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257 Persistent vegetative state in children:

terminology, aetiology, prognosis and

ethical issues

D. Neubauer, Sv. Grosek, P. Hamilton, M.

LoGiudice, D. Matthys, V. Molina, L. Nikolovski,E. Siebke, A. Tenore, F.P. Crawley

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¶·È‰È·ÙÚÈÎ‹∆fiÌÔ˜ 70 ñ ∆Â‡¯Ô˜ 4 ñ πÔ‡ÏÈÔ˜-∞‡ÁÔ˘ÛÙÔ˜ 2007

∫ˆ‰ÈÎfi ̃¢ÈÂ‡ı˘ÓÛË ̃∂ÔÙÂ›· ̃ªª∂: 3889

ISSN 0377-2551

Pediatri July-Aug 07 09-07-07 17:07 ™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

∂. Galanakis

L. Thomaidou

M. Kanariou

∂. Katsarou-Pectasides

A. Kattamis

S. Kitsiou-Tzeli

∞. Papadopoulou

N. Papadopoulos

A. Siamopoulou-Mavridou

M. Tsolia

Manuscript Editing

Greek Editing

A. Vasilopoulou

English Editing

S. Nakou

Publisher

K. Griveas

Publishing Coordinator

SCIENTIFIC PUBLICATIONS Ltd

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Contents

EDITORIAL COMMENTARY

253 The death of ethics

Th. Pelegrinis

REVIEW ARTICLES

257 Persistent vegetative state in children:

terminology, aetiology, prognosis and

ethical issues

D. Neubauer, Sv. Grosek, P. Hamilton,

M. LoGiudice, D. Matthys, V. Molina, L. Nikolovski, E. Siebke, A. Tenore, F.P. Crawley

266 The increase of allergic conditions in recent

years: epidemiology and causes

A. Sofianou-Katsoulis

272 Breastfeeding: does it also protect against

neoplasms?

D. Matthaios, E. Mantadakis, P. Laios, S. Kakolyris, A. Chatzimihail

278 Contraindications to breastfeeding

E. Hatzidaki, C. Giannakopoulou

ORIGINAL ARTICLES

285 Effect of a supportive program on

breastfeeding

A. Ntourntoufi, V. Cholevas, L. Kontou, M. Pavlou,S. Andronikou

293 Environmental factors possibly associated

with the pathogenesis of diabetes mellitus

type 1 (DM1)

K. Karavanaki, E. Tsoka, C. Karayianni, V. Petrou,E. Pippidou, M. Brisimitzi, M. Mavrikiou, K. Kakleas, C. Dacou-Voutetakis

300 Waist circumference percentiles of

children of Crete aged 3 to 16 years

∂. Linardakis, K. Vardavas, A. Kafatos

308 Hormones regulating the food intake and

metabolism of preterm infants

T. Siahanidou, I. Papassotiriou, M. Vounatsou, H. Militsi, H. Mandyla

CASE REPORTS

316 Coexistence of neuroblastoma and

hereditary spherocytosis

J.P. Panagiotou, G. Lekka, A. Garoufi, A. Stamoulakatou, E. Premetis, A. Constantopoulos

320 Congenital nasal pyriform stenosis and

single central upper maxillary incisor in

three infants

A. Andreou, A. Koutla, E. Zeugaridou, A. Sakellaropoulou

325 Blue Rubber Bleb Nevus Syndrome with

concurrent neurological and skeletal

involvement

M. Tzoufi, P. Sihlimiri, I. Nakou, M. Argyropoulou, A. Siamopoulou-Mavridou

PRACTICAL ISSUE

330 Therapeutic management of childhood

atopic dermatitis

T. Kakourou

336 PAEDIATRIC NEWS IN BRIEF

E. Galanakis

338 NEWS FROM THE INTERNET

N. Papadopoulos

340 CLINICAL QUIZ

G. Dioudis, V. Georgopoulou, M. Manolaki, N. Myriokefalitakis

341 LETTERS TO THE EDITOR

A. AndreouS. PetmezakiG.P. Chroussos, M. Karantza

PaediatrikiVolume 70 ñ Number 4 ñ July-August 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·

∂È‰ÈÎÔ› ™˘ÓÙ¿ÎÙÂ˜

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

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

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

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

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

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

ª·Ú›· ∫·Ó¿ÚÈÔ˘, ∞ÓÔÛÔÏÔÁ›·, ∞ı‹Ó·

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

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

™ÔÊ›· ∫›ÙÛÈÔ˘-∆˙¤ÏË, °ÂÓÂÙÈÎ‹, ∞ı‹Ó·

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

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

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

ª·Ú›˙· ∆ÛÔÏÈ¿, §ÔÈÌˆÍÈÔÏÔÁ›·, ∞ı‹Ó·

Editor-in-Chief

Constantinos Stefanidis, Athens

Section Editors

Stella Andronikou, Neonatology, Ioannina

Persefoni Avgoustides-Savvopoulou, MetabolicDisorders, Thessaloniki

Andriani Vazaiou-Gerasimidi, Endocrinology, Athens

George Varlamis, Cardiology, Thessaloniki

Emmanouil Galanakis, Ethics and Deontology, Heraklion

Loretta Thomaidou, Developmental Pediatrics, Athens

Maria Kanariou, Immunology, Athens

Eustathia Katsarou-Pektasides, Neurology, Athens

Antonis Kattamis, Haematology - √ncology, Athens

Sophia Kitsiou-Tzeli, Genetics, Athens

Alexandra Papadopoulou, Gastroenterology - Nutrition,Athens

Nicos Papadopoulos, Allergology - Pneumonology, Athens

Antigoni Siamopoulou-Mavridou, Rheumatology,Ioannina

Marisa Tsolia, Infectious Diseases, Athens

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


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§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ∏ıÈÎ‹, ÔÏÈÙÈÛÌfi˜, ÁÏÒÛÛ·.

The death of ethics

Th. Pelegrinis

Abstract: Ethics today is in such a grave crisis, so that one may suppose that it is one step before the end.There are three reasons to support this. First, the questioning of moral language and the fact thataccording to certain philosophers it is possible to omit moral terms from the language without any changeof meaning. Second, the great advancement of technology, due to which basic moral concepts seem to beobsolete. Third, the questioning of the subject of moral life, i.e. the self as a condensed entity which directsour thoughts and actions. The questioning of Ethics is subject to the general attitude of renewing ourculture through the rejection of certain forms of it and their substitution with other forms as it happenedwith mythology. Mythology at a certain time ceased to be a source of creativity without causing a negativeeffect upon our culture’s progress.

Key words: Ethics, culture, language.

Correspondence:

Theodosis [email protected] of Philosophy andDean of the School ofPhilosophy, University ofAthens, Greece

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

AÏÏËÏÔÁÚ·Ê›·:

£ÂÔ‰fiÛË˜ ¶ÂÏÂÁÚ›ÓË˜[email protected]·ıËÁËÙ‹˜ ºÈÏÔÛÔÊ›·˜ Î·È∫ÔÛÌ‹ÙÔÚ·˜ ÙË˜ºÈÏÔÛÔÊÈÎ‹˜ ™¯ÔÏ‹˜ ÙÔ˘¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ

¶·È‰È·ÙÚÈÎ‹ 2007;70:253-256

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“¯ˆÚ›˜ ÙËÓ ËıÈÎ‹”, ÂÓÓÔÒ ¯ˆÚ›˜ ·Ó·ÊÔÚ¿ ÛÂ Î·ÌÈ¿

ËıÈÎ‹ ·Ú¯‹ ‹ ·Í›·, Î·È fi¯È ¯ˆÚ›˜ ÙËÓ Ù¿‰Â ËıÈÎ‹ ·Ú-

¯‹ ·ÏÏ¿ ÌÂ ÙË ‰Â›Ó· ËıÈÎ‹ ·Ú¯‹. °È· Ó· ÏÂÈÙÔ˘ÚÁ‹ÛÂÈ

ÌÈ· ËıÈÎ‹ ·Ú¯‹, ¯ÚÂÈ¿˙ÂÙ·È ·ÛÊ·ÏÒ˜ ¯ÚfiÓÔ, ÚÔÎÂÈ-

Ì¤ÓÔ˘ Ó· ÌÔÚ¤ÛÂÈ Ó· ·ÁÈˆıÂ› ÛÙË Û˘ÓÂ›‰ËÛË ÙˆÓ

ÚÔÛÒˆÓ ÛÙ· ÔÔ›· ·Â˘ı‡ÓÂÙ·È, ÒÛÙÂ Ó· ‰ËÌÈ-

Ô˘ÚÁËıÂ› ÛÂ ·˘Ù¿ Ë ·›ÛıËÛË ÙÔ˘ Î·ı‹ÎÔÓÙÔ˜, fiÙÈ

‰ËÏ·‰‹ ÔÊÂ›ÏÔ˘Ó Ó· ÂÓ·ÚÌÔÓÈÛÙÔ‡Ó ÚÔ˜ ÙËÓ ·Ú¯‹

·˘Ù‹. √È ÂÍÂÏ›ÍÂÈ˜, fiÌˆ˜, ÛÙÔÓ ÙÔÌ¤· ÙË˜ È·ÙÚÈÎ‹˜ -

ÂÈ‰ÈÎ¿, Ì¿ÏÈÛÙ·, Î·Ù¿ ÙÈ˜ ÙÂÏÂ˘Ù·›Â˜ ‰ÂÎ·ÂÙ›Â˜- ÙÚ¤-

¯Ô˘Ó ÌÂ ÙfiÛË Ù·¯‡ÙËÙ·, ÒÛÙÂ Ó· Â›Ó·È ·‰‡Ó·ÙÔÓ Ó·

Î·Ï˘ÊıÔ‡Ó ·fi ÙÈ˜ ÂÎ¿ÛÙÔÙÂ ˘ÊÈÛÙ¿ÌÂÓÂ˜ ËıÈÎ¤˜

·Ú¯¤˜. ∂ÎÙfi˜ ÎÈ ·Ó ı¤ÏÔ˘ÌÂ ÔÈ ÂÎÚfiÛˆÔÈ ÙË˜ È·-

ÙÚÈÎ‹˜ Ó· ˙Ô˘Ó ÛÂ ÌÈ· ·ÙÌfiÛÊ·ÈÚ· ·ÎÔ‡ÛÈ·˜, ¤ÛÙˆ,

˘ÔÎÚÈÛ›·˜ - Ú¿ÁÌ·, ¿ÏÏˆÛÙÂ, Ô˘ ¤¯ˆ ÙËÓ ÂÓÙ‡-

ˆÛË fiÙÈ Û˘Ì‚·›ÓÂÈ. °È·Ù› ÌÔÚÂ› ÌÂÓ Ô ÁÈ·ÙÚfi˜,

Û‡ÌÊˆÓ· ÌÂ ÙÔÓ fiÚÎÔ ÙÔ˘ πÔÎÚ¿ÙË, ÛÙÔÓ ÔÔ›Ô

‰›‰ÂÈ ›ÛÙÈÓ, Ó· ÔÊÂ›ÏÂÈ Ó· ‰È‰¿ÛÎÂÈ Î·È Ó· ·ÛÎÂ› ÙËÓ

ÂÈÛÙ‹ÌË ÙÔ˘ “¿ÓÂ˘ ÌÈÛıÔ‡ Î·È Í˘ÁÁÚ·Ê‹˜” ‹ Ó·

ÌËÓ “Ù¤ÌÓÂÈ”, ·ÏÏ¿ ÛÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ· Â›Ó·È

·‰È·ÓfiËÙÔ, Û‹ÌÂÚ·, ¤Ó·˜ ÁÈ·ÙÚfi˜ Ó· ÌËÓ ·ÌÂ›‚ÂÙ·È

Î·È Ó· ÌËÓ ·Ú¿ÁÂÈ Û˘ÁÁÚ·ÊÈÎfi ¤ÚÁÔ ‹ ÎÏ¿‰ÔÈ ÙË˜

È·ÙÚÈÎ‹˜, fiˆ˜ Ô ¯ÂÈÚÔ˘ÚÁÈÎfi˜, Ô ÔÚıÔÂ‰ÈÎfi˜, Ô

ÔÊı·ÏÌÔÏÔÁÈÎfi˜ Ó· ··ÈÙÔ‡Ó ·fi ÙÔÓ ÁÈ·ÙÚfi Ó· ÌËÓ

“Ù¤ÌÓÂÈ”. ª‹ˆ˜, ÏÔÈfiÓ, Ë Ï‡ÛË ÁÈ· Ó· ÂÈÙÂÏÂ›

·ÚfiÛÎÔÙ· Î·È, Î·Ù’ Â¤ÎÙ·ÛË, ÛˆÛÙ¿ ÙÔ ¤ÚÁÔ ÙÔ˘

Ô ÁÈ·ÙÚfi˜ ı· ‹Ù·Ó Ó· Î·Ù·ÚÁËıÂ› Ë ËıÈÎ‹ - ¯ˆÚ›˜ Ó·

ÙÔ ÂÓÓÔÒ ·˘Ùfi ÛÙÔ ÚÔÛÂ¯¤˜ Ì¤ÏÏÔÓ, ·ÏÏ¿ ÛÂ ‚¿ıÔ˜

¯ÚfiÓÔ˘; ÿÛˆ˜, Ì¿ÏÈÛÙ·, ·Ú·Î¿ÌÙÔÓÙ·˜ ÛÙÈ˜ Î·ıË-

ÌÂÚÈÓ¤˜ ˘Ôı¤ÛÂÈ˜ Ì·˜ ÙËÓ ËıÈÎ‹, Ë ˙ˆ‹ Ì·˜ Ó· ÁÈ-

ÓfiÙ·Ó ÈÔ ÂÏÎ˘ÛÙÈÎ‹.

°È·Ù›, Â›Ó·È ·Ï‹ıÂÈ·, Ë ËıÈÎ‹ ÁÈ· ‰È¿ÊÔÚÔ˘˜ Ïfi-

ÁÔ˘˜ Ì·˜ Â›Ó·È ÂÓÔ¯ÏËÙÈÎ‹. ∏ ·ÚÂÙ‹, ·›ÊÓË˜, ÚÔ˜

ÙËÓ ·fiÎÙËÛË ÙË˜ ÔÔ›·˜ ·‰È·ÏÂ›Ùˆ˜ Ì·˜ ÚÔÙÚ¤-

ÂÈ Ë ËıÈÎ‹ Î·È ÙÔ Î·ı‹ÎÔÓ Ô˘ ·ÔÚÚ¤ÂÈ ·fi ÙÔ Ìfi-

ÓÈÌÔ ·›ÙËÌ· ÙË˜ ·fiÎÙËÛË˜ ÙË˜ ·ÚÂÙ‹˜ ··ÈÙÔ‡Ó ·fi

Ì·˜ Ó· ı˘ÛÈ¿˙Ô˘ÌÂ Î¿ÙÈ ·fi ÙËÓ ̆ ÁÂ›· Ì·˜ Î·È ÙËÓ Â˘-

Ù˘¯›· Ì·˜. ∂Ó›ÔÙÂ, Ì¿ÏÈÛÙ·, fiÙ·Ó, fiˆ˜ Ï¤ÂÈ Ô ÔÈË-

Ù‹˜, Ú¤ÂÈ Ó· Ô‡ÌÂ ÙÔ ÌÂÁ¿ÏÔ Ó·È ‹ ÙÔ ÌÂÁ¿ÏÔ fi¯È,

ÂÓ‰¤¯ÂÙ·È Ë ·ÚÂÙ‹ Î·È ÙÔ Î·ı‹ÎÔÓ Ó· Ì·˜ ÚÔÙÚ¤-

„Ô˘Ó Ó· ‰È·ÎÈÓ‰˘ÓÂ‡ÛÔ˘ÌÂ Î·È ÙË ˙ˆ‹ Ì·˜ ·ÎfiÌË.

∂›Ó·È ÛÙËÓ Ê‡ÛË Ì·˜ Ó· ı¤ÏÔ˘ÌÂ Ó· ·ÔÏ·Ì‚¿-

ÓÔ˘ÌÂ ÙË ˙ˆ‹, ÎÈ ·˘Ùfi, ‰˘ÛÙ˘¯Ò˜, ‰ÂÓ Û˘Ì‚·›ÓÂÈ, ÂÓ

ÔÏÏÔ›˜, ÂÍ·ÈÙ›·˜ ÙË˜ ËıÈÎ‹˜ Î·È ÙˆÓ ˘Ô¯ÚÂÒÛÂˆÓ


Ô˘ ·˘Ù‹ Ì·˜ ˘·ÁÔÚÂ‡ÂÈ. ¢ÂÓ Ì·˜ ·Ú¤ÛÂÈ Ó· Ì·˜

Ï¤ÓÂ ÙÈ Ú¤ÂÈ Ó· Î¿ÓÔ˘ÌÂ, ÔfiÙÂ Î¿ÓÔÓÙ·˜ Ú¿Á-

Ì·Ù· Ô˘ Ì·˜ ÂÈ‚¿ÏÏÔÓÙ·È, ·ÈÛı·ÓfiÌ·ÛÙÂ ‰˘ÛÊÔ-

Ú›·. ªÔÚÔ‡ÌÂ, ‚¤‚·È·, Ó· ·ÁÓÔ‹ÛÔ˘ÌÂ fi,ÙÈ Ì·˜ Ï¤-

ÓÂ ˆ˜ ÔÊÂ›ÏÔ˘ÌÂ Ó· Î¿ÓÔ˘ÌÂ. ∞ÏÏ¿, ÙfiÙÂ, ÓÈÒıÔ˘-

ÌÂ ÂÎÙÂıÂÈÌ¤ÓÔÈ ·¤Ó·ÓÙÈ ÛÙÔ˘˜ ¿ÏÏÔ˘˜, ˘ÔÊ¤ÚÔ-

ÓÙ·˜ ¤ÙÛÈ ·fi ÙÔ ‚¿ÚÔ˜ ÙË˜ ÂÓÔ¯‹˜, ÌÂ ·ÔÙ¤ÏÂÛÌ·

Ó· ·Ì·˘ÚÒÓÂÙ·È Ë ·fiÏ·˘ÛË Ô˘ ÂÈÌfiÓˆ˜ ˙ËÙ¿ÌÂ.

¶ÚÔ˜ ÙÈ, ÏÔÈfiÓ, Ë ‰È·Ù‹ÚËÛË ÙË˜ ËıÈÎ‹˜, Ë

ÔÔ›· ÌÔÚÂ› Ó· Ï¤ÂÈ fiÙÈ Ì·˜ ˘Ô¯ÚÂÒÓÂÈ Ó· ˙Ô‡ÌÂ

ÌÂ ¤Ó·Ó ÔÚÈÛÌ¤ÓÔ ÙÚfiÔ ÚÔÎÂÈÌ¤ÓÔ˘ Ó· Ù‡¯Ô˘ÌÂ

ÂÓfi˜ Î·Ï‡ÙÂÚÔ˘ ‚›Ô˘, ·ÏÏ¿ ÛÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ·

Ì·˜ ÚÔÛÊ¤ÚÂÈ ÙË ÌÈ˙¤ÚÈ·; ∫·È Ë ·ÔÚ›· ·˘Ù‹ Á›ÓÂ-

Ù·È ÂÓÙÔÓfiÙÂÚË, Â¿Ó ÛÎÂÊÙÔ‡ÌÂ fiÙÈ Ë ËıÈÎ‹ ‰ÂÓ Ë-

Á¿˙ÂÈ ·fi ÙË Ê‡ÛË ÙˆÓ Ú·ÁÌ¿ÙˆÓ. ∞Ó, È‰›ˆ˜, Â›Ì·-

ÛÙÂ ˘Ô¯ÚÂˆÌ¤ÓÔÈ Ó· Ú˘ıÌ›˙Ô˘ÌÂ ÙË Û˘ÌÂÚÈÊÔÚ¿

Ì·˜ Û‡ÌÊˆÓ· ÌÂ ÙÈ˜ ÂÈÙ·Á¤˜ ÙË˜ ËıÈÎ‹˜, ‰ÂÓ Â›Ó·È

ÁÈ·Ù› Ì·˜ ˘Ô‰ÂÈÎÓ‡ÂÙ·È ·˘Ùfi ·fi ÙËÓ ·Ó·ÁÎ·ÈfiÙË-

Ù· ÙˆÓ Ú·ÁÌ¿ÙˆÓ ‹, fiˆ˜ ·Ó¤ÊÂÚ· ÚÔËÁÔ˘Ì¤Óˆ˜,

·fi ÙËÓ ·ÓıÚÒÈÓË Ê‡ÛË Ì·˜, ·ÏÏ¿ ÂÂÈ‰‹ ‚ÚÂı‹-

Î·ÌÂ ÂÁÎÏˆ‚ÈÛÌ¤ÓÔÈ ÛÂ ÌÈ· ÁÏÒÛÛ·, ÙËÓ ÔÔ›· ÂÌÂ›˜

ÂÈÓÔ‹Û·ÌÂ.

√È ¿ÓıÚˆÔÈ, Û˘ÁÎÂÎÚÈÌ¤Ó·, ÁÈ· Ó· ÂÙ‡¯Ô˘Ó Ó·

ÂÚÈÔÚ›ÛÔ˘Ó “ÙË ÛÙÚÔ‚ÈÏ›˙Ô˘Û· ÔÏ˘ÏÔÎfiÙËÙ·

ÙÔ˘ ÎfiÛÌÔ˘ ÛÂ ¤Ó· ÛÎfiÈÌÔ Î·È ¯Ú‹ÛÈÌÔ Û¯‹Ì·”,

fiˆ˜ ı· ¤ÏÂÁÂ Ô ¡›ÙÛÂ, ÁÈ· Ó· ÌÔÚ¤ÛÔ˘Ó, ‰ËÏ·‰‹,

Ó· ‚¿ÏÔ˘Ó ÙË ¯·Ò‰Ë Ú·ÁÌ·ÙÈÎfiÙËÙ· ÛÂ Ù¿ÍË ‰ËÌÈ-

Ô‡ÚÁËÛ·Ó ÙÈ˜ Ï¤ÍÂÈ˜, ÒÛÙÂ, ÌÂ ‚¿ÛË ·˘Ù¤˜, Ó· Î·Ù·-

Ù¿ÛÛÔ˘Ó Ù· Ú¿ÁÌ·Ù· ÛÂ Î·ÙËÁÔÚ›Â˜, ÒÛÙÂ Ó· Ù· ÍÂ-

¯ˆÚ›˙Ô˘Ó ÙÔ ¤Ó· ·fi ÙÔ ¿ÏÏÔ Î·È Ó· Â›Ó·È ÛÂ ı¤ÛË,

¤ÙÛÈ, Ó· ÂÈÎÔÈÓˆÓÔ‡Ó ÌÂÙ·Í‡ ÙÔ˘˜. ∆Ô Î·Îfi ÌÂ ÙÔ˘˜

·ÓıÚÒÔ˘˜ Â›Ó·È fiÙÈ ·fi ¤Ó· ÛËÌÂ›Ô Î·È ÌÂÙ¿ Í¤¯·-

Û·Ó fiÙÈ ÔÈ Ï¤ÍÂÈ˜ ‰È·‰Ú·Ì·Ù›˙Ô˘Ó ¤Ó·Ó Î·ı·Ú¿ ÏÂÈ-

ÙÔ˘ÚÁÈÎfi ÚfiÏÔ Î·È ›ÛÙÂ„·Ó ˆ˜ ·˘Ù¤˜ Ï¤ÔÓ Â›Ó·È

Ù· ›‰È· Ù· Ú¿ÁÌ·Ù·. ∂Ó ÙÔÈ·‡ÙË ÂÚÈÙÒÛÂÈ, ÔÈ Ï¤-

ÍÂÈ˜ ÌÔÈ¿˙Ô˘Ó Ó· ÔÚıÒÓÔÓÙ·È ÌÚÔÛÙ¿ Ì·˜ Û·Ó Û˘-

Ì·ÁÂ›˜ fiÁÎÔÈ Ú·ÁÌ¿ÙˆÓ Ô˘ Â›Ó·È ·‰‡Ó·ÙÔÓ Ó·

ÙÔ˘˜ ·Ú·Î¿Ì„ÂÈ Î·ÓÂ›˜. ªÂ ·˘Ù‹ ÙËÓ ¤ÓÓÔÈ·, ‰Ò-

Û·ÌÂ ÛÙÔ “Î·Ïfi”, ÛÙÔ “ÛˆÛÙfi”, ÛÙÔ “‰›Î·ÈÔ”, ÛÙÔ

“Ú¤ÂÈ” Î·È ÛÙÈ˜ ¿ÏÏÂ˜ Ï¤ÍÂÈ˜ Ô˘ Û˘ÁÎÚÔÙÔ‡Ó ÙËÓ

ÁÏÒÛÛ· ÙË˜ ËıÈÎ‹˜ ÔÓÙÔÏÔÁÈÎ‹ ˘fiÛÙ·ÛË ‰ËÌÈÔ˘Ú-

ÁÒÓÙ·˜ ÙËÓ ÂÔ›ıËÛË fiÙÈ, ·Ó ÂÈ¯ÂÈÚ‹ÛÂÈ Ó· ÙÈ˜

·ˆı‹ÛÂÈ Î·ÓÂ›˜, ı· Ê¿ÂÈ Ù· ÌÔ‡ÙÚ· ÙÔ˘, fiÙÈ, fiˆ˜

Ï¤ÂÈ ¿ÏÈ Ô ¡›ÙÛÂ, ÛÎÔÓÙ¿ÊÙÔÓÙ·˜ ¿Óˆ ÙÔ˘˜ “ı·

Û¿ÛÂÈ ÙÔ fi‰È ÙÔ˘ Ì¿ÏÏÔÓ ·Ú¿ ·˘Ù¤˜”.

∞fi Ù· Ì¤Û· ÙÔ˘ ÂÚ·ÛÌ¤ÓÔ˘ ·ÈÒÓ· -ÂÓÓÔÒ ÙÔ˘

20Ô‡ ·ÈÒÓ·-, fiÌˆ˜, ˘‹ÚÍ·Ó ÊÈÏfiÛÔÊÔÈ Ô˘ ÂÈ-

¯Â›ÚËÛ·Ó Ó· Ì·˜ ‚Á¿ÏÔ˘Ó ·fi ÙËÓ Ï¿ÓË ·˘Ù‹ Ï¤-

ÁÔÓÙ·˜ fiÙÈ ÔÈ ËıÈÎ¤˜ Ï¤ÍÂÈ˜ ‰ÂÓ ·ÔÙÂÏÔ‡Ó ·ÍÂ¤-

Ú·ÛÙÔ˘˜ ÔÓÙÔÏÔÁÈÎÔ‡˜ fiÁÎÔ˘˜, ·ÏÏ¿ fiÙÈ ı· ÌÔ-

ÚÔ‡Û·ÌÂ Î¿ÏÏÈÛÙ· Ó· ÌÂÙ·¯ÂÈÚÈÛÙÔ‡ÌÂ ÂÚÈÁÚ·Ê¤˜

·fi ÙÈ˜ ÔÔ›Â˜ Ó· ·Ô˘ÛÈ¿˙Ô˘Ó ÔÈ ËıÈÎÔ› fiÚÔÈ Î·È

Ó· ··ÏÏ·ÁÔ‡ÌÂ, ¤ÙÛÈ, ·fi ÙÈ˜ Ô¯Ï‹ÛÂÈ˜ Ô˘ Û˘ÓÂ-

¿ÁÂÙ·È Ë ËıÈÎ‹. ∞ÓÙ›, ÁÈ· ·Ú¿‰ÂÈÁÌ·, Ó· ÂÈ Î·-

ÓÂ›˜ ÁÈ· Î¿ÔÈÔÓ fiÙÈ Â›Ó·È Î·Ïfi˜ ·Ù¤Ú·˜, ı· ÌÔ-

ÚÔ‡ÛÂ, ··ÏÂ›ÊÔÓÙ·˜ ÙÔÓ ˙ËÌÈÔÁfiÓÔ ËıÈÎfi fiÚÔ

“Î·Ïfi˜”, Ó· ·Ú·ÙËÚ‹ÛÂÈ fiÙÈ ÊÚÔÓÙ›˙ÂÈ ÁÈ· Ù· ·È-

‰È¿ ÙÔ˘ Ó· ÌËÓ ÂÈÓ¿ÓÂ, Ó· ÌÔÚÊˆıÔ‡Ó, Ó· ÓÈÒıÔ˘Ó

·ÛÊ¿ÏÂÈ·, Î.Ô.Î.

√ ·ÂÁÎÏˆ‚ÈÛÌfi˜ Ì·˜ ·fi ÙËÓ ËıÈÎ‹ ÁÏÒÛÛ· Î·È

Ë ·ÂÏÂ˘ı¤ÚˆÛ‹ Ì·˜ ·fi ÙÈ˜ ·ÚÂÓ¤ÚÁÂÈ¤˜ ÙË˜ Â˘-

ÓÔÔ‡ÓÙ·È ·fi ÙÔ Î·ÈÓÔ‡ÚÈÔ ÂÚÈ‚¿ÏÏÔÓ Ô˘ ‰È·ÌÔÚ-

ÊÒÓÂÙ·È ¯¿ÚË ÛÙËÓ ÂÍ¤ÏÈÍË ÙË˜ ÂÈÛÙ‹ÌË˜ Î·È ÙË˜

ÙÂ¯ÓÔÏÔÁ›·˜. ∫ÔÚ˘Ê·›· Û‡Ì‚ÔÏ· ÙÔ˘ ËıÈÎÔ‡ ‚›Ô˘

Ì·˜ ˘ÔÓÔÌÂ‡ÔÓÙ·È Î·È ÌÔÈ¿˙Ô˘Ó Ó· Î·Ù·ÚÚ¤Ô˘Ó Î¿-

Ùˆ ·fi ÙÔ ‚¿ÚÔ˜ ÙˆÓ ÂÈÛÙËÌÔÓÈÎÒÓ Î·È ÙÂ¯ÓÔÏÔÁÈ-

ÎÒÓ ÂÍÂÏ›ÍÂˆÓ. §fiÁÔ˘ ¯¿ÚÈÓ, Ë ¤ÓÓÔÈ· ÙË˜ ÌËÙ¤Ú·˜,

ÌÂ fiÏË ÙËÓ ËıÈÎ‹ ·‡Ú· Ô˘ Û¤ÚÓÂÈ Ì·˙› ÙË˜, Î·È ÙÔ˘

·ÁÓÒÛÙÔ˘ ÛÙÚ·ÙÈÒÙË, Ô˘ ÂÎÊÚ¿˙ÂÈ ÙÔ ·‰È·Ú·ÁÌ¿-

ÙÂ˘ÙÔ ËıÈÎfi ¯Ú¤Ô˜ Ì·˜ ÚÔ˜ ÙËÓ ·ÙÚ›‰· Ì·˜, ÂÌÊ·-

Ó›˙ÔÓÙ·È Û·Ó Î·Ù¿ÏÔÈ· ÌÈ·˜ ¿ÏÏË˜ ÂÔ¯‹˜. §¤ÁÔ-

ÓÙ·˜ “ÌËÙ¤Ú·”, Û˘ÁÎÂÎÚÈÌ¤Ó·, ÂÓÓÔÔ‡ÌÂ ÙÔ Ï¿ÛÌ·

ÂÎÂ›ÓÔ Ô˘ ·Ú¿ÁÂÈ ˆ¿ÚÈ·, Û˘ÏÏ·Ì‚¿ÓÂÈ, Î˘ÔÊÔÚÂ›

Ì¤Û· ÙÔ˘ ÙÔ ¤Ì‚Ú˘Ô Î·È, ÙÂÏÈÎ¿, ÁÂÓÓ¿ÂÈ ÙÔ ·È‰›.

∞fi ÙÈ˜ ÏÂÈÙÔ˘ÚÁ›Â˜ ·˘Ù¤˜ ÙË˜ ÌËÙ¤Ú·˜, ˆÛÙfiÛÔ, ÔÈ

ÙÚÂÈ˜ -Ë Û‡ÏÏË„Ë, Ë Î˘ÔÊÔÚ›· Î·È Ë Á¤ÓÓËÛË- ¤¯Ô˘Ó

‹‰Ë, ̄ ¿ÚË ÛÙËÓ ÂÍ¤ÏÈÍË ÙË˜ ÂÈÛÙ‹ÌË˜, ÌÂÙ·ÙÔÈÛÙÂ›

·fi ÙÔÓ ÂÛˆÙÂÚÈÎfi ÎfiÛÌÔ ÙË˜ ÌËÙ¤Ú·˜ ÛÂ ¿ÏÏ· ÂÚÈ-

‚¿ÏÏÔÓÙ·. ¶Ú¿ÁÌ·ÙÈ, Û‹ÌÂÚ· Ë Û‡ÏÏË„Ë ÌÔÚÂ› Ó·

ÂÈÙÂ˘¯ıÂ› ÛÂ ‰ÔÎÈÌ·ÛÙÈÎfi ÛˆÏ‹Ó·, Ë Î˘ÔÊÔÚ›· Ó·

Á›ÓÂÈ ÛÙË Ì‹ÙÚ· ÌÈ·˜ ¿ÏÏË˜ Á˘Ó·›Î·˜, ÙË˜ Î·ÏÔ‡ÌÂ-

ÓË˜ ‰·ÓÂÈÎ‹˜ ÌËÙ¤Ú·˜, Î·È Ë Á¤ÓÓËÛË Ó· Û˘ÓÙÂÏÂÛÙÂ›

·fi ÙË ‰·ÓÂÈÎ‹ ÌËÙ¤Ú·. ø˜ ÚÔ˜ ÙËÓ ¿ÏÏË ÏÂÈÙÔ˘Ú-

Á›· ‰Â, ÙËÓ ·Ú·ÁˆÁ‹ ˆ·Ú›ˆÓ, ÔÈÔ˜ ÌÔÚÂ› Ó· ·Ô-

ÎÏÂ›ÛÂÈ fiÙÈ ÛÙÔ Ì¤ÏÏÔÓ Ë ÂÈÛÙ‹ÌË ‰ÂÓ ı· ÌÔÚÂ› Ó·

Ù· ‰ËÌÈÔ˘ÚÁÂ› ÌÂ ÙÂ¯ÓËÙfi ÙÚfiÔ; ∞Ó¿ÏÔÁÔ˜ Â›Ó·È Î·È

Ô ÂÎÊ˘ÏÈÛÌfi˜ Ô˘ ¤¯ÂÈ ˘ÔÛÙÂ›, ÂÍ·ÈÙ›·˜ ÙË˜ ÚÔfi-

‰Ô˘ ÙË˜ ÂÈÛÙ‹ÌË˜ Î·È ÙË˜ ÙÂ¯ÓÔÏÔÁ›·˜, Ë ¤ÓÓÔÈ· ÙÔ˘

¿ÁÓˆÛÙÔ˘ ÛÙÚ·ÙÈÒÙË. ∞Ó, ‰ËÏ·‰‹, ÛÙÔ ·ÚÂÏıfiÓ

ÌÔÚÔ‡Û·ÌÂ Ó· ÌÈÏ¿ÌÂ ÁÈ· ÙÔÓ ¿ÁÓˆÛÙÔ ÛÙÚ·ÙÈÒÙË

Ô˘ ¤ÂÛÂ ÛÙÔ Â‰›Ô ÙË˜ Ì¿¯Ë˜, Û‹ÌÂÚ· ‰ÂÓ ‰ÈÎ·È-

Ô‡ÌÂı· Ó· ÙÔ Î¿ÓÔ˘ÌÂ, ÂÂÈ‰‹, ¯¿ÚË ÛÙËÓ ·Ó¿Ï˘ÛË

ÙÔ˘ DN∞ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ·Ó·Î·Ï˘ÊıÂ› Ë Ù·˘ÙfiÙË-

Ù· ÙÔ˘ Î¿ıÂ ·ÓıÚÒÔ˘.

∞ÏÏ¿, ¤Ú· ·fi ÙËÓ ·ÌÊÈÛ‚‹ÙËÛË ÙˆÓ Û˘Ì‚fi-

ÏˆÓ ÙË˜ ËıÈÎ‹˜ Û˘ÌÂÚÈÊÔÚ¿˜ Ì·˜, ÙÂ›ÓÂÈ Ó· ·Î˘Úˆ-

ıÂ› ·ÎfiÌË Î·È Ô ›‰ÈÔ˜ Ô Â·˘Ùfi˜ Ì·˜, ÂÎÂ›ÓÔ˜ Ô˘

˘ÔÙ›ıÂÙ·È ˆ˜ Ú¿ÙÙÂÈ Î·È ¯ÚÂÒÓÂÙ·È ÙËÓ ËıÈÎ‹

Â˘ı‡ÓË ÙˆÓ Ú¿ÍÂÒÓ Ì·˜. ¶Ô‡ ˘¿Ú¯ÂÈ, ·Ï‹ıÂÈ·, Ô

Â·˘Ùfi˜ Ì·˜ Î·È ÙÈ Â›Ó·È ·˘Ùfi˜;

√‡ÙÂ Ó· ÙÔÓ ‰Ô‡ÌÂ, Ô‡ÙÂ Ó· ÙÔÓ ·ÁÁ›ÍÔ˘ÌÂ, Ô‡ÙÂ

Ó· ÙÔÓ ·ÓÙÈÏËÊıÔ‡ÌÂ Î·ı’ ÔÈÔÓ‰‹ÔÙÂ ¿ÏÏÔ ÙÚfiÔ

ÌÔÚÔ‡ÌÂ. ∞ÏÒ˜, ıÂˆÚÔ‡ÌÂ fiÙÈ ı· Ú¤ÂÈ Ó·

˘¿Ú¯ÂÈ Î¿Ô˘ ‚·ıÈ¿ Ì¤Û· Ì·˜, ÚÔÎÂÈÌ¤ÓÔ˘ Ó· ‰È-

Î·ÈÔÏÔÁ‹ÛÔ˘ÌÂ ÙÔÓ ÔÚÁ·ÓˆÌ¤ÓÔ ÙÚfiÔ ÌÂ ÙÔÓ

ÔÔ›Ô ÂÓÂÚÁÔ‡ÌÂ. ∫·È Ë ÈÔ ·Ï‹ ÂÓ¤ÚÁÂÈ¿ Ì·˜, ÙÔ

255√ ı¿Ó·ÙÔ˜ ÙË˜ ËıÈÎ‹˜

¶·È‰È·ÙÚÈÎ‹ 2007;70:253-256


Ó· ·ÏÒÛÔ˘ÌÂ, ÁÈ· ·Ú¿‰ÂÈÁÌ·, ÙÔ ¯¤ÚÈ Ì·˜ ÁÈ· Ó·ÌÂÙ·ÎÈÓ‹ÛÔ˘ÌÂ ÛÙÔ ÙÚ·¤˙È ¤Ó· ÛÙ·¯ÙÔ‰Ô¯Â›Ô, ··È-ÙÂ› ¤Ó· Û‡ÓÔÏÔ ÎÈÓ‹ÛÂˆÓ ÙˆÓ Î˘ÙÙ¿ÚˆÓ Ì·˜ Î·È ÙˆÓÌ˘ÒÓ Ì·˜, ÔÈ ÔÔ›Â˜ Ú¤ÂÈ Ó· ÌÔ˘Ó ÛÙËÓ ÛÂÈÚ¿ Î·ÈÓ· ÂÓ·ÚÌÔÓÈÛÙÔ‡Ó, ÒÛÙÂ Ó· ÂÎÏËÚˆıÂ› Ô ÛÎÔfi˜Ì·˜ - Ë ÌÂÙ·Î›ÓËÛË ÙÔ˘ ÛÙ·¯ÙÔ‰Ô¯Â›Ô˘, ÂÓ ÚÔÎÂÈÌ¤-Óˆ. ∫¿ÔÈÔ˜, fiÌˆ˜, ÂÈÎ¿˙Ô˘ÌÂ, ¤Ó·˜ Ú˘ıÌÈÛÙ‹˜ ÂÓÙfi˜Ì·˜, ı· Ú¤ÂÈ Ó· ̆ ¿Ú¯ÂÈ ÁÈ· Ó· Û˘ÓÙÔÓ›˙ÂÈ ÙÈ˜ ÎÈÓ‹-ÛÂÈ˜ Ì·˜, ÒÛÙÂ Ó· ÌÔÚÔ‡ÌÂ Ó· ÂÈÙÂÏÔ‡ÌÂ ÙÈ˜ Ú¿-ÍÂÈ˜ ÛÙÈ˜ ÔÔ›Â˜ ÚÔ‚·›ÓÔ˘ÌÂ. ∞˘Ùfi˜ Ô ÂÛˆÙÂÚÈÎfi˜Ú˘ıÌÈÛÙ‹˜ Â›Ó·È fi,ÙÈ ÔÓÔÌ¿˙Ô˘ÌÂ “Â·˘Ùfi” Ì·˜, ÔÔÔ›Ô˜, ‰ÚÒÓÙ·˜ ·ÓÂÍ¿ÚÙËÙ· ·fi Ù· Ì¤ÚË ·fi Ù·ÔÔ›· Û˘ÓÙ›ıÂÙ·È, ¤¯ÂÈ ÙËÓ Â˘ı‡ÓË Î·È, ˆ˜ ÂÎ ÙÔ‡ÙÔ˘,Â›Ó·È ˘fiÏÔÁÔ˜ ÁÈ· ÙÔÓ ÙÚfiÔ ÌÂ ÙÔÓ ÔÔ›Ô ÂÓÂÚÁÔ‡-ÌÂ Î·È Ú¿ÙÙÔ˘ÌÂ. ∫¿ıÂ ÔÚÁ·ÓˆÌ¤ÓÔ Û‡ÓÔÏÔ, fiˆ˜,·˜ Ô‡ÌÂ, ¤Ó· ÂÚÁÔÛÙ¿ÛÈÔ ‹ ¤Ó· ÁÚ·ÊÂ›Ô, ‰ÈÔÈÎÂ›Ù·È·fi Î¿ÔÈÔÓ, Ô ÔÔ›Ô˜ ¤¯ÂÈ ÙËÓ ÙÂÏÈÎ‹ Â˘ı‡ÓË ÁÈ·ÙÔÓ ÙÚfiÔ ÌÂ ÙÔÓ ÔÔ›Ô ÂÓÂÚÁÔ‡Ó Ù· Ì¤ÏË ÙÔ˘ Î·È Â›-Ó·È, ÙÂÏÈÎ¿, Ô ˘fiÏÔÁÔ˜ ÁÈ· ÙÔ ¤ÚÁÔ Ô˘ ·Ú¿ÁÂÙ·È.

øÛÙfiÛÔ, ı· ÌÔÚÔ‡Û·Ó Ó· ÂÈÛËÌ·ÓıÔ‡Ó ÔÚÁ·-ÓˆÌ¤Ó· Û‡ÓÔÏ·, Ù· Ì¤ÏË ÙˆÓ ÔÔ›ˆÓ ÚÔ‚·›ÓÔ˘Ó ÛÂÔÈÎ›ÏÂ˜ Û˘ÓÙÔÓÈÛÌ¤ÓÂ˜ ÂÓ¤ÚÁÂÈÂ˜ ¯ˆÚ›˜ Ó· ˘¿Ú¯ÂÈÎ·Ó¤Ó·˜ Ú˘ıÌÈÛÙ‹˜. ¶·Ú·‰Â›ÁÌ·ÙÔ˜ ¯¿ÚÈÓ, Ù· Ì¤ÏËÌÈ·˜ ·ÔÈÎ›·˜ Ì˘ÚÌËÁÎÈÒÓ Î·Ù·ÛÎÂ˘¿˙Ô˘Ó ÛÙÈ˜ Êˆ-ÏÈ¤˜ ÙÔ˘˜ ÛÙÔ¤˜, ÂÍfi‰Ô˘˜ Î·È ¿ÏÏ· ÌË¯·ÓÈÎ¿ ¤ÚÁ·, ‹Ù· Ì¤ÏË ÂÓfi˜ ÛÌ‹ÓÔ˘˜ ·Ô‰ËÌËÙÈÎÒÓ Ô˘ÏÈÒÓ ‰È·-ÙÚ¤¯Ô˘Ó ÙÂÚ¿ÛÙÈÂ˜ ·ÔÛÙ¿ÛÂÈ˜ ÂÙÒÓÙ·˜ ÛÂ ‰È¿ÊÔ-Ú· ‡„Ë, ÛÙ·Ì·ÙÒÓÙ·˜ Â‰Ò ÎÈ ÂÎÂ›, ¯ˆÚ›˜, ÙfiÛÔ ÛÙËÌ›· fiÛÔ Î·È ÛÙËÓ ¿ÏÏË ÂÚ›ÙˆÛË, Ó· Ù· Î·ÙÂ˘ı‡ÓÂÈÛÙÈ˜ ÂÓ¤ÚÁÂÈ¤˜ ÙÔ˘˜ Î¿ÔÈÔ˜ ·Ú¯ËÁfi˜. ∞ÏÒ˜, ÙÔ Î¿-ıÂ Ì˘ÚÌ‹ÁÎÈ ÛÙËÓ ·ÔÈÎ›· Î·È ÙÔ Î¿ıÂ Ì¤ÏÔ˜ ÙÔ˘ÛÌ‹ÓÔ˘˜ ÙˆÓ ·Ô‰ËÌËÙÈÎÒÓ Ô˘ÏÈÒÓ ‰Ú· ‚Ï¤Ô-ÓÙ·˜ ÙÈ Î¿ÓÂÈ ÙÔ ‰ÈÏ·Ófi ÙÔ˘.

ªÂ ·Ó¿ÏÔÁÔ ÙÚfiÔ ı· ÌÔÚÔ‡Û·ÌÂ Ó· ÂÎÏ¿‚Ô˘-ÌÂ ÙÔ Î¿ıÂ ·ÓıÚÒÈÓÔ ÔÓ Û·Ó ¤Ó·Ó ÔÚÁ·ÓÈÛÌfi Ô˘

·ÔÙÂÏÂ›Ù·È ·fi ¯ÈÏÈ¿‰Â˜ Î‡ÙÙ·Ú· Ô˘ Û˘ÁÎÚÔÙÔ‡-ÓÙ·È ÛÂ Û‡ÓÔÏ·, Ù· ÔÔ›· Û˘ÌÂÚÈÊ¤ÚÔÓÙ·È ÙÔ Î·ı¤-Ó· ÙÔ˘˜ ÎÔÈÙÒÓÙ·˜ Ò˜ ÂÓÂÚÁÂ› ÙÔ ‰ÈÏ·Ófi ÙÔ˘˜. ∂ÓÙÔÈ·‡ÙË ÂÚÈÙÒÛÂÈ, ‰ÂÓ ̄ ÚÂÈ¿˙ÂÙ·È Ó· Î·Ù·ÊÂ‡ÁÔ˘-ÌÂ ÛÙËÓ ˘fiıÂÛË ÙÔ˘ Â·˘ÙÔ‡ Ì·˜ ˆ˜ ˘Â‡ı˘ÓÔ˘ ÁÈ·fi,ÙÈ Î¿ÓÔ˘ÌÂ.

¶ÚÔÊ·ÓÒ˜, ÛÂ ¤Ó· ÂÚÈ‚¿ÏÏÔÓ, fiÔ˘ ‰ÂÓ ı·˘¿Ú¯Ô˘Ó ËıÈÎ¿ Û‡Ì‚ÔÏ·, fiÔ˘ ÔÈ ¿ÓıÚˆÔÈ ‰ÂÓ ı·ÌÂÙ·¯ÂÈÚ›˙ÔÓÙ·È ÙË ÁÏÒÛÛ· ÙË˜ ËıÈÎ‹˜ Î·È ‰ÂÓ ı··Â˘ı‡ÓÔÓÙ·È Ô ¤Ó·˜ ÛÙÔÓ ¿ÏÏÔ Û·Ó Ó· ˘¿Ú¯ÂÈ ·fi›Ûˆ Î¿ÔÈÔ˜ Ú˘ıÌÈÛÙ‹˜ ÁÈ· Ó· ·Ó·Ï¿‚ÂÈ ÙËÓ Â˘ı‡ÓËÁÈ· fiÛ· Ú¿ÙÙÔ˘Ó, Ë ËıÈÎ‹ ÌÔÚÊ‹ ˙ˆ‹˜ ‰ÂÓ ı· ¤¯ÂÈÎ·ÌÈ¿ ı¤ÛË. ∞˘Ùfi, ‚¤‚·È·, Â’ Ô˘‰ÂÓ› ‰ÂÓ ÛËÌ·›ÓÂÈfiÙÈ, Â¿Ó Î·È ÂÊfiÛÔÓ Î·Ù·ÚÁËıÂ› Ë ËıÈÎ‹, ı· ÁÂÌ›ÛÂÈ ÔÎfiÛÌÔ˜ ·fi Î·ÎÔÔÈÔ‡˜. √È ¿ÓıÚˆÔÈ ı· Û˘ÓÂ¯›-ÛÔ˘Ó Ó· Î¿ÓÔ˘Ó Ï›ÁÔ ÔÏ‡ Ù· ›‰È· Ú¿ÁÌ·Ù·. ∞ÏÒ˜,‰ÂÓ ı· ¤¯Ô˘Ó Î·Ó¤Ó·Ó ÏfiÁÔ Ó· Ù· ·ÍÈÔÏÔÁÔ‡Ó ËıÈÎ¿fiˆ˜ Î¿ÓÔ˘Ó Ì¤¯ÚÈ ÙÒÚ·. ∞˜ ÛÎÂÊÙÔ‡ÌÂ ÌfiÓÔ ÙÔ‡-ÙÔ: fiÙ·Ó ¤·„Â Ë Ì˘ıÔÏÔÁ›· Ó· ·ÔÙÂÏÂ› Û˘ÛÙ·ÙÈÎfiÙË˜ ˙ˆ‹˜ ÙˆÓ ·ÓıÚÒˆÓ, Ù· ‰¤ÓÙÚ·, ÔÈ ı¿Ï·ÛÛÂ˜, ÔÈÏ›ÌÓÂ˜, Ù· ıËÚ›· Î·È fiÏ· Ù· ¿ÏÏ· fiÓÙ· ÁÈ· Ù· ÔÔ›·ÌÈÏÔ‡Û·Ó ÔÈ Ì‡ıÔÈ, ‰ÂÓ ÂÍ·Ê·Ó›ÛÙËÎ·Ó. ™˘Ó¤¯ÈÛ·ÓÓ· ˘¿Ú¯Ô˘Ó fiˆ˜ Î·È ÚÈÓ - ··ÏÏ·ÁÌ¤Ó· ·ÏÒ˜·fi ÙÔ Ó¤ÊÔ˜ ÙˆÓ Ì˘ıÔÏÔÁÈÎÒÓ ÂÚÈÁÚ·ÊÒÓ. √ÈfiÔÈÂ˜ ·Ó·ÊÔÚ¤˜ Ì·˜ Û‹ÌÂÚ· ÛÙÔ˘˜ Ì‡ıÔ˘˜ Á›ÓÔ-ÓÙ·È, fi¯È, ‚¤‚·È· ÁÈ·Ù› ÙÔ˘˜ ÈÛÙÂ‡Ô˘ÌÂ, ·ÏÏ¿ ÚÔ˜Ù¤Ú„Ë Ì·˜. ¶ÔÈÔ˜ Í¤ÚÂÈ, ÏÔÈfiÓ, Ì‹ˆ˜ ¤ÙÛÈ -·Ó Ô-Ù¤ Î·È ÂÊfiÛÔÓ Î·Ù·ÚÁËıÂ› Ë ËıÈÎ‹- ‰ÂÓ ÁÏÈÙÒÛÔ˘Ó‰È· ·ÓÙfi˜ ÔÈ ÁÈ·ÙÚÔ› ·fi ¤Ó· ÌÂÁ¿ÏÔ Ì¤ÚÔ˜ ÚÔ-‚ÏËÌ¿ÙˆÓ Ô˘ ÙÔ˘˜ ‰ËÌÈÔ˘ÚÁÂ› Û‹ÌÂÚ· Ë ËıÈÎ‹ ÌÂÙÈ˜ ˘Ô¯ÚÂÒÛÂÈ˜ Ô˘ ÙÔ˘˜ ÂÈ‚¿ÏÏÂÈ, Î·È ÂÌÂ›˜, ·ÓÙ›ÁÈ· ÙË ÌÈ˙¤ÚÈ· Ô˘ Â‰Ò Î·È ·ÈÒÓÂ˜ Ì·˜ ÚÔÍÂÓÂ› ËËıÈÎ‹, ‰ÂÓ ‚ÈÒÓÔ˘ÌÂ Ï¤ÔÓ ÙËÓ ·fiÏ·˘ÛË, ÙËÓÔÔ›·, fiˆ˜ ·Ó¤ÊÂÚ· ·Ú·¿Óˆ, ·fi ÙË Ê‡ÛË Ì·˜ÂÈ˙ËÙÔ‡ÌÂ ÛÙË ˙ˆ‹ Ì·˜.

256 £. ¶ÂÏÂÁÚ›ÓË˜



Persistent vegetative state in children: terminology,

aetiology, prognosis and ethical issues

D. Neubauer, Sv

. Grosek, P. Hamilton, M. LoGiudice, D. Matthys, V. Molina, L. Nikolovski, E. Siebke,

A. Tenore, F.P. Crawley

Abstract: The vegetative state comprises a group of clinical features of profound brain damage, whichappear to demonstrate that the patient is awake but not aware of internal or external environments. Theterm was introduced to replace others used in the past, such as prolonged coma or coma vigile. Childrenare in a special position because at certain ages there should be consideration not only of their severedisability or handicap but also of their potential to become conscious. Terminology and definitions that arenow quite well delineated are described. The boundaries of the vegetative state are noted and itsdiagnosis and prognosis are discussed in detail. Finally, ethical considerations are discussed, with regardto the different stances taken in different countries. In the Appendix the results of a short survey ofmembers of the Paediatric section of UEMS (European Union of Medical Specialists)/EAP are summarizedon the various attitudes and ethical considerations on persistent vegetative state in children.

Key words: End-of-life decisions, children, ethical considerations, euthanasia.

257REVIEW ARTICLE ∞¡∞™∫√¶∏™∏

Ethics Working Group of thePaediatric Section of theUEMS/European Academyof Paediatrics (formerlyCESP)

Correspondence:

Prof. David Neubauer,[email protected] of Child,Adolescent & DevelopmentalNeurologyUniversity Children's Hospital, Ljubljana, Slovenia

¶·È‰È·ÙÚÈÎ‹ 2007;70:257-265

Introduction

More than three decades have passed since

Professor Bryan Jennett and Professor Fred

Plum led the world in understanding the devas-

tating condition of unconsciousness, termed the

vegetative state (1). The vegetative state com-

prises a group of clinical features of profound

brain damage that appear to demonstrate that

the patient is awake but not aware of internal or

external environments. The complexity of its

clinical features means that considerable experi-

ence is needed to be confident of the diagnosis,

and much supportive evidence from a multidis-

ciplinary team experienced in the management

of severe brain damage is needed (2). At present

neurophysiological assessment and even func-

tional neuroimaging can still play only a sup-

portive rather than a diagnostic or a prognostic

role. In spite of concerted attempts to establish

clear terminology there is still a relative lack of

understanding of the existing nomenclature.

Amongst the relatives of brain-damaged persons

the term “vegetative” is especially disliked, main-

ly because of its association with the word “veg-

etable” (2,3). The term was introduced to replace

others used in the past (some of which are still

used, although not considered exact), such as

prolonged coma or coma vigile (the patients by

definition are not in coma), decerebrate demen-

tia, parasomnia, akinetic mutism and apallic

syndrome (still preferred and used by German

speaking professionals) (2). Confidence in the

diagnosis can sometimes be questioned due to

the existence of similar conditions, such as de-

efferentated state, locked-in syndrome (also

coined by Plum and Posner), and especially the

minimally conscious state at one end of the spec-

trum, with brain death at the other. The progno-

sis was best represented in the paper by the Mul-

ti-Society Task Force, which consisted of adult

and paediatric neurologists and neurosurgeons,

representing five major medical societies in the

US (American Academy of Neurology, Child

Neurology Society, American Neurology Associ-

ation, American Association of Neurological

Surgeons and the American Academy of Pedi-

atrics) (4,5). Their tables, especially those on the

probability of one-year outcomes, of adults and

children respectively, are still generally accepted

as a basis for decision-making by both medical

and legal professionals (6). Finally, there is a

huge bulk of literature on ethical issues, especial-

ly on reasons for allowing withdrawal of artifi-

cially provided hydration and nutrition (AHN),

which is still a debated and controversial topic,

with very diverse policies in different European

countries (7,8). Children are in a special position

because at certain ages there should be consider-

ation not only of their severe disability or handi-

cap but also of their potential to become con-

scious, particularly in the case of severely dam-

aged newborn or preterm infants (9). The basic

statements on decision-making in extreme situ-

ations have already been laid down by the Royal


College of Paediatrics (10) and by EAP/the Ethics

Working Group (11) (Table 1), which are also used in

the recommendations.

This paper is an attempt to deal with the termino-

logical, aetiological, prognostic and ethical issues con-

cerning persistent vegetative state and other border-

line conditions of consciousness in children and ado-

lescents.

Terminology and definitions

Consciousness is a spontaneously occurring state

of awareness of oneself and one’s environment and it

has two dimensions, wakefulness and awareness

(4,5,12).

Normal consciousness requires arousals, au-

tonomous brain functions that activate mechanisms

to induce the wakeful state, while awareness requires

wakefulness (but not vice versa) (13). The disorders of

consciousness in children include coma and vegetative

state, while the term minimally conscious state (MCS)

was introduced to better describe those children and

adults who are emerging from a vegetative state, and

thus represents a condition “of severely altered con-

sciousness in which minimal but definite behavioural

evidence of self or environmental awareness is demon-

strated” (12). The diagnostic criteria include simple

command following, gestural responses, intelligible

verbalization and purposeful behaviour (appropriate

smile/cry, vocalization, reaching for objects, touch-

ing/holding objects and pursuit eye movements) (14).

The term vegetative state can be described as a condi-

tion of complete unawareness of the self and the envi-

ronment, accompanied by preserved sleep-wake cycles

with either complete or partial preservation of hypo-

thalamic and brain stem autonomic functions (4,5).

The multi-society task force also expressed the view

that persistent vegetative state (PVS) was a diagnosis,

while permanent vegetative state was a prognosis.

The word persistent usually describes those children

and adults who are vegetative for more than one,

three or 12 months, according to the aetiology, while

permanent describes those who remain vegetative for

more than 12 months after traumatic brain injury or

more than 3 months after non-traumatic (e.g. anoxic-

ischaemic) brain injury. However, it is now generally

agreed that it is preferable to describe the duration and

aetiology of the vegetative state rather than to use the

terms persistent/permanent (12). The definition of

PVS in infants and children includes 10 clinical char-

acteristics that are generally accepted as constituting

an operational definition (Table 3). The term coma

describes a state of deep, unarousable sustained patho-

logic unconsciousness with the eyes closed that results

from dysfunction of the ascending reticular activating

system either in the brainstem or in both cerebral

hemispheres (12). Coma usually requires the period of

unconsciousness to persist for at least one hour - to

distinguish it from other states of transient uncon-

sciousness. Patients in coma lack wakefulness and

awareness (patients in vegetative state lack awareness

but have retained wakefulness) while the depth of co-

ma can be specified by assessment of brainstem reflex-

es, breathing pattern, change of pulse and/or respirato-

ry rate to stimulation and stimulus induced non-spe-

cific movement (12,15). In comparison, brain death is

a permanent absence of all brain functions, including

those of the brain stem, and the guidelines for its diag-

nosis in infants and children are now well established

(15). Finally, there are some conditions which should

be clearly differentiated from those cited above. New-

born infants cannot be regarded as being in PVS. Even

full-term, healthy newborn babies fulfill only five of

nine psychological criteria for being conscious. They

have perception, record sensory stimulation, can be

Table 1. Considerations on the decision to withhold or withdraw life-supporting treatment in extreme situations (11)

1. Circumstances where life and/or life-supporting treatment are judged as unbearable for the child without the prospect ofrecovery.

2. One must honestly try to find out the best interest of children.3. Actual or potential physical or mental disability itself is not a reason to withhold or withdraw life-sustaining treatment.4. All remedial causes for the child’s condition should be excluded.5. Available evidence for diagnosis, prognosis and alternative therapy should have been thoroughly explored and discussed. 6. Serious doubts in regarding what is in the best interest of the child should favour supporting the life of the child.7. Each decision must be made in partnership with the competent child (not relevant in persistent vegetative states), the

parents/guardians, the family and the entire health care team.8. Withholding or withdrawal of life-supporting measures must be coupled with maximal palliative care, including prevention of

suffering from hunger, thirst or pain, considering cultural sensitive social and psychosocial support and reflecting religiousbelief.

9. Paediatricians reject intentional ending of life by administration of a lethal dosage of medication. Treatment to relief sufferingthat may shorten life as a side-effect is acceptable where the intention of medication is not to end the life of the child.

10.During and after the death bereavement and consulting support should be ensured.

258 D. Neubauer et al.



awakened, show emotions and interact socially. How-

ever, they have limited long-term memory and can-

not speak, and they lack symbolic thinking and free

will (9,16).

Aetiological problems and boundaries of

persistent vegetative state in children

Some of the major neurological conditions that

every clinician must be aware of and be able to differ-

entiate from a vegetative state are listed in Table 2. The

majority of members of the American Child Neurolo-

gy Society agreed that the most appropriate statement

on childhood PVS is that it “can be diagnosed based

on the appropriate clinical neurological examination

for age, knowledge of the insult causing brain injury,

and appropriate period of observation depending on

the age of the patient and nature of the insult” (17).

The majority (70%) of child neurologists questioned

believed that a diagnosis of PVS could reliably be made

in children above two years of age, while before this

age, especially below the age of two months, the diag-

nosis was thought by 16% of child neurologists to be

feasible. Some practical and easy approaches can be

used to better present the interconnections of different

conditions and the boundaries of PVS (Table 4) (15).

Diagnosis and prognosis of PVS

New polysomnographic techniques, which allow

long-term monitoring and even ambulatory recordings

in infants and small children, can contribute to the dif-

ferentiation of sleep/wake stages and thus to assessing

some of the higher cortical functions. Regarding the

outcome it seems that somatosensory evoked respons-

es are the most sensitive and reliable (15). Classical

electroencephalography (EEG) may be supportive of

the diagnosis but cannot be diagnostic per se and is still

far from being prognostic (2). New visual functional

techniques and especially some of the techniques for

cognitive functional assessment in infants and new-

borns (e.g. visual evoked potentials and cognitive

evoked potentials) will in the future permit better un-

derstanding and will define the possibility of the infant

for sudden focusing and even tracking of objects when

possible emergence from the vegetative state is under

question. However, the problem remains that there are

no tests that can confirm whether the child has any “in-

ternal awareness” and whether there exist any abilities

to react with others or have any meaningful response to

the spoken word. Serial investigations of brain meta-

bolic activity (e.g. measured by positron emission to-

mography - PET) may potentially be of great value in

providing objective criteria confirming the clinical di-

agnosis of PVS, particularly in small children. Howev-

er, the restricted availability of this technology, recent

statements on the diagnosis of the vegetative state with-

out the need for any radiological or laboratory investi-

gations and the limitations of its interpretation in

young children due to low rates of brain metabolic ac-

tivity and blood flow, all limit its value as a practical di-

agnostic and/or prognostic tool (6,15). A study made

25 years ago showed very poor outcomes for children in

vegetative state following coma as there were only 10

survivors (out of 17 in the series) and only one child be-

came ambulant a year after the initial insult and was

moderately mentally retarded (18). The same study al-

so confirmed the notion that children who develop the

vegetative state following coma have a poor prognosis,

especially when there are early indicators such as decor-

ticate or decerebrate responses, roving eye-movements

and spontaneous blinking. More recent studies have

shown that the survival rate of PVS children appears

to be directly related to age, as the younger children,

Table 2. Definitions of persistent vegetative state in infants and children*

Apply (%) Supportive (%) Necessary (%)

1. Wakefulness without awareness 95 16 842. Eyes-open unconsciousness 94 33 673. No “voluntary” action/behaviour 91 23 774. No “cognitive” response 90 22 785. No “voluntary” language 84 29 716. Inability to follow commands 83 22 787. Spontaneous eye movements but no sustained tracking 83 47 538. Intact brainstem reflexes and sleep/wake cycles 75 53 479. Spontaneous breathing, chewing and swallowing impaired 75 65 3510. Bowel and bladder incontinence 53 53 47

*Opinion of 250 Child Neurologists (members of American Child Neurology Society) in a study by Ashwal et al (ref. 17) as towhich of the listed criteria would apply, be supportive or be necessary as a clinical characteristic for the constitution of theoperational guideline of persistent vegetative state (PVS). The data reflect the general opinion that PVS in infants and children isdefined as a loss of higher cortical functions rather than the existence of vegetative functions.

259Persistent vegetative state in children

¶·È‰È·ÙÚÈÎ‹ 2007;70:257-265


especially those below two months of age, tended tohave much shorter survival than children above sevenyears (mean duration of survival 4.1 vs. 7.4 years re-spectively) (17). Regarding the aetiology, the longerduration of survival was found in the non-traumaticgroup of PVS children compared to the traumaticgroup (8.6 vs. 3.0 years respectively) and perinatal in-juries are associated with much shorter survival thanthose due to developmental/chromosomal abnormal-ities (4.1 vs. 8.2 years respectively) (19). These find-ings suggest the possibility that relative sparing ofbrainstem and hypothalamic functions in the lattergroup in contrast to the perinatal-insult group (wherethese structures may be seriously injured) is essentialfor survival. More recent data suggest that the one-year outcome is much better after a one month fol-low-up, compared with a follow-up of three and sixmonths respectively (Table 5) (4-6). Some authoritiesbelieve that the estimates of long-term survival by theTask Force Report are too low and that many report-ed deaths could be the result of decisions to limit life-sustaining measures. There might be a difference be-tween how long these patients could live and howlong they do live, as the practice of limiting life-sus-taining medical treatment once the vegetative state isdeclared permanent becomes more widely accepted

(6,7). Finally, a recent paper by Ashwal (15) reports

the following probabilities for recovery:

1. After 3 months, children in post-traumatic VS

have a 56% chance of regaining consciousness, in

contrast to only 3% of children with non-traumatic

VS. Good or moderate recovery is expected in 32% of

children.

2. After 6 months, children in post-traumatic VS

have a 31% chance of recovering consciousness, in

contrast to only 3% of children with non-traumatic

VS. Good or moderate recovery can be expected in

only 11%.

3. VS can thus be considered permanent 12

months after brain trauma or 3 months after non-

traumatic brain injury in children. The chance of re-

covery after this period seems to be exceedingly rare

(however, cases of good recovery are well document-

ed even after 12 months of PVS) and is almost always

associated with severe disability.

Ethical issues and decisions on withdrawal of

artificially provided hydration and nutrition

(AHN)

When Chalmers wrote on the phenomenology of

the conscious mind, he noted: “…when I close my



Table 3. Severe disturbances of consciousness and related conditions (adapted from 3,4,5)

Condition Self aware- Pain & Sleep/wake Motor Respiratory EEG Outcome/ness suffering cycling function function recovery

Brain death Absent No Absent None; Absent No cerebral No recoverySpinal reflexes electrical possible activity/silence

Coma Absent No Absent No purposeful Variably Polymorphic Evolves to recovery, movements depressed delat/theta PVS or death in

2-4 weeksPVS Absent No Intact No purposeful Normal/mildy Polymorphic Depends on

movements depressed theta/delta aetiology(acute traumatic/non-traumatic; degenerative/metabolic; developmental/chromosomal)

Minimally Present but Yes Intact Some Normal/mildy Polymorphic Recovery unkown, conscious very limited purposeful depressed theta/delta probably depends on state movements aetiology (see above)Akinetic Limited Yes Intact Moderate Normal/mildly Slow Recovery unlikely mutism limitation of depressed or limited

movementsLocked-in- Present Yes Intact Tetraplegia; Normal to Normal Recovery unlikely; syndrome pseudobulbar variably remain tetraplegic

palsy;eye depressedmovements preserved

EEG=electroencephalogram, PVS=persistent vegetative state


eyes, the whole world disappears and when I open

them again, the world appears again” and this is a

simplified description of the assessment of conscious-

ness (see Table 3). As Searle stated: “consciousness

consists of inner, qualitative, subjective states and

processes of sentience or awareness. Consciousness

begins when we wake in the morning and continues

until we fall asleep again, die, go into coma, or other-

wise become ‘unconscious’” (16). However, things

become further complicated when other philosophi-

cal aspects of consciousness are taken into account,

and perhaps its most frequently discussed role in-

volves awareness of the sensory world as well as the

awareness of self (including feelings and thoughts)

and voluntary control involved in self-regulation

(20,21). When the medical professionals and the par-

ents have finally become convinced that the child has

reached a (permanent) vegetative state condition, the

question of final outcome becomes important, while

the ethical decisions should depend on the most reli-

able prognosis. It is rather impractical to separate dis-

cussion of the ethical and legal issues raised by deci-

sions to limit life-prolonging measures for vegetative

patients, as the law is largely concerned with ethical

principles in particular situations, and doctors and

ethicists seek the formal approval of the public or so-

ciety (represented by the judiciary) for their decisions

to limit or stop artificially provided hydration and nu-

trition (AHN) (22).

The appendix presents the variations regarding at-

titudes about PVS in children in different EU coun-

tries according to the results of a short survey on these

issues among CESP/EAP members.

Despite the fact that there are guidelines to help

physicians decide whether certain actions would be

ethical or not, they must also confront the obstacles of

personal values, as well as professional, religious and

cultural factors. The decision about withdrawing

Table 5. The Multi-Society Task Force data (4,5) - conclusionsabout long-term prognosis are based on review of 754 casespublished in the English language literature who were vegetativeat one month after an acute insult and from whom one-yearoutcome was available. The present table includes only childrenwith PVS ( Total: 151, with traumatic injury: 106). The age limitwas not defined but most were probably under the age of 16 years

One-year outcome of those in vegetative state at 1, 3 and 6months respectively

a) Vegetative state - children after head trauma (n = 106).All figures in %.Outcome At 1 month At 3 months At 6 monthsdied 9 14 14vegetative 29 30 54conscious 62 56 32(independent) (27) (32) (11)

b) Vegetative state - children with non-traumatic causes (n = 45). All figures in %.Outcome At 1 month At 3 months At 6 monthsdied 22 3 0vegetative 65 94 97conscious 13 3 3(independent) (6) (0) (0)

Children did much better than adults (one-year outcome ofthose adults in vegetative state at one month: died aftertrauma 33% and dead due to non-traumatic causes 53%).Also one-year outcome of children in vegetative state at onemonth revealed that 62%/13% regained consciousness incomparison to adults where these percentages were 52%/15%respectively. The highest independence rate was achieved inhead injured children (27%), the lowest in nontraumaticadults (4%) (6).


¶·È‰È·ÙÚÈÎ‹ 2007;70:257-265

Table 4. Stepwise approach in evaluation of the unconscious child as proposed by S. Ashwal (adapted from 11, 14)

Is the patient conscious?Evidence of sustained or reproducible purposeful response or external stimuli

NO YESabsent brainstem function and apnoea preserved functional interactive communication and/or

functional use of one or more obejctsYES NO NO* YES

BRAIN DEATH preserved sleep/wake cycle MINIMALLY vertical eye movements presentand eye opening to stimulus CONSCIOUS and/or eye blinking

or spontaneously STATENO YES YES NO

COMA VEGETATIVE STATE LOCKED-IN EMERGENCE SYNDROME FROM

MCS†

* usually preserved: following simple commands and/or gestural or yes/no responses and/or intelligible verbalization and/orpurposeful behaviours in response to environmental stimuli (not reflex activity) BUT not able to express preferences† patient has emerged from minimally conscious state (MCS) and may have: mild to severe disability or may become normal


AHN and other life-sustaining medical treatment is

still associated with a great deal of controversy, espe-

cially in paediatric practice. Even when the team in

the intensive care unit and the members of the family

all agree that it is the right thing to do, there is still suf-

ficient negative professional and public sentiment to

make it worth pursuing a judicial order to support

such an act (7). Finally, a list is provided of some of

the recent examples of practical decision-making and

conclusions about treatment regimes in severely ill

patients, and especially of the decisions when to with-

hold or withdraw life-sustaining treatment in chil-

dren. Recently the Ethics Task Force argued that the

word “passive euthanasia” should not be used for

withdrawing or withholding life-prolonging treat-

ment that is not providing a benefit to the patient (23)

(see also the arguments in the RCPCH document

quoted above). However, there are also some rebut-

tals to this argument, as some believe that profession-

als should be allowed to employ this term in their dis-

cussions of policy and clinical practice (24). Regard-

ing the challenges in end-of-life care in the intensive

care units, the recommendation is that the patient

must be assured a pain-free death. The patient must

be given sufficient analgesia to alleviate pain and dis-

tress; if such analgesia hastens death, this “double-ef-

fect” should not detract from the primary aim of en-

suring comfort (25). Some practical instructions on

decision-making about withdrawal of life-sustaining

treatment in children are given by Alderson and Ni-

cholson (26). They suggest that the decisions should

not be rushed, and should be based on all the evidence

available. There should be frequent sharing of infor-

mation and discussions between all the members of

the team, and regular informing and listening to the

family, taking into account the child’s interests. Treat-

ment should be withdrawn in a certain sequence (for

example, first withdrawal of experimental interven-

tions, then withdrawal of mechanical ventilation,

withdrawal of inotropic pressor agents, forgoing an-

tibiotics, forgoing artificial nutrition, including naso-

gastric tube feeding and decrease of intravenous flu-

ids. Apart from these actions, the physician has a duty

to comfort and cherish the child, to prevent and re-

lieve suffering (pain) and to inform and support the

family. Once an end-of-life decision has been made,

the primary aim is to relieve suffering; pain relief is es-

sential even if it hastens death (allowing the principle

of the double effect - that is, associated repression of

respiration, if it relieves suffering, is acceptable). If a

ventilator is to be switched off, the time should be de-

cided in agreement with the parents and with careful

preparation and support. The use of paralyzing agents

should be carefully reconsidered. The care should also

continue after the child’s death (10,26). Finally, some

advice has been addressed to the family physicians,

who are frequently in a position to integrate medical

knowledge, individual values and cultural influences

into end-of-life care, especially after the Patient Self-

Determination Act was written in response to the

Cruzan case (27). This implementation is particularly

useful in those cases where a self-decision to end one’s

life has been expressed.

Conclusions

Thirty years after the term “persistent vegetative

state” was first coined by Jennett and Plum it remains

the most commonly used term, despite many argu-

ments (more or less substantial) that it should be

changed. In addition to the term vegetative state,

many authors would like to include aetiological cause

and duration. The majority of child neurologists be-

lieve that wakefulness without awareness, uncon-

sciousness with the eyes wide open, and absence of

voluntary behaviour and language along with lack of

cognitive response, are the landmarks of the defini-

tion of PVS in children (17). However, such a defini-

tion is difficult to be applied in those children who

(due to immaturity or disease condition) already

demonstrated some of these characteristics before ap-

pearance of PVS (9,16).

Concerning the aetiological borders, there are not

too many problems regarding the distinction of PVS

from other similar conditions (refer to Tables 2 and

3), although again in the young age-group they may

be questionable and difficult to determine.

The Multi-Society Task Force on PVS presented

data which gave approximate figures of the long-term

(6 and 12 months respectively) outcome of those chil-

dren who had been at least one month in PVS, due to

either traumatic or non-traumatic causes (4,5). The

common notion is that children in VS with traumatic

brain injury have the best prognosis, as more than half

will recover and another half of these will have at least

a fair or even a good recovery (4,5,16).

Finally but definitely, the most important are the

ethical issues related to PVS. The ethics of PVS man-

agement rests on some (un)resolved court cases in the

recent past. Good clinical practice (28,30) requires a

multidisciplinary team (consisting of at least a paedi-

atric intensive care specialist, a child neurologist, a se-

nior registered nurse working in paediatric intensive

care unit and a child psychologist) who should first

reach an absolute consensus between the members of

the team. Thereafter, the team is allowed to sit down

with the parents and other relatives to discuss with




them the possibility of withdrawal of AHN in a childwho is in PVS. However, there is still an ongoing de-bate with pro-life representatives about whether suchan act is ever justified (“killing or letting die” (6)), re-gardless of the wishes of the parents. However, someauthorities (see an excellent paper on a personal expe-rience by Dr. Richard J. Lin (7)) recommend that:“even if the health-care team and the family of the pa-tient feel it is the ‘right’ thing to do, there is stillenough negative professional and public sentimentthat it may be worthwhile for a family wishing towithdraw AHN for a loved one to pursue a judicial or-der supporting their wishes” (7).

Acknowledgements

The Working Group acknowledges the particular inputand support of Ronald Kurz and Francis Crawley in preparingthe present publication, as well as the valuable comments ofJanez Primozvicv.

References

1. Jennett B, Plum F. Persistent vegetative state after braindamage. A syndrome in search of a name. Lancet 1972;1:734-737.

2. Andrews K. The vegetative state-clinical diagnosis.Postgrad Med J 1999;75:321-324.

3. Giacino JT, Zasler ND. Outcome after severe traumaticbrain injury: coma, the vegetative state, and the minimallyresponsive state. J Head Trauma Rehabil 1995;10:40-56.

4. The Multi-Society Task Force on PVS. Medical aspects ofthe persistent vegetative state (first of two parts). N Engl JMed 1994;330:1499-1508.

5. The Multi-Society Task Force on PVS. Medical aspects ofthe persistent vegetative state (second of two parts). NEngl J Med 1994;330:1572-1579.

6. Jennett B. The vegetative state. Medical facts, ethical andlegal dilemmas. Cambridge: Cambridge University Press;2002.

7. Lin RJ. Withdrawing life-sustaining medical treatment - aphysician's personal reflection. Ment Retard Dev DisabilRes Rev 2003;9:10-15.

8. Harris J. Consent and end of life decisions. J Med Ethics2003;29:10-15.

9. Lagercrantz H. Should euthanasia be legal? Aninternational survey of neonatal intensive care units staff.Arch Dis Child Fetal Neonatal Ed 2004;89:F2.

10. Royal College of Paediatrics. Withholding or WithdrawingLife-Sustaining Treatment in Children: A Framework forPractice - 2nd edition, 2004: www.rcpch.ac.uk/publications/recentpublications/witholding.pdf

11. Kurz R, Ethics Working Group of Confederation of theEuropean Specialists of Paediatrics. Decision making inextreme situations involving children: withholding orwithdrawal of life supporting treatment in paediatric care.Statement of the ethics working group of the Confederationof the European Specialists of Paediatrics (CESP). Eur JPediatr 2001;160:214-216.

12. Ashwal S. Medical aspects of the minimally conscious statein children. Brain Dev 2003;25:535-545.

13. Zeman A. Consciousness. Brain 2001;124:1263-1289.14. Giacino JT, Ashwal S, Childs N, Cranford R, Jennett B,

Katz DI, et al. The minimally conscious state: definitionand diagnostic criteria. Neurology 2002;58:349-353.

15. Ashwal S. Pediatric vegetative state: epidemiological andclinical issues. NeuroRehabilitation 2004;19:349-360.

16. Searle JR. Consciousness. Annu Rev Neurosci 2000;23:557-578.

17. Ashwal S, Bale JF, Coulter DL, Eiben R, Garg BP, Hill A, etal. The persistent vegetative state in children: Report of theChild Neurology Society Ethics Committee. Ann Neurol1992;32:570-576.

18. Gillies JD, Seshia SS. Vegetative state following coma inchildhood: evolution and outcome. Dev Med ChildNeurol 1980;22:642-648.

19. Ashwal S, Eyman RK, Call TL. Life expectancy of children ina persistent vegetative state. Pediatr Neurol 1994;10:27-33.

20. Posner MI, Rothbart MK. Attention, self-regulation andconsciousness. Philos Trans R Soc Lond B Biol Sci1998;353:1915-1927.

21. Bownds MD. The biology of mind: origins and structuresof mind, brain, and consciousness. Maryland: FitzgeraldScience Press, Bethesda;1999.

22. Orentlicher D. From the Office of the General Counsel.The right to die after Cruzan. JAMA 1990;264:2444-2446.

23. Materstvedt LJ, Clark D, Ellershaw J, Forde R, GravgaardAM, Muller-Busch HC, et al. Euthanasia and physician-assisted suicide: a view from an EACP Ethics Task Force.Palliat Med 2003;17:97-101.

24. Garrard E, Wilkinson S. Passive euthanasia. J Med Ethics2005;31:64-68.

25. Thompson BT, Cox PN, Antonelli M, Carlet JM, Cassell J,Hill NS, et al. Challenges in end-of-life care in the ICU:statement of the 5th International Consensus Conferencein Critical Care: Brussels, Belgium, April 2003: executivesummary. Crit Care Med 2004;32:1781-1784.

26. Alderson P, Nicholson R. Deciding when to withhold orwithdraw life-sustaining treatment for children. Bull MedEthics 1997;127:13-20.

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¶·È‰È·ÙÚÈÎ‹ 2007;70:257-265


Appendix

A questionnaire (A) was sent to each of the 35 members and to the observer national delegates to thePaediatric Section of UEMS/European Academy of Paediatrics (formerly CESP). Replies were received from 22countries and the results are tabulated (B).

A. Questionnaire: Bioethics Committees in Europe and dealing with persistent vegetative state

(PVS) in children.

1. Is there a National Bioethics Comittee in your country? yes no

2. Are the interests of children always represented? yes no

3. Does your National Paediatric Society have an Ethics Committee ? yes no

4. Are there special guidelines on ethics in paediatric practice ? yes no

5. Do local hospitals and universities have ethics committees? yes no

6. Do you have a strict definition of PVS? yes noIf yes, please answer the following:

6a. Do you use the definition below? yes no

7. Do you encounter the cases of PVS? yes no

8. Would you ever consider withdrawal of artificially provided hydration and nutrition (AHN) in PVS children? yes noIf yes, please answer the following:

8a. Would you still consider that it may be worthwhile to pursue a judicial order to support such an act? yes no

9. PVS patients do not require any technological support in order to maintain their vital functions and such patients cannot in any way be considered terminal patients, since their condition can be stable and enduring. yes no

10. Do you think that the word “passive euthanasia” should not be used for the withdrawing or withholding of life-prolonging treatment which is not providing a benefit to the patient ? yes no




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∂ÈÛ·ÁˆÁ‹: √È ÂÓ‰Â›ÍÂÈ˜ Û¯ÂÙÈÎ¿ ÌÂ ÙËÓ ·‡ÍËÛË ÙË˜ Â›ÙˆÛË˜ ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ ·ı‹ÛÂˆÓ Â›Ó·È ÔÏ‡ÈÛ¯˘Ú¤˜. ¶¤Ú· ·fi Ù· “ÎÏ·ÛÈÎ¿” ·ÙÔÈÎ¿ ÓÔÛ‹Ì·Ù·, ˘¿Ú¯ÂÈ Î·È ¤Ó·˜ ÈÎ·Ófi˜ ·ÚÈıÌfi˜ ·ÏÏÂÚÁÈÎÒÓ ÓÔ-ÛËÌ¿ÙˆÓ, ÂÓ‰Â¯ÔÌ¤Óˆ˜ ÂÈÎ›Ó‰˘ÓˆÓ ÁÈ· ÙË ̇ ˆ‹, fiˆ˜ ÔÈ ÙÚÔÊÈÎ¤˜ ·ÏÏÂÚÁ›Â˜, Ô˘ Ï¤ÔÓ ‰È·ÁÈÁÓÒÛÎÔÓÙ·ÈÔÏ‡ Û˘¯Ó¿.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ∏ ·Ó·˙‹ÙËÛË ‚È‚ÏÈÔÁÚ·Ê›·˜ ÁÈ· ÙËÓ ·Ó·ÛÎfiËÛË ¤ÁÈÓÂ Ì¤Ûˆ ÙÔ˘ Medline Î·ıÒ˜ Î·ÈÌÂ ÂÍ¤Ù·ÛË Î·ıÂÌ›·˜ ÂÎ ÙˆÓ ·Ó·ÊÔÚÒÓ ÙˆÓ Û¯ÂÙÈÎÒÓ ¿ÚıÚˆÓ.

∞ÔÙÂÏ¤ÛÌ·Ù·: ∏ ·‡ÍËÛË ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ ·ı‹ÛÂˆÓ ‰È·ÈÛÙÒÓÂÙ·È ·fi ¤Ó·Ó ·ÚÈıÌfi ÌÂÏÂÙÒÓ Ô˘ ·ÂÈ-ÎÔÓ›˙Ô˘Ó ÙËÓ ·˘Í·ÓfiÌÂÓË Â˘·ÈÛıËÙÔÔ›ËÛË ÙˆÓ ‰È·‰Ô¯ÈÎÒÓ ÁÂÓÂÒÓ ¤Ó·ÓÙÈ Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ·ÏÏÂÚÁÈÔÁfi-ÓˆÓ. π‰È·›ÙÂÚ· ÛÙ· ·È‰È¿ Î·Ù·ÁÚ¿ÊÔÓÙ·È ˘„ËÏ¿ Â›Â‰· ÂÈ‰ÈÎÒÓ ·ÓÔÛÔÛÊ·ÈÚÈÓÒÓ ∂ (πgE), ¤Ó·ÓÙÈ ‰È·-ÊfiÚˆÓ ·ÏÏÂÚÁÈÔÁfiÓˆÓ. ∏ ·ÏÏ·Á‹ ·˘Ù‹ Û˘Ó‰¤ÂÙ·È ÛÂ ÔÏÏ¤˜ ÌÂÏ¤ÙÂ˜ ÌÂ ÙËÓ “˘fiıÂÛË ÙË˜ ˘ÁÈÂÈÓ‹˜” Î·ÈÙË ÛÙÚÔÊ‹ ·fi ÙÔÓ ·Ú·‰ÔÛÈ·Îfi ·ÁÚÔÙÈÎfi ÙÚfiÔ ˙ˆ‹˜ ÛÂ ¤Ó· “‰˘ÙÈÎÔ‡ Ù‡Ô˘” ÌÔÓÙ¤ÏÔ ˙ˆ‹˜, Ô˘ Â›¯Âˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÂÏ¿ÙÙˆÛË ÙË˜ ¤ÎıÂÛË˜ ÛÂ ÌÈÎÚfi‚È· Î·È ÙÈ˜ ·Ú·ÁfiÌÂÓÂ˜ ÂÓ‰ÔÙÔÍ›ÓÂ˜. ™Â ·ÓÔÛÈ·ÎfiÂ›Â‰Ô, ÛÙ· ·ÙÔÈÎ¿ ¿ÙÔÌ· ÂÈÎÚ·ÙÂ› Ë Ù‡Ô˘ 2 ·ÓÔÛÔÏÔÁÈÎ‹ ·ÓÙ›‰Ú·ÛË ÙˆÓ ‚ÔËıËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ ∆.

™˘ÌÂÚ¿ÛÌ·Ù·: H ·‡ÍËÛË ÙË˜ Û˘¯ÓfiÙËÙ·˜ ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ ·ı‹ÛÂˆÓ Ê·›ÓÂÙ·È fiÙÈ ¿Ú¯ÈÛÂ ÙË ‰ÂÎ·ÂÙ›·ÙÔ˘ 1960 Î·È Û˘ÓÂ¯›ÛÙËÎÂ ÛÙÈ˜ ÂfiÌÂÓÂ˜ ÁÂÓÈ¤˜. √ ÂÈÔÏ·ÛÌfi˜ ÙÔ˘˜ Ê·›ÓÂÙ·È Ó· Â›Ó·È ˘„ËÏfiÙÂÚÔ˜ ÛÙÈ˜·Ó·Ù˘ÁÌ¤ÓÂ˜ ¯ÒÚÂ˜, ÂÓÒ Î·È ÔÈ ·Ó·Ù˘ÛÛfiÌÂÓÂ˜ ¯ÒÚÂ˜ Ô˘ ˘ÈÔıÂÙÔ‡Ó ÙÔÓ ‰˘ÙÈÎfi ÙÚfiÔ ˙ˆ‹˜ ·ÎÔÏÔ˘-ıÔ‡Ó ·˘Ù‹ ÙËÓ Ù¿ÛË. √ ·ÓÔÛÔÏÔÁÈÎfi˜ ÌË¯·ÓÈÛÌfi˜ Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È ÛÙËÓ “˘fiıÂÛË ˘ÁÈÂÈÓ‹˜” ¤¯ÂÈ Á›ÓÂÈ·ÓÙÈÎÂ›ÌÂÓÔ ÂÎÙÂÙ·Ì¤ÓË˜ ¤ÚÂ˘Ó·˜ Î·Ù¿ ÙËÓ ÙÂÏÂ˘Ù·›· 15ÂÙ›·. ∏ ÂÈ‰ËÌÈÔÏÔÁÈÎ‹ ‚¿ÛË ÙÔ˘ Ê·ÈÓÔÌ¤ÓÔ˘,ˆÛÙfiÛÔ, ·ÏÏ¿ Î·È ÔÈ Èı·ÓÔ› ÙÚfiÔÈ ÚfiÏË„Ë˜ ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ ÓÔÛËÌ¿ÙˆÓ Â›Ó·È ÌÂÚÈÎ¿ ·fi Ù· ·ÓÙÈÎÂ›-ÌÂÓ· ÙË˜ Û‡Á¯ÚÔÓË˜ ¤ÚÂ˘Ó·˜.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ∂È‰ËÌÈÔÏÔÁ›·, ·ÏÏÂÚÁ›·, ˘ÁÈÂÈÓ‹, Â˘·ÈÛıËÙÔÔ›ËÛË.

The increase of allergic conditions in recent years: epidemiology and

causes

A. Sofianou-Katsoulis

Abstract

Background: There is robust evidence of a rising prevalence of allergic conditions. In many countries thepercentages of atopic manifestations have even doubled over a period of fifteen years. Apart from the“classical” atopic conditions, a number of potentially life threatening allergies are very commonly diag-nosed, especially food allergies. This is a review of the relevant literature.

Methods: The literature search for this review was performed mainly on Medline. Following selection ofthe relevant papers, a manual search of their references was made.

Results: The rise in frequency of allergic conditions has not only been reported by patients and clinicians,but also documented by a number of studies that illustrate the increase in sensitivity to specific allergensbetween birth cohorts, and the presence of high levels of specific IgEs, particularly in younger populations.This change in population sensitivities has been linked by many studies to the “hygiene hypothesis”, butalso to the shift of many traditionally rural societies to a “westernized” life model, resulting in reduced mi-crobial exposure. At the immunological level, atopic individuals exhibit the type 2 response of the helperT cells.

Conclusions: The increase in allergic conditions started probably after the 1960s, and seems to be main-tained in subsequent birth cohorts. Their prevalence is higher in the developed countries, but developingcountries adopting a “westernized” lifestyle follow this trend. The immunological mechanism described inthe “hygiene hypothesis” has been investigated extensively in the past 15 years. The epidemiological ba-sis of the increase in allergic conditions and prevention strategies are some of the current research topics.

Key words: Allergy, epidemiology, sensitization, hygiene.

Barnet and Chase FarmHospitals NHS Trust, London Southampton University,Medical School, UnitedKingdom


∞. ™ÔÊÈ·ÓÔ‡-∫·ÙÛÔ‡ÏË[email protected]¡ÂfiÊÚÔÓÔ˜ 6, ∆.∫. 161 21, ∞ı‹Ó·

Barnet and Chase FarmHospitals NHS Trust,London Southampton UniversityMedical School, UnitedKingdom

Correspondence:

A. [email protected], Neofronos St.161 21, Athens, Greece


∂ÈÛ·ÁˆÁ‹

∏ ÚfiÛÊ·ÙË ‚È‚ÏÈÔÁÚ·Ê›· ·Ú¤¯ÂÈ ÈÛ¯˘Ú¤˜ ÂÓ-‰Â›ÍÂÈ˜ ˆ˜ ÚÔ˜ ÙËÓ ·˘Í·ÓfiÌÂÓË Â›ÙˆÛË ÙˆÓ ·Ï-ÏÂÚÁÈÎÒÓ ·ı‹ÛÂˆÓ. √È ÎÏ·ÛÈÎ¤˜ ·ÙÔÈÎ¤˜ ·ı‹-ÛÂÈ˜, fiˆ˜ ÙÔ ¿ÛıÌ·, ÙÔ ¤Î˙ÂÌ·, Ë ·ÏÏÂÚÁÈÎ‹ ÚÈÓ›ÙÈ-‰·, ·ÏÏ¿ Î·È ÔÈ ÙÚÔÊÈÎ¤˜ ·ÏÏÂÚÁ›Â˜ Â›Ó·È ÔÏ‡ Û˘-¯ÓfiÙÂÚÂ˜ ÛÂ Û¯¤ÛË ÌÂ ÙÔ ·ÚÂÏıfiÓ, ÁÈ· ·Ú¿‰ÂÈÁÌ·Û·Ú¿ÓÙ· ¯ÚfiÓÈ· ÚÈÓ. ∏ ÁÂˆÁÚ·ÊÈÎ‹ Â›ÛË˜ Î·Ù·ÓÔ-Ì‹ ÙË˜ Â›ÙˆÛË˜ ‰È·Ê¤ÚÂÈ ÛËÌ·ÓÙÈÎ¿ Î·È ¤¯ÂÈ È‰È·›-ÙÂÚÔ ÂÓ‰È·Ê¤ÚÔÓ Ë ·ÔÙ‡ˆÛ‹ ÙË˜ ÛÙÔÓ ·ÁÎfiÛÌÈÔ¯¿ÚÙË, ·fi ÙËÓ ÔÔ›· ÌÔÚÔ‡Ó Ó· ÚÔÎ‡„Ô˘Ó ÛËÌ·-ÓÙÈÎ¿ Û˘ÌÂÚ¿ÛÌ·Ù·, ̂ ˜ ÚÔ˜ ÙÈ˜ ·ÈÙ›Â˜ ÙË˜ ·Ú·ÙË-ÚÔ‡ÌÂÓË˜ ·‡ÍËÛË˜. √ ÛÎÔfi˜ ÙË˜ ·ÚÔ‡Û·˜ ·Ó·-ÛÎfiËÛË˜ Â›Ó·È Ó· ·ÚÔ˘ÛÈ·ÛÙÂ› Ë Ï¤ÔÓ ÚfiÛÊ·ÙË‚È‚ÏÈÔÁÚ·Ê›· Ô˘ ·ÊÔÚ¿ ÙËÓ ÂÈ‰ËÌÈÔÏÔÁ›· ÙˆÓ ·Ï-ÏÂÚÁÈÎÒÓ ·ı‹ÛÂˆÓ Î·È ÙÈ˜ ·ÈÙ›Â˜ ¤Í·ÚÛË˜ ·˘ÙÒÓ.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ

∏ ·Ó·˙‹ÙËÛË ‚È‚ÏÈÔÁÚ·Ê›·˜ ÁÈ· ÙË Û˘ÁÁÚ·Ê‹ ÙË˜ ·ÚÔ‡-Û·˜ ·Ó·ÛÎfiËÛË˜ ¤ÁÈÓÂ ÌÂ ¤ÚÂ˘Ó· ÛÙË Medline ̄ ÚËÛÈÌÔÔÈÒ-ÓÙ·˜ ÙÈ˜ Ï¤ÍÂÈ˜ ÎÏÂÈ‰È¿ “immediate hypersensitivity” OR“hypersensitivity, immediate” OR (“hypersensitivity”) OR“hypersensitivity” OR (“allergy and immunology”) OR(“allergy and immunology” OR Allergy) AND ((“diseaseoutbreaks” [TIAB] NOT Medline[SB]) OR “disease outbreaks”[MeSH Terms] OR Epidemic[Text Word]) AND “humans”[MeSH Terms], ÌÂ ·Ó·˙‹ÙËÛË Û¯ÂÙÈÎÒÓ ·Ó·ÛÎÔ‹ÛÂˆÓ ÙË˜ÙÂÏÂ˘Ù·›·˜ ‰ÂÎ·ÂÙ›·˜. √È ·Ó·ÊÔÚ¤˜ ÙˆÓ ¿ÚıÚˆÓ Ô˘ ÎÚ›ıË-Î·Ó Î·Ù¿ÏÏËÏ· ÂÍÂÙ¿ÛıËÎ·Ó Ì›· ÚÔ˜ Ì›· ÌÂ ÛÎÔfi Ó· ‚ÚÂ-ıÔ‡Ó ËÁ¤˜ Ô˘ ‰ÂÓ ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÈ˜ ËÏÂÎÙÚÔÓÈÎ¤˜ ‚¿ÛÂÈ˜‰Â‰ÔÌ¤ÓˆÓ ‹ Ô˘ Â›¯·Ó ‰ËÌÔÛÈÂ˘ıÂ› ·ÚÎÂÙ¿ ·ÏÈ¿.

∂È‰ËÌÈÔÏÔÁ›· ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ ·ı‹ÛÂˆÓ

∆· ÂÈ‰ËÌÈÔÏÔÁÈÎ¿ ‰Â‰ÔÌ¤Ó· Ô˘ ˘ÔÛÙËÚ›˙Ô˘Ó ·˘ÙfiÔ˘ Û‹ÌÂÚ· ·ÔÎ·ÏÂ›Ù·È “ÂÈ‰ËÌ›·” ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ ·ı‹-ÛÂˆÓ Â›Ó·È Ô˘ÛÈ·ÛÙÈÎ¿. ¢ËÌÔÛÈÂ‡ÛÂÈ˜ Ô˘ ÚˆÙÔ¤ÁÈÓ·Ó ÛÙ·Ì¤Û· ÙË˜ ‰ÂÎ·ÂÙ›·˜ ÙÔ˘ 1980 ·ÔÂÈÚ¿ıËÎ·Ó Ó· Û˘ÁÎÚ›ÓÔ˘ÓÙËÓ ÙfiÙÂ Â›ÙˆÛË ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ ·ı‹ÛÂˆÓ ÌÂ ·ÚfiÌÔÈ·ÛÙÔÈ¯Â›· ·fi ÚÔËÁÔ‡ÌÂÓÂ˜ ‰ÂÎ·ÂÙ›Â˜. ¶ÔÏÏ¤˜ ÌÂÏ¤ÙÂ˜ ÙË˜ÂÔ¯‹˜ Î·Ù¤‰ÂÈÍ·Ó ÛËÌ·ÓÙÈÎ‹ ·‡ÍËÛË ÛÙÈ˜ ·ÙÔÈÎ¤˜ ·ı‹-ÛÂÈ˜, È‰È·›ÙÂÚ· ÛÂ ¯ÒÚÂ˜ fiˆ˜ Ë ¢·Ó›· Î·È ÙÔ ∏ÓˆÌ¤ÓÔ µ·Û›-ÏÂÈÔ. √È Û˘ÁÁÚ·ÊÂ›˜ ·¤‰ˆÛ·Ó ÙËÓ ·‡ÍËÛË ·˘Ù‹ ÛÙËÓ ÂÚÈ-‚·ÏÏÔÓÙÈÎ‹ ÌfiÏ˘ÓÛË, Î·ıÒ˜ Î·È ÛÙËÓ ¤ÎıÂÛË ÛÙ· “ÔÈÎÈ·Î¿”·ÏÏÂÚÁÈÔÁfiÓ· (2).

∞Ó¿ÌÂÛ· ÛÙÈ˜ ÌÂÏ¤ÙÂ˜ Ô˘ Î·Ù·‰ÂÈÎÓ‡Ô˘Ó ÙËÓ ·‡ÍËÛËÙˆÓ ·ÏÏÂÚÁÈÎÒÓ ·ı‹ÛÂˆÓ, È‰È·›ÙÂÚË ·Í›· ¤¯Ô˘Ó ·˘Ù¤˜ Ô˘Û˘ÁÎÚ›ÓÔ˘Ó ÙËÓ Â›ÙˆÛ‹ ÙÔ˘˜ ·Ó¿ÌÂÛ· ÛÂ ‰˘Ô ¯ÚÔÓÈÎ¤˜ÛÙÈÁÌ¤˜ ÛÙÔ ·ÚÂÏıfiÓ. ™Â Ì›· ·fi ·˘Ù¤˜, Ë ‰È¿ÁÓˆÛË ÙÔ˘

¿ÛıÌ·ÙÔ˜ ¤ÁÈÓÂ ‚¿ÛÂÈ ÙˆÓ ·Ó·ÊÂÚfiÌÂÓˆÓ Û˘ÌÙˆÌ¿ÙˆÓ, ·Ï-Ï¿ Î·È ‚¿ÛÂÈ ‰ÔÎÈÌ·ÛÈÒÓ ÚfiÎÏËÛË˜. ∏ ÌÂÏ¤ÙË ·Ó·Ê¤ÚÂÈ ·‡-ÍËÛË ÛÙË Û˘¯ÓfiÙËÙ· ÙÔ˘ ¿ÛıÌ·ÙÔ˜ ÛÙË µÚÂÙ·Ó›· ·fi 6 ÛÂ12% Ì¤Û· ÛÂ 15 ¯ÚfiÓÈ·. ∆· ÔÛÔÛÙ¿ ·‡ÍËÛË˜ ‹Ù·Ó Â›ÛË˜ÂÓÙ˘ˆÛÈ·Î¿ ÁÈ· ÙËÓ ·ÙÔÈÎ‹ ‰ÂÚÌ·Ù›ÙÈ‰· (·fi 5 ÛÂ 16%)Î·È ÙËÓ ·ÏÏÂÚÁÈÎ‹ ÚÈÓ›ÙÈ‰· (·fi 9 ÛÂ 15%)(5).

∏ ¤ÎıÂÛË Û¯ÂÙÈÎ¿ ÌÂ ÙËÓ ·ÚÔ¯‹ ˘ËÚÂÛÈÒÓ ˘ÁÂ›·˜ ÛÂ·ÛıÂÓÂ›˜ ÌÂ ·ÏÏÂÚÁÈÎ¿ ÓÔÛ‹Ì·Ù·, Ë ÔÔ›· ÂÎ‰fiıËÎÂ ·fi ÙÔµ·ÛÈÏÈÎfi ∫ÔÏ¤ÁÈÔ ÙˆÓ ¶·ıÔÏfiÁˆÓ ∞ÁÁÏ›·˜ ÙÔ 2004, ·Ó·Ê¤-ÚÂÈ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ Ù· ÂÍ‹˜: Ù· Û˘¯ÓfiÙÂÚ· ·ÏÏÂÚÁÈÎ¿ ÓÔÛ‹-Ì·Ù· ¤¯Ô˘Ó ·˘ÍËıÂ› ÛÙÔ ÙÚÈÏ¿ÛÈÔ Î·Ù¿ Ù· ÙÂÏÂ˘Ù·›· 20 ̄ Úfi-ÓÈ· ÛÙË µÚÂÙ·Ó›·, ÂÓÒ ÂÚ›Ô˘ ÙÔ ¤Ó· ¤ÌÙÔ ÙÔ˘ ÏËı˘-ÛÌÔ‡ ¤¯ÂÈ ·ÔÙ·ÓıÂ› ÛÂ Î¿ÔÈ· Ê¿ÛË ÙË˜ ˙ˆ‹˜ ÙÔ˘ ÛÂ ÂÈ‰ÈÎfi,ÏfiÁˆ Î¿ÔÈ·˜ ·ÏÏÂÚÁÈÎ‹˜ ¿ıËÛË˜ (1,7,18).

∂›Ó·È ·Ï‹ıÂÈ· fiÙÈ Ë ÏÂÈÔÓfiÙËÙ· ÙˆÓ ÂÚÂ˘ÓÒÓ Ô˘ Î·Ù·-ÁÚ¿ÊÔ˘Ó ·˘Ù‹ ÙËÓ ·‡ÍËÛË ‚·Û›˙ÔÓÙ·È ÛÂ ·ÔÙÂÏ¤ÛÌ·Ù· ÂÚˆ-ÙËÌ·ÙÔÏÔÁ›ˆÓ Î·È ÂÔÌ¤Óˆ˜ ÛÂ ·Ó·ÊÂÚfiÌÂÓ· Û˘ÌÙÒÌ·Ù·,Ô˘ ÔˆÛ‰‹ÔÙÂ ÂÓ¤¯Ô˘Ó ˘ÔÎÂÈÌÂÓÈÎfiÙËÙ·. øÛÙfiÛÔ, ÛÂÌÂÚÈÎ¤˜ ÌÂÏ¤ÙÂ˜ Ù· Û˘ÌÂÚ¿ÛÌ·Ù· ‚·Û›˙ÔÓÙ·È ÛÙË Û‡ÁÎÚÈÛËÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ÂÈ‰ÈÎÒÓ ·ÓÔÛÔÛÊ·ÈÚÈÓÒÓ IgE ÙÔ˘ ÔÚÔ‡ÙˆÓ Û˘ÌÌÂÙÂ¯fiÓÙˆÓ (4). ™Â Ì›· ·fi ·˘Ù¤˜ ÙÈ˜ ÂÚÁ·Û›Â˜ ¤ÁÈÓÂÛ‡ÁÎÚÈÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ÂÈ‰ÈÎÒÓ πgE Ô˘ ÂÍÂÙ¿ÛÙËÎ·Ó ÛÂÙÚÂÈ˜ ¯ÚÔÓÈÎ¤˜ ÛÙÈÁÌ¤˜ ÛÂ ‰È¿ÛÙËÌ· 25 ÂÙÒÓ. ¢Â›ÁÌ·Ù· ·›Ì·-ÙÔ˜ ÂÏ‹ÊıËÛ·Ó ·fi ÙÚÂÈ˜ ÔÌ¿‰Â˜ ÂıÂÏÔÓÙÒÓ, Ì›· ÛÂ Î¿ıÂ¯ÚÔÓÈÎ‹ ÛÙÈÁÌ‹. ŸÏÔÈ ÔÈ ÂıÂÏÔÓÙ¤˜ ¤¯Ô˘Ó ÙËÓ ›‰È· ËÏÈÎ›· Û‹-ÌÂÚ·, ÂÓÒ ÔÈ ÔÌ¿‰Â˜ Â›¯·Ó ·ÚfiÌÔÈ· ‰ËÌÔÁÚ·ÊÈÎ¿ Î·È Ê˘ÛÈ-Î¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿. ∆· ·ÔÙÂÏ¤ÛÌ·Ù· ¤‰ÂÈÍ·Ó ÛËÌ·ÓÙÈÎ¿·˘ÍËÌ¤Ó· Â›Â‰· IgE ÛÂ Â·Ê‹ ÌÂ ÙË Á‡ÚË ÙˆÓ ‰¤Ó‰ÚˆÓ Î·ÈÙˆÓ ·ÁÚÒÓ, Î·ıÒ˜ Î·È ÙÈ˜ Á¿ÙÂ˜ (8). ∞fi Ù· ·Ú·¿Óˆ ‰È·È-ÛÙÒÓÂÙ·È fiÙÈ Ë Û˘¯ÓfiÙËÙ· ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ ·ı‹ÛÂˆÓ ‰ÂÓ ·˘-Í¿ÓÂÙ·È ÌfiÓÔ ÛÙÈ˜ ÓÂfiÙÂÚÂ˜ ÁÂÓÈ¤˜ ·ÏÏ¿ Î·È ÛÂ ·ÓıÚÒÔ˘˜ÌÂÁ·Ï‡ÙÂÚË˜ ËÏÈÎ›·˜, ÂÊfiÛÔÓ ÂÎÙ›ıÂÓÙ·È ÛÙÔÓ Û‡Á¯ÚÔÓÔ ÙÚfi-Ô ˙ˆ‹˜, fiˆ˜ ı· ÂÚÈÁÚ·ÊÂ› ·Ú·Î¿Ùˆ (¶›Ó·Î·˜ 1).

™¯ÂÙÈÎ¿ ÌÂ Ù· ·Ú·¿Óˆ Â›Ó·È Î·È Ù· Â˘Ú‹Ì·Ù· ÙˆÓLinneberg Î·È Û˘Ó, Ô˘ Û˘Ó¤ÎÚÈÓ·Ó ÌÂÚÈÎ¤˜ ÁÂÓÈ¤˜ ˆ˜ ÚÔ˜ÙËÓ Â˘·ÈÛıËÙÔÔ›ËÛ‹ ÙÔ˘˜ ÛÂ ·ÂÚÔ·ÏÏÂÚÁÈÔÁfiÓ· (12). ™ËÌ·-ÓÙÈÎ‹ ‰È·ÊÔÚ¿ ‚Ú¤ıËÎÂ ÌÂÙ·Í‡ ÙˆÓ ·ÙfiÌˆÓ Ô˘ Â›¯·Ó ÁÂÓÓË-ıÂ› ÚÈÓ Î·È ÌÂÙ¿ ÙÔ 1960. ∆Ô ‰È¿ÁÚ·ÌÌ· ÛÙËÓ ∂ÈÎfiÓ· 1 ‰Â›¯ÓÂÈfiÙÈ Ë Â˘·ÈÛıËÙÔÔ›ËÛË ÙÔ˘ ÏËı˘ÛÌÔ‡ Êı›ÓÂÈ ÛÙÈ˜ ·Ï·ÈfiÙÂ-ÚÂ˜ ÁÂÓÈ¤˜. ∂›Ó·È ÂÓ‰È·Ê¤ÚÔÓ, ̂ ÛÙfiÛÔ, Î·È Û¯ÂÙÈÎfi ÌÂ Ù· Â˘Ú‹-Ì·Ù· ÙˆÓ Law Î·È Û˘Ó. fiÙÈ ÌÂÙ·Í‡ 1990-1998 ·ÎfiÌ· Î·È Ë ÌÂ-Á·Ï‡ÙÂÚË ÁÂÓÈ¿ ·ÚÔ˘ÛÈ·˙fiÙ·Ó ÈÔ Â˘·ÈÛıËÙÔÔÈËÌ¤ÓË (12).

Ã·Ú·ÎÙËÚÈÛÙÈÎ¿ Û˘ÌÂÚ¿ÛÌ·Ù· Û¯ÂÙÈÎ¿ ÌÂ ÙÈ˜ ‰È·ÊÔ-Ú¤˜ Â›ÙˆÛË˜ ÙË˜ ·ÏÏÂÚÁ›·˜ ÌÂÙ·Í‡ ÙˆÓ ÁÂÓÂÒÓ ¤‰ˆÛÂ Î·ÈË ·ÎfiÏÔ˘ıË ÌÂÏ¤ÙË. ™ÙË ÌÂÏ¤ÙË ·˘Ù‹ Ô˘ Ú·ÁÌ·ÙÔÔÈ‹-ıËÎÂ ÛÙË ºÈÏ·Ó‰›· ÂÍÂÙ¿ÛÙËÎ·Ó IgE ÛÂ ·ÂÚÔ·ÏÏÂÚÁÈÔÁfiÓ·Î·È ÛÂ ÙÚÔÊÈÎ¿ ·ÏÏÂÚÁÈÔÁfiÓ· ·fi ‰Â›ÁÌ·Ù· ·›Ì·ÙÔ˜ ÂıÂÏÔ-ÓÙÒÓ Ô˘ Â›¯·Ó ÁÂÓÓËıÂ› Î·Ù¿ ÙÈ˜ ‰ÂÎ·ÂÙ›Â˜ ÙÔ˘ 1920, 1940,1960 Î·È 1990. ∏ ‰È·ÊÔÚ¿ ÛÙË Û˘¯ÓfiÙËÙ· ‰È¿ÁÓˆÛË˜ ¿ÛıÌ·-ÙÔ˜ ·fi È·ÙÚfi ‹Ù·Ó ÛÙ·ÙÈÛÙÈÎÒ˜ ÛËÌ·ÓÙÈÎ‹. ∆· Â›Â‰· IgE·ÚÔ˘Û›·˙·Ó ·‡ÍËÛË ÛÙÈ˜ ÓÂfiÙÂÚÂ˜ ÁÂÓÈ¤˜, ÌÂ ÛËÌ·ÓÙÈÎ¤˜

¶›Ó·Î·˜ 1. ∞Ó·ÏÔÁ›· ·Ó‰ÚÒÓ Ô˘ ‚Ú¤ıËÎ·Ó ıÂÙÈÎÔ› ÛÙÔ Phadiatop* ¤Ó·ÓÙÈ ÙÚÈÒÓ ·ÏÏÂÚÁÈÔÁfiÓˆÓ, ÛÂ ÙÚÂÈ˜ ¯ÚÔÓÈÎ¤˜ ÛÙÈÁÌ¤˜. √È ÙÈÌ¤˜ Â›-Ó·È % ÔÛÔÛÙ¿. ¢ËÌÔÛ›Â˘ÛË Î·ÙfiÈÓ ·‰Â›·˜ (8). ∆Ô χÇ Â›¯Â ÙÈÌ‹<0,001 ÁÈ· ÙÔ Phadiatop Î·È ÁÈ· Î·ı¤Ó· ·fi Ù· 3 ·ÏÏÂÚÁÈÔÁfiÓ·

ŒÙÔ˜ Phadiatop °Ú·Û›‰È °‡ÚË ‰¤Ó‰ÚˆÓ °¿Ù·

1975-6 30 (26-34) 16 (13-19) 5,7 (3,8-8,0) 4,1 (2,6-6,2) 1981-2 33 (29-37) 18 (14-21) 5,1 (3,3-7,3) 4,5 (2,9-6,6) 1996-8 42 (37-46) 27 (23-31) 12,6 (9,9-15,8) 10,1 (7,6-13,1) M¤ÛË ·fiÏ˘ÙË ÂÙ‹ÛÈ· ·‡ÍËÛË ÂÈÔÏ·ÛÌÔ‡ (%) 0,45 (0,17- 0,73) 0,53 (0,30- 0,77) 0,36 (0,19-0,53) 0,25 (0,13 -0,38)

*™ÎÂ‡·ÛÌ· 11 ÎÔÈÓÒÓ ÂÈÛÓÂfiÌÂÓˆÓ ·ÏÏÂÚÁÈÔÁfiÓˆÓ Ô˘ ¯ÚËÛÈÌÔÔÈÂ›Ù·È ˆ˜ ‰Â›ÎÙË˜ ·ÙÔ›·˜

267∂È‰ËÌÈÔÏÔÁ›· ·ÏÏÂÚÁÈÎÒÓ ·ı‹ÛÂˆÓ

¶·È‰È·ÙÚÈÎ‹ 2007;70:266-271


‰È·ÊÔÚ¤˜ ·Ó¿ÌÂÛ· ÛÙ· ÂÚÈÛÛfiÙÂÚ· ˙Â‡ÁË ÁÂÓÂÒÓ, ÛÂ fi,ÙÈ·ÊÔÚ¿ Ù· ·ÂÚÔ·ÏÏÂÚÁÈÔÁfiÓ·. ∞ÓÙ›ıÂÙ·, ÛÙ· ÙÚÔÊÈÎ¿ ·ÏÏÂÚ-ÁÈÔÁfiÓ· ÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿ ÛÙ· Â›Â‰· IgE Î·Ù·ÁÚ¿ÊËÎÂÌfiÓÔ ÌÂÙ·Í‡ ÙË˜ ÁÂÓÈ¿˜ ÙÔ˘ 1920 Î·È ÙÔ˘ 1990. ŒÓ· ·fi Ù·ÛËÌ·ÓÙÈÎ¿ Â˘Ú‹Ì·Ù· ·˘Ù‹˜ ÙË˜ ÌÂÏ¤ÙË˜ Â›Ó·È fiÙÈ Ë Â˘·ÈÛıË-ÙÔÔ›ËÛË ÙË˜ ÁÂÓÈ¿˜ ÙÔ˘ 1940 ‰ÂÓ ‰È·Ê¤ÚÂÈ ·fi ·˘Ù‹ ÙÔ˘1920. ∂›Ó·È Èı·Ófi ÔÈ Î·Î¤˜ Û˘Óı‹ÎÂ˜ ˘ÁÈÂÈÓ‹˜ Î·Ù¿ ÙÔÓ 2Ô¶·ÁÎfiÛÌÈÔ ¶fiÏÂÌÔ Ó· ·Ó¤ÎÔ„·Ó ÚÔÛˆÚÈÓ¿ ÙËÓ ÂÍ¤ÏÈÍË ÙˆÓ·ÏÏÂÚÁÈÎÒÓ ·ı‹ÛÂˆÓ (¶›Ó·Î·˜ 2) (9).

∂ÎÙfi˜ fiÌˆ˜ ·fi ÙË Û˘¯ÓfiÙËÙ·, ¤¯ÂÈ ·ÏÏ¿ÍÂÈ Î·È Ë Ê‡ÛËÙˆÓ ·ÏÏÂÚÁÈÎÒÓ ·ı‹ÛÂˆÓ Ô˘ ÚÔÛ‚¿ÏÏÔ˘Ó ÙÔÓ ÏËı˘ÛÌfi.∆ÚÔÊÈÎ¤˜ ·ÏÏÂÚÁ›Â˜ Ô˘ ÂÓ‰¤¯ÂÙ·È Ó· ·Ô‚Ô‡Ó ÂÈÎ›Ó‰˘ÓÂ˜ÁÈ· ÙË ˙ˆ‹, fiˆ˜ Ë ·ÏÏÂÚÁ›· ÛÙÔ˘˜ ÍËÚÔ‡˜ Î·ÚÔ‡˜, ·Ú·-ÙËÚÔ‡ÓÙ·È ÈÔ Û˘¯Ó¿. ∞˘Ùfi ÔÊÂ›ÏÂÙ·È ÛÙËÓ ÂÈÛ·ÁˆÁ‹ ÛÙËÓÎ·ıËÌÂÚÈÓ‹ ‰È·ÙÚÔÊ‹ ÂÂÍÂÚÁ·ÛÌ¤ÓˆÓ ÙÚÔÊÒÓ Î·ıÒ˜ Î·ÈÊ·ÁËÙÒÓ ·fi ¯ÒÚÂ˜ ÙË˜ ∞Û›·˜, fiÔ˘ Â›Ó·È Û˘¯ÓfiÙÂÚË Ë ¯Ú‹-ÛË ÍËÚÒÓ Î·ÚÒÓ (1,17,18).

ŒÓ· ·ÎfiÌË ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ ·ı‹ÛÂˆÓÛÙÈ˜ Ì¤ÚÂ˜ Ì·˜ Â›Ó·È fiÙÈ ÙÂ›ÓÔ˘Ó Ó· ¤¯Ô˘Ó ÔÏ˘Û˘ÛÙËÌ·ÙÈÎ¤˜ÂÎ‰ËÏÒÛÂÈ˜: ÔÏÏ¿ ·È‰È¿ ÌÂ ÙÚÔÊÈÎ‹ ·ÏÏÂÚÁ›·, ÁÈ· ·Ú¿-‰ÂÈÁÌ·, ˘ÔÊ¤ÚÔ˘Ó ·fi ·ÙÔÈÎ‹ ‰ÂÚÌ·Ù›ÙÈ‰· Î·È ‚ÚÔÁ¯ÈÎfi¿ÛıÌ·, Ù¿ÛË Ô˘ Î·Ù·ÁÚ¿ÊÂÙ·È ÛÙËÓ ÙÚ›ÙË Ê¿ÛË ÙË˜ ÔÏ˘-ÎÂÓÙÚÈÎ‹˜ ÌÂÏ¤ÙË˜ ISAAC (International Study of Asthma andAllergies in Childhood) . ∞Í›˙ÂÈ Ó· ÛËÌÂÈˆıÂ› fiÙÈ ·Ú¿ÏÏËÏ·ÌÂ ÙËÓ ÔÏ˘Û˘ÛÙËÌ·ÙÈÎfiÙËÙ· ÛÙÈ˜ ÂÎ‰ËÏÒÛÂÈ˜ ÙˆÓ ·ÙÔÈ-ÎÒÓ ÓÔÛËÌ¿ÙˆÓ ÛÙËÓ 3Ë Ê¿ÛË ÙË˜ ÌÂÏ¤ÙË˜ ·Ú·ÙËÚÂ›Ù·È Î·ÈÌ›· ·ÏÏ·Á‹ ÛÙËÓ “ÎÏ·ÛÈÎ‹” ÛÂÈÚ¿ ÂÌÊ¿ÓÈÛË˜ ÙˆÓ ·ÏÏÂÚÁÈÎÒÓÓÔÛËÌ¿ÙˆÓ ·Ó¿ ËÏÈÎ›·. ∏ ÁÓˆÛÙ‹ ·ÏÏËÏÔ˘¯›· ÂÌÊ¿ÓÈÛË˜ÙˆÓ ÓÔÛËÌ¿ÙˆÓ ·Ô‰›‰ÂÙ·È ·fi ÙÔÓ fiÚÔ “·ÙÔÈÎ‹ ·Ú¤Ï·-ÛË”- atopic marching (1,18,20).

∞fi Ù· Û˘ÌÂÚ¿ÛÌ·Ù· ÙË˜ ÌÂÏ¤ÙË˜ ISAAC, ÛÂ fiÏÂ˜ ÙË˜

Ê¿ÛË˜ ‰ÈÂÍ·ÁˆÁ‹˜ ÙË˜, ÚÔÎ‡ÙÂÈ fiÙÈ ÔÈ ¯ÒÚÂ˜ ÌÂ ÙË ÌÂÁ·Ï‡-

ÙÂÚË Û˘¯ÓfiÙËÙ· ·ÏÏÂÚÁÈÒÓ Â›Ó·È ÔÈ ÈÔ ·Ó·Ù˘ÁÌ¤ÓÂ˜ ÔÈÎÔÓÔ-

ÌÈÎ¿ Î·È ‚ÈÔÌË¯·ÓÈÎ¿, ÂÓÒ ·Ú¿ÏÏËÏ· ÔÈ ÏËı˘ÛÌÔ› ÙÔ˘˜ ÂÓ-

‰Â¯ÔÌ¤Óˆ˜ Ó· ¤¯Ô˘Ó ÔÌÔÈfiÙËÙÂ˜ Î·È ÛÂ ÁÂÓÂÙÈÎfi Â›Â‰Ô (∂È-

ÎfiÓ· 2)(7, 20). ™ÙËÓ ∂ÏÏ¿‰·, ˆÛÙfiÛÔ, Ë Û˘¯ÓfiÙËÙ¿ ÙÔ˘˜ ·-

Ú·Ì¤ÓÂÈ Û¯ÂÙÈÎ¿ ¯·ÌËÏ‹, ·Ó Î·È ·Ó·Ì¤ÓÔÓÙ·È ÓÂÒÙÂÚ· ÛÙÔÈ-

¯Â›· ·fi ÙËÓ ˘fi ÂÍ¤ÏÈÍË Â˘Úˆ·˚Î‹ ÌÂÏ¤ÙË Â›ÙˆÛË˜ ÙË˜

ÙÚÔÊÈÎ‹˜ ·ÏÏÂÚÁ›·˜ ∂uropreval.

™Â ÚfiÛÊ·ÙË ‰ËÌÔÛ›Â˘ÛË, ÔÈ ∞ÓıÚ·ÎfiÔ˘ÏÔ˜ Î·È Û˘Ó.

‰ËÌÔÛÈÂ‡Ô˘Ó Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÌÈ·˜ ÌÂÏ¤ÙË˜ ÂÈÔÏ·ÛÌÔ‡

ÙÔ˘ ¿ÛıÌ·ÙÔ˜ ÛÙËÓ ÂÚÈÔ¯‹ ÙˆÓ ¶·ÙÚÒÓ. ∏ Î·Ù·ÁÚ·Ê‹ ÙÔ˘

ÂÈÔÏ·ÛÌÔ‡ ÛÂ ‰È¿ÊÔÚÂ˜ ¯ÚÔÓÈÎ¤˜ ÛÙÈÁÌ¤˜ Ù· ÙÂÏÂ˘Ù·›· 25

¯ÚfiÓÈ· ÛÙËÓ ÂÚÈÔ¯‹ ‰Â›¯ÓÂÈ fiÙÈ Ù· ÔÛÔÛÙ¿ ¿ÛıÌ·ÙÔ˜ ·˘Í¿-

ÓÔ˘Ó, ·Ó Î·È ÛÂ ¯·ÌËÏfiÙÂÚÔ˘˜ Ú˘ıÌÔ‡˜ ÛÂ Û¯¤ÛË ÌÂ ÙÔ ·-

ÚÂÏıfiÓ (21).

∞ÈÙÈÔÏÔÁÈÎÔ› ·Ú¿ÁÔÓÙÂ˜

∆ËÓ ÙÂÏÂ˘Ù·›· 15ÂÙ›· ¤¯Ô˘Ó Á›ÓÂÈ ÔÏÏ¤˜ ÚÔÛ¿ıÂÈÂ˜ Ó·

ÂÚÌËÓÂ˘ÙÂ› Ë ·Ú·ÙËÚÔ‡ÌÂÓË ·‡ÍËÛË ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ ·-

ı‹ÛÂˆÓ. Œ¯Ô˘Ó ‰È·Ù˘ˆıÂ› ÔÈÎ›ÏÂ˜ “ıÂˆÚ›Â˜” Î·È “˘Ôı¤-

ÛÂÈ˜”, Ô˘ ÛÂ ÔÏÏ¤˜ ÂÚÈÙÒÛÂÈ˜ Û˘ÌÏËÚÒÓÔ˘Ó Ë Ì›· ÙËÓ

¿ÏÏË.

∏ “˘fiıÂÛË ÙË˜ ˘ÁÈÂÈÓ‹˜” ‰È·Ù˘ÒıËÎÂ ÙÔ 1989 ·fi ÙÔÓ

David Strachan. H ÌÂÏ¤ÙË ÙÔ˘ ¤‰ÂÈÍÂ fiÙÈ ÂÓ‰¤¯ÂÙ·È Ô ÏfiÁÔ˜

ÁÈ· ÙËÓ ·‡ÍËÛË ÙˆÓ ·ÙÔÈÎÒÓ ·ı‹ÛÂˆÓ Ó· Â›Ó·È Ë ÌÂ›ˆÛË

ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ·È‰ÈÒÓ ÛÙÈ˜ ÔÈÎÔÁ¤ÓÂÈÂ˜, ·ÏÏ¿ Î·È Ë ‚ÂÏ-

Ù›ˆÛË ÙˆÓ Û˘ÓıËÎÒÓ ˘ÁÈÂÈÓ‹˜ Ì¤Û· ÛÙÔ Û›ÙÈ. ™˘ÁÎÂÎÚÈÌ¤Ó·,

ÚÔ¤Î˘„Â fiÙÈ Ë Â›ÙˆÛË ÙË˜ ·ÏÏÂÚÁÈÎ‹˜ ÚÈÓ›ÙÈ‰·˜ Â›Ó·È

·ÓÙÈÛÙÚfiÊˆ˜ ·Ó¿ÏÔÁË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ·È‰ÈÒÓ ÛÙËÓ ÔÈÎÔ-

Á¤ÓÂÈ· Î·È ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÌÂÁ·Ï‡ÙÂÚˆÓ ·‰ÂÚÊÒÓ (3).

™·Ó Û˘Ó¤¯ÂÈ· ÙË˜ ·Ú·¿Óˆ ˘fiıÂÛË˜ ¤¯ÂÈ ‚ÚÂıÂ› fiÙÈ Ë

·ÏÏ·Á‹ ÛÙË ÌÈÎÚÔ‚È·Î‹ ¯ÏˆÚ›‰· ÙÔ˘ ÂÓÙ¤ÚÔ˘ ‰ËÌÈÔ˘ÚÁÂ› ·Ï-

ÏÂÚÁÈÎ‹ ÚÔ‰È¿ıÂÛË, ÏfiÁˆ ÙË˜ ÌÂÈˆÌ¤ÓË˜ Î·Ù·Ó¿ÏˆÛË˜ ÌË

·ÛÙÂÚÈˆÌ¤ÓÔ˘ Á¿Ï·ÙÔ˜ Î·È ÏfiÁˆ ÙÔ˘ Û‡Á¯ÚÔÓÔ˘ ÙÚfiÔ˘

‰È·ÙÚÔÊ‹˜ - ‰›·ÈÙÂ˜ ÔÏ˘ÂÂÍÂÚÁ·ÛÌ¤ÓˆÓ ÙÚÔÊÒÓ, Ùˆ¯¤˜

ÛÂ Ê˘ÙÈÎ¤˜ ›ÓÂ˜. ™ÙË ‰È·Ù·Ú·¯‹ Â›ÛË˜ ÙË˜ ¯ÏˆÚ›‰·˜ ÙÔ˘

ÂÓÙ¤ÚÔ˘ Û˘Ì‚¿ÏÏÂÈ Ë ÌÂÈˆÌ¤ÓË ¤ÎıÂÛË ÛÂ ÌÈÎÚÔ‚È·ÎÔ‡˜ ·-

Ú¿ÁÔÓÙÂ˜ Î·È Ù· ÚÔ˚fiÓÙ· ÙÔ˘˜, fiˆ˜ Â›ÛË˜ Î·È Ë Î·Ù¿¯ÚË-

ÛË ÙˆÓ ·ÓÙÈ‚ÈÔÙÈÎÒÓ (11). °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi, ÂÍÂÙ¿ÛÙËÎÂ Ô

ÚfiÏÔ˜ ÙˆÓ ÚÔ‚ÈÔÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ÛÙË ‰È·ÙÚÔÊ‹, ÌÂ ÛÎÔ-

fi ÙËÓ ÂÏ¿ÙÙˆÛË ÙË˜ Û˘¯ÓfiÙËÙ·˜ ÙˆÓ ·ÙÔÈÎÒÓ ·ı‹ÛÂˆÓ

(19). ∆· ·ÔÙÂÏ¤ÛÌ·Ù· Â›Ó·È ÔÚÈ·Î¿ ˘¤Ú ÙÔ˘ ÚfiÏÔ˘ ÙˆÓ

ÚÔ‚ÈÔÙÈÎÒÓ Î·È ÔˆÛ‰‹ÔÙÂ ¯Ú‹˙Ô˘Ó ÂÚ·ÈÙ¤Úˆ ¤ÚÂ˘Ó·˜.

∞Í›˙ÂÈ Ó· ÛËÌÂÈˆıÂ› fiÙÈ ‰ÂÓ ÈÛ¯‡ÂÈ Ô ÈÛ¯˘ÚÈÛÌfi˜ fiÙÈ ÔÈ Î·-

Î¤˜ Û˘Óı‹ÎÂ˜ ̆ ÁÈÂÈÓ‹˜ ÚÔÛÙ·ÙÂ‡Ô˘Ó ¿ÓÙ· ·fi ÙËÓ ·Ó¿Ù˘-

ÍË ·ÙÔ›·˜. ∞ÓÙÈı¤Ùˆ˜, ÂÚÈÙÒÛÂÈ˜, fiˆ˜ ÁÈ· ·Ú¿‰ÂÈÁÌ· Ë

ÏÔ›ÌˆÍË ·fi ÙÔÓ ·Ó·ÓÂ˘ÛÙÈÎfi Û˘ÁÎ˘ÙÈ·Îfi Èfi (RSV), ÚÔ-

‰È·ı¤ÙÔ˘Ó ÁÈ· ·Ó¿Ù˘ÍË ¿ÛıÌ·ÙÔ˜. ∏ ÈÔ ÛˆÛÙ‹ ‰È·Ù‡ˆÛË

Â›Ó·È fiÙÈ Ô ·Ú·‰ÔÛÈ·Îfi˜ ·ÁÚÔÙÈÎfi˜ ÙÚfiÔ˜ ̇ ˆ‹˜ ÚÔÛÙ·ÙÂ‡-

ÂÈ ·fi ÙËÓ ·Ó¿Ù˘ÍË ·ÙÔ›·˜. ™Â ¤Ó· “·ÁÚÔÙÈÎfi” ÂÚÈ‚¿ÏÏÔÓ,

Ë ¤ÎıÂÛË ÛÂ Gram ·ÚÓËÙÈÎ¿ ‚·ÎÙ‹ÚÈ· Ô‰ËÁÂ› ÛÙËÓ ¤ÎıÂÛË

ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ ÛˆÏ‹Ó· ÛÂ ‚·ÎÙËÚÈ·Î‹ ÂÓ‰ÔÙÔÍ›ÓË. ∏

¶›Ó·Î·˜ 2. ∂ÈÔÏ·ÛÌfi˜ (%) -ÌÂ 95% ‰È¿ÛÙËÌ· ‚Â‚·ÈfiÙËÙ·˜ - ¿ÛıÌ·ÙÔ˜, ·ÏÏÂÚÁ›·˜ ÛÙËÓ ÚˆÙÂ˝ÓË Á¿Ï·ÎÙÔ˜ ·ÁÂÏ¿‰Ô˜ Î·È ·ÓÈ¯ÓÂ‡ÛÈ-ÌˆÓ ÂÈ‰ÈÎÒÓ IgE ÛÂ ¿ÙÔÌ· Ô˘ ÂÎÚÔÛˆÔ‡Ó ÙÈ˜ ÁÂÓÈ¤˜ ÙÔ˘ 1990, 1963-66, 1943-46 Î·È 1923-26. ¢ËÌÔÛ›Â˘ÛË Î·ÙfiÈÓ ·‰Â›·˜ (9)

∏ÏÈÎÈ·Î¤˜ ÔÌ¿‰Â˜ 1990 1963-67 1943-46 1923-267 ÂÙÒÓ, n=100 27 ÂÙÒÓ, n=100 47 ÂÙÒÓ, n=100 67 ÂÙÒÓ, n=100

ÕÛıÌ· 10 (4,9-17,7) 1 (0,03-5,5) 1 (0,03-5,5) 5 (1,6-11)ÀÂÚÂ˘·ÈÛıËÛ›· ÛÙÔ Á¿Ï· 14 (7,9-22,4) 10 (4,9-17,6) 14 (8-22,6) 13 (7,1-21)∂È‰ÈÎ¤˜ ·ÓÔÛÔÛÊ·ÈÚ›ÓÂ˜ πgE ÛÙÔ Á¿Ï· 9 (4,2-16,4) 4,4 (1,2-10,8) 1 (0,03-5,5) 7,1 (2,9-14)

45

40

35

30

25

20

15

10

5

0

1990

1998

15-22 23-30 31-38 39-46 4754 55-62 63-70 70-77∏ÏÈÎ›· (¤ÙË)

∂

ÈÔ

Ï·

ÛÌ

fi˜

(%)

∂ÈÎfiÓ· 1. ∞ÏÏ·Á‹ ÛÙË Û˘¯ÓfiÙËÙ· Â˘·ÈÛıËÙÔÔ›ËÛË˜ Î·Ù¿ ËÏÈ-ÎÈ·Î‹ ÔÌ¿‰· ÛÙÔÓ ÁÂÓÈÎfi ÏËı˘ÛÌfi ÌÂÙ·Í‡ 1990-1998. ¢ËÌÔÛ›-Â˘ÛË Î·ÙfiÈÓ ·‰Â›·˜ (15).

268 ∞. ™ÔÊÈ·ÓÔ‡-∫·ÙÛÔ‡ÏË



ÂÓ‰ÔÙÔÍ›ÓË ·˘Ù‹ Û˘Ì‚¿ÏÏÂÈ ÛÙËÓ ÂÈ‚›ˆÛË Î·È ˆÚ›Ì·ÓÛË ÙˆÓ·ÓÙÈÁÔÓÔ·ÚÔ˘ÛÈ·ÛÙÈÎÒÓ ‰ÂÓ‰ÚÈÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ. ø˜ Û˘Ó¤-ÂÈ· ÙˆÓ ·Ú·¿Óˆ, Ù· ‰ÂÓ‰ÚÈÙÈÎ¿ Î‡ÙÙ·Ú· ·Ó·Ù‡ÛÛÔ˘Ó˘Ô‰Ô¯Â›˜ ∆LR (toll-like receptors) Ô˘ Û˘Ì‚¿ÏÏÔ˘Ó ÛÙËÓ·Ó¿Ù˘ÍË ÌË ·ÏÏÂÚÁÈÎ‹˜ ·ÓÔÛÔÏÔÁÈÎ‹˜ ·¿ÓÙËÛË˜. ∞˘ÙfiÛ˘Ì‚·›ÓÂÈ ÌÂ ÙËÓ ·Ú·ÁˆÁ‹ Î·Ù¿ÏÏËÏˆÓ Î˘Ù·ÚÔÎÈÓÒÓ (πL-12,INF-Á) Î·È ÙËÓ ÂÈÎÚ¿ÙËÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ Th1 (16).

¢ÂÓ ˘¿Ú¯ÂÈ ·ÌÊÈ‚ÔÏ›· Î·È ¤¯ÂÈ ·Ô‰ÂÈ¯ıÂ› Î·È ·fi Û¯Â-ÙÈÎ‹ ÌÂÏ¤ÙË ÛÙË ¢·Ó›· fiÙÈ Ë ÌÂÙ·Î›ÓËÛË ÙˆÓ ÏËı˘ÛÌÒÓ ÛÙÈ˜ÌÂÁ¿ÏÂ˜ fiÏÂÈ˜ Ô‰ËÁÂ› ÛÙËÓ ·ÒÏÂÈ· ÙË˜ “·ÓÔÛÔÏÔÁÈÎ‹˜·ÓÔ¯‹˜” ÛÙ· ·ÏÏÂÚÁÈÔÁfiÓ·. ∞˘Ùfi Û˘Ì‚·›ÓÂÈ ÁÈ·Ù› Ë ¤ÎıÂÛËÙˆÓ ·ÓıÚÒˆÓ ÛÂ ·ÏÏÂÚÁÈÔÁfiÓ·, .¯. Á‡ÚË, Â›Ó·È ÔÏ‡ ÌÈÎÚfi-ÙÂÚË, ÌÂ ·ÔÙ¤ÏÂÛÌ· Ó· ̄ ¿ÓÔ˘Ó ÙËÓ ·ÓÔÛÔÏÔÁÈÎ‹ ·ÓÔ¯‹ ÙÔ˘˜ÛÂ ·˘Ù¿ Î·È Ó· Â˘·ÈÛıËÙÔÔÈÔ‡ÓÙ·È. ™ÙËÓ ·ÓÔÛÔıÂÚ·Â›·,·ÓÙÈı¤Ùˆ˜, Ë ·Â˘·ÈÛıËÙÔÔ›ËÛË ÂÈÙ˘Á¯¿ÓÂÙ·È ÌÂ ÙËÓ ·˘-Í·ÓfiÌÂÓË ¤ÎıÂÛË ÛÂ Î¿ÔÈÔ ·ÏÏÂÚÁÈÔÁfiÓÔ. ∞˘Ùfi˜ Â›Ó·È Ô Ïfi-ÁÔ˜ Ô˘ Ë Û˘ÁÎÂÎÚÈÌ¤ÓË ÌÂÏ¤ÙË ÔÓfiÌ·ÛÂ ÙËÓ ·Ú·¿Óˆ ‰È·-‰ÈÎ·Û›· ·Ó¿Ù˘ÍË˜ ·ÏÏÂÚÁÈÒÓ ÏfiÁˆ ·ÛÙÈÎÔÔ›ËÛË˜, “·ÓÙ›-ÛÙÚÔÊË ÂÚ›ÙˆÛË ·ÓÔÛÔıÂÚ·Â›·˜” (15).

∆Ô ·Ú¿‰ÂÈÁÌ· ÙË˜ ÚÒËÓ ∞Ó·ÙÔÏÈÎ‹˜ °ÂÚÌ·Ó›·˜ ¤¯ÂÈ¯ÚËÛÈÌÔÔÈËıÂ› Â›ÛË˜ ·fi ÔÏÏÔ‡˜ ÂÚÂ˘ÓËÙ¤˜. √ ÏfiÁÔ˜Â›Ó·È fiÙÈ Ë ÂÓˆÌ¤ÓË °ÂÚÌ·Ó›· ·ÔÙÂÏÂ›Ù·È ·fi ‰‡Ô ÁÂÓÂÙÈÎ¿·ÚfiÌÔÈÔ˘˜ ÏËı˘ÛÌÔ‡˜, Ô˘ fiÌˆ˜ ÂÎÙ¤ıËÎ·Ó ÛÂ ·ÏÏÂÚ-ÁÈÔÁfiÓ· ÛÂ ‰È·ÊÔÚÂÙÈÎfi ‚·ıÌfi ÚÈÓ ·fi ÙËÓ ÂÓÔÔ›ËÛË. √‚·ıÌfi˜ ÙË˜ Â˘·ÈÛıËÙÔÔ›ËÛË˜ Ô˘ ÂÎÙÈÌ‹ıËÎÂ ·fi ‰ÂÚÌ·-

ÙÈÎ¤˜ ‰ÔÎÈÌ·Û›Â˜ Ó˘ÁÌÔ‡ (skin prick tests) ‹Ù·Ó ¯·ÌËÏfiÙÂ-ÚÔ˜ ÛÙËÓ ∞Ó·ÙÔÏÈÎ‹ ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙË ¢˘ÙÈÎ‹ °ÂÚÌ·Ó›·.∞fi ÙËÓ ¿ÏÏË ÌÂÚÈ¿, Ë Â›ÙˆÛË ÙË˜ ·ÏÏÂÚÁÈÎ‹˜ ÚÈÓ›ÙÈ‰·˜,·Ú·ÙËÚÂ›Ù·È ·˘ÍËÌ¤ÓË ÛÂ fiÏÂÈ˜ ÙË˜ ∞Ó·ÙÔÏÈÎ‹˜ °ÂÚÌ·-Ó›·˜ Ì¤Û· ÛÂ Ï›Á· ¯ÚfiÓÈ· ÌÂÙ¿ ÙËÓ ÂÓÔÔ›ËÛË. ∞˘Ùfi Èı·-ÓfiÓ Ó· ÔÊÂ›ÏÂÙ·È ÛÙÔÓ ÈÔ “‰˘ÙÈÎfi” ÙÚfiÔ ˙ˆ‹˜ Ô˘ ˘ÈÔıÂ-Ù‹ıËÎÂ (6).

ªÂÏ¤ÙÂ˜ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÛÙË ‰ÂÎ·ÂÙ›· ÙÔ˘ 1990ˆÛÙfiÛÔ, ‰ÂÓ ‰Â›¯ÓÔ˘Ó ‰È·ÊÔÚ¤˜ ÛÙËÓ Â›ÙˆÛË .¯. ÙÔ˘¿ÛıÌ·ÙÔ˜ ‹ ÛÙËÓ Â˘·ÈÛıËÙÔÔ›ËÛË ÙÔ˘ ÏËı˘ÛÌÔ‡ ‚¿ÛÂÈÙˆÓ ÙÈÌÒÓ IgE. ¶·ÚfiÌÔÈ· ·ÔÙÂÏ¤ÛÌ·Ù· ÚÔ¤Ú¯ÔÓÙ·È ·fiÌÂÏ¤ÙÂ˜ ÛÙËÓ πÙ·Ï›·, ÙËÓ ∂Ï‚ÂÙ›· Î·È ÙËÓ ∞˘ÛÙÚ·Ï›·. ∏ÂÍ‹ÁËÛË Ô˘ ‰›ÓÂÙ·È Â›Ó·È fiÙÈ ÂÓ‰Â¯ÔÌ¤Óˆ˜ Ë ·‡ÍËÛË ÙˆÓ·ÏÏÂÚÁÈÎÒÓ ÂÎ‰ËÏÒÛÂˆÓ Ó· ¤¯ÂÈ ÊÙ¿ÛÂÈ ÛÂ ¤Ó· “Ï·Ùfi”(13,20, 22, 23).

™ÙÔ Î˘ÙÙ·ÚÈÎfi Â›Â‰Ô, Ë ˘fiıÂÛË “˘ÁÈÂÈÓ‹˜” ÌÔÚÂ› Ó·ÂÍËÁËıÂ› ·fi ÙËÓ ·ÒÏÂÈ· ÙË˜ ¯ÚfiÓÈ·˜ ÌÈÎÚÔ‚È·Î‹˜ ‰È¤ÁÂÚ-ÛË˜ ÛÙ· Î‡ÙÙ·Ú· ÙË˜ ÂÁÁÂÓÔ‡˜ ·ÓÔÛ›·˜, Ì¤Ûˆ ÙˆÓ ˘Ô‰Ô¯¤-ˆÓ TLR. OÈ toll-like receptors Â›Ó·È ˘Ô‰Ô¯Â›˜ (Ì¤¯ÚÈ ÛÙÈÁÌ‹˜¤¯Ô˘Ó ·Ó·Î·Ï˘ÊıÂ› ÙÔ˘Ï¿¯ÈÛÙÔÓ 10) ÛÙËÓ ÂÈÊ¿ÓÂÈ· ÙˆÓ‰ÂÓ‰ÚÈÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ Î·ıÒ˜ Î·È ÙˆÓ ¡∫ (natural killer)Î˘ÙÙ¿ÚˆÓ. √È ˘Ô‰Ô¯Â›˜ ·˘ÙÔ› ·ÏÏËÏÂÈ‰ÚÔ‡Ó ÌÂ ‰È¿ÊÔÚ·ÙÌ‹Ì·Ù· ÙˆÓ ‚·ÎÙËÚ›ˆÓ Î·È ÙˆÓ ÈÒÓ Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÔ·ÓÔÛÔÔÈËÙÈÎfi Û‡ÛÙËÌ·. ∞Ó¿ÏÔÁ· ÌÂ ÙÔÓ Ù‡Ô ÙÔ˘ ˘Ô‰Ô-¯¤· ·ÏÏ¿ Î·È ÙÔ ÙÌ‹Ì· ÙÔ˘ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡ Ô˘ ·ÚÔ˘ÛÈ¿-


¶·È‰È·ÙÚÈÎ‹ 2007;70:266-271

∂ÈÎfiÓ· 2. ¶·ÁÎfiÛÌÈÔ˜ ¯¿ÚÙË˜ ÙË˜ Î·Ù·ÓÔÌ‹˜ ÙÔ˘ ÂÙ‹ÛÈÔ˘ ÂÈÔÏ·ÛÌÔ‡ ÛÂ ÙÔ˘Ï¿¯ÈÛÙÔÓ ‰‡Ô ·fi ÙÈ˜ ÙÚÂÈ˜ ·ÙÔÈÎ¤˜ ·ı‹ÛÂÈ˜. ∫·Ù·-ÁÚ¿ÊÂÙ·È Â›ÛË˜ Ë ·Ó·ÏÔÁ›· ÙˆÓ ·È‰ÈÒÓ ÌÂ Î¿ÔÈ· ÙÔ˘Ï¿¯ÈÛÙÔÓ ·fi ÙÈ˜ ÎÔÈÓ¤˜ ·ÙÔÈÎ¤˜ ·ı‹ÛÂÈ˜. ¢ËÌÔÛ›Â˘ÛË Î·ÙfiÈÓ ·‰Â›·˜ (7).

∂ÈÔÏ·ÛÌfi˜¿ÛıÌ·ÙÔ˜ ÙÔ˘˜

ÙÂÏÂ˘Ù·›Ô˘˜ 12 Ì‹ÓÂ˜

∂ÈÔÏ·ÛÌfi˜ ÚÈÓ›ÙÈ‰·˜ ÙÔ˘˜ ÙÂÏÂ˘Ù·›Ô˘˜ 12 Ì‹ÓÂ˜

∂È-ÔÏ·ÛÌfi˜ ÂÎ˙¤Ì·ÙÔ˜

ÙÔ˘˜ ÙÂÏÂ˘Ù·›Ô˘˜

12 Ì‹ÓÂ˜

8,0%

3,4% 1,2%

1,3%

3,6%1,3%7,5%

★ ≥9%

◆ 6-9%

● 3-6%

■ <3%


˙ÂÙ·È ÚÔÎ‡ÙÂÈ Î·È Ë ·Ó¿ÏÔÁË ·ÓÔÛÔÏÔÁÈÎ‹ ·¿ÓÙËÛË, Ô˘

ÂÍ·ÚÙ¿Ù·È ·fi ÙÔ Â›‰Ô˜ ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ Ô˘ ÂÎÎÚ›ÓÔÓÙ·È.

∏ ÂÏ¿ÙÙˆÛË ÙÔ˘ ÌÈÎÚÔ‚È·ÎÔ‡ ÊÔÚÙ›Ô˘ Û˘ÓÂ¿ÁÂÙ·È ÂÓ›-

Û¯˘ÛË ÙË˜ ·ÓÔÛÔÏÔÁÈÎ‹˜ Ì¿ÏÏÔÓ ·¿ÓÙËÛË˜ Ì¤Ûˆ ÙˆÓ ‚ÔË-

ıËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ Th2, Ô˘ Â˘ı‡ÓÔÓÙ·È Î˘Ú›ˆ˜ ÁÈ· ÙÈ˜ ·Ï-

ÏÂÚÁÈÎ¤˜ ·ÓÙÈ‰Ú¿ÛÂÈ˜, ·Ú¿ ÙË˜ ∆h1 ·¿ÓÙËÛË˜. √ ÌË¯·ÓÈ-

ÛÌfi˜ ÌÂ ÙÔÓ ÔÔ›Ô ÚÔÎ‡ÙÂÈ ·˘Ù‹ Ë “·ÓÈÛÔÚÚÔ›·” ˘¤Ú

ÙË˜ ∆h2 ·¿ÓÙËÛË˜ ‰ÂÓ ¤¯ÂÈ ‰ÈÂ˘ÎÚÈÓÈÛÙÂ›. ¶Èı·ÓfiÓ Ó· Â›Ó·È

·ÔÙ¤ÏÂÛÌ· ˘ÂÚ·Ú·ÁˆÁ‹˜ ∆h2 Î˘ÙÙ·ÚÔÎÈÓÒÓ ‹ ÌÂÈˆÌ¤-

ÓË˜ ‰È¤ÁÂÚÛË˜ ÙˆÓ “Ú˘ıÌÈÛÙÈÎÒÓ” ∆ Î˘ÙÙ¿ÚˆÓ (10).

∏ ·¿ÓÙËÛË Th2 Â›Ó·È Ô˘ÛÈ·ÛÙÈÎ¿ ·ÏÏÂÚÁÈÎ‹ ·¿ÓÙËÛË

ÙÔ˘ ·ÓÔÛÔÏÔÁÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÛÂ ¤Ó·Ó “·ıÒÔ ÂÈÛ‚ÔÏ¤·”, ÙÔ

·ÏÏÂÚÁÈÔÁfiÓÔ, Î·È Â›Ó·È ·ÚfiÌÔÈ· ÌÂ ÙËÓ ·¿ÓÙËÛË Ô˘ ı· Â›-

¯·ÌÂ ÌÂÙ¿ ÙËÓ ÂÈÛ‚ÔÏ‹ ÂÓfi˜ ·Ú·Û›ÙÔ˘ ÛÙÔÓ ÔÚÁ·ÓÈÛÌfi. ™ÙÈ˜

‰˘ÙÈÎ¤˜ ÎÔÈÓˆÓ›Â˜ Ê·›ÓÂÙ·È fiÙÈ Ë ·¿ÓÙËÛË ·˘Ù‹ ÂÓÂÚÁÔÔÈÂ›-

Ù·È ·fi ÎÔÈÓ¿ ·ÏÏÂÚÁÈÔÁfiÓ· Î·È ·˘Ùfi Û˘Ì‚·›ÓÂÈ, Èı·ÓfiÙ·Ù·,

ÏfiÁˆ ¤ÏÏÂÈ„Ë˜ ÈÎ·ÓÔ‡ ·ÓÔÛÔÚÚ˘ıÌÈÛÙÈÎÔ‡ ÊÔÚÙ›Ô˘ ·Ú·Û›-

ÙˆÓ ÛÙÈ˜ Û˘Óı‹ÎÂ˜ ‚ÂÏÙÈˆÌ¤ÓË˜ ˘ÁÈÂÈÓ‹˜. ∞˘Ùfi˜ Â›Ó·È Ô ÏfiÁÔ˜

Ô˘ Ù· ·Ú¿ÛÈÙ· ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ·fi ÔÚÈÛÌ¤ÓÂ˜ ÌÂÏ¤ÙÂ˜

ÛÙËÓ ÚÔÛ¿ıÂÈ· ·Ó·ÛÙÚÔÊ‹˜ ÙË˜ ·ÏÏÂÚÁÈÎ‹˜ ÚÔ‰È¿ıÂÛË˜

ÔÚÈÛÌ¤ÓˆÓ ·ÙfiÌˆÓ (14). ™Â ¿ÏÏÂ˜ ÌÂÏ¤ÙÂ˜, ¤Ó· Ì˘ÎÔ‚·ÎÙËÚ›-

‰ÈÔ, ÙÔ ª.vaccae, ¯ÔÚËÁ‹ıËÎÂ ÛÂ ÌÈÎÚ¤˜ ÔÛfiÙËÙÂ˜ ÌÂ ÙË ÌÔÚ-

Ê‹ ·ÓÔÛÔıÂÚ·Â›·˜, ÚÈÓ ÙËÓ ¤Ó·ÚÍË ÙË˜ ¤Í·ÚÛË˜ ÙË˜ ·ÏÏÂÚ-

ÁÈÎ‹˜ ÚÈÓ›ÙÈ‰·˜ ÛÂ ÌÈ· ÚÔÛ¿ıÂÈ· ÂÏ¤Á¯Ô˘ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ

(16). ∆· ·ÔÙÂÏ¤ÛÌ·Ù· ·˘ÙÒÓ ÙˆÓ ÂÚÂ˘ÓÒÓ Â›Ó·È ÛÂ ÔÏ‡

ÚÒÈÌÔ ÛÙ¿‰ÈÔ, fiÌˆ˜ ‰È·Ê·›ÓÂÙ·È fiÙÈ ›Ûˆ˜ Ë ˘fiıÂÛË ÙË˜ ˘ÁÈ-

ÂÈÓ‹˜ ‰ËÌÈÔ˘ÚÁ‹ÛÂÈ Ó¤Â˜ ÛÙÚ·ÙËÁÈÎ¤˜ ·ÓÙÈÌÂÙÒÈÛË˜ ÙË˜ ·-

Ú·ÙËÚÔ‡ÌÂÓË˜ ·‡ÍËÛË˜ ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ ·ı‹ÛÂˆÓ.

™˘Ì¤Ú·ÛÌ·

∆· ÎÏ·ÛÈÎ¿ ·ÏÏÂÚÁÈÎ¿ ÓÔÛ‹Ì·Ù· ·ÚÔ˘ÛÈ¿˙Ô˘Ó

·‡ÍËÛË Ô˘ Î·Ù·‰ÂÈÎÓ‡ÂÙ·È ·fi ÔÏ˘ÎÂÓÙÚÈÎ¤˜ ÌÂ-

Ï¤ÙÂ˜ Ô˘ ‰ÈÂÍ¿ÁÔÓÙ·È ÛÂ ·ÁÎfiÛÌÈÔ Â›Â‰Ô. √È

·Ó·Ù˘ÁÌ¤ÓÂ˜ ¯ÒÚÂ˜ ‚Ú›ÛÎÔÓÙ·È ÛÙËÓ ÎÔÚ˘Ê‹ ÙˆÓ

·˘ÍËÙÈÎÒÓ Ù¿ÛÂˆÓ, ·ÏÏ¿ Î·È ÔÈ ·Ó·Ù˘ÛÛfiÌÂÓÂ˜ ̄ Ò-

ÚÂ˜ Ô˘ ·ÎÔÏÔ˘ıÔ‡Ó ÙÔ ‰˘ÙÈÎfi ÌÔÓÙ¤ÏÔ ˙ˆ‹˜ ·ÎÔ-

ÏÔ˘ıÔ‡Ó ÌÂ ÛËÌ·ÓÙÈÎ¿ ÔÛÔÛÙ¿. ¢È·ÊÔÚ¤˜ ÛÙ· Ô-

ÛÔÛÙ¿ ÂÎ‰‹ÏˆÛË˜ ‰ÂÓ ·Ú·ÙËÚÔ‡ÓÙ·È ÌfiÓÔ ÛÙ·

·È‰È¿ ·Ó¿ÌÂÛ· ÛÙÈ˜ ‰ÂÎ·ÂÙ›Â˜. ∞‡ÍËÛË ÙˆÓ ·ÏÏÂÚ-

ÁÈÎÒÓ ·ı‹ÛÂˆÓ ÛÙËÓ ÂÔ¯‹ Ì·˜ ·Ú·ÙËÚÂ›Ù·È Î·È

ÛÙÔÓ ÂÓ‹ÏÈÎÔ ÏËı˘ÛÌfi. ∆Ô ¿ÏÏÔ ÛËÌ·ÓÙÈÎfi ¯·Ú·-

ÎÙËÚÈÛÙÈÎfi ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ ÓÔÛËÌ¿ÙˆÓ ÛÙÈ˜ Ì¤ÚÂ˜

Ì·˜ Â›Ó·È Ë “ÔÏ˘Û˘ÛÙËÌ·ÙÈÎfiÙËÙ·” ÌÂ ÙËÓ ÔÔ›·

ÂÎ‰ËÏÒÓÔÓÙ·È.

√È ·ÈÙ›Â˜ Ô˘ ¤¯Ô˘Ó Ô‰ËÁ‹ÛÂÈ ÛÙËÓ ·‡ÍËÛË ÙË˜

Û˘¯ÓfiÙËÙ·˜ ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ ·ı‹ÛÂˆÓ ÛÙÈ˜ Ì¤ÚÂ˜

Ì·˜ Â›Ó·È ·ÎfiÌ· ·ÓÙÈÎÂ›ÌÂÓÔ ¤ÚÂ˘Ó·˜. ∏ “˘fiıÂÛË

˘ÁÈÂÈÓ‹˜” ¯ÚËÛÈÌÔÔÈÂ›Ù·È Â˘Ú¤ˆ˜ ˆ˜ ÌÔÓÙ¤ÏÔ ÁÈ·

ÙËÓ ÂÚ·ÈÙ¤Úˆ ÌÂÏ¤ÙË ÙÔ˘˜ ÛÂ ÂÈ‰ËÌÈÔÏÔÁÈÎfi Î·È

·ÓÔÛÔÏÔÁÈÎfi Â›Â‰Ô, ÌÂ ÂÓ‰È·Ê¤ÚÔÓÙ· ·ÔÙÂÏ¤-

ÛÌ·Ù· ˆ˜ ÚÔ˜ ÙÔÓ ÚfiÏÔ ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ, ÙˆÓ

‰È·ÊfiÚˆÓ ˘Ô‰Ô¯¤ˆÓ Î·È ÙÔ˘ ÌÈÎÚÔ‚È·ÎÔ‡ ÊÔÚÙ›Ô˘,

ÛÙÔ ÔÔ›Ô ÂÎÙ›ıÂÓÙ·È ‰È¿ÊÔÚÔÈ ÏËı˘ÛÌÔ›.

∂›Ó·È ÛËÌ·ÓÙÈÎfi ÔÈ ·ÛıÂÓÂ›˜ ÌÂ ·ÏÏÂÚÁ›Â˜ Ó·

·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È ·fi È·ÙÚÔ‡˜ ÂÍÂÈ‰ÈÎÂ˘Ì¤ÓÔ˘˜

ÛÙËÓ ·Ú·ÎÔÏÔ‡ıËÛ‹ ÙÔ˘˜, ÌÈ·˜ Î·È ÛÙÈ˜ Ì¤ÚÂ˜ Ì·˜

·ÚÔ˘ÛÈ¿˙Ô˘Ó Û˘Ó‹ıˆ˜ ‚·Ú‡ÙÂÚÂ˜ ÂÎ‰ËÏÒÛÂÈ˜, ÛÂ

ÔÏÏ¿ Û˘ÛÙ‹Ì·Ù·. ∂ÔÌ¤Óˆ˜, ¯ÚÂÈ¿˙ÔÓÙ·È ÚÔÛÂ-

ÎÙÈÎ‹ ‰ÈÂÚÂ‡ÓËÛË Î·È ÂÍ·ÙÔÌÈÎÂ˘Ì¤ÓË ıÂÚ·Â˘ÙÈÎ‹

·ÓÙÈÌÂÙÒÈÛË.

µÈ‚ÏÈÔÁÚ·Ê›·

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blueprint for better patient care. Report of a working par-

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ease. Clin Exp Allergy 1998;28 (5 suppl):S45-S49.

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junctivitis and atopic eczema: ISAAC. Lancet 1998;351:

1220-1221.

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Changes in atopy over a quarter of a century, based on

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epidemic extends beyond the past few decades. Clin Exp

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hygiene hypothesis: missing immune deviation, reduced

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352-363.

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A, JÔ/rgensen T. Is the increase in allergic respiratory dis-

ease caused by a cohort effect? Clin Exp Allergy 2002;32:

1702-1705.

13. Zollner IK, Weiland SK, Piechotowski I, Gabrio T, von

Mutius E, Link B, et al. No increase in the prevalence of

asthma, allergies, and atopic sensitisation among children

in Germany:1992-2001. Thorax 2005;60:545-548.

14. Falcone FH, Pritchard DI. Parasite role reversal: worms on

trial. Trends Parasitol 2005;21:157-160.

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epidemic-a reverse case of immunotherapy? Allergy 2005;

60:538-539.

16. Matricaldi PM, Bonini S. Mimicking microbial ‘education’

of the immune system: a strategy to revert the epidemic

trend of atopy and allergic asthma? Respir Res 2000;1:

129-132.

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proposals to improve allergy care. Clin Med 2002;2:

122-127.

18. Royal College of Physicians. Containing the allergy epi-

demic: summary and recommendations of a new report

270 ∞. ™ÔÊÈ·ÓÔ‡-∫·ÙÛÔ‡ÏË




¶·È‰È·ÙÚÈÎ‹ 2007;70:266-271

from the Royal College of Physicians. Clin Exp Allergy2004;34:515-517.

19. ∫alliomaki M, Salminen S, Arvilommi H, Kero P, KoskinenP, Isolauri E. Probiotics in primary prevention of atopic dis-ease: a randomised placebo-controlled trial. Lancet 2001;357(9262):1076-1079.

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repeat multicountry cross-sectional surveys. Lancet 2006;368:733-743.

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Quiz

1. À„ËÏfiÙÂÚÔ˜ ÂÙ‹ÛÈÔ˜ ÂÈÔÏ·ÛÌfi˜ ÛÂ ÙÔ˘Ï¿¯ÈÛÙÔÓ ‰‡Ô ·ÙÔÈÎ¤˜ ·ı‹ÛÂÈ˜ Ù·˘Ùfi¯ÚÔÓ· Û˘Ó·ÓÙ¿Ù·È:·. ™Â ¯ÒÚÂ˜ ÙË˜ ¡ÔÙÈÔ·Ó·ÙÔÏÈÎ‹˜ ∞Û›·˜‚. ™ÙË ª. µÚÂÙ·Ó›·Á. ™Â ¯ÒÚÂ˜ ÙË˜ ∫ÂÓÙÚÈÎ‹˜ ∂˘ÚÒË˜ ‰. ™ÙËÓ ∂ÏÏ¿‰·

2. ¶ÔÈ· ·fi ÙÈ˜ ·Ú·Î¿Ùˆ ‰È·Ù˘ÒÛÂÈ˜ ‰ÂÓ Û˘ÌÂÚÈÏ·Ì‚¿ÓÂÙ·È ÛÙËÓ “˘fiıÂÛË ÙË˜ ˘ÁÈÂÈÓ‹˜”;·. ∏ Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛË˜ ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ ·ı‹ÛÂˆÓ ÛÙÈ˜ Ì¤ÚÂ˜ Ì·˜ ÔÊÂ›ÏÂÙ·È ÛÙË ‚ÂÏÙ›ˆÛË ÙˆÓ Û˘Ó-

ıËÎÒÓ ˘ÁÈÂÈÓ‹˜ ÛÙÔ ÔÈÎÈ·Îfi ÂÚÈ‚¿ÏÏÔÓ‚. ∏ Â›ÙˆÛË ÙË˜ ·ÏÏÂÚÁÈÎ‹˜ ÚÈÓ›ÙÈ‰·˜ ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ· Â›Ó·È ·ÓÙÈÛÙÚfiÊˆ˜ ·Ó¿ÏÔÁË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ

·È‰ÈÒÓ Î·È ÙË˜ ÛÂÈÚ¿˜ Á¤ÓÓËÛË˜Á. ∏ ·‡ÍËÛË ÙˆÓ ·ÏÏÂÚÁÈÒÓ ÔÊÂ›ÏÂÙ·È ÌÂÙ·Í‡ ¿ÏÏˆÓ ÛÂ ÂÚÈ‚·ÏÏÔÓÙÈÎÔ‡˜ Î·È ÎÏÈÌ·ÙÔÏÔÁÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜‰. ∆Ô ·ÛÙÈÎÔÔÈËÌ¤ÓÔ ÌÔÓÙ¤ÏÔ ˙ˆ‹˜ Î·È ‰È·ÙÚÔÊ‹˜ Û˘Ì‚¿ÏÏÂÈ Â›ÛË˜ ÛÙËÓ ·‡ÍËÛË ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ

·ı‹ÛÂˆÓ

3. ™ÙÔ ÎÏ·ÛÈÎfi ÌÔÓÙ¤ÏÔ “·ÙÔÈÎ‹˜ ·Ú¤Ï·ÛË˜” (atopic marching), Ë ·ÏÏËÏÔ˘¯›· ÂÌÊ¿ÓÈÛË˜ ÙˆÓ ·ÙÔÈÎÒÓ·ı‹ÛÂˆÓ Â›Ó·È:·. ∆ÚÔÊÈÎ¤˜ ·ÏÏÂÚÁ›Â˜-¤Î˙ÂÌ·-¿ÛıÌ·-·ÏÏÂÚÁÈÎ‹ ÚÈÓ›ÙÈ‰·‚. ŒÎ˙ÂÌ·-ÙÚÔÊÈÎ¤˜ ·ÏÏÂÚÁ›Â˜-¿ÛıÌ·-·ÏÏÂÚÁÈÎ‹ ÚÈÓ›ÙÈ‰·Á. ŒÎ˙ÂÌ·-¿ÛıÌ·-ÙÚÔÊÈÎ¤˜ ·ÏÏÂÚÁ›Â˜-·ÏÏÂÚÁÈÎ‹ ÚÈÓ›ÙÈ‰·‰. ∞ÏÏÂÚÁÈÎ‹ ÚÈÓ›ÙÈ‰·-¤Î˙ÂÌ·-¿ÛıÌ·-ÙÚÔÊÈÎ¤˜ ·ÏÏÂÚÁ›Â˜

4. √È ·Ú·Î¿Ùˆ Î˘ÙÙ·ÚÔÎ›ÓÂ˜ ¯·Ú·ÎÙËÚ›˙Ô˘Ó ÙËÓ Ù‡Ô˘ Th2 ·ÓÔÛÔÏÔÁÈÎ‹ ·¿ÓÙËÛË Ô˘ Â˘ı‡ÓÂÙ·È ÁÈ· ÙËÓ·Ó¿Ù˘ÍË ·ÏÏÂÚÁÈÎÒÓ ÂÎ‰ËÏÒÛÂˆÓ, ÂÎÙfi˜ ·fi ÙËÓ:·. INF- Á‚. IL-4Á. IL-5‰. IL-13

5. ∞‡ÍËÛË ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ ·ı‹ÛÂˆÓ ·Ú·ÙËÚÂ›Ù·È:·. ™Â ¯ÒÚÂ˜ Ô˘ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ˘ÈÔı¤ÙËÛ·Ó ÙÔ “‰˘ÙÈÎfi” ÌÔÓÙ¤ÏÔ ˙ˆ‹˜‚. ™Â ÌÂÁ·Ï‡ÙÂÚÔ ‚·ıÌfi ÛÙÔ˘˜ ÓÂfiÙÂÚÔ˘˜ ÛÂ Û¯¤ÛË ÌÂ ÙÔ˘˜ ÈÔ ËÏÈÎÈˆÌ¤ÓÔ˘˜Á. ™Â ·ÓıÚÒÔ˘˜ ÌÂÁ·Ï‡ÙÂÚË˜ ËÏÈÎ›·˜ ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙÈ˜ ÚÔ¯ˆÚËÌ¤ÓÂ˜ ËÏÈÎ›Â˜ ÛÂ ÚÔËÁÔ‡ÌÂÓÂ˜ ‰ÂÎ·-

ÂÙ›Â˜‰. ™Â fiÏÂ˜ ÙÈ˜ ·Ú·¿Óˆ ÂÚÈÙÒÛÂÈ˜

√È ÛˆÛÙ¤˜ ··ÓÙ‹ÛÂÈ˜ ÛÙË ÛÂÏ›‰· 292




ªËÙÚÈÎfi˜ ıËÏ·ÛÌfi˜: ÚÔÛÙ·ÙÂ‡ÂÈ ÙÂÏÈÎ¿ Î·È ·fi ÓÂÔÏ·-

Û›Â˜;

¢. ª·Ùı·›Ô˜3, ∂. ª·ÓÙ·‰¿ÎË˜2, ¶. §¿ÈÔ˜1, ™. ∫·ÎÔÏ‡ÚË˜3, ∞. Ã·Ù˙ËÌÈ¯·‹Ï1

¶ÂÚ›ÏË„Ë: ∆Ô ÌËÙÚÈÎfi Á¿Ï· ÂÚÈ¤¯ÂÈ Ô˘Û›Â˜ Ô˘ ÚÔÛÙ·ÙÂ‡Ô˘Ó ÙÔ ‚Ú¤ÊÔ˜ ·fi ÏÔÈÌÒÍÂÈ˜ Î·È ‚ÔËıÔ‡ÓÛÙËÓ ˆÚ›Ì·ÓÛË ÙÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡ ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜. ∂ÂÈ‰‹ Ë √§§, Ë Û˘¯ÓfiÙÂÚË ÓÂÔÏ·Û›· ÛÙ· ·È‰È¿ÌÔÚÂ› Ó· Û¯ÂÙ›˙ÂÙ·È ÌÂ Î·ı˘ÛÙÂÚËÌ¤ÓË ¤ÎıÂÛË ÛÂ ÎÔÈÓ¤˜ ÏÔÈÌÒÍÂÈ˜, ˘¿Ú¯ÂÈ Ë ¿Ô„Ë fiÙÈ Ô ÌËÙÚÈÎfi˜ ıË-Ï·ÛÌfi˜ ı· ÌÔÚÔ‡ÛÂ Ó· ÌÂÙ·‚¿ÏÂÈ ÙËÓ Â›ÙˆÛ‹ ÙË˜ Ì¤Ûˆ ÚÔÊ‡Ï·ÍË˜ ·fi ÎÔÈÓ¤˜ ÏÔÈÌÒÍÂÈ˜. ¶ÚÔÎÂÈ-Ì¤ÓÔ˘ Ó· ‰ÈÂÚÂ˘Ó‹ÛÔ˘ÌÂ ·Ó fiÓÙˆ˜ Ô ÌËÙÚÈÎfi˜ ıËÏ·ÛÌfi˜ ·ÛÎÂ› ÚÔÛÙ·ÙÂ˘ÙÈÎ‹ Â›‰Ú·ÛË ¤Ó·ÓÙÈ ÙË˜ √§§,·ÏÏ¿ Î·È ¿ÏÏˆÓ ÓÂÔÏ·ÛÈÒÓ ÙË˜ ·È‰ÈÎ‹˜ Î·È ÂÓ‹ÏÈÎË˜ ̇ ˆ‹˜, ÚÔ‚‹Î·ÌÂ ÛÂ ·Ó·ÛÎfiËÛË ÌÂÏÂÙÒÓ Ô˘ ‰Ë-ÌÔÛÈÂ‡ÙËÎ·Ó ÛÙËÓ Medline ÌÂÙ·Í‡ 1948-2006, Î·ıÒ˜ Î·È ÙˆÓ ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ÙÔ˘˜ ·Ó·ÊÔÚÒÓ. ∏ Û˘-ÓÙÚÈÙÈÎ‹ ÏÂÈÔ„ËÊ›· ÙˆÓ Û¯ÂÙÈÎÒÓ ÌÂÏÂÙÒÓ Â›Ó·È ÌÂÏ¤ÙÂ˜ ·Ú·Ù‹ÚËÛË˜ ·ÛıÂÓÒÓ-Ì·ÚÙ‡ÚˆÓ, ·ÚÎÂÙ¤˜ ÌÂÌÈÎÚfi ·ÚÈıÌfi ·ÛıÂÓÒÓ, ÂÓÒ ÛÂ ÔÏÏ¤˜ ‰ÂÓ ˘¿Ú¯ÂÈ Â·ÚÎ‹˜ ¤ÏÂÁ¯Ô˜ ÁÈ· Û˘Ó˘¿Ú¯Ô˘ÛÂ˜ ÌÂÙ·‚ÏËÙ¤˜.¢‡Ô ‰ËÌÔÛÈÂ˘Ì¤ÓÂ˜ ÌÂÙ··Ó·Ï‡ÛÂÈ˜ ÙˆÓ ·Ú·¿Óˆ ÌÂÏÂÙÒÓ ·Ó·Ê¤ÚÔ˘Ó fiÙÈ Ë ·‡ÍËÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓÌËÙ¤ÚˆÓ Ô˘ ıËÏ¿˙Ô˘Ó ı· ÌÔÚÔ‡ÛÂ ÛÙËÓ Î·Ï‡ÙÂÚË ÂÚ›ÙˆÛË Ó· ÌÂÈÒÛÂÈ ÙÔÓ ·ÚÈıÌfi Ó¤ˆÓ ÂÚÈÛÙ·ÙÈ-ÎÒÓ ÔÍÂ›·˜ ÏÂ˘¯·ÈÌ›·˜ ‹ ÏÂÌÊÒÌ·ÙÔ˜ ÛÙ· ·È‰È¿ Î·Ù¿ 5%, ÂÓÒ ıÂÙÈÎ‹ Â›‰Ú·ÛË ÛÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜ ‚Ú¤ıËÎÂÌfiÓÔ ÁÈ· ÙÔÓ ÚÔÂÌÌËÓÔ·˘ÛÈ·Îfi Î·ÚÎ›ÓÔ ÙÔ˘ Ì·ÛÙÔ‡. ™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, ··ÈÙÔ‡ÓÙ·È Î·Ï‡ÙÂÚ· Û¯Â-‰È·ÛÌ¤ÓÂ˜, Ì·ÎÚÔ¯ÚfiÓÈÂ˜, ÚÔÔÙÈÎ¤˜ ÌÂÏ¤ÙÂ˜ ÛÙÔ Ì¤ÏÏÔÓ, Ô˘ Ó· Ï·Ì‚¿ÓÔ˘Ó ˘fi„Ë ‰È¿ÊÔÚÔ˘˜ ÂÈÌ¤-ÚÔ˘˜ ·Ú¿ÁÔÓÙÂ˜, ÒÛÙÂ Ó· ‰ÈÂ˘ÎÚÈÓÈÛÙÂ› Ï‹Úˆ˜ Ù˘¯fiÓ Â›‰Ú·ÛË ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡ ÛÙËÓ ·Ó¿Ù˘-ÍË ÓÂÔÏ·ÛÈÒÓ. ∞Ó Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ·fi ÙÈ˜ ÌÂÏ¤ÙÂ˜ ·˘Ù¤˜ Â›Ó·È ıÂÙÈÎ¿, ÔÈ ·È‰›·ÙÚÔÈ ·ÏÏ¿ Î·È Ë ÎÔÈÓˆÓ›·ÁÂÓÈÎfiÙÂÚ· ı· ¤¯Ô˘Ó ¤Ó· ·ÎfiÌ· ÂÈ¯Â›ÚËÌ· ÁÈ· Ó· ÚÔˆı‹ÛÔ˘Ó ÂÓÂÚÁ¿ ÙÔÓ ÌËÙÚÈÎfi ıËÏ·ÛÌfi.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ªËÙÚÈÎfi˜ ıËÏ·ÛÌfi˜, Î·ÚÎ›ÓÔ˜, ·ÓıÚÒÈÓÔ Á¿Ï·, ÏÂ˘¯·ÈÌ›·, ·Ó·ÛÎfiËÛË.

µreastfeeding: does it also protect against neoplasms?

D. Matthaios3, E. Mantadakis2, P.Laios1, S. Kakolyris3, A. Chatzimihail1

Abstract: Human milk contains substances that protect infants against infections and help the maturationof the immune system. Since acute lymphatic leukaemia (ALL), the most common paediatric neoplasm,has been related to delayed exposure to common infections, the opinion has been expressed thatbreastfeeding could modify its incidence by offering protection against these infections. In order to clarifywhether breastfeeding is indeed protective against ALL and other forms of neoplasia in children andadults, a review was made of Medline-indexed papers published between 1948 and 2006, and theirreferences. The vast majority of relevant studies were observational case-control studies, several of whichconcerned small numbers of patients, and many did not correct adequately for confounding variables.Two published metanalyses of these studies suggest that increasing the number of women who breastfeedcould at best decrease the incidence of acute leukaemia and lymphoma in children by 5%, while aprotective role for adults was seen only for premenopausal breast cancer. In conclusion, better-plannedlong-term, prospective studies are required, with control for confounding variables, in order to define therole, if any, of breastfeeding in the development of malignancies. If these studies provide positiveindications of a protective role, then paediatricians and society will have another reason for activelypromoting breastfeeding.

Key words: Breastfeeding, cancer, human milk, leukaemia, review.

1 ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹¶·ÓÂÈÛÙËÌÈ·ÎÔ‡¡ÔÛÔÎÔÌÂ›Ô˘∞ÏÂÍ·Ó‰ÚÔ‡ÔÏË˜

2 ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹∞ÈÌ·ÙÔÏÔÁ›·˜ - √ÁÎÔÏÔÁ›·˜,¶·ÓÂÈÛÙËÌÈ·ÎÔ‡¡ÔÛÔÎÔÌÂ›Ô˘ ∏Ú·ÎÏÂ›Ô˘

3 ∫ÏÈÓÈÎ‹ ¶·ıÔÏÔÁÈÎ‹˜√ÁÎÔÏÔÁ›·˜,¶·ÓÂÈÛÙËÌÈ·ÎÔ‡¡ÔÛÔÎÔÌÂ›Ô˘∞ÏÂÍ·Ó‰ÚÔ‡ÔÏË˜


¶·Ó·ÁÈÒÙË˜ §¿ÈÔ˜[email protected]ª·˘ÚÔÎÔÚ‰¿ÙÔ˘ 15∆.∫. 681 00,∞ÏÂÍ·Ó‰ÚÔ‡ÔÏË

1 Paediatric Department,Alexandroupoli UniversityHospital

2 Paediatric Haematology -Oncology Department,Herakleion UniversityHospital

3 Internal OncologyDepartment,Alexandroupoli UniversityHospital

Correspondence:

Panagiotis [email protected], Mavrokordatou St.681 00, Alexandroupoli,Greece

™˘ÓÙÔÌÔÁÚ·Ê›Â˜

ALL Acute Lymphoblastic LeukemiaHAMLET Human Alpha-Lactalbumin Made

LEthal to Tumor cells√§§ √ÍÂ›· §ÂÌÊÔ‚Ï·ÛÙÈÎ‹ §Â˘¯·ÈÌ›·∫¡™ ∫ÂÓÙÚÈÎfi ¡Â˘ÚÈÎfi ™‡ÛÙËÌ·

∂ÈÛ·ÁˆÁ‹

∏ Â˘ÓÔ˚Î‹ Â›‰Ú·ÛË ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·-

ÛÌÔ‡ ÛÙËÓ ÚfiÏË„Ë ÙË˜ ÂÌÊ¿ÓÈÛË˜ ÓÔÛËÌ¿ÙˆÓ

ÙfiÛÔ ÛÙË ‚ÚÂÊÈÎ‹ fiÛÔ Î·È ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›·

¤¯ÂÈ ·Ô‰ÂÈ¯ıÂ› ·fi ‰È¿ÊÔÚÂ˜ ÌÂÏ¤ÙÂ˜ (1). O

ÌËÙÚÈÎfi˜ ıËÏ·ÛÌfi˜ Â›Ó·È ·Ô‰Â‰ÂÈÁÌ¤ÓÔ fiÙÈ

ÚÔÛÙ·ÙÂ‡ÂÈ ·fi ÏÔÈÌÒÍÂÈ˜ ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈ-

ÎÔ‡, ˆÙ›ÙÈ‰Â˜, ÏÔÈÌÒÍÂÈ˜ ÙÔ˘ Î·ÙÒÙÂÚÔ˘ ·Ó·-

ÓÂ˘ÛÙÈÎÔ‡, ÓÂÎÚˆÙÈÎ‹ ÂÓÙÂÚÔÎÔÏ›ÙÈ‰·, ¤Î˙Â-

Ì·, ‰ÈÂÈÛ‰˘ÙÈÎ¤˜ ÏÔÈÌÒÍÂÈ˜ (ÌÈÎÚÔ‚È·ÈÌ›Â˜,


ÌËÓÈÁÁ›ÙÈ‰Â˜) Î·È Ô˘ÚÔÏÔÈÌÒÍÂÈ˜ (2-10). ∆· ÓÂÔÁÓ¿

Ô˘ ıËÏ¿˙Ô˘Ó ÂÌÊ·Ó›˙Ô˘Ó Â›ÛË˜ ·˘ÍËÌ¤ÓË ·ÓÙÈ-

ÛˆÌ·ÙÈÎ‹ ·¿ÓÙËÛË ÛÂ ÂÌ‚fiÏÈ· Î·È ÌÂÁ·Ï‡ÙÂÚÔ ı‡-

ÌÔ ·‰¤Ó· (11,12), ÂÓÒ Ù· ‚Ú¤ÊË Ô˘ ıËÏ¿˙Ô˘Ó ÁÈ·

‰È¿ÛÙËÌ· ÌÂÁ·Ï‡ÙÂÚÔ ·fi 6 Ì‹ÓÂ˜ ¤¯Ô˘Ó ÌÈÎÚfiÙÂÚË

ıÓËÙfiÙËÙ· Î·È ıÓËÛÈÌfiÙËÙ· ÛÂ Û¯¤ÛË ÌÂ ·˘Ù¿ Ô˘

‰ÂÓ ıËÏ¿˙Ô˘Ó (13).

∆Ô ÌËÙÚÈÎfi Á¿Ï· ·Ú¤¯ÂÈ ÚÔÛÙ·Û›· ¤Ó·ÓÙÈ ÙˆÓ

ÌÈÎÚÔ‚È·ÎÒÓ ÏÔÈÌÒÍÂˆÓ, Ì¤Ûˆ ÙˆÓ ·ÓÙÈÛˆÌ¿ÙˆÓ,

ÏÈÈ‰›ˆÓ, ÁÏ˘ÎÔÚˆÙÂ˚ÓÒÓ Î·È ¿ÏÏˆÓ ÚˆÙÂ˚ÓÒÓ

Ô˘ ÂÚÈ¤¯ÂÈ (14-16). ¶·Ú¿ÏÏËÏ·, ÛÙÔ ÌËÙÚÈÎfi Á¿Ï·

¤¯Ô˘Ó ‚ÚÂıÂ› ÔÚÌfiÓÂ˜, Î˘ÙÙ·ÚÔÎ›ÓÂ˜ Î·È ¤Ó˙˘Ì· Ô˘

‰È·‰Ú·Ì·Ù›˙Ô˘Ó ÛËÌ·ÓÙÈÎfi ·ÓÔÛÔÙÚÔÔÔÈËÙÈÎfi

ÚfiÏÔ ÛÙËÓ ˆÚ›Ì·ÓÛË ÙÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·-

ÙÔ˜ ÙÔ˘ ‚Ú¤ÊÔ˘˜ (17).

™‡ÌÊˆÓ· ÌÂ Ì›· ÌÂÏ¤ÙË, ÙÔ ÌËÙÚÈÎfi Á¿Ï· ÂÚÈ¤-

¯ÂÈ Ï‹ıÔ˜ ·Ú·ÁfiÓÙˆÓ, ÔÏÏÔ› ·fi ÙÔ˘˜ ÔÔ›Ô˘˜

‰ÂÓ ¤¯Ô˘Ó ·ÎfiÌ· Ù·˘ÙÔÔÈËıÂ› Î·È ÔÈ ÔÔ›ÔÈ ‰ÚÔ˘Ó

ÛÂ ÂÏ¿¯ÈÛÙÂ˜ Û˘ÁÎÂÓÙÚÒÛÂÈ˜ Î·È Û˘¯Ó¿ Û˘ÓÂÚÁÈÎ¿

(5). ∏ ‰ÈÂÚÂ‡ÓËÛË Ô˘ÛÈÒÓ, fiˆ˜ ÙÔ Û‡ÌÏÂÁÌ·

HAMLET, Ô˘ ÚÔÎ‡ÙÂÈ ·fi ÙÔ ÌËÙÚÈÎfi Á¿Ï· Î·È

¤¯ÂÈ È‰ÈfiÙËÙÂ˜ ÂÈÏÂÎÙÈÎ‹˜ Î·Ù·ÛÙÚÔÊ‹˜ ÙˆÓ Î·ÚÎÈ-

ÓÈÎÒÓ Î˘ÙÙ¿ÚˆÓ Ì¤Ûˆ Â·ÁˆÁ‹˜ ÙË˜ ·fiÙˆÛË˜,

·ÔÙÂÏÂ› ·ÓÙÈÎÂ›ÌÂÓÔ ÌÂÏ¤ÙË˜ (18-20). ∆Ô ›‰ÈÔ ÈÛ¯‡-

ÂÈ Î·È ÁÈ· ÙËÓ Â›‰Ú·ÛË ÙÔ˘ ÌËÙÚÈÎÔ‡ Á¿Ï·ÙÔ˜ ÛÙËÓ

ÚfiÏË„Ë ¯ÚfiÓÈˆÓ ÓÔÛËÌ¿ÙˆÓ, fiˆ˜ Ë ·¯˘Û·ÚÎ›·

Î·È Ô Û·Î¯·ÚÒ‰Ë˜ ‰È·‚‹ÙË˜, ÙfiÛÔ ÛÙ· ·È‰È¿ fiÛÔ

Î·È ÛÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜ (1).

∆ÂÏÂ˘Ù·›·, Ô ÚfiÏÔ˜ ÙÔ˘ ÌËÙÚÈÎÔ‡ Á¿Ï·ÙÔ˜ ÛÙËÓ

ÚfiÏË„Ë ‰È·ÊfiÚˆÓ ÌÔÚÊÒÓ ÓÂÔÏ·Û›·˜ ·ÔÙÂÏÂ›

·ÓÙÈÎÂ›ÌÂÓÔ ÌÂÏ¤ÙË˜. ™ÙËÓ ·ÚÔ‡Û· Û‡ÓÙÔÌË ·Ó·-

ÛÎfiËÛË ‰ÈÂÚÂ˘ÓÒÓÙ·È ÔÈ Èı·Ó¤˜ ÂÈ‰Ú¿ÛÂÈ˜ ÙÔ˘

ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡ ÛÙËÓ ÚfiÏË„Ë ‰È·ÊfiÚˆÓ ÓÂÔ-

Ï·ÛÈÒÓ ÙfiÛÔ ÛÙËÓ ·È‰ÈÎ‹ fiÛÔ Î·È ÛÙËÓ ÂÓ‹ÏÈÎË

˙ˆ‹. °È· ÙÔÓ ÛÎÔfi ·˘Ùfi, Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ ·Ó·-

ÛÎfiËÛË ÌÂÏÂÙÒÓ Ô˘ ‰ËÌÔÛÈÂ‡ÙËÎ·Ó ÛÙËÓ

Medline ÌÂÙ·Í‡ 1948-2006 Î·È ÙˆÓ ·Ó·ÊÔÚÒÓ ÙÔ˘˜.

™˘ÓÔÏÈÎ¿, ¤ÁÈÓÂ ·Ó·ÛÎfiËÛË 41 ÂÚÁ·ÛÈÒÓ Ô˘

Ú·ÁÌ·ÙÂ‡ÔÓÙ·È ÙË Û¯¤ÛË ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡ Î·È

ÂÌÊ¿ÓÈÛË˜ ÓÂÔÏ·ÛÈÒÓ, ÔÈ 26 ÛÂ ·È‰È¿ Î·È ÔÈ 15 ÛÂ

ÂÓ‹ÏÈÎÂ˜ (21-60). √È ÂÚÁ·Û›Â˜ ·˘Ù¤˜ ÂÚÈÏ·Ì‚¿ÓÔ-

ÓÙ·È ÛÂ ‰‡Ô ÌÂÙ·Ó·Ï‡ÛÂÈ˜ Ô˘ ÔÏÔÎÏËÚÒıËÎ·Ó ·fi

ÙËÓ ›‰È· ÔÌ¿‰· ÂÚÂ˘ÓËÙÒÓ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ÙÔ˘

Bristol Î·È ÙÔ˘ ÓÔÛÔÎÔÌÂ›Ô˘ St. George ÙÔ˘ §ÔÓ‰›ÓÔ˘

(61,62). ¶ÚÈÓ ·Ó·ÊÂÚıÔ‡ÌÂ, fiÌˆ˜, ÛÙ· ‚È‚ÏÈÔÁÚ·ÊÈ-

Î¿ ‰Â‰ÔÌ¤Ó·, ·˜ Û˘˙ËÙ‹ÛÔ˘ÌÂ ÂÓ Ù¿¯ÂÈ ÙÈ˜ ·fi„ÂÈ˜

ÁÈ· ÙËÓ ·ıÔÁ¤ÓÂÛË ÙË˜ √§§, ÙË˜ Û˘¯ÓfiÙÂÚË˜ ·È-

‰È·ÙÚÈÎ‹˜ ÓÂÔÏ·Û›·˜.

∞ÈÙÈÔ·ıÔÁ¤ÓÂÛË ·È‰ÈÎÒÓ ÏÂ˘¯·ÈÌÈÒÓ

∞Ó Î·È Ù· ·›ÙÈ· ÙË˜ ·È‰ÈÎ‹˜ ÏÂ˘¯·ÈÌ›·˜ ÌÂÏÂ-

ÙÔ‡ÓÙ·È ¿Óˆ ·fi ÌÈÛfi ·ÈÒÓ·, ‰ÂÓ ¤¯Ô˘Ó ·ÎfiÌ· ‰È-

Â˘ÎÚÈÓÈÛÙÂ›. ∂›Ó·È fiÌˆ˜ Û·Ê¤˜ fiÙÈ Ë ·È‰ÈÎ‹ ÏÂ˘-

¯·ÈÌ›· ·ÔÙÂÏÂ› ÔÏ˘·Ú·ÁÔÓÙÈÎ‹ ÓfiÛÔ. ∂È‰ËÌÈÔ-

ÏÔÁÈÎ¤˜ ÌÂÏ¤ÙÂ˜ ·Ú¤¯Ô˘Ó ¤ÌÌÂÛÂ˜ ÂÓ‰Â›ÍÂÈ˜ fiÙÈ Ë

ÔÍÂ›· ÏÂ˘¯·ÈÌ›· ÙˆÓ ·È‰ÈÒÓ ¤¯ÂÈ ÂÌ‚Ú˘˚Î‹ ÚÔ¤-

ÏÂ˘ÛË, ·ÚfiÏÔ Ô˘ Ì›· Ù¤ÙÔÈ· Û˘Û¯¤ÙÈÛË Â›Ó·È ÈÔ

ÂÌÊ·Ó‹˜ ÁÈ· ÙËÓ ÔÍÂ›· Ì˘ÂÏÔÁÂÓ‹ ÏÂ˘¯·ÈÌ›· ÙˆÓ

‚ÚÂÊÒÓ ·Ú¿ ÁÈ· ÙËÓ √§§ ÙˆÓ ‚ÚÂÊÒÓ ‹ ÙˆÓ ·È-

‰ÈÒÓ. °ÂÓÂÙÈÎ¤˜ ·ÓˆÌ·Ï›Â˜, fiˆ˜ ÙÔ Û‡Ó‰ÚÔÌÔ

Down, ÙÔ Û‡Ó‰ÚÔÌÔ Bloom, Ë ·Ó·ÈÌ›· Fanconi, Ë

·Ù·Í›·-ÙËÏ·ÁÁÂÈÂÎÙ·Û›·, ·ÏÏ¿ Î·È Ë ¤ÎıÂÛË ÛÂ ÈÔÓ›-

˙Ô˘Û· ·ÎÙÈÓÔ‚ÔÏ›·, ·ÎfiÌ· Î·È Î·Ù¿ ÙËÓ ÂÓ‰ÔÌ‹ÙÚÈÔ

˙ˆ‹, Î·ıÒ˜ Î·È Ë ¯Ú‹ÛË ¯ËÌÈÎÒÓ, Ê·ÚÌ¿ÎˆÓ ‹ ¯Ë-

ÌÂÈÔıÂÚ·Â›·˜ Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ·˘ÍËÌ¤ÓË Â›ÙˆÛË

·È‰ÈÎ‹˜ ÏÂ˘¯·ÈÌ›·˜. ∂ÓÙÔ‡ÙÔÈ˜, ÙÔ ÔÛÔÛÙfi ÙË˜

·È‰ÈÎ‹˜ ÏÂ˘¯·ÈÌ›·˜ Ô˘ Û¯ÂÙ›˙ÂÙ·È ÌÂ ÁÓˆÛÙÔ‡˜

Î·ÚÎÈÓÔÁfiÓÔ˘˜ ·Ú¿ÁÔÓÙÂ˜ ‹ ÎÏËÚÔÓÔÌÔ‡ÌÂÓÂ˜ ÁÂ-

ÓÂÙÈÎ¤˜ ‰È·Ù·Ú·¯¤˜ Â›Ó·È <5% (63).

∏ Èı·Ó‹ Û˘Û¯¤ÙÈÛË ·È‰ÈÎÒÓ ÏÂ˘¯·ÈÌÈÒÓ ÌÂ

ÏÔÈÌÒÍÂÈ˜ Î·È ·ÛÙ˘ÊÈÏ›· ·ÔÙÂÏÂ› ·ÓÙÈÎÂ›ÌÂÓÔ ÌÂ-

Ï¤ÙË˜ ÙÔ˘ Kinlen Â‰Ò Î·È ‰ÂÎ·ÂÙ›Â˜ (64-67). ª¿ÏÈ-

ÛÙ·, ̆ ¿Ú¯ÂÈ Ë ¿Ô„Ë fiÙÈ Ù· ̆ „ËÏ¿ ÔÛÔÛÙ¿ ıÓËÙfi-

ÙËÙ·˜ ·fi ÏÂ˘¯·ÈÌ›Â˜ ÛÙ· ·È‰È¿ Î·Ù¿ ÙÈ˜ ‰ÂÎ·ÂÙ›Â˜

ÙÔ˘ 1950 Î·È 1960 ÛÙËÓ ∂ÏÏ¿‰· Î·È ÙËÓ πÙ·Ï›· Û¯ÂÙ›-

˙ÔÓÙ·Ó ÌÂ ÙËÓ ÂÛˆÙÂÚÈÎ‹ ÌÂÙ·Ó¿ÛÙÂ˘ÛË ·fi ·ÁÚÔ-

ÙÈÎ¤˜ ÛÂ ·ÛÙÈÎ¤˜ ÂÚÈÔ¯¤˜ Ô˘ ÂÈÎÚ·ÙÔ‡ÛÂ ÙËÓ Â-

Ú›Ô‰Ô ÂÎÂ›ÓË (67).

∆· ‰Â‰ÔÌ¤Ó· ÈÔÁÂÓÔ‡˜ Î·ÚÎÈÓÔÁ¤ÓÂÛË˜ Î·È ÏÂ˘-

¯·ÈÌÈÔÁ¤ÓÂÛË˜ ÛÙÔ˘˜ ·ÓıÚÒÔ˘˜ Â›Ó·È ÔÏÏ¿

(68,69), ·ÏÏ¿ ‰ÂÓ Û¯ÂÙ›˙ÔÓÙ·È ¿ÌÂÛ· ÌÂ ÙÔÓ ·È‰ÈÎfi

Î·ÚÎ›ÓÔ, ÌÂ ÂÍ·›ÚÂÛË ÙÔ ÂÓ‰ËÌÈÎÔ‡ Ù‡Ô˘ Ï¤ÌÊˆÌ·

Burkitt Ô˘ Â›Ó·È ÂÍ·ÈÚÂÙÈÎ¿ Û˘¯Ófi ÛÙËÓ ∞ÊÚÈÎ‹ Î·È

·Ô‰Â‰ÂÈÁÌ¤Ó· Û¯ÂÙ›˙ÂÙ·È ÌÂ ÙÔÓ Èfi Epstein Barr

(69), ·ÏÏ¿ Î·È ÙÔ Ë·ÙÔÎ˘ÙÙ·ÚÈÎfi Î·ÚÎ›ÓˆÌ· Ô˘

Û¯ÂÙ›˙ÂÙ·È ÌÂ ÙÔÓ Èfi ÙË˜ Ë·Ù›ÙÈ‰·˜ µ (70). ∞ÈÙÈÔÏÔ-

ÁÈÎ‹ Û˘Û¯¤ÙÈÛË ÛÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜ ˘¿Ú¯ÂÈ Î·È ÌÂÙ·Í‡

ÙÔ˘ ÈÔ‡ ÙË˜ Ë·Ù›ÙÈ‰·˜ C Î·È ÙˆÓ Û¿ÓÈˆÓ ÌË

Hodgkin ÏÂÌÊˆÌ¿ÙˆÓ ÙÔ˘ ‹·ÙÔ˜ (71).

√ ‚ÚÂÙ·Ófi˜ ·ÓÔÛÔÏfiÁÔ˜ Mel Greaves ‰È·Ù‡ˆ-

ÛÂ ÙËÓ ¿Ô„Ë fiÙÈ Ë ÎÔÈÓ‹ √§§ µ-Î˘ÙÙ·ÚÈÎ‹˜ ÚÔ-

¤ÏÂ˘ÛË˜, Ë ÈÔ Û˘¯Ó‹ ÌÔÚÊ‹ ÏÂ˘¯·ÈÌ›·˜ ÙˆÓ ·È-

‰ÈÒÓ, Â›Ó·È ·ÔÙ¤ÏÂÛÌ· Ì›·˜ ·ÓÒÌ·ÏË˜ ‹ Î·ı˘ÛÙÂ-

ÚËÌ¤ÓË˜ ·¿ÓÙËÛË˜ ÙÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹-

Ì·ÙÔ˜ ÛÂ ÎÔÈÓ¤˜ ÏÔÈÌÒÍÂÈ˜ Î·È fi¯È ·ÔÙ¤ÏÂÛÌ·

ÏÂ˘¯·ÈÌÈÔÁ¤ÓÂÛË˜ ·fi ¤Ó·Ó Û˘ÁÎÂÎÚÈÌ¤ÓÔ ÏÔÈÌÔ-

ÁfiÓÔ ·Ú¿ÁÔÓÙ·, Ô˘ Ô‡Ùˆ˜ ‹ ¿ÏÏˆ˜ Ô˘‰¤ÔÙÂ

¤¯ÂÈ Ù·˘ÙÔÔÈËıÂ› (63,72-74). ŒÓ· ·Ú¯ÈÎfi Ù˘¯·›Ô

Û˘Ì‚¿Ó Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ‰È·›ÚÂÛË˜ ÙˆÓ Úfi-

‰ÚÔÌˆÓ µ Î˘ÙÙ¿ÚˆÓ ÚÈÓ ‹ ÌÂÙ¿ ÙË Á¤ÓÓËÛË ·ÎÔ-

ÏÔ˘ıÂ›Ù·È ·fi ¤Ó· ‰Â‡ÙÂÚÔ Û˘Ì‚¿Ó ÛÙÔÓ ÌÂÙ·ÏÏ·Á-

Ì¤ÓÔ ÎÏÒÓÔ, ˆ˜ ·ÔÙ¤ÏÂÛÌ· Î·ı˘ÛÙÂÚËÌ¤ÓË˜ ‹

˘ÂÚ‚ÔÏÈÎ¿ ·ÓÒÌ·ÏË˜ ·ÓoÛÔÏÔÁÈÎ‹˜ ‰È¤ÁÂÚÛË˜

Î·Ù¿ ÙËÓ ÂÍˆÌ‹ÙÚÈÔ ˙ˆ‹, ÌÂ Û˘ÓÂ·ÎfiÏÔ˘ıË ÂÌ-

Ê¿ÓÈÛË ÏÂ˘¯·ÈÌ›·˜. ∆Ô ÚfiÙ˘Ô Î·È Ë ¯ÚÔÓÈÎ‹ ÛÙÈÁ-

Ì‹ ÙˆÓ ÌË ÂÈ‰ÈÎÒÓ ÏÔÈÌÒÍÂˆÓ Â›Ó·È Èı·ÓfiÙ·Ù· ÔÈ

273ªËÙÚÈÎfi˜ ıËÏ·ÛÌfi˜ Î·È ÓÂÔÏ·Û›Â˜

¶·È‰È·ÙÚÈÎ‹ 2007;70:272-277


Ï¤ÔÓ ÛËÌ·ÓÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË

ÏÂ˘¯·ÈÌ›·˜.

¶Ú¿ÁÌ·ÙÈ, ÂÈ‰ËÌÈÔÏÔÁÈÎ¤˜ ¤ÚÂ˘ÓÂ˜ ‰È·›ÛÙˆ-

Û·Ó fiÙÈ ·È‰È¿ ÌÂ ÏÂ˘¯·ÈÌ›· ‰ÂÓ Â›¯·Ó ÂÎÙÂıÂ› Î·Ù¿

ÙËÓ ÚÒÈÌË ‚ÚÂÊÈÎ‹ ËÏÈÎ›· ÛÂ ÎÔÈÓ¤˜ ÏÔÈÌÒÍÂÈ˜ ÛÂ

Û¯¤ÛË ÌÂ ÔÌ¿‰· ÂÏ¤Á¯Ô˘. ∏ ·˘ÍËÌ¤ÓË Â›ÙˆÛË ÙË˜

ÓfiÛÔ˘ ÛÂ ÂÚÈÛÛfiÙÂÚÔ ·Ó·Ù˘ÁÌ¤ÓÂ˜ ÎÔÈÓˆÓ›Â˜

Û˘Ì‚·‰›˙ÂÈ ÌÂ ÙË ıÂˆÚ›· ·˘Ù‹ (63,72-74).

∏ Û˘ÏÏÔÁ‹ ·›Ì·ÙÔ˜ ÓÂÔÁÓÒÓ ÛÂ Î¿ÚÙÂ˜ Guthrie

Á›ÓÂÙ·È ·Ú·‰ÔÛÈ·Î¿ ÁÈ· ÙËÓ ·Ó›¯ÓÂ˘ÛË ÎÏËÚÔÓÔ-

ÌÔ‡ÌÂÓˆÓ ‰È·Ù·Ú·¯ÒÓ ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡, fiˆ˜ Ë

Ê·ÈÓ˘ÏÎÂÙÔÓÔ˘Ú›·, ·ÏÏ¿ Û˘Ì‚¿ÏÏÂÈ Î·È ÛÙË ‰ÈÂ-

ÚÂ‡ÓËÛË ¿ÏÏˆÓ ÁÂÓÂÙÈÎÒÓ ·ÏÏ·ÁÒÓ Ô˘ Û˘Ì‚·›-

ÓÔ˘Ó Î·Ù¿ ÙËÓ ÂÓ‰ÔÌ‹ÙÚÈÔ ˙ˆ‹. ∏ ÁÂÓÂÙÈÎ‹ Ù·˘ÙÔ-

Ô›ËÛË ÛÂ Ù¤ÙÔÈÂ˜ Î¿ÚÙÂ˜ ÙË˜ ÎÚ˘ÙÈÎ‹˜ ÌÂÙ¿ÏÏ·-

ÍË˜ TEL-AML1, ÙË˜ Û˘¯ÓfiÙÂÚË˜ Â›ÎÙËÙË˜ ÌÔÚÈ·-

Î‹˜ ·ÓˆÌ·Ï›·˜ ·È‰ÈÒÓ ÌÂ √§§, ÂÓÈÛ¯‡ÂÈ ÙËÓ ·-

Ú·¿Óˆ ıÂˆÚ›· (72,75,76). ¶·ÚfiÏÔ Ô˘ ‰ÂÓ ˘¿Ú-

¯Ô˘Ó ·ÎfiÌ· ·ÚÎÂÙ¿ ‰Â‰ÔÌ¤Ó·, Â›Ó·È ÔÏ‡ Èı·Ófi

fiÙÈ ÔÏ‡ ÂÚÈÛÛfiÙÂÚ· ÓÂÔÁÓ¿ Ê¤ÚÔ˘Ó ÙË ÌÂÙ¿ÏÏ·-

ÍË TEL-AML1 ·fi fiÛ· ÙÂÏÈÎ¿ ı· ·Ó·Ù‡ÍÔ˘Ó ÎÔÈ-

Ó‹ √§§, Î¿ÙÈ Ô˘ ÛËÌ·›ÓÂÈ fiÙÈ Ë ÌÂÙ¿ÏÏ·ÍË ·˘Ù‹

·fi ÌfiÓË ÙË˜ ‰ÂÓ ·ÚÎÂ› ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ÏÂ˘¯·È-

Ì›·˜, ·ÏÏ¿ fiÙÈ ¤Ó· ‰Â‡ÙÂÚÔ ÁÂÁÔÓfi˜, Èı·ÓfiÓ Ë

·ÒÏÂÈ· ÙÔ˘ ‰Â‡ÙÂÚÔ˘ ÁÔÓÈ‰›Ô˘ TEL Â›Ó·È ··Ú·›-

ÙËÙË ÁÈ· ÙËÓ ÂÎ‰‹ÏˆÛË ÙË˜ ÎÔÈÓ‹˜ √§§ ÛÙËÓ ·È-

‰ÈÎ‹ ËÏÈÎ›· (72).

∞Ó Ë ıÂˆÚ›· ÙÔ˘ Greaves Â›Ó·È ÛˆÛÙ‹, ÙfiÙÂ ÔÙÈ‰‹-

ÔÙÂ ÚÔÛÙ·ÙÂ‡ÂÈ ÙÔ ·È‰› ·fi ÎÔÈÓ¤˜ ÏÔÈÌÒÍÂÈ˜ ‹

‚ÔËı¿ÂÈ ÙË ÛˆÛÙ‹ ̂ Ú›Ì·ÓÛË ÙÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡ ÙÔ˘

Û˘ÛÙ‹Ì·ÙÔ˜ ı· ÌÔÚÔ‡ÛÂ Ó· ÌÂÈÒÛÂÈ ÙËÓ Â›ÙˆÛË

ÙË˜ ÏÂ˘¯·ÈÌ›·˜, Ì›·˜ ÓfiÛÔ˘ Ô˘ Î·Ù¿ ÙÔÓ Greaves

ÌÔÚÂ› Ó· ·ÔÙÂÏÂ› ÙÔ Ù›ÌËÌ· ÙË˜ ÔÈÎÔÓÔÌÈÎ‹˜ ·Ó¿-

Ù˘ÍË˜ ÙˆÓ ·ÓıÚÒÈÓˆÓ ÎÔÈÓˆÓÈÒÓ (63,72-74).

°È· ÙÔ˘˜ ·Ú·¿Óˆ ÏfiÁÔ˘˜ ÂÚÂ˘Ó¿Ù·È Ë ı¤ÛË ÙÔ˘

ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡ ÛÙËÓ ÚfiÏË„Ë ÓÂÔÏ·ÛÈÒÓ ÙÔ˘

·ÈÌÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, Î·ıÒ˜ Â›Ó·È ÁÓˆÛÙfi fiÙÈ

ÙÔ ÌËÙÚÈÎfi Á¿Ï· ÂÚÈ¤¯ÂÈ ÔÈÎ›ÏÔ˘˜ ·ÓÙÈÌÈÎÚÔ‚È·-

ÎÔ‡˜, ·ÓÙÈÊÏÂÁÌÔÓÒ‰ÂÈ˜ Î·È ·ÓÔÛÔÙÚÔÔÔÈËÙÈ-

ÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜ Ô˘ ÚÔÛÙ·ÙÂ‡Ô˘Ó ·fi ÏÔÈÌÒ-

ÍÂÈ˜. ∂È‰ÈÎfiÙÂÚ·, fiˆ˜ ‹‰Ë ·Ó·Ê¤ÚıËÎÂ ÛÙËÓ ÂÈÛ·-

ÁˆÁ‹, ÙÔ ÌËÙÚÈÎfi Á¿Ï· ÌÔÚÂ› Ó· ÌÂÈÒÛÂÈ ÙÔÓ Î›Ó‰˘-

ÓÔ ·Ó¿Ù˘ÍË˜ ÏÔÈÌÒÍÂˆÓ ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ Î·È

·Ó·ÓÂ˘ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Î·Ù¿ ÙË ÓÂÔÁÓÈÎ‹ Î·È

ÌÂÙ¤ÂÈÙ· ˙ˆ‹ ÙÔ˘ ·È‰ÈÔ‡, Ì¤Ûˆ ÌÂÙ·ÊÔÚ¿˜ ÌËÙÚÈ-

ÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ, Ì·ÎÚÔÊ¿ÁˆÓ Î·È ÏÂÌÊÔÎ˘ÙÙ¿-

ÚˆÓ Ô˘ ˘¿Ú¯Ô˘Ó Î·Ù·Ú¯‹Ó ÛÙÔ ÚˆÙfiÁ·Ï· Î·È

ÌÂÙ¤ÂÈÙ· ÛÙÔ ÒÚÈÌÔ ÌËÙÚÈÎfi Á¿Ï·.

∞˜ ‰Ô‡ÌÂ fiÌˆ˜ ÂÚÈÏËÙÈÎ¿ Ù· ˘¿Ú¯ÔÓÙ· ‚È-

‚ÏÈÔÁÚ·ÊÈÎ¿ ‰Â‰ÔÌ¤Ó· Û¯ÂÙÈÎ¿ ÌÂ ÙËÓ Â›‰Ú·ÛË ÙÔ˘

ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡ ÛÙËÓ ·Ó¿Ù˘ÍË ·È‰ÈÎ‹˜ ÏÂ˘-

¯·ÈÌ›·˜, ·ÏÏ¿ Î·È ÁÂÓÈÎfiÙÂÚ· ÓÂÔÏ·ÛÈÒÓ ÙË˜ ·È‰È-

Î‹˜ Î·È ÂÓ‹ÏÈÎË˜ ˙ˆ‹˜.

ªËÙÚÈÎfi˜ ıËÏ·ÛÌfi˜ Î·È ÓÂÔÏ·Û›Â˜ ÙË˜

·È‰ÈÎ‹˜ ËÏÈÎ›·˜

¶ÚÈÓ ÙÔ 2006, ‰ËÌÔÛÈÂ‡ıËÎ·Ó Û˘ÓÔÏÈÎ¿ 26 ÌÂÏ¤-

ÙÂ˜ Ô˘ Ú·ÁÌ·ÙÂ‡ÔÓÙ·È ÙËÓ Â›‰Ú·ÛË ÙÔ˘ ÌËÙÚÈ-

ÎÔ‡ ıËÏ·ÛÌÔ‡ ÛÙËÓ ÂÌÊ¿ÓÈÛË ÓÂÔÏ·ÛÈÒÓ ÙË˜ ·È-

‰ÈÎ‹˜ ËÏÈÎ›·˜ Î·È Ô˘ ÂÚÈ¤¯Ô˘Ó ·Ó·ÏÔÁ›· Èı·ÓÔ-

Ù‹ÙˆÓ (odds ratio) ÛÙË ÛÙ·ÙÈÛÙÈÎ‹ ÙÔ˘˜ ·Ó¿Ï˘ÛË

(21-46). √È ÌÂÏ¤ÙÂ˜ ·˘Ù¤˜ Û˘ÌÂÚÈÂÏ‹ÊıËÛ·Ó ÛÂ

Ì›· ÌÂÙ··Ó¿Ï˘ÛË Ô˘ ¤ÁÈÓÂ ÙËÓ ›‰È· ¯ÚÔÓÈ¿, ÚÔÎÂÈ-

Ì¤ÓÔ˘ Ó· ‰ÔıÂ› ·¿ÓÙËÛË ÛÙÔ ÂÚÒÙËÌ· ÙË˜ ÂÓ‰Â¯fi-

ÌÂÓË˜ Â›‰Ú·ÛË˜ ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡ ÛÙËÓ ÂÌ-

Ê¿ÓÈÛË ÓÂÔÏ·ÛÈÒÓ Î·Ù¿ ÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›· (61).

√È 24 ·fi ·˘Ù¤˜ ‹Ù·Ó ÌÂÏ¤ÙÂ˜ ·Ú·Ù‹ÚËÛË˜ ·ÛıÂ-

ÓÒÓ-Ì·ÚÙ‡ÚˆÓ (observational, case-control studies)

(21-23,25-28,30-46) Î·È ÌfiÏÈ˜ ‰‡Ô ‹Ù·Ó ÌÂÏ¤ÙÂ˜ ÎÔ-

fiÚÙË˜ (cohort studies) (24,29). ™ÙÈ˜ 6 ÌÂÏÂÙ‹ıËÎÂ Ë

Â›‰Ú·ÛË ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡ ÛÙÈ˜ ÏÂ˘¯·ÈÌ›Â˜

ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜ (21,27,33,35,37,42), ÛÙÈ˜ 2 ÛÙÈ˜

ÏÂ˘¯·ÈÌ›Â˜ Î·È Ù· ÏÂÌÊÒÌ·Ù· Hodgkin (46) Î·È ÌË

Hodgkin (43), ÛÙÈ˜ 5 ÛÙËÓ √§§ ÌfiÓÔ (22,24,31,38,

45), ÛÙÈ˜ 7 ÛÙÈ˜ ·È‰ÈÎ¤˜ ÓÂÔÏ·Û›Â˜ ÁÂÓÈÎfiÙÂÚ·

(13,25,28,34,36,39,44), ÂÓÒ ÛÂ ÍÂ¯ˆÚÈÛÙ¤˜ ÌÂÏ¤ÙÂ˜

ÂÍÂÙ¿ÛÙËÎ·Ó ÙÔ ÓÂ˘ÚÔ‚Ï¿ÛÙˆÌ· (30), ÔÈ ÓÂÔÏ·Û›Â˜

ÙÔ˘ ∫¡™ (27), ÔÈ fiÁÎÔÈ ·fi ·Ú¯¤ÁÔÓ· ÁÂÓÓËÙÈÎ¿ Î‡Ù-

Ù·Ú· (26), ÔÈ ÓÂ·ÓÈÎÔ› ÔÛÙÈÎÔ› fiÁÎÔÈ (32) Î·È ÙÔ Ï¤Ì-

ÊˆÌ· Hodgkin (41). √È ÙÚÂÈ˜ ÌÂÁ·Ï‡ÙÂÚÂ˜ Î·È ÛÙ·ÙÈ-

ÛÙÈÎ¿ ÏËÚ¤ÛÙÂÚÂ˜ ÌÂÏ¤ÙÂ˜ ‹Ù·Ó ÂÎÂ›ÓË ÙÔ˘ ·ÌÂÚÈÎ·-

ÓÈÎÔ‡ Children’s Cancer Group ÌÂ >2.500 ·È‰È¿ ÌÂ

Î·ÚÎ›ÓÔ (33), Ë ‚ÚÂÙ·ÓÈÎ‹ ÌÂÏ¤ÙË U∫ Childhood

Cancer ÌÂ >3.000 ·È‰È¿ ÌÂ Î·ÚÎ›ÓÔ (28) Î·È Ù¤ÏÔ˜ Ë

ÌÂÏ¤ÙË ÙË˜ √ÍÊfiÚ‰Ë˜ (Oxford Survey of Childhood

Cancers) ÌÂ >3.000 ·È‰È¿ ÌÂ Î·ÚÎ›ÓÔ (34). ™Â fiÏÂ˜

Û¯Â‰fiÓ ÙÈ˜ ÌÂÏ¤ÙÂ˜ ˘‹Ú¯Â ‰ÈfiÚıˆÛË ÁÈ· ÌÂÙ·‚ÏË-

Ù¤˜, fiˆ˜ Ë ÌËÙÚÈÎ‹ ËÏÈÎ›· Î·È ÙÔ Ê‡ÏÔ, ·ÏÏ¿ ÛÙÈ˜

ÂÚÈÛÛfiÙÂÚÂ˜ Ô ¤ÏÂÁ¯Ô˜ ÁÈ· ÌÂÙ·‚ÏËÙ¤˜ Ô˘ Èı·ÓfiÓ

ÂËÚÂ¿˙Ô˘Ó ÙËÓ Â›ÙˆÛË Î·ÚÎ›ÓÔ˘, fiˆ˜ Ë ÎÔÈÓˆ-

ÓÈÎ‹ Ù¿ÍË, Ë ‰È·ÌÔÓ‹, Ô ‚·ıÌfi˜ ·ÛÙÈÎÔÔ›ËÛË˜, Ë ÌË-

ÙÚÈÎ‹ ÂÎ·›‰Â˘ÛË, ÙÔ ÂÈÛfi‰ËÌ·, ÙÔ Ì¤ÁÂıÔ˜ ÙË˜ ÔÈÎÔ-

Á¤ÓÂÈ·˜ (·ÚÈıÌfi˜ ·È‰ÈÒÓ) Î·È Ë ¤ÎıÂÛË ÛÂ ¯ËÌÈÎ¿,

Î·Ófi ‹ ·ÏÎÔfiÏ, Ô›ÎÈÏÂ ÔÏ‡ ·fi ÌÂÏ¤ÙË ÛÂ ÌÂÏ¤ÙË.

∂›ÛË˜, Ë Ì¤ıÔ‰Ô˜ ÂÎÙ›ÌËÛË˜ ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·-

ÛÌÔ‡ Ô›ÎÈÏÂ ÌÂÙ·Í‡ Î·Ù’ È‰›·Ó Û˘Ó¤ÓÙÂ˘ÍË˜ ÙˆÓ ÌË-

Ù¤ÚˆÓ ÌÂ ÙÔÓ ÂÚÂ˘ÓËÙ‹ (25,28,29,31,34,35,39,43,44,

46), ÙËÏÂÊˆÓÈÎÒÓ Û˘ÓÂÓÙÂ‡ÍÂˆÓ ÌÂ ÙÔÓ ÂÚÂ˘ÓËÙ‹

(30,41), ·Ó·ÛÎfiËÛË˜ È·ÙÚÈÎÒÓ ÈÛÙÔÚÈÎÒÓ (23,36),

Î·È Û˘ÌÏ‹ÚˆÛË˜ ÂÚˆÙËÌ·ÙÔÏÔÁ›ˆÓ Ô˘ Ù·¯˘‰ÚÔ-

Ì‹ıËÎ·Ó ÛÙÔ˘˜ ÁÔÓÂ›˜ (38,45).

∏ ÌÂÙ··Ó¿Ï˘ÛË ¤‰ÂÈÍÂ fiÙÈ ·È‰È¿ Ô˘ ı‹Ï·Û·Ó

‰È¤ÙÚÂ¯·Ó ÌÈÎÚfiÙÂÚÔ Î›Ó‰˘ÓÔ Ó· ·Ó·Ù‡ÍÔ˘Ó √§§

Î·Ù¿ 9% (95% fiÚÈ· ÂÌÈÛÙÔÛ‡ÓË˜ 2-16%), Ï¤ÌÊˆÌ·

Hodgkin Î·Ù¿ 24% (95% fiÚÈ· ÂÌÈÛÙÔÛ‡ÓË˜ 3-40%)

Î·È ÓÂ˘ÚÔ‚Ï¿ÛÙˆÌ· Î·Ù¿ 41% (95% fiÚÈ· ÂÌÈÛÙÔÛ‡-

ÓË˜ 22-56%) ÌÂ ÌÈÎÚÔ‡ ‚·ıÌÔ‡ ÂÙÂÚÔÁ¤ÓÂÈ· ·Ó¿ÌÂÛ·

274 ¢. ª·Ùı·›Ô˜ Î·È Û˘Ó.



ÛÙÈ˜ ÌÂÏ¤ÙÂ˜ (61). ŸÌˆ˜, fiˆ˜ ‹‰Ë ·Ó·Ê¤ÚıËÎÂ, Ù·

·ÔÙÂÏ¤ÛÌ·Ù· ÁÈ· ÙÔ Ï¤ÌÊˆÌ· Hodgkin Î·È ÙÔ ÓÂ˘-

ÚÔ‚Ï¿ÛÙˆÌ· ÚÔ¤Ú¯ÔÓÙ·Ó ·fi ‰‡Ô ÌfiÓÔ ÌÂÏ¤ÙÂ˜

(41,30), Î¿ÙÈ Ô˘ ÛËÌ·›ÓÂÈ fiÙÈ Ë Û˘Û¯¤ÙÈÛË ·˘Ù‹

Ú¤ÂÈ Ó· ÂÈ‚Â‚·ÈˆıÂ› ÛÙÔ Ì¤ÏÏÔÓ Î·È ·fi ¿ÏÏÂ˜

ÂÚÁ·Û›Â˜. ∫·Ì›· Â›‰Ú·ÛË ‰ÂÓ Ê¿ÓËÎÂ Ó· ¤¯ÂÈ Ô ıË-

Ï·ÛÌfi˜ ÛÙËÓ ·Ó¿Ù˘ÍË ÔÍÂ›·˜ Ì˘ÂÏÔÁÂÓÔ‡˜ ÏÂ˘¯·È-

Ì›·˜, ÓÂÔÏ·ÛÈÒÓ ÙÔ˘ ∫¡™, fiÁÎˆÓ ·fi ·Ú¯¤ÁÔÓ·

ÁÂÓÓËÙÈÎ¿ Î‡ÙÙ·Ú· Î·È ÔÛÙÈÎÒÓ ‹ ¿ÏÏˆÓ Û˘Ì·ÁÒÓ

fiÁÎˆÓ. ∏ ÂÎÙ›ÌËÛË ÙˆÓ ‚ÚÂÙ·ÓÒÓ ÂÚÂ˘ÓËÙÒÓ ‹Ù·Ó

fiÙÈ Ë ·‡ÍËÛË ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡, ‰ËÏ·‰‹ ÙÔ˘

·ÚÈıÌÔ‡ ÙˆÓ ÌËÙ¤ÚˆÓ Ô˘ ıËÏ¿˙Ô˘Ó ‹ ¿ÏÏˆ˜ ÙÔ˘

ÂÈÔÏ·ÛÌÔ‡ ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡ ·fi 50% ÛÂ

100% ı· ÌÔÚÔ‡ÛÂ ÛÙËÓ Î·Ï‡ÙÂÚË ÂÚ›ÙˆÛË Ó·

ÌÂÈÒÛÂÈ ÙÔÓ ·ÚÈıÌfi Ó¤ˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ ÔÍÂ›·˜ ÏÂ˘-

¯·ÈÌ›·˜ ‹ ÏÂÌÊÒÌ·ÙÔ˜ ÛÙ· ·È‰È¿ Î·Ù¿ 5% (61).

ªËÙÚÈÎfi˜ ıËÏ·ÛÌfi˜ Î·È ÓÂÔÏ·Û›Â˜ ÌÂÙ¿ ÙËÓ

ÂÓËÏÈÎ›ˆÛË

H Â›‰Ú·ÛË ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡ ÛÙËÓ ·Ó¿-

Ù˘ÍË ÓÂÔÏ·ÛÈÒÓ ÛÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹ ¤¯ÂÈ ÌÂÏÂÙËıÂ›

·ÚÎÂÙ¿, fiˆ˜ Ê·›ÓÂÙ·È ·fi ÙË ‰ËÌÔÛ›Â˘ÛË ·ÚÎÂÙÒÓ

ÌÂÏÂÙÒÓ Ô˘ Ú·ÁÌ·ÙÂ‡ÔÓÙ·È ÙÔ ı¤Ì· (47-60,62). ∏

ÈÔ ÚfiÛÊ·ÙË ·fi ·˘Ù¤˜, ÁÓˆÛÙ‹ Î·È ˆ˜ ÌÂÏ¤ÙË

Boyd Orr ·ÊÔÚ¿ 4.999 ¿ÙÔÌ· Ô˘ ¤Ï·‚·Ó ·Ú¯ÈÎ¿ Ì¤-

ÚÔ˜ ÛÙË ÌÂÏ¤ÙË Î·Ù¿ ÙËÓ ÂÚ›Ô‰Ô 1937-1939 ÛÂ ËÏÈ-

Î›· 0-19 ÂÙÒÓ, Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ‰ËÏ·‰‹ ÙË˜ ·È‰È-

Î‹˜ Î·È ÂÊË‚ÈÎ‹˜ ËÏÈÎ›·˜ (62). °È· 4.379 ·fi ·˘ÙÔ‡˜,

‰ËÏ·‰‹ ÙÔ 88% ÂÚ›Ô˘ ÙˆÓ ·ÛıÂÓÒÓ ˘‹Ú¯·Ó ‰È·-

ı¤ÛÈÌ· ÛÙÔÈ¯Â›· fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ·Ó¿Ù˘ÍË ÓÂÔÏ·-

ÛÈÒÓ ·fi ÙÔ 1948 ˆ˜ ÙÔ 2003. ÃÚËÛÈÌÔÔÈÒÓÙ·˜ ·Ó·-

ÏÔÁ›Â˜ ÎÈÓ‰‡ÓÔ˘ (hazard ratios), ÔÈ ÂÚÂ˘ÓËÙ¤˜ ÙË˜ ÌÂ-

Ï¤ÙË˜ ‰ÂÓ ‰È·›ÛÙˆÛ·Ó ÚÔÛÙ·ÙÂ˘ÙÈÎ‹ Â›‰Ú·ÛË

ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡ ÛÙËÓ ·Ó¿Ù˘ÍË Î·ÚÎ›ÓÔ˘

ÛÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹ (·Ó·ÏÔÁ›· ÎÈÓ‰‡ÓÔ˘ 1,07, 95%

fiÚÈ· ÂÌÈÛÙÔÛ‡ÓË˜ 0,89-1,28). √È ÓÂÔÏ·Û›Â˜ Ô˘

ÌÂÏÂÙ‹ıËÎ·Ó ‹Ù·Ó Ô Î·ÚÎ›ÓÔ˜ Ì·ÛÙÔ‡, ÚÔÛÙ¿ÙË,

ÛÙÔÌ¿¯Ô˘ Î·È Ô ÔÚıÔÎÔÏÈÎfi˜ Î·ÚÎ›ÓÔ˜ (62).

™ÙËÓ ›‰È· ‰ËÌÔÛ›Â˘ÛË, ÔÈ ÂÚÂ˘ÓËÙ¤˜ ÚÔ¤‚ËÛ·Ó

Î·È ÛÂ Ì›· ÌÂÙ··Ó¿Ï˘ÛË ÙˆÓ 14 ÚÔÁÂÓ¤ÛÙÂÚˆÓ ÌÂÏÂ-

ÙÒÓ Ô˘ ·Û¯ÔÏ‹ıËÎ·Ó ÌÂ ÙÔ ı¤Ì· -Î·È ÔÈ ÔÔ›Â˜ ÛÙËÓ

ÏÂÈÔÓfiÙËÙ¿ ÙÔ˘˜ ‹Ù·Ó ÌÂÏ¤ÙÂ˜ ·Ú·Ù‹ÚËÛË˜ ·ÛıÂ-

ÓÒÓ-Ì·ÚÙ‡ÚˆÓ- Î·È Î·Ù¤‰ÂÈÍ·Ó fiÙÈ Ô ÌËÙÚÈÎfi˜ ıËÏ·-

ÛÌfi˜ ÚÔÛÙ·ÙÂ‡ÂÈ ·fi ÙÔÓ ÚÔÂÌÌËÓÔ·˘ÛÈ·Îfi

Î·ÚÎ›ÓÔ ÙÔ˘ Ì·ÛÙÔ‡ (Û¯ÂÙÈÎfi˜ Î›Ó‰˘ÓÔ˜ 0,88, 95%

fiÚÈ· ÂÌÈÛÙÔÛ‡ÓË˜ 0,79-0,98), ·ÏÏ¿ fi¯È ·fi ÙÔÓ ÌÂ-

ÙÂÌÌËÓÔ·˘ÛÈ·Îfi Î·ÚÎ›ÓÔ ÙÔ˘ Ì·ÛÙÔ‡ ‹ ¿ÏÏÔ˘˜

Î·ÚÎ›ÓÔ˘˜ ÙË˜ ÂÓ‹ÏÈÎË˜ ˙ˆ‹˜ (62). ∞fi ÙÈ˜ ÌÂÏ¤ÙÂ˜

Ô˘ Û˘ÌÂÚÈ¤Ï·‚Â Ë ÌÂÙ··Ó¿Ï˘ÛË ÙˆÓ Martin Î·È

Û˘Ó. (62), ÔÈ ÂÙ¿ ÂÚÈÏ¿Ì‚·Ó·Ó ¿Óˆ ·fi 500 ·ÛıÂ-

ÓÂ›˜ ÌÂ Î·ÚÎ›ÓÔ (49-51,53,54,56,58) ÌÂ ÌÂÁ·Ï‡ÙÂÚË ÙË

ÌÂÏ¤ÙË ÙˆÓ Titus-Ernstoff Î·È Û˘Ó. Ô˘ ÂÚÈÏ¿Ì‚·ÓÂ

4.008 ·ÛıÂÓÂ›˜ ÌÂ ‰È¿ÊÔÚÂ˜ ÓÂÔÏ·Û›Â˜ (49). ™ÙÔÓ

·ÓÙ›Ô‰·, ÔÈ ·Ï·ÈfiÙÂÚÂ˜ ÌÂÏ¤ÙÂ˜ ÙˆÓ Tokuhata Î·ÈÛ˘Ó. ÛÂ ·ÔÁfiÓÔ˘˜ Á˘Ó·ÈÎÒÓ ÌÂ Î·ÚÎ›ÓÔ ÙÔ˘ Ì·ÛÙÔ‡(52) Î·È ÙˆÓ Henderson Î·È Û˘Ó. Û¯ÂÙÈÎ¿ ÌÂ ÙÔ˘˜ ·-Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÂÌÊ¿ÓÈÛË Î·ÚÎ›ÓÔ˘ ÙˆÓ fiÚ¯Â-ˆÓ ÛÂ ÓÂ·ÚÔ‡˜ ÂÓ‹ÏÈÎÂ˜ (59) ÂÚÈÏ¿Ì‚·Ó·Ó <80·ÛıÂÓÂ›˜ Î·È ÂÔÌ¤Óˆ˜ ÂÏ¿¯ÈÛÙË ÛÙ·ÙÈÛÙÈÎ‹ ÈÛ¯‡.

°ÂÓÈÎfiÙÂÚ·, Û¯ÔÏÈ¿˙ÔÓÙ·˜ Ù· ‰Â‰ÔÌ¤Ó· ÙfiÛÔ ÁÈ·ÙÈ˜ ·È‰È·ÙÚÈÎ¤˜ ÓÂÔÏ·Û›Â˜ fiÛÔ Î·È ÁÈ· ·˘Ù¤˜ ÙˆÓÂÓËÏ›ÎˆÓ, Â›Ó·È Èı·Ófi Ù˘¯fiÓ Û¯ÂÙÈÎ‹ ÌÂ›ˆÛË ÙË˜Â›ÙˆÛË˜ ÛÂ Û¯¤ÛË ÌÂ ÙÔÓ ÌËÙÚÈÎfi ıËÏ·ÛÌfi Ó· Â›-Ó·È ·ÔÙ¤ÏÂÛÌ· fi¯È ·˘ÙÔ‡ Î·ı’ Â·˘ÙÔ‡ ÙÔ˘ ÌËÙÚÈ-ÎÔ‡ ıËÏ·ÛÌÔ‡, ·ÏÏ¿ ÌÂÙ·‚ÏËÙÒÓ Ô˘ ‰ÂÓ ÂÏ¤Á¯ıË-Î·Ó ‹ Î·È ·ÔÙ¤ÏÂÛÌ· ÂÈÛ·ÁˆÁ‹˜ ÚÔÎ·Ù·Ï‹„ÂˆÓ(bias) ˘¤Ú ÙÔ˘ ıËÏ·ÛÌÔ‡. ∞ÎfiÌ· fiÌˆ˜ Î·È ·Ó Ô ÌË-ÙÚÈÎfi˜ ıËÏ·ÛÌfi˜ Â›Ó·È fiÓÙˆ˜ ÚÔÛÙ·ÙÂ˘ÙÈÎfi˜ ¤Ó·-ÓÙÈ ÓÂÔÏ·ÛÈÒÓ, Ë ÚÔÛÙ·ÙÂ˘ÙÈÎ‹ ÙÔ˘ Â›‰Ú·ÛË Â›-Ó·È Ì¿ÏÏÔÓ ÌÈÎÚ‹ Î·È fi¯È ÛËÌ·ÓÙÈÎ‹ ÛÂ Â›Â‰ÔÚfiÏË„Ë˜ ÙÔ˘ Î·ÚÎ›ÓÔ˘.

™˘ÌÂÚ¿ÛÌ·Ù·

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∞ÓÙÂÓ‰Â›ÍÂÈ˜ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡

∂. Ã·Ù˙Ë‰¿ÎË, Ã. °È·ÓÓ·ÎÔÔ‡ÏÔ˘

¶ÂÚ›ÏË„Ë: ∆Ô ÌËÙÚÈÎfi Á¿Ï· ·ÔÙÂÏÂ› ÙËÓ È‰·ÓÈÎfiÙÂÚË ÙÚÔÊ‹ ÁÈ· Ù· ‚Ú¤ÊË. √ ÌËÙÚÈÎfi˜ ıËÏ·ÛÌfi˜ ÌÂÈ-ÒÓÂÈ ÙËÓ Â›ÙˆÛË Î·È ÙË ÛÔ‚·ÚfiÙËÙ· ÔÏÏÒÓ ÏÔÈÌÒÍÂˆÓ, fiˆ˜ ‚·ÎÙËÚÈ·Î‹ ÌËÓÈÁÁ›ÙÈ‰·, ÛË„·ÈÌ›·,Á·ÛÙÚÂÓÙÂÚ›ÙÈ‰·, ÏÔÈÌÒÍÂÈ˜ ÙÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, ÓÂÎÚˆÙÈÎ‹ ÂÓÙÂÚÔÎÔÏ›ÙÈ‰·, Ì¤ÛË ˆÙ›ÙÈ‰·,Ô˘ÚÔÏÔ›ÌˆÍË, Î·È fi„ÈÌË ÛË„·ÈÌ›·, ÛÂ ÚfiˆÚ· Î·È ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿, ·ÏÏ¿ Î·È ÙË ‚ÚÂÊÈÎ‹ ıÓËÛÈÌfi-ÙËÙ·. ŸÛÔÓ ·ÊÔÚ¿ ÛÙË ÌËÙ¤Ú·, ÂÚÈÔÚ›˙ÂÈ ÙËÓ ·ÒÏÂÈ· ·›Ì·ÙÔ˜ ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi, ‚ÔËı¿ÂÈ ÛÙËÓ ·Ô-Î·Ù¿ÛÙ·ÛË ÙË˜ ·ÈÛıËÙÈÎ‹˜ ÙÔ˘ ÛÒÌ·ÙÔ˜, ÂÓÒ ¤¯ÂÈ ·Ú·ÙËÚËıÂ› fiÙÈ ÔÈ ıËÏ¿˙Ô˘ÛÂ˜ ÌËÙ¤ÚÂ˜ ¤¯Ô˘Ó ÌÂÈ-ˆÌ¤ÓË Â›ÙˆÛË Î·Ù·ÁÌ¿ÙˆÓ ÙÔ˘ ÈÛ¯›Ô˘ Î·È ÔÛÙÂÔfiÚˆÛË˜ Î·Ù¿ ÙË ÌÂÙÂÌÌËÓÔ·˘ÛÈ·Î‹ ÂÚ›Ô‰Ô Î·ÈÌÈÎÚfiÙÂÚÂ˜ Èı·ÓfiÙËÙÂ˜ ·Ó¿Ù˘ÍË˜ Î·ÚÎ›ÓÔ˘ Ì·ÛÙÔ‡ Î·È ˆÔıËÎÒÓ. øÛÙfiÛÔ, ˘¿Ú¯Ô˘Ó Î·È ÂÚÈÙÒ-ÛÂÈ˜ Ô˘ Ë ˘ÁÂ›· ÙÔ˘ ‚Ú¤ÊÔ˘˜ ‹ ÙË˜ ÌËÙ¤Ú·˜ ÙÔ˘ ‰ËÌÈÔ˘ÚÁÔ‡Ó ÂÚˆÙËÌ·ÙÈÎ¿ Û¯ÂÙÈÎ¿ ÌÂ ÙËÓ ·ÛÊ¿ÏÂÈ·ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡. ∞ÓÙ¤Ó‰ÂÈÍË ÁÈ· ÌËÙÚÈÎfi ıËÏ·ÛÌfi ·ÔÙÂÏÂ› ÙÔ Û‡Ó‰ÚÔÌÔ Â›ÎÙËÙË˜ ·ÓÔÛÔ·ÓÂ-¿ÚÎÂÈ·˜ ÛÙÈ˜ ·Ó·Ù˘ÁÌ¤ÓÂ˜ ¯ÒÚÂ˜, fiÔ˘ Ë ¯ÔÚ‹ÁËÛË ÙÚÔÔÔÈËÌ¤ÓÔ˘ Á¿Ï·ÎÙÔ˜ ·ÁÂÏ¿‰·˜ Â›Ó·È ÂÊÈ-ÎÙ‹ Î·È ‰È·ı¤ÛÈÌË, Ë ¯Ú‹ÛË Ú·‰ÈÔ˚ÛÔÙfiˆÓ ÁÈ· ‰È·ÁÓˆÛÙÈÎÔ‡˜ ‹ ıÂÚ·Â˘ÙÈÎÔ‡˜ ÛÎÔÔ‡˜ ÁÈ· fiÛÔ ‰È¿-ÛÙËÌ· ·ÂÎÎÚ›ÓÂÙ·È ÙÔ Ú·‰ÈÔ˚ÛfiÙÔÔ ÛÙÔ ÌËÙÚÈÎfi Á¿Ï·, Ë ¯Ú‹ÛË Ó·ÚÎˆÙÈÎÒÓ Ô˘ÛÈÒÓ, ·ÓÙÈÌÂÙ·‚ÔÏÈ-ÙÒÓ ‹ ¯ËÌÂÈÔıÂÚ·Â˘ÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ Î·È Ê·ÚÌ·ÎÂ˘ÙÈÎÒÓ ÛÎÂ˘·ÛÌ¿ÙˆÓ ·fi ÙË ÌËÙ¤Ú· fiˆ˜ ÌÂ-ÙÚÔÓÈ‰·˙fiÏË, ÎÏÈÓÙ·Ì˘Î›ÓË, ¯ÏˆÚ·ÌÊ·ÈÓÈÎfiÏË, Î¿ÔÈˆÓ ‚-·Ó·ÛÙÔÏ¤ˆÓ Î·È „˘¯ÔÙÚfiˆÓ. ∏ Ë·Ù›ÙÈ‰· µÂÊfiÛÔÓ ̄ ÔÚËÁËıÂ› ̆ ÂÚ¿ÓÔÛË Á-ÛÊ·ÈÚ›ÓË, Î·È ÌÈ· ‰fiÛË ÂÌ‚ÔÏ›Ô˘, ‰ÂÓ ·ÔÙÂÏÂ› ·ÓÙ¤Ó‰ÂÈÍË ÁÈ· ÙÔÓ ÌË-ÙÚÈÎfi ıËÏ·ÛÌfi. ∏ ÏÔ›ÌˆÍË ·fi Î˘ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi ‰ÂÓ ·ÔÙÂÏÂ› ·ÓÙ¤Ó‰ÂÈÍË, Â¿Ó Ë ÔÚÔÌÂÙ·ÙÚÔ‹ ‰ÂÓ Â›-Ó·È ÚfiÛÊ·ÙË Î·È ÙÔ ÓÂÔÁÓfi Â›Ó·È ÙÂÏÂÈfiÌËÓÔ. ∂¿Ó Ë ÌËÙ¤Ú· ¤¯ÂÈ ÂÓÂÚÁfi Ê˘Ì·Ù›ˆÛË, ÙÔ ÓÂÔÁÓfi ÙË˜·ÔÌ·ÎÚ‡ÓÂÙ·È ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi. ∆Ô Á¿Ï· ÙË˜ ÌËÙ¤Ú·˜ ÌÔÚÂ› Ó· ¯ÔÚËÁÂ›Ù·È ÛÙÔ ÓÂÔÁÓfi ÂÎÙfi˜Î·È Â¿Ó ˘¿Ú¯ÂÈ Ê˘Ì·ÙÈÒ‰Ë˜ Ì·ÛÙ›ÙÈ‰·.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ªËÙÚÈÎfi˜ ıËÏ·ÛÌfi˜, ÔÊ¤ÏË, ·ÓÙÂÓ‰Â›ÍÂÈ˜.

Contraindications to breastfeeding

E. Hatzidaki, C. Giannakopoulou

Abstract: Maternal breast milk is the ideal nutrient for infants. There is strong evidence that breastfeedingdecreases the incidence and severity of a wide range of infectious diseases, including bacterial meningitis,bacteraemia, diarrhoea, respiratory tract infection, necrotizing enterocolitis, otitis media, urinary tractinfection and late onset sepsis in preterm infants, as well as reducing infant mortality. Benefits for themother include decreased postpartum bleeding, earlier return to pre-pregnancy weight, decreased risk ofbreast and ovarian cancer, and lowered risk of hip fractures and osteoporosis in the postmenopausalperiod. However, there are situations where maternal or neonatal health may be under threat as far asbreastfeeding safety is concerned. Breastfeeding is contraindicated for mothers who are infected withhuman immunodeficiency virus in developed countries where formula preparation is safe, for motherswho are receiving diagnostic or therapeutic radioactive isotopes or who have been exposed to radioactivematerials as long as radioactivity is present in their milk, and for mothers who are using narcotics or beingadministered antimetabolites, chemotherapeutic agents or certain other medications such asmetronidazole, clindamycin, chloramphenicol, some beta-blocking agents and psychotropic drugs.Hepatitis B is not a contraindication to breastfeeding when the infant has received hepatitis Bimmunoglobulin and the first dose of vaccine soon after birth. Cytomegalovirus infection is not acontraindication to breastfeeding if the conversion is not recent and the infant is full term. Separation ofinfants immediately after birth is appropriate if their mothers are suffering from active tuberculosis. Theonly contraindication to using breast milk is when the mother has tuberculosis mastitis.

Key words: Breastfeeding, benefits, contraindications.

¡ÂÔÁÓÔÏÔÁÈÎ‹ ∫ÏÈÓÈÎ‹ ÙÔ˘¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹ÙË˜


ÃÚÈÛÙ›Ó· °È·ÓÓ·ÎÔÔ‡ÏÔ˘[email protected],[email protected]∞ÙÏ·ÓÙ›‰Ô˜ 37,∆.∫. 71 305, ∏Ú¿ÎÏÂÈÔ ∫Ú‹ÙË˜

Neonatology Department,University of Crete, Greece

Correspondence:

Christina [email protected],[email protected], Atlantidos St.,71 305, Herakleion, Crete, Greece


∂ÈÛ·ÁˆÁ‹

∆Ô ÌËÙÚÈÎfi Á¿Ï· ·ÔÙÂÏÂ› ·Ó·ÌÊÈÛ‚‹ÙËÙ· ÙËÓ

È‰·ÓÈÎfiÙÂÚË ÙÚÔÊ‹ ÁÈ· ÙÔ ‚Ú¤ÊÔ˜ Î·È ·fi ÙfiÙÂ Ô˘

ÙÔ Á¤ÓÔ˜ ÙˆÓ ·ÓıÚÒˆÓ ÂÌÊ·Ó›ÛÙËÎÂ ÛÙË ÁË ·ÔÙ¤-

ÏÂÛÂ ÙËÓ ·ÔÎÏÂÈÛÙÈÎ‹ ÙÚÔÊ‹ ÁÈ· ÙÔ˘˜ ÚÒÙÔ˘˜ Ì‹-

ÓÂ˜ ÙË˜ ˙ˆ‹˜. ¶ÂÚÈ¤¯ÂÈ fiÏ· Ù· ··Ú·›ÙËÙ· ıÚÂÙÈÎ¿

Û˘ÛÙ·ÙÈÎ¿ ÛÂ È‰·ÓÈÎ‹ ·Ó·ÏÔÁ›· ÁÈ· ÙË ÛˆÛÙ‹ ·Ó¿-

Ù˘ÍË ÙÔ˘ ‚Ú¤ÊÔ˘˜. ∂›Ó·È ¤Ó· ‰˘Ó·ÌÈÎfi Î·È fi¯È ÛÙ·-

ÙÈÎfi ÚÔ˚fiÓ ÌÂ Ï‹ıÔ˜ Î˘ÙÙ¿ÚˆÓ, ·ÓÙÈÛˆÌ¿ÙˆÓ, ·˘-

ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ Î·È ¿ÏÏˆÓ ÂÓÂÚÁÒÓ ‚ÈÔÏÔÁÈ-

ÎÒÓ ÛÙÔÈ¯Â›ˆÓ Ô˘ ‚ÔËıÔ‡Ó ÛÙËÓ ¿Ì˘Ó· Î·È ÙËÓ

·Ó¿Ù˘ÍË ÙÔ˘ Ó¤Ô˘ ÔÚÁ·ÓÈÛÌÔ‡ (1,2).

√ ÌËÙÚÈÎfi˜ ıËÏ·ÛÌfi˜, Û‡ÌÊˆÓ· ÌÂ ‰ËÌÔÛÈÂ˘Ì¤-

ÓÂ˜ ·Ó·ÊÔÚ¤˜, Ê·›ÓÂÙ·È fiÙÈ ÌÂÈÒÓÂÈ ÙË ‚ÚÂÊÈÎ‹ ıÓË-

ÛÈÌfiÙËÙ· (3), ÙËÓ Â›ÙˆÛË Î·È ÙË ÛÔ‚·ÚfiÙËÙ· ÔÏ-

ÏÒÓ ÏÔÈÌÒÍÂˆÓ fiˆ˜ ‚·ÎÙËÚÈ·Î‹ ÌËÓÈÁÁ›ÙÈ‰· (4),

ÛË„·ÈÌ›· (5), Á·ÛÙÚÂÓÙÂÚ›ÙÈ‰· (6,7), ÏÔÈÌÒÍÂÈ˜ ÙÔ˘

·Ó·ÓÂ˘ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ (8-10), ÓÂÎÚˆÙÈÎ‹ ÂÓÙÂ-

ÚÔÎÔÏ›ÙÈ‰· (11), Ì¤ÛË ˆÙ›ÙÈ‰· (12), Ô˘ÚÔÏÔ›ÌˆÍË

(13), Î·È fi„ÈÌË ÛË„·ÈÌ›·, ÛÂ ÚfiˆÚ· Î·È ÙÂÏÂÈfiÌËÓ·

ÓÂÔÁÓ¿ (14). ∫¿ÔÈÔÈ ÂÚÂ˘ÓËÙ¤˜ ·Ó·Ê¤ÚÔ˘Ó ÌÂÈˆÌ¤-

ÓË Â›ÙˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘

(15,16), ÙÔ˘ Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË Ù‡Ô˘ π Î·È ππ

(17,18), ÙˆÓ ÏÂÌÊˆÌ¿ÙˆÓ, ÙË˜ ÏÂ˘¯·ÈÌ›·˜, ÙË˜ ÓfiÛÔ˘

Hodgkin (19), ÙË˜ ·¯˘Û·ÚÎ›·˜ (20-22), ÙË˜ ̆ ÂÚ¯Ô-

ÏËÛÙÂÚÔÏ·ÈÌ›·˜ (23) Î·È ÙÔ˘ ¿ÛıÌ·ÙÔ˜ (24) ÛÂ ÌÂÁ·-

Ï‡ÙÂÚ· ·È‰È¿ Î·È ÂÓ‹ÏÈÎÂ˜ Ô˘ ı‹Ï·Û·Ó Î·Ù¿ ÙË

‚ÚÂÊÈÎ‹ ËÏÈÎ›· ÛÂ Û¯¤ÛË ÌÂ ¿ÙÔÌ· Ô˘ ‰ÂÓ ı‹Ï·Û·Ó.

Œ¯ÂÈ Â›ÛË˜ ·Ó·ÊÂÚıÂ› fiÙÈ Ô ıËÏ·ÛÌfi˜ Û˘Û¯ÂÙ›˙ÂÙ·È

ÌÂ ÂÏ·ÊÚ¿ ˘ÂÚÔ¯‹ ÛÙËÓ Â›‰ÔÛË ÛÂ ‰ÔÎÈÌ·Û›Â˜

ÓÔËÙÈÎÔ‡ ÂÈ¤‰Ô˘ (25), ÂÓÒ ¤¯ÂÈ ·Ú·ÙËÚËıÂ› fiÙÈ

Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÂÒ‰˘ÓˆÓ ‰È·‰ÈÎ·ÛÈÒÓ fiˆ˜ ·ÈÌÔ-

ÏË„›· ·fi ÙË Ù¤ÚÓ· ÙÔ˘ ÓÂÔÁÓÔ‡ ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô

ÚÔ˘Ù›Ó·˜ ·Ú¤¯ÂÈ ·Ó·ÏÁËÛ›· ÛÙÔ ÓÂÔÁÓfi (26).

√ ıËÏ·ÛÌfi˜ ·Ú¤¯ÂÈ Â›ÛË˜, ÛËÌ·ÓÙÈÎ¿ ÔÊ¤ÏË

ÛÙË ÌËÙ¤Ú·. ¶ÂÚÈÔÚ›˙ÂÈ ÙËÓ ·ÒÏÂÈ· ·›Ì·ÙÔ˜ ÌÂÙ¿

ÙÔÓ ÙÔÎÂÙfi Î·È ‚ÔËı¿ÂÈ ÙË Ì‹ÙÚ· Ó· Â·Ó¤ÏıÂÈ ÁÚ‹-

ÁÔÚ· ÛÙËÓ ·Ú¯ÈÎ‹ ÙË˜ ÌÔÚÊ‹ (27). µÔËı¿ÂÈ ÛÙË ÁÚË-

ÁÔÚfiÙÂÚË Î·Ù·Ó¿ÏˆÛË Ï›Ô˘˜ Î·È ÛÙËÓ ·ÔÎ·Ù¿-

ÛÙ·ÛË ÙË˜ ·ÈÛıËÙÈÎ‹˜ ÙÔ˘ ÛÒÌ·ÙÔ˜ Î·È ÙÔ˘ ÛÙ‹ıÔ˘˜

(28), ÂÓÒ ¤¯ÂÈ ·Ú·ÙËÚËıÂ› fiÙÈ ÔÈ ıËÏ¿˙Ô˘ÛÂ˜ ÌËÙ¤-

ÚÂ˜ ¤¯Ô˘Ó Î·Ï‡ÙÂÚË ÔÛÙÈÎ‹ ˘ÎÓfiÙËÙ·, ÌÂÈˆÌ¤ÓË

Â›ÙˆÛË Î·Ù·ÁÌ¿ÙˆÓ ÙÔ˘ ÈÛ¯›Ô˘ Î·È ÔÛÙÂÔfiÚˆ-

ÛË˜ Î·Ù¿ ÙË ÌÂÙÂÌÌËÓÔ·˘ÛÈ·Î‹ ÂÚ›Ô‰Ô (29) Î·È

ÌÈÎÚfiÙÂÚÂ˜ Èı·ÓfiÙËÙÂ˜ ·Ó¿Ù˘ÍË˜ Î·ÚÎ›ÓÔ˘ Ì·-

ÛÙÔ‡ Î·È ˆÔıËÎÒÓ (30).

øÛÙfiÛÔ, ˘¿Ú¯Ô˘Ó Î·È ÂÚÈÙÒÛÂÈ˜ Ô˘ Ë Ê˘ÛÈ-

Î‹ Î·Ù¿ÛÙ·ÛË Î·È Ë ˘ÁÂ›· ÙÔ˘ ‚Ú¤ÊÔ˘˜ ‹ ÙË˜ ÌËÙ¤-

Ú·˜ ÙÔ˘, ‰ËÌÈÔ˘ÚÁÔ‡Ó Î¿ÔÈ· ÂÚˆÙËÌ·ÙÈÎ¿ ÙfiÛÔ

fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ·ÛÊ¿ÏÂÈ·, ·ÏÏ¿ Î·È ÙËÓ ·ÔÙÂÏÂ-

ÛÌ·ÙÈÎfiÙËÙ· ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡ ÛÙÔ ‚Ú¤ÊÔ˜.

∆fiÙÂ, fiˆ˜ Â›Ó·È ÏÔÁÈÎfi, ··ÈÙÂ›Ù·È ÚÔÛÂÎÙÈÎ‹

ÂÎÙ›ÌËÛË ÙˆÓ ÎÈÓ‰‡ÓˆÓ Ô˘ Ù˘¯fiÓ ·ÔÚÚ¤Ô˘Ó ·fi

ÙË ¯Ú‹ÛË ÙÔ˘ ÌËÙÚÈÎÔ‡ Á¿Ï·ÎÙÔ˜, ÛÂ Û¯¤ÛË ÌÂ ÙÔ

·Ó·ÌÂÓfiÌÂÓÔ fiÊÂÏÔ˜. ™ÎÔfi˜ ÙË˜ ·Ó·ÛÎfiËÛË˜

·˘Ù‹˜ Â›Ó·È Ó· ·ÚÔ˘ÛÈ·ÛÙÔ‡Ó ÔÈ ÙÚ¤¯Ô˘ÛÂ˜ ·ÓÙÈÏ‹-

„ÂÈ˜ Û¯ÂÙÈÎ¿ ÌÂ ÙÈ˜ Û˘¯ÓfiÙÂÚÂ˜ ·fi ÙÈ˜ ·ÓÙÂÓ‰Â›ÍÂÈ˜

ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡.

§ÔÈÌÒÍÂÈ˜ ÙË˜ ÌËÙ¤Ú·˜

§ÔÈÌÒ‰Ë ÓÔÛ‹Ì·Ù· ÙË˜ ÌËÙ¤Ú·˜ Á›ÓÔÓÙ·È ÔÏ‡

Û˘¯Ó¿ ·ÈÙ›Â˜ ÚÔ‚ÏËÌ·ÙÈÛÌÔ‡ ÁÈ· ÙÔÓ ÂÓ‰Â¯fiÌÂÓÔ

Î›Ó‰˘ÓÔ ÁÈ· ÙÔ ÓÂÔÁÓfi Î·È ÙÔ ‚Ú¤ÊÔ˜, Ô˘ ·ÔÚÚ¤ÂÈ

·fi ÙË Û˘Ó¤¯ÈÛË ÙÔ˘ ıËÏ·ÛÌÔ‡. ™Â ÔÏÏ¤˜ ÂÚÈÙÒ-

ÛÂÈ˜, ÙÔ ÓÂÔÁÓfi ¤¯ÂÈ ‹‰Ë ÂÎÙÂıÂ› ÛÙÔÓ ÏÔÈÌÒ‰Ë ·Ú¿-

ÁÔÓÙ·. ¢È·ÎÔ‹ ÙÔ˘ ıËÏ·ÛÌÔ‡ Î·Ù¿ ÙË Ê¿ÛË Ô˘

·ÓÙÈÛÒÌ·Ù· Î·È ·ÓÔÛÔÚ˘ıÌÈÛÙÈÎ¤˜ Ô˘Û›Â˜ ÂÎÎÚ›ÓÔ-

ÓÙ·È ÛÙÔ ÌËÙÚÈÎfi Á¿Ï· Î·È ÚÔÛÙ·ÙÂ‡Ô˘Ó ÙÔ ‚Ú¤ÊÔ˜

·fi ÙË ÏÔ›ÌˆÍË ‹ ÂÚÈÔÚ›˙Ô˘Ó ÙË ÛÔ‚·ÚfiÙËÙ· ÙˆÓ

Û˘ÌÙˆÌ¿ÙˆÓ, Â¿Ó Ë ÏÔ›ÌˆÍË ¤¯ÂÈ ‹‰Ë ÂÁÎ·Ù·ÛÙ·-

ıÂ›, Ì¿ÏÏÔÓ ‰ÂÓ ˆÊÂÏÂ›. To ÎÔÈÓfi ÎÚ˘ÔÏfiÁËÌ· Â›Ó·È

·fi Ù· Î·Ï‡ÙÂÚ· ·Ú·‰Â›ÁÌ·Ù· ÓfiÛÔ˘ Î·Ù¿ ÙË ‰È¿Ú-

ÎÂÈ· ÙË˜ ÔÔ›·˜ Â›Ó·È ÚÔÙÈÌfiÙÂÚË Ë Û˘Ó¤¯ÈÛË ÙÔ˘

ıËÏ·ÛÌÔ‡. §ÔÈÌÒÍÂÈ˜ ÙÔ˘ Ô˘ÚÔÔÈÔÁÂÓÓËÙÈÎÔ‡ Î·È

ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÙË˜ ÌËÙ¤Ú·˜ ‰ÂÓ

ÂÎı¤ÙÔ˘Ó ÙÔ ‚Ú¤ÊÔ˜ ÛÂ Î›Ó‰˘ÓÔ, ÂÎÙfi˜ ÙˆÓ ÂÚÈÙÒ-

ÛÂˆÓ Ô˘ ¤¯ÂÈ ÂÁÎ·Ù·ÛÙ·ıÂ› ÛË„·ÈÌ›· (31,32).

™‡Ó‰ÚÔÌÔ Â›ÎÙËÙË˜ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·˜

√ Èfi˜ ·ÓÈ¯ÓÂ‡ÂÙ·È ÛÙÔ ÌËÙÚÈÎfi Á¿Ï· Î·È ÌÂÙ·‰›-

‰ÂÙ·È ÛÙÔ ÓÂÔÁÓfi ÌÂ ÙÔÓ ıËÏ·ÛÌfi. ™ÙÈ˜ ·Ó·Ù˘ÁÌ¤-

ÓÂ˜ ¯ÒÚÂ˜, fiÔ˘ ˘¿Ú¯Ô˘Ó Â‡ÎÔÏ· ‰È·ı¤ÛÈÌÂ˜ Ë-

Á¤˜ ÙÂ¯ÓËÙ‹˜ ‰È·ÙÚÔÊ‹˜, Û˘ÓÈÛÙ¿Ù·È Ë ·ÔÊ˘Á‹ ÙÔ˘

ıËÏ·ÛÌÔ‡, ÂÓÒ ÁÈ· ÙÈ˜ ·Ó·Ù˘ÛÛfiÌÂÓÂ˜ ¯ÒÚÂ˜ ÂÎÙÈ-

Ì¿Ù·È Ô Î›Ó‰˘ÓÔ˜ Ô˘ ·ÔÚÚ¤ÂÈ ·fi ÙË Û›ÙÈÛË ·fi

¿ÏÏÂ˜ ËÁ¤˜ Î·È Ì¿ÏÏÔÓ ÂÓı·ÚÚ‡ÓÔÓÙ·È ÔÈ ÌËÙ¤ÚÂ˜,

ÂÊfiÛÔÓ ‚¤‚·È· Ë Ê˘ÛÈÎ‹ ÙÔ˘˜ Î·Ù¿ÛÙ·ÛË ÙÔ ÂÈÙÚ¤-

ÂÈ, Ó· ıËÏ¿ÛÔ˘Ó Ù· ‚Ú¤ÊË ÙÔ˘˜ (2,31,33).

§Ô›ÌˆÍË ·fi ·Ú‚Ô˚fi µ19

¢ÂÓ ˘¿Ú¯Ô˘Ó ÂÓ‰Â›ÍÂÈ˜ ÌÂÙ¿‰ÔÛË˜ ÙÔ˘ ÈÔ‡ ·fi

ÙÔ ·ÓıÚÒÈÓÔ ÌËÙÚÈÎfi Á¿Ï·, ·Ó Î·È ¤¯ÂÈ ·ÓÈ¯ÓÂ˘ÙÂ›

ÛÂ Á¿Ï· ÔÓÙÈÎÔ‡. ¢ÂÓ ÚÔÙÂ›ÓÂÙ·È Ë ‰È·ÎÔ‹ ÙÔ˘

ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡ (31).

§Ô›ÌˆÍË ·fi Î˘ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi

√ Èfi˜ ·ÓÈ¯ÓÂ‡ÂÙ·È ÛÙÔ ÌËÙÚÈÎfi Á¿Ï·. ∏ ‰È·Ï·-

ÎÔ˘ÓÙÈ·Î‹ ÌÂÙ·ÊÔÚ¿ ÌËÙÚÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ Î·Ù¿

ÙÔ˘ ÈÔ‡, ÚÔÛÙ·ÙÂ‡ÂÈ Ù· ÙÂÏÂÈfiÌËÓ· ‚Ú¤ÊË ÔÚÔıÂÙÈ-

ÎÒÓ ÌËÙ¤ÚˆÓ. ªÂÙ¿ ÙË Á¤ÓÓËÛË, ¤ÎıÂÛË ÛÙÔÓ Èfi

‚ÚÂÊÒÓ Ô˘ ‰ÂÓ ‰È·ı¤ÙÔ˘Ó Ù· ÂÈ‰ÈÎ¿ ·ÓÙÈÛÒÌ·Ù·

¤Ó·ÓÙÈ ÙÔ˘ ÈÔ‡, fiˆ˜ ÚfiˆÚ· ÓÂÔÁÓ¿ Î·È ‚Ú¤ÊË ÔÚÔ-

·ÚÓËÙÈÎÒÓ ÌËÙ¤ÚˆÓ, ÌÔÚÂ› Ó· ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ·

ÙËÓ ÂÎ‰‹ÏˆÛË ÛÔ‚·Ú‹˜ ÓfiÛÔ˘. £ËÏ¿˙ÔÓÙ· ‚Ú¤ÊË

ÔÚÔıÂÙÈÎÒÓ ÌËÙ¤ÚˆÓ ÌÔÚÂ› Ó· ÂÎ‰ËÏÒÛÔ˘Ó Û˘-

ÌÙˆÌ·ÙÈÎ‹ ÓfiÛÔ, Â¿Ó Ë ÔÚÔÌÂÙ·ÙÚÔ‹ Á›ÓÂÈ Î·Ù¿

279∞ÓÙÂÓ‰Â›ÍÂÈ˜ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡

¶·È‰È·ÙÚÈÎ‹ 2007;70:278-284


ÙËÓ ÂÚ›Ô‰Ô ÙË˜ Á·ÏÔ˘¯›·˜. ∏ ÏÔ›ÌˆÍË ·fi Î˘ÙÙ·-

ÚÔÌÂÁ·ÏÔ˚fi ‰ÂÓ ·ÔÙÂÏÂ› ·ÓÙ¤Ó‰ÂÈÍË, Â¿Ó Ë ÔÚÔÌÂ-

Ù·ÙÚÔ‹ ‰ÂÓ ¤ÁÈÓÂ Î·Ù¿ ÙËÓ ÂÚ›Ô‰Ô ÙË˜ Á·ÏÔ˘¯›·˜

Î·È ÙÔ ÓÂÔÁÓfi Â›Ó·È ÙÂÏÂÈfiÌËÓÔ. øÛÙfiÛÔ, ‰ÂÓ ÈÛ¯‡ÂÈ

ÙÔ ›‰ÈÔ ÁÈ· Ù· ÔÏ‡ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛË˜ Úfi-

ˆÚ· ÓÂÔÁÓ¿ ÔÚÔıÂÙÈÎÒÓ ÌËÙ¤ÚˆÓ. ∏ ·fiÊ·ÛË ÁÈ· ÙË

¯ÔÚ‹ÁËÛË ÌËÙÚÈÎÔ‡ Á¿Ï·ÎÙÔ˜ ı· Ú¤ÂÈ Ó· Ï·Ì‚¿-

ÓÂÙ·È ÌÂÙ¿ ·fi ÚÔÛÂÎÙÈÎ‹ ÂÎÙ›ÌËÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘

ÌÂÙ¿‰ÔÛË˜ ÙË˜ ÓfiÛÔ˘, ÛÂ Û¯¤ÛË ÌÂ ÙÔ fiÊÂÏÔ˜ ÁÈ· ÙÔ

ÓÂÔÁÓfi ·fi ÙÔÓ ÌËÙÚÈÎfi ıËÏ·ÛÌfi. ∂›Ó·È ÁÓˆÛÙfi fiÙÈ

Î·Ù¿„˘ÍË ‹ ·ÛÙÂÚ›ˆÛË ÙÔ˘ ÌËÙÚÈÎÔ‡ Á¿Ï·ÎÙÔ˜

ÂÚÈÔÚ›˙ÂÈ ÛËÌ·ÓÙÈÎ¿ ÙÔ È˚Îfi ÊÔÚÙ›Ô ÙÔ˘ Î˘ÙÙ·ÚÔÌÂ-

Á·ÏÔ˚Ô‡ (2,31,34,35).

§Ô›ÌˆÍË ·fi ÙÔÓ Èfi ÙÔ˘ ·ÏÔ‡ ¤ÚËÙ·

ŒÓ· ˘ÁÈ¤˜ ÓÂÔÁÓfi Ô˘ ÁÂÓÓ‹ıËÎÂ ·fi ÌËÙ¤Ú· ÌÂ

ÏÔ›ÌˆÍË ·fi ÙÔÓ Èfi ÌÔÚÂ› Ó· ıËÏ¿ÛÂÈ, ÂÎÙfi˜ ·fi

ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ Ô˘ ˘¿Ú¯ÂÈ ÂÓÂÚÁfi˜ ‚Ï¿‚Ë ÛÙÔÓ

Ì·ÛÙfi ÙË˜ ÌËÙ¤Ú·˜ ÙÔ˘. ™ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ Ô˘

˘¿Ú¯ÂÈ ÂÓÂÚÁfi˜ ‚Ï¿‚Ë ÛÙÔÓ Ì·ÛÙfi, Ô ıËÏ·ÛÌfi˜

Ú¤ÂÈ Ó· ‰È·ÎfiÙÂÙ·È Ì¤¯ÚÈ Ë ‚Ï¿‚Ë Ó· ÂÍ·Ê·ÓÈ-

ÛÙÂ› (2,31,32,34,36,37).

§Ô›ÌˆÍË ·fi ÙÔÓ Èfi ÙË˜ ·ÓÂÌÂ˘ÏÔÁÈ¿˜

™ÙÔ ÌËÙÚÈÎfi Á¿Ï· ·ÓÈ¯ÓÂ‡ÔÓÙ·È ÙfiÛÔ ÙÔ DNA

ÙÔ˘ ÈÔ‡, fiÛÔ Î·È ·ÓÙÈÛÒÌ·Ù· ÂÓ·ÓÙ›ÔÓ ÙÔ˘. ™ÙÈ˜ Â-

ÚÈÙÒÛÂÈ˜ ÂÎÂ›ÓÂ˜ Ô˘ Ë ÌËÙ¤Ú· ÂÌÊ·Ó›ÛÂÈ ÙË ÓfiÛÔ,

Ô Î›Ó‰˘ÓÔ˜ ÌÂÙ¿‰ÔÛË˜ Û¯ÂÙ›˙ÂÙ·È ÌÂ ÙË ÛÙÂÓ‹ Â·-

Ê‹ Î·È Â›Ó·È ›‰ÈÔ˜ ÁÈ· ÙÔ ‚Ú¤ÊÔ˜ Ô˘ ıËÏ¿˙ÂÈ ·ÏÏ¿

Î·È ÁÈ· ·˘Ùfi Ô˘ ÛÈÙ›˙ÂÙ·È ÌÂ ÙÚÔÔÔÈËÌ¤ÓÔ Á¿Ï·

·ÁÂÏ¿‰·˜. ∞ÔÌ·ÎÚ‡ÓÔ˘ÌÂ ÏÔÈfiÓ ÙÔ ÓÂÔÁÓfi ÁÈ·

fiÛÔ ‰È¿ÛÙËÌ· Ë ÌËÙ¤Ú· ÌÂÙ·‰›‰ÂÈ ÙË ÓfiÛÔ, ·Ó Î·È Ë

·ÔÌ¿ÎÚ˘ÓÛË ÌÔÚÂ› Ó· ÌËÓ ¤¯ÂÈ È‰È·›ÙÂÚÔ ÓfiËÌ·,

Î·ıÒ˜ ÙÔ ÓÂÔÁÓfi ¤¯ÂÈ ÂÎÙÂıÂ› ÛÙË ÓfiÛÔ Î·Ù¿ ÙË

‰È¿ÚÎÂÈ· ÙÔ˘ ÚÔ‰ÚÔÌÈÎÔ‡ ÛÙ·‰›Ô˘. ∆Ô Á¿Ï· ÙË˜

ÌËÙ¤Ú·˜ ÌÔÚÂ› Ó· ¯ÔÚËÁÂ›Ù·È ÛÙÔ ‚Ú¤ÊÔ˜, ÂÎÙfi˜

Â¿Ó ˘¿Ú¯Ô˘Ó ‰ÂÚÌ·ÙÈÎ¤˜ ‚Ï¿‚Â˜ ÛÙÔÓ Ì·ÛÙfi. ∏

ÌËÙ¤Ú· ÌÔÚÂ› Ó· ıËÏ¿ÛÂÈ ÙÔ ÌˆÚfi ÙË˜, fiÙ·Ó ‰ÂÓ

¤¯Ô˘Ó ÂÌÊ·ÓÈÛÙÂ› Ó¤Â˜ ‚Ï¿‚Â˜ ÁÈ· 72 ÒÚÂ˜, ÂÓÒ ÔÈ

˘¿Ú¯Ô˘ÛÂ˜ ¤¯Ô˘Ó ÂÊÂÏÎÈ‰ÔÔÈËıÂ›, Û˘Ó‹ıˆ˜ 6 ÌÂ

10 Ì¤ÚÂ˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË ÙÔ˘ ÂÍ·Óı‹Ì·ÙÔ˜ (31,32).

∏·Ù›ÙÈ‰Â˜

∏·Ù›ÙÈ‰· ∞. ªÂÙ¿‰ÔÛË ÙÔ˘ ÈÔ‡ ·fi ÙÔ ÌËÙÚÈÎfi

Á¿Ï· ¤¯ÂÈ ·Ó·ÊÂÚıÂ› ÛÂ Ì›· ÂÚ›ÙˆÛË. øÛÙfiÛÔ, ‰ÂÓ

Â›Ó·È ‚¤‚·ÈÔ fiÛÔ Û˘¯Ó¿ Ô Èfi˜ ÙË˜ Ë·Ù›ÙÈ‰·˜ ∞

ÌÔÚÂ› Ó· ·ÔÌÔÓˆıÂ› ÛÙÔ ÌËÙÚÈÎfi Á¿Ï·. ∏ ¤ÎıÂÛË

ÙÔ˘ ‚Ú¤ÊÔ˘˜ ÛÙÔÓ Èfi Û˘Ó‹ıˆ˜ ¤¯ÂÈ ‹‰Ë ÚÔËÁËıÂ›

ÙË˜ ‰È·ÁÓˆÛÙÈÎ‹˜ ÂÈ‚Â‚·›ˆÛË˜ ÙË˜ ÓfiÛÔ˘ ÛÙË ÌË-

Ù¤Ú·. ¢ÂÓ ˘¿Ú¯ÂÈ ÏfiÁÔ˜ ‰È·ÎÔ‹˜ ÙÔ˘ ıËÏ·ÛÌÔ‡.

™ÙË ÌËÙ¤Ú· Û˘ÓÈÛÙ¿Ù·È ÙÔ ÚÔÛÂÎÙÈÎfi Ï‡ÛÈÌÔ ÙˆÓ

¯ÂÚÈÒÓ Î·È Ë ÛˆÛÙ‹ ˘ÁÈÂÈÓ‹, ÁÂÓÈÎfiÙÂÚ·, Î·È ÂÓı·Ú-

Ú‡ÓÂÙ·È Ó· ıËÏ¿ÛÂÈ ÙÔ ÓÂÔÁÓfi ÙË˜ (31,32,34,37).

∏·Ù›ÙÈ‰· µ. √ Èfi˜ ÙË˜ Ë·Ù›ÙÈ‰·˜ µ ÚÔÎ·ÏÂ› ÙË

Û˘¯ÓfiÙÂÚË Î·È ÛÔ‚·ÚfiÙÂÚË ÂÚÈÁÂÓÓËÙÈÎ‹ ÏÔ›ÌˆÍË.

∆Ô ·ÓÙÈÁfiÓÔ ÙÔ˘ ÈÔ‡ ·ÓÈ¯ÓÂ‡ÂÙ·È ÛÙÔ ÌËÙÚÈÎfi Á¿Ï·.

∆Ô È˚Îfi ÊÔÚÙ›Ô fiÌˆ˜ Â›Ó·È ÌÈÎÚfi Î·È ‰ÂÓ ¤¯ÂÈ ·Ô-

‰ÂÈ¯ıÂ› ÌÂÙ¿‰ÔÛË ÙÔ˘ ÈÔ‡ ·fi ÙÔ ÌËÙÚÈÎfi Á¿Ï·. ¢ÂÓ

Û˘ÓÈÛÙ¿Ù·È ·ÔÊ˘Á‹ ÙÔ˘ ıËÏ·ÛÌÔ‡ ÂÊfiÛÔÓ ¤¯ÂÈ

ÚÔËÁËıÂ› Û˘Ó‰˘·ÛÌ¤ÓË ÂÓÂÚÁËÙÈÎ‹ Î·È ·ıËÙÈÎ‹

·ÓÔÛÔÔ›ËÛË ÌÂ ˘ÂÚ¿ÓÔÛË Á-ÛÊ·ÈÚ›ÓË Î·È Ì›· ‰fi-

ÛË ÂÌ‚ÔÏ›Ô˘ (31,32,34,37).

∏·Ù›ÙÈ‰· C. √ Èfi˜ ÙË˜ Ë·Ù›ÙÈ‰·˜ C ÌÂÙ·‰›‰ÂÙ·È

ÌÂ ÙËÓ ·ÚÂÓÙÂÚÈÎ‹ Ô‰fi. ∏ ÌÂÙ¿‰ÔÛË ÙÔ˘ ÈÔ‡ ÌÂ ÙÔÓ

ıËÏ·ÛÌfi ‰ÂÓ ¤¯ÂÈ ·Ô‰ÂÈ¯ÙÂ›. ∏ ı¤ÛË ÙÔ˘ Center for

Disease Control and Prevention ÙˆÓ ∏¶∞ Â›Ó·È fiÙÈ Ë

ÏÔ›ÌˆÍË ·fi ÙÔÓ Èfi ÙË˜ Ë·Ù›ÙÈ‰·˜ C ‰ÂÓ ·ÔÙÂÏÂ›

·ÓÙ¤Ó‰ÂÈÍË ÁÈ· ÙÔÓ ÌËÙÚÈÎfi ıËÏ·ÛÌfi, ÂÎÙfi˜ ÙˆÓ Â-

ÚÈÙÒÛÂˆÓ Ô˘ Û˘Ó˘¿Ú¯ÂÈ Ë·ÙÈÎ‹ ·ÓÂ¿ÚÎÂÈ·.

øÛÙfiÛÔ ÈÛÙÂ‡ÂÙ·È fiÙÈ ıËÏ¤˜ ÌÂ Ï‡ÛË Û˘ÓÂ¯Â›·˜ ÙÔ˘

‰¤ÚÌ·ÙÔ˜ ‹ ıËÏ¤˜ Ô˘ ·ÈÌÔÚÚ·ÁÔ‡Ó ÌÔÚÂ› Ó· ·˘-

Í‹ÛÔ˘Ó ÙÔÓ Î›Ó‰˘ÓÔ ÌÂÙ¿‰ÔÛË˜ (31,32,34,35,37).

∞ÓÂÍ¿ÚÙËÙ· ·fi ÙÔÓ ·ÈÙÈÔÏÔÁÈÎfi ·Ú¿ÁÔÓÙ· ÙË˜

Ë·Ù›ÙÈ‰·˜ A, B, ‹ C, Ô ıÂˆÚËÙÈÎfi˜ Î›Ó‰˘ÓÔ˜ ÌÂÙ¿-

‰ÔÛË˜ ·fi ÙÔ ÌËÙÚÈÎfi Á¿Ï· ı· Ú¤ÂÈ Ó· Û˘˙ËÙÂ›Ù·È

ÌÂ ÙÔ˘˜ ÁÔÓÂ›˜, ÔÈ ÔÔ›ÔÈ ı· Ú¤ÂÈ Ó· ·ÔÊ·Û›˙Ô˘Ó

ÁÈ· ÙÔ Â›‰Ô˜ ÙË˜ ‰È·ÙÚÔÊ‹˜ ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘˜ (31).

§Ô›ÌˆÍË ·fi ̄ Ï·Ì‡‰È·

∂È‰ÈÎ¤˜ πgA ·ÓÔÛÔÛÊ·ÈÚ›ÓÂ˜ ¤¯Ô˘Ó ·ÓÈ¯ÓÂ˘ÙÂ›

ÛÙÔ ‡·Ú Î·È ÛÙÔ ÌËÙÚÈÎfi Á¿Ï·. ¢ÂÓ ˘¿Ú¯Ô˘Ó ÂÓ-

‰Â›ÍÂÈ˜ ÁÈ· ÂÓ‰Â¯fiÌÂÓË ÌÂÙ¿‰ÔÛË ÙË˜ ÓfiÛÔ˘ ·fi ÙÔÓ

ÌËÙÚÈÎfi ıËÏ·ÛÌfi (31).

§ÈÛÙÂÚ›ˆÛË

¢ÂÓ ˘¿Ú¯Ô˘Ó ·Ó·ÊÔÚ¤˜ Ô˘ Ó· ÂÓÔ¯ÔÔÈÔ‡Ó ÙÔ

ÌËÙÚÈÎfi Á¿Ï· Û·Ó ËÁ‹ ÌÂÙ¿‰ÔÛË˜ ÙË˜ ÏÈÛÙ¤ÚÈ·˜.

∆Ô ÌËÙÚÈÎfi Á¿Ï· ıÂˆÚÂ›Ù·È Î·Ù¿ÏÏËÏË ÙÚÔÊ‹ ÁÈ· ÙÔ

‚Ú¤ÊÔ˜ ˘fi ÙËÓ ÚÔ¸fiıÂÛË fiÙÈ ÁÈ· ÙË ıÂÚ·Â›·

ÙË˜ ÌËÙ¤Ú·˜ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ·ÓÙÈÌÈÎÚÔ‚È·ÎÔ› ·-

Ú¿ÁÔÓÙÂ˜ Ô˘ ÂÈÙÚ¤ÔÓÙ·È Î·Ù¿ ÙÔÓ ıËÏ·ÛÌfi (31).

°ÔÓÔÎÎÔÎÈÎ‹ ÏÔ›ÌˆÍË

¢ÂÓ ˘¿Ú¯ÂÈ Î›Ó‰˘ÓÔ˜ ÌÂÙ¿‰ÔÛË˜ ÙË˜ ÓfiÛÔ˘ ·fi

ÙÔ ÌËÙÚÈÎfi Á¿Ï· (31).

™‡ÊÈÏË

¢ÂÓ ˘¿Ú¯Ô˘Ó ÂÓ‰Â›ÍÂÈ˜ ÁÈ· ÂÓ‰Â¯fiÌÂÓË ÌÂÙ¿‰Ô-

ÛË ÙË˜ ÓfiÛÔ˘ ÌÂ ÙÔÓ ıËÏ·ÛÌfi, ÂÎÙfi˜ ·Ó ˘¿Ú¯Ô˘Ó

ÂÓÙÔÈÛÌ¤ÓÂ˜ ‚Ï¿‚Â˜ ÛÙÔ Ì·ÛÙfi ‹ ÙË ıËÏ‹, ÔfiÙÂ Ô

ıËÏ·ÛÌfi˜ Ú¤ÂÈ Ó· ·ÔÊÂ‡ÁÂÙ·È, Ì¤¯ÚÈ Ë ÌËÙ¤Ú· Ó·

¿ÚÂÈ ıÂÚ·Â›· Î·È Ó· ˘Ô¯ˆÚ‹ÛÔ˘Ó ÔÈ ‚Ï¿‚Â˜ (31).

∆ÔÍÔÏ¿ÛÌˆÛË

ªÂÙ¿‰ÔÛË ÙË˜ ÓfiÛÔ˘ ·fi ÙÔÓ ÌËÙÚÈÎfi ıËÏ·ÛÌfi

‰ÂÓ ¤¯ÂÈ ÙÂÎÌËÚÈˆıÂ›. √È ıËÏ¿˙Ô˘ÛÂ˜ ÌËÙ¤ÚÂ˜

280 ∂. Ã·Ù˙Ë‰¿ÎË, Ã. °È·ÓÓ·ÎÔÔ‡ÏÔ˘



ÚÔÛÊ¤ÚÔ˘Ó ÛÙ· ÓÂÔÁÓ¿ ÙÔ˘˜ ÂÈ‰ÈÎ¿ ·ÓÙÈÛÒÌ·Ù· ÌÂ

ÙÔ Á¿Ï· ÙÔ˘˜. ¢ÂÓ ˘¿Ú¯ÂÈ ÏÔÈfiÓ Î·Ì›· ·ÓÙ¤Ó‰ÂÈÍË

ÁÈ· ÙÔÓ ÌËÙÚÈÎfi ıËÏ·ÛÌfi (31,37).

º˘Ì·Ù›ˆÛË

™ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ ÂÎÂ›ÓÂ˜ Ô˘ ˘¿Ú¯ÂÈ ÌfiÓÔ ıÂ-

ÙÈÎ‹ ‰ÂÚÌ·ÙÈÎ‹ ‰ÔÎÈÌ·Û›· Ê˘Ì·Ù›ÓË˜, Ô ıËÏ·ÛÌfi˜

Û˘ÓÈÛÙ¿Ù·È ·ÓÂÈÊ‡Ï·ÎÙ·. ∂¿Ó Ë ÌËÙ¤Ú· ¤¯ÂÈ ÂÓÂÚÁ‹

ÓfiÛÔ, ÙÔ ÓÂÔÁÓfi ·ÔÌ·ÎÚ‡ÓÂÙ·È ·fi ÙË ÌËÙ¤Ú· ÙÔ˘

·Ì¤Ûˆ˜ ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi. ∆Ô Ì˘ÎÔ‚·ÎÙËÚ›‰ÈÔ ÙË˜

Ê˘Ì·Ù›ˆÛË˜ ‰ÂÓ ·ÔÌÔÓÒÓÂÙ·È ÛÙÔ ÌËÙÚÈÎfi Á¿Ï·.

∏ ÌËÙ¤Ú· ÌÔÚÂ› Ó· ·Ê·ÈÚÂ› ÙÔ Á¿Ï· ÙË˜ ÌÂ ·ÓÙÏ›·

Î·È Ó· ̄ ÔÚËÁÂ›Ù·È ÛÙÔ ÓÂÔÁÓfi ÙË˜ ·fi ¿ÏÏÔ ¿ÙÔÌÔ. ∏

ÌfiÓË ·ÓÙ¤Ó‰ÂÈÍË ¯ÔÚ‹ÁËÛË˜ ÌËÙÚÈÎÔ‡ Á¿Ï·ÎÙÔ˜ Â›-

Ó·È Ë Ê˘Ì·ÙÈÒ‰Ë˜ Ì·ÛÙ›ÙÈ‰· ÙË˜ ÌËÙ¤Ú·˜. ™ÙËÓ ÂÈ-

ÏÔÁ‹ ÙË˜ ·ÓÙÈÊ˘Ì·ÙÈÎ‹˜ ·ÁˆÁ‹˜ ÛÙË ÌËÙ¤Ú· Ï·Ì‚¿-

ÓÂÙ·È ˘fi„Ë Ë ÂÓ‰Â¯fiÌÂÓË ·¤ÎÎÚÈÛË ÙÔ˘ Ê·ÚÌ¿-

ÎÔ˘ ÛÙÔ ÌËÙÚÈÎfi Á¿Ï· Î·È ÔÈ ÂÈ‰Ú¿ÛÂÈ˜ ÛÙËÓ ˘ÁÂ›·

ÙÔ˘ ÓÂÔÁÓÔ‡. ∏ ·ÔÌ¿ÎÚ˘ÓÛË ÙÔ˘ ÓÂÔÁÓÔ‡ ÂÊ·ÚÌfi-

˙ÂÙ·È Ì¤¯ÚÈ Ó· ·Ô‰ÂÈ¯ıÂ› fiÙÈ Ë ÌËÙ¤Ú· ‰ÂÓ ÌÂÙ·‰›-

‰ÂÈ ÙË ÓfiÛÔ (31,32,35,37).

¡ÔÛ‹Ì·Ù· ÌÂÙ·‚ÔÏÈÛÌÔ‡

°·Ï·ÎÙÔ˙·ÈÌ›·

∏ Á·Ï·ÎÙÔ˙·ÈÌ›· Â›Ó·È ÌÈ· ÓfiÛÔ˜ Ô˘ ÔÊÂ›ÏÂÙ·È

ÛÂ ·ÓÂ¿ÚÎÂÈ· ÙÔ˘ ÂÓ˙‡ÌÔ˘ galactose-1-phosphate

uridyl transferase. ™ÙËÓ ÎÏ·ÛÈÎ‹ ÙË˜ ÌÔÚÊ‹ Ë ¤ÏÏÂÈ-

„Ë ÙÔ˘ ÂÓ˙‡ÌÔ˘ Â›Ó·È Ï‹ÚË˜ Î·È ÙÔ ÓÂÔÁÓfi ‰ÂÓ ÌÔ-

ÚÂ› Ó· ·ÓÂ¯ÙÂ› ÙËÓ ·ÚÔ˘Û›· Á·Ï·ÎÙfi˙Ë˜ ÛÙË ‰›·ÈÙ¿

ÙÔ˘, ÂÔÌ¤Óˆ˜ Ô ÌËÙÚÈÎfi˜ ıËÏ·ÛÌfi˜ ‰ÂÓ Â›Ó·È ·ÓÂ-

ÎÙfi˜ Î·È ‰ÂÓ ÂÈÙÚ¤ÂÙ·È. À¿Ú¯Ô˘Ó fiÌˆ˜ Î·È ÌÔÚ-

Ê¤˜ fiÔ˘ Ë ·ÓÂ¿ÚÎÂÈ· ÙÔ˘ ÂÓ˙‡ÌÔ˘ ‰ÂÓ Â›Ó·È Ï‹-

ÚË˜ Î·È Î¿ÔÈ· ÔÛfiÙËÙ· Á·Ï·ÎÙfi˙Ë˜ ÌÔÚÂ› Ó· Â›-

Ó·È ·ÓÂÎÙ‹ ·fi ÙÔ ÓÂÔÁÓfi, ÔfiÙÂ Î·È ÙÔ Á¿Ï· ÙË˜ ÌË-

Ù¤Ú·˜ ÙÔ˘ ÌÔÚÂ› Ó· ¯ÚËÛÈÌÔÔÈËıÂ› ÁÈ· Ó· Î·Ï‡„ÂÈ

ÙÌ‹Ì· ÙˆÓ ‰È·ÙÚÔÊÈÎÒÓ ÙÔ˘ ·Ó·ÁÎÒÓ (2,31,32,37).

º·ÈÓ˘ÏÎÂÙÔÓÔ˘Ú›·

∏ Ê·ÈÓ˘ÏÎÂÙÔÓÔ˘Ú›· ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ‰˘Û·-

ÓÂÍ›· ÛÙË Ê·ÈÓ˘Ï·Ï·Ó›ÓË. ∆Ô ÌËÙÚÈÎfi Á¿Ï· Â›Ó·È

ÁÓˆÛÙfi fiÙÈ ÂÚÈ¤¯ÂÈ ÌÈÎÚ¿ ÔÛ¿ Ê·ÈÓ˘Ï·Ï·Ó›ÓË˜. ∏

ÚÔÛÊÔÚ¿ Î¿ÔÈˆÓ ÔÛÔÙ‹ÙˆÓ ÌËÙÚÈÎÔ‡ Á¿Ï·ÎÙÔ˜

Î·È Ë ÚÔÛı‹ÎË ÂÈ‰ÈÎÔ‡ Á¿Ï·ÙÔ˜ ÂÏÂ‡ıÂÚÔ˘ ÛÂ Ê·È-

Ó˘Ï·Ï·Ó›ÓË ˆ˜ Û˘ÌÏËÚˆÌ·ÙÈÎ‹ ‰È·ÙÚÔÊ‹ Â›Ó·È Ë

È‰·ÓÈÎfiÙÂÚË Ï‡ÛË (32,37).

¡fiÛÔ˜ Wilson

™ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ Ô˘ Ë ÌËÙ¤Ú· ¿Û¯ÂÈ ·fi ÓfiÛÔ

ÙÔ˘ Wilson Ô˘ ÛÙË ÏÂÈÔ„ËÊ›· ÙˆÓ ÂÚÈÙÒÛÂˆÓ

‚Ú›ÛÎÂÙ·È ˘fi ıÂÚ·Â›· ÌÂ ÂÓÈÎÈÏÏ·Ì›ÓË, Ô ıËÏ·-

ÛÌfi˜ ‰ÂÓ ÂÈÙÚ¤ÂÙ·È. ∏ ÂÓÈÎÈÏÏ·Ì›ÓË ·ÂÎÎÚ›ÓÂ-

Ù·È ·fi ÙÔ ÌËÙÚÈÎfi Á¿Ï· Î·È ÂÎÙfi˜ ·fi ÙÔÓ ¯·ÏÎfi,

‰ÂÛÌÂ‡ÂÈ ÙÔ Ì·ÁÓ‹ÛÈÔ Î·È ÙÔÓ Û›‰ËÚÔ (32).

™˘Ó‹ıÂÈÂ˜ ÙË˜ ıËÏ¿˙Ô˘Û·˜ ÌËÙ¤Ú·˜

¢ÈÔÚıˆÙÈÎ¤˜ ÂÂÌ‚¿ÛÂÈ˜ ÙÔ˘ ÛÙ‹ıÔ˘˜

ÌÂ ÛÈÏÈÎfiÓË

∞ÔÙÂÏÂ› ÌÈ· Û˘Ó‹ıË Ù·ÎÙÈÎ‹ ÛÙÈ˜ ∏¶∞ fiÔ˘

·Ó·Ê¤ÚÔÓÙ·È ÂÚÈÛÛfiÙÂÚÂ˜ ·fi 200.000 ÂÂÌ‚¿-

ÛÂÈ˜ ÂÙËÛ›ˆ˜, Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·. √È ÂÚÈÛÛfiÙÂ-

ÚÂ˜ ·fi ·˘Ù¤˜ Â›Ó·È ÛÂ ¤ÊË‚Â˜ Î·È ÓÂ·Ú¤˜ ÂÓ‹ÏÈÎÂ˜

Á˘Ó·›ÎÂ˜. ™‡ÌÊˆÓ· ÌÂ ÙËÓ ∞ÌÂÚÈÎ·ÓÈÎ‹ ∞Î·‰ËÌ›·

¶·È‰È·ÙÚÈÎ‹˜ ‰ÂÓ ·ÔÙÂÏÂ› ·ÓÙ¤Ó‰ÂÈÍË ÁÈ· ÙÔÓ ÌË-

ÙÚÈÎfi ıËÏ·ÛÌfi (38). øÛÙfiÛÔ, ¤¯Ô˘Ó ‰ËÌÈÔ˘ÚÁËıÂ›

ÂÚˆÙËÌ·ÙÈÎ¿, Î·ıÒ˜ ‰ÂÓ ˘¿Ú¯Ô˘Ó ·ÚÎÂÙ¤˜ ÌÂÏ¤-

ÙÂ˜ Ô˘ Ó· ÙÂÎÌËÚÈÒÓÔ˘Ó ÙËÓ ·ÛÊ¿ÏÂÈ· ÙÔ˘ ÌËÙÚÈ-

ÎÔ‡ ıËÏ·ÛÌÔ‡ (39).

¢È·ÈÙËÙÈÎ¤˜ Û˘Ó‹ıÂÈÂ˜

∏ ÌËÙ¤Ú· ÌÂ ÙÔ Á¿Ï· ÙË˜ Î·Ï‡ÙÂÈ ÙÈ˜ ‰È·ÙÚÔÊÈ-

Î¤˜ ·Ó¿ÁÎÂ˜ ÙÔ˘ ‚Ú¤ÊÔ˘˜ ÙË˜, ·Ú¤¯ÔÓÙ¿˜ ÙÔ˘ fiÏ·

Ù· ··Ú·›ÙËÙ· ıÚÂÙÈÎ¿ Û˘ÛÙ·ÙÈÎ¿, fiˆ˜ Úˆ-

ÙÂ˝ÓÂ˜, Ï›Ë, ˘‰·Ù¿ÓıÚ·ÎÂ˜, ‚ÈÙ·Ì›ÓÂ˜, È¯ÓÔÛÙÔÈ-

¯Â›· ÛÙË ÛˆÛÙ‹ ·Ó·ÏÔÁ›· ÁÈ· ÙËÓ ÔÌ·Ï‹ ÙÔ˘ ·Ó¿-

Ù˘ÍË. À¿Ú¯Ô˘Ó fiÌˆ˜ ÂÚÈÙÒÛÂÈ˜ ÌËÙ¤ÚˆÓ Ô˘

Ë ‰È·ÙÚÔÊ‹ ÙÔ˘˜ Â›Ó·È ÚÔÛ·ÚÌÔÛÌ¤ÓË, fi¯È Û‡ÌÊˆ-

Ó· ÌÂ ÙÈ˜ ·Ó¿ÁÎÂ˜ ÙÔ˘˜, ·ÏÏ¿ Û‡ÌÊˆÓ· ÌÂ ÔÏÈÙÈ-

ÛÌÈÎ¤˜ ‹ ÚÔÛˆÈÎ¤˜ ÂÔÈı‹ÛÂÈ˜. ÃÔÚÙÔÊ·Á›·,

·ÔÊ˘Á‹ Á·Ï·ÎÙÔÎÔÌÈÎÒÓ ÚÔ˚fiÓÙˆÓ, ˘ÔıÂÚÌÈ‰È-

Î‹ ‰È·ÙÚÔÊ‹, Â›Ó·È ÌÂÚÈÎ¤˜ ·fi ·˘Ù¤˜ ÙÈ˜ Î·ÙËÁÔ-

Ú›Â˜ ‰È·ÈÙËÙÈÎ‹˜ Û˘ÌÂÚÈÊÔÚ¿˜. √È ÌËÙ¤ÚÂ˜ ÂÓËÌÂ-

ÚÒÓÔÓÙ·È ÁÈ· ÙËÓ ÂÓ‰Â¯fiÌÂÓË ‰È·ÈÙËÙÈÎ‹ ·ÓÂ¿Ú-

ÎÂÈ¿ ÙÔ˘˜ Î·È ÂÓı·ÚÚ‡ÓÔÓÙ·È Ó· ·›ÚÓÔ˘Ó Û˘ÌÏË-

ÚÒÌ·Ù· ‰È·ÙÚÔÊ‹˜ ÌÂ ÛÙfi¯Ô ÙËÓ ÂÍ·ÛÊ¿ÏÈÛË ÏË-

Ú¤ÛÙÂÚË˜ ‰È·ÙÚÔÊÈÎ‹˜ Â¿ÚÎÂÈ·˜ ÛÙÔ ‚Ú¤ÊÔ˜ ÙÔ˘˜

(32,37).

∫¿ÓÈÛÌ·

∆Ô Î¿ÓÈÛÌ· ÙË˜ ÌËÙ¤Ú·˜ ‰ÂÓ ·ÔÙÂÏÂ› ·ÓÙ¤Ó-

‰ÂÈÍË ÁÈ· ÙÔÓ ıËÏ·ÛÌfi, ˆÛÙfiÛÔ Ë ÌËÙ¤Ú· Ú¤ÂÈ Ó·

ÂÓı·ÚÚ‡ÓÂÙ·È Ó· ÌËÓ Î·Ó›˙ÂÈ ÛÙÔ ÂÚÈ‚¿ÏÏÔÓ ÙÔ˘

ÛÈÙÈÔ‡ Î·È Ó· Î·Ù·‚¿ÏÂÈ Î¿ıÂ ‰˘Ó·Ù‹ ÚÔÛ¿ıÂÈ·

Ó· ‰È·Îfi„ÂÈ ÙÔ Î¿ÓÈÛÌ· fiÛÔ ÙÔ ‰˘Ó·ÙfiÓ ÈÔ Û‡ÓÙÔ-

Ì· (2,38).

∞ÏÎÔfiÏ

√È ıËÏ¿˙Ô˘ÛÂ˜ ÌËÙ¤ÚÂ˜ Ú¤ÂÈ Ó· ·ÔÊÂ‡ÁÔ˘Ó

ÙË Ï‹„Ë ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ, ÂÂÈ‰‹ ÙÔ ·ÏÎÔfiÏ Û˘-

ÁÎÂÓÙÚÒÓÂÙ·È ÛÙÔ ÌËÙÚÈÎfi Á¿Ï· Î·È Ë ¯Ú‹ÛË ÙÔ˘

·Ó·ÛÙ¤ÏÏÂÈ ÙËÓ ·Ú·ÁˆÁ‹ ÌËÙÚÈÎÔ‡ Á¿Ï·ÎÙÔ˜. ¶Â-

ÚÈÛÙ·ÛÈ·Î‹ Ï‹„Ë ÂÓfi˜ ÌÈÎÚÔ‡ ·ÏÎÔÔÏÔ‡¯Ô˘ ÔÙÔ‡

Â›Ó·È ·Ô‰ÂÎÙ‹, ·ÏÏ¿ Ô ıËÏ·ÛÌfi˜ Ú¤ÂÈ Ó· ·Ô-

ÊÂ‡ÁÂÙ·È ÁÈ· 2 ÒÚÂ˜ ÌÂÙ¿ ·fi ÙË Ï‹„Ë ÙÔ˘ (2,40).

ÃÚ‹ÛË Ó·ÚÎˆÙÈÎÒÓ Ô˘ÛÈÒÓ

∏ ¯Ú‹ÛË ·fi ÙË ÌËÙ¤Ú· Ó·ÚÎˆÙÈÎÒÓ Ô˘ÛÈÒÓ

·ÔÙÂÏÂ› ·ÓÙ¤Ó‰ÂÈÍË ÁÈ· ıËÏ·ÛÌfi (2).


¶·È‰È·ÙÚÈÎ‹ 2007;70:278-284


ŒÎıÂÛË ÛÂ Ê˘ÙÔÊ¿ÚÌ·Î· Î·È ·Ú·ÛÈÙÔÎÙfiÓ·

™Â ÂÚÈÙÒÛÂÈ˜ ·Û˘Ó‹ıÈÛÙ· ˘„ËÏ‹˜ ÂÚÈ‚·ÏÏÔ-

ÓÙÈÎ‹˜ ÊfiÚÙÈÛË˜ ÔÈ ÌËÙ¤ÚÂ˜ Â›Ó·È ‰˘ÓËÙÈÎ¿ ÛÂ Î›Ó‰˘-

ÓÔ. ∫¿ıÂ ÂÚ›ÙˆÛË ÌÂÏÂÙ¿Ù·È ÌÂ ÚÔÛÔ¯‹ (32).

ŒÎıÂÛË ÛÂ ‚·Ú¤· Ì¤Ù·ÏÏ·

Œ¯ÂÈ ·Ó·ÊÂÚıÂ› ¤ÎıÂÛË ‚ÚÂÊÒÓ ÛÂ ‚·Ú¤· Ì¤Ù·Ï-

Ï· fiˆ˜ ÌfiÏ˘‚‰Ô, ˘‰Ú¿ÚÁ˘ÚÔ, ·ÚÛÂÓÈÎfi, Î·È Î¿‰-

ÌÈÔ. ∏ ¤ÎıÂÛË ·˘Ù‹ ÌÔÚÂ› Ó· Û¯ÂÙ›˙ÂÙ·È ÌÂ ÙË ‰È·-

ı¤ÛÈÌË ·ÚÔ¯‹ ÓÂÚÔ‡ ÙË˜ Û˘ÁÎÂÎÚÈÌ¤ÓË˜ ÂÚÈÔ¯‹˜,

ÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜ ·ÏÏ¿ Î·È ÙÔ ÙÚÔÔÔÈËÌ¤ÓÔ Á¿Ï·

·ÁÂÏ¿‰·˜. øÛÙfiÛÔ Ë ¤ÎıÂÛË ÁÈ· Ù· ÓÂÔÁÓ¿ Ô˘ ÛÈÙ›-

˙ÔÓÙ·È ÌÂ ÌËÙÚÈÎfi Á¿Ï· Â›Ó·È ÂÚÈÔÚÈÛÌ¤ÓË ÛÂ Û¯¤ÛË

ÌÂ ÙË Û›ÙÈÛË ÌÂ ÙÚÔÔÔÈËÌ¤ÓÔ Á¿Ï· ·ÁÂÏ¿‰·˜,

·ÎfiÌ· Î·È ÛÂ ÁÂˆÁÚ·ÊÈÎ¤˜ ÂÚÈÔ¯¤˜ Ô˘ ˘¿Ú¯Ô˘Ó

˘„ËÏ¿ Â›Â‰· ÙÔ˘ ÌÂÙ¿ÏÏÔ˘ (32,37).

ªfiÏ˘‚‰Ô˜: √ ÌfiÏ˘‚‰Ô˜ ‰È¤Ú¯ÂÙ·È ÙÔÓ Ï·ÎÔ‡-

ÓÙ·, Î·È ·ÂÎÎÚ›ÓÂÙ·È Î·È ÛÙÔ ÌËÙÚÈÎfi Á¿Ï·. ∂¿Ó Ù·

Â›Â‰· ÙÔ˘ ÌÔÏ‡‚‰Ô˘ ÛÙË ÌËÙ¤Ú· Â›Ó·È ÌÈÎÚfiÙÂÚ·

ÙˆÓ 40 Ìg/dl, Ô ıËÏ·ÛÌfi˜ ıÂˆÚÂ›Ù·È ·ÛÊ·Ï‹˜. ∏ ÁÂ-

ÓÈÎfiÙÂÚË ÛÙÚ·ÙËÁÈÎ‹ fiÛÔÓ ·ÊÔÚ¿ ÙÔÓ ıËÏ·ÛÌfi ÛÙÈ˜

ÂÚÈÙÒÛÂÈ˜ ¤ÎıÂÛË˜ ÛÂ ‚·Ú¤· Ì¤Ù·ÏÏ· ÂÍ·ÚÙ¿Ù·È

¿ÌÂÛ· ·fi ÙÔ ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎfi Â›Â‰Ô ÙË˜ ÔÈ-

ÎÔÁ¤ÓÂÈ·˜ Î·È ÙË ‰˘Ó·ÙfiÙËÙ¿ ÙË˜ Ó· ¯ÔÚËÁ‹ÛÂÈ ÛÙÔ

ÓÂÔÁÓfi ÙÚÔÔÔÈËÌ¤ÓÔ Á¿Ï· ·ÁÂÏ¿‰·˜. ™Â ÌÂÚÈÎ¤˜

ÂÚÈÙÒÛÂÈ˜ Ë ÂÚÈ‚·ÏÏÔÓÙÈÎ‹ ÊfiÚÙÈÛË Â›Ó·È ÌÂÁ¿-

ÏË Î·È ÙÔ ÙÂ¯ÓËÙ¿ ·Ú·ÛÎÂ˘·˙fiÌÂÓÔ Á¿Ï· ÂÎı¤ÙÂÈ

ÙÔ ‚Ú¤ÊÔ˜ ÛÂ ÌÂÁ·Ï‡ÙÂÚ· ÔÛ¿ ÌÂÙ¿ÏÏÔ˘ ÛÂ Û¯¤ÛË

ÌÂ ÙÔ ÌËÙÚÈÎfi (32,37).

À‰Ú¿ÚÁ˘ÚÔ˜: ŒÎıÂÛË ÛÂ ˘‰Ú¿ÚÁ˘ÚÔ ¤¯ÂÈ ·Ó·ÊÂÚ-

ıÂ› ÛÂ Ô‰ÔÓÙÈ·ÙÚÈÎÔ‡˜ ·ÛıÂÓÂ›˜ Î·È Ô‰ÔÓÙÈ¿ÙÚÔ˘˜,

Î·È ÌÂÙ¿ ·fi Î·Ù·Ó¿ÏˆÛË ÌÔÏ˘ÛÌ¤ÓˆÓ ı·Ï·ÛÛÈÓÒÓ

Î·È „·ÚÈÒÓ. ªÂÏ¤ÙÂ˜ Ô˘ ‰ÈÂÓÂÚÁ‹ıËÎ·Ó ÛÙ· ÓËÛÈ¿

™Â¸¯¤ÏÏÂ˜ ÛÂ ·È‰È¿ Ô˘ ÂÎÙ¤ıËÎ·Ó ÛÙÔ Û˘ÁÎÂÎÚÈ-

Ì¤ÓÔ Ì¤Ù·ÏÏÔ ÌÂÙ¿ ·fi Î·Ù·Ó¿ÏˆÛË ÌÔÏ˘ÛÌ¤ÓˆÓ

„·ÚÈÒÓ, ‰ÂÓ ‰È·ÈÛÙÒıËÎÂ Î›Ó‰˘ÓÔ˜ ·fi ÙËÓ ÂÈ-

Ï¤ÔÓ ¤ÎıÂÛË ÛÂ ÌËÙÚÈÎfi Á¿Ï·. ∏ ÓÂ˘ÚÔ·Ó·Ù˘ÍÈ·-

Î‹ ÂÍ¤ÏÈÍË ÙˆÓ ·È‰ÈÒÓ Ô˘ ı‹Ï·˙·Ó ‹Ù·Ó Î·Ï‡ÙÂÚË

ÛÂ Û¯¤ÛË ÌÂ ·˘Ù¿ Ô˘ ÛÈÙ›ÛÙËÎ·Ó ÌÂ ÙÂ¯ÓËÙ‹ ‰È·-

ÙÚÔÊ‹ (32,37).

∫¿‰ÌÈÔ: ∆Ô Î¿‰ÌÈÔ Â›Ó·È ÁÓˆÛÙfi fiÙÈ ‰È¤Ú¯ÂÙ·È ÙÔÓ

Ï·ÎÔ‡ÓÙ·. ŒÎıÂÛË ¤¯ÂÈ ·Ó·ÊÂÚıÂ› ÛÂ ‚ÈÔÌË¯·ÓÈÎ¤˜

ÂÚÈÔ¯¤˜ Î·È ÛÂ ‚·ÚÂ›˜ Î·ÓÈÛÙ¤˜. ∆Ô ¤Ì‚Ú˘Ô ¤¯ÂÈ

‹‰Ë ÂÎÙÂıÂ› Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ Î‡ËÛË˜. ∏ ÌËÙ¤Ú·

ı· Ú¤ÂÈ Ó· ÂÓËÌÂÚÒÓÂÙ·È ÁÈ· ÙÔÓ ÂÓ‰Â¯fiÌÂÓÔ Î›Ó-

‰˘ÓÔ ·fi ÙË ¯ÔÚ‹ÁËÛË ÌËÙÚÈÎÔ‡ Á¿Ï·ÙÔ˜ ÛÙÔ ‚Ú¤-

ÊÔ˜ ÙË˜ ÛÂ Û¯¤ÛË ÌÂ ÙÔ fiÊÂÏÔ˜ Î·È Ó· ·ÔÊ·Û›˙ÂÈ.

ªÂÚÈÎÔ› ÚÔÙÂ›ÓÔ˘Ó ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙÔ˘ ÌÂ-

Ù¿ÏÏÔ˘ ÛÙÔ ·›Ì· ÙË˜ ıËÏ¿˙Ô˘Û·˜ fiÙ·Ó Ë ¤ÎıÂÛË Â›-

Ó·È ·Û˘Ó‹ıÈÛÙ· ÛËÌ·ÓÙÈÎ‹ (32,37).

ƒ·‰ÈÔÓÔ˘ÎÏÂÔÙ›‰È·: ∏ ÂÚÈ‚·ÏÏÔÓÙÈÎ‹ ¤ÎıÂÛË ÛÂ

Ú·‰ÈÔÓÔ˘ÎÏÂÔÙ›‰È· ¤¯ÂÈ ··Û¯ÔÏ‹ÛÂÈ Â› ‰ÂÎ·ÂÙ›Â˜

ÙÔ˘˜ ÂÚÂ˘ÓËÙ¤˜. øÛÙfiÛÔ, ÚÔÛÂÎÙÈÎ¤˜ ÂÎÙÈÌ‹ÛÂÈ˜

Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ˘ÚËÓÈÎÒÓ ·Ù˘¯ËÌ¿ÙˆÓ ·ÔÎ¿Ï˘-

„·Ó, fiÙÈ Ù· Â›Â‰· ÙÔ˘ ÛÙÚÔÓÙ›Ô˘ (strontium 90)

ÛÙÔ ÌËÙÚÈÎfi Á¿Ï· Â›Ó·È ÌÈÎÚfiÙÂÚ· ·fi ·˘Ù¿ Ô˘

˘¿Ú¯Ô˘Ó ÛÙÔ ÙÚÔÔÔÈËÌ¤ÓÔ Á¿Ï· ·ÁÂÏ¿‰·˜, ÛÙÔ

Á¿Ï· ·ÁÂÏ¿‰·˜ Î·È ÛÙÔ ÓÂÚfi (32,37).

§‹„Ë Ê·ÚÌ·ÎÂ˘ÙÈÎÒÓ Ô˘ÛÈÒÓ ·fi ÙË ÌËÙ¤Ú·

¶ÔÏÏ¤˜ ÌËÙ¤ÚÂ˜ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÏÔ¯Â›·˜

¯ÚËÛÈÌÔÔÈÔ‡Ó ‰È¿ÊÔÚ· Ê·ÚÌ·ÎÂ˘ÙÈÎ¿ ÛÎÂ˘¿ÛÌ·-

Ù·. ∏ ÁÓÒÛË ÙË˜ Ê·ÚÌ·ÎÔÎÈÓËÙÈÎ‹˜ Î·È ÙË˜ ‚ÈÔ‰È·-

ıÂÛÈÌfiÙËÙ·˜ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ÛÙË ÌËÙ¤Ú· Î·È ÛÙÔ ÓÂÔ-

ÁÓfi, Î·È ÙˆÓ ÂÓ‰Â¯fiÌÂÓˆÓ ÂÈ‰Ú¿ÛÂˆÓ ÛÙËÓ ˘ÁÂ›·

ÙÔ˘˜, Â›Ó·È ÚˆÙÂ‡Ô˘Û·˜ ÛËÌ·Û›·˜. À¿Ú¯Ô˘Ó Î¿-

ÔÈÂ˜ ÂÚÈÙÒÛÂÈ˜ Ô˘ Ë ¯ÔÚ‹ÁËÛË ÙÔ˘ ÌËÙÚÈÎÔ‡

Á¿Ï·ÙÔ˜ ‰ÂÓ Â›Ó·È ·ÛÊ·Ï‹˜. °È· Ó· ÚÔÙÂ›ÓÔ˘ÌÂ ÙË

Û˘Ó¤¯ÈÛË ‹ ÙË ‰È·ÎÔ‹ ÙÔ˘ ıËÏ·ÛÌÔ‡, Â›Ó·È ··Ú·›-

ÙËÙÔ Ó· Û˘ÓÂÎÙÈÌ‹ÛÔ˘ÌÂ ÔÏÏÔ‡˜ ·Ú¿ÁÔÓÙÂ˜,

fiˆ˜ Ë ·Ó·ÁÎ·ÈfiÙËÙ· ÙË˜ ¯ÔÚ‹ÁËÛË˜ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘

ÛÙË ÌËÙ¤Ú·, Ë ‰˘Ó·ÙfiÙËÙ· ·ÓÙÈÎ·Ù¿ÛÙ·Û‹˜ ÙÔ˘ ÌÂ

ÛÎÂ˘¿ÛÌ·Ù· Ô˘ ·ÂÎÎÚ›ÓÔÓÙ·È ÛÙÔ ÌËÙÚÈÎfi Á¿Ï·

ÛÂ ÌÈÎÚfiÙÂÚÂ˜ ÔÛfiÙËÙÂ˜ Î·È Ë Ú‡ıÌÈÛË ÙˆÓ ÌÂÛÔ-

‰È·ÛÙËÌ¿ÙˆÓ ¯ÔÚ‹ÁËÛË˜, ¤ÙÛÈ ÒÛÙÂ Ë Ì¤ÁÈÛÙË Û˘-

ÁÎ¤ÓÙÚˆÛË ÛÙÔ Ï¿ÛÌ· Ó· ·¤¯ÂÈ ¯ÚÔÓÈÎ¿ Î·Ù¿ ÙÔ

‰˘Ó·ÙfiÓ ÂÚÈÛÛfiÙÂÚÔ ·fi ÙËÓ ÒÚ· ÙˆÓ ÁÂ˘Ì¿ÙˆÓ

ÙÔ˘ ‚Ú¤ÊÔ˘˜. À¿Ú¯Ô˘Ó ÂÚÈÙÒÛÂÈ˜ fiˆ˜, Ï‹„Ë

·Ó·ÈÛıËÛ›·˜ ‹ Ú·‰ÈÔÊ·ÚÌ¿ÎˆÓ ÁÈ· ‰È·ÁÓˆÛÙÈÎÔ‡˜

ÏfiÁÔ˘˜, Î·Ù¿ ÙÈ˜ ÔÔ›Â˜ ÌÔÚÂ› Ó· ‰È·ÎÔÂ› ÚÔÛˆ-

ÚÈÓ¿ Ô ıËÏ·ÛÌfi˜ Î·È ÛÙË Û˘Ó¤¯ÂÈ· Ë ÌËÙ¤Ú· Ó· ıË-

Ï¿˙ÂÈ ÙÔ ‚Ú¤ÊÔ˜ ÙË˜ ̄ ˆÚ›˜ Úfi‚ÏËÌ· (36,38,41). ™Ë-

Ì·ÓÙÈÎ‹ Â›ÛË˜ ·Ú¿ÌÂÙÚÔ ·ÔÙÂÏÂ› Î·È Ë ËÏÈÎ›·

ÙÔ˘ ‚Ú¤ÊÔ˘˜ Ô˘ ıËÏ¿˙ÂÈ. ∆Ô ÓÂÔÁÓfi Î·È ÙÔ ÌÈÎÚfi

‚Ú¤ÊÔ˜ Â›Ó·È ÈÔ Â˘·›ÛıËÙÔ ·fi ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ‚Ú¤-

ÊÔ˜ ÂÍ·ÈÙ›·˜ ÙË˜ ·ÓˆÚÈÌfiÙËÙ·˜ ÙfiÛÔ ÙˆÓ ÌË¯·ÓÈ-

ÛÌÒÓ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙˆÓ Ê·ÚÌ¿ÎˆÓ ÛÙÔ ‹·Ú, fiÛÔ

Î·È ÙË˜ ÓÂÊÚÈÎ‹˜ ·¤ÎÎÚÈÛË˜ (41).

∏ ¯Ú‹ÛË ·ÓÙÈÓÂÔÏ·ÛÌ·ÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ·fi

ÙË ÌËÙ¤Ú· Î·È Ë ¤ÎıÂÛË ÙÔ˘ ‚Ú¤ÊÔ˘˜ ÛÂ ·ÓÙÈÓÂÔ-

Ï·ÛÌ·ÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜ ÛÙË Ê¿ÛË Ô˘ Ë ·Ó¿Ù˘-

ÍË ÙˆÓ ÈÛÙÒÓ ÙÔ˘ Â›Ó·È Ù·¯‡Ù·ÙË Û›ÁÔ˘Ú· ÚÔ‚ÏË-

Ì·Ù›˙ÂÈ. ∞Ó Î·È ‰ÂÓ ̆ ¿Ú¯Ô˘Ó ÌÂÏ¤ÙÂ˜ Ô˘ Ó· ÙÂÎÌË-

ÚÈÒÓÔ˘Ó Î˘ÙÙ·ÚÈÎ‹ ‹ ÔÚÁ·ÓÈÎ‹ ‚Ï¿‚Ë, Ô ıËÏ·ÛÌfi˜

ÛÂ ·˘Ù¤˜ ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ Ô˘ Ë ÌËÙ¤Ú· Â›Ó·È ˘fi

·ÁˆÁ‹ ÌÂ ·ÓÙÈÌÂÙ·‚ÔÏ›ÙÂ˜ ‹ ¯ËÌÂÈÔıÂÚ·Â˘ÙÈÎÔ‡˜

·Ú¿ÁÔÓÙÂ˜, ·ÓÙÂÓ‰Â›ÎÓ˘Ù·È. ∏ ¯Ú‹ÛË Ú·‰ÈÔ˚ÛÔÙfi-

ˆÓ ÁÈ· ‰È·ÁÓˆÛÙÈÎÔ‡˜ ‹ ıÂÚ·Â˘ÙÈÎÔ‡˜ ÛÎÔÔ‡˜

·ÔÙÂÏÂ› ·ÓÙ¤Ó‰ÂÈÍË ÁÈ· ıËÏ·ÛÌfi ÁÈ· fiÛÔ ¯ÚÔÓÈÎfi

‰È¿ÛÙËÌ· ·ÂÎÎÚ›ÓÂÙ·È ÙÔ Ú·‰ÈÔ˚ÛfiÙÔÔ ÛÙÔ ÌËÙÚÈ-

Îfi Á¿Ï· (2,38,41). ∏ ¯Ú‹ÛË ÙË˜ ·ÛÈÚ›ÓË˜ ·fi ÙË

ıËÏ¿˙Ô˘Û· Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÌÂ ÚÔÛÔ¯‹. ªÔÚÂ›

Ó· ÚÔÎ·Ï¤ÛÂÈ ‰È·Ù·Ú·¯‹ ÛÙË ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ·

ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ, ·ÈÌÔÚÚ·ÁÈÎ‹ ‰È¿ıÂÛË Î·È ÌÂÙ·-

‚ÔÏÈÎ‹ ÔÍ¤ˆÛË. ¶ÚÔÙÂ›ÓÂÙ·È ÛÙÈ˜ ÌËÙ¤ÚÂ˜ Ô˘ ıË-

Ï¿˙Ô˘Ó Ù· ÓÂÔÁÓ¿ ‹ Ù· ÔÏ‡ ÌÈÎÚ¿ ‚Ú¤ÊË ÙÔ˘˜ Î·È




¯ÚÂÈ¿˙ÔÓÙ·È ·ÓÙÈÊÏÂÁÌÔÓÒ‰ÂÈ˜ ·Ú¿ÁÔÓÙÂ˜, Ó·

·›ÚÓÔ˘Ó È‚Ô˘ÚÔ˘Ê¤ÓË ‹ Ó·ÚÔÍ¤ÓË (38,41,42). ∏

¯Ú‹ÛË ‚-·Ó·ÛÙÔÏ¤ˆÓ ·fi ÙË ÌËÙ¤Ú· ¤¯ÂÈ Û˘Û¯ÂÙÈ-

ÛıÂ› ÌÂ ˘fiÙ·ÛË, ‚Ú·‰˘Î·Ú‰›· Î·È Ù·¯‡ÓÔÈ· ÛÂ

ÌÈÎÚ¿ ‚Ú¤ÊË. ¶ÈÔ Û˘ÁÎÂÎÚÈÌ¤Ó· Ë ÛÔÙ·ÏfiÏË Ú¤ÂÈ

Ó· ·ÔÊÂ‡ÁÂÙ·È, Ë ·ÙÂÓÔÏfiÏË Ó· ¯ÚËÛÈÌÔÔÈÂ›Ù·È

ÌÂ ÚÔÛÔ¯‹Ø Ë Ï·‚ÂÙ·ÏfiÏË Î·È Ë ÚÔÚ·ÓÔÏfiÏË Â›-

Ó·È ÁÂÓÈÎ¿ Û˘Ì‚·Ù¤˜ ÌÂ ÙÔÓ ıËÏ·ÛÌfi ÌÂ ·Ú·ÎÔ-

ÏÔ‡ıËÛË ÙË˜ ·ÚÙËÚÈ·Î‹˜ ›ÂÛË˜ Î·È ÙÔ˘ Î·Ú‰È·ÎÔ‡

Ú˘ıÌÔ‡ ÙÔ˘ ‚Ú¤ÊÔ˘˜ (38,41,42). ∏ ¯Ú‹ÛË ¯ÏˆÚ·Ì-

ÊÂÓÈÎfiÏË˜ Ú¤ÂÈ Ó· ‰È·ÎfiÙÂÙ·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ·

ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡, ÂÍ·ÈÙ›·˜ ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÙÔ-

ÍÈÎfiÙËÙ·˜ ÛÙÔÓ Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ. ¶ÚÔÙÂ›ÓÂÙ·È ·Ó·-

ÌÔÓ‹ 24 ˆÚÒÓ ·fi ÙËÓ ÙÂÏÂ˘Ù·›· ‰fiÛË ÚÈÓ ÙËÓ

¤Ó·ÚÍË ÙÔ˘ ıËÏ·ÛÌÔ‡. ∫·È ÁÈ· ÙË ¯Ú‹ÛË ÙË˜ ÎÏÈÓÙ·-

Ì˘Î›ÓË˜ ÚÔÙÂ›ÓÂÙ·È ·ÔÊ˘Á‹ Î·Ù¿ ÙÔÓ ıËÏ·ÛÌfi.

¶ÚÔÙÂ›ÓÂÙ·È ·Ó·ÌÔÓ‹ 24 ˆÚÒÓ ·fi ÙËÓ ÙÂÏÂ˘Ù·›·

‰fiÛË ÚÈÓ ÙËÓ ¤Ó·ÚÍË ÙÔ˘ ıËÏ·ÛÌÔ‡. ∞Ó¿ÏÔÁË Ô‰Ë-

Á›· ·ÔÊ˘Á‹˜ ÈÛ¯‡ÂÈ Î·È ÁÈ· ÙË ÌÂÙÚÔÓÈ‰·˙fiÏË ÌÂ

ÚÔÙÂÈÓfiÌÂÓÔ ‰È¿ÛÙËÌ· ·ÔÊ˘Á‹˜ ÙÈ˜ 12 ÌÂ 24

ÒÚÂ˜ (42). ∞Ó ¤Ó· ‚Ú¤ÊÔ˜ ¤¯ÂÈ ¤ÏÏÂÈ„Ë G6PD, Ë

¯Ú‹ÛË ·fi ÙË ÌËÙ¤Ú· ÙÔ˘ Ó·ÏÈ‰ÈÍÈÎÔ‡ ÔÍ¤Ô˜, ÓÈÙÚÔ-

ÊÔ˘Ú·ÓÙÔ˝ÓË˜, Î·È ÛÔ˘ÏÊÔÓ·ÌÈ‰ÒÓ Ú¤ÂÈ Ó· ·Ô-

ÊÂ‡ÁÂÙ·È (34).

∆· „˘¯ÔÙÚfi· Ê·ÚÌ·ÎÂ˘ÙÈÎ¿ ÛÎÂ˘¿ÛÌ·Ù·

·ÂÎÎÚ›ÓÔÓÙ·È ÛÙÔ ÌËÙÚÈÎfi Á¿Ï·. ∏ Û˘ÁÎ¤ÓÙÚˆÛ‹

ÙÔ˘˜ ÌÔÚÂ› Ó· Â›Ó·È ̄ ·ÌËÏ‹ ·ÏÏ¿ Ô ̄ ÚfiÓÔ˜ ËÌÈ˙ˆ‹˜

Â›Ó·È ÌÂÁ¿ÏÔ˜. ∏ ¯Ú‹ÛË ÙÔ˘˜ ·fi ÙË ıËÏ¿˙Ô˘Û· ÌË-

Ù¤Ú· ¤¯ÂÈ Û˘Û¯ÂÙÈÛıÂ› ÌÂ ¿ÏÏÔÙÂ ¿ÏÏÂ˜ Û˘Ó¤ÂÈÂ˜

ÁÈ· ÙÔÓ ÂÁÎ¤Ê·ÏÔ ÙˆÓ ‚ÚÂÊÒÓ, Ô˘ fiˆ˜ Â›Ó·È ÁÓˆ-

ÛÙfi ·Ó·Ù‡ÛÛÂÙ·È ÌÂ ÁÚ‹ÁÔÚÔ˘˜ Ú˘ıÌÔ‡˜. ∏ ·fi-

Ê·ÛË ÁÈ· ÙË ¯ÔÚ‹ÁËÛË ‹ fi¯È ÌËÙÚÈÎÔ‡ Á¿Ï·ÙÔ˜ ı·

Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÂÙ·È ÌÂÙ¿ ·fi ÂÎÙÂÓ‹ Î·È ÏÂÙÔ-

ÌÂÚ‹ Û˘˙‹ÙËÛË ÌÂÙ·Í‡ ÙÔ˘ ıÂÚ¿ÔÓÙÔ˜ ÁÈ·ÙÚÔ‡ Î·È

ÙË˜ ÌËÙ¤Ú·˜, Û¯ÂÙÈÎ¿ ÌÂ ÙÈ˜ ÂÓ‰Â¯fiÌÂÓÂ˜ Û˘Ó¤ÂÈÂ˜

ÁÈ· ÙÔ ÓÂÔÁÓfi ÛÂ Û¯¤ÛË ÌÂ ÙÔ fiÊÂÏÔ˜ ·fi ÙË ¯Ú‹ÛË

ÙÔ˘. °ÂÓÈÎfiÙÂÚ·, ÔÈ Î·ÙÂ˘ı˘ÓÙ‹ÚÈÂ˜ ÁÚ·ÌÌ¤˜ ÚÔ-

ÙÂ›ÓÔ˘Ó ÙËÓ ·ÔÊ˘Á‹ ÙÔ˘ ıËÏ·ÛÌÔ‡ ÛÂ Ï‹ıÔ˜ Ù¤-

ÙÔÈˆÓ ÛÎÂ˘·ÛÌ¿ÙˆÓ (38,41).

√È Î·Ù¿ÏÔÁÔÈ ÙˆÓ Ê·ÚÌ·ÎÂ˘ÙÈÎÒÓ Ô˘ÛÈÒÓ Î·È

ÛÎÂ˘·ÛÌ¿ÙˆÓ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÛÙËÓ Î·ıËÌÂ-

ÚÈÓ‹ ¿ÛÎËÛË ÙË˜ È·ÙÚÈÎ‹˜ Â›Ó·È ÌÂÁ¿ÏÔÈ. ∫¿ıÂ ÚÔ-

Û¿ıÂÈ· ·Ó·ÊÔÚ¿˜ ÛÂ Î·ıÂÌ›· Û˘ÁÎÂÎÚÈÌ¤ÓË Ê·Ú-

Ì·ÎÂ˘ÙÈÎ‹ Ô˘Û›·, ı· ··ÈÙÔ‡ÛÂ ÌÂÁ¿ÏË ¤ÎÙ·ÛË Î·È

ı· Í¤ÊÂ˘ÁÂ ÂÓ‰Â¯ÔÌ¤Óˆ˜ ·fi ÙÔÓ ÛÎÔfi ·˘Ù‹˜ ÙË˜

·Ó·ÛÎfiËÛË˜. ∏ Â˘·ÈÛıËÙÔÔ›ËÛË ÙÔ˘ ÎÏÈÓÈÎÔ‡, Ë

·Ó·˙‹ÙËÛË Û‡Á¯ÚÔÓˆÓ ÏËÚÔÊÔÚÈÒÓ ·fi ÙÔ ‰È·‰›-

ÎÙ˘Ô, ‹ ·fi Î·Ù¿ ÙÔ ‰˘Ó·ÙfiÓ ÈÔ ÚfiÛÊ·ÙÂ˜ ·Ó·ÊÔ-

Ú¤˜, Û¯ÂÙÈÎ¿ ÌÂ ÙË ‰˘Ó·ÙfiÙËÙ· ¯Ú‹ÛË˜ Û˘ÁÎÂÎÚÈÌ¤-

ÓÔ˘ Ê·ÚÌ·ÎÂ˘ÙÈÎÔ‡ ÛÎÂ˘¿ÛÌ·ÙÔ˜, Ë Û˘ÓÂÎÙ›ÌËÛË

ÙˆÓ ·Ú·ÁfiÓÙˆÓ Ô˘ ÚÔ·Ó·Ê¤ÚıËÎ·Ó Î·È Ô ÛÂ‚·-

ÛÌfi˜ ÙË˜ ˘ÁÂ›·˜ ÙfiÛÔ ÙË˜ ÌËÙ¤Ú·˜ fiÛÔ Î·È ÙÔ˘ ÓÂÔ-

ÁÓÔ‡ ÙË˜, Â›Ó·È Î·ıÔÚÈÛÙÈÎ‹˜ ÛËÌ·Û›·˜ ÁÈ· ÙË Ï‹„Ë

·ÔÊ¿ÛÂˆÓ fiÛÔÓ ·ÊÔÚ¿ ÙË Û˘Ó¤¯ÈÛË ‹ ÙË ‰È·ÎÔ‹

ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡ (2,36,38,41).

™ÙÈ˜ Û‡Á¯ÚÔÓÂ˜ ÎÔÈÓˆÓ›Â˜ ¤¯Ô˘Ó Â¤ÏıÂÈ ÛËÌ·-

ÓÙÈÎ¤˜ ÙÚÔÔÔÈ‹ÛÂÈ˜ ÛÙË ‰ÔÌ‹ ÙË˜ ÔÈÎÔÁ¤ÓÂÈ·˜. ∏

Á˘Ó·›Î· ¤¯ÂÈ ·ÏÏ¿ÍÂÈ ÙÚfiÔ ˙ˆ‹˜, Û˘ÌÌÂÙ¤¯ÂÈ ÂÓÂÚ-

Á¿ ÛÙËÓ ÂÍ·ÛÊ¿ÏÈÛË ‚ÈÔÙÈÎÒÓ fiÚˆÓ, ·Ô˘ÛÈ¿˙ÂÈ

·ÚÎÂÙ¤˜ ÒÚÂ˜ ·fi ÙÔ Û›ÙÈ Î·È ÙË ÊÚÔÓÙ›‰· ÙÔ˘ ÓÂÔ-

Á¤ÓÓËÙÔ˘ ·Ó·Ï·Ì‚¿ÓÂÈ ÔÏ‡ Û˘¯Ó¿ ÙÚ›ÙÔ ÚfiÛˆÔ.

∏ ¯ÚËÛÈÌÔÔ›ËÛË ÙË˜ ÙÂ¯ÓËÙ‹˜ ‰È·ÙÚÔÊ‹˜ Û˘¯Ó¿

·ÔÙÂÏÂ› ÙËÓ Â‡ÎÔÏË Ï‡ÛË. ∆· ÏÂÔÓÂÎÙ‹Ì·Ù· ÙÔ˘

ıËÏ·ÛÌÔ‡ ÁÈ· ÙË ÌËÙ¤Ú·, ÙÔ ÓÂÔÁÓfi, ÙÔ ‚Ú¤ÊÔ˜ Î·È

ÙÔÓ ¿ÓıÚˆÔ ÁÂÓÈÎfiÙÂÚ·, Â›Ó·È ÔÏÏ¿ Î·È ÛËÌ·ÓÙÈ-

Î¿. √È ÂÚÈÙÒÛÂÈ˜ Ô˘ Ô ÌËÙÚÈÎfi˜ ıËÏ·ÛÌfi˜ ‰ÂÓ

Â›Ó·È ·ÛÊ·Ï‹˜ ‰ÂÓ Â›Ó·È ÔÏÏ¤˜, ·ÏÏ¿ Ô Î¿ıÂ ÎÏÈÓÈ-

Îfi˜ Ô˘ ·Û¯ÔÏÂ›Ù·È ÌÂ ÓÂÔÁÓ¿ Î·È ‚Ú¤ÊË Ú¤ÂÈ Ó·

Â›Ó·È ÂÓ‹ÌÂÚÔ˜. ∆ËÓ ÙÂÏÈÎ‹ ·fiÊ·ÛË ı· ¿ÚÂÈ Ì·˙›

ÌÂ ÙÔ˘˜ ÁÔÓÂ›˜, ·ÊÔ‡ ÙÔ˘˜ ÂÎı¤ÛÂÈ ÙÔ˘˜ ÎÈÓ‰‡ÓÔ˘˜

Ô˘ ·ÔÚÚ¤Ô˘Ó ·fi ÙË ¯Ú‹ÛË ÙÔ˘ ÌËÙÚÈÎÔ‡ Á¿Ï·-

ÙÔ˜ ÁÈ· ÙÔ ÓÂÔÁÓfi ÙÔ˘˜, ¿ÓÙ· ÌÂ ÁÓÒÌÔÓ· ÙÔÓ ÛÂ‚·-

ÛÌfi ÙË˜ ˘ÁÂ›·˜ ÙË˜ ÌËÙ¤Ú·˜ Î·È ÙÔ˘ ÓÂÔÁÓÔ‡.

ÃÚ¤Ô˜ ÙˆÓ ˘ËÚÂÛÈÒÓ ˘ÁÂ›·˜, ·ÏÏ¿ Î·È ÙË˜ ÎÔÈ-

ÓˆÓ›·˜ ÁÂÓÈÎfiÙÂÚ·, Â›Ó·È Ë ÚÔ·ÁˆÁ‹ ÙÔ˘ ÌËÙÚÈÎÔ‡

ıËÏ·ÛÌÔ‡. √ ÛÙfi¯Ô˜ ÛÙÈ˜ ·Ó·Ù˘ÁÌ¤ÓÂ˜ ¯ÒÚÂ˜ ÁÈ·

ÙÔ 2010 Â›Ó·È Ó· ÊÙ¿ÛÂÈ ÙÔ ÔÛÔÛÙfi ÙˆÓ ‚ÚÂÊÒÓ Ô˘

ıËÏ¿˙Ô˘Ó ÙÔ˘Ï¿¯ÈÛÙÔÓ ÙÔ 75%, ÂÎÂ›ÓˆÓ Ô˘ ıËÏ¿-

˙Ô˘Ó ÁÈ· ÂÚÈÛÛfiÙÂÚÔ ·fi 6 Ì‹ÓÂ˜ ÙÔ 50%, ÂÓÒ ·˘-

ÙÒÓ Ô˘ ıËÏ¿˙Ô˘Ó ÁÈ· ¤Ó· ¯ÚfiÓÔ ÙÔ 25% (2).


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∂›‰Ú·ÛË ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ̆ ÔÛÙ‹ÚÈÍË˜ ÙÔ˘ ÌËÙÚÈÎÔ‡

ıËÏ·ÛÌÔ‡

∞. ¡ÙÔ˘ÚÓÙÔ‡ÊË1, µ. ÃÔÏ¤‚·˜3, §. ∫ÔÓÙÔ‡2, ª. ¶·‡ÏÔ˘1, ™. ∞Ó‰ÚÔÓ›ÎÔ˘1

¶ÂÚ›ÏË„Ë

∂ÈÛ·ÁˆÁ‹: ∏ Û˘¯ÓfiÙËÙ· ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡ (ª£) Î·Ù¿ ÙËÓ ¤ÍÔ‰Ô ·fi ÙË ª·ÈÂ˘ÙÈÎ‹ ∫ÏÈÓÈÎ‹ (ª∫)ÙÔ˘ ¶·ÓÂÈÛÙËÌÈ·ÎÔ‡ °ÂÓÈÎÔ‡ ¡ÔÛÔÎÔÌÂ›Ô˘ πˆ·ÓÓ›ÓˆÓ (¶°¡π) ÂÎÙÈÌ‹ıËÎÂ ·fi ÚÔËÁÔ‡ÌÂÓË ÌÂÏ¤ÙË ˆ˜Û¯ÂÙÈÎ¿ ¯·ÌËÏ‹. ∞fi ÙÔÓ π·ÓÔ˘¿ÚÈÔ ÙÔ˘ 1998 ÂÊ·ÚÌfiÛÙËÎÂ ÂÓÙ·ÙÈÎfi ÚfiÁÚ·ÌÌ· ÂÓ›Û¯˘ÛË˜ Î·È ÚÔÒ-ıËÛË˜ ÙÔ˘ ª£. ™ÎÔfi˜ ÙË˜ ÌÂÏ¤ÙË˜ ‹Ù·Ó Ó· ÂÎÙÈÌËıÂ› Ë Â›‰Ú·ÛË ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ˘ÔÛÙ‹ÚÈÍË˜ ÙÔ˘ª£ ÛÙË Û˘¯ÓfiÙËÙ· ÙÔ˘ ª£ Î·Ù¿ ÙËÓ ¤ÍÔ‰Ô ·fi ÙÔ ÓÔÛÔÎÔÌÂ›Ô Î·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÚÒÙÔ˘ ¯Úfi-ÓÔ˘ ˙ˆ‹˜ ÙÔ˘ ‚Ú¤ÊÔ˘˜.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ∞fi ÙÔÓ π·ÓÔ˘¿ÚÈÔ ¤ˆ˜ ÙÔÓ ¢ÂÎ¤Ì‚ÚÈÔ ÙÔ˘ 1999 ÌÂÏÂÙ‹ıËÎ·Ó ÚÔ‰ÚÔÌÈÎ¿ 878 ˙Â˘-Á¿ÚÈ· (ÌËÙ¤Ú· – ÓÂÔÁÓfi), ˆ˜ ÚÔ˜ ÙË ‰È·ÙÚÔÊ‹ ÙÔ˘ ‚Ú¤ÊÔ˘˜ (ª£ ‹ ÙÂ¯ÓËÙ‹ ‰È·ÙÚÔÊ‹) Î·È ÙÔ˘˜ ·-Ú¿ÁÔÓÙÂ˜ Ô˘ ı· ÌÔÚÔ‡Û·Ó Ó· ÙËÓ ÂËÚÂ¿ÛÔ˘Ó. ∏ ‰È¿ÚÎÂÈ· ÙÔ˘ ıËÏ·ÛÌÔ‡ ÂÎÙÈÌ‹ıËÎÂ ÌÂÙ¿ ·fi ÙË-ÏÂÊˆÓÈÎ‹ ÂÈÎÔÈÓˆÓ›·. ∆· ·ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ Û˘ÁÎÚ›ıËÎ·Ó ÌÂ ÂÎÂ›Ó· ·ÚfiÌÔÈ·˜ÚÔËÁÔ‡ÌÂÓË˜ ÌÂÏ¤ÙË˜, Ô˘ Â›¯Â Á›ÓÂÈ ÚÈÓ ÙËÓ ·Ú¤Ì‚·ÛË, Î·Ù¿ ÙÔ ¤ÙÔ˜ 1997.

∞ÔÙÂÏ¤ÛÌ·Ù·: ªÂÙ¿ ÙËÓ ·Ú¤Ì‚·ÛË, Ë Û˘¯ÓfiÙËÙ· ÙÔ˘ ª£ Î·Ù¿ ÙËÓ ¤ÍÔ‰Ô ·fi ÙË ª∫ (3Ë ÌÂ 7Ë ËÌ¤-Ú· ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi) ·˘Í‹ıËÎÂ ÁÈ· ÙÔÓ Û˘ÓÔÏÈÎfi ª£ ·fi 81,9% ÛÂ 87% (p<0,01) Î·È ÁÈ· ÙÔÓ ·ÔÎÏÂÈ-ÛÙÈÎfi ª£ ·fi 38,6% ÛÂ 71% (p<0,001). ™ËÌ·ÓÙÈÎ‹ Â›‰Ú·ÛË ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÛÙËÓ ·‡ÍËÛË ÙÔ˘ Û˘-ÓÔÏÈÎÔ‡ Î·È ·ÔÎÏÂÈÛÙÈÎÔ‡ ıËÏ·ÛÌÔ‡ ·Ú·ÙËÚ‹ıËÎÂ ÛÙ· ÓÂÔÁÓ¿ ÌÂ ‚¿ÚÔ˜ Á¤ÓÓËÛË˜ (µ°) ≥2,5 kg, ÛÙ·ÎÔÚ›ÙÛÈ·, ÛÙ· ÓÂÔÁÓ¿ Ô˘ ÁÂÓÓ‹ıËÎ·Ó ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ÙÔÎÂÙfi (º∆) Î·È ÛÙ· ÓÂÔÁÓ¿ ÙˆÓ ÌËÙ¤ÚˆÓ ÌÂÁ·-Ï‡ÙÂÚË˜ ËÏÈÎ›·˜ Î·È ÌÂ ÂÌÂÈÚ›· ª£ ·fi ÚÔËÁÔ‡ÌÂÓ· ·È‰È¿. ∏ ‰È¿ÚÎÂÈ· ÙÔ˘ ª£ (Û˘ÓÔÏÈÎÔ‡ Î·È ·Ô-ÎÏÂÈÛÙÈÎÔ‡) ≥6 Ì‹ÓÂ˜ ‹Ù·Ó ÛÙ·ÙÈÛÙÈÎ¿ ÌÂÁ·Ï‡ÙÂÚË (p<0,001) ÌÂÙ¿ ÙËÓ ·Ú¤Ì‚·ÛË.

™˘ÌÂÚ¿ÛÌ·Ù·: ∏ ˘ÔÛÙ‹ÚÈÍË ÙÔ˘ ıËÏ·ÛÌÔ‡ Î·Ù¿ ÙÈ˜ ÚÒÙÂ˜ ËÌ¤ÚÂ˜ ·fi ÙÔÓ ÙÔÎÂÙfi ‚ÔËı¿ÂÈ ÛËÌ·-ÓÙÈÎ¿ ÛÙËÓ ÂÁÎ·Ù¿ÛÙ·ÛË ÙÔ˘ ·ÔÎÏÂÈÛÙÈÎÔ‡ ª£, Î·È ÛÙË ÌÂÁ·Ï‡ÙÂÚË ‰È¿ÚÎÂÈ· ÙÔ˘ ıËÏ·ÛÌÔ‡.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ªËÙÚÈÎfi˜ ıËÏ·ÛÌfi˜, Ú·ÎÙÈÎ¤˜ ª£.

Effect of a supportive program on breastfeeding

A. Ntourntoufi1, V. Cholevas3, L. Kontou2, M. Pavlou1, S. Andronikou1

Abstract

Background: The rate of breastfeeding (BF) at discharge from the maternity ward at the UniversityHospital of Ioannina was estimated to be relatively low in a previous study. From January 1998, BF wasactively supported for all neonates delivered at the maternity ward. The aim of the study was to evaluatethe effect of a supportive program on the rate of initiation and duration of BF, at discharge from thematernity ward and during the first year of life.

Methods: From January to December 1999, 878 mother-infant couples were studied prospectivelyregarding the type of feeding of the infant (BF or bottle feeding) and the factors that could have aninfluence on it. The duration of BF was evaluated by telephone contact. The results of this study werecompared to those of a previous similar study which was conducted before the intervention, during theyear 1997.

Results: The rate of BF at discharge from the maternity ward (3rd to 7th day after delivery) increased afterintervention from 81.9% to 87% for overall BF (p<0.01), and from 38.6% to 71% for exclusive BF(p<0.001). Significant increase of overall and exclusive BF after intervention was noticed in infants withbirth weight ≥2.5kg, in girls, in infants born by normal vaginal delivery, in multiparous mothers andmothers of a more mature age. The duration of BF (overall and exclusive) ≥6 months was significantlyhigher after intervention (p<0.001).

Conclusion: BF policies applied constantly in the maternity ward seem to increase the overall and exclusiveBF and the duration of BF ≥6 months.

Key words: Breastfeeding rate, maternity ward routines.

285∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞ ORIGINAL ARTICLE

1 ªÔÓ¿‰· ∂ÓÙ·ÙÈÎ‹˜¡ÔÛËÏÂ›·˜ ¡ÂÔÁÓÒÓ,

2 ª·ÈÂ˘ÙÈÎ‹ ∫ÏÈÓÈÎ‹,¶·ÓÂÈÛÙËÌÈ·Îfi °ÂÓÈÎfi¡ÔÛÔÎÔÌÂ›Ô πˆ·ÓÓ›ÓˆÓ

3 ∂ÚÁ·ÛÙ‹ÚÈÔ ÙÔ˘ ∆ÔÌ¤·ÀÁÂ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡,π·ÙÚÈÎ‹ ™¯ÔÏ‹¶·ÓÂÈÛÙËÌ›Ô˘πˆ·ÓÓ›ÓˆÓ.


∞Á·ı‹ ¡ÙÔ˘ÚÓÙÔ‡ÊË[email protected]¶·ÓÂÈÛÙ‹ÌÈÔ πˆ·ÓÓ›ÓˆÓπ·ÙÚÈÎ‹ ™¯ÔÏ‹∆ÔÌ¤·˜ ÀÁÂ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡∆·¯. £˘Ú. 1186∆.∫. 451 10, πˆ¿ÓÓÈÓ·

1 Neonatal Intensive CareUnit

2 Maternity Clinic,University GeneralHospital of Ioannina

3 Child Health DepartmentLaboratory, University ofIoannina Medical School

Correspondence:

Agathi [email protected] of IoanninaMedical SchoolChild Health DepartmentPO Box 1186451 10, Ioannina, Greece

¶·È‰È·ÙÚÈÎ‹ 2007;70:285-292



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ÛÙË ª∫ ÙÔ˘ ¶°¡π Â›¯Â ÂÎÙÈÌËıÂ› Î·Ù¿ ÙÔ ¤ÙÔ˜

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ÈÎ·ÓÔÔÈËÙÈÎ‹ (81,9%), Ë Û˘¯ÓfiÙËÙ· ÙÔ˘ ·ÔÎÏÂÈ-

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Î·È ˘ÔÛÙ‹ÚÈÍË˜ ÙÔ˘ ª£ Ô˘ ÂÊ·ÚÌfiÛÙËÎÂ ÛÙÔ

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ÌÂÏ¤ÙË˜ Ô˘ ‰ÈÂÍ‹¯ıË Î·Ù¿ ÙÔ ¤ÙÔ˜ 1997, fiÔ˘ ‰ÂÓ

˘‹Ú¯Â Ù·ÎÙÈÎ‹ ÂÈ‰ÈÎ‹˜ ÔÏÈÙÈÎ‹˜ ÁÈ· ÙËÓ ˘ÔÛÙ‹-

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∆ÔÓ √ÎÙÒ‚ÚÈÔ ÙÔ˘ 1997, ¤Ó·˜ ÓÂÔÁÓÔÏfiÁÔ˜ Î·È ‰‡Ô Ì·›-

Â˜ ÙÔ˘ ¶°¡π ·Ú·ÎÔÏÔ‡ıËÛ·Ó ÙÔ ÚfiÁÚ·ÌÌ· ÂÎ·›‰Â˘ÛË˜

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Î·È ÁÚ·Ù¤˜).

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™Â ÚÔËÁÔ‡ÌÂÓË ÌÂÏ¤ÙË ¤ÁÈÓÂ ·Ó·‰ÚÔÌÈÎ¿ ·Ó¿Ï˘ÛË 829ÈÛÙÔÚÈÎÒÓ ÓÂÔÁÓÒÓ Ô˘ ÁÂÓÓ‹ıËÎ·Ó ÛÙË ª∫ ÙÔ˘ ¶°¡π ÌÂ-Ù·Í‡ 1-1-97 Î·È 31-12-97, ÂÚ›Ô‰Ô Î·Ù¿ ÙËÓ ÔÔ›· ‰ÂÓ˘‹Ú¯Â ÂÈ‰ÈÎ‹ ˘ÔÛÙ‹ÚÈÍË ÙÔ˘ ª£. ªÂÙ¿ ÙËÓ ÂÊ·ÚÌÔÁ‹ÙË˜ ·Ú¤Ì‚·ÛË˜, ÌÂÏÂÙ‹ıËÎ·Ó ÚÔÔÙÈÎ¿ 878 ÓÂÔÁÓ¿ Ô˘ÁÂÓÓ‹ıËÎ·Ó ·fi 1-1-1999 ¤ˆ˜ 31-12-1999. ∏ ÏÂÈÔÓfiÙËÙ·ÙˆÓ ‚ÚÂÊÒÓ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó ‹Ù·Ó ÙÂÏÂÈfiÌËÓ· ÌÂ ËÏÈÎ›·Î‡ËÛË˜ (∏∫) ≥37 Â‚‰ÔÌ¿‰ˆÓ. ∫·Ù¿ ÙËÓ ÚÒÙË ÂÚ›Ô‰Ô(1997), 17 ‚Ú¤ÊË Â›¯·Ó ∏∫ 36 Â‚‰ÔÌ¿‰ˆÓ, ¤Ó· ‹Ù·Ó 35Â‚‰ÔÌ¿‰ˆÓ Î·È 6 ·fi ·˘Ù¿ Â›¯·Ó µ° <2,5 kg. ∫·Ù¿ ÙË ‰Â‡-ÙÂÚË ÂÚ›Ô‰Ô (1999), 20 ‹Ù·Ó 36 Â‚‰ÔÌ¿‰ˆÓ ∏∫ Î·È ¤Ó· 35Â‚‰ÔÌ¿‰ˆÓ. √ÎÙÒ ·fi ·˘Ù¿ Â›¯·Ó µ° <2,5 kg.

√ ¯ÚfiÓÔ˜ ·Ú·ÌÔÓ‹˜ ÛÙË ª∫ ÙˆÓ ÌËÙ¤ÚˆÓ Ô˘ Â›¯·ÓÁÂÓÓ‹ÛÂÈ ÌÂ º∆ ‹Ù·Ó 3 ÌÂ 4 ËÌ¤ÚÂ˜ Î·È ÂÎÂ›ÓˆÓ Ô˘ Â›¯·ÓÁÂÓÓ‹ÛÂÈ ÌÂ ∫∆ 5 ¤ˆ˜ 7 ËÌ¤ÚÂ˜. ŸÏ· Ù· ÓÂÔÁÓ¿ ÂÍÂÙ¿˙ÔÓÙ·Ó·fi ÓÂÔÁÓÔÏfiÁÔ ÚÈÓ ÙËÓ ¤ÍÔ‰fi ÙÔ˘˜ ·fi ÙË ª∫.

°È· Î¿ıÂ ÓÂÔÁÓfi Î·Ù·ÁÚ¿ÊËÎÂ Ô Ù‡Ô˜ ÙË˜ ‰È·ÙÚÔÊ‹˜ÙÔ˘, ·ÔÎÏÂÈÛÙÈÎfi˜ ‹ ÌÈÎÙfi˜ (ª£ Î·È Û˘ÌÏ‹ÚˆÌ·) ‹ ÙÂ-¯ÓËÙ‹ ‰È·ÙÚÔÊ‹, Î·Ù¿ ÙËÓ ¤ÍÔ‰fi ÙÔ˘ ·fi ÙË ª∫. ∂›ÛË˜Î·Ù·ÁÚ¿ÊËÎ·Ó ‰È¿ÊÔÚÔÈ ·Ú¿ÁÔÓÙÂ˜ Ô˘ ÌÔÚÂ› Ó· Û¯ÂÙ›-˙ÔÓÙ·È Î·È Ó· ÂËÚÂ¿˙Ô˘Ó ÙÔÓ ÙÚfiÔ ‰È·ÙÚÔÊ‹˜ ÙˆÓ ÓÂÔ-ÁÓÒÓ, fiˆ˜ ÙÔ Ê‡ÏÔ ÙÔ˘ ÓÂÔÁÓÔ‡ Î·È ÙÔ µ° (<2,5 kg, 2,5 - 3,0kg, >3,0 kg), Ô ÙÚfiÔ˜ Á¤ÓÓËÛË˜ (º∆, ∞∂, ∫∆), Ô ÙfiÎÔ˜ ÙË˜ÌËÙ¤Ú·˜ Î·È Ë ËÏÈÎ›· ÙË˜ (<20, 20-30, 31-40, >40 ÂÙÒÓ) Î·ÈÙÔ ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎfi Â›Â‰Ô ÙË˜ ÔÈÎÔÁ¤ÓÂÈ·˜, fiÔ˘ ËÙ¿ÍË π ·Ó·Ê¤ÚÂÙ·È ÛÂ ·ÓÂÈ‰›ÎÂ˘ÙÔ˘˜ ÂÚÁ¿ÙÂ˜, Ë Ù¿ÍË ππ ÛÂÂÍÂÈ‰ÈÎÂ˘Ì¤ÓÔ˘˜ ÂÚÁ¿ÙÂ˜ Î·È ÙÂ¯Ó›ÙÂ˜, Ë Ù¿ÍË πππ ÛÂ ·fi-ÊÔÈÙÔ˘˜ ·ÓÒÙÂÚˆÓ Û¯ÔÏÒÓ Î·È Ë Ù¿ÍË IV ÛÂ ·fiÊÔÈÙÔ˘˜·ÓÂÈÛÙËÌ›Ô˘ (6).

ŒÁÈÓÂ Û‡ÁÎÚÈÛË fiÏˆÓ ÙˆÓ ·Ú·¿Óˆ ·Ú·ÁfiÓÙˆÓ ÌÂÙ·Í‡ÙˆÓ ‰‡Ô ÂÚÈfi‰ˆÓ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó, ÚÈÓ ÙËÓ ·Ú¤Ì‚·ÛË(1997) Î·È ÌÂÙ¿ ·fi ·˘Ù‹Ó (1999). ∏ ‰È¿ÚÎÂÈ· ÙÔ˘ ıËÏ·ÛÌÔ‡ÂÎÙÈÌ‹ıËÎÂ, ÌÂÙ¿ ·fi ÙËÏÂÊˆÓÈÎ‹ ÂÈÎÔÈÓˆÓ›· ÌÂ ÙË ÌËÙ¤-Ú·, 6 Î·È 12 Ì‹ÓÂ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË ÙÔ˘ ÌˆÚÔ‡ ÙË˜.

√ÚÈÛÌÔ›: ∞ÔÎÏÂÈÛÙÈÎfi˜ ÌËÙÚÈÎfi˜ ıËÏ·ÛÌfi˜: ÛËÌ·›ÓÂÈ fiÙÈÙÔ ÌˆÚfi ÛÈÙ›˙ÂÙ·È ÌfiÓÔ ÌÂ ÌËÙÚÈÎfi Á¿Ï· ·fi ÙË ÌËÙ¤Ú· ÙÔ˘‹ Ì›· ÙÚÔÊfi, ‹ ÌËÙÚÈÎfi Á¿Ï· Ô˘ ¤¯ÂÈ Û˘ÏÏÂÁÂ›, Î·È Î·Ì›·¿ÏÏË ÛÙÂÚÂ¿ ‹ ˘ÁÚ‹ ÙÚÔÊ‹. ™˘ÓÔÏÈÎfi˜ ıËÏ·ÛÌfi˜: ÂÚÈÏ·Ì‚¿-ÓÂÈ ÙË Û›ÙÈÛË ÙÔ˘ ÌˆÚÔ‡ ÌÂ ÌËÙÚÈÎfi Á¿Ï·, Â›ÙÂ ·ÔÎÏÂÈÛÙÈ-Î¿ Â›ÙÂ ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ̄ ÔÚ‹ÁËÛË Û˘ÌÏËÚÒÌ·ÙÔ˜ ÙÚÔÔ-ÔÈËÌ¤ÓÔ˘ Á¿Ï·ÙÔ˜. ªÈÎÙ‹ ‰È·ÙÚÔÊ‹: Û›ÙÈÛË ÙÔ˘ ‚Ú¤ÊÔ˘˜ ÌÂÌËÙÚÈÎfi Á¿Ï· ·ÏÏ¿ Î·È Û˘ÌÏ‹ÚˆÌ· ÌÂ ÙÚÔÔÔÈËÌ¤ÓÔ Á¿-Ï·. ∆Â¯ÓËÙ‹ ‰È·ÙÚÔÊ‹: Û›ÙÈÛË ÙÔ˘ ‚Ú¤ÊÔ˘˜ ·ÔÎÏÂÈÛÙÈÎ¿ ÌÂÙÚÔÔÔÈËÌ¤ÓÔ Á¿Ï· ·ÁÂÏ¿‰Ô˜.

™Ù·ÙÈÛÙÈÎ‹ ·Ó¿Ï˘ÛË: ∏ ÂÎÙ›ÌËÛË ÙˆÓ ‰È·ÊfiÚˆÓ ·Ú·Áfi-ÓÙˆÓ ¤ÁÈÓÂ ÌÂ ·Ó¿Ï˘ÛË ¯2. ™˘Û¯¤ÙÈÛË ¤ÁÈÓÂ ÁÈ· Î¿ıÂ ÂÚ›Ô‰ÔÌÂÙ·Í‡ ÙˆÓ ÔÌ¿‰ˆÓ ÁÈ· Ó· ÂÎÙÈÌËıÂ› Ë Â›‰Ú·ÛË ÙˆÓ ‰È·-ÊfiÚˆÓ ·Ú·Ì¤ÙÚˆÓ ÛÙË Û˘¯ÓfiÙËÙ· ÙÔ˘ ıËÏ·ÛÌÔ‡. ™˘Û¯¤-ÙÈÛË ¤ÁÈÓÂ ÌÂÙ·Í‡ ÙˆÓ ‰‡Ô ÂÚÈfi‰ˆÓ, ÚÈÓ Î·È ÌÂÙ¿ ÙËÓ ·-Ú¤Ì‚·ÛË, ÁÈ· Ó· ÂÎÙÈÌËıÂ› Ë Â›‰Ú·ÛË ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ÚÔÒıËÛË˜ ÙÔ˘ ıËÏ·ÛÌÔ‡ Î·È ÙˆÓ ·Ú·ÁfiÓÙˆÓ Ô˘ ı·ÌÔÚÔ‡Û·Ó Ó· ÂËÚÂ¿ÛÔ˘Ó ÙÔÓ ª£.

∞ÔÙÂÏ¤ÛÌ·Ù·

™ÙÔÓ ¶›Ó·Î· 1 Ê·›ÓÔÓÙ·È ÔÈ ·Ú¿ÁÔÓÙÂ˜ Ô˘

286 ∞. ¡ÙÔ˘ÚÓÙÔ‡ÊË Î·È Û˘Ó.



Û¯ÂÙ›˙ÔÓÙ·È ÌÂ Ù· ‚Ú¤ÊË Î·È Ô˘ ı· ÌÔÚÔ‡Û·Ó Ó·

¤¯Ô˘Ó Î¿ÔÈ· Â›‰Ú·ÛË ÛÙÔÓ ÙÚfiÔ ‰È·ÙÚÔÊ‹˜

ÙÔ˘˜ Î·Ù¿ ÙËÓ ¤ÍÔ‰fi ÙÔ˘˜ ·fi ÙË ª∫, ÁÈ· ÙÈ˜ ‰‡Ô

ÂÚÈfi‰Ô˘˜ 1997 Î·È 1999. ∆Ô 1999, 87% ÙˆÓ ÓÂÔ-

ÁÓÒÓ ı‹Ï·˙·Ó Î·Ù¿ ÙËÓ ¤ÍÔ‰fi ÙÔ˘˜ ·fi ÙË ª∫ Û˘-

ÁÎÚÈÙÈÎ¿ ÌÂ 81,9% ÙÔ 1997 (p<0,01). ∆Ô ÔÛÔÛÙfi

ÙˆÓ ÓÂÔÁÓÒÓ Ô˘ ÛÈÙ›˙ÔÓÙ·Ó ·ÔÎÏÂÈÛÙÈÎ¿ ÌÂ ÌË-

ÙÚÈÎfi Á¿Ï· ‹Ù·Ó 71% Î·È 38,6% ·ÓÙ›ÛÙÔÈ¯· ÁÈ· Ù·

¤ÙË 1999 Î·È 1997 (p<0,001). ∏ ·‡ÍËÛË ÙÔ˘ Û˘ÓÔÏÈ-

ÎÔ‡ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡ Î·È Î˘Ú›ˆ˜ Ë ·‡ÍËÛË ÙÔ˘

·ÔÎÏÂÈÛÙÈÎÔ‡ ª£ ÙËÓ ÂÚ›Ô‰Ô ÌÂÙ¿ ÙËÓ ·Ú¤Ì-

‚·ÛË ‹Ù·Ó ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ (¶›Ó·Î·˜ 1).

º·›ÓÂÙ·È ˆ˜ Ë ·‡ÍËÛË ÙÔ˘ ª£ ÛÙ· ÎÔÚ›ÙÛÈ·

‹Ù·Ó ÛËÌ·ÓÙÈÎ¿ ˘„ËÏfiÙÂÚË ÁÈ· ÙÔÓ Û˘ÓÔÏÈÎfi Î·È

ÙÔÓ ·ÔÎÏÂÈÛÙÈÎfi ª£ (p<0,05 Î·È p<0,001, ·ÓÙ›-

ÛÙÔÈ¯·) Û˘ÁÎÚÈÙÈÎ¿ ÌÂ Ù· ·ÁfiÚÈ·, Î·Ù¿ ÙËÓ ÂÚ›Ô‰Ô

ÌÂÙ¿ ÙËÓ ·Ú¤Ì‚·ÛË.

∆Ô µ° Ê·›ÓÂÙ·È Ó· Î·ıÔÚ›˙ÂÈ ÙÔÓ Ù‡Ô Û›ÙÈÛË˜

Î·È ·˘Ùfi˜ Ô ·Ú¿ÁÔÓÙ·˜ ·Ú·Ì¤ÓÂÈ ÛÙ·ıÂÚfi˜ ÌÂÙ·-

Í‡ ÙˆÓ ‰‡Ô ÂÚÈfi‰ˆÓ. À¿Ú¯ÂÈ ÌÈ· ·‡ÍËÛË ÙË˜ Û˘-

¯ÓfiÙËÙ·˜ ÙÔ˘ ª£ ÛÂ Û¯¤ÛË ÌÂ ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ µ°

·fi <2,5 kg ¤ˆ˜ >3 kg. ∆· ÓÂÔÁÓ¿ ÌÂ µ° <2,5 kg ıË-

Ï¿˙Ô˘Ó ÏÈÁfiÙÂÚÔ ·fi ÂÎÂ›Ó· ÌÂ µ° >2,5 kg (p<0,05

ÚÈÓ Î·È p<0,01 ÌÂÙ¿ ÙËÓ ·Ú¤Ì‚·ÛË). ∆Ô ÌÈÎÚfiÙÂ-

ÚÔ µ° Ê·›ÓÂÙ·È ˆ˜ ÂËÚÂ¿˙ÂÈ ·ÚÓËÙÈÎ¿ ÙËÓ ¤Ó·Ú-

ÍË ÙÔ˘ ª£ Î·È Î˘Ú›ˆ˜ ÙÔ˘ ·ÔÎÏÂÈÛÙÈÎÔ‡ ª£. ∆·

ÓÂÔÁÓ¿ ÌÂ µ° ≥2,5 kg ıËÏ¿˙Ô˘Ó ÌÂ ÌÂÁ·Ï‡ÙÂÚË Û˘-

¯ÓfiÙËÙ· ·fi ÂÎÂ›Ó· ÌÂ ÌÈÎÚfiÙÂÚÔ µ°. ∆Ô ÚfiÁÚ·Ì-

Ì· ˘ÔÛÙ‹ÚÈÍË˜ ÙÔ˘ ıËÏ·ÛÌÔ‡ ‚Ô‹ıËÛÂ ÛËÌ·ÓÙÈÎ¿

ÛÙËÓ ·‡ÍËÛË ÙÔ˘ ª£ ÌfiÓÔ ÛÙ· ÓÂÔÁÓ¿ ÌÂ µ° ≥2,5

kg (p<0,05 Î·È p<0,001 ÁÈ· ÙÔÓ Û˘ÓÔÏÈÎfi Î·È ·Ô-

ÎÏÂÈÛÙÈÎfi ª£, ·ÓÙ›ÛÙÔÈ¯·) (¶›Ó·Î·˜ 1).

√ ¶›Ó·Î·˜ 2 ‰Â›¯ÓÂÈ ÙÔ˘˜ ÌËÙÚÈÎÔ‡˜ ·Ú¿ÁÔ-

ÓÙÂ˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÙË ‰È·ÙÚÔÊ‹ ÙÔ˘ ÓÂÔÁÓÔ‡

Î·Ù¿ ÙËÓ ¤ÍÔ‰Ô ·fi ÙË ª∫. ¶ÚÈÓ ÙËÓ ·Ú¤Ì‚·ÛË,

Ù· ÓÂÔÁÓ¿ Ô˘ ÁÂÓÓÈÔ‡ÓÙ·Ó ÌÂ º∆ Î·È ÂÎÂ›Ó· Ô˘

ÁÂÓÓÈÔ‡ÓÙ·Ó ÌÂ ∫∆ ı‹Ï·˙·Ó ÛÂ ·ÚfiÌÔÈ· ÔÛÔÛÙ¿

(83,6% Î·È 84,5% ·ÓÙ›ÛÙÔÈ¯·), ÂÓÒ ÂÎÂ›Ó· Ô˘ ÁÂÓ-

ÓÈÔ‡ÓÙ·Ó ÌÂ ∞∂ ı‹Ï·˙·Ó ÏÈÁfiÙÂÚÔ Û˘¯Ó¿ (72,3%,

p<0,01). ªÂÙ¿ ÙËÓ ·Ú¤Ì‚·ÛË, Ô Û˘ÓÔÏÈÎfi˜ ª£

·˘Í‹ıËÎÂ ÛÂ 88,6%, 91% Î·È 80,5% ·ÓÙ›ÛÙÔÈ¯· ÁÈ·

Ù· ÓÂÔÁÓ¿ Ô˘ ÁÂÓÓ‹ıËÎ·Ó ÌÂ º∆, ∞∂ Î·È ∫∆, ·ÓÙ›-

ÛÙÔÈ¯·. ∆· ÓÂÔÁÓ¿ Ô˘ ÁÂÓÓÈÔ‡ÓÙ·È ÌÂ ∫∆ Ê·›ÓÂÙ·È

fiÙÈ ıËÏ¿˙Ô˘Ó ÛËÌ·ÓÙÈÎ¿ ÏÈÁfiÙÂÚÔ (p<0,05), ÛÂ Û¯¤-

ÛË ÌÂ ÙÈ˜ 2 ¿ÏÏÂ˜ ÔÌ¿‰Â˜, ÌÂÙ¿ ÙËÓ ·Ú¤Ì‚·ÛË.

∂›ÛË˜, Ô ·ÔÎÏÂÈÛÙÈÎfi˜ ª£ ·˘Í‹ıËÎÂ ÛËÌ·ÓÙÈÎ¿

ÌÂÙ¿ ÙËÓ ·Ú¤Ì‚·ÛË Î·È ÛÙÈ˜ 3 ÔÌ¿‰Â˜ ÙÔÎÂÙÔ‡

(p<0,001), ·Ó Î·È ÛÙËÓ ÔÌ¿‰· ÙË˜ ∫∆ Ë Û˘¯ÓfiÙËÙ·

·ÔÎÏÂÈÛÙÈÎÔ‡ ıËÏ·ÛÌÔ‡ ‹Ù·Ó ÌÈÎÚfiÙÂÚË ÛÂ Û¯¤ÛË

ÌÂ ÙÈ˜ ¿ÏÏÂ˜ ‰‡Ô ÔÌ¿‰Â˜.

∏ ‡·ÚÍË ÚÔËÁÔ‡ÌÂÓÔ˘ ·È‰ÈÔ‡ ÙË˜ ÌËÙ¤Ú·˜

Ô˘ ¤¯ÂÈ ıËÏ¿ÛÂÈ ÂËÚÂ¿˙ÂÈ ıÂÙÈÎ¿ ÙÔÓ ª£. ∆Ô

1997, Ô ·ÚÈıÌfi˜ ÚÔËÁÔ‡ÌÂÓˆÓ ·È‰ÈÒÓ ÛÙËÓ ÔÈÎÔ-

Á¤ÓÂÈ· ‰ÂÓ Ê·›ÓÂÙ·È Ó· Â›¯Â ÛËÌ·ÓÙÈÎ‹ Â›‰Ú·ÛË

¶›Ó·Î·˜ 1. ™˘¯ÓfiÙËÙ· ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡ (ª£) (Û˘ÓÔÏÈÎfi˜, ·ÔÎÏÂÈÛÙÈÎfi˜ Î·È ÌÈÎÙfi˜) Î·Ù¿ ÙËÓ ¤ÍÔ‰Ô ÙÔ˘ ÓÂÔÁÓÔ‡ ·fi ÙË ª∫, ÚÈÓ(1997) Î·È ÌÂÙ¿ (1999) ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ·Ú¤Ì‚·ÛË˜ ÁÈ· ÙËÓ ÂÓ›Û¯˘ÛË ÙÔ˘ ª£ Î·È Û‡ÁÎÚÈÛË ÙˆÓ ·Ú·ÁfiÓÙˆÓ Ô˘ Û¯Â-Ù›˙ÔÓÙ·È ÌÂ ÙÔ ÓÂÔÁÓfi (Ê‡ÏÔ Î·È ‚¿ÚÔ˜ Á¤ÓÓËÛË˜) Î·È Ô˘ ı· ÌÔÚÔ‡Û·Ó Ó· ÂËÚÂ¿ÛÔ˘Ó ÙÔÓ ÙÚfiÔ Û›ÙÈÛË˜ (ÂÓÙfi˜ Î¿ıÂ ÂÚÈfi‰Ô˘ Î·È ÌÂ-Ù·Í‡ ÙˆÓ ‰‡Ô ÂÚÈfi‰ˆÓ)

∆ÚfiÔ˜ Û›ÙÈÛË˜ ™˘ÓÔÏÈÎfi˜ ∞ÔÎÏÂÈÛÙÈÎfi˜ ªÈÎÙfi˜ (ª£+ ∆Â¯ÓËÙ‹ ª£ ª£ ÙÂ¯ÓËÙ‹ ‰È·ÙÚÔÊ‹) ‰È·ÙÚÔÊ‹

™‡ÓÔÏÔ N∞ÚÈıÌfi˜ ÓÂÔÁÓÒÓ (%) 1997: 929 760 (81,9)** 359 (38,6)*** 401 (43,2) 169 (18,0)

1999: 878 764 (87,0)Á 623 (71,0) 141 (16,0) 114(13,0)

∞ÁfiÚÈ1997: 460 371 (80,5) 187 (40,7)*** 184 (40,1) 89 (19,4)1999: 442 374 (84,6) 277 (62,6)‚ 97 (21,9) 68 (15,4)

º‡ÏÔ∫ÔÚ›ÙÛÈ

1997: 469 389 (83,0)** 172 (36,7)** 217 (46,3) 80 (17,1)1999: 436 390 (89,4)· 327 (75,0)‚ 63 (14,4) 46 (10,4)

µ¿ÚÔ˜ Á¤ÓÓËÛË˜ (Kg)<2,5

1997: 6 3 (50,0)Á 1 (16,7)‰ 2 (33,3) 3 (50,0)1999: 8 4 (57,1)Â 1 (14,2)˙ 3 (42,9) 4 (42,8)

2,5-31997: 236 183 (77,7)Á,* 80 (34,2)‰,*** 103 (43,5) 53 (22,3)1999: 216 185 (85,6)Â 148 (68,5)˙ 37 (17,1) 31 (14,4)

>31997: 687 574 (83,4)Á,* 278 (40,5)‰,*** 296 (43,1) 113(16,6)1999: 654 576 (88,1)Â 442 (67,6)˙ 134 (15,3) 78 (11,9)

·,Á,‰ p<0,05, Â,˙ p<0,01 Î·È ‚ p<0,001: ∆ÈÌ¤˜ p, ¯2, ÁÈ· ÙÈ˜ ÔÌ¿‰Â˜ ‰È·ÊfiÚˆÓ ÙÚfiˆÓ Û›ÙÈÛË˜ Î·È ÙÔÓ ·ÚÈıÌfi ÙˆÓ ÓÂÔÁÓÒÓ, ÙÔ Ê‡ÏÔÎ·È ÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛË˜ ÂÓÙfi˜ ÙË˜ Î¿ıÂ ÂÚÈfi‰Ô˘ ÙË˜ ÌÂÏ¤ÙË˜. · & ‚: ÛËÌ·ÓÙÈÎfiÙËÙ· ÌÂÙ·Í‡ ÙˆÓ ‰‡Ô Ê‡ÏˆÓ Î·Ù¿ ÙËÓ ÂÚ›Ô‰Ô ÌÂÙ¿ ÙËÓ ·Ú¤Ì‚·ÛË ÁÈ· ÙÔÓ Û˘ÓÔÏÈÎfi (·) Î·È ÙÔÓ ·ÔÎÏÂÈÛÙÈÎfi(‚) ª£. Á & ‰: ÛËÌ·ÓÙÈÎfiÙËÙ· ÌÂÙ·Í‡ ÙˆÓ 3 ÔÌ¿‰ˆÓ ÙÔ˘ µ° ÚÈÓ ÙËÓ ·Ú¤Ì‚·ÛË (1997) ÁÈ· ÙÔÓ Û˘ÓÔÏÈÎfi (Á) Î·È ÙÔÓ ·ÔÎÏÂÈÛÙÈÎfi (‰) ª£Â & ˙: ÛËÌ·ÓÙÈÎfiÙËÙ· ÌÂÙ·Í‡ ÙˆÓ 3 ÔÌ¿‰ˆÓ ÙÔ˘ µ° ÌÂÙ¿ ÙËÓ ·Ú¤Ì‚·ÛË (1999) ÁÈ· ÙÔÓ Û˘ÓÔÏÈÎfi (Â) Î·È ÙÔÓ ·ÔÎÏÂÈÛÙÈÎfi (˙) ª£* p<0,05, ** p<0,01, ***p<0,001: ™ËÌ·ÓÙÈÎfiÙËÙ· ÌÂÙ·Í‡ ÙˆÓ ‰‡Ô ÂÚÈfi‰ˆÓ ÙË˜ ÌÂÏ¤ÙË˜ ÁÈ· ÙÔ˘˜ ‰È¿ÊÔÚÔ˘˜ ·Ú¿ÁÔÓÙÂ˜, fiÛÔÓ·ÊÔÚ¿ ÙÔÓ Û˘ÓÔÏÈÎfi Î·È ÙÔÓ ·ÔÎÏÂÈÛÙÈÎfi ª£.

287¶ÚÔÒıËÛË ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡

¶·È‰È·ÙÚÈÎ‹ 2007;70:285-292


¶›Ó·Î·˜ 2. ¶·Ú¿ÁÔÓÙÂ˜ Û¯ÂÙÈ˙fiÌÂÓÔÈ ÌÂ ÙË ÌËÙ¤Ú· (Ù‡Ô˜ ÙÔÎÂÙÔ‡, ·ÚÈıÌfi˜ ÙfiÎÔ˘ ÌËÙ¤Ú·˜, ËÏÈÎ›· ÌËÙ¤Ú·˜) ı· ÌÔÚÔ‡Û·Ó Ó· ÂËÚÂ¿-ÛÔ˘Ó ÙË Û˘¯ÓfiÙËÙ· ÙÔ˘ ª£ (Û˘ÓÔÏÈÎfi˜, ·ÔÎÏÂÈÛÙÈÎfi˜ Î·È ÌÈÎÙfi˜) Î·Ù¿ ÙËÓ ¤ÍÔ‰Ô ÙÔ˘ ÓÂÔÁÓÔ‡ ·fi ÙË ª∫, ÚÈÓ (1997) Î·È ÌÂÙ¿ (1999)ÙËÓ ·Ú¤Ì‚·ÛË, ÂÓÙfi˜ Î¿ıÂ ÂÚÈfi‰Ô˘ Î·È ÌÂÙ·Í‡ ÙˆÓ ‰‡Ô ÂÚÈfi‰ˆÓ


™‡ÓÔÏÔ N∆ÔÎÂÙfi˜ (%) º∆ 1997: 709 593 (83,6)·,** 281 (39,6)Á,*** 312 (44,0) 116(16,4)

1999: 647 573 (88,6)‚ 441 (68,1) 132 (20,4) 74 (11,4)∞∂ 1997: 148 107 (72,3)·,** 53 (35,8)Á,*** 54 (36,5) 41 (27,7)

1999: 67 61 (91,0)‚ 47 (70,2) 14 (20,8) 6 (8,9)∫∆ 1997: 71 60 (84,5)· 25 (35,2)Á,*** 35 (49,3) 11 (15,5)

1999: 164 132 (80,5)‚ 105 (64,0) 27 (16,5) 32 (19,5)∆fiÎÔ˜ ÌËÙ¤Ú·˜ (%) I 1997: 468 396 (84,6) 166 (35,5)Â,*** 230 (49,2) 89 (19,4)

1999: 414 350 (84,5)‰ 256 (61,8)˙ 94 (22,7) 64 (15,5)II 1997: 346 270 (78,0)*** 136 (39,3)Â,*** 134 (38,7) 80 (17,1)

1999: 346 306 (88,4)‰ 243 (70,2)˙ 63 (18,2) 40 (11,6)III 1997: 115 94 (81,7)** 57 (49,6)Â,** 37 (32,2) 21 (18,3)

1999: 118 110 (93,2)‰ 84 (71,0)˙ 26 (22,0) 8 (6,7)∏ÏÈÎ›· ÌËÙ¤Ú·˜ (¤ÙË) <20 1997: 31 29 (93,6)* 15 (48,4)* 14 (45,2) 2(6,5)

1999: 18 12 (66,6)Ë 10 (55,5)ı 2 (1,1) 6 (33,3)20-29 1997: 633 526 (83,1) 242 (38,2)*** 284 (44,9) 107 (16,9)

1999: 473 402 (85,0)Ë 316 (66,8)ı 86 (18,2) 71 (15,0)30-39 1997: 252 196 (77,8)*** 98 (38,9)*** 98 (38,9) 56 (22,2)

1999: 375 339 (90,4)Ë 258 (68,8)ı 81 (21,6) 36 (9,6)> 40 1997: 11 8 (72,7) 4 (36,4) 4 (36,4) 3 (27,3)

1999: 12 7 (58,3)Ë 5 (41,7)ı 2 (16,6) 5 (41,6)

‚,Á,‰,˙ p<0,05, ·,Â,ı p<0,01 Î·È Ë p<0,001: ™ËÌ·ÓÙÈÎfiÙËÙ· ÌÂÙ·Í‡ ÙˆÓ ÔÌ¿‰ˆÓ ÁÈ· Î¿ıÂ ·Ú¿ÁÔÓÙ· Î·Ù¿ ÙËÓ ›‰È· ÂÚ›Ô‰Ô ÙË˜ÌÂÏ¤ÙË˜*p<0,05, **p<0,01, ***p<0,001: ™ËÌ·ÓÙÈÎfiÙËÙ· ÌÂÙ·Í‡ ÙˆÓ ‰‡Ô ÂÚÈfi‰ˆÓ, ÁÈ· ÙÔ˘˜ ‰È¿ÊÔÚÔ˘˜ ·Ú¿ÁÔÓÙÂ˜.



¶ÚÈÓ ÙËÓ ·Ú¤Ì‚·ÛË

¶ÚÈÓ ÙËÓ ·Ú¤Ì‚·ÛË

ªÂÙ¿ ÙËÓ ·Ú¤Ì‚·ÛË

ªÂÙ¿ ÙËÓ ·Ú¤Ì‚·ÛË

™˘ÓÔÏÈÎfi˜ ª£

∞ÔÎÏÂÈÛÙÈÎfi˜ ª£

1Ë Â‚‰ÔÌ¿‰· 1Ô˜ Ì‹Ó·˜ 2Ô˜ Ì‹Ó·˜ 3Ô˜ Ì‹Ó·˜ 4-6 Ì‹ÓÂ˜ >6 Ì‹ÓÂ˜

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0

∂ÈÎfiÓ· 1. ¶ÔÛÔÛÙfi ÙˆÓ ‚ÚÂÊÒÓ Ô˘ ıËÏ¿˙Ô˘Ó (·ÔÎÏÂÈÛÙÈÎfi˜ Î·È Û˘ÓÔÏÈÎfi˜ ª£) Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÚÒÙÔ˘ ¯ÚfiÓÔ˘ ˙ˆ‹˜, ÚÈÓ Î·ÈÌÂÙ¿ ÙËÓ ·Ú¤Ì‚·ÛË. p<0,01 ·fi ÙËÓ 1Ë Â‚‰ÔÌ¿‰· ˆ˜ ÙÔÓ 2Ô Ì‹Ó· ÁÈ· ÙÔÓ Û˘ÓÔÏÈÎfi ª£. p<0,001 ·fi ÙÔÓ 3Ô Ì‹Ó· Î·È ÌÂÙ¿ ÙÔÓ 6Ô Ì‹-Ó· ÁÈ· ÙÔ Û˘ÓÔÏÈÎfi ª£ Î·È ·fi ÙËÓ 1Ë Â‚‰ÔÌ¿‰· ˆ˜ ÌÂÙ¿ ÙÔÓ 6Ô Ì‹Ó· ÁÈ· ÙÔÓ ·ÔÎÏÂÈÛÙÈÎfi ª£.


ÛÙÔÓ Û˘ÓÔÏÈÎfi ª£, ·ÏÏ¿ ·˘Í‹ıËÎÂ ÛËÌ·ÓÙÈÎ¿ Ë

Û˘¯ÓfiÙËÙ· ÙÔ˘ ·ÔÎÏÂÈÛÙÈÎÔ‡ ª£ (p<0,01). ªÂÙ¿

ÙËÓ ·Ú¤Ì‚·ÛË, Ê·›ÓÂÙ·È fiÙÈ fiÛÔ ·˘Í¿ÓÂÙ·È Ô ·ÚÈı-

Ìfi˜ ÙˆÓ ·È‰ÈÒÓ ÙË˜ ÔÈÎÔÁ¤ÓÂÈ·˜ Ô˘ ¤¯Ô˘Ó ıËÏ¿-

ÛÂÈ, ·˘Í¿ÓÂÙ·È Ô Û˘ÓÔÏÈÎfi˜ Î·È Ô ·ÔÎÏÂÈÛÙÈÎfi˜

ª£ (p<0,05). ∏ ·Ú¤Ì‚·ÛË ·‡ÍËÛÂ ÛËÌ·ÓÙÈÎ¿ ÙÔÓ

Û˘ÓÔÏÈÎfi ª£ ÛÙÈ˜ ÌËÙ¤ÚÂ˜ ÌÂ 2 Î·È 3 ‹ ÂÚÈÛÛfiÙÂ-

Ú· ·È‰È¿ (p<0,001 Î·È p<0,01, ·ÓÙ›ÛÙÔÈ¯·). ∏ Â›-

‰Ú·ÛË ÛÙËÓ ·‡ÍËÛË ÙÔ˘ ·ÔÎÏÂÈÛÙÈÎÔ‡ ª£ ‹Ù·Ó

ÈÔ ÛËÌ·ÓÙÈÎ‹ ÛÙÈ˜ ÌËÙ¤ÚÂ˜ ÌÂ 1 Î·È 2 ·È‰È¿

(p<0,001) Î·È ÏÈÁfiÙÂÚÔ ÛËÌ·ÓÙÈÎ‹ ÛÂ ÂÎÂ›ÓÂ˜ ÌÂ 3 ‹

ÂÚÈÛÛfiÙÂÚ· ·È‰È¿ (p<0,01).

∏ ËÏÈÎ›· ÙË˜ ÌËÙ¤Ú·˜ ‰ÂÓ Ê·›ÓÂÙ·È Ó· ÂËÚÂ¿-

˙ÂÈ ÙÔÓ ª£ ÚÈÓ ÙËÓ ·Ú¤Ì‚·ÛË. ªÂÙ¿ ÙËÓ ·Ú¤Ì-

‚·ÛË, Ô ª£ (Û˘ÓÔÏÈÎfi˜ Î·È ·ÔÎÏÂÈÛÙÈÎfi˜) ·˘Í¿-

ÓÂÈ ÌÂ ÙËÓ ËÏÈÎ›· ÙË˜ ÌËÙ¤Ú·˜ (p<0,001). ªËÙ¤ÚÂ˜

ËÏÈÎ›·˜ >40 ÂÙÒÓ ıËÏ¿˙Ô˘Ó ÏÈÁfiÙÂÚÔ Û˘¯Ó¿ Î·È

ÚÈÓ Î·È ÌÂÙ¿ ÙËÓ ·Ú¤Ì‚·ÛË. ∏ Â›‰Ú·ÛË ÙË˜ ·-

Ú¤Ì‚·ÛË˜ ÛÙË Û˘¯ÓfiÙËÙ· ÙÔ˘ ·ÔÎÏÂÈÛÙÈÎÔ‡ ª£

‹Ù·Ó ÛËÌ·ÓÙÈÎfiÙÂÚË ÛÙÈ˜ ËÏÈÎ›Â˜ 20-29 Î·È 30-39

ÂÙÒÓ (p<0,001).

∏ ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎ‹ Î·Ù¿ÛÙ·ÛË ÙË˜ ÔÈÎÔÁ¤-

ÓÂÈ·˜ ‰ÂÓ ÂËÚ¤·ÛÂ ÙË Û˘¯ÓfiÙËÙ· ÙÔ˘ ª£ Î·È ·˘-

Ùfi ‰ÂÓ ‰È¤ÊÂÚÂ ÌÂÙ·Í‡ ÙˆÓ ‰‡Ô ÂÚÈfi‰ˆÓ.

∏ ‰È¿ÚÎÂÈ· ÙÔ˘ ıËÏ·ÛÌÔ‡ ÚÈÓ Î·È ÌÂÙ¿ ÙËÓ ·-

Ú¤Ì‚·ÛË Ê·›ÓÂÙ·È ÛÙËÓ ∂ÈÎfiÓ· 1. ∏ ‰È¿ÚÎÂÈ· ÙÔ˘

Û˘ÓÔÏÈÎÔ‡ ıËÏ·ÛÌÔ‡ ÛÙËÓ ÚÒÙË ÂÚ›Ô‰Ô ‰Â›¯ÓÂÈ

ÌÈ· ÚÔÔ‰Â˘ÙÈÎ‹ ÂÏ¿ÙÙˆÛË ·fi 81,3% ÙËÓ 1Ë

Â‚‰ÔÌ¿‰· ÛÙÔ 40% ÌÂÙ·Í‡ ÙÔ˘ 4Ô˘ Î·È 6Ô˘ Ì‹Ó·

Î·È ÛÙÔ 22,6% ÌÂÙ¿ ÙÔÓ 6Ô Ì‹Ó·, ÂÓÒ Ô ·ÔÎÏÂÈÛÙÈ-

Îfi˜ ıËÏ·ÛÌfi˜ ¤ÊÙÂÈ ·fi 39% ÛÙÔ 18,8% Î·È 9%

ÛÙÈ˜ ›‰ÈÂ˜ ÂÚÈfi‰Ô˘˜. ªÂÙ¿ ÙËÓ ·Ú¤Ì‚·ÛË, Ù· Ô-

ÛÔÛÙ¿ Û˘ÓÔÏÈÎÔ‡ ª£ Â›Ó·È 84,4%, 64,9% Î·È 44,4%

ÛÙÔ Ù¤ÏÔ˜ ÙË˜ 1Ë˜ Â‚‰ÔÌ¿‰·˜, Î·Ù¿ ÙÔÓ 4Ô ÌÂ 6Ô

Ì‹Ó· Î·È ÌÂÙ¿ ÙÔÓ 6Ô Ì‹Ó· ·ÓÙ›ÛÙÔÈ¯·, ÂÓÒ ÙÔ˘

·ÔÎÏÂÈÛÙÈÎÔ‡ ıËÏ·ÛÌÔ‡ 61,8%, 42,8% Î·È 29,1%

(∂ÈÎfiÓ· 1). ∏ ·‡ÍËÛË ÙË˜ ‰È¿ÚÎÂÈ·˜ ÙÔ˘ ª£ (Û˘-

ÓÔÏÈÎÔ‡ Î·È ·ÔÎÏÂÈÛÙÈÎÔ‡) Î·Ù¿ ≥6 Ì‹ÓÂ˜ Â›Ó·È

ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ (p<0,001) ÌÂÙ¿ ÙËÓ ·Ú¤Ì-

‚·ÛË.

™˘˙‹ÙËÛË

ªÂÙ¿ ÙËÓ ÂÊ·ÚÌÔÁ‹ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ˘ÔÛÙ‹ÚÈ-

ÍË˜ Î·È ÂÓ›Û¯˘ÛË˜ ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡ ÌÂÙ¿

ÙÔÓ ÙÔÎÂÙfi Î·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ·Ú·ÌÔÓ‹˜

ÙˆÓ ÌËÙ¤ÚˆÓ Î·È ÙˆÓ ÓÂÔÁÓÒÓ ÙÔ˘˜ ÛÙË ª∫ ÙÔ˘ ÓÔ-

ÛÔÎÔÌÂ›Ô˘, ·Ú·ÙËÚ‹ıËÎÂ ÌÈ· ·‡ÍËÛË ÙÔ˘ Û˘ÓÔÏÈ-

ÎÔ‡ ª£ ·fi 81,9% ÛÙÔ 87%, ·ÏÏ¿ Î˘Ú›ˆ˜ ÌÈ· ·‡-

ÍËÛË ÙÔ˘ ·ÔÎÏÂÈÛÙÈÎÔ‡ ıËÏ·ÛÌÔ‡ Ô˘ Û¯Â‰fiÓ ‰È-

Ï·ÛÈ¿ÛÙËÎÂ ·fi 38,6% ÙÔ 1997, ÚÈÓ ÙËÓ ·Ú¤Ì-

‚·ÛË, ÛÙÔ 71% ÙÔ 1999 (¶›Ó·Î·˜ 1). ŒÙÛÈ, ÙÔ ÔÛÔ-

ÛÙfi ÙˆÓ ÓÂÔÁÓÒÓ Ô˘ ‰ÂÓ ¤·ÈÚÓ·Ó Î·ıfiÏÔ˘ ÙÚÔ-

ÔÔÈËÌ¤ÓÔ Á¿Ï· Î·Ù¿ ÙËÓ ¤ÍÔ‰fi ÙÔ˘˜ ·fi ÙË ª∫

ÂÏ·ÙÙÒıËÎÂ Û¯Â‰fiÓ ÛÙÔ ÌÈÛfi.

ªÂÏÂÙÒÓÙ·˜ ÙË Û˘¯ÓfiÙËÙ· ÙÔ˘ ª£ ÙÔ 1997,

‚Ú¤ıËÎÂ fiÙÈ ÂÓÒ ¤Ó· ÛËÌ·ÓÙÈÎfi ÔÛÔÛÙfi ÙˆÓ ÌËÙ¤-

ÚˆÓ Â›¯·Ó ÛÎÔfi Ó· ıËÏ¿ÛÔ˘Ó Î·È ÍÂÎ›Ó·Á·Ó ª£,

ÌfiÓÔ ÙÔ ¤Ó· ÙÚ›ÙÔ Û¯Â‰fiÓ ·˘ÙÒÓ, Î·Ù¿ÊÂÚ·Ó Ó· ıË-

Ï¿ÛÔ˘Ó ·ÔÎÏÂÈÛÙÈÎ¿ Î·Ù¿ ÙËÓ ¤ÍÔ‰Ô ·fi ÙË ª∫.

º·›ÓÂÙ·È ˆ˜ Ë ·fiÊ·ÛË ÙË˜ ÌËÙ¤Ú·˜ Ó· ıËÏ¿ÛÂÈ

·fi ÌfiÓË ÙË˜ ‰ÂÓ Â·ÚÎÂ› ÁÈ· Ó· ÂÙ‡¯ÂÈ Ô ÛÙfi¯Ô˜.

°È· ÙËÓ ÂÁÎ·Ù¿ÛÙ·ÛË ÙÔ˘ ª£ Â›Ó·È ·Ó·ÁÎ·›Â˜ Ûˆ-

ÛÙ¤˜ Ô‰ËÁ›Â˜ Î·È ˘ÔÛÙ‹ÚÈÍË ÙˆÓ ÌËÙ¤ÚˆÓ ·fi ÙÔ

ÚÔÛˆÈÎfi ˘ÁÂ›·˜ ÙË˜ ª∫ (ÓÂÔÁÓÔÏfiÁÔÈ, ·È‰›·-

ÙÚÔÈ, Ì·›Â˜, ÓÔÛËÏÂ‡ÙÚÈÂ˜) (7).

™ÙÈ˜ ÛÎ·Ó‰ÈÓ·‚ÈÎ¤˜ ¯ÒÚÂ˜, Ë ÛËÌ·ÓÙÈÎ‹ ·‡ÍËÛË

ÙË˜ Û˘¯ÓfiÙËÙ·˜ ÙÔ˘ ª£ ÂÈÙÂ‡¯ıËÎÂ ÌÂÙ¿ ·fi

·Ú¤Ì‚·ÛË ÛÙÈ˜ Ú·ÎÙÈÎ¤˜ ÙˆÓ ª∫ Î·È Î˘Ú›ˆ˜ ÙË


¶·È‰È·ÙÚÈÎ‹ 2007;70:285-292

¶›Ó·Î·˜ 3. ™˘¯ÓfiÙËÙ· ª£ (Û˘ÓÔÏÈÎfi˜, ·ÔÎÏÂÈÛÙÈÎfi˜ Î·È ÌÈÎÙfi˜) Î·Ù¿ ÙËÓ ¤ÍÔ‰Ô ÙÔ˘ ÓÂÔÁÓÔ‡ ·fi ÙË ª∫, ÛÂ Û¯¤ÛË ÌÂ ÙÔ ÎÔÈÓˆÓÈÎÔÔÈ-ÎÔÓÔÌÈÎfi Â›Â‰Ô Î·Ù¿ ÙÈ˜ ‰‡Ô ÂÚÈfi‰Ô˘˜ ÙË˜ ÌÂÏ¤ÙË˜ ÚÈÓ (1997) Î·È ÌÂÙ¿ (1999) ÙËÓ ·Ú¤Ì‚·ÛË


™‡ÓÔÏÔ N∆¿ÍË (N, %) I 1997: 193 154 (79,8) 72 (37,3)* 82 (42,5) 39 (20,2)

1999: 154 133 (86,4) 109 (70,8) 24 (15,6) 21 (13,6)II 1997: 288 233 (80,9) 118 (41,0)* 115 (40,0) 55 (19,1)

1999: 352 300 (85,2) 219 (62,2) 81 (23,0) 52 (14,8)III 1997: 219 176 (80,4) 81 (37,0)* 95 (43,4) 43 (19,6)

1999: 189 165 (87,3) 136 (72,0) 29 (15,3) 24 (12,7)IV 1997: 216 186 (86,1) 80 (37,0)* 106(49,1) 30 (13,9)

1999: 183 159 (86,9) 115 (62,8) 44 (24,0) 24 (13,1)

* p<0,001: ™ËÌ·ÓÙÈÎfiÙËÙ· ÌÂÙ·Í‡ ÙˆÓ 2 ÂÚÈfi‰ˆÓ ÙË˜ ÌÂÏ¤ÙË˜. ∆¿ÍË I: ·ÓÂÈ‰›ÎÂ˘ÙÔÈ ÂÚÁ¿ÙÂ˜, ∆¿ÍË II: ÂÈ‰ÈÎÂ˘Ì¤ÓÔÈ ÂÚÁ¿ÙÂ˜ Î·È ÙÂ¯Ó›ÙÂ˜, ∆¿ÍË III: ·fiÊÔÈÙÔÈ ·ÓÒÙÂÚˆÓ Û¯ÔÏÒÓ, ∆¿ÍË IV: ·fiÊÔÈÙÔÈ ·ÓÂÈÛÙËÌ›Ô˘.


Û˘ÓÂ¯‹ Â·Ê‹ ÌËÙ¤Ú·˜ - ÓÂÔÁÓÔ‡ Î·È ÙËÓ ·ÚÔ¯‹

ÚÔÛˆÈÎ‹˜ ÂÍ·ÙÔÌÈÎÂ˘Ì¤ÓË˜ ‚Ô‹ıÂÈ·˜ ÛÂ Î¿ıÂ

ÌËÙ¤Ú· ÁÈ· ÙËÓ ÂÁÎ·Ù¿ÛÙ·ÛË ÙÔ˘ ª£ (4). √ ÛÙfi-

¯Ô˜ ÙË˜ ·Ú¤Ì‚·ÛË˜ ÁÈ· ÂÓ›Û¯˘ÛË ÙÔ˘ ª£ ÛÙËÓ

·ÚÔ‡Û· ÌÂÏ¤ÙË ‹Ù·Ó Ó· ·˘ÍËıÂ› fi¯È ÌfiÓÔ Ë Û˘-

¯ÓfiÙËÙ· ÙÔ˘ ª£ Û˘ÓÔÏÈÎ¿ ·ÏÏ¿ Î·È ÂÎÂ›ÓË ÙÔ˘

·ÔÎÏÂÈÛÙÈÎÔ‡ ª£ Ô˘ ‹Ù·Ó ÔÏ‡ ¯·ÌËÏ‹ ÛÂ Û¯¤-

ÛË ÌÂ ¿ÏÏÂ˜ Â˘Úˆ·˚Î¤˜ ¯ÒÚÂ˜ Î·È Î˘Ú›ˆ˜ ÙÈ˜

ÛÎ·Ó‰ÈÓ·‚ÈÎ¤˜ ¯ÒÚÂ˜ (2). ¶ÚÔËÁÔ‡ÌÂÓÂ˜ ÌÂÏ¤ÙÂ˜

(1) ¤‰ÂÈÍ·Ó fiÙÈ Ô ·ÔÎÏÂÈÛÙÈÎfi˜ ª£ Î·Ù¿ ÙËÓ ÚÒ-

ÙË Â‚‰ÔÌ¿‰· ˙ˆ‹˜ Â›¯Â ÛËÌ·ÓÙÈÎ‹ Â›‰Ú·ÛË ÛÙË

Û˘ÓÔÏÈÎ‹ ‰È¿ÚÎÂÈ· ÙÔ˘ ıËÏ·ÛÌÔ‡. ŒÙÛÈ, Ë Â›ÙÂ˘ÍË

ÙË˜ ÛËÌ·ÓÙÈÎ‹˜ ·‡ÍËÛË˜ ÙÔ˘ ·ÔÎÏÂÈÛÙÈÎÔ‡ ª£

Î·Ù¿ ÙËÓ ÚÒÙË Â‚‰ÔÌ¿‰· ˙ˆ‹˜ Ê·›ÓÂÙ·È ˆ˜ Â›-

Ó·È ÛËÌ·ÓÙÈÎfi ÁÂÁÔÓfi˜ ÁÈ· ÙË Û˘¯ÓfiÙËÙ· ÙÔ˘ ª£

ÛÙËÓ ÂÚÈÔ¯‹ ÙË˜ µ¢ ∂ÏÏ¿‰·˜, Ï·Ì‚¿ÓÔÓÙ·˜ ˘fi-

„Ë fiÙÈ ¿Óˆ ·fi ÙÔ 50% ÙˆÓ ÙÔÎÂÙÒÓ Á›ÓÔÓÙ·È

ÛÙÔ ¶°¡π.

∆Ô ÁÂÁÔÓfi˜ fiÙÈ Ë ·ÚÔ¯‹ ‚Ô‹ıÂÈ·˜ ÛÙÈ˜ ÌËÙ¤ÚÂ˜

Î·Ù¿ ÙÈ˜ ÚÒÙÂ˜ Â‚‰ÔÌ¿‰Â˜ ¤¯ÂÈ Û·Ó ·ÔÙ¤ÏÂÛÌ·

ÙËÓ Î·Ï‡ÙÂÚË ÂÈÙ˘¯›· ÙÔ˘ ª£ ÌÂÁ·Ï‡ÙÂÚË˜ ‰È¿Ú-

ÎÂÈ·˜ ·Ó·Ê¤ÚÂÙ·È Î·È ÛÂ ¿ÏÏÂ˜ ÌÂÏ¤ÙÂ˜ (8-10).

™ÙË ÌÂÏ¤ÙË ÙˆÓ Ahluwalia Î·È Û˘Ó. Û˘ÌÂÚ·›ÓÂ-

Ù·È fiÙÈ “Ë ÛÙÚ·ÙËÁÈÎ‹ ÌÂ Ù· Î·Ï‡ÙÂÚ· ·ÔÙÂÏ¤ÛÌ·-

Ù· Â›Ó·È Ë ·ÚÔ¯‹ ‚Ô‹ıÂÈ·˜ Î·È Ë Î·ıÔ‰‹ÁËÛË Ô˘

·Ú¤¯ÂÙ·È ÛÙÈ˜ ÌËÙ¤ÚÂ˜ Ï›ÁÔ ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi ÛÙÔ

ÓÔÛÔÎÔÌÂ›Ô” (11). √È Ú·ÎÙÈÎ¤˜ Ô‰ËÁ›Â˜ Ô˘ ‰›ÓÔ-

ÓÙ·È ÛÙÈ˜ ÌËÙ¤ÚÂ˜ ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi ÌÔÚÂ›

Ó· ÙÔ˘˜ ÚÔÛÊ¤ÚÔ˘Ó ÙËÓ Î·Ù¿ÏÏËÏË ‚Ô‹ıÂÈ· ÁÈ·

ÙÔÓ ÂÈÙ˘¯‹ ıËÏ·ÛÌfi ÙÔ˘ ÌˆÚÔ‡ ÙÔ˘˜.

∏ ·‡ÍËÛË ÙÔ˘ Û˘ÓÔÏÈÎÔ‡ Î·È ÙÔ˘ ·ÔÎÏÂÈÛÙÈÎÔ‡

ª£ ÌÂ ÙËÓ ·Ú¤Ì‚·ÛË ÂÓ›Û¯˘ÛË˜ ÙÔ˘ ª£ ÛÙË ª∫

Û˘ÌÊˆÓÂ› Î·È ÌÂ ¿ÏÏÂ˜ ·Ó·ÊÔÚ¤˜ ÛÙË ‚È‚ÏÈÔÁÚ·Ê›·

fiÙÈ Ë ÂÎ·›‰Â˘ÛË Î·È Ë ˘ÔÛÙ‹ÚÈÍË Û¯ÂÙ›˙ÔÓÙ·È ÌÂ

·‡ÍËÛË ÙË˜ ¤Ó·ÚÍË˜ ÙÔ˘ ª£ (11-13). ªÈ· ÌÂÏ¤ÙË

·fi ÙËÓ ∆Ô˘ÚÎ›· ¤‰ÂÈÍÂ ˘„ËÏfiÙÂÚË Û˘¯ÓfiÙËÙ·

·ÔÎÏÂÈÛÙÈÎÔ‡ ª£ ÛÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·ÛË˜ ÛÂ

Û¯¤ÛË ÌÂ ÙËÓ ÔÌ¿‰· ÂÏ¤Á¯Ô˘ (14). ∂›ÛË˜, ÔÈ

Kurinij Î·È Û˘Ó. ¤‰ÂÈÍ·Ó fiÙÈ Ë ÔÏÈÙÈÎ‹ ÙÔ˘ ÓÔÛÔÎÔ-

ÌÂ›Ô˘ ÂËÚÂ¿˙ÂÈ ÙËÓ Èı·ÓfiÙËÙ· Ô˘ ¤¯ÂÈ ÌÈ· ÌËÙ¤-

Ú· Ó· ıËÏ¿ÛÂÈ ·ÔÎÏÂÈÛÙÈÎ¿ ÙÔ ÌˆÚfi ÙË˜ (15).

™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË, fiˆ˜ Î·È ÛÂ ¿ÏÏÂ˜ ÌÂÏ¤-

ÙÂ˜ (16-18), Ù· ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛË˜ ÓÂÔÁÓ¿

(<2,5 kg) Â›¯·Ó ÏÈÁfiÙÂÚÂ˜ Èı·ÓfiÙËÙÂ˜ Ó· ıËÏ¿ÛÔ˘Ó

(p<0,05) ÛÂ Û¯¤ÛË ÌÂ ÂÎÂ›Ó· ÌÂÁ·Ï‡ÙÂÚÔ˘ µ° (>2,5

kg). ∏ Û˘¯ÓfiÙËÙ· ª£ ‹Ù·Ó ÂÚ›Ô˘ 50% ÛÙ· <2,5

kg Î·È >80% ÛÙ· ÌÂÁ·Ï‡ÙÂÚÔ˘ µ° (>2,5 kg) ÓÂÔÁÓ¿.

∆Ô ÚfiÁÚ·ÌÌ· ˘ÔÛÙ‹ÚÈÍË˜ ÙÔ˘ ª£ ‰ÂÓ ÂË-

Ú¤·ÛÂ ÛËÌ·ÓÙÈÎ¿ ÙË Û˘¯ÓfiÙËÙ· ª£ ÙˆÓ ÓÂÔÁÓÒÓ

ÌÂ ¯·ÌËÏfi µ° (·‡ÍËÛË ·fi ÙÔ 50% ÛÙÔ 57,1%).

ª›· ·fi ÙÈ˜ Èı·Ó¤˜ ·ÈÙ›Â˜ ÙË˜ ÌÈÎÚfiÙÂÚË˜ Û˘¯Ófi-

ÙËÙ·˜ ª£ ÛÙ· ÓÂÔÁÓ¿ ÌÂ µ° <2,5 kg Â›Ó·È Ë Û¯ÂÙÈÎ‹

·ÓˆÚÈÌfiÙËÙ¿ ÙÔ˘˜ (35-36 Â‚‰ÔÌ¿‰Â˜) ÛÂ Û¯¤ÛË ÌÂ

Ù· ÌÂÁ·Ï‡ÙÂÚ· ÓÂÔÁÓ¿, ÌÂÁ·Ï‡ÙÂÚË˜ ∏∫ Î·È Â›-

ÛË˜ Ë ÌÂÁ·Ï‡ÙÂÚË ·‚Â‚·ÈfiÙËÙ· ÙË˜ ÌËÙ¤Ú·˜ fiÛÔÓ

·ÊÔÚ¿ ÙËÓ Â¿ÚÎÂÈ· ÙÔ˘ Á¿Ï·Ùfi˜ ÙË˜, fiˆ˜ ·Ó·-

Ê¤ÚÔ˘Ó Î·È ÔÈ Barros Î·È Û˘Ó. (18). √È Rajan Î·È

Û˘Ó. Â›ÛË˜ ·Ó·Ê¤ÚÔ˘Ó fiÙÈ Ù· ÓÂÔÁÓ¿ ÌÂ µ° >2,5 kg

¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚÂ˜ Èı·ÓfiÙËÙÂ˜ Ó· ıËÏ¿ÛÔ˘Ó ·Ô-

ÎÏÂÈÛÙÈÎ¿ ·’ fiÙÈ ÂÎÂ›Ó· ÌÂ µ° <2,5 kg (19).

∏ Â›‰Ú·ÛË ÙÔ˘ Ù‡Ô˘ ÙÔ˘ ÙÔÎÂÙÔ‡ ÛÙËÓ ÂÈÙ˘-

¯›· ÙÔ˘ ª£ ¤¯ÂÈ ·Ó·ÊÂÚıÂ› ÛÂ ÔÏÏ¤˜ ÌÂÏ¤ÙÂ˜ (20-

22). ™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË, Ë ∞∂ Î·È Ë ∫∆ Ê·›ÓÂÙ·È

ˆ˜ ¤¯Ô˘Ó ·ÚÓËÙÈÎ‹ Â›‰Ú·ÛË ÛÙÔÓ ª£. ∏ ·Ú¤Ì-

‚·ÛË ˘ÔÛÙ‹ÚÈÍË˜ ÙÔ˘ ıËÏ·ÛÌÔ‡ ‚Ô‹ıËÛÂ ÙÈ˜ ÌË-

Ù¤ÚÂ˜ Ó· ÂÙ‡¯Ô˘Ó ÙÔÓ ª£ (p<0,01) ÌfiÓÔ ÛÙËÓ

ÔÌ¿‰· ÂÎÂ›ÓË Ô˘ Á¤ÓÓËÛÂ ÌÂ ∞∂ Î·È fi¯È ÌÂ ∫∆. ∏

·‡ÍËÛË ÙÔ˘ Û˘ÓÔÏÈÎÔ‡ ª£ (p<0,05) ‹Ù·Ó ÏÈÁfiÙÂÚÔ

ÛËÌ·ÓÙÈÎ‹ ÛÙ· ÌˆÚ¿ Ô˘ ÁÂÓÓ‹ıËÎ·Ó ÌÂ ∫∆, ÛÂ

Û¯¤ÛË ÌÂ ÂÎÂ›Ó· Ô˘ ÁÂÓÓ‹ıËÎ·Ó ÌÂ º∆ ‹ ∞∂, ÌÂÙ¿

ÙËÓ ·Ú¤Ì‚·ÛË. ∏ ·‡ÍËÛË ÙÔ˘ ·ÔÎÏÂÈÛÙÈÎÔ‡ ıË-

Ï·ÛÌÔ‡ ‹Ù·Ó ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ Î·È ÛÙÈ˜ ÙÚÂÈ˜

ÔÌ¿‰Â˜ ÌÂÙ¿ ÙËÓ ·Ú¤Ì‚·ÛË (p<0,001). √È Victora

Î·È Û˘Ó. Û‡ÁÎÚÈÓ·Ó ÙÔÓ ÙÚfiÔ Û›ÙÈÛË˜ ÛÂ ‚Ú¤ÊË

Ô˘ ÁÂÓÓ‹ıËÎ·Ó ÌÂ º∆ Î·È ÌÂ ∫∆ (20). ™ÙË ÌÂÏ¤ÙË

ÙÔ˘˜, Ô Ù‡Ô˜ ÙÔ˘ ÙÔÎÂÙÔ‡ ‰ÂÓ Ê·›ÓÂÙ·È Ó· ÂËÚÂ-

¿˙ÂÈ ÙËÓ ¤Ó·ÚÍË ÙÔ˘ ª£, ÂÓÙÔ‡ÙÔÈ˜ Ë ‰È¿ÚÎÂÈ· ÙÔ˘

ª£ ‹Ù·Ó ÛËÌ·ÓÙÈÎ¿ ÌÈÎÚfiÙÂÚË ÛÙ· ÌˆÚ¿ Ô˘ Â›-

¯·Ó ÁÂÓÓËıÂ› ÌÂ ∫∆. ∫·È ÛÂ ¿ÏÏÂ˜ ÌÂÏ¤ÙÂ˜ ·Ó·Ê¤-

ÚÂÙ·È Â›‰Ú·ÛË ÙÔ˘ Â›‰Ô˘˜ ÙÔ˘ ÙÔÎÂÙÔ‡ ÛÙÔÓ ÙÚfi-

Ô Û›ÙÈÛË˜ ÙÔ˘ ‚Ú¤ÊÔ˘˜ (21,22). ¶Èı·ÓfiÓ Ë ·ÈÙ›·

ÙË˜ ÌÈÎÚfiÙÂÚË˜ Û˘¯ÓfiÙËÙ·˜ ª£ ÛÙ· ‚Ú¤ÊË Ô˘

ÁÂÓÓÈÔ‡ÓÙ·È ÌÂ ∫∆ Â›Ó·È Ë Î·ı˘ÛÙÂÚËÌ¤ÓË ÙÔÔı¤-

ÙËÛË ÙÔ˘ ÌˆÚÔ‡ ÛÙÔ ÛÙ‹ıÔ˜ ÙË˜ ÌËÙ¤Ú·˜ ÙÔ˘, Ô˘

‰‡ÛÎÔÏ· ÂËÚÂ¿˙ÂÙ·È ·fi ·Ú¤Ì‚·ÛË.

√ ÙfiÎÔ˜ ÙË˜ ÌËÙ¤Ú·˜ ‹ Ô ·ÚÈıÌfi˜ ·È‰ÈÒÓ ÙË˜

ÔÈÎÔÁ¤ÓÂÈ·˜ ‰ÂÓ Ê·›ÓÂÙ·È Ó· ÂËÚÂ¿˙ÂÈ ÛËÌ·ÓÙÈÎ¿

ÙË Û˘¯ÓfiÙËÙ· ÙÔ˘ Û˘ÓÔÏÈÎÔ‡ ª£, ·Ó Î·È Ë Û˘¯Ófi-

ÙËÙ· ÙÔ˘ ·ÔÎÏÂÈÛÙÈÎÔ‡ ª£ ·˘Í·ÓfiÙ·Ó ·Ú¿ÏÏË-

Ï· ÌÂ ÙËÓ ·‡ÍËÛË ÙÔ˘ ·ÚÈıÌÔ‡ ·È‰ÈÒÓ ÛÙËÓ ÔÈÎÔ-

Á¤ÓÂÈ· ÙÔ 1997. ªÂÙ¿ ÙËÓ ·Ú¤Ì‚·ÛË ˘‹Ú¯Â ÛÙ·-

ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ ·‡ÍËÛË Î·È ÙÔ˘ Û˘ÓÔÏÈÎÔ‡ Î·È

ÙÔ˘ ·ÔÎÏÂÈÛÙÈÎÔ‡ ª£ (p<0,05). À¿Ú¯ÂÈ ‰È¯Ô-

ÁÓˆÌ›· ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· fiÛÔÓ ·ÊÔÚ¿ ÙËÓ Â›‰Ú·-

ÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ·È‰ÈÒÓ ÙË˜ ÔÈÎÔÁ¤ÓÂÈ·˜ ÛÙË

Û˘¯ÓfiÙËÙ· ÙÔ˘ ª£. ™Â Ì›· ÌÂÏ¤ÙË ·fi ÙÔ ¶ÂÚÔ‡, Ë

‡·ÚÍË Ó¤ˆÓ ·È‰ÈÒÓ ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ· Û¯ÂÙÈ˙fiÙ·Ó

ıÂÙÈÎ¿ ÌÂ ÙËÓ Â›ÙˆÛË ÙÔ˘ ª£ Î·È ÙË ‰È¿ÚÎÂÈ¿

ÙÔ˘ (23). ª›· ÌÂÏ¤ÙË ·fi ÙËÓ ∞ÁÁÏ›· ÙÔ 1990 ‰Â›-

¯ÓÂÈ fiÙÈ ÙÔ ÚÒÙÔ ·È‰› ÙË˜ ÔÈÎÔÁ¤ÓÂÈ·˜ ıËÏ¿˙ÂÈ ÌÂ

ÌÂÁ·Ï‡ÙÂÚË Û˘¯ÓfiÙËÙ· ÛÂ Û¯¤ÛË ÌÂ ÙÔ ‰Â‡ÙÂÚÔ Î·È

Ù· ÂfiÌÂÓ· ·È‰È¿ (24). ™ÙË ÌÂÏ¤ÙË ÙˆÓ Victora

Î·È Û˘Ó. ·Ó·Ê¤ÚÂÙ·È fiÙÈ Ù· ·È‰È¿ ÌËÙ¤ÚˆÓ Ô˘ Â›-

¯·Ó ıËÏ¿ÛÂÈ ¤Ó· ÚÔËÁÔ‡ÌÂÓÔ ·È‰› Â›¯·Ó ÂÚÈÛÛfi-

ÙÂÚÂ˜ Èı·ÓfiÙËÙÂ˜ Ó· ıËÏ¿ÛÔ˘Ó (20). ™ÙËÓ ·ÚÔ‡-

Û· ÌÂÏ¤ÙË, ÙÔ ÚfiÁÚ·ÌÌ· ÂÓ›Û¯˘ÛË˜ ÙÔ˘ ıËÏ·ÛÌÔ‡




‹Ù·Ó ÈÔ ·ÔÙÂÏÂÛÌ·ÙÈÎfi ÁÈ· ÙÈ˜ ÌËÙ¤ÚÂ˜ Ô˘ Â›¯·Ó

ÚÔËÁÔ‡ÌÂÓË ÂÌÂÈÚ›· ıËÏ·ÛÌÔ‡.

∏ ËÏÈÎ›· ÙË˜ ÌËÙ¤Ú·˜ ‰ÂÓ Ê·›ÓÂÙ·È Ó· ÂËÚÂ¿˙ÂÈ

ÙÔÓ ª£ ÚÈÓ ÙËÓ ·Ú¤Ì‚·ÛË. ªÂÙ¿ ÙËÓ ·Ú¤Ì‚·-

ÛË, ÙÔ 1999, Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ‰Â›¯ÓÔ˘Ó fiÙÈ Ô ª£

·˘Í¿ÓÂÈ ·Ú¿ÏÏËÏ· ÌÂ ÙËÓ ËÏÈÎ›· ÙË˜ ÌËÙ¤Ú·˜ ˆ˜

ÙËÓ ËÏÈÎ›· ÙˆÓ 40 ÂÙÒÓ. ™Â ÌËÙ¤ÚÂ˜ ÌÂÁ·Ï‡ÙÂÚË˜

ËÏÈÎ›·˜ (>40 ÂÙÒÓ), Ë ·Ú¤Ì‚·ÛË ‰ÂÓ ‰Â›¯ÓÂÈ Ó·

¤¯ÂÈ Î¿ÔÈ· Â›‰Ú·ÛË, ·Ó Î·È Ô ·ÚÈıÌfi˜ ÙˆÓ ÌËÙ¤-

ÚˆÓ ·˘Ù‹˜ ÙË˜ ËÏÈÎ›·˜ ‹Ù·Ó ÔÏ‡ ÌÈÎÚfi˜. ¶·ÚfiÌÔÈ·

·ÔÙÂÏ¤ÛÌ·Ù· ·Ó·Ê¤ÚÔÓÙ·È Î·È ÛÂ ¿ÏÏÂ˜ ÌÂÏ¤ÙÂ˜

(21,23). ∏ ÌÈÎÚfiÙÂÚË ËÏÈÎ›· ÙË˜ ÌËÙ¤Ú·˜ ‰ÂÓ Ê·›ÓÂ-

Ù·È Ó· ÂËÚÂ¿˙ÂÈ ÙË Û˘¯ÓfiÙËÙ· Î·È ÙË ‰È¿ÚÎÂÈ· ÙÔ˘

ª£, fiˆ˜ ·Ó·Ê¤ÚÂÙ·È ÛÂ ÌÂÏ¤ÙË ·fi ÙË ¢·Ó›·

(25), ·ÓÙ›ıÂÙ· ÌÂ ¿ÏÏÂ˜ ÌÂÏ¤ÙÂ˜ (24). √È ‰È·ÊÔÚ¤˜

·˘Ù¤˜ ÌÔÚÂ› Ó· ÔÊÂ›ÏÔÓÙ·È fi¯È ÛÙËÓ ËÏÈÎ›· ·ÏÏ¿ ÛÂ

ÂıÓÈÎ¤˜ Î·È ÎÔÈÓˆÓÈÎ¤˜ ‰È·ÊÔÚ¤˜. ∏ ÎÔÈÓˆÓÈÎÔÔÈÎÔ-

ÓÔÌÈÎ‹ Î·Ù¿ÛÙ·ÛË ÙË˜ ÔÈÎÔÁ¤ÓÂÈ·˜, ÛÙËÓ ·ÚÔ‡Û·

ÌÂÏ¤ÙË, ‰ÂÓ ‰Â›¯ÓÂÈ Ó· ÂËÚÂ¿˙ÂÈ ÙË Û˘¯ÓfiÙËÙ· ÙÔ˘

ª£, fiˆ˜ ·Ó·Ê¤ÚÂÙ·È Î·È ÛÂ ¿ÏÏÂ˜ Â˘Úˆ·˚Î¤˜ ÌÂ-

Ï¤ÙÂ˜ (25,26). ™ÙÈ˜ ‰˘ÙÈÎ¤˜ ‚ÈÔÌË¯·ÓÔÔÈËÌ¤ÓÂ˜

¯ÒÚÂ˜, Â›Ó·È ÎÔÈÓfi Ê·ÈÓfiÌÂÓÔ ÌËÙ¤ÚÂ˜ ˘„ËÏfiÙÂÚˆÓ

ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎÒÓ Ù¿ÍÂˆÓ, ÌÂ ÌÂÁ·Ï‡ÙÂÚË

ÌfiÚÊˆÛË, Ó· ıËÏ¿˙Ô˘Ó Û˘¯ÓfiÙÂÚ· Î·È ÁÈ· ÌÂÁ·Ï‡-

ÙÂÚÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ·fi ÙÈ˜ Á˘Ó·›ÎÂ˜ ¯·ÌËÏfiÙÂ-

ÚˆÓ ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎÒÓ ÂÈ¤‰ˆÓ. ∆Ô ·ÓÙ›ıÂÙÔ

·Ú·ÙËÚÂ›Ù·È ÛÙÈ˜ ÂÚÈÔ¯¤˜ ˘fi ·Ó¿Ù˘ÍË, fiÔ˘ ÔÈ

ÌËÙ¤ÚÂ˜ ¯·ÌËÏfiÙÂÚˆÓ ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎÒÓ

ÛÙÚˆÌ¿ÙˆÓ, ÌÂ ÌÈÎÚfiÙÂÚË ÌfiÚÊˆÛË, ıËÏ¿˙Ô˘Ó Â-

ÚÈÛÛfiÙÂÚÔ (21-23). ∞˘Ù‹ Ë ‰È·ÊÔÚ¿ ‰Â›¯ÓÂÈ fiÙÈ ÔÈ

ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ ‰‡Ó·ÓÙ·È Ó·

ÂËÚÂ¿ÛÔ˘Ó ÛËÌ·ÓÙÈÎ¿ ÙÔÓ ª£ (27). ™ÙËÓ ·ÚÔ‡-

Û· ÌÂÏ¤ÙË ‰ÂÓ ·Ú·ÙËÚ‹ıËÎÂ ÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿

ÌÂÙ·Í‡ ÙˆÓ ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎÒÓ Ù¿ÍÂˆÓ, ·Ó Î·È

Ê·›ÓÂÙ·È fiÙÈ ÔÈ ÌËÙ¤ÚÂ˜ ÌÂ ÌÂÁ·Ï‡ÙÂÚË ÌfiÚÊˆÛË

ÍÂÎÈÓÔ‡Ó Ó· ıËÏ¿˙Ô˘Ó ÌÂ ÌÂÁ·Ï‡ÙÂÚË Û˘¯ÓfiÙËÙ·,

·ÏÏ¿ ÂÎÂ›ÓÂ˜ ÌÂ ÌÈÎÚfiÙÂÚË ÌfiÚÊˆÛË ıËÏ¿˙Ô˘Ó ÁÈ·

ÌÂÁ·Ï‡ÙÂÚÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·.

∆Ô ÚfiÁÚ·ÌÌ· ˘ÔÛÙ‹ÚÈÍË˜ ÙÔ˘ ª£ Â›¯Â Û·Ó

·ÔÙ¤ÏÂÛÌ· ÙËÓ ·‡ÍËÛË fi¯È ÌfiÓÔ ÙË˜ Û˘¯ÓfiÙËÙ·˜

ÙË˜ ¤Ó·ÚÍË˜ ÙÔ˘ ª£ ·ÏÏ¿ Î·È ÙË˜ ‰È¿ÚÎÂÈ¿˜ ÙÔ˘.

∫·Ù¿ ÙËÓ ÂÚ›Ô‰Ô ÌÂÙ¿ ÙËÓ ·Ú¤Ì‚·ÛË, Ë Û˘¯Ófi-

ÙËÙ· ÙÔ˘ ª£ ‹Ù·Ó 64,9% Î·È ÙÔ˘ ·ÔÎÏÂÈÛÙÈÎÔ‡

ª£ ‹Ù·Ó 42,8% ÌÂÙ·Í‡ ÙÔ˘ 4Ô˘ - 6Ô˘ Ì‹Ó·, Û˘¯Ófi-

ÙËÙ· Ô˘ ÏËÛÈ¿˙ÂÈ ÙÔ˘˜ ÛÙfi¯Ô˘˜ ÙÔ˘ “Healthy

People” ÁÈ· ÙÔ 2000 (28).

√ ·ÔÎÏÂÈÛÙÈÎfi˜ ıËÏ·ÛÌfi˜ Î·Ù¿ ÙËÓ ¤ÍÔ‰Ô ·fi

ÙËÓ ª∫ ÙÔ˘ ÓÔÛÔÎÔÌÂ›Ô˘ Ì·˜ ‹Ù·Ó ¯·ÌËÏfi˜

(38,6%) ÚÔ ÙË˜ ·Ú¤Ì‚·ÛË˜, ÂÓÒ ÌÂÙ¿ ·fi ÙËÓ

˘ÔÛÙ‹ÚÈÍË Î·È ÙËÓ Î·ıÔ‰‹ÁËÛË ÙˆÓ ÌËÙ¤ÚˆÓ ·fi

ÙÔ ÓÔÛËÏÂ˘ÙÈÎfi ÚÔÛˆÈÎfi ÙË˜ ª∫ ·fi ÙËÓ ·›ıÔ˘-

Û· ÙÔÎÂÙÔ‡ Î·È Î·Ù¿ ÙÈ˜ ÚÒÙÂ˜ Ì¤ÚÂ˜ ˙ˆ‹˜ ÂÈ-

ÙÂ‡¯ıËÎÂ ÌÈ· ÛËÌ·ÓÙÈÎ‹ ·‡ÍËÛË (71%). ∏ ˘ÔÛÙ‹-

ÚÈÍË Î·È Ë ÂÓı¿ÚÚ˘ÓÛË ÙˆÓ ÌËÙ¤ÚˆÓ Ó· ıËÏ¿ÛÔ˘Ó

ÛÙËÓ ÚÒÈÌË ÌÂÙ·ÁÂÓÓËÙÈÎ‹ ÂÚ›Ô‰Ô Ê·›ÓÂÙ·È Î·-

ıÔÚÈÛÙÈÎ‹ ÁÈ· ÙËÓ ÂÁÎ·Ù¿ÛÙ·ÛË Î·È ÂÔÌ¤Óˆ˜ ÁÈ·

ÙË Ì·ÎÚÔ¯ÚfiÓÈ· ‰È¿ÚÎÂÈ· ÙÔ˘ ıËÏ·ÛÌÔ‡. ∆· “ÊÈÏÈ-

Î¿ ÚÔ˜ Ù· ‚Ú¤ÊË” ÓÔÛÔÎÔÌÂ›· ¤¯Ô˘Ó Û·Ó ÛÙfi¯Ô

ÙËÓ ˘ÔÛÙ‹ÚÈÍË ÙˆÓ ÌËÙ¤ÚˆÓ Î·È ÙˆÓ ‚ÚÂÊÒÓ ÙÔ˘˜

ÁÈ· ıËÏ·ÛÌfi ·ÔÎÏÂÈÛÙÈÎ¿ Î·È ÁÈ· Ì·ÎÚfi ¯ÚÔÓÈÎfi

‰È¿ÛÙËÌ· (5,29). ∂ÈÏ¤ÔÓ, Ë Û˘ÓÂ¯‹˜ Â·Ê‹ ÙˆÓ

ÌËÙ¤ÚˆÓ ÌÂ ¿ÙÔÌ· ÂÈ‰ÈÎ¿ ÂÎ·È‰Â˘Ì¤Ó· ÛÙÔÓ ª£

Â›Ó·È ÛËÌ·ÓÙÈÎ‹ ÁÈ· ÙË ‰È·Ù‹ÚËÛË ÙÔ˘ ª£.


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™ˆÛÙ¤˜ ··ÓÙ‹ÛÂÈ˜ ÙÔ˘ Quiz ÁÈ· ÙÔ ¿ÚıÚÔ “∏ ·‡ÍËÛË ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ ÓÔÛËÌ¿ÙˆÓ ÛÙË

Û‡Á¯ÚÔÓË ÂÔ¯‹: ÂÈ‰ËÌÈÔÏÔÁÈÎ¿ ‰Â‰ÔÌ¤Ó· Î·È ·ÈÙÈÔÏÔÁ›·”

1. À„ËÏfiÙÂÚÔ˜ ÂÙ‹ÛÈÔ˜ ÂÈÔÏ·ÛÌfi˜ ÛÂ ÙÔ˘Ï¿¯ÈÛÙÔÓ ‰‡Ô ·ÙÔÈÎ¤˜ ·ı‹ÛÂÈ˜ Ù·˘Ùfi¯ÚÔÓ· Û˘Ó·ÓÙ¿Ù·È:‚. ™ÙË ª. µÚÂÙ·Ó›·

2. ¶ÔÈ· ·fi ÙÈ˜ ·Ú·Î¿Ùˆ ‰È·Ù˘ÒÛÂÈ˜ ‰ÂÓ Û˘ÌÂÚÈÏ·Ì‚¿ÓÂÙ·È ÛÙËÓ “˘fiıÂÛË ÙË˜ ˘ÁÈÂÈÓ‹˜”;Á. ∏ ·‡ÍËÛË ÙˆÓ ·ÏÏÂÚÁÈÒÓ ÔÊÂ›ÏÂÙ·È ÌÂÙ·Í‡ ¿ÏÏˆÓ ÛÂ ÂÚÈ‚·ÏÏÔÓÙÈÎÔ‡˜ Î·È ÎÏÈÌ·ÙÔÏÔÁÈÎÔ‡˜ ·-

Ú¿ÁÔÓÙÂ˜

3. ™ÙÔ ÎÏ·ÛÈÎfi ÌÔÓÙ¤ÏÔ “·ÙÔÈÎ‹˜ ·Ú¤Ï·ÛË˜” (atopic marching), Ë ·ÏÏËÏÔ˘¯›· ÂÌÊ¿ÓÈÛË˜ ÙˆÓ ·ÙÔÈ-ÎÒÓ ·ı‹ÛÂˆÓ Â›Ó·È:‚. ŒÎ˙ÂÌ·-ÙÚÔÊÈÎ¤˜ ·ÏÏÂÚÁ›Â˜-¿ÛıÌ·-·ÏÏÂÚÁÈÎ‹ ÚÈÓ›ÙÈ‰·

4. √È ·Ú·Î¿Ùˆ Î˘ÙÙ·ÚÔÎ›ÓÂ˜ ¯·Ú·ÎÙËÚ›˙Ô˘Ó ÙËÓ Ù‡Ô˘ Th2 ·ÓÔÛÔÏÔÁÈÎ‹ ·¿ÓÙËÛË Ô˘ Â˘ı‡ÓÂÙ·È ÁÈ·ÙËÓ ·Ó¿Ù˘ÍË ·ÏÏÂÚÁÈÎÒÓ ÂÎ‰ËÏÒÛÂˆÓ, ÂÎÙfi˜ ·fi ÙËÓ:·. INF- Á

5. ∞‡ÍËÛË ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ ·ı‹ÛÂˆÓ ·Ú·ÙËÚÂ›Ù·È:‰. ™Â fiÏÂ˜ ÙÈ˜ ·Ú·¿Óˆ ÂÚÈÙÒÛÂÈ˜ (ÛÂ ¯ÒÚÂ˜ Ô˘ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ˘ÈÔı¤ÙËÛ·Ó ÙÔ “‰˘ÙÈÎfi” ÌÔÓÙ¤-

ÏÔ ˙ˆ‹˜, ÛÂ ÌÂÁ·Ï‡ÙÂÚÔ ‚·ıÌfi ÛÙÔ˘˜ ÓÂfiÙÂÚÔ˘˜ ÛÂ Û¯¤ÛË ÌÂ ÙÔ˘˜ ÈÔ ËÏÈÎÈˆÌ¤ÓÔ˘˜, Î·ıÒ˜ Î·È ÛÂ ·Ó-ıÚÒÔ˘˜ ÌÂÁ·Ï‡ÙÂÚË˜ ËÏÈÎ›·˜ ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙÈ˜ ÚÔ¯ˆÚËÌ¤ÓÂ˜ ËÏÈÎ›Â˜ ÛÂ ÚÔËÁÔ‡ÌÂÓÂ˜ ‰ÂÎ·ÂÙ›Â˜)


∏ Û˘Ì‚ÔÏ‹ ÂÚÈ‚·ÏÏÔÓÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ÛÙËÓ ·ıÔÁ¤ÓÂÈ·

ÙÔ˘ Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË Ù‡Ô˘ 1 (™¢1)

∫. ∫·Ú·‚·Ó¿ÎË3, ∂. ∆ÛfiÎ·2, Ã. ∫·Ú·ÁÈ¿ÓÓË3, µ. ¶¤ÙÚÔ˘1, ∂. ¶È›‰Ô˘2, ª. ªÚÈÛÈÌÈÙ˙‹2,

ª. ª·˘ÚÈÎ›Ô˘2, ∫. ∫·ÎÏ¤·˜3, ∞. ¢¿ÎÔ˘-µÔ˘ÙÂÙ¿ÎË1

¶ÂÚ›ÏË„Ë

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ªÂÏÂÙ‹Û·ÌÂ 106 ·È‰È¿ ÌÂ Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË Ù‡Ô˘ 1 (™¢1) ÌÂ Ì¤ÛË ËÏÈÎ›· 11,73¤ÙË, Î·ıÒ˜ Î·È 150 Ì¿ÚÙ˘ÚÂ˜ ÌÂ ·ÓÙ›ÛÙÔÈ¯Ë ËÏÈÎ›· Î·È Ê‡ÏÔ, ÌÂ ÛÎÔfi Ó· ÂÎÙÈÌ‹ÛÔ˘ÌÂ ÙËÓ Â›‰Ú·ÛË Â-ÚÈ‚·ÏÏÔÓÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ÛÙËÓ ÂÎ‰‹ÏˆÛË ÙÔ˘ ™¢1, ·Ó¿ÏÔÁ· ÌÂ ÙËÓ ÎÔÈÓˆÓÈÎ‹ Ù¿ÍË. √È ÁÔÓÂ›˜ Û˘-ÌÏ‹ÚˆÛ·Ó ÂÚˆÙËÌ·ÙÔÏfiÁÈ· Ô˘ ·ÊÔÚÔ‡Û·Ó ÙËÓ ÂÎ·›‰Â˘ÛË Î·È ÙÔ Â¿ÁÁÂÏÌ¿ ÙÔ˘˜, Î·ıÒ˜ Î·È ÙÔ ·ÙÔ-ÌÈÎfi ÈÛÙÔÚÈÎfi ÙˆÓ ·È‰ÈÒÓ fiÛÔÓ ·ÊÔÚ¿ ÙÔÓ ıËÏ·ÛÌfi, Î·ıÒ˜ Î·È ÙË Û˘¯ÓfiÙËÙ· ÈÔÁÂÓÒÓ ÏÔÈÌÒÍÂˆÓ, ÂÌ-‚ÔÏÈ·ÛÌÒÓ Î·È ·ÏÏÂÚÁÈÎÒÓ ·ÓÙÈ‰Ú¿ÛÂˆÓ.

∞ÔÙÂÏ¤ÛÌ·Ù·: ∆· ·È‰È¿ ÙˆÓ Î·ÙÒÙÂÚˆÓ ÎÔÈÓˆÓÈÎÒÓ Ù¿ÍÂˆÓ ÂÌÊ¿ÓÈ˙·Ó ̆ „ËÏfiÙÂÚÔ Î›Ó‰˘ÓÔ ÂÎ‰‹ÏˆÛË˜™¢1, ·fi ÂÎÂ›Ó· ÙË˜ Ì¤ÛË˜ Î·È ·ÓÒÙÂÚË˜ ÎÔÈÓˆÓÈÎ‹˜ Ù¿ÍË˜ (OR = 0,16, 95% CI: (0,03, 0,80)). ∏ ÂÎ‰‹-ÏˆÛË Î¿ıÂ ·ÏÏÂÚÁÈÎ‹˜ ·ÓÙ›‰Ú·ÛË˜ (OR=0,06; 95% CI: (0,01, 0,23)), ·ÓÂÍ¿ÚÙËÙ· ·fi ÙËÓ ÎÔÈÓˆÓÈÎ‹ Ù¿-ÍË, Î·ıÒ˜ Î·È Ô ÌËÙÚÈÎfi˜ ıËÏ·ÛÌfi˜ (OR=0,45, 95% CI: (0,27, 0,77)) ‰ÚÔ‡Û·Ó ÚÔÛÙ·ÙÂ˘ÙÈÎ¿ ÛÙËÓ ÂÎ-‰‹ÏˆÛË ™¢1. ∫·Ù¿ ÙËÓ ·Ó¿Ï˘ÛË ÙË˜ ÔÏÏ·Ï‹˜ ÏÔÁÈÛÙÈÎ‹˜ ·ÏÈÓ‰ÚfiÌËÛË˜, Ë ÂÎ‰‹ÏˆÛË Û˘ÌÙˆÌ¿ÙˆÓ·ÏÏÂÚÁ›·˜ (OR=0,10,95% CI: (0,03, 0,40)), Ë ·˘ÍËÌ¤ÓË Û˘¯ÓfiÙËÙ· ÈÔÁÂÓÒÓ ÏÔÈÌÒÍÂˆÓ (OR=0,11, 95%CI: (0,02, 0,50)), È‰È·›ÙÂÚ· Î·Ù¿ Ù· ‰˘Ô ÚÒÙ· ¯ÚfiÓÈ· ˙ˆ‹˜, Î·ıÒ˜ Î·È Ë ÚÔ¤ÏÂ˘ÛË ·fi ÙÈ˜ ·ÓÒÙÂÚÂ˜ÎÔÈÓˆÓÈÎ¤˜ Ù¿ÍÂÈ˜ (OR=0,16, 95% CI: (0,03, 0,80)) ‰ÚÔ‡Û·Ó ÚÔÛÙ·ÙÂ˘ÙÈÎ¿ ÁÈ· ÙËÓ ÂÎ‰‹ÏˆÛË ™¢1.

™˘ÌÂÚ¿ÛÌ·Ù·: ™Ù· ·È‰È¿ ÌÂ ™¢1 ÙË˜ ÌÂÏ¤ÙË˜ Ì·˜, Ë ·ÚÔ˘Û›· ·ÏÏÂÚÁÈÎÒÓ ÂÎ‰ËÏÒÛÂˆÓ, Ô ÌËÙÚÈÎfi˜ıËÏ·ÛÌfi˜, ÔÈ Û˘¯Ó¤˜ ÈÔÁÂÓÂ›˜ ÏÔÈÌÒÍÂÈ˜, È‰È·›ÙÂÚ· Î·Ù¿ Ù· ‰‡Ô ÚÒÙ· ¯ÚfiÓÈ· ˙ˆ‹˜, Î·ıÒ˜ Î·È Ë ÚÔ¤-ÏÂ˘ÛË ·fi ÙË ÌÂÛ·›· Î·È ÙËÓ ·ÓÒÙÂÚË ÎÔÈÓˆÓÈÎ‹ Ù¿ÍË ‰ÚÔ‡Û·Ó ÚÔÛÙ·ÙÂ˘ÙÈÎ¿ ÛÙËÓ ÂÎ‰‹ÏˆÛË ™¢1.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: πÔÁÂÓÂ›˜ ÏÔÈÌÒÍÂÈ˜, ÂÌ‚ÔÏÈ·ÛÌfi˜ ÌÂ MMR, ÌËÙÚÈÎfi˜ ıËÏ·ÛÌfi˜, ·ÏÏÂÚÁ›Â˜, ÎÔÈÓˆÓÈÎ‹ Ù¿ÍË, ·ıÔ-

Á¤ÓÂÈ· ™¢1.

∂nvironmental factors possibly associated with the pathogenesis of

diabetes mellitus type 1 (DM1)

K. Karavanaki3, E. Tsoka2, C. Karayianni3, V. Petrou1, E. Pippidou2, M. Brisimitzi2, M. Mavrikiou2,

K. Kakleas3, C. Dacou-Voutetakis1

Abstract

Methods: We studied 106 children with type 1 diabetes mellitus (DM1) with a median age of 11.73 yearsand 150 controls with similar age and sex distribution, with the aim to assess the potential associationsbetween environmental factors and the development of DM1, stratified by social class. The parentscompleted questionnaires on their education and occupation and on their children’s personal history ofbreastfeeding, allergic symptoms and viral infections.

Results: Children of the lower classes had a higher risk of DM1 compared to children of the middle orupper social classes (OR = 0.16, 95% CI: (0.03, 0.80)). The occurrence of any assessed allergic symptoms(OR=0.06; 95% CI: (0.01, 0.23)), irrespectively of social class, as well as breastfeeding (OR=0.45, 95% CI:(0.27, 0.77)) were protective of DM1 presentation. According to the multiple logistic regression analysis,the presence of allergic symptoms (OR=0.10, 95% CI: (0.03,0.40)), the increased frequency of infections(OR=0.11, 95% CI: (0.02,0.50)), especially during the first 2 years of life and the origin from upper andmiddle social classes (OR=0.16, 95% CI: (0.03,0.80)), were protective of DM1 presentation.

Conclusion: In the children with DM1 of our study, the presence of allergic symptoms, breastfeeding,frequent viral infections and originating from a middle or upper social class had a protective effect on DM1presentation.

Key words: Viral infections, MMR vaccination, breastfeeding, allergies, social class, DM1 pathogenesis.

293∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞ ORIGINAL ARTICLE

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

2 µ’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹¡ÔÛÔÎÔÌÂ›Ô˘ ¶·›‰ˆÓ“∞Á›· ™ÔÊ›·” ∞ıËÓÒÓ

3 ¢È·‚ËÙÔÏÔÁÈÎfi π·ÙÚÂ›Ô, µ’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ,¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ“¶&∞ ∫˘ÚÈ·ÎÔ‡”


∫˘ÚÈ·Î‹ ∫·Ú·‚·Ó¿ÎË[email protected]µ’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ,¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶&∞ ∫˘ÚÈ·ÎÔ‡”£Ë‚ÒÓ Î·È §Â‚·‰Â›·˜,∆.∫. 115 27, ∞ı‹Ó·

1 Department ofEndocrinology, FirstDepartment of Paediatricsof the University ofAthens, “Aghia Sofia”Children’s Hospital

2 Second Department ofPaediatrics, “Aghia Sofia”Children’s Hospital

3 Diabetic Clinic, SecondDepartment of Paediatricsof the University ofAthens, “P. & A. Kyriakou”Children’s Hospital

Correspondence:

Kyriaki Karavanaki,[email protected] Paediatric Clinic of theUniversity of Athens, “P. & A. Kyriakou”Children’s Hospital∆hivon and Levadeias St.,115 27, Athens, Greece

¶·È‰È·ÙÚÈÎ‹ 2007;70:293-299


∂ÈÛ·ÁˆÁ‹

√ Û·Î¯·ÚÒ‰Ë˜ ‰È·‚‹ÙË˜ Ù‡Ô˘ 1 (™¢1) ÔÊÂ›ÏÂ-

Ù·È ÛÂ ·˘ÙÔ¿ÓÔÛË Î·Ù·ÛÙÚÔÊ‹ ÙˆÓ ‚-Î˘ÙÙ¿ÚˆÓ ÙÔ˘

·ÁÎÚ¤·ÙÔ˜ ÛÂ ÁÂÓÂÙÈÎ¿ ÚÔ‰È·ÙÂıÂÈÌ¤Ó· ¿ÙÔÌ·.

£ÂˆÚÂ›Ù·È fiÙÈ Ë ·˘ÙÔ¿ÓÔÛË ‰È·‰ÈÎ·Û›· Â¿ÁÂÙ·È

·fi ÔÚÈÛÌ¤ÓÔ˘˜ ÂÚÈ‚·ÏÏÔÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜,

fiˆ˜ Ë ÌÈÎÚ‹ ‰È¿ÚÎÂÈ· ·ÔÎÏÂÈÛÙÈÎÔ‡ ıËÏ·ÛÌÔ‡

Î·È Ë ÚÒÈÌË ¤ÎıÂÛË ÛÂ ÚˆÙÂ˝ÓÂ˜ Á¿Ï·ÎÙÔ˜ ·ÁÂÏ¿-

‰Ô˜ Î·È ‰ËÌËÙÚÈ·Î¿ ÛÙË ‚ÚÂÊÈÎ‹ ËÏÈÎ›· (1), Ë ÌÂÁ¿-

ÏË ËÏÈÎ›· ÙË˜ ÌËÙ¤Ú·˜ (2) Î·È ÙÔ ¯·ÌËÏfi ÎÔÈÓˆÓÈÎÔ-

ÔÈÎÔÓÔÌÈÎfi Â›Â‰Ô (3). √È ÈÔÁÂÓÂ›˜ ÏÔÈÌÒÍÂÈ˜ ÌÔ-

ÚÂ› Ó· ıÂˆÚËıÔ‡Ó ÂÈÙ·¯˘ÓÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ ÙË˜

·˘ÙÔ¿ÓÔÛË˜ Î·Ù·ÛÙÚÔÊ‹˜ ÙˆÓ ‚-Î˘ÙÙ¿ÚˆÓ (4).

∞ÓÙ›ıÂÙ·, Û‡ÌÊˆÓ· ÌÂ ÙËÓ ˘fiıÂÛË ÙË˜ ˘ÁÈÂÈÓ‹˜

(hygiene hypothesis), Ë ÌÂÈˆÌ¤ÓË ¤ÎıÂÛË ÛÂ ÌÈÎÚÔ-

ÔÚÁ·ÓÈÛÌÔ‡˜, ˆ˜ Û˘Ó¤ÂÈ· ÙˆÓ ‚ÂÏÙÈˆÌ¤ÓˆÓ Û˘ÓıË-

ÎÒÓ ‰È·‚›ˆÛË˜, Û¯ÂÙ›˙ÂÙ·È ÌÂ ·˘ÍËÌ¤ÓÔ Î›Ó‰˘ÓÔ ·Ï-

ÏÂÚÁÈÎÒÓ Î·È ·˘ÙÔ¿ÓÔÛˆÓ ÓÔÛËÌ¿ÙˆÓ (5). ∆ÂÏÂ˘-

Ù·›·, Û‡ÌÊˆÓ· ÌÂ ÙËÓ ˘fiıÂÛË ÙË˜ ÂÈÙ¿¯˘ÓÛË˜

(accelerator hypothesis), Èı·ÓÔÏÔÁÂ›Ù·È Ë Û˘¯ÓfiÙÂ-

ÚË ¤Ó·ÚÍË ÙÔ˘ ™¢1 ‹ ™¢2 ÛÂ ¿ÙÔÌ· ÌÂ ·˘ÍËÌ¤ÓÔ Ûˆ-

Ì·ÙÈÎfi ‚¿ÚÔ˜ Î·Ù¿ ÙË ‚ÚÂÊÈÎ‹ ËÏÈÎ›· Î·È ÔÈ ‰‡Ô ·˘-

Ù¤˜ ÌÔÚÊ¤˜ ‰È·‚‹ÙË ·Ô‰›‰ÔÓÙ·È ÛÂ ÂÓÈ·›· ‰È·Ù·Ú·-

¯‹ ÙË˜ ·ÓÙ›ÛÙ·ÛË˜ ÛÙËÓ ÈÓÛÔ˘Ï›ÓË (6).

√ ÛÎÔfi˜ ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ ‹Ù·Ó Ó· ‰ÈÂ-

ÚÂ˘Ó‹ÛÂÈ ÙÔÓ ÚfiÏÔ Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ÂÚÈ‚·ÏÏÔÓÙÈÎÒÓ

·Ú·ÁfiÓÙˆÓ, ÔÈ ÔÔ›ÔÈ Èı·ÓÒ˜ Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÙËÓ

·ıÔÁ¤ÓÂÈ· ÙÔ˘ ™¢1.


∏ ÌÂÏ¤ÙË Û˘ÌÂÚÈ¤Ï·‚Â fiÏ· Ù· ·È‰È¿ ËÏÈÎ›·˜ 3,5 -14,9

ÂÙÒÓ, ÛÙ· ÔÔ›· ‰È·ÁÓÒÛıËÎÂ ™¢1 ÛÙËÓ ∂ÏÏ¿‰· ÙÔ 1992. ∏ ÂÈ-

ÎÔÈÓˆÓ›· ÌÂ fiÏ· Ù· ·È‰È·ÙÚÈÎ¿ ÓÔÛÔÎÔÌÂ›· (È‰ÈˆÙÈÎ¿ ‹ ‰ËÌfi-

ÛÈ·) ÙË˜ ∂ÏÏ¿‰·˜ ¤ÁÈÓÂ ÌÂ ÂÈÛÙÔÏ¤˜ Î·È ÌÂ ÙËÏÂÊˆÓÈÎ‹ ÂÈ-

ÎÔÈÓˆÓ›·, ÙfiÛÔ ÚÈÓ ·fi ÙËÓ ¤Ó·ÚÍË ÙË˜ ÌÂÏ¤ÙË˜, fiÛÔ Î·È ÌÂÙ¿

ÙËÓ ÔÏÔÎÏ‹ÚˆÛË ÙÔ˘ 12Ô˘ Ì‹Ó· ÙË˜ ÌÂÏ¤ÙË˜. ∂ÈÚfiÛıÂÙ·,

ÂÈÛÙÔÏ¤˜ ÂÛÙ¿ÏËÛ·Ó ÛÂ fiÏÔ˘˜ ÙÔ˘˜ È·ÙÚÔ‡˜ ÌÂ ÂÍÂÈ‰›ÎÂ˘ÛË

ÛÙÔ ™¢, ÛÂ ÂÓ‰ÔÎÚÈÓÔÏfiÁÔ˘˜ Ô˘ ·Ú·ÎÔÏÔ˘ıÔ‡Ó ·È‰È¿ ÌÂ

™¢1 ÛÙËÓ ∂ÏÏ¿‰·, Î·ıÒ˜ Î·È ÛÂ fiÏÔ˘˜ ÙÔ˘˜ ·È‰È¿ÙÚÔ˘˜ (7).

ªÂ ÙÔÓ ÙÚfiÔ ·˘Ùfi ÂÓÙÔ›Û·ÌÂ ÛÙËÓ ∂ÏÏ¿‰·, Î·Ù¿ ÙÔ ¤ÙÔ˜

1992, 106 ·È‰È¿ ÌÂ ÚfiÛÊ·ÙË ‰È¿ÁÓˆÛË ™¢1. √ ÏËı˘ÛÌfi˜

ÙˆÓ Ì·ÚÙ‡ÚˆÓ ÂÚÈÏ¿Ì‚·ÓÂ 150 ·È‰È¿ ÌÂ ·Ó¿ÏÔÁË ËÏÈÎ›· Î·È

Ê‡ÏÔ. ∆· ·È‰È¿ ·˘Ù¿ ÓÔÛËÏÂ‡ıËÎ·Ó ÁÈ· ÚÔÛˆÚÈÓfi Úfi‚ÏËÌ·

(Î‹ÏË, ÔÍÂ›· ÛÎˆÏËÎÔÂÈ‰›ÙÈ‰·, ÓÂ˘ÌÔÓ›·, Á·ÛÙÚÂÓÙÂÚ›ÙÈ‰·,

ÎÏ) Î·È ‰ÂÓ ¤·Û¯·Ó ·fi ¯ÚfiÓÈÔ ÓfiÛËÌ·. ∞fi ÙËÓ ÔÌ¿‰· ÙˆÓ

Ì·ÚÙ‡ÚˆÓ ÂÍ·ÈÚ¤ıËÎ·Ó ·È‰È¿ Ô˘ ÓÔÛËÏÂ‡ÔÓÙ·Ó ÛÙÈ˜ ·È‰È·-

ÙÚÈÎ¤˜ ÎÏÈÓÈÎ¤˜ ÏfiÁˆ ÎÚ›ÛÂˆÓ ¿ÛıÌ·ÙÔ˜ ‹ ¿ÏÏˆÓ ·ÏÏÂÚÁÈÎÒÓ

·ÓÙÈ‰Ú¿ÛÂˆÓ, ‰ÈfiÙÈ ¤¯ÂÈ ·Ó·ÊÂÚıÂ› fiÙÈ Ë ‡·ÚÍË ·ÏÏÂÚÁÈÒÓ

·ÓÙ·ÁˆÓ›˙ÂÙ·È ÙËÓ ÂÌÊ¿ÓÈÛË ·˘ÙÔ¿ÓÔÛˆÓ ÓÔÛËÌ¿ÙˆÓ (8).

√È ÁÔÓÂ›˜ ÙˆÓ ·È‰ÈÒÓ ÌÂ ™¢1 Î·È ÙˆÓ Ì·ÚÙ‡ÚˆÓ ·¿ÓÙË-

Û·Ó ÛÂ Û˘ÁÎÂÎÚÈÌ¤ÓÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ. √È ÂÚˆÙ‹ÛÂÈ˜ Î·È ÛÙÈ˜

‰‡Ô ÔÌ¿‰Â˜ ÂÙ¤ıËÛ·Ó ·fi ·È‰›·ÙÚÔ ÌÂ ÂÍÂÈ‰›ÎÂ˘ÛË ÛÙÔ ™¢1

Î·È ÔÈ ··ÓÙ‹ÛÂÈ˜ Û˘ÌÏËÚÒıËÎ·Ó ·fi ÙÔÓ ›‰ÈÔ ÛÙÔ ¤ÓÙ˘Ô

ÙÔ˘ ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘. ∂È‰ÈÎfiÙÂÚ·, fiÛÔÓ ·ÊÔÚ¿ ÙÔ ÈÛÙÔÚÈÎfi

ÙˆÓ ÂÌ‚ÔÏÈ·ÛÌÒÓ, Ô È·ÙÚfi˜ ¤Ï·‚Â ÙÈ˜ ÏËÚÔÊÔÚ›Â˜ Û¯ÂÙÈÎ¿

ÌÂ ÙÔ Â›‰Ô˜, ÙÔÓ ·ÚÈıÌfi ‰fiÛÂˆÓ Î·È ÙËÓ ËÏÈÎ›· ÙˆÓ ÂÌ‚ÔÏÈ·-

ÛÌÒÓ ·fi ÙÔ ‚È‚ÏÈ¿ÚÈÔ ÀÁÂ›·˜ ÙˆÓ ·È‰ÈÒÓ.

∆Ô ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ÂÚÈÏ¿Ì‚·ÓÂ ÙÈ˜ ÂÍ‹˜ ÏËÚÔÊÔÚ›Â˜:

·) ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎ¿ Î·È ÔÈÎÔÁÂÓÂÈ·Î¿ ¯·Ú·ÎÙËÚÈÛÙÈ-

Î¿ (ËÏÈÎ›· ÁÔÓ¤ˆÓ, ÌfiÚÊˆÛË, Â·ÁÁÂÏÌ·ÙÈÎ‹ Î·È ÔÈÎÔÁÂÓÂÈ·-

Î‹ Î·Ù¿ÛÙ·ÛË, ·ÚÈıÌfi˜ ·‰ÂÚÊÒÓ),

‚) ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi (‰È·‚‹ÙË˜, ˘¤ÚÙ·ÛË, Î·Ú‰È·Á-

ÁÂÈ·Î¤˜ Î·È ·ÓÔÛÔÏÔÁÈÎ¤˜ ·ı‹ÛÂÈ˜),

Á) ·ÙÔÌÈÎfi ·Ó·ÌÓËÛÙÈÎfi:

1. ™˘¯ÓfiÙËÙ· ÏÔÈÌÒÍÂˆÓ, fiÔ˘ Û˘ÌÂÚÈÂÏ‹ÊıËÛ·Ó:

∞. §ÔÈÌÒ‰Ë ÓÔÛ‹Ì·Ù· ÌÂ ·ıÔÁÓˆÌÔÓÈÎ‹ ÎÏÈÓÈÎ‹ ÂÈÎfiÓ·

(·ÓÂÌÂ˘ÏÔÁÈ¿) ‹ ÙÂÎÌËÚÈˆÌ¤Ó· ÌÂ ·ÓÙÈÛˆÌ·ÙÈÎfi ¤ÏÂÁ¯Ô,

fiˆ˜ Ë ÏÔ›ÌˆÍË ·fi ÈÔ‡˜ ÂÚ˘ıÚ¿˜, ·ÚˆÙ›ÙÈ‰·˜, Epstein

Barr (EBV) Î·È Î˘ÙÙ·ÚÔÌÂÁ·ÏÔÈfi (CMV).

µ. ∫ÔÈÓ¤˜ ÈÔÁÂÓÂ›˜ ÏÔÈÌÒÍÂÈ˜, fiˆ˜ ÔÈ ÏÔÈÌÒÍÂÈ˜ ·fi ÈÔ‡˜

ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ‹ ÙÔ˘ ÂÓÙ¤ÚÔ˘

(9). √È ÈÔ› Ô˘ ıÂˆÚÔ‡ÓÙ·È ˆ˜ ÔÈ ÈÔ Èı·ÓÔ› ÁÈ· ÙËÓ ÚfiÎÏË-

ÛË ÎÔÈÓÒÓ ÈÔÁÂÓÒÓ ÏÔÈÌÒÍÂˆÓ Â›Ó·È ÔÈ ÚÈÓÔ˚Ô›, ÔÈ Rota-ÈÔ› Î·È

ÔÈ ÈÔ› ÙË˜ ÁÚ›Ë˜ Î·È ÙË˜ ·Ú·ÁÚ›Ë˜, ÁÈ· ÙÔ˘˜ ÔÔ›Ô˘˜ ‰ÂÓ

˘¿Ú¯ÂÈ ·ıËÙÈÎ‹ ·ÓÔÛÔÔ›ËÛË (9). ∞ÓÙ›ıÂÙ·, ÏÔÈÌÒÍÂÈ˜

Ô˘ ÚÔÏ·Ì‚¿ÓÔÓÙ·È ÌÂ Ù· ÂÌ‚fiÏÈ·, fiˆ˜ Ë ÈÏ·Ú¿, Ë ·Úˆ-

Ù›ÙÈ‰·, Ë ÂÚ˘ıÚ¿, Ë ·ÓÂÌÂ˘ÏÔÁÈ¿ Î·È Ô ÎÔÎÎ‡ÙË˜ Â›Ó·È ÂÍ·ÈÚÂ-

ÙÈÎ¿ ÌÔÏ˘ÛÌ·ÙÈÎ¤˜ Î·È ÌÂÙ·‰›‰ÔÓÙ·È Â‡ÎÔÏ· (8). ∏ Û˘¯ÓfiÙË-

Ù· ÙˆÓ ÏÔÈÌÒÍÂˆÓ Î·ıÔÚ›ÛÙËÎÂ ˆ˜ ÂÍ‹˜: ·Ô˘Û›· ÏÔÈÌÒÍÂ-

ˆÓ: ≤ 2/¤ÙÔ˜, Û¿ÓÈÂ˜: 2-5/¤ÙÔ˜, Û˘¯Ó¤˜:> 5/¤ÙÔ˜.

2. ∆‡Ô˜ Î·È ËÏÈÎ›· ·ÓÔÛÔÔ›ËÛË˜ ÌÂ ˙ÒÓÙÂ˜ ÂÍ·ÛıÂÓË-

Ì¤ÓÔ˘˜ ÈÔ‡˜, ‰ËÏ·‰‹ ÂÌ‚ÔÏÈ·ÛÌfi˜ ¤Ó·ÓÙÈ ÈÏ·Ú¿˜-ÂÚ˘ıÚ¿˜-

·ÚˆÙ›ÙÈ‰·˜ (MMR).

3. πÛÙÔÚÈÎfi ·ÏÏÂÚÁÈÎÒÓ ·ÓÙÈ‰Ú¿ÛÂˆÓ (Ù‡Ô˜ Î·È Û˘¯Ófi-

ÙËÙ· ÂÂÈÛÔ‰›ˆÓ). √ ·È‰›·ÙÚÔ˜ ÌÂ ÂÍÂÈ‰›ÎÂ˘ÛË ÛÙÔ ™¢1 Î·-

Ù¤ÁÚ·ÊÂ ÙËÓ ·ÎÚÈ‚‹ ·¿ÓÙËÛË ÙÔ˘ ÁÔÓ¤· ÛÙÈ˜ ÂÚˆÙ‹ÛÂÈ˜

“¶·ÚÔ˘ÛÈ¿˙ÂÈ ÙÔ ·È‰› Û·˜ ·ÏÏÂÚÁÈÎ¤˜ ·ÓÙÈ‰Ú¿ÛÂÈ˜; ∂¿Ó Ó·È,

ÂÚÈÁÚ¿„ÙÂ ÙÈ˜. ¶fiÛÔ Û˘¯Ó¿ ÙÈ˜ ·ÚÔ˘ÛÈ¿˙ÂÈ Î·È ·fi ÔÈ·

ËÏÈÎ›·; ÃÚÂÈ¿ÛıËÎÂ ÓÔÛËÏÂ›· ÛÂ ÓÔÛÔÎÔÌÂ›Ô ÁÈ· ÙÔ ÏfiÁÔ ·˘-

Ùfi;”. ™ÙË Û˘Ó¤¯ÂÈ·, ÔÈ ·ÛıÂÓÂ›˜ Î·Ù·Ù¿¯ıËÎ·Ó ÛÙÈ˜ ‰È¿ÊÔÚÂ˜

Î·ÙËÁÔÚ›Â˜ ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ ·ÓÙÈ‰Ú¿ÛÂˆÓ (¿ÛıÌ·, ·ÙÔÈÎ‹

‰ÂÚÌ·Ù›ÙÈ‰·, ÎÓ›‰ˆÛË, ·ÁÁÂÈÔÓÂ˘ÚˆÙÈÎfi Ô›‰ËÌ·, ÂÈÂÊ˘Î›-

ÙÈ‰·, ÚÈÓ›ÙÈ‰·, ÙÚÔÊÈÎ‹ ·ÏÏÂÚÁ›· Î·È Ê·ÚÌ·ÎÂ˘ÙÈÎ‹ ·ÏÏÂÚ-

Á›·) ÌÂ ‚¿ÛË ÙÈ˜ ··ÓÙ‹ÛÂÈ˜, ÛÂ Û˘ÓÂÚÁ·Û›· ÌÂ ·ÏÏÂÚÁÈÔÏfiÁÔ

ÙÔ˘ ÓÔÛÔÎÔÌÂ›Ô˘.

4. ™˘¯ÓfiÙËÙ· Î·È ‰È¿ÚÎÂÈ· ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡.

ªÂıÔ‰ÔÏÔÁ›·

™ÙË ªÂÁ¿ÏË µÚÂÙ·Ó›· Î·È ÛÂ ¿ÏÏÂ˜ ¯ÒÚÂ˜, Ë Â·ÁÁÂÏÌ·-

ÙÈÎ‹ ÎÔÈÓˆÓÈÎ‹ Ù¿ÍË ‰È·ÈÚÂ›Ù·È ÛÂ ¤ÍÈ ÔÌ¿‰Â˜: Â·ÁÁÂÏÌ·ÙÈÎ‹

··Û¯fiÏËÛË (I), ‰ÈÔÈÎËÙÈÎ‹ Î·È ÙÂ¯ÓÈÎ‹ ··Û¯fiÏËÛË (II), ÂÈ-

‰ÈÎÂ˘Ì¤ÓË ··Û¯fiÏËÛË (III), ËÌÈ-ÂÈ‰ÈÎÂ˘Ì¤ÓË ¯ÂÈÚˆÓ·ÎÙÈÎ‹

··Û¯fiÏËÛË (IV) Î·È ·ÓÂÈ‰›ÎÂ˘ÙË ¯ÂÈÚˆÓ·ÎÙÈÎ‹ ··Û¯fiÏË-

ÛË (V) (10). ™ÙË ÌÂÏ¤ÙË Ì·˜, Ë ÂÎÙ›ÌËÛË ÙË˜ ÎÔÈÓˆÓÈÎ‹˜ Ù¿-

ÍË˜ ÙˆÓ ÁÔÓ¤ˆÓ ‚·Û›ÛÙËÎÂ ÛÙÔ ÌÔÚÊˆÙÈÎfi Î·È Â·ÁÁÂÏÌ·ÙÈ-

Îfi Â›Â‰Ô Î·È ÙˆÓ ‰˘Ô ÁÔÓ¤ˆÓ Ù·˘Ùfi¯ÚÔÓ·. ™˘ÁÎÂÎÚÈÌ¤Ó·,

Â¿Ó Î·È ÔÈ ‰˘Ô ÁÔÓÂ›˜ Â›¯·Ó Ï¿‚ÂÈ ·ÓÒÙÂÚË ‹ ·ÓÒÙ·ÙË ÂÎ·›-

‰Â˘ÛË Î·È ·Ó‹Î·Ó ÛÙËÓ Â·ÁÁÂÏÌ·ÙÈÎ‹ Î·ÙËÁÔÚ›· I ‹ II, ÙfiÙÂ

Ë ÎÔÈÓˆÓÈÎ‹ Ù¿ÍË ¯·Ú·ÎÙËÚÈ˙fiÙ·Ó ˆ˜ “∞ÓÒÙÂÚË”. ™ÙËÓ ÂÚ›-

ÙˆÛË Ô˘ Î·È ÔÈ ‰˘Ô ÁÔÓÂ›˜ ‹Ù·Ó Ì¤¯ÚÈ ·fiÊÔÈÙÔÈ ÙÔ˘ §˘-

ÎÂ›Ô˘ Î·È ·Ó‹Î·Ó ÛÙËÓ Â·ÁÁÂÏÌ·ÙÈÎ‹ Î·ÙËÁÔÚ›· III, IV ‹ V,

ÙfiÙÂ Ë ÎÔÈÓˆÓÈÎ‹ Ù¿ÍË ¯·Ú·ÎÙËÚÈ˙fiÙ·Ó ˆ˜ “∫·ÙÒÙÂÚË”. ∏

“ª¤ÛË” ÎÔÈÓˆÓÈÎ‹ Ù¿ÍË ÂÚÈÏ¿Ì‚·ÓÂ fiÏÂ˜ ÙÈ˜ ˘fiÏÔÈÂ˜

ÂÚÈÙÒÛÂÈ˜.

™Ù·ÙÈÛÙÈÎ‹ ·Ó¿Ï˘ÛË

∏ ÛÙ·ÙÈÛÙÈÎ‹ ·Ó¿Ï˘ÛË ¤ÁÈÓÂ ÌÂ ÙÔ ÛÙ·ÙÈÛÙÈÎfi ÚfiÁÚ·ÌÌ·

Stata 8. ∆· ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÁÓˆÚ›ÛÌ·Ù· ÙˆÓ ‰ÂÈÁÌ¿ÙˆÓ Û˘-

ÁÎÚ›ıËÎ·Ó ÌÂÙ·Í‡ ·ÛıÂÓÒÓ Î·È Ì·ÚÙ‡ÚˆÓ ÌÂ ÙË ‰ÔÎÈÌ·Û›· x2,

294 ∫. ∫·Ú·‚·Ó¿ÎË Î·È Û˘Ó.



ÂÎÙfi˜ ·fi ÙËÓ ËÏÈÎ›·, ÁÈ· ÙËÓ ÔÔ›· ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë ÌË-

·Ú·ÌÂÙÚÈÎ‹ ‰ÔÎÈÌ·Û›· Mann-Whitney U Test. ∏ ÌÔÓÔ·-

Ú·ÁÔÓÙÈÎ‹ ·Ó¿Ï˘ÛË ÂÚÈÂÏ¿Ì‚·ÓÂ ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙÔ˘

Û¯ÂÙÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘ (Ôdds ratio) ÂÌÊ¿ÓÈÛË˜ ™¢1 ÁÈ· Î¿ıÂ ÌÂ-

Ù·‚ÏËÙ‹ ÍÂ¯ˆÚÈÛÙ¿. ™Â ‰Â‡ÙÂÚË Ê¿ÛË, ÔÈ ›‰ÈÂ˜ Û˘Û¯ÂÙ›ÛÂÈ˜

ÂÍÂÙ¿ÛıËÎ·Ó ÌÂÌÔÓˆÌ¤Ó· ÁÈ· ÙË ÌÂÛ·›·/·ÓÒÙÂÚË Î·È ÙËÓ

Î·ÙÒÙÂÚË ÎÔÈÓˆÓÈÎ‹ Ù¿ÍË. ªÂ ÙËÓ ·Ó¿Ï˘ÛË ÙË˜ ÔÏÏ·Ï‹˜

ÏÔÁÈÛÙÈÎ‹˜ ·ÏÈÓ‰ÚfiÌËÛË˜ ÂÎÙÈÌ‹ıËÎÂ Ë ·ÏÏËÏÂ›‰Ú·ÛË

ÙˆÓ ·ÓˆÙ¤ÚˆÓ ÌÔÓÔÌÂÙ·‚ÏËÙÒÓ ÛÙËÓ ÂÎ‰‹ÏˆÛË ™¢1, Î·È

Â›ÛË˜ ‰È·ÈÛÙÒıËÎÂ Â¿Ó ·˘Ù‹ Ë Û˘Û¯¤ÙÈÛË ÙÚÔÔÔÈÔ‡Ù·Ó

·fi ÙËÓ ÎÔÈÓˆÓÈÎ‹ Ù¿ÍË.


A. ∫·Ù·ÓÔÌ‹ ̂ ˜ ÚÔ˜ ÙÔ Ê‡ÏÔ Î·È ÙËÓ ËÏÈÎ›·

∏ ÌÂÏ¤ÙË ÂÚÈ¤Ï·‚Â 106 ·È‰È¿ (55,7% ·ÁfiÚÈ·

Î·È 44,3% ÎÔÚ›ÙÛÈ·) ÌÂ ÚfiÛÊ·Ù· ‰È·ÁÓˆÛı¤ÓÙ·

™¢1 (ÛÂ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÂÓfi˜ ÌËÓfi˜ ·fi ÙË ‰È¿-

ÁÓˆÛË) Î·È 150 Ì¿ÚÙ˘ÚÂ˜ (55,3% ·ÁfiÚÈ· Î·È 44,7%

ÎÔÚ›ÙÛÈ·), ÌÂ ·Ó¿ÏÔÁË ËÏÈÎ›· Î·È Ê‡ÏÔ. ∏ ËÏÈÎ›· ÙˆÓ

·È‰ÈÒÓ Î·Ù¿ ÙË ‰È¿ÁÓˆÛË ÙÔ˘ ‰È·‚‹ÙË Î˘Ì·ÈÓfiÙ·Ó

·fi Ù· 3,5 ¤ˆ˜ Ù· 14,9 ¤ÙË (‰È¿ÌÂÛÔ˜ ÙÈÌ‹=11,7) Î·È

‰ÂÓ ‰È¤ÊÂÚÂ ÛËÌ·ÓÙÈÎ¿ ·fi ÙËÓ ËÏÈÎ›· ÂÍ¤Ù·ÛË˜

ÙˆÓ Ì·ÚÙ‡ÚˆÓ.

B. ªÔÚÊˆÙÈÎfi Â›Â‰Ô ÙˆÓ ÁÔÓ¤ˆÓ,

Â·ÁÁÂÏÌ·ÙÈÎ‹ Î·È ÎÔÈÓˆÓÈÎ‹ Ù¿ÍË

√È ·Ù¤ÚÂ˜ ÙˆÓ ·È‰ÈÒÓ ÌÂ ™¢1 ‰ÂÓ ‰È¤ÊÂÚ·Ó

ÛËÌ·ÓÙÈÎ¿ ·fi ÂÎÂ›ÓÔ˘˜ ÙˆÓ Ì·ÚÙ‡ÚˆÓ, ˆ˜ ÚÔ˜ ÙÔ

ÌÔÚÊˆÙÈÎfi Â›Â‰Ô, ÙËÓ Â·ÁÁÂÏÌ·ÙÈÎ‹ Î·È ÙËÓ

ÎÔÈÓˆÓÈÎ‹ Ù¿ÍË.

∞ÓÙ›ıÂÙ·, ÔÈ ÌËÙ¤ÚÂ˜ ÙˆÓ ·È‰ÈÒÓ ÌÂ ™¢1 ÂÌÊ¿-

ÓÈ˙·Ó ÈÔ Û˘¯Ó¿ ¯·ÌËÏfiÙÂÚÔ ÌÔÚÊˆÙÈÎfi Â›Â‰Ô

(‚·ÛÈÎ‹ Î·È ‰Â˘ÙÂÚÔ‚¿ıÌÈ· ÂÎ·›‰Â˘ÛË) (p<0,001),

·Û¯ÔÏÔ‡ÓÙ·Ó ÛÂ ˘„ËÏfiÙÂÚÔ ÔÛÔÛÙfi ÌÂ Ù· ÔÈÎÈ·Î¿

(75%) Î·È ·Ó‹Î·Ó ÛÙËÓ Î·ÙÒÙÂÚË ÎÔÈÓˆÓÈÎ‹ Ù¿ÍË ÛÂ

ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi (92,1%), Û˘ÁÎÚÈÙÈÎ¿ ÌÂ ÂÎÂ›-

ÓÂ˜ ÙˆÓ Ì·ÚÙ‡ÚˆÓ, ·ÓÙ›ÛÙÔÈ¯· (ÔÈÎÈ·Î¿: 57,7%,

p=0,022, ÎÔÈÓˆÓÈÎ‹ Ù¿ÍË: 75,3%, p=0,001).

√ Î·ıÔÚÈÛÌfi˜ ÙË˜ ÔÈÎÔÁÂÓÂÈ·Î‹˜ ÎÔÈÓˆÓÈÎ‹˜

Ù¿ÍË˜ ‚·Û›ÛÙËÎÂ ÙfiÛÔ ÛÙËÓ ·ÙÚÈÎ‹, fiÛÔ Î·È ÛÙË

ÌËÙÚÈÎ‹ ÎÔÈÓˆÓÈÎ‹ Ù¿ÍË. ¶·Ú·ÙËÚ‹ıËÎÂ fiÙÈ Ë Û˘-

¯ÓfiÙËÙ· ÙË˜ Î·ÙÒÙÂÚË˜ ÎÔÈÓˆÓÈÎ‹˜ Ù¿ÍË˜ ‹Ù·Ó

ÔÚÈ·Î¿ ˘„ËÏfiÙÂÚË ÛÙ· ·È‰È¿ ÌÂ ‰È·‚‹ÙË (46,2%),

Û˘ÁÎÚÈÓfiÌÂÓË ÌÂ ÂÎÂ›ÓË ÙˆÓ Ì·ÚÙ‡ÚˆÓ (34,9%)(p=0,07) (¶›Ó·Î·˜ 1).

°. ªÔÓÔ·Ú·ÁÔÓÙÈÎ‹ ·Ó¿Ï˘ÛË

∏ ÔÌ¿‰· ÙˆÓ ·È‰ÈÒÓ ÌÂ ™¢1 Û˘ÁÎÚ›ıËÎÂ ÌÂ ÙËÓÔÌ¿‰· ÙˆÓ Ì·ÚÙ‡ÚˆÓ, ̂ ˜ ÚÔ˜ ÙÔ ÈÛÙÔÚÈÎfi ÌËÙÚÈÎÔ‡ıËÏ·ÛÌÔ‡, ÎÔÈÓÒÓ ÈÔÁÂÓÒÓ ÏÔÈÌÒÍÂˆÓ, ÂÌ‚ÔÏÈ·-ÛÌÔ‡ ÌÂ MMR Î·È ÙÔ ÈÛÙÔÚÈÎfi ·ÏÏÂÚÁÈÎÒÓ Û˘ÌÙˆ-Ì¿ÙˆÓ (¶›Ó·Î·˜ 2). ∂ÎÙÈÌ‹ıËÎÂ Â›ÛË˜ Ë ‰È·ÊÔÚÔ-Ô›ËÛË ÙˆÓ ·Ú·¿Óˆ Û¯¤ÛÂˆÓ ·Ó¿ÏÔÁ· ÌÂ ÙËÓÎÔÈÓˆÓÈÎ‹ Ù¿ÍË ÙˆÓ ÁÔÓ¤ˆÓ.

∞fi ÙËÓ ÌÔÓÔ·Ú·ÁÔÓÙÈÎ‹ ·Ó¿Ï˘ÛË ‰È·ÈÛÙÒÛ·-ÌÂ fiÙÈ ÙÔ ÈÛÙÔÚÈÎfi ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡ ÂÌÊ·Ó›˙ÂÈÚÔÛÙ·ÙÂ˘ÙÈÎ‹ Â›‰Ú·ÛË ¤Ó·ÓÙÈ ÙÔ˘ ™¢1 ·) ÛÙÔ Û‡-ÓÔÏÔ ÙˆÓ ·È‰ÈÒÓ ÌÂ ™¢1 (¶›Ó·Î·˜ 2, OR = 0,45, p =0,003), ‚) ÛÙ· ·È‰È¿ ÙË˜ Ì¤ÛË˜ Î·È ·ÓÒÙÂÚË˜ ÎÔÈÓˆ-ÓÈÎ‹˜ Ù¿ÍË˜ (OR=0,35, p=0,004), ·ÏÏ¿ fi¯È ÛÂ ÂÎÂ›Ó·ÙË˜ Î·ÙÒÙÂÚË˜ ÎÔÈÓˆÓÈÎ‹˜ Ù¿ÍË˜. ∂ÈÏ¤ÔÓ, Ë ÌÂÁ·-Ï‡ÙÂÚË ‰È¿ÚÎÂÈ· ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡ Û¯ÂÙÈ˙fiÙ·ÓÌÂ ¯·ÌËÏfiÙÂÚÔ Î›Ó‰˘ÓÔ ÂÎ‰‹ÏˆÛË˜ ™¢1 ÛÙË Û˘ÓÔÏÈ-Î‹ ÔÌ¿‰· ·È‰ÈÒÓ ÌÂ ™¢1 (¶›Ó·Î·˜ 2, OR=0,89,p=0,032), ·ÏÏ¿ fi¯È ÛÙÈ˜ ÂÈÌ¤ÚÔ˘˜ ÎÔÈÓˆÓÈÎ¤˜ Ù¿ÍÂÈ˜.

¢È·ÈÛÙÒıËÎÂ ·ÚÓËÙÈÎ‹ Û˘Û¯¤ÙÈÛË ÌÂÙ·Í‡ ÙË˜·ÚÔ˘Û›·˜ ÏÔÈÌÒÍÂˆÓ Î·È ÙÔ˘ ™¢1 (¶›Ó·Î·˜ 2,OR=0,51, p=0,020). √ ÚÔÛÙ·ÙÂ˘ÙÈÎfi˜ ÚfiÏÔ˜ ÙˆÓÏÔÈÌÒÍÂˆÓ ‰È·ÈÛÙÒıËÎÂ Â›ÛË˜ ÁÈ· Ù· ·È‰È¿ ÌÂ™¢1 ÙË˜ Î·ÙÒÙÂÚË˜ ÎÔÈÓˆÓÈÎ‹˜ Ù¿ÍË˜ (OR=0,35,p=0,026), ·ÏÏ¿ fi¯È ÁÈ· ÂÎÂ›Ó· ÙË˜ Ì¤ÛË˜ Î·È ·ÓÒÙÂ-ÚË˜ ÎÔÈÓˆÓÈÎ‹˜ Ù¿ÍË˜. ∂È‰ÈÎfiÙÂÚ·, ÔÈ ‚·ÎÙËÚÈ·Î¤˜ÏÔÈÌÒÍÂÈ˜ ‰ÂÓ Û¯ÂÙ›˙ÔÓÙ·Ó ÛÂ ÛËÌ·ÓÙÈÎfi ‚·ıÌfi ÌÂÙËÓ ÂÌÊ¿ÓÈÛË ™¢1 Ô‡ÙÂ ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ ·È‰ÈÒÓ ÌÂ™¢1 (¶›Ó·Î·˜ 2), Ô‡ÙÂ ÛÙÈ˜ ÂÈÌ¤ÚÔ˘˜ ÎÔÈÓˆÓÈÎ¤˜Ù¿ÍÂÈ˜. ∞ÓÙ›ıÂÙ·, Ë ·ÚÔ˘Û›· ÈÔÁÂÓÒÓ ÏÔÈÌÒÍÂˆÓÂËÚ¤·˙Â ÛËÌ·ÓÙÈÎ¿ ÙËÓ ÂÎ‰‹ÏˆÛË ÙÔ˘ ™¢1 ·) ÛÙÔÛ‡ÓÔÏÔ ÙˆÓ ·È‰ÈÒÓ ÌÂ ™¢1 (¶›Ó·Î·˜ 2, OR = 0,47,p=0,011) Î·È ‚) ÛÂ ÂÎÂ›Ó· ÙË˜ Î·ÙÒÙÂÚË˜ ÎÔÈÓˆÓÈÎ‹˜Ù¿ÍË˜ (OR=0,30, p=0,014). ŸÛÔÓ ·ÊÔÚ¿ ÙÔ ¯ÚÔÓÈÎfi‰È¿ÛÙËÌ· ÙË˜ ÚÒÙË˜ ÂÌÊ¿ÓÈÛË˜ ÙˆÓ ÈÔÁÂÓÒÓ ÏÔÈ-ÌÒÍÂˆÓ, ÔÈ ÏÔÈÌÒÍÂÈ˜ Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·Ó Î˘Ú›ˆ˜ ÛÙ·‰˘Ô ÚÒÙ· ¯ÚfiÓÈ· ÙË˜ ˙ˆ‹˜ (¶›Ó·Î·˜ 2, OR=0,33,p=0,005) ‹ Î·È ·ÚÁfiÙÂÚ· (OR=0,53, p=0,053), ‰ÚÔ‡-Û·Ó ÚÔÛÙ·ÙÂ˘ÙÈÎ¿ ¤Ó·ÓÙÈ ÙË˜ ÂÎ‰‹ÏˆÛË˜ ÙÔ˘ ™¢1.

295¶ÂÚÈ‚·ÏÏÔÓÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ Î·È ·ıÔÁ¤ÓÂÈ· ÙÔ˘ Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË Ù‡Ô˘ 1

¶›Ó·Î·˜ 1. ∆·ÍÈÓfiÌËÛË ·Ó¿ÏÔÁ· ÌÂ ÙËÓ ÎÔÈÓˆÓÈÎ‹ Ù¿ÍË ÙˆÓ ÁÔÓ¤ˆÓ

∫ÔÈÓˆÓÈÎ‹ Ù¿ÍË ÙˆÓ ÁÔÓ¤ˆÓ¶·ÙÚÈÎ‹ ÎÔÈÓˆÓÈÎ‹ Ù¿ÍË ªËÙÚÈÎ‹ ÎÔÈÓˆÓÈÎ‹ Ù¿ÍË √ÈÎÔÁÂÓÂÈ·Î‹ ÎÔÈÓˆÓÈÎ‹ Ù¿ÍË

¶·È‰È¿ ÌÂ ‰È·‚‹ÙË ª¿ÚÙ˘ÚÂ˜ ¶·È‰È¿ ÌÂ ‰È·‚‹ÙË ª¿ÚÙ˘ÚÂ˜ ¶·È‰È¿ ÌÂ ‰È·‚‹ÙË ª¿ÚÙ˘ÚÂ˜N = 106 (%) N = 146 (%) N = 88 (%) N = 146 (%) N = 106 (%) N = 146 (%)

∫·ÙÒÙÂÚË 49 (46,23) 56 (38,36) 81 (92,05) 110 (75,34) 49 (46,23) 51 (34,93)∞ÓÒÙÂÚË 57 (53,77) 90 (61,64) 7 (7,95) 36 (24,66) 57 (53,77)* 95 (65,07)*

p-value = 0,211 p-value = 0,001 p-value = 0,070

* ∏ ÔÈÎÔÁÂÓÂÈ·Î‹ ÎÔÈÓˆÓÈÎ‹ Ù¿ÍË ¤¯ÂÈ ÔÚÈÛıÂ› ÌÂ ÙÚ›· Â›Â‰· ‚·ÛÈ˙fiÌÂÓË ÛÙÈ˜ ÎÔÈÓˆÓÈÎ¤˜ Ù¿ÍÂÈ˜ ÙÔ˘ ·Ù¤Ú· Î·È ÙË˜ ÌËÙ¤-Ú·˜: Î·ÙÒÙÂÚË, Ì¤ÛË, ·ÓÒÙÂÚË. ∂‰Ò Ë Ì¤ÛË Î·È Ë ·ÓÒÙÂÚË ÎÔÈÓˆÓÈÎ‹ Ù¿ÍË Û˘ÁÎÚ›ÓÔÓÙ·È ÌÂ ÙËÓ Î·ÙÒÙÂÚË ÎÔÈÓˆÓÈÎ‹ Ù¿ÍË

¶·È‰È·ÙÚÈÎ‹ 2007;70:293-299


∏ Û˘Û¯¤ÙÈÛË ·˘Ù‹ ·Ú¤ÌÂÈÓÂ ÛËÌ·ÓÙÈÎ‹ ÁÈ· Ù· ·È-‰È¿ ÌÂ ™¢1 ÙË˜ Î·ÙÒÙÂÚË˜ ÎÔÈÓˆÓÈÎ‹˜ Ù¿ÍË˜, ·ÏÏ¿fi¯È ÁÈ· ÂÎÂ›Ó· ÙË˜ Ì¤ÛË˜ Î·È ·ÓÒÙÂÚË˜ ÎÔÈÓˆÓÈÎ‹˜Ù¿ÍË˜. ∞Ó·ÊÔÚÈÎ¿ ÌÂ ÙË Û˘¯ÓfiÙËÙ· ÙˆÓ ÈÔÁÂÓÒÓÏÔÈÌÒÍÂˆÓ, Ë ·ÚÔ˘Û›· ‰˘Ô ‹ ÂÚÈÛÛÔÙ¤ÚˆÓ ÏÔÈÌÒ-ÍÂˆÓ/¤ÙÔ˜ Û¯ÂÙÈ˙fiÙ·Ó ÌÂ ÌÈÎÚfiÙÂÚÔ Î›Ó‰˘ÓÔ ÂÎ‰‹-ÏˆÛË˜ ™¢1, Û˘ÁÎÚÈÙÈÎ¿ ÌÂ ÙËÓ ÂÌÊ¿ÓÈÛË ÏÈÁfiÙÂÚˆÓ·fi ‰‡Ô ÏÔÈÌÒÍÂˆÓ ÙÔÓ ̄ ÚfiÓÔ (¶›Ó·Î·˜ 2, OR=0,20,p<0,001). ∏ ·Ú·¿Óˆ Û˘Û¯¤ÙÈÛË ·Ú¤ÌÂÈÓÂ ÛËÌ·-ÓÙÈÎ‹ Î·È ÛÙÈ˜ ÂÈÌ¤ÚÔ˘˜ ÎÔÈÓˆÓÈÎ¤˜ Ù¿ÍÂÈ˜.

√ ÂÌ‚ÔÏÈ·ÛÌfi˜ ÌÂ MMR Â›ÛË˜ ·Ô‰Â›¯ıËÎÂfiÙÈ ‰Ú· ÚÔÛÙ·ÙÂ˘ÙÈÎ¿ ¤Ó·ÓÙÈ ÙË˜ ÂÎ‰‹ÏˆÛË˜ ™¢1,ÙfiÛÔ ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ ·È‰ÈÒÓ (¶›Ó·Î·˜ 2, OR=0,05,p<0,001) fiÛÔ Î·È ÛÙÈ˜ ÂÈÌ¤ÚÔ˘˜ ÎÔÈÓˆÓÈÎ¤˜ Ù¿ÍÂÈ˜.∆· ·È‰È¿ ÌÂ ™¢1 ÂÌ‚ÔÏÈ¿ÛıËÎ·Ó ÌÂ MMR ÛÂ ÛË-Ì·ÓÙÈÎ¿ ÌÂÁ·Ï‡ÙÂÚË ËÏÈÎ›· Û˘ÁÎÚÈÙÈÎ¿ ÌÂ ÙÔ˘˜Ì¿ÚÙ˘ÚÂ˜ (¶›Ó·Î·˜ 2, OR=1,59, p=0,046). ∏ ‰È·ÊÔ-Ú¿ ·˘Ù‹ ‰ÂÓ ‹Ù·Ó ÛËÌ·ÓÙÈÎ‹ ÛÙÈ˜ ÂÈÌ¤ÚÔ˘˜ ÎÔÈÓˆ-ÓÈÎ¤˜ Ù¿ÍÂÈ˜.

∏ ÂÌÊ¿ÓÈÛË ·ÏÏÂÚÁÈÎÒÓ ·ÓÙÈ‰Ú¿ÛÂˆÓ ÁÂÓÈÎ¿‰ÚÔ‡ÛÂ ÚÔÛÙ·ÙÂ˘ÙÈÎ¿ ÛÙËÓ ÂÎ‰‹ÏˆÛË ÙÔ˘ ™¢1(OR=0,06, p<0,001)(¶›Ó·Î·˜ 2). ∏ Û˘Û¯¤ÙÈÛË ·˘Ù‹‰ÂÓ ‰È·ÊÔÚÔÔÈ‹ıËÎÂ ÛÙÈ˜ ÂÈÌ¤ÚÔ˘˜ ÎÔÈÓˆÓÈÎ¤˜Ù¿ÍÂÈ˜ (Î·ÙÒÙÂÚË: OR=0,08, p=0,06, ·ÓÒÙÂÚË Î·ÈÌ¤ÛË Ù¿ÍË: OR=0,05, p<0,001).

¢. ∞Ó¿Ï˘ÛË ÔÏÏ·Ï‹˜ ÏÔÁÈÛÙÈÎ‹˜

·ÏÈÓ‰ÚfiÌËÛË˜

™ÙÔ ÌÔÓÙ¤ÏÔ ÔÏÏ·Ï‹˜ ÏÔÁÈÛÙÈÎ‹˜ ·ÏÈÓ‰Úfi-ÌËÛË˜ Û˘ÌÌÂÙÂ›¯·Ó ÔÈ ·ÎfiÏÔ˘ıÂ˜ ·Ú¿ÌÂÙÚÔÈ Ô˘Û¯ÂÙ›˙ÔÓÙ·Ó ÛËÌ·ÓÙÈÎ¿ ÌÂ ÙËÓ ÂÎ‰‹ÏˆÛË ÙÔ˘ ™¢1Î·Ù¿ ÙËÓ ÌÔÓÔ·Ú·ÁÔÓÙÈÎ‹ ·Ó¿Ï˘ÛË (Û˘¯ÓfiÙËÙ·ÙˆÓ ÈÔÁÂÓÒÓ ÏÔÈÌÒÍÂˆÓ Î·È ÂÚ›Ô‰Ô˜ ˙ˆ‹˜ Ô˘ ¤ÁÈ-ÓÂ Ë ÚÒÙË ¤ÎıÂÛË ÛÂ ·˘Ù¤˜, Û˘¯ÓfiÙËÙ· ÙÔ˘ ÂÌ‚Ô-ÏÈ·ÛÌÔ‡ ÌÂ MMR, ÌËÙÚÈÎfi˜ ıËÏ·ÛÌfi˜ Î·È ÎÔÈÓˆÓÈ-Î‹ Ù¿ÍË) (¶›Ó·Î·˜ 3), ÌÂ ÛÎÔfi Ó· ÌÂÏÂÙËıÂ› Ë ·Ï-ÏËÏÂ›‰Ú·Û‹ ÙÔ˘˜ ÛÙËÓ ÂÎ‰‹ÏˆÛË ÙÔ˘ ™¢1. ∏ Ô-Ï˘·Ú·ÁÔÓÙÈÎ‹ ·Ó¿Ï˘ÛË ÂÈ‚Â‚·›ˆÛÂ ÙÔÓ ÚÔÛÙ·-ÙÂ˘ÙÈÎfi ÚfiÏÔ ÙË˜ ·ÚÔ˘Û›·˜ ·ÏÏÂÚÁÈÎÒÓ ·ÓÙÈ‰Ú¿ÛÂ-ˆÓ ÛÙËÓ ÂÎ‰‹ÏˆÛË ÙÔ˘ ™¢1 (OR=0,10, 95% CI:(0,03, 0,40)). ∂›ÛË˜, Ë ·ÚÔ˘Û›· ÈÔÁÂÓÒÓ ÏÔÈÌÒÍÂ-ˆÓ, Â›ÙÂ Î·Ù¿ Ù· ‰‡Ô ÚÒÙ· ¯ÚfiÓÈ· ˙ˆ‹˜ (OR=0,08,95% CI: (0,01, 0,93)), Â›ÙÂ ·ÚÁfiÙÂÚ· (OR=0,07, 95%CI: (0,07, 0,70)) ‰È·‰Ú·Ì·Ù›˙ÂÈ ÚÔÛÙ·ÙÂ˘ÙÈÎfi ÚfiÏÔÛÙËÓ ÂÎ‰‹ÏˆÛË ÙÔ˘ ™¢1. ∂ÈÚfiÛıÂÙ·, Ë ÂÎ‰‹ÏˆÛË‰‡Ô ‹ ÂÚÈÛÛfiÙÂÚˆÓ ÏÔÈÌÒÍÂˆÓ/¯ÚfiÓÔ Û¯ÂÙ›˙ÂÙ·ÈÌÂ ÌÂÈˆÌ¤ÓÔ Î›Ó‰˘ÓÔ ÂÎ‰‹ÏˆÛË˜ ™¢1, Û˘ÁÎÚÈÙÈÎ¿ ÌÂÙËÓ ÂÎ‰‹ÏˆÛË ÏÈÁfiÙÂÚˆÓ ·fi ‰‡Ô ÏÔÈÌÒÍÂˆÓ ÙÔÓ¯ÚfiÓÔ (OR=0,11, 95% CI: (0,02, 0,50)). ∂›ÛË˜, Ù··È‰È¿ ÙË˜ Î·ÙÒÙÂÚË˜ ÎÔÈÓˆÓÈÎ‹˜ Ù¿ÍË˜ ÂÌÊ·Ó›˙Ô˘ÓÌÂÁ·Ï‡ÙÂÚÔ Î›Ó‰˘ÓÔ ÂÎ‰‹ÏˆÛË˜ ™¢1, Û˘ÁÎÚÈÓfiÌÂÓ·

296 ∫. ∫·Ú·‚·Ó¿ÎË Î·È Û˘Ó.


¶›Ó·Î·˜ 2. ªÔÓÔ·Ú·ÁÔÓÙÈÎ‹ ·Ó¿Ï˘ÛË: Ë Â›‰Ú·ÛË ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡, ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ ·ÓÙÈ‰Ú¿ÛÂˆÓ, ÙˆÓ ÈÔÁÂÓÒÓ ÏÔÈÌÒÍÂˆÓ Î·ÈÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÌÂ MMR ÛÙËÓ ÂÎ‰‹ÏˆÛË ÙÔ˘ ™¢1

N (ÂÚÈÙÒÛÂÈ˜ / ¶·È‰È¿ ÌÂ ª¿ÚÙ˘ÚÂ˜ OR p-valueÌ¿ÚÙ˘ÚÂ˜) ‰È·‚‹ÙË (%) (%) (95% CI)

ªËÙÚÈÎfi˜ ıËÏ·ÛÌfi˜ªËÙÚÈÎfi˜ ıËÏ·ÛÌfi˜ 103/150 53 (51,46) 105 (70,00) 0,45 (0,27, 0,77) 0,003¢È¿ÚÎÂÈ· ÌËÙÚÈÎÔ‡ 96/140 0 (0, 8) 1 (0, 8) 0,89 (0,79, 0,99)** 0,032ıËÏ·ÛÌÔ‡ (ÛÂ Ì‹ÓÂ˜)*

§ÔÈÌÒÍÂÈ˜§ÔÈÌÒÍÂÈ˜ 106/99 57 (53,77) 69 (69,70) 0,51 (0,28, 0,91) 0,020

∂›‰Ô˜ ÏÔÈÌÒÍÂˆÓπÔÁÂÓÂ›˜ 106/99 49 (46,23) 64 (64,65) 0,47 (0,26, 0,85) 0,011µ·ÎÙËÚÈ·Î¤˜ 8 (7,55) 5 (5,05) 0,98 (0,29, 3,29) 0,973

¶ÂÚ›Ô‰Ô˜ ÙË˜ ˙ˆ‹˜ ÌÂ ÙËÓ ÚÒÙË ¤ÎıÂÛË ÛÙÈ˜ ÏÔÈÌÒÍÂÈ˜¶ÚÒÙ· 2 ¤ÙË ˙ˆ‹˜

106/9917 (16,04) 28 (28,28) 0,33 (0,14, 0,75) 0,005

∞ÚÁfiÙÂÚ· 48 (45,28) 49 (49,49) 0,53 (0,27, 1,02) 0,053

™˘¯ÓfiÙËÙ· ÏÔÈÌÒÍÂˆÓ(2 ÊÔÚ¤˜ / ¤ÙÔ˜) ¤Ó·ÓÙÈ(< 2 ÊÔÚ¤˜/ ¤ÙÔ˜) 75/94 15 (20,00) 52 (55,32) 0,20 (0,10, 0,43) <0,001

∂Ì‚ÔÏÈ·ÛÌfi˜∂Ì‚ÔÏÈ·ÛÌfi˜ ÌÂ MMR 106/97 51 (48,11) 92 (94,85) 0,05 (0,02, 0,16) <0,001∏ÏÈÎ›· ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÌÂ MMR* 51/92 1,5 (1,0, 4,0) 1.3 (1,2, 3,9) 1,59 (1,01, 2,50)** 0,046

∞ÏÏÂÚÁÈÎ¤˜ ·ÓÙÈ‰Ú¿ÛÂÈ˜∞ÏÏÂÚÁ›Â˜ 90/36 34 (37,38) 33 (91,67) 0,06 (0,01, 0,23) <0,001

* Œ¯Ô˘Ó ·Ó·ÊÂÚıÂ› ÔÈ ‰È¿ÌÂÛÂ˜ ÙÈÌ¤˜ Î·È Ù· ·ÓÙ›ÛÙÔÈ¯· ÂÓ‰ÔÙÂÙ·ÚÙËÌÔÚÈ·Î¿ Â‡ÚË. ** OR Î·Ù¿ ÌÈ· ÌÔÓ¿‰· ·˘Í¿ÓÂÙ·È ÛÙËÓ “¤ÎıÂÛË”.


ÌÂ ÂÎÂ›Ó· ÙË˜ Ì¤ÛË˜ Î·È ·ÓÒÙÂÚË˜ ÎÔÈÓˆÓÈÎ‹˜ Ù¿-

ÍË˜ (OR = 0,16, 95% CI: (0,03, 0,80)). ™ÙËÓ ·Ó¿Ï˘ÛË

ÙË˜ ÔÏÏ·Ï‹˜ ÏÔÁÈÛÙÈÎ‹˜ ·ÏÈÓ‰ÚfiÌËÛË˜, Ë Â›-

‰Ú·ÛË ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡ Î·È ÙÔ˘ ÂÌ‚ÔÏÈ·-

ÛÌÔ‡ ÌÂ MMR ‰ÂÓ Û˘Ó¤‚·Ï·Ó ÛËÌ·ÓÙÈÎ¿ ÛÙËÓ ÂÌ-

Ê¿ÓÈÛË ÙÔ˘ ™¢1.

™˘˙‹ÙËÛË

∏ ·ÚÔ‡Û· ÌÂÏ¤ÙË ·ÚÔ˘ÛÈ¿˙ÂÈ ÛÙÔÈ¯Â›· Û¯ÂÙÈ-

Î¿ ÌÂ ÙÔÓ ÚfiÏÔ ÙˆÓ ÈÔÁÂÓÒÓ ÏÔÈÌÒÍÂˆÓ, ÙÔ˘ ÂÌ‚Ô-

ÏÈ·ÛÌÔ‡ ÌÂ ̇ ÒÓÙÂ˜ ÂÍ·ÛıÂÓËÌ¤ÓÔ˘˜ ÈÔ‡˜, ÙÔ˘ ÌËÙÚÈ-

ÎÔ‡ ıËÏ·ÛÌÔ‡ Î·È ÙË˜ ·ÚÔ˘Û›·˜ ·ÏÏÂÚÁÈÒÓ ÛÙËÓ

·ıÔÁ¤ÓÂÈ· ÙÔ˘ ™¢1.

∞fi ÙÔ˘˜ ÂÚÈ‚·ÏÏÔÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜, ÔÚÈ-

ÛÌ¤ÓÔÈ ÈÔ› (Coxsackie, Echo, Rota, CMV, ∂Ú˘ıÚ¿˜

Î·È ¶·ÚˆÙ›ÙÈ‰·˜) ¤¯ÂÈ ıÂˆÚËıÂ› fiÙÈ Û˘Ì‚¿ÏÏÔ˘Ó

ÛÙËÓ ·ıÔÁ¤ÓÂÈ· ÙÔ˘ ™¢1 (11,12). ªÂÚÈÎ¤˜ ÌÂÏ¤ÙÂ˜

˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ ÔÈ ÈÔÁÂÓÂ›˜ ÏÔÈÌÒÍÂÈ˜ ·ÔÙÂÏÔ‡Ó

Èı·ÓÔ‡˜ ·ÈÙÈÔÏÔÁÈÎÔ‡˜ ‹ ÂÈÙ·¯˘ÓÙÈÎÔ‡˜ ·Ú¿ÁÔ-

ÓÙÂ˜ ÂÌÊ¿ÓÈÛË˜ ÙÔ˘ ™¢1 (13,14). ∞ÓÙ›ıÂÙ·, Ë ˘fiıÂ-

ÛË ÙË˜ ˘ÁÈÂÈÓ‹˜ (5) ˘ÔÛÙËÚ›˙ÂÈ fiÙÈ ÙÔ ˘„ËÏfi ‚ÈÔÙÈ-

Îfi Â›Â‰Ô Û˘Û¯ÂÙ›˙ÂÙ·È ÌÂ ÌÂÈˆÌ¤ÓË ¤ÎıÂÛË ÛÂ ÌÈ-

ÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜ Î·È ÌÂ ·˘ÍËÌ¤ÓÔ Î›Ó‰˘ÓÔ ÂÎ‰‹Ïˆ-

ÛË˜ ·ÏÏÂÚÁÈÒÓ Î·È ·˘ÙÔ¿ÓÔÛˆÓ ÓÔÛËÌ¿ÙˆÓ ÛÙËÓ

·È‰ÈÎ‹ ËÏÈÎ›·. ∂›ÛË˜, Ë ıÂˆÚ›· ·˘Ù‹ ˘ÔÛÙËÚ›˙ÂÈ

ˆ˜ Ô ÌÂÈˆÌ¤ÓÔ˜ ·ÓÔÛÔÏÔÁÈÎfi˜ ÂÚÂıÈÛÌfi˜ ÙÔ˘ ·Ó·-

Ù˘ÛÛfiÌÂÓÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ (È‰È·›ÙÂ-

Ú· Î·Ù¿ Ù· ‰‡Ô ÚÒÙ· ¯ÚfiÓÈ· ˙ˆ‹˜), ÙÔ Î¿ÓÂÈ ÈÔ

Â˘¿ÏˆÙÔ ÛÙË ÌÂÙ¤ÂÈÙ· ¤ÎıÂÛË ÛÙÔ˘˜ ÏÔÈÌÔÁfiÓÔ˘˜

·Ú¿ÁÔÓÙÂ˜, ÁÂÁÔÓfi˜ Ô˘ ÂÓ‰Â¯ÔÌ¤Óˆ˜ ÂÈÛÂ‡‰ÂÈ

ÙËÓ ÂÌÊ¿ÓÈÛË ™¢1 Î·È ·ÏÏÂÚÁÈÒÓ (15,16). ¶Ú¿ÁÌ·ÙÈ,

Ù· ·È‰È¿ ÌÂ ‰È·‚‹ÙË ÙË˜ ÌÂÏ¤ÙË˜ Ì·˜ ÂÌÊ¿ÓÈ˙·Ó ÏÈ-

ÁfiÙÂÚÔ Û˘¯Ó¿ ÎÔÈÓ¤˜ ÈÔÁÂÓÂ›˜ ÏÔÈÌÒÍÂÈ˜ Û˘ÁÎÚÈÙÈÎ¿

ÌÂ ÙÔ˘˜ Ì¿ÚÙ˘ÚÂ˜, È‰È·›ÙÂÚ· Î·Ù¿ Ù· ‰‡Ô ÚÒÙ·

¯ÚfiÓÈ· ˙ˆ‹˜ Î·È ÙÔ ÁÂÁÔÓfi˜ ·˘Ùfi ‹Ù·Ó ÈÔ ¤Î‰ËÏÔ

ÛÙÈ˜ Î·ÙÒÙÂÚÂ˜ ÎÔÈÓˆÓÈÎ¤˜ Ù¿ÍÂÈ˜.

¶ÔÈÎ›Ï· ‰Â‰ÔÌ¤Ó· ˘Ê›ÛÙ·ÓÙ·È ÁÈ· ÙË Û˘Û¯¤ÙÈÛË

ÙˆÓ ÂÌ‚ÔÏ›ˆÓ Î·È ÙË˜ ÂÎ‰‹ÏˆÛË˜ ™¢1 ÛÙ· ·È‰È¿.

¶ÚfiÛÊ·ÙÂ˜ ÌÂÏ¤ÙÂ˜ (17,18) ıÂˆÚÔ‡Ó ÙÔÓ ÂÌ‚ÔÏÈ·-

ÛÌfi ÌÂ MMR ˆ˜ ÚÔÛÙ·ÙÂ˘ÙÈÎfi ·Ú¿ÁÔÓÙ· ¤Ó·ÓÙÈ

ÏÔÈÌÒÍÂˆÓ Ô˘ Èı·ÓfiÓ Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÙËÓ ÂÎ‰‹Ïˆ-

ÛË ™¢1. ™ÙË ÌÂÏ¤ÙË Ì·˜, ÛÙ· ·È‰È¿ ÌÂ ‰È·‚‹ÙË ‰È·-

ÈÛÙÒıËÎÂ ÌÂÈˆÌ¤ÓË Û˘¯ÓfiÙËÙ· ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÌÂ

MMR Î·È ÌÂÁ·Ï‡ÙÂÚË ËÏÈÎ›· ÂÌ‚ÔÏÈ·ÛÌÔ‡, Û˘ÁÎÚÈ-

ÙÈÎ¿ ÌÂ ÙÔ˘˜ Ì¿ÚÙ˘ÚÂ˜. ∆· ‰Â‰ÔÌ¤Ó· ·˘Ù¿ Èı·ÓfiÓ

˘Ô‰ËÏÒÓÔ˘Ó fiÙÈ Ë ÌÂÈˆÌ¤ÓË ‹ Î·È Î·ı˘ÛÙÂÚËÌ¤ÓË

‰È¤ÁÂÚÛË ÙÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÚÔ‰È·-

ı¤ÙÂÈ ÛÙËÓ ÂÎ‰‹ÏˆÛË ÙÔ˘ ™¢1 Î·È Û˘ÌÊˆÓÔ‡Ó ÌÂ

ÙËÓ ˘fiıÂÛË ÙË˜ ˘ÁÈÂÈÓ‹˜ (5,19).

∏ Û¯¤ÛË ÌÂÙ·Í‡ ·ÙÔ›·˜ Î·È ·˘ÙÔ·ÓÔÛ›·˜ Â›Ó·È

·ÌÊÈÏÂÁfiÌÂÓË. ∫·Ù¿ ÙËÓ ıÂˆÚ›· ÙÔ˘ Th1/Th2 ·Ú·-

‰Â›ÁÌ·ÙÔ˜ (20,21), Ù· ∆2 ‚ÔËıËÙÈÎ¿ ÏÂÌÊÔÎ‡ÙÙ·Ú·

(∆h2) Â˘Ô‰ÒÓÔ˘Ó ÙËÓ ·Ú·ÁˆÁ‹ IgE ·ÓÔÛÔÛÊ·ÈÚÈ-

ÓÒÓ, Ì¤Ûˆ ÙË˜ ·ÂÏÂ˘ı¤ÚˆÛË˜ Î˘ÙÙ·ÚÔÎÈÓÒÓ, ÂÓÒ Ù·

∆1 ‚ÔËıËÙÈÎ¿ ÏÂÌÊÔÎ‡ÙÙ·Ú· (Th1) ÙËÓ ÂÚÈÔÚ›˙Ô˘Ó

Î·È ÚÔ¿ÁÔ˘Ó ÙËÓ ÂÌÊ¿ÓÈÛË ·˘ÙÔ·ÓfiÛˆÓ ÓÔÛËÌ¿ÙˆÓ,

fiˆ˜ Ô ™¢1 (22). ∫·Ù¿ Û˘Ó¤ÂÈ·, ÛÂ ÂÚÈÙÒÛÂÈ˜ ·˘-

ÙÔ¿ÓÔÛˆÓ ·ı‹ÛÂˆÓ, Ë Û˘¯ÓfiÙËÙ· ÙˆÓ ∆h2 ·ÏÏÂÚÁÈ-

ÎÒÓ ·ı‹ÛÂˆÓ Â›Ó·È ÌÂÈˆÌ¤ÓË. ¶Ú¿ÁÌ·ÙÈ, ¤¯ÂÈ ·Ó·-

ÊÂÚıÂ› fiÙÈ Ù· ·È‰È¿ ÌÂ ™¢1 ÂÌÊ·Ó›˙Ô˘Ó ÌÂÈˆÌ¤ÓÔ

Î›Ó‰˘ÓÔ ÁÈ· ÂÎ‰‹ÏˆÛË ·ÙÔÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ (8) Î·È

Ù· ·È‰È¿ ÌÂ ·ÙÔÈÎfi ¤Î˙ÂÌ· ¤¯Ô˘Ó ÌÂÈˆÌ¤ÓÔ Î›Ó‰˘-

ÓÔ ÁÈ· ÂÎ‰‹ÏˆÛË ™¢1, ÁÂÁÔÓfi˜ Ô˘ ‰Â›¯ÓÂÈ fiÙÈ Ô Ù‡-

Ô˜ ·˘Ùfi˜ ÙË˜ ·ÙÔÈÎ‹˜ ·ÓÙ›‰Ú·ÛË˜ ›Ûˆ˜ ·Ú¤¯ÂÈ ÌÂ-

ÚÈÎ‹ ÚÔÛÙ·Û›· ¤Ó·ÓÙÈ ÙÔ˘ ™¢1 (23). ∆· Â˘Ú‹Ì·Ù·

ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ Û˘ÌÊˆÓÔ‡Ó ÌÂ ÙÈ˜ ·Ú·¿Óˆ

ÌÂÏ¤ÙÂ˜, ·ÊÔ‡ ‰È·ÈÛÙÒÛ·ÌÂ ÌÂÈˆÌ¤ÓË Û˘¯ÓfiÙËÙ·

·ÏÏÂÚÁÈÒÓ ÛÂ ·È‰È¿ ÌÂ ™¢1, Û˘ÁÎÚÈÙÈÎ¿ ÌÂ ÙÔ˘˜ Ì¿Ú-

Ù˘ÚÂ˜. ∞ÓÙ›ıÂÙ·, ¿ÏÏÂ˜ ÌÂÏ¤ÙÂ˜ (24) ·Ó·Ê¤ÚÔ˘Ó fiÙÈ Ë

Û˘¯ÓfiÙËÙ· ÙÔ˘ ¿ÛıÌ·ÙÔ˜ ‹Ù·Ó ·˘ÍËÌ¤ÓË ÛÂ ·È‰È¿

ÌÂ ·˘ÙÔ¿ÓÔÛ· ÓÔÛ‹Ì·Ù·, fiˆ˜ Ô ™¢1 Î·È Ë ÎÔÈÏÈÔÎ¿-

ÎË, ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÂÎÂ›ÓË ÛÙ· Ê˘ÛÈÔÏÔÁÈÎ¿ ·È‰È¿.

™ÙÈ˜ ·ÓÙÈÎÚÔ˘fiÌÂÓÂ˜ ·fi„ÂÈ˜ ¿Óˆ ÛÙÔ ı¤Ì· ÙË˜ È-

ı·Ó‹˜ Û˘Ó‡·ÚÍË˜ ‹ fi¯È ·ÙÔ›·˜ Î·È ·˘ÙÔ·ÓÔÛ›·˜, ÔÈ

Huang Î·È Û˘Ó. (25) ÚÔÙÂ›ÓÔ˘Ó ÙËÓ ÂÚÌËÓÂ›· fiÙÈ Ë

·ÓÔÛÔÏÔÁÈÎ‹ ·¿ÓÙËÛË Ù‡Ô˘ Th2 ·Ú¯›˙ÂÈ ÓˆÚ›˜

ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›·, ÚÔ¿ÁÔÓÙ·˜ ÙËÓ ÂÌÊ¿ÓÈÛË ·Ï-

ÏÂÚÁÈÒÓ Î·È ÛÙ·Ì·Ù¿ ÛÂ Î¿ÔÈ· ̄ ÚÔÓÈÎ‹ ÛÙÈÁÌ‹. ∞ÓÙ›-

ıÂÙ·, Ë Th1 ·¿ÓÙËÛË Â›Ó·È Ì›· Ì·ÎÚ¿ ‰È·‰ÈÎ·Û›·,

Ô˘ ‰È·ÚÎÂ› ·fi Ì‹ÓÂ˜ ¤ˆ˜ Î·È 10 ¯ÚfiÓÈ·, ˆ˜ ÙËÓ

Ï‹ÚË Î·Ù·ÛÙÚÔÊ‹ ÙÔ˘ ÔÚÁ¿ÓÔ˘-ÛÙfi¯Ô˘ (fiˆ˜ Ù· ‚-

Î‡ÙÙ·Ú· ÙÔ˘ ·ÁÎÚ¤·ÙÔ˜). ŸÙ·Ó Ë ‰È·‰ÈÎ·Û›· ·˘Ù‹


¶·È‰È·ÙÚÈÎ‹ 2007;70:293-299

¶›Ó·Î·˜ 3. ∞Ó¿Ï˘ÛË ÙË˜ ÔÏÏ·Ï‹˜ ÏÔÁÈÛÙÈÎ‹˜ ·ÏÈÓ‰ÚfiÌËÛË˜ ̂ ˜ ÚÔ˜ ÙËÓ ·ÏÏËÏÂ›‰Ú·ÛË ‰È·ÊfiÚˆÓ ·Ú·ÁfiÓÙˆÓ ÛÙËÓ ÂÎ‰‹ÏˆÛË ÙÔ˘ ™¢1

OR 95% CI p-value

∞ÏÏÂÚÁÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ 0,10 (0,03, 0,40) 0,001¶ÂÚ›Ô‰Ô˜ ÙË˜ ˙ˆ‹˜ Î·Ù¿ ÙËÓ ÚÒÙË ¤ÎıÂÛË ÛÙÈ˜ ÏÔÈÌÒÍÂÈ˜ ¶ÚÒÙ· 2 ¤ÙË ˙ˆ‹˜ 0,08 (0,01, 0,93) 0,043

∞ÚÁfiÙÂÚ· 0,07 (0,07, 0,70) 0,024™˘¯ÓfiÙËÙ· ÏÔÈÌÒÍÂˆÓ( 2 ÊÔÚ¤˜ / ¤ÙÔ˜ ¤Ó·ÓÙÈ < 2ÊÔÚ¤˜/¤ÙÔ˜) 0,11 (0,02, 0,50) 0,004∫ÔÈÓˆÓÈÎ‹ Ù¿ÍË(Ì¤ÛË & ·ÓÒÙÂÚË ¤Ó·ÓÙÈ Î·ÙÒÙÂÚË˜) 0,16 (0,03, 0,80) 0,026


ÔÏÔÎÏËÚˆıÂ›, ÌÔÚÂ› Ó· ÂÓÂÚÁÔÔÈËıÂ› Ë Th2 ·¿-ÓÙËÛË Ô‰ËÁÒÓÙ·˜ ÛÂ ÂÌÊ¿ÓÈÛË ·ÏÏÂÚÁÈÒÓ.

√ ÚfiÏÔ˜ ÙË˜ ¤Ó·ÚÍË˜ Ï‹„Ë˜ Í¤ÓË˜ ÙÚÔÊ‹˜ ·fi ÙÔ‚Ú¤ÊÔ˜ ˆ˜ ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍËÙÔ˘ ™¢1 ‹ ™¢2 ÛÙË ÌÂÙ¤ÂÈÙ· ˙ˆ‹ Â›Ó·È ·ÌÊÈÏÂÁfiÌÂ-ÓÔ˜ (26). Œ¯ÂÈ ·Ô‰ÂÈ¯ÙÂ› fiÙÈ Ë ̆ ÁÈÂÈÓ‹ Î·È Ë ËÌÈ-·Ô-ÛÙÂÈÚˆÌ¤ÓË ‰È·ÙÚÔÊ‹ Î·Ù¿ ÙËÓ ÚÒÙË ‚ÚÂÊÈÎ‹ ËÏÈ-Î›· (27) ÙÚÔÔÔÈÂ› ÙÔÓ ·ÔÈÎÈÛÌfi ÙÔ˘ ÂÓÙ¤ÚÔ˘ ÌÂ‚·ÎÙËÚ›‰È· Î·È ÚÔÛÙ·ÙÂ‡ÂÈ ·fi ÙËÓ ÂÌÊ¿ÓÈÛË ·Ï-ÏÂÚÁÈÒÓ Î·È ·˘ÙÔ·ÓÔÛ›·˜. ∞ÓÙ›ıÂÙ·, Ë ÚÒÈÌË ¤ÎıÂ-ÛË ÛÙÈ˜ ÚˆÙÂ˝ÓÂ˜ ÙÔ˘ Á¿Ï·ÙÔ˜ ·ÁÂÏ¿‰·˜ (1) Î·È ÛÙ·‰ËÌËÙÚÈ·Î¿, Î·ıÒ˜ Î·È ÙÔ ·˘ÍËÌ¤ÓÔ ‚¿ÚÔ˜ Î·Ù¿ ÙË‚ÚÂÊÈÎ‹ ËÏÈÎ›· (6) ¤¯Ô˘Ó ÂÓÔ¯ÔÔÈËıÂ› ˆ˜ ·Ú¿ÁÔ-ÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ™¢1. ∂ÔÌ¤Óˆ˜, Èı·ÓÔÏÔÁÂ›Ù·ÈfiÙÈ Â›Ó·È ‰˘Ó·Ùfi Ó· “ÂÏ¤ÁÍÔ˘ÌÂ”, Ì¤Ûˆ ÙË˜ ‰È·ÙÚÔÊÈ-Î‹˜ ·Ú¤Ì‚·ÛË˜, ÙËÓ ·˘ÙÔ·ÓÔÛ›· ¤Ó·ÓÙÈ ÙˆÓ ‚-Î˘Ù-Ù¿ÚˆÓ, ÌÂ ÙÔÓ ·ÔÎÏÂÈÛÙÈÎfi Î·È ·Ú·ÙÂÙ·Ì¤ÓÔ ÌË-ÙÚÈÎfi ıËÏ·ÛÌfi (28). ∏ ÚÔÛÙ·ÙÂ˘ÙÈÎ‹ ‰Ú¿ÛË ÙÔ˘ıËÏ·ÛÌÔ‡ ÛÙËÓ ÂÌÊ¿ÓÈÛË ÙÔ˘ ™¢1 ¤¯ÂÈ ·Ô‰ÂÈ¯ıÂ›Î·È ÛÙË ÌÂÏ¤ÙË Ì·˜ ÛÙ· ·È‰È¿ ÌÂ ‰È·‚‹ÙË, Î·È È‰È·›-ÙÂÚ· ÛÂ ÂÎÂ›Ó· ÙˆÓ ·ÓÒÙÂÚˆÓ ÎÔÈÓˆÓÈÎÒÓ Ù¿ÍÂˆÓ.

ø˜ ÌÂÈÔÓ¤ÎÙËÌ· ÙË˜ ÌÂÏ¤ÙË˜ Ì·˜ ÌÔÚÂ› Ó· ıÂ-ˆÚËıÂ› fiÙÈ Ë ÔÌ¿‰· ÙˆÓ Ì·ÚÙ‡ÚˆÓ ÂÚÈ¤Ï·‚Â ·È-‰È¿ Ô˘ ÓÔÛËÏÂ‡ıËÎ·Ó ÌÂ ÔÍ‡ ·È‰È·ÙÚÈÎfi Úfi‚ÏË-Ì· (Á·ÛÙÚÂÓÙÂÚ›ÙÈ‰·). ŸÌˆ˜, ÈÛÙÂ‡Ô˘ÌÂ fiÙÈ Ë ÂÈ-ÏÔÁ‹ ·˘ÙÒÓ ÙˆÓ Ì·ÚÙ‡ÚˆÓ ‰ÂÓ ÂËÚ¤·ÛÂ ÙËÓ ·ÍÈÔ-ÈÛÙ›· ÙÔ˘˜ ÛÙËÓ ·¿ÓÙËÛË ÙÔ˘ ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘ÙË˜ ÌÂÏ¤ÙË˜.

™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, ÛÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË ‰È·È-ÛÙÒıËÎÂ fiÙÈ ÛÂ Ì›· ÔÌ¿‰· ·È‰ÈÒÓ ÌÂ ÚfiÛÊ·Ù·‰È·ÁÓˆÛÌ¤ÓÔ ™¢1, Ë ·ÚÔ˘Û›· Û˘¯ÓÒÓ ÈÔÁÂÓÒÓ ÏÔÈ-ÌÒÍÂˆÓ Î·Ù¿ Ù· 2 ÚÒÙ· ¯ÚfiÓÈ· ˙ˆ‹˜, Ô ÌËÙÚÈÎfi˜ıËÏ·ÛÌfi˜, Ë ·ÚÔ˘Û›· ·ÏÏÂÚÁÈÎÒÓ ·ÓÙÈ‰Ú¿ÛÂˆÓ,Î·ıÒ˜ Î·È Ë ÚÔ¤ÏÂ˘ÛË ·fi ÙÈ˜ ·ÓÒÙÂÚÂ˜ ÎÔÈÓˆÓÈ-Î¤˜ Ù¿ÍÂÈ˜ ‹Ù·Ó ·Ú¿ÁÔÓÙÂ˜ ÚÔÛÙ·ÙÂ˘ÙÈÎÔ› ÛÙËÓÂÌÊ¿ÓÈÛË ™¢1. √È ÎÏÈÓÈÎ¤˜ ·˘Ù¤˜ ·Ú·ÙËÚ‹ÛÂÈ˜Ô‰ËÁÔ‡Ó ÛÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ ÎÔÈÓÔ› ÂÚÈ‚·ÏÏÔÓÙÈ-ÎÔ› ·Ú¿ÁÔÓÙÂ˜ (fiˆ˜ ÌÂÈˆÌ¤ÓÔ˜ ·ÓÔÛÔÏÔÁÈÎfi˜ÂÚÂıÈÛÌfi˜ Î·Ù¿ Ù· ÚÒÙ· ¯ÚfiÓÈ· ˙ˆ‹˜) ÚÔ¿ÁÔ˘ÓÙËÓ ÂÎ‰‹ÏˆÛË ·ÙÔ›·˜ Î·È ·˘ÙÔ·ÓÔÛ›·˜. ŸÌˆ˜, Â›-Ó·È Èı·Ófi Ë ·ÏÏËÏÂ›‰Ú·ÛË ÌÂÙ·Í‡ ÙË˜ Th1 Î·ÈTh2 ·ÓÔÛÔÏÔÁÈÎ‹˜ ·¿ÓÙËÛË˜ Ó· ‰Ú· ÚÔÛÙ·ÙÂ˘ÙÈ-Î¿ ÛÙËÓ ÂÌÊ¿ÓÈÛË ™¢1.


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20. Roep BO. The role of T-cells in the pathogenesis of Type 1diabetes: from cause to cure. Diabetologia 2003;46:305-321.

21. Mallia P, Johnston SL. Respiratory viruses: do they protectfrom or induce asthma? Allergy 2002;57:1118-1129.

22. Offit PA, Hackett CJ. Addressing parents’ concerns: dovaccines cause allergic or autoimmune diseases? Pediatrics2003;111:653-659.

23. Sheikh A, Smeeth L, Hubbard R. There is no evidence ofan inverse relationship between TH2-mediated atopy andTH1-mediated autoimmune disorders: Lack of supportfor the hygiene hypothesis. J Allergy Clin Immunol 2003;111:131-135.

24. ∫ero J, Gissler M, Hemminki E, Isolauri E. Could TH1 and

TH2 diseases coexist? Evaluation of asthma incidence inchildren with coeliac disease, type 1 diabetes or rheuma-toid arthritis: a register study. J Allergy Clin Immunol2001;108:781-783.

25. Huang SW. Is the “hygiene hypothesis” being challenged?J Allergy Clin Immunol 2003;112:461-462.

26. Hummel M, Füchtenbusch M, Schenker M, Ziegler AG. Nomajor association of breast-feeding, vaccinations, andchildhood viral diseases with early islet autoimmunity in theGerman BABYDIAB Study. Diabetes Care 2000;23:969-974.

27. Tedeschi A, Airaghi L. Common risk factors in type 1 dia-betes and asthma. Lancet 2001;357:1622.

28. Akerblom HK, Virtanen SM, Ilonen J, Savilahti E, VaaralaO, Reunanen A, et al. Dietary manipulation of beta cell au-toimmunity in infants at increased risk of type 1 diabetes:a pilot study. Diabetologia 2005;48:829-837.


¶·È‰È·ÙÚÈÎ‹ 2007;70:293-299


300 ∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞ ORIGINAL ARTICLE


∂Î·ÙÔÛÙÈ·›Â˜ ı¤ÛÂÈ˜ ÂÚÈÌ¤ÙÚÔ˘ Ì¤ÛË˜ ·È‰ÈÒÓ ÙË˜ ∫Ú‹ÙË˜

ËÏÈÎ›·˜ 3 ¤ˆ˜ 16 ÂÙÒÓ

∂. §ÈÓ·Ú‰¿ÎË˜, ∫. µ·Ú‰·‚¿˜, ∞. ∫·Ê¿ÙÔ˜

¶ÂÚ›ÏË„Ë

∂ÈÛ·ÁˆÁ‹: ™ÎÔfi˜ ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ ‹Ù·Ó Ô ˘ÔÏÔÁÈÛÌfi˜ ÂÎ·ÙÔÛÙÈ·›ˆÓ ı¤ÛÂˆÓ (∂£) Î·È Ë ‰ËÌÈ-Ô˘ÚÁ›· Î·Ì˘ÏÒÓ ÂÚÈÌ¤ÙÚÔ˘ Ì¤ÛË˜ (¶ª) ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ ÙË˜ ∫Ú‹ÙË˜.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ™ÙË ÌÂÏ¤ÙË Û˘ÌÌÂÙÂ›¯·Ó 5.321 ·È‰È¿ - 2.643 ·ÁfiÚÈ· Î·È 2.678 ÎÔÚ›ÙÛÈ·, ËÏÈÎ›·˜ 2,5-16,5 ÂÙÒÓ, Î·È ‰ÈÂÓÂÚÁ‹ıËÎ·Ó 7.538 ÌÂÙÚ‹ÛÂÈ˜ ¶ª. √È ÌÂÙÚ‹ÛÂÈ˜ ·˘Ù¤˜ ÚÔ¤Ú¯ÔÓÙ·È ·fi ÂÙ¿ ÌÂÏ¤ÙÂ˜Ô˘ ‰ÈÂÍ‹¯ıËÛ·Ó ÌÂÙ·Í‡ 1992-2005 ÛÂ ·ÓÙÈÚÔÛˆÂ˘ÙÈÎ¿ ‰Â›ÁÌ·Ù· ·È‰ÈÒÓ, ·fi ÙËÓ ∫ÏÈÓÈÎ‹ ¶ÚÔÏË-ÙÈÎ‹˜ π·ÙÚÈÎ‹˜ Î·È ¢È·ÙÚÔÊ‹˜, ÙË˜ π·ÙÚÈÎ‹˜ ™¯ÔÏ‹˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹ÙË˜. OÈ ÂÍÔÌ·Ï˘ÛÌ¤ÓÂ˜ ∂£ÙË˜ ¶ª ˘ÔÏÔÁ›ÛÙËÎ·Ó ÌÂ ÙË ¯Ú‹ÛË ÔÏ˘ˆÓ˘ÌÈÎÒÓ ÌÔÓÙ¤ÏˆÓ, ÂÓÒ ¤ÁÈÓÂ Û‡ÁÎÚÈÛË ÙË˜ ¶ª ÙˆÓ ·È‰ÈÒÓÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ ÌÂ ÌÂÙÚ‹ÛÂÈ˜ ¿ÏÏˆÓ ‰ÈÂıÓÒÓ ÌÂÏÂÙÒÓ.

∞ÔÙÂÏ¤ÛÌ·Ù·: ∏ ¶ª ˘ÔÏÔÁ›ÛÙËÎÂ ·Ó¿ Ê‡ÏÔ Î·È ËÏÈÎ›· Î·ıÒ˜ Î·È ÔÈ ÂÍÔÌ·Ï˘ÛÌ¤ÓÂ˜ ∂£: 5Ë, 10Ë, 25Ë,50‹, 75Ë, 85Ë, 90‹ Î·È 95Ë. ™˘ÁÎÚÈÙÈÎ¿, ‚Ú¤ıËÎÂ fiÙÈ Ù· ·È‰È¿ Î·È ÔÈ ¤ÊË‚ÔÈ ÙË˜ ∫Ú‹ÙË˜ ¤¯Ô˘Ó, ÛÙÈ˜ Â-ÚÈÛÛfiÙÂÚÂ˜ ËÏÈÎ›Â˜, ÛËÌ·ÓÙÈÎ¿ ÌÂÁ·Ï‡ÙÂÚË ¶ª ·fi Ù· ·È‰È¿ Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜ ÙË˜ ∫‡ÚÔ˘ Î·È ÙˆÓ∏¶∞ (p<0,05), Î·È ÛÂ fiÏÂ˜ ÙÈ˜ ËÏÈÎ›Â˜ ÛËÌ·ÓÙÈÎ¿ ˘„ËÏfiÙÂÚÂ˜ Ì¤ÛÂ˜ ÙÈÌ¤˜ ·fi Ù· ·È‰È¿ ÙË˜ √ÏÏ·Ó‰›·˜,ÙË˜ ª. µÚÂÙ·Ó›·˜, ÙË˜ ∞˘ÛÙÚ·Ï›·˜ Î·È ÙÔ˘ ∫·Ó·‰¿. øÛÙfiÛÔ, ‰ÂÓ ‰È¤ÊÂÚ·Ó ÛËÌ·ÓÙÈÎ¿ (p>0,05) ÛÙÈ˜ Â-ÚÈÛÛfiÙÂÚÂ˜ ËÏÈÎ›Â˜ ·fi Ù· ·È‰È¿ ÙË˜ πÛ·Ó›·˜, ÂÓÒ ÛÂ fiÏÂ˜ ÙÈ˜ ËÏÈÎ›Â˜ Â›¯·Ó ÛËÌ·ÓÙÈÎ¿ ¯·ÌËÏfiÙÂÚÂ˜ ÙÈ-Ì¤˜ ¶ª (50‹ ∂£) ·fi Ù· ·È‰È¿ ÙË˜ πÙ·Ï›·˜ (p<0,001).

™˘ÌÂÚ¿ÛÌ·Ù·: ∏ ¯Ú‹ÛË ÙˆÓ ∂£ ÙË˜ ¶ª ·ÔÙÂÏÂ› ¯Ú‹ÛÈÌÔ Î·È ·ÍÈfiÈÛÙÔ ÂÚÁ·ÏÂ›Ô ÁÈ· ÁÔÓÂ›˜ Î·È ·È-‰›·ÙÚÔ˘˜, ÂÓÒ Ë ¶ª Î·Ù·‰ÂÈÎÓ‡ÂÈ ÙÔ ÛÔ‚·Úfi Úfi‚ÏËÌ· ÙË˜ ·È‰ÈÎ‹˜ ÎÂÓÙÚÈÎ‹˜ ·¯˘Û·ÚÎ›·˜ ÛÙ· ·È-‰È¿ ÙË˜ ∫Ú‹ÙË˜.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ¶·È‰È¿, ÂÚ›ÌÂÙÚÔ˜ Ì¤ÛË˜, ÎÂÓÙÚÈÎ‹ ·¯˘Û·ÚÎ›·, ÂÎ·ÙÔÛÙÈ·›Â˜ ı¤ÛÂÈ˜.

Waist circumference percentiles of children of Crete aged 3 to 16 years

E. Linardakis, K. Vardavas, A. Kafatos

Abstract

Background: The aim of this study was to estimate percentiles and growth curves of the waistcircumference (WC) in children and adolescents of Crete, Greece.

Methods: WC measurements were recorded for 5,321 subjects, 2,643 boys and 2,678 girls, aged 2.5 to16.5 years, on whom a total of 7,538 were made. These measurements were derived from seven studiesconducted between 1992 and 2005, on representative samples of children and adolescents in Crete, bythe Preventive Medicine and Nutrition Clinic of the University of Crete. Smoothed percentiles of WC wereestimated using polynomial models. The WC distribution was compared with that reported in othercountries.

Results: The age-sex specific descriptive characteristics and the smoothed percentiles of the 5th, 10th,25th, 50th, 75th, 85th, 90th and 95th place were estimated. The mean WC of children and adolescents inthis study in most age groups was found to be higher than that of children from Cyprus and the U.S(p<0.05) and higher in all age groups than that of children from the Netherlands, the U.K, Australia andCanada. The WC of the Cretan children did not differ significantly from that of Spanish children in mostage groups but was lower (50th percentiles) in all age groups compared to Italian children (p<0.001).

Conclusions: WC percentiles can be a useful and reliable tool for use by parents and paediatricians. Theuse of WC percentiles confirms that childhood central obesity is a major health problem in Crete.

Key words: Children, waist circumference, central obesity, percentiles.

¶·ÓÂÈÛÙ‹ÌÈÔ ∫Ú‹ÙË˜,∆Ì‹Ì· π·ÙÚÈÎ‹˜,∆ÔÌ¤·˜ ∫ÔÈÓˆÓÈÎ‹˜ π·ÙÚÈÎ‹˜,∫ÏÈÓÈÎ‹ ¶ÚÔÏËÙÈÎ‹˜π·ÙÚÈÎ‹˜ Î·È ¢È·ÙÚÔÊ‹˜,∏Ú¿ÎÏÂÈÔ ∫Ú‹ÙË˜


EÌÌ·ÓÔ˘‹Ï §ÈÓ·Ú‰¿ÎË˜[email protected]¢È·ÛÙ·‡ÚˆÛË µÔ‡ÙÂ˜ –™Ù·˘Ú¿ÎÈ·∆.∫. 71 003, ∆.£. 2208 ∏Ú¿ÎÏÂÈÔ ∫Ú‹ÙË˜

University of Crete, Facultyof MedicineDepartment of SocialMedicine, Division ofPreventive Medicine andNutrition, Heraklion, Crete,Greece

Correspondence:

Emmanouil [email protected] Junction71 003, PO Box.: 2208 Heraklion, Crete, Greece


¶M ¶ÂÚ›ÌÂÙÚÔ˜ ª¤ÛË˜

∂£ ∂Î·ÙÔÛÙÈ·›· £¤ÛË

¢ª™ ¢Â›ÎÙË˜ ª¿˙·˜ ™ÒÌ·ÙÔ˜

IOTF International Obesity Task Force


∂ÈÛ·ÁˆÁ‹

∏ ¤Ó·ÚÍË ÙË˜ ÂÈ‰ËÌÈÎ‹˜ ¤Í·ÚÛË˜ ÙË˜ ·¯˘-

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‰Â›ÎÙÂ˜ Ì¤ÙÚËÛË˜ ÙË˜ ·¯˘Û·ÚÎ›·˜ Î·È ¯ÚËÛÈÌÔ-

ÔÈËıÂ› ÙfiÛÔ ÁÈ· ÙËÓ Î·Ù·ÁÚ·Ê‹ ÙË˜ fiÛÔ Î·È ÁÈ· ÙË

‰È·¯ÚÔÓÈÎ‹ Î·È ‰È·ÔÏÈÙÈÛÌÈÎ‹ Û‡ÁÎÚÈÛË ÙÔ˘ Ê·È-

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‰Â›ÍÂÈ ÙÔÓ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÙË˜ Ì¤ÙÚËÛË˜ ÙË˜ ÂÚÈ-

Ì¤ÙÚÔ˘ Ì¤ÛË˜ (¶ª) ˆ˜ ‰Â›ÎÙË ÎÂÓÙÚÈÎ‹˜ ·¯˘Û·Ú-

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ı˘ÛÌfi (3-11).

∏ Ì¤ÙÚËÛË ÙË˜ ¶ª ÛÂ ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ ·Ô-

ÙÂÏÂ› ·ÍÈfiÈÛÙÔ ÚÔÁÓˆÛÙÈÎfi ‰Â›ÎÙË, ÛÂ Û˘Ó‰˘·ÛÌfi

ÌÂ ¿ÏÏÔ˘˜ ·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘, ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË

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¯ÚfiÓÈˆÓ ÓÔÛËÌ¿ÙˆÓ (3-6). ∏ ¶ª ·È‰ÈÒÓ Î·È ÂÓË-

Ï›ÎˆÓ ·ÔÙÂÏÂ› Â›ÛË˜ Ì›· ·fi ÙÈ˜ ¤ÓÙÂ Û˘ÓÈÛÙÒ-

ÛÂ˜ ÙÔ˘ ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ (6-11). ∏ ·˘ÍËÌ¤-

ÓË ÂÓ·fiıÂÛË ÎÔÈÏÈ·ÎÔ‡ Ï›Ô˘˜ Û˘ÓÔ‰Â‡ÂÙ·È ·fi

·˘ÍËÌ¤ÓË ·ÓÙ›ÛÙ·ÛË ÛÙË ‰Ú¿ÛË ÙË˜ ÈÓÛÔ˘Ï›ÓË˜ Î·È

·˘ÍËÌ¤ÓÔ Î›Ó‰˘ÓÔ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË Û·Î¯·ÚÒ‰Ë

‰È·‚‹ÙË Ù‡Ô˘ 2. ∏ Û‡ÓıÂÛË Â›ÛË˜ ÙÔ˘ ÎÔÈÏÈ·ÎÔ‡

Ï›Ô˘˜ ÛÂ ÏÈ·Ú¿ ÔÍ¤· Â›Ó·È ‰˘ÛÌÂÓ¤ÛÙÂÚË ¤Ó·ÓÙÈ

ÙÔ˘ ÁÏÔ˘ÙÈ·›Ô˘ (5).

∏ Ì¤ÙÚËÛË ÙË˜ ¶ª ˆ˜ ‰Â›ÎÙË ÎÂÓÙÚÈÎ‹˜ ·¯˘-

Û·ÚÎ›·˜ Â›Ó·È ·Ï‹, Ë Èı·ÓfiÙËÙ· ÛÊ¿ÏÌ·ÙÔ˜ ÛÙË

‰È·‰ÈÎ·Û›· Ì¤ÙÚËÛË˜ ÌÈÎÚ‹ Î·È Ë Î·ıÈ¤ÚˆÛ‹ ÙË˜

ÛÙËÓ Î·ıËÌÂÚÈÓ‹ ·È‰È·ÙÚÈÎ‹ ÎÏÈÓÈÎ‹ ÂÍ¤Ù·ÛË Ê·›-

ÓÂÙ·È ÂÈ‚Â‚ÏËÌ¤ÓË.

∏ ·ÚÔ‡Û· ÌÂÏ¤ÙË ÛÙÔ¯Â‡ÂÈ ÛÙÔ Ó· Ù·ÍÈÓÔÌ‹ÛÂÈ

·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ ÛÂ ÂÎ·ÙÔÛÙÈ·›Â˜ ı¤ÛÂÈ˜ (∂£),

ÒÛÙÂ Ó· ˘¿Ú¯ÂÈ ¤Ó· Ì¤ÙÚÔ Û‡ÁÎÚÈÛË˜ ÛÙËÓ Î·ıËÌÂ-

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ÔÏ·ÛÌÔ‡ ÙË˜ ÎÂÓÙÚÈÎ‹˜ ·¯˘Û·ÚÎ›·˜.


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∏ ÌÂÏ¤ÙË Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ ÛÂ ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ ÙË˜

∫Ú‹ÙË˜ Ô˘ Û˘ÌÌÂÙÂ›¯·Ó ÛÂ ÌÂÏ¤ÙÂ˜ ÙË˜ ∫ÏÈÓÈÎ‹˜ ¶ÚÔÏË-

ÙÈÎ‹˜ π·ÙÚÈÎ‹˜ Î·È ¢È·ÙÚÔÊ‹˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹ÙË˜.

∏ ∫Ú‹ÙË ‰È·ÈÚÂ›Ù·È ÛÂ Ù¤ÛÛÂÚÈ˜ ÓÔÌÔ‡˜, ÂÎÙÂ›ÓÂÙ·È ÛÂ

8.335 km2, ÌÂ ÌfiÓÈÌÔ ÏËı˘ÛÌfi 594.368 Î·ÙÔ›ÎÔ˘˜ (·ÔÁÚ·-

Ê‹ 2001), ·fi ÙÔ˘˜ ÔÔ›Ô˘˜ 142.880 ‹ 24% Â›Ó·È <19 ÂÙÒÓ.

∆Ô 42% ÙÔ˘ ÏËı˘ÛÌÔ‡ Â›Ó·È ·ÁÚÔÙÈÎfi˜, ÙÔ 46% ·ÛÙÈÎfi˜ Î·È

ÙÔ 12% ËÌÈ·ÛÙÈÎfi˜.

¶ÏËı˘ÛÌfi˜ ÌÂÏ¤ÙË˜

°È· ÙË ÌÂÏ¤ÙË ÂÈÏ¤¯ıËÎ·Ó Î·È ÂÏ‹ÊıËÛ·Ó ·fi fiÏÂ˜ Û¯Â-

‰fiÓ ÙË˜ ÂÚÈÔ¯¤˜ ÙË˜ ∫Ú‹ÙË˜ (∂ÈÎfiÓ· 1) 5.321 ·È‰È¿ Î·È

¤ÊË‚ÔÈ - 2.643 ·ÁfiÚÈ· Î·È 2.678 ÎÔÚ›ÙÛÈ·, ËÏÈÎ›·˜ 2,5-16,5

ÂÙÒÓ, ÙˆÓ ÔÔ›ˆÓ ÌÂÙÚ‹ıËÎÂ Ë ¶ª. ∆· ·È‰È¿ Î·È ÔÈ ¤ÊË‚ÔÈ

Û˘ÌÌÂÙÂ›¯·Ó ÛÂ ·ÓÙÈÚÔÛˆÂ˘ÙÈÎ¿ ‰Â›ÁÌ·Ù· ·È‰ÈÎÒÓ Î·È

ÂÊË‚ÈÎÒÓ ÏËı˘ÛÌÒÓ ÂÙ¿ ‰È·¯ÚÔÓÈÎÒÓ Î·È Û˘Á¯ÚÔÓÈÎÒÓ

ÌÂÏÂÙÒÓ (¶›Ó·Î·˜ 1) Ô˘ ‰ÈÂÍ‹¯ıËÛ·Ó ·fi ÙËÓ ∫ÏÈÓÈÎ‹

¶ÚÔÏËÙÈÎ‹˜ π·ÙÚÈÎ‹˜ Î·È ¢È·ÙÚÔÊ‹˜, ÙË˜ π·ÙÚÈÎ‹˜ ™¯ÔÏ‹˜

ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹ÙË˜.

√È ÌÂÏ¤ÙÂ˜ ·˘Ù¤˜ Ô˘ ‰ÈÂÍ‹¯ıËÛ·Ó ÌÂÙ·Í‡ ÙˆÓ ÂÙÒÓ

1992 Î·È 2005, ·ÊÔÚÔ‡Û·Ó ¶ÚÔÁÚ¿ÌÌ·Ù· ∞ÁˆÁ‹˜ Î·È ¶ÚÔ·-

ÁˆÁ‹˜ ÙË˜ ÀÁÂ›·˜ ÁÈ· ÙË ÛˆÌ·ÙÈÎ‹ ·Ó¿Ù˘ÍË Î·È ÙËÓ ÚfiÏË-

„Ë ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘.

∏ ÂÈÏÔÁ‹ ÙˆÓ ·È‰ÈÒÓ ÛÙÈ˜ ÂÙ¿ ÌÂÏ¤ÙÂ˜ ‹Ù·Ó Ù˘¯·›· -

ÔÏ˘ÛÙ·‰È·Î‹. ∞ÊÔ‡ ÂÈÏ¤¯ıËÎ·Ó Ù˘¯·›· ÔÈ ÂÚÈÔ¯¤˜ ÌÂÏ¤ÙË˜

(·ÛÙÈÎ¤˜, ËÌÈ·ÛÙÈÎ¤˜ Î·È ·ÁÚÔÙÈÎ¤˜) Î·È ÂÓ Û˘ÓÂ¯Â›· Ù· Û¯ÔÏÂ›·

ÙˆÓ ÂÚÈÔ¯ÒÓ, Û˘ÌÂÚÈÂÏ‹ÊıËÛ·Ó fiÏ· Ù· ·È‰È¿ ÙˆÓ Û¯ÔÏÂ›-

ˆÓ. ¶ÂÚÈÛÛfiÙÂÚÂ˜ ÏÂÙÔÌ¤ÚÂÈÂ˜ ˆÛÙfiÛÔ ·Ó·Ê¤ÚÔÓÙ·È ÛÂ

ÚÔËÁÔ‡ÌÂÓÂ˜ ‰ËÌÔÛÈÂ˘Ì¤ÓÂ˜ ÂÚÁ·Û›Â˜ ÙˆÓ ÌÂÏÂÙÒÓ (12-20).

∂›ÛË˜, ÔÈ ÂÍÂÙ¿ÛÂÈ˜ ÙˆÓ ·È‰ÈÒÓ ¤ÁÈÓ·Ó ÛÙÔÓ ¯ÒÚÔ ÙˆÓ

Û¯ÔÏÂ›ˆÓ ÙÔ˘˜ Î·ÙfiÈÓ ¤ÁÎÚÈÛË˜ ÙˆÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ Î·È ÙˆÓ

ÂÍÂÙ¿ÛÂÒÓ ÙÔ˘˜ ·fi ÙÔ ÀÔ˘ÚÁÂ›Ô ¶·È‰Â›·˜, ÂÓÒ ÁÈ· ÙË Û˘Ì-

ÌÂÙÔ¯‹ ÙÔ˘˜ ÚÔËÁ‹ıËÎÂ ÏÂÙÔÌÂÚ‹˜ ÂÓËÌ¤ÚˆÛË Î·È ÂÓ˘-

fiÁÚ·ÊË Û˘ÁÎ·Ù¿ıÂÛË ÙˆÓ ÁÔÓ¤ˆÓ. ¶ÚÔËÁ‹ıËÎÂ ·ÎfiÌË

¤ÁÎÚÈÛË ÙˆÓ ÌÂÏÂÙÒÓ ·fi ÙËÓ ÂÈÙÚÔ‹ ∏ıÈÎ‹˜ Î·È ¢ÂÔÓÙÔ-

ÏÔÁ›·˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹ÙË˜.

ª¤ÙÚËÛË ¶ÂÚÈÌ¤ÙÚÔ˘ ª¤ÛË˜

∏ Ì¤ÙÚËÛË ÙË˜ ¶ª ¤ÁÈÓÂ ¯ˆÚ›˜ ÚÔ‡¯·, ÛÂ ÂÎ·ÙÔÛÙ¿, ÌÂ

Ï·ÛÙÈÎ‹ ÌÂÙÚÈÎ‹ Ù·ÈÓ›·, Î¿ÙˆıÂÓ ÙÔ˘ ÏÂ˘ÚÈÎÔ‡ ÙfiÍÔ˘ -

ÛÙÔ Ì¤ÛÔ ÙË˜ ·fiÛÙ·ÛË˜ ÌÂÙ·Í‡ ÏÂ˘ÚÈÎÔ‡ ÙfiÍÔ˘ Î·È Ï·ÁÔ-

Ó›Ô˘ ·ÎÚÔÏÔÊ›·˜ (∂ÈÎfiÓ· 2).

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∏ ·Ó¿Ï˘ÛË ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ ¤ÁÈÓÂ ÌÂ ÙË ¯Ú‹ÛË ÙÔ˘ ÚÔ-

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ıÒ˜ Î·È ÛÙË ÁÚ·ÊÈÎ‹ ·ÂÈÎfiÓÈÛË ÙˆÓ Î·Ì˘ÏÒÓ ÙÔ˘˜, ˘Ô-

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¶ÔÏ˘ˆÓ˘ÌÈÎ¿ ÌÔÓÙ¤Ï· ÚÔÛ·ÚÌÔÁ‹˜ Áã ‚·ıÌÔ‡ (cubic

models) (21,22) ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÁÈ· ÙËÓ ÂÍÔÌ¿Ï˘ÓÛË ÙˆÓ

ÙÈÌÒÓ ÙˆÓ ·‰ÚÒÓ ∂£, Ù· ÔÔ›· ¤‰ˆÛ·Ó Û˘ÓÙÂÏÂÛÙ¤˜ ÚÔÛ·Ú-

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sample t test) ¤ÁÈÓÂ Û‡ÁÎÚÈÛË ÙˆÓ Ì¤ÛˆÓ ÙÈÌÒÓ ÙË˜ ¶ª ÙˆÓ

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(22-30), ÂÓÒ ·Ó··Ú·ÛÙ¿ıËÎ·Ó ÁÚ·ÊÈÎ¿ ÔÈ 90¤˜ ∂£ ÙˆÓ ÌÂ-

ÏÂÙÒÓ ·˘ÙÒÓ (·fi ÙË ÌÂÏ¤ÙË ÙˆÓ Fredriks et al, 2005 (23)

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∂£ ÙË˜ ¶ª ·ÊÔÚ¿ ÙË ¯Ú‹ÛË ÙË˜ ˆ˜ fiÚÈÔ Î·ıÔÚÈÛÌÔ‡ ÙˆÓ

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# ∆∞: Ù˘ÈÎ‹ ·fiÎÏÈÛË† ∏ ËÏÈÎ›· ·ÊÔÚ¿ ËÏÈÎÈ·Î¤˜ ÔÌ¿‰Â˜: Ù· 3 ¤ÙË ÂÚÈÏ·Ì‚¿-ÓÔ˘Ó ·È‰È¿ ËÏÈÎ›·˜ 2,5-3,4 ¯ÚfiÓˆÓ Î.Ô.Î.*√È ÙÈÌ¤˜ Â›Ó·È ÛÂ ÂÎ·ÙÔÛÙ¿ (cm)

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∂ÈÎfiÓ· 3. ∫·Ì‡ÏÂ˜ ÂÎ·ÙÔÛÙÈ·›ˆÓ ı¤ÛÂˆÓ ÂÚÈÌ¤ÙÚÔ˘ Ì¤ÛË˜.


¶·È‰È·ÙÚÈÎ‹ 2007;70:300-307


√ÏÏ·Ó‰›·˜, ∞˘ÛÙÚ·Ï›·˜, ∫·Ó·‰¿ Î·È ∏¶∞ (22-29),Ô˘ ·ÊÔÚÔ‡Ó ÂÚÁ·Û›Â˜ ˘ÔÏÔÁÈÛÌÔ‡ ∂£ ÙË˜ ¶ª,·ÔÙÂÏÔ‡Ó Û˘Á¯ÚÔÓÈÎ¤˜ ÌÂÏ¤ÙÂ˜ Î·È ¤¯Ô˘Ó ‰ÈÂÍ·-¯ıÂ› ÛÂ ‰È·ÛÙ‹Ì·Ù· ‰È¿ÚÎÂÈ·˜ ÌÈÎÚfiÙÂÚË˜ ÙˆÓ ‰‡ÔÂÙÒÓ. øÛÙfiÛÔ, Ë ·fi ÎÔÈÓÔ‡ ¯Ú‹ÛË ‰È·¯ÚÔÓÈÎÒÓ Î·ÈÛ˘Á¯ÚÔÓÈÎÒÓ ÌÂÏÂÙÒÓ ÁÈ· ÙË ‰ËÌÈÔ˘ÚÁ›· ∂£ Î·Ì˘-ÏÒÓ ·Ó¿Ù˘ÍË˜ Ô˘ Î·Ï‡ÙÔ˘Ó Â›ÛË˜ ÌÂÁ·Ï‡ÙÂÚ·¯ÚÔÓÈÎ¿ ‰È·ÛÙ‹Ì·Ù· ¤¯ÂÈ ‹‰Ë ÂÊ·ÚÌÔÛÙÂ› ÛÂ ∏¶∞Î·È ª. µÚÂÙ·Ó›· (30,31).

∏ ¶ª Â›Ó·È ·Ï‹ Î·È Â‡ÎÔÏË ÛÙË Ì¤ÙÚËÛ‹ ÙË˜·ÏÏ¿ Î·È ÌÂÁ¿ÏË˜ ÛÔ˘‰·ÈfiÙËÙ·˜, Î·ıÒ˜ Â›Ó·È ‰Â›-ÎÙË˜ ÎÂÓÙÚÈÎ‹˜ ·¯˘Û·ÚÎ›·˜. √È Mamalakis Î·È Û˘Ó.(5), ¤‰ÂÈÍ·Ó fiÙÈ Ë Û‡ÓıÂÛË ÛÂ ÏÈ·Ú¿ ÔÍ¤· ÙÔ˘ ÎÔÈ-ÏÈ·ÎÔ‡ ˘Ô‰fiÚÈÔ˘ Ï›Ô˘˜ Â›Ó·È ÛËÌ·ÓÙÈÎ¿ ‰˘ÛÌÂÓ¤-ÛÙÂÚË ÙÔ˘ ÁÏÔ˘ÙÈ·›Ô˘ (˘„ËÏfiÙÂÚ· Â›Â‰· ÎÔÚÂ-ÛÌ¤ÓˆÓ Î·È trans ÏÈ·ÚÒÓ ÔÍ¤ˆÓ Î·È ¯·ÌËÏfiÙÂÚ·ÌÔÓÔ·ÎfiÚÂÛÙˆÓ Î·È ÔÏ˘·ÎfiÚÂÛÙˆÓ) Î·È Û¯ÂÙ›˙ÂÙ·ÈÂ›ÛË˜ Î·Ï‡ÙÂÚ· ÌÂ Ù· ÏÈ›‰È· ÔÚÔ‡ ·›Ì·ÙÔ˜. ∂È-Ï¤ÔÓ, Ë ÎÂÓÙÚÈÎ‹ ·¯˘Û·ÚÎ›· ·ÔÙÂÏÂ› ¤Ó·Ó ·fiÙÔ˘˜ ·Ú¿ÁÔÓÙÂ˜ ÙÔ˘ ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ (6-11). √È Moreno Î·È Û˘Ó. (11), ·Ó·Ê¤ÚÔ˘Ó fiÙÈ Ë ¶ªˆ˜ ‰Â›ÎÙË˜ ·¯˘Û·ÚÎ›·˜ ·ÔÙÂÏÂ› ÛÂ ·È‰È¿ Î·ÈÂÊ‹‚Ô˘˜ Î·Ï‡ÙÂÚÔ ÚÔÁÓˆÛÙÈÎfi ‰Â›ÎÙË ÙÔ˘ ÌÂÙ·-

‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘, ·fi fi,ÙÈ Ô ‰Â›ÎÙË˜ Ì¿˙·˜ ÛÒ-Ì·ÙÔ˜ (¢ª™) ‹ ÙÔ ¿¯Ô˜ ÙˆÓ ‰ÂÚÌ·ÙÈÎÒÓ Ù˘¯ÒÓ.

°È· ÙËÓ ·˘Í·ÓfiÌÂÓË Û˘¯ÓfiÙËÙ· ÙË˜ ·¯˘Û·ÚÎ›·˜Î·È ÙÔ˘ ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ ÛÙ· ·È‰È¿ Î·ÈÛÙÔ˘˜ ÂÊ‹‚Ô˘˜ Â˘ı‡ÓÔÓÙ·È Î˘Ú›ˆ˜ Ë ¤ÏÏÂÈ„Ë ÛˆÌ·-ÙÈÎ‹˜ ¿ÛÎËÛË˜, Ë Î·Î‹ ‰È·ÙÚÔÊ‹ Î·È ÙÔ stress, Ô˘Ô‰ËÁÔ‡Ó ÛÂ ·ÔÚÚ‡ıÌÈÛË ÙÔ˘ ¿ÍÔÓ· ˘Ôı·Ï¿ÌÔ˘-˘fiÊ˘ÛË˜-ÂÈÓÂÊÚÈ‰›ˆÓ (32). ∏ ÎÂÓÙÚÈÎ‹ ·¯˘Û·Ú-Î›· Û¯ÂÙ›˙ÂÙ·È ÌÂ ·ÓÙ›ÛÙ·ÛË ÛÙË ‰Ú¿ÛË ÙË˜ ÈÓÛÔ˘Ï›-ÓË˜, ·‡ÍËÛË ÙˆÓ ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ, ÌÂ›ˆÛË ÙË˜ HDL¯ÔÏËÛÙÂÚfiÏË˜ Î·È ·‡ÍËÛË ÙÔ˘ Û·Î¯¿ÚÔ˘. ™Ô˘‰·›ÔÚfiÏÔ Â›ÛË˜ Ê·›ÓÂÙ·È ˆ˜ ¤¯ÂÈ Ë ÔÚÌÔÓÈÎ‹ ‰Ú¿ÛËÙË˜ ÏÂÙ›ÓË˜, Î·ıÒ˜ ¤¯ÂÈ ‚ÚÂıÂ› ÛÂ ·È‰È¿ Î·È ÂÓ‹-ÏÈÎÂ˜ Ó· Û¯ÂÙ›˙ÂÙ·È ÌÂ ÙÔ˘˜ ·Ú·¿Óˆ ·Ú¿ÁÔÓÙÂ˜Î·È È‰È·›ÙÂÚ· ÌÂ ÙËÓ ÎÂÓÙÚÈÎ‹ ·¯˘Û·ÚÎ›· Ô˘ Ô‰Ë-ÁÂ› ÛÂ Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË Ù‡Ô˘ 2 (33-35).

™Â 1.209 ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ ÙË˜ ∫Ú‹ÙË˜ ËÏÈÎ›·˜3-18 ÂÙÒÓ (19), ‚Ú¤ıËÎ·Ó 48 ·È‰È¿ (3,9%) ÌÂ ÙÚÂÈ˜ ‹ÂÚÈÛÛfiÙÂÚÂ˜ Û˘ÓÈÛÙÒÛÂ˜ ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘,ÂÎ ÙˆÓ ÔÔ›ˆÓ ÙÔ 62% Â›¯·Ó ÎÂÓÙÚÈÎ‹ ·¯˘Û·ÚÎ›·(¶ª>90‹ ∂£). ™ÙÔ Û‡ÓÔÏÔ ÙˆÓ ·È‰ÈÒÓ, ÙÔ 8,5%‚Ú¤ıËÎÂ ÌÂ ÎÂÓÙÚÈÎ‹ ·¯˘Û·ÚÎ›·, ÂÓÒ, ÌÂ ‚¿ÛË ÙÔÓ¢ª™ (fiÚÈ· International Obesity Task Force - IOTF)

304 ∂. §ÈÓ·Ú‰¿ÎË˜ Î·È Û˘Ó.


¶›Ó·Î·˜ 3. ∆ÈÌ¤˜ ÂÍÔÌ·Ï˘ÛÌ¤ÓˆÓ ÂÎ·ÙÔÛÙÈ·›ˆÓ ı¤ÛÂˆÓ ÂÚÈÌ¤ÙÚÔ˘ Ì¤ÛË˜ 7.538 ÌÂÙÚ‹ÛÂˆÓ 5.321 ·È‰ÈÒÓ ÙË˜ ∫Ú‹ÙË˜

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¶·È‰È·ÙÚÈÎ‹ 2007;70:300-307


(2), ÙÔ ÔÛÔÛÙfi ÙˆÓ ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ ‹Ù·Ó

9,9%. ∏ ‰È·ÊÔÚ¿ ·˘Ù‹ ÔÊÂ›ÏÂÙ·È Î·Ù¿ Î‡ÚÈÔ ÏfiÁÔ

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ÚÈÊÂÚÂÈ·Î¿) Î·È ÛÙÔ fiÙÈ Ù· fiÚÈ· ÙÔ˘ IOTF ‰ÂÓ ÂÚÈ-

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ÛˆÌ·ÙÈÎ‹ ·Ó¿Ù˘ÍË ÙˆÓ ·È‰ÈÒÓ, ÙË ÌÂÙ·‚ÔÏ‹ ÙˆÓ

ÛˆÌ·ÙÔÌÂÙÚ‹ÛÂÒÓ ÙÔ˘˜ ·ÏÏ¿ Î·È ÙÔÓ ˘ÔÏÔÁÈÛÌfi

∂£ Î·È ÙËÓ Î·Ù·ÛÎÂ˘‹ Î·Ì˘ÏÒÓ ·Ó¿Ù˘ÍË˜, Ó·

Ï·Ì‚¿ÓÔÓÙ·È ˘fi„Ë ÎÔÈÓˆÓÈÎÔ›, ÔÏÈÙÈÛÌÈÎÔ›, ÂÚÈ-

‚·ÏÏÔÓÙÈÎÔ› Î·È ‚ÈÔÏÔÁÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ (1,36).

∞fi ÙË Û‡ÁÎÚÈÛË ÙË˜ ¶ª ÙˆÓ ·È‰ÈÒÓ ÙË˜ ∫Ú‹-

ÙË˜ ÌÂ ·È‰È¿ ¿ÏÏˆÓ ¯ˆÚÒÓ Î·È ·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ

Ô Î·ıÔÚÈÛÌfi˜ ÙˆÓ ËÏÈÎÈ·ÎÒÓ ÔÌ¿‰ˆÓ ‰È¤ÊÂÚÂ ÛÙÈ˜

ÂÚÈÛÛfiÙÂÚÂ˜ ÂÚÈÙÒÛÂÈ˜, ‰È·ÈÛÙÒıËÎÂ fiÙÈ Ù·

·È‰È¿ ÙË˜ ∫Ú‹ÙË˜ ¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚË ¶ª ÛÂ Û‡-

ÁÎÚÈÛË ÌÂ ·È‰È¿ ¿ÏÏˆÓ ̄ ˆÚÒÓ, ÌÂ ÌÔÓ·‰ÈÎ‹ ÂÍ·›ÚÂ-

ÛË ÂÎÂ›Ó· ÙË˜ πÙ·Ï›·˜. ∞˘Ùfi ÙÂÎÌËÚÈÒÓÂÙ·È Î·È ·fi

ÙÔ ˘„ËÏfi ÔÛÔÛÙfi ÙˆÓ ˘¤Ú‚·ÚˆÓ Î·È ·¯‡Û·ÚÎˆÓ

·È‰ÈÒÓ ÙË˜ ∫Ú‹ÙË˜ Ô˘ ÌÂ ‚¿ÛË ÙÔÓ ¢ª™ (fiÚÈ·

IOTF) ·Ó¤Ú¯ÂÙ·È Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÛÙÔ 33,1%

(19). ™ÙËÓ πÙ·Ï›·, ·ÓÙ›ÛÙÔÈ¯·, ÙÔ ÔÛÔÛÙfi ˘¤Ú‚·-

ÚˆÓ Î·È ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ ‚Ú¤ıËÎÂ ˘„ËÏfiÙÂÚÔ,

ÊÙ¿ÓÔÓÙ·˜ ÙÔ 36%, ÂÓÒ ·ÎÔÏÔ˘ıÔ‡Ó Ô ∫·Ó·‰¿˜ ÌÂ

30%, Ë πÛ·Ó›· ÌÂ 27%, ÔÈ ∏¶∞ ÌÂ 25,6% (ÙÔ 1988-

94) Î·È Ë ª. µÚÂÙ·Ó›· ÌÂ 20% (2).

¢˘ÛÙ˘¯Ò˜, Ë ¤ÏÏÂÈ„Ë ‰ËÌÔÛÈÂ˘Ì¤ÓˆÓ ‰Â‰ÔÌ¤-

ÓˆÓ ∂£ ÙË˜ ¶ª ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ ·fi ¿ÏÏÂ˜ Â-

ÚÈÔ¯¤˜ ÙË˜ ∂ÏÏ¿‰·˜, Î·ıÈÛÙÔ‡Ó ·‰‡Ó·ÙË ÙË Û‡ÁÎÚÈ-

ÛË ÌÂ ·È‰È¿ ¿ÏÏˆÓ ÂÚÈÔ¯ÒÓ. ∂ÈÏ¤ÔÓ, ÏfiÁˆ

¤Í·ÚÛË˜ ÙË˜ ·¯˘Û·ÚÎ›·˜ Î·Ù¿ Ù· ÙÂÏÂ˘Ù·›· ¯Úfi-

ÓÈ·, ‰ÂÓ ‰‡Ó·Ù·È Ó· ÂÏÂÁ¯ıÂ› Ë ÏËı˘ÛÌÈ·Î‹ Ù¿ÛË

(secular trend) ÙÔ˘ ·È‰ÈÎÔ‡ ÏËı˘ÛÌÔ‡ ÛÂ Û¯¤ÛË

ÌÂ ÙËÓ ¶ª. °È’ ·˘Ùfi Ô ˘ÔÏÔÁÈÛÌfi˜ ∂£ ÙË˜ ¶ª ·È-

‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ ÙË˜ ∫Ú‹ÙË˜, ¤¯ÂÈ È‰È·›ÙÂÚË ÛÔ˘-

‰·ÈfiÙËÙ·, ÒÛÙÂ ÌÂÏÏÔÓÙÈÎ¿ Ó· ˘¿ÚÍÂÈ Ì¤ÙÚÔ Û‡-

ÁÎÚÈÛË˜ ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô ‰È·¯ÚÔÓÈÎÒÓ ·ÏÏ·ÁÒÓ.

°ÂÓÈÎ¿, Â›Ó·È ·Ó·ÁÎ·›· Ë ‰ÈÂÍ·ÁˆÁ‹ ÌÂÏ¤ÙË˜ ÛÂ

ÂıÓÈÎfi Â›Â‰Ô ÌÂ ÙË Ï‹„Ë ·ÓÙÈÚÔÛˆÂ˘ÙÈÎÔ‡

ÂıÓÈÎÔ‡ ‰Â›ÁÌ·ÙÔ˜ ·È‰ÈÒÓ fiÏˆÓ ÙˆÓ ËÏÈÎÈÒÓ, ÚÔ-

ÎÂÈÌ¤ÓÔ˘ Ó· ˘ÔÏÔÁÈÛıÔ‡Ó Î·È Ó· ‰ËÌÈÔ˘ÚÁËıÔ‡Ó

∂£ Î·È Î·Ì‡ÏÂ˜ ¶ª. ¶·Ú¿ÏÏËÏ·, ÂÎÙfi˜ ·fi ÙËÓ

ÂÎÙ›ÌËÛË ÙÔ˘ ÂÈ¤‰Ô˘ ˘ÁÂ›·˜, ıÚ¤„Ë˜ Î·È ·Ó¿Ù˘-

ÍË˜, ÔÈ ∂£ ÙË˜ ¶ª ÌÔÚÔ‡Ó Ó· ÂÓÛˆÌ·ÙˆıÔ‡Ó Î·È

ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ Î·Ì˘ÏÒÓ ·Ó¿Ù˘ÍË˜ ÙÔ˘ ‚È‚ÏÈ·Ú›-

Ô˘ ˘ÁÂ›·˜ ÙˆÓ ·È‰ÈÒÓ, ÒÛÙÂ Ó· ·ÔÙÂÏÔ‡Ó ¤Ó· ÔÏÔ-

ÎÏËÚˆÌ¤ÓÔ Î·È Û‡Á¯ÚÔÓÔ ÂÚÁ·ÏÂ›Ô ÁÈ· ÙÔÓ ¤ÏÏËÓ·

·È‰›·ÙÚÔ Î·È ÁÔÓÈfi.

XÚËÌ·ÙÔ‰fiÙËÛË

∏ ¯ÚËÌ·ÙÔ‰fiÙËÛË ÙˆÓ ¶ÚÔÁÚ·ÌÌ¿ÙˆÓ ∞ÁˆÁ‹˜ Î·È ¶ÚÔ·-

ÁˆÁ‹˜ ÙË˜ ÀÁÂ›·˜ ÙˆÓ ·È‰ÈÒÓ ÚÔÛ¯ÔÏÈÎ‹˜ ËÏÈÎ›·˜ ¤ÁÈÓÂ ·fi

ÙË Friesland Hellas, Î·È ÂÎÂ›ÓˆÓ Ô˘ ·ÊÔÚÔ‡Û·Ó ·È‰È¿ Û¯ÔÏÈ-

Î‹˜ ËÏÈÎ›·˜, ·fi ÙË °ÂÓÈÎ‹ °Ú·ÌÌ·ÙÂ›· ∞ıÏËÙÈÛÌÔ‡, ÙÔ

ÀÔ˘ÚÁÂ›Ô ¶·È‰Â›·˜ Î·È £ÚËÛÎÂ˘Ì¿ÙˆÓ, ÙÔ ¶·È‰·ÁˆÁÈÎfi

πÓÛÙÈÙÔ‡ÙÔ, ÙÈ˜ ‰ËÌÔÙÈÎ¤˜ ·˘ÙÔ‰ÈÔÈÎ‹ÛÂÈ˜ ÙˆÓ ¢‹ÌˆÓ ∞Á. ¡È-

ÎÔÏ¿Ô˘, ƒÔ‡‚·, ÃÂÚÛÔÓ‹ÛÔ˘, ∏Ú·ÎÏÂ›Ô˘ Î·È Ã·Ó›ˆÓ, Î·ıÒ˜

Î·È ÙË ¡ÔÌ·Ú¯È·Î‹ ∞˘ÙÔ‰ÈÔ›ÎËÛË Ã·Ó›ˆÓ.

∂˘¯·ÚÈÛÙ›Â˜

∂˘¯·ÚÈÛÙÔ‡ÌÂ ıÂÚÌ¿ ÁÈ· ÙËÓ ÔÏÔÎÏ‹ÚˆÛË ÙË˜ ÌÂÏ¤ÙË˜

ÙÔ˘˜ 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,

Caroline Codrington, ∞Ï›Ó· ¶··‰¿ÎË, ∫·ÙÂÚ›Ó· ™·ÚÚ‹,

ª˘ÚˆÓ›· §·ÓÙ˙Ô˘Ú¿ÎË Î·È ·fi ÙËÓ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ÙÔ˘

°ÂÓÈÎÔ‡ ¡ÔÛÔÎÔÌÂ›Ô˘ Ã·Ó›ˆÓ ÙÔ˘˜ ¢ËÌ‹ÙÚË ∞ı·Ó·ÛfiÔ˘ÏÔ

Î·È ∂˘·ÁÁÂÏ›· ª·ÏˆÌÂÓ¿ÎË. ∂›ÛË˜, ·ÔÙÂÏÂÛÌ·ÙÈÎ¿ Û˘-

Ó¤‚·Ï·Ó ÙÔ π·ÙÚÔÎÔÈÓˆÓÈÎfi ∫¤ÓÙÚÔ Î·È Ë ¢ÈÂ‡ı˘ÓÛË ¶ÚˆÙÔ-

‚¿ıÌÈ·˜ ∂Î·›‰Â˘ÛË˜ ÙÔ˘ ¡ÔÌÔ‡ Ã·Ó›ˆÓ.


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306 ∂. §ÈÓ·Ú‰¿ÎË˜ Î·È Û˘Ó.


ª. µÚÂÙ·Ó›·

∞˘ÛÙÚ·Ï›·

ÎÔÚ›ÙÛÈ·

¶ÂÚ

›ÌÂÙ

ÚÔ

˜ ª

¤ÛË

˜ (c

m)

·ÁfiÚÈ·¶

ÂÚ›Ì

ÂÙÚ

Ô˜

ª¤Û

Ë˜

(cm

)100

95

90

85

80

75

70

65

60

55

50

100

95

90

85

80

75

70

65

60

55

50


3 4 5 6 7 8 9 10 11 12 13 14 15 16 3 4 5 6 7 8 9 10 11 12 13 14 15 16


πÙ·Ï›·∫Ú‹ÙË

∏¶∞∫‡ÚÔ˜

√ÏÏ·Ó‰›·∫·Ó·‰¿˜



πÙ·Ï›·

∫Ú‹ÙË

∏¶∞

∫‡ÚÔ˜

√ÏÏ·Ó‰›·

∫·Ó·‰¿˜



∂ÈÎfiÓ· 4. ™¯ËÌ·ÙÈÎ‹ Û‡ÁÎÚÈÛË Î·Ì˘ÏÒÓ 90Ë˜ ÂÎ·ÙÔÛÙÈ·›·˜ ı¤ÛË˜ ‹/Î·È +2SD ÙË˜ ÂÚÈÌ¤ÙÚÔ˘ Ì¤ÛË˜ ·È‰ÈÒÓ ‰È·ÊfiÚˆÓ ÌÂÏÂÙÒÓ.


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36. ∫·Ê¿ÙÔ˜ ∞. ∫·Ì‡ÏÂ˜ ÛˆÌ·ÙÈÎ‹˜ ·Ó¿Ù˘ÍË˜ ·È‰ÈÒÓ

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¶·È‰È·ÙÚÈÎ‹ 2007;70:300-307


√ÚÌfiÓÂ˜ Ô˘ Ú˘ıÌ›˙Ô˘Ó ÙËÓ fiÚÂÍË Î·È ÙÔÓ ÌÂÙ·‚ÔÏÈÛÌfi ÛÂ

ÚfiˆÚ· ÓÂÔÁÓ¿

∆. ™È·¯·Ó›‰Ô˘1, π. ¶··ÛˆÙËÚ›Ô˘2, ª. µÔ˘Ó¿ÙÛÔ˘2, ∂. ªËÏ›ÙÛË2, ∂. ª¿Ó‰˘Ï·1

¶ÂÚ›ÏË„Ë

∂ÈÛ·ÁˆÁ‹: ∏ ·Ó¿Ù˘ÍË Î·È ıÚ¤„Ë Î·Ù¿ ÙË ÓÂÔÁÓÈÎ‹ ËÏÈÎ›· Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÙË ÌÂÙ¤ÂÈÙ· ˘ÁÂ›· ‹ ÂÌÊ¿ÓÈ-ÛË ÓÔÛËÌ¿ÙˆÓ ÊıÔÚ¿˜. ™ÎÔfi˜ ÙË˜ ÌÂÏ¤ÙË˜ ·˘Ù‹˜ ‹Ù·Ó Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜, ÛÂ ÚfiˆÚ· ÓÂÔÁÓ¿, ÙˆÓ ÂÈ-¤‰ˆÓ ÔÚÌÔÓÒÓ Ô˘ ÌÂÙ¤¯Ô˘Ó ÛÙËÓ ÚfiÛÏË„Ë ÙÚÔÊ‹˜ Î·È ÙÔÓ ÌÂÙ·‚ÔÏÈÛÌfi, ·ÏÏ¿ Î·È Ë ·Ó·˙‹ÙËÛË ÙË˜ÌÂÙ·Í‡ ÙÔ˘˜ Û¯¤ÛË˜, Î·ıÒ˜ Î·È ÙË˜ Û˘Û¯¤ÙÈÛ‹˜ ÙÔ˘˜ ÌÂ ÙÈ˜ ÛˆÌ·ÙÔÌÂÙÚÈÎ¤˜ ·Ú·Ì¤ÙÚÔ˘˜ ÙˆÓ ·È‰ÈÒÓÎ·È ÙÔÓ Ú˘ıÌfi ·‡ÍËÛË˜ ÙÔ˘ ÛˆÌ·ÙÈÎÔ‡ ‚¿ÚÔ˘˜.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ∆· Â›Â‰· ÔÏÈÎÔ‡ ÂÙÈ‰›Ô˘ ÀÀ (ƒÀÀ), ƒÀÀ3-36, ÁÎÚÂÏ›ÓË˜, ÈÓÛÔ˘Ï›ÓË˜, ÏÂÙ›ÓË˜ Î·È·‰ÈÔÓÂÎÙ›ÓË˜ ÚÔÛ‰ÈÔÚ›ÛÙËÎ·Ó ÛÙÔÓ ÔÚfi 62 ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ, ËÏÈÎ›·˜ Î‡ËÛË˜ 32,0±2,1 Â‚‰ÔÌ¿‰ˆÓ,ÛÂ ËÏÈÎ›· 40±14 ËÌ¤ÚÂ˜ ˙ˆ‹˜, Î·ıÒ˜ Î·È 15 ÙÂÏÂÈfiÌËÓˆÓ ÓÂÔÁÓÒÓ ·Ó¿ÏÔÁË˜ ËÏÈÎ›·˜ Î·È Ê‡ÏÔ˘. ŸÏ· Ù·ÓÂÔÁÓ¿ ÛÈÙ›ÛÙËÎ·Ó ÌÂ ÙÚÔÔÔÈËÌ¤ÓÔ Á¿Ï·.

∞ÔÙÂÏ¤ÛÌ·Ù·: ∆· Â›Â‰· ƒÀÀ, ƒÀÀ3-36 Î·È ÁÎÚÂÏ›ÓË˜ ‹Ù·Ó ˘„ËÏfiÙÂÚ· ÛÙ· ÚfiˆÚ· ·fi Ù· ÙÂÏÂÈfiÌË-Ó· (p<0,001 ÁÈ· fiÏÂ˜ ÙÈ˜ ‰È·ÊÔÚ¤˜), ÙË˜ ·‰ÈÔÓÂÎÙ›ÓË˜ ‹Ù·Ó ¯·ÌËÏfiÙÂÚ· (p<0,01), ÂÓÒ Ù· Â›Â‰· ÏÂ-Ù›ÓË˜ Î·È ÈÓÛÔ˘Ï›ÓË˜ ‰ÂÓ ‰È¤ÊÂÚ·Ó. øÛÙfiÛÔ, ÛÙ· ÚfiˆÚ· ÓÂÔÁÓ¿, ÌÂÙ¿ ·fi ‰ÈfiÚıˆÛË ÁÈ· ÙÔ ‚¿ÚÔ˜ÛÒÌ·ÙÔ˜, Ù· Â›Â‰· ÙË˜ ·‰ÈÔÓÂÎÙ›ÓË˜ ‹Ù·Ó ˘„ËÏfiÙÂÚ· (p=0,02) Î·È ÙË˜ ÈÓÛÔ˘Ï›ÓË˜ ¤ÙÂÈÓ·Ó Ó· Â›Ó·È˘„ËÏfiÙÂÚ· (p=0,07) ·fi ·˘Ù¿ ÙˆÓ ÙÂÏÂÈfiÌËÓˆÓ. ∆· Â›Â‰· ƒÀÀ Î·È ƒÀÀ3-36 ÛÙÔÓ ÔÚfi ÙˆÓ ÚfiˆÚˆÓÓÂÔÁÓÒÓ Û˘Û¯ÂÙ›ÛıËÎ·Ó ıÂÙÈÎ¿ ÌÂ Ù· Â›Â‰· ÁÎÚÂÏ›ÓË˜ (r=0,33, p=0,009 Î·È r=0,30, p=0,01, ·ÓÙ›ÛÙÔÈ-¯·) Î·È ÈÓÛÔ˘Ï›ÓË˜ (r=0,37, p=0,003 Î·È r=0,38, p=0,003, ·ÓÙ›ÛÙÔÈ¯·). ¢È·ÈÛÙÒıËÎÂ ·ÚÓËÙÈÎ‹ Û˘Û¯¤ÙÈ-ÛË ÙÔ˘ ‚¿ÚÔ˘˜ ÛÒÌ·ÙÔ˜ ÙˆÓ ÚÔÒÚˆÓ ÌÂ ÙÔ ƒÀÀ (r=-0,44, p<0,001), ÙÔ ƒÀÀ3-36 (r=-0,33, p=0,01) Î·ÈÙËÓ ÈÓÛÔ˘Ï›ÓË (r=-0,43, p<0,01), ·ÏÏ¿ ıÂÙÈÎ‹ ÌÂ ÙËÓ ·‰ÈÔÓÂÎÙ›ÓË (r=0,28, p=0,02). ∆· Â›Â‰· ÏÂÙ›ÓË˜Û˘Û¯ÂÙ›ÛÙËÎ·Ó ·ÚÓËÙÈÎ¿ (r=-0,27, p<0,05) Î·È ÙË˜ ·‰ÈÔÓÂÎÙ›ÓË˜ ıÂÙÈÎ¿ (r=0,26, p<0,05) ÌÂ ÙÔÓ Ú˘ıÌfi·‡ÍËÛË˜ ‚¿ÚÔ˘˜ ÙˆÓ ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ. ªÂ ÙË Ì¤ıÔ‰Ô ÙË˜ ÔÏÏ·Ï‹˜ ÂÍ¿ÚÙËÛË˜ ‰È·ÈÛÙÒıËÎÂ fiÙÈ Ë‰È·ÙÚÔÊ‹ ÌÂ Á¿Ï· Ô˘ ÂÚÈÂ›¯Â LCPUFAs ÂËÚ¤·ÛÂ ıÂÙÈÎ¿ Ù· Â›Â‰· ÙË˜ ·‰ÈÔÓÂÎÙ›ÓË˜ (‚=0,28,p=0,03).

™˘ÌÂÚ¿ÛÌ·Ù·: ™˘ÌÂÚ·›ÓÂÙ·È fiÙÈ Ù· ÚfiˆÚ· ‚Ú¤ÊË ‰ÂÓ ÌÂÈÔÓÂÎÙÔ‡Ó ˆ˜ ÚÔ˜ ÙË Û‡ÓıÂÛË/¤ÎÎÚÈÛËÙˆÓ ÔÚÌÔÓÒÓ Ô˘ Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÙËÓ ·‡ÍËÛË Î·È ÙÔÓ ÌÂÙ·‚ÔÏÈÛÌfi, ˆÛÙfiÛÔ Ô ‚ÈÔÏÔÁÈÎfi˜ ÚfiÏÔ˜ ÙˆÓ ÔÚ-ÌÔÓÒÓ ·˘ÙÒÓ ¯ÚÂÈ¿˙ÂÙ·È ÂÚ·ÈÙ¤Úˆ ‰ÈÂÚÂ‡ÓËÛË.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ¶ÂÙ›‰ÈÔ ÀÀ, ÁÎÚÂÏ›ÓË, ÏÂÙ›ÓË, ·‰ÈÔÓÂÎÙ›ÓË, ÓÂÔÁÓ¿.

Hormones regulating the food intake and metabolism of preterm

infants

T. Siahanidou1, I. Papassotiriou2, M. Vounatsou2, H. Militsi2, H. Mandyla1

Abstract

Background: Growth and nutrition in the neonatal period have been linked with health and disease inlater life. The aim of this study was to determine in preterm infants the circulating levels of hormonesimplicated in the regulation of food intake and metabolism, and to examine their interrelation andcorrelations with anthropometric parameters and weight gain.

Methods: Serum levels of total peptide YY (PYY), PYY3-36, ghrelin, insulin, leptin and adiponectin weredetermined in 62 preterm infants (gestational age 32.0±2.1 weeks) at 40±14 days of life, and in 15 fullterm infants of a comparable postnatal age and gender. All the infants were formula fed.

Results: In the preterm infants, the levels of PYY, PYY3-36 and ghrelin were significantly higher than in thefull term infants (p<0.001 for all), adiponectin levels were lower (p<0.01) and there was no difference inleptin and insulin levels between the two groups. However, after correction for body weight, serumadiponectin levels were significantly higher (p=0.02) and insulin levels tended to be higher (p=0.07) inpreterm than in full term infants. In the preterm infants, serum PYY and PYY3-36 levels were positivelycorrelated with serum ghrelin (r=0.33, p=0.009 and r=0.30, p=0.01, respectively) and insulin levels(r=0.37, p=0.003 and r=0.38, p=0.003, respectively). PYY, PYY3-36 and insulin levels correlated negatively(r=-0.44, p<0.001; r=-0.33, p=0.01 and r=-0.43, p<0.01, respectively), and adiponectin levels positively

308 ∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞ ORIGINAL ARTICLE

1 ∞’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹¶·Ó/Ì›Ô˘ ∞ıËÓÒÓ,

2 µÈÔ¯ËÌÈÎfi ∂ÚÁ·ÛÙ‹ÚÈÔ,¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ“∞Á›· ™ÔÊ›·”


∆¿ÓÈ· ™È·¯·Ó›‰Ô˘[email protected]ªÔÓ¿‰· ¡ÂÔÁÓÒÓ, ∞’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹¶·Ó/Ì›Ô˘ ∞ıËÓÒÓ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”£Ë‚ÒÓ & §Â‚·‰Â›·˜∆.∫. 115 27, ∞ı‹Ó·

1 First Department ofPaediatrics, University ofAthens

2 Biochemistry Laboratory,“Aghia Sophia” Hospital,Athens, Greece

Correspondence:

Tania [email protected] Unit, First Department ofPaediatrics, University ofAthens “Aghia Sophia” Children’sHospitalThivon & Levadias St115 27, Athens, Greece



309√ÚÌfiÓÂ˜ Ô˘ Û˘Ì‚¿ÏÏÔ˘Ó ÛÙËÓ fiÚÂÍË Î·È ÙoÓ ÌÂÙ·‚ÔÏÈÛÌfi

¶·È‰È·ÙÚÈÎ‹ 2007;70:308-315

(r=0.28, p=0.02), with the body weight, while leptin levels correlated negatively (r=-0.27, p<0.05) andadiponectin levels positively (r=0.26, p<0.05) with the growth rate. In multiple regression analysis, feedingwith a formula containing LCPUFAs was an independent predictor of the serum adiponectin level (‚=0.28,p=0.03).

Conclusions: Preterm infants are not defective in the synthesis/secretion of the hormones implicated in theregulation of growth and metabolism; however the physiological role of these hormones needs to befurther elucidated.

Key words: Peptide YY, ghrelin, leptin, adiponectin, neonates.

∂ÈÛ·ÁˆÁ‹

∂›Ó·È ÁÓˆÛÙfi fiÙÈ ÓÂÔÁÓ¿ ÌÂ ¯·ÌËÏfi ‚¿ÚÔ˜Á¤ÓÓËÛË˜ ¤¯Ô˘Ó ·˘ÍËÌ¤ÓÔ Î›Ó‰˘ÓÔ Ó· ÂÌÊ·Ó›-ÛÔ˘Ó Î·Ú‰È·ÁÁÂÈ·Î¿ ÓÔÛ‹Ì·Ù· Î·È ÌÂÙ·‚ÔÏÈÎfiÛ‡Ó‰ÚÔÌÔ (˘¤ÚÙ·ÛË, ˘ÂÚÏÈÈ‰·ÈÌ›·, ·ÓÙÔ¯‹ÛÙËÓ ÈÓÛÔ˘Ï›ÓË Î·È Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË Ù‡Ô˘2) Î·Ù¿ ÙËÓ ÂÓ‹ÏÈÎÔ ˙ˆ‹ (1). ŸÌˆ˜, ˘¿Ú¯Ô˘ÓÂÓ‰Â›ÍÂÈ˜ fiÙÈ Î·È Ù· ÚfiˆÚ· ÓÂÔÁÓ¿ ¤¯Ô˘Ó ·˘-ÍËÌ¤ÓÔ Î›Ó‰˘ÓÔ Ó· ÂÌÊ·Ó›ÛÔ˘Ó ÓÔÛ‹Ì·Ù· ÊıÔ-Ú¿˜ ·ÚÁfiÙÂÚ·, ·ÓÂÍ·ÚÙ‹Ùˆ˜ ·Ó ÙÔ ‚¿ÚÔ˜ ÙÔ˘˜Î·Ù¿ ÙË Á¤ÓÓËÛË ‹Ù·Ó ¯·ÌËÏfi ‹ Î·ÓÔÓÈÎfi ÁÈ·ÙË ‰È¿ÚÎÂÈ· Î‡ËÛË˜ (2). ∂ÈÏ¤ÔÓ, Ë ‰È·ÙÚÔÊ‹,Ë ·Ó¿Ù˘ÍË Î·È Ë ıÚ¤„Ë Î·Ù¿ ÙË ÓÂÔÁÓÈÎ‹ ËÏÈ-Î›· Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÙË ÌÂÙ¤ÂÈÙ· Î·Ï‹ ÂÍ¤ÏÈÍË ‹ÙËÓ ÂÌÊ¿ÓÈÛË ÓÔÛËÌ¿ÙˆÓ ÊıÔÚ¿˜ (3-5).

∞fi Ù· ÂÙ›‰È· Ô˘ ¤¯Ô˘Ó Ì¤¯ÚÈ Û‹ÌÂÚ··Ó·ÁÓˆÚÈÛıÂ› fiÙÈ Ú˘ıÌ›˙Ô˘Ó ÙËÓ ÚfiÛÏË„ËÙÚÔÊ‹˜ Î·È ÙÔ ÈÛÔ˙‡ÁÈÔ ÂÓ¤ÚÁÂÈ·˜, ÙÔ ÂÙ›‰ÈÔÀÀ (ƒÀÀ) ÂÎÎÚ›ÓÂÙ·È Î˘Ú›ˆ˜ ·fi ÂÓ‰ÔÎÚÈÓÈÎ¿Î‡ÙÙ·Ú· ÙÔ˘ ÏÂÙÔ‡ Î·È ÙÔ˘ ·¯¤Ô˜ ÂÓÙ¤ÚÔ˘Î·È ÔÈ Î‡ÚÈÔÈ ÈÛfiÙ˘Ô› ÙÔ˘ Â›Ó·È ÙÔ ƒÀÀ1-36 Î·ÈÙÔ ƒÀÀ3-36. ∏ ¯ÔÚ‹ÁËÛË ÙÔ˘ ƒÀÀ1-36 ÛÂ ÂÈ-Ú·Ì·Ùfi˙ˆ· ·ÛÎÂ› ÔÚÂÍÈÔÁfiÓÔ ‰Ú¿ÛË Ì¤Ûˆ ÙˆÓÀ1 ˘Ô‰Ô¯¤ˆÓ ÙÔ˘ ˘Ôı·Ï¿ÌÔ˘ Î·È ·ÓÔÚÂÍÈÔ-ÁfiÓÔ ‰Ú¿ÛË Ì¤Ûˆ ÙˆÓ À2 ˘Ô‰Ô¯¤ˆÓ, ÂÓÒ Ë ¯Ô-Ú‹ÁËÛË ÙÔ˘ ƒÀÀ3-36 ¤¯ÂÈ ÌfiÓÔÓ ·ÓÔÚÂÍÈÔÁfiÓÔ‰Ú¿ÛË Ì¤Ûˆ ÙˆÓ À2 ˘Ô‰Ô¯¤ˆÓ Î·È ·Ó·ÛÙ¤ÏÏÂÈÙËÓ ·‡ÍËÛË ÙÔ˘ ÛˆÌ·ÙÈÎÔ‡ ‚¿ÚÔ˘˜ (6,7). ∏ÁÎÚÂÏ›ÓË ·Ú¿ÁÂÙ·È Î˘Ú›ˆ˜ ·fi Î‡ÙÙ·Ú· ÙÔ˘ÛÙÔÌ¿¯Ô˘ Î·È ·ÛÎÂ› ÔÚÂÍÈÔÁfiÓÔ ‰Ú¿ÛË Ì¤Ûˆ‰È¤ÁÂÚÛË˜ ÙˆÓ À1 ˘Ô‰Ô¯¤ˆÓ ÙÔ˘ ˘Ôı·Ï¿ÌÔ˘.∏ ¯ÚfiÓÈ· ¯ÔÚ‹ÁËÛ‹ ÙË˜ ÛÂ ÂÈÚ·Ì·Ùfi˙ˆ· Ô‰Ë-ÁÂ› ÛÂ ·‡ÍËÛË ÙÔ˘ ÛˆÌ·ÙÈÎÔ‡ ‚¿ÚÔ˘˜ Ì¤Ûˆ ·‡-ÍËÛË˜ ÙË˜ ÚÔÛÏ·Ì‚·ÓfiÌÂÓË˜ ÙÚÔÊ‹˜ ·ÏÏ¿Î·È, ÂÓ‰Â¯ÔÌ¤Óˆ˜, Ì¤Ûˆ ÂÏ¿ÙÙˆÛË˜ ÙË˜ ÔÍÂ›‰ˆ-ÛË˜ ÙÔ˘ Ï›Ô˘˜ Î·È ÌÂ›ˆÛË˜ ÙË˜ Î·Ù·Ó¿ÏˆÛË˜ÂÓ¤ÚÁÂÈ·˜ (8). ∏ ÏÂÙ›ÓË ·Ú¿ÁÂÙ·È ·fi ÙÔÓ ÏÈ-Ò‰Ë ÈÛÙfi Î·È, Ì¤Ûˆ ÙË˜ ÎÂÓÙÚÈÎ‹˜ ‰Ú¿ÛË˜ ÙË˜ÛÂ Î‡ÙÙ·Ú· ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘, ÂÚÈÔÚ›˙ÂÈ ÙËÓ Úfi-ÛÏË„Ë ÙÚÔÊ‹˜ Î·È ·ÚÂÌ‚·›ÓÂÈ ÛÙÔÓ ÌÂÙ·‚ÔÏÈ-ÛÌfi ·Ó·ÛÙ¤ÏÏÔÓÙ·˜ ÙË ÓÂÔÁÏ˘ÎÔÁ¤ÓÂÛË (9). ∆·Â›Â‰¿ ÙË˜ ÛÙÔÓ ÔÚfi Â›Ó·È ·˘ÍËÌ¤Ó· ÛÂ ¿ÙÔÌ·

ÌÂ ·¯˘Û·ÚÎ›· Î·È ÌÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ, ÏfiÁˆ·Ó¿Ù˘ÍË˜ ·ÓÙÔ¯‹˜. ∏ ÈÓÛÔ˘Ï›ÓË, ÂÎÙfi˜ ·fiÙÔÓ ÁÓˆÛÙfi ÙË˜ ÚfiÏÔ ÛÙËÓ ÔÌÔÈÔÛÙ·Û›· ÙË˜ÁÏ˘Îfi˙Ë˜, ¤¯ÂÈ ÎÂÓÙÚÈÎ‹ ‰Ú¿ÛË, Û˘ÓÂÚÁÈÎ‹ ÌÂ·˘Ù‹ ÙË˜ ÏÂÙ›ÓË˜, ÛÙË Ú‡ıÌÈÛË ÙË˜ ÚfiÛÏË-„Ë˜ ÙÚÔÊ‹˜ Î·È ÛÙÔ ÈÛÔ˙‡ÁÈÔ ÂÓ¤ÚÁÂÈ·˜ (9). ∆¤-ÏÔ˜, Ë ·‰ÈÔÓÂÎÙ›ÓË ·Ú¿ÁÂÙ·È ·fi ÙÔÓ ÏÈÒ‰ËÈÛÙfi Î·È ·˘Í¿ÓÂÈ ÙËÓ Â˘·ÈÛıËÛ›· ÙˆÓ ÈÛÙÒÓ ÛÙËÓÈÓÛÔ˘Ï›ÓË, ÚÔÛÙ·ÙÂ‡ÔÓÙ·˜ ·fi ÙËÓ ·Ó¿Ù˘ÍË·ÓÙÔ¯‹˜ ÛÙËÓ ÈÓÛÔ˘Ï›ÓË Î·È ·fi ÙËÓ ÂÌÊ¿ÓÈÛËÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ (10).

™ÎÔfi˜ ÙË˜ ÌÂÏ¤ÙË˜ ·˘Ù‹˜ ‹Ù·Ó Ó· ÚÔÛ-‰ÈÔÚÈÛÙÔ‡Ó Ù· Â›Â‰· ÔÏÈÎÔ‡ ƒÀÀ, ƒÀÀ3-36,ÁÎÚÂÏ›ÓË˜, ÈÓÛÔ˘Ï›ÓË˜, ÏÂÙ›ÓË˜ Î·È ·‰ÈÔÓÂ-ÎÙ›ÓË˜ ÛÙÔÓ ÔÚfi ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ ÂÚ› ÙÔ Ù¤-ÏÔ˜ ÙÔ˘ 1Ô˘ Ì‹Ó· ˙ˆ‹˜ ÙÔ˘˜ Î·È Ó· ·Ó·˙ËÙËıÂ›Ë ÌÂÙ·Í‡ ÙÔ˘˜ Û¯¤ÛË, Î·ıÒ˜ Î·È Ë Û˘Û¯¤ÙÈÛ‹ÙÔ˘˜ ÌÂ ÙÈ˜ ÛˆÌ·ÙÔÌÂÙÚÈÎ¤˜ ·Ú·Ì¤ÙÚÔ˘˜ ÙˆÓ·È‰ÈÒÓ, ÙËÓ ÚfiÛÏË„Ë ÙÚÔÊ‹˜ Î·È ÙÔÓ Ú˘ıÌfi·‡ÍËÛË˜ ÙÔ˘ ‚¿ÚÔ˘˜.


ªÂÏÂÙ‹ıËÎ·Ó 62 ÚfiˆÚ· ÓÂÔÁÓ¿ (ÎÔÚ›ÙÛÈ·/·ÁfiÚÈ·

34/28), ËÏÈÎ›·˜ Î‡ËÛË˜ 32,0±2,1 Â‚‰ÔÌ¿‰ˆÓ Î·È ‚¿-

ÚÔ˘˜ Á¤ÓÓËÛË˜ 1542±275 g, Ô˘ ÓÔÛËÏÂ‡ÙËÎ·Ó ÛÙË

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‚ÚÔÁ¯ÔÓÂ˘ÌÔÓÈÎ‹ ‰˘ÛÏ·Û›·, ÂÁÎÂÊ·ÏÈÎ‹ ·ÈÌÔÚÚ·-

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Ì·ÙÔ˜ Î·È ÙË˜ ÎÏÈÓÈÎ‹˜ ÂÍ¤Ù·ÛË˜ ÙÔ˘ ÓÂÔÁÓÔ‡. ø˜ ÏÈÔ-

‚·Ú‹ ÁÈ· ÙË ‰È¿ÚÎÂÈ· Î‡ËÛË˜ ÔÚ›ÛÙËÎ·Ó Ù· ÓÂÔÁÓ¿ ÌÂ

‚¿ÚÔ˜ Á¤ÓÓËÛË˜ <-2 SD ÁÈ· ÙËÓ ËÏÈÎ›· Î‡ËÛË˜ Î·È ÙÔ

Ê‡ÏÔ. ∂Ù¿ ·fi Ù· 62 ÚfiˆÚ· ‹Ù·Ó ÏÈÔ‚·Ú‹ (11,3%).

ŸÏ· Ù· ÓÂÔÁÓ¿ ÛÈÙ›ÛÙËÎ·Ó ÌÂ ÙÔ ›‰ÈÔ ÙÚÔÔÔÈËÌ¤-

ÓÔ Á¿Ï· (S-26, Wyeth Nutritional, Ireland). ∏ ÂÙ·ÈÚÂ›·

·Ú·ÁˆÁ‹˜ ÂÈÛ‹Á·ÁÂ ÛÙËÓ ·ÁÔÚ¿ Á¿Ï· ÌÂ ÙËÓ ›‰È·

ÂˆÓ˘Ì›·, ÙÔ ÔÔ›Ô ÂÚÈÂ›¯Â ÔÏ˘·ÎfiÚÂÛÙ· ÏÈ·Ú¿

ÔÍ¤· ÔÏ‡ Ì·ÎÚ¿˜ ·Ï‡ÛÔ˘ (LCPUFAs), ·Ú·¯È‰ÔÓÈÎfi

(97 mg/100g ÛÎfiÓË˜ Á¿Ï·ÎÙÔ˜) Î·È ÂÈÎÔÛÈ‰˘ÔÂÍ·ÓÔ˚Îfi


(56 mg/100 g ÛÎfiÓË˜ Á¿Ï·ÎÙÔ˜), fiÌˆ˜ ‰ÂÓ ‰È¤ÊÂÚÂ ˆ˜ ÚÔ˜

ÙË ÏÔÈ‹ Û‡ÓıÂÛ‹ ÙÔ˘ ·fi ÙÔ ÚÔËÁÔ‡ÌÂÓÔ Á¿Ï·, Ô‡ÙÂ ˆ˜

ÚÔ˜ ÙËÓ ÂÚÈÂÎÙÈÎfiÙËÙ¿ ÙÔ˘ ÛÂ ıÂÚÌ›‰Â˜ (67 Kcal/100 ml

Á¿Ï·ÎÙÔ˜). ∂ÓÓ¤· ·fi Ù· 62 ÚfiˆÚ· ÛÈÙ›ÛÙËÎ·Ó ÌÂ ÙÔ Á¿Ï·

Ô˘ ‹Ù·Ó ÂÌÏÔ˘ÙÈÛÌ¤ÓÔ ÌÂ LCPUFAs. ∏ ËÏÈÎ›· Î‡ËÛË˜, ÙÔ

Ê‡ÏÔ Î·È Ù· ÛˆÌ·ÙÔÌÂÙÚÈÎ¿ Î·Ù¿ ÙË Á¤ÓÓËÛË ÙˆÓ ÚfiˆÚˆÓ

ÓÂÔÁÓÒÓ Ô˘ ÛÈÙ›ÛÙËÎ·Ó ÌÂ Á¿Ï· Ô˘ ÂÚÈÂ›¯Â LCPUFAs ‰ÂÓ

‰È¤ÊÂÚ·Ó ·fi Ù· ·ÓÙ›ÛÙÔÈ¯· ÙˆÓ ˘ÔÏÔ›ˆÓ ÚfiˆÚˆÓ ÓÂÔ-

ÁÓÒÓ. ∆· ÓÂÔÁÓ¿ ÛÈÙ›ÛÙËÎ·Ó ·Ú¯ÈÎ¿ ÌÂ ÚÈÓÔÁ·ÛÙÚÈÎfi Î·ıÂÙ‹-

Ú· Î·È ÛÙË Û˘Ó¤¯ÂÈ· ÌÂ ı‹Ï·ÛÙÚÔ Î¿ıÂ 3 ÒÚÂ˜. ŒÁÈÓÂ Î·Ù·-

ÁÚ·Ê‹ ÙË˜ ÚÔÛÏ·Ì‚·ÓfiÌÂÓË˜ ÔÛfiÙËÙ·˜ Á¿Ï·ÙÔ˜ Î·È ˘Ô-

ÏÔÁ›ÛÙËÎÂ Ë ÚfiÛÏË„Ë ıÂÚÌ›‰ˆÓ/∫g*/24ˆÚÔ Î·Ù¿ ÙËÓ ÙÂ-

ÏÂ˘Ù·›· Â‚‰ÔÌ¿‰· ÚÈÓ ÙËÓ ¤ÍÔ‰Ô.

∆· ÓÂÔÁÓ¿ ˙˘Á›˙ÔÓÙ·Ó Î·ıËÌÂÚÈÓ¿ ÛÙËÓ ›‰È· ËÏÂÎÙÚÔÓÈ-

Î‹ ˙˘Á·ÚÈ¿. ∆Ô Ì‹ÎÔ˜ ÛÒÌ·ÙÔ˜ Î·È Ë ÂÚ›ÌÂÙÚÔ˜ ÎÂÊ·Ï‹˜

ÙÔ˘˜ ÌÂÙÚÈfiÙ·Ó ·Ó¿ Â‚‰ÔÌ¿‰· ·fi ÙÔÓ ›‰ÈÔ ÂÚÂ˘ÓËÙ‹. ∂ÎÙÈ-

Ì‹ıËÎÂ Ë ·fiÎÏÈÛË ÙÔ˘ ‚¿ÚÔ˘˜ ÛÒÌ·ÙÔ˜ ·fi ÙÔ Ì¤ÛÔ Ê˘-

ÛÈÔÏÔÁÈÎfi ÁÈ· ÙËÓ ËÏÈÎ›· Î·È ÙÔ Ê‡ÏÔ (z-score) ÌÂ Î·Ù¿ÏÏËÏÔ

ÚfiÁÚ·ÌÌ· (http://www.biomedcentral.com). YÔÏÔÁ›ÛÙËÎÂ

Ô Ú˘ıÌfi˜ ·‡ÍËÛË˜ ÙÔ˘ ‚¿ÚÔ˘˜ ÛÒÌ·ÙÔ˜ (g/Kg*/24ˆÚÔ), Î·-

ıÒ˜ Î·È Ô ‰Â›ÎÙË˜ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ (BMI). ∫·Ù¿ ÙËÓ ËÌ¤Ú·

ÙË˜ ÂÍfi‰Ô˘ ÙÔ˘˜ ·fi ÙÔ ÙÌ‹Ì· ÓÂÔÁÓÒÓ, Ù· ÓÂÔÁÓ¿ ˘Ô‚Ï‹-

ıËÎ·Ó ÛÂ ·ÈÌÔÏË„›· ÁÈ· ÙÔÓ Û˘Ó‹ıË ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô

Î·È ÂÈÏ¤ÔÓ ÁÈ· ÙË Ì¤ÙÚËÛË ÙˆÓ ÂÈ¤‰ˆÓ ÔÏÈÎÔ‡ ƒÀÀ,

ƒÀÀ3-36, ÁÎÚÂÏ›ÓË˜, ÈÓÛÔ˘Ï›ÓË˜, ÏÂÙ›ÓË˜ Î·È ·‰ÈÔÓÂÎÙ›-

ÓË˜ ÛÙÔÓ ÔÚfi. ∏ Ì¤ÛË ËÏÈÎ›· ÙÔ˘˜ Î·Ù¿ ÙËÓ ·ÈÌÔÏË„›· ‹Ù·Ó

40±14 ËÌ¤ÚÂ˜ ˙ˆ‹˜.

∏ Ì¤ÙÚËÛË ÙˆÓ ÂÈ¤‰ˆÓ ÔÏÈÎÔ‡ ƒÀÀ Î·È ƒÀÀ3-36 ¤ÁÈÓÂ

ÌÂ RIA (Linco Research), fiˆ˜ Î·È ÙË˜ ÁÎÚÂÏ›ÓË˜ (Phoenix

Pharmaceuticals) Î·È ÙË˜ ·‰ÈÔÓÂÎÙ›ÓË˜ (Linco Research). H

ÏÂÙ›ÓË ÚÔÛ‰ÈÔÚ›ÛÙËÎÂ ÌÂ ELISA (Diagnostic Systems

Laboratories, USA). ∏ ÂÏ¿¯ÈÛÙË ·ÓÈ¯ÓÂ‡ÛÈÌË Û˘ÁÎ¤ÓÙÚˆÛË

Î·È Ô ÂÓ‰Ô- Î·È ‰È·- ·Ó·Ï˘ÙÈÎfi˜ Û˘ÓÙÂÏÂÛÙ‹˜ ÌÂÙ·‚ÏËÙfiÙË-

Ù·˜ ÙˆÓ ¯ÚËÛÈÌÔÔÈËı¤ÓÙˆÓ ÂÌÔÚÈÎÒÓ Û˘ÛÎÂ˘·ÛÈÒÓ (kits)

‹Ù·Ó 10 pg/ml, 4,5% Î·È 6,5% ·ÓÙ›ÛÙÔÈ¯· ÁÈ· ÙÔ ÔÏÈÎfi PYY, 20

pg/ml, 7% Î·È 6,4% ·ÓÙ›ÛÙÔÈ¯· ÁÈ· ÙÔ PYY3-36, 12 pg/ml,

5,5% Î·È 2,1% ·ÓÙ›ÛÙÔÈ¯· ÁÈ· ÙË ÁÎÚÂÏ›ÓË, 1 Ìg/ml, 7% Î·È

6% ·ÓÙ›ÛÙÔÈ¯· ÁÈ· ÙËÓ ·‰ÈÔÓÂÎÙ›ÓË Î·È 0,05 Ìg/L, 3,2% Î·È

4% ·ÓÙ›ÛÙÔÈ¯· ÁÈ· ÙË ÏÂÙ›ÓË. ∏ Ì¤ÙÚËÛË ÙË˜ ÈÓÛÔ˘Ï›ÓË˜ ¤ÁÈ-

ÓÂ ÌÂ ÙË Ì¤ıÔ‰Ô ÙË˜ ¯ËÌÂÈÔÊˆÙ·‡ÁÂÈ·˜ ÛÂ ·˘ÙfiÌ·ÙÔ ·Ó·Ï˘-

Ù‹ (ASC:180, Bayer Diagnostics Corp.).

°È· ÙË Û‡ÁÎÚÈÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ÔÚÌÔÓÒÓ, ¯ÚËÛÈÌÔ-

ÔÈ‹ıËÎ·Ó ˆ˜ ÔÌ¿‰· ·Ó·ÊÔÚ¿˜ 15 ˘ÁÈ‹ ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿,

‚¿ÚÔ˘˜ Á¤ÓÓËÛË˜ 3200±498 g, Ô˘ Â›¯·Ó ·ÚfiÌÔÈ· ËÏÈÎ›·

(36±15 ËÌ¤ÚÂ˜ ˙ˆ‹˜) Î·È Ê‡ÏÔ (ÎÔÚ›ÙÛÈ·/·ÁfiÚÈ· 9/6) ÌÂ Ù·

ÚfiˆÚ· Î·È ÛÈÙ›ÛÙËÎ·Ó ·fi ÙË Á¤ÓÓËÛË ÌÂ ÙÔ ›‰ÈÔ ÙÚÔÔÔÈ-

ËÌ¤ÓÔ Á¿Ï· (S-26, Wyeth) ¯ˆÚ›˜ LCPUFAs. ∏ ÌÂÏ¤ÙË ÂÁÎÚ›-

ıËÎÂ ·fi ÙËÓ ∂ÈÙÚÔ‹ ∏ıÈÎ‹˜ Î·È ¢ÂÔÓÙÔÏÔÁ›·˜ ÙÔ˘ ¡ÔÛÔ-

ÎÔÌÂ›Ô˘ Î·È Ï‹ÊıËÎÂ ¤ÁÁÚ·ÊË Û˘ÁÎ·Ù¿ıÂÛË ÙˆÓ ÁÔÓ¤ˆÓ ÙˆÓ

·È‰ÈÒÓ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó.

∆· ·ÔÙÂÏ¤ÛÌ·Ù· ÂÎÊÚ¿ÛÙËÎ·Ó ˆ˜ Ì¤ÛË ÙÈÌ‹±SD, ÌÂ

ÂÍ·›ÚÂÛË ÙËÓ ÈÓÛÔ˘Ï›ÓË Î·È ÙË ÏÂÙ›ÓË, ÙˆÓ ÔÔ›ˆÓ Ù· Â›-

Â‰· ÂÎÊÚ¿ÛÙËÎ·Ó ˆ˜ Â‡ÚÔ˜ Î·È ‰È¿ÌÂÛË ÙÈÌ‹, ÏfiÁˆ ÌË Î·-

ÓÔÓÈÎ‹˜ Î·Ù·ÓÔÌ‹˜. ∏ Î·Ù·ÓÔÌ‹ ÙˆÓ ÙÈÌÒÓ ÙÔ˘ ÔÏÈÎÔ‡ PYY,

ÙÔ˘ PYY3-36 Î·È ÙË˜ ·‰ÈÔÓÂÎÙ›ÓË˜ ‹Ù·Ó Î·ÓÔÓÈÎ‹. °È· ÙË

Û‡ÁÎÚÈÛË ÙˆÓ ÔÌ¿‰ˆÓ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÔÈ ‰ÔÎÈÌ·Û›Â˜ t-

test Î·È Mann-Whitney U-test. ∏ ·Ó·˙‹ÙËÛË ÙˆÓ Û˘Û¯ÂÙ›ÛÂ-

ˆÓ ¤ÁÈÓÂ ÌÂ ÌÂıfi‰Ô˘˜ ·Ï‹˜ Û˘Û¯¤ÙÈÛË˜ (correlation

analysis), ·Ï‹˜ ÂÍ¿ÚÙËÛË˜ (regression analysis) Î·È ÔÏÏ·-

Ï‹˜ ÂÍ¿ÚÙËÛË˜ (multiple regression analysis). °È· ÙË ÌÂÏ¤ÙË

ÙˆÓ Û˘Û¯ÂÙ›ÛÂˆÓ ¤ÁÈÓÂ ÏÔÁ·Ú›ıÌËÛË ÙˆÓ ÙÈÌÒÓ ÙˆÓ ÔÚÌÔÓÒÓ

Ô˘ ‰ÂÓ Â›¯·Ó Î·ÓÔÓÈÎ‹ Î·Ù·ÓÔÌ‹.


∆· ÛˆÌ·ÙÔÌÂÙÚÈÎ¿ ÙˆÓ ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ Î·Ù¿ÙËÓ ¤ÍÔ‰fi ÙÔ˘˜ ·fi ÙË ªÔÓ¿‰· ¡ÂÔÁÓÒÓ, Î·ıÒ˜ Î·ÈÙˆÓ ÙÂÏÂÈfiÌËÓˆÓ ÓÂÔÁÓÒÓ, Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î·1. ™Ù· ÚfiˆÚ· ÓÂÔÁÓ¿, Ë ·fiÎÏÈÛË ÙÔ˘ ‚¿ÚÔ˘˜ ÙÔ˘˜·fi ÙÔ Ì¤ÛÔ Ê˘ÛÈÔÏÔÁÈÎfi ÁÈ· ÙËÓ ËÏÈÎ›· Î·È ÙÔ Ê‡ÏÔ(z-score) Î·Ù¿ ÙËÓ ¤ÍÔ‰Ô ·fi ÙË ªÔÓ¿‰· ¡ÂÔÁÓÒÓ‹Ù·Ó ·ÚÓËÙÈÎ‹ (-2,0±0,4). ∂›ÛË˜, ÙÔ ÈÛÔ˙‡ÁÈÔ ÙÔ˘ÛˆÌ·ÙÈÎÔ‡ ÙÔ˘˜ ‚¿ÚÔ˘˜ ‹Ù·Ó ·ÚÓËÙÈÎfi, ‰ÈfiÙÈ Ë ‰È·-ÊÔÚ¿ ÙÔ˘ z-score ÙÔ˘ ‚¿ÚÔ˘˜ Á¤ÓÓËÛË˜ ·fi ÙÔ z-score ÙÔ˘ ‚¿ÚÔ˘˜ ÙÔ˘˜ Î·Ù¿ ÙËÓ ¤ÍÔ‰Ô ·fi ÙË ªÔ-Ó¿‰· (¢z-score ‚¿ÚÔ˘˜) ‹Ù·Ó ·ÚÓËÙÈÎ‹ (-0,92±0,72,¶›Ó·Î·˜ 1), ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙÔ˘ ˘„ËÏÔ‡ ÔÛÔÛÙÔ‡ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ ÌÂ ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜ <-2 SD Î·Ù¿ÙËÓ ¤ÍÔ‰Ô (63%) ¤Ó·ÓÙÈ ÌÈÎÚfiÙÂÚÔ˘ ÔÛÔÛÙÔ‡ Î·Ù¿ÙË Á¤ÓÓËÛË (11,3%). ∏ ÔÛfiÙËÙ· ÙÔ˘ ÚÔÛÏ·Ì‚·-ÓfiÌÂÓÔ˘ Á¿Ï·ÙÔ˜/∫g*/24ˆÚÔ ‰ÂÓ ‰È¤ÊÂÚÂ, Î·È ÂÔ-Ì¤Óˆ˜ Ô‡ÙÂ ÙÔ ÔÛfi ıÂÚÌ›‰ˆÓ/∫g*/24ˆÚÔ ÌÂÙ·Í‡ÚfiˆÚˆÓ Î·È ÙÂÏÂÈfiÌËÓˆÓ ÓÂÔÁÓÒÓ (156±20 Î·È155±27 Kcal/Kg/24ˆÚÔ, ·ÓÙ›ÛÙÔÈ¯·).

∆· Â›Â‰· ÔÏÈÎÔ‡ ƒÀÀ, ƒÀÀ3-36 Î·È ÁÎÚÂÏ›ÓË˜,‹Ù·Ó ÛËÌ·ÓÙÈÎ¿ ˘„ËÏfiÙÂÚ· ÛÙ· ÚfiˆÚ· ·fi Ù· ÙÂ-ÏÂÈfiÌËÓ· ÓÂÔÁÓ¿. ∆· Â›Â‰· ·‰ÈÔÓÂÎÙ›ÓË˜ ‹Ù·ÓÛËÌ·ÓÙÈÎ¿ ¯·ÌËÏfiÙÂÚ· ÛÙ· ÚfiˆÚ· Î·È ‰ÂÓ ‰È¤ÊÂ-Ú·Ó Ù· Â›Â‰· ÈÓÛÔ˘Ï›ÓË˜ Î·È ÏÂÙ›ÓË˜ ÌÂÙ·Í‡ÚfiˆÚˆÓ Î·È ÙÂÏÂÈfiÌËÓˆÓ. øÛÙfiÛÔ, ÌÂÙ¿ ·fi ‰ÈfiÚ-ıˆÛË ÁÈ· ÙÔ ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜, Ù· Â›Â‰· ·‰ÈÔÓÂ-ÎÙ›ÓË˜ ‹Ù·Ó ˘„ËÏfiÙÂÚ· ÛÙ· ÚfiˆÚ· ·fi Ù· ÙÂÏÂÈfi-ÌËÓ·, ÂÓÒ Ë ‰È·ÊÔÚ¿ ˆ˜ ÚÔ˜ Ù· Â›Â‰· ÈÓÛÔ˘Ï›-ÓË˜ ¤ÙÂÈÓÂ Ó· Â›Ó·È ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ (p=0,07)(¶›Ó·Î·˜ 2).

™Ù· ÚfiˆÚ· ÓÂÔÁÓ¿, Ù· Â›Â‰· ƒÀÀ3-36 ·Ô-ÙÂÏÔ‡Û·Ó ÙÔ 48% ÙˆÓ Î˘ÎÏÔÊÔÚÔ‡ÓÙˆÓ ÂÈ¤‰ˆÓÔÏÈÎÔ‡ ƒÀÀ, ÔÛÔÛÙfi ·ÚfiÌÔÈÔ ÌÂ ·˘Ùfi ÙˆÓ ÙÂÏÂÈ-fiÌËÓˆÓ (42%), Ë ‰Â Û˘Û¯¤ÙÈÛË ÌÂÙ·Í‡ ƒÀÀ Î·ÈƒÀÀ3-36 ‹Ù·Ó ıÂÙÈÎ‹ (r=0,82, p<0,01). ∆· Â›Â‰·ƒÀÀ, Î·ıÒ˜ Î·È ƒÀÀ3-36, Û˘Û¯ÂÙ›ÛıËÎ·Ó ıÂÙÈÎ¿ ÌÂÙ· Â›Â‰· ÁÎÚÂÏ›ÓË˜ (r=0,33, p=0,009, ∂ÈÎfiÓ· 1∞,Î·È r=0,30, p=0,01, ·ÓÙ›ÛÙÔÈ¯·) Î·È ÈÓÛÔ˘Ï›ÓË˜(r=0,37, p=0,003, ∂ÈÎfiÓ· 1µ, Î·È r=0,38, p=0,003,·ÓÙ›ÛÙÔÈ¯·).

310 ∆. ™È·¯·Ó›‰Ô˘ Î·È Û˘Ó.


¶›Ó·Î·˜ 1. ™ˆÌ·ÙÔÌÂÙÚÈÎ¤˜ ·Ú¿ÌÂÙÚÔÈ ÙˆÓ ·È‰ÈÒÓ ÙË˜ ÌÂÏ¤ÙË˜

¶ÚfiˆÚ· ∆ÂÏÂÈfiÌËÓ·(n=62) (n=15)

∏ÏÈÎ›· ÂÍˆÌ‹ÙÚÈ·˜ ˙ˆ‹˜ (ËÌ¤ÚÂ˜) 40±14 36±15µ¿ÚÔ˜ ÛÒÌ·ÙÔ˜ (g) 2269±162** 3835±706ª‹ÎÔ˜ ÛÒÌ·ÙÔ˜ (cm) 46,7±0,7** 54,3±3,3¶ÂÚ›ÌÂÙÚÔ˜ ÎÂÊ·Ï‹˜ (cm) 33,2±1,0** 36,7±1,6¢z-score ‚¿ÚÔ˘˜# -0,92±0,72** -0,15±0,63

# ¢È·ÊÔÚ¿ z-score ‚¿ÚÔ˘˜ Á¤ÓÓËÛË˜ ·fi ÙÔ z-score ÙÔ˘ ‚¿-ÚÔ˘˜ ÛÒÌ·ÙÔ˜ Î·Ù¿ ÙËÓ ·ÈÌÔÏË„›·**p≤0,01 Û˘ÁÎÚÈÙÈÎ¿ ÌÂ Ù· ÙÂÏÂÈfiÌËÓ·


¢È·ÈÛÙÒıËÎÂ ·ÚÓËÙÈÎ‹ Û˘Û¯¤ÙÈÛË ÙˆÓ ÂÈ¤-

‰ˆÓ ƒÀÀ, Î·ıÒ˜ Î·È ƒÀÀ3-36, ÌÂ ÙÔ ‚¿ÚÔ˜ ÛÒÌ·-

ÙÔ˜ ÙˆÓ ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ (r=-0,44, p<0,001, ∂ÈÎfi-

Ó· 2∞, Î·È r=-0,33, p=0,01, ·ÓÙ›ÛÙÔÈ¯·) Î·È ÌÂ ÙÔÓ

µªπ (r=-0,46, p<0,001 Î·È r=-0,38, p<0,01, ·ÓÙ›-

ÛÙÔÈ¯·). ∂›ÛË˜, Ù· Â›Â‰· ÈÓÛÔ˘Ï›ÓË˜ Û˘Û¯ÂÙ›-

ÛıËÎ·Ó ·ÚÓËÙÈÎ¿ ÌÂ ÙÔ ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜ ÙˆÓ Úfiˆ-

ÚˆÓ ÓÂÔÁÓÒÓ (r=-0,43, p<0,01, ∂ÈÎfiÓ· 2µ) Î·È ÌÂ

ÙÔÓ µªπ (r=-0,52, p<0,01). ¢ÂÓ ‰È·ÈÛÙÒıËÎÂ ÛË-

Ì·ÓÙÈÎ‹ Û˘Û¯¤ÙÈÛË ÙˆÓ ÂÈ¤‰ˆÓ ÁÎÚÂÏ›ÓË˜ Î·È

ÏÂÙ›ÓË˜ ÔÚÔ‡ ÌÂ ÙÈ˜ ÛˆÌ·ÙÔÌÂÙÚÈÎ¤˜ ·Ú·Ì¤-

ÙÚÔ˘˜ ÙˆÓ ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ Î·Ù¿ ÙË Á¤ÓÓËÛË ‹

ÙËÓ ¤ÍÔ‰Ô ·fi ÙË ªÔÓ¿‰·. ∆· Â›Â‰· ÏÂÙ›ÓË˜

Û˘Û¯ÂÙ›ÛıËÎ·Ó ·ÚÓËÙÈÎ¿ ÌÂ ÙÔÓ Ú˘ıÌfi ·‡ÍËÛË˜


°ÎÚÂÏ›ÓË ÔÚÔ‡ (pg/ml)

11001000900800700600500400

OÏ

ÈÎfi

Â

Ù›‰

ÈÔ À

À Ô

ÚÔ

‡ (

pg/

ml)

OÏ

ÈÎfi

Â

Ù›‰

ÈÔ À

À Ô

ÚÔ

‡ (

pg/

ml)

A

Log ÈÓÛÔ˘Ï›ÓË ÔÚÔ‡ (mU/L)

1,41,21,0,8,6,4,20,0-,2

B1600

1400

1200

1000

800

600

400

1600

1400

1200

1000

800

600

400

∂ÈÎfiÓ· 1. ™˘Û¯¤ÙÈÛË ÙˆÓ ÂÈ¤‰ˆÓ ÔÏÈÎÔ‡ ƒÀÀ ÔÚÔ‡ ÛÂ ÚfiˆÚ·ÓÂÔÁÓ¿ ÌÂ ∞) Ù· Â›Â‰· ÁÎÚÂÏ›ÓË˜ (r=0,33, p=0,009, µ) Ù· Â›-Â‰· ÈÓÛÔ˘Ï›ÓË˜ (r=0,37, p=0,003).

B¿ÚÔ˜ ÛÒÌ·ÙÔ˜ (g)

B¿ÚÔ˜ ÛÒÌ·ÙÔ˜ (g)

280026002400220020001800

¶Â

Ù›‰

ÈÔ À

À (

pg/

ml)

1600

1400

1200

1000

800

600

400

A

280026002400220020001800

log

ÈÓÛ

Ô˘

Ï›Ó

Ë (

mU

/L)

1,4

1,2

1,0

,8

,6

,4

,2

0,0

-,2

B

∂ÈÎfiÓ· 2. ™˘Û¯¤ÙÈÛË ÙˆÓ ÂÈ¤‰ˆÓ ∞) ÔÏÈÎÔ‡ ƒÀÀ ÔÚÔ‡ (r=-0,44,p<0,001) Î·È µ) ÈÓÛÔ˘Ï›ÓË˜ ÔÚÔ‡ (r=-0,43, p<0,01) ÌÂ ÙÔ ‚¿ÚÔ˜ÛÒÌ·ÙÔ˜ ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ.

¶›Ó·Î·˜ 2. ∂›Â‰· ÔÚÌÔÓÒÓ ÛÙÔÓ ÔÚfi ÙˆÓ ·È‰ÈÒÓ ÙË˜ ÌÂÏ¤ÙË˜

¶ÚfiˆÚ· (n=62) ∆ÂÏÂÈfiÌËÓ· (n=15) p

√ÏÈÎfi ƒÀÀ (pg/ml) 1126±215 825±234 <0,001ƒÀÀ3-36 (pg/ml) 544±157 350±114 <0,001°ÎÚÂÏ›ÓË (pg/ml) 721±98 602±93 <0,001πÓÛÔ˘Ï›ÓË (mU/L) 0,7-22,2 (‰È¿ÌÂÛË 2,3) 0,5-10,6 (‰È¿ÌÂÛË 3,1) >0,05πÓÛÔ˘Ï›ÓË/Kg* (mU/L/∫g*) 0,3-9,7 (‰È¿ÌÂÛË 1,0) 0,1-3,4 (‰È¿ÌÂÛË 0,7) 0,07§ÂÙ›ÓË (Ìg/L) 0,1-15,6 (‰È¿ÌÂÛË 1,2) 0,1-9,7 (‰È¿ÌÂÛË 1,2) >0,05∞‰ÈÔÓÂÎÙ›ÓË (Ìg/ml) 40±15 53±16 <0,01∞‰ÈÔÓÂÎÙ›ÓË/Kg*(Ìg/ml/Kg*) 18,0±6,8 14,1±4,8 0,02

¶·È‰È·ÙÚÈÎ‹ 2007;70:308-315


‚¿ÚÔ˘˜ ÙˆÓ ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ (r=-0,27, p<0,05,

∂ÈÎfiÓ· 3).

¢È·ÈÛÙÒıËÎÂ ÛËÌ·ÓÙÈÎ‹ ıÂÙÈÎ‹ Û˘Û¯¤ÙÈÛË ÙˆÓ

ÂÈ¤‰ˆÓ ·‰ÈÔÓÂÎÙ›ÓË˜ ÔÚÔ‡ ÌÂ ÙÔ ‚¿ÚÔ˜ Á¤ÓÓË-

ÛË˜ ÙˆÓ ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ (r=0,31, p<0,05), ÙÔ z-

score ÙÔ˘ ‚¿ÚÔ˘˜ ÙÔ˘˜ Î·Ù¿ ÙËÓ ¤ÍÔ‰Ô ·fi ÙË ªÔ-

Ó¿‰· (r=0,28, p=0,02, ∂ÈÎfiÓ· 4∞) Î·È ÙÔÓ Ú˘ıÌfi ·‡-

ÍËÛË˜ ÙÔ˘ ÛˆÌ·ÙÈÎÔ‡ ÙÔ˘˜ ‚¿ÚÔ˘˜ (r=0,26, p<0,05,

∂ÈÎfiÓ· 4µ). ªÂ ÙË Ì¤ıÔ‰Ô ÙË˜ ·Ï‹˜ ÂÍ¿ÚÙËÛË˜

‰È·ÈÛÙÒıËÎÂ fiÙÈ Ë Á¤ÓÓËÛË ÌÂ ‚¿ÚÔ˜ <-2SD (ÏÈÔ-

‚·Ú‹ ÁÈ· ÙË ‰È¿ÚÎÂÈ· Î‡ËÛË˜ ÓÂÔÁÓ¿) Î·È Ë ‡·ÚÍË

‚¿ÚÔ˘˜ ÛÒÌ·ÙÔ˜ <-2SD Î·Ù¿ ÙËÓ ¤ÍÔ‰Ô ·fi ÙË ªÔ-

Ó¿‰· (Î¿Ùˆ ·fi Ù· Ê˘ÛÈÔÏÔÁÈÎ¿ fiÚÈ·) ÂËÚ¤·Û·Ó

·ÚÓËÙÈÎ¿ Ù· Â›Â‰· ·‰ÈÔÓÂÎÙ›ÓË˜ (‚=-0,26,

p<0,05 Î·È ‚=-0,25, p<0,05, ·ÓÙ›ÛÙÔÈ¯·), ÂÓÒ Ë ‰È·-

ÙÚÔÊ‹ ÌÂ ÙÚÔÔÔÈËÌ¤ÓÔ Á¿Ï· Ô˘ ÂÚÈÂ›¯Â

LCPUFAs Ù· ÂËÚ¤·ÛÂ ıÂÙÈÎ¿ (‚=0,28, p=0,02). ªÂ

ÙË Ì¤ıÔ‰Ô ÙË˜ ÔÏÏ·Ï‹˜ ÂÍ¿ÚÙËÛË˜ ‰È·ÈÛÙÒıËÎÂ

fiÙÈ Ë ‰È·ÙÚÔÊ‹ ÌÂ Á¿Ï· ÂÌÏÔ˘ÙÈÛÌ¤ÓÔ ÌÂ

LCPUFAs, ÙÔ ¯·ÌËÏfi ‚¿ÚÔ˜ Á¤ÓÓËÛË˜ ÁÈ· ÙË ‰È¿Ú-

ÎÂÈ· Î‡ËÛË˜ (ÏÈÔ‚·Ú‹ ÓÂÔÁÓ¿) Î·È Ô Ú˘ıÌfi˜ ·‡ÍË-

ÛË˜ ‚¿ÚÔ˘˜ Û˘Û¯ÂÙ›ÛıËÎ·Ó ·ÓÂÍ¿ÚÙËÙ· ÌÂ Ù· Â›-

Â‰· ·‰ÈÔÓÂÎÙ›ÓË˜ (¶›Ó·Î·˜ 3).

¶ÚÔÎÂÈÌ¤ÓÔ˘ Ó· ‰ÈÂÚÂ˘ÓËıÂ› ÂÚ·ÈÙ¤Úˆ Ë Û˘-

Û¯¤ÙÈÛË ÙË˜ ·‰ÈÔÓÂÎÙ›ÓË˜ ÌÂ ÙÔÓ Ú˘ıÌfi ·‡ÍËÛË˜

‚¿ÚÔ˘˜, ·Ó·˙ËÙ‹ıËÎ·Ó Î·È ¿ÏÏÔÈ ·Ú¿ÁÔÓÙÂ˜ Ô˘

Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÙËÓ ËÌÂÚ‹ÛÈ· ÚfiÛÏË„Ë ‚¿ÚÔ˘˜ ÛÙ·

ÚfiˆÚ· ÓÂÔÁÓ¿. ∂ÎÙfi˜ ÙË˜ ·‰ÈÔÓÂÎÙ›ÓË˜ Î·È ÙË˜

ÏÂÙ›ÓË˜ (Ë ÔÔ›· ‹‰Ë ·Ó·Ê¤ÚıËÎÂ fiÙÈ Û˘Û¯ÂÙ›˙Â-

Ù·È ·ÚÓËÙÈÎ¿ ÌÂ ÙËÓ ÚfiÛÏË„Ë ‚¿ÚÔ˘˜), ÙÔ ‚¿ÚÔ˜

Á¤ÓÓËÛË˜ Î·È ÙÔ Ì‹ÎÔ˜ ÛÒÌ·ÙÔ˜ ÙˆÓ ÚfiˆÚˆÓ ÓÂÔ-

ÁÓÒÓ Û˘Û¯ÂÙ›ÛıËÎ·Ó ·ÚÓËÙÈÎ¿ (r=-0,27, p<0,05 Î·È

r=-0,36, p=0,02, ·ÓÙ›ÛÙÔÈ¯·), ÂÓÒ Ë ËÌÂÚ‹ÛÈ· Úfi-

ÛÏË„Ë ıÂÚÌ›‰ˆÓ Û˘Û¯ÂÙ›ÛıËÎÂ ıÂÙÈÎ¿ ÌÂ ÙÔÓ Ú˘ıÌfi

·‡ÍËÛË˜ ÙÔ˘ ‚¿ÚÔ˘˜ ÙÔ˘˜ (r=0,53, p<0,001). ªÂ ÙË

Ì¤ıÔ‰Ô ÙË˜ ÔÏÏ·Ï‹˜ ÂÍ¿ÚÙËÛË˜ ‰È·ÈÛÙÒıËÎÂ

fiÙÈ Ë ÚfiÛÏË„Ë ıÂÚÌ›‰ˆÓ Î·È Ù· Â›Â‰· ·‰ÈÔÓÂ-

ÎÙ›ÓË˜ ‹Ù·Ó ÔÈ ÌfiÓÔÈ ·ÓÂÍ¿ÚÙËÙÔÈ ·Ú¿ÁÔÓÙÂ˜ Ô˘

ÂËÚ¤·Û·Ó ÙÔÓ Ú˘ıÌfi ·‡ÍËÛË˜ ‚¿ÚÔ˘˜ (¶›Ó·Î·˜ 4).

¢ÂÓ ‰È·ÈÛÙÒıËÎÂ Û˘Û¯¤ÙÈÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ

ÔÚÌÔÓÒÓ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó ÌÂ ÙËÓ ÔÛfiÙËÙ· ÙË˜ ÚÔ-

ÛÏ·Ì‚·ÓfiÌÂÓË˜ ÙÚÔÊ‹˜ Î·È ÙÔ ÔÛfi ÙˆÓ ıÂÚÌ›‰ˆÓ.

™˘˙‹ÙËÛË

∏ ÌÂÏ¤ÙË ·˘Ù‹ ¤‰ÂÈÍÂ fiÙÈ Ù· ÚfiˆÚ· ÓÂÔÁÓ¿, Â-

Ú› ÙÔ Ù¤ÏÔ˜ ÙÔ˘ 1Ô˘ Ì‹Ó· ˙ˆ‹˜ ÙÔ˘˜, ¤¯Ô˘Ó ˘„ËÏfi-

ÙÂÚ· Â›Â‰· ÔÏÈÎÔ‡ ƒÀÀ, ƒÀÀ3-36 Î·È ÁÎÚÂÏ›ÓË˜,

Û˘ÁÎÚ›ÛÈÌ· Â›Â‰· ÈÓÛÔ˘Ï›ÓË˜ Î·È ÏÂÙ›ÓË˜, Î·È

¯·ÌËÏfiÙÂÚ· Â›Â‰· ·‰ÈÔÓÂÎÙ›ÓË˜ ÔÚÔ‡ ·fi ÙÂ-

ÏÂÈfiÌËÓ· ÓÂÔÁÓ¿ ·ÚfiÌÔÈ·˜ ËÏÈÎ›·˜ Î·È Ê‡ÏÔ˘. ∆Ô

ÔÏÈÎfi ƒÀÀ Ô˘ Î˘ÎÏÔÊÔÚÂ› ÛÙÔÓ ÔÚfi ·ÔÙÂÏÂ›Ù·È,

ÂÚ›Ô˘ Î·Ù¿ ÙÔ ‹ÌÈÛ˘, ·fi ÙÔ ƒÀÀ3-36, fiˆ˜ Î·È

ÛÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜ (11). ∞’ fiÛÔ ÁÓˆÚ›˙Ô˘ÌÂ, ·˘Ù‹ Â›Ó·È

∞‡ÍËÛË ‚¿ÚÔ˘˜ ÛÒÌ·ÙÔ˜ (g/Kg/24ˆÚÔ)

302724211815129630

Lo

g Ï

ÂÙ›

ÓË˜

ÔÚ

Ô‡

(Ì

g/L

)1,5

1,0

,5

0,0

-,5

-1,0

-1,5

∂ÈÎfiÓ· 3. ™˘Û¯¤ÙÈÛË ÙˆÓ ÂÈ¤‰ˆÓ ÏÂÙ›ÓË˜ ÔÚÔ‡ ÌÂ ÙÔÓ Ú˘ıÌfi·‡ÍËÛË˜ ÙÔ˘ ‚¿ÚÔ˘˜ ÛÒÌ·ÙÔ˜ ÙˆÓ ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ (r=-0,27,p<0,05).

z-score ‚¿ÚÔ˘˜ ÛÒÌ·ÙÔ˜

∞‡ÍËÛË ‚¿ÚÔ˘˜ ÛÒÌ·ÙÔ˜ (g/Kg/24ˆÚÔ)

-,5-1,0-1,5-2,0-2,5-3,0

·‰

ÈÔ

ÓÂÎ

Ù›ÓË

ÔÚ

Ô‡

(‡

Ìg/

ml)

·‰

ÈÔ

ÓÂÎ

Ù›ÓË

ÔÚ

Ô‡

(‡

Ìg/

ml)

100

80

60

40

20

0

∞

302520151050

100

80

60

40

20

0

µ

∂ÈÎfiÓ· 4. ™˘Û¯¤ÙÈÛË ÙˆÓ ÂÈ¤‰ˆÓ ·‰ÈÔÓÂÎÙ›ÓË˜ ÔÚÔ‡ ÌÂ ∞) ÙÔz-score ÙÔ˘ ‚¿ÚÔ˘˜ ÛÒÌ·ÙÔ˜ ÙˆÓ ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ (r=0,28,p=0,02) Î·È µ) ÙÔÓ Ú˘ıÌfi ·‡ÍËÛË˜ ‚¿ÚÔ˘˜ (r=0,26, p<0,05).

312 ∆. ™È·¯·Ó›‰Ô˘ Î·È Û˘Ó.



Ë ÚÒÙË ÌÂÏ¤ÙË Î·Ù¿ ÙËÓ ÔÔ›· ÚÔÛ‰ÈÔÚ›ÛÙËÎ·Ó

Û˘Á¯ÚfiÓˆ˜ ÛÙÔÓ ÔÚfi ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ ·˘Ù¤˜ ÔÈ ÔÚ-

ÌfiÓÂ˜ Î·È ·Ó·˙ËÙ‹ıËÎÂ Ë ÌÂÙ·Í‡ ÙÔ˘˜ Û¯¤ÛË, Î·ıÒ˜

Î·È Ë Û¯¤ÛË ÙÔ˘˜ ÌÂ ÙËÓ ÚfiÛÏË„Ë ÙÚÔÊ‹˜ Î·È ÌÂ

·Ú·Ì¤ÙÚÔ˘˜ ·‡ÍËÛË˜.

∏ Û‡ÓıÂÛË ‹/Î·È ¤ÎÎÚÈÛË ÙÔ˘ ƒÀÀ (ÔÏÈÎÔ‡ Î·È

ƒÀÀ3-36) Î·È ÙË˜ ÁÎÚÂÏ›ÓË˜ Ú˘ıÌ›˙ÔÓÙ·È ·fi ‰È¿ÊÔ-

ÚÔ˘˜ ·Ú¿ÁÔÓÙÂ˜, ÛÙÔ˘˜ ÔÔ›Ô˘˜ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È

Ù· ıÚÂÙÈÎ¿ Û˘ÛÙ·ÙÈÎ¿ (ÚˆÙÂ˝ÓË, Ï›Ô˜, ˘‰·Ù¿Ó-

ıÚ·ÎÂ˜), ÙÔ ÔÛfi ıÂÚÌ›‰ˆÓ, ÙÔ ¯ÔÏÈÓÂÚÁÈÎfi Û‡ÛÙËÌ·

(Ë ‰È¤ÁÂÚÛË ¯ÔÏÈÓÂÚÁÈÎÒÓ ÈÓÒÓ ÙÔ˘ ÓÂ˘ÌÔÓÔÁ·ÛÙÚÈ-

ÎÔ‡ Ô‰ËÁÂ› ÛÂ ¤ÎÎÚÈÛË PYY Î·È ÁÎÚÂÏ›ÓË˜), ÔÈ ÔÚÌfi-

ÓÂ˜ (Á·ÛÙÚ›ÓË, ÈÓÛÔ˘Ï›ÓË, ¯ÔÏÔÎ˘ÛÙÔÎÈÓ›ÓË, Á·ÛÙÚÈ-

Îfi ·Ó·ÛÙ·ÏÙÈÎfi ÂÙ›‰ÈÔ, ·˘ÍËÙÈÎ‹ ÔÚÌfiÓË, ÛˆÌ·-

ÙÔÛÙ·Ù›ÓË, ÏÂÙ›ÓË, ÁÏ˘ÎÔÎÔÚÙÈÎÔÂÈ‰‹, Î.·.) Î·È ÔÈ

·˘ÍËÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ (IGF-1, TGF-·, ÂÈ‰ÂÚÌÈÎfi˜

·˘ÍËÙÈÎfi˜ ·Ú¿ÁˆÓ, Î.¿.) (12-14). ∏ ıÂÙÈÎ‹ Û˘Û¯¤ÙÈ-

ÛË ÌÂÙ·Í‡ ƒÀÀ, ÁÎÚÂÏ›ÓË˜ Î·È ÈÓÛÔ˘Ï›ÓË˜ ÛÙ· Úfiˆ-

Ú· ÓÂÔÁÓ¿ ÙË˜ ÌÂÏ¤ÙË˜ Ì·˜ ˘Ô‰ËÏÒÓÂÈ fiÙÈ ÂÓ‰Â¯Ô-

Ì¤Óˆ˜ ˘¿Ú¯ÂÈ ·ÏÏËÏÔÚÚ‡ıÌÈÛË ÙË˜ ¤ÎÎÚÈÛË˜ ÙˆÓ

ÂÙÈ‰›ˆÓ ·˘ÙÒÓ ‹ Ë ¤ÎÎÚÈÛ‹ ÙÔ˘˜ ˘fiÎÂÈÙ·È ÛÂ ÎÔÈ-

Ó‹ Ú‡ıÌÈÛË. ∞Ó Î·È ÙÔ ·›ÙÈÔ Ô˘ Â˘ı‡ÓÂÙ·È ÁÈ· Ù·

˘„ËÏfiÙÂÚ· Â›Â‰· ƒÀÀ Î·È ÁÎÚÂÏ›ÓË˜ ÛÙ· ÚfiˆÚ·

ÓÂÔÁÓ¿ Ô˘ ÌÂÏÂÙ‹Û·ÌÂ ‰ÂÓ Â›Ó·È ÁÓˆÛÙfi, Â›Ó·È ·ÍÈÔ-

ÛËÌÂ›ˆÙÔ fiÙÈ Ù· ·˘ÍËÌ¤Ó· Â›Â‰· ÁÎÚÂÏ›ÓË˜ ÛÙÔÓ

ÔÚfi ·ÔÙÂÏÔ‡Ó ÛÙ·ıÂÚfi Â‡ÚËÌ· ÛÂ Î·Ù·ÛÙ¿ÛÂÈ˜ Ô˘

Û˘ÓÔ‰Â‡ÔÓÙ·È ·fi ·ÚÓËÙÈÎfi ÈÛÔ˙‡ÁÈÔ ÂÓ¤ÚÁÂÈ·˜ ‹

·ÒÏÂÈ· ‚¿ÚÔ˘˜, .¯. ÓÂ˘ÚÔÁÂÓ‹˜ ·ÓÔÚÂÍ›·, Î·¯ÂÍ›·

ÏfiÁˆ Î·Ú‰ÈÔ¿ıÂÈ·˜ ‹ Î·ÚÎ›ÓÔ˘, Î.· (15,16). ÀÔ-

ÛÙËÚ›˙ÂÙ·È fiÙÈ Ë ÁÎÚÂÏ›ÓË ·˘Í¿ÓÂÙ·È ÛÙÈ˜ Î·Ù·ÛÙ¿-

ÛÂÈ˜ ·˘Ù¤˜ ÚÔÎÂÈÌ¤ÓÔ˘ Ó· ·ÛÎ‹ÛÂÈ ·ÓÙÈÛÙ·ıÌÈÛÙÈÎ‹

‰Ú¿ÛË Ì¤Ûˆ ÙË˜ ıÂÙÈÎ‹˜ Â›‰Ú·Û‹˜ ÙË˜ ÛÙËÓ fiÚÂÍË

Î·È ÛÙËÓ ·‡ÍËÛË ÙÔ˘ ÏÈÒ‰Ô˘˜ ÈÛÙÔ‡. Œ¯Ô˘Ó Â›ÛË˜

·Ó·ÊÂÚıÂ› ·˘ÍËÌ¤Ó· Â›Â‰· ƒÀÀ ÛÂ Î·Ù·ÛÙ¿ÛÂÈ˜

ÌÂ ·ÚÓËÙÈÎfi ÈÛÔ˙‡ÁÈÔ ÂÓ¤ÚÁÂÈ·˜ Î·È ·ÒÏÂÈ· ‚¿ÚÔ˘˜,

·Ó Î·È Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÙˆÓ Ï›ÁˆÓ Ì¤¯ÚÈ Û‹ÌÂÚ· ÌÂ-

ÏÂÙÒÓ Â›Ó·È ·ÓÙÈÎÚÔ˘fiÌÂÓ· (15,17). ∞ÚÓËÙÈÎfi ÈÛÔ˙‡-

ÁÈÔ ÛˆÌ·ÙÈÎÔ‡ ‚¿ÚÔ˘˜ ·Ú·ÙËÚ‹ıËÎÂ ÛÙ· ÚfiˆÚ·

ÓÂÔÁÓ¿ ÙË˜ ÌÂÏ¤ÙË˜ Ì·˜ Î·È ÂÈÏ¤ÔÓ, Ë Û˘Û¯¤ÙÈÛË

ÌÂÙ·Í‡ ÙˆÓ ÂÈ¤‰ˆÓ ƒÀÀ Î·È ÙÔ˘ ‚¿ÚÔ˘˜ ÛÒÌ·ÙÔ˜

‹ ÙÔ˘ BMI ‹Ù·Ó ·ÚÓËÙÈÎ‹.

∏ ‰È·›ÛÙˆÛË fiÙÈ Ù· Â›Â‰· ÈÓÛÔ˘Ï›ÓË˜ ÛÙ·

ÚfiˆÚ· ÓÂÔÁÓ¿ Ô˘ ÌÂÏÂÙ‹Û·ÌÂ ¤ÙÂÈÓ·Ó Ó· Â›Ó·È

ÛËÌ·ÓÙÈÎ¿ ˘„ËÏfiÙÂÚ· ·fi ·˘Ù¿ ÙˆÓ ÙÂÏÂÈfiÌËÓˆÓ

ÌÂÙ¿ ·fi ‰ÈfiÚıˆÛË ÁÈ· ÙÔ ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜, ÛÂ Û˘Ó-

‰˘·ÛÌfi ÌÂ ÙËÓ ·ÚÓËÙÈÎ‹ Û˘Û¯¤ÙÈÛË ÙË˜ ÈÓÛÔ˘Ï›ÓË˜

ÌÂ ÙÔ ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜ ÙˆÓ ÚfiˆÚˆÓ Î·È ÙËÓ ·Ô˘Û›·

¯·ÌËÏfiÙÂÚˆÓ ÂÈ¤‰ˆÓ ÏÂÙ›ÓË˜ ÛÙ· ÚfiˆÚ· Û˘-

ÁÎÚÈÙÈÎ¿ ÌÂ Ù· ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿, Â›Ó·È ÂÓ‰Â¯ÔÌ¤-

Óˆ˜ ÂÓ‰ÂÈÎÙÈÎ‹ ÂÓfi˜ ÚÔÁÚ·ÌÌ·ÙÈÛÌÔ‡ Ô˘ ·ÊÔÚ¿

ÛÙË ÌÂÙ¤ÂÈÙ· ÂÌÊ¿ÓÈÛË ·ÓÙÔ¯‹˜ ÛÙËÓ ÈÓÛÔ˘Ï›ÓË

Î·È ÙË ÏÂÙ›ÓË ÛÂ ·È‰È¿ Ô˘ ÁÂÓÓ‹ıËÎ·Ó ÚfiˆÚ· ‹

ÌÂ ¯·ÌËÏfi ‚¿ÚÔ˜ (2,18).

∆· Â›Â‰· ·‰ÈÔÓÂÎÙ›ÓË˜ ÛÙ· ÚfiˆÚ· ÓÂÔÁÓ¿

ÙË˜ ÌÂÏ¤ÙË˜ Ì·˜, ·Ó Î·È ¯·ÌËÏfiÙÂÚ· ·fi ·˘Ù¿ ÙˆÓ

ÙÂÏÂÈfiÌËÓˆÓ, ‹Ù·Ó ˘„ËÏfiÙÂÚ· ·fi ÂÎÂ›Ó· ÙˆÓ ÙÂ-

ÏÂÈfiÌËÓˆÓ ÌÂÙ¿ ·fi ‰ÈfiÚıˆÛË ÁÈ· ÙÔ ‚¿ÚÔ˜ ÛÒÌ·-

ÙÔ˜, ·ÏÏ¿ Î·È ·fi Ù· Â›Â‰· Ô˘ ¤¯Ô˘Ó ·Ó·ÊÂÚıÂ›

ÛÂ ÌÂÁ¿Ï· ·È‰È¿ Î·È ÂÓ‹ÏÈÎÂ˜ (19). ∆· ˘„ËÏ¿ Â›-

Â‰· ·‰ÈÔÓÂÎÙ›ÓË˜ Î·Ù¿ ÙË ÓÂÔÁÓÈÎ‹ ËÏÈÎ›· Î·È Ë

ıÂÙÈÎ‹ Û˘Û¯¤ÙÈÛ‹ ÙÔ˘˜ ÌÂ ÙÔ ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜ Û˘Ì-

ÊˆÓÔ‡Ó ÌÂ Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÚÔËÁÔ‡ÌÂÓˆÓ ÌÂÏÂ-

ÙÒÓ ÛÂ ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿ (19,20). ∂ÓÒ ÛÂ ÌÂÁ¿Ï·

·È‰È¿ Î·È ÂÓ‹ÏÈÎÂ˜, fiÛÔ ÌÂÁ·Ï‡ÙÂÚÔ Â›Ó·È ÙÔ ‚¿ÚÔ˜

ÛÒÌ·ÙÔ˜ Î·È Ë Ì¿˙· ÙÔ˘ ÏÈÒ‰Ô˘˜ ÈÛÙÔ‡, ÙfiÛÔ ¯·-

ÌËÏfiÙÂÚ· Â›Ó·È Ù· Â›Â‰· ·‰ÈÔÓÂÎÙ›ÓË˜ (10,21),

ÙÔ‡ÙÔ ‰ÂÓ Û˘Ì‚·›ÓÂÈ ÛÂ ÓÂÔÁÓ¿, ‰ÈfiÙÈ ÂÓ‰Â¯ÔÌ¤Óˆ˜

‰ÂÓ ¤¯Ô˘Ó ·ÎfiÌË ·Ó·Ù˘¯ıÂ› ÔÈ ÌË¯·ÓÈÛÌÔ› Ô˘

·Ó·ÛÙ¤ÏÏÔ˘Ó ÙËÓ ·Ú·ÁˆÁ‹ ·‰ÈÔÓÂÎÙ›ÓË˜, Î˘Ú›ˆ˜

ÏfiÁˆ ‰È·ÊÔÚÂÙÈÎ‹˜ Û‡ÓıÂÛË˜ Î·È Î·Ù·ÓÔÌ‹˜ ÙÔ˘ ÏÈ-

Ò‰Ô˘˜ ÈÛÙÔ‡ .¯. ÌÈÎÚ¿-·ÓÒÚÈÌ· ÏÈÔÎ‡ÙÙ·Ú·,


¶·È‰È·ÙÚÈÎ‹ 2007;70:308-315

¶›Ó·Î·˜ 3. ¶·Ú¿ÁÔÓÙÂ˜ Ô˘ ÂËÚÂ¿˙Ô˘Ó Ù· Â›Â‰· ·‰ÈÔÓÂÎÙ›ÓË˜ ÔÚÔ‡ ÛÙ· ÚfiˆÚ· ÓÂÔÁÓ¿ (r2 ÙÔ˘ ÌÔÓÙ¤ÏÔ˘=0,25, p=0,006)

∞ÓÂÍ¿ÚÙËÙÂ˜ ÌÂÙ·‚ÏËÙ¤˜ ‚ p

µ¿ÚÔ˜ Á¤ÓÓËÛË˜ <-2 SD (ÏÈÔ‚·Ú‹ ÁÈ· ÙË ‰È¿ÚÎÂÈ· Î‡ËÛË˜) -0,28 0,04z-score ‚¿ÚÔ˘˜ ÛÒÌ·ÙÔ˜ Î·Ù¿ ÙËÓ ¤ÍÔ‰Ô ·fi ÙË ªÔÓ¿‰· -0,006 0,96ƒ˘ıÌfi˜ ·‡ÍËÛË˜ ‚¿ÚÔ˘˜ ÛÒÌ·ÙÔ˜ (g/Kg/24ˆÚÔ) 0,27 0,03™›ÙÈÛË ÌÂ Á¿Ï· Ô˘ ÂÚÈÂ›¯Â LCPUFAs 0,28 0,03

∂Í·ÚÙËÌ¤ÓË ÌÂÙ·‚ÏËÙ‹: Â›Â‰· ·‰ÈÔÓÂÎÙ›ÓË˜ ÔÚÔ‡‚, Û˘ÓÙÂÏÂÛÙ‹˜ Û˘Û¯¤ÙÈÛË˜

¶›Ó·Î·˜ 4. ¶·Ú¿ÁÔÓÙÂ˜ Ô˘ ÂËÚÂ¿˙Ô˘Ó ÙÔ Ú˘ıÌfi ·‡ÍËÛË˜ ‚¿-ÚÔ˘˜ ÛÒÌ·ÙÔ˜ ÙˆÓ ÚÔÒÚˆÓ (r2 ÙÔ˘ ÌÔÓÙ¤ÏÔ˘=0,48, p=0,001)

∞ÓÂÍ¿ÚÙËÙÂ˜ ÌÂÙ·‚ÏËÙ¤˜ ‚ p

µ¿ÚÔ˜ Á¤ÓÓËÛË˜ 0,08 0,56ª‹ÎÔ˜ ÛÒÌ·ÙÔ˜ -0,23 0,12¶ÚfiÛÏË„Ë ıÂÚÌ›‰ˆÓ/Kg/24ˆÚÔ 0,46 0,003∂›Â‰· ÏÂÙ›ÓË˜ ÔÚÔ‡ -0,11 0,41∂›Â‰· ·‰ÈÔÓÂÎÙ›ÓË˜ ÔÚÔ‡ 0,30 0,03

∂Í·ÚÙËÌ¤ÓË ÌÂÙ·‚ÏËÙ‹: ·‡ÍËÛË ‚¿ÚÔ˘˜ ÛÒÌ·ÙÔ˜(g/Kg/24ˆÚÔ) ‚, Û˘ÓÙÂÏÂÛÙ‹˜ Û˘Û¯¤ÙÈÛË˜


‡·ÚÍË Ê·ÈÔ‡ Ï›Ô˘˜, ·ÚÔ˘Û›· Ï›Ô˘˜ Î˘Ú›ˆ˜

ÛÙÔÓ ˘Ô‰fiÚÈÔ ÈÛÙfi Î·È fi¯È ÂÓ‰ÔÎÔÈÏÈ·Î¿ ÛÙ· ÓÂÔ-

ÁÓ¿, Û˘ÁÎÚÈÙÈÎ¿ ÌÂ ÌÂÁ¿Ï· ·È‰È¿ Î·È ÂÓ‹ÏÈÎÂ˜ (20).

∏ ÌÂÏ¤ÙË Ì·˜ ¤‰ÂÈÍÂ fiÙÈ ÛÙ· ÚfiˆÚ· ÓÂÔÁÓ¿, Ô

Ú˘ıÌfi˜ ·‡ÍËÛË˜ ‚¿ÚÔ˘˜ ·ÔÙÂÏÂ› ·Ú¿ÁÔÓÙ· Ô˘

ÂËÚÂ¿˙ÂÈ ıÂÙÈÎ¿ Ù· Â›Â‰· ·‰ÈÔÓÂÎÙ›ÓË˜ (¶›Ó·-

Î·˜ 3). ∆Ô‡ÙÔ ÂÓ‰Â¯ÔÌ¤Óˆ˜ ÔÊÂ›ÏÂÙ·È ÛÂ ¿ÏÏÔ˘˜ ·-

Ú¿ÁÔÓÙÂ˜, .¯. IGF-1, ·˘ÍËÙÈÎ‹ ÔÚÌfiÓË, Î.·., ÔÈ ÔÔ›ÔÈ

·ÊÂÓfi˜ ÂÈ‰ÚÔ‡Ó ıÂÙÈÎ¿ ÛÙËÓ ·‡ÍËÛË Î·È ·ÊÂÙ¤ÚÔ˘

Â¿ÁÔ˘Ó ÙË Û‡ÓıÂÛË ÙË˜ ·‰ÈÔÓÂÎÙ›ÓË˜ (22). ∞ÏÏ¿

Î·È ·ÓÙ›ÛÙÚÔÊ·, Ë ·‰ÈÔÓÂÎÙ›ÓË ‚Ú¤ıËÎÂ fiÙÈ ·ÔÙÂ-

ÏÂ› ·Ú¿ÁÔÓÙ· Ô˘ ÂËÚÂ¿˙ÂÈ ÙÔÓ Ú˘ıÌfi ·‡ÍËÛË˜

(¶›Ó·Î·˜ 4), ÂÓ‰Â¯ÔÌ¤Óˆ˜ ÌÂ ¿ÌÂÛË ‰Ú¿ÛË ‹/Î·È ·˘-

Í¿ÓÔÓÙ·˜ ÙËÓ Â˘·ÈÛıËÛ›· ÙˆÓ ÈÛÙÒÓ ÛÂ ÔÚÌfiÓÂ˜ Ô˘

‰ÈÂÁÂ›ÚÔ˘Ó ÙËÓ ·‡ÍËÛË, .¯. ÈÓÛÔ˘Ï›ÓË Î·È IGF (23).

∞Ó Î·È Â›Ó·È ÌÈÎÚfi˜ Ô ·ÚÈıÌfi˜ ÙˆÓ ÚfiˆÚˆÓ ÓÂÔ-

ÁÓÒÓ Ô˘ ÛÈÙ›ÛÙËÎ·Ó ÌÂ Á¿Ï· Ô˘ ÂÚÈÂ›¯Â

LCPUFAs, Ë ıÂÙÈÎ‹ Â›‰Ú·ÛË ÙˆÓ LCPUFAs ÛÙ· Â›-

Â‰· ·‰ÈÔÓÂÎÙ›ÓË˜ ·ÔÙÂÏÂ›, Î·Ù¿ ÙË ÁÓÒÌË Ì·˜,

ÛËÌ·ÓÙÈÎfi Â‡ÚËÌ· Î·È ·Ó·Ê¤ÚÂÙ·È ÁÈ· ÚÒÙË ÊÔÚ¿

ÛÙÔÓ ¿ÓıÚˆÔ. ª¤¯ÚÈ Û‹ÌÂÚ·, ÂÏ¿¯ÈÛÙÂ˜ ÌÂÏ¤ÙÂ˜, ÔÈ

ÔÔ›Â˜ Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó ÌfiÓÔ ÛÂ ÂÈÚ·Ì·Ùfi˙ˆ·,

¤‰ÂÈÍ·Ó fiÙÈ Ë ‰È·ÙÚÔÊ‹ Ô˘ ÂÚÈ¤¯ÂÈ LCPUFAs, Û˘-

ÁÎÂÎÚÈÌ¤Ó· ÂÈÎÔÛÈÂÓÙ·ÓÔ˚Îfi (20:5, n-3) Î·È ÂÈÎÔÛÈ-

‰˘ÔÂÍ·ÓÔ˚Îfi (22:6, n-3), ÚÔÎ·ÏÂ› ·‡ÍËÛË ÙˆÓ ÂÈ-

¤‰ˆÓ ·‰ÈÔÓÂÎÙ›ÓË˜, Èı·ÓfiÙ·Ù· Ì¤Ûˆ ‰È¤ÁÂÚÛË˜

ÙË˜ Û‡ÓıÂÛË˜ ‹/Î·È ¤ÎÎÚÈÛ‹˜ ÙË˜ ·fi Ù· ÏÈÔÎ‡ÙÙ·-

Ú· (24). ∂›ÛË˜, fiˆ˜ Î·Ù·‰Â›¯ıËÎÂ ÛÂ ÂÈÚ·Ì·Ùfi-

˙ˆ·, ‰›·ÈÙ· ÏÔ‡ÛÈ· ÛÂ LCPUFAs Î·Ù¿ ÙËÓ ÂÚÈÁÂÓ-

ÓËÙÈÎ‹ ÂÚ›Ô‰Ô Û˘Ì‚¿ÏÏÂÈ ÛÙËÓ ÚfiÏË„Ë ÙÔ˘ ÌÂÙ·-

‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ Î·Ù¿ ÙËÓ ÂÓ‹ÏÈÎÔ ˙ˆ‹ (3). ∆Ô

ÁÂÁÔÓfi˜ ·˘Ùfi ÌÔÚÂ› Ó· ÂÚÌËÓÂ‡ÛÂÈ ÙËÓ ˆÊ¤ÏÈÌË

‰Ú¿ÛË ÙˆÓ LCPUFAs Î·Ù¿ ÙË˜ ·ÓÙ›ÛÙ·ÛË˜ ÛÙËÓ ÈÓ-

ÛÔ˘Ï›ÓË, Î·ıÒ˜ Î·È ÙË ÌÈÎÚfiÙÂÚË Û˘¯ÓfiÙËÙ· ·¯˘-

Û·ÚÎ›·˜, ·ÓÙÔ¯‹˜ ÛÙËÓ ÈÓÛÔ˘Ï›ÓË, Û·Î¯·ÚÒ‰Ô˘˜ ‰È·-

‚‹ÙË Ù‡Ô˘ 2, ˘¤ÚÙ·ÛË˜ Î·È ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ Î·-

Ù¿ ÙËÓ ÂÓ‹ÏÈÎÔ ˙ˆ‹ ÛÂ ·È‰È¿ Ô˘ ÛÈÙ›ÛÙËÎ·Ó Î·Ù¿

ÙË ‚ÚÂÊÈÎ‹ ËÏÈÎ›· ÌÂ ÌËÙÚÈÎfi Á¿Ï·, ÙÔ ÔÔ›Ô Â›Ó·È

ÁÓˆÛÙfi fiÙÈ Â›Ó·È ÏÔ‡ÛÈÔ ÛÂ LCPUFAs (3). ÃÚÂÈ¿˙Â-

Ù·È Ó· ‰ÈÂÚÂ˘ÓËıÂ› ·Ó Ô ÂÌÏÔ˘ÙÈÛÌfi˜ ÙÔ˘ ÙÚÔÔ-

ÔÈËÌ¤ÓÔ˘ Á¿Ï·ÙÔ˜ ÌÂ LCPUFAs ÁÈ· ÙË ‰È·ÙÚÔÊ‹

ÚfiˆÚˆÓ ‹ ÙÂÏÂÈfiÌËÓˆÓ ÓÂÔÁÓÒÓ Ô˘ ‰ÂÓ ıËÏ¿˙Ô˘Ó

ı· Â›¯Â ·ÚfiÌÔÈ· Â˘ÂÚÁÂÙÈÎ¿ ·ÔÙÂÏ¤ÛÌ·Ù·.

¢ÂÓ ‰È·ÈÛÙÒıËÎÂ Û˘Û¯¤ÙÈÛË ÙˆÓ ÔÚÌÔÓÒÓ Ô˘

ÌÂÏÂÙ‹Û·ÌÂ ÌÂ ÙËÓ ÔÛfiÙËÙ· ÙË˜ ÚÔÛÏ·Ì‚·ÓfiÌÂ-

ÓË˜ ÙÚÔÊ‹˜ Î·È ÙÔ ÔÛfi ÙˆÓ ıÂÚÌ›‰ˆÓ. ∂›ÛË˜, ÌÂ

ÂÍ·›ÚÂÛË ÙË ÏÂÙ›ÓË Î·È ÙËÓ ·‰ÈÔÓÂÎÙ›ÓË, ‰ÂÓ ‰È·-

ÈÛÙÒıËÎÂ Û˘Û¯¤ÙÈÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ˘ÔÏÔ›-

ˆÓ ÔÚÌÔÓÒÓ ÌÂ ÙÔÓ Ú˘ıÌfi ·‡ÍËÛË˜ ÙÔ˘ ‚¿ÚÔ˘˜

ÙˆÓ ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ. ŸÌˆ˜, Ú¤ÂÈ Ó· ÏËÊıÂ›

˘fi„Ë fiÙÈ ÔÈ ÌË¯·ÓÈÛÌÔ› Ô˘ Ú˘ıÌ›˙Ô˘Ó ÙËÓ Úfi-

ÛÏË„Ë ÙÚÔÊ‹˜ Î·È ÙÔ ÈÛÔ˙‡ÁÈÔ ÛˆÌ·ÙÈÎÔ‡ ‚¿ÚÔ˘˜

Â›Ó·È ÔÏ‡ÏÔÎÔÈ Î·È fiÙÈ Ë ·ÏÏËÏÂ›‰Ú·ÛË ‰È·Êfi-

ÚˆÓ ÔÚÌÔÓÒÓ Î·È ·Ú·ÁfiÓÙˆÓ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÂÈ-

ÛÎÈ¿˙ÂÈ ÙË Û˘Û¯¤ÙÈÛË ÌÂÙ·Í‡ ÙˆÓ ÔÚÌÔÓÒÓ Ô˘ ÌÂ-

ÏÂÙ‹Û·ÌÂ Î·È ÙË˜ ÔÛfiÙËÙ·˜ ÙË˜ ÚÔÛÏ·Ì‚·ÓfiÌÂ-

ÓË˜ ÙÚÔÊ‹˜ ‹ ÙÔ˘ Ú˘ıÌÔ‡ ·‡ÍËÛË˜. ∂Í¿ÏÏÔ˘, Ô ‚ÈÔ-

ÏÔÁÈÎfi˜ ÚfiÏÔ˜ ÙˆÓ ˘fi ÌÂÏ¤ÙË ÔÚÌÔÓÒÓ ‰ÂÓ ¤¯ÂÈ

Ï‹Úˆ˜ ‰ÈÂ˘ÎÚÈÓÈÛÙÂ› Î·È, fiˆ˜ ˘ÔÛÙËÚ›˙ÂÙ·È ÛÂ

¿ÏÏÂ˜ ÌÂÏ¤ÙÂ˜ (25), ‰ÂÓ ·ÔÎÏÂ›ÂÙ·È Ó· Â›Ó·È ‰È·ÊÔ-

ÚÂÙÈÎfi˜ ‹ ÂÚÈÛÛfiÙÂÚÔ Û‡ÓıÂÙÔ˜ ·fi ·˘ÙfiÓ Ô˘ Ì¤-

¯ÚÈ Û‹ÌÂÚ· ÁÓˆÚ›˙Ô˘ÌÂ.

™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, Ù· ÚfiˆÚ· ÓÂÔÁÓ¿ ‰ÂÓ ÌÂÈÔÓÂ-

ÎÙÔ‡Ó Û˘ÁÎÚÈÙÈÎ¿ ÌÂ Ù· ÙÂÏÂÈfiÌËÓ· ˆ˜ ÚÔ˜ ÙË Û‡Ó-

ıÂÛË/¤ÎÎÚÈÛË ÔÚÌÔÓÒÓ Ô˘ ıÂˆÚÂ›Ù·È fiÙÈ Û¯ÂÙ›˙Ô-

ÓÙ·È ÌÂ ÙËÓ ·‡ÍËÛË Î·È ÙÔÓ ÌÂÙ·‚ÔÏÈÛÌfi. ∞Ó Î·È Ô

‚ÈÔÏÔÁÈÎfi˜ ÚfiÏÔ˜ ÙˆÓ ÔÚÌÔÓÒÓ ·˘ÙÒÓ ÛÙ· ÚfiˆÚ·

ÓÂÔÁÓ¿ Ì¤ÏÏÂÈ Ó· ‰ÈÂ˘ÎÚÈÓÈÛÙÂ› ÂÚ·ÈÙ¤Úˆ, ·fi Ù·

·ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ ÌÂÏ¤ÙË˜ Ì·˜ ÚÔÎ‡ÙÔ˘Ó ÂÓ‰Â›-

ÍÂÈ˜ fiÙÈ ÔÈ ‰È·Ù·Ú·¯¤˜ Ô˘ ‰È·ÈÛÙÒÓÔÓÙ·È ÛÂ ·È‰È¿

Ô˘ ÁÂÓÓ‹ıËÎ·Ó ÚfiˆÚ· ‹ ÌÂ ¯·ÌËÏfi ‚¿ÚÔ˜

(1,2,18) ÂÓ‰Â¯ÔÌ¤Óˆ˜ ÍÂÎÈÓÔ‡Ó ÔÏ‡ ÓˆÚ›˜, ·fi ÙË

ÓÂÔÁÓÈÎ‹ ËÏÈÎ›·. ∏ ·‰ÈÔÓÂÎÙ›ÓË Ê·›ÓÂÙ·È fiÙÈ ·›˙ÂÈ

ÚfiÏÔ ÛÙËÓ ·‡ÍËÛË.


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¶·È‰È·ÙÚÈÎ‹ 2007;70:308-315


™˘Ó‡·ÚÍË ÓÂ˘ÚÔ‚Ï·ÛÙÒÌ·ÙÔ˜ Î·È ÎÏËÚÔÓÔÌÈÎ‹˜

ÛÊ·ÈÚÔÎ˘ÙÙ¿ÚˆÛË˜

π.¶. ¶·Ó·ÁÈÒÙÔ˘1, °. §¤ÎÎ·2, ∞. °·ÚÔ‡ÊË2, ∞. ™Ù·ÌÔ˘Ï·Î¿ÙÔ˘3, ∂. ¶ÚÂÌ¤ÙË˜3, ∞. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜2

¶ÂÚ›ÏË„Ë: ∆Ô ÓÂ˘ÚÔ‚Ï¿ÛÙˆÌ· Û˘ÓÈÛÙ¿ ÙÔÓ Û˘¯ÓfiÙÂÚÔ ÂÍˆÎÚ·ÓÈ·Îfi Û˘Ì·Á‹ Î·ÎÔ‹ıË fiÁÎÔ ÙË˜ ·È-‰ÈÎ‹˜ ËÏÈÎ›·˜, ÂÎÚÔÛˆÒÓÙ·˜ ÙÔ 8-10% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ Î·ÎÔËıÒÓ ÓÔÛËÌ¿ÙˆÓ ÛÙ· ·È‰È¿. ¶ÚÔ¤Ú¯Â-Ù·È ·fi Ù· Î‡ÙÙ·Ú· ÙÔ˘ Û˘Ì·ıËÙÈÎÔ‡ ÓÂ˘ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Î·È Ë ÚÔ‚ÔÏ‹ ÙÔ˘ ÔÈÎ›ÏÏÂÈ ÂÍ·ÚÙÒÌÂÓË·fi ÙËÓ ÚˆÙÔ·ı‹ ÂÓÙfiÈÛË Î·È ÙÔ ÛÙ¿‰ÈÔ ÙÔ˘ fiÁÎÔ˘. ∏ ·Ó·ÈÌ›· ‰ÂÓ ·ÔÙÂÏÂ› Û‡ÓËıÂ˜ Â‡ÚËÌ· ÙÔ˘ÓÂ˘ÚÔ‚Ï·ÛÙÒÌ·ÙÔ˜ Î·È ÌÔÚÂ› Ó· ÔÊÂ›ÏÂÙ·È ÛÂ ‰È‹ıËÛË ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ, ·ÈÌÔÚÚ·Á›· ÙÔ˘ fiÁÎÔ˘‹ ·˘ÙÔ¿ÓÔÛË ·ÈÌÔÏ˘ÙÈÎ‹ ·Ó·ÈÌ›·. ∏ ÎÏËÚÔÓÔÌÈÎ‹ ÛÊ·ÈÚÔÎ˘ÙÙ¿ÚˆÛË Â›Ó·È ¤Ó· Û¯ÂÙÈÎ¿ Û˘¯Ófi ·ÈÌ·ÙÔ-ÏÔÁÈÎfi ÓfiÛËÌ· ÙË˜ ÏÂ˘Î‹˜ Ê˘Ï‹˜, Ô˘ ÚÔ‚¿ÏÏÂÈ ÌÂ ·Ó·ÈÌ›·, ›ÎÙÂÚÔ, ÛÏËÓÔÌÂÁ·Ï›·. ∏ ÙÚÈ¿‰· ÙˆÓ Û˘-ÌÙˆÌ¿ÙˆÓ ÛÂ ¿ÏÏÔ˘˜ ·ÛıÂÓÂ›˜ ÂÎÊÚ¿˙ÂÙ·È Ï‹Úˆ˜ Î·È ÛÂ ¿ÏÏÔ˘˜ Ë ˘fiÓÔÈ· Î·È ‰È¿ÁÓˆÛË ÙÔ˘ ÓÔÛ‹-Ì·ÙÔ˜ ÚÔÎ‡ÙÂÈ ÛÂ Ù˘¯·›Ô ·ÈÌ·ÙÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô. ªfiÓÔ ÙÔ 1/3 ÙˆÓ ÂÚÈÙÒÛÂˆÓ ‰È·ÁÈÁÓÒÛÎÂÙ·È Î·Ù¿ÙÔÓ 1Ô ¯ÚfiÓÔ ˙ˆ‹˜. ∏ ÎÏËÚÔÓÔÌÈÎ‹ ÛÊ·ÈÚÔÎ˘ÙÙ¿ÚˆÛË ‰ÂÓ Û˘ÓÔ‰Â‡ÂÙ·È ·fi ·˘ÍËÌ¤ÓÔ Î›Ó‰˘ÓÔ ÂÌÊ¿-ÓÈÛË˜ Î·ÎÔËıÒÓ ÓÔÛËÌ¿ÙˆÓ. Œ¯Ô˘Ó ÂÚÈÁÚ·ÊÂ› ÌÂÌÔÓˆÌ¤ÓÂ˜ ÂÚÈÙÒÛÂÈ˜ Û˘Ó‡·ÚÍË˜ ÌÂ ·ÈÌ·ÙÔÏÔÁÈ-Î¤˜ Î·ÎÔ‹ıÂÈÂ˜, fiˆ˜ ÔÍÂ›· ÏÂÌÊÔ‚Ï·ÛÙÈÎ‹ ·Ó·ÈÌ›·, Î·È ·ÎfiÌË ÏÈÁfiÙÂÚÂ˜ ÌÂ Û˘Ì·ÁÂ›˜ fiÁÎÔ˘˜. ™˘Ó‡-·ÚÍË ÛÊ·ÈÚÔÎ˘ÙÙ¿ÚˆÛË˜ Î·È ÓÂ˘ÚÔ‚Ï·ÛÙÒÌ·ÙÔ˜ ‰ÂÓ ¤¯ÂÈ Ì¤¯ÚÈ ÙÒÚ· ÂÚÈÁÚ·ÊÂ›, fiˆ˜ ·˘Ùfi ÚÔÎ‡-ÙÂÈ ·fi ÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›·, ·Ó Î·È Ë Û˘¯ÓfiÙËÙ· Î·ıÂÌ›·˜ ·fi ÙÈ˜ ‰‡Ô Î·Ù·ÛÙ¿ÛÂÈ˜ ‰ÂÓ Â›Ó·È Î·È Ùfi-ÛÔ Û¿ÓÈ·. ¶ÂÚÈÁÚ¿ÊÂÙ·È ı‹Ï˘ ‚Ú¤ÊÔ˜ 2,5 ÌËÓÒÓ ÌÂ ·Ó·ÈÌ›· Î·È ÌfiÚÊˆÌ· ·ÚÈÛÙÂÚÔ‡ ÂÈÓÂÊÚÈ‰›Ô˘Ô˘ ·ÓÙÈÛÙÔÈ¯Ô‡ÛÂ ÛÂ ÓÂ˘ÚÔ‚Ï¿ÛÙˆÌ·. ∏ ·Ó·ÈÌ›· ‹Ù·Ó ÙÔ ÚÔ¤¯ÔÓ Û‡ÌÙˆÌ· Î·È ‰ÂÓ ÔÊÂÈÏfiÙ·Ó ÛÙÔÓÂ˘ÚÔ‚Ï¿ÛÙˆÌ· ·ÏÏ¿ ÛÂ ÎÏËÚÔÓÔÌÈÎ‹ ÛÊ·ÈÚÔÎ˘ÙÙ¿ÚˆÛË Ô˘ ÎÏËÚÔÓÔÌ‹ıËÎÂ ÌÂ ˘ÔÏÂÈfiÌÂÓÔ ÛˆÌ·-ÙÈÎfi ÁÔÓ›‰ÈÔ, fiˆ˜ ·Ô‰Â›¯ıËÎÂ ·fi ÙÔÓ ¤ÏÂÁ¯Ô ÙÔ˘ ‚Ú¤ÊÔ˘˜ Î·È ÙˆÓ ÁÔÓ¤ˆÓ ÙÔ˘.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ¡Â˘ÚÔ‚Ï¿ÛÙˆÌ·, ÎÏËÚÔÓÔÌÈÎ‹ ÛÊ·ÈÚÔÎ˘ÙÙ¿ÚˆÛË, ·Ó·ÈÌ›·, ‚Ú¤ÊÔ˜.

Coexistence of neuroblastoma and hereditary spherocytosis

J.P. Panagiotou1, G. Lekka2, A. Garoufi2, A. Stamoulakatou3, E. Premetis3, A. Constantopoulos2

Abstract: Neuroblastoma is the most common extracranial solid tumour of childhood, accounting for 8-10% of all childhood cancers. It originates from neural crest cells of the sympathetic nervous system andits clinical presentation depends on the primary tumour site and the extension of the disease. Anaemia isnot a common feature of neuroblastoma, but when present it may be due to bone marrow metastasis,tumor haemorrhage or autoimmune haemolytic anaemia. Hereditary spherocytosis is a relatively commonhaematologic disease in Caucasian populations. Its cardinal symptoms are anaemia, jaundice, andsplenomegaly, which may all be present, but some patients are asymptomatic and the disease is detectedon routine examination. Only one third of cases are diagnosed during the first year of life. Hereditaryspherocytosis is not associated with an increased risk of malignancies. Rarely, coexistence of spherocytosiswith blood cancers, such as acute lymphoblastic leukaemia, has been reported and even less frequentlywith solid tumours. To the knowledge of the authors, coexistence of spherocytosis and neuroblastoma hasnever been described, even though neither condition is rare. The case is described of an infant girl, aged2.5 months, who presented with anaemia as the primary symptom, and who had a mass in the left adrenalgland, found to be neuroblastoma. The cause of the anaemia was hereditary spherocytosis, transmitted asan autosomal recessive trait, as confirmed by the laboratory investigation of the infant and her parents.

Key words: Neuroblastoma, hereditary spherocytosis, anaemia, infant.

316 ∂¡¢π∞º∂ƒ√À™∞ ¶∂ƒπ¶∆ø™∏ CASE REPORT

1 ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹¡ÔÛÔÎÔÌÂ›Ô˘ ™¿ÚÙË˜

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

3 ∞ÈÌ·ÙÔÏÔÁÈÎfi ∂ÚÁ·ÛÙ‹ÚÈÔ¡ÔÛÔÎÔÌÂ›Ô˘ ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”


πˆ¿ÓÓË˜ ¶. ¶·Ó·ÁÈÒÙÔ˘[email protected] ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ¡ÔÛÔÎÔÌÂ›Ô˘ ™¿ÚÙË˜

1 Paediatric Department,Sparta Hospital

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

3 Haematology Lab, “Aghia Sophia” Children’sHospital

Correspondence:

John P. [email protected] Paediatric ClinicSparta Hospital, Greece


∂ÈÛ·ÁˆÁ‹

∆Ô ÓÂ˘ÚÔ‚Ï¿ÛÙˆÌ· ·Ó‹ÎÂÈ ÛÙ· Î·ÎÔ‹ıË ÓÔ-

Û‹Ì·Ù· Î·È ÚÔ¤Ú¯ÂÙ·È ·fi Ù· Î‡ÙÙ·Ú· ÙÔ˘ Û˘-

Ì·ıËÙÈÎÔ‡ ÓÂ˘ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ∏ Û˘¯ÓfiÙË-

Ù¿ ÙÔ˘ Â›Ó·È ÂÚ›Ô˘ 1:10.000 ·È‰È¿ Î·È ÂÎÚÔ-

ÛˆÂ› ÙÔ 8-10% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ Î·ÎÔËıÒÓ ÓÔ-

ÛËÌ¿ÙˆÓ ÛÙ· ·È‰È¿. ™˘Ó‹ıˆ˜ ·ÊÔÚ¿ ·È‰È¿

Î¿Ùˆ ÙˆÓ 5 ÂÙÒÓ (50% Î¿Ùˆ ÙˆÓ 2 ÂÙÒÓ, 1/3 Î¿-

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˙ÂÈ Ó· Û¯ËÌ·Ù›˙ÂÙ·È ÂÓ‰ÔÌËÙÚ›ˆ˜ Î·È ÌÔÚÂ› Ó·

‰È·ÁÓˆÛıÂ› ÌÂ ÙÔ ÂÌ‚Ú˘˚Îfi ˘ÂÚË¯ÔÁÚ¿ÊËÌ·.


™ÙË ‚ÚÂÊÈÎ‹ ËÏÈÎ›·, ·ÔÙÂÏÂ› ÙÔÓ Û˘¯ÓfiÙÂÚÔ Û˘-

Ì·Á‹ fiÁÎÔ. ™Ù· 2/3 ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÍÂÎÈÓ¿ÂÈ ·fi

ÙËÓ ÎÔÈÏÈ¿ Î·È ÙÔ 65% ·˘ÙÒÓ ·fi Ù· ÂÈÓÂÊÚ›‰È·.

ªÔÚÂ› Ó· ÂÌÊ·Ó›˙ÂÈ Û˘ÌÙÒÌ·Ù· Ô˘ ÌÔÈ¿˙Ô˘Ó ÌÂ

ÔÔÈ·‰‹ÔÙÂ ¿ÏÏË ÓfiÛÔ, fiˆ˜ ‰È¿ÚÚÔÈÂ˜, ·ÓÔÚÂÍ›·,

ÔÛÙÈÎ¿ ¿ÏÁË ‹ Ó· ‰È·ÁÓˆÛıÂ› ÛÂ Ù˘¯·›Ô ÎÏÈÓÈÎfi ‹ ÂÚ-

Á·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô. ∏ ·Ó·ÈÌ›· ‰ÂÓ Â›Ó·È Û˘¯Ó‹ ÂÎ‰‹-

ÏˆÛË ÙÔ˘ ÓÂ˘ÚÔ‚Ï·ÛÙÒÌ·ÙÔ˜ Î·È Û˘Ó‹ıˆ˜ ·ÎÔÏÔ˘-

ıÂ› ÙË ¯ËÌÂÈÔıÂÚ·Â›· (1-4).

∏ ÎÏËÚÔÓÔÌÈÎ‹ ÛÊ·ÈÚÔÎ˘ÙÙ¿ÚˆÛË Â›Ó·È ¤Ó· Û¯Â-

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¤ÏÏÂÈÌÌ· ÙÔ˘ ÚˆÙÂ˚ÓÈÎÔ‡ ÂÚ˘ıÚÔÎ˘ÙÙ·ÚÈÎÔ‡ ÛÎÂ-

ÏÂÙÔ‡. ∆Ô ·ÔÙ¤ÏÂÛÌ· ÙË˜ ‚Ï¿‚Ë˜ ·˘Ù‹˜ Â›Ó·È Ù·

ÂÚ˘ıÚ¿ ·ÈÌÔÛÊ·›ÚÈ· Ó· Ï·Ì‚¿ÓÔ˘Ó ÛÊ·ÈÚÈÎfi Û¯‹Ì·,

Ó· Á›ÓÔÓÙ·È ‰‡ÛÎ·ÌÙ· (·˘ÍËÌ¤ÓË Â˘ıÚ·˘ÛÙfiÙËÙ·)

Î·È Ó· Î·Ù·ÛÙÚ¤ÊÔÓÙ·È Î·ıÒ˜ ‰È¤Ú¯ÔÓÙ·È ·fi Ù·

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Î·È Î˘Ú›ˆ˜ ÙÔ˘ ÛÏ‹Ó·. ∏ Â›ÙˆÛ‹ ÙË˜ ÛÙË µfiÚÂÈ·

∂˘ÚÒË Â›Ó·È Û¯Â‰fiÓ 1:2000. ∏ ‰È¿ÁÓˆÛË ÌÔÚÂ› Ó·

ÙÂıÂ› ÛÙË ÓÂÔÁÓÈÎ‹, ÛÙË ‚ÚÂÊÈÎ‹ ‹ ÛÂ ÌÂÁ·Ï‡ÙÂÚË

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‚¿ÏÂÈ ÌÂ ÔÏ‡ ‚·Ú‡ Ê·ÈÓfiÙ˘Ô, ·ÎfiÌË Î·È ÛÂ ·ÛıÂ-

ÓÂ›˜ Ô˘ ·ÚÁfiÙÂÚ· ÂÌÊ·Ó›˙Ô˘Ó ‹ÈÂ˜ ‹ Ì¤ÙÚÈ·˜ ‚·-

Ú‡ÙËÙ·˜ ÌÔÚÊ¤˜ ÙË˜ ÓfiÛÔ˘ (5-7).

¶ÂÚÈÁÚ¿ÊÂÙ·È ‚Ú¤ÊÔ˜ ı‹Ï˘ ËÏÈÎ›·˜ 2,5 ÌËÓÒÓ ÌÂ

ÓÂ˘ÚÔ‚Ï¿ÛÙˆÌ· Î·È ÎÏËÚÔÓÔÌÈÎ‹ ÛÊ·ÈÚÔÎ˘ÙÙ¿Úˆ-

ÛË, ‰‡Ô ÓÔÛÔÏÔÁÈÎ¤˜ ÔÓÙfiÙËÙÂ˜, Ë Û˘Ó‡·ÚÍË ÙˆÓ

ÔÔ›ˆÓ ‰ÂÓ ¤¯ÂÈ ÂÚÈÁÚ·ÊÂ› Ì¤¯ÚÈ Û‹ÌÂÚ· ÛÙËÓ ÂÏ-

ÏËÓÈÎ‹ ‹ ÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›·.

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛË˜

£‹Ï˘ ‚Ú¤ÊÔ˜ 2,5 ÌËÓÒÓ ÂÈÛ‹¯ıË ÛÙËÓ ÎÏÈÓÈÎ‹

ÁÈ· ¤ÏÂÁ¯Ô ·Ó·ÈÌ›·˜. ∂›Ó·È ÙÔ ‰Â‡ÙÂÚÔ ·È‰› Ê·ÈÓÔ-

Ù˘ÈÎ¿ ˘ÁÈÒÓ ÁÔÓ¤ˆÓ, Ô˘ ÁÂÓÓ‹ıËÎÂ ÌÂ Ê˘ÛÈÔÏÔÁÈ-

Îfi ÙÔÎÂÙfi ÌÂÙ¿ ·fi ÙÂÏÂÈfiÌËÓË Ê˘ÛÈÔÏÔÁÈÎ‹ Î‡ËÛË

Î·È ÌÂ ‚¿ÚÔ˜ Á¤ÓÓËÛË˜ 3390 g. ∆Ô ÔÈÎÔÁÂÓÂÈ·Îfi

ÈÛÙÔÚÈÎfi ·Ó·Ê¤ÚÂÙ·È ÂÏÂ‡ıÂÚÔ. ™Â ËÏÈÎ›· 1,5 ÌËÓÒÓ

ÓÔÛËÏÂ‡ıËÎÂ ÁÈ· ‚ÚÔÁ¯ÈÔÏ›ÙÈ‰·, fiÔ˘ Î·È ‰È·ÈÛÙÒ-

ıËÎÂ ·Ó·ÈÌ›· (Hb:8,8gr/dl, ∏t:24,5% ), Ë ÔÔ›· ÌÂÙ¿

·fi 15 ËÌ¤ÚÂ˜ ÂÈ‰ÂÈÓÒıËÎÂ (Hb:7,4gr/dl,

∏t:20,5%) Î·È ÂÈÛ‹¯ıË ÁÈ· ÂÚ·ÈÙ¤Úˆ ¤ÏÂÁ¯Ô.

∫·Ù¿ ÙËÓ ÎÏÈÓÈÎ‹ ÂÍ¤Ù·ÛË ‰È·ÈÛÙÒıËÎ·Ó ˆ¯Úfi-

ÙËÙ· Î·È „ËÏ·ÊËÙfi ÌfiÚÊˆÌ· ÛÙÔ ·ÚÈÛÙÂÚfi ˘Ô¯fiÓ-

‰ÚÈÔ, ÛÎÏËÚ‹˜ Û‡ÛÙ·ÛË˜, ·ÓÒ‰˘ÓÔ, ÎÈÓËÙfi, Ô˘ ‰ÂÓ

Ê·ÈÓfiÙ·Ó Ó· ÂÍÔÚÌ¿Ù·È ·fi ÙÔÓ ÛÏ‹Ó·. ∏ ÏÔÈ‹

Î·Ù¿ Û˘ÛÙ‹Ì·Ù· ÂÍ¤Ù·ÛË ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ‹.

∏ ·Ó·ÈÌ›· ÙÔ˘ ‚Ú¤ÊÔ˘˜, ÌÂ ‚¿ÛË Ù· ÌÔÚÊÔÏÔÁÈ-

Î¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙˆÓ ÂÚ˘ıÚÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ, ‰Ë-

Ï·‰‹ ·ÓÈÛÔÎ˘ÙÙ¿ÚˆÛË, ÌÈÎÚÔÎ˘ÙÙ¿ÚˆÛË, ÔÏ˘¯Úˆ-

Ì·ÙÔÊÈÏ›· Î·È ¤ÓÙÔÓË ÛÊ·ÈÚÔÎ˘ÙÙ¿ÚˆÛË, ÙËÓ ·‡ÍË-

ÛË ÙˆÓ ¢∂∫ (¢∂∫:9,04%, ‰ÈÔÚıˆÌ¤Ó· ¢∂∫:5,97%),

ÙË ÌÈÎÚÔ‡ ‚·ıÌÔ‡ ¤ÌÌÂÛË ˘ÂÚ¯ÔÏÂÚ˘ıÚÈÓ·ÈÌ›·

(1,7mg/dl) Î·È ÙÈ˜ ·ÚÓËÙÈÎ¤˜ ‰ÔÎÈÌ·Û›Â˜ Coombs,

Ù·ÍÈÓÔÌ‹ıËÎÂ ÛÙËÓ ÔÌ¿‰· ÙˆÓ ÌË ¿ÓÔÛˆÓ ·ÈÌÔÏ˘ÙÈ-

ÎÒÓ ·Ó·ÈÌÈÒÓ, ÌÂ Èı·ÓfiÙÂÚË ‰È¿ÁÓˆÛË ÙËÓ ÎÏËÚÔ-

ÓÔÌÈÎ‹ ÛÊ·ÈÚÔÎ˘ÙÙ¿ÚˆÛË.

™ÙÔÓ ·ÂÈÎÔÓÈÛÙÈÎfi ¤ÏÂÁ¯Ô Ô˘ ·ÎÔÏÔ‡ıËÛÂ

(˘ÂÚË¯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜, ˘ÔÏÔÁÈÛÙÈÎ‹ ÙÔÌÔÁÚ·-

Ê›· ÎÔÈÏ›·˜, ÛÈÓıËÚÔÁÚ¿ÊËÌ· ÌÂ ÛÂÛËÌ·ÛÌ¤ÓË ÌÂ-

Ù·-Èˆ‰Ô-‚ÂÓ˙˘Ï-ÁÔ˘·ÓÈ‰›ÓË (MIµG)) ‰È·ÈÛÙÒıËÎÂ

ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ÚfiÛıÈÔ˘ ·Ú·ÓÂÊÚÈ-

ÎÔ‡ ¯ÒÚÔ˘ Â˘ÌÂÁ¤ıË˜ ¯ˆÚÔÎ·Ù·ÎÙËÙÈÎ‹ ÂÍÂÚÁ·Û›·

Ì¤ÁÈÛÙË˜ ‰È·Ì¤ÙÚÔ˘ 6 cm, ÌÂ ÌÔÚÊÔÏÔÁÈÎ¿ ̄ ·Ú·ÎÙË-

ÚÈÛÙÈÎ¿ Û˘Ì‚·Ù¿ ÌÂ ÓÂ˘ÚÔ‚Ï¿ÛÙˆÌ·. ∞ÎÔÏÔ‡ıËÛÂ

ÂÎÙÂÙ·Ì¤ÓÔ˜ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ÚÔ˜ ÂÈ‚Â-

‚·›ˆÛË ÙË˜ ‰È¿ÁÓˆÛË˜ Î·È ÛÙ·‰ÈÔÔ›ËÛË ÙÔ˘ ÓÔÛ‹-

Ì·ÙÔ˜. ªÂ ÙÔÓ ·Ú·ÎÏÈÓÈÎfi ¤ÏÂÁ¯Ô ‰ÂÓ ‰È·ÈÛÙÒıË-

Î·Ó ·ÔÌ·ÎÚ˘ÛÌ¤ÓÂ˜ ÌÂÙ·ÛÙ¿ÛÂÈ˜. ∞ÎÔÏÔ‡ıËÛÂ

Ï‹ÚË˜ ¯ÂÈÚÔ˘ÚÁÈÎ‹ ÂÍ·›ÚÂÛË ÙÔ˘ ÚˆÙÔ·ıÔ‡˜

fiÁÎÔ˘. ∏ ·ıÔÏÔÁÔ·Ó·ÙÔÌÈÎ‹ ¤ÎıÂÛË ÂÈ‚Â‚·›ˆÛÂ

ÙË ‰È¿ÁÓˆÛË ÙÔ˘ ÓÂ˘ÚÔ‚Ï·ÛÙÒÌ·ÙÔ˜, ·ıÔÏÔÁÔ·-

Ó·ÙÔÌÈÎÔ‡ ÛÙ·‰›Ô˘ π, Î·È ÙÔ ‚Ú¤ÊÔ˜ ·Ú·¤ÌÊıËÎÂ

ÛÙÔ √ÁÎÔÏÔÁÈÎfi ∆Ì‹Ì· ÙÔ˘ ¡ÔÛÔÎÔÌÂ›Ô˘ ÁÈ· Â-

Ú·ÈÙ¤Úˆ ·ÓÙÈÌÂÙÒÈÛË.

ªÂÙ¿ ÙËÓ ÔÏÔÎÏ‹ÚˆÛË ÙË˜ ıÂÚ·Â›·˜ ‰ÈÂÓÂÚÁ‹-

ıËÎÂ Ï‹ÚË˜ ·ÈÌ·ÙÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÛÙÔ ‚Ú¤ÊÔ˜ Î·È

ÛÂ fiÏË ÙËÓ ÔÈÎÔÁ¤ÓÂÈ·. ™ÙËÓ ·Ó¿Ï˘ÛË ÙˆÓ ÚˆÙÂ˚-

ÓÒÓ ÙË˜ ÌÂÌ‚Ú¿ÓË˜ ÙˆÓ ÂÚ˘ıÚÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ ‰ÂÓ

‚Ú¤ıËÎÂ Î·Ì›· ÔÛÔÙÈÎ‹ ‹ ÔÈÔÙÈÎ‹ ‰È·Ù·Ú·¯‹ ÙˆÓ

ÚˆÙÂ˚ÓÒÓ. ™ÙË ‰ÔÎÈÌ·Û›· ÔÛÌˆÙÈÎ‹˜ ·ÓÙ›ÛÙ·ÛË˜

ÂÚ˘ıÚÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ ÌÂ ‰È¿Ï˘Ì· NaCl 5 g/l ‰È·È-

ÛÙÒıËÎÂ Ï‡ÛË ÛÙÔ 39% ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÙÔ˘ ‚Ú¤ÊÔ˘˜

Î·È ÛÙÔ 8,5% ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÙÔ˘ ·Ù¤Ú· (ÊÙ 0-5%),

ÂÓÒ ÛÂ ‰È¿Ï˘Ì· NaCl 5,5 g/l ‰È·ÈÛÙÒıËÎÂ Ï‡ÛË ÛÙÔ

1,9% ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÙË˜ ÌËÙ¤Ú·˜ (ÊÙ 0%). ∆· ·Ô-

ÙÂÏ¤ÛÌ·Ù· ÙÔ˘ ÂÏ¤Á¯Ô˘ ¤ıÂÛ·Ó ÙË ‰È¿ÁÓˆÛË ÙË˜

ÎÏËÚÔÓÔÌÈÎ‹˜ ÛÊ·ÈÚÔÎ˘ÙÙ¿ÚˆÛË˜ ÌÂ ÛˆÌ·ÙÈÎfi

˘ÔÏÂÈfiÌÂÓÔ Ù‡Ô ÌÂÙ·‚›‚·ÛË˜.

™˘˙‹ÙËÛË

∆Ô ÓÂ˘ÚÔ‚Ï¿ÛÙˆÌ· ·Ó‹ÎÂÈ ÛÙÔ˘˜ Î·ÎÔ‹ıÂÈ˜

fiÁÎÔ˘˜ ÙÔ˘ Û˘Ì·ıËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Î·È ·ÓÙÈÚÔ-

ÛˆÂ‡ÂÈ ÙÔ 8-10% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ Î·ÎÔËıÒÓ ÓÔ-

ÛËÌ¿ÙˆÓ ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜. ∂È‰ÈÎfiÙÂÚ· fiÌˆ˜,

ÁÈ· ÙË ‚ÚÂÊÈÎ‹ ËÏÈÎ›· ·ÔÙÂÏÂ› ÙÔÓ Û˘¯ÓfiÙÂÚÔ Û˘-

Ì·Á‹ fiÁÎÔ (2). ∏ ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· ÔÈÎ›ÏÏÂÈ ÛËÌ·-

ÓÙÈÎ¿ Î·È ÂÍ·ÚÙ¿Ù·È ·fi ÙËÓ ÂÓÙfiÈÛË Î·È ÙÔ Ì¤ÁÂ-

ıÔ˜ ÙÔ˘ fiÁÎÔ˘. ™Â ÂÚ›Ô˘ 2/3 ÙˆÓ ÂÚÈÙÒÛÂˆÓ

ÂÓÙÔ›˙ÂÙ·È ÛÙËÓ ÎÔÈÏÈ¿ ÌÂ Û˘¯ÓfiÙÂÚË ÂÓÙfiÈÛË Ù·

ÂÈÓÂÊÚ›‰È· Î·È ÎÏÈÓÈÎ¿ ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÌÂ ‰ÈfiÁÎˆÛË

ÎÔÈÏ›·˜, Ë ÔÔ›· Û˘¯Ó¿ ·Ó·Î·Ï‡ÙÂÙ·È Ù˘¯·›· ·fi

ÙÔ˘˜ ÁÔÓÂ›˜ ‹ ÌÂ „ËÏ·ÊËÙ‹ Ì¿˙· Ô˘ ·ÔÎ·Ï‡ÙÂ-

Ù·È ÛÂ Ù˘¯·›· ÎÏÈÓÈÎ‹ ÂÍ¤Ù·ÛË ·fi ÙÔÓ ·È‰›·ÙÚÔ. ™Â

ÂÚ›ÙˆÛË Ô˘ ˘¿Ú¯Ô˘Ó ‰ÈËı‹ÛÂÈ˜ Î·È ¿ÏÏˆÓ ÔÚ-

Á¿ÓˆÓ, Ë ÓfiÛÔ˜ ÌÔÚÂ› Ó· ÚÔ‚¿ÏÂÈ ÌÂ ·Ó¿ÏÔÁË

ÎÏÈÓÈÎ‹ Û˘ÌÙˆÌ·ÙÔÏÔÁ›·, fiˆ˜ ·Ó·ÈÌ›·, ·Ó ¤¯ÂÈ

317¡Â˘ÚÔ‚Ï¿ÛÙˆÌ· Î·È ÎÏËÚÔÓÔÌÈÎ‹ ÛÊ·ÈÚÔÎ˘ÙÙ¿ÚˆÛË

¶·È‰È·ÙÚÈÎ‹ 2007;70:316-319


‰ÈËıËıÂ› Ô Ì˘ÂÏfi˜ ÙˆÓ ÔÛÙÒÓ, Ë·ÙÔÌÂÁ·Ï›· ÛÂ

ÂÓÙfiÈÛË ÙË˜ ÓfiÛÔ˘ ÛÙÔ ‹·Ú, ÎÏ (1,4,8).

™ÙËÓ ÂÚ›ÙˆÛË Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È, ÙÔ ÓÂ˘ÚÔ-

‚Ï¿ÛÙˆÌ· ·ÔÎ·Ï‡ÊıËÎÂ Ù˘¯·›· Î·Ù¿ ÙËÓ ÎÏÈÓÈÎ‹

ÂÍ¤Ù·ÛË ÙÔ˘ ·È‰ÈÔ‡ Ô˘ ¤ÁÈÓÂ ÏfiÁˆ ·Ó·ÈÌ›·˜. ∞Ú¯È-

Î¿, ÙÔ „ËÏ·ÊËÙfi ÌfiÚÊˆÌ· Ô˘ ÂÓÙÔ›ÛıËÎÂ ÛÙËÓ

˘ÔÛÏËÓÈÎ‹ ÂÚÈÔ¯‹, ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ÙËÓ ˘¿Ú-

¯Ô˘Û· ·ÈÌÔÏ˘ÙÈÎ‹ ·Ó·ÈÌ›·, ıÂˆÚ‹ıËÎÂ Û·Ó Èı·Ó‹

ÂÍˆÌ˘ÂÏÈÎ‹ ÂÛÙ›· ·ÈÌÔÔ›ËÛË˜. ™Â ·ÁfiÚÈ 9 ÂÙÒÓ ÌÂ

ÎÏËÚÔÓÔÌÈÎ‹ ÛÊ·ÈÚÔÎ˘ÙÙ¿ÚˆÛË ¤¯ÂÈ ÂÚÈÁÚ·ÊÂ›

ÂÍˆÌ˘ÂÏÈÎ‹ ·ÈÌÔÔ›ËÛË, ˘Ô‰˘fiÌÂÓË Ì¿˙· ÙˆÓ ÂÈ-

ÓÂÊÚÈ‰›ˆÓ, Ë ÔÔ›· ·ÔÎ·Ï‡ÊıËÎÂ ÛÙÔÓ ˘ÂÚË¯Ô-

ÁÚ·ÊÈÎfi ¤ÏÂÁ¯Ô ÙË˜ ÎÔÈÏ›·˜ Ô˘ ¤ÁÈÓÂ ÏfiÁˆ ÈÎÙ¤ÚÔ˘,

ÂÓÒ Ë ÔÚÈÛÙÈÎ‹ ‰È¿ÁÓˆÛË Ù¤ıËÎÂ ÌÂ ÙÔÓ ·ÂÈÎÔÓÈÛÙÈ-

Îfi ¤ÏÂÁ¯Ô Î·È ÙËÓ ÈÛÙÔÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË ÙÔ˘ ÌÔÚÊÒÌ·-

ÙÔ˜ (9). ™ÙË ‰ÈÎ‹ Ì·˜ ÂÚ›ÙˆÛË, Ù· ·ÂÈÎÔÓÈÛÙÈÎ¿

Â˘Ú‹Ì·Ù· Ì·˜ ÚÔÛ·Ó·ÙfiÏÈÛ·Ó ÚÔ˜ ÙËÓ Èı·Ó‹

‰È¿ÁÓˆÛË ÙÔ˘ ÓÂ˘ÚÔ‚Ï·ÛÙÒÌ·ÙÔ˜, ÁÂÁÔÓfi˜ Ô˘ ÂÓÈ-

Û¯‡ıËÎÂ ·fi ÙËÓ ·ÓÂ‡ÚÂÛË ·˘ÍËÌ¤ÓˆÓ ÂÈ¤‰ˆÓ

‚·ÓÈÏÌ·Ó‰ÂÏÈÎÔ‡ (VMA) Î·È ÔÌÔ‚·ÏÈÓÈÎÔ‡ ÔÍ¤Ô˜

(HVA) ÛÙ· Ô‡Ú· Î·È ÙÂÏÈÎ¿ ÂÈ‚Â‚·ÈÒıËÎÂ ÌÂ ÙËÓ

ÈÛÙÔÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË ÙÔ˘ ÚˆÙÔ·ıÔ‡˜ fiÁÎÔ˘.

°ÂÓÈÎ¿, ÛÙË ‰È¿ÁÓˆÛË ÙÔ˘ ÓÂ˘ÚÔ‚Ï·ÛÙÒÌ·ÙÔ˜

Û˘Ì‚¿ÏÏÔ˘Ó Ù· ·ÂÈÎÔÓÈÛÙÈÎ¿ Â˘Ú‹Ì·Ù· Î·È ÔÈ ‚ÈÔ-

¯ËÌÈÎÔ› ‰Â›ÎÙÂ˜. ∞fi ÙÔ˘˜ ‚ÈÔ¯ËÌÈÎÔ‡˜ ‰Â›ÎÙÂ˜, ÛË-

Ì·ÓÙÈÎ‹ ‰È·ÁÓˆÛÙÈÎ‹ ·Í›· ¤¯Ô˘Ó Ù· ·˘ÍËÌ¤Ó· Â›-

Â‰· ÙˆÓ ÌÂÙ·‚ÔÏÈÙÒÓ ÙˆÓ Î·ÙÂ¯ÔÏ·ÌÈÓÒÓ, VMA

Î·È HVA, ÛÙ· Ô‡Ú· ÙˆÓ ·ÛıÂÓÒÓ, Ô˘ ‚Ú›ÛÎÔÓÙ·È

·˘ÍËÌ¤Ó· ÛÂ ¿Óˆ ·fi 90% ÙˆÓ ÂÚÈÙÒÛÂˆÓ. ∞fi

ÙÔÓ ·ÂÈÎÔÓÈÛÙÈÎfi ¤ÏÂÁ¯Ô, Ë ÈÔ ÂÈ‰ÈÎ‹ ÂÍ¤Ù·ÛË Â›-

Ó·È ÙÔ ÔÏfiÛˆÌÔ ÛÈÓıËÚÔÁÚ¿ÊËÌ· ÌÂ MIBG, ·Ó Î·È

¿ÏÏÂ˜ ·ÂÈÎÔÓÈÛÙÈÎ¤˜ Ì¤ıÔ‰ÔÈ, fiˆ˜ Ë ·Ï‹ ·ÎÙÈÓÔ-

ÁÚ·Ê›·, ÙÔ ̆ ÂÚË¯ÔÁÚ¿ÊËÌ· Î·È Ë ̆ ÔÏÔÁÈÛÙÈÎ‹ ÙÔ-

ÌÔÁÚ·Ê›·, ÚÔÛÊ¤ÚÔ˘Ó ÛËÌ·ÓÙÈÎ‹ ‚Ô‹ıÂÈ· (1). ∏

ÔÚÈÛÙÈÎ‹ ‰È¿ÁÓˆÛË Ù›ıÂÙ·È ·fi ÙËÓ ÈÛÙÔÏÔÁÈÎ‹ ÌÂ-

Ï¤ÙË ÈÛÙÈÎÒÓ ‰ÂÈÁÌ¿ÙˆÓ ÙÔ˘ fiÁÎÔ˘, ‹ ·fi ÙÔ Û˘Ó-

‰˘·ÛÌfi ‰È‹ıËÛË˜ ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ Î·È ·˘ÍË-

Ì¤ÓˆÓ ÂÈ¤‰ˆÓ VMA Î·È HVA (3).

∏ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ÓÔÛ‹Ì·ÙÔ˜ ÂÚÈÏ·Ì‚¿ÓÂÈ

Û˘Ó‰˘·ÛÌfi ¯ÂÈÚÔ˘ÚÁÈÎ‹˜ ÂÍ·›ÚÂÛË˜, ¯ËÌÂÈÔıÂÚ·-

Â›·˜ Î·È ·ÎÙÈÓÔıÂÚ·Â›·˜. ™Â ÂÚÈÛÙ·ÙÈÎ¿ ÌÂ ‰˘-

ÛÌÂÓ‹ ÚfiÁÓˆÛË (ÛÙ¿‰ÈÔ IV, ˘ÔÙÚÔ‹ ÓfiÛÔ˘)

ÌÔÚÂ› Ó· ÂÈ¯ÂÈÚËıÂ› ·˘ÙfiÏÔÁË ÌÂÙ·ÌfiÛ¯Â˘ÛË ·Ú-

¯¤ÁÔÓˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ (1).

∏ ·Ó·ÈÌ›· ÛÂ ·È‰È¿ ÌÂ Î·ÎÔ‹ıË ÓÔÛ‹Ì·Ù· Â›Ó·È

·ÚÎÂÙ¿ Û˘¯Ó‹ Î·È ÌÔÚÂ› Ó· Û¯ÂÙ›˙ÂÙ·È ÌÂ ÙË ‰È‹ıË-

ÛË ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ ·fi Î·ÎÔ‹ıË Î‡ÙÙ·Ú·, ÙË

¯ËÌÂÈÔıÂÚ·Â›· Î·È ·ÎÙÈÓÔıÂÚ·Â›· ‹/Î·È ÙËÓ ÔÍÂ›·

·ÒÏÂÈ· ·›Ì·ÙÔ˜. ∆· ÔÛÔÛÙ¿ ·Ó·ÈÌ›·˜ Â›Ó·È Û·ÊÒ˜

ÌÂÁ·Ï‡ÙÂÚ· ÛÙÈ˜ Î·ÎÔ‹ıÂÈÂ˜ ÌÂ ‰È‹ıËÛË ÙÔ˘ Ì˘ÂÏÔ‡

ÙˆÓ ÔÛÙÒÓ (ÏÂ˘¯·ÈÌ›·, Ï¤ÌÊˆÌ·, ÓÂ˘ÚÔ‚Ï¿ÛÙˆÌ·

ÛÙ·‰›Ô˘ 3-4), Û˘ÁÎÚÈÓfiÌÂÓ· ÌÂ ¿ÏÏÔ˘˜ Ù‡Ô˘˜ Î·Ú-

Î›ÓÔ˘. ∏ ·Ó·ÈÌ›· ÛÂ fiÏÂ˜ ·˘Ù¤˜ ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ Â›-

Ó·È Î·Ù¿ Î·ÓfiÓ· ÔÚıfi¯ÚˆÌË - ÔÚıÔÎ˘ÙÙ·ÚÈÎ‹, ÔÊÂÈ-

ÏfiÌÂÓË ÛÂ ·ÓÂ·ÚÎ‹ ·Ú·ÁˆÁ‹ ÂÚ˘ıÚÔÎ˘ÙÙ¿ÚˆÓ. ∏

·ÈÌÔÏ˘ÙÈÎ‹ ·Ó·ÈÌ›· Ô˘ Û˘Ó‰˘¿˙ÂÙ·È ÌÂ Î·ÎÔ‹ıË

ÓÔÛ‹Ì·Ù· ··ÓÙ¿Ù·È Î˘Ú›ˆ˜ ÛÂ ÏÂÌÊÒÌ·Ù·, Î·È ¤¯ÂÈ

¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ¿ÓÔÛÔ˘ Ù‡Ô˘ ·ÈÌÔÏ˘ÙÈÎ‹˜ ·Ó·È-

Ì›·˜ (10). ∆Ô È‰È·›ÙÂÚÔ ÛÙÔÈ¯Â›Ô ÙË˜ ÂÚ›ÙˆÛË˜

Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È Â›Ó·È fiÙÈ Ë ·Ó·ÈÌ›· ‰ÂÓ Û˘Û¯ÂÙÈ˙fi-

Ù·Ó ÌÂ ÙÔ ÓÂ˘ÚÔ‚Ï¿ÛÙˆÌ·, ·ÏÏ¿ ÔÊÂÈÏfiÙ·Ó ÛÂ ÌË

¿ÓÔÛÔ˘ Ù‡Ô˘ ·ÈÌfiÏ˘ÛË Î·È ÂÈ‰ÈÎfiÙÂÚ· ÛÙËÓ ÎÏËÚÔ-

ÓÔÌÈÎ‹ ÛÊ·ÈÚÔÎ˘ÙÙ¿ÚˆÛË, fiˆ˜ ÚÔ¤Î˘„Â ·fi ÙÔÓ

ÂÚ·ÈÙ¤Úˆ ¤ÏÂÁ¯Ô.

∏ ÎÏËÚÔÓÔÌÈÎ‹ ÛÊ·ÈÚÔÎ˘ÙÙ¿ÚˆÛË ·ÔÙÂÏÂ› ·È-

Ì·ÙÔÏÔÁÈÎfi ÓfiÛËÌ· Ô˘ Î·Ù¿ Î·ÓfiÓ· ÌÂÙ·‚È‚¿˙Â-

Ù·È ÌÂ ÛˆÌ·ÙÈÎfi ÂÈÎÚ·ÙËÙÈÎfi (~75%), Û·ÓÈfiÙÂÚ·

ÌÂ ÛˆÌ·ÙÈÎfi ˘ÔÏÂÈfiÌÂÓÔ ÁÔÓ›‰ÈÔ (~25%), ÂÓÒ ÌÈ-

ÎÚfi ÌfiÓÔ ÔÛÔÛÙfi ·ÊÔÚ¿ Ó¤Â˜ ÌÂÙ·ÏÏ¿ÍÂÈ˜. √ÊÂ›-

ÏÂÙ·È ÛÂ ¤ÏÏÂÈÌÌ· ÙÔ˘ ÚˆÙÂ˚ÓÈÎÔ‡ ÂÚ˘ıÚÔÎ˘ÙÙ·ÚÈ-

ÎÔ‡ ÛÎÂÏÂÙÔ‡, Ô˘ ÌÔÚÂ› Ó· ·ÊÔÚ¿ ÔÛÔÙÈÎ¤˜ ‰È·-

Ù·Ú·¯¤˜ ÙˆÓ ÚˆÙÂ˚ÓÒÓ ÛÂÎÙÚ›ÓË˜, ·ÁÎ˘Ú›ÓË˜,

ÚˆÙÂ˝ÓË˜ 3 ‹ ÚˆÙÂ˝ÓË˜ 4,2, Î·È Ô‰ËÁÂ› ÛÂ ÛÊ·ÈÚÈ-

Îfi Û¯‹Ì· ÂÚ˘ıÚÔÎ˘ÙÙ¿ÚˆÓ (5). ∏ ÂÏ·ÙÙˆÌ¤ÓË Â˘-

Î·Ì„›· ÙˆÓ ÛÊ·ÈÚÔÎ˘ÙÙ·ÚÈÎÒÓ ÂÚ˘ıÚÔÎ˘ÙÙ¿ÚˆÓ

ÚÔÎ·ÏÂ› ÙËÓ ÚfiˆÚË Î·Ù·ÛÙÚÔÊ‹ ÙÔ˘˜ ÛÙÔÓ ÛÏ‹-

Ó·. ∏ ‚·Ú‡ÙËÙ· ÙË˜ ÓfiÛÔ˘ ÔÈÎ›ÏÏÂÈ ·fi ·Û˘ÌÙˆ-

Ì·ÙÈÎ‹ ¤ˆ˜ ‚·ÚÈ¿ ·ÈÌÔÏ˘ÙÈÎ‹ ·Ó·ÈÌ›· ÌÂ ÛÏËÓÔÌÂ-

Á·Ï›· Î·È Û˘¯Ó¤˜ ÌÂÙ·ÁÁ›ÛÂÈ˜. ∏ ‰È¿ÁÓˆÛË ÙË˜ ÛÊ·È-

ÚÔÎ˘ÙÙ¿ÚˆÛË˜ Ù›ıÂÙ·È ·fi (5,6):

1) ÙËÓ ‡·ÚÍË ÛÙÔ Â›¯ÚÈÛÌ· ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·-

ÙÔ˜ ÛÊ·ÈÚÔÎ˘ÙÙ¿ÚˆÓ ÛÂ ÔÛÔÛÙfi ¿Óˆ ·fi 15-20%,

2) ÙË ‰ÔÎÈÌ·Û›· ÔÛÌˆÙÈÎ‹˜ ·ÓÙ›ÛÙ·ÛË˜ ÂÚ˘ıÚÒÓ

·ÈÌÔÛÊ·ÈÚ›ˆÓ (¤ÎıÂÛË ÛÂ ˘fiÙÔÓÔ ‰È¿Ï˘Ì· NaCl

Ô‰ËÁÂ› ÛÂ Ù·¯‡ÙÂÚË Ï‡ÛË ÙˆÓ ÛÊ·ÈÚÔÎ˘ÙÙ¿ÚˆÓ), Î·È

3) ÙËÓ ·Ó¿Ï˘ÛË ÙˆÓ ÚˆÙÂ˚ÓÒÓ ÙË˜ ÌÂÌ‚Ú¿ÓË˜

ÙˆÓ ÂÚ˘ıÚÒÓ (ËÏÂÎÙÚÔÊfiÚËÛË Á¤ÏË˜ ÁÈ· Ù·˘ÙÔÔ›-

ËÛË ÙË˜ ÂÈ‰ÈÎ‹˜ ÚˆÙÂ˚ÓÈÎ‹˜ ·ÓˆÌ·Ï›·˜).

ªÂ ÙË ‰ÔÎÈÌ·Û›· ÔÛÌˆÙÈÎ‹˜ ·ÓÙ›ÛÙ·ÛË˜ ÂÚ˘-

ıÚÒÓ ÂÈ‚Â‚·ÈÒıËÎÂ Ë ÛÊ·ÈÚÔÎ˘ÙÙ¿ÚˆÛË ÛÙÔ ‚Ú¤-

ÊÔ˜ Î·È Ë ÂÙÂÚÔ˙˘ÁˆÙ›· ÛÙÔ˘˜ ÁÔÓÂ›˜. ¡· ÛËÌÂÈˆıÂ›

fiÙÈ ÙÔ ÁÂÁÔÓfi˜ ÙË˜ ÌË Î·Ù·ÁÚ·Ê‹˜ Â˘ÚËÌ¿ÙˆÓ ·fi

ÙËÓ ·Ó¿Ï˘ÛË ÚˆÙÂ˚ÓÒÓ ÙË˜ ÌÂÌ‚Ú¿ÓË˜, fiˆ˜ Û˘-

Ó¤‚Ë ÛÙËÓ ÂÚ›ÙˆÛË Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È, ‰ÂÓ ·Ô-

ÎÏÂ›ÂÈ ÙÔ ÓfiÛËÌ·, Î·È ÙfiÙÂ Ë ‰È¿ÁÓˆÛË Ù›ıÂÙ·È ·fi

ÙË ‰ÔÎÈÌ·Û›· ÔÛÌˆÙÈÎ‹˜ ·ÓÙ›ÛÙ·ÛË˜ ÂÚ˘ıÚÒÓ Î·È ÙË

ÌÔÚÊÔÏÔÁ›· ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜ ÛÂ ¿Û¯ÔÓÙ·

Î·È ÁÔÓÂ›˜.

∏ Û˘Ó‡·ÚÍË ÛÊ·ÈÚÔÎ˘ÙÙ·ÚÈÎ‹˜ ·Ó·ÈÌ›·˜ Î·È

ÓÂ˘ÚÔ‚Ï·ÛÙÒÌ·ÙÔ˜ Ê·›ÓÂÙ·È Ó· ·ÔÙÂÏÂ› ÂÍ·ÈÚÂÙÈ-

Î¿ Û¿ÓÈÔ Û˘Ó‰˘·ÛÌfi, ‰Â‰ÔÌ¤ÓÔ˘ fiÙÈ ‰ÂÓ ¤¯ÂÈ ÂÚÈ-

ÁÚ·ÊÂ› ¿ÏÏÔ ·Ó¿ÏÔÁÔ ÂÚÈÛÙ·ÙÈÎfi ÛÙËÓ ÚÔÛÈÙ‹ ÛÂ

Ì·˜ ‰ÈÂıÓ‹ Î·È ÂÏÏËÓÈÎ‹ ‚È‚ÏÈÔÁÚ·Ê›·. ∞ÎfiÌË,

·ÛıÂÓÂ›˜ ÌÂ Û˘ÁÁÂÓ‹ ÛÊ·ÈÚÔÎ˘ÙÙ¿ÚˆÛË ‰ÂÓ Ê·›ÓÂ-

Ù·È Ó· ÂÌÊ·Ó›˙Ô˘Ó ·˘ÍËÌ¤ÓÔ Î›Ó‰˘ÓÔ ·ÈÌ·ÙÔÏÔÁÈ-

Î‹˜ ‹ ¿ÏÏË˜ Î·ÎÔ‹ıÂÈ·˜, ·ÊÔ‡ ¤¯Ô˘Ó ·Ó·ÊÂÚıÂ›

318 π.¶. ¶·Ó·ÁÈÒÙÔ˘ Î·È Û˘Ó.



ÌÂÌÔÓˆÌ¤ÓÂ˜ ÌfiÓÔ ÂÚÈÙÒÛÂÈ˜ Û˘Ó‰˘·ÛÌÔ‡ ÙË˜

.¯. ÌÂ ÔÍÂ›· ÏÂÌÊÔ‚Ï·ÛÙÈÎ‹ ÏÂ˘¯·ÈÌ›·, ÌÂ Ì˘ÂÏÔ-

‰˘ÛÏ·ÛÙÈÎfi Û‡Ó‰ÚÔÌÔ ‹ ÌÂ ÔÏÏ·ÏÔ‡Ó Ì˘¤ÏˆÌ·

(11). Œ¯ÂÈ Â›ÛË˜ ·Ó·ÊÂÚıÂ› ÌÂÙ·ÙÚÔ‹ ÙˆÓ Ê˘ÛÈÔ-

ÏÔÁÈÎÒÓ ÂÚ˘ıÚÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ ÛÂ ÛÊ·ÈÚÔÎ‡ÙÙ·Ú·,

ÌÂÙ¿ ·fi ÂÒ·ÛË ÌÂ Î·ÎÔ‹ıË Î‡ÙÙ·Ú·, ÚÔÊ·ÓÒ˜

·fi ÙËÓ Â›‰Ú·ÛË Ô˘ ¿ÛÎËÛ·Ó ¿Óˆ ÙÔ˘˜ Ù· Î·-

ÎÔ‹ıË Î‡ÙÙ·Ú·, ¯ˆÚ›˜ fiÌˆ˜ Ó· ÌÔÚÂ› Ó· ·ÈÙÈÔÏÔ-

ÁËıÂ› ·˘Ùfi ÙÔ Ê·ÈÓfiÌÂÓÔ (12). ∆¤ÏÔ˜, Û˘Ó‡·ÚÍË

Û˘ÁÁÂÓÔ‡˜ ÛÊ·ÈÚÔÎ˘ÙÙ¿ÚˆÛË˜ ÌÂ Î·ÏÔ‹ıÂÈ˜

fiÁÎÔ˘˜, fiˆ˜ ·Ì·ÚÙÒÌ·Ù· ÛÏËÓfi˜, ÂÛÙ›Â˜ ÂÍˆ-

Ì˘ÂÏÈÎ‹˜ ·ÈÌÔÔ›ËÛË˜ Î·È Ì˘ÂÏÔÏ›ˆÌ·, ·Ó·Ê¤ÚÔ-

ÓÙ·È Û˘¯ÓfiÙÂÚ· (9).

¶Èı·ÓÒ˜, ÛÙÔ Ì¤ÏÏÔÓ, ÂÊfiÛÔÓ ˘¿ÚÍÔ˘Ó ¿ÏÏ·

·Ó¿ÏÔÁ· ÂÚÈÛÙ·ÙÈÎ¿, Ó· ‰ÈÂ˘ÎÚÈÓÈÛıÂ› ·Ó Ë Û˘Ó‡-

·ÚÍË ÙˆÓ ‰‡Ô ·˘ÙÒÓ ‰È·ÊÔÚÂÙÈÎÒÓ ÓÔÛÔÏÔÁÈÎÒÓ

ÔÓÙÔÙ‹ÙˆÓ, Ì›·˜ ·ÈÌ·ÙÔÏÔÁÈÎ‹˜ Î·È ÂÓfi˜ Û˘Ì·ÁÔ‡˜

fiÁÎÔ˘ (ÎÏËÚÔÓÔÌÈÎ‹ ÛÊ·ÈÚÔÎ˘ÙÙ¿ÚˆÛË-ÓÂ˘ÚÔ‚Ï¿-

ÛÙˆÌ·), ‹Ù·Ó Ù˘¯·›· ‹ ·Ó ˘¿Ú¯ÂÈ Î¿ÔÈÔ˜ ÎÔÈÓfi˜

·ıÔÁÂÓÂÙÈÎfi˜ ÌË¯·ÓÈÛÌfi˜.


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faand C, Barett A (editors). Cancer in children: Clinical

management. 4th ed. Oxford University Press;1997. p

274-291.

2. Stiller CA, Draper GJ. The epidemiology of cancer in chil-

dren. In: Voute PA, Kalifaand C, Barett A (editors).Cancer in children: Clinical management. 4th ed. OxfordUniversity Press;1997. p 1-20.

3. Golden CB, Feusner JH. Malignant abdominal masses inchildren: quick guide to evaluation and diagnosis. PediatrClin North Am 2002;49:1369-1392.

4. Chandler JC, Gauderer MW. The neonate with an abdom-inal mass. Pediatr Clin North Am 2004;51:979-997.

5. Packman CH. The spherocytic haemolytic anaemias. Br JHaematol 2001;112:888-899.

6. Bolton-Maggs PH. The diagnosis and management ofhereditary spherocytosis. Baillieres Best Pract Res ClinHaematol 2000;13:327-342.

7. Segel GB, Hirsh MG, Feif SA. Managing anemia in pedi-atric office practice : Part 1. Pediatr Rev 2002;23:75-84.

8. Michon J. Incidence of anemia in pediatric cancer patientsin Europe: results of a large, international survey. Med Pe-diatr Oncol 2002;39:448-450.

9. Calhoun SK, Murphy RC, Shariati N, Jacir N, Bergman K.Extramedullary hematopoiesis in a child with hereditaryspherocytosis: an uncommon cause of an adrenal mass.Pediatr Radiol 2001;31:879-881.

10. Ruggiero A, Riccardi R. Interventions for anemia in pedi-atric cancer patients. Med Pediatr Oncol 2002;39:451-454.

11. Martinez-Climent JA, Lopez- Andreu JA, Ferris-TortajadaJ, Perez-Sirvent ML, Castel-Sanchez V. Acute lymphoblas-tic leukaemia in a child with hereditary spherocytosis. EurJ Pediatr 1995;154:753-754.

12. Chaimoff C, Fishman P, Hart J, Djaldetti M. Transforma-tion of erythrocytes to spherocytes following incubationwith malignant cells. J Submicrosc Cytol 1985;17:465-468.

319¡Â˘ÚÔ‚Ï¿ÛÙˆÌ· Î·È ÎÏËÚÔÓÔÌÈÎ‹ ÛÊ·ÈÚÔÎ˘ÙÙ¿ÚˆÛË

¶·È‰È·ÙÚÈÎ‹ 2007;70:316-319


320 ∂¡¢π∞º∂ƒ√À™∞ ¶∂ƒπ¶∆ø™∏ CASE REPORT


∂ÈÛ·ÁˆÁ‹

√ ÌÔÓ‹ÚË˜ ÎÂÓÙÚÈÎfi˜ ¿Óˆ ÙÔÌ¤·˜ Ô‰fiÓÙ·˜(ª∫∞∆√) ÛÂ ÓÂÔÁÓ¿ ÌÂ Û˘ÁÁÂÓ‹ ÛÙ¤ÓˆÛË ÚÈÓÈ-ÎÒÓ ÎÔÈÏÔÙ‹ÙˆÓ (™™ƒ∫) ·ÔÙÂÏÂ› ¤Ó·Ó Î·Ï¿ÙÂÎÌËÚÈˆÌ¤ÓÔ, Û¿ÓÈÔ Û˘Ó‰˘·ÛÌfi Ô˘ ÂÚÈ-ÁÚ¿ÊËÎÂ ÂÎÙÂÓÒ˜ ÙË ‰ÂÎ·ÂÙ›· ÙÔ˘ 1980 (1). ∏™™ƒ∫ Û˘ÓÔ‰Â˘fiÙ·Ó ÌÂ ª∫∞∆√ ÛÂ ÔÛÔÛÙfi60%-70% (2-4), ÂÓÒ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ª∫∞∆√ Ë·ÚÔ˘Û›· Î¿ÔÈ·˜ ÌÔÚÊ‹˜ ™™ƒ∫ Â›Ó·È ÛÙ·ıÂÚfiÂ‡ÚËÌ· (5).

ªÂÌÔÓˆÌ¤Ó· ‹ ÛÂ Û˘Ó‰˘·ÛÌÔ‡˜, Ë ™™ƒ∫Î·È Ô ª∫∞∆√ ÌÔÚÂ› Ó· Û˘Ó‰¤ÔÓÙ·È ÌÂ Û˘ÁÁÂ-ÓÂ›˜ ·ÓˆÌ·Ï›Â˜ ·fi ¿ÏÏ· Û˘ÛÙ‹Ì·Ù·, ÁÓˆÛÙ¿

Û‡Ó‰ÚÔÌ· Î·È ¯ÚˆÌÔÛˆÌÈÎ¤˜ ·ÓˆÌ·Ï›Â˜ ‹ Ó···ÓÙÔ‡Ó ÛÂ Î·Ù¿ Ù· ¿ÏÏ· Ê˘ÛÈÔÏÔÁÈÎ¿ ¿ÙÔÌ·(6). ªÔÚÂ› Â›ÛË˜, Ó· ·ÔÙÂÏÔ‡Ó ÙÈ˜ ÌÔÓ·‰È-Î¤˜ ÎÏÈÓÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ ÔÏÔÚÔÛÂÁÎÂÊ·Ï›·˜,˘Ô-˘ÔÊ˘ÛÈÛÌÔ‡ Î·È Î·ı˘ÛÙ¤ÚËÛË˜ ÙË˜ ·Ó¿-Ù˘ÍË˜ Î·Ù¿ ÙË ‚ÚÂÊÈÎ‹ ËÏÈÎ›· (6,7).

¶ÂÚÈÁÚ¿ÊÔ˘ÌÂ ÙÚ›· ÓÂÔÁÓ¿ ÌÂ ™™∞∆ Î·Èª∫∞∆√ ÁÈ· Ó· ÙÔÓÈÛıÂ› Ë Û·ÓÈfiÙËÙ· Î·È Ë ÛË-Ì·Û›· ÙË˜ ‰È¿ÁÓˆÛË˜ Î·Ù¿ ÙË ÓÂÔÁÓÈÎ‹ ËÏÈÎ›·.

¶ÂÚ›ÙˆÛË 1Ë

¡ÂÔÁÓfi, ·ÁfiÚÈ, ‰Â‡ÙÂÚÔ ·È‰› Ê·ÈÓÔÌÂÓÈÎ¿˘ÁÈÒÓ ÁÔÓ¤ˆÓ Ô˘ ‰ÂÓ Â›¯·Ó Û˘ÁÁ¤ÓÂÈ· ÌÂÙ·Í‡

™˘ÁÁÂÓ‹˜ ÛÙ¤ÓˆÛË ÚÈÓÈÎÒÓ ÎÔÈÏÔÙ‹ÙˆÓ Î·È ÌÔÓ‹ÚË˜ ÎÂÓÙÚÈÎfi˜

¿Óˆ ÙÔÌ¤·˜ Ô‰fiÓÙ·˜ ÛÂ ÙÚ›· ‚Ú¤ÊË

∞. ∞Ó‰Ú¤Ô˘, ∞. ∫Ô‡ÙÏ·, ∂. ∑Â˘Á·Ú›‰Ô˘, A. ™·ÎÂÏÏ·ÚÔÔ‡ÏÔ˘

¶ÂÚ›ÏË„Ë: ¶ÂÚÈÁÚ¿ÊÔÓÙ·È ÙÚ›· ‚Ú¤ÊË ÌÂ Û˘ÁÁÂÓ‹ ÛÙ¤ÓˆÛË ·ÈÔÂÈ‰Ô‡˜ ÙÚ‹Ì·ÙÔ˜ (™™∞∆) Î·È ÌÔÓ‹ÚËÎÂÓÙÚÈÎfi ¿Óˆ ÙÔÌ¤· Ô‰fiÓÙ· (ª∫∞∆√). √ ª∫∞∆√ ÛÂ ÓÂÔÁÓ¿ ÌÂ ™™AT ·ÔÙÂÏÂ› ¤Ó·Ó Î·Ï¿ ÙÂÎÌËÚÈˆÌ¤ÓÔ,Û¿ÓÈÔ Û˘Ó‰˘·ÛÌfi Ô˘ ÂÚÈÁÚ¿ÊËÎÂ ÂÎÙÂÓÒ˜ ÙË ‰ÂÎ·ÂÙ›· ÙÔ˘ 1980. ∏ ‰È¿ÁÓˆÛË ÙË˜ ™™∞∆ Ù¤ıËÎÂ ÛÙËÓÂÔÁÓÈÎ‹ ËÏÈÎ›· ‚·ÛÈÛÌ¤ÓË ÛÙ· ÎÏÈÓÈÎ¿ Â˘Ú‹Ì·Ù· ÙË˜ ıÔÚ˘‚Ò‰Ô˘˜, Û˘Ú›ÙÙÔ˘Û·˜ ÚÈÓÈÎ‹˜ ·Ó·ÓÔ‹˜ Î·ÈÙË˜ ·‰˘Ó·Ì›·˜ ‰Èfi‰Ô˘ ÚÈÓÔÁ·ÛÙÚÈÎÔ‡ Î·ıÂÙ‹Ú· ÌÂÁ¤ıÔ˘˜ Fr 8. ∏ ÂÈ‚Â‚·›ˆÛË ¤ÁÈÓÂ ÌÂ ·ÍÔÓÈÎ‹ ÙÔÌÔ-ÁÚ·Ê›· ¿Óˆ ÁÓ¿ıÔ˘. ∏ ‡·ÚÍË ª∫∞∆√ ‰È·ÁÓÒÛıËÎÂ ÌÂ ·ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›· ¿Óˆ ÁÓ¿ıÔ˘ ÛÙ· 2 ÂÚÈ-ÛÙ·ÙÈÎ¿ Î·Ù¿ ÙË ÓÂÔÁÓÈÎ‹ ËÏÈÎ›· Î·È ÛÙÔ ¿ÏÏÔ ÎÏÈÓÈÎ¿, ÛÂ ËÏÈÎ›· 10 ÌËÓÒÓ. ŒÓ· ÓÂÔÁÓfi Â›¯Â ÔÏÏ·Ï¤˜ÌÂ›˙ÔÓÂ˜ Û˘ÁÁÂÓÂ›˜ ·ÓˆÌ·Ï›Â˜ ˘fi ÌÔÚÊ‹ Û˘Ó‰ÚfiÌÔ˘ ÌÂ ˘Ô-˘ÔÊ˘ÛÈÛÌfi, ·ÙÚËÛ›· ÚˆÎÙÔ‡, ÎÚ˘-„ÔÚ¯›·, ÌÈÎÚfi ¤Ô˜, ıÔÏˆÙ‹ ˘ÂÚÒ· Î·È ÓÂÊÚÈÎ¤˜ ·ÓˆÌ·Ï›Â˜. ∆· ¿ÏÏ· ‰‡Ô Â›¯·Ó ‹È· Û˘ÓÔ‰¿ ÚÔ‚Ï‹-Ì·Ù·, fiˆ˜ ·ÚÔ‰ÈÎ‹ ‰˘ÛÊ·Á›· Î·È Î·ı˘ÛÙ¤ÚËÛË ÛˆÌ·ÙÈÎ‹˜ ·Ó¿Ù˘ÍË˜. ™˘˙ËÙÂ›Ù·È Ë Û¯¤ÛË Ô˘ ¤¯Ô˘ÓÔÈ ·ÓˆÌ·Ï›Â˜ ·˘Ù¤˜ ÌÂ ÛÔ‚·Ú¤˜ ·ı‹ÛÂÈ˜, fiˆ˜ Ë ÔÏÔÚÔÛÂÁÎÂÊ·Ï›·, Ô ˘Ô-˘ÔÊ˘ÛÈÛÌfi˜ Î·È ÙÔ ÎÔÓÙfi·Ó¿ÛÙËÌ·.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ™˘ÁÁÂÓ‹˜ ÛÙ¤ÓˆÛË ÚÈÓÈÎÒÓ ÎÔÈÏÔÙ‹ÙˆÓ, Û˘ÁÁÂÓ‹˜ ÛÙ¤ÓˆÛË ·ÈÔÂÈ‰Ô‡˜ ÙÚ‹Ì·ÙÔ˜, ÌÔÓ‹ÚË˜ ÎÂ-

ÓÙÚÈÎfi˜ ¿Óˆ ÙÔÌ¤·˜ Ô‰fiÓÙ·˜.

Congenital nasal pyriform stenosis and single central upper maxillary

incisor in three infants

A. Andreou, A. Koutla, E. Zeugaridou, A. Sakellaropoulou

Abstract: Three neonates with congenital nasal pyriform stenosis (CNPS) and a single central maxillaryincisor (SCMI) are described. SCMI in neonates with CNPS comprises a well documented but rarecombination that was extensively described in the 1980s. The diagnosis of CNPS was made in infancy,based on the clinical findings of noisy, wheezing nasal breathing and the inability of passage of a rhino-gastric tube size Fr 8. SCMI was diagnosed in infancy in two of the neonates by computer tomography(CT) scanning of upper maxilla, and in the third on the basis of clinical findings at the 10th month of age.One neonate had associated multiple major congenital abnormalities in the form of a syndrome, withhypopituitarism, anal atresia, cryptorchidism, small penis, high arched palate and renal malformations.The other two had mild coexisting problems, such as transient dysphagia and developmental retardation.The relationship between CNPS and SCMI and severe abnormalities, such as holoprosencephaly,hypopituitarism and short stature are discussed.

Key words: Congenital nasal stenosis, congenital nasal pyriform stenosis, single central upper maxillary incisor.

¡ÂÔÁÓÔÏÔÁÈÎfi ∆Ì‹Ì· ∂™À,°¶¡ “πÔÎÚ¿ÙÂÈÔ”,£ÂÛÛ·ÏÔÓ›ÎË


∞Ï¤Í·Ó‰ÚÔ˜ ∞Ó‰Ú¤Ô˘[email protected]ÃÂÈÌˆÓ›‰Ô˘ 15, ∫·Ï·Ì·ÚÈ¿T.K. 551 33, £ÂÛÛ·ÏÔÓ›ÎË

Neonatology Department¡∏π, Hippokration GeneralHospital, Thessaloniki,Greece

Correspondence:

Alexandros [email protected], Chimonidou St, Kalamaria551 33, Thessaloniki, Greece


321™˘ÁÁÂÓ‹˜ ÛÙ¤ÓˆÛË ÚÈÓÈÎÒÓ ÎÔÈÏÔÙ‹ÙˆÓ Î·È ÌÔÓ‹ÚË˜ ÎÂÓÙÚÈÎfi˜ ¿Óˆ ÙÔÌ¤·˜ Ô‰fiÓÙ·˜

¶·È‰È·ÙÚÈÎ‹ 2007;70:320-324

ÙÔ˘˜, ÌÂÙ·Ê¤ÚıËÎÂ ÛÙËÓ ÎÏÈÓÈÎ‹ Ì·˜ ·Ì¤Ûˆ˜ ÌÂÙ¿

ÙË Á¤ÓÓËÛË ÏfiÁˆ ·Ó·ÓÂ˘ÛÙÈÎ‹˜ ‰˘Û¯¤ÚÂÈ·˜. °ÂÓ-

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ÓÂ›˜ ·ÓˆÌ·Ï›Â˜.

H ‚·ıÌÔÏÔÁ›· Apgar ‹Ù·Ó 9 ÛÙÔ 1Ô Î·È 5Ô ÏÂÙfi.

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√ ˘ÂÚË¯ÔÁÚ·ÊÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙË˜ ÎÔÈÏÈ·Î‹˜ ¯ÒÚ·˜

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ÏÔÁÈÎ‹.

√ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ÙË˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÙË˜

˘fiÊ˘ÛË˜ ÛÂ ËÏÈÎ›· 2 ÂÙÒÓ ¤‰ÂÈÍÂ ·ÓÂ¿ÚÎÂÈ· ÙË˜

·˘ÍËÙÈÎ‹˜ ÔÚÌfiÓË˜ (Â›Â‰· ÛÙ· 0 ÏÂÙ¿: 0,36

ng/ml, ÛÙ· 60 ÏÂÙ¿: 0,48 ng/ml, ÛÙ· 90 ÏÂÙ¿: 0,44

ng/ml, Î·È ÛÙ· 120 ÏÂÙ¿: 0,4 ng/ml), ÙË˜ ı˘Ï·ÎÈÔ-

ÙÚfiÔ˘ (FSH: 0) Î·È ÙË˜ ˆ¯ÚÈÓÔÙÚfiÔ˘ ÔÚÌfiÓË˜

(LH: 0). ∂Ï·ÙÙˆÌ¤Ó· ‹Ù·Ó Î·È Ù· Â›Â‰· ÔÏÈÎ‹˜ ı˘-

ÚÔÍ›ÓË˜ (∆4: 2,78 mg/dl), ÔÏÈÎ‹˜ ÙÚÈ-Èˆ‰Ôı˘ÚÔÓ›ÓË˜

(∆3: 51,6 ng/dl), ÂÏÂ‡ıÂÚË˜ ∆4 (FT4: 0,51 ng/dl) Î·È

ÂÏÂ‡ıÂÚË˜ ∆3 (F∆3: 1,07 pg/dl). ∆· Â›Â‰· ÙË˜

ÊÏÔÈÔÙÚfiÔ˘ (ACTH) Î·È ı˘ÚÂÔÙÚfiÔ˘ ÔÚÌfiÓË˜

(TSH), Î·ıÒ˜ Î·È ÙË˜ ÎÔÚÙÈ˙fiÏË˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ¿.


¡ÂÔÁÓfi, ÎÔÚ›ÙÛÈ, ÙÚ›ÙÔ ·È‰› ÙË˜ ÔÈÎÔÁ¤ÓÂÈ·˜,

ÌÂÙ·Ê¤ÚıËÎÂ ÛÙËÓ ÎÏÈÓÈÎ‹ Ì·˜ ÛÂ ËÏÈÎ›· 16 ËÌÂ-

ÚÒÓ, ÏfiÁˆ ·Ó·ÓÂ˘ÛÙÈÎ‹˜ ‰˘Û¯¤ÚÂÈ·˜ Î·È ÛÙ¤Óˆ-

ÛË˜ ÙˆÓ ÚÈÓÈÎÒÓ ÎÔÈÏÔÙ‹ÙˆÓ ¿ÌÊˆ. ∏ ÌËÙ¤Ú·, 32

ÂÙÒÓ, ¤·Û¯Â ·fi ÛÎÏ‹Ú˘ÓÛË Î·Ù¿ Ï¿Î·˜ Î·È ‰ÂÓ

Â›¯Â Û˘ÁÁ¤ÓÂÈ· ÌÂ ÙÔÓ Î·ıfiÏ· ˘ÁÈ‹ ·Ù¤Ú·. ¢ÂÓ

·Ó·Ê¤ÚÔÓÙ·È Û˘ÁÁÂÓÂ›˜ ·ÓˆÌ·Ï›Â˜ ÛÙÔ ÔÈÎÔÁÂÓÂÈ·-

Îfi ÂÚÈ‚¿ÏÏÔÓ.

∆Ô Ì·ÈÂ˘ÙÈÎfi ÈÛÙÔÚÈÎfi ‹Ù·Ó ÂÏÂ‡ıÂÚÔ. ∏ Î‡ËÛË

ÂÚ·ÙÒıËÎÂ ÙËÓ 37Ë Â‚‰ÔÌ¿‰·, ÌÂ Î·ÈÛ·ÚÈÎ‹ ÙÔÌ‹

ÏfiÁˆ ÚÔËÁËıÂ›Û·˜. ∆Ô ÓÂÔÁÓfi ¤ÎÏ·„Â ·Ì¤Ûˆ˜ ÌÂ-

Ù¿ ÙË Á¤ÓÓËÛË Î·È Ï›ÁÂ˜ ÒÚÂ˜ ·ÚÁfiÙÂÚ· ÂÌÊ¿ÓÈÛÂ

·Ó·ÓÂ˘ÛÙÈÎ‹ ‰˘Û¯¤ÚÂÈ· Î·È ÂÈÛÓÂ˘ÛÙÈÎfi Û˘ÚÈÁ-

Ìfi. ∏ ÂÈÛ·ÁˆÁ‹ ÚÈÓÈÎÔ‡ Î·ıÂÙ‹Ú· ÌÂÁ¤ıÔ˘˜ Fr 6 ÛÂ

·ÌÊfiÙÂÚÂ˜ ÙÈ˜ ÚÈÓÈÎ¤˜ ÎÔÈÏfiÙËÙÂ˜ ‰ÂÓ ‹Ù·Ó ‰˘Ó·Ù‹.

§fiÁˆ ÂÈ‰Â›ÓˆÛË˜ ÙË˜ ·Ó·ÓÂ˘ÛÙÈÎ‹˜ ‰˘Û¯¤ÚÂÈ·˜

ÙÔ ÓÂÔÁÓfi ÌÂÙ·Ê¤ÚıËÎÂ ÛÙËÓ ÎÏÈÓÈÎ‹ Ì·˜.

∫·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹, Ù· ÛˆÌ·ÙÔÌÂÙÚÈÎ¿ ¯·Ú·ÎÙË-

ÚÈÛÙÈÎ¿ ‹Ù·Ó µ° 2890 g, ª™ 48 cm Î·È ¶∫ 33,5 cm.

∂ÈÛÎÔÈÎ¿, ÙÔ ¯ÚÒÌ· ‹Ù·Ó Úfi‰ÈÓÔ, ÔÈ ·Ó·ÓÔ¤˜

‹Ù·Ó 70 ÙÔ ÏÂÙfi Î·È ˘‹Ú¯Â ·Ó·¤Ù·ÛË ÚÈÓÈÎÒÓ

ÙÂÚ˘Á›ˆÓ. ∞ÎÚÔ·ÛÙÈÎ¿, ˘‹Ú¯Â ÂÈÛÓÂ˘ÛÙÈÎfi˜ Û˘-

ÚÈÁÌfi˜. ¢ÂÓ ‹Ù·Ó ‰˘Ó·Ù‹ Ë ‰›Ô‰Ô˜ ÚÈÓÔÁ·ÛÙÚÈÎÔ‡ Î·-

ıÂÙ‹Ú· ÌÂÁ¤ıÔ˘˜ Fr 8 ‰È·Ì¤ÛÔ˘ ÙˆÓ ‰‡Ô ÚÈÓÈÎÒÓ ÎÔÈ-

ÏÔÙ‹ÙˆÓ. H ÂÍ¤Ù·ÛË ÙˆÓ ÏÔÈÒÓ Û˘ÛÙËÌ¿ÙˆÓ ‹Ù·Ó

Ê˘ÛÈÔÏÔÁÈÎ‹. ∆ËÓ 6Ë ËÌ¤Ú· ˙ˆ‹˜, ÏfiÁˆ ÂÈ‰Â›ÓˆÛË˜

∂ÈÎfiÓ· 1. ™˘ÁÁÂÓ‹˜ ÛÙ¤ÓˆÛË ·ÈÔÂÈ‰Ô‡˜ ÙÚ‹Ì·ÙÔ˜ Î·È ÌÔÓ‹ÚË˜ÎÂÓÙÚÈÎfi˜ ÙÔÌ¤·˜ Ô‰fiÓÙ·˜ ÛÙËÓ ·ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›· ÙˆÓ ÚÈÓÈ-ÎÒÓ ÎÔÈÏÔÙ‹ÙˆÓ Î·È ÙË˜ ¿Óˆ ÁÓ¿ıÔ˘ ÛÙËÓ 1Ë ÂÚ›ÙˆÛË.


322 ∞. ∞Ó‰Ú¤Ô˘ Î·È Û˘Ó.


ÙË˜ ·Ó·ÓÂ˘ÛÙÈÎ‹˜ ‰˘Û¯¤ÚÂÈ·˜, ÙÔ ÓÂÔÁÓfi ‰È·ÛˆÏË-ÓÒıËÎÂ Î·È ÙÔÔıÂÙ‹ıËÎÂ ÛÂ Û˘ÓÂ¯‹ ıÂÙÈÎ‹ ›ÂÛË·ÂÚ·ÁˆÁÒÓ ÁÈ· 2 ËÌ¤ÚÂ˜.

√ Û˘Ó‹ıË˜ ·ÈÌ·ÙÔÏÔÁÈÎfi˜ Î·È ‚ÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ-¯Ô˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜. ∏ ·ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›· ÙˆÓÚÈÓÈÎÒÓ ÎÔÈÏÔÙ‹ÙˆÓ ¤‰ÂÈÍÂ ÛÙ¤ÓˆÛË ÛÙÔ ·ÈÔÂÈ‰¤˜ÙÚ‹Ì· ¿ÌÊˆ (∂ÈÎfiÓ· 2). ∞ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›· ¿ÓˆÁÓ¿ıÔ˘ ÁÈ· ÙËÓ ‡·ÚÍË ª∫∞∆√ ‰ÂÓ Ú·ÁÌ·ÙÔÔÈ-‹ıËÎÂ ÁÈ· ÙÂ¯ÓÈÎÔ‡˜ ÏfiÁÔ˘˜. ∏ ·Ï‹ ·ÎÙÈÓÔÁÚ·Ê›·¿Óˆ ÁÓ¿ıÔ˘ ‰ÂÓ ÛÎÈ·ÁÚ¿ÊËÛÂ Â˘ÎÚÈÓÒ˜ ÙÈ˜ Ô‰ÔÓÙÈ-Î¤˜ Ú›˙Â˜ Î·È ‰ÂÓ ‹Ù·Ó ‰È·ÁÓˆÛÙÈÎ‹ ÁÈ· ‡·ÚÍË ‹ÌË ª∫∞∆√. ∏ ™™∞∆ ·ÓÙÈÌÂÙˆ›ÛÙËÎÂ ÌÂ ‰È·ÛÙÔ-

Ï¤˜ ÌÂ ÎËÚ›· ÌÂÁ¤ıÔ˘˜ Fr 7, 8 Î·È 9. §fiÁˆ ‰˘ÛÊ·-

Á›·˜, Ë Û›ÙÈÛË ÁÈÓfiÙ·Ó ÌÂ ÚÈÓÔÁ·ÛÙÚÈÎfi ÛˆÏ‹Ó· ÁÈ·

8 ËÌ¤ÚÂ˜.

™Â ËÏÈÎ›· 1 ÌËÓfi˜ ÂÍ‹ÏıÂ ÌÂ µ™ 3240 g (3Ë-10Ë

∂£), ¶∫ 36 cm (50Ë-75Ë ∂£), Î·È ª™ 48 cm (10Ë

∂£). ™Â ËÏÈÎ›· 3 ÌËÓÒÓ Ô ¤ÏÂÁ¯Ô˜ ÁÈ· ∆4, ∆3, ∆SH,

ÎÔÚÙÈ˙fiÏË ÔÚÔ‡ Î·È ·˘ÍËÙÈÎ‹ ÔÚÌfiÓË ‹Ù·Ó Ê˘ÛÈÔÏÔ-

ÁÈÎfi˜. ∆Ô ·ÌÈÓfiÁÚ·ÌÌ· ÔÚÔ‡, Ô‡ÚˆÓ Î·È Ù· ÔÚÁ·ÓÈÎ¿

ÔÍ¤· Ô‡ÚˆÓ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ¿. √ ˘ÂÚË¯ÔÁÚ·ÊÈÎfi˜

¤ÏÂÁ¯Ô˜ ÙË˜ ÎÔÈÏÈ¿˜ Î·È ÔÈ ̂ ÙÔ·ÎÔ˘ÛÙÈÎ¤˜ ÂÎÔÌ¤˜

‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ¤˜. ∏ ·ÍÔÓÈÎ‹ Î·È Ì·ÁÓËÙÈÎ‹ ÙÔÌÔ-

ÁÚ·Ê›· ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ¤˜. ™ÙÔÓ

Â·Ó¤ÏÂÁ¯Ô ÛÂ ËÏÈÎ›· 10,5 ÌËÓÒÓ ¤ÁÈÓÂ ·ÓÙÈÏËÙ‹,

ÂÈÛÎÔÈÎ¿, Ë ‡·ÚÍË ª∫∞∆√. ™Â ËÏÈÎ›· 25 ÌËÓÒÓ,

ÙÔ µ™ ‹Ù·Ó 9700g (3Ë -10Ë ∂£), ÙÔ ª™ 76,5 cm (3Ë

∂£) Î·È Ë ¶∫ 46,5 cm (10Ë - 50Ë ∂£). ∏ „˘¯ÔÎÈÓË-

ÙÈÎ‹ ·Ó¿Ù˘ÍË ÙÔ˘ ‚Ú¤ÊÔ˘˜ ÌÂ ÙË ‰ÔÎÈÌ·Û›· Denver

‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ‹.


¡ÂÔÁÓfi, ÎÔÚ›ÙÛÈ, 1Ô ·È‰› ÙË˜ ÔÈÎÔÁ¤ÓÂÈ·˜, ÌÂÙ·-

Ê¤ÚıËÎÂ ÛÙËÓ ÎÏÈÓÈÎ‹ Ì·˜ ÙÔ 2Ô 24ˆÚÔ ˙ˆ‹˜, ÏfiÁˆ

·Ó·ÓÂ˘ÛÙÈÎ‹˜ ‰˘Û¯¤ÚÂÈ·˜ Î·È ÌÂÁ¿ÏË˜ ÛÙ¤ÓˆÛË˜

ÙˆÓ ÚÈÓÈÎÒÓ ÎÔÈÏÔÙ‹ÙˆÓ ¿ÌÊˆ. ∏ ÌËÙ¤Ú·, 30 ÂÙÒÓ,

Î·È Ô ·Ù¤Ú·˜, 37 ÂÙÒÓ, ‹Ù·Ó Ê·ÈÓÔÌÂÓÈÎ¿ ˘ÁÈÂ›˜ Î·È

‰ÂÓ Â›¯·Ó Û˘ÁÁ¤ÓÂÈ· ÌÂÙ·Í‡ ÙÔ˘˜. ¢ÂÓ ·Ó·Ê¤ÚÔÓÙ·È

¿ÙÔÌ· ÌÂ Û˘ÁÁÂÓÂ›˜ ·ÓˆÌ·Ï›Â˜ ÛÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi

ÂÚÈ‚¿ÏÏÔÓ.

∏ Î‡ËÛË ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ‹ Î·È ÂÚ·ÙÒıËÎÂ ÙËÓ

39Ë Â‚‰ÔÌ¿‰·, ÌÂ ÛÈÎ‡·. ∏ ‚·ıÌÔÏÔÁ›· Apgar ‹Ù·Ó

9 ÛÙÔ 1Ô Î·È 5Ô ÏÂÙfi. ∆Ô ÓÂÔÁÓfi ÂÌÊ¿ÓÈÛÂ ·Ì¤Ûˆ˜

ÌÂÙ¿ ÙË Á¤ÓÓËÛË ¤ÓÙÔÓË ·Ó·ÓÂ˘ÛÙÈÎ‹ ‰˘Û¯¤ÚÂÈ·,

ÂÈÛÓÂ˘ÛÙÈÎfi Û˘ÚÈÁÌfi Î·È Ì¤ÙÚÈÂ˜ ÂÈÛÔÏÎ¤˜ ÌÂÛÔ-

ÏÂ˘Ú›ˆÓ. ŒÁÈÓÂ ·Ú¯ÈÎ¿ ÚÔÛ¿ıÂÈ· ÂÈÛfi‰Ô˘ ÚÈÓÔ-

Á·ÛÙÚÈÎÔ‡ Î·ıÂÙ‹Ú· ÌÂÁ¤ıÔ˘˜ Fr 8 ·ÌÊÔÙÂÚfiÏÂ˘-

Ú·, Ë ÔÔ›· ·¤Ù˘¯Â. ÃÔÚËÁ‹ıËÎÂ ÔÍ˘ÁfiÓÔ ÌÂ Ì¿-

ÛÎ· ÁÈ· Ì›· ËÌ¤Ú· Î·È ÙË 2Ë ËÌ¤Ú· ˙ˆ‹˜ ÏfiÁˆ ÂÈ-

‰Â›ÓˆÛË˜ ÙË˜ ·Ó·ÓÂ˘ÛÙÈÎ‹˜ ‰˘Û¯¤ÚÂÈ·˜ ‰È·ÛˆÏË-

ÓÒıËÎÂ Î·È ‰È·ÎÔÌ›ÛÙËÎÂ ÛÙËÓ ÎÏÈÓÈÎ‹ Ì·˜.

∫·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹, Ù· ÛˆÌ·ÙÔÌÂÙÚÈÎ¿ ¯·Ú·ÎÙË-

ÚÈÛÙÈÎ¿ ‹Ù·Ó µ° 3150 g (25Ë -50Ë ∂£), ¶∫ 34 cm

(50Ë ∂£)Î·È ª™ 50 cm (50Ë -75Ë ∂£). ∏ ·fiÛÙ·ÛË

ÌÂÙ·Í‡ ÙˆÓ ¤Íˆ Î·ÓıÒÓ ‹Ù·Ó 5,1 cm (3Ë ∂£), ÌÂÙ·-

Í‡ ÙˆÓ ¤Ûˆ Î·ÓıÒÓ 1,7cm (3Ë ∂£) Î·È ÌÂÙ·Í‡ ÙˆÓ

ÎÔÚÒÓ 3,1 cm (<3Ë ∂£). ∏ ÂÍ¤Ù·ÛË ÙÔ˘ ·Ó·ÓÂ˘ÛÙÈ-

ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÙÔ˘ ‰È·ÛˆÏËÓˆÌ¤ÓÔ˘ ÓÂÔÁÓÔ‡

¤‰ÂÈÍÂ ÚÈÓÈÎ‹ Û˘ÌÊfiÚËÛË Î·È ¤ÎÎÚÈÌ· ¿ÌÊˆ. ∆· ÏÔÈ-

¿ Û˘ÛÙ‹Ì·Ù· ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ¿. ∆Ô ÓÂÔÁÓfi Ù¤ıËÎÂ

ÛÂ ÂÓ‰ÔÙÚ·¯ÂÈ·Î‹ ÂÊ·ÚÌÔÁ‹ Û˘ÓÂ¯Ô‡˜ ıÂÙÈÎ‹˜ ›Â-

ÛË˜ ·ÂÚÔÊfiÚˆÓ Ô‰ÒÓ ÁÈ· 6 ËÌ¤ÚÂ˜ Î·È ÛÙË Û˘Ó¤¯ÂÈ·

ÙÔÔıÂÙ‹ıËÎÂ ·ÂÚ·ÁˆÁfi˜ ÁÈ· 3 ËÌ¤ÚÂ˜. À‹Ú¯Â ‰˘-

Û¯¤ÚÂÈ· ÛÙË Û›ÙÈÛË Î·È ÙËÓ Î·Ù¿ÔÛË.

√ Û˘Ó‹ıË˜ ·ÈÌ·ÙÔÏÔÁÈÎfi˜ Î·È ‚ÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜

∂ÈÎfiÓ· 2. ™˘ÁÁÂÓ‹˜ ÛÙ¤ÓˆÛË ·ÈÔÂÈ‰Ô‡˜ ÙÚ‹Ì·ÙÔ˜ ÛÙËÓ ·ÍÔÓÈÎ‹ÙÔÌÔÁÚ·Ê›· ÙˆÓ ÚÈÓÈÎÒÓ ÎÔÈÏÔÙ‹ÙˆÓ ÛÙË 2Ë ÂÚ›ÙˆÛË.

∂ÈÎfiÓ· 3. ™˘ÁÁÂÓ‹˜ ÛÙ¤ÓˆÛË ·ÈÔÂÈ‰Ô‡˜ ÙÚ‹Ì·ÙÔ˜ Î·È ÌÔÓ‹ÚË˜ÎÂÓÙÚÈÎfi˜ ÙÔÌ¤·˜ Ô‰fiÓÙ·˜ ÛÙËÓ ·ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›· ÙˆÓ ÚÈÓÈ-ÎÒÓ ÎÔÈÏÔÙ‹ÙˆÓ Î·È ÙË˜ ¿Óˆ ÁÓ¿ıÔ˘ ÛÙËÓ 3Ë ÂÚ›ÙˆÛË.


323™˘ÁÁÂÓ‹˜ ÛÙ¤ÓˆÛË ÚÈÓÈÎÒÓ ÎÔÈÏÔÙ‹ÙˆÓ Î·È ÌÔÓ‹ÚË˜ ÎÂÓÙÚÈÎfi˜ ¿Óˆ ÙÔÌ¤·˜ Ô‰fiÓÙ·˜

¶·È‰È·ÙÚÈÎ‹ 2007;70:320-324

‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜. ∏ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜, Î·-

ıÒ˜ Î·È Ô ˘ÂÚË¯ÔÁÚ·ÊÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙË˜ Î·Ú‰È¿˜

Î·È ÙˆÓ ÓÂÊÚÒÓ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜. ∏ ·ÍÔÓÈÎ‹ ÙÔ-

ÌÔÁÚ·Ê›· ¿Óˆ ÁÓ¿ıÔ˘ Î·È ÚÈÓÈÎÒÓ ÎÔÈÏÔÙ‹ÙˆÓ ·Ô-

Î¿Ï˘„Â ™™∞∆ Î·È ‡·ÚÍË ª∫∞∆√ (∂ÈÎfiÓ· 3). ∆Ô

Â‡ÚÔ˜ ÙˆÓ ÚÈÓÈÎÒÓ ¯Ô·ÓÒÓ ÛÙÔ ‡„Ô˜ ÙÔ˘ ·ÈÔÂÈ‰Ô‡˜

ÎfiÏÔ˘ ‹Ù·Ó 3,6 mm Î·È 4,8 mm ·ÓÙ›ÛÙÔÈ¯· (º.∆.

13,4 mm). ∏ ‚˘ıÔÛÎfiËÛË Î·È Ù· ·ÎÔ˘ÛÙÈÎ¿ ÚÔ-

ÎÏËÙ¿ ‰˘Ó·ÌÈÎ¿ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ¿. ∂Í‹ÏıÂ ÛÂ ËÏÈ-

Î›· ÂÓfi˜ ÌËÓfi˜ ÌÂ ‹ÈÔ ÂÈÛÓÂ˘ÛÙÈÎfi Û˘ÚÈÁÌfi. ™Â

ËÏÈÎ›· ÙÚÈÒÓ ÌËÓÒÓ Ë Ì·ÁÓËÙÈÎ‹ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂ-

Ê¿ÏÔ˘ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ‹.

™˘˙‹ÙËÛË

∏ ‡·ÚÍË ª∫∞∆√ ·Ó·Ê¤ÚıËÎÂ ÁÈ· ÚÒÙË ÊÔÚ¿

ÙÔ 1958 ·fi ÙÔÓ Scott (8). H Û‡Ó‰ÂÛË ÙÔ˘ ª∫∞∆√

ÌÂ ÙË ™™ƒ∫ ·Ó·ÁÓˆÚ›ÛıËÎÂ ·fi ÙÔ˘˜ Arlis Î·È Û˘Ó.

ÙÔ 1992 (5,9). À¿Ú¯Ô˘Ó ÙÚÂÈ˜ Ù‡ÔÈ ™™ƒ∫ ·Ó¿ÏÔÁ·

ÌÂ ÙËÓ ·Ó·ÙÔÌÈÎ‹ ı¤ÛË ÙË˜ ÛÙ¤ÓˆÛË˜ Î·È fiÏÔÈ ÙÔ˘˜

ÌÔÚÂ› Ó· Û˘Ó‰˘¿˙ÔÓÙ·È ÌÂ ª∫∞∆√. ∂›Ó·È Ë ·ÙÚË-

Û›· ÙˆÓ Ô›ÛıÈˆÓ ÚÈÓÈÎÒÓ ̄ Ô·ÓÒÓ, Ë ÌÂÛÔÚÈÓÈÎ‹ ÛÙ¤-

ÓˆÛË Î·È Ë ÚfiÛÊ·Ù· ·Ó·ÁÓˆÚÈÛıÂ›Û· ÛÙ¤ÓˆÛË ÙÔ˘

·ÈÔÂÈ‰Ô‡˜ ÙÚ‹Ì·ÙÔ˜ (1). ∆Ô ·ÈÔÂÈ‰¤˜ ÙÚ‹Ì· Â›Ó·È

ÙÔ ÛÙÂÓfiÙÂÚÔ ÔÛÙ¤ÈÓÔ ÙÌ‹Ì· ÙË˜ ÚÈÓÈÎ‹˜ ÎÔÈÏfiÙËÙ·˜

Î·È ‹Ù·Ó Ë ·ÈÙ›· ™™ƒ∫ Î·È ÛÙÈ˜ ÙÚÂÈ˜ ÂÚÈÙÒÛÂÈ˜

Ô˘ ÂÚÈÁÚ¿ÊËÎ·Ó. ∏ ÛÙ¤ÓˆÛ‹ ÙÔ˘ ıÂˆÚÂ›Ù·È fiÙÈ

ÔÊÂ›ÏÂÙ·È ÛÂ ˘ÂÚ·Ó¿Ù˘ÍË ÙË˜ ¿Óˆ ÁÓ¿ıÔ˘ Î·Ù¿

ÙËÓ ÂÌ‚Ú˘ÔÁ¤ÓÂÛË (5).

∫Ï·ÛÈÎ¿, Ë ·‰˘Ó·Ì›· ‰Èfi‰Ô˘ ÚÈÓÔÁ·ÛÙÚÈÎÔ‡ Î·-

ıÂÙ‹Ú· ÌÂÁ¤ıÔ˘˜ Fr 8 ı¤ÙÂÈ ÙËÓ ˘Ô„›· ÁÈ· ÔÛÙ¤ÈÓË

ÚÈÓÈÎ‹ ·fiÊÚ·ÍË, fiˆ˜ ÛÙÈ˜ ÂÚÈÙÒÛÂÈ˜ Ô˘ ÂÚÈ-

ÁÚ¿ÊÔÓÙ·È. ∏ ™™∞∆ ıÂˆÚÂ›Ù·È ·Û˘Ó‹ıË˜ ·ÈÙ›· ÚÈÓÈ-

Î‹˜ ·fiÊÚ·ÍË˜ ÛÙ· ÓÂÔÁÓ¿ Î·È ÛÙ· ·È‰È¿, Èı·ÓfiÓ

fiÌˆ˜, Ó· Â›Ó·È ÈÔ Û˘¯Ó‹ (3) Î·È ÚÔÎ·ÏÂ› fiÌÔÈ· ÎÏÈ-

ÓÈÎ¿ ÛËÌÂ›· ÌÂ ÙËÓ ·ÙÚËÛ›· ÙˆÓ ÚÈÓÈÎÒÓ ¯Ô·ÓÒÓ

(10). ∏ ÛÔ‚·ÚfiÙËÙ· ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÔÈÎ›ÏÏÂÈ

·Ó¿ÏÔÁ· ÌÂ ÙÔÓ ‚·ıÌfi ÙË˜ ·fiÊÚ·ÍË˜ Î·È ÂÎ‰ËÏÒ-

ÓÂÙ·È ÌÂ ÚÈÓÈÎ‹ Û˘ÌÊfiÚËÛË, Û˘ÚÈÁÌfi, Î˘ÎÏÈÎ¿ ÂÂÈ-

Ûfi‰È· Î˘¿ÓˆÛË˜ Î·È ·ÂÈÏËÙÈÎ¤˜ ÁÈ· ÙË ˙ˆ‹ Î·Ù·-

ÛÙ¿ÛÂÈ˜.

∏ ‡·ÚÍË ª∫∞∆√ Á›ÓÂÙ·È Û˘Ó‹ıˆ˜ ·ÓÙÈÏËÙ‹

Î·Ù¿ ÙË ‚ÚÂÊÈÎ‹ ËÏÈÎ›· ÌÂÙ¿ ÙËÓ ·Ó·ÙÔÏ‹ ÙˆÓ ÓÂÔ-

ÁÈÏÒÓ Ô‰fiÓÙˆÓ, fiˆ˜ Ë 2Ë ÂÚ›ÙˆÛË. ∏ ˘fiÓÔÈ·

‡·ÚÍË˜ ª∫∞∆√ ÛÙË ÓÂÔÁÓÈÎ‹ ËÏÈÎ›· Ù›ıÂÙ·È fiÙ·Ó

˘¿Ú¯ÂÈ ™™ƒ∫ Î·È Ë ‰È¿ÁÓˆÛË ‚·Û›˙ÂÙ·È ÛÙËÓ ·ÍÔÓÈ-

Î‹ ÙÔÌÔÁÚ·Ê›· ¿Óˆ ÁÓ¿ıÔ˘, fiˆ˜ Û˘Ó¤‚Ë ÛÙËÓ 1Ë

Î·È 3Ë ÂÚ›ÙˆÛË. ™ÙË 2Ë ÂÚ›ÙˆÛË ÏfiÁˆ ÙÂ¯ÓÈÎÔ‡

ÎˆÏ‡Ì·ÙÔ˜ ‰ÂÓ ¤ÁÈÓÂ ·ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›· ¿Óˆ ÁÓ¿-

ıÔ˘ Î·È Ë ·Ï‹ ·ÎÙÈÓÔÁÚ·Ê›· ¿Óˆ ÁÓ¿ıÔ˘ ‰ÂÓ ‹Ù·Ó

‰È·ÁÓˆÛÙÈÎ‹ ÏfiÁˆ Î·È ÙË˜ ÌË Î·Ï‹˜ ·Û‚ÂÛÙÔÔ›Ë-

ÛË˜ ÙˆÓ Ô‰fiÓÙˆÓ ÛÂ ·˘Ù‹ ÙËÓ ËÏÈÎ›·.

∏ ™™ƒ∫ Î·È Ô ª∫∞∆√ ÌÂÌÔÓˆÌ¤Ó· ‹ ÛÂ Û˘Ó-

‰˘·ÛÌfi ¤¯Ô˘Ó ·Ó·ÊÂÚıÂ› Û·Ó ÌÂÌÔÓˆÌ¤Ó· Â˘Ú‹Ì·-

Ù· ÛÂ Ê·ÈÓÔÌÂÓÈÎ¿ ˘ÁÈÂ›˜ ·ÛıÂÓÂ›˜. ™ÙÈ˜ ÂÚÈÛÛfiÙÂ-

ÚÂ˜ ÂÚÈÙÒÛÂÈ˜ Û˘Ó‰¤ÔÓÙ·È ÌÂ ¿ÏÏÂ˜ Û˘ÁÁÂÓÂ›˜ Î·È

¯ÚˆÌÔÛˆÌÈÎ¤˜ ·ÓˆÌ·Ï›Â˜ ‹ ÁÓˆÛÙ¿ Û‡Ó‰ÚÔÌ· (6).

°È· ÙÔÓ ¤ÏÂÁ¯Ô Û˘ÓÔ‰ÒÓ ·ÓˆÌ·ÏÈÒÓ ı· Ú¤ÂÈ Ó·

‰ÈÂÓÂÚÁÂ›Ù·È Ì·ÁÓËÙÈÎ‹ ÙÔÌÔÁÚ·Ê›· ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘,

¯ÚˆÌÔÛˆÌÈÎ‹ ·Ó¿Ï˘ÛË, ¤ÏÂÁ¯Ô˜ ÙË˜ ÏÂÈÙÔ˘ÚÁ›·˜

ÙË˜ ˘fiÊ˘ÛË˜, ÔÚÌÔÓÈÎfi˜ ¤ÏÂÁ¯Ô˜ Î·È ¤ÏÂÁ¯Ô˜ ÙˆÓ

ËÏÂÎÙÚÔÏ˘ÙÒÓ.

∏ ™™ƒ∫ Â›Ó·È Û˘¯Ófi Î·È Î·Ù¿ ÔÚÈÛÌ¤ÓÔ˘˜ (5)

ÛÙ·ıÂÚfi Â‡ÚËÌ· ÛÂ ª∫∞∆√ (2,3,5,9). ∏ ™™∞∆ ¤¯ÂÈ

·Ó·ÊÂÚıÂ› fiÙÈ Û˘ÓÔ‰Â‡ÂÙ·È ·fi ª∫∞∆√ ÛÂ ÔÛÔ-

ÛÙfi 60%-70% (2,4). ∫·ıÒ˜ Ë ™™ƒ∫ ‰È·ÁÈÁÓÒÛÎÂÙ·È

Î˘Ú›ˆ˜ ÛÙË ÓÂÔÁÓÈÎ‹ ËÏÈÎ›·, ÌÔÚÂ› Ó· ıÂˆÚËıÂ› ˆ˜

ÛÙÔÈ¯Â›Ô ÁÈ· ÙË ‰È¿ÁÓˆÛË ÙÔ˘ ª∫∞∆√, ÚÈÓ ÙËÓ

·Ó·ÙÔÏ‹ ÙˆÓ ÓÂÔÁÈÏÒÓ Ô‰fiÓÙˆÓ. ™Â Î¿ıÂ ÓÂÔÁÓfi ÌÂ

˘Ô„›· ™™ƒ∫ ı· Ú¤ÂÈ Ó· ‰ÈÂÓÂÚÁÂ›Ù·È ·ÍÔÓÈÎ‹ ÙÔ-

ÌÔÁÚ·Ê›· ÙÔ˘ ÚÔÛÒÔ˘, ·fi ÙËÓ ˘ÂÚÒ· Ì¤¯ÚÈ ÙË

ÌÂÛfiÙËÙ· ÙÔ˘ ÔÊı·ÏÌÈÎÔ‡ ÎfiÁ¯Ô˘ (10,11) ÁÈ· ‰È¿-

ÁÓˆÛË Î·È ÂÓÙÔÈÛÌfi ÙË˜ ÚÈÓÈÎ‹˜ ·fiÊÚ·ÍË˜ Î·È

ÙÔ˘ ª∫∞∆√.

∆Ô ÎÔÓÙfi ·Ó¿ÛÙËÌ· Â›Ó·È ¤Ó· ·fi Ù· ÚÒÙ· Â˘-

Ú‹Ì·Ù· Ô˘ Û˘Ó‰˘¿ÛÙËÎ·Ó ÌÂ ™™ƒ∫ Î·È ª∫∞∆√

(2,5,9). ∏ 1Ë Î·È 2Ë ÂÚ›ÙˆÛË ·ÚÔ˘Û›·Û·Ó ÛËÌ·-

ÓÙÈÎ‹ Î·ı˘ÛÙ¤ÚËÛË ÙË˜ ÛˆÌ·ÙÈÎ‹˜ ·Ó¿Ù˘ÍË˜ Î·È

‰˘ÛÙÚÔÊ›·. ™ÙÈ˜ ÂÚÈÛÛfiÙÂÚÂ˜ ÂÚÈÙÒÛÂÈ˜, Ë ·ÈÙÈÔ-

ÏÔÁ›· Â›Ó·È Ë ·ÓÂ¿ÚÎÂÈ· ÙË˜ ·˘ÍËÙÈÎ‹˜ ÔÚÌfiÓË˜.

∞fi Ù· ‰‡Ô ÂÚÈÛÙ·ÙÈÎ¿ Ì·˜ ÌÂ ÎÔÓÙfi ·Ó¿ÛÙËÌ·, Ô

¤Ó·˜ ·ÛıÂÓ‹˜ Â›¯Â ·ÓÂ¿ÚÎÂÈ· ·˘ÍËÙÈÎ‹˜ ÔÚÌfiÓË˜

Î·È ˘Ô-˘ÔÊ˘ÛÈÛÌfi.

∏ ™™∞∆ Î·È Ô ª∫∞∆√ ·ÔÙÂÏÔ‡Ó ·ÓˆÌ·Ï›Â˜

ÙË˜ Ì¤ÛË˜ ÁÚ·ÌÌ‹˜ Î·È ÌÔÚÂ› ·fi ÌfiÓÂ˜ ÙÔ˘˜ Ó·

Â›Ó·È ÔÈ ÌÔÓ·‰ÈÎ¤˜ ÎÏÈÓÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ ÔÏÔÚÔÛÂ-

ÁÎÂÊ·Ï›·˜ (7). ªÈÎÚfi ÔÛÔÛÙfi ·ÛıÂÓÒÓ ÌÂ ÔÏÔÚÔ-

ÛÂÁÎÂÊ·Ï›· ÌÔÚÂ› Ó· ¤¯ÂÈ Ê˘ÛÈÔÏÔÁÈÎfi ÚÔÛˆÂ›Ô

‹ ‹ÈÂ˜, ÂÏ¿¯ÈÛÙÂ˜ ÎÏÈÓÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜, fiˆ˜

™™ƒ∫, ª∫∞∆√, ˘ÔÛÌ›· Î·È ˘ÔÙËÏÔÚÈÛÌfi (7).

Œ¯ÂÈ ·Ó·ÊÂÚıÂ› fiÙÈ ™™∞∆ Î·È ™ª∞∆√ ÌÔÚÂ› Ó·

Û˘Ó˘¿Ú¯Ô˘Ó ÌÂ ˘ÔÙËÏÔÚÈÛÌfi, Â›ÌÔÓË ÚÈÓÈÎ‹

Û˘ÌÊfiÚËÛË, ‰˘ÛÎÔÏ›Â˜ ÛÙË Û›ÙÈÛË, fiˆ˜ ÛÙË 2Ë Î·È

3Ë ÂÚ›ÙˆÛË, ‹ ÌÂ ÌÈÎÚfi ¤Ô˜ Î·È ÎÚ˘„ÔÚ¯›·,

fiˆ˜ ÛÙËÓ 1Ë ÂÚ›ÙˆÛË (6). √ ÚÒÙÔ˜ ·ÛıÂÓ‹˜

Ì·˜ ·ÚÔ˘Û›·˙Â Â›ÛË˜ ·ÙÚËÛ›· ÙÔ˘ ÚˆÎÙÔ‡ Î·È

ÓÂÊÚÈÎ¤˜ ·ÓˆÌ·Ï›Â˜. √ Û˘Ó‰˘·ÛÌfi˜ ·˘ÙÒÓ ÙˆÓ

·ÓˆÌ·ÏÈÒÓ ¤¯ÂÈ Û¿ÓÈ· ·Ó·ÊÂÚıÂ› ÛÙÔ Û‡Ó‰ÚÔÌÔ

VACTREL (6). √ ·ÛıÂÓ‹˜ Ì·˜ ‰ÂÓ Â›¯Â Ù· ¿ÏÏ· ¯·-

Ú·ÎÙËÚÈÛÙÈÎ¿ Â˘Ú‹Ì·Ù· ·˘ÙÔ‡ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘,

fiÌˆ˜, ÙÔ Û‡ÓÔÏÔ ÙˆÓ Û˘ÁÁÂÓÒÓ ·ÓˆÌ·ÏÈÒÓ ÙÔ˘ È-

ı·ÓÔÏÔÁÂ› ÙËÓ ‡·ÚÍË Û˘Ó‰ÚfiÌÔ˘.

∏ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ™™∞∆ ‚·Û›˙ÂÙ·È ÛÙË ÛÔ‚·-

ÚfiÙËÙ· ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ. ÕÌÂÛË ‰È·ÛˆÏ‹ÓˆÛË ÙË˜

ÙÚ·¯Â›·˜ Î·È ·ÂÚÈÛÌfi˜ ··ÈÙÂ›Ù·È Û˘¯Ó¿ ÙÈ˜ ÚÒÙÂ˜

ËÌ¤ÚÂ˜ ˙ˆ‹˜, Î·ıÒ˜ Ù· ÓÂÔÁÓ¿ ·Ó·Ó¤Ô˘Ó ˘Ô¯ÚÂˆ-

ÙÈÎ¿ ·fi ÙË Ì‡ÙË. ™Â ‰‡Ô ·fi ÙÔ˘˜ ·ÛıÂÓÂ›˜ Ì·˜


324 ∞. ∞Ó‰Ú¤Ô˘ Î·È Û˘Ó.


¯ÚÂÈ¿ÛıËÎÂ ·Ú¯ÈÎ¿ ‰È·ÛˆÏ‹ÓˆÛË ÙË˜ ÙÚ·¯Â›·˜ ÁÈ··ÂÚÈÛÌfi. ∆ÔÈÎ‹ ıÂÚ·Â›· Î·È ÚÈÓÈÎÔ› Î·ıÂÙ‹ÚÂ˜ÂÊ·ÚÌfi˙ÔÓÙ·È ÛÂ ‹ÈÂ˜ ÂÚÈÙÒÛÂÈ˜ (3,12). ∫·È ÔÈÙÚÂÈ˜ ÂÚÈÙÒÛÂÈ˜ Ì·˜ ·ÓÙÈÌÂÙˆ›ÛıËÎ·Ó Û˘ÓÙËÚË-ÙÈÎ¿ ÌÂ ÙÔÔı¤ÙËÛË ÚÈÓÈÎÒÓ Î·ıÂÙ‹ÚˆÓ Î·È ·ÂÚ·-ÁˆÁÒÓ.

ÃÂÈÚÔ˘ÚÁÈÎ‹ ·ÓÙÈÌÂÙÒÈÛË ÂÊ·ÚÌfi˙ÂÙ·È ÛÂ·ÛıÂÓÂ›˜ ÌÂ ¿ÓÔÈ· Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘,Â·ÓÂÈÏËÌÌ¤ÓÂ˜ ‰È·ÛˆÏËÓÒÛÂÈ˜, ·ÔÙ˘¯›· ·ÔÛˆ-Ï‹ÓˆÛË˜, ‰˘ÛÎÔÏ›· Û›ÙÈÛË˜ Ô˘ Û˘ÓÔ‰Â‡ÂÙ·È ·fiÎ˘¿ÓˆÛË, ÌË ·ÓÙ·fiÎÚÈÛË ÛÙË ¯ÔÚ‹ÁËÛË Û˘ÓÂ¯Ô‡˜ıÂÙÈÎ‹˜ ›ÂÛË˜ ÛÙÔ˘˜ ·ÂÚ·ÁˆÁÔ‡˜ Î·È fiÙ·Ó ˘¿Ú¯ÂÈ·ÔÙ˘¯›· ÙË˜ Û˘ÓÙËÚËÙÈÎ‹˜ ·ÓÙÈÌÂÙÒÈÛË˜ ÁÈ· ¿-Óˆ ·fi 10-15 ËÌ¤ÚÂ˜ (3).

∆¤ÏÔ˜, Â›Ó·È ‰˘Ó·Ù‹ Î·È ÚÔÁÂÓÓËÙÈÎ‹ ‰È¿ÁÓˆÛËÌÂ ˘ÂÚË¯ÔÁÚ¿ÊËÌ· ÛÂ ËÏÈÎ›· Î‡ËÛË˜ 18-22 Â‚‰Ô-Ì¿‰ˆÓ (13).

BÈ‚ÏÈÔÁÚ·Ê›·

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2. Lo FS, Lee ÀJ, Lin SP, Shen EY, Huang JK, Lee KS. Solitarymaxillary central incisor and congenital nasal pyriformaperture stenosis. Eur J Pediatr 1998;157:39-44.

3. Van Den Abbeele T, Triglia JM, Francois M, Narcy P.Congenital nasal pyriform aperture stenosis: diagnosis andmanagement of 20 cases. Ann Otol Rhinol Laryngol2001;110:70-75.

4. Huang J∫, Cheng SJ, Lin JC, Sheu CY. Congenital nasal

pyriform aperture stenosis and single central maxillary in-

cisor: CT and MRI findings. Clin Imaging 1998;22:393-397.

5. Hall R∫, Bankier ∞, Aldred ªJ, Kan K, Lucas JO, Perks

AG. Solitary median maxillary central incisor, short

stature, choanal atresia/ midnasal stenosis (SMMCI) syn-

drome. Oral Surg Oral Med Oral Pathol Oral Radiol En-

dod 1997;84:651-662.

6. Nanni L, Ming JE, Du À, Hall RK, Aldred M, Bankier A, et

al. SHH mutation is associated with solitary median max-

illary central incisor: a study of 13 patients and review of

the literature. Am J Med Genet 2001;102:1-10.

7. Hattori H, Okuno T, Momoi T, Kataoka K, Mikawa H,

Shiota K. Single central maxillary incisor and holoprosen-

cephaly. Am J Med Genet 1987;28:483-487.

8. Scott DC. Absence of upper central incisor. Brit Dent J

1958;104:247-248.

9. Arlis H, Ward RF. Congenital nasal pyriform aperture

stenosis. Isolated abnormality vs developmental field de-

fect. Arch Otolaryngol Head Neck Surg 1992;118:989-991.

10. Royal SA, Hedlund GL, Wiatrak µJ. Single central maxillary

incisor with nasal pyriform aperture stenosis-CT diagnosis

prior to tooth eruption. Pediatr Radiol 1999;29:357-359.

11. Huang JK, Cheng SJ, Yang CC, Yun CH, Shih SL. Congen-

ital nasal pyriform aperture stenosis and single central

maxillary incisor: preoperative evaluation with three-di-

mensional computed tomography. J Formos Med Assoc

2004;103:37-40.

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ture stenosis: non-surgical management and long-term

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(SMMCI) syndrome. Orphanet J Rare Dis 2006;1:12.


325∂¡¢π∞º∂ƒ√À™∞ ¶∂ƒπ¶∆ø™∏ CASE REPORT

¶·È‰È·ÙÚÈÎ‹ 2007;70:325-329

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ÓÂ˘ÚÈÎÔ‡ Î·È ÂÚÂÈÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜

ª. ∆˙Ô‡ÊË1, ¶. ™È¯ÏÈÌ›ÚË1, π. ¡¿ÎÔ˘1, ª. ∞ÚÁ˘ÚÔÔ‡ÏÔ˘2, ∞. ™È·ÌÔÔ‡ÏÔ˘ - ª·˘Ú›‰Ô˘1

¶ÂÚ›ÏË„Ë: ∆Ô Û‡Ó‰ÚÔÌÔ Blue Rubber Bleb Nevus (BRBN) ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÊÏÂ‚ÈÎ¤˜ ‰˘ÛÏ·Û›Â˜,Ô˘ ·ÊÔÚÔ‡Ó Î˘Ú›ˆ˜ ÙÔ ‰¤ÚÌ· Î·È ÙoÓ Á·ÛÙÚÂÓÙÂÚÈÎfi ÛˆÏ‹Ó·. ¶ÈÔ Û¿ÓÈ· Â›Ó·È Ë ÚÔÛ‚ÔÏ‹ ÙÔ˘ ÓÂ˘-ÚÈÎÔ‡ Î·È ÙÔ˘ ÂÚÂÈÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ∆Ô Û‡Ó‰ÚÔÌÔ ·˘Ùfi Â›Ó·È Û¿ÓÈÔ, ·ÊÔ‡ ¤ˆ˜ Û‹ÌÂÚ· ¤¯Ô˘Ó ‰ËÌÔ-ÛÈÂ˘ıÂ› ÏÈÁfiÙÂÚÂ˜ ·fi 200 ÂÚÈÙÒÛÂÈ˜. ∆· ·ÈÌ·ÁÁÂÈÒÌ·Ù· ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ ‰È·ÈÛÙÒÓÔÓÙ·È ÛÙË Á¤ÓÓËÛËÎ·È ÂÈ‰ÂÈÓÒÓÔÓÙ·È ÌÂ ÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ ÛÒÌ·ÙÔ˜, ÚÔÎ·ÏÒÓÙ·˜ ·ÈÛıËÙÈÎ¿ Î˘Ú›ˆ˜ ÚÔ‚Ï‹Ì·Ù·, ÂÓÒ Ù··ÓÙ›ÛÙÔÈ¯· ÚÔ‚Ï‹Ì·Ù· ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ ÛˆÏ‹Ó· ÌÔÚÔ‡Ó Ó· ÂÌÊ·ÓÈÛÙÔ‡Ó ÛÂ ÌÂÁ·Ï‡ÙÂÚË ËÏÈÎ›·.∞Ó ·ÈÌÔÚÚ·Á‹ÛÔ˘Ó, ÚÔÎ·ÏÔ‡Ó ¯ÚfiÓÈ· ·Ó·ÈÌ›·, ‹ ÌÔÚÂ› Ó· ¤¯Ô˘Ó ÂÈÏÔÎ¤˜, fiˆ˜ Ú‹ÍË, Û˘ÛÙÚÔÊ‹ÂÓÙ¤ÚÔ˘ Î·È ÂÁÎÔÏÂ·ÛÌfi. ∂›ÛË˜, ÌÔÚÂ› Ó· ÚÔÛ‚ÏËıÔ‡Ó Î·È ¿ÏÏ· fiÚÁ·Ó·. ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛËÂÓfi˜ ·ÁÔÚÈÔ‡ ËÏÈÎ›·˜ 13 ÂÙÒÓ, ÌÂ Û‡Ó‰ÚÔÌÔ BRBN, ÌÂ ÔÏÏ¤˜ ÓÔÛËÏÂ›Â˜, ÙÔ˘ ÔÔ›Ô˘ Ë ·Ú·ÎÔÏÔ‡ıËÛËÍÂÎ›ÓËÛÂ ·fi ÙË ÓÂÔÁÓÈÎ‹ ËÏÈÎ›·. ¶·ÚÔ˘ÛÈ¿˙ÂÈ ÔÏÏ·Ï¤˜ ·ÁÁÂÈ·Î¤˜ ‰˘ÛÏ·Û›Â˜ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ Î·È ÙˆÓ‚ÏÂÓÓÔÁfiÓˆÓ, ÂÓÒ ÔÈ ·ÓÙ›ÛÙÔÈ¯Â˜ ‰˘ÛÏ·Û›Â˜ ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ ÛˆÏ‹Ó· ÂÎ‰ËÏÒıËÎ·Ó ÌÂ ̄ ÚfiÓÈ· ·Ó·È-Ì›· Î·È ÂÈÏÂÔÂÈÏÂ˚Îfi ÂÁÎÔÏÂ·ÛÌfi. ∞ÍÈÔÛËÌÂ›ˆÙË Â›Ó·È Ë ÂÎÙÂÙ·Ì¤ÓË ÚÔÛ‚ÔÏ‹ ÙÔ˘ ÓÂ˘ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜,ÌÂ ·ÈÌ·ÁÁÂ›ˆÌ· ÛÙÔÓ ·ÚÈÛÙÂÚfi ÈÓÈ·Îfi ÏÔ‚fi, Ô˘ Â›¯Â ÚÔÎ·Ï¤ÛÂÈ ˆ˜ ÂÈÏÔÎ‹ ·ÁÁÂÈ·Îfi ÂÁÎÂÊ·ÏÈÎfiÂÂÈÛfi‰ÈÔ Î·È ÌÂ ·ÈÌ·ÁÁÂÈÒÌ·Ù· ·Ú·ÛÔÓ‰˘ÏÈÎ¿, Ù· ÔÔ›· È¤˙Ô˘Ó ÙÔÓ ÓˆÙÈ·›Ô Ì˘ÂÏfi. √ ·ÛıÂÓ‹˜ ·-ÚÔ˘ÛÈ¿˙ÂÈ ·ÓıÂÎÙÈÎ¤˜, Û‡ÓıÂÙÂ˜ ÂÛÙÈ·Î¤˜ Î·È ÁÂÓÈÎÂ˘Ì¤ÓÂ˜ ÂÈÏËÙÈÎ¤˜ ÎÚ›ÛÂÈ˜ Î·È ¿Û¯ÂÈ ·fi ÂÁÎÂÊ·ÏÈÎ‹·Ú¿Ï˘ÛË. ∆¤ÏÔ˜, ·fi ÙË Á¤ÓÓËÛ‹ ÙÔ˘, ÂÌÊ·Ó›˙ÂÈ ÔÏÏ·Ï¤˜ ÛÎÂÏÂÙÈÎ¤˜ ·ÓˆÌ·Ï›Â˜. ™ÙË ‰È·ı¤ÛÈÌË ‚È-‚ÏÈÔÁÚ·Ê›·, ·˘Ù‹ Â›Ó·È Ë ÚÒÙË ÂÚ›ÙˆÛË Ù·˘Ùfi¯ÚÔÓË˜ ÚÔÛ‚ÔÏ‹˜ ÙÔ˘ ÓÂ˘ÚÈÎÔ‡ Î·È ÙÔ˘ ÂÚÂÈÛÙÈÎÔ‡Û˘ÛÙ‹Ì·ÙÔ˜.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: BRBNS, ÓÂ˘ÚÈÎfi Û‡ÛÙËÌ·, ÂÚÂÈÛÙÈÎfi Û‡ÛÙËÌ·.

Blue Rubber Bleb Nevus Syndrome with concurrent neurological and

skeletal involvement

M. Tzoufi1, P. Sihlimiri1, I. Nakou1, M. Argyropoulou2, A. Siamopoulou - Mavridou1

Abstract: The blue rubber bleb nevus syndrome (BRBNS) consists of venous malformations affecting theskin and gastrointestinal tract. It is less common for the nervous and the skeletal systems to be involved.This syndrome is rare, as descriptions of less than 200 cases have been published. The skinhaemangiomata are present at birth and deteriorate as the body grows, causing mainly cosmeticproblems. Haemangiomata of the gastrointestinal tract may appear later in life and can bleed, causingchronic anaemia, or present with complications such as rupture, intestinal torsion and intussusception.Other organs may also be involved. The case of a 13 year-old boy with BRBNS is described, who wasmonitored since birth, and had multiple hospitalizations. He presented with multiple nevi of the skin andmucous membranes, and gastrointestinal tract lesions, which caused anaemia and ileoileicintussusception. This boy’s nervous system was significantly affected, with a haemangioma of the leftoccipital lobe, which caused a stroke, and multiple paravertebral haemangiomata causing pressuresymptoms. He suffers from complex partial and generalized epileptic seizures and cerebral palsy. Multipleskeletal anomalies have also been present from birth. This is the first case of BRBNS in the availableliterature describing concurrent neurological and skeletal involvement.

Key words: BRBNS, nervous system, skeletal involvement.

1 ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹,¶·ÓÂÈÛÙËÌÈ·Îfi °ÂÓÈÎfi¡ÔÛÔÎÔÌÂ›Ô πˆ·ÓÓ›ÓˆÓ

2 ∞ÎÙÈÓÔÏÔÁÈÎfi ∆Ì‹Ì·,¶·ÓÂÈÛÙËÌÈ·Îfi °ÂÓÈÎfi¡ÔÛÔÎÔÌÂ›Ô πˆ·ÓÓ›ÓˆÓ


ªÂÚfiË ∆˙Ô‡ÊË[email protected] ∆ÔÌ¤·˜ ÀÁÂ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡π·ÙÚÈÎ‹ ™¯ÔÏ‹¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ,∆.£. 1186∆.∫. 45110, πˆ¿ÓÓÈÓ·

1 Paediatric Department,University GeneralHospital of Ioannina,Ioannina

2 Radiology Department,University GeneralHospital of Ioannina,Ioannina

Correspondence:

Meropi [email protected] Department of Child HealthUniversity of Ioannina,Medical School,PO Box: 1186GR 45110, Ioannina, Greece

∂ÈÛ·ÁˆÁ‹

∆Ô Blue Rubber Bleb Nevus ™‡Ó‰ÚÔÌÔ(BRBN) Â›Ó·È ÌÈ· Û¿ÓÈ· ÔÓÙfiÙËÙ·, Ë ÔÔ›· ̄ ·-Ú·ÎÙËÚ›˙ÂÙ·È ·fi ·ÁÁÂÈ·Î¤˜ ·ÓˆÌ·Ï›Â˜ ÙÔ˘‰¤ÚÌ·ÙÔ˜ Î·È ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ ÛˆÏ‹Ó·. √G. Gascoven ÛËÌÂ›ˆÛÂ ÚÒÙÔ˜ ÙË Û¯¤ÛË ÙˆÓ

ÊÏÂ‚ÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ Î·È ÙË˜ ·ÈÌÔÚÚ·Á›·˜ ·fi

ÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi Û‡ÛÙËÌ·, ÙÔ 1860 (1). ™¯Â‰fiÓ

¤Ó·Ó ·ÈÒÓ· ·ÚÁfiÙÂÚ·, ÙÔ 1958, Ô William

Bennet Bean, ÔÓfiÌ·ÛÂ Ù· ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ·Á-

ÁÂ›· “Blue rubber bleb nevus”, ÂÍ·ÈÙ›·˜ ÙÔ˘

¯ÚÒÌ·ÙÔ˜, ÙË˜ ̆ Ê‹˜ Î·È ÙÔ˘ Û¯‹Ì·Ùfi˜ ÙÔ˘˜ (2).


326 ª. ∆˙Ô‡ÊË Î·È Û˘Ó.


°È’ ·˘Ùfi ÙÔÓ ÏfiÁÔ, ÙÔ BRBNS ·Ó·Ê¤ÚÂÙ·È ÛÙË ‚È‚ÏÈÔ-

ÁÚ·Ê›· Î·È ˆ˜ Û‡Ó‰ÚÔÌÔ Bean’s.

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛË˜

¶·ÚÔ˘ÛÈ¿˙ÂÙ·È Ë ÂÚ›ÙˆÛË ÂÓfi˜ ‰ÂÎ·ÙÚÈ¿¯ÚÔ-

ÓÔ˘ ·ÁÔÚÈÔ‡, ÙÔ ÔÔ›Ô ÁÂÓÓ‹ıËÎÂ ·fi ÙÂÙ·ÚÙÔÙfiÎÔ

ÌËÙ¤Ú·, ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ÙÔÎÂÙfi, ÙÂÏÂÈfiÌËÓÔ Î·È ÌÂ

‚¿ÚÔ˜ Á¤ÓÓËÛË˜ 3.500 g. ∆Ô 6Ô ·È‰› ÙË˜ ÔÈÎÔÁ¤ÓÂÈ-

·˜ ¿Û¯ÂÈ ·fi ÓÂ˘ÚÔ˚ÓˆÌ¿ÙˆÛË Ù‡Ô˘ 1, ÂÓÒ Ù·

˘fiÏÔÈ· Ì¤ÏË ÙË˜ ÔÈÎÔÁ¤ÓÂÈ·˜ Â›Ó·È ˘ÁÈ‹.

∞Ì¤Ûˆ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË, ÓÔÛËÏÂ‡ÙËÎÂ ÛÙË ÓÂÔ-

ÁÓÈÎ‹ ÌÔÓ¿‰· ÂÍ·ÈÙ›·˜ ÂÚÈÁÂÓÓËÙÈÎ‹˜ ·ÛÊ˘Í›·˜ Î·È

ÏÔ›ÌˆÍË˜. ™ÙËÓ ÎÏÈÓÈÎ‹ ÂÍ¤Ù·ÛË ‰È·ÈÛÙÒıËÎ·Ó:

·) ÔÏÏ·Ï¿ ·ÈÌ·ÁÁÂÈÒÌ·Ù· ‰¤ÚÌ·ÙÔ˜ (¿Óˆ

‚Ï¤Ê·ÚÔ, ÙÂÚ‡ÁÈÔ ÙÔ˘ ·˘ÙÈÔ‡, Î¿Ùˆ ÁÓ¿ıÔÈ, ¿Óˆ

Î·È Î¿Ùˆ ¿ÎÚ·, Ï¿ÙË), Î·ıÒ˜ Î·È ·ÈÌ·ÁÁÂÈÒÌ·Ù·

ÛÙ· Ô‡Ï· Î·È ÙÔ ‚ÏÂÓÓÔÁfiÓo ÙˆÓ ¯ÂÈÏ¤ˆÓ,

‚) ÔÏÏ·Ï¤˜ ÛÎÂÏÂÙÈÎ¤˜ ·ÓˆÌ·Ï›Â˜ (ÛÎÔÏ›ˆÛË,

ıÒÚ·Î·˜ ˘Ô‰ËÌ·ÙÔÔÈÒÓ, Û˘ÁÁÂÓ¤˜ ÂÍ¿ÚıÚËÌ·

·ÚÈÛÙÂÚÔ‡ ÈÛ¯›Ô˘, Î·Ù¿ÁÌ·Ù· ‰ÂÍÈÔ‡ Î·È ·ÚÈÛÙÂÚÔ‡

ÈÛ¯›Ô˘, ÂÍ¿ÚıÚËÌ· Î·È ÛÙÈ˜ ‰‡Ô Î·Ù¿ ÁfiÓ˘ ·ÚıÚÒ-

ÛÂÈ˜ Î·È ·ÌÊÔÙÂÚfiÏÂ˘ÚË Ú·È‚Ô˚ÔÔ‰›·),

Á) ‚·Ï·ÓÈÎfi˜ ˘ÔÛ·‰›· Î·È ÎÚ˘„ÔÚ¯›· ¿ÌÊˆ,

‰) ÎÈÓËÙÈÎ¤˜ Î·È ·ÈÛıËÙÈÎ¤˜ ‰È·Ù·Ú·¯¤˜ ÛÙ· Î¿Ùˆ

¿ÎÚ· (·Ô˘Û›· ·ÓÙ›‰Ú·ÛË˜ ÛÙÔÓ fiÓÔ, ÙÔ ˙ÂÛÙfi Î·È

ÙÔ ÎÚ‡Ô), ·ÎÚ¿ÙÂÈ· Ô‡ÚˆÓ Î·È ·Ô˘Û›· ÎÔÈÏÈ·ÎÒÓ

·ÓÙ·Ó·ÎÏ·ÛÙÈÎÒÓ (∂ÈÎfiÓÂ˜ 1,2).

™Â ËÏÈÎ›· ‰‡Ô ÌËÓÒÓ, ÛÙÔÓ ÂÓ‰ÔÛÎÔÈÎfi ¤ÏÂÁ¯Ô

ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ‰È·ÈÛÙÒıËÎ·Ó

ÔÏÏ·Ï¿ ·ÈÌ·ÁÁÂÈÒÌ·Ù· ÛÂ fiÏÔ ÙÔ Ì‹ÎÔ˜ ÙÔ˘ Á·-

ÛÙÚÂÓÙÂÚÈÎÔ‡ ÛˆÏ‹Ó· Î·È ¤ÙÛÈ ¤ÁÈÓÂ Ë ‰È¿ÁÓˆÛË ÙÔ˘

BRBNS. √ ÏÔÈfi˜ ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍÂ:

·) ·ÈÌ·ÁÁÂ›ˆÌ· ÛÙÔÓ ·ÚÈÛÙÂÚfi ÈÓÈ·Îfi ÏÔ‚fi, ÌÂÁ¤-

ıÔ˘˜ 2 cm,

‚) ·ÈÌ·ÁÁÂ›ˆÌ· ÛÂ Â·Ê‹ ÌÂ ÙÔÓ ‰ÂÍÈfi ÓÂÊÚfi,

Ô˘ ÂÂÎÙÂÈÓfiÙ·Ó ÛÙË ÛÔÓ‰˘ÏÈÎ‹ ÛÙ‹ÏË,

Á) ÙÂÚ¿ÛÙÈÔ ·ÈÌ·ÁÁÂ›ˆÌ· ÛÙËÓ ÔÈÛıÔÂÚÈÙÔÓ·˚-

Î‹ ¯ÒÚ· ÛÂ Â·Ê‹ ÌÂ ÙÔ ‰ÂÍÈfi ÂÈÓÂÊÚ›‰ÈÔ,

‰) ˘ÔÏ·ÛÙÈÎfi-‰˘ÛÏ·ÛÙÈÎfi ÓÂÊÚfi Î·È

Â) ÓÂ˘ÚÔÁÂÓ‹ Î‡ÛÙË ˘ÔÙÔÓÈÎÔ‡ Ù‡Ô˘.

™Â ËÏÈÎ›· 2 ÌËÓÒÓ Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ ¯ÂÈÚÔ˘Ú-

ÁÈÎ‹ Â¤Ì‚·ÛË ÌÂ ÌÂÚÈÎ‹ ÂÎÙÔÌ‹ ÙÔ˘ ·ÈÌ·ÁÁÂÈÒÌ·-

ÙÔ˜, ÙÔ ÔÔ›Ô ÂÚ¯fiÙ·Ó ÛÂ Â·Ê‹ ÌÂ ÙÔ ‰ÂÍÈfi ÂÈÓÂ-

ÊÚ›‰ÈÔ. ™ÙËÓ ›‰È· ËÏÈÎ›·, Î·Ù¿ ÙË ÓÂ˘ÚÔÏÔÁÈÎ‹ ÂÍ¤-

Ù·ÛË ‰È·ÈÛÙÒıËÎÂ Û˘ÁÁÂÓ‹˜ ·Ú·ÏËÁ›·.

™Â ËÏÈÎ›· 3 ÂÙÒÓ, Ë ÂÎÙ›ÌËÛË ÙË˜ ÓÔËÙÈÎ‹˜ ÙÔ˘

ÏÂÈÙÔ˘ÚÁ›·˜ ÌÂ ÂÈ‰ÈÎ¿ ·Ó·Ù˘ÍÈ·Î¿ ÙÂÛÙ (Denver ππ

Î·È Early Language Milestone) ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ‹.

™Â ËÏÈÎ›· 4 ÂÙÒÓ, ÂÈÛ‹¯ıË ÛÙËÓ ÎÏÈÓÈÎ‹ Ì·˜ ÌÂ

ÛÔ‚·Ú¤˜ ËÏÂÎÙÚÔÏ˘ÙÈÎ¤˜ ‰È·Ù·Ú·¯¤˜ ÛÂ ËÌÈ-ÎˆÌ·-

ÙÒ‰Ë Î·Ù¿ÛÙ·ÛË, ÛÙËÓ ÔÔ›· ·Ú¤ÌÂÈÓÂ ÁÈ· ÙÚ›·

ÙÔ˘Ï¿¯ÈÛÙÔÓ 24ˆÚ·. ∆fiÙÂ ·ÚÔ˘Û›·ÛÂ Î·È Â·ÓÂÈ-

ÏËÌÌ¤Ó· ÂÂÈÛfi‰È· ÂÛÙÈ·ÎÒÓ Û·ÛÌÒÓ ÌÂ ‰Â˘ÙÂÚÔ-

·ı‹ ÁÂÓ›ÎÂ˘ÛË (‰È¿ÚÎÂÈ·˜ ≤30 min). AÂÈÎÔÓÈÛÙÈ-

Î¿, ÛÙËÓ ·ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘, ‰È·ÈÛÙÒ-

ıËÎÂ ÂÈÌ‹ÎË˜ ˘fi˘ÎÓË ÂÚÈÔ¯‹, ÛÙÔÓ ÌÂÙˆÈ·›Ô,

‚ÚÂÁÌ·ÙÈÎfi Î·È ÈÓÈ·Îfi ÏÔ‚fi, ÌÂ Â·Û‚ÂÛÙÒÛÂÈ˜.

™ÙÔ Ï·›ÛÈÔ ÙË˜ Ù·ÎÙÈÎ‹˜ ·Ú·ÎÔÏÔ‡ıËÛË˜ ÙÔ˘

·ÛıÂÓÔ‡˜ ÌÂÙ¿ ·fi ‰‡Ô Ì‹ÓÂ˜, ‰È·ÈÛÙÒıËÎÂ ËÌÈ-

ÏËÁ›· ‰ÂÍÈÔ‡ ¿Óˆ ¿ÎÚÔ˘, ÛÔ‚·Ú‹ ‰È·Ù·Ú·¯‹ ÔÌÈ-

Ï›·˜, ‹È· ¤ÎÙˆÛË ÙË˜ ÓÔËÌÔÛ‡ÓË˜ Î·È ‰È·Ù·Ú·¯¤˜

Û˘ÌÂÚÈÊÔÚ¿˜. ∂ÈÏ¤ÔÓ, 6 Ì‹ÓÂ˜ ·ÚÁfiÙÂÚ·, ·ÚÔ˘-

Û›·ÛÂ ÚÔÔ‰Â˘ÙÈÎ¿, ÔÏ‡ Û˘¯Ó¤˜, Û‡ÓıÂÙÂ˜ ÂÛÙÈ·Î¤˜

ÎÚ›ÛÂÈ˜ (>10-15 ËÌÂÚËÛ›ˆ˜) ÌÈÎÚ‹˜ ‰È¿ÚÎÂÈ·˜ Î·È

Û·ÓÈfiÙÂÚ· ÁÂÓÈÎÂ˘Ì¤ÓÂ˜, ÌÂÁ¿ÏË˜ ‰È¿ÚÎÂÈ·˜ (status

epilepticus). ∞ÓÙÈÌÂÙˆ›ÛıËÎÂ ÌÂ ÔÏÏ·Ï‹ Î·È ÌÂ-

Ù·‚·ÏÏfiÌÂÓË ·ÓÙÈÛ·ÛÌˆ‰ÈÎ‹ Ê·ÚÌ·ÎÂ˘ÙÈÎ‹ ·Áˆ-

Á‹, ÌÂ ÌÂÚÈÎ‹ ÂÈÙ˘¯›· (Ú‡ıÌÈÛË Î·Ù¿ 75%).

™Â ËÏÈÎ›· 6,5 ÂÙÒÓ, ·ÚÔ˘Û›·ÛÂ Û˘ÌÙÒÌ·Ù·

ÂÓÙÂÚÈÎ‹˜ ·fiÊÚ·ÍË˜. ∆¤ıËÎÂ Ë ‰È¿ÁÓˆÛË ÙÔ˘

∂ÈÎfiÓ· 1. √ ·ÛıÂÓ‹˜.

∂ÈÎfiÓ· 2. ¢ÂÚÌ·ÙÈÎ¤˜ Î·È ÛÎÂÏÂÙÈÎ¤˜ ·ÓˆÌ·Ï›Â˜.


327™‡Ó‰ÚÔÌÔ Blue Rubber Bleb Nevus

¶·È‰È·ÙÚÈÎ‹ 2007;70:325-329

ÂÈÏÂÔÂÈÏÂ˚ÎÔ‡ ÂÁÎÔÏÂ·ÛÌÔ‡, Ô ÔÔ›Ô˜ ÔÊÂÈÏfiÙ·Ó ÛÂ

ÌÂÁ¿ÏÔ ·ÈÌ·ÁÁÂ›ˆÌ· ÛÙËÓ ÂÚÈÔ¯‹ Î·È ÙÔ ÔÔ›Ô

·Ê·ÈÚ¤ıËÎÂ ¯ÂÈÚÔ˘ÚÁÈÎ¿. ∂ÈÏ¤ÔÓ, ÂÂÈ‰‹ Û˘Ó¤¯È-

˙Â Ó· ·ÚÔ˘ÛÈ¿˙ÂÈ Û˘¯Ó¤˜ ÂÈÏËÙÈÎ¤˜ ÎÚ›ÛÂÈ˜, ¤ÁÈÓÂ

Ì·ÁÓËÙÈÎ‹ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ (MRI), ÛÙËÓ

ÔÔ›· ‰È·ÈÛÙÒıËÎÂ ÂÎÙÂÙ·Ì¤ÓË ‚Ï¿‚Ë Ì·ÎÚÔÎ˘-

ÛÙÈÎ‹˜ ÂÁÎÂÊ·ÏÔÌ·Ï¿Î˘ÓÛË˜ ÛÙÔ ·ÚÈÛÙÂÚfi ÂÁÎÂÊ·-

ÏÈÎfi ËÌÈÛÊ·›ÚÈÔ, Ë ÔÔ›· ÚÔÎ·ÏÔ‡ÛÂ ¤ÏÍË ÙË˜ Û‡-

ÛÙÔÈ¯Ë˜ Ï¿ÁÈ·˜ ÎÔÈÏ›·˜, ÚÔÊ·ÓÒ˜ ·fiÙÔÎÔ˜ ÙÔ˘

ıÚÔÌ‚ˆÙÈÎÔ‡ ·ÁÁÂÈ·ÎÔ‡ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘,

Ô˘ Â›¯Â ˘ÔÛÙÂ› ÛÙËÓ ËÏÈÎ›· ÙˆÓ 4 ÂÙÒÓ .

™Â ËÏÈÎ›· 12 ÂÙÒÓ, ‰È·ÈÛÙÒıËÎÂ ÁÈ· ÚÒÙË ÊÔ-

Ú¿ „ËÏ·ÊËÙ‹ ÂÒ‰˘ÓË Ì¿˙· ÛÙÔÓ ·˘¯¤Ó·. ∏ Ì·-

ÁÓËÙÈÎ‹ ÙÔÌÔÁÚ·Ê›· (MRI) ·˘¯ÂÓÈÎ‹˜ ÌÔ›Ú·˜ ·Ô-

Î¿Ï˘„Â ¤Ó· ÌÂÁ¿ÏÔ Î·È ·ÚÎÂÙ¿ ÌÈÎÚfiÙÂÚ· ·ÈÌ·Á-

ÁÂÈÒÌ·Ù· ÛÙËÓ ·˘¯ÂÓÈÎ‹ ÂÚÈÔ¯‹ (∂ÈÎfiÓ· 3), ÂÓÒ Ë

Â·Ó·ÏËÙÈÎ‹ MRI ÂÁÎÂÊ¿ÏÔ˘ ‹Ù·Ó ¯ˆÚ›˜ Ô˘ÛÈ·-

ÛÙÈÎ‹ ÌÂÙ·‚ÔÏ‹.

™Â ËÏÈÎ›· 13 ÂÙÒÓ, ÂÂÈ‰‹ Û˘Ó¤¯È˙Â Ó· ·ÚÔ˘ÛÈ¿-

˙ÂÈ Û˘¯Ó¤˜ ÂÈÏËÙÈÎ¤˜ ÎÚ›ÛÂÈ˜, ÚÔÔ‰Â˘ÙÈÎ¿ ÂÈ-

‰ÂÈÓÔ‡ÌÂÓÂ˜, ¤ÁÈÓÂ Î·È ‰Â‡ÙÂÚË Â·Ó·ÏËÙÈÎ‹ MRI

ÂÁÎÂÊ¿ÏÔ˘, fiÔ˘ ‰È·ÈÛÙÒıËÎ·Ó ÔÈ ›‰ÈÂ˜ ‚Ï¿‚Â˜

ÙË˜ ÂÁÎÂÊ·ÏÔÌ·Ï¿Î˘ÓÛË˜ ÛÙÔ ·ÚÈÛÙÂÚfi ÂÁÎÂÊ·ÏÈÎfi

ËÌÈÛÊ·›ÚÈÔ (∂ÈÎfiÓ· 4), Î·ıÒ˜ Î·È ‹È· ·ÙÚÔÊ›· ÙÔ˘

Û‡ÛÙÔÈ¯Ô˘ ÂÁÎÂÊ·ÏÈÎÔ‡ ÛÎ¤ÏÔ˘˜ Î·È ÙÔ˘ ·ÓÙ›ÛÙÔÈ-

¯Ô˘ ËÌÈÛÊ·ÈÚ›Ô˘ ÙË˜ ·ÚÂÁÎÂÊ·Ï›‰·˜.

™ÙË ‰È¿ÚÎÂÈ· ÙË˜ Ì·ÎÚfi¯ÚÔÓË˜ ·Ú·ÎÔÏÔ‡ıË-

Û‹˜ ÙÔ˘, ÂÈÛ‹¯ıË ÔÏÏ¤˜ ÊÔÚ¤˜ ÛÂ ÓÔÛÔÎÔÌÂ›Ô ÂÍ·È-

Ù›·˜ ÛÔ‚·ÚÒÓ ÏÔÈÌÒÍÂˆÓ ÙÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡ Î·È

ÙÔ˘ Ô˘ÚÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, ÔÈ ÔÔ›Â˜ Î·È ·ÓÙÈ-

ÌÂÙˆ›ÛÙËÎ·Ó ·ÔÙÂÏÂÛÌ·ÙÈÎ¿. √È ÂÚÁ·ÛÙËÚÈ·Î¤˜

ÂÍÂÙ¿ÛÂÈ˜, Û˘ÓÂ¯›˙Ô˘Ó Ó· ‰Â›¯ÓÔ˘Ó ÛÙ·ıÂÚ‹ Î·È ÂÌ-

Ì¤ÓÔ˘Û· ÛÈ‰ËÚÔÂÓÈÎ‹ ·Ó·ÈÌ›·, Î·ıÒ˜ Î·È ÛÙ·ıÂÚ‹

ÌÈÎÚÔÛÎÔÈÎ‹ ·Ô‚ÔÏ‹ ·›Ì·ÙÔ˜ ÛÙ· ÎfiÚ·Ó·. ÃÚÂÈ-

¿ÛÙËÎÂ Ó· ÌÂÙ·ÁÁÈÛÙÂ› 3 ÊÔÚ¤˜ Î·È Û˘ÓÂ¯›˙ÂÙ·È Ë ¯Ô-

Ú‹ÁËÛË ÛÈ‰‹ÚÔ˘ Î·È Ë Û˘ÌÏËÚˆÌ·ÙÈÎ‹ ‰È·ÙÚÔÊ‹.

∆¤ÏÔ˜, ·Ú·ÎÔÏÔ˘ıÂ›Ù·È ÌÂ Ù·ÎÙÈÎfi ÎÏÈÓÈÎfi Î·È ÂÚ-

Á·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô.

™˘˙‹ÙËÛË

To µRBNS ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ·ÁÁÂÈ·Î¤˜ ·Óˆ-

Ì·Ï›Â˜ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ Î·È ¿ÏÏˆÓ ÔÚÁ¿ÓˆÓ. ∂›Ó·È ÌÈ·

Û¿ÓÈ· ÔÓÙfiÙËÙ·, ·ÊÔ‡ ·fi ÙËÓ ·Ú¯ÈÎ‹ ÂÚÈÁÚ·Ê‹

ÙÔ˘ ÙÔ 1958 (2), ¤¯Ô˘Ó ‰ËÌÔÛÈÂ˘ıÂ› ÏÈÁfiÙÂÚÂ˜ ·fi

200 ÂÚÈÙÒÛÂÈ˜, Î˘Ú›ˆ˜ ÛÂ ÏÂ˘ÎÔ‡˜ Î·È π¿ˆÓÂ˜,

ÂÓÒ ÌfiÓÔÓ ÙÚÂÈ˜ ·ÛıÂÓÂ›˜ ·Ó‹ÎÔ˘Ó ÛÙË Ì·‡ÚË Ê˘Ï‹.

√È ÂÚÈÛÛfiÙÂÚÂ˜ ÂÚÈÙÒÛÂÈ˜ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘

‰È·ÈÛÙÒÓÔÓÙ·È Î·Ù¿ ÙË Á¤ÓÓËÛË ‹ ÛÙ· ÚÒÙ· ¯Úfi-

ÓÈ· ˙ˆ‹˜, ÂÓÒ Û˘¯Ó¿ ÔÈ ‚Ï¿‚Â˜ Â›Ó·È ·ÚÔ‡ÛÂ˜ Î·È

·fi ÙËÓ ÂÓ‰ÔÌ‹ÙÚÈÔ ˙ˆ‹. ∂Ï¿¯ÈÛÙÂ˜ ÂÚÈÙÒÛÂÈ˜

‰È·ÁÓÒÛÙËÎ·Ó ÛÙËÓ ÂÓ‹ÏÈÎÔ ˙ˆ‹ (3).

∆Ô Û‡Ó‰ÚÔÌÔ ÂÌÊ·Ó›˙ÂÙ·È Î·È ÛÙ· ‰‡Ô Ê‡Ï·. √È

ÂÚÈÛÛfiÙÂÚÂ˜ ÂÚÈÙÒÛÂÈ˜ Â›Ó·È ÛÔÚ·‰ÈÎ¤˜, ·Ó

Î·È ¤¯Ô˘Ó ÂÚÈÁÚ·ÊÂ› Î·È Î¿ÔÈÂ˜ Ô˘ ÎÏËÚÔÓÔ-ÌÔ‡ÓÙ·È ÌÂ ÙÔÓ ·˘ÙoÛˆÌ·ÙÈÎfi ÂÈÎÚ·ÙÔ‡ÓÙ· ¯·-Ú·ÎÙ‹Ú·, ÔÊÂÈÏfiÌÂÓÂ˜ ÛÂ ÁÔÓ›‰ÈÔ Ô˘ Â‰Ú¿˙ÂÙ·È

∂ÈÎfiÓ· 3. MRI ·˘¯ÂÓÈÎ‹˜ ÌÔ›Ú·˜: ·ÈÌ·ÁÁÂÈÒÌ·Ù· ·˘¯ÂÓÈÎ‹˜ÂÚÈÔ¯‹˜.

∂ÈÎfiÓ· 4. MRI ÂÁÎÂÊ¿ÏÔ˘: ÂÎÙÂÙ·Ì¤ÓË ‚Ï¿‚Ë Ì·ÎÚÔÎ˘ÛÙÈÎ‹˜ÂÁÎÂÊ·ÏÔÌ·Ï¿Î˘ÓÛË˜ ÛÙÔ ·ÚÈÛÙÂÚfi ÂÁÎÂÊ·ÏÈÎfi ËÌÈÛÊ·›ÚÈÔ.


328 ª. ∆˙Ô‡ÊË Î·È Û˘Ó.


ÛÙÔ 9p ¯ÚˆÌfiÛˆÌ· (4). ¡ÂfiÙÂÚ· ‰Â‰ÔÌ¤Ó· ‰›ÓÔ˘Ó

ÂÚÈÛÛfiÙÂÚÂ˜ ÏËÚÔÊÔÚ›Â˜ Û¯ÂÙÈÎ¿ ÌÂ ÙÔÓ ÙÚfiÔ ÁÂ-

ÓÂÙÈÎ‹˜ ÌÂÙ·‚›‚·ÛË˜ ·˘ÙÒÓ ÙˆÓ ·ÁÁÂÈ·ÎÒÓ ·ÓˆÌ·-

ÏÈÒÓ (5).

∆· Â˘Ú‹Ì·Ù· ÛÙÔ BRBNS ‰È·ÎÚ›ÓÔÓÙ·È ÛÂ ‰ÂÚÌ·-

ÙÈÎ¤˜ Î·È ÂÍˆ‰ÂÚÌ·ÙÈÎ¤˜ ·ÓˆÌ·Ï›Â˜. √È ‰ÂÚÌ·ÙÈÎ¤˜

·ÓˆÌ·Ï›Â˜ Â›Ó·È Û˘Ó‹ıˆ˜ ÔÏÏ·Ï¤˜ Î·È ‰È·Ê¤ÚÔ˘Ó

ÛÂ Ì¤ÁÂıÔ˜, ·fi Ï›Á· ¯ÈÏÈÔÛÙ¿ Ì¤¯ÚÈ ·ÚÎÂÙ¿ ÂÎ·ÙÔ-

ÛÙ¿ ÛÂ ‰È¿ÌÂÙÚÔ. ªÔÚÂ› Ó· Â›Ó·È Â˘·›ÛıËÙÂ˜ ÛÙËÓ

„ËÏ¿ÊËÛË Î·È Ó· Û˘ÓÔ‰Â‡ÔÓÙ·È ·fi ˘ÂÚÈ‰ÚˆÛ›·.

™·ÓÈfiÙ·Ù· ·ÈÌÔÚÚ·ÁÔ‡Ó, ÂÎÙfi˜ ·Ó ÙÚ·˘Ì·ÙÈÛÙÔ‡Ó.

ªÂ ÙËÓ ¿ÚÔ‰Ô ÙË˜ ËÏÈÎ›·˜ ·Ú·ÙËÚÂ›Ù·È ·‡ÍËÛË

ÙÔ˘ ÌÂÁ¤ıÔ˘˜ Î·È ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ·ÁÁÂÈ·ÎÒÓ ‰˘-

ÛÏ·ÛÈÒÓ . º·›ÓÂÙ·È fiÙÈ ÙÔ BRBNS ÂÈ‰ÂÈÓÒÓÂÙ·È ÌÂ

ÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ ÛÒÌ·ÙÔ˜ Î·È ÌfiÓÔ Û·ÓÈfiÙ·Ù·

‚ÂÏÙÈÒÓÂÙ·È, ÂÓÒ ÂÚÈÁÚ¿ÊÔÓÙ·È Î·È ÂÚÈÙÒÛÂÈ˜

Â·ÓÂÌÊ¿ÓÈÛË˜ ÙˆÓ “·ÈÌ·ÁÂÈˆÌ¿ÙˆÓ” ÌÂÙ¿ ·fi ¯ÂÈ-

ÚÔ˘ÚÁÈÎ‹ ÂÍ·›ÚÂÛË (3).

Œ¯Ô˘Ó ·Ó·ÊÂÚıÂ› ÙÚÂÈ˜ Ù‡ÔÈ ·ÁÁÂÈ·ÎÒÓ ‰ÂÚÌ·-

ÙÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ: ·) Ê˘Û·Ï›‰Â˜ ÌÏÂ, ÂÏ·ÛÙÈÎ¤˜,

ÁÂÌ¿ÙÂ˜ ÌÂ ·›Ì· (blue rubber bleb), ÌÂ ÏÂ›· ‹ Ú˘ÙÈ-

‰ˆÌ¤ÓË ÂÈÊ¿ÓÂÈ·, Ô˘ ˘Ô¯ˆÚÔ‡Ó Î·È Í·Ó·ÁÂÌ›-

˙Ô˘Ó ÁÚ‹ÁÔÚ·, fiÙ·Ó ·ÛÎËıÂ› ›ÂÛË, ‚) ÌÂÁ¿ÏÂ˜ ‰‡-

ÛÌÔÚÊÂ˜ ÊÏÂ‚ÈÎ¤˜ ·ÓˆÌ·Ï›Â˜, Ô˘ ÌÔÚÂ› Ó· È¤-

ÛÔ˘Ó ˙ˆÙÈÎ¿ fiÚÁ·Ó· Î·È Á) ÌÏÂ ·ÓÒÌ·ÏÂ˜ Ì¿˙Â˜.

∞Ó Î·È ÌÔÚÂ› Ó· ÂÌÊ·ÓÈÛÙÔ‡Ó ÔÔ˘‰‹ÔÙÂ, ÂÓÙÔ›-

˙ÔÓÙ·È Î˘Ú›ˆ˜ ÛÙ· ¿Óˆ ¿ÎÚ·, ÙÔÓ ÎÔÚÌfi Î·È ÙÔ ÂÚ›-

ÓÂÔ. ∞ÈÌ·ÁÁÂÈÒÌ·Ù· ÛÙ· Î¿Ùˆ ¿ÎÚ· Â›Ó·È ·Û˘Ó‹ıÈ-

ÛÙ· Î·È, fiÙ·Ó ˘¿Ú¯Ô˘Ó, Û˘ÓÔ‰Â‡ÔÓÙ·È ·fi ·ÍÈÔÛË-

ÌÂ›ˆÙÂ˜ ‰È·Ù·Ú·¯¤˜ (6).

∆· “·ÈÌ·ÁÁÂÈÒÌ·Ù·” ÛÙÔÓ Á·ÛÙÚÂÓÙÂÚÈÎfi ÛˆÏ‹-

Ó· (·fi ÙÔ ÛÙfiÌ· ˆ˜ ÙÔ ÔÚıfi, ÌÂ Û˘¯ÓfiÙÂÚË ÂÓÙfiÈ-

ÛË ÛÙÔ ÏÂÙfi ¤ÓÙÂÚÔ) ‰È·ÈÛÙÒÓÔÓÙ·È ÛÂ fiÏÔ˘˜ ÙÔ˘˜

·ÛıÂÓÂ›˜ ÌÂ BRBNS. øÛÙfiÛÔ, Ù· “·ÈÌ·ÁÁÂÈÒÌ·Ù·”

ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ ÌÔÚÂ› Ó· ÂÌÊ·ÓÈÛÙÔ‡Ó ÛÂ ÌÂ-

Á·Ï‡ÙÂÚË ËÏÈÎ›· (ÂÊË‚Â›· ‹ Î·È ·ÚÁfiÙÂÚ·) Î·È fi¯È

·fi ÙË Á¤ÓÓËÛË, fiˆ˜ Û˘Ì‚·›ÓÂÈ ÌÂ ÙÈ˜ ·ÓÙ›ÛÙÔÈ¯Â˜

‚Ï¿‚Â˜ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜. ™Â ·ÓÙ›ıÂÛË ÌÂ ÙÈ˜ ‰ÂÚÌ·ÙÈ-

Î¤˜ ‚Ï¿‚Â˜, ÔÈ ÊÏÂ‚ÈÎ¤˜ ·ÓˆÌ·Ï›Â˜ ÙÔ˘ Á·ÛÙÚÂÓÙÂ-

ÚÈÎÔ‡ ÛˆÏ‹Ó· ·ÈÌÔÚÚ·ÁÔ‡Ó Û˘¯Ó¿. ªÔÚÂ› Ó· ˘Ô-

ÛÙÔ‡Ó Ú‹ÍË ·˘ÙfiÌ·Ù· Î·È Ó· ÚÔÎ·Ï¤ÛÔ˘Ó ÔÍÂ›· ÛÔ-

‚·Ú‹ ·ÈÌÔÚÚ·Á›· Î·È ı¿Ó·ÙÔ. ™˘Ó‹ıˆ˜ fiÌˆ˜, Ë ·È-

ÌÔÚÚ·Á›· Â›Ó·È ·ÚÁ‹, ÌÈÎÚ‹ Î·È ¯ÚfiÓÈ·, ¤¯ÔÓÙ·˜ ˆ˜

·ÔÙ¤ÏÂÛÌ· ÛÈ‰ËÚÔÂÓÈÎ‹ ·Ó·ÈÌ›·. ∂Ó›ÔÙÂ, ÔÈ ÊÏÂ-

‚ÈÎ¤˜ ·ÓˆÌ·Ï›Â˜ ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡, Â˘ı‡ÓÔÓÙ·È

ÁÈ· ÂÈÏÔÎ¤˜ fiˆ˜ ÂÈÏÂfi, Û˘ÛÙÚÔÊ‹ ‹ ÂÁÎÔÏÂ·ÛÌfi

(7). √ ·ÛıÂÓ‹˜ Ì·˜ ·ÔÙÂÏÂ› ·ÓÙÈÚÔÛˆÂ˘ÙÈÎ‹ Â-

Ú›ÙˆÛË, ·ÊÔ‡ ·ÚÔ˘ÛÈ¿˙ÂÈ Ù˘ÈÎ¤˜ ‰ÂÚÌ·ÙÈÎ¤˜

‚Ï¿‚Â˜, ÛÈ‰ËÚÔÂÓÈÎ‹ ·Ó·ÈÌ›· ÌÂ ıÂÙÈÎ‹ ªayer ÎÔ-

Ú¿ÓˆÓ Î·È ÂÂÈÛfi‰ÈÔ ÂÁÎÔÏÂ·ÛÌÔ‡.

√È ÔÚıÔÂ‰ÈÎ¤˜ ·ÓˆÌ·Ï›Â˜ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Â-

ÚÈÏ·Ì‚¿ÓÔ˘Ó Î˘ÚÙÒÛÂÈ˜ ÙˆÓ ÔÛÙÒÓ, ·ıÔÏÔÁÈÎ¿

Î·Ù¿ÁÌ·Ù·, ·ÚıÚÈÎ¤˜ ‚Ï¿‚Â˜ Î·È ˘ÂÚ·Ó¿Ù˘ÍË

ÙˆÓ ÔÛÙÒÓ (6,8). √È ÔÛÙÈÎ¤˜ ‚Ï¿‚Â˜ ÚÔÎ‡ÙÔ˘Ó

ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙË˜ ·ÛÎÔ‡ÌÂÓË˜ ›ÂÛË˜ ·fi ÙÈ˜

·Ú·ÎÂ›ÌÂÓÂ˜ ÊÏÂ‚ÈÎ¤˜ ‚Ï¿‚Â˜. µÏ¿‚Â˜ ÛÙËÓ ·-

Ú·ÎÂ›ÌÂÓË ÙˆÓ ÛÔÓ‰‡ÏˆÓ ÂÚÈÔ¯‹ ÌÔÚÂ› Ó· ÚÔ-

Î·Ï¤ÛÔ˘Ó ›ÂÛË ÛÙË ÛÔÓ‰˘ÏÈÎ‹ ÛÙ‹ÏË Î·È Î·ı›˙Ë-

ÛË ÙˆÓ ÛÔÓ‰‡ÏˆÓ, ÂÓÒ Â›Ó·È Èı·Ófi Ó· ÂÎÙÂ›ÓÔ-

ÓÙ·È ÛÙ· ÌÂÛÔÛÔÓ‰‡ÏÈ· ‰È·ÛÙ‹Ì·Ù·, ÂËÚÂ¿˙Ô-

ÓÙ·˜ ÙËÓ ÎÈÓËÙÈÎfiÙËÙ· Î·È ÙËÓ ·ÈÛıËÙÈÎfiÙËÙ·. √

·ÛıÂÓ‹˜ Ì·˜ ·ÚÔ˘Û›·˙Â ·ıÔÏÔÁÈÎ¿ Î·Ù¿ÁÌ·Ù·

·fi ÙË Á¤ÓÓËÛ‹ ÙÔ˘, ·ÚıÚÈÎ¤˜ ‚Ï¿‚Â˜ (Û˘ÁÁÂÓ‹ ‰˘-

ÛÏ·Û›· ÈÛ¯›Ô˘) Î·È ›ÂÛË ÛÙË ÛÔÓ‰˘ÏÈÎ‹ ÛÙ‹ÏË,

ÌÂ Û˘ÓÔ‰fi ·Ú·ÏËÁ›·. ™ÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›·,

˘¿Ú¯Ô˘Ó ¿ÏÏ· 14 ÂÚÈÛÙ·ÙÈÎ¿ ÌÂ ÙÔ Û‡Ó‰ÚÔÌÔ Î·È

Û˘ÓÔ‰¤˜ ÔÚıoÂ‰ÈÎ¤˜ ·ÓˆÌ·Ï›Â˜ (6,8).

Ã·Ú·ÎÙËÚÈÛÙÈÎ¤˜ ‚Ï¿‚Â˜ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ¤¯Ô˘Ó

ÂÚÈÁÚ·ÊÂ› ÛÙÔ ‹·Ú, ÙÔÓ ÛÏ‹Ó·, ÙÔ ÂÚÈÙfiÓ·ÈÔ,

ÙÔ˘˜ ÓÂ‡ÌÔÓÂ˜, ÙËÓ ÙÚ·¯Â›·, ÙÔ˘˜ ÛÎÂÏÂÙÈÎÔ‡˜

Ì‡Â˜, Ù· Ì¿ÙÈ·, ÙË ¯ÔÏË‰fi¯Ô Î‡ÛÙË, ÙÔ ¤Ô˜, ÙÈ˜ ·-

ÚˆÙ›‰Â˜ Î·È ÙÔ ∫ÂÓÙÚÈÎfi ¡Â˘ÚÈÎfi ™‡ÛÙËÌ· (∫¡™)

(3,7,8). ∞Ó Î·È ·ÚÎÂÙÔ› ÂÚÂ˘ÓËÙ¤˜ ¤¯Ô˘Ó ·Ó·Ê¤ÚÂÈ

Û˘ÌÌÂÙÔ¯‹ ÙÔ˘ ∫¡™ ÛÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜, ÔÚÈÛÌ¤ÓÂ˜

·fi ÙÈ˜ ‰È·ÁÓÒÛÂÈ˜ ‰ÂÓ ‹Ù·Ó Û·ÊÂ›˜. H ÚÒÙË ÙÂÎ-

ÌËÚÈˆÌ¤ÓË ÂÚÈÁÚ·Ê‹ ¤ÁÈÓÂ ÙÔ 1978 ·fi ÙÔ˘˜

Waybright et al (9), ÛÂ ·ÛıÂÓ‹ Ô˘ ·ÚÔ˘Û›·˙Â

ÂÛÙÈ·ÎÔ‡˜ Û·ÛÌÔ‡˜ Î·È ÓÂ˘ÚÔÏÔÁÈÎ¿ ÛËÌÂ›·, ÂÍ·È-

Ù›·˜ ıÚÔÌ‚ÒÛÂˆ˜ ÙË˜ ÊÏ¤‚·˜ ÙÔ˘ °·ÏËÓÔ‡, ÂÓÒ Î·È

ÔÏÏ¿ ¿ÏÏ· ·ÈÌ·ÁÁÂÈÒÌ·Ù· ‹Ù·Ó Â›ÛË˜ ıÚÔÌ‚ˆ-

Ì¤Ó·. ∆· ÂÛÙÈ·Î¿ ÓÂ˘ÚÔÏÔÁÈÎ¿ ÛËÌÂ›· Ê·›ÓÂÙ·È fiÙÈ

ÔÊÂ›ÏÔÓÙ·È ÛÂ ıÚfiÌ‚ˆÛË ÙˆÓ ·ÁÁÂÈ·ÎÒÓ ‰˘ÛÏ·-

ÛÈÒÓ. √È ‰˘ÛÏ·Û›Â˜ ·˘Ù¤˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ıÚfiÌ‚ˆ-

ÛË ÏfiÁˆ ¯·ÌËÏ‹˜ ÚÔ‹˜ ·›Ì·ÙÔ˜, fiˆ˜ ·Ô‰ÂÈÎÓ‡Â-

Ù·È ·fi ÙËÓ ÂÓ·fiıÂÛË ·ÈÌÔÛÈ‰ËÚ›ÓË˜ ÛÙÔ˘˜ ÂÚÈ-

‚¿ÏÏÔÓÙÂ˜ ÈÛÙÔ‡˜ Î·È ÙËÓ ·Û‚ÂÛÙÔÔ›ËÛ‹ ÙÔ˘˜.

∂ÎÙfi˜ ·fi ÙÈ˜ ÊÏÂ‚ÈÎ¤˜ ‰˘ÛÏ·Û›Â˜, ÛÂ ·ÛıÂÓÂ›˜ ÌÂ

BRBNS ¤¯Ô˘Ó ÂÚÈÁÚ·ÊÂ› ÛÔÓ‰˘ÏÈÎ¿ ·ÈÌ·ÁÁÂÈÒ-

Ì·Ù· Ô˘ ÚÔÎ·ÏÔ‡Ó ›ÂÛË ÛÙË ÛÔÓ‰˘ÏÈÎ‹ ÛÙ‹ÏË,

ÁÈÁ·ÓÙÈ·›Ô ÊÏÂ‚ÈÎfi ·ÁÁÂ›ˆÌ·, ¿ÓÔÈ· Û¯ÂÙÈ˙fiÌÂÓË ÌÂ

ÙË ¯ÚfiÓÈ· ÂÓ‰·ÁÁÂÈ·Î‹ ‰È·ÛÔÚ¿ ıÚfiÌ‚ˆÓ, ÔÏÏ·-

Ï¿ ÂÁÎÂÊ·ÏÈÎ¿ ·ÁÁÂÈ·Î¿ ¤ÌÊÚ·ÎÙ·, Î·ıÒ˜ Î·È ·Ú-

ÙËÚÈÔÊÏÂ‚Ò‰Â˜ Û˘Ú›ÁÁÈÔ (10).

√È ·Ú·ÎÏÈÓÈÎ¤˜ Ì¤ıÔ‰ÔÈ Ô˘ ¯ÚËÛÈÌÂ‡Ô˘Ó ÛÙË

‰È¿ÁÓˆÛË ÙÔ˘ BRBNS Â›Ó·È ÂÍÂÙ¿ÛÂÈ˜ ·›Ì·ÙÔ˜, ÁÂÓÈ-

Î‹ Ô‡ÚˆÓ (ÁÈ· ‡·ÚÍË ·ÈÌ·ÙÔ˘Ú›·˜), Mayer ÎÔÚ¿-

ÓˆÓ, ÂÓ‰ÔÛÎÔÈÎ¤˜ Ì¤ıÔ‰ÔÈ Î·È MRI ÂÁÎÂÊ¿ÏÔ˘, Ë

ÔÔ›· ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÙÂÏÂ˘Ù·›· ÁÈ· ÙËÓ ·ÓÂ‡ÚÂÛË

·Û˘ÌÙˆÌ·ÙÈÎÒÓ ·Û¯fiÓÙˆÓ, ÌÂÏÒÓ ÙË˜ ÔÈÎÔÁ¤ÓÂÈ-

·˜ ÙÔ˘ ¿Û¯ÔÓÙÔ˜ (11).

∞ÔÙÂÏÂÛÌ·ÙÈÎ‹ ıÂÚ·Â›· ÁÈ· ÙÔ˘˜ ¿Û¯ÔÓÙÂ˜

·fi BRBNS ‰ÂÓ ˘¿Ú¯ÂÈ. ∏ ·Ó·ÈÌ›· ·ÓÙÈÌÂÙˆ›˙Â-

Ù·È ÌÂ ÙË ¯ÔÚ‹ÁËÛË ÛÈ‰‹ÚÔ˘ Î·È ÌÂ ÌÂÙ·ÁÁ›ÛÂÈ˜. ∏

¯ÂÈÚÔ˘ÚÁÈÎ‹ ıÂÚ·Â›· ÂÍ·ÚÙ¿Ù·È ·fi ÙÔ Ì¤ÁÂıÔ˜,

ÙÔÓ ·ÚÈıÌfi, ÙËÓ ÂÓÙfiÈÛË Î·È Ù· Û˘ÌÙÒÌ·Ù· ÙÔ˘

·ÛıÂÓÔ‡˜. √È ÂÊ·ÚÌÔÛÌ¤ÓÂ˜ Ì¤ıÔ‰ÔÈ ÁÈ· ıÂÚ·Â›·


329™‡Ó‰ÚÔÌÔ Blue Rubber Bleb Nevus

¶·È‰È·ÙÚÈÎ‹ 2007;70:325-329

Â›Ó·È ¯ÂÈÚÔ˘ÚÁÈÎ‹ ÂÍ·›ÚÂÛË ÌÂÌÔÓˆÌ¤ÓˆÓ ‚Ï·‚ÒÓ,¯ÂÈÚÔ˘ÚÁÈÎ‹ ÂÎÙÔÌ‹ ÙÌ‹Ì·ÙÔ˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘ ‹ ÂÈ‰ÈÎ¤˜ÂÓ‰ÔÛÎÔÈÎ¤˜ ıÂÚ·Â›Â˜ ÌÂ Laser. √È ÔÚıÔÂ‰ÈÎ¤˜·ÓˆÌ·Ï›Â˜ ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È ÌÂ ‰ÈÔÚıˆÙÈÎ¤˜ ¯ÂÈ-ÚÔ˘ÚÁÈÎ¤˜ ÂÂÌ‚¿ÛÂÈ˜. ∞Ó ÔÈ ‚Ï¿‚Â˜ ÚÔÎ·ÏÔ‡Ó ÁÈÁ·-ÓÙÈÛÌfi, Ô ·ÎÚˆÙËÚÈ·ÛÌfi˜ Â›Ó·È Èı·ÓfiÙÂÚ· Ë Î·Ï‡ÙÂ-ÚË ıÂÚ·Â›· (6).

∏ ÚfiÁÓˆÛË ÔÈÎ›ÏÂÈ Î·È ÂÍ·ÚÙ¿Ù·È ·fi ÙËÓ¤ÎÙ·ÛË ÙË˜ Û˘ÌÌÂÙÔ¯‹˜ ÙˆÓ ÂÛˆÙÂÚÈÎÒÓ ÔÚÁ¿ÓˆÓ,ÂÓÒ Ë Û˘ÌÌÂÙÔ¯‹ ÙÔ˘ ∫¡™, fiÙ·Ó ˘¿Ú¯ÂÈ, Ô‰ËÁÂ› ÛÂÌ›· ¯ÚfiÓÈ·, ‚Ú·‰¤ˆ˜ ÂÈ‰ÂÈÓÔ‡ÌÂÓË ÔÚÂ›·, ÏfiÁˆÙˆÓ ÂÈÏËÙÈÎÒÓ ÎÚ›ÛÂˆÓ (11,12).

√ ·ÛıÂÓ‹˜ Ô˘ ÂÚÈÁÚ¿„·ÌÂ ·ÚÔ˘ÛÈ¿˙ÂÈ È‰È·›-ÙÂÚÔ ÂÓ‰È·Ê¤ÚÔÓ, ÁÈ·Ù› ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· ·Ó·Ê¤ÚÔ-ÓÙ·È ÌfiÓÔ ‰‡Ô ÂÚÈÙÒÛÂÈ˜ ·È‰ÈÒÓ ÌÂ ÚÔÛ‚ÔÏ‹ÙÔ˘ ∫¡™, ÌÂ ÚÒÙÔ Û‡ÌÙˆÌ· ÙËÓ ÂÌÊ¿ÓÈÛË ÂÛÙÈ·-ÎÒÓ ÂÈÏËÙÈÎÒÓ ÎÚ›ÛÂˆÓ ÛÙË ÓÂÔÁÓÈÎ‹ Î·È ‚ÚÂÊÈÎ‹ËÏÈÎ›·, ÌÂ Î·Ï‹ ‹ ÌÂÚÈÎ‹ ·ÓÙ·fiÎÚÈÛË ÛÙË Ê·ÚÌ·-ÎÂ˘ÙÈÎ‹ ·ÁˆÁ‹ Î·È ·Ó·Ù˘ÍÈ·Î‹ ÂÈ‚Ú¿‰˘ÓÛË(11,12). ∂›ÛË˜, ÚÔ¯ˆÚÒÓÙ·˜ ÛÂ ·Ó·ÛÎfiËÛË ÙË˜‰È·ı¤ÛÈÌË˜ ‚È‚ÏÈÔÁÚ·Ê›·˜ ‰ÂÓ ˘¿Ú¯ÂÈ ¿ÏÏË Î·Ù·-ÁÂÁÚ·ÌÌ¤ÓË ÂÚ›ÙˆÛË ·È‰ÈÔ‡ ÌÂ BRBN Û‡Ó‰ÚÔ-ÌÔ, ÌÂ Ù·˘Ùfi¯ÚÔÓË ÚÔÛ‚ÔÏ‹ ÙÔ˘ ∫¡™, ÙÔ˘ ÓˆÙÈ·›-Ô˘ Ì˘ÂÏÔ‡ Î·È ÙÔ˘ ÂÚÂÈÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜.

BÈ‚ÏÈÔÁÚ·Ê›·

1. Gascoyen CG. Case of nevus involving the parotid glandand causing death frouffocation: nevi of viscera. TransPath Soc Lond 1860;11:267.

2. Bean WB. Blue rubber bleb naevi of the skin and gastroin-testinal tract. In: Thomas CC, editor. Vascular spiders andrelated lesions of the skin. Spring-field, IL: CharlesThomas, 1958:178-185.

3. ¡ahmWK, Moise S, Eichenfield LF, Paller AS, NathansonL, Malicki D, et al. Venous malformations in blue rubberbleb nevus syndrome: variable onset of presentation. J AmAcad Dermatol. 2004;50 (Suppl 5):S101-106.

4. Gallione CJ, Pasyk KA, Boon LM, Lennon F, Johnson DW,Helmbold EA et al. A gene for familial venous malforma-tions maps to chromosome 9 in a second large kindred. JMed Genet 1995;32:197-199.

5. Chen DH, Lipe HP, Qin Z, Bird TD. Cerebral cavernousmalformation: novel mutation in a Chinese family an evi-dence for heterogeneity. J Neurol Sci 2002;196:91-96.

6. ªcCarthy JC, Goldberg MJ, Zimbler S. Orthopaedic dys-function in blue rubber-bleb nevus syndrome. J Bone JointSurg Am 1982;64:280-283.

7. Dobru D, Seuchea N, Dorin M, Careianu V. Blue rubberbleb nevus syndrome: case report and literature review.Rom J Gastroenterol 2004;13:237-240.

8. Kassarjian A, Fishman SJ, Fox VL, Burrows PE. Imagingcharacteristics of blue rubber bleb nevus syndrome. Am JRoentgenol 2003;181:1041-1048.

9. Waybright EA, Selhorst JB, Rosenblum WI, Suter CG.Blue rubber bleb nevus syndrome with CNS involvementand thrombosis of a vein of galen malformation. AnnNeurol 1978;3:464-467.

10. Carvalho S, Barbosa V, Santos N, Machado E. Blue rub-ber-bleb nevus syndrome: report of a familiar case with adural arteriovenous fistula. Am J Neuroradiol 2003;24:1916-1918.

11. Kim SJ. Blue rubber bleb nevus syndrome with centralnervous system involvement. Pediatric Neurol 2000;22:410-412.

12. Eiris-Punal J, Picon-Cotos M, Viso-Lorenzo A, Castro-Gago M. Epileptic disorder as the first neurologic manifes-tation of blue rubber bleb nevus syndrome. J Child Neurol2002;17:219-222.


∞ÙÔÈÎ‹ ‰ÂÚÌ·Ù›ÙÈ‰· ÛÙ· ·È‰È¿ - ıÂÚ·Â˘ÙÈÎ‹ ÚÔÛ¤ÁÁÈÛË

∆. ∆ÛÈ‚ÈÙ·Ó›‰Ô˘ - ∫¿ÎÔ˘ÚÔ˘

¶ÂÚ›ÏË„Ë: ∏ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ·È‰ÈÒÓ ÌÂ ·ÙÔÈÎ‹ ‰ÂÚÌ·Ù›ÙÈ‰· (∞¢) ‰ÂÓ ÛÙËÚ›˙ÂÙ·È ÌfiÓÔ ÛÙË ÁÓÒÛË,·ÏÏ¿ Î·È ÛÙËÓ Ù¤¯ÓË ÙÔ˘ ¯ÂÈÚÈÛÌÔ‡ ÙÔ˘ ¿Û¯ÔÓÙÔ˜ ‰¤ÚÌ·ÙÔ˜. ª›· ·fi ÙÈ˜ ÛÔ˘‰·ÈfiÙÂÚÂ˜ ·Ú·Ì¤ÙÚÔ˘˜ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ·È‰ÈÒÓ ÌÂ ∞¢ Â›Ó·È Ë ÂÎ·›‰Â˘ÛË ÙÔ˘ ·ÛıÂÓÔ‡˜ Î·È ÙË˜ ÔÈÎÔÁ¤ÓÂÈ¿˜ ÙÔ˘, fiÛÔÓ ·ÊÔ-Ú¿ ÙË Ê‡ÛË Î·È ÙËÓ ÔÚÂ›· ÙË˜ ÓfiÛÔ˘, ÙËÓ ·ÔÊ˘Á‹ ÂÎÏ˘ÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ, ÙË ÛˆÛÙ‹ ÂÓ˘‰¿ÙˆÛË ÙÔ˘‰¤ÚÌ·ÙÔ˜ Î·È ÙËÓ ÂÈ‰ÈÎ‹ ıÂÚ·Â›·. ∏ Û˘˙‹ÙËÛË ÌÂ ÙÔ ·È‰› Î·È ÙÔ˘˜ ÁÔÓÂ›˜ ÁÈ· ÙÔÓ ÙÚfiÔ ‰Ú¿ÛË˜, ÙË Ì¤-ıÔ‰Ô ÂÊ·ÚÌÔÁ‹˜ Î·È ÙËÓ ·ÛÊ¿ÏÂÈ· ÙˆÓ ÙÔÈÎÒÓ ÛÎÂ˘·ÛÌ¿ÙˆÓ ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙËÓ Î·Ï‡ÙÂÚË Û˘Ì-ÌfiÚÊˆÛË Î·È ÙÔÓ ¤ÏÂÁ¯Ô ÙË˜ ÓfiÛÔ˘. ∏ ‰È·Ù‹ÚËÛË ·Î¤Ú·ÈÔ˘ ÂÈ‰ÂÚÌÈ‰ÈÎÔ‡ ÊÚ·ÁÌÔ‡ ·ÔÙÂÏÂ› ÛËÌ·ÓÙÈ-Î‹ ·Ú¿ÌÂÙÚÔ ·ÓÙÈÌÂÙÒÈÛË˜ ÙË˜ ∞¢, ‰Â‰ÔÌ¤ÓÔ˘ fiÙÈ Ë ÍËÚÔ‰ÂÚÌ›· ÂÈÙÚ¤ÂÈ ÙËÓ Â›ÛÔ‰Ô ÂÚÂıÈÛÙÈÎÒÓÔ˘ÛÈÒÓ ÛÙÔ ‰¤ÚÌ· ÌÂ ·ÔÙ¤ÏÂÛÌ· ÙË ‰ËÌÈÔ˘ÚÁ›· ÊÏÂÁÌÔÓ‹˜ Î·È ÙËÓ ¤Í·ÚÛË ÙË˜ ÓfiÛÔ˘. ∆· ÙÔÈÎ¿ ÎÔÚ-ÙÈÎÔÛÙÂÚÔÂÈ‰‹ ·ÔÙÂÏÔ‡Ó ıÂÚ·Â›· ÚÒÙË˜ ÁÚ·ÌÌ‹˜. ŸÙ·Ó ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÛˆÛÙ¿, ÂÏ·¯ÈÛÙÔÔÈÂ›Ù·ÈË Èı·ÓfiÙËÙ· ˘ÔÙÚÔ‹˜, Ù·¯˘Ê˘Ï·Í›·˜ Î·È ÂÌÊ¿ÓÈÛË˜ ¿ÏÏˆÓ ÙÔÈÎÒÓ Î·È Û˘ÛÙËÌ·ÙÈÎÒÓ ·ÚÂÓÂÚÁÂÈ-ÒÓ. √È ÙÔÈÎÔ› ·Ó·ÛÙÔÏÂ›˜ ÙË˜ Î·ÏÛÈÓÂ˘Ú›ÓË˜ ÂÓ‰Â›ÎÓ˘ÓÙ·È ÁÈ· ·È‰È¿ ÌÂ Ì¤ÙÚÈ· ‹ ÛÔ‚·Ú‹ ∞¢. ™Â ÛÔ‚·-Ú‹ ¤Í·ÚÛË ÙË˜ ∞¢ Û˘ÓÈÛÙÒÓÙ·È ÙÔÈÎ¿ ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹ Î·È fiÙ·Ó ˘¿ÚÍÂÈ ‚ÂÏÙ›ˆÛË ÂÊ·ÚÌfi˙ÂÙ·È ÙÔÈ-Îfi˜ ·Ó·ÛÙÔÏ¤·˜ ÙË˜ Î·ÏÛÈÓÂ˘Ú›ÓË˜ ÌÂ¯ÚÈ ÙËÓ Ï‹ÚË ‡ÊÂÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ. ™Â ÂÚ›ÙˆÛË ˘ÔÙÚÔ-‹˜ ÂÊ·ÚÌfi˙ÂÙ·È ¿ÌÂÛ· ÙÔÈÎfi˜ ·Ó·ÛÙÔÏ¤·˜ ÙË˜ Î·ÏÛÈÓÂ˘Ú›ÓË˜. ŒÙÛÈ, Ë ¯Ú‹ÛË ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰ÒÓ Â-ÚÈÔÚ›˙ÂÙ·È ÌfiÓÔ ÛÙÈ˜ Ê¿ÛÂÈ˜ ¤ÓÙÔÓË˜ ¤Í·ÚÛË˜ ÙË˜ ∞¢. ∆· ·ÓÙÈ˚ÛÙ·ÌÈÓÈÎ¿ ¯ÔÚËÁÔ‡ÓÙ·È Û˘ÛÙËÌ·ÙÈÎ¿ ÁÈ·ÙËÓ ·ÓÙÈÎÓËÛÌÒ‰Ë Î·È ËÚÂÌÈÛÙÈÎ‹ ÙÔ˘˜ ‰Ú¿ÛË. ∏ ¯Ú‹ÛË ÙÔÈÎÔ‡ ·ÓÙÈ‚ÈÔÙÈÎÔ‡ ¤¯ÂÈ ÛÙfi¯Ô ÙËÓ ÂÏ¿ÙÙˆÛËÙÔ˘ ÛÙ·Ê˘ÏÔÎÔÎÎÈÎÔ‡ ÊÔÚÙ›Ô˘ ‹ ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ÏÔ›ÌˆÍË˜.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ∞ÙÔÈÎ‹ ‰ÂÚÌ·Ù›ÙÈ‰·, ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹, ÙÔÈÎÔ› ·Ó·ÛÙÔÏÂ›˜ Î·ÏÛÈÓÂ˘Ú›ÓË˜, ·ÓÙÈ˚ÛÙ·ÌÈÓÈÎ¿,

·ÓÙÈ‚ÈÔÙÈÎ¿.

Therapeutic management of childhood atopic dermatitis

T. Kakourou

Abstract: The management of children with Atopic Dermatitis (AD) is as much based on knowledge, as itis an art form. One of the most important aspects in the management of AD is education of the patient andhis/her family regarding the nature and course of the disease, the avoidance of trigger factors, the properhydration of the skin and the specific treatment. Explanation and discussion with the patient and theparents about the mode of action, the methods of application and the safety of topical preparations mayachieve higher compliance and better control of the disease. The maintenance of an intact skin barrier isparticularly important because xerosis allows the entry of antigens, which causes irritation of the skin anddisease exacerbations. Topical corticosteroids (TCS) are first-line treatment for AD and when usedproperly, they minimize the possibility of rebound, tachyphylaxis, as well as topical and systemic sideeffects. Topical Calcineurin Inhibitors (TCI) are reserved for children with moderate and severe ADproviding effective long-term disease control. It is suggested that a major flare should be managed withTCS and, when the inflammation subsides, TCI should be applied until the skin becomes clear. If the firstsign reoccurs, TCI therapy should be restarted. Antihistamines are used for their sedative and antipruriticaction and anti-infectious agents are used in order to reduce the staphylococcal burden or to treat aninfection.

Key words: Atopic dermatitis, corticosteroids, topical calcineurin inhibitors, antihistamines, antibiotics.

330 ¶ƒ∞∫∆π∫√ £∂ª∞ PRACTICAL ISSUE

∞’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ


∆¿ÏÈ· ∆ÛÈ‚ÈÙ·Ó›‰Ô˘-∫¿ÎÔ˘ÚÔ˘[email protected] ∞’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹¶·Ó/Ì›Ô˘ ∞ıËÓÒÓ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”£Ë‚ÒÓ &¶··‰È·Ì·ÓÙÔÔ‡ÏÔ˘,∆.∫. 115 27, ∞ı‹Ó·

First Paediatric Departmentof the University of Athens,Greece

Correspondence:

Talia [email protected] First Department of Paediatrics of the Universityof Athens“Aghia Sofia” Children’sHospital Thivon & Papadiamantopoulou St.115 27, Athens, Greece


∂ÈÛ·ÁˆÁ‹

∏ Â›ÙˆÛË ÙË˜ ·ÙÔÈÎ‹˜ ‰ÂÚÌ·Ù›ÙÈ‰·˜(∞¢) ÛÂ ·È‰È¿ ÛÙËÓ ∂˘ÚÒË Â›Ó·È ÂÚ›Ô˘15% (1). ∏ Û˘¯ÓfiÙËÙ· ÙˆÓ È·ÙÚÈÎÒÓ ÂÈÛÎ¤„Â-ˆÓ ÁÈ· ∞¢ ÛÂ ·È‰Ô‰ÂÚÌ·ÙÔÏÔÁÈÎfi È·ÙÚÂ›Ô Î·Ù¿ÙÔ˘˜ ¯ÂÈÌÂÚÈÓÔ‡˜ Ì‹ÓÂ˜ Â›Ó·È 25,2% (ÚÔÛˆÈ-Î‹ ÂÌÂÈÚ›·). ∂›ÛË˜, ÁÈ·ÙÚÔ› ¿ÏÏˆÓ ÂÈ‰ÈÎÔÙ‹-

ÙˆÓ, fiˆ˜ ·È‰›·ÙÚÔÈ, ‰ÂÚÌ·ÙÔÏfiÁÔÈ, ·ÏÏÂÚ-ÁÈÔÏfiÁÔÈ, ÂÍÂÙ¿˙Ô˘Ó Î·ıËÌÂÚÈÓ¿ ·È‰È¿ ÌÂ ∞¢Î·È ¤ÙÛÈ ÂÓ‰È·Ê¤ÚÔÓÙ·È ÁÈ· ÙË ÓfiÛÔ (2). ∏ ·ÓÙÈ-ÌÂÙÒÈÛË ÙË˜ ∞¢, fiˆ˜ Î·È Î¿ıÂ ‰ÂÚÌ·ÙÔÏÔÁÈ-ÎÔ‡ ÓÔÛ‹Ì·ÙÔ˜, ‰ÂÓ ÛÙËÚ›˙ÂÙ·È ÌfiÓÔ ÛÙË ÁÓÒ-ÛË ·ÏÏ¿ ÂÍ›ÛÔ˘ Î·È ÛÙËÓ Ù¤¯ÓË ÙÔ˘ ¯ÂÈÚÈÛÌÔ‡ÙÔ˘ ¿Û¯ÔÓÙÔ˜ ‰¤ÚÌ·ÙÔ˜. ŒÙÛÈ, ÛÙËÓ ·ÚÔ‡Û·


ÂÈÛ‹ÁËÛË, Ë Û˘ÁÁÚ·Ê¤·˜ ‰ÂÓ ı· ·ÚÔ˘ÛÈ¿ÛÂÈ ÙÈ˜ ÙÂ-

ÏÂ˘Ù·›Â˜ Î·ÙÂ˘ı˘ÓÙ‹ÚÈÂ˜ Ô‰ËÁ›Â˜ fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ

·ÓÙÈÌÂÙÒÈÛË ÙË˜ ∞¢, ·ÏÏ¿ ÙÈ˜ Ô‰ËÁ›Â˜ ·˘Ù¤˜ ÛÂ

Û˘Ó‰˘·ÛÌfi ÌÂ ÙË ‰ÈÎ‹ ÙË˜ “Ù¤¯ÓË”, fiÛÔÓ ·ÊÔÚ¿ ÙËÓ

·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ÓÔÛ‹Ì·ÙÔ˜.

∂Î·›‰Â˘ÛË

ª›· ·fi ÙÈ˜ ÛÔ˘‰·ÈfiÙÂÚÂ˜ ·Ú·Ì¤ÙÚÔ˘˜ ÛÙËÓ

·ÓÙÈÌÂÙÒÈÛË ·È‰ÈÒÓ ÌÂ ∞¢ Â›Ó·È Ë ÂÎ·›‰Â˘ÛË

ÙÔ˘ ·ÛıÂÓÔ‡˜ Î·È ÙË˜ ÔÈÎÔÁ¤ÓÂÈ¿˜ ÙÔ˘, fiÛÔÓ ·ÊÔÚ¿

ÙË Ê‡ÛË Î·È ÙËÓ ÔÚÂ›· ÙË˜ ÓfiÛÔ˘, ÙËÓ ·ÔÊ˘Á‹

ÂÎÏ˘ÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ, ÙË ÛˆÛÙ‹ ÂÓ˘‰¿ÙˆÛË ÙÔ˘

‰¤ÚÌ·ÙÔ˜ Î·È ÙËÓ ÂÈ‰ÈÎ‹ ıÂÚ·Â›·.

ŒÙÛÈ, ÛÙËÓ ÚÒÙË Â›ÛÎÂ„Ë ‰›ÓÂÙ·È fiÛÔ˜ ¯ÚfiÓÔ˜

¯ÚÂÈ¿˙ÂÙ·È ÁÈ· Ó· Î·Ù·ÓÔ‹ÛÔ˘Ó ÔÈ ÁÔÓÂ›˜ Î·È ÙÔ ·È-

‰› fiÙÈ Ë ÚÔ‰È¿ıÂÛË ÁÈ· ·ÙÔÈÎ‹ ‰ÂÚÌ·Ù›ÙÈ‰· ‚Ú›-

ÛÎÂÙ·È ÛÙ· ÁÔÓ›‰È¿ Ì·˜, fiÙÈ Ë ÓfiÛÔ˜ ¯·Ú·ÎÙËÚ›˙ÂÙ·È

·Ô ˘Ê¤ÛÂÈ˜ Î·È ÂÍ¿ÚÛÂÈ˜, fiÙÈ ÔÈÎ›ÏÔÈ ·Ú¿ÁÔÓÙÂ˜

(.¯. ·Î·Ù¿ÏÏËÏÔ ÓÙ‡ÛÈÌÔ, ÌÈÎÚfi‚È·, „˘¯ÔÏÔÁÈÎfi

ÛÙÚÂ˜) Û˘Ì‚¿ÏÏÔ˘Ó ÛÙËÓ ¤Ó·ÚÍË Î·È ÔÚÂ›· ÙË˜ Ófi-

ÛÔ˘ Î·È fiÙÈ ÙÂÏÈÎ¿ Â˘ÂÏÈÛÙÔ‡ÌÂ fiÙÈ ÙÔ ·È‰› ÌÂÁ·-

ÏÒÓÔÓÙ·˜ ı· ··ÏÏ·ÁÂ› ·fi ÙÔ Úfi‚ÏËÌ¿ ÙÔ˘. ∂›Ó·È

ÔÏ‡ ÛËÌ·ÓÙÈÎfi ÔÈ ÁÔÓÂ›˜ Ó· ÌËÓ ·ÈÛı¿ÓÔÓÙ·È ¤ÓÔ-

¯ÔÈ, ÂÂÈ‰‹ ÙÔ ·È‰› ÙÔ˘˜ ¿Û¯ÂÈ ·fi ∞¢.

¶ÚÔÏËÙÈÎ¿ Ì¤ÙÚ·

∆o ˙ÂÛÙfi ÓÂÚfi ÚÔÎ·ÏÂ› ˘ÂÚ·ÈÌ›· Î·È ÂÈ‰ÂÈÓÒ-

ÓÂÈ ÙÔ ¤Î˙ÂÌ·, ÁÈ’ ·˘Ùfi ÙÔ ÓÂÚfi ÙÔ˘ Ì¿ÓÈÔ˘ Ú¤ÂÈ

Ó· Â›Ó·È ¯ÏÈ·Úfi (33-34oC). ∂›ÛË˜, ÙÔ ÎÔÈÓfi Û·Ô‡ÓÈ

ÂÈ‰ÂÈÓÒÓÂÈ ÙÔ ‹‰Ë ÍËÚfi ‰¤ÚÌ· ÙÔ˘ ·ÙÔÈÎÔ‡ ·È‰È-

Ô‡, ÁÈ’ ·˘Ùfi Ú¤ÂÈ Ó· ¯ÚËÛÈÌÔÔÈÂ›Ù·È ˘ÔÎ·Ù¿-

ÛÙ·ÙÔ Û·Ô˘ÓÈÔ‡ ‹ ÂÈ‰ÈÎfi Ï¿‰È (bath oil) ÛÙÔ ÓÂÚfi

ÙÔ˘ Ì¿ÓÈÔ˘. ∆Ô ‰¤ÚÌ· ı· Ú¤ÂÈ Ó· ÛÎÔ˘›˙ÂÙ·È

Ù·ÌÔÓ·ÚÈÛÙ¿ Î·È fi¯È ÌÂ ÙÚ›„ÈÌÔ, ÙÔ Ì¿ÓÈÔ ÙÔ˘

·È‰ÈÔ‡ Ó· Â›Ó·È Î·ıËÌÂÚÈÓfi Î·È ÔÈ Ì·Ï·ÎÙÈÎ¤˜ Ô˘-

Û›Â˜ Ó· ÂÊ·ÚÌfi˙ÔÓÙ·È ÙfiÛÔ Û˘¯Ó¿, ÒÛÙÂ ÙÔ ‰¤ÚÌ·

ÙÔ˘ ·È‰ÈÔ‡ Ó· ‰È·ÙËÚÂ›Ù·È “‚ÂÏÔ‡‰ÈÓÔ”. ∂›Ó·È ÚÔ-

ÙÈÌfiÙÂÚÔ Ó· ÂÊ·ÚÌfi˙ÔÓÙ·È ÛÂ Óˆfi ‰¤ÚÌ·, ·Ì¤Ûˆ˜

ÌÂÙ¿ ÙÔ Ì¿ÓÈÔ, ÁÈ· Î·Ï‡ÙÂÚÔ ·ÔÙ¤ÏÂÛÌ·. √È ‰È·-

Ù·Ú·¯¤˜ ÙÔ˘ ÂÈ‰ÂÚÌÈ‰ÈÎÔ‡ ÊÚ·ÁÌÔ‡ ÙÔ˘ ·ÙÔÈÎÔ‡

‰¤ÚÌ·ÙÔ˜ ÂÈÙÚ¤Ô˘Ó ÙË ‰È·‰ÂÚÌÈÎ‹ ·ÒÏÂÈ· ÓÂÚÔ‡

Ô˘ Ô‰ËÁÂ› ÛÂ ÍËÚfiÙËÙ· ÙÔ˘ ‰¤ÚÌ·ÙÔ˜, ·Ú¿ÏÏËÏ·

fiÌˆ˜ ÂÈÙÚ¤Ô˘Ó Î·È ÙËÓ Â›ÛÔ‰Ô ÂÚÂıÈÛÙÈÎÒÓ Ô˘-

ÛÈÒÓ ·Ô ÙÔ ÂÚÈ‚¿ÏÏÔÓ ÛÙÔ ‰¤ÚÌ· ÌÂ ·ÔÙ¤ÏÂÛÌ·

ÙË ‰ËÌÈÔ˘ÚÁ›· ÊÏÂÁÌÔÓ‹˜. ∂ÔÌ¤Óˆ˜, Ë ‰ÈfiÚıˆÛË

ÙÔ˘ ÂÈ‰ÂÚÌÈ‰ÈÎÔ‡ ÊÚ·ÁÌÔ‡ ·ÔÙÂÏÂ› ‚·ÛÈÎfi Ì¤ÙÚÔ

ÚfiÏË„Ë˜ ÙÔ˘ ÂÎ˙¤Ì·ÙÔ˜ (∂ÈÎfiÓ· 1). ÀÔÏÔÁ›˙ÂÙ·È

fiÙÈ ÁÈ· ÛˆÛÙ‹ ÂÓ˘‰¿ÙˆÛË ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ ÂÓfi˜ ÌÈÎÚÔ‡

·È‰ÈÔ‡ ··ÈÙÔ‡ÓÙ·È 150-200 g Ì·Ï·ÎÙÈÎ‹˜ Ô˘Û›·˜

Â‚‰ÔÌ·‰È·›ˆ˜, ÂÓÒ ÁÈ· ÂÓ‹ÏÈÎ· 500 g.

¢˘ÛÙ˘¯Ò˜, Ù· ˘ÔÎ·Ù¿ÛÙ·Ù· Û·Ô˘ÓÈÔ‡ Î·È Ù·

Ì·Ï·ÎÙÈÎ¿ ÛÎÂ˘¿ÛÌ·Ù· ‰ÂÓ Û˘ÓÙ·ÁÔÁÚ·ÊÔ‡ÓÙ·È

·fi Ù· Ù·ÌÂ›· Î·È Â›Ó·È ·ÚÎÂÙ¿ ‰··ÓËÚ¿. ŒÙÛÈ,

ÚÔÙÂ›ÓÂÙ·È Ó· Û˘ÓÙ·ÁÔÁÚ·ÊÔ‡ÓÙ·È 2-3 ˘ÔÎ·Ù¿-

ÛÙ·Ù· Û·Ô˘ÓÈÔ‡, bath oils Î·È Ì·Ï·ÎÙÈÎ¤˜ ÎÚ¤ÌÂ˜/

·ÏÔÈÊ¤˜, ÒÛÙÂ ÔÈ ÁÔÓÂ›˜ Î·È ÙÔ ·È‰› Ó· ¤¯Ô˘Ó ÙË ‰˘-

Ó·ÙfiÙËÙ· Ó· ÂÈÏ¤ÍÔ˘Ó ÙÔ ÂÚÈÛÛfiÙÂÚÔ ·ÔÙÂÏÂ-

ÛÌ·ÙÈÎfi, ÎÔÛÌËÙÈÎ¿ ·Ô‰ÂÎÙfi Î·È ÔÈÎÔÓÔÌÈÎ¿ Û‡Ì-

ÊÔÚÔ Û¯‹Ì· ÂÚÈÔ›ËÛË˜ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜. ∆· Ó‡¯È·

Ú¤ÂÈ Ó· Îfi‚ÔÓÙ·È Û˘¯Ó¿, Ù· ÚÔ‡¯· Ó· Â›Ó·È ‚·Ì‚·-

ÎÂÚ¿, ¯·Ï·Ú¿ Î·È ¿ÓÂÙ· Î·È Ù· ÎÏÈÓÔÛÎÂ¿ÛÌ·Ù· Ó·

Â›Ó·È Â›ÛË˜ ‚·Ì‚·ÎÂÚ¿ Î·È Ó· Ï¤ÓÔÓÙ·È ÛÂ ıÂÚÌÔ-

ÎÚ·Û›· >55ÔC ·Ó¿ Â‚‰ÔÌ¿‰·. ¡· ÚÔÙÈÌÔ‡ÓÙ·È

·ÔÚÚ˘·ÓÙÈÎ¿ ÛÂ ˘ÁÚ‹ ÌÔÚÊ‹ Î·È Ó· ·ÔÊÂ‡ÁÂÙ·È

ÙÔ Ì·Ï·ÎÙÈÎfi, ÁÈ·Ù› ·Ú·Ì¤ÓÂÈ ÛÙÈ˜ ›ÓÂ˜ ÙˆÓ ÚÔ‡¯ˆÓ

Î·È ÌÔÚÂ› Ó· ÂÚÂı›ÛÂÈ ÙÔ ‰¤ÚÌ·. ∏ ¤ÎıÂÛË ÛÂ ÔÈÎÈ·-

Î‹ ÛÎfiÓË, Á‡ÚË, ÙÚ›¯ˆÌ· ˙ÒˆÓ Î·È Î·Ófi Ú¤ÂÈ Ó·

·ÔÊÂ‡ÁÂÙ·È. ŒÙÛÈ, ÙÔ ˘ÓÔ‰ˆÌ¿ÙÈÔ ÙÔ˘ ·ÙÔÈÎÔ‡

·È‰ÈÔ‡ Ú¤ÂÈ Ó· Â›Ó·È ÏÈÙfi ¯ˆÚ›˜ ÌÈÎÚÔ·ÓÙÈÎÂ›ÌÂ-

Ó· Ô˘ ‰ÂÓ Ï¤ÓÔÓÙ·È ‹ ¯·ÏÈ¿ ÌÂ ·¯‡ ¤ÏÔ˜. ∆Ô

¿ÙˆÌ· Ú¤ÂÈ Ó· ÛÎÔ˘›˙ÂÙ·È ÌÂ ËÏÂÎÙÚÈÎ‹ ÛÎÔ‡-

· Î·ıËÌÂÚÈÓ¿ Î·È Ù· ¤ÈÏ· Ó· ÍÂÛÎÔÓ›˙ÔÓÙ·È ÌÂ

‚ÚÂÁÌÂÓÔ ·Ó› ‰‡Ô ÊÔÚ¤˜ ÙËÓ Â‚‰ÔÌ¿‰·, Ù· ·È¯Ó›-

‰È· Ó· Ï¤ÓÔÓÙ·È Î¿ıÂ 10 ËÌ¤ÚÂ˜, ÂÓÒ Ù· ÏÔ˘ÏÔ‡‰È·

ÛÙÔÓ ÂÛˆÙÂÚÈÎfi ̄ ÒÚÔ ÙÔ˘ ÛÈÙÈÔ‡ Â›Ó·È ÚÔÙÈÌfiÙÂÚÔ

Ó· ·ÔÊÂ‡ÁÔÓÙ·È, fiˆ˜ Î·È Ë Â·Ê‹ ÌÂ ÙÚÈ¯ˆÙ¿ Î·-

ÙÔÈÎ›‰È· ˙Ò·, ÌÂ ÙËÓ ÚÔ¸fiıÂÛË fiÙÈ ÙÔ ÙÂÏÂ˘Ù·›Ô

‰ÂÓ ÂËÚÂ¿˙ÂÈ Û˘Ó·ÈÛıËÌ·ÙÈÎ¿ ÙÔ ·È‰›. ∏ ıÂÚÌÔ-

ÎÚ·Û›· ÛÙÔ Û›ÙÈ ÙÔ˘˜ ¯ÂÈÌÂÚÈÓÔ‡˜ Ì‹ÓÂ˜ ‰ÂÓ ı·

Ú¤ÂÈ Ó· ˘ÂÚ‚·›ÓÂÈ ÙÔ˘˜ 18ÔC, ÂÓÒ ı· Ú¤ÂÈ Ó·

˘¿Ú¯ÂÈ Ì¤ÙÚÈ· ˘ÁÚ·Û›·. ∆Ô ÙÂÏÂ˘Ù·›Ô ÂÍ·ÛÊ·Ï›˙Â-

Ù·È Â¿Ó ˘¿Ú¯ÂÈ ÌÒÏ ÌÂ ÓÂÚfi ÛÙÔ ‰ˆÌ¿ÙÈÔ. √ ÌË-

ÙÚÈÎfi˜ ıËÏ·ÛÌfi˜ Û˘ÓÈÛÙ¿Ù·È ÙÔ˘Ï¿¯ÈÛÙÔ Ì¤¯ÚÈ ÙËÓ

ËÏÈÎ›· ÙˆÓ 6 ÌËÓÒÓ, ÌÂ ÙÈ˜ ÛÙÂÚÂ¤˜ ÙÚÔÊ¤˜ Ó· ÂÈÛ¿-

ÁÔÓÙ·È ÚÔÔ‰Â˘ÙÈÎ¿ ·Ô ÙÔÓ 7Ô Ì‹Ó· (Ì›· Î·ÈÓÔ‡Ú-

ÁÈ· ÙÚÔÊ‹ ·Ó¿ Â‚‰ÔÌ¿‰·), ÒÛÙÂ Ó· Á›ÓÂÙ·È ¤ÁÎ·ÈÚË

·Ó·ÁÓÒÚÈÛË Ù˘¯fiÓ ÙÚÔÊÈÎ‹˜ ·ÏÏÂÚÁ›·˜. ∂ÎÙfi˜ ·fi

Ù· Û˘ÓÙËÚËÙÈÎ¿ Î·È ÙÈ˜ ¯ÚˆÛÙÈÎ¤˜ Ô˘ Ú¤ÂÈ Ó·

·ÔÊÂ‡ÁÔÓÙ·È, Ù· ·È‰È¿ Ú¤ÂÈ Ó· ¤¯Ô˘Ó ÂÏÂ‡ıÂÚÔ

‰È·ÈÙÔÏfiÁÈÔ. ¢È·ÈÙËÙÈÎÔ› ¯ÂÈÚÈÛÌÔ› ‹/Î·È ÂÚÁ·ÛÙË-

ÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ÂÓ‰Â›ÎÓ˘ÓÙ·È fiÙ·Ó ÙÔ ÈÛÙÔÚÈÎfi ÙÔ˘

·È‰ÈÔ‡ ı¤ÙÂÈ ÈÛ¯˘Ú¤˜ ˘Ô„›Â˜ ÁÈ· ·ÏÏÂÚÁ›· ÛÂ Û˘-

ÁÎÂÎÚÈÌ¤ÓË ÙÚÔÊ‹ ‹ fiÙ·Ó ÙÔ ¤Î˙ÂÌ· ‰ÂÓ ·ÓÙ·ÔÎÚ›-

ÓÂÙ·È ÛÙËÓ Î·Ù¿ÏÏËÏË ıÂÚ·Â˘ÙÈÎ‹ ·ÁˆÁ‹. ∆Ô ÂÌ-

‚fiÏÈÔ ÙË˜ ÈÏ·Ú¿˜ Â›Ó·È ·ÛÊ·Ï¤˜ ÛÂ ÂÚÈÙÒÛÂÈ˜ ·Ï-

ÏÂÚÁ›·˜ ÛÙÔ ·˘Áfi (3).

£ÂÚ·Â›·

∆ÔÈÎ¿ ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹

√È ÁÔÓÂ›˜ ‰È‰¿ÛÎÔÓÙ·È fiÙÈ ·) ÛÙË ‰ÂÚÌ·ÙÔÏÔÁ›·

ÈÛ¯‡ÂÈ ÙÔ ·Í›ˆÌ· “˘ÁÚfi ÛÙÔ ˘ÁÚfi Î·È ÍËÚfi ÛÙÔ ÍËÚfi”

Î·È fiÙÈ ‚) Ë Ï¤ÍË ¤Î˙ÂÌ· ÚÔ¤Ú¯ÂÙ·È ·fi ÙÔ Ú‹Ì·

˙¤ˆ (‚Ú¿˙ˆ). ∂ÔÌ¤Óˆ˜ ÂÎ˙ÂÌ·ÙÈÎ¤˜ ‚Ï¿‚Â˜ Ô˘ Â›-

Ó·È ˘ÁÚ¤˜ Î·È ÔÚÔÚÚÔÔ‡Ó ÌÔÚÂ› Ó· ˘Ô‰ËÏÒÓÔ˘Ó

·Ï¿ ¤Î˙ÂÌ· ÛÙËÓ ÔÍÂ›· ÙÔ˘ Ê¿ÛË, ·ÏÏ¿ Î·È ÂÎ‰‹-

ÏˆÛË ÏÔ›ÌˆÍË˜. ŒÙÛÈ,

331∞ÙÔÈÎ‹ ‰ÂÚÌ·Ù›ÙÈ‰· – ıÂÚ·Â›·

¶·È‰È·ÙÚÈÎ‹ 2007;70:330-335


∞) √È ‚Ï¿‚Â˜ Ô˘ Â›Ó·È ˘ÁÚ¤˜ ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È

·Ú¯ÈÎ¿ ÌÂ ÂÈı¤Ì·Ù· ‹ „ÂÎ·ÛÌÔ‡˜ ÌÂ NaCl 0,9%,

Ì¤¯ÚÈ˜ fiÙÔ˘ ÙÔ ‰¤ÚÌ· ÛÙ·Ì·Ù‹ÛÂÈ Ó· ÔÚÔÚÚÔÂ›. ∞˘-

Ùfi ÂÈÙ˘Á¯¿ÓÂÙ·È ÛÂ 1-3 24ˆÚ·. ™ÙË Û˘Ó¤¯ÂÈ·, ÂÊ·Ú-

Ìfi˙ÂÙ·È ÙÔÈÎfi ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰¤˜ (‹È·˜ ÈÛ¯‡Ô˜ ÛÂ

ÚfiÛˆÔ Î·È ÁÂÓÓËÙÈÎ¿ fiÚÁ·Ó· ÁÈ· ‚Ú¤ÊË ¤ˆ˜ ¤ÍÈ

ÌËÓÒÓ, Ì¤ÙÚÈ·˜ ÈÛ¯‡Ô˜ ÁÈ· ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿) ÛÂ

Û¯‹Ì· ÚÔÔ‰Â˘ÙÈÎ‹˜ ÌÂ›ˆÛË˜.

°È· ·Ú¿‰ÂÈÁÌ·, ÂÊ·ÚÌfi˙ÂÙ·È ˘‰ÚÔÎÔÚÙÈ˙fiÓË

1% ÙÚÂÈ˜ ÊÔÚ¤˜ ËÌÂÚËÛ›ˆ˜ (Úˆ› - ÌÂÛËÌ¤ÚÈ - ‚Ú¿-

‰˘) Ì¤¯ÚÈ Ó· ˘¿ÚÍÂÈ ‚ÂÏÙ›ˆÛË (ÏÈÁfiÙÂÚÔ ÂÚ‡ıËÌ·

Î·È ÎÓËÛÌfi˜), .¯. ÁÈ· 3 ËÌ¤ÚÂ˜. ™ÙË Û˘Ó¤¯ÂÈ·, ÂÊ·Ú-

Ìfi˙ÂÙ·È ‰‡Ô ÊÔÚ¤˜ ËÌÂÚËÛ›ˆ˜ (Úˆ›-‚Ú¿‰˘) ÁÈ· 3

ËÌ¤ÚÂ˜, Î·È Ì›· ÊÔÚ¿ ËÌÂÚËÛ›ˆ˜ (Úˆ›) ÁÈ· ¿ÏÏÂ˜ 3

ËÌ¤ÚÂ˜. ∞ÎfiÌË Î·È Û‹ÌÂÚ·, ÌÂ ÙËÓ Î·ÈÓÔ‡ÚÁÈ· ÁÂÓÈ¿

ÙˆÓ ÙÔÈÎÒÓ ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰ÒÓ (.¯. fluticasone

propionate, mometasone furoate) Ô˘ ¤¯Ô˘Ó Ì·ÎÚ‡

¯ÚfiÓÔ ‰Ú¿ÛË˜ (·ÚÎÂ› Ë Â¿ÏÂÈ„Ë Ì›· ÊÔÚ¿ ÙËÓ ËÌ¤-

Ú·) Î·È ÏÈÁfiÙÂÚÂ˜ ·ÚÂÓ¤ÚÁÂÈÂ˜ (ÌÔÚÂ› Ó· ̄ ÚËÛÈÌÔ-

ÔÈËıÔ‡Ó Î·ıËÌÂÚÈÓ¿ ÁÈ· ¤Ó·Ó Ì‹Ó· ÌÂ ·ÛÊ¿ÏÂÈ·)

(4,5), Â›Ó·È ÚÔÙÈÌfiÙÂÚÔ ÙÔ Û¯‹Ì· ÚÔÔ‰Â˘ÙÈÎ‹˜

ÌÂ›ˆÛË˜ (‰‡Ô ÊÔÚ¤˜ ËÌÂÚËÛ›ˆ˜ .¯. 5 ËÌ¤ÚÂ˜, Î·È

ÛÙË Û˘Ó¤¯ÂÈ· Ì›· ÊÔÚ¿ ËÌÂÚËÛ›ˆ˜ ÁÈ· 5 ËÌ¤ÚÂ˜). ∂›-

Ó·È ÔÏ‡ ÛËÌ·ÓÙÈÎfi ÔÈ ÁÔÓÂ›˜ Ó· Î·Ù·ÓÔÔ‡Ó ÙË ‰È·-

ÊÔÚ¿ ¯Ú‹ÛË˜ Ì·Ï·ÎÙÈÎÔ‡ ÛÎÂ˘¿ÛÌ·ÙÔ˜ Î·È ÛˆÛÙ‹˜

¯Ú‹ÛË˜ ÙÔÈÎÔ‡ ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰Ô‡˜.

™ËÌÂÈÒÓÂÙ·È fiÙÈ fiÙ·Ó ÙÔ ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰¤˜

ÂÊ·ÚÌfi˙ÂÙ·È Ì›· ÊÔÚ¿ ËÌÂÚËÛ›ˆ˜, Â›Ó·È ÚÔÙÈÌfiÙÂ-

ÚÔ Ë ÂÊ·ÚÌÔÁ‹ Ó· Á›ÓÂÙ·È ÙÔ Úˆ› Î·È fi¯È ÙÔ ‚Ú¿‰˘

ÁÈ· Ó· ÂÏ·¯ÈÛÙÔÔÈÂ›Ù·È Ë Èı·ÓfiÙËÙ· Î·Ù·ÛÙÔÏ‹˜

ÙÔ˘ ¿ÍÔÓ· ˘Ôı¿Ï·ÌÔ˜- ˘fiÊ˘ÛË- ÂÈÓÂÊÚ›‰È·. ∏

‰È·ÏÂ›Ô˘Û· ¯Ú‹ÛË ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰ÒÓ ÂÏ·¯ÈÛÙÔ-

ÔÈÂ› ÙËÓ Èı·ÓfiÙËÙ· ˘ÔÙÚÔ‹˜, Ù·¯˘Ê˘Ï·Í›·˜

(·ÓÔ¯‹˜ ÛÙ· ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹) Î·È ÙËÓ ÂÌÊ¿ÓÈÛË

¿ÏÏˆÓ ÙÔÈÎÒÓ Î·È Û˘ÛÙËÌ·ÙÈÎÒÓ ·ÚÂÓÂÚÁÂÈÒÓ.

™‡ÌÊˆÓ· ÌÂ ÙËÓ ÂÌÂÈÚ›· ÌÔ˘, Ë ¯Ú‹ÛË Ê˘ÛÈÔ-

ÏÔÁÈÎÔ‡ ÔÚÔ‡ ÛÙÔ ¤Î˙ÂÌ· Ô˘ Â›Ó·È ˘ÁÚfi, ÂÏ·ÙÙÒ-

ÓÂÈ ÙÔÓ ¯ÚfiÓÔ ¯ÔÚ‹ÁËÛË˜ ÙÔÈÎÔ‡ ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ-

‰Ô‡˜. ∞Ú¯ÈÎ¿ Û˘ÓÈÛÙÔ‡Û·ÌÂ ·oÛÙ·ÁÌ¤ÓÔ ÓÂÚfi

·ÓÙ› ÁÈ· Ê˘ÛÈÔÏÔÁÈÎfi ÔÚfi ÌÂ ÙÔ ·ÈÙÈÔÏÔÁÈÎfi fiÙÈ ÙÔ

·Ï·ÙÔ‡¯Ô ‰È¿Ï˘Ì· ı· ÂÚ¤ıÈ˙Â ÙÔ ¿Û¯ÔÓ ‰¤ÚÌ·,

fiÌˆ˜ ‰È·ÈÛÙÒıËÎÂ fiÙÈ ¤¯ÂÈ ·ÎÚÈ‚Ò˜ Ù· ·ÓÙ›ıÂÙ·

·ÔÙÂÏ¤ÛÌ·Ù·.

∆ÔÈÎ¿ ·ÓÙÈ‚ÈÔÙÈÎ¿ / ·ÓÙÈ‚ÈÔÙÈÎ¿ ÌÂ ÙË

Û˘ÛÙËÌ·ÙÈÎ‹ Ô‰fi

µ) ∂¿Ó ÔÈ ÂÎ˙ÂÌ·ÙÈÎ¤˜ ‚Ï¿‚Â˜ ÂÍ·ÎÔÏÔ˘ıÔ‡Ó Î·È

Â›Ó·È ˘ÁÚ¤˜ ÌÂÙ¿ ·Ô 5 ËÌ¤ÚÂ˜ „ÂÎ·ÛÌÒÓ ÌÂ Ê˘ÛÈÔ-

ÏÔÁÈÎfi ÔÚfi Î·È ÙÔ ·È‰› Î·Ù¿ Ù· ¿ÏÏ· Â›Ó·È Î·Ï¿, Ùfi-

ÙÂ ÚÔÛÙ›ıÂÙ·È ÙÔÈÎfi ·ÓÙÈ‚ÈÔÙÈÎfi ÌÂ ÛÙfi¯Ô Ó·

ÂÏ·ÙÙˆıÂ› ÙÔ ÛÙ·Ê˘ÏÔÎÔÎÎÈÎfi ÊÔÚÙ›Ô ‹ Ó· ·ÓÙÈÌÂ-

ÙˆÈÛıÂ› Èı·Ó‹ ÏÔ›ÌˆÍË (6). ŸÙ·Ó ÔÈ ‚Ï¿‚Â˜ ÛÙ·-

Ì·Ù‹ÛÔ˘Ó Ó· ÔÚÔÚÚÔÔ‡Ó, Ú¿ÁÌ· Ô˘ ÂÈÙ˘Á¯¿ÓÂ-

332 ∆. ∆ÛÈ‚ÈÙ·Ó›‰Ô˘-∫¿ÎÔ˘ÚÔ˘


∂ÈÎfiÓ· 2. ∞ÙÔÈÎ‹ ‰ÂÚÌ·Ù›ÙÈ‰· ÛÂ ‚Ú¤ÊÔ˜. √È ‚Ï¿‚Â˜ Â›Ó·È ÍËÚ¤˜.

∂ÈÎfiÓ· 3. √È ÂÎ˙ÂÌ·ÙÈÎ¤˜ ‚Ï¿‚Â˜ Â›Ó·È ˘ÁÚ¤˜ Î·Ù· ÙfiÔ˘˜ ÌÂÙ¿·Ô 5‹ÌÂÚË ·ÁˆÁ‹ ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ÔÚfi ÔfiÙÂ ı· ÚÔÛÙÂıÂ› ·ÓÙÈ-‚›ˆÛË ÙÔÈÎ¿.

∂ÈÎfiÓ· 1. •ËÚÔ‰ÂÚÌ›· ÛÂ ÎÔÚ›ÙÛÈ ÌÂ ·ÙÔÈÎ‹ ‰ÂÚÌ·Ù›ÙÈ‰·.


Ù·È Û˘Ó‹ıˆ˜ ÌÂÙ¿ ·Ô 2-3 ËÌ¤ÚÂ˜ ÙÔÈÎ‹˜ ·ÓÙÈ‚ÈÔ-

ÙÈÎ‹˜ ıÂÚ·Â›·˜, Û˘ÓÈÛÙ¿Ù·È ÎÚ¤Ì· ÙÔÈÎÔ‡ ÎÔÚÙÈ-

ÎÔÛÙÂÚÔÂÈ‰Ô‡˜/ ·ÓÙÈ‚ÈÔÙÈÎÔ‡ ÛÂ Û¯‹Ì· ÚÔÔ‰Â˘ÙÈ-

Î‹˜ ÌÂ›ˆÛË˜.

°) ∂·Ó ÔÈ ÂÎ˙ÂÌ·ÙÈÎ¤˜ ‚Ï¿‚Â˜ ÂÍ·ÎÔÏÔ˘ıÔ‡Ó Ó·

Â›Ó·È ˘ÁÚ¤˜ ÌÂÙ¿ ·Ô 5 ËÌ¤ÚÂ˜ ÙÔÈÎ‹˜ ·ÓÙÈ‚ÈÔÙÈÎ‹˜

·ÁˆÁ‹˜ ‹ Â¿Ó ÙÔ ¤ÎÎÚÈÌ· Â›Ó·È ÔÚÔ˘Ò‰Â˜, ˘¿Ú-

¯Ô˘Ó ÊÏ˘ÎÙ·ÈÓ›‰È· ‹ ¿ÏÏ· Û˘ÌÙÒÌ·Ù·, ¯ÔÚËÁÂ›Ù·È

·ÓÙÈ‚ÈÔÙÈÎfi ·Ô ÙÔ ÛÙfiÌ· ‹, ÔÏ‡ Û¿ÓÈ·, ÂÓ‰ÔÊÏÂ-

‚›ˆ˜ (∂ÈÎfiÓÂ˜ 2-6).

∆ÔÈÎÔ› ·Ó·ÛÙÔÏÂ›˜ ÙË˜ Î·ÏÛÈÓÂ˘Ú›ÓË˜

™ÙËÓ ÂÚ›ÙˆÛË Û˘¯ÓÒÓ ˘ÔÙÚÔÒÓ ‹ ÂÎÙÂÙ·Ì¤-

ÓˆÓ Î·È Â›ÌÔÓˆÓ ÂÎ˙ÂÌ·ÙÈÎÒÓ ‚Ï·‚ÒÓ Ô˘ Ú·ÎÙÈ-

Î¿ ÂÎÊÚ¿˙ÔÓÙ·È ÌÂ ÂÊ·ÚÌÔÁ‹ ÙÔÈÎÒÓ ÎÔÚÙÈÎÔÛÙÂ-

ÚÔÂÈ‰ÒÓ >10 Ì¤ÚÂ˜/ Ì‹Ó· ÛÙÔ ÚfiÛˆÔ Î·È >15 Ì¤-

ÚÂ˜/ Ì‹Ó· ÛÙÔ ÛÒÌ· ‹/Î·È ̄ Ú‹ÛË ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰Ô‡˜

>15gr/Ì‹Ó· ÛÂ ‚Ú¤ÊÔ˜ Î·È >30gr/Ì‹Ó· ÛÂ ÌÂÁ·Ï‡ÙÂ-

ÚÔ ·È‰›, ÙfiÙÂ ÚÔÛÙ›ıÂÙ·È Î·È ÙÔÈÎfi˜ ·Ó·ÛÙÔÏ¤·˜

ÙË˜ Î·ÏÛÈÓÂ˘Ú›ÓË˜ (tacrolimus, pimecrolimus) (3) .

™ËÌÂÈÒÓÂÙ·È fiÙÈ ÙÔ tacrolimus Î˘ÎÏÔÊÔÚÂ› ˆ˜

·ÏÔÈÊ‹ Î·È ÙÔ pimecrolimus ÌÂ ÙË ÌÔÚÊ‹ ÎÚ¤Ì·˜. ∏

·ÓÙÈÊÏÂÁÌÔÓÒ‰Ë˜ ‰Ú¿ÛË ÙÔ˘ tacrolimus 0,1% Â›Ó·È

·ÚfiÌÔÈ· ÌÂ ÂÎÂ›ÓË ÂÓfi˜ Ì¤ÙÚÈ·˜ ÈÛ¯‡Ô˜ ÎÔÚÙÈÎÔ-

ÛÙÂÚÔÂÈ‰Ô‡˜, ÂÓÒ ÙÔ pimecrolimus 1% Â›Ó·È ËÈfiÙÂ-

ÚÔ (7-9). ∏ ÂÁÎÂÎÚÈÌ¤ÓË ËÏÈÎ›· ¯ÔÚ‹ÁËÛË˜ ·Ó·ÛÙÔ-

Ï¤· ÙË˜ Î·ÏÛÈÓÂ˘Ú›ÓË˜ ÛÂ ·È‰È¿ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË

ÙˆÓ ‰‡Ô ÂÙÒÓ.

∂¿Ó ¤Ó· ·È‰› ÏËÚÂ› Ù· ÎÚÈÙ‹ÚÈ· ¯Ú‹ÛË˜ ÙÔÈ-

ÎÔ‡ ·Ó·ÛÙÔÏ¤· Î·ÏÛÈÓÂ˘Ú›ÓË˜, ÙfiÙÂ ÛÙË Ê¿ÛË Ô˘

ÙÔ ÙÔÈÎfi ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰¤˜ ¯ÔÚËÁÂ›Ù·È ÌfiÓÔ ÙÔ

Úˆ›, Ô ·Ó·ÛÙÔÏ¤·˜ ÙË˜ Î·ÏÛÈÓÂ˘Ú›ÓË˜ ÂÊ·ÚÌfi˙ÂÙ·È

ÙÔ ‚Ú¿‰˘ Î·È fiÙ·Ó Á›ÓÂÈ ‰È·ÎÔ‹ ÙÔ˘ ÎÔÚÙÈÎÔÛÙÂÚÔ-

ÂÈ‰Ô‡˜, ÙfiÙÂ ÂÊ·ÚÌfi˙ÂÙ·È Úˆ›- ‚Ú¿‰˘ Ì¤¯ÚÈ Ï‹-

ÚÔ˘˜ ˘Ô¯ÒÚËÛË˜ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ.

™Â ¤Ó·ÚÍË ˘ÔÙÚÔ‹˜ (‹ÈÔ ÂÚ‡ıËÌ·, ÎÓËÛÌfi˜)

ÂÊ·ÚÌfi˙ÂÙ·È ÙÔÈÎfi˜ ·Ó·ÛÙÔÏ¤·˜ Î·ÏÛÈÓÂ˘Ú›ÓË˜,

‰‡Ô ÊÔÚ¤˜ ËÌÂÚËÛ›ˆ˜ Î·È Á›ÓÂÙ·È ·fiÙÔÌË ‰È·ÎÔ‹

fiÙ·Ó ˘Ô¯ˆÚ‹ÛÔ˘Ó Ù· Û˘ÌÙÒÌ·Ù·.

ŸÙ·Ó ÔÈ ·Ó·ÛÙÔÏÂ›˜ ÙË˜ Î·ÏÛÈÓÂ˘Ú›ÓË˜ ¯ÚËÛÈÌÔ-

ÔÈÔ‡ÓÙ·È ¤ÁÎ·ÈÚ·, ÌÂÈÒÓÔ˘Ó ÙË ‚·Ú‡ÙËÙ·, ÂÈÌËÎ‡-

ÓÔ˘Ó ÙÔÓ ̄ ÚfiÓÔ ÌÂÙ·Í‡ ÙˆÓ ÂÍ¿ÚÛÂˆÓ Î·È ‚ÂÏÙÈÒÓÔ˘Ó

Û˘ÓÔÏÈÎ¿ ÙÔÓ ¤ÏÂÁ¯Ô ÙË˜ ÓfiÛÔ˘. ŒÙÛÈ, Ë ¯Ú‹ÛË ÎÔÚ-

ÙÈÎÔÛÙÂÚÔÂÈ‰ÒÓ ÂÚÈÔÚ›˙ÂÙ·È ÌfiÓÔ ÛÙÈ˜ Ê¿ÛÂÈ˜

¤ÓÙÔÓË˜ ¤Í·ÚÛË˜ ÙÔ˘ ÂÎ˙¤Ì·ÙÔ˜. ªÂÏ¤ÙÂ˜ ÌÂ

pimecrolimus ÛÂ ‚Ú¤ÊË ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ, fiÙ·Ó ¯ÚË-

ÛÈÌÔÔÈÂ›Ù·È Î·Ù¿ ÙËÓ ¤Ó·ÚÍË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ,

ÌÔÚÂ› Ó· ·ÔÙÚ¤„ÂÈ ¤Í·ÚÛË ÙË˜ ÓfiÛÔ˘ ÁÈ· ‰È¿ÛÙË-

Ì· Ì¤¯ÚÈ Î·È 12 Ì‹ÓÂ˜ (10).

∞ÓÙÈ˚ÛÙ·ÌÈÓÈÎ¿

∞ÓÙÈ˚ÛÙ·ÌÈÓÈÎ¿ ¯ÔÚËÁÔ‡ÓÙ·È Û˘ÛÙËÌ·ÙÈÎ¿ ÁÈ·

ÙËÓ ·ÓÙÈÎÓËÛÌÒ‰Ë Î·È ËÚÂÌÈÛÙÈÎ‹ ÙÔ˘˜ ‰Ú¿ÛË. ŒÙÛÈ,

∂ÈÎfiÓ· 4. ∞ÙÔÈÎ‹ ‰ÂÚÌ·Ù›ÙÈ‰· ÛÂ ·È‰› Û¯ÔÏÈÎ‹˜ ËÏÈÎ›·˜. √È‚Ï¿‚Â˜ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÂÓÙÔ›˙ÔÓÙ·È ÛÙÈ˜ ¤Ûˆ ÂÈÊ¿ÓÂÈÂ˜ ÙˆÓ¿ÎÚˆÓ Î·È ÙÔÓ ÎÔÚÌfi.

∂ÈÎfiÓ· 5. §ÂÈ¯ËÓÔÔÈËÌ¤ÓÂ˜ ÂÎ˙ÂÌ·ÙÈÎ¤˜ ‚Ï¿‚Â˜ ÛÂ ¤ÊË‚Ô.

∂ÈÎfiÓ· 6. ŒÎ˙ÂÌ· ÛÙÈ˜ ¤Ûˆ ÂÈÊ¿ÓÂÈÂ˜ ÙˆÓ ‰·ÎÙ‡ÏˆÓ (‰˘ÛÈ‰ÚˆÛÈ-Îfi) ÌÂ ÔÚÔ˘Ò‰Â˜ ¤ÎÎÚÈÌ· ·fi 10ËÌ¤ÚÔ˘, ·Ú¿ ÙËÓ ÙÔÈÎ‹ ·ÓÙÈ-‚ÈÔÙÈÎ‹ ·ÁˆÁ‹. £· ‰ÔıÂ› ·ÓÙÈÛÙ·Ê˘ÏÔÎÔÎÎÈÎfi ·fi ÙÔ ÛÙfiÌ·.


¶·È‰È·ÙÚÈÎ‹ 2007;70:330-335


ÚÔÙÈÌÒÓÙ·È Ù· ÚÒÙË˜ ÁÂÓÈ¿˜ ·ÓÙÈ˚ÛÙ·ÌÈÓÈÎ¿ Ô˘

ÏËÚÔ‡Ó ÙÈ˜ ·ÓˆÙ¤Úˆ È‰ÈfiÙËÙÂ˜. √˘‰¤ÔÙÂ fiÌˆ˜

ÂÊ·ÚÌfi˙ÔÓÙ·È ÙÔÈÎ¿, ÁÈ·Ù› Â˘·ÈÛıËÙÔÔÈÔ‡Ó ÙÔ

‰¤ÚÌ· (3).

∂˘Ú¤ˆ˜ Û˘ÓÙ·ÁÔÁÚ·ÊÂ›Ù·È Ë ˘‰ÚÔÍ˘˙›ÓË. ™ËÌÂÈ-

ÒÓÂÙ·È fiÙÈ Ô Ì¤ÛÔ˜ ¯ÚfiÓÔ˜ ˘Ô‰ÈÏ·ÛÈ·ÛÌÔ‡ ÙË˜

˘‰ÚÔÍ˘˙›ÓË˜ ÛÙ· ·È‰È¿ Â›Ó·È 7,1±2,3 ÒÚÂ˜ ÌÂ Â‡ÚÔ˜

4 ÒÚÂ˜ ÛÙ· ‚Ú¤ÊË ËÏÈÎ›·˜ 12 ÌËÓÒÓ Î·È 11 ÒÚÂ˜ ÛÙ·

·È‰È¿ 14 ¯ÚÔÓÒÓ (11). ŒÙÛÈ, ÛÙ· ·È‰È¿ ÚÔÛ¯ÔÏÈ-

Î‹˜ ËÏÈÎ›·˜ Ë ˘‰ÚÔÍ˘˙›ÓË ¯ÔÚËÁÂ›Ù·È 3 ÊÔÚ¤˜ ËÌÂ-

ÚËÛ›ˆ˜, ÒÛÙÂ Ó· ÂÈÙ˘Á¯¿ÓÔÓÙ·È ÛÙ·ıÂÚ¿ ıÂÚ·Â˘-

ÙÈÎ¿ Â›Â‰· ÛÙÔ ·›Ì·. ÃÔÚËÁÂ›Ù·È ·Ú¯ÈÎ¿ ¯·ÌËÏ‹

‰fiÛË ˘‰ÚÔÍ˘˙›ÓË˜ (1mg/kg/24ˆÚÔ) Î·È ÔÈ ÁÔÓÂ›˜

ÌÔÚÂ› ÚÔÔ‰Â˘ÙÈÎ¿ Ó· ‰ÈÏ·ÛÈ¿ÛÔ˘Ó ‹ Î·È Ó· ÙÚÈ-

Ï·ÛÈ¿ÛÔ˘Ó ÙËÓ 24ˆÚË ‰fiÛË ¯ˆÚ›˜ Ó· ˙ËÙ‹ÛÔ˘Ó ÙË

Û˘Ó‰ÚÔÌ‹ ÙÔ˘ ÁÈ·ÙÚÔ‡ ÙÔ˘˜. ∂¿Ó ÙÔ ·È‰› ÂÍ·ÎÔÏÔ˘-

ıÂ› Î·È ¤¯ÂÈ ÎÓËÛÌfi ÛÂ fiÏË ÙË ‰È¿ÚÎÂÈ· ÙË˜ ËÌ¤Ú·˜,

·˘Í¿ÓÔ˘Ó Î·È ÙÈ˜ ÙÚÂÈ˜ ‰fiÛÂÈ˜, ÂÓÒ Â¿Ó ¤¯ÂÈ ÎÓËÛÌfi

ÛÂ Û˘ÁÎÂÎÚÈÌ¤ÓË ÂÚ›Ô‰Ô ÙË˜ ËÌ¤Ú·˜, ÁÈ· ·Ú¿‰ÂÈÁ-

Ì· ÙÔ ‚Ú¿‰˘, ÙfiÙÂ ·˘Í¿ÓÔ˘Ó ÙË ‚Ú·‰ÈÓ‹ ‰fiÛË ÌfiÓÔ.

∏ ˘‰ÚÔÍ˘˙›ÓË ¯ÔÚËÁÂ›Ù·È ÁÈ· ¤ÓÙÂ ËÌ¤ÚÂ˜ ÂÈÏ¤-

ÔÓ, ÌÂÙ¿ ÙËÓ ˘Ô¯ÒÚËÛË ÙÔ˘ ÎÓËÛÌÔ‡.

ªÂ ÙÔ ·ÓˆÙ¤Úˆ Û¯‹Ì· ıÂÚ·Â›·˜, Ë ‰fiÛË ÙË˜

˘‰ÚÔÍ˘˙›ÓË˜ fi¯È ÌfiÓÔ ÂÍ·ÙÔÌÈÎÂ‡ÂÙ·È ·ÏÏ¿ ‰È·Ê¤-

ÚÂÈ ÛÙÔ ›‰ÈÔ ÙÔ ·È‰› Î¿ıÂ ÊÔÚ¿, ·Ó¿ÏÔÁ· ÌÂ ÙË ‚·-

Ú‡ÙËÙ· ÙË˜ ˘ÔÙÚÔ‹˜. ∂ÈÏ¤ÔÓ, Ë ‰È·ÏÂ›Ô˘Û·

¯ÔÚ‹ÁËÛË ·ÓÙÈ˚ÛÙ·ÌÈÓÈÎÔ‡ ÂÏ·ÙÙÒÓÂÈ ÙËÓ Èı·ÓfiÙË-

Ù· Ù·¯˘Ê˘Ï·Í›·˜ Î·È ¿ÏÏˆÓ Û˘ÛÙËÌ·ÙÈÎÒÓ ·ÚÂ-

ÓÂÚÁÂÈÒÓ.

∞ÓÙÈ-ÈÈÎ‹ ·ÁˆÁ‹

√È ·ÛıÂÓÂ›˜ ÌÂ ·ÙÔÈÎ‹ ‰ÂÚÌ·Ù›ÙÈ‰· Â›Ó·È ÂÈÚ-

ÚÂÂ›˜ ÛÂ ÈÔÁÂÓÂ›˜ ÏÔÈÌÒÍÂÈ˜ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ (·Ïfi˜

¤ÚË˜, ÌÔÏ˘ÛÌ·ÙÈÎ‹ Ù¤ÚÌÈÓıÔ˜, Ì˘ÚÌËÁÎÈ¤˜) (∂ÈÎfi-

ÓÂ˜ 7-9). √È ÁÔÓÂ›˜ Ú¤ÂÈ Ó· Â›Ó·È Â˘·ÈÛıËÙÔÔÈË-

Ì¤ÓÔÈ Î·È Ó· ÂÈÛÎ¤ÙÔÓÙ·È ÙÔÓ ·È‰›·ÙÚfi ÙÔ˘˜ Ìfi-

ÏÈ˜ ·ÓÙÈÏËÊıÔ‡Ó ÔÈ·‰‹ÔÙÂ ·Û˘Ó‹ıË ‰ÂÚÌ·ÙÈÎ‹

‚Ï¿‚Ë (12).

™˘ÛÙËÌ·ÙÈÎ‹ ·ÓÙÈÊÏÂÁÌÔÓÒ‰Ë˜ ·ÁˆÁ‹

∏ Û˘ÛÙËÌ·ÙÈÎ‹ ·ÓÙÈÊÏÂÁÌÔÓÒ‰Ë˜ ·ÁˆÁ‹ (.¯.

ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰¤˜, Î˘ÎÏÔÛÔÚ›ÓË, ·˙·ıÈÔÚ›ÓË)

ÂÚÈÔÚ›˙ÂÙ·È ÛÂ Â›ÌÔÓÂ˜, ÛÔ‚·Ú¤˜ Î·È ·ÓıÂÎÙÈÎ¤˜

ÛÙËÓ ÙÔÈÎ‹ ·ÁˆÁ‹ ÂÚÈÙÒÛÂÈ˜ ·ÙÔÈÎÔ‡ ÂÎ˙¤Ì·-

ÙÔ˜ (3,13).

™ÙË ¯ÒÚ· Ì·˜, Ù· ÂÚÈÛÛfiÙÂÚ· ·È‰È¿ ÌÂ ·ÙÔÈ-

Î‹ ‰ÂÚÌ·Ù›ÙÈ‰· ¤¯Ô˘Ó ‹È· ‹ Ì¤ÙÚÈ·˜ ‚·Ú‡ÙËÙ·˜ Ófi-

ÛÔ. ∞˘Ùfi Èı·ÓÒ˜ ÔÊÂ›ÏÂÙ·È ÛÙÈ˜ ÎÏÈÌ·ÙÔÏÔÁÈÎ¤˜

Û˘Óı‹ÎÂ˜, ÙÔÓ ÙÚfiÔ ‰È·‚›ˆÛË˜ Î·È ÙË ‰È·ÙÚÔÊ‹

(ÌÂÛÔÁÂÈ·Î‹ ‰›·ÈÙ·).

™˘Ì¤Ú·ÛÌ·

∏ ·ÙÔÈÎ‹ ‰ÂÚÌ·Ù›ÙÈ‰· Â›Ó·È ¯ÚfiÓÈ· ÓfiÛÔ˜ Ô˘

334 ∆. ∆ÛÈ‚ÈÙ·Ó›‰Ô˘-∫¿ÎÔ˘ÚÔ˘


∂ÈÎfiÓ· 7. ¶ÔÏÏ·Ï¤˜ ‚Ï¿‚Â˜ ÌÔÏ˘ÛÌ·ÙÈÎ‹˜ ÙÂÚÌ›ÓıÔ˘ ÛÂ ·È‰›ÌÂ ÍËÚÔ‰ÂÚÌ›·- ·ÙÔÈÎ‹ ‰ÂÚÌ·Ù›ÙÈ‰·.

∂ÈÎfiÓ· 8. µÏ¿‚Â˜ ·ÏÔ‡ ¤ÚËÙ·.

∂ÈÎfiÓ· 9. √Ì·Ï¤˜ Ì˘ÚÌËÁÎÈ¤˜.


¯·Ú·ÎÙËÚ›˙ÂÙ·È ·Ô ÂÍ¿ÚÛÂÈ˜ Î·È ˘Ê¤ÛÂÈ˜. ∂›Ó·ÈÂÔÌ¤Óˆ˜ ÛËÌ·ÓÙÈÎfi ÙÔ ·È‰› Î·È Ë ÔÈÎÔÁ¤ÓÂÈ¿ ÙÔ˘Ó· ÂÎ·È‰Â˘ıÔ‡Ó ÒÛÙÂ Ó· ·ÓÙÈÌÂÙˆ›˙Ô˘Ó ÛÂ ÌÂÁ¿-ÏÔ ‚·ıÌfi ÙË ÓfiÛÔ ÌfiÓÔÈ ÙÔ˘˜, Ó· ˙ËÙÔ‡Ó ¿ÌÂÛ· È·-ÙÚÈÎ‹ ‚Ô‹ıÂÈ· fiÙ·Ó ¤¯Ô˘Ó Ó· ·ÓÙÈÌÂÙˆ›ÛÔ˘Ó Î¿ÙÈ·Û‡ÓËıÂ˜, Ó· ·Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·È ÛÂ Ù·ÎÙÈÎ¿ ¯ÚÔÓÈ-Î¿ ‰È·ÛÙ‹Ì·Ù· ·Ô ÂÈ‰ÈÎfi Î·È Î˘Ú›ˆ˜ Ó· ¤¯Ô˘Ó ¿ÌÂ-ÛË ÚfiÛ‚·ÛË ÛÙÔÓ ·È‰›·ÙÚÔ ÙÔ˘˜, fiÔÙÂ Î·È fiÙ·ÓÙÔ ÎÚ›ÓÔ˘Ó ··Ú·›ÙËÙÔ.


1. Schultz Larsen F, Diepgen T, Svensson A. The occurrence ofatopic dermatitis in north Europe: an international ques-tionnaire study. J Am Acad Dermatol 1996;34:760-764.

2. Barbarot S, Beauchet A, Zaid S, Lacour JP, Groupe deRecherche Clinique en Dermatologie Pédiatrique. Themanagement of atopic dermatitis in children by dermatol-ogists, paediatricians, general practitioners and allergolo-gists: a national survey on practice patterns. Ann DermatolVenereol 2005;132:283-295.

3. Darsow U, Lubbe J, Taieb A. Seidenari S, Wollenberg A,Calza AM, et al. Position paper on diagnosis and treatmentof atopic dermatitis. J Eur Acad Dermatol Venereol 2005;19:286-295.

4. Friedlander SF, Hebert AA, Allen DB, Fluticasone Pedi-atrics Safety Study Group. Safety of fluticasone propionatecream 0.05% for the treatment of severe and extensiveatopic dermatitis in children as young as 3 months. J AmAcad Dermatol 2002;46:387-393.

5. Lebwohl M. A comparison of once-daily application of

mometasone furoate 0.1% cream compared with twice-daily hydrocortisone valerate 0.2% cream in pediatricatopic dermatitis patients who failed to respond to hydro-cortisone: mometasone furoate study group. Int J Derma-tol 1999;38:604-606.

6. Lever R, Hadley K, Downey D, Mackie R. Staphylococcalcolonization in atopic dermatitis and the effect of topicalmupirocin therapy. Br J Dermatol 1988;119:189-198.

7. Abramovits W. Atopic dermatitis. J Am Acad Dermatol2005;53 (1 Suppl):S86-93.

8. Paller A, Eichenfield LF, Leung DY, Stewart D, Appell M.A 12-week study of tacrolimus ointment for the treatmentof atopic dermatitis in pediatric patients. J Am Acad Der-matol 2001;44 (1 Suppl):S47-S57.

9. Eichenfield LF, Lucky AW, Boguniewicz M, Langley RG,Cherill R, Marshall K. Safety and efficacy of pimecrolimus(ASM 981) cream 1% in the treatment of mild and moder-ate atopic dermatitis in children and adolescents. J AmAcad Dermatol 2002;46:495-504.

10. Kapp A, Papp K, Bingham A, Folster-Holst R, Ortonne JP,Potter PC, et al. Long-term management of atopic dermati-tis in infants with topical pimecrolimus, a nonsteroid anti-inflammatory drug. J Allergy Clin Immunol 2002;110: 277-284.

11. Simons FE, Simons KJ, Becker AB, Haydey RP. Pharmaco-kinetics and antipruritic effects of hydroxyzine in childrenwith atopic dermatitis. J Pediatr 1984;104:123-127.

12. Wollenberg A, Wetzel S, Burgdorf WH, Haas J. Viral infec-tions in atopic dermatitis: pathogenic aspects and clinicalmanagement. J Allergy Clin Immunol 2003;112:667-674.

13. Dohil MA, Eichenfield LF. A treatment approach foratopic dermatitis. Pediatr Ann 2005;34:201-210.


¶·È‰È·ÙÚÈÎ‹ 2007;70:330-335


336 ™À¡∆√ª∞ ¶∞π¢π∞∆ƒπ∫∞ ¡∂∞


∏ıÈÎ¿ ˙ËÙ‹Ì·Ù· ÛÙËÓ ÂÚÈÁÂÓÓËÙÈÎ‹

È·ÙÚÈÎ‹

™ÙÔ ·ÚfiÓ ÙÂ‡¯Ô˜ ÙË˜ “¶·È‰È·ÙÚÈÎ‹˜” ÊÈÏÔ-ÍÂÓÔ‡ÓÙ·È Ë ÂÓ·ÚÎÙ‹ÚÈ· ÔÌÈÏ›· ÛÙÔ ÊÂÙÈÓfi 45Ô¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ (£ÂÔ‰fiÛË˜¶ÂÏÂÁÚ›ÓË˜. √ ı¿Ó·ÙÔ˜ ÙË˜ ËıÈÎ‹˜) Î·È Ë ·Ó·-ÛÎfiËÛË ÙˆÓ Neubauer Î·È Û˘Ó. (EthicsWorking Group, UEMS/European Academy ofPaediatrics) ÁÈ· ËıÈÎ¿ ˙ËÙ‹Ì·Ù· Ô˘ Û˘Ó‰¤Ô-ÓÙ·È ÌÂ ÙË ÊÚÔÓÙ›‰· ÙÔ˘ ·È‰ÈÔ‡ ÛÂ ÎÒÌ·. ∆·ËıÈÎ¿ ̇ ËÙ‹Ì·Ù· ÛÙËÓ ·È‰È·ÙÚÈÎ‹ Î·È ÙËÓ ÂÚÈ-ÁÂÓÓËÙÈÎ‹ È·ÙÚÈÎ‹ Â›Ó·È ÔÏÏ¿ Î·È ·Î·ÓıÒ‰Ë.¶ÔÏ‡ ÚfiÛÊ·Ù· ÛËÌÂÈÒıËÎ·Ó ¤ÓÙÔÓÂ˜ ·ÓÙÈ·-Ú·ı¤ÛÂÈ˜ ÁÈ· ˙ËÙ‹Ì·Ù· ‰È·ÎÔ‹˜ ÙË˜ Î‡ËÛË˜ÛÙÈ˜ ∏¶∞ Î·È ÛÙËÓ ∂ÏÏ¿‰·. ™ÙÈ˜ ∏¶∞, ÙÔ ∞ÓÒ-Ù·ÙÔ ¢ÈÎ·ÛÙ‹ÚÈÔ (Supreme Court, 18 ∞ÚÈÏ›Ô˘2007) ÁÓˆÌÔ‰fiÙËÛÂ (ÏÂÈÔ„ËÊ›· 5 ÚÔ˜ 4) Î·-Ù¿ ÙË˜ ‰È·ÎÔ‹˜ ÙË˜ ÚÔ¯ˆÚËÌ¤ÓË˜ Î‡ËÛË˜,·ÎfiÌË ÎÈ ·Ó Û˘ÓÙÚ¤¯Ô˘Ó È·ÙÚÈÎ¤˜ ÂÓ‰Â›ÍÂÈ˜ (ÌÂÂÍ·›ÚÂÛË ÙËÓ ·ÂÈÏ‹ ÁÈ· ÙË ˙ˆ‹ ÙË˜ ÂÁÎ‡Ô˘). HÈ·ÙÚÈÎ‹ ·ÓÙ›‰Ú·ÛË ˘‹ÚÍÂ ¿ÌÂÛË, ÙÔ ∞ÌÂÚÈÎ·-ÓÈÎfi ∫ÔÏ¤ÁÈÔ ª·ÈÂ˘Ù‹ÚˆÓ Î·È °˘Ó·ÈÎÔÏfiÁˆÓ¯·Ú·ÎÙ‹ÚÈÛÂ ÙËÓ ·fiÊ·ÛË “ÂÔÓÂ›‰ÈÛÙË Î·È·‰È·ÓfiËÙË” Î·È ÙÔ New Engl J Med ÊÈÏÔÍ¤ÓËÛÂ4 ÎÂ›ÌÂÓ· ÛÙÈ˜ ÊÂÈ‰ˆÏ¤˜ ÛÂÏ›‰Â˜ ÙÔ˘ (24 ª·˝Ô˘2007;356:2195, 2125, 2128, 2201) ÌÂ ‰ËÎÙÈÎ¤˜ÂÎÊÚ¿ÛÂÈ˜ ÁÈ· ÓÔÌÈÎÔ‡˜ Î·È ‰ÈÎ·ÛÙÈÎÔ‡˜ Ô˘·ÚÂÌ‚·›ÓÔ˘Ó ÛÙËÓ Î·ıËÌÂÚÈÓ‹ È·ÙÚÈÎ‹ Ú·-ÎÙÈÎ‹ Î·È “·ÛÎÔ‡Ó È·ÙÚÈÎ‹ ¯ˆÚ›˜ ¿‰ÂÈ· ¿ÛÎË-ÛË˜”. ™ÙËÓ ∂ÏÏ¿‰·, Ë ∂ıÓÈÎ‹ ∂ÈÙÚÔ‹ µÈÔËıÈ-Î‹˜ ‰È·Ù‡ˆÛÂ (29 ª·ÚÙ›Ô˘ 2007, ÌÂ ÌÂÈÔ„Ë-Ê›· ÂÓfi˜ Ì¤ÏÔ˘˜) Î·ÙÂ˘ı‡ÓÛÂÈ˜ ÁÈ· ˙ËÙ‹Ì·Ù·ÚÔÁÂÓÓËÙÈÎ‹˜ ‰È¿ÁÓˆÛË˜ (www.bioethics.gr).∂ÎÊÚ¿ÛÂÈ˜ fiˆ˜ “Ë ∂ÈÙÚÔ‹ ıÂˆÚÂ› ‰ÈÎ·ÈÔÏÔ-ÁËÌ¤ÓË ÙËÓ ÂÈÏÔÁ‹ ÂÌ‚Ú‡Ô˘, ˆ˜ ÁÂÓÈÎ‹ ‰˘Ó·-ÙfiÙËÙ· ÙˆÓ ̆ Ô„ËÊ›ˆÓ ÁÔÓ¤ˆÓ…”, Î·È “Ë ·Ô-‰Ô¯‹ ÙË˜ Á¤ÓÓËÛË˜ ·È‰ÈÒÓ ÌÂ ÛÔ‚·Ú¤˜ ‚Ï¿‚Â˜ÛÙËÓ ˘ÁÂ›· ÙÔ˘˜, fiÛÔ Î·È ·Ó ı· ÌÔÚÔ‡ÛÂ Ó· ‰È-Î·ÈÔÏÔÁËıÂ› ÛÂ ÂÓÙÂÏÒ˜ ·ÎÚ·›Â˜ ÂÚÈÙÒ-ÛÂÈ˜…, Î·Ù¿ Î·ÓfiÓ· ÂÏ¤Á¯ÂÙ·È ËıÈÎ¿” ÂÈÎÚ›-ıËÎ·Ó ·fi ÙËÓ ∂ÎÎÏËÛ›· (16 ª·˝Ô˘ 2007,www.ecclesia.gr/ greek/holysynod): “Ë ∂ÎÎÏËÛ›·Ì·˜ Î·Ù·‰ÈÎ¿˙ÂÈ ·˘ÙfiÓ ÙÔÓ ÎÚ˘ÙÔ-Ú·ÙÛÈÛÌfi,ÙÈÌ¿ ÙÔ ·Á·ıfi ÙË˜ ˙ˆ‹˜ ˆ˜ ÈÂÚfi Ì˘ÛÙ‹ÚÈÔ ·Îfi-ÌË Î·È Ì¤Û· ·fi ·Ó·ËÚ›Â˜, ·Ù¤ÏÂÈÂ˜ ‹ ÛÔ‚·-

Ú¤˜ ·Ûı¤ÓÂÈÂ˜…” Î·È “Ô fiÓÔ˜ ÁÂÓÓ¿ ÙËÓ ·Á¿-Ë Î·È fi¯È Ë Î·ÏÔ¤Ú·ÛË ÙÔ˘ Â˘ÁÔÓÈÎÔ‡ Û¯Â-‰È·ÛÌÔ‡”. ∞ÓÙÈ·Ú·ı¤ÛÂÈ˜ ÛÂ ˙ËÙ‹Ì·Ù· È·ÙÚÈ-Î‹˜ ËıÈÎ‹˜ ÛËÌÂÈÒÓÔÓÙ·È Î·È ÛÂ ¿ÏÏÂ˜ ¯ÒÚÂ˜,Î·È Â›Ó·È Â˘ÚfiÛ‰ÂÎÙÂ˜ Î·È ÁfiÓÈÌÂ˜. ∞˘Ùfi Ô˘ÍÂ¯ˆÚ›˙ÂÈ ÛÙËÓ ÂÏÏËÓÈÎ‹ ÂÚ›ÙˆÛË Â›Ó·È ËÛÈˆ‹ ÙˆÓ ÂÏÏ‹ÓˆÓ È·ÙÚÒÓ.

∆· Î·Ï¿ ÙˆÓ ÏÔÈÌÒÍÂˆÓ

∏ ·ÙÔ›· ¤¯ÂÈ ·˘ÍËıÂ› ÙÂÏÂ˘Ù·›· ÛÙÈ˜ ‰˘ÙÈ-Î¤˜ ÎÔÈÓˆÓ›Â˜, ·ÏÏ¿ ÙÔ ÁÈ·Ù› ·Ú·Ì¤ÓÂÈ ·‰ÈÂ˘-ÎÚ›ÓÈÛÙÔ. ªÈ· ÂÚÌËÓÂ˘ÙÈÎ‹ ˘fiıÂÛË, ÁÓˆÛÙ‹ˆ˜ “˘fiıÂÛË ÙË˜ ˘ÁÈÂÈÓ‹˜” (hygiene hypo-thesis) ÚÂÛ‚Â‡ÂÈ fiÙÈ Ë ÚÒÈÌË ¤ÎıÂÛË ÛÂ ÏÔÈ-ÌÒÍÂÈ˜ (fiˆ˜ Ë·Ù›ÙÈ‰· ∞, ÂÏÈÎÔ‚·ÎÙËÚ›‰ÈÔ˘ÏˆÚÔ‡, ÙÔÍfiÏ·ÛÌ·, ¤ÏÌÈÓıÂ˜) ÂÈ‰Ú¿ Â˘-ÂÚÁÂÙÈÎ¿ ÛÙÔ ·ÓÔÛÔÔÈËÙÈÎfi Û‡ÛÙËÌ· ·Ô-ÙÚ¤ÔÓÙ·˜ ÙËÓ ÂÌÊ¿ÓÈÛË ·ÙÔ›·˜ - ¿Ú· Ù··È‰È¿ ¯ˆÚ›˜ ÔÏÏ¤˜ ÏÔÈÌÒÍÂÈ˜ ı· Â›Ó·È ÈÔ·ÙÔÈÎ¿. ¶ÚfiÛÊ·ÙË ÌÂÏ¤ÙË ·fi ÙË °ÂÚÌ·Ó›·(J Epidemiol Community Health 2007;61:638)ÌÂ 3347 ·È‰È¿ ¤‰ÂÈÍÂ fiÙÈ fiÛÔ ÈÔ Û˘¯Ófi˜ Ô·ÔÈÎÈÛÌfi˜ ÌÂ Helicobacter pylori, ÙfiÛÔ ÏÈÁfi-ÙÂÚÔ Û˘¯Ófi ÙÔ ¤Î˙ÂÌ· (OR=0,31, p=0,006).√ÌÔ›ˆ˜, ÂÚÁ·Û›· ·fi ÙÈ˜ ∏¶∞ (Arch InternMed 2007;167:821) ÌÂ 7663 ÂÓ‹ÏÈÎÂ˜ Î·Ù¤ÏËÍÂfiÙÈ fiÛÔ ÈÔ Û˘¯Ófi˜ Ô ·ÔÈÎÈÛÌfi˜ ÌÂ cagA(+)ÛÙÂÏ¤¯Ë H pylori, ÙfiÛÔ ÏÈÁfiÙÂÚÔ Û˘¯Ófi ÙÔ¿ÛıÌ· (È‰È·›ÙÂÚ· ÚÈÓ Ù· 15 ¤ÙË ˙ˆ‹˜, OR=0,63,95% CI 0,43-0,93), Ë ·ÏÏÂÚÁÈÎ‹ ÚÈÓ›ÙÈ‰·, Ù· ·Ï-ÏÂÚÁÈÎ¿ Û˘ÌÙÒÌ·Ù· Î·È Ë ‰ÂÚÌ·ÙÈÎ‹ Â˘·ÈÛıË-ÙÔÔ›ËÛË ÛÂ Á‡ÚË Î·È Ì‡ÎËÙÂ˜. ∞Ó·Ê¤ÚÂÙ·È ÏÔÈ-fiÓ fiÙÈ o ¯ÚfiÓÈÔ˜ ÂÚÂıÈÛÌfi˜ ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ÏÂÌ-ÊÈÎÔ‡ ÈÛÙÔ‡ ·fi ÙÔ H. pylori ÂÓ‰¤¯ÂÙ·È Ó· Â˘Ô-‰ÒÓÂÈ ÙËÓ ˆÚ›Ì·ÓÛË ÙË˜ ·ÓÔÛ›·˜. ∏ ÏÔ›ÌˆÍË H.pylori Û˘Ó‹ıˆ˜ Û˘Ì‚·›ÓÂÈ Î·Ù¿ ÙËÓ ÚÒÙË ‰Â-Î·ÂÙ›· ÙË˜ ˙ˆ‹˜ Î·È ¤¯ÂÈ ÌÂÈˆıÂ› ÛÙÈ˜ ‚ÈÔÌË¯·-ÓÈÎ¤˜ ¯ÒÚÂ˜. ™Â ÌÈ· ÌÈÎÚfiÙÂÚË˜ ÎÏ›Ì·Î·˜ ÌÂ-Ï¤ÙË ·fi ÙËÓ ∆Ô˘ÚÎ›· (J Trop Ped 2007; ˘fi‰ËÌÔÛ›Â˘ÛË) ‰ÂÓ ÂÈ‚Â‚·ÈÒıËÎÂ ·˘Ù‹ Ë Û¯¤-ÛË. ∏ ÔÏ‡ ÂÓ‰È·Ê¤ÚÔ˘Û· “˘fiıÂÛË ÙË˜ ˘ÁÈÂÈ-Ó‹˜” Û˘˙ËÙÂ›Ù·È ·fi ÙË ‰ÂÎ·ÂÙ›· ÙÔ˘ 1980, ¿Ï-ÏÔÙÂ ÂÚÈÛÛfiÙÂÚÔ Î·È ¿ÏÏÔÙÂ ÏÈÁfiÙÂÚÔ, ˆÛÙfi-ÛÔ ·Ú·Ì¤ÓÂÈ ˘fiıÂÛË. ¶ÂÚÈÛÛfiÙÂÚ· ÁÈ· ÙËÓ“˘fiıÂÛË ÙË˜ ˘ÁÈÂÈÓ‹˜” ÛÙÔ ·ÚfiÓ ÙÂ‡¯Ô˜ ÙË˜

∂ÌÌ·ÓÔ˘‹Ï °·Ï·Ó¿ÎË˜AÏÏËÏÔÁÚ·Ê›·:

∂ÌÌ·ÓÔ˘‹Ï °·Ï·Ó¿ÎË˜[email protected]¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹ÙË˜


337PAEDIATRIC NEWS IN BRIEF

¶·È‰È·ÙÚÈÎ‹ 2007;70:336-337

¶·È‰È·ÙÚÈÎ‹˜, ÛÙËÓ ·Ó·ÛÎfiËÛË ™ÔÊÈ·ÓÔ‡-∫·-ÙÛÔ‡ÏË Î·È ÛÙË ÌÂÏ¤ÙË ∫·Ú·‚·Ó¿ÎË Î·È Û˘Ó, fiÔ˘ÔÈ Û˘¯Ó¤˜ ÈÔÁÂÓÂ›˜ ÏÔÈÌÒÍÂÈ˜ ÛÙ· ‰˘Ô ÚÒÙ· ¤ÙË˙ˆ‹˜ Ê¤ÚÔÓÙ·È Ó· ‰ÚÔ˘Ó ÚÔÛÙ·ÙÂ˘ÙÈÎ¿ ÛÙËÓ ÂÎ-‰‹ÏˆÛË Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË Ù‡Ô˘ 1.

√È ‰˘Ô fi„ÂÈ˜ ÙË˜ ËÏÈÔÚÔÛÙ·Û›·˜

∏ ˘ÂÚÈÒ‰Ë˜ ·ÎÙÈÓÔ‚ÔÏ›· Â›Ó·È Î·ÚÎÈÓÔÁfiÓÔ˜Î·È Ë ˘ÂÚ‚ÔÏÈÎ‹ ¤ÎıÂÛË ÛÙÔÓ ‹ÏÈÔ Â›Ó·È ÂÈÎ›Ó‰˘-ÓË ÁÈ· fiÏÔ˘˜ - ÔÏ‡ ÂÚÈÛÛfiÙÂÚÔ ÁÈ· Ù· ÌÈÎÚ¿ ·È-‰È¿. ∞fi ÙËÓ ¿ÏÏË fiÌˆ˜, Ë ËÏÈ·Î‹ ·ÎÙÈÓÔ‚ÔÏ›· Â˘Ô-‰ÒÓÂÈ ÙË Û‡ÓıÂÛË ÙË˜ ‚ÈÙ·Ì›ÓË˜ D Î·È Ë ˘ÂÚ‚ÔÏÈ-Î‹ ·ÔÊ˘Á‹ ÙË˜ ¤ÎıÂÛË˜ Ê·›ÓÂÙ·È Ó· ÌËÓ Â›Ó·È¿Û¯ÂÙË ÌÂ ÙËÓ ÚfiÛÊ·ÙË Â·ÓÂÌÊ¿ÓÈÛË ÙË˜ Ú·¯›ÙÈ-‰·˜ ·ÎfiÌË Î·È ÛÂ ËÏÈfiÏÔ˘ÛÙÂ˜ ¯ÒÚÂ˜ (Am FamPhysician 2006;74:619: “Ë Ú·¯›ÙÈ‰· ‰ÂÓ Â›Ó·È ÓfiÛÔ˜ÙÔ˘ ·ÚÂÏıfiÓÙÔ˜”, Î·È J Clin Invest 2006 116:2062:“Ë ÓÂÎÚ·Ó¿ÛÙ·ÛË ÙË˜ ·ÓÂ¿ÚÎÂÈ·˜ ‚ÈÙ·Ì›ÓË˜ D Î·ÈÙË˜ Ú·¯›ÙÈ‰·˜”). ∆Ô Úfi‚ÏËÌ· ÌÂ ÙÔÓ ‹ÏÈÔ Â›Ó·È fiÙÈÙÔ ·ÛÊ·Ï¤˜ fiÚÈÔ ¤ÎıÂÛË˜ ·Ú·Ì¤ÓÂÈ ¿ÁÓˆÛÙÔ (MedJ Aust 2006;185:268). ∞fi ÙËÓ ·ÓÂÈÛÙËÌÈ·Î‹ ·È-‰È·ÙÚÈÎ‹ ÎÏÈÓÈÎ‹ ÙÔ˘ ∏Ú·ÎÏÂ›Ô˘ ¤Ú·Û·Ó ÙË ÊÂÙÈÓ‹¿ÓÔÈÍË 3 ‚Ú¤ÊË ÌÂ Ú·¯›ÙÈ‰· - fiÏ· ‰È¤ÌÂÓ·Ó ÛÙË Ófi-ÙÈ· ∫Ú‹ÙË, fiÔ˘ Ë ËÏÈÔÊ¿ÓÂÈ· Â›Ó·È ·˘ÙÔÓfiËÙË.ŸÏÂ˜ ÔÈ ¤ÁÎ˘Â˜ ÎÈ fiÏ· Ù· ‚Ú¤ÊË (Î·È Ì¿ÏÈÛÙ· Ù· ÌÂ-Ï·¯ÚÈÓ¿ ¿ÙÔÌ·) Ô˘ ‰ÂÓ ÂÎÙ›ıÂÓÙ·È ÛÙÔÓ ‹ÏÈÔ Ê·›-ÓÂÙ·È fiÙÈ ¯ÚÂÈ¿˙ÔÓÙ·È Û˘ÌÏËÚˆÌ·ÙÈÎ‹ ‚ÈÙ·Ì›ÓË D.

º˘Ì·Ù›ˆÛË Î·È ˘ÂÚ·ÙÏ·ÓÙÈÎ¤˜ Ù‹ÛÂÈ˜

™ÙÈ˜ 29 ª·˝Ô˘ 2007, ¿Ó‰Ú·˜ 32 ÂÙÒÓ ÌÂ ÂÍ·ÈÚÂ-ÙÈÎ¿ ·ÓıÂÎÙÈÎ‹ Ê˘Ì·Ù›ˆÛË (extensively drug-resistant tuberculosis, XDR TB) Ù¤ıËÎÂ ÛÂ Î·Ú·ÓÙ›-Ó· ÛÙÈ˜ ∏¶∞ ÌÂ ÓÔÛËÏÂ›· ˘fi ÊÚÔ‡ÚËÛË (CNN,BBC Î·È in.gr 30 ª·˝Ô˘ 2007, ‰ÂÏÙ›· Ù‡Ô˘ CDC 2Î·È 8 πÔ˘Ó›Ô˘ 2007). ◊Ù·Ó Ë ÚÒÙË ÊÔÚ¿ ÌÂÙ¿ ·fi44 ¤ÙË Ô˘ ÂÊ·ÚÌfiÛıËÎÂ Ù¤ÙÔÈ· Î·Ú·ÓÙ›Ó· ÛÙÈ˜∏¶∞, Ë ÚÔËÁÔ‡ÌÂÓË ‹Ù·Ó ÙÔ 1963 Î·È ·ÊÔÚÔ‡ÛÂÎÚÔ‡ÛÌ· Â˘ÏÔÁÈ¿˜. √ ·ÛıÂÓ‹˜ Â›¯Â Ù·ÍÈ‰¤„ÂÈ ÔÏ‡ÚfiÛÊ·Ù· ÛÂ ∂˘ÚÒË (Î·È ∂ÏÏ¿‰·, 14-21 ª·˝Ô˘)ÌÂ ‰‡Ô ˘ÂÚ·ÙÏ·ÓÙÈÎ¤˜ Ù‹ÛÂÈ˜: ∞ÙÏ¿ÓÙ·-¶·Ú›ÛÈÎ·È ¶Ú¿Á·-ªfiÓÙÚÂ·Ï (12 Î·È 24 ª·˝Ô˘). ∏ ÌÔÏ˘-ÛÌ·ÙÈÎfiÙËÙ¿ ÙÔ˘ ıÂˆÚ‹ıËÎÂ ¯·ÌËÏ‹, ˆÛÙfiÛÔ ÙÔCDC Û˘Ó¤ÛÙËÛÂ ¤ÏÂÁ¯Ô ÁÈ· Ù· ÏËÚÒÌ·Ù· ÙˆÓ ·Â-ÚÔÛÎ·ÊÒÓ Î·È ÁÈ· fiÏÔ˘˜ ÙÔ˘˜ Û˘ÓÂÈ‚¿ÙÂ˜ (Î·È Ì¿-ÏÈÛÙ· fiÛÔ˘˜ Î¿ıÔÓÙ·Ó ÛÙËÓ ›‰È· ÛÂÈÚ¿ ‹ ‰‡Ô ÛÂÈÚ¤˜ÌÚÔÛÙ¿ Î·È ‰˘Ô ÛÂÈÚ¤˜ ›Ûˆ). ∏ Û‡ÛÙ·ÛË ·ÊÔ-ÚÔ‡ÛÂ ÙÈ˜ ˘ÂÚ·ÙÏ·ÓÙÈÎ¤˜ Î·È fi¯È ÙÈ˜ Â˘Úˆ·˚Î¤˜Ù‹ÛÂÈ˜ ÏfiÁˆ ÙÔ˘ ÌÂÁ·Ï‡ÙÂÚÔ˘ ¯ÚfiÓÔ˘ ¤ÎıÂÛË˜.∞fi ÙÔ˘˜ 274 ÔÏ›ÙÂ˜ ∏¶∞ ÂÓÙÔ›ÛıËÎ·Ó ÁÚ‹ÁÔÚ·ÔÈ 255. ∞fi ÙÈ˜ 25 ª·˝Ô˘ ÙÔ ı¤Ì· Û˘ÓÙfiÓÈÛÂ Ë ¶·-

ÁÎfiÛÌÈ· √ÚÁ¿ÓˆÛË ÀÁÂ›·˜. ∂ÓËÌÂÚÒıËÎ·Ó ÔÈ ¯Ò-

ÚÂ˜ ÌÂ ÔÏ›ÙÂ˜-Û˘ÓÂÈ‚¿ÙÂ˜ Î·È ÔÈ ¯ÒÚÂ˜ ·fi fiÔ˘

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ÎÔÈÓ‹˜ ÔÏÈÙÈÎ‹˜ ÙË˜ ∂˘Úˆ·˚Î‹˜ ŒÓˆÛË˜ Î·È ÛÙËÓ

∂ÏÏ¿‰· Ù¤ıËÎÂ ÛÂ ÂÊ·ÚÌÔÁ‹ ÙÔ Û¯¤‰ÈÔ “¶ÂÚÛ¤·˜”.

ŒÓ·˜ ŒÏÏËÓ·˜ Û˘ÓÂÈ‚¿ÙË˜ ÛÙËÓ Ù‹ÛË ∞ÙÏ¿ÓÙ·-

¶·Ú›ÛÈ ‚Ú¤ıËÎÂ Î·È ÂÏ¤Á¯ıËÎÂ. ™ÙÈ˜ ∏¶∞, Ë XDR

∆µ ¤¯ÂÈ ‰È·ÁÓˆÛıÂ› ÛÂ 49 ·ÓıÚÒÔ˘˜ ·fi ÙÔ 1993

¤ˆ˜ ÙÔ 2006, ·ÏÏ¿ Â›Ó·È ÔÏ‡ ÈÔ Û˘¯Ó‹ (Î·È Û˘Ó‹-

ıˆ˜ ı·Ó·ÙËÊfiÚ·) ÛÂ ¿ÏÏÂ˜ ¯ÒÚÂ˜. ∏ ·ÓÙÈÌÂÙÒÈÛË

Î¿ıÂ ÎÚÔ‡ÛÌ·ÙÔ˜ ÛÙÈ˜ ∏¶∞ ÎÔÛÙ›˙ÂÈ ÂÚ› Ù·

$500.000 (ú400.000).

À¿Ú¯ÂÈ Ï‡ÛÛ· ÛÙËÓ ∂ÏÏ¿‰·;

Ÿ¯È Û¿ÓÈ· ¯ÚÂÈ¿˙ÂÙ·È Ó· ‰ÒÛÔ˘ÌÂ Ô‰ËÁ›Â˜ ÁÈ·

·È‰È¿ ÌÂ ‰‹ÁÌ·Ù· (‹ Èı·Ó¿ ‰‹ÁÌ·Ù· ‹ ¿ÏÏË Â·-

Ê‹) ·fi ÛÎ˘ÏÈ¿ ‹ (Û·ÓÈfiÙÂÚ·) ·ÏÂÔ‡‰Â˜, Ó˘¯ÙÂ-

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ÓfiÛËÌ· ÌÂ ÙË ÌÂÁ·Ï‡ÙÂÚË ıÓËÙfiÙËÙ· (100%), ‰ÂÓ

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ÛÂˆÓ (Ë ÌÔÓ·‰ÈÎ‹ ÂÍ·›ÚÂÛË, ÛÂ 15ÂÙ¤˜ ÎÔÚ›ÙÛÈ, Â-

ÚÈÁÚ¿ÊÂÙ·È ÛÙÔ New Engl J Med 2005;352:2508). ∂›-

Ó·È ÁÓˆÛÙ‹ Ë ·Í›· ÙË˜ ÚÔÊ‡Ï·ÍË˜ (ÂÚÈÔ›ËÛË

ÙÚ·‡Ì·ÙÔ˜, ÂÈ‰ÈÎ‹ ·ÓÔÛÔÛÊ·ÈÚ›ÓË, ÂÌ‚fiÏÈÔ) ÌÂÙ¿

ÙËÓ ¤ÎıÂÛË Î·È ÚÈÓ ÙÈ˜ ÎÏÈÓÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜.

ŸÌˆ˜, Ë Ï‡ÛÛ· ÛÙÔÓ ¿ÓıÚˆÔ Â›Ó·È ÔÏ‡ Û¿ÓÈ·

Î·È, ·fi ÙËÓ ¿ÏÏË, ÙÔ ·Ó·ÌÓËÛÙÈÎfi Â›Ó·È Û˘¯Ó¿

·Û·Ê¤˜ ‹ ÙÔ ÛÎ˘Ï› Â›Ó·È ·‰¤ÛÔÙÔ Î·È ‰ÂÓ ÌÔÚÂ›

Ó· ·Ú·ÎÔÏÔ˘ıËıÂ›. ¢˘Ô ÚfiÛÊ·Ù· ÎÚÔ‡ÛÌ·Ù·

ÛÙÈ˜ ∏¶∞ (MMWR 2007;56:361) ·ÊÔÚÔ‡Û·Ó ·ÁfiÚÈ

11 ÂÙÒÓ ÌÂ ‰‹ÁÌ· ·fi ÛÎ˘Ï› ÚÔ 2ÂÙ›·˜ Î·È ÎÔÚ›ÙÛÈ

ËÏÈÎ›·˜ 10 ÂÙÒÓ ÌÂ ‰‹ÁÌ· ·fi Ó˘¯ÙÂÚ›‰· ÚÔ 3Ì‹-

ÓÔ˘. ∆· ·È‰È¿ ‰ÂÓ Â›¯·Ó ¿ÚÂÈ ÚÔÊ˘Ï·ÎÙÈÎ‹ ·Áˆ-

Á‹ Î·È Î·Ù¤ÏËÍ·Ó, ÌÔÏÔÓfiÙÈ ·ÓÙÈÌÂÙˆ›ÛıËÎ·Ó ÌÂ

ÙËÓ ÈÔ ÂÓÙ·ÙÈÎ‹ Î·È ÙÂÎÌËÚÈˆÌ¤ÓË ·ÁˆÁ‹. ™ÙÈ˜

∏¶∞ ·Ó·Ê¤ÚÔÓÙ·È 3 ÂÚ›Ô˘ ÎÚÔ‡ÛÌ·Ù· ÂÙËÛ›ˆ˜.

À¿Ú¯ÂÈ Ï‡ÛÛ· ÛÙËÓ ∂ÏÏ¿‰·; ∏ ¿ÌÂÛË ‰‹ÏˆÛË ÙˆÓ

ÎÚÔ˘ÛÌ¿ÙˆÓ Â›Ó·È (ıÂˆÚËÙÈÎÒ˜ ÙÔ˘Ï¿¯ÈÛÙÔÓ) ˘Ô-

¯ÚÂˆÙÈÎ‹ ÛÙË ¯ÒÚ· Ì·˜ Î·È ÌÂ ÙËÓ ÙÚ·ÁÈÎ‹ ÙÔ˘˜

Î·Ù¿ÏËÍË, ‰ÂÓ ı· ÂÚÓÔ‡Û·Ó ··Ú·Ù‹ÚËÙ·. ∞fi

ÌÈ· ÂÈÛÎfiËÛË ÙˆÓ ‰ËÌÔÛÈÂ˘Ì¤ÓˆÓ ‰ÂÏÙ›ˆÓ ÙË˜

∂™À∂, ÙË˜ PubMed Î·È ÙË˜ iatrotek on-line ÚÔÎ‡-

ÙÂÈ fiÙÈ ‰ÂÓ ¤¯ÂÈ ·Ó·ÊÂÚıÂ› ·ÓıÚÒÈÓÔ ÎÚÔ‡ÛÌ·

ÛÙËÓ ∂ÏÏ¿‰· ·fi ÙË ‰ÂÎ·ÂÙ›· ÙÔ˘ 1970. øÛÙfiÛÔ,

ÛÙË ‰ÂÎ·ÂÙ›· 1951-1960 Â›¯·Ó ·Ó·ÊÂÚıÂ› 53 ı·Ó·-

ÙËÊfiÚ· ·ÓıÚÒÈÓ· ÎÚÔ‡ÛÌ·Ù· (Parassitologia

1988;30:93).


338


¡∂∞ ∞¶√ ∆√ ¢π∞¢π∫∆À√

¡ÈÎfiÏ·Ô˜ ¶··‰fiÔ˘ÏÔ˜, ¶·È‰›·ÙÚÔ˜, ∞ÏÏÂÚÁÈÔÏfiÁÔ˜

πÛÙÔÛÂÏ›‰Â˜ ÁÈ· ÌÔ˘ÛÈÎ‹ ÁÈ· ·È‰È¿

∏ ÌÔ˘ÛÈÎ‹ ·ÔÙÂÏÂ› ·Ó·ÌÊ›‚ÔÏ· ·Ó·fiÛ·ÛÙÔ ÎÔÌÌ¿ÙÈ ÙË˜ Û˘ÓÔÏÈÎ‹˜ ÌÔÚÊˆÙÈÎ‹˜ ÂÎ·›-‰Â˘ÛË˜ ÙˆÓ ·È‰ÈÒÓ ·fi ÙËÓ ‚ÚÂÊÈÎ‹ ÙÔ˘˜ ÎÈfiÏ·˜ ËÏÈÎ›·. ¶ÔÏÏ¤˜ ÂÈÛÙËÌÔÓÈÎ¤˜ ÌÂÏ¤ÙÂ˜ ¤¯Ô˘ÓÎ·Ù·Ï‹ÍÂÈ ÛÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ Ë ÌÔ˘ÛÈÎ‹ „˘¯·ÁˆÁ›· ÙˆÓ ·È‰ÈÒÓ Û˘Ì‚¿ÏÏÂÈ ÛÙË ‰È·ÌfiÚÊˆÛËÙÔ˘ ¯·Ú·ÎÙ‹Ú· ÙÔ˘˜ Î·ıÒ˜ Î·È ÛÙÔÓ ÌÂÙ¤ÂÈÙ· Â·ÁÁÂÏÌ·ÙÈÎfi ÙÔ˘˜ ÚÔÛ·Ó·ÙÔÏÈÛÌfi, fiÙ·Ó ·˘Ù‹·ÔÎÙ¿ Ù·ÎÙÈÎfi Î·È ÔÚÁ·ÓˆÌ¤ÓÔ ¯·Ú·ÎÙ‹Ú·. ∞Ó¿ÌÂÛ· ÛÂ Ì›· ÏËıÒÚ· ‰˘Ó·ÙÔÙ‹ÙˆÓ, ÙÔ ‰È·‰›-ÎÙ˘Ô ÚÔÛÊ¤ÚÂÈ Î·È ÂÎÂ›ÓË ÙË˜ ÌÔ˘ÛÈÎ‹˜ ÂÎ·›‰Â˘ÛË˜, ÚÔÛÂÏÎ‡ÔÓÙ·˜ ÙËÓ ÚÔÛÔ¯‹ fi¯È ÌfiÓÔÙˆÓ ·È‰ÈÒÓ Î·È ÙˆÓ ÂÊ‹‚ˆÓ, ·ÏÏ¿ Î·È ÙˆÓ ÁÔÓ¤ˆÓ ‹ Î·È ÙˆÓ ‰·ÛÎ¿ÏˆÓ.

ªÔ˘ÛÈÎ‹ ÂÎ·›‰Â˘ÛË ÁÈ· ·È‰È¿ - http://www.music4kids.com/meyc/

Music Education for Young Children, aresource for teachers and parents, Â›Ó·È Ô Ù›Ù-ÏÔ˜ ÙË˜ ÚÒÙË˜ ÈÛÙÔÛÂÏ›‰·˜ Ô˘ ÌÂ È‰È·›ÙÂ-ÚË Â˘ÎÔÏ›· ÌÔÚÂ› Ó· ‚ÚÂÈ Î¿ÔÈÔ˜ ÛÙÔ ‰È·-‰›ÎÙ˘Ô. ∞Ï‹, ÌÂ ÏÈÙ¿ ·È‰ÈÎ¿ Û¯¤‰È· Ó·ÎÔÛÌÔ‡Ó ÙÔÓ “¯ÒÚÔ” ÙË˜, Ë ÛÂÏ›‰· ·˘Ù‹ÂÍ˘ËÚÂÙÂ› ÌÂ Ï·ÎˆÓÈÎfi ÙÚfiÔ ÙÔÓ ÏfiÁÔÏÂÈÙÔ˘ÚÁ›·˜ ÙË˜. ª›· ÛÙ‹ÏË ·ÚÈÛÙÂÚ¿ Ô‰Ë-ÁÂ› ÙÔÓ ÂÈÛÎ¤ÙË ÛÙ· Î·›ÚÈ· links ÙË˜,

ñ Books, Periodicals, Catalogsñ Music Curriculañ Songs and Music Gamesñ Teaching Ideasñ Musical Developmentñ Music and the Brainñ Professional Organizations

ÂÓÒ ˘¿Ú¯Ô˘Ó ÂÚ·ÈÙ¤Úˆ ÏÂÈÙÔ˘ÚÁ›Â˜ fiˆ˜ ‰˘Ó·ÙfiÙËÙ· register ÛÂ Discussion Forum, ÛÙÔ ÔÔ›Ô ÔÂÎ¿ÛÙÔÙÂ ÁÔÓ¤·˜ ‹ ‰¿ÛÎ·ÏÔ˜ ÌÔÚÂ› Ó· ·ÓÙ·ÏÏ¿ÍÂÈ È‰¤Â˜ Î·È Ó· ·Ó·Ù‡ÍÂÈ ‰È¿ÏÔÁÔ Û¯ÂÙÈÎ¿ ÌÂ ÙÔı¤Ì·.

ªÔ˘ÛÈÎ‹ Û‡ÓıÂÛË - http://www.creatingmusic.com/

A˘Ù‹ Ë ÈÛÙÔÛÂÏ›‰· ·Ó·Ê¤ÚÂÙ·È ÂÚÈÛÛfiÙÂÚÔ ÛÂ·È‰È¿ Ô˘ ‹‰Ë ¤¯Ô˘Ó ÂÈÛ¯ˆÚ‹ÛÂÈ ÌÂ ÙÔÓ ¤Ó· ‹ ÌÂÙÔÓ ¿ÏÏÔ ÙÚfiÔ ÛÙÔÓ ¯ÒÚÔ ÙË˜ ÌÔ˘ÛÈÎ‹˜ ÂÎ·›‰Â˘-ÛË˜.

¶ÂÚÈÛÛfiÙÂÚÔ ÂÍÂÈ‰ÈÎÂ˘Ì¤ÓË ÏÔÈfiÓ ·ÏÏ¿ ¯ˆÚ›˜Ó· ·ÔÎÏÂ›ÂÈ ÙÔÓ ÂÈÚ·Ì·ÙÈÛÌfi ÙˆÓ ·È‰ÈÒÓ ÛÙËÌÔ˘ÛÈÎ‹ Û‡ÓıÂÛË, Ë ÈÛÙÔÛÂÏ›‰· ·Ú¤¯ÂÈ ¤Ó· on line‰ËÌÈÔ˘ÚÁÈÎfi ÌÔ˘ÛÈÎfi ÂÚÈ‚¿ÏÏÔÓ ÁÈ· ·È‰È¿ fiÏˆÓÙˆÓ ËÏÈÎÈÒÓ. ªÔÚÔ‡Ó Ó· Û˘Óı¤ÛÔ˘Ó, Ó· Û¯ËÌ·Ù›-ÛÔ˘Ó ÌÔ˘ÛÈÎ¿ puzzles ·ÏÏ¿ Î·È Ó· ·Û¯ÔÏËıÔ‡Ó ÌÂ·È‰ÈÎ¿ ·È¯Ó›‰È·.

|

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


¡ÈÎfiÏ·Ô˜ ¶··‰fiÔ˘ÏÔ˜[email protected]


339NEWS FROM THE INTERNET

¶·È‰È·ÙÚÈÎ‹ 2007;70:338-339

∫Ï·ÛÈÎ‹ ÌÔ˘ÛÈÎ‹ ÁÈ· ·È‰È¿ - http://www.classicsforkids.com/

∏ ÈÛÙÔÛÂÏ›‰· ·˘Ù‹ ÂÈÛ¿ÁÂÈ ÌÂ Â˘¯¿ÚÈÛÙÔ ÙÚfiÔÙ· ·È‰È¿ ÛÙÔÓ ¯ÒÚÔ ÂÓfi˜ ˘„ËÏÔ‡ Î·È È‰È·›ÙÂÚÔ˘ Â›-‰Ô˘˜ ÌÔ˘ÛÈÎ‹˜. ¶ÚfiÎÂÈÙ·È ÁÈ· ÙËÓ ÎÏ·ÛÈÎ‹ ÌÔ˘ÛÈÎ‹.∆Ô ÏÔ‡ÛÈÔ ÂÚÈÂ¯fiÌÂÓÔ ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÌÂ ¤ÓÙÔÓ·¯ÚÒÌ·Ù· Î·È ÁÚ·ÊÈÎ¿, ÂÓÒ ÔÏ‡ Â‡ÎÔÏ· ·Ó·Î·Ï‡-ÙÂÈ Î·ÓÂ›˜ fiÙÈ ÚfiÎÂÈÙ·È ÁÈ· Ì›· ÈÛÙÔÛÂÏ›‰· ÌÂÔÏÏ¤˜ Ú·ÎÙÈÎ¤˜ ÂÊ·ÚÌÔÁ¤˜ Î·È ÏÈÁfiÙÂÚÂ˜ ıÂˆÚË-ÙÈÎ¤˜ ·Ó·Ï‡ÛÂÈ˜. ∆· ·È‰È¿ ¤¯Ô˘Ó ÙË ‰˘Ó·ÙfiÙËÙ· Ó··ÎÔ‡ÛÔ˘Ó ‰ˆÚÂ¿Ó ÎÏ·ÛÈÎ‹ ÌÔ˘ÛÈÎ‹, Ë ÔÔ›· ·Ó·-‚·ıÌ›˙ÂÙ·È ÛÂ Â‚‰ÔÌ·‰È·›· ‚¿ÛË. ∆· ‚‹Ì·Ù· ÁÈ· ÙËÓ¤Ó·ÚÍË ÙË˜ ÂÊ·ÚÌÔÁ‹˜ Â›Ó·È ·Ï¿, ÂÓÒ ·ÎÔÏÔ˘ıÔ‡ÓQuiz ÌÂ ÂÚˆÙ‹ÛÂÈ˜ Û¯ÂÙÈÎ¿ ÌÂ ÙÔÓ ÂÎ¿ÛÙÔÙÂ ÎÏ·ÛÈ-Îfi Û˘Óı¤ÙË. ∂Ê·ÚÌÔÁ¤˜ fiˆ˜ ÌÔ˘ÛÈÎfi ÏÂÍÈÎfi,·ÎÚfi·ÛË ÁÈ· ÔÏ‡ ÌÈÎÚ¿ ·È‰È¿, Î·ıÒ˜ Î·È ÏÔ‡ÛÈ··Ú¯Â›· ÌÂ ‚ÈÔÁÚ·ÊÈÎ¿ ÛÙÔÈ¯Â›· ÙˆÓ Û˘ÓıÂÙÒÓ,events Î·È ·È¯Ó›‰È· Â›Ó·È ÌÂÚÈÎ¿ ÌfiÓÔ ·fi Ù· Â-ÚÈÂ¯fiÌÂÓ· ÙÔ˘.

Children’s music - http://www.childrensmusic.org/

∏ ÛÂÏ›‰· ¤¯ÂÈ Û·Ê‹ ‰È·¯ˆÚÈÛÙÈÎ¿ fiÚÈ· ÙË˜ıÂÌ·ÙÔÏÔÁ›·˜ ÙË˜, ÌÂ ÙÔÌÂ›˜ Ô˘ ·Â˘ı‡ÓÔÓÙ·ÈÛÙÔ˘˜ ÁÔÓÂ›˜, ÛÙ· ·È‰È¿, ÛÙÔ˘˜ ‰·ÛÎ¿ÏÔ˘˜, Î·-ıÒ˜ Î·È ·Ú¯Â›Ô ÌÂ ÏËıÒÚ· ÌÔ˘ÛÈÎÒÓ ÂÎÙÂÏÂ-ÛÙÒÓ. ∏ ÈÛÙÔÛÂÏ›‰· ·Ú¤¯ÂÈ ÚfiÛ‚·ÛË Î·È ÛÙ·Children's Music Web Awards 2007, ‚Ú·‚Â›· Ô˘ÂÈÏ¤ÁÔÓÙ·È Î·È ·ÔÓ¤ÌÔÓÙ·È ·ÔÎÏÂÈÛÙÈÎ¿ ·fiÙ· ·È‰È¿. ∞Ó·Ê¤ÚÔÓÙ·È ·ÎfiÌË ‰Ú·ÛÙËÚÈfiÙËÙÂ˜Û¯ÂÙÈÎ¤˜ ÌÂ ÊÈÏ·ÓıÚˆÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜, fiˆ˜ Ë‰ÈÔÚÁ¿ÓˆÛË ÎÔÓÛ¤ÚÙˆÓ ÛÂ ·È‰ÈÎ¿ ÓÔÛÔÎÔÌÂ›·.µ·ÛÈÎ‹ ÂÈ‰›ˆÍË ÙÔ˘ ‰È·‰ÈÎÙ˘·ÎÔ‡ ·˘ÙÔ‡ ¯Ò-ÚÔ˘ Â›Ó·È Ë Ì‡ËÛË ÙˆÓ ·È‰ÈÒÓ ÛÙÔÓ ¯ÒÚÔ ÙÔ˘Ú·‰ÈÔÊÒÓÔ˘, ÛÙÔÓ ÔÔ›Ô ÂÈÛ¤Ú¯ÔÓÙ·È Â‡ÎÔÏ· ÌÂÙËÓ ¤Ó·ÚÍË Ì›·˜ ·Ï‹˜ ÂÊ·ÚÌÔÁ‹˜.


340 ∫§π¡π∫√ ∫√Àπ∑

Paediatriki 2007;70:340,344

1 ∞’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹2 µ’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹°ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ¶ÂÓÙ¤ÏË˜


µ·ÛÈÏÈÎ‹ °ÂˆÚÁÔÔ‡ÏÔ˘[email protected]∞ÈÏÈ·ÓÔ‡ 29∆.∫. 112 54, ∫¿Ùˆ ¶·Ù‹ÛÈ·∞ı‹Ó·

°. ¡ÙÈÔ‡‰Ë˜1, µ. °ÂˆÚÁÔÔ‡ÏÔ˘1, ¡. ª·ÓˆÏ¿ÎË2, ¡. ª˘ÚÈÔÎÂÊ·ÏÈÙ¿ÎË˜1

µÚ¤ÊÔ˜ ı‹Ï˘, ËÏÈÎ›·˜ 3 ÌËÓÒÓ, ·ÚÔ˘Û›·ÛÂ

ÂÈ‰ÂÈÓÔ‡ÌÂÓË ˆ¯ÚfiÙËÙ· Î·È ·ÓÔÚÂÍ›· ·fi

15ËÌ¤ÚÔ˘ Î·È ÌÂÙÂˆÚÈÛÌfi ÎÔÈÏ›·˜ ·fi 7ËÌ¤ÚÔ˘.

∆Ô ·ÙÔÌÈÎfi Î·È ÙÔ ÎÏËÚÔÓÔÌÈÎfi ÈÛÙÔÚÈÎfi ·Ó·Ê¤-

ÚÔÓÙ·È ÂÏÂ‡ıÂÚ·. ∆· ˘ÂÚË¯ÔÁÚ·Ê‹Ì·Ù· ·Ú·-

ÎÔÏÔ‡ıËÛË˜ ÙÔ˘ Î˘‹Ì·ÙÔ˜ ·Ó·Ê¤ÚÔÓÙ·È ¯ˆÚ›˜

·ıÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù·. ∏ ÛˆÌ·ÙÈÎ‹ ·‡ÍËÛË Î·È Ë

„˘¯ÔÎÈÓËÙÈÎ‹ ÂÍ¤ÏÈÍË ÙÔ˘ ‚Ú¤ÊÔ˘˜ ‹Ù·Ó Ê˘ÛÈÔ-

ÏÔÁÈÎ¤˜. ∫·Ù¿ ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈÎ‹ ÂÍ¤Ù·ÛË ‰È·È-

ÛÙÒıËÎÂ ÎÔÈÏÈ·Î‹ Ì¿˙· ÛÎÏËÚ‹˜ Û‡ÛÙ·ÛË˜, Ô˘

Î·Ù·Ï¿Ì‚·ÓÂ ÙÔ ‰ÂÍÈfi ̆ Ô¯fiÓ‰ÚÈÔ Î·È ÂÂÎÙÂÈÓfi-

Ù·Ó ÛÙÔ ÂÈÁ¿ÛÙÚÈÔ. ∞fi Ù· ÏÔÈ¿ Û˘ÛÙ‹Ì·Ù· ‰ÂÓ

ÚÔ¤Î˘„Â Î¿ÙÈ ·ıÔÏÔÁÈÎfi. ∏ ÁÂÓÈÎ‹ ·›Ì·ÙÔ˜ Î·È

Ô ‚ÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ (ÁÏ˘Îfi˙Ë, Ô˘Ú›·, ÎÚÂ·ÙÈÓ›-

ÓË, SGOT, SGPT, ÁGT, ALP, LDH, ËÏÂÎÙÚÔÏ‡ÙÂ˜,

pH) ‰ÂÓ ¤‰ÂÈÍ·Ó ·ıÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù·. ∆Ô ˘Â-

ÚË¯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜ ¤‰ÂÈÍÂ ÌfiÚÊˆÌ· ÂÙÂÚÔÁÂ-

ÓÔ‡˜ Ë¯Ô‰ÔÌ‹˜, ÙÔ˘Ï¿¯ÈÛÙÔÓ 10 cm, ÌÂ ‰È¿Û·Ú-

ÙÂ˜ ÌÈÎÚÔ·ÔÙÈÙ·ÓÒÛÂÈ˜, Ô˘ ·ÚÂÎÙfiÈ˙Â ÙÔÓ

·ÚÈÛÙÂÚfi ÏÔ‚fi ÙÔ˘ ‹·ÙÔ˜, ÙÔÓ ÛÙfiÌ·¯Ô Î·È,

ÚÔ˜ Ù· ›Ûˆ, ÙËÓ Î¿Ùˆ ÎÔ›ÏË ÊÏ¤‚· Î·È ÙËÓ ·ÔÚ-

Ù‹. √ ‰ÂÍÈfi˜ ÏÔ‚fi˜ ÙÔ˘ ‹·ÙÔ˜ ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚÔ˜

Î·Ù¿ 3,5 cm, ÌÂ Ê˘ÛÈÔÏÔÁÈÎ‹ ˘Ê‹, ÂÓÒ Ô ·ÚÈÛÙÂ-

Úfi˜ ‰ÂÓ ‹Ù·Ó ‰˘Ó·ÙfiÓ Ó· ·ÂÈÎÔÓÈÛÙÂ›. ∆· ˘fi-

ÏÔÈ· ÂÓ‰ÔÎÔÈÏÈ·Î¿ fiÚÁ·Ó· ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ¿. √

¤ÏÂÁ¯Ô˜ ËÎÙÈÎfiÙËÙ·˜, Ë ÁÂÓÈÎ‹ Ô‡ÚˆÓ Î·È Ë

·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ¿. √

˘fiÏÔÈÔ˜ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ‰ÂÓ ¤‰ÂÈÍÂ

·ıÔÏÔÁÈÎ¿ ÛÙÔÈ¯Â›· (·-ÂÌ‚Ú˘˚Î‹ ÚˆÙÂ˝ÓË,

ÊÂÚÚÈÙ›ÓË, ¿ÌÂÛÔ˜-¤ÌÌÂÛÔ˜ Coombs, VMA Î·È

HVA Ô‡ÚˆÓ 24ÒÚÔ˘). ∆Ô Ì˘ÂÏfiÁÚ·ÌÌ· ¤‰ÂÈÍÂ ÂÈ-

ÎfiÓ· ·ÓÙ›‰Ú·ÛË˜ Ì˘ÂÏÔ‡ ÛÂ Û˘ÛÙËÌ·ÙÈÎ‹ ‹ ¯Úfi-

ÓÈ· ÓfiÛÔ ÂÍˆÌ˘ÂÏÈÎ‹˜ ÂÓÙfiÈÛË˜. ∆Ô ·È‰› ˘Ô-

‚Ï‹ıËÎÂ ÛÂ CT ÎÔÈÏ›·˜, fiÔ˘ ‰È·ÈÛÙÒıËÎÂ ÂÙÂ-

ÚÔÁÂÓ‹˜ Ì¿˙· ÛÙÔÓ ·ÚÈÛÙÂÚfi ÏÔ‚fi ÙÔ˘ ‹·ÙÔ˜

(ÙÌ‹Ì· ππ), ‰È·ÛÙ¿ÛÂˆÓ 10Ã10,5Ã6 cm, ÌÂ ·ÔÙÈ-

Ù·ÓÒÛÂÈ˜, Û·Ê‹ fiÚÈ·, ¤ÓÙÔÓË ÂÚÈÊÂÚÈÎ‹ Úfi-

ÛÏË„Ë ÛÎÈ·ÁÚ·ÊÈÎÔ‡ Î·È ÎÂÓÙÚÈÎ¤˜ Ù‹ÍÂÈ˜ (∂ÈÎfi-

Ó· 1). ∏ Ì¿˙· ÚÔÎ·ÏÔ‡ÛÂ ÈÂÛÙÈÎ¿ Ê·ÈÓfiÌÂÓ·

ÛÙÔÓ ÛÏ‹Ó· Î·È ÙÔÓ ·ÚÈÛÙÂÚfi ÓÂÊÚfi, ¯ˆÚ›˜ Ó· Ù·

‰ÈËıÂ›. ∆· ˘fiÏÔÈ· fiÚÁ·Ó· ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ¿.

∞ÎÔÏÔ‡ıËÛ·Ó ÂÚÂ˘ÓËÙÈÎ‹ Ï··ÚÔÙÔÌ›·, ‚ÈÔ„›·

‹·ÙÔ˜, ÈÛÙÔÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË Î·È ·ÓÔÛÔ˚ÛÙÔ¯ËÌÈ-

Îfi˜ ¤ÏÂÁ¯Ô˜ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜.

¶Èı·Ó¤˜ ‰È·ÁÓÒÛÂÈ˜:

1. ™ËÚ·ÁÁÒ‰Â˜ ·ÈÌ·ÁÁÂ›ˆÌ·

2. ∏·ÙÔ‚Ï¿ÛÙˆÌ·

3. ªÂÛÂÁ¯˘Ì·ÙÈÎfi ·Ì¿ÚÙˆÌ·

4. ™‡Ó‰ÚÔÌÔ Kasabach-Merritt

5. µÚÂÊÈÎfi Ë·ÙÈÎfi ·ÈÌ·ÁÁÂÈÔÂÓ‰ÔıËÏ›ˆÌ·

(µ∏∞)

∏ ·¿ÓÙËÛË ·ÎÔÏÔ˘ıÂ› ÛÙË ÛÂÏ›‰· 344

∂ÈÎfiÓ· 1. ÀÔÏÔÁÈÛÙÈÎ‹ ÙÔÌÔÁÚ·Ê›· ‡ÛÙÂÚ· ·fi ÂÓ‰ÔÊÏ¤-‚È· ¯ÔÚ‹ÁËÛË ÛÎÈ·ÁÚ·ÊÈÎÔ‡. ∂ÙÂÚÔÁÂÓ‹˜ Ì¿˙· ÛÙÔÓ ·ÚÈ-ÛÙÂÚfi ÏÔ‚fi ÙÔ˘ ‹·ÙÔ˜, ÌÂ ·ÔÙÈÙ·ÓÒÛÂÈ˜ Î·È Û·Ê‹ fiÚÈ·.


341∂¶π™∆√§∂™ ¶ƒ√™ ∆∏ ™À¡∆∞•∏ LETTERS TO THE EDITOR

¶·È‰È·ÙÚÈÎ‹ 2007;70:341-343

¶ÚÔ˜ ÙËÓ ∂ÈÙÚÔ‹ ™‡ÓÙ·ÍË˜ ÙË˜ “¶·È‰È·ÙÚÈÎ‹˜”

™¯ÂÙÈÎ¿ ÌÂ ÙËÓ ÂÈÛ‹ÁËÛË ÙË˜ ∂ÏÏËÓÈÎ‹˜ ¡ÂÔÁÓÔÏÔÁÈÎ‹˜ ∂Ù·ÈÚÂ›·˜ ÁÈ· ¯ÔÚ‹ÁËÛË Synagis ÁÈ·ÚfiÏË„Ë ÓfiÛÔ˘ ·fi ·Ó·ÓÂ˘ÛÙÈÎfi Û˘ÁÎ˘ÙÈ·Îfi Èfi

∞ÍÈfiÙÈÌÂ Î‡ÚÈÂ ¢ÈÂ˘ı˘ÓÙ¿,™Â ÚfiÛÊ·ÙÔ ÙÂ‡¯Ô˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ ‰ËÌÔÛÈÂ‡ıËÎ·Ó Û˘ÛÙ¿ÛÂÈ˜ ÙË˜ ∂ÏÏËÓÈÎ‹˜ ¡ÂÔÁÓÔÏÔÁÈÎ‹˜

∂Ù·ÈÚÂ›·˜ (∂¡∂) (Â› ÚÔÂ‰Ú›·˜ Î. ª. •¿ÓıÔ˘) ÁÈ· ̄ ÔÚ‹ÁËÛË ÙÔ˘ Synagis ÁÈ· ÙËÓ ÚfiÏË„Ë ÙË˜ ÓfiÛÔ˘·fi ÙÔÓ ·Ó·ÓÂ˘ÛÙÈÎfi Û˘ÁÎ˘ÙÈ·Îfi Èfi (RSV) (1). ∆Ô ¿ÚıÚÔ ·˘Ùfi Â›Ó·È Ô˘ÛÈ·ÛÙÈÎ¿ ÌÈ· ·ÎÚÈ‚‹˜ ÌÂÙ¿-ÊÚ·ÛË Û˘ÛÙ¿ÛÂˆÓ Ô˘ ÚÔÙÂ›ÓÔ˘Ó ÂÙ·ÈÚÂ›Â˜ ¿ÏÏˆÓ ÎÚ·ÙÒÓ ÁÈ· ÙÈ˜ ¯ÒÚÂ˜ ÙÔ˘˜. ∞˘Ùfi Â›Ó·È Î·ıfiÏ·ÛÎfiÈÌÔ ·fi ÙË ÛÙÈÁÌ‹ Ô˘ ‰ÂÓ ˘¿Ú¯Ô˘Ó ÌÂÏ¤ÙÂ˜ ÁÈ· ÙÔ ·Ú·¿Óˆ ı¤Ì· ÛÙÔÓ ÂÏÏ·‰ÈÎfi ¯ÒÚÔ.

∆Ô ÌfiÓÔ ÛËÌÂ›Ô Ô˘ ÌÔÚÂ› Ó· ‰È·Ê¤ÚÂÈ ·fi ¯ÒÚ· ÛÂ ¯ÒÚ· Â›Ó·È ÙÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÂÌÊ¿ÓÈÛË˜ÙÔ˘ RSV, fiˆ˜ ·Ó·Ê¤ÚÂÙ·È Î·È ÛÙÔ ¿ÚıÚÔ. ¶ÈÔ Û˘ÁÎÂÎÚÈÌ¤Ó·, ·Ó·Ê¤ÚÂÙ·È fiÙÈ: “ÛÙËÓ ∂ÏÏ¿‰· (Ô RSV)ÂÌÊ·Ó›˙ÂÙ·È Î˘Ú›ˆ˜ ÌÂÙ·Í‡ ¡ÔÂÌ‚Ú›Ô˘ Î·È ª·ÚÙ›Ô˘” (1). ŸÌˆ˜, Ô˘ıÂÓ¿ ÛÙÔ ÎÂ›ÌÂÓÔ ‰ÂÓ ·Ó·Ê¤ÚÂ-Ù·È ÂÏÏËÓÈÎ‹ ÌÂÏ¤ÙË Â›ÙÂ Î¿ÔÈÔ ¿ÏÏÔ ÛÙÔÈ¯Â›Ô ·fi ÙÔ ÔÔ›Ô Ó· ÚÔÎ‡ÙÂÈ ·˘Ùfi ÙÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙË-Ì· ÂÌÊ¿ÓÈÛË˜ ÙÔ˘ RSV ÛÙËÓ ∂ÏÏ¿‰·. ¶·Ú·ı¤Ùˆ ‰‡Ô ÂÈ‰ËÌÈÔÏÔÁÈÎ¿ ‰Â‰ÔÌ¤Ó· ·fi ÙÔÓ ÂÏÏ·‰ÈÎfi ̄ Ò-ÚÔ Ô˘ ‰Â›¯ÓÔ˘Ó fiÙÈ ÙÔ ·Ó·ÊÂÚfiÌÂÓÔ ·fi ÙËÓ ∂¡∂ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· Â›Ó·È ÂÛÊ·ÏÌ¤ÓÔ:

1. ¶·ÓÂÏÏ‹ÓÈ· ÂÈ‰ËÌÈÔÏÔÁÈÎ‹ ÌÂÏ¤ÙË, ‰ËÌÔÛÈÂ˘Ì¤ÓË ÙÔ 2002, Ô˘ ‰ÂÓ ·Ó·Ê¤ÚÂÙ·È ÛÙÔ ¿ÚıÚÔ ÙË˜∂¡∂ ‰Â›¯ÓÂÈ fiÙÈ Ë ÏÔ›ÌˆÍË ·fi RSV Â›Ó·È ÈÔ Û˘¯Ó‹ ÙÔÓ ∞Ú›ÏÈÔ ·fi ÙÔÓ ¡Ô¤Ì‚ÚÈÔ Î·È ÙÔÓ ¢ÂÎ¤Ì-‚ÚÈÔ Î·È ÂÍ›ÛÔ˘ Û˘¯Ó‹ ÌÂ ÙÔÓ π·ÓÔ˘¿ÚÈÔ. ¶ÈÔ Û˘ÁÎÂÎÚÈÌ¤Ó·, ÔÛÔÛÙfi 7,9-11,3% ÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓÛËÌÂÈÒÓÔÓÙ·È ÙÔÓ ∞Ú›ÏÈÔ Î·È 0,3-4,6% ÙÔÓ ª¿ÈÔ (2), ÂÓÒ ÙÔÓ ¡Ô¤Ì‚ÚÈÔ ÛËÌÂÈÒÓÔÓÙ·È 1,9% Î·È ÙÔÓ¢ÂÎ¤Ì‚ÚÈÔ 9,8% (2). ™Ù· ÙÂÏÂ˘Ù·›· 10 ¯ÚfiÓÈ· ÓÔÛËÏÂ‡ıËÎ·Ó ÛÙËÓ ª∂¡¡, fiÔ˘ ÚÔ˝ÛÙ·Ì·È, 47 ‚Ú¤-ÊË ÌÂ ‚ÚÔÁ¯ÈÔÏ›ÙÈ‰· (ÛÙË ÏÂÈÔÓfiÙËÙ· ·fi RSV) Î·È Ë Êı›ÓÔ˘Û· ·ÚÈıÌËÙÈÎ‹ Î·Ù·ÓÔÌ‹ ÙÔ˘˜ ·Ó¿ Ì‹-Ó· ‹Ù·Ó: ∞Ú›ÏÈÔ˜ 12, ºÂ‚ÚÔ˘¿ÚÈÔ˜ 11, ª¿ÚÙÈÔ˜ 8, π·ÓÔ˘¿ÚÈÔ˜ 6, ª¿ÈÔ˜ 5, πÔ‡ÓÈÔ˜ 2 Î·È ·fi ¤Ó· ÙÔ˘˜Ì‹ÓÂ˜ √ÎÙÒ‚ÚÈÔ, ¡Ô¤Ì‚ÚÈÔ Î·È ¢ÂÎ¤Ì‚ÚÈÔ. ¶·ÚfiÙÈ Ô ÌÈÎÚfi˜ ·ÚÈıÌfi˜ ·˘ÙÒÓ ÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ Î·È ËÂÈÏÂÎÙÈÎfiÙËÙ¿ ÙÔ˘˜ ‰ÂÓ ÂÈÙÚ¤Ô˘Ó ÙËÓ ÂÍ·ÁˆÁ‹ ·ÛÊ·ÏÒÓ Û˘ÌÂÚ·ÛÌ¿ÙˆÓ, ÂÓÙÔ‡ÙÔÈ˜ ·Ú¤¯ÂÙ·ÈÌ›· ¤Ó‰ÂÈÍË ÁÈ· ÙÔ˘˜ Ì‹ÓÂ˜ Î·Ù¿ ÙÔ˘˜ ÔÔ›Ô˘˜ ÛËÌÂÈÒÓÔÓÙ·È ‚·ÚÈ¤˜ ÏÔÈÌÒÍÂÈ˜ ·fi RSV Ô˘ ¯Ú‹˙Ô˘ÓÓÔÛËÏÂ›·˜ ÛÙË ª∂¡¡. ŸÏ· Ù· ‚Ú¤ÊË ¯ÚÂÈ¿ÛÙËÎ·Ó ÔÍ˘ÁfiÓÔ Î·È 26 ·fi Ù· 47 ¯ÚÂÈ¿ÛıËÎ·Ó ÌË¯·ÓÈÎ‹˘ÔÛÙ‹ÚÈÍË ÙË˜ ·Ó·ÓÔ‹˜.

∞fi Ù· ·Ú·¿Óˆ Á›ÓÂÙ·È Û·Ê¤˜ fiÙÈ Ë ¯ÚÔÓÈÎ‹ ÂÚ›Ô‰Ô˜ ÂÌÊ¿ÓÈÛË˜ ÙÔ˘ RSV, ÙËÓ ÔÔ›· ·Ó·Ê¤ÚÂÈË ∂¡∂, ‰ÂÓ ÈÛ¯‡ÂÈ ÁÈ· Ù· ÂÈ‰ËÌÈÔÏÔÁÈÎ¿ ‰Â‰ÔÌ¤Ó· ÙË˜ ∂ÏÏ¿‰·˜. ∫·Ù¿ ÙÔ˘˜ Ì‹ÓÂ˜ ∞Ú›ÏÈÔ Î·È ª¿ÈÔÎ·Ù·ÁÚ¿ÊÔÓÙ·È ·ÚÎÂÙ¿ ÂÚÈÛÙ·ÙÈÎ¿, ÂÚÈÛÛfiÙÂÚ· ·fi fi,ÙÈ ÙÔÓ ¡Ô¤Ì‚ÚÈÔ Î·È ÙÔÓ ¢ÂÎ¤Ì‚ÚÈÔ.

√ÚÈÛÌ¤Ó· Ù·ÌÂ›·, ‚·ÛÈ˙fiÌÂÓ· ÛÙËÓ ·ÙÂÎÌËÚ›ˆÙË Ô‰ËÁ›· ÙË˜ ∂¡∂ fiÙÈ Ô RSV ÂÌÊ·Ó›˙ÂÙ·È ÛÙËÓ∂ÏÏ¿‰· Î·Ù¿ ÙÔ˘˜ Ì‹ÓÂ˜ ÌÂÙ·Í‡ ¡ÔÂÌ‚Ú›Ô˘ Î·È ª·ÚÙ›Ô˘, ·ÚÓÔ‡ÓÙ·È Ó· ¯ÔÚËÁ‹ÛÔ˘Ó Synagis ÙÔÓ∞Ú›ÏÈÔ Î·È ÙÔÓ ª¿ÈÔ ÌÂ fi,ÙÈ ·˘Ùfi Û˘ÓÂ¿ÁÂÙ·È ÁÈ· ÙËÓ ˘ÁÂ›· ÓÂÔÁÓÒÓ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘. £· ·Ú·-Î·ÏÔ‡Û· fiÏÔ˘˜ ÙÔ˘˜ ·È‰È¿ÙÚÔ˘˜ Î·È Ù· Ù·ÌÂ›· Ó· Ï¿‚Ô˘Ó ̆ fi„Ë Ù· ÛÙÔÈ¯Â›· ·˘Ù¿. ∂›ÛË˜, ÌÂ ·ÊÔÚ-Ì‹ ÙÔ Úfi‚ÏËÌ· ·˘Ùfi ı· ‹Ù·Ó ÛÎfiÈÌÔ ÔÈ Û˘ÛÙ¿ÛÂÈ˜ ÙˆÓ ∂Ù·ÈÚÂÈÒÓ ÀÔÂÈ‰ÈÎÔÙ‹ÙˆÓ Ó· ‚·Û›˙ÔÓÙ·ÈÛÂ ÙÂÎÌËÚÈˆÌ¤ÓÂ˜ ·fi„ÂÈ˜ ÔÌ¿‰·˜ ÂÈ‰ÈÎÒÓ.

ªÂ ÂÎÙ›ÌËÛË

∞. ∞Ó‰Ú¤Ô˘¢ÈÂ˘ı˘ÓÙ‹˜ ¡ÂÔÁÓÔÏÔÁÈÎÔ‡ ∆Ì‹Ì·ÙÔ˜ ∂™ÀπÔÎÚ¿ÙÂÈÔ °¡£


1. ∂ÏÏËÓÈÎ‹ ¡ÂÔÁÓÔÏÔÁÈÎ‹ ∂Ù·ÈÚÂ›· (EÈÌ¤ÏÂÈ· ™. ¶ÂÙÌÂ˙¿ÎË). ∂ÈÛ‹ÁËÛË ÁÈ· ¯ÔÚ‹ÁËÛË Synagis ÁÈ· ÚfiÏË„Ë ÓfiÛÔ˘·fi ·Ó·ÓÂ˘ÛÙÈÎfi Û˘ÁÎ˘ÙÈ·Îfi Èfi (RSV). ¶·È‰È·ÙÚÈÎ‹ 2006;69:69-71.

2. Constantopoulos AG, Kafetzis DA, Syrogiannopoulos GA, Roilides EJ, Malaka-Zafiriou EE, Sbyrakis SS, et al. Burdenof respiratory syncytial viral infections on pediatric hospitals: a two-year prospective epidemiological study. Eur J ClinMicrobiol Infect Dis 2002;21:102-107.


¶ÚÔ˜ ÙËÓ ∂ÈÙÚÔ‹ ™‡ÓÙ·ÍË˜ ÙË˜ “¶·È‰È·ÙÚÈÎ‹˜”

∞ÍÈfiÙÈÌÂ Î‡ÚÈÂ ¢ÈÂ˘ı˘ÓÙ¿,

™¯ÂÙÈÎ¿ ÌÂ ÙËÓ ÂÈÛÙÔÏ‹ ÙÔ˘ Î˘Ú›Ô˘ ∞Ó‰Ú¤Ô˘, Ô˘ ·Ó·Ê¤ÚÂÙ·È ÛÙÈ˜ Û˘ÛÙ¿ÛÂÈ˜ ÙË˜ ∂ÏÏËÓÈÎ‹˜ ¡Â-ÔÁÓÔÏÔÁÈÎ‹˜ ∂Ù·ÈÚÂ›·˜ (∂¡∂) ÁÈ· ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ Synagis (1), ı· ‹ıÂÏ· Ó· ··ÓÙ‹Ûˆ Ù· ÂÍ‹˜:

1. √ÚıÒ˜ ÙÔÓ›˙ÂÙ·È ÛÙËÓ ÂÈÛÙÔÏ‹ fiÙÈ ÔÈ Û˘ÛÙ¿ÛÂÈ˜ ËÁ¿˙Ô˘Ó ·fi ÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›·, ÁÂÁÔ-Ófi˜ Ô˘ ·Ó·Ê¤ÚÂÙ·È Î·È ÛÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ¿ÚıÚÔ˘. ∫‡ÚÈ· ËÁ‹ ·ÔÙÂÏÔ‡Ó ÔÈ Û˘ÛÙ¿ÛÂÈ˜ ÙË˜ ∞ÌÂÚÈ-Î·ÓÈÎ‹˜ ¶·È‰È·ÙÚÈÎ‹˜ ∂Ù·ÈÚÂ›·˜ (2), ÛÙËÓ ÔÔ›· Î·È ·Ó·Ê¤ÚÔÓÙ·È ÔÈ ÂÚÈÛÛfiÙÂÚÂ˜ ÌÂÏ¤ÙÂ˜ ¿ÏÏˆÓ ̄ ˆ-ÚÒÓ.

2. √ÚıÒ˜ Â›ÛË˜ ·Ó·Ê¤ÚÂÙ·È fiÙÈ Ë ¯ÚÔÓÈÎ‹ ÂÚ›Ô‰Ô˜ Û˘¯ÓfiÙÂÚË˜ Â›ÙˆÛË˜ ÙË˜ ÏÔ›ÌˆÍË˜ ·fi·Ó·ÓÂ˘ÛÙÈÎfi Û˘ÁÎ˘ÙÈ·Îfi Èfi (RSV) ‰È·Ê¤ÚÂÈ ·fi ̄ ÒÚ· ÛÂ ̄ ÒÚ·. ∆Ô ÛÙÔÈ¯Â›Ô ·˘Ùfi ÂÏ‹ÊıË ̆ fi„Ë Î·È¯ˆÚ›˜ ·ÌÊÈ‚ÔÏ›· ÛÙËÓ ∂ÏÏ¿‰· Â›Ó·È ‰È·ÊÔÚÂÙÈÎfi (3), fiˆ˜ ·Ó·Ê¤ÚÂÙ·È Î·È ÛÙÈ˜ Û˘ÛÙ¿ÛÂÈ˜ (1). ∂›-ÛË˜, Ù· ‰Â‰ÔÌ¤Ó· ·˘Ù¿ ·Ó·Ê¤ÚıËÎ·Ó ÂÎÙÂÓÒ˜ ÛÙËÓ ÔÌÈÏ›· ÌÔ˘ ÛÙÔ ™˘ÌfiÛÈÔ ÙÔ˘ 1Ô˘ ™˘ÓÂ‰Ú›Ô˘ ÙË˜∂¡∂ (∞Ú›ÏÈÔ˜ 2006).

3. ªÂÙ¿ ·fi Û˘ÏÏÔÁ‹ ÛÙÔÈ¯Â›ˆÓ ·fi ªÔÓ¿‰Â˜ ∂ÓÙ·ÙÈÎ‹˜ £ÂÚ·Â›·˜ ¡ÂÔÁÓÒÓ ‰È·ÈÛÙÒıËÎÂ fiÙÈÂÚÈÛÙ·ÙÈÎ¿ ÌÂ ‚ÚÔÁ¯ÈÔÏ›ÙÈ‰· ·fi RSV Î·Ù·ÁÚ¿ÊËÎ·Ó Î·È ÙÔÓ ª¿ÈÔ. ∆· Â˘Ú‹Ì·Ù· ·˘Ù¿ ·Ó·ÎÔÈÓÒ-ıËÎ·Ó ÛÙÔ 44Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ (∞Ó·ÙÔÏ›ÙÔ˘ º. Î·È Û˘Ó. Î·È °È·ÓÓ¿ÎË ¶. Î·È Û˘Ó.).

4. ∆Ô Ó¤Ô ¢ÈÔÈÎËÙÈÎfi ™˘Ì‚Ô‡ÏÈÔ ÙË˜ ∂¡∂ ÌÂ Ù· ‰Â‰ÔÌ¤Ó· ·˘Ù¿ ¤Î·ÓÂ ÂÈÛ‹ÁËÛË ÚÔ˜ ÙÔ ÀÔ˘Ú-ÁÂ›Ô ÀÁÂ›·˜ Î·È ∫ÔÈÓˆÓÈÎ‹˜ ∞ÏÏËÏÂÁÁ‡Ë˜, ÌÂ ·ÔÙ¤ÏÂÛÌ· Ó· Á›ÓÂÈ ·Ô‰ÂÎÙ‹ Ë ·Ú¿Ù·ÛË ÙÔ˘ ¯ÚfiÓÔ˘¯ÔÚ‹ÁËÛË˜ ÙÔ˘ Synagis Î·È Î·Ù¿ ÙÔÓ ∞Ú›ÏÈÔ, ÒÛÙÂ Ó· Î·Ï˘ÊıÔ‡Ó Ù· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÓÂÔÁÓ¿ Î·ÈÙÔÓ ª¿ÈÔ.

5. ŒÁÈÓÂ ÂÓËÌ¤ÚˆÛË ÙˆÓ ∆·ÌÂ›ˆÓ Î·È ·Ó·ÁÓÒÚÈÛË ÙÔ˘ ÂÈÏ¤ÔÓ ÎfiÛÙÔ˘˜ ¯ÔÚ‹ÁËÛË˜ ÙÔ˘ SynagisÎ·È ÙÔÓ ∞Ú›ÏÈÔ.

6. Œ¯ÂÈ ÂÙÔÈÌ·ÛıÂ› ÎÂ›ÌÂÓÔ ÌÂ ·Ó¿ÏÔÁÔ ÂÚÈÂ¯fiÌÂÓÔ ÁÈ· Î·Ù·¯ÒÚÈÛË ÛÙËÓ ÈÛÙÔÛÂÏ›‰· ÙË˜ ∂¡∂.7. ∂ÈÛ˘Ó¿ÙÔÓÙ·È ·ÓÙ›ÁÚ·Ê· ÙË˜ ÂÈÛ‹ÁËÛË˜ ÚÔ˜ ÙÔÓ ÀÔ˘ÚÁfi ÀÁÂ›·˜ Î·È ∫ÔÈÓˆÓÈÎ‹˜ ∞ÏÏËÏÂÁ-

Á‡Ë˜ Î·ıÒ˜ Î·È ÙÔ˘ ÎÂÈÌ¤ÓÔ˘ ÁÈ· ÙËÓ Î·Ù·¯ÒÚÈÛË ÛÙËÓ ÈÛÙÔÛÂÏ›‰· ÙË˜ ∂¡∂.∂˘¯·ÚÈÛÙÔ‡ÌÂ ÔÏ‡ ÙÔÓ Î‡ÚÈÔ ∞Ó‰Ú¤Ô˘ ÁÈ· Ù· Û¯fiÏÈ¿ ÙÔ˘ Î·È ÁÈ· ÙËÓ Â˘Î·ÈÚ›· Ô˘ Ì·˜ ÚÔÛ¤ÊÂ-

ÚÂ Ó· ·Ó·ÊÂÚıÔ‡ÌÂ ÛÙÈ˜ ÂÓ¤ÚÁÂÈÂ˜ ÙË˜ ∂¡∂ ÁÈ· ÙÔ ı¤Ì· ·˘Ùfi.

ªÂ ÂÎÙ›ÌËÛË Î·È Û˘Ó·‰ÂÏÊÈÎÔ‡˜ ¯·ÈÚÂÙÈÛÌÔ‡˜,

™ÔÊ›· ¶ÂÙÌÂ˙¿ÎË¶·È‰›·ÙÚÔ˜ ¡ÂÔÁÓÔÏfiÁÔ˜¢ÈÂ˘ı‡ÓÙÚÈ· ª∂¡¡ “ªËÙ¤Ú·”


1. ∂ÏÏËÓÈÎ‹ ¡ÂÔÁÓÔÏÔÁÈÎ‹ ∂Ù·ÈÚÂ›· (EÈÌ¤ÏÂÈ· ™. ¶ÂÙÌÂ˙¿ÎË). ∂ÈÛ‹ÁËÛË ÁÈ· ¯ÔÚ‹ÁËÛË Synagis ÁÈ· ÚfiÏË„ËÓfiÛÔ˘ ·fi ·Ó·ÓÂ˘ÛÙÈÎfi Û˘ÁÎ˘ÙÈ·Îfi Èfi (RSV). ¶·È‰È·ÙÚÈÎ‹ 2006;69:69-71.

2. American Academy of Pediatrics Committee on Infectious Diseases and Committee of Fetus and Newborn.Prevention of respiratory syncytial virus infections: indications for the use of palivizumab and update on the use ofRSV-IGIV. Pediatrics 1998;102:1211-1216.

3. Constantopoulos AG, Kafetzis DA, Syrogiannopoulos GA, Roilides EJ, Malaka-Zafiriou EE, Sbyrakis SS, et al. Bur-den of respiratory syncytial viral infections on pediatric hospitals: a two-year prospective epidemiological study.Eur J Clin Microbiol Infect Dis 2002;21:102-107.

342 ∂¶π™∆√§∂™ ¶ƒ√™ ∆∏ ™À¡∆∞•∏ LETTERS TO THE EDITOR



343∂¶π™∆√§∂™ ¶ƒ√™ ∆∏ ™À¡∆∞•∏ LETTERS TO THE EDITOR

¶·È‰È·ÙÚÈÎ‹ 2007;70:341-343

∞Á·ËÙÔ› Î‡ÚÈÔÈ,

∂›Ì·ÛÙÂ ÛÙËÓ Â˘¯¿ÚÈÛÙË ı¤ÛË Ó· Û·˜ ÂÓËÌÂÚÒÛÔ˘ÌÂ fiÙÈ ÙÔ ∫¤ÓÙÚÔ ¶ÚfiÏË„Ë˜ Î·È ÀÁÂ›·˜ ÙˆÓ∂Ê‹‚ˆÓ (∫∂.¶.À.∂.-“º›ÏÔÈ ∂Ê‹‚ˆÓ”) ÙË˜ ∞ã ¶·È‰È·ÙÚÈÎ‹˜ ∫ÏÈÓÈÎ‹˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ,Û˘ÌÏ‹ÚˆÛÂ ‰‡Ô ¯ÚfiÓÈ· ÂÈÙ˘¯Ô‡˜ ÏÂÈÙÔ˘ÚÁ›·˜. ∏ ·ÓÔ‰ÈÎ‹ ÔÚÂ›· ÙÔ˘ ÚÒÙÔ˘ ∫¤ÓÙÚÔ˘ ÁÈ· ÂÊ‹-‚Ô˘˜ Û˘ÓÂ¯›˙ÂÙ·È, ÌÂÙÚÒÓÙ·˜ Ì¤¯ÚÈ Û‹ÌÂÚ· 600 ÂÊ‹‚Ô˘˜ Î·È ÔÏÏÔ‡˜ ÁÔÓÂ›˜ Ô˘ ¤Ï·‚·Ó ÛËÌ·ÓÙÈ-Î‹ ‚Ô‹ıÂÈ· Î·È ÛÙ‹ÚÈÍË ÛÂ ı¤Ì·Ù· Ô˘ ÙÔ˘˜ ··Û¯ÔÏÔ‡Û·Ó.

∆Ô ∫∂.¶.À.∂. ‰¤¯ÂÙ·È ÂÊ‹‚Ô˘˜ 11-18 ÂÙÒÓ Î·È ÙÈ˜ ÔÈÎÔÁ¤ÓÂÈ¤˜ ÙÔ˘˜, ÛÂ ÒÚÂ˜ Û˘Ì‚·Ù¤˜ ÌÂ ÙÈ˜‰Ú·ÛÙËÚÈfiÙËÙÂ˜ ÙË˜ ÂÊË‚ÈÎ‹˜ ËÏÈÎ›·˜ Î·È ÔÈ ˘ËÚÂÛ›Â˜ Ô˘ ·Ú¤¯ÔÓÙ·È Â›Ó·È:

1. ™˘Ì‚Ô˘ÏÂ˘ÙÈÎ‹ Î·È ÚÔÏËÙÈÎ‹ ·ÁˆÁ‹ ˘ÁÂ›·˜, 2. ¢È·ÁÓˆÛÙÈÎ‹ Î·È ıÂÚ·Â˘ÙÈÎ‹ ‚Ô‹ıÂÈ· ÛÂ ÂÊ‹‚Ô˘˜ ÌÂ ÔÚÁ·ÓÈÎ¿ ‹ „˘¯ÔÏÔÁÈÎ¿ ÚÔ‚Ï‹Ì·Ù·,3. ∂ÓËÌ¤ÚˆÛË ÙˆÓ ÁÔÓ¤ˆÓ ÁÈ· ÙË Û˘ÌÂÚÈÊÔÚ¿ Î·È ÙÈ˜ È‰È·ÈÙÂÚfiÙËÙÂ˜ ÙˆÓ ÂÊ‹‚ˆÓ.√È ·Ó¿ÁÎÂ˜ ÙˆÓ ÂÊ‹‚ˆÓ Î·Ï‡ÙÔÓÙ·È ·fi Ù· ·Ú·Î¿Ùˆ ÂÈ‰ÈÎ¿ ÙÌ‹Ì·Ù· :ñ ∞ÁˆÁ‹˜ ÀÁÂ›·˜ñ ¢È·ÙÚÔÊ‹˜-ÕÛÎËÛË˜ñ ∂Ó‰ÔÎÚÈÓÔÏÔÁ›·˜ñ °˘Ó·ÈÎÔÏÔÁ›·˜ñ ¢ÂÚÌ·ÙÔÏÔÁ›·˜ñ ∞ÏÏÂÚÁÈÔÏÔÁ›·˜ñ ¡Â˘ÚÔÏÔÁ›·˜ñ æ˘¯È·ÙÚÈÎ‹˜ñ æ˘¯ÔÏÔÁÈÎ‹˜ ˘ÔÛÙ‹ÚÈÍË˜ (·ÙÔÌÈÎ‹ ˘ÔÛÙ‹ÚÈÍË ‹ ÔÌ¿‰· ÂÊ‹‚ˆÓ) ÎÏ.¶·Ú¿ÏÏËÏ· ̆ ¿Ú¯ÂÈ Û˘ÓÂÚÁ·Û›· Î·È ÌÂ ¿ÏÏÂ˜ ÂÈ‰ÈÎfiÙËÙÂ˜, ·Ó¿ÏÔÁ· ÌÂ ÙÈ˜ ·Ó¿ÁÎÂ˜ ÙˆÓ ÂÊ‹‚ˆÓ.∏ ÂÊË‚Â›· Â›Ó·È ÌÈ· ËÏÈÎ›· ÌÂ ÔÏÏ¤˜ ‰˘ÛÎÔÏ›Â˜ ÛÙËÓ ·Ó¿Ù˘ÍË ÙˆÓ ‰È·ÚÔÛˆÈÎÒÓ Û¯¤ÛÂˆÓ.

ø˜ ÂÎ ÙÔ‡ÙÔ˘, Ë ÂÈÏÔÁ‹ ÙˆÓ ÂÈ‰ÈÎÒÓ ÙÔ˘ ∫¤ÓÙÚÔ˘ Ì·˜, ÌÂ ÎÚÈÙ‹ÚÈÔ ÙËÓ Î·Ù¿ÏÏËÏË ÁÓÒÛË Î·ÈÂÌÂÈÚ›· Î·ıÒ˜ Î·È Ë Ù‹ÚËÛË ·fiÏ˘ÙË˜ Â¯ÂÌ‡ıÂÈ·˜ ·fi ÏÂ˘Ú¿˜ ÙÔ˘˜, ‚ÔËı¿ÂÈ ÛÙËÓ ÂÏ¿ÙÙˆÛËÙˆÓ ‰˘ÛÎÔÏÈÒÓ ÙË˜ ÂÈÎÔÈÓˆÓ›·˜ È·ÙÚÔ‡-ÂÊ‹‚Ô˘.

™ÙÔ ∫∂.¶.À.∂. Î·Ù¿ ÙËÓ ÚÒÙË Â›ÛÎÂ„Ë ÙÔ˘ ÂÊ‹‚Ô˘ Ú·ÁÌ·ÙÔÔÈÂ›Ù·È Ô ‚·ÛÈÎfi˜ ÔÚÁ·ÓÈÎfi˜¤ÏÂÁ¯Ô˜ Î·ıÒ˜ Î·È Û˘˙‹ÙËÛË Ô˘ ·ÊÔÚ¿ ÛÙËÓ „˘¯ÔÎÔÈÓˆÓÈÎ‹ ÙÔ˘ ·Ó¿Ù˘ÍË Î·È Û˘ÌÂÚÈÊÔÚ¿,ÚÔÛÊ¤ÚÔÓÙ¿˜ ÙÔ˘ ¤ÙÛÈ Ù· Î·Ù¿ÏÏËÏ· ÂÊfi‰È· ÁÈ· ÛˆÛÙ¤˜ ÂÈÏÔÁ¤˜ Î·È ·ÔÊ¿ÛÂÈ˜ Ô˘ ı· Î·ıÔÚ›-ÛÔ˘Ó ÙËÓ ÔÚÂ›· ÙÔ˘ ÚÔ˜ ÙËÓ ÂÓËÏÈÎ›ˆÛË.

°È· ÏËÚÔÊÔÚ›Â˜ Î·È Ú·ÓÙÂ‚Ô‡ ÔÈ ¤ÊË‚ÔÈ ‹ Î·È ÔÈ ÔÈÎÔÁ¤ÓÂÈ¤˜ ÙÔ˘˜ ÌÔÚÔ‡Ó Ó· Î·ÏÔ‡Ó ÛÙÔ 210746 74 54 Î·ıËÌÂÚÈÓ¿ 10.00-14.30 ‹ ÛÙÔ 210 746 74 52 15.00-17.00.

ªÂ ÙÈÌ‹,

√ ¢ÈÂ˘ı˘ÓÙ‹˜ ∏ ∂ÈÛÙËÌÔÓÈÎ‹ ÀÂ‡ı˘ÓË°ÂÒÚÁÈÔ˜ ¶. ÃÚÔ‡ÛÔ˜ ∫·Ú¿ÓÙ˙· ª·Ú›·∫·ıËÁËÙ‹˜-¢ÈÂ˘ı˘ÓÙ‹˜ ¶·È‰›·ÙÚÔ˜-∂Ó‰ÔÎÚÈÓÔÏfiÁÔ˜∞ã ¶·È‰È·ÙÚÈÎ‹˜ ∫ÏÈÓÈÎ‹˜¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ


344 CLINICAL QUIZ

Paediatriki 2007;70:340,344

∫ÏÈÓÈÎfi QUIZ

∞¶∞¡∆∏™∏

∏ ‰È¿ÁÓˆÛË ‹Ù·Ó ‚ÚÂÊÈÎfi Ë·ÙÈÎfi ·ÈÌ·ÁÁÂÈÔ-ÂÓ‰ÔıËÏ›ˆÌ· (µ∏∞). √È Ë·ÙÈÎÔ› fiÁÎÔÈ ÛÙ· ·È-‰È¿ Â›Ó·È Û¿ÓÈÔÈ (2-3% ÙˆÓ fiÁÎˆÓ) (1). ∆Ô µ∏∞Â›Ó·È Ô ÙÚ›ÙÔ˜ ÈÔ Û˘¯Ófi˜ fiÁÎÔ˜ ‹·ÙÔ˜ ÛÙ· ·È-‰È¿ (12%) Î·È Ô ÈÔ Û˘¯Ófi˜ Î·ÏÔ‹ıË˜ ·ÁÁÂÈ·Îfi˜fiÁÎÔ˜ ‹·ÙÔ˜ ÛÙ· ‚Ú¤ÊË, Ô ÔÔ›Ô˜ fiÌˆ˜ ÌÔÚÂ›Ó· ÂÍ·ÏÏ·ÁÂ› ÛÂ Û¿ÚÎˆÌ· (2,3). √È ÂÚÈÛÛfiÙÂÚÔÈfiÁÎÔÈ ·˘Í¿ÓÔ˘Ó ÛÂ Ì¤ÁÂıÔ˜ Î·Ù¿ ÙÔ ÚÒÙÔ ¤ÙÔ˜ÙË˜ ˙ˆ‹˜ Î·È Û˘Ó‹ıˆ˜ ˘ÔÛÙÚ¤ÊÔ˘Ó Ì¤¯ÚÈ ÙÔ‰Â‡ÙÂÚÔ (3,4).

∏ ‚Ï¿‚Ë ÌÔÚÂ› Ó· Â›Ó·È ÌÔÓ‹ÚË˜ ‹ ÔÏ˘Â-ÛÙÈ·Î‹ (5). √ ÌÔÓ‹ÚË˜ fiÁÎÔ˜ Â›Ó·È Û·ÊÒ˜ ÂÚÈÁÂ-ÁÚ·ÌÌ¤ÓÔ˜, ¯ˆÚ›˜ Î¿„·, ÌÂ ‰È¿ÌÂÙÚÔ 0,2 ¤ˆ˜ 15cm (6). Œ¯Ô˘Ó ·Ó·ÁÓˆÚÈÛÙÂ› ‰‡Ô Ù‡ÔÈ µ∏∞. ™ÙÔÓÙ‡Ô π, ÙÔ ÌfiÚÊˆÌ· ·ÚÔ˘ÛÈ¿˙ÂÈ Û˘¯Ó¿ ·ÔÙÈÙ·-ÓÒÛÂÈ˜, ÌÂ ÔÏÏ·Ï¿ ÌÈÎÚ¿ ·ÁÁÂ›· ÌÂ ·ÓÒÚÈÌ· ÂÓ-‰ÔıËÏÈ·Î¿ Î‡ÙÙ·Ú· Î·È Û¯ÈÛÌÔÂÈ‰Â›˜ ¯ÒÚÔ˘˜,ÛÙÔ˘˜ ÔÔ›Ô˘˜ ÂÁÎÏˆ‚›˙ÔÓÙ·È ¯ÔÏËÊfiÚ· ·ÁÁÂ›·.™ÙÔÓ Ù‡Ô ππ, Ù· ÂÓ‰ÔıËÏÈ·Î¿ Î‡ÙÙ·Ú· ÙˆÓ ·ÁÁÂ›-ˆÓ ÙÔ˘ ÌÔÚÊÒÌ·ÙÔ˜ ÂÌÊ·Ó›˙ÔÓÙ·È ÂÚÈÛÛfiÙÂÚÔ·‰È·ÊÔÚÔÔ›ËÙ·, ¯ˆÚ›˜ ÛÙÚÒÌ· ¯ÔÏËÊfiÚˆÓ ·Á-ÁÂ›ˆÓ (7,8). ∆Ô µ∏∞ ÙÔ˘ Û˘ÁÎÂÎÚÈÌ¤ÓÔ˘ ·È‰ÈÔ‡‹Ù·Ó Ù‡Ô˘ π.

√ fiÁÎÔ˜ ÌÔÚÂ› Ó· Â›Ó·È ·Û˘ÌÙˆÌ·ÙÈÎfi˜, Û˘-¯Ó¿ fiÌˆ˜ ÚÔ‚¿ÏÏÂÈ ÌÂ Ë·ÙÔÌÂÁ·Ï›·, ÌÂÙÂˆÚÈ-ÛÌfi ÎÔÈÏ›·˜ ‹ „ËÏ·ÊËÙ‹ Ì¿˙·. ªÔÚÂ› Ó· ˘¿Ú-¯Ô˘Ó ÂÎÙÂÙ·Ì¤ÓÂ˜ ·ÚÙËÚÈÔÊÏÂ‚Ò‰ÂÈ˜ ÂÈÎÔÈÓˆ-Ó›Â˜, ÔÈ ÔÔ›Â˜ ÚÔÎ·ÏÔ‡Ó ·˘ÍËÌ¤ÓÂ˜ ÂÚÈÊÂÚÈ-Î¤˜ ·ÓÙÈÛÙ¿ÛÂÈ˜ Î·È Û˘ÌÊÔÚËÙÈÎ‹ Î·Ú‰È·Î‹ ·ÓÂ-¿ÚÎÂÈ· ÌÂ ˘„ËÏ‹ ·ÚÔ¯‹, ÌÈÎÚÔ·ÁÁÂÈÔ·ıËÙÈÎ‹·ÈÌÔÏ˘ÙÈÎ‹ ·Ó·ÈÌ›· Î·È ıÚÔÌ‚ÔÎ˘ÙÙ·ÚÔÂÓ›·, Ïfi-Áˆ Î·Ù·ÛÙÚÔÊ‹˜ ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ ÂÓÙfi˜ ÙÔ˘fiÁÎÔ˘. ™ÙÔ 50% ÙˆÓ ÂÚÈÙÒÛÂˆÓ Û˘Ó˘¿Ú¯ÂÈÂÈ‰ÂÚÌÈ‰ÈÎfi ·ÈÌ·ÁÁÂ›ˆÌ·. ªÔÚÂ› Ó· Û˘Ó˘¿Ú-¯Ô˘Ó ›ÎÙÂÚÔ˜, ÛÙ·ÛÈÌfiÙËÙ· ‚¿ÚÔ˘˜, ÂÓÙÂÚÈÎ‹·fiÊÚ·ÍË, ·Ó·ÓÂ˘ÛÙÈÎ‹ ‰˘Û¯¤ÚÂÈ·, ·ÈÌÔÂÚÈ-ÙfiÓ·ÈÔ Î·È shock, ÏfiÁˆ Ú‹ÍË˜ ÙÔ˘ fiÁÎÔ˘ (5,8,9).

∏ ‰È¿ÁÓˆÛË ‚·Û›˙ÂÙ·È ÛÙ· Â˘Ú‹Ì·Ù· ÙÔ˘·ÂÈÎÔÓÈÛÙÈÎÔ‡ ÂÏ¤Á¯Ô˘ Î·È ÛÙËÓ ÈÛÙÔÏÔÁÈÎ‹ÂÍ¤Ù·ÛË. ™Â ÂÚÈÙÒÛÂÈ˜ µ∏∞ ÌÂ ·ÚÙËÚÈÔÊÏÂ-‚Ò‰ÂÈ˜ ÂÈÎÔÈÓˆÓ›Â˜, Ù· ‰È·ÙÂÙ·Ì¤Ó· ·ÁÁÂ›· ÌÂ·˘ÍËÌ¤ÓË ÚÔ‹ ·›Ì·ÙÔ˜ ‰›ÓÔ˘Ó Ù˘ÈÎ‹ ÂÈÎfiÓ·ÛÙÔ Doppler. ªÂ ÙËÓ CT Î·È ÙËÓ MRI ÎÔÈÏ›·˜Î·ıÔÚ›˙ÔÓÙ·È Ù· ·ÎÚÈ‚‹ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙË˜ Ì¿-˙·˜, ÙÔ Ì¤ÁÂıÔ˜, Ë ÔÌÔÈÔÁ¤ÓÂÈ· ‹ Ë ÂÙÂÚÔÁ¤ÓÂÈ··˘Ù‹˜, Ë ‡·ÚÍË ·ÈÌÔÚÚ·ÁÈÒÓ, ÓÂÎÚÒÛÂˆÓ, ÈÓÒ-ÛÂˆÓ ‹ ·ÔÙÈÙ·ÓÒÛÂˆÓ Î·È Ë ‰È‹ıËÛË ‹ Ë ·ÚÂ-ÎÙfiÈÛË ·Ú·ÎÂ›ÌÂÓˆÓ ÔÚÁ¿ÓˆÓ (4,5).

¢È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË ı· Á›ÓÂÈ ·fi ÙÔ ÛËÚ·Á-ÁÒ‰Â˜ ·ÈÌ·ÁÁÂ›ˆÌ·, ÙÔ Ë·ÙÔ‚Ï¿ÛÙˆÌ· Î·È ÙÔÌÂÛÂÁ¯˘Ì·ÙÈÎfi ·Ì¿ÚÙˆÌ·. ∆Ô ÚÒÙÔ ··ÓÙ¿Ù·È

ÛÂ ÌÂÁ·Ï‡ÙÂÚË ËÏÈÎ›· Î·È ÛÙÔ ÛÒÌ· Û˘Ó˘¿Ú¯Ô˘Ó

Î·È ¿ÏÏ· ·ÈÌ·ÁÁÂÈÒÌ·Ù·, ÂÓÒ ÙÔ ‰Â‡ÙÂÚÔ Â›Ó·È Î·-

ÎÔ‹ıË˜ fiÁÎÔ˜, Ô˘ ··ÓÙ¿Ù·È ÛÂ ËÏÈÎ›· ÌÈÎÚfiÙÂ-

ÚË ÙˆÓ 5 ÂÙÒÓ. ∆¤ÏÔ˜, ÙÔ ÌÂÛÂÁ¯˘Ì·ÙÈÎfi ·Ì¿ÚÙˆ-

Ì· Â›Ó·È Î˘ÛÙÈÎ‹˜ ˘Ê‹˜ Î·È ÚÔ‚¿ÏÏÂÈ ÌÂ ˘ÚÂÙfi,

ÌÂÙÂˆÚÈÛÌfi, ÂÌ¤ÙÔ˘˜ Î·È ‰˘ÛÎÔÈÏÈfiÙËÙ· (4).

™Â ·È‰È¿ ÌÂ ·Û˘ÌÙˆÌ·ÙÈÎfi µ∏∞ ‰ÂÓ ··È-

ÙÂ›Ù·È ıÂÚ·Â›·, ÂÓÒ, fiÙ·Ó ˘¿Ú¯Ô˘Ó Û˘ÌÙÒÌ·-

Ù·, Ë ·ÓÙÈÌÂÙÒÈÛË ÂÚÈÏ·Ì‚¿ÓÂÈ ÙË ¯ÔÚ‹ÁËÛË

ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰ÒÓ Î·È ·-ÈÓÙÂÚÊÂÚfiÓË˜. ™Â ·ÛıÂ-

ÓÂ›˜ ÛÙÔ˘˜ ÔÔ›Ô˘˜ ·ÔÙ˘Á¯¿ÓÂÈ Ë Û˘ÓÙËÚËÙÈÎ‹

·ÁˆÁ‹, ÚÔÙÂ›ÓÂÙ·È ÂÌ‚ÔÏÈÛÌfi˜ ‹ ·ÔÏ›ÓˆÛË ÙË˜

Ë·ÙÈÎ‹˜ ·ÚÙËÚ›·˜. √È ÌÔÓ‹ÚÂÈ˜ Û˘ÌÙˆÌ·ÙÈÎÔ›

fiÁÎÔÈ ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È ÌÂ ¯ÂÈÚÔ˘ÚÁÈÎ‹ ÂÍ·›ÚÂÛË,

fiˆ˜ ¤ÁÈÓÂ ÛÙÔ ‚Ú¤ÊÔ˜ Ô˘ ÂÚÈÁÚ¿„·ÌÂ, ÛÂ ÂÈ‰È-

Îfi Î¤ÓÙÚÔ ÙÔ˘ ÂÍˆÙÂÚÈÎÔ‡. ™ÙËÓ ÂÚ›ÙˆÛË Ô˘

ÔÈ ˘fiÏÔÈÂ˜ Ì¤ıÔ‰ÔÈ ·ÔÙ‡¯Ô˘Ó, Û˘ÓÈÛÙ¿Ù·È Ë

ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜ (5,9).


1. Parker BR. The hepatobiliary system. In: Silverman

FN, Kuhn JP, eds. Caffey’s pediatric x-ray diagnosis:

an integrating imaging approach. 9th ed. St. Louis,

Mo: Mosby; 1993. 915-969.

2. Mortelé KJ, Vanzieleghem B, Mortelé B, Benoit Y,

Ros PR. Solitary hepatic infantile hemangioendothe-

lioma: dynamic gadolinium-enhanced MR imaging

findings. Eur Radiol 2002;12:862-865.

3. Sty JR, Wells RG, Starshak RJ, Gregg DC. The hepa-

tobiliary system. In: Sty JR, Wells RG, Starshak RJ,

Gregg DC (eds). Diagnostic imaging of infants and

children. Gaithersburg, Md: Aspen Publishers;1992.

247-293.

4. Rajendran VR, Manoj B. Giant infantile heman-

gioendothelioma liver in a two month old baby with

a normal identical twin- a case report. Calicut Med J

2004;2:E6.

5. Konus √L, Ozdemir H, Onal B, Isik S. Infantile he-

patic hemangioendothelioma: findings in the liver

with spectral and color Doppler Sonography. Gazi

Med J 1999;10:156-160.

6. Horton KM, Bluemke DA, Hruban RH, Soyer P,

Fishman EK. CT and MR imaging of benign hepatic

and biliary tumors. Radiographics 1999;19:431-451.

7. Dehner LP, Ishak KG. Vascular tumors of the liver in

infants and children. A study of 30 cases and review

of the literature. Arch Pathol 1971;92:101-111.

8. Zenge JP, Fenton L, Lovell MA, Grover TR. Case re-

port: infantile hemangioendothelioma. Curr Opin

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xiii¶ƒ√™∂Ã∏ ™À¡∂¢ƒπ∞

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21 - 23 ™ÂÙÂÌ‚Ú›Ô˘ 2007 ™ÂÌÈÓ¿ÚÈÔ ∂ÍÂÈ‰ÈÎÂ˘Ì¤ÓË˜ ÀÔÛÙ‹ÚÈÍË˜ ÙË˜ ∑ˆ‹˜ ∏Ú¿ÎÏÂÈÔ,

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∆Ì‹Ì· π·ÙÚÈÎ‹˜, ¶·ÓÂÈÛÙ‹ÌÈÔ ∫Ú‹ÙË˜¶ÏËÚÔÊÔÚ›Â˜: ª.∂.£.¶. ¶·.°.¡.∏.∆ËÏ.: 2810 392447Fax: 2810 392652∂-mail: [email protected]

21-23 ™ÂÙÂÌ‚Ú›Ô˘ 2007 2Ë ∂ÈÛÙËÌÔÓÈÎ‹ ™˘Ó¿ÓÙËÛË ∂ÏÏËÓÈÎ‹˜ ™Î·ÊÈ‰È¿

∞Î·‰ËÌ›·˜ ¶·È‰È·ÙÚÈÎ‹˜ ∏ÏÂ›·˜

Aldemar Olympian Village Resort ¶ÏËÚÔÊÔÚ›Â˜: FIRSTEVENT ∆ËÏ.: 210 8228950Fax: 210 8228901E-mail: [email protected]

21-23 ™ÂÙÂÌ‚Ú›Ô˘ 2007 3rd ESH-EHA Conference on Focus on Paediatric Sestri Levante,

Haematology and Oncology Italy

Contact: Conference Secretariat: European School of Haematology (ESH), Centre Hayem, Hôpital Saint-Louis, 1, av. Claude Vellefaux Cedex 10, 75475 ParisTel.: 33 142 066 540Fax: 33 142 060 587E-mail: [email protected]

26-29 ™ÂÙÂÌ‚Ú›Ô˘ 2007 The 7th Congress of the European Pediatric Kuçadasi,

Neurology Society Turkey

Contact: Flap TourTel.: 90-3-124-540-000Fax: 90-3-124-540-001E-mail: [email protected]: www.epns2007.org

18-22 √ÎÙˆ‚Ú›Ô˘ 2007 19th International Congress of Pediatrics Tehran, Iran

Contact: Dr GhR Walizadeh, Dr A HabibolahiTel.: 982 166 428 998Fax: 982 166 923 054E-mail: [email protected]


Παιδιατρική | Τόμος 70 • Τεύχος 4 • Ιούλιος - Αύγουστος...

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