·È ÙÔ˘ ÔÚÈ˙fiÓÙÈ-

Ô˘ ¿ÍÔÓ· (Area under curve - AUC) ÌÔÚÂ› Ó· ÂÎÙÈÌËıÂ› Ë

Û˘ÓÔÏÈÎ‹ ‰È·ÁÓˆÛÙÈÎ‹ ÈÎ·ÓfiÙËÙ·. ™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË, Î·-

ÙÒÙÂÚÔ ·Ô‰ÂÎÙfi fiÚÈÔ ÁÈ· ÙËÓ AUC ıÂˆÚ‹ıËÎÂ Ë ÙÈÌ‹ 0,7,

ÂÓÒ ÔÈ ÙÈÌ¤˜ 0,7-0,8 ıÂˆÚ‹ıËÎÂ ˆ˜ ÂÎÊÚ¿˙Ô˘Ó Ì¤ÙÚÈ· ‰È·-

ÎÚÈÙÈÎ‹ ÈÎ·ÓfiÙËÙ·, ÔÈ ÙÈÌ¤˜ 0,8-0,9 Î·Ï‹ Î·È ÔÈ ÙÈÌ¤˜ 0,9-1

¿ÚÈÛÙË ‰È·ÎÚÈÙÈÎ‹ ÈÎ·ÓfiÙËÙ· (19,21,22).

°È· ÙÔÓ Î·ıÔÚÈÛÌfi ÙË˜ Â˘·ÈÛıËÛ›·˜, ÙË˜ ÂÈ‰ÈÎfiÙËÙ·˜, ÙË˜

ÚÔÁÓˆÛÙÈÎ‹˜ ·Í›·˜ Î·È ÙˆÓ ·Ó·ÏÔÁÈÒÓ Èı·ÓÔÙ‹ÙˆÓ, ¯ÚËÛÈ-

ÌÔÔÈ‹ıËÎ·Ó ‰È·ÊÔÚÂÙÈÎ¿ ÛËÌÂ›· ÙÔÌ‹˜ (cutoff points) ÁÈ·

ÙÔÓ Î¿ıÂ ÂÚÁ·ÛÙËÚÈ·Îfi ‰Â›ÎÙË, ‰È·ÊÔÚÂÙÈÎ¤˜ ‰ËÏ·‰‹ ÙÈÌ¤˜

ÁÈ· ÙÈ˜ ÔÔ›Â˜ Ë ‰ÔÎÈÌ·Û›· ıÂˆÚ‹ıËÎÂ ıÂÙÈÎ‹. °È· Ù· ÏÂ˘Î¿

·ÈÌÔÛÊ·›ÚÈ· ·ÍÈÔÏÔÁ‹ıËÎ·Ó ˆ˜ ·ıÔÏÔÁÈÎ¤˜: ·) ÙÈÌ¤˜

>15.000/ÌL ‹ <5.000/ÌL (15), ‚) ÙÈÌ¤˜ >15.000/ÌL (13) Î·È Á)

ÙÈÌ¤˜ >20.000/ÌL (14) (¶›Ó·Î·˜ 1). °È· Ù· ˘ÔÛÊ·›ÚÈ· ÛÙË ÌÈ-

ÎÚÔÛÎÔÈÎ‹ Ô‡ÚˆÓ ·ÍÈÔÏÔÁ‹ıËÎ·Ó ˆ˜ ·ıÔÏÔÁÈÎ¤˜ ÙÈÌ¤˜ >5

ÎÔ (ÙÈÌ‹ Ô˘ ·ÔÙÂÏÂ› ÙÔÓ ÎÏ·ÛÈÎfi ÔÚÈÛÌfi ÙË˜ ÛËÌ·ÓÙÈÎ‹˜

˘Ô˘Ú›·˜) Î·È ÙÈÌ¤˜ >10 ÎÔ (ÎÚÈÙ‹ÚÈÔ Ô˘ ¯ÚËÛÈÌÔÔÈÂ›Ù·È

ÛÙ· ÚˆÙfiÎÔÏÏ· ÂÎÙ›ÌËÛË˜ ÛÔ‚·Ú‹˜ ÌÈÎÚÔ‚È·Î‹˜ ÓfiÛÔ˘).

°È· ÙËÓ ∆∫∂ ÛËÌÂ›Ô ÙÔÌ‹˜ ıÂˆÚ‹ıËÎÂ Ë ÙÈÌ‹ 30 mm/h Î·È

ÁÈ· ÙË CRP Ë ÙÈÌ‹ 1 mg/dL (16-18,22,23).

∏ ÛÙ·ÙÈÛÙÈÎ‹ ÂÂÍÂÚÁ·Û›· ¤ÁÈÓÂ ÌÂ ÙÔ ÚfiÁÚ·ÌÌ· SPSS

11.0, ÂÓÒ Ë Î·Ù·ÛÎÂ˘‹ ÙˆÓ Î·Ì˘ÏÒÓ ROC, Ô ˘ÔÏÔÁÈÛÌfi˜

ÙˆÓ AUC Î·È Ë ÌÂÙ·Í‡ ÙÔ˘˜ Û‡ÁÎÚÈÛË, ÌÂ ÙÔ ÚfiÁÚ·ÌÌ·

MedCalc 8.1.0.0.


∞fi Ù· 115 ·È‰È¿ Ô˘ ÏËÚÔ‡Û·Ó Ù· ÎÚÈÙ‹ÚÈ·

ÂÈÛ·ÁˆÁ‹˜ ÛÙË ÌÂÏ¤ÙË, 27 Â›¯·Ó ıÂÙÈÎ‹ Î·ÏÏÈ¤ÚÁÂÈ·

222 ™. ºÔ‡˙·˜ Î·È Û˘Ó.



Ô‡ÚˆÓ. ∞fi ·˘Ù¿, Ù· 14 ‹Ù·Ó ÎÔÚ›ÙÛÈ· Î·È Ù· 13 ·Áfi-

ÚÈ·. ∏ Û˘¯ÓfiÙËÙ· ÙË˜ Ô˘ÚÔÏÔ›ÌˆÍË˜ Î·Ù¿ ËÏÈÎÈ·Î‹

ÔÌ¿‰· ‹Ù·Ó 16% ÁÈ· Ù· ÓÂÔÁÓ¿ ËÏÈÎ›·˜ 15-29 ËÌÂ-

ÚÒÓ, 25% ÁÈ· Ù· ‚Ú¤ÊË ËÏÈÎ›·˜ 30-59 ËÌÂÚÒÓ Î·È

29% ÁÈ· Ù· ‚Ú¤ÊË ËÏÈÎ›·˜ 60-90 ËÌÂÚÒÓ. √È ˘Â‡-

ı˘ÓÔÈ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ› ‹Ù·Ó: Escherichia coli 85%,

Klebsiella pneumoniae 7%, Enterobacter spp. 4% Î·È

Pseudomonas aeruginosa 4%. ¢‡Ô ·ÛıÂÓÂ›˜ ÌÂ Ô˘ÚÔ-

ÏÔ›ÌˆÍË - Î·È ÔÈ ‰‡Ô ËÏÈÎ›·˜ ÌÈÎÚfiÙÂÚË˜ ÙˆÓ 30

ËÌÂÚÒÓ - ·ÚÔ˘Û›·Û·Ó ‰È·ÛÔÚ¿ ÙË˜ ÓfiÛÔ˘ ÌÂ ıÂÙÈ-

Î‹ Î·ÏÏÈ¤ÚÁÂÈ· ·›Ì·ÙÔ˜ (E. coli).

∆· ‚Ú¤ÊË ÌÂ Ô˘ÚÔÏÔ›ÌˆÍË, Û˘ÁÎÚÈÓfiÌÂÓ· ÌÂ

ÂÎÂ›Ó· ¯ˆÚ›˜ Ô˘ÚÔÏÔ›ÌˆÍË, ·ÚÔ˘Û›·Û·Ó ÌÂÁ·Ï‡ÙÂ-

ÚÔ ·ÚÈıÌfi ˘ÔÛÊ·ÈÚ›ˆÓ ÛÙË ÌÈÎÚÔÛÎÔÈÎ‹ Ô‡ÚˆÓ

(38,8 ± 56,4 ÎÔ ¤Ó·ÓÙÈ 1,6 ± 1,8 ÎÔ, p<0,0001), ÌÂ-

Á·Ï‡ÙÂÚÔ ·ÚÈıÌfi ÏÂ˘ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ ÛÙË ÁÂÓÈÎ‹

·›Ì·ÙÔ˜ (17.495 ± 7.491 /ÌL ¤Ó·ÓÙÈ 13.356 ± 9.547

/ÌL, p=0,041) Î·È ÌÂÁ·Ï‡ÙÂÚË ∆∫∂ (38,9 ± 27,4

mm/h ¤Ó·ÓÙÈ 17,4 ± 14,6 mm/h, p<0,0001), ÂÓÒ Ë

‰È·ÊÔÚ¿ ÛÙÈ˜ ÙÈÌ¤˜ ÙË˜ CRP ÎÈÓ‹ıËÎÂ ÛÙ· fiÚÈ· ÙÔ˘

ÛÙ·ÙÈÛÙÈÎÔ‡ Ï¿ıÔ˘˜ (7,3 ± 19 mg/dL ¤Ó·ÓÙÈ 2,8 ± 5,8

mg/dL, p=0,049).

√È ROC Î·Ì‡ÏÂ˜ ÁÈ· ÙËÓ Î¿ıÂ ÂÚÁ·ÛÙËÚÈ·Î‹ ·-

Ú¿ÌÂÙÚÔ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÙËÓ ∂ÈÎfiÓ· 1. √ ·ÚÈıÌfi˜

ÙˆÓ ˘ÔÛÊ·ÈÚ›ˆÓ ÛÙË ÁÂÓÈÎ‹ Ô‡ÚˆÓ ÌÂ AUC 0,825

(95%CI: 0,743-0,889) ÂÌÊ¿ÓÈÛÂ Î·Ï‹ ‰È·ÎÚÈÙÈÎ‹ ÈÎ·-

ÓfiÙËÙ·, ÂÓÒ Ë ∆∫∂ Â›¯Â Ì¤ÙÚÈ· ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·

ÛÙË ‰È¿ÎÚÈÛË ÙË˜ ÓfiÛÔ˘ ÌÂ AUC 0,771 (95% CI:

0,684-0,845). ∏ ‰È·ÎÚÈÙÈÎ‹ ÈÎ·ÓfiÙËÙ· ÙfiÛÔ ÙÔ˘ ·ÚÈı-

ÌÔ‡ ÏÂ˘ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ ÛÙË ÁÂÓÈÎ‹ ·›Ì·ÙÔ˜ (AUC:

0,683), fiÛÔ Î·È ÙË˜ CRP (AUC: 0,663) ‹Ù·Ó ÌÈÎÚ‹.

∞fi ÙË Û‡ÁÎÚÈÛË ÙˆÓ Î·Ì˘ÏÒÓ ROC ‰È·ÈÛÙÒıËÎÂ

ÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿ ÛÙË ‰È·ÎÚÈÙÈÎ‹ ÈÎ·ÓfiÙËÙ· ÙÔ˘

·ÚÈıÌÔ‡ ˘ÔÛÊ·ÈÚ›ˆÓ ÛÙË ÁÂÓÈÎ‹ Ô‡ÚˆÓ ÛÂ Û¯¤ÛË ÌÂ

ÙÔÓ ·ÚÈıÌfi ÏÂ˘ÎÒÓ (p=0,04) Î·È ÙË CRP (p=0,03).

∏ Â˘·ÈÛıËÛ›·, Ë ÂÈ‰ÈÎfiÙËÙ·, Ë ıÂÙÈÎ‹ Î·È ·ÚÓËÙÈ-

Î‹ ÚÔÁÓˆÛÙÈÎ‹ ·Í›· Î·È Ë ıÂÙÈÎ‹ Î·È ·ÚÓËÙÈÎ‹ ·Ó·-

ÏÔÁ›· Èı·ÓÔÙ‹ÙˆÓ ÁÈ· ÙËÓ Î¿ıÂ ÂÚÁ·ÛÙËÚÈ·Î‹ ·-

Ú¿ÌÂÙÚÔ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1.

√ ·ÚÈıÌfi˜ ˘ÔÛÊ·ÈÚ›ˆÓ >10 ÎÔ ·ÚÔ˘Û›·ÛÂ

223∫›Ó‰˘ÓÔ˜ Ô˘ÚÔÏÔ›ÌˆÍË˜ ÛÂ ÂÌ‡ÚÂÙ· ‚Ú¤ÊË

¶›Ó·Î·˜ 1. ™˘ÁÎÚÈÙÈÎ‹ ·ÍÈÔÏfiÁËÛË ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ‰ÂÈÎÙÒÓ ÁÈ· ÙË ‰È¿ÁÓˆÛË Ô˘ÚÔÏÔ›ÌˆÍË˜

¶˘ÔÛÊ·›ÚÈ· (ÎÔ) §Â˘Î¿ (/ÌL) ∆∫∂ CRP

>5 >10 >20.000 >15.000 >15.000 >30 >1‹ <5.000 mm/h mg/dL

∂˘·ÈÛıËÛ›· 56% 56% 45% 74% 78% 48% 59%∂È‰ÈÎfiÙËÙ· 96% 99% 83% 76% 76% 78% 70%PPV 83% 94% 45% 49% 50% 40% 38%NPV 88% 88% 83% 90% 92% 83% 85%LR(+)* 16,3 48,9 2,6 3,1 3,26 2,23 2LR(-)** 0,46 0,45 0,67 0,35 0,29 0,66 0,58

PPV: £ÂÙÈÎ‹ ÚÔÁÓˆÛÙÈÎ‹ ·Í›·, NPV: ∞ÚÓËÙÈÎ‹ ÚÔÁÓˆÛÙÈÎ‹ ·Í›·, LR(+): £ÂÙÈÎ‹ ·Ó·ÏÔÁ›· Èı·ÓÔÙ‹ÙˆÓ, LR(-): ∞ÚÓËÙÈÎ‹·Ó·ÏÔÁ›· Èı·ÓÔÙ‹ÙˆÓ, *: ™ËÌ·ÓÙÈÎ¤˜ ıÂˆÚÔ‡ÓÙ·È ÙÈÌ¤˜ >10, **: ™ËÌ·ÓÙÈÎ¤˜ ıÂˆÚÔ‡ÓÙ·È ÙÈÌ¤˜ <0,1

TKE

1

0,9

0,8

0,7

0,6

0,5

0,4

0,3

0,2

0,1

00 0,2 0,4 0,6 0,8 1

1

0,9

0,8

0,7

0,6

0,5

0,4

0,3

0,2

0,1

00 0,2 0,4 0,6 0,8 1

1 - ∂È‰ÈÎfiÙËÙ· 1 - ∂È‰ÈÎfiÙËÙ·

∂˘

·ÈÛ

ıË

Û›·

∂˘

·ÈÛ

ıË

Û›·

∞ µ

¶˘ÔÛÊ·›ÚÈ·

CRP§Â˘Î¿

∂ÈÎfiÓ· 1. ∫·Ì‡ÏÂ˜ ROC. ∞: §Â˘Î¿ ·ÈÌÔÛÊ·›ÚÈ· ÛÙË ÁÂÓÈÎ‹ ·›Ì·ÙÔ˜ Î·È ∆∫∂ Î·È µ: ¶˘ÔÛÊ·›ÚÈ· ÛÙË ÁÂÓÈÎ‹ Ô‡ÚˆÓ Î·È CRP. ∏ ‰È·-ÁÓˆÛÙÈÎ‹ ÈÎ·ÓfiÙËÙ· Î·ıÔÚ›˙ÂÙ·È ·fi ÙËÓ ÂÚÈÔ¯‹ Î¿Ùˆ ·fi ÙËÓ Î·Ì‡ÏË (AUC). ªÂÁ·Ï‡ÙÂÚË AUC ÛËÌ·›ÓÂÈ Î·È Î·Ï‡ÙÂÚË ·fi‰ÔÛËÙË˜ ‰ÔÎÈÌ·Û›·˜.

¶·È‰È·ÙÚÈÎ‹ 2007;70:221-226


˘„ËÏ‹ ıÂÙÈÎ‹ ÚÔÁÓˆÛÙÈÎ‹ ·Í›· (94%) Î·È ÂÍ·ÈÚÂÙÈ-

Î‹ ıÂÙÈÎ‹ ·Ó·ÏÔÁ›· Èı·ÓÔÙ‹ÙˆÓ (48,9), ·ÔÙÂÏ¤-

ÛÌ·Ù· Û·ÊÒ˜ ·ÓÒÙÂÚ· ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙÔÓ ·ÚÈıÌfi

˘ÔÛÊ·ÈÚ›ˆÓ >5 ÎÔ (ıÂÙÈÎ‹ ÚÔÁÓˆÛÙÈÎ‹ ·Í›· 83%

Î·È ıÂÙÈÎ‹ ·Ó·ÏÔÁ›· Èı·ÓÔÙ‹ÙˆÓ 16,3, p=0,016 Î·È

p<0,001, ·ÓÙ›ÛÙÔÈ¯·). ∆· ˘ÔÛÊ·›ÚÈ·, ÙfiÛÔ ÁÈ· ÙÈÌ¤˜

>5 ÎÔ fiÛÔ Î·È ÁÈ· ÙÈÌ¤˜ >10 ÎÔ, ·ÚÔ˘Û›·Û·Ó

˘„ËÏ‹ ÂÈ‰ÈÎfiÙËÙ· (96% Î·È 99%, ·ÓÙ›ÛÙÔÈ¯·), ·ÏÏ¿

¯·ÌËÏ‹ Â˘·ÈÛıËÛ›· (56%), ¯·ÌËÏ‹ ·ÚÓËÙÈÎ‹ ÚÔ-

ÁÓˆÛÙÈÎ‹ ·Í›· (88%) Î·È ÌË ÛËÌ·ÓÙÈÎ‹ ·ÚÓËÙÈÎ‹

·Ó·ÏÔÁ›· Èı·ÓÔÙ‹ÙˆÓ (0,46 Î·È 0,45, ·ÓÙ›ÛÙÔÈ¯·).

™Â fi,ÙÈ ·ÊÔÚ¿ Ù· ÏÂ˘Î¿ ·ÈÌÔÛÊ·›ÚÈ· ÛÙË ÁÂÓÈÎ‹

·›Ì·ÙÔ˜, ÔÈ Ï¤ÔÓ ÈÎ·ÓÔÔÈËÙÈÎÔ› ‰È·ÁÓˆÛÙÈÎÔ› ‰Â›-

ÎÙÂ˜ ÚÔ¤Î˘„·Ó fiÙ·Ó ıÂˆÚ‹ıËÎ·Ó ·ıÔÏÔÁÈÎ¤˜ ÙÈ-

Ì¤˜ ÌÂÁ·Ï‡ÙÂÚÂ˜ ÙˆÓ 15.000/ÌL ‹ ÌÈÎÚfiÙÂÚÂ˜ ÙˆÓ

5.000/ÌL. øÛÙfiÛÔ, ÌÂ ÂÍ·›ÚÂÛË ÙËÓ ·ÚÓËÙÈÎ‹ ÚÔ-

ÁÓˆÛÙÈÎ‹ ·Í›· (92%), ÔÈ ˘fiÏÔÈÔÈ ‰Â›ÎÙÂ˜ ‹Ù·Ó ¯·-

ÌËÏÔ› Î·È ÔÈ ·Ó·ÏÔÁ›Â˜ Èı·ÓÔÙ‹ÙˆÓ ÌË ÛËÌ·ÓÙÈÎ¤˜

(ıÂÙÈÎ‹ LR: 3,26 Î·È ·ÚÓËÙÈÎ‹ LR: 0,29). ™Â Û‡ÁÎÚÈÛË

ÌÂ Ù· ˘ÔÛÊ·›ÚÈ· ÛÙË ÁÂÓÈÎ‹ Ô‡ÚˆÓ (>10 ÎÔ), Ù·

ÏÂ˘Î¿ ÛÙË ÁÂÓÈÎ‹ ·›Ì·ÙÔ˜ (>15.000/ÌL ‹ <5.000/ÌL)

·ÚÔ˘Û›·Û·Ó ÌÂÁ·Ï‡ÙÂÚË Â˘·ÈÛıËÛ›· (p<0,001),

·ÚfiÌÔÈ· ·ÚÓËÙÈÎ‹ ÚÔÁÓˆÛÙÈÎ‹ ·Í›· (p=0,42) Î·È

ÌÈÎÚfiÙÂÚË ÂÈ‰ÈÎfiÙËÙ· (p<0,0001) Î·È ıÂÙÈÎ‹ ÚÔ-

ÁÓˆÛÙÈÎ‹ ·Í›· (p<0,0001) (¶›Ó·Î·˜ 1).

°È· ÙËÓ ∆∫∂ Î·È ÙË CRP, Ë Â˘·ÈÛıËÛ›·, Ë ÂÈ‰ÈÎfi-

ÙËÙ·, Ë ıÂÙÈÎ‹ Î·È ·ÚÓËÙÈÎ‹ ÚÔÁÓˆÛÙÈÎ‹ ·Í›·, Î·-

ıÒ˜ Î·È ÔÈ ·Ó·ÏÔÁ›Â˜ Èı·ÓÔÙ‹ÙˆÓ, ÎÈÓ‹ıËÎ·Ó ÛÂ ÌË

ÈÎ·ÓÔÔÈËÙÈÎ¿ Â›Â‰· (¶›Ó·Î·˜ 1).

™˘˙‹ÙËÛË

∏ Û˘¯ÓfiÙËÙ· ÙË˜ Ô˘ÚÔÏÔ›ÌˆÍË˜ ÛÙ· 115 ‚Ú¤ÊË

ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ ‹Ù·Ó 23,5% (27 ‚Ú¤ÊË), ·Ó·-

‰ÂÈÎÓ‡ÔÓÙ·˜ ÙËÓ Ô˘ÚÔÏÔ›ÌˆÍË ˆ˜ È‰È·›ÙÂÚ· ÛËÌ·-

ÓÙÈÎ‹ ·ÈÙ›· ˘ÚÂÙÔ‡ ÛÂ ‚Ú¤ÊË ËÏÈÎ›·˜ ÌÈÎÚfiÙÂÚË˜

ÙˆÓ 3 ÌËÓÒÓ ¯ˆÚ›˜ ÂÛÙ›· ÏÔ›ÌˆÍË˜. ∏ Û˘¯ÓfiÙËÙ·

‹Ù·Ó ›‰È· ÁÈ· ·ÁfiÚÈ· Î·È ÎÔÚ›ÙÛÈ·, ÂÓÒ ‰È·ÛÔÚ¿ ÙË˜

ÓfiÛÔ˘ Î·È ‚·ÎÙËÚÈ·ÈÌ›· ·Ú·ÙËÚ‹ıËÎÂ ÛÂ ÔÛÔÛÙfi

7,4% (2 ·ÛıÂÓÂ›˜ ËÏÈÎ›·˜ ÌÈÎÚfiÙÂÚË˜ ÙˆÓ 30 ËÌÂ-

ÚÒÓ). ∆· ·Ú·¿Óˆ ·ÔÙÂÏ¤ÛÌ·Ù· Â›Ó·È Û˘ÁÎÚ›ÛÈÌ·

ÌÂ ·˘Ù¿ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›·

(1-3,6,18).

∞fi ÙË ÌÂÏ¤ÙË ÙË˜ Û˘ÓÔÏÈÎ‹˜ ·fi‰ÔÛË˜ ÙˆÓ

ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ‰ÂÈÎÙÒÓ ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÙÈ˜ Î·-

Ì‡ÏÂ˜ ROC, ÚÔÎ‡ÙÂÈ fiÙÈ ÌfiÓÔ Ô ·ÚÈıÌfi˜ ˘Ô-

ÛÊ·ÈÚ›ˆÓ ·ÚÔ˘ÛÈ¿˙ÂÈ ÛËÌ·ÓÙÈÎ‹ ‰È·ÎÚÈÙÈÎ‹ ÈÎ·-

ÓfiÙËÙ· (AUC: 0,825). øÛÙfiÛÔ, Ë ÛËÌ·Û›· ÙË˜ ÌÈ-

ÎÚÔÛÎÔÈÎ‹˜ ÂÍ¤Ù·ÛË˜ ÙˆÓ Ô‡ÚˆÓ ÁÈ· ÙËÓ ÂÎÙ›ÌË-

ÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ Ô˘ÚÔÏÔ›ÌˆÍË˜ ¯Ú‹˙ÂÈ ÂÚ·ÈÙ¤Úˆ

·Ó¿Ï˘ÛË˜. ™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË, Ë ˘Ô˘Ú›· ·-

ÚÔ˘Û›·ÛÂ ˘„ËÏ‹ ÂÈ‰ÈÎfiÙËÙ· ÙfiÛÔ ÁÈ· ÙÈÌ¤˜ >5 ÎÔ

(94%), fiÛÔ Î·È ÁÈ· ÙÈÌ¤˜ >10 ÎÔ (99%). ∆Ô ÁÂÁÔ-

Ófi˜ ·˘Ùfi, fiÌˆ˜, ‰ÂÓ Ú¤ÂÈ Ó· ıÂˆÚËıÂ› Û·Ó ÈÎ·Ófi-

ÙËÙ· ·ÔÎÏÂÈÛÌÔ‡ ÙË˜ Ô˘ÚÔÏÔ›ÌˆÍË˜, ÈÎ·ÓfiÙËÙ·

Ô˘ ÌÔÚÂ› Ó· ÂÎÊÚ·ÛÙÂ› ·ÍÈfiÈÛÙ· ÌfiÓÔ ·fi ÙËÓ

·ÚÓËÙÈÎ‹ ·Ó·ÏÔÁ›· Èı·ÓÔÙ‹ÙˆÓ, Ë ÔÔ›· Î˘Ì¿Ó-

ıËÎÂ ÛÂ ÌË ÛËÌ·ÓÙÈÎ¿ Â›Â‰· (0,46 ÁÈ· ÙÈÌ¤˜ >5

ÎÔ Î·È 0,45 ÁÈ· ÙÈÌ¤˜ >10 ÎÔ, ÌÂ ÛËÌ·ÓÙÈÎ¤˜ ÙÈ˜

ÙÈÌ¤˜ <0,1). ∂ÔÌ¤Óˆ˜, Ô ¯·ÌËÏfi˜ ·ÚÈıÌfi˜ ˘Ô-

ÛÊ·ÈÚ›ˆÓ ‰ÂÓ ÌÔÚÂ› Ó· ıÂˆÚËıÂ› ·ÍÈfiÈÛÙÔ˜ ‰Â›-

ÎÙË˜ ÁÈ· ÙÔÓ ·ÔÎÏÂÈÛÌfi ÙË˜ Ô˘ÚÔÏÔ›ÌˆÍË˜. ŒÙÛÈ,

Â¿Ó Ë ·fiÊ·ÛË ÁÈ· Î·ÏÏÈ¤ÚÁÂÈ· ÛÙ· ‚Ú¤ÊË ÙË˜ ·-

ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ ‚·ÛÈ˙fiÙ·Ó ÛÙË ÌÈÎÚÔÛÎÔÈÎ‹ Ô‡-

ÚˆÓ Î·È ıÂˆÚÒÓÙ·˜ Û·Ó ·ıÔÏÔÁÈÎ‹ ÙÈÌ‹ Ù· >10

˘ÔÛÊ·›ÚÈ· ÎÔ, ÔÈ 12 ·fi ÙÈ˜ 27 Ô˘ÚÔÏÔÈÌÒÍÂÈ˜

‰ÂÓ ı· Â›¯·Ó ‰È·ÁÓˆÛÙÂ›. ∞ÓÙ›ıÂÙ·, Ë ıÂÙÈÎ‹ ·Ó·ÏÔ-

Á›· Èı·ÓÔÙ‹ÙˆÓ ‹Ù·Ó ÂÍ·ÈÚÂÙÈÎ‹ ÙfiÛÔ ÁÈ· ÙÈÌ¤˜ >5

ÎÔ, fiÛÔ Î·È ÁÈ· ÙÈÌ¤˜ >10 ÎÔ (16,3 Î·È 48,9, ·ÓÙ›-

ÛÙÔÈ¯·, ÌÂ ÛËÌ·ÓÙÈÎ¤˜ ÙÈ˜ ÙÈÌ¤˜ >10), ·Ó·‰ÂÈÎÓ‡Ô-

ÓÙ·˜ ÙËÓ ˘Ô˘Ú›· ÛÂ È‰È·›ÙÂÚ· ¯Ú‹ÛÈÌÔ ‰Â›ÎÙË ÁÈ·

ÙÔÓ ÂÓÙÔÈÛÌfi ÙˆÓ ‚ÚÂÊÒÓ ÌÂ Ô˘ÚÔÏÔ›ÌˆÍË. √

·ÚÈıÌfi˜ ˘ÔÛÊ·ÈÚ›ˆÓ >10 ÎÔ ·Ô‰Â›¯ıËÎÂ Â-

ÚÈÛÛfiÙÂÚÔ ·ÍÈfiÈÛÙÔ˜ ÛÂ Û¯¤ÛË ÌÂ Ù· >5 ˘ÔÛÊ·›-

ÚÈ· ÎÔ, ÂÂÈ‰‹ Û˘Ó‰˘¿ÛÙËÎÂ ÌÂ ÏÈÁfiÙÂÚ· „Â˘‰Ò˜

ıÂÙÈÎ¿ ·ÔÙÂÏ¤ÛÌ·Ù· Î·È ·ÚÔ˘Û›·ÛÂ Î·Ï‡ÙÂÚË

ıÂÙÈÎ‹ ·Ó·ÏÔÁ›· Èı·ÓÔÙ‹ÙˆÓ.

∏ ̄ ÚËÛÈÌfiÙËÙ· ÙˆÓ ÏÂ˘ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ ̂ ˜ ÌÂ-

ÌÔÓˆÌ¤ÓË ÂÍ¤Ù·ÛË ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘

Ô˘ÚÔÏÔ›ÌˆÍË˜ ·Ô‰Â›¯ıËÎÂ ÂÚÈÔÚÈÛÌ¤ÓË. √È ÙÈÌ¤˜

ÏÂ˘ÎÒÓ >15.000/ÌL ‹ <5.000/ÌL ˘ÂÚÂ›¯·Ó ¤Ó·ÓÙÈ

ÙˆÓ ¿ÏÏˆÓ ÙÈÌÒÓ ÏÂ˘ÎÒÓ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó. ªË ÈÎ·-

ÓÔÔÈËÙÈÎ¿ ·ÔÙÂÏ¤ÛÌ·Ù· ÚÔ¤Î˘„·Ó Î·È ·fi ÙË

ÌÂÏ¤ÙË ÙË˜ ∆∫∂ Î·È ÙË˜ CRP, ÌÂ ·ÔÙ¤ÏÂÛÌ· Ô Úfi-

ÏÔ˜ ÙÔ˘˜ ÛÙËÓ ÂÎÙ›ÌËÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ Ô˘ÚÔÏÔ›Ìˆ-

ÍË˜ Ó· Â›Ó·È ÂÚÈÔÚÈÛÌ¤ÓÔ˜.

∫·Ó¤Ó·˜ ·fi ÙÔ˘˜ ÂÚÁ·ÛÙËÚÈ·ÎÔ‡˜ ‰Â›ÎÙÂ˜ ‰ÂÓ

·Ô‰Â›¯ıËÎÂ ·fi ÌfiÓÔ˜ ÙÔ˘ ÈÎ·Ófi˜ Ó· ·ÔÎÏÂ›ÛÂÈ

ÙËÓ Èı·ÓfiÙËÙ· Ô˘ÚÔÏÔ›ÌˆÍË˜ ÛÂ ‚Ú¤ÊË ÌÂ ˘ÚÂÙfi

¯ˆÚ›˜ ÂÛÙ›·. øÛÙfiÛÔ, Ô Û˘Ó‰˘·ÛÌfi˜ ˘ÔÛÊ·ÈÚ›ˆÓ

<10 ÎÔ Î·È ÏÂ˘ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ 5.000-15.000/ÌL

Â›¯Â Î·Ï‡ÙÂÚ· ·ÔÙÂÏ¤ÛÌ·Ù· ÛÂ Û¯¤ÛË ÌÂ ÙÔÓ Î¿ıÂ

‰Â›ÎÙË ÍÂ¯ˆÚÈÛÙ¿. ∏ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ·Ú·¿Óˆ ÎÚÈ-

ÙËÚ›Ô˘ ÛÙ· ‚Ú¤ÊË ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜, ı· Ô‰Ë-

ÁÔ‡ÛÂ ÛÂ ·ÔÙ˘¯›· ‰È¿ÁÓˆÛË˜ 3 Ô˘ÚÔÏÔÈÌÒÍÂˆÓ

(11%) ÛÂ Û¯¤ÛË ÌÂ ÙÈ˜ 12 Ô˘ÚÔÏÔÈÌÒÍÂÈ˜ (44%) Ô˘

‰ÂÓ ı· Â›¯·Ó ‰È·ÁÓˆÛÙÂ› Â¿Ó ÎÚÈÙ‹ÚÈÔ ·ÔÎÏÂÈÛÌÔ‡

‹Ù·Ó ÌfiÓÔ Ù· ˘ÔÛÊ·›ÚÈ· (p<0,0001) Î·È ÙÈ˜ 6 Ô˘ÚÔ-

ÏÔÈÌÒÍÂÈ˜ (22%) Ô˘ ‰ÂÓ ı· Â›¯·Ó ‰È·ÁÓˆÛÙÂ› Â¿Ó

ÎÚÈÙ‹ÚÈÔ ·ÔÎÏÂÈÛÌÔ‡ ‹Ù·Ó ÌfiÓÔ Ù· ÏÂ˘Î¿

(p=0,38). ∞˘Ù¿ Ù· ˘„ËÏ¿ ÔÛÔÛÙ¿ ·ÔÙ˘¯›·˜ ‚Ú›-

ÛÎÔÓÙ·È ÛÂ ·ÓÙÈÛÙÔÈ¯›· ÌÂ Ù· ÔÛÔÛÙ¿ Ô˘ ·Ó·Ê¤-

ÚÔÓÙ·È ÛÂ ÛÂÈÚ¿ ¿ÏÏˆÓ ÌÂÏÂÙÒÓ (13-18).

√È ÂÚÁ·ÛÙËÚÈ·ÎÔ› ‰Â›ÎÙÂ˜ Ô˘ ·ÍÈÔÏÔÁ‹ıËÎ·Ó

ÛÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË, ÂÈÏ¤¯ıËÎ·Ó ‰ÈfiÙÈ Î·ıÔÚ›˙Ô-

ÓÙ·È ¿ÌÂÛ·, ÌÂ ¯·ÌËÏfi ÎfiÛÙÔ˜ Î·È ¯ˆÚ›˜ ÂÍÂÈ‰ÈÎÂ˘-

Ì¤ÓÔ ÂÚÁ·ÛÙËÚÈ·Îfi ÂÍÔÏÈÛÌfi. ª›· Ó¤· Ì¤ıÔ‰Ô˜

224 ™. ºÔ‡˙·˜ Î·È Û˘Ó.



ÂÓÈÛ¯˘Ì¤ÓË˜ ·Ó¿Ï˘ÛË˜ Ô‡ÚˆÓ ÌÂ ÙË ̄ Ú‹ÛË Î˘ÙÙ·ÚÔ-

ÌÂÙÚËÙ‹ Î·È ÙÔÓ Î·ıÔÚÈÛÌfi ÙË˜ ˘Ô˘Ú›·˜ ˆ˜ ÙÔÓ

·ÚÈıÌfi ÏÂ˘ÎÔÎ˘ÙÙ¿ÚˆÓ/mm3 ÛÂ ÌË Ê˘ÁÔÎÂÓÙÚËÌ¤-

ÓÔ ‰Â›ÁÌ· Ô‡ÚˆÓ, ¤¯ÂÈ ·Ô‰ÂÈ¯ıÂ› ÂÚÈÛÛfiÙÂÚÔ ·ÍÈfi-

ÈÛÙË ·fi ÙËÓ ·Ï‹ ÌÈÎÚÔÛÎÔÈÎ‹ Ô‡ÚˆÓ (25).

øÛÙfiÛÔ, ÚfiÎÂÈÙ·È ÁÈ· ÂÍ¤Ù·ÛË Ô˘ ··ÈÙÂ› ÂÍÂÈ‰È-

ÎÂ˘Ì¤ÓÔ ÚÔÛˆÈÎfi, ÌÂ ·ÌÊÈÛ‚ËÙÔ‡ÌÂÓË Û¯¤ÛË

·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜-ÎfiÛÙÔ˘˜ Î·È ·ÛÊ·ÏÒ˜ ‰˘-

ÛÚfiÛÈÙË ÙfiÛÔ ÛÂ Â›Â‰Ô ÚˆÙÔ‚¿ıÌÈ·˜ ÂÚ›ı·Ï-

„Ë˜, fiÛÔ Î·È ÛÂ ÌË ÂÍÂÈ‰ÈÎÂ˘Ì¤ÓÂ˜ ÓÔÛËÏÂ˘ÙÈÎ¤˜

ÌÔÓ¿‰Â˜ ÙË˜ ÂÚÈÊ¤ÚÂÈ·˜ (3-8,18).

∆Ô ˘„ËÏfi ÔÛÔÛÙfi Ô˘ÚÔÏÔÈÌÒÍÂˆÓ Ô˘ ÚÔ¤-

Î˘„Â ·fi ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË ‰ÂÓ ÌÔÚÂ› Ó· ıÂˆ-

ÚËıÂ› ·ÓÙÈÚÔÛˆÂ˘ÙÈÎfi ÙÔ˘ ÁÂÓÈÎÔ‡ ÏËı˘ÛÌÔ‡.

∞Ó Î·È Ë ÂÈÛ·ÁˆÁ‹ ÁÈ· Ï‹ÚË ¤ÏÂÁ¯Ô ÙˆÓ ÂÌ‡ÚÂÙˆÓ

‚ÚÂÊÒÓ ¯ˆÚ›˜ ÂÛÙ›· ÏÔ›ÌˆÍË˜ ·ÔÙÂÏÂ› ÔÏÈÙÈÎ‹

ÙË˜ Û˘ÁÎÂÎÚÈÌ¤ÓË˜ ÎÏÈÓÈÎ‹˜, Â›Ó·È ÚÔÊ·Ó¤˜ fiÙÈ

¤Ó·˜ ÛËÌ·ÓÙÈÎfi˜ ·ÚÈıÌfi˜ Ù¤ÙÔÈˆÓ ‚ÚÂÊÒÓ ‰ÂÓ Î·Ù·-

Ï‹ÁÂÈ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô. ∂ÈÏ¤ÔÓ, ¤Ó· Ì¤ÚÔ˜ ÙˆÓ

‚ÚÂÊÒÓ Ô˘ Â›¯·Ó ÂÈÛ·¯ıÂ› ÁÈ· ¤ÏÂÁ¯Ô ‰ÂÓ ÏËÚÔ‡-

ÛÂ Ù· ÎÚÈÙ‹ÚÈ· ÂÈÛ·ÁˆÁ‹˜ ÛÙË ÌÂÏ¤ÙË (Ï‹ÚË˜ ¤ÏÂÁ-

¯Ô˜ ÛË„·ÈÌ›·˜, Ï‹„Ë Ô‡ÚˆÓ ÌfiÓÔ ÌÂ ˘ÂÚË‚ÈÎ‹ ·-

Ú·Î¤ÓÙËÛË, ¯ˆÚ›˜ ·ÓÙÈ‚›ˆÛË ÚÈÓ ÙËÓ ÂÈÛ·ÁˆÁ‹).

øÛÙfiÛÔ, Ë ÂÊ·ÚÌÔÁ‹ ·˘ÙÒÓ ÙˆÓ ÎÚÈÙËÚ›ˆÓ ÎÚ›ıËÎÂ

·Ó·ÁÎ·›· ÚÔÎÂÈÌ¤ÓÔ˘ Ó· ÂÍ·ÛÊ·ÏÈÛÙÂ› Ë ÔÌÔÈÔÁ¤-

ÓÂÈ· ÙÔ˘ ÏËı˘ÛÌÔ‡ ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ Î·È Ó·

ÂÚÈÔÚÈÛÙÂ› ÙÔ ÂÓ‰Â¯fiÌÂÓÔ „Â˘‰Ò˜ ıÂÙÈÎÒÓ ‹ ·ÚÓË-

ÙÈÎÒÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ.

∏ ·ÍÈÔÏfiÁËÛË, Ù¤ÏÔ˜, ÙˆÓ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ·Ú·-

Ì¤ÙÚˆÓ ¤ÁÈÓÂ ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÓÂfiÙÂÚÂ˜ Î·È ÂÚÈÛ-

ÛfiÙÂÚÔ ·ÍÈfiÈÛÙÂ˜ ÛÙ·ÙÈÛÙÈÎ¤˜ ÌÂıfi‰Ô˘˜, fiˆ˜ ÔÈ

·Ó·ÏÔÁ›Â˜ Èı·ÓÔÙ‹ÙˆÓ Î·È ÔÈ Î·Ì‡ÏÂ˜ ROC ÁÈ·

ÙËÓ ÂÎÙ›ÌËÛË ÙË˜ Û˘ÓÔÏÈÎ‹˜ ·fi‰ÔÛË˜ ÙË˜ Î¿ıÂ ‰Ô-

ÎÈÌ·Û›·˜. ∂ÈÏ¤ÔÓ, Ù· ˘ÔÛÊ·›ÚÈ· ÛÙË ÌÈÎÚÔÛÎÔ-

ÈÎ‹ Ô‡ÚˆÓ Î·È Ù· ÏÂ˘Î¿ ÛÙË ÁÂÓÈÎ‹ ·›Ì·ÙÔ˜ ÂÎÙÈ-

Ì‹ıËÎ·Ó ÌÂ ‚¿ÛË ÂÚÈÛÛfiÙÂÚÂ˜ ·ıÔÏÔÁÈÎ¤˜ ÙÈÌ¤˜,

ÙÈÌ¤˜ Ô˘ ¤¯Ô˘Ó ·ÍÈÔÏÔÁËıÂ› ÛÂ ÛÂÈÚ¿ ÌÂÏÂÙÒÓ Î·È

Ô˘ ·ÔÙÂÏÔ‡Ó ‚·ÛÈÎ¿ ÎÚÈÙ‹ÚÈ· ÛÙ· ÚˆÙfiÎÔÏÏ·

ÂÎÙ›ÌËÛË˜ ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÛÔ‚·Ú‹˜ ÌÈÎÚÔ‚È·Î‹˜ ÏÔ›-

ÌˆÍË˜ ÛÂ ÂÌ‡ÚÂÙ· ‚Ú¤ÊË ¯ˆÚ›˜ ÂÛÙ›· (13-15).

ŒÙÛÈ, ÛÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË ÂÈ¯ÂÈÚÂ›Ù·È Î·È Ë ÂÎÙ›-

ÌËÛË ÙË˜ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ ·˘ÙÒÓ ÙˆÓ ÚˆÙÔ-

ÎfiÏÏˆÓ ÛÂ fi,ÙÈ ·ÊÔÚ¿ Ê˘ÛÈÎ¿ ÙËÓ ·Ó¿‰ÂÈÍË ÙÔ˘ ÎÈÓ-

‰‡ÓÔ˘ Ô˘ÚÔÏÔ›ÌˆÍË˜.

™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, Ë ÂÎÙ›ÌËÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ Ô˘-

ÚÔÏÔ›ÌˆÍË˜ ÛÂ ÂÌ‡ÚÂÙ· ‚Ú¤ÊË ¯ˆÚ›˜ ÂÌÊ·Ó‹

ÂÛÙ›· ‰ÂÓ ÌÔÚÂ› Ó· ‚·ÛÈÛÙÂ› ÛÙË ÌÈÎÚÔÛÎÔÈÎ‹ ÂÍ¤-

Ù·ÛË Ô‡ÚˆÓ, ÛÙË ÁÂÓÈÎ‹ ·›Ì·ÙÔ˜, ÛÙËÓ ∆∫∂ Î·È ÛÙË

CRP. ∏ ·ÓÂ‡ÚÂÛË >10 ˘ÔÛÊ·ÈÚ›ˆÓ ÎÔ ÛÙË ÌÈÎÚÔ-

ÛÎÔÈÎ‹ ÂÍ¤Ù·ÛË ÙˆÓ Ô‡ÚˆÓ ı· Ú¤ÂÈ Ó· Î·ÙÂ˘ı‡-

ÓÂÈ ÙÔÓ ıÂÚ¿ÔÓÙ· È·ÙÚfi ÚÔ˜ ÙËÓ Èı·ÓfiÙËÙ· Ô˘-

ÚÔÏÔ›ÌˆÍË˜. øÛÙfiÛÔ, ÛÂ Î·Ì›· ÂÚ›ÙˆÛË Ô ¯·ÌË-

ÏfiÙÂÚÔ˜ ·ÚÈıÌfi˜ ˘ÔÛÊ·ÈÚ›ˆÓ (·ÎfiÌ· Î·È <5 ÎÔ)

‰ÂÓ ÌÔÚÂ› Ó· ıÂˆÚËıÂ› ÎÚÈÙ‹ÚÈÔ ÁÈ· ÙÔÓ ·ÔÎÏÂÈ-

ÛÌfi ÙË˜ ÓfiÛÔ˘. ∞ÎfiÌË Î·È Ô Û˘Ó‰˘·ÛÌfi˜ ÙÔ˘ ·ÚÈı-

ÌÔ‡ ˘ÔÛÊ·ÈÚ›ˆÓ ÌÂ ÙÔÓ ·ÚÈıÌfi ÏÂ˘ÎÒÓ ÛÙË ÁÂÓÈÎ‹

·›Ì·ÙÔ˜, ÎÚÈÙ‹ÚÈÔ Ô˘ ¯ÚËÛÈÌÔÔÈÂ›Ù·È Â˘Ú¤ˆ˜ ÁÈ·

ÙËÓ ÂÎÙ›ÌËÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÛÔ‚·Ú‹˜ ÌÈÎÚÔ‚È·Î‹˜

ÓfiÛÔ˘, ‰ÂÓ ÌÔÚÂ› Ó· Ô‰ËÁ‹ÛÂÈ ÛÂ ·ÛÊ·Ï‹ Û˘ÌÂ-

Ú¿ÛÌ·Ù· ÛÂ fi,ÙÈ ·ÊÔÚ¿ ÙÔÓ ·ÔÎÏÂÈÛÌfi ÙË˜ Ô˘ÚÔ-

ÏÔ›ÌˆÍË˜. ∂ÔÌ¤Óˆ˜, Ë Î·ÏÏÈ¤ÚÁÂÈ· Ô‡ÚˆÓ ·ÔÙÂ-

ÏÂ› ÙË ÌfiÓË ·ÍÈfiÈÛÙË ÂÍ¤Ù·ÛË ÁÈ· ÙË ‰È¿ÁÓˆÛË Ô˘-

ÚÔÏÔ›ÌˆÍË˜ ÛÂ ÂÌ‡ÚÂÙ· ‚Ú¤ÊË ËÏÈÎ›·˜ 15-90 ËÌÂ-

ÚÒÓ ¯ˆÚ›˜ ÂÌÊ·Ó‹ ÂÛÙ›· ÏÔ›ÌˆÍË˜ Î·È ı· Ú¤ÂÈ Ó·

Ú·ÁÌ·ÙÔÔÈÂ›Ù·È ¿ÌÂÛ·, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙÔ Úˆ-

ÙfiÎÔÏÏÔ ‰È·ÁÓˆÛÙÈÎ‹˜ ÚÔÛ¤ÁÁÈÛË˜ Î·È ·ÓÙÈÌÂÙÒ-

ÈÛË˜ Ô˘ ¯ÚËÛÈÌÔÔÈÂ›Ù·È.


