Παιδιατρική | Τόμος 71 • Τεύχος 2 • Μάρτιος - Απρίλιος 2008

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87 Paediatric liver transplantation:

historical notes

G. C. Sotiropoulos, S. Nadalin, A. Radtke, H. Lang

92 Childhood obesity – ∞ public health crisis

across the European Union

A. J. Nicholson, S. Del Torso, A. Hadjipanyidis, D. Van Esso

96 Use of the new World Health Organization

growth standards in the prevention of

childhood overweight and obesity

M. Ponce-Rivera, D. Fuentes-Lugo

105 µ·ÛÈÎ¤˜ ÙÂ¯ÓÈÎ¤˜ ÙË˜ ÌÔÚÈ·Î‹˜ ‚ÈÔÏÔÁ›·˜ Î·È Ë

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162 Recurrent Respiratory Papillomatosis: case

report and literature review

D. A. Nunez

165 ∫§π¡π∫√ ∫√Àπ∑

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Contents

REVIEW ARTICLES

87 Paediatric liver transplantation:

historical notes

G. C. Sotiropoulos, S. Nadalin, A. Radtke, H. Lang

92 Childhood obesity – ∞ public health crisis

across the European Union


96 Use of the new World Health Organization

growth standards in the prevention of

childhood overweight and obesity


105 Basic techniques of molecular biology and

their applications in the diagnosis of

childhood diseases

S. Megremis, A. Pampanos

116 New aspects of infant nutrition

C. Costalos

123 Indications for administering growth

hormone to children and adolescents

E. Kousta, A. Papathanassiou, C. Hadjiathanassiou†

ORIGINAL ARTICLES

128 Final height of children with growth

hormone deficiency who received

replacement treatment

M. Papadopoulou, S. Douma, ∫. ∫itsios, ¡. ∫adoglou, ∫. ∫osta, π. Tsiouris

135 Study of the immunophenotype of

peripheral blood lymphocyte subsets in

children with Epstein-Barr virus and

cytomegalovirus infection: association

with outcome

∂. Papadopoulou-Alataki, ∞. Fleva, V. Antari, ∞. Pavlitou-∆siontsi, ª. Moskofidis, G. Varlamis

141 Liver transplantation in children:

15 years experience in one center

O. Vrani, ª. Pantikidou, G. Imvrios, π. Xinias, V. Demertzidou, ∫. ∫antziou, ∞. Mavroudi, D. Takoudas, T. Papastaurou, ∫. Spyroglou

148 Economic evaluation of new vaccines

against varicella, serogroup C

meningococcus and pneumococcus

V. ∆siantou, ∞. ∫arokis, ∂. Pavi, G. ∫yriopoulos

PRACTICAL ISSUE

157 Childhood and adolescent nutrition for

promoting health and growth and

preventing chronic diseases

∞. ∫afatos

CASE REPORT

162 Recurrent Respiratory Papillomatosis:

case report and literature review

D. A. Nunez

165 CLINICAL QUIZ

P. Sifianou, ∫. Fotiou, ∫. Skiadas, ∫. Papagaroufalis

CURRENT ISSUE

166 National Immunization Programme

PAEDIATRIC NEWS IN BRIEF

171 National Immunization Programme 2008

E. Galanakis

NEWS FROM THE INTERNET

173 Paediatric news in brief at the internet

C. Stefanidis

PaediatrikiVolume 71 ñ Number 2 ñ March-April 2008


v™À¡∆∞∫∆π∫∏ E¶π∆ƒ√¶∏ EDITORIAL BOARD

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

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Editor-in-Chief

Constantinos Stefanidis, Athens

Section Editors

Stella Andronikou, Neonatology, Ioannina

Persefoni Avgoustides-Savvopoulou, Metabolic Disorders, Thessaloniki

Andriani Vazaiou-Gerasimidi, Endocrinology, Athens

George Varlamis, Cardiology, Thessaloniki

Emmanouil Galanakis, Ethics and Deontology, Heraklion

Loretta Thomaidou, Developmental Pediatrics, Athens

Maria Kanariou, Immunology, Athens

Eustathia Katsarou-Pektasides, Neurology, Athens

Antonis Kattamis, Haematology - √ncology, Athens

Sophia Kitsiou-Tzeli, Genetics, Athens

Alexandra Papadopoulou, Gastroenterology - Nutrition, Athens

Nicos Papadopoulos, Allergology - Pneumonology, Athens

Antigoni Siamopoulou-Mavridou, Rheumatology, Ioannina

Marisa Tsolia, Infectious Diseases, Athens

Alexis Arzimanoglou, Paris, France

Ellis D. Avner, Milwaukee, USA

Swati Bhave, New Delhi, India

Alberto Bissot, Panama, Panama

David Branski, Jerusalem, Israel

Francesco Chiarelli, Chieti, Italy

Chok-Wan Chan, Hong Kong, China

Denis Daneman, Toronto, Canada

Jochen Ehrich, Hannover, Germany

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Eva Tsalikian, Iowa City, USA

Catherine Weil-Olivier, Paris, France

Max Zach, Graz, Austria

Zheng-Yan Zhao, Hangzhou, China

Johannes Zschocke, Heidelberg, Germany


Paediatric liver transplantation: historical notes

G. C. Sotiropoulos1,2, S. Nadalin2, A. Radtke1,2, H. Lang1,2

Abstract: Liver transplantation (LT) is now a standard treatment for children with end-stage liver disease,with very good 1- and 5-year survival rates, which have been achieved through the constant improvementof surgical techniques and clinical management, and use of new immunosuppressive drugs. The indicationsfor LT in infants and children include acute liver failure, chronic liver failure with pruritus, complications ofcholestasis and failure to thrive. In young children the most common liver disease leading to transplantationis biliary atresia, which accounts for at least 50% of all LTs in children and is characterized by the failure ofthe bile ducts to develop normally and drain bile from the liver. Although the majority of transplanted chil-dren enjoy an excellent quality of life, there are still many possible complications, including short-term pri-mary non-function, vascular and biliary problems, bowel perforation, severe rejection, infection, hyperten-sion with long-term renal impairment, chronic rejection, de novo autoimmunity, lymphoproliferative diseaseand cancer, most of which are related to anti-rejection drug toxicity. This paper focuses on the historical de-velopment of surgical techniques in the era of paediatric LT.

Key words: Liver transplantation, paediatric transplant programme, split liver, living donor liver

transplantation, split techniques, liver insufficiency, liver failure, biliary atresia.

87∞¡∞™∫√¶∏™∏ REVIEW ARTICLE

1 Department of General,Abdominal and TransplantSurgery, University Hospital,Johannes GutenbergUniversity Mainz, Germany

2 Department of General,Visceral and TransplantationSurgery, University HospitalEssen, Germany

Correspondence:

Georgios C. [email protected] Klinik für Allgemein-,Abdominal- undTransplantationschirurgie, Klinikum der JohannesGutenberg Universität Mainz, Langenbeckstraße 1, 55131 Mainz, Germany

¶·È‰È·ÙÚÈÎ‹ 2008;71:87-91

Introduction

Paediatric liver transplantation (LT) is an es-

tablished method of treatment for patients with

end-stage liver failure. Its mortality has de-

creased dramatically since its first description,

thanks to new strategies for immunosuppres-

sion, new surgical techniques (1,2), and the im-

proved overall condition of the patients prior to

transplantation. The introduction of the split-

liver (SL) techniques has dramatically improved

the problem of organ shortage (3,4).

Full-Size LT

The first clinical attempt at liver replacement

was made by Starzl on March 1st, 1963 on a 3

year-old child who had developed end-stage liver

disease from biliary atresia, but “he bled to death

as we worked desperately to stop the haemor-

rhage. The operation could not be completed”

(5). This attempt was followed in 1963 by trans-

plantation of livers into four adult patients, who

all died from pulmonary embolism, after other-

wise successful transplants. Starzl performed the

next eight LTs in infants and children (6) all of

whom survived surgery, but four died after 2-6

months from sepsis. This series of fatal complica-

tions was attributed to inadequate immunosup-

pression, followed by rejection. Between March

1963 and July 1976, 111 LTs were performed at

the University of Colorado, but with a 1-year sur-

vival rate of only 28%. Such poor results were at-

tributed to technical and medical problems (80%)

and acute rejection (20%) (7). From July 1976 to

December 1977, following technical and diagnos-

tic improvements the paediatric 1-year survival

rate doubled from 34 to 62%. Based on these im-

proved results, the development of other LT cen-

tres was undertaken.

In Europe, the first attempt at LT was made on

a 10 month-old child with biliary atresia on June

6th, 1968 in Cambridge, UK, by Sir Roy Calne. As

with Starzl’s first attempt, the child died during

surgery. The first successful LT in Europe was per-

formed by Otte et al. on March 17th, 1971 on a 17

month-old boy with biliary atresia. The recovery

was uneventful until the child developed acute re-

jection, which was reversed by steroids, but he

died 7 weeks after transplantation from massive

intrathoracic bleeding caused by a liver biopsy

(8). Following this case, as in the USA, there was a

long-term moratorium before the LT programme

was finally resumed in 1984. The four children

transplanted that year are still alive, including the

first patient who received a reduced liver graft and

who is currently, worldwide, the longest survivor

with her original cut-down liver (9).

All the early LT patients were treated with a

drug regimen that had been developed for kid-

ney grafts, namely azathioprine and steroids,

sometimes with the addition of antilymphocyte

globulins. Because of inadequate immunosup-

pression, long-term survival was observed in less

than one third of patients. At the beginning of the

1980s, the introduction of cyclosporine led to a


significant increase of graft and patient survival rates.In March 1980, the liver trials with cyclosporine A im-munosuppression began in Denver. Twelve patientsentered the study between March and September1980, of whom 11 lived for one year or longer (10).

In October 1986 representatives of the eight cen-tres in Europe and the USA with experience of at least20 paediatric LTs (i.e., Boston, Brussels, Cambridge,Dallas, Hannover, Minneapolis, Pittsburgh and LosAngeles) met for an update on the status of paediatricLT: long-term (>1 year) patient survival had reached57-83%; all centres were using cyclosporine-basedprimary immunosuppression; the major indications -biliary atresia being the most frequent - were alreadyclearly delineated.

Since the implementation of LT for end-stage liverdisease there has been a strong disparity between organdemand and the cadaveric donor supply for children.This initially resulted in a pre-transplant mortality for

children on the waiting list for LT of around 25%,which was disproportionably high compared with thatof adult patients (11). The problem of size mismatchand the different epidemiology of paediatric donorshipand terminally diseased children were responsible forthe disparity (12). This stimulated the development oftechnical innovations, based on the segmental anatomyof the liver, which facilitated transplanting parts of alarge cadaveric donor liver into smaller recipients: i.e.reduced size LT, split LT and living donor LT.

Reduced size liver transplantation (RSLT)

The first step in solving the size mismatch prob-lem was the introduction of reduced-size techniques.With this approach, after harvesting the liver from acadaver donor, liver resection is performed on theback table to tailor the size of the graft to that of onesingle recipient. The remaining resected liver tissue isdiscarded. In paediatric RSLT either the left lateral

Figure 1b. Adult split liver transplantationRight versus left liver split for an adult recipient, 3-dimensionalreconstruction of the hepatic veins. The line of division lies exactlyover the MHV-middle hepatic vein (yellow). RHV-right hepaticvein (blue), LHV-left hepatic vein (red).

Figure 1c. Adult split liver transplantationLeft liver graft segments 1-4 for an adult recipient, 3-dimensionalreconstruction. The right-sided border of the MHV-middlehepatic vein (yellow) can be seen exposed on the transectionsurface. All tributaries from segments 5 and 8 are exposed at theirconfluence with the MHV trunk. RHV-right hepatic vein (blue),LHV-left hepatic vein (red).

88 G. C. Sotiropoulos et al.

Paediatriki 2008;71:87-91

Figure 1a. Adult split liver transplantationRight versus left liver split for an adult recipient, 3-dimensionalreconstruction. Right graft segments 5-8 (green), left graft segments1-4 (brown). RHV-right hepatic vein (blue), MHV-middle hepaticvein (yellow), LHV-left hepatic vein (red).

Figure 1d. Adult split liver transplantationRight liver graft segments 5-8 for an adult recipient, 3-dimensionalreconstruction. The left-sided border of the MHV-middle hepaticvein (yellow) can be seen exposed on the transection surface. Alltributaries from segments 4a and 4b are exposed at their confluencewith the MHV trunk. RHV-right hepatic vein (blue), LHV-lefthepatic vein (red).


segment (Couinaud's segments II-III) or the full left

lobe (Couinaud's segments II-IV) is usually retained.

The technique as originally described by Bismuth and

Houssin (13) was validated in the late 1980s and later

became standard practice worldwide with 1-year sur-

vival rates of about 80% (14-18).

Although RSLT increases the number of paediatric

donor organs, it does not increase the total number of

organs available for LT, and indeed, it is actually dis-

advantageous to the adult recipient pool, which is

continuously growing (19).

Split liver transplantation (SLT)

The disadvantage of RSLT, namely, a discarded

liver segment, was solved by the introduction of split

liver techniques. SLT evolved from the RSLT and was

first described by Pichlmayr (20). This technique al-

lowed the preparation of two split grafts by dividing

all vascular and biliary structures and parenchyma for

the benefit of two recipients, one recipient receiving a

right lobe graft, and the other receiving either a left

lobe (segments 2-4, Figure 1) or left lateral segment

graft (segments 2-3, Figure 2). Usually the right lobe istransplanted into an adult and the left lobe or the leftlateral segment into a child. In 1989, Pichlmayr andcolleagues were the first to report the transplantationof one donor liver into two recipients (20,21). Thefirst series was reported by Broelsch and co-workers atthe University of Chicago (22) and in the early 1990sthe technique was further validated (23-25).

Technically, SLT is a complex procedure that canbe performed in two ways, ex situ or in situ, both ofwhich require precise knowledge of the liver anatomyand extensive experience with liver resection tech-niques and all the technical modalities of liver graftimplantation. Unfortunately, the wider application ofthe split technique is still hindered by the lack of ex-perience and unwillingness of some centres to splitevery suitable donor liver (26). Recent comprehensivestudies confirm that SLTs generally lead to lessfavourable results for individual recipients, but they

Figure 2d. Pediatric split liver transplantationRemnant liver (segments 1,4-8) including RHV-right hepatic vein(blue) and MHV-middle hepatic vein (yellow) after retrieval of a leftlateral liver graft (segments 2-3) including LHV-left hepatic vein(red) for a child, 3-dimensional reconstruction.

89Paediatric liver transplantation

¶·È‰È·ÙÚÈÎ‹ 2008;71:87-91

Figure 2b. Pediatric split liver transplantationLeft lateral liver split for a child, 3-dimensional reconstruction of thehepatic veins. The line of division lies exactly over the LHV-lefthepatic vein (red). Main tributaries of the MHV-middle hepaticvein (yellow) draining segments IVa/IVb in the remnant liver arepreserved. RHV-right hepatic vein (blue).

Figure 2c. Pediatric split liver transplantationLeft lateral graft (segments 2-3) including LHV-left hepatic vein(red) for a child, 3-dimensional reconstruction. RHV-right hepaticvein (blue), MHV-middle hepatic vein (yellow) remained with theremnant liver.

Figure 2a. Pediatric split liver transplantationLeft lateral liver split for a child, 3-dimensional reconstruction of thehepatic vein anatomy. Graft segments 2-3 (brown), remnantsegments 1,4-8 (green), RHV-right hepatic vein (blue), MHV-middle hepatic vein (yellow), LHV-left hepatic vein (red).


also result in more individuals deriving the benefit of

LT. While initially holding great promise and being

adopted as standard policy by many paediatric trans-

plant centres, early experience demonstrated a higher

incidence of technical complications and decreased

graft and patient survival rates in recipients of right

lobe grafts. Unfortunately, relevant extensive, detailed

data on this issue are not yet available.

Living donor liver transplantation (LDLT)

The development of LDLT in the USA and Europe

has been driven by the shortage of donor organs in

spite of the use of innovative techniques for cadaveric

LT, such as RSLT and SLT (27). In Japan, where organ

procurement from brain-dead donors was not legal

until recently, LDLT was the only option.

LDLT was first reported by Raia et al. in two pa-

tients in 1989 (28). Both recipients died shortly after

the procedure of medical complications, but lived long

enough for the technical feasibility of the procedure to

be established. This was soon followed by a report

from Strong et al. in Australia, where the first success-

ful LT of a child using its mother's left lobe was per-

formed in July 1989 (29). Even before the initial re-

ports by Raia and Strong, an extensive ethical appraisal

of the concept of LDLT was in progress at the Univer-

sity of Chicago, where clinical ethicists and transplant

physicians convened a yearlong series of seminars and

discussions open to the entire university community

(30). The introduction of LDLT required a balance be-

tween the presumed benefits of an elective transplant

for the recipient and the risk of morbidity or even

mortality from LDLT for the donor. At the outset the

main ethical problems the Chicago group had to deal

with for the introduction of paediatric LDLT were the

principle of equipoise and the principle of coercion

(30,31). A proposal derived from these meetings was

submitted to the institutional review board and a suc-

cessful LDLT was performed in November 1989 by Dr.

Broelsch, who subsequently initiated the systematic

use of LDLT for children with end-stage liver disease

(32). Between November 1989 and July 1996, 100

LDLTs were performed, with 1-year patient and graft

survival rates of 88% and 72%, respectively. Similar re-

sults were reproduced worldwide, confirming the ef-

fectiveness of the procedure (33,34).

LDLT has several advantages for the child and for

the transplant population as a whole. First, it increases

the number of organs directly available for the paedi-

atric population. Second, most recipients receive their

transplants on an elective basis and thus should incur

lower morbidity and mortality rates and decreased

overall cost. Third, the minimal cold ischaemia time

and the use of healthy donors may contribute to theabsence of primary non-function. The application ofLDLT for children with end-stage liver disease had aprofound impact on organ waiting list times and de-creased waiting list mortality markedly (35). Paedi-atric LDLT is now accepted therapy for childrenthroughout the world and frequently accounts for50% or more of all paediatric LTs performed at re-gional referral centres (35).

Despite the impressive results of LDLT, consider-able debate persists concerning donor safety. Therisks to the donor include those associated with inva-sive pre-surgical testing and with the surgical proce-dure. These risks are accepted by the potential donorsin exchange for the knowledge that the child's life maybe saved without the uncertainty of the cadavericwaiting list. The most recent donor outcomes frommultiple centres have been excellent (36-38).

The development of segmental hepatic grafts hasexpanded the supply of size-appropriate organs, al-lowing children who otherwise would have died onthe waiting list the opportunity to undergo LT. Re-cently the association between graft type, recipient ageand graft survival has been better defined: amongchildren <3 years of age, LDLT provides superiorgraft survival compared to RLT and SLT. In olderchildren it appears that cadaveric organs may offer abetter outcome (39,40). While RLT and SLT graftsproduce an overall inferior outcome in the nationalexperience, they remain an important and necessarytool in paediatric centre armamentarium. They pro-vide appropriately sized grafts for children with nosuitable living donor and for those for whom no ca-daveric paediatric donor is available, and they canyield an excellent outcome in experienced centres. Itis apparent that the technical complexities and peri-operative events surrounding these procedures have asignificant impact on the outcome. This emphasizesthe importance of experience, attention to continuedtechnical refinement, and judicious selection of ap-propriate donors for specific recipients.

References

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2. Burdelski MM, Rogiers X. What lessons have we learned inpediatric liver transplantation? J Hepatol 2005;42:28-33.

3. Rogiers X, Malagfi M, Gawad K, Jauch KW, Olausson M,Knoefel WT, et al. In situ splitting of cadaveric livers. Theultimate expansion of a limited donor pool. Ann Surg1996;224:331-339.

4. Ringe B, Burdelski M, Rodeck B, Pichlmayr R. Experiencewith partial liver transplantation in Hannover. ClinTranspl 1990;4:135-144.

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5. Starzl TE. The Puzzle People: Memoirs of a TransplantSurgeon. Pittsburgh, Pennsylvania: University of Pitts-burgh Press; 1992.

6. Starzl TE, Groth CG, Brettschneider L, Penn I, FulginitiVA, Moon JB, et al. Orthotopic homotransplantation ofthe human liver. Ann Surg 1968;168:392-415.

7. Starzl TE, Koep LJ, Halgrimson CG, Hood J, Schroter GP,Porter KA, et al. Fifteen years of clinical liver transplanta-tion. Gastroenterology 1979;77:375-388.

8. Otte JB. History of pediatric liver transplantation. Whereare we coming from? Where do we stand? Pediatr Trans-plant 2002;6:378-387.

9. Otte JB, de Ville de Goyet J, Sokal E, Alberti D, Moulin D,de Hemptinne B, et al. Size reduction of the donor liver is asafe way to alleviate the shortage of size-matched organs inpediatric liver transplantation. Ann Surg 1990;211:146-157.

10. Starzl TE, Klintmalm GB, Porter KA, Iwatsuki S, SchröterGP. Liver transplantation with use of cyclosporin a andprednisone. N Engl J Med 1981;305:266-269.

11. Malagfi M, Rogiers X, Broelsch CE. Reduced-size hepaticallografts. Annu Rev Med 1995;46:507-512.

12. Emond JC, Whitington PF, Thistlethwaite JR, Alonso EM,Broelsch CE. Reduced-size orthotopic liver transplanta-tion: use in the management of children with chronic liverdisease. Hepatology 1989;10:867-872.

13. Bismuth H, Houssin D. Reduced-sized orthotopic livergraft in hepatic transplantation in children. Surgery 1984;95:367-370.

14. Strong R, Ong TH, Pillay P, Wall D, Balderson G, Lynch S.A new method of segmental orthotopic liver transplanta-tion in children. Surgery 1988;104:104-107.

15. Broelsch CE, Emond JC, Thistlethwaite JR, Whitington PF,Zucker AR, Baker AL, et al. Liver transplantation, includ-ing the concept of reduced-size liver transplants in chil-dren. Ann Surg 1988;208:410-420.

16. Broelsch CE, Emond JC, Thistlethwaite JR, Rouch DA,Whitington PF, Lichtor JL. Liver transplantation with re-duced-size donor organs. Transplantation 1988;45:519-524.

17. Ringe B, Pichlmayr R, Burdelski M. A new technique of he-patic vein reconstruction in partial liver transplantation.Transpl Int 1988;1:30-35.

18. Ong TH, Lynch SV, Pillay SP, Balderson GA, Wall DR,Shepherd R, et al. Reduced-size orthotopic liver transplan-tation in children: an experience with seven cases. Trans-plant Proc 1989;21:2443-2444.

19. Busuttil RW, Goss JA. Split liver transplantation. Ann Surg1999;229:313-321.

20. Pichlmayr R, Ringe B, Gubernatis G, Hauss J, BunzendahlH. [Transplantation of a donor liver to 2 recipients (split-ting transplantation)--a new method in the further devel-opment of segmental liver transplantation]. LangenbecksArch Chir 1988;373:127-130.

21. Pichlmayr R, Bretschneider HJ, Kirchner E, Ringe B,Lamesch P, Gubernatis G, et al. [Ex situ operation on theliver. A new possibility in liver surgery]. Langenbecks ArchChir 1988;373:122-126.

22. Broelsch CE, Emond JC, Whitington PF, ThistlethwaiteJR, Baker AL, Lichtor JL. Application of reduced-size liv-er transplants as split grafts, auxiliary orthotopic grafts,and living related segmental transplants. Ann Surg 1990;212: 368-375.

23. Bismuth H, Morino M, Castaing D, Gillon MC, DescorpsDeclere A, Saliba F, et al. Emergency orthotopic liver trans-plantation in two patients using one donor liver. Br J Surg1989;76:722-724.

24. Otte JB, de Ville de Goyet J, Alberti D, Balladur P, deHemptinne B. The concept and technique of the split liverin clinical transplantation. Surgery 1990;107:605-612.

25. Otte JB, de Ville de Goyet J, Reding R, Van Obbergh L,Veyckemans F, Carlier MA, et al. Pediatric liver transplan-tation: from the full-size liver graft to reduced, split, andliving related liver transplantation. Pediatr Surg Int 1998;13:308-318.

26. Colledan M, Segalin A, Spada M, Lucianetti A, Corno V,Gridelli B. Liberal policy of split liver for pediatric livertransplantation. A single centre experience. Transpl Int2000;13:S131-133.

27. Trotter JF, Wachs M, Everson GT, Kam I. Adult-to-adulttransplantation of the right hepatic lobe from a livingdonor. N Engl J Med 2002;346:1074-1082.

28. Raia S, Nery JR, Mies S. Liver transplantation from livedonors. Lancet 1989;2:497.

29. Strong RW, Lynch SV, Ong TH, Matsunami H, Koido Y,Balderson GA. Successful liver transplantation from a liv-ing donor to her son. N Engl J Med 1990;322:1505-1507.

30. Singer PA, Siegler M, Whitington PF, Lantos JD, EmondJC, Thistlethwaite JR, et al. Ethics of liver transplantationwith living donors. N Engl J Med 1989;321:620-622.

31. Singer PA, Lantos JD, Whitington PF, Broelsch CE, SieglerM. Equipoise and the ethics of segmental liver transplanta-tion. Clin Res 1988;36:539-545.

32. Broelsch CE, Whitington PF, Emond JC, Heffron TG,Thistlethwaite JR, Stevens L, et al. Liver transplantation inchildren from living related donors. Surgical techniquesand results. Ann Surg 1991;214:428-437.

33. Reding R, de Goyet Jde V, Delbeke I, Sokal E, Jamart J,Janssen M, et al. Pediatric liver transplantation with cadav-eric or living related donors: comparative results in 90 elec-tive recipients of primary grafts. J Pediatr 1999;134: 280-286.

34. Inomata Y, Tanaka K, Uemoto S, Asonuma K, Egawa H,Kiuchi T, et al. Living donor liver transplantation: an 8-year experience with 379 consecutive cases. TransplantProc 1999;31:381.

35. Emond JC, Heffron TG, Kortz EO, Gonzalez-Vallina R,Contis JC, Black DD, et al. Improved results of living-relat-ed liver transplantation with routine application in a pedi-atric program. Transplantation 1993;55:835-840.

36. Renz JF, Roberts JP. Long-term complications of livingdonor liver transplantation. Liver Transpl 2000;6:S73-76.

37. Lo CM. Complications and long-term outcome of livingliver donors: a survey of 1,508 cases in five Asian centers.Transplantation 2003;75:S12-15.

38. Nadalin S, Heuer M, Wallot M, Auth M, Schaffer R,Sotiropoulos GC, et al. Paediatric acute liver failure andtransplantation: the University of Essen experience.Transpl Int. 2007;20:519-527.

39. Emond JC. Living donor liver transplantation in children:what to recommend? Am J Transplant 2004;4:293-294.

40. Abt PL, Rapaport-Kelz R, Desai NM, Frank A, Sonnad S,Rand E, et al. Survival among pediatric liver transplant re-cipients: impact of segmental grafts. Liver Transpl 2004;10:1287-1293.

91Paediatric liver transplantation

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92 ∞¡∞™∫√¶∏™∏ REVIEW ARTICLE


The definition of childhood obesity

The Body Mass Index (BMI) is the most prac-

tical measure of obesity and it is used in growth

monitoring to assess fatness. The BMI charts for

boys and girls (Tables 1 and 2) show the recom-

mended International Obesity Task Force cut-off

points for obesity and overweight in children. Th-

ese correspond to the adult definitions of over-

weight (BMI >25) and obesity (BMI >30) at age

18 years. Rapid changes in BMI can occur during

normal growth. The BMI is recommended as a

practical estimate of overweight in children and

adolescents, but it needs to be interpreted with

caution as it is not a direct measure of adiposity.

For epidemiological purposes overweight

should be defined as BMI greater than or equal to

the 85th centile of the 1990 reference data, and

obesity as BMI greater than or equal to the 95th

centile of the 1990 reference data.

The international epidemic of childhood

obesity

The definitions of overweight and obesity in

children differ between epidemiological studies,

making comparisons of cross-sectional data dif-ficult. The rates have increased threefold over 25years in the USA and fourfold over 18 years inEgypt (see the international childhood obesitymap) (1,2).

Consequences of childhood obesity

Childhood obesity is a multisystem diseasewith potentially devastating consequences. Itcauses hypertension, dyslipidaemia, increasedblood clotting tendency, endothelial dysfunctionand hyperinsulinism. Type 2 diabetes mellitus,once virtually unknown in adolescence, is largelyattributable to childhood obesity (4). A prediabet-ic state of glucose intolerance and insulin resis-tance appears to be highly prevalent among se-verely obese children irrespective of ethnic group.Type 2 diabetes is almost entirely attributable tothe childhood obesity epidemic, although heredi-tary and life-style factors affect individual risk.

Pulmonary complications include sleep-dis-ordered breathing (sleep apnoea), asthma andexercise intolerance. The development of exer-cise intolerance in an obese child can limit phys-ical activity and thus lead to further weight gain.

Childhood obesity – A public health crisis across the

European Union


Abstract: In the past, a fat child meant a healthy child, but in the last decade, excessive fatness or obesityhas become the primary paediatric health issue in the EU. It is known that some 10% of children are eitheroverweight or obese, and that obesity worldwide, apart from in sub-Saharan Africa, has reached epidemicproportions, with a threefold or more rise in most European countries since the 1980s (1,2,14,18). The maincauses of the obesity epidemic are clear - overeating, especially of foods rich in fats, extracted sugars orrefined starches, and a progressive decline in physical activity. The management of this epidemic dependson the successful motivation of people to eat less, to eat healthier foods and to exercise more, all of whichare difficult to achieve in societies where fruit and vegetables are less available than high-fat processedfoods, and where exercise no longer plays a regular part in most people’s lives. Management of childhoodobesity is time-consuming, frustrating, difficult and expensive (18). Adult obesity is the strongest predictorof childhood obesity; if both parents are obese, the chance of their child being obese increases tenfold.Breast feeding exerts a small protective effect against obesity. Television viewing is important, as it is knownthat for each additional hour of television watched at 5 years of age, the risk of adult obesity rises by 8%(7,8,18). Long-term increase or decrease in activity levels will influence whether a child becomes obese.Studies have implicated inactivity, with over 4 hours TV or computer use, and consumption of takeawayfoods more than twice weekly and fizzy drinks in the rising rates of obesity. Prevention of obesity will occuronly if there are fundamental changes in society, involving the production and availability of cheap healthyfoods, urban planning to ensure that people exercise more, education about eating, beginning in schools,and a global code to promote only healthy food and drink to children and adolescents. The vast majority ofobese children have primary obesity due to a disturbed energy balance. A very small percentage (5%) havea genetic cause for their obesity, and only very rarely are hormonal causes found.

Key words: Childhood obesity, epidemiology, management, prevention.

Primary / Secondary CareGroup of the EuropeanAcademy of Paediatrics

Correspondence:

Alf [email protected] Lady of Lourdes Hospital,Drogheda, Co. Louth, Ireland


93Childhood obesity

¶·È‰È·ÙÚÈÎ‹ 2008;71:92-95

Childhood obesity, of course, has substantial psy-chosocial consequences, and overweight children candevelop a negative self-image at as early as 5 years ofage, while obese adolescents show diminishing de-grees of self-esteem associated with sadness, loneli-ness and risk-taking behaviour (3,15).

Causes of childhood obesity

Genetic causes

In 1997, two massively obese Pakistani children ofconsanguineous parents were found to have a muta-tion in the gene encoding leptin and since then fivegenetic mutations causing obesity have been identi-fied, all presenting in childhood (5,6).

Prader-Willi syndrome (PWS) is a rare cause ofobesity, with a deletion of chromosome 15 and fea-tures of a voracious appetite, poor linear growth,small hands and genitalia and dysmorphic features.Progress has been made in mapping the genetic loci ofPWS but the molecular cause of this obesity syn-drome has not yet been identified.

Thus, single gene defects account for a very smallfraction of human obesity and predisposition to obe-sity appears to be related to a complex interaction be-tween at least 250 obesity-associated genes.

Physical activity

A lifestyle characterized by a lack of physical activ-ity and excessive television viewing has been shown tobe associated with childhood obesity. Among chil-dren from Mexico City, the risk of obesity decreasedby 10% for each hour of moderate to vigorous physi-cal activity and increased by 12% for each hour perday of television viewing.

Television viewing

Television viewing is thought to promote weightgain not only by displacing physical activity but alsoby increasing energy intake (7,8). Children tend topassively consume excessive amounts of energy-dense

foods while watching television. Furthermore, televi-

sion advertising could adversely influence dietary pat-

terns at other times throughout the day. Screen time

for children of over 2 years should be limited to no

more than 1 to 2 hours per day (18).

Diet

Children who were bottle fed appear to be at

greater risk of obesity later in childhood than those

who were breast fed (9).

Sugar-sweetened soft drinks have been the subject of

several studies, which have shown that the total energy

intake was 10% greater among children who consumed

soft drinks than in those who did not (18). Increasing

portion sizes are also a factor. Fast food typically incor-

porates potentially adverse dietary factors including sat-

urated fat, a high glycaemic index, high energy density

and, increasingly, large portion size. A large fast food

meal could contain 2,200 kcal, which, at 85 kcal per

mile, would require a full Marathon to burn off.

Breakfast skipping, snacking and eating out (in par-

ticular at fast food establishments) are all associated

with obesity (18). The ‘traffic light diet’, recommended

for consumption by children in the age-group 6 to 12

years, consists of low energy, high nutrient foods such

as fruit and vegetables (green), moderate energy foods

(orange) and high energy foods (red). ‘Green’ foods

may be eaten often, ‘orange’ foods in moderation and

‘red’ foods should be eaten sparingly (10,18).

Family factors

Parent-child interactions and the home environ-

ment can affect the risk of developing obesity. Tradi-

tional family meals tend to decrease television viewing

and improve dietary quality; the child takes a diet with

less saturated and trans fats, less fried foods, lower

glycaemic load, more fibre, fewer soft drinks and

more fruit and vegetables.

Table 2. Tests to be considered in obesity

Secondary causes of obesity are exceedingly rare; most obesityis what is termed simple obesity, and no investigations arerequired. - Short stature/hypertension/striae - morning and evening

cortisol levels (to exclude Cushings disease)- Short stature/goitre/hip pain - thyroid function tests , hip

X-ray to exclude slipped capital femoral epiphysis- Small hands and feet/voracious appetite - karyotype, FISH

(Prader-Willi syndrome)- Excessive thirst/increased urine output - fasting + 2 hour

blood sugar levels, glucose tolerance test (Diabetes)- Hirsutism/obesity/absence of periods - blood testosterone

level, ultrasound scan of ovaries showing numerous cysts(polycystic ovary syndrome)

Table 1. Complications of obesity

Short-term Long-term

Poor self-esteem/depression Persistence of obesityAsthma Social stigmatisation Sleep apnoea Sleep apnoeaType 2 diabetes mellitus Type 2 diabetes mellitusOrthopaedic problems Osteoarthritis(e.g. slipped epiphysis)Hypertension/ Hypertension/high cholesterol high cholesterolEarly puberty/ Menstrual irregularities/polycystic ovaries hirsutismGallstones Gallstones


Prevention and treatment

Prevention and treatment ultimately involves eat-

ing less and exercising more. Most efforts to reduce

obesity in children have used family-based or school-

based approaches and only in severe cases are phar-

macological and surgical treatments considered. Fol-

lowing a review of randomised controlled trials, Eb-

stein et al. (10) concluded, somewhat soberly, that

most interventions to treat childhood obesity are

marked by only small changes in weight or BMI and

very high rates of subsequent relapse.

School-based interventions have been oriented to-

wards prevention of obesity, targeting all children. The

Pathways programme (12), for American Indian chil-

dren at high risk of type 2 diabetes and cardiovascular

disease, aimed to reduce dietary fat consumption and

increase physical activity. This 3-year programme pro-

duced a significant decrease in fat consumption and a

trend towards increased physical activity but the BMI

did not differ between children in the intervention and

the control schools at the end of the programme. The

Planet Earth trial (11) focussed largely on changing the

school environment over two school years to include

reduced television viewing, increased physical activity,

decreased fat intake, increased fruit and vegetable in-

take, altered class curricula and extensive education of

families. In this trial there was a significant reduction

in obesity in girls (absolute risk 0.47, CI 0.24-0.93),

with trends in the same direction in boys, although not

reaching statistical significance. The authors reported

that the effect observed was largely attributable to ob-

served reductions in television viewing.

Most children managed in the community will have

simple obesity with no underlying medical cause and

without comorbidity. Treatment should be offered

when the obese child and family are willing to make the

necessary life-style changes. For children who are over-

weight and most children who are obese, weight main-

tenance is an acceptable goal (13). Weight maintenance

can only be achieved by sustained behavioural changes,

including healthier eating, an increase in physical activ-

ity to a minimum of 30 minutes per day and reduction

of physical inactivity (e.g., watching television or play-

ing computer games) to less than 2 hours per day. Par-

ticular attention should be given to methods for in-

creasing physical activity in adolescents (18).

Suggestions for parents

Suggestions for increasing physical activity:

- any increase in activity will help,

- aim for simple changes at first, such as walking,

cycling and using stairs rather than lifts,

- develop an active life-style for the whole family,

- encourage active play that is enjoyable and do all

you can to keep exercise fun,

- decrease TV viewing and other sedentary activities,

- schedule unstructured free playtime on a daily

basis.

Dietary suggestions:

- a balanced, varied diet for the whole family,

- serve meals at regular times; avoid ‘grazing’ and

TV snacks,

- serve smaller portions,

- avoid snacks as rewards or treats,

- offer healthy snacks (e.g., fruit) as alternatives to

sweets, chocolates, potato crisps, biscuits and cakes,

- use less energy dense food (e.g., semi-skimmed

milks and low fat spreads),

- provide whole foods that take time to eat (e.g.,

fruits and wholemeal bread),

- promote low calorie drinks (preferably water),

- ensure at least five portions of fruit and vegeta-

bles per day,

- grill, boil or bake foods rather than frying them,

- “Eat to live, don’t live to eat”,

- pare down the amount of ‘junk’ food in the house,

- comfort with attention, listening and hugs in-

stead of food.

The perfect meal plan

Modern families may rarely sit down to a meal

all together, and one major suggestion is to bring

back the traditional family meal; the perfect meal

plan entails:

- firstly turn off the TV,

- involve children in the cooking process,

- switch mobile phones to silent,

- make sure that everyone sits down together at the

table,

- serve the plates from a central location to ensure

control over portion sizes,

- the meal should last at least 20 minutes,

- share the positive events of the day,

- be mindful while eating of the colour, texture

and smell of the food,

- make dessert a continuation of the meal and not

something too special,

- substitute fruit for dessert at times,

- parents, not children, should be responsible for

food decision making,

- limit soft drink consumption.

Drug treatment for obesity

Drug treatment is not recommended for chil-

dren under 12 years, and in adolescence it is only

94 A. J. Nicholson et al.



95Childhood obesity

¶·È‰È·ÙÚÈÎ‹ 2008;71:92-95

recommended in situations where there are medicalcomplications (orthopaedic complications or sleep ap-noea) or severe psychological issues arising from theobesity. Medication used as part of a structured life-stylemodification produces an average weight loss of 5 to10%, which typically reaches a plateau at 4 to 6 monthsof treatment, and weight regain is common after thedrug is withdrawn (16,18). Prescribing should be madeby a specialist multidisciplinary team. The drugs usedare orlistat and sibutramine and they are generally usedfor a 6-12 month trial with regular reviews of effective-ness, adverse effects and adherence. Sibutramine is anappetite suppressant and orlistat works as a reversible li-pase inhibitor (18). Drug treatment may be used to helpthe adolescent maintain weight loss as well as to contin-ue to lose weight. Four experimental drugs have pro-duced weight loss in small studies involving childrenwith special conditions, specifically, metformin in obeseadolescents with insulin resistance, octeotride for hypo-thalamic obesity, growth hormone in Prader-Willi syn-drome and leptin for congenital leptin deficiency (17).

Bariatric surgery for obesity

Surgery is generally not recommended for chil-dren and adolescents and constitutes, at best, a last re-sort for severely obese adolescents. Exceptional cir-cumstances in which surgery might be considered arewhen the BMI is >40, or when in the case of a signifi-cant complication, such as hypertension or type 2 di-abetes that could be improved by weight loss, all ap-propriate non-surgical measures have failed or whenthey are receiving intensive care.

Key points to remember

- Obesity is now the commonest chronic condi-tion affecting children across the EU.

- Obesity is due to an imbalance between energyconsumption and energy expenditure. Obese childrendo not have low energy needs.

- Family support is necessary for treatment tosucceed.

- Generally the aim of treatment is to help childrenand adolescents to maintain their weight.

- In younger children the main impact of obesity issocial and emotional rather than medical.

- A medical cause for obesity is more likely in chil-dren who are both short and obese for age.

- Most children are not obese because of an under-lying medical problem, but rather as a result of theirlife-style.

- Weight reduction or stabilization goals shouldalways be kept reasonable.

- The major calorie culprits are high-fat fast food,large portions and sugar-containing soft drinks.

- If a child is at risk of obesity due to family histo-

ry, the earlier the modifications (e.g., reducing TV

time) the better.

References

1. Strauss RS, Pollack HA. Epidemic increase in childhood

overweight, 1986-1998. JAMA 2001;286:2845-2848.

2. Ebbeling CB, Pawlak DB, Ludwig DS. Childhood obesity:

public-health crisis, common sense cure. Lancet 2002;360:

473-482.

3. Strauss RS. Childhood obesity and self-esteem. Paediatrics

2000;105:e15.

4. Sinha R, Fisch G, Teague B, Tamborlane WV, Banyas B,

Allen K, et al. Prevalence of impaired glucose tolerance

among children and adolescents with marked obesity. N

Eng J Med 2002;346:802-810.

5. Montague CT, Farooqi IS, Whitehead JP, Soos MA, Rau H,

Wareham NJ, et al. Congenital leptin deficiency is associat-

ed with severe early-onset obesity in humans. Nature 1997;

387:903-908.

6. Farooqi IS, O’Rahilly S. Recent advances in the genetics of

severe childhood obesity. Arch Dis Child 2000;83:31-34.

7. Robinson TN. Does television cause childhood obesity?

JAMA 1998;279: 959-960.

8. Robinson TN. Reducing children’s television viewing to

prevent obesity: a randomized controlled trial. JAMA

1999;282:1561-1567.

9. Ludwig DS, Peterson KE, Gortmaker SL. Causes of obesity.

Lancet 2001;357:1978-1979.

10. Epstein LH, Roemmich JN, Raynor HA. Behavioral thera-

py in the treatment of pediatric obesity. Pediatr Clin North

Am 2001;48:981-993.

11. Sahota P, Rudolf MC, Dixey R, Hill AJ, Barth JH, Cade J.

Randomised controlled trial of primary school based inter-

vention to reduce risk factors for obesity. BMJ 2001;323:

1029-1032.

12. Lohman TG, Going S, Stewart D, et al. The effect of Path-

ways obesity prevention study on body composition in

American children. FASEB J 2001;15:A1093.

13. Summerbell CD, Ashton V, Campbell KJ, Edmunds L, Kel-

ly S, Waters E. Interventions for treating obesity in chil-

dren. Cochrane Database Syst Rev 2003;(3):CD001872.

14. Wiegand S, Maikowski U, Blankenstein O, Biebermann H,

Tarnow P, Grüters A. Type 2 diabetes and impaired glu-

cose tolerance in European children and adolescents with

obesity - a problem that is no longer restricted to minority

groups. Eur J Endocrinol 2004;151:199-206.

15. Sabin MA, Ford AL, Holly JM, Hunt LP, Crowne EC,

Shield JP. Characterisation of morbidity in a UK, hospital

based, obesity clinic. Arch Dis Child 2006;91:126-130.

16. Glazer G. Long-term pharmacotherapy of obesity 2000: a

review of efficacy and safety. Arch Intern Med 2001;161:

1814-1824.

17. Farooqi IS, Jebb SA, Langmack G, Lawrence E, Cheetham

CH, Prentice AM, et al. Effects of recombinant leptin ther-

apy in a child with congenital leptin deficiency. N Eng J

Med 1999;341:879-884.

18. Spear BA, Barlow SE, Ervin C, Ludwig DS, Saelens BE,

Schetzina KE, et al. Recommendations for treatment of

child and adolescent overweight and obesity. Pediatrics

2007;120:S254-S288.




Use of the new World Health Organization growth standards

in the prevention of childhood overweight and obesity


Abstract: The prevalence of overweight and obesity in young children continues to rise in most parts ofthe world. Obese children have a significantly higher risk of becoming obese adults, which underlinesthe importance of adequate growth monitoring from early ages. Different international references forgrowth assessment are currently being used by paediatricians in most countries. This review examinesthe differences between the Centers for Disease Control (CDC) growth reference and the new WorldHealth Organization (WHO) growth standards for children of less than five years when used asdiagnostic tools for the detection of excess weight. It also includes preliminary results from aretrospective study conducted in a cohort of 300 healthy children from a paediatric clinic in Mexicoevaluating differences in overweight prevalence depending on the growth reference employed. Resultsshowed a higher prevalence of overweight and obesity with WHO standards than with the CDCreference in children from 1 through 5 years of age, independent of gender, in agreement with otherstudies. Use of the new WHO growth standards is emphatically encouraged for both routine clinicalpractice and epidemiological research, in order to avoid potential pitfalls and inaccuracies whenmonitoring child growth and to detect childhood overweight and obesity effectively. The new WHOstandards provide a unique opportunity for redesigning child overweight surveillance and preventionprogrammes so that they become more useful for detection and decision making and less complicatedfor gathering epidemiological data.

Key words: Childhood obesity, childhood overweight, growth reference, growth standard.

Facultad de Ciencias de laSalud, UniversidadAutonoma del Carmen,Ciudad del Carmen,Campeche, Mexico

Correspondence:

Daniel [email protected] de Ciencias de la Salud,Universidad Autonoma del Carmen,Ciudad del Carmen, Mexico

Childhood globesity: understanding the

magnitude of the problem

Overweight and obesity have achieved global

acknowledgement during the past decade. Excess

body weight is now considered one of the most

important risk factors contributing to the overall

burden of disease. Worldwide, around 1.2 billion

adults are classified as being overweight, of which

312 million are considered obese (1). The preva-

lence of obesity has reached alarming levels, affect-

ing both developed and developing countries and

all socioeconomic groups, irrespective of age, sex

or ethnicity. If effective preventive measures are

not implemented soon, this public health problem

will continue to expand to the extent that it will be-

come out of control. For example, it is estimated

that in the US by 2015, 75% of adults will be over-

weight, of which more than half will be obese (2).

Concerning childhood obesity, around 10%

of children in the world have some degree of

overweight and over 22 million children under

the age of 5 are already obese (3). The prevalence

of overweight is dramatically higher in the eco-

nomically developed regions, but it is also rising

significantly in most other parts of the world. In

developing nations, childhood obesity is most

prevalent in the wealthier sections of the popula-

tion. However, it is also increasing among the ur-

ban poor in these countries, possibly due to their

exposure to westernized diets. The prevalence of

childhood overweight in America is currently

above 20%, reaching up to 40% in the case of the

US and Mexico. In Europe, the number of chil-

dren who are overweight is expected to rise by 1.3

million children per year, with more than

300,000 of them becoming obese each year (4).

By 2010 it is estimated that 26 million children in

European countries will be overweight, including

6.4 million who will be obese (5). Such rapid

changes in the numbers of obese children within

a relatively stable population indicate that genet-

ic factors are not the primary reason for change,

although they play a role that is yet to be precise-

ly determined.

Childhood obesity is usually associated with

complications that include diabetes types 1 and 2

(6,7), insulin resistance, atherosclerosis (8,9),

hypertension, dyslipidaemia, polycystic ovary

disease, kidney disease (10) and fatty liver

among many others (11). Children with body

mass index (BMI) and waist circumference ex-

ceeding the established normal values are at in-

creased risk for metabolic syndrome when they

reach adulthood (12,13). A higher BMI during


97Prevention of childhood overweight and obesity

¶·È‰È·ÙÚÈÎ‹ 2008;71:96-104

childhood is also associated with an increased risk for

coronary heart disease (CHD) in adulthood (14) and

this association appears to be stronger in boys than in

girls and to increase with age in both sexes (15).

In addition, excess body weight appears to be an

important risk factor for some cancers. A systematic

review compared associations between 20 cancer types

and BMI (16). Their results show that a higher BMI is

associated with an increased risk of thyroid, renal and

colon cancers, oesophageal adenocarcinoma, multiple

myeloma, leukaemia and non-Hodgkin lymphoma in

both sexes, rectal cancer and malignant melanoma in

men, and gallbladder, pancreas, endometrial and post-

menopausal breast cancers in women.

Several theories have been formulated to account

for the obesity epidemic. Clearly, the main causes are

overeating and lack of physical activity. However, it is

of paramount importance to identify all the risk factors

that predispose an individual to become obese (17).

There appears to be a direct causal relationship be-

tween childhood overweight and maternal pre-preg-

nancy body size, maternal smoking during pregnancy

(18), early weaning (19), rapid growth (20) and chil-

dren’s use of television and media, while breastfeeding

appears to have a protective effect against overweight

(21). Further studies are needed to elucidate the exact

mechanisms by which these factors influence child-

hood adiposity, for example, its relationship with so-

cioeconomic status (22). Some authors have claimed

that, although clinically irrelevant, temperament may

be slightly related to overweight and rapid early weight

gain in infants (23). Others have proposed that a high

early protein intake, particularly from dairy products,

increases obesity risk (24,25). Some studies suggest that

sleep deprivation may influence weight through effects

on appetite, physical activity, and thermoregulation

(26). Short sleep duration appears independently asso-

ciated with weight gain in younger age groups (27).

Unfortunately, to date, scientific evidence regarding

risk factors for childhood obesity is still insufficient,

with much of the literature being of limited quality, in-

conclusive and contradictory (28).

There is strong evidence to suggest a direct rela-

tionship between weight status in childhood and

eventual adult obesity, but many studies are based on

cross-sectional data or have relatively long periods of

time between measurements. It is now accepted that

obesity in adolescence is highly predictive of obesity

in adulthood. Therefore, an important next step will

be to identify those young children at greatest risk of

developing obesity in adolescence, and to intervene

before chronic overweight is established during early

childhood. Children who are found to be overweight

at least once at ages 24, 36 or 54 months during the

preschool period are 5 times more likely to be over-

weight at age 12 years than those who are below the

85th percentile for BMI at all three of the preschool

ages. The longer a child remains in the lower range of

normal BMI, the less likelihood there is that the child

will become overweight by early adolescence (29).

Adequate detection of overweight and

obesity in childhood

Not long ago, a fat child meant a healthy child, and

the concept of “bigger is better” was widely accepted by

parents, paediatricians and caregivers. Such a point of

view belongs to the past, however (30), and at present,

child obesity is one of the most evident, yet most ne-

glected public health problems in the world. Although

the problem is well recognized, most obesity preven-

tion measures worldwide have been small, timid and

ineffective to halt the epidemic (31). Arguably, ‘globe-

sity’ might have been detectable earlier if a prescriptive

reference had been available 20 years ago, and even

now the first problem that needs to be addressed is

agreement of a definition of true obesity. Some of the

contradictory childhood obesity rates seen in the liter-

ature are a direct consequence of using different crite-

ria to define overweight and obesity. The main pur-

poses for defining overweight and obesity are to pre-

dict health risks and to provide comparisons between

populations. For practical reasons, the definitions have

usually been based on anthropometry, but regardless of

which definition is used, the increasing rates have high-

lighted the relevance of the problem (32).

Obesity is defined as an excess of body fat or adipose

tissue. It is actually fat and not weight which is associat-

ed with all the comorbid conditions. Measuring fat is

not as straightforward as measuring weight; therefore

weight, rather than adiposity, is the usual clinical mark-

er for identifying obesity. Although body weight tends

to be associated with adiposity, weight alone is an insuf-

ficient measure of obesity by itself, because it is correlat-

ed with height (33). To avoid this limitation, a number

of measures of weight in relation to height have been

devised over the years. The simplest and most frequent-

ly used are weight-for-height and the BMI.

BMI is a practical indirect measure of adiposity, al-

though the relationship changes according to age, sex

and ethnicity, but also degree of fatness. A child’s BMI

can be compared with a reference data set and be con-

verted into a Z-score. A BMI Z-score of 0 is equivalent

to the median or 50th percentile value, a Z-score of

+2.00 is approximately equivalent to the 98th per-

centile and a Z-score of +2.85 is >99th percentile.

Some authors postulate that even though BMI Z-score


98 M. Ponce-Rivera, D. Fuentes-Lugo


is optimal for assessing adiposity on a single occasion,

it is not necessarily the best scale for measuring change

in adiposity, as the within-child variability over time

depends on the child’s level of adiposity (34).

Use of BMI index charts during a paediatric health

supervision visit increases physician recognition of

overweight patients better than height-for-weight

charts (35). Regrettably, BMI charts are not routinely

used (36) and due to ineffective detection not all chil-

dren with overweight receive either a formal diagnosis

or treatment (37). A study conducted among public

and private practice paediatricians in the US revealed

that they identified overweight in only 27% of children

with BMI at the 85th-94.9th percentile and up to 86%

with a BMI at or above the 95th percentile (38). Rate

recognition by physicians increased as the severity of

obesity increased. US paediatricians may not use BMI

charts because they recognize obesity empirically when

they see it, at least when the BMI is above the 95th per-

centile. However, they may overlook excess weight in

children with BMI at the 85th-94th percentile, perhaps

because these children seem fairly normal.

Adequate growth and weight gain should concern

not only paediatricians and child caretakers but also

parents (39). One study showed that parents of

younger children were significantly more likely to un-

derestimate overweight (65%) than parents of adoles-

cents (51%). Overweight parents were not more like-

ly to underestimate weight, nor was accuracy associat-

ed with parental education or socieconomic status.

Parental recognition of childhood overweight may be

improved with BMI screening and feedback (40).

Growth references versus growth standards:

which should be used?

Growth references are a fundamental tool for the

interpretation of anthropometric data. Classifying a

child as overweight or obese assumes that such a child

is comparable to the reference population, so choos-

ing the right tool for proper detection is mandatory

(41). In the US, reference growth charts based on na-

tionally representative surveys have been produced

since 1977. An expert committee recommended their

use for children and adolescents, with the 95th BMI

percentile for age and sex (or BMI 30 kg/m2) as the

cutoff points for overweight and the 85th percentile as

“at risk of overweight” for screening purposes. The

fact that the committee decided not to use the term

‘obese’, which they associated with excess fat rather

than weight, has lead to some confusion (42).

In May 2000 the US Centers for Disease Control

(CDC) released new growth charts to replace the 1977

NCHS reference. The CDC-2000 charts were based

on five nationally representative surveys conducted

between 1963 and 1994. This reference, currently

used in about 100 countries, is based on data from

several samples of children from a single country and

suffers from a number of technical drawbacks that

makes it inadequate for monitoring growth in early

childhood. A survey reported that CDC-2000 is the

growth reference most commonly used worldwide.

Another interesting fact from this international study

is that most paediatricians prefer using percentiles

rather than Z-scores (43). The use of Z-scores offers

advantages over the use of percentiles; for instance,

when conducting epidemiological studies, Z-scores

allow easier comparison between growth references.

In the late 1990s, the International Obesity Task

Force (IOTF) determined that although BMI was not

ideal as a measure of adiposity, it could be used to de-

fine overweight and obesity in children and adoles-

cents. IOTF recommended cutoff points based on

age-specific values that project to the adult cutoff

points of 25 kg/m2 for overweight and 30 kg/m2 for

obesity. Using data collected between 1963 and 1993

from six different populations (Great Britain, Brazil,

the Netherlands, Hong Kong, Singapore and USA)

IOTF published their reference curves in 2000 (44).

These are useful mainly for epidemiological research,

since children and adolescents can only be categorized

as non-overweight or overweight/obese. Since the

adult cutoff points of BMI 25 and 30 may not be uni-

versally applicable, the IOTF curves are inappropriate

for some child populations. A number of reports have

shown that these cutoff points substantially underes-

timate the prevalence of childhood obesity in differ-

ent settings (45). In short, the IOTF reference appears

to be a less adequate tool for detecting overweight and

obesity in clinical practice compared with methods

based on percentiles or Z-scores.

WHO 2006 Child Growth Standards

The WHO 2006 Child Growth Standards are the

product of a long systematic process which started in

the early 1990s. They are based for the first time on a

prospective, prescriptive, international sample of in-

fants selected to represent optimum growth (46). The

WHO Multicenter Growth Reference Study (MGRS)

was designed to provide data that describe how chil-

dren should grow from birth to five years under opti-

mal environmental conditions, rather than describing

their growth in a particular time and place, and there-

fore, they can be applied to all children everywhere,

regardless of ethnicity, socioeconomic status and type

of feeding (47).

The MGRS was carried out from July 1997 to


December 2003 as a population-based study coveringthe cities of Davis, California, USA; Muscat, Oman;Oslo, Norway; and Pelotas, Brazil, together with se-lected affluent neighborhoods of Accra, Ghana andSouth Delhi, India. The WHO combined a longitudi-nal follow-up from birth to 24 months with a cross-sectional component of children aged 18-71 months.The study population lived under socioeconomicconditions favourable to growth. The individual in-clusion criteria were: no known health or environ-mental constraints to growth, mothers willing to fol-low MGRS feeding recommendations (exclusive orpredominant breast-feeding for at least 4 months, in-troduction of complementary foods by 6 months ofage, and continued breast-feeding to at least 12months of age), no maternal smoking before and afterdelivery, single term birth and absence of significantmorbidity (48). Prior to their release, the standardswere field-tested in four countries: Argentina, Italy,Maldives and Pakistan (49).

One important feature of the WHO standards tobear in mind is that it makes breast-feeding the bio-logical norm and establishes the breast-fed infant asthe normative growth model (50). The previous refer-ences were based mostly on the growth pattern of ar-tificially-fed children. The WHO-2006 standardsdemonstrate that healthy children from around theworld who are raised in healthy environments andfollow recommended feeding practices have similarpatterns of growth. This indicates that the same po-tential for growth should be expected in any country.It also implies that deviations from this ideal growthpattern must be assumed to reflect adverse conditionsthat require correction (51).

Since there are substantial differences in methodol-ogy, cutoff values and selected population between thevarious growth references, it is expected that signifi-cant changes would be found when one reference iscompared to another, even if they are from the samecountry. For instance, the CDC-2000 reference under-

estimates the weight-for-height Z-scores of individual

children compared to the 1977 NCHS reference, both

of which are references derived from American chil-

dren. A child classified as close to +3 Z-score using the

1977 NCHS reference will be just below +2 Z-score

when the CDC 2000 reference is applied (52).

Few studies have compared the 1977 NCHS crite-

ria for defining overweight or obesity with the CDC-

2000 reference curves and the IOTF alternative set of

cutoff points. In younger children, the IOTF curves

gave significantly lower estimates for the prevalence of

obesity. One study involving 258 Italian children (av-

erage age 4.8 years) found that the CDC -2000 refer-

ence led to a significantly higher prevalence of obesity

in both males and females when compared to the

growth charts of the IOTF (53). BMI cutoff points

from the CDC and IOTF have relatively high specifici-

ty, but lower sensitivity, meaning that children with

normal weight are unlikely to be wrongly labelled, but

overweight and obese children may be missed. Detect-

ing a child with overweight depends basically on which

reference and which cutoff value is used, and this

clearly represents a major problem (Tables 1 and 2).

When CDC-2000 reference curves are compared

with the new WHO-2006 standards, significant dif-

ferences are found that vary by age group, growth

Table 2. Body mass index (BMI) cutoff values for obesity fromIOTF and WHO-2006 growth standards in children aged 2 to 5years

IOTF WHO 2006BMI 25 Kg/m2 +3 S.D.

Age (years) Boys Girls Boys Girls

2 20.09 19.81 20.6 20.62.5 19.80 19.55 20.2 20.43 19.57 19.36 20.0 20.33.5 19.39 19.23 19.8 20.44 19.29 19.15 19.9 20.64.5 19.26 19.12 20.0 20.85 19.30 19.17 20.3 21.1


¶·È‰È·ÙÚÈÎ‹ 2008;71:96-104

Table 1. Body mass index (BMI) cutoff values for overweight from the IOTF, CDC-2000 and WHO-2006 growth standards in childrenaged 2 to 5 years

IOTF CDC 2000 WHO 2006BMI 25 Kg/m2 +2 S.D. +2 S.D.

Age (years) Boys Girls Boys Girls Boys Girls

2 18.41 18.02 20.14 19.80 18.9 18.72.5 18.30 17.76 19.38 19.31 18.6 18.53 17.89 17.56 18.86 19.01 18.4 18.43.5 17.69 17.40 18.55 18.89 18.2 18.44 17.55 17.28 18.43 18.93 18.2 18.54.5 17.47 17.19 18.48 19.10 18.2 18.75 17.42 17.15 18.69 19.39 18.3 18.8


indicator and Z-score curve. The main differences in

weight-for-age Z-score curves occur during infancy

(Graph 1). Regarding weight-for-length Z-score

curves for boys, estimates of overweight and obesity

are higher when based on the WHO standards (54).

The change in the shape of the curves is probably

due to issues related to study design and the charac-

teristics of the sample, as well as differences in the

type of feeding. The CDC used samples of less than

100 infants per age group during the first six

months; consequently, the CDC-2000 curves proba-

bly fail to capture the rapid and changing rate of

weight gain in early infancy. The WHO-2006 stan-

dard is based on a much larger sample size (428 boys

and 454 girls) and shorter measurement intervals.

These design characteristics allowed the WHO

curves to capture rapidly changing patterns of

growth in early infancy.

Comparison of weight-for-length and weight-for-

height chart shows that CDC-2000 children were

generally heavier than those included in the WHO-

2006 sample. The BMI-for-age curves are dramatical-

ly different, partly reflecting obesity in the US sam-

ple. This flaw makes the CDC-2000 weight-for-

height curves inadequate for monitoring obesity

from 100 cm onwards. In addition, the pattern of

lower centiles of the CDC weight-for-length chart

below 53 cm may reflect peculiarities of the birth

registry data used to design the CDC curves (55). In

summary, the CDC-2000 charts provide a growth

reference rather than a prescriptive standard, such as

the WHO-2006.

Based on this rationale, a retrospective study was

conducted in a cohort of healthy children from a sin-

gle paediatric clinic in Mexico City in order to assess

differences between the CDC-2000 reference and the

new WHO-2006 standards (56). Among the main

outcomes examined were differences in estimated

overweight/obesity prevalence. From the files with

complete weight and height records from birth up to

five years of age, 300 children (167 boys and 133 girls)

were randomly selected. Children with a history of

chronic disease were excluded. Weight-for-age,

height-for-age, weight-for-height and BMI per-

centiles and Z-scores were obtained at 0, 12, 24, 36, 48

and 60 months of age (±2 months). To classify chil-

dren with overweight or obesity, Z-score values of

+2.00 S.D. and +3.00 S.D. respectively, were used.

Anova regression analysis was performed to compare

the curves from birth to five years of age derived from

the two reference instruments.

Using weight-for-height as an anthropometric

marker, the results showed a relatively low prevalence

of overweight in the complete cohort between the first

and second years of age with both references, al-

though the prevalence using the WHO-2006 stan-

dards was significantly different from that obtained

z-BMI for girls(n=133)

Age

2 3 4 5

Z

1

0.5

0

-0.5

-1

WHO 2006

CDC 2000

Graph 3. WHO Growth Standard versus CDC Growth Reference.

z-BMI for boys(n=167)

Age

2 3 4 5

Z

1

0.5

0

-0.5

-1

WHO 2006

CDC 2000

Graph 2. WHO Growth Standard versus CDC Growth Reference.

Table 3. Prevalence of overweight (including obesity) usingweight-for-height Z-scores from the CDC-2000 growth referenceand WHO-2006 growth standards during the first year of life

Boys GirlsWHO CDC WHO CDC

+2 S.D. +2 S.D. +2 S.D. +2 S.D.

Birth 0% 0.59% 0% 3%1 year 2.39% 0% 2.25% 2.25%



0.80.60.40.2

0-0.2-0.4-0.6-0.8

0 1 2 3 4 5 6 7 8 9 10 11 12Age (months)

Mean weight-for-age Z-scores

NCHSCDCWHO

Graph 1. WHO Growth Standard versus CDC-2000 and NCHS-1977 Growth References (adapted from references 52 and 54).



¶·È‰È·ÙÚÈÎ‹ 2008;71:96-104

with the CDC-2000 reference (1.33% versus 0.66%

overweight). The main differences in the weight-for-

height Z-score were observed from 12 to 36 months of

age. At 1 year of age, differences were found for the

boys but not the girls (Table 3). The prevalence of

overweight increased markedly at age 4-5, but with

significant differences between CDC and WHO

scores regardless of gender.

It was not possible to compare Z-BMI curves be-

tween the two references during the first two years be-

cause such data is not included in the CDC-2000

growth curves. When BMI Z-score was used to iden-

tify overweight (+2.0) and obesity (+3.0), there were

statistically significant differences between the two

references (p<0.001) for both boys and girls from 2 to

5 years of age. Although the median values of the BMI

Z-score were within the normal weight range with

both references, the WHO-2006 curve pattern was al-

ways above the CDC curve pattern for both boys and

girls from age 2 years to 5 years (Graphs 2 and 3). In

addition, the prevalence of overweight and obesity us-

ing WHO standards was higher than the prevalence

found when CDC growth references were used

(Graphs 4 and 5). Furthermore, as pointed out else-

where, the weight-for-height Z-score proved to be of

lesser sensitivity in detecting overweight accurately

when compared to the BMI Z-score, with both refer-

ences (p<0.001).

Final comments

The shift to the new WHO standards provides a

unique opportunity not only to monitor linear

growth, but also to redesign surveillance programmes

so that they are more useful for problem detection

and decision making, and less complicated for gather-

ing epidemiological data (57). The WHO standards

would set a markedly lower standard for weight gain

beyond 4 months of age, and could thus support ef-

forts to avoid future childhood obesity (58). Howev-

er, there is evidence that they might not be appropri-

ate for use across all populations, and specifically

some populations in Asia (59) and Africa (60). One

study conducted in refugee camps in Algeria, Kenya

and Bangladesh showed important differences in the

weight-for-height cutoff points used for defining

acute malnutrition between those obtained from the

WHO standards and those derived from the NCHS

reference. The WHO standards apparently resulted in

a higher measured prevalence of severe acute malnu-

trition. For such reasons, assessment of the new WHO

growth standards in different populations and envi-

ronments is recommended. Compared to previous

international references they appear to be more accu-

rate and easier to interpret. In addition, last year

WHO published a second set of standards that in-

clude head circumference-for-age, arm circumfer-

ence-for-age, triceps and subscapular skinfold-for-

age, and new international growth standards for the

screening, surveillance and monitoring of school-age

children and adolescents (61-63), all available at the

WHO website.

Prevention is perhaps the only effective way to stop

this childhood obesity epidemic, and the first step for

proper prevention, is proper detection. The WHO

2006 standards were created basically for that purpose.

The authors agree with others who suggest that all the

demographic surveys should now be derived using the

Table 4. Prevalence of overweight (including obesity) using bodymass index (BMI) Z-scores from the CDC-2000 growth referenceand WHO-2006 growth standards

Age Boys Girls(years) WHO CDC WHO CDC

2 3.58% 0% 3% 0.75%3 7.77% 4.18% 6.76% 4.50%4 11.97% 7.77% 5.26% 4.50%5 11.36% 8.97% 6.76% 3.75%

WHO 2006CDC 2000

Age (years)2 3 4 5

12

10

8

6

4

2

0

%

Graph 4. Prevalence of overweight/obesity in boys (BMI Z-score=/>2.0) (n=167).

WHO 2006CDC 2000

Age (years)2 3 4 5

7

6

5

4

3

2

1

0

%

Graph 5. Prevalence of overweight/obesity in girls (BMI Z-score=/>2.0) (n=133).


WHO standards (64). Perhaps in the future techno-logical advances will allow a more direct assessment ofadiposity than BMI, and new charts will need to becreated (65). Currently, there are few reports in theliterature of studies assessing the level of body fat inchildhood (66-68) and only one that has actually pro-duced body fat reference curves for children aged old-er than five (69).

There is a marked mismatch between the publichealth importance of childhood obesity and thenumber and quality of studies conducted so far toassess preventive interventions (70,71). There is anurgent need for well-designed intervention studiesto demonstrate the long-term effectiveness of pre-ventive strategies that would provide a basis for evi-dence-based recommendations (72,73). In Europe, aseries of initiatives and actions have been launchedin recent years, one of which is the creation of na-tional centres for collecting country-specific data toback up concrete strategies for future policy building(74). In the US, the new National Children’s Studywill seek information on enviromental risks and in-dividual susceptibility factors for obesity, amongother diseases. This will be conducted in a cohort of100,000 US born children, which will be followedfrom conception to 21 years of age. Environmentalexposures will be assessed repeatedly during preg-nancy and throughout childhood in the children’shomes, schools and communities. Chemical assayswill be performed by the CDC and banks of biologi-cal and genetic material and environmental sampleswill be collected. Recruitment started in 2007 at 7sites and will be extended to 105 sites across the US(75). Unfortunately, it will be a long time before pre-liminary results are available. In the meantime, untilall these studies start to answer some of the numer-ous questions regarding childhood obesity, it wouldbe advisable to promote physical activity and healthyeating habits among children and to encourage ade-quate monitoring of growth and weight gain fromearly infancy.

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Basic techniques of molecular biology and their applications in the

diagnosis of childhood diseases

S. Megremis, ∞. Pampanos

Abstract: All the techniques applied in molecular biology focus on the characterization, isolation andmanipulation of the molecular components of the cell. These components include DNA, which is therepository of genetic information, RNA and proteins. Genes are the functional units of the DNA, specifyingthe structure of proteins. There are about 24,000 protein-coding genes in the human genome as estimatedby the Human Genome Project. Most of the molecular tests that are used in clinical diagnosis screenmultiple genes for specific and/or non-specific mutations. Nowadays, a vast variety of genetic tests areavailable for use by clinicians in order to obtain diagnostic and prognostic information. Most of these testsare feasible because of the capability of the DNA double helix to denature and anneal or hybridize. In thisreview some of the basic molecular diagnostic techniques are presented, such as the polymerase chainreaction, DNA sequencing, DHPLC, and the southern and northern blotting techniques.

Key words: Genetics, molecular diagnostics, paediatrics.

∂ÚÁ·ÛÙ‹ÚÈÔ π·ÙÚÈÎ‹˜°ÂÓÂÙÈÎ‹˜¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ,ÃˆÚ¤ÌÂÈÔ ∂ÚÂ˘ÓËÙÈÎfi∂ÚÁ·ÛÙ‹ÚÈÔ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”

AÏÏËÏÔÁÚ·Ê›·:

∞Ó‰Ú¤·˜ ¶¿Ì·ÓÔ˜ [email protected]∂ÚÁ·ÛÙ‹ÚÈÔ π·ÙÚÈÎ‹˜°ÂÓÂÙÈÎ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ,ÃˆÚ¤ÌÂÈÔ ∂ÚÂ˘ÓËÙÈÎfi∂ÚÁ·ÛÙ‹ÚÈÔ,¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”£Ë‚ÒÓ Î·È §Â‚·‰Â›·˜,∆.∫. 115 27, ∞ı‹Ó·

Medical GeneticsLaboratory,University of Athens,Choremio ResearchLaboratory,“Aghia Sophia” Children’sHospital, Athens, Greece

Correspondence:

Andreas [email protected] Genetics Laboratory,University of Athens,Choremio Research Laboratory,“Aghia Sophia” Children’sHospitalThivon & Levadias St.,115 27, Athens, Greece


106 ™. ªÂÁÚ¤ÌË˜, ∞. ¶¿Ì·ÓÔ˜


∂ÏÏ¿‰·, Ô ¶˘ı·ÁfiÚ·˜ ‰È·Ù‡ˆÛÂ ÙËÓ ˘fiıÂÛË fiÙÈ

Ë ˙ˆ‹ ÍÂÎÈÓ¿ ÌÂ ÙËÓ ·Ó¿ÌÂÈÍË ·ÚÛÂÓÈÎÒÓ Î·È ıËÏ˘-

ÎÒÓ ÛÂÚÌ¿ÙˆÓ (1). ∆ÔÓ 4o ·ÈÒÓ· .Ã., Ô ∞ÚÈÛÙÔÙ¤-

ÏË˜ ˘ÔÛÙ‹ÚÈÍÂ fiÙÈ Ô Î¿ıÂ ÁÔÓ¤·˜ Û˘Ì‚¿ÏÏÂÈ ÛÙË

ÌÂÙ·ÊÔÚ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ÛÙÔ˘˜ ·ÔÁfiÓÔ˘˜ (1).

™ÙÈ˜ ·Ú¯¤˜ ÙÔ˘ 19Ô˘ ·ÈÒÓ·, Ô °¿ÏÏÔ˜ Ê˘ÛÈÔ‰›ÊË˜

Lamarck ˘ÔÛÙ‹ÚÈÍÂ fiÙÈ Ù· Â›ÎÙËÙ· ¯·Ú·ÎÙËÚÈÛÙÈ-

Î¿ ÎÏËÚÔÓÔÌÔ‡ÓÙ·È (3), ÂÓÒ ÙÔ 1859 Ô Darwin ÙfiÓÈ-

ÛÂ ÙË ÛËÌ·Û›· ÙˆÓ ÌË¯·ÓÈÛÌÒÓ ÙË˜ ÎÏËÚÔÓÔÌÈÎfi-

ÙËÙ·˜ ÛÙË ÌÂÏ¤ÙË ÙË˜ ÂÍ¤ÏÈÍË˜ ÙˆÓ ÂÈ‰ÒÓ (1). §›Á·

¯ÚfiÓÈ· ·ÚÁfiÙÂÚ·, ÙÔ 1865, Ô Mendel ‰ËÌÔÛÈÂ‡ÂÈ ÙÈ˜

ıÂˆÚ›Â˜ ÙÔ˘. ∆Ô 1903 ·Ô‰ÂÈÎÓ‡ÂÙ·È fiÙÈ Ù· ¯ÚˆÌÔ-

ÛÒÌ·Ù· Â›Ó·È ÊÔÚÂ›˜ ÙÔ˘ ÁÂÓÂÙÈÎÔ‡ ˘ÏÈÎÔ‡ (1), ÂÓÒ

ÙÔ 1910 Ô Morgan ÂÎÙÈÌ¿ fiÙÈ Ù· ÁÔÓ›‰È· ÂÓÙÔ›˙Ô-

ÓÙ·È ÛÙ· ¯ÚˆÌÔÛÒÌ·Ù· (4). ∆Ô DNA ·Ú¯ÈÎ¿ ÔÓÔÌ¿-

ÛÙËÎÂ ÓÔ˘ÎÏÂ˝ÓË Î·È ·Ó·Î·Ï‡ÊıËÎÂ ·fi ÙÔÓ

Meischer ÙÔ 1867 (4), ·ÏÏ¿ ÙÔ ÛËÌ·ÓÙÈÎfiÙÂÚÔ ÁÂÁÔ-

Ófi˜ Û˘ÓÙÂÏÂ›Ù·È ÙÔ 1953, fiÙ·Ó ÔÈ Watson Î·È Crick

ÚÔÙÂ›ÓÔ˘Ó ÙÔ ÌÔÓÙ¤ÏÔ ÙË˜ ‰ÈÏ‹˜ ¤ÏÈÎ·˜ ÙÔ˘ DNA

(4,5), ÂÓÒ ÙÔ 1956 ÔÈ Tjio Î·È Levan ·Ô‰ÂÈÎÓ‡Ô˘Ó

fiÙÈ Ô ·ÚÈıÌfi˜ ÙˆÓ ¯ÚˆÌÔÛˆÌ¿ÙˆÓ ÙÔ˘ ·ÓıÚÒÔ˘

Â›Ó·È 46 (1).

∞fi ÙfiÙÂ Ë ÂÍ¤ÏÈÍË ÙË˜ ÌÔÚÈ·Î‹˜ ‚ÈÔÏÔÁ›·˜ Î·È

ÁÂÓÂÙÈÎ‹˜ Â›Ó·È Ù¤ÙÔÈ·, ÒÛÙÂ Ó· ıÂˆÚÂ›Ù·È Ï¤ÔÓ ‰Â-

‰ÔÌ¤ÓË Ë ¯Ú‹ÛË ÙˆÓ ÌÂıfi‰ˆÓ ÙÔ˘˜ ÛÙËÓ ÎÏÈÓÈÎ‹

‰È¿ÁÓˆÛË. ∏ ÂÈÏÔÁ‹ ÙË˜ ÌÂıfi‰Ô˘ Ô˘ ı· ¯ÚËÛÈÌÔ-

ÔÈËıÂ› ÁÈ· ÙË ÌÔÚÈ·Î‹ ‰È¿ÁÓˆÛË ÌÈ·˜ ÁÂÓÂÙÈÎ‹˜

·Ûı¤ÓÂÈ·˜ Î·ıÔÚ›˙ÂÙ·È ·fi ÙÔ ÌË¯·ÓÈÛÌfi Ô˘ ÚÔ-

Î·ÏÂ› ÙËÓ ›‰È· ÙË ÓfiÛÔ. ™Ùfi¯Ô˜ ÙÔ˘ ¿ÚıÚÔ˘ Â›Ó·È Ë

·Ó·ÊÔÚ¿ ÛÙÈ˜ ‚·ÛÈÎfiÙÂÚÂ˜ ÌÔÚÈ·Î¤˜ ÙÂ¯ÓÈÎ¤˜ ·Ó¿-

Ï˘ÛË˜ DNA, ÔÈ ÔÔ›Â˜ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ˆ˜ Â› ÙÔ

ÏÂ›ÛÙÔÓ ÛÙË ‰È¿ÁÓˆÛË ÁÂÓÂÙÈÎÒÓ ÓfiÛˆÓ Î·È ·Ó‹-

ÎÔ˘Ó Ï¤ÔÓ ÛÙËÓ Î·ıËÌÂÚÈÓ‹ Ú¿ÍË ÙˆÓ ÂÚÈÛÛÔÙ¤-

ÚˆÓ ·È‰È·ÙÚÈÎÒÓ ˘ÔÂÈ‰ÈÎÔÙ‹ÙˆÓ (¶›Ó·Î·˜ 1).

∆Ô ‰ÂÔÍ˘ÚÈ‚ÔÓÔ˘ÎÏÂ˚Îfi ÔÍ‡ (DNA)

∂›Ó·È ÁÓˆÛÙfi fiÙÈ ÔÈ ÎÏËÚÔÓÔÌÈÎ¤˜ ÏËÚÔÊÔÚ›Â˜

ÌÂÙ·‚È‚¿˙ÔÓÙ·È ·fi Î¿ıÂ Î‡ÙÙ·ÚÔ ÛÙ· ı˘Á·ÙÚÈÎ¿

ÙÔ˘, Î·Ù¿ ÙËÓ Î˘ÙÙ·ÚÈÎ‹ ‰È·›ÚÂÛË, ‰È·Ì¤ÛÔ˘ ÙˆÓ ÁÔ-

ÓÈ‰›ˆÓ. ◊‰Ë, ·fi ÙÈ˜ ·Ú¯¤˜ ÙÔ˘ ÂÈÎÔÛÙÔ‡ ·ÈÒÓ·, ÔÈ

ÂÈÛÙ‹ÌÔÓÂ˜ ıÂˆÚÔ‡Û·Ó ‰Â‰ÔÌ¤ÓÔ fiÙÈ Ù· ÁÔÓ›‰È·

‚Ú›ÛÎÔÓÙ·È ÛÙ· ¯ÚˆÌÔÛÒÌ·Ù·, Ù· ÔÔ›· ÙfiÙÂ ‹Ù·Ó

ÁÓˆÛÙ¿ ˆ˜ ÓËÌ·ÙÔÂÈ‰Â›˜ ‰ÔÌ¤˜ ÙÔ˘ ˘Ú‹Ó· ÙˆÓ Â˘-

Î·Ú˘ˆÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ Ô˘ Á›ÓÔÓÙ·È ÔÚ·Ù¿ fiÙ·Ó ÙÔ

Î‡ÙÙ·ÚÔ ·Ú¯›˙ÂÈ Ó· ‰È·ÈÚÂ›Ù·È. ªÂ ÙËÓ ¿ÚÔ‰Ô ‰Â

ÙÔ˘ ¯ÚfiÓÔ˘ Î·È ÌÂ ÙËÓ ÂÍ¤ÏÈÍË ÙˆÓ ‚ÈÔ¯ËÌÈÎÒÓ ·Ó·-

Ï‡ÛÂˆÓ ÂÈ‚Â‚·ÈÒıËÎÂ fiÙÈ Ù· ¯ÚˆÌÔÛÒÌ·Ù· ·ÔÙÂ-

ÏÔ‡ÓÙ·È ·fi DNA Î·È ÚˆÙÂ˝ÓÂ˜.

∞Ú¯ÈÎ¿, ÔÈ ÂÈÛÙ‹ÌÔÓÂ˜ ‰˘ÛÎÔÏÂ‡ÔÓÙ·Ó Ó· ‰Â-

¯ÙÔ‡Ó ÙÔ Ì·ÎÚ‡ ·˘Ùfi ÔÏ˘ÌÂÚ¤˜ ˘ÏÈÎfi Ô˘ ·ÔÙÂ-

ÏÔ‡ÓÙ·Ó ·fi 4 ÌfiÓÔ Â›‰Ë ˘ÔÔÌ¿‰ˆÓ, ˆ˜ ÁÂÓÂÙÈÎfi

˘ÏÈÎfi, ÏfiÁˆ ÙË˜ Ê·ÈÓÔÌÂÓÈÎ‹˜ ·ÏfiÙËÙ·˜ ÙË˜ ¯Ë-

ÌÂ›·˜ ÙÔ˘. ∆Ô 1953, fiÌˆ˜, ÔÈ J. Watson & F. Crick

(4,5) ˘¤‚·Ï·Ó ÛÂ ·Ó¿Ï˘ÛË ÂÚ›ıÏ·ÛË˜ ·ÎÙ›ÓˆÓ Ã

(ÙÂ¯ÓÈÎ‹ Î·ıÔÚÈÛÌÔ‡ ÙÚÈÛ‰È¿ÛÙ·ÙË˜ ·ÙÔÌÈÎ‹˜ ‰Ô-

Ì‹˜ ÙˆÓ ÌÔÚ›ˆÓ) ÙÔ ‰ÂÔÍ˘ÚÈ‚ÔÓÔ˘ÎÏÂ˚Îfi ÔÍ‡ (DNA)

·Ô‰›‰ÔÓÙ¿˜ ÙÔ˘ ÙË ‰›ÎÏˆÓË ÂÏÈÎÔÂÈ‰‹ ÌÔÚÊ‹, ‰›-

ÓÔÓÙ·˜ ¤ÙÛÈ ·¿ÓÙËÛË ÛÂ ÂÚˆÙ‹Ì·Ù· ÙÔ˘ Ù‡Ô˘: ‰˘-

Ó·ÙfiÙËÙ· ·ÎÚÈ‚Ô‡˜ ·ÓÙÈÁÚ·Ê‹˜ ÙˆÓ 2 ÎÏÒÓˆÓ Î·È

ÌÂÙ·ÊÔÚ¿ ÏËÚÔÊÔÚÈÒÓ, ˘fi ¯ËÌÈÎ‹ ÌÔÚÊ‹, ÁÈ· ÙË

‰ËÌÈÔ˘ÚÁ›· ÂÓfi˜ ÔÚÁ·ÓÈÛÌÔ‡.

∏ ¤Ó·ÚÍË ÙË˜ Û‡ÓıÂÛË˜ ÙÔ˘ DNA, fiˆ˜ ·Ú·ÙË-

ÚÂ›Ù·È ÛÙÔ ËÏÂÎÙÚÔÓÈÎfi ÌÈÎÚÔÛÎfiÈÔ, Ú·ÁÌ·ÙÔÔÈÂ›-

Ù·È ÛÙÈ˜ ÏÂÁfiÌÂÓÂ˜ ‰È¯¿ÏÂ˜ ·ÓÙÈÁÚ·Ê‹˜ (replication

forks) ̆ fi ÙËÓ ·ÚÔ˘Û›· ÂÈ‰ÈÎÒÓ ÂÓ·ÚÎÙ‹ÚÈˆÓ ÚˆÙÂ-

˚ÓÒÓ Ô˘ ·Ó·ÁÓˆÚ›˙Ô˘Ó Û˘ÁÎÂÎÚÈÌ¤ÓÂ˜ ·ÏÏËÏÔ˘¯›Â˜

ÙÔ˘ DNA ÛÙÈ˜ ·ÊÂÙËÚ›Â˜ ·ÓÙÈÁÚ·Ê‹˜ Î·È ·Ô‰È·Ù¿Û-

ÛÔ˘Ó ÙÔÈÎ¿ ÙÔ˘˜ 2 ÎÏÒÓÔ˘˜ ÙË˜ ‰ÈÏ‹˜ ¤ÏÈÎ·˜. √È

ÚÔÎ‡ÙÔÓÙÂ˜ ÂÎÙÂıÂÈÌ¤ÓÔÈ ÌÔÓÔ› ÎÏÒÓÔÈ ·Ú·Ì¤-

ÓÔ˘Ó ·Ó¤·ÊÔÈ Î·È ÏÂÈÙÔ˘ÚÁÔ‡Ó ˆ˜ ÂÎÌ·ÁÂ›· ÁÈ· ÙÔ

Û¯ËÌ·ÙÈÛÌfi Û˘ÌÏËÚˆÌ·ÙÈÎÒÓ ÎÏÒÓˆÓ DNA (∂ÈÎfi-

ÓÂ˜ 1· Î·È 1‚) ˘fi ÙËÓ Â›‰Ú·ÛË ÙÔ˘ ÂÓ˙‡ÌÔ˘ DNA

ÔÏ˘ÌÂÚ¿ÛË Î·È ¿ÓÙÔÙÂ ÚÔ˜ ÙËÓ Î·ÙÂ‡ı˘ÓÛË 5ã→3ã.

∆· Î‡ÙÙ·Ú· ÂÎÊÚ¿˙Ô˘Ó ÙÈ˜ ÁÂÓÂÙÈÎ¤˜ ÙÔ˘˜ Ô‰Ë-

Á›Â˜, Ù· ÁÔÓ›‰È¿ ÙÔ˘˜, Ì¤Ûˆ ÙË˜ ÌÂÙ·ÁÚ·Ê‹˜ Î·È ÙË˜

ÌÂÙ¿ÊÚ·ÛË˜, ¤ÙÛÈ ÒÛÙÂ Ë ÚÔ‹ ÙˆÓ ÁÂÓÂÙÈÎÒÓ ÏËÚÔ-

ÊÔÚÈÒÓ Ó· Â›Ó·È ¿ÓÙ· Ë ÂÍ‹˜:

DNA→RNA→¶ÚˆÙÂ˝ÓÂ˜.

∆Ô RNA ‰È·‰Ú·Ì·Ù›˙ÂÈ Î˘Ú›ˆ˜ ÙÔ ÚfiÏÔ ÂÓfi˜ ÌÂ-

Û¿˙ÔÓÙ· (∂ÈÎfiÓ· 2). ∫·Ù¿ Û˘Ó¤ÂÈ·, Ù· ÁÔÓ›‰È· ‰ÂÓ

Â›Ó·È Ù›ÔÙÂ ¿ÏÏÔ ·fi ÙÈ˜ ıÂÌÂÏÈÒ‰ÂÈ˜ ÏÂÈÙÔ˘ÚÁÈÎ¤˜

ÌÔÓ¿‰Â˜ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜ Î¿ıÂ ˙ÒÓÙÔ˜ ÔÚÁ·ÓÈ-

ÛÌÔ‡ Ô˘ Î·Ù·Ï·Ì‚¿ÓÔ˘Ó ¤Ó·Ó ÂÈ‰ÈÎfi ÙfiÔ-ı¤ÛË

(locus) ¿Óˆ ÛÂ Î¿ıÂ ¯ÚˆÌfiÛˆÌ·. ∏ ‰ÔÌ‹ ÙÔ˘ Î¿ıÂ

¶›Ó·Î·˜ 1. ∂Ó‰Â›ÍÂÈ˜ ·Ó¿Ï˘ÛË˜ DNA

ÃÚfiÓÔ˜ DNA ∂Ó‰Â›ÍÂÈ˜ (·Ú·‰Â›ÁÌ·Ù·)·Ó¿Ï˘ÛË˜

¶ÚÔÁÂÓÓËÙÈÎ¿ ñ ¢È¿ÁÓˆÛË Î‡ËÛË˜ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ (.¯.ÈÛÙÔÚÈÎfi Ì˘˚Î‹˜ ‰˘ÛÙÚÔÊ›·˜ Duchenne)

¡ÂÔÁÓ¿ - µÚ¤ÊË ñ ∂È‚Â‚·›ˆÛË ÎÏÈÓÈÎ‹˜ ‰È¿ÁÓˆÛË˜ (.¯.Ê·ÈÓfiÙ˘Ô˜ Î˘ÛÙÈÎ‹˜ ›ÓˆÛË˜ ÌÂ ıÂÙÈÎfiÙÂÛÙ È‰ÚÒÙ·)

¶·È‰È¿ ñ ¢ÈÂÚÂ‡ÓËÛË ÓÔËÙÈÎ‹˜ ˘ÛÙ¤ÚËÛË˜ (.¯.·ÔÎÏÂÈÛÌfi˜ Û˘Ó‰ÚfiÌÔ˘ Â˘ıÚ·‡ÛÙÔ˘¯ÚˆÌÔÛÒÌ·ÙÔ˜ Ã)

ñ ∂È‚Â‚·›ˆÛË ‰È¿ÁÓˆÛË˜ ÓÔÛ‹Ì·ÙÔ˜ ÌÂ¤Ó·ÚÍË ÂÎ‰ËÏÒÛÂˆÓ ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›·(.¯ Ì˘˚Î‹ ‰˘ÛÙÚÔÊ›· Duchenne)

∂Ó‹ÏÈÎÂ˜ ñ ŒÏÂÁ¯Ô˜ ÊÔÚ¤ˆÓ (.¯. ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔ-ÚÈÎfi Î˘ÛÙÈÎ‹˜ ›ÓˆÛË˜)

ñ ¶ÚÔÛ˘ÌÙˆÌ·ÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ (ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi Î·ÚÎ›ÓÔ˘ Ì·ÛÙÔ‡/ˆÔıËÎÒÓ)

ñ ∂È‚Â‚·›ˆÛË ‰È¿ÁÓˆÛË˜ ÓÔÛ‹Ì·ÙÔ˜ ÌÂ¤Ó·ÚÍË ÂÎ‰ËÏÒÛÂˆÓ ÛÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹(.¯. ÓfiÛÔ˜ Huntington)


ÁÔÓÈ‰›Ô˘ Â›Ó·È ¯·Ú·ÎÙËÚÈÛÙÈÎ‹ Î·È ·ÔÙÂÏÂ›Ù·È ·fiÌË Îˆ‰ÈÎÔÔÈÔ‡ÛÂ˜ ·ÏÏËÏÔ˘¯›Â˜, ÁÓˆÛÙ¤˜ ˆ˜ ÂÛfi-ÓÈ· (introns), ÂÓ·ÏÏ·ÛÛfiÌÂÓÂ˜ ÌÂ Îˆ‰ÈÎÔÔÈÔ‡ÛÂ˜·ÏÏËÏÔ˘¯›Â˜, Ù· ÂÍfiÓÈ· (exons). ™˘Ó‹ıˆ˜, Ù· ÂÍfiÓÈ·Â›Ó·È ‚Ú·¯‡ÙÂÚ· ·fi Ù· ÈÓÙÚfiÓÈ· Î·È Ë ÂÚÈÔ¯‹ Ô˘Îˆ‰ÈÎÔÔÈÂ›Ù·È Û˘¯Ó¿ ·ÓÙÈÚÔÛˆÂ‡ÂÈ ÌfiÓÔ ¤Ó· ÌÈ-ÎÚfi ÔÛÔÛÙfi ÙÔ˘ ÂÎ¿ÛÙÔÙÂ ÁÔÓÈ‰›Ô˘ (∂ÈÎfiÓ· 3). ™Ë-Ì·ÓÙÈÎfi ÚfiÏÔ ÛÙË ‰ÔÌ‹ Î·È Ê˘ÛÈÎ¿ ÛÙË ÏÂÈÙÔ˘ÚÁ›·ÙÔ˘ Î¿ıÂ ÁÔÓÈ‰›Ô˘ ¤¯Ô˘Ó ÔÈ ˘ÔÎÈÓËÙ¤˜ (promoters).

¶ÚfiÎÂÈÙ·È ÁÈ· ·ÏÏËÏÔ˘¯›Â˜ DNA ÛÙÈ˜ ÔÔ›Â˜ ÚÔÛ-‰¤ÓÂÙ·È Ë RNA ÔÏ˘ÌÂÚ¿ÛË ÚÔÙÔ‡ ·Ú¯›ÛÂÈ ÙË ÌÂ-Ù·ÁÚ·Ê‹ ÙÔ˘ DNA ÛÂ RNA.

∆Ô ÁÔÓÈ‰›ˆÌ· ÂÓfi˜ ÔÚÁ·ÓÈÛÌÔ‡ Â›Ó·È fiÏÂ˜ ÔÈÎÏËÚÔÓÔÌ‹ÛÈÌÂ˜ ÏËÚÔÊÔÚ›Â˜ Î·È Îˆ‰ÈÎÔÔÈÂ›Ù·ÈÛÙÔ DNA. ™‡ÌÊˆÓ· ÌÂ ÚfiÛÊ·ÙÂ˜ ÂÎÙÈÌ‹ÛÂÈ˜, ̆ Ô-ÏÔÁ›˙ÂÙ·È fiÙÈ ÙÔ ·ÓıÚÒÈÓÔ ÁÔÓÈ‰›ˆÌ· ¤¯ÂÈ Ì¤ÁÂıÔ˜ÂÚ›Ô˘ 3 ‰ÈÛÂÎ·ÙÔÌÌ‡ÚÈ· ‚¿ÛÂÈ˜ Î·È ÂÚÈÏ·Ì‚¿-ÓÂÈ 20.000-25.000 ÁÔÓ›‰È· (6). ∏ ÁÔÓÈ‰È·Î‹ ˘ÎÓfi-ÙËÙ· ÂÓfi˜ ÁÔÓÈ‰ÈÒÌ·ÙÔ˜ Â›Ó·È Ô ·ÚÈıÌfi˜ ÙˆÓ ÁÔÓÈ-‰›ˆÓ ·Ó¿ ¤Ó· ÂÎ·ÙÔÌÌ‡ÚÈÔ ‚¿ÛÂÈ˜ (megabase, Mb).

¶˘Ú‹Ó·˜

∫˘ÙÙ·ÚfiÏ·ÛÌ·

¶ÚˆÙÔÁÂÓ¤˜ RNA ÌÂÙ¿ÁÚ·ÊÔ

πÓÙÚfiÓÈ·

°ÔÓ›‰ÈÔ

∂ÍfiÓÈ·

∞∞∞∞m RNA

∫·Ï‡ÙÚ· RNA

DNA

m RNA

¶ÚˆÙÂ˝ÓË

∞∞∞∞

∞∞∞∞

MÂÙ·ÁÚ·Ê‹

MÂÙ¿ÊÚ·ÛË

¶ÚÔÛı‹ÎË5' Î·Ï‡ÙÚ·˜ Î·ÈÔ˘Ú¿˜ ÔÏ˘ ∞

™˘ÚÚ·Ê‹ RNA

EÍ·ÁˆÁ‹

∂ÈÎfiÓ· 2. ∏ ÚÔ‹ ÁÂÓÂÙÈÎÒÓ ÏËÚÔÊÔÚÈÒÓ ·fi DNA ÛÂ ÚˆÙÂ˝ÓË. ™¯ËÌ·ÙÈÎ‹ ·Ó··Ú¿ÛÙ·ÛË ÙˆÓ ÛÙ·‰›ˆÓ Ô˘ ··ÈÙÔ‡ÓÙ·È ÁÈ· Ó· ÂÎ-ÊÚ·ÛıÂ› Ë ÁÂÓÂÙÈÎ‹ ÏËÚÔÊÔÚ›·. ™Ù· Â˘Î·Ú˘ˆÙÈÎ¿ Î‡ÙÙ·Ú· ÙÔ ·Ú¯ÈÎfi ÌfiÚÈÔ ÙÔ˘ RNA ÂÚÈ¤¯ÂÈ ÈÓÙÚfiÓÈ· Ù· ÔÔ›· ·Ê·ÈÚÔ‡ÓÙ·È ÌÂ ÌÈ·ÂÓ˙˘ÌÈÎ¿ Î·Ù·Ï˘fiÌÂÓË ·ÓÙ›‰Ú·ÛË Û˘ÚÚ·Ê‹˜. ∞fi ÙÈ˜ ÌÂÙ·ÙÚÔ¤˜ ·˘Ù¤˜ ·Ú¿ÁÂÙ·È mRNA, ÙÔ ÔÔ›Ô ÌÂÙ·Ê¤ÚÂÙ·È ·fi ÙÔÓ ˘Ú‹Ó· ÛÙÔÎ˘ÙÙ·ÚfiÏ·ÛÌ·, fiÔ˘ Î·È ÌÂÙ·ÊÚ¿˙ÂÙ·È ÛÂ ÚˆÙÂ˝ÓË.

5ã3ã

5ã

3ã

3ã5ã

3ã

5ã

∞ÊÂÙËÚ›· ·ÓÙÈÁÚ·Ê‹˜

ªÔÓfiÎÏˆÓ· DNA ÂÎÌ·ÁÂ›·,¤ÙÔÈÌ· ÁÈ· ÙË Û‡ÓıÂÛË DNA

¢È¿ÓÔÈÍË ÙË˜ ‰ÈÏ‹˜ ¤ÏÈÎ·˜ ÌÂ ÙË ‚Ô‹ıÂÈ· ÂÓ·ÚÎÙ‹ÚÈˆÓÂÎÌ·ÁÂ›ˆÓ

¢›ÎÏˆÓ· DNA

∂ÈÎfiÓ· 1‚. ∞ÓÙÈÁÚ·Ê‹ DNA. ∂È‰ÈÎ¤˜ ÂÓ·ÚÎÙ‹ÚÈÂ˜ ÚˆÙÂ˝ÓÂ˜·Ó·ÁÓˆÚ›˙Ô˘Ó Û˘ÁÎÂÎÚÈÌ¤ÓÂ˜ ·ÏÏËÏÔ˘¯›Â˜ ÙÔ˘ DNA ÛÙÈ˜ ·ÊÂ-ÙËÚ›Â˜ ·ÓÙÈÁÚ·Ê‹˜ Î·È ÙÔÈÎ¿ ·Ô‰È·Ù¿ÛÛÔ˘Ó ÙÔ˘˜ 2 ÎÏÒÓÔ˘˜ÙË˜ ‰ÈÏ‹˜ ¤ÏÈÎ·˜. √È ÚÔÎ‡ÙÔÓÙÂ˜ ÌÔÓÔ› ÎÏÒÓÔÈ ‰‡Ó·ÓÙ·È Ó·ÏÂÈÙÔ˘ÚÁ‹ÛÔ˘Ó ˆ˜ ÂÎÌ·ÁÂ›· ·ÓÙÈÁÚ·Ê‹˜ ÙÔ˘ DNA.

∂ÈÎfiÓ· 1·. ™‡ÓıÂÛË DNA ÛÙÈ˜ ‰È¯¿ÏÂ˜ ·ÓÙÈÁÚ·Ê‹˜ (replicationforks). ∏ÏÂÎÙÚÔÓÈÎ‹ ÌÈÎÚÔÊˆÙÔÁÚ·Ê›· ¯ÚˆÌÔÛÒÌ·ÙÔ˜ Â˘Î·-Ú˘ˆÙÈÎÔ‡ Î˘ÙÙ¿ÚÔ˘, ÛÙÔ ÔÔ›Ô ÔÈ ‰È¯¿ÏÂ˜ ·ÓÙÈÁÚ·Ê‹˜ ÌÂÙ·ÎÈ-ÓÔ‡ÓÙ·È ÚÔ˜ ·ÓÙ›ıÂÙÂ˜ Î·ÙÂ˘ı‡ÓÛÂÈ˜ ÍÂÎÈÓÒÓÙ·˜ ·fi ÔÏÏ·-Ï¤˜ ·ÊÂÙËÚ›Â˜ ·ÓÙÈÁÚ·Ê‹˜.

∞ÊÂÙËÚ›Â˜ ·ÓÙÈÁÚ·Ê‹˜

∫·ÙÂ‡ı˘ÓÛËÙË˜ ‰È¯¿Ï·˜

1

2

3

0,1 Ìm

0,1 Ìm

¢È¯¿ÏÂ˜ ·ÓÙÈÁÚ·Ê‹˜

107ªÔÚÈ·Î‹ ‚ÈÔÏÔÁ›· ÛÙËÓ ·È‰È·ÙÚÈÎ‹ Ú¿ÍË

¶·È‰È·ÙÚÈÎ‹ 2008;71:105-115


H ÁÔÓÈ‰È·Î‹ ˘ÎÓfiÙËÙ· ÙÔ˘ ·ÓıÚÒÈÓÔ˘ ÁÔÓÈ‰ÈÒ-Ì·ÙÔ˜ Â›Ó·È Û¯Â‰fiÓ 12-15 ÁÔÓ›‰È·/ÌÂÁ·‚¿ÛË (7).

√È ‰ÈÂÚÁ·Û›Â˜ ·ÓÙÈÁÚ·Ê‹˜ Î·È ÂÈ‰ÈfiÚıˆÛË˜ ÙÔ˘ÁÂÓÂÙÈÎÔ‡ ˘ÏÈÎÔ‡ Î¿ıÂ Î˘ÙÙ¿ÚÔ˘ Û¿ÓÈ· ·ÔÙ˘Á¯¿-ÓÔ˘Ó Î·È ¤ÙÛÈ ‰È·ÙËÚÂ›Ù·È Ë ÓÔ˘ÎÏÂÔÙÈ‰ÈÎ‹ ÙÔ˘ ·Ï-ÏËÏÔ˘¯›· ÛÙ·ıÂÚ‹. ∂Ó›ÔÙÂ, fiÌˆ˜, ‰‡Ó·Ù·È Ó· ·Ú·-ÙËÚËıÔ‡Ó ÓÔ˘ÎÏÂÔÙÈ‰ÈÎ¤˜ ·ÏÏ·Á¤˜, ÛËÌÂÈ·Î¤˜ ‹ ÌË,ÌÂ ·ÔÙ¤ÏÂÛÌ· Ó· Ô‰ËÁÔ‡Ì·ÛÙÂ ÛÂ Û‡ÓıÂÛË ·ıÔ-ÏÔÁÈÎÒÓ ÚˆÙÂ˚ÓÒÓ Î·È Î·Ù¿ Û˘Ó¤ÂÈ· ÙË ÌË Ê˘ÛÈÔ-ÏÔÁÈÎ‹ Û˘ÁÎ¤ÓÙÚˆÛË ÙÔ˘ ·Ú·ÁÒÁÔ˘ ÙÔ˘ ÁÔÓÈ‰›Ô˘ÛÙÔÓ ÔÚÁ·ÓÈÛÌfi. √ÔÈ·‰‹ÔÙÂ Ù¤ÙÔÈ· ·ÏÏ·Á‹ Î·-ÏÂ›Ù·È ÌÂÙ¿ÏÏ·ÍË. ∂ÓÙÔ‡ÙÔÈ˜, ÛËÌÂÈ·Î¤˜ ·ÏÏ·Á¤˜ ÛÂÁÔÓ›‰ÈÔ, ÔÈ ÔÔ›Â˜ ‰ÂÓ ¤¯Ô˘Ó Â›ÙˆÛË ÛÙË ÏÂÈÙÔ˘Ú-Á›· ÙË˜ Îˆ‰ÈÎÔÔÈÔ‡Û·˜ ÚˆÙÂ˝ÓË˜, ¯·Ú·ÎÙËÚ›˙Ô-ÓÙ·È ˆ˜ ÔÏ˘ÌÔÚÊÈÛÌÔ› ‹ ÔÏ˘ÌÔÚÊÈÎ¤˜ ı¤ÛÂÈ˜.ªÂÙ·ÏÏ¿ÍÂÈ˜ ‰ÂÓ ·Ú·ÙËÚÔ‡ÓÙ·È ÌfiÓÔ ÛÙÈ˜ Îˆ‰È-ÎÔÔÈÔ‡ÛÂ˜ ÂÚÈÔ¯¤˜ ÙˆÓ ÁÔÓÈ‰›ˆÓ, ·ÏÏ¿ Î·È ÛÂ ÌËÎˆ‰ÈÎÔÔÈÔ‡ÛÂ˜, ÌÂ Ù· ›‰È· ·ÔÙÂÏ¤ÛÌ·Ù· (8). OÈÎ˘ÚÈfiÙÂÚÔÈ Ù‡ÔÈ ÌÂÙ·ÏÏ¿ÍÂˆÓ ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔÓ¶›Ó·Î· 2.

∞ÔÌfiÓˆÛË DNA

∏ ÂÍ¤Ù·ÛË ÙÔ˘ ÁÔÓÈ‰ÈÒÌ·ÙÔ˜ ÚÔ¸Ôı¤ÙÂÈ ÛÂÚÒÙË Ê¿ÛË ÙËÓ ÂÍ·ÁˆÁ‹ Î·È ·ÔÌfiÓˆÛË ÙÔ˘ DNA(ÁÂÓˆÌÈÎÔ‡, ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ ‹ ÈÈÎÔ‡) ·fi ÂÚÈÊÂÚÈ-Îfi ·›Ì· ‹ ¿ÏÏÔ˘˜ ÈÛÙÔ‡˜, ÌÂ ÛÎÔfi ÙÔ ‰È·¯ˆÚÈÛÌfiÙÔ˘ ·fi Ù· ˘fiÏÔÈ· Û˘ÛÙ·ÙÈÎ¿ ÙˆÓ Î˘ÙÙ¿ÚˆÓ(ÚˆÙÂ˝ÓÂ˜, ÏÈ›‰È·, RNA, Î.Ï.). √È ‰È¿ÊÔÚÂ˜ Ì¤ıÔ-‰ÔÈ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙË ÌË¯·-ÓÈÎ‹ ıÚ·‡ÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ, ÒÛÙÂ Ó· ·ÓÔ›ÍÔ˘Ó ÌÂ ÙË¯Ú‹ÛË ‰È¿ÊÔÚˆÓ ¯ËÌÈÎÒÓ Ô˘ÛÈÒÓ Î·È ÂÓ˙‡ÌˆÓ, ÌÂÛÎÔfi ÙËÓ Î·Ù·ÛÙÚÔÊ‹ ÙˆÓ ÌÂÌ‚Ú·ÓÒÓ Î·È ÙˆÓ ÙÔÈ-¯ˆÌ¿ÙˆÓ ÙˆÓ Î˘ÙÙ¿ÚˆÓ (9-11).

À¿Ú¯Ô˘Ó ‰‡Ô Ì¤ıÔ‰ÔÈ ·ÔÌfiÓˆÛË˜ DNA ·fiÂÚÈÊÂÚÈÎfi ·›Ì· ‹ ·fi ‰È¿ÊÔÚÔ˘˜ ÈÛÙÔ‡˜, Ë Ì¤ıÔ-‰Ô˜ ÙÔ˘ NaCl (10) Î·È Ë ¯Ú‹ÛË ÙˆÓ ÂÌÔÚÈÎ¿ ‰È·ı¤-ÛÈÌˆÓ ‘kits’, Ù· ÔÔ›· ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Ï¤ÔÓ Â-ÚÈÛÛfiÙÂÚÔ ÏfiÁˆ ÙË˜ ˘ÂÚÔ¯‹˜ ÙÔ˘˜ ÛÂ Ù·¯‡ÙËÙ·(ÂÚ›Ô˘ 25 ÏÂÙ¿, ¤Ó·ÓÙÈ ‰‡Ô ËÌÂÚÒÓ ÛÙË Ì¤ıÔ‰ÔÙÔ˘ NaCl) (12) Î·È ÙË˜ Î·ı·ÚfiÙËÙ·˜ ÙÔ˘ ÂÍ·ÁfiÌÂ-ÓÔ˘ DNA. ∆· ÂÌÔÚÈÎ¿ ‰È·ı¤ÛÈÌ· kits Â›Ó·È Û¯Â‰È·-

ÛÌ¤Ó· ÌÂ Ù¤ÙÔÈÔ ÙÚfiÔ, ÒÛÙÂ Ó· ·Ô‰›‰Ô˘Ó ÂÚ›-

Ô˘ 6 Ìg DNA ·fi 200 Ìl ÂÚÈÊÂÚÈÎÔ‡ ÔÏÈÎÔ‡ ·›Ì·-

ÙÔ˜ ÌÂ ·ÓÙÈËÎÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜ -fiˆ˜ EDTA-

Î·È Ì¤¯ÚÈ 50 Ìg DNA ·fi Ù· ÂÈıËÏÈ·Î¿ Î‡ÙÙ·Ú·

ÙË˜ ÛÙÔÌ·ÙÈÎ‹˜ ÎÔÈÏfiÙËÙ·˜ Ô˘ ÂÚÈ¤¯ÔÓÙ·È ÛÂ 200

Ìl ÛÈ¤ÏÔ˘ (13).

AÓ¿Ï˘ÛË Î·È ÌÂÏ¤ÙË ÙÔ˘ DNA

∞Ï˘ÛÈ‰ˆÙ‹ ·ÓÙ›‰Ú·ÛË ÔÏ˘ÌÂÚ¿ÛË˜ (Polymerase

Chain Reaction, PCR)

∏ Ì¤ıÔ‰Ô˜ ·Ó·Î·Ï‡ÊıËÎÂ ÙÔ 1987 ·fi ÙÔÓ

Mullis (14), Ô ÔÔ›Ô˜ ‚Ú·‚Â‡ÙËÎÂ ÌÂ Nobel ÙÔ 1995,

Î·È ·ÔÛÎÔÂ› ÛÙÔÓ ÂÎıÂÙÈÎfi ÔÏÏ·Ï·ÛÈ·ÛÌfi ÌÈ-

ÎÚÒÓ ÙÌËÌ¿ÙˆÓ DNA ÌÂ ÙË ¯Ú‹ÛË Û˘ÓıÂÙÈÎÒÓ ÔÏÈ-

ÁÔÓÔ˘ÎÏÂÔÙÈ‰›ˆÓ (ÂÎÎÈÓËÙ¤˜-primers) Î·È ıÂÚÌÔ·Ó-

ıÂÎÙÈÎÔ‡ ÂÓ˙‡ÌÔ˘ (15-17). √ ÔÏÏ·Ï·ÛÈ·ÛÌfi˜

·ÊÔÚ¿ Û˘ÁÎÂÎÚÈÌ¤ÓÂ˜ ÂÚÈÔ¯¤˜ DNA Ô˘ ÌÔÚÂ› Ó·

ÂÚÈ¤¯Ô˘Ó Â›ÙÂ ¤Ó· ·Ïfi ÁÔÓ›‰ÈÔ ‹ Ì¤ÚÔ˜ ·˘ÙÔ‡ ‹ ÌË

Îˆ‰ÈÎÔÔÈÔ‡ÛÂ˜ ÂÚÈÔ¯¤˜, ÌÂÁ¤ıÔ˘˜ Ì¤¯ÚÈ 10.000

‚¿ÛÂÈ˜ (bp) (18-21). ∏ ÙÂ¯ÓÈÎ‹ PCR ‚·Û›˙ÂÙ·È ÛÙËÓ

ÂÓ˙˘Ì·ÙÈÎ‹ ÎÏˆÓÔÔ›ËÛË ÙÔ˘ ÁÂÓˆÌÈÎÔ‡ ˘ÏÈÎÔ‡,

¯ˆÚ›˜ ÙË ¯Ú‹ÛË ˙ÒÓÙˆÓ ÔÚÁ·ÓÈÛÌÒÓ fiˆ˜ ∂. coli ‹

Ì‡ÎËÙÂ˜ (14-17).

∏ Ì¤ıÔ‰Ô˜ ÂÊ·ÚÌfi˙ÂÙ·È Â˘Ú‡Ù·Ù· ÛÙËÓ ÎÏÈÓÈÎ‹

Ú¿ÍË Î·È ÙË ‚ÈÔÏÔÁÈÎ‹ ¤ÚÂ˘Ó· ‰Â‰ÔÌ¤ÓÔ˘ fiÙÈ

ÌÔÚÂ› Ó· ÂÓÙÔ›ÛÂÈ ÌÈ· Û˘ÁÎÂÎÚÈÌ¤ÓË ·ÏÏËÏÔ˘¯›·

DNA ‹ RNA ÛÂ ÔÔÈÔ‰‹ÔÙÂ ˘fi ÂÍ¤Ù·ÛË ÎÏÈÓÈÎfi

‰Â›ÁÌ· (22). ∫Ï·ÛÈÎ¿ ·Ú·‰Â›ÁÌ·Ù· Â›Ó·È ÔÈ ÁÂÓÂÙÈ-

Î¤˜ ·ı‹ÛÂÈ˜ ÁÓˆÛÙÒÓ ÌÔÓÔÁÔÓÈ‰È·ÎÒÓ ‹ ÔÏ˘ÁÔ-

ÓÈ‰È·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ, fiÔ˘ ÌÂ PCR ·ÓÈ¯ÓÂ‡ÂÙ·È Ë

ÌÂÙ·‚ÔÏ‹ ¤ÛÙˆ Î·È ÌÈ·˜ ÌfiÓÔ ‚¿ÛÂˆ˜ Î·È ‰È·ÁÈÁÓÒ-

ÛÎÔÓÙ·È ÔÌfi˙˘ÁÂ˜ ‹ ÂÙÂÚfi˙˘ÁÂ˜ Î·Ù·ÛÙ¿ÛÂÈ˜, Î·-

Ù·Ï˘ÙÈÎ‹˜ ÛËÌ·Û›·˜ ÁÈ· ÙËÓ ÂÍÂÏÈÎÙÈÎ‹ ÔÚÂ›· ÙË˜

ÓfiÛÔ˘ (¶›Ó·Î·˜ 3). ªÂ ÙÔÓ ÙÚfiÔ ·˘Ùfi, Î·ı›ÛÙ·Ù·È

ÂÊÈÎÙfi˜ Ô ÚÔÁÂÓÓËÙÈÎfi˜, ·fi ·ÌÓÈ·Îfi ˘ÁÚfi (23) ‹

¯ÔÚÈ·Î¤˜ Ï¿¯ÓÂ˜ (24,25), Î·ıÒ˜ Î·È Ë ÚÔÂÌÊ˘ÙÂ˘-

ÙÈÎ‹ ‰È¿ÁÓˆÛË ·fi ‚Ï·ÛÙÔÎ‡ÛÙË (26) ‹ ÔÏÈÎfi Ûˆ-

Ì¿ÙÈÔ (27).

¶›Ó·Î·˜ 2. ∆‡ÔÈ ÌÂÙ·ÏÏ¿ÍÂˆÓ

1. ∂ÏÏÂ›„ÂÈ˜ ‹ ‰ÈÏ·ÛÈ·ÛÌÔ› ÂÓfi˜ ‹ ÂÚÈÛÛfiÙÂÚˆÓ ÂÍÔÓ›ˆÓÂÓfi˜ ÁÔÓÈ‰›Ô˘.

2. ªÂÙ·ÏÏ¿ÍÂÈ˜ ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ˘ÔÎÈÓËÙ‹.3. ªÂÙ·ÏÏ¿ÍÂÈ˜ Ô˘ ÂËÚÂ¿˙Ô˘Ó ÙË ‰È·‰ÈÎ·Û›· ÙÔ˘ Ì·Ù›-

ÛÌ·ÙÔ˜.4. ªÂÙ·ÏÏ¿ÍÂÈ˜ Ô˘ ·ÏÏ¿˙Ô˘Ó ÙÔ Ï·›ÛÈÔ ·Ó¿ÁÓˆÛË˜

(frameshifts).5. ªÂÙ·ÏÏ¿ÍÂÈ˜ Ô˘ ‰ËÌÈÔ˘ÚÁÔ‡Ó Îˆ‰ÈÎfiÓÈÔ ÙÂÚÌ·ÙÈÛÌÔ‡

(nonsense mutation).6. ªÂÙ·ÏÏ¿ÍÂÈ˜ Ô˘ ·ÏÏ¿˙Ô˘Ó ¤Ó· ·ÌÈÓÔÍ‡ ÙË˜ Ê˘ÛÈÔÏÔÁÈ-

Î‹˜ ÚˆÙÂ˝ÓË˜ ÌÂ ¤Ó· ¿ÏÏÔ (missense mutation).7. MÂÙ·ÏÏ¿ÍÂÈ˜ Ô˘, ÂÓÒ ·ÏÏ¿˙Ô˘Ó ÙÔ Îˆ‰ÈÎfiÓÈÔ ÂÓfi˜ ·ÌÈ-

ÓÔÍ¤Ô˜, ‰ÂÓ ·ÏÏ¿˙Ô˘Ó ÙÔ ·ÌÈÓÔÍ‡ Ô˘ Îˆ‰ÈÎÔÔÈÂ›Ù·È(silent mutation).

πÓÙÚfiÓÈÔ

∂ÍfiÓÈÔ

™ËÌÂ›Ô ÂÎÎ›ÓËÛË˜ÌÂÙ·ÁÚ·Ê‹˜ ÛÂ RNA

TGA-Îˆ‰ÈÎfiÓÈÔÙÂÚÌ·ÙÈÛÌÔ‡ ÌÂÙ¿ÊÚ·ÛË˜

tga-1

∂ÈÎfiÓ· 3. ∆˘ÈÎfi ÁÔÓ›‰ÈÔ Â˘Î·Ú˘ˆÙÈÎÔ‡ Î˘ÙÙ¿ÚÔ˘. ∫¿ıÂ ÁÔÓ›-‰ÈÔ ·ÔÙÂÏÂ›Ù·È ·fi Îˆ‰ÈÎÔÔÈÔ‡ÛÂ˜ (ÂÍÒÓÈ·) Î·È ÌË Îˆ‰ÈÎÔ-ÔÈÔ‡ÛÂ˜ ÂÚÈÔ¯¤˜ (ÂÛfiÓÈ· ‹ ÈÓÙÚfiÓÈ·).

108 ™. ªÂÁÚ¤ÌË˜, ∞. ¶¿Ì·ÓÔ˜



∏ ¯Ú‹ÛË ÙË˜ PCR ÂÓ‰Â›ÎÓ˘Ù·È Â›ÛË˜ ÛÙË ‰È¿ÁÓˆ-ÛË ÈÔÁÂÓÒÓ ÏÔÈÌÒÍÂˆÓ, ‰ÈfiÙÈ Ë Â˘·ÈÛıËÛ›· ÙË˜ Â›Ó·ÈÌÂÁ·Ï‡ÙÂÚË ·ÎfiÌ· Î·È ·fi ·˘Ù‹ ÙˆÓ ·ÓÔÛÔÂÓ˙˘ÌÈ-

ÎÒÓ ÌÂıfi‰ˆÓ (Elisa) (28) Î·È ··ÈÙÂ›Ù·È ÂÏ¿¯ÈÛÙÔ ÁÂ-ÓÂÙÈÎfi ˘ÏÈÎfi ÙÔ˘ ·ıÔÁfiÓÔ˘ ·ÈÙ›Ô˘ (¤Ó· ÌfiÓÔ ·ÓÙ›-ÁÚ·ÊÔ), ÒÛÙÂ Ó· ÌË ‚·Û›˙ÂÙ·È Ë ‰È¿ÁÓˆÛË ÛÙËÓ ‡·Ú-ÍË ‹ ÌË ÙˆÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ÙÔ˘ (¶›Ó·Î·˜ 4). ∏ PCR¯ÚËÛÈÌÔÔÈÂ›Ù·È Â›ÛË˜ ÛÙËÓ ·Ó›¯ÓÂ˘ÛË ·ÏÏËÏÔ˘¯ÈÒÓÁÔÓÈ‰ÈÒÌ·ÙÔ˜ ÈÒÓ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È ¿ÌÂÛ· ÌÂ Î·ÎÔ‹-ıÂÈ˜ fiÁÎÔ˘˜ ‹ ÛÙËÓ ·Ó›¯ÓÂ˘ÛË ÌÂÙ·ÏÏ¿ÍÂˆÓ ÛÂ ÔÁÎÔ-ÁÔÓ›‰È· ‹/Î·È ÔÁÎÔÎ·Ù·ÛÙ·ÏÙÈÎ¿ ÁÔÓ›‰È· (¶›Ó·Î·˜ 4).

∏ ·ÓÙ›‰Ú·ÛË Ú·ÁÌ·ÙÔÔÈÂ›Ù·È ÛÙÔ ıÂÚÌÈÎfi Î˘-ÎÏÔÔÈËÙ‹, Ô ÔÔ›Ô˜ ·˘ÍÔÌÂÈÒÓÂÈ ÙË ıÂÚÌÔÎÚ·Û›· ÙË˜·ÓÙ›‰Ú·ÛË˜, ÌÂ ÛÎÔfi ÙË ‰È·‰Ô¯ÈÎ‹ ·Ô‰È¿Ù·ÍË Î·È˘‚ÚÈ‰ÔÔ›ËÛË ÙË˜ ‰ÈÏ‹˜ ¤ÏÈÎ·˜ DNA. H ·ÓÙ›‰Ú·ÛËPCR ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÚ›· ÛÙ¿‰È· (∂ÈÎfiÓÂ˜ 4 Î·È 5):

1. AÔ‰È¿Ù·ÍË ÙÔ˘ ˘ÔÛÙÚÒÌ·ÙÔ˜ (templatedenaturation) ÛÂ ˘„ËÏ‹ ıÂÚÌÔÎÚ·Û›· (94ÔC-96ÔC)ÌÂ ‰È¿ÚÎÂÈ· ÂÓfi˜ ÏÂÙÔ‡.

2. ™‡Ó‰ÂÛË (annealing) ÙˆÓ ÂÎÎÈÓËÙÒÓ ÌÂ ÙÈ˜ Û˘-ÌÏËÚˆÌ·ÙÈÎ¤˜ ÙÔ˘˜ ·ÏÏËÏÔ˘¯›Â˜ ÛÙÔ DNA ÛÂ ıÂÚ-ÌÔÎÚ·Û›· ÌÂÙ·Í‡ 37ÔC-70ÔC Û˘Ó‹ıˆ˜ ÁÈ· ¤Ó· ÏÂÙfi.

3. ∂ÈÌ‹Î˘ÓÛË ÙˆÓ ˘‚ÚÈ‰ÈÛÌ¤ÓˆÓ ÂÎÎÈÓËÙÒÓ(primer extension), Ë ÔÔ›· Á›ÓÂÙ·È ÛÂ ıÂÚÌÔÎÚ·Û›·

¶›Ó·Î·˜ 3. ¶·Ú·‰Â›ÁÌ·Ù· ÎÏËÚÔÓÔÌÈÎÒÓ ÓÔÛËÌ¿ÙˆÓ Ô˘ ‰‡Ó·-ÓÙ·È Ó· ‰È·ÁÓˆÛıÔ‡Ó ÌÂ PCR

ñ A˘ÙÔÛˆÌ·ÙÈÎfi˜ EÈÎÚ·ÙËÙÈÎfi˜ ∫ˆ‰ÈÎfi˜ PubMed

¶ÔÏ˘Î˘ÛÙÈÎ‹ ÓfiÛÔ˜ ÙˆÓ ÓÂÊÚÒÓ OMIM 600666¡fiÛÔ˜ ÙÔ˘ Huntington OMIM 143100ª˘ÔÙÔÓÈÎ‹ ‰˘ÛÙÚÔÊ›· OMIM 160900√˙Ò‰Ë˜ ÛÎÏ‹Ú˘ÓÛË OMIM 191100∫ÒÊˆÛË DFN∞5 OMIM 608798ÀÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· √ªπª 44010ƒÂÙÈÓÔ‚Ï¿ÛÙˆÌ· OMIM 180200

ñ ∞˘ÙÔÛˆÌ·ÙÈÎfi˜ YÔÏÂÈfiÌÂÓÔ˜ ∫ˆ‰ÈÎfi˜ PubMed™˘ÁÁÂÓ¤˜ ÓÂÊÚˆÙÈÎfi Û‡Ó‰ÚÔÌÔ √ªπª 600995∫˘ÛÙÈÎ‹ ›ÓˆÛË √ªπª 219700¡Â˘ÚÔ·ÈÛıËÙ‹ÚÈ· ‚·ÚËÎÔ˝· DFNB1 √ªπª 220290µ ÌÂÛÔÁÂÈ·Î‹ ·Ó·ÈÌ›· √ªπª 141900º·ÈÓ˘ÏÔÎÂÙÔÓÔ˘Ú›· √ªπª 261600™‡Ó‰ÚÔÌÔ Usher 1 OMIM 276900ŒÏÏÂÈ„Ë 21-˘‰ÚÔÍ˘Ï¿ÛË˜ OMIM 201910NfiÛÔ˜ Tay-Sachs OMIM 272800¡fiÛÔ˜ Gaucher OMIM 230800™‡Ó‰ÚÔÌÔ Bloom OMIM 210900¡ˆÙÈ·›· Ì˘˚Î‹ ·ÙÚÔÊ›· (SMA) OMIM 253300

ñ Ã º˘ÏÔÛ‡Ó‰ÂÙÔ˜ ∫ˆ‰ÈÎfi˜ PubMed™‡Ó‰ÚÔÌÔ Â‡ıÚ·˘ÛÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ Ã OMIM 300624¡ÂÊÚÔÏÈı›·ÛË OMIM 310468∞ÈÌÔÊÈÏ›· ∞/µ √ªπª 306700/

306900ª˘˚Î‹ ‰˘ÛÙÚÔÊ›· Duchenne √ªπª 310200ª˘˚Î‹ ‰˘ÛÙÚÔÊ›· Becker √ªπª 300376∞¯ÚˆÌ·ÙÔ„›· ÂÚ˘ıÚÔ‡-Ú·Û›ÓÔ˘ (‰·ÏÙÔÓÈÛÌfi˜) √ªπª 303900X Ê˘ÏÔÛ‡Ó‰ÂÙË È¯ı‡·ÛË √ªπª 607602Ã Ê˘ÏÔÛ‡Ó‰ÂÙË ·Á·ÌÌ·ÛÊ·ÈÚÈÓ·ÈÌ›· √ªπª 300300ŒÏÏÂÈ„Ë ÁÏ˘Îfi˙Ë˜ 6 ÊˆÛÊ·Ù¿ÛË˜ ·Ê˘‰ÚÔÁÔÓ¿ÛË˜ √ªπª 305900

¶›Ó·Î·˜ 4. ¶·Ú·‰Â›ÁÌ·Ù· Â›ÎÙËÙˆÓ ÓÔÛËÌ¿ÙˆÓ Ô˘ ‰‡Ó·ÓÙ·ÈÓ· ‰È·ÁÓˆÛıÔ‡Ó ÌÂ PCR

§ÔÈÌÒ‰Ë ÓÔÛ‹Ì·Ù· ÕÚıÚÔ ∞Ó·ÊÔÚ¿˜πfi˜ ÙÔ˘ Epstein-Barr (EBV) 49∫˘ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi˜ (CMV) 50πfi˜ ·ÏÔ‡ ¤ÚËÙÔ˜ (HSV) 51πfi˜ ÙˆÓ ·ÓıÚˆ›ÓˆÓ ıËÏˆÌ¿ÙˆÓ (HPV) 28ª˘ÎÔ‚·ÎÙ‹ÚÈÔ Ê˘Ì·Ù›ˆÛË˜ 29¡ÂÔÏ·Û›Â˜ ∫ˆ‰ÈÎfi˜ PubMed√ÁÎÔÎ·Ù·ÛÙ·ÏÙÈÎ¿ ÁÔÓ›‰È· BRCA1/ √ªπª 113705/BRCA2 600185P53 √ªπª 191170MYC √ªπª 190080RAS √ªπª 190020

£¤ÚÌ·ÓÛË ÁÈ· ÙÔ

‰È·¯ˆÚÈÛÌfi ÙˆÓ

ÎÏÒÓˆÓ

À‚ÚÈ‰ÈÛÌfi˜ ÙˆÓ

ÂÎÎÈÓËÙÒÓ

+DNA ÔÏ˘ÌÂÚ¿ÛË

+dNTPs

¢›ÎÏˆÓÔ DNA

™Ù¿‰ÈÔ 3™Ù¿‰ÈÔ 2

1Ô˜ Î‡ÎÏÔ˜

™Ù¿‰ÈÔ 1

∂ÈÎfiÓ· 4. ∏ ‚·ÛÈÎ‹ ·Ú¯‹ ÙË˜ ÌÂıfi‰Ô˘ ÙË˜ PCR.∏ ‚·ÛÈÎ‹ ·Ú¯‹ ÙË˜ ÌÂıfi‰Ô˘ PCR, fiˆ˜ Ú·ÁÌ·ÙÔÔÈÂ›Ù·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÂÓfi˜ Î‡ÎÏÔ˘. √È ‰‡Ô ·Ï˘Û›‰Â˜ DNA ·Ô‰È·Ù¿ÛÛÔÓÙ·È(ÛÙ¿‰ÈÔ 1) Î·È Ô Î¿ıÂ ÂÎÎÈÓËÙ‹˜ ÚÔÛÎÔÏÏ¿Ù·È ÛÙÔ Û˘ÌÏËÚˆÌ·ÙÈÎfi ÙÔ˘ ÎÏÒÓÔ (ÛÙ¿‰ÈÔ 2). √È ÂÎÎÈÓËÙ¤˜ ÂÈÌËÎ‡ÓÔÓÙ·È ÌÂ ÙË ‰Ú¿ÛËÙË˜ DNA ÔÏ˘ÌÂÚ¿ÛË˜ ·ÓÙÈÁÚ¿ÊÔÓÙ·˜ ÙËÓ ÂÚÈÔ¯‹ ÛÙfi¯Ô ÙÔ˘ DNA (ÛÙ¿‰ÈÔ 3).


¶·È‰È·ÙÚÈÎ‹ 2008;71:105-115


72ÔC ÁÈ· ¤Ó· ÂÚ›Ô˘ ÏÂÙfi. ∆· ÙÚ›· ·˘Ù¿ ÛÙ¿‰È··ÔÙÂÏÔ‡Ó ¤Ó·Ó Î‡ÎÏÔ ÙË˜ ·ÓÙ›‰Ú·ÛË˜. ªÈ· Û˘ÓËıÈ-ÛÌ¤ÓË PCR ·ÔÙÂÏÂ›Ù·È ·fi 25-30 Î‡ÎÏÔ˘˜. ™ÙÔ Ù¤-ÏÔ˜ Î¿ıÂ Î‡ÎÏÔ˘, ÙÔ ÚÔ˚fiÓ ÙË˜ ÂÈÌ‹Î˘ÓÛË˜ ÙÔ˘Î¿ıÂ ÂÎÎÈÓËÙ‹ ı· ·ÔÙÂÏ¤ÛÂÈ -‡ÛÙÂÚ· ·fi ·Ô‰È¿-Ù·ÍË- ÙÔ ˘fiÛÙÚˆÌ· ÙÔ˘ ¿ÏÏÔ˘ ÂÎÎÈÓËÙ‹.

∏ ·Ï˘ÛÈ‰ˆÙ‹ ·ÓÙ›‰Ú·ÛË ÔÏ˘ÌÂÚ¿ÛË˜ ÂÚÈÏ·Ì-‚¿ÓÂÈ ÔÈÎÈÏ›· ·Ú·ÏÏ·ÁÒÓ, fiˆ˜ nested PCR,ARMS PCR, QRT-PCR ÌÂ ÙË ıÂÌÂÏÈÒ‰Ë ·Ú¯‹ ÙË˜ÌÂıfi‰Ô˘ Ó· ·Ú·Ì¤ÓÂÈ Ë ›‰È· (14,17,24).

∏ÏÂÎÙÚÔÊfiÚËÛË ÚÔ˚fiÓÙˆÓ PCR ÛÂ ‹ÎÙˆÌ·

·Á·Úfi˙Ë˜

∏ Ì¤ıÔ‰Ô˜ Â›Ó·È Û˘ÌÏËÚˆÌ·ÙÈÎ‹ ÙË˜ PCR,ÚÔÎÂÈÌ¤ÓÔ˘ Ó· ÂÏÂÁ¯ıÂ› Ë ÂÈÙ˘¯›· ÙË˜ (29). ∆·ÚÔ˚fiÓÙ· ÙË˜ ·ÓÙ›‰Ú·ÛË˜ PCR ËÏÂÎÙÚÔÊÔÚÔ‡ÓÙ·ÈÛÂ ‹ÎÙˆÌ· ·Á·Úfi˙Ë˜ (∂ÈÎfiÓ· 6). ∏ ·Á·Úfi˙Ë Â›Ó·È¤Ó· ÁÚ·ÌÌÈÎfi ÔÏ˘ÌÂÚ¤˜, Û˘ÛÙ·ÙÈÎfi ÙÔ˘ ¿Á·Ú, Ô˘¤¯ÂÈ ÙËÓ Ù¿ÛË Ó· Û¯ËÌ·Ù›˙ÂÈ ËÎÙÒÌ·Ù·, Ë ÂÚÈÂÎÙÈ-ÎfiÙËÙ· ÙÔ˘ ÔÔ›Ô˘ ÂÈÏ¤ÁÂÙ·È ÌÂ ‚¿ÛË ÙÔ Ì¤ÁÂıÔ˜ÙˆÓ ıÚ·˘ÛÌ¿ÙˆÓ DNA Ô˘ ı· ‰È·¯ˆÚÈÛıÔ‡Ó.

∆· ÚÔ˚fiÓÙ· ÙË˜ PCR ËÏÂÎÙÚÔÊÔÚÔ‡ÓÙ·È ÛÙÔ‹ÎÙˆÌ· Ì·˙› ÌÂ ÂÈ‰ÈÎ‹ ¯ÚˆÛÙÈÎ‹ (loading dye) Î·ÈÎ·Ù¿ ÙÔ ‰È·¯ˆÚÈÛÌfi ‚¿ÊÔÓÙ·È ÌÂ ‚ÚˆÌÈÔ‡¯Ô ·Èı›-‰ÈÔ, ÙÔ ÔÔ›Ô ¤¯ÂÈ ÙËÓ ÈÎ·ÓfiÙËÙ· ÚfiÛ‰ÂÛË˜ ÌÂÙ·Í‡ÙˆÓ ‚¿ÛÂˆÓ ÙÔ˘ DNA (29). ∆· ‰È·ÊÔÚÂÙÈÎ¿ ıÚ·‡-ÛÌ·Ù· DNA, ‰Â‰ÔÌ¤ÓÔ˘ fiÙÈ ¤¯Ô˘Ó ·ÚÓËÙÈÎfi ÊÔÚÙ›Ô,Î·ÙÂ˘ı‡ÓÔÓÙ·È ÚÔ˜ ÙÔ ıÂÙÈÎfi fiÏÔ ÌÂ Ù·¯‡ÙËÙ·Ô˘ Â›Ó·È ·ÓÙÈÛÙÚfiÊˆ˜ ·Ó¿ÏÔÁË ÙˆÓ ÏÔÁ·Ú›ıÌˆÓÙÔ˘ ÌÔÚÈ·ÎÔ‡ ÙÔ˘˜ ‚¿ÚÔ˘˜. ™ÙÔ Ù¤ÏÔ˜ ÙË˜ ËÏÂÎÙÚÔ-ÊfiÚËÛË˜, ÔÈ ˙ÒÓÂ˜ ÙÔ˘ DNA Á›ÓÔÓÙ·È ÔÚ·Ù¤˜ ÌÂÙ¿·fi ¤ÎıÂÛË ÛÂ ˘ÂÚÈÒ‰Ë ·ÎÙÈÓÔ‚ÔÏ›· (∂ÈÎfiÓ· 6).

°È· Ó· Â›Ó·È ‰˘Ó·Ù‹ Ë ·ÍÈÔÏfiÁËÛË ÙÔ˘ ÚÔ˚fiÓÙÔ˜,

ËÏÂÎÙÚÔÊÔÚÂ›Ù·È ·Ú·ÏÏ‹Ïˆ˜ Î·È ¤Ó· ÌÂ›ÁÌ· ıÚ·˘-

ÛÌ¿ÙˆÓ DNA ÁÓˆÛÙÔ‡ ÌÂÁ¤ıÔ˘˜.

ªÂ ÙË Ì¤ıÔ‰Ô PCR ÌÔÚÔ‡Ó Â›ÛË˜ Ó· ·ÓÈ¯ÓÂ˘-

ıÔ‡Ó Î·È ÔÈ ÔÈÎ›ÏÔ˘ ·ÚÈıÌÔ‡ Â·Ó·Ï·Ì‚·ÓfiÌÂÓÂ˜

M

·

‚

∂ÈÎfiÓ· 6. ∏ÏÂÎÙÚÔÊfiÚËÛË ARMS-PCR ÛÂ ‹ÎÙˆÌ· ·Á·Úfi˙Ë˜.¢Â›ÁÌ·Ù· ˘fi ÂÍ¤Ù·ÛË Û˘ÁÎÚÈÓfiÌÂÓ· ÌÂ ·ıÔÏÔÁÈÎfi ‰Â›ÁÌ·.ª¿ÚÙ˘Ú·˜ ÌÂÁ¤ıÔ˘˜ ·ÏÏËÏÔ˘¯ÈÒÓ: 100 bp ladder·: ˙ÒÓË ÂÏ¤Á¯Ô˘ ÙˆÓ ˘fi ÂÍ¤Ù·ÛË ‰ÂÈÁÌ¿ÙˆÓ, ··Ú·›ÙËÙË ÁÈ·ÙËÓ ÂÈ‚Â‚·›ˆÛË ÙË˜ ÂÈÙ˘¯ËÌ¤ÓË˜ ·ÓÙ›‰Ú·ÛË˜ (ÛÂ ÂÚ›ÙˆÛË·Ô˘Û›·˜ ÙË˜, Ë ·ÓÙ›‰Ú·ÛË ‰ÂÓ ‹Ù·Ó ÂÈÙ˘¯‹˜),‚: ˙ÒÓË ·ıÔÏÔÁÈÎ‹˜ ·ÏÏËÏÔ˘¯›·˜ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ Ô˘ ¯ÚËÛÈÌÔ-ÔÈÂ›Ù·È ˆ˜ ıÂÙÈÎfi ÎÔÓÙÚfiÏ.™ÙË Û˘ÁÎÂÎÚÈÌ¤ÓË ËÏÂÎÙÚÔÊfiÚËÛË, Ë ·ÓÙ›‰Ú·ÛË Â›Ó·È ÂÈÙ˘¯‹˜Î·È Î·Ó¤Ó· ‰Â›ÁÌ· ‰ÂÓ Ê¤ÚÂÈ ÌÂÙ¿ÏÏ·ÍË.

110 ™. ªÂÁÚ¤ÌË˜, ∞. ¶¿Ì·ÓÔ˜


¢›ÎÏˆÓÔ DNA

™‡ÓıÂÛË DNA

¢È·¯ˆÚÈÛÌfi˜ ÙˆÓ

ÎÏÒÓˆÓ ÙÔ˘ DNA

Î·È ÚÔÛı‹ÎË

ÂÎÎÈÓËÙÒÓ

¢È·¯ˆÚÈÛÌfi˜ ÙˆÓ

ÎÏÒÓˆÓ ÙÔ˘ DNA

Î·È ÚÔÛı‹ÎË

ÂÎÎÈÓËÙÒÓ

2Ô˜ Î‡ÎÏÔ˜

(·Ú¿ÁÂÈ 4 ‰›ÎÏˆÓ·

ÌfiÚÈ· DNA)

™‡ÓıÂÛË DNA

1Ô˜ Î‡ÎÏÔ˜

(·Ú¿ÁÂÈ 2 ‰›ÎÏˆÓ·

ÌfiÚÈ· DNA)

DNA

ÔÏÈÁÔÓÔ˘ÎÏÂÔÙÈ‰ÈÎÔ›

ÂÎÎÈÓËÙ¤˜

∂ÈÎfiÓ· 5. √ ÚÒÙÔ˜ Î·È ‰Â‡ÙÂÚÔ˜ Î‡ÎÏÔ˜ ÌÈ·˜ ·ÓÙ›‰Ú·ÛË˜ PCR. ∫·Ù¿ ÙÔÓ 1Ô Î‡ÎÏÔ ÙË˜ ·ÓÙ›‰Ú·ÛË˜ ·Ú¿ÁÔÓÙ·È 2 ‰›ÎÏˆÓ· ÌfiÚÈ·DNA, Î·Ù¿ ÙÔ 2Ô Î‡ÎÏÔ 4 ‰›ÎÏˆÓ· ÌfiÚÈ· DNA, Î·Ù¿ ÙÔÓ 3Ô Î‡ÎÏÔ 16 Î.Ô.Î.


·ÏÏËÏÔ˘¯›Â˜ (Variable Number of Tandem Repeats,

VNTRs), Ì‹ÎÔ˘˜ 14-100 ‚¿ÛÂˆÓ. Ã·Ú·ÎÙËÚ›˙ÔÓÙ·È

·fi ÌÈ· ÎÂÓÙÚÈÎ‹ ·ÏÏËÏÔ˘¯›· Ô˘ ·ÔÙÂÏÂ›Ù·È ·fi

¤Ó·Ó ·ÚÈıÌfi Ù·˘ÙfiÛËÌˆÓ Â·Ó·Ï·Ì‚·ÓfiÌÂÓˆÓ ·Ï-

ÏËÏÔ˘¯ÈÒÓ, ÔÈ ÔÔ›Â˜ ÔÚÁ·ÓÒÓÔÓÙ·È ÛÂ ÔÌ¿‰Â˜ (ÌÂ

·ÚÈıÌfi Â·Ó¿ÏË„Ë˜ 4 ¤ˆ˜ 40 ÊÔÚ¤˜). ∞˘Ù¤˜ ÔÈ ÔÌ¿-

‰Â˜ ‚Ú›ÛÎÔÓÙ·È ÛÂ fiÏ· Ù· ¯ÚˆÌÔÛÒÌ·Ù· Î·È ÎÏËÚÔ-

ÓÔÌÔ‡ÓÙ·È Î·È ·fi ÙÔ˘˜ ‰‡Ô ÁÔÓÂ›˜.

OÈ VNTRs ¯ˆÚ›˙ÔÓÙ·È ÛÂ ‰‡Ô Î·ÙËÁÔÚ›Â˜ ÌÂ ‚¿-

ÛË ÙÔ Ì¤ÁÂıfi˜ ÙÔ˘˜: 1) ÛÙÈ˜ Ì›ÓÈ-‰ÔÚ˘ÊÔÚÈÎ¤˜ ·ÏÏË-

ÏÔ˘¯›Â˜ (minisatellites) Î·È 2) ÛÙÈ˜ ÌÈÎÚÔ‰ÔÚ˘ÊÔÚÈ-

Î¤˜ ·ÏÏËÏÔ˘¯›Â˜ (microsatellites).

OÈ Ì›ÓÈ-‰ÔÚ˘ÊÔÚÈÎÂ˜ ·ÏÏËÏÔ˘¯›Â˜ ·ÔÙÂÏÔ‡ÓÙ·È

·fi 10-100 bp Î·È ·ÓÂ˘Ú›ÛÎÔÓÙ·È ÛÂ ÂÚÈÛÛfiÙÂÚÂ˜

·fi 1000 ÂÚÈÔ¯¤˜ ÙÔ˘ ·ÓıÚÒÈÓÔ˘ ÁÔÓÈ‰ÈÒÌ·ÙÔ˜.

™˘Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ¯ÚˆÌÔÛˆÌÈÎ¤˜ ÂÚÈÔ¯¤˜, ÔÈ ÔÔ›Â˜

Â›Ó·È ÂÈÚÚÂÂ›˜ ÛÂ ıÚ˘ÌÌ·ÙÈÛÌÔ‡˜, fiˆ˜ ÙÂÏÔÌÂÚ›-

‰È·, ÂÓÒ ‚Ú›ÛÎÔÓÙ·È ÎÔÓÙ¿ ÛÂ ÛËÌÂ›· ÌÂÙ·ı¤ÛÂˆÓ

(30). ∂ÈÚÔÛı¤Ùˆ˜, ÔÈ ÂÚÈÔ¯¤˜ Ô˘ Î·Ï‡ÙÔÓÙ·È

·fi Ì›ÓÈ-‰ÔÚ˘ÊÔÚÈÎ¤˜ ·ÏÏËÏÔ˘¯›Â˜ Â›Ó·È ÔÈ ÂÚÈÛÛfi-

ÙÂÚÔ ·ÛÙ·ıÂ›˜ ÛÙÔ ·ÓıÚÒÈÓÔ ÁÔÓÈ‰›ˆÌ· (31). ∏ ¯·Ú-

ÙÔÁÚ¿ÊËÛ‹ ÙÔ˘˜ ‚Ô‹ıËÛÂ ÛÂ ÌÂÁ¿ÏÔ ‚·ıÌfi ÙË ÁÂÓÂÙÈ-

Î‹ Ù·˘ÙÔÔ›ËÛË (DNA fingerprint) Ô˘ Â›Ó·È ··Ú·›-

ÙËÙË ÛÙËÓ È·ÙÚÔ‰ÈÎ·ÛÙÈÎ‹ Î·È Â›ÛË˜ ÛÙË ‰È¿ÁÓˆÛË

ÁÂÓÂÙÈÎÒÓ ·ı‹ÛÂˆÓ Ô˘ ÔÊÂ›ÏÔÓÙ·È ÛÂ ÌË Ê˘ÛÈÔÏÔ-

ÁÈÎfi ·Ó·‰ÈÏ·ÛÈ·ÛÌfi ÙÔ˘ DNA (ÔÏ˘ÌÔÚÊÈÛÌÔ›

·ÚÈıÌÔ‡ ·ÓÙÈÁÚ¿ÊˆÓ - copy number variation) (32).

√È ÌÈÎÚÔ‰ÔÚ˘ÊÔÚÈÎ¤˜ ·ÏÏËÏÔ˘¯›Â˜ (microsatellite

or Small Tandem Repeats, STRs) ·ÔÙÂÏÔ‡ÓÙ·È ·fi

100-200 ‚¿ÛÂÈ˜. ∂ÎÙÈÌ¿Ù·È fiÙÈ ÔÈ ÌÈÎÚÔ‰ÔÚ˘ÊÔÚÈÎ¤˜

·ÏÏËÏÔ˘¯›Â˜ ‰ÂÓ ÌÔÚÔ‡Ó Ó· ıÂˆÚËıÔ‡Ó ˘Â‡ı˘ÓÂ˜

ÁÈ· ÙËÓ ÚfiÎÏËÛË ÓfiÛÔ˘, ·ÏÏ¿ ·ÔÙÂÏÔ‡Ó ÂÍ·ÈÚÂÙÈ-

ÎÔ‡˜ ‰Â›ÎÙÂ˜ ÁÈ· ÙËÓ Ù·˘ÙÔÔ›ËÛË ÂÓfi˜ ¯ÚˆÌÔÛÒÌ·-

ÙÔ˜ ‹ ÌÈ·˜ ÁÂÓÂÙÈÎ‹˜ ı¤ÛË˜ Î·È ‚Ú›ÛÎÔ˘Ó ÂÊ·ÚÌÔÁ‹

ÛÙË ¯·ÚÙÔÁÚ¿ÊËÛË ÁÔÓÈ‰›ˆÓ Î·È ÛÙoÓ ¤ÏÂÁ¯Ô ·ÙÚfi-

ÙËÙ·˜ (33) (∂ÈÎfiÓ· 7).

∞Ó¿Ï˘ÛË ÙË˜ ·ÏÏËÏÔ˘¯›·˜ ÙË˜ ÚˆÙÔÙ·ÁÔ‡˜

‰ÔÌ‹˜ ÙÔ˘ DNA (Sequencing)

ªÂ ÙË Ì¤ıÔ‰Ô ·˘Ù‹ ·Ó·ÁÓˆÚ›˙ÂÙ·È Ë ÓÔ˘ÎÏÂÔÙÈ-

‰ÈÎ‹ ·ÏÏËÏÔ˘¯›· ÂÓfi˜ ÙÌ‹Ì·ÙÔ˜ DNA (.¯. ÁÔÓ›‰ÈÔ),

ÂÈÙÚ¤ÔÓÙ·˜ ¤ÙÛÈ ÙËÓ ·Ó›¯ÓÂ˘ÛË ÌÂÙ·ÏÏ¿ÍÂˆÓ

(34,35). ∆Ô ÙÌ‹Ì· Ô˘ ·Ó·Ï‡ÂÙ·È ·Ô‰È·Ù¿ÛÛÂÙ·È

Î·È ÏÂÈÙÔ˘ÚÁÂ› ˆ˜ Ì‹ÙÚ· ÛÙËÓ ÔÔ›· ˘‚ÚÈ‰›˙ÂÙ·È

¤Ó·˜ ÂÎÎÈÓËÙ‹˜ ÚÔÎÂÈÌ¤ÓÔ˘ Ó· ÍÂÎÈÓ‹ÛÂÈ Ë ÂÓ˙˘Ì·-

ÙÈÎ‹ ÂÈÌ‹Î˘ÓÛË ÙË˜ ÂÚÈÔ¯‹˜-ÛÙfi¯Ô˘.

∞·Ú·›ÙËÙË ÚÔ¸fiıÂÛË ÁÈ· ÙËÓ ·Ó¿Ï˘ÛË ÙË˜

·ÏÏËÏÔ˘¯›·˜ Â›Ó·È Ë Ú·ÁÌ·ÙÔÔ›ËÛË ·ÓÙ›‰Ú·ÛË˜,

Û‡ÓıÂÛË˜ ·ÓÙÈÁÚ¿ÊˆÓ ÙÔ˘ È‰›Ô˘ ÌÔÓfiÎÏˆÓÔ˘ DNA-

Ì‹ÙÚ·, ÌÂ ÙË ¯Ú‹ÛË 4 ddNTPs, Î·ı¤Ó· ·fi Ù· ÔÔ›·

Ê¤ÚÂÈ Û‹Ì·ÓÛË ÌÂ ‰È·ÊÔÚÂÙÈÎ‹ ÊıÔÚ›˙Ô˘Û· ¯ÚˆÛÙÈ-

Î‹. ∆Ô ÚÔ˚fiÓ ÙË˜ ·ÓÙ›‰Ú·ÛË˜ ‰È·¯ˆÚ›˙ÂÙ·È ÌÂ Î¿-

ıÂÙË ËÏÂÎÙÚÔÊfiÚËÛË ÛÂ ‹ÎÙˆÌ· ·ÎÚ˘Ï·Ì›‰Ë˜ Î·È

‰‡Ó·Ù·È Ó· ·ÓÈ¯ÓÂ˘ıÂ› ÌÂ ‰¤ÛÌË ÊˆÙfi˜ laser (36-39).

∏ ·ÓÙ›‰Ú·ÛË Ï·Ì‚¿ÓÂÈ ¯ÒÚ· ÛÂ ıÂÚÌÈÎfi Î˘ÎÏÔÔÈË-

Ù‹ (40). ∫·Ù¿ Ì¤ÛÔ fiÚÔ ··ÈÙÔ‡ÓÙ·È 30-35 Î‡ÎÏÔÈ,

¤ÙÛÈ ÒÛÙÂ Ó· ‰È·ÛÊ·ÏÈÛıÂ› Ë ·Ú·ÁˆÁ‹ Â·ÚÎÔ‡˜

·ÚÈıÌÔ‡ ·ÓÙÈÁÚ¿ÊˆÓ (∂ÈÎfiÓ· 8).

∏ Â˘·ÈÛıËÛ›· ÙË˜ ÌÂıfi‰Ô˘ Sequencing Â›Ó·È Ù¤-

ÙÔÈ· ÒÛÙÂ Ó· ÂÈÙÚ¤ÂÈ ÙËÓ ·Ó›¯ÓÂ˘ÛË ·ÏÏ·Á‹˜ ·Îfi-

ÌË Î·È ÌÈ·˜ ÌfiÓÔ ‚¿ÛË˜ ÛÙËÓ ˘fi ÌÂÏ¤ÙË ·ÏÏËÏÔ˘-

¯›·. ¶ÚfiÎÂÈÙ·È ‰ËÏ·‰‹ ÁÈ· ÌÈ· ÂÍ·ÈÚÂÙÈÎ¿ ¯Ú‹ÛÈÌË

ÙÂ¯ÓÈÎ‹, Ë ÔÔ›· ÌÔÚÂ› Ó· ¯ÚËÛÈÌÔÔÈËıÂ› ÁÈ· ÙËÓ

·Ó›¯ÓÂ˘ÛË ÌÂÙ·ÏÏ¿ÍÂˆÓ ÛÂ ÔÔÈÔ‰‹ÔÙÂ ÁÂÓÂÙÈÎfi

ÓfiÛËÌ·, ÂÊfiÛÔÓ ÁÓˆÚ›˙Ô˘ÌÂ ÙË Ê˘ÛÈÔÏÔÁÈÎ‹ ÓÔ˘-

ÎÏÂÔÙÈ‰ÈÎ‹ ·ÏÏËÏÔ˘¯›· ÙË˜ ÂÚÈÔ¯‹˜-ÛÙfi¯Ô˘.

M C F

Human paternity analysis using NICETM probe 33.6

∂ÈÎfiÓ· 7. ŒÏÂÁ¯Ô˜ ·ÙÚfiÙËÙ·˜ ÌÂ ¯Ú‹ÛË ÙˆÓ VNTRs. M=MËÙ¤Ú·, F= ¶·Ù¤Ú·˜, C= ¶·È‰›.∫¿ıÂ ˙ÒÓË ·ÓÙÈÚÔÛˆÂ‡ÂÈ ÌÈÎÚÔ-‰ÔÚ˘ÊÔÚÈÎ¤˜ ı¤ÛÂÈ˜(microsatellites). ™Â Î¿ıÂ ı¤ÛË ·ÓÙÈÛÙÔÈ¯Ô‡Ó 2 ·ÏÏËÏfiÌÔÚÊ·.º·›ÓÔÓÙ·È ÔÈ ÌÈÎÚÔ-‰ÔÚ˘ÊÔÚÈÎ¤˜ ı¤ÛÂÈ˜ Ô˘ ¤¯Ô˘Ó ÎÏËÚÔÓÔÌË-ıÂ› ·fi ÙÔÓ Î¿ıÂ ÁÔÓ¤· (ÎfiÎÎÈÓ· ‚¤ÏË-ı¤ÛÂÈ˜ Ô˘ ÎÏËÚÔÓÔÌÔ‡-ÓÙ·È ·fi ÙÔÓ ·Ù¤Ú·, ÌÏ¤ ‚¤ÏË-ı¤ÛÂÈ˜ Ô˘ ÎÏËÚÔÓÔÌÔ‡ÓÙ·È·fi ÙË ÌËÙ¤Ú·).

A C A T C (g>a) A T C C C

∂ÈÎfiÓ· 8. ∞Ó¿Ï˘ÛË ÙË˜ ·ÏÏËÏÔ˘¯›·˜ ÙË˜ ÚˆÙÔÙ·ÁÔ‡˜ ‰ÔÌ‹˜ÙÔ˘ DNA (Sequencing). ¶·Ú·ÙËÚÂ›Ù·È ·ÓÙÈÎ·Ù¿ÛÙ·ÛË ÁÔ˘·Ó›-ÓË˜ ·fi ·‰ÂÓ›ÓË.


¶·È‰È·ÙÚÈÎ‹ 2008;71:105-115


ªÂÚÈÎ¿ ·fi Ù· ÂÎ·ÙÔÓÙ¿‰Â˜ ·Ú·‰Â›ÁÌ·Ù· ÁÂÓÂ-

ÙÈÎÒÓ ·ı‹ÛÂˆÓ, fiÔ˘ Ë ÙÂ¯ÓÈÎ‹ ·˘Ù‹ ‚Ú›ÛÎÂÈ ÂÊ·Ú-

ÌÔÁ‹ ÁÈ· ÙË ‰È¿ÁÓˆÛË, Â›Ó·È Ë Î˘ÛÙÈÎ‹ ›ÓˆÛË, Ë Ì˘˚Î‹

‰˘ÛÙÚÔÊ›·, ÙÔ Û‡Ó‰ÚÔÌÔ Rett, ÔÈ ·ÈÌÔÛÊ·ÈÚÈÓÔ¿ıÂÈ-

Â˜, Ë Ô˙Ò‰Ë˜ ÛÎÏ‹Ú˘ÓÛË Î·È Ë ÓfiÛÔ˜ Wilson (41,42).

∞Ô‰È·Ù·ÎÙÈÎ‹ ̄ ÚˆÌ·ÙÔÁÚ·Ê›· ̆ ÁÚ‹˜ Ê¿ÛË˜

(Denaturing High Performance Liquid

Chromatography, DHPLC)

¶ÚfiÎÂÈÙ·È ÁÈ· ¤Ó· ÂÍ·ÈÚÂÙÈÎ¿ ·ÍÈfiÈÛÙÔ Û‡ÛÙËÌ·

·Ó›¯ÓÂ˘ÛË˜ ÌÂÙ·ÏÏ¿ÍÂˆÓ Î·È Û˘Á¯ÚfiÓˆ˜ ÁÚ‹ÁÔÚÔ,

‰Â‰ÔÌ¤ÓÔ˘ fiÙÈ ÌÔÚÂ› Ó· Ú·ÁÌ·ÙÔÔÈ‹ÛÂÈ ÙÔÓ

¤ÏÂÁ¯Ô ÂÓfi˜ ‰Â›ÁÌ·ÙÔ˜ ÛÂ 6 ÏÂÙ¿. ø˜ ÂÎ ÙÔ‡ÙÔ˘,

ÛÙË ‰È¿ÚÎÂÈ· ÂÓfi˜ 24ÒÚÔ˘ ÌÔÚÂ› Ó· Ú·ÁÌ·ÙÔÔÈ-

ËıÂ› Ô ¤ÏÂÁ¯Ô˜ ÂÚ›Ô˘ 240 ‰ÂÈÁÌ¿ÙˆÓ.

∏ ÙÂ¯ÓÈÎ‹ DHPLC ÌÔÚÂ› Ó· ¯ÚËÛÈÌÔÔÈËıÂ› ÁÈ·

ÙËÓ ·Ó›¯ÓÂ˘ÛË ÌÂÙ·ÏÏ¿ÍÂˆÓ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ DNA ‹

ÛËÌÂÈ·ÎÒÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ, fiˆ˜ ÂÓı¤ÛÂˆÓ, ÂÏÏÂ›„Â-

ˆÓ, ·ÓÙÈÎ·Ù·ÛÙ¿ÛÂˆÓ, ÛËÌÂÈ·ÎÒÓ ÔÏ˘ÌÔÚÊÈÛÌÒÓ

(SNPs) Î·È ‰È·‰Ô¯ÈÎÒÓ Â·Ó·Ï‹„ÂˆÓ (∂ÈÎfiÓ· 9). √

ÂÓÙÔÈÛÌfi˜ ÙˆÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ Ú·ÁÌ·ÙÔÔÈÂ›Ù·È Ì¤-

Ûˆ ÙË˜ ·Ó›¯ÓÂ˘ÛË˜ ÂÙÂÚÔ‰ÈÌÂÚÒÓ Ô˘ ‰ËÌÈÔ˘ÚÁÔ‡-

ÓÙ·È ÏfiÁˆ ÌË Û˘ÌÏËÚˆÌ·ÙÈÎÒÓ ‚¿ÛÂˆÓ ÛÙÔ ˘fi

ÌÂÏ¤ÙË ÙÌ‹Ì· ÙÔ˘ DNA. ∂ÈÚÔÛı¤Ùˆ˜, ÌÔÚÂ› Ó·

Ú·ÁÌ·ÙÔÔÈËıÂ› ‰È·¯ˆÚÈÛÌfi˜ ÌÂ ‚¿ÛË ÙÔ Ì‹ÎÔ˜

(fragment analysis), ÙËÓ ·Ó¿Ï˘ÛË Î·È ÙÔÓ Î·ı·ÚÈÛÌfi

ÔÏÈÁÔÓÔ˘ÎÏÂÔÙÈ‰›ˆÓ (Ôligonucleotide purification

and analysis). ∏ Â˘·ÈÛıËÛ›· ÙË˜ ·Ó›¯ÓÂ˘ÛË˜ ÌÂÙ·Ï-

Ï¿ÍÂˆÓ Î·È Ë ·ÎÚ›‚ÂÈ· ÙÔ˘ ·ÔÙÂÏ¤ÛÌ·ÙÔ˜ ·ÁÁ›˙ÂÈ

ÙÔ 100%, ÂÓÒ Ë ÂÏ¿¯ÈÛÙË ÔÛfiÙËÙ· ÙˆÓ ·ÓÙÈ‰Ú·ÛÙË-

Ú›ˆÓ Î·È ÙÔ ¯·ÌËÏfi ÎfiÛÙÔ˜ ÙÔ˘˜, ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ

ÙËÓ ·ÔÊ˘Á‹ ¯Ú‹ÛË˜ ÂÈÎ›Ó‰˘ÓˆÓ ¯ËÌÈÎÒÓ Ô˘ÛÈÒÓ,

Î·ıÈÛÙÔ‡Ó ÙË Ì¤ıÔ‰Ô ·˘Ù‹ ÌÈ· ·fi ÙÈ˜ Ï¤ÔÓ ‰È·‰Â-

‰ÔÌ¤ÓÂ˜ ÙÂ¯ÓÈÎ¤˜ ÌÔÚÈ·ÎÔ‡ ÂÏ¤Á¯Ô˘. Ã·Ú·ÎÙËÚÈÛÙÈ-

Îfi ·Ú¿‰ÂÈÁÌ· ÙË˜ ÂÊ·ÚÌÔÁ‹˜ ÙÔ˘ DHPLC ·ÔÙÂ-

ÏÂ› Ë ·Ó›¯ÓÂ˘ÛË ÌÂÙ·ÏÏ¿ÍÂˆÓ ÛÙ· 2 ÁÔÓ›‰È· Ô˘ ÂÓ¤-

¯ÔÓÙ·È ÛÙÔÓ Î·ÚÎ›ÓÔ ÙÔ˘ Ì·ÛÙÔ‡ Î·È ÙˆÓ ˆÔıËÎÒÓ,

BRCA1 Î·È BRCA2 (43,44).

ª¤ıÔ‰ÔÈ ̆ ‚ÚÈ‰ÔÔ›ËÛË˜: Southern Blotting Î·È

Northern Blotting

∆Ô Ê·ÈÓfiÌÂÓÔ ÙË˜ ˘‚ÚÈ‰ÔÔ›ËÛË˜, ‰ËÏ·‰‹ ÙË˜

‰˘Ó·ÙfiÙËÙ·˜ ÂÓfi˜ ÌÔÓfiÎÏˆÓÔ˘ ÌÔÚ›Ô˘ ÓÔ˘ÎÏÂ˚ÎÔ‡

ÔÍ¤Ô˜ Ó· Û¯ËÌ·Ù›˙ÂÈ ‰›ÎÏˆÓË ¤ÏÈÎ· ÌÂ ¤Ó· ¿ÏÏÔ ÌÔ-

ÓfiÎÏˆÓÔ ÌfiÚÈÔ, ·ÔÙÂÏÂ› ÙË ‚¿ÛË ÁÈ· ÔÏÏ¤˜ ÙÂ¯ÓÈ-

Î¤˜ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÙfiÛÔ ÛÙË ÌÔÚÈ·Î‹ ‰È¿-

ÁÓˆÛË, fiÛÔ Î·È ÛÙË ÁÂÓÂÙÈÎ‹ ÌË¯·ÓÈÎ‹. ªÂÙ·Í‡ ·˘-

ÙÒÓ Û˘ÌÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÔÈ ÙÂ¯ÓÈÎ¤˜ Southern Î·È

NÔrthern Blot.

Southern Blotting

∏ Ì¤ıÔ‰Ô˜ ÙÔ˘ Southern Blotting ‹ÚÂ ÙÔ fiÓÔÌ¿

ÙË˜ ·fi ÙÔÓ Edwin Southern Î·È ÌÔÚÂ› Ó· ‰È·¯ˆÚ›-

ÛÂÈ, ÌÂ ‚¿ÛË ÙÔ Ì¤ÁÂıÔ˜, Û˘ÁÎÂÎÚÈÌ¤Ó· ÙÌ‹Ì·Ù· ÁÂ-ÓˆÌÈÎÔ‡ ˘ÏÈÎÔ‡ ·fi ¤Ó· ÌÂ›ÁÌ· ÔÏÏÒÓ ‰È·ÊÔÚÂÙÈ-ÎÒÓ ÙÌËÌ¿ÙˆÓ (45). ∆Ô ÚÔ˜ ·Ó¿Ï˘ÛË DNA (.¯. ÙÔDNA ÂÓfi˜ ÔÚÁ·ÓÈÛÌÔ‡) Âˆ¿˙ÂÙ·È ÌÂ ÙË ¯Ú‹ÛË Â-ÚÈÔÚÈÛÙÈÎÔ‡ ÂÓ˙‡ÌÔ˘. °È· ¤Ó·Ó ÔÚÁ·ÓÈÛÌfi ÌÂ Û‡ÓıÂ-ÙÔ ÁÔÓÈ‰›ˆÌ·, ·˘Ù‹ Ë ¤„Ë ÌÔÚÂ› Ó· ‰ËÌÈÔ˘ÚÁ‹ÛÂÈÂÎ·ÙÔÌÌ‡ÚÈ· ‰È·ÊÔÚÂÙÈÎ¿ ÚÔ˚fiÓÙ· ÎÔ‹˜ (ÎÏ¿-ÛÌ·Ù· ÂÚÈÔÚÈÛÌÔ‡).

∆· ÚÔ˚fiÓÙ· ÙË˜ ¤„Ë˜ ‰È·¯ˆÚ›˙ÔÓÙ·È ÌÂ ËÏÂ-ÎÙÚÔÊfiÚËÛË ÛÂ ‹ÎÙˆÌ· ·Á·Úfi˙Ë˜. ªÂÙ¿ ÙËÓ ÔÏÔ-ÎÏ‹ÚˆÛË ÙË˜ ËÏÂÎÙÚÔÊfiÚËÛË˜ ÙÔ ‹ÎÙˆÌ· ÂÎÙ›ıÂ-Ù·È ÛÂ ˘ÂÚÈÒ‰Ë ·ÎÙÈÓÔ‚ÔÏ›· Î·È ÙÔ DNA ·ÂÈÎÔÓ›-˙ÂÙ·È ˆ˜ Û˘ÓÂ¯fiÌÂÓË Ù·ÈÓ›·. ¶ÚÔÎÂÈÌ¤ÓÔ˘ Ó· Á›ÓÔ˘ÓÂÌÊ·Ó‹ Ù· ‰È·ÊÔÚÂÙÈÎ¿ ıÚ·‡ÛÌ·Ù· Ô˘ ÚÔÎ‡-ÙÔ˘Ó ·fi ÙËÓ ¤„Ë, ÌÂÙ·Ê¤ÚÔÓÙ·È ÛÂ ıÂÙÈÎ¿ ÊÔÚ-ÙÈÛÌ¤ÓË ÌÂÌ‚Ú¿ÓË Ó¿ÈÏÔÓ ‹ ÓÈÙÚÔÎ˘ÙÙ·Ú›ÓË˜. ¶ÚÈÓÎ·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÌÂÙ·ÊÔÚ¿˜, ÙÔ ‹ÎÙˆÌ··Ú·Ì¤ÓÂÈ ÛÂ ·ÏÎ·ÏÈÎfi ‰È¿Ï˘Ì· ÚÔÎÂÈÌ¤ÓÔ˘ Ó··Ô‰È·Ù·¯ıÂ› ÙÔ DNA Î·È Ó· Á›ÓÂÈ ÌÔÓfiÎÏˆÓÔ. ∆ÔÊ›ÏÙÚÔ ÛÙË Û˘Ó¤¯ÂÈ· ˘‚ÚÈ‰›˙ÂÙ·È ÌÂ ÛËÌ·ÛÌ¤ÓÔ˘˜·ÓÈ¯ÓÂ˘Ù¤˜ Ô˘ Ê¤ÚÔ˘Ó ·ÏÏËÏÔ˘¯›Â˜ ÙÔ˘ ˘fi ‰ÈÂ-ÚÂ‡ÓËÛË ÁÔÓÈ‰›Ô˘, ÌÂ ·ÔÙ¤ÏÂÛÌ· ÙÔ ÌÔÓfiÎÏˆÓÔDNA ÙË˜ ÂÚÈÔ¯‹˜ ÙÔ˘ ÁÔÓÈ‰›Ô˘ Ó· ÛËÌ·›ÓÂÙ·È Î·È¿Ú· Ó· ·ÓÈ¯ÓÂ‡ÂÙ·È. ∆ÂÏÈÎ¿, Ë ÊˆÙÔÁÚ¿ÊËÛË ÌÂÊÈÏÌ ·ÎÙ›ÓˆÓ Ã ·ÔÎ·Ï‡ÙÂÈ Ù· ÛËÌ·ÛÌ¤Ó· ıÚ·‡-ÛÌ·Ù· (45) (∂ÈÎfiÓ· 10).

ªÂ ÙË Ì¤ıÔ‰Ô ·˘Ù‹ ÌÔÚÔ‡Ó Ó· ·ÓÈ¯ÓÂ˘ıÔ‡ÓÎ˘Ú›ˆ˜ ÌÔÚÈ·Î¤˜ ‚Ï¿‚Â˜ Ô˘ ·ÏÏÔÈÒÓÔ˘Ó ÙÔ Ì‹-ÎÔ˜ ÂÓfi˜ ÙÌ‹Ì·ÙÔ˜ DNA (.¯. ÂÏÏÂ›ÌÌ·Ù·, ‰ÈÏ·-ÛÈ·ÛÌÔ›), ·ÏÏ¿ fi¯È ÛËÌÂÈ·Î¤˜ ÌÂÙ·ÏÏ¿ÍÂÈ˜ . ∆Ë ÌÂ-Á·Ï‡ÙÂÚË ›Ûˆ˜ ·Í›· ÛÙËÓ ÎÏÈÓÈÎ‹ Ú¿ÍË Â›¯Â ËÂÊ·ÚÌÔÁ‹ ÙÔ˘ Southern Blotting ÁÈ· ÙËÓ ·Ó›¯ÓÂ˘ÛËÙˆÓ ÔÏ˘ÌÔÚÊÈÛÌÒÓ ÌÂÁ¤ıÔ˘˜ ÎÏ·ÛÌ¿ÙˆÓ ÂÚÈÔ-ÚÈÛÌÔ‡ (RFLP: Ê˘ÛÈÔÏÔÁÈÎ¿ ÎÏËÚÔÓÔÌÔ‡ÌÂÓÂ˜

112 ™. ªÂÁÚ¤ÌË˜, ∞. ¶¿Ì·ÓÔ˜


8

7

6

5

4

3

2

1

0

-1

3,94

4

4,61

2

8,24

8

4,41

2

mV

min765432

∂ÈÎfiÓ· 9. ŒÏÂÁ¯Ô˜ ÌÂÙ·ÏÏ¿ÍÂˆÓ ÌÂ ÙË Ì¤ıÔ‰Ô DHPLC.DHPLC: ∞Ô‰È·Ù·ÎÙÈÎ‹ ÃÚˆÌ·ÙÔÁÚ·Ê›· ÀÁÚ‹˜ º¿ÛË˜. ™‡ÁÎÚÈ-ÛË ‰Â›ÁÌ·ÙÔ˜ ̆ fi ÂÍ¤Ù·ÛË (Ú¿ÛÈÓÔ) ÌÂ ·ıÔÏÔÁÈÎfi ‰Â›ÁÌ· (Î·-Ê¤) ˆ˜ ÛËÌÂ›Ô ·Ó·ÊÔÚ¿˜. ∏ Î·Ì‡ÏË Ô˘ ˘Ô‰ÂÈÎÓ‡ÂÙ·È ·Ô ÙÔ‚¤ÏÔ˜ ·ÓÙÈÛÙÔÈ¯Â› ÛÙËÓ ¤ÎÏÔ˘ÛË ÙˆÓ ÂÙÂÚÔ‰ËÌÂÚÒÓ Ô˘ ‰ËÌÈ-Ô˘ÚÁÔ‡ÓÙ·È ÏfiÁˆ ÙË˜ ˘¿Ú¯Ô˘Û·˜ ÌÂÙ¿ÏÏ·ÍË˜.


ÔÈÎÈÏÔÌÔÚÊ›Â˜ ÎÔÓÙ¿ ÛÙÔÓ ˘fi ÌÂÏ¤ÙË ÁÂÓÂÙÈÎfiÙfiÔ, ÔÈ ÔÔ›Â˜ ÌÔÚÔ‡Ó Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó ÁÈ·ÙËÓ ÂÓÙfiÈÛË ÂÓfi˜ ÓÔÛÔÁfiÓÔ˘ ÁÔÓÈ‰›Ô˘, ·ÎfiÌ· Î·È fiÙ·Ó ‰ÂÓ ÌÔÚÂ› Ó· ·ÓÈ¯ÓÂ˘ıÂ› Ë Û˘ÁÎÂÎÚÈÌ¤ÓËÌÔÚÈ·Î‹ ‰È·Ù·Ú·¯‹) (46). ªÂ ÙËÓ ·Ó·Î¿Ï˘„Ë,fiÌˆ˜, ÙˆÓ ÚÔ·Ó·ÊÂÚı¤ÓÙˆÓ ÓÂfiÙÂÚˆÓ ÌÔÚÈ·ÎÒÓÙÂ¯ÓÈÎÒÓ, ÙÔ Southern Blotting Û·Ó›ˆ˜ Ï¤ÔÓ¯ÚËÛÈÌÔÔÈÂ›Ù·È, ÂÎÙfi˜ ·fi Î¿ÔÈÂ˜ ÂÚÈÙÒÛÂÈ˜∂˘ıÚ·‡ÛÙÔ˘ Ã.

Northern Blotting

ªÂ ÙË Ì¤ıÔ‰Ô ·˘Ù‹ ÂÈÙ˘Á¯¿ÓÂÙ·È Ë ·Ó›¯ÓÂ˘ÛËÛ˘ÁÎÂÎÚÈÌ¤ÓÔ˘ RNA ·fi ¤Ó· ÌÂ›ÁÌ· ‰È·ÊÔÚÂÙÈÎÒÓRNAs. ∞Ú¯ÈÎ¿ ÏfiÁˆ ·Ó·ÏÔÁ›·˜ Î·È ÔÌÔÈfiÙËÙ·˜ ÙË˜ÌÂıfi‰Ô˘ ÌÂ ÙÔ Southern µlotting Î·È ÌÂ ¯ÈÔ˘ÌÔÚÈÛÙÈ-Î‹ ‰È¿ıÂÛË ÙË˜ ·Â‰fiıË ÙÔ fiÓÔÌ· Northern µlotting,ÌÈ· ÔÓÔÌ·Û›· Ô‡ ÙÂÏÈÎ¿ ÂÈÎÚ¿ÙËÛÂ ‰ÈÂıÓÒ˜.

∆Ô ˘fi ÂÍ¤Ù·ÛË ‰Â›ÁÌ· RNA ˘Ê›ÛÙ·Ù·È ÂÂÍÂÚ-Á·Û›· ÌÂ Û˘ÁÎÂÎÚÈÌ¤ÓÂ˜ ¯ËÌÈÎ¤˜ Ô˘Û›Â˜ (.¯. ÊÔÚ-Ì·Ï‰Â˛‰Ë), ÂÈÙ˘Á¯¿ÓÔÓÙ·˜ ÙËÓ ·Ô‰È¿Ù·ÍË ÙˆÓ‰Â˘ÙÂÚÔÙ·ÁÒÓ ‰ÔÌÒÓ ÙÔ˘. T· ‰È·ÊÔÚÂÙÈÎ¿ ÌfiÚÈ·RNA ÙÔ˘ ÌÂ›ÁÌ·ÙÔ˜, ‰È·¯ˆÚ›˙ÔÓÙ·È ÌÂ ËÏÂÎÙÚÔÊfi-ÚËÛË ÌÂ ‚¿ÛË ÙÔ Ì¤ÁÂıfi˜ ÙÔ˘˜ Î·È ÌÂÙ·Ê¤ÚÔÓÙ·È ÛÂÊ›ÏÙÚÔ ÓÈÙÚÔÎ˘ÙÙ·Ú›ÓË˜. ™ÙË Û˘Ó¤¯ÂÈ·, ÙÔ Ê›ÏÙÚÔÂÎÙ›ıÂÙ·È ÛÂ ÛËÌ·ÛÌ¤ÓÔ ÂÎÎÈÓËÙ‹ DNA (probe) Î·È˘fiÎÂÈÙ·È ÛÂ Ú·‰ÈÔ·˘ÙÔÁÚ·Ê›·.

∏ ÙÂ¯ÓÈÎ‹ ¯ÚËÛÈÌÔÔÈÂ›Ù·È Â˘Ú‡Ù·Ù· ÁÈ· ÙË ÌÂ-Ï¤ÙË ÙË˜ ¤ÎÊÚ·ÛË˜ ÂÓfi˜ ÏËı˘ÛÌÔ‡ mRNA ÛÂ ‰È·-

ÊÔÚÂÙÈÎ¿ ÛÙ¿‰È· ·Ó¿Ù˘ÍË˜ ÙˆÓ ˘fi ÌÂÏ¤ÙË ÈÛÙÒÓ(.¯. mRNA ÙÔ˘ ÁÔÓÈ‰›Ô˘ ÙË˜ ‚-ÛÊ·ÈÚ›ÓË˜) (47,48).

∂›ÏÔÁÔ˜

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ÌÂ ÙÔ ÁÂÓÂÙÈÎfi Úfi‚ÏËÌ· ÛÙÈ˜ Î·Ù¿ÏÏËÏÂ˜ ˘ËÚÂ-Û›Â˜ ÎÏÈÓÈÎ‹˜ Î·È ÌÔÚÈ·Î‹˜ ÁÂÓÂÙÈÎ‹˜, ÒÛÙÂ ÂÁÎ·›-Úˆ˜ Î·È ̆ Â‡ı˘Ó· Ó· ÂÓËÌÂÚÒÓÔÓÙ·È ÁÈ· ÙÈ˜ ‰˘Ó·Ùfi-ÙËÙÂ˜ Ô˘ ÌÔÚÔ‡Ó Ó· ÙÔ˘˜ ÚÔÛÊÂÚıÔ‡Ó ÛÙ· Ï·›-ÛÈ· ÙË˜ ÌÔÚÈ·Î‹˜ ‰È¿ÁÓˆÛË˜.

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¶ÂÚ›ÏË„Ë: ∏ ÚÔÛ¿ıÂÈ· Ì›ÌËÛË˜ ÙÔ˘ ÌËÙÚÈÎÔ‡ Á¿Ï·ÎÙÔ˜ ÁÈ· ÙË ‰È·ÙÚÔÊ‹ ÙÔ˘ ‚Ú¤ÊÔ˘˜ Ô‰‹ÁËÛÂ ÛÂÛÔ‚·Ú¿ Ï¿ıË ÎÈ ·˘Ùfi ‰ÈfiÙÈ Ë Û‡ÛÙ·ÛË ÙÔ˘ ·ÓıÚˆ›ÓÔ˘ Á¿Ï·ÎÙÔ˜ ‰ÂÓ Â›Ó·È ÛÙ·ıÂÚ‹ Î·È ÂÍ¿ÏÏÔ˘ Ë ‚ÈÔ-‰È·ıÂÛÈÌfiÙËÙ· ÙˆÓ ‰È·ÊfiÚˆÓ Û˘ÛÙ·ÙÈÎÒÓ ÛÙÔ ÌËÙÚÈÎfi Á¿Ï· Â›Ó·È ‰È·ÊÔÚÂÙÈÎ‹ ·’ fi,ÙÈ ÛÙ· ÙÚÔÔÔÈË-Ì¤Ó· Á¿Ï·Ù·. ∏ ·ÚÔ‡Û· ·Ó·ÛÎfiËÛË ÂÈ¯ÂÈÚÂ› Ó· Ú›ÍÂÈ ÌÈ· ÎÚÈÙÈÎ‹ Ì·ÙÈ¿ ÛÂ ÔÚÈÛÌ¤Ó· ÓÂfiÙÂÚ· Û˘-ÛÙ·ÙÈÎ¿ ÙÔ˘ ÚÔÛ·ÚÌÔÛÌ¤ÓÔ˘ ÚÔ˜ ÙÔ ÌËÙÚÈÎfi Á¿Ï·, fiˆ˜ Â›Ó·È Ù· ÓÔ˘ÎÏÂÔÙ›‰È·, Ù· ÔÏ˘·ÎfiÚÂÛÙ· ÏÈ-·Ú¿ ÔÍ¤·, Ë ÁÏÔ˘Ù·Ì›ÓË, Ë ·ÚÁÈÓ›ÓË, Ë Î·ÚÓÈÙ›ÓË, Ô Û›‰ËÚÔ˜, Ù· ÚÂ‚ÈÔÙÈÎ¿, Ù· ÚÔ‚ÈÔÙÈÎ¿ Î·È Ù· Á¿-Ï·Ù· ˘„ËÏ‹˜ ıÚÂÙÈÎ‹˜ ·Í›·˜. ∞fi ÙË Û˘˙‹ÙËÛË ÚÔÎ‡ÙÂÈ fiÙÈ ÁÈ· ÔÚÈÛÌ¤ÓÂ˜ Ô˘Û›Â˜ ‰ÂÓ ˘¿Ú¯Ô˘ÓÂ·ÚÎ‹ ÛÙÔÈ¯Â›· Ô˘ Ó· ‰ÈÎ·ÈÔÏÔÁÔ‡Ó ÙËÓ ÚÔÛı‹ÎË ÙÔ˘˜. ø˜ ÂÎ ÙÔ‡ÙÔ˘, ÔÔÈ·‰‹ÔÙÂ ÙÚÔÔÔ›ËÛË ˆ˜ÚÔ˜ ÙË Û‡ÓıÂÛË ÙˆÓ ¯ÔÚËÁÔ‡ÌÂÓˆÓ Á·Ï¿ÙˆÓ ı· Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÌfiÓÔ ¤ÂÈÙ· ·fi ÂÓ‰ÂÏÂ¯Â›˜ ÎÏÈÓÈÎ¤˜ÌÂÏ¤ÙÂ˜, ÌÂ ÛÙfi¯Ô fi¯È ÌfiÓÔ Ù˘¯fiÓ ‚Ú·¯˘ÚfiıÂÛÌÔ fiÊÂÏÔ˜, ·ÏÏ¿ Î·È ÙËÓ Â˘ÓÔ˚Î‹ Â›ÙˆÛË ÂÓfi˜ Û˘ÁÎÂ-ÎÚÈÌ¤ÓÔ˘ ÙÚÔÊÈÎÔ‡ ·Ú¿ÁÔÓÙ· ÛÙË ÓÔËÙÈÎ‹ ÂÍ¤ÏÈÍË ÙÔ˘ ‚Ú¤ÊÔ˘˜, Î·ıÒ˜ Î·È ÛÂ ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù· ÙË˜ÂÓËÏ›ÎÔ˘ ˙ˆ‹˜.

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Û›‰ËÚÔ˜, ÚÂ‚ÈÔÙÈÎ¿, ÚÔ‚ÈÔÙÈÎ¿, Á¿Ï·Ù· ˘„ËÏ‹˜ ‰È·ÙÚÔÊÈÎ‹˜ ·Í›·˜.

New aspects of infant nutrition

C. Costalos

Abstract: Efforts to imitate human milk for feeding the infant led to serious miscalculations of the levelsof supplementation needed, with resultant dangers. As the exact content of human milk is difficult toestimate due to its wide fluctuations, only limited information can be deduced from measurement ofthe levels of specific components of human milk. In addition, there may be possible differences inbioavailability and substances other than components of human milk may be needed to achieve thedesired effect. This article provides a critical review of these factors, which include nucleotides,polyunsaturated fatty acids, glutamine, arginine, carnitine, iron, prebiotics, probiotics and high energyformulae. Following discussion of these nutrients, it is concluded that for some of them there isinsufficient data to justify their use and that there may even be potential dangers from their inclusion.Independent scientific bodies should evaluate any proposed modification of infant formulae beyondthe established standards before permission is given for introduction of such products into the market.It is important that such research considers not only the short-term effects of the nutrients on growth,but also safety aspects and the possibility of evaluating long-term effects on neurodevelopmentalachievement and the incidence of chronic diseases.

Key words: Infant nutrition, nucleotides, polyunsaturated fatty acids, glutamine, arginine, carnitine, iron,

prebiotics, probiotics, high energy formulae.

¡ÂÔÁÓÔÏÔÁÈÎfi ∆Ì‹Ì· ¶ÂÚÈÊÂÚÂÈ·ÎÔ‡ °ÂÓÈÎÔ‡¡ÔÛÔÎÔÌÂ›Ô˘“∞ÏÂÍ¿Ó‰Ú·” ∞ıËÓÒÓ


Ã. ∫ÒÛÙ·ÏÔ˜[email protected]¡ÂÔÁÓÔÏÔÁÈÎfi ∆Ì‹Ì·,¶ÂÚÈÊÂÚÂÈ·Îfi °ÂÓÈÎfi¡ÔÛÔÎÔÌÂ›Ô“∞ÏÂÍ¿Ó‰Ú·” ∞ıËÓÒÓ

Neonatal Unit, Alexandra Regional GeneralHospital, Athens, Greece

Correspondence:

C. Costalos [email protected] Unit, Alexandra Regional GeneralHospital, Athens, Greece

∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· Á›Ó·ÌÂ Ì¿ÚÙ˘ÚÂ˜ ÌÈ·˜ÌÂÙ·ÛÙÚÔÊ‹˜ ˆ˜ ÚÔ˜ ÙÔ˘˜ ÛÙfi¯Ô˘˜ ÙË˜ ‰È·-ÙÚÔÊ‹˜ ÙÔ˘ ‚Ú¤ÊÔ˘˜. EÓÒ ·Ï·ÈfiÙÂÚ· Ô Î‡ÚÈÔ˜ÛÙfi¯Ô˜ Î·Ù¿ ÙËÓ ·Ú·ÛÎÂ˘‹ ÂÓfi˜ ÚÔÛ·ÚÌÔ-ÛÌ¤ÓÔ˘ ÚÔ˜ ÙÔ ÌËÙÚÈÎfi Á¿Ï· ‹Ù·Ó Ë ·ÚÔ¯‹ÛˆÛÙ‹˜ ÔÛfiÙËÙ·˜ Î·È ·Ó·ÏÔÁ›·˜ ÌÂÁ·ÏÔÌÔ-ÚÈ·ÎÒÓ Û˘ÛÙ·ÙÈÎÒÓ, Û‹ÌÂÚ· Ë ¤ÚÂ˘Ó· ·Ô‚Ï¤-ÂÈ ÛÙÔÓ ÂÌÏÔ˘ÙÈÛÌfi ÙÔ˘ Á¿Ï·ÎÙÔ˜ ÌÂ ÂÈ‰ÈÎ¿Û˘ÛÙ·ÙÈÎ¿ ÙË˜ ÙÚÔÊ‹˜, Ù· ÔÔ›· ·ÓÈ¯ÓÂ‡ÔÓÙ·ÈÛÙÔ ÌËÙÚÈÎfi Á¿Ï· Î·È, ÂÎÙfi˜ ·fi ÙÈ˜ Î·ı·Ú¿‰È·ÙÚÔÊÈÎ¤˜ ÙÔ˘˜ ·Í›Â˜, ÂËÚÂ¿˙Ô˘Ó ÙË ÁÂÓÈÎfi-ÙÂÚË ˘ÁÂ›· ÙÔ˘ ·È‰ÈÔ‡. ŒÙÛÈ, Ë ‰È·›ÛÙˆÛË ÙË˜

·ÚÔ˘Û›·˜ ÛÙÔ ·ÓıÚÒÈÓÔ Á¿Ï· ·Ú¯ÈÎ¿ ÙË˜ Ù·˘-Ú›ÓË˜ Î·È ÛÙË Û˘Ó¤¯ÂÈ· ÙˆÓ ÓÔ˘ÎÏÂÔÙÈ‰›ˆÓ ÙˆÓÔÏ˘·ÎfiÚÂÛÙˆÓ ÏÈ·ÚÒÓ ÔÍ¤ˆÓ, ÙˆÓ ÚÂ‚ÈÔÙÈ-ÎÒÓ, ÙˆÓ ÚÔ‚ÈÔÙÈÎÒÓ, ÙË˜ ÁÏÔ˘Ù·Ì›ÓË˜, ÙË˜ ·Ú-ÁÈÓ›ÓË˜ Ô‰‹ÁËÛÂ ÛÙËÓ ÚÔÛı‹ÎË ÙˆÓ Ô˘ÛÈÒÓ ·˘-ÙÒÓ ÛÙ· ÙÚÔÔÔÈËÌ¤Ó· Á¿Ï·Ù·. ¶·Ú¿ ÙÈ˜ ÊÈÏfi-ÙÈÌÂ˜ ÚÔÛ¿ıÂÈÂ˜, Î·Ó¤Ó· ÚÔÛ·ÚÌÔÛÌ¤ÓÔÚÔ˜ ÙÔ ÌËÙÚÈÎfi Á¿Ï· ‰ÂÓ ÌÔÚÂ› Ó· ¤¯ÂÈ ÙÈ˜È‰ÈfiÙËÙÂ˜ ÙÔ˘ ·ÓıÚˆ›ÓÔ˘, ÎÈ ·˘Ùfi ÁÈ·Ù› Ë Û‡Ó-ıÂÛË ÙÔ˘ ÌËÙÚÈÎÔ‡ Á¿Ï·ÎÙÔ˜ ‰ÂÓ Â›Ó·È ÛÙ·ıÂÚ‹,·ÏÏ¿ ÌÂÙ·‚¿ÏÏÂÙ·È ÌÂ ÙËÓ ¿ÚÔ‰Ô ÙÔ˘ ¯ÚfiÓÔ˘.ŒÙÛÈ, Â›Ó·È ‰‡ÛÎÔÏÔ˜ Ô ·ÎÚÈ‚‹˜ ˘ÔÏÔÁÈÛÌfi˜


117¢È·ÙÚÔÊ‹ ÙÔ˘ ‚Ú¤ÊÔ˘˜

¶·È‰È·ÙÚÈÎ‹ 2008;71:116-122

ÙË˜ ··ÈÙÔ‡ÌÂÓË˜ ÔÛfiÙËÙ·˜ ÁÈ· Î¿ıÂ ÛÙÔÈ¯Â›Ô. ∏

‚ÈÔ‰È·ıÂÛÈÌfiÙËÙ· ÂÍ¿ÏÏÔ˘ Î·È Ë Â›‰Ú·ÛË ÛÙÔ ÌÂ-

Ù·‚ÔÏÈÛÌfi Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ Ô˘ÛÈÒÓ ÌÔÚÂ› Ó· Â›Ó·È

‰È·ÊÔÚÂÙÈÎ‹ ÛÙÔ ÌËÙÚÈÎfi Á¿Ï· ·’ fi,ÙÈ ÛÙÔ Í¤ÓÔ

Á¿Ï·. ∆Ô ÌËÙÚÈÎfi Á¿Ï· ÂÚÈ¤¯ÂÈ Ï‹ıÔ˜ ÔÚÌÔÓÒÓ

Î·È ·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ Ô˘ ÌÔÚÂ› Ó· Â˘Ô‰Ò-

ÓÔ˘Ó ‹ Ó· ÂÚÈÔÚ›˙Ô˘Ó ÙË ‰Ú¿ÛË ÌÈ·˜ Û˘ÁÎÂÎÚÈÌ¤-

ÓË˜ Ô˘Û›·˜, ÁÂÁÔÓfi˜ Ô˘ ‰ÂÓ Û˘Ì‚·›ÓÂÈ ÌÂ ÙÔ Í¤ÓÔ

Á¿Ï·. ™ÙËÓ Ú¿ÍË ·Ô‰Â›¯ıËÎÂ fiÙÈ Ù· ÔÏ˘‰È·ÊË-

ÌÈ˙fiÌÂÓ· ÔÊ¤ÏË ÁÈ· ÔÏÏ¤˜ Ô˘Û›Â˜ Â›Ó·È ·Ó‡·Ú-

ÎÙ· ‹ ÛÙËÓ Î·Ï‡ÙÂÚË ÂÚ›ÙˆÛË ÔÚÈ·Î¿, ÂÓÒ

˘¿Ú¯Ô˘Ó Î·È Î›Ó‰˘ÓÔÈ ·fi ÙËÓ ·ÓÂÍ¤ÏÂÁÎÙË ¯Ú‹-

ÛË ÙÔ˘˜. ™ÙË Û˘Ó¤¯ÂÈ· ı· ÚÔÛ·ı‹ÛÔ˘ÌÂ Ó· Î¿-

ÓÔ˘ÌÂ ÌÈ· ·ÓÙÈÎÂÈÌÂÓÈÎ‹ ·ÍÈÔÏfiÁËÛË Î¿ıÂ ÌÈ·˜ ·fi

·˘Ù¤˜ ÙÈ˜ Ô˘Û›Â˜.

¡Ô˘ÎÏÂÔÙ›‰È· (¡∫)

∞ÔÙÂÏÔ‡Ó Úfi‰ÚÔÌÂ˜ Ô˘Û›Â˜ ÙÔ˘ RNA Î·È ÙÔ˘

DNA. £ÂˆÚÔ‡ÓÙ·È ··Ú·›ÙËÙ· ÛÙËÓ ·‡ÍËÛË Î·È

ÙËÓ ˆÚ›Ì·ÓÛË ÙÔ˘ ÂÙÈÎÔ‡, ÛÙË ‚ÂÏÙ›ˆÛË ÙË˜

ÂÓÙÂÚÈÎ‹˜ ¯ÏˆÚ›‰·˜, ÛÙËÓ ÂÓ›Û¯˘ÛË ÙÔ˘ ·ÓÔÛÔÔÈ-

ËÙÈÎÔ‡, ÛÙË ÌÂ›ˆÛË ÙË˜ Á·ÛÙÚÂÓÙÂÚ›ÙÈ‰·˜ Î·È ÙˆÓ

ÏÔÈÌÒÍÂˆÓ ÁÂÓÈÎfiÙÂÚ·, Î·ıÒ˜ Î·È ÛÙË ÛˆÌ·ÙÈÎ‹

·‡ÍËÛË ÓÂÔÁÓÒÓ ÌÂ ÂÓ‰ÔÌ‹ÙÚÈ· Î·ı˘ÛÙ¤ÚËÛË ÛÙËÓ

·Ó¿Ù˘ÍË (1).

∞. ∂›‰Ú·ÛË ÛÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ ÂÙÈÎÔ‡

£ÂÙÈÎ‹ Â›‰Ú·ÛË ÙˆÓ ¡∫ ÛÙÔ ÂÙÈÎfi ‚Ú¤ıËÎÂ

ÛÂ ÌÂÏ¤ÙË Ô˘ ¤ÁÈÓÂ ÛÂ ÔÓÙ›ÎÈ· Ô˘ ¤Ï·‚·Ó 2 ÙÚÔ-

Ê¤˜, ÂÎ ÙˆÓ ÔÔ›ˆÓ Ë Ì›· ÂÚÈÂ›¯Â ¡∫ Î·È Ë ¿ÏÏË

‰ÂÓ ÂÚÈÂ›¯Â Î·ıfiÏÔ˘ ¡∫. ™ÙËÓ Ú¿ÍË, fiÌˆ˜, ‰ÂÓ

˘¿Ú¯ÂÈ Î·Ó¤Ó· Á¿Ï· Ô˘ Ó· ÌËÓ ÂÚÈ¤¯ÂÈ Î·ıfiÏÔ˘

¡∫. ∂›ÛË˜, ÂÓÒ ÛÙËÓ ÔÌ¿‰· ÙˆÓ ÔÓÙÈÎÒÓ Ô˘

¤Ï·‚Â Á¿Ï· ÂÌÏÔ˘ÙÈÛÌ¤ÓÔ ÌÂ ÓÔ˘ÎÏÂÔÙ›‰È· ·Ú·-

ÙËÚ‹ıËÎÂ ÌÂÁ·Ï‡ÙÂÚË ·‡ÍËÛË ÙË˜ ÂÚÈÂÎÙÈÎfiÙËÙ·˜

ÙÔ˘ ÙÔÈ¯ÒÌ·ÙÔ˜ ÙÔ˘ ·ÓÒÙÂÚÔ˘ ÂÓÙ¤ÚÔ˘, ÂÓÒ ·Ú·-

‰fiÍˆ˜ ÛÂ ÚˆÙÂ˝ÓË ‰ÂÓ ·Ú·ÙËÚ‹ıËÎÂ Î·Ì›· ‰È·-

ÊÔÚ¿ ÛÙÔ Ì¤ÛÔ Î·È ÙÔ ÙÂÏÈÎfi ÙÌ‹Ì· ÙÔ˘ ÂÓÙ¤ÚÔ˘ (2).

ŒÙÛÈ, ¯ÚÂÈ¿˙ÔÓÙ·È ÂÈÏ¤ÔÓ ÌÂÏ¤ÙÂ˜ ÁÈ· ÙËÓ ÂÈ‚Â-

‚·›ˆÛË ÙˆÓ ·Ú·¿Óˆ.

µ. ∂ÓÙÂÚÈÎ‹ ̄ ÏˆÚ›‰·

∂˘ÓÔ˚Î¿ ·ÔÙÂÏ¤ÛÌ·Ù· ÙˆÓ ¡∫ ·Ó·Ê¤ÚÔÓÙ·È ÛÂ

ÌÈ· ÌÂÏ¤ÙË, fiÔ˘ Û˘ÁÎÚ›ıËÎÂ ÌÈ· ÔÌ¿‰· ÓÂÔÁÓÒÓ

Ô˘ ¤·ÈÚÓÂ Á¿Ï· ÂÌÏÔ˘ÙÈÛÌ¤ÓÔ ÌÂ ¡∫ ÌÂ ¿ÏÏË

Ô˘ ¤·ÈÚÓÂ Á¿Ï· ¯ˆÚ›˜ ¡∫. ∏ ÌÂÏ¤ÙË ÂÚÈÂ›¯Â ÌÈ-

ÎÚfi ·ÚÈıÌfi Û˘ÌÌÂÙÂ¯fiÓÙˆÓ ¯ˆÚ›˜ ÛˆÛÙ‹ Ù˘¯·ÈÔÔ›-

ËÛË. ¢ÂÓ ‚Ú¤ıËÎÂ ÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿ ˆ˜ ÚÔ˜ ÙÔÓ

·fiÏ˘ÙÔ ·ÚÈıÌfi ÙˆÓ ·ÔÈÎÈÒÓ ÙˆÓ ÌÈÎÚÔ‚›ˆÓ ÛÙ·

ÎfiÚ·Ó·. ªfiÓÔ fiÙ·Ó ¤ÁÈÓÂ Û‡ÁÎÚÈÛË ÌÂÙ·Í‡ ÙˆÓ

ÔÛÔÛÙÒÓ Î¿ıÂ ÌÈÎÚÔ‚›Ô˘ ÛÙ· ÎfiÚ·Ó· ‚Ú¤ıËÎÂ

Î¿ÔÈ· ‰È·ÊÔÚ¿ (3). ™Ù· ›‰È· Û˘ÌÂÚ¿ÛÌ·Ù· Î·Ù·-

Ï‹ÁÂÈ Î·È ÈÔ ÚfiÛÊ·ÙË ÌÂÏ¤ÙË (4).

°. ∂›‰Ú·ÛË ÛÙÔ ·ÓÔÛÔÔÈËÙÈÎfi

∞Ó Î·È ·Ó·Ê¤ÚıËÎÂ ‚ÂÏÙ›ˆÛË ÙË˜ ÏÂÈÙÔ˘ÚÁ›·˜

ÙˆÓ Ê˘ÛÈÎÒÓ Î˘ÙÙ·ÚÔÎÙfiÓˆÓ Î˘ÙÙ¿ÚˆÓ (¡∫ cells)

Î·È ˘„ËÏfiÙÂÚÔÈ Ù›ÙÏÔÈ ·ÓÙÈÛˆÌ¿ÙˆÓ Î·Ù¿ ÙÔ˘ ·ÈÌfi-

ÊÈÏÔ˘ ÙË˜ ÈÓÊÏÔ˘¤ÓÙ˙·˜ Î·È ÙË˜ ‰ÈÊıÂÚ›ÙÈ‰·˜ ÌÂÙ¿

·fi ÂÌ‚ÔÏÈ·ÛÌfi ÛÙÔ˘˜ 2 Ì‹ÓÂ˜ ˙ˆ‹˜ ÛÂ ‚Ú¤ÊË Ô˘

¤Ï·‚·Ó Á¿Ï· ÂÌÏÔ˘ÙÈÛÌ¤ÓÔ ÌÂ ¡∫, ‰ÂÓ ˘‹Ú¯Â Î·-

Ì›· ‰È·ÊÔÚ¿ ÛÙËÓ ËÏÈÎ›· ÙˆÓ 4 ÌËÓÒÓ (5) ÛÂ Û¯¤ÛË

ÌÂ ÙÔ˘˜ Ì¿ÚÙ˘ÚÂ˜. ¢ÂÓ ·Ú·ÙËÚ‹ıËÎÂ Â›ÛË˜ ÛËÌ·-

ÓÙÈÎ‹ ‰È·ÊÔÚ¿ ̂ ˜ ÚÔ˜ ÙË Û˘¯ÓfiÙËÙ· ‹ ÙË ‚·Ú‡ÙËÙ·

ÙˆÓ ÏÔÈÌÒÍÂˆÓ ÌÂÙ·Í‡ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ.

¢. ¢È¿ÚÚÔÈ·-ÏÔÈÌÒÍÂÈ˜

∞Ó Î·È ÔÈ ÚÒÙÂ˜ ÌÂÏ¤ÙÂ˜ ÛÂ ÂÈÚ·Ì·Ùfi˙ˆ· ¤‰ÂÈ-

Í·Ó Î·Ï‡ÙÂÚË ÂÔ‡ÏˆÛË ÙÔ˘ ‚ÏÂÓÓÔÁfiÓÔ˘ ÙÔ˘ ÂÓÙ¤-

ÚÔ˘ ÌÂÙ¿ ·fi ÚÔÎÏËÙ‹ ‚Ï¿‚Ë (2) ÌÂÙ¿ ÙË ¯ÔÚ‹ÁË-

ÛË ¡∫, ÎÏÈÓÈÎ‹ ÌÂÏ¤ÙË ÛÂ ·È‰È¿ ‰ÂÓ ¤‰ÂÈÍÂ ÛËÌ·-

ÓÙÈÎ‹ ‰È·ÊÔÚ¿ ÛÙÔ Û˘ÓÔÏÈÎfi ·ÚÈıÌfi ÙˆÓ ÂÂÈÛÔ‰›ˆÓ

‰È¿ÚÚÔÈ·˜ Î·È ÙË ¯ÚÔÓÈÎ‹ ‰È¿ÚÎÂÈ· Î¿ıÂ ÂÂÈÛÔ‰›Ô˘.

¢ÂÓ ·Ú·ÙËÚ‹ıËÎÂ Â›ÛË˜ ‰È·ÊÔÚ¿ ˆ˜ ÚÔ˜ ÙË Û˘-

¯ÓfiÙËÙ· ÙˆÓ ÏÔÈÌÒÍÂˆÓ ÙÔ˘ ·ÓˆÙ¤ÚÔ˘ Î·È ÙÔ˘ Î·-

ÙˆÙ¤ÚÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡, ÙÔ˘ ‰¤ÚÌ·ÙÔ˜, ÙÔ˘ ÔÊı·Ï-

ÌÔ‡ Î·È ÙË˜ ·Ú·ÌÔÓ‹˜ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô ÛÂ Û¯¤ÛË ÌÂ

Ì¿ÚÙ˘ÚÂ˜ (6).

∂. ∂›‰Ú·ÛË ÛÙË ÛˆÌ·ÙÈÎ‹ ·‡ÍËÛË

ªÈ· ÌÂÏ¤ÙË ¤‰ÂÈÍÂ Î·Ï‡ÙÂÚË ·ÓÙÈÚÚÔÈÛÙÈÎ‹ ·‡-

ÍËÛË ÛÂ ÙÂÏÂÈfiÌËÓ· ÌÂ ÂÓ‰ÔÌ‹ÙÚÈ· Î·ı˘ÛÙ¤ÚËÛË

ÙË˜ ·Ó¿Ù˘ÍË˜ (7) ÌÂÙ¿ ÙË Ï‹„Ë ¡∫. ÕÏÏÂ˜ ÌÂÏ¤ÙÂ˜

‰ÂÓ ÂÈ‚Â‚·›ˆÛ·Ó ·˘Ù‹ ÙËÓ ¿Ô„Ë (8,9). À„ËÏ¤˜

‰fiÛÂÈ˜ ¡∫ ‚Ú¤ıËÎÂ fiÙÈ ·˘Í¿ÓÔ˘Ó ÙÔÓ Î›Ó‰˘ÓÔ ·Ó·-

ÓÂ˘ÛÙÈÎÒÓ ÏÔÈÌÒÍÂˆÓ (10). ¢ÈÎ‹ Ì·˜ Ù˘¯·ÈÔÔÈË-

Ì¤ÓË Ù˘ÊÏ‹ ÌÂÏ¤ÙË ‰ÂÓ ¤‰ÂÈÍÂ Â›‰Ú·ÛË ÙˆÓ ÓÔ˘-

ÎÏÂÔÙÈ‰›ˆÓ ÛÙËÓ ·ÔÚÚfiÊËÛË Ï›Ô˘˜ Î·È ˘‰·Ù·Ó-

ıÚ¿ÎˆÓ Ô‡ÙÂ Î·È ÌÂ›ˆÛË ÙÔ˘ ÏËı˘ÛÌÔ‡ ÙˆÓ ÂÓÙÂ-

ÚÔ·ıÔÁfiÓˆÓ ÛÙ· ÎfiÚ·Ó· (11). ªÈ· Èı·Ó‹ ÂÍ‹ÁË-

ÛË ÙË˜ ÌË ·ÓÂ‡ÚÂÛË˜ ıÂÙÈÎÔ‡ ·ÔÙÂÏ¤ÛÌ·ÙÔ˜ ›Ûˆ˜

Ó· Â›Ó·È fiÙÈ Ë ÌÂÏ¤ÙË ‰ÂÓ ÂÚÈÂÏ¿Ì‚·ÓÂ Â·ÚÎ‹

·ÚÈıÌfi ÓÂÔÁÓÒÓ ÌÂ ÂÓ‰ÔÌ‹ÙÚÈ· ‰˘ÛÙÚÔÊ›·, Ù·

ÔÔ›·, Î·Ù¿ ÙË ÁÓÒÌË Ì·˜, ı· ˆÊÂÏÔ‡ÓÙ·Ó ÂÚÈÛÛfi-

ÙÂÚÔ ·fi ÙËÓ ÚÔÛı‹ÎË ÙˆÓ ÓÔ˘ÎÏÂÔÙÈ‰›ˆÓ.

¶ÔÏ˘·ÎfiÚÂÛÙ· ÏÈ·Ú¿ ÔÍ¤· (¶∞§√)

∞ÔÙÂÏÔ‡Ó Úfi‰ÚÔÌÂ˜ Ô˘Û›Â˜ ÚÔÛÙ·ÁÏ·Ó‰È-

ÓÒÓ, ÚÔÛÙ·Î˘ÎÏ›ÓË˜, ıÚÔÌ‚ÔÍ¿ÓË˜, ÏÂ˘ÎÔÙÚÈÂÓ›ˆÓ

Î·È ıÂˆÚÔ‡ÓÙ·È ··Ú·›ÙËÙ· ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘

ÓÂÔÁÓÈÎÔ‡ ÂÁÎÂÊ¿ÏÔ˘ Î·È ÙË˜ ÔÙÈÎ‹˜ ÏÂÈÙÔ˘ÚÁ›·˜.

¶·›˙Ô˘Ó ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ·Ó¿Ù˘ÍË ÙˆÓ ÓÂ˘ÚÈ-

ÎÒÓ Û˘Ó¿„ÂˆÓ (12-14). ∂È‰ÚÔ‡Ó, Â›ÛË˜, ÛÙÔ ·ÓÔ-

ÛÔÔÈËÙÈÎfi, ÙË ÊÏÂÁÌÔÓÒ‰Ë ·ÓÙ›‰Ú·ÛË, ÙÔ ÌÂÙ·‚Ô-

ÏÈÛÌfi ÙˆÓ ÔÛÙÒÓ (15).

∞Ó¿ÏÔÁ· ÌÂ ÙË ı¤ÛË ÙÔ˘ ÚÒÙÔ˘ ‰ÈÏÔ‡ ‰ÂÛÌÔ‡

·fi ÙÔ ÌÂı˘ÏÈÎfi ¿ÎÚÔ ‰È·ÎÚ›ÓÔÓÙ·È ÛÂ ˆ-3 Î·È ˆ-6.


∆· Î˘ÚÈfiÙÂÚ· Â›Ó·È ÙÔ ·Ú·¯È‰ÔÓÈÎfi Î·È ÙÔ 22-ÂÍ·ÓÔ˚-

Îfi ÔÍ‡ (DHA). ∞ÔÙÂÏÔ‡Ó Û˘ÛÙ·ÙÈÎfi ÙË˜ Î˘ÙÙ·ÚÈ-

Î‹˜ ÌÂÌ‚Ú¿ÓË˜, Ë ÔÔ›· Â›Ó·È Â˘·ı‹˜ ÛÂ ÔÍÂÈ‰ˆÙÈ-

Î‹ ‰Ú¿ÛË ÂÏÂ‡ıÂÚˆÓ ÚÈ˙ÒÓ ÔÍ˘ÁfiÓÔ˘. ÀÂÚ‚ÔÏÈÎ‹

¯ÔÚ‹ÁËÛË ¶∞§√ ·˘Í¿ÓÂÈ ÙËÓ ·ÈÌfiÏ˘ÛË ÂÚ˘ıÚÒÓ ·È-

ÌÔÛÊ·ÈÚ›ˆÓ, ÂÈÙÂ›ÓÂÈ ÙËÓ ˘ÂÚÔÍÈÎ‹ ‚Ï¿‚Ë ÙˆÓ

ÓÂ˘ÌfiÓˆÓ Î·È ÙË ÊˆÙÔÙÔÍÈÎ‹ ‚Ï¿‚Ë ÙˆÓ Ú·‚‰›ˆÓ

ÙÔ˘ ·ÌÊÈ‚ÏËÛÙÚÔÂÈ‰Ô‡˜, ÚÔ‰È·ı¤ÙÔÓÙ·˜ ›Ûˆ˜ ÛÂ

˘„ËÏfiÙÂÚ· ÔÛÔÛÙ¿ ¯ÚfiÓÈ·˜ ÓÂ˘ÌÔÓÔ¿ıÂÈ·˜

(Ã¶), ÓÂÎÚˆÙÈÎ‹˜ ÂÓÙÂÚÔÎÔÏ›ÙÈ‰·˜ (¡∂∫), ·ÌÊÈ-

‚ÏËÛÙÚÔÂÈ‰Ô¿ıÂÈ·˜ ÙË˜ ÚÔˆÚfiÙËÙ·˜ (∞¶) (16).

¶ÚfiˆÚ· Ô˘ ¤Ï·‚·Ó È¯ı˘¤Ï·ÈÔ Â›¯·Ó ¯·ÌËÏfiÙÂÚË

·‡ÍËÛË ÙÔ˘ ÛˆÌ·ÙÈÎÔ‡ ÙÔ˘˜ ‚¿ÚÔ˘˜ ÛÂ Û¯¤ÛË ÌÂ

Ì¿ÚÙ˘ÚÂ˜ (17). ∞˘Ùfi ÔÊÂÈÏfiÙ·Ó ÛÂ ·ÚÂÌfi‰ÈÛË

·fi Ù· ˆ-3 ÏÈ›‰È· ÙË˜ ÌÂÙ·ÙÚÔ‹˜ ÙÔ˘ ÏÈÓÔÏÂ˚ÎÔ‡

ÔÍ¤Ô˜ ÛÂ ·Ú·¯È‰ÔÓÈÎfi. ªÂ ‚¿ÛË ·˘Ù¿, Ë ∂˘Úˆ·˚Î‹

∂Ù·ÈÚÂ›· ¶·È‰È·ÙÚÈÎ‹˜ °·ÛÙÚÂÓÙÂÚÔÏÔÁ›·˜, ∏·ÙÔ-

ÏÔÁ›·˜ Î·È ¢È·ÙÚÔÊ‹˜ ÚÔÙÂ›ÓÂÈ Ë ÔÛfiÙËÙ· ÙÔ˘

DHA ÛÙÔ ÚÔÛ·ÚÌÔÛÌ¤ÓÔ ÚÔ˜ ÙÔ ÌËÙÚÈÎfi Á¿Ï· Ó·

ÌËÓ ˘ÂÚ‚·›ÓÂÈ ÙÔ 0,5% ÙÔ˘ Û˘ÓÔÏÈÎÔ‡ Ï›Ô˘˜ Î·È Ë

ÂÚÈÂÎÙÈÎfiÙËÙ· ÛÂ ∞∞ Ó· Â›Ó·È ÙÔ˘Ï¿¯ÈÛÙÔÓ ›ÛË ÌÂ

·˘Ù‹ ÙÔ˘ DHA (18).

∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÔÏÔ¤Ó· Î·È ÂÚÈÛÛfiÙÂÚÂ˜

‚ÈÔÌË¯·Ó›Â˜ ·Ú·ÛÎÂ˘‹˜ ‚ÚÂÊÈÎÒÓ Á·Ï¿ÙˆÓ ÚÔ-

Ûı¤ÙÔ˘Ó ¶∞§√ ÛÙ· ÚÔ˚fiÓÙ· ÙÔ˘˜. Œ¯Ô˘Ó Á›ÓÂÈ ÔÏ-

Ï¤˜ ÌÂÏ¤ÙÂ˜ ÙfiÛÔ ÛÂ ÚfiˆÚ· fiÛÔ Î·È ÛÂ ÙÂÏÂÈfiÌËÓ·

ÓÂÔÁÓ¿ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÛÙË ¯Ú‹ÛË ÙˆÓ ¶∞§√ Î·-

Ù¿ ÙË ‚ÚÂÊÈÎ‹ ÂÚ›Ô‰Ô Î·È Ù· Û˘ÌÂÚ¿ÛÌ·Ù· Â›Ó·È

·ÓÙÈÊ·ÙÈÎ¿. £· ÛÙ·¯˘ÔÏÔÁ‹ÛÔ˘ÌÂ ÌÂÚÈÎ¤˜ ·fi ·˘-

Ù¤˜ ÙÈ˜ ÌÂÏ¤ÙÂ˜.

ªÂÏ¤ÙÂ˜ ÛÂ ÚfiˆÚ· ÓÂÔÁÓ¿

ªÂÁ¿ÏË ÚfiÛÊ·ÙË ·Ó·ÛÎfiËÛË Ô˘ Û˘ÌÂÚÈ¤-

Ï·‚Â 11 ÌÂÏ¤ÙÂ˜ ¤‰ÂÈÍÂ fiÙÈ Ë ÚÔÛı‹ÎË ¶∞§√ ÛÂ

ÚfiˆÚ· ‰ÂÓ Â›¯Â Î·Ì›· ıÂÙÈÎ‹ Â›‰Ú·ÛË ÛÙË ÛˆÌ·-

ÙÈÎ‹ Î·È ÓÔËÙÈÎ‹ ÂÍ¤ÏÈÍ‹ ÙÔ˘˜ (19). √È ÌÂÏ¤ÙÂ˜ ‰ÂÓ

ÂÚÈÂÏ¿Ì‚·Ó·Ó fiÌˆ˜ ÓÂÔÁÓ¿ ÌÂ ÂÍ·ÈÚÂÙÈÎ¿ ¯·ÌËÏfi

‚¿ÚÔ˜ Á¤ÓÓËÛË˜. ÕÏÏË Ù˘¯·ÈÔÔÈËÌ¤ÓË ÌÂÏ¤ÙË

¤‰ÂÈÍÂ fiÙÈ Ë ÚÔÛı‹ÎË ¶∞§√ ÛÙË ‰È·ÙÚÔÊ‹ ÚÔÒ-

ÚˆÓ Ô‰‹ÁËÛÂ ÛÂ Î·Ï‡ÙÂÚË ·Ó¿Ù˘ÍË ÛÂ ‚¿ÚÔ˜ Î·È

Ì‹ÎÔ˜ ÛÙËÓ ËÏÈÎ›· ÙˆÓ 9 ÌËÓÒÓ. ∆· ·ÁfiÚÈ· ÙË˜ ÌÂ-

Ï¤ÙË˜ Â›¯·Ó ÛÙÔ˘˜ 18 Ì‹ÓÂ˜ ˙ˆ‹˜ ˘„ËÏfiÙÂÚÔ ÓÔËÙÈ-

Îfi ‰Â›ÎÙË ÛÂ Û¯¤ÛË ÌÂ ÙÔ˘˜ Ì¿ÚÙ˘ÚÂ˜ (20). ÕÏÏË

ÌÂÏ¤ÙË ¤‰ÂÈÍÂ ¿ÏÈ fiÙÈ ÚfiˆÚ· Ô˘ ¤Ï·‚·Ó ¶∞§√

Â›¯·Ó ÛÙË ‰ÈÔÚıˆÌ¤ÓË ËÏÈÎ›· ÙˆÓ 18 ÌËÓÒÓ ˘„ËÏfi-

ÙÂÚÔ˘˜ ‰Â›ÎÙÂ˜ ÓÔËÌÔÛ‡ÓË˜ Û‡ÌÊˆÓ· ÌÂ ÙËÓ ÎÏ›Ì·-

Î· Bayley (21).

ªÂÏ¤ÙÂ˜ ÛÂ ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿

√È ÌÂÏ¤ÙÂ˜ Ô˘ ¤ÁÈÓ·Ó ÛÂ ÙÂÏÂÈfiÌËÓ· ¤‰ÂÈÍ·Ó

·ÓÙÈÊ·ÙÈÎ¿ ·ÔÙÂÏ¤ÛÌ·Ù·. ªÂÁ¿ÏË ·Ó·ÛÎfiËÛË

Ô˘ ÂÚÈÂÏ¿Ì‚·ÓÂ 10 ÎÏÈÓÈÎ¤˜ ÌÂÏ¤ÙÂ˜ ‰ÂÓ ¤‰ÂÈÍÂ

Î·Ó¤Ó· fiÊÂÏÔ˜ ·fi ÙË ̄ Ú‹ÛË ÙˆÓ ¶∞§√ (22). ™Â ¿Ï-

ÏË ·Ó·ÛÎfiËÛË ¿ÏÈ ‚Ú¤ıËÎÂ fiÙÈ Ô ÂÌÏÔ˘ÙÈÛÌfi˜ ÌÂ

¶∞§√ Â›¯Â ıÂÙÈÎ‹ ‰Ú¿ÛË ÛÙËÓ ÔÙÈÎ‹ ÔÍ‡ÙËÙ· ÓÂÔ-

ÁÓÒÓ ÛÙÔ 2Ô Ì‹Ó· ˙ˆ‹˜ (23). À¿Ú¯ÂÈ, fiÌˆ˜, Î·È ÌÂ-

Ï¤ÙË Ô˘ ‰Â›¯ÓÂÈ ¯ÂÈÚfiÙÂÚË ÓÔËÙÈÎ‹ ¤Î‚·ÛË ÛÙËÓ

ËÏÈÎ›· ÙˆÓ 39 ÌËÓÒÓ ÛÂ Û‡ÁÎÚÈÛË ÌÂ Ì¿ÚÙ˘ÚÂ˜ (24).

Ÿˆ˜ ·Ó·Ê¤ÚÂÈ Ë Fewtrell (25), ÌÂÚÈÎÔ› ·fi ÙÔ˘˜

ÏfiÁÔ˘˜, ÁÈ· ÙÔ˘˜ ÔÔ›Ô˘˜ Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÙˆÓ ÎÏÈ-

ÓÈÎÒÓ ÌÂÏÂÙÒÓ ¿Óˆ ÛÙ· ¶∞§√ Â›Ó·È ·ÓÙÈÊ·ÙÈÎ¿, Â›-

Ó·È ÔÈ ÂÍ‹˜: ·) √È ÂÏ¿¯ÈÛÙÂ˜ ·Ó·ÁÎ·›Â˜ ËÌÂÚ‹ÛÈÂ˜

·Ó¿ÁÎÂ˜ ‰ÂÓ Â›Ó·È ÁÓˆÛÙ¤˜. ‚) ∏ Û¯¤ÛË 18:ˆ-3/18:ˆ-

6 ÛÙ· ¯ÔÚËÁÔ‡ÌÂÓ· ¶∞§√ Î·È Ë ÚÔ¤ÏÂ˘Û‹ ÙÔ˘˜

ÔÈÎ›ÏÏÂÈ. Á) ∏ ¯ÔÚËÁÔ‡ÌÂÓË ÔÛfiÙËÙ·, Â›ÛË˜, ÔÈ-

Î›ÏÏÂÈ. ‰) ¢ÂÓ ˘¿Ú¯Ô˘Ó, Ù¤ÏÔ˜, Ì·ÎÚfi¯ÚÔÓÂ˜ ÌÂÏ¤-

ÙÂ˜ Û¯ÂÙÈÎ¿ ÌÂ ÙËÓ ¤Î‚·ÛË ÙˆÓ ˘fi ÌÂÏ¤ÙË ·È‰ÈÒÓ.

∞fi Ù· ·Ú·¿Óˆ Ê·›ÓÂÙ·È fiÙÈ ·˘Ù¿ Ô˘ ˆÊÂ-

ÏÔ‡ÓÙ·È ÂÚÈÛÛfiÙÂÚÔ ·fi ÙË ¯Ú‹ÛË ÙˆÓ ¶∞§√ Â›Ó·È

Ù· ÔÏ‡ ÚfiˆÚ· ÓÂÔÁÓ¿, Ù· ÔÔ›· ¤¯Ô˘Ó Î·È Ù· ¯·-

ÌËÏfiÙÂÚ· ·Ôı¤Ì·Ù· ÙˆÓ ÏÈ·ÚÒÓ ·˘ÙÒÓ ÔÍ¤ˆÓ Î·-

Ù¿ ÙË Á¤ÓÓËÛË. ∏ ·Ó·ÁÎ·ÈfiÙËÙ· ̄ ÚËÛÈÌÔÔ›ËÛ‹˜ ÙˆÓ

¶∞§√ ÛÙ· ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿ Ì¤ÓÂÈ Ó· ·Ô‰ÂÈ¯ıÂ›.

°ÏÔ˘Ù·Ì›ÓË

∞ÔÙÂÏÂ› ËÁ‹ ÂÓ¤ÚÁÂÈ·˜ ÁÈ· Ù· ÂÓÙÂÚÔÎ‡ÙÙ·Ú·

Î·È ·Ú¤¯ÂÈ ¿˙ˆÙÔ ÁÈ· ÙË Û‡ÓıÂÛË ·ÌÈÓÔÍ¤ˆÓ Ô˘

Â›Ó·È ··Ú·›ÙËÙ· ÁÈ· ÙÔÓ ÔÏÏ·Ï·ÛÈ·ÛÌfi ÙˆÓ

ÂÓÙÂÚÔÎ˘ÙÙ¿ÚˆÓ, ÙËÓ ·Ú·ÁˆÁ‹ ‚Ï¤ÓÓË˜, ÙËÓ ·ÓÔ-

ÛÔÏÔÁÈÎ‹ ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ÂÓÙ¤ÚÔ˘, ÙËÓ ·ÎÂÚ·ÈfiÙËÙ·

ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ÊÚ·ÁÌÔ‡ (26). ¶ÚfiˆÚ· ÛÂ ·ÚÂÓÙÂÚÈ-

Î‹ ‰È·ÙÚÔÊ‹ Ô˘ ¤Ï·‚·Ó ÂÏ¿¯ÈÛÙË ÂÓÙÂÚÈÎ‹ ‰È·ÙÚÔ-

Ê‹ Ô˘ ‹Ù·Ó ÂÌÏÔ˘ÙÈÛÌ¤ÓË ÌÂ ÁÏÔ˘Ù·Ì›ÓË Â›¯·Ó

¯·ÌËÏfiÙÂÚË Û˘¯ÓfiÙËÙ· ÛË„·ÈÌ›·˜ Î·È ·˘ÍËÌ¤ÓË

·ÓÔ¯‹ ÂÓÙÂÚÈÎ‹˜ ÙÚÔÊ‹˜ (27). ∏ ·ÔÙÂÏÂÛÌ·ÙÈÎfi-

ÙËÙ· ÙË˜ ÁÏÔ˘Ù·Ì›ÓË˜ ·ÌÊÈÛ‚ËÙÂ›Ù·È ÛÂ ·ı‹ÛÂÈ˜,

fiˆ˜ Û‡Ó‰ÚÔÌÔ ÙÔ˘ ‚Ú·¯¤Ô˜ ÂÓÙ¤ÚÔ˘, ÊÏÂÁÌÔÓÒ‰Ë

ÂÓÙÂÚÔ¿ıÂÈ· Î·È ·ÎÙÈÓÈÎ‹ ‚Ï¿‚Ë ÙÔ˘ ÂÓÙ¤ÚÔ˘ (28),

ÂÓÒ ÌÂÏ¤ÙÂ˜ ÛÂ ÓÂÔÁÓ¿ ¤‰ÂÈÍ·Ó fiÙÈ Ë ¯Ú‹ÛË ÙË˜ ‰ÂÓ

ÌÂÈÒÓÂÈ ÙË Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛË˜ ÏÔÈÌÒÍÂˆÓ Î·È

¡∂∫, ·ÏÏ¿ Ô‡ÙÂ Î·È Ô‰ËÁÂ› ÛÂ Î·Ï‡ÙÂÚË ·ÓÔ¯‹ ÂÓÙÂ-

ÚÈÎ‹˜ ÙÚÔÊ‹˜ (29,30). ∂›ÛË˜, ·Ó·Ê¤ÚÂÙ·È Î·È Èı·-

Ó‹ ÙÔÍÈÎ‹ ‰Ú¿ÛË ÙË˜ ÁÏÔ˘Ù·Ì›ÓË˜ ‹ ÙÔ˘ ÁÏÔ˘Ù·ÌÈ-

ÎÔ‡, Ô˘ ·ÔÙÂÏÂ› ·Ú¿ÁˆÁfi ÙË˜, ÛÙÔ ∫¡™. ∏ ÁÏÔ˘-

Ù·Ì›ÓË, Ù¤ÏÔ˜, ÌÔÚÂ› Ó· ·Ú¤Ì‚ÂÈ ·ÚÓËÙÈÎ¿ ÛÙÔ ÌÂ-

Ù·‚ÔÏÈÛÌfi ¿ÏÏˆÓ ·ÌÈÓÔÍ¤ˆÓ (31).

∞ÚÁÈÓ›ÓË

∂›Ó·È ··Ú·›ÙËÙË ÁÈ· ÙË Û‡ÓıÂÛË ÔÍÂÈ‰›Ô˘ ÙÔ˘

·˙ÒÙÔ˘, ÙËÓ ÂÓÙÂÚÈÎ‹ ·ÈÌ·ÙÈÎ‹ ÚÔ‹, ÙËÓ ÂÓ›Û¯˘ÛË ÙÔ˘

·ÓÔÛÔÔÈËÙÈÎÔ‡, ÙËÓ ·Ú·ÁˆÁ‹ ·˘ÍËÙÈÎ‹˜ ÔÚÌfiÓË˜

(32). ∏ ̄ ÔÚ‹ÁËÛ‹ ÙË˜ ÛÂ ·ÛıÂÓÂ›˜ ÓÔÛËÏÂ˘fiÌÂÓÔ˘˜ ÛÂ

ÂÓÙ·ÙÈÎ‹ ÌÔÓ¿‰· ‚ÂÏÙ›ˆÛÂ ÙËÓ ÂÈ‚›ˆÛË (33). ¶Úfiˆ-

Ú· Ô˘ ·Ó¤Ù˘Í·Ó ¡∂∫ Â›¯·Ó ¯·ÌËÏfiÙÂÚ· Â›Â‰·

·ÚÁÈÓ›ÓË˜ ·›Ì·ÙÔ˜ (34) ÛÂ Û¯¤ÛË ÌÂ Ì¿ÚÙ˘ÚÂ˜. ∆Ô ·ÌÈ-

ÓÔÍ‡ ·˘Ùfi ÌÔÚÂ› Ó· ÂËÚÂ¿ÛÂÈ ÙÔ ÌÂÙ·‚ÔÏÈÛÌfi ÙË˜

118 Ã. ∫ÒÛÙ·ÏÔ˜




¶·È‰È·ÙÚÈÎ‹ 2008;71:116-122

ÁÏ˘Îfi˙Ë˜, ¤¯ÂÈ ÈÛÙ·ÌÈÓÈÎ‹ ‰Ú¿ÛË (35), ÂÓÒ ·˘Í¿ÓÂÈ ÙË

Û‡ÓıÂÛË ÔÍÂÈ‰›Ô˘ ÙÔ˘ ·˙ÒÙÔ˘ Ô˘ ÌÔÚÂ› Ó· Ô‰ËÁ‹-

ÛÂÈ ÛÂ ·ÓÂ·ÓfiÚıˆÙÔ ÛËÙÈÎfi ÛÔÎ (36).

∫·ÚÓÈÙ›ÓË

∂›Ó·È ··Ú·›ÙËÙË ÁÈ· ÙËÓ ÔÍÂ›‰ˆÛË ÙˆÓ ÏÈ·ÚÒÓ

ÔÍ¤ˆÓ ÛÙ· ÌÈÙÔ¯fiÓ‰ÚÈ· Î·È ÙËÓ ·ÔÌ¿ÎÚ˘ÓÛË ·ÎÂ-

Ù˘ÏÈˆÌ¤ÓˆÓ ÚÔ˚fiÓÙˆÓ ÌÂÙ·‚ÔÏÈÛÌÔ‡ (37). ¡ÂfiÙÂ-

ÚÂ˜ ÌÂÏ¤ÙÂ˜ ·ÌÊÈÛ‚ËÙÔ‡Ó ÙË ¯ÚËÛÈÌfiÙËÙ¿ ÙË˜ (38),

ÂÓÒ ÔÚÈÛÌ¤ÓÔÈ ıÂˆÚÔ‡Ó fiÙÈ ÌÔÚÂ› Î·È Ó· ‚Ï¿ÙÂÈ

·Ó ¯ÔÚËÁËıÂ› ÛÂ ·˘ÍËÌ¤ÓË ‰fiÛË (39).

™›‰ËÚÔ˜

∂ÌÔ‰›˙ÂÈ ÙËÓ ·ÔÚÚfiÊËÛË „Â˘‰·ÚÁ‡ÚÔ˘ Î·È

¯·ÏÎÔ‡ ·fi ÙÔ ÂÙÈÎfi. ∂›Ó·È ÈÛ¯˘Úfi ÔÍÂÈ‰ˆÙÈÎfi Î·È

ÌÔÚÂ› Ó· ‰ËÌÈÔ˘ÚÁ‹ÛÂÈ ÔÍÂÈ‰ˆÙÈÎ‹ ‚Ï¿‚Ë. ™Â ÂÓ‹-

ÏÈÎÂ˜ ˘¿Ú¯ÂÈ ¿ÌÂÛË Û¯¤ÛË ÌÂÙ·Í‡ ·ÔıÂÌ¿ÙˆÓ ÛÈ-

‰‹ÚÔ˘ Î·È Î·Ú‰È·ÁÁÂÈ·Î‹˜ ÓfiÛÔ˘ (40). ™Â ÌÂÏ¤ÙË

·fi ÙË ™Ô˘Ë‰›· ÛÂ ‚Ú¤ÊË ËÏÈÎ›·˜ 4-9 ÌËÓÒÓ ÌÂ

Â·ÚÎ‹ ·Ôı¤Ì·Ù· ÛÈ‰‹ÚÔ˘, Ë ¯ÔÚ‹ÁËÛË ÂÈÏ¤ÔÓ

ÛÈ‰‹ÚÔ˘ ·fi ÙÔ ÛÙfiÌ· Ô‰‹ÁËÛÂ ÛÂ ÌÂÈˆÌ¤ÓË ·‡ÍË-

ÛË ÂÈ˜ Ì‹ÎÔ˜ ÛÙËÓ ËÏÈÎ›· ÙˆÓ 5 ÂÙÒÓ. ∂›ÛË˜, Ù·

‚Ú¤ÊË ÂÌÊ¿ÓÈÛ·Ó, Û˘ÁÎÚÈÙÈÎ¿ ÌÂ Ì¿ÚÙ˘ÚÂ˜, ˘„ËÏfi-

ÙÂÚË Û˘¯ÓfiÙËÙ· ‰È¿ÚÚÔÈ·˜ Î·È ÏÔÈÌÒÍÂÈ˜ ÙÔ˘ ·ÓÒÙÂ-

ÚÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡ (41).

¶ÚÂ‚ÈÔÙÈÎ¿

∆Ô ÌËÙÚÈÎfi Á¿Ï· ÂÎÙfi˜ ·fi ÙÈ˜ ¿ÏÏÂ˜ ÙÔ˘ È‰ÈfiÙË-

ÙÂ˜ ÂÓÈÛ¯‡ÂÈ ÂÈÏ¤ÔÓ ÙËÓ ¿Ì˘Ó· ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ Ì¤-

Ûˆ ÙË˜ Â˘ÂÚÁÂÙÈÎ‹˜ ÙÔ˘ ‰Ú¿ÛË˜ ÛÙÔ ·ÓÔÛÔÔÈËÙÈÎfi

Û‡ÛÙËÌ· ÙÔ˘ ÓÂÔÁÓÔ‡, ÂÓÒ ·Ú¿ÏÏËÏ· ÌÂÈÒÓÂÈ ÙËÓ

ÂÎ‰‹ÏˆÛË ·ÏÏÂÚÁÈÎÒÓ ÓÔÛËÌ¿ÙˆÓ (42). ª¤ÚÔ˜ ÙË˜

Â˘ÓÔ˚Î‹˜ ÙÔ˘ ‰Ú¿ÛË˜ ÔÊÂ›ÏÂÙ·È ÛÙËÓ ·ÚÔ˘Û›· Á·Ï·-

ÎÙÔ-ÔÏÈÁÔÛ·Î¯·ÚÈ‰›ˆÓ, Ù· ÔÔ›· ÚÔ¿ÁÔ˘Ó ÙËÓ ·Ó¿-

Ù˘ÍË ÙˆÓ bifidobacteria Î·È Á·Ï·ÎÙÔ‚·Î›ÏÏˆÓ ÛÙÔ

·¯‡ ¤ÓÙÂÚÔ (43). ŒÙÛÈ, Î·ıÈÂÚÒıËÎÂ Ô fiÚÔ˜ «ÚÂ‚ÈÔ-

ÙÈÎ¿», Ô˘ ̆ Ô‰ËÏÒÓÂÈ ÔÚÈÛÌ¤Ó· Â›‰Ë ̆ ‰·Ù·ÓıÚ¿ÎˆÓ

Ê˘ÙÈÎ‹˜ ÚÔ¤ÏÂ˘ÛË˜ Ô˘ ‰ÂÓ ‰È·ÛÒÓÙ·È ÛÙÔ ÏÂÙfi

¤ÓÙÂÚÔ, ·ÏÏ¿ Êı¿ÓÔ˘Ó ·Ó·ÏÏÔ›ˆÙ· ÛÙÔ ·¯‡ ¤ÓÙÂÚÔ,

fiÔ˘ ÚÔ¿ÁÔ˘Ó ÙÔÓ ÔÏÏ·Ï·ÛÈ·ÛÌfi ÙË˜ ÂÓ‰ÔÁÂ-

ÓÔ‡˜ ÂÓÙÂÚÈÎ‹˜ ¯ÏˆÚ›‰·˜ ÌÂ Â˘ÓÔ˚Î¤˜ Û˘Ó¤ÂÈÂ˜ ÁÈ·

ÙÔÓ ÍÂÓÈÛÙ‹ (44). À¿Ú¯Ô˘Ó ‰È¿ÊÔÚ· Â›‰Ë ÚÂ‚ÈÔÙÈ-

ÎÒÓ, ÌÂ Î˘ÚÈfiÙÂÚ· Ù· ÊÚÔ˘ÎÙÔ-ÔÏÈÁÔÛ·Î¯·Ú›‰È·

(º√™), Ô˘ ÚÔ¤Ú¯ÔÓÙ·È ·fi Ê˘Ù¿ .¯. Ì·Ó¿Ó·,

Ú·‰›ÎÈ·, ÛÈÙ¿ÚÈ, ÎÚÂÌÌ‡‰È·, Î·È Ù· Á·Ï·ÎÙÔ-ÔÏÈÁÔ-

Û·Î¯·Ú›‰È· (°√™) Ô˘ ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙÔ Á¿Ï·

(45). √È ‚ÈÔÌË¯·Ó›Â˜ ·È‰ÈÎÒÓ ÙÚÔÊÒÓ ·Ú‹Á·Á·Ó

ÚÔÛ·ÚÌÔÛÌ¤Ó· ÚÔ˜ ÙÔ ÌËÙÚÈÎfi Á¿Ï· ÂÚÈ¤¯ÔÓÙ·

ÌÂ›ÁÌ· º√™ Î·È °√™ Ô˘ ÌÈÌÔ‡ÓÙ·È ÙË ÌÔÚÈ·Î‹ ‰ÔÌ‹

ÙˆÓ ÔÏÈÁÔÛ·Î¯·ÚÈ‰›ˆÓ ÙÔ˘ ÌËÙÚÈÎÔ‡ Á¿Ï·ÎÙÔ˜ (46).

∏ ¯ÔÚ‹ÁËÛË ÙÔ˘ ÌÂ›ÁÌ·ÙÔ˜ ·˘ÙÔ‡ ÙfiÛÔ ÛÂ ÙÂÏÂÈfiÌË-

Ó· (47,48) fiÛÔ Î·È ÛÂ ÚfiˆÚ· ÓÂÔÁÓ¿ (49,50) ‹Ù·Ó Î·-

Ï¿ ·ÓÂÎÙ‹ Î·È Û˘ÓÔ‰Â‡ÙËÎÂ ·fi ·˘ÍËÌ¤ÓË ·Ó¿Ù˘ÍË

bifidobacteria ÛÙÔ ·¯‡ ¤ÓÙÂÚÔ, Î·È ÛÂ ÔÚÈÛÌ¤ÓÂ˜ Â-

ÚÈÙÒÛÂÈ˜ ÌÂ Î·Ù·ÛÙÔÏ‹ ÙÔ˘ ÏËı˘ÛÌÔ‡ ÙˆÓ ·ıÔ-

ÁfiÓˆÓ ÂÓÙÂÚÔ‚·ÎÙËÚÈ‰›ˆÓ. ¶·Ú¿ÏÏËÏ·, Ô ·ÚÈıÌfi˜

ÙˆÓ ÎÂÓÒÛÂˆÓ Î·È Ë Û‡ÛÙ·ÛË ÙˆÓ ÎÔÚ¿ÓˆÓ, fiˆ˜

Î·È ÙÔ pH, ·ÚÔÌÔ›·˙·Ó ÌÂ ÂÎÂ›Ó· ÓÂÔÁÓÒÓ Ô˘ ÙÚ¤-

ÊÔÓÙ·Ó ÌÂ ÌËÙÚÈÎfi Á¿Ï·. ¶ÚfiÛÊ·Ù·, ·Ó·Ê¤ÚıËÎÂ Î·È

Â˘ÓÔ˚Î‹ ‰Ú¿ÛË ÙˆÓ ÚÂ‚ÈÔÙÈÎÒÓ ÛÙËÓ ÚfiÏË„Ë ÙË˜

·ÙÔÈÎ‹˜ ‰ÂÚÌ·Ù›ÙÈ‰·˜ (51).

∞Ó Î·È Ù· ÚÂ‚ÈÔÙÈÎ¿ ·ÎfiÌ· ‰ÂÓ ıÂˆÚÔ‡ÓÙ·È

·fiÏ˘Ù· ·ÛÊ·Ï‹, ı· Ú¤ÂÈ Ó· ‰›ÓÔÓÙ·È ÌÂ ÚÔÛÔ-

¯‹ ÂÈ‰ÈÎ¿ ÛÂ ÚfiˆÚ· ‹ ‰˘ÛÙÚÔÊÈÎ¿ ÓÂÔÁÓ¿ ÁÈ·Ù›

ÌÔÚÂ› Ó· ÌÂÈÒÛÔ˘Ó ÙËÓ ¤„Ë Î·È ÙËÓ ·ÔÚÚfiÊËÛË

Ï›Ô˘˜ Î·È ˘‰·Ù·ÓıÚ¿ÎˆÓ ·fi ÙÔ ¤ÓÙÂÚÔ (52).

¶ÚÔ‚ÈÔÙÈÎ¿

∂›Ó·È ˙ÒÓÙÂ˜ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ› Ô˘ ¯ÔÚËÁÔ‡ÌÂÓÔÈ

ÛÂ Â·ÚÎÂ›˜ ÔÛfiÙËÙÂ˜ ÚÔ¿ÁÔ˘Ó ÙËÓ ˘ÁÂ›· ÙÔ˘ ÍÂ-

ÓÈÛÙ‹. ∆· ÂÚÈÛÛfiÙÂÚÔ ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓ· Â›Ó·È Á·-

Ï·ÎÙÔ‚¿ÎÈÏÏÔÈ Î·È bifidobacteria, Ù· ÔÔ›· ̆ ¿Ú¯Ô˘Ó

Ê˘ÛÈÔÏÔÁÈÎ¿ Î·È ÛÙÔ ¤ÓÙÂÚÔ ‚ÚÂÊÒÓ Ô˘ ·›ÚÓÔ˘Ó

ÌËÙÚÈÎfi Á¿Ï·. ∏ ·ÚÔ˘Û›· ÙÔ˘˜ ÛÙÔ ¤ÓÙÂÚÔ Î·Ù·-

ÛÙ¤ÏÏÂÈ ÙÔÓ ÔÏÏ·Ï·ÛÈ·ÛÌfi ÙˆÓ ·ıÔÁfiÓˆÓ ÌÈÎÚÔ-

‚›ˆÓ, ÌÂÈÒÓÂÈ ÙË ÊÏÂÁÌÔÓÒ‰Ë ·ÓÙ›‰Ú·ÛË ÙÔ˘ ÂÓÙ¤-

ÚÔ˘ Î·È ÙËÓ ·ÓÙ›‰Ú·ÛË ˘ÂÚÂ˘·ÈÛıËÛ›·˜ ÛÂ ·ÏÏÂÚ-

ÁÈÔÁfiÓ· (53,54). ¶ÚÔ‚ÈÔÙÈÎ¿ ¤¯Ô˘Ó ¯ÚËÛÈÌÔÔÈËıÂ›

ÌÂ ÂÈÙ˘¯›· ÛÂ Á·ÛÙÚÂÓÙÂÚ›ÙÈ‰· ·fi ROTA Èfi (55),

ÛÙË ‰È¿ÚÚÔÈ· ·fi ¯ÔÚ‹ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ (56), ÛÙËÓ

ÚfiÏË„Ë ÙÚÔÊÈÎ‹˜ ·ÏÏÂÚÁ›·˜ (57) Î·È ÈÔ ÚfiÛÊ·Ù·

ÛÙËÓ ÚfiÏË„Ë ÙË˜ ¡∂∫ ÛÂ ÚfiˆÚ· ÓÂÔÁÓ¿ (58,59).

°È· Ù· ÚÔ‚ÈÔÙÈÎ¿ ··ÈÙÔ‡ÓÙ·È ÂÚ·ÈÙ¤Úˆ ÌÂÏ¤-

ÙÂ˜. ¶·ÚÂÓ¤ÚÁÂÈÂ˜ ·Ó·Ê¤ÚÔÓÙ·È ÔÏ‡ Û¿ÓÈ· ÌÂÙ¿ ÙË

¯ÔÚ‹ÁËÛË Á·Ï·ÎÙÔ‚¿ÎÈÏÏˆÓ Î·È ˙˘ÌÔÌ‡ÎËÙˆÓ Î·È

ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Û˘ÛÙËÌ·ÙÈÎ¤˜ ÏÔÈÌÒÍÂÈ˜, ÂÈ‰ÈÎ¿ ÛÂ

·ÓÔÛÔÎ·Ù·ÛÙ·ÏÌ¤Ó· ¿ÙÔÌ·, ÌÂÙ·‚ÔÏÈÎ‹ ÔÍ¤ˆÛË (Á·-

Ï·ÎÙÔ‚¿ÎÈÏÏÔÈ Ô˘ ·Ú¿ÁÔ˘Ó Á·Ï·ÎÙÈÎfi ÔÍ‡), ÌÂÙ·-

ÊÔÚ¿ ÁÂÓÂÙÈÎÔ‡ ˘ÏÈÎÔ‡ ÚÔ˜ ¿ÏÏ· ÌÈÎÚfi‚È·, ÌÂ Û˘Ó¤-

ÂÈ· ÙË ‰ËÌÈÔ˘ÚÁ›· ·ÓıÂÎÙÈÎÒÓ ÛÙÂÏÂ¯ÒÓ (60,61).

™˘Ì‚ÈÔÙÈÎ¿

ŒÓ· ÌÂÈÔÓ¤ÎÙËÌ· ÙˆÓ ÚÔ‚ÈÔÙÈÎÒÓ Â›Ó·È fiÙÈ

¤¯Ô˘Ó ‚Ú·¯Â›· ‰Ú¿ÛË, ÌÂ Û˘Ó¤ÂÈ· Ó· Ú¤ÂÈ Ó· ¯Ô-

ÚËÁÔ‡ÓÙ·È Î·ıËÌÂÚÈÓ¿ .∏ ÚÔÛı‹ÎË ÚÂ‚ÈÔÙÈÎÒÓ

ÛÙ· ÚÔ‚ÈÔÙÈÎ¿ ·˘Í¿ÓÂÈ ÙÔ ¯ÚfiÓÔ ‰Ú¿ÛË˜ ÙÔ˘˜ ÎÈ

¤ÙÛÈ ‰ÂÓ ··ÈÙÂ›Ù·È Û˘¯Ó‹ ¯ÔÚ‹ÁËÛ‹ ÙÔ˘˜ (62). ∏

¯Ú‹ÛË ÙÔ˘˜, fiÌˆ˜, ‰ÂÓ ¤¯ÂÈ ·ÎfiÌË ÙÂÎÌËÚÈˆıÂ› ÛÙË

‚È‚ÏÈÔÁÚ·Ê›·.

°¿Ï·Ù· ·˘ÍËÌ¤ÓË˜ ıÚÂÙÈÎ‹˜ ·Í›·˜

∏ ÂÓ‰ÔÌ‹ÙÚÈ· ‰˘ÛÙÚÔÊ›·, ·ÏÏ¿ Î·È Ë Î·Î‹ ıÚ¤-

„Ë Ì¤Û· ÛÙÔ˘˜ ÚÒÙÔ˘˜ ÎÚ›ÛÈÌÔ˘˜ Ì‹ÓÂ˜ ˙ˆ‹˜,

ÌÔÚÂ› Ó· ¤¯ÂÈ ÛÔ‚·ÚfiÙ·ÙÂ˜ Û˘Ó¤ÂÈÂ˜ ÛÙËÓ „˘¯Ô-

ÎÈÓËÙÈÎ‹ Î·È ÛˆÌ·ÙÈÎ‹ ·Ó¿Ù˘ÍË ÙÔ˘ ‚Ú¤ÊÔ˘˜

(63,64). H Û˘¯ÓfiÙËÙ· ÂÓ‰ÔÌ‹ÙÚÈ·˜ ‰˘ÛÙÚÔÊ›·˜ ÛÂ




ÓÂÔÁÓ¿ ÌÂ ÔÏ‡ ¯·ÌËÏfi ‚¿ÚÔ˜ Á¤ÓÓËÛË˜ Êı¿ÓÂÈ Î·ÈÙÔ 30%. ªÂÁ¿ÏÔ˜ ·ÚÈıÌfi˜ ·˘ÙÒÓ ÙˆÓ ·È‰ÈÒÓ ÂÍ·-ÎÔÏÔ˘ıÔ‡Ó Ó· ˘ÔÛÈÙ›˙ÔÓÙ·È Î·È ÌÂÙ¿ ÙË Á¤ÓÓËÛË,ÏfiÁˆ ÙË˜ ÏËıÒÚ·˜ ÙˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ Ô˘ ·ÓÙÈÌÂ-Ùˆ›˙Ô˘Ó Î·Ù¿ ÙË ÓÔÛËÏÂ›· ÙÔ˘˜ ÛÂ ÂÓÙ·ÙÈÎ‹ ÌÔÓ¿-‰·, ÌÂ Û˘Ó¤ÂÈ· Ó· ÂÌÊ·Ó›˙ÔÓÙ·È ‰˘ÛÙÚÔÊÈÎ¿ Î·Ù¿ÙËÓ ¤ÍÔ‰Ô ·fi ÙÔ ÓÔÛÔÎÔÌÂ›Ô (65).

ŒÙÛÈ ÙÔ ‚¿ÚÔ˜ ¤¯ÂÈ ÂÈÎÂÓÙÚˆıÂ› ÛÙË ÛˆÛÙ‹ Û›ÙÈ-ÛË ÙˆÓ ·È‰ÈÒÓ ·˘ÙÒÓ ÌÂÙ¿ ÙËÓ ¤ÍÔ‰Ô ·fi ÙÔ ÓÔÛÔ-ÎÔÌÂ›Ô. ∆· ·ÔÙÂÏ¤ÛÌ·Ù· Â›Ó·È ·ÓÙÈÎÚÔ˘fiÌÂÓ·.À¿Ú¯Ô˘Ó ÌÂÏ¤ÙÂ˜ Ô˘ ‰Â›¯ÓÔ˘Ó fiÙÈ Ë Ù·¯Â›· ·Ó·-ÏËÚˆÌ·ÙÈÎ‹ ·‡ÍËÛË ÌÂÙ¿ ÙË Á¤ÓÓËÛË ÛÂ ÂÏÏÈÔ-‚·Ú‹ ÓÂÔÁÓ¿ Ô‰ËÁÂ› ÛÂ Î·Ï‡ÙÂÚË ÓÔËÙÈÎ‹ ÂÍ¤ÏÈÍË(66,67). À¿Ú¯ÂÈ, fiÌˆ˜, Î·È Ë ¿Ô„Ë fiÙÈ Ù·¯Â›· Úfi-ÛÏË„Ë ‚¿ÚÔ˘˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË ÌÔÚÂ› Ó· ÚÔ‰È·-ı¤ÛÂÈ ÛÂ ¯ÚfiÓÈ· Î·Ú‰È·ÁÁÂÈ·Î‹ ÓfiÛÔ, ˘¤ÚÙ·ÛË,Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË Ù‡Ô˘ 2 Î·È ÔÛÙÂÔfiÚˆÛË ÛÙËÓÂÓ‹ÏÈÎË ˙ˆ‹ (68). ªÈ· ÌÂÁ¿ÏË ·Ó·ÛÎfiËÛË ‰ÂÓ¤‰ÂÈÍÂ Î·Ó¤Ó· fiÊÂÏÔ˜ ˆ˜ ÚÔ˜ ÙË ÛˆÌ·ÙÈÎ‹ Î·È æ∫ÂÍ¤ÏÈÍË (69).

∞fi Ù· ·Ú·¿Óˆ Û˘ÌÂÚ·›ÓÂÙ·È fiÙÈ ÛÙÔ ı¤Ì·ÙË˜ ‰È·ÙÚÔÊ‹˜ ÙÔ˘ ÓÂÔÁÓÔ‡ ··ÈÙÂ›Ù·È Û‡ÓÂÛË Î·ÈÚÔÛÔ¯‹ ÛÙËÓ ˘ÈÔı¤ÙËÛË Ó¤ˆÓ ·Ú¯ÒÓ. Àfi ·˘Ùfi ÙÔÓÂ‡Ì·, Ë ESPGHAN ÂÍ¤‰ˆÛÂ Ô‰ËÁ›Â˜ Ô˘ ÂÈÛË-Ì·›ÓÔ˘Ó fiÙÈ “Ë ·Ï‹ ·ÚÔ˘Û›· ÌÈ·˜ Ô˘Û›·˜ ÛÙÔ ÌË-ÙÚÈÎfi Á¿Ï· ‰ÂÓ ‰ÈÎ·ÈÔÏÔÁÂ› ÙËÓ ·˘ÙfiÌ·ÙË ÚÔÛı‹ÎËÙË˜ ÛÙÔ Û˘ÓıÂÙÈÎfi Á¿Ï·, ¯ˆÚ›˜ ÚÔËÁÔ˘Ì¤Óˆ˜ Ó·‰È·ÈÛÙˆıÂ› fi¯È ÌfiÓÔ ÙÔ ‚Ú·¯˘ÚfiıÂÛÌÔ, ·ÏÏ¿ Î·ÈÙÔ Ì·ÎÚÔÚfiıÂÛÌÔ fiÊÂÏÔ˜ Ô˘ ·ÔÊ¤ÚÂÈ ÛÙÔÓ ·Ó·-Ù˘ÛÛfiÌÂÓÔ ÔÚÁ·ÓÈÛÌfi” (70).


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¶·È‰È·ÙÚÈÎ‹ 2008;71:123-127

∂Ó‰Â›ÍÂÈ˜ ¯ÔÚ‹ÁËÛË˜ ·˘ÍËÙÈÎ‹˜ ÔÚÌfiÓË˜ ÛÙ· ·È‰È¿ Î·È

ÙÔ˘˜ ÂÊ‹‚Ô˘˜

E. ∫Ô‡ÛÙ·, ∞. ¶··ı·Ó·Û›Ô˘, Ã. Ã·Ù˙Ë·ı·Ó·Û›Ô˘†

¶ÂÚ›ÏË„Ë: ª¤¯ÚÈ ÙË ‰ÂÎ·ÂÙ›· ÙÔ˘ 1980, Ë ·˘ÍËÙÈÎ‹ ÔÚÌfiÓË (GH) Â›¯Â ¯ÚËÛÈÌÔÔÈËıÂ› ·ÔÎÏÂÈÛÙÈÎ¿ ÁÈ·ÙË ıÂÚ·Â›· ·È‰ÈÒÓ ÌÂ ÛÔ‚·Ú‹ Î·ı˘ÛÙ¤ÚËÛË ÛˆÌ·ÙÈÎ‹˜ ·Ó¿Ù˘ÍË˜, ÔÊÂÈÏfiÌÂÓË ÛÂ ·ÓÂ¿ÚÎÂÈ· ·˘ÍËÙÈ-Î‹˜ ÔÚÌfiÓË˜ (GHD). ∏ GHD ·ÊÔÚ¿ Û˘Ó‰˘·ÛÌfi ÎÏÈÓÈÎÒÓ, ·ÎÙÈÓÔÏÔÁÈÎÒÓ, ÌÂÙ·‚ÔÏÈÎÒÓ Î·È ÔÚÌÔÓÔÏÔÁÈ-ÎÒÓ Â˘ÚËÌ¿ÙˆÓ. ∏ ÂÈÏÔÁ‹ ÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ, ÛÙ· ÔÔ›· ı· Á›ÓÔ˘Ó ‰È·ÁÓˆÛÙÈÎ¤˜ ‰ÔÎÈÌ·Û›Â˜ ¤ÎÎÚÈÛË˜ ·˘-ÍËÙÈÎ‹˜ ÔÚÌfiÓË˜, ÚÔ¸Ôı¤ÙÂÈ ÙË ÛˆÛÙ‹ ·ÍÈÔÏfiÁËÛË ÙˆÓ ÎÏÈÓÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ Î·È Î˘Ú›ˆ˜ ÙÔ˘ ‰È·ÁÚ¿ÌÌ·-ÙÔ˜ ·‡ÍËÛË˜. ∏ ıÂÚ·Â›· ÌÂ G∏ ÛÙ· ·È‰È¿ ÌÂ GHD Ô‰ËÁÂ› ÛÂ ÂÈÙ¿¯˘ÓÛË ÙÔ˘ Ú˘ıÌÔ‡ ·‡ÍËÛË˜ Î·È Â›Ó·È‰˘Ó·Ùfi Ó· ÊÙ¿ÛÔ˘Ó ÛÂ Ê˘ÛÈÔÏÔÁÈÎfi ÙÂÏÈÎfi ·Ó¿ÛÙËÌ·, Â¿Ó Ë ıÂÚ·Â›· ·Ú¯›ÛÂÈ ÂÁÎ·›Úˆ˜. E›ÛË˜, ÂÎÙfi˜ ·fiÙÔ ‡„Ô˜, Ë GH ¤¯ÂÈ Â˘ÂÚÁÂÙÈÎ‹ Â›‰Ú·ÛË ÛÙË ÛˆÌ·ÙÈÎ‹ Û‡ÛÙ·ÛË, ÂÏ·ÙÙÒÓÔÓÙ·˜ ÙÔ ÏÈÒ‰Ë ÈÛÙfi, ·˘Í¿ÓÔ-ÓÙ·˜ ÙË Ì˘˚Î‹ Ì¿˙· Î·È ·˘Í¿ÓÔÓÙ·˜ ÙËÓ ÔÛÙÈÎ‹ ˘ÎÓfiÙËÙ·, ¯ˆÚ›˜ Ó· ˘¿Ú¯Ô˘Ó ÛÔ‚·Ú¤˜ ·ÚÂÓ¤ÚÁÂÈÂ˜. ∫·-Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÙÂÏÂ˘Ù·›ˆÓ 20 ÂÙÒÓ, ÔÈ ÂÓ‰Â›ÍÂÈ˜ ¤¯Ô˘Ó ÂÂÎÙ·ıÂ› Î·È ¤¯ÂÈ ÂÁÎÚÈıÂ› Ë ¯ÔÚ‹ÁËÛ‹ ÙË˜ ÛÙ·ÎÔÚ›ÙÛÈ· ÌÂ Û‡Ó‰ÚÔÌÔ Turner Î·È ÛÂ ·È‰È¿ ÌÂ ̄ ÚfiÓÈ· ÓÂÊÚÈÎ‹ ·ÓÂ¿ÚÎÂÈ· Î·È Û‡Ó‰ÚÔÌÔ Prader-Willi. ™ÙÈ˜∏¶∞ Î·È ÙÈ˜ ¯ÒÚÂ˜ ÙË˜ ∂˘Úˆ·˚Î‹˜ ŒÓˆÛË˜ ¤¯ÂÈ ÂÁÎÚÈıÂ› Ë ¯ÔÚ‹ÁËÛË ·˘ÍËÙÈÎ‹˜ ÔÚÌfiÓË˜ ÛÂ ·È‰È¿ ÌÈÎÚfi-ÛˆÌ· ÁÈ· ÙËÓ ËÏÈÎ›· Î‡ËÛË˜, ÂÓÒ Ë ¯ÔÚ‹ÁËÛË GH ÛÂ ·È‰È¿ ÌÂ È‰ÈÔ·ı¤˜ ¯·ÌËÏfi ·Ó¿ÛÙËÌ· ¤¯ÂÈ ÂÁÎÚÈıÂ›ÌfiÓÔ ÛÙÈ˜ ∏¶∞. ∏ ıÂÚ·Â›· fiÌˆ˜ ÛÙ· ·È‰È¿ ·˘Ù¿ ‰ÂÓ ¤¯ÂÈ ÂÁÎÚÈıÂ› ÛÙË ¯ÒÚ· Ì·˜. ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·¤¯ÂÈ ÂÂÎÙ·ıÂ› Ë ̄ Ú‹ÛË ÙË˜ ÛÙÔ˘˜ ÂÊ‹‚Ô˘˜ Î·È ÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜ ÌÂ ÛÔ‚·ÚÔ‡ ‚·ıÌÔ‡ GHD. ∏ ıÂÚ·Â›· ÌÂ GHÂ›Ó·È ÌÈ· ·ÎÚÈ‚‹ ıÂÚ·Â›· Î·È ¯ÚÂÈ¿˙ÂÙ·È Ù·ÎÙÈÎ‹ ·Ú·ÎÔÏÔ‡ıËÛË ·fi ÂÍÂÈ‰ÈÎÂ˘Ì¤Ó· Î¤ÓÙÚ·.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ∞˘ÍËÙÈÎ‹ ÔÚÌfiÓË, ·ÓÂ¿ÚÎÂÈ· ·˘ÍËÙÈÎ‹˜ ÔÚÌfiÓË˜, Û‡Ó‰ÚÔÌÔ ∆urner, Û‡Ó‰ÚÔÌÔ Prader-Willi,

¯ÚfiÓÈ· ÓÂÊÚÈÎ‹ ·ÓÂ¿ÚÎÂÈ·.

Indications for administering growth hormone to children and

adolescents

∂. Kousta, A. Papathanassiou, C. Hadjiathanassiou†

Abstract: Recombinant growth hormone (GH) was used exclusively for the treatment of children withsevere growth retardation due to GH deficiency (GHD) up until the end of the 1980’s. GHD is characterizedby a combination of clinical, radiological, metabolic and hormonal abnormalities. The selection of cases forwhom there is a need to proceed to stimulation tests requires accurate auxological data and correctinterpretation of the growth curve. GH treatment in children with GHD leads to acceleration of growthvelocity and, if treatment is started early enough, to a final height within the normal range. Treatment withGH improves not only the height, but also body composition, by decreasing fat mass and increasing bonedensity, without significant side effects. During the last 20 years, the indications for treatment with GH havebeen expanded and its use has been approved for girls with Turner syndrome and for children with chronicrenal failure and Prader-Willi syndrome. In the USA and some countries of the EU, GH treatment is approvedfor children born small for gestational age. Treatment for idiopathic short stature has been approved only inthe USA. These indications have not been approved in Greece. Over the last few years its use has beenextended to adolescents and adults with severe GH deficiency. GH treatment is an expensive therapy andregular monitoring of its use needs to be made in specialised centres.

Key words: Growth hormone, growth hormone deficiency, Tyrner syndrome, Prader-Willi syndrome, chronic

renal failure.

∂Ó‰ÔÎÚÈÓÔÏÔÁÈÎfi ∆Ì‹Ì·¡ÔÛÔÎÔÌÂ›Ô˘ ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó·


∂Ï¤ÓË ∫Ô‡ÛÙ·[email protected]™. ∞Ú‚·ÓÈÙ¿ÎË 6∆.∫. 491 00, ∫¤ÚÎ˘Ú·

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

Correspondence:

Eleni [email protected], Sp. ∞rvanitaki St., 491 00, Corfu, Greece

™˘ÓÙÔÌÔÁÚ·Ê›Â˜

GH A˘ÍËÙÈÎ‹ ÔÚÌfiÓËGHD AÓÂ¿ÚÎÂÈ· ·˘ÍËÙÈÎ‹˜ ÔÚÌfiÓË˜IGFs A˘ÍËÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ISS I‰ÈÔ·ı¤˜ ¯·ÌËÏfi ·Ó¿ÛÙËÌ·SGA ¶·È‰È¿ Ô˘ ÁÂÓÓÈÔ‡ÓÙ·È ÌÈÎÚfiÛˆÌ· ÁÈ· ÙËÓ

ËÏÈÎ›· Î‡ËÛË˜

Ã¡∞ ÃÚfiÓÈ· ÓÂÊÚÈÎ‹ ·ÓÂ¿ÚÎÂÈ·

EÈÛ·ÁˆÁ‹

∏ GH ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÂÈÙ˘¯Ò˜ ÁÈ· ÙË ıÂ-

Ú·Â›· ·È‰ÈÒÓ ÌÂ ¯·ÌËÏfi ·Ó¿ÛÙËÌ· ÁÈ· Û¯Â-

‰fiÓ 50 ¯ÚfiÓÈ·. ∞Ú¯ÈÎ¿, ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ GH


124 E. ∫Ô‡ÛÙ· Î·È Û˘Ó.


ÚÔÂÚ¯fiÌÂÓË ·fi ·ÓıÚÒÈÓÔ ÈÛÙfi ̆ fiÊ˘ÛË˜, Ë ̄ Ú‹-

ÛË ÙË˜ ÔÔ›·˜ fiÌˆ˜ ‰È·ÎfiËÎÂ ÏfiÁˆ ÙË˜ ·ÈÙÈÔÏÔÁÈ-

Î‹˜ Û˘Û¯¤ÙÈÛ‹˜ ÙË˜ ÌÂ ÙË ÓfiÛÔ Creutzfeldt-Jakob,

ÌÈ· Û¿ÓÈ· ı·Ó·ÙËÊfiÚÔ, ÛÔÁÁÔÂÈ‰‹ ÂÁÎÂÊ·ÏÔ¿-

ıÂÈ·. ∏ ·Ú·ÁˆÁ‹ ‚ÈÔÛ˘ÓıÂÙÈÎ‹˜ GH Ô‰‹ÁËÛÂ ÛÙËÓ

Â˘Ú‡ÙÂÚË ¯Ú‹ÛË ÙË˜ GH. M¤¯ÚÈ Ù· Ì¤Û· ÙË˜ ‰ÂÎ·Â-

Ù›·˜ ÙÔ˘ 1980, Ë GH ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ ·ÔÎÏÂÈÛÙÈÎ¿

ÁÈ· ÙË ıÂÚ·Â›· ·È‰ÈÒÓ ÌÂ ÛÔ‚·Ú‹ Î·ı˘ÛÙ¤ÚËÛË

ÛˆÌ·ÙÈÎ‹˜ ·Ó¿Ù˘ÍË˜, ÔÊÂÈÏfiÌÂÓË ÛÂ GHD. ∫·Ù¿

ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÙÂÏÂ˘Ù·›ˆÓ 20 ÂÙÒÓ, ÔÈ ÂÓ‰Â›ÍÂÈ˜

¤¯Ô˘Ó ÂÂÎÙ·ıÂ› Î·È ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙÔ Û‡Ó‰ÚÔÌÔ

Turner (1), ÙË ¯ÚfiÓÈ· ÓÂÊÚÈÎ‹ ·ÓÂ¿ÚÎÂÈ· (2) Î·È ÙÔ

Û‡Ó‰ÚÔÌÔ Prader-Willi (3). H GH ¯ÚËÛÈÌÔÔÈÂ›Ù·È

·ÎfiÌË ÛÂ ·È‰È¿ Ô˘ ÁÂÓÓÈÔ‡ÓÙ·È ÌÈÎÚfiÛˆÌ· ÁÈ· ÙËÓ

ËÏÈÎ›· Î‡ËÛË˜ (Small for Gestational Age - SGA) (4).

∏ ¤Ó‰ÂÈÍË ·˘Ù‹ ¤¯ÂÈ ÂÁÎÚÈıÂ› ÛÂ ∞ÌÂÚÈÎ‹ Î·È ∂˘ÚÒË

Î·È ÛÙËÓ ∂ÏÏ¿‰· ¤¯ÂÈ ÂÁÎÚÈıÂ› ·fi ÙÔÓ ∂√º Î·È ÙÔ

∫∂™À Î·È ‚Ú›ÛÎÂÙ·È ÛÙÔ ÙÂÏÈÎfi ÛÙ¿‰ÈÔ ˘ÔÁÚ·Ê‹˜.

∞ÎfiÌ·, Ë GH ¤¯ÂÈ ¯ÔÚËÁËıÂ› ÛÂ ·È‰È¿ ÌÂ È‰ÈÔ·ı¤˜

¯·ÌËÏfi ·Ó¿ÛÙËÌ· (Idiopathic Short Stature - ISS) (5).

™ÙÈ˜ ∏¶∞ ¤¯ÂÈ ‰ÔıÂ› ¤ÁÎÚÈÛË ÌfiÓÔ ÛÂ ¤Ó· ÛÎÂ‡·ÛÌ·

Î·È ÚÔ˜ ÙÔ ·ÚfiÓ Ë ¯ÔÚ‹ÁËÛ‹ ÙË˜ ÛÙ· ·È‰È¿ ·˘Ù¿

ı· Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÌfiÓÔ ÛÙ· Ï·›ÛÈ· ÂÚÂ˘ÓËÙÈÎÒÓ

ÚˆÙÔÎfiÏÏˆÓ.

ª¤¯ÚÈ ÚfiÛÊ·Ù·, ÛÙ· ·È‰È¿ ÌÂ GHD ÁÈÓfiÙ·Ó

‰È·ÎÔ‹ ÙË˜ ıÂÚ·Â›·˜ ÌÂÙ¿ ÙÔ Ù¤ÏÔ˜ ÙË˜ ÂÚÈfi‰Ô˘

·Ó¿Ù˘ÍË˜. ∆ÒÚ·, Û˘ÓÈÛÙ¿Ù·È Ó· Á›ÓÂÙ·È Â·Ó¤ÏÂÁ-

¯Ô˜ ÙË˜ ¤ÎÎÚÈÛË˜ ÙË˜ GH ÌÂÙ¿ ÙË ‰È·ÎÔ‹ ÙË˜ ıÂ-

Ú·Â›·˜ Î·Ù¿ ÙË Û‡ÁÎÏÂÈÛË ÙˆÓ ÂÈÊ‡ÛÂˆÓ, È‰È·ÈÙ¤-

Úˆ˜ ÙˆÓ ·È‰ÈÒÓ ÌÂ ÔÏ‡ ¯·ÌËÏ¤˜ ÙÈÌ¤˜ GH Î·È ÌÂ

·ıÔÏÔÁÈÎ‹ Ì·ÁÓËÙÈÎ‹ ÙÔÌÔÁÚ·Ê›· ˘fiÊ˘ÛË˜ (ÌÈ-

ÎÚfi ‡„Ô˜, ¤ÎÙÔË ˘fiÊ˘ÛË) ‹ ÈÛÙÔÚÈÎfi fiÁÎÔ˘ ‹

·ÎÙÈÓÔ‚ÔÏ›·˜. ™Â fiÛÔ˘˜ ÏËÚÔ‡Ó Ù· ÎÚÈÙ‹ÚÈ· ¯·ÌË-

Ï‹˜ ¤ÎÎÚÈÛË˜ GH ÌÂ ‚¿ÛË Ù· ÎÚÈÙ‹ÚÈ· ÙˆÓ ÂÓËÏ›-

ÎˆÓ, Û˘ÓÈÛÙ¿Ù·È Û˘Ó¤¯ÈÛË ÙË˜ ıÂÚ·Â›·˜ ÌÂ ‰ÔÛÔÏÔ-

Á›· ÂÓËÏ›ÎˆÓ, ÏfiÁˆ ÙˆÓ ÌÂÙ·‚ÔÏÈÎÒÓ ÂÈÙÒÛÂˆÓ

ÙË˜ ÛÔ‚·Ú‹˜ ·ÓÂ¿ÚÎÂÈ·˜ ÛÙËÓ ÂÓ‹ÏÈÎÔ ˙ˆ‹. ∫¿-

ÔÈÔÈ ÂÚÂ˘ÓËÙ¤˜ Û˘ÓÈÛÙÔ‡Ó ÙË Û˘Ó¤¯ÈÛË ÙË˜ ıÂÚ·-

Â›·˜ ÛÙÔ˘˜ ÂÊ‹‚Ô˘˜ ÁÈ· Î¿ÔÈÔ ‰È¿ÛÙËÌ· ÌÂÙ¿ ÙË

Û‡ÁÎÏÂÈÛË ÙˆÓ ÂÈÊ‡ÛÂˆÓ, ÏfiÁˆ ÙË˜ ıÂÙÈÎ‹˜ Â›-

‰Ú·ÛË˜ ÛÙËÓ ÔÛÙÈÎ‹ ˘ÎÓfiÙËÙ· (6).

∏ ıÂÚ·Â›· ÌÂ GH ¯ÚÂÈ¿˙ÂÙ·È Ù·ÎÙÈÎ‹ ·Ú·ÎÔ-

ÏÔ‡ıËÛË ·fi ÂÍÂÈ‰ÈÎÂ˘Ì¤Ó· Î¤ÓÙÚ·. ∆Ô ÎfiÛÙÔ˜ ÙË˜

ıÂÚ·Â›·˜ Â›Ó·È ÌÂÁ¿ÏÔ, È‰È·›ÙÂÚ· ÛÙ· ·È‰È¿ ÌÂ

Û‡Ó‰ÚÔÌÔ Turner, ¯ÚfiÓÈ· ÓÂÊÚÈÎ‹ ·ÓÂ¿ÚÎÂÈ· Î·È

È‰ÈÔ·ı¤˜ ¯·ÌËÏfi ·Ó¿ÛÙËÌ·, Ù· ÔÔ›· ¯ÚÂÈ¿˙ÔÓÙ·È

ÌÂÁ·Ï‡ÙÂÚË ‰fiÛË GH. ∂ÈÏ¤ÔÓ, ÚÈÓ ·ÔÊ·ÛÈÛÙÂ›

Ë ıÂÚ·Â›· ÌÂ GH, Ú¤ÂÈ ¤Ú· ·fi ÙËÓ Â˘ÓÔ˚Î‹

Â›‰Ú·ÛË ÙË˜ ıÂÚ·Â›·˜ ÛÙÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ·, Ó·

ÏËÊıÔ‡Ó ˘fi„Ë „˘¯ÔÎÔÈÓˆÓÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ Î·È Ë

Ù˘¯fiÓ ·ÚÓËÙÈÎ‹ Â›ÙˆÛË ÙË˜ ıÂÚ·Â›·˜ ÛÙËÓ ÔÈfi-

ÙËÙ· ˙ˆ‹˜ ÙÔ˘ ·È‰ÈÔ‡ Î·È ÙË˜ ÔÈÎÔÁ¤ÓÂÈ·˜ ·fi ÙÈ˜

Î·ıËÌÂÚÈÓ¤˜ ˘Ô‰fiÚÈÂ˜ ÂÓ¤ÛÂÈ˜. ¶·ÚfiÏÔ Ô˘ ÙÔ ¯·-

ÌËÏfi ·Ó¿ÛÙËÌ· ·Ó·Ê¤ÚÂÙ·È fiÙÈ ÌÔÚÂ› Ó· ÂÈ‚·Ú‡-

ÓÂÈ „˘¯ÔÏÔÁÈÎ¿ Î¿ÔÈ· ·È‰È¿, Ú¤ÂÈ Ó· ÙÔÓÈÛÙÂ›

fiÙÈ ‰ÂÓ ¤¯ÂÈ ÙÂÎÌËÚÈˆıÂ› Î·È ‰ÂÓ Â›Ó·È ·fi fiÏÔ˘˜

·Ô‰ÂÎÙ‹ Ë Â˘ÓÔ˚Î‹ Â›‰Ú·ÛË ÙË˜ ıÂÚ·Â›·˜ ÌÂ GH

ÛÙÔÓ „˘¯ÈÛÌfi ÙˆÓ ·È‰ÈÒÓ ·˘ÙÒÓ.

∞ÓÂ¿ÚÎÂÈ· ·˘ÍËÙÈÎ‹˜ ÔÚÌfiÓË˜ (GHD)

∏ GHD ÛÙ· ·È‰È¿ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÙÔ Û˘Ó-

‰˘·ÛÌfi ÎÏÈÓÈÎÒÓ Î·È ÂÚÁ·ÛÙËÚÈ·ÎÒÓ Â˘ÚËÌ¿ÙˆÓ, Ù·

ÔÔ›· ÌÔÚÂ› Ó· Û˘Ó˘¿Ú¯Ô˘Ó ÛÂ ÌÈÎÚfi ‹ ÌÂÁ¿ÏÔ

‚·ıÌfi ·Ó¿ÏÔÁ· ÌÂ ÙËÓ Ï‹ÚË ‹ ÌÂÚÈÎ‹ ·ÓÂ¿ÚÎÂÈ·

‹ ÌË ¤ÎÎÚÈÛË ‰Ú·ÛÙÈÎ‹˜ GH ‹ ÂÏ¿ÙÙˆÛË ·˘ÍËÙÈÎÒÓ

·Ú·ÁfiÓÙˆÓ (IGFs) (7).

∏ ‰È¿ÁÓˆÛË ÙË˜ GHD ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›· Â›Ó·È

¤Ó· ‰‡ÛÎÔÏÔ ı¤Ì·, ‰ÈfiÙÈ Ë ¤ÎÎÚÈÛË ÙË˜ GH ÛÙ· ·È-

‰È¿ Î·Ï‡ÙÂÈ ¤Ó· Û˘ÓÂ¯¤˜ Ê¿ÛÌ·, ÙÔ ÔÔ›Ô ÂÎÙÂ›ÓÂ-

Ù·È ·fi Ù· fiÚÈ· ÙÔ˘ Ê˘ÛÈÔÏÔÁÈÎÔ‡ ¤ˆ˜ ÙË Ì¤ÙÚÈ·

·ÓÂ¿ÚÎÂÈ· ¤ÎÎÚÈÛË˜ (ÌÂÌÔÓˆÌ¤ÓË GHD) Ì¤¯ÚÈ ÙË

ÛÔ‚·Ú‹ ·ÓÂ¿ÚÎÂÈ· (fiˆ˜ Û˘Ì‚·›ÓÂÈ ÛÂ ÔÏÏ·Ï‹

˘ÔÊ˘ÛÈ·Î‹ ·ÓÂ¿ÚÎÂÈ· ‹ ‰È·Ù·Ú·¯‹ ÙÔ˘ ̆ Ô‰Ô¯¤·

ÙÔ˘ ˘Ôı·Ï·ÌÈÎÔ‡ ÂÎÏ˘ÙÈÎÔ‡ ·Ú¿ÁÔÓÙ·) ‹ Ï‹ÚË

¤ÏÏÂÈ„Ë (·¿ÏÂÈ„Ë ÁÔÓÈ‰›Ô˘ ÙË˜ GH). ™˘Ó‹ıˆ˜, ‰ÂÓ

˘¿Ú¯ÂÈ ‰˘ÛÎÔÏ›· ÛÙËÓ ·Ó·ÁÓÒÚÈÛË ÙË˜ ‘ÎÏ·ÛÈÎ‹˜’,

Ï‹ÚÔ˘˜ GHD, fiÌˆ˜ Ë ·Ó·ÁÓÒÚÈÛË ÙË˜ ÔÌ¿‰·˜ ÙˆÓ

·È‰ÈÒÓ, Ù· ÔÔ›·, ÂÓÒ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÔÚÈ·Î‹ ‰È·Ù·-

Ú·¯‹ ÛÙËÓ ¤ÎÎÚÈÛË ÙË˜ GH, ı· ÂˆÊÂÏËıÔ‡Ó ·fi

ÙË ¯ÔÚ‹ÁËÛ‹ ÙË˜, ·Ú·Ì¤ÓÂÈ ÌÈ· ÚfiÎÏËÛË (8,9).

¶ÚfiÛÊ·Ù·, Î·ıÈÂÚÒıËÎ·Ó ÎÏÈÓÈÎ¿ Î·È ·˘ÍÔÏÔÁÈÎ¿

‰ÈÂıÓ‹ ‰È·ÁÓˆÛÙÈÎ¿ ÎÚÈÙ‹ÚÈ· ÁÈ· ÙË GHD, Ù· ÔÔ›·

‚·Û›˙ÔÓÙ·È ÛÂ ·ÍÈÔÏfiÁËÛË ÙË˜ ·‡ÍËÛË˜, Î·ıÒ˜ Î·È

ÙÔ˘ ¿ÍÔÓ· GH-IGF. ∆· ÎÏÈÓÈÎ¿ Î·È ·˘ÍÔÏÔÁÈÎ¿ ÎÚÈ-

Ù‹ÚÈ· ¤ÏÏÂÈ„Ë˜ GH ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1.

∏ GH ÂÎÎÚ›ÓÂÙ·È Î·Ù¿ ÒÛÂÈ˜ ÛÙË ‰È¿ÚÎÂÈ· ÙÔ˘

‡ÓÔ˘. ∂ÔÌ¤Óˆ˜, Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙË˜ GH ÛÙÔ

Ï¿ÛÌ·, ¯ˆÚ›˜ Ó· ÚÔËÁËıÂ› ‰È¤ÁÂÚÛË, ‰ÂÓ ¤¯ÂÈ ‰È·-

ÁÓˆÛÙÈÎ‹ ·Í›· Î·È ‰ÂÓ Ú¤ÂÈ Ó· ¯ÚËÛÈÌÔÔÈÂ›Ù·È.

°È· ÙË ‰È¿ÁÓˆÛË ÙË˜ GHD ··ÈÙÂ›Ù·È Ì¤ÁÈÛÙË ·ÓÙ·-

fiÎÚÈÛË GH (peak) Î¿Ùˆ ·fi Ù· fiÚÈ· ÙÔ˘ Ê˘ÛÈÔÏÔ-

ÁÈÎÔ‡ (GH <10 ng/ml) ÛÂ ‰‡Ô ÙÔ˘Ï¿¯ÈÛÙÔÓ ‰ÔÎÈÌ·-

Û›Â˜ ‰È¤ÁÂÚÛË˜. ™ÎÔfi˜ ÙˆÓ ‰ÔÎÈÌ·ÛÈÒÓ Â›Ó·È Ó·

¶›Ó·Î·˜ 1. ∫ÏÈÓÈÎ¿ Î·È ·˘ÍÔÏÔÁÈÎ¿ ÎÚÈÙ‹ÚÈ· GHD

ñ ™ËÌ·ÓÙÈÎÔ‡ ‚·ıÌÔ‡ Î·ı˘ÛÙ¤ÚËÛË ‡„Ô˘˜ (<3 SD)ñ ⁄„Ô˜ <1,5 SD Î¿Ùˆ ·fi ÙÔ ‡„Ô˜-ÛÙfi¯Ôñ ⁄„Ô˜ <-2 SD Î·È Ú˘ıÌfi˜ ·Ó¿Ù˘ÍË˜ <1 SD Î¿Ùˆ ·fi ÙÔ

Ì¤ÛÔ fiÚÔ ÙÔÓ ÚÔËÁÔ‡ÌÂÓÔ ¯ÚfiÓÔ (‹ -0,5 SD ÁÈ· ·È‰È¿Î¿Ùˆ ÙˆÓ 2 ÂÙÒÓ)

ñ ™Â ·È‰È¿ Ê˘ÛÈÔÏÔÁÈÎÔ‡ ‡„Ô˘˜, ÙÒÛË Ú˘ıÌÔ‡ ·Ó¿Ù˘ÍË˜<1,5 SD Â› 2 ¯ÚfiÓÈ·

ñ ™ËÌÂ›· ÂÓ‰ÔÎÚ·ÓÈ·Î‹˜ ‚Ï¿‚Ë˜ ‹ ÔÏÏ·Ï‹˜ ˘ÔÊ˘ÛÈ·Î‹˜·ÓÂ¿ÚÎÂÈ·˜

ñ ™˘ÌÙÒÌ·Ù· Î·È ÛËÌÂ›· ¤ÏÏÂÈ„Ë˜ GH ÛÙÔ ÓÂÔÁÓfi (˘ÔÁÏ˘Î·ÈÌ›·, ÌÈÎÚfi ¤Ô˜)


125∂Ó‰Â›ÍÂÈ˜ ¯ÔÚ‹ÁËÛË˜ ·˘ÍËÙÈÎ‹˜ ÔÚÌfiÓË˜

¶·È‰È·ÙÚÈÎ‹ 2008;71:123-127

Û˘ÌÏËÚÒÛÔ˘Ó ÙËÓ ÎÏÈÓÈÎ‹ ˘Ô„›· ÙË˜ GHD ÛÂ Ù¤-

ÙÔÈÔ ‚·ıÌfi, ÒÛÙÂ Ó· ÌÂÈˆıÔ‡Ó ÛÙÔ ÂÏ¿¯ÈÛÙÔ „Â˘‰Ò˜

ıÂÙÈÎ¤˜ ‹ „Â˘‰Ò˜ ·ÚÓËÙÈÎ¤˜ ‰È·ÁÓÒÛÂÈ˜ (10). √

ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙÔ˘ IGF-1, Â¿Ó ¤¯Ô˘Ó ·ÔÎÏÂÈÛıÂ›

¿ÏÏÂ˜ ·ÈÙ›Â˜ (Ë·ÙÔ¿ıÂÈ·, ¯ÚfiÓÈ· ·Ó·ÈÌ›·, Î.Ï.),

‚ÔËı¿ ÛÙË ‰È¿ÁÓˆÛË ÛÂ ·È‰› ÌÂ ÈÛÙÔÚÈÎfi Î·È Î·-

Ì‡ÏË ·Ó¿Ù˘ÍË˜ Ô˘ ı¤ÙÔ˘Ó ÙËÓ ˘Ô„›· GHD.

¶ÚÔËÁÔ˘Ì¤Óˆ˜, Ú¤ÂÈ Ó· ·ÔÎÏÂÈÛıÔ‡Ó Î·Ù·ÛÙ¿-

ÛÂÈ˜, fiˆ˜ Ô ˘Ôı˘ÚÂÔÂÈ‰ÈÛÌfi˜, ¯ÚfiÓÈ· Û˘ÛÙËÌ·ÙÈ-

Î¿ ÓÔÛ‹Ì·Ù·, ÙÔ Û‡Ó‰ÚÔÌÔ Turner Î·È ÛÎÂÏÂÙÈÎ¤˜

·ÓˆÌ·Ï›Â˜. ™ÙË ‰ÈÂÚÂ‡ÓËÛË ÙË˜ GHD ÛÙ· ·È‰È¿

ÌÔÚÂ› Â›ÛË˜ Ó· ‚ÔËı‹ÛÂÈ Ë Ì·ÁÓËÙÈÎ‹ ÙÔÌÔÁÚ·-

Ê›· ÙË˜ ˘fiÊ˘ÛË˜, ÌÂ ÙËÓ ÔÔ›· ÌÔÚÂ› Ó· ‰È·ÁÓˆ-

ÛıÂ› Ë ˘ÔÏ·Û›· ÙÔ˘ ÚÔÛı›Ô˘ ÏÔ‚Ô‡ ÙË˜ ˘fiÊ˘-

ÛË˜, Ë ÂÎÙÔ›· ÙÔ˘ ÔÈÛı›Ô˘ ÏÔ‚Ô‡, Ë ·ÁÂÓÂÛ›· ÙÔ˘

Ì›Û¯Ô˘, Î·ıÒ˜ Î·È ¿ÏÏÂ˜ ·ıÔÏÔÁÈÎ¤˜ Î·Ù·ÛÙ¿ÛÂÈ˜.

∏ ·ÍÈÔÈÛÙ›· ÙˆÓ Ê·ÚÌ·ÎÔÏÔÁÈÎÒÓ ‰ÔÎÈÌ·ÛÈÒÓ

‰È¤ÁÂÚÛË˜ ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô ¤ÎÎÚÈÛË˜ GH ¤¯ÂÈ ·ÌÊÈ-

Û‚ËÙËıÂ› ·fi ÔÏÏÔ‡˜ ÂÚÂ˘ÓËÙ¤˜ (11). ™ÙÈ˜ ·Ó·-

ÛÎÔ‹ÛÂÈ˜ ÔÏ˘ÎÂÓÙÚÈÎÒÓ ÌÂÏÂÙÒÓ ÌÂ ÌÂÁ¿ÏÔ ·ÚÈı-

Ìfi ·ÛıÂÓÒÓ, ÛÙÔ˘˜ ÔÔ›Ô˘˜ ¯ÔÚËÁ‹ıËÎÂ ıÂÚ·Â›·

ÌÂ GH, ·Ó·Ê¤ÚÂÙ·È fiÙÈ Ú¤ÂÈ Ó· ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È

ÔÏ‡ Ï›ÁÂ˜ ·ÍÈfiÈÛÙÂ˜ ‰ÔÎÈÌ·Û›Â˜ ‰È¤ÁÂÚÛË˜ Î·È Ó·

Á›ÓÂÈ ÚÔÛ¿ıÂÈ· Ó· Î·ıÔÚÈÛıÔ‡Ó Ê˘ÛÈÔÏÔÁÈÎ¤˜ ÙÈ-

Ì¤˜ ÁÈ· ÙÈ˜ ‰È¿ÊÔÚÂ˜ ËÏÈÎ›Â˜ (12,13).

H ÂÙ·ÈÚÂ›· ¤ÚÂ˘Ó·˜ GH (Growth Hormone

Research Society) ¤¯ÂÈ ÂÎ‰ÒÛÂÈ Î·ÙÂ˘ı˘ÓÙ‹ÚÈÂ˜ Ô‰Ë-

Á›Â˜ ÁÈ· ÙË ‰È¿ÁÓˆÛË Î·È ÙË ıÂÚ·Â›· ÙË˜ GHD ÛÙ·

·È‰È¿ (14). ŒÓ· ÌÂÁ¿ÏÔ ÔÛÔÛÙfi ÙˆÓ ·È‰ÔÂÓ‰Ô-

ÎÚÈÓÔÏfiÁˆÓ ·ÎÔÏÔ˘ıÂ› ·˘Ù¤˜ ÙÈ˜ Ô‰ËÁ›Â˜, ·ÚfiÙÈ

˘¿Ú¯Ô˘Ó ·ÚÎÂÙ¤˜ ·ÔÎÏ›ÛÂÈ˜ ÛÙÈ˜ ‰È¿ÊÔÚÂ˜ Â˘Úˆ-

·˚Î¤˜ ¯ÒÚÂ˜ (15,16).

∏ ıÂÚ·Â›· ÌÂ G∏ Ô‰ËÁÂ› ÛÂ ÂÈÙ¿¯˘ÓÛË ÙÔ˘

Ú˘ıÌÔ‡ ·‡ÍËÛË˜ Î·È, Â¿Ó Ë ıÂÚ·Â›· ·Ú¯›ÛÂÈ ÂÁÎ·›-

Úˆ˜, ÛÂ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· ÂÓÙfi˜ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ

ÔÚ›ˆÓ. ÃÚÂÈ¿˙ÂÙ·È ÚÔÔ‰Â˘ÙÈÎ‹ ·‡ÍËÛË ÙË˜ ‰fiÛË˜

ÌÂ ÙËÓ ËÏÈÎ›·, ÒÛÙÂ ÙÔ ·È‰› Ó· ‚Ú›ÛÎÂÙ·È ÛÙ· Ê˘-

ÛÈÔÏÔÁÈÎ¿ fiÚÈ· ÙË˜ Î·Ì‡ÏË˜ ·‡ÍËÛË˜ Î·È Ó· ÂÈÙ‡-

¯ÂÈ ÙÔ ÁÂÓÂÙÈÎÒ˜ ·Ó·ÌÂÓfiÌÂÓÔ ·Ó¿ÛÙËÌ·. ∏ ıÂÚ·-

Â›· ÌÂ GH, ¤Ú· ·fi ÙÔ ‡„Ô˜, ¤¯ÂÈ Â˘ÂÚÁÂÙÈÎ‹ Â›-

‰Ú·ÛË ÛÙË ÛˆÌ·ÙÈÎ‹ Û‡ÛÙ·ÛË (body composition),

ÂÏ·ÙÙÒÓÔÓÙ·˜ ÙÔ ÏÈÒ‰Ë ÈÛÙfi, ·˘Í¿ÓÔÓÙ·˜ ÙË Ì˘˚Î‹

Ì¿˙· Î·È ·˘Í¿ÓÔÓÙ·˜ ÙËÓ ÔÛÙÈÎ‹ ˘ÎÓfiÙËÙ·. Œ¯ÂÈ

Â›ÛË˜ Â˘ÂÚÁÂÙÈÎ¤˜ ÌÂÙ·‚ÔÏÈÎ¤˜ ÂÈ‰Ú¿ÛÂÈ˜: ÌÂÈÒ-

ÓÂÈ ÙÔ ÏfiÁÔ ÙË˜ ÔÏÈÎ‹˜ ¯ÔÏËÛÙÂÚfiÏË˜ ÚÔ˜ ÙËÓ

HDL-¯ÔÏËÛÙÂÚfiÏË Î·È ‚ÂÏÙÈÒÓÂÈ ÙËÓ ·ÓÙ›ÛÙ·ÛË

ÛÙËÓ ÈÓÛÔ˘Ï›ÓË. ∏ ‰fiÛË ÙË˜ ıÂÚ·Â›·˜ Î˘Ì·›ÓÂÙ·È

·fi 0,15 ¤ˆ˜ 0,30 mg/Kg/Â‚‰ÔÌ¿‰·, ÛÂ Î·ıËÌÂÚÈÓ¤˜

˘Ô‰fiÚÈÂ˜ ÂÓ¤ÛÂÈ˜.

¶·ÚfiÏÔ Ô˘ Ë ıÂÚ·Â›· ÌÂ GH Ô‰ËÁÂ› ÛÂ ·‡ÍË-

ÛË ÙÔ˘ IGF-1, ÙÔ ÔÔ›Ô ¤¯ÂÈ ÌÈÙÔÁfiÓÔ ‰Ú¿ÛË, ‰ÂÓ

¤¯ÂÈ ·Ú·ÙËÚËıÂ› ·˘ÍËÌ¤ÓÔ˜ Î›Ó‰˘ÓÔ˜ ÁÈ· ·Ó¿Ù˘-

ÍË Î·ÎÔ‹ıÂÈ·˜ ÛÙ· ·È‰È¿ Ô˘ ·›ÚÓÔ˘Ó ÙË ıÂÚ·-

Â›· (17). Œ¯Ô˘Ó ·Ó·ÊÂÚıÂ› Û¿ÓÈ· Î·ÏÔ‹ıË˜ ÂÓ‰Ô-

ÎÚ·ÓÈ·Î‹ ˘¤ÚÙ·ÛË, ÂÚÈÊÂÚÈÎfi Ô›‰ËÌ·, ÂÈÊ˘ÛÈÔ-

Ï›ÛıËÛË ÙË˜ ÎÂÊ·Ï‹˜ ÙÔ˘ ÌËÚÈ·›Ô˘, ÂÈ‰Â›ÓˆÛË ÙË˜

ÛÎÔÏ›ˆÛË˜ Î·È Á˘Ó·ÈÎÔÌ·ÛÙ›· (17).

™‡Ó‰ÚÔÌÔ Turner

∏ Û˘¯ÓfiÙËÙ· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Â›Ó·È 1/2.500 -

1/3.000 ÁÂÓÓ‹ÛÂÈ˜ ÎÔÚÈÙÛÈÒÓ (1). T· ÎÔÚ›ÙÛÈ· ·˘Ù¿,

·Ú¿ ÙË Ê˘ÛÈÔÏÔÁÈÎ‹ ÂÓ‰ÔÁÂÓ‹ ¤ÎÎÚÈÛË GH, ·ÚÔ˘-

ÛÈ¿˙Ô˘Ó ¯·ÌËÏfi ·Ó¿ÛÙËÌ·, Ë ·ÈÙÈÔÏÔÁ›· ÙÔ˘ ÔÔ›Ô˘

Â›Ó·È Èı·ÓfiÓ ÔÏ˘·Ú·ÁÔÓÙÈÎ‹. ¢È¿ÊÔÚÔÈ ÌË¯·ÓÈ-

ÛÌÔ› ¤¯Ô˘Ó ÂÓÔ¯ÔÔÈËıÂ›, fiˆ˜: ÂÏ·ÙÙˆÌ¤ÓË ‚ÈÔ‰Ú·-

ÛÙÈÎfiÙËÙ· ÙË˜ GH, ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ¿ÍÔÓ· IGF, ÌÔÓÔ-

ÛˆÌ›· ÙÔ˘ Ã-¯ÚˆÌÔÛÒÌ·ÙÔ˜ (·Ô˘Û›· ÙÔ˘ ÁÔÓÈ‰›Ô˘

SHOX, Ô˘ Î·ıÔÚ›˙ÂÈ ÙÔ ·Ó¿ÛÙËÌ· Î·È ‚Ú›ÛÎÂÙ·È ÛÙÔ

‚Ú·¯‡ ÛÎ¤ÏÔ˜ ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ Ã) Î·È Èı·ÓfiÓ Î·È

Ë Ï‹ÚË˜ ·ÓÂ¿ÚÎÂÈ· ÔÈÛÙÚÔÁfiÓˆÓ Î·Ù¿ ÙËÓ ·È‰ÈÎ‹

Î·È ÂÊË‚ÈÎ‹ ËÏÈÎ›· (1,18). ∂ÂÈ‰‹ ‰ÂÓ ˘¿Ú¯ÂÈ GHD,

‰ÂÓ ¯ÚÂÈ¿˙ÂÙ·È ÔÈ ·ÛıÂÓÂ›˜ Ó· ˘Ô‚¿ÏÏÔÓÙ·È ÛÂ ‰ÔÎÈ-

Ì·Û›Â˜ ‰È¤ÁÂÚÛË˜ ÚÈÓ ·fi ÙË ¯ÔÚ‹ÁËÛË G∏. ∆Ô

‡„Ô˜ ÙˆÓ ·ÛıÂÓÒÓ ÌÂ Û‡Ó‰ÚÔÌÔ Turner Ú¤ÂÈ Ó·

ÚÔ‚¿ÏÏÂÙ·È ÛÙ· ÂÈ‰ÈÎ¿ ‰È·ÁÚ¿ÌÌ·Ù· ·‡ÍËÛË˜ (19).

∏ ¯ÔÚ‹ÁËÛË GH ÛÂ ·È‰È¿ Ô˘ ¿Ú¯ÈÛ·Ó ÙË ıÂÚ·-

Â›· ÛÙËÓ ËÏÈÎ›· ÙˆÓ 7-13 ÂÙÒÓ Ô‰ËÁÂ› ÛÂ ‚ÂÏÙ›ˆÛË

ÙÔ˘ Ú˘ıÌÔ‡ ·‡ÍËÛË˜ Î·È ÙÔ˘ ÙÂÏÈÎÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜

·fi 3 ¤ˆ˜ 12 cm (1,20,21). H ·ÓÙ·fiÎÚÈÛË ÛÙË ıÂÚ·-

Â›· ÌÂ GH, fiÛÔÓ ·ÊÔÚ¿ ÙÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ·, Â›Ó·È

Î·Ï‡ÙÂÚË fiÛÔ ÓˆÚ›ÙÂÚ· ·Ú¯›˙ÂÈ Ë ıÂÚ·Â›· (20,22).

∏ ıÂÚ·Â›· ÌÂ GH Á›ÓÂÙ·È Û˘Ó‹ıˆ˜ ÔÏ‡ Î·Ï¿ ·ÓÂ-

ÎÙ‹, Ë Î·ÏÔ‹ıË˜ ÂÓ‰ÔÎÚ¿ÓÈ· ˘¤ÚÙ·ÛË Î·È Ë ‹È·

·ÓÙ›ÛÙ·ÛË ÛÙËÓ ÈÓÛÔ˘Ï›ÓË Ô˘ ÌÔÚÂ› Ó· ÂÌÊ·ÓÈ-

ÛÙÔ‡Ó Â›Ó·È ·Ó·ÛÙÚ¤„ÈÌÂ˜, ·ÏÏ¿ Ë ÂÌÊ¿ÓÈÛË Ì¤ÛË˜

ˆÙ›ÙÈ‰·˜ Î·È Ë ·Ó¿ÁÎË ¯ÂÈÚÔ˘ÚÁÈÎ‹˜ Â¤Ì‚·ÛË˜ (ÛÙ·

·˘ÙÈ¿, ÙË Ì‡ÙË Î·È ÙÔ Ï¿Ú˘ÁÁ·) ·Ó·Ê¤ÚÂÙ·È Û˘¯ÓfiÙÂ-

ÚË ÛÙ· ·È‰È¿ Ô˘ ¤Ï·‚·Ó ıÂÚ·Â›· ÌÂ GH (1,20). √È

Ì·ÎÚÔÚfiıÂÛÌÂ˜ ÂÈÙÒÛÂÈ˜ ÙË˜ ıÂÚ·Â›·˜ ÌÂ G∏,

fiÛÔÓ ·ÊÔÚ¿ ÙÔ Î·Ú‰È·ÁÁÂÈ·Îfi Û‡ÛÙËÌ· Î·È ÙÔ ÌÂÙ¤-

ÂÈÙ· Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛË˜ ‰È·‚‹ÙË Ù‡Ô˘ 2 ÛÂ ÎÔÚ›-

ÙÛÈ· ÌÂ Û‡Ó‰ÚÔÌÔ Turner, ‰ÂÓ Â›Ó·È ·ÎfiÌ· Ï‹Úˆ˜

ÁÓˆÛÙ¤˜ (1). ÃÚÂÈ¿˙ÂÙ·È Ó· Á›ÓÔ˘Ó ÂÚÈÛÛfiÙÂÚÂ˜ Ì·-

ÎÚÔÚfiıÂÛÌÂ˜ ÌÂÏ¤ÙÂ˜, ÌÂ ÌÂÁ¿ÏÔ ·ÚÈıÌfi ·ÛıÂÓÒÓ,

ÁÈ· Ó· ÂÍ·¯ıÔ‡Ó ÔÚÈÛÙÈÎ¿ Û˘ÌÂÚ¿ÛÌ·Ù·.

∏ ÂÈÎÚ·ÙÔ‡Û· ¿Ô„Ë Â›Ó·È Ó· ¯ÔÚËÁÂ›Ù·È G∏

ÛÂ Î¿ıÂ ·È‰› ÌÂ Û‡Ó‰ÚÔÌÔ Turner (1). ∏ Û˘Ó‹ıË˜

‰fiÛË Â›Ó·È 0,30-0,35 mg/Kg/Â‚‰ÔÌ¿‰·. ∏ ıÂÚ·Â›·

Û˘Ó‰˘¿˙ÂÙ·È ÌÂ ÙË ¯ÔÚ‹ÁËÛË ÔÈÛÙÚÔÁfiÓˆÓ ÌÂÙ¿ ÙËÓ

ËÏÈÎ›· ÙˆÓ 12 ÂÙÒÓ.

ÃÚfiÓÈ· ÓÂÊÚÈÎ‹ ·ÓÂ¿ÚÎÂÈ· (Ã¡∞)

∆Ô ¯·ÌËÏfi ·Ó¿ÛÙËÌ· ·ÔÙÂÏÂ› ÛÔ‚·Úfi Úfi-

‚ÏËÌ· ÛÙ· ·È‰È¿ ÌÂ Ã¡∞. H ·ÈÙÈÔÏÔÁ›· ÙÔ˘ ¯·ÌË-

ÏÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜ Â›Ó·È ÔÏ˘·Ú·ÁÔÓÙÈÎ‹ Î·È ·ÊÔ-

Ú¿ ÙfiÛÔ ‰È·Ù·Ú·¯¤˜ ÛÙÔÓ ¿ÍÔÓ· GH-πGF-1, fiÛÔ Î·È


126 E. ∫Ô‡ÛÙ· Î·È Û˘Ó.


ÌÂÙ·‚ÔÏÈÎ¤˜ ‰È·Ù·Ú·¯¤˜ Î·È ‰È·Ù·Ú·¯¤˜ ÙË˜ ıÚ¤„Ë˜

(23,24). ∂ÂÈ‰‹ ‰ÂÓ ˘¿Ú¯ÂÈ ·ÓÂ¿ÚÎÂÈ·, ·ÏÏ¿ ·ÓÙ›-

ÛÙ·ÛË ÛÙË ‰Ú¿ÛË ÙË˜ GH, ‰ÂÓ ¯ÚÂÈ¿˙ÂÙ·È ÔÈ ·ÛıÂÓÂ›˜

Ó· ˘Ô‚¿ÏÏÔÓÙ·È ÛÂ ‰ÔÎÈÌ·Û›Â˜ ‰È¤ÁÂÚÛË˜ ÚÈÓ ·fi

ÙË ¯ÔÚ‹ÁËÛË G∏. ∏ ıÂÚ·Â›· ÌÂ GH, Â¿Ó ‰ÔıÂ› Óˆ-

Ú›˜, ÂÈÙ·¯‡ÓÂÈ ÙÔ Ú˘ıÌfi ·‡ÍËÛË˜ Î·È ‚ÂÏÙÈÒÓÂÈ ÙÔ

ÙÂÏÈÎfi ·Ó¿ÛÙËÌ·, ¯ˆÚ›˜ Ó· ˘¿Ú¯Ô˘Ó ÛËÌ·ÓÙÈÎ¤˜

·ÚÂÓ¤ÚÁÂÈÂ˜ (2,23,24). ∏ ıÂÚ·Â›· ¤¯ÂÈ ÂÁÎÚÈıÂ›

·fi ÙÔ 1996 Î·È ̄ ÔÚËÁÂ›Ù·È ÛÂ ·ÛıÂÓÂ›˜ ÌÂ Ã¡∞ ÚÔ-

ÂÊË‚ÈÎ‹˜ ËÏÈÎ›·˜ ÚÔÙÂÏÈÎÔ‡ Î·È ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘.

∏ ıÂÚ·Â›· Ú¤ÂÈ Ó· ·Ú¯›˙ÂÈ ÛÂ fiÛÔ ‰˘Ó·ÙfiÓ ÌÈ-

ÎÚfiÙÂÚË ËÏÈÎ›·, ÂÊfiÛÔÓ Ô Ú˘ıÌfi˜ ·‡ÍËÛË˜ ÂÌÊ·Ó›-

˙ÂÈ ÙÒÛË, Ë ÔÔ›· ‰ÂÓ ÔÊÂ›ÏÂÙ·È ÛÂ ·ÓÂ·ÚÎ‹ ıÚ¤-

„Ë ‹ ÌÂÙ·‚ÔÏÈÎ¤˜ ‰È·Ù·Ú·¯¤˜. ∏ ‰fiÛË ÙË˜ GH ÛÙË

Ã¡∞ Â›Ó·È 0,35 mg/Kg/Â‚‰ÔÌ¿‰·.

™‡Ó‰ÚÔÌÔ Prader-Willi

¶ÚfiÎÂÈÙ·È ÁÈ· Û¿ÓÈÔ ÁÂÓÂÙÈÎfi Û‡Ó‰ÚÔÌÔ (Û˘-

¯ÓfiÙËÙ· 1/10.000-15.000), ÙÔ ÔÔ›Ô ÔÊÂ›ÏÂÙ·È ÛÙËÓ

·ÒÏÂÈ· ÙË˜ ÁÔÓÈ‰È·Î‹˜ ¤ÎÊÚ·ÛË˜ ÙË˜ ÂÚÈÔ¯‹˜

15q11-q13 ÙÔ˘ ·ÙÚÈÎÔ‡ ·ÏÏËÏfiÌÔÚÊÔ˘ ·ÔÙ˘ˆ-

Ì¤ÓÔ˘ ÁÔÓÈ‰›Ô˘ (imprinted gene) Î·È ¯·Ú·ÎÙËÚ›˙ÂÙ·È

·fi ˘ÂÚÊ·Á›·, ·¯˘Û·ÚÎ›·, ˘ÔÁÔÓ·‰ÈÛÌfi, ¯·ÌË-

Ïfi ·Ó¿ÛÙËÌ· Î·È GHD ÔÊÂÈÏfiÌÂÓË ÛÂ ˘Ôı·Ï·ÌÈÎ‹

‰È·Ù·Ú·¯‹ (3,25). ∏ ıÂÚ·Â›· ÌÂ GH ÂÈÙ·¯‡ÓÂÈ ÙÔ

Ú˘ıÌfi ·‡ÍËÛË˜, ‚ÂÏÙÈÒÓÂÈ ÙÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· Î·È

¤¯ÂÈ È‰È·›ÙÂÚ· Â˘ÂÚÁÂÙÈÎ‹ Â›‰Ú·ÛË ÛÙË ÛˆÌ·ÙÈÎ‹

Û‡ÛÙ·ÛË, ÂÏ·ÙÙÒÓÔÓÙ·˜ ÙÔ ÏÈÒ‰Ë ÈÛÙfi Î·È ·˘Í¿ÓÔ-

ÓÙ·˜ ÙË Ì˘˚Î‹ Ì¿˙· (3,25). ∏ Û˘ÓÈÛÙÒÌÂÓË ‰fiÛË Â›-

Ó·È 0,25 mg/Kg/Â‚‰ÔÌ¿‰·. ¶ÚfiÛÊ·Ù· ·Ó·Ê¤ÚıËÎ·Ó

·ÈÊÓ›‰ÈÔÈ ı¿Ó·ÙÔÈ, Î˘Ú›ˆ˜ ·fi ÏÔÈÌÒÍÂÈ˜ ÙÔ˘ ·Ó·-

ÓÂ˘ÛÙÈÎÔ‡ Î·È ˘Ô·ÂÚÈÛÌfi ÛÂ ·È‰È¿ ÌÂ ÙÔ Û‡Ó-

‰ÚÔÌÔ, Ù· ÔÔ›· ÂÏ¿Ì‚·Ó·Ó ıÂÚ·Â›· ÌÂ GHØ ·Úfi-

ÏÔ Ô˘ ‰ÂÓ ¤¯ÂÈ ·Ô‰ÂÈ¯ıÂ› Ë Û˘Û¯¤ÙÈÛË ÙË˜ ıÂÚ·-

Â›·˜ ÌÂ GH, ¯ÚÂÈ¿˙ÂÙ·È Ó· Á›ÓÂÙ·È ÚÔÛÂÎÙÈÎfi˜

ˆÙÔÚÈÓÔÏ·Ú˘ÁÁÔÏÔÁÈÎfi˜ Î·È ·Ó·ÓÂ˘ÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜

ÚÈÓ ·fi ÙËÓ ¤Ó·ÚÍË ÙË˜ ıÂÚ·Â›·˜ (26).

ÕÏÏÂ˜ ÂÚÈÙÒÛÂÈ˜ ÛÙÈ˜ ÔÔ›Â˜ ¯ÔÚËÁÂ›Ù·È GH

ÛÂ ·È‰È¿, ÔÈ ÔÔ›Â˜ fiÌˆ˜ ‰ÂÓ ¤¯Ô˘Ó ¿ÚÂÈ

¤ÁÎÚÈÛË ÛÙË ¯ÒÚ· Ì·˜

¶·È‰È¿ Ô˘ ÁÂÓÓÈÔ‡ÓÙ·È ÌÈÎÚfiÛˆÌ· ÁÈ· ÙËÓ ËÏÈÎ›·

Î‡ËÛË˜ (Small for Gestational Age, SGA)

¶ÂÚ›Ô˘ 10% ÙˆÓ ·È‰ÈÒÓ ÌÂ SGA (‚¿ÚÔ˜ ‹/Î·È

Ì‹ÎÔ˜ <2 SD) ‰ÂÓ ÂÌÊ·Ó›˙Ô˘Ó ÂÈÙ¿¯˘ÓÛË ÙÔ˘ Ú˘ı-

ÌÔ‡ ·‡ÍËÛË˜ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ 2 ÚÒÙˆÓ ÂÙÒÓ

ÙË˜ ˙ˆ‹˜, ÌÂ ·ÔÙ¤ÏÂÛÌ· ¯·ÌËÏfi ·Ó¿ÛÙËÌ· ÛÙËÓ

·È‰ÈÎ‹ ËÏÈÎ›· Î·È ¯·ÌËÏfi ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· (ÂÚ›-

Ô˘ 1 SD Î¿Ùˆ ÙÔ˘ Ì¤ÛÔ˘ fiÚÔ˘) (27). ™Â ·È‰È¿ 2-4

ÂÙÒÓ ÌÂ SGA, Ù· ÔÔ›· ‰ÂÓ ÂÌÊ·Ó›˙Ô˘Ó ÂÈÙ¿¯˘ÓÛË

ÙÔ˘ Ú˘ıÌÔ‡ ·‡ÍËÛË˜ Î·È ¤¯Ô˘Ó ‡„Ô˜ <-2,5 SD (‹ ÛÂ

·È‰È¿ ÌÂ SGA ÌÂÁ·Ï‡ÙÂÚ· ÙˆÓ 4 ÂÙÒÓ ÌÂ ‡„Ô˜ <-2

SD), Û˘ÓÈÛÙ¿Ù·È Ó· Ï·Ì‚¿ÓÔ˘Ó ıÂÚ·Â›· ÌÂ GH

(27). ∏ ¯ÔÚ‹ÁËÛË GH ‚ÂÏÙÈÒÓÂÈ ÙÔ Ú˘ıÌfi ·‡ÍËÛË˜

Î·È ÙÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· ·˘ÙÒÓ ÙˆÓ ·ÛıÂÓÒÓ (4). §fi-

Áˆ ÙˆÓ Â˘ÓÔ˚ÎÒÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ÙˆÓ ÎÏÈÓÈÎÒÓ ÌÂ-

ÏÂÙÒÓ ˆ˜ ÚÔ˜ ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙË˜ ıÂÚ·-

Â›·˜, ·Ó Î·È ÛÂ ÂÚÈÔÚÈÛÌ¤ÓÔ ·ÚÈıÌfi ·ÛıÂÓÒÓ, ¤¯ÂÈ

‹‰Ë ÂÁÎÚÈıÂ› Ë ıÂÚ·Â›· ÛÂ ·˘Ù¿ Ù· ·È‰È¿ ÛÂ ∞ÌÂ-

ÚÈÎ‹ Î·È ∂˘ÚÒË Î·È ÛÙËÓ ∂ÏÏ¿‰· ¤¯ÂÈ ÂÁÎÚÈıÂ› ·fi

ÙÔÓ ∂√º Î·È ÙÔ ∫∂™À Î·È ‚Ú›ÛÎÂÙ·È ÛÙÔ ÙÂÏÈÎfi ÛÙ¿-

‰ÈÔ ̆ ÔÁÚ·Ê‹˜. √È Ì·ÎÚÔÚfiıÂÛÌÂ˜, fiÌˆ˜, ÌÂÙ·‚Ô-

ÏÈÎ¤˜ ÂÈÙÒÛÂÈ˜ ÙË˜ ıÂÚ·Â›·˜ ÌÂ GH, fiÛÔÓ ·ÊÔÚ¿

ÙËÓ ·ÓÙ›ÛÙ·ÛË ÛÙËÓ ÈÓÛÔ˘Ï›ÓË Î·È ÙËÓ ˘ÂÚÈÓÛÔ˘ÏÈ-

Ó·ÈÌ›· ÛÂ ·˘Ù¿ Ù· ·È‰È¿, Â›Ó·È ·ÎfiÌË ̆ fi ÌÂÏ¤ÙË. ∏

Û˘ÓÈÛÙÒÌÂÓË ‰fiÛË Â›Ó·È 0,25 mg/Kg/Â‚‰ÔÌ¿‰·.

¶·È‰È¿ ÌÂ È‰ÈÔ·ı¤˜ ̄ ·ÌËÏfi ·Ó¿ÛÙËÌ·

(Idiopathic Short Stature, ISS)

T· ·È‰È¿ ÌÂ È‰ÈÔ·ı¤˜ ¯·ÌËÏfi ·Ó¿ÛÙËÌ· (<2,25

SD) Â›Ó·È ÌÈ· ÂÙÂÚÔÁÂÓ‹˜ ÔÌ¿‰·, Ù· ÂÚÈÛÛfiÙÂÚ·

·fi ·˘Ù¿ (·ÏÏ¿ fi¯È fiÏ·) ‰ÂÓ ÊÙ¿ÓÔ˘Ó ÛÙÔ Ê˘ÛÈÔÏÔ-

ÁÈÎfi ÙÂÏÈÎfi ·Ó¿ÛÙËÌ·. ∏ ıÂÚ·Â›· ÌÂ GH ÁÈ· ·ÚÎÂ-

Ù¿ ¯ÚfiÓÈ· ·Ó·Ê¤ÚÂÙ·È fiÙÈ ÂÈÙ·¯‡ÓÂÈ ÙÔ Ú˘ıÌfi ·‡-

ÍËÛË˜, Â¿Ó ‰ÔıÂ› ÓˆÚ›˜, È‰›ˆ˜ ÛÙËÓ ·Ú¯‹ ÙË˜ ıÂÚ·-

Â›·˜ Î·È ‚ÂÏÙÈÒÓÂÈ ÙÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· Î·Ù¿ 4-7

cm, ÛÂ Î¿ÔÈÂ˜, ·ÏÏ¿ fi¯È ÛÂ fiÏÂ˜ ÙÈ˜ ÌÂÏ¤ÙÂ˜ (5). T·

Ì¤¯ÚÈ Û‹ÌÂÚ· ·ÔÙÂÏ¤ÛÌ·Ù·, ·ÚfiÙÈ ‰Â›¯ÓÔ˘Ó fiÙÈ Ë

ıÂÚ·Â›· ÌÂ GH Â›Ó·È ·ÛÊ·Ï‹˜ ÛÙ· ·È‰È¿ ·˘Ù¿, Â›-

Ó·È ·ÓÙÈÎÚÔ˘fiÌÂÓ· (5). ™ÙÈ˜ ∏¶∞ ¤¯ÂÈ ‰ÔıÂ› ¤ÁÎÚÈÛË

ÌfiÓÔ ÛÂ ¤Ó· ÛÎÂ‡·ÛÌ·. ¶ÚÔ˜ ÙÔ ·ÚfiÓ, Ë ¯ÔÚ‹ÁËÛË

GH ÛÙ· ·È‰È¿ ·˘Ù¿ Â›Ó·È ˘fi ÌÂÏ¤ÙË Î·È ı· Ú¤ÂÈ

Ó· Á›ÓÂÙ·È ÛÙ· Ï·›ÛÈ· ÂÚÂ˘ÓËÙÈÎÒÓ ÚˆÙÔÎfiÏÏˆÓ.

∏ Û˘ÓÈÛÙÒÌÂÓË ‰fiÛË Â›Ó·È 0,30 mg/Kg/Â‚‰ÔÌ¿‰·.

ÕÏÏÂ˜ ÂÚÈÙÒÛÂÈ˜ ̄ ÔÚ‹ÁËÛË˜ GH

H GH ¤¯ÂÈ Â›ÛË˜ ̄ ÔÚËÁËıÂ› ÌÂ Â˘ÓÔ˚Î¿ ·ÔÙÂÏ¤-

ÛÌ·Ù· ÛÂ ·È‰È¿ ÌÂ Û˘ÁÁÂÓ‹ ˘ÂÚÏ·Û›· ÂÈÓÂÊÚÈ-

‰›ˆÓ (28) Î·È ÛÂ ·È‰È¿ ÌÂ ÈÓÔÎ˘ÛÙÈÎ‹ ÓfiÛÔ (29), Ë

¯Ú‹ÛË ÙË˜, fiÌˆ˜, ÛÂ ·˘Ù¿ Ù· ·È‰È¿ ·ÎfiÌË ÌÂÏÂÙ¿Ù·È.

GHD ÛÂ ÂÓ‹ÏÈÎÂ˜

∞ÊÔÚ¿ ÂÚ›Ô˘ 200 ·ÛıÂÓÂ›˜ ·Ó¿ 1.000.000. ∏

ıÂÚ·Â›· ¯ÔÚËÁÂ›Ù·È ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ÛÔ‚·ÚÔ‡ ‚·ı-

ÌÔ‡ ·ÓÂ¿ÚÎÂÈ·, ‰ËÏ·‰‹ ÌÂ Ì¤ÁÈÛÙË ·¿ÓÙËÛË GH

ÛÙË ‰ÔÎÈÌ·Û›· ˘ÔÁÏ˘Î·ÈÌ›·˜, ÌÂÙ¿ ·fi ¯ÔÚ‹ÁËÛË

ÈÓÛÔ˘Ï›ÓË˜ <3 ng/ml. ∏ ¤ÏÏÂÈ„Ë GH ÛÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜

Ô‰ËÁÂ› ÛÂ ÎÂÓÙÚÈÎ‹ ·¯˘Û·ÚÎ›·, ÂÏ·ÙÙˆÌ¤ÓË ¿ÏÈÔ

Ì¿˙· (lean body mass), ÂÏ·ÙÙˆÌ¤ÓË ÔÛÙÈÎ‹ ˘ÎÓfi-

ÙËÙ·, ·˘ÍËÌ¤ÓË Î·Ú‰È·ÁÁÂÈ·Î‹ ÓÔÛËÚfiÙËÙ· Î·È

ÂËÚÂ·ÛÌ¤ÓË ÔÈfiÙËÙ· ˙ˆ‹˜, ÂÓÒ Ë ¯ÔÚ‹ÁËÛË GH

‚ÂÏÙÈÒÓÂÈ ÙË ÛˆÌ·ÙÈÎ‹ Û‡ÛÙ·ÛË Î·È ÙËÓ ÔÈfiÙËÙ·

˙ˆ‹˜ ÛÙÔ˘˜ ÂÚÈÛÛfiÙÂÚÔ˘˜ ·ÛıÂÓÂ›˜ (30). ∏ ‰fiÛË

Î·Ù¿ ÙËÓ ¤Ó·ÚÍË ÙË˜ ıÂÚ·Â›·˜ Î˘Ì·›ÓÂÙ·È ·fi

0,15-0,3 mg/ËÌ¤Ú·, ÌÂ ÚÔÔ‰Â˘ÙÈÎ‹ ·‡ÍËÛË, Ô˘

Î·ıÔÚ›˙ÂÙ·È ·fi Ù· Â›Â‰· ÙÔ˘ IGF-1 (30).


127∂Ó‰Â›ÍÂÈ˜ ¯ÔÚ‹ÁËÛË˜ ·˘ÍËÙÈÎ‹˜ ÔÚÌfiÓË˜

¶·È‰È·ÙÚÈÎ‹ 2008;71:123-127

BÈ‚ÏÈÔÁÚ·Ê›·

1. Sybert VP, McCauley E. Turner's syndrome. N Engl J Med2004;351:1227-1238.

2. Vimalachandra D, Hodson EM, Willis NS, Craig JC, Cow-ell C, Knight JF. Growth hormone for children with chron-ic kidney disease. Cochrane Database Syst Rev 2006;3:CD003264.

3. Burman P, Ritzén EM, Lindgren AC. Endocrine dysfunc-tion in Prader-Willi syndrome: a review with special refer-ence to GH. Endocr Rev 2001;22:787-799.

4. Ong K, Beardsall K, de Zegher F. Growth hormone therapyin short children born small for gestational age. Early HumDev 2005;81:973-980.

5. Cuttler L. Safety and efficacy of growth hormone treatmentfor idiopathic short stature. J Clin Endocrinol Metab 2005;90:5502-5504.

6. Saggese G, Baroncelli GI, Vanacore T, Fiore L, Ruggieri S,Federico G. Indications and strategies for continuing GHtreatment during transition from late adolescence to earlyadulthood in patients with GH deficiency: the impact onbone mass. J Endocrinol Invest 2004;27:596-602.

7. Sizonenko ƒC, Clayton ƒE, Cohen ƒ, Hintz RL. Tanaka T,Laron Z. Diagnosis and management of growth hormonedeficiency in childhood and adolescence. Part 1: diagnosisof growth hormone deficiency. Growth Horm IGF Res2001;11:137-165.

8. Rosenfeld RG, Albertsson-Wikland K, Cassorla F, FrasierSD, Hasegawa Y, Hintz RL, et al. Diagnostic controversy:the diagnosis of childhood growth hormone deficiency re-visited. J Clin Endocrinol Metab 1995;80:1532-1540.

9. Van den Broeck J, Arends N, Hokken-Koelega A. Growthresponse to recombinant human growth hormone (GH) inchildren with idiopathic growth retardation by level ofmaximum GH peak during GH stimulation tests. HormRes 2000;53:267-273.

10. Hindmarsh PC, Swift PG. An assessment of growth hor-mone provocation tests. Arch Dis Child 1995;72:362-368.

11. Gandrud LM, Wilson DM. Is growth hormone stimulationtesting in children still appropriate? Growth Horm IGF Res2004;14:185-194.

12. Carel JC, Tresca JP, Letrait ª, Chaussain JL, Lebouc Y, JobJC, et al. Growth hormone testing for the diagnosis ofgrowth hormone deficiency in childhood: a populationregister-based study. J Clin Endocrinol Metab 1997;82:2117-2121.

13. Ghigo E, Bellone J, Aimaretti G, Bellone S, Loche S, CappaM, et al. Reliability of provocative tests to assess growthhormone secretory status. Study in 472 normally growingchildren. J Clin Endocrinol Metab 1996;81:3323-3327.

14. Growth Hormone Research Society. Consensus guidelinesfor the diagnosis and treatment of growth hormone (GH)deficiency in childhood and adolescence: summary state-ment of the GH Research Society. GH Research Society. JClin Endocrinol Metab 2000;85:3990-3993.

15. Frasier SD. Editorial: the diagnosis and treatment of child-hood and adolescent growth hormone deficiency--consen-sus or confusion? J Clin Endocrinol Metab 2000;85:3988-3989.

16. Juul A, Bernasconi S, Clayton PE, Kiess W, DeMuinck-Keizer Schrama S; Drugs and Therapeutics Committee ofthe European Society for Paediatric Endocrinology(ESPE). European audit of current practice in diagnosisand treatment of childhood growth hormone deficiency.Horm Res 2002;58:233-241.

17. Bowlby DA, Rapaport R. Safety and efficacy of growth hor-mone therapy in childhood. Pediatr Endocrinol Rev 2004;2Suppl 1:68-77.

18. Rao E, Weiss B, Fukami M, Rump A, Niesler B, Mertz A, etal. Pseudoautosomal deletions encompassing a novelhomeobox gene cause growth failure in idiopathic shortstature and Turner syndrome. Nat Genet 1997;16:54-63.

19. Lyon AJ, Preece MA, Grant DB. Growth curve for girlswith Turner syndrome. Arch Dis Child 1985;60:932-935.

20. Stephure DK; Canadian Growth Hormone Advisory Com-mittee. Impact of growth hormone supplementation onadult height in turner syndrome: results of the Canadianrandomized controlled trial. J Clin Endocrinol Metab2005;90:3360-3366.

21. Baxter L, Bryant J, Cave CB, Milne R. Recombinant growthhormone for children and adolescents with Turner syn-drome. Cochrane Database Syst Rev 2007;(1):CD003887.

22. Ranke MB, Lindberg A, Ferrãandez Long ãas A, DarendelilerF, Albertsson-Wikland K, Dunger D, et al. Major determi-nants of height development in Turner syndrome (TS) pa-tients treated with GH: analysis of 987 patients from KIGS.Pediatr Res 2007;61:105-110.

23. Mahan JD, Warady BA; the Consensus Committee. Assess-ment and treatment of short stature in pediatric patientswith chronic kidney disease: a consensus statement. Pedia-tr Nephrol 2006;21:917-930.

24. Stefanidis CJ, Klaus G. Growth of prepubertal children ondialysis. Pediatr Nephrol. 2007;22:1251-1259.

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26. Eiholzer U. Deaths in children with Prader-Willi syn-drome. A contribution to the debate about the safety ofgrowth hormone treatment in children with PWS. HormRes 2005;63:33-39.

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28. Gallagher MP, Levine LS, Oberfield SE. A review of the ef-fects of therapy on growth and bone mineralization in chil-dren with congenital adrenal hyperplasia. Growth HormIGF Res 2005;15 Suppl A:S26-30.

29. Hardin DS, Ferkol T, Ahn C, Dreimane D, Dyson M,Morse M, et al. A retrospective study of growth hormoneuse in adolescents with cystic fibrosis. Clin Endocrinol(Oxf) 2005;62:560-566.

30. Drake WM, Howell SJ, Monson JP, Shalet SM. Optimizinggh therapy in adults and children. Endocr Rev 2001;22:425-450.


∆ÂÏÈÎfi ·Ó¿ÛÙËÌ· ÛÂ ·È‰È¿ ÌÂ ·ÓÂ¿ÚÎÂÈ· ·˘ÍËÙÈÎ‹˜ ÔÚÌfi-

ÓË˜ Ô˘ ¤Ï·‚·Ó ıÂÚ·Â›· ˘ÔÎ·Ù¿ÛÙ·ÛË˜

ª. ¶··‰ÔÔ‡ÏÔ˘1, ™. ¡ÙÔ˘Ì¿2, ∫. ∫›ÙÛÈÔ˜3, ¡. ∫·‰fiÁÏÔ˘3, ∫. ∫ÒÛÙ·1, π. ∆ÛÈÔ‡ÚË˜1

¶ÂÚ›ÏË„Ë

∂ÈÛ·ÁˆÁ‹: ™ÎÔfi˜ ÙË˜ ÌÂÏ¤ÙË˜ ‹Ù·Ó Ë ÂÎÙ›ÌËÛË ÙÔ˘ ÙÂÏÈÎÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜ ÛÂ ·È‰È¿ ÌÂ ·ÓÂ¿ÚÎÂÈ· ·˘-ÍËÙÈÎ‹˜ ÔÚÌfiÓË˜ (GH) Ô˘ ¤Ï·‚·Ó ıÂÚ·Â›· ˘ÔÎ·Ù¿ÛÙ·ÛË˜ ÌÂ ·Ó·Û˘Ó‰˘·ÛÌ¤ÓË GH Î·È Ô ÚÔÛ‰ÈÔ-ÚÈÛÌfi˜ ·Ú·ÁfiÓÙˆÓ Ô˘ Û˘Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÙÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ·.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ªÂÏÂÙ‹ıËÎ·Ó 72 ·È‰È¿ (25 ÚÔÂÊË‚ÈÎ¿) ÌÂ ÌÂÌÔÓˆÌ¤ÓË (61/72) ‹ Û˘Ó‰˘·ÛÌ¤ÓË(11/72) ·ÓÂ¿ÚÎÂÈ· GH, Ô˘ ‰È·ÁÓÒÛÙËÎÂ ÌÂÙ¿ ·fi ÚÔÛ‰ÈÔÚÈÛÌfi ÙË˜ GH ÌÂ ‰ÔÎÈÌ·Û›Â˜ ‰È¤ÁÂÚÛË˜. ∆··È‰È¿ ¤Ï·‚·Ó ıÂÚ·Â›· ˘ÔÎ·Ù¿ÛÙ·ÛË˜ ÌÂ GH sc, 3, 6 ‹ 7 ÊÔÚ¤˜ Â‚‰ÔÌ·‰È·›ˆ˜. ¶ÚÔÛ‰ÈÔÚ›ÛÙËÎÂ ÁÈ·Î¿ıÂ ·È‰› ÙÔ ‡„Ô˜-ÛÙfi¯Ô˜. ∫·Ù·ÁÚ¿ÊËÎ·Ó Î·Ù¿ ÙËÓ ¤Ó·ÚÍË ÙË˜ ıÂÚ·Â›·˜ Î·È ·ÎÔÏÔ‡ıˆ˜ ·Ó¿ ÂÍ¿ÌË-ÓÔ ÙÔ ‡„Ô˜ ÛÂ fiÚıÈ· ı¤ÛË, Ë ÔÛÙÈÎ‹ ËÏÈÎ›·, Ô ÂÙ‹ÛÈÔ˜ Ú˘ıÌfi˜ ·‡ÍËÛË˜ Î·È ÙÔ ÛÙ¿‰ÈÔ ÂÓ‹‚ˆÛË˜.

∞ÔÙÂÏ¤ÛÌ·Ù·: ∏ ‰È·ÊÔÚ¿ ÙË˜ Ì¤ÛË˜ ÛÙ·ıÂÚ‹˜ ·fiÎÏÈÛË˜ ·Ó·ÛÙ‹Ì·ÙÔ˜ ÛÙÔ Ù¤ÏÔ˜ ÙË˜ ıÂÚ·Â›·˜ ÛÂÛ¯¤ÛË ÌÂ Ù· ÚÔ ·˘Ù‹˜ Â›Â‰· ‹Ù·Ó 1,3. ™ÙÔ ‡„Ô˜-ÛÙfi¯Ô ¤ÊÙ·Û·Ó 23 ·È‰È¿ (32%). À‹Ú¯Â ÛËÌ·ÓÙÈ-Î‹ Û˘Û¯¤ÙÈÛË ÙÔ˘ ÙÂÏÈÎÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜ ÌÂ ÙÔ ·Ú¯ÈÎfi ‡„Ô˜, ÙÔ ‡„Ô˜-ÛÙfi¯Ô Î·È ÙÔÓ ·ÚÈıÌfi ÙˆÓ ÂÓ¤ÛÂˆÓ·Ó¿ Â‚‰ÔÌ¿‰·, ÂÓÒ ‰ÂÓ ‰È·ÈÛÙÒıËÎÂ ÛËÌ·ÓÙÈÎ‹ Û˘Û¯¤ÙÈÛË ÌÂ ÙËÓ ËÏÈÎ›· ¤Ó·ÚÍË˜ ÙË˜ ıÂÚ·Â›·˜, ÙË‰È¿ÚÎÂÈ· ÙË˜ ıÂÚ·Â›·˜, ÙÔ Ê‡ÏÔ Î·È ÙÔ Ú˘ıÌfi ·‡ÍËÛË˜ Î·Ù¿ ÙÔ ÚÒÙÔ ¤ÙÔ˜ ÙË˜ ıÂÚ·Â›·˜. ∆· ·È‰È¿ ÌÂÛ˘Ó‰˘·ÛÌ¤ÓË ·ÓÂ¿ÚÎÂÈ· ÔÚÌÔÓÒÓ Î¤Ú‰ÈÛ·Ó ÂÚÈÛÛfiÙÂÚÔ ‡„Ô˜ ÌÂ ÙË ıÂÚ·Â›· ÛÂ Û¯¤ÛË ÌÂ ÂÎÂ›Ó· ÌÂÌÂÌÔÓˆÌ¤ÓË ·ÓÂ¿ÚÎÂÈ· GH.

™˘ÌÂÚ¿ÛÌ·Ù·: ∏ ¯ÔÚ‹ÁËÛË GH ·ÔÙÂÏÂ› ·ÔÙÂÏÂÛÌ·ÙÈÎ‹ ıÂÚ·Â›· ÁÈ· ·È‰È¿ ÌÂ ¯·ÌËÏfi ·Ó¿ÛÙËÌ·ÔÊÂÈÏfiÌÂÓÔ ÛÂ ·ÓÂ¿ÚÎÂÈ· ·˘Ù‹˜. ∆Ô ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· ÛÙ· ·È‰È¿ ·˘Ù¿ Ê·›ÓÂÙ·È ˆ˜ Î·ıÔÚ›˙ÂÙ·È ÛÂ ÌÂ-Á¿ÏÔ ‚·ıÌfi ·fi ÙÔ ‡„Ô˜-ÛÙfi¯Ô Î·È ·fi ÙÔÓ ·ÚÈıÌfi ÙˆÓ ÂÓ¤ÛÂˆÓ GH ·Ó¿ Â‚‰ÔÌ¿‰·.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: A˘ÍËÙÈÎ‹ ÔÚÌfiÓË, ‹‚Ë, Û˘Ó‰˘·ÛÌ¤ÓË ·ÓÂ¿ÚÎÂÈ· ÔÚÌÔÓÒÓ, ÙÂÏÈÎfi ·Ó¿ÛÙËÌ·, ‡„Ô˜-ÛÙfi¯Ô˜.

Final height of children with growth hormone deficiency who

received replacement treatment

M. Papadopoulou1, S. Douma2, K. Kitsios3, N. Kadoglou3, K. Kosta1, I. Tsiouris1

Abstract

Background: The aim of the study was the evaluation of the final height of children with Growth Hormone(GH) deficiency treated with recombinant GH, and of the factors related to their final height.

Methods: Seventy two children (25 prepubertal) with isolated (61/72) or combined (11/72) GHdeficiency, diagnosed after measurement of GH following stimulation tests with clonidin or insulin, weremonitored. The children were treated with 3, 6 or 7 weekly subcutaneous injections of recombinant GH.The target height (TH) was calculated for each child. Height, bone age, growth velocity and pubertal stagewere recorded at the beginning of treatment and every 6 months. Final height was defined as the heightat the time of the complete fusion of the epiphyses observed in a plain X-ray of the hand and wrist.

Results: The difference in the SDS of the mean final height before and after GH treatment was 1.3. Twentythree children (32%) reached the TH. The final height was associated statistically with the initial height, theTH and the number of weekly injections, while no relationship was observed with the age at the beginningof treatment, the duration of treatment, the growth velocity during the first year of treatment or the sex ofthe child. Children with combined hormone deficiency gained more height than those with isolated GHdeficiency, but they also had a greater TH.

Conclusions: GH replacement therapy is beneficial for children with small height due to deficiency of thehormone. The final height in these children appears to be highly predictable by the TH and the number ofGH injections given weekly.

Key words: Growth hormone, puberty, combined hormone deficiency, final height, target height.

128 ∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞ ORIGINAL ARTICLE

1. °’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹∞¶£, πÔÎÚ¿ÙÂÈÔ °¶¡£

2. ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹,°ÂÓÈÎfi ¡ÔÛÔÎoÌÂ›Ô ∫ÈÏÎ›˜

3. ∞’ ¶·ıÔÏÔÁÈÎ‹ ∫ÏÈÓÈÎ‹,πÔÎÚ¿ÙÂÈÔ °¶¡£


∫ˆÓÛÙ·ÓÙ›Ó· ∫ÒÛÙ·,[email protected]°’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ∞¶£,πÔÎÚ¿ÙÂÈÔ °¶¡£

1. 3rd PaediatricDepartment, AristotleUniversity of Thessaloniki,Hippokration GeneralHospital of Thessaloniki

2. Paediatric Department,General Hospital of Kilkis

3. 1st Department ofInternal Medicine,Hippokration GeneralHospital of Thessaloniki

Correspondence:

∫onstantina Kosta,[email protected] Paediatric Department,Aristotle University of Thessaloniki,Hippokration GeneralHospital of Thessaloniki



∂ÈÛ·ÁˆÁ‹

∏ ·ÓıÚÒÈÓË ·˘ÍËÙÈÎ‹ ÔÚÌfiÓË (GH) Â›Ó·È Ë Î‡-

ÚÈ· ‰Ú·ÛÙÈÎ‹ ÔÚÌfiÓË Ô˘ ÚÔ¿ÁÂÈ ÙËÓ ·‡ÍËÛË ÛÙËÓ

·È‰ÈÎ‹ ËÏÈÎ›·, È‰›ˆ˜ ÌÂÙ¿ ÙÔÓ ÚÒÙÔ ¯ÚfiÓÔ ÙË˜ ˙ˆ-

‹˜ (1). ∏ GH Â›Ó·È ·Ó·‚ÔÏÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ Ô˘

ÚÔ¿ÁÂÈ ÙËÓ ·‡ÍËÛË fiÏˆÓ ÙˆÓ ÈÛÙÒÓ ÙÔ˘ ÛÒÌ·ÙÔ˜.

√È ‰Ú¿ÛÂÈ˜ ÙË˜ Â›Ó·È ·) ¿ÌÂÛÂ˜ ÌÂÙ·‚ÔÏÈÎ¤˜ Ô˘ ‰È-

Â˘ÎÔÏ‡ÓÔ˘Ó ÙËÓ ·‡ÍËÛË ÙˆÓ Ì˘ÒÓ Î·È ÙËÓ ÂÍÔÈÎÔÓfi-

ÌËÛË ÙË˜ ÁÏ˘Îfi˙Ë˜ Î·È ‚) ·˘ÍËÙÈÎ¤˜ ÛÙÔ ÛÎÂÏÂÙfi. ∏

·‡ÍËÛË ÙÔ˘ ÛÎÂÏÂÙÔ‡ Ï·Ì‚¿ÓÂÈ ̄ ÒÚ· ÛÙÈ˜ ÂÈÊ‡ÛÂÈ˜

ÙˆÓ Ì·ÎÚÒÓ ÔÛÙÒÓ Î·È Ë Â›‰Ú·ÛË ·˘Ù‹ ‰È·ÎfiÙÂ-

Ù·È ÌÂ ÙË Û‡ÁÎÏÈÛË ÙˆÓ ÂÈÊ‡ÛÂˆÓ. ∏ GH ‰Ú· ÛÙÔ

Û˘˙Â˘ÎÙÈÎfi ¯fiÓ‰ÚÔ, fiÔ˘ ‰ÈÂÁÂ›ÚÂÈ ÙÔÓ ÔÏÏ·Ï·-

ÛÈ·ÛÌfi ÙˆÓ ¯ÔÓ‰ÚÔÎ˘ÙÙ¿ÚˆÓ ·ÊÂÓfi˜ Î·È ·ÊÂÙ¤ÚÔ˘

ÙËÓ ·Ú·ÁˆÁ‹ ÙˆÓ ÈÓÛÔ˘ÏÈÓoÌfiÚÊˆÓ ·˘ÍËÙÈÎÒÓ ·-

Ú·ÁÔÓÙˆÓ (IGF). √ ÈÓÛÔ˘ÏÈÓfiÌÔÚÊÔ˜ ·Ú¿ÁÔÓÙ·˜ π

(IGF-1) ‰ÈÂÁÂ›ÚÂÈ ÙÔÓ ÔÏÏ·Ï·ÛÈ·ÛÌfi Î·È ÙË ‰È·-

ÊÔÚÔÔ›ËÛË ÙˆÓ ¯ÔÓ‰ÚÔÎ˘ÙÙ¿ÚˆÓ. ∏ ¤ÏÏÂÈ„Ë ·˘-

ÍËÙÈÎ‹˜ ÔÚÌfiÓË˜ ÂÎ‰ËÏÒÓÂÙ·È ˆ˜: ·) ¯·ÌËÏfi ·Ó¿-

ÛÙËÌ· (2,5 ÛÙ·ıÂÚ¤˜ ·ÔÎÏ›ÛÂÈ˜ (SDS) Î¿Ùˆ ·fi ÙÔ

Ì¤ÛÔ fiÚÔ ÁÈ· ÙËÓ ËÏÈÎ›· Î·È ÙÔ Ê‡ÏÔ), ‚) Î·ı˘ÛÙ¤ÚË-

ÛË ÛÙËÓ ˆÚ›Ì·ÓÛË ÙˆÓ ÔÛÙÒÓ, Á) ¯·ÌËÏ‹ Ù·¯‡ÙËÙ·

·‡ÍËÛË˜ Î·È ‰) ¯·ÌËÏ‹ ¤ÎÎÚÈÛË ÙË˜ ·˘ÍËÙÈÎ‹˜ ÔÚ-

ÌfiÓË˜ ÌÂÙ¿ ·fi ‰ÔÎÈÌ·Û›· ‰È¤ÁÂÚÛË˜.

™Â ·È‰È¿ ÌÂ ¤ÏÏÂÈ„Ë ·˘ÍËÙÈÎ‹˜ ÔÚÌfiÓË˜, ¯ÔÚË-

ÁÂ›Ù·È ıÂÚ·Â˘ÙÈÎ¿ ‚ÈÔÛ˘ÓıÂÙÈÎ‹ GH Ô˘ ·Ú¿ÁÂ-

Ù·È ÌÂ ÙË Ì¤ıÔ‰Ô ÙÔ˘ ·Ó·Û˘Ó‰˘·ÛÌ¤ÓÔ˘ DNA. ∏ ̄ Ô-

Ú‹ÁËÛË Á›ÓÂÙ·È ÌÂ ÙË ÌÔÚÊ‹ ˘Ô‰ÔÚ›ˆÓ ÂÓ¤ÛÂˆÓ. ∏

‚ÈÔÛ˘ÓıÂÙÈÎ‹ GH ·Ú·ÛÎÂ˘¿ÛÙËÎÂ ·Ú¯ÈÎ¿ ÙÔ 1979,

·ÏÏ¿ ¿Ú¯ÈÛÂ Ó· ¯ÚËÛÈÌÔÔÈÂ›Ù·È Â˘Ú¤ˆ˜ ·fi ÙÔ

1985, ÔfiÙÂ Î·È ·ÓÙÈÎ·Ù¿ÛÙËÛÂ ÙËÓ ÙˆÌ·ÙÈÎ‹ ·˘-

ÍËÙÈÎ‹ ÔÚÌfiÓË Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ ·fi ÙÔ 1957.

∏ ıÂÚ·Â›· ·ÔÛÎÔÂ› ÛÙÔ Ó· ÂÈÙÂ˘¯ıÂ› ÙÂÏÈÎfi

‡„Ô˜ Ì¤Û· ÛÙ· Ï·›ÛÈ· ÙÔ˘ ·Ó·ÌÂÓfiÌÂÓÔ˘ ÁÈ· ÙËÓ

ÔÈÎÔÁ¤ÓÂÈ· ‡„Ô˘˜, ÚÔÛ·ÚÌÔÛÌ¤ÓÔ˘ ÛÙÔ Ê‡ÏÔ.

™ÎÔfi˜ ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ Â›Ó·È Ë ÂÎÙ›ÌËÛË

ÙÔ˘ ÙÂÏÈÎÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜ ÛÂ ·È‰È¿ ÌÂ ·ÓÂ¿ÚÎÂÈ·

·˘ÍËÙÈÎ‹˜ ÔÚÌfiÓË˜ Ô˘ ¤Ï·‚·Ó ıÂÚ·Â›· ˘ÔÎ·Ù¿-

ÛÙ·ÛË˜ Î·È Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ ·Ú·ÁfiÓÙˆÓ Ô˘ Û˘-

Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ·˘Ùfi.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ

ªÂÏÂÙ‹ıËÎ·Ó 72 ·È‰È¿, 43 ·ÁfiÚÈ· Î·È 29 ÎÔÚ›ÙÛÈ·, ÌÂ

¯·ÌËÏfi ·Ó¿ÛÙËÌ· Î·È ·ÓÂ¿ÚÎÂÈ· ·˘ÍËÙÈÎ‹˜ ÔÚÌfiÓË˜, Ô˘

¤Ï·‚·Ó ıÂÚ·Â›· ˘ÔÎ·Ù¿ÛÙ·ÛË˜ ÌÂ ·˘ÍËÙÈÎ‹ ÔÚÌfiÓË (GH)

¯ÔÚËÁÔ‡ÌÂÓË ˘Ô‰fiÚÈ·. ∆· 61 Â›¯·Ó ÌÂÌÔÓˆÌ¤ÓË ·ÓÂ¿Ú-

ÎÂÈ· ·˘ÍËÙÈÎ‹˜ ÔÚÌfiÓË˜ Î·È Ù· 11 Û˘Ó‰˘·ÛÌ¤ÓË. ∂È‰ÈÎfiÙÂÚ·:

6 ·È‰È¿, 4 ·ÁfiÚÈ· Î·È 2 ÎÔÚ›ÙÛÈ·, Â›¯·Ó ·ÓÂ¿ÚÎÂÈ· ı˘ÚÔÍ›-

ÓË˜ (∆4), 1 ·ÁfiÚÈ Â›¯Â ·ÓÂ¿ÚÎÂÈ· ∆4 Î·È ÙÂÛÙÔÛÙÂÚfiÓË˜, 1

ÎÔÚ›ÙÛÈ Â›¯Â ·ÓÂ¿ÚÎÂÈ· ∆4 Î·È ÔÈÛÙÚÔÁfiÓˆÓ, 1 ·ÁfiÚÈ Â›¯Â

·ÓÂ¿ÚÎÂÈ· ∆4 Î·È ¿ÔÈÔ ‰È·‚‹ÙË Î·È 2 ÎÔÚ›ÙÛÈ· ·Ó˘ÔÊ˘-

ÛÈÛÌfi ÌÂÙ¿ ·fi ¯ÂÈÚÔ˘ÚÁËı¤ÓÙÂ˜ ÂÁÎÂÊ·ÏÈÎÔ‡˜ fiÁÎÔ˘˜. ∏

Ì¤ÛË ËÏÈÎ›· ÙˆÓ ·È‰ÈÒÓ Î·Ù¿ ÙËÓ ¤Ó·ÚÍË ÙË˜ ·ÁˆÁ‹˜ ‹Ù·Ó

11,6±2,9 ¤ÙË Î·È Î·Ù¿ ÙÔ ¤Ú·˜ ·˘Ù‹˜ 16,2±1,6. ∞ÓıÚˆÔÌÂ-

ÙÚÈÎ¤˜ ÌÂÙÚ‹ÛÂÈ˜ Á›ÓÔÓÙ·Ó ÌÂ ·Ó·ÛÙËÌfiÌÂÙÚÔ Harpenden

ÛÙËÓ ¤Ó·ÚÍË ÙË˜ ıÂÚ·Â›·˜ Î·È ·Ó¿ ÂÍ¿ÌËÓÔ Î·ı’ fiÏË ÙË ‰È¿Ú-

ÎÂÈ¿ ÙË˜. ∏ Ì¤ÙÚËÛË ÙÔ˘ ‡„Ô˘˜ Î¿ıÂ ·È‰ÈÔ‡ ÁÈÓfiÙ·Ó ÛÂ fiÚıÈ·

ı¤ÛË Î·È ÙÔ ·ÔÙ¤ÏÂÛÌ· ÛËÌÂÈˆÓfiÙ·Ó ÛÙÈ˜ Î·Ì‡ÏÂ˜ ·‡ÍËÛË˜

ÙˆÓ Tanner Î·È Whitehouse ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË ÙË˜ ÂÎ·ÙÔÛÙÈ·›-

·˜ ı¤ÛË˜ (∂£). ¶ÚÔÛ‰ÈÔÚÈ˙fiÙ·Ó Ô ÂÙ‹ÛÈÔ˜ Ú˘ıÌfi˜ ·‡ÍËÛË˜

(∂ƒ∞). √ ∂ƒ∞ ‹ height velocity Â›Ó·È Ë ‰È·ÊÔÚ¿ ÙÔ˘ ‡„Ô˘˜ ÛÂ

¤Ó· ¯ÚfiÓÔ. ¶ÚÔÛ‰ÈÔÚ›˙ÂÙ·È ·fi ÙÔ ËÏ›ÎÔ ÙË˜ ‰È·ÊÔÚ¿˜ ÙÔ˘

‡„Ô˘˜ ·Ó¿ÌÂÛ· ÛÂ ‰‡Ô ÌÂÙÚ‹ÛÂÈ˜ ‰È· ÙÔ˘ ̄ ÚfiÓÔ˘ Ô˘ ÌÂÛÔÏ¿-

‚ËÛÂ Î·È ÂÎÊÚ¿˙ÂÙ·È ÛÂ cm/¤ÙÔ˜. ∆Ô ̄ ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ̆ ÔÏÔ-

Á›˙ÂÙ·È ·ÎÚÈ‚Ò˜ ÌÂ ÙÔ ‰ÂÎ·‰ÈÎfi ËÌÂÚÔÏfiÁÈÔ. √È ÌÂÙÚ‹ÛÂÈ˜ ÙÔ˘

‡„Ô˘˜ Î·È ÙÔ˘ ∂ƒ∞ ÙÔ˘ Î¿ıÂ ·È‰ÈÔ‡ ÂÎÊÚ¿ÛÙËÎ·Ó ÛÂ ‰Â›ÎÙÂ˜

ÛÙ·ıÂÚ‹˜ ·fiÎÏÈÛË˜ (Standard Deviation Score, SDS) ÌÂ ‚¿ÛË

ÙË ¯ÚÔÓÔÏÔÁÈÎ‹ ËÏÈÎ›·. √ ‰Â›ÎÙË˜ ·˘Ùfi˜ ‰Â›¯ÓÂÈ fiÛÂ˜ ·ÎÚÈ-

‚Ò˜ ÛÙ·ıÂÚ¤˜ ·ÔÎÏ›ÛÂÈ˜ ·fi ÙÔ Ì¤ÛÔ fiÚÔ ‚Ú›ÛÎÂÙ·È ÙÔ ‡„Ô˜

‹ ¿ÏÏË Ì¤ÙÚËÛË ÙÔ˘ ·È‰ÈÔ‡. √ ‰Â›ÎÙË˜ ·˘Ùfi˜ ˘ÔÏÔÁ›˙ÂÙ·È

·fi ÙÔÓ Ù‡Ô: SDS=(X-XÌÙ) / SD, fiÔ˘ Ã: ‡„Ô˜ (‹ ¿ÏÏË Ì¤-

ÙÚËÛË ÙÔ˘ ·È‰ÈÔ‡), ÃÌÙ: Ë Ì¤ÛË ÙÈÌ‹ ÙÔ˘ ‡„Ô˘˜ (·fi ›Ó·-

ÎÂ˜) Ô˘ ·ÓÙÈÛÙÔÈ¯Â› ÛÙËÓ ËÏÈÎ›· Î·È ÙÔ Ê‡ÏÔ ÙÔ˘ ·È‰ÈÔ‡ Î·È

SD: Ë ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË ÙË˜ ›‰È·˜ ËÏÈÎ›·˜ (2).

∂›ÛË˜, ˘ÔÏÔÁ›ÛÙËÎÂ ÙÔ ‡„Ô˜-ÛÙfi¯Ô˜ (target height,

TH) ÁÈ· Ó· ÂÏÂÁ¯ıÂ› ·Ó ÙÔ ÙÂÏÈÎfi ‡„Ô˜ ÙÔ˘ ·È‰ÈÔ‡ ‚Ú›ÛÎÂÙ·È

ÂÓÙfi˜ ÙÔ˘ ÁÂÓÂÙÈÎÔ‡ ‰˘Ó·ÌÈÎÔ‡ ÙÔ˘. ∆Ô TH ˘ÔÏÔÁ›˙ÂÙ·È ·Ó

ÛÙÔ Ì¤ÛÔ ‡„Ô˜ ÙˆÓ ÁÔÓ¤ˆÓ ÚÔÛÙÂıÔ‡Ó 6,5 cm, ÚÔÎÂÈÌ¤ÓÔ˘

ÁÈ· ·ÁfiÚÈ, ‹ ·Ê·ÈÚÂıÔ‡Ó 6,5 cm, ÚÔÎÂÈÌ¤ÓÔ˘ ÁÈ· ÎÔÚ›ÙÛÈ.

°ÈÓfiÙ·Ó ˘ÔÏÔÁÈÛÌfi˜ ÙË˜ ÔÛÙÈÎ‹˜ ËÏÈÎ›·˜ ÛÙËÓ ¤Ó·ÚÍË

ÙË˜ ·ÁˆÁ‹˜ Î·È ·Ó¿ ¤ÙÔ˜, Û‡ÌÊˆÓ· ÌÂ ÙÔÓ ¿ÙÏ·ÓÙ· TWRUS.

∂›ÛË˜, ÁÈÓfiÙ·Ó ÛÙ·‰ÈÔÔ›ËÛË ÙË˜ ÂÊË‚Â›·˜ Î·Ù¿ Tanner

ÛÙËÓ ¤Ó·ÚÍË ÙË˜ ıÂÚ·Â›·˜ Î·È ·Ó¿ ÂÍ¿ÌËÓÔ. ¶ÚÔÂÊË‚ÈÎfi

ıÂˆÚÂ›ÙÔ Î¿ıÂ ÎÔÚ›ÙÛÈ ̄ ˆÚ›˜ „ËÏ·ÊËÙfi Ì·˙ÈÎfi ·‰¤Ó· Î·È Î¿-

ıÂ ·ÁfiÚÈ ÌÂ fiÁÎÔ fiÚ¯ÂˆÓ <4 ml. ∆Ô Ì¤ÁÂıÔ˜ ÙˆÓ fiÚ¯ÂˆÓ ÂÎÙÈ-

Ì‹ıËÎÂ ÌÂ ÔÚ¯È‰fiÌÂÙÚÔ Prader.

ø˜ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· ıÂˆÚ‹ıËÎÂ ÙÔ ‡„Ô˜ ÙÔ˘ ·È‰ÈÔ‡ ÙË

¯ÚÔÓÈÎ‹ ÛÙÈÁÌ‹ Ô˘ ÛÙËÓ ·Ï‹ ·ÎÙÈÓÔÁÚ·Ê›· ¯ÂÈÚÒÓ ‰È·È-

ÛÙˆÓfiÙ·Ó Ï‹ÚË˜ Û‡ÁÎÏÈÛË ÙˆÓ ÂÈÊ‡ÛÂˆÓ ÙˆÓ Ì·ÎÚÒÓ

ÔÛÙÒÓ.

∂ÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜

™Â Î¿ıÂ ·È‰› ÂÎÙÈÌ‹ıËÎÂ Ë ¤ÎÎÚÈÛË GH ÌÂÙ¿ ·fi ‰ÔÎÈ-

Ì·Û›· ‰È¤ÁÂÚÛË˜ ÌÂ ÎÏÔÓÈ‰›ÓË ‹ ‰È·Ï˘Ù‹ ÈÓÛÔ˘Ï›ÓË ÌÂ ÚÔÛ-

‰ÈÔÚÈÛÌfi ÙË˜ GH ÛÂ ¯ÚfiÓÔ˘˜ 0, 15, 30, 45, 60, 90, 120 min.

¶·ıÔÏÔÁÈÎ‹ ıÂˆÚÂ›ÙÔ ÙÈÌ‹ GH <10 ng/ml Ô˘ ÂÈ‚Â‚·ÈˆÓfi-

Ù·Ó ÛÂ ‰Â‡ÙÂÚË ‰ÔÎÈÌ·Û›· ÂÓÙfi˜ ÂÓfi˜ ÌËÓfi˜.

°È· ÙÔÓ ¤ÏÂÁ¯Ô ¤Ó·ÚÍË˜ ÙË˜ ÂÊË‚Â›·˜ ÁÈÓfiÙ·Ó ‰ÔÎÈÌ·Û›·

LHRH ÌÂ ÚÔÛ‰ÈÔÚÈÛÌfi ÙÈÌÒÓ LH, FSH ÛÂ ¯ÚfiÓÔ˘˜ 0, 30, 60

min. ŒÓ·ÚÍË ÙË˜ ÂÊË‚Â›·˜ ıÂˆÚÂ›ÙÔ ÙÈÌ‹ LH >15 IU/L (3).

∂›ÛË˜, ÁÈÓfiÙ·Ó ‰ÔÎÈÌ·Û›· TRH ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô ÙË˜ ı˘ÚÂ-

ÔÂÈ‰ÈÎ‹˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÌÂ ÚÔÛ‰ÈÔÚÈÛÌfi ÙË˜ TSH (Ê˘ÛÈÔÏÔÁÈ-

Î¤˜ ÙÈÌ¤˜ TSH: 0,4-4 ÌπU/ml) ÛÂ ̄ ÚfiÓÔ˘˜ 0, 30, 60 min Î·È ÙË˜

∆4 ÛÂ ¯ÚfiÓÔ 0 (Ê˘ÛÈÔÏÔÁÈÎ¤˜ ÙÈÌ¤˜ ∆4: 5,6-12 Ìg/dl).

∞Ó¿ ÂÍ¿ÌËÓÔ ÁÈÓfiÙ·Ó ¤ÏÂÁ¯Ô˜ ÁÏ˘Îfi˙Ë˜ ÔÚÔ‡, ÁÏ˘ÎÔ˙˘-

ÏÈˆÌ¤ÓË˜ ·ÈÌÔÛÊ·ÈÚ›ÓË˜ (HbA1c%), ı˘ÚÂÔÂÈ‰ÈÎ‹˜ ÏÂÈÙÔ˘Ú-

Á›·˜ (TSH, T3, T4), ÁÂÓÈÎ‹ ·›Ì·ÙÔ˜ Î·È ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÔÛÙÈ-

Î‹˜ ËÏÈÎ›·˜ ÛÙ· ·È‰È¿ Ô˘ Ë ÂÊË‚Â›· Â›¯Â ÍÂÎÈÓ‹ÛÂÈ.

™Ù·ÙÈÛÙÈÎ‹ ·Ó¿Ï˘ÛË

√È ÔÛÔÙÈÎ¤˜ ÌÂÙ·‚ÏËÙ¤˜ Û˘ÓÔ„›ÛÙËÎ·Ó ¯ÚËÛÈÌÔÔÈÒ-

ÓÙ·˜ Ì¤ÛÔ˘˜ fiÚÔ˘˜ Î·È Ù˘ÈÎ¤˜ ·ÔÎÏ›ÛÂÈ˜ (standard

deviation). °È· ÙË Û‡ÁÎÚÈÛË ‰‡Ô Ì¤ÛˆÓ fiÚˆÓ ¯ÚËÛÈÌÔÔÈ‹ıË-

ÎÂ Ë ‰ÔÎÈÌ·Û›· Î·Ù¿ Student’s t-test. ¶·Ú¿ÏÏËÏ· ¤ÁÈÓÂ ¤ÏÂÁ-

¯Ô˜ ÁÈ· ÙËÓ Î·ÓÔÓÈÎfiÙËÙ· ÙˆÓ ÌÂÙ·‚ÏËÙÒÓ ¯ÚËÛÈÌÔÔÈÒÓÙ·˜

ÙË ‰ÔÎÈÌ·Û›· Î·Ù¿ Shapiro-Wilk, fiÔ˘ ‰ÂÓ ‰È·ÈÛÙÒıËÎÂ

·fiÎÏÈÛË ·fi ÙËÓ Î·ÓÔÓÈÎfiÙËÙ· Î·È ÁÈ· ÙÔ ÏfiÁÔ ·˘Ùfi ‰ÂÓ

129AÓÂ¿ÚÎÂÈ· ·˘ÍËÙÈÎ‹˜ ÔÚÌfiÓË˜

¶·È‰È·ÙÚÈÎ‹ 2008;71:128-134


··ÈÙ‹ıËÎÂ ÔÔÈ·‰‹ÔÙÂ ÌÂÙ·ÙÚÔ‹ ÙˆÓ ÌÂÙ·‚ÏËÙÒÓ. ∞Ú¯È-

Î¿, Ë Û¯¤ÛË ÙÔ˘ ÙÂÏÈÎÔ‡ ‡„Ô˘˜ ÌÂ ÙÈ˜ ¿ÏÏÂ˜ Î·ÙËÁÔÚÈÎ¤˜ ÌÂ-

Ù·‚ÏËÙ¤˜ ÂÍÂÙ¿ÛÙËÎÂ ÌÂ ÙÔ Û˘ÓÙÂÏÂÛÙ‹ Û˘Û¯¤ÙÈÛË˜ Î·Ù¿

Pearson, ÂÓÒ ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË ÙË˜ Û¯¤ÛË˜ Ê‡ÏÔ˘ Î·È ÙÂÏÈÎÔ‡

‡„Ô˘˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ô Û˘ÓÙÂÏÂÛÙ‹˜ Û˘Û¯¤ÙÈÛË˜ Î·Ù¿

Spearman. ∂Ê·ÚÌfiÛÙËÎÂ ÔÏ˘·Ú·ÁÔÓÙÈÎ‹ ÁÚ·ÌÌÈÎ‹ ·ÏÈÓ-

‰ÚfiÌËÛË ÁÈ· Ó· ÂÍÂÙ·ÛÙÂ› Ë Û˘ÓÔÏÈÎ‹ Û¯¤ÛË ÙÔ˘ ÙÂÏÈÎÔ‡

‡„Ô˘˜ ÙˆÓ Û˘ÌÌÂÙÂ¯fiÓÙˆÓ ÌÂ ¿ÏÏÔ˘˜ ‚·ÛÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜.

™’ fiÏÂ˜ ÙÈ˜ ÛÙ·ÙÈÛÙÈÎ¤˜ ·Ó·Ï‡ÛÂÈ˜, ÙÔ Â›Â‰Ô ÛËÌ·ÓÙÈÎfiÙËÙ·˜

ÔÚ›ÛÙËÎÂ ˆ˜ 0,05 Î·È ·ÌÊ›ÏÂ˘ÚÔ. √È ÛÙ·ÙÈÛÙÈÎ¤˜ ·Ó·Ï‡ÛÂÈ˜

ÂÊ·ÚÌfiÛÙËÎ·Ó ÌÂ Ù· ÛÙ·ÙÈÛÙÈÎ¿ ·Î¤Ù· SPSS 13.0 Î·È STATA.

∞ÔÙÂÏ¤ÛÌ·Ù·

∆· ‚·ÛÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙˆÓ ·ÛıÂÓÒÓ Î·Ù¿

ÙËÓ ¤Ó·ÚÍË ÙË˜ ıÂÚ·Â›·˜ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÙÔÓ

¶›Ó·Î· 1.

∆· ·ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ ıÂÚ·Â›·˜ ·ÚÔ˘ÛÈ¿˙Ô-

ÓÙ·È Û˘ÓÔÙÈÎ¿ ÛÙÔÓ ¶›Ó·Î· 2.

¢È·ÈÛÙÒıËÎÂ ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ Û˘Û¯¤ÙÈÛË

ÙÔ˘ ÙÂÏÈÎÔ‡ ‡„Ô˘˜ ÌÂ: ÙÔ ·Ú¯ÈÎfi ‡„Ô˜, ÙÔ ‡„Ô˜-

ÛÙfi¯Ô˜, ÙÔ ‡„Ô˜ ÙË˜ ÌËÙ¤Ú·˜, ÙÔ ‡„Ô˜ ÙÔ˘ ·Ù¤Ú·

Î·È ÙÔÓ ·ÚÈıÌfi ÙˆÓ ÂÓ¤ÛÂˆÓ ·Ó¿ Â‚‰ÔÌ¿‰· (¶›Ó·-

Î·˜ 3). ¢ÂÓ ‚Ú¤ıËÎÂ Û˘Û¯¤ÙÈÛË ÙÔ˘ ÙÂÏÈÎÔ‡ ·Ó·-

ÛÙ‹Ì·ÙÔ˜ ÌÂ ÙÔ Ê‡ÏÔ, ÙË ‰È¿ÚÎÂÈ· ıÂÚ·Â›·˜ Î·È

ÙËÓ Ù·¯‡ÙËÙ· ·‡ÍËÛË˜ (height velocity) Î·Ù¿ ÙÔ

ÚÒÙÔ ¤ÙÔ˜ ıÂÚ·Â›·˜.

ªÂ ÙËÓ ÔÏ˘·Ú·ÁÔÓÙÈÎ‹ ·Ó¿Ï˘ÛË ÁÚ·ÌÌÈÎ‹˜

·ÏÈÓ‰ÚfiÌËÛË˜, ÂÍÂÙ¿ÛÙËÎÂ Ë Û¯¤ÛË ÙÔ˘ ÙÂÏÈÎÔ‡·Ó·ÛÙ‹Ì·ÙÔ˜ ÙˆÓ ·ÛıÂÓÒÓ, Ï·Ì‚¿ÓÔÓÙ·˜ ˘fi„Ë Ù·‚·ÛÈÎ¿ ÙÔ˘˜ ̄ ·Ú·ÎÙËÚÈÛÙÈÎ¿. ∆ÂÏÈÎ¿, ‰È·ÌÔÚÊÒıËÎÂ¤Ó· ÔÏ˘·Ú·ÁÔÓÙÈÎfi ÌÔÓÙ¤ÏÔ ·Ó¿Ï˘ÛË˜, ÌÂ ÙÔÔÔ›Ô ÌÔÚÂ› Ó· ÚÔ‚ÏÂÊıÂ› ÙÔ 38,7% (R2adj=0,387) ÙÔ˘ ÙÂÏÈÎÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜. ∞fi ÙËÓ ·Ú·¿-Óˆ ·Ó¿Ï˘ÛË ÚÔÎ‡ÙÂÈ fiÙÈ ÙÔ ‡„Ô˜ Î·Ù¿ ÙËÓ ¤Ó·ÚÍËÙË˜ ıÂÚ·Â›·˜ ˘ÔÎ·Ù¿ÛÙ·ÛË˜ ÌÂ GH, Ô ·ÚÈıÌfi˜ÙˆÓ ÂÓ¤ÛÂˆÓ Â‚‰ÔÌ·‰È·›ˆ˜, ÙÔ ‡„Ô˜ ÙË˜ ÌËÙ¤Ú·˜fiÛÔ Î·È ÙÔ˘ ·Ù¤Ú· ·ÔÙÂÏÔ‡Ó ·ÓÂÍ¿ÚÙËÙÔ˘˜ ÚÔ-ÁÓˆÛÙÈÎÔ‡˜ ‰Â›ÎÙÂ˜ ÙÔ˘ ÙÂÏÈÎÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜ ÂÓfi˜·ÙfiÌÔ˘ ÌÂ ·ÓÂ¿ÚÎÂÈ· ·˘ÍËÙÈÎ‹˜ ÔÚÌfiÓË˜.

™ÙË Û˘Ó¤¯ÂÈ· ÌÂÏÂÙ‹ıËÎ·Ó ˆ˜ ÍÂ¯ˆÚÈÛÙ‹ ˘ÔÔ-Ì¿‰· Ù· ·È‰È¿ Ô˘ ÍÂÎ›ÓËÛ·Ó ÙË ıÂÚ·Â›· ÚÈÓ·fi ÙËÓ ¤Ó·ÚÍË ÙË˜ ‹‚Ë˜. ∆· ‚·ÛÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈ-Î¿ ÙˆÓ ·È‰ÈÒÓ ·˘ÙÒÓ Î·Ù¿ ÙËÓ ¤Ó·ÚÍË ÙË˜ ıÂÚ·-Â›·˜ Î·ıÒ˜ Î·È Ù· ·ÔÙÂÏ¤ÛÌ·Ù¿ ÙË˜ ·ÚÔ˘ÛÈ¿˙Ô-ÓÙ·È Û˘ÓÔÙÈÎ¿ ÛÙÔ˘˜ ¶›Ó·ÎÂ˜ 4 Î·È 5.

∆Ô ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· ÛÙ· ·È‰È¿ Ô˘ ÍÂÎ›ÓËÛ·ÓıÂÚ·Â›· ÚÈÓ ·fi ÙËÓ ‹‚Ë Â›Ó·È ÌÈÎÚfiÙÂÚÔ ÛÂ Û¯¤-ÛË ÌÂ ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ÙˆÓ ·È‰ÈÒÓ Ô˘ ÍÂÎ›ÓËÛ·Ó ıÂ-Ú·Â›· ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË ÙË˜ ‹‚Ë˜ (p=0,037). ∆Ô·ÔÙ¤ÏÂÛÌ· ·˘Ùfi, fiÌˆ˜, Ê·›ÓÂÙ·È Ó· ÔÊÂ›ÏÂÙ·È ÛÙÔfiÙÈ Î·È ÙÔ ·Ú¯ÈÎfi ‡„Ô˜ ÙˆÓ ·È‰ÈÒÓ Ô˘ ÍÂÎ›ÓËÛ·ÓıÂÚ·Â›· ÚÈÓ ·fi ÙËÓ ‹‚Ë ‹Ù·Ó ÌÈÎÚfiÙÂÚÔ(p=0,016). ŸÙ·Ó Û˘ÁÎÚ›ıËÎÂ Ë ‰È·ÊÔÚ¿ ÙË˜ Ì¤ÛË˜

¶›Ó·Î·˜ 2. ∞ÔÙÂÏ¤ÛÌ·Ù· ıÂÚ·Â›·˜ ˘ÔÎ·Ù¿ÛÙ·ÛË˜ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ·ÓÂ¿ÚÎÂÈ· ·˘ÍËÙÈÎ‹˜ ÔÚÌfiÓË˜

∞ÛıÂÓÂ›˜ (¡=72) ª¤ÛÔ˜ fiÚÔ˜ (ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË) ª¤ÁÈÛÙË ÙÈÌ‹ ∂Ï¿¯ÈÛÙË ÙÈÌ‹

∆ÂÏÈÎfi ‡„Ô˜ (SDS) -1,23±1,02 1,22 -5,08∆·¯‡ÙËÙ· ·‡ÍËÛË˜ Î·Ù¿ ÙÔ ÚÒÙÔ ¤ÙÔ˜ ıÂÚ·Â›·˜ (Height Velocity) (SDS) 6,26±4,95 19,00 -1,99∏ÏÈÎ›· ‰È·ÎÔ‹˜ GH (¤ÙË) 16,16±1,61 19,27 12,44¢ height (SDS) 1,3±0,97 4,46 -0,88∆ÂÏÈÎfi ‡„Ô˜ (SDS)-∆∏ (SDS) -0,47±0,91 1,75 -3,70¢ÔÛÔÏÔÁ›· GH (IU/kgr/Â‚‰ÔÌ¿‰·) 0,47±0,11 0,80 0,27∞ÚÈıÌfi˜ ÂÓ¤ÛÂˆÓ/Â‚‰ÔÌ¿‰· 6,57±1,23 7,00 3,00¢È¿ÚÎÂÈ· ıÂÚ·Â›·˜ (¤ÙË) 4,64±2,75 14,81 1,10

SDS: standard deviation score, GH: ·˘ÍËÙÈÎ‹ ÔÚÌfiÓË, ∆∏: ·Ó·ÌÂÓfiÌÂÓÔ ÁÈ· ÙËÓ ÔÈÎÔÁ¤ÓÂÈ· ‡„Ô˜, ÚÔÛ·ÚÌÔÛÌ¤ÓÔ ÛÙÔ Ê‡ÏÔ, ¢height: ÙÂÏÈÎfi ‡„Ô˜ (SDS)-·Ú¯ÈÎfi ‡„Ô˜ (SDS)

130 ª. ¶··‰ÔÔ‡ÏÔ˘ Î·È Û˘Ó.


¶›Ó·Î·˜ 1. µ·ÛÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ·ÛıÂÓÒÓ ÌÂ ·ÓÂ¿ÚÎÂÈ· ·˘ÍËÙÈÎ‹˜ ÔÚÌfiÓË˜ Î·Ù¿ ÙËÓ ¤Ó·ÚÍË ıÂÚ·Â›·˜ ˘ÔÎ·Ù¿ÛÙ·ÛË˜

∞ÛıÂÓÂ›˜ ª¤ÛÔ˜ fiÚÔ˜ (ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË) ª¤ÁÈÛÙË ÙÈÌ‹ ∂Ï¿¯ÈÛÙË ÙÈÌ‹

º‡ÏÔ 72 (43 ¿ÚÚÂÓ·, 29 ı‹ÏÂ·)∏ÏÈÎ›· ¤Ó·ÚÍË˜ GH (¤ÙË) 11,59±2,95 16,06 3,23∞Ú¯ÈÎfi ‡„Ô˜ (SDS) -2,5±0,84 -0,51 -5,78√ÛÙÈÎ‹ ËÏÈÎ›· Î·Ù¿ ÙËÓ ¤Ó·ÚÍË GH (¤ÙË) 9,49±3,02 14,10 1,50∞Ú¯ÈÎfi ‡„Ô˜ ÚÔÛ·ÚÌÔÛÌ¤ÓÔ ÛÙËÓ ÔÛÙÈÎ‹ ËÏÈÎ›· (SDS) -0,74±1,05 1,83 -4,73⁄„Ô˜-ÛÙfi¯Ô˜ (∆∏) (SDS) -0,77±0,74 1,05 -2,21⁄„Ô˜ ÌËÙ¤Ú·˜ (SDS) -0,91±0,9 1,3 -3,36⁄„Ô˜ ·Ù¤Ú· (SDS) -0,66±0,91 1,54 -2,51

SDS: standard deviation score, GH: ·˘ÍËÙÈÎ‹ ÔÚÌfiÓË, ∆∏: ·Ó·ÌÂÓfiÌÂÓÔ ÁÈ· ÙËÓ ÔÈÎÔÁ¤ÓÂÈ· ‡„Ô˜, ÚÔÛ·ÚÌÔÛÌ¤ÓÔ ÛÙÔ Ê‡ÏÔ


Ù˘ÈÎ‹˜ ·fiÎÏÈÛË˜ ÙÂÏÈÎÔ‡ ‡„Ô˘˜-·Ú¯ÈÎÔ‡ ‡„Ô˘˜

(¢ height SDS), ·˘Ù‹ ‰ÂÓ ‰È¤ÊÂÚÂ ÛËÌ·ÓÙÈÎ¿ ÛÙÈ˜ 2

˘ÔÔÌ¿‰Â˜ (p=0,9). ∆· ·ÓˆÙ¤Úˆ Û˘ÓÔ„›˙ÔÓÙ·È

ÛÙÔÓ ¶›Ó·Î· 6.

ªÈ· ¿ÏÏË ˘ÔÔÌ¿‰· ·ÛıÂÓÒÓ Ô˘ ÌÂÏÂÙ‹ıËÎÂ

ÍÂ¯ˆÚÈÛÙ¿ ‹Ù·Ó Ù· ·È‰È¿ ÌÂ ¤ÏÏÂÈ„Ë Î·È ¿ÏÏˆÓ ÔÚ-

ÌÔÓÒÓ ÏËÓ ÙË˜ ·˘ÍËÙÈÎ‹˜. ∆Ô ¢ height ÛÙ· ·È‰È¿

·˘Ù¿ ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚÔ ÛÂ Û¯¤ÛË ÌÂ ÂÎÂ›Ó· Ô˘ Â›¯·Ó

ÌÂÌÔÓˆÌ¤ÓË ·ÓÂ¿ÚÎÂÈ· ·˘ÍËÙÈÎ‹˜ ÔÚÌfiÓË˜

(p=0,001), ·Ó Î·È ÙÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· ‰ÂÓ ‰È¤ÊÂÚÂ

ÛËÌ·ÓÙÈÎ¿ ÛÙÈ˜ 2 ·˘Ù¤˜ ˘ÔÔÌ¿‰Â˜ (p=0,091). ∆·

·ÓˆÙ¤Úˆ Û˘ÓÔ„›˙ÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 7.

™˘˙‹ÙËÛË

∏ Ì¤ÛË Ù˘ÈÎ‹ ·fiÎÏÈÛË ÙÔ˘ ‡„Ô˘˜ ÙˆÓ ·È‰ÈÒÓ

Î·Ù¿ ÙËÓ ¤Ó·ÚÍË ÙË˜ ıÂÚ·Â›·˜ (HtSDS) ‹Ù·Ó -2,5,

ÂÓÒ Ë Ì¤ÛË Ù˘ÈÎ‹ ·fiÎÏÈÛË ÙÔ˘ ÙÂÏÈÎÔ‡ ‡„Ô˘˜

(FHSDS) ‹Ù·Ó -1,22. ∏ ıÂÚ·Â›· ˘ÔÎ·Ù¿ÛÙ·ÛË˜

‚ÂÏÙ›ˆÛÂ Û·ÊÒ˜ ÙÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· ÙˆÓ ·È‰ÈÒÓ

·˘ÙÒÓ, ·Ó Î·È ÌfiÓÔ 23 ·È‰È¿ (32%) ¤ÊÙ·Û·Ó ÙÔ

‡„Ô˜-ÛÙfi¯Ô (TH). ¶·È‰È¿ ÌÂ È‰ÈÔ·ı‹ ·ÓÂ¿ÚÎÂÈ·

·˘ÍËÙÈÎ‹˜ ÔÚÌfiÓË˜ (GHD) ‹ ˘ÔÊ˘ÛÈÛÌfi Ô˘ ‰ÂÓ

Ï·Ì‚¿ÓÔ˘Ó ıÂÚ·Â›· ·ÚÔ˘ÛÈ¿˙Ô˘Ó FHSDS ÌÂÙ·Í‡

-4 Î·È -6 (4). ™Â ÌÈ· ÛÂÈÚ¿ ·fi ·Ó¿ÏÔÁÂ˜ ÂÚÁ·Û›Â˜Ô˘ ‰ËÌÔÛÈÂ‡ÙËÎ·Ó ÌÂÙ·Í‡ 1995 Î·È 2006, ÙÔFHSDS ·Ó·Ê¤ÚÂÙ·È ÌÂÙ·Í‡ -0,4 Î·È -2,0 (5-13). ™ÂÌÂÏ¤ÙÂ˜ Ô˘ ‰ËÌÔÛÈÂ‡ÙËÎ·Ó ÌÂÙ·Í‡ 1981 Î·È 1989,ÙÔ FHSDS ·Ó·Ê¤ÚÂÙ·È ÌÂÙ·Í‡ -1,75 Î·È -3,0 (14-20).∆· Ùˆ¯fiÙÂÚ· ·ÔÙÂÏ¤ÛÌ·Ù· ÙˆÓ ·Ï·ÈfiÙÂÚˆÓ ·˘-ÙÒÓ ÌÂÏÂÙÒÓ ÔÊÂ›ÏÔÓÙ·È ÛÙË ¯Ú‹ÛË ÚÈÓ ·fi ÙÔ1985 ÙË˜ ÙˆÌ·ÙÈÎ‹˜ ·˘ÍËÙÈÎ‹˜ ÔÚÌfiÓË˜ Î·ıÒ˜ Î·ÈÛÙË ıÂÚ·Â›· ÛÂ ÔÏÏ¤˜ ÂÚÈÙÒÛÂÈ˜ ÌÂ 3 ÌfiÓÔ ÂÓ¤-ÛÂÈ˜ GH Â‚‰ÔÌ·‰È·›ˆ˜.

∏ ¿ÚÈÛÙË ‰fiÛË ÙË˜ GH ¤¯ÂÈ ÔÚÈÛıÂ› ÛÙÈ˜ 0,3-0,6πU/kg/Â‚‰ÔÌ¿‰· Î·Ù¿ ÙËÓ ÂÚ›Ô‰Ô ÙË˜ ·È‰ÈÎ‹˜ËÏÈÎ›·˜ (21). ™ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÂÊË‚Â›·˜, Ë ¤ÎÎÚÈÛËÙË˜ ·˘ÍËÙÈÎ‹˜ ÔÚÌfiÓË˜ ·˘Í¿ÓÂÙ·È Î·È Û˘ÓÂÒ˜ ı·Ú¤ÂÈ Ë ‰fiÛË ÙË˜ ·˘ÍËÙÈÎ‹˜ ÔÚÌfiÓË˜ Ó· ·Ó·ÚÔ-Û·ÚÌfi˙ÂÙ·È ·Ó¿ÏÔÁ· ÌÂ ÙÈ˜ ·Ó¿ÁÎÂ˜ (22). √È RankeÎ·È Butendandt (1989) (19) Î·ıÒ˜ Î·È Ë ÌÂÏ¤ÙËKIGS (20,23) ¤‰ÂÈÍ·Ó fiÙÈ ÙÔ FHSDS Û˘Û¯ÂÙ›˙ÂÙ·È ÌÂÙÔÓ ·ÚÈıÌfi ÙˆÓ ÂÓ¤ÛÂˆÓ GH. ∞˘Ùfi ‰È·ÈÛÙÒıËÎÂÎ·È ÛÙË ‰ÈÎ‹ Ì·˜ ÌÂÏ¤ÙË, ÛÙËÓ ÔÔ›· 6 ·È‰È¿ ¤Î·-Ó·Ó 3 ÌfiÓÔ ÂÓ¤ÛÂÈ˜ Â‚‰ÔÌ·‰È·›ˆ˜, ÂÓÒ 66 ·È‰È¿·ÎÔÏÔ‡ıËÛ·Ó Û¯‹Ì· 6 ‹ 7 ÂÓ¤ÛÂˆÓ Â‚‰ÔÌ·‰È·›ˆ˜.∂ÓÙÔ‡ÙÔÈ˜, Û¯‹Ì·Ù· ÌÂ ÂÚÈÛÛfiÙÂÚÂ˜ ÙË˜ ÌÈ·˜ ¤ÓÂ-ÛË˜ ËÌÂÚËÛ›ˆ˜ ‰ÂÓ Ê·›ÓÂÙ·È Ó· ÚÔÛÊ¤ÚÔ˘Ó ÌÂÁ·-Ï‡ÙÂÚÔ fiÊÂÏÔ˜ (24).

√ ·Ú¿ÁÔÓÙ·˜ Ô˘ ‚Ú¤ıËÎÂ Ó· ¤¯ÂÈ ÙËÓ ÈÛ¯˘Úfi-ÙÂÚË Û˘Û¯¤ÙÈÛË ÌÂ ÙÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· ‹Ù·Ó ÛÙË ÌÂ-Ï¤ÙË Ì·˜ ÙÔ ‡„Ô˜-ÛÙfi¯Ô˜ (·Ó·ÌÂÓfiÌÂÓÔ ÁÈ· ÙËÓ ÔÈ-ÎÔÁ¤ÓÂÈ· ‡„Ô˜, ÚÔÛ·ÚÌÔÛÌ¤ÓÔ ÛÙÔ Ê‡ÏÔ) (T∏). ∏Û˘Û¯¤ÙÈÛË ·˘Ù‹ ¤¯ÂÈ ·Ó·ÊÂÚıÂ› Î·È ÛÂ ÚÔËÁÔ‡ÌÂ-ÓÂ˜ ÌÂÏ¤ÙÂ˜ (12,14,19,20,23,25). º·›ÓÂÙ·È ÙÂÏÈÎ¿ˆ˜ ÙÔ ÁÂÓÂÙÈÎfi ‰˘Ó·ÌÈÎfi Â›Ó·È ·˘Ùfi Ô˘ ÛÂ ÌÂÁ¿ÏÔ‚·ıÌfi Î·ıÔÚ›˙ÂÈ ÙÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ·. ∂›ÛË˜, ÙÔ ÙÂ-ÏÈÎfi ·Ó¿ÛÙËÌ· Û˘Û¯ÂÙ›ÛÙËÎÂ ÛÙË ÌÂÏ¤ÙË Ì·˜ Î·È ÌÂÙÔ ‡„Ô˜ Î·Ù¿ ÙËÓ ¤Ó·ÚÍË ÙË˜ ıÂÚ·Â›·˜ (12,26).

∞ÍÈÔÛËÌÂ›ˆÙÔ Â›Ó·È ÙÔ ÁÂÁÔÓfi˜ ÙË˜ ÌË ·ÓÂ‡ÚÂ-ÛË˜ ÛÙË ÌÂÏ¤ÙË Ì·˜ Û˘Û¯¤ÙÈÛË˜ ÌÂÙ·Í‡ ÙÂÏÈÎÔ‡·Ó·ÛÙ‹Ì·ÙÔ˜ Î·È ‰È¿ÚÎÂÈ·˜ ıÂÚ·Â›·˜. ™ÙË ÌÂÏ¤ÙËKIGS (20,23) ˘‹ÚÍÂ ÔÚÈ·Î‹ Û˘Û¯¤ÙÈÛË ÙˆÓ ‰˘Ô

¶›Ó·Î·˜ 4. µ·ÛÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ·ÛıÂÓÒÓ ÌÂ ·ÓÂ¿ÚÎÂÈ· ·˘ÍËÙÈÎ‹˜ ÔÚÌfiÓË˜ Î·È ¤Ó·ÚÍË ıÂÚ·Â›·˜ ˘ÔÎ·Ù¿ÛÙ·ÛË˜ Î·Ù¿ ÙËÓ ÚÔÂÊË-‚ÈÎ‹ ËÏÈÎ›·

∞ÛıÂÓÂ›˜ ª¤ÛÔ˜ fiÚÔ˜ (ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË) ª¤ÁÈÛÙË ÙÈÌ‹ ∂Ï¿¯ÈÛÙË ÙÈÌ‹

º‡ÏÔ 25 (11 ¿ÚÚÂÓ·, 14 ı‹ÏÂ·)∏ÏÈÎ›· ¤Ó·ÚÍË˜ GH (¤ÙË) 8,4±2,39 10,99 3,23∞Ú¯ÈÎfi ‡„Ô˜ (SDS) -2,89±1,08 -0,51 -5,78√ÛÙÈÎ‹ ËÏÈÎ›· Î·Ù¿ ÙËÓ ¤Ó·ÚÍË GH (¤ÙË) 6,32±2,64 10,10 1,50∞Ú¯ÈÎfi ‡„Ô˜ ÚÔÛ·ÚÌÔÛÌ¤ÓÔ ÛÙËÓ ÔÛÙÈÎ‹ ËÏÈÎ›· (SDS) -0,855±1,45 1,83 -4,73∆∏ ‡„Ô˜ (SDS) -0,9±0,78 1,01 -2,21⁄„Ô˜ ÌËÙ¤Ú·˜ (SDS) -1,06±1,05 1,11 -3,36⁄„Ô˜ ·Ù¤Ú· (SDS) -0,76±0,89 1,51 -2,21

SDS: standard deviation, GH: ·˘ÍËÙÈÎ‹ ÔÚÌfiÓË, ∆∏: ·Ó·ÌÂÓfiÌÂÓÔ ÁÈ· ÙËÓ ÔÈÎÔÁ¤ÓÂÈ· ‡„Ô˜, ÚÔÛ·ÚÌÔÛÌ¤ÓÔ ÛÙÔ Ê‡ÏÔ(target height)


¶·È‰È·ÙÚÈÎ‹ 2008;71:128-134

¶›Ó·Î·˜ 3. ¶·Ú¿ÁÔÓÙÂ˜ Ô˘ Î·ıÔÚ›˙Ô˘Ó ÙÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· ÛÂ·ÛıÂÓÂ›˜ ÌÂ ·ÓÂ¿ÚÎÂÈ· ·˘ÍËÙÈÎ‹˜ ÔÚÌfiÓË˜

¶·Ú¿ÁÔÓÙÂ˜ ∆ÂÏÈÎfi ·Ó¿ÛÙËÌ·™˘Û¯¤ÙÈÛË p

∞Ú¯ÈÎfi ‡„Ô˜ (SDS) r=0,474 <0,01∞ÚÈıÌfi˜ ÂÓ¤ÛÂˆÓ/Â‚‰ÔÌ¿‰· r=0,265 0,024∞Ú¯ÈÎfi ‡„Ô˜ ÚÔÛ·ÚÌÔÛÌ¤ÓÔ ÛÙËÓ ÔÛÙÈÎ‹ ËÏÈÎ›· (SDS) r=0,384 <0,01TH (SDS) r=0,51 <0,001⁄„Ô˜ ÌËÙ¤Ú·˜ (SDS) r=0,394 <0,01⁄„Ô˜ ·Ù¤Ú· (SDS) r=0,434 <0,001

SDS: standard deviation, GH: ·˘ÍËÙÈÎ‹ ÔÚÌfiÓË, ∆∏: ·Ó·-ÌÂÓfiÌÂÓÔ ÁÈ· ÙËÓ ÔÈÎÔÁ¤ÓÂÈ· ‡„Ô˜, ÚÔÛ·ÚÌÔÛÌ¤ÓÔ ÛÙÔÊ‡ÏÔ


·˘ÙÒÓ ·Ú·Ì¤ÙÚˆÓ (Ú=0,06) Î·È ÈÛ¯˘Ú‹ Û˘Û¯¤ÙÈÛË

ÌÂÙ·Í‡ ÙË˜ ‰È·ÊÔÚ¿˜ ÙÂÏÈÎÔ‡-·Ú¯ÈÎÔ‡ ·Ó·ÛÙ‹Ì·-

ÙÔ˜ (¢ height) Î·È ÙË˜ ‰È¿ÚÎÂÈ·˜ ıÂÚ·Â›·˜

(p=0,001). ∂È¯ÂÈÚÒÓÙ·˜ Û‡ÁÎÚÈÛË ÙÔ˘ ÙÂÏÈÎÔ‡

·Ó·ÛÙ‹Ì·ÙÔ˜ ÌÂÙ·Í‡ ÙˆÓ ·È‰ÈÒÓ Ô˘ ÍÂÎ›ÓËÛ·Ó

ıÂÚ·Â›· ÚÈÓ ·fi ÙËÓ ¤Ó·ÚÍË ÙË˜ ‹‚Ë˜ Î·È ·˘ÙÒÓ

Ô˘ ÍÂÎ›ÓËÛ·Ó ÌÂÙ¿, ‰È·ÈÛÙÒıËÎÂ ˆ˜ ÙÔ ¢ height

‰ÂÓ ‰È¤ÊÂÚÂ ÛËÌ·ÓÙÈÎ¿ ÛÙÈ˜ ‰‡Ô ˘ÔÔÌ¿‰Â˜

(p=0,9). ∆· ·È‰È¿ Ô˘ ÍÂÎ›ÓËÛ·Ó ıÂÚ·Â›· ÚÔÂ-

ÊË‚ÈÎ¿ Â›¯·Ó ÛËÌ·ÓÙÈÎ¿ ÌÈÎÚfiÙÂÚÔ ·Ú¯ÈÎfi ‡„Ô˜

(p=0,016) Î·È ÛËÌ·ÓÙÈÎ¿ ÌÈÎÚfiÙÂÚÔ ÙÂÏÈÎfi ‡„Ô˜

(p=0,037) ÛÂ Û¯¤ÛË ÌÂ Ù· ·È‰È¿ Ô˘ ÍÂÎ›ÓËÛ·Ó

·ÁˆÁ‹ Î·Ù¿ ÙËÓ ÂÊË‚Â›·. ∆Ô fiÊÂÏÔ˜ ·fi ÙË ıÂÚ·-

Â›·, fiˆ˜ ·ÓÙÈÎ·ÙÔÙÚ›˙ÂÙ·È ÛÙÔ ÎÂÚ‰Ëı¤Ó ·Ó¿-

ÛÙËÌ·, ‹Ù·Ó ÙÔ ›‰ÈÔ ÛÙÈ˜ ‰‡Ô ·˘Ù¤˜ ˘ÔÔÌ¿‰Â˜.

∂ÓÙÔ‡ÙÔÈ˜, ÙÔ 54% ÙˆÓ ·È‰ÈÒÓ ÌÂ ¤Ó·ÚÍË ıÂÚ·Â›-

·˜ ÚÔÂÊË‚ÈÎ¿ Êı¿ÓÂÈ ÛÙÔ ‡„Ô˜-ÛÙfi¯Ô, ÂÓÒ ÙÔ

·ÓÙ›ÛÙÔÈ¯Ô ÔÛÔÛÙfi ÁÈ· Ù· ·È‰È¿ ÌÂ ¤Ó·ÚÍË ıÂÚ·-

Â›·˜ Î·Ù¿ ÙËÓ ÂÊË‚Â›· Â›Ó·È ÌfiÏÈ˜ 18,4% (13,27).

£· Ú¤ÂÈ Ó· ÛËÌÂÈˆıÂ›, ˆÛÙfiÛÔ, fiÙÈ Ù· ·È‰È¿ Ô˘

ÍÂÎ›ÓËÛ·Ó ·˘ÍËÙÈÎ‹ ÔÚÌfiÓË ÚÈÓ ·fi ÙËÓ ÂÊË‚Â›·

‹Ú·Ó ıÂÚ·Â›· ÁÈ· ÛËÌ·ÓÙÈÎ¿ ÌÂÁ·Ï‡ÙÂÚÔ ¯ÚÔÓÈÎfi

‰È¿ÛÙËÌ· Î·È ÛÂ ˘„ËÏfiÙÂÚË ‰fiÛË ÛÂ Û¯¤ÛË ÌÂ Ù·

·È‰È¿ Ô˘ ÍÂÎ›ÓËÛ·Ó ıÂÚ·Â›· Î·Ù¿ ÙË ‰È¿ÚÎÂÈ·

ÙË˜ ÂÊË‚Â›·˜ (p<0,001 Î·È p=0,001).

∞ÍÈÔÛËÌÂ›ˆÙÔ Â›Ó·È ˆ˜ ÛÙÔ Û‡ÓÔÏÔ, ÌfiÓÔ Ù· 23

·fi Ù· 72 ·È‰È¿ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó (32%) ¤ÊÙ·Û·Ó

ÛÙÔ ‡„Ô˜-ÛÙfi¯Ô (∆∏). ™Â 47 ·fi Ù· 72 ·È‰È¿, Ë ‹‚Ë

Â›¯Â ‹‰Ë ÍÂÎÈÓ‹ÛÂÈ Î·Ù¿ ÙËÓ ¤Ó·ÚÍË ÙË˜ ·ÁˆÁ‹˜. ∂›-

Ó·È ÁÓˆÛÙfi fiÙÈ ÙÔ 80-85% ÙË˜ ·‡ÍËÛË˜ Ï·Ì‚¿ÓÂÈ ̄ Ò-

Ú· ÚÈÓ ·fi ÙËÓ ‹‚Ë Î·È ¤ÙÛÈ Ù· ·È‰È¿ Ô˘ ÌÂÏÂÙ‹-

ıËÎ·Ó ¤¯·Û·Ó ¤Ó· ÛËÌ·ÓÙÈÎfi ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·,

¶›Ó·Î·˜ 6. ™˘ÁÎÚÈÙÈÎ‹ ·ÍÈÔÏfiÁËÛË ÙË˜ Â›‰Ú·ÛË˜ ÙË˜ ıÂÚ·Â›·˜ ˘ÔÎ·Ù¿ÛÙ·ÛË˜ ÌÂ ·˘ÍËÙÈÎ‹ ÔÚÌfiÓË ÛÙËÓ ÚÔÂÊË‚ÈÎ‹ Î·È ÂÊË‚ÈÎ‹ ËÏÈÎ›·

∞ÛıÂÓÂ›˜ (¡=72) ¶ÚÔÂÊË‚ÈÎ‹ ËÏÈÎ›· ∂ÊË‚ÈÎ‹ ËÏÈÎ›· p

AÚÈıÌfi˜ - º‡ÏÔ 25 (11 ¿ÚÚÂÓ·, 14 ı‹ÏÂ·) 47 (32 ¿ÚÚÂÓ·, 15 ı‹ÏÂ·) 0,01∏ÏÈÎ›· ¤Ó·ÚÍË˜ GH (¤ÙË) 8,4±2,39 13,29±1,39 <0,001∞Ú¯ÈÎfi ‡„Ô˜ (SDS) -2,89±1,08 -2,29±0,59 0,016√ÛÙÈÎ‹ ËÏÈÎ›· Î·Ù¿ ÙËÓ ¤Ó·ÚÍË GH (¤ÙË) 6,32±2,64 11,18±1,43 <0,001∞Ú¯ÈÎfi ‡„Ô˜ ÚÔÛ·ÚÌÔÛÌ¤ÓÔ ÛÙËÓ ÔÛÙÈÎ‹ ËÏÈÎ›· (SDS) -0,855±1,45 -0,67±0,76 0,56∆∏ ‡„Ô˜ (SDS) -0,9±0,78 -0,7±0,71 0,29⁄„Ô˜ ÌËÙ¤Ú·˜ (SDS) -1,06±1,05 -0,83±0,82 0,30⁄„Ô˜ ·Ù¤Ú· (SDS) -0,76±0,89 -0,6±0,93 0,48∆ÂÏÈÎfi ‡„Ô˜ (SDS) -1,56±1,3 -1,04±0,79 0,037∆·¯‡ÙËÙ· ·‡ÍËÛË˜ Î·Ù¿ ÙÔ ÚÒÙÔ ¤ÙÔ˜ıÂÚ·Â›·˜ (height velocity) (SDS) 5,93±4,66 6,43±5,14 0,69∏ÏÈÎ›· ‰È·ÎÔ‹˜ GH (¤ÙË) 15,36±1,8 16,58±1,34 0,005¢ height (SDS) 1,32±1,37 1,28±0,69 0,9∆ÂÏÈÎfi ‡„Ô˜( SDS)-∆∏ (SDS) -0,66±1,2 -0,36±0,71 0,26¢ÔÛÔÏÔÁ›· GH (IU/kgr/Â‚‰ÔÌ¿‰·) 0,54±0,13 0,43±0,09 0,001∞ÚÈıÌfi˜ ÂÓ¤ÛÂˆÓ/Â‚‰ÔÌ¿‰· 6,08±1,68 6,83±0,82 0,044¢È¿ÚÎÂÈ· ıÂÚ·Â›·˜ (¤ÙË) 6,97±3,13 3,4±1,42 <0,001

SDS: standard deviation, GH: ·˘ÍËÙÈÎ‹ ÔÚÌfiÓË, ∆∏: ·Ó·ÌÂÓfiÌÂÓÔ ÁÈ· ÙËÓ ÔÈÎÔÁ¤ÓÂÈ· ‡„Ô˜, ÚÔÛ·ÚÌÔÛÌ¤ÓÔ ÛÙÔ Ê‡ÏÔ(target height), ¢ height: ÙÂÏÈÎfi ‡„Ô˜ (SDS)-·Ú¯ÈÎfi ‡„Ô˜ (SDS)

132 ª. ¶··‰ÔÔ‡ÏÔ˘ Î·È Û˘Ó.


¶›Ó·Î·˜ 5. ∞ÔÙÂÏ¤ÛÌ·Ù· ıÂÚ·Â›·˜ ˘ÔÎ·Ù¿ÛÙ·ÛË˜ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ·ÓÂ¿ÚÎÂÈ· ·˘ÍËÙÈÎ‹˜ ÔÚÌfiÓË˜ Î·È ¤Ó·ÚÍË ıÂÚ·Â›·˜ ˘ÔÎ·Ù¿ÛÙ·-ÛË˜ Î·Ù¿ ÙËÓ ÚÔÂÊË‚ÈÎ‹ ËÏÈÎ›·

∞ÛıÂÓÂ›˜ (¡=25) ª¤ÛÔ˜ fiÚÔ˜ (ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË) ª¤ÁÈÛÙË ÙÈÌ‹ ∂Ï¿¯ÈÛÙË ÙÈÌ‹

∆ÂÏÈÎfi ‡„Ô˜ (SDS) -1,56±1,3 1,22 -5,08∆·¯‡ÙËÙ· ·‡ÍËÛË˜ Î·Ù¿ ÙÔ ÚÒÙÔ ¤ÙÔ˜ ıÂÚ·Â›·˜ (height velocity) (SDS) 5,93±4,66 17,97 -0,37∏ÏÈÎ›· ‰È·ÎÔ‹˜ GH (¤ÙË) 15,36±1,8 18,1 12,44¢ height (SDS) 1,32±1,37 4,46 -0,88∆ÂÏÈÎfi ‡„Ô˜ (SDS)-TH (SDS) -0,66±1,2 1,75 -3,70¢ÔÛÔÏÔÁ›· GH (IU/kgr/Â‚‰ÔÌ¿‰·) 0,54±0,13 0,80 0,35∞ÚÈıÌfi˜ ÂÓ¤ÛÂˆÓ/Â‚‰ÔÌ¿‰· 6,08±1,68 7,00 3,00¢È¿ÚÎÂÈ· ıÂÚ·Â›·˜ (¤ÙË) 6,97±3,13 14,81 2,72

SDS: standard deviation, GH: ·˘ÍËÙÈÎ‹ ÔÚÌfiÓË, ∆∏: ·Ó·ÌÂÓfiÌÂÓÔ ÁÈ· ÙËÓ ÔÈÎÔÁ¤ÓÂÈ· ‡„Ô˜, ÚÔÛ·ÚÌÔÛÌ¤ÓÔ ÛÙÔ Ê‡ÏÔ(target height), ¢ height: ÙÂÏÈÎfi ‡„Ô˜ (SDS)-·Ú¯ÈÎfi ‡„Ô˜ (SDS)


ÏfiÁˆ Î·ı˘ÛÙ¤ÚËÛË˜ ÛÙËÓ ·Ó·˙‹ÙËÛË ÂÍÂÈ‰ÈÎÂ˘Ì¤-

ÓË˜ ·Ú¤Ì‚·ÛË˜ (28-30).

ªÂÙ¿ ÙËÓ ¤Ó·ÚÍË ÙË˜ ıÂÚ·Â›·˜ ÌÂ ·˘ÍËÙÈÎ‹

ÔÚÌfiÓË, Ù· ·È‰È¿ ‚ÂÏÙÈÒÓÔ˘Ó ÙÔÓ ÂÙ‹ÛÈÔ Ú˘ıÌfi

·‡ÍËÛË˜ Î·Ù¿ 2 ÊÔÚ¤˜ ÛÂ Û¯¤ÛË ÌÂ ÂÎÂ›ÓÔÓ ÚÈÓ

·fi ÙË ıÂÚ·Â›·. ŸÛÔ ÌÈÎÚfiÙÂÚÔ Â›Ó·È ÙÔ ·È‰›, Ùfi-

ÛÔ ÌÂÁ·Ï‡ÙÂÚË ‚ÂÏÙ›ˆÛË ÙÔ˘ Ú˘ıÌÔ‡ ·‡ÍËÛË˜ ÂÈ-

Ù˘Á¯¿ÓÂÈ ÌÂ ÙËÓ ¤ÁÎ·ÈÚË ¤Ó·ÚÍË ÙË˜ ıÂÚ·Â›·˜. ∏

Ù·¯‡ÙËÙ· ·‡ÍËÛË˜ Î·Ù¿ ÙÔÓ ÚÒÙÔ ¯ÚfiÓÔ ÙË˜ ıÂÚ·-

Â›·˜ Â›Ó·È Û˘Ó‹ıˆ˜ Î·È Ë Ì¤ÁÈÛÙË Ô˘ ÂÈÙ˘Á¯¿ÓÂ-

Ù·È Î·ı’ fiÏË ÙË ‰È¿ÚÎÂÈ· ¯ÔÚ‹ÁËÛË˜ ÙË˜ GH (27). ∏

ÌË ·ÓÂ‡ÚÂÛË ÛÙË ÌÂÏ¤ÙË Ì·˜ Û˘Û¯¤ÙÈÛË˜ ÙÔ˘ ÙÂÏÈ-

ÎÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜ ÌÂ ÙËÓ Ù·¯‡ÙËÙ· ·‡ÍËÛË˜ Î·Ù¿

ÙÔÓ ÚÒÙÔ ¯ÚfiÓÔ ÙË˜ ıÂÚ·Â›·˜ ÔÊÂ›ÏÂÙ·È Èı·ÓÒ˜

ÛÙË ÌÂÁ¿ÏË Û¯ÂÙÈÎ¿ ËÏÈÎ›· ÙˆÓ ·È‰ÈÒÓ Î·Ù¿ ÙËÓ

¤Ó·ÚÍË ÙË˜ ıÂÚ·Â›·˜.

™˘ÁÎÚ›ÓÔÓÙ·˜ Ù· ·È‰È¿ ÌÂ ÔÏÏ·Ï‹ ·ÓÂ¿Ú-

ÎÂÈ· ÔÚÌÔÓÒÓ ÌÂ ÂÎÂ›Ó· ÌÂ ÌÂÌÔÓˆÌ¤ÓË ·ÓÂ¿ÚÎÂÈ·

GH, ‰È·ÈÛÙÒıËÎÂ fiÙÈ ÙÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· ‰ÂÓ ‰È¤-

ÊÂÚÂ ÛÙ·ÙÈÛÙÈÎÒ˜ ÛËÌ·ÓÙÈÎ¿ ÛÙÈ˜ 2 ˘ÔÔÌ¿‰Â˜,

fiˆ˜ ¤¯ÂÈ ·Ú·ÙËÚËıÂ› Î·È ÛÂ ¿ÏÏÂ˜ ÌÂÏ¤ÙÂ˜

(12,31). ∆Ô 45,5% ÙˆÓ ·È‰ÈÒÓ ·˘ÙÒÓ ¤ÊÙ·ÛÂ ÛÙÔ

‡„Ô˜-ÛÙfi¯Ô. ∂ÓÙÔ‡ÙÔÈ˜, ÙÔ ¢ height ‹Ù·Ó ÛËÌ·ÓÙÈÎ¿

ÌÂÁ·Ï‡ÙÂÚÔ (p=0,001) ÛÙ· ·È‰È¿ ÌÂ ÔÏÏ·Ï‹ ·ÓÂ-

¿ÚÎÂÈ· ÔÚÌÔÓÒÓ, Ù· ÔÔ›· Ê·›ÓÂÙ·È Ó· ˆÊÂÏ‹ıË-

Î·Ó ÂÚÈÛÛfiÙÂÚÔ ·fi ÙË ıÂÚ·Â›· (13). £· Ú¤ÂÈ

Ó· ÛËÌÂÈˆıÂ›, ˆÛÙfiÛÔ, fiÙÈ Ë ·ÚÔ‡Û· ÔÌ¿‰· ÙˆÓ 11

·È‰ÈÒÓ ÌÂ ·ÓÂ¿ÚÎÂÈ· ÔÏÏÒÓ ÔÚÌÔÓÒÓ ·ÚÔ˘Û›·-

˙Â ÛËÌ·ÓÙÈÎ¿ ÌÈÎÚfiÙÂÚË SDS ÁÈ· ÙÔ TH ÛÂ Û¯¤ÛË ÌÂ

Ù· ·È‰È¿ ÌÂ ÌÂÌÔÓˆÌ¤ÓË ¤ÏÏÂÈ„Ë ·˘ÍËÙÈÎ‹˜ ÔÚÌfi-

ÓË˜ Î·È, Û˘ÓÂÒ˜, ˘‹Ú¯Â ‰È·ÊÔÚ¿ ˆ˜ ÚÔ˜ ÙÔ ÁÂÓÂ-

ÙÈÎ¿ Î·ıÔÚÈÛÌ¤ÓÔ ·Ó¿ÛÙËÌ·. ∞·ÈÙÂ›Ù·È, ÂÔÌ¤Óˆ˜,

ÌÂÁ·Ï‡ÙÂÚÔ˜ ·ÚÈıÌfi˜ ·È‰ÈÒÓ ÁÈ· ÙËÓ ÂÍ·ÁˆÁ‹

·ÛÊ·ÏÒÓ Û˘ÌÂÚ·ÛÌ¿ÙˆÓ .

™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ ÌÂÏ¤ÙË˜

Ì·˜, Î·ıÒ˜ Î·È ¿ÏÏˆÓ ·ÓÙ›ÛÙÔÈ¯ˆÓ ÌÂÏÂÙÒÓ ‰ÈÂ-

ıÓÒ˜, ‰Â›¯ÓÔ˘Ó ÌÈ· Û·Ê‹ ‚ÂÏÙ›ˆÛË ÛÙÔ ÙÂÏÈÎfi ·Ó¿-

ÛÙËÌ· ÌÂ ÙË ¯Ú‹ÛË ÙË˜ ‚ÈÔÛ˘ÓıÂÙÈÎ‹˜ GH 6 ‹ 7 ÊÔ-

Ú¤˜ Â‚‰ÔÌ·‰È·›ˆ˜, ÛÂ Û¯¤ÛË ÌÂ ÙË ¯ÔÚ‹ÁËÛË 3 ‰fiÛÂ-

ˆÓ Ô˘ ·ÔÙÂÏÔ‡ÛÂ Û˘Ó‹ıË Ú·ÎÙÈÎ‹ ÛÙÔ ·ÚÂÏ-

ıfiÓ. ∂ÓÙÔ‡ÙÔÈ˜, ÙÔ ÙÂÏÈÎfi ·ÔÙ¤ÏÂÛÌ· ÌÔÚÂ› Ó·

ÌËÓ Â›Ó·È ÈÎ·ÓÔÔÈËÙÈÎfi ÁÈ· fiÏÔ˘˜ ÙÔ˘ ·ÛıÂÓÂ›˜ Î·È

È‰›ˆ˜ ÁÈ· ÂÎÂ›ÓÔ˘˜ Ô˘ ÍÂÎ›ÓËÛ·Ó ÙËÓ ·ÁˆÁ‹ Û¯ÂÙÈ-

Î¿ ·ÚÁ¿. ∏ ‚ÂÏÙ›ˆÛË ÙÔ˘ Ú˘ıÌÔ‡ ·‡ÍËÛË˜ Î·Ù¿ ÙËÓ

ÂÊË‚Â›· Ê·›ÓÂÙ·È Ó· ··ÈÙÂ› ÌÈ· ·‡ÍËÛË Î·Ù¿ 50%

ÂÚ›Ô˘ ÙË˜ ¯ÔÚËÁÔ‡ÌÂÓË˜ ‰fiÛË˜ ÚÈÓ ·fi ÙËÓ

‹‚Ë. ∆¤ÏÔ˜, ‰ÂÓ ı· Ú¤ÂÈ Ó· ·Ú·‚Ï¤ÂÈ Î·ÓÂ›˜ ÙÔ

ÚfiÏÔ Ô˘ ·›˙ÂÈ ÙÔ ÁÂÓÂÙÈÎfi ‰˘Ó·ÌÈÎfi ÛÙÔÓ Î·ıÔÚÈ-

ÛÌfi ÙÔ˘ ÙÂÏÈÎÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜.


1. Hindmarsh PC, Dattani MT. Use of growth hormone in

children. Nat Clin Pract Endocrinol Metab 2006;2:260-268.

2. ÃÈÒÙË˜ ¢, ∆ÛÈÊÙ‹˜ °, Ã·Ù˙ËÛ˘ÌÂÒÓ ª, ª·ÓÈ¿ÙË-

ÃÚËÛÙ›‰Ë ª, ∫Ú›ÎÔ˜ •, ¢¿ÎÔ˘-µÔ˘ÙÂÙ¿ÎË ∞. ∞Ó¿ÛÙËÌ·

Î·È ÛˆÌ·ÙÈÎfi ‚¿ÚÔ˜ ÂÏÏËÓÔ·›‰ˆÓ ËÏÈÎ›·˜ 0-18 ÂÙÒÓ

(2001-2002): Û‡ÁÎÚÈÛË ÌÂ ‰Â‰ÔÌ¤Ó· ÌÂÏ¤ÙË˜ ÙÔ˘ 1978-

1979. ¢ÂÏÙ›Ô ∞ã ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹˜ 2003;50:136-156.

3. Cavallo A, Richards GE, Busey S, Michaels SE. A simplified


¶·È‰È·ÙÚÈÎ‹ 2008;71:128-134

¶›Ó·Î·˜ 7. ™˘ÁÎÚÈÙÈÎ‹ ·ÍÈÔÏfiÁËÛË ÙË˜ Â›‰Ú·ÛË˜ ÙË˜ ıÂÚ·Â›·˜ ˘ÔÎ·Ù¿ÛÙ·ÛË˜ ÌÂ ·˘ÍËÙÈÎ‹ ÔÚÌfiÓË ÛÂ ·È‰È¿ ÌÂ Û˘Ó‰˘·ÛÌ¤ÓË Î·È ·È‰È¿ÌÂ ÌÂÌÔÓˆÌ¤ÓË ·ÓÂ¿ÚÎÂÈ· GH

∞ÛıÂÓÂ›˜ (¡=72) ∞ÓÂ¿ÚÎÂÈ· ªÂÌÔÓˆÌ¤ÓË pÔÏÏ·ÏÒÓ ÔÚÌÔÓÒÓ ·ÓÂ¿ÚÎÂÈ· GH

º‡ÏÔ 11 (6 ¿ÚÚÂÓ·, 5 ı‹ÏÂ·) 61 (37 ¿ÚÚÂÓ·, 24 ı‹ÏÂ·) NS∏ÏÈÎ›· ¤Ó·ÚÍË˜ GH (¤ÙË) 10,26±3,38 11,83±2,82 0,1∞Ú¯ÈÎfi ‡„Ô˜ (SDS) -2,91±0,78 -2,42±0,83 0,075√ÛÙÈÎ‹ ËÏÈÎ›· Î·Ù¿ ÙËÓ ¤Ó·ÚÍË GH (¤ÙË) 7,17±3,71 9,91±2,71 0,005∞Ú¯ÈÎfi ‡„Ô˜ ÚÔÛ·ÚÌÔÛÌ¤ÓÔ ÛÙËÓ ÔÛÙÈÎ‹ ËÏÈÎ›· (SDS) -0,52±1,05 -0,77±1,05 0,47∆∏ ‡„Ô˜ (SDS) -0,183±1,02 -0,88±0,63 0,003⁄„Ô˜ ÌËÙ¤Ú·˜ (SDS) -0,5±1,41 -0,98±0,78 0,29⁄„Ô˜ ·Ù¤Ú· (SDS) 0,08±0,87 -0,79±0,86 0,003∆ÂÏÈÎfi ‡„Ô˜ (SDS) -0,75±1,18 -1,31±0,97 0,091∆·¯‡ÙËÙ· ·‡ÍËÛË˜ Î·Ù¿ ÙÔ ÚÒÙÔ ¤ÙÔ˜ ıÂÚ·Â›·˜ (height velocity) (SDS) 6,62±4,71 6,19±5,03 0,79∏ÏÈÎ›· ‰È·ÎÔ‹˜ GH (¤ÙË) 16,8±1,07 16,04±1,67 0,15¢ height (SDS) 2,17±1,1 1,14±0,87 0,001∆ÂÏÈÎfi ‡„Ô˜ (SDS)-∆∏ (SDS) -0,56±1,01 -0,45±0,9 0,71¢ÔÛÔÏÔÁ›· GH (IU/kgr/Â‚‰ÔÌ¿‰·) 0,52±0,14 0,46±0,11 0,14∞ÚÈıÌfi˜ ÂÓ¤ÛÂˆÓ/Â‚‰ÔÌ¿‰· 6±1,73 6,67±1,11 0,24¢È¿ÚÎÂÈ· ıÂÚ·Â›·˜ (¤ÙË) 6,55±3,2 4,29±2,54 0,011

SDS: standard deviation, GH: ·˘ÍËÙÈÎ‹ ÔÚÌfiÓË, ∆∏: ·Ó·ÌÂÓfiÌÂÓÔ ÁÈ· ÙËÓ ÔÈÎÔÁ¤ÓÂÈ· ‡„Ô˜, ÚÔÛ·ÚÌÔÛÌ¤ÓÔ ÛÙÔ Ê‡ÏÔ(target height), NS: non significant, ¢ height: ÙÂÏÈÎfi ‡„Ô˜ (SDS)-·Ú¯ÈÎfi ‡„Ô˜ (SDS)


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134 ª. ¶··‰ÔÔ‡ÏÔ˘ Î·È Û˘Ó.



135∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞ ORIGINAL ARTICLE

¶·È‰È·ÙÚÈÎ‹ 2008;71:135-140

ªÂÏ¤ÙË ÙÔ˘ ·ÓÔÛÔÊ·ÈÓfiÙ˘Ô˘ ÛÂ ·È‰È¿ ÌÂ ÏÔ›ÌˆÍË ·fi Èfi

Epstein-Barr Î·È ÌÂÁ·ÏÔÎ˘ÙÙ·ÚÔ˚fi Î·È Û˘Û¯¤ÙÈÛË ÌÂ ÙËÓ ÎÏÈÓÈÎ‹

¤Î‚·ÛË

∂. ¶··‰ÔÔ‡ÏÔ˘-∞Ï·Ù¿ÎË1, ∞. ºÏ¤‚·2, µ. ∞ÓÙ¿ÚË1, ∞. ¶·˘Ï›ÙÔ˘-∆ÛÈfiÓÙÛË2, ª. ªÔÛÎÔÊ›‰Ë˜3, °. µ·ÚÏ¿ÌË˜1

¶ÂÚ›ÏË„Ë

∂ÈÛ·ÁˆÁ‹: ™ÎÔfi˜ ÙË˜ ÂÚÁ·Û›·˜ ‹Ù·Ó Ë ÌÂÏ¤ÙË ÙÔ˘ ·ÓÔÛÔÊ·ÈÓfiÙ˘Ô˘ ÙˆÓ ·È‰ÈÒÓ ÌÂ Û‡Ó‰ÚÔÌÔ ÏÔÈ-ÌÒ‰Ô˘˜ ÌÔÓÔ˘Ú‹ÓˆÛË˜ (™§ª) Î·Ù¿ ÙËÓ ÔÍÂ›· Ê¿ÛË Î·È ÌÂÙ¿ ÙËÓ ·Ô‰ÚÔÌ‹ ÙË˜ ÏÔ›ÌˆÍË˜, Î·ıÒ˜ Î·ÈË Û˘Û¯¤ÙÈÛ‹ ÙÔ˘ ÌÂ ÙËÓ ÎÏÈÓÈÎ‹ ¤Î‚·ÛË.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ªÂÏÂÙ‹ıËÎ·Ó 26 ·È‰È¿ ÌÂ ™§ª, ÌÂ Ì¤ÛÔ fiÚÔ ËÏÈÎ›·˜ 6,6±3,5 ¤ÙË. ¶·Ú·ÎÔÏÔ˘ı‹ıËÎÂË ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· Î·È ÔÚÂ›· Î·È ¤ÁÈÓÂ ¤ÏÂÁ¯Ô˜ ÌÂ ˘ÂÚË¯ÔÁÚ¿ÊËÌ· ÛÏËÓfi˜, Ì¤ÙÚËÛË ÙˆÓ ·ÓÙÈ-ÈÈÎÒÓ ·ÓÙÈ-ÛˆÌ¿ÙˆÓ, ÁÂÓÈÎ‹ ·›Ì·ÙÔ˜, ÚÔÛ‰ÈÔÚÈÛÌfi ÙÚ·ÓÛ·ÌÈÓ·ÛÒÓ, Á-GT, ·ÓÔÛÔÛÊ·ÈÚÈÓÒÓ (IgG, IgA, IgM) Î·È ÙˆÓÎ˘ÙÙ·ÚÈÎÒÓ ˘ÔÏËı˘ÛÌÒÓ, ∆ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ (CD3+, CD3+/CD4+, CD3+/CD8+), µ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ(CD19+) Î·È Ê˘ÛÈÎÒÓ Î˘ÙÙ·ÚÔÎÙfiÓˆÓ (CD3-/CD16+56+) Î·Ù¿ ÙËÓ ÔÍÂ›· Ê¿ÛË Î·È ÌÂÙ¿ ·fi 3-6 Ì‹ÓÂ˜.

∞ÔÙÂÏ¤ÛÌ·Ù·: ∆Ô 69% ÙˆÓ ·È‰ÈÒÓ ·ÚÔ˘Û›·˙Â ÏÔ›ÌˆÍË ·fi Èfi Epstein-Barr (EBV), ÂÓÒ ÙÔ 31% ·fi ÌÂÁ·-ÏÔÎ˘ÙÙ·ÚÔ˚fi (CMV). ∫·Ù¿ ÙÔÓ Â·Ó¤ÏÂÁ¯Ô, ·Ú·ÙËÚ‹ıËÎÂ ÌÂ›ˆÛË ÙˆÓ ÂÈ¤‰ˆÓ IgM Î·È ·‡ÍËÛË ÙˆÓ IgG·ÓÙÈ-ÈÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ÌÂ ·Ú¿ÏÏËÏË ÎÏÈÓÈÎ‹ ·ÔÎ·Ù¿ÛÙ·ÛË. ∏ ÛÏËÓÔÌÂÁ·Ï›·, Ë ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÛË Î·È Ë·‡ÍËÛË ÙˆÓ ÙÚ·ÓÛ·ÌÈÓ·ÛÒÓ ˘Ô¯ÒÚËÛ·Ó ÛËÌ·ÓÙÈÎ¿. ∏ ˘ÂÚÁ·ÌÌ·ÛÊ·ÈÚÈÓ·ÈÌ›·, Î˘Ú›ˆ˜ ÙË˜ IgM, ·ÔÎ·-Ù·ÛÙ¿ıËÎÂ. ∫·Ù¿ ÙËÓ ÔÍÂ›· ÏÔ›ÌˆÍË, Ù· CD3+/CD8+ ·ÚÔ˘Û›·Û·Ó ÛËÌ·ÓÙÈÎ‹ ·‡ÍËÛË, ÌÂ ÂÏ¿ÙÙˆÛË ÙÔ˘ ÏfiÁÔ˘CD4+/CD8+, ÂÓÒ Ù· CD19+ Î·È Ù· CD3+/CD4+ ‹Ù·Ó ÂÏ·ÙÙˆÌ¤Ó·. ™ÙÔÓ Â·Ó¤ÏÂÁ¯Ô, Ù· CD3+ Î·È CD3+/CD8+ ·-ÚÔ˘Û›·˙·Ó ÛËÌ·ÓÙÈÎ‹ ÂÏ¿ÙÙˆÛË, ÂÓÒ Ù· CD3+/CD4+, Ù· CD19+ Î·È Ô ÏfiÁÔ˜ CD4+/CD8+ ·ÚÔ˘Û›·˙·Ó ·‡ÍËÛË.

™˘ÌÂÚ¿ÛÌ·Ù·: ∆· CD3+/CD8+ ∆ ÏÂÌÊÔÎ‡ÙÙ·Ú· ·ÔÙÂÏÔ‡Ó ÙËÓ Î˘ÙÙ·ÚÔÙÔÍÈÎ‹ ∆ ÏÂÌÊÔÎ˘ÙÙ·ÚÈÎ‹ ·¿-ÓÙËÛË ÛÙ· EBV Î·È CMV ·ÓÙÈÁfiÓ· Î·È Ë ÌÂ›ˆÛ‹ ÙÔ˘˜ Û¯ÂÙ›˙ÂÙ·È ÌÂ ÙËÓ ‡ÊÂÛË ÙË˜ Û˘ÌÙˆÌ·ÙÔÏÔÁ›·˜.∞fi ÙË ÌÂÏ¤ÙË ÚÔÎ‡ÙÂÈ Ë ̄ ÚËÛÈÌfiÙËÙ· ÙÔ˘ ·ÓÔÛÔÊ·ÈÓfiÙ˘Ô˘ ÁÈ· ÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ·È‰ÈÒÓ ÌÂ™§ª Ô˘ ¯ÚÔÓ›˙ÂÈ.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ∞ÓÔÛÔÊ·ÈÓfiÙ˘Ô˜, EBV, CMV ÏÔ›ÌˆÍË, ÎÏÈÓÈÎ‹ ¤Î‚·ÛË.

Study of the immunophenotype of peripheral blood lymphocyte

subsets in children with Epstein-Barr virus and cytomegalovirus

infection: association with outcome

E. Papadopoulou-Alataki1, A. Fleva2, V. Antari1, A. Pavlitou-Tsiontsi2, M. Moskofidis3, G. Varlamis1

Abstract

Background: The purpose of this study was to identify the immunophenotype of children withinfectious mononucleosis during the acute phase of the disease and convalescence and to investigateits association with the disease outcome.

Methods: A study was made of 26 children aged 6.6±3.5 years, affected by infectious mononucleosis. Theclinical presentation, spleen size, peripheral blood count, anti-virus specific antibodies, levels of SGOT,SGPT, Á-GT, IgG, IgA and IgM, and immunophenotype of blood T, B and NK cells were studied during theacute phase and 3-6 months later.

Results: Of the 26 children, 69% were infected by Epstein-Barr virus (EBV) and 31% by cytomegalovirus(CMV). At 3-6 month reevaluation a significant decrease in IgM and an increase in IgG antivirus antibodieswere observed, and the splenomegaly, lymphocytosis and high initial levels of SGOT were restored tonormal. At the time of onset of symptoms, the CD3+/CD8+ cells were considerably increased, CD19+ andCD3+/CD4+ percentages were low and a marked lowering of the CD4+/CD8+ ratio was observed. Atreevaluation, CD3+ and CD3+/CD8+ were lower, while CD3+/CD4+, CD19+ cells and the CD4+/CD8+ ratiowere significantly increased.

Conclusions: The increase in CD3+/CD8+ cells represents the cytotoxic response to the proliferation of EBVand CMV antigens, and may be related with the remission of symptoms. Immunophenotyping ofperipheral blood could be helpful in the follow-up of children with persistent infectious mononucleosis.

Key words: Immunophenotype, EBV, CMV infection, clinical outcome.

1 ¢’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹∞¶£, °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô“¶··ÁÂˆÚÁ›Ô˘”,£ÂÛÛ·ÏÔÓ›ÎË

2 ∂ÚÁ·ÛÙ‹ÚÈÔ ∞ÓÔÛÔÏÔÁ›·˜-πÛÙÔÛ˘Ì‚·ÙfiÙËÙ·˜, °ÂÓÈÎfi¡ÔÛÔÎÔÌÂ›Ô“¶··ÁÂˆÚÁ›Ô˘”,£ÂÛÛ·ÏÔÓ›ÎË

3 ªÈÎÚÔ‚ÈÔÏÔÁÈÎfi-µÈÔ¯ËÌÈÎfi-πÔÏÔÁÈÎfi∆Ì‹Ì·, °ÂÓÈÎfi¡ÔÛÔÎÔÌÂ›Ô“¶··ÁÂˆÚÁ›Ô˘”,£ÂÛÛ·ÏÔÓ›ÎË


∂˘ÊËÌ›· ¶··‰ÔÔ‡ÏÔ˘-∞Ï·Ù¿ÎË [email protected] °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô“¶··ÁÂˆÚÁ›Ô˘”,¶ÂÚÈÊÂÚÂÈ·Î‹ Ô‰fi˜¡. ∂˘Î·Ú›·, ∆.∫. 564 03, £ÂÛÛ·ÏÔÓ›ÎË

1 4th Department ofPaediatrics, AristotleUniversity of Thessaloniki,Papageorgiou GeneralHospital, Thessaloniki

2 Immunology-HistocompatibilityLaboratory, PapageorgiouGeneral Hospital,Thessaloniki

3 Microbiological-Biochemical-VirologicalDepartment,Papageorgiou GeneralHospital, Thessaloniki

Correspondence:

Efimia [email protected] Papageorgiou GeneralHospital, Ring road,564 03, ¡. Efkarpia, Thessaloniki, Greece


136 ∂. ¶··‰ÔÔ‡ÏÔ˘-∞Ï·Ù¿ÎË Î·È Û˘Ó.


™˘ÓÙÔÌÔÁÚ·Ê›Â˜

EBV πfi˜ Epstein-Barr

CMV ªÂÁ·ÏÔÎ˘ÙÙ·ÚÔ˚fi˜

™§ª ™‡Ó‰ÚÔÌÔ §ÔÈÌÒ‰Ô˘˜ ªÔÓÔ˘Ú‹ÓˆÛË˜

§ª §ÔÈÌÒ‰Ë˜ ªÔÓÔ˘Ú‹ÓˆÛË

SGOT OÍ·ÏÔÍÈÎ‹ ÙÚ·ÓÛ·ÌÈÓ¿ÛË

SGPT ¶˘ÚÔÛÙ·Ê˘ÏÈÎ‹ ÙÚ·ÓÛ·ÌÈÓ¿ÛË

Á-GT Á-ÁÏÔ˘Ù·Ì˘ÏÔÙÚ·ÓÛÊÂÚ¿ÛË

CD3+ flÚÈÌ· ∆ ÏÂÌÊÔÎ‡ÙÙ·Ú· ÌÂ TCR ˘Ô‰Ô¯¤·

CD3+/CD4+ µÔËıËÙÈÎ¿ ∆ ÏÂÌÊÔÎ‡ÙÙ·Ú·

CD3+/CD8+ ∫·Ù·ÛÙ·ÏÙÈÎ¿/Î˘ÙÙ·ÚÔÙÔÍÈÎ¿ ∆ ÏÂÌÊÔ-

Î‡ÙÙ·Ú·

CD19+ µ ÏÂÌÊÔÎ‡ÙÙ·Ú·

CD3-/16+56+ º˘ÛÈÎ¿ Î˘ÙÙ·ÚÔÎÙfiÓ· (NK)

∂ÈÛ·ÁˆÁ‹

∏ §ÔÈÌÒ‰Ë˜ ªÔÓÔ˘Ú‹ÓˆÛË (§ª) Â›Ó·È ¤Ó·

ÎÏÈÓÈÎfi Û‡Ó‰ÚÔÌÔ Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ˘ÚÂÙfi,

Ê·Ú˘ÁÁÔ·Ì˘Á‰·Ï›ÙÈ‰· Î·È ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ·. ∞Ó Î·È

Ë ÏÂÈÔÓfiÙËÙ· ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÔÊÂ›ÏÔÓÙ·È ÛÙÔÓ Èfi

Epstein-Barr (EBV), ÏÔÈÌÒÍÂÈ˜ ·fi ¿ÏÏ· ·›ÙÈ·, fiˆ˜

Ô ÌÂÁ·ÏÔÎ˘ÙÙ·ÚÔ˚Ô˜ (CMV), Ô ÂÚËÙÔ˚fi˜ 6 (HSV), Ô

Èfi˜ ÙË˜ ·ÓıÚÒÈÓË˜ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·˜ (HIV), ÔÈ

·‰ÂÓÔ˚Ô›, Ô Èfi˜ ÙË˜ ÂÚ˘ıÚ¿˜, Ô Èfi˜ Parvo µ19, ÔÈ ÈÔ›

ÙË˜ Ë·Ù›ÙÈ‰·˜ ∞ Î·È µ, ÙÔ ÙÔÍfiÏ·ÛÌ·, ·ÚÔ˘ÛÈ¿-

˙Ô˘Ó ·ÚfiÌÔÈ· ÎÏÈÓÈÎ‹ Î·È ·ÈÌ·ÙÔÏÔÁÈÎ‹ ÂÈÎfiÓ· Î·È

ÚÔÎ·ÏÔ‡Ó ÙÔ Û‡Ó‰ÚÔÌÔ ÙË˜ ÏÔÈÌÒ‰Ô˘˜ ÌÔÓÔ˘Ú‹-

ÓˆÛË˜ (™§ª) (1-3).

∏ ‰È¿ÁÓˆÛË ÙË˜ ÚfiÛÊ·ÙË˜ ÏÔ›ÌˆÍË˜ ‚·Û›˙Â-

Ù·È ÛÙËÓ ·ÚÔ˘Û›· ·ÓÙÈ-ÈÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ÙË˜ Ù¿-

ÍË˜ IgM. ∂È‰ÈÎ¿ ÁÈ· ÙÔÓ EBV, Ë ·Ó›¯ÓÂ˘ÛË ·ÓÙÈÛˆ-

Ì¿ÙˆÓ Î·Ù¿ ÙˆÓ Î·„È‰ÈÎÒÓ, ÚÒÈÌˆÓ Î·È ˘ÚËÓÈ-

ÎÒÓ ·ÓÙÈÁfiÓˆÓ ˘Ô‚ÔËıÔ‡Ó ÙË ‰È¿ÁÓˆÛË. ∏ ·-

ÚÔ˘Û›· ·ÓÙÈÎ·„È‰ÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ Î·È Ë ·Ô˘Û›·

·ÓÙÈ˘ÚËÓÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ Â›Ó·È ÂÓ‰ÂÈÎÙÈÎ¤˜ ÙË˜

ÔÍÂ›·˜ ÏÔ›ÌˆÍË˜, ‰ÈfiÙÈ Ù· EBV ·ÓÙÈ˘ÚËÓÈÎ¿ ·ÓÙÈ-

ÛÒÌ·Ù· ÂÌÊ·Ó›˙ÔÓÙ·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ·Ó¿Ú-

ÚˆÛË˜ (4,5).

∏ ÔÍÂ›· §ª Â›Ó·È Û˘Ó‹ıˆ˜ ·˘ÙÔÂÚÈÔÚÈ˙fiÌÂÓË

ÓfiÛÔ˜ (6). øÛÙfiÛÔ, ÛÂ ÔÚÈÛÌ¤ÓÔ˘˜ ·ÛıÂÓÂ›˜ Î·Ù·Ï‹-

ÁÂÈ ÛÂ ¯ÚfiÓÈ· ÂÓÂÚÁfi ÏÔ›ÌˆÍË Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È

·fi ˘ÔÙÚÔ¤˜ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Î·È Ùˆ¯‹ Úfi-

ÁÓˆÛË (7,8). ∞ÔÙÂÏÂ› ÌÈ· ÛÔ‚·Ú‹ ·Ûı¤ÓÂÈ· ÌÂ

¿ÁÓˆÛÙË ·ıÔÁ¤ÓÂÈ· Ô˘ ÂÈÌ¤ÓÂÈ ¿Óˆ ·fi 3-6

Ì‹ÓÂ˜ ¤ˆ˜ Î·È ¯ÚfiÓÈ·, ÂÓÒ ÌÔÚÂ› Ó· ·ÚÔ˘ÛÈ·ÛÙÂ›

Î·È ÛÂ ¿ÙÔÌ· ÌÂ Î·Ï‹ ·ÓÔÛÔÏÔÁÈÎ‹ Î·Ù¿ÛÙ·ÛË (9-

11). ∂ÈÏ¤ÔÓ, ÛÂ ·È‰È¿ ÌÂ ‰È·Ù·Ú·¯‹ ÙˆÓ ∆ ÏÂÌ-

ÊÔÎ˘ÙÙ¿ÚˆÓ, Ë EBV ÏÔ›ÌˆÍË Ô‰ËÁÂ› Û˘¯Ó¿ ÛÂ ¯Úfi-

ÓÈ· ÂÓÂÚÁfi ÏÔ›ÌˆÍË ÌÂ Èı·Ó‹ ÂÍ¤ÏÈÍË ÛÂ Î·ÎÔ‹ıÂÈ·

ÙÔ˘ ÏÂÌÊÈÎÔ‡ ÈÛÙÔ‡. ™Â ÔÚÈÛÌ¤ÓÔ˘˜ ·ÛıÂÓÂ›˜, Ë §ª

ÌÔÚÂ› Ó· ·ÎÔÏÔ˘ı‹ÛÂÈ ÂÈıÂÙÈÎ‹ ÔÚÂ›· ÌÂ ·ÂÈ-

ÏËÙÈÎ¤˜ ÁÈ· ÙË ˙ˆ‹ ÂÈÏÔÎ¤˜ (7,12,13).

™ÎÔfi˜ ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ ‹Ù·Ó Ë ·Ó·˙‹ÙËÛË

ÙˆÓ ·ÓÔÛÔÏÔÁÈÎÒÓ ÌÂÙ·‚ÔÏÒÓ ÙˆÓ ·È‰ÈÒÓ ÌÂ ™§ª

Î·Ù¿ ÙËÓ ÔÍÂ›· Ê¿ÛË Î·È ÌÂÙ¿ ÙËÓ ·Ô‰ÚÔÌ‹ ÙË˜ ÏÔ›-

ÌˆÍË˜, Î·ıÒ˜ Î·È Ë ‰ÈÂÚÂ‡ÓËÛË ÙË˜ Û¯¤ÛË˜ ÙÔ˘˜ ÌÂÙËÓ ÎÏÈÓÈÎ‹ ¤Î‚·ÛË Î·È ÙËÓ ÂÁÎ·Ù¿ÛÙ·ÛË ·ÓÔÛ›·˜.


ªÂÏÂÙ‹ıËÎ·Ó 26 ·ÛıÂÓÂ›˜, 15 ·ÁfiÚÈ· Î·È 11 ÎÔÚ›ÙÛÈ·, ËÏÈ-Î›·˜ 2-14 ÂÙÒÓ, ÌÂ Ì¤ÛÔ fiÚÔ ËÏÈÎ›·˜ 6,6±3,5 ¤ÙË. √È ·ÛıÂÓÂ›˜ÓÔÛËÏÂ‡ıËÎ·Ó ÛÙËÓ ÎÏÈÓÈÎ‹ Ì·˜ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÂÙÒÓ2005-2006 Î·È ÏËÚÔ‡Û·Ó Ù· ÂÍ‹˜ ‰È·ÁÓˆÛÙÈÎ¿ ÎÚÈÙ‹ÚÈ·: ·)ÙÔ˘Ï¿¯ÈÛÙÔÓ ÙÚ›· ·fi Ù· ·Ú·Î¿Ùˆ: ˘ÚÂÙfi˜, Ê·Ú˘ÁÁÔ·Ì˘-Á‰·Ï›ÙÈ‰·, ÙÚ·¯ËÏÈÎ‹ ÏÂÌÊ·‰ÂÓ›ÙÈ‰·, ÛÏËÓÔÌÂÁ·Ï›·, ÙÚ·Ó-Û·ÌÈÓ·Û·ÈÌ›· Î·È ‚) ıÂÙÈÎ¿ IgM ·ÓÙÈÛÒÌ·Ù· ˆ˜ ÚÔ˜ EBV ‹CMV. √ ¤ÏÂÁ¯Ô˜ ·ÓÙÈÛˆÌ¿ÙˆÓ ¿ÏÏˆÓ ·ÈÙ›ˆÓ Ô˘ ÂÓ¤¯ÔÓÙ·ÈÛÙÔ ™§ª (ÂÚËÙÔ˚Ô‡ 6, Parvo B19, ·‰ÂÓÔ˚Ô‡ Î·È ÙÔÍÔÏ¿ÛÌ·-ÙÔ˜) ·¤‚Ë ·ÚÓËÙÈÎfi˜. ∫·Ó¤Ó·˜ ·fi ÙÔ˘˜ ·ÛıÂÓÂ›˜ Ì·˜ ‰ÂÓ Â›-¯Â ÁÓˆÛÙ‹ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ· ‹ ·ÓÔÛÔÎ·Ù·ÛÙÔÏ‹. √ ÛÎÔfi˜ÙË˜ ÌÂÏ¤ÙË˜ ÂÍËÁ‹ıËÎÂ ÛÙÔ˘˜ ÁÔÓÂ›˜ Î·È fiÏÔÈ ÔÈ ÁÔÓÂ›˜ ¤‰ˆ-Û·Ó ÁÚ·Ù‹ Û˘ÁÎ·Ù¿ıÂÛË ÚÈÓ ·fi ÙËÓ ¤Ó·ÚÍË ÙË˜ ÌÂÏ¤ÙË˜.

™Â fiÏ· Ù· ·È‰È¿ ¤ÁÈÓÂ ÎÏÈÓÈÎ‹ ÂÍ¤Ù·ÛË Î·È Î·Ù·ÁÚ·Ê‹ÙˆÓ ÎÏÈÓÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ, Î·ıÒ˜ Î·È ˘ÂÚË¯ÔÁÚ·ÊÈÎfi˜ ¤ÏÂÁ-¯Ô˜ ÙÔ˘ ÛÏËÓfi˜. ∆· ·È‰È¿ ÙË˜ ÌÂÏ¤ÙË˜ Ù·ÍÈÓÔÌ‹ıËÎ·Ó ÛÂ‰‡Ô ÔÌ¿‰Â˜, ·Ó¿ÏÔÁ· ÌÂ ÙÔ ·›ÙÈÔ ÙË˜ ÏÔ›ÌˆÍË˜: Ë Ì›· ÔÌ¿‰·ÂÚÈÂÏ¿Ì‚·ÓÂ 18 ·È‰È¿ Ô˘ Â›¯·Ó ıÂÙÈÎ¿ EBV IgM ·ÓÙÈÛÒ-Ì·Ù· Î·È Ë ¿ÏÏË ÂÚÈÂÏ¿Ì‚·ÓÂ 8 ·È‰È¿ Ô˘ Â›¯·Ó ıÂÙÈÎ¿CMV IgM ·ÓÙÈÛÒÌ·Ù·. √ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ÂÚÈÂÏ¿Ì-‚·ÓÂ: ÁÂÓÈÎ‹ ·›Ì·ÙÔ˜, SGOT, SGPT, Á-GT, ·ÓÔÛÔÛÊ·ÈÚ›ÓÂ˜IgG, IgA, IgM Î·È ·ÓÔÛÔÊ·ÈÓfiÙ˘Ô ∆, µ Î·È ¡∫ ÏÂÌÊÔÎ˘ÙÙ¿-ÚˆÓ. ∆ÚÂÈ˜ ¤ˆ˜ ¤ÍÈ Ì‹ÓÂ˜ ÌÂÙ¿, ¤ÁÈÓÂ ÂÎÙ›ÌËÛË ÙË˜ ÎÏÈÓÈÎ‹˜ÔÚÂ›·˜ Î·È Â·Ó¿ÏË„Ë ÙÔ˘ ÂÚÁ·ÛÙËÚÈ·ÎÔ‡ ÂÏ¤Á¯Ô˘.

∏ ·Ó›¯ÓÂ˘ÛË ·ÓÙÈÛˆÌ¿ÙˆÓ IgG ¤Ó·ÓÙÈ ÙÔ˘ ÌÂÁ·ÏÔÎ˘ÙÙ·-ÚÔ˚Ô‡, ÙÔ˘ ·‰ÂÓÔ˚Ô‡ Î·È ÙÔ˘ ÙÔÍÔÏ¿ÛÌ·ÙÔ˜ (Toxoplasmagondii) ¤ÁÈÓÂ ÔÛÔÙÈÎ¿, Ë ‰Â ·Ó›¯ÓÂ˘ÛË ·ÓÙÈÛˆÌ¿ÙˆÓ IgM¤ÁÈÓÂ ÔÈÔÙÈÎ¿ ÌÂ ÙË ÌÈÎÚÔÛˆÌ·ÙÈ‰È·Î‹ ·ÓÔÛÔÂÓ˙˘ÌÈÎ‹ Ì¤-ıÔ‰Ô (MEIA, Axsym, Abbott). ∏ ·Ó›¯ÓÂ˘ÛË ÙˆÓ ·ÓÙÈÛˆÌ¿ÙˆÓIgG Î·È IgM ¤Ó·ÓÙÈ ÙÔ˘ Î·„È‰ÈÎÔ‡ ·ÓÙÈÁfiÓÔ˘ ÙÔ˘ EBV (EBV-VCA IgG/IgM, Virotech), ÙÔ˘ HSV (HSV-IgG/IgM, Virotech)Î·È ÙÔ˘ Parvo µ19 (Parvovirus B19 IgG/IgM, Focus) ¤ÁÈÓ·Ó ÌÂÙËÓ ¤ÌÌÂÛË ·ÓÔÛÔÂÓ˙˘ÌÈÎ‹ Ì¤ıÔ‰Ô (Elisa). √ ÚÔÛ‰ÈÔÚÈÛÌfi˜ÙˆÓ Î˘ÙÙ·ÚÈÎÒÓ ÏËı˘ÛÌÒÓ (CD3+, CD3+/CD4+, CD3+/CD8+,CD19+, CD3-/CD16+56+, ÏfiÁÔ˘ CD4+/CD8+) ¤ÁÈÓÂ ÌÂ Î˘ÙÙ·-ÚÔÌÂÙÚ›· ÚÔ‹˜ ÛÂ ·Ó·Ï˘Ù‹ Epics Elite ESP, Coulter Î·È ÌÂ ÙË¯Ú‹ÛË ÌÔÓÔÎÏˆÓÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ÙË˜ ÂÙ·ÈÚÂ›·˜ BeckmanCoulter, Immunotech. ∏ ÔÛÔÙÈÎ‹ Ì¤ÙÚËÛË ÙˆÓ ·ÓÔÛÔÛÊ·È-ÚÈÓÒÓ (IgG, IgA Î·È πgM) Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ ÌÂ ÙË ÓÂÊÂÏÔ-ÌÂÙÚÈÎ‹ Ì¤ıÔ‰Ô ÛÙÔÓ ·Ó·Ï˘Ù‹ Beckman Immage ¯ÚËÛÈÌÔ-ÔÈÒÓÙ·˜ ·ÓÙÈ‰Ú·ÛÙ‹ÚÈ· ÙË˜ ÂÙ·ÈÚÂ›·˜ Beckman Coulter.

™Ù·ÙÈÛÙÈÎ‹ ·Ó¿Ï˘ÛË

∏ ÛÙ·ÙÈÛÙÈÎ‹ ·Ó¿Ï˘ÛË ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ ¤ÁÈÓÂ ÌÂ ÙË ¯Ú‹ÛËÙÔ˘ ÛÙ·ÙÈÛÙÈÎÔ‡ ÚÔÁÚ¿ÌÌ·ÙÔ˜ SPSS 11.0. ∏ ‰È·‰ÈÎ·Û›· ÛÙ·ÙÈ-ÛÙÈÎ‹˜ ·Ó¿Ï˘ÛË˜ ÂÚÈÂÏ¿Ì‚·ÓÂ ̆ ÔÏÔÁÈÛÌfi ÁÈ· Î¿ıÂ ÌÂÙ·‚ÏË-Ù‹ ÙË˜ Ì¤ÛË˜ ÙÈÌ‹˜ (mean) Î·È ÙË˜ Ù˘ÈÎ‹˜ ·fiÎÏÈÛË˜ (SD).

∏ Û‡ÁÎÚÈÛË ÙˆÓ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ Î·È ÎÏÈÓÈÎÒÓ ·Ú·Ì¤ÙÚˆÓÌÂÙ·Í‡ ÙˆÓ ÔÌ¿‰ˆÓ ÙˆÓ ·È‰ÈÒÓ ¤ÁÈÓÂ ÌÂ t-test. √ Û¯ÂÙÈÎfi˜Û˘ÓÙÂÏÂÛÙ‹˜ Pearson ̆ ÔÏÔÁ›ÛıËÎÂ ÁÈ· ÙËÓ ÂÚ·ÈÙ¤Úˆ ·Ó¿Ï˘-ÛË ÙË˜ Û˘Û¯¤ÙÈÛË˜ ÌÂÙ·Í‡ ÙˆÓ Î˘ÙÙ·ÚÈÎÒÓ ˘ÔÏËı˘ÛÌÒÓÎ·È ÙˆÓ ¿ÏÏˆÓ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ Î·È ÎÏÈÓÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ. ø˜fiÚÈÔ ÛÙ·ÙÈÛÙÈÎ‹˜ ÛËÌ·ÓÙÈÎfiÙËÙ·˜ ıÂˆÚ‹ıËÎÂ Ë ÙÈÌ‹ p<0,05.


∞fi Ù· 26 ·È‰È¿ ÙË˜ ÌÂÏ¤ÙË˜, Ù· 18 Â›¯·Ó EBVÏÔ›ÌˆÍË, ÂÓÒ Ù· ˘fiÏÔÈ· Â›¯·Ó CMV ÏÔ›ÌˆÍË. √


¯ÚfiÓÔ˜ ÓÔÛËÏÂ›·˜ Î˘Ì·ÈÓfiÙ·Ó ·fi 3 ¤ˆ˜ Î·È 10

ËÌ¤ÚÂ˜.

√ ˘ÚÂÙfi˜ ‹Ù·Ó ÙÔ Û‡ÌÙˆÌ· Ô˘ ·ÚÔ˘Û›·˙·Ó

fiÏ· Ù· ·È‰È¿ Î·È ·ÔÙ¤ÏÂÛÂ ÙËÓ Î‡ÚÈ· ·ÈÙ›· ÚÔÛ¤-

ÏÂ˘ÛË˜. ∆ËÓ ÎÏ·ÛÈÎ‹ ÎÏÈÓÈÎ‹ ÙÚÈ¿‰· (˘ÚÂÙfi˜, ÏÂÌ-

Ê·‰ÂÓ›ÙÈ‰· Î·È Ê·Ú˘ÁÁÔ·Ì˘Á‰·Ï›ÙÈ‰·) ·ÚÔ˘Û›·ÛÂ

ÙÔ 65% ÙˆÓ ·È‰ÈÒÓ. √›‰ËÌ· ‚ÏÂÊ¿ÚˆÓ ‰È·ÈÛÙÒ-

ıËÎÂ ÛÙÔ 23%, ·fiÊÚ·ÍË ·ÂÚÔÊfiÚˆÓ Ô‰ÒÓ 23%,

ÂÍ¿ÓıËÌ· 11%, ÂÚÈÎ·Ú‰›ÙÈ‰· 11%, ÂÓÒ ÓÂ˘ÌÔÓ›·,

·ÁÎÚÂ·Ù›ÙÈ‰· Î·È ·ÓÎ˘ÙÙ·ÚÔÂÓ›· ·fi ¤Ó· ·È‰›

·ÓÙ›ÛÙÔÈ¯·.

ŸÏ· Ù· ·È‰È¿ ÙË˜ ÌÂÏ¤ÙË˜ ·ÚÔ˘Û›·Û·Ó ·‡ÍËÛË

ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙÔ˘ ÛÏËÓfi˜ ¿Óˆ ·fi Ù· ·ÓÒÙÂÚ·

fiÚÈ· ÁÈ· ÙËÓ ËÏÈÎ›· ÙÔ˘˜, Û‡ÌÊˆÓ· ÌÂ ÙÔÓ ˘ÂÚË¯Ô-

ÁÚ·ÊÈÎfi ¤ÏÂÁ¯Ô. ∆Ô Ì¤ÁÂıÔ˜ ÙÔ˘ ÛÏËÓfi˜ ‹Ù·Ó

11,5±1,9 cm ÛÙËÓ ÔÌ¿‰· EBV Î·È 9,8±1,8 cm ÛÙËÓ

ÔÌ¿‰· CMV (p=0,04).

∞fi ÙËÓ ·Ó¿Ï˘ÛË ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜ ‚Ú¤-

ıËÎÂ fiÙÈ ÙÔ 77% ÙˆÓ ·ÛıÂÓÒÓ Â›¯Â ÔÛÔÛÙfi ÏÂÌÊÔ-

Î˘ÙÙ¿ÚˆÓ >50% ÙˆÓ Û˘ÓÔÏÈÎÒÓ ÏÂ˘ÎÒÓ Î·È ·fiÏ˘-

ÙÔ ·ÚÈıÌfi ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ >5000, ÂÓÒ ÛÙÔ 54%

‚Ú¤ıËÎ·Ó ¿Ù˘· ÏÂÌÊÔÎ‡ÙÙ·Ú· ÛÂ ÔÛÔÛÙfi 4-29%

ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ. ™ÙÔ 81% ‰È·È-

ÛÙÒıËÎÂ ·‡ÍËÛË ÙË˜ SGOT Î·È ÙË˜ SGPT. √È Ì¤ÛÂ˜

ÙÈÌ¤˜ ÙˆÓ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ, ÙˆÓ ¿Ù˘ˆÓ ÏÂÌÊÔÎ˘Ù-Ù¿ÚˆÓ Î·È ÙˆÓ Ë·ÙÈÎÒÓ ‰ÂÈÎÙÒÓ Ê·›ÓÔÓÙ·È ÛÙÔÓ¶›Ó·Î· 1.

ÀÂÚÁ·ÌÌ·ÛÊ·ÈÚÈÓ·ÈÌ›·, ÙÔ˘Ï¿¯ÈÛÙÔÓ ÛÂ Ì›· Ù¿ÍË·ÓÔÛÔÛÊ·ÈÚÈÓÒÓ, ·ÚÔ˘Û›·ÛÂ ÙÔ 69% ÙˆÓ ·È‰ÈÒÓÛÙËÓ IgM 53% Î·È ÛÙËÓ IgG 16%. ∞fi ÙËÓ ·ÓÔÛÔÊ·È-ÓÔÙ˘ÈÎ‹ ·Ó¿Ï˘ÛË ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜, ÚÔ¤Î˘-„Â fiÙÈ ÙÔ 58% ÙˆÓ ·È‰ÈÒÓ ÂÌÊ¿ÓÈ˙Â ·‡ÍËÛË ÙˆÓCD3+ (Ì¤ÛÔ˜ fiÚÔ˜ >80%), ÙÔ 46% ÂÏ¿ÙÙˆÛË ÙˆÓCD3+/CD4+ Î·È ÙÔ 58% ÂÏ¿ÙÙˆÛË ÙˆÓ CD19+ (Î·ÙÒ-ÙÂÚË ÙÈÌ‹ 1,9%). ™Â fiÏ· Ù· ·È‰È¿ ·Ú·ÙËÚ‹ıËÎÂ ÛË-Ì·ÓÙÈÎ‹ ·‡ÍËÛË ÙˆÓ CD3+/CD8+ ÌÂ Û‡Á¯ÚÔÓË ÂÏ¿Ù-ÙˆÛË ÙÔ˘ ÏfiÁÔ˘ CD4+/CD8+ Ô˘ Î˘Ì·ÈÓfiÙ·Ó ·fi 0,12¤ˆ˜ Î·È 1. ∫·Ó¤Ó· ·È‰› ‰ÂÓ Â›¯Â ·ıÔÏÔÁÈÎ‹ ÙÈÌ‹ ÙˆÓCD3-/CD16+56+. ∞fi ÙË Û‡ÁÎÚÈÛË ÙˆÓ Ì¤ÛˆÓ ÙÈÌÒÓÙˆÓ ·Ú·¿Óˆ ·Ú·Ì¤ÙÚˆÓ ‰ÂÓ ‚Ú¤ıËÎ·Ó ÛËÌ·ÓÙÈ-Î¤˜ ‰È·ÊÔÚ¤˜ ÌÂÙ·Í‡ ÙˆÓ ·È‰ÈÒÓ ÌÂ EBV ÏÔ›ÌˆÍËÎ·È CMV ÏÔ›ÌˆÍË Î·Ù¿ ÙËÓ ÔÍÂ›· Ê¿ÛË (¶›Ó·Î·˜ 2).

∫·Ù¿ ÙÔÓ Â·Ó¤ÏÂÁ¯Ô, fiÏ· Ù· ·È‰È¿ ‹Ù·Ó ÂÏÂ‡ıÂ-Ú· Û˘ÌÙˆÌ¿ÙˆÓ Î·È ·ÚÔ˘Û›·˙·Ó ÌÂ›ˆÛË ÙˆÓ ÂÈ-¤‰ˆÓ IgM Î·È ·‡ÍËÛË ÙˆÓ IgG ·ÓÙÈ-ÈÈÎÒÓ ·ÓÙÈÛˆÌ¿-ÙˆÓ, ÏËÓ Ì›·˜ ·ÛıÂÓÔ‡˜, ÙË˜ ÔÔ›·˜ Ë ·Ó¿ÚÚˆÛË‰È‹ÚÎÂÛÂ 8 Ì‹ÓÂ˜. ™ÙÔ Û‡ÓÔÏÔ ÙˆÓ ·ÛıÂÓÒÓ, Ë Ì¤ÛËÙÈÌ‹ ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙÔ˘ ÛÏËÓfi˜ (8,7±1,4 cm) ‹Ù·ÓÛËÌ·ÓÙÈÎ¿ ¯·ÌËÏfiÙÂÚË (p<0,001), ÛÂ Û‡ÁÎÚÈÛË ÌÂÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë ÙË˜ ÔÍÂ›·˜ ÏÔ›ÌˆÍË˜. √È Ì¤ÛÂ˜ ÙÈÌ¤˜ÙË˜ ÂÎ·ÙÔÛÙÈ·›·˜ ·Ó·ÏÔÁ›·˜ ÙˆÓ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ(47±10%), ÙÔ˘ ·fiÏ˘ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÏÂÌÊÔÎ˘ÙÙ¿-ÚˆÓ (3817±1136/Ìl), ÙË˜ IgM (1±0,4 g/L) ‹Ù·Ó ÛÙ·ÙÈ-ÛÙÈÎ¿ ¯·ÌËÏfiÙÂÚÂ˜ (p<0,001), ÂÓÒ ÔÈ Ì¤ÛÂ˜ ÙÈÌ¤˜ ÙË˜IgG (11,4±3,1 g/L) Î·È ÙË˜ IgA (1,7±1 g/L) ‰ÂÓ Â›¯·ÓÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ¤˜ ÌÂÙ·‚ÔÏ¤˜. √È Ì¤ÛÂ˜ ÙÈÌ¤˜ÙˆÓ CD3+ (72±5%), ÙˆÓ CD3/+CD8+ (26±6%) ‹Ù·ÓÛËÌ·ÓÙÈÎ¿ ¯·ÌËÏfiÙÂÚÂ˜ (p<0,001), ÂÓÒ ÙˆÓCD3+/CD4+ (38±7%) Î·È CD19+ (18,37±12,7%) ‹Ù·ÓÛËÌ·ÓÙÈÎ¿ ·˘ÍËÌ¤ÓÂ˜. ¢ÂÓ ·Ú·ÙËÚ‹ıËÎÂ Î·Ì›··ÍÈÔÛËÌÂ›ˆÙË ÌÂÙ·‚ÔÏ‹ ÛÙ· ¡∫ Î‡ÙÙ·Ú· (∂ÈÎfiÓ· 1).∏ Ì¤ÛË ÙÈÌ‹ ÙÔ˘ ÏfiÁÔ˘ CD4+/CD8+ (1,55±0,6) ‹Ù·ÓÛËÌ·ÓÙÈÎ¿ ˘„ËÏfiÙÂÚË ÛÙÔÓ Â·Ó¤ÏÂÁ¯Ô ÛÂ Û‡ÁÎÚÈÛËÌÂ ÙË˜ ÔÍÂ›·˜ ÏÔ›ÌˆÍË˜ (p<0,001) (∂ÈÎfiÓ· 2).

∏ ‰ÔÎÈÌ·Û›· Pearson ¤‰ÂÈÍÂ fiÙÈ ÙÔ Ì¤ÁÂıÔ˜ ÙÔ˘

¶›Ó·Î·˜ 1. ∫ÏÈÓÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿, ·ÈÌ·ÙÔÏÔÁÈÎÔ› Î·È Ë·ÙÈÎÔ› ‰Â›ÎÙÂ˜ ÙˆÓ ·È‰ÈÒÓ ÌÂ ™§ª Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹

™‡ÓÔÏÔ EBV ÏÔ›ÌˆÍË CMV ÏÔ›ÌˆÍË p

∞ÛıÂÓÂ›˜ 26 18 8∏ÏÈÎ›· (¤ÙË) 6,6±3,5 7±3,6 5,7±3,1 ª™ÃÚfiÓÔ˜ ÓÔÛËÏÂ›·˜ (ËÌ¤ÚÂ˜) 6,2±1,9 6,3±1,8 6±2,4 ª™§Â˘Î¿ (Î/Ìl) 15.917±7.130 14.828±6.008 18.366±9.159 ª™§ÂÌÊÔÎ‡ÙÙ·Ú· (%) 57,1±10,31 56,51±10,3 58,42±10,3 ª™ÕÙ˘· ÏÂÌÊÔÎ‡ÙÙ·Ú· (%) 14,6±7,17 14,37±7,15 15,25±8,3 ª™SGPT (U/L) 147±130 173±160 84±51 ª™SGOT (U/L) 110±84,38 124±96 77,14±27,5 ª™

ª™: ªË ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎfi

137∞ÓÔÛÔÊ·ÈÓfiÙ˘Ô˜ ·È‰ÈÒÓ ÌÂ EBV Î·È CMV ÏÔ›ÌˆÍË

¶·È‰È·ÙÚÈÎ‹ 2008;71:135-140

82%72%

23%38%

49%26%

8%18%

10% 9%

10% 60% 0% 20% 30% 40% 50% 70% 80% 90%

√ÍÂ›· ÏÔ›ÌˆÍË ∂·Ó¤ÏÂÁ¯Ô˜

CD3+

CD3+/CD4+

CD3+/CD8+

CD19+

NK

∂ÈÎfiÓ· 1. ª¤ÛÂ˜ ÙÈÌ¤˜ ̆ ÔÏËı˘ÛÌÒÓ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ ÙˆÓ ·È-‰ÈÒÓ ÌÂ ™§ª ÛÙËÓ ÔÍÂ›· ÏÔ›ÌˆÍË Î·È ÛÙÔÓ Â·Ó¤ÏÂÁ¯Ô.


ÛÏËÓfi˜ Â›¯Â ıÂÙÈÎ‹ Û˘Û¯¤ÙÈÛË ÌÂ Ù· CD3+/CD8+

ÏÂÌÊÔÎ‡ÙÙ·Ú· Î·È ·ÚÓËÙÈÎ‹ Û˘Û¯¤ÙÈÛË ÌÂ ÙÔ ÏfiÁÔ

CD4+/CD8+. ªÂÙ·Í‡ ÙË˜ IgA Î·È ÙˆÓ Ë·ÙÈÎÒÓ ‰ÂÈ-

ÎÙÒÓ ‚Ú¤ıËÎÂ ıÂÙÈÎ‹ Û˘Û¯¤ÙÈÛË, ÂÓÒ ·ÚÓËÙÈÎ‹ ‹Ù·Ó

Ë Û˘Û¯¤ÙÈÛË ÌÂÙ·Í‡ ÙË˜ IgA Î·È ÙˆÓ CD3+/CD4+ Î·È

ÙÔ˘ ÏfiÁÔ˘ CD4+/CD8+ Î·È ÈÛ¯˘Ú¿ ıÂÙÈÎ‹ ÌÂ Ù·

CD3+/CD8+. ∏ IgG Â›¯Â ıÂÙÈÎ‹ Û˘Û¯¤ÙÈÛË ÌÂ ÙËÓ IgA

Î·È Ù· CD3+/CD8+ (¶›Ó·Î·˜ 3).

∞fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ ·È‰ÈÒÓ Ô˘ Â·ÓÂÏ¤Á¯ıË-

Î·Ó, ÙÚ›· ·È‰È¿ (‰‡Ô ·ÁfiÚÈ· Î·È ¤Ó· ÎÔÚ›ÙÛÈ) ËÏÈ-

Î›·˜ 9-11 ÂÙÒÓ, ·ÚÔ˘Û›·˙·Ó Î·Ù·‚ÔÏ‹ Î·È ÌÂÈˆÌ¤-

ÓË ‰Ú·ÛÙËÚÈfiÙËÙ·. ∆· ‰‡Ô ·fi ·˘Ù¿ Â›¯·Ó ÏÔ›ÌˆÍË

·fi EBV Î·È ·¤ÎÙËÛ·Ó ·ÓÔÛ›· 3 Ì‹ÓÂ˜ ÌÂÙ¿ ÙËÓ

ÔÍÂ›· Ê¿ÛË. ™ÙÔ ÙÚ›ÙÔ ·È‰›, ÎÔÚ›ÙÛÈ, ÌÂ CMV ÏÔ›-

ÌˆÍË, Ë ÂÁÎ·Ù¿ÛÙ·ÛË ·ÓÔÛ›·˜ Î·ı˘ÛÙ¤ÚËÛÂ, ÌÂ ÂÈ-

ÌÔÓ‹ ÙˆÓ ·ÓÙÈ-CMV IgM ·ÓÙÈÛˆÌ¿ÙˆÓ Â› 8 Ì‹ÓÂ˜,

ÙˆÓ ÔÔ›ˆÓ Ô Ù›ÙÏÔ˜ ÛÙ·‰È·Î¿ ÌË‰ÂÓ›ÛÙËÎÂ Î·È ·-

Ú·ÙËÚ‹ıËÎÂ ÂÈÎÚ¿ÙËÛË ÙˆÓ ·ÓÙÈ-CMV IgG ·ÓÙÈ-

ÛˆÌ¿ÙˆÓ. ∆ËÓ ·ÈÌ·ÙÔÏÔÁÈÎ‹ ÙÔ˘˜ ÂÈÎfiÓ· ¯·Ú·ÎÙ‹-

ÚÈ˙Â Â›ÌÔÓË ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÛË (>50%), Î·ıÒ˜ Î·È

·ÚÔ˘Û›· ¿Ù˘ˆÓ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ Â› 3 Ì‹ÓÂ˜. ∏

·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ˘ÔÏËı˘ÛÌÒÓ ÙˆÓ ÏÂÌÊÔ-

Î˘ÙÙ¿ÚˆÓ ¤‰ÂÈÍÂ fiÙÈ ÛÙËÓ ÔÍÂ›· Ê¿ÛË Ù· ‰‡Ô ·È‰È¿

ÌÂ EBV ÏÔ›ÌˆÍË Î·È ÙÔ ¤Ó· ·È‰› ÌÂ CMV ÏÔ›ÌˆÍË

Â›¯·Ó ˘„ËÏ¿ CD3+/CD8+: 40%, 70% Î·È 70% ·ÓÙ›-

ÛÙÔÈ¯·, ÂÓÒ Ô ÏfiÁÔ˜ CD4+/CD8+ ‹Ù·Ó ¯·ÌËÏfi˜: 0,5,

0,15 Î·È 0,23 ·ÓÙ›ÛÙÔÈ¯·. ™ÙÔ ·È‰› ÌÂ ÙË CMV ÏÔ›-

ÌˆÍË, Ô ÏfiÁÔ˜ CD4+/CD8+ ·Ú¤ÌÂÈÓÂ <1 ÁÈ· ¯ÚÔÓÈÎfi

‰È¿ÛÙËÌ· ÌÂÁ·Ï‡ÙÂÚÔ ÙˆÓ 8 ÌËÓÒÓ.

™˘˙‹ÙËÛË

™ÙË ÌÂÏ¤ÙË Ì·˜ ‰È·ÈÛÙÒıËÎÂ fiÙÈ Ù· ·È‰È¿ ÌÂ

ÔÍÂ›· EBV Î·È CMV ÏÔ›ÌˆÍË ·ÚÔ˘Û›·Û·Ó ·‡ÍËÛË

ÙˆÓ CD8+ ∆ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ, Ù· ÔÔ›· ÂÏ·ÙÙÒıËÎ·Ó

·Ú¿ÏÏËÏ· ÌÂ ÙËÓ ÎÏÈÓÈÎ‹ ·ÔÎ·Ù¿ÛÙ·ÛË. ∞Ó¿ÏÔ-

ÁÂ˜ ÌÂÏ¤ÙÂ˜, ·Ó·ÊÔÚÈÎ¿ ÌÂ ÙÔÓ ·ÓÔÛÔÊ·ÈÓfiÙ˘Ô

ÙˆÓ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ ÙˆÓ ·È‰ÈÒÓ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ·

ÙË˜ ·Ó¿ÚÚˆÛË˜, Â›Ó·È ÔÏ‡ ÂÚÈÔÚÈÛÌ¤ÓÂ˜ Î·È ·ÊÔ-

ÚÔ‡Ó ÌfiÓÔ ÙÔÓ EBV (14,15). √ EBV ·ÔÙ¤ÏÂÛÂ ·›ÙÈÔ

ÙÔ˘ ™§ª ÛÙÔ 69% ÙˆÓ ·È‰ÈÒÓ, Û˘¯ÓfiÙËÙ· ̄ ·ÌËÏfi-

ÙÂÚË ·fi ÙÔ 85-90% ÚÔËÁÔ‡ÌÂÓË˜ ÌÂÏ¤ÙË˜ ÛÂ

ÂÓ‹ÏÈÎÂ˜ (3). ∏ Ì¤ÛË ËÏÈÎ›· ÓfiÛËÛË˜ ‹Ù·Ó 6,6 ¤ÙË,

CD

4+/C

D8+

√ÍÂ›· ÏÔ›ÌˆÍË ∂·Ó¤ÏÂÁ¯Ô˜

4

3

2

1

0

-1

∂ÈÎfiÓ· 2. ¢È·Î‡Ì·ÓÛË ÙˆÓ ÙÈÌÒÓ ÙÔ˘ ÏfiÁÔ˘ CD4+/CD8+ Î·È Ë Ì¤-ÛË ÙÈÌ‹ ÙÔ˘ (ÔÚÈ˙fiÓÙÈ· ÁÚ·ÌÌ‹ ÂÓÙfi˜ ÙˆÓ ·Ú·ÏÏËÏÔÁÚ¿ÌÌˆÓ)ÛÙÔ˘˜ ‰È·ÊÔÚÂÙÈÎÔ‡˜ ¯ÚfiÓÔ˘˜ Ì¤ÙÚËÛË˜. TÔ 1o Î·È 3o ÙÂÙ·ÚÙË-ÌfiÚÈÔ (25% Î·È 75% ÙˆÓ ·Ú·ÙËÚ‹ÛÂˆÓ) ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÌÂ ÙËÓ¿Óˆ Î·È Î¿Ùˆ ÏÂ˘Ú¿ ÙÔ˘ ·Ú·ÏÏËÏÔÁÚ¿ÌÌÔ˘. √È ÔÚÈ˙fiÓÙÈÂ˜ÁÚ·ÌÌ¤˜ Ô˘ ÚÔ‚¿ÏÏÔ˘Ó ÂÎÙfi˜ ÙÔ˘ ·Ú·ÏÏËÏÔÁÚ¿ÌÌÔ˘ ‰ËÏÒ-ÓÔ˘Ó ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô 95% ‰È¿ÛÙËÌ· ÂÌÈÛÙÔÛ‡ÓË˜ ÙË˜ Ì¤ÛË˜ ÙÈÌ‹˜ÙÔ˘ ÏfiÁÔ˘ CD4+/CD8+.

¶›Ó·Î·˜ 2. ∞ÓÔÛÔÛÊ·ÈÚ›ÓÂ˜ Î·È ˘ÔÏËı˘ÛÌÔ› ∆ Î·È µ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ ÙˆÓ ·ÛıÂÓÒÓ ÌÂ ™§ª Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹

™‡ÓÔÏÔ EBV ÏÔ›ÌˆÍË CMV ÏÔ›ÌˆÍË p

IgG (g/L) 13±3,9 13,5±4,1 12,1±3,3 ª™IgA (g/L) 2,1±1,3 2,1±1,1 2,2±1,7 ª™IgM (g/L) 2,2±0,9 2,2±0,9 2,15±1,04 ª™CD3+ (%) 82±9 78,6±10,2 81,1±6,5 ª™CD3+/CD4+ (%) 22,9±10,6 22,3±10,1 24,2±12,5 ª™CD3+/CD8+ (%) 48,5±15,5 47,8±14,3 49,9±17,5 ª™CD19+ (%) 7,7±4,9 7,8±4,3 7,4±6,2 ª™CD3-/CD16+56+ (%) 9,4±3,7 9,3±3,2 9,4±4,9 ª™CD4+/CD8+ 0,4±0,3 0,5±0,3 0,4±0,2 ª™

ª™: ªË ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎfi

138 ∂. ¶··‰ÔÔ‡ÏÔ˘-∞Ï·Ù¿ÎË Î·È Û˘Ó.



È‰È·ÈÙ¤Úˆ˜ ¯·ÌËÏ‹ ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙËÓ ·Ó·ÊÂÚfiÌÂ-ÓË ÛÂ ¿ÏÏÂ˜ ÌÂÏ¤ÙÂ˜, ÔÈ ÔÔ›Â˜ ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ ËÏÔ›ÌˆÍË Â›Ó·È Û˘¯ÓfiÙÂÚË ÛÂ ÂÊ‹‚Ô˘˜ Î·È ÓÂ·ÚÔ‡˜ÂÓ‹ÏÈÎÂ˜ ˘„ËÏÒÓ ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎÒÓ ÔÌ¿‰ˆÓ(16), Î·ıÒ˜ Î·È ÛÂ ËÏÈÎ›Â˜ 10-19 ÂÙÒÓ, È‰›ˆ˜ ÛÂ ÎÏÂÈ-ÛÙÔ‡˜ ÏËı˘ÛÌÔ‡˜ ÛÙÚ·ÙÈˆÙÈÎÒÓ Î·È ÊÔÈÙËÙÒÓ(17). ™Â ¿ÙÔÌ· ¯·ÌËÏÔ‡ ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎÔ‡ ÂÈ-¤‰Ô˘ Î·È ÛÂ ÙÚÔÈÎ¤˜ Î·È ·Ó·Ù˘ÛÛfiÌÂÓÂ˜ ¯ÒÚÂ˜,Ë ÏÔ›ÌˆÍË Â›Ó·È Û·ÓÈfiÙÂÚË Î·È ÂÌÊ·Ó›˙ÂÙ·È Î˘Ú›ˆ˜ÛÂ ÌÈÎÚ‹ ·È‰ÈÎ‹ ËÏÈÎ›· ˆ˜ ·Û˘ÌÙˆÌ·ÙÈÎ‹ (9,18).

√ CMV ˘‹ÚÍÂ ·ÍÈÔÛËÌÂ›ˆÙÔ ·›ÙÈÔ ™§ª, Î·ıÒ˜ÚÔÛ¤‚·ÏÂ 8 ·fi Ù· 26 ·È‰È¿ ÙË˜ ÌÂÏ¤ÙË˜. ŸÌˆ˜,‰ÂÓ Â›Ó·È ‰˘Ó·Ùfi Ó· ÂÍ·¯ıÔ‡Ó Û¯ÂÙÈÎ¿ ·ÍÈfiÈÛÙ· Û˘-ÌÂÚ¿ÛÌ·Ù· ÛÙË Û‡ÁÎÚÈÛË ÙˆÓ Â˘ÚËÌ¿ÙˆÓ ÙˆÓ ·È-‰ÈÒÓ ÌÂ CMV Î·È EBV ÏÔ›ÌˆÍË, ÏfiÁˆ ÙÔ˘ ÌÈÎÚÔ‡‰Â›ÁÌ·ÙÔ˜ ÙˆÓ ·ÛıÂÓÒÓ.

ø˜ ÚÔ˜ ÙËÓ ÎÏÈÓÈÎ‹ ÂÈÎfiÓ·, ÔÈ ÂÎ‰ËÏÒÛÂÈ˜ Â›Ó·ÈÌÂÓ ¯·Ú·ÎÙËÚÈÛÙÈÎ¤˜, ·ÏÏ¿ fi¯È ÂÈ‰ÈÎ¤˜, fiˆ˜ ÂÚÈ-ÁÚ¿ÊÂÙ·È Î·È ·ÏÏÔ‡ (19). ŸÏ· Ù· ·È‰È¿ ÙË˜ ÌÂÏ¤ÙË˜Ì·˜ ·ÚÔ˘Û›·Û·Ó ˘ÚÂÙfi Î·È ÛÏËÓÔÌÂÁ·Ï›· Î·Ù¿ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÔÍÂ›·˜ ÏÔ›ÌˆÍË˜. ∆· Û˘ÌÙÒÌ·Ù··˘Ù¿ Â›¯·Ó ÌÂÁ·Ï‡ÙÂÚË Û˘¯ÓfiÙËÙ· ·fi Ù· ·ÓÙ›ÛÙÔÈ-¯· (84% Î·È 64%) ÛÂ ·Ó¿ÏÔÁË ÌÂÏ¤ÙË (14). ŸÛÔÓ·ÊÔÚ¿ ÙÈ˜ ·Ú·ÙËÚÔ‡ÌÂÓÂ˜ ÎÏÈÓÈÎ¤˜ ÂÈÏÔÎ¤˜, Ë·fiÊÚ·ÍË ÙˆÓ ·ÓÒÙÂÚˆÓ ·Ó·ÓÂ˘ÛÙÈÎÒÓ Ô‰ÒÓ ÂÌ-Ê·Ó›ÛÙËÎÂ ÛÂ ÔÏ‡ ÏÈÁfiÙÂÚ· ·È‰È¿ (23%) ÛÙË ÌÂ-Ï¤ÙË Ì·˜ ÛÂ Û‡ÁÎÚÈÛË ÌÂ Ù· ·È‰È¿ (64%) ÙË˜ ·Óˆ-Ù¤Úˆ ÌÂÏ¤ÙË˜, ÂÓÒ ÙÔ Ô›‰ËÌ· ‚ÏÂÊ¿ÚˆÓ ·Ú·ÙËÚ‹-ıËÎÂ ÛÙÔ ›‰ÈÔ ÂÚ›Ô˘ ÔÛÔÛÙfi (23% Î·È 29% ·ÓÙ›-ÛÙÔÈ¯·). ¶Ï‹ÚË˜ ·Ó¿ÚÚˆÛË ·Ú·ÙËÚ‹ıËÎÂ ÛÂ ¯ÚÔ-ÓÈÎfi ‰È¿ÛÙËÌ· 3-6 ÌËÓÒÓ ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ ·È‰ÈÒÓ,ÂÎÙfi˜ ·fi Ì›· ·ÛıÂÓ‹, ÁÂÁÔÓfi˜ Ô˘ ‰È·Ê¤ÚÂÈ ·fiÙÈ˜ ÌÂÏ¤ÙÂ˜ ÛÂ ÂÓ‹ÏÈÎÂ˜, fiÔ˘ Ë ‰È¿ÚÎÂÈ· ‹Ù·Ó ÌÂÁ·-Ï‡ÙÂÚË ·fi 6 Ì‹ÓÂ˜ (19,20). ™ÙÔ ‰È¿ÛÙËÌ· ·˘Ùfi, ÔÈÂÓ‹ÏÈÎÂ˜ Ì¿ÏÏÔÓ ·Ú·Ì¤ÓÔ˘Ó ÌÂÙ·‰ÔÙÈÎÔ›, fiˆ˜ÚÔÎ‡ÙÂÈ ·fi ÙËÓ ÂÈÌÔÓ‹ ÙÔ˘ ˘„ËÏÔ‡ ∂µV DNAÊÔÚÙ›Ô˘ ÛÙÔ Û›ÂÏfi ÙÔ˘˜ (21).

§ÂÌÊÔÎ˘ÙÙ¿ÚˆÛË ·Ú·ÙËÚ‹ıËÎÂ ÛÙÔ 77% ÙˆÓ·È‰ÈÒÓ ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙÔ 32% Î·È ÙÔ 85% ¿ÏÏˆÓ ÌÂ-ÏÂÙÒÓ ÛÂ ÂÓ‹ÏÈÎÂ˜ (3,22). ∞‡ÍËÛË ÙˆÓ ÙÚ·ÓÛ·ÌÈÓ·-ÛÒÓ ‰È·ÈÛÙÒıËÎÂ Û˘¯ÓfiÙÂÚ· ÛÙ· ·È‰È¿ ÙË˜ ‰ÈÎ‹˜

Ì·˜ ÌÂÏ¤ÙË˜ (80%) ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙÔ 59% ·Ó¿ÏÔÁË˜ÌÂÏ¤ÙË˜ (14). ÀÂÚÁ·ÌÌ·ÛÊ·ÈÚÈÓ·ÈÌ›·, Î˘Ú›ˆ˜ IgMÙ¿ÍË˜, ·Ú·ÙËÚ‹ıËÎÂ ÛÙÔ 50% ÙˆÓ ·ÛıÂÓÒÓ Ì·˜.

∞fi ÙËÓ ·Ó¿Ï˘ÛË ÙÔ˘ ·ÓÔÛÔÊ·ÈÓfiÙ˘Ô˘ ÙˆÓ·È‰ÈÒÓ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÔÍÂ›·˜ ÏÔ›ÌˆÍË˜ ÚÔ-Î‡ÙÂÈ fiÙÈ Ù· CD3+ ‹Ù·Ó ·˘ÍËÌ¤Ó· ÛÙÔ 50% ÙˆÓ·ÛıÂÓÒÓ, Â‡ÚËÌ· Ô˘ Û˘ÌÊˆÓÂ› ÌÂ ¿ÏÏÔ˘˜ ÂÚÂ˘ÓË-Ù¤˜ (9,22). ∆Ô 50% ÙˆÓ ·ÛıÂÓÒÓ Ì·˜ ·ÚÔ˘Û›·ÛÂ È‰È-·›ÙÂÚË ÌÂ›ˆÛË ÙˆÓ CD3+/CD4+ Î·È ÙˆÓ CD19+, ÛÂ·ÓÙ›ıÂÛË ÌÂ ÌÂÏ¤ÙË ÂÓËÏ›ÎˆÓ, fiÔ˘ ‰ÂÓ ‰È·ÈÛÙÒ-ıËÎÂ ·ÍÈÔÛËÌÂ›ˆÙË ÌÂÙ·‚ÔÏ‹ (22). ∫·Ó¤Ó· ·È‰› ‰ÂÓ·ÚÔ˘Û›·ÛÂ ÌÂÙ·‚ÔÏ‹ ÛÙ· Ê˘ÛÈÎ¿ Î˘ÙÙ·ÚÔÎÙfiÓ·¡∫, fiˆ˜ ‰È·ÈÛÙÒıËÎÂ Î·È ·fi ÙÔ˘˜ WeisbergerÎ·È Û˘Ó. (23), ÂÓÒ ·ÓÙ›ıÂÙ· ÔÈ Williams Î·È Û˘Ó. (22)·Ó¤‰ÂÈÍ·Ó ÛËÌ·ÓÙÈÎ¿ ·˘ÍËÌ¤Ó· Â›Â‰· ¡∫ Î˘ÙÙ¿-ÚˆÓ ÛÂ ÂÓ‹ÏÈÎÂ˜ ÌÂ ÔÍÂ›· §ª. ™Â fiÏ· Ù· ·È‰È¿, ·-Ú·ÙËÚ‹ıËÎÂ ·‡ÍËÛË ÙˆÓ CD3+/CD8+ (Ì¤ÛË ÙÈÌ‹:48,5%). ¶Èı·ÓfiÙ·Ù·, Ù· CD3+/CD8+ Û˘ÓÈÛÙÔ‡Ó Ù·ÂÓÂÚÁÔÔÈËÌ¤Ó· ∆ ÏÂÌÊÔÎ‡ÙÙÙ·Ú· Ô˘ ÌÔÚÊÔÏÔÁÈ-Î¿ ÔÚ›˙ÔÓÙ·È ˆ˜ ‘¿Ù˘·’ ÏÂÌÊÔÎ‡ÙÙ·Ú· Î·È ·ÔÙÂ-ÏÔ‡Ó ¤ˆ˜ Î·È ÙÔ 50% ÙÔ˘ Û˘ÓÔÏÈÎÔ‡ ÏÂÌÊÔÎ˘ÙÙ·ÚÈ-ÎÔ‡ ÏËı˘ÛÌÔ‡ (20). ∏ ·‡ÍËÛË ÙˆÓ CD3+/CD8+

ÛÙËÓ ÔÍÂ›· ÏÔ›ÌˆÍË ÛÂ ÂÓ‹ÏÈÎÂ˜ ÂÈÛËÌ·›ÓÂÙ·È Î·È·fi ¿ÏÏÔ˘˜ ÂÚÂ˘ÓËÙ¤˜ (20,22,24,25). ∆· CD3+/CD8+,ˆ˜ Ô Î˘Ú›·Ú¯Ô˜ ̆ ÔÏËı˘ÛÌfi˜ ÙˆÓ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ,·›˙Ô˘Ó ÚˆÙ·Ú¯ÈÎfi ÚfiÏÔ ÛÙËÓ Î·Ù·ÛÙÔÏ‹ ÙÔ˘ ÔÏ-Ï·Ï·ÛÈ·ÛÌÔ‡ ÙÔ˘ ÈÔ‡. ∞ÛÎÔ‡Ó Î˘ÙÙ·ÚÔÙÔÍÈÎ‹ ‰Ú¿-ÛË ¤Ó·ÓÙÈ ÙˆÓ ÚÔÛ‚ÏËı¤ÓÙˆÓ ·fi ÙÔÓ Èfi µ ÏÂÌÊÔ-Î˘ÙÙ¿ÚˆÓ, ‰ÈÎ·ÈÔÏÔÁÒÓÙ·˜ Èı·ÓÒ˜ ÙËÓ ÙÒÛË ÙˆÓCD19+ Ô˘ ‰È·ÈÛÙÒıËÎÂ ÛÙË ÌÂÏ¤ÙË Ì·˜. ∏ ·Ú·-ÙËÚÔ‡ÌÂÓË Î˘ÙÙ·ÚÔÙÔÍÈÎ‹ ‰Ú¿ÛË ÙˆÓ CD3+/CD8+

ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ ·Ú·ÙËÚÂ›Ù·È Î·È ÛÂ ¿ÏÏÂ˜ ÏÔÈÌÒ-ÍÂÈ˜, fiˆ˜ ÛÙËÓ ∏IV Î·È ÙËÓ HCV ÏÔ›ÌˆÍË. øÛÙfiÛÔ,ÛÙË §ª Ù· CD3+/CD8+ ¤¯Ô˘Ó Ê·ÈÓfiÙ˘Ô CD45R0+/CD45RA-, Û˘Ì‚·Ùfi ÌÂ ∆ ÌÓËÌÔÓÈÎ¿ Î‡ÙÙ·Ú· ·Ú¿ ÌÂ·Úı¤Ó· ∆ ÏÂÌÊÔÎ‡ÙÙ·Ú· (20). ™Â fiÏ· Ù· ·È‰È¿, ÔÏfiÁÔ˜ CD4+/CD8+ ‹Ù·Ó ÂÏ·ÙÙˆÌ¤ÓÔ˜ (0,12-1), ÁÂÁÔ-Ófi˜ ·Ó·ÌÂÓfiÌÂÓÔ ·fi ÙË ÛËÌ·ÓÙÈÎ‹ ·‡ÍËÛË ÙˆÓCD3+/CD8+ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ, Â‡ÚËÌ· Ô˘ Û˘ÌÊˆÓÂ›ÌÂ ÙÔ˘˜ Weisberger Î·È Û˘Ó. (0,1-0,9) (23) Î·È LimaÎ·È Û˘Ó. (0,11-1,23) (25).

¶›Ó·Î·˜ 3. ™˘Û¯¤ÙÈÛË ÌÂÙ·Í‡ ÙˆÓ ˘ÔÏËı˘ÛÌÒÓ ÙˆÓ ∆, µ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ, ÙÔ˘ ÏfiÁÔ˘ CD4+/CD8+, ÙˆÓ ·ÓÔÛÔÛÊ·ÈÚÈÓÒÓ, ÙÔ˘ ÌÂÁ¤ıÔ˘˜ÙÔ˘ ÛÏËÓfi˜ Î·È ÙˆÓ ‚ÈÔ¯ËÌÈÎÒÓ ