• Home

  • Documents

  • Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004
85
ISSN 0377-2551 Greek Paediatric Society ∞¡∞™∫O¶∏™∂π™ OÈ ‰˘ÛÏÈȉ·È̛˜ ÛÙ· ·È‰È¿ Î·È Ë ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘˜ ∞. ∆ÂÚÙ›Ë, µ. ¶¤ÙÚÔ˘, Ã. £ÂÔ‰ˆÚ›‰Ë˜ ∂ȉڿÛÂȘ Ê·Ú̿ΈÓ, ·ÏÎÔfiÏ˘ Î·È Î·Ó›ÛÌ·ÙÔ˜ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÁ΢ÌÔÛ‡Ó˘ ÛÙÔ ¤Ì‚Ú˘Ô Î·È ÙÔ ÓÂÔÁÓfi °. ª·ÚÔ‡Ù˘, ª. ¢·ÛÔÔ‡ÏÔ˘ ∏ ÎÂÊ·Ï·ÏÁ›· Û·Ó Û‡Ìو̷ ÛÙË ÁÂÓÈ΋ ·È‰È·ÙÚÈ΋ ∂. ª·˙›ÁÔ˘-ºˆÙÔÔ‡ÏÔ˘ µƒ∞µ∂Àª∂¡∏ ∂ƒ°∞™π∞ O ·ÓıÚÒÈÓÔ˜ ÌÂÙ·Ó¢ÌÔÓÔ˚fi˜ ˆ˜ ·›ÙÈÔ ÔÍ›·˜ ‚ÚÔÁ¯ÈÔÏ›Ùȉ·˜ ÛÙË ‚ÚÂÊÈ΋ ËÏÈΛ· ¶. •Â··‰¿ÎË, ™. æ·ÚÚ¿˜, ∞. ªfiÛÈÔ˜, ª. ∆ÛÔÏÈ¿, ¢. ∫·ÊÂÙ˙‹˜, ¡. °. ¶··‰fiÔ˘ÏÔ˜ ∂ƒ∂À¡∏∆π∫∂™ ∂ƒ°∞™π∂™ ∏ Û¯¤ÛË Ù˘ ‰È·ÙÚÔÊ‹˜ Ì ·Ó·Ù˘ÍȷΤ˜ Î·È ÂÎ·È‰Â˘ÙÈΤ˜ ‰ÂÍÈfiÙËÙ˜ ·È‰ÈÒÓ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ ∂. ∫·Ú·ÎˆÓÛÙ·ÓÙ¿ÎË, ∞. ∫·Ê¿ÙÔ˜, ª. §ÈÓ·Ú‰¿Î˘, ™. ªÈ¯ÂÏÔÁÈ¿ÓÓ˘ ªÈÎÚ¿ ·È‰È¿… ÌÂÁ¿ÏÔ˜ ·‰ÂÏÊfi˜ ∫. ∆˙È¿ÚÔ˘, ª. ∆·‚Ï·ÓÙ¿, Ã. •˘ÔÏÈ¿, ¶. ∆·‚Ï·ÓÙ¿˜ µ·ıÌfi˜ ÁÓÒÛ˘ ÙˆÓ ÂȤ‰ˆÓ ÏÈȉ›ˆÓ ÙÔ˘ ·›Ì·ÙÔ˜ Û ÊÔÈÙËÙ¤˜ ·ÁÁÂÏÌ¿ÙˆÓ ˘Á›·˜-ÚfiÓÔÈ·˜ ™. ∞ÓÙˆÓÈ¿‰Ë˜, ™. ∫˘ÚÈ·ÎÔÔ‡ÏÔ˘, µ. ∞ÚÁ˘ÚÔÔ‡ÏÔ˘, •. ∫Ú›ÎÔ˜ REVIEW ARTICLES Dyslipidaemias in children and their management A. Tertipi, V. Petrou, H. Theodoridis Prenatal drug effects on the foetus and the newborn infant G. Baroutis, M. Dasopoulou Headache as a symptom in the practice of the general paediatrics H. Bazigou-Fotopoulou AWARD-WINNING ARTICLE Human metapneumovirus as a cause of acute bronchiolitis in infancy P. Xepapadaki, S. Psarras, A. Bossios, M. Tsolia, D. Kafetzis, N. G. Papadopoulos ORIGINAL ARTICLES The association of nutrition with developmental and educational abilities of school age children H. Karakonstantaki, A. Kafatos, M. Linardakis, S. Michelogiannis Young children… Big Brother K. Tziarou, M. Tavlanta, C. Xypolia, P. Tavlantas Levels of knowledge of blood lipids levels in health students S. Antoniadis, S. Kyriakopoulou, V. Argyropoulou, X. Krikos 151 160 168 173 178 190 195 May - June 2004 ñ Volume 67 ñ No 3 ¶AI¢IATPIKH ● TOMO™ 67 ● TEYXO™ 3 ● ETO™ 2004 ª¿ÈÔ˜ - πÔ‡ÓÈÔ˜ 2004 ñ ∆fiÌÔ˜ 67 ñ ∆‡¯Ô˜ 3 Continuation of table of contents inside title page ∏ Û˘Ó¤¯ÂÈ· ÙˆÓ ÂÚȯÔÌ¤ÓˆÓ ÛÙËÓ ÚÒÙË ÂÛˆÙÂÚÈ΋ ÛÂÏ›‰·

Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

Embed Size (px)

DESCRIPTION

Τριμηνιαία έκδοση της Ελληνικής Παιδιατρικής Εταιρείας

Citation preview

Page 1: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

ISSN 0377-2551

Greek Paediatric Society

∞¡∞™∫O¶∏™∂π™OÈ ‰˘ÛÏÈȉ·È̛˜ ÛÙ· ·È‰È¿ Î·È Ë ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘˜∞. ∆ÂÚÙ›Ë, µ. ¶¤ÙÚÔ˘, Ã. £ÂÔ‰ˆÚ›‰Ë˜

∂ȉڿÛÂȘ Ê·Ú̿ΈÓ, ·ÏÎÔfiÏ˘ Î·È Î·Ó›ÛÌ·ÙÔ˜ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÁ΢ÌÔÛ‡Ó˘ ÛÙÔ ¤Ì‚Ú˘Ô Î·È ÙÔ ÓÂÔÁÓfi°. ª·ÚÔ‡Ù˘, ª. ¢·ÛÔÔ‡ÏÔ˘

∏ ÎÂÊ·Ï·ÏÁ›· Û·Ó Û‡Ìو̷ ÛÙË ÁÂÓÈ΋ ·È‰È·ÙÚÈ΋∂. ª·˙›ÁÔ˘-ºˆÙÔÔ‡ÏÔ˘

µƒ∞µ∂Àª∂¡∏ ∂ƒ°∞™π∞O ·ÓıÚÒÈÓÔ˜ ÌÂÙ·Ó¢ÌÔÓÔ˚fi˜ ˆ˜ ·›ÙÈÔÔÍ›·˜ ‚ÚÔÁ¯ÈÔÏ›Ùȉ·˜ ÛÙË ‚ÚÂÊÈ΋ ËÏÈΛ·¶. •Â··‰¿ÎË, ™. æ·ÚÚ¿˜, ∞. ªfiÛÈÔ˜, ª. ∆ÛÔÏÈ¿, ¢. ∫·ÊÂÙ˙‹˜, ¡. °. ¶··‰fiÔ˘ÏÔ˜

∂ƒ∂À¡∏∆π∫∂™ ∂ƒ°∞™π∂™∏ Û¯¤ÛË Ù˘ ‰È·ÙÚÔÊ‹˜ Ì ·Ó·Ù˘ÍȷΤ˜ Î·È ÂÎ·È‰Â˘ÙÈΤ˜ ‰ÂÍÈfiÙËÙ˜ ·È‰ÈÒÓ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜∂. ∫·Ú·ÎˆÓÛÙ·ÓÙ¿ÎË, ∞. ∫·Ê¿ÙÔ˜, ª. §ÈÓ·Ú‰¿Î˘, ™. ªÈ¯ÂÏÔÁÈ¿ÓÓ˘

ªÈÎÚ¿ ·È‰È¿… ÌÂÁ¿ÏÔ˜ ·‰ÂÏÊfi˜∫. ∆˙È¿ÚÔ˘, ª. ∆·‚Ï·ÓÙ¿, Ã. •˘ÔÏÈ¿, ¶. ∆·‚Ï·ÓÙ¿˜

µ·ıÌfi˜ ÁÓÒÛ˘ ÙˆÓ ÂȤ‰ˆÓ ÏÈȉ›ˆÓ ÙÔ˘ ·›Ì·ÙÔ˜ Û ÊÔÈÙËÙ¤˜ ·ÁÁÂÏÌ¿ÙˆÓ ˘Á›·˜-ÚfiÓÔÈ·˜™. ∞ÓÙˆÓÈ¿‰Ë˜, ™. ∫˘ÚÈ·ÎÔÔ‡ÏÔ˘, µ. ∞ÚÁ˘ÚÔÔ‡ÏÔ˘, •. ∫Ú›ÎÔ˜

REVIEW ARTICLESDyslipidaemias in children and their managementA. Tertipi, V. Petrou, H. Theodoridis

Prenatal drug effects on the foetus and the newborn infantG. Baroutis, M. Dasopoulou

Headache as a symptom in the practice of the general paediatricsH. Bazigou-Fotopoulou

AWARD-WINNING ARTICLEHuman metapneumovirus as a cause of acute bronchiolitis in infancyP. Xepapadaki, S. Psarras, A. Bossios, M. Tsolia, D. Kafetzis, N. G. Papadopoulos

ORIGINAL ARTICLESThe association of nutrition withdevelopmental and educational abilities of school age childrenH. Karakonstantaki, A. Kafatos, M. Linardakis, S. Michelogiannis

Young children… Big Brother K. Tziarou, M. Tavlanta, C. Xypolia, P. Tavlantas

Levels of knowledge of blood lipids levels in health students S. Antoniadis, S. Kyriakopoulou, V. Argyropoulou, X. Krikos

151

160

168

173

178

190

195

MMaayy -- JJuunnee 22000044 ññ VVoolluummee 6677 ññ NNoo 33

¶A

I¢

IA

TP

IK

H

●T

OM

O™

6

7●

TE

YX

O™

3

●E

TO

™

20

04

ªª¿¿ÈÈÔÔ˜̃ -- ππÔÔ‡‡ÓÓÈÈÔÔ˜̃ 22000044 ññ ∆∆fifiÌÌÔÔ˜̃ 6677 ññ ∆∆‡‡¯̄ÔÔ˜̃ 33

Continuation of table of contents inside title page

∏ Û˘Ó¤¯ÂÈ· ÙˆÓ ÂÚȯÔÌ¤ÓˆÓ ÛÙËÓ ÚÒÙËÂÛˆÙÂÚÈ΋ ÛÂÏ›‰·

COVER May-June 04 19-07-04 18:10 ™ÂÏ›‰·1

Page 2: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

Hellenic Paediatric Society

Greek Paediatric Society

MM¿¿ÈÈÔÔ˜̃ -- IIÔÔ‡‡ÓÓÈÈÔÔ˜̃ 22000044 ññ ∆∆fifiÌÌÔÔ˜̃ 6677 ññ ∆∆‡‡¯̄ÔÔ˜̃ 33

Hellenic Paediatric Society

Greek Paediatric Societyªªaayy -- JJuunnee 22000044 ññ VVoolluummee 6677 ññ NNoo 33

EN¢π∞º∂ƒOÀ™∂™ ¶∂ƒπ¶∆ø™∂π™∫ÏËÚÔÓÔÌÈ΋ ·ÈÌÔÚÚ·ÁÈ΋ ÙËÏ·ÁÁÂÈÂÎÙ·Û›·(Û‡Ó‰ÚÔÌÔ Rendu-Osler-Weber). ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ Î·È ·Ó·ÛÎfiËÛË Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜™. ª¿Ú·Î·, ∂. ™·Úȉ¿Î˘, µ. ∞ÁÁÂÏ¿ÎÔ˘, ™. ª¿ÎˆÛË, °. µÏ·¯¿ÎË, ∂. ∫fiÎÔÚË

∞ÈÊÓ›‰ÈÔ Ô›‰ËÌ· fiÛı˘ Î·È ÔÛ¯¤Ô˘ ˆ˜ ·Ú¯È΋ ÂΉ‹ÏˆÛË ÓÂÊÚˆÛÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘∂. ÃÚÈÛÙÈ·Ó¿Î˘, °. µ¿Ô˜, ∞. ™·ÎÂÏ·ÚfiÔ˘ÏÔ˜, ∑. ∫·Ú·Î·ÙÛ¿ÓË

AÛ˘Ó‹ı˘ ·Ô˘Û›· Ó¢ÚÔÏÔÁÈ΋˜ Û˘Ó‰ÚÔÌ‹˜Û ÎÔÚ›ÙÛÈ 4 ÂÙÒÓ Ì ·Ù·Í›·-ÙËÏ·ÁÁÂÈÂÎÙ·Û›·(Û‡Ó‰ÚÔÌÔ Louis-Bar)°. ∆Ú›Ì˘, ∫. ∞ı·Ó·Û¿ÎË, ∞. °È·ÓÓÔ‡ÏÈ·-∫·Ú·ÓÙ·Ó¿,ª. ∫·Ó¿ÚÈÔ˘, •. ∫Ú›ÎÔ˜, ¶. ¡ÈÎÔÏ·˝‰Ô˘

∂¶π∫∞πƒO £∂ª∞∫ÏËÚÔÓÔÌÔ‡ÌÂÓ· ÂÚÈÔ‰Èο Â̇ÚÂÙ· Û‡Ó‰ÚÔÌ·Ÿ. µÔ˘ÁÈԇη

∂π¢π∫O ∞ƒ£ƒO∏ÌÈÎÚ·ÓÈο ÈÛÔ‰‡Ó·Ì· ÛÙ· ·È‰È¿™. ¢. ª·ÛÙÚÔÁÈ¿ÓÓË, ∫. µÔ‡‰Ú˘, ∂. ∫·ÙÛ·ÚÔ‡

CASE REPORTS Hereditary haemorrhagic telangiectasia(Rendu-Osler-Weber syndrome). Case report and review of the literatureS. Maraka, E. Saridakis, V. Aggelakou, S. Bakosi, G. Vlahaki, E. Kokori

Sudden oedema of prepuce and scrotum asinitial manifestation of nephrotic syndromeE. Christianakis, G. Vaos, A. Sakelaropoulos, Z. Karakatsani

Unusual absence of neurological symptoms ina 4 year-old girl with ataxia-telangiectasia(Louis-Bar syndrome)G. Trimis, K. Athanasaki, A. Giannoulia-Karantana, M. Kanariou, X. Krikos, P. Nikolaidou

CURRENT ISSUEHereditary periodic fever syndromesO. Vougiouka

SPECIAL ARTICLEMigraine equivalents in childrenS. D. Mastrogianni, K. Voudris, E. Katsarou

200

205

208

212

218

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

™˘Ó¯›˙ÔÓÙ·È Continued

May-June 04 chris new 19-07-04 19:23 ™ÂÏ›‰·1

Page 3: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

Hellenic Paediatric Society

Greek Paediatric Society

MM¿¿ÈÈÔÔ˜̃ -- ππÔÔ‡‡ÓÓÈÈÔÔ˜̃ 22000044 ññ ∆∆fifiÌÌÔÔ˜̃ 6677 ññ ∆∆‡‡¯̄ÔÔ˜̃ 33

Hellenic Paediatric Society

Greek Paediatric SocietyMMaayy -- JJuunnee 22000044 ññ VVoolluummee 6677 ññ NNoo 33

¡∂∞ ∞¶O ∆O ¢π∞¢π∫∆ÀO

¶ÚÔÛ¯‹ ™˘Ó¤‰ÚÈ·

™˘ÓÙÔÌÔÁڷʛ˜

NEWS FROM THE INTERNET

Scheduled Medical Meetings

Abbreviations

223

xi

xiv

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

May-June 04 chris new 19-07-04 19:23 ™ÂÏ›‰·2

Page 4: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

¢ÈÌËÓÈ·›· ¤Î‰ÔÛËE›ÛËÌÔ ¶ÂÚÈÔ‰ÈÎfi Ù˘ EÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ EÙ·ÈÚ›·˜

EΉfiÙ˘K. °ÚÈ‚¤·˜

I‰ÈÔÎÙ‹Ù˘©EÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ EÙ·ÈÚ›·Mȯ·Ï·ÎÔÔ‡ÏÔ˘ 92Aı‹Ó·È 115 28TËÏ.: 210 7771 140 / 210 7771 663, Fax: 210 7758 354

EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹¶Úfi‰ÚÔ˜ : ∞. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜¢È¢ı˘ÓÙ‹˜ ™‡ÓÙ·Í˘ : ™. ÷˚‰¿˜∞Ó·Ï. ¢È¢ı. ™‡ÓÙ·Í˘ : ∫. ™ÙÂÊ·Ó›‰Ë˜M¤ÏË : ∂. ∞ÓÙˆÓÔÔ‡ÏÔ˘

A. µ·˙·›Ô˘-°ÂÚ·ÛÈÌ›‰Ë°. µ·ÚÏ¿Ì˘∂. ∫·ÙÛ·ÚÔ‡-¶ÂÎÙ·Û›‰ËÃ. ∫ÒÛÙ·ÏÔ˜°. ªÚÈ·ÛÔ‡Ï˘¡. ¶··‰fiÔ˘ÏÔ˜∞. ¶··‰ÔÔ‡ÏÔ˘ª. ∆ÛÔÏÈ¿-¶·Û·Ú¿ÎË

ºÈÏÔÏÔÁÈ΋ EÈ̤ÏÂÈ·∂È̤ÏÂÈ· ÂÏÏËÓÈÎÒÓ ÎÂÈ̤ӈÓI. K·Ú·‚Ú¿ÓÔ˘

EÈ̤ÏÂÈ· ·ÁÁÏÈÎÒÓ ÎÂÈ̤ӈә. ¡¿ÎÔ˘

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

Bimonthly PublicationThe Official Journal of the Greek Paediatric Society

PublisherK. Griveas

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

Scientific Editorial BoardPresident : A. ConstantopoulosEditor : S. HaidasAssistant Editor : C. StefanidisMembers : H. Antonopoulou

A. Vazeou-GerasimidiG. Varlamis∂. Katsarou-PectasidesCh. CostalosG. BriasoulisN. Papadopoulos∞. PapadopoulouM. Tsolia-Pasparaki

Manuscript Editing

Greek EditingI. Karavranou

English EditingS. Nakou

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

™˘ÓÙÔÓÈÛÙ‹˜ ∂ΉfiÛˆ˜E¶I™THMONIKE™ EK¢O™EI™ E.¶.E.∞ÚÙ¤ÌȉԘ 3, 151 25 M·ÚÔ‡ÛÈTËÏ.: 210 87 78 810 Fax: 210 87 78 822

EÙ‹ÛÈ· ™˘Ó‰ÚÔÌ‹ 40 €EȉÈ΢fiÌÂÓÔÈ, ºÔÈÙËÙ¤˜: 20 €

Publishing CoordinatorSCIENTIFIC PUBLICATIONS LtdArtemidos 3, Marousi 151 25Tel.: 210 87 78 810 Fax: 210 87 78 822

Annual SubscriptionAll foreign countries: US $ 50

Hellenic Paediatric Society

Greek Paediatric Society

MM¿¿ÈÈÔÔ˜̃ -- IIÔÔ‡‡ÓÓÈÈÔÔ˜̃ 22000044 ññ ∆∆fifiÌÌÔÔ˜̃ 6677 ññ ∆∆‡‡¯̄ÔÔ˜̃ 33

Hellenic Paediatric Society

Greek Paediatric SocietyGreek Paediatric SocietyMMaayy -- JJuunnee 22000044 ññ VVoolluummee 6677 ññ NNoo 33

πSSN 0377-2551

Hellenic Paediatric Society

Greek Paediatric Society

i

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·7

Page 5: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

A. °ÂÓÈΤ˜ ¶ÏËÚÔÊÔڛ˜∆Ô ÂÚÈÔ‰ÈÎfi “¶·È‰È·ÙÚÈ΋” Â›Ó·È Ë ÂÈÛÙËÌÔÓÈ΋ ¤Î-

‰ÔÛË Î·È È‰ÈÔÎÙËÛ›· Ù˘ EÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ EÙ·ÈÚ›-·˜, Ô˘ ‰È·Ó¤ÌÂÙ·È ÛÙ· ̤ÏË Ù˘. Œ¯ÂÈ ˆ˜ ‚·ÛÈÎÔ‡˜ ÛÙfi-¯Ô˘˜ ÙËÓ ·ÔÙ‡ˆÛË ÙÔ˘ ·È‰È·ÙÚÈÎÔ‡ ÂÈÛÙËÌÔÓÈÎÔ‡¤ÚÁÔ˘ Î·È ÙË Û˘Ó¯‹ ÂÓË̤ڈÛË ÙˆÓ ¶·È‰È¿ÙÚˆÓ. °È· ÙÔÛÎÔfi ·˘Ùfi ‰¤¯ÂÙ·È ÁÈ· ‰ËÌÔÛ›Â˘ÛË ÔÈÎÈÏ›· ¿ÚıÚˆÓ Î·ÈÛ˘ÁÎÂÎÚÈ̤ӷ:

1. ÕÚıÚ· Û‡ÓÙ·Í˘ (ÌÂÙ¿ ·fi ÚfiÛÎÏËÛË Ù˘ EÈÛÙË-ÌÔÓÈ΋˜ ™˘ÓÙ·ÎÙÈ΋˜ EÈÙÚÔ‹˜).

2. ∞Ó·ÛÎÔ‹ÛÂȘ.3. µÚ·‚Â˘Ì¤Ó˜ ÂÚÁ·Û›Â˜.4. ∂Ú¢ÓËÙÈΤ˜ ÌÂϤÙ˜.5. ∂ÈÏÂÁ̤Ó˜ Û˘˙ËÙ‹ÛÂȘ ÛÙÚÔÁÁ˘ÏÒÓ ÙÚ·Â˙ÒÓ.6. ∂›Î·ÈÚ· ı¤Ì·Ù·.7. £¤Ì·Ù· Âη›‰Â˘Û˘ Î·È ÔÚÁ¿ÓˆÛ˘ ˘Á›·˜.8. ∫ÏÈÓÈΤ˜ Î·È ·ÂÈÎÔÓÈÛÙÈΤ˜ ÂÚÈÙÒÛÂȘ.9. ™‡ÓÙÔÌ· Ó¤·.

10. µÚ·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ.11. ∂ÈÛÙÔϤ˜ ÚÔ˜ ÙË Û‡ÓÙ·ÍË.12. ¶ÂÚÈÏ‹„ÂȘ Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜.13. ∞Ó·ÎÔÈÓÒÛÂȘ ÚÔÛ¯ÒÓ Û˘Ó‰ڛˆÓ Î·È ÂÈÛÙËÌÔÓÈ-

ÎÒÓ ÂΉËÏÒÛˆÓ14. ∞Ó·ÊÔÚ¤˜ Î·È ÎÚÈÙÈ΋ Ó¤ˆÓ ÂΉfiÛˆÓ, ÂÏÏËÓÈÎÒÓ Î·È

ͤӈÓ, ·È‰È·ÙÚÈÎÔ‡ ÂӉȷʤÚÔÓÙÔ˜.

H EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ‰È·ÙËÚ› ÙÔ ‰Èη›-ˆÌ· Ó· ‰ËÌÔÛȇÂÈ ¿ÚıÚ· Ì ȉȷ›ÙÂÚÔ ÂÈÛÙËÌÔÓÈÎfi ÂӉȷ-ʤÚÔÓ Î·ıÒ˜ Î·È ¿ÚıÚ· Ì ›ηÈÚ· ı¤Ì·Ù· ¯ˆÚ›˜ Ó· ÙË-ÚÂ›Ù·È Ë ÛÂÈÚ¿ ̆ Ô‚ÔÏ‹˜. ∂›Û˘, ÌÔÚ› Ó· ·ÔÊ·Û›˙ÂÈ ÁÈ·ÙË ‰ËÌÔÛ›Â˘ÛË ÂÚÁ·ÛÈÒÓ Ô˘ ¤¯Ô˘Ó ·ÚÔ˘ÛÈ·Ûı› ÛÙÔÂÙ‹ÛÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ, ÙËÓ ÔÏÈ΋ ‹ ÌÂÚÈ΋ ‰ËÌÔÛ›-¢ÛË ·ÚÔ˘ÛÈ¿ÛÂˆÓ È‰È·›ÙÂÚÔ˘ ÂӉȷʤÚÔÓÙÔ˜ Î·È ÙËÓ ÔÏÈ-΋ ‹ ÌÂÚÈ΋ ‰ËÌÔÛ›Â˘ÛË ÂÈÛÙÔÏÒÓ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È Û‰ËÌÔÛÈÂ˘Ì¤Ó· ÂÈÛÙËÌÔÓÈο ¿ÚıÚ· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡.

™ÙȘ ÂÚÁ·Û›Â˜ Ì ›ηÈÚ· ı¤Ì·Ù· Ú¤ÂÈ Ó· ·Ó·ÁÚ¿-ÊÂÙ·È ÛÙËÓ ÚÒÙË ÛÂÏ›‰· Ë ÚfiıÂÛË ÙˆÓ Û˘ÁÁڷʤˆÓÁÈ· ÙËÓ ·Ó·ÁηÈfiÙËÙ· Ù˘ Ù·¯Â›·˜ ‰ËÌÔÛ›Â˘Û˘. ∏ ∂È-ÙÚÔ‹ ™‡ÓÙ·Í˘ ‰È·ÙËÚ› ÙÔ ‰Èη›ˆÌ· Ù˘ ·Ô‰Ô¯‹˜ Ù˘ٷ¯Â›·˜ ‰ËÌÔÛ›Â˘Û˘.

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

Û›Â˘ÛË ÛÙÔ ÂÚÈÔ‰ÈÎfi “¶·È‰È·ÙÚÈ΋” ·ÔÛÙ¤ÏÏÔÓÙ·È ÂȘÙÚÈÏÔ‡Ó ÛÙË ‰È‡ı˘ÓÛË:

EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹EÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ EÙ·ÈÚ›·Mȯ·Ï·ÎÔÔ‡ÏÔ˘ 92115 28 Aı‹Ó·

ŸÏ˜ ÔÈ ÂÚÁ·Û›Â˜ Ú¤ÂÈ Ó· Û˘Óԉ‡ÔÓÙ·È ·fi ÂÈ-ÛÙÔÏ‹, Ë ÔÔ›· ı· Û˘Ó˘ÔÁÚ¿ÊÂÙ·È ·fi fiÏÔ˘˜ ÙÔ˘˜ Û˘Á-ÁÚ·Ê›˜ ÛÙËÓ ÔÔ›· ı· ‰ËÏÒÓÂÙ·È fiÙÈ Ë ÂÚÁ·Û›· ‰ÂÓ ¤¯ÂÈÂÓ Ì¤ÚÂÈ ‹ ÂÍ ÔÏÔÎÏ‹ÚÔ˘ ‰ËÌÔÛÈ¢ı› ‹ ˘Ô‚ÏËı› ÁÈ·ÎÚ›ÛË Û ¿ÏÏÔ ÂÚÈÔ‰ÈÎfi Î·È fiÙÈ ÔÈ Û˘ÁÁÚ·Ê›˜ ÂÁÎÚ›ÓÔ˘ÓÙË ‰ËÌÔÛ›Â˘Û‹ Ù˘ ÛÙÔ ÂÚÈÔ‰ÈÎfi “¶·È‰È·ÙÚÈ΋”. ∂ÈϤ-ÔÓ, ı· Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È Ù˘¯fiÓ ÂȉÔÙ‹ÛÂȘ - ¯ÔÚË-

Á›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢. ŸÏ˜ ÔÈ ÎÏÈÓÈΤ˜ ¤Ú¢Ó˜ڤÂÈ Ó· Û˘Óԉ‡ÔÓÙ·È ·fi ÁÚ·Ù‹ ‰‹ÏˆÛË ÙˆÓ Û˘Á-ÁڷʤˆÓ fiÙÈ ¤ÁÈÓ·Ó ÌÂÙ¿ ·fi ÏËÚÔÊÔÚË̤ÓË Û˘Ó·›ÓÂÛËÙˆÓ ÌÂÙ¯fiÓÙˆÓ ‹ ÙˆÓ ÓÔÌ›ÌˆÓ ÂÎÚÔÛÒˆÓ ÙÔ˘˜ Û‡Ìʈ-Ó· Ì ÙȘ ‰È·ÎËÚ‡ÍÂȘ ÙÔ˘ EÏÛ›ÓÎÈ Î·È ÙÔ˘ TfiÎÈÔ.

∫·ıÒ˜ Î·È fiÙÈ ÙËÚ‹ıËÎ·Ó ÔÈ Ô‰ËÁ›Â˜ ÁÈ· ÙË ÊÚÔÓÙ›‰·ÂÈÚ·Ì·Ùfi˙ˆˆÓ ÙÔ˘ ∂ıÓÈÎÔ‡ πÓÛÙÈÙÔ‡ÙÔ˘ ÀÁ›·˜ ÙˆÓ ∏¶∞(DHEW Publication, NIH, 80-23). ™ÙȘ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ ı·Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÂÙ·È fiÙÈ ¤¯Ô˘Ó ÂÁÎÚÈı› ·fi ÙËÓ ÂÈÙÚÔ-‹ ∏ıÈ΋˜ Î·È ¢ÂÔÓÙÔÏÔÁ›·˜ ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ.

ŸÏ˜ ÔÈ ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ÂÚÁ·Û›Â˜ ıˆÚÔ‡ÓÙ·È È‰ÈÔ-ÎÙËÛ›· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ “¶·È‰È·ÙÚÈ΋” Î·È Ë ÔÏÈ΋ ‹ ÌÂÚÈ-΋ ·Ó·‰ËÌÔÛ›Â˘Û‹ ÙÔ˘˜ ÂÈÙÚ¤ÂÙ·È ÌfiÓÔ ÌÂÙ¿ ·fi ¤Á-ÁÚ·ÊË Û˘ÁηٿıÂÛË ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡.

∏ ¶∞π¢π∞∆ƒπ∫∏ ÚÔÙ›ÓÂÈ Ó· ·ÎÔÏÔ˘ıÔ‡ÓÙ·È ÔÈ “∫ÔÈ-Ó¤˜ ¶ÚԉȷÁڷʤ˜ ÁÈ· ÃÂÈÚfiÁÚ·Ê· Ô˘ ˘Ô‚¿ÏÏÔÓÙ·ÈÛ µÈÔ˚·ÙÚÈο ¶ÂÚÈÔ‰Èο” (Uniform Requirements forManuscripts Submitted to Biomedical Journals) Ô˘ ‰Ë-ÌÔÛȇÙËÎ·Ó ÛÙÔ JAMA 1997;277:927-934

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

OÈ ·fi„ÂȘ Î·È Ù· Û˘ÌÂÚ¿ÛÌ·Ù· ÙˆÓ Û˘ÁÁڷʤˆÓÔ˘ ‰È·Ù˘ÒÓÔÓÙ·È ÛÙȘ ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ÂÚÁ·Û›Â˜ ‰ÂÓ·ÓÙÈηÙÔÙÚ›˙Ô˘Ó ··Ú·›ÙËÙ· ·˘Ù¤˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. Hηٷ¯ÒÚËÛË ‰È·ÊËÌ›ÛÂˆÓ ÛÙÔ ÂÚÈÔ‰ÈÎfi ‰ÂÓ ˘Ô‰ËÏÒ-ÓÂÈ ÔˆÛ‰‹ÔÙ ¤ÁÎÚÈÛË ÙˆÓ ÂÚȯÔÌ¤ÓˆÓ ÙÔ˘˜ ·fi ÙËÓEÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ EÙ·ÈÚ›·, ÙËÓ EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·-ÎÙÈ΋ EÈÙÚÔ‹ ‹ ·fi ÙÔÓ EΉfiÙË ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡.

EÊfiÛÔÓ Ë ÂÚÁ·Û›· Á›ÓÂÈ ·Ô‰ÂÎÙ‹, ÙÔ ‰ÈÔÚıˆÌ¤ÓÔÛ‡Ìʈӷ Ì ÙȘ ˘Ô‰Â›ÍÂȘ ÙˆÓ ÎÚÈÙÒÓ Î·È ÂÎ Ó¤Ô˘ ‰·ÎÙ˘-ÏÔÁÚ·ÊË̤ÓÔ Î›ÌÂÓÔ Ú¤ÂÈ Ó· ˘Ô‚¿ÏÏÂÙ·È ÛÙËÓ EÈÛÙË-ÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ Û˘Óԉ¢fiÌÂÓÔ ·fi ‰ÈÛÎ¤Ù·Ô˘ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ÂÚÁ·Û›· Û ÚfiÁÚ·ÌÌ· Word ηÈÙÔ˘˜ ›Ó·Î˜, ·Ó Â›Ó·È ‰˘Ó·ÙfiÓ, Û ÚfiÁÚ·ÌÌ· Excel, η-ıÒ˜ Î·È ÂÈÛÙÔÏ‹ fiÔ˘ Ó· ·Ó·Ê¤ÚÔÓÙ·È ·Ó·Ï˘ÙÈο ÔÈ ÙÚÔ-ÔÔÈ‹ÛÂȘ ‹ ÔÈ ·ÓÙÈÚÚ‹ÛÂȘ ÛÙȘ ÚÔÙ¿ÛÂȘ ÙˆÓ ÎÚÈÙÒÓ.

H ηı˘ÛÙ¤ÚËÛË Ù˘ ·ӢԂÔÏ‹˜ ÙÔ˘ ÙÚÔÔÔÈ-Ë̤ÓÔ˘ ÎÂÈ̤ÓÔ˘ ¤Ú·Ó ÙˆÓ 30 ËÌÂÚÒÓ Û˘Ó¿ÁÂÙ·ÈÓ¤· ˘Ô‚ÔÏ‹.

°È· Ó· ÂÈÙ¢¯ı› Ë ¤ÁηÈÚË ‰ËÌÔÛ›Â˘ÛË Ù˘ ÂÚÁ·-Û›·˜ Â›Ó·È ··Ú·›ÙËÙÔ Ó· ÂÈÛÙÚ¤ÊÂÙ·È ÙÔ ‰ÈÔÚıˆÌ¤ÓÔÙ˘ÔÁÚ·ÊÈÎfi ‰ÔΛÌÈÔ ·fi ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ ̤۷ Û‰‡Ô (2) Ë̤Ú˜.

T· ¤ÍÔ‰· ÙˆÓ ÊÈÏÌ Î·È ÙˆÓ ·Ó·Ù‡ˆÓ ‚·Ú‡ÓÔ˘Ó ÙÔ˘˜Û˘ÁÁÚ·Ê›˜ Î·È Ú¤ÂÈ Ó· ÏËÚÒÓÔÓÙ·È Ì ÙËÓ ·ÔÛÙÔÏ‹ÙÔ˘ ÚÒÙÔ˘ ‰ÔÎÈÌ›Ô˘ ηÙ¢ı›·Ó ÛÙÔÓ Ù˘ÔÁÚ¿ÊÔ.

T· ΛÌÂÓ· ÙˆÓ ÂÚÁ·ÛÈÒÓ Ô˘ ‰ÂÓ Á›ÓÔÓÙ·È ·Ô‰ÂÎÙ¤˜ÁÈ· ‰ËÌÔÛ›Â˘ÛË ‰ÂÓ ÂÈÛÙÚ¤ÊÔÓÙ·È. MÔÚ› Ó· ÂÈÛÙÚ·-ÊÔ‡Ó, ÂÊfiÛÔÓ ˙ËÙËı› ÂÓÙfi˜ ÂÍ·Ì‹ÓÔ˘, Ù· Û¯‹Ì·Ù· Î·È ÔÈʈÙÔÁڷʛ˜ Ô˘ Ù· Û˘Óԉ‡ԢÓ.

°. ™‡ÓÙ·ÍË ÙˆÓ ∂ÚÁ·ÛÈÒÓTÔ Û‡ÓÔÏÔ Ù˘ ÂÚÁ·Û›·˜ (Û˘ÌÂÚÈÏ·Ì‚·ÓÔ̤ӈÓ

ÙˆÓ ÈÓ¿ÎˆÓ Î·È ÙˆÓ Ù›ÙÏˆÓ ÙˆÓ ÂÈÎfiÓˆÓ) Ú¤ÂÈ Ó· ›ӷȉ·ÎÙ˘ÏÔÁÚ·ÊË̤ÓÔ ÛÙË ÌÈ· fi„Ë Ï¢ÎÔ‡ ¯·ÚÙÈÔ‡ ÌÂÁ¤ıÔ˘˜

O‰ËÁ›Â˜ ÚÔ˜ ÙÔ˘˜ ™˘ÁÁÚ·Ê›˜

v

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·11

Page 6: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

A4 (21x29.7 cm) Ì ‰ÈÏfi ‰È¿ÛÙËÌ· ÌÂٷ͇ ÙˆÓ ÁÚ·ÌÌÒÓÎ·È ÂÚÈıÒÚÈ· ÙÔ˘Ï¿¯ÈÛÙÔÓ 2,5 cm ÛÙȘ ‰‡Ô Ï¢ڤ˜.

TÔ Î›ÌÂÓÔ Ú¤ÂÈ Ó· ¤¯ÂÈ ÙËÓ ·ÎfiÏÔ˘ıË ‰È¿Ù·ÍË:ÛÂÏ›‰· Ù›ÙÏÔ˘, ‚Ú·¯‡˜ Ù›ÙÏÔ˜, ÂÚ›ÏË„Ë ÛÙ· ÂÏÏËÓÈο ηÈÙ· ·ÁÁÏÈο, ΛÌÂÓÔ, ¢¯·ÚÈÛٛ˜ ηıÒ˜ Î·È ·Ó·ÊÔÚ¿ ÛÂÂȉÔÙ‹ÛÂȘ-¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢, ‚È-‚ÏÈÔÁÚ·Ê›·, ›Ó·Î˜, ÂÈÎfiÓ˜, Ù›ÙÏÔÈ ÂÈÎfiÓˆÓ, ηٿÏÔÁÔ˜Û˘ÓÙÌ‹ÛˆÓ. K¿ı ¤Ó· ·fi Ù· ·Ú·¿Óˆ ÛÙÔȯ›· Ú¤-ÂÈ Ó· ·Ú¯›˙ÂÈ Û ¯ˆÚÈÛÙfi ʇÏÏÔ Î·È ÔÈ ÛÂÏ›‰Â˜ Ó· ·ÚÈı-ÌÔ‡ÓÙ·È ‰È·‰Ô¯Èο ·Ú¯›˙ÔÓÙ·˜ Ì ÙË ÛÂÏ›‰· Ù›ÙÏÔ˘.

H ¤ÎÙ·ÛË ÚÔÛ‰ÈÔÚ›˙ÂÙ·È ÁÈ·: ·. ÙȘ ·Ó·ÛÎÔ‹ÛÂȘ Û 2000-3000 ϤÍÂȘ. ‚. ÙȘ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜ Î·È ÙȘ ÂӉȷʤÚÔ˘Û˜ Â-

ÚÈÙÒÛÂȘ Û 1500-2500 ϤÍÂȘ. Á. ÙȘ ‚Ú·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ Û 1000-1500 ϤÍÂȘ. ‰. ÙȘ ÂÈÛÙÔϤ˜ Û 250-500 ϤÍÂȘ.

™ÂÏ›‰· Ù›ÙÏÔ˘¶Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ:

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

- ÙÔ fiÓÔÌ· Î·È ÙÔ ÂÒÓ˘ÌÔ Î¿ıÂ Û˘ÁÁڷʤ· ÛÙËÓÔÓÔÌ·ÛÙÈ΋,

- ÙÔ ÂÈÛÙËÌÔÓÈÎfi ΤÓÙÚÔ (›‰Ú˘Ì·, ÎÏÈÓÈ΋, ÂÚÁ·ÛÙ‹-ÚÈÔ) ·fi fiÔ˘ ÚÔ¤Ú¯ÂÙ·È Ë ÂÚÁ·Û›·. ™Â ÂÚ›ÙˆÛˤÏÏÂȄ˘ Û˘ÓÂÚÁ·Û›·˜ ÌÂ Û˘ÁÎÂÎÚÈ̤ӷ ΤÓÙÚ·,Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÂÙ·È Ë È‰ÈfiÙËÙ· ÙÔ˘/ÙˆÓ Û˘ÁÁÚ·-ʤˆÓ (.¯. ȉÈÒÙ˘ ·È‰›·ÙÚÔ˜) Î·È Ô ÙfiÔ˜ ‰È·ÌÔ-Ó‹˜ ÙÔ˘/ÙˆÓ,

- ÙËÓ Ï‹ÚË ‰È‡ı˘ÓÛË, e-mail Î·È ÙÔ ÙËϤʈÓÔ ÙÔ˘Û˘ÁÁڷʤ· Ì ÙÔÓ ÔÔ›Ô Á›ÓÂÙ·È Ë ·ÏÏËÏÔÁÚ·Ê›·.

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

Ù˘ ÂÚÁ·Û›·˜, ÙË ÌÂıÔ‰ÔÏÔÁ›·, Ù· ΢ÚÈfiÙÂÚ· ·ÔÙÂϤ-ÛÌ·Ù· Î·È Ù· Û˘ÌÂÚ¿ÛÌ·Ù· Ù˘ ÌÂϤÙ˘. £· Ú¤ÂÈ Ó·ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÔ˘Ï¿¯ÈÛÙÔÓ 200 ϤÍÂȘ, fï˜ ‰ÂÓ ı· Ú¤-ÂÈ Ó· ˘ÂÚ‚·›ÓÂÈ ÙȘ 250 ϤÍÂȘ. ∏ ÂÚ›ÏË„Ë ÙˆÓ ÂÚÁ·-ÛÈÒÓ Ú¤ÂÈ Ó· Â›Ó·È ‰ÔÌË̤ÓË ÛÙȘ ÂÍ‹˜ ·Ú·ÁÚ¿ÊÔ˘˜:ÂÈÛ·ÁˆÁ‹, ̤ıÔ‰ÔÈ, ·ÔÙÂϤÛÌ·Ù· Î·È Û˘ÌÂÚ¿ÛÌ·Ù·.

™ÙËÓ ÂÚ›ÏË„Ë ÛÙ· ·ÁÁÏÈο Ú¤ÂÈ Ó· ·Ó·ÁÚ¿ÊÔ-ÓÙ·È ÛÙËÓ ·Ú¯‹ ÙÔ˘ ÎÂÈ̤ÓÔ˘ Ô Ù›ÙÏÔ˜ Ù˘ ÂÚÁ·Û›·˜ ηÈÙ· ÔÓfiÌ·Ù· ÙˆÓ Û˘ÁÁڷʤˆÓ ÛÙ· ·ÁÁÏÈο. TÔ ÂÚȯfi-ÌÂÓÔ ÙÔ˘ ·ÁÁÏÈÎÔ‡ ÎÂÈ̤ÓÔ˘ Ú¤ÂÈ Ó· Â›Ó·È ‰ÔÌË̤ÓÔÛ ÂÈÛ·ÁˆÁ‹ (background), ̤ıÔ‰ÔÈ (methods), ·ÔÙÂ-ϤÛÌ·Ù· (results) Î·È Û˘ÌÂÚ¿ÛÌ·Ù· (conclusions). HÂÚ›ÏË„Ë ÛÙ· ·ÁÁÏÈο ‰ÂÓ Ú¤ÂÈ Ó· ‰È·Ê¤ÚÂÈ ·fi ÙËÓ·ÓÙ›ÛÙÔÈ¯Ë ÛÙ· ÂÏÏËÓÈο.

T· ¿ÚıÚ· Û‡ÓÙ·Í˘ Î·È ÔÈ ·ÂÈÎÔÓÈÛÙÈΤ˜ ÂÚÈÙÒ-ÛÂȘ ¤¯Ô˘Ó ÌfiÓÔ ·ÁÁÏÈ΋ ÂÚ›ÏË„Ë.

K¿Ùˆ ·fi ÙËÓ ÂÏÏËÓÈ΋ Î·È ÙËÓ ·ÁÁÏÈ΋ ÂÚ›ÏË„ËÛËÌÂÈÒÓÔÓÙ·È ÙÚÂȘ ¤ˆ˜ ¤ÓÙ ϤÍÂȘ ÎÏÂȉȿ Ô˘ ı·¯ÚËÛÈÌÔÔÈËıÔ‡Ó ÁÈ· ÙÔ ıÂÌ·ÙÈÎfi ¢ÚÂÙ‹ÚÈÔ.

K›ÌÂÓÔOÈ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó: ÂÈÛ·ÁˆÁ‹,

ÌÂıfi‰Ô˘˜, ·ÔÙÂϤÛÌ·Ù· Î·È Û˘˙‹ÙËÛË. H ÂÈÛ·ÁˆÁ‹ Â-ÚÈÏ·Ì‚¿ÓÂÈ Ù· ÙÂÏÂ˘Ù·›· ‰Â‰Ô̤ӷ Ù˘ ¤Ú¢ӷ˜ ÛÙÔ Û˘-ÁÎÂÎÚÈ̤ÓÔ ı¤Ì· Ì ÙȘ ΢ÚÈfiÙÂÚ˜ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·-

Ô̤˜ Î·È ÙÔ ÛÎÔfi Ù˘ ÂÚÁ·Û›·˜. H ÂÚÈÁÚ·Ê‹ ÙˆÓ ÌÂ-ıfi‰ˆÓ Ú¤ÂÈ Ó· Â›Ó·È ·ÎÚÈ‚‹˜ Î·È ·ÚÎÂÙ¿ ÏÂÙÔÌÂÚ‹˜ÒÛÙ ӷ ÂÈÙÚ¤ÂÈ ÙËÓ ·Ó··Ú·ÁˆÁ‹ ÙÔ˘˜ ·fi ¿ÏÏÔ˘˜ÂÚ¢ÓËÙ¤˜. ∂›Û˘, Ú¤ÂÈ Ì ÏÂÙÔ̤ÚÂȘ Ó· ·Ó·Ê¤ÚÔ-ÓÙ·È ÔÈ ÛÙ·ÙÈÛÙÈΤ˜ ̤ıÔ‰ÔÈ ·Ó¿Ï˘Û˘ Î·È ·ÍÈÔÏfiÁËÛË˜ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ. T· ·ÔÙÂϤÛÌ·Ù· Ú¤ÂÈ Ó· ·ÚÔ˘-ÛÈ¿˙ÔÓÙ·È Ì ۷ʋÓÂÈ· Î·È Ó· Û˘Óԉ‡ÔÓÙ·È ·fi ÙËÓ ··-Ú·›ÙËÙË ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË. H Û˘˙‹ÙËÛË Ú¤ÂÈ Ó· ÂÚÈ-Ï·Ì‚¿ÓÂÈ Ù· Û˘ÌÂÚ¿ÛÌ·Ù· Ô˘ ÚÔ·ÙÔ˘Ó ·fi ÙËÓ ÂÚ-Á·Û›·, ÙË ÛËÌ·Û›· Ô˘ ÌÔÚ› Ó· ¤¯Ô˘Ó Î·È ÙËÓ Èı·Ó‹ Û˘-Û¯¤ÙÈÛ‹ ÙÔ˘˜ Ì ·Ú·ÙËÚ‹ÛÂȘ ¿ÏÏˆÓ ÂÚ¢ÓËÙÒÓ.

OÈ ÂӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Û‡ÓÙÔ-ÌË ÂÈÛ·ÁˆÁ‹, ÂÚÈÁÚ·Ê‹ Ù˘ ÂÚ›ÙˆÛ˘ Î·È ‚Ú·¯Â›· Û˘˙‹-ÙËÛË. OÈ ·ÂÈÎÔÓÈÛÙÈΤ˜ ÂÚÈÙÒÛÂȘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Û‡ÓÙÔ-ÌË ÂÚÈÁÚ·Ê‹ Ù˘ ÂÚ›ÙˆÛ˘ Î·È ‚Ú·¯Â›· Û˘˙‹ÙËÛË Ì ¤Ì-Ê·ÛË ÛÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË. T· ˘fiÏÔÈ· ı¤Ì·Ù· ¤¯Ô˘ÓÂχıÂÚË ‰ÔÌ‹ ηٿ ÙËÓ ÎÚ›ÛË ÙˆÓ Û˘ÁÁڷʤˆÓ ÙÔ˘˜.

∂˘¯·ÚÈÛٛ˜ ‹ ·Ó·ÁÓˆÚ›ÛÂȘ (·Ó·ÊÔÚ¿ Û ÂȉÔÙ‹-ÛÂȘ - ¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢) ı· Ú¤ÂÈÓ· ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔ Ù¤ÏÔ˜ ÙÔ˘ ÎÂÈ̤ÓÔ˘ Î·È ÚÈÓ ·fi ÙȘ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·Ô̤˜.

TÈ̤˜ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛˆÓOÈ ÙÈ̤˜ ÙˆÓ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛÂˆÓ Ú¤ÂÈ Ó·

ÂÎÊÚ¿˙ÔÓÙ·È ÛÙÔ ¢ÈÂıÓ¤˜ ™‡ÛÙËÌ· MÔÓ¿‰ˆÓ (SI Units)Î·È ÛÙÔ MÂÙÚÈÎfi (Conventional-™˘Ì‚·ÙÈÎfi) ™‡ÛÙËÌ· ̤-Û· Û ·Ú¤ÓıÂÛË. ¶›Ó·Î˜ ÌÂÙ·ÙÚÔ‹˜ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·ÈÛÙÔ JAMA 1986;255:2329-2339.

™˘ÓÙÔÌÔÁڷʛ˜OÈ Û˘ÓÙÔÌÔÁڷʛ˜ Ô˘ ¤¯Ô˘Ó ÂÈ‚ÏËı› ‰ÈÂıÓÒ˜ ‰Ë-

ÌÔÛȇÔÓÙ·È Û οı Ù‡¯Ô˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. ™‡ÓıÂÙÔÈÎ·È Ì·ÎÚÔÛÎÂÏ›˜ fiÚÔÈ Ô˘ ·ӷϷ̂¿ÓÔÓÙ·È Û˘¯Ó¿ÛÙÔ Î›ÌÂÓÔ ÌÔÚÔ‡Ó Ó· ·ÓÙÈηı›ÛÙ·ÓÙ·È ·fi Û˘ÓÙÔÌÔ-Áڷʛ˜ Ô˘ ÂÂÍËÁÔ‡ÓÙ·È ·fi ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ Û ÂÈ-‰ÈÎfi ηٿÏÔÁÔ, Ô ÔÔ›Ô˜ ˘Ô‚¿ÏÏÂÙ·È Ì·˙› Ì ÙËÓ ÂÚÁ·-Û›·. OÈ Û˘ÓÙÔÌÔÁڷʛ˜ ·Ó·Ê¤ÚÔÓÙ·È Û ·Ú¤ÓıÂÛË Ìfi-ÓÔ ÛÙȘ ÂÚÈÏ‹„ÂȘ.

BÈ‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·Ô̤˜™ÙÔ ÙÌ‹Ì· Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜ ηٷ¯ˆÚÔ‡ÓÙ·È fiϘ ÔÈ

‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·Ô̤˜ Ì ÙË ÛÂÈÚ¿ Ô˘ ·Ó·Ê¤ÚÔ-ÓÙ·È ÛÙÔ Î›ÌÂÓÔ. ™ÙÔ Î›ÌÂÓÔ ÔÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·Ô-̤˜ ·Ó·Ê¤ÚÔÓÙ·È Ì ·Ú·‚ÈÎÔ‡˜ ·ÚÈıÌÔ‡˜ Û ·Ú¤ÓıÂ-ÛË. OÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·Ô̤˜ ‰ÂÓ Ú¤ÂÈ Ó· ˘ÂÚ-‚·›ÓÔ˘Ó ÙȘ 70 ÛÙȘ ·Ó·ÛÎÔ‹ÛÂȘ, ÙȘ 30 ÛÙȘ ÂÚ¢ÓËÙÈ-Τ˜ ÂÚÁ·Û›Â˜, ÙȘ 12 ÛÙ· ›ηÈÚ· ı¤Ì·Ù· Î·È ÙȘ ÂӉȷ-ʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ, ÙȘ 5 ÛÙȘ ‚Ú·¯Â›Â˜ ‰ËÌÔÛȇ-ÛÂȘ Î·È ÛÙȘ ÂÈÛÙÔϤ˜.

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

vi

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·12

Page 7: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

¶·Ú·‰Â›ÁÌ·Ù· ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·ÔÌÒÓ

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

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

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

ÛË ÛÙËÓ ÂȉËÌÈÔÏÔÁ›· ÙˆÓ ÏÔÈ̈‰ÒÓ ÓÔÛËÌ¿ÙˆÓ Î·È ÙËӷȉȷÙÚÈ΋ Ú¿ÍË. ¶·È‰È·ÙÚÈ΋ 1999;59:272-279.

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

™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜ ÂÚÈÔ‰ÈÎÔ‡:Flyvbjerg A. Role of growth hormone, insulin-like

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

Èڛ˜ Û˘ÁÁڷʤ·:National Institutes of Health Consensus Development

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

¶ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù‡Ô˘ ¿ÚıÚÔ˘:÷ڷϷ̛‰Ë˜ π, ¶··‰fiÔ˘ÏÔ˜ ∞. ¶·¯˘Û·ÚΛ· ηÈ

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

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

J Am Soc Nephrol 1991;2:562.

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

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

II. µÈ‚Ï›·

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

syndrome. In: Barratt TM, Arner ED, Harmon WE, editors.Pediatric Nephrology. 4th ed. Baltimore: LippincottWilliam Wilkins; 1999. p. 742.

™‡ÁÁÚ·ÌÌ· ‹ ÌÔÓÔÁÚ·Ê›·:Gorlin RJ, Cohen MM, Levin LS. Syndromes of the head

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

¢ËÌÔÛ›Â˘ÛË Û ÙfiÌÔ Ú·ÎÙÈÎÒÓ:Bauer AW. The two definitions of bacterial resistance.

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

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

¢È‰·ÎÙÔÚÈ΋ ‰È·ÙÚÈ‚‹:¶··‰fiÔ˘ÏÔ˜ Ã.. ∏ ıÂڷ›· ÙÔ˘ ÛÙÚ·‚ÈÛÌÔ‡. [‰È‰·-

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

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

¶›Ó·Î˜ Î·È EÈÎfiÓ˜AÔÛÙ¤ÏÏÔÓÙ·È ÂȘ ÙÚÈÏÔ‡Ó (¤Ó· ÚˆÙfiÙ˘Ô+‰‡Ô

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

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

ŸÏÔ ÙÔ ·ÂÈÎÔÓÈÛÙÈÎfi ˘ÏÈÎfi (Û¯‹Ì·Ù·, ‰È·ÁÚ¿ÌÌ·Ù·,ʈÙÔÁڷʛ˜, Î.Ï.) ̄ ·Ú·ÎÙËÚ›˙ÂÙ·È ̂ ˜ ÂÈÎfiÓ˜. £· Ú¤ÂÈÓ· Â›Ó·È ¿ÚÈÛÙ˘ ÔÈfiÙËÙ·˜ Ì ÌÔÚÊ‹ ʈÙÔÁÚ·ÊÈÒÓ ‹ ηÈÚˆÙÔÙ‡ˆÓ. ™ÙÔ ›Ûˆ ̤ÚÔ˜ ÙˆÓ ÂÈÎfiÓˆÓ Ú¤ÂÈ Ó· ÛË-ÌÂÈÒÓÂÙ·È Ì ÌÔχ‚È Ô ·ÚÈıÌfi˜ Ù˘ ÂÈÎfiÓ·˜ Î·È ÙÔ fiÓÔÌ·ÙÔ˘ ÚÒÙÔ˘ Û˘ÁÁڷʤ·, ηıÒ˜ Î·È ¤Ó· ‚¤ÏÔ˜ ÙÔ ÔÔ›Ô Ó·‰Â›¯ÓÂÈ ÙÔ ¿Óˆ ̤ÚÔ˜ Ù˘ ÂÈÎfiÓ·˜. ™ÙȘ ʈÙÔÁڷʛ˜·ÛıÂÓÒÓ ‰ÂÓ Ú¤ÂÈ Ó· ·Ó·ÁÓˆÚ›˙ÂÙ·È Ë Ù·˘ÙfiÙËÙ¿ ÙÔ˘˜.OÈ ·ÛıÂÓ›˜ ‰ÂÓ Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È ÔÓÔÌ·ÛÙÈο.

¶ÚÈÓ ·ÔÛÙ›ÏÂÙ ÙËÓ ÂÚÁ·Û›· Û·˜ ‚‚·Èˆı›Ù fiÙÈ Â-ÚÈÏ·Ì‚¿ÓÂÈ:

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

·. Ù›ÙÏÔ Î·È ‚Ú·¯‡ Ù›ÙÏÔ ÂÚÁ·Û›·˜, ‚. fiÓÔÌ· Î·È ÂÒÓ˘ÌÔ Û˘ÁÁڷʤˆÓ (ÔÏÔÁڿʈ˜), Á. ÂÈÛÙËÌÔÓÈÎfi/¿ ΤÓÙÚÔ/· fiÔ˘ ¤ÁÈÓÂ Ë ÂÚÁ·Û›·, ‰. fiÓÔÌ·, ‰È‡ı˘ÓÛË Î·È ÙËϤʈÓÔ Û˘ÁÁڷʤ· ÁÈ·

·ÏÏËÏÔÁÚ·Ê›·. 5. ¶ÂÚ›ÏË„Ë ÂÏÏËÓÈ΋-·ÁÁÏÈ΋, ϤÍÂȘ ÎÏÂȉȿ (‰ÈÏfi

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

ÚÈÛÙ‹ ÛÂÏ›‰·).7. ∫›ÌÂÓÔ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·).8. ∂˘¯·ÚÈÛٛ˜ ‹ ·Ó·ÁÓˆÚ›ÛÂȘ (·Ó·ÊÔÚ¿ Û ÂȉÔÙ‹-

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

10. ¶›Ó·Î˜ (Ô Î·ı¤Ó·˜ Û ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) ÂȘ ÙÚÈÏÔ‡Ó.11. ∂ÈÎfiÓ˜, Ì ‚¤ÏÔ˜ ÛÙÔ ›Ûˆ ̤ÚÔ˜ Ó· ‰Â›¯ÓÂÈ ÚÔ˜

Ù· ¿ӈ, ·ÚÈıÌË̤Ó˜, ÂȘ ÙÚÈÏÔ‡Ó.12. ∆›ÙÏÔÈ ÂÈÎfiÓˆÓ (‰ÈÏfi ‰È¿ÛÙËÌ· - Ô Î·ı¤Ó·˜ Û ¯ˆ-

ÚÈÛÙ‹ ÛÂÏ›‰·) ÂȘ ÙÚÈÏÔ‡Ó.

vii

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·13

Page 8: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

OÈ ‰˘ÛÏÈȉ·È̛˜ ÛÙ· ·È‰È¿ Î·È Ë ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘˜ ∞. ∆ÂÚÙ›Ë, µ. ¶¤ÙÚÔ˘, Ã. £ÂÔ‰ˆÚ›‰Ë˜

Dyslipidaemias in children and their management A. Tertipi, V. Petrou, H. Theodoridis

�¶ÂÚ›ÏË„Ë: ∏ ·‡ÍËÛË Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘ ηÈË Ì›ˆÛË Ù˘ ∏DL-¯ÔÏËÛÙÂÚfiÏ˘ ·ÔÙÂÏÔ‡Ó ·ÓÂ-Í¿ÚÙËÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ÚfiÎÏËÛËÚÒÈÌ˘ ·ıËڈ̿وÛ˘ Î·È ÙËÓ ÂΉ‹ÏˆÛË Î·Ú-‰È·ÁÁÂÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ. ¶·ıÔÏÔÁÔ·Ó·ÙÔÌÈΤ˜ ÌÂ-ϤÙ˜ Û ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ ¤‰ÂÈÍ·Ó fiÙÈ ÔÈ ·ıËÚˆ-Ì·ÙÈΤ˜ ‚Ï¿‚˜ ÙˆÓ ·ÁÁ›ˆÓ ÂÌÊ·Ó›˙ÔÓÙ·È ‹‰Ë ·fiÙËÓ ·È‰È΋ ËÏÈΛ·, ÂÓÒ Ë Û‡Á¯ÚÔÓË ·ÓÙ›ÏË„Ë ÁÈ·ÚfiÏË„Ë ÂÈ‚¿ÏÏÂÈ ÙË ‰È·Ù‹ÚËÛË ÙˆÓ ÏÈȉ›ˆÓ ÙÔ˘·›Ì·ÙÔ˜ Û ›‰· Ô˘ Ó· ÌËÓ Úԉȷı¤ÙÔ˘Ó ÁÈ·ÚÒÈÌË Î·Ú‰È·ÁÁÂȷ΋ ÓfiÛÔ. ™Ù· ·È‰È¿ ‰ÂÓ ÂΉË-ÏÒÓÔÓÙ·È Û˘Ó‹ıˆ˜ ηډȷÁÁÂȷο ÓÔÛ‹Ì·Ù·, ·ÏÏ¿fiÙ·Ó ˘¿Ú¯ÂÈ ÁÂÓÂÙÈ΋ ÚԉȿıÂÛË, ÌÔÚ› Ó· ÂÌ-Ê·ÓÈÛÙ› ÔÔÈ·‰‹ÔÙ ‰˘ÛÏÈȉ·ÈÌ›·. ∏ ·ıËڈ̿-ÙˆÛË Â›Ó·È ¤Ó· Ê˘ÛÈÔÏÔÁÈÎfi, ÔÏ˘·Ú·ÁÔÓÙÈ΋˜ ·È-ÙÈÔÏÔÁ›·˜, Ê·ÈÓfiÌÂÓÔ. ∂ÎÙfi˜ ·fi ÙËÓ ·ÚÔ˘Û›· ‰˘-ÛÏÈȉ·ÈÌ›·˜, Ôχ ÛËÌ·ÓÙÈÎfi Â›Ó·È ÙÔ ÔÈÎÔÁÂÓÂÈ·ÎfiÈÛÙÔÚÈÎfi ÚfiˆÚ˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘, ηıÒ˜˘Ô‰ÂÈÎÓ‡ÂÈ fiÙÈ ÙÔ ·È‰› ¤¯ÂÈ Èı·ÓfiÓ ÎÏËÚÔÓÔÌ‹ÛÂÈÁÓˆÛÙ¿ ‹ ¿ÁÓˆÛÙ· ÁÔÓ›‰È· Ô˘ ÚÔ¿ÁÔ˘Ó ÙËÓ ÚÒ-ÈÌË ·ıËڈ̿وÛË. £Â̤ÏÈÔ˜ Ï›ıÔ˜ ÛÙËÓ ·ÓÙÈÌÂÙÒÈ-ÛË ÙˆÓ ‰˘ÛÏÈȉ·ÈÌÈÒÓ Â›Ó·È Ë ‰È·ÈÙËÙÈ΋ ·ÁˆÁ‹ ηÈË ¿ÛÎËÛË. OÈ Û˘Óı‹Î˜ Ô˘ ÂÈÎÚ·ÙÔ‡Ó ÛÙȘ Û‡Á-¯ÚÔÓ˜ ÔÈÎÔÁ¤ÓÂȘ (ÂÚÁ·˙fiÌÂÓ˜ ÌËÙ¤Ú˜ Ì ÂÚÈÔ-ÚÈṲ̂ÓÔ ÂχıÂÚÔ ¯ÚfiÓÔ) Î·È ÔÈ ‰È·ÈÙËÙÈΤ˜ Û˘Ó‹ıÂÈ-˜ ÙˆÓ ÂÊ‹‚ˆÓ, Ô˘ Ôχ Û˘¯Ó¿ Û˘Óԉ‡ÔÓÙ·È Î·È·fi ÙËÓ ·Ô˘Û›· Ê˘ÛÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ (·Ú·-ÎÔÏÔ‡ıËÛË ÙËÏÂfiÚ·Û˘ ÛÙÔÓ ÂχıÂÚÔ ¯ÚfiÓÔ,˘ÂÚ‚ÔÏÈ΋ ··Û¯fiÏËÛË Û ÊÚÔÓÙÈÛÙ‹ÚÈ· Î.Ï.),¢ÓÔÔ‡Ó ÙË Û˘¯Ó‹ ηٷӿψÛË ¤ÙÔÈÌÔ˘ Ê·ÁËÙÔ‡, ÙÔÔÔ›Ô ¤¯ÂÈ ‰˘ÛÌÂÓ‹ ›‰Ú·ÛË ÛÙ· ›‰· ÙˆÓ ÏÈÈ-‰›ˆÓ. O ÁÈ·ÙÚfi˜ Ú¤ÂÈ Ó· ÙÔÓ›˙ÂÈ ÛÙÔ˘˜ ÁÔÓ›˜ fiÙÈ ÌfiÓÔ ÙÔ ‰ÈÎfi ÙÔ˘˜ ·Ú¿‰ÂÈÁÌ· Î·È Ë ÂÈÌÔÓ‹ÌÔÚ› Ó· ÂÍ·ÛÊ·Ï›ÛÔ˘Ó ÙË Û˘Ó·›ÓÂÛË ÙÔ˘ ·È‰ÈÔ‡ÛÙÔ˘˜ ‰È¿ÊÔÚÔ˘˜ ‰È·ÈÙËÙÈÎÔ‡˜ ÂÚÈÔÚÈÛÌÔ‡˜.

�Abstract: Increased LDL-cholesterol anddecreased HDL-cholesterol blood levels are riskfactors for premature atheromatosis andcardiovascular disease. Histological studies inchildren and adolescents have shown thatatheromatic vascular lesions start from childhood.The contemporary concept for cardiovasculardisease prevention demands the maintenance ofserum lipids in children at levels not predisposing toearly atheromatosis. Cardiovascular disease is notusually present in children but where there is agenetic predisposition, any dyslipidaemia mayappear during childhood. Atherogenesis is aphysiological phenomenon of multifactorialaetiology. Apart from dyslipidaemia, a family historyof premature cardiovascular disease is an indicationthat a child may have inherited known or unknowngenes predisposing to early atheromatosis. Dietand exercise constitute the cornerstone of themanagement of dyslipidaemias. The situation oftoday’s families (working mothers with limited freetime) and adolescent eating habits (frequentconsumption of fast food), usually accompanied bythe absence of physical activity (TV watching, heavyhomework load etc.), adversely affect serum lipids.The doctor’s duty to parents is to emphasize thatonly their attitude and insistence can ensure theirchildren’s compliance with the dietary restrictionsrecommended for the management ofdyslipidaemia, and to stress the need for healthydietary habits and systematic exercise, not only forchildren with dyslipidaemia but for all children.

∂Ó‰ÔÎÚÈÓÔÏÔÁÈ΋ ∫ÏÈÓÈ΋, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó·

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

151

¶·È‰È·ÙÚÈ΋ 2004;67:151-159 Paediatriki 2004;67:151-159

∞¡∞™∫O¶∏™∏ REVIEW ARTICLE

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·151

Page 9: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

™˘ÓÙÔÌÔÁڷʛ˜ Oà OÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË LDL-¯ LDL-¯ÔÏËÛÙÂÚfiÏË ∏DL-¯ ∏DL-¯ÔÏËÛÙÂÚfiÏË ∆° ∆ÚÈÁÏ˘ÎÂÚ›‰È· ∫∫ ∫·Ú‰È·ÁÁÂÈ·Îfi˜ ΛӉ˘ÓÔ˜

∂ÈÛ·ÁˆÁ‹∏ ·ÚÙËÚÈÔÛÎÏ‹Ú˘ÓÛË Â›Ó·È ÙÔ Û˘¯ÓfiÙÂÚÔ ·›ÙÈÔ

ı·Ó¿ÙÔ˘ Î·È ÓÔÛËÚfiÙËÙ·˜ ÛÙÔ˘˜ ÂÓËÏ›ÎÔ˘˜, ÙfiÛÔÛÙËÓ ∂ÏÏ¿‰· fiÛÔ Î·È ÛÙÔÓ ˘fiÏÔÈÔ ‰˘ÙÈÎfi ÎfiÛÌÔ.OÈ ·ıËڈ̷ÙÈΤ˜ ‚Ï¿‚˜ ÛÙ· ÛÙÂÊ·ÓÈ·›·, Ù· ÂÁÎÂ-Ê·ÏÈο Î·È Ù· ÂÚÈÊÂÚÈο ·ÁÁ›· ·Ú¯›˙Ô˘Ó ‹‰Ë ·fiÙËÓ ·È‰È΋ ËÏÈΛ· ‹ ·ÎfiÌË ·fi ÙËÓ ÂÓ‰ÔÌ‹ÙÚÈ·˙ˆ‹ (1-3). ∂Ô̤ӈ˜, Ë Ï‹„Ë ÚÔÏËÙÈÎÒÓ ‹ ıÂÚ·-¢ÙÈÎÒÓ Ì¤ÙÚˆÓ Ú¤ÂÈ Ó· ·Ú¯›˙ÂÈ ÓˆÚ›˜ (4).

ªÂ ÙÔÓ fiÚÔ ‰˘ÛÏÈȉ·È̛˜ ·Ó·Ê¤ÚÂÙ·È ÔÔÈ·-‰‹ÔÙ ÂÎÙÚÔ‹ ÙˆÓ ÂȤ‰ˆÓ ÙˆÓ ÏÈȉ›ˆÓ ÙÔ˘ ·›-Ì·ÙÔ˜ ¿Óˆ ·fi ÙËÓ 90‹ ‹ οو ·fi ÙË 10Ë Âη-ÙÔÛÙÈ·›· ı¤ÛË ÙˆÓ ÂȤ‰ˆÓ ÙÔ˘ ÁÂÓÈÎÔ‡ ÏËı˘-ÛÌÔ‡. Ÿˆ˜ ¤¯ÂÈ ·Ô‰Âȯı› Ì ÚÔÔÙÈΤ˜ ÌÂϤ-Ù˜ ÛÙÔ˘˜ ÂÓËÏ›ÎÔ˘˜, Ë ·˘ÍË̤ÓË ¯ÔÏËÛÙÂÚfiÏË Â›-Ó·È ·ÓÂÍ¿ÚÙËÙÔ˜ ·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ÂÌ-Ê¿ÓÈÛË ÚfiˆÚ˘ ·ıËڈ̿وÛ˘, ÂÓÒ ·ÓÙ›ÛÙÔȯ·,Ë Ì›ˆÛ‹ Ù˘ ÂÏ·ÙÙÒÓÂÈ ÙÔÓ Î·Ú‰È·ÁÁÂÈ·Îfi ΛӉ˘ÓÔ(5-8). ™Ù· ·È‰È¿, Ë ÂÎÙ›ÌËÛË ÙÔ˘ ηډȷÁÁÂÈ·ÎÔ‡ÎÈÓ‰‡ÓÔ˘ Á›ÓÂÙ·È Ì ‚¿ÛË ÙËÓ ·ÍÈÔÏfiÁËÛË ÙˆÓ ·-Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ Ô˘ ¤¯Ô˘Ó ·Ô‰Âȯı› ÛËÌ·ÓÙÈ-ÎÔ› ÁÈ· ÙÔ˘˜ ÂÓËÏ›ÎÔ˘˜ (9).

∞ÓÂÍ¿ÚÙËÙÔÈ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ÂΉ‹ÏˆÛË Î·Ú‰È·ÁÁÂȷ΋˜ ÓfiÛÔ˘

∏ ·ÚÔ˘Û›· ÁÂÓÂÙÈÎÒÓ ‹ ÂÚÈ‚·ÏÏÔÓÙÈÎÒÓ ·-Ú·ÁfiÓÙˆÓ, fiˆ˜ Ë ËÏÈΛ· (>45 ÂÙÒÓ ÁÈ· ÙÔ˘˜ ¿Ó-‰Ú˜ Î·È >55 ÂÙÒÓ ÁÈ· ÙȘ Á˘Ó·›Î˜), ÙÔ ÔÈÎÔÁÂÓÂÈ-·Îfi ÈÛÙÔÚÈÎfi ÚÒÈÌ˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘ (¤Ì-ÊÚ·ÁÌ· Ì˘Ôηډ›Ô˘, ·ÈÊÓ›‰ÈÔ˜ ı¿Ó·ÙÔ˜, ·ÁÁÂÈ·ÎfiÂÁÎÂÊ·ÏÈÎfi ÂÂÈÛfi‰ÈÔ ‹ ÂÚÈÊÂÚÈ΋ ·ÚÙËÚÈÔÛÎÏ‹-Ú˘ÓÛË Û ÚÒÙÔ˘ ‚·ıÌÔ‡ Û˘ÁÁÂÓ‹, ËÏÈΛ·˜ ÌÈÎÚfi-ÙÂÚ˘ ÙˆÓ 55 ÂÙÒÓ ÚÔÎÂÈ̤ÓÔ˘ ÁÈ· ¿Ó‰Ú˜ ‹ ÌÈ-ÎÚfiÙÂÚ˘ ÙˆÓ 65 ÂÙÒÓ ÚÔÎÂÈ̤ÓÔ˘ ÁÈ· Á˘Ó·›Î˜),Ô Û·Î¯·Ú҉˘ ‰È·‚‹Ù˘, Ë ˘¤ÚÙ·ÛË, ÙÔ Î¿ÓÈ-ÛÌ·, Ë ·˘ÍË̤ÓË LDL-¯ÔÏËÛÙÂÚfiÏË Î·È Ë ¯·ÌËÏ‹HDL-¯ÔÏËÛÙÂÚfiÏË, ıˆÚÔ‡ÓÙ·È ·ÓÂÍ¿ÚÙËÙÔÈ ·Ú¿-ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË Î·Ú‰È·ÁÁÂȷ΋˜ÓfiÛÔ˘, ηıÒ˜ Ë ·ÚÔ˘Û›· ÂÓfi˜ ¤ÛÙˆ ·fi ·˘ÙÔ‡˜·ÚΛ ÁÈ· Ó· ·˘ÍËı› ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο Ë Èı·-ÓfiÙËÙ· ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘ (5).

ª·ÎÚÔ¯ÚfiÓȘ ÌÂϤÙ˜ ÁÈ· ÙË Û˘Û¯¤ÙÈÛË ˘ÂÚ-¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·˜ Î·È Î·Ú‰È·ÁÁÂȷ΋˜ ÓfiÛÔ˘Ô‰‹ÁËÛ·Ó ÛÙÔÓ Î·ıÔÚÈÛÌfi ÂÈı˘ÌËÙÒÓ(desirable) Î·È ·Ô‰ÂÎÙÒÓ (acceptable) ÂȤ‰ˆÓÁÈ· ÙËÓ ÔÏÈ΋ Î·È Î˘Ú›ˆ˜ ÁÈ· ÙËÓ LDL-¯ÔÏËÛÙÂÚfi-ÏË, ÙfiÛÔ ÛÙÔ˘˜ ÂÓ‹ÏÈΘ fiÛÔ Î·È ÛÙ· ·È‰È¿ (¶›-ӷΘ 1 Î·È 2). ∆· ÂÈı˘ÌËÙ¿ ›‰· ·ÓÙÈÛÙÔÈ-¯Ô‡Ó ÂÚ›Ô˘ ÛÙËÓ 75Ë ÂηÙÔÛÙÈ·›· ı¤ÛË ÙˆÓ ÂÈ-¤‰ˆÓ ÙÔ˘ ÁÂÓÈÎÔ‡ ÏËı˘ÛÌÔ‡ Î·È Ù· ·Ô‰ÂÎÙ¿ÛÙËÓ 90‹ ÂηÙÔÛÙÈ·›· ı¤ÛË. ¶·ıÔÏÔÁÔ·Ó·ÙÔÌÈΤ˜ÌÂϤÙ˜ Û ·È‰È¿ ¤‰ÂÈÍ·Ó fiÙÈ Ë ·ıËڈ̿وÛËÙˆÓ ·ÁÁ›ˆÓ ·˘Í¿ÓÂÙ·È ÛËÌ·ÓÙÈο fiÙ·Ó Ù· ›Â-‰· Ù˘ ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ ˘ÂÚ‚·›ÓÔ˘Ó ÙËÓ90‹ ÂηÙÔÛÙÈ·›· ı¤ÛË (9). ™Â Ì›· ·Ï·ÈfiÙÂÚË ÂÏ-ÏËÓÈ΋ ÌÂϤÙË Û ·ÛÙÈÎfi ÏËı˘ÛÌfi, Ë 75Ë Î·È Ë90‹ ÂηÙÔÛÙÈ·›· ı¤ÛË ÁÈ· ÙËÓ ÔÏÈ΋ Î·È ÙËÓ LDL-¯ÔÏËÛÙÂÚfiÏË Î·È Ù· ÙÚÈÁÏ˘ÎÂÚ›‰È·, fiˆ˜ Î·È Ë10Ë ÂηÙÔÛÙÈ·›· ı¤ÛË ÁÈ· ÙËÓ ∏DL-¯ÔÏËÛÙÂÚfiÏË,‹Ù·Ó ·ÚfiÌÔȘ Ì ÂΛӘ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÁÈ·ÙÔ˘˜ ·È‰ÈÎÔ‡˜ ÏËı˘ÛÌÔ‡˜ Í¤ÓˆÓ ¯ˆÚÒÓ (10).¶ÚfiÛÊ·ÙË, fï˜, ÂÏÏËÓÈ΋ ÌÂϤÙË ¤‰ÂÈÍ ˘„ËÏfi-ÙÂÚ˜ ÙÈ̤˜ ÔÏÈ΋˜ Î·È LDL-¯ÔÏËÛÙÂÚfiÏ˘ ÁÈ· ÙËÓ75Ë Î·È ÙËÓ 90‹ ÂηÙÔÛÙÈ·›· ı¤ÛË (11), ‡ÚËÌ·Ô˘ ·ÔÙÂÏ› ¤Ó‰ÂÈÍË ·‡ÍËÛ˘ ÙˆÓ ÂȤ‰ˆÓ ÙˆÓÏÈȉ›ˆÓ ÛÙÔÓ ÁÂÓÈÎfi ·È‰ÈÎfi ÏËı˘ÛÌfi. ªÂٷ͇·È‰ÈÒÓ ·fi 17 ¯ÒÚ˜, Ù· ∂ÏÏËÓfiÔ˘Ï· ‚Ú›ÛÎÔ-ÓÙ·È ÛÙË ‰Â‡ÙÂÚË ı¤ÛË Ì ٷ ˘„ËÏfiÙÂÚ· ›‰·ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ Î·È ÌÂٷ͇ ·È‰ÈÒÓ ·fi 8¯ÒÚ˜, η٤¯Ô˘Ó ÙË ‰Â‡ÙÂÚË ı¤ÛË Ì ٷ ˘„ËÏfiÙÂ-Ú· ›‰· LDL-¯ÔÏËÛÙÂÚfiÏ˘ (12).

™Ù· ·È‰È¿ ÂÌÊ·Ó›˙ÔÓÙ·È Î·È ¿ÏϘ, Ôχ Û¿-ÓȘ, ÌÔÚʤ˜ ‰˘ÛÏÈȉ·ÈÌ›·˜, fiˆ˜ ÙÔ Û‡Ó‰ÚÔÌÔ¯˘ÏÔÌÈÎÚÔÓ·ÈÌ›·˜, ÙÔ ÔÔ›Ô ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fiÔχ ÌÂÁ¿ÏË ·‡ÍËÛË ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ, ¿ıËÛËÔ˘ ‰ÂÓ ·˘Í¿ÓÂÈ ÙÔÓ Î·Ú‰È·ÁÁÂÈ·Îfi ΛӉ˘ÓÔ, ÌÔ-Ú› fï˜ Ó· ÚÔηϤÛÂÈ ÔÍ›· ‹ ¯ÚfiÓÈ· ·ÁÎÚ·ٛ-Ùȉ· Î·È ·ÁÎÚ·ÙÈ΋ ·Ó¿ÚÎÂÈ·.

µ·ÛÈο ÛÙÔȯ›· ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ OÈ ÏÈÔÚˆÙ½Ó˜ Â›Ó·È ÛˆÌ·Ù›‰È· Ô˘ ·ÔÙÂ-

ÏÔ‡ÓÙ·È ·fi ÏÈ›‰È· (ÂχıÂÚË Î·È ÂÛÙÂÚÔÔÈË̤-ÓË ¯ÔÏËÛÙÂÚfiÏË, ʈÛÊÔÏÈ›‰È· Î·È ÙÚÈÁÏ˘ÎÂÚ›‰È·)Î·È ·fi ÚˆÙ½Ó˜ (·ÔÏÈÔÚˆÙ½Ó˜). O ÚfiÏÔ˜ÙÔ˘˜ Â›Ó·È Ë ÌÂÙ·ÊÔÚ¿ ÛÙÔ Ï¿ÛÌ· ÙˆÓ ˘‰ÚfiÊÔ-‚ˆÓ ÏÈȉ›ˆÓ, ‰ËÏ·‰‹ ÙˆÓ ÂÛÙ¤ÚˆÓ ¯ÔÏËÛÙÂÚfiÏË˜Î·È ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ Ô˘ ·ÔÚÚÔÊÔ‡ÓÙ·È ·fiÙÔ ¤ÓÙÂÚÔ ‹ ·Ú¿ÁÔÓÙ·È ÛÙÔ ‹·Ú. ∏ ÔÓÔÌ·Û›·

∏ ·ÓÙÈÌÂÙÒÈÛË ·˘Ù‹ Ú¤ÂÈ Ó· ·ÊÔÚ¿ Û fiÏ· Ù··È‰È¿ Î·È fi¯È ÌfiÓÔ Û ÂΛӷ Ì ‰˘ÛÏÈȉ·ÈÌ›·.

§¤ÍÂȘ ÎÏÂȉȿ: ‰˘ÛÏÈȉ·ÈÌ›· Û ·È‰È¿, ‰È¿ÁÓˆÛË,¤ÏÂÁ¯Ô˜, ıÂڷ›·.

Key words: dyslipidaemia in children, diagnosis,investigation, treatment.

152

¶·È‰È·ÙÚÈ΋ 2004;67:151-159 Paediatriki 2004;67:151-159

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·152

Page 10: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

153

¶·È‰È·ÙÚÈ΋ 2004;67:151-159 Paediatriki 2004;67:151-159

ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ, ÂÎÙfi˜ ÙˆÓ ¯˘ÏÔÌÈÎÚÒÓ, ηıÔ-Ú›˙ÂÙ·È ·fi ÙËÓ ˘ÎÓfiÙËÙ¿ ÙÔ˘˜, ÙË Û¯ÂÙÈ΋ ‰ËÏ·-‰‹ ÂÚÈÂÎÙÈÎfiÙËÙ· Û ÏÈ›‰È· Î·È ÚˆÙ½Ó˜. OÈVLDL (very low density lipoproteins) Â›Ó·È ÔÈ ÏÈÔ-ÚˆÙ½Ó˜ Ôχ ¯·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜, ÔÈ IDL(intermediate density lipoproteins) Â›Ó·È ÔÈ ÏÈÔ-ÚˆÙ½Ó˜ ÂӉȿÌÂÛ˘ ˘ÎÓfiÙËÙ·˜, ÔÈ LDL (lowdensity lipoproteins) Â›Ó·È ÔÈ ÏÈÔÚˆÙ½Ó˜ ¯·ÌË-Ï‹˜ ˘ÎÓfiÙËÙ·˜ Î·È ÔÈ HDL (high densitylipoproteins) Â›Ó·È ÔÈ ÏÈÔÚˆÙ½Ó˜ ˘„ËÏ‹˜ ˘-ÎÓfiÙËÙ·˜. ∏ Lp(a), ‰ËÏ·‰‹ Ë ÏÈÔÚˆÙ½ÓË (a),¤¯ÂÈ ›‰ÈÔ Ì¤ÁÂıÔ˜ Î·È ˘ÎÓfiÙËÙ· Ì ÙȘ LDL, ·ÏÏ¿ÂÚȤ¯ÂÈ ÂÈϤÔÓ ÙËÓ ·ÔÏÈÔÚˆÙ½ÓË (a). O η-ıÔÚÈÛÌfi˜ Ù˘ ˘ÎÓfiÙËÙ·˜ ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ Á›-ÓÂÙ·È Ì ˘ÂÚÊ˘ÁÔΤÓÙÚËÛË (¶›Ó·Î·˜ 3). ∆Ô ÂÚ›-‚ÏËÌ· ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ ·ÔÙÂÏÂ›Ù·È ·fi ʈ-ÛÊÔÏÈ›‰È· Î·È ÂχıÂÚË ¯ÔÏËÛÙÂÚfiÏË Î·È Â›Ó·È˘‰ÚfiÊÈÏÔ. ∆· ÙÚÈÁÏ˘ÎÂÚ›‰È· Î·È ÔÈ ÂÛÙ¤Ú˜ ¯ÔÏË-ÛÙÂÚfiÏ˘ ‚Ú›ÛÎÔÓÙ·È ÛÙÔ ÂÛˆÙÂÚÈÎfi, ÛÙÔÓ ˘Ú‹-Ó· ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ Î·È ÔÈ ·ÔÏÈÔÚˆÙ½Ó˜ÛÙËÓ ÂÈÊ¿ÓÂÈ·.

∆· ¯˘ÏÔÌÈÎÚ¿ ÂÚȤ¯Ô˘Ó ΢ڛˆ˜ ÙÚÈÁÏ˘ÎÂÚ›‰È·Î·È ·Ú¿ÁÔÓÙ·È ÛÙÔ ¤ÓÙÂÚÔ ·fi Ù· ÏÈ›‰È· Ù˘ ÙÚÔ-Ê‹˜. OÈ VLDL ÂÚȤ¯Ô˘Ó ΢ڛˆ˜ ÙÚÈÁÏ˘ÎÂÚ›‰È· ηȷڿÁÔÓÙ·È ÛÙÔ ‹·Ú ·fi Ù· ÏÈ›‰È· Ô˘ ·Ú¿ÁÔ-ÓÙ·È ÂÓ‰ÔË·ÙÈο ‹ ÌÂٷʤÚÔÓÙ·È ÂΛ ·fi ÙÔÓ ÏÈ-Ò‰Ë ÈÛÙfi ‹ ÙËÓ Î˘ÎÏÔÊÔÚ›·. ™ÙËÓ Î˘ÎÏÔÊÔÚ›·, ÌÂÙË ‰Ú¿ÛË Ù˘ ÏÈÔÚˆÙÂ˚ÓÈ΋˜ ÏÈ¿Û˘, Ù· ÙÚÈÁÏ˘-ÎÂÚ›‰È· ÙˆÓ ¯˘ÏÔÌÈÎÚÒÓ Î·È ÙˆÓ VLDL ·Ô‰›‰Ô˘ÓÂχıÂÚ· ÏÈ·Ú¿ Ôͤ·, Ô˘ ÂÈÛ¤Ú¯ÔÓÙ·È ÛÙ· ·Ù-Ù·Ú· Î·È ÔÍÂȉÒÓÔÓÙ·È ÁÈ· ÙËÓ ·Ú·ÁˆÁ‹ ATP. ∆·ÛˆÌ·Ù›‰È· Ô˘ ·Ô̤ÓÔ˘Ó ÌÂÙ¿ ÙË ‰Ú¿ÛË Ù˘ ÏÈ-ÔÚˆÙÂ˚ÓÈ΋˜ ÏÈ¿Û˘ ÛÙ· ¯˘ÏÔÌÈÎÚ¿ Î·È ÛÙȘVLDL ϤÁÔÓÙ·È ˘ÔÏ›ÌÌ·Ù· ¯˘ÏÔÌÈÎÚÒÓ Î·È ˘Ô-Ï›ÌÌ·Ù· VLDL ‹ IDL, ·ÓÙ›ÛÙÔȯ·. OÈ ÂÛÙ¤Ú˜ ¯ÔÏË-ÛÙÂÚfiÏ˘ ÂÈÛ¤Ú¯ÔÓÙ·È Ì¤Û· ÛÙ· ·ÙÙ·Ú·, fiÔ˘·Ô‰›‰Ô˘Ó ÂχıÂÚË ¯ÔÏËÛÙÂÚfiÏË.

∏ ¯ÔÏËÛÙÂÚfiÏË Â›Ó·È ·Ó·Áη›· ÁÈ· ÙË Û‡ÓıÂÛËÙˆÓ Î˘ÙÙ·ÚÈÎÒÓ ÌÂÌ‚Ú·ÓÒÓ Û fiÏ· Ù· ·ÙÙ·Ú·,ÁÈ· ÙËÓ ·Ú·ÁˆÁ‹ ÙˆÓ ÛÙÂÚÔÂȉÒÓ ÔÚÌÔÓÒÓ

ÛÙÔ˘˜ ÛÙÂÚÔÂȉԷڷÁˆÁÔ‡˜ ÈÛÙÔ‡˜ (ÂÈÓÂÊÚ›-‰È·, ÁÔÓ¿‰Â˜, Ï·ÎÔ‡ÓÙ·˜), Ù˘ ‚ÈÙ·Ì›Ó˘ D ÛÙÔ‰¤ÚÌ· Î·È ÙˆÓ ¯ÔÏÈÎÒÓ ·Ï¿ÙˆÓ ÛÙÔ ‹·Ú. OÈ IDL(‹ ˘ÔÏ›ÌÌ·Ù· VLDL) ηٿ 50% ÚÔÛÏ·Ì‚¿ÓÔ-ÓÙ·È ·fi ÙÔ˘˜ ÈÛÙÔ‡˜ Î·È Î·Ù¿ 50% ÌÂÙ·ÙÚ¤ÔÓÙ·ÈÂÓ‰·ÁÁÂȷο Û LDL, Ô˘ ÂÚȤ¯ÂÈ ·ÔÎÏÂÈÛÙÈοۯ‰fiÓ ÂÛÙ¤Ú˜ ¯ÔÏËÛÙÂÚfiÏ˘. ∏ ›ÛÔ‰Ô˜ ÙˆÓLDL ̤۷ ÛÙ· ·ÙÙ·Ú· Á›ÓÂÙ·È Ì¤Ûˆ ÙÔ˘ ÂȉÈÎÔ‡˘Ô‰Ô¯¤· Ù˘ LDL ÛÙËÓ ÂÈÊ¿ÓÂÈ· ÙˆÓ Î˘ÙÙ¿ÚˆÓ.O ηٷ‚ÔÏÈÛÌfi˜ ÙˆÓ ˘ÔÏÂÈÌÌ¿ÙˆÓ Á›ÓÂÙ·È Ì¤ÛˆÙ˘ ÚfiÛÏË„‹˜ ÙÔ˘˜ ·fi ÂȉÈÎÔ‡˜ ΢ÙÙ·ÚÈÎÔ‡˜˘Ô‰Ô¯Â›˜, ÙÔ˘˜ ˘Ô‰Ô¯Â›˜ ÙˆÓ ˘ÔÏÂÈÌÌ¿ÙˆÓ. ∏HDL ·Ú¿ÁÂÙ·È ÛÙÔ ‹·Ú Î·È ÙÔ ¤ÓÙÂÚÔ. ∂›Ó·È·ÓÙÈ·ıËÚÔÁfiÓÔ˜, ÁÈ·Ù› ÂÈÙÂÏ› ÙË ÏÂÁfiÌÂÓË “·Ó¿-ÛÙÚÔÊË ÌÂÙ·ÊÔÚ¿ ¯ÔÏËÛÙÂÚfiÏ˘”, ÙË ÌÂÙ·ÊÔÚ¿‰ËÏ·‰‹ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ ·fi ÙÔ˘˜ ÈÛÙÔ‡˜,fiˆ˜ ÙÔ ·ÁÁÂÈ·Îfi ÙÔ›¯ˆÌ·, ÚÔ˜ ÙÔ ‹·Ú, fiÔ˘ÌÂÙ·‚ÔÏ›˙ÂÙ·È (13-16).

OÈ ·ÔÏÈÔÚˆÙ½Ó˜ Â›Ó·È ·Ó·Áη›Â˜ ÁÈ· ÙËÛ‡ÓıÂÛË Î·È ÙÔÓ ÌÂÙ·‚ÔÏÈÛÌfi ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ(17). OÈ Î˘ÚÈfiÙÂÚ˜ Â›Ó·È Ë ·Ô-µ, Ô˘ ‚Ú›ÛÎÂÙ·ÈÛÙÔ ÛˆÌ·Ù›‰ÈÔ ÙˆÓ ¯˘ÏÔÌÈÎÚÒÓ Î·È ÙˆÓ ˘ÔÏÂÈÌÌ¿-ÙˆÓ ÙÔ˘˜, ÙˆÓ VLDL, ÙˆÓ IDL Î·È ÙˆÓ LDL, Ë ·Ô-∞πÛÙȘ HDL, Ë ·Ô-CII, Ë ·Ô-CIII Î·È Ë ·Ô-∂ ÛÙ· ¯˘-ÏÔÌÈÎÚ¿, ÛÙȘ VLDL Î·È Ù· ˘ÔÏ›ÌÌ·Ù¿ ÙÔ˘˜. ∏·ÔÏÈÔÚˆÙ½ÓË (a) ‚Ú›ÛÎÂÙ·È ·ÔÎÏÂÈÛÙÈο ÛÙËÓLp(a). ∏ ·Ô-µ Â›Ó·È ÙÔ ÚfiÛ‰ÂÌ· ÁÈ· ÙË Û‡Ó‰ÂÛËÙˆÓ LDL Ì ÙÔÓ ˘Ô‰Ô¯¤· ÙÔ˘˜ Î·È Ë ·Ô-∂ Â›Ó·È ÙÔÚfiÛ‰ÂÌ· ÁÈ· ÙË Û‡Ó‰ÂÛË ÙˆÓ ˘ÔÏÂÈÌÌ¿ÙˆÓ ÌÂÙÔÓ ˘Ô‰Ô¯¤· ÙÔ˘˜. ∏ ·Ô-∞π Â›Ó·È ·Ó·Áη›· ÁÈ·ÙÔÓ Û¯ËÌ·ÙÈÛÌfi ÙˆÓ HDL.

∏ ·Ô-µ Ô˘ ÚÔÛ‰ÈÔÚ›˙ÂÙ·È ÛÙÔ ·›Ì· ÛÙË ÓË-ÛÙ›·, Â›Ó·È Î·Ù¿ 90% Ë ·Ô-µ ÙˆÓ LDL Î·È ·˘ÍË̤-Ó· ›‰¿ Ù˘ ÛÙÔ ·›Ì· Û˘Ó‰˘¿˙ÔÓÙ·È Û˘Ó‹ıˆ˜ Ì·˘ÍË̤ÓË LDL-¯ÔÏËÛÙÂÚfiÏË, ÂÓÒ ¯·ÌËÏ¿ ›‰·Ù˘ ·Ô-∞π Ì ¯·ÌËÏ‹ HDL-¯ÔÏËÛÙÂÚfiÏË.

∞ıËÚÔÁfiÓ˜ ȉÈfiÙËÙ˜ ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ ∞ıËÚÔÁfiÓ˜ Â›Ó·È ÔÈ ÌÈÎÚÔ‡ ÌÂÁ¤ıÔ˘˜ ÏÈÔÚˆ-

Ù½Ó˜, fiˆ˜ ÔÈ LDL, Ù· ˘ÔÏ›ÌÌ·Ù· ¯˘ÏÔÌÈÎÚÒÓ, ÔÈIDL Î·È Ë Lp(a), Ô˘ ÏfiÁˆ ÌÂÁ¤ıÔ˘˜ ÌÔÚÔ‡Ó Ó· ÂÈ-Û¤ÏıÔ˘Ó Î·È Ó· ·Ú·Ì›ÓÔ˘Ó ÛÙÔ ·ÁÁÂÈ·Îfi ÙÔ›¯ˆÌ·.∂ȉÈÎfiÙÂÚ·, ÔÈ LDL Î·È Ë Lp(a) ˘Ê›ÛÙ·ÓÙ·È ÔÍ›‰ˆÛË,‰ËÏ·‰‹ ÙÚÔÔÔ›ËÛË ÙÔ˘ ÌÔÚ›Ô˘ ÙÔ˘˜, Ô˘ ·˘Í¿ÓÂÈÙȘ ·ıËÚÔÁfiÓ˜ ȉÈfiÙËÙ¤˜ ÙÔ˘˜. ∆· ¯˘ÏÔÌÈÎÚ¿ Î·È ÔÈ

¶›Ó·Î·˜ 1. ∂Èı˘ÌËÙ¿ Î·È ·Ô‰ÂÎÙ¿ ›‰· ÏÈȉ›ˆÓ Î·È ÏÈÔÚˆÙÂ˚ÓÒÓ ÔÚÔ‡ ÛÙ· ·È‰È¿

OÏÈ΋ LDL- HDL- ∆ÚÈÁÏ˘ÎÂÚ›‰È· Lp(a)¯ÔÏËÛÙÂÚfiÏË ¯ÔÏËÛÙÂÚfiÏË ¯ÔÏËÛÙÂÚfiÏË (mg%) (mg%)

(mg%) (mg%) (mg%)

∂Èı˘ÌËÙ¿ ≤170 ≤110 ≥45 ≤80 <30∞Ô‰ÂÎÙ¿ 171-200 111-130 40-45 81-100∞˘ÍË̤ӷ >200 >130 >60 >100 >30

¶›Ó·Î·˜ 2. ∂Èı˘ÌËÙ¿ ›‰· ·ÔÏÈÔÚˆÙÂ˚ÓÒÓ ÔÚÔ‡ ÛÙ··È‰È¿

·Ô-∞π (mg%) ·Ô-µ (mg%)≥120 ≤90

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·153

Page 11: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

154

¶·È‰È·ÙÚÈ΋ 2004;67:151-159 Paediatriki 2004;67:151-159

VLDL, ÏfiÁˆ ÙÔ˘ ÌÂÁ¿ÏÔ˘ Û¯ÂÙÈο ÌÂÁ¤ıÔ˘˜ ÙÔ˘˜,‰ÂÓ ÌÔÚÔ‡Ó Ó· ÂÈÛ¤ÏıÔ˘Ó Â‡ÎÔÏ· ÛÙÔ ·ÁÁÂÈ·ÎfiÙÔ›¯ˆÌ· Î·È ‰ÂÓ Â›Ó·È ·ıËÚÔÁfiÓ˜.

ªÂÙ·‚ÔϤ˜ ÙˆÓ ÏÈȉ›ˆÓ ÙÔ˘ ·›Ì·ÙÔ˜ Ì ÙËÓ ËÏÈΛ· ™ÙËÓ ÂÎÙ›ÌËÛË ÙÔ˘ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘

ÛÙ· ·È‰È¿ Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÂÙ·È ˘’ fi„ÈÓ fiÙÈ Ù·Â›Â‰· Ù˘ ÔÏÈ΋˜ Î·È Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘ ηÈÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ ·˘Í¿ÓÔÓÙ·È Ì ÙËÓ ËÏÈΛ· ηÈÛÙ· ‰‡Ô ʇϷ, ÂÓÒ Ù· ›‰· Ù˘ HDL-¯ÔÏËÛÙÂ-ÚfiÏ˘ ÛÙ· ÎÔÚ›ÙÛÈ· ·Ú·Ì¤ÓÔ˘Ó ÁÂÓÈο ÛÙ·ıÂÚ¿ ‹·˘Í¿ÓÔÓÙ·È, ÂÓÒ ÛÙ· ·ÁfiÚÈ· ÌÂÈÒÓÔÓÙ·È Ì ÙËÓÂÊ˂›· (18-21). ÕÚ·, Â¿Ó Ù· ›‰· ÙˆÓ ÏÈȉ›ˆÓÂ›Ó·È ‰˘ÛÌÂÓ‹ ·fi ÙËÓ ·È‰È΋ ËÏÈΛ·, ·Ó·Ì¤ÓÂÙ·ÈÓ· ÂȉÂÈÓˆıÔ‡Ó ÛÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹.

¶ÚˆÙÔ·ı›˜ ‰˘ÛÏÈȉ·È̛˜ ÛÙ· ·È‰È¿ ∏ Û˘¯ÓfiÙÂÚË ÚˆÙÔ·ı‹˜ ‰˘ÛÏÈȉ·ÈÌ›· ÛÙ·

·È‰È¿ Â›Ó·È Ë ÔÈÎÔÁÂÓ‹˜ ÔÏ˘ÁÔÓȉȷ΋ ˘ÂÚ¯ÔÏË-ÛÙÂÚÔÏ·ÈÌ›·, fiˆ˜ Î·È ÛÙÔ˘˜ ÂÓ‹ÏÈΘ (22). O ÂÈ-ÔÏ·ÛÌfi˜ Ù˘, Û ͤÓ˜ ÛÙ·ÙÈÛÙÈΤ˜, ·Ó·Ê¤ÚÂÙ·È·fi 1/100 ¤ˆ˜ 1/20. OÈ ˘Â‡ı˘Ó˜ ÁÔÓȉȷΤ˜ ‰È·-Ù·Ú·¯¤˜ Â›Ó·È ¿ÁÓˆÛÙ˜, ·ÏÏ¿ Ë ÏÔ‡ÛÈ· ‰È·ÙÚÔÊ‹Û ÏÈ·Ú¿ Î·È Ë ·¯˘Û·ÚΛ· ·˘Í¿ÓÔ˘Ó ÙËÓ Èı·Ófi-ÙËÙ· ÂÌÊ¿ÓÈÛ‹˜ Ù˘ (23). ∏ ÔÏÈ΋ Î·È Ë LDL-¯ÔÏË-ÛÙÂÚfiÏË Â›Ó·È ·˘ÍË̤Ó˜. ™ÙÔ˘˜ ÂÓ‹ÏÈΘ ˘¿Ú-¯Ô˘Ó Û˘¯Ó¿ Í·ÓıÂÏ¿ÛÌ·Ù· ÙˆÓ ‚ÏÂÊ¿ÚˆÓ ‹ Î·È Ùfi-ÍÔ ÎÂÚ·ÙÔÂȉԇ˜ (·ÚfiÌÔÈÔ Ì ÙÔ ÁÂÚÔÓÙfiÙÔÍÔ),fi¯È fï˜ Î·È ÛÙ· ·È‰È¿.

∏ ÂÙÂÚfi˙˘ÁË ÔÈÎÔÁÂÓ‹˜ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·ÔÊ›ÏÂÙ·È Û ÌÂÙ·ÏÏ¿ÍÂȘ ÙÔ˘ ˘Ô‰Ô¯¤· Ù˘ LDL,Ô˘ ÂÌÔ‰›˙Ô˘Ó ÙËÓ Â›ÛÔ‰Ô Ù˘ LDL ÛÙ· ·ÙÙ·Ú·Î·È ÙÔÓ ÌÂÙ·‚ÔÏÈÛÌfi Ù˘ (24,25). ∞ÔÙ¤ÏÂÛÌ· ›ӷÈË Ôχ ÌÂÁ¿ÏË ·‡ÍËÛË Ù˘ ÔÏÈ΋˜ Î·È Ù˘ LDL-¯Ô-ÏËÛÙÂÚfiÏ˘ ÛÙÔ ·›Ì·. O ÂÈÔÏ·ÛÌfi˜ Ù˘ ÓfiÛÔ˘Û ‰È¿ÊÔÚ˜ ÂıÓfiÙËÙ˜ ·Ó·Ê¤ÚÂÙ·È ·fi 1/500 ¤ˆ˜1/270. ÷ڷÎÙËÚÈÛÙÈÎfi Ù˘ ÓfiÛÔ˘ ÛÙÔ˘˜ ÂÓ‹ÏÈΘ

Â›Ó·È Ù· ÙÂÓfiÓÙÈ· Í·ÓıÒÌ·Ù· ÛÙË Ú·¯È·›· ÂÈÊ¿ÓÂÈ·Ù˘ ·Ï¿Ì˘, ÙÔ˘˜ ·ÁÎÒÓ˜, Ù· ÁfiÓ·Ù· ‹ ÛÙÔ˘˜·¯›ÏÏÂÈÔ˘˜ Ù¤ÓÔÓÙ˜. ™˘¯Ó¿ ˘¿Ú¯Ô˘Ó Î·È Â‰Ò Í·Ó-ıÂÏ¿ÛÌ·Ù· ‚ÏÂÊ¿ÚˆÓ ‹ Î·È ÙfiÍÔ ÎÂÚ·ÙÔÂȉԇ˜. ∏ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ˜ ÂΉËÏÒÓÂÙ·È ÌÂÙ¿ ÙËÓ ËÏÈΛ· ÙˆÓ40 ÂÙÒÓ. ™Ù· ·È‰È¿ ‰ÂÓ ÂÌÊ·Ó›˙ÔÓÙ·È ÙÂÓfiÓÙÈ· Í·Ó-ıÒÌ·Ù· ‹ Í·ÓıÂÏ¿ÛÌ·Ù·, ı· Ú¤ÂÈ, fï˜, Ó· ·Ó·-˙ËÙÔ‡ÓÙ·È ÛÙÔ˘˜ ÁÔÓ›˜ ‹ ÙÔ˘˜ ·Ô‡‰Â˜. ∏ ÔÌfi-˙˘ÁË ÌÔÚÊ‹ Â›Ó·È Ôχ Û¿ÓÈ· Î·È ¯·Ú·ÎÙËÚ›˙ÂÙ·È·fi ÌÂÁ¿Ï·, Ô˙Ò‰Ë Í·ÓıÒÌ·Ù· Î·È ÂΉ‹ÏˆÛË ÛÙÂ-Ê·ÓÈ·›·˜ ÓfiÛÔ˘ ·fi ÙËÓ ·È‰È΋ ËÏÈΛ· (26). O ÂÈ-ÔÏ·ÛÌfi˜ Ù˘ Â›Ó·È 1/1.000.000.

∏ ÔÈÎÔÁÂÓ‹˜ ˘Ô-·ÏÊ·-ÏÈÔÚˆÙÂ˚Ó·ÈÌ›· ¯·Ú·-ÎÙËÚ›˙ÂÙ·È ·fi ¯·ÌËÏ‹ ÙÈÌ‹ Ù˘ HDL-¯ÔÏËÛÙÂÚfiÏ˘,‰ËÏ·‰‹ 20-40 mg% (Ë HDL ÔÓÔÌ¿˙ÂÙ·È ·-ÏÈÔÚˆ-Ù½ÓË ÁÈ·Ù› ÛÙËÓ ËÏÂÎÙÚÔÊfiÚËÛË ÎÈÓÂ›Ù·È ÛÙË ı¤ÛËÙˆÓ ·-ÛÊ·ÈÚÈÓÒÓ). ∏ ÔÏÈ΋ Î·È Ë LDL-¯ÔÏËÛÙÂÚfiÏËÂ›Ó·È Ê˘ÛÈÔÏÔÁÈΤ˜, ·ÏÏ¿ ÌÔÚ› Ó· ˘¿Ú¯ÂÈ ÌÈÎÚ‹·‡ÍËÛË ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ. ∏ ÓfiÛÔ˜ Â›Ó·È ÔÏ˘ÁÔ-Óȉȷ΋˜ Î·È ¿ÁÓˆÛÙ˘ ·ÈÙÈÔÏÔÁ›·˜ (27,28).

∏ ÔÈÎÔÁÂÓ‹˜ Û˘Ó‰˘·Ṳ̂ÓË ˘ÂÚÏÈȉ·ÈÌ›· ›ӷÈÛ¯ÂÙÈο Û˘¯Ó‹ Î·È ·ÚÔ˘ÛÈ¿˙ÂÙ·È Ì ˘ÂÚ¯ÔÏËÛÙÂ-ÚÔÏ·ÈÌ›· ‹/Î·È ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›·, Û˘¯Ó¿ Ì ¯·-ÌËÏ‹ HDL-¯ÔÏËÛÙÂÚfiÏË. ∆˘Èο, οÔÈ· ̤ÏË Ù˘ÔÈÎÔÁ¤ÓÂÈ·˜ ¤¯Ô˘Ó ÌfiÓÔ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·, ¿Ï-Ï· ÌfiÓÔ ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›· Î·È Î¿ÔÈ· ¿ÏÏ· ηÈÙȘ ‰‡Ô ‰È·Ù·Ú·¯¤˜. ™˘¯Ó¿, Ë ·Ô-µ Â›Ó·È ·˘ÍË̤-ÓË. ¶·È‰È¿ ÔÈÎÔÁÂÓÂÈÒÓ Ì ÙË ÓfiÛÔ ÌÔÚ› Ó· ¤¯Ô˘ÓÂÏ·ÊÚ¿ ·‡ÍËÛË Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ ‹/Î·È ÙˆÓ ÙÚÈ-ÁÏ˘ÎÂÚȉ›ˆÓ, ¯·ÌËÏ‹ HDL-¯ÔÏËÛÙÂÚfiÏË Î·È ·˘ÍË-̤ÓË ·Ô-µ. OÈ ˘Â‡ı˘Ó˜ ÁÔÓȉȷΤ˜ ‚Ï¿‚˜ ›ӷȿÁÓˆÛÙ˜, ·ÏÏ¿ Ë ÓfiÛÔ˜ Û˘Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ÈÓ-ÛÔ˘ÏÈÓÔ·ÓÙ›ÛÙ·ÛË Î·È ÙÔ ÌÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ(Û‡Ó‰ÚÔÌÔ Ã) (29,30).

∏ ÔÈÎÔÁÂÓ‹˜ ‰È·Ù·Ú·¯‹ Ù˘ ·Ô-µ ÔÊ›ÏÂÙ·È ÛÂÌÂÙ·ÏÏ¿ÍÂȘ Ù˘ ·Ô-µ, Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·‰˘Ó·-Ì›· Û‡Ó‰ÂÛ˘ Ù˘ LDL Ì ÙÔÓ ˘Ô‰Ô¯¤· Ù˘ Î·È ÙËÓ

¶›Ó·Î·˜ 3. ∆· ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ

¶˘ÎÓfiÙËÙ· ª¤ÁÂıÔ˜ ∆fiÔ˜ ∫‡ÚÈÔ ÏÈ›‰ÈÔ §ÂÈÙÔ˘ÚÁ›·(g/ml) (nm) ·Ú·ÁˆÁ‹˜ ÙÔ˘ ˘Ú‹Ó·

Ã˘ÏÔÌÈÎÚ¿ <0,95 75-1200 ŒÓÙÂÚÔ ∆ÚÈÁÏ˘ÎÂÚ›‰È· ¶·ÚÔ¯‹ ÏÈ·ÚÒÓ ÔͤˆÓ ÛÙÔ˘˜ ÈÛÙÔ‡˜

ÀÔÏ›ÌÌ·Ù· <1,006 40-70 ∂Ó‰·ÁÁÂȷο ∆ÚÈÁÏ˘ÎÂÚ›‰È· ¶·ÚÔ¯‹ ÏÈ·ÚÒÓ ÔͤˆÓ ¯˘ÏÔÌÈÎÚÒÓ ÛÙÔ˘˜ ÈÛÙÔ‡˜VLDL 0,95-1,006 30-80 ◊·Ú ∆ÚÈÁÏ˘ÎÂÚ›‰È· ¶·ÚÔ¯‹ ÏÈ·ÚÒÓ ÔͤˆÓ

ÛÙÔ˘˜ ÈÛÙÔ‡˜IDL 1,006-1,019 25-35 ∂Ó‰·ÁÁÂȷο ∆ÚÈÁÏ˘ÎÂÚ›‰È·, ÂÛÙ¤Ú˜ ¶·ÚÔ¯‹ ÏÈ·ÚÒÓ ÔͤˆÓ (˘ÔÏ›ÌÌ·Ù· VLDL) ¯ÔÏËÛÙÂÚfiÏ˘ ÛÙÔ˘˜ ÈÛÙÔ‡˜LDL 1,019-1,063 18-25 ∂Ó‰·ÁÁÂȷο ∂ÛÙ¤Ú˜ ¶·ÚÔ¯‹ ¯ÔÏËÛÙÂÚfiÏ˘

¯ÔÏËÛÙÂÚfiÏ˘ ÛÙÔ˘˜ ÈÛÙÔ‡˜HDL 1,063-1,21 5-12 ◊·Ú, ¤ÓÙÂÚÔ, ∂ÛÙ¤Ú˜ ªÂÙ·ÊÔÚ¿ ¯ÔÏËÛÙÂÚfiÏ˘ ·fi

ÂÓ‰·ÁÁÂȷο ¯ÔÏËÛÙÂÚfiÏ˘ ÙÔ˘˜ ÈÛÙÔ‡˜ ÚÔ˜ ÙÔ ‹·ÚLp(a) 1,055-1,085 20-25 ◊·Ú, ∂ÛÙ¤Ú˜ ¶·ÚÔ¯‹ ¯ÔÏËÛÙÂÚfiÏ˘

ÂÓ‰·ÁÁÂȷο (;) ¯ÔÏËÛÙÂÚfiÏ˘ ÛÙÔ˘˜ ÈÛÙÔ‡˜ (;)

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·154

Page 12: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

155

¶·È‰È·ÙÚÈ΋ 2004;67:151-159 Paediatriki 2004;67:151-159

·‡ÍËÛË Ù˘ ÔÏÈ΋˜ Î·È Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘ ÛÙÔ·›Ì·. ∫ÏÈÓÈο, ÌÔÈ¿˙ÂÈ Ôχ Ì ÙËÓ ÔÈÎÔÁÂÓ‹ ˘ÂÚ-¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·, ‰ÂÓ Ê·›ÓÂÙ·È fï˜ Ó· ·˘Í¿ÓÂÈÛÙÔÓ ›‰ÈÔ ‚·ıÌfi ÙÔÓ Î·Ú‰È·ÁÁÂÈ·Îfi ΛӉ˘ÓÔ. ™Â ͤ-Ó˜ ÌÂϤÙ˜, Ô ÂÈÔÏ·ÛÌfi˜ Ù˘ ·Ó·Ê¤ÚÂÙ·È ·fi1/1300 ¤ˆ˜ 1/200 (31).

∏ ÔÈÎÔÁÂÓ‹˜ ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›· ·ÚÔ˘ÛÈ¿˙ÂÈ·‡ÍËÛË ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ, Û˘¯Ó¿ Ì ¯·ÌËÏ‹HDL-¯ÔÏËÛÙÂÚfiÏË. ŸÏ· Ù· ¿Û¯ÔÓÙ· ̤ÏË Ù˘ ÔÈ-ÎÔÁ¤ÓÂÈ·˜ ¤¯Ô˘Ó ·˘ÍË̤ӷ ÌfiÓÔ Ù· ÙÚÈÁÏ˘ÎÂÚ›‰È·.OÈ ˘Â‡ı˘Ó˜ ÁÔÓȉȷΤ˜ ‰È·Ù·Ú·¯¤˜ Â›Ó·È ¿ÁÓˆ-ÛÙ˜, ÂÓÒ Ë ·‡ÍËÛË ÙÔ˘ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘ÛÙÔ ÓfiÛËÌ· ·˘Ùfi ‰ÂÓ Â›Ó·È ÙÂÎÌËÚȈ̤ÓË (32).

∆· ‰‡Ô ÙÂÏÂ˘Ù·›· ÓÔÛ‹Ì·Ù·, Ì ÙËÓ Â›‰Ú·ÛËοÔÈÔ˘ ‰Â˘ÙÂÚÔÁÂÓÔ‡˜ ·Ú¿ÁÔÓÙ· Ô˘ ·˘Í¿ÓÂÈ›Û˘ Ù· ÙÚÈÁÏ˘ÎÂÚ›‰È·, fiˆ˜ .¯. Ë Ï‹„Ë ·ÏÎÔfiÏ‹ Ê·Ú̿ΈÓ, ÌÔÚÔ‡Ó Ó· Ô‰ËÁ‹ÛÔ˘Ó Û ۇӉÚÔÌÔ¯˘ÏÔÌÈÎÚÔÓ·ÈÌ›·˜. ™ÙÔ Û‡Ó‰ÚÔÌÔ ·˘Ùfi, Ù· ›‰·ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ ÙÔ˘ ·›Ì·ÙÔ˜ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚ· ·fi1000 mg% Î·È ˘¿Ú¯ÂÈ Î›Ó‰˘ÓÔ˜ ÂÌÊ¿ÓÈÛ˘ ÔÍ›·˜·ÁÎÚ·ٛÙȉ·˜ ηÈ, Û ·ÓÂÈÏËÌ̤ӷ ÂÂÈÛfi‰È·,ÂӉ¯fiÌÂÓË ÂΉ‹ÏˆÛË ·ÁÎÚ·ÙÈ΋˜ ·Ó¿ÚÎÂÈ·˜.

∏ ÔÈÎÔÁÂÓ‹˜ ·‡ÍËÛË Ù˘ Lp(a) ÂÌÊ·Ó›˙ÂÈ ·˘ÍË-̤ÓË ÙÈÌ‹ Ù˘ Lp(a), ¯ˆÚ›˜ ¿ÏÏË ‰È·Ù·Ú·¯‹ ÙˆÓ ÏÈ-ȉ›ˆÓ. ∂Âȉ‹, fï˜, Ë ·˘ÍË̤ÓË Lp(a) ıˆÚ›ٷȷÓÂÍ¿ÚÙËÙÔ˜ ·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘, Ô Î·Ú‰È·ÁÁÂÈ-·Îfi˜ ΛӉ˘ÓÔ˜ ·˘Í¿ÓÂÙ·È (33,34). ∏ ÌÂÌÔӈ̤ÓË·‡ÍËÛË Ù˘ Lp(a) Â›Ó·È Û¯ÂÙÈο Û¿ÓÈ·, ·ÏÏ¿ ·˘ÍË-̤ÓË Lp(a) Û˘Ó˘¿Ú¯ÂÈ Û˘¯Ó¿ Ì ¿ÏÏË ‰˘ÛÏÈȉ·È-Ì›·, fiˆ˜ ·˘ÍË̤ÓË LDL-¯ÔÏËÛÙÂÚfiÏË ‹ ¯·ÌËÏ‹HDL-¯ÔÏËÛÙÂÚfiÏË.

∏ ÔÈÎÔÁÂÓ‹˜ ‰˘Û-‚ËÙ·-ÏÈÔÚˆÙÂ˚Ó·ÈÌ›· ›ӷÈÔχ Û¿ÓÈ·. OÊ›ÏÂÙ·È Û ÌÂÙ·ÏÏ¿ÍÂȘ Ù˘ ·ÔÏÈ-ÔÚˆÙ½Ó˘ ∂, Ô˘ ÌÂÈÒÓÔ˘Ó ÙÔÓ ÌÂÙ·‚ÔÏÈÛÌfiÙˆÓ ˘ÔÏÂÈÌÌ¿ÙˆÓ ¯˘ÏÔÌÈÎÚÒÓ Î·È ÙˆÓ IDL. ∏ ÔÏÈ-

΋ Î·È Ë LDL-¯ÔÏËÛÙÂÚfiÏË, ηıÒ˜ Î·È Ù· ÙÚÈÁÏ˘ÎÂ-Ú›‰È· Â›Ó·È Ôχ ·˘ÍË̤ӷ. ¶·ıÔÁÓˆÌÔÓÈÎfi ‡ÚË-Ì· Â›Ó·È Ù· ·Ï·ÌÈ·›· Í·ÓıÒÌ·Ù·, Ë ÂÓ·fiıÂÛË,‰ËÏ·‰‹, ÏÈȉ›ˆÓ ÛÙȘ ÁÚ·ÌÌÒÛÂȘ Ù˘ ·Ï¿Ì˘,ÂÓÒ ˘¿Ú¯Ô˘Ó Î·È Ô˙Ò‰Ë ÙÂÓfiÓÙÈ· Í·ÓıÒÌ·Ù·ÛÙÔ˘˜ ·ÁÎÒÓ˜ Î·È Ù· ÁfiÓ·Ù· (35-37) (¶›Ó·Î·˜ 4).

¶Ú¤ÂÈ Ó· ÙÔÓÈÛÙ› fiÙÈ Ì ‚¿ÛË ÌfiÓÔ ÙËÓ ÎÏÈÓÈ΋ÂÈÎfiÓ·, Â›Ó·È ·‰‡Ó·ÙÔ, Û˘Ó‹ıˆ˜, Ó· ÙÂÎÌËÚȈı› Ì‚‚·ÈfiÙËÙ· Ô Ù‡Ô˜ Ù˘ ‰˘ÛÏÈȉ·ÈÌ›·˜.

¢Â˘ÙÂÚÔ·ı›˜ ‰˘ÛÏÈȉ·È̛˜ ™Ù· ·È‰È¿, ÌÔÚ› Ó· ÂÌÊ·ÓÈÛÙÔ‡Ó Î·È ‰Â˘ÙÂ-

ÚÔ·ı›˜ ‰˘ÛÏÈȉ·È̛˜, fiˆ˜ ˘ÂÚ¯ÔÏËÛÙÂÚÔ-Ï·ÈÌ›· Û ˘Ôı˘ÚÂÔÂȉÈÛÌfi Î·È ÓÂÊÚˆÛÈÎfi Û‡Ó-‰ÚÔÌÔ ‹ ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›· Û ۷ί·ÚÒ‰Ë ‰È·-‚‹ÙË Î·È ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ·, ηıÒ˜ Î·È ‰È¿ÊÔÚ˜‰È·Ù·Ú·¯¤˜ ·fi Ê¿Ú̷η (38-42) (¶›Ó·Î·˜ 5).

¢˘ÛÏÈȉ·È̛˜ Ì ¯·ÌËÏ¿ ›‰· ¯ÔÏËÛÙÂÚfiÏ˘ ∏ ÔÈÎÔÁÂÓ‹˜ ˘Ô-‚ËÙ·-ÏÈÔÚˆÙÂ˚Ó·ÈÌ›· (43,44)

¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ¯·ÌËÏ¿ ›‰· Ù˘ ÔÏÈ΋˜ (90-135 mg%) Î·È Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘ (60-85 mg%)Î·È ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ (<40 mg%). OÊ›ÏÂÙ·È ÛÂÌÂÙ·ÏÏ¿ÍÂȘ ÙÔ˘ ÁÔÓȉ›Ô˘ Ù˘ ·o-µ, Ì ·ÔÙ¤ÏÂÛÌ·ÙËÓ ·Ú·ÁˆÁ‹ Û˘ÁÎÂÎÔÌÌ¤ÓˆÓ ÌÔÚ›ˆÓ Ù˘ ·o-µ100Î·È Ù˘ ·Ô-µ48 (·o-µ4, ·o-µ9, ·o-µ25, Î.¿.) ‹ ÙËÓÏ‹ÚË ¤ÏÏÂÈ„Ë ·Ú·ÁˆÁ‹˜ ·Ô-µ. ∏ ¤ÏÏÂÈ„Ë ·Ô-µÔ‰ËÁ› Û ÌÂȈ̤ÓË ‹ Ï‹ÚË ·‰˘Ó·Ì›· ·Ú·ÁˆÁ‹˜ÏÈÔÚˆÙÂ˚ÓÒÓ. ∫ÏËÚÔÓÔÌÂ›Ù·È Ì ˘ÔÏÂÈfiÌÂÓÔ ¯·-Ú·ÎÙ‹Ú· Î·È ÔÈ ÂÙÂÚÔ˙˘ÁÒÙ˜ Â›Ó·È ·Û˘Ìو̷ÙÈÎÔ›.OÈ ÔÌÔ˙˘ÁÒÙ˜, fï˜, ·ÚÔ˘ÛÈ¿˙Ô˘Ó ‚·ÚÈ¿ ÎÏÈÓÈ΋ÂÈÎfiÓ·, Ì ۇӉÚÔÌÔ ‰˘Û·ÔÚÚfiÊËÛ˘, Ó¢ÚÔÌ˘˚-΋ ÂÎʇÏÈÛË Î.¿.

∏ ÔÈÎÔÁÂÓ‹˜ ·-‚ËÙ·-ÏÈÔÚˆÙÂ˚Ó·ÈÌ›· ÔÊ›ÏÂ-Ù·È Û ÌÂÙ·ÏÏ¿ÍÂȘ ÙÔ˘ ÂÓ˙‡ÌÔ˘ Ô˘ Û˘Ó‰¤ÂÈ Ù·

¶›Ó·Î·˜ 4. ¶ÚˆÙÔ·ı›˜ ‰˘ÛÏÈȉ·È̛˜. ∂›Â‰· ÏÈȉ›ˆÓ (mg%) Î·È Î·Ú‰È·ÁÁÂÈ·Îfi˜ ΛӉ˘ÓÔ˜

¢˘ÛÏÈȉ·ÈÌ›· OX LDL-¯ ∏DL-¯ T° ·Ô-µ ·Ô-∞π Lp(a) ∫K

OÈÎÔÁÂÓ‹˜ 250-350 190-260 ÎÊ ÎÊ ÎÊ ÎÊ ÎÊ ↑ÔÏ˘ÁÔÓȉȷ΋˘ÂÚ¯ÔÏ/Ì›·∂ÙÂÚfi˙˘ÁË ÔÈÎÔÁÂÓ‹˜ 300-600 >250 ÎÊ (<40) ÎÊ >90 ÎÊ ÎÊ ↑↑˘ÂÚ¯ÔÏ/Ì›·OÈÎÔÁÂÓ‹˜ ˘Ô-·ÏÊ·- ÎÊ ÎÊ <40 ÎÊ (>100) ÎÊ <120 ÎÊ ↑ÏÈÔÚˆÙ/Ì›·OÈÎÔÁÂÓ‹˜ Û˘Ó‰˘·Ṳ̂ÓË 250-400 160-250 <40 200-400 >90 <120 ÎÊ ↑↑˘ÂÚÏÈÔÚ/Ì›·*OÈÎÔÁÂÓ‹˜ ‰È·Ù·Ú·¯‹ 250-580 200-400 ÎÊ ÎÊ >90 ÎÊ ÎÊ ↑Ù˘ ·Ô-µOÈÎÔÁÂÓ‹˜ ÎÊ ÎÊ <40 (ÎÊ) 250-500 ÎÊ <120 (ÎÊ) ÎÊ ;˘ÂÚÙÚÈÁÏ/Ì›·OÈÎÔÁÂÓ‹˜ ÎÊ ÎÊ ÎÊ ÎÊ ÎÊ ÎÊ >30 ↑·‡ÍËÛË Ù˘ Lp(a)

* ™ÙËÓ ÔÈÎÔÁÂÓ‹ Û˘Ó‰˘·Ṳ̂ÓË ˘ÂÚÏÈȉ·ÈÌ›· ÌÔÚ› Ó· Â›Ó·È ·ıÔÏÔÁÈΤ˜ ÔÈ ÙÈ̤˜ ÌfiÓÔ ÂÓfi˜ ‹ ‰‡Ô ÏÈȉ›ˆÓ

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·155

Page 13: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

156

¶·È‰È·ÙÚÈ΋ 2004;67:151-159 Paediatriki 2004;67:151-159

ÙÚÈÁÏ˘ÎÂÚ›‰È· Ì ÙËÓ ·Ô-µ100 ÁÈ· ÙËÓ ·Ú·ÁˆÁ‹ÙˆÓ VLDL ÛÙÔ ‹·Ú, ηıÒ˜ Î·È Ì ÙËÓ ·Ô-µ48 ÁÈ·ÙËÓ ·Ú·ÁˆÁ‹ ÙˆÓ ¯˘ÏÔÌÈÎÚÒÓ ÛÙÔ ¤ÓÙÂÚÔ, ·ÓÙ›-ÛÙÔȯ·. ∫ÏËÚÔÓÔÌÂ›Ù·È Î·È ·˘Ù‹ Ì ˘ÔÏÂÈfiÌÂÓÔ¯·Ú·ÎÙ‹Ú· Î·È ÔÈ ÔÌÔ˙˘ÁÒÙ˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ‚·ÚÈ¿ÎÏÈÓÈ΋ ÂÈÎfiÓ·, ·ÚfiÌÔÈ· Ì Ù˘ ÔÈÎÔÁÂÓÔ‡˜ ˘Ô-‚ËÙ·-ÏÈÔÚˆÙÂ˚Ó·ÈÌ›·˜ (36). OÈ ‰˘ÛÏÈȉ·È̛˜ ·˘-Ù¤˜ ‰ÂÓ Û¯ÂÙ›˙ÔÓÙ·È Ì ·˘ÍË̤ÓÔ Î·Ú‰È·ÁÁÂÈ·ÎfiΛӉ˘ÓÔ.

¶fiÙ ڤÂÈ Ó· Á›ÓÂÙ·È ¤ÏÂÁ¯Ô˜ ÏÈȉ›ˆÓ ÛÙ· ·È‰È¿ ∆· ·È‰È¿ ËÏÈΛ·˜ ÌÂÁ·Ï‡ÙÂÚ˘ ÙˆÓ 2 ÂÙÒÓ Ú¤-

ÂÈ Ó· ˘Ô‚¿ÏÏÔÓÙ·È Û ¤ÏÂÁ¯Ô ÏÈȉ›ˆÓ fiÙ·Ó: ·)¤¯Ô˘Ó ¤Ó·Ó ÁÔÓ¤· ‹ ·Ô‡-ÁÈ·ÁÈ¿ Ì ÈÛÙÔÚÈÎfi ÛÙÂ-Ê·ÓÈ·›·˜ ÓfiÛÔ˘, ·ÁÁÂÈ·ÎÔ‡ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÂÈÛÔ‰›-Ô˘ ‹ ÂÚÈÊÂÚÈ΋˜ ·ÚÙËÚÈÔÛÎÏ‹Ú˘ÓÛ˘ Û ËÏÈΛ· ÌÈ-ÎÚfiÙÂÚË ÙˆÓ 55 ÂÙÒÓ Î·È ‚) ¤¯Ô˘Ó ¤Ó·Ó ÁÔÓ¤· Ì›‰· ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ ˘„ËÏfiÙÂÚ· ·fi 240mg% (4).

∆o 1/3 ÙˆÓ ·È‰ÈÒÓ Ô˘ ÂϤÁ¯ÔÓÙ·È ÁÈ· ÙÔ˘˜ ·-Ú·¿Óˆ ÏfiÁÔ˘˜, ·ÚÔ˘ÛÈ¿˙ÂÈ Î¿ÔÈ·˜ ÌÔÚÊ‹˜ ‰˘-ÛÏÈȉ·ÈÌ›· (4). ™Â ÚfiÛÊ·ÙË, fï˜, ÂÏÏËÓÈ΋ ÌÂ-ϤÙË, Ë ÔÔ›· ÂÚÈÂÏ¿Ì‚·Ó 1118 ·È‰È¿ ËÏÈΛ·˜ 3-15 ÂÙÒÓ, ‰È·ÈÛÙÒıËΠfiÙÈ Ë ¯ÚËÛÈÌÔÔ›ËÛË ÙˆÓ·Ú·¿Óˆ ÎÚÈÙËÚ›ˆÓ ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô ÙÔ˘ ·È‰ÈÎÔ‡ÏËı˘ÛÌÔ‡, ·Ê‹ÓÂÈ ÙÔ 25% ÂÚ›Ô˘ ÙˆÓ ·È‰ÈÒÓÌ ‰˘ÛÏÈȉ·ÈÌ›· ¯ˆÚ›˜ ‰È¿ÁÓˆÛË, ‡ÚËÌ· Ô˘ η-Ù¿ ÙË ÁÓÒÌË ÙˆÓ Û˘ÁÁڷʤˆÓ Û˘ÓËÁÔÚ› ÁÈ· ÙÔÓ¤ÏÂÁ¯Ô ÙˆÓ ÏÈȉ›ˆÓ Û fiÏ· Ù· ·È‰È¿ ËÏÈΛ·˜ ÌÂ-Á·Ï‡ÙÂÚ˘ ÙˆÓ 3 ÂÙÒÓ (45).

ø˜ ·Ú¯ÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÚÔÙ›ÓÂÙ·È Ë Ì¤ÙÚËÛË Ù˘ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ Î·È Â¿Ó ·˘Ù‹ ‚ÚÂı› >170mg%, ·ӷϷ̂¿ÓÂÙ·È Ë Ì¤ÙÚËÛ‹ Ù˘ ÌÂÙ¿ 3‚‰ÔÌ¿‰Â˜ ÙÔ˘Ï¿¯ÈÛÙÔÓ. ∂¿Ó Ô Ì¤ÛÔ˜ fiÚÔ˜ ÙˆÓ‰‡Ô ÌÂÙÚ‹ÛÂˆÓ Â›Ó·È >170 mg%, ÙfiÙ Á›ÓÂÙ·È Ì¤-ÙÚËÛË Î·È ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ Î·È Ù˘ HDL-¯ÔÏË-ÛÙÂÚfiÏ˘ Î·È ˘ÔÏÔÁÈÛÌfi˜ Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘(46). OÈ Û˘ÁÁÚ·Ê›˜ ÈÛÙÂ‡Ô˘Ó fiÙÈ ·˘Ù‹ Ë Ù·ÎÙÈ΋

Ú¤ÂÈ Ó· ·ÎÔÏÔ˘ıÂ›Ù·È ÁÈ· ÙÔÓ Ì·˙ÈÎfi ¤ÏÂÁ¯Ô ÙÔ˘ÏËı˘ÛÌÔ‡ ‹ Û ·È‰È¿ ¯ˆÚ›˜ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈ-Îfi ‰˘ÛÏÈȉ·ÈÌ›·˜ ‹ ÚfiˆÚ˘ ηډȷÁÁÂȷ΋˜ Ófi-ÛÔ˘ ¯ˆÚ›˜ ¿ÏÏÔ˘˜ ÂÈ‚·Ú˘ÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜,fiˆ˜ ·¯˘Û·ÚΛ·, ۷ί·Ú҉˘ ‰È·‚‹Ù˘ Î·È˘¤ÚÙ·ÛË. ∂ÈϤÔÓ, Ù· ·È‰È¿ ¤¯Ô˘Ó Û˘¯Ó¿ ·˘ÍË-̤ÓË ÙËÓ HDL-¯ÔÏËÛÙÂÚfiÏË (>60 mg%), Ì ·ÔÙ¤-ÏÂÛÌ· ÙËÓ ·‡ÍËÛË Ù˘ ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘. ™Ù··È‰È¿ ·˘Ù¿ ‰ÂÓ ¯ÚÂÈ¿˙ÂÙ·È Î·Ì›· ·Ú¤Ì‚·ÛË (21).∞ıËÚÔÁfiÓÔ˜ Â›Ó·È Ë LDL-¯ÔÏËÛÙÂÚfiÏË Î·È ÙÔ ÂÓ‰Â-¯fiÌÂÓÔ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·˜ ˘Ê›ÛÙ·Ù·È ÌfiÓÔfiÙ·Ó Â›Ó·È ·˘ÍË̤ÓË Ë LDL-¯ÔÏËÛÙÂÚfiÏË.

∏ ̤ÙÚËÛË ÙˆÓ ÏÈȉ›ˆÓ Î·È ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓÚ¤ÂÈ Ó· Á›ÓÂÙ·È ÌÂÙ¿ 12ˆÚË ÓËÛÙ›·. ¶ÚÔÛ‰ÈÔÚ›-˙ÔÓÙ·È Ë ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË, Ù· ÙÚÈÁÏ˘ÎÂÚ›‰È· Î·È ËHDL-¯ÔÏËÛÙÂÚfiÏË, ÂÓÒ Ë LDL-¯ÔÏËÛÙÂÚfiÏË ˘Ô-ÏÔÁ›˙ÂÙ·È ·fi ÙÔÓ Ù‡Ô:

LDL-¯ = OÃ -∆°

- HDL-¯,5Ì ÙËÓ ÚÔ¸fiıÂÛË fiÙÈ Ù· ÙÚÈÁÏ˘ÎÂÚ›‰È· ›ӷÈ<400 mg%.

∂¿Ó ‰È·ÈÛÙˆı› ‰˘ÛÏÈȉ·ÈÌ›·, ÌÂÙÚÒÓÙ·È Î·È ÔÈ·Ô-µ, ·Ô-∞π Î·È Lp(a). ∞˘ÍË̤ÓË ·Ô-µ ‹ Lp(a) ‹ÌÂȈ̤ÓË ·Ô-∞π ˘Ô‰ËÏÒÓÔ˘Ó ·˘ÍË̤ÓÔ ÌÂÏÏÔÓÙÈ-Îfi ηډȷÁÁÂÈ·Îfi ΛӉ˘ÓÔ (47-49).

°È· ÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË, ı· Ú¤ÂÈ Ó· Á›ÓÔ˘ÓÌÂÙÚ‹ÛÂȘ ÏÈȉ›ˆÓ Î·È ÛÙÔ˘˜ ÁÔÓ›˜. §·Ì‚¿ÓÂÙ·ÈÏÂÙÔÌÂÚ¤˜ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÁÈ· Ù˘¯fiÓ ‡·Ú-ÍË ‰˘ÛÏÈȉ·ÈÌ›·˜, ÚÒÈÌ˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘(ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ˜, ·ÈÊÓ›‰ÈÔ˜ ı¿Ó·ÙÔ˜, ÂÁÎÂÊ·ÏÈοÂÂÈÛfi‰È·, ÂÚÈÊÂÚÈ΋ ·ÁÁÂÈÔ¿ıÂÈ·) Î·È ÁÈ· ÌÂÙ·-‚ÔÏÈο ÓÔÛ‹Ì·Ù· (۷ί·Ú҉˘ ‰È·‚‹Ù˘, ˘¤ÚÙ·-ÛË, Û‡Ó‰ÚÔÌÔ Ã), ÛÂ Û˘ÁÁÂÓ›˜ ÚÒÙÔ˘ Î·È ‰Â‡ÙÂ-ÚÔ˘ ‚·ıÌÔ‡.

°È· ÙÔÓ ·ÔÎÏÂÈÛÌfi ‰Â˘ÙÂÚÔ·ıÔ‡˜ ‰˘ÛÏÈȉ·È-Ì›·˜, Ú¤ÂÈ Ó· Á›ÓÂÙ·È ¤ÏÂÁ¯Ô˜ Ù˘ Ë·ÙÈ΋˜, ÓÂ-ÊÚÈ΋˜ Î·È ı˘ÚÂÔÂȉÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜.

∞ÓÙÈÌÂÙÒÈÛË ™ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ·È‰ÈÔ‡ Ì ‰˘ÛÏÈȉ·È-

Ì›· ‰ÂÓ ¤¯ÂÈ È‰È·›ÙÂÚË Ú·ÎÙÈ΋ ·Í›· Ë ·ÎÚÈ‚‹˜ ‰È¿-ÁÓˆÛË ÙÔ˘ ›‰Ô˘˜ Ù˘ ÁÂÓÂÙÈ΋˜ ‰È·Ù·Ú·¯‹˜, ·ÏÏ¿:·) Ô ÂÓÙÔÈÛÌfi˜ Ù˘¯fiÓ ‰Â˘ÙÂÚÔ·ıÔ‡˜ ‰˘ÛÏÈȉ·È-Ì›·˜ Î·È Ë ıÂڷ›· ÙÔ˘ ÚˆÙÔ·ıÔ‡˜ ·ÈÙ›Ô˘ Î·È ‚)Ë Ì›ˆÛË ÙˆÓ ·˘ÍËÌ¤ÓˆÓ ÂȤ‰ˆÓ Ù˘ LDL-¯ÔÏË-ÛÙÂÚfiÏ˘ ‹ ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ ‹/Î·È Ë ·‡Í‹ÛË ÙˆÓ¯·ÌËÏÒÓ ÂȤ‰ˆÓ Ù˘ HDL-¯ÔÏËÛÙÂÚfiÏ˘, ¤ÛÙˆÎ·È ·Ó ‰ÂÓ Â›Ó·È ÁÓˆÛÙ‹ Ë ·ÎÚÈ‚‹˜ ·ÈÙ›· ÙÔ˘˜.

¢›·ÈÙ· ™Â ÂÚ›ÙˆÛË ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·˜, ÂÊ·ÚÌfi-

˙ÔÓÙ·È ‰›·ÈÙ˜ Ì Ì›ˆÛË ÙˆÓ ÎÔÚÂÛÌ¤ÓˆÓ ÏÈ·ÚÒÓÔͤˆÓ Ô˘ ·˘Í¿ÓÔ˘Ó ÙËÓ ÔÏÈ΋ Î·È ÙËÓ LDL-¯ÔÏË-ÛÙÂÚfiÏË Î·È ·‡ÍËÛË ÙˆÓ ÌÔÓÔ·ÎfiÚÂÛÙˆÓ Î˘Ú›ˆ˜

¶›Ó·Î·˜ 5. ∞›ÙÈ· ‰Â˘ÙÂÚÔ·ıÒÓ ‰˘ÛÏÈȉ·ÈÌÈÒÓ

¡ÔÛ‹Ì·Ù· OX LDL-¯ ∏DL-¯ T°

™·Î¯·Ú҉˘ ‰È·‚‹Ù˘ ↑↔ ↑ ↓ ↑ÀÔı˘ÚÂÔÂȉÈÛÌfi˜ ↑ ↑ ↑ ↔ÀÂÚı˘ÚÂÔÂȉÈÛÌfi˜ ↓ ↓ ↓ ↔º¿Ú̷η

¶ÚÂ˙ÔÏfiÓË ↑ ↑º·ÈÓÔ‚·Ú‚ÈÙ¿ÏË ↑∫·Ú‚·Ì·˙›ÓË ↑ ↑∞Û·Ú·ÁÈÓ¿ÛË ↑πÓÙÂÚÊÂÚfiÓË ↑∫˘ÎÏÔÛÔÚ›ÓË ↑ ↑ƒÂÙÈÓÔÂȉ‹ ↑ ↓ ↑OÈÛÙÚÔÁfiÓ· ↓ ↓ ↑ ↑∞Ó‰ÚÔÁfiÓ· ↑ ↑ ↓ ↑

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·156

Page 14: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

157

¶·È‰È·ÙÚÈ΋ 2004;67:151-159 Paediatriki 2004;67:151-159

Î·È ÔÏ˘·ÎfiÚÂÛÙˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ Ô˘ ÙȘ ÌÂÈÒ-ÓÔ˘Ó. OÈ ‰›·ÈÙ˜ ·˘Ù¤˜ ¤¯Ô˘Ó ·Ô‰Âȯı› Ì·ÎÚÔ-¯ÚfiÓÈ· ·ÛÊ·Ï›˜ ÛÙ· ·È‰È¿, ·Ú¤¯Ô˘Ó fiÏ· Ù· ·Ó·-Áη›· Û˘ÛÙ·ÙÈο Î·È ÌÂÈÒÓÔ˘Ó ÙËÓ LDL-¯ÔÏËÛÙÂÚfi-ÏË Î·Ù¿ 10-15% (55,51).

∆· ‰È·ÈÙÔÏfiÁÈ· ·˘Ù¿ ÂÚȤ¯Ô˘Ó ηٿ 30% ϛԘ,50-55% ˘‰·Ù¿ÓıڷΘ Î·È 15-20% ÚˆÙ½Ó˜. ∏ËÌÂÚ‹ÛÈ· ÚfiÛÏË„Ë ¯ÔÏËÛÙÂÚfiÏ˘ Â›Ó·È ÏÈÁfiÙÂÚË·fi 300 mg, ÌÂÈÒÓÂÙ·È Ë ÔÛfiÙËÙ· ÙˆÓ ÎÔÚÂṲ̂-ÓˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ (Á¿Ï·, Ù˘Ú›, ‚Ô‰ÈÓfi) Î·È ·ÓÙÈη-ı›ÛÙ·Ù·È ·fi ÌÔÓÔ·ÎfiÚÂÛÙ· (ÂÏ·ÈfiÏ·‰Ô) Î·È Ô-Ï˘·ÎfiÚÂÛÙ· ÏÈ·Ú¿ (Ï·¯·ÓÈο, „¿ÚÈ·).

™Â ÂÚÈÙÒÛÂȘ ·ÓıÂÎÙÈ΋˜ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·È-Ì›·˜, Û˘ÓÈÛÙ¿Ù·È ‰›·ÈÙ· Ì ÂÚÈÔÚÈÛÌfi ÙÔ˘ Ï›Ô˘˜ÛÙÔ 20% ÙˆÓ Û˘ÓÔÏÈÎÒÓ ıÂÚÌ›‰ˆÓ Î·È ËÌÂÚ‹ÛÈ·ÚfiÛÏË„Ë ¯ÔÏËÛÙÂÚfiÏ˘ ÌÈÎÚfiÙÂÚË ·fi 200 mg.

∫·Ïfi Â›Ó·È Ù· ‰È·ÈÙÔÏfiÁÈ· ·˘Ù¿ Ó· ¯ÔÚËÁÔ‡ÓÙ·È·fi ÂÍÂȉÈÎÂ˘Ì¤ÓÔ˘˜ ‰È·ÈÙÔÏfiÁÔ˘˜, ÒÛÙ ӷ ÂÍ·-ÛÊ·Ï›˙ÂÙ·È ÙfiÛÔ Ë Î¿Ï˘„Ë ÙˆÓ ‰È·ÙÚÔÊÈÎÒÓ ·Ó·-ÁÎÒÓ ÙˆÓ ·È‰ÈÒÓ fiÛÔ Î·È Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·Ù˘ ‰›·ÈÙ·˜.

ÕÛÎËÛË ∏ ¿ÛÎËÛË Ú¤ÂÈ Ó· Á›ÓÂÙ·È Û˘ÛÙËÌ·ÙÈο, ÙÔ˘-

Ï¿¯ÈÛÙÔÓ 3 ÒÚ˜ ÙËÓ Â‚‰ÔÌ¿‰·. ∆Ô ÛËÌ·ÓÙÈÎfiÙÂÚÔÂ›Ó·È Ó· ηıÈÂÚˆı› Î·È Ó· ·Ú·Ì›ÓÂÈ ÌfiÓÈÌË Ë Û˘-Ó‹ıÂÈ· Ù˘ Ê˘ÛÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜, Ë ÔÔ›· ¤¯ÂÈÌfiÓÔ Â˘ÂÚÁÂÙÈΤ˜ ÂȉڿÛÂȘ. ∏ ¿ÛÎËÛË ÌÂÈÒÓÂÈ ÙÔۈ̷ÙÈÎfi ‚¿ÚÔ˜, ÙËÓ ÔÏÈ΋ Î·È ÙËÓ LDL-¯ÔÏËÛÙÂ-ÚfiÏË Î·È Ù· ÙÚÈÁÏ˘ÎÂÚ›‰È·, ÂÓÒ ·˘Í¿ÓÂÈ ÙËÓ ∏DL-¯ÔÏËÛÙÂÚfiÏË (52) Î·È ÙËÓ „˘¯È΋ ¢ÂÍ›·.

º·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ ™Â ·È‰È¿ ËÏÈΛ·˜ ÌÂÁ·Ï‡ÙÂÚ˘ ÙˆÓ 10 ÂÙÒÓ ÌÂ

˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·, ¯ÔÚËÁÂ›Ù·È ¯ÔÏÂÛÙ˘Ú·Ì›ÓË(Questran, Ê¿ÎÂÏÔÈ ÙˆÓ 4 g), Â¿Ó ÌÂÙ¿ 6-12 Ì‹Ó˜‰È·ÈÙËÙÈ΋˜ ÚÔÛ¿ıÂÈ·˜ Ë LDL-¯ÔÏËÛÙÂÚfiÏË Â›Ó·È>190 mg% ‹ fiÙ·Ó Â›Ó·È >160 mg% ·ÏÏ¿ Û˘Ó˘¿Ú-¯Ô˘Ó ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÚÒÈÌ˘ ηډȷÁÁÂÈ·-΋˜ ÓfiÛÔ˘ ‹ ¿ÏÏÔÈ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘, fiˆ˜‰È·‚‹Ù˘ ‹ ˘¤ÚÙ·ÛË. O ÛÙfi¯Ô˜ Â›Ó·È Ó· ÌÂȈıÔ‡ÓÙ· ›‰· Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘ Û <110 mg% ‹ÙÔ˘Ï¿¯ÈÛÙÔÓ <130 mg%.

∏ ‰fiÛË Ù˘ ¯ÔÏÂÛÙ˘Ú·Ì›Ó˘ Â›Ó·È ¤ˆ˜ 20 g/Ë̤-Ú·, ‰È·ÈÚÂ̤ÓË Û 2-3 ‰fiÛÂȘ, ÌÂÙ¿ ÙÔ Ê·ÁËÙfi. ÃÔ-ÚËÁÂ›Ù·È ÛÙ·‰È·Î¿, ÍÂÎÈÓÒÓÙ·˜ ·fi 4-8 g/Ë̤ڷ(53-55).

∏ ¯ÔÚ‹ÁËÛË ¿ÏÏˆÓ ˘Ô¯ÔÏËÛÙÂÚÔÏ·ÈÌÈÎÒÓÊ·ÚÌ¿ÎˆÓ ÛÙ· ·È‰È¿ ‰ÂÓ ¤¯ÂÈ ·ÎfiÌË Î·ıÈÂÚˆı›.∏ ‚Ú·¯˘¯ÚfiÓÈ· ¯ÔÚ‹ÁËÛË ·Ó·ÛÙÔϤˆÓ Ù˘ ˘‰ÚÔ-͢-ÌÂı˘ÏÔ-ÁÏÔ˘Ù·Ú˘Ï-CoA ·Ó·ÁˆÁ¿Û˘ (‹ ÛÙ·Ù›-Ó˜) Û ·È‰È¿ Ì ÂÙÂÚfi˙˘ÁË ÔÈÎÔÁÂÓ‹ ˘ÂÚ¯ÔÏË-ÛÙÂÚÔÏ·ÈÌ›·, fiˆ˜ Ë ÏÔ‚·ÛÙ·Ù›ÓË ‹ Ë Ú·‚·ÛÙ·Ù›-ÓË (Û ‰fiÛÂȘ 5-40 mg/Ë̤ڷ) ¤ÊÂÚ ÛËÌ·ÓÙÈ΋Ì›ˆÛË Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘ ¯ˆÚ›˜ ÛÔ‚·Ú¤˜,

¿ÌÂÛ˜, ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ (56,57). ∆· ·È‰È¿ Ì ̤ÙÚÈ· ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›· Û˘-

Ó‹ıˆ˜ ··ÓÙÔ‡Ó Î·Ï¿ ÛÙË ‰È·ÈÙËÙÈ΋ ·ÁˆÁ‹ ηȉÂÓ ¯ÚÂÈ¿˙ÔÓÙ·È Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹.

∏ HDL-¯ÔÏËÛÙÂÚfiÏË ÌÔÚ› Ó· ·˘ÍËı› Ì ÙËÓÂÊ·ÚÌÔÁ‹ ‰›·ÈÙ·˜, Ô˘ ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ·ÓÙÈηٿ-ÛÙ·ÛË ÙˆÓ ÎÔÚÂÛÌ¤ÓˆÓ ÏÈ·ÚÒÓ Î˘Ú›ˆ˜ Ì ÔÏ˘·-ÎfiÚÂÛÙ· fiˆ˜ Â›Ó·È ÙÔ ÂÏ·ÈfiÏ·‰Ô Î·È ÙËÓ ¿ÛÎËÛË.∏ ¿ÛÎËÛË ¤¯ÂÈ ‰È·ÈÛÙˆı› fiÙÈ ·˘Í¿ÓÂÈ Û ÛËÌ·ÓÙÈ-Îfi ‚·ıÌfi ÙËÓ HDL-¯ÔÏËÛÙÂÚfiÏË.

°È· Ù· ·È‰È¿ Ì ·˘ÍË̤ÓË Lp(a) ‰ÂÓ ˘¿Ú¯ÂÈ ÂÈ-‰È΋ ·ÁˆÁ‹, Ú¤ÂÈ, fï˜, Ó· ‰ÈÔÚıÒÓÔÓÙ·È Ù˘¯fiÓÛ˘Ó˘¿Ú¯Ô˘Û˜ ‰˘ÛÏÈȉ·È̛˜.

µÈ‚ÏÈÔÁÚ·Ê›·1. PDAY Research Group. Relationship of atherosclerosis in

young men to serum lipoprotein cholesterol concentrationsand smoking. A preliminary report from the PathobiologicalDeterminants of Atherosclerosis in Youth (PDAY) ResearchGroup. JAMA 1990;264:3018-3024.

2. McGill HC Jr, McMahan CA and the PathobiologicalDeterminants of Atherosclerosis in Youth (PDAY) ResearchGroup. Determinants of atherosclerosis in the young. Am JCardiol 1998;82:30T-36T.

3. Napoli C, Glass CK, Witztum JL, Deutsch R, D’-Armiento FP,Palinski W. Influence of maternal hypercholesterolaemiaduring pregnancy on progression of early atheroscleroticlesions in childhood. Fate of Early Lesions in Children(FELIC) study. Lancet 1999;354:1234-1241.

4. American Academy of Pediatrics. National CholesterolEducation Program. Report of the Expert Panel on BloodCholesterol Levels in Children and Adolescents. Pediatrics1992;89 (Suppl):S525-S584.

5. National Cholesterol Education Program. Second Report ofthe Expert Panel on Detection, Evaluation, and Treatment ofHigh Blood Cholesterol in Adults (Adult Treatment Panel II).Circulation 1994;89:1329-1440.

6. Castelli WP. Cholesterol and lipids in the risk of coronaryartery disease. The Framingham Heart Study. Can J Cardiol1988;4 (Suppl A):5A-10A.

7. Lipid Research Clinics Program. The Lipid Research ClinicsCoronary Primary Prevention Trial Results. II. The relationshipof reduction in incidence of coronary heart disease tocholesterol lowering. JAMA 1984;251:365-374.

8. Kwiterovich PO Jr. State-of-the-art update and review:clinical trials of lipid-lowering agents. Am J Cardiol 1998;82(12A):3U-17U.

9. Gidding SS. The rationale for lowering serum cholesterollevels in American children. Am J Dis Child 1993;147:386-392.

10. ∫·Ê¿ÙÔ˜ ∞°, Christakis G, Hsia SL, Cassady J, ¶·Ó·ÁȈٷ-ÎfiÔ˘ÏÔ˜ °. §È›‰È· ÔÚÔ‡ Û 1010 ·È‰È¿ Ù˘ ∞ı‹Ó·˜ ËÏÈ-Λ·˜ 10-14 ¯ÚfiÓˆÓ. π·ÙÚÈ΋ 1980;38:283-290.

11. ∫·‚·˙·Ú¿Î˘ ∂, ∆ÛfiÏ·˜ °, ™ÎÔ‡ÚÔ˘-÷Ù˙Ë·ÚÁ˘ÚÔ‡ ¢, ºÔ˘-ÛÙÔ‡ÎÔ˘ ª, ¢‹ÌÔ˘ ™, ¢ÂÏËÁÈ¿ÓÓË µ. ∫·Ù·ÓÔÌ‹ ÔÏÈ΋˜ ¯ÔÏË-ÛÙÂÚfiÏ˘, ÏÈÔÚˆÙÂ˚ÓÒÓ Î·È ·ÔÏÈÔÚˆÙÂ˚ÓÒÓ Û ‚Ú¤ÊËÎ·È ·È‰È¿. ¶·È‰È·ÙÚÈ΋ 1998;61:148-160.

12. Brotons C, Ribera A, Perich RM, Abrodos D, Magana P,

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·157

Page 15: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

158

¶·È‰È·ÙÚÈ΋ 2004;67:151-159 Paediatriki 2004;67:151-159

Pablo S et al. Worldwide distribution of blood lipids andlipoproteins in childhood and adolescence: a review study.Atherosclerosis 1998;139:1-9.

13. Jialal I. A practical approach to the laboratory diagnosis ofdyslipidemia. Am J Clin Pathol 1996;106:128-138.

14. Dixon JL, Ginsberg HN. Hepatic synthesis of lipoproteins andapolipoproteins. Semin Liver Dis 1992;12:364-372.

15. Kwiterovich PO Jr. The antiatherogenic role of high-densitylipoprotein cholesterol. Am J Cardiol 1998;82:13Q-21Q.

16. Tall AR. Metabolic and genetic control of HDL cholesterollevels. J Intern Med 1992;231:661-668.

17. Franceschini G. Apolipoprotein function in health anddisease: insights from natural mutations. Eur J Clin Invest1996;26:733-746.

18. ¶··ı·Ó·Û›Ô˘-∫ÏÒÓÙ˙· ¢, ∆ÚȯÔÔ‡ÏÔ˘ ∞, ¶··˙‹Û˘ °,§·Áfi˜ ¶, ∞Á·ıfiÔ˘ÏÔ˜ ∞, ¶··‰fiÔ˘ÏÔ˜ ° Î·È Û˘Ó. ∆È̤˜¯ÔÏËÛÙÂÚfiÏ˘ ·›Ì·ÙÔ˜ Û ·ÛÙÈÎfi ∂ÏÏËÓÈÎfi ÏËı˘ÛÌfi ËÏÈ-Λ·˜ 6-19 ÂÙÒÓ. ∏ ›‰Ú·ÛË Ù˘ ‹‚˘. ¢ÂÏÙ›Ô ∞’ ¶·È‰È·ÙÚÈ-΋˜ ∫ÏÈÓÈ΋˜ ¶·Ó/Ì›Ô˘ ∞ıËÓÒÓ 1979;26 (™˘ÌÏ 41):17-23.

19. §·Áfi˜ ¶, ∆ÚȯÔÔ‡ÏÔ˘ ∞, ¶··ı·Ó·Û›Ô˘-∫ÏÒÓÙ˙· ¢, ∞Á·-ıfiÔ˘ÏÔ˜ ∞, µÔ˘ÙÂÙ¿Î˘ ™, ∫·ÙÛ·ÚÔ‡-¶ÂÎÙ·Û›‰Ë ∂ Î·È Û˘Ó.∆È̤˜ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ ·›Ì·ÙÔ˜ Û ·ÛÙÈÎfi ∂ÏÏËÓÈÎfi ÏËı˘ÛÌfiËÏÈΛ·˜ 8-19 ÂÙÒÓ. ∏ ›‰Ú·ÛË Ù˘ ‹‚˘. ¢ÂÏÙ›Ô ∞’ ¶·È‰È·-ÙÚÈ΋˜ ∫ÏÈÓÈ΋˜ ¶·Ó/Ì›Ô˘ ∞ıËÓÒÓ 1979;26 (™˘ÌÏ 41):24-29.

20. Webber LS, Srinivasan SR, Wattigney WA, Berenson GS.Tracking of serum lipids and lipoproteins from childhood toadulthood. The Bogalusa Heart Study. Am J Epidemiol1991;133:884-899.

21. °ÚËÁÔÚ¤·˜ Ã, ¡Ù·Ú›ÏÏ˘ ∂, ∆¿ÛË-¶··ı¤Ô˘ ¢, ∞˘ÁÔ˘ÛÙ›-‰Ô˘-™·‚‚ÔÔ‡ÏÔ˘ ¶, ∫·Ú·Ì¤Ú˘ ™, ª·Ï·Î¿-∑·ÊÂÈÚ›Ô˘ ∫.∂›Â‰· Î·È ‰È·Ù·Ú·¯¤˜ ÏÈȉ›ˆÓ-ÏÈÔÚˆÙÂ˚ÓÒÓ ÔÚÔ‡ Û·ȉȿ ÂÌÊÚ·ÁÌ·ÙÈÒÓ ÁÔÓ¤ˆÓ. ¶·È‰È·ÙÚÈ΋ 1990;53:152-161.

22. Kwiterovich PO Jr. Dyslipoproteinemia and other risk factorsfor atherosclerosis in children and adolescents.Atherosclerosis 1994;108 (Suppl):S55-S71.

23. Vega GL, Denke MA, Grundy SM. Metabolic basis of primaryhypercholesterolemia. Circulation 1991;84:118-128.

24. Humphries SE, Galton D, Nicholls P. Genetic testing forfamilial hypercholesterolaemia: practical and ethical issues.QJM 1997;90:169-181.

25. Traeger-Synodinos J, Mavroidis N, Kanavakis E, Drogari E,Humphries SE, Day IN et al. Analysis of low densitylipoprotein receptor gene mutations and microsatellitehaplotypes in Greek FH heterozygous children: sixindependent ancestors account for 60% of probands. HumGenet 1998;102:343-347.

26. Sprecher DL, Schaeffer EJ, Kent KE, Gregg RE, Zech LA,Hoeg JM et al. Cardiovascular features of homozygousfamilial hypercholesterolemia: analysis of 16 patients. Am JCardiol 1984;54:20-30.

27. Rosenson RS. Low levels of high-density lipoproteincholesterol (hypoalphalipoproteinemia). An approach tomanagement. Arch Intern Med 1993;153:1528-1538.

28. Third JL, Montag J, Flynn M, Freidel J, Laskarzewski P,Glueck CJ. Primary and familial hypoalphalipoproteinemia.Metabolism 1984;33:136-146.

29. Kwiterovich PO Jr. Genetics and molecular biology of familialcombined hyperlipidemia. Curr Opin Lipidol 1993;4:133-143.

30. Shamir R, Tershakovec AM, Gallagher PR, Liacouras CA,

Hayman LL, Cortner JA. The influence of age and relativeweight on the presentation of familial combinedhyperlipidemia in childhood. Atherosclerosis 1996;121:85-91.

31. Innerarity TL, Mahley RW, Weisgraber KH, Bersot TP, KraussRM, Vega GL et al. Familial defective apolipoprotein B-100: amutation of apolipoprotein B that causes hyper-cholesterolemia. J Lipid Res 1990;31:1337-1349.

32. Davignon J, Genest J Jr. Genetics of lipoprotein disorders.Endocrinol Metab Clin North Am 1998;27:521-550.

33. Marcovina SM, Koschinsky ML. Lipoprotein(a) as a risk factorfor coronary artery disease. Am J Cardiol 1998;82:57U-66U.

34. Kostner GM, Czinner A, Pfeiffer KH, Bihari-Varga M.Lipoprotein(a) concentrations as risk indicators foratherosclerosis. Arch Dis Child 1991;66:1054-1056.

35. Dammerman M, Breslow JL. Genetic basis of lipoproteindisorders. Circulation 1995;91:505-512.

36. Humphries SE, Mailly F, Gudnason V, Talmud P. Themolecular genetics of pediatric lipid disorders: recentprogress and future research directions. Pediatr Res1993;34:403-415.

37. Genest JJ Jr, Martin-Munley SS, McNamara JR, Ordovas JM,Jenner J, Myers RH et al. Familial lipoprotein disorders inpatients with premature coronary artery disease. Circulation1992;85:2025-2033.

38. Joven J, Villabona C, Vilella E, Masana L, Alberti R, Valles M.Abnormalities of lipoprotein metabolism in patients with thenephrotic syndrome. N Engl J Med 1990;323:579-584.

39. Ma KW, Greene EL, Raij L. Cardiovascular risk factors inchronic renal failure and hemodialysis populations. Am JKidney Dis 1992;19:505-513.

40. Mittman N, Avram MM. Dyslipidemia in renal disease. SeminNephrol 1996;16:202-213.

41. O’Brien T, Nguyen TT, Zimmerman BR. Hyperlipidemia anddiabetes mellitus. Mayo Clin Proc 1998;73:969-976.

42. Pazos F, Alvarez JJ, Rubies-Prat J, Varela C, Lasuncion MA.Long-term thyroid replacement therapy and levels oflipoprotein(a) and other lipoproteins. J Clin Endocrinol Metab1995;80:562-566.

43. Linton MF, Farese RV Jr, Young SG. Familialhypobetalipoproteinemia. J Lipid Res 1993;34:521-541.

44. Farese RV Jr, Linton MF, Young SG. Apolipoprotein B genemutations affecting cholesterol levels. J Intern Med1992;231:643-652.

45. ∆ÛfiÏ·˜ °, ¢Ú·Î¿ÙÔ˜ ∞, ∆ÛÔ˘Î¿ÙÔ˘ £, ºˆÙÂÈÓÔ‡ ∞, ¶·Ó·-ÁÔ‡ÏÈ· ª, ∫·‚·˙·Ú¿Î˘ ∂. ¶ÚÔÏËÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÁÈ· ÙËÓ·Ó›¯Ó¢ÛË Ù˘ ˘ÂÚÏÈȉ·ÈÌ›·˜ ÛÙ· ·È‰È¿. ¶·È‰È·ÙÚÈ΋1999;62:295-304.

46. US Public Health Service. Cholesterol screening in children.Am Fam Phys 1995;51:1923-1927.

47. Freedman DS, Srinivasan SR, Shear CL, Franklin FA, WebberLS, Berenson GS. The relation of apolipoproteins A-I and B inchildren to parental myocardial infarction. N Engl J Med1986;315:721-726.

48. Srinivasan SR, Berenson GS. Serum apolipoproteins A-I andB as markers of coronary artery disease risk in early life: theBogalusa Heart Study. Clin Chem 1995;41:159-164.

49. Schaefer EJ. Familial lipoprotein disorders and prematurecoronary artery disease. Med Clin North Am 1994;78:21-39.

50. The Writing Group for the DISC Collaborative Research

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·158

Page 16: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

159

¶·È‰È·ÙÚÈ΋ 2004;67:151-159 Paediatriki 2004;67:151-159

Group. Efficacy and safety of lowering dietary intake of fatand cholesterol in children with elevated low-densitylipoprotein cholesterol. The Dietary Intervention Study inChildren (DISC). JAMA 1995;273:1429-1435.

51. Mietus-Snyder M, Baker AL, Neufeld EJ, Roberts C,Dermarkarian S, Beiser AS et al. Effects of nutritionalcounseling on lipoprotein levels in a pediatric lipid clinic. AmJ Dis Child 1993;147:378-381.

52. Raitakari OT, Porkka KV, Taimela S, Telama R, Rasanen L,Viikari JS. Effects of persistent physical activity and inactivityon coronary risk factors in children and young adults. TheCardiovascular Risk in Young Finns Study. Am J Epidemiol1994;140:195-205.

53. West RJ, Lloyd JK, Leonard JV. Long-term follow-up ofchildren with familial hypercholesterolaemia treated withcholestyramine. Lancet 1980;2:873-875.

54. Liacouras CA, Coates PM, Gallagher PR, Cortner JA. Use ofcholestyramine in the treatment of children with familialcombined hyperlipidemia. J Pediatr 1993;122:477-482.

55. Tonstad S, Sivertsen M, Aksnes L, Ose L. Low dose

colestipol in adolescents with familial hypercholesterolaemia.Arch Dis Child 1996;74:157-160.

56. Lambert M, Lupien PJ, Gagne C, Levy E, Blaichman S,Langlois S et al. Treatment of familial hypercholesterolemia inchildren and adolescents: effect of lovastatin. CanadianLovastatin in Children Study Group. Pediatrics 1996;97:619-628.

57. Knipscheer HC, Boelen CC, Kastelein JJ, van Diermen DE,Groenemeijer BE, van den Ende A et al. Short-term efficacyand safety of pravastatin in 72 children with familialhypercholesterolemia. Pediatr Res 1996;39:867-871.

∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 09-05-2003∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 16-01-2004

¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∞ı·Ó·Û›· ∆ÂÚÙ›Ë ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡” £Ë‚ÒÓ & §Â‚·‰Â›·˜, ∆.∫. 115 27, ∞ı‹Ó·

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·159

Page 17: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

160

¶·È‰È·ÙÚÈ΋ 2004;67:160-167 Paediatriki 2004;67:160-167

∞¡∞™∫O¶∏™∏ REVIEW ARTICLE

∂ȉڿÛÂȘ Ê·Ú̿ΈÓ, ·ÏÎÔfiÏ˘ Î·È Î·Ó›ÛÌ·ÙÔ˜ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÁ΢ÌÔÛ‡Ó˘ ÛÙÔ ¤Ì‚Ú˘Ô Î·È ÙÔ ÓÂÔÁÓfi°. ª·ÚÔ‡Ù˘, ª. ¢·ÛÔÔ‡ÏÔ˘

Prenatal drug effects on the foetus and the newborn infant G. Baroutis, M. Dasopoulou

∂ÈÛ·ÁˆÁ‹∏ ·ÏÎÔfiÏË, Ù· ÚÔ˚fiÓÙ· ηÓÔ‡, ηıÒ˜ ηÈ

Ê¿Ú̷η fiˆ˜ Ù· ·ÓÙÈÂÈÏËÙÈο, Ë ÈÛÔÙÚÂÙÈÓÔ˝ÓË,ÙÔ Ï›ıÈÔ, ÔÈ ·Ó·ÛÙÔÏ›˜ ÙÔ˘ ÌÂÙ·ÙÚÂÙÈÎÔ‡ ÂÓ˙‡ÌÔ˘Î·È Ù· ·ÓÙÈËÎÙÈο, Ï·Ì‚¿ÓÔÓÙ·È Û˘¯Ó¿ ηٿ ÙˉȿÚÎÂÈ· Ù˘ ÂÁ΢ÌÔÛ‡Ó˘. ∏ Ï‹„Ë ·˘ÙÒÓ ÙˆÓ Ô˘-ÛÈÒÓ Î·È Ê·ÚÌ¿ÎˆÓ Â›Ó·È Û˘¯Ó¿ ˘Â‡ı˘ÓË ÁÈ· ÙËÓÂÌÊ¿ÓÈÛË ·ÚÂÓÂÚÁÂÈÒÓ ÛÙÔ ¤Ì‚Ú˘Ô Î·È ÙÔ ÓÂÔÁÓfi,fiˆ˜ Ë ÂÌÊ¿ÓÈÛË Û˘Ó‰ÚfïÓ, ÙÂÚ·ÙÔÁ¤ÓÂÛ˘,¯ÚfiÓÈ·˜ Ó¢ÌÔÓÔ¿ıÂÈ·˜, ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘, ·È-ÌÔÚÚ·ÁÈ΋˜ ÓfiÛÔ˘, Û˘ÁÁÂÓÔ‡˜ ηډÈÔ¿ıÂÈ·˜, ÔÏÈ-Á¿ÌÓÈÔ˘ Î·È ÓÂÊÚÈ΋˜ ÓfiÛÔ˘. ∏ ÚÔÛ¯ÙÈ΋ Ï‹„ËÙÔ˘ ·ÙÔÌÈÎÔ‡ ÈÛÙÔÚÈÎÔ‡ Ù˘ ÌËÙ¤Ú·˜, ηıÒ˜ Î·È ËÁÓÒÛË ÙˆÓ ÎÈÓ‰‡ÓˆÓ ·fi ÙË ¯Ú‹ÛË ÙˆÓ ÚÔ·Ó·-

ÊÂÚı¤ÓÙˆÓ Ê·ÚÌ¿ÎˆÓ Â›Ó·È ··Ú·›ÙËÙ˜ ÚÔ¸Ô-ı¤ÛÂȘ ÁÈ· ÙË ÛˆÛÙ‹ ÎÏÈÓÈ΋ ÂÎÙ›ÌËÛË ÙÔ˘ ÓÂÔÁÓÔ‡Î·È ÙËÓ ¤ÁηÈÚË ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÚÔ‚ÏËÌ¿ÙˆÓÙÔ˘ (¶›Ó·Î·˜ 1).

∂Ì‚Ú˘˚Îfi Û‡Ó‰ÚÔÌÔ ·fi ÙË Ï‹„Ë ·ÏÎÔfiÏ Î·ÈÓ¢ÚÔ·Ó·Ù˘ÍȷΤ˜ ‰È·Ù·Ú·¯¤˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·ÈÌ ÙË Ï‹„Ë ·ÏÎÔfiÏ

∆Ô ·ÏÎÔfiÏ Î·È Ù· ÚÔ˚fiÓÙ· ηÓÔ‡ Â›Ó·È ÔÈ Û˘-¯ÓfiÙÂÚ˜ Ô˘Û›Â˜ Ô˘ ÌÂٷʤÚÔÓÙ·È ‰È·Ï·ÎÔ˘-ÓÙȷο ·fi ÙË ÌËÙ¤Ú· ÛÙÔ ¤Ì‚Ú˘Ô. µÚ¤ıËΠfiÙÈ ÙÔ10% ÂÚ›Ô˘ ÙˆÓ Á˘Ó·ÈÎÒÓ ÛÙËÓ ·Ó··Ú·ÁˆÁÈ΋ËÏÈΛ· οÓÂÈ Î·Ù¿¯ÚËÛË ·ÏÎÔfiÏ (ÂÚ›Ô˘ 6-7 ÔÙ¿ÙËÓ Ë̤ڷ) (1). ∆Ô ÔÛÔÛÙfi ÙˆÓ ÎÔÚÈÙÛÈÒÓ Ô˘

�¶ÂÚ›ÏË„Ë: OÚÈṲ̂ӷ ·fi Ù· Ê¿Ú̷η Ô˘ Û˘-ÓÙ·ÁÔÁÚ·ÊÔ‡ÓÙ·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÁ΢ÌÔÛ‡-Ó˘, ‰ËÌÈÔ˘ÚÁÔ‡Ó ÂÚˆÙËÌ·ÙÈο Û¯ÂÙÈο Ì ÙÔ˘˜ È-ı·ÓÔ‡˜ ÎÈÓ‰‡ÓÔ˘˜ ·fi ÙË ¯ÔÚ‹ÁËÛ‹ ÙÔ˘˜ ÛÙÔ ¤Ì-‚Ú˘Ô Î·È ÙÔ ÓÂÔÁÓfi. ¶ÂÚÈÁÚ¿ÊÔÓÙ·È ÔÈ ‰˘ÓËÙÈÎԛΛӉ˘ÓÔÈ ·fi ÙË ¯ÔÚ‹ÁËÛË ÙˆÓ ÈÔ Û˘¯Ó¿ ¯ÚËÛÈÌÔ-ÔÈÔ‡ÌÂÓˆÓ Ê·Ú̿ΈÓ, Ù· ÎÏÈÓÈο ·ÔÙÂϤÛÌ·Ù·,ÔÈ ‰È·ÁÓˆÛÙÈΤ˜ ÛΤ„ÂȘ, Ë ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ÂÌ-‚Ú‡Ô˘ ‹ ÙÔ˘ ‚Ú¤ÊÔ˘˜ Ô˘ ÂÎÙ¤ıËΠ۠·˘Ù¿ Î·È ËÂΉ‹ÏˆÛË ÙˆÓ ¿ÌÂÛˆÓ Î·È Ì·ÎÚÔ¯ÚfiÓÈˆÓ ·ÔÙÂÏÂ-ÛÌ¿ÙˆÓ. ∞ӷʤÚÔÓÙ·È, ›Û˘, ÔÈ ÈÔ Û˘¯Ó¤˜ ·ı‹-ÛÂȘ, fiˆ˜ Ë Ó¢ÌÔÓÔ¿ıÂÈ·, ÙÔ Û‡Ó‰ÚÔÌÔ ·ÈÊÓ›-‰ÈÔ˘ ı·Ó¿ÙÔ˘ ÙˆÓ ‚ÚÂÊÒÓ Î·È ¿ÏÏ·.

§¤ÍÂȘ ÎÏÂȉȿ: Ê¿Ú̷η, ÚÔÁÂÓÓËÙÈ΋ ÂÚ›Ô‰Ô˜,¤Ì‚Ú˘Ô, ÓÂÔÁÓfi, ÂÁ΢ÌÔÛ‡ÓË, ·ÓÙÈÂÈÏËÙÈο, ÂÌ-‚Ú˘˚Îfi Û‡Ó‰ÚÔÌÔ ·fi ÙË Ï‹„Ë ·ÏÎÔfiÏ, ·ÓÙÈËÎÙÈ-ο, Û‡Ó‰ÚÔÌÔ ·fi ÙË Ï‹„Ë ‚·ÚÊ·Ú›Ó˘, Ï›ıÈÔ, ο-ÓÈÛÌ· ÌËÙ¤Ú·˜, ·Ó·ÛÙÔÏ›˜ ÙÔ˘ ÌÂÙ·ÙÚÂÙÈÎÔ‡ ÂÓ-˙‡ÌÔ˘ Ù˘ ·ÁÁÂÈÔÙÂÓÛ›Ó˘.

�Abstract: Some of the drugs prescribed duringpregnancy are of questionable safety regarding thepossible risks of their administration for the foetusand the newborn infant. This article indicates thepotential risks of commonly used drugs and theirclinical effects, makes some diagnosticsuggestions, and covers management of the foetusor infant exposed to them, along with theappearance of short and long-term effects. It alsorefers to the most commonly-encountered drug-related diseases, including pulmonary disease andSIDS.

Key words: prenatal drugs, foetus, newborn,pregnancy, anticonvulsants, foetal alcoholsyndrome, anticoagulants, warfarin syndrome,lithium, maternal smoking, angiotensin-convertingenzyme (ACE) inhibitors.

¡ÂÔÁÓÔÏÔÁÈÎfi ∆Ì‹Ì·, °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô “∞ÏÂÍ¿Ó‰Ú·”, ∞ı‹Ó·

Department of Neonatology, “Alexandra” General Hospital, Athens

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·160

Page 18: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

161

¶·È‰È·ÙÚÈ΋ 2004;67:160-167 Paediatriki 2004;67:160-167

ηٷӷÏÒÓÔ˘Ó ·ÏÎÔfiÏ ÛÙȘ Â˘Úˆ·˚Τ˜ ¯ÒÚ˜ ΢-Ì·›ÓÂÙ·È ÛÙ· ›‰È· ›‰·, ÂÓÒ ÁÈ· ÙËÓ ∂ÏÏ¿‰· ›ӷÈÂÚ›Ô˘ 33% (2). ∆· ·È‰È¿ ÌËÙ¤ÚˆÓ Ì ˘ÂÚηٷ-ӿψÛË ·ÏÎÔfiÏ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÛËÌ›· Î·È Û˘ÌÙÒ-Ì·Ù· ‰ËÏËÙËÚ›·Û˘ ·fi ‰È¿ÊÔÚ· Û˘ÛÙ‹Ì·Ù· ηÈ΢ڛˆ˜ ·fi ÙÔ ÎÂÓÙÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ·, Ì ÚÔ-ÂÍ¿Ú¯ÔÓÙ· ÙËÓ Î·Ù·ÛÙÔÏ‹ Î·È ÙËÓ ˘ÔÁÏ˘Î·ÈÌ›·(3). ™˘¯Ó¿ ·ÓȯÓ‡ÔÓÙ·È ÙÔÍÈο ›‰· ·ÏÎÔfiÏ ÛÙÔ·›Ì· ÙÔ˘ ÔÌÊ¿ÏÈÔ˘ ÏÒÚÔ˘. ∆· ÓÂÔÁÓ¿ ÌËÙ¤ÚˆÓ Ì¯ÚfiÓÈ· ηٿ¯ÚËÛË ·ÏÎÔfiÏ ÂÓ›ÔÙ ·ÚÔ˘ÛÈ¿˙Ô˘ÓÛ˘ÌÙÒÌ·Ù· ÂÍ¿ÚÙËÛ˘, fiˆ˜ ÙÚfiÌÔ, ·ÓËÛ˘¯›·,˘ÂÚ‚ÔÏÈÎfi ÎÏ¿Ì·, ˘ÂÚÙÔÓ›·, ¤ÓÙÔÓÔ ÛËÌ›Ôstartle (·ÓÙ›‰Ú·ÛË ÛÙÔ ÂÚ¤ıÈÛÌ·) Î·È ÔÈÛıfiÙÔÓÔ(1,3). ∆· Û˘ÌÙÒÌ·Ù· ·˘Ù¿ ÌÔÚ› Ó· ‰È·ÚΤÛÔ˘Ó72 ÒÚ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË.

∂›Û˘, Û˘¯Ó‹ Â›Ó·È Ë ÙÂÚ·ÙÔÁfiÓÔ˜ ‰Ú¿ÛË ÙÔ˘·ÏÎÔfiÏ ÛÙÔ ¤Ì‚Ú˘Ô Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÁ΢ÌÔ-Û‡Ó˘, Ô˘ ÚÔηÏ› ÓÔËÙÈ΋ ˘ÛÙ¤ÚËÛË ÛÙË ÌÂÙ¤-ÂÈÙ· ˙ˆ‹ (1,3,6). ∆Ô ÂÌ‚Ú˘˚Îfi Û‡Ó‰ÚÔÌÔ ·fi ÙËÏ‹„Ë ·ÏÎÔfiÏ (∂™∞) (foetal alcohol syndrome -FAS), ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÚ›· ÎÚÈÙ‹ÚÈ·: ·) ÂÓ‰ÔÌ‹ÙÚÈ· ‹Î·È ÌÂÙ¿ ÙË Á¤ÓÓËÛË Î·ı˘ÛÙ¤ÚËÛË ÛˆÌ·ÙÈ΋˜ ·Ó¿-Ù˘Í˘, ‚) ÚÔÛ‚ÔÏ‹ ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘-ÛÙ‹Ì·ÙÔ˜ Î·È Á) Ù˘Èο ‰˘ÛÌÔÚÊÈο ¯·Ú·ÎÙËÚÈÛÙÈ-ο ÚÔÛÒÔ˘ (¶›Ó·Î·˜ 2·). ∆· ÂÚÈÛÛfiÙÂÚ· ·È-‰È¿ Ô˘ ¤¯Ô˘Ó ÂÎÙÂı› ÂÓ‰ÔÌ‹ÙÚÈ· Û ÙÔÍÈο ›Â-‰· ·ÏÎÔfiÏ, ‰ÂÓ ÂΉËÏÒÓÔ˘Ó Ï‹Úˆ˜ Ù· ¯·Ú·ÎÙËÚÈ-ÛÙÈο ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘. ¶·ÚÔ˘ÛÈ¿˙Ô˘Ó, fï˜, ηı˘-ÛÙ¤ÚËÛË Ù˘ ·Ó¿Ù˘Í˘, ‰È·Ù·Ú·¯¤˜ Û˘ÌÂÚÈÊÔ-Ú¿˜, ÎÈÓËÙÈ΋ ηı˘ÛÙ¤ÚËÛË Î·È Î·ı˘ÛÙ¤ÚËÛË ÛÙËÓ·Ó¿Ù˘ÍË ÙÔ˘ ÏfiÁÔ˘.

O fiÚÔ˜ “Û˘Ó¤ÂȘ ·fi ÙË Ï‹„Ë ·ÏÎÔfiÏ ÛÙÔ¤Ì‚Ú˘Ô” ¯ÚËÛÈÌÔÔÈÂ›Ù·È Û ·ÓÙÈηٿÛÙ·ÛË ÙÔ˘∂™∞ ÁÈ· Ó· ÂÚÈÁÚ¿„ÂÈ ÙÔ Â‡ÚÔ˜ ÙˆÓ ·Ó·Ù˘ÍÈ·ÎÒӉȷٷڷ¯ÒÓ ·fi ÙË ¯ÚfiÓÈ· Ï‹„Ë ·ÏÎÔfiÏ (1,3,4)(¶›Ó·Î·˜ 2‚). ¶ÚfiÛÊ·Ù·, ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ô fiÚÔ˜“Ó¢ÚÔ·Ó·Ù˘ÍȷΤ˜ ‰È·Ù·Ú·¯¤˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·ÈÌ ÙÔ ·ÏÎÔfiÏ” (alcohol-related neurodevelopmentaldisorders - ARND), Ô ÔÔ›Ô˜ ÂÚÈÏ·Ì‚¿ÓÂÈ ÙȘ ‰È·-

Ù·Ú·¯¤˜ ÁÓÒÛ˘ ‹ ÙȘ ‰È·Ù·Ú·¯¤˜ Û˘ÌÂÚÈÊÔÚ¿˜,¯ˆÚ›˜ Ù· ÎÏ·ÛÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ ÚÔÛÒÔ˘ÙÔ˘ ∂™∞. ªÂ ÙÔÓ fiÚÔ “Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜ Ô˘Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì ÙË Ï‹„Ë ·ÏÎÔfiÏ” (alcohol-relatedbirth defects - ARBD) ÂÚÈÁÚ¿ÊÔÓÙ·È ·ÓˆÌ·Ï›Â˜·fi ÙË Á¤ÓÓËÛË, ¯ˆÚ›˜ Ù· ÎÏ·ÛÈο ¯·Ú·ÎÙËÚÈÛÙÈοÙÔ˘ ÚÔÛÒÔ˘ ÙÔ˘ ∂™∞ (1,3).

∏ ·ÈÙÈÔÏÔÁ›· ÙˆÓ ·Ú·¿Óˆ Û˘Ó‰ÚfiÌˆÓ ‰ÂÓ Â›-Ó·È ÙÂÏ›ˆ˜ ÁÓˆÛÙ‹ Î·È ÌÔÚ› Ó· Â›Ó·È ÔÏ˘·Ú·-ÁÔÓÙÈ΋. ™˘Û¯ÂÙ›˙ÂÙ·È, fï˜, Ì ÙËÓ Â›‰Ú·ÛË Ù˘·ÏÎÔfiÏ˘ ‹ ÙˆÓ ÌÂÙ·‚ÔÏÈÙÒÓ Ù˘ ÛÙË ÌÂÙ·ÊÔÚ¿ıÚÂÙÈÎÒÓ Ô˘ÛÈÒÓ Î·È Ô͢ÁfiÓÔ˘ ̤ۈ ÙÔ˘ Ï·ÎÔ‡-ÓÙ· ‹ ÙËÓ ¿ÌÂÛË Â›‰Ú·ÛË Û ÌÂÙ·‚ÔÏÈΤ˜ ‚ÈÔ¯ËÌÈ-Τ˜ Ô‰Ô‡˜ ÙÔ˘ ·Ó·Ù˘ÛÛfiÌÂÓÔ˘ ÂÌ‚Ú‡Ô˘ (7). OÈ

¶›Ó·Î·˜ 1. ¶·Ú¿ÁÔÓÙ˜ Ô˘ ÌÔÚ› Ó· ÂËÚ¿˙Ô˘Ó ÙËÓ Â›-‰Ú·ÛË Ê·ÚÌ¿ÎˆÓ ÛÙÔ ¤Ì‚Ú˘Ô Î·È ÙÔ ÓÂÔÁÓfi

ñ ∏ ¯ÔÚ‹ÁËÛË ÙˆÓ Ê·ÚÌ¿ÎˆÓ ÛÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÚÒÙÔ˘ ÙÚÈ-Ì‹ÓÔ˘ ·ËÛ˘ (ÔÚÁ·ÓÔÁ¤ÓÂÛË), .¯. ÎÔ˘Ì·Ú›ÓË, ·ÏÎÔfiÏ

ñ ∏ ¯ÚfiÓÈ· ¯Ú‹ÛË ÙˆÓ Ê·ÚÌ¿ÎˆÓ ‹ Ô˘ÛÈÒÓ, .¯. οÓÈÛÌ·,Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË

ñ ∏ ‰fiÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘, .¯. ·ÏÎÔfiÏ, οÓÈÛÌ·, ·ÓÙÈÂÈÏË-ÙÈο, ·Ó·ÛÙÔÏ›˜ ÙÔ˘ ÌÂÙ·ÙÚÂÙÈÎÔ‡ ÂÓ˙‡ÌÔ˘

ñ ∏ Ê·ÚÌ·ÎÔÎÈÓËÙÈ΋ Î·È Ô ÌÂÙ·‚ÔÏÈÛÌfi˜ οı ʷÚÌ¿ÎÔ˘ ñ ∏ ¯Ú‹ÛË Ê·ÚÌ¿ÎˆÓ Î·È Ô˘ÛÈÒÓ ÌÂÙ¿ ÙË Á¤ÓÓËÛË, .¯. Ë Û˘-

Ó¤¯ÈÛË ÙÔ˘ ÏÈı›Ô˘ ‹ ÙÔ˘ ηӛÛÌ·ÙÔ˜ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡

ñ ∏ ÔÏ˘Ê·Ú̷Λ·, .¯. ÂÚÈÛÛfiÙÂÚ· ÙÔ˘ ÂÓfi˜ ·ÓÙÈÂÈÏËÙÈο ñ ¢È·ÙÚÔÊÈÎÔ› ·Ú¿ÁÔÓÙ˜, .¯. ·ÓÙÈÂÈÏËÙÈο Î·È Ê˘ÏÏÈÎfi

Ô͇/ ‚ÈÙ·Ì›ÓË ∫

¶›Ó·Î·˜ 2·. OÈ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ÙÔ˘ ÂÌ‚Ú˘˚ÎÔ‡ Û˘Ó‰Úfi-ÌÔ˘ ·fi ÙË Ï‹„Ë ·ÏÎÔfiÏ

∫Ú·ÓÈÔÚÔÛˆÈΤ˜ ªÈÎÚ¤˜ ‚ÏÂÊ·ÚÈΤ˜ Û¯ÈṲ̂˜ ∂›Â‰Ô ÚfiÛˆÔ ∂›Â‰Ë ÚÈÓÔ¯ÂÈÏÈ΋ ·‡Ï·Î· ∫˘ÚÙfi ¿Óˆ ¯Â›ÏÔ˜ ∫·Ú‰È·Î¤˜ ªÂÛÔÎÔÏÈο ÂÏÏ›ÌÌ·Ù· ªÂÛÔÎÔÈÏȷο ÂÏÏ›ÌÌ·Ù· ∆ÂÙÚ·ÏÔÁ›· Fallot ™ÎÂÏÂÙÈΤ˜ ÀÔÏ·ÛÙÈο Ó‡¯È· ∫ÔÓÙ‹ ¤ÌÙË Ê¿Ï·ÁÁ· ∫ÏÈÓÔ‰·ÎÙ˘Ï›· ™‡Ó‰ÚÔÌÔ Klippel-Feil ™ÎÔÏ›ˆÛË ¡ÂÊÚÈΤ˜ ∞Ï·ÛÙÈÎÔ›/˘ÔÏ·ÛÙÈÎÔ›/‰˘ÛÏ·ÛÙÈÎÔ› ÓÂÊÚÔ› ¶ÂÙ·ÏÔÂȉ‹˜ ÓÂÊÚfi˜ ¢ÈÏ·ÛÈ·ÛÌfi˜ Ô˘ÚËÙ‹Ú· ∞Ó¿Ù˘Í˪ÈÎÚ¿ ÁÈ· ÙËÓ ËÏÈΛ· ·ËÛ˘ ÓÂÔÁÓ¿ ¢˘Û¯¤ÚÂÈ· Û›ÙÈÛ˘ ¢˘Û·Ó·ÏÔÁ›· ‚¿ÚÔ˘˜-‡„Ô˘˜ ∫ÂÓÙÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ· ªÈÎÚÔÎÂÊ·Ï›· ªÂÚÈ΋ ‹ ÔÏÈ΋ ·Ï·Û›· ÙÔ˘ ÌÂÛÔÏÔ‚›Ô˘ ¶·ÚÂÁÎÂÊ·ÏȉÈ΋ ˘ÔÏ·Û›· ÀÔÏ·Û›· ÙÔ˘ ÔÙÈÎÔ‡ Ó‡ÚÔ˘ ™ÙÚ·‚ÈÛÌfi˜

¶›Ó·Î·˜ 2‚. ¡Â˘ÚÔ·Ó·Ù˘ÍȷΤ˜ ‰È·Ù·Ú·¯¤˜ Ô˘ Û¯ÂÙ›˙Ô-ÓÙ·È Ì ÙË Ï‹„Ë ·ÏÎÔfiÏ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÁ΢ÌÔÛ‡Ó˘

∂ËÚ·Ṳ̂ÓË ÏÂÙ‹ ÎÈÓËÙÈÎfiÙËÙ· ¡Â˘ÚÔ·ÈÛıËÙ‹ÚÈ· ÎÒʈÛË ºÙˆ¯‹ Û˘Ó¤ÚÁÂÈ· ÔÊı·ÏÌÔ‡-¯ÂÚÈÔ‡ ª·ıËÛȷΤ˜ ‰˘ÛÎÔϛ˜ ¶ÚÔ‚Ï‹Ì·Ù· ÌÓ‹Ì˘, ÚÔÛÔ¯‹˜ Î·È ÎÚ›Û˘ ∫·Îfi˜ ¤ÏÂÁ¯Ô˜ ·ÚÔÚÌËÙÈÎfiÙËÙ·˜ ¶ÚÔ‚Ï‹Ì·Ù· ÎÔÈÓˆÓÈ΋˜ ·Ô‰Ô¯‹˜ ÀÂÚÎÈÓËÙÈÎfiÙËÙ· ¶ÚÔ‚Ï‹Ì·Ù· ÂÈÎÔÈÓˆÓ›·˜

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·161

Page 19: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

Ô‰Ô› ·˘Ù¤˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙË Û‡ÓıÂÛË ÚˆÙÂ˚ÓÒÓ,ÙËÓ ·Ú·ÁˆÁ‹ ÂÓ¤ÚÁÂÈ·˜, ÙËÓ ¤Ó·ÚÍË ‹ ÙÔÓ ÙÂÚÌ·-ÙÈÛÌfi ‚ÈÔ¯ËÌÈÎÒÓ ·ÓÙȉڿÛˆÓ, ÙË ÌÂÙ·Ó¿ÛÙ¢ÛË΢ÙÙ¿ÚˆÓ, ÙËÓ ·˘ÍË̤ÓË ·fiÙˆÛË Î·È ÙËÓ ·Ú·-ÁˆÁ‹ Ó¢Úԉȷ‚È‚·ÛÙÒÓ.

∏ Û˘¯ÓfiÙËÙ· ÙÔ˘ ∂™∞ Â›Ó·È 5 ·Ó¿ 10.000 ˙ÒÓÙ·ÓÂÔÁÓ¿ ÛÙȘ ∏¶∞, ÂÓÒ Â›Ó·È ·ÎfiÌË ˘„ËÏfiÙÂÚË ÛÂÔÚÈṲ̂Ó˜ ÏËı˘ÛÌȷΤ˜ ˘Ô-ÔÌ¿‰Â˜, fiˆ˜ ÔÈ ÌÂÈ-ÔÓfiÙËÙ˜. ∏ Û˘¯ÓfiÙËÙ·, fï˜, ÙÔ˘ ∂™∞ ηıÒ˜ ηÈÙˆÓ Û˘ÁÁÂÓÒÓ ·ÓˆÌ·ÏÈÒÓ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÏ‹„Ë ·ÏÎÔfiÏ, Â›Ó·È Ôχ ÌÂÁ·Ï‡ÙÂÚË Î·È ÂÎÙÈ̿ٷȉ‡ÛÎÔÏ· (5). ªÂÚÈÎÔ› ÂÚ¢ÓËÙ¤˜ ˘ÔÏÔÁ›˙Ô˘Ó ÙËÛ˘¯ÓfiÙËÙ· ÙˆÓ Û˘Ó‰ÚfiÌˆÓ Û 1 ·Ó¿ 300 ·È‰È¿ (5).∏ ÂÓ‰ÔÌ‹ÙÚÈ· ¤ÎıÂÛË ÛÙÔ ·ÏÎÔfiÏ Û ÌÈÎÚfiÙÂÚËËÏÈΛ· ·ËÛ˘ Èı·ÓÒ˜ ÚÔηÏ› ÙÔ ÎÏ·ÛÈÎfi ÂÌ-‚Ú˘˚Îfi Û‡Ó‰ÚÔÌÔ ÌÂ Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜, ÂÓÒ Ë¤ÎıÂÛË Û ÌÂÁ·Ï‡ÙÂÚË ËÏÈΛ· ·ËÛ˘ Â›Ó·È ˘Â‡-ı˘ÓË ÁÈ· ‰È·Ù·Ú·¯¤˜ Ó¢ÚÔ·Ó¿Ù˘Í˘ Î·È Û˘ÌÂÚÈ-ÊÔÚ¿˜ (5). ∏ ¤ÎıÂÛË ÛÙËÓ ·ÏÎÔfiÏË ÌÔÚ› Ó· ¢-ı‡ÓÂÙ·È ÁÈ· ÙÔ 5% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ Û˘ÁÁÂÓÒÓ ·Óˆ-Ì·ÏÈÒÓ (6). ∏ ̤ÛË Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ÙÔ˘ ∂™∞ÛÙȘ ÌËÙ¤Ú˜ Ô˘ οÓÔ˘Ó ¯Ú‹ÛË ·ÏÎÔfiÏ ÛÙË ‰È¿Ú-ÎÂÈ· Ù˘ ÂÁ΢ÌÔÛ‡Ó˘ Â›Ó·È 2-3% (5). O ΛӉ˘ÓÔ˜,fï˜, ÂÌÊ¿ÓÈÛ˘ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ·˘Í¿ÓÂÈ Û 85%ÛÙȘ ÌËÙ¤Ú˜ Ì ÚÔÁÂÓÓËÙÈÎÔ‡˜ ÂÈ‚·Ú˘ÓÙÈÎÔ‡˜·Ú¿ÁÔÓÙ˜, fiˆ˜ ÙÔ ˘„ËÏfi ÔÛÔÛÙfi ËÌÂÚÒÓ ¤Î-ıÂÛ˘ Û ·ÏÎÔfiÏ, Û ÌËÙ¤Ú˜ Ì ÔÏϷϤ˜ ΢‹-ÛÂȘ Î·È Û ÂΛӘ Ô˘ ··ÓÙÔ‡Ó Î·Ù·Ê·ÙÈο ÛÙËÓÂÚÒÙËÛË Â¿Ó Î·Ù·Ó¿ÏˆÛ·Ó ·ÏÎÔfiÏ ÛÙË ‰È¿ÚÎÂÈ·Ù˘ ·ËÛ˘ (5). O ΛӉ˘ÓÔ˜ Ó· ÂËÚ·ÛÙ› ÙÔ ¤Ì-‚Ú˘Ô Â›Ó·È ÌÂÁ·Ï‡ÙÂÚÔ˜, fiÛÔ ÌÂÁ·Ï‡ÙÂÚË Â›Ó·È ËÔÛfiÙËÙ· ÙÔ˘ ·ÏÎÔfiÏ Ô˘ ηٷӷÏÒıËÎÂ.

∏ ÂÚÈÛÙ·Ûȷ΋ ηٷӿψÛË ÌÂÁ¿ÏˆÓ ÔÛÔÙ‹-ÙˆÓ ·ÏÎÔfiÏ Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ ÂÈΛӉ˘ÓË ·fi Ù˯ÚfiÓÈ· ηٷӿψÛË ÌÈÎÚÒÓ ÔÛÔÙ‹ÙˆÓ (5). ∫ÏÈÓÈ-Τ˜ ÂΉËÏÒÛÂȘ ÙÔ˘ ∂™∞ ·Ú·ÙËÚ‹ıËÎ·Ó Û 10%ÙˆÓ ÓÂÔÁÓÒÓ, ÙˆÓ ÔÔ›ˆÓ ÔÈ ÌËÙ¤Ú˜ ηٷӿψӷÓηıËÌÂÚÈÓ¿ ÂÚ›Ô˘ 30-60 ml ηı·ÚÔ‡ ·ÏÎÔfiÏ.™‡Ìʈӷ Ì ÙȘ ÌÂϤÙ˜, ˆ˜ ¤Ó· ÔÙfi ÔÚ›˙ÔÓÙ·È360 ml ̇ڷ˜ ‹ 150 ml ÎÚ·ÛÈÔ‡ ‹ 45 ml ÏÈΤÚ, Ô˘·ÓÙÈÛÙÔÈ¯Ô‡Ó Û 15 ml ηı·ÚÔ‡ ·ÏÎÔfiÏ. O ΛӉ˘-ÓÔ˜ ·˘Í¿ÓÂÈ Û 40%, fiÙ·Ó Ë Î·Ù·Ó¿ÏˆÛË Î·ı·ÚÔ‡·ÏÎÔfiÏ ÍÂÂÚ¿ÛÂÈ Ù· 150 ml ÙËÓ Ë̤ڷ (1). O ΛÓ-‰˘ÓÔ˜ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË Ó¢ÚÔ·Ó·Ù˘Íȷ΋˜ ‰È·Ù·-Ú·¯‹˜ Ô˘ Û¯ÂÙ›˙ÂÙ·È Ì ÙË Ï‹„Ë ·ÏÎÔfiÏ Â›Ó·È ·Îfi-ÌË ‰˘ÛÎÔÏfiÙÂÚÔ Ó· ˘ÔÏÔÁÈÛÙ› ÂÍ·ÈÙ›·˜ ÙÔ˘ ÌÂÁ¿-ÏÔ˘ ‡ÚÔ˘˜ ÙˆÓ ÎÏÈÓÈÎÒÓ ÂΉËÏÒÛÂˆÓ ÙÔ˘ Û˘Ó‰Úfi-ÌÔ˘. OÈ ÂÚÈÛÛfiÙÂÚÔÈ ÂÚ¢ÓËÙ¤˜ Û˘ÌʈÓÔ‡Ó fiÙÈ ËηٷӿψÛË ÌÂÁ¿ÏˆÓ ÔÛÔÙ‹ÙˆÓ ·ÏÎÔfiÏ Û˘Û¯ÂÙ›-˙ÂÙ·È Ì ¯·ÌËÏfi ‰Â›ÎÙË Â˘Ê˘˝·˜ Î·È ‰È·Ù·Ú·¯¤˜ Û˘-ÌÂÚÈÊÔÚ¿˜. ¢ÂÓ ¤¯ÂÈ ÚÔÛ‰ÈÔÚÈÛÙ› ̤¯ÚÈ Û‹ÌÂÚ·¤Ó· ·ÛʷϤ˜ fiÚÈÔ Î·Ù·Ó¿ÏˆÛ˘ ·ÏÎÔfiÏ ÛÙË ‰È¿Ú-ÎÂÈ· Ù˘ ÂÁ΢ÌÔÛ‡Ó˘ (5).

∆Ô ∂™∞, ÔÈ Ó¢ÚÔ·Ó·Ù˘ÍȷΤ˜ ‰È·Ù·Ú·¯¤˜ ηÈÔÈ Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜ Ô˘ Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÏ‹„Ë ·ÏÎÔfiÏ ¤¯Ô˘Ó ÛÔ‚·Ú¤˜ ÎÔÈÓˆÓÈΤ˜ Î·È ÔÈÎÔ-ÓÔÌÈΤ˜ Û˘Ó¤ÂȘ Î·È Ô ÓÂÔÁÓÔÏfiÁÔ˜ ‹ Ô ·È‰›·-ÙÚÔ˜ ı· Ú¤ÂÈ Ó· Â›Ó·È Ôχ ÚÔÛÂÎÙÈÎfi˜ ÛÙËÓ·Ó·ÁÓÒÚÈÛË ÙˆÓ ÎÏÈÓÈÎÒÓ ÂΉËÏÒÛÂˆÓ ÙˆÓ ·Ú·-¿Óˆ Û˘Ó‰ÚfïÓ, ȉȷ›ÙÂÚ· fiÙ·Ó ˘¿Ú¯ÂÈ ıÂÙÈÎfiÈÛÙÔÚÈÎfi ÌÂÁ¿Ï˘ ηٷӿψÛ˘ ·ÏÎÔfiÏ Î·Ù¿ ÙˉȿÚÎÂÈ· Ù˘ ÂÁ΢ÌÔÛ‡Ó˘ (1). OÈ ÎÏÈÓÈΤ˜ ÂΉËÏÒ-ÛÂȘ ÂÓ›ÔÙ ‰ÂÓ Â›Ó·È ÂÌÊ·Ó›˜ ·fi ÙË ÓÂÔÁÓÈ΋ Â-Ú›Ô‰Ô Î·È ÔÈ Ó¢ÚÔ·Ó·Ù˘ÍȷΤ˜ ‰È·Ù·Ú·¯¤˜ ÂÌÊ·-Ó›˙ÔÓÙ·È ·ÚÁfiÙÂÚ·.

ŸÙ·Ó ˘¿Ú¯ÂÈ Ë ˘Ô„›· Ù˘ ‰È¿ÁÓˆÛ˘, ÙÔ ·È-‰› ÂÎÙÈÌ¿Ù·È ·fi ÙÔ˘˜ ·È‰Ô·Ó·Ù˘ÍÈÔÏfiÁÔ˘˜,ÒÛÙ ӷ Á›ÓÂÈ ·ÎÚÈ‚‹˜ Ë ‰È¿ÁÓˆÛË.

∫¿ÓÈÛÌ· ÀÔÏÔÁ›˙ÂÙ·È fiÙÈ ÂÚ›Ô˘ 20% ÙˆÓ Á˘Ó·ÈÎÒÓ

ÛÙȘ ∏¶∞ ηӛ˙ÂÈ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÁ΢ÌÔÛ‡-Ó˘. ∆· ›‰È· ÂÚ›Ô˘ ÔÛÔÛÙ¿ ·ÊÔÚÔ‡Ó Û Á˘Ó·›-Θ Û ·Ó··Ú·ÁˆÁÈ΋ ËÏÈΛ· ÛÙËÓ ∂˘ÚÒË, ÂÓÒÛÙËÓ ∂ÏÏ¿‰· ÙÔ ÔÛÔÛÙfi ÙˆÓ Á˘Ó·ÈÎÒÓ Û ·Ó··-Ú·ÁˆÁÈ΋ ËÏÈΛ· Ô˘ ηӛ˙ÂÈ Â›Ó·È 27% (2). ∏ ·Úȷ›وÛË ÙÔ˘ ηӛÛÌ·ÙÔ˜ ÛÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ ÂÌ-‚Ú‡Ô˘ Â›Ó·È Ë ÂÏ·Ùو̤ÓË ÚfiÛÏË„Ë ‚¿ÚÔ˘˜ (8).¶ÔÏÏÔ› ÂÚ¢ÓËÙ¤˜, fï˜, ÂÎÙÈÌÔ‡Ó fiÙÈ ÔÈ Û˘Ó¤ÂȘÙÔ˘ ηӛÛÌ·ÙÔ˜ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÁ΢ÌÔÛ‡-Ó˘ Â›Ó·È ÔχÏ¢Ú˜, fiˆ˜ ‰È·Ù·Ú·¯¤˜ Û˘ÌÂÚÈ-ÊÔÚ¿˜, ‰È·Ù·Ú·¯¤˜ ÛÙËÓ Î·Ù·ÓfiËÛË Î·È ¤ÎÊÚ·ÛËÙÔ˘ ÏfiÁÔ˘, ˘ÂÚÎÈÓËÙÈÎfiÙËÙ·, ‰È·Ù·Ú·¯¤˜ ÚÔÛÔ-¯‹˜ Î·È ¯·ÌËÏfi ÓÔËÙÈÎfi ËÏ›ÎÔ (¶›Ó·Î·˜ 3). øÛÙfi-ÛÔ, ÔÈ Ì·ÎÚÔ¯ÚfiÓȘ Û˘Ó¤ÂȘ ÙÔ˘ ηӛÛÌ·ÙÔ˜‰ÂÓ ¤¯Ô˘Ó ‰È¢ÎÚÈÓÈÛÙ›. ™Â ÂȉËÌÈÔÏÔÁÈΤ˜ ¤Ú¢-Ó˜, ÙÔ Î¿ÓÈÛÌ· ·Ó·ÁÓˆÚ›˙ÂÙ·È Û·Ó ·Ú¿ÁÔÓÙ·˜ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙÔ Û‡Ó‰ÚÔÌÔ ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ ÛÙ·‚Ú¤ÊË (sudden infant death syndrome - SIDS), Ô˘Èı·Ó¿ ÔÊ›ÏÂÙ·È Û ‰È·Ù·Ú·¯‹ ÛÙÔÓ Ì˯·ÓÈÛÌfi·Ê‡ÓÈÛ˘ (9).

162

¶·È‰È·ÙÚÈ΋ 2004;67:160-167 Paediatriki 2004;67:160-167

¶›Ó·Î·˜ 3. ∞ÔÙÂϤÛÌ·Ù· ÙÔ˘ ηӛÛÌ·ÙÔ˜ ηٿ ÙËÓ ÂÁ΢-ÌÔÛ‡ÓË

¶ÂÚÈÁÂÓÓËÙÈο ÚÔ‚Ï‹Ì·Ù·∞˘ÙfiÌ·ÙË ·Ô‚ÔÏ‹ ∂Ó‰ÔÌ‹ÙÚÈ· ηı˘ÛÙ¤ÚËÛË Ù˘ ·Ó¿Ù˘Í˘ ¶ÚfiˆÚË Ú‹ÍË ˘Ì¤ÓˆÓ: ·‡ÍËÛË Û¯ÂÙÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘ ηٿ 3 ¶ÚfiˆÚÔ˜ ÙÔÎÂÙfi˜: ·‡ÍËÛË Û¯ÂÙÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘ ηٿ 2 ∞ÔÎfiÏÏËÛË Ï·ÎÔ‡ÓÙ·: ·‡ÍËÛË Û¯ÂÙÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘ ηٿ 2,5 ∂Ȉ̷ÙÈÎfi˜ Ï·ÎÔ‡ÓÙ·˜: ·‡ÍËÛË Û¯ÂÙÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘ ηٿ 3 ¶ÚÔ‚Ï‹Ì·Ù· ÚÒÙ˘ ‚ÚÂÊÈ΋˜ ËÏÈΛ·˜ªÈÎÚ‹ ÂÚ›ÌÂÙÚÔ˜ ÎÂÊ·Ï‹˜ ªÂȈ̤ÓË ÏÂÎÙÈ΋ ÈηÓfiÙËÙ· ÷ÌËÏfi ÓÔËÙÈÎfi ËÏ›ÎÔ ∞˘ÍË̤ÓË Â›ÙˆÛË ‚ÚÔÁ¯ÈÎÔ‡ ¿ÛıÌ·ÙÔ˜ ∞˘ÍË̤ÓÔ˜ ΛӉ˘ÓÔ˜ ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ ÙˆÓ ‚ÚÂÊÒÓ

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·162

Page 20: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

163

¶·È‰È·ÙÚÈ΋ 2004;67:160-167 Paediatriki 2004;67:160-167

OÈ ·ıÔÊ˘ÛÈÔÏÔÁÈÎÔ› Ì˯·ÓÈÛÌÔ› Ô˘ ÂÓÔ¯Ô-ÔÈÔ‡ÓÙ·È Â›Ó·È Ë ¤ÎıÂÛË ÙfiÛÔ Ù˘ ÌËÙ¤Ú·˜ fiÛÔÎ·È ÙÔ˘ ÂÌ‚Ú‡Ô˘ ÛÙË ÓÈÎÔÙ›ÓË Î·È ÙÔ ÌÔÓÔÍ›‰ÈÔÙÔ˘ ¿Óıڷη. ∏ ÓÈÎÔÙ›ÓË ¤¯ÂÈ ·Ô‰Âȯı› fiÙÈ ÚÔ-ηÏ› ÙËÓ ·ÂÏ¢ı¤ÚˆÛË Î·Ù¯ÔÏ·ÌÈÓÒÓ, Ô˘ÚÔηÏÔ‡Ó ·ÁÁÂÈÔÛ‡Û·ÛË ÙˆÓ ·ÁÁ›ˆÓ Ù˘ Ì‹-ÙÚ·˜ Ì ·ÔÙ¤ÏÂÛÌ· ÙË Ì›ˆÛË Ù˘ ÌËÙÚÔÏ·-ÎÔ˘ÓÙȷ΋˜ ÚÔ‹˜ ·›Ì·ÙÔ˜ Î·È Ù˘ ÌÂÙ·ÊÔÚ¿˜ ıÚÂ-ÙÈÎÒÓ Ô˘ÛÈÒÓ Î·È Ô͢ÁfiÓÔ˘ ÛÙÔ ¤Ì‚Ú˘Ô (10).Œ¯ÂÈ ˘ÔÏÔÁÈÛÙ› fiÙÈ Ë Û˘ÁΤÓÙÚˆÛË ÓÈÎÔÙ›Ó˘ÛÙÔ ¤Ì‚Ú˘Ô Â›Ó·È 10-15% ˘„ËÏfiÙÂÚË Û ۯ¤ÛË ÌÂÙ· ›‰· ÓÈÎÔÙ›Ó˘ Ô˘ ·ÓȯÓ‡ÔÓÙ·È ÛÙË ÌËÙ¤-Ú·. ∆Ô ÌÔÓÔÍ›‰ÈÔ ÙÔ˘ ¿Óıڷη, ÚÔ˚fiÓ ÙÔ˘ η-ÓÔ‡, ·ÓÙ·ÁˆÓ›˙ÂÙ·È ÙÔ Ô͢ÁfiÓÔ ÛÙË Û‡Ó‰ÂÛ‹ ÙÔ˘Ì ÙËÓ ·ÈÌÔÛÊ·ÈÚ›ÓË, ÁÈ·Ù› Û˘Ó‰¤ÂÙ·È Ì ·˘Ù‹ ηȷڿÁÂÙ·È Ë Î·Ú‚Ô͢·ÈÌÔÛÊ·ÈÚ›ÓË, Ë ÔÔ›· ÂÌÔ-‰›˙ÂÈ ÙË ÌÂÙ·ÊÔÚ¿ Ô͢ÁfiÓÔ˘ ÛÙÔ˘˜ ÈÛÙÔ‡˜. ∏ ÂÌ-‚Ú˘˚΋ ·ÈÌÔÛÊ·ÈÚ›ÓË ¤¯ÂÈ ÌÂÁ·Ï‡ÙÂÚË ‰ÂÛÌ¢ÙÈ΋ÈηÓfiÙËÙ· ÚÔ˜ ÙÔ ÌÔÓÔÍ›‰ÈÔ ÙÔ˘ ¿Óıڷη ·fiÙÔ Ô͢ÁfiÓÔ, Ì ·ÔÙ¤ÏÂÛÌ· Ó· ÂÚÈÔÚ›˙ÂÙ·È ·Îfi-ÌË ÂÚÈÛÛfiÙÂÚÔ Ë ÌÂÙ·ÊÔÚ¿ Ô͢ÁfiÓÔ˘ ÚÔ˜ ÙÔ˘˜ÈÛÙÔ‡˜.

¶·ıÔÏÔÁÔ·Ó·ÙÔÌÈΤ˜ ÌÂϤÙ˜ Ï·ÎÔ˘ÓÙÈ·ÎÔ‡˘ÏÈÎÔ‡ Û ÌËÙ¤Ú˜ ηӛÛÙÚȘ ¤‰ÂÈÍ·Ó ÈÛÙÈΤ˜ ÓÂ-ÎÚˆÙÈΤ˜ ‚Ï¿‚˜, ÌÈÎÚÔ¤ÌÊÚ·ÎÙ·, ‰ËÌÈÔ˘ÚÁ›·ÈÓÒ‰Ô˘˜ Î·È ˙ÒÓ˜ Ì ˘Ô·ÁÁ›ˆÛË Î·È ·ÙÚÔÊÈΤ˜Ï¿¯Ó˜, Û·Ó ·ÔÙ¤ÏÂÛÌ· ·ÁÁÂÈÔÛ‡Û·Û˘ ηÈÈÛ¯·ÈÌ›·˜.

∆Ô ·ÔÙ¤ÏÂÛÌ· ÙÔ˘ ηӛÛÌ·ÙÔ˜ Â›Ó·È ‰ÔÛÔÂ-Í·ÚÙÒÌÂÓÔ, ·˘Í¿ÓÂÙ·È ‰ËÏ·‰‹ ·Ó¿ÏÔÁ· Ì ÙÔÓ·ÚÈıÌfi ÙˆÓ ÙÛÈÁ¿ÚˆÓ Ô˘ ηٷӷÏÒÓÔÓÙ·È ËÌÂÚË-Û›ˆ˜. ŸÙ·Ó Ô ·ÚÈıÌfi˜ ÙˆÓ ÙÛÈÁ¿ÚˆÓ Ô˘ ηٷӷ-ÏÒÓÔÓÙ·È Â›Ó·È ÌÈÎÚfiÙÂÚÔ˜ ·fi 10 ËÌÂÚËÛ›ˆ˜, ·-Ú·ÙËÚÔ‡ÓÙ·È Ï›Á˜ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ.

∆Ô Î¿ÓÈÛÌ· Ù˘ ÌËÙ¤Ú·˜ Û˘Ó‹ıˆ˜ Û˘Ó¯›˙ÂÙ·ÈÎ·È ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi, Ì ·ÔÙ¤ÏÂÛÌ· ÙÔ ‚Ú¤ÊÔ˜ Ó·ÂÎÙ›ıÂÙ·È ÂÚ·ÈÙ¤Úˆ ÛÙÔ˘˜ ÎÈÓ‰‡ÓÔ˘˜ ·fi ·˘Ùfi. ∏¤ÎıÂÛË ÙÔ˘ ‚Ú¤ÊÔ˘˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË ÛÙÔ Î¿ÓÈ-ÛÌ· ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙ› Ì ÙËÓ ·Ó¿Ù˘ÍË ¯ÚfiÓÈ·˜ ·Ó·-Ó¢ÛÙÈ΋˜ ÓfiÛÔ˘ Î·È ÙÔ Û‡Ó‰ÚÔÌÔ ·ÈÊÓ›‰ÈÔ˘ ı·-Ó¿ÙÔ˘. ∆Ô ÌËÙÚÈÎfi Á¿Ï· ÙˆÓ ÌËÙ¤ÚˆÓ Ô˘ ηӛ-˙Ô˘Ó ÂÚȤ¯ÂÈ ÛËÌ·ÓÙÈΤ˜ ÔÛfiÙËÙ˜ ÓÈÎÔÙ›Ó˘.

∞ÓÙÈÂÈÏËÙÈο ™·ÛÌÔ› ÂÌÊ·Ó›˙ÔÓÙ·È ÂÚ›Ô˘ ÛÙÔ 0,4-0,8%

ÙÔ˘ ÏËı˘ÛÌÔ‡, ÂÓÒ ÔÏÏ¿ ·fi Ù· ·ÓÙÈÂÈÏËÙÈοʿÚ̷η Â›Ó·È ÙÂÚ·ÙÔÁfiÓ· (14,15).

∏ ÂΉ‹ÏˆÛË ÙˆÓ Û˘ÁÁÂÓÒÓ ·ÓˆÌ·ÏÈÒÓ Û ÓÂÔ-ÁÓ¿ ÙˆÓ ÔÔ›ˆÓ ÔÈ ÌËÙ¤Ú˜ ÂÌÊ·Ó›˙Ô˘Ó Û·ÛÌÔ‡˜Î·È Ï·Ì‚¿ÓÔ˘Ó Î¿ÔÈ· Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ ›ӷÈ2-3 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚË ·fi fi,ÙÈ ÛÙÔÓ ÁÂÓÈÎfi ÏËı˘-ÛÌfi (11-13). OÈ ·ÈÙÈÔÏÔÁÈÎÔ› ·Ú¿ÁÔÓÙ˜ ÂÌÊ¿ÓÈ-Û˘ Û˘ÁÁÂÓÒÓ ·ÓˆÌ·ÏÈÒÓ Â›Ó·È Ë ›‰È· Ë ÂÈÏË„›·

¯ˆÚ›˜ Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹, Ë ÁÂÓÂÙÈ΋ ÚԉȿıÂ-ÛË, Ë ‚·Ú‡ÙËÙ· ÙˆÓ Û·ÛÌÒÓ, ÙÔ Â›‰Ô˜ Ù˘ ·ÓÙÈÂ-ÈÏËÙÈ΋˜ ·ÁˆÁ‹˜, Ù· ›‰· ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ηÈË ıÂڷ›· Ì ÂÚÈÛÛfiÙÂÚ· ÙÔ˘ ÂÓfi˜ Ê¿Ú̷η(14,20,21).

™˘¯Ó¿ ·Ú·ÙËÚÂ›Ù·È ·ÏÏËÏÔÂÈÎ¿Ï˘„Ë ÙˆÓ·ÓˆÌ·ÏÈÒÓ ·Ó¿ÌÂÛ· Û ‰È¿ÊÔÚ· ‰˘ÛÌÔÚÊÈο Û‡Ó-‰ÚÔÌ· Ô˘ ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› Î·È Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÏ‹„Ë ·ÓÙÈÂÈÏËÙÈÎÒÓ Ê·Ú̿ΈÓ, ÂÓÒ ˘ÔÛÙËÚ›˙Â-Ù·È fiÙÈ Ù· Û‡Ó‰ÚÔÌ· ·˘Ù¿ ·ÓÙÈÚÔÛˆÂ‡Ô˘Ó ‰È·-ÊÔÚÂÙÈΤ˜ ÌÔÚʤ˜ ÙÔ˘ ›‰ÈÔ˘ ÂÌ‚Ú˘˚ÎÔ‡ Û˘Ó‰ÚfiÌÔ˘(¶›Ó·Î·˜ 4) (16-18).

OÈ Ì˯·ÓÈÛÌÔ› Ô˘ ÂÓÔ¯ÔÔÈÔ‡ÓÙ·È ÁÈ· ÙËÓ ·-ıÔÁ¤ÓÂÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ›ӷÈ: ·) Ô ÌÂÙ·‚ÔÏÈÛÌfi˜·˘ÙÒÓ ÙˆÓ Ê·ÚÌ¿ÎˆÓ Ô˘ Ô‰ËÁ› ÛÙËÓ ·Ú·ÁˆÁ‹ÙÔÍÈÎÒÓ ·ÛÙ·ıÒÓ ·Ú·ÁÒÁˆÓ ÙˆÓ ÂÔÍÂȉ›ˆÓ (19).™Â ÔÚÈṲ̂ӷ ¿ÙÔÌ·, Ë ·Ú·ÁˆÁ‹ ÂÔÍÂȉ›ˆÓ ¢ÓÔ-Â›Ù·È ·fi ÙËÓ ‡·ÚÍË ÁÂÓÂÙÈÎÔ‡ ÂÏÏ›ÌÌ·ÙÔ˜ Ô˘

¶›Ó·Î·˜ 4. ™˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜ Ô˘ Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì ·ÓÙÈÂ-ÈÏËÙÈο

º·ÈÓ˘ÓÙÔ˝ÓË◊È· ¤ˆ˜ ̤ÙÚÈ· ηı˘ÛÙ¤ÚËÛË ·Ó¿Ù˘Í˘ ∂˘Ú›· ÚfiÛıÈ· ËÁ‹ ÀÂÚÙÂÏÔÚÈÛÌfi˜ ∫·ı›˙ËÛË Ù˘ ‚¿Û˘ Ù˘ ÚÈÓfi˜ ∫ÔÓÙ‹ ̇ÙË Ì ΢ÚÙfi ¿Óˆ ¯Â›ÏÔ˜ ∂˘Ú¤· Ê·ÙÓ›· §·Áfi¯ÂÈÏÔ˜ Î·È Ï˘ÎfiÛÙÔÌ· ÀÔÏ·Û›· ÙˆÓ ¿ˆ Ê·Ï¿ÁÁˆÓ ÙˆÓ ‰·ÎÙ‡ÏˆÓ ªÈÎÚ¿ Ó‡¯È· ∫ÔÓÙfi˜ Ï·ÈÌfi˜ ∞ӈ̷ϛ˜ Ï¢ÚÒÓ ÀÂÚÙÚ›¯ˆÛË µ·Ï‚ȉÈ΋ ÛÙ¤ÓˆÛË Ó¢ÌÔÓÈ΋˜ ‹ ·ÔÚÙ‹˜ ªÂÛÔÎÔÈÏȷο ÂÏÏ›ÌÌ·Ù· ÀÔÛ·‰›·˜µ·ÏÚÔ˚ÎfiæËÏfi Ì¤ÙˆÔ ∂›Î·ÓıÔ˜ ∂˘Ú›· ‚¿ÛË Ì‡Ù˘ ÕÓˆ ÊÔÚ¿ ÙˆÓ ÚˆıÒÓˆÓ ª·ÎÚ‡ ÚÈÓÔ¯ÂÈÏÈÎfi ‰È¿ÛÙËÌ· ªÈÎÚfi ÛÙfiÌ· ™¯ÈÛٛ˜ Ì·Ïı·Î‹˜ ˘ÂÚÒ·˜ πÛıÌÈ΋ ÛÙ¤ÓˆÛË Ù˘ ·ÔÚÙ‹˜ ÀÔÏ·ÛÙÈ΋ ·ÚÈÛÙÂÚ‹ ÎÔÈÏ›· µ·Ï‚ȉÈ΋ ÛÙ¤ÓˆÛË ·ÔÚÙ‹˜ ªÂÛÔÎÔÏÈÎfi ¤ÏÏÂÈÌÌ· ªÂÛÔÎÔÈÏȷο ÂÏÏ›ÌÌ·Ù· ª·ÎÚÈ¿ ÏÂÙ¿ ‰¿ÎÙ˘Ï· ∫˘ÚÙ¿ Ó‡¯È· ∂ÏÏ›ÌÌ·Ù· Ó¢ÚÈÎÔ‡ ۈϋӷ ÀÔÛ·‰›·˜ ∫·Ú‚·Ì·˙›ÓË∫Ú·ÓÈÔÚÔÛˆÈο ÂÏÏ›ÌÌ·Ù· ∂ÏÏ›ÌÌ·Ù· Ó¢ÚÈÎÔ‡ ۈϋӷ º·ÈÓÔ‚·Ú‚ÈÙ¿Ï˧·Áfi¯ÂÈÏÔ˜ Î·È Ï˘ÎfiÛÙÔÌ· ∫·Ú‰È·Î¿ ÂÏÏ›ÌÌ·Ù·

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·163

Page 21: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

ÂϤÁ¯ÂÈ ÙË ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ˘‰ÚÔÏ¿Û˘ ÙÔ˘ ÂÔ-ÍÂȉ›Ô˘ (14), ‚) Ë ·ÂÏ¢ı¤ÚˆÛË ÙÔÍÈÎÒÓ ÂχıÂ-ÚˆÓ ÚÈ˙ÒÓ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙˆÓÊ·Ú̿ΈÓ, Á) Ë ·Ó¿ÚÎÂÈ· Ê˘ÏÏÈÎÔ‡ ÔͤԘ ÏfiÁˆÌÂȈ̤Ó˘ ·ÔÚÚfiÊËÛ˘ ‹ ·˘ÍË̤ÓÔ˘ Ë·ÙÈÎÔ‡ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙÔ˘ (14) Î·È ‰) Ë ·Ó·ÛÙÔÏ‹ Ù˘ ·-Ú·ÁˆÁ‹˜ Ê˘ÏÏÈÎÔ‡ ÔͤԘ ·fi ÙË ‰Ú¿ÛË ÙÔ˘ ‚·Ï-ÚÔ˚ÎÔ‡ ÔͤԘ (14).

ŒÁÎ˘Â˜ Á˘Ó·›Î˜ Ô˘ ¿Û¯Ô˘Ó ·fi ÂÈÏË„›·,Ì ¯·ÌËÏ¿ ›‰· Ê˘ÏÏÈÎÔ‡ ÔͤԘ, ¤¯Ô˘Ó ·˘ÍË-̤ÓË Èı·ÓfiÙËÙ· Ó· ÁÂÓÓ‹ÛÔ˘Ó ·È‰È¿ ÌÂ Û˘ÁÁÂ-Ó›˜ ·ÓˆÌ·Ï›Â˜ (23). ∏ ηڂ·Ì·˙›ÓË Î·È ÙÔ ‚·Ï-ÚÔ˚Îfi Ô͇ ÂÓÔ¯ÔÔÈÔ‡ÓÙ·È ÁÈ· ·ÓˆÌ·Ï›Â˜ ÙÔ˘Ó¢ÚÈÎÔ‡ ۈϋӷ (1-2%), ÔÈ Ôԛ˜ ÛÙÔ ÌÂÁ·Ï‡ÙÂ-ÚÔ ÔÛÔÛÙfi Â›Ó·È ÔÛÊ˘˚Τ˜ ÌËÓÈÁÁÔÌ˘ÂÏÔ΋Ϙ(14). ∏ Ï‹„Ë Ê˘ÏÏÈÎÔ‡ ÔͤԘ ÚÈÓ ‹ ·Ì¤Ûˆ˜ ÌÂÙ¿ÙË Û‡ÏÏË„Ë, ÌÂÈÒÓÂÈ ·˘ÙfiÓ ÙÔÓ Î›Ó‰˘ÓÔ Î·È Û˘ÓÈ-ÛÙ¿Ù·È Ë ÚÔÏËÙÈ΋ ¯ÔÚ‹ÁËÛË Ê˘ÏÏÈÎÔ‡ ÔͤԘÛÙȘ Á˘Ó·›Î˜ Ô˘ ÚfiÎÂÈÙ·È Ó· Ì›ÓÔ˘Ó ¤ÁÎ˘Â˜ Û‰fiÛË 0,4 mg ËÌÂÚËÛ›ˆ˜. ªÂÚÈÎÔ› Û˘ÓÈÛÙÔ‡Ó ·Îfi-ÌË ÌÂÁ·Ï‡ÙÂÚ˜ ‰fiÛÂȘ, fiˆ˜ 4 mg ËÌÂÚËÛ›ˆ˜(14,23).

∏ ·ÈÌÔÚÚ·ÁÈ΋ ÓfiÛÔ˜ ÙÔ˘ ÓÂÔÁÓÔ‡ ÔÊ›ÏÂÙ·ÈÛ ¤ÏÏÂÈ„Ë ‚ÈÙ·Ì›Ó˘ ∫. º¿Ú̷η fiˆ˜ Ë Ê·ÈÓ˘-ÓÙÔ˝ÓË, Ë Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË, Ë ÚÈÌȉfiÓË, Ë Î·Ú‚·-Ì·˙›ÓË Î·È Ë ÂıÔÛÔ˘ÍÈÌ›‰Ë, ÌÂÈÒÓÔ˘Ó ÙË ‰È·Ï·-ÎÔ˘ÓÙȷ΋ ÌÂÙ·ÊÔÚ¿ ‚ÈÙ·Ì›Ó˘ ∫ Î·È Â˘ı‡ÓÔÓÙ·ÈÁÈ· ÙËÓ ·ÈÌÔÚÚ·ÁÈ΋ ÓfiÛÔ ÙˆÓ ÓÂÔÁÓÒÓ (14). ∆·Ê¿Ú̷η ·˘Ù¿ ÌÂÙ¤¯Ô˘Ó ÛÙÔÓ ÌÂÙ·‚ÔÏÈÛÌfi Ù˘‚ÈÙ·Ì›Ó˘ D, Ì ·ÔÙ¤ÏÂÛÌ· Ó· ÚÔηÏÔ‡Ó ‰Â˘ÙÂ-ÚÔ·ı‹ ˘·Û‚ÂÛÙÈ·ÈÌ›· ÛÙË ÌËÙ¤Ú· Î·È ÙÔ ÓÂÔÁÓfi(14,22). ¢ÂÓ ¤¯ÂÈ ·Ô‰Âȯı› ·ÎfiÌË Ë ÙÂÚ·ÙÔÁfiÓÔ˜‰Ú¿ÛË ÙˆÓ ÓÂfiÙÂÚˆÓ ·ÓÙÈÂÈÏËÙÈÎÒÓ Ê·Ú̿ΈÓ,fiˆ˜ Ë Ï·ÌÔÙÚÈÁ›ÓË, Ë Áη̷ÂÓÙ›ÓË Î·È Ë ÊÂÏ-‚·Ì¿ÙË (13). O ¤ÏÂÁ¯Ô˜ ÙˆÓ Û·ÛÌÒÓ Î·Ù¿ ÙËÓÂÁ΢ÌÔÛ‡ÓË Â›Ó·È È‰È·›ÙÂÚ· ÛËÌ·ÓÙÈÎfi˜. ∏ ÂÌÊ¿ÓÈ-ÛË Û·ÛÌÒÓ ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÁ΢ÌÔÛ‡Ó˘ ¤¯ÂÈÛ˘Û¯ÂÙÈÛÙ› Ì ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· ÚfiˆÚˆÓ·Ô‚ÔÏÒÓ, ÚfiˆÚÔ˘ ÙÔÎÂÙÔ‡, ÂÓ‰ÔÎÚ¿ÓÈ·˜ ·È-ÌÔÚÚ·Á›·˜ ÛÙÔ ¤Ì‚Ú˘Ô, ÂÓ‰ÔÌ‹ÙÚÈÔ˘ ı·Ó¿ÙÔ˘ ηȉȷٷڷ¯ÒÓ ÛÙË Ì¿ıËÛË Î·È ·Ó¿Ù˘ÍË (13). ¶Èı·-Ó¿ ·›ÙÈ· ıˆÚÔ‡ÓÙ·È ÙÔ ÙÚ·‡Ì· Î·È Ë ˘ÔÍ›·/ÈÛ¯·È-Ì›· Ô˘ ÔÊ›ÏÂÙ·È Û ÂÏ·Ùو̤ÓË ‰È·Ï·ÎÔ˘ÓÙÈ·-΋ ÚÔ‹ (13,14). °È· ÙÔ˘˜ ·Ú·¿Óˆ ÏfiÁÔ˘˜ Û˘ÓÈ-ÛÙ¿Ù·È Ë Û˘Ó¤¯ÈÛË Ù˘ ·ÓÙÈÂÈÏËÙÈ΋˜ ·ÁˆÁ‹˜ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÁ΢ÌÔÛ‡Ó˘.

∏ ¯ÔÚ‹ÁËÛË ‚ÈÙ·Ì›Ó˘ ∫ Â›Ó·È ··Ú·›ÙËÙË ÁÈ·Ù· ÓÂÔÁÓ¿ Ô˘ ¤¯Ô˘Ó ÂÎÙÂı› ÂÓ‰ÔÌËÙÚ›ˆ˜ Û·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η. ∆· ÓÂÔÁÓ¿ ÙˆÓ ÔÔ›ˆÓ ÔÈÌËÙ¤Ú˜ ÙÂÏÔ‡Ó ˘fi ·ÁˆÁ‹ Ì ʷÈÓÔ‚·Ú‚ÈÙ¿ÏË ‹ÚÈÌȉfiÓË, Ú¤ÂÈ Ó· ·Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·È ÁÈ· ÂΉË-ÏÒÛÂȘ ÛÙÂÚËÙÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘, ¤ˆ˜ Î·È ÙËÓ 7Ë Ë̤-Ú· ˙ˆ‹˜.

O ÌËÙÚÈÎfi˜ ıËÏ·ÛÌfi˜ ‰ÂÓ ·ÓÙÂӉ›ÎÓ˘Ù·È ÛÙËÓÂÚ›ÙˆÛË Ô˘ Ë ÌËÙ¤Ú· Ï·Ì‚¿ÓÂÈ ·ÓÙÈÂÈÏËÙÈ΋·ÁˆÁ‹. À¿Ú¯Ô˘Ó, fï˜, ÂӉ›ÍÂȘ ηٷÛÙÔÏ‹˜ ÛÂıËÏ¿˙ÔÓÙ· ‚Ú¤ÊË ÌËÙ¤ÚˆÓ Ô˘ Ï·Ì‚¿ÓÔ˘Ó Ê·ÈÓÔ-‚·Ú‚ÈÙ¿ÏË ‹ ÚÈÌȉfiÓË (14).

πÛÔÙÚÂÙÈÓÔ˝ÓË ∏ ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜ ¯ÔÚ‹ÁËÛË ÈÛÔÙÚÂÙÈÓÔ˝Ó˘

ÁÈ· ÙË ıÂڷ›· Ù˘ ·ÎÌ‹˜ ηٿ ÙÔ ÚÒÙÔ ‰ÂηÂÓ-ı‹ÌÂÚÔ Ù˘ ·ËÛ˘ Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ÂÌÊ¿ÓÈÛË Û˘Á-ÁÂÓÒÓ ·ÓˆÌ·ÏÈÒÓ ÛÙÔ ¤Ì‚Ú˘Ô Û ÔÛÔÛÙfi ÂÚ›Ô˘35% (¶›Ó·Î·˜ 5) (12). O ·ıÔÊ˘ÛÈÔÏÔÁÈÎfi˜ Ì˯·ÓÈ-ÛÌfi˜ Ì ÙÔÓ ÔÔ›Ô ÚÔηÏÔ‡ÓÙ·È ÔÈ Î˘ÙÙ·ÚÔÙÔÍÈΤ˜‚Ï¿‚˜ ÛÙÔ Ú·¯È·›Ô ÙÌ‹Ì· ÙÔ˘ Ó¢ÚÈÎÔ‡ ۈϋӷ, ›-Ó·È Ë ·ÂÏ¢ı¤ÚˆÛË ÙˆÓ ÚÈ˙ÒÓ ˘ÂÚÔÍÂȉ›Ô˘ (12).

∆· ÂÚÈÛÛfiÙÂÚ· ·fi Ù· ÓÂÔÁÓ¿ Ô˘ ¤¯Ô˘ÓÂÎÙÂı› ÙȘ ÚÒÙ˜ Ë̤Ú˜ ÂÁ΢ÌÔÛ‡Ó˘ ÛÙÔ Ê¿Ú-Ì·ÎÔ, ÂÌÊ·Ó›˙Ô˘Ó Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜. ∏ ·Ô˘-Û›· Û˘ÁÁÂÓÒÓ ·ÓˆÌ·ÏÈÒÓ ‰ÂÓ ·ÔÎÏ›ÂÈ ÙËÓ ÂÌÊ¿-ÓÈÛË ÓÔËÙÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ. °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi, Û˘-ÓÈÛÙ¿Ù·È Ë Ó¢ÚÔ·Ó·Ù˘Íȷ΋ ÂÎÙ›ÌËÛË fiÏˆÓ ÙˆÓ·È‰ÈÒÓ.

§›ıÈÔ ∆Ô Ï›ıÈÔ Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈÎfi Ê¿ÚÌ·ÎÔ ÁÈ· ÙË

Ì·ÓÈÔηٿıÏÈ„Ë Î·È ÙË Ì·Ó›·. ∆Ô Ê¿ÚÌ·ÎÔ Û˘Û¯Â-Ù›˙ÂÙ·È Ì ÙËÓ ÂÌÊ¿ÓÈÛË Ù˘ ·ÓˆÌ·Ï›·˜ Ebstein(23,24). ∞˘Ù‹ Ë Û˘ÁÁÂÓ‹˜ ηډÈÔ¿ıÂÈ· ÂΉËÏÒ-ÓÂÙ·È Ì ΢¿ÓˆÛË Ô˘ ÔÊ›ÏÂÙ·È Û ‚·Ï‚ȉÈ΋

164

¶·È‰È·ÙÚÈ΋ 2004;67:160-167 Paediatriki 2004;67:160-167

¶›Ó·Î·˜ 5. ∞ӈ̷ϛ˜ Û¯ÂÙÈ˙fiÌÂÓ˜ Ì ÙË Ï‹„Ë ÈÛÔÙÚÂÙÈ-ÓÔ˝Ó˘

∫Ú·ÓÈÔÚÔÛˆÈΤ˜ªÈÎÚÔ‰ÔÓÙ›· ‹ ·ÓÔ‰ÔÓÙ›· ™Ù¤ÓˆÛË ÙÔ˘ ¤Íˆ ·ÎÔ˘ÛÙÈÎÔ‡ fiÚÔ˘ ¶·Ú¿Ï˘ÛË ÙÔ˘ ÚÔÛˆÈÎÔ‡ Ó‡ÚÔ˘ ªÈÎÚÔÁÓ·ı›· ∫·ı›˙ËÛË Ù˘ ‚¿Û˘ Ù˘ ÚÈÓfi˜ ÀÂÚÙÂÏÔÚÈÛÌfi˜ ™¯ÈÛٛ˜ Ì·Ïı·Î‹˜ ˘ÂÚÒ·˜ £‡ÌÔ˘∂ÎÙÔ›· ÀÔÏ·Û›· ¢˘ÛÏ·Û›· ∫·Ú‰È·Î¤˜ªÔÓ‹Ú˘ ηډȷÎfi˜ ÎÒÓÔ˜ ∆ÂÙÚ·ÏÔÁ›· Fallot ªÂÙ¿ıÂÛË ÌÂÁ¿ÏˆÓ ·ÁÁ›ˆÓ ªÂÛÔÎÔÈÏȷο ÂÏÏ›ÌÌ·Ù· ∞Û˘Ó¤¯ÂȘ ·ÔÚÙÈÎÔ‡ ÙfiÍÔ˘ ÀÔÏ·ÛÙÈ΋ ·ÚÈÛÙÂÚ‹ ÎÔÈÏ›· ∫ÂÓÙÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ·À‰ÚÔΤʷÏÔ˜ ªÈÎÚÔÎÂÊ·Ï›· ¶·ÚÂÁÎÂÊ·ÏȉÈ΋ ˘ÔÏ·Û›· ¡ÔËÙÈ΋ ηı˘ÛÙ¤ÚËÛË ¢Èۯȉ‹˜ Ú¿¯Ë

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·164

Page 22: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

165

¶·È‰È·ÙÚÈ΋ 2004;67:160-167 Paediatriki 2004;67:160-167

·Ó¿ÚÎÂÈ· Î·È ˘ÂÚÎÔÈÏȷ΋ Ù·¯˘Î·Ú‰›·. ÕÏϘ ÂȉڿÛÂȘ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Â›Ó·È Ë ÓÂÔÁÓÈ-

΋ ‚ÚÔÁ¯Ô΋ÏË, Ë ˘ÔÙÔÓ›·, Ô ÎÔÏÈÎfi˜ ÙÂÚ˘ÁÈ-ÛÌfi˜, Ë ·Ó·ÛÙÚÔÊ‹ ÙÔ˘ ∆ ·̷ÙÔ˜ ÛÙÔ ËÏÂÎÙÚÔ-ηډÈÔÁÚ¿ÊËÌ·, Ô ¿ÔÈÔ˜ ‰È·‚‹Ù˘, ÙÔ shock, ÔÈÛ·ÛÌÔ› Î·È Ô ÚfiˆÚÔ˜ ÙÔÎÂÙfi˜ (12,24).

¢ÂÓ Û˘ÓÈÛÙ¿Ù·È Ë ‰È·ÎÔ‹ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ÂÍ·È-Ù›·˜ Ù˘ ‰˘ÛÎÔÏ›·˜ Ó· ÂÏÂÁ¯ı› Ë Ì·ÓÈÔηٿıÏÈ„Ë,·ÏÏ¿ ı· Ú¤ÂÈ Ó· ·Ú·ÎÔÏÔ˘ıÂ›Ù·È ËÏÂÎÙÚÔηÚ-‰ÈÔÁÚ·ÊÈο ÙÔ ¤Ì‚Ú˘Ô Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÚÒ-ÙÔ˘ ÙÚÈÌ‹ÓÔ˘ Ù˘ ·ËÛ˘.

∆Ô Ï›ıÈÔ ÂÎÎÚ›ÓÂÙ·È ÛÙÔ ÌËÙÚÈÎfi Á¿Ï·, Û ¤ÁÎ˘Â˜Á˘Ó·›Î˜ Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È Û ıÂڷ›· Ì ·˘Ùfi.∆· ›‰· ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ÛÙ· ‚Ú¤ÊË Â›Ó·È 10-15%Ù˘ ÔÛfiÙËÙ·˜ Ô˘ Ï·Ì‚¿ÓÂÈ Ë ÌËÙ¤Ú·. OÈ ÂÈÏÔ-Τ˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Î˘¿ÓˆÛË, ˘ÔÙÔÓ›· Î·È ËÏÂ-ÎÙÚÔηډÈÔÁÚ·ÊÈΤ˜ ·ÓˆÌ·Ï›Â˜ (12,24).

∞Ó·ÛÙÔÏ›˜ ÙÔ˘ ÌÂÙ·ÙÚÂÙÈÎÔ‡ ÂÓ˙‡ÌÔ˘ Ù˘·ÁÁÂÈÔÙÂÓÛ›Ó˘

OÈ ·Ó·ÛÙÔÏ›˜ ÙÔ˘ ÌÂÙ·ÙÚÂÙÈÎÔ‡ ÂÓ˙‡ÌÔ˘(ACE), fiˆ˜ Ë Î·ÙÔÚ›ÏË, Ë ÂÓ·Ï·Ú›ÏË, Ë Ï˘ÛÈ-ÓÔÚ›ÏË Î·È Ë ÎÈÓ·Ú›ÏË, Â›Ó·È Ôχ ·ÔÙÂÏÂÛÌ·ÙÈ-ο ·ÓÙȸÂÚÙ·ÛÈο Ê¿Ú̷η, ¤¯Ô˘Ó Ï›Á˜ ·ÚÂÓ¤Ú-ÁÂȘ Î·È ¯ÔÚËÁÔ‡ÓÙ·È Û Á˘Ó·›Î˜ ·Ó··Ú·ÁˆÁÈ-΋˜ ËÏÈΛ·˜.

∆Ô ¤Ó˙˘ÌÔ ACE ÌÂÙ·ÙÚ¤ÂÈ ÙËÓ ·ÁÁÂÈÔÙÂÓÛ›ÓË πÛ ·ÁÁÂÈÔÙÂÓÛ›ÓË ππ, Ô˘ ¤¯ÂÈ ·ÁÁÂÈÔÛ˘Û·ÛÙÈΤ˜È‰ÈfiÙËÙ˜. ∆Ô Û‡ÛÙËÌ· Ù˘ ·ÁÁÂÈÔÙÂÓÛ›Ó˘ ¤¯ÂÈ·Ô‰Âȯı› ÛËÌ·ÓÙÈÎfi ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË Î·È ÏÂÈ-ÙÔ˘ÚÁ›· ÙÔ˘ ÓÂÊÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ηٿ ÙËÓ ÂÌ-‚Ú˘˚΋ ÂÚ›Ô‰Ô. ∆· ·ÓÙȸÂÚÙ·ÛÈο Ê¿Ú̷η ACE‰ÂÓ ÚÔηÏÔ‡Ó Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜ Î·È ÏÂÈÙÔ˘ÚÁÈ-Τ˜ ‰È·Ù·Ú·¯¤˜ fiÙ·Ó Ï·Ì‚¿ÓÔÓÙ·È Î·Ù¿ ÙÔ 1Ô ÙÚ›-ÌËÓÔ Ù˘ ·ËÛ˘. ∞ÓÙ›ıÂÙ·, Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜Î·È ÏÂÈÙÔ˘ÚÁÈΤ˜ ‰È·Ù·Ú·¯¤˜ ÚÔηÏÔ‡ÓÙ·È ÛÙ· ÓÂ-ÔÁÓ¿ Ô˘ ¤¯Ô˘Ó ÂÎÙÂı› ÛÙÔ Ê¿ÚÌ·ÎÔ Î·Ù¿ ÙÔ 2ÔÎ·È 3Ô ÙÚ›ÌËÓÔ Ù˘ ·ËÛ˘. ∆· Ê¿Ú̷η ·˘Ù¿ ÚÔ-ηÏÔ‡Ó ÂÏ·Ùو̤ÓË ÓÂÊÚÈ΋ ÚÔ‹, Ì ·ÔÙ¤ÏÂÛÌ·ÔÏÈÁÔ˘Ú›·, ·ÓÔ˘Ú›·, ÓÂÊÚÈ΋ ÛˆÏËÓ·Úȷ΋ ‰˘ÛÁÂ-ÓÂÛ›· Î·È ÔÏÈÁ¿ÌÓÈÔ (26). ∏ ¯·ÌËÏ‹ ·ÚÙËÚȷ΋ ›Â-ÛË Î·È ÙÔ ÔÏÈÁ¿ÌÓÈÔ Â˘ı‡ÓÔÓÙ·È ÁÈ· ÙË ÊÙˆ¯‹ ÂÚÈ-ÊÂÚÈ΋ ÈÛÙÈ΋ ·ÈÌ¿ÙˆÛË Î·È ÙȘ ·˘ÍË̤Ó˜ ȤÛÂȘÛÙÔ ÂÌ‚Ú˘˚Îfi ÎÚ·Ó›Ô, Ì ·ÔÙ¤ÏÂÛÌ· ÊÙˆ¯‹ ÔÛÙÂ-ÔÔ›ËÛË ÙˆÓ ÔÛÙÒÓ ÙÔ˘ ÎÚ·Ó›Ô˘. ∆· ÓÂÔÁÓ¿ Ô˘¤¯Ô˘Ó ÂÎÙÂı› ÂÓ‰ÔÌËÙÚ›ˆ˜ Û ·˘Ù¿ Ù· Ê¿Ú̷η,ÌÔÚ› Ó· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó ÛÔ‚·Ú‹ ˘fiÙ·ÛË Î·È·ÓÔ˘Ú›·, Ó¢ÌÔÓÈ΋ ˘ÔÏ·Û›· ÏfiÁˆ ›ÂÛ˘ ηȷӷÙÔÌÈΤ˜ ‰˘ÛϷۛ˜ (¶›Ó·Î·˜ 6) (26). ∆· Ê¿Ú-̷η ·˘Ù¿ ‰ÂÓ ÚÔηÏÔ‡Ó ÂÓ‰ÔÌ‹ÙÚÈ· ηı˘ÛÙ¤ÚË-ÛË Ù˘ ·Ó¿Ù˘Í˘.

∏ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË ·˘ÙÒÓ ÙˆÓ ÓÂÔÁÓÒÓÌÂÙ¿ ÙË Á¤ÓÓËÛË ÂÚÈÏ·Ì‚¿ÓÂÈ ¤ÏÂÁ¯Ô Ù˘ ·ÚÙË-

Úȷ΋˜ ›ÂÛ˘ Î·È Ù˘ ‰ÈÔ‡ÚËÛ˘ Î·È ÂͤٷÛË ÙÔ˘·Ó·Ó¢ÛÙÈÎÔ‡. ∏ Ú‡ıÌÈÛË Ù˘ ·ÚÙËÚȷ΋˜ ›Â-Û˘ ··ÈÙ› ÙËÓ ÚÔÛÂÎÙÈ΋ ¯ÔÚ‹ÁËÛË ˘ÁÚÒÓ Î·ÈËÏÂÎÙÚÔÏ˘ÙÒÓ Î·È ¤ÏÂÁ¯Ô Ù˘ Ô˘Ú›·˜ Î·È Ù˘ ÎÚÂ-·ÙÈÓ›Ó˘.

O ˘ÂÚ˯ÔÁÚ·ÊÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙˆÓ ÓÂÊÚÒÓ Ì Doppler ı· ÚÔÛ‰ÈÔÚ›ÛÂÈ ÙËÓ Î·Ù¿ÛÙ·ÛË Ù˘ ÓÂÊÚÈ΋˜ ÚÔ‹˜ Î·È Ë ·ÎÙÈÓÔÁÚ·Ê›· ÙÔ˘ ÎÚ·Ó›-Ô˘ ı· ·Ôηχ„ÂÈ ÂÚÈÔ¯¤˜ ÊÙˆ¯‹˜ ÔÛÙÂÔÔ›-ËÛ˘ (26).

∞ÓÙÈËÎÙÈο ∏ ¯ÔÚ‹ÁËÛË ·ÓÙÈËÎÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ ıˆÚ›ٷÈ

ȉȷ›ÙÂÚ· ÂÈΛӉ˘ÓË ÁÈ· ÙÔ ¤Ì‚Ú˘Ô, ·ÏÏ¿ Ë ¤Ó‰ÂÈÍ˯ÔÚ‹ÁËÛ‹˜ ÙÔ˘˜ Û ÌËÙ¤Ú˜ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÁÈ·ıÚÔÌ‚ÔÂÌ‚ÔÏÈο ÂÂÈÛfi‰È· Â›Ó·È ··Ú·›ÙËÙË.

∏ ÎÔ˘Ì·Ú›ÓË ¯ÔÚËÁÂ›Ù·È ÁÈ· ÙËÓ ÚfiÏË„Ë Î·ÈıÂڷ›· Ù˘ ıÚÔÌ‚ÔÂÌ‚ÔÏÈ΋˜ ÓfiÛÔ˘. ∞Ó·ÛÙ¤ÏÏÂÈÙË Û‡ÓıÂÛË ÙˆÓ ·fi ÙË ‚ÈÙ·Ì›ÓË ∫ ÂÍ·ÚÙÒÌÂÓˆÓ·Ú·ÁfiÓÙˆÓ ‹Í˘, fiˆ˜ Ô II, VII, IX Î·È X. ∆Ô Ê¿Ú-Ì·ÎÔ ÂÚÓ¿ ÛÙËÓ Î˘ÎÏÔÊÔÚ›· ÙÔ˘ ÂÌ‚Ú‡Ô˘ ‰È·Ì¤-ÛÔ˘ ÙÔ˘ Ï·ÎÔ‡ÓÙ· Î·È ¤¯ÂÈ ÙÂÚ·ÙÔÁfiÓÔ ‰Ú¿ÛË ÛÙÔ¤Ì‚Ú˘Ô (12) (¶›Ó·Î·˜ 7). ∏ ¤ÎıÂÛË ÛÙË ‚·ÚÊ·Ú›ÓËÌÂٷ͇ 6˘ Î·È 12˘ ‚‰ÔÌ¿‰·˜ ·ËÛ˘, ÚÔηÏ›ÙÔ ÁÓˆÛÙfi Û‡Ó‰ÚÔÌÔ Ù˘ ‚·ÚÊ·Ú›Ó˘ ÛÂ Û˘¯ÓfiÙË-Ù· 25% (12). ∏ ¤ÎıÂÛË ÛÙÔ Ê¿ÚÌ·ÎÔ ÌÂÙ¿ ÙË 12Ë‚‰ÔÌ¿‰· ·ËÛ˘, ÚÔηÏ› Ô˘Ï¤˜ (<5%) Ô˘ÔÊ›ÏÔÓÙ·È Û ·ÈÌÔÚÚ·Á›· ÛÙÔÓ ÂÌ‚Ú˘˚Îfi ÈÛÙfi. ∂›-Û˘, ÂÚÈÁÚ¿ÊÂÙ·È Ô Î›Ó‰˘ÓÔ˜ Ù˘ ·ÈÌÔÚÚ·Á›·˜ ÙÔ˘ÂÌ‚Ú‡Ô˘ ÛÙÔ ÎÂÓÙÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ·, ηٿ ÙˉȿÚÎÂÈ· ÙÔ˘ ÙÔÎÂÙÔ‡, Â¿Ó Ë ÌËÙ¤Ú· Û˘Ó¯›˙ÂÈ ÙËÏ‹„Ë ÎÔ˘Ì·Ú›Ó˘ (12).

∏ Ë·Ú›ÓË ıˆÚÂ›Ù·È Ê¿ÚÌ·ÎÔ ÂÎÏÔÁ‹˜ ÁÈ· ÙËıÂڷ›· ıÚÔÌ‚ÔÂÌ‚ÔÏÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ Ù˘ ÂÁ·-Ô˘. ∆Ô Ê¿ÚÌ·ÎÔ ‰ÂÓ ÂÚÓ¿ ÛÙËÓ Î˘ÎÏÔÊÔÚ›· ÙÔ˘ÂÌ‚Ú‡Ô˘ ‰È·Ì¤ÛÔ˘ ÙÔ˘ Ï·ÎÔ‡ÓÙ·, ‰ÂÓ Â›Ó·È ÙÂÚ·-ÙÔÁfiÓÔ Î·È ‰ÂÓ ·Ó·Ê¤ÚÔÓÙ·È ¿ÏϘ ·ÚÂÓ¤ÚÁÂȘÛÙÔ ¤Ì‚Ú˘Ô Î·È ÙÔ ÓÂÔÁÓfi. π‰È·›ÙÂÚ·, Ë ÌÈÎÚfiÙÂÚÔ˘ÌÔÚÈ·ÎÔ‡ ‚¿ÚÔ˘˜ Ë·Ú›ÓË ıˆÚÂ›Ù·È ÂÚÈÛÛfiÙÂÚÔ·ÛÊ·Ï‹˜ ÁÈ· ¯ÔÚ‹ÁËÛË Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÚÒ-ÙÔ˘ ÙÚÈÌ‹ÓÔ˘ Ù˘ ·ËÛ˘.

¶›Ó·Î·˜ 6. ∂ȉڿÛÂȘ ÙÔ˘ ÌÂÙ·ÙÚÂÙÈÎÔ‡ ÂÓ˙‡ÌÔ˘ Ù˘ ·Á-ÁÂÈÔÙÂÓÛ›Ó˘

§ÂÈÙÔ˘ÚÁÈΤ˜∞ÁÁÂÈԉȷÛÙÔÏ‹ ÀfiÙ·ÛË ∞ÓÔ˘Ú›· OÏÈÁÔ˘Ú›· OÏÈÁÔ¸‰Ú¿ÌÓÈÔ∞Ó·ÙÔÌÈΤ˜∞ӈ̷ϛ˜ ¿ÎÚˆÓ ¶Ó¢ÌÔÓÈ΋ ˘ÔÏ·Û›· ∂ÏÏ›ÌÌ·Ù· ÎÚ·ÓÈ·ÎÒÓ ÔÛÙÒÓ

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·165

Page 23: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

∆· ÓÂÔÁÓ¿ Ì ¤ÎıÂÛË ÛÙËÓ ÎÔ˘Ì·Ú›ÓË Î·Ù¿ ÙˉȿÚÎÂÈ· ÙÔ˘ ÚÒÙÔ˘ ÙÚÈÌ‹ÓÔ˘ ·ËÛ˘ Ú¤ÂÈ Ó·ÂÍÂÙ¿˙ÔÓÙ·È ÚÔÛÂÎÙÈο ÌÂÙ¿ ÙË Á¤ÓÓËÛË, ÚÔÎÂÈ-̤ÓÔ˘ Ó· ‰È·ÈÛÙˆı› Ù˘¯fiÓ ÂÌ‚Ú˘Ô¿ıÂÈ·. ∂¿Ó ˤÎıÂÛË Û˘Ì‚Â› ÛÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‰Â‡ÙÂÚÔ˘ ‹ ÙÚ›ÙÔ˘ÙÚÈÌ‹ÓÔ˘ ·ËÛ˘, Ë ÂͤٷÛË ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÔ ÎÂ-ÓÙÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ· Î·È ÙÔÓ ¤ÏÂÁ¯Ô Ì ˘ÂÚË-¯ÔÁÚ¿ÊËÌ· ÂÁÎÂÊ¿ÏÔ˘. ∂¿Ó Ë ÌËÙ¤Ú· Ï¿Ì‚·ÓÂÎÔ˘Ì·Ú›ÓË 48-72 ÒÚ˜ ÚÈÓ ·fi ÙÔÓ ÙÔÎÂÙfi, ÙÔ ÓÂ-ÔÁÓfi ı· Ú¤ÂÈ Ó· ÂϤÁ¯ÂÙ·È ÁÈ· ·ÈÌÔÚÚ·ÁÈΤ˜ ÂÎ-‰ËÏÒÛÂȘ (12).

™˘ÌÂÚ¿ÛÌ·Ù· ªÂ ÂÍ·›ÚÂÛË ÙËÓ ÈÛÔÙÚÂÙÈÓÔ˝ÓË Ô˘ ·ÓÙÂӉ›-

ÎÓ˘Ù·È ÏfiÁˆ ‰˘ÓËÙÈ΋˜ ÙÂÚ·ÙÔÁ¤ÓÂÛ˘, fiÏ· Ù· ¿Ï-Ï· Ê¿Ú̷η ÌÔÚÔ‡Ó Ó· ¯ÔÚËÁËıÔ‡Ó, ÂÊfiÛÔÓ˘¿Ú¯ÂÈ ·fiÏ˘ÙË ¤Ó‰ÂÈÍË Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ÂÁ΢ÌÔÛ‡Ó˘. O ÓÂÔÁÓÔÏfiÁÔ˜ ‹ Ô ·È‰›·ÙÚÔ˜ ı·Ú¤ÂÈ Ó· ÁÓˆÚ›˙ÂÈ ÙÔ˘˜ ÎÈÓ‰‡ÓÔ˘˜ ·fi ÙËÓ ¤ÎıÂÛËÙÔ˘ ÂÌ‚Ú‡Ô˘ Û ·˘ÙÔ‡˜ ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ Î·È Ó· ›-Ó·È È‰È·›ÙÂÚ· ÚÔÛÂÎÙÈÎfi˜ ηٿ ÙËÓ ÂÎÙ›ÌËÛË ÙÔ˘ÓÂÔÁÓÔ‡.

µÈ‚ÏÈÔÁÚ·Ê›· 1. American Academy of Pediatrics. Committee on Substance

Abuse and Committee on Children with Disabilities. Fetalalcohol syndrome and alcohol-related neurodevelopmentaldisorders. Pediatrics 2000;106:358-361.

2. Hibell B, Andersson B, Ahlstrom S, Balakireva O,Bjarnason T, Kokkevi A et al. Alcohol and other drug useamong students in 30 European countries. The 1999ESPAD Report. The European School Survey Project onAlcohol and Other Drugs. 1999. p. 88-91.

3. Clarren SK, Smith DW. The fetal alcohol syndrome. N EnglJ Med 1978;298:1063-1067.

4. Aase JM, Jones KL, Clarren SK. Do we need the term“FAE”? Pediatrics 1995;95:428-430.

5. Cordero JF, Floyd RL, Martin ML, Davis M, Hymbaugh K.Tracking the prevalence of FAS. Alcohol Health Res World1994;18:82-85.

6. Boyle RJ. Effects of certain prenatal drugs on the fetus andthe newborn. Pediatr Rev 2002;23:17-24.

7. Charness ME, Simon RP, Greenberg DA. Ethanol and thenervous system. N Engl J Med 1989;321:442-454.

8. Harrison GG, Branson RS, Vaucher YE. Association ofmaternal smoking with body composition of the newborn.Am J Clin Nutr 1983;38:757-762.

9. Klonoff-Cohen HS, Srinivasan IP, Edelstein SL. Prenataland intrapartum events and sudden infant deathsyndrome. Paediatr Perinat Epidemiol 2002;16:82-89.

10. Temesvari P, Boda D, Kecskemeti L, Eck E, Endreffy E.Deleterious effects of smoking during pregnancy: studies onblood oxygen affinity. Acta Paediatr Hung 1984;25:371-376.

11. Eller DP, Patterson CA, Webb GW. Maternal and fetalimplications of anticonvulsive therapy during pregnancy.Obstet Gynecol Clin North Am 1997;24:523-534.

12. Koren G, Pastuszak A, Ito S. Drugs in pregnancy. N Engl JMed 1998;338:1128-1137.

13. Malone FD, D’Alton ME. Drugs in pregnancy:anticonvulsants. Semin Perinatol 1997;21:114-123.

14. Zahn CA, Morrell MJ, Collins SD, Labiner DM, Yerby MS.Management issues for women with epilepsy: a review ofthe literature. Neurology 1998;51:949-956.

15. Hauser WA, Annegers JF, Rocca WA. Descriptiveepidemiology of epilepsy: contributions of population-based studies from Rochester, Minnesota. Mayo Clin Proc1996;71:576-586.

16. Yerby MS, Leppik I. Epilepsy and the outcome ofpregnancy. J Epilepsy 1990;3:193-199.

17. Speidel BD, Meadow SR. Maternal epilepsy andabnormalities of the fetus and newborn. Lancet1972;2:839-843.

18. Nakane Y, Okuma T, Takahashi R, Sato Y, Wada T, Sato Tet al. Multi-institutional study on the teratogenicity and fetaltoxicity of antiepileptic drugs: a report of a collaborativestudy group in Japan. Epilepsia 1980;21:663-680.

19. Lindhout D, Hoppener RJ, Meinardi H. Teratogenicity ofantiepileptic drug combinations with special emphasis onepoxidation (of carbamazepine). Epilepsia 1984;25:77-83.

20. Kelly TE, Edwards P, Rein M, Miller JQ, Dreifuss FE.Teratogenicity of anticonvulsant drugs. II: A prospectivestudy. Am J Med Genet 1984;19:435-443.

21. Kaneko S, Otani K, Fukushima Y, Ogawa Y, Nomura Y,Ono T et al. Teratogenicity of antiepileptic drugs: analysisof possible risk factors. Epilepsia 1988;29:459-467.

22. Sheth RD, Wesolowski CA, Jacob JC, Penney S, HobbsGR, Riggs JE et al. Effect of carbamazepine and valproateon bone mineral density. J Pediatr 1995;127:256-262.

23. MRC Vitamin Study Research Group. Prevention of neuraltube defects: results of the Medical Research Councilvitamin study. Lancet 1991;338:131-137.

24. Committee on Drugs. American Academy of Pediatrics.Use of psychoactive medication during pregnancy andpossible effects on the fetus and newborn. Pediatrics2000;105:880-887.

25. Cohen LS, Friedman JM, Jefferson JW, Johnson EM,

166

¶·È‰È·ÙÚÈ΋ 2004;67:160-167 Paediatriki 2004;67:160-167

¶›Ó·Î·˜ 7. ™‡Ó‰ÚÔÌÔ ‚·ÚÊ·Ú›Ó˘

∂Ì‚Ú˘Ô¿ıÂÈ· ·fi ÙË Ï‹„Ë ‚·ÚÊ·Ú›Ó˘ÀÔÏ·Û›· ̇Ù˘ ∫·ı›˙ËÛË ‚¿Û˘ Ù˘ ÚÈÓfi˜ ªË ÔÛÙÂÔÔÈË̤Ó˜ ÂÈʇÛÂȘ ‹ ÎÔÎΛˆÛË ÂÈʇÛˆÓ, ȉȷ›ÙÂÚ· ÙÔ˘ ÎÔÚÌÈÎÔ‡ ÛÎÂÏÂÙÔ‡ Î·È ÙÔ˘ ÂÁÁ‡˜ ÌËÚÈ·›Ô˘ ª¤ÙÚÈ· ˘ÔÏ·Û›· Ó˘¯ÈÒÓ Î·È ÎÔÓÙ¿ ‰¿¯Ù˘Ï· ¡ÔËÙÈ΋ ηı˘ÛÙ¤ÚËÛË ™·ÛÌÔ› ÕÏϘ ÂÌ‚Ú˘˚Τ˜/ÓÂÔÁÓÈΤ˜ Û˘Ó¤ÂȘ∞˘ÙfiÌ·ÙË ¤ÎÙÚˆÛË ∂Ó‰ÔÌ‹ÙÚÈÔ˜ ı¿Ó·ÙÔ˜ ªÈÎÚÔÎÂÊ·Ï›· À‰ÚÔΤʷÏÔ˜ ¢˘ÛÏ·Û›· Dandy-Walker ∞ÁÂÓÂÛ›· ÌÂÛÔÏÔ‚›Ô˘ OÙÈ΋ ·ÙÚÔÊ›· ªÈÎÚÔÊı·ÏÌ›· ∂Ó‰ÔÎÚ¿ÓÈ· ·ÈÌÔÚÚ·Á›·

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·166

Page 24: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

167

¶·È‰È·ÙÚÈ΋ 2004;67:160-167 Paediatriki 2004;67:160-167

Weiner ML. A reevaluation of risk of in utero exposure tolithium. JAMA 1994;271:146-150.

26. Rosa FW, Bosco LA, Graham CF, Milstien JB, Dreis M,Creamer J. Neonatal anuria with maternal angiotensin-converting enzyme inhibition. Obstet Gynecol1989;74:371-374.

∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 28-03-2003 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 09-09-2003

¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ª·Ú›· ¢·ÛÔÔ‡ÏÔ˘ ¶··‰È·Ì·ÓÙÔÔ‡ÏÔ˘ 11, ∆.∫. 115 28, πÏ›ÛÈ· E-mail: [email protected]

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·167

Page 25: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

∞¡∞™∫O¶∏™∏ REVIEW ARTICLE

∏ ÎÂÊ·Ï·ÏÁ›· Û·Ó Û‡Ìو̷ ÛÙË ÁÂÓÈ΋ ·È‰È·ÙÚÈ΋∂. ª·˙›ÁÔ˘ - ºˆÙÔÔ‡ÏÔ˘

Headache as a symptom in the practice of the general paediatricsH. Bazigou - Fotopoulou

∂ÈÛ·ÁˆÁ‹∏ ›ӷ Î·È Ë ‰›„· Ì·˙› Ì ÙËÓ ÎÂÊ·Ï·ÏÁ›· ıˆ-

ÚÔ‡ÓÙ·È ÔÈ Û˘¯ÓfiÙÂÚ˜ ·Èٛ˜ ·ÓıÚÒÈÓ˘ ηÎÔ˘-¯›·˜ Û fiϘ ÙȘ ËÏÈ˘ Î·È Û fiϘ ÙȘ ÂÔ¯¤˜. ∏ÔÛÊ˘·ÏÁ›· Î·È Ë ÎÂÊ·Ï·ÏÁ›· Â›Ó·È Û˘ÌÙÒÌ·Ù·Ô˘ ·ÓÙÈÚÔÛˆÂ‡Ô˘Ó ¿Ú· ÔÏÏ¿ ÓÔÛ‹Ì·Ù·. ∏·ÈÌ·ÙÔ˘Ú›· Î·È Ë ÎÂÊ·Ï·ÏÁ›· Â›Ó·È Î·Ù’ ÂÍÔ¯‹Ó Ù·Û˘ÌÙÒÌ·Ù· Ô˘ ÚÔηÏÔ‡Ó ÙË ÌÂÁ·Ï‡ÙÂÚË ·ÓË-Û˘¯›· ÙˆÓ ·ÛıÂÓÒÓ Î¿ı ËÏÈΛ·˜. ∏ ÎÂÊ·Ï·ÏÁ›· ›-Ó·È ÙÔ Û˘¯ÓfiÙÂÚÔ Û‡Ìو̷ Ô˘ Ô ·ÛıÂÓ‹˜ ÂÈ˙Ë-Ù¿ Ó¢ÚÔ·ÂÈÎÔÓÈÛÙÈÎfi ¤ÏÂÁ¯Ô.

∂ȉËÌÈÔÏÔÁÈο ÛÙÔȯ›· ¶ÚfiÛÊ·Ù˜ ÌÂϤÙ˜ ·Ô‰ÂÈÎÓ‡Ô˘Ó fiÙÈ Ù· ÙÂÏ¢-

Ù·›· 30 ̄ ÚfiÓÈ· ·Ú·ÙËÚ‹ıËΠÛËÌ·ÓÙÈ΋ ·‡ÍËÛË Ù˘ÎÂÊ·Ï·ÏÁ›·˜ ÛÙÔÓ ÁÂÓÈÎfi ÏËı˘ÛÌfi ÁÈ· ¿ÁÓˆÛÙÔ˘˜ÏfiÁÔ˘˜. ŸÛÔÓ ·ÊÔÚ¿ ÛÙ· ·È‰È¿, ÙÔ 1974, ÔÛÔÛÙfi14,4% ÙˆÓ ·È‰ÈÒÓ ËÏÈΛ·˜ 7 ÂÙÒÓ ·ÚÔ˘Û›·˙ ÎÂÊ·-Ï·ÏÁ›·, ÂÓÒ ÙÔ 1992, ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ÔÛÔÛÙfi ‹Ù·Ó51,5%. ∞Ó¿ÏÔÁË ·‡ÍËÛË, ÛÙÔÓ ›‰ÈÔ ÏËı˘ÛÌfi, ·-

ÚÔ˘Û›·ÛÂ Î·È Ô ÂÈÔÏ·ÛÌfi˜ Ù˘ ËÌÈÎÚ·Ó›·˜, Ë ÔÔ›··fi 1,9% ÙÔ 1974 ·Ó‹Ïı Û 5,7% ÙÔ 1992 (1).

∏ Û˘¯ÓfiÙËÙ· Ù˘ ÎÂÊ·Ï·ÏÁ›·˜ Î˘Ì·›ÓÂÙ·È ÛÙËÓÚÔÛ¯ÔÏÈ΋ ËÏÈΛ· Û ÔÛÔÛÙfi 4-20%, ηٿ ÙËÓ Â›-ÛÔ‰Ô ÛÙÔ Û¯ÔÏÂ›Ô Û 38-50% Î·È ÛÙËÓ ÂÊ˂›· ÛÂ50-75% (1,2). ∏ ÎÂÊ·Ï·ÏÁ›·, ÂÍ¿ÏÏÔ˘, ˆ˜ ˘ÔÎÂÈ-ÌÂÓÈÎfi Û‡Ìو̷, ··ÈÙ› ÙË Ì·ÚÙ˘Ú›· ÙÔ˘ ·ÛıÂ-ÓÔ‡˜, Ë ÔÔ›· fï˜ ·Ô˘ÛÈ¿˙ÂÈ Ù· ÙÚ›· ÚÒÙ· ¯Úfi-ÓÈ· Ù˘ ˙ˆ‹˜ Ì ·ÔÙ¤ÏÂÛÌ· Ó· ˘ÔÂÎÙÈÌ¿Ù·È Ë Û˘-¯ÓfiÙËÙ¿ Ù˘ ÛÙËÓ ËÏÈΛ· ·˘Ù‹ (3). ™Â ÌÂÌÔӈ̤ÓËÌÂϤÙË ·Ó·Ê¤ÚÂÙ·È fiÙÈ ·È‰È¿ ËÏÈΛ·˜ 3 ÂÙÒÓ Â›¯·ÓÂÌÂÈÚ›· ÎÂÊ·Ï·ÏÁ›·˜ Û ÔÛÔÛÙfi 15%, ÂÓÒ 3% ›-¯Â ˘ÔÙÚÔÈ¿˙ÔÓÙ˜ ÔÓÔÎÂÊ¿ÏÔ˘˜ (4).

∏ ‚·ÛÈ΋ ·ÓËÛ˘¯›· ÛÙËÓ ÚÔÛ¤ÁÁÈÛË Ù˘ ÎÂÊ·-Ï·ÏÁ›·˜, ÁÂÓÈο, Â›Ó·È Ô ‰È·¯ˆÚÈÛÌfi˜ Ù˘ ÚˆÙÔ·-ıÔ‡˜ ·fi ÙË ‰Â˘ÙÂÚÔ·ı‹ ‹ ÔÚÁ·ÓÈ΋, ÛÙËÓ ÔÔ›··Ó·Ê¤ÚÂÙ·È ÙÔ ¿ÚıÚÔ ·˘Ùfi. ∏ ‰Â˘ÙÂÚÔ·ı‹˜ ÎÂ-Ê·Ï·ÏÁ›· ·ÔÙÂÏ› ÙÔ 10% Ù˘ ·È‰È΋˜ ÎÂÊ·Ï·Ï-Á›·˜ ÛÙÔ Û‡ÓÔÏfi Ù˘. ªÂÙ¿ ÙÔÓ ‰È·¯ˆÚÈÛÌfi ·˘Ùfi, ËÚÔÛÔ¯‹ ÂÈÎÂÓÙÚÒÓÂÙ·È ÛÙËÓ ·ÈÙÈÔÏfiÁËÛË Ù˘

�¶ÂÚ›ÏË„Ë: ∏ ÎÂÊ·Ï·ÏÁ›· Â›Ó·È ¤Ó· Ôχ Û˘ÓËıÈ-Ṳ̂ÓÔ Û‡Ìو̷ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ ÌÂ Û˘¯ÓfiÙË-Ù· Ô˘ ·˘Í¿ÓÂÈ Ì ÙËÓ ¿ÚÔ‰Ô Ù˘ ËÏÈΛ·˜. O ‰È·-¯ˆÚÈÛÌfi˜ Ù˘ Û ڈÙÔ·ı‹, Ì ·ÚÈÔ ÂÎÚfiÛˆÔÙËÓ ËÌÈÎÚ·Ó›· Î·È Û ‰Â˘ÙÂÚÔ·ı‹ ‹ ÔÚÁ·ÓÈ΋˜ ·È-ÙÈÔÏÔÁ›·˜ ÎÂÊ·Ï·ÏÁ›·, ·ÔÙÂÏ› ÙÔ ÚÒÙÔ ‚‹Ì·ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛ‹ Ù˘. ∆Ô ¿ÚıÚÔ ·˘Ùfi ·Ó·Ê¤ÚÂÙ·ÈÛÙË ‰Â˘ÙÂÚÔ·ı‹ ÎÂÊ·Ï·ÏÁ›·, Ì ÔÍ›· ‹ ¯ÚfiÓÈ·ÔÚ›·, ÛÙËÓ ·ÈÙÈÔÏÔÁ›· Ù˘ Î·È ÛÙË ÛÙÚ·ÙËÁÈ΋fiÛÔÓ ·ÊÔÚ¿ ÛÙË ‰È·ÁÓˆÛÙÈ΋ Ù˘ ÚÔÛ¤ÁÁÈÛË.

§¤ÍÂȘ ÎÏÂȉȿ: ‰Â˘ÙÂÚÔ·ı‹˜ ÎÂÊ·Ï·ÏÁ›·, ÁÂÓÈ΋·È‰È·ÙÚÈ΋.

�Abstract: Headache is a common occurrence inthe paediatric population and its prevalenceincreases with age. Headache disorders are dividedinto primary (migraine) and secondary categories.In clinical practice it is necessary first to exclude oridentify secondary headaches, based on a directedhistory, physical examination and the use ofdiagnostic tests. This article considers acute andchronic non-migraine headaches in children,covering differential aetiologies and diagnosticdecisions.

Key words: secondary headache, generalpaediatrics.

¶·È‰ÔÓ¢ÚÔÏÔÁÈ΋ ∫ÏÈÓÈ΋,¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ ¶ÂÓÙ¤Ï˘, ∞ı‹Ó·

Department of Paediatric Neurology, Penteli Children’s Hospital, Athens

168

¶·È‰È·ÙÚÈ΋ 2004;67:168-172 Paediatriki 2004;67:168-172

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·168

Page 26: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

169

¶·È‰È·ÙÚÈ΋ 2004;67:168-172 Paediatriki 2004;67:168-172

‰Â˘ÙÂÚÔ·ıÔ‡˜ ϤÔÓ ÎÂÊ·Ï·ÏÁ›·˜, Ì ÛÎÔfi Ó··ÔÎÏÂÈÛÙÔ‡Ó ÛÔ‚·Ú¤˜ Ó¢ÚÔÏÔÁÈΤ˜ ·ı‹ÛÂȘ,fiˆ˜ ¯ˆÚÔηٷÎÙËÙÈΤ˜ ÂÂÍÂÚÁ·Û›Â˜ ÙÔ˘ ÂÁÎÂ-Ê¿ÏÔ˘, ÊÏÂÁÌÔÓ¤˜ ÙÔ˘ ∫¡™, ÂÓ‰ÔÎÚ·ÓȷΤ˜ ·ÈÌÔÚ-Ú·Á›Â˜ Î·È ÔÏ˘Û˘ÛÙËÌ·ÙÈο ÓÔÛ‹Ì·Ù·. ∏ ÂÈÛÙ‹-ÌË Ù˘ ÛÙ·ÙÈÛÙÈ΋˜ Î·È Ë ÛˆÛÙ‹ È·ÙÚÈ΋ ·ÍÈÔÏfiÁË-ÛË ÙˆÓ ·ÛıÂÓÒÓ Â›Ó·È ‚·ÛÈο ÛËÌ›·, ÛÙ· ÔÔ›· ÔÁÈ·ÙÚfi˜ Ú¤ÂÈ Ó· ÛÙËÚȯÙ› ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË Ù˘ÎÂÊ·Ï·ÏÁ›·˜ Û ÔÔÈ·‰‹ÔÙ ËÏÈΛ·.

™Â Ì›· ÌÂϤÙË Ô˘ ·ÊÔÚÔ‡Û Û 54.000 ·È‰È¿Ô˘ ÚÔÛÎÔÌ›ÛÙËÎ·Ó ÛÙ· Â͈ÙÂÚÈο È·ÙÚ›· ÙÔ˘·È‰È·ÙÚÈÎÔ‡ ÓÔÛÔÎÔÌ›Ԣ ÙÔ˘ Miami ÙÔ 1993, ‚Ú¤-ıËΠfiÙÈ ÛÙÔ ‰È¿ÛÙËÌ· ·˘Ùfi 696 ·ÛıÂÓ›˜ (1,3%) ›-¯·Ó ˆ˜ ·ÚÈÔ Û‡Ìو̷ ÙËÓ ÎÂÊ·Ï·ÏÁ›· (4). ™ÙËÓ›‰È· ÌÂϤÙË ‚Ú¤ıËΠfiÙÈ Û 288 ·fi ·˘Ù¿ Ù· ·È‰È¿Ù· Û˘¯ÓfiÙÂÚ· ·›ÙÈ· Ù˘ ÎÂÊ·Ï·ÏÁ›·˜ ÂÚÈÂÏ¿Ì‚·-Ó·Ó (∂ÈÎfiÓ· 1): ÈÔÁÂÓ›˜ ÏÔÈÌÒÍÂȘ (39,2%), ÊÏÂÁ-ÌÔÓ¤˜ ·Ú·ÚÚ›ÓÈˆÓ ÎfiÏˆÓ (16%), ËÌÈÎÚ·Ó›·(15,6%), ÌÂÙ·ÙÚ·˘Ì·ÙÈ΋ ÎÂÊ·Ï·ÏÁ›· (6,6%), ÈÔÁÂ-Ó‹ ÌËÓÈÁÁ›Ùȉ· (5,2%), ÛÙÚÂÙÔÎÔÎÎÈ΋ Ê·Ú˘ÁÁ›ÙÈ-‰· (5,2%), ÎÂÊ·Ï·ÏÁ›· Ù¿Û˘ (4,5%) Î·È ¿ÏÏ· ·›ÙÈ·(7,7%). ™Â ·ÚfiÌÔȘ ÌÂϤÙ˜ ‰È·ÈÛÙÒÓÂÙ·È fiÙÈ ÙÔÔÛÔÛÙfi ÎÂÊ·Ï·ÏÁ›·˜ ÛÙ· ·È‰È·ÙÚÈο Â͈ÙÂÚÈοȷÙÚ›· Ô˘ ÔÊ›ÏÂÙ·È Û ÛÔ‚·Ú¤˜ Ó¢ÚÔÏÔÁÈΤ˜·ı‹ÛÂȘ, ÏËÓ ÙˆÓ ÊÏÂÁÌÔÓÒÓ ÙÔ˘ ∫¡™, Î˘Ì·›ÓÂ-Ù·È ·fi 0-1% (5,6).

∆‡ÔÈ Î·È ·ÈÙÈÔÏÔÁ›· ÎÂÊ·Ï·ÏÁÈÒÓ O ÙÚfiÔ˜ ÂÈÛ‚ÔÏ‹˜ Ù˘ ÎÂÊ·Ï·ÏÁ›·˜ Î·È Ë Û˘-

ÓÔÏÈ΋ Ù˘ ‰È¿ÚÎÂÈ· ·Ú¤¯Ô˘Ó ÛËÌ·ÓÙÈΤ˜ ÏËÚÔ-ÊÔڛ˜ ÁÈ· ÙË ‰ÈÂÚ‡ÓËÛ‹ Ù˘. ™‡Ìʈӷ Ì ٷÛÙÔȯ›· ·˘Ù¿, Ë ÎÂÊ·Ï·ÏÁ›· ‰È·ÎÚ›ÓÂÙ·È Û ÔÍ›·(ÁÂÓÈÎÂ˘Ì¤ÓË ‹ ÂÓÙÔÈṲ̂ÓË), ÔÍ›· ˘ÔÙÚÔÈ¿˙Ô˘-Û· Î·È ¯ÚfiÓÈ· (ÂȉÂÈÓÔ‡ÌÂÓË ‹ ÛÙ·ıÂÚ‹) (∂ÈÎfiÓ·2). ¶ÔÛÔÛÙfi 70% ÙˆÓ ÎÂÊ·Ï·ÏÁÈÒÓ Â›Ó·È ÔÍ›˜.

OÍ›· ÁÂÓÈÎÂ˘Ì¤ÓË ÎÂÊ·Ï·ÏÁ›· ∆· Û˘ÓËı¤ÛÙÂÚ· ·›ÙÈ· Ì›·˜ ÔÍ›·˜ ÁÂÓÈÎÂ˘Ì¤Ó˘

ÎÂÊ·Ï·ÏÁ›·˜ ÛÙ· ·È‰È¿ ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1(2,6). O ˘ÚÂÙfi˜ ÔÔÈ·Û‰‹ÔÙ ·ÈÙÈÔÏÔÁ›·˜ ıˆÚ›-Ù·È ÙÔ Û˘¯ÓfiÙÂÚÔ ·›ÙÈÔ. ™˘Ó‹ıˆ˜, Ë ¤Ó·ÚÍË Î·È Ë ‡ÊÂ-ÛË Ù˘ ÎÂÊ·Ï·ÏÁ›·˜ Û˘Ì›ÙÔ˘Ó Ì ÙËÓ ÂÈÛ‚ÔÏ‹ ηÈÙËÓ ·ÔıÂڷ›· Ù˘ Ïԛ̈͢, ·ÓÙ›ÛÙÔȯ·. ™Â ÂÚ›-ÙˆÛË Ïԛ̈͢ ÙÔ˘ ∫¡™, Ë ÂËÚ·Ṳ̂ÓË ÁÂÓÈ΋ η-Ù¿ÛÙ·ÛË Ì·˙› Ì ٷ Â˘Ú‹Ì·Ù· ·fi ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ΋ÂͤٷÛË Î·È ÙËÓ ÔÛÊ˘ÔÓˆÙÈ·›· ·Ú·Î¤ÓÙËÛË Û˘Ì-‚¿ÏÏÔ˘Ó ÛÙËÓ ·ÍÈÔÏfiÁËÛË Ù˘ ÎÂÊ·Ï·ÏÁ›·˜. ™ÙËÓÂÚ›ÙˆÛË Î¿ÎˆÛ˘ Ù˘ ÎÂÊ·Ï‹˜, ı· Ú¤ÂÈ Ó· Ï·Ì-‚¿ÓÂÙ·È ˘’ fi„ÈÓ ÙÔ ÂӉ¯fiÌÂÓÔ Î·ÎÔÔ›ËÛ˘ ÙÔ˘·ÛıÂÓÔ‡˜. ™ÙËÓ ˘·Ú·¯ÓÔÂȉ‹ ·ÈÌÔÚÚ·Á›·, Ë ·Ô˘-Û›· ˘ÚÂÙÔ‡, Ë ‰˘Ûη̄›· Î·È Ë Í·Óıԯڈ̷ÙÈ΋fi„Ë ÙÔ˘ ∂¡À ı¤ÙÔ˘Ó Â‡ÎÔÏ· ÙË ÛˆÛÙ‹ ‰È¿ÁÓˆÛË.

OÍ›· ÂÓÙÔÈṲ̂ÓË ÎÂÊ·Ï·ÏÁ›· ™ÙËÓ ÔÍ›· ÂÓÙÔÈṲ̂ÓË ÎÂÊ·Ï·ÏÁ›· (6), ÔÈ ÔÍ›˜

ÊÏÂÁÌÔÓ¤˜ ÙˆÓ ÎfiÏˆÓ ÙÔ˘ ÎÚ·Ó›Ô˘ ·ÔÙÂÏÔ‡Ó ÙÔÛ˘¯ÓfiÙÂÚÔ ·›ÙÈÔ (¶›Ó·Î·˜ 2). ÃÚfiÓȘ ÊÏÂÁÌÔÓ¤˜‰ÂÓ ÚÔηÏÔ‡Ó ÎÂÊ·Ï·ÏÁ›·. ™ÙȘ ÔÍ›˜ ÈÁÌÔÚ›Ùȉ˜,ÙÔ ¿ÏÁÔ˜ ÂÓÙÔ›˙ÂÙ·È Î¿Ùˆ ·fi ÙÔ˘˜ ÔÊı·ÏÌÈÎÔ‡˜ÎfiÁ¯Ô˘˜, ÂÓÒ ÛÙȘ ÊÏÂÁÌÔÓ¤˜ ÙÔ˘ ÛÊËÓÔÂȉԇ˜ ‹ËıÌÔÂȉԇ˜ ÎfiÏÔ˘ ÂÚÈÔÊı·ÏÌÈο Î·È ·ÓÙ·Ó·ÎÏ¿Û fiÏÔ ÙÔ ÎÚ·Ó›Ô. ∏ ÎÂÊ·Ï·ÏÁ›· Â›Ó·È Û˘Ó‹ıˆ˜ Úˆ-ÈÓ‹ Î·È Û˘Óԉ‡ÂÙ·È ·fi Â̤ÙÔ˘˜ ‹ ‚‹¯·. OÈ ·ı‹-ÛÂȘ ÙÔ˘ ̤ÛÔ˘ ˆÙfi˜ Î·È Ù· Ô‰ÔÓÙÈο ÚÔ‚Ï‹Ì·Ù·Â˘ı‡ÓÔÓÙ·È Û ÌÂÁ¿ÏÔ, ›Û˘, ÔÛÔÛÙfi ÛÙËÓ ÔÍ›·ÂÓÙÔÈṲ̂ÓË ÎÂÊ·Ï·ÏÁ›·. ∏ ·˘ÍË̤ÓË ÚÔÛ¿ıÂÈ·ÙˆÓ ÔÊı·ÏÌÈÎÒÓ Ì˘ÒÓ Ó· ·ÓÙÈÛÙ·ıÌ›ÛÔ˘Ó ÙȘ ˘¿Ú-¯Ô˘Û˜ ‰È·ıÏ·ÛÙÈΤ˜ ·ÓˆÌ·Ï›Â˜ ÚÔηÏ› ·ÚÎÂÙ¿

∂ÈÎfiÓ· 1. ∫·Ù·ÓÔÌ‹ Ù˘ ÎÂÊ·Ï·ÏÁ›·˜ ‚¿ÛÂÈ ÙÔ˘ ·ÈÙ›Ô˘(n=288) (Burton LJ et al. Pediatr Emerg Care 1997;13:1-4).

∂ÈÎfiÓ· 2. ªÔÚʤ˜ ÎÂÊ·Ï·ÏÁ›·˜ (Pakalnis A. Adolesc Med2002;13:433-442).

¶›Ó·Î·˜ 1. ™˘Ó‹ıË ·›ÙÈ· ÔÍ›·˜ ÁÂÓÈÎÂ˘Ì¤Ó˘ ÎÂÊ·Ï·ÏÁ›·˜

¶˘ÚÂÙfi˜ ÔÔÈ·Û‰‹ÔÙ ·ÈÙÈÔÏÔÁ›·˜ ∫Ú·ÓÈÔÂÁÎÂÊ·ÏÈ΋ οΈÛË §Ô›ÌˆÍË ∫¡™ º˘ÛÈ΋ ηٷfiÓËÛË ¶·Ú·ÙÂٷ̤ÓË ¤ÎıÂÛË ÛÙÔÓ ‹ÏÈÔ ∞ÁÁÂÈ·Îfi ÂÂÈÛfi‰ÈÔ À·Ú·¯ÓÔÂȉ‹˜ ·ÈÌÔÚÚ·Á›· ¢ËÏËÙËÚ›·ÛË Ì ʷÚ̷΢ÙÈΤ˜ Ô˘Û›Â˜

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·169

Page 27: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

Û˘¯Ó¿ ÎÂÊ·Ï·ÏÁ›· ÛÙ· ·È‰È¿. ™Â ·˘Ù‹ ÙËÓ ÂÚ›Ùˆ-ÛË, ÙÔ ¿ÏÁÔ˜ ÂÓÙÔ›˙ÂÙ·È ÂÚÈÔÊı·ÏÌÈο, ·ÏÏ¿ ηÈ̤۷ ÛÙÔ˘˜ ÔÊı·ÏÌÔ‡˜ Î·È ÂÌÊ·Ó›˙ÂÙ·È Û¯Â‰fiÓ·ÔÎÏÂÈÛÙÈο ηٿ ÙË ‰È¿ÚÎÂÈ· ÔχˆÚ˘ ÌÂϤÙ˘ ‹ÌÂϤÙ˘ Ì ηΤ˜ Û˘Óı‹Î˜ ʈÙÈÛÌÔ‡.

OÍ›· ˘ÔÙÚÔÈ¿˙Ô˘Û· ÎÂÊ·Ï·ÏÁ›· ™ÙËÓ ÔÍ›· ˘ÔÙÚÔÈ¿˙Ô˘Û· ÎÂÊ·Ï·ÏÁ›·, Ë ËÌÈ-

ÎÚ·Ó›· Î·È Ù· ËÌÈÎÚ·ÓÈο ÈÛÔ‰‡Ó·Ì·, Ô˘ ·Ó‹ÎÔ˘ÓÛÙËÓ ÚˆÙÔ·ı‹ ÎÂÊ·Ï·ÏÁ›·, η٤¯Ô˘Ó ÚˆÙ‡-Ô˘Û· ı¤ÛË, ÂÓÒ ÏÈÁfiÙÂÚÔ Û˘ÓËıÈṲ̂ӷ ·›ÙÈ· ›ӷȉ˘ÛÏÂÈÙÔ˘ÚÁ›Â˜ ÛÙË ‚·Ï‚›‰· › ˘‰ÚÔÎÂÊ¿ÏÔ˘(2,6) (¶›Ó·Î·˜ 3).

ÃÚfiÓÈ· ÂȉÂÈÓÔ‡ÌÂÓË ÎÂÊ·Ï·ÏÁ›· ∏ ¯ÚfiÓÈ· ÂȉÂÈÓÔ‡ÌÂÓË ÎÂÊ·Ï·ÏÁ›· ··ÈÙ› ÛÂ

ÌÂÁ·Ï‡ÙÂÚÔ ‚·ıÌfi ÙË Û˘Ó¯‹ ·ÁÚ‡ÓËÛË ÙÔ˘ ·È-‰È¿ÙÚÔ˘ Î·È ÙË Û˘ÓÂÚÁ·Û›· Û˘Ó·ÊÒÓ ˘ÔÂȉÈÎÔÙ‹-ÙˆÓ, ηıÒ˜ ÌÔÚ› Ó· ÔÊ›ÏÂÙ·È Û ·ı‹ÛÂȘ ·ÂÈ-ÏËÙÈΤ˜ ÁÈ· ÙË ˙ˆ‹ ÙÔ˘ ·ÛıÂÓÔ‡˜ (2,6). ∏ ηÏÔ‹ı˘ÂÓ‰ÔÎÚ¿ÓÈ· ˘¤ÚÙ·ÛË Û˘Ó‹ıˆ˜ Û˘Óԉ‡ÂÙ·È ·fi Ô›-‰ËÌ· ÙˆÓ ÔÙÈÎÒÓ ıËÏÒÓ Ì ‹ ̄ ˆÚ›˜ ‰Èψ›· Î·È ·˘-ÍË̤ÓË ›ÂÛË ÛÙÔ ∂¡À (¶›Ó·Î·˜ 4). ∏ ·Ô˘Û›· ¢ÚË-Ì¿ÙˆÓ, ÙfiÛÔ Î·Ù¿ ÙË Ó¢ÚÔÏÔÁÈ΋ ÂͤٷÛË fiÛÔ Î·Èηٿ ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi Î·È Ó¢ÚÔ·ÂÈÎÔÓÈÛÙÈÎfi ¤ÏÂÁ-¯Ô, ·ÔÙÂÏ› ÙÔ ‚·ÛÈÎfi ¯·Ú·ÎÙËÚÈÛÙÈÎfi Ù˘. ¶Ú¤ÂÈÓ· ÙÔÓÈÛÙ›, fï˜, fiÙÈ Ë ·Ô˘Û›· Ôȉ‹Ì·ÙÔ˜ ÙˆÓ ÔÙÈ-ÎÒÓ ıËÏÒÓ ‰ÂÓ ·ÔÎÏ›ÂÈ ÙË ‰È¿ÁÓˆÛË Ù˘ ÂÓ‰ÔÎÚ¿-ÓÈ·˜ ˘¤ÚÙ·Û˘ (9,10). OÈ ¯·Ú·ÎÙ‹Ú˜ Ù˘ ÎÂÊ·Ï·Ï-Á›·˜ ÛÙÔ˘˜ fiÁÎÔ˘˜ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ ‰ÂÓ Â›Ó·È ÂȉÈÎÔ›,ÂÓÙÔ‡ÙÔȘ ÙÔ ¿ÏÁÔ˜ ÛÙÔ˘˜ fiÁÎÔ˘˜ Â›Ó·È ‚‡ıÈÔ Û·ÓÙȉȷÛÙÔÏ‹ Ì ÙÔ ¤ÓÙÔÓÔ ¿ÏÁÔ˜ Ù˘ ËÌÈÎÚ·Ó›·˜. OȤÌÂÙÔÈ, Ë Ó·˘Ù›· Î·È ÙÔ Ô›‰ËÌ· ÙˆÓ ÔÙÈÎÒÓ ıËÏÒÓ

‰ÂÓ ·ÔÙÂÏÔ‡Ó ÔˆÛ‰‹ÔÙ ÛËÌ›· Ô˘ Û˘Óԉ‡-Ô˘Ó ÙË ÓfiÛÔ. ™˘ÓËı¤ÛÙÂÚ· Â›Ó·È Ù· ·ıÔÏÔÁÈο ¢-Ú‹Ì·Ù· Ô˘ ÚÔ·ÙÔ˘Ó ·fi Ì›· ÏÂÙÔÌÂÚ‹ Ó¢ÚÔ-ÏÔÁÈ΋ ÂͤٷÛË. ∆Ô ˘ÂÚÛÎËÓȉȷÎfi ÎÚ·ÓÈÔÊ·Ú˘Á-Á›ˆÌ·, ÙÔ ÂÂÓ‰‡ÌˆÌ·, ÙÔ ÚˆÙÔÏ·ÛÌ·ÙÈÎfi ·ÛÙÚÔ-·Ùو̷ Î·È ÙÔ ˘ÔÛÎËÓȉȷÎfi ÈÏÔ΢ÙÙ·ÚÈÎfi ·ÛÙÚÔ-·Ùو̷ ıˆÚÔ‡ÓÙ·È ÔÈ fiÁÎÔÈ ÂΛÓÔÈ Ô˘ Û˘Óԉ‡Ô-ÓÙ·È Û ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ·fi ÎÂÊ·Ï·ÏÁ›·. ÕÏÏ·ÏÈÁfiÙÂÚÔ Û˘ÓËıÈṲ̂ӷ ·›ÙÈ·, Â›Ó·È Ô ˘‰ÚÔΤʷÏÔ˜ÁÂÓÈο, ÔÈ ‰˘ÛÏÂÈÙÔ˘ÚÁ›Â˜ ‚·Ï‚›‰·˜, ÔÈ fiÁÎÔÈ Î·È ÔȉÈËıËÙÈΤ˜ ÂÍÂÚÁ·Û›Â˜ ÙÔ˘ ÎÚ·Ó›Ô˘, .¯. ˈÛÈÓfiÊÈÏÔÎÔÎΛˆÌ· Î·È ¿ÏÏ·.

ÃÚfiÓÈ· ÛÙ·ıÂÚ‹ ÎÂÊ·Ï·ÏÁ›· ∆· Û˘ÓËı¤ÛÙÂÚ· ·›ÙÈ· Ù˘ ¯ÚfiÓÈ·˜ ÛÙ·ıÂÚ‹˜

ÎÂÊ·Ï·ÏÁ›·˜ (2) Â›Ó·È Û˘Ó‹ıˆ˜ Ë ÎÂÊ·Ï·ÏÁ›· Ù¿-Ûˆ˜ ÌË ÔÚÁ·ÓÈ΋˜ ·ÈÙÈÔÏÔÁ›·˜, „˘¯È·ÙÚÈο Î·È „˘-¯ÔÏÔÁÈο ÚÔ‚Ï‹Ì·Ù·, Ë ÌÂÙ·ÙÚ·˘Ì·ÙÈ΋ ÂÈÏË-„›·, Ì ۷ÊÒ˜ ÌÈÎÚfiÙÂÚË Û˘¯ÓfiÙËÙ· ·fi ÂΛÓËÙˆÓ ÂÓËϛΈÓ, Ë ‰˘ÛÏ·Û›· Arnold-Chiari, ÔÏ˘Û˘-ÛÙËÌ·ÙÈο ÓÔÛ‹Ì·Ù·, ‰ËÏËÙËÚ›·ÛË Ì ÙÔÍÈΤ˜ Ô˘-ۛ˜ Î·È ¿ÏÏ· (¶›Ó·Î·˜ 5). ∏ ÂÈÏË„›· ·ÔÙÂÏ› ·È-Ù›· Ù˘ ¯ÚfiÓÈ·˜ ÛÙ·ıÂÚ‹˜ ÎÂÊ·Ï·ÏÁ›·˜ ΢ڛˆ˜ ÌÂ-Ù¿ ÙËÓ ÎÚ›ÛË Î·È - Û ÌÈÎÚfiÙÂÚÔ ÔÛÔÛÙfi - ÚÈÓ ‹Î·Ù¿ ÙËÓ ÎÚ›ÛË Ì ¿ÏÏÔÙ ¿ÏÏË ‰È¿ÚÎÂÈ·. ™ÙȘ ÁÂÓÈ-ÎÂ˘Ì¤Ó˜ ÂÈÏË„›Â˜ ¤¯ÂÈ ·Ú·ÙËÚËı› fiÙÈ Ë ÎÂÊ·-Ï·ÏÁ›· Â›Ó·È Û˘Ó¯‹˜, ÂÓÒ ÛÙȘ ÂÛÙȷΤ˜ ¤¯ÂÈ ‰È·-Ï›ÔÓÙ· ÛÊ˘ÁÌÒ‰Ë ¯·Ú·ÎÙ‹Ú· (11).

¢È·ÁÓˆÛÙÈ΋ ÚÔۤϷÛË ªÂ ‚¿ÛË Ù· ÛÙ·ÙÈÛÙÈο ‰Â‰Ô̤ӷ fiÛÔÓ ·ÊÔÚ¿

ÛÙË Û˘¯ÓfiÙËÙ· ÙˆÓ ·ÈÙ›ˆÓ Ù˘ ÎÂÊ·Ï·ÏÁ›·˜, Ë ÎÏÈÓÈ-΋ ·ÍÈÔÏfiÁËÛË ÙˆÓ ·ÛıÂÓÒÓ Â›Ó·È ÙÔ ÂfiÌÂÓÔ ‚‹Ì·ÛÙË ‰ÈÂÚ‡ÓËÛË Ù˘ ÎÂÊ·Ï·ÏÁ›·˜. ∆Ô ÏÂÙÔÌÂÚ¤˜·ÙÔÌÈÎfi Î·È ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi, Ë Ê˘ÛÈ΋, Ó¢ÚÔ-ÏÔÁÈ΋, ˆÙÔÚÈÓÔÏ·Ú˘ÁÁÔÏÔÁÈ΋ Î·È ÔÊı·ÏÌÔÏÔÁÈ΋ÂͤٷÛË Î·È Ô Î·Ù¿ÏÏËÏÔ˜ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜·ÔÙÂÏÔ‡Ó ÛËÌ·ÓÙÈΤ˜ ËÁ¤˜ ÏËÚÔÊÔÚÈÒÓ.

∫·Ù¿ ÙË Ï‹„Ë ÙÔ˘ ÈÛÙÔÚÈÎÔ‡, ÔÚÈṲ̂ӷ ÛÙÔȯ›·Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÔÓÙ·È È‰È·›ÙÂÚ· ˘’ fi„ÈÓ, fiˆ˜ ÔÙÚfiÔ˜ ÂÈÛ‚ÔÏ‹˜ Ù˘ ÎÂÊ·Ï·ÏÁ›·˜, Ë ‰È¿ÚÎÂÈ· ÙÔ˘ÂÂÈÛÔ‰›Ô˘, Ë ÂÓÙfiÈÛË, Ë Û˘¯ÓfiÙËÙ· Î·È Ë Û˘ÓÔÏÈ-΋ ‰È¿ÚÎÂÈ¿ Ù˘. ™˘ÌÙÒÌ·Ù· Ô˘ Û˘ÓÔ‰Â‡Ô˘Ó ÙËÓÎÂÊ·Ï·ÏÁ›·, Èı·ÓÔ› ÂÎÏ˘ÙÈÎÔ› ·Ú¿ÁÔÓÙ˜, Ë Ê˘-ÛÈ΋ Î·È „˘¯È΋ ηٿÛÙ·ÛË ÙÔ˘ ·È‰ÈÔ‡ Î·È Ë ËÏÈ-Λ· ¤Ó·Ú͢ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Ú¤ÂÈ Â›Û˘ Ó·

¶›Ó·Î·˜ 5. ™˘Ó‹ıË ·›ÙÈ· ¯ÚfiÓÈ·˜ ÛÙ·ıÂÚ‹˜ ÎÂÊ·Ï·ÏÁ›·˜

∫ÂÊ·Ï·ÏÁ›· Ù¿Ûˆ˜ ªÂÙ·ÙÚ·˘Ì·ÙÈ΋ ÂÈÏË„›·æ˘¯È·ÙÚÈο-„˘¯ÔÏÔÁÈο ÓÔÛ‹Ì·Ù· ¢˘ÛÏ·Û›· Arnold-Chiari ¶ÔÏ˘Û˘ÛÙËÌ·ÙÈο ÓÔÛ‹Ì·Ù· ∆ÔÍÈΤ˜ Ô˘Û›Â˜ ∞Ù·ÍÈÓfiÌËÙ˜ ÌÔÚʤ˜

¶›Ó·Î·˜ 2. ™˘Ó‹ıË ·›ÙÈ· ÔÍ›·˜ ÂÓÙÔÈṲ̂Ó˘ ÎÂÊ·Ï·ÏÁ›·˜

OÍ›˜ ÊÏÂÁÌÔÓ¤˜ ÙˆÓ ÎfiÏˆÓ ÙÔ˘ ÎÚ·Ó›Ô˘ ¶·ı‹ÛÂȘ ̤ÛÔ˘ ˆÙfi˜ O‰ÔÓÙÈο ÚÔ‚Ï‹Ì·Ù· OÊı·ÏÌÔÏÔÁÈΤ˜ ‰È·Ù·Ú·¯¤˜ ∫Ú·ÓÈÔÂÁÎÂÊ·ÏÈ΋ οΈÛË

¶›Ó·Î·˜ 3. ™˘Ó‹ıË ·›ÙÈ· ÔÍ›·˜ ˘ÔÙÚÔÈ¿˙Ô˘Û·˜ ÎÂÊ·-Ï·ÏÁ›·˜

∫ÔÈÓ‹ ËÌÈÎÚ·Ó›· ∂ÈÂÏÂÁ̤ÓË ËÌÈÎÚ·Ó›· ∏ÌÈÎÚ·ÓÈο ÈÛÔ‰‡Ó·Ì· ¢˘ÛÏÂÈÙÔ˘ÚÁ›· ÛÙË ‚·Ï‚›‰· › ˘‰ÚÔÎÂÊ¿ÏÔ˘

¶›Ó·Î·˜ 4. ™˘Ó‹ıË ·›ÙÈ· ¯ÚfiÓÈ·˜ ÂȉÂÈÓÔ‡ÌÂÓ˘ ÎÂÊ·Ï·Ï-Á›·˜

∫·ÏÔ‹ı˘ ÂÓ‰ÔÎÚ¿ÓÈ· ˘¤ÚÙ·ÛË ŸÁÎÔÈ ÂÁÎÂÊ¿ÏÔ˘ À‰ÚÔΤʷÏÔ˜ ¢˘ÛÏÂÈÙÔ˘ÚÁ›Â˜ ‚·Ï‚›‰·˜ ŸÁÎÔÈ Î·È ‰ÈËıËÙÈΤ˜ ÂÍÂÚÁ·Û›Â˜ ÙÔ˘ ÎÚ·Ó›Ô˘

170

¶·È‰È·ÙÚÈ΋ 2004;67:168-172 Paediatriki 2004;67:168-172

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·170

Page 28: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

171

¶·È‰È·ÙÚÈ΋ 2004;67:168-172 Paediatriki 2004;67:168-172

·ÍÈÔÏÔÁÔ‡ÓÙ·È. ∫·Ù¿ ÙË Ê˘ÛÈ΋ ÂͤٷÛË, ÂÎÙÈÌÒÓÙ·ÈË Ê˘ÛÈ΋ Î·È Û˘Ó·ÈÛıËÌ·ÙÈ΋ ηٿÛÙ·ÛË ÙÔ˘ ·ÛıÂ-ÓÔ‡˜ Î·È ÙÔ Â›Â‰Ô Û˘Ó›‰ËÛ˘. ∂ϤÁ¯ÔÓÙ·È Ë ıÂÚ-ÌÔÎÚ·Û›· ÙÔ˘ ÛÒÌ·ÙÔ˜, Ë ·ÚÙËÚȷ΋ ›ÂÛË Î·È Ë Â-Ú›ÌÂÙÚÔ˜ ÎÂÊ·Ï‹˜. æËÏ·Ê¿Ù·È ÙÔ ÎÚ·Ó›Ô Î·È ·Ó·˙Ë-ÙÔ‡ÓÙ·È È‰È·›ÙÂÚ· ÌÔÚÊÔÏÔÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο ‹·ÏÏÔÈÒÛÂȘ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ Ô˘ ÌÔÚ› Ó· Â›Ó·È ÂÓ‰ÂÈ-ÎÙÈο Û˘Ó‰ÚfiÌÔ˘ ‹ ÁÂÓÂÙÈ΋˜ ·ÓˆÌ·Ï›·˜, οΈÛ˘‹ ηÎÔÔ›ËÛ˘ Î·È ÂӉ›ÍÂȘ ÌËÓÈÁÁÈÎÔ‡ ÂÚÂıÈÛÌÔ‡ ‹·˘ÍË̤Ó˘ ÂÓ‰ÔÎÚ·Óȷ΋˜ ›ÂÛ˘. ∏ Ê˘ÛÈ΋ Âͤٷ-ÛË Û˘ÌÏËÚÒÓÂÙ·È ·fi Ì›· ÏÂÙÔÌÂÚ‹ Ó¢ÚÔÏÔÁÈ΋ÂͤٷÛË. ™ÙÔ 90% ÙˆÓ ÂÚÈÙÒÛˆÓ, Ë ‰È¿ÁÓˆÛË Ù›-ıÂÙ·È ·fi ÙÔ ÈÛÙÔÚÈÎfi Î·È ÙË Ê˘ÛÈ΋ Î·È Ó¢ÚÔÏÔÁÈ-΋ ÂͤٷÛË. ∂¿Ó ÚÔ·„ÂÈ ·ÎfiÌË Î·È ÂÏ¿¯ÈÛÙË ˘Ô-„›· ‹ ·Ó Ë ÎÏÈÓÈ΋ ÂͤٷÛË ‰ÂÓ ÌÔÚ› Ó· Â›Ó·È Ï‹-Ú˘, ÂÈ‚¿ÏÏÂÙ·È ÂÚ·ÈÙ¤Úˆ ‰ÈÂÚ‡ÓËÛË Ì ·ÈÌ·ÙÔ-ÏÔÁÈÎfi Î·È ‚ÈÔ¯ËÌÈÎfi ¤ÏÂÁ¯Ô, ÔÛÊ˘ÔÓˆÙÈ·›· ·Ú·Î¤-ÓÙËÛË, ·ÎÙÈÓÔÁÚ·Ê›· ÎÚ·Ó›Ô˘ Î·È Ó¢ÚÔ·ÂÈÎfiÓÈÛËfiÔ˘ ÎÚ›ÓÂÙ·È ··Ú·›ÙËÙË, ηıÒ˜ ›Û˘ ·Ó·˙ËÙ›-Ù·È Î·È Ë Û˘ÓÂÚÁ·Û›· ¿ÏÏˆÓ ÂȉÈÎÔًوÓ. ∏ Û˘Ì‚ÔÏ‹ÙÔ˘ ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·Ê‹Ì·ÙÔ˜ (∏∂°) ÛÙË ‰ÈÂ-Ú‡ÓËÛË Ù˘ ÎÂÊ·Ï·ÏÁ›·˜ Â›Ó·È ÂÚÈÔÚÈṲ̂ÓË Î·ÈÛ˘ÓÈÛÙ¿Ù·È Û ˘Ô„›· ÂÈÏËÙÈ΋˜ ÎÚ›Û˘ ‹ ÂÁÎÂÊ·-Ï›Ùȉ·˜ (7). ™Â ÂÚ›ÙˆÛË ÂÁÎÂÊ·Ï›Ùȉ·˜, ÙÔ ∏∂°Ú¤ÂÈ Ó· Á›ÓÂÙ·È Ì ÙÔÓ ·ÛıÂÓ‹ Û ÂÁÚ‹ÁÔÚÛË Î·Èfi¯È ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘.

∂Ӊ›ÍÂȘ Ó¢ÚÔ·ÂÈÎfiÓÈÛ˘ ∏ ·ÍÈÔÏfiÁËÛË Ì›·˜ ‰Â˘ÙÂÚÔ·ıÔ‡˜ ÎÂÊ·Ï·ÏÁ›·˜

ÔÏÔÎÏËÚÒÓÂÙ·È Ì ÙËÓ ÂÈÛ‹Ì·ÓÛË ÙˆÓ ÛËÌ›ˆÓ ÂÈ-ÎÈÓ‰˘ÓfiÙËÙ·˜ Ô˘ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÙË ¯·Ú·ÎÙËÚ›-˙Ô˘Ó (¶›Ó·Î·˜ 6) (13). ∏ ÚÔԉ¢ÙÈ΋ Âȉ›ӈÛËÌ›·˜ ÔÍ›·˜ ÎÂÊ·Ï·ÏÁ›·˜ ‹ Ë ·ÏÏ·Á‹ ¯·Ú·ÎÙ‹ÚˆÓÌ›·˜ ¯ÚfiÓÈ·˜ ÛÙ·ıÂÚ‹˜ ‹ ÔÍ›·˜ ˘ÔÙÚÔÈ¿˙Ô˘Û·˜(·‡ÍËÛË Ù˘ ¤ÓÙ·Û˘ ‹ Û˘¯ÓfiÙËÙ·˜, ÚÔÛı‹ÎË Û˘-ÌÙˆÌ¿ÙˆÓ Î·È ÛËÌ›ˆÓ Ô˘ ÙË Û˘Óԉ‡ԢÓ, ÂÌÊ¿ÓÈ-ÛË Ù˘ ÎÂÊ·Ï·ÏÁ›·˜ ÙË Ó‡¯Ù·, ·ÏÏ·Á‹ Ù˘ Û˘ÌÂÚÈ-ÊÔÚ¿˜ Î.Ï.) ·ÔÙÂÏÔ‡Ó ÂÈ‚·Ú˘ÓÙÈÎÔ‡˜ ·Ú¿ÁÔ-ÓÙ˜ fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÂÈÎÈÓ‰˘ÓfiÙËÙ¿ Ù˘, Ë ÔÔ›··˘Í¿ÓÂÈ ÛËÌ·ÓÙÈο fiÙ·Ó Û˘Ó˘¿Ú¯Ô˘Ó Î·È ·ÓÙÈÎÂÈÌÂ-

ÓÈο Â˘Ú‹Ì·Ù· ·fi ÙË Ê˘ÛÈ΋ Î·È Ó¢ÚÔÏÔÁÈ΋ Âͤ-Ù·ÛË Î·È Î˘Ú›ˆ˜ Ô›‰ËÌ· ÔÙÈÎÒÓ ıËÏÒÓ. ∏ ·ÚÔ˘Û›·ÙˆÓ ÛËÌ›ˆÓ ÂÈÎÈÓ‰˘ÓfiÙËÙ·˜ ÂÈ‚¿ÏÏÂÈ ÙË ‰ÈÂÓ¤Ú-ÁÂÈ· Ó¢ÚÔ·ÂÈÎfiÓÈÛ˘ ÁÈ· ÙÔÓ ·ÔÎÏÂÈÛÌfi Ù˘¯fiÓ¯ˆÚÔηٷÎÙËÙÈ΋˜ ‹ ¿ÏÏ˘ ÂÂÍÂÚÁ·Û›·˜. ∞fi ‰È¿-ÊÔÚ˜ ÌÂϤÙ˜ ÚÔ·ÙÂÈ fiÙÈ ÛÙÔ Û‡ÓÔÏÔ Ù˘ ÎÂÊ·-Ï·ÏÁ›·˜, Ë ·Ó‡ÚÂÛË ıÂÙÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ ÛÙË Ó¢ÚÔ-·ÂÈÎfiÓÈÛË Î˘Ì·›ÓÂÙ·È ·fi 3,7% ¤ˆ˜ 16,6% (12,13).™ÙËÓ ÏÂÈÔÓfiÙËÙ¿ ÙÔ˘˜, fï˜, Ù· Â˘Ú‹Ì·Ù· ·˘Ù¿ ‰ÂÓÂËÚ¿˙Ô˘Ó ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ‹ ÙËÓ ¤Î‚·ÛË Ù˘ ÎÂ-Ê·Ï·ÏÁ›·˜. ∂¿Ó ̆ ¿Ú¯Ô˘Ó Ó¢ÚÔ·ÂÈÎÔÓÈÛÙÈο ¢ڋ-Ì·Ù· ÂÓ‰ÂÈÎÙÈο ÁÈ· ¿ÌÂÛË ·Ú¤Ì‚·ÛË, ·˘Ù¿ ı· Ú¤-ÂÈ Ó· Û˘ÓÂÎÙÈÌËıÔ‡Ó Ì ÙÔÓ Ù‡Ô Ù˘ ÎÂÊ·Ï·ÏÁ›·˜,ÙÔÓ Û˘ÓÔÏÈÎfi ¯ÚfiÓÔ ‰È¿ÚÎÂÈ¿˜ Ù˘ Î·È ÙËÓ ·ÚÔ˘Û›·ÂÓfi˜ Ë ÂÚÈÛÛfiÙÂÚˆÓ ÛËÌ›ˆÓ ÂÈÎÈÓ‰˘ÓfiÙËÙ·˜. ªËËÌÈÎÚ·ÓÈÎÔ‡ Ù‡Ô˘ ÎÂÊ·Ï·ÏÁ›· Ì ¯ÚÔÓÈ΋ ‰È¿ÚÎÂÈ·ÌÈÎÚfiÙÂÚË ÙˆÓ 6 ÌËÓÒÓ Î·È ·ÚÔ˘Û›· ÂÓfi˜ ‹ ÂÚÈÛ-ÛfiÙÂÚˆÓ ÛËÌ›ˆÓ ÂÈÎÈÓ‰˘ÓfiÙËÙ·˜ ¯·Ú·ÎÙËÚ›˙ÂÈ Ù·¿ÙÔÌ· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘, fiÔ˘ Ë Èı·ÓfiÙËÙ· ·Ó‡ÚÂ-Û˘ ÂÓ‰ÔÎÚ·ÓÈ·ÎÔ‡ fiÁÎÔ˘ ·Ó¤Ú¯ÂÙ·È Û 4%. ™Ù·¿ÙÔÌ· ¯·ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘, Ì ÌË ËÌÈÎÚ·ÓÈÎÔ‡ Ù‡Ô˘ÎÂÊ·Ï·ÏÁ›· Ì ¯ÚÔÓÈ΋ ‰È¿ÚÎÂÈ· ÌÂÁ·Ï‡ÙÂÚË ÙˆÓ 6ÌËÓÒÓ Î·È ·Ô˘Û›· ÛËÌ›ˆÓ ÂÈÎÈÓ‰˘ÓfiÙËÙ·˜, ÙÔ·ÓÙ›ÛÙÔÈ¯Ô ÔÛÔÛÙfi Â›Ó·È 0,01%. ™Â ËÌÈÎÚ·ÓÈÎÔ‡ Ù‡-Ô˘ ÎÂÊ·Ï·ÏÁ›· ÌÂ Ê˘ÛÈÔÏÔÁÈ΋ Ó¢ÚÔÏÔÁÈ΋ Âͤٷ-ÛË, ÙÔ ÔÛÔÛÙfi ·Ó‡ÚÂÛ˘ ÂÓ‰ÔÎÚ·Óȷ΋˜ ÂÂÍÂÚ-Á·Û›·˜ ·Ó¤Ú¯ÂÙ·È Û 0,04% (13). ∆· ÔÛÔÛÙ¿ ·˘Ù¿Î·ıÔÚ›˙Ô˘Ó ÙË ÛÙÚ·ÙËÁÈ΋ Ô˘ Ú¤ÂÈ Ó· ·ÎÔÏÔ˘ıË-ı› fiÛÔÓ ·ÊÔÚ¿ ÛÙË ‰ÈÂÓ¤ÚÁÂÈ· ·ÂÈÎfiÓÈÛ˘ (∂ÈÎfiÓ·3). ™Â ·È‰È¿ ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ 6 ÂÙÒÓ, Ë Ó¢-ÚÔ·ÂÈÎfiÓÈÛË Á›ÓÂÙ·È Ì ÌÂÁ·Ï‡ÙÂÚË Â˘ÎÔÏ›·.

∏ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ‰Â˘ÙÂÚÔ·ıÔ‡˜ ÎÂÊ·Ï·Ï-Á›·˜ Â›Ó·È ·ÈÙÈÔÏÔÁÈ΋.

™˘ÌÂÚ¿ÛÌ·Ù· ¢ÂÓ ˘¿Ú¯ÂÈ “Ê˘ÛÈÔÏÔÁÈÎfi˜” ÔÓÔΤʷÏÔ˜, η-

ıÒ˜ Ù· ˘ÁÈ‹ ¿ÙÔÌ· ‰ÂÓ ¿Û¯Ô˘Ó ·fi ÎÂÊ·Ï·ÏÁ›·.∏ ‰È¿ÁÓˆÛË Ù˘ ÎÂÊ·Ï·ÏÁ›·˜ Ù›ıÂÙ·È Î˘Ú›ˆ˜ ·fiÙÔ ÈÛÙÔÚÈÎfi, Ë ‰Â ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË Î·ıÔÚ›˙ÂÈ

¶›Ó·Î·˜ 6. ™ËÌ›· Ô˘ ¯·Ú·ÎÙËÚ›˙Ô˘Ó ÙËÓ ÂÈÎÈÓ‰˘ÓfiÙËÙ·Ù˘ ÎÂÊ·Ï·ÏÁ›·˜

¶ÚÔԉ¢ÙÈ΋ Âȉ›ӈÛË ∞ÏÏ·Á‹ ¯·Ú·ÎÙ‹ÚˆÓ (·‡ÍËÛË Ù˘ ¤ÓÙ·Û˘ Î·È Ù˘ Û˘¯Ófi-ÙËÙ·˜) ™˘Ó‡·ÚÍË ÚˆÈÓÒÓ Î˘Ú›ˆ˜ Â̤وÓ, Û‡Á¯˘Û˘ Î·È ‰È·Ù·Ú·-¯ÒÓ ÔÌÈÏ›·˜ ∞ÓıÂÎÙÈÎfiÙËÙ· ÛÙË ıÂڷ›· ™·ÛÌÔ› O›‰ËÌ· ÙˆÓ ÔÙÈÎÒÓ ıËÏÒÓ ¶·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù· ÛÙË Ê˘ÛÈ΋ Î·È Ó¢ÚÔÏÔÁÈ΋ ÂͤٷÛË ∫·ı˘ÛÙ¤ÚËÛË ÛˆÌ·ÙÈ΋˜ ·Ó¿Ù˘Í˘ ¢È·Ù·Ú·¯¤˜ Û˘ÌÂÚÈÊÔÚ¿˜ ¶·ÚÔ˘Û›· ÁÓˆÛÙ‹˜ ÔÏ˘Û˘ÛÙËÌ·ÙÈ΋˜ ÓfiÛÔ˘

∂ÈÎfiÓ· 3. ∞ÏÁfiÚÈıÌÔ˜ ÁÈ· ÙË ‰ÈÂÓ¤ÚÁÂÈ· Ó¢ÚÔ·ÂÈÎfiÓÈÛ˘ÛÙËÓ ÎÂÊ·Ï·ÏÁ›·.

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·171

Page 29: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

ÙËÓ ÂÚ·ÈÙ¤Úˆ ‰ÈÂÚ‡ÓËÛ‹ Ù˘. ∏ ·ÚÔ˘Û›· ÛËÌ›-ˆÓ ÂÈÎÈÓ‰˘ÓfiÙËÙ·˜ ÂÈ‚¿ÏÏÂÈ ÙË ‰ÈÂÓ¤ÚÁÂÈ· Ó¢ÚÔ-·ÂÈÎfiÓÈÛ˘, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙÔ ÌÈÎÚfi ÔÛÔÛÙfiÙˆÓ Â˘ÚËÌ¿ÙˆÓ Ô˘ ¯ÚÂÈ¿˙ÔÓÙ·È ·Ú¤Ì‚·ÛË.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Sillanpaa M, Anttila P. Increasing prevalence of headache

in 7-year-old schoolchildren. Headache 1996;36:466-470. 2. Pakalnis A. Nonmigraine headaches in adolescents.

Adolesc Med 2002;13:433-442. 3. Aromaa M, Sillanpaa ML, Rautava P, Helenius H.

Childhood headache at school entry: a controlled clinicalstudy. Neurology 1998;50:1729-1736.

4. Burton LJ, Quinn B, Pratt-Cheney JL, Pourani M.Headache etiology in a pediatric emergency department.Pediatr Emerg Care 1997;13:1-4.

5. Kan L, Nagelberg J, Maytal J. Headaches in a pediatricemergency department: etiology, imaging, and treatment.Headache 2000;40:25-29.

6. ∫Ô‡ÙÏ·˜ ∂. ∫ÂÊ·Ï·ÏÁ›· - ª‡ıÔ˜ Î·È Ú·ÁÌ·ÙÈÎfiÙËÙ·. π·-ÙÚÈÎfi µ‹Ì· 1991;2:41-46.

7. Lewis DW, Ashwal S, Dahl G, Dorbad D, Hirtz D, PrenskyA et al. Practice parameter: evaluation of children andadolescents with recurrent headaches: report of theQuality Standards Subcommittee of the AmericanAcademy of Neurology and the Practice Committee of theChild Neurology Society. Neurology 2002;59:490-498.

8. Deda G, Caksen H, Ocal A. Headache etiology in children:a retrospective study of 125 cases. Pediatr Int 2000;42:668-673.

9. Winner P, Bello L. Idiopathic intracranial hypertension in ayoung child without visual symptoms or signs. Headache1996;36:574-576.

10. Krishna R, Kosmorsky GS, Wright KW. Pseudotumorcerebri sine papilledema with unilateral sixth nerve palsy. JNeuroophthalmol 1998;18:53-55.

11. Karaali-Savrun F, Goksan B, Yeni SN, Ertan S, Uzun N.Seizure-related headache in patients with epilepsy.Seizure 2002;11:67-69.

12. Lewis DW, Dorbad D. The utility of neuroimaging in theevaluation of children with migraine or chronic dailyheadache who have normal neurological examinations.Headache 2000;40:629-632.

13. Medina LS, Kuntz KM, Pomeroy S. Children with headachesuspected of having a brain tumor: a cost-effectivenessanalysis of diagnostic strategies. Pediatrics 2001;108:255-263.

172

¶·È‰È·ÙÚÈ΋ 2004;67:168-172 Paediatriki 2004;67:168-172

∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 04-03-2003 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 31-10-2003

¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∂ϤÓË ª·˙›ÁÔ˘-ºˆÙÔÔ‡ÏÔ˘ ¶·È‰ÔÓ¢ÚÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ ¶ÂÓÙ¤Ï˘, ∞ı‹Ó·

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·172

Page 30: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

µƒ∞µ∂Àª∂¡∏ ∂ƒ°∞™π∞ AWARD-WINNING ARTICLE

O ·ÓıÚÒÈÓÔ˜ ÌÂÙ·Ó¢ÌÔÓÔ˚fi˜ ˆ˜ ·›ÙÈÔ ÔÍ›·˜ ‚ÚÔÁ¯ÈÔÏ›Ùȉ·˜ ÛÙË ‚ÚÂÊÈ΋ ËÏÈΛ·* ¶. •Â··‰¿ÎË, ™. æ·ÚÚ¿˜, ∞. ªfiÛÈÔ˜, ª. ∆ÛÔÏÈ¿, ¢. ∫·ÊÂÙ˙‹˜, ¡. °. ¶··‰fiÔ˘ÏÔ˜

Human metapneumovirus as a cause of acute bronchiolitis in infancy* P. Xepapadaki, S. Psarras, A. Bossios, M. Tsolia, D. Kafetzis, N. G. Papadopoulos

�¶ÂÚ›ÏË„Ë: O ·ÓıÚÒÈÓÔ˜ ÌÂÙ·Ó¢ÌÔÓÔ˚fi˜¤¯ÂÈ ·ÔÌÔÓˆı› ÚfiÛÊ·Ù· Û ·È‰È¿ Ì Ïԛ̈ÍËÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Î·È ¤¯ÂÈ Ù·ÍÈÓÔ-ÌËı› ÛÙËÓ ˘Ô-ÔÈÎÔÁ¤ÓÂÈ· ÙˆÓ ÌÂÙ·Ó¢ÌÔÓÔ˚ÒÓ,Ë ÔÔ›· ·Ó‹ÎÂÈ ÛÙËÓ Â˘Ú‡ÙÂÚË ÔÈÎÔÁ¤ÓÂÈ· ÙˆÓ ·-Ú·Ì˘ÍÔ˚ÒÓ. ™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‹Ù·ÓÓ· ·ÓȯÓ¢ı› Ô ·ÓıÚÒÈÓÔ˜ ÌÂÙ·Ó¢ÌÔÓÔ˚fi˜ ÛÂÚÈÓÈο ÂÎχ̷ٷ ·È‰ÈÒÓ Ô˘ ÓÔÛËχÙËÎ·Ó ÛÙÔÓÔÛÔÎÔÌÂ›Ô Ì ÔÍ›· ‚ÚÔÁ¯ÈÔÏ›Ùȉ·, ¯ÚËÛÈÌÔÔÈÒ-ÓÙ·˜ ÙËÓ Ù¯ÓÈ΋ Ù˘ ·Ó¿ÛÙÚÔÊ˘ ·ÓÙ›‰Ú·Û˘·Ï˘ÛȉˆÙ‹˜ ÔÏ˘ÌÂÚ¿Û˘ Î·È Ó· ‰ÈÂÚ¢ÓËı› È-ı·Ó‹ ·ÈÙÈÔÏÔÁÈ΋ Û˘Û¯¤ÙÈÛË ÙÔ˘ ÈÔ‡ Ì ٷ ÎÏÈÓÈο¯·Ú·ÎÙËÚÈÛÙÈο Ù˘ ÓfiÛÔ˘. ∏ ·ÚÔ˘Û›· ÙÔ˘ Èԇ̠ÙËÓ Ù¯ÓÈ΋ Ù˘ ·Ó¿ÛÙÚÔÊ˘ ·ÓÙ›‰Ú·Û˘ ·Ï˘-ÛȉˆÙ‹˜ ÔÏ˘ÌÂÚ¿Û˘ ÂȂ‚·ÈÒıËΠ۠16%ÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ ‚ÚÔÁ¯ÈÔÏ›Ùȉ·˜ Ô˘ ÌÂÏÂÙ‹ıË-Î·Ó Î·È ‹Ù·Ó ‰Â‡ÙÂÚÔ˜ ÛÂ Û˘¯ÓfiÙËÙ· ÌÂÙ¿ ÙÔÓ·Ó·Ó¢ÛÙÈÎfi Û˘Á΢ÙÈ·Îfi Èfi, Ô ÔÔ›Ô˜ ·ÔÌÔÓÒ-ıËΠ۠67,9% ÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ. O ·ÓıÚÒÈÓÔ˜ÌÂÙ·Ó¢ÌÔÓÔ˚fi˜ ·Ó·ÁÓˆÚ›ÛÙËΠ›Ù ˆ˜ ÌÔÓ·‰È-Îfi˜ ·ıÔÁfiÓÔ˜ Èfi˜, ›Ù ˆ˜ Û˘Ó˘¿Ú¯ˆÓ Ì ÙÔÓ ·Ó·Ó¢ÛÙÈÎfi Û˘Á΢ÙÈ·Îfi Èfi, Ì ÙÔÓ ÔÔ›Ô Ê¿-ÓËΠӷ ¤¯Ô˘Ó ·ÚfiÌÔÈ· ÂÔ¯È΋ ηٷÓÔÌ‹. ¢ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ‰È·ÊÔÚ¤˜ ÛÙ· ÎÏÈÓÈο ‹ ÂÚ-Á·ÛÙËÚȷο ¯·Ú·ÎÙËÚÈÛÙÈο ÌÂٷ͇ ÙˆÓ ÂÚÈÛÙ·-ÙÈÎÒÓ ‚ÚÔÁ¯ÈÔÏ›Ùȉ·˜ ÛÙ· ÔÔ›· ·ÔÌÔÓÒıËΠԷÓıÚÒÈÓÔ˜ ÌÂÙ·Ó¢ÌÔÓÔ˚fi˜ Î·È ÂÎÂ›ÓˆÓ Ô˘ÔÊ›ÏÔÓÙ·Ó ÛÙÔÓ ·Ó·Ó¢ÛÙÈÎfi Û˘Á΢ÙÈ·Îfi Èfi ‹¿ÏÏÔ ·ıÔÁfiÓÔ Û٤ϯԘ. ∆· Â˘Ú‹Ì·Ù· Ù˘ ·-ÚÔ‡Û·˜ ÌÂϤÙ˘ Û˘ÓËÁÔÚÔ‡Ó fiÙÈ Ô ·ÓıÚÒÈÓÔ˜ÌÂÙ·Ó¢ÌÔÓÔ˚fi˜ ·ÔÙÂÏ› ÛËÌ·ÓÙÈÎfi ·ÈÙÈÔÏÔÁÈÎfi·Ú¿ÁÔÓÙ· Û ‚Ú¤ÊË Ì ÔÍ›· ‚ÚÔÁ¯ÈÔÏ›Ùȉ·, ÌÂ

�Abstract: Human metapneumovirus has recentlybeen isolated from children with acute respiratorytract infections. It is classified in theMetapneumovirinae subfamily of the Paramyxoviridaefamily. In this study RT-PCR was used to detecthuman metapneumovirus in nasal washes fromchildren admitted to hospital for acute bronchiolitis,and possible correlation of the virus with clinicalcharacteristics of the disease was assessed. PCRrevealed the presence of human metapneumovirus in16% of cases of bronchiolitis, rendering it second infrequency to respiratory syncytial virus (67.9%) of theviral pathogens identified in this cohort. Humanmetapneumovirus was observed either as the soleviral pathogen or co-existent with respiratory syncytialvirus, with which it has a similar seasonal distribution.There were no differences in disease characteristics,either clinical or laboratory, between cases ofbronchiolitis where human metapneumovirus waspresent and those caused by respiratory syncytialvirus or other pathogens. These findings support thepremise that human metapneumovirus is animportant causative agent of bronchiolitis in infants,with clinical characteristics similar to those ofrespiratory syncytial virus bronchiolitis.

∂Ú¢ÓËÙÈο ∂ÚÁ·ÛÙ‹ÚÈ·, µ’ ¶·È‰È·ÙÚÈ΋ ¶·ÓÂÈÛÙËÌȷ΋ ∫ÏÈÓÈ΋, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó·

* ∞’ ÈڤÌÂÈÔ Œ·ıÏÔ 41Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ, 2003

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

* 1st “Choremio” Award 41st Panhellenic Paediatric Meeting, 2003

173

¶·È‰È·ÙÚÈ΋ 2004;67:173-177 Paediatriki 2004;67:173-177

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·173

Page 31: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

174

¶·È‰È·ÙÚÈ΋ 2004;67:173-177 Paediatriki 2004;67:173-177

ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο fiÌÔÈ· Ì ÂΛӷ ÙÔ˘ ·Ó·-Ó¢ÛÙÈÎÔ‡ Û˘Á΢ÙÈ·ÎÔ‡ ÈÔ‡.

§¤ÍÂȘ ÎÏÂȉȿ: ÌÂÙ·Ó¢ÌÔÓÔ˚fi˜, ÔÍ›· ‚ÚÔÁ¯ÈÔÏ›-Ùȉ·, ‚Ú¤ÊË.

Key words: Human metapneumovirus, acutebronchiolitis, infants.

™˘ÓÙÔÌÔÁڷʛ˜ hMPV ∞ÓıÚÒÈÓÔ˜ ÌÂÙ·Ó¢ÌÔÓÔ˚fi˜

(Human metapneumovirus) ∏RSV ∞Ó·Ó¢ÛÙÈÎfi˜ Û˘Á΢ÙÈ·Îfi˜ Èfi˜ RV ∞ÓıÚÒÈÓÔ˜ ÚÈÓÔ˚fi˜ RT-PCR ∞Ó¿ÛÙÚÔÊË ·ÓÙ›‰Ú·ÛË ·Ï˘ÛȉˆÙ‹˜ ÔÏ˘ÌÂÚ¿Û˘

∂ÈÛ·ÁˆÁ‹ŒÓ·˜ Ó¤Ô˜ ·Ó·Ó¢ÛÙÈÎfi˜ Èfi˜, Ô ·ÓıÚÒÈÓÔ˜

ÌÂÙ·Ó¢ÌÔÓÔ˚fi˜ (Human metapneumovirus -hMPV), ·ÔÌÔÓÒıËΠÚfiÛÊ·Ù· Û ÚÈÓÔÊ·Ú˘ÁÁÈ-ο ÂÎχ̷ٷ ·È‰ÈÒÓ ÛÙËÓ OÏÏ·Ó‰›· (1). O hMPVÂ›Ó·È ÙÔ ÚÒÙÔ ·ÓıÚÒÈÓÔ ·ıÔÁfiÓÔ Û٤ϯԘ ÙÔ˘·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Ô˘ Ù·ÍÈÓÔÌ‹ıËΠˆ˜Ì¤ÏÔ˜ ÙÔ˘ Á¤ÓÔ˘˜ ÙˆÓ ÌÂÙ·Ó¢ÌÔÓÔ˚ÒÓ, ÔÈ ÔÔ›ÔÈÌ·˙› Ì ÙÔ˘˜ Ó¢ÌÔÓÔ˚Ô‡˜ ··ÚÙ›˙Ô˘Ó ÙËÓPneumovirinae ˘Ô-ÔÈÎÔÁ¤ÓÂÈ·, Ë ÔÔ›· ·Ó‹ÎÂÈÛÙËÓ Â˘Ú‡ÙÂÚË ÔÈÎÔÁ¤ÓÂÈ· ÙˆÓ ·Ú·Ì˘ÍÔ˚ÒÓ(Paramyxoviridae family), fiÔ˘ ·Ó‹ÎÔ˘Ó ·ÎfiÌË ÔÈfi˜ Ù˘ ·Ú·Áڛ˘ (Parainfluenza) Î·È Ô ·Ó·Ó¢-ÛÙÈÎfi˜ Û˘Á΢ÙÈ·Îfi˜ Èfi˜ (respiratory syncytial virus -RSV). O ηÈÓÔ‡ÚÁÈÔ˜ Èfi˜ ·ÚÔ˘ÛÈ¿˙ÂÈ ÛÙÔ ËÏÂÎÙÚÔ-ÓÈÎfi ÌÈÎÚÔÛÎfiÈÔ ÏÂÈÔÌÔÚÊÈο ÙÌ‹Ì·Ù· Ì ÌÔÚ-ÊÔÏÔÁ›· ·Ú·Ì˘ÍÔ˚ÒÓ, Â›Ó·È Â˘·›ÛıËÙÔ˜ ÛÙÔ ¯Ïˆ-ÚÔÊfiÚÌÈÔ Î·È ÔÏÏ·Ï·ÛÈ¿˙ÂÙ·È ·ÚÔ˘Û›· ÙÚ˘„›-Ó˘ Û tª∫ ·ÙÙ·Ú·. ÷ڷÎÙËÚÈÛÙÈΤ˜ ΢ÙÙ·ÚÔ·-ıÔÏÔÁÈΤ˜ ÂȉڿÛÂȘ ÙÔ˘ ÈÔ‡ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Û¯Ë-Ì·ÙÈÛÌfi Û˘ÁÎ˘Ù›ˆÓ Î·È Ú·Á‰·›· ÂÛˆÙÂÚÈ΋ ‰È¿Û·-ÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÌÂ Û˘Ó·ÎfiÏÔ˘ıË ·ÔÎfiÏÏËÛË·fi ÙÚ˘‚Ï›· ΢ÙÙ·ÚÈÎÒÓ Î·ÏÏÈÂÚÁÂÈÒÓ (1,2). º˘ÏÔ-ÁÂÓÂÙÈΤ˜ ·Ó·Ï‡ÛÂȘ ·¤‰ÂÈÍ·Ó ‰È·ÊÔÚ¤˜ ÛÙËÓ ·Ï-ÏËÏÔ˘¯›· ÌÂٷ͇ ÙˆÓ ÙÌËÌ¿ÙˆÓ ÙÔ˘ ÈÔ‡ Ô˘ ·Ô-ÌÔÓÒÓÔÓÙ·Ó, ˘Ô‰ËÏÒÓÔÓÙ·˜ ÙËÓ ‡·ÚÍË Èı·ÓfiÓ‰‡Ô ‰È·ÊÔÚÂÙÈÎÒÓ ÁÂÓÂÙÈÎÒÓ ÔÌ¿‰ˆÓ (1,2). ∆· ·È-‰È¿, ·fi Ù· ÔÔ›· ·ÔÌÔÓÒıËÎÂ Ô Èfi˜ ÛÙËÓ OÏÏ·Ó-‰›·, ·ÚÔ˘Û›·˙·Ó ÔÈΛÏË ÎÏÈÓÈ΋ ÂÈÎfiÓ·, Ô˘ ΢-Ì·ÈÓfiÙ·Ó ·fi Û˘ÌÙÒÌ·Ù· ÌfiÓÔ ·fi ÙÔ ·ÓÒÙÂÚÔ·Ó·Ó¢ÛÙÈÎfi ¤ˆ˜ ÛÔ‚·Ú‹ ‚ÚÔÁ¯ÈÔÏ›Ùȉ· Î·È Ó¢-ÌÔÓ›· (1). ªÂÙ¤ÂÈÙ· ÌÂϤÙ˜ Ô˘ Ú·ÁÌ·ÙÔÔÈ‹-ıËÎ·Ó Û ‰È¿ÊÔÚ˜ ÂÚÈÔ¯¤˜ ÙÔ˘ Ï·Ó‹ÙË, ·Ó¤‰ÂÈ-Í·Ó ÙÔÓ Èı·Ófi ÚfiÏÔ ÙÔ˘ ÈÔ‡ ·ÊÂÓfi˜ Û ·È‰È¿ ÌÂÔÍ›· ‚ÚÔÁ¯ÈÔÏ›Ùȉ· (3), ·ÊÂÙ¤ÚÔ˘ Û ÏÔÈÌÒÍÂȘÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û ¿ÙÔÌ· οı ËÏÈΛ·˜ (2,4).¶·Ú’ fiÏ· ·˘Ù¿, Ù· ÂȉËÌÈÔÏÔÁÈο Î·È ÎÏÈÓÈο ¯·-Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ÏÔÈÌÒÍÂˆÓ Ô˘ ÚÔηÏÔ‡ÓÙ·È·fi ÙÔÓ hMPV ¯Ú‹˙Ô˘Ó ÂÚ·ÈÙ¤Úˆ ÌÂϤÙ˘.

¶·Ú¿ ÙË ¯Ú‹ÛË Û‡Á¯ÚÔÓˆÓ ÌÂıfi‰ˆÓ ·Ó›¯Ó¢-Û˘ ÈÒÓ, fiϘ ۯ‰fiÓ ÔÈ ÌÂϤÙ˜ ‚ÚÂÊÒÓ Ì ‚ÚÔÁ-

¯ÈÔÏ›Ùȉ· Û˘ÌʈÓÔ‡Ó fiÙÈ Û ÌÂÁ¿ÏÔ ÔÛÔÛÙfi ›ӷȷ‰‡Ó·ÙË Ë ·Ó·ÁÓÒÚÈÛË ˘Â‡ı˘ÓÔ˘ ·ÈÙÈÔÏÔÁÈÎÔ‡·Ú¿ÁÔÓÙ·. ∂ÈÚfiÛıÂÙ·, ÁÓˆÚ›˙ÔÓÙ·˜ ÙȘ ‰ÔÌÈΤ˜ÔÌÔÈfiÙËÙ˜ ÙÔ˘ hMPV Î·È ÙÔ˘ RSV, ηıÒ˜ Î·È fiÙÈ·ÔÌÔÓÒıËΠ۠·ÛıÂÓ›˜ Ì ‚ÚÔÁ¯ÈÔÏ›Ùȉ·, ˘Ô-ı¤Û·Ì fiÙÈ Ô hMPV Èı·Ó¿ Ó· ·ÔÙÂÏ› ÛËÌ·ÓÙÈÎfi·ıÔÁfiÓÔ Û٤ϯԘ Û ‚Ú¤ÊË Ì ‚ÚÔÁ¯ÈÔÏ›Ùȉ·.

¶ÚfiÛÊ·Ù· ·Ó·ÎÔÈÓÒıËÎ·Ó Ù· ·ÔÙÂϤÛÌ·Ù·ÙÔ˘ ÈÔÏÔÁÈÎÔ‡ ÂϤÁ¯Ô˘ Ì›·˜ ÔÌ¿‰·˜ ‚ÚÂÊÒÓ Ô˘ÂÈÛ‹¯ıËÛ·Ó ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô ÏfiÁˆ ÔÍ›·˜ ‚ÚÔÁ¯ÈÔ-Ï›Ùȉ·˜, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÙË Ì¤ıÔ‰Ô Ù˘ ·Ó¿ÛÙÚÔ-Ê˘ ÌÂÙ·ÁÚ·Ê‹˜ Ù˘ ·ÓÙ›‰Ú·Û˘ ·Ï˘ÛȉˆÙ‹˜ Ô-Ï˘ÌÂÚ¿Û˘ (RT-PCR), ÚÔÎÂÈ̤ÓÔ˘ Ó· ·ÓȯÓ¢ıÔ‡Ó¤ÓÙÂη ·ıÔÁfiÓ· ÛÙÂϤ¯Ë ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘-ÛÙ‹Ì·ÙÔ˜ (5). Ÿˆ˜ ·Ó·ÌÂÓfiÙ·Ó, Ô RSV ‹Ù·Ó ÙÔ΢ÚÈfiÙÂÚÔ ·ıÔÁfiÓÔ Û٤ϯԘ, ·ÎÔÏÔ˘ıÔ‡ÌÂÓÔ·fi ÙÔÓ ·ÓıÚÒÈÓÔ ÚÈÓÔ˚fi (RV), Ô ÔÔ›Ô˜ ·Ó·ÁÓˆ-Ú›ÛÙËΠÛÙÔ ¤Ó· ÙÚ›ÙÔ ÂÚ›Ô˘ ÙˆÓ ÂÚÈÙÒÛˆÓ.™Â ÌÈÎÚfiÙÂÚÔ ÔÛÔÛÙfi ·Ó¢ڤıËÛ·Ó ·‰ÂÓÔ˚Ô›,Corona ÈÔ›, ηıÒ˜ Î·È ÔÈ ÈÔ› Ù˘ Áڛ˘ Î·È ·Ú·-Áڛ˘. ¢ÂÓ ·Ó·ÁÓˆÚ›ÛÙËΠ·ıÔÁfiÓÔ Û٤ϯԘÛÙÔ 25% ÂÚ›Ô˘ ÙˆÓ ÂÚÈÙÒÛÂˆÓ (5).

™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‹Ù·Ó Ó· ‰ÈÂÚ¢-ÓËı› Ë ·ÚÔ˘Û›· ÙÔ˘ hMPV ÛÙ· ÚÈÓÈο ÂÎχ̷ٷ·È‰ÈÒÓ Ô˘ ÂÈÛ‹¯ıËÛ·Ó ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô Ì ÔÍ›·‚ÚÔÁ¯ÈÔÏ›Ùȉ· Î·È Ó· ÂÎÙÈÌËı› Èı·Ó‹ Û¯¤ÛË ÌÂÙ·-͇ ÙÔ˘ ÈÔ‡ Î·È ÙˆÓ ÎÏÈÓÈÎÒÓ Î·È ÂȉËÌÈÔÏÔÁÈÎÒÓ ¯·-Ú·ÎÙËÚÈÛÙÈÎÒÓ Ù˘ ÓfiÛÔ˘.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ∏ ÌÂϤÙË ‰ÈÂÓÂÚÁ‹ıËΠÛÙË µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ÙÔ˘

¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ “¶. & ∞.∫˘ÚÈ·ÎÔ‡”, ηٿ ÙÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÌÂٷ͇ 1˘ OÎÙˆ‚Ú›-Ô˘ 1999 Î·È 30‹˜ ™ÂÙÂÌ‚Ú›Ô˘ 2000 Î·È ÂÁÎÚ›ıËΠ·fi ÙË ‰Â-ÔÓÙÔÏÔÁÈ΋ ÂÈÙÚÔ‹ ÙÔ˘ ÓÔÛÔÎÔÌ›Ԣ. ∫·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹,Ù· ·È‰È¿ ·ÍÈÔÏÔÁ‹ıËÎ·Ó ·fi È·ÙÚÔ‡˜ Ù˘ ÎÏÈÓÈ΋˜, ÙfiÛÔ ÎÏÈ-ÓÈο fiÛÔ Î·È ‚¿ÛÂÈ ÂÓfi˜ Ù˘ÔÔÈË̤ÓÔ˘ ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘.∆Ô ÈÛÙÔÚÈÎfi ÂÚÈÂÏ¿Ì‚·Ó ÏËÚÔÊÔڛ˜ fiˆ˜ Ë ËÏÈΛ·, ÙÔʇÏÔ, ÙÔ ÂÚÈÁÂÓÓËÙÈÎfi ÈÛÙÔÚÈÎfi (‰È¿ÚÎÂÈ· ·ËÛ˘, ‚¿ÚÔ˜Á¤ÓÓËÛ˘), ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ·ÙÔ›·˜ (Ô˘ ÔÚ›ÛÙËΈ˜ ıÂÙÈÎfi ÈÛÙÔÚÈÎfi È·ÙÚÈ΋˜ ‰È¿ÁÓˆÛ˘ ¿ÛıÌ·ÙÔ˜, ·ÏÏÂÚÁÈ-΋˜ ÚÈÓ›Ùȉ·˜ ‹ ·Ó·Ê˘Ï·Í›·˜ ÛÂ Û˘ÁÁÂÓ›˜ ÚÒÙÔ˘ ‚·ıÌÔ‡),Ë ¤ÎıÂÛË Û ηÓfi ÙÛÈÁ¿ÚÔ˘ (Ô˘ ÔÚ›ÛÙËΠˆ˜ ıÂÙÈÎfi ÂÊfi-ÛÔÓ ¤Ó·˜ ·fi ÙÔ˘˜ ‰‡Ô ÁÔÓ›˜ οÓÈ˙ ÔÔÈÔÓ‰‹ÔÙ ·ÚÈıÌfiÙÛÈÁ¿ÚˆÓ ̤۷ ÛÙÔ Û›ÙÈ), ηıÒ˜ Î·È ÙÔ ÚÔËÁÔ‡ÌÂÓÔ ÈÛÙÔ-ÚÈÎfi ÂÂÈÛÔ‰›ˆÓ Û˘ÚÈÁÌÔ‡ ‹ ¿ÏÏ˘ ¯ÚfiÓÈ·˜ ¿ıËÛ˘ Ì ȷ-ÙÚÈ΋ Áӈ̿Ù¢ÛË. ™ÙË ÌÂϤÙË ÂÚÈÂÏ‹ÊıËÛ·Ó ·È‰È¿ ÌÂ

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·174

Page 32: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

175

¶·È‰È·ÙÚÈ΋ 2004;67:173-177 Paediatriki 2004;67:173-177

ÔÍ›· ‚ÚÔÁ¯ÈÔÏ›Ùȉ·, ËÏÈΛ·˜ οو ÙˆÓ 18 ÌËÓÒÓ. ø˜ ‚ÚÔÁ-¯ÈÔÏ›Ùȉ· ÔÚ›ÛÙËÎÂ Ë ÔÍ›· Ïԛ̈ÍË ÙÔ˘ ηÙÒÙÂÚÔ˘ ·Ó·Ó¢-ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, ¯·Ú·ÎÙËÚÈ˙fiÌÂÓË ·fi ·˘ÍË̤ÓË ·Ó·-Ó¢ÛÙÈ΋ ÚÔÛ¿ıÂÈ· (Ù·¯‡ÓÔÈ· Ì >50 ·Ó·ÓÔ¤˜/minηÈ/‹ ¯Ú‹ÛË ÂÈÎÔ˘ÚÈÎÒÓ ·Ó·Ó¢ÛÙÈÎÒÓ Ì˘ÒÓ), ÂÎÓ¢ÛÙÈÎfiÛ˘ÚÈÁÌfi ηÈ/‹ ˘ÁÚÔ‡˜ ÚfiÁ¯Ô˘˜. ∆· ÎÚÈÙ‹ÚÈ· ·ÔÎÏÂÈÛÌÔ‡ÂÚÈÂÏ¿Ì‚·Ó·Ó ¯ÚfiÓȘ ·ı‹ÛÂȘ (΢ÛÙÈ΋ ›ÓˆÛË, ‚ÚÔÁ¯Ô-Ó¢ÌÔÓÈ΋ ‰˘ÛÏ·Û›·, Û˘ÁÁÂÓ›˜ ηډȷΤ˜ ·ı‹ÛÂȘ, ·ÓÔ-ÛÔ·Ó¿ÚÎÂÈ·) Î·È ˘ÔÙÚÔÈ¿˙ÔÓÙ· ÂÂÈÛfi‰È· Û˘ÚÈÁÌÔ‡.OÚ›ÛÙËΠÎÏÈÓÈ΋ Îϛ̷η ‚·Ú‡ÙËÙ·˜ ÙÔ˘ ÂÂÈÛÔ‰›Ô˘ ‚·ÛÈ˙fi-ÌÂÓË ÛÙÔÓ Î·Ú‰È·Îfi Î·È ·Ó·Ó¢ÛÙÈÎfi Ú˘ıÌfi, ÙÔÓ Û˘ÚÈÁÌfi,ÙËÓ Î˘¿ÓˆÛË, ÙË ‰˘Û¯¤ÚÂÈ· Ï‹„˘ ÙÚÔÊ‹˜ Î·È ÙÔÓ ÎÔÚÂÛÌfiÔ͢ÁfiÓÔ˘. OÈ ·ÛıÂÓ›˜ ˘Ô‚Ï‹ıËÎ·Ó Û ·ÎÙÈÓÔÁÚ·Ê›· ıÒ-Ú·ÎÔ˜, ·ÈÌÔÏË„›· Î·È Ï‹„Ë ÚÈÓÔÊ·Ú˘ÁÁÈÎÔ‡ ÂÎχ̷ÙÔ˜ ÌÂ2 ml Ê˘ÛÈÔÏÔÁÈÎÔ‡ ÔÚÔ‡ Û οı ÚÒıˆÓ·, ÙÔ ÔÔ›Ô ‰È·¯ˆÚ›-ÛÙËΠ۠ÎÏ¿ÛÌ·Ù· Î·È ‰È·ÙËÚ‹ıËΠÛÙÔ˘˜ -70ÔC. ¡¤Ô ÎÏ¿-ÛÌ· ¯ÚËÛÈÌÔÔÈ‹ıËΠÁÈ· ÙËÓ ·Ó›¯Ó¢ÛË ÙÔ˘ hMPV. ∫·Ù’ ·˘-ÙfiÓ ÙÔÓ ÙÚfiÔ, ÌÂÏÂÙ‹ıËΠ˘ÏÈÎfi Ô˘ ÚÔÂÚ¯fiÙ·Ó ·fi 56·È‰È¿. ∆· ‚Ú¤ÊË ıÂڷ‡ÙËÎ·Ó Û‡Ìʈӷ Ì ÙÔ ÚˆÙfiÎÔÏ-ÏÔ Ù˘ ÎÏÈÓÈ΋˜ Î·È ÂÍ‹Ïı·Ó Û ηϋ ÁÂÓÈ΋ ηٿÛÙ·ÛË.

∂ÈÚfiÛıÂÙ·, ÚÈÓÔÊ·Ú˘ÁÁÈÎfi ¤ÎÏ˘Ì· Ï‹ÊıËΠ·fi 10˘ÁÈ‹ ·È‰È¿, ¯ˆÚ›˜ ÛËÌ›· ‹ Û˘ÌÙÒÌ·Ù· Ïԛ̈͢ ·ÓÒÙÂ-ÚÔ˘ ‹ ηÙÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡, Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ˆ˜Ì¿ÚÙ˘Ú˜.

∞Ó›¯Ó¢ÛË ÙÔ˘ hPMV Ì ÙË Ì¤ıÔ‰Ô Ù˘ PCR ∞ÔÌÔÓÒıËΠÈÈÎfi RNA ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÙË Ê·ÈÓfiÏ/ÁÔ˘-

·Óȉ›ÓË ÈÛÔıÂÈÔ΢·ÓÈ΋ ̤ıÔ‰Ô (5). ∏ ·Ó¿ÛÙÚÔÊË ÌÂÙ·ÁÚ·-Ê‹ ‰ÈÂÓÂÚÁ‹ıËΠÛÙÔ˘˜ 37ÔC Û 50 mM Tris-HCL, 75 mMKCL, 3 mM MgCl2 Ú˘ıÌÈÛÙÈÎfi ‰È¿Ï˘Ì·, Ô˘ ÂÚÈ›¯Â 10 mªDTT, 0,4 mM dNTPs, 0,5 Ìg Ù˘¯·›Ô˘˜ ÂÍ·ÌÂÚ›˜ ÂÎÎÈÓËÙ¤˜Î·È 200 ÌÔÓ¿‰Â˜ ·Ó¿ÛÙÚÔÊ˘ ÙÚ·ÓÛÎÚÈÙ¿Û˘(SuperscriptTM, Invitrogen). ∆Ô cDNA ‰È·ÙËÚ‹ıËΠÛÙÔ˘˜ -20ÔC ¤ˆ˜ fiÙÔ˘ Ó· ¯ÚËÛÈÌÔÔÈËı›. OÈ ÂÎÎÈÓËÙ¤˜ (¿ÓˆMPVNF: 5’AGGCCCTCAGCACCAGACA3’, οو MPVNR:5’TTGACCGGCCCCATAAGC3’) ۯ‰ȿÛÙËÎ·Ó ÁÈ· ÙË ¡ (ÓÔ˘-ÎÏÂÔηۛ‰ÈÔ) ÂÚÈÔ¯‹ ÙÔ˘ 00-1 ÙÌ‹Ì·ÙÔ˜ ÙÔ˘ hMPV Ô˘·ÔÌÔÓˆÓfiÙ·Ó (Genbank accesion Nr AF 371337.2), ÚÔÎÂÈ-̤ÓÔ˘ Ó· ÂÓÈÛ¯˘ı› ıÚ·‡ÛÌ· ·ÔÙÂÏÔ‡ÌÂÓÔ ·fi 318 ‚¿ÛÂȘ,Ô˘ ·ÓÙÈÛÙÔȯ› ÛÙ· ÓÔ˘ÎÏÂÔÙ›‰È· 505-822 ÙÔ˘ ‰ËÌÔÛÈÂ˘Ì¤-ÓÔ˘ ÁÂÓÂÙÈÎÔ‡ ÙÌ‹Ì·ÙÔ˜ ÙÔ˘ ÈÔ‡ (1). ∏ ·ÓÙ›‰Ú·ÛË ·Ï˘Ûȉˆ-Ù‹˜ ÔÏ˘ÌÂÚ¿Û˘ ‰ÈÂÓÂÚÁ‹ıËΠ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ 2,5 mMMgCl2, 400 ÌM dNTPs, 0,25 ̪ ·fi οı hMPV ÂÎÎÈÓËÙ‹ ηÈ2,5 ÌÔÓ¿‰Â˜ Taq ÔÏ˘ÌÂÚ¿ÛË (Invitrogen) ÁÈ· 40 ·ÎÏÔ˘˜(94ÔC ÁÈ· 40 sec, 55ÔC ÁÈ· 40 sec, 72ÔC ÁÈ· 1 min, οı ·-ÎÏÔ˜). ™ÙË Û˘Ó¤¯ÂÈ·, 20% ·fi ÙÔ ÚÔ˚fiÓ Ù˘ PCR ËÏÂÎÙÚÔ-ÊÔÚ‹ıËΠ۠1,8% ‹Îو̷ ·Á·Úfi˙˘ ηÈ, ÂÊfiÛÔÓ Ù· ÂÓÈ-Û¯˘Ì¤Ó· ÙÌ‹Ì·Ù· ÙˆÓ 318 ‚¿ÛÂˆÓ ‹Ù·Ó ·ÚfiÓÙ·, ·ÔÎfiË-Î·Ó Î·È Î·ı·Ú›ÛÙËÎ·Ó Ì ÙÔ Concert Rapid Gel ExtractionSystem Kit (GibcoBRL), Û‡Ìʈӷ Ì ÙȘ Ô‰ËÁ›Â˜ ÙÔ˘ ηٷ-Û΢·ÛÙ‹. ∂ÈÏÂÁ̤ӷ ‰Â›ÁÌ·Ù· ÍËÚ¿ÓıËÎ·Ó ˘fi ÎÂÓfi Î·È˘¤ÛÙËÛ·Ó ·Ó¿Ï˘ÛË ·ÏÏËÏÔ˘¯›·˜, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÙȘ˘ËÚÂۛ˜ Ù˘ MWG AG Biotech (Ebersberg, Germany, ˘Ë-ÚÂÛ›· ·Ó¿Ï˘Û˘ ·ÏÏËÏÔ˘¯ÈÒÓ). ¶Ú·ÁÌ·ÙÔÔÈ‹ıËΠۇÁÎÚÈ-ÛË ÙˆÓ ıÚ·˘ÛÌ¿ÙˆÓ Ô˘ ·Ó·Ï‡ıËÎ·Ó Ì ÙÔ ÁÂÓÂÙÈÎfi ˘ÏÈÎfi

ÙÔ˘ hMPV, Ì ˘Ô‚ÔÏ‹ ÙˆÓ ·ÏÏËÏÔ˘¯ÈÒÓ ÛÙËÓ Genbank,¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÙËÓ ÎÏ·ÛÈ΋ ̤ıÔ‰Ô ·Ó¿Ï˘Û˘ ÓÔ˘ÎÏÂÔÙÈ-‰›ˆÓ BLAST (blastn).

™Ù·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ∏ ÛÙ·ÙÈÛÙÈ΋ ‰ÔÎÈÌ·Û›· ∞nova ¯ÚËÛÈÌÔÔÈ‹ıËΠÁÈ·

ÙË Û‡ÁÎÚÈÛË Û˘Ó¯ÒÓ ÌÂÙ·‚ÏËÙÒÓ ÌÂٷ͇ ÙˆÓ ·ÛıÂÓÒÓ Ì hMPV, ¯ˆÚ›˜ hMPV Î·È Ì RSV. ¢ÈÂÓÂÚÁ‹ıËΠ‰ÔÎÈÌ·Û›·¯2 ÁÈ· ÙËÓ ÂÂÍÂÚÁ·Û›· Ù·ÎÙÈÎÒÓ ‹ ηÙËÁÔÚÈÔÔÈËÌ¤ÓˆÓ ‰Â-‰Ô̤ӈÓ. ∆· ·ÔÙÂϤÛÌ·Ù· Û˘Ó¯ÒÓ ‰Â‰ÔÌ¤ÓˆÓ ÂÎÊÚ¿-ÛÙËÎ·Ó ˆ˜ ̤ÛÔ ± ÛÙ·ıÂÚfi ÛÊ¿ÏÌ· ̤ÛÔ˘. ™Ù·ÙÈÛÙÈΤ˜·Í›Â˜ ÌÈÎÚfiÙÂÚ˜ ·fi 0,05 ıˆڋıËÎ·Ó ˆ˜ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜.

∞ÔÙÂϤÛÌ·Ù· O ·ÓıÚÒÈÓÔ˜ ÌÂÙ·Ó¢ÌÔÓÔ˚fi˜ (hMPV) ‚Ú¤ıË-

Π۠9 ·fi Ù· 56 ‰Â›ÁÌ·Ù· Ô˘ ÂÍÂÙ¿ÛÙËηÓ(16,1%), fiˆ˜ Ê¿ÓËΠ·fi ÙÔ ÚÔ˚fiÓ Ù˘ PCR,·ÔÙÂÏÔ‡ÌÂÓÔ ·fi 318 ‚¿ÛÂȘ ÛÙÔ ‹Îو̷ ËÏÂ-ÎÙÚÔÊfiÚËÛ˘. ∏ ·ÚÔ˘Û›· ÙÔ˘ ÈÔ‡ ÂȂ‚·ÈÒıËηfi ÙËÓ ·Ó¿Ï˘ÛË ·ÏÏËÏÔ˘¯›·˜ Ô˘ ¤ÁÈÓ Û ıÂÙÈοÚÔ˚fiÓÙ· Ù˘ PCR (6,7). O ·Ó·Ó¢ÛÙÈÎfi˜ Û˘Á΢-ÙÈ·Îfi˜ Èfi˜ (RSV) ‹Ù·Ó ÙÔ Î‡ÚÈÔ ·ıÔÁfiÓÔ ÛÙ¤ÏÂ-¯Ô˜, ·ÊÔ‡ ·ÔÌÔÓÒıËΠ۠38 ·fi Ù· 56 ‰Â›ÁÌ·Ù·(67,9%), ÂÓÒ Ô ·ÓıÚÒÈÓÔ˜ ÚÈÓÔ˚fi˜ (RV) ‚Ú¤ıËÎÂÛ 8 ‰Â›ÁÌ·Ù· (14,3%). ÕÏÏÔÈ ÈÔ› Ô˘ ·ÔÌÔÓÒıË-Î·Ó ‹Ù·Ó ·‰ÂÓÔ˚Ô› (4 ÂÚÈÙÒÛÂȘ) Î·È ÈÔ› Corona (3ÂÚÈÙÒÛÂȘ), ÂÓÒ Û ¤Ó· ‰Â›ÁÌ· ·ÔÌÔÓÒıËΠÈfi˜Ù˘ ·Ú·Áڛ˘ (5).

¢¤Î· ¤ÍÈ ·ÛıÂÓ›˜ ‚Ú¤ıËÎ·Ó Ù·˘Ùfi¯ÚÔÓ· ıÂÙÈ-ÎÔ› Û 2 ÈÔ‡˜, ÂÓÒ ‰ÂÓ ‚Ú¤ıËΠ·ıÔÁfiÓÔ Û٤ϯԘÛ 9 ÂÚÈÙÒÛÂȘ. ŸÏ· Ù· ÚÈÓÔÊ·Ú˘ÁÁÈο ÂÎχ-Ì·Ù· ·fi ÙÔ˘˜ ˘ÁÈ›˜ Ì¿ÚÙ˘Ú˜ Ô˘ ·Ó·Ï‡ıËηÓÌ PCR ÁÈ· hMPV ‹Ù·Ó ·ÚÓËÙÈο.

™Â 5 ·fi Ù· ıÂÙÈο ÁÈ· hMPV ‰Â›ÁÌ·Ù·, Ô Èfi˜‹Ù·Ó ÙÔ ÌÔÓ·‰ÈÎfi ·ıÔÁfiÓÔ Û٤ϯԘ, ÂÓÒ ÛÙ·˘fiÏÔÈ· 4 Û˘Ó˘‹Ú¯Â Ì ÙÔÓ RSV. ¢ÂÓ ·Ú·ÙËÚ‹-ıËÎÂ Û˘Ó‡·ÚÍË ÙÔ˘ ÈÔ‡ Ì ¿ÏÏÔ˘˜ ÈÔ‡˜ ÙÔ˘ ·Ó·-Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜.

OÈ ÂÚÈÛÛfiÙÂÚ˜ ÏÔÈÌÒÍÂȘ Ì ÙÔÓ hMPV Ê·›ÓÂ-Ù·È Ó· ÚˆÙÔÂÌÊ·Ó›˙ÔÓÙ·È ÙÔÓ ºÂ‚ÚÔ˘¿ÚÈÔ Î·È, ·-Ú¿ ÙÔ fiÙÈ ÚÔԉ¢ÙÈο ÂÍ·ÛıÂÓÔ‡Ó, ÂÈ̤ÓÔ˘Ó Ì¤-¯ÚÈ ÙÔÓ ∞Ú›ÏÈÔ (∂ÈÎfiÓ· 1). ∏ ·ÓÙ›ÛÙÔÈ¯Ë ÂÚ›Ô‰Ô˜ÂÌÊ¿ÓÈÛ˘ ÙÔ˘ RSV ÙËÓ ›‰È· ¯ÚÔÓÈ¿ ‹Ù·Ó ·fi ÙÔÓ¢ÂΤ̂ÚÈÔ ¤ˆ˜ ÙÔÓ ª¿ÚÙÈÔ. ¶·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ô·ÚÈıÌfi˜ ÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ Â›Ó·È Û¯ÂÙÈο ÌÈÎÚfi˜,Ê·›ÓÂÙ·È fiÙÈ Ô hMPV ·ÚÔ˘ÛÈ¿˙ÂÈ ·ÚfiÌÔÈ·, ·ÏÏ¿ -·Ú’ fiÏ· ·˘Ù¿ - ¢‰È¿ÎÚÈÙË ÂÔ¯È΋ ηٷÓÔÌ‹ ÛÂÛ¯¤ÛË Ì ÙÔÓ RSV.

¢ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ‰È·ÊÔÚ¤˜ ÛÙËÓ ÎÏÈÓÈ΋ ÂÈÎfi-Ó· ÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ ‚ÚÔÁ¯ÈÔÏ›Ùȉ·˜ fiÔ˘ ·ÔÌÔ-ÓÒıËÎÂ Ô hMPV, Ô RSV ‹ ¿ÏÏÔ ·ıÔÁfiÓÔ Û٤ϯԘ(¶›Ó·Î·˜ 1). ∂ÈϤÔÓ, ‰ÂÓ ˘‹ÚÍ ‰È·ÊÔÚ¿ ÛÙË ‚·-Ú‡ÙËÙ· Ù˘ ÓfiÛÔ˘ ÌÂٷ͇ ÙˆÓ ıÂÙÈÎÒÓ ÁÈ· hMPV ηÈÙˆÓ ‰ÈÏ¿ ıÂÙÈÎÒÓ ÁÈ· hMPV-RSV ÂÚÈÙÒÛˆÓ

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·175

Page 33: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

(‰Â›ÎÙ˘ ‚·Ú‡ÙËÙ·˜: 8,3±0,6 ¤Ó·ÓÙÈ 8,4±0,6). ¢È·-ÊÔÚ¤˜ ‰ÂÓ ·Ú·ÙËÚ‹ıËηÓ, ›Û˘, fiÙ·Ó Ù· ÛÙÔÈ-¯Â›· Ô˘ ηıfiÚÈÛ·Ó ÙË ‚·Ú‡ÙËÙ· Ù˘ ÓfiÛÔ˘ ÂÍÂÙ¿-ÛÙËÎ·Ó Í¯ˆÚÈÛÙ¿ (ηډȷÎfi˜ Ú˘ıÌfi˜, ·Ó·Ó¢-ÛÙÈÎfi˜ Ú˘ıÌfi˜, Û˘ÚÈÁÌfi˜, ¯ÚÒÌ· ‰¤ÚÌ·ÙÔ˜ Î·È ·Ú-ÙËÚÈ·Îfi˜ ÎÔÚÂÛÌfi˜ Ô͢ÁfiÓÔ˘).

∆¤ÏÔ˜, Ù· ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· ÌÂٷ͇ وӷȉÈÒÓ Ì ‹ ¯ˆÚ›˜ ÙÔÓ hMPV ‰ÂÓ ·ÚÔ˘Û›·˙·ÓÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ (¶›Ó·Î·˜ 2).

™˘˙‹ÙËÛË ¶·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ô ·ÓıÚÒÈÓÔ˜ ·Ó·Ó¢ÛÙÈ-

Îfi˜ Û˘Á΢ÙÈ·Îfi˜ Èfi˜ ·ÔÙÂÏ› ÙÔ ÈÔ Û˘¯Ófi ·›ÙÈÔÔÍ›·˜ ‚ÚÔÁ¯ÈÔÏ›Ùȉ·˜ Û ·È‰È¿, ·Ú·Ì¤ÓÂÈ ÛËÌ·-ÓÙÈÎfi˜ ·ÚÈıÌfi˜ ÂÚÈÙÒÛÂˆÓ ÛÙȘ Ôԛ˜ ‰ÂÓ ·Ó¢-Ú›ÛÎÂÙ·È ·ÈÙÈÔÏÔÁÈÎfi˜ ·Ú¿ÁÔÓÙ·˜. ÿÛˆ˜, Ô hMPVÔ˘ ·Ó·Î·Ï‡ÊıËΠÚfiÛÊ·Ù·, Ó· ‰ÒÛÂÈ Ì›· ÂÍ‹-ÁËÛË Û ÂÚÈÙÒÛÂȘ ÏÔÈÌÒÍÂˆÓ ÙÔ˘ ·Ó·Ó¢ÛÙÈ-ÎÔ‡ Ô˘ ‰ÂÓ ¤¯Ô˘Ó ‰È·ÁÓˆÛÙ› ¤ˆ˜ ÙÒÚ· (1).

∏ ·ÚÔ‡Û· ÌÂϤÙË, Ì ÙË ¯ÚËÛÈÌÔÔ›ËÛË Ù˘ÌÂıfi‰Ô˘ PCR, ·ÔηχÙÂÈ Û˘¯Ó‹ Û˘ÌÌÂÙÔ¯‹ ÙÔ˘hMPV Û ‚Ú¤ÊË Ì ÔÍ›· ‚ÚÔÁ¯ÈÔÏ›Ùȉ·. ™‡ÌʈӷÌ ÙËÓ ·Ó¿Ï˘ÛË, Ô hMPV ‚Ú¤ıËΠ۠16% ÙˆÓ Â-ÚÈÛÙ·ÙÈÎÒÓ ‚ÚÔÁ¯ÈÔÏ›Ùȉ·˜, ÔÛÔÛÙfi ÌfiÏȘ ‰Â‡ÙÂ-ÚÔ ÛÂ Û˘¯ÓfiÙËÙ· ÌÂÙ¿ ÙÔÓ RSV (5). O hMPV ‹Ù·ÓÌÔÓ·‰ÈÎfi ·ıÔÁfiÓÔ Û٤ϯԘ ‹ Û˘Ó˘‹Ú¯Â Ì ÙÔÓRSV, ·ÚÔ˘ÛÈ¿˙ÔÓÙ·˜ Ì›· ·Ú¿ÏÏËÏË ·ÏÏ¿ ηÈ,

Ù·˘Ùfi¯ÚÔÓ·, ‰È·ÎÚÈÙ‹ ÂÔ¯È΋ ηٷÓÔÌ‹ Û ۯ¤ÛËÌ ÙÔÓ RSV. ¶·ÚfiÌÔÈ· ÂÔ¯È΋ ηٷÓÔÌ‹ ·Ó·Ê¤ÚÂ-Ù·È Î·È ÛÙË ÌÂϤÙË ÙˆÓ Jartti Î·È Û˘Ó Û ·ÛıÂÓ›˜ Ì·ÈÊÓ›‰ÈÔ Û˘ÚÈÁÌfi (3).

∏ ·ÚÔ˘Û›· ÙÔ˘ hMPV ÛÙËÓ ÂÚÈÔ¯‹ Ù˘ ªÂÛÔ-Á›Ԣ ·ÔÙÂÏ› Ì›· ÂÈϤÔÓ ¤Ó‰ÂÈÍË ˘¤Ú Ù˘ ·-ÁÎfiÛÌÈ·˜ ηٷÓÔÌ‹˜ ÙÔ˘ ÈÔ‡, Û˘ÌÏËÚÒÓÔÓÙ·˜ ÙȘ˘¿Ú¯Ô˘Û˜ ÌÂϤÙ˜ Ô˘ ·ÊÔÚÔ‡Ó ÛÙË µfiÚÂÈ· ∂˘-ÚÒË, ÙË µfiÚÂÈ· ∞ÌÂÚÈ΋ Î·È ÙËÓ ∞˘ÛÙÚ·Ï›·(1,3,4,7-9).

∂ÍÂÙ¿˙ÔÓÙ·˜ ‰È¿ÊÔÚ· ÛÙÔȯ›· ÙfiÛÔ ·fi ÙÔÈÛÙÔÚÈÎfi, fiˆ˜ ËÏÈΛ·, ʇÏÔ, ‚¿ÚÔ˜ Á¤ÓÓËÛ˘, ÔÈ-ÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ·ÙÔ›·˜ Î·È ¤ÎıÂÛË Û ηÓfiÙÛÈÁ¿ÚÔ˘, fiÛÔ Î·È ·fi Ù· ÂÂÈÛfi‰È· ‚ÚÔÁ¯ÈÔÏ›ÙÈ-‰·˜, fiˆ˜ ¯ÚfiÓÔ˜ ¤Ó·Ú͢ Ù˘ ÓfiÛÔ˘ ηٿ ÙËÓ ÂÈ-Û·ÁˆÁ‹, ‰È¿ÚÎÂÈ· ÓÔÛËÏ›·˜ Î·È ·ÚÔ˘Û›· ˘ÚÂ-ÙÔ‡, ‰ÂÓ ‚Ú¤ıËÎ·Ó ‰È·ÊÔÚ¤˜ ÌÂٷ͇ ÙˆÓ ÂÚÈÙÒ-ÛÂˆÓ fiÔ˘ ·ÔÌÔÓÒıËÎÂ Ô hMPV, Ô RSV ‹ ¿ÏÏÔ·ıÔÁfiÓÔ Û٤ϯԘ. ¢ÂÓ ·Ú·ÙËÚ‹ıËηÓ, ÂÈÚfi-ÛıÂÙ·, ‰È·ÊÔÚ¤˜ ÛÙË ‚·Ú‡ÙËÙ· Ù˘ ÓfiÛÔ˘ ÌÂÙ·Í‡ÙˆÓ hMPV Î·È ÙˆÓ ‰ÈÏ¿ ıÂÙÈÎÒÓ hMPV-RSV ÂÚÈ-ÙÒÛˆÓ. ¶·ÚfiÌÔÈ·, ‰ÂÓ ˘‹ÚÍ·Ó ‰È·ÊÔÚ¤˜ ÛÙ·ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù·. ŸÏ· Ù· ·Ú·¿Óˆ Ê·›-ÓÂÙ·È Ó· ˘ÔÛÙËÚ›˙Ô˘Ó ÙËÓ ·ÓÙ›ÏË„Ë fiÙÈ Ô hMPVÌÔÚ› Ó· ÚÔηϤÛÂÈ ÂÂÈÛfi‰ÈÔ ‚ÚÔÁ¯ÈÔÏ›Ùȉ·˜Ô˘ ÎÏÈÓÈο ÔÌÔÈ¿˙ÂÈ Ì ·˘Ùfi Ô˘ ÚÔηÏÂ›Ù·È ·fiÙÔÓ RSV, η٤¯ÔÓÙ·˜ ÙË ‰Â‡ÙÂÚË ı¤ÛË Û ÛÂÈÚ¿ Û˘-¯ÓfiÙËÙ·˜.

∞fi ÌÂϤÙ˜ Ê·›ÓÂÙ·È fiÙÈ Ô hMPV ÌÔÚ› Ó·ÚÔηϤÛÂÈ ÎÏÈÓÈ΋ ÓfiÛÔ Û fiϘ ÙȘ ËÏÈÎȷΤ˜ ÔÌ¿-‰Â˜, ÂÓÒ ıˆÚÂ›Ù·È ·ıÔÁfiÓÔ Û٤ϯԘ ÙfiÛÔ ÙÔ˘·ÓÒÙÂÚÔ˘ fiÛÔ Î·È ÙÔ˘ ηÙÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡Û˘ÛÙ‹Ì·ÙÔ˜ (1-4). ¶·Ú’ fiÏ· ·˘Ù¿, ÛÙȘ ÂÚÈÛÛfiÙÂ-Ú˜ ÌÂϤÙ˜ ¤ˆ˜ ÙÒÚ· Û˘ÏϤÁÔÓÙ·È ÏËÚÔÊÔڛ˜·fi ·ÓfiÌÔȘ ÏËı˘ÛÌȷΤ˜ ÔÌ¿‰Â˜, Ì ÔÈΛÏË·Ó·Ó¢ÛÙÈ΋ Û˘Ìو̷ÙÔÏÔÁ›·, fiÔ˘ ‰ÂÓ Ê·›ÓÂ-Ù·È Ó· ·Ó·Ï‡ÂÙ·È Â·ÚÎÒ˜ Ì›· ηϿ ¯·Ú·ÎÙËÚÈṲ̂-ÓË, fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ·, ÔÌ¿‰· (3).

¶ÚfiÛÊ·Ù˜ ÌÂϤÙ˜ ·Ô‰ÂÈÎÓ‡Ô˘Ó fiÙÈ Ô hMPVÈı·ÓfiÓ Ó· Â›Ó·È ˘Â‡ı˘ÓÔ˜ ÁÈ· ¤Ó· ÌÂÁ¿ÏÔ ÔÛÔ-ÛÙfi ÂÚÈÛÙ·ÙÈÎÒÓ, ÛÙ· ÔÔ›· ‰ÂÓ ·Ó¢ÚÈÛÎfiÙ·Ó

∂ÈÎfiÓ· 1. ∂Ô¯È΋ ηٷÓÔÌ‹ ÙÔ˘ hMPV. OÈ Ì·‡Ú˜ Ú¿‚‰ÔÈ·ÂÈÎÔÓ›˙Ô˘Ó ÙÔÓ ·ÚÈıÌfi ÙˆÓ ‰ÂÈÁÌ¿ÙˆÓ Ô˘ ‚Ú¤ıËÎ·Ó ıÂÙÈοÁÈ· hMPV, ÔÈ ÁÎÚÈ ÁÈ· RSV Î·È ÔÈ Ï¢Τ˜ ÁÈ· ÔÔÈÔÓ‰‹ÔÙ ¿ÏÏÔ ·Ó·Ó¢ÛÙÈÎfi Èfi.

No¤Ì. ¢ÂÎ. π·Ó. ºÂ‚. ª¿Ú. ∞Ú. ª¿ÈÔ˜

30

20

10

0

™‡ÓÔÏÔRSVMPV

¶›Ó·Î·˜ 1. ÷ڷÎÙËÚÈÛÙÈο Ù˘ ÓfiÛÔ˘ Û ·ÛıÂÓ›˜ Ô˘ ·ÓȯÓ‡ıËΠ‹ fi¯È Ô hMPV Û ۇÁÎÚÈÛË Ì ÙÔ˘˜ ·ÛıÂÓ›˜ fiÔ˘ ·Ô-ÌÔÓÒıËÎÂ Ô RSV

ªÂÙ·‚ÏËÙ‹ MPV (+) (n=9) MPV (-) (n=47) RSV (n=38)

º‡ÏÔ (¿ÚÚÂÓ) 67% 70% 71%∏ÏÈΛ· (Ì‹Ó˜) 5,3±1,1 5,4±0,5 5,0±0,5µ¿ÚÔ˜ Á¤ÓÓËÛ˘ (g) 3118±150 3150±71 3103±86ŒÎıÂÛË Û ηÓfi 44% 74% 65%OÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ·ÙÔ›·˜ 33% 24% 19%∏̤ڷ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ÓfiÛÔ˘ ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹ 2,6±0,4 3,3±0,3 3,0±0,3¢È¿ÚÎÂÈ· ÓÔÛËÏ›·˜ (Ë̤Ú˜) 5,3±0,9 4,8±0,4 5,1±0,5¶˘ÚÂÙfi˜ 44% 35% 34%µ·ıÌÔÏÔÁ›· ÛÔ‚·ÚfiÙËÙ·˜ ÓfiÛÔ˘ 8,3±0,4 8,3±0,2 8,3±0,2

176

¶·È‰È·ÙÚÈ΋ 2004;67:173-177 Paediatriki 2004;67:173-177

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·176

Page 34: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

177

¶·È‰È·ÙÚÈ΋ 2004;67:173-177 Paediatriki 2004;67:173-177

¤ˆ˜ ÙÒÚ· ·ÈÙÈÔÏÔÁÈÎfi˜ ·Ú¿ÁÔÓÙ·˜. £· Ú¤ÂÈ Ó·‰ÈÂÍ·¯ıÔ‡Ó ÂÚ·ÈÙ¤Úˆ ÌÂϤÙ˜, ÚÔÎÂÈ̤ÓÔ˘ Ó· ‰È-¢ÎÚÈÓÈÛÙ› Ô ÚfiÏÔ˜ ÙÔ˘ hMPV Û ‰È¿ÊÔÚ˜ Ófi-ÛÔ˘˜ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÛÙÔÓ ¿ÓıÚˆ-Ô, ·Ú¤¯ÔÓÙ·˜ Ì ·˘ÙfiÓ ÙÔÓ ÙÚfiÔ ÛËÌ·ÓÙÈΤ˜ÏËÚÔÊÔڛ˜ ÁÈ· ÙÔÓ ÌÂÏÏÔÓÙÈÎfi ۯ‰ȷÛÌfi ÂȉÈ-ÎÒÓ ·ÓÙÈ-ÈÈÎÒÓ ıÂÚ·ÂÈÒÓ Î·È ÂÌ‚ÔÏ›ˆÓ.

µÈ‚ÏÈÔÁÚ·Ê›· 1. van den Hoogen BG, de Jong JC, Groen J, Kuiken T, de

Groot R, Fouchier RA et al. A newly discovered humanpneumovirus isolated from young children with respiratorytract disease. Nat Med 2001;7:719-724.

2. Boivin G, Abed Y, Pelletier G, Ruel L, Moisan D, Cote S et al.Virological features and clinical manifestations associatedwith human metapneumovirus: a new paramyxovirusresponsible for acute respiratory-tract infections in all agegroups. J Infect Dis 2002;186:1330-1334.

3. Jartti T, van den Hoogen B, Garofalo RP, Osterhaus AD,Ruuskanen O. Metapneumovirus and acute wheezing inchildren. Lancet 2002;360:1393-1394.

4. Stockton J, Stephenson I, Fleming D, Zambon M. Humanmetapneumovirus as a cause of community-acquiredrespiratory illness. Emerg Infect Dis 2002;8:897-901.

5. Papadopoulos NG, Moustaki M, Tsolia M, Bossios A, AstraE, Prezerakou A et al. Association of rhinovirus infection withincreased disease severity in acute bronchiolitis. Am JRespir Crit Care Med 2002;165:1285-1289.

6. van den Hoogen BG, Bestebroer TM, Osterhaus AD,Fouchier RA. Analysis of the genomic sequence of a humanmetapneumovirus. Virology 2002;295:119-132.

7. Peret TC, Boivin G, Li Y, Couillard M, Humphrey C,Osterhaus AD et al. Characterization of humanmetapneumoviruses isolated from patients in NorthAmerica. J Infect Dis 2002;185:1660-1663.

8. Nissen MD, Siebert DJ, Mackay IM, Sloots TP, Withers SJ.Evidence of human metapneumovirus in Australianchildren. Med J Aust 2002;176:188.

9. Howe M. Australian find suggests worldwide reach formetapneumovirus. Lancet Infect Dis 2002;2:202.

¶›Ó·Î·˜ 2. ∂ÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· ÙˆÓ ·ÛıÂÓÒÓ, ÛÙÔ˘˜ÔÔ›Ô˘˜ ·ÔÌÔÓÒıËΠ‹ fi¯È Ô Èfi˜. ¢ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ÛÙ·-ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ

ªÂÙ·‚ÏËÙ‹ hMPV (n=9) Èڛ˜ hMPV (n=47)

§Â˘ÎÔ·ÙÙ·Ú· (n) (/mm3) 12,5±0,45 12,7±0,45¶ÔÏ˘ÌÔÚÊÔ‡ÚËÓ· (%) 31,7±5,7 31,7±2,8§ÂÌÊÔ·ÙÙ·Ú· (%) 41,2±8,8 47,9±2,9ªÔÓÔ·ÙÙ·Ú· (%) 10,1±2,3 9,6±1,7∏ˆÛÈÓfiÊÈÏ· (%) 2,5±0,4 2,4±0,4∆∫∂ (mm/h) 41,1±12,5 31,2±4,2CRP (mg/l) 11,6±3,7 15,0±3,0IgE (U/l) 389,5±88,3 363,4±39,3

¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ¶·Ú·Û΢‹ •Â··‰¿ÎË ∂Ú¢ÓËÙÈο ∂ÚÁ·ÛÙ‹ÚÈ·, µ’ ¶·È‰È·ÙÚÈ΋ ¶·ÓÂÈÛÙËÌȷ΋ ∫ÏÈÓÈ΋ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡” ∆.∫. 115 27, °Ô˘‰›, ∞ı‹Ó· ∂-mail: [email protected]

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·177

Page 35: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

178

¶·È‰È·ÙÚÈ΋ 2004;67:178-189 Paediatriki 2004;67:178-189

∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞ ORIGINAL ARTICLE

∏ Û¯¤ÛË Ù˘ ‰È·ÙÚÔÊ‹˜ Ì ·Ó·Ù˘ÍȷΤ˜ Î·È ÂÎ·È‰Â˘ÙÈΤ˜ ‰ÂÍÈfiÙËÙ˜ ·È‰ÈÒÓ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ ∂. ∫·Ú·ÎˆÓÛÙ·ÓÙ¿ÎË, ∞. ∫·Ê¿ÙÔ˜, ª. §ÈÓ·Ú‰¿Î˘, ™. ªÈ¯ÂÏÔÁÈ¿ÓÓ˘

The association of nutrition with developmental and educational abilities of school age children H. Karakonstantaki, A. Kafatos, M. Linardakis, S. Michelogiannis

�¶ÂÚ›ÏË„Ë: ¶·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ë Û¯¤ÛË Ù˘ ‰È·-ÙÚÔÊ‹˜ Ì ÙË ÛˆÌ·ÙÈ΋ ˘Á›· ·ÔÙÂÏ› ·ÓÙÈΛÌÂÓÔÛ˘ÛÙËÌ·ÙÈ΋˜ ‰ÈÂÚ‡ÓËÛ˘, Ë Û¯¤ÛË Ù˘ Ì ÙË ÏÂÈ-ÙÔ˘ÚÁ›· ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ ·Ú·Ì¤ÓÂÈ Û¯ÂÙÈο ¿ÁÓˆ-ÛÙË. ∏ ÌÂϤÙË Ù˘ Û¯¤Û˘ Ù˘ ÔÈfiÙËÙ·˜ ‰È·ÙÚÔ-Ê‹˜ Ì ÙÔ ÁÓˆÛÙÈÎfi Î·È Û˘Ó·ÈÛıËÌ·ÙÈÎfi ÙÌ‹Ì· Ù˘·ÓıÚÒÈÓ˘ Û˘ÌÂÚÈÊÔÚ¿˜ ·ÚÔ˘ÛÈ¿˙ÂÈ, ·Ó·ÌÊ›-‚ÔÏ·, ÌÂÁ¿ÏÔ ÂӉȷʤÚÔÓ. ∏ ·ÚÔ‡Û· ¤Ú¢ӷ ÂÈ-¯ÂÈÚ› Ì›· ÚÔÛ¤ÁÁÈÛË ·˘ÙÔ‡ ÙÔ˘ ı¤Ì·ÙÔ˜. ™Â ‰Â›Á-Ì· Ô˘ Û˘ÌÌÂÙ›¯Â ÛÙÔ ¶ÚfiÁÚ·ÌÌ· ∂Î·È‰Â˘ÙÈ΋˜¶·Ú¤Ì‚·Û˘ “∞ÁˆÁ‹ ÀÁ›·˜”, ¤ÁÈÓ ÂÎÙ›ÌËÛË ÙˆÓ·Ó·Ù˘ÍÈ·ÎÒÓ Î·È ÂÎ·È‰Â˘ÙÈÎÒÓ ÈηÓÔÙ‹ÙˆÓ Ì Ù˯ڋÛË ÂȉÈ΋˜ Îϛ̷η˜ Ì·ıËÛȷ΋˜ ÈηÓfiÙËÙ·˜·fi ÙÔ˘˜ ÂÎ·È‰Â˘ÙÈÎÔ‡˜. ŒÁÈÓÂ Û˘Û¯¤ÙÈÛË ÙˆÓ ‰ÂÈ-ÎÙÒÓ Ì·ıËÛȷ΋˜ ›‰ÔÛ˘ Î·È ÙˆÓ Û¯ÔÏÈÎÒÓ ‚·ı-ÌÒÓ Ì ÙÔ˘˜ ·ÈÌ·ÙÔÏÔÁÈÎÔ‡˜ ‰Â›ÎÙ˜, ÙÔ˘˜ ‰È·ÙÚÔ-ÊÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜, Ù· ‰Â‰Ô̤ӷ ÙˆÓ ÛˆÌ·ÙÔÌÂ-ÙÚ‹ÛÂˆÓ Î·È ÙËÓ Â›‰ÔÛË Û ̛· ‰ÔÎÈÌ·Û›· Ê˘ÛÈ΋˜Î·Ù¿ÛÙ·Û˘, ÙÔ ·Ï›Ó‰ÚÔÌÔ ÙÂÛÙ ·ÓÙÔ¯‹˜. µÚ¤ıË-ΠfiÙÈ Ë Î·Ù·Ó¿ÏˆÛË Á·Ï·ÎÙÔÎÔÌÈÎÒÓ, Ï·¯·ÓÈÎÒÓÎ·È ÊÚÔ‡ÙˆÓ ‚ÂÏÙÈÒÓÂÈ Î¿ÔȘ ÈηÓfiÙËÙ˜. ™Â ·˘-Ùfi Ê·›ÓÂÙ·È Ó· ¤¯Ô˘Ó οÔÈÔ ÚfiÏÔ ÔÈ ‚Èٷ̛Ә µ12Î·È ∞, ÙÔ ·Û‚¤ÛÙÈÔ Î·È ÔÈ ÚˆÙ½Ó˜. π‰È·›ÙÂÚÔ ÂÓ-‰È·Ê¤ÚÔÓ ·ÚÔ˘ÛÈ¿˙ÂÈ ÙÔ Â‡ÚËÌ· Û‡Ìʈӷ Ì ÙÔÔÔ›Ô Ë Ê˘ÛÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· Û¯ÂÙ›˙ÂÙ·È Ì ˘„Ë-Ï‹ ‚·ıÌÔÏÔÁ›· ÛÙËÓ Îϛ̷η Ì·ıËÛȷ΋˜ ›‰Ô-Û˘. ™ÙÔ ‰Â›ÁÌ· Ô˘ ÂÍÂÙ¿ÛÙËÎÂ, Ù· ÎÔÚ›ÙÛÈ· ·-ÚÔ˘Û›·Û·Ó ηχÙÂÚË Â›‰ÔÛË Û ·˘Ù‹ ÙËÓ Îϛ̷ηÛ ۯ¤ÛË Ì ٷ ·ÁfiÚÈ·. OÈ Ì·ıËÙ¤˜ Ì ˘„ËÏfiÙÂÚË›‰ÔÛË ÛÙËÓ Îϛ̷η ›¯·Ó ÌÂÁ·Ï‡ÙÂÚÔ ‚¿ÚÔ˜,·˘ÍË̤ÓË Î·Ù·Ó¿ÏˆÛË Ï·¯·ÓÈÎÒÓ Î·È ÊÚÔ‡ÙˆÓ Î·ÈÚfiÛÏË„Ë ‚ÈÙ·Ì›Ó˘ µ12 Û ۯ¤ÛË Ì ÙÔ˘˜ Ì·ıËÙ¤˜Ô˘ ·ÚÔ˘Û›·Û·Ó ¯·ÌËÏfiÙÂÚË Â›‰ÔÛË. ∆· ¢ڋ-Ì·Ù· Ù˘ ¤Ú¢ӷ˜ Â›Ó·È Û‡Ìʈӷ Ì ·˘Ù¿ ¿ÏψÓÂÚ¢ÓÒÓ Î·È Û˘ÓËÁÔÚÔ‡Ó ˘¤Ú Ù˘ ¿Ô„˘ fiÙÈ ËÔÈfiÙËÙ· Ù˘ ‰È·ÙÚÔÊ‹˜ Û˘Û¯ÂÙ›˙ÂÙ·È fi¯È ÌfiÓÔ ÌÂ

�Abstract: While the relationship between nutritionand physical well-being is well established, thatbetween nutrition and brain function still remainsuncertain. This study attempts an approach to theinvestigation of the association between the qualityof nutrition and the cognitive and emotional aspectsof human behaviour. The developmental andeducational skills of students who had participatedin a health education intervention programme wereevaluated. The evaluation was carried out by theirteachers, using an academic performance scale.Performance scores and school grades werecorrelated with haematological and anthropometricindices, dietary intake and performance on aphysical fitness scale. The findings indicated thatconsumption of dairy products, vegetables andfruits was associated with improvements in somecognitive abilities. Vitamins B12 and A, and calciumand proteins appear to play a role. The associationobserved between physical activity and high scoreson the academic performance scale is of specialinterest. Girls scored higher than boys on this scale,and pupils with higher scores in the scale hadgreater body weight and recorded higher intakes ofvegetables, fruits and vitamin B12 than pupils withlower scores. These findings are in accordance withthose of other studies and suggest that the qualityof nutrition correlates not just with physical well-being but also with cognitive performance. Thisassociation should be further investigated. In viewof the possible negative consequences ofmalnutrition and reduced physical activity on thegeneral performance of children, prevention andintervention programmes are indicated.

π·ÙÚÈ΋ ™¯ÔÏ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘, ∏Ú¿ÎÏÂÈÔ Medical School, University of Crete, Heraklion

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·178

Page 36: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

179

¶·È‰È·ÙÚÈ΋ 2004;67:178-189 Paediatriki 2004;67:178-189

™˘ÓÙÔÌÔÁڷʛ˜ HDL-C ÃÔÏËÛÙÂÚfiÏË ÙˆÓ ˘„ËÏ‹˜ ˘ÎÓfiÙËÙ·˜

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

ÏÈÔÚˆÙÂ˚ÓÒÓ TC/HDL ∞ıËڈ̷ÙÈÎfi˜ ‰Â›ÎÙ˘ ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘

ÚÔ˜ ˘„ËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈÔÚˆÙ½ÓË ¶∆∞ ¶·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜ ¢ª™ ¢Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜

∂ÈÛ·ÁˆÁ‹∏ ¤Ú¢ӷ Û¯ÂÙÈο Ì ÙËÓ Â›‰Ú·ÛË Ù˘ ‰È·ÙÚÔ-

Ê‹˜ ÛÙËÓ ˘Á›· ‰ÂÓ Â›Ó·È ÚfiÛÊ·ÙË. §fiÁˆ ÙÔ˘ ÙÚfi-Ô˘ ˙ˆ‹˜ ÛÙȘ Û‡Á¯ÚÔÓ˜ ‚ÈÔÌ˯·ÓÈΤ˜ ÎÔÈӈӛ˜,Ë ÌÂϤÙË ÙˆÓ ‰È·ÙÚÔÊÈÎÒÓ Û˘ÓËıÂÈÒÓ Î·È ÙˆÓ Û˘-ÓÂÂÈÒÓ ÙÔ˘˜ ÛÙË Ê˘ÛÈ΋ ηٿÛÙ·ÛË ÙÔ˘ ÔÚÁ·ÓÈ-ÛÌÔ‡, ¯·›ÚÂÈ Â˘Ú›·˜ ·Ô‰Ô¯‹˜ (1).

øÛÙfiÛÔ, ÌfiÏȘ Ù· ÙÂÏÂ˘Ù·›· ÙÚÈ¿ÓÙ· ¯ÚfiÓÈ·, Ë·ÁÎfiÛÌÈ· ÂÈÛÙËÌÔÓÈ΋ ÎÔÈÓfiÙËÙ· ¤ÛÙÚ„ ÙÔÂӉȷʤÚÔÓ Ù˘ ÛÙË ÌÂϤÙË ÙˆÓ ÂȉڿÛÂˆÓ Ù˘‰È·ÙÚÔÊ‹˜ ÛÙÔ ÎÂÓÙÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ· (∫¡™).ŒÌÊ·ÛË ¤¯ÂÈ ‰Ôı› ÛÙËÓ ·ÚÓËÙÈ΋ ›‰Ú·ÛË Ù˘η΋˜ ‰È·ÙÚÔÊ‹˜ ÛÙÔÓ ÁÓˆÛÙÈÎfi ÙÔ̤· Î·È ÙË Û˘-ÌÂÚÈÊÔÚ¿, ÂÓÒ ÏÈÁfiÙÂÚÔ ¤¯Ô˘Ó ÌÂÏÂÙËı› Ô Û˘-Ó·ÈÛıËÌ·ÙÈÎfi˜ Î·È ÎÈÓËÙÈÎfi˜ ÙÔ̤·˜ ·Ó¿Ù˘Í˘(2). ™ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ, ¤¯ÂÈ ÌÂÏÂÙË-ı› Ë Â›‰Ú·ÛË Ù˘ ‰È·ÙÚÔÊ‹˜ ÛÙË ÁÓˆÛÙÈ΋ Èη-ÓfiÙËÙ· ¢·ıÒÓ ÔÌ¿‰ˆÓ ‹ ¤¯ÂÈ ‰ÈÂÚ¢ÓËı› ÔÙÚfiÔ˜ Ô˘ Ë ‰È·ÙÚÔÊ‹ ÙˆÓ ‚ÚÂÊÒÓ ÂËÚ¿˙ÂÈ ÙËÌÂÙ¤ÂÈÙ· ÂͤÏÈÍ‹ ÙÔ˘˜ (3-5). ™Â ¿ÏϘ ÂÚÈÙÒ-ÛÂȘ, ÂȯÂÈÚ‹ıËÎÂ Ë Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ηٷӿψ-Û˘ ÚˆÈÓÔ‡ Á‡̷ÙÔ˜ Î·È Û¯ÔÏÈÎÒÓ ‚·ıÌÒÓ(6,7). ∞’ fiÛÔ Â›Ó·È ÁÓˆÛÙfi, ‰ÂÓ ¤¯Ô˘Ó Á›ÓÂÈ ¤Ú¢-Ó˜ Ô˘ Ó· Û˘Û¯ÂÙ›˙Ô˘Ó Û˘ÁÎÂÎÚÈ̤ӷ ‰È·ÙÚÔÊÈοÛÙÔȯ›· ÌÂ Û˘ÁÎÂÎÚÈ̤Ó˜ ÂȉfiÛÂȘ ÛÙÔÓ ÁÓˆ-ÛÙÈÎfi ÙÔ̤· ηٿ ÙË Û¯ÔÏÈ΋ ËÏÈΛ·. ø˜ η΋ ‰È·-ÙÚÔÊ‹ ÔÚ›˙ÂÙ·È Ë Î·ÙÒÙÂÚË ÙÔ˘ ÚÔ‚ÏÂfiÌÂÓÔ˘ËÌÂÚ‹ÛÈÔ˘ ÔÚ›Ô˘ ÚfiÛÏË„Ë ÂÓ¤ÚÁÂÈ·˜ Î·È ıÚÂÙÈ-ÎÒÓ Û˘ÛÙ·ÙÈÎÒÓ (.¯. ‚ÈÙ·ÌÈÓÒÓ, ÌÂÙ¿ÏψÓ), Ô˘ÌÔÚ› Ó· Ï¿‚ÂÈ ¯ÒÚ· ›Ù ηٿ ÙËÓ ÚÔÁÂÓÓËÙÈ΋ÂÚ›Ô‰Ô, ÂËÚ¿˙ÔÓÙ·˜ ÙÔÓ ·Ó·Ù˘ÛÛfiÌÂÓÔ ÂÁΤ-Ê·ÏÔ, ›Ù ηٿ ÙË ÌÂÙ·ÁÂÓÓËÙÈ΋ ÂÚ›Ô‰Ô (8,9). ∏

η΋ ‰È·ÙÚÔÊ‹ Û˘Ó›ÛÙ·Ù·È ÙfiÛÔ ÛÙËÓ ÂÏÏÈ‹ Ô-ÛfiÙËÙ· fiÛÔ Î·È ÛÙËÓ Î·Î‹ ÔÈfiÙËÙ· ÙÚÔÊ‹˜. ªÔ-Ú›, ÏÔÈfiÓ, Ó· ÔÊ›ÏÂÙ·È ÛÙËÓ ¤ÏÏÂÈ„Ë ÙÚÔÊ‹˜ Ïfi-Áˆ ¤Ó‰ÂÈ·˜, Û ·Ûı¤ÓÂȘ ‹ Û ‰È¿ÊÔÚÔ˘˜ ÎÔÈÓˆ-ÓÈÎÔÔÈÎÔÓÔÌÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜, fiˆ˜ ÙÔ ÌÔÚʈÙÈ-Îfi Â›Â‰Ô ÙˆÓ ÁÔÓ¤ˆÓ ‹ Ë ··Û¯fiÏËÛË Ù˘ ÌË-Ù¤Ú·˜ (8).

O ·ÎÚÈ‚‹˜ Ì˯·ÓÈÛÌfi˜ Ù˘ ›‰Ú·Û˘ Ù˘ ‰È·-ÙÚÔÊ‹˜ ÛÙË ÁÓˆÛÙÈ΋ ÈηÓfiÙËÙ· ‰ÂÓ Â›Ó·È ÁÓˆÛÙfi˜Î·È Â›Ó·È ‰‡ÛÎÔÏÔ Ó· ÌÂÏÂÙËı›. À¿Ú¯ÂÈ, ˆÛÙfiÛÔ,·ÚÎÂÙ‹ ÁÓÒÛË ÒÛÙ ӷ ˘ÔÛÙËÚȯı› ·ÚÎÒ˜ Ì›·Ù¤ÙÔÈ· ıˆڛ·. ∏ η΋ ‰È·ÙÚÔÊ‹ ÌÔÚ› Ó· ÂȉڿÛÙÔ ∫¡™ ›Ù ¤ÌÌÂÛ·, ÚÔηÏÒÓÙ·˜ ·‰˘Ó·Ì›· ηÈÌÂȈ̤ÓË ‰È¿ıÂÛË ÁÈ· ÂÍÂÚ‡ÓËÛË ÙÔ˘ ÂÚÈ‚¿ÏÏÔ-ÓÙÔ˜ ηÈ, ÂÔ̤ӈ˜, ı¤ÙÔÓÙ·˜ ÂÚÈÔÚÈÛÌÔ‡˜ ÛÙÔÓÁÓˆÛÙÈÎfi, ÎÈÓËÙÈÎfi Î·È Û˘Ó·ÈÛıËÌ·ÙÈÎfi ÙÔ̤· Ù˘·Ó¿Ù˘Í˘ (8,10), ›Ù ¿ÌÂÛ·, ‰È·Ù·Ú¿ÛÛÔÓÙ·˜ ÙËÓ¢ÚÔ¯ËÌÈ΋ ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Î·È ÂËÚÂ-¿˙ÔÓÙ·˜ ÙË Û‡ÓıÂÛË Î·È ‰Ú¿ÛË ÙˆÓ Ó¢Úԉȷ‚È‚·-ÛÙÒÓ, Ô˘ - ˆ˜ ÁÓˆÛÙfiÓ - ÂϤÁ¯Ô˘Ó ÙËÓ ÂΉ‹ÏˆÛËÙfiÛÔ ÙˆÓ Û˘Ó·ÈÛıËÌ·ÙÈÎÒÓ Î·È ÁÓˆÛÙÈÎÒÓ ·ÓÙȉڿ-ÛÂˆÓ fiÛÔ Î·È ·˘ÙÒÓ Ù˘ Û˘ÌÂÚÈÊÔÚ¿˜ (9).

OÈ ÂÚ¢ÓËÙ¤˜ Strupp Î·È Levitsky ηٷϋÁÔ˘ÓÛÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ ÔÈ ÁÓˆÛÙÈΤ˜ ‚Ï¿‚˜ Ô˘ ÚÔ-ηÏÔ‡ÓÙ·È ·fi ÙËÓ Î·Î‹ ‰È·ÙÚÔÊ‹ Â›Ó·È Ôχ ÏÂ-Ù¤˜, ‰È·ÌÂÛÔÏ·‚Ô‡ÓÙ·È ·fi ¤Ó·Ó Ó¢ÚÔ¯ËÌÈÎfi ÌË-¯·ÓÈÛÌfi Î·È Èı·Ó¿ ·ÊÔÚÔ‡Ó Û ÂÍÂȉÈÎÂ˘Ì¤Ó˜ ‰Â-ÍÈfiÙËÙ˜, fiˆ˜ ÛÙȘ ÂÎÙÂÏÂÛÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜ -ۯ‰ȷÛÌfi Û˘ÌÂÚÈÊÔÚ¿˜, ÛÙÔÓ ¤ÏÂÁ¯Ô ÚÔÛÔ¯‹˜,ÛÙËÓ ·Ó·ÛÙÔÏ‹ ·ÓÙȉڿÛÂˆÓ (ÚÔÌÂوȷ›Ô˜ ÊÏÔÈ-fi˜), ÛÙË Ì·ÎÚfi¯ÚÔÓË ÌÓ‹ÌË ÁÂÁÔÓfiÙˆÓ (Èfiη-ÌÔ˜), ÛÙËÓ ÔÚÁ¿ÓˆÛË ÙˆÓ ÎÈÓ‹ÛÂˆÓ Î·È ÛÙË ‰È·‰È-ηÛÙÈ΋ Ì¿ıËÛË, .¯. ηٿ ÙËÓ Âη›‰Â˘ÛË ÛÙËÁÚ·Ê‹ ‹ ÙËÓ ·Ó¿ÁÓˆÛË (·ÚÂÁÎÂÊ·Ï›‰·) (11).

∂ÈϤÔÓ, ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ Ô ˘ÔÛÈÙÈÛÌfi˜ ηٿÙË ‰È¿ÚÎÂÈ· Ù˘ ·ËÛ˘ ‹ ÙÔ˘ ıËÏ·ÛÌÔ‡ ÂËÚ¿˙ÂÈ·ÚÓËÙÈο Ù· ΛÓËÙÚ· Î·È ÙË Û˘Ó·ÈÛıËÌ·ÙÈ΋ ·ÓÙ›‰Ú·-ÛË Î·È ÚÔÛ·ÚÌÔÛÙÈÎfiÙËÙ·, ‰È·Ì¤ÛÔ˘ Ì›·˜ ÓÔÚ·-‰ÚÂÓÂÚÁÈ΋˜ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·˜. ∂ȯÂÈÚÔ‡Ó, ‰ËÏ·‰‹,¤Ó·Ó Û˘Û¯ÂÙÈÛÌfi Ì ÙÔÓ Ì˯·ÓÈÛÌfi ·Ó¿Ù˘Í˘ ÙˆÓÛ˘Ó·ÈÛıËÌ·ÙÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ Î·È ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ

ÙË ÛˆÌ·ÙÈ΋ ˘Á›·, ·ÏÏ¿ Î·È Ì ÙË ÁÓˆÛÙÈ΋ ÏÂÈ-ÙÔ˘ÚÁ›·. ∏ Û¯¤ÛË ·˘Ù‹ ¯Ú‹˙ÂÈ Û˘ÛÙËÌ·ÙÈ΋˜ ‰ÈÂ-Ú‡ÓËÛ˘. §fiÁˆ ÙˆÓ Èı·ÓÒÓ ·ÚÓËÙÈÎÒÓ Û˘ÓÂÂÈ-ÒÓ Ù˘ η΋˜ ‰È·ÙÚÔÊ‹˜ Î·È Ù˘ ÌÂȈ̤Ó˘ Ê˘ÛÈ-΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÛÙË ÁÂÓÈ΋ ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ·ÙˆÓ ·ÙfïÓ, ÎÚ›ÓÂÙ·È ··Ú·›ÙËÙË Ë ÂÊ·ÚÌÔÁ‹ ÚÔ-ÁÚ·ÌÌ¿ÙˆÓ ÚfiÏ˄˘ Î·È ·Ú¤Ì‚·Û˘ ·fi ÙËÛ¯ÔÏÈ΋ ËÏÈΛ·.

§¤ÍÂȘ ÎÏÂȉȿ: ‰È·ÙÚÔÊ‹, ÁÓˆÛÙÈ΋ ›‰ÔÛË, Ê˘ÛÈ-΋ ‰Ú·ÛÙËÚÈfiÙËÙ·, ‚Èٷ̛Ә, Û¯ÔÏÈ΋ ËÏÈΛ·.

Key words: nutrition, cognitive performance,physical activity, vitamins, school age.

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·179

Page 37: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

Ë Û¯¤ÛË ‰È·ÙÚÔÊ‹˜-Û˘Ó·ÈÛı‹Ì·ÙÔ˜ ¯Ú‹˙ÂÈ Û˘ÛÙË-Ì·ÙÈ΋˜ ‰ÈÂÚ‡ÓËÛ˘ (11,12).

¶ÂÈÚ¿Ì·Ù· Û ˙Ò·, ·ÏÏ¿ Î·È ÌÂϤÙ˜ ÌÂ Û˘-ÌÏËÚÒÌ·Ù· ‰È·ÙÚÔÊ‹˜ Û ·ÓıÚÒÔ˘˜, ‰ÈÂÚ¢-ÓÔ‡Ó Ù˘¯fiÓ Ê˘ÛÈÔÏÔÁÈΤ˜, Û˘ÌÂÚÈÊÔÚÈΤ˜ ηÈÁÓˆÛÙÈΤ˜ ‰È·Ù·Ú·¯¤˜. ∞ӷʤÚÂÙ·È fiÙÈ Ë ÛȉËÚÔ-ÂÓÈ΋ ·Ó·ÈÌ›· Û ‚Ú¤ÊË ÚÔηÏ› ηı˘ÛÙ¤ÚËÛËÛÙËÓ ÎÈÓËÙÈ΋ Î·È ÓÔËÙÈ΋ ·Ó¿Ù˘ÍË (13) ‹ ÌÂȈ̤-ÓË Â›‰ÔÛË ÛÙËÓ ·ÚÈıÌËÙÈ΋ Î·È ·Ó¿ÁÓˆÛË ÛÙËÓËÏÈΛ· ÙˆÓ 12 ÂÙÒÓ (14). ™Â ¤Ú¢ӷ Ô˘ ÂͤٷÛ ·ÓË Ï‹„Ë Û˘ÌÏËÚˆÌ¿ÙˆÓ ÌÈÎÚÔıÚÂÙÈÎÒÓ Ô˘ÛÈÒÓÂËÚ¿˙ÂÈ ÙË ÓÔËÌÔÛ‡ÓË ÂÊ‹‚ˆÓ, ·Ú·ÙËÚ‹ıËÎÂÛËÌ·ÓÙÈ΋ ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÙˆÓ ÂȤ‰ˆÓÙÔ˘ ·ÛÎÔÚ‚ÈÎÔ‡ ÔͤԘ Î·È ÙÔ˘ ·Ú¯ÈÎÔ‡ ‰Â›ÎÙË ÌËÏÂÎÙÈ΋˜ ÓÔËÌÔÛ‡Ó˘ Û ·ÁfiÚÈ·. ¢ÂÓ ÂȂ‚·ÈÒıË-ÎÂ, fï˜, Ë ˘fiıÂÛË fiÙÈ Ë Ï‹„Ë Û˘ÌÏËڈ̿وÓÔ‰ËÁ› Û ·‡ÍËÛË ÙÔ˘ ‰Â›ÎÙË ÓÔËÌÔÛ‡Ó˘ (15).øÛÙfiÛÔ, Ì›· ÚfiÛÊ·ÙË ·Ó·ÛÎfiËÛË Ù˘ ‚È‚ÏÈÔ-ÁÚ·Ê›·˜ η٤‰ÂÈÍ ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ Ù˘ϋ„˘ Û˘ÌÏËÚˆÌ¿ÙˆÓ ÌÈÎÚÔıÚÂÙÈÎÒÓ Ô˘ÛÈÒÓÎ·È Ù˘ ÌË ÏÂÎÙÈ΋˜ ÓÔËÌÔÛ‡Ó˘, ÂȉÈο Û ·È‰È¿ÙˆÓ ÔÔ›ˆÓ Ë ‰È·ÙÚÔÊ‹ ‹Ù·Ó ÊÙˆ¯‹ Û ÌÈÎÚÔıÚÂ-ÙÈΤ˜ Ô˘Û›Â˜ (16). ŒÚ¢ӷ Ô˘ Ú·ÁÌ·ÙÔÔÈ‹ıË-Π۠ÚfiˆÚ· ‚Ú¤ÊË ¤‰ÂÈÍ fiÙÈ Ù· ··Ú·›ÙËÙ· ÏÈ-·Ú¿ Ôͤ· Ô˘ ‰ÂÓ ÌÔÚ› Ó· Û˘Óı¤ÛÂÈ Ô ·ÓıÚÒÈ-ÓÔ˜ ÔÚÁ·ÓÈÛÌfi˜, Â›Ó·È ‚·ÛÈο ‰ÔÌÈο Û˘ÛÙ·ÙÈÎ¿ÙˆÓ ÂÁÎÂÊ·ÏÈÎÒÓ Î˘ÙÙ¿ÚˆÓ Î·È Ë ¤ÏÏÂÈ„‹ ÙÔ˘˜ÂËÚ¿˙ÂÈ ·ÚÓËÙÈο ÙËÓ ÔÙÈ΋ ÏÂÈÙÔ˘ÚÁ›· (13). °Â-ÓÈο, ‰È·ÈÛÙÒıËΠfiÙÈ Ë Î·Î‹ ‰È·ÙÚÔÊ‹ ÚÔηÏ›·‰ÂÍÈfiÙËÙ·, ‰È¿Û·ÛË ÚÔÛÔ¯‹˜, ÊÙˆ¯¤˜ Û¯¤ÛÂȘÌ ÙÔ˘˜ Û˘ÓÔÌËÏ›ÎÔ˘˜ Î·È ¯·ÌËϤ˜ ÂȉfiÛÂȘ ÛÙÔÛ¯ÔÏÂ›Ô (10).

OÈ ·ÚÓËÙÈΤ˜ Û˘Ó¤ÂȘ Ù˘ η΋˜ ‰È·ÙÚÔÊ‹˜ÌÂÙÚÈ¿˙ÔÓÙ·È Ì ηٿÏÏËÏË ÂÚÈ‚·ÏÏÔÓÙÈ΋ ·Ú¤Ì-‚·ÛË (2).

∏ ·ÚÔ‡Û· ¤Ú¢ӷ ÌÂÏÂÙ¿ ÙȘ ‰È·ÙÚÔÊÈΤ˜ Û˘-Ó‹ıÂȘ Î·È ÙË Û¯ÔÏÈ΋ ›‰ÔÛË Ì·ıËÙÒÓ Ì ÛÎÔ-fi ÙËÓ ·Ó›¯Ó¢ÛË ·ÚÓËÙÈÎÒÓ ÂȉڿÛÂˆÓ Î·È ÙÔÓÂÓÙÔÈÛÌfi ·Ó·ÁÎÒÓ ÁÈ· ÔÚÁ¿ÓˆÛË Î·Ù¿ÏÏËψÓÚÔÁÚ·ÌÌ¿ÙˆÓ Âη›‰Â˘Û˘ ÁÈ· ÙË ÛˆÛÙ‹ ‰È·-ÙÚÔÊ‹.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ∏ ¤Ú¢ӷ ‰ÈÂÍ‹¯ıË Û ۯÔÏ›· Ù˘ ∫Ú‹Ù˘, ηٿ Ù· ¤ÙË

1999-2000, ÛÙÔ Ï·›ÛÈÔ ÙÔ˘ ¶ÚÔÁÚ¿ÌÌ·ÙÔ˜ ∂Î·È‰Â˘ÙÈ΋˜¶·Ú¤Ì‚·Û˘ “∞ÁˆÁ‹ ÀÁ›·˜”, ÙÔ ÔÔ›Ô ÔÚÁ·ÓÒıËΠ·fi ÙËÓ∫ÏÈÓÈ΋ ¶ÚÔÏËÙÈ΋˜ π·ÙÚÈ΋˜ Î·È ¢È·ÙÚÔÊ‹˜ ÙÔ˘ ¶·ÓÂÈ-ÛÙËÌ›Ô˘ ∫Ú‹Ù˘ (17). ∞fi ÙÔ ·Ú¯ÈÎfi ‰Â›ÁÌ· ÙˆÓ 583 Ì·ıË-ÙÒÓ ËÏÈΛ·˜ 9-12 ÂÙÒÓ, Û˘ÁÎÂÓÙÚÒıËÎ·Ó Ï‹ÚË ÛÙÔȯ›· ÁÈ·166 Ì·ıËÙ¤˜. ŸÏÔÈ ÊÔÈÙÔ‡Û·Ó ÛÙËÓ ∂’ ¢ËÌÔÙÈÎÔ‡, ‹Ù·Ó ËÏÈ-Λ·˜ 11-12 ÂÙÒÓ Î·È ÚÔ¤Ú¯ÔÓÙ·Ó ·fi ¤ÍÈ Û¯ÔÏ›· ·ÛÙÈÎÒÓ,ËÌÈ·ÛÙÈÎÒÓ Î·È ·ÁÚÔÙÈÎÒÓ ÂÚÈÔ¯ÒÓ ÙÔ˘ ∏Ú·ÎÏ›Ԣ, ÙÔ˘ ƒÂ-ı‡ÌÓÔ˘ Î·È ÙÔ˘ ∞Á›Ô˘ ¡ÈÎÔÏ¿Ô˘. OÈ ÂÍÂÙ¿ÛÂȘ Ô˘ Ú·ÁÌ·-

ÙÔÔÈ‹ıËÎ·Ó ·ÊÔÚÔ‡Û·Ó ÛÙË Ï‹„Ë ÈÛÙÔÚÈÎÔ‡ ‰È·ÈÙÔÏÔÁ›Ô˘ÙÔ˘ ÚÔËÁÔ‡ÌÂÓÔ˘ 24ÒÚÔ˘, Û ۈ̷ÙÔÌÂÙÚÈΤ˜ ÌÂÙÚ‹ÛÂȘ,ÛÙË Ì¤ÙÚËÛË ‚ÈÔ¯ËÌÈÎÒÓ Î·È ·ÈÌ·ÙÔÏÔÁÈÎÒÓ ‰ÂÈÎÙÒÓ, ÛÙËÓ·ÍÈÔÏfiÁËÛË Ù˘ Ê˘ÛÈ΋˜ ηٿÛÙ·Û˘ Ì ·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈ-ÌÔ ·ÓÙÔ¯‹˜ (¶∆∞) Î·È Û ÂÎÙ›ÌËÛË Ù˘ Ì·ıËÛȷ΋˜ ›‰ÔÛ˘.OÈ ÁÔÓ›˜ ÙˆÓ ·È‰ÈÒÓ ÂÓËÌÂÚÒıËÎ·Ó ÁÚ·ÙÒ˜ ÁÈ· ÙȘ ÂÍÂÙ¿-ÛÂȘ Î·È ˘¤ÁÚ·„·Ó ˘Â‡ı˘ÓË ‰‹ÏˆÛË ÁÈ· ÙË Û˘ÌÌÂÙÔ¯‹ ‹ÌË ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜.

∏ Û˘ÏÏÔÁ‹ ÙˆÓ ÛÙÔȯ›ˆÓ ÁÈ· ÙË ‰È·ÙÚÔÊ‹ ÙˆÓ Ì·ıËÙÒÓ¤ÁÈÓ Ì ÙË Ì¤ıÔ‰Ô Ù˘ ηٷÁÚ·Ê‹˜ ‰È·ÈÙÔÏÔÁ›Ô˘ ÙÔ˘ ÚÔË-ÁÔ‡ÌÂÓÔ˘ 24ÒÚÔ˘ Î·È ·ÊÔÚÔ‡Û ÛÙËÓ Ï‹ÚË Î·È ·Ó·Ï˘ÙÈ΋ηٷÁÚ·Ê‹ ·fi ‰È·ÈÙÔÏfiÁÔ - ̤ۈ ÚÔÛˆÈ΋˜ Û˘Ó¤ÓÙ¢-͢ - ÙˆÓ ÙÚÔÊ›ÌˆÓ Î·È ÙˆÓ ÔÛÔÙ‹ÙˆÓ Ô˘ ηٷӿψ۷ÓÙÔ ÚÔËÁÔ‡ÌÂÓÔ 24ˆÚÔ (17,18). ™ÙË Û˘Ó¤¯ÂÈ·, Ù· ÙÚfiÊÈÌ·‰È·¯ˆÚ›ÛÙËÎ·Ó Û ‚·ÛÈΤ˜ ÔÌ¿‰Â˜, fiˆ˜ Á·Ï·ÎÙÔÎÔÌÈοÚÔ˚fiÓÙ·, ÎÚ¤·˜-·˘Á¿, „¿ÚÈ·, fiÛÚÈ·, ‰ËÌËÙÚȷο, Ï·¯·ÓÈ-ο, ÊÚÔ‡Ù·, ·Ó·„˘ÎÙÈο Î·È Ù˘ÔÔÈË̤ӷ ÚÔ˚fiÓÙ·(snacks). ∏ ·Ó¿Ï˘ÛË ÙÔ˘ ‰È·ÈÙÔÏÔÁ›Ô˘ ¤ÁÈÓ ·fi ËÏÂÎÙÚÔÓÈ-΋ ‚¿ÛË ‰Â‰ÔÌ¤ÓˆÓ ÙÚÔʛ̈Ó, ‚·ÛÈṲ̂ÓË ÙfiÛÔ ÛÙË ‚¿ÛËÙÔ˘ ÀÔ˘ÚÁ›Ԣ °ÂˆÚÁ›·˜ ÙˆÓ ∏ÓˆÌ¤ÓˆÓ ¶ÔÏÈÙÂÈÒÓ (UnitedStates Department of Agriculture - USDA) fiÛÔ Î·È ÛÙË ¯ËÌÈ-΋ ·Ó¿Ï˘ÛË 120 ÂÏÏËÓÈÎÒÓ ÙÚÔÊ›ÌˆÓ Ô˘ ¤ÁÈÓ ÛÙÔ TNONutrition Institute ÛÙËÓ OÏÏ·Ó‰›· ÛÙÔ Ï·›ÛÈÔ ÙÔ˘ Â˘Úˆ·˚-ÎÔ‡ ÚÔÁÚ¿ÌÌ·ÙÔ˜ Transfair, ÂÓÒ 20 ÙÚfiÊÈÌ· ·Ó·Ï‡ıËηӯËÌÈο ÛÙÔ Wegeningen Agricultural University (17,18). ∞fiÙË ‚¿ÛË ‰Â‰ÔÌ¤ÓˆÓ ÙÚÔʛ̈Ó, ÂÎÙÈÌ‹ıËÎÂ Ë ËÌÂÚ‹ÛÈ· Úfi-ÛÏË„Ë ÂÓ¤ÚÁÂÈ·˜, ÙˆÓ ‚ÈÙ·ÌÈÓÒÓ A, C, E, B1, µ2, B6, B12 ηÈÙ˘ ÓÈ·Û›Ó˘. ∆Ô ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜ ÌÂÙÚ‹ıËΠ̠ËÏÂÎÙÚÔÓÈÎfi˙˘Áfi Ù‡Ô˘ Seca Alpha ·ÎÚȂ›·˜ ±100 g Î·È Ë ˙‡ÁÈÛË ¤ÁÈÓÂÌfiÓÔ Ì ÂÛÒÚÔ˘¯·, ¯ˆÚ›˜ ·Ô‡ÙÛÈ·. ∆Ô ‡„Ô˜ ÌÂÙÚ‹ıËÎÂÌ ·Ó·ÛÙËÌfiÌÂÙÚÔ ·ÎÚȂ›·˜ <0,5 cm, Û fiÚıÈ· ı¤ÛË, ¯ˆ-Ú›˜ ·Ô‡ÙÛÈ·, Ì ¯·Ï·ÚÔ‡˜ ÒÌÔ˘˜ Î·È Ù· ¯¤ÚÈ· ÙÔÔıÂÙË-̤ӷ ÛÙÔ Ï¿È. O ‰Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ (¢ª™) ˘ÔÏÔÁ›-ÛÙËΠ·fi ÙË Û¯¤ÛË ‚¿ÚÔ˘˜ Û ÎÈÏ¿ ÚÔ˜ ÙÔ ‡„Ô˜ Û ̤ÙÚ·ÛÙÔ ÙÂÙÚ¿ÁˆÓÔ (kg/m2). ∏ ÂÚ›ÌÂÙÚÔ˜ ̤Û˘ ÌÂÙÚ‹ıËΠÌÂÏ·ÛÙÈ΋ ÌÂÙÚÈ΋ Ù·ÈÓ›· ÛÙÔ ‡„Ô˜ ÙÔ˘ ÔÌÊ·ÏÔ‡ Î·È Î¿ÙˆıÂÓÙÔ˘ Ï¢ÚÈÎÔ‡ ÙfiÍÔ˘ (ÛÙÔ Ì¤ÛÔ Ù˘ ·fiÛÙ·Û˘ ÌÂٷ͇Ï¢ÚÈÎÔ‡ ÙfiÍÔ˘ Î·È Ï·ÁÔÓ›Ô˘ ·ÎÚÔÏÔÊ›·˜) Î·È Ë ÂÚ›ÌÂ-ÙÚÔ˜ ÏÂοÓ˘ ÛÙÔ ‡„Ô˜ ÙˆÓ Î·Ù’ ÈÛ¯›ˆÓ ·ÚıÚÒÛÂˆÓ Î·È¿ÓˆıÂÓ ÙÔ˘ ÂÊË‚·›Ô˘ (18).

∆· ·È‰È¿ ˘Ô‚Ï‹ıËηÓ, ›Û˘, Û ‚ÈÔ¯ËÌÈΤ˜ Î·È ·ÈÌ·-ÙÔÏÔÁÈΤ˜ ÂÍÂÙ¿ÛÂȘ. ¢Â›ÁÌ·Ù· ·›Ì·ÙÔ˜ ÂÏ‹ÊıËÛ·Ó ÙȘ Úˆ-ÈÓ¤˜ ÒÚ˜ ÌÂÙ¿ ·fi 12ˆÚË ÓËÛÙ›· Î·È ÌÂÙÚ‹ıËÎ·Ó Ë ÔÏÈ΋¯ÔÏËÛÙÂÚfiÏË (TC), Ù· ÙÚÈÁÏ˘ÎÂÚ›‰È· (Trigl), Ë HDL-¯ÔÏËÛÙÂ-ÚfiÏË, Ë LDL-¯ÔÏËÛÙÂÚfiÏË (˘ÔÏÔÁ›ÛÙËΠ·fi ÙÔÓ Ù‡Ô LDL= TC - (Trigl/5+HDL), Ô ·ıËڈ̷ÙÈÎfi˜ ‰Â›ÎÙ˘ (˘ÔÏÔÁ›ÛÙË-Π·fi ÙÔ ËÏ›ÎÔ Ù˘ ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ ÚÔ˜ HDL-¯ÔÏË-ÛÙÂÚfiÏË), Ë ·ÈÌÔÛÊ·ÈÚ›ÓË, Ô ·ÈÌ·ÙÔÎÚ›Ù˘ Î·È Ô Ì¤ÛÔ˜ fiÁÎÔ˜ÂÚ˘ıÚÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ (17,18).

∏ ÂÎÙ›ÌËÛË Ù˘ Ê˘ÛÈ΋˜ ηٿÛÙ·Û˘ ÙˆÓ ·È‰ÈÒÓ ¤ÁÈÓÂÌ ÙÔ ·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜ (endurance shuttle runtest) (18,19).

∞fi Ù· 583 ·È‰È¿ ËÏÈΛ·˜ 9-12 ÂÙÒÓ Ô˘ ·ÔÙÂÏÔ‡Û·ÓÙÔ ·Ú¯ÈÎfi ‰Â›ÁÌ· (17), ÂÈϤ¯ıËÎ·Ó fiÛ· ÊÔÈÙÔ‡Û·Ó ÛÙËÓ ∂’

180

¶·È‰È·ÙÚÈ΋ 2004;67:178-189 Paediatriki 2004;67:178-189

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·180

Page 38: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

181

¶·È‰È·ÙÚÈ΋ 2004;67:178-189 Paediatriki 2004;67:178-189

¢ËÌÔÙÈÎÔ‡, ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂÎÙÈÌËıÔ‡Ó ÔÈ Û¯ÔÏÈΤ˜ ÈηÓfiÙË-Ù¤˜ ÙÔ˘˜ Ì ÂȉÈÎfi ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Ô˘ Û˘ÌÏËÚˆÓfiÙ·Ó·fi ÙÔÓ ÂÎ·È‰Â˘ÙÈÎfi. OÈ Ì·ıËÙ¤˜ ÙˆÓ ÌÈÎÚfiÙÂÚˆÓ Ù¿ÍˆӷÔÎÏ›ÛÙËÎ·Ó ·fi ·˘Ù‹ ÙËÓ ÂÎÙ›ÌËÛË, ÁÈ·Ù› ÎÚ›ıËΠfiÙÈ ÔÈÈηÓfiÙËÙ˜ Ô˘ ÂÚÈÁÚ¿ÊÔÓÙ·Ó ÛÙÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ÌÔ-ÚÔ‡Ó Ó· ÌÂÏÂÙËıÔ‡Ó Â˘ÎÔÏfiÙÂÚ· ÛÙ· ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿.∫·ıÒ˜ Ù· ·È‰È¿ Ù˘ ∂’ ¢ËÌÔÙÈÎÔ‡ ‹Ù·Ó ÂÚÈÛÛfiÙÂÚ· ·fi Ù··È‰È¿ Ù˘ ™Ù’ ¢ËÌÔÙÈÎÔ‡, ıˆڋıËΠfiÙÈ ı· ·ÔÙÂÏÔ‡Û·ÓÈÔ ·ÓÙÈÚÔÛˆÂ˘ÙÈÎfi ‰Â›ÁÌ·.

°È· ÙËÓ ÂÎÙ›ÌËÛË Ù˘ Ì·ıËÛȷ΋˜ ›‰ÔÛ˘, ¯ÔÚËÁ‹ıËÎÂÛÙÔ˘˜ ÂÎ·È‰Â˘ÙÈÎÔ‡˜ ÂȉÈ΋ Îϛ̷η, fiˆ˜ ÚÔÙ›ÓÂÙ·È ·fiÙË J. Lerner (20). ¶ÚfiÎÂÈÙ·È ÁÈ· ÌË ÛÙ·ıÌÈṲ̂ÓÔ ÛÙ· ÂÏÏËÓÈ-ο ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ, ÙÔ ÔÔ›Ô fï˜ ¤¯ÂÈ ÙÚÔÔÔÈËı› ηȤ¯ÂÈ ¯ÚËÛÈÌÔÔÈËı› Ì ÂÈÙ˘¯›· Û ÚÔËÁÔ‡ÌÂÓ˜ ¤Ú¢Ó˜(21). ∏ Îϛ̷η ·˘Ù‹ ÂÎÙÈÌ¿ ‰È¿ÊÔÚ˜ ·Ú·Ì¤ÙÚÔ˘˜ Ù˘ Ì¿-ıËÛ˘ Î·È Û˘ÁÎÂÎÚÈ̤ӷ ÙËÓ ·ÎÔ˘ÛÙÈ΋ ·ÓÙ›ÏË„Ë, ÙÔÓ ÚÔ-ÊÔÚÈÎfi ÏfiÁÔ, ÙÔÓ ÚÔÛ·Ó·ÙÔÏÈÛÌfi, ÙË Û˘ÌÂÚÈÊÔÚ¿, ÙËÓ ÎÈ-ÓËÙÈ΋ ÈηÓfiÙËÙ·, ÙË ÁψÛÛÈ΋ ›‰ÔÛË, Ù˘¯fiÓ ‰È¿Û·ÛËÚÔÛÔ¯‹˜, ÔÙÈÎÔÎÈÓËÙÈΤ˜ ‰È·Ù·Ú·¯¤˜, ‰˘ÛÎÔϛ˜ ÛÙËÓ·ÎÔ˘ÛÙÈ΋ ÂÂÍÂÚÁ·Û›· Î·È ·‰˘Ó·Ì›Â˜ ÌÓ‹Ì˘. ∞ÔÙÂÏ›ٷȷfi 50 ÂÚˆÙ‹ÛÂȘ Ô˘ ÂÚÈÁÚ¿ÊÔ˘Ó Î¿ÔȘ ÈηÓfiÙËÙ˜ ‹·‰˘Ó·Ì›Â˜ ÛÙÔ˘˜ ·Ú·¿Óˆ Ì·ıËÛÈ·ÎÔ‡˜ ÙÔÌ›˜ (‚Ï. ¶·-Ú¿ÚÙËÌ·). °È· ÙȘ ·Ó¿ÁΘ Ù˘ ¤Ú¢ӷ˜, ÔÈ ÂÚˆÙ‹ÛÂȘ ÔÌ·-‰ÔÔÈ‹ıËÎ·Ó Û ¤ÍÈ ÙÔÌ›˜ Ì·ıËÛȷ΋˜ ›‰ÔÛ˘: 1) ÁÏÒÛ-Û·, 2) ÌÓ‹ÌË, 3) ÚÔÛÔ¯‹, 4) ÔÙÈÎÔÎÈÓËÙÈ΋ ··ÚÙ›ˆÛË, 5)ÎÈÓËÙÈ΋ ÈηÓfiÙËÙ· Î·È 6) Û˘ÌÂÚÈÊÔÚ¿.

ªÂÙ¿ ·fi Ì›· ÂÓË̤ڈÛË ÙˆÓ ÂÎ·È‰Â˘ÙÈÎÒÓ ·fi ¤ÌÂÈ-ÚÔ „˘¯ÔÏfiÁÔ, ÙÔ˘˜ ˙ËÙ‹ıËΠӷ ·Ú·ÙËÚ‹ÛÔ˘Ó Î·È Ó· ·ÍÈÔ-ÏÔÁ‹ÛÔ˘Ó ÙÔ˘˜ Ì·ıËÙ¤˜ ÙÔ˘˜ ÛÙÔ˘˜ Û˘ÁÎÂÎÚÈ̤ÓÔ˘˜ ÙÔÌ›˜,Û ̛· Îϛ̷η ·fi 0-3, fiÔ˘ ÙÔ 0 ·ÓÙÈÚÔۈ‡ÂÈ ÙËÓ ¿ÚÈ-ÛÙË Â›‰ÔÛË, ÂÓÒ ÙÔ 3 ‰ËÏÒÓÂÈ ÙËÓ ‡·ÚÍË ¤ÓÙÔÓˆÓ ÚÔ‚ÏË-Ì¿ÙˆÓ. ∞ÎfiÌË, ˙ËÙ‹ıËΠӷ ηٷÁÚ·ÊÔ‡Ó Î·È ÔÈ ‚·ıÌÔ› ÙˆÓÛ˘ÌÌÂÙ¯fiÓÙˆÓ ÛÙ· ª·ıËÌ·ÙÈο, ÙË °ÏÒÛÛ·, ÙËÓ πÛÙÔÚ›·, Ù˺˘ÛÈ΋ Î·È ÙËÓ ∞ÈÛıËÙÈ΋ ∞ÁˆÁ‹ Î·È ˘ÔÏÔÁ›ÛÙËÎÂ Ô Ì¤ÛÔ˜fiÚÔ˜ ÙÔ˘˜.

ŒÁÈÓÂ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ Ù˘ ηٷӿψÛ˘ ÙˆÓ ÙÚÔÊ›-̈Ó, ÙˆÓ ÂȤ‰ˆÓ ÙˆÓ ·ÈÌ·ÙÔÏÔÁÈÎÒÓ Î·È ‚ÈÔ¯ËÌÈÎÒÓ ·Ú·-ÁfiÓÙˆÓ Î·È ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ ÙˆÓ ÛˆÌ·ÙÔÌÂÙÚ‹ÛÂˆÓ Ì ÙȘ‚·ıÌÔÏÔÁ›Â˜ ÛÙÔ˘˜ ¤ÍÈ ÙÔÌ›˜ Ì·ıËÛȷ΋˜ ›‰ÔÛ˘, ·ÏÏ¿Î·È Ì ÙË Û˘ÓÔÏÈ΋ ‚·ıÌÔÏÔÁ›· ÛÙËÓ Îϛ̷η Ì·ıËÛȷ΋˜Â›‰ÔÛ˘. ∞ÎfiÌË, Û˘Û¯ÂÙ›ÛÙËÎ·Ó ÔÈ ‚·ıÌÔÏÔÁ›Â˜ ÛÙÔ˘˜ ÙÔ-Ì›˜ Ì·ıËÛȷ΋˜ ›‰ÔÛ˘, Ë Û˘ÓÔÏÈ΋ ‚·ıÌÔÏÔÁ›· Ù˘ ÎÏ›-̷η˜ Î·È Ô Ì¤ÛÔ˜ fiÚÔ˜ ÙˆÓ Û¯ÔÏÈÎÒÓ ‚·ıÌÒÓ Ì ٷ ‰È·-ÙÚÔÊÈο ÛÙÔȯ›·. ∞Ó·˙ËÙ‹ıËÎ·Ó Ù˘¯fiÓ ÂȉڿÛÂȘ ÙÔ˘ ʇ-ÏÔ˘, Ù˘ ËÏÈΛ·˜, ÙÔ˘ ‰Â›ÎÙË Ì¿˙·˜ ÛÒÌ·ÙÔ˜, Ù˘ ›‰ÔÛ˘ÛÙÔ ·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜, ÙˆÓ ıÂÚÌ›‰ˆÓ Î·È Ù˘TC/HDL. ∆¤ÏÔ˜, ÂÓÙÔ›ÛÙËÎ·Ó ÔÈ ‰‡Ô ÔÚȷΤ˜ ÔÌ¿‰Â˜ ÙÔ˘‰Â›ÁÌ·ÙÔ˜, ‰ËÏ·‰‹ ÔÈ Ì·ıËÙ¤˜ Ì Ôχ ˘„ËÏ‹ ›‰ÔÛË ÛÙËÓÎϛ̷η (>75%) Î·È ÔÈ Ì·ıËÙ¤˜ Ì Ôχ ¯·ÌËÏ‹ ›‰ÔÛË(<25%), ÂÓÒ ¤ÁÈÓ ۇÁÎÚÈÛË ÙˆÓ ÛˆÌ·ÙÔÌÂÙÚÈÎÒÓ ÌÂÁÂıÒÓÙÔ˘˜, ÙˆÓ ·ÈÌ·ÙÔÏÔÁÈÎÒÓ Î·È ‚ÈÔ¯ËÌÈÎÒÓ ‰ÂÈÎÙÒÓ, ÙˆÓ ‰È·ÈÙË-ÙÈÎÒÓ ÛÙÔȯ›ˆÓ Î·È ÙÔ˘ ‰Â›ÎÙË Ê˘ÛÈ΋˜ ηٿÛÙ·Û˘.

∏ ·Ó¿Ï˘ÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ¤ÁÈÓ Ì ÙÔ ÛÙ·ÙÈÛÙÈÎfiÚfiÁÚ·ÌÌ· STATISTICA. OÈ Û˘Û¯ÂÙ›ÛÂȘ ÂϤÁ¯ıËÎ·Ó ÌÂ

Pearson correlation test (partial correlation coefficient) ηÈÌ ÙȘ ÌÂıfi‰Ô˘˜ Ù˘ ÁÚ·ÌÌÈ΋˜ ·Ó¿Ï˘Û˘ ·ÏÈÓ‰ÚfiÌËÛË˜Î·È Ù˘ ·Ó¿Ï˘Û˘ Û˘Ó‰È·Î‡Ì·ÓÛ˘, ÂϤÁ¯ÔÓÙ·˜ ÁÈ· Ù˘¯fiÓÂȉڿÛÂȘ ÙÔ˘ ʇÏÔ˘, Ù˘ ËÏÈΛ·˜ Î·È ÙÔ˘ ‰Â›ÎÙË Ì¿˙·˜ÛÒÌ·ÙÔ˜.

∞ÔÙÂϤÛÌ·Ù· ™ÙËÓ ¤Ú¢ӷ Û˘ÌÌÂÙ›¯·Ó 166 Ì·ıËÙ¤˜ Ù˘ ∂’

¢ËÌÔÙÈÎÔ‡, ËÏÈΛ·˜ 11-12 ÂÙÒÓ, Ô˘ ÊÔÈÙÔ‡Û·Ó Û¤ÍÈ Û¯ÔÏ›· Ù˘ ¢ڇÙÂÚ˘ ÂÚÈÔ¯‹˜ ÙÔ˘ ∏Ú·ÎÏ›-Ô˘, ÙÔ˘ ƒÂı‡ÌÓÔ˘ Î·È ÙÔ˘ ∞Á›Ô˘ ¡ÈÎÔÏ¿Ô˘. ∞fi ·˘-ÙÔ‡˜, ÔÈ 92 ‹Ù·Ó ·ÁfiÚÈ· Î·È ÔÈ 74 ‹Ù·Ó ÎÔÚ›ÙÛÈ· (¶›-ӷΘ 1 Î·È 2).

OÈ ·Ó·Ï‡ÛÂȘ ¤‰ÂÈÍ·Ó fiÙÈ ˘¿Ú¯ÂÈ Û˘Û¯¤ÙÈÛË ÌÂ-ٷ͇ Ù˘ ηٷӿψÛ˘ Á·Ï·ÎÙÔÎÔÌÈÎÒÓ ÚÔ˚fiÓÙˆÓÎ·È ÙˆÓ ÙÔ̤ˆÓ ÁÏÒÛÛ·˜ Î·È ÌÓ‹Ì˘, ηıÒ˜ ηÈÙ˘ Û˘ÓÔÏÈ΋˜ ‚·ıÌÔÏÔÁ›·˜ ÛÙËÓ Îϛ̷η Ì·ıË-Ûȷ΋˜ ›‰ÔÛ˘. ∞ÎfiÌË, ·Ú·ÙËÚ‹ıËÎÂ Û˘Û¯¤ÙÈ-ÛË ÌÂٷ͇ Ù˘ ηٷӿψÛ˘ Ï·¯·ÓÈÎÒÓ Î·È Ù˘ÚÔÛÔ¯‹˜, ηıÒ˜ Î·È ÌÂٷ͇ Ù˘ ηٷӿψÛ˘ÊÚÔ‡ÙˆÓ Î·È ÙÔ˘ ÙÔ̤· Ù˘ ÁÏÒÛÛ·˜. ŸÏ˜ ÔÈ Û˘-Û¯ÂÙ›ÛÂȘ ‹Ù·Ó ıÂÙÈΤ˜, ˘Ô‰ËÏÒÓÔÓÙ·˜ ¤ÙÛÈ fiÙÈ Ë·‡ÍËÛË Ù˘ ηٷӿψÛ˘ Á·Ï·ÎÙÔÎÔÌÈÎÒÓ, Ï·¯·-ÓÈÎÒÓ Î·È ÊÚÔ‡ÙˆÓ Û˘Óԉ‡ÂÙ·È ·fi ·‡ÍËÛË ÙˆÓÂȉfiÛÂˆÓ ÛÙÔ˘˜ ‰È¿ÊÔÚÔ˘˜ ÙÔÌ›˜ Ù˘ Îϛ̷η˜(¶›Ó·Î·˜ 3).

OÈ ·ÈÌ·ÙÔÏÔÁÈΤ˜ ·Ú¿ÌÂÙÚÔÈ ·ÚÔ˘Û›·Û·Ó,›Û˘, ıÂÙÈΤ˜ Û˘Û¯ÂÙ›ÛÂȘ Ì ÙÔ˘˜ Ì·ıËÛÈ·ÎÔ‡˜ÙÔÌ›˜, ηٷ‰ÂÈÎÓ‡ÔÓÙ·˜ fiÙÈ Ù· ·˘ÍË̤ӷ ›‰··ÈÌÔÛÊ·ÈÚ›Ó˘ Î·È ·ÈÌ·ÙÔÎÚ›ÙË Û˘Óԉ‡ÔÓÙ·È ·fi˘„ËϤ˜ ÂȉfiÛÂȘ ÛÙÔ˘˜ ÙÔÌ›˜ ·˘ÙÔ‡˜ (¶›Ó·Î·˜4). ™˘ÁÎÂÎÚÈ̤ӷ, Ë ·ÈÌÔÛÊ·ÈÚ›ÓË Û˘Û¯ÂÙ›˙ÂÙ·È ÌÂÙËÓ Â›‰ÔÛË ÛÙÔ˘˜ ÙÔÌ›˜ ÁÏÒÛÛ·˜, ÌÓ‹Ì˘ ηÈÛ˘ÌÂÚÈÊÔÚ¿˜, Ì ÙË Û˘ÓÔÏÈ΋ ‚·ıÌÔÏÔÁ›· ÛÙËÓÎϛ̷η Ì·ıËÛȷ΋˜ ›‰ÔÛ˘ Î·È Ì ÙÔÓ Ì¤ÛÔfiÚÔ ÙˆÓ Û¯ÔÏÈÎÒÓ ‚·ıÌÒÓ. ∂›Û˘, Ô ·ÈÌ·ÙÔÎÚ›-Ù˘ ·ÚÔ˘ÛÈ¿˙ÂÈ Û˘Û¯¤ÙÈÛË Ì fiÏÔ˘˜ ÙÔ˘˜ Ì·ıË-ÛÈ·ÎÔ‡˜ ÙÔÌ›˜, ÏËÓ Ù˘ ÔÙÈÎÔÎÈÓËÙÈ΋˜ ··Ú-Ù›ˆÛ˘.

OÈ Û˘Û¯ÂÙ›ÛÂȘ ÙˆÓ ‚·ıÌÒÓ ÛÙÔ˘˜ Ì·ıËÛÈ·ÎÔ‡˜ÙÔÌ›˜ Ì ٷ ÛÙÔȯ›· ‰È·ÙÚÔÊ‹˜ η٤‰ÂÈÍ·Ó ÙÔÓÚfiÏÔ ÙˆÓ ‚ÈÙ·ÌÈÓÒÓ, ÙÔ˘ ·Û‚ÂÛÙ›Ô˘ Î·È ÙˆÓ ÚˆÙÂ-˚ÓÒÓ ÛÙË Ì·ıËÛȷ΋ ›‰ÔÛË (¶›Ó·Î·˜ 5). ™˘ÁÎÂ-ÎÚÈ̤ӷ, Ë ‚ÈÙ·Ì›ÓË µ12 ·ÚÔ˘Û›·Û ıÂÙÈΤ˜ Û˘Û¯Â-Ù›ÛÂȘ Ì ÙÔ˘˜ ÙÔÌ›˜ Û˘ÌÂÚÈÊÔÚ¿˜, ÁÏÒÛÛ·˜,ÌÓ‹Ì˘ Î·È Ì ÙË Û˘ÓÔÏÈ΋ ‚·ıÌÔÏÔÁ›· ÛÙËÓ Îϛ̷-η Ì·ıËÛȷ΋˜ ›‰ÔÛ˘. ¶·ÚÔÌÔ›ˆ˜, Ë ‚ÈÙ·Ì›ÓË ∞·ÚÔ˘Û›·Û ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË Ì ÙÔ˘˜ ÙÔÌ›˜ Û˘-ÌÂÚÈÊÔÚ¿˜ Î·È ÚÔÛÔ¯‹˜. ∞ÓÙ›ıÂÙ· ·fi ÙȘ ‚ÈÙ·-̛Ә µ12 Î·È ∞, ÔÈ Ôԛ˜ - fiˆ˜ Ê·›ÓÂÙ·È - Û˘Û¯Â-Ù›˙ÔÓÙ·È Ì ‚ÂÏÙ›ˆÛË ÙˆÓ ÂȉfiÛÂˆÓ ÛÙÔ Û¯ÔÏ›Ô,ÔÈ ‚Èٷ̛Ә µ1 Î·È ÓÈ·Û›ÓË Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì ÊÙˆ-¯¤˜ ÂȉfiÛÂȘ, fiˆ˜ Ì·ÚÙ˘ÚÔ‡Ó ÔÈ ·ÚÓËÙÈΤ˜ Û˘-Û¯ÂÙ›ÛÂȘ Ô˘ ·ÚÔ˘Û›·Û·Ó Ì ÙÔ˘˜ Ì·ıËÛÈ·ÎÔ‡˜

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·181

Page 39: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

ÙÔÌ›˜. ™˘ÁÎÂÎÚÈ̤ӷ, Ë ‚ÈÙ·Ì›ÓË µ1 ·ÚÔ˘Û›·Û·ÚÓËÙÈ΋ Û˘Û¯¤ÙÈÛË Ì ÙË Û˘ÌÂÚÈÊÔÚ¿, ÙË ÁÏÒÛ-Û·, ÙË ÌÓ‹ÌË Î·È ÙÔÓ Û¯ÔÏÈÎfi ‚·ıÌfi, ÂÓÒ Ë ÓÈ·Û›ÓË·ÚÔ˘Û›·Û ·ÚÓËÙÈ΋ Û˘Û¯¤ÙÈÛË Ì ÙÔÓ ÙÔ̤· Ù˘ΛÓËÛ˘.

∆Ô ·Û‚¤ÛÙÈÔ ÂÌÊ¿ÓÈÛ ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË Ì ÙÔ˘˜ÙÔÌ›˜ ÁÏÒÛÛ·˜ Î·È ÌÓ‹Ì˘, Ì ÙË Û˘ÓÔÏÈ΋ ‚·ıÌÔ-ÏÔÁ›· ÛÙËÓ Îϛ̷η Î·È Ì ÙÔÓ Û¯ÔÏÈÎfi ‚·ıÌfi.

∏ ÚfiÛÏË„Ë ÂÓ¤ÚÁÂÈ·˜ ·fi ÚˆÙ½Ó˜ ÂÌÊ¿ÓÈ-Û ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË Ì ÙÔÓ Û¯ÔÏÈÎfi ‚·ıÌfi, Ì ÙËÛ˘ÓÔÏÈ΋ ‚·ıÌÔÏÔÁ›· ÛÙËÓ Îϛ̷η Î·È Ì ηı¤Ó·Ó·fi ÙÔ˘˜ Ì·ıËÛÈ·ÎÔ‡˜ ÙÔÌ›˜, ÏËÓ Ù˘ ΛÓËÛË˜Î·È Ù˘ ÔÙÈÎÔÎÈÓËÙÈ΋˜ ··ÚÙ›ˆÛ˘.

∏ ÂÓ¤ÚÁÂÈ· ·fi ÔÏ˘·ÎfiÚÂÛÙ· Ï›Ë Â›¯Â ıÂÙÈ΋ۯ¤ÛË Ì ÙËÓ ÚÔÛÔ¯‹.

∏ ·Ó¿Ï˘ÛË ·ÏÈÓ‰ÚfiÌËÛ˘ ‰ÂÓ ÂÓÙfiÈÛ ο-ÔÈÔ ÚfiÏÔ ÙˆÓ ıÂÚÌ›‰ˆÓ Û fi,ÙÈ ·ÊÔÚ¿ ÙËÓ Â›‰Ô-ÛË ÙˆÓ Ì·ıËÙÒÓ ÛÙËÓ Îϛ̷η (¶›Ó·Î·˜ 6). ∞ÓÙ›ıÂ-Ù·, ¤‰ÂÈÍ fiÙÈ ÔÈ ‚·ıÌÔÏÔÁ›Â˜ Û οı ̷ıËÛÈ·ÎfiÙÔ̤·, ·ÏÏ¿ Î·È Ë Û˘ÓÔÏÈ΋ ‚·ıÌÔÏÔÁ›· fiÏˆÓ ÙˆÓÙÔ̤ˆÓ, ηıÒ˜ Î·È ÔÈ Û¯ÔÏÈÎÔ› ‚·ıÌÔ›, ·ÚÔ˘ÛÈ¿-˙Ô˘Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ Û˘Û¯¤ÙÈÛË Ì ÙËÓ ËÏÈΛ·ÙˆÓ ·È‰ÈÒÓ. ™˘ÁÎÂÎÚÈ̤ӷ, fiÛÔ ·˘Í¿ÓÂÈ Ë ËÏÈΛ·ÙˆÓ Ì·ıËÙÒÓ, ÌÂÈÒÓÂÙ·È Ë Û¯ÔÏÈ΋ ‚·ıÌÔÏÔÁ›· ηÈË Â›‰ÔÛ‹ ÙÔ˘˜ ÛÙÔ˘˜ ˘fi ÂͤٷÛË Ì·ıËÛÈ·ÎÔ‡˜ÙÔÌ›˜. ∆· ÎÔÚ›ÙÛÈ· ‚Ú¤ıËΠfiÙÈ ·ÚÔ˘ÛÈ¿˙Ô˘Ó˘„ËÏfiÙÂÚÔ˘˜ ‚·ıÌÔ‡˜ ·fi Ù· ·ÁfiÚÈ· Î·È ˘„ËÏfi-ÙÂÚË Â›‰ÔÛË ÛÙËÓ Îϛ̷η ÁÂÓÈο, ·ÏÏ¿ Î·È ÂȉÈÎfi-ÙÂÚ· ÛÙÔ˘˜ ÙÔÌ›˜ ÁÏÒÛÛ·˜, Û˘ÌÂÚÈÊÔÚ¿˜, ΛÓË-Û˘ Î·È ÚÔÛÔ¯‹˜.

O ‰Â›ÎÙ˘ Ê˘ÛÈ΋˜ ηٿÛÙ·Û˘ ·ÚÔ˘ÛÈ¿˙ÂÈ ıÂ-ÙÈ΋ Û˘Û¯¤ÙÈÛË Ì ÙË Û˘ÓÔÏÈ΋ ‚·ıÌÔÏÔÁ›· fiψÓÙˆÓ Ì·ıËÛÈ·ÎÒÓ ÙÔ̤ˆÓ Î·È Ì ÙË ‚·ıÌÔÏÔÁ›· ÛÂοı ¤Ó·Ó ·fi ÙÔ˘˜ ÙÔÌ›˜ ÁÏÒÛÛ·˜, ÔÙÈÎÔÎÈÓËÙÈ-΋˜ ··ÚÙ›ˆÛ˘, Û˘ÌÂÚÈÊÔÚ¿˜, ΛÓËÛ˘ Î·È ÌÓ‹-Ì˘. ∞˘Ùfi ÛËÌ·›ÓÂÈ fiÙÈ Ë Ê˘ÛÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ·Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ Î·Ï‹ ›‰ÔÛË Û ·˘ÙÔ‡˜ ÙÔ˘˜ÁÓˆÛÙÈÎÔ‡˜ ÙÔÌ›˜ Î·È ÛÙËÓ Îϛ̷η Ì·ıËÛȷ΋˜Â›‰ÔÛ˘, ÁÂÓÈÎfiÙÂÚ·.

O ÏfiÁÔ˜ ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ ÚÔ˜ HDL-¯ÔÏË-ÛÙÂÚfiÏË Û˘Û¯ÂÙ›˙ÂÙ·È ıÂÙÈο Ì ÙÔÓ Û¯ÔÏÈÎfi ‚·ıÌfiÎ·È ÙËÓ Â›‰ÔÛË ÛÙÔ˘˜ ÙÔÌ›˜ ÁÏÒÛÛ·˜, Û˘ÌÂÚÈ-ÊÔÚ¿˜ Î·È Î›ÓËÛ˘.

O ‰Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ ·ÚÔ˘ÛÈ¿˙ÂÈ ıÂÙÈÎ‹Û˘Û¯¤ÙÈÛË Ì ÙË Ì·ıËÛȷ΋ ›‰ÔÛË ÁÂÓÈο ηÈ, ÂÈ-‰ÈÎfiÙÂÚ·, Ì ÙÔÓ ÙÔ̤· Ù˘ ÌÓ‹Ì˘.

∏ ·Ó¿Ï˘ÛË Û˘Ó‰È·Î‡Ì·ÓÛ˘ ¤‰ÂÈÍ fiÙÈ ÔÈ Ì·ıË-Ù¤˜ Ì ÙËÓ ˘„ËÏfiÙÂÚË ‚·ıÌÔÏÔÁ›· ÛÙËÓ Îϛ̷η ›-¯·Ó ÌÂÁ·Ï‡ÙÂÚÔ ‚¿ÚÔ˜, ηχÙÂÚË Ê˘ÛÈ΋ ηٿ-ÛÙ·ÛË Î·È Û¯Â‰fiÓ ‰ÈÏ¿ÛÈ· ηٷӿψÛË Ï·¯·ÓÈÎÒÓÎ·È ÊÚÔ‡ÙˆÓ Î·È ÚfiÛÏË„Ë ‚ÈÙ·Ì›Ó˘ µ12 Û ۯ¤ÛËÌ ÙÔ˘˜ Ì·ıËÙ¤˜ Ô˘ ÂÌÊ¿ÓÈÛ·Ó ÙË ¯·ÌËÏfiÙÂÚË›‰ÔÛË (¶›Ó·Î·˜ 7).

™˘˙‹ÙËÛË ∏ ·ÚÔ‡Û· ¤Ú¢ӷ Û˘ÓËÁÔÚ› ˘¤Ú Ù˘ ‡·Ú-

͢ ıÂÙÈ΋˜ Û˘Û¯¤ÙÈÛ˘ ÌÂٷ͇ Ù˘ ·ÈÌÔÛÊ·ÈÚ›Ó˘,ÙÔ˘ Ûȉ‹ÚÔ˘, ÙÔ˘ ·Û‚ÂÛÙ›Ô˘, ÙˆÓ ‚ÈÙ·ÌÈÓÒÓ ∞ ηȵ12, ÙÔ˘ ÔÏ˘·ÎfiÚÂÛÙÔ˘ Ï›Ô˘˜ Ù˘ ÙÚÔÊ‹˜, Ù˘ÂÓ¤ÚÁÂÈ·˜ ·fi ÚˆÙ½Ó˜, Ù˘ ηٷӿψÛ˘ Á·Ï·-ÎÙÔÎÔÌÈÎÒÓ, Ï·¯·ÓÈÎÒÓ Î·È ÊÚÔ‡ÙˆÓ, ÙÔ˘ ·ıËÚˆ-Ì·ÙÈÎÔ‡ ‰Â›ÎÙË (ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË ÚÔ˜ HDL) ηÈÙ˘ Ê˘ÛÈ΋˜ ηٿÛÙ·Û˘ Ì ‰È¿ÊÔÚÔ˘˜ ÁÓˆÛÙÈ-ÎÔ‡˜ ÙÔÌ›˜. ∏ ÚfiÛÏË„Ë ‚ÈÙ·ÌÈÓÒÓ µ1 Î·È ÓÈ·Û›Ó˘·ÚÔ˘ÛÈ¿˙ÂÈ ·ÚÓËÙÈ΋ Û˘Û¯¤ÙÈÛË Ì ÙË Ì·ıËÛȷ΋›‰ÔÛË. ∏ ÚfiÛÏË„Ë ıÂÚÌ›‰ˆÓ ‰ÂÓ Ê·›ÓÂÙ·È Ó·ÂËÚ¿˙ÂÈ ÙË Ì·ıËÛȷ΋ ›‰ÔÛË, ˆÛÙfiÛÔ, Ô ‰Â›-ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ ·›˙ÂÈ Î¿ÔÈÔ ÚfiÏÔ, ηıÒ˜ ÔÈηχÙÂÚÔÈ Ì·ıËÙ¤˜ ¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚÔ ‚¿ÚÔ˜. ∆·ÎÔÚ›ÙÛÈ· ¤¯Ô˘Ó, ÁÂÓÈο, ηχÙÂÚ˜ ÂȉfiÛÂȘ ·fiÙ· ·ÁfiÚÈ·. ŸÛÔ ·˘Í¿ÓÂÈ Ë ËÏÈΛ·, ÔÈ Û¯ÔÏÈÎÔ› ‚·ı-ÌÔ› Á›ÓÔÓÙ·È ¯·ÌËÏfiÙÂÚÔÈ Î·È ÌÂÈÒÓÂÙ·È Ë Ì·ıËÛÈ·-΋ ›‰ÔÛË.

™˘ÁÎÂÎÚÈ̤ӷ, ÛÙÔ ‰Â›ÁÌ· Ù˘ ·ÚÔ‡Û·˜ ÌÂϤ-Ù˘ ·Ú·ÙËÚ‹ıËΠfiÙÈ Ë ·‡ÍËÛË ÙˆÓ ÂȤ‰ˆÓ ·È-ÌÔÛÊ·ÈÚ›Ó˘ Î·È ·ÈÌ·ÙÔÎÚ›ÙË Û˘Û¯ÂÙ›˙ÂÙ·È Ì ‚ÂÏ-Ù›ˆÛË Ù˘ ›‰ÔÛ˘ ÛÙȘ ˘ÔÎϛ̷Θ Ù˘ ÁÏÒÛ-Û·˜, Ù˘ ÌÓ‹Ì˘ Î·È Ù˘ ÚÔÛÔ¯‹˜. ∏ Û¯¤ÛË Ù˘·ÈÌÔÛÊ·ÈÚ›Ó˘ Î·È ÙÔ˘ ·ÈÌ·ÙÔÎÚ›ÙË Ì ÙË Ì·ıË-Ûȷ΋ ›‰ÔÛË Â·ÏËı‡ÂÙ·È ·fi Ï‹ıÔ˜ ÂÚ¢-ÓÒÓ. ∞ӷʤÚÂÙ·È ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· fiÙÈ Ë ¯ÔÚ‹ÁË-ÛË Ûȉ‹ÚÔ˘ Û ¤Ê˂˜ Ì ¤ÏÏÂÈ„‹ ÙÔ˘ ›¯Â ˆ˜·ÔÙ¤ÏÂÛÌ· ÙË ‚ÂÏÙ›ˆÛË Ù˘ ÏÂÎÙÈ΋˜ Ì¿ıËÛË˜Î·È Ù˘ ÌÓ‹Ì˘ (22). ∞ÎfiÌË ·Ó·Ê¤ÚÂÙ·È fiÙÈ Ë ¯·-ÌËÏ‹ ·ÈÌÔÛÊ·ÈÚ›ÓË ˆ˜ ÙËÓ ËÏÈΛ· ÙˆÓ 2 ÂÙÒÓ Û˘-Û¯ÂÙ›˙ÂÙ·È Ì ¤ÎÙˆÛË ÛÙË ÓÔËÙÈ΋ ·Ó¿Ù˘ÍË, Ë

182

¶·È‰È·ÙÚÈ΋ 2004;67:178-189 Paediatriki 2004;67:178-189

¶›Ó·Î·˜ 1. ™¯ÔÏ›· ‰Â›ÁÌ·ÙÔ˜

∏Ú¿ÎÏÂÈÔ ƒ¤ı˘ÌÓÔ §·Û›ıÈ

¢ËÌÔÙÈÎfi ¶ÚÔÊ‹ÙË ∏Ï›· ¢ËÌÔÙÈÎfi ¶ÂÚ¿Ì·ÙÔ˜ 2Ô ¢ËÌÔÙÈÎfi ∞Á›Ô˘ ¡ÈÎÔÏ¿Ô˘19Ô ¢ËÌÔÙÈÎfi ∏Ú·ÎÏ›Ԣ 1Ô ¢ËÌÔÙÈÎfi ƒÂı‡ÌÓÔ˘

1Ô ¢ËÌÔÙÈÎfi ∞ÚηÏÔ¯ˆÚ›Ô˘

¶›Ó·Î·˜ 2. ∫·Ù·ÓÔÌ‹ Ì·ıËÙÒÓ ·Ó¿ ÓÔÌfi

¡ÔÌfi˜ ¡

∏Ú¿ÎÏÂÈÔ 88ƒ¤ı˘ÌÓÔ 39§·Û›ıÈ 39™‡ÓÔÏÔ 166

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·182

Page 40: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

183

¶·È‰È·ÙÚÈ΋ 2004;67:178-189 Paediatriki 2004;67:178-189

ÔÔ›· Â›Ó·È È‰È·›ÙÂÚ· ¤ÓÙÔÓË ÛÙÔ˘˜ 18 Ì‹Ó˜ (8).™‡ÌʈÓË Â›Ó·È Î·È Ë ÁÓÒÌË ÙˆÓ Lozoff Î·È Û˘Ó(14), ÔÈ ÔÔ›ÔÈ ‚Ú‹Î·Ó fiÙÈ Ù· ¯·ÌËÏ¿ ›‰· ·È-ÌÔÛÊ·ÈÚ›Ó˘ ÛÙË ‚ÚÂÊÈ΋ ËÏÈΛ· ·˘Í¿ÓÔ˘Ó ÙÔÓΛӉ˘ÓÔ ÓÔËÙÈ΋˜ ˘ÛÙ¤ÚËÛ˘ ÛÙËÓ ËÏÈΛ· ÙˆÓ 10ÂÙÒÓ. ∂›Û˘, ‚Ú‹Î·Ó fiÙÈ ·È‰È¿ Ì ÛÔ‚·Ú‹, ¯Úfi-ÓÈ· ¤ÏÏÂÈ„Ë Ûȉ‹ÚÔ˘ ·ÚÔ˘Û›·Û·Ó ÛÙËÓ ËÏÈΛ·ÙˆÓ 12 ÂÙÒÓ Î·Î‹ ›‰ÔÛË ÛÙËÓ ·ÚÈıÌËÙÈ΋ Î·È ÙËÁÚ·Ù‹ ¤ÎÊÚ·ÛË, ÊÙˆ¯‹ ÎÈÓËÙÈ΋ ÈηÓfiÙËÙ· ηȷ‰˘Ó·Ì›Â˜ Û ‰È¿ÊÔÚ˜ ÁÓˆÛÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜(¯ˆÚÈ΋ ÌÓ‹ÌË, ÂÈÏÂÎÙÈ΋ ·Ó¿ÎÏËÛË). ¶ÔÏÏ¿ ·È-‰È¿ ·ӤϷ‚·Ó οÔÈ· Ù¿ÍË ‹ ·Ú·¤ÌÊıËηÓ

ÁÈ· ÂÓÈÛ¯˘ÙÈ΋ ‰È‰·Ûηϛ·. ∂›Û˘, Û˘¯Ó¿ ·ÚÔ˘-Û›·˙·Ó ÚÔ‚Ï‹Ì·Ù· ÛÙÔ Û˘Ó·›ÛıËÌ· Î·È ÙË Û˘-ÌÂÚÈÊÔÚ¿ (¿Á¯Ô˜, ηٿıÏÈ„Ë, ‰È·Ù·Ú·Á̤ÓË ÎÔÈ-ÓˆÓÈÎfiÙËÙ·, ÚÔ‚Ï‹Ì·Ù· ÚÔÛÔ¯‹˜). ∞ӷʤÚÔ˘Ó,·ÎfiÌË, fiÙÈ ¤Ú¢Ó˜ Û ˙Ò· ‰Â›¯ÓÔ˘Ó fiÙÈ Ë ¤ÏÏÂÈ„ËÛȉ‹ÚÔ˘ ÂËÚ¿˙ÂÈ ÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ÈfiηÌÔ˘,ÁÂÁÔÓfi˜ Ô˘ ÂÍËÁ› Î·È ÙÔ Â‡ÚËÌ· Ù˘ ·ÚÔ‡Û·˜ÌÂϤÙ˘ ÁÈ· ÙË Û¯¤ÛË ·ÈÌÔÛÊ·ÈÚ›Ó˘-·ÈÌ·ÙÔÎÚ›ÙËÌ ÙË ÌÓ‹ÌË. OÈ ›‰ÈÔÈ ÂÚ¢ÓËÙ¤˜ ·Ó·Ê¤ÚÔ˘Ó fiÙÈ ÌÂ-Á·Ï‡ÙÂÚ˜ Û˘ÁÎÂÓÙÚÒÛÂȘ Ûȉ‹ÚÔ˘ ˘¿Ú¯Ô˘Ó ÛÂÂÚÈÔ¯¤˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ Î›ÓËÛË Î·È ÙÔÓÚÔÛ·Ó·ÙÔÏÈÛÌfi, ˆÛÙfiÛÔ, ÛÙËÓ ·ÚÔ‡Û· ¤Ú¢ӷ

¶›Ó·Î·˜ 3. ™¯¤ÛË ÁÓˆÛÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ Ì ÙÚfiÊÈÌ·

∆ÚfiÊÈÌ· ™˘ÓÔÏÈÎfi˜ ‚·ıÌfi˜ Îϛ̷η˜ °ÏÒÛÛ· ªÓ‹ÌË ¶ÚÔÛÔ¯‹

°·Ï·ÎÙÔÎÔÌÈο 0,177 (0,023) 0,169 (0,031) 0,154 (0,050)§·¯·ÓÈο 0,158 (0,044)ºÚÔ‡Ù· 0,155 (0,048)

™˘ÓÙÂÏÂÛÙ¤˜ ÌÂÚÈ΋˜ Û˘Û¯¤ÙÈÛ˘ r-Pearson (p-value): ÂϤÁ¯ÔÓÙ·È Ù˘¯fiÓ ÂȉڿÛÂȘ ÙÔ˘ ʇÏÔ˘, Ù˘ ËÏÈΛ·˜ Î·È ÙÔ˘ ¢ª™

¶›Ó·Î·˜ 4. ™¯¤ÛË ÁÓˆÛÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ Ì ·ÈÌ·ÙÔÏÔÁÈÎÔ‡˜ ‰Â›ÎÙ˜

™˘ÓÔÏÈÎfi˜ °ÏÒÛÛ· ªÓ‹ÌË ¶ÚÔÛÔ¯‹ ∫›ÓËÛË ™˘ÌÂÚÈÊÔÚ¿ ™¯ÔÏÈÎfi˜ ‚·ıÌfi˜ ‚·ıÌfi˜

Îϛ̷η˜

∞ÈÌ·ÙÔÏÔÁÈÎÔ› ‰Â›ÎÙ˜∞ÈÌÔÛÊ·ÈÚ›ÓË 0,180 (0,021) 0,183 (0,019) 0,197 (0,012) 0,171 (0,029) 0,200 (0,011)∞ÈÌ·ÙÔÎÚ›Ù˘ 0,238 (0,002) 0,240 (0,002) 0,246 (0,002) 0,185 (0,018) 0,200 (0,010) 0,242 (0,002) 0,218 (0,005)

™˘ÓÙÂÏÂÛÙ¤˜ ÌÂÚÈ΋˜ Û˘Û¯¤ÙÈÛ˘ r-Pearson (p-value): ÂϤÁ¯ÔÓÙ·È Ù˘¯fiÓ ÂȉڿÛÂȘ ÙÔ˘ ʇÏÔ˘, Ù˘ ËÏÈΛ·˜ Î·È ÙÔ˘ ¢ª™

¶›Ó·Î·˜ 5. ™¯¤ÛË ·Ú·ÁfiÓÙˆÓ Ì·ıËÛȷ΋˜ ·ÍÈÔÏfiÁËÛ˘ ·È‰ÈÒÓ Ù˘ ∫Ú‹Ù˘ Ì ÛÙÔȯ›· Ù˘ ‰È·ÙÚÔÊ‹˜ ÙÔ˘˜

¶·Ú¿ÁÔÓÙ˜ ·ÍÈÔÏfiÁËÛ˘ ™ÙÔȯ›· ‰È·ÙÚÔÊ‹˜ r-Pearson* p-value

™˘ÓÔÏÈÎfi˜ ‚·ıÌfi˜ Îϛ̷η˜ ∞Û‚¤ÛÙÈÔ 0,161 0,040µÈÙ·Ì›ÓË µ12 0,172 0,028

¶ÚˆÙ½Ó˜ (% ÂÓÂÚÁ.) 0,215 0,006™¯ÔÏÈÎfi˜ ‚·ıÌfi˜ (ª.O.) ∞Û‚¤ÛÙÈÔ 0,159 0,045

µÈÙ·Ì›ÓË µ1 -0,180 0,024¶ÚˆÙ½Ó˜ (% ÂÓÂÚÁ.) 0,265 0,001

™˘ÌÂÚÈÊÔÚ¿ µÈÙ·Ì›ÓË A 0,177 0,024µÈÙ·Ì›ÓË µ1 -0,156 0,047µÈÙ·Ì›ÓË µ12 0,167 0,033

¶ÚˆÙ½Ó˜ (% ÂÓÂÚÁ.) 0,219 0,005°ÏÒÛÛ· ∞Û‚¤ÛÙÈÔ 0,152 0,050

µÈÙ·Ì›ÓË µ1 -0,195 0,013µÈÙ·Ì›ÓË µ12 0,204 0,009

¶ÚˆÙ½Ó˜ (% ÂÓÂÚÁ.) 0,247 0,001∫›ÓËÛË ¡È·Û›ÓË -0,163 0,039¶ÚÔÛÔ¯‹ µÈÙ·Ì›ÓË A 0,185 0,018

¶ÚˆÙ½Ó˜ (% ÂÓÂÚÁ.) 0,184 0,019¶ÔÏ˘·ÎfiÚÂÛÙÔ Ï›Ô˜ (% ÂÓÂÚÁ.) 0,183 0,020

ªÓ‹ÌË ∞Û‚¤ÛÙÈÔ 0,160 0,041µÈÙ·Ì›ÓË µ1 -0,155 0,048µÈÙ·Ì›ÓË µ12 0,185 0,018

¶ÚˆÙ½Ó˜ (% ÂÓÂÚÁ.) 0,214 0,006

* ™˘ÓÙÂÏÂÛÙ¤˜ ÌÂÚÈ΋˜ Û˘Û¯¤ÙÈÛ˘ r-Pearson: ÂϤÁ¯ÔÓÙ·È Ù˘¯fiÓ ÂȉڿÛÂȘ ÙÔ˘ ʇÏÔ˘, Ù˘ ËÏÈΛ·˜ Î·È ÙÔ˘ ¢ª™

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·183

Page 41: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

‰ÂÓ ‚Ú¤ıËÎÂ Û˘Û¯¤ÙÈÛË Ì ÙÔÓ ·Ú¿ÁÔÓÙ· ÔÙÈÎÔ-ÎÈÓËÙÈ΋˜ ··ÚÙ›ˆÛ˘.

∆Ô ·Û‚¤ÛÙÈÔ Î·È Ë ‚ÈÙ·Ì›ÓË µ12 ‚Ú¤ıËΠfiÙÈ ·-ÚÔ˘ÛÈ¿˙Ô˘Ó ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË Ì ÙÔ˘˜ ÙÔÌ›˜ ÁψÛ-ÛÈ΋˜ ÈηÓfiÙËÙ·˜, ÌÓ‹Ì˘ Î·È Ì ÙÔ Û‡ÓÔÏÔ Ù˘‚·ıÌÔÏÔÁ›·˜ ÛÙËÓ Îϛ̷η Ì·ıËÛȷ΋˜ ›‰ÔÛ˘.∞ÎfiÌ·, ÙÔ ·Û‚¤ÛÙÈÔ ·ÚÔ˘ÛÈ¿˙ÂÈ ıÂÙÈ΋ Û˘Û¯¤ÙÈÛËÌ ÙÔÓ Û¯ÔÏÈÎfi ‚·ıÌfi Î·È Ë ‚ÈÙ·Ì›ÓË µ12 ıÂÙÈ΋ Û˘-Û¯¤ÙÈÛË Ì ÙÔÓ ÙÔ̤· Û˘ÌÂÚÈÊÔÚ¿˜. ∞ӷʤÚÂÙ·ÈÛÙË ‚È‚ÏÈÔÁÚ·Ê›· fiÙÈ ÙÔ ·Û‚¤ÛÙÈÔ Î·È Ë ‚ÈÙ·Ì›Ó˵12 Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ÈηÓfiÙËÙ· ÁÈ· Û˘Ì‚ÔÏÈÎfi·È¯Ó›‰È (8), Ë ÔÔ›· - fiˆ˜ Î·È Ë ÁψÛÛÈ΋ ÈηÓfi-ÙËÙ· - ·ÔÙÂÏ› ·ÓÒÙÂÚË ÁÓˆÛÙÈ΋ ÏÂÈÙÔ˘ÚÁ›·. ∂È-ϤÔÓ, ˘ÔÛÙËÚ›˙ÂÙ·È fiÙÈ Ë ıÂڷ›· Ì µ12 ‚ÂÏ-ÙÈÒÓÂÈ ÙË ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ÌÂوȷ›Ô˘ ÏÔ‚Ô‡ Î·È ÙËÁψÛÛÈ΋ ÈηÓfiÙËÙ· (23). O ÚfiÏÔ˜ Ù˘ ·˘Ù‹˜ Ù˘‚ÈÙ·Ì›Ó˘ ÛÙËÓ ·Ó¿Ù˘ÍË Ó¢ÚÔÏÔÁÈÎÒÓ ‰È·Ù·Ú·-¯ÒÓ ¤¯ÂÈ ·Ô‰Âȯı› (24).

∏ ‚ÈÙ·Ì›ÓË µ1 ·ÚÔ˘Û›·Û ·ÚÓËÙÈΤ˜ Û˘Û¯ÂÙ›-ÛÂȘ Ì ÙÔ˘˜ ÙÔÌ›˜ Û˘ÌÂÚÈÊÔÚ¿˜, ÁψÛÛÈ΋˜ Èη-ÓfiÙËÙ·˜ Î·È ÌÓ‹Ì˘, ηıÒ˜ Î·È Ì ÙÔÓ Û¯ÔÏÈÎfi ‚·ı-Ìfi. ∏ ÓÈ·Û›ÓË ·ÚÔ˘Û›·Û ·ÚÓËÙÈ΋ Û˘Û¯¤ÙÈÛË ÌÂÙËÓ ÎÈÓËÙÈ΋ ÈηÓfiÙËÙ·. ™ÙË ‚È‚ÏÈÔÁÚ·Ê›· ‰ÂÓ ·Ó·-ʤÚÔÓÙ·È Ù¤ÙÔȘ Û˘Û¯ÂÙ›ÛÂȘ. ∞ÓÙ›ıÂÙ·, Â›Ó·È ÁÓˆ-ÛÙfi fiÙÈ Ë ¤ÏÏÂÈ„Ë ‚ÈÙ·Ì›Ó˘ µ1 ÌÔÚ› Ó· ÚÔηϤ-

ÛÂÈ ÂÁÎÂÊ·ÏÔ¿ıÂÈ· Wernicke, ¯·Ú·ÎÙËÚÈÛÙÈο Û˘-ÌÙÒÌ·Ù· Ù˘ ÔÔ›·˜ Â›Ó·È Ë ·Ù·Í›·, Ë ÔÊı·ÏÌÔ-ÏËÁ›· Î·È Ë ÓÔËÙÈ΋ Û‡Á¯˘ÛË. ŒÏÏÂÈ„Ë ÓÈ·Û›Ó˘ԉËÁ› ÛÙËÓ ÂΉ‹ÏˆÛË Ó¢ÚÔÏÔÁÈÎÒÓ Û˘Ìو̿-ÙˆÓ, fiˆ˜ ÎfiˆÛË, Ï‹ı·ÚÁÔ˜, ·‰˘Ó·Ì›· Û˘ÁΤ-ÓÙÚˆÛ˘, ηٿıÏÈ„Ë Î·È ·Ú·ÈÛı‹ÛÂȘ (24).

∏ ‚ÈÙ·Ì›ÓË ∞ ·ÚÔ˘Û›·Û ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË ÌÂÙÔ˘˜ ÙÔÌ›˜ Û˘ÌÂÚÈÊÔÚ¿˜ Î·È ÚÔÛÔ¯‹˜. OÈ LaRue Î·È Û˘Ó (25) ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ Ô˘Û›Â˜ Ì·ÓÙÈÔÍÂȉˆÙÈΤ˜ ȉÈfiÙËÙ˜, fiˆ˜ Ë ‚ÈÙ·Ì›ÓË ∞, η-ı˘ÛÙÂÚÔ‡Ó ÙËÓ „˘¯ÔÎÈÓËÙÈ΋ ÂÈ‚Ú¿‰˘ÓÛË, ÙËÓ¤ÎÙˆÛË Ù˘ ÌÓËÌÔÓÈ΋˜ ÈηÓfiÙËÙ·˜ Î·È ÙË Ì›ˆ-ÛË Ù˘ ¢ÂÏÈÍ›·˜ ÛÙË ÛΤ„Ë, Ô˘ ÚÔηÏÔ‡ÓÙ·È·fi ÙËÓ ·‡ÍËÛË Ù˘ ÌÔÓÔ·ÌÈÓÔÍÂȉ¿Û˘ µ, ηٿÙË Á‹Ú·ÓÛË. ∂ÚÂ˘Ó¿Ù·È Ô ıÂڷ¢ÙÈÎfi˜ ÚfiÏÔ˜ÙˆÓ ·ÓÙÈÔÍÂȉˆÙÈÎÒÓ Û ÓfiÛÔ˘˜ ÙÔ˘ ∫¡™ (26) ηÈ,ȉȷ›ÙÂÚ·, Ë Â›‰Ú·Û‹ ÙÔ˘˜ ÛÙË ÌÓËÌÔÓÈ΋ ÈηÓfi-ÙËÙ· (27). ª›· ÚfiÛÊ·ÙË ¤Ú¢ӷ ·Ó·Ê¤ÚÂÈ fiÙÈÙÚÔʤ˜ fiˆ˜ ÙÔ Û·Ó¿ÎÈ Î·È ÔÈ ÊÚ¿Ô˘Ï˜, ÔÈÔԛ˜ Â›Ó·È ÏÔ‡ÛȘ Û ·ÓÙÈÔÍÂȉˆÙÈΤ˜ Ô˘Û›Â˜,Û˘ÓÙÂÏÔ‡Ó ÛÙËÓ ÂÈ‚Ú¿‰˘ÓÛË Ù˘ ÏÂÈÙÔ˘ÚÁÈ΋˜¤ÎÙˆÛ˘ ÙÔ˘ ∫¡™ Î·È ÂӉ¯Ô̤ӈ˜ ¤¯Ô˘Ó ο-ÔÈ· ıÂÙÈ΋ ›‰Ú·ÛË Û Ó¢ÚÔÂÎÊ˘ÏÈÛÙÈΤ˜ Ófi-ÛÔ˘˜ (28). ∏ ÂÚÈÂÎÙÈÎfiÙËÙ· ÙˆÓ Ï·¯·ÓÈÎÒÓ Û ‚È-ٷ̛Ә Ô˘ ¤¯Ô˘Ó ·ÓÙÈÔÍÂȉˆÙÈΤ˜ ȉÈfiÙËÙ˜,

184

¶·È‰È·ÙÚÈ΋ 2004;67:178-189 Paediatriki 2004;67:178-189

¶›Ó·Î·˜ 6. ™¯¤ÛË ÁÓˆÛÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ Ì ÙËÓ ËÏÈΛ·, ÙÔ ¶∆∞, ÙÔ Ê‡ÏÔ, ÙÔÓ ¢ª™, ÙÔÓ ·ıËڈ̷ÙÈÎfi ‰Â›ÎÙË TC/HDL Î·È ÙËÓÚfiÛÏË„Ë ÂÓ¤ÚÁÂÈ·˜

¶·Ú¿ÁÔÓÙ˜ Beta t p-value

™˘ÓÔÏÈÎfi˜ ‚·ıÌfi˜ Îϛ̷η˜ ∏ÏÈΛ· -0,386 -5,56 <0,001¶∆∞ 0,305 3,87 <0,001º‡ÏÔ 0,206 2,78 0,006¢ª™ 0,170 2,27 0,024

™¯ÔÏÈÎfi˜ ‚·ıÌfi˜ (ª.O.) ∏ÏÈΛ· -0,323 -4,50 <0,001TC/HDL 0,231 3,22 0,002

º‡ÏÔ 0,199 2,80 0,006°ÏÒÛÛ· ∏ÏÈΛ· -0,466 -6,80 <0,001

¶∆∞ 0,217 3,00 0,003º‡ÏÔ 0,180 2,52 0,013

TC/HDL 0,149 2,16 0,033OÙÈÎÔÎÈÓËÙÈ΋ ··ÚÙ›ˆÛË ∏ÏÈΛ· -0,355 -4,90 <0,001

¶∆∞ 0,186 2,56 0,011™˘ÌÂÚÈÊÔÚ¿ ∏ÏÈΛ· -0,423 -6,09 <0,001

¶∆∞ 0,250 3,42 0,001º‡ÏÔ 0,208 2,87 0,005

TC/HDL 0,138 1,98 0,050∫›ÓËÛË ∏ÏÈΛ· -0,379 -5,43 <0,001

º‡ÏÔ 0,286 3,93 <0,001¶∆∞ 0,234 3,18 0,002

TC/HDL 0,152 2,16 0,032¶ÚÔÛÔ¯‹ ∏ÏÈΛ· -0,381 -5,37 <0,001

º‡ÏÔ 0,181 2,55 0,012ªÓ‹ÌË ∏ÏÈΛ· -0,349 -5,02 <0,001

¶∆∞ 0,341 4,60 <0,001¢ª™ 0,204 2,76 0,006

∞Ó¿Ï˘ÛË ‚ËÌ·ÙÈ΋˜ ÁÚ·ÌÌÈ΋˜ ·ÏÈÓ‰ÚfiÌËÛ˘ (Stepwise Linear Regression)

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·184

Page 42: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

185

¶·È‰È·ÙÚÈ΋ 2004;67:178-189 Paediatriki 2004;67:178-189

‰ÈηÈÔÏÔÁ› ÙÔ Â‡ÚËÌ· Ù˘ ·ÚÔ‡Û·˜ ¤Ú¢ӷ˜ ÁÈ·ÙË Û˘Û¯¤ÙÈÛË Ù˘ ηٷӿψÛ˘ Ï·¯·ÓÈÎÒÓ Ì ÙËÓηϋ ›‰ÔÛË ÛÂ Û˘ÁÎÂÎÚÈ̤ÓÔ˘˜ Ì·ıËÛÈ·ÎÔ‡˜ÙÔÌ›˜.

∆Ô ÔÏ˘·ÎfiÚÂÛÙÔ Ï›Ô˜ ·ÚÔ˘Û›·Û ıÂÙÈÎ‹Û˘Û¯¤ÙÈÛË Ì ÙÔÓ ÙÔ̤· Ù˘ ÚÔÛÔ¯‹˜. ™ÙÔ ·-ÚÂÏıfiÓ ¤¯ÂÈ ÂÚÈÁÚ·Ê› Ë Û¯¤ÛË ÙˆÓ ÔÏ˘·ÎfiÚÂ-ÛÙˆÓ ÏÈÒÓ Ì ÙËÓ ˆÚ›Ì·ÓÛË ÙÔ˘ ∫¡™ Û ‚Ú¤ÊË.™Ù· ÔÏ˘·ÎfiÚÂÛÙ· ÏÈ·Ú¿ Ôͤ· ÙÔ˘ ÌËÙÚÈÎÔ‡ Á¿-Ï·ÙÔ˜ ·Ô‰›‰ÂÙ·È Ë Â˘ÂÚÁÂÙÈ΋ ›‰Ú·ÛË ÙÔ˘ ıË-Ï·ÛÌÔ‡ ÛÙË Ó¢ÚÔÏÔÁÈ΋ (4) Î·È ÁÓˆÛÙÈ΋ (5) ·Ó¿-Ù˘ÍË ÙˆÓ ·È‰ÈÒÓ. µÚ¤ıËΠfiÙÈ ÚfiˆÚ· ‚Ú¤ÊËÔ˘ ÙÚ¿ÊËÎ·Ó ÁÈ· ¤Ó· Ì‹Ó· Ì Á¿Ï· ÂÌÏÔ˘ÙÈṲ̂-ÓÔ Ì ÔÏ˘·ÎfiÚÂÛÙ· ÏÈ·Ú¿ Ôͤ·, ÛÙÔ Ù¤ÏÔ˜ ÙÔ˘Ì‹Ó·, ‰ÂÓ ·ÚÔ˘Û›·Û·Ó ‰È·ÊÔÚ¿ ˆ˜ ÚÔ˜ ÙËÓ·Ó¿Ù˘ÍË ÙÔ˘ ∫¡™, Û˘ÁÎÚÈÙÈο Ì ‚Ú¤ÊË Ô˘ ı‹-Ï·Û·Ó (29).

∏ ÚfiÛÏË„Ë ÂÓ¤ÚÁÂÈ·˜ ·fi ÙËÓ Î·Ù·Ó¿ÏˆÛËÚˆÙÂ˚ÓÒÓ ·ÚÔ˘Û›·Û ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË Ì fiÏÔ˘˜ÙÔ˘˜ ÁÓˆÛÙÈÎÔ‡˜ ÙÔÌ›˜, ÏËÓ Ù˘ ÎÈÓËÙÈ΋˜ ÈηÓfi-ÙËÙ·˜ Î·È Ù˘ ÔÙÈÎÔÎÈÓËÙÈ΋˜ ··ÚÙ›ˆÛ˘.

™Â fi,ÙÈ ·ÊÔÚ¿ ÙȘ ÔÌ¿‰Â˜ ÙÚÔʛ̈Ó, ‚Ú¤ıËÎÂ

fiÙÈ Ë Î·Ù·Ó¿ÏˆÛË Á·Ï·ÎÙÔÎÔÌÈÎÒÓ Û˘Û¯ÂÙ›˙ÂÙ·È ÌÂηϋ ÁÂÓÈ΋ ›‰ÔÛË ÛÙËÓ Îϛ̷η ηÈ, Û˘ÁÎÂÎÚÈ̤-Ó·, ÛÙÔ˘˜ ÙÔÌ›˜ ÁÏÒÛÛ·˜ Î·È ÌÓ‹Ì˘. ∫·ıÒ˜ Ù·Á·Ï·ÎÙÔÎÔÌÈο ÚÔ˚fiÓÙ· Â›Ó·È ÏÔ‡ÛÈ· Û ·Û‚¤-ÛÙÈÔ Î·È ‚ÈÙ·Ì›ÓË µ12, Ô˘Û›Â˜ Ô˘ - fiˆ˜ ÚÔ·Ó·-ʤÚıËΠ- ÂÓ‰¤¯ÂÙ·È Ó· ¤¯Ô˘Ó Û¯¤ÛË Ì ÙȘ ·ÓÒÙÂ-Ú˜ ÁÓˆÛÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜, Ë Û˘Û¯¤ÙÈÛË Ô˘ ·Ú·-ÙËÚ‹ıËΠ‹Ù·Ó ·Ó·ÌÂÓfiÌÂÓË. ∏ ηٷӿψÛË Ï·¯·-ÓÈÎÒÓ ‚Ú¤ıËΠfiÙÈ ·ÚÔ˘ÛÈ¿˙ÂÈ Û˘Û¯¤ÙÈÛË Ì ÙËÓηϋ ›‰ÔÛË ÛÙÔÓ ÙÔ̤· Ù˘ ÚÔÛÔ¯‹˜, fiˆ˜ÂÍ¿ÏÏÔ˘ Î·È Ë ‚ÈÙ·Ì›ÓË ∞ Ô˘ ÂÚȤ¯ÂÙ·È Û ·˘Ù¿.ª¿ÏÈÛÙ·, ·Ú·ÙËÚ‹ıËΠfiÙÈ ÔÈ Ì·ıËÙ¤˜ Ì ÙËÓ˘„ËÏfiÙÂÚË Â›‰ÔÛË Î·Ù·Ó·ÏÒÓÔ˘Ó ÌÂÁ·Ï‡ÙÂÚ˜ÔÛfiÙËÙ˜ Ï·¯·ÓÈÎÒÓ.

O Û¯ÔÏÈÎfi˜ ‚·ıÌfi˜ ·ÚÔ˘Û›·Û ıÂÙÈΤ˜ Û˘Û¯Â-Ù›ÛÂȘ Ì ٷ ›‰· ÙˆÓ ·ÈÌ·ÙÔÏÔÁÈÎÒÓ ‰ÂÈÎÙÒÓ,ÙÔ˘ ·Û‚ÂÛÙ›Ô˘, ÙˆÓ ÚˆÙÂ˚ÓÒÓ Î·È Ì ÙÔÓ ·ıËÚˆ-Ì·ÙÈÎfi ‰Â›ÎÙË (ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË ÚÔ˜ HDL), ηٷ‰ÂÈÎÓ‡ÔÓÙ·˜ fiÙÈ ÔÈ ·ÈÌ·ÙÔÏÔÁÈÎÔ› Î·È ‰È·ÙÚÔ-ÊÈÎÔ› ·Ú¿ÁÔÓÙ˜ ÂËÚ¿˙Ô˘Ó ÙË ‚·ıÌÔÏÔÁ›·.¶ÚfiÛÊ·ÙÔ ¿ÚıÚÔ ·Ó·Ê¤ÚÂÈ fiÙÈ ÔÈ Û¯ÔÏÈÎÔ› ‚·ıÌÔ›ÙˆÓ Ì·ıËÙÒÓ Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì ÙȘ ‰È·ÙÚÔÊÈΤ˜

¶›Ó·Î·˜ 7. ™‡ÁÎÚÈÛË ÛˆÌ·ÙÔÌÂÙÚÈÎÒÓ, ·ÈÌ·ÙÔÏÔÁÈÎÒÓ, ‚ÈÔ¯ËÌÈÎÒÓ Î·È ‰È·ÙÚÔÊÈÎÒÓ ÛÙÔȯ›ˆÓ, ηıÒ˜ Î·È ÙÔ˘ ‰Â›ÎÙË Ê˘ÛÈ΋˜Î·Ù¿ÛÙ·Û˘ ÌÂٷ͇ Ì·ıËÙÒÓ Ì ¯·ÌËÏ‹ Î·È ˘„ËÏ‹ ‚·ıÌÔÏÔÁ›· ÛÙËÓ Îϛ̷η ÁÓˆÛÙÈ΋˜ ›‰ÔÛ˘

÷ÌËÏ‹ ‚·ıÌÔÏÔÁ›· (≤25%) À„ËÏ‹ ‚·ıÌÔÏÔÁ›· (≥75%) p-value(n = 42) (n = 42)

ª¤ÛÔ˜ fiÚÔ˜ ± Ù˘È΋ ·fiÎÏÈÛË

™¢ª™ (kg/m2) 18,6 ± 0,6 19,9 ± 0,6 ª™*µ¿ÚÔ˜ (kg) 37,1 ± 1,5 41,9 ± 1,5 0,029¶ÂÚ›ÌÂÙÚÔ˜ ̤Û˘ (cm) 68,4 ± 1,7 71,7 ± 1,7 ª™¶∆∞ (ÛÙ¿‰È·) 2,5 ± 0,2 3,5 ± 0,3 0,008OÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË (mg/dl) 173,5 ± 5,2 176,2 ± 5,2 ª™∆ÚÈÁÏ˘ÎÂÚ›‰È· (mg/dl) 66,0 ± 4,5 60,8 ± 4,5 ª™HDL-C (mg/dl) 51,1 ± 2,2 49,3 ± 2,3 ª™LDL-C (mg/dl) 109,2 ± 4,9 114,8 ± 4,9 ª™∞ıËڈ̷ÙÈÎfi˜ ‰Â›ÎÙ˘ ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ ÚÔ˜ HDL 3,5 ± 0,3 4,1 ± 0,3 ª™∞ÈÌÔÛÊ·ÈÚ›ÓË (g/dl) 13,2 ± 0,2 13,5 ± 0,2 ª™∞ÈÌ·ÙÔÎÚ›Ù˘ (%) 39,3 ± 0,4 40,3 ± 0,4 ª™ª¤ÛÔ˜ fiÁÎÔ˜ ÂÚ˘ıÚÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ (fL) 81,0 ± 1,0 83,2 ± 1,0 ª™∂Ó¤ÚÁÂÈ· (kcal) 1603 ± 98 1500 ± 98 ª™∞Û‚¤ÛÙÈÔ (mg) 644 ± 69 826 ± 69 ª™µÈÙ·Ì›ÓË B1 (mg) 2,9 ± 0,5 2,0 ± 0,5 ª™µÈÙ·Ì›ÓË B12 (Ìg) 1,8 ± 0,4 3,1 ± 0,4 0,026°·Ï·ÎÙÔÎÔÌÈο (ÌÂÚ›‰Â˜/Ë̤ڷ) 1,8 ± 0,2 2,4 ± 0,2 ª™§·¯·ÓÈο Î·È ÊÚÔ‡Ù· (ÌÂÚ›‰Â˜/Ë̤ڷ)** 1,6 ± 0,4 3,0 ± 0,4 0,026∫Ú¤·˜, ·˘Á¿ (ÌÂÚ›‰Â˜/Ë̤ڷ)** 2,4 ± 0,4 2,3 ± 0,4 ª™¢ËÌËÙÚȷο (ÌÂÚ›‰Â˜/Ë̤ڷ)** 7,9 ± 0,8 7,6 ± 0,8 ª™

∞Ó¿Ï˘ÛË Û˘Ó‰È·Î‡Ì·ÓÛ˘ (∞¡COVA): ˆ˜ Û˘ÌÌÂÙ·‚ÏËÙ¤˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÙÔ Ê‡ÏÔ, Ë ËÏÈΛ· Î·È Ô ¢ª™ * ª™: ÛÙ·ÙÈÛÙÈÎÒ˜ ÌË ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿

** 1 ÌÂÚ›‰· ÈÛÔ‰˘Ó·Ì›: Á·Ï·ÎÙÔÎÔÌÈο: 30 g Ù˘Ú› ‹ 245 g ÁÈ·Ô‡ÚÙÈ ‹ Á¿Ï· Ï·¯·ÓÈο: 100 g Ï·¯·ÓÈÎÒÓ ÊÚÔ‡Ù·: 100 g ÔÚÙÔοÏÈ ‹ 80 g Ì‹ÏÔ ‹ 120 g ‚ÂÚ›ÎÔÎÔ ‹ 200 g ÂfiÓÈ ‹ ηÚÔ‡˙È ‹ 60 g Ì·Ó¿Ó· ‹ ۇη ‹ 15 g ÍËڿۇη ‹ ÛÙ·Ê›‰Â˜ ‰ËÌËÙÚȷο: 25 g „ˆÌ› ‹ 20 g ‰ËÌËÙÚȷο ÁÈ· ÚˆÈÓfi ‹ 50 g ̷ηÚfiÓÈ· Ì·ÁÂÈÚÂ̤ӷ ‹ 100 g ·Ú·Î¿˜ ‹ 100 g ·Ù¿Ù· ‹50 g ηϷÌfiÎÈ ÎÚ¤·˜-·˘Á¿: 30 g ÎÚ¤·˜ ‹ 50 g ·˘Á¿

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·185

Page 43: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

186

¶·È‰È·ÙÚÈ΋ 2004;67:178-189 Paediatriki 2004;67:178-189

Û˘Ó‹ıÂȘ Î·È Î˘Ú›ˆ˜ Ì ÙËÓ Ù·ÎÙÈ΋ ηٷӿψÛËÙÚÈÒÓ ÁÂ˘Ì¿ÙˆÓ ËÌÂÚËÛ›ˆ˜ (30). ÕÏϘ ¤Ú¢ÓÂ˜Û˘Û¯ÂÙ›˙Ô˘Ó ÙËÓ Î·Ù·Ó¿ÏˆÛË ÚˆÈÓÔ‡ Á‡̷ÙԘ̠ÙÔÓ Û¯ÔÏÈÎfi ‚·ıÌfi. ∞ÚÓËÙÈ΋ Û˘Û¯¤ÙÈÛË ÂÓÙÔ›-ÛÙËΠÌÂٷ͇ Ù˘ ‚ÈÙ·Ì›Ó˘ µ1 Î·È ÙÔ˘ Û¯ÔÏÈÎÔ‡‚·ıÌÔ‡. ¶·Ú·ÙËÚ‹ıËÎÂ, ·ÎfiÌË, fiÙÈ Ù· ÎÔÚ›ÙÛÈ· ÂÌ-Ê·Ó›˙Ô˘Ó ˘„ËÏfiÙÂÚË ‚·ıÌÔÏÔÁ›· ·fi Ù· ·ÁfiÚÈ·,ÂÓÒ ÔÈ ‚·ıÌÔ› ÌÂÈÒÓÔÓÙ·È Î·ıÒ˜ ·˘Í¿ÓÂÈ Ë ËÏÈΛ·.∞˘Ùfi, ÛÙËÓ ·ÚÔ‡Û· ¤Ú¢ӷ, Èı·ÓfiÓ ÔÊ›ÏÂÙ·ÈÛÙÔ ÌÈÎÚfi Ê¿ÛÌ· ËÏÈÎÈÒÓ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜.

O ‰Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ Ê·›ÓÂÙ·È Ó· ÂȉڿÛÙË Û˘ÓÔÏÈ΋ ‚·ıÌÔÏÔÁ›· Ù˘ Îϛ̷η˜ Î·È ÛÙÔÓÙÔ̤· Ù˘ ÌÓ‹Ì˘. øÛÙfiÛÔ, Ë ·Ó¿Ï˘ÛË Û˘Ó‰È·Î‡-Ì·ÓÛ˘ ¤‰ÂÈÍ fiÙÈ ÔÈ Ì·ıËÙ¤˜ Ì ˘„ËÏ‹ ‚·ıÌÔÏÔ-Á›· ÛÙËÓ Îϛ̷η ‰ÂÓ ‰È¤ÊÂÚ·Ó ·fi ·˘ÙÔ‡˜ Ì ¯·-ÌËÏ‹ ‚·ıÌÔÏÔÁ›· ˆ˜ ÚÔ˜ ÙÔÓ ‰Â›ÎÙË Ì¿˙·˜ ÛÒÌ·-ÙÔ˜. ∞ÓÙ›ıÂÙ·, ÔÈ ÚÒÙÔÈ, ›¯·Ó ÌÂÁ·Ï‡ÙÂÚÔ ‚¿ÚÔ˜·fi ÙÔ˘˜ ‰Â‡ÙÂÚÔ˘˜, ‡ÚËÌ· Ô˘ ·ÚÔ˘ÛÈ¿˙ÂÈ ÂÓ-‰È·Ê¤ÚÔÓ Î·È ¯ÚÂÈ¿˙ÂÙ·È ‰ÈÂÚ‡ÓËÛË.

∂ӉȷʤÚÔÓ ·ÚÔ˘ÛÈ¿˙ÂÈ ÙÔ Â‡ÚËÌ·, Û‡ÌʈӷÌ ÙÔ ÔÔ›Ô Ë Ê˘ÛÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· Û˘Û¯ÂÙ›˙ÂÙ·ÈÌ ÙË ÁÏÒÛÛ·, ÙËÓ ÔÙÈÎÔÎÈÓËÙÈ΋ ··ÚÙ›ˆÛË, ÙËÛ˘ÌÂÚÈÊÔÚ¿, ÙË ÌÓ‹ÌË, ·ÏÏ¿ Î·È Û˘ÓÔÏÈο Ì ÙËÌ·ıËÛȷ΋ ›‰ÔÛË, fiˆ˜ ·˘Ù‹ ÂÎÙÈÌ¿Ù·È ·fi ÙËÓÎϛ̷η Ì·ıËÛȷ΋˜ ›‰ÔÛ˘. ∆Ô Â‡ÚËÌ· ·˘ÙfiÛ˘ÌʈÓ› Ì ÚfiÛÊ·ÙË ¤Ú¢ӷ Ô˘ ‰ÈÂÍ‹¯ıËÛÙÔÓ ∫·Ó·‰¿, Ì ÛÎÔfi ÙË ‰ÈÂÚ‡ÓËÛË Ù˘ Û¯¤-Û˘ Ù˘ ΛÓËÛ˘ Ì ÙËÓ „˘¯ÔÏÔÁÈ΋ ·Ó¿Ù˘ÍË. OÈÛ˘ÁÁÚ·Ê›˜ ·Ú·ÙËÚÔ‡Ó fiÙÈ Ë ÎÔڇʈÛË Ù˘ ÎÈ-ÓËÙÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÛÙËÓ ËÏÈ-Λ· ÙˆÓ 7-9 ÂÙÒÓ, ‰ËÏ·‰‹ ÛÙËÓ ÂÚ›Ô‰Ô Ù˘ Û˘-ÁÎÂÎÚÈ̤Ó˘ ÛΤ„˘, ηٿ ÙÔÓ Piaget. ÀÔÛÙËÚ›-˙Ô˘Ó, ÏÔÈfiÓ, fiÙÈ Ù· ·È‰È¿ ¯ÚËÛÈÌÔÔÈÔ‡Ó ÙËÓ Î›-ÓËÛË ÁÈ· ÙËÓ ·fiÎÙËÛË ÁÓˆÛÙÈÎÒÓ ÂÌÂÈÚÈÒÓ, ÙËÚ‡ıÌÈÛË ÙÔ˘ ÂȤ‰Ô˘ ‰È¤ÁÂÚÛ‹˜ ÙÔ˘˜ Î·È ÙËÓ ¤Î-ÊÚ·ÛË ÙˆÓ Û˘Ó·ÈÛıËÌ¿ÙˆÓ ÙÔ˘˜, fiÛÔ Â›Ó·È ·ÓÒ-ÚÈÌ· ÁÓˆÛÙÈο. ∏ ÎÈÓËÙÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· ÌÂÈÒÓÂ-Ù·È Î·Ù¿ ÙËÓ ÂÊ˂›·, ÛËÌ·ÙÔ‰ÔÙÒÓÙ·˜ Ì›· ÛÙÚÔ-Ê‹ ÚÔ˜ ÙËÓ ·ÊËÚË̤ÓË ÛΤ„Ë, ÙË Ú‡ıÌÈÛË ÙÔ˘ÂȤ‰Ô˘ ‰È¤ÁÂÚÛ˘ ̤۷ ·fi Û˘Ì‚ÔÏÈΤ˜ ‰È·‰È-ηۛ˜ Î·È ÙË ÁÓˆÛÙÈ΋ ¤ÎÊÚ·ÛË ÙÔ˘ Û˘Ó·ÈÛı‹Ì·-ÙÔ˜ ̤۷ ·fi ÙÔÓ ÏfiÁÔ. ∞ÎfiÌË, ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈË Î›ÓËÛË ‚ÂÏÙÈÒÓÂÈ ÙË Û¯ÔÏÈ΋ ›‰ÔÛË Î·È ÚÔÙ›-ÓÔ˘Ó ÙËÓ ÂÓۈ̿وۋ Ù˘ ÛÙÔ ÚfiÁÚ·ÌÌ· ‰È‰·-Ûηϛ·˜, ÙfiÛÔ ÛÙ· ÚÒÙ· fiÛÔ Î·È ÛÙ· ÙÂÏÂ˘Ù·›·¯ÚfiÓÈ· Ù˘ ÊÔ›ÙËÛ˘ ÛÙÔ ¢ËÌÔÙÈÎfi. ™Â fi,ÙÈ ·ÊÔÚ¿ÙË Û¯¤ÛË Î›ÓËÛ˘-Û˘ÌÂÚÈÊÔÚ¿˜, ÔÈ Û˘ÁÁÚ·Ê›˜ÂÈÛËÌ·›ÓÔ˘Ó fiÙÈ, ·fi ÙË ‚ÚÂÊÈ΋ ËÏÈΛ· ˆ˜ ÙËÓÂÓËÏÈΛˆÛË, Ë ÎÔÈÓˆÓÈ΋ Û˘ÌÂÚÈÊÔÚ¿ ‰È·ÌÔÚÊÒ-ÓÂÙ·È Û ÌÂÁ¿ÏÔ ‚·ıÌfi ·fi ÙÔ Â›Â‰Ô ÎÈÓËÙÈÎfi-ÙËÙ·˜ ÙˆÓ ·ÙfïÓ, ηıÒ˜ ̤۷ ·fi ÙËÓ Î›ÓËÛËÂÍÂÚ¢ÓÔ‡Ó ÙÔ ÂÚÈ‚¿ÏÏÔÓ ÙÔ˘˜ Î·È ÂÌϤÎÔÓÙ·ÈÛ ÎÔÈÓˆÓÈΤ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜, fiˆ˜ ÙÔ ·È¯Ó›‰È.

π‰È·›ÙÂÚ· ÂӉȷʤÚÔ˘Û· Â›Ó·È Ë ¿Ô„‹ ÙÔ˘˜ ÁÈ· ÙËÛ¯¤ÛË Ù˘ ΛÓËÛ˘ Ì ÙËÓ ÚÔÛÔ¯‹, Û¯¤ÛË Ô˘ÛÙËÓ ·ÚÔ‡Û· ¤Ú¢ӷ ‰ÂÓ ÂÓÙÔ›ÛÙËÎÂ. ÀÔÛÙË-Ú›˙Ô˘Ó fiÙÈ Û ÂÚÈÙÒÛÂȘ ¤ÓÙÔÓ˘ ÎÈÓËÙÈÎfiÙËÙ·˜,fiˆ˜ Â›Ó·È ÔÈ ·ıÏËÙÈΤ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜, ÙÔ ¿ÙÔ-ÌÔ ·Ó·Áο˙ÂÙ·È Ó· ·ÊÈÂÚÒÓÂÈ ÌÈÎÚ‹˜ ‰È¿ÚÎÂÈ·˜ÚÔÛÔ¯‹ Û ÔÏÏ¿ ÂÚÂı›ÛÌ·Ù· Ù·˘Ùfi¯ÚÔÓ·. ∏Û˘ÌÂÚÈÊÔÚ¿ ·˘Ù‹ ¯·Ú·ÎÙËÚ›˙ÂÈ Î·È Ù· ·È‰È¿ ÙËÓÂÚ›Ô‰Ô Ô˘ Ë ÎÈÓËÙÈÎfiÙËÙ¿ ÙÔ˘˜ ·˘Í¿ÓÂÈ, ‰›ÓÔ-ÓÙ·˜ Û ¤Ó·Ó ÂÓ‹ÏÈÎÔ ÙËÓ ÂÓÙ‡ˆÛË fiÙÈ Â›Ó·È·ÚfiÛ¯ٷ (31).

¶·Ú¿ ÙȘ ÔÏϷϤ˜ Û˘Û¯ÂÙ›ÛÂȘ Ô˘ ÂÓÙÔ›-ÛÙËηÓ, ÌfiÓÔ ÙÚÂȘ ·Ú¿ÁÔÓÙ˜ ‚Ú¤ıËΠfiÙÈ ÌÔ-ÚÔ‡Ó Ó· ‰È·ÎÚ›ÓÔ˘Ó ÙÔ ‰Â›ÁÌ· Û ˘Ô-ÔÌ¿‰Â˜ Ì‚¿ÛË Ù· ·ÔÙÂϤÛÌ·Ù· ÛÙËÓ Îϛ̷η ›‰ÔÛ˘: ÙÔ‚¿ÚÔ˜, Ë ÚfiÛÏË„Ë ‚ÈÙ·Ì›Ó˘ µ12 Î·È Ë Î·Ù·Ó¿Ïˆ-ÛË Ï·¯·ÓÈÎÒÓ Î·È ÊÚÔ‡ÙˆÓ.

∂›Ó·È ۷ʤ˜ fiÙÈ ÔÈ ·Ó·Ù˘ÍȷΤ˜ ‰ÂÍÈfiÙËÙ˜ÛÙÔÓ ¿ÓıÚˆÔ ‰ÂÓ Â›Ó·È ·ÓÂÍ¿ÚÙËÙ˜ ·fi ÙÔ ÎÔÈ-ÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎfi ÂÚÈ‚¿ÏÏÔÓ (2,8,10,11,32). ¶·Ú’fiÏÔ, ÏÔÈfiÓ, Ô˘ ÔÈ ‚Ï¿‚˜ ÏfiÁˆ Ù˘ η΋˜ ‰È·-ÙÚÔÊ‹˜ - fiÙ·Ó Ï·Ì‚¿ÓÔ˘Ó ¯ÒÚ· ηٿ ÙȘ ÎÚ›ÛÈ̘ÂÚÈfi‰Ô˘˜ Ù˘ ÂͤÏÈ͢ - Ô‰ËÁÔ‡Ó Û ·Ó·Ù˘ÍÈ·-Τ˜ ηı˘ÛÙÂÚ‹ÛÂȘ, ÁÂÓÈο Â›Ó·È ·Ó·ÛÙÚ¤„È̘,ÂÊfiÛÔÓ ÂÍ·ÛÊ·ÏÈÛÙ› ¤Ó· ¢ÓÔ˚Îfi ÂÚÈ‚¿ÏÏÔÓ Î·Èۯ‰ȷÛÙ› Ë Î·Ù¿ÏÏËÏË ·Ú¤Ì‚·ÛË (11). ™‡Ìʈ-Ó· Ì ÚfiÛÊ·ÙÔ ¿ÚıÚÔ, Û ÏËı˘ÛÌÔ‡˜ Ô˘ ‚Ú›-ÛÎÔÓÙ·È Û ‰˘ÛÌÂÓ›˜ ÎÔÈÓˆÓÈΤ˜ Û˘Óı‹Î˜, ··È-ÙÂ›Ù·È ·Ú¤Ì‚·ÛË ÛÙËÓ ËÏÈΛ· ÙˆÓ 18-24 ÌËÓÒÓ,ÂÓÒ ÌÂÙ¿ ÙÔ˘˜ 24 Ì‹Ó˜ Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ¿Ù˘ ÂÍ·ÚÙ¿Ù·È ·fi ÙÔ Â›‰Ô˜ (‰È·ÙÚÔÊÈ΋, È·ÙÚÈ΋,ÂÎ·È‰Â˘ÙÈ΋) Î·È ÙË ‰È¿ÚÎÂÈ¿ Ù˘ (2). ™˘Ó‹ıˆ˜, ˷ڤ̂·ÛË ÂÚÈÏ·Ì‚¿ÓÂÈ ¤Ó· ‰È·ÈÙÔÏfiÁÈÔ ÚÔ-Û·ÚÌÔṲ̂ÓÔ ÛÙȘ ·Ó¿ÁΘ ÙÔ˘ ·ÙfiÌÔ˘, ÛˆÛÙ‹ È·-ÙÚÈ΋ ÂÚ›ı·Ï„Ë Î·È, Ù·˘Ùfi¯ÚÔÓ·, Û˘ÌÌÂÙÔ¯‹ ÛÂÚÔÁÚ¿ÌÌ·Ù· Âη›‰Â˘Û˘ ÁÔÓ¤ˆÓ Î·È ·È‰ÈÒÓ(2). ŒÚ¢ӷ Ô˘ ÌÂϤÙËÛ ÙȘ ÛÙ¿ÛÂȘ Ì·ıËÙÒÓËÏÈΛ·˜ 7-17 ÂÙÒÓ ˆ˜ ÚÔ˜ ÙË ‰È·ÙÚÔÊ‹, ·Ôο-Ï˘„ fiÙÈ ÔÈ ›‰ÈÔÈ ÔÈ Ì·ıËÙ¤˜ ·Ó·ÁÓˆÚ›˙Ô˘Ó fiÙÈ Ë˘ÁÈÂÈÓ‹ ‰È·ÙÚÔÊ‹ Î·È Ë Ê˘ÛÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ·Ô‰ËÁÔ‡Ó Û ‚ÂÏÙ›ˆÛË ÙˆÓ ·Ó·Ù˘ÍÈ·ÎÒÓ ÈηÓÔÙ‹-ÙˆÓ Î·È Ù˘ Ê˘ÛÈ΋˜ ηٿÛÙ·Û˘, ηıÒ˜ Î·È Û„˘¯ÔÏÔÁÈο Î·È ÎÔÈÓˆÓÈο ÔʤÏË. ¶ÈÛÙÂ‡Ô˘Ó fiÙÈÁÈ· Ó· ÂÈÙ‡¯Ô˘Ó ÛˆÛÙ‹ ‰È·ÙÚÔÊ‹ Î·È ¿ÛÎËÛ˯ÚÂÈ¿˙ÔÓÙ·È, ÌÂٷ͇ ¿ÏψÓ, ˘ÔÛÙ‹ÚÈÍË ·fi ÁÔ-Ó›˜ Î·È ÂÎ·È‰Â˘ÙÈÎÔ‡˜ Î·È ÂÓË̤ڈÛË (33).

∫·ıÒ˜ Ë Î·Î‹ ‰È·ÙÚÔÊ‹ Ì·ÎÚÔ¯ÚfiÓÈ· ÂȉڿÛÙËÓ ÂÎ·È‰Â˘ÙÈ΋ Î·È Â·ÁÁÂÏÌ·ÙÈ΋ ÔÚ›·, ÙËÓ„˘¯È΋ ˘Á›· Î·È ÙȘ ÎÔÈÓˆÓÈΤ˜ Û¯¤ÛÂȘ ÙÔ˘ ·Ùfi-ÌÔ˘, Ô Û¯Â‰È·ÛÌfi˜ ÙfiÛÔ ÚÔÁÚ·ÌÌ¿ÙˆÓ ÚfiÏ˄˘fiÛÔ Î·È ÚÔÁÚ·ÌÌ¿ÙˆÓ ·Ú¤Ì‚·Û˘ ÁÈ· ·È‰È¿Û¯ÔÏÈ΋˜ ËÏÈΛ·˜, ηı›ÛÙ·Ù·È ··Ú·›ÙËÙÔ˜.

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·186

Page 44: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

187

¶·È‰È·ÙÚÈ΋ 2004;67:178-189 Paediatriki 2004;67:178-189

¶·Ú¿ÚÙËÌ·.

∫ϛ̷η Ì·ıËÛȷ΋˜ ›‰ÔÛ˘

∞Á·ËÙ¤ ‰¿ÛηÏÂ/‰·ÛοϷ. ∑ËÙ¿Ì ӷ ÂÓÙÔ›ÛÔ˘Ì ·È‰È¿Ô˘ ¤¯Ô˘Ó ‰˘ÛÎÔϛ˜ ÛÙÔ Û¯ÔÏ›Ô, ·ÓÂÍ¿ÚÙËÙ· ÙÔ˘ ¿Ӥ¯Ô˘Ó Î·È È‰È·›ÙÂÚ· ÚÔÛfiÓÙ·. £· ‚ÔËıËıԇ̠ÛÙÔ Ó· ÂÓÙÔ-›ÛÔ˘Ì ·Èٛ˜ Î·È ·˘Ùfi ı· ‚ÔËı‹ÛÂÈ ÔÏÏ¿ ·È‰È¿. ∞˘Ùfi˜ ›-Ó·È Ô ÛÎÔfi˜ ÙˆÓ ÂÚˆÙ‹ÛÂˆÓ Ô˘ ·ÎÔÏÔ˘ıÔ‡Ó.

™¯ÔÏ›Ô: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .∆¿ÍË: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .∆ËϤʈÓÔ: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OÓÔÌ·ÙÂÒÓ˘ÌÔ Ì·ıËÙ‹: . . . . . . . . . . . . . . . . . . . . . . . . . .µ·ıÌÔ› (1-10): ª·ıËÌ·ÙÈο: . . . . . . . . . . . . . . . . . . . . . . . .°ÏÒÛÛ·: . . . . . . . . . . . . . . . . .πÛÙÔÚ›·: . . . . . . . . . . . . . . .Œ¯ÂÈ È‰È·›ÙÂÚ· ηϋ ›‰ÔÛË Û οÔÈÔ Ì¿ıËÌ·; ™Â ÔÈÔ; . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(µ·ıÌÔÏÔÁ‹ÛÙ ÛËÌÂÈÒÓÔÓÙ·˜ à ÛÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë ı¤ÛË ˆ˜ÂÍ‹˜: 3=Ôχ ηÎfi, 2=ÏÈÁfiÙÂÚÔ Î·Îfi, 1=‡ÔÙÔ, 0=ηÏfi)

∞ÎÔ˘ÛÙÈ΋ ·ÓÙ›ÏË„Ë 0 1 2 31. Œ¯ÂÈ ÙËÓ ÈηÓfiÙËÙ· Ó· ·ÎÔÏÔ˘ı‹ÛÂÈ

ÚÔÊÔÚÈΤ˜ Ô‰ËÁ›Â˜;2. ∞ÓÙÈÏ·Ì‚¿ÓÂÙ·È ÙË Û˘˙‹ÙËÛË

ÛÙË Û¯ÔÏÈ΋ Ù¿ÍË;3. Œ¯ÂÈ ÙËÓ ÈηÓfiÙËÙ· Ó· Û˘ÁÎÚ·Ù‹ÛÂÈ fiÙÈ

·ÎÔ‡ÂÈ ÛÙÔ Ì¿ıËÌ·;4. ∞ÓÙÈÏ·Ì‚¿ÓÂÙ·È ÙË ÛËÌ·Û›· ÙˆÓ Ï¤ÍˆÓ;

¶ÚÔÊÔÚÈÎfi˜ ÏfiÁÔ˜ 0 1 2 35. ∏ ¤ÎÊÚ·Û‹ ÙÔ˘/Ù˘ Â›Ó·È Ï‹Ú˘

Î·È ·ÎÚÈ‚‹˜;6. ÃÚËÛÈÌÔÔÈ› ÏÔ‡ÛÈÔ ÏÂÍÈÏfiÁÈÔ;7. Œ¯ÂÈ ÙËÓ ÈηÓfiÙËÙ· Ó· ı˘Ì¿Ù·È ϤÍÂȘ;8. Œ¯ÂÈ ÙËÓ ÈηÓfiÙËÙ· Ó· Û˘Û¯ÂÙ›˙ÂÈ ÂÌÂÈڛ˜;9. Œ¯ÂÈ ÙËÓ ÈηÓfiÙËÙ· Ó· ‰È·ÌÔÚÊÒÓÂÈ È‰¤Â˜;

¶ÚÔÛ·Ó·ÙÔÏÈÛÌfi˜ 0 1 2 310. ¶ÚÔÛ·Ó·ÙÔÏ›˙ÂÙ·È ÁÚ‹ÁÔÚ·;11. ¶ÚÔÛ·Ó·ÙÔÏ›˙ÂÙ·È Â‡ÎÔÏ· ÛÙÔÓ ¯ÒÚÔ;12. ∂ÎÙÈÌ¿ ‡ÎÔÏ· ‰È¿ÊÔÚ· ÌÂÁ¤ıË,

.¯. ·fiÛÙ·ÛË;13. ª·ı·›ÓÂÈ Â‡ÎÔÏ· ηÙ¢ı‡ÓÛÂȘ;™˘ÌÂÚÈÊÔÚ¿: ÙÔÓ/ÙË ‰È·ÎÚ›ÓÂÈ 0 1 2 314. ™˘ÓÂÚÁ·Û›·15. ¶ÚÔÛÔ¯‹16. πηÓfiÙËÙ· ÁÈ· ÔÚÁ¿ÓˆÛË17. πηÓfiÙËÙ· Ó· ·ÓÙÂÂͤگÂÙ·È

Û Ӥ˜ ηٷÛÙ¿ÛÂȘ18. ∫ÔÈÓˆÓÈ΋ ·Ô‰Ô¯‹

(.¯. ·fi ÙÔ˘˜ Û˘ÌÌ·ıËÙ¤˜ ÙÔ˘/Ù˘)19. ∞Ó·Ï·Ì‚¿ÓÂÈ Ì ˘Â˘ı˘ÓfiÙËÙ·

˘Ô¯ÚÂÒÛÂȘ;20. ∂ÎÙÂÏ› fiÙÈ ÙÔ˘/Ù˘ ·Ó·Ù›ıÂÙ·È;21. §ÂÙfiÙËÙ· ÛÙË Û˘ÌÂÚÈÊÔÚ¿ ∫ÈÓËÙÈ΋ Û˘ÌÂÚÈÊÔÚ¿ 0 1 2 322. OÈ ÎÈÓ‹ÛÂȘ ÙÔ˘/Ù˘ Â›Ó·È Û˘ÓÙÔÓÈṲ̂Ó˜;23. ∆ÔÓ/ÙË ‰È·ÎÚ›ÓÂÈ ÈÛÔÚÚÔ›· ÛÙÔ ‚¿‰ÈÛÌ·

Î·È ÙÔ ÙÚ¤ÍÈÌÔ;24. ∆ÔÓ/ÙË ‰È·ÎÚ›ÓÂÈ ‰ÂÍÈÔÙ¯ӛ·; 25. Œ¯ÂÈ ‰˘ÛÎÔÏ›· ÛÙË ÁÚ·Ê‹ ÁÚ·ÌÌ¿ÙˆÓ

Î·È ·ÚÈıÌÒÓ, ·Ú·ÙËÚÂ›Ù·È Î·ÎÔÁÚ·Ê›·;

26. ¢˘ÛÎÔχÂÙ·È ÛÙË ˙ˆÁÚ·ÊÈ΋;27. ∂›Ó·È “¿ÙÛ·ÏÔ˜/Ë”, ‰˘ÛÎÔχÂÙ·È Ó·

Ù·ÎÙÔÔÈ‹ÛÂÈ Ù· Ú¿ÁÌ·Ù¿ ÙÔ˘/Ù˘;28. ∆Ô˘/Ù˘ ¤ÊÙÔ˘Ó Û˘¯Ó¿ Ú¿ÁÌ·Ù·;29. ¢ÂÓ ÌÔÚ› Ó· ÁÚ¿„ÂÈ Ù· ÁÚ¿ÌÌ·Ù· ‹

ÙÔ˘˜ ·ÚÈıÌÔ‡˜ Û ÂÚÈÔÚÈṲ̂ÓÔ ¯ÒÚÔ (ÁÚ¿ÊÂÈ ¿ÓÙ· ÌÂÁ¿ÏÔ˘˜ ·ÚÈıÌÔ‡˜);

°ÏˆÛÛÈο 0 1 2 330. ¢È·‚¿˙ÂÈ Ì ¢¯¤ÚÂÈ·, ¯ˆÚ›˜ Ï¿ıË;31. ™ÙËÓ ÚÔÊÔÚÈ΋ ¤ÎÊÚ·ÛË, ¯ÚËÛÈÌÔÔÈ›

ÔÏÔÎÏËڈ̤Ó˜ ÚÔÙ¿ÛÂȘ ¯ˆÚ›˜ Ï¿ıË;32. ∂›‰ÔÛË ÛÙËÓ ¤ÎıÂÛË33. •Â¯ˆÚ›˙ÂÈ ˘ÔΛÌÂÓÔ, Ú‹Ì·, ·ÓÙÈΛÌÂÓÔ;34. •Â¯ˆÚ›˙ÂÈ ÎÏÈÙ¿ Î·È ¿ÎÏÈÙ· ̤ÚË ÙÔ˘ ÏfiÁÔ˘;35. ∫¿ÓÂÈ ÔÚıÔÁÚ·ÊÈο Ï¿ıË ÛÙȘ ηٷϋÍÂȘ

ÙˆÓ Ï¤ÍˆÓ;¢È¿Û·ÛË ÚÔÛÔ¯‹˜ 0 1 2 336. ¢˘ÛÎÔχÂÙ·È ÛÙË ‰È·Ù‹ÚËÛË Ù˘

ÚÔÛÔ¯‹˜ ÙÔ˘/Ù˘ ÛÙ· Ì·ı‹Ì·Ù· ‹ Û ‰È¿ÊÔÚ· ÛÙ¿‰È· Â›Ï˘Û˘ ÚÔ‚ÏËÌ¿ÙˆÓ;

37. ¢˘ÛÎÔχÂÙ·È ÛÙË ‰È·Ù‹ÚËÛË Ù˘ ÚÔÛÔ¯‹˜ Û ÛÔ‚·Ú¤˜ ¯ÚÔÓÈΤ˜ ÛÙÈÁ̤˜ (fiÙ·Ó Ô ‰¿ÛηÏÔ˜ ‰›ÓÂÈ Ô‰ËÁ›Â˜ ÁÈ· ÙÔ Ì¿ıËÌ· ‹ ÁÈ· ÙËÓ Â›Ï˘ÛËÚÔ‚Ï‹Ì·ÙÔ˜);

¢È·Ù·Ú·¯¤˜ ÔÙÈÎÔÎÈÓËÙÈΤ˜ 0 1 2 338. ¢˘ÛÎÔχÂÙ·È, ¯ˆÚÔÙ·ÍÈο, ÛÙÔ Ê‡ÏÏÔ

¯·ÚÙÈÔ‡ Ô˘ ÂÚÁ¿˙ÂÙ·È;39. ¢˘ÛÎÔχÂÙ·È ÛÂ Û˘ÌÌÂÙڛ˜ ‹

·Ó·ÛÙÚÔʤ˜ (‰È¿ÎÚÈÛË ÌÂٷ͇ 6 Î·È 9, 2 Î·È 5, 17 Î·È 71, Â Î·È 3, Ú Î·È 9 Î.Ï.);

40. Œ¯ÂÈ ‰˘ÛÎÔϛ˜ Ì ٷ ÓÔÌ›ÛÌ·Ù·, Ù· ۇ̂ÔÏ· ڿ͈Ó, ÙÔ˘˜ ‰Â›ÎÙ˜ ÚÔÏÔÁÈÔ‡;

41. ¢˘ÛÎÔχÂÙ·È Ó· ÁÚ¿„ÂÈ ÛÙÔ ¯·ÚÙ›, Û ¢ı›· ÁÚ·ÌÌ‹;

42. ¢˘ÛÎÔχÂÙ·È Ôχ Û ̷ıËÌ·ÙÈο ÚÔ‚Ï‹Ì·Ù·, fiÔ˘ Ú¤ÂÈ Ó· ÂÚÁ·ÛÙ› ÛÙÔÓ ¯ÒÚÔ, .¯. ÚÔ‚Ï‹Ì·Ù· Ô˘ ··ÈÙÔ‡Ó Û˘Û¯¤ÙÈÛË ÙˆÓ: ¿Óˆ-οو Î·È ·ÚÈÛÙÂÚ¿-‰ÂÍÈ¿ (fiˆ˜ οıÂÙË ÚfiÛıÂÛË), Ù·ÎÙÔÔ›ËÛË ·ÚÈıÌÒÓ Û ÔÌ¿‰Â˜, ÛÙÔȯÂÈÔı¤ÙËÛË ·˘ÙÒÓ;

43. ¢˘ÛÎÔχÂÙ·È Ó· ÁÚ¿„ÂÈ ¤Ó·Ó Ì·ÎÚ‡ ·ÚÈıÌfi ‹ Ì›· ÌÂÁ¿ÏË Ï¤ÍË Û ¢ı›· ÁÚ·ÌÌ‹;

¢˘ÛÎÔϛ˜ ÛÙËÓ ·ÎÔ˘ÛÙÈ΋ ÂÂÍÂÚÁ·Û›· 0 1 2 344. ¢˘ÛÎÔχÂÙ·È ÛÙÔ Ó· οÓÂÈ

ÚÔÊÔÚÈΤ˜ ·Û΋ÛÂȘ;45. ¢ÂÓ ÌÔÚ› Ó· Û˘Ó¯›ÛÂÈ ÙÔ Ì¤ÙÚËÌ·

Û ̛· ·ÎÔÏÔ˘ı›·;∞‰˘Ó·Ì›Â˜ ÌÓ‹Ì˘ 0 1 2 346. ¢ÂÓ ÌÔÚ› Ó· Û˘ÁÎÚ·Ù‹ÛÂÈ

Ó¤· ÏËÚÔÊÔÚ›· ‹, ȉȷ›ÙÂÚ·, Ì·ıËÌ·ÙÈο ÓÔ‡ÌÂÚ·;

47. •Â¯Ó¿ ÛÙ¿‰È· Û ̷ıËÌ·ÙÈΤ˜ Ú¿ÍÂȘ;48. ∏ ·fi‰ÔÛ‹ ÙÔ˘/Ù˘ Â›Ó·È ÊÙˆ¯‹

ÛÙËÓ Â·Ó¿ÏË„Ë Ì·ıËÌ¿ÙˆÓ ‹ ÙËÓ ·ÓÙ›ÏË„Ë ÌÈÎÙÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ;

49. ¢˘ÛÎÔχÂÙ·È Ó· ÂÈ ÙËÓ ÒÚ·; 50. ¢˘ÛÎÔχÂÙ·È Ó· χÛÂÈ ÚÔÊÔÚÈο

ÚÔ‚Ï‹Ì·Ù· Ô˘ ¤¯Ô˘Ó ÔÏÏ¿ ÛÙ¿‰È·;

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·187

Page 45: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

188

¶·È‰È·ÙÚÈ΋ 2004;67:178-189 Paediatriki 2004;67:178-189

∂˘¯·ÚÈÛٛ˜ ∏ ÌÂϤÙË ¯ÚËÌ·ÙÔ‰ÔÙ‹ıËΠ·fi ÙËÓ ÂÙ·ÈÚ›· Kellog’s

Î·È ÙÔ ÀÔ˘ÚÁÂ›Ô ∂ıÓÈ΋˜ ¶·È‰Â›·˜ Î·È £ÚËÛÎÂ˘Ì¿ÙˆÓ. ∂˘-¯·ÚÈÛÙԇ̠ıÂÚÌ¿ ÙËÓ ÂÚ¢ÓËÙÈ΋ ÔÌ¿‰· Ù˘ ∫ÏÈÓÈ΋˜ ¶ÚÔ-ÏËÙÈ΋˜ π·ÙÚÈ΋˜ Î·È ¢È·ÙÚÔÊ‹˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘ÁÈ· ÙË Û˘ÓÂÚÁ·Û›· Î·È ÙËÓ ÔχÙÈÌË ‚Ô‹ıÂÈ¿ Ù˘: ºÚfiÛˆªÂÚ‚·Ó¿ÎË, ƒ¤Ó· ª¿ÚηÙ˙Ë, ™ÔÊ›· ºÏÔ˘Ú‹, ª˘ÚˆÓ›· §·-ÓÙ˙Ô˘Ú¿ÎË, ∂ϤÓË §ÔÁÔı¤ÙË, °ÂˆÚÁ›· ¶ÂÚ‚ÔÏ·Ú¿ÎË, ∫·ÙÂ-Ú›Ó· ™·ÚÚ‹, ∂ÈÚ‹ÓË ™ËÊ¿ÎË, πˆ¿ÓÓ· ∞ÔÛÙÔÏ¿ÎË, ÃÚ‹ÛÙÔ÷Ù˙‹ Î·È °È¿ÓÓË ª·ÓÈfi.

µÈ‚ÏÈÔÁÚ·Ê›· 1. James WP, Nelson M, Ralph A, Leather S. Socioeconomic

determinants of health. The contribution of nutrition toinequalities in health. BMJ 1997;314:1545-1549.

2. Pollitt E. Developmental sequel from early nutritionaldeficiencies: conclusive and probability judgments. J Nutr2000;130 (2 Suppl):S350-S353.

3. Auestad N, Scott DT, Janowsky JS, Jacobsen C, CarrollRE, Montalto MB et al. Visual, cognitive, and languageassessments at 39 months: a follow-up study of childrenfed formulas containing long-chain polyunsaturated fattyacids to 1 year of age. Pediatrics 2003;112:177-183.

4. Lanting CI, Fidler V, Huisman M, Touwen BC, Boersma ER.Neurological differences between 9-year-old children fedbreast-milk or formula-milk as babies. Lancet 1994;344:1319-1322.

5. Oddy WH, Kendall GE, Blair E, De Klerk NH, Stanley FJ,Landau LI et al. Breast feeding and cognitive developmentin childhood: a prospective birth cohort study. PaediatrPerinat Epidemiol 2003;17:81-90.

6. Abalkhail B, Shawky S. Prevalence of daily breakfastintake, iron deficiency anaemia and awareness of beinganaemic among Saudi school students. Int J Food Sci Nutr2002;53:519-528.

7. Kleinman RE, Hall S, Green H, Korzec-Ramirez D, PattonK, Pagano ME et al. Diet, breakfast, and academicperformance in children. Ann Nutr Metab 2002;46 (1Suppl):S24-S30.

8. Wachs TD. Relation of mild-to-moderate malnutrition tohuman development: correlational studies. J Nutr1995;125 (8 Suppl):S2245-S2254.

9. Anderson GH. Diet, neurotransmitters and brain function.Br Med Bull 1981;37:1:95-100.

10. Grantham-McGregor S. A review of studies of the effect ofsevere malnutrition on mental development. J Nutr1995;125 (8 Suppl):S2233-S2238.

11. Strupp BJ, Levitsky DA. Enduring cognitive effects of earlymalnutrition: a theoretical reappraisal. J Nutr 1995;125 (8Suppl):S2221-S2232.

12. Levitsky DA, Strupp BJ. Malnutrition and the brain:changing concepts, changing concerns. J Nutr 1995;125(8 Suppl):S2212-S2220.

13. Schurch B. Malnutrition and behavioral development: thenutrition variable. J Nutr 1995;125 (8 Suppl):S2255-S2262.

14. Lozoff B, Jimenez E, Hagen J, Mollen E, Wolf AW. Poorerbehavioral and developmental outcome more than 10years after treatment for iron deficiency in infancy.Pediatrics 2000;105:E51.

15. Southon S, Wright AJ, Finglas PM, Bailey AL, LoughridgeJM, Walker AD. Dietary intake and micronutrient status ofadolescents: effect of vitamin and trace elementsupplementation on indices of status and performance intests of verbal and non-verbal intelligence. Br J Nutr1994;71:897-918.

16. Benton D. Micro-nutrient supplementation and theintelligence of children. Neurosci Biobehav Rev2001;25:297-309.

17. Moschandreas JA, Kafatos A. Calcium intake in relation todiet and health indicators in Cretan primary and highschool pupils, Greece. Int J Vitam Nutr Res 2002;72:264-277.

18. ∫·Ê¿ÙÔ˜ ∞, ª·ÓÈfi˜ °, ÷Ù˙‹˜ Ã, ªÔÛ¯·Ó‰Ú¤· π, ª·Ïˆ-ÌÂÓ¿ÎË ∂, ∞ı·Ó·ÛfiÔ˘ÏÔ˜ ¢ Î·È Û˘Ó. ∞ÍÈÔÏfiÁËÛË ÚÔ-ÁÚ¿ÌÌ·ÙÔ˜ “∞ÁˆÁ‹ ÀÁ›·˜” ÌÂÙ¿ ·fi ÙÚ›· ¯ÚfiÓÈ· ÂηÈ-‰Â˘ÙÈ΋˜ ·Ú¤Ì‚·Û˘ ÛÙ· ‰ËÌÔÙÈο Û¯ÔÏ›· Ù˘ ∫Ú‹Ù˘.¶·È‰È·ÙÚÈ΋ 1998;61:483-497.

19. Mamalakis G, Kafatos A, Manios Y, Anagnostopoulou T,Apostolaki I. Obesity indices in a cohort of primary schoolchildren in Crete: a six year prospective study. Int J ObesRelat Metab Disord 2000;24:765-771.

20. Lerner JW. Learning disabilities: theories, diagnosis andteaching strategies. Boston, USA: Houghton MifflinCompany; 1993.

21. ∆˙ÂÓ¿ÎË ª, ∫·Ú·ÎˆÓÛÙ·ÓÙ¿ÎË ∂, §ÈÓ·Ú‰¿Î˘ ª, ªÈ¯ÂÏÔ-ÁÈ¿ÓÓ˘ ™. O ÚfiÏÔ˜ ÙÔ˘ ·È‰È¿ÙÚÔ˘ ÛÙËÓ ·Ó›¯Ó¢ÛË ÙÔ˘Û˘Ó‰ÚfiÌÔ˘ ÂÏÏÂÈÌÌ·ÙÈ΋˜ ÚÔÛÔ¯‹˜ Ì ˘ÂÚÎÈÓËÙÈÎfiÙË-Ù·. ¶·È‰È·ÙÚÈ΋ 2002;65:452-462.

22. Sandstead HH. Causes of iron and zinc deficiencies andtheir effects on brain. J Nutr 2000;130 (2 Suppl):S347-S349.

23. Eastley R, Wilcock GK, Bucks RS. Vitamin B12 deficiency indementia and cognitive impairment: the effects oftreatment on neuropsychological function. Int J GeriatrPsychiatry 2000;15:226-233.

24. Jeffery DR. Nutrition and diseases of the nervous system.In: Shils ME, Olson JA, Shike M, Ross AC, editors. Modernnutrition in health and disease. 9th ed. Baltimore:Lippincott William & Wilkins; 1999. p. 1544-1548.

25. La Rue A, Koehler KM, Wayne SJ, Chiulli SJ, Haaland KY,Garry PJ. Nutritional status and cognitive functioning in anormally aging sample: a 6-y reassessment. Am J ClinNutr 1997;65:20-29.

26. Vatassery GT, Bauer T, Dysken M. High doses of vitamin Ein the treatment of disorders of the central nervous systemin the aged. Am J Clin Nutr 1999;70:793-801.

27. Perkins AJ, Hendrie HC, Callahan CM, Gao S, UnverzagtFW, Xu Y et al. Association of antioxidants with memory ina multiethnic elderly sample using the Third NationalHealth and Nutrition Examination Survey. Am J Epidemiol1999;150:37-44.

28. Joseph JA, Shukitt-Hale B, Denisova NA, Prior RL, Cao G,Martin A et al. Long-term dietary strawberry, spinach, orvitamin E supplementation retards the onset of age-relatedneuronal signal-transduction and cognitive behavioraldeficits. J Neurosci 1998;18:8047-8055.

29. Bougle D, Denise P, Vimard F, Nouvelot A, Penneillo MJ,Guillois B. Early neurological and neuropsychologicaldevelopment of the preterm infant and polyunsaturated

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·188

Page 46: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

189

¶·È‰È·ÙÚÈ΋ 2004;67:178-189 Paediatriki 2004;67:178-189

fatty acids supply. Clin Neurophysiol 1999;110:1363-1370. 30. Kim HY, Frongillo EA, Han SS, Oh SY, Kim WK, Jang YA et

al. Academic performance of Korean children is associatedwith dietary behaviours and physical status. Asia Pac J ClinNutr 2003;12:186-192.

31. Eaton WO, McKeen NA, Campbell DW. The waxing andwaning of movement: implications for psychologicaldevelopment. Dev Rev 2001;21:205-223.

32. Mendez MA, Adair LS. Severity and timing of stunting inthe first two years of life affect performance on cognitivetests in late childhood. J Nutr 1999;129:1555-1562.

33. O’dea JA. Why do kids eat healthful food? Perceivedbenefits of and barriers to healthful eating and physicalactivity among children and adolescents. J Am Diet Assoc2003;103:497-501.

∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 06-05-2003 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 22-04-2004

¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∂ϤÓË ∫·Ú·ÎˆÓÛÙ·ÓÙ¿ÎË πˆÓ›·˜ 79, ∆.∫. 713 05, ∏Ú¿ÎÏÂÈÔ ∫Ú‹Ù˘

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·189

Page 47: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

190

¶·È‰È·ÙÚÈ΋ 2004;67:190-194 Paediatriki 2004;67:190-194

∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞ ORIGINAL ARTICLE

ªÈÎÚ¿ ·È‰È¿… ÌÂÁ¿ÏÔ˜ ·‰ÂÏÊfi˜∫. ∆˙È¿ÚÔ˘1, ª. ∆·‚Ï·ÓÙ¿1, Ã. •˘ÔÏÈ¿2, ¶. ∆·‚Ï·ÓÙ¿˜1

Young children… Big BrotherK. Tziarou1, M. Tavlanta1, C. Xypolia2, P. Tavlantas1

∂ÈÛ·ÁˆÁ‹∏ ÙËÏÂfiÚ·ÛË ÂÌÊ·Ó›ÛÙËΠÛÙȘ ∏.¶.∞. ÁÈ· ÚÒ-

ÙË ÊÔÚ¿ ÙÔ 1939, ·fi ÙÔ ‰›ÎÙ˘Ô N.B.C. Î·È ÙÔ 1941

ÌÂÙ¤‰ˆÛ ÙËÓ ÚÒÙË ÂÓÙ¿ÏÂÙË ‰È·Ê‹ÌÈÛË (1,2).OÚÈṲ̂ÓÔÈ Û˘ÁÁÚ·Ê›˜, ·fi Ù· ÚÒÙ· ¯ÚfiÓÈ·, ¤‰È-Ó·Ó ÙË ‰È΋ ÙÔ˘˜ ıÂÙÈ΋ ÂÚÌËÓ›· fiÛÔÓ ·ÊÔÚ¿ ÛÙË

�¶ÂÚ›ÏË„Ë: ∏ ÙËÏÂfiÚ·ÛË ·ÔÙÂÏ› Ì›· ·Î·Ù·Ó›-ÎËÙË ‰‡Ó·ÌË, ηıÒ˜ - Ì ٷ ‰ÔÚ˘ÊÔÚÈο ÚÔÁÚ¿Ì-Ì·Ù· - ¤Û·Û ٷ Û‡ÓÔÚ· ÙˆÓ Ï·ÒÓ Î·È Î·ıȤڈÛÂÓ¤· ‹ıË. ∏ ›‰Ú·Û‹ Ù˘ ÛÙ· ·È‰È¿ Â›Ó·È ·Ó·ÌÊÈ-Û‚‹ÙËÙ· ÌÂÁ¿ÏË, ÁÈ·Ù› οÔÈÔÈ ·Ì˘ÓÙÈÎÔ› Ì˯·ÓÈ-ÛÌÔ› ÙÔ˘˜ Â›Ó·È ·ÓÒÚÈÌÔÈ Î·È ·ÓÂͤÏÂÁÎÙÔÈ, ‰ËÌÈ-Ô˘ÚÁÒÓÙ·˜ ‡ÎÔÏ· Ì ·˘ÙfiÓ ÙÔÓ ÙÚfiÔ ÚfiÙ˘·Î·È ÙÚfiÔ˘˜ Û˘ÌÂÚÈÊÔÚ¿˜. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ÌÂÙ¿‰ÔÛ˘ Ù˘ ÂÎÔÌ‹˜ “Big Brother” ·fi ÙËÓ ÙË-ÏÂfiÚ·ÛË, ÂÂȉ‹ ‰¤¯ÙËΠÛÎÏËÚ‹ Î·È ·ÚÓËÙÈ΋ ÎÚÈ-ÙÈ΋ ÙfiÛÔ ÛÙËÓ ∂ÏÏ¿‰· fiÛÔ Î·È ÛÙÔÓ ˘fiÏÔÈÔ Îfi-ÛÌÔ, ÍÂΛÓËÛÂ Ë Î·Ù·ÁÚ·Ê‹ ÙˆÓ ·fi„ÂˆÓ ÙˆÓ ÁÔ-Ó¤ˆÓ Î·È ÙˆÓ ÌÈÎÚÒÓ ·È‰ÈÒÓ ÁÈ· ÙËÓ Â›‰Ú·ÛË Ô˘·ÛΛ Ë ÙËÏÂfiÚ·ÛË Î·È È‰È·›ÙÂÚ· Ë Û˘ÁÎÂÎÚÈ̤ÓËÂÎÔÌ‹ ÛÙÔÓ ÙÚfiÔ Û˘ÌÂÚÈÊÔÚ¿˜ Î·È ÛÙË ‰È·-ÌfiÚʈÛË ÙÔ˘ ¯·Ú·ÎÙ‹Ú· ÙˆÓ ·È‰ÈÒÓ. ∞fi ÙË ÌÂ-ϤÙË ‰È·ÈÛÙÒıËΠfiÙÈ, ÛÙËÓ Â·Ú¯›·, Ë ÙËÏÂfiÚ·ÛË·ÔÙÂÏ› ÙÔ ÌÔÓ·‰ÈÎfi ̤ÛÔ „˘¯·ÁˆÁ›·˜ Î·È ÂÓË̤-ÚˆÛ˘. ∆· ·È‰È¿ ·Ú·ÎÔÏÔ˘ıÔ‡Ó ÙËÏÂfiÚ·ÛË ·ÓÂ-ͤÏÂÁÎÙ·, ÔÏϤ˜ ÒÚ˜ ÙËÓ Ë̤ڷ, Ì fiÏ· Ù· ·-ÎfiÏÔ˘ı·. ∆· ·È‰È¿ ÛÙËÓ ÏÂÈÔ„ËÊ›· ÙÔ˘˜ ‰ÂÓ ÁÓÒ-ÚÈ˙·Ó ÙËÓ ÚˆÙÂ‡Ô˘Û· ÙÔ˘ ÓÔÌÔ‡, ÙÔÓ ¶Úfi‰ÚÔÙ˘ ¢ËÌÔÎÚ·Ù›·˜ Î·È Ù˘ ∫˘‚¤ÚÓËÛ˘, ·ÏÏ¿ ÁÓÒÚÈ-˙·Ó ·ÎÚÈ‚Ò˜ ÙËÓ ÒÚ· ÌÂÙ¿‰ÔÛ˘ Ù˘ ÂÎÔÌ‹˜, Ù·ÔÓfiÌ·Ù· ÙˆÓ ·È¯ÙÒÓ Î·È ÙÈ ·ÎÚÈ‚Ò˜ ÁÈÓfiÙ·Ó ÛÙÔÛ›ÙÈ ÙÔ˘ “ªÂÁ¿ÏÔ˘ ∞‰ÂÏÊÔ‡”.

§¤ÍÂȘ ÎÏÂȉȿ: ·È‰È¿, ÙËÏÂfiÚ·ÛË, ÔÈÎÔÁ¤ÓÂÈ·, ÙË-Ï·ȯӛ‰È·.

�Abstract: Nowadays television is considered tohave an unbeatable power, which, along with itssatellite programmes, breaks national borders andestablishes new sets of morals. The effects oftelevision on children’s behaviour are particularlyserious because a part of their defensive mechanismis weak, immature and uncontrollable. For thisreason television can easily shape models and waysof behaving. The strong, negative criticism that “BigBrother” received, not only in Greece but also all overthe world, led to a study of what parents andyoungsters in the rural area of Argolida believe,based on their written accounts. Most of the pointsthat were raised concerned the effects on theattitudes of teenagers, and the possibility that thedevelopment of their character may be influenced bytelevision and more specifically by the reality show.From the research that was undertaken, it was foundthat television is the most common form ofentertainment in the district. Children watch televisionmany hours a day, facing at the end, all of itsconsequences. However, one finding of the studywas that the majority of the children did not knowbasic facts like the capital of the region, or name ofthe President of Democracy, or the party inGovernment, but a surprisingly large percentagehappened to know the exact time of transmission ofthe show, the name of each player, as well as exactlywhat was going on in the house of “Big Brother”.

Key words: children, television, family, realityshows.

1 ∫¤ÓÙÚÔ ÀÁ›·˜ §˘ÁÔ˘ÚÈÔ‡, ¡. ∞ÚÁÔÏ›‰·˜ 2 ¢ËÌÔÙÈÎfi ™¯ÔÏÂ›Ô ∞ÛÎÏËÈ›Ԣ, ¡. ∞ÚÁÔÏ›‰·˜

1 Health Centre of Lygourio, Prefecture of Argolida 2 Primary School of Asklipieio, Prefecture of Argolida

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·190

Page 48: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

191

¶·È‰È·ÙÚÈ΋ 2004;67:190-194 Paediatriki 2004;67:190-194

ÌÂÙ·‰ÔÙÈ΋ ›‰Ú·Û‹ Ù˘ ÛÙËÓ ÎÔÈÓˆÓ›· ÁÂÓÈÎfiÙÂ-Ú·, ˘ÔÛÙËÚ›˙ÔÓÙ·˜ fiÙÈ Ù· ÌËӇ̷ٿ Ù˘ ·ÔÙÂ-ÏÔ‡Ó ¤Ó· ÔÙÈÎÔ·ÎÔ˘ÛÙÈÎfi ̤ÛÔ ÂÈÎÔÈÓˆÓ›·˜ ηÈÌ›· ÈηÓfiÙËÙ· ÂÚÌËÓ›·˜ Ù˘ ‰ÈۉȿÛÙ·Ù˘ ·ÚÔ˘-Û›·Û˘ Ù˘ ΛÓËÛ˘ Î·È ÙÔ˘ ¯ÒÚÔ˘ (3). ™ÙËÓ ∂ÏÏ¿-‰·, Ë ÙËÏÂfiÚ·ÛË ¿Ú¯ÈÛ ӷ ÂΤÌÂÈ ÙÔ 1966 Û·ÓÎÚ·ÙÈÎfi˜ ÊÔÚ¤·˜. ∞ÔÙÂÏ› ÙÔ ‰ËÌÔÊÈϤÛÙÂÚÔ Ì¤-ÛÔ ÂÈÎÔÈÓˆÓ›·˜ Î·È ‰È·ÛΤ‰·Û˘. ∂›Ó·È Ì›· ·Î·Ù·-Ó›ÎËÙË ‰‡Ó·ÌË, Ë ÔÔ›·, Ì ٷ ‰ÔÚ˘ÊÔÚÈο ÚÔ-ÁÚ¿ÌÌ·Ù·, ¤Û·Û ٷ Û‡ÓÔÚ· ÙˆÓ Ï·ÒÓ Î·È Î·ıȤ-ÚˆÛ Ӥ· ‹ıË. ∏ ›‰Ú·Û‹ Ù˘, ˆÛÙfiÛÔ, ÛÙ· ·È-‰È¿ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË, ÁÈ·Ù› οÔÈÔÈ ·Ì˘ÓÙÈÎÔ› Ì˯·-ÓÈÛÌÔ› ÙÔ˘˜ Â›Ó·È ·ÓÒÚÈÌÔÈ Î·È ·ÓÂͤÏÂÁÎÙÔÈ Î·È Â‡-ÎÔÏ· ‰ËÌÈÔ˘ÚÁÔ‡Ó ÚfiÙ˘· Î·È ÙÚfiÔ˘˜ Û˘ÌÂÚÈ-ÊÔÚ¿˜ (4-6).

ª¤Û· ÛÙÔ Ï‹ıÔ˜ ÙˆÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ Ô˘ η-Ù·Îχ˙Ô˘Ó Û ηıËÌÂÚÈÓ‹ ‚¿ÛË ÙËÓ ÙËÏÂfiÚ·ÛË, ÂÌ-Ê·Ó›ÛÙËÎÂ Î·È ÙÔ ÙËÏ·ȯӛ‰È “Big Brother”, ‚·ÛÈ-Ṳ̂ÓÔ ÛÙËÓ È‰¤· fiÙÈ Ù· ¿ÓÙ· ÛÙË ˙ˆ‹ ÙÔ˘ ·ÓıÚÒ-Ô˘ ı· “ηٷÁÚ¿ÊÔÓÙ·È-ÂϤÁ¯ÔÓÙ·È” ·fi ¤Ó· ·fi-Ú·ÙÔ Ì¿ÙÈ, ÙÔÓ “ªÂÁ¿ÏÔ ∞‰ÂÏÊfi”. ∏ ȉ¤· ÚÔ‹Ïı·fi ÙÔ ‚È‚Ï›Ô ÙÔ˘ George Orwell (1984) “O ªÂÁ¿-ÏÔ˜ ∞‰ÂÏÊfi˜” (7). ŸÛÔÈ ¤¯Ô˘Ó ·Ú·ÎÔÏÔ˘ı‹ÛÂÈÛ˘ÛÙËÌ·ÙÈο ‹ ÂÚÈÛÙ·Ûȷο Ù· Û˘ÁÎÂÎÚÈ̤ӷ ÙË-Ï·ȯӛ‰È· ÛÙËÓ ÂÏÏËÓÈ΋ ÙÔ˘˜ ÂΉԯ‹ ÁÓˆÚ›˙Ô˘ÓfiÙÈ ·˘Ù¿ Û˘Ó›ÛÙ·ÓÙ·È ÛÙË ‰È·ÌÔÓ‹ οÔÈˆÓ ·ÙfïÓ- Î·È ÙˆÓ ‰‡Ô Ê‡ÏˆÓ - Û ¤Ó·Ó ÎÏÂÈÛÙfi ¯ÒÚÔ, ¤Ó·“Û›ÙÈ”, fiÔ˘ ˙Ô˘Ó ÁÈ· ÔÚÈṲ̂ÓÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·,Ì·ÎÚÈ¿ ·fi ÙȘ ÔÈÎÔÁ¤ÓÂȤ˜ ÙÔ˘˜ Î·È ÙÔ˘˜ Ê›ÏÔ˘˜ÙÔ˘˜, ÂÓÒ Ë ˙ˆ‹ ÙÔ˘˜ ·Ú·ÎÔÏÔ˘ıÂ›Ù·È fiÏÔ ÙÔ24ˆÚÔ. ŸÏÔÈ ÔÈ Û˘ÌÌÂÙ¤¯ÔÓÙ˜ Á›ÓÔÓÙ·È ÁÓˆÛÙÔ›ÛÙÔ Â˘Ú‡ ÎÔÈÓfi - ¤Ó· ›‰Ô˜ ÂÊ‹ÌÂÚˆÓ ÛÙ·Ú - ›Ù ÌÂÙÔ fiÓÔÌ¿ ÙÔ˘˜ ›Ù Ì ÙË Ê˘ÛÈÔÁӈ̛· ÙÔ˘˜. ŒÙÛÈÁ›ÓÔÓÙ·È ·Ó·ÁÓˆÚ›ÛÈÌÔÈ, ÂÓÒ ·˘Ù‹ Ë ÚÔÛˆÚÈÓ‹‰È·ÛËÌfiÙËÙ· ÌÔÚ› ÂӉ¯Ô̤ӈ˜ Ó· ‚ÔËı‹ÛÂÈÛÙËÓ Â·ÁÁÂÏÌ·ÙÈ΋ ÙÔ˘˜ ηÚȤڷ. ¶ÚfiÎÂÈÙ·È ÁÈ·Ì›· ÛÙË̤ÓË ÚfiÎÏËÛË ÛÙËÓ ·ÓıÚÒÈÓË Ê‡ÛË Î·-ı·˘Ù‹, ÛÙËÓ ·ÓıÚÒÈÓË Ô˘Û›·, ÛÙËÓ Î·Ú‰È¿ ÙÔ˘„˘¯ÈÎÔ‡ ÎfiÛÌÔ˘, ÛÙËÓ È‰È·ÈÙÂÚfiÙËÙ· ÙÔ˘ ηıÂÓfi˜,ηıÒ˜ ·˘Ù‹ Ë È‰È·ÈÙÂÚfiÙËÙ· ÌÂÙ·ÙÚ¤ÂÙ·È Û ÙËÏÂ-ÔÙÈÎfi ·ÓÙÈΛÌÂÓÔ. ∆Ô ÂÚȯfiÌÂÓÔ Ù˘ ÂÎÔÌ‹˜“Big Brother”, Û·Ó ı¤Ì· Ù˘ ÙËÏÂfiÚ·Û˘, ·ÔÙÂÏ›¤Ó· ‰›Ô ·Ó¿Ù˘Í˘-‰Ú¿Û˘-ÚÔ‚ÏËÌ·ÙÈÛÌÔ‡ Ù˘ÂÈÚ·Ì·ÙÈ΋˜ „˘¯ÔÏÔÁ›·˜, fiÔ˘ ÂÈÎÚ·Ù› Ë „˘¯Ô-ÏÔÁ›· ÙÔ˘ “˙‡ÁÔ˘˜”: ÚfiıÂÛË-·fiÚÚÈ„Ë, ‰È¤ÁÂÚ-ÛË-·Ó·ÛÙÔÏ‹, ·Ú·ÌÔÓ‹-·fi‰Ú·ÛË, ÛÂÍÔ˘·ÏÈ΋·ʋ-·ÔÊ˘Á‹, ËıÔÔÈ›·-ÂÍ¢ÙÂÏÈÛÌfi˜.

∆Ô Û˘ÁÎÂÎÚÈ̤ÓÔ ÙËÏ·ȯӛ‰È, ÙÔ ÔÔ›Ô ·ÚÔ˘-ÛÈ¿ÛÙËÎÂ Î·È Û ¿ÏϘ ¯ÒÚ˜, ‰¤¯ÙËΠÛÎÏËÚ‹ ·Ú-ÓËÙÈ΋ ÎÚÈÙÈ΋ ÂÍ·ÈÙ›·˜ ÙÔ˘ ÂÚȯÔ̤ÓÔ˘ Î·È ÙÔ˘ÙÚfiÔ˘ ‰ÈÂÍ·ÁˆÁ‹˜ ÙÔ˘. ∆Ô ›‰ÈÔ Û˘Ó¤‚Ë Î·È ÛÙËÓ∂ÏÏ¿‰·. ªÂ ·˘Ù‹ ÙËÓ ·ÊÔÚÌ‹, ÍÂΛÓËÛÂ Ë Î·Ù·-ÁÚ·Ê‹ Ù˘ ›‰Ú·Û˘ Ô˘ ·ÛΛ Ë ÙËÏÂfiÚ·ÛË ÛÙËÓ

ÂÏÏËÓÈ΋ ÔÈÎÔÁ¤ÓÂÈ·, ηıÒ˜ Î·È Ù˘ Ù˘¯fiÓ ‰È·ÊÔ-ÚÔÔ›ËÛ˘ ÛÙË Û˘ÌÂÚÈÊÔÚ¿ ÙˆÓ ·È‰ÈÒÓ Î·È ÛÙˉËÌÈÔ˘ÚÁ›· ÚÔÙ‡ˆÓ Ô˘ ÂÈ‚¿ÏÏÂÈ ÙÔ “BigBrother” ÛÙË ˙ˆ‹ ÙÔ˘˜.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ∏ ¤Ú¢ӷ ·˘Ù‹ ‰ÈÂÓÂÚÁ‹ıËΠ۠·ÁÚÔÙÈ΋ ÂÚÈÔ¯‹ ÙÔ˘

ÓÔÌÔ‡ ∞ÚÁÔÏ›‰·˜, ·fi ÙÔÓ ™Â٤̂ÚÈÔ ÙÔ˘ 2001 ¤ˆ˜ Î·È ÙÔÓπ·ÓÔ˘¿ÚÈÔ ÙÔ˘ 2002, Ù·˘Ùfi¯ÚÔÓ· Ì ÙË ÌÂÙ¿‰ÔÛË ÙÔ˘ ÙËÏÂ-·È¯ÓȉÈÔ‡ “Big Brother”. ¢È·ÓÂÌ‹ıËÎ·Ó 200 ·ÓÒÓ˘Ì· ÂÚˆÙË-Ì·ÙÔÏfiÁÈ· Û ÈÛ¿ÚÈıÌÔ˘˜ ŒÏÏËÓ˜, Ô˘ ‹Ù·Ó ÁÔÓ›˜ ·È‰ÈÒÓËÏÈΛ·˜ 6-14 ÂÙÒÓ Î·È Î·Ù·ÁÚ¿ÊËÎ·Ó ÔÈ ·fi„ÂȘ ÙÔ˘˜ ÁÈ· ÙËÓ›‰Ú·ÛË Ô˘ ·ÛΛ Ë ÙËÏÂfiÚ·ÛË ÛÙËÓ ÔÈÎÔÁÂÓÂȷ΋ ÙÔ˘˜˙ˆ‹. ∂Ï‹ÊıË ÚÔÊÔÚÈ΋ Û˘Ó¤ÓÙ¢ÍË ·fi 106 ·È‰È¿, ËÏÈΛ·˜10-14 ÂÙÒÓ Î·È ·ÔÙ˘ÒıËÎ·Ó ÔÈ ·fi„ÂȘ ÙÔ˘˜ ÁÈ· ÙÔ ›‰ÈÔ ı¤-Ì·. ∆· ÂÚˆÙËÌ·ÙÔÏfiÁÈ· ‰È·ÓÂÌ‹ıËÎ·Ó ÛÙÔ˘˜ ÁÔÓ›˜ Î·È Û˘-ÌÏËÚÒıËÎ·Ó Î·Ù¿ ÙȘ ÂÈÛΤ„ÂȘ ÙÔ˘˜ ÛÙÔ ∫¤ÓÙÚÔ ÀÁ›·˜ -¯ˆÚ›˜ ÙËÓ ·ÚÔ˘Û›· ¿ÏÏˆÓ - Î·È ÂÈÛÙÚ¿ÊËÎ·Ó ÚÔ Ù˘ ·Ô-¯ÒÚËÛ‹˜ ÙÔ˘˜ ·fi ·˘Ùfi. ¢ÂÓ ˘‹ÚÍ·Ó ÌË Û˘ÌÏËڈ̤ӷÂÚˆÙËÌ·ÙÔÏfiÁÈ·. ∏ ÚÔÊÔÚÈ΋ Û˘Ó¤ÓÙ¢ÍË ÛÙ· ·È‰È¿ ‹Ù·Ó·ÙÔÌÈ΋, ¤ÁÈÓ ηٿ ÙÔ ›‰ÈÔ ‰È¿ÛÙËÌ· ÌÂÙ¿ ·fi Û˘ÁηٿıÂÛËÙˆÓ ÁÔÓ¤ˆÓ ÙÔ˘˜ Î·È ¯ˆÚ›˜ Ó· Â›Ó·È ·ÚfiÓÙ˜ ÛÙËÓ ·›ıÔ˘Û·,ÛÙÔ ›‰ÈÔ Ì¤ÚÔ˜, ÙËÚÒÓÙ·˜ ÙËÓ È‰ÈˆÙÈÎfiÙËÙ· ÙˆÓ ·È‰ÈÒÓ Î·ÈÌ ÙÚfiÔ ÒÛÙ ÔÈ ··ÓÙ‹ÛÂȘ ÙÔ˘˜ Ó· ÌË ıˆÚËıÔ‡Ó ˘Ô‚fi-ÏÈ̘ ·fi ÙÔÓ ¿ÓıÚˆÔ Ô˘ ‰ÈÂÓÂÚÁÔ‡Û ÙË Û˘Ó¤ÓÙ¢ÍË.

∆Ô ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ, ÛÙÔ ÔÔ›Ô ·¿ÓÙËÛ·Ó ÔÈ ÁÔÓ›˜,‹Ù·Ó ÙÔ ÂÍ‹˜:

i) ¶fiÛ˜ ÙËÏÂÔÚ¿ÛÂȘ ¤¯ÂÙ ÛÙÔ Û›ÙÈ Û·˜; ii) Œ¯Ô˘Ó ÙËÏÂfiÚ·ÛË Ù· ·È‰È¿ ÛÙÔ ‰ˆÌ¿ÙÈfi ÙÔ˘˜; ii) µÏ¤ÂÈ ÙÔ ·È‰› fi,ÙÈ ı¤ÏÂÈ ÛÙËÓ ÙËÏÂfiÚ·ÛË; iv) À¿Ú¯Ô˘Ó ÚÔÁÚ¿ÌÌ·Ù· Ô˘ ÙÔ˘ ÂÈÙÚ¤ÂÙ ‹ ÙÔ˘

··ÁÔÚ‡ÂÙ ӷ ·Ú·ÎÔÏÔ˘ı‹ÛÂÈ; v) ÃÚËÛÈÌÔÔț٠ÙËÓ ÙËÏÂfiÚ·ÛË Û·Ó ÂÓË̤ڈÛË, „˘¯·-

ÁˆÁ›·, ÌfiÚʈÛË; vi) ∏ ÙËÏÂfiÚ·ÛË ¤¯ÂÈ ÂÏ·ÙÙÒÛÂÈ, ÁÂÓÈο, ÙȘ ‰Ú·ÛÙËÚÈfi-

ÙËÙ¤˜ Û·˜ Û·Ó ÔÈÎÔÁ¤ÓÂÈ·; vii) ¶ÈÛÙ‡ÂÙ fiÙÈ Ë ÙËÏÂfiÚ·ÛË ‰ËÌÈÔ˘ÚÁ› ÚfiÙ˘· ηÈ

ÂÈ‚¿ÏÏÂÈ ‰ÈÎÔ‡˜ Ù˘ ÙÚfiÔ˘˜ Û˘ÌÂÚÈÊÔÚ¿˜; viii) ªÈÌÔ‡ÓÙ·È Ù· ·È‰È¿ Û·˜ ‹ÚˆÂ˜ ÙËÏÂÔÙÈÎÒÓ ÂÎÔ-

ÌÒÓ; ix) ¢È·ÊÔÚÔÔÈÔ‡Ó ÙÔÓ ¯·Ú·ÎÙ‹Ú· Î·È ÙË Û˘ÌÂÚÈÊÔÚ¿

ÙˆÓ ·È‰ÈÒÓ ÔÚÈṲ̂Ó˜ ÙËÏÂÔÙÈΤ˜ ÂÎÔ̤˜; x) ¶fiÛ˜ ÒÚ˜ ÙËÓ Ë̤ڷ ·Ú·ÎÔÏÔ˘ı›Ù ÙËÏÂÔÙÈο

ÚÔÁÚ¿ÌÌ·Ù·; xi) ¶fiÛ˜ ÒÚ˜ ÙËÓ Ë̤ڷ ·Ú·ÎÔÏÔ˘ıÔ‡Ó Ù· ·È‰È¿

Û·˜ ÙËÏÂfiÚ·ÛË; xii) ¶ÈÛÙ‡ÂÙ fiÙÈ ˘¿Ú¯ÂÈ Ô˘ÛÈ·ÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙˆÓ ÚÔ-

ÁÚ·ÌÌ¿ÙˆÓ Ô˘ ÚÔ‚¿ÏÏÔÓÙ·È ·fi ÙËÓ ÙËÏÂfiÚ·ÛË; xiii) ∞Ó Û·˜ ¤ÏÂÁ·Ó Ó· ÎÏ›ÛÂÙ ÙËÓ ÙËÏÂfiÚ·ÛË ÁÈ· ¤Ó·

Ì‹Ó·, ÙÈ ı· οӷÙÂ; xiv) Œ¯ÂÙÂ Û˘Ó‰ÚÔÌËÙÈ΋ Û‡Ó‰ÂÛË ÙËÏÂfiÚ·Û˘; xv) ÃÚËÛÈÌÔÔț٠ÙËÓ ÙËÏÂfiÚ·ÛË ÁÈ· Ó· ··Û¯Ôϛ٠ٷ

·È‰È¿ Û·˜ ‹/Î·È ÁÈ· ¿ÏÏÔ˘˜ ÏfiÁÔ˘˜ Î·È ÔÈÔ˘˜;

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·191

Page 49: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

192

¶·È‰È·ÙÚÈ΋ 2004;67:190-194 Paediatriki 2004;67:190-194

xvi) ∞Ó ÙÔ ·È‰› ı¤ÏÂÈ Ó· ‚ϤÂÈ Î·È ¿ÏÏ· ÚÔÁÚ¿ÌÌ·Ù·ÂÎÙfi˜ ÙˆÓ ·È‰ÈÎÒÓ Ì ٷ ÔÔ›· ‰È·ÊˆÓ›ÙÂ, Ò˜ ·ÓÙȉڿÙÂ;

xvii) ∞ÁÔÚ¿˙ÂÙ ÚÔ˚fiÓÙ· Ô˘ ‰È·ÊËÌ›˙ÂÈ Ë ÙËÏÂfiÚ·ÛË; xviii) ¶·Ú·ÎÔÏÔ˘ı›Ù ÙÔ “Big Brother”; ∆· ·È‰È¿ ·¿ÓÙËÛ·Ó ÛÙȘ ÂÍ‹˜ ÂÚˆÙ‹ÛÂȘ: i) ¶fiÛ˜ ÙËÏÂÔÚ¿ÛÂȘ ¤¯ÂÙ ۛÙÈ; ii) Œ¯ÂÙ ÙËÏÂfiÚ·ÛË ÛÙÔ ‰ˆÌ¿ÙÈfi Û·˜; iii) ¶fiÛ˜ ÒÚ˜ ÙËÓ Ë̤ڷ ‚ϤÂÙ ÙËÏÂfiÚ·ÛË; ™·˜ ··-

ÁÔÚÂ‡Ô˘Ó ÔÈ ÁÔÓ›˜ Û·˜ Ó· ‚ϤÂÙ fi,ÙÈ ı¤ÏÂÙÂ; iv) ∑Ëٿ٠·fi ÙÔ˘˜ ÁÔÓ›˜ Û·˜ Ó· Û·˜ ·ÁÔÚ¿ÛÔ˘Ó ÚÔ˚-

fiÓÙ· Ô˘ ‰È·ÊËÌ›˙ÂÈ Ë ÙËÏÂfiÚ·ÛË; v) ™·˜ ·Ú¤ÛÔ˘Ó ÔÈ ‹ÚˆÂ˜ ÙˆÓ ÙËÏÂÔÙÈÎÒÓ ÂÎÔÌÒÓ

ηÈ, ·Ó Ó·È, ÔÈÔÈ; Œ¯ÂÙ ‰ÂÈ ÙÔ ÙËÏ·ȯӛ‰È “Big Brother”;°ÓˆÚ›˙ÂÙ ÔÈ· ÒÚ· ÌÂÙ·‰›‰ÂÙ·È Î·È ·fi ÔÈÔ ÙËÏÂÔÙÈÎfiÛÙ·ıÌfi; ∆È ı˘Ì¿ÛÙ ·fi ÙÔ ·È¯Ó›‰È;

vi) ¶ÔÈ· Â›Ó·È Ë ÚˆÙÂ‡Ô˘Û· ÙÔ˘ ÓÔÌÔ‡ ∞ÚÁÔÏ›‰·˜ ηÈÔÈ· Ù˘ ∂ÏÏ¿‰·˜;

vii) ¶ÔÈÔ˜ Â›Ó·È Ô ¶Úfi‰ÚÔ˜ Ù˘ ¢ËÌÔÎÚ·Ù›·˜ Î·È ÔÈÔ˜ Ô¶Úˆı˘Ô˘ÚÁfi˜ Ù˘ ∂ÏÏ¿‰·˜;

∞ÔÙÂϤÛÌ·Ù· ∆· ·ÔÙÂϤÛÌ·Ù· ·fi Ù· ÂÚˆÙËÌ·ÙÔÏfiÁÈ· Ô˘

‰fiıËÎ·Ó ÛÙÔ˘˜ ÁÔÓ›˜ Û˘ÓÔ„›˙ÔÓÙ·È ÛÙ· ·ÎfiÏÔ˘ı·.∏ ÂÏÏËÓÈ΋ ÔÈÎÔÁ¤ÓÂÈ· ·Á·¿, ÁÂÓÈο, ÙËÓ ÙËÏÂfiÚ·-ÛË. OÈ ÂÚÈÛÛfiÙÂÚÔÈ ÁÔÓ›˜ (87%) ÙËÓ ÂÈϤÁÔ˘ÓÛ·Ó Ì¤ÛÔ ÂÓË̤ڈÛ˘ Î·È ‰È·ÛΤ‰·Û˘, ·ÏÏ¿ Ô-ÛÔÛÙfi 42% ‰ÂÓ ı· ÌÔÚÔ‡Û ӷ ÙË ÛÙÂÚËı›. ¢È·-ı¤ÙÔ˘Ó ¯Ú‹Ì·Ù· ÁÈ· ‰Â‡ÙÂÚË ÙËÏÂfiÚ·ÛË (33%) ‹ÁÈ· ÙÚ›ÙË (8%). ŒÓ· Ôχ ÌÈÎÚfi ÔÛÔÛÙfi ÙˆÓ ÁÔÓ¤-ˆÓ (9%) ‰È·ı¤ÙÂÈ Û˘Ó‰ÚÔÌËÙÈ΋ Û‡Ó‰ÂÛË. ¶ÔÛÔÛÙfi11% ÙˆÓ ·È‰ÈÒÓ ¤¯ÂÈ ÙËÏÂfiÚ·ÛË ÛÙÔ ‰ˆÌ¿ÙÈfi ÙÔ˘.∆Ô 72% ÙˆÓ ÁÔÓ¤ˆÓ ·Ó·Ê¤ÚÂÈ fiÙÈ ÂϤÁ¯ÂÈ Ù· ÚÔ-ÁÚ¿ÌÌ·Ù· Ô˘ ·Ú·ÎÔÏÔ˘ıÔ‡Ó Ù· ·È‰È¿. ∆· ·È-‰È¿ ·Ú·ÎÔÏÔ˘ıÔ‡Ó ÙËÏÂfiÚ·ÛË Î·Ù¿ ̤ÛÔ fiÚÔ 19ÒÚ˜, ÂÓÒ ÔÈ ÁÔÓ›˜ ηٿ ̤ÛÔ fiÚÔ 13 ÒÚ˜ ‚‰Ô-Ì·‰È·›ˆ˜. ¶ÔÛÔÛÙfi 51% ÙˆÓ ÁÔÓ¤ˆÓ ıˆÚ› fiÙÈ ËÌ›ÌËÛË ÙˆÓ ËÚÒˆÓ Ù˘ ÙËÏÂfiÚ·Û˘ Â›Ó·È ·Ó·fi-Ê¢ÎÙË, Ì fiÏ· Ù· ·ÎfiÏÔ˘ı·. ∆Ô 68% ¯ÚËÛÈÌÔ-ÔÈ› ÙËÓ ÙËÏÂfiÚ·ÛË ÁÈ· Ó· ··Û¯ÔÏ› Ù· ·È‰È¿ÛÙÔ Û›ÙÈ, ÂÓÒ ÔÛÔÛÙfi 22% ÙË ¯ÚËÛÈÌÔÔÈ› ÁÈ· Ó·‰È¢ÎÔÏ˘Óı› Ô ‡ÓÔ˜. ∆Ô 85% ÈÛÙ‡ÂÈ fiÙÈ Ë ÙËÏÂ-fiÚ·ÛË Ú¤ÂÈ Ó· ÂϤÁ¯ÂÙ·È ·fi Û˘Ì‚Ô‡ÏÈÔ ÔÏÈÙÈ-ÛÙÈÎÒÓ ÊÔÚ¤ˆÓ. OÈ ÂÚÈÛÛfiÙÂÚÔÈ ÁÔÓ›˜ (43%) ÂË-Ú¿˙ÔÓÙ·È ·fi ÙË ‰È·Ê‹ÌÈÛË ÚÔ˚fiÓÙˆÓ Î·È ·ÚÎÂ-Ù¤˜ ÊÔÚ¤˜ ÂÈϤÁÔ˘Ó Ó· ·ÁÔÚ¿ÛÔ˘Ó Î¿ÔÈ· ·fi·˘Ù¿. ™ÙËÓ ÏÂÈÔ„ËÊ›· ÙÔ˘˜ (79%) ·Ú·‰¤¯ÔÓÙ·ÈfiÙÈ ÌÂÈÒÓÂÙ·È Ë Û¯ÔÏÈ΋ ›‰ÔÛË ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜fiÙ·Ó ·Ú·ÎÔÏÔ˘ıÔ‡Ó ÔÏϤ˜ ÒÚ˜ ÙËÏÂfiÚ·ÛË,ÂÓÒ ÙÔ 39% ÙˆÓ ÁÔÓ¤ˆÓ ·Ó·Ê¤ÚÂÈ fiÙÈ ·Ú·ÎÔÏÔ˘-ı› ÙÔ ÙËÏ·ȯӛ‰È “Big Brother” ·fi ÂÚȤÚÁÂÈ·.

™ÙËÓ ÚÔÊÔÚÈ΋ Û˘Ó¤ÓÙ¢ÍË, Ô˘ ÂÏ‹ÊıË ·fi·È‰È¿ ËÏÈΛ·˜ 10-14 ÂÙÒÓ, ·ÔÙ˘ÒıËÎ·Ó ÔÈ ·Îfi-ÏÔ˘ı˜ ·fi„ÂȘ. ¶Ôχ Ï›Á· ·È‰È¿ (7%) ¤¯Ô˘Ó ÙË-ÏÂfiÚ·ÛË ÛÙÔ ‰ˆÌ¿ÙÈfi ÙÔ˘˜, ÂÓÒ ÙÔ 21% ·Ó·Ê¤ÚÂÈ

‡·ÚÍË ‰Â‡ÙÂÚ˘ Û˘Û΢‹˜ ÛÙÔ Û›ÙÈ. ™ÙËÓ ÏÂÈ-Ô„ËÊ›· ÙÔ˘˜ (76%) ·Ú·ÎÔÏÔ˘ıÔ‡Ó ÙËÏÂfiÚ·ÛËÔÏϤ˜ ÒÚ˜ ÙËÓ Ë̤ڷ (ηٿ ̤ÛÔ fiÚÔ 28 ÒÚ˜ÙËÓ Â‚‰ÔÌ¿‰·) Î·È Ì¿ÏÈÛÙ· ·ÓÂͤÏÂÁÎÙ·, ÂÓÒ ÔÈÁÔÓ›˜ ÈÛ¯˘Ú›˙ÔÓÙ·È ÙÔ ·ÓÙ›ıÂÙÔ. ∞ÚÎÂÙ¿ ·È‰È¿(47%) ·Ó·Áο˙Ô˘Ó ÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘˜ Ó· ÙÔ˘˜ ·ÁÔ-Ú¿˙Ô˘Ó ÚÔ˚fiÓÙ· Ô˘ ‰È·ÊËÌ›˙ÂÈ Ë ÙËÏÂfiÚ·ÛË.ŸÏ·, ·ÓÂÍ·ÈÚ¤Ùˆ˜, Ù· ·È‰È¿ ÁÓÒÚÈ˙·Ó ÙËÓ ÒÚ·ÌÂÙ¿‰ÔÛ˘ Ù˘ ÂÎÔÌ‹˜ “Big Brother”, Ù· ÌÈÎÚ¿ÔÓfiÌ·Ù· ÙˆÓ ·ÈÎÙÒÓ, ηıÒ˜ Î·È fi,ÙÈ ÁÈÓfiÙ·Ó Ì¤-Û· ÛÙÔ Û›ÙÈ ÙÔ˘ “ªÂÁ¿ÏÔ˘ ∞‰ÂÏÊÔ‡”. ÃÚËÛÈÌÔ-ÔÈÔ‡Ó ·Ù¿Î˜ ÙˆÓ ·ÈÎÙÒÓ, fiˆ˜ “οÙÛ’ οو, ˆ!ηÏfi, ˆ! ηÎfi, ÎÔ˘Ì¿ÚÂ, Î.Ï.” Î·È ı¤ÏÔ˘Ó Ó· ÌÈ-ÌËıÔ‡Ó Ù· ÂӉȷʤÚÔÓÙ¿ ÙÔ˘˜, .¯. Ó· Ì¿ıÔ˘Ó Ó··›˙Ô˘Ó ÙÔ˘ÌÂÚϤÎÈ.

¶ÔÛÔÛÙfi ÌfiÏȘ 68% ·¿ÓÙËÛ ۈÛÙ¿ ÛÙȘ ÂÚˆ-Ù‹ÛÂȘ ÁÈ· ÙËÓ ÚˆÙÂ‡Ô˘Û· ÙÔ˘ ÓÔÌÔ‡, 37% ÁÈ· ÙÔÓ¶Úfi‰ÚÔ Ù˘ ¢ËÌÔÎÚ·Ù›·˜ Î·È 41% ÁÈ· ÙÔÓ ¶Úˆ-ı˘Ô˘ÚÁfi Ù˘ ¯ÒÚ·˜.

™˘˙‹ÙËÛË ∏ ÙËÏÂfiÚ·ÛË Â›Ó·È Ì›· Ú·ÁÌ·ÙÈÎfiÙËÙ· ÛÙË ˙ˆ‹

Ù˘ ÂÏÏËÓÈ΋˜ ÔÈÎÔÁ¤ÓÂÈ·˜. À¿Ú¯Ô˘Ó Ù¤ÛÛÂÚ·ÂηÙÔÌ̇ÚÈ· ÙËÏÂÔÙÈΤ˜ Û˘Û΢¤˜ ÛÙËÓ ∂ÏÏ¿‰·.OÈ ·ÓËÛ˘¯›Â˜ ÁÈ· ÙËÓ Â›‰Ú·Û‹ Ù˘ ÛÙ· ·È‰È¿¤¯Ô˘Ó ›ÎÂÓÙÚÔ, ۯ‰fiÓ ¿ÓÙÔÙÂ, ÙÔ ÂÚȯfiÌÂÓÔÙˆÓ ÂÎÔÌÒÓ Ô˘ ·˘Ù¿ ·Ú·ÎÔÏÔ˘ıÔ‡Ó.

∏ ÙËÏÂfiÚ·ÛË, ÛÙËÓ Â·Ú¯›·, ÂÈϤÁÂÙ·È Û·Ó Ì¤-ÛÔ ÂÓË̤ڈÛ˘ Î·È ‰È·ÛΤ‰·Û˘. ∏ ÏÂÈÔ„ËÊ›·ÙˆÓ ÁÔÓ¤ˆÓ ÈÛ¯˘Ú›˙ÂÙ·È fiÙÈ ÂϤÁ¯ÂÈ Ù· ÚÔÁÚ¿ÌÌ·-Ù· Ô˘ ·Ú·ÎÔÏÔ˘ıÔ‡Ó Ù· ·È‰È¿. ∂›Ó·È, fï˜, ·˘-Ùfi ‰˘Ó·Ùfi ÂÊfiÛÔÓ ˘¿Ú¯Ô˘Ó ÔÏϤ˜ Û˘Û΢¤˜ ÛÙÔÛ›ÙÈ Î·È Ì¿ÏÈÛÙ· ÛÙ· ‰ˆÌ¿ÙÈ· ÙˆÓ ·È‰ÈÒÓ; ∏ ÙË-ÏÂfiÚ·ÛË ¯ÚËÛÈÌÔÔÈ›ٷÈ, Û˘¯Ó¿, ÁÈ· Ó· ··Û¯Ô-ÏËıÔ‡Ó Ù· ·È‰È¿ - ÚfiÏÔ˜ “baby-sitter” (8). ™¯Â‰fiÓÛÙÔ Û‡ÓÔÏfi ÙÔ˘˜, ÔÈ ÁÔÓ›˜ ÈÛÙÂ‡Ô˘Ó fiÙÈ Ë ÙËÏÂfi-Ú·ÛË Ú¤ÂÈ Ó· ÂϤÁ¯ÂÙ·È Ô˘ÛÈ·ÛÙÈο ·fi Û˘Ì‚Ô‡-ÏÈÔ ÔÏÈÙÈÛÙÈÎÒÓ ÊÔÚ¤ˆÓ. ∂›Û˘, ·Ó·ÁÓˆÚ›˙Ô˘ÓfiÙÈ ÔÈ ÔÏϤ˜ ÒÚ˜ ·Ú·ÎÔÏÔ‡ıËÛ˘ ÌÂÈÒÓÔ˘Ó ÙËÛ¯ÔÏÈ΋ ›‰ÔÛË ÙˆÓ ·È‰ÈÒÓ, Ë ÔÔ›· ‰È·ÌÔÚÊÒ-ÓÂÈ ¯·Ú·ÎÙ‹Ú˜ Î·È Û˘ÌÂÚÈÊÔÚ¤˜ (9).

™‡Ìʈӷ Ì ÙÔ˘˜ ÁÔÓ›˜, Ù· ·È‰È¿ ·Ú·ÎÔÏÔ˘-ıÔ‡Ó ÙËÏÂfiÚ·ÛË Î·Ù¿ ̤ÛÔ fiÚÔ 19 ÒÚ˜ ÙËÓ Â‚‰Ô-Ì¿‰·, ÂÓÒ Û‡Ìʈӷ Ì ٷ ·È‰È¿ ÔÈ ÒÚ˜ Â›Ó·È Ô-χ ÂÚÈÛÛfiÙÂÚ˜ (ηٿ ̤ÛÔ fiÚÔ 28), ÌÂÈÒÓÔÓÙ·˜¤ÙÛÈ ÙÔÓ ¯ÚfiÓÔ Ô˘ ‰È·Ù›ıÂÙ·È ÛÙÔ ‰È¿‚·ÛÌ· Î·È Û¿ÏϘ ‰Ú·ÛÙËÚÈfiÙËÙ˜ (10-12). ∆fiÛÔ Ë Ì›ÌËÛË ÙˆÓËÚÒˆÓ Ù˘ ÙËÏÂfiÚ·Û˘ fiÛÔ Î·È Ë ‰È·ÊÔÚÔÔ›ËÛËÛÙÔÓ ¯·Ú·ÎÙ‹Ú· Î·È ÙË Û˘ÌÂÚÈÊÔÚ¿ ÙˆÓ ·È‰ÈÒÓÂ›Ó·È ·Ó·fiÊ¢ÎÙ˜, Ì fiÏ· Ù· ·ÎfiÏÔ˘ı· ÚÔ-‚Ï‹Ì·Ù·. ª›· ÂÎÔÌ‹ Ì ·Ó¿ÏÔÁ˜ ÂÈÙÒÛÂȘ ›-Ó·È Î·È ÙÔ ÙËÏ·ȯӛ‰È “Big Brother”.

¶ÔÏÏÔ› ÂÚ¢ÓËÙ¤˜ ÚÔÛ·ıÔ‡Ó Ó· ‰È·ÈÛÙÒÛÔ˘Ó

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·192

Page 50: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

193

¶·È‰È·ÙÚÈ΋ 2004;67:190-194 Paediatriki 2004;67:190-194

·Ó Ù· ÚÔÁÚ¿ÌÌ·Ù· ‚›·˜ οÓÔ˘Ó Ù· ·È‰È¿ ÈÔ ÂÈ-ıÂÙÈο Î·È ·Ó Ù· ÂÔÈÎÔ‰ÔÌËÙÈο ÚÔÁÚ¿ÌÌ·Ù· Ù·ÂÓı·ÚÚ‡ÓÔ˘Ó ÛÙË ‰È·ÌfiÚʈÛË ÛˆÛÙ‹˜ Û˘ÌÂÚÈ-ÊÔÚ¿˜. ∂ȯÂÈÚÔ‡Ó, ‰ËÏ·‰‹, Ó· ·Ó·Î·Ï‡„Ô˘Ó ·ÓÙ· ÚfiÙ˘· Ô˘ ‰›ÓÂÈ Ë ÙËÏÂfiÚ·ÛË ÂËÚ¿˙Ô˘Ó ÙËÛΤ„Ë ÙˆÓ ·È‰ÈÒÓ, ·ÓÔ›ÁÔÓÙ·˜ Ó¤Ô˘˜ ÔÚ›˙ÔÓÙ˜ ‹ÂÚÈÔÚ›˙ÔÓÙ¿˜ Ù·. O ‰È·ÚÎÒ˜ ÂÓ·ÏÏ·ÛÛfiÌÂÓÔ˜ η-Ù·ÈÁÈÛÌfi˜ ÂÈÎfiÓˆÓ Î·È ‹¯ˆÓ Ô˘ ‚ÔÌ‚·Ú‰›˙ÂÈ Ù· Ì¿-ÙÈ· Î·È Ù· ·˘ÙÈ¿, ‰ËÌÈÔ˘ÚÁ› ÙËÓ ·˘Ù·¿ÙË Ì›·˜ Ô-Ï˘Ô›ÎÈÏ˘ ÂÌÂÈÚ›·˜ ÁÈ· ÙÔÓ ı·ً. ŸÔÈ· Î·È ·ÓÂ›Ó·È Ë ÂÎÔÌ‹, ˘¿Ú¯ÂÈ Ì›· ÔÌÔÈfiÙËÙ· ‚Ȉ̿وÓÛ οı ÙËÏÂÔÙÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË. ¶ÚfiÎÂÈÙ·È ÁÈ·Ì›· ‰È·‰Èηۛ· ÌÔÓ‹˜ ηÙ‡ı˘ÓÛ˘ Ô˘ ··ÈÙ›·fi ÙȘ ·ÈÛı‹ÛÂȘ Ó· ·ÊÔÌÔÈÒÛÔ˘Ó ¤Ó· Û˘ÁÎÂÎÚÈ-̤ÓÔ ˘ÏÈÎfi Ì ¤Ó·Ó ȉȷ›ÙÂÚÔ ÙÚfiÔ, ·ÓÂÍ¿ÚÙËÙ··fi ÙÔ ÂÚȯfiÌÂÓfi ÙÔ˘ (12).

¶Ú·ÁÌ·ÙÈο, ÛÙË ˙ˆ‹ ÙÔ˘ ·È‰ÈÔ‡ ‰ÂÓ ˘¿Ú¯ÂÈη̛· ¿ÏÏË ÂÌÂÈÚ›·, ηٿ ÙËÓ ÔÔ›· ÙÔ ·È‰› Ó·Ï·Ì‚¿ÓÂÈ ÙfiÛÔ ÔÏÏ¿ ηÈ, fï˜, Ó· ·ÔÎÔÌ›˙ÂÈ Ùfi-ÛÔ Ï›Á·. ∞fi Ù· ÚÒÙ· ¯ÚfiÓÈ· ÏÂÈÙÔ˘ÚÁ›·˜ Ù˘ ÙË-ÏÂfiÚ·Û˘, ÔÈ ÎÚÈÙÈÎÔ› ÙËÓ ·ÚÔ˘Û›·˙·Ó Û·Ó ¤Ó·‡Ô˘ÏÔ Ó·ÚΈÙÈÎfi ÁÈ· ÙÔ˘˜ ÁÔÓ›˜ ηÈ, ηْ ¤-ÎÙ·ÛË, ÁÈ· Ù· ·È‰È¿.

∞ӷʤÚÂÙ·È fiÙÈ Ô ÂÚÈÔÚÈÛÌfi˜ ÙÔ˘ ¯ÚÔÓÈÎÔ‡‰È·ÛÙ‹Ì·ÙÔ˜ ÙËÏÂı¤·Û˘ ÛÙ· ·È‰È¿ ËÏÈΛ·˜ 6ÂÙÒÓ, ÌÂÙ¤ÙÚ„ ÙÔÓ ÓÂ˘Ì·ÙÈÎfi ÙÔ˘˜ ÎfiÛÌÔ ·fi·˘ıfiÚÌËÙÔ Û ÂÚÈÛÛfiÙÂÚÔ ÛÙÔ¯·ÛÙÈÎfi Î·È ÚÔο-ÏÂÛ ‚·ıÌÔÏÔÁÈÎfi ÂӉȷʤÚÔÓ ÛÙÔÓ ‰Â›ÎÙË ÓÔËÌÔ-Û‡Ó˘ ÙÔ˘˜ (13).

£ÂˆÚÂ›Ù·È fiÙÈ Ë ÙËÏÂfiÚ·ÛË ·ÔÙÂÏ› Ì›· ˙ˆÓÙ·-Ó‹ Ú·ÁÌ·ÙÈÎfiÙËÙ· ηÈ, ›Ûˆ˜, ÙÔ ÈÔ Û·ÁËÓ¢ÙÈÎfi̤ÛÔ ÌÂÙ·ÊÔÚ¿˜ Ù˘ Ê·ÓÙ·Û›·˜ ÛÙËÓ Ú·ÁÌ·ÙÈÎfi-ÙËÙ·. OÈ ÂȉڿÛÂȘ Ù˘ ÙËÏÂfiÚ·Û˘ Â›Ó·È Ì›· Û˘-Ó¿ÚÙËÛË fi¯È ÌfiÓÔ ÙˆÓ ÂÈÙÒÛÂˆÓ Ô˘ ÚÔηÏÔ‡-ÓÙ·È ÛÙÔ ·È‰› ·fi ·˘Ù‹, ·ÏÏ¿ Î·È ÙˆÓ ÂÎÔÌÒÓÔ˘ ·Ú·ÎÔÏÔ˘ı› (14,15). ∆· ÚÔÁÚ¿ÌÌ·Ù· ÔÊ›-ÏÔ˘Ó Ó· Â›Ó·È ÚÔÛ·ÚÌÔṲ̂ӷ ÛÙȘ Ú·ÁÌ·ÙÈΤ˜·Ó¿ÁΘ ÙˆÓ ·È‰ÈÒÓ (15,16).

¢È·ÈÛÙÒıËΠfiÙÈ Ë ·Ú·ÎÔÏÔ‡ıËÛË Ù˘ ÂÎÔ-Ì‹˜ “Big Brother” ·fi ÙÔ˘˜ ÁÔÓ›˜ Î·È Ù· ·È‰È¿ÂÚÈÂÏ¿Ì‚·Ó Ôχ ÌÂÁ¿ÏÔ ÔÛÔÛÙfi. OÈ ÙËÏÂı·-Ù¤˜ (ÁÔÓ›˜ Î·È ·È‰È¿) ·Ú·ÎÔÏÔ˘ıÔ‡Ó ·ıËÙÈοÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ ÙËÏ·ȯӛ‰È, ÁÈ·Ù›: ·) ¤ÏÎÔÓÙ·È Î·ÈηıËÏÒÓÔÓÙ·È ·fi ÙÔ ¿ÁÓˆÛÙÔ Î·È ·ÚfiÛÌÂÓÔ ÛÂ-Ó¿ÚÈÔ Ô˘ ÂÍÂÏ›ÛÛÂÙ·È ·fi ÙÔ˘˜ ·›ÎÙ˜, ÙÔ ÔÔ›ÔÌÔÈ¿˙ÂÈ Ì ηÏÂȉÔÛÎfiÈÔ ·fi ·ÓıÚÒÈÓ˜ ÂÈÎfiÓ˜,ÊÈÁÔ‡Ú˜ Î·È Û˘ÌϤÁÌ·Ù· Û˘ÌÂÚÈÊÔÚ¿˜, ·ÚÈÔ¤ÚÁÔ ÙˆÓ ÔÔ›ˆÓ Â›Ó·È ÙÔ ¿ÁÓˆÛÙÔ, ‚) Ú·ÁÌ·ÙÔ-ÔÈÂ›Ù·È ÌÔÈÚ·›· Ù·‡ÙÈÛ‹ ÙÔ˘˜ Ì ÙÔ˘˜ ·›ÎÙ˜ ο-ı ÛÙÈÁÌ‹ Î·È Á) ‰È·ÙËÚÂ›Ù·È ÙÔ ÂӉȷʤÚÔÓ ÙÔ˘˜·fi ÙÔ ›‰ÈÔ ÙÔ ı¤·Ì·, Û·Ó ÁÂÁÔÓfi˜, Û·Ó Û‡ÌÏÂÁ-Ì·, Û·Ó ‰Ú¿ÛË, Û·Ó ‰Ú¿Ì· ‹ Έ̈‰›·, ηıÒ˜ ÍÂ-ʇÁÂÈ ·fi ÙÔ ÁÓˆÛÙfi, ÙÔ Î·ıËÌÂÚÈÓfi, ÙÔ Ù˘ÔÔÈ-

Ë̤ÓÔ, ÙÔ Û˘ÓËıÈṲ̂ÓÔ Î·È ÙÔ Î·ıÈÂڈ̤ÓÔ. ∆· ·È-‰È¿ ·Ú·ÎÔÏÔ˘ıÔ‡Ó fiÏ· ·˘Ù¿, Ì ÙȘ ÂÈÙÒÛÂÈ˜Ô˘ Û˘Ó¿ÁÔÓÙ·È ÛÙÔÓ ¯·Ú·ÎÙ‹Ú· Î·È ÙË Û˘ÌÂ-ÚÈÊÔÚ¿ ÙÔ˘˜, ηıÒ˜, Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, Ë ÙËÏÂ-fiÚ·ÛË ·ÓÙÈη٤ÛÙËÛ ÙȘ ·Ú·‰fiÛÂȘ Î·È Ù· ·Ú·-̇ıÈ·, ÙÔ˘˜ ÁÚ›ÊÔ˘˜ Î·È Ù· ·ÈÓ›ÁÌ·Ù·, ÙȘ ÈÛÙÔÚ›Â˜Î·È ÙȘ ·ÚÔÈ̛˜, Ì ٷ ÔÔ›· Ë ÁÈ·ÁÈ¿ Á·ÏÔ˘¯Ô‡ÛÂÎ·È Î·ıÔ‰ËÁÔ‡Û ÙË Ó¤· ÁÂÓÈ¿ ‰›Ï· ÛÙÔ Ù˙¿ÎÈ. ∏ÙËÏÂfiÚ·ÛË, fï˜, ·ÓÙ› Ó· Û˘Ó¯›ÛÂÈ ÙÔÓ ÚfiÏÔ Ù˘ÁÈ·ÁÈ¿˜, ·ÓÙ¤ÁÚ·„ ͤÓ˜ ·Ú·‰fiÛÂȘ Î·È ‹ÚˆÂ˜,Ì ·ÔÙ¤ÏÂÛÌ· Ë Ó¤· ÁÂÓÈ¿ - ÂËÚ·Ṳ̂ÓË Î·È ·fi‰È¿ÊÔÚ˜ ¿ÏϘ ·Ú·Ì¤ÙÚÔ˘˜ - Ó· ÎÈÓ‰˘Ó‡ÂÈ Ó·¯¿ÛÂÈ ÙËÓ Ù·˘ÙfiÙËÙ¿ Ù˘ (17).

∞Í›˙ÂÈ, ›Û˘, Ó· ·Ó·ÊÂÚı› fiÙÈ Î·Ù·Ó·ÏÒıË-Î·Ó ÂηÙÔÓÙ¿‰Â˜ ÒÚ˜ ÙËÏÂÔÙÈÎÒÓ ÂÎÔÌÒÓ, Ì·ڿı˘Ú· Î·È ÌË, ·ÊÈÂڈ̤Ó˜ Û ÙËÏÂ-·›ÁÓÈ· ηÈÙËÏÂ-‹ıË, Û ·›ÎÙ˜ Î·È Û ÙËÏÂ-fiÚ·ÛË ÁÂÓÈÎfiÙÂ-Ú·. ∂›Ó·È ‰˘Û¿ÚÂÛÙÔ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÙÔ ·Ú¯ÈÎfi “ÎÈ-ÓÔ‡Ó ·›ÙÈÔ” ·˘Ù‹˜ Ù˘ ·Ó·Î˘ÎÏÔ‡ÌÂÓ˘ “ÌÂÁ·ÏÔ·-‰ÂÏÊÈ΋˜ ÊÏ˘·Ú›·˜” ‰ÂÓ Â›Ó·È Ì›· - ¤ÛÙˆ Û˘ÓÙËÚË-ÙÈÎÒÓ ·ÓÙ·Ó·ÎÏ·ÛÙÈÎÒÓ - ËıÈ΋ ÂͤÁÂÚÛË, ·ÏÏ¿¤Ó·˜ ÔÓËÚfi˜ ˘ÔÏÔÁÈÛÌfi˜, ÌÂÚ›‰ÈÔ ÛÙ· ÔÛÔÛÙ¿ÙËÏÂı¤·Û˘ ÙˆÓ Î·Ù·ÁÁÂÏÏÔ̤ӈÓ. ∆Ô ¯ÂÈÚfiÙÂÚÔ,fï˜, Â›Ó·È fiÙÈ ·˘Ù‹ Ë ÊÏ˘·Ú›· ÌÂÙ·ı¤ÙÂÈ Î·È Â˘ÙÂ-Ï›˙ÂÈ ÙÔ ı¤Ì· Ì›·˜ ·Ó·Áη›·˜ Î·È ÎÚ›ÛÈÌ˘ Û˘˙‹ÙË-Û˘ Î·È Ì›·˜ ›Û˘ ·Ó·Áη›·˜, ÎÚ›ÛÈÌ˘ Î·È ÂÍ·È-ÚÂÙÈο ηı˘ÛÙÂÚË̤Ó˘, ÂÎÛ˘Á¯ÚÔÓÈÛÙÈ΋˜ ηÈÂÎÏÔÁÈ΢ÙÈ΋˜ ·Ú¤Ì‚·Û˘ ÛÙÔ Â‰›Ô Ù˘ ÙËÏÂÔ-ÙÈ΋˜ ·ÁÔÚ¿˜ (18).

µÈ‚ÏÈÔÁÚ·Ê›· 1. ºÚ·Ù˙ÂÛο΢ °. ∂ÊËÌÂÚ›‰· ∫·ıËÌÂÚÈÓ‹. ¶ÂÚÈÔ‰ÈÎfi

View: ∞ı‹Ó·; 2002. 2. ∂Á΢ÎÏÔ·›‰ÂÈ· Grand Larousse. ∂ÓfiÙËÙ· 1. ∞ı‹Ó·;

2002. ÛÂÏ. 289. 3. Greenfield MP. ª¤Û· ÂÓË̤ڈÛ˘ Î·È ·È‰›. ∞ı‹Ó·: ∂Ήfi-

ÛÂȘ ∫Ô˘ÙÛÔ˘Ìfi˜; 1988. ÛÂÏ. 185. 4. Ferguson ES. The mind’s eye: nonverbal thought in

technology. Science 1977;197:827-836. 5. Bronfenbrenner U. Who cares for American’s children?

Address presented at the Conference of the NationalAssociation for the Education of Young Children; 1970.

6. Nielsen Television Index. S Report on Television Usage(A.C. Nielsen Co., Hachensack, N.J.).

7. ŸÚÁÔ˘ÂÏ ∆. O ªÂÁ¿ÏÔ˜ ∞‰ÂÏÊfi˜. ∞ı‹Ó·: ∂ΉfiÛÂȘ ∫¿-ÎÙÔ˜; 1984.

8. Gadberry S. Television as baby-sitter: a field comparison ofpreschooler’s behavior during playtime and duringtelevision viewing. Child Dev 1974;45:1132-1136.

9. LoSciuto LA. A national inventory of television viewingbehavior. In: Rubinstein EA, Comstock GA, Murray JP,editors. Television and social behavior. Vol. 4. Television inday to day life: patterns of use. Government Printing Office:Washington, DC; 1971.

10. ∞ÁÔÚ›ÙÛ· ™, ∫ˆÛÙ·Ú›‰Ô˘ ™, ™ˆÙËÚÔÔ‡ÏÔ˘ º, ª·ÓÈ¿ ¢,∞Ó·ÛÙ·Û¤·-µÏ¿¯Ô˘ ∫. ∂›Ó·È Î·È Ù· ·È‰È¿ Ù˘ ·گ›·˜

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·193

Page 51: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

194

¶·È‰È·ÙÚÈ΋ 2004;67:190-194 Paediatriki 2004;67:190-194

Ê·Ó·ÙÈÎÔ› ÙËÏÂı·٤˜; ¶·È‰È·ÙÚÈ΋ 1997;60:703-708. 11. ºÚ˘Û›Ú·-∫·ÓÈÔ‡Ú· ∂, ∞Ó·ÛÙ·Û¤·-µÏ¿¯Ô˘ ∫, ¶··ı·Ó·-

Û›Ô˘-∫ÏÒÓÙ˙· ¢, •˘ÔÏ˘Ù¿-∑·¯·ÚÈ¿‰Ë ∞, ª·ÙÛ·ÓÈÒÙ˘¡. ∏ ›‰Ú·ÛË Ù˘ ÙËÏÂfiÚ·Û˘ ÛÙ· ∂ÏÏËÓfiÔ˘Ï·, ÛÙÔÙ¤ÏÔ˜ ÙÔ˘ 20Ô‡ ·ÈÒÓ· Î·È Ô ¶·È‰›·ÙÚÔ˜. ¶·È‰È·ÙÚÈ΋1993;56:300-316.

12. American Academy of Pediatrics Committee onCommunications. The commercialization of children’stelevision. Pediatrics 1992;89:343-344.

13. Strasburger VC. Does television affect learning and schoolperformance? Pediatrician 1986;13:141-147.

14. Winn Miller M. ∆ËÏÂfiÚ·ÛË: ¤Ó·˜ ͤÓÔ˜ ÛÙÔ Û›ÙÈ. ∞ı‹Ó·:∂ΉfiÛÂȘ ∞ÎÚ›Ù·˜; 1996. ÛÂÏ. 19.

15. Kelly H, Gardner H. Viewing children through television.San Fransisco: Jossey-Bass; 1981.

16. Salomon G. Television watching and mental effort.Pediatrician 1992;15:171-177.

17. Potter RL. TV and my classroom: an evolutionary tale.Television and Children 1979;2:19-20.

18. °·Ï·Ófi˜ °. ∫·Ó›‚·ÏÔÈ „˘¯ÒÓ - O ªÂÁ¿ÏÔ˜ ∞‰ÂÏÊfi˜ ÛÙËÓÙËÏÂfiÚ·ÛË. £ÂÛÛ·ÏÔÓ›ÎË: ∂ΉfiÛÂȘ ∞ÊÔ› ∫˘ÚȷΛ‰Ë;2001.

∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 26-08-2003 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 23-04-2004

¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ¶ÚÔÎfiÈÔ˜ ∆·‚Ï·ÓÙ¿˜ §˘ÁÔ˘ÚÈfi ∞ÚÁÔÏ›‰·˜, ∆.∫. 210 52E-mail: [email protected]

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·194

Page 52: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

195

¶·È‰È·ÙÚÈ΋ 2004;67:195-199 Paediatriki 2004;67:195-199

∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞ ORIGINAL ARTICLE

µ·ıÌfi˜ ÁÓÒÛ˘ ÙˆÓ ÂȤ‰ˆÓ ÏÈȉ›ˆÓ ÙÔ˘ ·›Ì·ÙÔ˜ Û ÊÔÈÙËÙ¤˜ ·ÁÁÂÏÌ¿ÙˆÓ ˘Á›·˜-ÚfiÓÔÈ·˜™. ∞ÓÙˆÓÈ¿‰Ë˜, ™. ∫˘ÚÈ·ÎÔÔ‡ÏÔ˘, µ. ∞ÚÁ˘ÚÔÔ‡ÏÔ˘, •. ∫Ú›ÎÔ˜

Levels of knowledge of blood lipids levels in health studentsS. Antoniadis, S. Kyriakopoulou, V. Argyropoulou, X. Krikos

�¶ÂÚ›ÏË„Ë: OÈ ˘ÔÏÔÁÈÛÌÔ› Ù˘ ¶·ÁÎfiÛÌÈ·˜OÚÁ¿ÓˆÛ˘ ÀÁ›·˜ Û fi,ÙÈ ·ÊÔÚ¿ Ù· ÔÛÔÛÙ¿ ı·-Ó¿ÙˆÓ ·fi ηډȷÁÁÂȷο ÓÔÛ‹Ì·Ù· ‰ÂÓ Â›Ó·È Î·-ıfiÏÔ˘ ÂÓı·ÚÚ˘ÓÙÈÎÔ›. ¶ÚԂϤÂÙ·È fiÙÈ, ÙÔ ¤ÙÔ˜2020, Ù· ı·Ó·ÙËÊfiÚ· ÂÂÈÛfi‰È· ı· ÊÙ¿ÛÔ˘Ó Ù·25.000.000. ™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‹Ù·ÓÓ· ‰ÈÂÚ¢ÓËı› Ô ‚·ıÌfi˜ ÁÓÒÛ˘ ÙˆÓ ÂȤ‰ˆÓÙˆÓ ÏÈȉ›ˆÓ ÙÔ˘ ·›Ì·ÙÔ˜ Û ÊÔÈÙËÙ¤˜ ·ÁÁÂÏÌ¿-ÙˆÓ ˘Á›·˜-ÚfiÓÔÈ·˜, ÏfiÁˆ Ù˘ ÌÂÁ¿Ï˘ ÛËÌ·Û›·˜ÙˆÓ ÏËÚÔÊÔÚÈÒÓ Û fi,ÙÈ ·ÊÔÚ¿ ÙËÓ ÎÏËÚÔÓÔÌÈÎfi-ÙËÙ·, ηıÒ˜ Î·È ÙÔÓ ÙÚfiÔ ˙ˆ‹˜ ÙˆÓ ÔÈÎÔÁÂÓÂÈÒÓÛ ۯ¤ÛË Ì ٷ ·È‰È¿. ™ÙÔ ‰È¿ÛÙËÌ· ÙˆÓ 8 ÌËÓÒÓÔ˘ ‰È‹ÚÎÂÛ ·˘Ù‹ Ë ÂÚÁ·Û›·, ˘Ô‚Ï‹ıËΠÂÚˆÙË-Ì·ÙÔÏfiÁÈÔ Û 1282 ÊÔÈÙËÙ¤˜. ™‡Ìʈӷ Ì ٷ ·Ô-ÙÂϤÛÌ·Ù·, 375 ÊÔÈÙËÙ¤˜ (29,2%) ›¯·Ó ÂϤÁÍÂÈ Ù·Â›Â‰· ÙˆÓ ÏÈȉ›ˆÓ ÙÔ˘ ·›Ì·ÙÔ˜, ÂÓÒ 907 (70,8%)‰ÂÓ Â›¯·Ó ÂÏÂÁ¯ı› ÔÙ¤, ·Ú’ fiÏÔ Ô˘ 503 ·fi ·˘-ÙÔ‡˜ (55,4%) ÙÔ Â›¯·Ó ÛÎÂÊÙ›. ∞˘ÍË̤ӷ ÏÈ›‰È· ·›-Ì·ÙÔ˜ ‚Ú¤ıËÎ·Ó Û 11 ÊÔÈÙËÙ¤˜ (2,9%). ™Â fi,ÙÈ·ÊÔÚ¿ ÙÔÓ ÙÚfiÔ ˙ˆ‹˜ ÙÔ˘˜, 1080 (84,2%) ·ÎÔ-ÏÔ˘ıÔ‡Û·Ó ÂχıÂÚÔ ‰È·ÈÙÔÏfiÁÈÔ, 801 (62,4%) η-Ù·Ó¿ÏˆÓ·Ó ÎÚ¤·˜ 1-3 ÊÔÚ¤˜ ÙËÓ Â‚‰ÔÌ¿‰· Î·È 481(37,5%) 4-7 ÊÔÚ¤˜. °·Ï·ÎÙÔÎÔÌÈο ÚÔ˚fiÓÙ·, fiˆ˜‚Ô‡Ù˘ÚÔ, ·¯È¿ Ù˘ÚÈ¿ Î·È Ï‹Ú˜ Á¿Ï·, ηıÒ˜ ηȷ˘Á¿ Î·Ù·Ó¿ÏˆÓ·Ó ÂχıÂÚ· 474 ÊÔÈÙËÙ¤˜(36,9%). ™‡Ìʈӷ Ì ÙȘ ··ÓÙ‹ÛÂȘ, 1153 (89,9%)ıˆÚÔ‡Û·Ó ··Ú·›ÙËÙÔ ÙÔÓ ¤ÏÂÁ¯Ô Ù˘ ‰È·ÙÚÔÊ‹˜·fi ÙËÓ ËÏÈΛ· ÙˆÓ 3-5 ÂÙÒÓ. ∫·ÓÈÛÙ¤˜ ‹Ù·Ó 419ÊÔÈÙËÙ¤˜ (32,6%), 633 (49,3%) Á˘ÌÓ¿˙ÔÓÙ·Ó, ÂÓÒ213 (16,6%) ‹Ù·Ó ·ıÏËÙ¤˜. °È· fiÏ· Ù· ·Ú·¿Óˆ,ÔÈ Û˘Ó‹ıÂȘ ÙˆÓ ÁÔÓ¤ˆÓ ‹Ù·Ó ·ÔÁÔËÙ¢ÙÈΤ˜. ™Âfi,ÙÈ ·ÊÔÚ¿ ÙÔ ÎÏËÚÔÓÔÌÈÎfi ÙÔ˘˜ ÈÛÙÔÚÈÎfi, ‚Ú¤ıËÎÂfiÙÈ ÌfiÓÔ 1 ÛÙÔ˘˜ 3 ‹ÍÂÚÂ Â¿Ó Â›¯·Ó ÂÏÂÁ¯ı› ÔÈ ÁÔ-Ó›˜ ÙÔ˘ ÁÈ· Ù· ›‰· ÏÈȉ›ˆÓ ÙÔ˘ ·›Ì·ÙÔ˜, ·fiÙÔ˘˜ ÔÔ›Ô˘˜ ÙÔ 1/3 ÙˆÓ ·Ù¤ÚˆÓ ›¯Â ·ıÔÏÔÁÈΤ˜ÙÈ̤˜, ÂÓÒ ÁÈ· fiÛÔ˘˜ ‰ÂÓ Â›¯·Ó ÂÏÂÁ¯ı› Î·È Â›¯·Ó

�Abstract: The estimations of the WHO of deathsdue to cardiovascular problems are discouraging. Itis foreseen that by the year 2020, fatal episodes willrich the figure of 25,000,000. The objective of thisstudy was to determine the level of knowledge inhealth students concerning their own blood lipidlevels. The survey lasted 8 months, during whichtime 1282 students provided answers to aquestionnaire. It was found that 375 (29.2%) hadalready had a check-up for their blood lipids and907 (70.8%) had never been checked, although 503(55.4%) were thinking of doing it some time.Increased lipid levels had been found in 11 (2.9%).In questions related to their diet and lifestyle, 1080(84.2%) had not been taking any care about theirdietary habits, and 801 (62.4%) reported eatingmeat 1-3 times, and 481 (37.5%) 4-7 times a week.Dairy products and eggs were consumed freely by474 (37%). Concerning attitudes, 1153 (89.9%)answered that it is necessary to be careful aboutdiet from the early ages of 3 and 5 years.Concerning lifestyle, 419 (32.6%) were cigarettesmokers, 633 (49.3%) took part in athletic activitiesand 213 in competitive sports. The relevant familyhistory and parental habits were not particularlyencouraging. About 1 in 3 had knowledge of thefamily history. Of those, 1 in 3 of the fathers hadincreased lipid levels, some of whom had never hada check-up but were examined because ofsymptoms, in which case the consequences wererather bad. Their knowledge about theirgrandparents was limited; 80% knew nothing. Inconclusion, although the efforts of doctors andother health authorities, as well as of the media, indisseminating information concerning theimportance of prevention are not at a bad level, it is

∆Ì‹Ì· µÚÂÊÔÓËÈÔÎÔÌ›·˜ ∞ÓÒÙ·ÙÔ˘ ™.∂.À.¶. ∆.∂.π. ∞ı‹Ó·˜ ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ

Pre-School Education Department, S.E.I.P. T.E.I. of Athens 1st Department of Paediatrics, University of Athens

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·195

Page 53: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

∂ÈÛ·ÁˆÁ‹™‡Ìʈӷ Ì ÚfiÛÊ·Ù· ·ÔÙÂϤÛÌ·Ù· ÛÙ·ÙÈÛÙÈ-

ÎÒÓ Ù˘ ¶·ÁÎfiÛÌÈ·˜ OÚÁ¿ÓˆÛ˘ ÀÁ›·˜, οı 4‰Â˘ÙÂÚfiÏÂÙ· Û˘Ì‚·›ÓÂÈ Ì›· ηډȷ΋ ÚÔÛ‚ÔÏ‹Î·È Î¿ı 5 ‰Â˘ÙÂÚfiÏÂÙ· ¤Ó· ÂÁÎÂÊ·ÏÈÎfi ÂÂÈÛfi-‰ÈÔ. ªÂ ÙÔ˘˜ ÈÔ ÌÂÙÚÈÔ·ı›˜ Ì·ıËÌ·ÙÈÎÔ‡˜ ˘Ô-ÏÔÁÈÛÌÔ‡˜, Â¿Ó ‰ÂÓ ÏËÊıÔ‡Ó Ù· ηٿÏÏËÏ· ̤ÙÚ·Û fi,ÙÈ ·ÊÔÚ¿ ÙËÓ ÂÓË̤ڈÛË Î·È ÙËÓ ÚfiÏË„Ë ÁÈ·fiÛÔ ÙÔ ‰˘Ó·Ùfi ¢ڇÙÂÚ˜ ÔÌ¿‰Â˜ ÏËı˘ÛÌÔ‡, ÔÈ17.000.000 ı¿Ó·ÙÔÈ Ô˘ ÛËÌÂÈÒıËÎ·Ó ·fi Ù· ηÚ-‰È·ÁÁÂȷο ÓÔÛ‹Ì·Ù· ÙÔ 1999, ı· ÊÙ¿ÛÔ˘Ó Ù·25.000.000 ÙÔ 2020 (1,2).

™‹ÌÂÚ· Â›Ó·È ·fiÏ˘Ù· ÙÂÎÌËÚȈ̤ÓÔ fiÙÈ Ë ‰È·-‰Èηۛ· Ù˘ ·ıËڈ̷ÙÔÛÎÏ‹Ú˘ÓÛ˘, Ù˘ ÛÙÂÊ·ÓÈ-·›·˜ ·Ó¿ÚÎÂÈ·˜, Ù˘ ÛÙËı¿Á¯Ë˜ Î·È ÙÔ˘ ÂÌ-ÊÚ¿ÁÌ·ÙÔ˜, Ô˘ ÚÔηÏ› ÛÔ‚·Ú¿ ÚÔ‚Ï‹Ì·Ù·Ì ηٿÏËÍË ÙËÓ ÂÂÌ‚·ÙÈ΋ ηډÈÔÏÔÁ›· (Ì·ÏÔ-Ó¿ÎÈ), ÙË ¯ÂÈÚÔ˘ÚÁÈ΋ ¤̂·ÛË (bypass) ‹ ·ÎfiÌËÎ·È ÙÔÓ ı¿Ó·ÙÔ, ¤¯ÂÈ ÙËÓ ·Ú¯‹ Ù˘ ÛÙËÓ ·È‰È΋ ËÏÈ-Λ· (3,4). ¶ÚÈÓ ·fi ÂÚ›Ô˘ 10 ¯ÚfiÓÈ·, Û‡ÌʈӷÌ ٷ Â˘Ú‹Ì·Ù· ·ıÔÏÔÁÔ·Ó·ÙÔÌÈÎÒÓ Î˘Ú›ˆ˜ ÌÂ-ÏÂÙÒÓ, Ê¿ÓËΠfiÙÈ ÔÈ ÚÒÙ˜ ÂÓ·Ôı¤ÛÂȘ Ï›Ô˘˜ÛÙËÓ ·ÔÚÙ‹ Â›Ó·È ÂÌÊ·Ó›˜ ·fi ÙËÓ ËÏÈΛ· ÙˆÓ 3ÂÙÒÓ, ÂÓÒ ÛÙ· ÛÙÂÊ·ÓÈ·›· ÛÙËÓ ËÏÈΛ· ÙˆÓ 12-14ÂÙÒÓ, Ì›· ‰È·‰Èηۛ· Ô˘ ÚÔԉ¢ÙÈο ı· ÂȉÂÈ-Óˆı› ÛÙȘ ÂfiÌÂÓ˜ 3-5 ‰ÂηÂٛ˜, ÁÈ· Ó· ηٷϋ-ÍÂÈ - Û ¿ÏÏÔÙ ¿ÏÏÔ ¯ÚfiÓÔ - ÛÙË ‰ËÌÈÔ˘ÚÁ›· ÛÔ-‚·ÚÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ (5).

§·Ì‚¿ÓÔÓÙ·˜ ˘’ fi„ÈÓ Ù· ·Ú·¿Óˆ ÛÙÔȯ›·,Ê·›ÓÂÙ·È Î·ı·Ú¿ ÙÔ Ì¤ÁÂıÔ˜ ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ Î·È Ë ÌÂ-Á¿ÏË ÛËÌ·Û›· Ù˘ ÏËÚÔÊfiÚËÛ˘ ÁÈ· ÙË Ï‹„Ë ÙˆÓηٿÏÏËÏˆÓ Ì¤ÙÚˆÓ. ∂›Ó·È ÁÓˆÛÙfi fiÙÈ ÙÔ 50% ÙˆÓηÙÔ›ÎˆÓ ÙˆÓ ∏.¶.∞. Ì ˘„ËÏfi ÌÔÚʈÙÈÎfi ›‰ԉÂÓ ÁÓˆÚ›˙ÂÈ ÙÔ ÏÈȉ·ÈÌÈÎfi ÙÔ˘ ÚÔÊ›Ï. ∂ÈÚfi-

ÛıÂÙ·, ¤¯ÂÈ Á›ÓÂÈ Ï¤ÔÓ ÎÔÈÓ‹ ÂÔ›ıËÛË fiÙÈ Â›Ó·È·fiÏ˘Ù· ··Ú·›ÙËÙÔ˜ Ô ¤ÏÂÁ¯Ô˜ Û οı ·È‰› Ì‚‚·ÚË̤ÓÔ ÎÏËÚÔÓÔÌÈÎfi ÈÛÙÔÚÈÎfi ηÈ, Ì¿ÏÈÛÙ·,fiÛÔ ÙÔ ‰˘Ó·Ùfi ÓˆÚ›ÙÂÚ·, ·fi ÙËÓ ËÏÈΛ· ÙˆÓ 3ÂÙÒÓ. ™Ù· ·È‰È¿ Ô˘ ‰ÂÓ ˘¿Ú¯ÂÈ ÁÓˆÛÙ‹ ÎÏËÚÔ-ÓÔÌÈ΋ ÂÈ‚¿Ú˘ÓÛË, Â›Ó·È Ôχ ¯Ú‹ÛÈÌÔ Ó· Á›ÓÂÙ·È Ô¤ÏÂÁ¯Ô˜ Ì ÙËÓ Â˘Î·ÈÚ›· ·ÈÌÔÏË„›·˜ ÁÈ· οÔÈ· ¿Ï-ÏË ·ÈÙ›·. ∏ ¯ÚËÛÈÌfiÙËÙ· ÙÔ˘ ÂϤÁ¯Ô˘, Û fiÏ· ·ÓÂ-Í·ÈÚ¤Ùˆ˜ Ù· ·È‰È¿, ‰ÂÓ ¤¯ÂÈ ‰È¢ÎÚÈÓÈÛÙ› ·fiÏ˘Ù·Ì¤¯ÚÈ ÙÒÚ·, ηıÒ˜ οÔÈÔÈ ıˆÚÔ‡Ó fiÙÈ ›Ûˆ˜ ‰ÂÓÂ›Ó·È ··Ú·›ÙËÙÔ˜, ÂÓÒ ˘¿Ú¯Ô˘Ó Î·È ·ÓÙ›ıÂÙ˜·fi„ÂȘ Ô˘ ÙÔ ˘ÔÛÙËÚ›˙Ô˘Ó (5).

™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÂÚÁ·Û›·˜ ‹Ù·Ó Ó· ‰ÈÂ-Ú¢ÓËı› Ô ‚·ıÌfi˜ ÁÓÒÛ˘ ÙˆÓ ÂȤ‰ˆÓ ÙˆÓ ÏÈÈ-‰›ˆÓ ÙÔ˘ ·›Ì·ÙÔ˜ Û Ó·ÚÔ‡˜ ÊÔÈÙËÙ¤˜ ·ÁÁÂÏÌ¿-ÙˆÓ ˘Á›·˜-ÚfiÓÔÈ·˜.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ™ÙË ÌÂϤÙË, Ë ÔÔ›· ‰È‹ÚÎÂÛ 8 Ì‹Ó˜ (01/04/2003 -

01/12/2003), ¤Ï·‚·Ó ̤ÚÔ˜ 1282 ÊÔÈÙËÙ¤˜ Ù˘ π·ÙÚÈ΋˜ ™¯Ô-Ï‹˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ Î·È ÙÔ˘ ∆Ì‹Ì·ÙÔ˜ ÙˆÓ ∞ÓÒ-Ù·ÙˆÓ ™¯ÔÏÒÓ ∂·ÁÁÂÏÌ¿ÙˆÓ ÀÁ›·˜-¶ÚfiÓÔÈ·˜ ÙÔ˘ ∆.∂.π.∞ı‹Ó·˜, ‰ËÏ·‰‹ ÊÔÈÙËÙ¤˜ ª·È¢ÙÈ΋˜, ¡ÔÛËÏ¢ÙÈ΋˜ º˘ÛÈÔ-ıÂڷ›·˜, ∂ÚÁÔıÂڷ›·˜, µÚÂÊÔÓËÈÔÎÔÌ›·˜, ∫ÔÈÓˆÓÈ΋˜EÚÁ·Û›·˜ Î·È π·ÙÚÈÎÒÓ ∂ÚÁ·ÛÙËÚ›ˆÓ, ËÏÈΛ·˜ 18-25 ÂÙÒÓ. ∏ÌÂϤÙË Ú·ÁÌ·ÙÔÔÈ‹ıËΠ‚¿ÛÂÈ ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘, ÙÔÔÔ›Ô ‰È·ÓÂÌ‹ıËΠÛÙÔ˘˜ ÊÔÈÙËÙ¤˜ Î·È Û˘ÌÏËÚÒıËΠ·fi·˘ÙÔ‡˜, ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ ¯ˆÚ›˜ η̛· ·Ú¤Ì-‚·ÛË ÙˆÓ ÂÚ¢ÓËÙÒÓ, Û ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· 15-30 ÏÂÙÒÓ,̤۷ ÛÙȘ ·›ıÔ˘Û˜ ‰È‰·Ûηϛ·˜ (·ÌÊÈı¤·ÙÚ·). ∆· ¤ÙË ÊÔ›-ÙËÛ˘ Ô›ÎÈÏ·Ó, ÂÎÙfi˜ ·fi ÙÔ˘˜ ÊÔÈÙËÙ¤˜ Ù˘ π·ÙÚÈ΋˜, ÔÈÔÔ›ÔÈ ÊÔÈÙÔ‡Û·Ó ÛÙ· “ÙÚ›ÌËÓ·” ÙÔ˘ 6Ô˘ ¤ÙÔ˘˜. ¶ÔÛÔÛÙfi95,5% ÙˆÓ Û˘ÌÌÂÙ¯fiÓÙˆÓ ‹Ù·Ó ŒÏÏËÓ˜ Î·È 4,5% ·ÏÏÔ‰·-Ô›. ¢ÂÓ ˘‹ÚÍ ηӤӷ Úfi‚ÏËÌ· ˆ˜ ÚÔ˜ ÙËÓ ÚÔı˘Ì›·

ÁÈ· ÚÒÙË ÊÔÚ¿ ÂÍÂÙ·ÛÙ› ÏfiÁˆ Û˘Ìو̿وÓ, ٷ·ÎfiÏÔ˘ı· ‹Ù·Ó Ôχ ÛÔ‚·Ú¿. ™Â fi,ÙÈ ·ÊÔÚ¿ÙÔ˘˜ ÁÔÓ›˜ ÙˆÓ ÁÔÓ¤ˆÓ ÙÔ˘˜, ÙÔ ÔÛÔÛÙfi ·˘ÙÒÓÔ˘ ‰ÂÓ ÁÓÒÚÈ˙·Ó ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚÔ ·fi 80%. ™˘-ÌÂÚ·ÛÌ·ÙÈο, Ê·›ÓÂÙ·È fiÙÈ ÔÈ ÚÔÛ¿ıÂȘ ÁÈ· ÂÓË-̤ڈÛË ·fi ÙÔ˘˜ ÁÈ·ÙÚÔ‡˜, ÙÔ˘˜ ‰È¿ÊÔÚÔ˘˜ ˘ÁÂÈ-ÔÓÔÌÈÎÔ‡˜ ÊÔÚ›˜, ηıÒ˜ Î·È Ù· ªª∂ Û fi,ÙÈ ·ÊÔ-Ú¿ ÙË ÛËÌ·Û›· Ù˘ ÚfiÏ˄˘, ¤¯Ô˘Ó ˆ˜ ¤Ó· ‚·ıÌfi·Ô‰ÒÛÂÈ. ÃÚÂÈ¿˙ÂÙ·È, fï˜, ·ÎfiÌË ÂÚÈÛÛfiÙÂÚËÚÔÛ¿ıÂÈ·, ÂÈÎÂÓÙÚÒÓÔÓÙ·˜ ÛÙȘ ÌÈÎÚ¤˜ ËÏÈ˘,ÛÙÔ˘˜ ·È‰È¿ÙÚÔ˘˜, ·ÏÏ¿ Î·È ÛÙÔ˘˜ ÊÔÈÙËÙ¤˜ (ÌÂÏ-ÏÔÓÙÈÎÔ‡˜ ·ÁÁÂÏ̷ٛ˜ ˘Á›·˜), Ô‡Ùˆ˜ ÒÛÙ ӷÁ›ÓÂÈ ÁÓˆÛÙ‹ Î·È Ú·ÎÙÈο ÂÊ·ÚÌfiÛÈÌË Ë ÛËÌ·Û›·Ù˘ ¤ÁηÈÚ˘ ‰È¿ÁÓˆÛ˘ Ù˘ ˘ÂÚÏÈȉ·ÈÌ›·˜ ÛÂfiÛÔ ÙÔ ‰˘Ó·ÙfiÓ ÌÂÁ·Ï‡ÙÂÚÔ ·ÚÈıÌfi ·ÙfïÓ.

§¤ÍÂȘ ÎÏÂȉȿ: ÏÈ›‰È· ·›Ì·ÙÔ˜, ÎÏËÚÔÓÔÌÈÎfiÙËÙ·,ÁÓÒÛË, ÚfiÏË„Ë.

obvious that there is need for greater promotion.This should focus on early diagnosis. Paediatriciansand health workers need to be prepared in order toinform greater numbers of people to make apractice of paying attention to early diagnosis of acondition which is a major cause of death in adults,which is hereditary, and which starts from the earlychildhood ages of 3-5 years.

Key words: blood lipids, heredity, information,prevention.

196

¶·È‰È·ÙÚÈ΋ 2004;67:195-199 Paediatriki 2004;67:195-199

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·196

Page 54: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

197

¶·È‰È·ÙÚÈ΋ 2004;67:195-199 Paediatriki 2004;67:195-199

ÁÈ· Û˘ÌÌÂÙÔ¯‹. ∆· ·ÔÙÂϤÛÌ·Ù· Ù˘ ¤Ú¢ӷ˜ ÚԤ΢„·Ó̤ۈ ·Ó¿Ï˘Û˘ ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ ÙˆÓ ÂÚˆÙËÌ·ÙÔÏÔÁ›ˆÓ Û¢ÔÏÔÁÈÛÙ‹ Ì ÙË ‚Ô‹ıÂÈ· ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ SPSS. º˘ÛÈÔ-ÏÔÁÈΤ˜ ıˆڋıËÎ·Ó ÔÈ ÙÈ̤˜ 200 mg% ÁÈ· ÙËÓ ÔÏÈ΋ ¯ÔÏË-ÛÙÂÚfiÏË, <180 mg% ÁÈ· Ù· ÙÚÈÁÏ˘ÎÂÚ›‰È·, >45 mg% ÁÈ· ÙËÓHDL Î·È <160 mg% ÁÈ· ÙËÓ LDL.

∞ÔÙÂϤÛÌ·Ù·™‡Ìʈӷ Ì ٷ ·ÔÙÂϤÛÌ·Ù·, 375 ÊÔÈÙËÙ¤˜

(29,2%) ›¯·Ó ÂϤÁÍÂÈ Ù· ›‰· ÙˆÓ ÏÈȉ›ˆÓ ÙÔ˘˜Ì›· ÊÔÚ¿, ÂÓÒ ÔÈ ˘fiÏÔÈÔÈ 907 (70,8%) ‰ÂÓ Â›¯·ÓÂÏÂÁ¯ı› ÔÙ¤, ·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ 503 ·fi ·˘-ÙÔ‡˜ (55,4%) ÙÔ Â›¯·Ó ÛÎÂÊÙ›, ÂÓÒ ÔÈ ˘fiÏÔÈÔÈ404 (44,6%) ‰‹ÏˆÛ·Ó fiÙÈ ‰ÂÓ ÙÔ Â›¯·Ó ÛÎÂÊÙ› Ô-Ù¤ Î·È ¤‰ÂÈÍ·Ó ·‰È·ÊÔÚ›·. ∞fi ÙÔ˘˜ 375 ÊÔÈÙËÙ¤˜Ô˘ ›¯·Ó οÓÂÈ ÂÚÁ·ÛÙËÚȷΤ˜ ÂÍÂÙ¿ÛÂȘ, 11(2,9%) ‚Ú¤ıËΠӷ ¤¯Ô˘Ó ·˘ÍË̤ӷ ›‰· ¯ÔÏË-ÛÙÂÚfiÏ˘ ·›Ì·ÙÔ˜, 6 (1,6%) ›¯·Ó, ›Û˘, ·˘ÍË̤-Ó· ÙÚÈÁÏ˘ÎÂÚ›‰È·, ÂÓÒ 3 (0,8%) ›¯·Ó Î·È ·˘ÍË̤Ó˜ÙÈ̤˜ ¯ÔÏËÛÙÂÚfiÏ˘ ¯·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜ (LDL).∆· ›‰· Ù˘ ˘„ËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ¯ÔÏËÛÙÂÚfiÏ˘(HDL) ‹Ù·Ó Û fiÏÔ˘˜ ̤۷ ÛÙ· Ê˘ÛÈÔÏÔÁÈο fiÚÈ·.

™Â fi,ÙÈ ·ÊÔÚ¿ ÙÔÓ ÙÚfiÔ ˙ˆ‹˜ Î·È ÙȘ ηıËÌÂÚÈ-Ó¤˜ ÙÔ˘˜ Û˘Ó‹ıÂȘ, ‚Ú¤ıËΠfiÙÈ 419 ÊÔÈÙËÙ¤˜(32,6%) ‹Ù·Ó ηÓÈÛÙ¤˜, 633 (49,3%) Á˘ÌÓ¿˙ÔÓÙ·Ó›Ù Û Á˘ÌÓ·ÛÙ‹ÚÈÔ ‹ ‚·‰›˙ÔÓÙ·˜ Î·È Î¿ÓÔÓÙ·˜Ù˙fiÁÎÈÓÁÎ, ÂÓÒ 213 (16,6%) ·ıÏÔ‡ÓÙ·Ó Û˘ÛÙËÌ·ÙÈ-ο. ∞Ó·ÊÔÚÈο Ì ÙÔ ‰È·ÈÙÔÏfiÁÈÔ Ô˘ ·ÎÔÏÔ˘ıÔ‡-Û·Ó, 801 (62,4%) ¤ÙÚˆÁ·Ó ÎÚ¤·˜ 1-3 ÊÔÚ¤˜ ÙËÓ‚‰ÔÌ¿‰·, ÂÓÒ 481 (37,6%) 4-7 ÊÔÚ¤˜. °·Ï·ÎÙÔÎÔ-ÌÈο ÚÔ˚fiÓÙ·, fiˆ˜ Ï‹Ú˜ Á¿Ï·, ‚Ô‡Ù˘ÚÔ Î·È·¯È¿ Ù˘ÚÈ¿, Î·Ù·Ó¿ÏˆÓ·Ó Î·ıËÌÂÚÈÓ¿ 474 ÊÔÈÙË-Ù¤˜ (37%). ∞fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ ÂÚˆÙËı¤ÓÙˆÓ, 1080(84%) ·ÎÔÏÔ˘ıÔ‡Û·Ó ÂχıÂÚÔ ‰È·ÈÙÔÏfiÁÈÔ, Û·ÓÙ›ıÂÛË Ì 202 (15,8%) Ô˘ ‰‹ÏˆÛ·Ó fiÙÈ ÚfiÛÂ-¯·Ó ÙË ‰È·ÙÚÔÊ‹ ÙÔ˘˜. ¶ÔÛÔÛÙfi 89,9% (1153 ÊÔÈ-ÙËÙ¤˜) ıˆÚÔ‡Û ··Ú·›ÙËÙÔ Ó· ÂϤÁ¯ÂÙ·È Ë ‰È·-ÙÚÔÊ‹ ·fi ÙËÓ ËÏÈΛ· ÙˆÓ 3-5 ÂÙÒÓ.

OÈ ÏËÚÔÊÔڛ˜ Û¯ÂÙÈο Ì ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi-ÎÏËÚÔÓÔÌÈÎfi ÈÛÙÔÚÈÎfi, fiÛÔÓ ·ÊÔÚ¿ ÛÙÔ˘˜ ÁÔÓ›˜ÙÔ˘˜, ÂÚÈÂÏ¿Ì‚·Ó·Ó Ù· ·ÎfiÏÔ˘ı·: ÔÛÔÛÙfi35,4% (455 ÊÔÈÙËÙ¤˜) ‹ÍÂÚ fiÙÈ Ô ·Ù¤Ú·˜ ›¯ÂÂϤÁÍÂÈ Ù· ÏÈ›‰È¿ ÙÔ˘, 22,6% (290 ÊÔÈÙËÙ¤˜) ÁÓÒ-ÚÈ˙ fiÙÈ ‰ÂÓ Ù· ›¯Â ÂϤÁÍÂÈ, ÂÓÒ 41,8% (537 ÊÔÈÙË-Ù¤˜) ‰ÂÓ ÁÓÒÚÈ˙ ÔÙȉ‹ÔÙ ۯÂÙÈÎfi. ™Â fi,ÙÈ ·ÊÔÚ¿ÙȘ ·ÓÙ›ÛÙÔȯ˜ ÁÓÒÛÂȘ ÁÈ· ÙË ÌËÙ¤Ú·, 409 ÊÔÈÙË-Ù¤˜ (31,9%) ·¿ÓÙËÛ·Ó fiÙÈ ÁÓÒÚÈ˙·Ó fiÙÈ Ù· ›‰·ÙˆÓ ÏÈȉ›ˆÓ ›¯·Ó ÂÏÂÁ¯ı›, 288 (22,4%) fiÙÈ ‰ÂÓ Â›-¯·Ó ÂÏÂÁ¯ı›, ÂÓÒ 585 (45,6%) ‰ÂÓ ÁÓÒÚÈ˙·Ó οÙÈ.ø˜ ÚÔ˜ ÙÔ ‰È·ÈÙÔÏfiÁÈÔ Ô˘ ·ÎÔÏÔ˘ıÔ‡Û·Ó ÔÈ ÁÔ-Ó›˜ Ê¿ÓËΠfiÙÈ 881 (68,7%) ›¯·Ó ÂÈϤÍÂÈ ÙÔ Âχ-ıÂÚÔ, ÂÓÒ 401 (31,3%) ÚfiÛ¯·Ó ÙË ‰È·ÙÚÔÊ‹ÙÔ˘˜. ∫·ÓÈÛÙ¤˜ ‹Ù·Ó 579 (45,1%) ·fi ÙÔ˘˜ ·Ù¤-Ú˜ Î·È 395 (30,8%) ·fi ÙȘ ÌËÙ¤Ú˜.

∞fi ÙÔ˘˜ 455 ·Ù¤Ú˜ Ô˘ ›¯·Ó ÂÏÂÁ¯ı› ˆ˜ÚÔ˜ Ù· ›‰· ÙˆÓ ÏÈȉ›ˆÓ ÙÔ˘˜, ÔÈ 139 (30,5%)›¯·Ó ‚ÚÂı› Ì ·ıÔÏÔÁÈΤ˜ ÙÈ̤˜ ¯ÔÏËÛÙÂÚfiÏ˘,ÔÈ 96 (21%) ›¯·Ó Ù·˘Ùfi¯ÚÔÓ· Î·È ˘„ËϤ˜ ÙÈ̤˜ ÙÚÈ-ÁÏ˘ÎÂÚȉ›ˆÓ, ÂÓÒ Ë LDL ‹Ù·Ó ·ıÔÏÔÁÈ΋ Û 46(10%). ª›· ¿ÏÏË ÔÌ¿‰· ·ÔÙÂÏÔ‡Û·Ó ÔÈ 664 ·Ù¤-Ú˜ Ô˘ ›¯·Ó ÂÍÂÙ·ÛÙ› ÁÈ· Èı·Ófi ηډÈÔÏÔÁÈÎfiÚfi‚ÏËÌ·, ¯ˆÚ›˜ ··Ú·›ÙËÙ· Ó· ¤¯ÂÈ ÚÔËÁËı›ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜. ™Â 41 ·fi ·˘ÙÔ‡˜ (6,1%)›¯Â ‰È·ÁÓˆÛÙ› ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ˜, Û 50 (7,5%) ¤Ì-ÊÚ·ÁÌ·, ÂÓÒ 20 (3%) ›¯·Ó ˘Ô‚ÏËı› Û ¯ÂÈÚÔ˘Ú-ÁÈ΋ ¤̂·ÛË (bypass) Î·È 19 (2,8%), › ÙÔ˘ Û˘-ÓfiÏÔ˘, ›¯·Ó ·Ô‚ÈÒÛÂÈ (¯ˆÚ›˜ ·ÓÙÈÌÂÙÒÈÛË ‹ ÌÂ-Ù¿ ·fi ·ÓÙÈÌÂÙÒÈÛË Ì ÂÂÌ‚·ÙÈ΋-¯ÂÈÚÔ˘ÚÁÈ΋̤ıÔ‰Ô).

™Â fi,ÙÈ ·ÊÔÚ¿ ÙȘ ÌËÙ¤Ú˜, Ù· ÔÛÔÛÙ¿ ÁÓÒÛ˘ÁÈ· ¤ÏÂÁ¯Ô ‹Ù·Ó ÂÚ›Ô˘ ›‰È· Ì ÂΛӷ ÙˆÓ ·Ù¤-ÚˆÓ, ˆÛÙfiÛÔ, Û fiϘ ÙȘ ˘fiÏÔȘ ·Ú·Ì¤ÙÚÔ˘˜˘‹Ú¯·Ó Ôχ ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜. ¶ÈÔ Û˘ÁÎÂÎÚÈ-̤ӷ, 75 (18,3%) ·fi ÙȘ 409 ÌËÙ¤Ú˜ Ô˘ ›¯·ÓÂϤÁÍÂÈ Ù· ÏÈ›‰È· ÙÔ˘ ·›Ì·Ùfi˜ ÙÔ˘˜ ›¯·Ó ·ıÔÏÔ-ÁÈο ›‰· ¯ÔÏËÛÙÂÚfiÏ˘, 28 (6,8%) ›¯·Ó, ›-Û˘, ˘„ËϤ˜ ÙÈ̤˜ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ, ÂÓÒ Ë LDL ‹Ù·Ó·ıÔÏÔÁÈ΋ Û 23 (5,6%).

∞fi ÙȘ 581 ÌËÙ¤Ú˜ Ô˘ ›¯·Ó ÂÍÂÙ·ÛÙ› ÁÈ· È-ı·Ófi ηډÈÔÏÔÁÈÎfi Úfi‚ÏËÌ·, 3 (0,5%) ¤·Û¯·Ó·fi ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ Î·È 5 (0,8%) ›¯·Ó ·ÚÔ˘ÛÈ¿-ÛÂÈ ¤ÌÊÚ·ÁÌ·. ª›· ÌËÙ¤Ú· (0,1%) ›¯Â ¯ÂÈÚÔ˘ÚÁË-ı› (bypass), ÂÓÒ 4 (0,6%) ›¯·Ó ·Ô‚ÈÒÛÂÈ. ∆¤ÏÔ˜,Û fi,ÙÈ ·ÊÔÚ¿ ÙÔ˘˜ ÁÔÓ›˜ ÙˆÓ ÁÔÓ¤ˆÓ ÙÔ˘˜, 252ÊÔÈÙËÙ¤˜ (19,6%) ·¿ÓÙËÛ·Ó fiÙÈ ÁÓÒÚÈ˙·Ó Â¿Ó Î¿-ÔÈÔ˜ ·Ô‡˜ ÙÔ˘˜ ·ÚÔ˘Û›·˙ ˘ÂÚÏÈȉ·ÈÌ›· ‹¤·Û¯Â ·fi ηډÈÔÏÔÁÈÎfi ÓfiÛËÌ·, ÂÓÒ ÁÈ· ÙȘ ÁÈ·-ÁÈ¿‰Â˜ ÁÓÒÚÈ˙·Ó ÌfiÓÔ 176 (13,7%).

™˘˙‹ÙËÛË ∆Ô ÁÂÁÔÓfi˜ fiÙÈ ÙÔ 1/3 ÙˆÓ ÊÔÈÙËÙÒÓ Â›¯Â ÂϤÁÍÂÈ

Ù· ›‰· ÙˆÓ ÏÈȉ›ˆÓ Â›Ó·È Ôχ ÛËÌ·ÓÙÈÎfi, ÂÓÒÂÓı·ÚÚ˘ÓÙÈÎfi Â›Ó·È Î·È ÙÔ fiÙÈ ÔÈ ÌÈÛÔ› ÂÚ›Ô˘ ·fiÙÔ˘˜ ˘fiÏÔÈÔ˘˜ ›¯·Ó ÛÎÂÊÙ› fiÙÈ Ú¤ÂÈ Î¿ÔÈ·ÛÙÈÁÌ‹ Ó· ÂÏÂÁ¯ıÔ‡Ó. ¶·Ú’ fiÏ· ·˘Ù¿, Ê·›ÓÂÙ·È fiÙÈÂÚ›Ô˘ ÙÔ 1/3 ÙˆÓ Ó¤ˆÓ Ô˘ ÛÙÔ Ì¤ÏÏÔÓ ı· ·Ô-ÙÂϤÛÔ˘Ó ÙÔ˘˜ ·ÁÁÂÏ̷ٛ˜ ˘Á›·˜, ·ÚÔ˘ÛÈ¿˙ÂÈÏ‹ÚË ·‰È·ÊÔÚ›· (6). ™Â ·˘Ùfi, Â›Ó·È Èı·Ófi Ó·Û˘Ì‚¿ÏÂÈ Î·È Ë ÌÈÎÚ‹ ËÏÈΛ· (7). µ¤‚·È·, ÔÈ 11 ÂÚÈ-ÙÒÛÂȘ (2,6%) Ì ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù· ‰ÂÓ ·Ô-ÙÂÏÔ‡Ó ·ÓËÛ˘¯ËÙÈÎfi ÛÙÔȯ›Ô, ηıÒ˜ ÙÔ ÂӉȷʤ-ÚÔÓ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‰ÂÓ ÂÛÙÈ·˙fiÙ·Ó ÛÙ· Ô-ÛÔÛÙ¿ ÙˆÓ ·ıÔÏÔÁÈÎÒÓ ÂÚÈÙÒÛÂˆÓ Û ·˘Ù¤˜ ÙȘËÏÈ˘, ·ÏÏ¿ ÛÙËÓ Â˘·ÈÛıËÙÔÔ›ËÛË ÙfiÛÔ ÙˆÓ Û˘Ì-ÌÂÙ¯fiÓÙˆÓ fiÛÔ Î·È ÙÔ˘ ÛÙÂÓÔ‡ ‹ ¢ڇÙÂÚÔ˘ ÂÚÈ-‚¿ÏÏÔÓÙfi˜ ÙÔ˘˜ fiÛÔÓ ·ÊÔÚ¿ ÛÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔÚfi‚ÏËÌ· (8-10).

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·197

Page 55: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

198

¶·È‰È·ÙÚÈ΋ 2004;67:195-199 Paediatriki 2004;67:195-199

∂›Ó·È ÂÓı·ÚÚ˘ÓÙÈÎfi ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÌfiÓÔ 32,6%‹Ù·Ó ηÓÈÛÙ¤˜, ηıÒ˜ ‰Â›¯ÓÂÈ fiÙÈ ÙÔ Û‡ÓÔÏÔ Ù˘·ÓÙÈηÓÈÛÙÈ΋˜ ÂÎÛÙÚ·Ù›·˜ Ô˘ Ú·ÁÌ·ÙÔÔÈ›-Ù·È ·fi ÙÔ ÎÚ¿ÙÔ˜, ÙÔ˘˜ ÁÈ·ÙÚÔ‡˜ ‹ ¿ÏÏÔ˘˜ ˘ÁÂÈÔ-ÓÔÌÈÎÔ‡˜ ÊÔÚ›˜ ¤¯ÂÈ Û ÌÂÁ¿ÏÔ ‚·ıÌfi ıÂÙÈο ·Ô-ÙÂϤÛÌ·Ù· (11). OÈ ÌÈÛÔ› ÊÔÈÙËÙ¤˜ ÂÚ›Ô˘ ‰‹Ïˆ-Û·Ó fiÙÈ Á˘ÌÓ¿˙ÔÓÙ·È, ÂÓÒ ÙÔ 16,6% fiÙÈ ·ıÏÂ›Ù·È Û˘-ÛÙËÌ·ÙÈο. ∫·È ÛÙȘ ‰‡Ô ÂÚÈÙÒÛÂȘ, ÔÈ ·ÚÈıÌÔ›‰Â›¯ÓÔ˘Ó fiÙÈ Ë ·Ó·ÁηÈfiÙËÙ· Ù˘ ¿ÛÎËÛ˘ ÙÔ˘ ÛÒ-Ì·ÙÔ˜ ·fi οı ¿Ô„Ë ¤¯ÂÈ Á›ÓÂÈ ÎÔÈÓ‹ ÂÔ›ıËÛË(12,13).

™Â fi,ÙÈ ·ÊÔÚ¿ ÙÔ ‰È·ÈÙÔÏfiÁÈÔ, Ê·›ÓÂÙ·È fiÙÈ˘¿Ú¯Ô˘Ó ÌÂÁ¿Ï˜ ‰È·ÊÔÚ¤˜ ÌÂٷ͇ ıˆڛ·˜ ηÈÚ¿Í˘. ŒÙÛÈ, ÂÓÒ ÙÔ 90% ÂÚ›Ô˘ ıˆÚ› fiÙÈ Â›Ó·È··Ú·›ÙËÙÔ Ó· Â›Ó·È ÚÔÛÂÁ̤ÓË Ë ‰È·ÙÚÔÊ‹ ηÈ,Ì¿ÏÈÛÙ·, ·fi ÙËÓ ËÏÈΛ· ÙˆÓ 3-5 ÂÙÒÓ, ÌfiÓÔ ÙÔ15,8% ÙÔ ÙËÚÔ‡ÛÂ. ∆· ÔÛÔÛÙ¿ ·˘ÙÒÓ Ô˘ ηٷ-Ó¿ÏˆÓ·Ó Î·ıËÌÂÚÈÓ¿ ‚Ô‡Ù˘ÚÔ, ·¯È¿ Ù˘ÚÈ¿, Ï‹-Ú˜ Á¿Ï·, ·˘Á¿ Î.Ï. (37%), ηıÒ˜ Î·È fiÛˆÓ ¤ÙÚˆ-Á·Ó ηıËÌÂÚÈÓ¿ ÎÚ¤·˜ (37,6%) ‰ÂÓ Â›Ó·È ·ÌÂÏËÙ¤·(14-18).

∞Ó·ÊÔÚÈο Ì ÙȘ ··ÓÙ‹ÛÂȘ ÁÈ· ÙȘ Û˘Ó‹ıÂÈÂ˜ÙˆÓ ÁÔÓ¤ˆÓ ÙÔ˘˜, ‰È·ÈÛÙÒıËΠfiÙÈ ÂÚ›Ô˘ 2ÛÙÔ˘˜ 3 ‰ÂÓ ‹ÍÂÚ·Ó Â¿Ó Â›¯Â ÂÏÂÁ¯ı› Ô ·Ù¤Ú·˜‹ Ë ÌËÙ¤Ú· ÙÔ˘˜ ÁÈ· Ù· ›‰· ÙˆÓ ÏÈȉ›ˆÓ ÙÔ˘·›Ì·ÙÔ˜, Ì ·ÔÙ¤ÏÂÛÌ· Ó· ÌËÓ ÁÓˆÚ›˙Ô˘Ó ÙÔ ÎÏË-ÚÔÓÔÌÈÎfi ÙÔ˘˜ ÈÛÙÔÚÈÎfi (19-21). ™Â fi,ÙÈ ¤¯ÂÈ Û¯¤ÛËÌ ÙË ‰È·ÙÚÔÊ‹, ·Ú’ fiÏÔ Ô˘ ÔÈ ÁÔÓ›˜ - Û ‰È-Ï¿ÛÈÔ ÔÛÔÛÙfi ·fi Ù· ·È‰È¿ ÙÔ˘˜ - ÚfiÛ¯·ÓÙÔ ‰È·ÈÙÔÏfiÁÈfi ÙÔ˘˜, Ù· ·ÔÙÂϤÛÌ·Ù· ‰ÂÓ Â›Ó·ÈηıfiÏÔ˘ ÈηÓÔÔÈËÙÈο, Â¿Ó ÏËÊı› ˘’ fi„ÈÓ Ë ‰È·-ÊÔÚ¿ ËÏÈΛ·˜ (22,23). ∆Ô ÔÛÔÛÙfi ÙˆÓ ÁÔÓ¤ˆÓ-η-ÓÈÛÙÒÓ (·Ù¤Ú˜ 45,1% Î·È ÌËÙ¤Ú˜ 38,8%) ˘Ô-‰ËÏÒÓÂÈ fiÙÈ, ÂÎÙfi˜ ÙˆÓ ‚Ï·‚ÒÓ Ô˘ ˘Ê›ÛÙ·ÓÙ·È·fi ÙÔ Î¿ÓÈÛÌ·, ·ÔÙÂÏÔ‡Ó Î·Îfi ·Ú¿‰ÂÈÁÌ·ÁÈ· Ù· ·È‰È¿ ÙÔ˘˜.

∆Ô ÁÂÁÔÓfi˜ fiÙÈ ÛÙËÓ ÔÌ¿‰· ÙˆÓ ÁÔÓ¤ˆÓ Ô˘ÂϤÁ¯ıËηÓ, 1 ÛÙÔ˘˜ 3 ·Ù¤Ú˜ ‚Ú¤ıËΠӷ ¤¯ÂÈ˘„ËÏ¿ ›‰· ¯ÔÏËÛÙÂÚfiÏ˘ ·›Ì·ÙÔ˜, Ì fi¯È ·ÌÂ-ÏËÙ¤·, ·ÓÙ›ÛÙÔȯ·, ÔÛÔÛÙ¿ ÛÙȘ ÌËÙ¤Ú˜, Ê·ÓÂÚÒ-ÓÂÈ ÙËÓ ÙÂÚ¿ÛÙÈ· ÛËÌ·Û›· ÙÔ˘ ÚÔÏËÙÈÎÔ‡ ÂϤÁ-¯Ô˘. ∂ÈϤÔÓ, Ë ·Í›· Ù˘ ÚfiÏ˄˘ ·˘Í¿ÓÂÙ·È·ÎfiÌ· ÂÚÈÛÛfiÙÂÚÔ ·fi Ù· Ôχ ˘„ËÏ¿ ·ıÔÏÔÁÈ-ο ÔÛÔÛÙ¿ ÛÙËÓ ÔÌ¿‰· ÙÔ˘ ηډÈÔÏÔÁÈÎÔ‡ ÂϤÁ-¯Ô˘ Ô˘ Á›ÓÂÙ·È ÁÈ· ÚÒÙË ÊÔÚ¿ ÌÂÙ¿ ÙËÓ ÂÌÊ¿ÓÈ-ÛË Û˘ÌÙˆÌ¿ÙˆÓ (24-27).

∆¤ÏÔ˜, ÂÚÈÛÛfiÙÂÚÔÈ ·fi ÙÔ 80% ÙˆÓ Û˘ÌÌÂÙÂ-¯fiÓÙˆÓ ÛÙËÓ ¤Ú¢ӷ ‰ÂÓ ÁÓÒÚÈ˙·Ó Ù›ÔÙ· Û¯ÂÙÈÎfiÁÈ· ÙÔ˘˜ ÁÔÓ›˜ ÙˆÓ ÁÔÓ¤ˆÓ ÙÔ˘˜, ÁÂÁÔÓfi˜ ·fiÏ˘-Ù· ÏÔÁÈÎfi Â¿Ó ÏËÊı› ˘’ fi„ÈÓ fiÙÈ Ù· 2/3 ‰ÂÓ ‹ÍÂÚ·ÓÔ‡Ù ÁÈ· ÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘˜ (28-30).

¢È·ÈÛÙÒÓÂÙ·È, ÂÔ̤ӈ˜, fiÙÈ ·Ú’ fiÏÔ Ô˘ ÔÈÚÔÛ¿ıÂȘ ÂÓË̤ڈÛ˘ ÁÈ· ÙË ÛËÌ·Û›· ÙÔ˘ ÚÔ-

ÏËÙÈÎÔ‡ ÂϤÁ¯Ô˘, ÙËÓ Ù‹ÚËÛË ˘ÁÈÂÈÓÔ‡ ‰È·ÈÙÔÏÔÁ›-Ô˘, ÙË ‰È·ÎÔ‹ ÙÔ˘ ηӛÛÌ·ÙÔ˜, ÙË ÛËÌ·Û›· Ù˘¿ÛÎËÛ˘, ÙË ÁÓÒÛË Ù˘ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜ Î·È Î˘-Ú›ˆ˜ ÙËÓ ÂÊ·ÚÌÔÁ‹ fiÏˆÓ ·˘ÙÒÓ ·fi Ôχ ÌÈÎÚ‹ËÏÈΛ· ¤¯Ô˘Ó ˆ˜ ¤Ó·Ó ‚·ıÌfi ÂÈÙ‡¯ÂÈ, ˘¿Ú¯Ô˘Ó·ÎfiÌ· ·ÚÎÂÙ¿ ÂÚÈıÒÚÈ· ‚ÂÏÙ›ˆÛ˘. ∂›Ó·È ÛËÌ·-ÓÙÈÎfi Ó· Û˘Ó¯ÈÛÙ› Ë ÚÔÛ¿ıÂÈ· ·fi Ù· ªª∂,ÙÔ˘˜ ·ÁÁÂÏ̷ٛ˜ ˘Á›·˜-ÚfiÓÔÈ·˜, ÙÔ˘˜ ÁÔÓ›˜,ÙÔ˘˜ ÂÎ·È‰Â˘ÙÈÎÔ‡˜, ηıÒ˜ Î·È ÙÔ˘˜ ˘fiÏÔÈÔ˘˜˘ÁÂÈÔÓÔÌÈÎÔ‡˜ ÊÔÚ›˜ Î·È Ó· ÂÓÙ·ı›, ÂÈÎÂÓÙÚÒÓÔ-ÓÙ·˜ ȉȷ›ÙÂÚ· ÛÙ· ·È‰È¿, ÍÂÎÈÓÒÓÙ·˜ ·fi ÙËÓ ËÏÈ-Λ· ÙˆÓ 3 ÂÙÒÓ.

ªÂÁ·Ï‡ÙÂÚË ÛËÌ·Û›·, ˆÛÙfiÛÔ, ¤¯ÂÈ Ë ÚÔÂÙÔÈ-Ì·Û›· Î·È Ë ÂÓË̤ڈÛË ÙˆÓ ÊÔÈÙËÙÒÓ Ô˘ ı· ·Ô-ÙÂϤÛÔ˘Ó ÙÔ˘˜ ÌÂÏÏÔÓÙÈÎÔ‡˜ ·ÁÁÂÏ̷ٛ˜ ˘Á›-·˜, ηıÒ˜ - ÂÊ·ÚÌfi˙ÔÓÙ·˜ ÙËÓ Ù·ÎÙÈ΋ Ù˘ ÚfiÏË-„˘ ÁÈ· ÙÔÓ Â·˘Ùfi ÙÔ˘˜ - ÌÔÚÔ‡Ó Ó· ÌÂÙ·‰ÒÛÔ˘ÓÙË ÁÓÒÛË Î·È ÙȘ Û˘Ó‹ıÂȤ˜ ÙÔ˘˜, ÙfiÛÔ ÛÙÔ ¿ÌÂÛÔfiÛÔ Î·È ÛÙÔ Â˘Ú‡ÙÂÚÔ ÎÔÈÓˆÓÈÎfi ÙÔ˘˜ ÂÚÈ‚¿ÏÏÔÓ.

µÈ‚ÏÈÔÁÚ·Ê›·1. ∞ÓÙˆÓ·ÎÔ‡‰Ë˜ Ã. ¶ÚfiÏË„Ë ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘: ÙÔ ÌÂÁ¿ÏÔ

ÊÈ¿ÛÎÔ ÙˆÓ Î·Ú‰ÈÔÏfiÁˆÓ. ∫·È, fï˜, Ë ÚfiÏË„Ë Â›Ó·È Ë Ìfi-ÓË Ï‡ÛË. ∂ÏÏ ÿ‰Ú ∫·Ú‰ÈÔÏÔÁ›·˜ 2003;12:5-6.

2. Fruchart JC. Handbook of dyslipidemia and atherosclerosis.Paris: Excerpta Medica Publications; 2002.

3. Celermayer DS, Sorensen KA, Deanfield JE. Atherosclerosisa disease that begins in childhood [editorial]. Cardiol Young1994;4:224-227.

4. Palinski W, Napoli C. The fetal origins of atherosclerosis:maternal hypercholesterolemia, and cholesterol-lowering orantioxidant treatment during pregnancy influence in uteroprogramming and postnatal susceptibility to atherogenesis.FASEB J 2002;16:1348-1360.

5. Newburger JW. Dyslipidemia in childhood and adolescence.In: Fyler DC, editor. Nadas’ Pediatric cardiology.Philadelphia: Hanley & Belfus Inc; 1992. p. 285.

6. Muhonen LA, Burns TL, Nelson RP, Lauer RM. Coronary riskfactors in adolescents related to their knowledge of familialcoronary heart disease and hypercholesterolemia: theMuscatine study. Pediatrics 1994;93:444-451.

7. Tershakovec AM, Jawad AF, Stallings VA, Cortner JA, ZemelBS, Shannon BM. Age-related changes in cardiovasculardisease risk factors of hypercholesterolemic children. JPediatr 1998;132:414-420.

8. Harrell JS, McMurray RG, Bangdiwala SI, Frauman AC,Gansky SA, Bradley CB. Effects of a school-basedintervention to reduce cardiovascular disease risk factors inelementary-school children: the Cardiovascular Health inChildren (CHIC) study. J Pediatr 1996;128:797-805.

9. Bonow RO. Primary prevention of cardiovascular disease: acall to action. Circulation 2002;106:3140-3141.

10. Tuzcu EM, Kapadia SR, Tutar E, Ziada KM, Hobbs RE,McCarthy PM et al. High prevalence of coronaryatherosclerosis in asymptomatic teenagers and youngadults: evidence from intravascular ultrasound. Circulation2001;103:2705-2710.

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·198

Page 56: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

199

¶·È‰È·ÙÚÈ΋ 2004;67:195-199 Paediatriki 2004;67:195-199

11. Berenson GS, Srinivasan SR, Bao W, Newman WP 3rd, TracyRE, Wattigney WA. Association between multiplecardiovascular risk factors and atherosclerosis in childrenand young adults. N Engl J Med 1998;338:1650-1656.

12. Gaziano JM. When should heart disease prevention begin? NEngl J Med 1998;338:1690-1692.

13. LaRosa JC. Prevention and treatment of coronary heartdisease: who benefits? Circulation 2001;104:1688-1692.

14. Freedman DS, Khan LK, Dietz WH, Srinivasan SR, BerensonGS. Relationship of childhood obesity to coronary heartdisease risk factors in adulthood. The Bogalusa Heart Study.Pediatrics 2001;108:712-718.

15. Teixeira PJ, Sardinha LB, Going SB, Lohman TG. Total andregional fat and serum cardiovascular disease risk factors inlean and obese children and adolescents. Obes Res2001;9:432-442.

16. Ball EJ, O’Connor J, Abbott R, Steinbeck KS, Davies PS,Wishart C et al. Total energy expenditure, body fatness, andphysical activity in children aged 6-9 y. Am J Clin Nutr2001;74:524-528.

17. Freedman DS, Srinivasan SR, Valdez RA, Williamson DF,Berenson GS. Secular increases in relative weight andadiposity among children over two decades. The BogalusaHeart Study. Pediatrics 1997;99:420-426.

18. Muratova VN, Islam SS, Spangler EC, Demerath EW, NealWA. Cholesterol screening in children and family history ofcoronary heart disease [poster presentation abstract].Circulation 2001;103:1369.

19. Resnicow K, Cross D. Are parents’ self-reported totalcholesterol levels useful in identifying children withhyperlipidemia? An examination of current guidelines.Pediatrics 1993;92:347-353.

20. Griffin TC, Christoffel KK, Binns HJ, McGuire PA. Familyhistory evaluation as a predictive screen for childhoodhypercholesterolemia. Pediatric Practice Research Group.Pediatrics 1989;84:365-373.

21. Ketomaki A, Gylling H, Siimes MA, Vuorio A, Miettinen TA.Squalene and noncholesterol sterols in serum andlipoproteins of children with and without familialhypercholesterolemia. Pediatr Res 2003;53:648-653.

22. Raman RP. Obesity and health risks. J Am Coll Nutr2002;21:S134-S139.

23. Nicklas TA, Baranowski T, Cullen KW, Berenson G. Eatingpatterns, dietary quality and obesity. J Am Coll Nutr2001;20:599-608.

24. Wadowski SJ, Karp RJ, Murray-Bachmann R, Senft C. Familyhistory of coronary artery disease and cholesterol: screeningchildren in a disadvantaged inner-city population. Pediatrics1994;93:109-113.

25. Tonstad S, Refsum H, Sivertsen M, Christophersen B, Ose L,Ueland PM. Relation of total homocysteine and lipid levels inchildren to premature cardiovascular death in male relatives.Pediatr Res 1996;40:47-52.

26. Arashiro R, Katsuren K, Maung KK, Fukuyama S, Ohta T.Effect of a common mutation (D442G) of the cholesteryl estertransfer protein gene on lipids and lipoproteins in children.Pediatr Res 2001;50:455-459.

27. Gidding SS. The aging of the cardiovascular system: whenshould children be treated like adults? J Pediatr2002;141:159-161.

28. Humphries SE, Mailly F, Gudnason V, Talmud P. Themolecular genetics of pediatric lipid disorders: recentprogress and future research directions. Pediatr Res1993;34:403-415.

29. Greenland P, Gidding SS, Tracy RP. Commentary: lifelongprevention of atherosclerosis: the critical importance of majorrisk factor exposures. Int J Epidemiol 2002;31:1129-1134.

30. Tonstad S, Novik TS, Vandvik IH. Psychosocial functionduring treatment for familial hypercholesterolemia. Pediatrics1996;98:249-255.

∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 25-10-2003 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 15-03-2004

¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ™Ù¤ÏÈÔ˜ ∞ÓÙˆÓÈ¿‰Ë˜∏Ú·ÎÏ›ÙÔ˘ 4, ∆.∫. 106 73, ∫ÔψӿÎÈ

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·199

Page 57: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

200

¶·È‰È·ÙÚÈ΋ 2004;67:200-204 Paediatriki 2004;67:200-204

∂¡¢π∞º∂ƒOÀ™∞ ¶∂ƒπ¶∆ø™∏ CASE REPORT

∫ÏËÚÔÓÔÌÈ΋ ·ÈÌÔÚÚ·ÁÈ΋ ÙËÏ·ÁÁÂÈÂÎÙ·Û›· (Û‡Ó‰ÚÔÌÔ Rendu-Osler-Weber). ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ Î·È ·Ó·ÛÎfiËÛË Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜™. ª¿Ú·Î·, ∂. ™·Úȉ¿Î˘, µ. ∞ÁÁÂÏ¿ÎÔ˘, ™. ª¿ÎˆÛË, °. µÏ·¯¿ÎË, ∂. ∫fiÎÔÚË

Hereditary haemorrhagic telangiectasia (Rendu-Osler-Weber syndrome). Case report and review of the literatureS. Maraka, E. Saridakis, V. Aggelakou, S. Bakosi, G. Vlahaki, E. Kokori

∂ÈÛ·ÁˆÁ‹∏ ÎÏËÚÔÓÔÌÈ΋ ·ÈÌÔÚÚ·ÁÈ΋ ÙËÏ·ÁÁÂÈÂÎÙ·Û›·

Â›Ó·È Ì›· Û¿ÓÈ· ÓfiÛÔ˜, Ô˘ Û˘¯ÓfiÙÂÚ· ÂÌÊ·Ó›˙Â-Ù·È Ì ·ÈÌÔÚÚ·Á›· Î·È ·Ó·ÈÌ›·. O Rendu ÙÔ 1896, ÔOsler ÙÔ 1901 Î·È Ô Weber ÙÔ 1907, ‰È·‰Ô¯Èο, Â-ÚȤÁÚ·„·Ó ·˘Ù‹ ÙË ÓfiÛÔ, ÁÓˆÛÙ‹ Î·È ˆ˜ Û‡Ó‰ÚÔÌÔRendu-Osler-Weber (1). ∫ÏËÚÔÓÔÌÂ›Ù·È Ì ·˘ÙÔÛˆ-Ì·ÙÈÎfi ÂÈÎÚ·ÙÔ‡ÓÙ· Ù‡Ô Î·È ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fiÙËÓ Ù˘È΋ ÎÏÈÓÈ΋ ÙÚÈ¿‰·: ÔÏϷϤ˜ ÙËÏ·ÁÁÂÈÂ-Îٷۛ˜, ˘ÔÙÚÔÈ¿˙ÔÓÙ· ÂÂÈÛfi‰È· ›ÛÙ·Í˘ ηÈıÂÙÈÎfi ÎÏËÚÔÓÔÌÈÎfi ÈÛÙÔÚÈÎfi (1-3). ∏ ›وÛË Ù˘ÓfiÛÔ˘ ˘ÔÏÔÁ›˙ÂÙ·È Û 1-2 ÂÚÈÙÒÛÂȘ ·Ó¿100.000 ¿ÙÔÌ· (1,2). Œ¯Ô˘Ó ÌÂÏÂÙËı› ‰‡Ô Ù‡ÔÈÙ˘ ÓfiÛÔ˘, Ô˘ ıˆÚÂ›Ù·È fiÙÈ ÔÊ›ÏÔÓÙ·È Û ÌÂÙ·Ï-

Ï¿ÍÂȘ ÛÙ· ÁÔÓ›‰È· Ù˘ ÂÓ‰ÔÁÏ›Ó˘ Î·È Ù˘ ALK-1(activin receptor-like kinase 1) (3,4). ∏ ÚÈÓÔÚÚ·Á›··ÔÙÂÏ› ÙËÓ ÚÒÙË ÂΉ‹ÏˆÛË Ù˘ ÓfiÛÔ˘ ÛÙÔ 80%ÙˆÓ ÂÚÈÙÒÛÂˆÓ (2). ™ÙÔ 15-20% ÙˆÓ ÂÚÈÙÒÛÂ-ˆÓ ·Ú·ÙËÚÔ‡ÓÙ·È ÌÈÎÚ¤˜ ‹ ÌÂÁ¿Ï˜ Ó¢ÌÔÓÈΤ˜·ÚÙËÚÈÔÊÏ‚҉ÂȘ ‰˘ÛϷۛ˜, Ô˘ ÌÔÚ› Ó· ÂÎ-‰ËψıÔ‡Ó Ì ·ÈÌfiÙ˘ÛË ‹ Î·È ˘ÔÍ·ÈÌ›· (5,6). OÈ·ÛıÂÓ›˜ Ì ÎÏËÚÔÓÔÌÈ΋ ·ÈÌÔÚÚ·ÁÈ΋ ÙËÏ·ÁÁÂÈÂ-ÎÙ·Û›· ¤¯Ô˘Ó Ê˘ÛÈÔÏÔÁÈ΋ ÏÂÈÙÔ˘ÚÁ›· ·ÈÌÔÂÙ·-Ï›ˆÓ Î·È ËÎÙÈÎfiÙËÙ· ·›Ì·ÙÔ˜ (2).

¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ÎÔÚÈÙÛÈÔ‡ ËÏÈΛ·˜15 ÌËÓÒÓ, Ô˘ ÂÌÊ¿ÓÈÛ ‰‡Ô ÂÂÈÛfi‰È· ·ÈÌfiÙ˘-Û˘, ÂÓÒ ÛÙÔ ·ÙÔÌÈÎfi ·Ó·ÌÓËÛÙÈÎfi ÙÔ˘ ·Ó·Ê¤ÚÂٷȤӷ ÂÂÈÛfi‰ÈÔ Â›ÛÙ·Í˘. ∆Ô ÎÔÚ›ÙÛÈ ÏËÚÔ‡Û ٷ

�¶ÂÚ›ÏË„Ë: ∏ ÎÏËÚÔÓÔÌÈ΋ ·ÈÌÔÚÚ·ÁÈ΋ ÙËÏ·Á-ÁÂÈÂÎÙ·Û›·, ÁÓˆÛÙ‹ Î·È ˆ˜ Û‡Ó‰ÚÔÌÔ Rendu-Osler-Weber, ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÙËÓ Ù˘È΋ ÎÏÈÓÈ΋ ÙÚÈ¿-‰·: ÔÏϷϤ˜ ÙËÏ·ÁÁÂÈÂÎٷۛ˜, ˘ÔÙÚÔÈ¿˙Ô-ÓÙ· ÂÂÈÛfi‰È· ›ÛÙ·Í˘ Î·È ıÂÙÈÎfi ÎÏËÚÔÓÔÌÈÎfiÈÛÙÔÚÈÎfi. ∫ÏËÚÔÓÔÌÂ›Ù·È Ì ÙÔÓ ·˘ÙÔۈ̷ÙÈÎfi ÂÈ-ÎÚ·ÙÔ‡ÓÙ· Ù‡Ô ÌÂÙ·‚›‚·Û˘. ∏ ·ÚÔ˘Û›· ·ÚÙË-ÚÈÔÊÏ‚ÈÎÒÓ ‰˘ÛÏ·ÛÈÒÓ Û ‰È¿ÊÔÚ· fiÚÁ·Ó· Î·È Ë·ÈÌÔÚÚ·Á›· Ô˘ ÌÔÚ› Ó· ÚÔÎÏËı›, ·ÔÙÂÏÔ‡ÓÙËÓ Î‡ÚÈ· ·ÈÙ›· ÓÔÛËÚfiÙËÙ·˜ Î·È ıÓËÙfiÙËÙ·˜. ∏ ÚÈ-ÓÔÚÚ·Á›· ·ÔÙÂÏ› ÙËÓ ÚÒÙË ÂΉ‹ÏˆÛË Ù˘ Ófi-ÛÔ˘ ÛÙÔ 80% ÙˆÓ ÂÚÈÙÒÛˆÓ. ¶ÂÚÈÁÚ¿ÊÂÙ·È ËÂÚ›ÙˆÛË ÎÔÚÈÙÛÈÔ‡ ËÏÈΛ·˜ 15 ÌËÓÒÓ Ì ·ÈÌfiÙ˘-ÛË Î·È Â›ÛÙ·ÍË Ô˘ ÏËÚÔ‡Û ٷ ÎÚÈÙ‹ÚÈ· ÙÔ˘Û˘Ó‰ÚfiÌÔ˘ Rendu-Osler-Weber Î·È Á›ÓÂÙ·È ·Ó·-ÛÎfiËÛË Ù˘ ÚfiÛÊ·Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜.

§¤ÍÂȘ ÎÏÂȉȿ: ÎÏËÚÔÓÔÌÈ΋ ·ÈÌÔÚÚ·ÁÈ΋ ÙËÏ·Á-ÁÂÈÂÎÙ·Û›·, Û‡Ó‰ÚÔÌÔ Rendu-Osler-Weber, ÚÈÓÔÚ-Ú·Á›·, ›ÛÙ·ÍË, ·ÚÙËÚÈÔÊÏ‚҉ÂȘ ‰˘ÛϷۛ˜.

�Abstract: Hereditary haemorrhagic telangiectasia,also known as the Rendu-Osler-Weber syndrome, isan autosomal dominant disorder, typically identifiedby the triad of multiple telangiectasias, recurrentepistaxis and familial occurrence. The major cause ofmorbidity and mortality due to this disorder lies in thepresence of multiorgan arteriovenous malformationsand the associated haemorrhages. Nasal bleeding isthe first manifestation of the disease in about 80% ofcases. The case of a 15 month-old female isreported, who presented with haemoptysis andepistaxis and had all the diagnostic criteria of Rendu-Osler-Weber syndrome. A review of the recentbibliography on Rendu-Osler-Weber syndrome ispresented.

Key words: hereditary haemorrhagic telangiectasia,Rendu-Osler-Weber disease, nasal bleeding,epistaxis, arteriovenous malformations.

∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋, µÂÓÈ˙¤ÏÂÈÔ ¡ÔÛÔÎÔÌÂ›Ô ∏Ú·ÎÏ›Ԣ ∫Ú‹Ù˘

1st Paediatric Clinic, Venizelion General Hospital of Heraklion, Crete

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·200

Page 58: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

201

¶·È‰È·ÙÚÈ΋ 2004;67:200-204 Paediatriki 2004;67:200-204

ÎÏÈÓÈο ‰È·ÁÓˆÛÙÈο ÎÚÈÙ‹ÚÈ· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘Rendu-Osler-Weber. ™˘˙ËÙÔ‡ÓÙ·È Ë ÌÔÚȷ΋ ‚¿ÛË,ÔÈ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ, Ë ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË, Ù·‰È·ÁÓˆÛÙÈο ÎÚÈÙ‹ÚÈ·, ηıÒ˜ Î·È Ë ·ÓÙÈÌÂÙÒÈÛËÙÔ˘ Û˘Ó‰ÚfiÌÔ˘.

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ∫ÔÚ›ÙÛÈ ËÏÈΛ·˜ 15 ÌËÓÒÓ ÚÔÛ‹Ïı ÛÙËÓ ÎÏÈÓÈ-

΋ ÏfiÁˆ ·Ô‚ÔÏ‹˜ ÌÂÁ¿Ï˘ ÔÛfiÙËÙ·˜ ·›Ì·ÙÔ˜,˙ˆËÚÔ‡ ÎfiÎÎÈÓÔ˘ ¯ÚÒÌ·ÙÔ˜, ·fi ÙÔ ÛÙfiÌ·.

∞fi ÙÔ ·ÙÔÌÈÎfi ·Ó·ÌÓËÛÙÈÎfi ·Ó·Ê¤ÚÂÙ·È fiÙÈÁÂÓÓ‹ıËΠÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ÙÔÎÂÙfi Î·È ‚¿ÚÔ˜ Á¤Ó-ÓËÛ˘ 3,45 kg, ÌÂÙ¿ ·fi ÙÂÏÂÈfiÌËÓË - ¯ˆÚ›˜ ȉȷ›-ÙÂÚ· ÚÔ‚Ï‹Ì·Ù· - ·ËÛË Î·È Â›¯Â Ê˘ÛÈÔÏÔÁÈ΋ Â-ÚÈÁÂÓÓËÙÈ΋ ÂÚ›Ô‰Ô. ™Â ËÏÈΛ· 2 ÌËÓÒÓ ÂÌÊ¿ÓÈÛÂÌÈÎÚ¤˜ ÂÚ˘ıÚ¤˜ ÎËÏ›‰Â˜, ·Ú¯Èο ÛÙÔ ÚfiÛˆÔ Î·ÈÛÙË Û˘Ó¤¯ÂÈ· ÛÙÔÓ ÙÚ¿¯ËÏÔ Î·È Ù· ¿ÎÚ·. ™Â ËÏÈΛ·11 ÌËÓÒÓ ¤ÁÈÓ ‚ÈÔ„›· ‰¤ÚÌ·ÙÔ˜ Î·È ıˆڋıËΠÈ-ı·Ó‹ Ë ‰È¿ÁÓˆÛË Ù˘ Ì·ÛÙÔ΢ÙÙ¿ÚˆÛ˘. ª›·Â‚‰ÔÌ¿‰· ÚÔ Ù˘ ÂÈÛ·ÁˆÁ‹˜ ·Ó·Ê¤ÚÂÙ·È ¤Ó·ÂÂÈÛfi‰ÈÔ ·ÈÌfiÙ˘Û˘ Î·È ÚÈÓÔÚÚ·Á›·˜, ÙÔ ÔÔ›Ô·Ô‰fiıËΠ۠Èı·Ó‹ οΈÛË Ù˘ ÎÂÊ·Ï‹˜, ÌÂÙ¿·fi ÙÒÛË ÛÙÔ ¤‰·ÊÔ˜. ∆fiÙÂ, ÂÎÙfi˜ ·fi ·ÎÙÈÓÔ-ÁÚ·Ê›· ÎÚ·Ó›Ô˘, ‰ÂÓ ¤ÁÈÓ ÂÚ·ÈÙ¤Úˆ ¤ÏÂÁ¯Ô˜.

∞fi ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ·Ó·ÌÓËÛÙÈÎfi ·Ó·Ê¤ÚÂÙ·ÈfiÙÈ Ë ÌËÙ¤Ú· ÂÌÊ·Ó›˙ÂÈ ‰‡Ô ÙËÏ·ÁÁÂÈÂÎÙ·ÛÈΤ˜‚Ï¿‚˜ ÛÙȘ ¿ÎÚ˜ ¯Â›Ú˜ Î·È Û˘¯Ó¿ ÂÂÈÛfi‰È· ÚÈÓÈ-ÎÒÓ ÂÈÛٿ͈Ó, ÂÓÒ Ë ÁÈ·ÁÈ¿ (·fi ÙË ÌËÙ¤Ú·) Ì›·ÙËÏ·ÁÁÂÈÂÎÙ·ÛÈ΋ ‚Ï¿‚Ë ÛÙËÓ ÂÚÈÔ¯‹ Ù˘ ÚÈÓfi˜.

∏ ÂͤٷÛË Î·Ù¿ Û˘ÛÙ‹Ì·Ù· ‰ÂÓ ¤‰ÂÈÍ ·ıÔÏÔ-ÁÈο Â˘Ú‹Ì·Ù·, ÏËÓ ‰È¿Û·ÚÙˆÓ ÂÚ˘ıÚÒÓ ÎËÏ›-‰ˆÓ ÌÈÎÚ‹˜ ‰È·Ì¤ÙÚÔ˘ ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ÚÔÛÒ-Ô˘ Î·È ÙˆÓ ¿Óˆ Î·È Î¿Ùˆ ¿ÎÚˆÓ. ∏ ·ÚÙËÚȷ΋ ›Â-ÛË ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋ Î·È Ô ‰È·‰ÂÚÌÈÎfi˜ ÎÔÚÂÛÌfi˜O2 (SatO2) ‹Ù·Ó 98%. ∆Ô ·È‰› ÂÍÂÙ¿ÛÙËΠ·fiˆÙÔÚÈÓÔÏ·Ú˘ÁÁÔÏfiÁÔ, ·ÏÏ¿ ‰ÂÓ ‚Ú¤ıËΠÂÛÙ›· ·È-ÌÔÚÚ·Á›·˜.

∞fi ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô, Ô˘ ¤ÁÈÓ ÙËÓË̤ڷ Ù˘ ÂÈÛ·ÁˆÁ‹˜ ÙÔ˘ ·È‰ÈÔ‡ ÛÙËÓ ÎÏÈÓÈ΋,‰È·ÈÛÙÒıËηÓ: ·ÈÌÔÛÊ·ÈÚ›ÓË: 12,1 g/dl, ·ÈÌ·ÙÔÎÚ›-Ù˘: 34%, ·ÈÌÔÂÙ¿ÏÈ·: 578.000/mm3 Î·È ∆∫∂: 10mm/1Ë ÒÚ·. ∞fi ÙÔÓ ¤ÏÂÁ¯Ô ËÎÙÈÎfiÙËÙ·˜ ÙÔ˘ ·›-Ì·ÙÔ˜, ‰È·ÈÛÙÒıËÎÂ: PT: 12,6”, INR: 1,16, APTT:32,6” Î·È ÈÓˆ‰ÔÁfiÓÔ: 203 mg/dl. ™ÙËÓ ·ÎÙÈÓÔÁÚ·Ê›·ıÒÚ·ÎÔ˜ ‰È·ÈÛÙÒıËΠ›ٷÛË ÙˆÓ Î˘„ÂÏȉÈÎÒÓÛÙÔȯ›ˆÓ ÛÙÔÓ ‰ÂÍÈfi Ó‡ÌÔÓ· (∂ÈÎfiÓ· 1).

§›Á˜ ÒÚ˜ ÌÂÙ¿ ÙËÓ Â›ÛÔ‰fi ÙÔ˘ ÛÙÔ ÓÔÛÔÎÔ-Ì›Ô, ÙÔ ÎÔÚ›ÙÛÈ ·ÚÔ˘Û›·ÛÂ Ó¤Ô ÂÂÈÛfi‰ÈÔ ·Ô‚Ô-Ï‹˜ ·›Ì·ÙÔ˜ ·fi ÙÔ ÛÙfiÌ·, ‰È¿ÚÎÂÈ·˜ 2-3 min, ÌÂÛ˘ÓÔ‰fi ¤ÓÙÔÓË ·ÓËÛ˘¯›· Î·È ˘ÁÚÔ‡˜ ÚfiÁ¯Ô˘˜ ·fiÙËÓ ·ÎÚfi·ÛË ÙÔ˘ ıÒڷη. ∏ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›·ıÒڷη ·Ó¤‰ÂÈÍ ÂÚÈÔ¯‹ ‡ÎÓˆÛ˘ ÛÙÔ Ô›ÛıÈÔÎ·È ¤Íˆ ÙÌ‹Ì· ÙÔ˘ ‰ÂÍÈÔ‡ οو ÏÔ‚Ô‡, ÂÓÙfi˜ Ù˘

ÔÔ›·˜ ‰ÈÓfiÙ·Ó Ë ÂÓÙ‡ˆÛË ·ÚÔ˘Û›·˜ ‰È·ÙÂٷ̤-ÓÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ·ÁÁÂÈ·ÎÔ‡ ÎÏ¿‰Ô˘ (∂ÈÎfiÓ· 2). ªÂÙËÓ ˘Ô„›· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Ù˘ ÎÏËÚÔÓÔÌÈ΋˜ ·È-ÌÔÚÚ·ÁÈ΋˜ ÙËÏ·ÁÁÂÈÂÎÙ·Û›·˜, ÙÔ ·È‰› ÌÂٷʤÚ-ıËÎÂ, ÙÔ 3Ô 24ˆÚÔ Ù˘ ÓÔÛËÏ›·˜ ÙÔ˘, Û ÓÔÛÔÎÔ-ÌÂ›Ô ¶·›‰ˆÓ ÙˆÓ ∞ıËÓÒÓ, ÁÈ· ÂÚ·ÈÙ¤Úˆ ¤ÏÂÁ¯Ô ηȷÓÙÈÌÂÙÒÈÛË Èı·ÓÔ‡ ÂÂÈÛÔ‰›Ô˘ ·ÈÌÔÚÚ·Á›·˜.

ŒÁÈÓ ÈÛÙÔÏÔÁÈ΋ ÂͤٷÛË ‰ÂÚÌ·ÙÈ΋˜ ‚Ï¿‚˘,Ë ÔÔ›· ¤‰ÂÈÍ ÂÈÎfiÓ· ÙËÏ·ÁÁÂÈÂÎÙ·Û›·˜. ™ÙÔ ˘Â-Ú˯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜ Î·È Î·Ú‰È¿˜, Ù· Â˘Ú‹Ì·Ù·‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο. OÈ ÁÔÓ›˜ ·ÚÓ‹ıËÎ·Ó Ó· Û˘Ó¯È-ÛÙ› Ô ¤ÏÂÁ¯Ô˜ Ì ̷ÁÓËÙÈ΋ ·ÁÁÂÈÔÁÚ·Ê›· ÂÁÎÂ-Ê¿ÏÔ˘ Î·È ÂÎÏÂÎÙÈ΋ ·ÁÁÂÈÔÁÚ·Ê›· Ó¢ÌfiÓˆÓ,fiˆ˜ Û˘ÓÂÛÙ‹ıË.

∆Ô ·È‰› ·Ú¤ÌÂÈÓ Û ηϋ ÁÂÓÈ΋ ηٿÛÙ·ÛËηı’ fiÏË ÙË ‰È¿ÚÎÂÈ· Ù˘ ÓÔÛËÏ›·˜ ÙÔ˘ Î·È ‹Ù·Ó˙ˆËÚfi ÌÂٷ͇ ÙˆÓ ÂÂÈÛÔ‰›ˆÓ, ¯ˆÚ›˜ Â˘Ú‹Ì·Ù··fi ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË. ∆Ô ·È‰› ·Ú·ÎÔ-ÏÔ˘ıÂ›Ù·È Û ٷÎÙÈο ¯ÚÔÓÈο ‰È·ÛÙ‹Ì·Ù·, ÎÏÈÓÈÎ¿Î·È ÂÚÁ·ÛÙËÚȷο, ÁÈ· Ù˘¯fiÓ ÂÌÊ¿ÓÈÛË Ó¤ˆÓ Û˘-Ìو̿وÓ.

™˘˙‹ÙËÛË ∏ ÎÏËÚÔÓÔÌÈ΋ ·ÈÌÔÚÚ·ÁÈ΋ ÙËÏ·ÁÁÂÈÂÎÙ·Û›·

‹ Û‡Ó‰ÚÔÌÔ Rendu-Osler-Weber ·ÔÙÂÏ› ¤Ó· Û¿-ÓÈÔ ÎÏËÚÔÓÔÌÈÎfi ÓfiÛËÌ·, Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fiÙËÓ ·ÚÔ˘Û›· ÔÏÏ·ÏÒÓ ·ÚÙËÚÈÔÊÏ‚ÈÎÒÓ ‰˘-ÛÏ·ÛÈÒÓ, ÔÈ Ôԛ˜ ÌÔÚ› Ó· ·ÊÔÚÔ‡Ó ÛÙÔ ‰¤Ú-Ì·, ÛÙÔ˘˜ ‚ÏÂÓÓÔÁfiÓÔ˘˜, ÛÙ· ÛÏ¿¯Ó· Î·È ÛÙÔÓÂÁΤʷÏÔ. ∏ ÛÔ‚·ÚfiÙËÙ· Ù˘ ÓfiÛÔ˘ ÂÍ·Úٿٷȷfi ÙÔ fiÚÁ·ÓÔ Ô˘ ÚÔÛ‚¿ÏÏÂÙ·È. ŒÙÛÈ, Ë ÎÏÈÓÈ΋¤ÎÊÚ·ÛË Ù˘ ÓfiÛÔ˘ ÔÈΛÏÏÂÈ ·fi ÙËÏ·ÁÁÂÈÂÎÙ·-ۛ˜ ÛÙÔ ‰¤ÚÌ· Î·È ÙÔ˘˜ ‚ÏÂÓÓÔÁfiÓÔ˘˜, ̤¯ÚÈ ÌÂ-Á¿Ï˜ ·ÚÙËÚÈÔÊÏ‚҉ÂȘ ‰˘ÛϷۛ˜ Î·È ÛÔ‚·Ú‹·˘ÙfiÌ·ÙË ·ÈÌÔÚÚ·Á›· (1-3).

∏ ÓfiÛÔ˜ ÎÏËÚÔÓÔÌÂ›Ù·È Ì ÙÔÓ ·˘ÙÔۈ̷ÙÈÎfiÂÈÎÚ·ÙÔ‡ÓÙ· Ù‡Ô ÌÂÙ·‚›‚·Û˘, ·ÏÏ¿ ÛÙÔ 20%

∂ÈÎfiÓ· 1. ∞ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜: ›ٷÛË ÙˆÓ Î˘„ÂÏȉÈÎÒÓÛÙÔȯ›ˆÓ ÛÙÔÓ ‰ÂÍÈfi Ó‡ÌÔÓ·.

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·201

Page 59: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

202

¶·È‰È·ÙÚÈ΋ 2004;67:200-204 Paediatriki 2004;67:200-204

ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ›ӷȷÚÓËÙÈÎfi (1-3). ∏ ÂÌÊ¿ÓÈÛË Ù˘ ÓfiÛÔ˘ Û ·ÛıÂÓ›˜Ì ·ÚÓËÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÌÔÚ› Ó· ÔÊ›-ÏÂÙ·È Û Ӥ˜ ÌÂÙ·ÏÏ¿ÍÂȘ ‹ Û ‰È·ÊÔÚ¤˜ ÛÙËÓ ÎÏÈ-ÓÈ΋ ¤ÎÊÚ·ÛË Ù˘ ÓfiÛÔ˘ (1,2). ∏ ‰ÈÂÈÛ‰˘ÙÈÎfiÙËÙ·Ù˘ ÓfiÛÔ˘ Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ËÏÈΛ· Î·È ÚÔÛÂÁÁ›˙ÂÈÙÔ 100% ÙˆÓ ·ÛıÂÓÒÓ ÛÙËÓ ËÏÈΛ· ÙˆÓ 40 ÂÙÒÓ(2,5). ∏ ÓfiÛÔ˜ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÁÂÓÂÙÈ΋ ÂÙÂÚÔ-Á¤ÓÂÈ· (1-4). Œ¯Ô˘Ó ÌÂÏÂÙËı› ‰‡Ô ÁÔÓȉȷΤ˜ ı¤-ÛÂȘ, Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ‰‡Ô Ù‡Ô˘˜ Ù˘ ÓfiÛÔ˘. ∆ÔÁÔÓ›‰ÈÔ OWR1 ÛÙË ı¤ÛË 9q33-34, Ô˘ Έ‰ÈÎÔÔÈ›ÁÈ· ÙËÓ ÂÓ‰ÔÁÏ›ÓË, Ì›· ÚˆÙ½ÓË Û‡Ó‰ÂÛ˘ ÙÔ˘TGF-‚ (Transforming growth factor-‚), ÂÓ¤¯ÂÙ·ÈÛÙÔÓ Ù‡Ô I Ù˘ ÓfiÛÔ˘. ∏ ÂÓ‰ÔÁÏ›ÓË Â›Ó·È Ì›· ÁÏ˘-ÎÔÚˆÙ½ÓË Ù˘ ÌÂÌ‚Ú¿Ó˘ ÙˆÓ ÂÓ‰ÔıËÏÈ·ÎÒÓ Î˘Ù-Ù¿ÚˆÓ ÙˆÓ ÊÏ‚ȉ›ˆÓ, ·ÚÙËÚȉ›ˆÓ Î·È ÙÚȯÔÂȉÒÓ·ÁÁ›ˆÓ Î·È ‚Ú¤ıËΠӷ ÂÎÊÚ¿˙ÂÙ·È Û ˘„ËÏ¿ ›-‰· Û fiÏÔ˘˜ ÙÔ˘˜ ÈÛÙÔ‡˜ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ÙÔÓÙ‡Ô I Ù˘ ÓfiÛÔ˘. ∏ ÁÔÓȉȷ΋ ı¤ÛË ÁÈ· ÙÔÓ Ù‡Ô II

Ù˘ ÓfiÛÔ˘ ‚Ú¤ıËΠÛÙÔ ¯ÚˆÌfiۈ̷ 12 (12q13) ηÈΈ‰ÈÎÔÔÈ› ÁÈ· ÙËÓ ALK-1 (activin receptor-likekinase 1), Ì›· ¿ÏÏË ÚˆÙ½ÓË Û‡Ó‰ÂÛ˘ ÙÔ˘ TGF-‚(1-4). ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÌÂÏÂÙ¿Ù·È Î·È Ì›· ÙÚ›ÙËÁÔÓȉȷ΋ ı¤ÛË ÛÙÔ ¯ÚˆÌfiۈ̷ 3 (3p22), Ô˘ È-ı·ÓfiÓ Û¯ÂÙ›˙ÂÙ·È Ì ÙË ÓfiÛÔ (2,4). À¿Ú¯ÂÈ Û˘Û¯¤-ÙÈÛË ÙÔ˘ Ê·ÈÓÔÙ‡Ô˘ Ì ÙÔÓ ÁÔÓfiÙ˘Ô Ù˘ ÓfiÛÔ˘,fiˆ˜ Ê·›ÓÂÙ·È ·fi ÙËÓ ·Ô˘Û›· Ó¢ÌÔÓÈÎÒÓ ·Ú-ÙËÚÈÔÊÏ‚ÈÎÒÓ ‰˘ÛÏ·ÛÈÒÓ Û ¿ÙÔÌ· ¯ˆÚ›˜ ÌÂÙ¿Ï-Ï·ÍË ÛÙË ı¤ÛË 9q (1-5).

∏ ÈÔ Û˘¯Ó‹ ÎÏÈÓÈ΋ ÂΉ‹ÏˆÛË Ù˘ ÓfiÛÔ˘ Â›Ó·È Ë˘ÔÙÚÔÈ¿˙Ô˘Û· ›ÛÙ·ÍË, Ô˘ ··ÓÙ¿Ù·È ÛÙÔ 80-90% ÙˆÓ ÂÚÈÙÒÛˆÓ, Ì ̤ÛË ËÏÈΛ· ÂÌÊ¿ÓÈÛ˘ٷ 12 ¤ÙË (1,2). OÈ ÙËÏ·ÁÁÂÈÂÎٷۛ˜ ÛÙÔ ‰¤ÚÌ·Î·È ÙÔ˘˜ ‚ÏÂÓÓÔÁfiÓÔ˘˜ ·ÔÙÂÏÔ‡Ó ÙËÓ ÂfiÌÂÓË ÈÔÛ˘¯Ó‹ ÂΉ‹ÏˆÛË, ·ÏÏ¿ Ù˘Èο ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Î·-Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ 2˘-3˘ ‰ÂηÂÙ›·˜ Ù˘ ˙ˆ‹˜(3,7). OÈ ·ÛıÂÓ›˜ ÌÔÚ› Ó· ÂÌÊ·Ó›˙Ô˘Ó ˆ¯ÚfiÙËÙ·ÏfiÁˆ ·Ó·ÈÌ›·˜. ™ÙÔ 15-20% ÙˆÓ ·ÛıÂÓÒÓ ·Ú·ÙË-ÚÔ‡ÓÙ·È ÌÈÎÚ¤˜ ‹ ÌÂÁ¿Ï˜ Ó¢ÌÔÓÈΤ˜ ·ÚÙËÚÈÔ-ÊÏ‚҉ÂȘ ‰˘ÛϷۛ˜, Ô˘ ÌÔÚ› Ó· ÚÔηϤ-ÛÔ˘Ó ·ÈÌfiÙ˘ÛË ‹ Î·È ·ÈÌÔıÒڷη. ™Ô‚·Ú‹ ˘Ô-Í·ÈÌ›·, ‰‡ÛÓÔÈ·, ΢¿ÓˆÛË, ÏËÎÙÚÔ‰·ÎÙ˘Ï›· ηÈÔÏ˘Î˘ÙÙ·Ú·ÈÌ›· ÌÔÚ› Ó· ÂÌÊ·ÓÈÛÙÔ‡Ó Â› ÛËÌ·-ÓÙÈ΋˜ ‰È·Ê˘Á‹˜ ·›Ì·ÙÔ˜ ·fi ‰ÂÍÈ¿ ÚÔ˜ Ù· ·ÚÈ-ÛÙÂÚ¿. ∏ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ıÒڷη ·Ôηχ-ÙÂÈ Û˘Ì·Á‹ Ì¿˙· ‹ Î·È ÙËÓ ÂÈÎÔÈÓˆÓ›·, Û˘ÓËı¤-ÛÙÂÚ· ÛÙÔ˘˜ οو ÏÔ‚Ô‡˜ ÙˆÓ Ó¢ÌfiÓˆÓ, ÂÓÒ ËÂÎÏÂÎÙÈ΋ ·ÁÁÂÈÔÁÚ·Ê›· ÌÔÚ› Ó· Û˘Ó‰˘·ÛÙ› ÌÂıÂڷ¢ÙÈ΋ ·ÔηٿÛÙ·ÛË Ì¤Ûˆ ÂÏ·ÛÙÈÎÔ‡ ÛÂÈ-Ú¿Ì·ÙÔ˜ (4-6). ∂ΉËÏÒÛÂȘ ·fi ÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfiÛ‡ÛÙËÌ· ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔ 10-40% ÙˆÓ ·ÛıÂÓÒÓ,Û˘Ó‹ıˆ˜ ÌÂÙ¿ ÙËÓ 5Ë ‰ÂηÂÙ›· Ù˘ ˙ˆ‹˜. OÈ ·ÛıÂ-Ó›˜ ÌÔÚ› Ó· ÂÌÊ·Ó›ÛÔ˘Ó ˘ÔÙÚÔÈ¿˙ÔÓÙ· ÂÂÈ-Ûfi‰È· ·ÈÌÔÚÚ·Á›·˜ ·fi ÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi, ÎÔÈÏÈ·-Îfi ¿ÏÁÔ˜ ÏfiÁˆ ıÚÔÌ‚ÒÛÂˆÓ ‹ Î·È Û˘ÌÊÔÚËÙÈ΋ηډȷ΋ ·Ó¿ÚÎÂÈ· Î·È ›ÎÙÂÚÔ, fiÙ·Ó ˘¿Ú¯Ô˘Ó‰È¿¯˘Ù˜ Ë·ÙÈΤ˜ ·ÚÙËÚÈÔÊÏ‚҉ÂȘ ‰˘ÛϷۛ˜(3,8). OÈ ·ÛıÂÓ›˜ Ì ÎÏËÚÔÓÔÌÈ΋ ·ÈÌÔÚÚ·ÁÈ΋ ÙË-Ï·ÁÁÂÈÂÎÙ·Û›· ¤¯Ô˘Ó ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÁÈ· ÂÓ‰Ô-ÎÚ¿ÓÈ· ·ÈÌÔÚÚ·Á›·, ·ÊÔ‡ ÂÚ›Ô˘ ÙÔ 5-11% ÙˆÓÂÓËÏ›ÎˆÓ ÂÌÊ·Ó›˙ÂÈ ·ÚÙËÚÈÔÊÏ‚҉ÂȘ ‰˘ÛϷۛ˜ÛÙÔÓ ÂÁΤʷÏÔ. ¡Â˘ÚÔÏÔÁÈο ÛËÌ›· Î·È Û˘ÌÙÒ-Ì·Ù·, fiˆ˜ ÎÂÊ·Ï·ÏÁ›· ‹ ÔÙÈΤ˜, ÎÈÓËÙÈΤ˜ Î·È ·È-ÛıËÙÈΤ˜ ‰È·Ù·Ú·¯¤˜, Ú¤ÂÈ Ó· ÂÁ›ÚÔ˘Ó ÙËÓ ˘Ô-„›· ÁÈ· Èı·Ófi ÂÁÎÂÊ·ÏÈÎfi ·ÁÁÂÈ·Îfi ÂÂÈÛfi‰ÈÔ ‹ÂÁÎÂÊ·ÏÈÎfi ·fiÛÙËÌ· (2,3,7).

∏ ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ÂÚÈ-Ï·Ì‚¿ÓÂÈ ·ı‹ÛÂȘ Ô˘ ÂΉËÏÒÓÔÓÙ·È Ì ·ÈÌÔÚÚ·-Á›· Î·È ÙËÏ·ÁÁÂÈÂÎÙ·ÛÈΤ˜ ‚Ï¿‚˜. OÈ ÙËÏ·ÁÁÂÈÂ-Îٷۛ˜ Î·È Ë Â›ÛÙ·ÍË ·ÔÙÂÏÔ‡Ó Û¯ÂÙÈο Û˘¯Ó¿Â˘Ú‹Ì·Ù· Û ˘ÁÈ‹ - ηٿ Ù· ¿ÏÏ· - ¿ÙÔÌ·. ∏ ˘Ô-ÙÚÔÈ¿˙Ô˘Û· ›ÛÙ·ÍË ÌÔÚ› Ó· Â›Ó·È ÂΉ‹ÏˆÛËÓfiÛÔ˘ Ì ·ÈÌÔÚÚ·ÁÈ΋ ‰È¿ıÂÛË, fiˆ˜ Ë ÓfiÛÔ˜ von

∂ÈÎfiÓ· 2. ∞ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ıÒڷη: ÂÚÈÔ¯‹ ‡ÎÓˆÛ˘ÛÙÔ Ô›ÛıÈÔ Î·È ¤Íˆ ÙÌ‹Ì· ÙÔ˘ ‰ÂÍÈÔ‡ οو ÏÔ‚Ô‡, ÂÓÙfi˜ Ù˘ÔÔ›·˜ ‰›ÓÂÙ·È Ë ÂÓÙ‡ˆÛË ·ÚÔ˘Û›·˜ ‰È·ÙÂٷ̤ÓÔ˘ ÂÚÈÊÂ-ÚÈÎÔ‡ ·ÁÁÂÈ·ÎÔ‡ ÎÏ¿‰Ô˘.

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·202

Page 60: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

203

¶·È‰È·ÙÚÈ΋ 2004;67:200-204 Paediatriki 2004;67:200-204

Willebrand. ∞ÍÈÔÛËÌ›ˆÙÔ Â›Ó·È ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÙÔÛ‡Ó‰ÚÔÌÔ Rendu-Osler-Weber ÌÔÚ› Ó· Û˘Ó˘¿Ú-¯ÂÈ ÌÂ Û˘ÛÙËÌ·ÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ Ô˘ ÚÔηÏÔ‡Ó·ÈÌÔÚÚ·ÁÈ΋ ‰È¿ıÂÛË, ȉȷ›ÙÂÚ· Ì ÙË ÓfiÛÔ vonWillebrand. ∆ËÏ·ÁÁÂÈÂÎٷۛ˜ ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÔÛ‡Ó‰ÚÔÌÔ Ù˘ ηÏÔ‹ıÔ˘˜ ÎÏËÚÔÓÔÌÈ΋˜ ÙËÏ·Á-ÁÂÈÂÎÙ·Û›·˜, ÛÙÔ ÔÔ›Ô, fï˜, ÔÈ ‚Ï¿‚˜ ·fi ÙÔ‰¤ÚÌ· Â›Ó·È Û˘Ó‹ıˆ˜ ÂÚÈÛÛfiÙÂÚÔ ‰È¿Û·ÚÙ˜ ηȷÊÔÚÔ‡Ó Î˘Ú›ˆ˜ ÛÙÔ ÚfiÛˆÔ, ÛÙ· ¿Óˆ ¿ÎÚ· ηÈÛÙÔ ¿Óˆ ̤ÚÔ˜ ÙÔ˘ ıÒڷη, ηıÒ˜ Î·È ÛÙÔ Û‡Ó-‰ÚÔÌÔ Ù˘ ȉÈÔ·ıÔ‡˜ ÙËÏ·ÁÁÂÈÂÎÙ·Û›·˜, fiÔ˘ÂÌÊ·Ó›˙ÔÓÙ·È Û˘Ó‹ıˆ˜ Û ÌÂÁ·Ï‡ÙÂÚË ËÏÈΛ·. ™ÙÔÛ‡Ó‰ÚÔÌÔ ·Ù·Í›·˜-ÙËÏ·ÁÁÂÈÂÎÙ·Û›·˜ Û˘Ó˘¿Ú-¯Ô˘Ó Ì ÂÁÎÂÊ·ÏÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·, ÂÓÒ ÛÙÔ Û‡Ó-‰ÚÔÌÔ CREST (Calcinosis, Raynaud’sphenomenon, esophageal motor dysfunction,sclerodactyly and telangiectasia) ÂÎÙfi˜ ·fi ÙȘ ÙË-Ï·ÁÁÂÈÂÎٷۛ˜, ÂÌÊ·Ó›˙ÔÓÙ·È Î·È Ù· ¿ÏÏ· ¯·Ú·-ÎÙËÚÈÛÙÈο ÛËÌ›· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘. ∆ËÏ·ÁÁÂÈÂÎÙ·-ۛ˜ ·Ú·ÙËÚÔ‡ÓÙ·È Î·È Û ‰È¿ÊÔÚ˜ ¿ÏϘ ηٷ-ÛÙ¿ÛÂȘ, fiˆ˜ Ë Î‡ËÛË Î·È Ë ¯ÚfiÓÈ· Ë·ÙÈ΋ Ófi-ÛÔ˜. ∞ÚÙËÚÈÔÊÏ‚҉ÂȘ ‰˘ÛϷۛ˜ ÛÙÔÓ Ó‡ÌÔ-Ó· ‹ ÙÔÓ ÂÁΤʷÏÔ ÌÔÚ› Ó· ·Ó¢ÚÂıÔ‡Ó ÌÂÌÔÓˆ-̤ӷ, ·ÏÏ¿ Î·È Û ·˘Ù‹ ÙËÓ ÂÚ›ÙˆÛË ÔÈ ·ÛıÂÓ›˜ı· Ú¤ÂÈ Ó· ‰ÈÂÚ¢ÓÒÓÙ·È Î·È ÁÈ· ¿ÏϘ ÂΉËÏÒ-ÛÂȘ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Rendu-Osler-Weber. ∏ ‰È¿-ÁÓˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Ù›ıÂÙ·È ÛÙÔ 30-60% ÙˆÓ Â-ÚÈÙÒÛÂˆÓ ·ÛıÂÓÒÓ Ì Ó¢ÌÔÓÈΤ˜ ·ÚÙËÚÈÔÊÏÂ-‚Ò‰ÂȘ ‰˘ÛϷۛ˜ (1,4). ∂›ÎÙËÙ˜ Ó¢ÌÔÓÈΤ˜·ÚÙËÚÈÔÊÏ‚҉ÂȘ ‰˘ÛϷۛ˜ ÌÔÚ› Ó· ‰È·È-ÛÙˆıÔ‡Ó Û ηٷÛÙ¿ÛÂȘ fiˆ˜ Ë Ë·ÙÈ΋ ΛÚÚˆÛËÎ·È ÏÈÁfiÙÂÚÔ Û˘¯Ó¿ Û ۯÈÛÙÔۈ̛·ÛË, ÛÙ¤ÓˆÛË ÌÈ-ÙÚÔÂȉԇ˜, ÙÚ·‡Ì·, ·ÎÙÈÓÔ̇ΈÛË Î·È ÛÙÔ Û‡Ó‰ÚÔ-ÌÔ Fanconi (1-3,5).

∆· ‰È·ÁÓˆÛÙÈο ÎÚÈÙ‹ÚÈ· Ù˘ ÓfiÛÔ˘ ›ӷÈ: ·) ËÚÈÓÔÚÚ·Á›·-›ÛÙ·ÍË, Ô˘ Â›Ó·È ˘ÔÙÚÔÈ¿˙Ô˘Û·,·˘ÙfiÌ·ÙË Î·È Û˘Ó‹ıˆ˜ Û˘Ì‚·›ÓÂÈ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ·Ù˘ Ó‡¯Ù·˜, ‚) ÔÈ ÙËÏ·ÁÁÂÈÂÎٷۛ˜, Ô˘ Â›Ó·È ÌÈ-ÎÚ¤˜ ÎfiÎÎÈÓ˜ ÎËÏ›‰Â˜, Ì ¯·Ú·ÎÙËÚÈÛÙÈ΋ ÂÓÙfiÈ-ÛË ÛÙË Ì‡ÙË, Ù· ¯Â›ÏË, ÙË ÁÏÒÛÛ·, ÙÔÓ ÛÙÔÌ·ÙÈÎfi‚ÏÂÓÓÔÁfiÓÔ, Ù· ·˘ÙÈ¿, ÙÔ ÚfiÛˆÔ, ÙȘ ·Ï¿ÌÂ˜Î·È ÙȘ ÎÔ›Ù˜ ÙˆÓ Ó˘¯ÈÒÓ, Á) ÔÈ ÛÏ·¯ÓÈΤ˜ ·ÚÙË-ÚÈÔÊÏ‚ÈΤ˜ ‰˘ÛϷۛ˜, Ì ¿ÌÂÛË ÂÈÎÔÈÓˆÓ›· ÌÂ-ٷ͇ ·ÚÙËÚÈÒÓ Î·È ÊÏ‚ÒÓ Î·È ÂÓÙfiÈÛË Î˘Ú›ˆ˜ÛÙÔ˘˜ Ó‡ÌÔÓ˜, ÙÔ ‹·Ú, ÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi ηÈÙÔÓ ÂÁΤʷÏÔ Î·È ‰) ÙÔ ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈ-Îfi, ‰ËÏ·‰‹ Ë ‡·ÚÍË ·’ ‚·ıÌÔ‡ Û˘ÁÁÂÓ‹ Ô˘ ÏË-ÚÔ› Ù· ÎÚÈÙ‹ÚÈ· Ù˘ ÓfiÛÔ˘. ∏ ‰È¿ÁÓˆÛË Â›Ó·È ÔÚÈ-ÛÙÈ΋ › ·ÚÔ˘Û›·˜ ÙÔ˘Ï¿¯ÈÛÙÔÓ 3 ÎÚÈÙËÚ›ˆÓ, È-ı·Ó‹ › ·ÚÔ˘Û›·˜ 2 ÎÚÈÙËÚ›ˆÓ, ÂÓÒ ‰ÂÓ ıˆÚ›-Ù·È Èı·Ó‹ Â¿Ó ˘¿Ú¯Ô˘Ó ÏÈÁfiÙÂÚ· ·fi 2 ÎÚÈÙ‹ÚÈ·(3,6,8) (¶›Ó·Î·˜ 1).

∆Ô ÎÔÚ›ÙÛÈ ÏËÚÔ‡Û ÙÔ˘Ï¿¯ÈÛÙÔÓ 3 ·fi Ù· 4

‰È·ÁÓˆÛÙÈο ÎÚÈÙ‹ÚÈ· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Rendu-Osler-Weber. ∆· ÂÂÈÛfi‰È· ·ÈÌfiÙ˘Û˘ ÛÂ Û˘Ó‰˘·-ÛÌfi Ì ٷ Â˘Ú‹Ì·Ù· ·fi ÙËÓ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›·ıÒÚ·ÎÔ˜, Û˘ÓËÁÔÚÔ‡Û·Ó ÁÈ· ÙËÓ ·ÚÔ˘Û›· Ó¢-ÌÔÓÈ΋˜ ·ÚÙËÚÈÔÊÏ‚È΋˜ ‰˘ÛÏ·Û›·˜. ∆Ô ÎÔÚ›ÙÛÈ·Ú·ÎÔÏÔ˘ıÂ›Ù·È Ù·ÎÙÈο ÛÙËÓ ÎÏÈÓÈ΋ Î·È ‰ÂÓ ¤¯ÂÈÂÌÊ·Ó›ÛÂÈ, ¤Ó· ¯ÚfiÓÔ ÌÂÙ¿, Ó¤Ô ÂÂÈÛfi‰ÈÔ ·ÈÌÔÚ-Ú·Á›·˜ ·fi ÙÔ ·Ó·Ó¢ÛÙÈÎfi.

∏ ıÂڷ›· Ù˘ ÓfiÛÔ˘ Â›Ó·È ÁÂÓÈο ˘ÔÛÙËÚÈÎÙÈ-΋ Î·È ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ÚfiÏË„Ë Î·È ·ÓÙÈÌÂÙÒÈÛËÙˆÓ ÂÂÈÛÔ‰›ˆÓ ·ÈÌÔÚÚ·Á›·˜. OÈ ·ÚÙËÚÈÔÊÏ‚ÈΤ˜‰˘ÛϷۛ˜ ÂÓÙÔ›˙ÔÓÙ·È Ì¤Ûˆ ·ÁÁÂÈÔÁÚ·Ê›·˜ ηÈÛÙË Û˘Ó¤¯ÂÈ· Ù· ‰È·ÙÂٷ̤ӷ ·ÁÁ›· ÂÌ‚ÔÏ›˙ÔÓÙ·È̤ۈ ηıÂÙ‹Ú· Ì ÙË ¯Ú‹ÛË ÂÏ·ÛÙÈÎÔ‡ ÛÂÈÚ¿Ì·-ÙÔ˜ ‹ ÌÈÎÚÔ‡ Ì·ÏÔÓÈÔ‡. ™ÙËÓ ÂÚ›ÙˆÛË ÌÂÁ¿ÏˆÓ·ÚÙËÚÈÔÊÏ‚ÈÎÒÓ ‰˘ÛÏ·ÛÈÒÓ, ÌÔÚ› Ó· ¯ÚÂÈ·-ÛÙ› Ï··ÚÔÛÎÔÈ΋ ‹ ·ÓÔÈÎÙ‹ ¯ÂÈÚÔ˘ÚÁÈ΋ ÂÍ·›ÚÂ-ÛË Ù˘ ¿Û¯Ô˘Û·˜ ÂÚÈÔ¯‹˜. OÈ ÚÈÓÔÚÚ·Á›Â˜ ·ÓÙÈ-ÌÂÙˆ›˙ÔÓÙ·È Ì ÂȈ̷ÙÈÛÌfi, ·Ï›„ÂȘ ‚·˙ÂÏ›-Ó˘, ÙÔÈο ·ÈÌÔÛÙ·ÙÈο Ê¿Ú̷η (c-·ÌÈÓÔηÚÔ˚-Îfi Ô͇), ‰È·ÊÚ·ÁÌ·ÙÈ΋ ‰ÂÚÌÔÏ·ÛÙÈ΋, ¯ÔÚ‹ÁËÛËÛ˘Ó‰˘·ÛÌÔ‡ ÚÔÁÂÛÙÂÚfiÓ˘ Î·È ÔÈÛÙÚÔÁfiÓˆÓ ‹laser Ì CO2 ‹ Argon (1-3,5,6,9-11).

OÈ ·ÛıÂÓ›˜ Ì ÎÏËÚÔÓÔÌÈ΋ ·ÈÌÔÚÚ·ÁÈ΋ ÙËÏÂ-·ÁÁÂÈÂÎÙ·Û›· ¯Ú‹˙Ô˘Ó Ù·ÎÙÈ΋˜ ·Ú·ÎÔÏÔ‡ıËÛ˘,ÙÔ˘Ï¿¯ÈÛÙÔÓ ·Ó¿ ¤ÙÔ˜, ÁÈ· Èı·Ó‹ ÂÌÊ¿ÓÈÛË Ó¤ˆÓÎÏÈÓÈÎÒÓ ÂΉËÏÒÛˆÓ. ∂›Ó·È ··Ú·›ÙËÙÔ Ó· Á›ÓÂÙ·ÈÙ·ÎÙÈ΋ Ó¢ÌÔÓÔÏÔÁÈ΋ Î·È Ó¢ÚÔÏÔÁÈ΋ ÂÎÙ›ÌËÛË,fiˆ˜ Î·È ÔÊı·ÏÌÔÏÔÁÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË ÁÈ· ·Ó›-¯Ó¢ÛË ÙËÏ·ÁÁÂÈÂÎÙ·Û›·˜ ÛÙÔÓ ·ÌÊÈ‚ÏËÛÙÚÔÂȉ‹,Ô˘ ÌÔÚ› Ó· ÚÔηϤÛÂÈ ÛÔ‚·Ú‹ ·ÈÌÔÚÚ·Á›·.∂›Û˘, ÔÈ ·ÛıÂÓ›˜ Ú¤ÂÈ Ó· ·Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·ÈÎ·È ÂÚÁ·ÛÙËÚȷο Û ٷÎÙ¿ ¯ÚÔÓÈο ‰È·ÛÙ‹Ì·Ù·. OÈÛ˘ÁÁÂÓ›˜ ·’ ‚·ıÌÔ‡ Ú¤ÂÈ Ó· ÂϤÁ¯ÔÓÙ·È ÁÈ· È-ı·Ó‹ ‡·ÚÍË Ù˘ ÓfiÛÔ˘. ∂›Ó·È ÛËÌ·ÓÙÈÎfi Ó· Ù›ıÂٷȤÁηÈÚ· Ë ‰È¿ÁÓˆÛË, ¤ÙÛÈ ÒÛÙ ӷ ÚÔÏ·Ì‚¿ÓÔÓÙ·ÈÙ· ÂÂÈÛfi‰È· ·ÈÌÔÚÚ·Á›·˜ Î·È Ó· ·Ó·ÁÓˆÚ›˙ÔÓÙ·È ÔÈӤ˜ ÂÚÈÙÒÛÂȘ Ù˘ ÓfiÛÔ˘ ÛÙËÓ ›‰È· ÔÈÎÔÁ¤ÓÂÈ·.§ÈÁfiÙÂÚÔ ·fi ÙÔ 10% ÙˆÓ ·ÛıÂÓÒÓ Î·Ù·Ï‹ÁÂÈ ·fiÙȘ ÂÈÏÔΤ˜ Ù˘ ÓfiÛÔ˘ (3). ∏ ηٷÓfiËÛË Ù˘ ÌÔ-Úȷ΋˜ ‚¿Û˘ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ı· ÂÈÙÚ¤„ÂÈ ÙË ÁÂ-ÓÂÙÈ΋ ηıÔ‰‹ÁËÛË Î·È ÙËÓ ·Ó·ÁÓÒÚÈÛË ÙˆÓ Ó¤ˆÓÂÚÈÙÒÛÂˆÓ ÛÙËÓ ›‰È· ÔÈÎÔÁ¤ÓÂÈ·.

¶›Ó·Î·˜ 1. ¢È·ÁÓˆÛÙÈο ÎÚÈÙ‹ÚÈ· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Rendu-Osler-Weber

ƒÈÓÔÚÚ·Á›·-›ÛÙ·ÍË ∆ËÏ·ÁÁÂÈÂÎٷۛ˜ ™Ï·¯ÓÈΤ˜ ·ÚÙËÚÈÔÊÏ‚҉ÂȘ ‰˘ÛϷۛ˜ £ÂÙÈÎfi ÎÏËÚÔÓÔÌÈÎfi ÈÛÙÔÚÈÎfi

∏ ‰È¿ÁÓˆÛË ıˆÚÂ›Ù·È ÔÚÈÛÙÈ΋ Â¿Ó ˘¿Ú¯Ô˘Ó 3 ‹ ÂÚÈÛÛfi-ÙÂÚ· ÎÚÈÙ‹ÚÈ·, Èı·Ó‹ Â¿Ó ˘¿Ú¯Ô˘Ó 2 ÎÚÈÙ‹ÚÈ· Î·È ÌË Èı·-Ó‹ Â¿Ó ˘¿Ú¯Ô˘Ó ÏÈÁfiÙÂÚ· ·fi 2 ÎÚÈÙ‹ÚÈ·

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·203

Page 61: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

204

¶·È‰È·ÙÚÈ΋ 2004;67:200-204 Paediatriki 2004;67:200-204

µÈ‚ÏÈÔÁÚ·Ê›· 1. Cooper B. William Osler on telangiectatic syndromes.

BUMC Proceedings 1999;12:238-240. 2. Bergler W, Gotte K. Hereditary hemorrhagic telangi-

ectasias: a challenge for the clinician. Eur Arch Otorhino-laryngol 1999;256:10-15.

3. Guttmacher AE, McDonald J. Hereditary hemorrhagictelangiectasia. (electronic article). GENE Reviews(www.genetests.org); 2000.

4. Wallace GM, Shovlin CL. A hereditary haemorrhagictelangiectasia family with pulmonary involvement isunlinked to the known HHT genes, endoglin and ALK-1.Thorax 2000;55:685-690.

5. Tong AK, La Hei ER, Currie B. Congenital pulmonaryarteriovenous malformations. Pediatr Surg Int2002;18:168-170.

6. Pick A, Deschamps C, Stanson AW. Pulmonaryarteriovenous fistula: presentation, diagnosis, andtreatment. World J Surg 1999;23:1118-1122.

7. Morgan T, McDonald J, Anderson C, Ismail M, Miller F,Mao R et al. Intracranial hemorrhage in infants and childrenwith hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome). Pediatrics 2002;109:E12.

8. Chen L, Lang S, Hu T, Zhong L, Li J. Hereditary hemor-rhagic telangiectasia: a rare cause of long-lasting

abdominal distension in an 8-year-old boy. Chin Med J2002;115:620-621.

9. Bennhagen RG, Holje G, Laurin S, Pesonen E. Coilembolization of a neonatal pulmonary arteriovenousmalformation. Pediatr Cardiol 2002;23:235-238.

10. Stockx L, Raat H, Caerts B, Van Cutsem E, Wilms G,Marchal G. Transcatheter embolization of hepaticarteriovenous fistulas in Rendu-Osler-Weber disease: acase report and review of the literature. Eur Radiol1999;9:1434-1437.

11. Perez-Encinas M, Rabunal Martinez MJ, Bello Lopez JL. Isthalidomide effective for the treatment of gastroinstestinalbleeding in hereditary hemorrhagic telangiectasia?Haematologica 2002;87:(08)ELT34.

∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 01-09-2003 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 24-02-2004

¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∂ϤÓË ∫fiÎÔÚË ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ µÂÓÈ˙¤ÏÂÈÔ˘ ¡ÔÛÔÎÔÌ›Ԣ ∏Ú·ÎÏ›Ԣ §ÂˆÊfiÚÔ˜ ∫ÓˆÛÛÔ‡, ∆.∫. 711 10, ∏Ú¿ÎÏÂÈÔ ∫Ú‹Ù˘ E-mail: [email protected]

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·204

Page 62: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

205

¶·È‰È·ÙÚÈ΋ 2004;67:205-207 Paediatriki 2004;67:205-207

∂¡¢π∞º∂ƒOÀ™∞ ¶∂ƒπ¶∆ø™∏ CASE REPORT

∞ÈÊÓ›‰ÈÔ Ô›‰ËÌ· fiÛı˘ Î·È ÔÛ¯¤Ô˘ ˆ˜ ·Ú¯È΋ ÂΉ‹ÏˆÛË ÓÂÊÚˆÛÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ ∂. ÃÚÈÛÙÈ·Ó¿Î˘1, °. µ¿Ô˜1, ∞. ™·ÎÂÏ·ÚfiÔ˘ÏÔ˜2, ∑. ∫·Ú·Î·ÙÛ¿ÓË3

Sudden oedema of prepuce and scrotum as initial manifestation of nephrotic syndrome E. Christianakis1, G. Vaos1, A. Sakelaropoulos2, Z. Karakatsani3

∂ÈÛ·ÁˆÁ‹∆Ô ÓÂÊÚˆÛÈÎfi Û‡Ó‰ÚÔÌÔ ÛÙÔ 90% ÙˆÓ ·È‰ÈÒÓ

Â›Ó·È È‰ÈÔ·ıÔ‡˜ ÌÔÚÊ‹˜ Î·È ·ÁÓÒÛÙÔ˘ ·ÈÙÈÔÏÔ-Á›·˜. ∂›Ó·È Û˘¯ÓfiÙÂÚÔ ÛÙ· ·ÁfiÚÈ· Û ۯ¤ÛË Ì ٷÎÔÚ›ÙÛÈ· (2:1), ÂÓÒ Û˘¯ÓfiÙÂÚ· ÚÔÛ‚¿ÏÏÔÓÙ·È ·È-‰È¿ ËÏÈΛ·˜ 2-6 ÂÙÒÓ. ∆Ô Î‡ÚÈÔ ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÎÏÈ-ÓÈÎfi ‡ÚËÌ· Â›Ó·È ÙÔ Ô›‰ËÌ·, Ô˘ Û˘Ó‹ıˆ˜ ·Ú·-ÙËÚÂ›Ù·È ÛÙȘ ÂÚÈÎÔÁ¯ÈΤ˜ ÂÚÈÔ¯¤˜ Î·È ÛÙ· οو¿ÎÚ· Î·È ·Ê‹ÓÂÈ ÂÓÙ‡ˆÌ· ÛÙËÓ ›ÂÛË. ¶·ÚÔ˘ÛÈ¿-˙ÂÙ·È Ë ÂÚ›ÙˆÛË ·ÁÔÚÈÔ‡ Ô˘ ÂÌÊ¿ÓÈÛ ԛ‰ËÌ·Ù˘ fiÛı˘ Î·È ÙÔ˘ ÔÛ¯¤Ô˘ ÚÈÓ ÙÔ ÁÂÓÈÎÂ˘Ì¤ÓÔ Ô›-‰ËÌ· ÙÔ˘ ÓÂÊÚˆÛÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘.

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ∞ÁfiÚÈ ËÏÈΛ·˜ ‰‡Ô ÂÙÒÓ ÂÌÊ¿ÓÈÛ ·ÈÊÓ›‰È· ·ÓÒ-

‰˘ÓÔ Î·È „˘¯Úfi, ˘fi Ù¿ÛË Ô›‰ËÌ· fiÛı˘ ηÈÔÛ¯¤Ô˘ (∂ÈÎfiÓ· 1). OÎÙÒ Ë̤Ú˜ ÚÈÓ Â›¯Â ÚÔËÁË-ı› χÛË ‚·Ï·ÓÔÔÛıÈÎÒÓ Û˘ÌʇÛÂˆÓ ˘fi ÙÔÈ΋·Ó·ÏÁËÛ›· Ì Îڤ̷ EMLA® Î·È Û˘ÓÂÛÙ‹ıË Ë ÙÔÈ-

΋ ¯Ú‹ÛË ÎÔÚÙÈ˙ÔÓÔ‡¯Ô˘ Îڤ̷˜. ∂ÈϤÔÓ, Û˘Ó˘-‹Ú¯Â Ïԛ̈ÍË ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘-ÛÙ‹Ì·ÙÔ˜ 4 Ë̤Ú˜ ÚÈÓ ÙËÓ ÂÌÊ¿ÓÈÛË ÙÔ˘ Ôȉ‹Ì·-ÙÔ˜. OÈ ÁÔÓ›˜ ‰ÂÓ ·Ú·Ù‹ÚËÛ·Ó, ÙÔ ÙÂÏÂ˘Ù·›Ô ‰È¿-ÛÙËÌ·, ·ÚÔ˘Û›· ÚˆÈÓÔ‡ ÂÚÈÎÔÁ¯ÈÎÔ‡ Ôȉ‹Ì·-ÙÔ˜, Ô‡Ù ¤‚ÏÂ·Ó ÙÔ ·È‰› ÙÔ˘˜ ÈÔ “·¯Ô˘Ïfi”. ∆ÔÔ›‰ËÌ· ÚÔηÏÔ‡Û ¤Î‰ËÏ· ‰˘ÛÔ˘ÚÈο ÂÓԯϋ̷-Ù· Î·È ‰˘Û¯¤ÚÂÈ· ‚·‰›Ûˆ˜ (Ó‹ÛÛÂÈÔ ‚¿‰ÈÛÌ·) ηÈÔ ·ÛıÂÓ‹˜ ÂÈÛ‹¯ıË ÛÙÔ ¶·È‰Ô¯ÂÈÚÔ˘ÚÁÈÎfi ∆Ì‹Ì·ÁÈ· ÂÚ·ÈÙ¤Úˆ ‰ÈÂÚ‡ÓËÛË. ∫·Ù¿ ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ΋ÂͤٷÛË, ÔÈ fiÚ¯ÂȘ ‹Ù·Ó ·„ËÏ¿ÊËÙÔÈ, ÙÔ fiÛ¯ÂÔ ÔÈ-‰ËÌ·Ù҉˜ Î·È ·ÓÒ‰˘ÓÔ ÛÙËÓ „ËÏ¿ÊËÛË Î·È ÙËÓ›ÂÛË, ¯ˆÚ›˜ ÂÚ˘ıÚfiÙËÙ· Î·È Ì ¢¯¤ÚÂÈ· ‰È·Ê·ÓÔ-ÛÎfiËÛ˘. ∂ÈÛÎÔÈο, ‰ÈÓfiÙ·Ó Ë ÂÓÙ‡ˆÛË ‡·Ú-͢ ˘ÁÚÔ‡, ˆ˜ › ˘‰ÚÔ΋Ï˘, ·ÏÏ¿ - Ì ÙËÓ ·Ê‹ -Ë ıÂÚÌÔÎÚ·Û›· Ù˘ ÔȉËÌ·ÙÒ‰Ô˘˜ ÂÚÈÔ¯‹˜ ‹Ù·Ó¯·ÌËÏ‹. ∆Ô ‰¤ÚÌ· ÙÔ˘ ÔÛ¯¤Ô˘ Î·È Ù˘ fiÛı˘ ‹Ù·Ó˘fi Ù¿ÛË, ‰È·Ê·Ó¤˜, ÏÂ˘Îˆfi Î·È Ì ÙËÓ ·›ÛıËÛËÏËÚfiÙËÙ·˜ ·fi ÔÚfi.

�¶ÂÚ›ÏË„Ë: ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË Ôȉ‹Ì·-ÙÔ˜ fiÛı˘ Î·È ÔÛ¯¤Ô˘ ˆ˜ ·Ú¯È΋ ÂΉ‹ÏˆÛË ÓÂ-ÊÚˆÛÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ Û ·È‰› ËÏÈΛ·˜ 2 ÂÙÒÓ. ∆·ÎÏÈÓÈο Î·È ˘ÂÚ˯ÔÁÚ·ÊÈο Â˘Ú‹Ì·Ù· ‰È·ÊÔÚÔ-ÔÈÔ‡Ó Ì ·ÛÊ¿ÏÂÈ· ÙÔ ÚÒÈÌÔ ÓÂÊÚˆÛÈÎfi Û‡Ó-‰ÚÔÌÔ ·fi ÙËÓ ˘‰ÚÔ΋ÏË ‹ ¿ÏϘ ηٷÛÙ¿ÛÂȘÔͤԘ ÔÛ¯¤Ô˘, ·ÔÙÚ¤ÔÓÙ·˜ ÌË ·Ó·Áη›Â˜ ¯ÂÈ-ÚÔ˘ÚÁÈΤ˜ ÂÂÌ‚¿ÛÂȘ

§¤ÍÂȘ ÎÏÂȉȿ: Ô›‰ËÌ· ÔÛ¯¤Ô˘, Ô›‰ËÌ· fiÛı˘, ÓÂ-ÊÚˆÛÈÎfi Û‡Ó‰ÚÔÌÔ, ·È‰›.

�Abstract: The case is presented of a two year-oldchild with oedema of the prepuce and scrotum asthe initial manifestation of nephrotic syndrome.Clinical and ultrasound findings will safelydifferentiate early nephrotic syndrome fromhydrocoeles or other acute scrotal conditions,avoiding unnecessary surgical exploration.

Key words: scrotal swelling, prepuce swelling,nephrotic syndrome, child.

1 ¶·È‰Ô¯ÂÈÚÔ˘ÚÁÈÎfi ∆Ì‹Ì·, °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ ¶ÂÓÙ¤Ï˘, ∞ı‹Ó·

2 ∞ÎÙÈÓÔÏÔÁÈÎfi ∆Ì‹Ì·, °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ ¶ÂÓÙ¤Ï˘, ∞ı‹Ó·

3 µ’ ¶·È‰È·ÙÚÈÎfi ∆Ì‹Ì·, °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ ¶ÂÓÙ¤Ï˘, ∞ı‹Ó·

1 Department of Paediatric Surgery, Penteli Children’s Hospital, Athens

2 Department of Radiology, Penteli Children’s Hospital, Athens

3 2nd Paediatric Clinic, Penteli Children’s Hospital, Athens

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·205

Page 63: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

206

¶·È‰È·ÙÚÈ΋ 2004;67:205-207 Paediatriki 2004;67:205-207

™‡Ìʈӷ Ì ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô, Ë ÁÂÓÈ΋·›Ì·ÙÔ˜ ‹Ù·Ó ÂÓÙfi˜ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÔÚ›ˆÓ (∆∫∂:125 mm, APTT: 43,5”, Ï¢ÎÒÌ·Ù· ÔÚÔ‡ ÔÏÈο: 4,5g/dl, ·Ï‚Ô˘Ì›ÓË: 2,3 g/dl, ¯ÔÏËÛÙÂÚ›ÓË: 375 g/dl,ÙÚÈÁÏ˘ÎÂÚ›‰È·: 99 g/dl, IgM: 146 g/dl, IgG: 250 g/dl).O ˘ÂÚ˯ÔÁÚ·ÊÈÎfi˜ ¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍ ¯·Ú·ÎÙËÚÈÛÙÈ-Îfi ÔÛ¯ÂÔÔÛıÈÎfi Ô›‰ËÌ· Ì ›ÂÛË Ù˘ Ô˘Ú‹ıÚ·˜(∂ÈÎfiÓ· 2) Î·È ·ÒıËÛË ÙˆÓ fiÚ¯ÂˆÓ ÛÙ· ¤Íˆ ‚Ô˘-‚ˆÓÈο ÛÙfiÌÈ· (∂ÈÎfiÓ· 3), ÂÓÒ ‰ÂÓ ‚Ú¤ıËΠϢÚÈ-ÙÈÎfi ‹ ·ÛÎÈÙÈÎfi ˘ÁÚfi. ∞ÂÈÎÔÓÈ˙fiÙ·Ó ¯·Ú·ÎÙËÚÈÛÙÈ-ο Ë ·‡ÍËÛË ÙÔ˘ ¿¯Ô˘˜ ÙˆÓ Ì·Ï·ÎÒÓ ÌÔÚ›ˆÓ ÙÔ˘ÔÛ¯¤Ô˘ Ì ·ÓÔÌÔÈÔÁÂÓ‹ ˘Ê‹, fiÔ˘ ÔÈ ˘fi˯˜ Â-ÚÈÔ¯¤˜ ·ÓÙÈÚÔÛÒ¢·Ó ÙËÓ Î·Ù·ÎÚ¿ÙËÛË ÌÂÛÔ-΢ÙÙ¿ÚÈÔ˘ ˘ÁÚÔ‡, ÂÓÒ ÔÈ Ë¯ÔÁÂÓ›˜ ÂÚÈÔ¯¤˜ ·ÓÙÈ-ÚÔÛÒ¢·Ó ÙËÓ ·Ó·ÙÔÌÈ΋ ‰ÔÌ‹ ÙÔ˘ ÔÛ¯¤Ô˘.™ÙËÓ fiÛıË ·ÂÈÎÔÓÈ˙fiÙ·Ó ¿¯˘ÓÛË ÙÔ˘ ÙÔȯÒÌ·-ÙÔ˜ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜, Ì ·ÓÔÌÔÈÔÁÂÓ‹ ˘Ê‹ ÏfiÁˆ η-Ù·ÎÚ¿ÙËÛ˘ ÌÂÛÔ΢ÙÙ¿ÚÈÔ˘ ˘ÁÚÔ‡ ÛÙÔÓ ‰·ÚÙfi.¢ÂÓ ··ÈÙ‹ıËΠÙÔÔı¤ÙËÛË Ô˘ÚÔηıÂÙ‹Ú·. ¢‡ÔË̤Ú˜ ·ÚÁfiÙÂÚ· ÂÌÊ·Ó›ÛÙËΠ“Ô›‰ËÌ· ·Ó¿ Û¿Ú-η” ÙÔ˘ ηÙÒÙÂÚÔ˘ ÎÔÚÌÔ‡ Î·È ÙˆÓ Î¿Ùˆ ¿ÎÚˆÓ,Ô˘ ÂÂÎÙ¿ıËΠÚÔԉ¢ÙÈο Î·È ÛÙÔ ˘fiÏÔÈÔÛÒÌ·. ∆Ô Ô›‰ËÌ·, ÏfiÁˆ Ù˘ ›ÂÛ˘, ÚÔοÏÂÛ ‰‡ÔÚ‹ÍÂȘ ÛÙÔ ‰¤ÚÌ· Ù˘ fiÛı˘. O ÂÚ·ÈÙ¤Úˆ ÂÚÁ·-ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ Û˘ÌÏ‹ÚˆÛ ÙËÓ ·ıÔÁÓˆÌÔÓÈ-΋ ÙÂÙÚ¿‰· ÙÔ˘ ÓÂÊÚˆÛÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ Ì ڈÙÂ-˚ÓÔ˘Ú›· (χΈ̷ Ô‡ÚˆÓ: 291 mg/dl Û 350 ml Û˘Ï-ÏÔÁ‹˜ Ô‡ÚˆÓ 24ÒÚÔ˘). Àfi Û˘ÛÙËÌ·ÙÈ΋ Ê·ÚÌ·-΢ÙÈ΋ ·ÁˆÁ‹ (Ú‰ÓÈ˙ÔÏfiÓË, ÊÔ˘ÚÔÛÂÌ›‰Ë Î·È·Ï‚Ô˘Ì›ÓË), Ù· Ôȉ‹Ì·Ù· ÌÂÈÒıËÎ·Ó ÛÙ·‰È·Î¿ Î·È ÔÌÈÎÚfi˜ ·ÛıÂÓ‹˜ ÂÍ‹Ïı Û ηϋ ÁÂÓÈ΋ ηٿÛÙ·ÛË,ÌÂÙ¿ ·fi ÓÔÛËÏ›· 24 ËÌÂÚÒÓ. ∏ ‰È·¯ÚÔÓÈ΋ ·-Ú·ÎÔÏÔ‡ıËÛË ÁÈ· Ù· ÂfiÌÂÓ· ‰‡Ô ¯ÚfiÓÈ· ‰ÂÓ ¤‰ÂÈ-Í οÙÈ ·ıÔÏÔÁÈÎfi.

™˘˙‹ÙËÛË ∂›Ó·È ÁÓˆÛÙfi fiÙÈ ÛÙÔ ÓÂÊÚˆÛÈÎfi Û‡Ó‰ÚÔÌÔ ÌÔ-

Ú› Ó· ÂÌÊ·ÓÈÛÙ› Ô›‰ËÌ· ÔÛ¯¤Ô˘, Ô˘ Û ۿÓȘÂÚÈÙÒÛÂȘ ·ÔÙÂÏ› Î·È ÙËÓ ·Ú¯È΋ ÂΉ‹ÏˆÛË

ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ (1,2). ∂›Ó·È, fï˜, ÚÒÙË ÊÔÚ¿,Û‡Ìʈӷ Ì ÙËÓ ÚÔÛÈÙ‹ ·ÁÁÏÈ΋ ‚È‚ÏÈÔÁÚ·Ê›·,Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È Ôȉ‹Ì·Ù· fiÛı˘ Î·È ÔÛ¯¤Ô˘ ˆ˜·Ú¯È΋ ÂΉ‹ÏˆÛË ÓÂÊÚˆÛÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘.

∆Ô ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ¤¯ÂÈ ·Ô‰Âȯı› ¯Ú‹ÛÈÌԉȷÁÓˆÛÙÈÎfi ̤ÛÔ ÁÈ· ÙȘ ·ı‹ÛÂȘ ÙÔ˘ ÔÛ¯¤Ô˘ ÛÙ··È‰È¿. µÔËı¿ ÛËÌ·ÓÙÈο ÛÙË ‰È·ÊÔÚԉȿÁÓˆÛË·ÚfiÌÔÈˆÓ ÔȉËÌ¿ÙˆÓ Î·È ‰ÈÔÁÎÒÛÂˆÓ ÙÔ˘ ÔÛ¯¤-Ô˘, Ô˘ ÌÔÚ› Ó· Â›Ó·È Î˘Ú›ˆ˜ ÙÔ È‰ÈÔ·ı¤˜ Ô›‰Ë-Ì· ÙÔ˘ ÔÛ¯¤Ô˘, Ë ÔÍ›· ˘‰ÚÔ΋ÏË, ΢ÛÙÈΤ˜ ‚Ï¿‚Â˜Î·È Î·Ù·ÛÙ¿ÛÂȘ ÔͤԘ ÔÛ¯¤Ô˘.

∆Ô ÓÂÊÚˆÛÈÎfi Û‡Ó‰ÚÔÌÔ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fiÚˆÙÂ˚ÓÔ˘Ú›·, ˘ÔÏÂ˘ÎˆÌ·ÙÈÓ·ÈÌ›·, Ô›‰ËÌ· Î·È˘ÂÚÏÈȉ·ÈÌ›·. ∏ ·ıÔÏÔÁÈ΋ ·˘Ù‹ ÙÂÙÚ¿‰· ‰ÂÓÂÌÊ·Ó›˙ÂÙ·È ¿ÓÙÔÙÂ, ȉȷ›ÙÂÚ· ÛÙȘ ˘ÔÙÚÔ¤˜. ∆Ô·Ú¯ÈÎfi ÎÏÈÓÈÎfi ‡ÚËÌ· Â›Ó·È Û˘Ó‹ıˆ˜ Ù· ÂÚÈÎÔÁ¯È-ο Ôȉ‹Ì·Ù· (3). ∆Ô Ô›‰ËÌ· Â›Ó·È Û˘Ó‹ıˆ˜ ÁÂÓÈ΢-̤ÓÔ Î·È Î·Ù·Ó¤ÌÂÙ·È ÛÙÔ ÚfiÛˆÔ, ȉȷ›ÙÂÚ· ÛÙȘÂÚÈÎÔÁ¯ÈΤ˜ ÂÚÈÔ¯¤˜, Ô˘ Â›Ó·È ‰ÈÔÁΈ̤Ó˜ ÙÔÚˆ› Î·È Ù›ÓÔ˘Ó Ó· ˘Ô¯ˆÚÔ‡Ó Î·Ù¿ ÙË ‰È¿ÚÎÂÈ·Ù˘ Ë̤ڷ˜, ÔfiÙÂ Î·È ÂÌÊ·Ó›˙ÂÙ·È Ô›‰ËÌ· ÛÙËÓÎÔÈÏÈ¿, ÛÙÔ ÂÚ›ÓÂÔ, ÛÙÔ˘˜ ÌËÚÔ‡˜ Î·È ÛÙ· οو¿ÎÚ·. ∆· Ôȉ‹Ì·Ù· ·˘Ù¿ ÌÔÚ› Ó· Û˘Óԉ‡ÔÓÙ·È·fi ·‡ÍËÛË ÙÔ˘ ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜ Î·È ·Ê‹ÓÔ˘ÓÂÓÙ˘ÒÌ·Ù· ÛÙËÓ ›ÂÛË. ∆Ô Ô›‰ËÌ· ÙÔ˘ ÔÛ¯¤Ô˘Û¿ÓÈ· ·ÚÔ˘ÛÈ¿˙ÂÈ ÛËÌ·ÓÙÈο ÚÔ‚Ï‹Ì·Ù·, fiˆ˜Ë ·˘ÙfiÌ·ÙË Ú‹ÍË ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ (2). ™Ù· Ôχ ÌÈ-ÎÚ¿ ·È‰È¿ Î·È Ù· ‚Ú¤ÊË, ÂÂȉ‹ ÔÈ ÈÛÙÔ› Â›Ó·È Â-ÚÈÛÛfiÙÂÚÔ ·ÓıÂÎÙÈÎÔ› ÛÙË ‰ËÌÈÔ˘ÚÁ›· Ôȉ‹Ì·ÙÔ˜ÛÙÔÓ ‰È¿ÌÂÛÔ ¯ÒÚÔ, ‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È Û˘Ó‹ıˆ˜ ÂÍÈ-‰ÚÒÌ·Ù·, fiˆ˜ ÙÔ Ï¢ÚÈÙÈÎfi Î·È ÙÔ ·ÛÎÈÙÈÎfi, ¯ˆ-Ú›˜ ¤ÓÙÔÓÔ ÁÂÓÈÎÂ˘Ì¤ÓÔ Ô›‰ËÌ·. Èڛ˜ ıÂڷ›·, ÙÔÔ›‰ËÌ· ÁÂÓÈ·ÂÙ·È Î·È ÂÓÙÔ›˙ÂÙ·È ÛÙËÓ ÔÛ¯Â˚Î‹Î·È ·È‰ÔÈÈ΋ ÂÚÈÔ¯‹, ÛÙ· ·ÁfiÚÈ· Î·È Ù· ÎÔÚ›ÙÛÈ··ÓÙ›ÛÙÔȯ·.

™ÙËÓ ·ÚÔ‡Û· ÂÚ›ÙˆÛË, ÙÔ ÓÂÊÚˆÛÈÎfi Û‡Ó-‰ÚÔÌÔ ÂΉËÏÒıËΠ·Ú¯Èο Ì ÔÛ¯ÂÔÔÛıÈÎfi Ô›‰ËÌ·. ∂›¯Â ÚÔËÁËı› ÙÚ·˘Ì·ÙÈÛÌfi˜ ·fi ÙËÓ

∂ÈÎfiÓ· 1. OÛ¯ÂÔÔÛıÈÎfi Ô›‰ËÌ· ˘fi Ù¿ÛË. ∂ÈÎfiÓ· 2. ÀÂÚ˯ÔÁÚ¿ÊËÌ· ÔÛ¯¤Ô˘: ¯·Ú·ÎÙËÚÈÛÙÈÎfi Ô›‰ËÌ·ÔÛ¯¤Ô˘, ÙÔ ÔÔ›Ô ‰ÂÓ ÂÚȤ¯ÂÈ fiÚ¯ÂȘ.

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·206

Page 64: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

207

¶·È‰È·ÙÚÈ΋ 2004;67:205-207 Paediatriki 2004;67:205-207

·ÔÎfiÏÏËÛË Ù˘ ·ÎÚÔÔÛı›·˜ ÏfiÁˆ ‚·Ï·ÓÔÔ-ÛıÈÎÒÓ Û˘ÌʇÛÂˆÓ Î·È Ë Ïԛ̈ÍË ÙÔ˘ ·ÓÒÙÂÚÔ˘·Ó·Ó¢ÛÙÈÎÔ‡. OÈ ÁÔÓ›˜ ‰ÂÓ ·ÓÙÈÏ‹ÊıËÎ·Ó ÙËÓ·ÚÔ˘Û›· ÚˆÈÓÔ‡ ÂÚÈÎÔÁ¯ÈÎÔ‡ Ôȉ‹Ì·ÙÔ˜ ‹ ¿-¯˘ÓÛË ÙÔ˘ ·È‰ÈÔ‡ ÙÔ ÙÂÏÂ˘Ù·›Ô ‰È¿ÛÙËÌ·. ™ÙËÓÔÚ›·, ÙÔ Ô›‰ËÌ· ÂÂÎÙ¿ıËΠÛÙÔÓ Î·ÙÒÙÂÚÔÎÔÚÌfi, ÛÙ· οو ¿ÎÚ· ηÈ, ·ÎÔÏÔ‡ıˆ˜, η٤Ϸ‚ÂÙÔ ˘fiÏÔÈÔ ÛÒÌ·.

£ÂˆÚËÙÈο, ÌÔÚ› Ó· ÚÔ¸‹Ú¯Â ÙÔ Û‡Ó‰ÚÔÌÔηÈ, ÏfiÁˆ Ù˘ ÌÈÎÚ‹˜ ËÏÈΛ·˜, ÙÔ ÁÂÓÈÎÂ˘Ì¤ÓÔ Ô›‰Ë-Ì· Ó· ÌËÓ ˘¤ÂÛ ÛÙËÓ ·ÓÙ›ÏË„Ë ÙˆÓ ÁÔÓ¤ˆÓ ‹ÙˆÓ ÁÈ·ÙÚÒÓ. ∂›Û˘, Ô ÙÔÈÎfi˜ ÙÚ·˘Ì·ÙÈÛÌfi˜ ·fiÙË Ï‡ÛË ÙˆÓ Û˘ÌʇÛÂˆÓ ı· ÌÔÚÔ‡Û ӷ ÚÔη-ϤÛÂÈ ÂÎÛÂÛËÌ·Ṳ̂ÓÔ Ô›‰ËÌ· Ù˘ fiÛı˘.

∂ÎÙfi˜ ·fi ÙËÓ ÂÏ¿ÙÙˆÛË ÙÔ˘ ÂÓ‰·ÁÁÂÈ·ÎÔ‡ ¯Ò-ÚÔ˘ ÏfiÁˆ ˘ÔÏÂ˘ÎˆÌ·ÙÈÓ·ÈÌ›·˜, Ô˘ ÂÓÂÚÁÔÔÈ›ÙË ‰ËÌÈÔ˘ÚÁ›· Ôȉ‹Ì·ÙÔ˜, ¤¯Ô˘Ó ‰È·Ù˘ˆı› ˘Ô-ı¤ÛÂȘ fiÙÈ ÙÔ Ô›‰ËÌ· ÌÔÚ› Ó· ÔÊ›ÏÂÙ·È ÛÙËÓ ·-ÚÔ˘Û›· οÔÈÔ˘ ·Ú¿ÁÔÓÙ· ÛÙËÓ Î˘ÎÏÔÊÔÚ›·, ÔÔÔ›Ô˜ ·˘Í¿ÓÂÈ ÙË ‰È·ÂÚ·ÙfiÙËÙ· ÙÔ˘ ÙÔȯÒÌ·ÙÔ˜ÙˆÓ ÙÚȯÔÂȉÒÓ Û fiÏÔ˘˜ ÙÔ˘˜ ÈÛÙÔ‡˜, Û˘ÌÂÚÈ-Ï·Ì‚·ÓÔÌ¤ÓˆÓ Î·È ÙˆÓ ÓÂÊÚÒÓ (4). O ·Ú¿ÁÔÓÙ·˜·˘Ùfi˜ Â›Ó·È Èı·Ófi Ó· ¤‰Ú·Û ÙÔÈο ÛÙÔ˘˜ ¯·-Ï·ÚÔ‡˜ ÈÛÙÔ‡˜ ÙÔ˘ ÔÛ¯¤Ô˘, Ì ·ÔÙ¤ÏÂÛÌ· ÙÔ Ô›-‰ËÌ¿ ÙÔ˘ Ó· Â›Ó·È ÂÌÊ·Ó¤˜ Î·È Ó· ÚÔËÁÂ›Ù·È ÙˆÓÁÂÓÈÎÂ˘Ì¤ÓˆÓ ÔȉËÌ¿ÙˆÓ, ÛÙÔÓ Û¯ËÌ·ÙÈÛÌfi ÙˆÓ

ÔÔ›ˆÓ ÙÔ ·ÁfiÚÈ ‹Ù·Ó ·ÓıÂÎÙÈÎfi ÏfiÁˆ Ù˘ ÌÈÎÚ‹˜ËÏÈΛ·˜.

∫·È ÛÙȘ ‰‡Ô ÂÚÈÙÒÛÂȘ, ˆÛÙfiÛÔ, ÙÔ Ô͇ÔÛ¯ÂÔÔÛıÈÎfi Ô›‰ËÌ· ‹Ù·Ó ·˘Ùfi Ô˘ Ô‰‹ÁËÛ ÙÔÓ·ÛıÂÓ‹ ÛÙÔÓ ÁÈ·ÙÚfi. ∂›Û˘, Ë ‰È¿ÎÚÈÛË ·˘ÙÔ‡ ÙÔ˘¯·Ú·ÎÙËÚÈÛÙÈÎÔ‡ Ôȉ‹Ì·ÙÔ˜ ·fi ¿ÏÏ˘ ·ÈÙÈÔÏÔÁ›·˜·ÚÂÌÊÂÚ‹ Ôͤ· Ôȉ‹Ì·Ù· ¤¯ÂÈ È‰È·›ÙÂÚË ÛËÌ·Û›·.∆· ÎÏÈÓÈο Î·È Ù· ˘ÂÚ˯ÔÁÚ·ÊÈο Â˘Ú‹Ì·Ù· ÌÔ-Ú› Ó· Â›Ó·È ·ıÔÁÓˆÌÔÓÈο, fiˆ˜ ÛÙËÓ ·ÚÔ‡Û·ÂÚ›ÙˆÛË, ÒÛÙ ӷ Û˘Ì‚¿ÏÔ˘Ó ÛÙËÓ ¤ÁηÈÚË ‰È·-ÊÔÚԉȿÁÓˆÛË ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜ Î·È Ó· ·ÎÔÏÔ˘-ıËı› Ë ÂӉ‰ÂÈÁ̤ÓË ıÂڷ¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË.

∆Ô ·ÈÊÓ›‰ÈÔ ÔÛ¯ÂÔÔÛıÈÎfi Ô›‰ËÌ· ÌÔÚ› Ó··ÔÙÂÏ› ÙËÓ ÚÒÙË ÂΉ‹ÏˆÛË ÓÂÊÚˆÛÈÎÔ‡ Û˘Ó-‰ÚfiÌÔ˘. ∆Ô „˘¯Úfi, ·ÓÒ‰˘ÓÔ, ‰È·˘Á¤˜ Î·È ˘‰·Ú¤˜˘fi Ù¿ÛË fiÛ¯ÂÔ, Ô˘ ·Ú·Ì¤ÓÂÈ ¤Ú·Ó ÙÔ˘24ÒÚÔ˘, ı¤ÙÂÈ ÙË ‚¿ÛÈÌË ˘Ô„›· ‡·Ú͢ ÙÔ˘ Û˘Ó-‰ÚfiÌÔ˘ ·˘ÙÔ‡. ∏ ˘ÂÚ˯ÔÁÚ·ÊÈ΋ ÂÈÎfiÓ· Â›Ó·È ¯·-Ú·ÎÙËÚÈÛÙÈ΋. ∏ ¤ÁηÈÚË ‰È¿ÁÓˆÛË Î·È Ë Î·Ù¿ÏÏË-ÏË ıÂڷ›· ·ÔÙÚ¤Ô˘Ó ÌË ·Ó·Áη›Â˜ ¯ÂÈÚÔ˘ÚÁÈ-Τ˜ ÂÂÌ‚¿ÛÂȘ.

µÈ‚ÏÈÔÁÚ·Ê›·1. Frank RG, Friedman SC, Wise GJ, Gerard PS. Scrotal wall

edema presenting as the initial manifestation of nephroticsyndrome. N Y State J Med 1991;91:462-463.

2. Welch TR, Gianis J, Sheldon CA. Perforation of the scrotumcomplicating nephrotic syndrome. J Pediatr 1988;113:336-337.

3. Bergstein GM. Nephrotic syndrome. In: Nelson WE, BehrmanRE, Kliegman RM, Arvin AM, editors. Nelson Textbook ofPediatrics. 16th ed. London: WB Saunders Co; 2000. p.1592-1595.

4. Humphreys MH. Mechanisms and management of nephroticedema. Kidney Int 1994;45:266-281.

∂ÈÎfiÓ· 3. ÀÂÚ˯ÔÁÚ¿ÊËÌ· ÔÛ¯¤Ô˘-‚Ô˘‚ˆÓÈÎÒÓ fiÚˆÓ: ·-ÚÂÎÙÔÈṲ̂ÓÔÈ fiÚ¯ÂȘ ÛÙ· ¤Íˆ ‚Ô˘‚ˆÓÈο ÛÙfiÌÈ· ÏfiÁˆ Ôȉ‹-Ì·ÙÔ˜ ÔÛ¯¤Ô˘.

∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 20-06-2003 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 30-03-2004

¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∂˘ÛÙÚ¿ÙÈÔ˜ ÃÚÈÛÙÈ·Ó¿Î˘ ¶·È‰Ô¯ÂÈÚÔ˘ÚÁÈÎfi ∆Ì‹Ì· °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ ¶ÂÓÙ¤Ï˘ πÔÎÚ¿ÙÔ˘˜ 6, ∆.∫. 152 36, ¶. ¶ÂÓÙ¤ÏË

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·207

Page 65: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

208

¶·È‰È·ÙÚÈ΋ 2004;67:208-211 Paediatriki 2004;67:208-211

∂¡¢π∞º∂ƒOÀ™∞ ¶∂ƒπ¶∆ø™∏ CASE REPORT

AÛ˘Ó‹ı˘ ·Ô˘Û›· Ó¢ÚÔÏÔÁÈ΋˜ Û˘Ó‰ÚÔÌ‹˜ Û ÎÔÚ›ÙÛÈ 4 ÂÙÒÓ Ì ·Ù·Í›·-ÙËÏ·ÁÁÂÈÂÎÙ·Û›· (Û‡Ó‰ÚÔÌÔ Louis-Bar)°. ∆Ú›Ì˘1, ∫. ∞ı·Ó·Û¿ÎË1, ∞. °È·ÓÓÔ‡ÏÈ· - ∫·Ú·ÓÙ·Ó¿1, ª. ∫·Ó¿ÚÈÔ˘2, •. ∫Ú›ÎÔ˜1, ¶. ¡ÈÎÔÏ·˝‰Ô˘1

Unusual absence of neurological symptoms in a 4 year-old girl with ataxia-telangiectasia (Louis-Bar syndrome) G. Trimis1, K. Athanasaki1, A. Giannoulia - Karantana1, M. Kanariou2, X. Krikos1, P. Nikolaidou1

∂ÈÛ·ÁˆÁ‹∏ ·Ù·Í›·-ÙËÏ·ÁÁÂÈÂÎÙ·Û›· (Û‡Ó‰ÚÔÌÔ Louis-

Bar) Â›Ó·È Ì›· Û¿ÓÈ·, ÔÏ˘Û˘ÛÙËÌ·ÙÈ΋, ÁÂÓÂÙÈ΋ÓfiÛÔ˜, Ì ·ÚȘ ÚÔ‚¿ÏÏÔ˘Û˜ ÂΉËÏÒÛÂȘ ÙËÓ·ÓÔÛÔ·Ó¿ÚÎÂÈ· Î·È ÙË Ó¢ÚÔÏÔÁÈ΋ Û˘Ó‰ÚÔÌ‹.∂ΉËÏÒÓÂÙ·È Û˘Ó‹ıˆ˜ ÎÏÈÓÈο ·fi ÙÔ ‰Â‡ÙÂÚÔ ¤ÙÔ˜Ù˘ ˙ˆ‹˜ Î·È ÂȉÂÈÓÒÓÂÙ·È Ì ÙËÓ ¿ÚÔ‰Ô ÙÔ˘ ¯Úfi-ÓÔ˘ (1). ∫ÏËÚÔÓÔÌÂ›Ù·È Ì ·˘ÙfiÛˆÌÔ ˘ÔÏÂÈfiÌÂÓÔÙ‡Ô Î·È ÙÔ ˘Â‡ı˘ÓÔ ÁÔÓ›‰ÈÔ (∞∆ª) ‰ڿ˙ÂÙ·È ÛÙÔÌ·ÎÚ‡ ÛΤÏÔ˜ ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ 11 (11q22-23)(2). ∏ Û˘¯ÓfiÙËÙ¿ Ù˘ Î˘Ì·›ÓÂÙ·È ÌÂٷ͇ 1/40.000 ηÈ1/100.000 ¿ÙÔÌ·, ÂΉËÏÒÓÂÙ·È ¿ÓÙ· ÛÙËÓ ·È‰È΋ËÏÈΛ·, ÂÓÒ ÙÔ ÔÛÔÛÙfi ÙˆÓ ÊÔÚ¤ˆÓ ÙÔ˘ ·ıÔÏÔÁÈ-ÎÔ‡ ÁÔÓȉ›Ô˘ ÛÙÔÓ ÁÂÓÈÎfi ÏËı˘ÛÌfi ˘ÔÏÔÁ›˙ÂÙ·È ÛÂ1%. ∆· ·ÚÈ· ÛÙÔȯ›· Ù˘ ÎÏÈÓÈ΋˜ ÚÔ‚ÔÏ‹˜ Â›Ó·È ËÚÔԉ¢ÙÈο ÂȉÂÈÓÔ‡ÌÂÓË ·ÚÂÁÎÂÊ·ÏȉÈ΋ ·Ù·-

Í›·, ÔÈ ÙËÏ·ÁÁÂÈÂÎٷۛ˜ ÛÙÔ˘˜ ÂÈÂÊ˘ÎfiÙ˜ ηÈÛÙÔ ‰¤ÚÌ· Î·È ÔÈ ¯ÚfiÓȘ ÏÔÈÌÒÍÂȘ ÙˆÓ ·Ú·ÚÚ›-ÓÈˆÓ ÎfiÏˆÓ Î·È ÙˆÓ Ó¢ÌfiÓˆÓ. ∏ ÓfiÛÔ˜ Û˘Ó‰˘¿-˙ÂÙ·È Ì ÔÈΛÏÔ˘ ‚·ıÌÔ‡ ÌÈÎÙ‹ ·ÓÔÛÔ·Ó¿ÚÎÂÈ·,ÂÈÏÂÎÙÈ΋ ·Ô˘Û›· Ù˘ ·ÓÔÛÔÛÊ·ÈÚ›Ó˘ IgA ÛÙÔÓÔÚfi Î·È ˘„ËÏ‹ ÙÈÌ‹ ·-ÊÂÙÔÚˆÙ½Ó˘ (1). ∏ ÚÔÁÂÓ-ÓËÙÈ΋ ‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘ Â›Ó·È ‰˘Ó·Ù‹ (3). Œ¯ÂÈ·Ú·ÙËÚËı› ·˘ÍË̤ÓË Â›ÙˆÛË Î·ÎÔËıÂÈÒÓ, ÙfiÛÔÛÙÔ˘˜ ·ÛıÂÓ›˜ fiÛÔ Î·È ÛÙÔ˘˜ Û˘ÁÁÂÓ›˜ Ô˘ ‰ÂÓ¤¯Ô˘Ó ÚÔÛ‚ÏËı› ·fi ÙË ÓfiÛÔ (4).

¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ÎÔÚÈÙÛÈÔ‡ ËÏÈΛ·˜4 ÂÙÒÓ Ô˘ ÚÔÛ‹Ïı ÁÈ· ‰ÈÂÚ‡ÓËÛË ÏfiÁˆ ·Ú·-ÙÂٷ̤ÓÔ˘ ÂÂÈÛÔ‰›Ô˘ ‚ÚÔÁ¯›Ùȉ·˜. ∏ ·ÛıÂÓ‹˜·ÚÔ˘Û›·˙ ÔÏÏ¿ ÛÙÔȯ›· Ù˘ ÎÏÈÓÈÎÔÂÚÁ·ÛÙË-Úȷ΋˜ ÂÈÎfiÓ·˜ Ù˘ ·Ù·Í›·˜-ÙËÏ·ÁÁÂÈÂÎÙ·Û›·˜,ÏËÓ fï˜ ·Ô˘Û›·˙ ÔÔÈ·‰‹ÔÙ ·ıÔÏÔÁÈ΋

�¶ÂÚ›ÏË„Ë: ∏ ·Ù·Í›·-ÙËÏ·ÁÁÂÈÂÎÙ·Û›· (Û‡Ó‰ÚÔ-ÌÔ Louis-Bar) Â›Ó·È Ì›· Û¿ÓÈ· ÔÏ˘Û˘ÛÙËÌ·ÙÈ΋,Ó¢ÚÔÂÎÊ˘ÏÈÛÙÈ΋ ÁÂÓÂÙÈ΋ ‰È·Ù·Ú·¯‹. ¶ÂÚÈÁÚ¿ÊÂ-Ù·È Ë ÂÚ›ÙˆÛË ÎÔÚÈÙÛÈÔ‡ ËÏÈΛ·˜ 4 ÂÙÒÓ Ì ÈÛÙÔ-ÚÈÎfi ˘ÔÙÚÔÈ·˙Ô˘ÛÒÓ ÏÔÈÌÒÍÂˆÓ ÙÔ˘ ·Ó·Ó¢ÛÙÈ-ÎÔ‡, ÛÙÔ ÔÔ›Ô ·Ó¢ڤıËÛ·Ó ÔÊı·ÏÌÔÏÔÁÈο ηȷÓÔÛÔÏÔÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο Ù˘ ÓfiÛÔ˘. ∏ ·Ô˘-Û›· Ó¢ÚÔÏÔÁÈ΋˜ Û˘Ó‰ÚÔÌ‹˜, ÁÂÁÔÓfi˜ ·Û˘Ó‹ıÈ-ÛÙÔ ÁÈ· ·ÛıÂÓ‹ ·˘Ù‹˜ Ù˘ ËÏÈΛ·˜, ‰˘Û¯¤Ú·Ó ÙˉȿÁÓˆÛË Ù˘ ÓfiÛÔ˘. ∂Ȃ‚·ÈÒÓÂÙ·È fiÙÈ ˘¿Ú¯Ô˘ÓÔÚÈṲ̂Ó˜ ÌÂÙ·ÏÏ¿ÍÂȘ ÙÔ˘ ˘Â‡ı˘ÓÔ˘ ÁÔÓȉ›Ô˘Ô˘ Úԉȷı¤ÙÔ˘Ó Û ‚Ú·‰‡ÙÂÚË Ó¢ÚÔÏÔÁÈ΋ ¤Î-ÙˆÛË.

§¤ÍÂȘ ÎÏÂȉȿ: ·Ù·Í›·-ÙËÏ·ÁÁÂÈÂÎÙ·Û›·, ·ÓÔÛÔ·-Ó¿ÚÎÂÈ·, Ó¢ÚÔÏÔÁÈ΋ Û˘Ó‰ÚÔÌ‹.

�Abstract: Ataxia-telangiectasia is a raremultisystem, neurodegenerative genetic disorder.The case is described of a 4 year-old girl with ahistory of frequent respiratory infections, whopresented the ocular and immunologic features ofthis syndrome. The absence of neurologicalsymptoms, which is very unusual for a patient of thisage, raised many difficulties in the diagnosis of thedisease. It is confirmed that some mutations of thegene responsible for the disease predispose toslower neurological deterioration.

Key words: ataxia-telangiectasia, immunodeficiency,neurological symptoms.

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

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

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

2 Department of Immunology, “Aghia Sophia” Children’s Hospital, Athens

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·208

Page 66: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

209

¶·È‰È·ÙÚÈ΋ 2004;67:208-211 Paediatriki 2004;67:208-211

Ó¢ÚÔÏÔÁÈ΋ ÛËÌÂÈÔÏÔÁ›·. ∆Ô ÂÚÈÛÙ·ÙÈÎfi ·ÚÔ˘-ÛÈ¿˙ÂÈ ÂӉȷʤÚÔÓ ÏfiÁˆ Ù˘ ·Û˘Ó‹ıÔ˘˜ ÎÏÈÓÈ΋˜ÚÔ‚ÔÏ‹˜, ηıÒ˜ Â›Ó·È Ôχ Û¿ÓÈ· Ë ¤ÏÏÂÈ„ËÓ¢ÚÔÏÔÁÈ΋˜ ¤ÎÙˆÛ˘ Û ·ÛıÂÓ‹ ·˘Ù‹˜ Ù˘ ËÏÈ-Λ·˜. ∆Ô ÁÂÁÔÓfi˜ ·˘Ùfi η٤ÛÙËÛ ȉȷ›ÙÂÚ· ‰˘-Û¯ÂÚ‹ ÙË ‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘, ·ÏÏ¿ Ù·˘Ùfi¯ÚÔÓ·ÂȂ‚·›ˆÛ ÙËÓ ÂÙÂÚÔÁ¤ÓÂÈ· ÙÔ˘ ÎÏÈÓÈÎÔ‡ Ê·ÈÓÔ-Ù‡Ô˘ Î·È ÙË Û˘Û¯¤ÙÈÛ‹ ÙÔ˘ Ì ÙȘ ˘¿Ú¯Ô˘Û˜ÌÂÙ·ÏÏ¿ÍÂȘ ÙÔ˘ ∞∆ª ÁÔÓȉ›Ô˘.

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ∫ÔÚ›ÙÛÈ ËÏÈΛ·˜ 4 ÂÙÒÓ ·Ú·¤ÌÊıËΠÛÙËÓ ∫ÏÈ-

ÓÈ΋ ÏfiÁˆ ·ÛıÌ·ÙÈ΋˜ ‚ÚÔÁ¯›Ùȉ·˜ ·fi ÌËÓfi˜, ËÔÔ›· ‰ÂÓ ·ÓÙ·ÔÎÚ›ıËΠÛÙË ıÂڷ›· Ì ‚ÚÔÁ¯Ô-‰È·ÛÙ·ÏÙÈο Î·È ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜ ·ÓÙÈÌÈÎÚԂȷ΋·ÁˆÁ‹. ™ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ·Ó·ÌÓËÛÙÈÎfi ·Ó·Ê¤ÚıËÎÂfiÙÈ Ô ÌËÙÚÈÎfi˜ ·Ô‡˜ Î·È Ë ·ÙÚÈ΋ ÁÈ·ÁÈ¿ ·Â-‚›ˆÛ·Ó Û ËÏÈΛ· 51 Î·È 32 ÂÙÒÓ, ·ÓÙ›ÛÙÔȯ·, ·fiηÚΛÓÔ ·ÁÎÚ¤·ÙÔ˜, ÂÓÒ Ë ÌËÙÚÈ΋ ÁÈ·ÁÈ¿ ÚÔ-Û‚Ï‹ıËΠ·fi ηÚΛÓÔ Ì·ÛÙÔ‡ ÛÙËÓ ËÏÈΛ· ÙˆÓ 49ÂÙÒÓ. ∏ ·ÛıÂÓ‹˜ ÁÂÓÓ‹ıËΠÌÂÙ¿ ·fi ÙÂÏÂÈfiÌËÓË·ËÛË ¯ˆÚ›˜ ÂÈÏÔΤ˜. ∆· ۈ̷ÙÔÌÂÙÚÈο ÌÂÁ¤ıËÛÙË Á¤ÓÓËÛË ‹Ù·Ó ÌÂٷ͇ 25˘ Î·È 50‹˜ ı¤Û˘ (µ™:2850 g, ª™: 50 cm, ¶∫: 33 cm). ∏ ÂÚÈÁÂÓÓËÙÈ΋ Â-Ú›Ô‰Ô˜ ‹Ù·Ó ÔÌ·Ï‹. ∏ ÚÒÈÌË ÎÈÓËÙÈ΋ ·Ó¿Ù˘ÍËÙÔ˘ ·È‰ÈÔ‡ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋. ∫¿ıÈÛ Û ËÏÈΛ· 6ÌËÓÒÓ Î·È ÂÚ¿ÙËÛ Û ËÏÈΛ· 1 ¤ÙÔ˘˜. ∏ ·ÛıÂÓ‹˜·ÚÔ˘Û›·˙ ٷ ÙÂÏÂ˘Ù·›· 2 ¯ÚfiÓÈ· Û˘¯Ó¤˜ ÏÔÈÌÒ-ÍÂȘ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Ì ·Ú·ÁˆÁÈÎfi ‚‹¯· ηȂÏÂÓÓÔ˘Ò‰Ë ¤ÎÎÚÈÛË, Ô˘ ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·Ó ÂÈÙ˘-¯Ò˜ Ì ·ÓÙÈÌÈÎÚԂȷ΋ ·ÁˆÁ‹, ¯ˆÚ›˜ ÔÙ¤ Ó· ¯ÚÂÈ-·ÛÙ› ÓÔÛËÏ›·. ∞ӷʤÚıËηÓ, ›Û˘, Û˘¯Ó¤˜ Ì˘-ÎËÙÈ¿ÛÂȘ ÛÙfiÌ·ÙÔ˜ Ô˘ ˘Ô¯ˆÚÔ‡Û·Ó Ì ÙÔÈ΋·ÁˆÁ‹ ηÈ, ÌÂÚÈΤ˜ ÊÔÚ¤˜, ‹È· ÂÂÈÛfi‰È· ‚‹¯· η-Ù¿ ÙË Û›ÙÈÛË Ì ˘‰·Ú›˜, ΢ڛˆ˜, ÙÚÔʤ˜. ∆Ô ·È‰›‹Ù·Ó Û ηϋ ÁÂÓÈ΋ ηٿÛÙ·ÛË Î·È ·fiÏ˘Ù· Û˘-ÓÂÚÁ¿ÛÈÌÔ. ¢ÂÓ ·ÚÔ˘Û›·˙ ٷ¯‡ÓÔÈ·, ΢¿ÓˆÛË,ÏËÎÙÚÔ‰·ÎÙ˘Ï›· ‹ Ô›‰ËÌ· (SaO2: 97%). ∏ ۈ̷ÙÈ-΋ ÙÔ˘ ·Ó¿Ù˘ÍË ˘ÔÏÂÈfiÙ·Ó ÁÈ· ÙËÓ ËÏÈΛ· ÙÔ˘(µ™: <3Ë ∂£, ª™ Î·È ¶∫ ÛÙË 10Ë ∂£). ∂ÈÛÎÔÈο,ÚÔηÏÔ‡Û ÂÓÙ‡ˆÛË Ë ·ÚÔ˘Û›· ÙËÏ·ÁÁÂÈÂÎÙ·-ÛÈÒÓ ÛÙÔ˘˜ ‚ÔÏ‚ÈÎÔ‡˜ ÂÈÂÊ˘ÎfiÙ˜ ·ÌÊÔÙÂÚfi-Ï¢ڷ. ¢ÂÓ „ËÏ·Ê›˙ÔÓÙ·Ó Ô˘ıÂÓ¿ ÏÂÌÊ·‰¤Ó˜, ËÎÔÈÏÈ¿ ‹Ù·Ó ̷Ϸ΋, ¢›ÂÛÙË ̄ ˆÚ›˜ ÔÚÁ·ÓÔÌÂÁ·Ï›·Î·È Ù· ¤Íˆ ÁÂÓÓËÙÈο fiÚÁ·Ó· ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎÔ‡ı‹ÏÂÔ˜. ∏ ·ÛıÂÓ‹˜ ·ÚÔ˘Û›·˙ ÂͤڢıÚ· ·Ú›-ÛıÌÈ· Ì ÔÈÛıÔÚÚÈÓÈ΋ ˘Ò‰Ë Ú‡ÛË Î·È ÌË ÌÔ˘ÛÈ-ÎÔ‡˜ ÚfiÁ¯Ô˘˜ Û fiÏÔ ÙÔ Â‡ÚÔ˜ Ù˘ ·Ó·ÓÔ‹˜. ∞fiÙËÓ ·ÎÚfi·ÛË Ù˘ ηډȿ˜ ‰ÂÓ ÚԤ΢Ù ٛÔÙ··ıÔÏÔÁÈÎfi. ∏ Ó¢ÚÔÏÔÁÈ΋ ÂͤٷÛË ‰ÂÓ ÂÓÙfiÈÛ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·. OÈ ÔÊı·ÏÌÈΤ˜ ÎÈÓ‹ÛÂȘ‹Ù·Ó Û˘ÌÌÂÙÚÈΤ˜ Î·È Ê˘ÛÈÔÏÔÁÈΤ˜, ÂÓÒ Ô ¤ÏÂÁ¯Ô˜ÙˆÓ ÂÁÎÂÊ·ÏÈÎÒÓ Û˘˙˘ÁÈÒÓ ‰ÂÓ ÂÓÙfiÈÛ ٛÔÙ· ·-ıÔÏÔÁÈÎfi. O Ì˘˚Îfi˜ ÙfiÓÔ˜ Î·È Ù· ÂÓ Ùˆ ‚¿ıÂÈ ÙÂÓfi-

ÓÙÈ· ·ÓÙ·Ó·ÎÏ·ÛÙÈο ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο Î·È ÔÈ ·ÚÂ-ÁÎÂÊ·ÏȉÈΤ˜ ‰ÔÎÈ̷ۛ˜ ÂÎÙÂϤÛÙËÎ·Ó ÈηÓÔÔÈËÙÈ-ο. ∆Ô ‚¿‰ÈÛÌ· ‹Ù·Ó ·ÚÁfi, ·ÏÏ¿ ÛÙ·ıÂÚfi.

∞fi ÙÔÓ ·‰Úfi ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô ‰È·ÈÛÙÒ-ıËΠϢÎÔÂÓ›· Î·È ÏÂÌÊÔÂÓ›·: Ht: 40%, Hb: 12,7g/dl, WBC: 3000/Ìl (¶: 71%, §: 24%, ª: 5%), PLT:386.000/Ìl. OÈ ‰Â›ÎÙ˜ ÊÏÂÁÌÔÓ‹˜ ‹Ù·Ó ¯·ÌËÏÔ›(∆∫∂: 24 mm, CRP: 4 mg/L) Î·È Ô ‚ÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ-¯Ô˜ Ê˘ÛÈÔÏÔÁÈÎfi˜. ∏ ·Ï‹ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜¤‰ÂÈÍ ÚÔÛ‚ÔÏ‹ ‰È¿ÌÂÛÔ˘ ÈÛÙÔ‡, ÂÓÒ Ë ‰ÂÚÌÔ·-ÓÙ›‰Ú·ÛË Mantoux ‹Ù·Ó ·ÚÓËÙÈ΋. ™ÙȘ ηÏÏȤÚÁÂÈ-˜ ÚÈÓÈÎÒÓ ÂÎÎÚÈÌ¿ÙˆÓ Î·È Ù˘¤ÏˆÓ ÁÈ· ÎÔÈÓ¿ ‚·-ÎÙ‹ÚÈ· ·Ó·Ù‡¯ıËΠ·ÈÌfiÊÈÏÔ˜ ÈÓÊÏÔ˘¤ÓÙÛ·˜ ·Ó-ıÂÎÙÈÎfi˜ ÛÙËÓ ÎÏ·ÚÈıÚÔÌ˘Î›ÓË, Ô˘ ¯ÔÚËÁÔ‡ÓÙ·ÓÚÈÓ ÙËÓ ÂÈÛ·ÁˆÁ‹.

ªÂ Ù· Â˘Ú‹Ì·Ù· ·˘Ù¿ ·ÔÊ·Û›ÛÙËÎÂ Ë ¤Ó·ÚÍË·ÁˆÁ‹˜ ÌÂ Û˘Ó‰˘·ÛÌfi ·ÌÔÍÈÎÈÏÏ›Ó˘ Î·È ÎÏ·‚Ô˘-Ï·ÓÈÎÔ‡ ÔͤԘ ÂÓ‰ÔÊÏ‚›ˆ˜. ÃÔÚËÁ‹ıËηÓ, ›-Û˘, Û·Ï‚Ô˘Ù·ÌfiÏË Î·È ‚ÚˆÌÈÔ‡¯Ô ÈÚ·ÙÚfiÈÔ ÌÂÓÂÊÂÏÔÔÈËÙ‹, Ù· ÔÔ›· ‰È·ÎfiËÎ·Ó ÏfiÁˆ ÌË ·ÓÙ·-fiÎÚÈÛ˘ Ù˘ ·ÛıÂÓÔ‡˜. §fiÁˆ Ù˘ ‚Ú·‰Â›·˜ ·ÓÙ·-fiÎÚÈÛ˘ ÛÙË ıÂڷ¢ÙÈ΋ ·ÁˆÁ‹ Î·È ÙÔ˘ ÂÈ‚·Ú˘-̤ÓÔ˘ ÌÂ Û˘¯Ó¤˜ ÏÔÈÌÒÍÂȘ ·ÙÔÌÈÎÔ‡ ·Ó·ÌÓËÛÙÈ-ÎÔ‡, Ô ¤ÏÂÁ¯Ô˜ ÂÂÎÙ¿ıËÎÂ. ŒÁÈÓ ÔÚÔÏÔÁÈÎfi˜¤ÏÂÁ¯Ô˜ ÁÈ· HIV, EBV, CMV, ·‰ÂÓÔ˚Ô‡˜, ÈÔ‡˜ ÁÚ›-˘ Î·È ·Ú·Áڛ˘, ¯Ï·Ì‡‰ÈÔ Î·È Ì˘ÎfiÏ·ÛÌ·Ù˘ Ó¢ÌÔÓ›·˜, ηıÒ˜ Î·È ·ÓÔÛÔÊıÔÚÈÛÌfi˜ Û ÚÈ-ÓÈÎfi ¤ÎÏ˘Ì· ÁÈ· ·Ó›¯Ó¢ÛË ÙÔ˘ ·ÓÙÈÁfiÓÔ˘ ÙÔ˘RSV. ¶ÚÔÛ‰ÈÔÚ›ÛÙËΠÙÔ Û˘Ìϋڈ̷ Î·È Ë ·1·ÓÙÈıÚ˘„›ÓË ÛÙÔÓ ÔÚfi, Ù· Rast Û ÙÚÔÊÈο Î·È ÂÈ-ÛÓÂfiÌÂÓ· ·ÏÏÂÚÁÈÔÁfiÓ· Î·È ¤ÁÈÓ ‰ÔÎÈÌ·Û›·È‰ÚÒÙ·. ∆¤ÏÔ˜, ÌÂÙÚ‹ıËÎÂ Ë ÛˆÌ·ÙỔ›ÓË, Ë ÈÓ-ÛÔ˘Ï›ÓË Î·È ÔÈ ÁÂÓÓËÙÈΤ˜ ÔÚÌfiÓ˜ Î·È ¤ÁÈÓ ·ÍÔÓÈ-΋ ÙÔÌÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ Î·È Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·-Ê›· ÂÁÎÂÊ¿ÏÔ˘. ∞fi fiϘ ÙȘ ÚÔËÁÔ‡ÌÂÓ˜ ÂÍÂÙ¿-ÛÂȘ ‰ÂÓ ÚԤ΢„ ٛÔÙ· ·ıÔÏÔÁÈÎfi. O ¤ÏÂÁ¯Ô˜Ù˘ ¯˘ÌÈ΋˜ Î·È Î˘ÙÙ·ÚÈ΋˜ ·ÓÔÛ›·˜ ‹Ù·Ó ·˘Ùfi˜Ô˘ ηÙˇı˘Ó ÙË ‰È¿ÁÓˆÛË. ∂Ȃ‚·ÈÒıËÎÂ Ë ÏÂÌ-ÊÔÂÓ›· (ÏÂÌÊÔ·ÙÙ·Ú·: 850/Ìl) Î·È Ë Ï¢ÎÔÂÓ›·(WBC: 3300/Ìl), ÂÓÒ Ë ·ÛıÂÓ‹˜ ·ÚÔ˘Û›·˙Â, ›-Û˘, ¯·ÌËÏ¿ ›‰· Ù˘ Ig∞ (<7 mg/dl) Î·È Ù˘Ig∂ (<2 IU/ml), Ê˘ÛÈÔÏÔÁÈ΋ IgG (551 mg/dl) Ì ÌÂÈ-ˆÌ¤Ó˜, fï˜, ÙÈ̤˜ ÙˆÓ ˘ÔÙ¿ÍÂˆÓ IgG2 (11mg/dl) Î·È IgG4 (<2 mg/dl), ηıÒ˜ Î·È ˘„ËÏ‹ ÙÈÌ‹Ù˘ Igª (319 mg/dl). O ·fiÏ˘ÙÔ˜ ·ÚÈıÌfi˜ ÙÔ˘ ÏË-ı˘ÛÌÔ‡ ÙˆÓ CD4 ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ‹Ù·Ó Ôχ ¯·ÌË-Ïfi˜ (180/Ìl) Î·È Ë ÙÈÌ‹ Ù˘ ·-ÊÂÙÔÚˆÙ½Ó˘ Ôχ˘„ËÏ‹ (294 ng/ml, ÊÙ: 0-20 ng/ml).

ªÂ ÙË ‰È¿ÁÓˆÛË Ù˘ ·ÓÔÛÔ·Ó¿ÚÎÂÈ·˜, ÙÔ ·È-‰› Ù¤ıËΠÛÂ Û˘ÛÙËÌ·ÙÈ΋ ¯ÔÚ‹ÁËÛË Á-ÛÊ·ÈÚ›Ó˘ÂÓ‰ÔÊÏ‚›ˆ˜ Û ‰fiÛË 400 mg/kg ·Ó¿ 3 ‚‰ÔÌ¿‰Â˜,ÚÔÊ˘Ï·ÎÙÈ΋ ¯ÔÚ‹ÁËÛË ÎÂÊ·ÎÏfiÚ˘ ·fi ÙÔ˘ ÛÙfi-Ì·ÙÔ˜ Û ‰fiÛË 20 mg/kg ËÌÂÚËÛ›ˆ˜ Î·È 50 mcg ÂÈ-ÛÓÔ‹ ÊÏÔ˘ÙÈη˙fiÓ˘ ¿·Í ËÌÂÚËÛ›ˆ˜. ŒÁÈÓÂ

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·209

Page 67: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

¤ÏÂÁ¯Ô˜ ÈÛÙÔÛ˘Ì‚·ÙfiÙËÙ·˜ ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ·, ÚÔ-ÎÂÈ̤ÓÔ˘ Ó· ‰ÈÂÚ¢ÓËı› Ë Èı·ÓfiÙËÙ· ÌÂÙ·Ìfi-Û¯Â˘Û˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ ÛÙÔ Ì¤ÏÏÔÓ, fiÔ˘ ‰È·-ÈÛÙÒıËΠHLA-Ù·˘ÙfiÙËÙ· ÌÂٷ͇ Ù˘ ·ÛıÂÓÔ‡˜Î·È Ù˘ ·‰ÂÚÊ‹˜ Ù˘. ∏ ηÏÏȤÚÁÂÈ· ÏÂÌÊÔ΢ÙÙ¿-ÚˆÓ Ù˘ ·ÛıÂÓÔ‡˜ ÂÎÙÈı¤ÌÂÓˆÓ Û ·ÎÙÈÓÔ‚ÔÏ›··Ó¤‰ÂÈÍ ·ıÔÏÔÁÈο ·˘ÍË̤ÓÔ ÔÛÔÛÙfi ıÚ·˘ÛÌ¿-ÙˆÓ ¯ÚˆÌÔÛˆÌ¿ÙˆÓ (6%) Î·È Ôχ ÌÈÎÚ‹ ÈηÓfiÙËÙ·ÂȉÈfiÚıˆÛ˘ (<5%). ∆Ô Â‡ÚËÌ· ·˘Ùfi Û˘ÓËÁÔÚÔ‡-Û ˘¤Ú Ù˘ ‰È¿ÁÓˆÛ˘ Ù˘ ·Ù·Í›·˜-ÙËÏ·ÁÁÂÈÂ-ÎÙ·Û›·˜. ∞ÎÔÏÔ‡ıˆ˜, ÚÔÁÚ·ÌÌ·Ù›ÛÙËΠÁÂÓÂÙÈÎfi˜¤ÏÂÁ¯Ô˜, fiÔ˘ ·ÓȯÓ‡ıËΠÙÚÔÔÔ›ËÛË ÛÙË ı¤ÛË8850 (G>T) ÙÔ˘ ÁÔÓȉ›Ô˘ ATM, ÛÙÔÈ¯Â›Ô Ô˘ ÛÂÛ˘Ó‰˘·ÛÌfi Ì ÙÔÓ ÎÏÈÓÈÎfi Ê·ÈÓfiÙ˘Ô ÂȂ‚·›ˆÛÂÙËÓ ·Ú·¿Óˆ ‰È¿ÁÓˆÛË.

¢‡Ô ¯ÚfiÓÈ· ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ·Ú·ÎÔÏÔ‡ıË-Û‹˜ Ù˘, Ë ·ÛıÂÓ‹˜ ÚÔÛ‚Ï‹ıËΠ‰‡Ô ÊÔÚ¤˜ ·fiÏÔÈÌÒÍÂȘ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡, ÔÈ Ôԛ˜ ·ÓÙÈÌÂÙˆ›-ÛÙËÎ·Ó ÂÈÙ˘¯Ò˜ Ì ÂÓ‰ÔÊϤ‚È· ·ÓÙÈÌÈÎÚԂȷ΋·ÁˆÁ‹. ™˘Ó¯›˙ÂÙ·È Ë ·ÁˆÁ‹ Ì Á-ÛÊ·ÈÚ›ÓË, ÎÂÊ·-ÎÏfiÚË, ÊÏÔ˘ÙÈη˙fiÓË Î·È ·ÎÔÏÔ˘ıÔ‡ÓÙ·È ‰È·ÈÙËÙÈΤ˜Ô‰ËÁ›Â˜ (Û˘¯Ó¿ Î·È ÌÈÎÚ¿ Á‡̷ٷ Ì ÙÚÔʤ˜ ˘„Ë-Ï‹˜ ‰È·ÙÚÔÊÈ΋˜ ·Í›·˜ Ô˘ ‰ÂÓ ¯ÚÂÈ¿˙ÔÓÙ·È È‰È·›ÙÂ-ÚË Ì¿ÛËÛË), ÏfiÁˆ Ù˘ ·Û˘Ó¤ÚÁÂÈ·˜ ÙˆÓ Ì˘ÒÓ Ù˘ηٿÔÛ˘ Ô˘ ‰È·ÈÛÙÒıËΠÌÂÙ¿ ·fi ‚·ÚÈÔ‡¯ÔÁ‡̷. ∏ ·ÛıÂÓ‹˜ ‰ÂÓ ¤¯ÂÈ ·ÚÔ˘ÛÈ¿ÛÂÈ Î·Ì›· ÂΉ‹-ψÛË ÂÓ‰ÂÈÎÙÈ΋ ÚÔÛ‚ÔÏ‹˜ ÙÔ˘ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·-ÙÔ˜. ¢È·ÙËÚ› ÙËÓ ÈηÓfiÙËÙ· Ó· ÓÙ‡ÓÂÙ·È Î·È Ó· Á‰‡-ÓÂÙ·È, Ó· ÙÚÒÂÈ Ì ÈÚÔ‡ÓÈ Î·È ÎÔ˘Ù¿ÏÈ, ¤ÛÙˆ Î·È ÌÂοÔÈ· ‰˘ÛÎÔÏ›·, Ó· ÁÚ¿ÊÂÈ Î·ı·Ú¿ ÙÔ fiÓÔÌ¿ ÙË˜Î·È Ó· ÔÌÈÏ› ηı·Ú¿ Ì ÚÔÙ¿ÛÂȘ ÔÏÏÒÓ Ï¤ÍˆÓ.

™˘˙‹ÙËÛË ∏ ‰È¿ÁÓˆÛË Ù˘ ·Ù·Í›·˜-ÙËÏ·ÁÁÂÈÂÎÙ·Û›·˜ Ù›-

ıÂÙ·È Û ·È‰È¿ ËÏÈΛ·˜ ¿Óˆ ÙÔ˘ 1 ¤ÙÔ˘˜ Ô˘ ·-ÚÔ˘ÛÈ¿˙Ô˘Ó ·Ù·Í›· ‹ ÛËÌ·ÓÙÈ΋ ·Û˘Ó¤ÚÁÂÈ· ÎÈÓ‹-ÛÂˆÓ Î·È ÙÈÌ‹ ·-ÊÂÙÔÚˆÙ½Ó˘ ÛÙÔÓ ÔÚfi ÌÂÁ·Ï‡-ÙÂÚË ·fi ÙÔ ‰ÈÏ¿ÛÈÔ Ù˘ ·ÓÒÙÂÚ˘ Ê˘ÛÈÔÏÔÁÈ΋˜.OÈ ·ÛıÂÓ›˜ Ú¤ÂÈ, ÂÈϤÔÓ, Ó· ÏËÚÔ‡Ó 3 ·fi Ù··ÎfiÏÔ˘ı· 4 ‰È·ÁÓˆÛÙÈο ÎÚÈÙ‹ÚÈ·: ·) ·Û˘Ó¤ÚÁÂÈ·ÎÂÊ·Ï‹˜ Î·È ÔÊı·ÏÌÒÓ, ȉ›ˆ˜ ÛÙËÓ Ï¿ÁÈ· ·fiÎÏÈ-ÛË ÙÔ˘ ‚ϤÌÌ·ÙÔ˜, ‚) ÙËÏ·ÁÁÂÈÂÎٷۛ˜ ÚÈÓ ÙÔ¤ÌÙÔ ¤ÙÔ˜ ˙ˆ‹˜, ·Ú¯Èο ÛÙÔ˘˜ ÂÈÂÊ˘ÎfiÙ˜ ηÈÌÂÙ¿ ÛÙÔ ‰¤ÚÌ·, Á) ·ÛÙ¿ıÂÈ· ‚¿‰ÈÛ˘ Î·È ‰) ÏÂÌ-ÊÔÂÓ›· Î·È ·Ó¿ÚÎÂÈ· Ù˘ IgA. ™Â ·ÛıÂÓ›˜ Ô˘ÏËÚÔ‡Ó ÏÈÁfiÙÂÚ· ·fi 3 ÙˆÓ ·ÓˆÙ¤Úˆ ÎÚÈÙËÚ›ˆÓ, ˉȿÁÓˆÛË ÂȂ‚·ÈÒÓÂÙ·È Ì ÙËÓ ·Ó‡ÚÂÛË ·ıÔ-ÏÔÁÈο ·˘ÍË̤ÓÔ˘ ÔÛÔÛÙÔ‡ ¢ıÚ·ÛÙfiÙËÙ·˜ ÙˆÓ¯ÚˆÌÔÛˆÌ¿ÙˆÓ ÙˆÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ÌÂÙ¿ ·fi ¤Î-ıÂÛË Û ·ÎÙÈÓÔ‚ÔÏ›· Î·È Ôχ ÌÈÎÚ‹˜ ÈηÓfiÙËÙ·˜ÂȉÈfiÚıˆÛ˘ ÙˆÓ ‚Ï·‚ÒÓ. ∏ ÌÔÚȷ΋ ÌÂϤÙË ÙÔ˘˘Â‡ı˘ÓÔ˘ ÁÔÓȉ›Ô˘ ∞∆ª ÛÙÔ ¯ÚˆÌfiۈ̷ 11 ÔÏÔ-ÎÏËÚÒÓÂÈ ÙË ‰ÈÂÚ‡ÓËÛË (5). ∆Ô ÁÔÓ›‰ÈÔ ÎψÓÔÔÈ‹-

ıËΠÙÔ 1995 Î·È ¤ÎÙÔÙ ¤¯Ô˘Ó Á›ÓÂÈ ÁÓˆÛÙ¤˜ ÂÚ›-Ô˘ 60 ÌÂÙ·ÏÏ¿ÍÂȘ ÙÔ˘, Ï›Á˜ ÂÎ ÙˆÓ ÔÔ›ˆÓ (5-10)Û˘Ó‰¤ÔÓÙ·È Ì ‚Ú·‰‡ÙÂÚË Ó¢ÚÔÏÔÁÈ΋ ¤ÎÙˆÛË(6). ∏ ÚˆÙ½ÓË, ÙËÓ ·Ú·ÁˆÁ‹ Ù˘ ÔÔ›·˜ ÂϤÁ¯ÂÈÙÔ ÁÔÓ›‰ÈÔ ∞∆ª, Ú˘ıÌ›˙ÂÈ ÙÔÓ Î˘ÙÙ·ÚÈÎfi ·ÎÏÔ Î·È·ÚÂÌÔ‰›˙ÂÈ ÙËÓ ·Ó··Ú·ÁˆÁ‹ ÙÔ˘ ‰ÔÌÈο ‰È·Ù·-Ú·Á̤ÓÔ˘ DNA (7). ™Â ÔÛÔÛÙfi 25-30% ÙˆÓ ·ÛıÂ-ÓÒÓ Ì ÙÔÓ ÎÏÈÓÈÎfi Ê·ÈÓfiÙ˘Ô Ù˘ ·Ù·Í›·˜-ÙËÏ·Á-ÁÂÈÂÎÙ·Û›·˜ ›Ù ‰ÂÓ ·ÓȯÓ‡ÂÙ·È Î¿ÔÈ· ÌÂÙ¿ÏÏ·ÍËÛÙÔ ˘Â‡ı˘ÓÔ ÁÔÓ›‰ÈÔ Â›Ù ÂÓÙÔ›˙ÂÙ·È Ì›· Ó¤·,fiˆ˜ ·˘Ù‹ Ô˘ ·Ó¢ڤıËΠÛÙË Û˘ÁÎÂÎÚÈ̤ÓË·ÛıÂÓ‹ (2).

∏ ·ÛıÂÓ‹˜ Ù˘ ·ÚÔ‡Û·˜ ÂÚ›ÙˆÛ˘ ÏËÚÔ‡-Û ٷ ÚÔ·Ó·ÊÂÚfiÌÂÓ· ÎÚÈÙ‹ÚÈ·, ÏfiÁˆ fï˜ Ù˘·Ô˘Û›·˜ Ó¢ÚÔÏÔÁÈÎÒÓ ÂΉËÏÒÛˆÓ, Ë ‰È¿ÁÓˆÛˉȤϷı ˆ˜ ÙËÓ ËÏÈΛ· ÙˆÓ 4 ÂÙÒÓ. ™˘Ó‹ıˆ˜, Ë Ófi-ÛÔ˜ ÚÔ‚¿ÏÏÂÈ ÚÈÓ ÙÔ Ù¤ÏÔ˜ ÙÔ˘ ‰Â‡ÙÂÚÔ˘ ¤ÙÔ˘˜˙ˆ‹˜ Ì ÚÔԉ¢ÙÈο ÂȉÂÈÓÔ‡ÌÂÓË ·ÚÂÁÎÂÊ·ÏÈ-‰È΋ ·Ù·Í›·. ∏ ÔÌÈÏ›· ·ÚÔ˘ÛÈ¿˙ÂÈ ‰˘Û·ÚıÚ›·, ÔÈ ÎÈ-Ó‹ÛÂȘ ÂÎÙÂÏÔ‡ÓÙ·È Ì ‰˘ÛÎÔÏ›· Î·È Û˘¯Ó¿ ·Ú·ÙË-ÚÂ›Ù·È ÚÔԉ¢ÙÈ΋ ÓÂ˘Ì·ÙÈ΋ ¤ÎÙˆÛË (1,5). ∏Û˘ÁÎÂÎÚÈ̤ÓË ·ÛıÂÓ‹˜ ›¯Â Ê˘ÛÈÔÏÔÁÈΤ˜ ÎÈÓËÙÈΤ˜Î·È ÓÔËÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜, fï˜ Ì›· ·Û˘Ó‹ıÈÛÙ· ·-Ú·ÙÂٷ̤ÓË Î·È ·ÓıÂÎÙÈ΋ ÛÙË ¯ÔÚËÁËı›۷ ·ÁˆÁ‹Ïԛ̈ÍË ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ ÙËÓ Ô‰‹ÁËÛ Û ÙÚÈÙÔ-‚¿ıÌÈÔ Î¤ÓÙÚÔ, fiÔ˘ Ì ÙË ‚Ô‹ıÂÈ· ÙÔ˘ ·Ú·ÎÏÈÓÈ-ÎÔ‡ ÂϤÁ¯Ô˘ Ù¤ıËÎÂ Ë ‰È¿ÁÓˆÛË.

∂›Ó·È ÁÓˆÛÙfi fiÙÈ Ù· ·ÓÔÛÔÏÔÁÈο Â˘Ú‹Ì·Ù· Ù˘·Ù·Í›·˜-ÙËÏ·ÁÁÂÈÂÎÙ·Û›·˜ ÔÈΛÏÏÔ˘Ó. ™˘Ó‹ıˆ˜,fiˆ˜ Î·È ÛÙËÓ ·ÛıÂÓ‹ Ù˘ ·ÚÔ‡Û·˜ ÂÚ›ÙˆÛ˘,·Ú·ÙËÚÂ›Ù·È ¯·ÌËÏ‹ ÙÈÌ‹ Ù˘ Ig∞ Î·È ÔÚÈÛÌ¤ÓˆÓ˘ÔÙ¿ÍÂˆÓ Ù˘ IgG. ∏ ˘ÔÁ·ÌÌ·ÛÊ·ÈÚÈÓ·ÈÌ›· ÚÔ-‰È·ı¤ÙÂÈ ÛÙËÓ ·Ó¿Ù˘ÍË ÏÔÈÌÒÍÂˆÓ ÙˆÓ ·Ú·ÚÚ›-ÓÈˆÓ ÎfiÏˆÓ Î·È ÙˆÓ Ó¢ÌfiÓˆÓ. ™˘¯Ó¿ ηٷÁÚ¿ÊÂ-Ù·È ÂÏ¿ÙÙˆÛË ÙˆÓ CD4 Î·È CD8 ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ, ·‡-ÍËÛË ÙˆÓ Ê˘ÛÈÎÒÓ Î˘ÙÙ·ÚÔÎÙfiÓˆÓ (¡∫) ΢ÙÙ¿ÚˆÓÎ·È ÌË ıÂÙÈÎÔÔ›ËÛË ÙˆÓ ·ÓÙȉڿÛÂˆÓ ÂÈ‚Ú·‰˘Ófi-ÌÂÓ˘ ˘ÂÚ¢·ÈÛıËÛ›·˜ (8). ¶·Ú’ fiÏ· ·˘Ù¿, ÏÔÈÌÒ-ÍÂȘ ·fi ¢ηÈÚȷο ·ıÔÁfiÓ· Â›Ó·È ÂÍ·ÈÚÂÙÈο Û¿-ÓȘ, ÁÈ’ ·˘Ùfi ‰ÂÓ Û˘ÛÙ‹ÓÂÙ·È ÚÔÊ˘Ï·ÎÙÈ΋ ·ÁˆÁ‹Ì ÙÚÈÌÂıÔÚ›ÌË-ÛÔ˘ÏÊÔÌÂıÔÍ·˙fiÏË (9). ∏ ¤ÎÙˆ-ÛË Ù˘ ·ÓÔÛ›·˜, Û ·ÓÙ›ıÂÛË Ì ÙË Ó¢ÚÔÏÔÁÈ΋ Û˘Ó-‰ÚÔÌ‹, ‰ÂÓ Â›Ó·È Û˘Ó‹ıˆ˜ ÚÔԉ¢ÙÈ΋ Î·È ¤ÙÛÈ ‰ÂÓ··ÈÙÂ›Ù·È ÂÚÈÔ‰ÈÎfi˜ ¤ÏÂÁ¯fi˜ Ù˘, ·Ú¿ ÌfiÓÔ ·Ó·Ú·ÙËÚËı› ·‡ÍËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ ÏÔÈÌÒ͈Ó(1,8). ŒÓ·˜ ÂÈϤÔÓ ·Ú¿ÁÔÓÙ·˜, ÏËÓ Ù˘ ·ÓÔÛÔ-·Ó¿ÚÎÂÈ·˜, Ô˘ ¢ı‡ÓÂÙ·È ÁÈ· ÙȘ ›ÌÔÓ˜ ÏÔÈÌÒ-ÍÂȘ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ ÛÙËÓ ·Ù·Í›·-ÙËÏ·ÁÁÂÈÂÎÙ·-Û›· Â›Ó·È Ë ·Û˘Ó¤ÚÁÂÈ· ÙˆÓ Ì˘ÒÓ Ù˘ ηٿÔÛË˜Ô˘ ÚÔηÏ› ÌÈÎÚÔÂÈÛÚÔÊ‹ÛÂȘ, fiˆ˜ Û˘Ó¤‚Ë Î·ÈÛÙËÓ ·ÛıÂÓ‹ Ù˘ ·ÚÔ‡Û·˜ ÂÚ›ÙˆÛ˘ (10).

∏ ¢¿ıÂÈ· Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ù· ¯ÚˆÌÔÛÒ-Ì·Ù· ÙˆÓ ·ÛıÂÓÒÓ ÛÙËÓ ¤ÎıÂÛË Û ·ÎÙÈÓÔ‚ÔÏ›·,

210

¶·È‰È·ÙÚÈ΋ 2004;67:208-211 Paediatriki 2004;67:208-211

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·210

Page 68: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

211

¶·È‰È·ÙÚÈ΋ 2004;67:208-211 Paediatriki 2004;67:208-211

·Ó·Áο˙ÂÈ ÙÔÓ ıÂÚ¿ÔÓÙ· È·ÙÚfi Ó· Â›Ó·È ÂÍ·ÈÚÂÙÈοÊÂȉˆÏfi˜ ÛÙË ‰ÈÂÓ¤ÚÁÂÈ· ·ÎÙÈÓÔÏÔÁÈÎÒÓ ÂÍÂÙ¿ÛÂ-ˆÓ. ™ËÌÂÈÒÓÂÙ·È È‰È·ÈÙ¤Úˆ˜ fiÙÈ Ë ·ÏfiÁÈÛÙË ¤ÎıÂÛËÛ ·ÎÙÈÓÔ‚ÔÏ›· ÌÔÚ› Ó· ÂÈÙ›ÓÂÈ ÙËÓ ÚԉȿıÂ-ÛË ÛÙËÓ ·Ó¿Ù˘ÍË Ì›·˜ ÓÂÔÏ·Û›·˜ ÙÔ˘ ÏÂÌÊÈÎÔ‡‹ ÂÈıËÏÈ·ÎÔ‡ ÈÛÙÔ‡ Û ·˘ÙÔ‡˜ ÙÔ˘˜ ·ÛıÂÓ›˜(11). ÀÔÁÚ·ÌÌ›˙ÂÙ·È fiÙÈ ·˘Ù‹ Ë ÚԉȿıÂÛË ¤¯ÂÈÂÓÙÔÈÛÙ› Î·È ÛÙÔ˘˜ ÂÙÂÚÔ˙˘ÁÒÙ˜, ‰Â‰Ô̤ÓÔ Ô˘Èı·ÓfiÓ ı· ÌÔÚÔ‡Û ӷ ÂÚÌËÓ‡ÛÂÈ ÙËÓ ·Û˘Ó‹ıÈ-ÛÙË Û˘ÛÛÒÚ¢ÛË ÂÚÈÛÙ·ÙÈÎÒÓ ÓÂÔÏ·Û›·˜ ÛÙÔÔÈÎÔÁÂÓÂÈ·Îfi ÂÚÈ‚¿ÏÏÔÓ Ù˘ ·ÛıÂÓÔ‡˜. §fiÁˆ ÙˆÓ·ÓˆÙ¤Úˆ, Û˘ÓÈÛÙ¿Ù·È ¤ÏÂÁ¯Ô˜ ÁÈ· ÙÔÓ ÂÓÙÔÈÛÌfiÙÔ˘ ·ıÔÏÔÁÈÎÔ‡ ÁÔÓȉ›Ô˘ ∞∆ª ÛÙÔ˘˜ Û˘ÁÁÂÓ›˜ÙˆÓ ·ÛıÂÓÒÓ Ì ·Ù·Í›·-ÙËÏ·ÁÁÂÈÂÎÙ·Û›·, ÚÔÎÂÈ-̤ÓÔ˘ - Û fiÛÔ˘˜ ·ÓȯÓ‡ÂÙ·È ‡ÔÙË ÌÂÙ¿ÏÏ·ÍË -Ó· Á›ÓÂÙ·È Û˘ÛÙËÌ·ÙÈÎfi˜ ÚÔÏËÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÁÈ·ÚÒÈÌË ÂÓÙfiÈÛË Èı·Ó‹˜ ηÎÔ‹ıÂÈ·˜ (3,11).

¶·Ú¿ ÙËÓ ‹È· ÔÚ›· Ô˘ ·ÚÔ˘ÛÈ¿˙ÂÈ ÚÔ˜ ÙÔ·ÚfiÓ Ë ÓfiÛÔ˜ ÛÙËÓ ·ÛıÂÓ‹ Ù˘ ·ÚÔ‡Û·˜ ÂÚ›-ÙˆÛ˘, Ë ÚfiÁÓˆÛË Â›Ó·È ·ÌÊ›‚ÔÏË. ∂›Ó·È ÁÓˆÛÙfifiÙÈ Ë ÏÂÈÔÓfiÙËÙ· ÙˆÓ ·ÛıÂÓÒÓ Î·ıËÏÒÓÂÙ·È Û·ӷËÚÈÎfi ηÚÔÙÛ¿ÎÈ ÌÂٷ͇ 8 Î·È 12 ÂÙÒÓ Î·È ‰ÂÓÌÔÚ› Ó· ÂÎÙÂϤÛÂÈ ·˘ÙfiÓÔÌ· Ô‡Ù ÙȘ ÛÙÔȯÂÈÒ-‰ÂȘ ÏÂÈÙÔ˘ÚÁ›Â˜ (5,12). ∏ ·Ó·Ó¢ÛÙÈ΋ ·Ó¿Ú-ÎÂÈ·, ̤ۈ ÚfiÎÏËÛ˘ ÂÎÙÂÙ·Ì¤ÓˆÓ ‚ÚÔÁ¯ÈÂÎÙ·-ÛÈÒÓ ·fi ÙȘ ·ӷϷ̂·ÓfiÌÂÓ˜ ÏÔÈÌÒÍÂȘ, ·Ô-ÙÂÏ› ÙË Û˘¯ÓfiÙÂÚË ·ÈÙ›· ı·Ó¿ÙÔ˘ Î·È ·ÎÔÏÔ˘ı› ËÚÔÛ‚ÔÏ‹ ·fi ÓÂÔÏ·Û›· (13). OÈ ÂÚÈÛÛfiÙÂÚÔÈηٷϋÁÔ˘Ó ÚÈÓ ÙÔ ¤Ú·˜ Ù˘ ÙÚ›Ù˘ ‰ÂηÂÙ›·˜˙ˆ‹˜, ·Ó Î·È ¤¯ÂÈ ÂÚÈÁÚ·Ê› ÂÓ ˙ˆ‹ ·ÛıÂÓ‹˜ ËÏÈ-Λ·˜ 60 ÂÙÒÓ (5). °ÂÓÈο, Ë ıÂڷ›· Ù˘ ÓfiÛÔ˘ ›-Ó·È ÌfiÓÔ Û˘Ìو̷ÙÈ΋ Î·È ÂÚÈÏ·Ì‚¿ÓÂÈ ¯ËÌÂÈÔ-ÚÔʇϷÍË Ô˘ Ó· ÚÔÊ˘Ï¿ÛÛÂÈ ·fi Ù· ÎÔÈÓ¿ ·-ıÔÁfiÓ·, fiˆ˜ Ë ÎÂÊ·ÎÏfiÚË, ÂÈÛÓÂfiÌÂÓ· ‚ÚÔÁ¯Ô-‰È·ÛÙ·ÏÙÈο, Ù·ÎÙÈ΋ ıÂڷ›· ˘ÔηٿÛÙ·Û˘ ÌÂÛ··ÛÌ· Á-ÛÊ·ÈÚ›Ó˘, Ê˘ÛÈÔıÂڷ›· Î·È ÂÚÁÔ-ıÂڷ›· ÁÈ· ÙËÓ ˘Ô‚Ô‹ıËÛË Ù˘ ÏÂÈÙÔ˘ÚÁÈÎfiÙË-Ù·˜ ÙÔ˘ Ì˘ÔÛÎÂÏÂÙÈÎÔ‡ Î·È ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘-ÛÙ‹Ì·ÙÔ˜ (1). ∏ ·Ô˘Û›· Ù˘ Ig∞ ·˘Í¿ÓÂÈ ÙÔÓ Î›Ó-‰˘ÓÔ ·ÏÏÂÚÁÈÎÒÓ ·ÓÙȉڿÛÂˆÓ Û ÌÂÙ·ÁÁ›ÛÂȘ, ÁÈ’·˘Ùfi Û˘ÓÈÛÙ¿Ù·È Ë ¯ÔÚ‹ÁËÛË Û΢¿ÛÌ·ÙÔ˜ Á-ÛÊ·È-Ú›Ó˘ Ô˘ ‰ÂÓ ÂÚȤ¯ÂÈ Ig∞ Î·È Ï˘Ì¤ÓˆÓ Î·È ·ÎÙÈ-ÓÔ‚ÔÏËÌ¤ÓˆÓ ÂÚ˘ıÚÔ΢ÙÙ¿ÚˆÓ ‹ ·ÈÌÔÂÙ·Ï›ˆÓ ·Ó˘¿ÚÍÂÈ ¤Ó‰ÂÈÍË (9). ¢ÂÓ ¤¯ÂÈ ·Ó·ÊÂÚı› ÂÈÙ˘¯‹˜ÌÂÙ·ÌfiÛ¯Â˘ÛË Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ.

™˘ÌÂÚ·ÛÌ·ÙÈο, Ë ·Ù·Í›·-ÙËÏ·ÁÁÂÈÂÎÙ·Û›· ›-Ó·È Ì›· ÔÏ˘Û˘ÛÙËÌ·ÙÈ΋ ÁÂÓÂÙÈ΋ ÓfiÛÔ˜, ¯ˆÚ›˜ ·È-ÙÈÔÏÔÁÈ΋ ıÂڷ›· Î·È Ôχ η΋ ÚfiÁÓˆÛË, Ô˘ÚÔÛ‚¿ÏÂÈ Î˘Ú›ˆ˜ ÙÔ Ó¢ÚÈÎfi Î·È ÙÔ ·ÓÔÛÔÏÔÁÈÎfiÛ‡ÛÙËÌ·. ∆Ô ÂÚÈÛÙ·ÙÈÎfi Ô˘ ÂÚÈÁÚ¿ÊËΠÂÈÛË-Ì·›ÓÂÈ ÙËÓ ÂÙÂÚÔÁ¤ÓÂÈ· ÙÔ˘ ÎÏÈÓÈÎÔ‡ Ê·ÈÓÔÙ‡Ô˘,ȉ›ˆ˜ fiÛÔÓ ·ÊÔÚ¿ ÛÙÔ Ó¢ÚÈÎfi Û‡ÛÙËÌ· Î·È ˘Ô-‰ÂÈÎÓ‡ÂÈ ÙËÓ ‡·ÚÍË Î¿ÔÈˆÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ ÙÔ˘˘Â‡ı˘ÓÔ˘ ÁÔÓȉ›Ô˘ Ô˘ Úԉȷı¤ÙÔ˘Ó Û ‚Ú·‰‡-

ÙÂÚË Ó¢ÚÔÏÔÁÈ΋ ¤ÎÙˆÛË, ¯ˆÚ›˜ fï˜ ·˘Ùfi Ó·Û˘Ó¿ÁÂÙ·È Â˘ÓÔ˚ÎfiÙÂÚË Û˘ÓÔÏÈ΋ ÚfiÁÓˆÛË.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Huang KY, Shyur SD, Wang CY, Shen EY, Liang DC.

Ataxia telangiectasia: report of two cases. J MicrobiolImmunol Infect 2001;34:71-75.

2. Li A, Swift M. Mutations at the ataxia-telangiectasia locusand clinical phenotypes of A-T patients. Am J Med Genet2000;92:170-177.

3. Fanos JH, Mackintosh MA. Never again joy withoutsorrow: the effect on parents of a child with ataxia-telangiectasia. Am J Med Genet 1999;87:413-419.

4. Geoffroy-Perez B, Janin N, Ossian K, Lauge A, CroquetteMF, Griscelli C et al. Cancer risk in heterozygotes forataxia-telangiectasia. Int J Cancer 2001;93:288-293.

5. Crawford TO, Mandir AS, Lefton-Greif MA, Goodman SN,Goodman BK, Sengul H et al. Quantitative neurologicassessment of ataxia-telangiectasia. Neurology2000;54:1505-1509.

6. Perlman S, Becker-Catania S, Gatti RA. Ataxia-telangiectasia: diagnosis and treatment. Semin PediatrNeurol 2003;10:173-182.

7. Heinloth AN, Shackelford RE, Innes CL, Bennett L, Li L,Amin RP et al. ATM-dependent and -independent geneexpression changes in response to oxidative stress,gamma irradiation, and UV irradiation. Radiat Res2003;160:273-290.

8. Schubert R, Reichenbach J, Zielen S. Deficiencies inCD4+ and CD8+ T cell subsets in ataxia telangiectasia.Clin Exp Immunol 2002;129:125-132.

9. Kutluk MT, Yalcin B, Buyukpamukcu M. Ataxiatelangiectasia and Hodgkin disease. Med Pediatr Oncol2000;34:62-64.

10. Lefton-Greif MA, Crawford TO, Winkelstein JA, LoughlinGM, Koerner CB, Zahurak M et al. Oropharyngealdysphagia and aspiration in patients with ataxia-telangiectasia. J Pediatr 2000;136:225-231.

11. Neubauer S, Arutyunyan R, Stumm M, Dork T, Bendix R,Bremer M et al. Radiosensitivity of ataxia telangiectasiaand Nijmegen breakage syndrome homozygotes andheterozygotes as determined by three-color FISHchromosome painting. Radiat Res 2002;157:312-321.

12. Mostofsky SH, Kunze JC, Cutting LE, Lederman HM,Denckla MB. Judgment of duration in individuals withataxia-telangiectasia. Dev Neuropsychol 2000;17:63-74.

1 3. Irsfeld H, Korholz D, Janssen G, Wahn V, Schroten H. Fataloutcome in two girls with Hodgkin disease complicatingataxia-telangiectasia (Louis-Bar syndrome) despitefavorable response to modified-dose chemotherapy. MedPediatr Oncol 2000;34:62-64.

∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 06-05-2003 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 24-03-2004

¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: °ÈÒÚÁÔ˜ ∆Ú›Ì˘ ∏Ï›· ∑ÂÚ‚Ô‡ 72, ∆.∫. 111 44, ¶·Ù‹ÛÈ· E-mail: [email protected]

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·211

Page 69: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

∂¶π∫∞πƒO £∂ª∞ CURRENT ISSUE

∫ÏËÚÔÓÔÌÔ‡ÌÂÓ· ÂÚÈÔ‰Èο Â̇ÚÂÙ· Û‡Ó‰ÚÔÌ· Ÿ. µÔ˘ÁÈԇη

Hereditary periodic fever syndromes O. Vougiouka

™˘ÓÙÔÌÔÁڷʛ˜ Oª¶ OÈÎÔÁÂÓ‹˜ ÌÂÛÔÁÂÈ·Îfi˜ ˘ÚÂÙfi˜

Hyper-IgD ÀÂÚÁ·Ì·ÛÊ·ÈÚÈÓ·ÈÌ›· D TRAPS ¶ÂÚÈÔ‰ÈÎfi Û‡Ó‰ÚÔÌÔ ÙÔ˘ ˘Ô‰Ô¯¤· ÙÔ˘

�¶ÂÚ›ÏË„Ë: ∆· ÎÏËÚÔÓÔÌÔ‡ÌÂÓ· ÂÚÈÔ‰Èο Â̇-ÚÂÙ· Û‡Ó‰ÚÔÌ· ÌÂÙ·‚È‚¿˙ÔÓÙ·È Û‡Ìʈӷ Ì ÙÔ˘˜Î·ÓfiÓ˜ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜ ÙÔ˘ Mendel Î·È ¯·Ú·-ÎÙËÚ›˙ÔÓÙ·È ·fi ˘ÔÙÚÔÈ¿˙ÔÓÙ· ÂÂÈÛfi‰È· ˘ÚÂ-ÙÔ‡ Î·È ÂÓÙÔÈṲ̂ӷ Ê·ÈÓfiÌÂÓ· ÊÏÂÁÌÔÓ‹˜, Ù·ÔÔ›· Û˘Ó‹ıˆ˜ ·ÊÔÚÔ‡Ó ÛÙÔ˘˜ ÔÚÔÁfiÓÔ˘˜, ÛÙÔ˘˜·ÚıÚÈÎÔ‡˜ ˘Ì¤Ó˜ Î·È ÛÙÔ ‰¤ÚÌ·. ∆· ÂÂÈÛfi‰È·Û˘Óԉ‡ÔÓÙ·È ·fi ·‡ÍËÛË ÙˆÓ ‰ÂÈÎÙÒÓ ÊÏÂÁÌÔ-Ó‹˜, fi¯È fï˜ Î·È ·fi ‰È¤ÁÂÚÛË ·Ú·ÁˆÁ‹˜ ·˘ÙÔ-·ÓÙÈÛˆÌ¿ÙˆÓ ‹ ÂȉÈÎÒÓ ∆-ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ. O ÁÔÓÈ-‰È·Îfi˜ ÙÔ˘˜ ÚÔÛ‰ÈÔÚÈÛÌfi˜ ·ÔÙÂÏ› ÚfiÛÊ·ÙÔÂÈÛÙËÌÔÓÈÎfi ›Ù¢ÁÌ· Î·È ·ÓÔ›ÁÂÈ ‰ÚfiÌÔ˘˜ ÁÈ·ÙË ÌÂϤÙË ÙˆÓ ÔχÏÔÎˆÓ Ì˯·ÓÈÛÌÒÓ Ù˘ ÊÏÂÁ-ÌÔÓ‹˜, ηıÒ˜ Î·È ÁÈ· ÂӉ¯fiÌÂÓ˜ ıÂڷ¢ÙÈΤ˜ÚÔÛÂÁÁ›ÛÂȘ. ∂› ÙÔ˘ ·ÚfiÓÙÔ˜, ¤¯Ô˘Ó Û·ÊÒ˜ Â-ÚÈÁÚ·Ê› Ù· ÂÍ‹˜ Û‡Ó‰ÚÔÌ·: ·fi Ù· ÌÂÙ·‚È‚·˙fi-ÌÂÓ· Ì ˘ÔÏÂÈfiÌÂÓÔ ·˘ÙÔۈ̷ÙÈÎfi ¯·Ú·ÎÙ‹Ú·:·) Ô ÔÈÎÔÁÂÓ‹˜ ÌÂÛÔÁÂÈ·Îfi˜ ˘ÚÂÙfi˜ Î·È ‚) ÙÔÛ‡Ó‰ÚÔÌÔ ˘ÂÚÁ·Ì·ÛÊ·ÈÚÈÓ·ÈÌ›·˜ D Î·È ·fi Ù·ÎÏËÚÔÓÔÌÔ‡ÌÂÓ· Ì ÂÈÎÚ·ÙËÙÈÎfi ·˘ÙÔۈ̷ÙÈÎfi¯·Ú·ÎÙ‹Ú·: ·) ÙÔ Û‡Ó‰ÚÔÌÔ ÙÔ˘ ˘Ô‰Ô¯¤· ÙÔ˘ ·-Ú¿ÁÔÓÙ· Ó¤ÎÚˆÛ˘ ÙÔ˘ fiÁÎÔ˘, ‚) ÙÔ ÔÈÎÔÁÂÓ¤˜ ·˘-ÙÔÊÏÂÁÌÔÓ҉˜ ÂÍ·ÓıËÌ·ÙÈÎfi Û‡Ó‰ÚÔÌÔ ÌÂÙ¿ ÁÂ-ÓÈÎÂ˘Ì¤ÓË ¤ÎıÂÛË ÛÙÔ ÎÚ‡Ô Î·È Á) ÙÔ Û‡Ó‰ÚÔÌÔMuckle-Wells.

§¤ÍÂȘ ÎÏÂȉȿ: ÎÏËÚÔÓÔÌÔ‡ÌÂÓ· ÂÚÈÔ‰Èο Û‡Ó-‰ÚÔÌ·, ÔÈÎÔÁÂÓ‹˜ ÌÂÛÔÁÂÈ·Îfi˜ ˘ÚÂÙfi˜, ˘ÂÚÁ·-Ì·ÛÊ·ÈÚÈÓ·ÈÌ›· D, ÂÚÈÔ‰ÈÎfi Û‡Ó‰ÚÔÌÔ ÙÔ˘ ˘Ô‰Ô-¯¤· ÙÔ˘ ·Ú¿ÁÔÓÙ· Ó¤ÎÚˆÛ˘ ÙÔ˘ fiÁÎÔ˘, ÔÈÎÔÁÂ-Ó¤˜ ·˘ÙÔÊÏÂÁÌÔÓ҉˜ Û‡Ó‰ÚÔÌÔ ÌÂÙ¿ ¤ÎıÂÛË ÛÙÔÎÚ‡Ô, Û‡Ó‰ÚÔÌÔ Muckle-Wells.

�Abstract: The hereditary periodic feversyndromes are a group of inherited disorderscharacterized by unprovoked episodes of fever andlocalized inflammation, most typically involving theserosa, synovium or skin. They are sometimesincluded in the broader spectrum of auto-inflammatory syndromes, because of their lack ofautoantibody production and antigen-specific T-cells. The best-described hereditary periodic feversyndromes to date are the recessively inheritedfamilial mediterranean fever and hyperimmuno-globulinaemia-D, and the dominantly inherited TNFreceptor associated periodic fever syndrome,familial cold induced autoinflammatory syndromeand Muckle-Wells’ syndrome.

Key words: hereditary periodic fever syndromes,familial mediterranean fever, hyperimmunoglo-bulinemia D, TNF receptor associated periodic feversyndrome, familial autoinflammmatory cold inducedsyndrome, Muckle-Wells’ syndrome.

µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó·

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

212

¶·È‰È·ÙÚÈ΋ 2004;67:212-217 Paediatriki 2004;67:212-217

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·212

Page 70: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

·Ú¿ÁÔÓÙ· Ó¤ÎÚˆÛ˘ ÙÔ˘ fiÁÎÔ˘ FACS OÈÎÔÁÂÓ¤˜ ·˘ÙÔÊÏÂÁÌÔÓ҉˜ Û‡Ó‰ÚÔÌÔ

ÌÂÙ¿ ¤ÎıÂÛË ÛÙÔ ÎÚ‡Ô

∂ÈÛ·ÁˆÁ‹∆· ÎÏËÚÔÓÔÌÔ‡ÌÂÓ· ÂÚÈÔ‰Èο Â̇ÚÂÙ· Û‡Ó-

‰ÚÔÌ· ·ÔÙÂÏÔ‡Ó Ì›· ÔÌ¿‰· ÎÏËÚÔÓÔÌÈÎÒÓ Û˘Ó-‰ÚfiÌˆÓ Ô˘ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ˘ÔÙÚÔÈ¿˙ÔÓÙ·ÂÂÈÛfi‰È· ˘ÚÂÙÔ‡ Î·È ÂΉËÏÒÛÂȘ ÂÓÙÔÈṲ̂Ó˘ÊÏÂÁÌÔÓ‹˜ Ô˘ ·ÊÔÚ¿ ÛÙÔ˘˜ ÔÚÔÁfiÓÔ˘˜ ˘Ì¤Ó˜,ÛÙÔÓ ·ÚıÚÈÎfi ˘Ì¤Ó· Î·È ÛÙÔ ‰¤ÚÌ· (1). ∆· ÂÂÈÛfi-‰È· ¤گÔÓÙ·È ·˘ÙfiÌ·Ù·, ¯ˆÚ›˜ ÙËÓ ÚfiÎÏËÛË ÂÌ-Ê·ÓÔ‡˜ Â͈ÁÂÓÔ‡˜ ·ÈÙ›Ô˘, fiˆ˜ ›Û˘ ·˘ÙÔ˚Ò-ÓÙ·È. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ‰Ú·ÛÙËÚÈfiÙËÙ¿˜ ÙÔ˘˜,Û˘Óԉ‡ÔÓÙ·È ·fi ·‡ÍËÛË ÙˆÓ ‰ÂÈÎÙÒÓ ÊÏÂÁÌÔ-Ó‹˜, fi¯È fï˜ Î·È ·fi ·Ó›¯Ó¢ÛË ·˘ÙÔ·ÓÙÈۈ̿وӋ ‰È¤ÁÂÚÛË ÂȉÈÎÒÓ ¤Ó·ÓÙÈ ·ÓÙÈÁfiÓˆÓ ∆-ÏÂÌÊÔ΢Ù-Ù¿ÚˆÓ, ÁÈ’ ·˘Ùfi Î·È ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È Û·Ó ·˘ÙÔ-ÊÏÂÁÌÔÓÒ‰Ë ÓÔÛ‹Ì·Ù·. ¶·Ú’ fiÏÔ Ô˘ ÛÙËÓ ÔÓÔÌ·-Û›· ÙÔ˘˜ ‰ÈÂıÓÒ˜ ¤¯ÂÈ ÂÚÈÏËÊı› Ë ¤ÓÓÔÈ· Ù˘ Â-ÚÈÔ‰ÈÎfiÙËÙ·˜, ÂÓÙÔ‡ÙÔȘ ‰ÂÓ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fiÛ·Ê‹ ÂÚÈÔ‰ÈÎfiÙËÙ· Î·È Ë Â·Ó·ÏË„ÈÌfiÙËÙ¿ ÙÔ˘˜·Ô‰›‰ÂÙ·È ÔÚÔÏÔÁÈο ÛˆÛÙfiÙÂÚ· ˆ˜ ˘ÔÙÚÔ‹.

∏ ·Ó·ÁÓÒÚÈÛ‹ ÙÔ˘˜ Û·Ó Í¯ˆÚÈÛÙ¤˜ ÎÏÈÓÈΤ˜ÔÓÙfiÙËÙ˜, ·Ú¿ Ù· ıÔÚ˘‚Ò‰Ë Û˘ÌÙÒÌ·Ù¿ ÙÔ˘˜,˘‹ÚÍ ηı˘ÛÙÂÚË̤ÓË, ÂÓÒ Ô ÁÂÓÂÙÈÎfi˜ ÙÔ˘˜ÚÔÛ‰ÈÔÚÈÛÌfi˜ Â›Ó·È Â›Ù¢ÁÌ· Ù˘ ÙÂÏÂ˘Ù·›·˜ Â-ÓÙ·ÂÙ›·˜, Ì Èı·Ófi ‰È·¯ˆÚÈÛÌfi Î·È ¿ÏÏˆÓ ·ÚÂÌ-ÊÂÚÒÓ ÎÏÈÓÈÎÒÓ Û˘Ó‰ÚÔÌÒÓ (2). ∆· Û‡Ó‰ÚÔÌ· Ô˘¤¯Ô˘Ó ·Ó·ÁÓˆÚÈÛÙ› ̤¯ÚÈ ÙÒÚ· ‰È·ÎÚ›ÓÔÓÙ·È ÛÂÎÏËÚÔÓÔÌÔ‡ÌÂÓ· Ì ˘ÔÏÂÈfiÌÂÓÔ ·˘ÙÔۈ̷ÙÈÎfi¯·Ú·ÎÙ‹Ú·, Ô˘ Â›Ó·È Ô ÔÈÎÔÁÂÓ‹˜ ÌÂÛÔÁÂÈ·Îfi˜˘ÚÂÙfi˜ Î·È ÙÔ Û‡Ó‰ÚÔÌÔ ˘ÂÚÁ·Ì·ÛÊ·ÈÚÈÓ·ÈÌ›·˜D Î·È Û ÎÏËÚÔÓÔÌÔ‡ÌÂÓ· Ì ÂÈÎÚ·ÙËÙÈÎfi ·˘ÙÔ-ۈ̷ÙÈÎfi ¯·Ú·ÎÙ‹Ú· Ô˘ Â›Ó·È ÙÔ ÂÚÈÔ‰ÈÎfi Û‡Ó-‰ÚÔÌÔ ÙÔ˘ ˘Ô‰Ô¯¤· ÙÔ˘ ·Ú¿ÁÔÓÙ· Ó¤ÎÚˆÛ˘ÙÔ˘ fiÁÎÔ˘ Û‡Ó‰ÚÔÌÔ (TNF receptor associatedperiodic syndrome - TRAPS), ÙÔ Û‡Ó‰ÚÔÌÔ Muckle-Wells Î·È ÙÔ ÔÈÎÔÁÂÓ¤˜ ·˘ÙÔÊÏÂÁÌÔÓ҉˜ ÂÍ·ÓıË-Ì·ÙÈÎfi Û‡Ó‰ÚÔÌÔ ÌÂÙ¿ ÁÂÓÈÎÂ˘Ì¤ÓË ¤ÎıÂÛË ÛÙÔÎÚ‡Ô (Familial cold autoinflammatory syndrome -FCAS) (¶›Ó·Î·˜ 1).

OÈÎÔÁÂÓ‹˜ ÌÂÛÔÁÂÈ·Îfi˜ ˘ÚÂÙfi˜ O ÔÈÎÔÁÂÓ‹˜ ÌÂÛÔÁÂÈ·Îfi˜ ˘ÚÂÙfi˜ (Oª¶) (¶›-

ӷη˜ 2) ÂÚÈÁÚ¿ÊËÎÂ Û·Ó Í¯ˆÚÈÛÙ‹ ÎÏÈÓÈ΋ ÔÓÙfi-

ÙËÙ· ÙÔ 1945 (3). ∞fi ÙÔ 1972, Ë ‰Â‡ÙÂÚË ÁÂÓÈ¿ÂÚ¢ÓËÙÒÓ ÌÂϤÙËÛ ٷ ÔʤÏË Ù˘ ıÂڷ›·˜ ÌÂÎÔϯÈΛÓË ÛÙËÓ ÚfiÏË„Ë ÙˆÓ ˘ÔÙÚÔÒÓ Î·È Ù˘ÂÓ·fiıÂÛ˘ ·Ì˘ÏÔÂȉԇ˜ (4). ∞fi ÙÔ 1997 ·Ó·Ù‡-¯ıËÎÂ Î·È ÂÍÂÏ›¯ıËÎÂ Ó¤Ô Â‰›Ô ‰Ú¿Û˘ Ì ÙÔÓ Î·-ıÔÚÈÛÌfi ÙˆÓ ˘Â‡ı˘ÓˆÓ ÁÔÓȉ›ˆÓ Ù˘ ÓfiÛÔ˘ (5,6).

∂›Ó·È ÁÓˆÛÙfi fiÙÈ Ë ÓfiÛÔ˜ ¤¯ÂÈ ÂıÓÔÏÔÁÈÎfi ¯·Ú·-ÎÙ‹Ú·. ∞·ÓÙ¿Ù·È ·ÎfiÌ· Î·È ÛÂ Û˘¯ÓfiÙËÙ· 1/250-1/1000 Û ÔÚÈṲ̂ÓÔ˘˜ Ï·Ô‡˜ Ù˘ ·Ó·ÙÔÏÈ΋˜ ªÂ-ÛÔÁ›Ԣ Î·È Û˘ÁÎÂÎÚÈ̤ӷ ÛÙÔ˘˜ ∂‚Ú·›Ô˘˜ Ù˘ µ.∞ÊÚÈ΋˜, ÛÙÔ˘˜ ∞Ṳ́ÓÈÔ˘˜ ÙÔ˘ §È‚¿ÓÔ˘, ÛÙÔ˘˜∆Ô‡ÚÎÔ˘˜ Ù˘ ∫ÂÓÙÚÈ΋˜ ∞Ó·ÙÔÏ›·˜ Î·È ÛÙÔ˘˜ ÕÚ·-‚˜ ÙÔ˘ πÚ¿Î.

∂›Ó·È ÓfiÛÔ˜ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜, ‰Â‰Ô̤ÓÔ˘ fiÙÈÛÙÔ 60% ÙˆÓ ·ÛıÂÓÒÓ ·Ú¯›˙ÂÈ Û ËÏÈΛ· ÌÈÎÚfiÙÂÚËÙˆÓ 10 ÂÙÒÓ Î·È ÛÙÔ 90% Û ËÏÈΛ· ÌÈÎÚfiÙÂÚË ÙˆÓ20 ¯ÚfiÓˆÓ (¶›Ó·Î·˜ 3). ∆· ¯·Ú·ÎÙËÚÈÛÙÈο, ·ӷ-Ï·Ì‚·ÓfiÌÂÓ· Û ¿ÏÏÔÙ ¿ÏÏÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·,Â›Ó·È Û‡ÓÙÔÌ˘ ‰È¿ÚÎÂÈ·˜ (12 ˆÚÒÓ ¤ˆ˜ 4 ËÌÂÚÒÓ)ÂÂÈÛfi‰È· ÂÒ‰˘Ó˘ Â̇ÚÂÙ˘ ÔÚÔÁÔÓ›Ùȉ·˜, ÌÂÂΉËÏÒÛÂȘ ·fi ÙÔ ÂÚÈÙfiÓ·ÈÔ, ÙÔÓ ˘Â˙ˆÎfiÙ·, ÙÔÓ·ÚıÚÈÎfi ˘Ì¤Ó·, ÙÔ ‰¤ÚÌ· Î·È ÚÔԉ¢ÙÈ΋ ·Ó¿Ù˘-ÍË ·Ì˘ÏÔ›‰ˆÛ˘, ÂÓÒ ÂÌÏÔ˘Ù›˙ÔÓÙ·È Î·È Ì ¿ÏÏ˜ÂΉËÏÒÛÂȘ ÏÈÁfiÙÂÚÔ Û˘¯Ó¤˜ (∂ÈÎfiÓ· 1).

∏ ‰È¿ ‚›Ô˘ ¯ÔÚ‹ÁËÛË ÎÔϯÈΛÓ˘ ·ÔÙÚ¤ÂÈ ÙËÓÂÌÊ¿ÓÈÛË ÂÂÈÛÔ‰›ˆÓ ÛÙÔ 65% ÙˆÓ ·ÛıÂÓÒÓ, ÂÈ-ʤÚÂÈ ‚ÂÏÙ›ˆÛË ÛÙÔ 20-30% Î·È ÚÔÏ·Ì‚¿ÓÂÈ ÙËÓ·Ì˘ÏÔ›‰ˆÛË ÛÙÔ 95%.

∞fi ÙÔ 1992 ¯·ÚÙÔÁÚ·Ê‹ıËΠÙÔ ‚Ú·¯‡ ÛΤÏÔ˜ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ 16 ÁÈ· ÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ÌÂÛÔ-ÁÂÈ·ÎÔ‡ ˘ÚÂÙÔ‡. ∆ÔÓ ™Â٤̂ÚÈÔ ÙÔ˘ 1997 Ù˘Ô-ÔÈ‹ıËΠÙÔ ÁÔÓ›‰ÈÔ MEFV ·fi ‰‡Ô ·ÓÂÍ¿ÚÙËÙ˜ÂÚ¢ÓËÙÈΤ˜ ÔÌ¿‰Â˜, ÙË Á·ÏÏÈ΋ Î·È ÙË ‰ÈÂıÓ‹. ∆ÔÁÔÓ›‰ÈÔ Îˆ‰ÈÎÔÔÈ› ÁÈ· ÙË Û‡ÓıÂÛË Ì›·˜ ÚˆÙ½Ó˘Ù˘ ˘Ú›Ó˘ ‹ Ì·ÚÂÓÔÛÙÚ›Ó˘, Ë ÔÔ›· ·ÔÙÂÏ›ٷȷfi 781 ·ÌÈÓÔͤ· Î·È Î·ıÔÚ›˙ÂÈ ÙË Ú‡ıÌÈÛË Ù˘ÊÏÂÁÌÔÓ‹˜ Î·È ÙËÓ ·ÚÂÌfi‰ÈÛË Ì·˙È΋˜ ÂÈÛÚÔ‹˜ÔÏ˘ÌÔÚÊÔ‡ÚËÓˆÓ ÛÙÔ˘˜ ÔÚÔÁfiÓÔ˘˜ ηٿ ÙȘÎÚ›ÛÂȘ. ª¤¯ÚÈ ÙÒÚ· ¤¯Ô˘Ó ηٷÁÚ·Ê› 29 ÌÂÙ·Ï-Ï¿ÍÂȘ. ∞fi ·˘Ù¤˜, Ë ª694V ‚Ú›ÛÎÂÙ·È ÛÙÔ 80% ÙˆÓ¯ÚˆÌÔÛˆÌ¿ÙˆÓ ÙˆÓ ·ÛıÂÓÒÓ Ì Oª¶ Î·È Û˘Ó‰¤Â-Ù·È Ì ‚·Ú‡ÙÂÚË ÚfiÁÓˆÛË. °ÂÓÂÙÈ΋ ‰È¿ÁÓˆÛË ÙÔ˘Oª¶ ÂÈÙ˘Á¯¿ÓÂÙ·È ÛÙÔ 60-90% ÙˆÓ ·ÛıÂÓÒÓ, ·Ó¿-ÏÔÁ· Ì ÙËÓ ÂıÓÔÏÔÁÈ΋ ÚÔ¤ÏÂ˘Û‹ ÙÔ˘˜ (7). ∆·¯·ÌËÏfiÙÂÚ· ÔÛÔÛÙ¿ ·ÊÔÚÔ‡Ó Û ¯ÒÚ˜ fiÔ˘ ÔÌÂÛÔÁÂÈ·Îfi˜ ˘ÚÂÙfi˜ ‰ÂÓ Â›Ó·È Û˘¯Ófi˜, ÂÓÒ ˘„Ë-ÏfiÙÂÚ· ÔÛÔÛÙ¿ ÚÔÛ‰ÈÔÚÈÛÌÔ‡ Ù˘ ÓfiÛÔ˘ ÂÈ-Ù˘Á¯¿ÓÔÓÙ·È Û ¯ÒÚ˜ fiÔ˘ Ë ÓfiÛÔ˜ Â›Ó·È Û˘¯Ó‹,fiˆ˜ ÙÔ πÛÚ·‹Ï Î·È Ë ∆Ô˘ÚΛ·.

¶›Ó·Î·˜ 2. OÈÎÔÁÂÓ‹˜ ÌÂÛÔÁÂÈ·Îfi˜ ˘ÚÂÙfi˜

1945: ∞Ó·ÁÓÒÚÈÛË ÎÏÈÓÈ΋˜ ÔÓÙfiÙËÙ·˜ 1972: ∫ÔϯÈΛÓË - ¶ÚfiÏË„Ë ·Ì˘ÏÔ›‰ˆÛ˘ 1997: °ÂÓÂÙÈÎfi˜ ÚÔÛ‰ÈÔÚÈÛÌfi˜

¶›Ó·Î·˜ 1. ∫ÏËÚÔÓÔÌÔ‡ÌÂÓ· ÂÚÈÔ‰Èο Â̇ÚÂÙ· Û‡Ó‰ÚÔÌ·

ÀÔÏÂÈfiÌÂÓÔ˜ ·˘ÙÔۈ̷ÙÈÎfi˜ ¯·Ú·ÎÙ‹Ú·˜ OÈÎÔÁÂÓ‹˜ ÌÂÛÔÁÂÈ·Îfi˜ ˘ÚÂÙfi˜ ™‡Ó‰ÚÔÌÔ ˘ÂÚÁ·Ì·ÛÊ·ÈÚÈÓ·ÈÌ›·˜ D ∂ÈÎÚ·ÙËÙÈÎfi˜ ·˘ÙÔۈ̷ÙÈÎfi˜ ¯·Ú·ÎÙ‹Ú·˜ ™‡Ó‰ÚÔÌÔ TRAPS ™‡Ó‰ÚÔÌÔ Muckle-Wells ™‡Ó‰ÚÔÌÔ FCAS

213

¶·È‰È·ÙÚÈ΋ 2004;67:212-217 Paediatriki 2004;67:212-217

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·213

Page 71: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

214

¶·È‰È·ÙÚÈ΋ 2004;67:212-217 Paediatriki 2004;67:212-217

™ÙËÓ ∂ÏÏ¿‰·, Ë ÓfiÛÔ˜ ·Ó·˙ËÙ‹ıËΠÁÈ· ÚÒÙËÊÔÚ¿ ÙÔ 1999 Û 8 ·ÛıÂÓ›˜ ËÏÈΛ·˜ 5-26 ÂÙÒÓ, ÔÈÔÔ›ÔÈ ÏËÚÔ‡Û·Ó Ù· ÎÏÈÓÈο ‰È·ÁÓˆÛÙÈο ÎÚÈÙ‹ÚÈ·ÙÔ˘ Oª¶ (¶›Ó·Î·˜ 4). ªÂÏÂÙ‹ıËÎ·Ó ÔÈ - ÁÓˆÛÙ¤˜Û·Ó ÎÏ·ÛÈΤ˜ - ÌÂÙ·ÏÏ¿ÍÂȘ M694V, M694I, M680I,E148Q Î·È ¿ÏϘ Û·ÓÈfiÙÂÚ˜ ÛÙÔ ÂÍfiÓÈÔ 10 Î·È 2.°ÂÓÂÙÈο Oª¶ ÂȂ‚·ÈÒıËΠ۠3 ·ÛıÂÓ›˜: ¤Ó·˜ÔÌÔ˙˘ÁÒÙ˘ E148Q, ¤Ó·˜ ‰ÈÏfi˜ ÂÙÂÚÔ˙˘ÁÒÙ˘M694V M680π Î·È ¤Ó·˜ M694V E148Q. ª›· ÌÂÙ¿ÏÏ·-ÍË, Ë M694V, ‚Ú¤ıËΠ۠2 ·ÛıÂÓ›˜ (¶›Ó·Î·˜ 5) (8).

™‡Ó‰ÚÔÌÔ ˘ÂÚÁ·Ì·ÛÊ·ÈÚÈÓ·ÈÌ›·˜ D ∆Ô Û‡Ó‰ÚÔÌÔ ˘ÂÚÁ·Ì·ÛÊ·ÈÚÈÓ·ÈÌ›·˜ D ÂÚÈ-

ÁÚ¿ÊËΠÁÈ· ÚÒÙË ÊÔÚ¿ ÙÔ 1984 ÛÙËÓ OÏÏ·Ó‰›·,ˆ˜ ÔÈÎÔÁÂÓ‹˜ ÔÏÏ·Ó‰ÈÎfi˜ ˘ÚÂÙfi˜ (9). ∞fi ÙfiÙÂ,¤¯Ô˘Ó ·Ó·ÊÂÚı› ÂÚ›Ô˘ 150 ·ÛıÂÓ›˜, ÌÂÙ·Í‡ÙˆÓ ÔÔ›ˆÓ Û ÌÈÎÚfiÙÂÚÔ ·ÚÈıÌfi °¿ÏÏÔÈ, πÙ·ÏÔ›,πÛ·ÓÔ›, ∆Ô‡ÚÎÔÈ Î·È ¿ÏÏÔÈ, ÁÂÁÔÓfi˜ Ô˘ ÂӉ¯Ô̤-Óˆ˜ ‰ËÏÒÓÂÈ ·Ó·Ú΋ ·Ó·ÊÔÚ¿ ÛÙË ÓfiÛÔ.

∏ ÓfiÛÔ˜ ÍÂÎÈÓ¿ Û ÌÈÎÚ‹ ËÏÈΛ· (68% ËÏÈΛ·˜ ÌÈ-ÎÚfiÙÂÚ˘ ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜, 96% οو ÙˆÓ 10 ÂÙÒÓ)(¶›Ó·Î·˜ 3). ∏ Û˘¯ÓfiÙËÙ· Î·È Ë ‰È¿ÚÎÂÈ· ÙˆÓ ÂÂÈ-ÛÔ‰›ˆÓ ÔÈΛÏÏÂÈ. ∏ ‰È¿ÚÎÂÈ· Â›Ó·È Ï›ÁÔ ÌÂÁ·Ï‡ÙÂÚË·fi ÂΛÓË ÙÔ˘ ÌÂÛÔÁÂÈ·ÎÔ‡ ˘ÚÂÙÔ‡ (3-7 Ë̤Ú˜).

™ÙÔ Û‡Ó‰ÚÔÌÔ ˘ÂÚÁ·Ì·ÛÊ·ÈÚÈÓ·ÈÌ›·˜ D ·Ô-‰›‰ÔÓÙ·È ‰È¿ÊÔÚ· Û˘ÌÙÒÌ·Ù· Î·È Â˘Ú‹Ì·Ù· (¶›-ӷη˜ 6). ÷ڷÎÙËÚÈÛÙÈΤ˜ ›ӷÈ, fï˜, ÔÈ ÎÔÈÏȷΤ˜ÂΉËÏÒÛÂȘ, ÁÈ· ÙȘ Ôԛ˜ ‰ÂÓ Â˘ı‡ÓÂÙ·È Ë ÔÚÔÁÔ-Ó›Ùȉ· Î·È È‰È·›ÙÂÚ· ‰È¿ÚÚÔȘ. ∂›Û˘, ÔÈ ÂΉËÏÒ-ÛÂȘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÏÂÌÊ·‰ÂÓ›Ùȉ·, ÛÏËÓÔÌÂÁ·-Ï›· Î·È ÔÈÎÈÏfiÌÔÚÊÔ ÂÍ¿ÓıËÌ· (¶›Ó·Î·˜ 7), ÂÓÒÛÙÔÓ Oª¶ ÙÔ ÂÍ¿ÓıËÌ· ÌÔÈ¿˙ÂÈ Ì ÂÚ˘Û›ÂÏ·˜ÛÙÔÓ ¿ÎÚÔ fi‰· Û˘Ó‹ıˆ˜ ‹ ÛÙÔ Î¿Ùˆ ¿ÎÚÔ, ·fi ÙÔ

ÁfiÓ·ÙÔ Î·È Î¿Ùˆ. OÈ ÂΉËÏÒÛÂȘ ·fi ÙÔ Ì˘ÔÛÎÂÏÂ-ÙÈÎfi Â›Ó·È Î˘Ú›ˆ˜ ÔÏ˘·ÚıÚ·ÏÁ›Â˜, ÂÓÒ ÛÙÔÓ Oª¶Â›Ó·È ·ÚÔ‰È΋ Û˘Ó‹ıˆ˜ ÌÔÓ·ÚıÚ›ÙȘ ÈÛ¯›Ô˘, ÁfiÓ·-ÙÔ˜ ‹ Ô‰ÔÎÓËÌÈ΋˜ (10). ∂› ÙÔ˘ ·ÚfiÓÙÔ˜, ‰ÂÓ¤¯ÂÈ ·Ó·ÊÂÚı› ·ÓÙȉڷÛÙÈ΋ ·Ì˘ÏÔ›‰ˆÛË.

OÈ ÎÚ›ÛÂȘ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ‰ÂÓ ˘·ÎÔ‡Ô˘Ó ÛÙ˯ÔÚ‹ÁËÛË ÎÔϯÈΛÓ˘. ™˘Ó‹ıˆ˜ ¯ÔÚËÁÔ‡ÓÙ·È ª™∞Ê¿Ú̷η. ∞˘ÍË̤ÓË Î·È ÛÙ· ÂӉȿÌÂÛ· ÙˆÓ ÎÚ›ÛÂ-ˆÓ (>100 iu/ml) ‚Ú›ÛÎÂÙ·È Ë ·ÓÔÛÔÛÊ·ÈÚ›ÓË D.Œ¯Ô˘Ó ·Ó·ÊÂÚı› ÂÚÈÙÒÛÂȘ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ¯ˆ-Ú›˜ ·‡ÍËÛË Ù˘ ·ÓÔÛÔÛÊ·ÈÚ›Ó˘ D, ÂÓÒ ·‡ÍËÛËÙ˘ ÛÊ·ÈÚ›Ó˘ ·˘Ù‹˜ ·Ú·ÙËÚÂ›Ù·È Î·È Û ¿ÏϘ·ıÔÏÔÁÈΤ˜ ηٷÛÙ¿ÛÂȘ, fiˆ˜ ϤÌʈ̷Hodgkin, Û·ÚÎÔ›‰ˆÛË, Ê˘Ì·Ù›ˆÛË, ·ÛÂÚÁ›Ïψ-ÛË, ·Ù·Í›·-ÙËÏ·ÁÁÂÈÂÎÙ·Û›· Î·È ÛÙÔ Û‡Ó‰ÚÔÌÔ Â›-ÎÙËÙ˘ ·ÓÔÛÔÏÔÁÈ΋˜ ·Ó¿ÚÎÂÈ·˜.

∆Ô 1999 Ù˘ÔÔÈ‹ıËΠÙÔ ÁÔÓ›‰ÈÔ MVK Ù˘˘ÂÚÁ·Ì·ÛÊ·ÈÚÈÓ·ÈÌ›·˜ D ÛÙÔ Ì·ÎÚfi ÛΤÏÔ˜ ÙÔ˘¯ÚˆÌÔÛÒÌ·ÙÔ˜ 12 (12q 24) (11). To ÁÔÓ›‰ÈÔ Îˆ‰È-ÎÔÔÈ› ÁÈ· ÙË Û‡ÓıÂÛË Ù˘ Ì‚·ÏÔÓÈ΋˜ ÎÈÓ¿Û˘,¤Ó˙˘ÌÔ ÙÔ ÔÔ›Ô Î·Ù·Ï‡ÂÈ ÙË ÊˆÛÊÔÚ˘Ï›ˆÛË ÙÔ˘Ì‚·ÏÔÓÈÎÔ‡ ÔͤԘ Û ÚÒÈÌÔ ÛÙ¿‰ÈÔ ÙÔ˘ ÌÂÙ·‚Ô-ÏÈÛÌÔ‡ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ (12). ∂› ÙÔ˘ ·ÚfiÓÙÔ˜,¤¯Ô˘Ó ηٷÁÚ·Ê› 5 ÌÂÙ·ÏÏ¿ÍÂȘ, ÔÈ ‰‡Ô ÂÎ ÙˆÓÔÔ›ˆÓ (59A C, 803T C) ‰ÂÓ Â›Ó·È ÁÓˆÛÙfi fiÙÈ Ô‰Ë-ÁÔ‡Ó Û ·Ú·ÁˆÁ‹ ÏÂÈÙÔ˘ÚÁÈο ÂÓÂÚÁ‹˜ Úˆ-Ù½Ó˘. ™˘¯ÓfiÙÂÚË Â›Ó·È Ë V377I (·ÓÙÈηٿÛÙ·ÛËÙ˘ ÈÛÔÏ¢ΛÓ˘ ·fi ‚·Ï›ÓË ÛÙË ı¤ÛË 377). OÈ ¿-Û¯ÔÓÙ˜ Â›Ó·È ‰ÈÏÔ› ÂÙÂÚÔ˙˘ÁÒÙ˜. ™Ô‚·Ú¤˜ ÌÂ-Ù·ÏÏ¿ÍÂȘ Ô‰ËÁÔ‡Ó Û ۯ‰fiÓ Ï‹ÚË ¤ÏÏÂÈ„Ë Ù˘Ì‚·ÏÔÓÈ΋˜ ÎÈÓ¿Û˘ (<0,2%), ¤¯Ô˘Ó Û·Ó ÂΉ‹Ïˆ-ÛË ÙÔÓ Ê·ÈÓfiÙ˘Ô Ù˘ Ì‚·ÏÔÓÈ΋˜ ·ÌÈÓÔ͢Ԣڛ·˜,Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ‰˘ÛÌÔÚÊ›·, ηٷÚÚ¿ÎÙË,

¶›Ó·Î·˜ 3. ∫ÏËÚÔÓÔÌÔ‡ÌÂÓ· ÂÚÈÔ‰Èο Â̇ÚÂÙ· Û‡Ó‰ÚÔÌ·

™‡Ó‰ÚÔÌÔ ∏ÏÈΛ· ¢È¿ÚÎÂÈ· ∫ÏÈÓÈο ¤Ó·Ú͢ ÂÂÈÛÔ‰›Ô˘ ¯·Ú·ÎÙËÚÈÛÙÈο ∫ÏËÚÔÓÔÌÈÎfiÙËÙ· ÃÚˆÌfiۈ̷ °ÔÓ›‰ÈÔ £Âڷ›·

(¤ÙË) (Ë̤Ú˜)

Oª¶ 90% <20 0,5-3 OÚÔÁÔÓ›Ùȉ·, ÀÔÏÂÈfiÌÂÓÔ˜ 16p13 MEFV ∫ÔϯÈΛÓËÌÔÓ·ÚıÚ›Ùȉ·, Û. ¯.·Ì˘ÏÔ›‰ˆÛË

ÀÂÚ-IgD 68% <1 3-7 §ÂÌÊ·‰ÂÓ›Ùȉ·, ÀÔÏÂÈfiÌÂÓÔ˜ 12q24 MVK ª™∞ÔÏ˘·ÚıÚ·ÏÁ›·, Û. ¯.ÎÔÈÏÈ·Îfi ¿ÏÁÔ˜

TRAPS 80% <20 >7 ∫ÔÈÏȷο ¿ÏÁË, ∂ÈÎÚ·ÙËÙÈÎfi˜ 12p13 TNFRF1 ∫ÔÚÙÈÎÔ-Ì˘·ÏÁ›·, ·ÚıÚ·ÏÁ›·, Û. ¯. ÛÙÂÚÈÓÔÂȉ‹

ÂÈÂÊ˘Î›Ùȉ·, EtanerceptÂÚÈÎÔÁ¯ÈÎfi Ô›‰ËÌ·,

·Ì˘ÏÔ›‰ˆÛËFCAS 95% <1/2 flÚ˜ °ÂÓÈÎÂ˘Ì¤ÓË ¤ÎıÂÛË ∂ÈÎÚ·ÙËÙÈÎfi˜ 1q44 CIAS1

ÛÙÔ ÎÚ‡Ô: ÂÍ¿ÓıËÌ·, Û. ¯.ÔÏ˘·ÚıÚ·ÏÁ›·,

ÂÈÂÊ˘Î›Ùȉ·MWS 80% <20 2-3 ¶ÔÏ˘·ÚıÚ·ÏÁ›·, ∂ÈÎÚ·ÙËÙÈÎfi˜ 1q44 CIAS1 ª™∞

Ó¢ÚÔ·ÈÛıËÙ‹ÚÈ· ‚·ÚËÎÔ˝·, Û. ¯. ·Ì˘ÏÔ›‰ˆÛË

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·214

Page 72: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

215

¶·È‰È·ÙÚÈ΋ 2004;67:212-217 Paediatriki 2004;67:212-217

Ì˘ÔÙÔÓ›·, ˘ÔÙÔÓ›·, ·Ù·Í›·, ۈ̷ÙÈ΋ Î·È „˘¯ÔÎÈ-ÓËÙÈ΋ ηı˘ÛÙ¤ÚËÛË, ¯ˆÚ›˜ ·‡ÍËÛË Ù˘ ÛÊ·ÈÚ›Ó˘D. ¶·Ú·ÌÔÓ‹ Ì‚·ÏÔÓÈ΋˜ ÎÈÓ¿Û˘ 0,8-3,6% Ô‰Ë-Á› ÛÙÔ Û‡Ó‰ÚÔÌÔ ˘ÂÚÁ·Ì·ÛÊ·ÈÚÈÓ·ÈÌ›·˜ D. ∏·Ô‚ÔÏ‹ Ì‚·ÏÔÓÈÎÔ‡ ÔͤԘ Â›Ó·È ·˘ÍË̤ÓË ÌfiÓÔηٿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÂÂÈÛÔ‰›ˆÓ ÛÙÔ˘˜ ¿Û¯ÔÓÙ˜·fi ˘ÂÚÁ·Ì·ÛÊ·ÈÚÈÓ·ÈÌ›· D. À¿Ú¯Ô˘Ó Î·È ·ÛıÂ-Ó›˜ ˘ÂÚÁ·Ì·ÛÊ·ÈÚÈÓ·ÈÌ›·˜ D ÌÂ Ê˘ÛÈÔÏÔÁÈ΋‰Ú·ÛÙËÚÈfiÙËÙ· Ì‚·ÏÔÓÈ΋˜ ÎÈÓ¿Û˘, ÁÂÁÔÓfi˜ Ô˘‰ËÏÒÓÂÈ ÙËÓ ÂÙÂÚÔÁ¤ÓÂÈ· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘. ∂› ÙÔ˘·ÚfiÓÙÔ˜, Ô ˘ÔΛÌÂÓÔ˜ Ì˯·ÓÈÛÌfi˜ ‰ÂÓ ¤¯ÂÈ·ÔÛ·ÊËÓÈÛÙ›. ∂ÓÔ¯ÔÔÈÔ‡ÓÙ·È Ë ‰È·Ù·Ú·¯‹ Ù˘ۇÓıÂÛ˘ ÈÛÔÚÂÓÔÂȉÒÓ, ÎÔÚÙÈÎÔÛÙÂÚÈÓÔÂȉÒÓ,¯ÔÏËÛÙÂÚfiÏ˘ Î·È ¿ÏÏˆÓ ÛÙÔȯ›ˆÓ, Ù· ÔÔ›· ÌÂÙ¤-¯Ô˘Ó ÛÙË Û‡ÓıÂÛË Ù˘ ΢ÙÙ·ÚÈ΋˜ ÌÂÌ‚Ú¿Ó˘ ‹Û˘Ì‚¿ÏÏÔ˘Ó Û ΢ÙÙ·ÚÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜.

¶ÂÚÈÔ‰ÈÎfi Û‡Ó‰ÚÔÌÔ ÙÔ˘ ˘Ô‰Ô¯¤· ÙÔ˘ ·Ú¿ÁÔÓÙ·Ó¤ÎÚˆÛ˘ ÙÔ˘ fiÁÎÔ˘

∆Ô ÂÚÈÔ‰ÈÎfi Û‡Ó‰ÚÔÌÔ ÙÔ˘ ˘Ô‰Ô¯¤· ÙÔ˘ ·-Ú¿ÁÔÓÙ· Ó¤ÎÚˆÛ˘ ÙÔ˘ fiÁÎÔ˘ (TRAPS) ÌÂÙ·‚È‚¿˙Â-Ù·È Ì ÂÈÎÚ·ÙËÙÈÎfi ·˘ÙÔۈ̷ÙÈÎfi ¯·Ú·ÎÙ‹Ú·, ÙÔÔÔ›Ô ·Ú¯Èο ÂÚÈÁÚ¿ÊËΠ۠ÔÈÎÔÁ¤ÓÂȘ ÈÚÏ·Ó‰È-΋˜ ηٷÁˆÁ‹˜ ˆ˜ ÈÚÏ·Ó‰ÈÎfi˜ ÔÈÎÔÁÂÓ‹˜ ˘ÚÂÙfi˜

(Familial hibernian fever) (13). ™Ù·‰È·Î¿, fï˜, ÚÔ-ÛÙ¤ıËÎ·Ó ÔÈÎÔÁ¤ÓÂȘ ·fi ‰È¿ÊÔÚ· ¤ıÓË.

∆· Â̇ÚÂÙ· ÂÂÈÛfi‰È· ‰È·Ê¤ÚÔ˘Ó ·fi ÂΛӷÙfiÛÔ ÙÔ˘ Oª¶ fiÛÔ Î·È Ù˘ ˘ÂÚÁ·Ì·ÛÊ·ÈÚÈÓ·È-Ì›·˜ D fiÛÔÓ ·ÊÔÚ¿ ÛÙË ‰È¿ÚÎÂÈ¿ ÙÔ˘˜, Ë ÔÔ›· ›-Ó·È Û·ÊÒ˜ ÌÂÁ·Ï‡ÙÂÚË Î·ıÒ˜ ‰È·ÚÎÔ‡Ó ÂÚÈÛÛfi-ÙÂÚÔ ·fi Ì›· ‚‰ÔÌ¿‰· Î·È ·ÚÎÂÙ¿ Û˘¯Ó¿ ¿Óˆ·fi ¤Ó· Ì‹Ó·, ÂÓÒ ÌÂÚÈÎÔ› ·ÛıÂÓ›˜ ‚Ú›ÛÎÔÓÙ·È ÛÂÛ˘Ó¯‹ ÊÏÂÁÌÔÓÒ‰Ë ‰ÈÂÚÁ·Û›· (¶›Ó·Î·˜ 3). ¶ÚÔ¤-¯ÔÓÙ· ÛËÌ›· Â›Ó·È Ë ÂÈÂÊ˘Î›Ùȉ· ηÈ/‹ ÙÔ ÂÙÂÚfi-Ï¢ÚÔ ÂÚÈÎÔÁ¯ÈÎfi Ô›‰ËÌ·, Ë ÂÓÙÔÈṲ̂ÓË ÈÛ¯˘Ú‹Ì˘·ÏÁ›· Î·È ÙÔ ÂÚÈÔÚÈṲ̂ÓÔ ÂÒ‰˘ÓÔ ÂÚ‡ıËÌ·‰¤ÚÌ·ÙÔ˜ ÂÓÙÔÈ˙fiÌÂÓÔ ÔÔ˘‰‹ÔÙÂ, Û˘Ó‹ıˆ˜fï˜ ÛÙ· ¿ÎÚ·, fiÔ˘ ÍÂÎÈÓ¿ÂÈ ÎÂÓÙÚÈο Î·È ÌÂÙ·-Ó·ÛÙ‡ÂÈ ÂÚÈÊÂÚÈο (¶›Ó·Î·˜ 8). ∞Ì˘ÏÔ›‰ˆÛˤ¯ÂÈ ·Ó·ÊÂÚı› ÛÙÔ 25% ÙˆÓ ·ÛıÂÓÒÓ (14).

∆Ô ÁÔÓ›‰ÈÔ ÙÔ˘ TRAPS (TNFR F1) ·ÔΈ‰ÈÎÔ-ÔÈ‹ıËΠÙÔ 1998 ÛÙÔ ·ÔÌ·ÎÚ˘Ṳ̂ÓÔ ÙÌ‹Ì· ÙÔ˘‚Ú·¯¤Ô˜ ÛΤÏÔ˘˜ ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ 12p13 (15).

∂› ÙÔ˘ ·ÚfiÓÙÔ˜, ¤¯Ô˘Ó ·ÔÎÚ˘ÙÔÁÚ·ÊËı› 16ÌÂÙ·ÏÏ¿ÍÂȘ, ÔÈ ÂÚÈÛÛfiÙÂÚ˜ ·fi ÙȘ Ôԛ˜ ·ÊÔ-ÚÔ‡Ó ÛÙËÓ ÂÍˆÎ˘ÙÙ¿ÚÈ· - ÏÔ‡ÛÈ· Û ΢ÛÙ½ÓË - Â-ÚÈÔ¯‹ ÙÔ˘ 55Kd ÙÔ˘ ˘Ô‰Ô¯¤· ÙÔ˘ TNF Î·È ¤¯Ô˘Óۯ‰fiÓ Ï‹ÚË ‰ÈÂÈÛ‰˘ÙÈÎfiÙËÙ· Î·È ̆ „ËÏ‹ Û˘¯ÓfiÙËÙ·

¶›Ó·Î·˜ 4. ¢È·ÁÓˆÛÙÈο ÎÚÈÙ‹ÚÈ· Oª¶

ªÂ›˙ÔÓ·∆˘Èο ÂÂÈÛfi‰È·: i) ˘ÚÂÙÔ‡, ii) Ï¢ڛÙȉ·˜-ÂÚÈηډ›ÙÈ-‰·˜, ii) ÌÔÓ·ÚıÚ›Ùȉ·˜ (ηْ ÈÛ¯›Ô, ηٿ ÁfiÓ˘, Ô‰ÔÎÓËÌÈ΋),iv) ÂÚÈÙÔÓ›Ùȉ·˜ ∂Ï¿ÛÛÔÓ· ÕÙ˘· ÂÂÈÛfi‰È· ·fi: i) ÎÔÈÏȷ΋ ¯ÒÚ·, ii) ıÒڷη, ii) ·Ú-ıÚÒÛÂȘ, iv) ¿ÏÁË ¿ÎÚˆÓ ÌÂÙ¿ ÎfiˆÛË, v) ·ÓÙ·fiÎÚÈÛË ÛÙËÓÎÔϯÈΛÓË ∂ÈÎÔ˘ÚÈοi) OÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfiii) ∂ıÓÈÎfiÙËÙ· iii) ∏ÏÈΛ· ¤Ó·Ú͢: <20 ÂÙÒÓ iv-vii) ÷ڷÎÙËÚÈÛÙÈο ÂÂÈÛÔ‰›ˆÓ (¤ÓÙ·ÛË, ·˘ÙfiÌ·ÙË ˘Ô¯Ò-ÚËÛË, ÂχıÂÚ· ÌÂÛԉȷÛÙ‹Ì·Ù·, ‰Â›ÎÙ˜ ÊÏÂÁÌÔÓ‹˜) viii) ¶·ÚÔ‰È΋ ·ÈÌ·ÙÔ˘Ú›· ix) ∞Ù˘¯‹˜ ÛΈÏËÎÔÂȉÂÎÙÔÌ‹ x) ™˘ÁÁ¤ÓÂÈ· ÁÔÓ¤ˆÓ ¢È¿ÁÓˆÛË 1 ·ÚÈÔ ‹ 2 ‰Â˘ÙÂÚ‡ÔÓÙ· ‹ 1 ‰Â˘ÙÂÚ‡ÔÓ Î·È 5 ÂÈÎÔ˘ÚÈο ‹1 ‰Â˘ÙÂÚ‡ÔÓ Î·È 4 ·fi Ù· 5 ÚÒÙ· ÂÈÎÔ˘ÚÈο

% Û ÁÂÓÂÙÈοÙÂÎÌËÚȈ̤ÓÔ˘˜·ÛıÂÓ›˜ (47)

∫·Ù¿ ÙËÓ ÎÚ›ÛË ∆∫∂ §Â˘ÎÒÓ πÓˆ‰ÔÁfiÓÔ˘(+) ÌÈÎÚÔÛÎÔÈ΋·ÈÌ·ÙÔ˘Ú›·/ÏÂ˘ÎˆÌ·ÙÔ˘Ú›·

96%˘ÚÂÙfi˜

∫ÂÊ·Ï·ÏÁ›·

ÕÛËÙËÌËÓÈÁÁ›Ùȉ·

¶ÂÚÈηډ›Ùȉ·

™ÏËÓÔÌÂÁ·Ï›·

O˙҉˘ ÔÏ˘·ÚÙËÚ›Ùȉ·™ÂÈÚ·Ì·ÙÔÓÂÊÚ›Ùȉ·

¶ÔÚʇڷ Henoch-SchonleinO›‰ËÌ· ÔÛ¯¤Ô˘∂̇ÚÂÙË Ì˘·ÏÁ›·

¶ÔÚÊ˘ÚÈÎfiÂÍ¿ÓıËÌ·

§Â˘ÎˆÌ·ÙÔ˘Ú›·

56% Ï¢ڛÙȉ·2% ·Ì˘ÏÔ›‰ˆÛË

91% ¿ÛËÙËÂÚÈÙÔÓ›Ùȉ·

45% ·ÚıÚ›Ùȉ·/·ÚıÚ·ÏÁ›·

13% ÂÍ¿ÓıËÌ·Û·Ó ÂÚ˘Û›ÂÏ·˜

KYPIA E¶π∫OÀƒπ∫∞

∂ÈÎfiÓ· 1. OÈÎÔÁÂÓ‹˜ ÌÂÛÔÁÂÈ·Îfi˜ ˘ÚÂÙfi˜: ÛËÌ›· Î·È Û˘-ÌÙÒÌ·Ù· (·fi: Kastner DL. Williams and Wilkins. Baltimore.Arthritis and allied conditions. 1279-1306).

¶›Ó·Î·˜ 5. °ÂÓÂÙÈ΋ ·Ó¿Ï˘ÛË ∂ÏÏËÓÔ·›‰ˆÓ Ì Oª¶

∫ˆ‰ÈÎfiÓÈÔ º˘ÛÈÔÏ. ªÂÙ¿ÏÏ·ÍË ∞ÛıÂÓ‹˜ ∂ÙÂÚÔ-ÁÔÓ. ˙˘ÁÒÙ˘

694 MM VM M694V/M680I:1 M694V:2694 MM IM M694V/E148Q:1726 VV AV680 MM IM148 EE QQ E148Q/E148Q:1

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·215

Page 73: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

·ÓÙȉڷÛÙÈ΋˜ ·Ì˘ÏÔ›‰ˆÛ˘. ∏ ‰È·Ù·Ú·¯‹ ·Ô-‰fiÌËÛ˘ ÙÔ˘ TNFrc Ô‰ËÁ› ÛÂ Û˘Ó¯‹ Û‹Ì·ÓÛËÙˆÓ Î˘ÙÙ¿ÚˆÓ, ηٿÛÙ·ÛË ˘ÂÚÊÏÂÁÌÔÓ‹˜ Î·È ¯·-ÌËÏ¿ ›‰· ÙÔ˘ ‰È·Ï˘ÙÔ‡ ˘Ô‰Ô¯¤· ÛÙÔÓ ÔÚfi.

∆· Û˘ÌÙÒÌ·Ù· Ù˘ ÓfiÛÔ˘ ‰ÂÓ ˘·ÎÔ‡Ô˘Ó ÛÙ˯ÔÚ‹ÁËÛË ÎÔϯÈΛÓ˘, ˘Ê›ÂÓÙ·È Ì ÙË ¯ÔÚ‹ÁËÛËÎÔÚÙÈÎÔÛÙÂÚÈÓÔÂȉÒÓ, ·ÏÏ¿ ¯ÚÂÈ¿˙ÔÓÙ·È fiÏÔ Î·È ÌÂ-Á·Ï‡ÙÂÚ˜ ‰fiÛÂȘ. ∂Óı·ÚÚ˘ÓÙÈο Â›Ó·È Ù· ·ÔÙÂϤ-ÛÌ·Ù· ıÂڷ›·˜ Ì Etanercept Ô˘ Â›Ó·È 75Kd·ÓÙÈ-TNFrc.

OÈÎÔÁÂÓ¤˜ ·˘ÙÔÊÏÂÁÌÔÓ҉˜ ÂÍ·ÓıËÌ·ÙÈÎfi Û‡Ó‰ÚÔÌÔ ÌÂÙ¿ ÁÂÓÈÎÂ˘Ì¤ÓË ¤ÎıÂÛË ÛÙÔ ÎÚ‡Ô Î·ÈÛ‡Ó‰ÚÔÌÔ Muckle-Wells

¢‡Ô ¿ÏϘ ·ıÔÏÔÁÈΤ˜ ÔÓÙfiÙËÙ˜, ÔÈ Ôԛ˜ ›-Ó·È ÁÓˆÛÙ¤˜ ·fi ÙÔ 1940 Î·È 1962 ·ÓÙ›ÛÙÔȯ·, ›ӷÈÙÔ ÔÈÎÔÁÂÓ¤˜ ·˘ÙÔÊÏÂÁÌÔÓ҉˜ ÂÍ·ÓıËÌ·ÙÈÎfi Û‡Ó-‰ÚÔÌÔ ÌÂÙ¿ ÁÂÓÈÎÂ˘Ì¤ÓË ¤ÎıÂÛË ÛÙÔ ÎÚ‡Ô (FC∞S)Î·È ÙÔ Û‡Ó‰ÚÔÌÔ Muckle-Wells (16,17). ∫·È Ù· ‰‡ÔÛ‡Ó‰ÚÔÌ· ÌÂÙ·‚È‚¿˙ÔÓÙ·È Î·Ù¿ ÙÔÓ ÂÈÎÚ·ÙËÙÈÎfiۈ̷ÙÈÎfi ¯·Ú·ÎÙ‹Ú· (¶›Ó·Î·˜ 3).

∆Ô Û‡Ó‰ÚÔÌÔ FC∞S ÚÔηÏ› ‰È·Ï›ÔÓÙ· ÂÂÈ-Ûfi‰È· ˘ÚÂÙÔ‡, ÂÍ·Óı‹Ì·ÙÔ˜, ·ÚıÚ·ÏÁÈÒÓ Î·È ÂÈ-ÂÊ˘Î›Ùȉ·˜ ÌÂÙ¿ ÁÂÓÈÎÂ˘Ì¤ÓË ¤ÎıÂÛË ÛÙÔ ÎÚ‡Ô,Û˘ÌÙÒÌ·Ù· Ù· ÔÔ›· ÂÌÊ·Ó›˙ÔÓÙ·È ·fi ÙÔ˘˜ ÚÒ-ÙÔ˘˜ 6 Ì‹Ó˜ Ù˘ ˙ˆ‹˜ ÛÙÔ 95% ÙˆÓ ·Û¯fiÓÙˆÓ. ∏̤ÛË ¯ÚÔÓÈ΋ ·fiÛÙ·ÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ·fiÙËÓ ¤ÎıÂÛË ÛÙÔ ÎÚ‡Ô Â›Ó·È 2-5 ÒÚ˜, ÂÓÒ Ë Ì¤ÛˉȿÚÎÂÈ· οı ÂÂÈÛÔ‰›Ô˘ Â›Ó·È 12 ÒÚ˜ (¶›Ó·Î·˜9). ∞Ì˘ÏÔ›‰ˆÛË ‰ÂÓ Â›Ó·È Û˘¯Ó‹, fï˜ ¤¯ÂÈ ·Ó·-ÊÂÚı› Û 2% ÙˆÓ ·ÛıÂÓÒÓ.

∆Ô Û‡Ó‰ÚÔÌÔ Muckle-Wells ¤¯ÂÈ ·ÚfiÌÔÈ· Û˘-Ìو̷ÙÔÏÔÁ›·, ÂÎÙfi˜ ·fi ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ù· Û˘-ÌÙÒÌ·Ù· ÂÌÊ·Ó›˙ÔÓÙ·È ·˘ÙfiÌ·Ù·, ¯ˆÚ›˜ ÚÔË-ÁÔ‡ÌÂÓË ¤ÎıÂÛË ÛÙÔ ÎÚ‡Ô, ·Ó·Ù‡ÛÛÂÙ·È ·ÒÏÂÈ··ÎÔ‹˜ Ó¢ÚÔ·ÈÛıËÙËÚÈ·ÎÔ‡ Ù‡Ô˘ Î·È Û˘¯ÓfiÙÂÚ··Ì˘ÏÔ›‰ˆÛË.

∆Ô ˘Â‡ı˘ÓÔ ÁÔÓ›‰ÈÔ ÙˆÓ ‰‡Ô Û˘Ó‰ÚfïÓÂÓÙÔ›ÛÙËΠÙÔ 2001 ÛÙÔ ¯ÚˆÌfiۈ̷ 1q44 ηȤ¯Ô˘Ó ηٷÁÚ·Ê› 4 ÌÂÙ·ÏÏ¿ÍÂȘ (18). ∆Ô ÁÔÓ›‰ÈÔ·˘Ùfi Έ‰ÈÎÔÔÈ› ÙË ‰ËÌÈÔ˘ÚÁ›· Ì›·˜ ÎÚ˘Ô˘Ú›-Ó˘, Ù˘ CIAS 1, Ô˘ ÂÈο˙ÂÙ·È fiÙÈ ÌÂÙ¤¯ÂÈ ÛÙÔ˘˜Ì˯·ÓÈÛÌÔ‡˜ ·fiÙˆÛ˘ ηٿ ÙËÓ ·ÓÙ›‰Ú·ÛË Ù˘ÊÏÂÁÌÔÓ‹˜.

ª¿ÏÈÛÙ·, Ë Â˘ı‡ÓË ÙÔ˘ ÁÔÓȉ›Ô˘ ·˘ÙÔ‡ ‰ÂÓÊ·›ÓÂÙ·È Ó· ÛÙ·Ì·Ù¿ÂÈ ÛÙ· ‰‡Ô ÚÔËÁÔ‡ÌÂÓ· Û‡Ó-‰ÚÔÌ·, ·ÊÔ‡ ÙÔÓ πÔ‡ÏÈÔ ÙÔ˘ 2002 ·Ó·ÎÔÈÓÒıËÎÂfiÙÈ ·ÚÔ˘ÛÈ¿˙ÂÈ ˘„ËÏ‹ ¤ÎÊÚ·ÛË Û 7 - ÌË Û˘ÁÁÂ-Ó›˜ ÌÂٷ͇ ÙÔ˘˜ - ·ÛıÂÓ›˜ ¿Û¯ÔÓÙ˜ ·fi ¯Úfi-ÓÈÔ ÊÏÂÁÌÔÓ҉˜ Û‡Ó‰ÚÔÌÔ ·ÚıÚÔ¿ıÂÈ·˜ ηȉÂÚÌ·ÙÔ¿ıÂÈ·˜ (Chronic inflammatory cutaneusand arthropathy syndrome - CINCA) ‹ IOMID(Infantile-onset multisystem disease) (¶›Ó·Î·˜ 10),ÙÔ ÔÔ›Ô ·Ú¯›˙ÂÈ ÛÙË ÓÂÔÁÓÈ΋ ËÏÈΛ·, ·ÚÔ˘ÛÈ¿˙ÂÈ

¶›Ó·Î·˜ 6. ∫ÚÈÙ‹ÚÈ· ˘ÂÚÁ·Ì·ÛÊ·ÈÚÈÓ·ÈÌ›·˜ D

°ÂÓÈο ÀÔÙÚÔ¤˜↑ IgD (>100 u/100 ml), 2 ÌÂÙÚ‹ÛÂȘ, 1 Ì‹Ó·˜ ·fiÛÙ·ÛË ↑ IgA ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÎÚ›Û˘ ↑ ∆∫∂ Î·È Ï¢ÎÒÓ ∞ÈÊÓ›‰È· ¤Ó·ÚÍË ˘ÚÂÙÔ‡ §ÂÌÊ·‰ÂÓ›Ùȉ· (ÙÚ·¯ËÏÈ΋) ∫ÔÈÏȷο ¿ÏÁË, ¤ÌÂÙÔÈ, ‰È¿ÚÚÔȘ ∂Í¿ÓıËÌ· ∞ÚıÚ·ÏÁ›·/·ÚıÚ›Ùȉ· ™ÏËÓÔÌÂÁ·Ï›·

¶›Ó·Î·˜ 7. ¢ÂÚÌ·ÙÈΤ˜ ÂΉËÏÒÛÂȘ Û˘Ó‰ÚfiÌÔ˘ ˘ÂÚÁ·Ì·-ÛÊ·ÈÚÈÓ·ÈÌ›·˜ D

∂Í¿ÓıËÌ· 63%∫ËÏȉԂϷÙȉ҉˜ 41%¶ÔÌÊÔ› 24%O˙҉˜ ÂÚ‡ıËÌ· 22%¢·ÎÙ˘ÏÈÔÂȉ¤˜ 19%¶ÔÚʇڷ 15%¶ÂÙ¤¯ÂȘ 10%

¶›Ó·Î·˜ 8. ∫ÏÈÓÈο ÎÚÈÙ‹ÚÈ· TRAPS

ªÂ›˙ÔÓ·ÀÔÙÚÔÈ¿˙ˆÓ ˘ÚÂÙfi˜ ÀÔÙÚÔÈ¿˙ÔÓÙ· ÎÔÈÏȷο ¿ÏÁË ‹ ÂÓÙÔÈṲ̂ÓË Ì˘·ÏÁ›· ∞ÔÎÏÂÈÛÌfi˜ ¿ÏÏˆÓ ÓÔÛËÌ¿ÙˆÓ ∂Ï¿ÛÛÔÓ· ŒÓÂÛË ÂÈÂÊ˘ÎfiÙˆÓ ∂Ò‰˘ÓÔ ÂÓÙÔÈṲ̂ÓÔ ÂÚ‡ıËÌ· ‰¤ÚÌ·ÙÔ˜ ¶ÂÚÈÎÔÁ¯ÈÎfi Ô›‰ËÌ· OÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ⁄ÊÂÛË Û˘ÌÙˆÌ¿ÙˆÓ Ì ÎÔÚÙÈÎÔÛÙÂÚÈÓÔÂȉ‹ ¢È¿ÁÓˆÛË 3 Ì›˙ÔÓ· Î·È 1 ¤Ï·ÛÛÔÓ

¶›Ó·Î·˜ 9. ¢È·ÁÓˆÛÙÈο ÎÚÈÙ‹ÚÈ· FC∞S

ÀÔÙÚÔÈ¿˙ˆÓ ˘ÚÂÙfi˜ Î·È ÂÍ¿ÓıËÌ· ÌÂÙ¿ ÁÂÓÈÎÂ˘Ì¤ÓË ¤ÎıÂÛË ÛÙÔ ÎÚ‡Ô ∫ÏËÚÔÓÔÌÈÎfiÙËÙ·: ÂÈÎÚ·ÙËÙÈÎfi˜ ·˘ÙÔۈ̷ÙÈÎfi˜ ¯·Ú·ÎÙ‹Ú·˜ ∏ÏÈΛ· ¤Ó·Ú͢: <6 ÌËÓÒÓ ¢È¿ÚÎÂÈ· Û˘Ìو̿وÓ: <24 ÒÚ˜ ∂ÈÂÊ˘Î›Ùȉ· ∞Ô˘Û›· ‚·ÚËÎÔ˝·˜, ÂÚÈÎÔÁ¯ÈÎÔ‡ Ôȉ‹Ì·ÙÔ˜, ÏÂÌÊ·‰ÂÓ›Ùȉ·˜, ÔÚÔÁÔÓ›Ùȉ·˜

¶›Ó·Î·˜ 10. CINCA / IOMID

ŒÓ·ÚÍË: ÓÂÔÁÓÈ΋ ËÏÈΛ· ÀÔÙÚÔÈ¿˙ÔÓÙ· Â̇ÚÂÙ· ÂÂÈÛfi‰È· ¢ÂÚÌ·ÙÈΤ˜ ÂΉËÏÒÛÂȘ ÀÔÙÚÔÈ¿˙Ô˘Û· ÊÏÂÁÌÔÓ҉˘ ÌËÓÈÁÁ›Ùȉ· ∞ÚıÚ›Ùȉ· ™ˆÌ·ÙÈ΋ ηı˘ÛÙ¤ÚËÛË æ˘¯ÔÎÈÓËÙÈ΋ ηı˘ÛÙ¤ÚËÛË

216

¶·È‰È·ÙÚÈ΋ 2004;67:212-217 Paediatriki 2004;67:212-217

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·216

Page 74: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

217

¶·È‰È·ÙÚÈ΋ 2004;67:212-217 Paediatriki 2004;67:212-217

‰ÂÚÌ·ÙÈΤ˜ ÂΉËÏÒÛÂȘ, ¯ÚfiÓÈ· ÌË ÌÈÎÚԂȷ΋˘ÔÙÚÔÈ¿˙Ô˘Û· ÌËÓÈÁÁ›Ùȉ·, ÛÔ‚·Ú‹ ·ÚıÚ›Ùȉ·Ì ˘ÔÏ·Û›· ÙÔ˘ ¯fiÓ‰ÚÔ˘ Î·È Î·Ù·ÛÙÚÔÊ‹ ÙÔ˘ÔÛÙÔ‡, ÚÒÈÌË Û‡ÁÎÏÂÈÛË ÂÈʇÛÂˆÓ Ô˘ Ô‰Ë-ÁÔ‡Ó Û ۈ̷ÙÈ΋ ηı˘ÛÙ¤ÚËÛË Î·È ·Ô‰›‰ÂÈ ÛÂÌË Û˘ÁÁÂÓ›˜ ÌÂٷ͇ ÙÔ˘˜ ·ÛıÂÓ›˜ ÎÔÈÓ¿ ÌÔÚÊÔ-ÏÔÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο (19).

∆· ÓÔÛ‹Ì·Ù· Ô˘ ·Ó·Ê¤ÚıËÎ·Ó ÂÚÈÏ·Ì‚¿ÓÔ-ÓÙ·È ÛÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ˘ÔÙÚÔÈ·˙fiÓÙˆÓÂ̇ÚÂÙˆÓ ÓÔÛËÌ¿ÙˆÓ. ∏ ÁÂÓÂÙÈ΋ ÙÔ˘˜ ·Ó¿Ï˘ÛË·ÊÂÓfi˜ ÌÂÓ ˘ÔÛÙËÚ›˙ÂÈ ÙËÓ ÎÏÈÓÈ΋ ÙÔ˘˜ ‰È¿ÁÓˆ-ÛË, ·ÊÂÙ¤ÚÔ˘ ÌÔÚ› Ó· Û˘Ì‚¿ÏÂÈ ÛÙË ‰ÈÂÚ‡ÓËÛËÙ˘ ÌÔÚȷ΋˜ ‚¿Û˘ Ù˘ ·ÓÙ›‰Ú·Û˘ ÊÏÂÁÌÔÓ‹˜Î·È ÛÙËÓ ·Ó‡ÚÂÛË ÔÚıÔÏÔÁÈÎfiÙÂÚ˘ ıÂڷ›·˜,fiˆ˜ .¯. ·ÁˆÁ‹ Ù˘ ‰Ú¿Û˘ Ù˘ ˘Ú›Ó˘ ‹·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ Èı·ÓÔÏÔÁÔ‡ÌÂÓ˘ ÌÂÙ·ÏÏ·Á-̤Ó˘ ˘Ú›Ó˘.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Grateau G, Drenth JP, Delpech M. Hereditary fevers. Curr

Opin Rheumatol 1999;11:75-78. 2. Drenth JP, van der Meer JW. Periodic fevers enter the era of

molecular diagnosis. BMJ 2000;320:1091-1092. 3. Eliakim M, Levy M, Ehrenfeld M. Recurrent polyserositis

(familial Mediterranean fever). Amsterdam: Elsevier/NorthHolland Biomedical Press; 1981.

4. Goldfinger SE. Colchicine for familial Mediterranean fever. NEngl J Med 1972;287:1302.

5. The International FMF Consortium. Ancient missensemutations in a new member of the RoRet gene family arelikely to cause familial Mediterranean fever. Cell1997;90:797-807.

6. The French FMF Consortium. A candidate gene for familialMediterranean fever. Nat Genet 1997;17:25-31.

7. Cazeneuve C, Sarkisian T, Pecheux C, Dervichian M,Nedelec B, Reinert P et al. MEFV-Gene analysis in armenianpatients with Familial Mediterranean fever: diagnostic valueand unfavorable renal prognosis of the M694V homozygousgenotype-genetic and therapeutic implications. Am J HumGenet 1999;65:88-97.

8. µÔ˘ÁÈԇη Ÿ, ª·ÚÎÔ‡ÚË ª, Touitou I, ∫·Ú¿ıÈÔ˜ £. °ÂÓÂ-ÙÈ΋ ·Ó¿Ï˘ÛË ∂ÏÏËÓÔ·›‰ˆÓ Ì ÔÈÎÔÁÂÓ‹ ÌÂÛÔÁÂÈ·Îfi ˘ÚÂ-Ùfi. 39Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ; 2001. AbstractNo EA075.

9. Van der Meer JW, Vossen JM, Radl J, van Nieuwkoop JA,Meyer CJ, Lobatto S et al. Hyperimmunoglobulinaemia Dand periodic fever: a new syndrome. Lancet 1984;1:1087-1090.

10. Drenth JP, Haagsma CJ, van der Meer JW. Hyper-immunoglobulinemia D and periodic fever syndrome. Theclinical spectrum in a series of 50 patients. InternationalHyper-IgD Study Group. Medicine 1994;73:133-144.

11. Drenth JP, Cuisset L, Grateau G, Vasseur C, van de Velde-Visser SD, de Jong JG et al. Mutations in the gene encodingmevalonate kinase cause hyper-IgD and periodic feversyndrome. International Hyper-IgD Study Group. Nat Genet1999;22:178-181.

12. Goldstein JL, Brown MS. Regulation of the mevalonatepathway. Nature 1990;343:425-430.

13. Williamson LM, Hull D, Mehta R, Reeves WG, Robinson BH,Toghill PJ. Familial Hibernian fever. Q J Med 1982;51:469-480.

14. McDermott EM, Smillie DM, Powell RJ. Clinical spectrum offamilial Hibernian fever: a 14-year follow-up study of theindex case and extended family. Mayo Clin Proc1997;72:806-817.

15. McDermott MF, Ogunkolade BW, McDermott EM, Jones LC,Wan Y, Quane KA et al. Linkage of familial Hibernian fever tochromosome 12p13. Am J Hum Genet 1998;62;1446-1451.

16. Kile RL, Rusk HA. A case of cold urticaria with unusual familyhistory. JAMA 1940;114:1067-1068.

17. Muckle TJ, Wells M. Urticaria, deafness, and amyloidosis: anew heredo-familial syndrome. Q J Med 1962;31:235-248.

18. Hoffman HM, Mueller JL, Broide DH, Wanderer AA, KolodnerRD. Mutation of a new gene encoding a putative pyrin-likeprotein causes familial cold autoinflammatory syndrome andMuckle-Wells syndrome. Nat Genet 2001;29:301-305.

19. Feldmann J, Prieur AM, Quartier P, Berquin P, Certain S,Cortis E, et al. Chronic infantile neurological cutaneous andarticular syndrome is caused by mutations in CIAS1, a genehighly expressed in polymorphonuclear cells andchondrocytes. Am J Hum Genet 2002;71:198-203.

∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 20-03-2003 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 02-09-2003

¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ŸÏÁ· ∂. µÔ˘ÁÈԇη µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡” £Ë‚ÒÓ & §Â‚·‰Â›·˜, ∆.∫. 115 27, °Ô˘‰›

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·217

Page 75: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

218

¶·È‰È·ÙÚÈ΋ 2004;67:218-222 Paediatriki 2004;67:218-222

∂π¢π∫O ∞ƒ£ƒO SPECIAL ARTICLE

∏ÌÈÎÚ·ÓÈο ÈÛÔ‰‡Ó·Ì· ÛÙ· ·È‰È¿ ™. ¢. ª·ÛÙÚÔÁÈ¿ÓÓË, ∫. µÔ‡‰Ú˘, ∂. ∫·ÙÛ·ÚÔ‡

Migraine equivalents in children S. D. Mastrogianni, K. Voudris, E. Katsarou

�¶ÂÚ›ÏË„Ë: ∆· “ËÌÈÎÚ·ÓÈο ÈÛÔ‰‡Ó·Ì·” Â›Ó·È ÎÏÈ-ÓÈΤ˜ ÔÓÙfiÙËÙ˜ Ì ÂÚÈÔ‰ÈÎfi ·ÚÔ͢ÛÌÈÎfi ¯·Ú·-ÎÙ‹Ú·, ηÏÔ‹ıË ÚfiÁÓˆÛË Î·È ·ÈÙÈÔÏÔÁÈ΋ Û˘Û¯¤-ÙÈÛË Ì ÙËÓ ËÌÈÎÚ·Ó›·, Ë ÔÔ›· ‚·Û›˙ÂÙ·È Î˘Ú›ˆ˜ÛÙÔ ÈÛ¯˘Úfi ÔÈÎÔÁÂÓÂÈ·Îfi ‹/Î·È ·ÙÔÌÈÎfi ÈÛÙÔÚÈÎfiËÌÈÎÚ·Ó›·˜. ¶¤ÓÙ ٤ÙÔȘ ηٷÛÙ¿ÛÂȘ ¤¯Ô˘Ó ÂÚÈ-ÁÚ·Ê› Ì ۷ʋÓÂÈ· ÛÙ· ·È‰È¿: ÙÔ Î·ÏfiËı˜ ·-ÚÔ͢ÛÌÈÎfi Ú·È‚fiÎÚ·ÓÔ ÛÙ· ‚Ú¤ÊË, Ô Î·ÏÔ‹ı˘ ·-ÚÔ͢ÛÌÈÎfi˜ ›ÏÈÁÁÔ˜, ÔÈ Î˘ÎÏÈÎÔ› ¤ÌÂÙÔÈ/ ÎÔÈÏȷ΋ËÌÈÎÚ·Ó›· Û Ӌȷ Î·È ÌÈÎÚ¿ ·È‰È¿, Ë ·ÎÂÊ·ÏÁÈ΋ËÌÈÎÚ·Ó›· Î·È Ë ÔÍ›· Û˘Á¯˘ÙÈ΋ ËÌÈÎÚ·Ó›· Û ÌÂ-Á·Ï‡ÙÂÚ· ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜. ∏ ËÏÈÎȷ΋ ηٷÓÔ-Ì‹ ÙˆÓ ‰È·ÊfiÚˆÓ ËÌÈÎÚ·ÓÈÎÒÓ ÈÛÔ‰‡Ó·ÌˆÓ ›ӷȯ·Ú·ÎÙËÚÈÛÙÈ΋ Î·È Ê·›ÓÂÙ·È Ó· ÂÎÊÚ¿˙ÂÈ ÙËÓ Â›-‰Ú·ÛË Ù˘ ·Ó¿Ù˘Í˘ ÛÙË ÁÂÓÂÙÈ΋ ¤ÎÊÚ·ÛË Ù˘ÚԉȿıÂÛ˘ ÁÈ· ËÌÈÎÚ·Ó›·. ¶·Ú¿ ÙËÓ ÂÓÙ˘ˆÛÈ·-΋ Î·È ¯·Ú·ÎÙËÚÈÛÙÈ΋ ÙÔ˘˜ Û˘Ìو̷ÙÔÏÔÁ›·, Ù·ËÌÈÎÚ·ÓÈο ÈÛÔ‰‡Ó·Ì· Ê·›ÓÂÙ·È fiÙÈ ˘Ô‰È·ÁÈÁÓÒ-ÛÎÔÓÙ·È. ™˘Ó‹ıˆ˜ ÚÔËÁÂ›Ù·È Ï‹ıÔ˜ ÂÚÁ·ÛÙËÚÈ·-ÎÒÓ ÂÍÂÙ¿ÛÂˆÓ ÁÈ· ÙÔÓ ·ÔÎÏÂÈÛÌfi ¿ÏÏˆÓ ÛÔ‚·-ÚÒÓ Î·Ù·ÛÙ¿ÛÂˆÓ Î·È Ë Û˘Û¯¤ÙÈÛË Ì ÙËÓ ËÌÈÎÚ·-Ó›· ‰ÂÓ ·Ó·ÁÓˆÚ›˙ÂÙ·È ÙÂÏÈο. ™‡Ìʈӷ Ì Úfi-ÛÊ·Ù· ‰Â‰Ô̤ӷ, Ë Û˘¯ÓfiÙËÙ· ÙˆÓ ËÌÈÎÚ·ÓÈÎÒÓÈÛÔ‰‡Ó·ÌˆÓ ·Ó¤Ú¯ÂÙ·È ÛÙÔ 1,8% ÙÔ˘ ÁÂÓÈÎÔ‡ ·È‰È-ÎÔ‡ ÏËı˘ÛÌÔ‡ Î·È ÛÙÔ 10% ÙˆÓ ·È‰ÈÒÓ Ì ËÌÈ-ÎÚ·Ó›·. °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi, ıˆÚÂ›Ù·È ÛÎfiÈÌË ËÂÓË̤ڈÛË ÙˆÓ ·È‰È¿ÙÚˆÓ ÁÈ· ÙËÓ ·Ó·ÁÓÒÚÈÛË·˘Ù‹˜ Ù˘ Û¯ÂÙÈο Û˘¯Ó‹˜ ·Ú·ÏÏ·Á‹˜ Ù˘ ËÌÈ-ÎÚ·Ó›·˜, Ì ÛÎÔfi fi¯È ÌfiÓÔ ÙÔÓ ÂÚÈÔÚÈÛÌfi ÙˆÓÂÍÂÙ¿ÛˆÓ, ·ÏÏ¿ Î·È ÙËÓ ·ÔÊ˘Á‹ ÂÚÈÙÙÔ‡ ¿Á-¯Ô˘˜ Î·È ·ÓËÛ˘¯›·˜ ÛÙ· ›‰È· Ù· ·È‰È¿ Î·È ÙȘ ÔÈÎÔ-Á¤ÓÂȤ˜ ÙÔ˘˜.

§¤ÍÂȘ ÎÏÂȉȿ: ËÌÈÎÚ·ÓÈο ÈÛÔ‰‡Ó·Ì·, Úfi‰ÚÔÌ·ËÌÈÎÚ·Ó›·˜, ËÌÈÎÚ·Ó›· ÛÙ· ·È‰È¿.

�Abstract: Migraine equivalents are clinicalconditions with a periodic paroxysmal character, abenign prognosis and an aetiological relationship tomigraine based on a strong positive family and/orpast medical history of migraine. Five suchequivalents are presently recognized: benignparoxysmal vertigo in infancy, benign paroxysmalvertigo and cyclical vomiting/ abdominal migraine intoddlers and young children and acephalgic andacute confusional migraine in late childhood toadolescence. The age distribution of migraineequivalents is characteristic and seems to reflectthe influence of the developmental process on theexpression of an inherited migrainouspredisposition. Despite the impressive anddistinctive clinical symptomatology, the diagnosis isusually missed. In most cases an extensivediagnostic work-up for the exclusion of otherserious conditions has been conducted, but therelationship with migraine is not always recognized.According to recent data the observed incidence ofmigraine equivalents is up to 1.8% of the totalpaediatric population and 10% of migrainesufferers. It is therefore important for paediatriciansto be aware of these relative common migrainesubtypes not only for limiting the number of testsbut also for avoiding unnecessary anxiety inchildren and their families.

Key words: migraine equivalents, migraineprecursors, migraine and children.

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

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

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·218

Page 76: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

219

¶·È‰È·ÙÚÈ΋ 2004;67:218-222 Paediatriki 2004;67:218-222

∂ÈÛ·ÁˆÁ‹ ªÂ ÙÔÓ fiÚÔ “ËÌÈÎÚ·ÓÈο ÈÛÔ‰‡Ó·Ì·” ÂÚÈÁÚ¿-

ÊÔÓÙ·È ÂÚÈÔ‰Èο ·ÚÔ͢ÛÌÈο Û‡Ó‰ÚÔÌ· ¯ˆÚ›˜¤ÓÙÔÓË Û˘ÓÔ‰fi ÎÂÊ·Ï·ÏÁ›·, Ù· ÔÔ›· ÂÌÊ·Ó›˙Ô˘Ó·ÈÙÈÔÏÔÁÈ΋ Û¯¤ÛË Ì ÙËÓ ËÌÈÎÚ·Ó›·. ÕÏÏÔÈ fiÚÔÈÁÈ· ·˘Ù¤˜ ÙȘ ·ÙÂÏÒ˜ ÚÔÛ‰ÈÔÚÈÛı›Û˜ ‰È·Ù·Ú·-¯¤˜ Â›Ó·È “Úfi‰ÚÔÌ· ËÌÈÎÚ·Ó›·˜” ‹ “ÂÚÈÔ‰ÈοۇӉÚÔÌ· Ù˘ ·È‰È΋˜ ËÏÈΛ·˜” (1,2). ¶¤ÓÙ ٤ÙÔÈ· Û‡Ó‰ÚÔÌ· ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› Ì ۯÂÙÈ΋۷ʋÓÂÈ· ÛÙËÓ ·È‰È΋ ËÏÈΛ·: ÙÔ Î·ÏfiËı˜ ·ÚÔ-͢ÛÌÈÎfi Ú·È‚fiÎÚ·ÓÔ (3,4), Ô Î·ÏÔ‹ı˘ ·ÚÔ͢-ÛÌÈÎfi˜ ›ÏÈÁÁÔ˜ (5-7), Ë ÎÔÈÏȷ΋ ËÌÈÎÚ·Ó›·/ ΢ÎÏÈ-ÎÔ› ¤ÌÂÙÔÈ (8-12), Ë ÔÍ›· Û˘Á¯˘ÙÈ΋ ËÌÈÎÚ·Ó›· (13-15) Î·È Ë ·ÎÂÊ·ÏÁÈ΋ ËÌÈÎÚ·Ó›· (16,17). ¶Úfi-ÎÂÈÙ·È ÁÈ· ÎÏÈÓÈΤ˜ ÔÓÙfiÙËÙ˜ Ì ÂÓÙ˘ˆÛȷ΋ Û˘-Ìو̷ÙÔÏÔÁ›·, ÔÈ Ôԛ˜ ¤¯Ô˘Ó ·Ó·ÁÓˆÚÈÛÙ›ÚÔ ‰ÂηÂÙÈÒÓ Î·È ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ηχÙÂÚ· ÛÂÚfiÛÊ·Ù˜ ÌÂϤÙ˜. ∏ ·ÈÙÈÔÏÔÁÈ΋-·ıÔÁÂÓÂÙÈ΋ۯ¤ÛË ·˘ÙÒÓ ÙˆÓ ÂÚÈÔ‰ÈÎÒÓ ÎÏÈÓÈÎÒÓ Û˘Ó‰ÚfïÓÌ ÙËÓ ËÌÈÎÚ·Ó›· ÛÙËÚ›¯ıËΠÛÙÔÓ ·ÚÔ͢ÛÌÈÎfiÙÔ˘˜ ¯·Ú·ÎÙ‹Ú·, ÛÙËÓ ·Ô˘Û›· ˘ÔÏÂÈÌÌ·ÙÈÎÒÓ‚Ï·‚ÒÓ, ÛÙÔ ÈÛ¯˘Úfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ËÌÈ-ÎÚ·Ó›·˜, ÛÙËÓ ÂÌÊ¿ÓÈÛË Û ·ÒÙÂÚÔ ¯ÚfiÓÔ Ù˘È-΋˜ ËÌÈÎÚ·Ó›·˜ Î·È ÛÙȘ ÔÌÔÈfiÙËÙ˜ Ì ·ÓÙ›ÛÙÔȯ·ËÌÈÎÚ·ÓÈο Û‡Ó‰ÚÔÌ· ÙˆÓ ÂÓËÏ›ÎˆÓ (1,2). ÷ڷ-ÎÙËÚÈÛÙÈ΋ Â›Ó·È Ë ÂΉ‹ÏˆÛË ÙˆÓ ÂÈ̤ÚÔ˘˜ Û˘Ó‰ÚfiÌˆÓ ÛÂ Û˘ÁÎÂÎÚÈ̤Ó˜ ËÏÈÎȷΤ˜ ÔÌ¿‰Â˜(ÙÔ Î·ÏfiËı˜ ·ÚÔ͢ÛÌÈÎfi Ú·È‚fiÎÚ·ÓÔ ÛÙ· ‚Ú¤-ÊË, Ô Î·ÏÔ‹ı˘ ·ÚÔ͢ÛÌÈÎfi˜ ›ÏÈÁÁÔ˜ Î·È Ë ÎÔÈ-Ïȷ΋ ËÌÈÎÚ·Ó›·/ ΢ÎÏÈÎÔ› ¤ÌÂÙÔÈ ÛÙË ÓËȷ΋ ηÈÚÒÙË ·È‰È΋ ËÏÈΛ· Î·È Ë ·ÎÂÊ·ÏÁÈ΋ Î·È ÔÍ›·Û˘Á¯˘ÙÈ΋ ËÌÈÎÚ·Ó›· ÛÙË ‰Â‡ÙÂÚË ·È‰È΋ ηÈÚÔÂÊË‚È΋ ËÏÈΛ·), Ë ÔÔ›· ·ÓÙÈηÙÔÙÚ›˙ÂÈ Èı·-ÓfiÓ ÙËÓ Â›‰Ú·ÛË Ù˘ ·Ó·Ù˘Íȷ΋˜ ‰È·‰Èηۛ·˜ÛÙËÓ ¤ÎÊÚ·ÛË Ù˘ ÁÂÓÂÙÈ΋˜ ÚԉȿıÂÛ˘ ÁÈ·ËÌÈÎÚ·Ó›· (2).

¶ÂÚÈÁÚ·Ê‹ ËÌÈÎÚ·ÓÈÎÒÓ ÈÛÔ‰‡Ó·ÌˆÓ ∫·ÏfiËı˜ ·ÚÔ͢ÛÌÈÎfi Ú·È‚fiÎÚ·ÓÔ Ù˘ ‚ÚÂ-

ÊÈ΋˜ ËÏÈΛ·˜ ∆Ô Î·ÏfiËı˜ ·ÚÔ͢ÛÌÈÎfi Ú·È‚fiÎÚ·ÓÔ

(benign paroxysmal torticollis) ÂÌÊ·Ó›˙ÂÙ·È Û˘Ó‹-ıˆ˜ ÛÙÔ Ù¤ÏÔ˜ ÙÔ˘ ÚÒÙÔ˘ ¯ÚfiÓÔ˘ ˙ˆ‹˜, ÌÂÔÚȷ΋ ËÏÈΛ· 2 ÌËÓÒÓ ¤ˆ˜ 3 ÂÙÒÓ (2,4). ¶·ÚÔ˘-ÛÈ¿˙ÂÙ·È Ì ÎÏ›ÛË Ù˘ ÎÂÊ·Ï‹˜ ÚÔ˜ ÙËÓ ›‰È· ‹ ÙËÓ·ÓÙ›ıÂÙË ÏÂ˘Ú¿, Ô˘ ·Ô‰›‰ÂÙ·È Û ‰˘ÛÙÔÓ›· ÙÔ˘·˘¯¤Ó· (18) Î·È ÌÔÚ› Ó· Û˘Óԉ‡ÂÙ·È ·fi ˆ¯Úfi-ÙËÙ·, ¤ÌÂÙÔ ‹ ‰È·Ù·Ú·¯¤˜ Û˘ÌÂÚÈÊÔÚ¿˜. OÈ ÎÚ›-ÛÂȘ ‰È·ÚÎÔ‡Ó ·fi Ï›Á˜ ÒÚ˜ ¤ˆ˜ 4 Ë̤Ú˜ Î·È˘Ô¯ˆÚÔ‡Ó ÌfiÓÔ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘. ∏Û˘¯ÓfiÙËÙ· ÙˆÓ ÂÂÈÛÔ‰›ˆÓ ÂÏ·ÙÙÒÓÂÙ·È ÚÔԉ¢-ÙÈο, ÂÓÒ ÛÙ·Ì·ÙÔ‡Ó Ì¤¯ÚÈ ÙËÓ ËÏÈΛ· ÙˆÓ 5 ÂÙÒÓ,ÁÈ· Ó· ·ÓÙÈηٷÛÙ·ıÔ‡Ó Èı·ÓfiÓ ·fi ÂÂÈÛfi‰È·

·ÚÔ͢ÛÌÈÎÔ‡ ÈÏ›ÁÁÔ˘ ‹ ËÌÈÎÚ·Ó›·˜ (4,19). O·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Â›Ó·È ··-Ú·›ÙËÙÔ˜ ÁÈ· Ó· ·ÔÎÏÂÈÛÙ› ¯ˆÚÔηٷÎÙËÙÈ΋ÂÍÂÚÁ·Û›· ÙÔ˘ Ô›ÛıÈÔ˘ ÎÚ·ÓÈ·ÎÔ‡ ‚fiıÚÔ˘ (19).

∏ ıÂڷ›· Â›Ó·È Û˘Ìو̷ÙÈ΋ Î·È ·ÊÔÚ¿ÛÙËÓ Î·Ù·ÛÙÔÏ‹ ÙÔ˘ ÈÔ ¤ÓÙÔÓÔ˘ ÂÓԯϋ̷ÙÔ˜.¢ÂÓ ˘¿Ú¯Ô˘Ó ·Ó·ÊÔÚ¤˜ ÁÈ· ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfi-ÙËÙ· Ù˘ ÚÔÊ˘Ï·ÎÙÈ΋˜ ·ÁˆÁ‹˜, Ì ÂÍ·›ÚÂÛˤӷ ÌÂÌÔӈ̤ÓÔ ÂÚÈÛÙ·ÙÈÎfi, ÛÙÔ ÔÔ›Ô ¯ÔÚËÁ‹-ıËΠÈ˙ÔÙÈÊ·›ÓÈÔ (Mosegor), ·ÎÂÙ·˙ÔÏ·Ì›‰Ë ηÈÊÏÔ˘Ó·ÚÈ˙›ÓË (Sibelium) ¯ˆÚ›˜ ·ÓÙ·fiÎÚÈÛË (19).

∫·ÏÔ‹ı˘ ·ÚÔ͢ÛÌÈÎfi˜ ›ÏÈÁÁÔ˜ Ù˘ ·È‰È΋˜ËÏÈΛ·˜

O ηÏÔ‹ı˘ ·ÚÔ͢ÛÌÈÎfi˜ ›ÏÈÁÁÔ˜ Ù˘ ·È‰È-΋˜ ËÏÈΛ·˜ (benign paroxysmal vertigo) ¯·Ú·ÎÙË-Ú›˙ÂÙ·È ·fi ‚Ú·¯Â›·˜ ‰È¿ÚÎÂÈ·˜ ÂÂÈÛfi‰È· ÈÏ›ÁÁÔ˘Û ˘ÁÈ‹ ·È‰È¿. ∂ΉËÏÒÓÂÙ·È ÛÙËÓ ËÏÈΛ· ÙˆÓ 2-5ÂÙÒÓ. ∆· ÂÂÈÛfi‰È· ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ·ÛÙ¿-ıÂÈ·, ˆ¯ÚfiÙËÙ· Î·È Êfi‚Ô, ‰È·ÚÎÔ‡Ó 1-5 ÏÂÙ¿ ηÈÛÙȘ Ù˘ÈΤ˜ ÂÚÈÙÒÛÂȘ ˘Ô¯ˆÚÔ‡Ó ‰‡Ô ¯ÚfiÓÈ·ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍ‹ ÙÔ˘˜ (6,7). ∞Ó¿ÏÔÁË ÎÏÈÓÈ΋ ÂÈÎfi-Ó· ÛÙÔ˘˜ ÂÓ‹ÏÈΘ ·Ó·Ê¤ÚÂÙ·È ˆ˜ “ÔÈÎÔÁÂÓ‹˜ η-ÏÔ‹ı˘ ˘ÔÙÚÔÈ¿˙ˆÓ ›ÏÈÁÁÔ˜” (familial benignrecurrent vertigo) Î·È ıˆÚÂ›Ù·È fiÙÈ ÔÊ›ÏÂÙ·È ÛÂÁÂÓÂÙÈ΋ ‰È·Ù·Ú·¯‹ Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ ÙˆÓ ‰È·‡ÏˆÓCa++ (20). O ›ÏÈÁÁÔ˜ ·Ú·ÙËÚÂ›Ù·È ÛÙÔ 25% ÙˆÓÂÓËÏ›ÎˆÓ ·ÛıÂÓÒÓ Ì ËÌÈÎÚ·Ó›· (21).

∏ ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ·fi ÔÚÁ·ÓÈο ·›ÙÈ· Â-ÚÈÊÂÚÈÎÔ‡ Î·È ÎÂÓÙÚÈÎÔ‡ Ù‡Ô˘ ÈÏ›ÁÁÔ˘, fiˆ˜ Ì·-ÛÙÔÂȉ›Ùȉ·, ˆÙ›Ùȉ·, Ó¢ڛÙȉ· ÙÔ˘ ·ÈıÔ˘Û·›Ô˘,οΈÛË Ï·‚˘Ú›ÓıÔ˘, ¤ÌÊÚ·ÎÙÔ ÙÔ˘ ÚÔÌ‹ÎÔ˘˜ ‹Ù˘ ·ÚÂÁÎÂÊ·Ï›‰·˜ Î·È ·Ó¿ÚÎÂÈ· Ù˘ ÛÔÓ‰˘-ÏÔ‚·ÛÈ΋˜ Â›Ó·È ··Ú·›ÙËÙË. °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi,ÂӉ›ÎÓ˘Ù·È ¤ÏÂÁ¯Ô˜ Ì ·ÎÔfiÁÚ·ÌÌ·, ËÏÂÎÙÚÔÓ˘-ÛÙ·ÁÌÔÁÚ·Ê›· Î·È - Û οÔȘ ÂÚÈÙÒÛÂȘ - ÌÂMRI ÂÁÎÂÊ¿ÏÔ˘ (21,22).

∏ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ·Ú·ÙÂÙ·Ì¤ÓˆÓ ÎÚ›ÛˆÓÂ›Ó·È Û˘Ìو̷ÙÈ΋ Ì ¯ÔÚ‹ÁËÛË ·ÓÙÈÂÌÂÙÈÎÒÓ[ÌÂÙÔÎÏÔÚ·Ì›‰Ë (Primperan) ‹ ‰ÔÌÂÚȉfiÓË(Cilroton)] Î·È ·ÓÙÈ-ÈÏÈÁÁÈÎÒÓ Ê·ÚÌ¿ÎˆÓ [‰ÈÌÂÓ˘-‰ÚÈÓ¿ÙË (Vomex) ‹ ‰ÈÊ·ÈÓ˘‰Ú·Ì›ÓË (Benadryl)],ÂÓÒ fiÙ·Ó ÔÈ ÎÚ›ÛÂȘ Â›Ó·È Û˘¯Ó¤˜ ÂӉ›ÎÓ˘Ù·È Ë ‰Ô-ÎÈÌ·ÛÙÈ΋ ¯ÔÚ‹ÁËÛË ÚÔÊ˘Ï·ÎÙÈ΋˜ ·ÁˆÁ‹˜ ÌÂÊ¿Ú̷η fiˆ˜ ÙÔ È˙ÔÙÈÊ·›ÓÈÔ Î·È Ë ÚÔÚ·ÓÔÏfi-ÏË (1,22).

∫ÔÈÏȷ΋ ËÌÈÎÚ·Ó›· - ΢ÎÏÈÎÔ› ¤ÌÂÙÔÈ ∏ ÎÔÈÏȷ΋ ËÌÈÎÚ·Ó›· (abdominal migraine) ηÈ

ÔÈ Î˘ÎÏÈÎÔ› ¤ÌÂÙÔÈ (cyclical vomiting) ÂΉËÏÒÓÔ-ÓÙ·È Û ËÏÈΛ· 4-10 ÂÙÒÓ. OÈ Î˘ÎÏÈÎÔ› ¤ÌÂÙÔÈ ÂÌÊ·-Ó›˙ÔÓÙ·È Û˘Ó‹ıˆ˜ Û ÌÈÎÚfiÙÂÚË ËÏÈΛ· (5 ÂÙÒÓ) ÛÂÛ¯¤ÛË Ì ÙËÓ ÎÔÈÏȷ΋ ËÌÈÎÚ·Ó›· (7 ÂÙÒÓ) (10,11).™˘Ó‹ıˆ˜ ˘¿Ú¯ÂÈ ·ÏÏËÏÔÂÈÎ¿Ï˘„Ë ÙˆÓ ‰‡Ô Û˘Ó-‰ÚfiÌˆÓ Î·È ÁÈ· ÙÔÓ ÏfiÁÔ ·˘Ùfi ˘¿Ú¯ÂÈ Ë Ù¿ÛË Ó·

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·219

Page 77: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

ÂÚÈÁÚ¿ÊÔÓÙ·È Ì·˙› ÛÙËÓ ÚfiÛÊ·ÙË ‚È‚ÏÈÔÁÚ·Ê›·(12). ÷ڷÎÙËÚ›˙ÔÓÙ·È ·fi ÂÚÈÔÌÊ·ÏÈÎfi ¿ÏÁÔ˜,Ó·˘Ù›·, Û˘¯ÓÔ‡˜ Â̤ÙÔ˘˜, ˆ¯ÚfiÙËÙ· Î·È ÂËÚ·-Ṳ̂ÓË ÁÂÓÈ΋ ηٿÛÙ·ÛË, ÂÓÒ Ë ÎÂÊ·Ï·ÏÁ›· ÌÂÙËÓ ÚfiÔ‰Ô Ù˘ ËÏÈΛ·˜ ηı›ÛÙ·Ù·È ‚·ÛÈÎfi Û‡-Ìو̷ Î·È Ë ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÌÔÈ¿˙ÂÈ ÂÚÈÛÛfiÙÂÚÔÌÂ Ù˘È΋ ËÌÈÎÚ·Ó›· (12). ∏ ‰È¿ÚÎÂÈ· ÙˆÓ ÂÂÈÛÔ-‰›ˆÓ Â›Ó·È ·ÚÎÂÙ¤˜ ÒÚ˜ ‹ Î·È Ë̤Ú˜, ·ÏÏ¿ Ë ‰È·-ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ı· Ú¤ÂÈ Ó· Â›Ó·È Ôχ ÚÔÛÂ-ÎÙÈ΋, ÂÓÒ È‰È·›ÙÂÚË ÛËÌ·Û›· ¤¯ÂÈ Ô ·ÔÎÏÂÈÛÌfi˜ÌÂÙ·‚ÔÏÈÎÒÓ, ¯ÂÈÚÔ˘ÚÁÈÎÒÓ ‹ ¿ÏÏˆÓ ·ÈÙ›ˆÓ ˘Ô-ÙÚÔÈ·˙fiÓÙˆÓ ÂÌ¤ÙˆÓ ‹ ÎÔÈÏÈ·ÎÔ‡ ¿ÏÁÔ˘˜ (23).

π‰È·›ÙÂÚË ÛËÌ·Û›· ¤¯ÂÈ Ë ‰È·Ù‹ÚËÛË ÙÔ˘ ÈÛÔ˙˘-Á›Ô˘ ˘ÁÚÒÓ Î·È ËÏÂÎÙÚÔÏ˘ÙÒÓ Ì ÙËÓ ·ÚÂÓÙÂÚÈ΋¯ÔÚ‹ÁËÛË ˘ÁÚÒÓ ÛÙ· ÛÔ‚·Ú¿ ÂÂÈÛfi‰È·. ∏ ¯ÔÚ‹-ÁËÛË ·ÓÙÈÂÌÂÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ ·Ó·ÎÔ˘Ê›˙ÂÈ ÙÔ ·È-‰› ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÎÚ›Û˘, ÂÓÒ fiÙ·Ó Ù· ÂÂÈ-Ûfi‰È· Â›Ó·È Û˘¯Ó¿ ÂӉ›ÎÓ˘Ù·È Ë ‰ÔÎÈÌ·ÛÙÈ΋ ¯Ô-Ú‹ÁËÛË ÚÔÊ˘Ï·ÎÙÈ΋˜ ·ÁˆÁ‹˜ (1,12,23).

OÍ›· Û˘Á¯˘ÙÈ΋ ËÌÈÎÚ·Ó›· ∏ ÔÍ›· Û˘Á¯˘ÙÈ΋ ËÌÈÎÚ·Ó›· (acute

confusional migraine) Â›Ó·È Ì›· ÂÓÙ˘ˆÛȷ΋ ÎÏÈÓÈ-΋ ÔÓÙfiÙËÙ·. ∂ÌÊ·Ó›˙ÂÙ·È Û ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿(6,5-15 ÂÙÒÓ) Î·È Â›Ó·È Û˘¯ÓfiÙÂÚË ÛÙ· ·ÁfiÚÈ·. ∏Û˘¯ÓfiÙËÙ· ÙˆÓ ÎÚ›ÛÂˆÓ Â›Ó·È ¯·ÌËÏ‹ Î·È Û˘Ó‹ıˆ˜·ÔÙÂÏ› ÙËÓ ·Ú¯È΋ ÂΉ‹ÏˆÛË Ù˘ ÚԉȿıÂÛ˘ÁÈ· ËÌÈÎÚ·Ó›· ÛÙÔ ·È‰›, ÁÂÁÔÓfi˜ Ô˘ ηıÈÛÙ¿ ‰‡-ÛÎÔÏË ÙËÓ ÚÒÈÌË ‰È¿ÁÓˆÛ‹ Ù˘. ™˘¯Ó¿ ·Ó·Ê¤ÚÂ-Ù·È ÚfiÛÊ·ÙÔ (Ï›Á˜ ÒÚ˜ ¤ˆ˜ 4 Ë̤Ú˜), ‹ÈÔÙÚ·‡Ì· ÎÂÊ·Ï‹˜. ∆Ô ·È‰› ÂÌÊ·Ó›˙ÂÙ·È Û˘Á¯˘ÙÈÎfi,·Ó‹Û˘¯Ô Î·È ¤¯ÂÈ ¤ÓÙÔÓ˜ ‰È·Ù·Ú·¯¤˜ ÌÓ‹Ì˘. ∏ÎÂÊ·Ï·ÏÁ›·, ·Ó ˘¿Ú¯ÂÈ, Û¿ÓÈ· ·Ó·ÁÓˆÚ›˙ÂٷȈ˜ ‚·ÛÈÎfi Û‡Ìو̷ Î·È Û˘Ó‹ıˆ˜ ÚÔËÁÂ›Ù·È ÙË˜Û˘Á¯˘ÙÈ΋˜ Ê¿Û˘. ∆· ÂÂÈÛfi‰È· ‰È·ÚÎÔ‡Ó Û˘Ó‹-ıˆ˜ ·fi Ï›Á˜ ÒÚ˜ ¤ˆ˜ Î·È ¤Ó· 24ˆÚÔ. ∆Ô ıÂÙÈ-Îfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ËÌÈÎÚ·Ó›·˜ Â›Ó·È ˘„ËÏfiÎ·È Û˘Ó‹ıˆ˜ ·fi ÙËÓ ÏÂ˘Ú¿ Ù˘ ÌËÙ¤Ú·˜. ∏ ·ÓÙÈ-ÌÂÙÒÈÛË ÙˆÓ ÎÚ›ÛÂˆÓ Â›Ó·È Û˘Ìو̷ÙÈ΋, ·ÏÏ¿ÚÔ¤¯ÂÈ Ë ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ·fi ¿ÏÏ· ·›ÙÈ·Ô˘ ··ÈÙÔ‡Ó ¿ÌÂÛË Î·È ÂȉÈ΋ ·ÓÙÈÌÂÙÒÈÛË,fiˆ˜ Ë ‰ËÏËÙËÚ›·ÛË ·fi Ê¿Ú̷η Î·È ÙÔÍÈΤ˜Ô˘Û›Â˜, ÔÈ ÌÂÙ·‚ÔÏÈΤ˜ Î·È ÈÔÁÂÓ›˜ ÂÁÎÂÊ·ÏÔ¿-ıÂȘ, ·ÏÏ¿ Î·È ÔÈ ÎÚ›ÛÂȘ ÈÓȷ΋˜ Î·È ÎÚÔÙ·ÊÈ΋˜ÂÈÏË„›·˜ Î·È ÔÈ „˘¯ÔÁÂÓ›˜ ηٷÛÙ¿ÛÂȘ (14,15).

AÎÂÊ·ÏÁÈ΋ ËÌÈÎÚ·Ó›· ∏ ·ÎÂÊ·ÏÁÈ΋ ËÌÈÎÚ·Ó›· (acephalgic migraine)

·Ú·ÙËÚÂ›Ù·È Û ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿ ËÏÈΛ·˜ 5-12ÂÙÒÓ. ÷ڷÎÙËÚ›˙ÂÙ·È ·fi Ù˘ÈΤ˜ ËÌÈÎÚ·ÓÈΤ˜·‡Ú˜ ¯ˆÚ›˜ ÎÂÊ·Ï·ÏÁ›·. ∂›Ó·È Û¯ÂÙÈο Û˘¯Ó‹ÌÔÚÊ‹ ËÌÈÎÚ·ÓÈÎÒÓ ÈÛÔ‰‡Ó·ÌˆÓ Ô˘ ·Ó¤Ú¯ÂÙ·ÈÛÙÔ 2% ÙˆÓ ËÌÈÎÚ·ÓÈÎÒÓ ·È‰ÈÒÓ. OÈ ·ÛıÂÓ›˜·Ó·Ê¤ÚÔ˘Ó ‰È·Ù·Ú·¯¤˜ Ù˘ ÔÙÈ΋˜ ·ÓÙ›Ï˄˘,·Ú·ÌÔÚÊÒÛÂȘ Ù˘ ÂÈÎfiÓ·˜ ÙÔ˘ ÛÒÌ·Ùfi˜ ÙÔ˘˜,·›ÛıËÌ· ÏÈÏÈÔ‡ÙÂÈÔ˘ Á›Á·ÓÙ·, ÎÈÓËÌ·ÙÔÁÚ·ÊÈ΋fiÚ·ÛË Ô˘ Û˘Ó›ÛÙ·Ù·È Û ·›ÛıËÌ· ÂÈÙ¿¯˘ÓÛ˘ ‹¿ÁˆÌ· Ù˘ ÂÈÎfiÓ·˜, ˘ÂÚ·ÎÔ˘Û›· Î.¿. (17). ∏ ·ÎÂÊ·ÏÁÈ΋ ËÌÈÎÚ·Ó›· ·Ó·Ê¤ÚÂÙ·È Î·È ˆ˜ “Û‡Ó-‰ÚÔÌÔ ∞Ï›Î˘ ÛÙË ¯ÒÚ· ÙˆÓ ı·˘Ì¿ÙˆÓ” ·fi ÙÔÁÓˆÛÙfi ·È‰ÈÎfi Ì˘ıÈÛÙfiÚËÌ· ÙÔ˘ Lewis Carroll,ÙÔ˘ ÔÔ›Ô˘ ÔÈ ÂÚÈÁڷʤ˜ ·Ô‰›‰ÔÓÙ·È ÛÙËÓ ÚÔ-ÛˆÈ΋ ÙÔ˘ ÂÌÂÈÚ›· ·fi ËÌÈÎÚ·ÓÈΤ˜ ÎÚ›ÛÂȘ(16). ∆· ÂÂÈÛfi‰È· ‰È·ÚÎÔ‡Ó Û˘Ó‹ıˆ˜ ¤ˆ˜ 10 ÏÂ-Ù¿, ÂÓÒ ‰ÂÓ ¤¯ÂÈ ·Ó·ÊÂÚı› ‰È¿ÚÎÂÈ· ÌÂÁ·Ï‡ÙÂÚË·fi 1 ÒÚ·. ∏ ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ÂÚÈÏ·Ì‚¿ÓÂÈÙȘ ›‰È˜ ηٷÛÙ¿ÛÂȘ Ô˘ ·Ó·Ê¤ÚıËÎ·Ó ÛÙËÓÔÍ›· Û˘Á¯˘ÙÈ΋ ËÌÈÎÚ·Ó›·. ∏ ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆ-ÛË ·fi ÙËÓ ÔÍ›· Û˘Á¯˘ÙÈ΋ ËÌÈÎÚ·Ó›· ‚·Û›˙ÂÙ·ÈÛÙËÓ ·Ô˘Û›· Ù˘ ÎÂÊ·Ï·ÏÁ›·˜ ÛÙËÓ ·ÎÂÊ·ÏÁÈ΋ËÌÈÎÚ·Ó›·, ÛÙË ‰È¿ÚÎÂÈ· Î·È ÙË Û˘¯ÓfiÙËÙ· ÙˆÓ ÎÚ›ÛÂˆÓ (17).

™˘˙‹ÙËÛË À¿Ú¯Ô˘Ó ÂӉ›ÍÂȘ fiÙÈ Ù· ËÌÈÎÚ·ÓÈο ÈÛÔ‰‡Ó·-

Ì· ·ÔÙÂÏÔ‡Ó ¤Ó· Û˘¯Ófi Úfi‚ÏËÌ· ÛÙ· ·È‰È¿ ηÈÈı·ÓfiÓ ˘Ô‰È·ÁÈÁÓÒÛÎÔÓÙ·È. Œˆ˜ ÙËÓ ÚfiÛÊ·ÙË·Ó·ÛÎÔÈ΋ ÌÂϤÙË ÙˆÓ Al-Twaijri Î·È Shevell (2),‰ÂÓ ˘‹Ú¯·Ó ÛÙÔȯ›· ÁÈ· ÙË Û˘¯ÓfiÙËÙ· ÙˆÓ ËÌÈ-ÎÚ·ÓÈÎÒÓ ÈÛÔ‰‡Ó·ÌˆÓ ÛÙÔÓ ·È‰ÈÎfi ÏËı˘ÛÌfi. ™Â¤Ó· ‰Â›ÁÌ· 5848 ·ÛıÂÓÒÓ Ô˘ ÂÈÛΤÊıËÎ·Ó ∂͈-ÙÂÚÈÎfi ¶·È‰ÔÓ¢ÚÔÏÔÁÈÎfi π·ÙÚ›Ô, ÂÎ ÙˆÓ ÔÔ›ˆÓ1106 Ì ËÌÈÎÚ·Ó›·, ‚Ú¤ıËÎ·Ó 108 ·È‰È¿ Ì ٷÚÔ·Ó·ÊÂÚı¤ÓÙ· ¤ÓÙ ËÌÈÎÚ·ÓÈο Û‡Ó‰ÚÔÌ·,·ÚÈıÌfi˜ Ô˘ ·ÓÙÈÛÙÔȯ› Û 1,8% ÙÔ˘ Û˘ÓfiÏÔ˘ ‹9,8% ÙˆÓ ËÌÈÎÚ·ÓÈÎÒÓ ·È‰ÈÒÓ (2). ™ÙËÓ ›‰È· ÌÂϤ-ÙË, Ô Î·ÏÔ‹ı˘ ·ÚÔ͢ÛÌÈÎfi˜ ›ÏÈÁÁÔ˜ Î·È Ë ·ÎÂ-Ê·ÏÁÈ΋ ËÌÈÎÚ·Ó›· ·ÓÙÈÚÔÛÒ¢·Ó Ù· 2/3 ÙˆÓËÌÈÎÚ·ÓÈÎÒÓ ÈÛÔ‰‡Ó·ÌˆÓ, ÂÓÒ ÙÔ ıÂÙÈÎfi ÔÈÎÔÁÂ-ÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ËÌÈÎÚ·Ó›·˜ Î˘Ì·ÈÓfiÙ·Ó ·fi 65%

¶›Ó·Î·˜ 1. ∫ÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ËÌÈÎÚ·ÓÈÎÒÓ ÈÛÔ‰‡Ó·ÌˆÓ

∆‡Ô˜ ËÌÈÎÚ·ÓÈÎÔ‡ ™˘¯ÓfiÙËÙ· ∏ÏÈΛ· ÂΉ‹ÏˆÛ˘ OÈÎÔÁÂÓÂÈ·Îfi ™˘Ó˘¿Ú¯Ô˘Û· ÈÛÔ‰‡Ó·ÌÔ˘ (¡=108) ÈÛÙÔÚÈÎfi ËÌÈÎÚ·Ó›·˜ Ù˘È΋ ËÌÈÎÚ·Ó›·

∫·ÏÔ‹ı˘ ·ÚÔ͢ÛÌÈÎfi˜ ›ÏÈÁÁÔ˜ 38% 5 ¤ÙË (1-13 ÂÙÒÓ) 68% 10%∞ÎÂÊ·ÏÁÈ΋ ËÌÈÎÚ·Ó›· 28,7% 6,8 ¤ÙË (5-14 ÂÙÒÓ) 70% 48%∫ÔÈÏȷ΋ ËÌÈÎÚ·Ó›·/ ΢ÎÏÈÎÔ› ¤ÌÂÙÔÈ 18,5% 6,5 ¤ÙË (9 ÌËÓÒÓ-13 ÂÙÒÓ) 65% 70%∫·ÏfiËı˜ ·ÚÔ͢ÛÌÈÎfi Ú·È‚fiÎÚ·ÓÔ 10,2% 1,17 ¤ÙË (2 ÌËÓÒÓ-3 ÂÙÒÓ) 73% 18%OÍ›· Û˘Á¯˘ÙÈ΋ ËÌÈÎÚ·Ó›· 4,6% 10,9 ¤ÙË (6,5-15 ÂÙÒÓ) 100% 20%

220

¶·È‰È·ÙÚÈ΋ 2004;67:218-222 Paediatriki 2004;67:218-222

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·220

Page 78: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

221

¶·È‰È·ÙÚÈ΋ 2004;67:218-222 Paediatriki 2004;67:218-222

ÁÈ· ÙËÓ ÎÔÈÏȷ΋ ËÌÈÎÚ·Ó›·/ ΢ÎÏÈÎÔ‡˜ Â̤ÙÔ˘˜,¤ˆ˜ 100% ÁÈ· ÙË Û˘Á¯˘ÙÈ΋ ËÌÈÎÚ·Ó›· (¶›Ó·Î·˜ 1).

¢Â‰Ô̤Ó˘ Ù˘ Û¯ÂÙÈο ˘„ËÏ‹˜ Û˘¯ÓfiÙËÙ·˜ÛÙÔÓ ÁÂÓÈÎfi ·È‰È·ÙÚÈÎfi ÏËı˘ÛÌfi, Â›Ó·È ÛÎfiÈÌËË Â˘·ÈÛıËÙÔÔ›ËÛË ÙˆÓ ·È‰È¿ÙÚˆÓ ÁÈ· ÙË ‰È¿-ÁÓˆÛË ·˘ÙÒÓ ÙˆÓ Î·Ù·ÛÙ¿ÛˆÓ. ™˘Ó‹ıˆ˜ ÚÔË-ÁÂ›Ù·È ¤Ó· Ï‹ıÔ˜ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛÂˆÓ Ïfi-Áˆ ÙˆÓ ÂÓÙ˘ˆÛÈ·ÎÒÓ Û˘ÌÙˆÌ¿ÙˆÓ Î·È ÙÔ˘ ÁÂ-ÁÔÓfiÙÔ˜ fiÙÈ Ë ËÌÈÎÚ·Ó›· Â›Ó·È ‰È¿ÁÓˆÛË Ô˘ Ù›ıÂ-Ù·È “ÂÍ ·ÔÎÏÂÈÛÌÔ‡” ¿ÏÏˆÓ ÛÔ‚·ÚfiÙÂÚˆÓ Î·Ù·-ÛÙ¿ÛˆÓ. ∏ ·Ó·ÁÓÒÚÈÛË ÙÔ˘ ËÌÈÎÚ·ÓÈÎÔ‡ ˘Ô-ÛÙÚÒÌ·ÙÔ˜ ‰ÂÓ Á›ÓÂÙ·È ¿ÓÙ· ·ÓÙÈÏËÙ‹ Î·È Ë ‰È¿-ÁÓˆÛË ÙÔ˘ ËÌÈÎÚ·ÓÈÎÔ‡ ÈÛÔ‰‡Ó·ÌÔ˘ ‰ÂÓ Ù›ıÂÙ·È,Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÚfiÎÏËÛË ¿ÛÎÔÔ˘ ¿Á¯Ô˘˜ÙfiÛÔ ÛÙ· ·È‰È¿ Ô˘ ‚ÈÒÓÔ˘Ó ÂÚ›ÂÚÁ· Û˘ÌÙÒ-Ì·Ù· fiÛÔ Î·È ÛÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘˜.

∏ ·ıÔÁ¤ÓÂÈ· ÙˆÓ ËÌÈÎÚ·ÓÈÎÒÓ ÈÛÔ‰‡Ó·ÌˆÓÛÙ· ·È‰È¿ ‰ÂÓ ¤¯ÂÈ ÌÂÏÂÙËı› Î·È ı· Ú¤ÂÈ Ì¿Ï-ÏÔÓ Ó· ·Ó·˙ËÙËı› ÛÙËÓ ·ıÔÁ¤ÓÂÈ· ·Ó¿ÏÔÁˆÓËÌÈÎÚ·ÓÈÎÒÓ Û˘Ó‰ÚfiÌˆÓ ÙˆÓ ÂÓËϛΈÓ. ™ÙËÓ Úfi-ÛÊ·ÙË ‚È‚ÏÈÔÁÚ·Ê›· ·Ó·Ê¤ÚÔÓÙ·È ÚÔÛ¿ıÂȘÁÂÓÂÙÈ΋˜ ÌÂϤÙ˘ Û ÔÈÎÔÁÂÓ‹ ËÌÈÎÚ·ÓÈο Û‡Ó-‰ÚÔÌ·. À¿Ú¯Ô˘Ó ÛÔ‚·Ú¤˜ ÂӉ›ÍÂȘ fiÙÈ ÙÔ ·ÚÔ-͢ÛÌÈÎfi Ú·È‚fiÎÚ·ÓÔ, Ô ·ÚÔ͢ÛÌÈÎfi˜ ›ÏÈÁÁÔ˜ ηÈοÔȘ ÌÔÚʤ˜ ËÌÈÎÚ·Ó›·˜ Â›Ó·È ÔÈÎÔÁÂÓ‹ ËÌÈ-ÎÚ·ÓÈο Û‡Ó‰ÚÔÌ·, Ù· ÔÔ›· Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì‰ȷٷڷ¯¤˜ Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ ÙˆÓ ‰È·‡ÏˆÓ ·Û‚Â-ÛÙ›Ô˘ (Ca channelopathy) (19-21,24). ªÂÙ·ÏÏ¿-ÍÂȘ ÛÙÔ ÁÔÓ›‰ÈÔ ÙˆÓ ‰È·‡ÏˆÓ Ca++, CACNA1A,Ô˘ ‰ڿ˙ÂÙ·È ÛÙÔ ¯ÚˆÌfiۈ̷ 19, ¤¯Ô˘Ó ‚ÚÂı›Û ·ÛıÂÓ›˜ Ì ÔÈÎÔÁÂÓ‹ ËÌÈÏËÁÈ΋ ËÌÈÎÚ·Ó›·,ÂÂÈÛԉȷ΋ ·Ù·Í›· Ù‡Ô˘ 2 (24) Î·È ÚfiÛÊ·Ù·ÛÙÔ Î·ÏfiËı˜ ·ÚÔ͢ÛÌÈÎfi Ú·È‚fiÎÚ·ÓÔ (19). º·›-ÓÂÙ·È fiÙÈ Ì›· ‰Â‰Ô̤ÓË ÌÂÙ¿ÏÏ·ÍË ÌÔÚ› Ó· ·-Ú¿ÁÂÈ ‰È·ÊÔÚÂÙÈΤ˜ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ Û ‰È·-ÊÔÚÂÙÈΤ˜ ËÏÈ˘, ÏfiÁˆ ÙÚÔÔÔ›ËÛ˘ Ù˘ ¤ÎÊÚ·Û˘ ÂÓfi˜ ÁÔÓȉ›Ô˘ ·fi ¿ÏÏ· ÁÔÓ›‰È·, ‚ÈÔ¯Ë-ÌÈΤ˜ ‹ Î·È ÔÚÌÔÓÈΤ˜ ·ÏÏ·Á¤˜, fiˆ˜ Ë ÂÌÌËÓ·Ú-¯‹. ∏ ÂΉ‹ÏˆÛË ÙˆÓ ÂÈ̤ÚÔ˘˜ Û˘Ó‰ÚfiÌˆÓ ÛÂÛ˘ÁÎÂÎÚÈ̤Ó˜ ËÏÈ˘ Èı·ÓfiÓ ·ÓÙÈηÙÔÙÚ›˙ÂÈÙËÓ Â›‰Ú·ÛË Ù˘ ·Ó·Ù˘Íȷ΋˜ ‰È·‰Èηۛ·˜ ÛÙËÓ ¤ÎÊÚ·ÛË Ù˘ ÁÂÓÂÙÈ΋˜ ÚԉȿıÂÛ˘ ÁÈ·ËÌÈÎÚ·Ó›· (2).

∏ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÂÂÈÛÔ‰›ˆÓ Â›Ó·È Û˘ÌÙˆ-Ì·ÙÈ΋, ΢ڛˆ˜ ÂÓ·ÓÙ›ÔÓ ÙÔ˘ ÚÔ¤¯ÔÓÙÔ˜ ÂÓԯϋ-Ì·ÙÔ˜ (¤ÌÂÙÔ˜, ›ÏÈÁÁÔ˜, ÎÂÊ·Ï·ÏÁ›·). °È· ÙË ıÂÚ·-›· ÙˆÓ ËÌÈÎÚ·ÓÈÎÒÓ ÈÛÔ‰‡Ó·ÌˆÓ ‰ÂÓ ˘¿Ú¯Ô˘ÓÂÎÙÂÓ›˜ ·Ó·ÊÔÚ¤˜ Î·È Û·Ê›˜ Û˘ÛÙ¿ÛÂȘ ÛÙË ‚È-‚ÏÈÔÁÚ·Ê›·, Ì ÂÍ·›ÚÂÛË ›Ûˆ˜ ÙÔÓ ·ÚÔ͢ÛÌÈÎfi›ÏÈÁÁÔ, ÙËÓ ÎÔÈÏȷ΋ ËÌÈÎÚ·Ó›· Î·È ÙÔ˘˜ ΢ÎÏÈÎÔ‡˜Â̤ÙÔ˘˜. ªfiÓÔ ÁÈ· ÙȘ ÂÚÈÙÒÛÂȘ ›ÌÔÓÔ˘ ÛÔ-‚·ÚÔ‡ ·ÚÔ͢ÛÌÈÎÔ‡ ÈÏ›ÁÁÔ˘ Î·È Î˘ÎÏÈÎÒÓ Â̤وÓÛ˘ÓÈÛÙ¿Ù·È Ë ‰ÔÎÈÌ·ÛÙÈ΋ ¯ÔÚ‹ÁËÛË Ê·Ú̿ΈÓ

ηٿ Ù˘ ËÌÈÎÚ·Ó›·˜, fiˆ˜ ÙÔ È˙ÔÙÈÊ·›ÓÈÔ(Mosegor 0,5-1,5 mg/∏, Û 1-2 ‰fiÛÂȘ) Î·È Ë ÚÔ-Ú·ÓÔÏfiÏË (Inderal 10 mg, 2-3 ÊÔÚ¤˜ ËÌÂÚËÛ›ˆ˜ÁÈ· ·È‰È¿ ËÏÈΛ·˜ 8-12 ÂÙÒÓ) Ì ıÂڷ¢ÙÈÎfi, ·Ï-Ï¿ Î·È ‰È·ÁÓˆÛÙÈÎfi ¯·Ú·ÎÙ‹Ú· (1,12,22,23).

µÈ‚ÏÈÔÁÚ·Ê›· 1. ∫ÔÓÙfiÔ˘ÏÔ˜ ∂. ∏ÌÈÎÚ·Ó›· - ∫ÂÊ·Ï·ÏÁ›· ÛÙËÓ ·È‰È΋ ËÏÈ-

Λ·. £ÂÛÛ·ÏÔÓ›ÎË; 1994. 2. Al-Twaijri WA, Shevell MI. Pediatric migraine equivalents:

occurrence and clinical features in practice. Pediatr Neurol2002;26:365-368.

3. Snyder CH. Paroxysmal torticollis in infancy. A possibleform of labyrinthitis. Am J Dis Child 1969;117:458-460.

4. Deonna T, Martin D. Benign paroxysmal torticollis ininfancy. Arch Dis Child 1981;56:956-959.

5. Basser LS. Benign paroxysmal vertigo of childhood: avariety of vestibular neuronitis. Brain 1964;87:141-152.

6. Lanzi G, Balottin U, Fazzi E, Tagliasacchi M, Manfrin M, MiraE. Benign paroxysmal vertigo of childhood: a long-termfollow-up. Cephalalgia 1994;14:458-460.

7. Drigo P, Carli G, Laverda AM. Benign paroxysmal vertigo ofchildhood. Brain Dev 2001;23:38-41.

8. Buchanan JA. The abdominal crises of migraine. J NervousMent Dis 1921;54:406-412.

9. Gee S. On fitful or recurrent vomiting. St Bartholomew’sHosp Rep 1882;18:1-6.

10. Symon DN, Russell G. Abdominal migraine: a childhoodsyndrome defined. Cephalalgia 1986;6:223-228.

11. Fleisher DR, Matar M. The cyclic vomiting syndrome: areport of 71 cases and literature review. J PediatrGastroenterol Nutr 1993;17:361-369.

12. Symon DN, Russell G. The relationship between cyclicvomiting syndrome and abdominal migraine. J PediatrGastroenterol Nutr 1995;21 (Suppl 1):S42-S43.

13. Gascon G, Barlow C. Juvenile migraine, presenting as anacute confusional state. Pediatrics 1970;45:628-635.

14. Sheth RD, Riggs JE, Bodensteiner JB. Acute confusionalmigraine: variant of transient global amnesia. Pediatr Neurol1995;12:129-131.

15. Shaabat A. Confusional migraine in childhood. PediatrNeurol 1996;15:23-25.

16. Golden GS. The Alice in Wonderland syndrome in juvenilemigraine. Pediatrics 1979;63:517-519.

17. Shevell MI. Acephalgic migraines of childhood. PediatrNeurol 1996;14:211-215.

18. Kimura S, Nezu A. Electromyographic study in an infantwith benign paroxysmal torticollis. Pediatr Neurol1998;19:236-238.

19. Giffin NJ, Benton S, Goadsby PJ. Benign paroxysmal torti-collis of infancy: four new cases and linkage to CACNA1Amutation. Dev Med Child Neurol 2002;44:490-493.

20. Oh AK, Lee H, Jen JC, Corona S, Jacobson KM, Baloh RW.Familial benign recurrent vertigo. Am J Med Genet2001;100:287-291.

21. Baloh RW. Episodic vertigo: central nervous systemcauses. Curr Opin Neurol 2002;15:17-21.

22. Weisleder P, Fife TD. Dizziness and headache: a common

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·221

Page 79: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

222

¶·È‰È·ÙÚÈ΋ 2004;67:218-222 Paediatriki 2004;67:218-222

association in children and adolescents. J Child Neurol2001;16:727-730.

23. Olson AD, Li BU. The diagnostic evaluation of children withcyclic vomiting: a cost-effectiveness assessment. J Pediatr2002;141:724-728.

24. Ophoff RA, Terwindt GM, Vergouwe MN, van Eijk R, OefnerPJ, Hoffman SM et al. Familial hemiplegic migraine andepisodic ataxia type-2 are caused by mutations in the Ca++

channel gene CACNL1A4. Cell 1996;87:543-552.

∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 14-03-2003∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 18-07-2003

¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ™ˆÙËÚ›· ª·ÛÙÚÔÁÈ¿ÓÓË ¡Â˘ÚÔÏÔÁÈÎfi ∆Ì‹Ì·, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡” E-mail: [email protected]

May-June 04 chris new 19-07-04 19:24 ™ÂÏ›‰·222

Page 80: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

223

¡∂∞ ∞¶O ∆O ¢π∞¢π∫∆ÀO

¶·È‰È·ÙÚÈ΋ 2004;67:223-224 Paediatriki 2004;67:223-224

∏ “¶∞π¢π∞∆ƒπ∫∏” ™∆O INTERNET - http://www.e-child.gr/

Ÿˆ˜ ÁÓˆÚ›˙ÂÙÂ, Ô ‰È·‰ÈÎÙ˘·Îfi˜ ÙfiÔ˜ e-child.gr Ù˘ ∂ÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ ∂Ù·ÈÚ›·˜‚Ú›ÛÎÂÙ·È ‹‰Ë Û ÏÂÈÙÔ˘ÚÁ›·.

ª¤Û· ·fi ÙȘ ÛÂÏ›‰Â˜ ÙÔ˘ ÌÔÚ›Ù ӷ ¤¯ÂÙÂÚfiÛ‚·ÛË ÛÙÔ Ï‹Ú˜ ÂÚȯfiÌÂÓÔ ÙÔ˘ ÂÚÈÔ‰È-ÎÔ‡ “¶·È‰È·ÙÚÈ΋”, ÌÂÙ¿ ·fi ‰ˆÚÂ¿Ó ÂÁÁÚ·Ê‹,·fi ÙÔ ¤ÙÔ˜ 2000 (ÙfiÌÔ˜ 63), ÛÙË ‰È‡ı˘ÓÛË: http://www.e-child.gr/PeriodikoPaidiatrikiList.asp

∏§∂∫∆ƒO¡π∫∂™ ¢π∂À£À¡™∂π™¡›ÎÔ˜ ¶··‰fiÔ˘ÏÔ˜, ¶·È‰›·ÙÚÔ˜ - ∞ÏÏÂÚÁÈÔÏfiÁÔ˜

“™˘Ó¯È˙fiÌÂÓË π·ÙÚÈ΋ ∂η›‰Â˘ÛË” on-line! -http://www.pedialink.org/pedialink/tour/aboutpedialink.cfm/

¶·Ú·ÎÏ¿‰È Ù˘ ∞ÌÂÚÈηÓÈ΋˜ ∞η‰ËÌ›·˜ Ù˘ ¶·È‰È·ÙÚÈ΋˜ (∞∞P), Ô‰ÈÎÙ˘·Îfi˜ ÙfiÔ˜ Pedialink ÚÔÛʤÚÂÈ ¤Ó· ËÏÂÎÙÚÔÓÈÎfi Û‡ÛÙËÌ· ÂÎ-Ì¿ıËÛ˘ ÛÙË ™˘Ó¯È˙fiÌÂÓË π·ÙÚÈ΋ ∂η›‰Â˘ÛË ÛÙËÓ ¶·È‰È·ÙÚÈ΋, ο-

Ùˆ ·fi Ì›· Ó¤· Î·È ÚˆÙÔÔÚȷ΋ ÚÔÛ¤ÁÁÈÛË. ∞¢ı‡ÓÂÙ·È ÛÙÔÓ Û‡Á¯ÚÔÓÔ ÂÈÛÙ‹ÌÔÓ·, ÔÔÔ›Ô˜ - ·Ó Î·È ÔÏ˘¿Û¯ÔÏÔ˜ - ÂӉȷʤÚÂÙ·È ÁÈ· ÙË Û˘Ó¯‹ ‚ÂÏÙ›ˆÛË ÙÔ˘ ·ÁÁÂÏÌ·ÙÈÎÔ‡ ÙÔ˘ÚÔÊ›Ï Ì¤Û· ·fi ÙËÓ ËÏÂÎÙÚÔÓÈ΋ Âη›‰Â˘ÛË Î·È ÂÓË̤ڈÛË. ∏ ηÈÓÔÙÔÌ›· Ù˘ Pedialink¤ÁÎÂÈÙ·È ÛÙȘ ¯Ú‹ÛÈ̘ Ô‰ËÁ›Â˜ Î·È Û˘Ì‚Ô˘Ï¤˜ ÁÈ· ÙËÓ Î·Ï‡ÙÂÚË ‰˘Ó·Ù‹ ™˘Ó¯È˙fiÌÂÓË π·ÙÚÈ-΋ ∂η›‰Â˘ÛË Ì¤Û· ·fi ÙÔ ‰È·‰›ÎÙ˘Ô. ∆Ô ∏ÏÂÎÙÚÔÓÈÎfi ªÔÓÙ¤ÏÔ ∂η›‰Â˘Û˘ Ô˘ ÚÔÛʤ-ÚÂÈ, ‚·Û›˙ÂÙ·È Û 4 ‚·ÛÈο ÂÚÁ·Ï›·: ·) ·ÔÙ‡ˆÛË ÙÔ˘ ÚÔÊ›Ï ÙÔ˘ ¯Ú‹ÛÙË, ‚) ¯¿Ú·ÍË ÂÓfi˜ÁÂÓÈÎÔ‡ Ï¿ÓÔ˘ ‰Ú¿Û˘, Á) ·ÓÙ·ÏÏ·Á‹ Î·È ‰È¿‰ÔÛË ÙÔ˘ ÂÎ·È‰Â˘ÙÈÎÔ‡ ˘ÏÈÎÔ‡ Î·È ‰) ‰È·Û‡Ó-‰ÂÛË Ì ¿ÏϘ ËÏÂÎÙÚÔÓÈΤ˜ ËÁ¤˜ ÂÎÌ¿ıËÛ˘.

ŒÓ· ÚˆÙfiÙ˘Ô website Ì ÙÔ Î‡ÚÔ˜ Î·È ÙËÓ ·ÚÙÈfiÙËÙ· Ù˘ ∞ÌÂÚÈηÓÈ΋˜ ∞η‰ËÌ›·˜ Ù˘¶·È‰È·ÙÚÈ΋˜, ÙÔ ÔÔ›Ô ÚÔÛʤÚÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· ÛÙÔÓ ¯Ú‹ÛÙË-ÂÈÛÙ‹ÌÔÓ· Ó· ‚ÂÏÙÈÒÛÂÈ ÙȘÁÓÒÛÂȘ ÛÙÔ ÂÈÛÙËÌÔÓÈÎfi ÙÔ˘ ‰›Ô Î·È Ó· ÙȘ ÂÊ·ÚÌfiÛÂÈ ÛÙËÓ Ú¿ÍË.

May-June 04 chris new 19-07-04 19:25 ™ÂÏ›‰·223

Page 81: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

¡∂∞ ∞¶O ∆O ¢π∞¢π∫∆ÀO

™‡Á¯ÚÔÓË Î·È ¤Á΢ÚË È·ÙÚÈ΋ ÂÓË̤ڈÛË ÁÈ· ÙÚÂȘ! - http://www.kidshealth.org/

ªÔÓÙ¤ÚÓÔ˜ Î·È Ó·ÓÈÎfi˜ ÛÙÔÓ Û¯Â‰È·ÛÌfi ÙÔ˘, Ô ‰ÈÎÙ˘·Îfi˜ ÙfiÔ˜Kids Health, Ì ηı·Ú¿ ÂÎ·È‰Â˘ÙÈÎfi ÂÚȯfiÌÂÓÔ, Â›Ó·È Ô ÌÂÁ·Ï‡ÙÂ-ÚÔ˜ Û ÂÈÛ΄ÈÌfiÙËÙ· ÛÙËÓ ∞ÌÂÚÈ΋, ·fi ÙÔ˘˜ ÂȉÈÎÔ‡˜ ÙÔ˘ Nemours

Foundation’s Center for Children’s Health Media. ∞¢ı‡ÓÂÙ·È Û ÁÔÓ›˜, ÂÊ‹‚Ô˘˜ Î·È ·È‰È¿,̤۷ ·fi ÙÚÂȘ ‰È·ÊÔÚÂÙÈΤ˜ ÈÛÙÔÛÂÏ›‰Â˜ ̠ͯˆÚÈÛÙfi ۯ‰ȷÛÌfi, ‡ÊÔ˜ Î·È ÂÚȯfiÌÂÓÔ -·Ó¿ÏÔÁ· Ì ÙËÓ Î·ÙËÁÔÚ›· - Î·È ÂÚÈÏ·Ì‚¿ÓÂÈ Ï‹ıÔ˜ ÏËÚÔÊÔÚÈÒÓ ÁÈ· ÁÂÓÈο Î·È ÂȉÈο ı¤-Ì·Ù· ˘Á›·˜ Û ·Ï‹ Î·È Î·Ù·ÓÔËÙ‹ ÁÏÒÛÛ·. ∂ÎÙfi˜ ·fi Ô‰ËÁ›Â˜ ÁÈ· ÚfiÏË„Ë Î·È ¤ÁηÈÚË·ÓÙÈÌÂÙÒÈÛË Û ȷÙÚÈο ı¤Ì·Ù·, ÙÔ Kids Health ÚÔÛʤÚÂÈ Î·È ¯Ú‹ÛÈ̘ Û˘Ì‚Ô˘Ï¤˜ fiÛÔÓ·ÊÔÚ¿ ÛÂ Û˘Ó·ÈÛıËÌ·ÙÈο Î·È „˘¯ÔÏÔÁÈο ˙ËÙ‹Ì·Ù·, ı¤Ì·Ù· ‰È·ÙÚÔÊ‹˜ Î·È ·Ó¿Ù˘Í˘. ∏ÈÛÙÔÛÂÏ›‰· ªfiÓÔ ÁÈ· ¶·È‰È¿ ÚÔÛÂÁÁ›˙ÂÈ Ù· È·ÙÚÈο ı¤Ì·Ù· Ì ÂÏ΢ÛÙÈÎfi Î·È ¯·ÚÔ‡ÌÂÓÔ ÙÚfi-Ô, ÚÔÛʤÚÔÓÙ·˜ - Ù·˘Ùfi¯ÚÔÓ· Ì ÙËÓ ÂÓË̤ڈÛË - Î·È „˘¯·ÁˆÁ›· ̤۷ ·fi ·È¯Ó›‰È·, ·È-Ó›ÁÌ·Ù· Î·È ÙÂÛÙ.

∏ ÈÛÙÔÛÂÏ›‰· Kids Health ÂÓËÌÂÚÒÓÂÙ·È Ù·ÎÙÈο Î·È ¤¯ÂÈ ÎÂÚ‰›ÛÂÈ ÔÏÏ¿ ‚Ú·‚›· ÁÈ· ÙÔÓÂÎ·È‰Â˘ÙÈÎfi ÚfiÏÔ Ù˘, fiˆ˜ ÙÔ “2004 Webby Award for Best Health Website”, ÙÔ “2004Parents’ Choice Gold Award” Î·È ¿ÏÏ·. ™˘ÛÙ‹ÓÂÙ·È ·ÓÂÈʇϷÎÙ·.

∂‡¯ÚËÛÙÔ˜ ËÏÂÎÙÚÔÓÈÎfi˜ Ô‰ËÁfi˜ ÁÂÓÈ΋˜ ·È‰È·ÙÚÈ΋˜ - http://www.generalpediatrics.com/

∆Ô General Pediatrics Â›Ó·È Ì›· ‰È·‰ÈÎÙ˘·Î‹ ‡-ÏË (portal) Ô˘ ·Â˘ı‡ÓÂÙ·È Í¯ˆÚÈÛÙ¿ Û ·Á-ÁÂÏ̷ٛ˜ ·È‰È¿ÙÚÔ˘˜ Î·È ÁÔÓ›˜, ηχÙÔÓÙ·˜

Ì›· ¢Ú›· Áο̷ È·ÙÚÈÎÒÓ ıÂÌ¿ÙˆÓ ÁÈ· ·È‰È¿, ·fi Û¯ÂÙÈÎÔ‡˜ ·È‰È·ÙÚÈÎÔ‡˜ ‰ÈÎÙ˘·ÎÔ‡˜ Ùfi-Ô˘˜. ∂ÎÙfi˜ ·fi Ù· ÌÂÌÔӈ̤ӷ ¿ÚıÚ·, ÂÚÈÏ·Ì‚¿ÓÂÈ, ›Û˘, Ì˯·Ó‹ ¢ÚÂÙËÚ›·Û˘ ηÈÏÔ‹ÁËÛ˘ ÛÙÔ ‰È·‰›ÎÙ˘Ô Û ÈÛÙÔÛÂÏ›‰Â˜ Ì ·ÓÙÈΛÌÂÓÔ ÙË °ÂÓÈ΋ ¶·È‰È·ÙÚÈ΋. ∞Ó Î·È Ôۯ‰ȷÛÌfi˜ ÙÔ˘ Â›Ó·È ·Ïfi˜ Î·È Ì¿ÏÏÔÓ ·‰È¿ÊÔÚÔ˜, ÙÔ General Pediatrics Â›Ó·È ¯Ú‹ÛÈÌÔÚˆÙ›ÛÙˆ˜ ˆ˜ ¤Ó·˜ ËÏÂÎÙÚÔÓÈÎfi˜ Ô‰ËÁfi˜ ·È‰È·ÙÚÈ΋˜ ÛÙÔ ‰È·‰›ÎÙ˘Ô.

π·ÙÚÂ›Ô º˘Ì·Ù›ˆÛ˘ Ù˘ ¶·È‰È΋˜ ∏ÏÈΛ·˜ - http://www.pedtb.gr/

¶ÚfiÎÂÈÙ·È ÁÈ· ÙËÓ Â›ÛËÌË ÈÛÙÔÛÂÏ›‰· ÙÔ˘ π·ÙÚ›Ԣ º˘Ì·Ù›ˆÛ˘ Ù˘ ¶·È‰È-΋˜ ∏ÏÈΛ·˜ Ô˘ ‰ËÌÈÔ˘ÚÁ‹ıËΠ·fi ÙË µ’ ¶·È‰È·ÙÚÈ΋ ¶·ÓÂÈÛÙËÌȷ΋ ∫ÏÈÓÈ-΋ ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”. ¶ÂÚÈÏ·Ì‚¿ÓÂÈ ¯Ú‹ÛÈ̘ ÏËÚÔÊÔڛ˜ ÁÈ· ÙËÓ ·Ó·ÁÓÒÚÈÛË Î·È ·ÓÙÈÌÂÙÒÈÛËÙ˘ Ê˘Ì·Ù›ˆÛ˘, ηıÒ˜ Î·È ÂÓËÌÂÚˆÙÈο Ê˘ÏÏ¿‰È· Û ͤÓ˜ ÁÏÒÛÛ˜.

™ÙȘ ÛÂÏ›‰Â˜ ·˘ÙÔ‡ ÙÔ˘ ‰È·‰ÈÎÙ˘·ÎÔ‡ ÙfiÔ˘ ˘¿Ú¯Ô˘Ó, ›Û˘, ¯Ú‹ÛÈÌ· ÛÙÔȯ›· ÁÈ· ÙË ÏÂÈ-ÙÔ˘ÚÁ›· ÙÔ˘ È·ÙÚ›Ԣ.

¶·È‰È·ÙÚÈ΋ 2004;67:223-224 Paediatriki 2004;67:223-224

224

May-June 04 chris new 19-07-04 19:25 ™ÂÏ›‰·224

Page 82: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

xi

15-20 ∞˘ÁÔ‡ÛÙÔ˘ 2004 24th International Congress of Pediatrics Cancun, Mexico ¶ÏËÚÔÊÔڛ˜: Congress Organiser ∆ËÏ.: 525 554 491 500 Fax: 525 554 491 555 E-mail: [email protected] Website: www.icp2004com

29 ∞˘ÁÔ‡ÛÙÔ˘- 13th Congress of the International Paediatric Adelaide, Australia2 ™ÂÙÂÌ‚Ú›Ô˘ 2004 Nephrology Association hosted by the

Australian and New Zealand Paediatric Nephrology Association¶ÏËÚÔÊÔڛ˜: Hartley Management Group Pty Ltd ∆ËÏ.: 61 883 634 399 Fax: 61 883 634 577 E-mail: [email protected]

24-28 ™ÂÙÂÌ‚Ú›Ô˘ 2004 XXXth World Congress of the International Istanbul, TurkeySociety of Hematology (ISH)¶ÏËÚÔÊÔڛ˜: Alper Sahinoglu ∆ËÏ.: 90 3 124 383 721 Fax: 90 3 124 383 723 E-mail: [email protected]

26 ™ÂÙÂÌ‚Ú›Ô˘- XII Meeting of the European Association £ÂÛÛ·ÏÔÓ›ÎË1 OÎÙˆ‚Ú›Ô˘ 2004 for Haematopathology

¶ÏËÚÔÊÔڛ˜: Triaena Tours & Congress ∆ËÏ.: +30 2310 25 61 94-5 Fax: +30 2310 25 61 96 E-mail: [email protected]

13-16 OÎÙˆ‚Ú›Ô˘ 2004 XIX European Congress of Perinatal Medicine ∞ı‹Ó· •ÂÓÔ‰Ô¯Â›Ô Athens Hilton ¶ÏËÚÔÊÔڛ˜: C&C International S.A.∆ËÏ.: +30 210 68 89 100Fax: +30 210 68 44 777E-mail: [email protected] Website: www.perinatal2004.gr

11-14 ¡ÔÂÌ‚Ú›Ô˘ 2004 14Ô ¢È··ÓÂÈÛÙËÌÈ·Îfi ™˘Ó¤‰ÚÈÔ ∞ÎÙÈÓÔÏÔÁ›·˜ ∏Ú¿ÎÏÂÈÔ ∫Ú‹Ù˘∂ÚÁ·ÛÙ‹ÚÈÔ ∞ÎÙÈÓÔÏÔÁ›·˜ Î·È π·ÙÚÈ΋˜ ∞ÂÈÎfiÓÈÛ˘ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘ ∞ÌÊÈı¤·ÙÚÔ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘ ¶ÏËÚÔÊÔڛ˜: PRC Congress & Travel ∆ËÏ.: +30 210 77 11 673 Fax: +30 210 77 11 289 E-mail: [email protected]

¶PO™EXH ™YNE¢PIA

May-June 04 chris new 19-07-04 19:25 ™ÂÏ›‰·227

Page 83: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

27 ¡ÔÂÌ‚Ú›Ô˘ 2004 3Ë ∏ÌÂÚ›‰· ∂ÏÏËÓÈ΋˜ ∂Ù·ÈÚ›·˜ ∞ı‹Ó·¶·È‰È·ÙÚÈ΋˜ ¢ÂÚÌ·ÙÔÏÔÁ›·˜∞ÌÊÈı¤·ÙÚÔ ¶ÔÏÂÌÈÎÔ‡ ªÔ˘Û›Ԣ ¶ÏËÚÔÊÔڛ˜: ∆ÛÈ‚ÈÙ·Ó›‰Ô˘-∫¿ÎÔ˘ÚÔ˘ ∆¿ÏÈ· ∆ËÏ.: +30 210 67 55 437 Fax: +30 210 67 45 117 E-mail: [email protected]

8-11 ¢ÂÎÂÌ‚Ú›Ô˘ 2004 6Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ ∞ÓÔÛÔÏÔÁ›·˜ £ÂÛÛ·ÏÔÓ›ÎË ∂ÏÏËÓÈ΋ ∂Ù·ÈÚ›· ∞ÓÔÛÔÏÔÁ›·˜ •ÂÓÔ‰Ô¯Â›Ô Electra Palace ¶ÏËÚÔÊÔڛ˜: ¢π∞™∆∞™∏ Travel ∆ËÏ.: +30 2310 88 92 44-45 Fax: +30 2310 88 92 46 E-mail: [email protected]

5-7 ª·˝Ô˘ 2005 8th Congress of the European Society of Budapest, Hungary Paediatric Dermatology Hilton Budapest Congress Center ¶ÏËÚÔÊÔڛ˜: Convention Budapest Ltd ∆ËÏ.: (361) 2990 184-6 Fax: (361) 2990 187 E-mail: [email protected]

[email protected] Website: www.convention.hu

4-9 ™ÂÙÂÌ‚Ú›Ô˘ 2005 ESPGHAN Summer School on Nutrition ∞Ó¿‚˘ÛÛÔ˜“Research Challenges in Clinical Nutrition”European Society for Paediatric Gastroenterology, Hepatology and Nutrition Eden Beach Hotel Club ¶ÏËÚÔÊÔڛ˜: ∞ÏÂÍ¿Ó‰Ú· ¶··‰ÔÔ‡ÏÔ˘ ∆ËÏ.: +30 210 77 26 355, 6945 29 30 71 E-mail: [email protected]

11-15 ™ÂÙÂÌ‚Ú›Ô˘ 2005 29th UMEMPS - Union of Middle Eastern and Istanbul, TurkeyMediterranean Pediatric Societies Congress ¶ÏËÚÔÊÔڛ˜: Pynar Aytac ∆ËÏ.: 90 2 163 473 535 Fax: 90 2 163 477 850 E-mail: [email protected]

¶PO™EXH ™YNE¢PIA

xii

May-June 04 chris new 19-07-04 19:25 ™ÂÏ›‰·228

Page 84: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

™˘ÓÙÔÌÔÁڷʛ˜AIDS

AMP, ADP, ATP

ATPasecalCSF ‹ ENYCNS ‹ ∫¡™cmCoAcmÑcm2

cAMPÆCCRPDNAECG ‹ ∏∫°EEG ‹ ∏∂°ELISA

ESR ‹ ∆∫∂EDTAgHctHbHLA

IgICU ‹ ª∂£IUi.m. ‹ ∂.ª.i.p. ‹ ∂.¶.i.v. ‹ ∂.º.LlogmolªW ‹ MBMCHMCVmRNAmminnNNS ‹ ª™Ôsm%PCRpHPCO2PO2p

EÏÏËÓÈÎÔ› fiÚÔÈÛ‡Ó‰ÚÔÌÔ Â›ÎÙËÙ˘ ·ÓÔÛÔ·Ó¿ÚÎÂÈ·˜

ÌÔÓÔ-, ‰È-, ÙÚÈʈÛÊÔÚÈ΋ ·‰ÂÓÔÛ›ÓË

ÙÚÈʈÛÊ·Ù¿ÛË Ù˘ ·‰ÂÓÔÛ›Ó˘ıÂÚÌ›‰·ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚfiÎÂÓÙÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ·ÂηÙÔÛÙfiÛ˘Ó¤Ó˙˘ÌÔ ∞΢‚ÈÎfi ÂηÙÔÛÙfi ÙÂÙÚ·ÁˆÓÈÎfi ÂηÙÔÛÙfi΢ÎÏÈÎfi AMP‚·ıÌfi˜ KÂÏÛ›Ô˘C-·ÓÙȉÚÒÛ· ÚˆÙ½ÓˉÂÔ͢ÚÈ‚Ô˙ÔÓÔ˘ÎÏÂ˚ÓÈÎfi Ô͇ËÏÂÎÙÚÔηډÈÔÁÚ¿ÊËÌ·ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ·¤Ó˙˘ÌÔ-Û˘Ó‰¤Ù˘ ·ÓÔÛÔÚÔÛÚfiÊËÛ˘ÚÔÛ‰ÈÔÚÈÛÌfi˜Ù·¯‡ÙËÙ· ηıÈ˙‹Ûˆ˜ ÂÚ˘ıÚÒÓÂı˘ÏÂÓԉȷÌÈÓÔÙÂÙÚ·ÔÍÂ˚Îfi Ô͇ÁÚ·ÌÌ¿ÚÈo·ÈÌ·ÙÔÎÚ›Ù˘·ÈÌÔÛÊ·ÈÚ›ÓË·ÓÙÈÁfiÓÔ ÈÛÙÔÛ˘Ì‚·ÙfiÙËÙ·˜

·ÓÔÛÔÛÊ·ÈÚ›ÓËÌÔÓ¿‰· ÂÓÙ·ÙÈ΋˜ ıÂڷ›·˜‰ÈÂıÓ‹˜ ÌÔÓ¿‰·ÂÓ‰ÔÌ˘˚οÂÓ‰ÔÂÚÈÙÔÓ·˚οÂÓ‰ÔÊϤ‚È·Ï›ÙÚÔ(·)ÏÔÁ¿ÚÈıÌÔ˜ÁÚ·ÌÌÔÌfiÚÈÔÌÔÚÈ·Îfi ‚¿ÚԘ̤ÛË ·ÈÌÔÛÊ·ÈÚ›ÓË ÂÚ˘ıÚÒÓ̤ÛÔ˜ fiÁÎÔ˜ ÂÚ˘ıÚÒÓ ·ÁÁÂÏÈÔÊfiÚÔ˜ RNA̤ÙÚÔÏÂÙfi·ÚÈıÌfi˜ Ó¢ÙÒÓÈÔÌË ÛËÌ·ÓÙÈÎfiÔÛÌÒÏÈÔ› ÙÔȘ ÂηÙfi·Ï˘ÛȉˆÙ‹ ·ÓÙ›‰Ú·ÛË ÔÏ˘ÌÂÚ¿ÛË˜Û˘ÁΤÓÙÚˆÛË ÈfiÓÙˆÓ ˘‰ÚÔÁfiÓÔ˘ÌÂÚÈ΋ Ù¿ÛË CO2ÌÂÚÈ΋ Ù¿ÛË Ô͢ÁfiÓÔ˘Èı·ÓfiÙËÙ·

AÁÁÏÈÎÔ› fiÚÔÈacquired immunodeficiencysyndromeadenosine 5mono-, di-,triphosphateadenosine triphosphatasecaloriecerebrospinal fluidcentral nervous systemcentimetercoenzyme Acubic centimetersquare centimetercyclic AMPdegree(s) CelsiusC-reactive proteindeoxyribonucleic acidelectrocardiogramelectroencephalogramenzyme-linked immunoabsorbentassayerythrocyte sedimentation rateethylenediaminetetracetategramhaematocrithaemoglobin(human) histocompatibilityleucocyte antigenimmunoglobulinintensive care unitinternational Unitintramuscularintraperitonealintravenousliterlogarithmmolemolecular weightmean corpuscular haemoglobinmean corpuscular volumemessenger RNAmeterminutenumber newtonnot significantosmolepercent polymerase chain reactionpotentia hydrogeniicarbon dioxide pressureoxygen pressureprobability

™YNTOMO°PAºIE™ ABBREVIATIONS

xiv

May-June 04 chris new 19-07-04 19:25 ™ÂÏ›‰·230

Page 85: Παιδιατρική | Τόμος 67 • Τεύχος 3 • Μάιος - Ιούνιος 2004

xv

EÏÏËÓÈÎÔ› fiÚÔÈ™˘ÓÙÔÌÔÁڷʛ˜

p.o.RIARNARDSsecs.c. ‹ À.¢.SDSEU

™˘Ó‰˘·˙fiÌÂÓ· ÚÔı¤Ì·Ù·

tera- (1012)giga- (109)mega-(106)kilo- (103)hecto(102)deca (101)deci (10-1)centi- (10-2)milli(10-3)micro (10-6)nano (10-9)pico (10-12) femto (10-15)atto (10-18)

·fi ÙÔ ÛÙfiÌ·Ú·‰ÈÔ·ÓÔÛÔ·ÔÚÚÔÊËÙÈ΋ ‰ÔÎÈÌ·Û›·ÚÈ‚ÔÓÔ˘ÎÏÂ˚ÓÈÎfi Ô͇ۇӉÚÔÌÔ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÈ·˜‰Â˘ÙÂÚfiÏÂÙÔ˘Ô‰fiÚÈ·ÛÙ·ıÂÚ‹ ·fiÎÏÈÛËÛÙ·ıÂÚfi ÛÊ¿ÏÌ·ÌÔÓ¿‰·

Combining prefixes

TGMkhdadcmÌnpfa

by mouthradioimmunoassayribonucleic acidrespiratory distress syndromesecondsubcutaneousstandard deviationstandard errorunit

AÁÁÏÈÎÔ› fiÚÔÈ

May-June 04 chris new 19-07-04 19:25 ™ÂÏ›‰·231


Μάιος 2009

Μάιος 2009

Documents
Αντίλαλοι απ ’ τους Σκάρους AP' TOYS SKAROYS 17.pdf · 2 Αντίλαλοι απ ’ τους Σκάρους Απρίλιος - Μάιος - Ιούνιος

Αντίλαλοι απ ’ τους Σκάρους AP' TOYS SKAROYS 17.pdf · 2 Αντίλαλοι απ ’ τους Σκάρους Απρίλιος - Μάιος - Ιούνιος

Documents
Περιοδικό του ΣA∆AΣ-ΠEA Μάιος/Ιούνιος 2005 · ΚΤΙΡΙΟ ΓΡΑΦΕΙΩΝ ΚΑΙ ΚΑΤΑΣΤΗΜΑΤΩΝ ΣΤΗ ΛΕΩΦΟΡΟ ΣΥΓΓΡΟΥ, ΑΘΗΝΑ

Περιοδικό του ΣA∆AΣ-ΠEA Μάιος/Ιούνιος 2005 · ΚΤΙΡΙΟ ΓΡΑΦΕΙΩΝ ΚΑΙ ΚΑΤΑΣΤΗΜΑΤΩΝ ΣΤΗ ΛΕΩΦΟΡΟ ΣΥΓΓΡΟΥ, ΑΘΗΝΑ

Documents
Παιδιατρική | Τόμος 72 • Τεύχος 2 • Απρίλιος - Μάιος - Ιούνιος 2009

Παιδιατρική | Τόμος 72 • Τεύχος 2 • Απρίλιος - Μάιος - Ιούνιος 2009

Documents
Τεύχος 192 Μάιος-Ιούνιος 2020 Number 192 May-June 2020 · Τεύχος 192 Μάιος-Ιούνιος 2020 Number 192 May-June 2020

Τεύχος 192 Μάιος-Ιούνιος 2020 Number 192 May-June 2020 · Τεύχος 192 Μάιος-Ιούνιος 2020 Number 192 May-June 2020

Documents
Μάιος 2003

Μάιος 2003

Documents
Παιδιατρική | Τόμος 73 • Τεύχος 2 • Απρίλιος - Μάιος - Ιούνιος 2010

Παιδιατρική | Τόμος 73 • Τεύχος 2 • Απρίλιος - Μάιος - Ιούνιος 2010

Documents
Εφημεριδα η Πάργα - 76 (Απρίλιος - Μάιος - Ιούνιος 2011)

Εφημεριδα η Πάργα - 76 (Απρίλιος - Μάιος - Ιούνιος 2011)

Documents
Μάιος 2010

Μάιος 2010

Documents
Μάιος 2004

Μάιος 2004

Documents
Insurance World #63, Μάιος-Ιούνιος 2015

Insurance World #63, Μάιος-Ιούνιος 2015

Documents
Μάιος 2008

Μάιος 2008

Documents
00. COVER 09/10/2012 9:59 ΠΜ Page 1195.134.76.37/scinews/Reports/PDF/T7T2.pdf · Τόμος 7, Τεύχος 2, Απρίλιος-Μάιος-Ιούνιος 2012 Kαρδιολογική

00. COVER 09/10/2012 9:59 ΠΜ Page 1195.134.76.37/scinews/Reports/PDF/T7T2.pdf · Τόμος 7, Τεύχος 2, Απρίλιος-Μάιος-Ιούνιος 2012 Kαρδιολογική

Documents
Μάιος 2014

Μάιος 2014

Documents
Pc master τεύχος 295 μάιος ιούνιος 2014

Pc master τεύχος 295 μάιος ιούνιος 2014

Documents
Μάιος 2007

Μάιος 2007

Documents
Αγωνιστής των Ταχυδρομικών - Τεύχος 360/30 Νέα Περίοδος - Απρίλιος - Μάιος - Ιούνιος 2012

Αγωνιστής των Ταχυδρομικών - Τεύχος 360/30 Νέα Περίοδος - Απρίλιος - Μάιος - Ιούνιος 2012

Documents
Τόμος Τεύχος Απρίλιος Μάιος Ιούνιος - ATINERειδικότερα παρουσιάζονται οι υποσχέσεις του συγκεκριμένου

Τόμος Τεύχος Απρίλιος Μάιος Ιούνιος - ATINERειδικότερα παρουσιάζονται οι υποσχέσεις του συγκεκριμένου

Documents
Αριθμός Φύλλου 66* Απρίλιος- Μάιος- Ιούνιος 2013 ΕΡΓΑ ΣΤΟΝ ... · ΜΕΣΟΓΕΙΑΚΗ ΔΙΑΤΡΟΦΗ . Ο Ιατρός –Καρδιολόγος

Αριθμός Φύλλου 66* Απρίλιος- Μάιος- Ιούνιος 2013 ΕΡΓΑ ΣΤΟΝ ... · ΜΕΣΟΓΕΙΑΚΗ ΔΙΑΤΡΟΦΗ . Ο Ιατρός –Καρδιολόγος

Documents
tritopoulou - 1-4-2013 · ENERMED Énergies Renouvelables Méditerranéennes Ιούνιος 2010-Μάιος 2013 Ιταλία, Σλοβενία, Κροατία, Ελλάδα

tritopoulou - 1-4-2013 · ENERMED Énergies Renouvelables Méditerranéennes Ιούνιος 2010-Μάιος 2013 Ιταλία, Σλοβενία, Κροατία, Ελλάδα

Documents
Μάιος 2005

Μάιος 2005

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

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

Documents
Μάιος 2013

Μάιος 2013

Documents
Eρειθιανούσικα Tιτιβίσματα/ Μάρτιος, Απρίλιος, Μάιος, Ιούνιος 2016/ Τεύχος 159

Eρειθιανούσικα Tιτιβίσματα/ Μάρτιος, Απρίλιος, Μάιος, Ιούνιος 2016/ Τεύχος 159

Education
Μάιος 2006

Μάιος 2006

Documents
Ένας χρόνος νέας Διοίκησης · 2017. 7. 31. · Ένας χρόνος νέας Διοίκησης ΓΝΗ Βενιζέλειο, Ιούνιος 2016-Μάιος

Ένας χρόνος νέας Διοίκησης · 2017. 7. 31. · Ένας χρόνος νέας Διοίκησης ΓΝΗ Βενιζέλειο, Ιούνιος 2016-Μάιος

Documents
2014 / Απρίλιος Μάιος Ιούνιος / Τιμή: 0,032 Τ ο καλοκαίρι ξεκίνησε με μία ακόμη τιμητική διάκριση για το Ταμείο

2014 / Απρίλιος Μάιος Ιούνιος / Τιμή: 0,032 Τ ο καλοκαίρι ξεκίνησε με μία ακόμη τιμητική διάκριση για το Ταμείο

Documents
Μάιος 2002

Μάιος 2002

Documents
ΠΡΟΦΟΡΙΚΕΣ ΑΝΑΚΟΙΝΩΣΕΙΣ / Vol. 27 - Issue 3 ORAL ...Μάιος - Ιούνιος 2018 / May - June 2018 Τόμος 27 - Τεύχος 3 ΠΡΟΦΟΡΙΚΕΣ ΑΝΑΚΟΙΝΩΣΕΙΣ

ΠΡΟΦΟΡΙΚΕΣ ΑΝΑΚΟΙΝΩΣΕΙΣ / Vol. 27 - Issue 3 ORAL ...Μάιος - Ιούνιος 2018 / May - June 2018 Τόμος 27 - Τεύχος 3 ΠΡΟΦΟΡΙΚΕΣ ΑΝΑΚΟΙΝΩΣΕΙΣ

Documents
33 - 5 . 10552 - . - Fax: 210-3313.067 – 2013, 183•agnanta.com.gr/newspapers/183.pdfΒ p 2 2 ΑΓΝΑΝΤΑ ΑΡΤΑΣ Απρίλιος - Μάιος - Ιούνιος 2013 Β p

33 - 5 . 10552 - . - Fax: 210-3313.067 – 2013, 183•agnanta.com.gr/newspapers/183.pdfΒ p 2 2 ΑΓΝΑΝΤΑ ΑΡΤΑΣ Απρίλιος - Μάιος - Ιούνιος 2013 Β p

Documents