1. American Academy of Pediatrics. Committee on Quality

Improvement. Subcommittee on Urinary Tract Infection.

Practice parameter: the diagnosis, treatment, and evalua-

tion of the initial urinary tract infection in febrile infants

and young children. Pediatrics 1999;103:843-852.

2. Shaw KN, Gorelick MH, McGowan KL, McDaniel-

Yakscoe N, Schwartz JS. Prevalence of urinary tract infec-

tion and occult bacteremia in febrile young children in the

emergency department. Arch Pediatr Adolesc Med 1996;

150:37.

3. Newman TB, Bernzweig JA, Takayama JI, Finch SA,

Wasserman RC, Pantell RH. Urine testing and urinary

tract infections in febrile infants seen in office settings: the

Pediatric Research in Office Settings’ Febrile Infant Study.

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

4. Shaw KN, McGowan KL, Gorelick MH, Schwartz JS.

Screening for urinary tract infection in infants in the emer-

gency department: which test is best? Pediatrics 1998;

101:E1.

5. Gorelick MH, Shaw KN. Screening tests for urinary tract

infection in children: A meta-analysis. Pediatrics 1999;

104:E54.

6. Lin DS, Huang SH, Lin CC, Tung YC, Huang TT, Chiu

NC et al. Urinary tract infection in febrile infants younger

than eight weeks of age. Pediatrics 2000;105:E20.

7. Bachur R, Harper MB. Reliability of the urinalysis for pre-

dicting urinary tract infections in young febrile children.

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

8. Lin DS, Huang FY, Chiu NC, Koa HA, Hung HY, Hsu CH

et al. Comparison of hemocytometer leukocyte counts and

standard urinalyses for predicting urinary tract infections

in febrile infants. Pediatr Infect Dis J 2000;19:223-227.

9. Doley A, Nelligan M. Is a negative dipstick urinalysis good

enough to exclude urinary tract infection in paediatric emer-

gency department patients? Emerg Med 2003;15:77-80.

10. Tamim MM, Alesseh H, Aziz H. Analysis of the efficacy of

urine culture as part of sepsis evaluation in the premature

infant. Pediatr Infect Dis J 2003;22:805-808.

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Charron M. Is urine culture necessary to rule out urinary

tract infection in young febrile children? Pediatr Infect Dis

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12. Martin B, Ghosh A. Towards evidence based emergency

225∫›Ó‰˘ÓÔ˜ Ô˘ÚÔÏÔ›ÌˆÍË˜ ÛÂ ÂÌ‡ÚÂÙ· ‚Ú¤ÊË

¶·È‰È·ÙÚÈÎ‹ 2007;70:221-226


medicine: best BETS from the Manchester Royal Infir-mary. Negative urine analysis to exclude urinary tract in-fection. Emerg Med J 2001;18:462-463.

13. Baker MD, Bell LM, Avner JR. Outpatient managementwithout antibiotics of fever in selected infants. N Engl JMed 1993;329:1437-1441.

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

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

16. Bachur RG, Harper MB. Predictive model for serious bac-terial infections among infants younger than 3 months ofage. Pediatrics 2001;108:311-316.

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

18. Herr SM, Wald ER, Pitetti RD, Choi SS. Enhanced urinal-ysis improves identification of febrile infants ages 60 daysand younger at low risk for serious bacterial illness. Pedi-atrics 2001;108:866-871.

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

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

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

24. Gassler N, Paul H, Runge M. Rapid detection of urinarytract infection-evaluation of flow cytometry. Clin Nephrol2006;66:331-335.

226 ™. ºÔ‡˙·˜ Î·È Û˘Ó.



227∂¡¢π∞º∂ƒ√À™∞ ¶∂ƒπ¶∆ø™∏ CASE REPORT

¶·È‰È·ÙÚÈÎ‹ 2007;70:227-231

∂ÈÛ·ÁˆÁ‹

∆Ô ÓÂ˘ÚÔ‚Ï¿ÛÙˆÌ· Â›Ó·È o ‰Â‡ÙÂÚÔ˜ ÛÂ Û˘-

¯ÓfiÙËÙ· Û˘Ì·Á‹˜ fiÁÎÔ˜ ÙË˜ ·È‰ÈÎ‹˜ ËÏÈ-

Î›·˜. ∏ Â›ÙˆÛË ÙË˜ ÓfiÛÔ˘ ÂÎÙÈÌ¿Ù·È ÛÂ 9-10

ÂÚÈÙÒÛÂÈ˜ ·Ó¿ 1.000.000 ·È‰È¿ ËÏÈÎ›·˜ ÌÈ-

ÎÚfiÙÂÚË˜ ÙˆÓ 15 ÂÙÒÓ ÂÙËÛ›ˆ˜ Î·È Â›Ó·È Ï›ÁÔ

™‡Ó‰ÚÔÌÔ Ô„oÌ˘fiÎÏoÓÔ˘-·Ù·Í›·˜ ÛÂ ·ÛıÂÓ‹ ÌÂ

ÓÂ˘ÚÔ‚Ï¿ÛÙˆÌ·: ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛË˜ Î·È ·Ó·ÛÎfiËÛË

ÙË˜ ‚È‚ÏÈÔÁÚ·Ê›·˜

¡. ∫·Ù˙ËÏ¿ÎË˜1, ∂. ª·ÓÙ·‰¿ÎË˜1, ∞. ™·‚‚›‰Ô˘1, ¶. µÔÚÁÈ¿1, ª. ƒ·˚Û¿ÎË2, ∂. ™ÙÂÈ·Î¿ÎË1, ª. ∫·ÏÌ·ÓÙ‹1

¶ÂÚ›ÏË„Ë: ∆Ô ÓÂ˘ÚÔ‚Ï¿ÛÙˆÌ· ·ÔÙÂÏÂ› ÙÔ 7-8% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ Î·ÎÔËıÂÈÒÓ ÛÙ· ·È‰È¿, ÂÓÒ Â˘ı‡-ÓÂÙ·È ÁÈ· ÙÔ 15% ÙˆÓ ı·Ó¿ÙˆÓ ·fi ÓÂÔÏ·Û›Â˜ ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜. ∏ Ù·ÍÈÓfiÌËÛË ‚·Û›˙ÂÙ·È ÛÙËÓ ¤ÎÙ·-ÛË ÙË˜ ÓfiÛÔ˘, ÙËÓ ËÏÈÎ›·, ÙËÓ ÈÛÙÔ·ıÔÏÔÁ›· Î·È ÛÂ ÌÔÚÈ·ÎÔ‡˜ ÚÔÁÓˆÛÙÈÎÔ‡˜ ‰Â›ÎÙÂ˜, fiˆ˜ Ë ÂÓ›Û¯˘-ÛË ÙÔ˘ ÔÁÎÔÁÔÓÈ‰›Ô˘ N-myc. ™˘Ó‹ıˆ˜ ÂÌÊ·Ó›˙ÂÙ·È ˆ˜ Ì¿˙· Î·Ù¿ Ì‹ÎÔ˜ ÙË˜ Û˘Ì·ıËÙÈÎ‹˜ ·Ï˘Û›‰·˜. √ÈÎÏÈÓÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ ÙÔ˘ ÓÂ˘ÚÔ‚Ï·ÛÙÒÌ·ÙÔ˜ ÔÈÎ›ÏÏÔ˘Ó ·Ó¿ÏÔÁ· ÌÂ ÙË ı¤ÛË ÙÔ˘ ÚˆÙÔ·ıÔ‡˜ fiÁÎÔ˘Î·È ÙËÓ ·ÚÔ˘Û›· ‹ fi¯È ÌÂÙ·ÛÙ·ÙÈÎ‹˜ ÓfiÛÔ˘. √ ÚˆÙÔ·ı‹˜ fiÁÎÔ˜ ÌÔÚÂ› Ó· ÂÓÙÔÈÛÙÂ› ÔÔ˘‰‹ÔÙÂÛÙÔ Û˘Ì·ıËÙÈÎfi Û‡ÛÙËÌ·, fiˆ˜ ÛÙ· ÂÈÓÂÊÚ›‰È·, ÛÙ· ÎÔÈÏÈ·Î¿ Û˘Ì·ıËÙÈÎ¿ Á¿ÁÁÏÈ· ‹ ÛÙÔ Ô›ÛıÈÔ ÌÂ-ÛÔıˆÚ¿ÎÈÔ. ∆· ‚Ú¤ÊË ÌÂ ÓÂ˘ÚÔ‚Ï¿ÛÙˆÌ· Û˘Ó‹ıˆ˜ ¤¯Ô˘Ó ÂÓÙÔÈÛÌ¤ÓË ÓfiÛÔ Î·Ï‹˜ ÚfiÁÓˆÛË˜, ÌÂ Â˘-ÓÔ˚ÎÔ‡˜ ÌÔÚÈ·ÎÔ‡˜ ‰Â›ÎÙÂ˜ ÛÂ ·ÓÙ›ıÂÛË ÌÂ ·È‰È¿ ËÏÈÎ›·˜ ¿Óˆ ÙÔ˘ ¤ÙÔ˘˜. ∆Ô Î˘ÚÈfiÙÂÚÔ ·Ú·ÓÂÔÏ·-ÛÌ·ÙÈÎfi Û‡Ó‰ÚÔÌÔ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ÓÂ˘ÚÔ‚Ï¿ÛÙˆÌ· Â›Ó·È Ô Ô„ÔÌ˘fiÎÏoÓÔ˜-·Ù·Í›· Ô˘ ·Ú·ÙËÚÂ›Ù·È ÛÙÔ2-3% ÙˆÓ ·ÛıÂÓÒÓ. ™ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ÔÈ ·ÛıÂÓÂ›˜ ·˘ÙÔ› ¤¯Ô˘Ó ¯·ÌËÏfi ÛÙ¿‰ÈÔ ÓfiÛÔ˘ Î·È ¿ÚÈÛÙËÌ·ÎÚÔ¯ÚfiÓÈ· ÂÈ‚›ˆÛË. øÛÙfiÛÔ, ˆ˜ ÚÔ˜ ÙËÓ „˘¯ÔÎÈÓËÙÈÎ‹ ÂÍ¤ÏÈÍË, ÛÂ ÌÂÁ¿ÏÔ ÔÛÔÛÙfi ·ÚÔ˘ÛÈ¿˙Ô˘ÓÂÈÌ¤ÓÔ˘Û· Î·ı˘ÛÙ¤ÚËÛË. √È ˘¿Ú¯Ô˘ÛÂ˜ ıÂÚ·Â˘ÙÈÎ¤˜ ÂÈÏÔÁ¤˜, fiˆ˜ Ù· ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹, Ë ÂÓ‰Ô-ÊÏ¤‚È· Á-ÛÊ·ÈÚ›ÓË, Ë Ï·ÛÌ·Ê·›ÚÂÛË Î·È Ë ¯ËÌÂÈÔıÂÚ·Â›·, ‰ÂÓ ¤¯Ô˘Ó ÚÔÛÊ¤ÚÂÈ Ù· ·Ó·ÌÂÓfiÌÂÓ·.¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ·È‰ÈÔ‡ ËÏÈÎ›·˜ 16 ÌËÓÒÓ ÌÂ ÓÂ˘ÚÔ‚Ï¿ÛÙˆÌ·, Ô„ÔÌ˘fiÎÏoÓÔ-·Ù·Í›· Î·È „˘-¯ÔÎÈÓËÙÈÎ‹ ·ÏÈÓ‰ÚfiÌËÛË, ÂÓÒ ·Ó·ÛÎÔÂ›Ù·È Ë ‚È‚ÏÈÔÁÚ·Ê›· ˆ˜ ÚÔ˜ ÙËÓ ·ÈÙÈÔ·ıÔÁ¤ÓÂÈ·, ÙË ıÂÚ·Â›·Î·È ÙË ÓÂ˘ÚÔÏÔÁÈÎ‹ ¤Î‚·ÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: NÂ˘ÚÔ‚Ï¿ÛÙˆÌ·, o„ÔÌ˘fiÎÏoÓÔ˜-·Ù·Í›·.

Opsoclonus-myoclonus-ataxia syndrome in a patient with

neuroblastoma: Case report and review of the literature

N. Katzilakis1, E. Mandadakis1, A. Savidou1, P. Vorgia1, M. Raissaki2, E. Steiakaki1, M. Kalmanti1

Abstract: Neuroblastoma represents 7-8% of all childhood malignancies and is responsible for 15% ofcancer-related deaths in children. Staging is based on the age of the child, the extent of the disease andthe histopathology and molecular prognostic markers, such as amplification of the N-myc oncogene.Neuroblastoma usually presents as a mass along the sympathetic chain, and its clinical manifestations arebased on the site of the primary tumour and the presence or absence of metastatic disease. Infants withneuroblastoma usually have localized disease with favourable molecular markers (absence of N-mycamplification) in contrast to children >1 year of age. The most frequent paraneoplastic syndrome inneuroblastoma is opsomyoclonus-ataxia (OMA), which is seen in 2-3% of cases. Most of these patientshave low-stage disease with a favourable prognosis regarding long-term survival, although their mentaland motor development may be substantially delayed. The available therapeutic options such ascorticosteroids, intravenous Á-globulin, exchange transfusion and chemotherapy do not offer theanticipated results in the development of these children. The case is presented of a 16 month-old boy withneuroblastoma, OMA and developmental retardation, along with a review of the literature of thisparaneoplastic syndrome, with emphasis on its treatment and the neurological outcome of children withneuroblastoma and OMA.

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

1 ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹∞ÈÌ·ÙÔÏÔÁ›·˜-√ÁÎÔÏÔÁ›·˜,¶·ÓÂÈÛÙËÌÈ·Îfi °ÂÓÈÎfi¡ÔÛÔÎÔÌÂ›Ô ∏Ú·ÎÏÂ›Ô˘∫Ú‹ÙË˜

2 ∆Ì‹Ì·∞ÎÙÈÓÔ‰È·ÁÓˆÛÙÈÎ‹˜,¶·ÓÂÈÛÙËÌÈ·Îfi °ÂÓÈÎfi¡ÔÛÔÎÔÌÂ›Ô ∏Ú·ÎÏÂ›Ô˘∫Ú‹ÙË˜


ª·Ú›· ∫·ÏÌ·ÓÙ‹ [email protected] ¶·ÓÂÈÛÙËÌÈ·Îfi °ÂÓÈÎfi¡ÔÛÔÎÔÌÂ›Ô ∏Ú·ÎÏÂ›Ô˘, µ’ ∫Ù‹ÚÈÔ ∆.∫. 711 10, ∏Ú¿ÎÏÂÈÔ∫Ú‹ÙË˜

1 Haematology-OncologyPaediatric Department,General UniversityHospital of Heraklion,Crete

2 Diagnostic RadiologyDepartment, GeneralUniversity Hospital ofHeraklion, Crete

Correspondence:

Maria Kalmanti [email protected] General University Hospitalof Heraklion, 2nd Building 711 10, Heraklion, Crete


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ËÏÈÎ›· ÌÂÁ·Ï‡ÙÂÚË ÙˆÓ 10 ÂÙÒÓ (1). ∆Ô ÌÂÙ·ÛÙ·ÙÈ-

Îfi ÓÂ˘ÚÔ‚Ï¿ÛÙˆÌ· ÛÂ ·È‰È¿ ËÏÈÎ›·˜ ÌÂÁ·Ï‡ÙÂÚË˜

ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜ Û¯ÂÙ›˙ÂÙ·È ÌÂ Ì›· ·fi ÙÈ˜ ¯ÂÈÚfiÙÂ-

ÚÂ˜ ÚÔÁÓÒÛÂÈ˜ ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ Î·ÎÔËıÂÈÒÓ ÙË˜

·È‰ÈÎ‹˜ ËÏÈÎ›·˜. ∞Ó Î·È ·Ú¯ÈÎ¿ ··ÓÙ¿ ÛÙË ¯ËÌÂÈ-

ÔıÂÚ·Â›·, Ë ÏÂÈÔÓfiÙËÙ· ÙˆÓ ·È‰ÈÒÓ ˘ÔÙÚÔ-

È¿˙ÂÈ Î·È Î·Ù·Ï‹ÁÂÈ ÌÂ ÚfiÔ‰Ô ÙË˜ ÓfiÛÔ˘.

√È ÓÂ˘ÚÔÁÂÓÂ›˜ fiÁÎÔÈ ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜ ÚÔ-

¤Ú¯ÔÓÙ·È ·fi ÚÔÁÔÓÈÎ¿-ÔÏ˘‰‡Ó·Ì· Û˘Ì·ıËÙÈ-

Î¿ Î‡ÙÙ·Ú· ÙË˜ ÓÂ˘ÚÈÎ‹˜ ·ÎÚÔÏÔÊ›·˜ ‹ ¯ÚˆÌÈfiÊÈ-

Ï· Î‡ÙÙ·Ú· ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÂÈÓÂÊÚÈ‰›ˆÓ. πÛÙÔÏÔ-

ÁÈÎ¿ ‰È·ÎÚ›ÓÔÓÙ·È ÛÂ ÓÂ˘ÚÔ‚Ï¿ÛÙˆÌ·, Á·ÁÁÏÈÔÓÂ˘-

ÚÔ‚Ï¿ÛÙˆÌ· (fiÁÎÔ˜ ÌÂ ÒÚÈÌ· Á·ÁÁÏÈ·Î¿ Î‡ÙÙ·Ú·

Î·È ÓÂ˘ÚÔ‚Ï¿ÛÙÂ˜) Î·È Á·ÁÁÏÈÔÓÂ‡ÚˆÌ·. √È ÎÏÈÓÈ-

Î¤˜ ÂÎ‰ËÏÒÛÂÈ˜ ÔÈÎ›ÏÏÔ˘Ó ·Ó¿ÏÔÁ· ÌÂ ÙË ı¤ÛË

ÙÔ˘ ÚˆÙÔ·ıÔ‡˜ fiÁÎÔ˘ Î·È ÙËÓ ·ÚÔ˘Û›· ‹ fi¯È

ÌÂÙ·ÛÙ·ÙÈÎ‹˜ ÓfiÛÔ˘.

¶ÂÚ›Ô˘ ÙÔ 70% ÙˆÓ ÚˆÙÔ·ıÒÓ fiÁÎˆÓ ÂÓÙÔ›-

˙ÂÙ·È ÛÙËÓ ÎÔÈÏÈ¿, 25% ÛÙÔÓ ÙÚ¿¯ËÏÔ ‹ ÛÙÔÓ ıÒÚ·Î·

Î·È 5% ÛÙËÓ ‡ÂÏÔ. √È ÌÂÙ·ÛÙ¿ÛÂÈ˜ ··ÓÙÒÓÙ·È Û˘-

¯ÓfiÙÂÚ· ÛÙÔÓ Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ, ÛÙ· ÔÛÙ¿ Î·È ÛÙÔ˘˜

ÏÂÌÊ·‰¤ÓÂ˜. ∆Ô ‹·Ú Î·È ÙÔ ‰¤ÚÌ· ÚÔÛ‚¿ÏÏÔÓÙ·È

Û˘¯ÓfiÙÂÚ· ÛÂ ‚Ú¤ÊË ÌÂ ÓfiÛÔ ÛÙ·‰›Ô˘ IVS (1).

√ Ô„ÔÌ˘fiÎÏoÓÔ˜ (Û‡Ó‰ÚÔÌÔ Kinsbourne) Â›Ó·È

Û¿ÓÈÔ ·Ú·ÓÂÔÏ·ÛÌ·ÙÈÎfi ‹ ÌÂÙ·ÏÔÈÌÒ‰Â˜ ÓÂ˘-

ÚÔÏÔÁÈÎfi Û‡Ó‰ÚÔÌÔ, Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ‚Ú·-

¯Â›Â˜ Â·Ó·Ï·Ì‚·ÓfiÌÂÓÂ˜ ÎÈÓ‹ÛÂÈ˜ ÙˆÓ ÔÊı·ÏÌÒÓ,

ÙÔ˘ ÎÔÚÌÔ‡ Î·È ÙˆÓ ¿ÎÚˆÓ Ô˘ Û˘¯Ó¿ Û˘Û¯ÂÙ›˙Ô-

ÓÙ·È ÌÂ ·ÚÂÁÎÂÊ·ÏÈ‰ÈÎ‹ ·Ù·Í›· (Û‡Ó‰ÚÔÌÔ Ô„Ô-

Ì˘fiÎÏoÓÔ˘-·Ù·Í›·˜, OMA) (2,3).

™Ù· ·È‰È¿, ÙÔ Û‡Ó‰ÚÔÌÔ OMA Û˘ÓËı¤ÛÙÂÚ·

Û˘Ó‰¤ÂÙ·È ÌÂ ÓÂ˘ÚÔ‚Ï¿ÛÙˆÌ·, ÙÔ˘ ÔÔ›Ô˘ ·ÔÙÂ-

ÏÂ› ÂÎ‰‹ÏˆÛË ÛÙÔ 2-3% ÙˆÓ ÂÚÈÙÒÛÂˆÓ (4).

™ÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜, ÙÔ Û‡Ó‰ÚÔÌÔ OMA ¤¯ÂÈ Û˘Ó‰ÂıÂ›

ÌÂ ÔÈÎ›Ï· ÓÂÔÏ¿ÛÌ·Ù·, fiˆ˜ Î·ÚÎ›ÓÔ Ì·ÛÙÒÓ,

ˆÔıËÎÒÓ Î·È ÌÈÎÚÔÎ˘ÙÙ·ÚÈÎfi Î·ÚÎ›ÓˆÌ· ÓÂ‡ÌÔ-

Ó· (5). ∆Ô ÌÂÙ·ÏÔÈÌÒ‰Â˜ ÓÂ˘ÚÔÏÔÁÈÎfi Û‡Ó‰ÚÔÌÔ

√ª∞ ¤¯ÂÈ Û˘Ó‰ÂıÂ› ÌÂ ÏÔ›ÌˆÍË ·fi ‰È¿ÊÔÚÔ˘˜

ÈÔ‡˜ (6).

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛË˜

¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ·ÁÔÚÈÔ‡ ËÏÈÎ›·˜ 16

ÌËÓÒÓ Ô˘ ·Ú·¤ÌÊıËÎÂ ÏfiÁˆ „˘¯ÔÎÈÓËÙÈÎ‹˜

·ÏÈÓ‰ÚfiÌËÛË˜, Ô„ÔÌ˘fiÎÏoÓÔ˘-·Ù·Í›·˜ Î·È ÙÚfi-

ÌÔ˘ ÎÔÚÌÔ‡, ÎÂÊ·Ï‹˜ Î·È ¿ÎÚˆÓ ·fi 15ËÌ¤ÚÔ˘

ÚÔ ÙË˜ ÂÈÛ·ÁˆÁ‹˜ ÙÔ˘.

∆Ô ·È‰› ÁÂÓÓ‹ıËÎÂ ÌÂ Î·ÈÛ·ÚÈÎ‹ ÙÔÌ‹ ÌÂÙ¿

·fi ‰›‰˘ÌË Î‡ËÛË 37 Â‚‰ÔÌ¿‰ˆÓ ÌÂ ‚¿ÚÔ˜ Á¤ÓÓË-

ÛË˜ 2030 g, ÂÚ›ÌÂÙÚÔ ÎÂÊ·Ï‹˜ 32,5 cm Î·È Ì‹ÎÔ˜

ÛÒÌ·ÙÔ˜ 46 cm. ∆Ô ÂÚÈÁÂÓÓËÙÈÎfi, Ì·ÈÂ˘ÙÈÎfi Î·È

ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ‹Ù·Ó ÂÏÂ‡ıÂÚÔ. ∆Ô ‚Ú¤ÊÔ˜

Â›¯Â Ê˘ÛÈÔÏÔÁÈÎ‹ „˘¯ÔÎÈÓËÙÈÎ‹ ·Ó¿Ù˘ÍË Ì¤¯ÚÈ

ÙËÓ ËÏÈÎ›· ÙˆÓ 15 ÌËÓÒÓ, Î·ıÒ˜ ÛÙ‹ÚÈÍÂ ÙÔ ÎÂÊ¿ÏÈ

ÛÂ ËÏÈÎ›· 3 ÌËÓÒÓ, Î¿ıÈÛÂ ÛÂ ËÏÈÎ›· 6-7 ÌËÓÒÓ, ‚¿-

‰ÈÛÂ ÛÂ ËÏÈÎ›· 13 ÌËÓÒÓ Î·È Â›Â Ï¤ÍÂÈ˜ ÛÙËÓ ËÏÈÎ›·

ÙˆÓ 14-15 ÌËÓÒÓ.

∞fi 15ËÌ¤ÚÔ˘ ÚÔ ÙË˜ ÂÈÛ·ÁˆÁ‹˜, ÙÔ ·È‰› ·-

ÚÔ˘Û›·ÛÂ ·Ù·Í›·, ÚÔÔ‰Â˘ÙÈÎ¿ ÂÈ‰ÂÈÓÔ‡ÌÂÓË ·‰˘-

Ó·Ì›· ÛÙ‹ÚÈÍË˜ ÎÂÊ·Ï‹˜, ·Ú·ÌÔÓ‹˜ ÛÂ fiÚıÈ· Î·È

Î·ıÈÛÙ‹ ı¤ÛË, Ô„ÔÌ˘fiÎÏoÓÔ, ÙÚfiÌÔ ÎÔÚÌÔ‡, ÎÂÊ·-

Ï‹˜ Î·È ¿ÎÚˆÓ Î·È ·ÏÈÓ‰ÚfiÌËÛË ÏfiÁÔ˘. ªÂÙ¿ ÙËÓ

ÂÍ¤Ù·ÛË ·fi ·È‰›·ÙÚÔ Î·È ·È‰ÔÓÂ˘ÚÔÏfiÁÔ, ·-

Ú·¤ÌÊıËÎÂ ÛÙËÓ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ÁÈ· ÂÚ·È-

Ù¤Úˆ ‰ÈÂÚÂ‡ÓËÛË.

∫·Ù¿ ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈÎ‹ ÂÍ¤Ù·ÛË ÛÙËÓ ÂÈÛ·ÁˆÁ‹

‹Ù·Ó ·‡ÚÂÙÔ, ÌÂ Î·Ï¿ ˙ˆÙÈÎ¿ ÛËÌÂ›·, ÂÚ›ÌÂÙÚÔ

ÎÂÊ·Ï‹˜ ÛÙËÓ 25Ë ÂÎ·ÙÔÛÙÈ·›· ı¤ÛË (∂£), ‡„Ô˜

ÛÒÌ·ÙÔ˜ ÛÙËÓ 3Ë-10Ë ∂£ Î·È ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜ Î¿Ùˆ

·fi ÙËÓ 3Ë ∂£. ∏ Î·Ù¿ Û˘ÛÙ‹Ì·Ù· ·ÓÙÈÎÂÈÌÂÓÈÎ‹

ÂÍ¤Ù·ÛË ‰ÂÓ ·Ó¤‰ÂÈÍÂ ·ıÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù·, ÂÓÒ

ÓÂ˘ÚÔÏÔÁÈÎ¿ Â›¯Â ·‰˘Ó·Ì›· ÛÙ‹ÚÈÍË˜ ÎÂÊ·Ï‹˜,

·‰˘Ó·Ì›· ÛÙ‹ÚÈÍË˜ ÛÂ fiÚıÈ· Î·È Î·ıÈÛÙ‹ ı¤ÛË,

·‰˘Ó·Ì›· ‚¿‰ÈÛË˜ Î·È Ô„ÔÌ˘fiÎÏoÓÔ-ÙÚfiÌÔ ÎÔÚ-

ÌÔ‡, ÎÂÊ·Ï‹˜ Î·È ¿ÎÚˆÓ. ∏ Ì˘˚Î‹ ÈÛ¯‡˜, Ô Ì˘˚Îfi˜

ÙfiÓÔ˜ Î·È Ù· ÙÂÓfiÓÙÈ· ·ÓÙ·Ó·ÎÏ·ÛÙÈÎ¿ ‹Ù·Ó Ê˘ÛÈÔ-

ÏÔÁÈÎ¿. ∏ ·ÍÈÔÏfiÁËÛË Î·Ù¿ Denver ‹Ù·Ó Û˘Ì‚·Ù‹

ÌÂ ËÏÈÎ›· 6-7 ÌËÓÒÓ ÛÙËÓ ·‰Ú‹, ÏÂÙ‹ ÎÈÓËÙÈÎfiÙË-

Ù· Î·È ÔÌÈÏ›· Î·È 10 ÌËÓÒÓ ÛÙËÓ ÎÔÈÓˆÓÈÎfiÙËÙ·.

∞fi ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô, Ë ÔÛÊ˘ÔÓˆÙÈ·›·

·Ú·Î¤ÓÙËÛË ‹Ù·Ó ·ÚÓËÙÈÎ‹, fiˆ˜ Î·È Ô ÈÔÏÔÁÈÎfi˜

¤ÏÂÁ¯Ô˜. ∏ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·Î·, ÙÔ ˘ÂÚË¯ÔÙÔ-

ÌÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜ Î·È Ë ·ÍÔÓÈÎ‹ Î·È Ì·ÁÓËÙÈÎ‹

ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ ÌÂ ÛÎÈ·ÁÚ·ÊÈÎfi ‰ÂÓ ¤‰ÂÈ-

Í·Ó ·ıÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù·. ∞ÓÙ›ıÂÙ·, Ë Ì·ÁÓËÙÈÎ‹

ÙÔÌÔÁÚ·Ê›· ÛÔÓ‰˘ÏÈÎ‹˜ ÛÙ‹ÏË˜ ÌÂ ÛÎÈ·ÁÚ·ÊÈÎfi

·Ó¤‰ÂÈÍÂ ·Ú·ÛÔÓ‰˘ÏÈÎ‹ ‚Ï¿‚Ë ÛÙÔ ‡„Ô˜ ÙÔ˘

£8-£9 ÛÔÓ‰‡ÏÔ˘ ‰ÂÍÈ¿ ˆ˜ ÙËÓ Î¿Ùˆ ÂÈÊ˘ÛÈ·Î‹

Ï¿Î· ÙÔ˘ £10, Ë ÔÔ›· ‰ÂÓ ÂÂÎÙÂÈÓfiÙ·Ó ÂÓÙfi˜

ÙÔ˘ ÛÔÓ‰˘ÏÈÎÔ‡ ÛˆÏ‹Ó·, ÌÂ Ì¤ÁÈÛÙË ÚÔÛıÈÔ›-

ÛıÈ· ‰È¿ÌÂÙÚÔ 2,4 cm, ÂÁÎ¿ÚÛÈ· 0,6 cm, Î·È ÎÂÊ·-

ÏÔ˘Ú·›· 2,3 cm ÛÙÔ Î·ÙÒÙÂÚÔ Ô›ÛıÈÔ ÌÂÛÔıˆÚ¿-

ÎÈÔ ·Ú¿ ÙË ‰ÂÍÈ¿ ¤Íˆ ÏÂ˘ÚÔ‰È·ÊÚ·ÁÌ·ÙÈÎ‹ Áˆ-

Ó›· (∂ÈÎfiÓÂ˜ 1 Î·È 2).

ªÂ Èı·Ó‹ ‰È¿ÁÓˆÛË ÓÂ˘ÚÔ‚Ï¿ÛÙˆÌ·, ÙÔ ·È‰›

ÌÂÙ·Ê¤ÚıËÎÂ ÛÙËÓ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ∞ÈÌ·ÙÔÏÔ-

Á›·˜-√ÁÎÔÏÔÁ›·˜ ÁÈ· ÂÚ·ÈÙ¤Úˆ ‰ÈÂÚÂ‡ÓËÛË. ∆Ô

ÛÈÓıËÚÔÁÚ¿ÊËÌ· ÌÂ 123π MIBG ‰ÂÓ ¤‰ÂÈÍÂ ·ıÔÏÔ-

ÁÈÎ‹ ÚfiÛÏË„Ë Ú·‰ÈÔÊ·ÚÌ¿ÎÔ˘, ÂÓÒ Ë ÊÂÚÚÈÙ›ÓË

ÔÚÔ‡ Î·È ÙÔ ‚·Ó˘ÏÌ·Ó‰ÂÏÈÓÈÎfi ÔÍ‡ ÙˆÓ Ô‡ÚˆÓ ‹Ù·Ó

Ê˘ÛÈÔÏÔÁÈÎ¿. ∆Ô Ì˘ÂÏfiÁÚ·ÌÌ· ‰ÂÓ ·Ó¤‰ÂÈÍÂ ·-

ÚÔ˘Û›· ÌÂÌÔÓˆÌ¤ÓˆÓ ÓÂ˘ÚÔ‚Ï·ÛÙÒÓ ‹ ÚÔ˙ÂÙÒÓ. ∏

228 ¡. ∫·Ù˙ËÏ¿ÎË˜ Î·È Û˘Ó.



ÈÛÙÔÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË ÙË˜ Ì¿˙·˜ Ô˘ ÂÍ·ÈÚ¤ıËÎÂ ÌÂ

ıˆÚ·ÎÔÎÔÈÏÈ·Î‹ ÚÔÛ¤Ï·ÛË ¤‰ÂÈÍÂ ÂÈÎfiÓ· ÓÂ˘-

ÚÔ‚Ï·ÛÙÒÌ·ÙÔ˜ Â˘ÓÔ˚Î‹˜ ÈÛÙÔÏÔÁ›·˜ Î·Ù¿

Shimada. ∏ Ì¿˙· ·Ê·ÈÚ¤ıËÎÂ Â› ˘ÁÈÒÓ ÔÚ›ˆÓ, ÂÓÒ

ÔÈ ÏÂÌÊ·‰¤ÓÂ˜ ‹Ù·Ó ·ÚÓËÙÈÎÔ› ÁÈ· ÌÂÙ·ÛÙ·ÙÈÎ‹ Ófi-

ÛÔ. ªÂ ÙÔÓ ÌÔÚÈ·Îfi ¤ÏÂÁ¯Ô Î˘ÙÙ¿ÚˆÓ ÙÔ˘ ÚˆÙÔ-

·ıÔ‡˜ fiÁÎÔ˘ ÌÂ in situ ˘‚ÚÈ‰ÈÛÌfi ÊıÔÚÈÔ¯ÚÒÌ·-

ÙÔ˜ ‰ÂÓ ‰È·ÈÛÙÒıËÎÂ ÂÓ›Û¯˘ÛË ÙÔ˘ ÔÁÎÔÁÔÓÈ‰›Ô˘

N-myc. H ÛÙ·‰ÈÔÔ›ËÛË Û‡ÌÊˆÓ· ÌÂ ÙÔ ‰ÈÂıÓ¤˜

Û‡ÛÙËÌ· ÛÙ·‰ÈÔÔ›ËÛË˜ ÓÂ˘ÚÔ‚Ï·ÛÙÒÌ·ÙÔ˜ ‹Ù·Ó

Û˘Ì‚·Ù‹ ÌÂ ÓfiÛÔ ÛÙ·‰›Ô˘ π. ø˜ ·ÓÔÛÔÙÚÔÔÔÈËÙÈ-

Î‹ Î·È ·ÓÔÛÔÎ·Ù·ÛÙ·ÏÙÈÎ‹ ·ÁˆÁ‹ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘

√ª∞ ¯ÔÚËÁ‹ıËÎÂ ÂÓ‰ÔÊÏ¤‚È· Á-ÛÊ·ÈÚ›ÓË ÙÚÈ˜,

‹È· ¯ËÌÂÈÔıÂÚ·Â›· ÌÂ ‚ÈÓÎÚÈÛÙ›ÓË (0,05 mg/kg)

Î·È Î·Ù·ÙÂÙÌËÌ¤ÓË Î˘ÎÏÔÊˆÛÊ·Ì›‰Ë (5 mg/kg/

ËÌ¤Ú· ÂÓ‰ÔÊÏÂ‚›ˆ˜ ÁÈ· 5 ËÌ¤ÚÂ˜, Î¿ıÂ 21 ËÌ¤ÚÂ˜)

ÁÈ· 4 Î‡ÎÏÔ˘˜, ·ÏÏ¿ Î·È ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹ ·fi ÙÔ

ÛÙfiÌ· ÛÂ ‰È·ÊÔÚÂÙÈÎ¿ ¯ÚÔÓÈÎ¿ ‰È·ÛÙ‹Ì·Ù·.

™ÙÔ Ï·›ÛÈÔ Ù·ÎÙÈÎ‹˜ ·Ú·ÎÔÏÔ‡ıËÛË˜, ÙÔ ·È‰›

‰ÂÓ ·ÚÔ˘ÛÈ¿˙ÂÈ ‚ÂÏÙ›ˆÛË ÛÙËÓ ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· ÙÔ˘

Û˘Ó‰ÚfiÌÔ˘ √ª∞ ‰¤Î· Ì‹ÓÂ˜ ÌÂÙ¿ ÙËÓ ·Ú¯ÈÎ‹ ‰È¿-

ÁÓˆÛË, ÂÓÒ ÙfiÛÔ Ë ÛˆÌ·ÙÈÎ‹ fiÛÔ Î·È Ë „˘¯ÔÎÈÓËÙÈ-

Î‹ ÙÔ˘ ÂÍ¤ÏÈÍË ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ÛÙ·ÛÈÌfiÙËÙ·.

™˘˙‹ÙËÛË

∆Ô Û‡Ó‰ÚÔÌÔ √ª∞ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ·Î·Ófi-

ÓÈÛÙÂ˜, Ù˘¯·›Â˜ ÎÈÓ‹ÛÂÈ˜ ÔÊı·ÏÌÔ‡, Ì˘ÔÎÏÔÓÈÎ¤˜

ÎÈÓ‹ÛÂÈ˜ ¿ÎÚˆÓ Î·È ÎÔÚÌÔ‡ Î·È ·Ù·Í›· (dancing

eyes, dancing feet) (2-12). ∆Ô 62% ÙˆÓ ·ÛıÂÓÒÓ ·-

ÚÔ˘ÛÈ¿˙ÂÙ·È ÌÂ Ô„fiÎÏoÓÔ, Ì˘fiÎÏÔÓÔ Î·È ·Ù·Í›· Î·È

ÙÔ 38% ÌÂ ¤Ó· ‹ ‰‡Ô ·fi Ù· ·Ú·¿Óˆ Û˘ÌÙÒÌ·-

Ù· (8). ∏ ËÏÈÎ›· ¤Ó·ÚÍË˜ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Î˘Ì·›-

ÓÂÙ·È ·fi 11 ¤ˆ˜ 31 Ì‹ÓÂ˜ (Ì¤ÛË ËÏÈÎ›·: 18 Ì‹ÓÂ˜).

∏ ‰È¿ÚÎÂÈ· ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ √ª∞ ÚÈÓ ·fi ÙË

‰È¿ÁÓˆÛË ÙÔ˘ ÓÂ˘ÚÔ‚Ï·ÛÙÒÌ·ÙÔ˜ ˘ÔÏÔÁ›˙ÂÙ·È ÛÂ

6 ËÌ¤ÚÂ˜ ¤ˆ˜ 17 Ì‹ÓÂ˜, ÌÂ Ì¤ÛË ‰È¿ÚÎÂÈ· ÙÈ˜ 6

Â‚‰ÔÌ¿‰Â˜ (2).

ÀÔÛÙËÚ›˙ÂÙ·È fiÙÈ ÙÔ Û‡Ó‰ÚÔÌÔ ¤¯ÂÈ ·ÓÔÛÔÏÔÁÈ-

Î‹ ‚¿ÛË (2,7,8). √È ÌÂÏ¤ÙÂ˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ Ù· ·È-

‰È¿ ÌÂ √ª∞ ·Ó·Ù‡ÛÛÔ˘Ó IgG ‹ IgM ·˘ÙÔ·ÓÙÈÛÒ-

Ì·Ù· Î·Ù¿ ÙÔ˘ fiÁÎÔ˘, Ù· ÔÔ›· ÛÙÚ¤ÊÔÓÙ·È fiÌˆ˜

Î·È Î·Ù¿ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÓÂ˘ÚÈÎÒÓ Î˘ÙÙ¿ÚˆÓ, ÌÂ

·ÔÙ¤ÏÂÛÌ· Ó· ÚÔÎ·ÏÂ›Ù·È ‚Ï¿‚Ë Î·È ÔÍÂ›· ÓÂ˘-

ÚÔÏÔÁÈÎ‹ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·. √È ·ÛıÂÓÂ›˜ ÌÂ Û‡Ó‰ÚÔÌÔ

√ª∞ ¤¯Ô˘Ó Û˘Ó‹ıˆ˜ ÓÂ˘ÚÔ‚Ï¿ÛÙˆÌ· ¯·ÌËÏÔ‡

ÛÙ·‰›Ô˘ π ‹ ππ Î·È Î·Ï‹˜ ÚfiÁÓˆÛË˜, Èı·ÓfiÓ ÏfiÁˆ

ÂÚÈÔÚÈÛÌÔ‡ ÙË˜ ·Ó¿Ù˘ÍË˜ ÙÔ˘ fiÁÎÔ˘ ·fi Ù· ·˘-

ÙÔ·ÓÙÈÛÒÌ·Ù· (8,9).

∆Ô ÌÂÛÔıˆÚ¿ÎÈÔ Â›Ó·È Û˘¯Ó‹ ÚˆÙÔ·ı‹˜

ÂÓÙfiÈÛË ÙÔ˘ ÓÂ˘ÚÔ‚Ï·ÛÙÒÌ·ÙÔ˜ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ

√ª∞, ÛÂ ·ÓÙ›ıÂÛË ÌÂ ·ÛıÂÓÂ›˜ ÌÂ ÓÂ˘ÚÔ‚Ï¿ÛÙˆÌ·

¯ˆÚ›˜ ÙÔ ·Ú·ÓÂÔÏ·ÛÌ·ÙÈÎfi Û‡Ó‰ÚÔÌÔ, fiÔ˘ Ë

ÓfiÛÔ˜ ÂÓÙÔ›˙ÂÙ·È Û˘¯ÓfiÙÂÚ· ÛÙËÓ ÎÔÈÏÈ¿. ∆Ô Û‡Ó-

‰ÚÔÌÔ Â›Ó·È Û¿ÓÈÔ ÛÂ ‚Ú¤ÊË ËÏÈÎ›·˜ ÌÈÎÚfiÙÂÚË˜

ÙÔ˘ ¤ÙÔ˘˜, Èı·ÓfiÙ·Ù· ÏfiÁˆ ÙË˜ ÌÂÈˆÌ¤ÓË˜ ·Ú·-

ÁˆÁ‹˜ ·ÓÙÈÛˆÌ¿ÙˆÓ ÛÙÔÓ ÚÒÙÔ ¯ÚfiÓÔ ÙË˜ ˙ˆ‹˜.

∞ÛıÂÓÂ›˜ ÌÂ √ª∞ ¤¯Ô˘Ó ÓÂ˘ÚÔ‚Ï¿ÛÙˆÌ· Â˘ÓÔ˚-

Î‹˜ ÈÛÙÔ·ıÔÏÔÁ›·˜ Î·È ‰ÂÓ ÂÌÊ·Ó›˙Ô˘Ó ÂÓ›Û¯˘ÛË

ÙÔ˘ ÔÁÎÔÁÔÓ›‰ÈÔ˘ N-myc, ÁÂÁÔÓfi˜ Ô˘ ‰È·ÈÛÙÒıË-

ÎÂ Î·È ÛÙËÓ ÂÚ›ÙˆÛË ÙÔ˘ ·ÛıÂÓ‹ ÙË˜ ·ÚÔ‡Û·˜

ÂÚ›ÙˆÛË˜. ∏ ÏÂÈÔ„ËÊ›· ÙÔ˘˜ ÂÌÊ·Ó›˙ÂÙ·È ÌÂ ÌË

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

¶·È‰È·ÙÚÈÎ‹ 2007;70:227-231

∂ÈÎfiÓ· 2. ∂ÁÎ¿ÚÛÈ· ÙÔÌ‹ Ì·ÁÓËÙÈÎ‹˜ ÙÔÌÔÁÚ·Ê›·˜, fiÔ˘ ‰È·-ÎÚ›ÓÂÙ·È Ë Ù˘ÈÎ‹ ·Ú·ÛÔÓ‰˘ÏÈÎ‹ ı¤ÛË ÙÔ˘ ·ıÔÏÔÁÈÎÔ‡ÈÛÙÔ‡ (‚¤ÏÔ˜).

∂ÈÎfiÓ· 1. ¶·Ú·Ô‚ÂÏÈ·›· ÙÔÌ‹ Ì·ÁÓËÙÈÎ‹˜ ÙÔÌÔÁÚ·Ê›·˜, fiÔ˘‰È·ÎÚ›ÓÂÙ·È ·ÙÚ·ÎÙÔÂÈ‰‹˜ ÈÛÙfi˜ (‚¤ÏÔ˜) Û·ÊÒÓ ÔÚ›ˆÓ Î·È ·ıÔ-ÏÔÁÈÎÔ‡ Û‹Ì·ÙÔ˜.


ÌÂÙ·ÛÙ·ÙÈÎ‹ ÓfiÛÔ, ÛÂ ·ÓÙ›ıÂÛË ÌÂ ·ÛıÂÓÂ›˜ ÌÂ ÓÂ˘-

ÚÔ‚Ï¿ÛÙˆÌ· ËÏÈÎ›·˜ ¿Óˆ ÙÔ˘ ¤ÙÔ˘˜ ¯ˆÚ›˜ √ª∞

Ô˘ Û˘¯Ó¿ ¿Û¯Ô˘Ó ·fi ÌÂÙ·ÛÙ·ÙÈÎ‹ ÓfiÛÔ Î·Ù¿ ÙË

‰È¿ÁÓˆÛË. ∞ÎfiÌ· fiÌˆ˜ Î·È ÁÈ· ÓfiÛÔ ÙÔ˘ È‰›Ô˘ ÛÙ·-

‰›Ô˘, ÔÈ ·ÛıÂÓÂ›˜ ÌÂ ÓÂ˘ÚÔ‚Ï¿ÛÙˆÌ· Î·È √ª∞

¤¯Ô˘Ó Î·Ï‡ÙÂÚË ÚfiÁÓˆÛË. ŒÙÛÈ, Ë ÙÚÈÂÙ‹˜ ÂÈ‚›ˆ-

ÛË ·ÛıÂÓÒÓ ËÏÈÎ›·˜ ¿Óˆ ÙÔ˘ ¤ÙÔ˘˜ ÌÂ ÌË ÌÂÙ·ÛÙ·-

ÙÈÎfi ÓÂ˘ÚÔ‚Ï¿ÛÙˆÌ· ÛÙ·‰›ˆÓ π, ππ Î·È πππ Î·È √ª∞

Â›Ó·È 100% ¤Ó·ÓÙÈ 77% ·˘Ù‹˜ ·ÚfiÌÔÈˆÓ ·ÛıÂÓÒÓ

·ÏÏ¿ ¯ˆÚ›˜ √ª∞ (9).

¶·Ú’ fiÏÔ Ô˘ ÔÈ ·ÛıÂÓÂ›˜ ÌÂ ÓÂ˘ÚÔ‚Ï¿ÛÙˆÌ·

Î·È Û‡Ó‰ÚÔÌÔ √ª∞ ¤¯Ô˘Ó ¿ÚÈÛÙË Ì·ÎÚÔ¯ÚfiÓÈ·

ÂÈ‚›ˆÛË, Û˘¯Ó¿ ÂÌÊ·Ó›˙Ô˘Ó Â›ÌÔÓ· ÓÂ˘ÚÔÏÔÁÈÎ¿

Û˘ÌÙÒÌ·Ù· Î·È ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ ¿Û¯Ô˘Ó ·fi Ì·-

ÎÚÔ¯ÚfiÓÈ· Â›ÌÔÓË ÎÈÓËÙÈÎ‹ (ÚÔ¤¯ÔÓ Û‡ÌÙˆÌ·)

Î·È ÓÔËÙÈÎ‹ Î·ı˘ÛÙ¤ÚËÛË, Î·ı˘ÛÙ¤ÚËÛË ÏfiÁÔ˘ Î·È

ÚÔ‚Ï‹Ì·Ù· Û˘ÌÂÚÈÊÔÚ¿˜ (2-4,9,10). ∞Í›˙ÂÈ Ó·

ÛËÌÂÈˆıÂ› fiÙÈ ‰ÂÓ ˘¿Ú¯ÂÈ Û˘Û¯ÂÙÈÛÌfi˜ ÌÂÙ·Í‡ ÙË˜

‰È¿ÚÎÂÈ·˜ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ OM∞

ÚÈÓ ·fi ÙË ‰È¿ÁÓˆÛË ÙÔ˘ ÓÂ˘ÚÔ‚Ï·ÛÙÒÌ·ÙÔ˜ Î·È

ÙË˜ ÓÂ˘ÚÔÏÔÁÈÎ‹˜ ÂÍ¤ÏÈÍË˜ ÙˆÓ ·ÛıÂÓÒÓ (9).

™¯Â‰fiÓ fiÏ· Ù· ·È‰È¿ ÌÂ √ª∞ ··ÈÙÔ‡Ó ·Ú·-

ÙÂÙ·Ì¤ÓË ·ÓÔÛÔÎ·Ù·ÛÙ·ÏÙÈÎ‹ Î·È ·ÓÔÛÔÙÚÔÔÔÈ-

ËÙÈÎ‹ ıÂÚ·Â›· ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô ÙˆÓ ÓÂ˘ÚÔÏÔÁÈÎÒÓ

ÂÎ‰ËÏÒÛÂˆÓ (2-4,8-12). ∏ ıÂÚ·Â˘ÙÈÎ‹ ·ÓÙÈÌÂÙÒ-

ÈÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ÂÚÈÏ·Ì‚¿ÓÂÈ ¯ÔÚ‹ÁËÛË ÎÔÚ-

ÙÈÎÔÛÙÂÚÔÂÈ‰ÒÓ, ÎÔÚÙÈÎÔÙÚÔ›ÓË˜ (ACTH), ÂÓ‰Ô-

ÊÏ¤‚È·˜ Á-ÛÊ·ÈÚ›ÓË˜, Ï·ÛÌ·Ê·›ÚÂÛË Î·È ·ÓÔÛÔ-

Î·Ù·ÛÙ·ÏÙÈÎ‹ ¯ËÌÂÈÔıÂÚ·Â›·. ªÂÁ¿ÏÔ ÔÛÔÛÙfi

·ÛıÂÓÒÓ ÌÔÚÂ› Ó· ·ÓÙ·ÔÎÚÈıÂ› ÛÙËÓ ·Ú¯ÈÎ‹ ıÂ-

Ú·Â›· ÌÂ ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹ ‹ ACTH. ∏ ·Ú¯ÈÎ‹,

fiÌˆ˜, ·¿ÓÙËÛË ‰ÂÓ Û˘Û¯ÂÙ›˙ÂÙ·È ÌÂ ÏÈÁfiÙÂÚ·

·ÒÙÂÚ· ÓÂ˘ÚÔÏÔÁÈÎ¿ Û˘ÌÙÒÌ·Ù· Î·È Ë ÏÂÈÔ„Ë-

Ê›· ÙˆÓ ·ÛıÂÓÒÓ ÂÌÊ·Ó›˙ÂÈ ˘ÔÙÚÔ¤˜ ÛÙË Ê¿ÛË

ÙË˜ ÛÙ·‰È·Î‹˜ ÌÂ›ˆÛË˜ Ùo˘ Ê·ÚÌ¿ÎÔ˘ (9). ¶ÔÏ‡

Û˘¯Ó‹ Â›Ó·È Î·È Ë ÂÌÊ¿ÓÈÛË ·ÚÂÁÎÂÊ·ÏÈ‰ÈÎ‹˜

·ÙÚÔÊ›·˜ ¯ˆÚ›˜ ¿ÏÏ· ˘ÂÚÛÎËÓÈ‰È·Î¿ ·ÂÈÎÔÓÈÛÙÈ-

Î¿ Â˘Ú‹Ì·Ù· ÛÂ ·ÛıÂÓÂ›˜ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó ÌÂ Ì·-

ÁÓËÙÈÎ‹ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ (4).

∏ ¯ÔÚ‹ÁËÛË ÂÓ‰ÔÊÏ¤‚È·˜ Á-ÛÊ·ÈÚ›ÓË˜ ‚ÂÏÙÈÒÓÂÈ

Ù· Û˘ÌÙÒÌ·Ù·, Èı·ÓfiÓ ÏfiÁˆ ÌÂ›ˆÛË˜ ·Ú·ÁˆÁ‹˜

·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ Î·È ·ÚÂÌfi‰ÈÛË˜ ÙË˜ ‰Ú¿ÛË˜

ÙÔ˘˜. ∆· ·È‰È¿ ÌÂ ÓÂ˘ÚÔ‚Ï¿ÛÙˆÌ· Î·È √ª∞ Ô˘

¤Ï·‚·Ó ·ÓÔÛÔÙÚÔÔÔÈËÙÈÎ‹ ¯ËÌÂÈÔıÂÚ·Â›· Ê·›-

ÓÂÙ·È Â›ÛË˜ Ó· ¤¯Ô˘Ó Î·Ï‡ÙÂÚË ÓÂ˘ÚÔÏÔÁÈÎ‹

¤Î‚·ÛË ÏfiÁˆ ÙË˜ ÌÂ›ˆÛË˜ ·Ú·ÁˆÁ‹˜ ·˘ÙÔ·ÓÙÈÛˆ-

Ì¿ÙˆÓ Ô˘ ÚÔÎ·ÏÂ› Ë ¯ËÌÂÈÔıÂÚ·Â›· (9). ∂Óı·Ú-

Ú˘ÓÙÈÎ¿ ·ÔÙÂÏ¤ÛÌ·Ù· ·Ó·Ê¤ÚÔÓÙ·È ÙÂÏÂ˘Ù·›· ÌÂ

ÙË ¯Ú‹ÛË ÙÔ˘ ·ÓÙÈ-CD20 ¯ÂÈÌÂÚÈÎÔ‡ ÌÔÓÔÎÏoÓÈÎÔ‡

·ÓÙÈÛÒÌ·ÙÔ˜ ÚÈÙÔ˘ÍÈÌ¿ÌË, ÙÔ ÔÔ›Ô ÛÙÚ¤ÊÂÙ·È

Î·Ù¿ ÙˆÓ CD20+ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ Ô˘ ÂÓ¤¯ÔÓÙ·È

ÛÙËÓ ·ÈÙÈÔ·ıÔÁ¤ÓÂÈ· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ (11,12). √È

Pranzatelli Î·È Û˘ÓÂÚÁ¿ÙÂ˜ ÌÂÏ¤ÙËÛ·Ó ÙÈ˜ ·ÓÔÛÔÏÔ-

ÁÈÎ¤˜ ·ÓÙÈ‰Ú¿ÛÂÈ˜ ÛÙÔ ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚfi (∂¡À)36 ·È‰ÈÒÓ ÌÂ √ª∞ (16 ·Ú·ÓÂÔÏ·ÛÌ·ÙÈÎ‹˜ ·È-ÙÈÔÏÔÁ›·˜ Î·È 20 ÌË Û˘Û¯ÂÙÈ˙fiÌÂÓÔ ÌÂ fiÁÎÔ˘˜) Î·È18 Ì¿ÚÙ˘ÚÂ˜ ÌÂ ‰È¿ÊÔÚ· ÌÔÓÔÎÏoÓÈÎ¿ ·ÓÙÈÛÒÌ·Ù·Î·ıÔÚÈÛÌÔ‡ ˘ÔÏËı˘ÛÌÒÓ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ. ¶·Ú’fiÏÔ Ô˘ ‰ÂÓ ·Ú·ÙËÚ‹ıËÎÂ ÏÂÈÔÎ‡ÙÙˆÛË ÛÙÔ∂¡À, ‚Ú¤ıËÎÂ ‰È·Ù·Ú·¯‹ ÛÙÔ˘˜ ˘ÔÏËı˘ÛÌÔ‡˜ÙˆÓ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ. ∂Ó‰È·Ê¤ÚÔÓ Â›Ó·È ÙÔ ÁÂÁÔÓfi˜fiÙÈ ÛÂ Ù˘ÊÏ‹ - ˆ˜ ÚÔ˜ Ù· Â˘Ú‹Ì·Ù· ÙÔ˘ ∂¡À - Î·-Ù·ÁÚ·Ê‹ ÙˆÓ ÓÂ˘ÚÔÏÔÁÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ ÌÂ ‚›ÓÙÂÔ,Ù· Â˘Ú‹Ì·Ù· ÙÔ˘ ∂¡À Û˘Û¯ÂÙ›˙ÔÓÙ·Ó ÌÂ ÙÈ˜ ÓÂ˘ÚÔ-ÏÔÁÈÎ¤˜ ‰È·Ù·Ú·¯¤˜ ÙˆÓ ·ÛıÂÓÒÓ (12).

™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, fiÛÔÓ ·ÊÔÚ¿ ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ÌÂ ÓÂ˘ÚÔ‚Ï¿ÛÙˆÌ· Î·È √ª∞: ·) Ë ÏÂÈÔ„ËÊ›·(62%) ·ÚÔ˘ÛÈ¿˙ÂÙ·È Î·È ÌÂ Ù· 3 Û˘ÌÙÒÌ·Ù· ÙÔ˘Û˘Ó‰ÚfiÌÔ˘, ‚) ÔÈ ·ÛıÂÓÂ›˜ Â›Ó·È Û˘Ó‹ıˆ˜ ÛÙ·‰›Ô˘ πÎ·È ππ, Á) ¤¯Ô˘Ó Â˘ÓÔ˚Î‹ ÈÛÙÔ·ıÔÏÔÁ›·, ‰) Û¿ÓÈ·¤¯Ô˘Ó ÂÓ›Û¯˘ÛË ÙÔ˘ ÔÁÎÔÁÔÓÈ‰›Ô˘ ¡-myc, Â) ÔÛÔ-ÛÙfi 70-80% ¤¯ÂÈ Ì·ÎÚÔÚfiıÂÛÌ· ÓÂ˘ÚÔÏÔÁÈÎ¿ ÂÏ-ÏÂ›ÌÌ·Ù· Î·È ÛËÌ·ÓÙÈÎÔ‡ ‚·ıÌÔ‡ „˘¯ÔÎÈÓËÙÈÎ‹Î·ı˘ÛÙ¤ÚËÛË Î·È ÛÙ) Ë ÂÍ·ÙÔÌÈÎÂ˘Ì¤ÓË ·ÓÙÈÌÂÙÒ-ÈÛË ÌÂ ·ÓÔÛÔÎ·Ù·ÛÙ·ÏÙÈÎ¤˜ ıÂÚ·Â›Â˜ ‰ÂÓ Ô‰ËÁÂ›ÛÂ ÈÎ·ÓÔÔÈËÙÈÎ¿ ·ÔÙÂÏ¤ÛÌ·Ù· ÛÙËÓ ÏÂÈÔ„ËÊ›·ÙˆÓ ÂÚÈÙÒÛÂˆÓ.


1. Castleberry RP, Pritchard J, Ambros P, Berthold F,Brodeur GM, Castel V et al. The International Neurob-lastoma Risk Groups (INRG): a preliminary report. Eur JCancer 1997;33:2113-2116.

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

3. Mitchell WG, Brumm VL, Azen CG, Patterson KE, AllerSK, Rodriguez J. Longitudinal neurodevelopmental eval-uation of children with opsoclonus-ataxia. Pediatrics2005;116:901-907.

4. Hayward K, Jeremy RJ, Jenkins S, Barkovich AJ, GultekinSH, Kramer J et al. Long-term neurobehavioral outcomesin children with neuroblastoma and opsoclonus-my-oclonus-ataxia syndrome: relationship to MRI findingsand anti-neuronal antibodies. J Pediatr 2001;139:552-559.

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

6. Araga S, Nakashima K. Neurologic signs and symptomsin viral infections - disease involving meninges, centralnervous system or peripheral nerve system. Nippon Rin-sho 1997;55:805-808.

7. ∞ntunes NL, Khakoo Y, Matthay KK, Seeger RC, StramDO, Gerstner E et al. Antineuronal antibodies in patientswith neuroblastoma and paraneoplastic opsoclonus-my-oclonus. J Pediatr Hematol Oncol 2000;22:315-320.

8. Cooper R, Khakoo Y, Matthay KK, Lukens JN, SeegerRC, Stram DO et al. Opsoclonus-myoclonus-ataxia syn-drome in neuroblastoma: histopathologic features - a re-port from the Children’s Cancer Group. Med PediatrOncol 2001;36:623-629.

230 ¡. ∫·Ù˙ËÏ¿ÎË˜ Î·È Û˘Ó.



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

¶·È‰È·ÙÚÈÎ‹ 2007;70:227-231

9. Rudnick E, Khakoo Y, Antunes NL, Seeger RC, BrodeurGM, Shimada H et al. Opsoclonus-myoclonus-ataxiasyndrome in neuroblastoma: clinical outcome and anti-neuronal antibodies-a report from the Children’s CancerGroup Study. Med Pediatr Oncol 2001;36:612-622.

10. Tate ED, Allison TJ, Pranzatelli MR, Verhulst SJ. Neuro-epidemiologic trends in 105 US cases of pediatric opso-clonus-myoclonus syndrome. J Pediatr Oncol Nurs2005;22:8-19.

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

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


232 ∂¡¢π∞º∂ƒ√À™∞ ¶∂ƒπ¶∆ø™∏ CASE REPORT


µÚ¤ÊÔ˜ ÌÂ ·˘ÙÔ¿ÓÔÛË Ô˘‰ÂÙÂÚÔÂÓ›·

º. ™ÙÚÈ¤ÏË1, π. ¶. ¶·Ó·ÁÈÒÙÔ˘1, ∂. ¢ËÌËÙÚ›Ô˘1, ∂. ∫ÔÂÌÙ˙›‰Ô˘1, £. ∞Ó·ÛÙ·Û›Ô˘2, ∞. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜1

¶ÂÚ›ÏË„Ë: ∏ ·˘ÙÔ¿ÓÔÛË Ô˘‰ÂÙÂÚÔÂÓ›· ÙˆÓ ‚ÚÂÊÒÓ Â›Ó·È Ë ÈÔ Û˘¯Ó‹ ÌÔÚÊ‹ ̄ ÚfiÓÈ·˜ Ô˘‰ÂÙÂÚÔÂÓ›·˜ÛÙ· ·È‰È¿. √ÊÂ›ÏÂÙ·È ÛÙËÓ ·ÚÔ˘Û›· ·ÓÙÈÔ˘‰ÂÙÂÚÔÊÈÏÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ, Ù· ÔÔ›· ÛÙÚ¤ÊÔÓÙ·È Î·Ù¿Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ·ÓÙÈÁfiÓˆÓ ÙË˜ ÂÈÊ¿ÓÂÈ·˜ ÙˆÓ Ô˘‰ÂÙÂÚfiÊÈÏˆÓ ÔÏ˘ÌÔÚÊÔ‡ÚËÓˆÓ. ∏ ‰È¿ÁÓˆÛ‹ ÙË˜Û˘¯Ó¿ ‰È·ÊÂ‡ÁÂÈ, Î·ıÒ˜ Ë ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· ÙË˜ ÓfiÛÔ˘ Â›Ó·È Û˘Ó‹ıˆ˜ ‹È·. ¶ÂÚÈÁÚ¿ÊÂÙ·È ‚Ú¤ÊÔ˜ ËÏÈÎ›·˜9,5 ÌËÓÒÓ ÌÂ ÈÛÙÔÚÈÎfi Û˘¯ÓÒÓ ÏÔÈÌÒÍÂˆÓ ·fi ÙËÓ ËÏÈÎ›· ÙˆÓ ÙÚÈÒÓ ÌËÓÒÓ, Ô˘ ·ÚÔ˘Û›·ÛÂ ÂÌ‡ÚÂÙËÛ˘Ó‰ÚÔÌ‹, ¤ÏÎË ÛÙÔÌ·ÙÈÎ‹˜ ÎÔÈÏfiÙËÙ·˜ Î·È ·Ú¯fiÌÂÓÔ ÂÚÈÂ‰ÚÈÎfi ·fiÛÙËÌ·. ¢È·ÁÓÒÛıËÎÂ Ô˘‰ÂÙÂÚÔÂ-Ó›· ¯ˆÚ›˜ ¿ÏÏÂ˜ ‰È·Ù·Ú·¯¤˜ ÛÂ Â›Â‰Ô ¯˘ÌÈÎ‹˜ ‹ Î˘ÙÙ·ÚÈÎ‹˜ ·ÓÔÛ›·˜. ∏ ·ÓÂ‡ÚÂÛË ·ÓÙÈÛˆÌ¿ÙˆÓ Î·Ù¿ÙˆÓ Ô˘‰ÂÙÂÚfiÊÈÏˆÓ ÔÏ˘ÌÔÚÊÔ‡ÚËÓˆÓ ÛÂ ÂÚÁ·ÛÙ‹ÚÈÔ ÙÔ˘ ÂÍˆÙÂÚÈÎÔ‡ ¤ıÂÛÂ ÙË ‰È¿ÁÓˆÛË ÙË˜ ·˘ÙÔ-¿ÓÔÛË˜ Ô˘‰ÂÙÂÚÔÂÓ›·˜. ÃÔÚËÁ‹ıËÎÂ ‰‡Ô ÊÔÚ¤˜ ·˘ÍËÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÙˆÓ ÎÔÎÎÈÔÎ˘ÙÙ¿ÚˆÓ ÌÂ ÈÎ·ÓÔ-ÔÈËÙÈÎ¿ ·ÔÙÂÏ¤ÛÌ·Ù·. ∏ ÂÚ·ÈÙ¤Úˆ ÔÚÂ›· ÙÔ˘ ·ÛıÂÓÔ‡˜ ‹Ù·Ó Î·Ï‹, ·Ú¿ ÙËÓ ÂÈÌ¤ÓÔ˘Û· Ô˘‰ÂÙÂ-ÚÔÂÓ›·.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ∞˘ÙÔ¿ÓÔÛË Ô˘‰ÂÙÂÚÔÂÓ›·, ‚Ú¤ÊË, ‰È¿ÁÓˆÛË, ıÂÚ·Â›·.

An infant with autoimmune neutropenia

F. Stripeli1, J. P. Panagiotou1, E. Dimitriou1, E. Koemzidou1, T. Anastasiou2, A. Constantopoulos1

Abstract: Autoimmune neutropenia of infancy, which is the most common cause of chronic neutropeniain childhood, is characterised by the presence of antineutrophil antibodies against specific neutrophilmembrane antigens. The diagnosis of autoimmune neutropenia is often missed because the clinicalfindings are frequently mild. A case of a 9.5 month-old male infant with a history of recurrent infections isdescribed, who presented with fever, mouth ulcers and perianal abscess. Initial laboratory evaluationrevealed neutropenia with no evidence of humoral or cellular immunodeficiency. Detection ofantineutrophil antibodies established the diagnosis of autoimmune neutropenia. The administration ofgranulocyte-colony stimulating factor was effective. The clinical course of the patient was uncomplicated,despite persisting neutropenia.

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

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

2 ∞ÈÌ·ÙÔÏÔÁÈÎfi ∆Ì‹Ì·,¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ∞ıËÓÒÓ “¶. Î·È ∞. ∫˘ÚÈ·ÎÔ‡”


ºˆÙÂÈÓ‹ ™ÙÚÈ¤ÏË [email protected] ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ ∞ıËÓÒÓ “¶. Î·È ∞. ∫˘ÚÈ·ÎÔ‡”£Ë‚ÒÓ Î·È §Â‚·‰Â›·˜, ∆.∫. 115 27, ∞ı‹Ó·

1 2nd Paediatric Clinic,Kapodistrian University of Athens, “P and A. Kyriakou”Children’s Hospital

2 Haematology Laboratory,“P and A. Kyriakou”Children’s Hospital

Correspondence:

Fotini [email protected] “P. and A. Kyriakou” Children’s Hospital Thivon & Levadias, 115 27 Athens

∂ÈÛ·ÁˆÁ‹

ªÂ ÙÔÓ fiÚÔ Ô˘‰ÂÙÂÚÔÂÓ›· ÚÔÛ‰ÈÔÚ›˙ÂÙ·È

Ë ÌÂ›ˆÛË ÙÔ˘ ·fiÏ˘ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ Ô˘‰ÂÙÂ-

ÚfiÊÈÏˆÓ ÔÏ˘ÌÔÚÊÔ‡ÚËÓˆÓ (∞∞√¶) Î¿Ùˆ

·fi Ù· 1500/ÌL, ÁÈ· ËÏÈÎ›Â˜ ÌÂÁ·Ï‡ÙÂÚÂ˜ ÙÔ˘

ÂÓfi˜ ¤ÙÔ˘˜. ™Ù· ‚Ú¤ÊË ˆ˜ Î·ÙÒÙÂÚË ÙÈÌ‹ ıÂˆ-

ÚÂ›Ù·È ·˘Ù‹ ÙˆÓ 1000/mL, ‰Â‰ÔÌ¤ÓÔ Ô˘ Ú¤-

ÂÈ Ó· Â›Ó·È ÁÓˆÛÙfi ÚÔÎÂÈÌ¤ÓÔ˘ Ó· ·ÔÊÂ‡-

ÁÂÙ·È Ë ˘ÂÚ‰È¿ÁÓˆÛË (1). ∏ Ô˘‰ÂÙÂÚÔÂÓ›·

·ÔÙÂÏÂ› Û˘¯Ófi ·ÈÌ·ÙÔÏÔÁÈÎfi Â‡ÚËÌ· ÙË˜

·È‰ÈÎ‹˜ ËÏÈÎ›·˜, Û˘Ó‹ıˆ˜ Û˘ÓÔ‰Â‡ÂÈ ÈÔÁÂÓÂ›˜

ÏÔÈÌÒÍÂÈ˜ Î·È ¤¯ÂÈ ·ÚÔ‰ÈÎfi ¯·Ú·ÎÙ‹Ú·. ∞Ó¿-

ÏÔÁ· ÌÂ ÙË ¯ÚÔÓÈÎ‹ ‰È¿ÚÎÂÈ· ‰È·ÎÚ›ÓÂÙ·È ÛÂ

ÔÍÂ›· Î·È ¯ÚfiÓÈ·, ·Ó Ë ‰È¿ÁÓˆÛË ¤¯ÂÈ ÙÂıÂ› ÛÂ

ÌÈÎÚfiÙÂÚÔ ‹ ÌÂÁ·Ï‡ÙÂÚÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·

·fi ¤ÍÈ Ì‹ÓÂ˜. ™ÙËÓ ÂÚ›ÙˆÛË Ô˘ Ë ÓfiÛÔ˜

‰È·ÚÎÂ› ÁÈ· ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÌÂÁ·Ï‡ÙÂÚÔ ·fi

¤ÍÈ Ì‹ÓÂ˜ Ú¤ÂÈ Ó· ·Ó·˙ËÙËıÂ› Ë ·ÈÙ›· Ô˘

ÙËÓ ÚÔÎ¿ÏÂÛÂ.

∏ ·˘ÙÔ¿ÓÔÛË Ô˘‰ÂÙÂÚÔÂÓ›· ·ÔÙÂÏÂ› Ù‡-

Ô ¯ÚfiÓÈ·˜ Ô˘‰ÂÙÂÚÔÂÓ›·˜, Ë ÔÔ›· ‰È·ÎÚ›ÓÂ-

Ù·È ÛÂ ‰‡Ô ˘ÔÔÌ¿‰Â˜: ·) ÛÙËÓ ÚˆÙÔ·ı‹,

fiÔ˘ Ë Ô˘‰ÂÙÂÚÔÂÓ›· ·ÔÙÂÏÂ› ÌÔÓ·‰ÈÎ‹ ·È-

Ì·ÙÔÏÔÁÈÎ‹ ‰È·Ù·Ú·¯‹ ¯ˆÚ›˜ Ó· Û˘Ó˘¿Ú¯ÂÈ ÌÂ

¿ÏÏÔ ÓfiÛËÌ· Î·È ‚) ÛÙË ‰Â˘ÙÂÚÔ·ı‹, fiÔ˘ Ë

Ô˘‰ÂÙÂÚÔÂÓ›· ÂÎ‰ËÏÒÓÂÙ·È ÛÙÔ Ï·›ÛÈÔ Û˘-

ÛÙËÌ·ÙÈÎÔ‡ ·˘ÙÔ¿ÓÔÛÔ˘ ÓÔÛ‹Ì·ÙÔ˜ ‹ Û˘Û¯ÂÙ›-

˙ÂÙ·È ÌÂ ÏÂÌÊÔ¸ÂÚÏ·ÛÙÈÎfi ÓfiÛËÌ· (2). ∏

ÚˆÙÔ·ı‹˜ ·˘ÙÔ¿ÓÔÛË Ô˘‰ÂÙÂÚÔÂÓ›· ·Ô-

ÙÂÏÂ› ÙË Û˘¯ÓfiÙÂÚË ·ÈÙ›· ÙË˜ ¯ÚfiÓÈ·˜ Ô˘‰ÂÙÂ-

ÚÔÂÓ›·˜. √ÊÂ›ÏÂÙ·È ÛÙËÓ ·ÚÔ˘Û›· ·ÓÙÈÔ˘‰Â-

ÙÂÚÔÊÈÏÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ (∞√∞), Ù· ÔÔ›·

ÛÙÚ¤ÊÔÓÙ·È Î·Ù¿ Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ·ÓÙÈÁfiÓˆÓ

ÙË˜ ÂÈÊ¿ÓÂÈ·˜ ÙˆÓ Ô˘‰ÂÙÂÚfiÊÈÏˆÓ ÔÏ˘ÌÔÚ-

ÊÔ‡ÚËÓˆÓ (3-5). ∏ ‰È¿ÁÓˆÛË ÙË˜ ·˘ÙÔ¿ÓÔÛË˜

Ô˘‰ÂÙÂÚÔÂÓ›·˜, fiÌˆ˜, Û˘¯Ó¿ ‰È·ÊÂ‡ÁÂÈ ÁÈ·Ù› Ë

ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· ÙË˜ ÓfiÛÔ˘ Â›Ó·È ‹È· Î·È ÂÔÌ¤-

Óˆ˜ ‰ÂÓ ·Ó·˙ËÙÂ›Ù·È.


¶ÂÚÈÁÚ·Ê‹ ÂÚÈÛÙ·ÙÈÎÔ‡

ÕÚÚÂÓ ‚Ú¤ÊÔ˜ 9,5 ÌËÓÒÓ ÚÔÛ‹ÏıÂ ÛÙ· ÂÍˆÙÂÚÈ-

Î¿ È·ÙÚÂ›· ÙË˜ ÎÏÈÓÈÎ‹˜ Ì·˜ ÏfiÁˆ ÂÌ‡ÚÂÙË˜ Û˘Ó-

‰ÚÔÌ‹˜ ‰È¿ÚÎÂÈ·˜ 4 ËÌÂÚÒÓ. ¢‡Ô ËÌ¤ÚÂ˜ ÚÈÓ ÙËÓ

ÂÈÛ·ÁˆÁ‹ ÙÔ˘ Â›¯Â ÂÌÊ·Ó›ÛÂÈ ¤ÏÎË ÛÙÔÌ·ÙÈÎ‹˜ ÎÔÈ-

ÏfiÙËÙ·˜ Î·È ·Ú¯fiÌÂÓÔ ÂÚÈÂ‰ÚÈÎfi ·fiÛÙËÌ·. ™ÙÔ

ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ·Ó·Ê¤ÚÂÙ·È ÌÂÁ·Ï‡ÙÂÚË

·‰ÂÏÊ‹ ÌÂ ÂÙÂÚÔ˙˘ÁˆÙÈÛÌfi ‚-ÌÂÛÔÁÂÈ·Î‹˜ ·Ó·È-

Ì›·˜. ∞fi ÙÔ ·ÙÔÌÈÎfi ÈÛÙÔÚÈÎfi ÛËÌÂÈÒÓÔÓÙ·È: ·) Û˘-

¯Ó¿ ÂÂÈÛfi‰È· ÛÙÔÌ·Ù›ÙÈ‰·˜ ·fi ÙË Á¤ÓÓËÛË, ‚) Î‡-

ÛÙÂ˜ ·Ó·ÙÔÏ‹˜, Á) ÂÂÈÛfi‰ÈÔ ÔÍÂ›·˜ Ì¤ÛË˜ ˆÙ›ÙÈ‰·˜,

‰) ÚÔÛ‚ÔÏ‹ ·fi ÎÔÎÎ‡ÙË Î·È ·ÓÂÌÂ˘ÏÔÁÈ¿ ÛÂ ËÏÈ-

Î›· 3 Î·È 4 ÌËÓÒÓ ·ÓÙ›ÛÙÔÈ¯·. ∆ÔÓ›˙ÂÙ·È fiÙÈ ÛÙÔ ÈÛÙÔ-

ÚÈÎfi ÙÔ˘ ·È‰ÈÔ‡ ‰ÂÓ ·Ó·Ê¤ÚÂÙ·È ÚÔËÁÔ‡ÌÂÓÔ˜ ÂÚ-

Á·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜. ∫·Ù¿ ÙËÓ Â›ÛÔ‰fi ÙÔ˘ ÂÌÊ¿ÓÈ-

˙Â ˆ¯ÚfiÙËÙ· ‰¤ÚÌ·ÙÔ˜, ¿ÊıÂ˜ ÛÙË ÛÙÔÌ·ÙÈÎ‹ ÎÔÈÏfi-

ÙËÙ· Î·È ÂÚÈÂ‰ÚÈÎfi ·fiÛÙËÌ·. ∏ ÛˆÌ·ÙÈÎ‹ ·Ó¿-

Ù˘ÍË ÙÔ˘ ·È‰ÈÔ‡ ‹Ù·Ó ¿ÚÈÛÙË. ™ÙË ÁÂÓÈÎ‹ ·›Ì·ÙÔ˜

‚Ú¤ıËÎÂ ∞∞√¶ 265/mL Î·È ÙÔ ‚Ú¤ÊÔ˜ ÂÈÛ‹¯ıË ÚÔ˜

ÂÚ·ÈÙ¤Úˆ ¤ÏÂÁ¯Ô Î·È ıÂÚ·Â›·.

∞fi ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô ÛËÌÂÈÒÓÔÓÙ·È Ù·

Î¿ÙˆıÈ:

1) °ÂÓÈÎ‹ ·›Ì·ÙÔ˜: Hb=8,8 g/dl, Ht=27,7%,

MCV=56,2 fl, RDW=21,7%, ÏÂ˘Î¿ ·ÈÌÔÛÊ·›-

ÚÈ·=5300/mL (ÔÏ˘ÌÔÚÊÔ‡ÚËÓ·: 5%, ÏÂÌÊÔÎ‡ÙÙ·-

Ú·: 59%, ÌÔÓÔÎ‡ÙÙ·Ú·: 35%), ·ÈÌÔÂÙ¿ÏÈ·=

278000/mL, ¢∂∫=0,85%. ™ÙÔ Â›¯ÚÈÛÌ· ·›Ì·ÙÔ˜ ‰È·-

ÈÛÙÒıËÎ·Ó ¤ÓÙÔÓÂ˜ ÌÔÚÊÔÏÔÁÈÎ¤˜ ·ÓˆÌ·Ï›Â˜ ÙˆÓ

ÂÚ˘ıÚÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ (·ÓÈÛÔÎ˘ÙÙ¿ÚˆÛË, ÌÈÎÚÔÎ˘Ù-

Ù¿ÚˆÛË, ˘Ô¯ÚˆÌ›·, ÔÈÎÈÏÔÎ˘ÙÙ¿ÚˆÛË) Û˘Ì‚·Ù¤˜

ÌÂ ÂÙÂÚÔ˙˘ÁˆÙÈÛÌfi ‚-ÌÂÛÔÁÂÈ·Î‹˜ ·Ó·ÈÌ›·˜.

2) ª˘ÂÏfiÁÚ·ÌÌ·: √ Ì˘ÂÏfi˜ ÙˆÓ ÔÛÙÒÓ ÂÌÊ¿ÓÈ˙Â

ÌÈÎÚÔ‡ ‚·ıÌÔ‡ ·Ó·ÛÙÔÏ‹ ˆÚ›Ì·ÓÛË˜ ÙË˜ ÎÔÎÎÈÒ-

‰Ô˘˜ ÛÂÈÚ¿˜ ÛÙÔ Â›Â‰Ô ÙÔ˘ Ú·‚‰Ô‡ÚËÓÔ˘ (ÛÙÚÔ-

Ê‹ ÚÔ˜ Ù· ·ÚÈÛÙÂÚ¿).

3) µÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ë·ÙÈÎ‹˜ Î·È ÓÂÊÚÈÎ‹˜

ÏÂÈÙÔ˘ÚÁ›·˜: ¯ˆÚ›˜ ·ıÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù·.

4) ŒÏÂÁ¯Ô˜ ‹ÍË˜: Ê˘ÛÈÔÏÔÁÈÎfi˜.

5) ∞ÓÔÛÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜: √È ·ÓÔÛÔÛÊ·ÈÚ›ÓÂ˜

Ì·˙› ÌÂ ÙÈ˜ ˘ÔÔÌ¿‰Â˜ ÙË˜ IgG, Ô ¤ÏÂÁ¯Ô˜ ÙÔ˘ Û˘-

ÌÏËÚÒÌ·ÙÔ˜ Î·È Ë Î˘ÙÙ·ÚÈÎ‹ ·ÓÔÛ›· ‹Ù·Ó ÂÓÙfi˜

Ê˘ÛÈÔÏÔÁÈÎÒÓ ÔÚ›ˆÓ.

6) √ÚÔÏÔÁÈÎ¤˜ ·ÓÙÈ‰Ú¿ÛÂÈ˜ ÁÈ· ÏÔ›ÌˆÍË ·fi

ÙÔ˘˜ ÈÔ‡˜ Epstein Barr (EBV), ÌÂÁ·ÏÔÎ˘ÙÙ·ÚÔ˚fi

(CMV), ÂÚ˘ıÚ¿˜, ¤ÚËÙ· 1, 2, 6, Coxsackie,

Parvovirus B19, Ë·Ù›ÙÈ‰·˜ µ, Ë·Ù›ÙÈ‰·˜ C Î·È ·Ó-

ıÚÒÈÓË˜ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·˜ (HIV), ‹Ù·Ó ·ÚÓËÙÈ-

Î¤˜. ∞ÓÙ›ÛÙÔÈ¯Ô˜ ¤ÏÂÁ¯Ô˜ ÁÈ· ÙÔ˘˜ ÈÔ‡˜ EBV, CMV,

ÂÚËÙÔ˚Ô‡˜-1/2 Î·È Parvovirus B19 ÌÂ ÙËÓ ÙÂ¯ÓÈÎ‹

ÙË˜ ·Ï˘ÛÈ‰ˆÙ‹˜ ·ÓÙ›‰Ú·ÛË˜ ÔÏ˘ÌÂÚ¿ÛË˜ ÛÂ ‰Â›Á-

Ì· Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ, ·¤‚Ë Â›ÛË˜ ·ÚÓËÙÈÎfi˜.

∆ËÓ 7Ë ËÌ¤Ú· ÙË˜ ÓÔÛËÏÂ›·˜ ·ÂÛÙ¿ÏË ÔÚfi˜ ÛÂ

ÂÍÂÈ‰ÈÎÂ˘Ì¤ÓÔ Î¤ÓÙÚÔ ÙÔ˘ ÂÍˆÙÂÚÈÎÔ‡ ÁÈ· ÙËÓ ·Ó›-

¯ÓÂ˘ÛË ÙˆÓ ∞√∞. ∆· ·ÓÙÈÛÒÌ·Ù· ÂÏ¤Á¯ıËÎ·Ó ÌÂ

ÙË Ì¤ıÔ‰Ô ·ÓÔÛÔÊıÔÚÈÛÌÔ‡ (GIFT) Î·È ÌÂ ÙË Ì¤-

ıÔ‰Ô ÙË˜ Û˘ÁÎfiÏÏËÛË˜ ÙˆÓ Ô˘‰ÂÙÂÚfiÊÈÏˆÓ (GAT).

ªÂ ÙË Ì¤ıÔ‰Ô GIFT ·ÓÈ¯ÓÂ‡ÙËÎ·Ó ÛÙÔÓ ÔÚfi ÙÔ˘

·ÛıÂÓÔ‡˜ ·ÓÙÈ-Ô˘‰ÂÙÂÚÔÊÈÏÈÎ¿ ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ

ÙÔ˘ ·ÓÙÈÁfiÓÔ˘ H¡∞1a ÙˆÓ Ô˘‰ÂÙÂÚfiÊÈÏˆÓ Î·È ¤ÙÛÈ

Ù¤ıËÎÂ Ë ‰È¿ÁÓˆÛË ÙË˜ ·˘ÙÔ¿ÓÔÛË˜ ‚ÚÂÊÈÎ‹˜ Ô˘-

‰ÂÙÂÚÔÂÓ›·˜.

∞fi ÙËÓ ÚÒÙË ËÌ¤Ú· ÓÔÛËÏÂ›·˜ ¯ÔÚËÁ‹ıËÎÂ

ÛÙÔ ‚Ú¤ÊÔ˜ ‰ÈÏ‹ ·ÓÙÈÌÈÎÚÔ‚È·Î‹ ·ÁˆÁ‹ (ÎÏÈÓ‰·Ì˘-

Î›ÓË Î·È ÓÂÙÈÏÌÈÎ›ÓË). ∆ËÓ 5Ë ËÌ¤Ú· ÙË˜ ÓÔÛËÏÂ›·˜,

¤ÁÈÓÂ ‰È¿ÓÔÈÍË Î·È ·ÚÔ¯¤ÙÂ˘ÛË ÙÔ˘ ·ÔÛÙ‹Ì·ÙÔ˜

Î·È ¯ÔÚËÁ‹ıËÎÂ ·˘ÍËÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÙˆÓ ÎÔÎÎÈÔ-

Î˘ÙÙ¿ÚˆÓ (G-CSF) ÌÂ ‰fiÛË 3 Ìg/kg/24ˆÚÔ. ∆¤ÛÛÂÚÈ˜

ËÌ¤ÚÂ˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË ÙÔ˘ G-CSF, Ô ∞∞√¶ ¤Êı·-

ÛÂ ÙÈ˜ 8900/mL Î·È ‰ÈÂÎfiË Ë ¯ÔÚ‹ÁËÛ‹ ÙÔ˘. ªÂ ‚¿-

ÛË ÙËÓ Î·ÏÏÈ¤ÚÁÂÈ· ÙÔ˘ ‡Ô˘ (∂. coli, Proteus mirabilis

Î·È Klebsiella pneumoniae ESBL) Î·È ÙÔ ·ÓÙÈ‚ÈfiÁÚ·Ì-

Ì· ¤ÁÈÓÂ ·ÓÙÈÎ·Ù¿ÛÙ·ÛË ÙË˜ ÎÏÈÓ‰·Ì˘Î›ÓË˜ ÌÂ Ù·˙Ô-

Ì·ÎÙ¿ÌË/ÈÂÚ·ÎÈÏÏ›ÓË. ∆Ô ‚Ú¤ÊÔ˜ ¤ÌÂÈÓÂ ÂÏÂ‡ıÂ-

ÚÔ Û˘ÌÙˆÌ¿ÙˆÓ ·fi ÙÔ ‰¤Î·ÙÔ 24ˆÚÔ ÙË˜ ÓÔÛËÏÂ›-

·˜ ÙÔ˘. ∫·Ù¿ ÙËÓ ¤ÍÔ‰Ô, ÙÔ‡ ¯ÔÚËÁ‹ıËÎÂ ¯ËÌÂÈÔÚÔ-

Ê‡Ï·ÍË ÌÂ ÙÚÈÌÂıÔÚ›ÌË/ ÛÔ˘ÏÊÔÌÂıÔÍ·˙fiÏË ÛÂ ‰Ô-

ÛÔÏÔÁÈÎfi Û¯‹Ì· 2 mg/kg/‰fiÛË Î¿ıÂ 12 ÒÚÂ˜ ÁÈ· ÙÚÂÈ˜

Û˘ÓÂ¯fiÌÂÓÂ˜ ËÌ¤ÚÂ˜ ÙË˜ Â‚‰ÔÌ¿‰·˜. ∂›ÛË˜, Û˘ÓÂ-

ÛÙ‹ıË ¤ÏÂÁ¯Ô˜ ÙÔ˘ ∞∞√¶ ÛÂ Î¿ıÂ ÂÌ‡ÚÂÙÔ ÂÂÈÛfi-

‰ÈÔ. ¢‡Ô Ì‹ÓÂ˜ ÌÂÙ¿ ÙËÓ ¤ÍÔ‰fi ÙÔ˘ ·fi ÙËÓ ÎÏÈÓÈÎ‹

Ì·˜ ÓÔÛËÏÂ‡ÙËÎÂ Î·È ¿ÏÈ, ÏfiÁˆ ÂÌ‡ÚÂÙË˜ Ô˘ÏÔ-

ÛÙÔÌ·Ù›ÙÈ‰·˜ ÌÂ ∞∞√¶ 535/mL. ¶·Ú·ÙËÚ‹ıËÎÂ Â›-

ÛË˜ ·˘ÍËÌ¤ÓË C-·ÓÙÈ‰ÚÒÛ· ÚˆÙÂ˝ÓË (189 mg/dl)

Î·È Ù·¯‡ÙËÙ· Î·ı›˙ËÛË˜ ÂÚ˘ıÚÒÓ (82 mm/h). ÃÔÚË-

Á‹ıËÎÂ ‰ÈÏ‹ ·ÓÙÈÌÈÎÚÔ‚È·Î‹ ·ÁˆÁ‹ (ÎÏÈÓ‰·Ì˘Î›ÓË

- ÓÂÙÈÏÌÈÎ›ÓË) ÁÈ· ¤ÓÙÂ ËÌ¤ÚÂ˜ Î·È G-CSF ÛÂ ‰fiÛË 3

Ìg/kg/24ˆÚÔ ÁÈ· ÙÚÂÈ˜ ËÌ¤ÚÂ˜ Î·È Ô ·ÛıÂÓ‹˜ ÂÍ‹ÏıÂ

ÛÂ ¿ÚÈÛÙË ÁÂÓÈÎ‹ Î·Ù¿ÛÙ·ÛË. ª¤¯ÚÈ ÙËÓ ËÏÈÎ›· ÙˆÓ

18 ÌËÓÒÓ Ù· Ô˘‰ÂÙÂÚfiÊÈÏ· ÂÍ·ÎÔÏÔ˘ıÔ‡Û·Ó Ó· Â›Ó·È

¯·ÌËÏ¿, ÏÈÁfiÙÂÚ· ·fi 1000/ÌL, ¯ˆÚ›˜ fiÌˆ˜ Ó· ·-

ÚÔ˘ÛÈ·ÛÙÔ‡Ó Ó¤Â˜ ÏÔÈÌÒÍÂÈ˜ (∂ÈÎfiÓ· 1).

™˘˙‹ÙËÛË

∏ Ô˘‰ÂÙÂÚÔÂÓ›· ·ÔÙÂÏÂ› Û¯ÂÙÈÎ¿ Û˘¯Ófi Â‡ÚË-

Ì· ÛÙ· ·È‰È¿. ∆· ÓÔÛ‹Ì·Ù· Ô˘ ÌÔÚÔ‡Ó Ó· ÚÔ-

Î·Ï¤ÛÔ˘Ó ÙËÓ ÙÒÛË ÙˆÓ Ô˘‰ÂÙÂÚfiÊÈÏˆÓ ÔÏ˘ÌÔÚ-

ÊÔ‡ÚËÓˆÓ ·Ó·ÁÚ¿ÊÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1.

∏ Û˘¯ÓfiÙÂÚË ÌÔÚÊ‹ ÙË˜ ¯ÚfiÓÈ·˜ Ô˘‰ÂÙÂÚÔÂ-

Ó›·˜ ÛÙË ‚ÚÂÊÈÎ‹ ËÏÈÎ›· Â›Ó·È Ë ÚˆÙÔ·ı‹˜ ·˘ÙÔ¿-

ÓÔÛË Ô˘‰ÂÙÂÚÔÂÓ›·. ∏ ÚÒÙË ·Ó·ÊÔÚ¿ ÛÙËÓ ÔÓÙfi-

ÙËÙ· ·˘Ù‹ ¤ÁÈÓÂ ÛÙÈ˜ ·Ú¯¤˜ ÙË˜ ‰ÂÎ·ÂÙ›·˜ ÙÔ˘ ’60

·fi ÙÔ˘˜ Zuelzer Î·È Bajoghli (6), ÂÓÒ ·ÚÁfiÙÂÚ· ÔÈ

Lalezari Î·È Û˘Ó. ÂÈ‚Â‚·›ˆÛ·Ó Ù· Â˘Ú‹Ì·Ù· ÙË˜

ÚÔËÁÔ‡ÌÂÓË˜ ÂÚÂ˘ÓËÙÈÎ‹˜ ÔÌ¿‰·˜ ·ÔÌÔÓÒÓÔÓÙ·˜

·ÓÙÈÔ˘‰ÂÙÂÚÔÊÈÏÈÎ¿ ·ÓÙÈÛÒÌ·Ù· ÛÂ 119 ·fi Ù· 121

‚Ú¤ÊË Î·È ·È‰È¿ ÌÂ ¯ÚfiÓÈ· Ô˘‰ÂÙÂÚÔÂÓ›· (7).

233µÚ¤ÊÔ˜ ÌÂ ·˘ÙÔ¿ÓÔÛË Ô˘‰ÂÙÂÚÔÂÓ›·

¶·È‰È·ÙÚÈÎ‹ 2007;70:232-236


™ÙÔÓ ¶›Ó·Î· 2 ·Ó·ÁÚ¿ÊÔÓÙ·È ÔÈ ¤ÓÙÂ ÔÌ¿‰Â˜ÙˆÓ ÂÙ¿ ÁÓˆÛÙÒÓ Ô˘‰ÂÙÂÚÔÊÈÏÈÎÒÓ ·ÓÙÈÁfiÓˆÓ(HNA = Human Neutrophil Alloantigens) Û‡ÌÊˆÓ·ÌÂ ÙËÓ Î·Ù¿Ù·ÍË ÙË˜ ÔÌ¿‰·˜ ÂÚÁ·Û›·˜ GranulocyteAntigen Working Party of the International Society ofBlood Transfusion (8). √ ‰È·¯ˆÚÈÛÌfi˜ ·˘Ùfi˜ ‚·Û›-ÛıËÎÂ ÛÙË ı¤ÛË Ô˘ Î·Ù¤¯Ô˘Ó Ù· ÂÓ ÏfiÁˆ ·ÓÙÈÁfiÓ·(·ÓÙÈÁÔÓÈÎ¤˜ ÚˆÙÂ˝ÓÂ˜) ÛÙËÓ Î˘ÙÙ·ÚÈÎ‹ ÌÂÌ‚Ú¿ÓËÙˆÓ Ô˘‰ÂÙÂÚfiÊÈÏˆÓ. √È ·ÓÔÛÔÁfiÓÂ˜ ÁÏ˘ÎÔÚˆ-ÙÂ˝ÓÂ˜ Û˘Ì‚ÔÏ›˙ÔÓÙ·È ÌÂ ·Ú·‚ÈÎÔ‡˜ ·ÚÈıÌÔ‡˜ Î·È·ÎÔÏÔ˘ıÔ‡ÓÙ·È ·fi ¤Ó· ÁÚ¿ÌÌ· ÙÔ˘ ·ÏÊ·‚‹ÙÔ˘Ô˘ Û˘Ì‚ÔÏ›˙ÂÈ ÙÔ˘˜ ·ÓÙ›ÛÙÔÈ¯Ô˘˜ ÔÏ˘ÌÔÚÊÈÛÌÔ‡˜ÙˆÓ ÁÏ˘ÎÔÚˆÙÂ˚ÓÒÓ. ∆· ·ÓÙÈÁfiÓ· HNA-1a, HNA-

lb and HNA-1c, ·ÔÙÂÏÔ‡Ó ÙÚÂÈ˜ ‰È·ÊÔÚÂÙÈÎÔ‡˜ Ô-

Ï˘ÌÔÚÊÈÎÔ‡˜ Ù‡Ô˘˜ ÙÔ˘ ›‰ÈÔ˘ Ô˘‰ÂÙÂÚfiÊÈÏÔ˘ ˘Ô-

‰Ô¯¤· FcÁIIIb (CD16). ∆Ô ·ÓÙÈÁfiÓÔ HNA-2a ·ÓÙÈ-

ÛÙÔÈ¯Â› ÛÙË ÁÏ˘ÎÔÚˆÙÂ˝ÓË Gp50-64 (CD177). ∆Ô

·ÓÙÈÁfiÓÔ HNA-3a, ÂÓÙÔ›˙ÂÙ·È ÛÂ Ì›· ÁÏ˘ÎÔÚˆ-

ÙÂ˝ÓË ÌÂ ÌÔÚÈ·Îfi ‚¿ÚÔ˜ 70-95 kDa. ∆· ·ÓÙÈÁfiÓ·

HNA-4a Î·È HNA-5a, Û˘Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÙÈ˜ ÁÏ˘ÎÔ-

ÚˆÙÂ˝ÓÂ˜ CD11b Î·È CD11a. ∞fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ

·ÓÙÈÁÔÓÈÎÒÓ ÚˆÙÂ˚ÓÒÓ, ÙÔ˘˜ ÈÔ Û˘¯ÓÔ‡˜ “ÛÙfi-

¯Ô˘˜” ÙˆÓ ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ ·ÔÙÂÏÔ‡Ó ÔÈ Úˆ-

ÙÂ˝ÓÂ˜ D11b, CD16b Î·È CD177, ÂÓÒ ÌfiÓÔ ÙÔ 30%

ÙˆÓ ·ÓÙÈÔ˘‰ÂÙÂÚÔÊÈÏÈÎÒÓ ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ ÛÙÚ¤-

ÊÂÙ·È Î·Ù¿ ÙË˜ ÚˆÙÂ˝ÓË˜ CD16b.

√ ·ÎÚÈ‚‹˜ ·ıÔÁÂÓÂÙÈÎfi˜ ÌË¯·ÓÈÛÌfi˜ ·Ó¿Ù˘-

ÍË˜ ÙË˜ ·˘ÙÔ¿ÓÔÛË˜ Ô˘‰ÂÙÂÚÔÂÓ›·˜ ‰ÂÓ Â›Ó·È ·Îfi-

ÌË Ï‹Úˆ˜ ‰ÈÂ˘ÎÚÈÓÈÛÌ¤ÓÔ˜. Œ¯ÂÈ ·Ó·ÊÂÚıÂ› Û˘Û¯¤-

ÙÈÛË ÌÂÙ·Í‡ ÙÔ˘ ·ÓÙÈ-HNA-1a ·ÓÙÈÛÒÌ·ÙÔ˜ Î·È ÙÔ˘

HLA-DR2, fiÌˆ˜, Ë ÂÎ‰‹ÏˆÛË ÙË˜ ·˘ÙÔ¿ÓÔÛË˜ Ô˘-

‰ÂÙÂÚÔÂÓ›·˜ ÛÂ ¤Ó·Ó ÌfiÓÔ ·fi ÙÔ˘˜ ‰‡Ô ÌÔÓÔ˙˘-

ÁˆÙÈÎÔ‡˜ ‰È‰‡ÌÔ˘˜ ·ÔÙÂÏÂ› ÈÛ¯˘Ú‹ ¤Ó‰ÂÈÍË fiÙÈ ‰ÂÓ

˘¿Ú¯ÂÈ Î¿ÔÈÔ˜ ÎÏËÚÔÓÔÌÔ‡ÌÂÓÔ˜ ÌË¯·ÓÈÛÌfi˜

Ô˘ Ó· ·ÚÂÌ‚·›ÓÂÈ ÛÙÔ ÌÂ›˙ÔÓ Û‡ÛÙËÌ· ÈÛÙÔÛ˘Ì-

‚·ÙfiÙËÙ·˜ (9). ÕÏÏË ÔÌ¿‰· ÂÚÂ˘ÓËÙÒÓ ÂÓÙfiÈÛÂ

·ÓÙÈÛÒÌ·Ù· IgM Î·Ù¿ ÙÔ˘ ·Ú‚Ô˚Ô‡ µ19 ÛÂ 5 ·fi 11

·ÛıÂÓÂ›˜ ÌÂ ¯ÚfiÓÈ· Ô˘‰ÂÙÂÚÔÂÓ›· Î·È ıÂÒÚËÛÂ fiÙÈ

Ú¤ÂÈ Ó· ˘¿Ú¯ÂÈ Û˘Û¯¤ÙÈÛË ÌÂÙ·Í‡ ÙÔ˘ ·Ú‚Ô˚Ô‡

µ19 Î·È ÙË˜ ·˘ÙÔ¿ÓÔÛË˜ Ô˘‰ÂÙÂÚÔÂÓ›·˜ (10). ªÂ-

Ù·ÁÂÓ¤ÛÙÂÚË fiÌˆ˜ ÌÂÏ¤ÙË ÙˆÓ Bux Î·È Û˘Ó. ·Ó›¯ÓÂ˘-

ÛÂ ÙÔ DNA ÙÔ˘ ·Ú‚Ô˚Ô‡ Î·È Ù· IgG/IgM ·ÓÙÈÛÒÌ·-

Ù· Î·Ù¿ ÙÔ˘ ÈÔ‡ ÌfiÓÔ ÛÂ 36 ·fi ÙÔ˘˜ 110 ·ÛıÂÓÂ›˜

Î·È ̆ ÔÛÙ‹ÚÈÍÂ fiÙÈ ‰ÂÓ ̆ ¿Ú¯ÂÈ ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈ-

Î‹ Û¯¤ÛË ÌÂÙ·Í‡ ÙË˜ ÏÔ›ÌˆÍË˜ ·fi ÙÔÓ ·Ú‚Ô˚fi µ19

Î·È ÙË˜ ·˘ÙÔ¿ÓÔÛË˜ Ô˘‰ÂÙÂÚÔÂÓ›·˜ (11). ŒÙÛÈ, Ì¤-

¯ÚÈ Û‹ÌÂÚ· ˘¿Ú¯Ô˘Ó ÔÏÏ¿ ·Ó·¿ÓÙËÙ· ÂÚˆÙ‹Ì·-

Ù· ÁÈ· ÙÔÓ ˘Â‡ı˘ÓÔ ·Ú¿ÁÔÓÙ· Î·È ÙÔÓ ÙÚfiÔ ÌÂ

ÙÔÓ ÔÔ›Ô ·˘Ùfi˜ ‰Ú· ‰ËÌÈÔ˘ÚÁÒÓÙ·˜ Ù· ·ÓÙÈÔ˘‰ÂÙÂ-

ÚÔÊÈÏÈÎ¿ ·ÓÙÈÛÒÌ·Ù·. ™ÙÔ ÂÚÈÛÙ·ÙÈÎfi Ô˘ ÂÚÈ-

ÁÚ¿ÊÔ˘ÌÂ, ‰ÂÓ ÚÔ¤Î˘„Â Â‡ÚËÌ· ·fi ÙÔÓ ÂÎÙÂÙ·-

Ì¤ÓÔ ¤ÏÂÁ¯Ô Ô˘ Ó· ÌÔÚÔ‡ÛÂ Ó· ‰ÈÎ·ÈÔÏÔÁ‹ÛÂÈ ÙËÓ

ÂÌÊ¿ÓÈÛË ÙË˜ ÓfiÛÔ˘.

∏ Ì¤ÛË ËÏÈÎ›· ÂÌÊ¿ÓÈÛË˜ ÙË˜ ·˘ÙÔ¿ÓÔÛË˜ Ô˘‰Â-

ÙÂÚÔÂÓ›·˜ Î˘Ì·›ÓÂÙ·È ÌÂÙ·Í‡ 6 Î·È 12 ÌËÓÒÓ. ™ÙÔ

‰ÈÎfi Ì·˜ ÂÚÈÛÙ·ÙÈÎfi ÈÛÙÂ‡Ô˘ÌÂ fiÙÈ ÙÔ Úfi‚ÏËÌ·

ÂÌÊ·Ó›ÛÙËÎÂ ÛÂ ËÏÈÎ›· 3 ÌËÓÒÓ ÂÚ›Ô˘, ¯ÚÔÓÈÎ‹

ÛÙÈÁÌ‹ Î·Ù¿ ÙËÓ ÔÔ›· ÙÔ ‚Ú¤ÊÔ˜ ÂÌÊ¿ÓÈÛÂ ÙËÓ

ÚÒÙË ÙÔ˘ ÛÔ‚·Ú‹ ÏÔ›ÌˆÍË (ÎÔÎÎ‡ÙË). øÛÙfiÛÔ ‰ÂÓ

˘¿Ú¯ÂÈ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ Ô˘ Ó· ÙÔ ÂÈ‚Â-

‚·ÈÒÓÂÈ. ∏ ‚·Ú‡ÙËÙ· ÙÔ˘ ∞∞√¶ Û˘¯Ó¿ Î˘Ì·›ÓÂÙ·È

ÛÂ ÂÓ‰È¿ÌÂÛ· Â›Â‰· (500-1000/mL), ·ÏÏ¿ ¤¯Ô˘Ó

ÂÚÈÁÚ·ÊÂ› ÂÚÈÛÙ·ÙÈÎ¿ Î·È ÌÂ ÙÈÌ¤˜ Î¿Ùˆ ÙˆÓ

200/mL. ∆Ô Û˘¯ÓfiÙÂÚÔ Úfi‚ÏËÌ· ÙˆÓ ·ÛıÂÓÒÓ ÌÂ

·˘ÙÔ¿ÓÔÛË Ô˘‰ÂÙÂÚÔÂÓ›· Â›Ó·È ÔÈ ÌÈÎÚÔ‚È·Î¤˜

ÏÔÈÌÒÍÂÈ˜, ÔÈ ÔÔ›Â˜ ÙÈ˜ ÂÚÈÛÛfiÙÂÚÂ˜ ÊÔÚ¤˜ Â›Ó·È

234 º. ™ÙÚÈ¤ÏË Î·È Û˘Ó.

¶›Ó·Î·˜ 1. ∞›ÙÈ· Ô˘‰ÂÙÂÚÔÂÓ›·˜

√˘‰ÂÙÂÚÔÂÓ›· ·fi ÂÍˆÁÂÓ‹ ·›ÙÈ· ñ §ÔÈÌÒÍÂÈ˜ñ º¿ÚÌ·Î·ñ ∞˘ÙÔ¿ÓÔÛË (ÚˆÙÔ·ı‹˜ Î·È ‰Â˘ÙÂÚÔ·ı‹˜) ñ ∞ÏÏÔ¿ÓÔÛËñ ∞ÓÙÈÎ·Ù¿ÛÙ·ÛË ‹ ·Ï·Û›· ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ (Î·ÎÔ‹-

ıÂÈÂ˜, ·Ï·Û›·)ñ ∞Ó·ÔÙÂÏÂÛÌ·ÙÈÎ‹ Ì˘ÂÏÔÔ›ËÛË (.¯. ¤ÏÏÂÈ„Ë µ12 Î·È

Ê˘ÏÏÈÎÔ‡)ñ ÀÂÚÛÏËÓÈÛÌfi˜ (¯ÚfiÓÈ· ·ÈÌfiÏ˘ÛË, ÂÏÔÓÔÛ›· Î.¿.)ñ ¡fiÛÔÈ ÙÔ˘ ÎÔÏÏ·ÁfiÓÔ˘ (.¯. ™˘ÛÙËÌ·ÙÈÎfi˜ ∂Ú˘ıËÌ·ÙÒ‰Ë˜

§‡ÎÔ˜)

√˘‰ÂÙÂÚÔÂÓ›· ·fi ÂÓ‰ÔÁÂÓ‹ ·›ÙÈ·ñ ÃÚfiÓÈ· Ô˘‰ÂÙÂÚÔÂÓ›· (.¯. Î˘ÎÏÈÎ‹ Ô˘‰ÂÙÂÚÔÂÓ›·)ñ µ·ÚÈ¿ Û˘ÁÁÂÓ‹˜ Ô˘‰ÂÙÂÚÔÂÓ›· (Û‡Ó‰ÚÔÌÔ Kostmann)ñ √˘‰ÂÙÂÚÔÂÓ›· Ô˘ Û˘Ó‰˘¿˙ÂÙ·È ÌÂ ·Á·Ì·ÛÊ·ÈÚÈÓ·ÈÌ›· ‹

Û‡Ó‰ÚÔÌÔ ˘ÂÚ-IgM ñ √˘‰ÂÙÂÚÔÂÓ›· Ô˘ Û¯ÂÙ›˙ÂÙ·È ÌÂ Û‡Ó‰ÚÔÌ· (·ÔıËÎÂ˘ÙÈ-

Î‹ ÓfiÛÔ˜ ÙÔ˘ ÁÏ˘ÎÔÁfiÓÔ˘ Ù‡Ô˘ π‚, Û‡Ó‰ÚÔÌÔShwachman-Diamond, Î·Ú‰ÈÔÛÎÂÏÂÙÈÎ‹ Ì˘Ô¿ıÂÈ·, ÔÓ˘-¯ÔÙÚÈ¯Ô‰˘ÛÏ·Û›·)

ñ ∞Ó·ÈÌ›· Fanconiñ ª˘ÂÏÔ‰˘ÛÏ·Û›·ñ ™˘ÁÁÂÓ‹˜ ‰˘ÛÎÂÚ¿ÙˆÛË

10.000

9.000

8.000

7.000

6.000

5.000

4.000

3.000

2.000

1.000

00 30 60 90 120 150 180 210 240 270

ÃÔÚ‹ÁËÛË G-CSF

ÃÔÚ‹ÁËÛË G-CSFŒÍÔ‰Ô˜ ·fi ÙÔ

ÓÔÛÔÎÔÌÂ›Ô

∂·ÓÂÈÛ·ÁˆÁ‹

∏Ì¤ÚÂ˜ ·Ú·ÎÔÏÔ‡ıËÛË˜

∞

fiÏ

˘Ù

Ô˜

·Ú

ÈıÌ

fi˜

Ô˘

‰ÂÙ

ÂÚfi

ÊÈÏ

ˆÓ

∂ÈÎfiÓ· 1. ¶ÔÚÂ›· ÙÔ˘ ·fiÏ˘ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ Ô˘‰ÂÙÂÚfiÊÈÏˆÓÙÔ˘ ·ÛıÂÓÔ‡˜



Ì¤ÙÚÈ·˜ ‚·Ú‡ÙËÙ·˜. ŒÙÛÈ, Û˘¯Ó¿ ‰È·ÈÛÙÒÓÔÓÙ·È

˘ÔÙÚÔÈ¿˙Ô˘ÛÂ˜ ·Ó·ÓÂ˘ÛÙÈÎ¤˜ ÏÔÈÌÒÍÂÈ˜, ˘Ô-

‰ÂÚÌ›·, Ì¤ÛË ˆÙ›ÙÈ‰· Î·È Á·ÛÙÚ›ÙÈ‰· (12). ∏ ÂÌÊ¿ÓÈ-

ÛË ÂÚÈÂ‰ÚÈÎÔ‡ ·ÔÛÙ‹Ì·ÙÔ˜ Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È

Â‰Ò, Â›Ó·È Û¿ÓÈ· ÂÎ‰‹ÏˆÛË ÙË˜ ÓfiÛÔ˘ (13). ∂›ÛË˜

Û¿ÓÈ· Â›Ó·È Ë ÂÌÊ¿ÓÈÛË ÂÁÎÂÊ·ÏÈÎÒÓ ·ÔÛÙËÌ¿-

ÙˆÓ (12). ™ÙÔ Ì˘ÂÏfiÁÚ·ÌÌ·, Ô Ì˘ÂÏfi˜ ÙˆÓ ÔÛÙÒÓ

‰Â›¯ÓÂÈ Ê˘ÛÈÔÏÔÁÈÎ‹ ‹ ·˘ÍËÌ¤ÓË Î˘ÙÙ·ÚÔ‚Ú›ıÂÈ·

ÙˆÓ Úfi‰ÚÔÌˆÓ Ì˘ÂÏÈÎÒÓ Î˘ÙÙ¿ÚˆÓ, ·ÏÏ¿ ÛÙËÓ

ÏÂÈÔÓfiÙËÙ· ÙˆÓ ·ÛıÂÓÒÓ ·Ú·ÙËÚÂ›Ù·È Û·Ê‹˜ ÌÂ›-

ˆÛË ÙˆÓ ÒÚÈÌˆÓ Ô˘‰ÂÙÂÚfiÊÈÏˆÓ.

∏ ÂÍ¤Ù·ÛË Ô˘ ÂÈ‚Â‚·ÈÒÓÂÈ ÙË ‰È¿ÁÓˆÛË ÙË˜ ·˘-

ÙÔ¿ÓÔÛË˜ Ô˘‰ÂÙÂÚÔÂÓ›·˜ Â›Ó·È Ë ·Ó›¯ÓÂ˘ÛË ÙˆÓ ÂÈ-

‰ÈÎÒÓ ·ÓÙÈÔ˘‰ÂÙÂÚÔÊÈÏÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ÛÙÔÓ ÔÚfi

ÙˆÓ ·ÛıÂÓÒÓ. √ ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ ·ÓÙÈÛˆÌ¿ÙˆÓ

ÂÈÙ˘Á¯¿ÓÂÙ·È Ì¤Ûˆ ‰È¿ÊÔÚˆÓ ÙÂ¯ÓÈÎÒÓ, ‰‡Ô fiÌˆ˜

Â›Ó·È ÔÈ ÂÈÎÚ·Ù¤ÛÙÂÚÂ˜: Ë Ì¤ıÔ‰Ô˜ Û˘ÁÎfiÏÏËÛË˜ ÙˆÓ

Ô˘‰ÂÙÂÚfiÊÈÏˆÓ (Granulocyte Agglutination Test -

GAT) Î·È Ë Ì¤ıÔ‰Ô˜ ·ÓÔÛÔÊıÔÚÈÛÌÔ‡ (Granulocyte

Immunofluorescence Test - GIFT) (14). ¶·ÚfiÙÈ Ë Ì¤-

ıÔ‰Ô˜ GIFT Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ Â˘·›ÛıËÙË (Â˘·ÈÛıË-

Û›· 97%), ÛÂ ÔÛÔÛÙfi 3% ÙˆÓ ÂÚÈÙÒÛÂˆÓ Ù· ·˘-

ÙÔ·ÓÙÈÛÒÌ·Ù· ÌÔÚÂ› Ó· Â›Ó·È ıÂÙÈÎ¿ ÌfiÓÔ ÛÙË Ì¤-

ıÔ‰Ô GAT. ªÂÈÔÓÂÎÙ‹Ì·Ù· ÂÌÊ·Ó›˙Ô˘Ó Î·È ÔÈ ‰‡Ô

ÙÂ¯ÓÈÎ¤˜. ∂ÂÈ‰‹ Ô Ù›ÙÏÔ˜ ÙˆÓ ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ ·Ú-

ÎÂÙ¿ Û˘¯Ó¿ Â›Ó·È ÌË ·ÓÈ¯ÓÂ‡ÛÈÌÔ˜, Ë ÂÍ¤Ù·ÛË ¯ÚÂÈ¿-

˙ÂÙ·È Ó· Â·Ó·ÏËÊıÂ› ‰‡Ô Î·È ÙÚÂÈ˜ ÊÔÚ¤˜ ÁÈ· ÙËÓ

Â‰Ú·›ˆÛË ‹ ÙÔÓ ·ÔÎÏÂÈÛÌfi ÙË˜ ‰È¿ÁÓˆÛË˜. ∂›ÛË˜,

ÛÂ Î·Ù·ÛÙ¿ÛÂÈ˜ fiÔ˘ ·Ú·ÙËÚÂ›Ù·È ˘ÂÚÁ·Ì·ÛÊ·È-

ÚÈÓ·ÈÌ›·, .¯. ÔÏÏ·ÏÔ‡Ó Ì˘¤ÏˆÌ·, Û‡Ó‰ÚÔÌÔ Â›-

ÎÙËÙË˜ ·ÓÔÛÔÏÔÁÈÎ‹˜ ·ÓÂ¿ÚÎÂÈ·˜ Î·È ·˘ÙÔ¿ÓÔÛ·

ÓÔÛ‹Ì·Ù·, ÔÈ ·Ú·¿Óˆ ÙÂ¯ÓÈÎ¤˜ ‰›ÓÔ˘Ó „Â˘‰Ò˜

ıÂÙÈÎ¿ ·ÔÙÂÏ¤ÛÌ·Ù· (15). ™ÙÔ ÂÚÈÛÙ·ÙÈÎfi Ô˘

·ÚÔ˘ÛÈ¿˙Ô˘ÌÂ, Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ ·ÓÙÈÔ˘‰ÂÙÂ-

ÚÔÊÈÏÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ÂÈÙÂ‡¯ıËÎÂ ÌÂ ÙÈ˜ ÌÂıfi-

‰Ô˘˜ GIFT Î·È GAT.

∏ ÔÚÂ›· ÙË˜ ÓfiÛÔ˘ Â›Ó·È Î·Ï‹ Î·È ÙÔ 95% ÙˆÓ

·ÛıÂÓÒÓ ÂÌÊ·Ó›˙ÂÈ ·˘ÙfiÌ·ÙË ‡ÊÂÛË ÛÂ Ì¤ÁÈÛÙÔ ‰È¿-

ÛÙËÌ· 2 ÂÙÒÓ ·fi ÙË ‰È¿ÁÓˆÛË (11). ªÂ ‰Â‰ÔÌ¤ÓË

ÙËÓ Î·Ï‹ ÂÍ¤ÏÈÍË ÙÔ˘ ÓÔÛ‹Ì·ÙÔ˜ ‰ÂÓ ¯ÔÚËÁÂ›Ù·È ÂÈ-

‰ÈÎ‹ ıÂÚ·Â›·, ÂÎÙfi˜ ·fi ÙË Û˘ÌÙˆÌ·ÙÈÎ‹ Î·È ·È-

ÙÈÔÏÔÁÈÎ‹ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÏÔÈÌÒÍÂˆÓ, fiÙ·Ó ·˘Ù¤˜

ÂÌÊ·ÓÈÛıÔ‡Ó. ∂ÈÏ¤ÔÓ, ÌÂÏ¤ÙÂ˜ ·¤‰ÂÈÍ·Ó fiÙÈ Ë

ÚÔÊ˘Ï·ÎÙÈÎ‹ ¯ÔÚ‹ÁËÛË ÙÚÈÌÂıÔÚ›ÌË˜ - ÛÔ˘ÏÊÔ-

ÌÂıÔÍ·˙fiÏË˜ ÌÂ›ˆÛÂ ÙË Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛË˜ ÙˆÓ

ÏÔÈÌÒÍÂˆÓ, ¯ˆÚ›˜ fiÌˆ˜ Ó· ÂËÚÂ¿ÛÂÈ ÙË ‰È¿ÚÎÂÈ·

ÙË˜ ÓfiÛÔ˘ (16). ∞fiÏ˘ÙË ¤Ó‰ÂÈÍË ÚÔÊ˘Ï·ÎÙÈÎ‹˜

¯ÔÚ‹ÁËÛË˜ ·ÓÙÈ‚ÈÔÙÈÎÒÓ ÛÙ· ‚Ú¤ÊË ·ÔÙÂÏÔ‡Ó ÔÈ

Â·Ó·Ï·Ì‚·ÓfiÌÂÓÂ˜ ÏÔÈÌÒÍÂÈ˜, È‰›ˆ˜ ÛÂ Û˘¯Ó¿ ÂÂÈ-

Ûfi‰È· ÔÍÂ›·˜ Ì¤ÛË˜ ˆÙ›ÙÈ‰·˜, ÚÔÎÂÈÌ¤ÓÔ˘ Ó· ·Ô-

ÊÂ˘¯ıÂ› Ë Î·Ù·ÛÙÚÔÊ‹ ÙˆÓ ÈÛÙÒÓ ÙÔ˘ Ì¤ÛÔ˘ ˆÙfi˜.

™ÙÔ ÂÚÈÛÙ·ÙÈÎfi Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È, ¯ÔÚËÁ‹ıËÎÂ

ÚÔÊ˘Ï·ÎÙÈÎ¿ ÙÚÈÌÂıÔÚ›ÌË - ÛÔ˘ÏÊÔÌÂıÔÍ·˙fiÏË,

ÏfiÁˆ ÙˆÓ Û˘¯ÓÒÓ ÏÔÈÌÒÍÂˆÓ Ô˘ Â›¯Â ÂÌÊ·Ó›ÛÂÈ Î·-

Ù¿ ÙÔ˘˜ Ì‹ÓÂ˜ Ô˘ ÚÔËÁ‹ıËÎ·Ó ÙË˜ ‰È¿ÁÓˆÛË˜.

∂ÎÙfi˜ ·fi ÙËÓ ·ÈÙÈÔÏÔÁÈÎ‹ ıÂÚ·Â›· ÙˆÓ ÏÔÈÌÒ-

ÍÂˆÓ, ÌÂÏÂÙ¿Ù·È Ë ¯ÔÚ‹ÁËÛË ·ÓÔÛÔÂÓÈÛ¯˘ÙÈÎ‹˜

˘ÔÛÙËÚÈÎÙÈÎ‹˜ ·ÁˆÁ‹˜ ÛÂ ÂÚÈÙÒÛÂÈ˜ ÂÈÎ›Ó‰˘-

ÓˆÓ ÁÈ· ÙË ˙ˆ‹ ÙˆÓ ·ÛıÂÓÒÓ ÏÔÈÌÒÍÂˆÓ. ¢ÔÎÈÌ¿-

ÛıËÎÂ Ë ÂÓ‰ÔÊÏ¤‚È· ¯ÔÚ‹ÁËÛË Á-ÛÊ·ÈÚ›ÓË˜ (IVIG),

Ë ÔÔ›· Ô‰‹ÁËÛÂ ÛÂ Ù·¯Â›· ¿ÓÔ‰Ô ÙˆÓ Ô˘‰ÂÙÂÚfiÊÈ-

ÏˆÓ, Ô˘ ‰È‹ÚÎÂÛÂ fiÌˆ˜, Ï›ÁÂ˜ ËÌ¤ÚÂ˜. ¶ÈÔ ·ÔÙÂ-

ÏÂÛÌ·ÙÈÎ‹ Ê·›ÓÂÙ·È Ë ¯ÔÚ‹ÁËÛË ÙÔ˘ G-CSF, ·ÏÏ¿ Ë

¯ÚfiÓÈ· ¯ÔÚ‹ÁËÛ‹ ÙÔ˘ ‰ÂÓ Â›Ó·È Û˘Ó‹ıˆ˜ ··Ú·›ÙË-

ÙË Î·È ÂÓ‰Â›ÎÓ˘Ù·È ÌfiÓÔ ÛÂ Â·Ó·Ï·Ì‚·ÓfiÌÂÓÂ˜ /

ÛÔ‚·Ú¤˜ ÏÔÈÌÒÍÂÈ˜ (17) ‹ ÛÂ ÂÚÈÙÒÛÂÈ˜ ÛÙÈ˜ ÔÔ›-

Â˜ ··ÈÙÂ›Ù·È ¯ÂÈÚÔ˘ÚÁÈÎ‹ Â¤Ì‚·ÛË. ∏ ·ÓÙ·fiÎÚÈ-

ÛË ÛÙÔÓ G-CSF Â›Ó·È ¿ÌÂÛË Î·È ‰È·ÚÎÂ› ÌÂÁ·Ï‡ÙÂÚÔ

¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· Ô˘ Êı¿ÓÂÈ Ì¤¯ÚÈ Î·È ‰‡Ô Ì‹ÓÂ˜.

™ÙÔ ‰ÈÎfi Ì·˜ ÂÚÈÛÙ·ÙÈÎfi ¯ÔÚËÁ‹ıËÎÂ ‰‡Ô ÊÔÚ¤˜

·˘ÍËÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ Î·È Ë ·ÓÙ·fiÎÚÈÛË ÙÔ˘

·ÛıÂÓÔ‡˜ ‹Ù·Ó ¿ÌÂÛË. £· Ú¤ÂÈ Ó· ‰ÈÂ˘ÎÚÈÓÈÛÙÂ›

fiÙÈ ÛÙË ‰Â‡ÙÂÚË ÓÔÛËÏÂ›· ÙÔ˘ ‚Ú¤ÊÔ˘˜, Ë ¯ÔÚ‹ÁËÛË

ÙÔ˘ G-CSF ‚·Û›ÛıËÎÂ ÛÙËÓ ˘Ô„›· ÁÈ· ÛÔ‚·Ú‹ ÌÈ-

ÎÚÔ‚È·Î‹ ÂÈÏÔÎ‹. ∆¤ÏÔ˜, ¤¯ÂÈ ‰ÔÎÈÌ·ÛıÂ› Î·È Ë

¯ÔÚ‹ÁËÛË ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰ÒÓ ÌÂ Î·Ï‹ ·ÓÙ·fiÎÚÈÛË

ÙˆÓ ·ÛıÂÓÒÓ ÛÙËÓ ¿ÓÔ‰Ô ÙÔ˘ ∞∞√ (12).

∆Ô ÂÚÈÛÙ·ÙÈÎfi ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÁÈ·Ù›, ÂÓÒ Ë ·˘-

ÙÔ¿ÓÔÛË Ô˘‰ÂÙÂÚÔÂÓ›· Â›Ó·È Ë Û˘¯ÓfiÙÂÚË ÌÔÚÊ‹

Ô˘‰ÂÙÂÚÔÂÓ›·˜ ÙˆÓ ‚ÚÂÊÒÓ Î·È ·È‰ÈÒÓ ÌÈÎÚ‹˜

ËÏÈÎ›·˜, ·ÔÙÂÏÂ› ÓÔÛÔÏÔÁÈÎ‹ ÔÓÙfiÙËÙ· ¿ÁÓˆÛÙË

ÛÙÔ˘˜ ÂÚÈÛÛfiÙÂÚÔ˘˜ ·È‰È¿ÙÚÔ˘˜. ∏ ‰È¿ÁÓˆÛ‹

ÙË˜ Ù›ıÂÙ·È Û˘Ó‹ıˆ˜ ÂÍ ·ÔÎÏÂÈÛÌÔ‡ ¿ÏÏˆÓ Î·Ù·-

ÛÙ¿ÛÂˆÓ Î·È ˘ÔÛÙËÚ›˙ÂÙ·È ·fi ÙËÓ ·ÓÂ‡ÚÂÛË

235µÚ¤ÊÔ˜ ÌÂ ·˘ÙÔ¿ÓÔÛË Ô˘‰ÂÙÂÚÔÂÓ›·

¶·È‰È·ÙÚÈÎ‹ 2007;70:232-236

¶›Ó·Î·˜ 2. ∞ÓÙÈÔ˘‰ÂÙÂÚÔÊÈÏÈÎ¿ ·ÓÙÈÛÒÌ·Ù·

√Ì¿‰Â˜ ·ÓÙÈÁfiÓˆÓ ∞ÓÙÈÁfiÓ· ¶ÚÔËÁÔ‡ÌÂÓË ÔÓÔÌ·Û›· °Ï˘ÎÔÚˆÙÂ˝ÓË

HNA-1 HNA-1a NA1 FcÁπππb (CD16)HNA-1b NA2 FcÁπππb (CD16)HNA-1c SH FcÁπππb (CD16)

HNA-2 HNA-2a NB1 CD177 (gp50-64)HNA-3 HNA-3a 5b Gp70-95HNA-4 HNA-4a MART CD11aHNA-5 HNA-5a OND CD11b


·ÓÙÈÔ˘‰ÂÙÂÚÔÊÈÏÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ. ∏ ¤ÁÎ·ÈÚË ‰È¿-ÁÓˆÛË ‚ÔËı¿ Î·È ÛÙËÓ ÈÔ ÔÚı‹ ·ÓÙÈÌÂÙÒÈÛË, ÌÂÎ‡ÚÈÔ ÛÙÔÈ¯Â›Ô ÙË ÛÙÂÓ‹ ·Ú·ÎÔÏÔ‡ıËÛË Î·È ÙË ıÂ-Ú·Â˘ÙÈÎ‹ ·Ú¤Ì‚·ÛË ÌfiÓÔ Â› ÂÓ‰Â›ÍÂˆÓ.


1. Lakshman R, Finn A. Neutrophil disorders and their man-agement. J Clin Pathol 2001;54:7-19.

2. Bux J, Mueller-Eckhardt C. Autoimmune neutropenia.Semin Hematol 1992;29:45-53.

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

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

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

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

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

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

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

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

11. Bux J, Behrens G, Jaeger G, Welte K. Diagnosis and clinicalcourse of autoimmune neutropenia in infancy: analysis of240 cases. Blood 1998;91:181-186.

12. Lejkowski M, Maheshwari A, Calhoun DA, ChristensenRD, Skoda-Smith S, Dabrow S. Persistent perianal abscessin early infancy as a presentation of autoimmune neu-tropenia. J Perinatol 2003;23:428-430.

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

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

15. Bux J, Sohn M, Hachmann R, Mueller-Eckhardt C. Quan-titation of granulocyte antibodies in sera and determina-tion of their binding sites. Br J Haematol 1992;82:20-25

16. Kobayashi M, Sato T, Kawaguchi H, Nakamura K, KiharaH, Hiraoka A, et al. Efficacy of prophylactic use of trimetho-prim-sulfamethoxazole in autoimmune neutropenia in in-fancy. J Pediatr Hematol Oncol 2003;25:553-537.

17. Palmblad JE, von dem Borne AE. Idiopathic, immune, in-fectious and idiosyncratic neutropenias. Semin Hematol2002;39:113-120.

236 º. ™ÙÚÈ¤ÏË Î·È Û˘Ó.



∫ÏÈÓÈÎ‹ Î·È ÂÚÁ·ÛÙËÚÈ·Î‹ ÚÔÛ¤ÁÁÈÛË ÙÔ˘ ·È‰ÈÔ‡

ÌÂ Ô˘‰ÂÙÂÚÔÂÓ›·

∞. ª¿ÎË˜, ¡. Ã·ÏÈ¿ÛÔ˜

¶ÂÚ›ÏË„Ë: √˘‰ÂÙÂÚÔÂÓ›· Â›Ó·È Ë ÛËÌ·ÓÙÈÎ‹ ÂÏ¿ÙÙˆÛË ÙÔ˘ ·fiÏ˘ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ Î˘ÎÏÔÊÔÚÔ‡ÓÙˆÓÔ˘‰ÂÙÂÚÔÊ›ÏˆÓ ÛÙÔ ÂÚÈÊÂÚÈÎfi ·›Ì·, ÌÂ ·ÔÙ¤ÏÂÛÌ· ÙËÓ Â˘·ÈÛıËÛ›· ÛÂ ÏÔÈÌÒÍÂÈ˜ ·fi ˘ÔÁfiÓÔ˘˜ ÌÈ-ÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜. ∏ Ô˘‰ÂÙÂÚÔÂÓ›· ÌÔÚÂ› Ó· Â›Ó·È ÔÍÂ›· ‹ ¯ÚfiÓÈ·, ÎÏËÚÔÓÔÌÈÎ‹ ‹ Â›ÎÙËÙË Î·È ÂÓ‰¤¯Â-Ù·È Ó· ÂÌÊ·ÓÈÛÙÂ› Î·Ù¿ ÙË ÓÂÔÁÓÈÎ‹ ËÏÈÎ›· (Û˘ÁÁÂÓ‹˜) ‹ ÛÙË ÌÂÙ¤ÂÈÙ· ˙ˆ‹. √È ÎÏËÚÔÓÔÌÈÎ¤˜ Ô˘‰ÂÙÂÚÔ-ÂÓ›Â˜ ÔÊÂ›ÏÔÓÙ·È ÛÂ ÂÓ‰ÔÁÂÓÂ›˜ ‰È·Ù·Ú·¯¤˜ ÙˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ Î·È ÂÓ‰¤¯ÂÙ·È Ó· Û˘Ó˘¿Ú-¯Ô˘Ó Ê·ÈÓÔÙ˘ÈÎ¤˜ ·ÓˆÌ·Ï›Â˜, ÂÓÒ ÔÈ Â›ÎÙËÙÂ˜ ÚÔ¤Ú¯ÔÓÙ·È Û˘Ó‹ıˆ˜ ·fi ÂÍˆÁÂÓÂ›˜ ·Ú¿ÁÔÓÙÂ˜ Ô˘ÂÈ‰ÚÔ‡Ó ÛÙÔ Ô˘‰ÂÙÂÚfiÊÈÏÔ. ∆· Û˘¯ÓfiÙÂÚ· ·›ÙÈ· ÛÙ· ·È‰È¿ Â›Ó·È Â›ÎÙËÙ· Î·È È‰È·›ÙÂÚ· ÔÈ ÈÔÁÂÓÂ›˜ ÏÔÈ-ÌÒÍÂÈ˜ Î·È Ù· Ê¿ÚÌ·Î·. √È ÏÔÈÌÒÍÂÈ˜ ÛÙ· ·È‰È¿ ÌÂ Ô˘‰ÂÙÂÚÔÂÓ›· ÚÔÎ·ÏÔ‡ÓÙ·È Û˘Ó‹ıˆ˜ ·fi ÌÈÎÚÔ-ÔÚÁ·ÓÈÛÌÔ‡˜ ÙË˜ ÂÓ‰ÔÁÂÓÔ‡˜ ¯ÏˆÚ›‰·˜. ∏ Â˘·ÈÛıËÛ›· ÛÙÈ˜ ‚·ÎÙËÚÈ·Î¤˜ ÏÔÈÌÒÍÂÈ˜ ÂÍ·ÚÙ¿Ù·È ·fi ÙÔÓ‚·ıÌfi Î·È ÙË ¯ÚÔÓÈfiÙËÙ· ÙË˜ Ô˘‰ÂÙÂÚÔÂÓ›·˜, ·ÏÏ¿ Î·È ·fi ÙË Ê‡ÛË ÙË˜ ˘ÔÎÂ›ÌÂÓË˜ ·ÈÙÈÔÏÔÁ›·˜. ∏ ·Ú-¯ÈÎ‹ ÚÔÛ¤ÁÁÈÛË ÙÔ˘ ·È‰ÈÔ‡ ÌÂ Ô˘‰ÂÙÂÚÔÂÓ›· ··ÈÙÂ› È‰È·›ÙÂÚË ÚÔÛÔ¯‹, È‰È·›ÙÂÚ· fiÙ·Ó ÂÌÊ·Ó›˙ÂÙ·ÈÛÙË ‚ÚÂÊÈÎ‹ ËÏÈÎ›·, fiÙ·Ó ‰È·ÚÎÂ› ·ÚÎÂÙfi ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ‹ fiÙ·Ó Û˘Ó‰˘¿˙ÂÙ·È ÌÂ ÛÔ‚·Ú¤˜ ÏÔÈÌÒÍÂÈ˜‹ ÛˆÌ·ÙÈÎ¤˜ ·ÓˆÌ·Ï›Â˜. ∆Ô ·Ó·Ï˘ÙÈÎfi ÈÛÙÔÚÈÎfi, Ë ÚÔÛÂÎÙÈÎ‹ ·ÓÙÈÎÂÈÌÂÓÈÎ‹ ÂÍ¤Ù·ÛË Î·È Ô Î·ıÔ‰ËÁÔ‡-ÌÂÓÔ˜ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ Ô‰ËÁÔ‡Ó ÛÙËÓ ·ÓÂ‡ÚÂÛË ÙË˜ ˘ÔÎÂ›ÌÂÓË˜ ·ÈÙÈÔÏÔÁ›·˜.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: √˘‰ÂÙÂÚÔÂÓ›·, ·È‰È¿.

Clinical and laboratory investigation of children with neutropenia

A. Makis, N. Chaliassos

Abstract: Neutropenia is defined as a decrease in the absolute neutrophil count to below normal levelsand is characterized by an increased risk of pyogenic infections. Neutropenia is classified as acute orchronic, inherited or acquired. Inherited neutropenias are caused by an intrinsic defect of proliferation andmaturation of stem or myeloid cells. Most of the acquired neutropenias are secondary to extrinsic factors,postinfectious and drug-induced neutropenia being the commonest forms in children. Neutropenicpatients usually become infected by organisms of their own endogenous flora; the resident bacteria of themouth and oropharynx, gastrointestinal tract, and skin. The type of infection depends on the degree andchronicity of the neutropenia and on the nature of the associated diseases. The risk of severe infection doesnot increase until the neutrophil count falls below 0.5x109/L, but it rises rapidly when the count is below0.2x109/L. The age of the child at presentation, the depth of the neutropenia, the severity of infections andthe presence or absence of non-haematological signs and symptoms all guide the initial investigation of achild with neutropenia.

Key words: Neutropenia, children.

237¶ƒ∞∫∆π∫√ £∂ª∞ PRACTICAL ISSUE

¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹¶·ÓÂÈÛÙËÌÈ·ÎÔ‡¡ÔÛÔÎÔÌÂ›Ô˘ πˆ·ÓÓ›ÓˆÓ


∞Ï¤Í·Ó‰ÚÔ˜ ª¿ÎË˜ [email protected] √Ì‹ÚÔ˘, ∫·Ú‰·Ì›ÙÛÈ·, ∆.∫. 459 00, πˆ¿ÓÓÈÓ·

Paediatric Department ofthe University GeneralHospital of Ioannina

Correspondence:

Alexandros [email protected] Omirou St., Kardamitsia,459 00, Ioannina, Greece

¶·È‰È·ÙÚÈÎ‹ 2007;70:237-245

∂ÈÛ·ÁˆÁ‹

∆· Ô˘‰ÂÙÂÚfiÊÈÏ· Â›Ó·È Î‡ÙÙ·Ú· Ù· ÔÔ›·

ÚÔ¤Ú¯ÔÓÙ·È ·fi ÔÏ˘‰‡Ó·Ì· Î‡ÙÙ·Ú· ÙË˜

ÎÔÎÎÈÒ‰Ô˘˜ Ì˘ÂÏÈÎ‹˜ ÛÂÈÚ¿˜, ÌÂÙ¿ ·fi ÙË ‰Ú¿-

ÛË ÙˆÓ ·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ GM-CSF Î·È G-

CSF Î·È ÚÔÊ˘Ï¿ÛÛÔ˘Ó ÙÔÓ ÔÚÁ·ÓÈÛÌfi ·fi ÙÔ˘˜

˘ÔÁfiÓÔ˘˜ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜. √˘‰ÂÙÂÚÔÂÓ›·

Â›Ó·È Ë ÛËÌ·ÓÙÈÎ‹ ÂÏ¿ÙÙˆÛË ÙÔ˘ ·fiÏ˘ÙÔ˘

·ÚÈıÌÔ‡ ÙˆÓ Î˘ÎÏÔÊÔÚÔ‡ÓÙˆÓ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ

ÛÙÔ ÂÚÈÊÂÚÈÎfi ·›Ì·. Ÿˆ˜ Ê·›ÓÂÙ·È ÛÙÔÓ ¶›Ó·-

Î· 1, ÙÔ Î·ÙÒÙÂÚÔ Ê˘ÛÈÔÏÔÁÈÎfi fiÚÈÔ ÛÙ· ‚Ú¤ÊË

Â›Ó·È 1,0x109/L. ªÂÙ¿ ÙË ‚ÚÂÊÈÎ‹ ÂÚ›Ô‰Ô, Ì¤¯ÚÈ

ÙËÓ ËÏÈÎ›· ÙˆÓ ‰¤Î· ÂÙÒÓ Â›Ó·È 1,5x109/L, ÂÓÒ

ÌÂÙ¤ÂÈÙ· ÙÔ fiÚÈÔ 1,8x109/L ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÁÈ·

ÙÔÓ ÔÚÈÛÌfi ÙË˜ Ô˘‰ÂÙÂÚÔÂÓ›·˜ (1).

∏ Ô˘‰ÂÙÂÚÔÂÓ›· Ù·ÍÈÓÔÌÂ›Ù·È ˆ˜ ‹È· (Î¿-

Ùˆ ·fi ÙÔ ¯·ÌËÏfiÙÂÚÔ fiÚÈÔ, ·ÏÏ¿ >1,0x109/L),

Ì¤ÙÚÈ· (ÌÂÙ·Í‡ 0,5 Î·È 1,0x109/L), ÛÔ‚·Ú‹ (ÌÂ-

Ù·Í‡ 0,2 Î·È 0,5x109/L) Î·È ÔÏ‡ ÛÔ‚·Ú‹

(<0,2x109/L). ∆· Î·ÙÒÙÂÚ· fiÚÈ· Â›Ó·È ¯Ú‹ÛÈÌ·

ÛÙËÓ ÎÏÈÓÈÎ‹ Ú¿ÍË, ÂÂÈ‰‹ Ô Î›Ó‰˘ÓÔ˜ ÛÔ‚·-

ÚÒÓ ÏÔÈÌÒÍÂˆÓ ˘Ê›ÛÙ·Ù·È Â¿Ó Ô ·ÚÈıÌfi˜ ÙˆÓ

Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ Â›Ó·È Î¿Ùˆ ·fi 0,5x109/L Î·È

·˘Í¿ÓÂÙ·È ÛËÌ·ÓÙÈÎ¿ fiÙ·Ó Â›Ó·È Î¿Ùˆ ·fi


0,2x109/L (2). ∏ Ô˘‰ÂÙÂÚÔÂÓ›· ÌÔÚÂ› Ó· Â›Ó·È ÎÏË-ÚÔÓÔÌÈÎ‹ ‹ Â›ÎÙËÙË Î·È ÂÓ‰¤¯ÂÙ·È Ó· ÂÌÊ·ÓÈÛÙÂ›Î·Ù¿ ÙË ÓÂÔÁÓÈÎ‹ ËÏÈÎ›· (Û˘ÁÁÂÓ‹˜) ‹ ÛÙË ÌÂÙ¤ÂÈÙ·˙ˆ‹. ∆· Û˘¯ÓfiÙÂÚ· ·›ÙÈ· Â›Ó·È Ù· Â›ÎÙËÙ· Î·È È‰È·›-ÙÂÚ· ÔÈ ÈÔÁÂÓÂ›˜ ÏÔÈÌÒÍÂÈ˜.

∏ ÚÔÛ¤ÁÁÈÛË ÙÔ˘ ·È‰ÈÔ‡ ÌÂ Ô˘‰ÂÙÂÚÔÂÓ›··ÔÙÂÏÂ› ÚfiÎÏËÛË ÁÈ· ÙÔÓ ÁÂÓÈÎfi ·È‰›·ÙÚÔ, È‰È·›-ÙÂÚ· fiÙ·Ó ÂÌÊ·Ó›˙ÂÙ·È ÛÙË ‚ÚÂÊÈÎ‹ ËÏÈÎ›·, fiÙ·Ó‰È·ÚÎÂ› ·ÚÎÂÙfi ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ‹ fiÙ·Ó Û˘Ó‰˘¿˙Â-Ù·È ÌÂ ÛÔ‚·Ú¤˜ ÏÔÈÌÒÍÂÈ˜ ‹ ÛˆÌ·ÙÈÎ¤˜ ·ÓˆÌ·Ï›Â˜.∆Ô ·Ó·Ï˘ÙÈÎfi ÈÛÙÔÚÈÎfi, Ë ÚÔÛÂÎÙÈÎ‹ ·ÓÙÈÎÂÈÌÂÓÈÎ‹ÂÍ¤Ù·ÛË Î·È Ô Î·ıÔ‰ËÁÔ‡ÌÂÓÔ˜ ÂÚÁ·ÛÙËÚÈ·Îfi˜¤ÏÂÁ¯Ô˜ Ô‰ËÁÔ‡Ó ÛÙË ‰È·ÏÂ‡Î·ÓÛË ÙË˜ ˘ÔÎÂ›ÌÂÓË˜·ÈÙÈÔÏÔÁ›·˜.

™ÙÔ ·ÚfiÓ ¿ÚıÚÔ ı· ·ÚÔ˘ÛÈ·ÛÙÔ‡Ó ÔÈ ÎÏÈÓÈÎ¤˜ÂÎ‰ËÏÒÛÂÈ˜ ÙË˜ Ô˘‰ÂÙÂÚÔÂÓ›·˜, Ù· ·›ÙÈ· Ô˘ Ô‰Ë-ÁÔ‡Ó ÛÂ Ô˘‰ÂÙÂÚÔÂÓ›· Î·È ı· ·Ó·Ï˘ıÂ› Ô ·ÏÁfiÚÈı-ÌÔ˜ ÙË˜ ÎÏÈÓÈÎ‹˜ Î·È ÂÚÁ·ÛÙËÚÈ·Î‹˜ ÚÔÛ¤ÁÁÈÛË˜.

∫ÏÈÓÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ Ô˘‰ÂÙÂÚÔÂÓ›·˜

√È ÏÔÈÌÒÍÂÈ˜ ÛÙ· ·È‰È¿ ÌÂ Ô˘‰ÂÙÂÚÔÂÓ›·ÚÔÎ·ÏÔ‡ÓÙ·È Û˘Ó‹ıˆ˜ ·fi ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜ ÙË˜ÂÓ‰ÔÁÂÓÔ‡˜ ¯ÏˆÚ›‰·˜, fiˆ˜ Â›Ó·È Ù· ÌÈÎÚfi‚È· Ô˘·ÔÈÎ›˙Ô˘Ó ÙË ÛÙÔÌ·ÙÈÎ‹ ÎÔÈÏfiÙËÙ·, ÙÔÓ Ê¿Ú˘ÁÁ·,ÙÔÓ Á·ÛÙÚÂÓÙÂÚÈÎfi ÛˆÏ‹Ó· Î·È ÙÔ ‰¤ÚÌ·. ∏ Â˘·È-ÛıËÛ›· ÛÙÈ˜ ‚·ÎÙËÚÈ·Î¤˜ ÏÔÈÌÒÍÂÈ˜ ÂÍ·ÚÙ¿Ù·È ·fiÙÔÓ ‚·ıÌfi Î·È ÙË ¯ÚÔÓÈfiÙËÙ· ÙË˜ Ô˘‰ÂÙÂÚÔÂÓ›·˜,·ÏÏ¿ Î·È ·fi ÙË Ê‡ÛË ÙË˜ ˘ÔÎÂ›ÌÂÓË˜ ·ÈÙÈÔÏÔÁ›·˜(3). ŸÙ·Ó Ë Ô˘‰ÂÙÂÚÔÂÓ›· ÔÊÂ›ÏÂÙ·È ÛÂ ÂÏ·ÙÙˆÌ¤-ÓË ·Ú·ÁˆÁ‹ ·fi ÙÔÓ Ì˘ÂÏfi, Ë ÛÔ‚·ÚfiÙËÙ· Î·È ËÛ˘¯ÓfiÙËÙ· ÙˆÓ ÏÔÈÌÒÍÂˆÓ Â›Ó·È ·Ó¿ÏÔÁË ÙÔ˘ ·ÚÈı-ÌÔ‡ ÙˆÓ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ Î·È ÙÔ˘ Â›‰Ô˘˜ ÙË˜ ‚Ï¿-‚Ë˜. ªÂ Ô˘‰ÂÙÂÚfiÊÈÏ· <0,2x109/L ˘¿Ú¯ÂÈ ·˘ÍËÌ¤-ÓÔ˜ Î›Ó‰˘ÓÔ˜ ÁÈ· ÛË„·ÈÌ›· ·fi ¯Ú˘Û›˙ÔÓÙ· ÛÙ·Ê˘-ÏfiÎÔÎÎÔ Î·È ·ÚÓËÙÈÎ¿ Î·Ù¿ gram ÌÈÎÚfi‚È·(Pseudomonas aeruginosa, Escherichia coli, Klebsiellaspp). ŸÙ·Ó Ô ·ÚÈıÌfi˜ ÙˆÓ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ Â›Ó·È>0,2x109/L, ÙfiÙÂ ·ÚÔ˘ÛÈ¿˙ÂÙ·È Î˘Ú›ˆ˜ Ô˘ÏÔÛÙÔ-Ì·Ù›ÙÈ‰·, ÂÚÈÚˆÎÙÈÎfi ·fiÛÙËÌ· ‹ Î˘ÙÙ·Ú›ÙÈ‰·,˘ÔÙÚÔÈ¿˙Ô˘ÛÂ˜ ˆÙ›ÙÈ‰Â˜ ‹ ÈÁÌÔÚ›ÙÈ‰Â˜. ∞ÔÛÙ‹-

Ì·Ù·, ÓÂ˘ÌÔÓ›· ‹ ÛË„·ÈÌ›· ÌÔÚÔ‡Ó Ó· ÂÌÊ·ÓÈ-ÛÙÔ‡Ó, ·ÏÏ¿ ÌÂ ÌÈÎÚfiÙÂÚË Û˘¯ÓfiÙËÙ·. ∞ÓÙÈı¤Ùˆ˜,Ù¤ÙÔÈ· ·Ó¿ÏÔÁË Û˘Û¯¤ÙÈÛË ‰ÂÓ ˘¿Ú¯ÂÈ fiÙ·Ó ÙÔ ·›-ÙÈÔ Â›Ó·È Ë ·˘ÍËÌ¤ÓË Î·Ù·ÛÙÚÔÊ‹, fiˆ˜ Â›Ó·È Ë ·˘-ÙÔ¿ÓÔÛË Ô˘‰ÂÙÂÚÔÂÓ›· ‹ Ë Ô˘‰ÂÙÂÚÔÂÓ›· ÌÂÙ¿·fi ÈÔÁÂÓÂ›˜ ÏÔÈÌÒÍÂÈ˜. ¶·È‰È¿ ÌÂ ·˘ÙÔ¿ÓÔÛË Ô˘-‰ÂÙÂÚÔÂÓ›· ÂÓ‰¤¯ÂÙ·È Ó· ¤¯Ô˘Ó Ô˘‰ÂÙÂÚfiÊÈÏ·<0,2x109/L ÁÈ· Ì‹ÓÂ˜ ‹ ¯ÚfiÓÈ· ¯ˆÚ›˜ ÛÔ‚·Ú¤˜ ÏÔÈÌÒÍÂÈ˜.

∆· ·È‰È¿ ÌÂ ¯ÚfiÓÈ· ÛÔ‚·Ú‹ Ô˘‰ÂÙÂÚÔÂÓ›· Ïfi-Áˆ ÂÏ·ÙÙˆÌ¤ÓË˜ ·Ú·ÁˆÁ‹˜ ·fi ÙÔÓ Ì˘ÂÏfi, ÂÌÊ·-Ó›˙Ô˘Ó ÏÈÁfiÙÂÚÔ Û˘¯Ó¿ ‚·ÚÈ¤˜ ÏÔÈÌÒÍÂÈ˜ ÛÂ Û¯¤ÛË ÌÂÙ· ·È‰È¿ Ô˘ ¤¯Ô˘Ó Ô˘‰ÂÙÂÚÔÂÓ›· ÏfiÁˆ ¯ÔÚ‹ÁË-ÛË˜ ·ÓÔÛÔÎ·Ù·ÛÙ·ÏÙÈÎÒÓ ‹ ¯ËÌÂÈÔıÂÚ·Â›·˜. √ Ïfi-ÁÔ˜ Â›Ó·È fiÙÈ ÛÙËÓ ÂÚ›ÙˆÛË ÙË˜ ¯ÚfiÓÈ·˜ ÛÔ‚·Ú‹˜Ô˘‰ÂÙÂÚÔÂÓ›·˜ ˘¿Ú¯ÂÈ Û˘Ó‹ıˆ˜ Ì›· ÌÂÌÔÓˆÌ¤ÓËÎ·È ÂÚÈÔÚÈÛÌ¤ÓË ‰È·Ù·Ú·¯‹ Ô˘ ·ÊÔÚ¿ ÌfiÓÔ ÛÙ·Ô˘‰ÂÙÂÚfiÊÈÏ·, ÌÂ Û˘ÓÔ‰fi ·ÓÙÈÚÚÔÈÛÙÈÎ‹ ·‡ÍËÛËÙˆÓ ÌÔÓÔÎ˘ÙÙ¿ÚˆÓ Î·È ÙˆÓ ËˆÛÈÓÔÊ›ÏˆÓ, Ô˘ ÌÂ ÙËÊ·ÁÔÎ˘ÙÙ·ÚÈÎ‹ ÙÔ˘˜ ‰Ú¿ÛË ·Ó·ÏËÚÒÓÔ˘Ó ÌÂÚÈÎÒ˜ÙÔ ¤ÏÏÂÈÌ· ÙˆÓ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ. ∞ÓÙ›ıÂÙ·, Ë ¯ËÌÂÈÔ-ıÂÚ·Â›· ÂÈ‰Ú¿ Î·Ù·ÛÙÚÔÊÈÎ¿ fi¯È ÌfiÓÔ ÛÙ· Ô˘‰Â-ÙÂÚfiÊÈÏ·, ·ÏÏ¿ Î·È ÛÂ ¿ÏÏÔ˘˜ ÌË¯·ÓÈÛÌÔ‡˜ ÙË˜¿Ì˘Ó·˜ ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡, Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓÔ˘ Î·ÈÙÔ˘ ÊÚ·ÁÌÔ‡ ÙÔ˘ ‚ÏÂÓÓÔÁfiÓÔ˘ ÙË˜ ÛÙÔÌ·ÙÈÎ‹˜ ÎÔÈ-ÏfiÙËÙ·˜ Î·È ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ ÛˆÏ‹Ó·, ÌÂ ·ÔÙ¤-ÏÂÛÌ· ÙËÓ Â›ÛÔ‰Ô ÛÙÔ ·›Ì· ÙˆÓ ÌÈÎÚÔ‚›ˆÓ ÙË˜ Ê˘-ÛÈÔÏÔÁÈÎ‹˜ ¯ÏˆÚ›‰·˜ Î·È ÙËÓ Â·ÎfiÏÔ˘ıË ÌÈÎÚÔ‚È-·ÈÌ›· ‹ ÛË„·ÈÌ›·.

∞›ÙÈ· Ô˘‰ÂÙÂÚÔÂÓ›·˜ ÛÙ· ·È‰È¿

∏ Ô˘‰ÂÙÂÚÔÂÓ›· ÛÙ· ·È‰È¿ ¤¯ÂÈ ÔÏÏ¿ ·›ÙÈ·,fiˆ˜ Ê·›ÓÂÙ·È ÛÙÔÓ ¶›Ó·Î· 2. ∆·ÍÈÓÔÌÂ›Ù·È ÛÂ ÎÏË-ÚÔÓÔÌÈÎ‹ Î·È Â›ÎÙËÙË, ÔÍÂ›· ‹ ¯ÚfiÓÈ·. ™˘ÁÁÂÓ‹˜Â›Ó·È Ë Ô˘‰ÂÙÂÚÔÂÓ›· Ô˘ ÂÌÊ·Ó›˙ÂÙ·È Ï›ÁÔ ÌÂÙ¿ÙË Á¤ÓÓËÛË ‹ ÙÈ˜ ÚÒÙÂ˜ Â‚‰ÔÌ¿‰Â˜ ÙË˜ ˙ˆ‹˜. √ÈÛ˘ÁÁÂÓÂ›˜ Ô˘‰ÂÙÂÚÔÂÓ›Â˜ Â›Ó·È ˆ˜ Â› ÙÔ ÏÂ›ÛÙÔÓÎÏËÚÔÓÔÌÈÎ¤˜ (.¯. ÓfiÛÔ˜ Kostmann, Î˘ÎÏÈÎ‹ Ô˘-‰ÂÙÂÚÔÂÓ›·), ·ÏÏ¿ ÌÔÚÂ› Ó· Â›Ó·È Î·È Â›ÎÙËÙÂ˜(.¯. ÈÛÔ¿ÓÔÛË Ô˘‰ÂÙÂÚÔÂÓ›·). √È ÎÏËÚÔÓÔÌÈÎ¤˜

238 ∞. ª¿ÎË˜, ¡. Ã·ÏÈ¿ÛÔ˜


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

ª¤ÛÔ˜ fiÚÔ˜ (x109/L) ∂‡ÚÔ˜ (x109/L) ¶ÔÛÔÛÙfi %

°¤ÓÓËÛË 11,0 6,0-26,0 6112 ÒÚÂ˜ 15,5 6,0-28,0 6824 ÒÚÂ˜ 11,5 5,0-21,0 611Ë Â‚‰ÔÌ¿‰· 5,5 1,5-10,0 452Ë Â‚‰ÔÌ¿‰· 4,5 1,0-9,5 401Ô˜ Ì‹Ó·˜ 3,8 1,0-9,0 351Ô ¤ÙÔ˜ 3,5 1,5-8,5 316Ô ¤ÙÔ˜ 4,3 1,5-8,0 5110Ô ¤ÙÔ˜ 4,4 1,8-8,0 5416Ô ¤ÙÔ˜ 4,4 1,8-8,0 59


Ô˘‰ÂÙÂÚÔÂÓ›Â˜ ÔÊÂ›ÏÔÓÙ·È ÛÂ ÂÓ‰ÔÁÂÓÂ›˜ ‰È·Ù·Ú·-

¯¤˜ ÙˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ, ÂÓÒ ÔÈ Â›ÎÙËÙÂ˜

ÚÔ¤Ú¯ÔÓÙ·È Û˘Ó‹ıˆ˜ ·fi ÂÍˆÁÂÓÂ›˜ ·Ú¿ÁÔÓÙÂ˜

Ô˘ ÂÈ‰ÚÔ‡Ó ÛÙÔ Ô˘‰ÂÙÂÚfiÊÈÏÔ.

∞. ∫ÏËÚÔÓÔÌÈÎ¤˜ Ô˘‰ÂÙÂÚÔÂÓ›Â˜

¡fiÛÔ˜ Kostmann (ÛÔ‚·Ú‹ ‚ÚÂÊÈÎ‹

·ÎÔÎÎÈÔÎ˘ÙÙ·Ú·ÈÌ›·)

¶ÚfiÎÂÈÙ·È ÁÈ· ¤Ó· ÓfiÛËÌ· Ô˘ ÌÂÙ·‚È‚¿˙ÂÙ·È ÌÂ

ÙÔÓ ·˘ÙÔÛˆÌÈÎfi ˘ÔÏÂÈfiÌÂÓÔ ¯·Ú·ÎÙ‹Ú·. ∆˘ÈÎ¿,

·ÚÔ˘ÛÈ¿˙ÂÙ·È ÛÙË ‚ÚÂÊÈÎ‹ ËÏÈÎ›· ÌÂ ÛÔ‚·Ú‹ ‹ Ô-

Ï‡ ÛÔ‚·Ú‹ Ô˘‰ÂÙÂÚÔÂÓ›· Î·È Û˘¯Ó¤˜ ÛÔ‚·Ú¤˜ ‚·-

ÎÙËÚÈ·Î¤˜ ÏÔÈÌÒÍÂÈ˜, ÂÓÒ ÛÙÔ Ì˘ÂÏfiÁÚ·ÌÌ· ·Ó·‰ÂÈ-

ÎÓ‡ÂÙ·È ·Ó·ÛÙÔÏ‹ ÙË˜ ˆÚ›Ì·ÓÛË˜ ÛÙË Ê¿ÛË ÙÔ˘

ÚÔÌ˘ÂÏÔÎ˘ÙÙ¿ÚÔ˘ / Ì˘ÂÏÔÎ˘ÙÙ¿ÚÔ˘ (4). ™˘¯Ó¿

˘¿Ú¯ÂÈ ·ÓÙÈ‰Ú·ÛÙÈÎ‹ ÌÔÓÔÎ˘ÙÙ¿ÚˆÛË Î·È ‹È· Ëˆ-

ÛÈÓÔÊÈÏ›·. ™Â ¤Ó· ÛËÌ·ÓÙÈÎfi ÔÛÔÛÙfi ÙˆÓ ·ÛıÂÓÒÓ,

ÂÚ›Ô˘ 12%, ˘¿Ú¯ÂÈ ÂÍ·ÏÏ·Á‹ ÛÂ Ì˘ÂÏÔ‰˘ÛÏ·-

ÛÙÈÎfi Û‡Ó‰ÚÔÌÔ ‹ ÔÍÂ›· Ì˘ÂÏÔÁÂÓ‹ ÏÂ˘¯·ÈÌ›· (5-7).

∏ ·ıÔÊ˘ÛÈÔÏÔÁ›· ÙË˜ ÓfiÛÔ˘ ·Ú·Ì¤ÓÂÈ ·ÎfiÌË ·‰È-

Â˘ÎÚ›ÓÈÛÙË. ¶ÚfiÛÊ·Ù·, ¤¯Ô˘Ó ‚ÚÂıÂ› ÌÂÙ·ÏÏ¿ÍÂÈ˜

ÛÙÔ ÁÔÓ›‰ÈÔ ELA2 Ô˘ Â›Ó·È ˘Â‡ı˘ÓÔ ÁÈ· ÙËÓ ·Ú·-

ÁˆÁ‹ ÙË˜ ÂÏ·ÛÙ¿ÛË˜ ÙˆÓ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ (8,9). ªÂ-

Ù·ÏÏ¿ÍÂÈ˜ ÛÙÔ ÁÔÓ›‰ÈÔ ELA2 ›Ûˆ˜ Ó· Ô‰ËÁÔ‡Ó ÛÂ ·-

Ú·ÁˆÁ‹ ÙÚÔÔÔÈËÌ¤ÓË˜ ÂÏ·ÛÙ¿ÛË˜, Ë ÔÔ›· ·Ô-

‰ÂÛÌÂ‡ÂÙ·È Ì¤Û· ÛÙÔ ÚÔÌ˘ÂÏÔÎ‡ÙÙ·ÚÔ Î·È ÙÔ Î·-

Ù·ÛÙÚ¤ÊÂÈ ‹ Â¿ÁÂÈ ÙËÓ ·fiÙˆÛ‹ ÙÔ˘ (10). ∏ ıÂÚ·-

Â›· Â›Ó·È Ë ¯ÔÚ‹ÁËÛË G-CSF Î·È Ë ÚÔÊ˘Ï·ÎÙÈÎ‹

Ï‹„Ë ·ÓÙÈ‚ÈÔÙÈÎÒÓ. ¢Â‰ÔÌ¤ÓÔ˘ ÙÔ˘ ÛËÌ·ÓÙÈÎÔ‡ ÎÈÓ-

‰‡ÓÔ˘ Î·ÎÔ‹ıÔ˘˜ ÂÍ·ÏÏ·Á‹˜, ÛÂ ·ÚÎÂÙ¿ Î¤ÓÙÚ· Á›-

ÓÂÙ·È ÌÂÙ·ÌfiÛ¯Â˘ÛË Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ, Â¿Ó ˘¿Ú-

¯ÂÈ Û˘Ì‚·Ùfi˜ ·‰ÂÚÊfi˜, ÚÈÓ ÙËÓ ÂÌÊ¿ÓÈÛË ¯ÚˆÌÔ-

ÛˆÌÈ·ÎÒÓ ·ÓˆÌ·ÏÈÒÓ (11).

∫˘ÎÏÈÎ‹ Ô˘‰ÂÙÂÚÔÂÓ›·

∏ Î˘ÎÏÈÎ‹ Ô˘‰ÂÙÂÚÔÂÓ›· ÌÂÙ·‚È‚¿˙ÂÙ·È ÌÂ ÙÔÓ

·˘ÙÔÛˆÌÈÎfi ÂÈÎÚ·ÙÔ‡ÓÙ· ¯·Ú·ÎÙ‹Ú· Î·È ÛÂ Û¯¤ÛË

ÌÂ ÙË ÓfiÛÔ ÙÔ˘ Kostmann ÂÎ‰ËÏÒÓÂÙ·È Ï›ÁÔ ·ÚÁfiÙÂ-

Ú· ·fi ÙË ‚ÚÂÊÈÎ‹ ËÏÈÎ›· Î·È ÌÂ ÏÈÁfiÙÂÚÔ ÛÔ‚·Ú¤˜

ÏÔÈÌÒÍÂÈ˜, ÂÓÒ ‰ÂÓ ˘¿Ú¯ÂÈ Î›Ó‰˘ÓÔ˜ ÏÂ˘¯·ÈÌÔÁ¤ÓÂ-

ÛË˜ (12). ∆˘ÈÎ¿ ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÂÚÈÔ‰ÈÎ‹ Ô˘‰ÂÙÂ-

ÚÔÂÓ›· <0,2x109/L ÁÈ· 3-5 ËÌ¤ÚÂ˜, Î¿ıÂ ÂÚ›Ô˘ 21

ËÌ¤ÚÂ˜ (ÌÂ Â‡ÚÔ˜ 13-35 ËÌ¤ÚÂ˜), ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ‹

Û¯Â‰fiÓ Ê˘ÛÈÔÏÔÁÈÎfi ·ÚÈıÌfi Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ ÛÙ· ÌÂ-

ÛÔ‰È·ÛÙ‹Ì·Ù·. ™ÙÔ Ó·‰›Ú ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ Ô˘‰ÂÙÂ-

ÚÔÊ›ÏˆÓ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Û˘Ó‹ıˆ˜ ÛÙÔÌ·ÙÈÎ¿ ¤ÏÎË

·fi ·Ó·ÂÚfi‚È· ÌÎÚfi‚È· ÌÂ ·˘ÍËÌ¤ÓÔ Î›Ó‰˘ÓÔ ÁÈ·

ÁÂÓÈÎÂ˘Ì¤ÓË ÏÔ›ÌˆÍË, ˘ÚÂÙfi˜, ˆÙ›ÙÈ‰·, ÏÔÈÌÒÍÂÈ˜

·Ó·ÓÂ˘ÛÙÈÎÔ‡ Î·È Û·ÓÈfiÙÂÚ· ÂÚÈÚˆÎÙÈÎ¿ ·Ô-

ÛÙ‹Ì·Ù·. ™Â ÔÚÈÛÌ¤ÓÂ˜ ÂÚÈÙÒÛÂÈ˜ ̆ ¿Ú¯ÂÈ Î·È Â-

ÚÈÔ‰ÈÎ‹ ıÚÔÌ‚ÔÂÓ›· Î·È ÂÏ¿ÙÙˆÛË ÙˆÓ ‰ÈÎÙ˘ÔÂÚ˘-

ıÚÔÎ˘ÙÙ¿ÚˆÓ. ™ËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ·ıÔÁ¤ÓÂÛË

ÙË˜ ÓfiÛÔ˘ ·›˙Ô˘Ó ÔÈ ÌÂÙ·ÏÏ¿ÍÂÈ˜ ÛÙÔ ÁÔÓ›‰ÈÔ ELA2

ÙË˜ ÂÏ·ÛÙ¿ÛË˜ ÙˆÓ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ, Î·ıÒ˜ ¤¯Ô˘Ó

‚ÚÂıÂ› ÛÙËÓ ÏÂÈÔ„ËÊ›· ÙˆÓ ·ÛıÂÓÒÓ (13). ∏ ‰È¿-

ÁÓˆÛË Ù›ıÂÙ·È ·fi ÙÔ ÎÏËÚÔÓÔÌÈÎfi Î·È ·ÙÔÌÈÎfi ·Ó·-

ÌÓËÛÙÈÎfi Î·È ÙËÓ ·Ó›¯ÓÂ˘ÛË ÙˆÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ

ELA2. ∂¿Ó ‰ÂÓ ˘¿Ú¯ÂÈ Ë ‰˘Ó·ÙfiÙËÙ· ÙÔ˘ ÌÔÚÈ·ÎÔ‡

ÂÏ¤Á¯Ô˘, ÙfiÙÂ Ú¤ÂÈ Ó· Á›ÓÂÙ·È ·ÈÌÔÏË„›· Î·È ÁÂÓÈ-

Î‹ ·›Ì·ÙÔ˜ ÙÚÂÈ˜ ÊÔÚ¤˜ ÙËÓ Â‚‰ÔÌ¿‰· ÁÈ· ¤ÍÈ Â‚‰Ô-

Ì¿‰Â˜ ÁÈ· Ó· ·Ó·‰ÂÈ¯ıÂ› Ë Î˘ÎÏÈÎ‹ Ô˘‰ÂÙÂÚÔÂÓ›·.

£ÂÚ·Â›· ·ÔÙÂÏÔ‡Ó Ë ¯ÔÚ‹ÁËÛË G-CSF Î·È Ë ÚÔ-

Ê˘Ï·ÎÙÈÎ‹ Ï‹„Ë ·ÓÙÈ‚ÈÔÙÈÎÒÓ.

™‡Ó‰ÚÔÌÔ Shwachman-Diamond

¶ÚfiÎÂÈÙ·È ÁÈ· Ì›· Û¿ÓÈ· ÓfiÛÔ Ô˘ ÌÂÙ·‚È‚¿˙Â-

Ù·È ÌÂ ÙÔÓ ·˘ÙÔÛˆÌÈÎfi ˘ÔÏÂÈfiÌÂÓÔ ÙÚfiÔ Î·È ¯·-

Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÂÍˆÎÚÈÓ‹ ·ÁÎÚÂ·ÙÈÎ‹ ·ÓÂ¿Ú-

ÎÂÈ·, ÛÎÂÏÂÙÈÎ¤˜ ·ÓˆÌ·Ï›Â˜ Î·È Ô˘‰ÂÙÂÚÔÂÓ›· (14).

ªÂÙ¿ ÙËÓ ÈÓÔÎ˘ÛÙÈÎ‹ ÓfiÛÔ Â›Ó·È Ë ‰Â‡ÙÂÚË ÛÂ Û˘-

¯ÓfiÙËÙ· ·ÈÙ›· ÂÍˆÎÚÈÓÔ‡˜ ·ÁÎÚÂ·ÙÈÎ‹˜ ·ÓÂ¿ÚÎÂÈ-

·˜ ÛÙ· ·È‰È¿. ¶·ÚÔ˘ÛÈ¿˙ÂÙ·È ÛÙË ‚ÚÂÊÈÎ‹ ËÏÈÎ›·

ÌÂ ·ÓÂ·ÚÎ‹ ÚfiÛÏË„Ë ‚¿ÚÔ˘˜, ‰˘Û·ÔÚÚfiÊËÛË

Î·È Û˘¯Ó¤˜ Î·È ÛÔ‚·Ú¤˜ ‚·ÎÙËÚÈ·Î¤˜ ÏÔÈÌÒÍÂÈ˜.

ÕÏÏÂ˜ ÂÎ‰ËÏÒÛÂÈ˜ Â›Ó·È ÙÔ ÎÔÓÙfi ·Ó¿ÛÙËÌ·, Ë ‰˘-

ÛÏ·Û›· ÂÈÊ‡ÛÂˆÓ Î·È ÌÂÙ·Ê‡ÛÂˆÓ, Ë Ë·ÙÈÎ‹ ‰˘-

ÛÏÂÈÙÔ˘ÚÁ›·, ÔÈ ÓÂÊÚÔÛˆÏËÓ·ÚÈ·Î¤˜ ‰È·Ù·Ú·¯¤˜ Î·È

ÂÓ‰Â¯ÔÌ¤Óˆ˜ Ë „˘¯ÔÎÈÓËÙÈÎ‹ Î·ı˘ÛÙ¤ÚËÛË. ™ÙÔ

50% ÙˆÓ ÂÚÈÙÒÛÂˆÓ Ë ·ÁÎÚÂ·ÙÈÎ‹ ‰˘ÛÏÂÈÙÔ˘Ú-

Á›· ·ÔÎ·ı›ÛÙ·Ù·È ÛÙ·‰È·Î¿ ÛÂ ÌÂÁ·Ï‡ÙÂÚË ËÏÈÎ›·.

∂Í·ÏÏ·Á‹ ÛÂ Ì˘ÂÏÔ‰˘ÛÏ·ÛÙÈÎfi Û‡Ó‰ÚÔÌÔ ‹ ÔÍÂ›·

Ì˘ÂÏÔÁÂÓ‹ ÏÂ˘¯·ÈÌ›· ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÛÙÔ 15% ÙˆÓ

ÂÚÈÙÒÛÂˆÓ (15). £ÂÚ·Â˘ÙÈÎ¿ ¯ÔÚËÁÔ‡ÓÙ·È ·-

ÁÎÚÂ·ÙÈÎ¿ ¤Ó˙˘Ì· Î·È, Â¿Ó Û˘Ì‚·›ÓÔ˘Ó ÛÔ‚·Ú¤˜ ÏÔÈ-

ÌÒÍÂÈ˜, ¯ÔÚËÁÂ›Ù·È Î·È G-CSF.

™‡Ó‰ÚÔÌÔ Pearson

∏ Û¿ÓÈ· ·˘Ù‹ ÓfiÛÔ˜ ‚Ú›ÛÎÂÙ·È ÛÙË ‰È·ÊÔÚÈÎ‹

‰È¿ÁÓˆÛË fiÙ·Ó ‰ÈÂÚÂ˘ÓÔ‡ÌÂ ·È‰› ÌÂ Èı·Ófi Û‡Ó‰ÚÔ-

ÌÔ Shwachman-Diamond, ·ÏÏ¿ ÙË ‰È¿ÁÓˆÛË ı¤ÙÂÈ Ë

239¢ÈÂÚÂ‡ÓËÛË Ô˘‰ÂÙÂÚoÂÓ›·˜ ÛÙ· ·È‰È¿

¶·È‰È·ÙÚÈÎ‹ 2007;70:237-245

¶›Ó·Î·˜ 2. ∞›ÙÈ· Ô˘‰ÂÙÂÚÔÂÓ›·˜ ÛÙ· ·È‰È¿

∫ÏËÚÔÓÔÌÈÎ‹ ∂›ÎÙËÙË

™‡Ó‰ÚÔÌÔ Kostmann §Ô›ÌˆÍË∫˘ÎÏÈÎ‹ Ô˘‰ÂÙÂÚÔÂÓ›· º¿ÚÌ·Î·™‡Ó‰ÚÔÌÔ Shwachman- πÛÔ- Î·È ·˘ÙÔ-¿ÓÔÛËDiamond™‡Ó‰ÚÔÌÔ Pearson ¢È‹ıËÛË Ì˘ÂÏÔ‡°Ï˘ÎÔÁÔÓ›·ÛË Ù‡Ô˘ 1b ÀÂÚÛÏËÓÈÛÌfi˜™‡Ó‰ÚÔÌ· ÚˆÙÔ·ıÒÓ ∞Ï·ÛÙÈÎ‹ ·Ó·ÈÌ›··ÓÔÛÔ·ÓÂ·ÚÎÂÈÒÓ∞Ó·ÈÌ›· Fanconi ª˘ÂÏÔ‰˘ÛÏ·ÛÙÈÎfi Û‡Ó‰ÚÔÌÔ™˘ÁÁÂÓ‹˜ ‰˘ÛÎÂÚ¿ÙˆÛË ¶·ÚÔÍ˘ÛÌÈÎ‹ Ó˘¯ÙÂÚÈÓ‹

·ÈÌÔÛÊ·ÈÚÈÓÔ˘Ú›·ª˘ÂÏÔÎ·¯ÂÍ›· ∞ÓÂ¿ÚÎÂÈ· µ12, Ê˘ÏÏÈÎÔ‡ ™‡Ó‰ÚÔÌÔ Barth


¯·Ú·ÎÙËÚÈÛÙÈÎ‹ ÂÈÎfiÓ· ÙÔ˘ Ì˘ÂÏÔ‡. ¶ÚfiÎÂÈÙ·È Ô˘-

ÛÈ·ÛÙÈÎ¿ ÁÈ· Ì›· Û˘ÛÙËÌ·ÙÈÎ‹ ÓfiÛÔ Ô˘ ÚÔÎ‡ÙÂÈ

·fi ÌÂÙ·ÏÏ¿ÍÂÈ˜ ÙÔ˘ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ DNA Î·È ÂÎ-

‰ËÏÒÓÂÙ·È ÛÂ ÌÈÎÚ‹ ËÏÈÎ›· ÌÂ ·ÓıÂÎÙÈÎ‹ ÛÈ‰ËÚÔ-

‚Ï·ÛÙÈÎ‹ ·Ó·ÈÌ›·, ÌÂ ÎÂÓÔÙfiÈ· ÛÙ· ¿ˆÚ· Ì˘ÂÏÈÎ¿

Î‡ÙÙ·Ú·, Ô˘‰ÂÙÂÚÔÂÓ›·, ıÚÔÌ‚ÔÂÓ›·, ÂÍˆÎÚÈÓ‹

·ÁÎÚÂ·ÙÈÎ‹ ·ÓÂ¿ÚÎÂÈ· Î·È Á·Ï·ÎÙÈÎ‹ ÔÍ¤ˆÛË

(16,17).

°Ï˘ÎÔÁÔÓ›·ÛË Ù‡Ô˘ 1b

∏ ÁÏ˘ÎÔÁÔÓ›·ÛË ·˘Ù‹ ÌÂÙ·‚È‚¿˙ÂÙ·È ÌÂ ÙÔÓ ·˘-

ÙÔÛˆÌÈÎfi ˘ÔÏÂÈfiÌÂÓÔ ÙÚfiÔ Î·È ÚÔÎ‡ÙÂÈ ·fi

ÙËÓ ¤ÏÏÂÈ„Ë ÙÔ˘ ÂÓ˙‡ÌÔ˘ ÁÏ˘ÎÔ˙Ô-6-ÊˆÛÊÔ-

translocase ÌÂ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·ÓÂ·ÚÎ‹ ·Ú·ÁˆÁ‹

ÁÏ˘Îfi˙Ë˜ ÌÂ ÙË ÁÏ˘ÎÔÓÂÔÁ¤ÓÂÛË ‹ ÙË ÁÏ˘ÎÔÁÔÓfiÏ˘-

ÛË. ∆· ·È‰È¿ ·˘Ù¿ ÂÌÊ·Ó›˙Ô˘Ó ˘ÔÁÏ˘Î·ÈÌ›·, Ë·-

ÙÔÛÏËÓÔÌÂÁ·Ï›·, Û·ÛÌÔ‡˜ Î·È ÌÂÚÈÎ¤˜ ÊÔÚ¤˜ ÛÔ-

‚·Ú‹ Ô˘‰ÂÙÂÚÔÂÓ›· ÌÂ Û˘ÓÔ‰fi ‰È·Ù·Ú·¯‹ ÙË˜ ÏÂÈ-

ÙÔ˘ÚÁ›·˜ ÙˆÓ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ ÌÂ ÌË¯·ÓÈÛÌfi Ô˘ ·-

Ú·Ì¤ÓÂÈ ·‰ÈÂ˘ÎÚ›ÓÈÛÙÔ˜ (18). ∂Ó‰Â¯fiÌÂÓˆ˜ Ó· ÂË-

ÚÂ¿˙ÂÙ·È ¿ÌÂÛ· Ë Ì˘ÂÏÔÔ›ËÛË, ‰ÈfiÙÈ ÛÂ ÂÚÈÙÒ-

ÛÂÈ˜ Ô˘ ¤ÁÈÓÂ ÔÚıÔÙÔÈÎ‹ ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜

‰ÂÓ ‰ÈÔÚıÒıËÎÂ Ë Ô˘‰ÂÙÂÚÔÂÓ›· (19).

™‡Ó‰ÚÔÌ· ÚˆÙÔ·ıÒÓ ·ÓÔÛÔ·ÓÂ·ÚÎÂÈÒÓ

∏ Ô˘‰ÂÙÂÚÔÂÓ›· ·ÔÙÂÏÂ› ÂÎ‰‹ÏˆÛË ·ÚÎÂÙÒÓ

Û˘Ó‰ÚfiÌˆÓ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·˜, fiˆ˜ Â›Ó·È Ë Ê˘ÏÔ-

Û‡Ó‰ÂÙË ·Á·ÌÌ·ÛÊ·ÈÚÈÓ·ÈÌ›· (ÓfiÛÔ˜ Bruton), ·ÓÂ-

¿ÚÎÂÈ· CD40-ligand (Ê˘ÏÔÛ‡Ó‰ÂÙÔ ˘ÂÚ-IgM Û‡Ó-

‰ÚÔÌÔ), cartilage hair hypoplasia, ‰ÈÎÙ˘ˆÙ‹ ‰˘ÛÁÂÓÂ-

Û›· (reticular dysgenesis) Î.¿. ¶Èı·ÓfiÓ, Ô ÌË¯·ÓÈÛÌfi˜

ÙË˜ Ô˘‰ÂÙÂÚÔÂÓ›·˜ Ó· Â›Ó·È ·˘ÙÔ¿ÓÔÛÔ˜, fiÌˆ˜

·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ ·ÓÂ˘Ú›ÛÎÔÓÙ·È

ÛÂ ¤Ó· Û¯ÂÙÈÎ¿ ÌÈÎÚfi ÔÛÔÛÙfi ·˘ÙÒÓ ÙˆÓ ·È‰ÈÒÓ

(20). ¶ÚfiÛÊ·Ù· ·Ó·‰Â›¯ıËÎÂ fiÙÈ Ô CD40 ligand ‰ÈÂ-

ÁÂ›ÚÂÈ Ù· Î‡ÙÙ·Ú· ÙÔ˘ ÛÙÚÒÌ·ÙÔ˜ ÙÔ˘ Ì˘ÂÏÔ‡ ÁÈ· Ó·

·Ú¿ÁÔ˘Ó flt3-ligand Î·È ıÚÔÌ‚ÔÔÈËÙ›ÓË Ô˘ Â›Ó·È

··Ú·›ÙËÙÔÈ ·˘ÍËÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ ÁÈ· ÙË Ì˘ÂÏÔ-

Ô›ËÛË (21). ∆Ô Â‡ÚËÌ· ·˘Ùfi ›Ûˆ˜ Ó· ÂÍËÁÂ› ÙËÓ Ô˘-

‰ÂÙÂÚÔÂÓ›· ÛÙ· ·È‰È¿ ÌÂ ·ÓÂ¿ÚÎÂÈ· CD40-

ligand. ∞Í›˙ÂÈ Ó· ÛËÌÂÈˆıÂ› fiÙÈ ÛÙËÓ ·ÓÂ¿ÚÎÂÈ·

CD40-ligand, Ë ÂÈÎfiÓ· ÙÔ˘ Ì˘ÂÏÔ‡ Â›Ó·È ·ÚfiÌÔÈ·

ÌÂ ÙË ÓfiÛÔ Kostmann, ‰ËÏ·‰‹ ÌÂ ·Ó·ÛÙÔÏ‹ ÙË˜ ̂ Ú›-

Ì·ÓÛË˜ ÛÙË Ê¿ÛË ÙÔ˘ ÚÔÌ˘ÂÏÔÎ˘ÙÙ¿ÚÔ˘-Ì˘ÂÏÔ-

Î˘ÙÙ¿ÚÔ˘. ∞˘Ùfi ·Ó·‰ÂÈÎÓ‡ÂÈ ÙË ÛËÌ·Û›· ÙÔ˘ ·ÓÔÛÔ-

ÏÔÁÈÎÔ‡ ÂÏ¤Á¯Ô˘ ÛÂ ·È‰È¿ Ô˘ ‰ÈÂÚÂ˘ÓÒÓÙ·È ÁÈ·

ÛÔ‚·Ú‹ ¯ÚfiÓÈ· Ô˘‰ÂÙÂÚÔÂÓ›·.

™‡Ó‰ÚÔÌÔ Chediak-Higashi: AÓ‹ÎÂÈ ÛÙ· Û‡Ó‰ÚÔÌ·

·ÏÊÈÛÌÔ‡ Î·È ÌÂÙ·‚È‚¿˙ÂÙ·È ÌÂ ÙÔÓ ·˘ÙÔÛˆÌÈÎfi

˘ÔÏÂÈfiÌÂÓÔ ¯·Ú·ÎÙ‹Ú·. Ã·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÌÂ-

ÚÈÎfi ÔÊı·ÏÌÔ‰ÂÚÌ·ÙÈÎfi ·ÏÊÈÛÌfi, ÂÚÈÊÂÚÈÎ‹ ÓÂ˘-

Ú›ÙÈ‰·, Ô˘‰ÂÙÂÚÔÂÓ›· ÌÂ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÌÂÁ¿Ï·

¤ÁÎÏÂÈÛÙ· ÛÙ· Ô˘‰ÂÙÂÚfiÊÈÏ· Î·È ÔÈÔÙÈÎ¤˜ ‰È·Ù·Ú·-

¯¤˜ ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ (22). ™ÙËÓ ÂÈÙ·¯˘ÓfiÌÂÓË

Ê¿ÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ˘¿Ú¯ÂÈ ·ÓÎ˘ÙÙ·ÚÔÂÓ›·,

ÁÂÓÈÎÂ˘Ì¤ÓË ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ·, Ë·ÙÔÛÏËÓÔÌÂÁ·-

Ï›· Î·È ÂÎÙÂÙ·Ì¤ÓË ‰È‹ıËÛË ÙˆÓ ÈÛÙÒÓ ·fi ÏÂÌÊÔ-

ÂÈ‰‹ Î‡ÙÙ·Ú·.

™‡Ó‰ÚÔÌÔ Wiskott Aldrich: ªÂÙ·‚È‚¿˙ÂÙ·È ÌÂ ÙÔÓ

Ê˘ÏÔÛ‡Ó‰ÂÙÔ ˘ÔÏÂÈfiÌÂÓÔ ¯·Ú·ÎÙ‹Ú· Î·È ÂÎ‰Ë-

ÏÒÓÂÙ·È Î˘Ú›ˆ˜ ÌÂ: ·) ¤Î˙ÂÌ·, ‚) ·ÈÌÔÚÚ·Á›Â˜ ÏfiÁˆ

ıÚÔÌ‚ÔÂÓ›·˜ (ÌÂ ÔÏ‡ ÌÈÎÚ¿ ·ÈÌÔÂÙ¿ÏÈ·) Î·È

ÔÈÔÙÈÎ‹˜ ‰È·Ù·Ú·¯‹˜ ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ Î·È Á) ÏÔÈ-

ÌÒÍÂÈ˜ ÏfiÁˆ ÙË˜ Ô˘‰ÂÙÂÚÔÂÓ›·˜ Î·È ÙË˜ ÌÈÎÙ‹˜

·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·˜ (23). À¿Ú¯ÂÈ, Â›ÛË˜, ·˘ÍËÌ¤-

ÓÔ˜ Î›Ó‰˘ÓÔ˜ ÁÈ· ÂÌÊ¿ÓÈÛË ÏÂÌÊˆÌ¿ÙˆÓ (24). ∂Êfi-

ÛÔÓ ˘¿Ú¯ÂÈ Û˘Ì‚·Ùfi˜ ·‰ÂÚÊfi˜, Ë ıÂÚ·Â›· Â›Ó·È Ë

ÌÂÙ·ÌfiÛ¯Â˘ÛË ·Ú¯¤ÁÔÓˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿-

ÚˆÓ. ™Â ·ÓÙ›ıÂÙË ÂÚ›ÙˆÛË, Á›ÓÂÙ·È ÛÏËÓÂÎÙÔÌ‹,

Ë ÔÔ›· fiÌˆ˜ ‰ÈÔÚıÒÓÂÈ ÌfiÓÔ ÙË ıÚÔÌ‚ÔÂÓ›·.

∞Ó·ÈÌ›· Fanconi

∏ ·Ó·ÈÌ›· Fanconi Â›Ó·È Ì›· ÌÔÚÊ‹ ·Ï·ÛÙÈÎ‹˜

·Ó·ÈÌ›·˜ Ô˘ ·Ó‹ÎÂÈ ÛÙ· ÎÏËÚÔÓÔÌÈÎ¿ Û‡Ó‰ÚÔÌ·

Ì˘ÂÏÈÎ‹˜ ·ÓÂ¿ÚÎÂÈ·˜ (25). ªÂÙ·‚È‚¿˙ÂÙ·È ÌÂ ÙÔÓ

·˘ÙÔÛˆÌÈÎfi ˘ÔÏÂÈfiÌÂÓÔ ¯·Ú·ÎÙ‹Ú· Î·È ˘¿Ú¯ÂÈ

‚·ÛÈÎ‹ ·ÓÂ¿ÚÎÂÈ· ÛÙËÓ ÂÈ‰ÈfiÚıˆÛË ÙˆÓ ‚Ï·‚ÒÓ

ÙÔ˘ DNA. ∂Î‰ËÏÒÓÂÙ·È Î˘Ú›ˆ˜ ÛÂ ËÏÈÎ›· 5-10 ÂÙÒÓ

Î·È Û¿ÓÈ· ÛÙË ‚ÚÂÊÈÎ‹ ËÏÈÎ›·. ™˘Ó‹ıˆ˜ Û˘Ó˘¿Ú-

¯Ô˘Ó ÔÏÏ·Ï¤˜ ·ÓˆÌ·Ï›Â˜, fiˆ˜ Â›Ó·È ÙÔ ÎÔÓÙfi

·Ó¿ÛÙËÌ·, ÌÈÎÚÔÎÂÊ·Ï›·, café-au-lait ÎËÏ›‰Â˜, ·Ô-

¯ÚˆÌ·ÙÈÛÌfi˜ ‰¤ÚÌ·ÙÔ˜, ÔÛÙÈÎ¤˜ ·ÓˆÌ·Ï›Â˜, ·Ó·ÙÔ-

ÌÈÎ¿ ÚÔ‚Ï‹Ì·Ù· ·fi ÙÔ Ô˘ÚÔÔÈÔÁÂÓÓËÙÈÎfi, Ù·

ÒÙ· Î·È ÙÔ˘˜ ÔÊı·ÏÌÔ‡˜ Î·È ‰È·ÓÔËÙÈÎ‹ Î·ı˘ÛÙ¤-

ÚËÛË. ™˘Ó‹ıˆ˜ ÂÎ‰ËÏÒÓÂÙ·È ÌÂ ·Ó·ÈÌ›· Î·È ıÚÔÌ-

‚ÔÂÓ›· Î·È Û·ÓÈfiÙÂÚ· ÌÂ ÌÂÌÔÓˆÌ¤ÓË Ô˘‰ÂÙÂÚÔ-

ÂÓ›·. ∏ ‰È¿ÁÓˆÛË ÂÈ‚Â‚·ÈÒÓÂÙ·È ÌÂ ÙË ‰ÔÎÈÌ·Û›·

Â˘ıÚ·˘ÛÙfiÙËÙ·˜ ÙˆÓ ¯ÚˆÌÔÛˆÌ¿ÙˆÓ ÛÂ ÌÈÙÔÁfiÓÂ˜

Ô˘Û›Â˜. ¢˘ÓËÙÈÎ¿ ˘¿Ú¯ÂÈ Î›Ó‰˘ÓÔ˜ ÁÈ· ÂÍ·ÏÏ·Á‹ ÛÂ

Ì˘ÂÏÔ‰˘ÛÏ·ÛÙÈÎfi Û‡Ó‰ÚÔÌÔ ‹ ÔÍÂ›· Ì˘ÂÏÔÁÂÓ‹

ÏÂ˘¯·ÈÌ›·, fiˆ˜ Â›ÛË˜ Î·È ÁÈ· ÂÌÊ¿ÓÈÛË Î·ÚÎ›ÓÔ˘

ÙÔ˘ ÚÈÓÔÊ¿Ú˘ÁÁ· (26).

™˘ÁÁÂÓ‹˜ ‰˘ÛÎÂÚ¿ÙˆÛË

∞ÔÙÂÏÂ› ¤Ó· Û¿ÓÈÔ ÓfiÛËÌ· Ô˘ ·Ó‹ÎÂÈ Î·È ·˘-

Ùfi ÛÙ· ÎÏËÚÔÓÔÌÈÎ¿ Û‡Ó‰ÚÔÌ· Ì˘ÂÏÈÎ‹˜ ·ÓÂ¿ÚÎÂÈ-

·˜. ªÂÙ·‚È‚¿˙ÂÙ·È ÌÂ ÙÔÓ Ê˘ÏÔÛ‡Ó‰ÂÙÔ ˘ÔÏÂÈfi-

ÌÂÓÔ ¯·Ú·ÎÙ‹Ú· Î·È ÂÎ‰ËÏÒÓÂÙ·È Î˘Ú›ˆ˜ ÛÙËÓ ÂÊË-

‚ÈÎ‹ ËÏÈÎ›· ‹ ÛÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹. Ã·Ú·ÎÙËÚ›˙ÂÙ·È

·fi ˘¤Ú¯ÚˆÛË ‰¤ÚÌ·ÙÔ˜, ‰˘ÛÙÚÔÊ›· ÔÓ‡¯ˆÓ, ÏÂ˘-

ÎÔÏ·Î›· Î·È ·Ï·ÛÙÈÎ‹ ·Ó·ÈÌ›· ÛÙÔ 50% ÙˆÓ ÂÚÈ-

ÙÒÛÂˆÓ. ∏ Ô˘‰ÂÙÂÚÔÂÓ›· ÂÓ‰¤¯ÂÙ·È Ó· ÂÌÊ·ÓÈ-

ÛÙÂ› ·Ú¯ÈÎ¿ ÚÈÓ ÙËÓ ·Ï·Û›· Î·È ÙˆÓ ̆ ÔÏÔ›ˆÓ ·È-

ÌÔÔÈËÙÈÎÒÓ ÛÂÈÚÒÓ. À¿Ú¯ÂÈ ·˘ÍËÌ¤ÓÔ˜ Î›Ó‰˘ÓÔ˜

ÁÈ· ÏÂ˘¯·ÈÌÔÁ¤ÓÂÛË, Î·ıÒ˜ Î·È ÁÈ· Î·ÚÎ›ÓÔ˘˜ ·fi

ÂÈıËÏÈ·Î¿ Î‡ÙÙ·Ú· (27,28).

240 ∞. ª¿ÎË˜, ¡. Ã·ÏÈ¿ÛÔ˜



ª˘ÂÏÔÎ·¯ÂÍ›·

ªÂÙ·‚È‚¿˙ÂÙ·È ÌÂ ÙÔÓ ·˘ÙÔÛˆÌÈÎfi ÂÈÎÚ·ÙÔ‡-

ÓÙ· ÙÚfiÔ. À¿Ú¯ÂÈ Ì¤ÙÚÈ· ¤ˆ˜ ÛÔ‚·Ú‹ Ô˘‰ÂÙÂÚÔ-

ÂÓ›· ÌÂ ¯·Ú·ÎÙËÚÈÛÙÈÎ‹ ÌÔÚÊÔÏÔÁ›· ÙˆÓ Ô˘‰ÂÙÂ-

ÚÔÊ›ÏˆÓ, Ù· ÔÔ›· ¤¯Ô˘Ó Î˘ÙÙ·ÚÔÏ·ÛÌ·ÙÈÎ¿ ÎÂÓÔ-

ÙfiÈ· Î·È ·ÓÒÌ·ÏÔ˘˜ ÔÏ˘Î·Ù¿ÙÌËÙÔ˘˜ ˘Ú‹ÓÂ˜.

º·›ÓÂÙ·È fiÙÈ Ô ÌË¯·ÓÈÛÌfi˜ ÙË˜ Ô˘‰ÂÙÂÚÔÂÓ›·˜ Û¯Â-

Ù›˙ÂÙ·È ÌÂ ÙËÓ ÂÏ·ÙÙˆÌ¤ÓË ¤ÎÊÚ·ÛË ÙÔ˘ bcl-x Î·È

ÛÙËÓ Â·ÁˆÁ‹ ÙË˜ ·fiÙˆÛË˜ ÙˆÓ Úfi‰ÚÔÌˆÓ Î˘Ù-

Ù¿ÚˆÓ (29).

™‡Ó‰ÚÔÌÔ Barth

∆Ô Û¿ÓÈÔ ·˘Ùfi Û‡Ó‰ÚÔÌÔ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi

ÙÔÓ Û˘Ó‰˘·ÛÌfi Ô˘‰ÂÙÂÚÔÂÓ›·˜ Î·È Î·Ú‰ÈÔÌ˘Ô¿-

ıÂÈ·˜. √È ÂÚÈÛÛfiÙÂÚÔÈ ·ÛıÂÓÂ›˜ ¤¯Ô˘Ó ÛÔ‚·Ú¿ ÚÔ-

‚Ï‹Ì·Ù· Î·Ú‰È·Î‹˜ ·ÓÂ¿ÚÎÂÈ·˜ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ·

ÏÔÈÌÒÍÂˆÓ. ªÂÙ·‚È‚¿˙ÂÙ·È ÌÂ ÙÔÓ Ê˘ÏÔÛ‡Ó‰ÂÙÔ

˘ÔÏÂÈfiÌÂÓÔ ¯·Ú·ÎÙ‹Ú· Î·È ˘¿Ú¯Ô˘Ó ÌÂÙ·ÏÏ¿-

ÍÂÈ˜ ÙÔ˘ ÁÔÓÈ‰›Ô˘ Ô˘ Â›Ó·È ˘Â‡ı˘ÓÔ ÁÈ· ÙË Û‡ÓıÂ-

ÛË ÙË˜ Î·Ú‰ÈÔÏÈ›ÓË˜ (30).

µ. ∂›ÎÙËÙÂ˜ Ô˘‰ÂÙÂÚÔÂÓ›Â˜

ªÂÙ·ÏÔÈÌÒ‰Ë˜ Ô˘‰ÂÙÂÚÔÂÓ›·

ª·˙› ÌÂ Ù· Ê¿ÚÌ·Î·, ·ÔÙÂÏÂ› ÙÔ Û˘¯ÓfiÙÂÚÔ ·›-

ÙÈÔ Ô˘‰ÂÙÂÚÔÂÓ›·˜ ÛÙËÓ Î·ıËÌÂÚÈÓ‹ ÎÏÈÓÈÎ‹ Ú¿ÍË

ÛÙ· ·È‰È¿. ∂ÌÊ·Ó›˙ÂÙ·È ÌÂÙ¿ ·fi ÏÔ›ÌˆÍË ·fi

ÈÔ‡˜, ‚·ÎÙ‹ÚÈ·, ÚˆÙfi˙ˆ· ‹ Ì‡ÎËÙÂ˜. √È ÌË¯·ÓÈ-

ÛÌÔ› Â›Ó·È Î˘Ú›ˆ˜ Ë ¿ÌÂÛË Î·Ù·ÛÙÔÏ‹ ÙÔ˘ Ì˘ÂÏÔ‡, Ë

Â›‰Ú·ÛË ÛÙËÓ ·Ó·Î·Ù·ÓÔÌ‹, Î·ıÒ˜ Â›ÛË˜ Î·È Ë

Î·Ù·ÛÙÚÔÊ‹ ÙˆÓ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ. ∏ Ô˘‰ÂÙÂÚÔÂÓ›·

ÌÔÚÂ› Ó· ÍÂÎÈÓ¿ÂÈ Ï›ÁÂ˜ ËÌ¤ÚÂ˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË

ÙË˜ ÏÔ›ÌˆÍË˜ Î·È Ó· ‰È·ÚÎÂ› Ì¤¯ÚÈ 4-6 Â‚‰ÔÌ¿‰Â˜.

∂ÈÚfiÛıÂÙ·, ÔÚÈÛÌ¤ÓÔÈ ÈÔ› Â›Ó·È ‰˘Ó·ÙfiÓ Ó· Â¿-

ÁÔ˘Ó ÙËÓ ·Ú·ÁˆÁ‹ ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÙˆÓ Ô˘‰Â-

ÙÂÚÔÊ›ÏˆÓ, ÌÂ Û˘Ó¤ÂÈ· Ë Ô˘‰ÂÙÂÚÔÂÓ›· Ó· ‰È·ÚÎÂ›

ÁÈ· Ì‹ÓÂ˜. √È ÛÔ‚·Ú¤˜ ‚·ÎÙËÚÈ·Î¤˜ ÏÔÈÌÒÍÂÈ˜ Â›Ó·È

ÂÍ·ÈÚÂÙÈÎ¿ Û¿ÓÈ· ÂÈÏÔÎ‹ ÙË˜ ÌÂÙ·ÏÔÈÌÒ‰Ô˘˜

Ô˘‰ÂÙÂÚÔÂÓ›·˜ (31).

√È ÈÔ› Ô˘ ÚÔÎ·ÏÔ‡Ó Ô˘‰ÂÙÂÚÔÂÓ›· Â›Ó·È Î˘-

Ú›ˆ˜ ÔÈ ÂÍ‹˜: EBV, CMV, RSV, Èfi˜ ÙË˜ ÂÚ˘ıÚ¿˜, ÈÏ·-

Ú¿˜, ·ÓÂÌÂ˘ÏÔÁÈ¿˜, ÁÚ›Ë˜, Ë·Ù›ÙÈ‰·˜ ∞, µ, C, Èfi˜

Parvo B19, HSV-6 Î·È HIV (32). √È ÏÔÈÌÒÍÂÈ˜ ·fi

ÛÙ·Ê˘ÏfiÎÔÎÎÔ, Ê˘Ì·Ù›ˆÛË, ‚ÚÔ˘Î¤ÏÏ· ‹ Û·ÏÌÔ-

Ó¤ÏÏ· ÚÔÎ·ÏÔ‡Ó Ì¤ÙÚÈ· Ô˘‰ÂÙÂÚÔÂÓ›·, ÂÎÙfi˜ Â¿Ó

ÚÔ¸¿Ú¯ÂÈ ÛË„·ÈÌ›·, ÔfiÙÂ Ë Ô˘‰ÂÙÂÚÔÂÓ›· ÌÔ-

ÚÂ› Ó· Â›Ó·È ÔÏ‡ ÛÔ‚·Ú‹. √˘‰ÂÙÂÚÔÂÓ›· ÌÔÚÂ›,

Â›ÛË˜, Ó· ÚÔÎ·Ï¤ÛÂÈ Ë ÏÔ›ÌˆÍË ·fi ÏÂ˚ÛÌ¿ÓÈ·,

ÂÏÔÓÔÛ›· ‹ ÈÛÙÔÏ¿ÛÌˆÛË.

º·ÚÌ·ÎÂ˘ÙÈÎ‹ Ô˘‰ÂÙÂÚÔÂÓ›·

∆· Ê¿ÚÌ·Î· ·ÔÙÂÏÔ‡Ó Û˘¯Ó¿ ·›ÙÈÔ Ô˘‰ÂÙÂÚÔ-

ÂÓ›·˜, Ë ÔÔ›· ÔÚÈÛÌ¤ÓÂ˜ ÊÔÚ¤˜ ÌÔÚÂ› Ó· Â›Ó·È

ÔÏ‡ ÛÔ‚·Ú‹. √È ÌË¯·ÓÈÛÌÔ› Ô˘ Ô‰ËÁÔ‡Ó ÛÂ Ô˘‰Â-

ÙÂÚÔÂÓ›· Â›Ó·È Î˘Ú›ˆ˜ Ë ¿ÌÂÛË Î·Ù·ÛÙÔÏ‹ ÙÔ˘ Ì˘Â-

ÏÔ‡, Ë Î·Ù·ÛÙÚÔÊ‹ ÙˆÓ Úfi‰ÚÔÌˆÓ Î˘ÙÙ¿ÚˆÓ Ì¤Ûˆ

·ÓÙÈÛˆÌ¿ÙˆÓ ‹ ÂÓÂÚÁÔÔ›ËÛË˜ ÙÔ˘ Û˘ÌÏËÚÒÌ·-

ÙÔ˜, Î·ıÒ˜ Î·È Ë ¿ÌÂÛË ÂÚÈÊÂÚÈÎ‹ Î·Ù·ÛÙÚÔÊ‹. ∆·

Ê¿ÚÌ·Î· Ô˘ ÚÔÎ·ÏÔ‡Ó Ô˘‰ÂÙÂÚÔÂÓ›· Â›Ó·È ÔÏ-

Ï¿. ∆· Î˘ÚÈfiÙÂÚ· Â›Ó·È Ù· ¯ËÌÂÈÔıÂÚ·Â˘ÙÈÎ¿, Ù·

·ÓÙÈ‚ÈÔÙÈÎ¿ (.¯. ÎÂÊ·ÏÔÛÔÚ›ÓÂ˜, ÙÚÈÌÂıÔÚ›ÌË-

ÛÔ˘ÏÊ·ÌÂıÔÍ·˙fiÏË), Ù· ·ÓÙÈÂÈÏËÙÈÎ¿, Ù· ·ÓÙÈı˘-

ÚÂÔÂÈ‰ÈÎ¿, Ô ¯Ú˘Ûfi˜, Ë ‰ÂÊÂÚÈÚfiÓË Î·È Ù· ÌË-ÛÙÂ-

ÚÔÂÈ‰‹ ·ÓÙÈÊÏÂÁÌÔÓÒ‰Ë (33,34). ∏ ‰È·ÎÔ‹ ÙÔ˘

Ê·ÚÌ¿ÎÔ˘ Ô‰ËÁÂ› Û˘Ó‹ıˆ˜ ÛÂ ÁÚ‹ÁÔÚË ·Ó¿Î·Ì„Ë

ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ. øÛÙfiÛÔ, ˘¿Ú-

¯Ô˘Ó ÂÚÈÙÒÛÂÈ˜ Ô˘ Ë Û˘Ó¤¯ÈÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Â›-

Ó·È ·Ó·ÁÎ·›· ÁÈ· ÙÔ ·È‰›, fiˆ˜ Û˘Ì‚·›ÓÂÈ .¯. ÌÂ Ù·

·ÓÙÈÂÈÏËÙÈÎ¿. ™ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ ·˘Ù¤˜, Â¿Ó Ô

·ÚÈıÌfi˜ ÙˆÓ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ Â›Ó·È >0,5-0,7x109/L

Î·È ‰ÂÓ Û˘Ì‚·›ÓÔ˘Ó ÏÔÈÌÒÍÂÈ˜, ÙfiÙÂ ÌÔÚÂ› Ó· Û˘ÓÂ-

¯ÈÛÙÂ› Ë ¯ÔÚ‹ÁËÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ˘fi ÛÙÂÓ‹ ·Ú·-

ÎÔÏÔ‡ıËÛË.

πÛÔ- Î·È ·˘ÙÔ-¿ÓÔÛË Ô˘‰ÂÙÂÚÔÂÓ›·

√È ‰‡Ô ·˘Ù¤˜ Î·Ù·ÛÙ¿ÛÂÈ˜ ÚÔÎ‡ÙÔ˘Ó ·fi ÙËÓ

·Ú·ÁˆÁ‹ ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ·ÓÙÈÁfiÓˆÓ ÙË˜ ÂÈ-

Ê¿ÓÂÈ·˜ ÙˆÓ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ.

∏ ÓÂÔÁÓÈÎ‹ ÈÛÔ¿ÓÔÛË Ô˘‰ÂÙÂÚÔÂÓ›· ÂÌÊ·Ó›˙Â-

Ù·È ÌÂÙ¿ ÙË Á¤ÓÓËÛË ‹ Ì¤Û· ÛÙÔ˘˜ ÚÒÙÔ˘˜ Ì‹ÓÂ˜

ÙË˜ ˙ˆ‹˜ Î·È Â›Ó·È ·Ó¿ÏÔÁË ÙË˜ ·ÈÌÔÏ˘ÙÈÎ‹˜ ÓfiÛÔ˘

Rhesus. À¿Ú¯ÂÈ, fiÌˆ˜, Ì›· ÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿: Ë

ÓÂÔÁÓÈÎ‹ ÈÛÔ¿ÓÔÛË Ô˘‰ÂÙÂÚÔÂÓ›· Û˘¯Ó¿ ·ÚÔ˘ÛÈ¿-

˙ÂÙ·È Î·È ÛÙÔ ÚÒÙÔ ·È‰›. ¶ÚfiÎÂÈÙ·È ÁÈ· Û¿ÓÈ· Î·-

Ù¿ÛÙ·ÛË Î·È ÔÈ ÛÔ‚·Ú¤˜ ÏÔÈÌÒÍÂÈ˜ Â›Ó·È ÂÍ·ÈÚÂÙÈÎ¿

Û¿ÓÈ· ÂÈÏÔÎ‹, ·Ú¿ ÙÈ˜ ÔÏ‡ ¯·ÌËÏ¤˜ ÙÈÌ¤˜ Ô˘-

‰ÂÙÂÚÔÊ›ÏˆÓ (<0,2x109/L) (35). ∏ ‰È¿ÁÓˆÛË ÂÈ‚Â-

‚·ÈÒÓÂÙ·È ÌÂ ÙËÓ ·Ó›¯ÓÂ˘ÛË ÙˆÓ ÂÈ‰ÈÎÒÓ ·ÓÙÈÛˆÌ¿-

ÙˆÓ ÛÙÔÓ ÔÚfi ÙË˜ ÌËÙ¤Ú·˜ Î·È ÙÔ˘ ·È‰ÈÔ‡ ¤Ó·ÓÙÈ

ÙˆÓ ·ÓÙÈÁfiÓˆÓ ÙˆÓ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ Ô˘ ÎÏËÚÔÓfiÌË-

ÛÂ ÙÔ ·È‰› ·fi ÙÔÓ ·Ù¤Ú·. ∆· ·ÓÙÈÛÒÌ·Ù· ·˘Ù¿

‰È¤Ú¯ÔÓÙ·È ÙÔÓ Ï·ÎÔ‡ÓÙ· Î·È ÌÔÚÂ› Ó· ÚÔÎ·ÏÔ‡Ó

Ô˘‰ÂÙÂÚÔÂÓ›· ÛÙÔ ‚Ú¤ÊÔ˜ Ì¤¯ÚÈ Ó· ÂÍ·Ê·ÓÈÛÙÔ‡Ó,

Û˘Ó‹ıˆ˜ ÛÂ 3-28 Â‚‰ÔÌ¿‰Â˜ (Ì¤ÛÔ˜ fiÚÔ˜: 11 Â‚‰Ô-

Ì¿‰Â˜). ¶·ÚfiÌÔÈ· ÂÈÎfiÓ· ÌÂ ÙË ÓÂÔÁÓÈÎ‹ ÈÛÔ¿ÓÔÛË

Ô˘‰ÂÙÂÚÔÂÓ›· ÌÔÚÂ› Ó· ÚÔÎ·Ï¤ÛÂÈ Ë ·ıËÙÈÎ‹

‰È¤ÏÂ˘ÛË ·fi ÙÔÓ Ï·ÎÔ‡ÓÙ· ·ÓÙÈÛˆÌ¿ÙˆÓ ·fi ÙË

ÌËÙ¤Ú· Ô˘ ¿Û¯ÂÈ ·fi ·˘ÙÔ¿ÓÔÛË Ô˘‰ÂÙÂÚÔÂÓ›·.

∏ ÚˆÙÔ·ı‹˜ ·˘ÙÔ¿ÓÔÛË Ô˘‰ÂÙÂÚÔÂÓ›· ÙË˜

·È‰ÈÎ‹˜ ËÏÈÎ›·˜ Â›Ó·È Ì›· Û¯ÂÙÈÎ¿ Î·ÏÔ‹ıË˜ ¿ıË-

ÛË Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ·Ú·ÁˆÁ‹ ·˘ÙÔ·ÓÙÈÛˆ-

Ì¿ÙˆÓ ¤Ó·ÓÙÈ ·ÓÙÈÁfiÓˆÓ ÙË˜ ÂÈÊ¿ÓÂÈ·˜ ÙˆÓ Ô˘‰Â-

ÙÂÚÔÊ›ÏˆÓ ÌÂ Û˘¯Ó¿ ÛÔ‚·Ú‹ Ô˘‰ÂÙÂÚÔÂÓ›·, ¯ˆÚ›˜

fiÌˆ˜ ‚·ÚÈ¤˜ ‚·ÎÙËÚÈ·Î¤˜ ÏÔÈÌÒÍÂÈ˜. ∂ÌÊ·Ó›˙ÂÙ·È

Û˘Ó‹ıˆ˜ ÛÙË ‚ÚÂÊÈÎ‹ ËÏÈÎ›· (5-15 ÌËÓÒÓ) Î·È ÛÙ·

ÂÚÈÛÛfiÙÂÚ· ·È‰È¿ (95%) ˘¿Ú¯ÂÈ ·˘ÙfiÌ·ÙË ·Ó¿-

Î·Ì„Ë ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ Ì¤¯ÚÈ ÙËÓ


¶·È‰È·ÙÚÈÎ‹ 2007;70:237-245


ËÏÈÎ›· ÙˆÓ 3-4 ÂÙÒÓ (17 Ì‹ÓÂ˜ Î·Ù¿ Ì¤ÛÔ fiÚÔ)

(36,37). ∞˘ÍËÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ G-CSF ‹ Î·È ÚÔÊ˘-

Ï·ÎÙÈÎ‹ ¯ÔÚ‹ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ ÂÊ·ÚÌfi˙ÂÙ·È ÌfiÓÔ

ÛÙÈ˜ Û¿ÓÈÂ˜ ÂÚÈÙÒÛÂÈ˜ Ô˘ Û˘Ì‚·›ÓÔ˘Ó ÛÔ‚·Ú¤˜

ÏÔÈÌÒÍÂÈ˜. ¢ÂÓ ˘¿Ú¯ÂÈ Î›Ó‰˘ÓÔ˜ Î·ÎÔ‹ıÔ˘˜ ÂÍ·Ï-

Ï·Á‹˜. ∏ ‰È¿ÁÓˆÛË Ù›ıÂÙ·È ÌÂ ‚¿ÛË: ·) ÙÔ ÈÛÙÔÚÈÎfi,

fiÔ˘ ‰ÂÓ ·Ó·‰ÂÈÎÓ‡ÔÓÙ·È ÛÔ‚·Ú¤˜ ÏÔÈÌÒÍÂÈ˜, ‚) ÙË

¯ˆÚ›˜ È‰È·›ÙÂÚ· Â˘Ú‹Ì·Ù· ·ÓÙÈÎÂÈÌÂÓÈÎ‹ ÂÍ¤Ù·ÛË, Á)

ÙË ÌÈÎÚÔÛÎÔÈÎ‹ ÂÍ¤Ù·ÛË ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜

fiÔ˘ ‰ÂÓ ‰È·ÈÛÙÒÓÔÓÙ·È ·ıÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù· Î·È

‰) ÙËÓ ·Ó›¯ÓÂ˘ÛË ÙˆÓ ÂÈ‰ÈÎÒÓ ·ÓÙÈÔ˘‰ÂÙÂÚÔÊÈÏÈÎÒÓ

·ÓÙÈÛˆÌ¿ÙˆÓ. ŸÙ·Ó Û˘Ó˘¿Ú¯Ô˘Ó Ù· ·ÓˆÙ¤Úˆ, ‰ÂÓ

¯ÚÂÈ¿˙ÂÙ·È Ó· Á›ÓÂÙ·È Ì˘ÂÏfiÁÚ·ÌÌ· (38).

¢Â˘ÙÂÚÔ·ı‹˜ ·˘ÙÔ¿ÓÔÛË Ô˘‰ÂÙÂÚÔÂÓ›· ÌÔ-

ÚÂ› Ó· ·Ú·ÙËÚËıÂ› ÛÙÔ Ï·›ÛÈÔ ˘ÔÎÂ›ÌÂÓÔ˘ ·˘ÙÔ-

·ÓfiÛÔ˘ ÓÔÛ‹Ì·ÙÔ˜, fiˆ˜ Â›Ó·È Ô Û˘ÛÙËÌ·ÙÈÎfi˜ ÂÚ˘-

ıËÌ·ÙÒ‰Ë˜ Ï‡ÎÔ˜ ‹ Ë ÓÂ·ÓÈÎ‹ È‰ÈÔ·ı‹˜ ·ÚıÚ›ÙÈ‰·.

∆Ô Û‡Ó‰ÚÔÌÔ Felty Â›Ó·È Ô Û˘Ó‰˘·ÛÌfi˜ ÛÏËÓÔÌÂÁ·-

Ï›·˜ Î·È Ô˘‰ÂÙÂÚÔÂÓ›·˜ ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ ÓÂ·ÓÈÎ‹

È‰ÈÔ·ı‹ ·ÚıÚ›ÙÈ‰·. ¢Â˘ÙÂÚÔ·ı‹˜ ·˘ÙÔ¿ÓÔÛË Ô˘-

‰ÂÙÂÚÔÂÓ›· ÌÔÚÂ› Ó· ÚÔÎ‡„ÂÈ ÌÂÙ¿ ·fi ÈÔÁÂÓÂ›˜

ÏÔÈÌÒÍÂÈ˜ ‹ Ï‹„Ë Ê·ÚÌ¿ÎˆÓ (39).

¢È‹ıËÛË Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ

√˘‰ÂÙÂÚÔÂÓ›· ÌÔÚÂ› Ó· ÚÔ¤ÏıÂÈ ·fi ÙËÓ

·ÓÙÈÎ·Ù¿ÛÙ·ÛË ÙˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ ÙÔ˘

Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ ·fi Î·ÎÔ‹ıË ‹ ÌË Î‡ÙÙ·Ú·, ÌÂ

·ÔÙ¤ÏÂÛÌ· ÙËÓ ·ÓÂ·ÚÎ‹ ·Ú·ÁˆÁ‹ Ô˘‰ÂÙÂÚÔÊ›-

ÏˆÓ. ™˘Ó‹ıˆ˜ Û˘Ó˘¿Ú¯ÂÈ ·Ó·ÈÌ›· ‹/Î·È ıÚÔÌ‚ÔÂ-

Ó›·. ∆¤ÙÔÈÂ˜ ·ı‹ÛÂÈ˜ Â›Ó·È Ë ÔÍÂ›· ÏÂ˘¯·ÈÌ›·, ÙÔ Ï¤Ì-

ÊˆÌ·, ÌÂÙ·ÛÙ¿ÛÂÈ˜ ·fi ÌË-·ÈÌ·ÙÔÏÔÁÈÎ¤˜ Î·ÎÔ‹ıÂÈ-

Â˜ (.¯. ÓÂ˘ÚÔ‚Ï¿ÛÙˆÌ·, Ú·‚‰ÔÌ˘ÔÛ¿ÛÚÎˆÌ·, ÔÛÙÂ-

ÔÛ¿ÚÎˆÌ·), ÈÛÙÈÔÎ˘ÙÙ¿ÚˆÛË, ÓfiÛÔ˜ Gaucher Î·È

ÔÛÙÂÔ¤ÙÚˆÛË. ∏ ÔÛÙÂÔ¤ÙÚˆÛË ÚÔÎ·ÏÂ› Î˘ÙÙ·-

ÚÔÂÓ›Â˜ ÂÂÈ‰‹ Ô Ì˘ÂÏÈÎfi˜ ¯ÒÚÔ˜ Î·Ù·Ï·Ì‚¿ÓÂÙ·È

·fi ÔÛÙ›ÙË ÈÛÙfi ÏfiÁˆ ·ÓÂ¿ÚÎÂÈ·˜ ÙˆÓ ÔÛÙÂÔÎÏ·-

ÛÙÒÓ Ó· ÙÔÓ ·Ô‰ÔÌ‹ÛÔ˘Ó.

ÕÏÏ· ·›ÙÈ·

√˘‰ÂÙÂÚÔÂÓ›· ÌÔÚÂ› Ó· ·ÚÔ˘ÛÈ·ÛÙÂ› ÛÂ Â-

ÚÈÙÒÛÂÈ˜ ˘ÂÚÛÏËÓÈÛÌÔ‡ (.¯. ÛÙË ÌÂÛÔÁÂÈ·Î‹

·Ó·ÈÌ›·), ·Ï·ÛÙÈÎ‹˜ ·Ó·ÈÌ›·˜ (È‰ÈÔ·ı‹˜, Â›ÎÙË-

ÙË), Ì˘ÂÏÔ‰˘ÛÏ·ÛÙÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘, ·ÚÔÍ˘ÛÌÈ-

Î‹˜ Ó˘¯ÙÂÚÈÓ‹˜ ·ÈÌÔÛÊ·ÈÚÈÓÔ˘Ú›·˜ ‹ ·ÓÂ¿ÚÎÂÈ·˜

µ12 ‹ Ê˘ÏÏÈÎÔ‡ ÔÍ¤Ô˜. ™˘Ó‹ıˆ˜ Û˘Ó˘¿Ú¯Ô˘Ó ·Ó·È-

Ì›· ‹/Î·È ıÚÔÌ‚ÔÂÓ›·.

¶ÚÔÛ¤ÁÁÈÛË ÙÔ˘ ·È‰ÈÔ‡ ÌÂ Ô˘‰ÂÙÂÚÔÂÓ›·

™ÙËÓ ∂ÈÎfiÓ· 1 ·ÚÔ˘ÛÈ¿˙ÂÙ·È ¤Ó·˜ ÚÔÙÂÈÓfiÌÂ-

ÓÔ˜ ·ÏÁfiÚÈıÌÔ˜ ÙË˜ ÎÏÈÓÈÎ‹˜ Î·È ÂÚÁ·ÛÙËÚÈ·Î‹˜

ÚÔÛ¤ÁÁÈÛË˜ ÙÔ˘ ·È‰ÈÔ‡ ÌÂ Ô˘‰ÂÙÂÚÔÂÓ›·:

1) ∏ ÚÔÛ¤ÁÁÈÛË ·Ú¯›˙ÂÈ ÌÂ ÙËÓ ÂÈ‚Â‚·›ˆÛË ÙË˜

Ô˘‰ÂÙÂÚÔÂÓ›·˜ Û‡ÌÊˆÓ· ÌÂ ÙÔ Ê˘ÛÈÔÏÔÁÈÎfi Â‡ÚÔ˜,

·Ó¿ÏÔÁ· ÌÂ ÙËÓ ËÏÈÎ›·.

2) ∆Ô ÈÛÙÔÚÈÎfi Î·È Ë ·ÓÙÈÎÂÈÌÂÓÈÎ‹ ÂÍ¤Ù·ÛË Î·-

ÙÂ˘ı‡ÓÔ˘Ó ÙËÓ ÚÔÛ¤ÁÁÈÛË. ∆Ô ÈÛÙÔÚÈÎfi ‚ÔËı¿ ÛÙË

‰È¿ÎÚÈÛË ÙË˜ ÔÍÂ›·˜ ·fi ÙË ¯ÚfiÓÈ· Ô˘‰ÂÙÂÚÔÂÓ›·.

ªÂ ÙÔ ÈÛÙÔÚÈÎfi Û˘ÏÏ¤ÁÔÓÙ·È ÛËÌ·ÓÙÈÎ¤˜ ÏËÚÔÊÔ-

Ú›Â˜, fiˆ˜: ÂÂÈÛfi‰È· ÏÔÈÌÒÍÂˆÓ ÛÙÔ ·ÚÂÏıfiÓ

(Ô˘ÏÔÛÙÔÌ·Ù›ÙÈ‰·, ÂÚÈÚˆÎÙÈÎ¿ ·ÔÛÙ‹Ì·Ù·,

πÛÙÔÚÈÎfi, ·ÓÙÈÎÂÈÌÂÓÈÎ‹ ÂÍ¤Ù·ÛË, ÁÂÓÈÎ‹ ·›Ì·ÙÔ˜

ÃÚfiÓÈ· Ô˘‰ÂÙÂÚÔÂÓ›· ‹ ÏÔÈÌÒÍÂÈ˜ ‹/Î·È Ô˘‰ÂÙÂÚfiÊÈÏ· <0,5 ÛÂ 3 ÌÂÙÚ‹ÛÂÈ˜

ª˘ÂÏfiÁÚ·ÌÌ·∫˘ÙÙ·ÚÔÌÂÙÚ›·

ÚÔ‹˜√ÛÙÂÔÌ˘ÂÏÈÎ‹

‚ÈÔ„›·∫˘ÙÙ·ÚÔÁÂÓÂÙÈÎ‹

™˘¯Ó¤˜ ¿Ù˘Â˜

ÏÔÈÌÒÍÂÈ˜

º·ÈÓÔÙ˘ÈÎ¤˜ ·ÓˆÌ·Ï›Â˜

ªÂÙ·‚ÔÏÈÎ¤˜ ‰È·Ù·Ú·¯¤˜

∫·Ú‰ÈÔÏÔÁÈÎ¿ ÚÔ‚Ï‹Ì·Ù·

∫·Î‹ ‰È·ÙÚÔÊ‹¢È¿ÚÚÔÈÂ˜

∞ÓÂ·ÚÎ‹˜ ÚfiÛÏË„Ë

‚¿ÚÔ˘˜

∞ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ

Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ

¶ÂÚÈÔ‰ÈÎfiÙËÙ·∫ÏËÚÔÓÔÌÈÎfi

πÛÙÔÚÈÎfi°ÔÓ›‰ÈÔ ELA2

πÔÁÂÓ‹˜ ÏÔ›ÌˆÍË

™Ô‚·Ú‹ ÂÌ‡ÚÂÙË ÏÔ›ÌˆÍË

º¿ÚÌ·Î·

√ÍÂ›· ÓfiÛÔ˜

1 2 3

4 8

5 6 7 9 10 11 1312 14

¢È·ÎÔ‹ Ê·ÚÌ¿ÎÔ˘∞‡ÍËÛË

Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ

µ·ÎÙ‹ÚÈ·¶ÚˆÙfi˙ˆ·ª‡ÎËÙÂ˜3-4 Â‚‰.

4-6 Â‚‰. ¤ˆ˜

6-17 Ì‹ÓÂ˜

∫˘ÎÏÈÎ‹ Ô˘‰ÂÙÂÚÔÂÓ›·

πÛÔ¿ÓÔÛË ‹

·˘ÙÔ¿ÓÔÛË Ô˘‰ÂÙÂÚÔÂÓ›·

µ12º˘ÏÏÈÎfi

SDSPearson’s

Fanconi’s™˘ÁÁ. ‰˘ÛÎÂÚ¿ÙˆÛË

Chediak-HigashiªÂÙ·‚ÔÏÈÎ¿

ÓÔÛ‹Ì·Ù·Barth’s

HIV™˘ÁÁÂÓÂ›˜

·ÓÔÛÔ·ÓÂ¿ÚÎÂÈÂ˜

¢È‹ıËÛË Ì˘ÂÏÔ‡MDS

Kostmann’s∞Ï·ÛÙÈÎ‹

·Ó·ÈÌ›·PNH

∂ÈÎfiÓ· 1. ∞ÏÁfiÚÈıÌÔ˜ ‰È·ÁÓˆÛÙÈÎ‹˜ ÚÔÛ¤ÁÁÈÛË˜ ·È‰ÈÔ‡ ÌÂ Ô˘‰ÂÙÂÚÔÂÓ›·. ∆ÚÔÔÔÈËÌ¤ÓÔ˜ ·ÏÁfiÚÈıÌÔ˜ ·fi ÙÔ ‚È‚Ï›Ô: PracticalAlgorithms in Pediatric Hematology and Oncology. R.H. Stills, editor. S. Karger AG; 2003.

242 ∞. ª¿ÎË˜, ¡. Ã·ÏÈ¿ÛÔ˜



Î˘ÙÙ·Ú›ÙÈ‰·, ÓÂ˘ÌÔÓ›·, ˆÙ›ÙÈ‰Â˜, Ë Û˘¯ÓfiÙËÙ· Î·È Ë

ÛÔ‚·ÚfiÙËÙ¿ ÙÔ˘˜, Î·ıÒ˜ Î·È Ë ·ÓÙ·fiÎÚÈÛË ÛÙË ıÂ-

Ú·Â›·), ·ÓÂ·ÚÎ‹˜ ÚfiÛÏË„Ë ‚¿ÚÔ˘˜ ‹ ‰È¿ÚÚÔÈÂ˜,

Ï‹„Ë Ê·ÚÌ¿ÎˆÓ ‹ ÂÌÊ¿ÓÈÛË Ô˘‰ÂÙÂÚÔÂÓ›·˜ Î·È ÏÔÈ-

ÌÒÍÂˆÓ ÛÂ ¿ÏÏ· Ì¤ÏË ÙË˜ ÔÈÎÔÁ¤ÓÂÈ·˜. ∏ ·ÓÙÈÎÂÈÌÂ-

ÓÈÎ‹ ÂÍ¤Ù·ÛË Ú¤ÂÈ Ó· ÂÛÙÈ¿˙ÂÙ·È ÛÙËÓ Èı·Ó‹ ·ÓÂ‡-

ÚÂÛË ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ·˜, Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›·˜,

ˆ¯ÚfiÙËÙ·˜, ·ÈÌÔÚÚ·ÁÈÎÒÓ ÂÎ‰ËÏÒÛÂˆÓ, ·ÒÏÂÈ· ‚¿-

ÚÔ˘˜ ‹ Ô˘ÏÔÛÙÔÌ·Ù›ÙÈ‰·˜. ™ËÌ·ÓÙÈÎfi Â›Ó·È Ó· ·Ó·˙Ë-

ÙÔ‡ÓÙ·È ÌË-·ÈÌ·ÙÔÏÔÁÈÎ¿ ÛËÌÂ›· Ô˘ Î·ÙÂ˘ı‡ÓÔ˘Ó

ÛÂ ÎÏËÚÔÓÔÌÈÎ¤˜ Ô˘‰ÂÙÂÚÔÂÓ›Â˜. ∆¤ÙÔÈ· ÛËÌÂ›· Â›-

Ó·È ÙÔ ÎÔÓÙfi ·Ó¿ÛÙËÌ·, ÔÈ ÔÛÙÈÎ¤˜ ·ÓˆÌ·Ï›Â˜, ÔÈ ‰ÂÚ-

Ì·ÙÈÎ¤˜ ·ÏÏÔÈÒÛÂÈ˜, Ë ÌÈÎÚÔÎÂÊ·Ï›·, Ë ‰˘ÛÙÚÔÊ›·

ÔÓ‡¯ˆÓ, Ë ÏÂ˘ÎÔÏ·Î›·, Ô ·ÏÊÈÛÌfi˜ ‹ ÙÔ ¤Î˙ÂÌ·. ∏

ËÏÈÎ›· ÂÌÊ¿ÓÈÛË˜ ÙË˜ Ô˘‰ÂÙÂÚÔÂÓ›·˜ ÛÂ Û˘Ó‰˘·ÛÌfi

ÌÂ ÙÔÓ ‚·ıÌfi ÙË˜ Â›Ó·È È‰È·›ÙÂÚ· ¯Ú‹ÛÈÌ·. ∂ÌÊ¿ÓÈÛË

Ô˘‰ÂÙÂÚÔÂÓ›·˜ Î·È ÛÔ‚·ÚÒÓ ‚·ÎÙËÚÈ·ÎÒÓ ÏÔÈÌÒÍÂ-

ˆÓ ÛÙÈ˜ ÚÒÙÂ˜ Â‚‰ÔÌ¿‰Â˜ ÙË˜ ˙ˆ‹˜ Î·ÙÂ˘ı‡ÓÔ˘Ó ÙË

‰ÈÂÚÂ‡ÓËÛË Î˘Ú›ˆ˜ ÚÔ˜ ÙË ÓfiÛÔ Kostmann, Î˘ÎÏÈÎ‹

Ô˘‰ÂÙÂÚÔÂÓ›· ‹ ÓÂÔÁÓÈÎ‹ ÈÛÔ¿ÓÔÛË Ô˘‰ÂÙÂÚÔÂÓ›·,

ÂÊfiÛÔÓ ÛÙÔ Ì˘ÂÏfiÁÚ·ÌÌ· ‰ÂÓ ·Ó·Ê·›ÓÂÙ·È Î·ÎÔ‹-

ıÂÈ·. ãAÙ˘Â˜ Î·È ÛÔ‚·Ú¤˜ ÏÔÈÌÒÍÂÈ˜ ˘Ô‰ÂÈÎÓ‡Ô˘Ó

Û˘ÁÁÂÓ‹ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ· ‹ ÏÔ›ÌˆÍË ·fi HIV.

3) ∏ ÂÎÙ›ÌËÛË ÙË˜ ÁÂÓÈÎ‹˜ ·›Ì·ÙÔ˜ Î·È Ë ÌÈÎÚÔ-

ÛÎÔÈÎ‹ ÂÎÙ›ÌËÛË ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜ Â›Ó·È

·ÔÏ‡Ùˆ˜ ··Ú·›ÙËÙ·. ∏ Û˘Ó‡·ÚÍË ·Ó·ÈÌ›·˜

‹/Î·È ıÚÔÌ‚ÔÂÓ›·˜ Î·ÙÂ˘ı‡ÓÂÈ ÙË ‰ÈÂÚÂ‡ÓËÛË

ÚÔ˜ Û˘ÁÎÂÎÚÈÌ¤ÓÂ˜ ·ÈÙ›Â˜, Î˘Ú›ˆ˜ Î·ÎÔ‹ıÂÈÂ˜ Î·È

·Ï·ÛÙÈÎ‹ ·Ó·ÈÌ›·. ™ÙÔ ÌÈÎÚÔÛÎfiÈÔ Ú¤ÂÈ ÔˆÛ-

‰‹ÔÙÂ Ó· Á›ÓÂÈ ·Ó·˙‹ÙËÛË ÁÈ· ‚Ï¿ÛÙÂ˜ (ÏÂ˘¯·ÈÌ›·),

ÂÌ‡ÚËÓ· ÂÚ˘ıÚ¿ (‰È‹ıËÛË, ·ÓÙÈÎ·Ù¿ÛÙ·ÛË Ì˘Â-

ÏÔ‡), ÔÏ˘Î·Ù¿ÙÌËÙ· Ô˘‰ÂÙÂÚfiÊÈÏ· (·ÓÂ¿ÚÎÂÈ·

µ12, Ê˘ÏÏÈÎÔ‡), ·ÓÒÌ·ÏÔ˘˜ ˘Ú‹ÓÂ˜ Ô˘‰ÂÙÂÚÔÊ›-

ÏˆÓ (Ì˘ÂÏÔÎ·¯ÂÍ›·), ·ÓÒÌ·Ï· ÌÂÁ¿Ï· ÎÔÎÎ›· ÛÙ·

Ô˘‰ÂÙÂÚfiÊÈÏ· (Û‡Ó‰ÚÔÌÔ Chediak-Higashi), ÌÈÎÚÔ-

ıÚÔÌ‚ÔÂÓ›· (Û‡Ó‰ÚÔÌÔ Wiskott Aldrich) ‹ Ì·ÎÚÔ-

Î˘ÙÙ¿ÚˆÛË (·Ó·ÈÌ›· Fanconi).

4) ™ÙËÓ ÂÚ›ÙˆÛË Ô˘ Ù· Ô˘‰ÂÙÂÚfiÊÈÏ· Â›Ó·È

<1,0x109/L Î·È Ê·›ÓÂÙ·È fiÙÈ Ë Ô˘‰ÂÙÂÚÔÂÓ›· ÂÌÊ·-

Ó›ÛÙËÎÂ ÔÍ¤ˆ˜, ÙfiÙÂ Ë ‰ÈÂÚÂ‡ÓËÛË Ú¤ÂÈ Ó· Á›ÓÂÈ

ˆ˜ ÂÍ‹˜:

5) ¶Ú¤ÂÈ Ó· ·Ó·˙ËÙËıÔ‡Ó Èı·Ó¿ Ê·ÚÌ·ÎÂ˘ÙÈ-

Î¿ ·›ÙÈ·. ™Â ·˘Ù‹ ÙËÓ ÂÚ›ÙˆÛË Ë ‰È·ÎÔ‹ ÙÔ˘

Ê·ÚÌ¿ÎÔ˘ ı· Ô‰ËÁ‹ÛÂÈ ÛÂ ¿ÓÔ‰Ô ÙˆÓ Ô˘‰ÂÙÂÚÔÊ›-

ÏˆÓ Î·È ı· ı¤ÛÂÈ ÙË ‰È¿ÁÓˆÛË.

6) ∂¿Ó ÙÔ ·È‰› ¤¯ÂÈ ÛÔ‚·Ú‹ ÂÌ‡ÚÂÙË ÓfiÛÔ Î·È

‰Â›ÎÙÂ˜ Ô˘ ˘Ô‰ÂÈÎÓ‡Ô˘Ó ÌÈÎÚÔ‚È·Î‹ ÏÔ›ÌˆÍË, Ùfi-

ÙÂ Èı·ÓÒ˜ Ë Ô˘‰ÂÙÂÚÔÂÓ›· ÔÊÂ›ÏÂÙ·È ÛÙÔÓ ÌÈÎÚÔ-

‚È·Îfi ·Ú¿ÁÔÓÙ·. ∂¿Ó Ë Ô˘‰ÂÙÂÚÔÂÓ›· ‰ÂÓ ·ÔÎ·-

ı›ÛÙ·Ù·È ÛÂ 3-4 Â‚‰ÔÌ¿‰Â˜ ÌÂÙ¿ ÙË ÏÔ›ÌˆÍË, ÙfiÙÂ

Ú¤ÂÈ Ó· ˘ÔÏÔÁÈÛÙÂ› ÙÔ ÂÓ‰Â¯fiÌÂÓÔ Ó· ˘¿Ú¯ÂÈ

˘ÔÎÂ›ÌÂÓË ¯ÚfiÓÈ· Ô˘‰ÂÙÂÚÔÂÓ›· Î·È Ë ·ÚÂÏıÔ‡-

Û· ÏÔ›ÌˆÍË Ó· ÔÊÂ›ÏÂÙ·È ÛÂ ·˘Ù‹.

7) ™ÙËÓ ÂÚ›ÙˆÛË Ô˘ ÙÔ ·È‰› ¤¯ÂÈ ÂÚ¿ÛÂÈ Ì›·

‹È· ÓfiÛÔ ÌÂ ¯·Ú·ÎÙ‹ÚÂ˜ Î·È ‰Â›ÎÙÂ˜ ÈÔÁÂÓÔ‡˜ ÏÔ›-

ÌˆÍË˜, ÙfiÙÂ Ë ÙÂÏÂ˘Ù·›· Â›Ó·È Ì¿ÏÏÔÓ Ë ·ÈÙ›· ÙË˜

Ô˘‰ÂÙÂÚÔÂÓ›·˜. ∏ ‰È¿ÁÓˆÛË ı· ÂÈ‚Â‚·ÈˆıÂ›, Â¿Ó

ÛÂ Â·Ó¿ÏË„Ë ÙË˜ ÁÂÓÈÎ‹˜ ·›Ì·ÙÔ˜ ÛÂ 4-6 Â‚‰ÔÌ¿-

‰Â˜ ¤¯ÂÈ ·ÔÎ·Ù·ÛÙ·ıÂ› Ô ·ÚÈıÌfi˜ ÙˆÓ Ô˘‰ÂÙÂÚÔÊ›-

ÏˆÓ. ™Â ÔÚÈÛÌ¤ÓÂ˜ ÂÚÈÙÒÛÂÈ˜ ÔÈ ÈÔÁÂÓÂ›˜ ÏÔÈÌÒ-

ÍÂÈ˜ Â¿ÁÔ˘Ó ÙËÓ ·Ú·ÁˆÁ‹ ·ÓÙÈÛˆÌ¿ÙˆÓ ÌÂ ·ÔÙ¤-

ÏÂÛÌ· Ë Ô˘‰ÂÙÂÚÔÂÓ›· Ó· ‰È·ÚÎÂ› ÂÚÈÛÛfiÙÂÚÔ Î·È

Ó· ¯ÚÂÈ¿˙ÂÙ·È, ÙfiÙÂ, Ó· Á›ÓÂÙ·È ÂÚÁ·ÛÙËÚÈ·Î‹ ·Ó›-

¯ÓÂ˘ÛË ÙˆÓ ·ÓÙÈÔ˘‰ÂÙÂÚÔÊÈÏÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ÁÈ·

Î·ıÔÚÈÛÌfi ÙË˜ ‰È¿ÁÓˆÛË˜.

8) ∂¿Ó ˘¿Ú¯ÂÈ ÈÛÙÔÚÈÎfi ¯ÚfiÓÈ·˜ Ô˘‰ÂÙÂÚÔÂÓ›·˜

‹ ÏÔÈÌÒÍÂˆÓ ‹/Î·È Ô˘‰ÂÙÂÚfiÊÈÏ· <0,5x109/L ÛÂ ÙÚÂÈ˜

ÌÂÙÚ‹ÛÂÈ˜, Ë ‰ÈÂÚÂ‡ÓËÛË Ú¤ÂÈ Ó· Á›ÓÂÈ ˆ˜ ÂÍ‹˜:

9) ŸÙ·Ó ˘¿Ú¯ÂÈ ÂÚÈÔ‰ÈÎfiÙËÙ· ÛÙËÓ ÂÌÊ¿ÓÈÛË

ÙˆÓ ÏÔÈÌÒÍÂˆÓ ‹ ÙË˜ Ô˘ÏÔÛÙÔÌ·Ù›ÙÈ‰·˜ ÛÂ Û˘Ó‰˘·-

ÛÌfi ÌÂ ıÂÙÈÎfi ÎÏËÚÔÓÔÌÈÎfi ÈÛÙÔÚÈÎfi Î·È ·ÓÂ‡ÚÂÛË˜

ÌÂÙ·ÏÏ¿ÍÂˆÓ ÛÙÔ ÁÔÓ›‰ÈÔ ELA2, Ù›ıÂÙ·È Ë ‰È¿ÁÓˆÛË

ÙË˜ Î˘ÎÏÈÎ‹˜ Ô˘‰ÂÙÂÚÔÂÓ›·˜. ∂¿Ó ‰ÂÓ ˘¿Ú¯ÂÈ Ë

‰˘Ó·ÙfiÙËÙ· ÙÔ˘ ÌÔÚÈ·ÎÔ‡ ÂÏ¤Á¯Ô˘, ÙfiÙÂ Ú¤ÂÈ Ó·

Á›ÓÂÙ·È ·ÈÌÔÏË„›· Î·È ÁÂÓÈÎ‹ ·›Ì·ÙÔ˜ ÙÚÂÈ˜ ÊÔÚ¤˜

ÙËÓ Â‚‰ÔÌ¿‰· ÁÈ· ¤ÍÈ Â‚‰ÔÌ¿‰Â˜ ÁÈ· Ó· ·Ó·‰ÂÈ¯ıÂ› Ë

Î˘ÎÏÈÎ‹ Ô˘‰ÂÙÂÚÔÂÓ›·.

10) ∏ ÂÌÊ¿ÓÈÛË Ô˘‰ÂÙÂÚÔÂÓ›·˜ ¯ˆÚ›˜ È‰È·›ÙÂÚ·

Û˘¯Ó¤˜ ÛÔ‚·Ú¤˜ ‚·ÎÙËÚÈ·Î¤˜ ÏÔÈÌÒÍÂÈ˜ ÛÙÈ˜ ÚÒÙÂ˜

Â‚‰ÔÌ¿‰Â˜ ÙË˜ ˙ˆ‹˜ Î·ÙÂ˘ı‡ÓÂÈ ÙË ‰ÈÂÚÂ‡ÓËÛË Î˘-

Ú›ˆ˜ ÚÔ˜ ÙË ÓÂÔÁÓÈÎ‹ ÈÛÔ¿ÓÔÛË Ô˘‰ÂÙÂÚÔÂÓ›·,

ÂÊfiÛÔÓ ·ÓÈ¯ÓÂ˘ÙÔ‡Ó Î·È Ù· ÂÈ‰ÈÎ¿ ·ÓÙÈÔ˘‰ÂÙÂÚÔÊÈ-

ÏÈÎ¿ ·ÓÙÈÛÒÌ·Ù· ÛÙÔÓ ÔÚfi ÙË˜ ÌËÙ¤Ú·˜ Î·È ÙÔ˘ ·È-

‰ÈÔ‡. ™Â ·È‰È¿ ËÏÈÎ›·˜ >6 ÌËÓÒÓ Ô˘ ‰ÂÓ ¤¯Ô˘Ó

ÈÛÙÔÚÈÎfi ÛÔ‚·ÚÒÓ ÏÔÈÌÒÍÂˆÓ, Û˘Ó‹ıˆ˜ Ë ‰È¿ÁÓˆÛË

Â›Ó·È ·˘ÙÔ¿ÓÔÛË Ô˘‰ÂÙÂÚÔÂÓ›· Î·È ÂÊfiÛÔÓ ·ÓÈ-

¯ÓÂ‡ÔÓÙ·È ·ÓÙÈÔ˘‰ÂÙÂÚÔÊÈÏÈÎ¿ ·ÓÙÈÛÒÌ·Ù·, ‰ÂÓ

¯ÚÂÈ¿˙ÂÙ·È Ó· Á›ÓÂÈ Ì˘ÂÏfiÁÚ·ÌÌ·.

11) ŸÙ·Ó ˘¿Ú¯ÂÈ Î·Î‹ ‰È·ÙÚÔÊ‹ ‹ ÛËÌÂ›· ‰˘-

Û·ÔÚÚfiÊËÛË˜ ÂÓ‰ÂÈÎÙÈÎ¿ ÂÍˆÎÚÈÓÔ‡˜ ·ÁÎÚÂ·ÙÈ-

Î‹˜ ·ÓÂ¿ÚÎÂÈ·˜ (.¯. ÛÙÂ·ÙfiÚÚÔÈ·, ·ÓÂ·ÚÎ‹˜

ÚfiÛÏË„Ë ‚¿ÚÔ˘˜), ÙfiÙÂ Ú¤ÂÈ Ó· Á›ÓÂÙ·È ¤ÏÂÁ-

¯Ô˜ ÁÈ· ·ÓÂ¿ÚÎÂÈ· µ12/Ê˘ÏÏÈÎÔ‡ Î·È ‰ÈÂÚÂ‡ÓËÛË

ÁÈ· Ù· Û‡Ó‰ÚÔÌ· Shwachman-Diamond (SDS) Î·È

Pearson.

12) ™Ù· ·È‰È¿ ÌÂ ¯ÚfiÓÈ· Ô˘‰ÂÙÂÚÔÂÓ›· Ô˘ Û˘-

Ó˘¿Ú¯Ô˘Ó Ê·ÈÓÔÙ˘ÈÎ¤˜ ·ÓˆÌ·Ï›Â˜, ÌÂÙ·‚ÔÏÈÎ¤˜

‰È·Ù·Ú·¯¤˜ ‹ Î·Ú‰ÈÔÏÔÁÈÎ¿ ÚÔ‚Ï‹Ì·Ù· Ú¤ÂÈ Ó·

Á›ÓÂÙ·È ¤ÏÂÁ¯Ô˜ ÁÈ· ·Ó·ÈÌ›· Fanconi, Û˘ÁÁÂÓ‹ ‰˘-

ÛÎÂÚ¿ÙˆÛË, Û‡Ó‰ÚÔÌÔ Chediak-Higashi, ÁÏ˘ÎÔÁÔ-

Ó›·ÛË Ù‡Ô˘ 1b Î·È Û‡Ó‰ÚÔÌÔ Barth, ·ÓÙ›ÛÙÔÈ¯·.

13) ™ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ Ô˘ Û˘Ì‚·›ÓÔ˘Ó Û˘¯Ó¤˜

Î·È ÛÔ‚·Ú¤˜ ¿Ù˘Â˜ ÏÔÈÌÒÍÂÈ˜ ÛÂ Û˘Ó‰˘·ÛÌfi

ÌÂ ¿ÏÏÂ˜ ‰È·Ù·Ú·¯¤˜, Ú¤ÂÈ Ó· Á›ÓÂÙ·È ‰ÈÂÚÂ‡ÓË-

ÛË ÁÈ· Û˘ÁÁÂÓÂ›˜ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈÂ˜ ‹ ÏÔ›ÌˆÍË ·fi

HIV.


¶·È‰È·ÙÚÈÎ‹ 2007;70:237-245


244 ∞. ª¿ÎË˜, ¡. Ã·ÏÈ¿ÛÔ˜


14) ™ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ Ô˘ ‰È·ÈÛÙÒÓÔÓÙ·È ·ÓËÛ˘-

¯ËÙÈÎ¿ ÛËÌÂ›· ÛÙËÓ ÎÏÈÓÈÎ‹ ÂÍ¤Ù·ÛË (.¯. ÏÂÌÊ·‰Â-

ÓÔ¿ıÂÈ·, Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›·), fiÙ·Ó Û˘Ó˘¿Ú¯ÂÈ

·Ó·ÈÌ›· ‹ ıÚÔÌ‚ÔÂÓ›· ‹ fiÙ·Ó ·ÓÂ˘Ú›ÛÎÔÓÙ·È ‚Ï¿-

ÛÙÂ˜ ÛÙÔ ÂÚÈÊÂÚÈÎfi ·›Ì·, Î·ıÒ˜ Â›ÛË˜ fiÙ·Ó Ë

·Ú¯ÈÎ‹ ‰ÈÂÚÂ‡ÓËÛË ‰ÂÓ ¤¯ÂÈ Ô‰ËÁ‹ÛÂÈ ÛÂ Û˘ÁÎÂÎÚÈ-

Ì¤ÓË ·ÈÙ›· Î·È ˘¿Ú¯ÂÈ ÈÛÙÔÚÈÎfi ÛÔ‚·ÚÒÓ ÏÔÈÌÒÍÂ-

ˆÓ, Ú¤ÂÈ Ó· Á›ÓÂÙ·È Ì˘ÂÏfiÁÚ·ÌÌ·, ‚ÈÔ„›· ÔÛÙÔ‡

Î·È ·ÓÔÛÔÊ·ÈÓÔÙ˘ÈÎfi˜ Î·È Î˘ÙÙ·ÚÔÁÂÓÂÙÈÎfi˜

¤ÏÂÁ¯Ô˜. ∏ ·ÓÙÈÎ·Ù¿ÛÙ·ÛË ÙÔ˘ Ì˘ÂÏÔ‡ ·fi Î·ÎÔ‹-

ıË Î‡ÙÙ·Ú· (ÏÂ˘¯·ÈÌ›·, Ï¤ÌÊˆÌ·, ÌÂÙ·ÛÙ·ÙÈÎÔ›

Û˘Ì·ÁÂ›˜ fiÁÎÔÈ) ÚÔÎ·ÏÂ› Û˘Ó‹ıˆ˜ ·ÓÎ˘ÙÙ·ÚÔ-

ÂÓ›·, ·Ú¿ ÌÂÌÔÓˆÌ¤ÓË Ô˘‰ÂÙÂÚÔÂÓ›·. ™Â ÂÚ›-

ÙˆÛË ÓfiÛÔ˘ Kostmann ı· Ê·ÓÂ› ·Ó·ÛÙÔÏ‹ ÛÙË

Ê¿ÛË ÙÔ˘ ÚÔÌ˘ÂÏÔÎ˘ÙÙ¿ÚÔ˘/Ì˘ÂÏÔÎ˘ÙÙ¿ÚÔ˘. ∏

ÂÈÎfiÓ· ‰˘ÛÏ·Û›·˜ ÙÔ˘ Ì˘ÂÏÔ‡ ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ

·ÓÒÌ·Ï· Î˘ÙÙ·ÚÔÁÂÓÂÙÈÎ¿ Â˘Ú‹Ì·Ù· Ô‰ËÁÂ› ÛÙË

‰È¿ÁÓˆÛË ÙÔ˘ Ì˘ÂÏÔ‰˘ÛÏ·ÛÙÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘

(MDS). ∏ ‚ÈÔ„›· ÔÛÙÔ‡ ‚ÔËı¿ ÛÙË ‰È¿ÁÓˆÛË ÙË˜

·Ï·ÛÙÈÎ‹˜ ·Ó·ÈÌ›·˜. ∏ ‰È¿ÁÓˆÛË ÙË˜ ·ÚÔÍ˘ÛÌÈ-

Î‹˜ Ó˘¯ÙÂÚÈÓ‹˜ ·ÈÌÔÛÊ·ÈÚÈÓÔ˘Ú›·˜ (PNH) Ù›ıÂÙ·È

ÌÂ ÙËÓ Î˘ÙÙ·ÚÔÌÂÙÚ›· ÚÔ‹˜.


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“∆· Ù˘ÊÏ¿ ·È‰È¿

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

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¶·È‰È·ÙÚÈÎ‹ 2007;70:237-245


246 ∫§π¡π∫√ ∫√Àπ∑

Paediatriki 2007;70:246,252

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∞ÁfiÚÈ ËÏÈÎ›·˜ 13 ÂÙÒÓ ·Ú·¤ÌÂÙ·È ÛÙËÓÎÏÈÓÈÎ‹ Ì·˜ ÏfiÁˆ ·ÓÒ‰˘ÓË˜, ˘fiÛÎÏËÚË˜ ‰Èfi-ÁÎˆÛË˜ ÏÂÌÊ·‰¤ÓˆÓ ÌÂ ÂÓÙfiÈÛË ÛÙËÓ ÂÚÈÔ¯‹ÙË˜ ‰ÂÍÈ¿˜ ·ÚÂÈ¿˜ Î·È ÛÙÔÓ Û‡ÛÙÔÈ¯Ô ˘ÔÁÓ¿ıÈÔ¯ÒÚÔ, ‰È·ÛÙ¿ÛÂˆÓ 5x6 cm ·fi 5ËÌ¤ÚÔ˘. √ ·ÛıÂ-Ó‹˜ Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ‹Ù·Ó ·‡ÚÂÙÔ˜, ·Ó¤ÊÂÚÂÌ˘·ÏÁ›Â˜, Î·Ù·‚ÔÏ‹ Î·È ·ÓÔÚÂÍ›· ·fi 10ËÌ¤ÚÔ˘,ÂÓÒ ·fi 5ËÌ¤ÚÔ˘ Â›¯Â Ï¿‚ÂÈ ·ÁˆÁ‹ ÌÂ ·ÌÔÍ˘ÎÈÏ-Ï›ÓË/ÎÏ·‚Ô˘Ï·ÓÈÎfi ÔÍ‡ ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜, ¯ˆÚ›˜ÎÏÈÓÈÎ‹ ‚ÂÏÙ›ˆÛË. ∆· ·ÔÙÂÏ¤ÛÌ·Ù· ÙÔ˘ ·ÈÌ·ÙÔ-ÏÔÁÈÎÔ‡ Î·È ‚ÈÔ¯ËÌÈÎÔ‡ ÂÏ¤Á¯Ô˘ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ-Î¿, ÔÈ ‰Â›ÎÙÂ˜ ÊÏÂÁÌÔÓ‹˜ Î·È Ë Mantoux ·ÚÓËÙÈ-ÎÔ›. ∞fi ÙÔÓ ·ÂÈÎÔÓÈÛÙÈÎfi ¤ÏÂÁ¯Ô Ô˘ ‰ÈÂÓÂÚÁ‹-ıËÎÂ ÌÂ ˘ÂÚË¯ÔÁÚ¿ÊËÌ· Î·È CT ÙË˜ ÂÚÈÔ¯‹˜‰È·ÈÛÙÒıËÎÂ Ë ·ÚÔ˘Û›· Â˘ÌÂÁ¤ıÔ˘˜ ÏÂÌÊ·‰¤-Ó· ‰È·ÛÙ¿ÛÂˆÓ 4,8x2,5x2,8 cm ˘ÔÁÓ¿ıÈ· ‰ÂÍÈ¿,ÌÂ ÈÂÛÙÈÎ¿ Ê·ÈÓfiÌÂÓ· ÛÙÈ˜ ÁÂÈÙÔÓÈÎ¤˜ ‰ÔÌ¤˜, ·-ÚÔ˘Û›· ÔÏÏ·ÏÒÓ ÌÈÎÚfiÙÂÚˆÓ ÏÂÌÊ·‰¤ÓˆÓ ÛÙÔÔ›ÛıÈÔ ÙÚ›ÁˆÓÔ, ¿¯˘ÓÛË ÙÔ˘ ‰ÂÍÈÔ‡ Ï¿ÁÈÔ˘ÙÔÈ¯ÒÌ·ÙÔ˜ ÙÔ˘ Ê¿Ú˘ÁÁ· ÌÂ ÚÔ‚ÔÏ‹ ‚Ï¿‚Ë˜ Ì·-Ï·ÎÔ‡ ÈÛÙÔ‡ Î·È ÏÂÌÊÈÎ‹ ÛÙ¿ÛË Û‡ÛÙÔÈ¯·. √·ÛıÂÓ‹˜ ÛÙËÓ ÎÏÈÓÈÎ‹ Ì·˜ Ù¤ıËÎÂ ÛÂ ·ÁˆÁ‹ ÌÂ·ÌÔÍ˘ÎÈÏÏ›ÓË/ÎÏ·‚Ô˘Ï·ÓÈÎfi ÔÍ‡ Î·È ÙÂ˚ÎÔÏ·Ó›-ÓË. ∆Ô ¤ÎÙÔ 24ˆÚÔ ·fi ÙËÓ ÂÈÛ·ÁˆÁ‹ ·ÚÔ˘Û›·ÛÂ˘„ËÏfi ˘ÚÂÙfi ˆ˜ 40ÔC Ô˘ Û˘ÓÔ‰Â‡ıËÎÂ ·fiÂÈ‰Â›ÓˆÛË ÙË˜ ÎÏÈÓÈÎ‹˜ Î·Ù¿ÛÙ·ÛË˜ ÌÂ ·ÒÏÂÈ·‚¿ÚÔ˘˜, ÂÌÊ¿ÓÈÛË ÂÙÂ¯ÂÈÒ‰Ô˘˜ ÂÍ·Óı‹Ì·ÙÔ˜,Ì˘·ÏÁ›Â˜, Î·Ù·‚ÔÏ‹ Î·È ÂÌ¤ÙÔ˘˜. ∞fi ÙËÓ ·ÓÙÈ-ÎÂÈÌÂÓÈÎ‹ ÂÍ¤Ù·ÛË ‰È·ÈÛÙÒıËÎÂ ÌË ÌÂÙ·‚ÔÏ‹ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙË˜ ÏÂÌÊ·‰ÂÓÈÎ‹˜ Ì¿˙·˜ Î·È ·fiÙÔÓ ·ÈÌ·ÙÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô ÏÂ˘ÎÔÂÓ›· (WBC:

1200/mm3) Î·È ıÚÔÌ‚ÔÂÓ›· (PLT: 22000/mm3),ÂÓÒ ÔÈ ‰Â›ÎÙÂ˜ ÊÏÂÁÌÔÓ‹˜ ‹Ù·Ó ÂÎ Ó¤Ô˘ ·ÚÓËÙÈ-ÎÔ›. √È Î·ÏÏÈ¤ÚÁÂÈÂ˜ ·›Ì·ÙÔ˜ Ô˘ ÂÏ‹ÊıËÛ·Ó‹Ù·Ó ·ÚÓËÙÈÎ¤˜. §fiÁˆ ÙÔ˘ ˘„ËÏÔ‡ ˘ÚÂÙÔ‡, ÙÔ˘ÂÙÂ¯ÂÈÒ‰Ô˘˜ ÂÍ·Óı‹Ì·ÙÔ˜ Î·È ÙË˜ ÌË ·ÓÙ·fi-ÎÚÈÛË˜ ÛÙËÓ ·Ú¯ÈÎ‹ ·ÓÙÈÌÈÎÚÔ‚È·Î‹ ıÂÚ·Â›· Ô·ÛıÂÓ‹˜ Ù¤ıËÎÂ ÛÂ ·ÁˆÁ‹ ÌÂ ÈÌÈÂÓ¤ÌË/ÛÈÏ·ÛÙ·-Ù›ÓË, ·ÌÈÎ·Û›ÓË Î·È ‚·ÓÎÔÌ˘Î›ÓË. ∆· ·ÓÙÈÛÒÌ·Ù·ÛÙÔÓ ÔÚfi ÁÈ· Toxoplasma, Bartonella henselae,Mycoplasma, Coxsackie B1-5, Salmonella, Shigella,Û‡ÊÈÏË, ÏÂ˚ÛÌ¿ÓÈ· ‹Ù·Ó ·ÚÓËÙÈÎ¿, ÂÓÒ ÛÂ fi,ÙÈ·ÊÔÚ¿ ÛÙ· ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ CMV Î·È EBV ‰È·-ÈÛÙÒıËÎÂ ·ÓÔÛ›·.

√ ·ÛıÂÓ‹˜ ˘Ô‚Ï‹ıËÎÂ ÛÂ Ì˘ÂÏfiÁÚ·ÌÌ· Î·ÈÔÛÙÂÔÌ˘ÂÏÈÎ‹ ‚ÈÔ„›·, Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÙˆÓÔÔ›ˆÓ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ¿, ÂÓÒ ·Ú¿ÏÏËÏ·, o¤ÏÂÁ¯Ô˜ ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ ¤‰ÂÈÍÂ: ANA+ (1/80),p-ANCA+ (6,31 U/ml) Î·È ‰ÈÂÓÂÚÁ‹ıËÎÂ ·Ê·›ÚÂ-ÛË ÙË˜ ÏÂÌÊ·‰ÂÓÈÎ‹˜ ‰ÈfiÁÎˆÛË˜, Ë ÔÔ›· ÙÂÎÌË-Ú›ˆÛÂ ÙË ‰È¿ÁÓˆÛË Ï›ÁÂ˜ ËÌ¤ÚÂ˜ ·ÚÁfiÙÂÚ·. ªÂÙ¿ÙËÓ ·Ê·›ÚÂÛË ÙË˜ Ì¿˙·˜, ¤ÁÈÓÂ ‰È·ÎÔ‹ ÙË˜ ·ÓÙÈ-ÌÈÎÚÔ‚È·Î‹˜ ·ÁˆÁ‹˜ Î·È ‰‡Ô 24ˆÚ· ·ÚÁfiÙÂÚ·, Ô·ÛıÂÓ‹˜ ·˘Ú¤ÙËÛÂ.

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¶·È‰È·ÙÚÈÎ‹ 2007;70:247-248

∏ Î·Ï‡ÙÂÚË ‚ÈÔ˚·ÙÚÈÎ‹ ÌÂÏ¤ÙË ÙË˜ ¯ÚÔÓÈ¿˜

∆Ô 2006 ‹Ù·Ó ÌÈ· Î·Ï‹ ÂÚÂ˘ÓËÙÈÎ‹ ¯ÚÔÓÈ¿:ÂÚ›Ô˘ 700.000 ¿ÚıÚ· Î·Ù·¯ˆÚ‹ıËÎ·Ó ÛÙË ‚¿-ÛË ‰Â‰ÔÌ¤ÓˆÓ PubMed. ∏ ‰ÈÂıÓ‹˜ ÂÎ‰ÔÙÈÎ‹ÔÌ¿‰· ÙÔ˘ Lancet, ÙËÚÒÓÙ·˜ ·Ú¿‰ÔÛË ÂÙÒÓ, ÍÂ-¯ÒÚÈÛÂ 23 ÂÍ ·˘ÙÒÓ Î·È Ù· ÚfiÙÂÈÓÂ ÛÙÔ˘˜ 13 ÂÎ-‰fiÙÂ˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. ªÂÙ¿ ·fi Û˘˙‹ÙËÛË, ÔÈÂÎ‰fiÙÂ˜ Â¤ÏÂÍ·Ó (Lancet 2007;369:91) ˆ˜ Î·-Ï‡ÙÂÚË ‚ÈÔ˚·ÙÚÈÎ‹ ÌÂÏ¤ÙË ÙÔ˘ 2006 ‰‡Ô Û˘ÓÂ¯fi-ÌÂÓ· ¿ÚıÚ· ÛÙÔ New England Journal of Medicine(2006;354:11 Î·È 354:23) Ô˘ ·ÊÔÚÔ‡Û·Ó ÙËÓ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Î·È ÙËÓ ·ÛÊ¿ÏÂÈ· ÙÔ˘ ÂÌ-‚ÔÏÈ·ÛÌÔ‡ Î·Ù¿ ÙÔ˘ ÈÔ‡ ÚfiÙ· (rotavirus). √È ÌÂ-Ï¤ÙÂ˜ Â›¯·Ó ‰È·Í·¯ıÂ› ·fi ÙÈ˜ ÔÏ˘ÎÂÓÙÚÈÎ¤˜ÔÌ¿‰Â˜ ÙˆÓ Gulielmo Ruiz-Palacios (™·ÓÙÈ¿ÁÔ,ÃÈÏ‹) Î·È Timo Vesikari (∆¿ÌÂÚÂ, ºÈÓÏ·Ó‰›·).∆Ô “·ÚÁ˘Úfi ÌÂÙ¿ÏÏÈÔ” ·ÔÓÂÌ‹ıËÎÂ Â›ÛË˜ ÛÂÌÂÏ¤ÙË ÁÈ· ÂÌ‚fiÏÈÔ, ÂÎÂ›ÓÔ ÙÔ˘ ÈÔ‡ ÙˆÓ ·ÓıÚÒ-ÈÓˆÓ ıËÏˆÌ¿ÙˆÓ HPV (Diane Harper,Darmouth/¡∏, ∏¶∞, Lancet 2006;367:1247).ÕÏÏÂ˜ ÌÂÏ¤ÙÂ˜ Ô˘ ‰È·ÎÚ›ıËÎ·Ó ·ÊÔÚÔ‡Û·Ó ÙËÓÚÒÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË ÚÔÛÒÔ˘ (Lancet2006;368:203) Î·È ÙË Û‡ÁÎÚÈÛË ÙˆÓ ÂÁÎÂÊ¿ÏˆÓÙÔ˘ ·ÓıÚÒÔ˘ Î·È ÙÔ˘ ¯ÈÌ·ÓÙ˙‹ (Nature

2006;443:167).

∆· Î·Ï¿ ÙÔ˘ ıËÏ·ÛÌÔ‡

∆· ÏÂÔÓÂÎÙ‹Ì·Ù· ÙÔ˘ ıËÏ·ÛÌÔ‡ Â›Ó·È ·-ÛÈÊ·Ó‹ ÎÈ Â›Ó·È ·ÔÚ›·˜ ¿ÍÈÔ Ò˜ ÊÙ¿Û·ÌÂ ÛÙÔÛËÌÂ›Ô Ù· ÌˆÚ¿ Ô˘ ıËÏ¿˙Ô˘Ó Ó· ·ÔÙÂÏÔ‡ÓÂÍ·›ÚÂÛË. √ ıËÏ·ÛÌfi˜ ÚÔÛÙ·ÙÂ‡ÂÈ, ÌÂÙ·Í‡ ¿Ï-ÏˆÓ, ·fi ÏÔÈÌÒÍÂÈ˜ Î·È ÙÔ ÁÂÁÔÓfi˜ ·˘Ùfi ÂÈ‚Â-‚·ÈÒÓÂÈ ÚfiÛÊ·ÙË ÌÂÏ¤ÙË ·fi ÙÔ ∏ÓˆÌ¤ÓÔ µ·-Û›ÏÂÈÔ Ô˘ Û˘ÌÂÚÈ¤Ï·‚Â 15.890 ˘ÁÈ‹ ÙÂÏÂÈfiÌË-Ó· ÓÂÔÁÓ¿ (Pediatrics 2007;119:e837). ∆· ‚Ú¤ÊËÔ˘ ıËÏ¿˙Ô˘Ó ÓÔÛËÏÂ‡ÔÓÙ·È ÁÈ· ÏÈÁfiÙÂÚÔ ¯Úfi-ÓÔ ÁÈ· ‰È¿ÚÚÔÈ· Î·È ÏÔÈÌÒÍÂÈ˜ ÙÔ˘ Î·ÙÒÙÂÚÔ˘·Ó·ÓÂ˘ÛÙÈÎÔ‡. ÀÔÏÔÁ›ÛÙËÎÂ fiÙÈ Ô ·ÔÎÏÂÈ-ÛÙÈÎfi˜ ıËÏ·ÛÌfi˜ ı· ÌÂ›ˆÓÂ ÙÔÓ ¯ÚfiÓÔ ÓÔÛËÏÂ›-·˜ ÁÈ· ‰È¿ÚÚÔÈ· Î·Ù¿ 53% Î·È ÁÈ· ÏÔ›ÌˆÍË ÙÔ˘Î·ÙÒÙÂÚÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡ Î·Ù¿ 27% ÛÙÔ˘˜ÚÒÙÔ˘˜ 8 Ì‹ÓÂ˜ ÙË˜ ̇ ˆ‹˜ ÙÔ˘ ·ÙfiÌÔ˘. ∆· ·ÓÙ›-ÛÙÔÈ¯· ÔÛÔÛÙ¿ ÁÈ· ÙÔ ÌÂÚÈÎfi ıËÏ·ÛÌfi ı· ‹Ù·Ó31% Î·È 25%. ∏ ¶·ÁÎfiÛÌÈ· √ÚÁ¿ÓˆÛË ÀÁÂ›·˜¤¯ÂÈ ÚÔ ÔÏÏÔ‡ Û˘ÛÙ‹ÛÂÈ ·ÔÎÏÂÈÛÙÈÎfi ıËÏ·-

ÛÌfi ¤ˆ˜ ÙÔ˘˜ 6 Ì‹ÓÂ˜ ÁÈ· ÙÔ 100% ÙˆÓ ‚ÚÂÊÒÓ.

™ÙËÓ ∫Ú‹ÙË ÌfiÓÔ 10% ÙˆÓ ‚ÚÂÊÒÓ ıËÏ¿˙Ô˘Ó

·ÔÎÏÂÈÛÙÈÎ¿ ÛÙÔ˘˜ 6 Ì‹ÓÂ˜ Î·È ÚfiÛÊ·ÙÂ˜ ÌÂ-

Ï¤ÙÂ˜ (J Pediatr Gastroenterol Nutr 2006;43:379

Î·È ¶·È‰È·ÙÚÈÎ‹ µÔÚÂ›Ô˘ ∂ÏÏ¿‰Ô˜ 2006;18:347)

ÂÈ‚Â‚·ÈÒÓÔ˘Ó ¯·ÌËÏ¿ ÔÛÔÛÙ¿ Î·È ÛÙËÓ ∞ı‹-

Ó· (12%) Î·È ÙË µÔÚÂÈÔ‰˘ÙÈÎ‹ ∂ÏÏ¿‰· (9%).

ÃÚÂÈ¿˙ÂÙ·È Â·Ó¿ÏË„Ë ÙË˜ Î·ÏÏÈ¤ÚÁÂÈ·˜

Ô‡ÚˆÓ ÛÙË ‰È¿ÚÎÂÈ· ıÂÚ·Â›·˜ ÙË˜

Ô˘ÚÔÏÔ›ÌˆÍË˜;

™Â 328 ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ Ô˘ ÓÔÛËÏÂ‡ıË-

Î·Ó ÁÈ· Ô˘ÚÔÏÔ›ÌˆÍË ÛÂ ÓÔÛÔÎÔÌÂ›Ô ÙË˜ ¡¤·˜

ÀfiÚÎË˜ ¤ÁÈÓÂ Â·Ó¿ÏË„Ë ÙË˜ Î·ÏÏÈ¤ÚÁÂÈ·˜ Ô‡-

ÚˆÓ ‰‡Ô ËÌ¤ÚÂ˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË ÙË˜ ÂÌÂÈÚÈ-

Î‹˜ ·ÓÙÈ‚›ˆÛË˜ (Pediatrics 2007;119:e325). ªfi-

ÓÔ ÛÂ ¤Ó· ·È‰› (0,3%, 95% ‰È¿ÛÙËÌ· ÂÌÈÛÙÔ-

Û‡ÓË˜ 0%-1,7%) ‰ÂÓ Â›¯·Ó ·ÔÛÙÂÈÚˆıÂ› Ù· Ô‡-

Ú·. ∂ÚfiÎÂÈÙÔ ÁÈ· ‚Ú¤ÊÔ˜ 7 ÌËÓÒÓ Ô˘ Â›¯Â ÂÈ-

Û·¯ıÂ› ÁÈ· Ô˘ÚÔÏÔ›ÌˆÍË Î·È ‚ÚÔÁ¯ÈÔÏ›ÙÈ‰·, Â›¯Â

Ï¿‚ÂÈ ÙÚÈÌÂıÔÚ›ÌË-ÛÔ˘ÏÊ·ÌÂıÔÍ·˙fiÏË (ÏfiÁˆ

·ÏÏÂÚÁ›·˜ ÛÙËÓ ·ÌÔÍ˘ÎÈÏÏ›ÓË) Î·È ÛÙËÓ Î·Ï-

ÏÈ¤ÚÁÂÈ· Ô‡ÚˆÓ ·Ó¤Ù˘ÍÂ Escherichia coli ·ÓıÂ-

ÎÙÈÎfi ÛÙËÓ ÙÚÈÌÂıÔÚ›ÌË-ÛÔ˘ÏÊ·ÌÂıÔÍ·˙fiÏË.

∆Ô Â‡ÏÔÁÔ Û˘Ì¤Ú·ÛÌ·-ÂÚÒÙËÌ· ÙË˜ ÌÂÏ¤ÙË˜

Â›Ó·È ·Ó ·Í›˙ÂÈ Ë ÂÈÌÔÓ‹ ÛÙËÓ Î·ÏÏÈ¤ÚÁÂÈ· Ô‡-

ÚˆÓ ˘fi ·ÓÙÈ‚›ˆÛË. ∏ ·ÓÙÔ¯‹ ÙˆÓ Ô˘ÚÔ·ıÔ-

ÁfiÓˆÓ, Û˘ÓÂÒ˜ Î·È Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙË˜

ÂÌÂÈÚÈÎ‹˜ ·ÁˆÁ‹˜, ‰È·Ê¤ÚÂÈ ·fi ¯ÒÚ· ÛÂ ¯Ò-

Ú· - ¿Ú·ÁÂ fiÛÔ Û˘¯Ó¿ ‚Ï¤Ô˘ÌÂ ÛÙËÓ ∂ÏÏ¿‰·

ıÂÙÈÎ¤˜ Î·ÏÏÈ¤ÚÁÂÈÂ˜ Ô‡ÚˆÓ 2 ‹ 3 24ˆÚ· ÌÂÙ¿

ÙËÓ ¤Ó·ÚÍË ÙË˜ ·ÓÙÈ‚ÈÔÙÈÎ‹˜ ·ÁˆÁ‹˜;

øÙ›ÙÈ‰Â˜ Î·È ÛˆÏËÓ¿ÎÈ·

∏ ̄ Ú‹ÛË ÛˆÏËÓ›ÛÎˆÓ ·ÂÚÈÛÌÔ‡ ÁÈ· ÙË ̄ ÚfiÓÈ·

ˆÙ›ÙÈ‰· ÛÙËÚ›¯ıËÎÂ ÛÂ ·Ó·‰ÚÔÌÈÎ¤˜ ÌÂÏ¤ÙÂ˜

ÙˆÓ ‰ÂÎ·ÂÙÈÒÓ 1950-1970 Ô˘ Â›¯·Ó Û˘Û¯ÂÙ›ÛÂÈ

ÙË ¯ÚfiÓÈ· Û˘ÏÏÔÁ‹ ˘ÁÚÔ‡ ÌÂ ·Ó·Ù˘ÍÈ·Î‹ Î·ı˘-

ÛÙ¤ÚËÛË. ∆· ÛˆÏËÓ¿ÎÈ· ¤ÁÈÓ·Ó ÁÚ‹ÁÔÚ· ‰ËÌÔ-

ÊÈÏ‹ Î·È ¤ÊÙ·Û·Ó Ó· Â›Ó·È Ë ‰Â‡ÙÂÚË ÛÂ Û˘¯Ófi-

ÙËÙ· ¯ÂÈÚÔ˘ÚÁÈÎ‹ ·Ú¤Ì‚·ÛË ÛÙÈ˜ ∏¶∞ (ÌÂÙ¿

ÙËÓ ÂÚÈÙÔÌ‹). ∏ ÚÔÛ¤ÁÁÈÛË ·˘Ù‹ ÎÚ›ÓÂÙ·È ÂÎ

ÙˆÓ ˘ÛÙ¤ÚˆÓ Ì¿ÏÏÔÓ ÂÈıÂÙÈÎ‹. ™ÙÔ Pittsburg

ÙˆÓ ∏¶∞ Ë ÔÌ¿‰· ÙÔ˘ John Paradise, ÁÓˆÛÙ‹ ÁÈ·

∂ÌÌ·ÓÔ˘‹Ï °·Ï·Ó¿ÎË˜ AÏÏËÏÔÁÚ·Ê›·:

∂ÌÌ·ÓÔ˘‹Ï °·Ï·Ó¿ÎË˜[email protected]¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹ÙË˜


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PAEDIATRIC NEWS IN BRIEF

ÙËÓ ¤ÚÂ˘Ó¿ ÙË˜ Û¯ÂÙÈÎ¿ ÌÂ ÙË Ì¤ÛË ˆÙ›ÙÈ‰·, ·Ú·ÎÔ-

ÏÔ‡ıËÛÂ 6.350 ÓÂÔÁÓ¿ ·fi ÙÈ˜ ·Ú¯¤˜ ÙË˜ ‰ÂÎ·ÂÙ›·˜

ÙÔ˘ 1990. ™Â 429 ‚ÚÂÊÔÓ‹È· ÌÂ ¯ÚfiÓÈ· ·ÚÔ˘Û›·

˘ÁÚÔ‡ ÛÙÔ Ì¤ÛÔ Ô˘˜, ÙÔÔıÂÙ‹ıËÎ·Ó, ÌÂ Ù˘¯·›· Î·-

Ù·ÓÔÌ‹, ÛˆÏËÓ¿ÎÈ· ·Ì¤Ûˆ˜ ‹ ÌÂÙ¿ ·fi 9 Ì‹ÓÂ˜ (·Ó

Â¤ÌÂÓÂ Ë Û˘ÏÏÔÁ‹ ˘ÁÚÔ‡). 391 ·È‰È¿ ·Ú·ÎÔÏÔ˘-

ı‹ıËÎ·Ó ÁÈ· 9-11 ¤ÙË (·ÍÈÔı·‡Ì·ÛÙË ÂÈÙ˘¯›· ÁÈ· Ù¤-

ÙÔÈÂ˜ ÌÂÏ¤ÙÂ˜). ∞ÔÙÂÏ¤ÛÌ·Ù·: Ù· ÛˆÏËÓ¿ÎÈ· ‰ÂÓ

‚ÂÏÙÈÒÓÔ˘Ó ·Ó·Ù˘ÍÈ·Î¤˜ ·Ú·Ì¤ÙÚÔ˘˜, fiˆ˜ Ë ÔÌÈ-

Ï›·, Ë ÁÏÒÛÛ·, Ë ÁÓˆÛÙÈÎ‹ Î·È Ë „˘¯ÔÎÔÈÓˆÓÈÎ‹ ÂÍ¤-

ÏÈÍË (N Engl J Med 2007;356:248). ™‡ÌÊˆÓ· ÌÂ Ùo Û˘-

ÓÔ‰Â˘ÙÈÎfi Û¯fiÏÈÔ ·fi ÙË Û‡ÓÙ·ÍË (N Engl J Med

2007;356:300), Ù· Â˘Ú‹Ì·Ù· ·˘Ù¿ ÛËÌ·ÙÔ‰ÔÙÔ‡Ó ÙÔ

Ù¤ÏÔ˜ ÙË˜ ÂÈıÂÙÈÎ‹˜ ¯Ú‹ÛË˜ ÛˆÏËÓ›ÛÎˆÓ ·ÂÚÈÛÌÔ‡,

¿Ô„Ë Ô˘ Û˘ÌÌÂÚ›˙ÔÓÙ·È Î·È ÔÈ ÂÎ‰fiÙÂ˜ ÙÔ˘

Pediatric Infections Disease Journal (Newsletter ∞ÚÈÏ›-

Ô˘ 2007). √È ·ÏÈ¤˜ Ô‰ËÁ›Â˜ ‹ıÂÏ·Ó ÛˆÏËÓ¿ÎÈ· ÌÂÙ¿

·fi 3 Ì‹ÓÂ˜ ÂÈÌÔÓ‹˜ ÙÔ˘ ˘ÁÚÔ‡, ÙÒÚ· fiÌˆ˜ ÔÈ ∞ÌÂ-

ÚÈÎ·ÓÈÎ¤˜ ∂Ù·ÈÚÂ›Â˜ ¶·È‰È·ÙÚÈÎ‹˜, √ÈÎÔÁÂÓÂÈ·Î‹˜ π·-

ÙÚÈÎ‹˜ Î·È øÙÔÚÈÓÔÏ·Ú˘ÁÁÔÏÔÁ›·˜ Ù· Û˘ÓÈÛÙÔ‡Ó ÌfiÓÔ

ÛÂ ÂÚ›ÙˆÛË ÛÔ‚·Ú‹˜ ·ÎÔ˘ÛÙÈÎ‹˜ ¤ÎÙˆÛË˜ (40

decibels ÙÔ˘Ï¿¯ÈÛÙÔÓ), Î·ı˘ÛÙ¤ÚËÛË˜ ÏfiÁÔ˘ ‹ ·Ó·ÙÔ-

ÌÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ. ∂ÎÙfi˜ ·fi ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfi-

ÙËÙ¿ ÙÔ˘˜ ·ÌÊÈÛ‚ËÙÂ›Ù·È Î·È Ë ·ÛÊ¿ÏÂÈ¿ ÙÔ˘˜: ÛÙÔ

ÙÂ‡¯Ô˜ ª·˝Ô˘ 2007 ÙÔ˘ European Journal of Pediatrics

(2007;166:385), ·Ó·ÛÎfiËÛË ·fi ÂÏÏËÓÈÎ‹ ÔÌ¿‰·

·Ó·‰ÂÈÎÓ‡ÂÈ Ï‹ıÔ˜ ÂÈÏÔÎÒÓ ÙË˜ ÙÔÔı¤ÙËÛË˜

ÛˆÏËÓ›ÛÎˆÓ ·ÂÚÈÛÌÔ‡, ·fi ˘Ò‰Ë ˆÙfiÚÚÔÈ· (10-

26%) ¤ˆ˜ Ô˘Ï¤˜ Î·È ÎÔÎÎÈÒÌ·Ù·. ∏ ÔÏÈÎ‹ Û˘¯ÓfiÙËÙ·

ÂÈÏÔÎÒÓ ÌÔÚÂ› Ó· ÊÙ¿ÛÂÈ ÛÂ ÔÛÔÛÙfi ¤ˆ˜ Î·È

80% ÙˆÓ ¯ÂÈÚÔ˘ÚÁËÌ¤ÓˆÓ ·˘ÙÈÒÓ.

∫Ú˘ÙÔÛÔÚ›‰ÈÔ ÛÙÔ ‰›ÎÙ˘Ô ‡‰ÚÂ˘ÛË˜

ªÂ›˙ÔÓ Úfi‚ÏËÌ· ‰ËÌfiÛÈ·˜ ˘ÁÂ›·˜ ÌÂ ÎÔÈÓˆÓÈ-

ÎÔÔÈÎÔÓÔÌÈÎ¤˜ ÚÔÂÎÙ¿ÛÂÈ˜ ÚÔ¤Î˘„Â ÛÙÔ Galway

ÙË˜ πÚÏ·Ó‰›·˜ (BBC News, 29 ª·ÚÙ›Ô˘ Î·È 6 ∞ÚÈÏ›-

Ô˘ 2007) fiÙ·Ó ÙÔ ‰›ÎÙ˘Ô ‡‰ÚÂ˘ÛË˜ ÌÔÏ‡ÓıËÎÂ ·fi

ÙÔ ÚˆÙfi˙ˆÔ Cryptosporidium parvum ÛÂ Û˘ÁÎÂ-

ÓÙÚÒÛÂÈ˜ ÂÍËÎÔÓÙ·Ï¿ÛÈÂ˜ ÙÔ˘ ÔÚ›Ô˘ ·ÛÊ·ÏÂ›·˜.

∆· ·È‰È¿ ‹Ù·Ó ÌÂÙ·Í‡ ÙˆÓ ÈÔ Â˘¿ÏˆÙˆÓ ÔÌ¿‰ˆÓ.

∆Ô Galway Â›Ó·È Ë ÙÚ›ÙË ÛÂ Ì¤ÁÂıÔ˜ fiÏË ÙË˜ πÚÏ·Ó-

‰›·˜ ÌÂ 700.000 ÂÚ›Ô˘ Î·ÙÔ›ÎÔ˘˜. ∆Ô Úfi‚ÏËÌ·

˘ÔÏÔÁ›˙ÂÙ·È Ó· ‰È·ÚÎ¤ÛÂÈ Ì‹ÓÂ˜ Î·È ·Ó·Ì¤ÓÂÙ·È Ó·

¤¯ÂÈ ÂÈÙÒÛÂÈ˜ ÛÙËÓ ÙÔ˘ÚÈÛÙÈÎ‹ ÂÚ›Ô‰Ô - ‹‰Ë Ù·

ÍÂÓÔ‰Ô¯Â›· ÂÁÎ·ıÈÛÙÔ‡Ó Î·Ù¿ÏÏËÏ· Ê›ÏÙÚ·. ™ÙÔ˘˜

Î·ÙÔ›ÎÔ˘˜ Û˘ÛÙ‹ıËÎÂ Ó· ·ÔÊÂ‡ÁÔ˘Ó ÙÔ ÓÂÚfi ÙÔ˘

‰ÈÎÙ‡Ô˘ ÁÈ· fiÛË, Ï‡ÛÈÌÔ ÙÚÔÊ›ÌˆÓ, Ï‡ÛÈÌÔ ‰Ô-

ÓÙÈÒÓ Î·È ·Á¿ÎÈ·. ∫·ıÒ˜ Ì¿ÏÈÛÙ· Ë ÌfiÏ˘ÓÛË Û˘Ó¤-

ÂÛÂ ÌÂ ÙÔ ¶¿Û¯·, fiÙ·Ó ÔÈ Î·ıÔÏÈÎÔ› ÙË˜ ÂÚÈÔ¯‹˜

Ú·›ÓÔÓÙ·È ÌÂ ·ÁÈ·ÛÌfi (Î·È ÂÓ›ÔÙÂ ÙÔÓ ›ÓÔ˘Ó), Ë ÙÔ-

ÈÎ‹ ∂ÎÎÏËÛ›· ÊÚfiÓÙÈÛÂ Ó· ÂÍ·ÛÊ·Ï›ÛÂÈ ÁÈ· ÙÔÓ

·ÁÈ·ÛÌfi ¯ÈÏÈ¿‰Â˜ ÊÈ¿ÏÂ˜ ÓÂÚÔ‡ Î·ÙÂ˘ıÂ›·Ó ·fi Ë-

Á¤˜. Œ¯Ô˘ÌÂ Û˘Ó‰¤ÛÂÈ ÙÔ ÎÚ˘ÙÔÛÔÚ›‰ÈÔ ÌÂ ÏÔÈÌÒ-

ÍÂÈ˜ ÛÂ ·ÓÔÛÔÎ·Ù·ÛÙ·ÏÌ¤ÓÔ˘˜ ÔÚÁ·ÓÈÛÌÔ‡˜ Î·ÈÊÙˆ¯¤˜ ¯ÒÚÂ˜. øÛÙfiÛÔ, Ë ÓÔÛËÚfiÙËÙ· ‰ÂÓ Â›Ó·È·ÌÂÏËÙ¤· Î·È ÛÙÈ˜ ÈÔ ÏÔ‡ÛÈÂ˜ ¯ÒÚÂ˜, ÌÂ ÂÍ¿ÚÛÂÈ˜ÛÂ ‚ÚÂÊÔÓËÈ·ÎÔ‡˜ ÛÙ·ıÌÔ‡˜ Î·È ÈÛ›ÓÂ˜ Î·È ÌÂ ÙÔ-ÈÎ¤˜ ÂÈ‰ËÌ›Â˜, fiˆ˜ ·˘Ù‹ ÛÙÔ Galway. ∆Ô ÎÚ˘ÙÔ-ÛÔÚ›‰ÈÔ ÌÂÙ·‰›‰ÂÙ·È Î˘Ú›ˆ˜ ·fi ¿ÓıÚˆÔ ÛÂ ¿Ó-ıÚˆÔ (Û˘Ó‹ıˆ˜ Ì¤Ûˆ Ï˘Ì¿ÙˆÓ Ô˘ Î·Ù·Ï‹ÁÔ˘ÓÛÙÔ ‰›ÎÙ˘Ô ‡‰ÚÂ˘ÛË˜, fiˆ˜ Û˘Ó¤‚Ë Î·È ÛÙÔ GalwayÛ‡ÌÊˆÓ· ÌÂ Ù· ‰È·ı¤ÛÈÌ· ÛÙÔÈ¯Â›·) Î·È ·ÓÙ¤¯ÂÈ Â›Ì·ÎÚfiÓ ÛÙÔ ÂÚÈ‚¿ÏÏÔÓ Î·È ÛÙË ¯ÏˆÚ›ˆÛË.

¶ÔÈÔ˜ ÌÂÙ·‰›‰ÂÈ ÙÔÓ ÎÔÎÎ‡ÙË ÛÙ· ‚Ú¤ÊË;

√È ÁÔÓÂ›˜ (55%), Ù· ·‰¤ÏÊÈ· (16%), ıÂ›ÔÈ-ıÂ›Â˜ Î·È·Ô‡‰Â˜-ÁÈ·ÁÈ¿‰Â˜ (16%), ¿ÏÏÔÈ Û˘ÁÁÂÓÂ›˜ Î·È Ê›ÏÔÈ(10%), ¿ÏÏÔÈ ÁÂÓÈÎÒ˜ 3%. ∆· ·ÔÙÂÏ¤ÛÌ·Ù· ÚÔ¤Ú¯Ô-ÓÙ·È ·fi ·ÌÂÚÈÎ·ÓÔ-Á·ÏÏÔ-Î·Ó·‰ÈÎ‹ ÌÂÏ¤ÙË ÛÂ ‚Ú¤ÊËËÏÈÎ›·˜ Î¿Ùˆ ÙˆÓ 6 ÌËÓÒÓ Ô˘ ‰ËÌÔÛÈÂ‡ıËÎÂ ÛÙÔ ÙÂ‡-¯Ô˜ ∞ÚÈÏ›Ô˘ ÙÔ˘ Pediatric Infections Disease Journal(2007;26:293). ŸÛÔ ‰ÂÓ ÂÌ‚ÔÏÈ¿˙ÔÓÙ·È ÔÈ ¤ÊË‚ÔÈ Î·È ÔÈÂÓ‹ÏÈÎÂ˜ ÙË˜ ÔÈÎÔÁ¤ÓÂÈ·˜, ÙfiÛÔ Ù· ‚Ú¤ÊË ı· ÎÈÓ‰˘ÓÂ‡-Ô˘Ó ·fi ÎÔÎÎ‡ÙË. ™ÙÔ ›‰ÈÔ ÙÂ‡¯Ô˜ (PIDJ 2007;26:316),ÊÈÓÏ·Ó‰ÈÎ‹ ÌÂÏ¤ÙË Î·Ù·Ï‹ÁÂÈ ÛÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ 8%ÙˆÓ ‚ÚÂÊÒÓ Ô˘ ÓÔÛËÏÂ‡ÔÓÙ·È ÌÂ ÂÈ‚Â‚·ÈˆÌ¤ÓË ÏÔ›-ÌˆÍË ·fi Èfi ÙÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡ Û˘ÁÎ˘Ù›Ô˘ (RSV) ¿-Û¯Ô˘Ó Î·È ·fi ÎÔÎÎ‡ÙË. ∞Ï‹ıÂÈ·, ÎÔÎÎ‡ÙË˜ fiˆ˜ ÙÔÓÍ¤Ú·ÌÂ ‹ ÎÔÎ›ÙË˜ fiˆ˜ ÂÈÌ¤ÓÔ˘Ó ÔÈ ·˘ÙfiÌ·ÙÔÈ ÔÚıÔ-ÁÚ¿ÊÔÈ ÛÙÈ˜ ÔıfiÓÂ˜ Ì·˜; ∫ÔÎÎ‡˙ˆ ÛËÌ·›ÓÂÈ (·fi ÙÔÓÎ·ÈÚfi ÙÔ˘ ∏Û›Ô‰Ô˘ ÙÔ˘Ï¿¯ÈÛÙÔÓ) ÎÚ¿˙ˆ (ÁÈ· ÎÔ‡ÎÔ˘˜,ÎfiÚ·ÎÂ˜ Î·È ÂÙÂÈÓÔ‡˜). ∆Ô ÎÔÎÎ‡ÙË˜ ·Ú·¤ÌÂÈ ÛÙÔ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÎÔÎÎÔÚfi‚Ë¯·, ÂÓÒ ÙÔ ÎÔÎ›ÙË˜ ·Ú·-¤ÌÂÈ ÛÙËÓ ÔÚıÔÁÚ·ÊÈÎ‹ Ì·˜ ¿ÓÂÛË.

º˘Ì·Ù›ˆÛË: ÂÌÂ›˜ ı· ı¤Ï·ÌÂ Ó· ÙËÓ

ÍÂ¯¿ÛÔ˘ÌÂ, ·ÏÏ¿ ÂÎÂ›ÓË fi¯È

∏ ÚfiÛÊ·ÙË ·ÁÎfiÛÌÈ· ·Ó·˙ˆ‡ÚˆÛË ÙË˜ Ê˘Ì·-Ù›ˆÛË˜ ·fi ÙÔ M. tuberculosis Ì¿˜ ‚Ú‹ÎÂ Î¿ˆ˜ ·ÚÔ-ÂÙÔ›Ì·ÛÙÔ˘˜. ∞fi ÙËÓ ¿ÏÏË, Ë Ê˘Ì·Ù›ˆÛË ·fi M.bovis, Ë ÔÔ›· ÂÌÊ·ÓÈ˙fiÙ·Ó ·ÚÎÂÙ¿ Û˘¯Ó¿ ÚÈÓ Î¿ÔÈ-Â˜ ‰ÂÎ·ÂÙ›Â˜, Â›¯Â Û¯Â‰fiÓ ÂÍ·ÏÂÈÊıÂ› ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË·ÛÙÂÚ›ˆÛË˜ ÙÔ˘ ·ÁÂÏ·‰ÈÓÔ‡ Á¿Ï·ÎÙÔ˜. øÛÙfiÛÔ, Î·ÈÙÔ M. bovis Í¤ÚÂÈ Ó· ·ÈÊÓÈ‰È¿˙ÂÈ: ÛÙÔ Lancet ÙÔ˘ ∞ÚÈÏ›-Ô˘ 2007 (369:1270) ÂÚÈÁÚ¿ÊÂÙ·È Û˘ÛÛÒÚÂ˘ÛË ÎÚÔ˘-ÛÌ¿ÙˆÓ M. bovis ÛÙËÓ ∞ÁÁÏ›· ÛÂ 6 Ó¤Ô˘˜ ÂÓ‹ÏÈÎÂ˜- ÔÈ 5‹Ù·Ó ÂÌ‚ÔÏÈ·ÛÌ¤ÓÔÈ ÌÂ BCG Î·È Ô ¤Ó·˜ Î·Ù¤ÏËÍÂ ÌÂÊ˘Ì·ÙÈÒ‰Ë ÌËÓÈÁÁ›ÙÈ‰·. ª¤Ûˆ ÌÔÚÈ·Î‹˜ ÂÈ‰ËÌÈÔÏÔ-Á›·˜ ‰È·ÈÛÙÒıËÎÂ fiÙÈ ÙÔ Ì˘ÎÔ‚·ÎÙËÚ›‰ÈÔ ÌÂÙ·‰fiıËÎÂ·fi ¿ÓıÚˆÔ ÛÂ ¿ÓıÚˆÔ Î·È Ì¿ÏÈÛÙ· ·fi Û˘Á¯ÚˆÙÈ-ÛÌfi ÛÂ Ì·Ú. •¤Ú·ÌÂ fiÙÈ ÙÔ M. bovis ÌÂÙ·‰›‰ÂÙ·È Ì¤ÛˆÙÔ˘ ··ÛÙÂÚ›ˆÙÔ˘ ‚fiÂÈÔ˘ Á¿Ï·ÎÙÔ˜ Î·È fi¯È ÛÙ· ÔÙÔ-ˆÏÂ›·, ·ÏÏ¿ Ë Ê˘Ì·Ù›ˆÛË ÎÚ‡‚ÂÈ ÂÎÏ‹ÍÂÈ˜, Î·Èfiˆ˜ ˘ÔÁÚ·ÌÌ›˙ÂÙ·È ÛÙÔ Û¯fiÏÈÔ ÙË˜ Û‡ÓÙ·ÍË˜(Lancet;2007;369:1236), ÙË Ê˘Ì·Ù›ˆÛË ·fi M. bovisÙËÓ ÍÂ¯¿Û·ÌÂ, ·ÏÏ¿ ÂÎÂ›ÓË ·Ú·Ì¤ÓÂÈ.


249¡∂∞ ∞¶√ ∆√ ¢π∞¢π∫∆À√

¶·È‰È·ÙÚÈÎ‹ 2007;70:249-251

ª·Ú›· ∫·Ó¿ÚÈÔ˘

πÛÙÔÛÂÏ›‰Â˜ ÁÈ· ÙÈ˜ ¶ÚˆÙÔ·ıÂ›˜ ∞ÓÔÛÔ·ÓÂ¿ÚÎÂÈÂ˜

√È ¶ÚˆÙÔ·ıÂ›˜ ∞ÓÔÛÔ·ÓÂ¿ÚÎÂÈÂ˜ (¶∞∞) Â›Ó·È ÎÏËÚÔÓÔÌÈÎ¿ ÓÔÛ‹Ì·Ù· Î·È Â›Ó·È ·ÔÙ¤ÏÂÛÌ··Ô˘Û›·˜ ‹ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·˜ Ì›·˜ ‹ ÂÚÈÛÛfiÙÂÚˆÓ ·ÓÔÛÈ·ÎÒÓ ·Ú·Ì¤ÙÚˆÓ. ∏ Û˘ÓËı¤ÛÙÂÚË ÎÏÈÓÈ-Î‹ ÂÎ‰‹ÏˆÛË Â›Ó·È ÔÈ ÏÔÈÌÒÍÂÈ˜, ÛÙÈ˜ ÔÔ›Â˜ ÔÈ ·ÛıÂÓÂ›˜ ÂÌÊ·Ó›˙Ô˘Ó ·˘ÍËÌ¤ÓË Â˘·ÈÛıËÛ›·.øÛÙfiÛÔ, ‰ÂÓ Â›Ó·È Û¿ÓÈÂ˜ ÔÈ ÂÚÈÙÒÛÂÈ˜ Ô˘ ÔÈ ¶∞∞ ÚÔ‚¿ÏÏÔ˘Ó ˆ˜ ·˘ÙÔ¿ÓÔÛ· ‹ ·ÏÏÂÚÁÈÎ¿ÓÔÛ‹Ì·Ù· ‹ ÏÂÌÊÔ¸ÂÚÏ·Û›Â˜.

¶ÔÏÏ¤˜ ÊÔÚ¤˜ Ë ·ÓÂ¿ÚÎÂÈ· ÙÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Â›Ó·È ‰‡ÛÎÔÏÔ Ó· ·Ó·ÁÓˆÚÈÛÙÂ›Î·È ·Ú·Ì¤ÓÂÈ ·‰È¿ÁÓˆÛÙË, ÌÂ Û˘Ó¤ÂÈ· ÔÈ ·ÛıÂÓÂ›˜ Ó· ÌË ÁÓˆÚ›˙Ô˘Ó ÙËÓ ·ÈÙ›· ÙˆÓ ·ıÔÏÔÁÈÎÒÓÙÔ˘˜ ÂÎ‰ËÏÒÛÂˆÓ, Î·È, fi¯È Û¿ÓÈ·, Ó· Ï·Ì‚¿ÓÔ˘Ó Ï·Óı·ÛÌ¤ÓË ıÂÚ·Â›· Î·È ÊÚÔÓÙ›‰·. ∏ ¿Ù˘Ë·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ· ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙË Ì·ÎÚfi¯ÚÔÓË Ù·Ï·ÈˆÚ›· ÙÔ˘ ·ÛıÂÓÔ‡˜ ÌÂ ÓÔÛËÏÂ›Â˜Î·È Èı·ÓÒ˜, ÂÈ‰Â›ÓˆÛË ÙË˜ ÎÏÈÓÈÎ‹˜ ÙÔ˘ Î·Ù¿ÛÙ·ÛË˜.

∂˘Úˆ·˚Î¤˜ ™˘ÛÙ¿ÛÂÈ˜ ÁÈ· ÙÈ˜ ¶ÚˆÙÔ·ıÂ›˜ ∞ÓÔÛÔ·ÓÂ¿ÚÎÂÈÂ˜ ÛÙÔ ¢È·‰›ÎÙ˘Ô -

http://www.eupidconference.com

√È ¶ÚˆÙÔ·ıÂ›˜ ∞ÓÔÛÔ·ÓÂ¿ÚÎÂÈÂ˜ Â›-Ó·È ÔÏ‡ Û˘¯ÓfiÙÂÚÂ˜ ·’ fiÛÔ Î·Ù·ÁÚ¿ÊÂ-Ù·È. ∏ ÌË ·Ó·ÁÓˆÚÈÛÈÌfiÙËÙ¿ ÙÔ˘˜, ÙÔ ·ÚÓË-ÙÈÎfi ÎfiÛÙÔ˜, Ë ÌÂÁ¿ÏË Â›ÙˆÛË ÛÙË ‰ËÌfi-ÛÈ· ˘ÁÂ›·, Î·ıÈÛÙÔ‡Ó ·Ó·ÁÎ·›· ÙËÓ ÂÊ·ÚÌÔ-Á‹ Û˘ÛÙ¿ÛÂˆÓ ÁÈ· ÙÈ˜ ÂÓ¤ÚÁÂÈÂ˜ Ô˘ ··È-ÙÔ‡ÓÙ·È ÂÎ Ì¤ÚÔ˘˜ ÙˆÓ ÂıÓÈÎÒÓ Î˘‚ÂÚÓ‹ÛÂ-ˆÓ ÙˆÓ ¯ˆÚÒÓ ÌÂÏÒÓ ÙË˜ ∂˘Úˆ·˚Î‹˜ ŒÓˆ-ÛË˜, ÒÛÙÂ Ó· ·Ú¯›ÛÂÈ Ë ‰È·‰ÈÎ·Û›· ·Ó·ÁÓÒ-ÚÈÛË˜ ·˘ÙÔ‡ ÙÔ˘ “ÎÚ˘ÊÔ‡” ı¤Ì·ÙÔ˜ ‰ËÌfi-ÛÈ·˜ ˘ÁÂ›·˜.

√ÏÔÎÏËÚˆÌ¤ÓÂ˜ Î·È Û·ÊÂ›˜ Û˘ÛÙ¿ÛÂÈ˜ÁÈ· ÙÈ˜ ¶∞∞, ÙËÓ ¤ÁÎ·ÈÚË ‰È¿ÁÓˆÛË, ÙËÓÚfiÁÓˆÛË Î·È ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂÚË ıÂ-Ú·Â›· ÚÔÛÊ¤ÚÂÈ Ë ÈÛÙÔÛÂÏ›‰· ·fi ÙÔ ∂˘-Úˆ·˚Îfi Consensus Conference 2006.

∂˘Úˆ·˚Î‹ ∂Ù·ÈÚÂ›· ÁÈ· ÙÈ˜ ∞ÓÔÛÔ·ÓÂ¿ÚÎÂÈÂ˜ - http://www.esid.org

∏ ∂˘Úˆ·˚Î‹ ∂Ù·ÈÚÂ›· ÁÈ· ÙÈ˜ ∞ÓÔÛÔ·ÓÂ¿ÚÎÂÈÂ˜ (ESID) ÛÙÔ¯Â‡ÂÈ ÛÙË ‰ÈÂ˘ÎfiÏ˘ÓÛË ÙË˜ ·ÓÙ·Ï-Ï·Á‹˜ È‰ÂÒÓ Î·È ÏËÚÔÊÔÚÈÒÓ ·Ó¿ÌÂÛ· ÛÂ È·ÙÚÔ‡˜, ÓÔÛËÏÂ˘Ù¤˜, ÂÚÂ˘ÓËÙ¤˜, ·ÛıÂÓÂ›˜ Î·È ÙÈ˜ ÔÈ-ÎÔÁ¤ÓÂÈÂ˜ Ô˘ ÂÓ‰È·Ê¤ÚÔÓÙ·È ‹ ÂËÚÂ¿˙ÔÓÙ·È ·fi ÙÈ˜ ¶ÚˆÙÔ·ıÂ›˜ ∞ÓÔÛÔ·ÓÂ¿ÚÎÂÈÂ˜. ∂ÓÈÛ¯‡-ÂÈ ÙËÓ ¤ÚÂ˘Ó· ÁÈ· ÙËÓ Î·Ù·ÓfiËÛË ÙˆÓ ·ÈÙÈÔ·ıÔÁÂÓÂÙÈÎÒÓ ÌË¯·ÓÈÛÌÒÓ Î·È ÙËÓ ÚÔÒıËÛË ıÂÚ·-ÂÈÒÓ ÁÈ· Ù· Û˘ÁÎÂÎÚÈÌ¤Ó· ÓÔÛ‹Ì·Ù·. ∏ ÈÛÙÔÛÂÏ›‰· ÙË˜ ∂Ù·ÈÚÂ›·˜ ·Ú¤¯ÂÈ, ÌÂÙ·Í‡ ¿ÏÏˆÓ, ÏË-ÚÔÊÔÚ›Â˜ ÁÈ· Ù· ÂÈÛÙËÌÔÓÈÎ¿ ‰ÚÒÌÂÓ·, Ù· ÛÙ·ÙÈÛÙÈÎ¿ ÛÙÔÈ¯Â›·, Ù· ‰È·ÁÓˆÛÙÈÎ¿ ÎÚÈÙ‹ÚÈ·, ÙÈ˜ÂÈÛÙËÌÔÓÈÎ¤˜ ÂÍÂÏ›ÍÂÈ˜ Î·È Ù· Ó¤· ıÂÚ·Â˘ÙÈÎ¿ Ì¤Û·, ÛÂ ·˘ÙfiÓ ÙÔÓ Û˘ÓÂ¯Ò˜ ÂÍÂÏÈÛÛfiÌÂÓÔ ÙÔ-Ì¤· ÙË˜ µ·ÛÈÎ‹˜ Î·È ∫ÏÈÓÈÎ‹˜ ∞ÓÔÛÔÏÔÁ›·˜.

∆Ì‹Ì· ∞ÓÔÛÔÏÔÁ›·˜-πÛÙÔÛ˘Ì‚·ÙfiÙËÙ·˜,¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó·


ª·Ú›· ∫·Ó¿ÚÈÔ˘ [email protected]


250 ¡∂∞ ∞¶√ ∆√ ¢π∞¢π∫∆À√


International Nursing Group for Immunodeficiencies - http://www.ingid.org

πÛÙÔÛÂÏ›‰· ÙË˜ ¢ÈÂıÓÔ‡˜ √Ì¿‰·˜ ¡ÔÛËÏÂ˘ÙÒÓ Ô˘ÂÚÁ¿˙ÔÓÙ·È ÌÂ ·È‰È¿ Î·È ÂÓ‹ÏÈÎÂ˜ ÌÂ ¶ÚˆÙÔ·ıÂ›˜ ∞ÓÔ-ÛÔ·ÓÂ¿ÚÎÂÈÂ˜. ∞Ó·Ù‡ÛÛÔ˘Ó Î·È ÂÂÎÙÂ›ÓÔ˘Ó ÙËÓÔÈfiÙËÙ· ÙË˜ ÊÚÔÓÙ›‰·˜ ÙˆÓ ·ÛıÂÓÒÓ ÌÂ ¶∞∞ Î·ÈÂÈ‰ÈÒÎÔ˘Ó ÙËÓ Î·Ï‡ÙÂÚË Î·Ù·ÓfiËÛË ÙˆÓ Û˘ÁÎÂÎÚÈ-Ì¤ÓˆÓ ÓÔÛËÌ¿ÙˆÓ Î·È ÙˆÓ È‰È·ÈÙÂÚÔÙ‹ÙˆÓ ÙˆÓ ·-Û¯fiÓÙˆÓ ·fi ·˘Ù¿.

Ÿ¯È ÌfiÓÔ ÔÈ ÓÔÛËÏÂ˘Ù¤˜ Ô˘ ÂÓ‰È·Ê¤ÚÔÓÙ·È ÁÈ· ÙÈ˜¶∞∞, ·ÏÏ¿ Î·È ÂÎÂ›ÓÔÈ Ô˘ ÂÚÁ¿˙ÔÓÙ·È ÁÂÓÈÎfiÙÂÚ· ÌÂ·ÓÔÛÔÎ·Ù·ÛÙ·ÏÌ¤ÓÔ˘˜ ·ÛıÂÓÂ›˜, ı· ‚ÚÔ˘Ó ÛÙËÓ ÈÛÙÔ-ÛÂÏ›‰· ÔÏÏ¤˜ Î·È ¯Ú‹ÛÈÌÂ˜ ÏËÚÔÊÔÚ›Â˜ ÁÈ· ÙË ‚ÂÏ-Ù›ˆÛË ÙË˜ ÔÈfiÙËÙ·˜ ÙˆÓ ˘ËÚÂÛÈÒÓ ÙÔ˘˜.

International Patient Organisation for Primary Immunodeficiencies -

http://www.ipopi.org

ªÈ· ·ÁÎfiÛÌÈ· ÔÚÁ¿ÓˆÛË Ô˘ ÂÚÁ¿˙ÂÙ·È ÁÈ· ÙË‚ÂÏÙ›ˆÛË ÙÔ˘ ÂÈ¤‰Ô˘ ˙ˆ‹˜ ÙˆÓ ·ÓıÚÒˆÓ ÌÂ¶∞∞, ÂÈ¯ÂÈÚÂ› Ó· Û˘Ì‚¿ÏÂÈ ÛÙËÓ ¤ÁÎ·ÈÚË ‰È¿ÁÓˆÛËÎ·È ÙËÓ È‰·ÓÈÎfiÙÂÚË ıÂÚ·Â›· Î·È ÊÚÔÓÙ›‰· ÙˆÓ·ÛıÂÓÒÓ. ¶·Ú¿ÏÏËÏ·, ÂÓÈÛ¯‡ÂÈ ÙÈ˜ ÂıÓÈÎ¤˜ ÔÚÁ·ÓÒ-ÛÂÈ˜ ÙˆÓ ·Û¯fiÓÙˆÓ Ó· ÛÙËÓ ÚÔÛ¿ıÂÈ¿ ÙÔ˘˜ ÁÈ·ÙË ‰ËÌÈÔ˘ÚÁ›· ÂÓfi˜ Î·Ï‡ÙÂÚÔ˘ ÎfiÛÌÔ˘ ÁÈ· ÙÔ˘˜ ·Ó-ıÚÒÔ˘˜ ÌÂ ¶∞∞.

Immune Deficiency Foundation - http://www.primaryimmune.org

ªÈ· ÈÛÙÔÛÂÏ›‰· ÌÂ ÔÏÏ·Ï¤˜ ÏËÚÔÊÔÚ›Â˜ Î·ÈÁÈ· Ù· È·ÙÚÈÎ¿, ÂÈÛÙËÌÔÓÈÎ¿-ÂÚÂ˘ÓËÙÈÎ¿, ÎÔÈÓˆÓÈÎ¿ı¤Ì·Ù· Ô˘ ··Û¯ÔÏÔ‡Ó ÙfiÛÔ ÙÔ˘˜ ÂÚÁ·˙fiÌÂÓÔ˘˜ ‹ÙÔ˘˜ ¤¯ÔÓÙÂ˜ ÂÓ‰È·Ê¤ÚÔÓ ÛÙÔÓ ÙÔÌ¤· ÙˆÓ ¶∞∞, fiÛÔÎ·È ÙÔ˘˜ ›‰ÈÔ˘˜ ÙÔ˘˜ ·ÛıÂÓÂ›˜. ™ËÌ·ÓÙÈÎ‹ Û˘Ì‚ÔÏ‹·ÔÙÂÏÂ› Ë ‰ËÌÔÛ›Â˘ÛË ÙˆÓ Ô‰ËÁÈÒÓ ÁÈ· ÙË ‰È¿ÁÓˆÛËÙˆÓ ¶∞∞ Î·È ÙË ÊÚÔÓÙ›‰· ÙˆÓ ·ÛıÂÓÒÓ.


251NEWS FROM THE INTERNET

¶·È‰È·ÙÚÈÎ‹ 2007;70:249-251

Institute of Medical Technology - Bioinformatics Group - http://bioinf.uta.fi

ñ Immunodeficiency Resourceñ ID diagnostics ñ ID bases√È ÈÛÙÔÛÂÏ›‰Â˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ÙÔ˘ Tampere

ÙË˜ ºÈÓÏ·Ó‰›·˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ‚¿ÛÂÈ˜ ‰Â‰ÔÌ¤ÓˆÓ Ô˘ÛÙÔ¯Â‡Ô˘Ó ÛÙË Û˘ÏÏÔÁ‹, ÙËÓ Ù·˘ÙÔÔ›ËÛË, ÙËÓ ÂÚÈ-ÁÚ·Ê‹ Î·È ÙË ÁÓˆÛÙÔÔ›ËÛË ÙˆÓ ˘ËÚÂÛÈÒÓ Ô˘ ÚÔ-ÛÊ¤ÚÔÓÙ·È ÁÈ· ÙË ‰È¿ÁÓˆÛË ÙˆÓ ·ÓÔÛÔ·ÓÂ·ÚÎÂÈÒÓ.

The Jeffrey Modell Foundation - http://www.jmfworld.com

πÛÙÔÛÂÏ›‰· Ô˘ ÔÚÁ·ÓÒıËÎÂ Î·È ÛÙËÚ›˙ÂÙ·È ·fiÎÏËÚÔ‰fiÙËÌ· ÙˆÓ ÁÔÓ¤ˆÓ ÙÔ˘ Jeffrey Modell, ·ÊÈÂÚˆ-Ì¤ÓÔ ÛÙË ÌÓ‹ÌË ÙÔ˘. ™ÎÔfi ¤¯ÂÈ Ó· ‚ÂÏÙÈÒÛÂÈ ÙËÓ ÔÈ-fiÙËÙ· ˙ˆ‹˜ ÙˆÓ ·ÛıÂÓÒÓ Î·È Ó· ÂÍ·ÛÊ·Ï›ÛÂÈ ÚfiÛ‚·-Û‹ ÙÔ˘˜ ÛÙ· ÂÈ‰ÈÎ¿ Î¤ÓÙÚ· ÁÈ· ÙÈ˜ ¶∞∞ Î·È ÛÙÈ˜ ·ÔÙÂ-ÏÂÛÌ·ÙÈÎfiÙÂÚÂ˜ Û‡Á¯ÚÔÓÂ˜ ıÂÚ·Â›Â˜. ¶ÚÔˆıÂ› ÙËÓ·Ó¿Ù˘ÍË ÙˆÓ ‰È·ÁÓˆÛÙÈÎÒÓ ÎÚÈÙËÚ›ˆÓ Ô˘ ı· Û˘Ì‚¿-ÏÔ˘Ó ÛÙËÓ ¤ÁÎ·ÈÚË ‰È¿ÁÓˆÛË ÙˆÓ ¶∞∞ Î·È ÛÙËÓ Â›-ÙÂ˘ÍË ·ÚÔ¯‹˜ ˘ËÚÂÛÈÒÓ ˘„ËÏ‹˜ ÔÈfiÙËÙ·˜ ÛÙÔ˘˜·ÛıÂÓÂ›˜.


Pagos

252 CLINICAL QUIZ

Paediatriki 2007;70:246,252

∫ÏÈÓÈÎfi QUIZ

∞¶∞¡∆∏™∏

¡fiÛÔ˜ Kikuchi-Fujimoto

∏ ÓfiÛÔ˜ Kikuchi-Fujimoto ÂÚÈÁÚ¿ÊËÎÂ ÁÈ·ÚÒÙË ÊÔÚ¿ ÙÔ 1972 ÛÙËÓ π·ˆÓ›· ·fi ÙÔ˘˜Kikuchi Î·È Fujimoto Î·È ÚÔÛ‚¿ÏÏÂÈ Û˘¯ÓfiÙÂ-Ú·, ¿ÙÔÌ· ÓÂ·Ú‹˜ ËÏÈÎ›·˜ (Ì¤ÛË ËÏÈÎ›· 30 ¤ÙË).∂›Ó·È Û˘¯ÓfiÙÂÚË ÛÙÈ˜ Á˘Ó·›ÎÂ˜ Î·È ÛÙÔ˘˜ ∞ÛÈ¿-ÙÂ˜, ÂÓÒ ·Ó·Ê¤ÚÂÙ·È Û¿ÓÈ· ÛÙËÓ ·È‰ÈÎ‹ ËÏÈ-Î›· (1). ¶ÚfiÎÂÈÙ·È ÁÈ· ·˘ÙÔ˚¿ÛÈÌË, Î·ÏÔ‹ıË Ófi-ÛÔ ¿ÁÓˆÛÙË˜ Ì¤¯ÚÈ Û‹ÌÂÚ· ·ÈÙÈÔÏÔÁ›·˜, ‰È¿Ú-ÎÂÈ·˜ ·fi 2 Â‚‰ÔÌ¿‰Â˜ ̂ ˜ 4 Ì‹ÓÂ˜. ∏ ÓfiÛÔ˜ ̄ ·-Ú·ÎÙËÚ›˙ÂÙ·È ÎÏÈÓÈÎ¿ ·fi ÙËÓ ·ÚÔ˘Û›· ˘ÚÂ-ÙÔ‡ (‰È¿ÚÎÂÈ·˜ 1 Â‚‰ÔÌ¿‰·˜-1 Ì‹Ó·) Î·È ÙË‰ÈfiÁÎˆÛË ÙˆÓ ÏÂÌÊ·‰¤ÓˆÓ (‰È·Ì¤ÙÚÔ˘ 1-2 cm,˘fiÛÎÏËÚˆÓ, Â˘Î›ÓËÙˆÓ ÌÂ Û˘¯ÓfiÙÂÚË ÂÓÙfiÈ-ÛË ÛÙÔÓ ÙÚ¿¯ËÏÔ). ø˜ Û˘ÓÔ‰¿ Û˘ÌÙÒÌ·Ù··Ó·Ê¤ÚÔÓÙ·È Ù· ·ÎfiÏÔ˘ı·: Ó·˘Ù›·, ¤ÌÂÙÔÈ,·ÒÏÂÈ· ‚¿ÚÔ˘˜, ·ÚıÚ·ÏÁ›Â˜, Ì˘·ÏÁ›Â˜, Ó˘¯ÙÂ-ÚÈÓÔ› È‰ÚÒÙÂ˜ Î·È ÛÙÔÌ·ÙÈÎ¿ ¤ÏÎË (1,2). ∞fiÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô ‰È·ÈÛÙÒÓÂÙ·È Û˘Ó‹-ıˆ˜ ÏÂ˘ÎÔÂÓ›·, ıÚÔÌ‚ÔÂÓ›·, ·ÁÎ˘ÙÙ·ÚÔÂ-Ó›· Î·È Ì¤ÙÚÈ· ·‡ÍËÛË ÙË˜ ∆∫∂ (1). ∏ ‰È¿ÁÓˆÛËÙË˜ ÓfiÛÔ˘ ÙÂÎÌËÚÈÒÓÂÙ·È ·fi Ù· ·ıÔÏÔÁÔ·-Ó·ÙÔÌÈÎ¿ Â˘Ú‹Ì·Ù· Ô˘ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fiÙËÓ ·ÚÔ˘Û›· ÂÚÈÔ¯ÒÓ Ó¤ÎÚˆÛË˜ fiÔ˘ ·ÓÂ˘-Ú›ÛÎÔÓÙ·È Û˘¯ÓfiÙÂÚ· ËˆÛÈÓfiÊÈÏ·, ÌÂ Û˘ÓÔ‰fiÏ‹ÚË ·Ô˘Û›· ÔÏ˘ÌÔÚÊÔ˘Ú‹ÓˆÓ Î·È·ıÚÔ›ÛÌ·Ù· (clusters) ÌÔÓÔÎ˘ÙÙ¿ÚˆÓ, ÏÂÌÊÔ-Î˘ÙÙ¿ÚˆÓ Î˘Ú›ˆ˜ ∆-ÚÔ¤ÏÂ˘ÛË˜ (1).

∏ ·ÈÙÈÔ·ıÔÁ¤ÓÂÈ· ÙË˜ ÓfiÛÔ˘ ·Ú·Ì¤ÓÂÈ¿ÁÓˆÛÙË Ì¤¯ÚÈ Û‹ÌÂÚ·, ÂÓÒ ¤¯ÂÈ ÚÔÙ·ıÂ› Ë‰È¤ÁÂÚÛË ÙˆÓ ∆ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ ˆ˜ ·¿ÓÙËÛËÛÂ Â›‰Ú·ÛË ÏÔÈÌÒ‰Ô˘˜ ·Ú¿ÁÔÓÙ·. ∫·Ù¿ Ù·ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· Ë ÓfiÛÔ˜ ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙÂ› ÌÂÙÔÓ Û˘ÛÙËÌ·ÙÈÎfi ÂÚ˘ıËÌ·ÙÒ‰Ë Ï‡ÎÔ (™∂§)

Î·È ÚfiÛÊ·Ù· ‚È‚ÏÈÔÁÚ·ÊÈÎ¿ ‰Â‰ÔÌ¤Ó· ˘Ô-ÛÙËÚ›˙Ô˘Ó fiÙÈ Ë ÓfiÛÔ˜ Kikuchi-Fujimoto Â›Ó·ÈÈı·ÓfiÓ Ó· ·ÔÙÂÏÂ› ¤Ó·Ó Ù‡Ô ·˘ÙÔÂÚÈÔÚÈ-˙fiÌÂÓÔ˘ ™∂§ (3,4). À¤Ú ÙË˜ Û˘Û¯¤ÙÈÛË˜ ÙˆÓ‰‡Ô ÓÔÛËÌ¿ÙˆÓ Î·È ÙÔ˘ ·˘ÙÔ¿ÓÔÛÔ˘ ˘Ô-ÛÙÚÒÌ·ÙÔ˜ ÙË˜ ÓfiÛÔ˘ Û˘ÓËÁÔÚÂ› ÙÔ ÁÂÁÔÓfi˜fiÙÈ ·ÚÎÂÙÔ› ·ÛıÂÓÂ›˜ ÂÌÊ·Ó›˙Ô˘Ó ıÂÙÈÎ¿ ·˘ÙÔ-·ÓÙÈÛÒÌ·Ù·, Î·ıÒ˜ Î·È Ë ·Ú·Ù‹ÚËÛË fiÙÈ ÔÚÈ-ÛÌ¤ÓÔÈ ÂÎ‰ËÏÒÓÔ˘Ó ™∂§ ·ÎfiÌË Î·È 10 ˆ˜ 20¯ÚfiÓÈ· ÌÂÙ¿ ÙËÓ ÂÎ‰‹ÏˆÛË ÙË˜ ÓfiÛÔ˘Kikuchi-Fujimoto (1,3). ∆¤ÏÔ˜, Û‡ÌÊˆÓ· ÌÂÚfiÛÊ·ÙË ÌÂÙ·Ó¿Ï˘ÛË ÙË˜ ‚È‚ÏÈÔÁÚ·Ê›·˜·Ó·Ê¤ÚÂÙ·È fiÙÈ ıÂÙÈÎ¿ ANA ÂÌÊ¿ÓÈ˙Â ÙÔ 15%Î·È ™∂§ ÂÎ‰‹ÏˆÛÂ ÙÔ 23% ∞ÛÈ·ÙÒÓ ÌÂ ÓfiÛÔKikuchi-Fujimoto (5).


1. Lazzareschi I, Barone G, Ruggiero A, Liotti L, Maur-izi P, Larocca LM, et al. Paediatric Kikuchi-Fujimo-to disease: A benign cause of fever and lym-phadenopathy. Pediatr Blood Cancer 2006 [Epubahead of print].

2. Scagni P, Peisino MG, Bianchi M, Morello M, SardiN, Linari A, et al. Kikuchi-Fujimoto disease is a rarecause of lymphadenopathy and fever of unknown ori-gin in children: report of two cases and review of theliterature. J Pediatr Hematol Oncol 2005;27:337-340.

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

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

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


xix¶ƒ√™∂Ã∏ ™À¡∂¢ƒπ∞

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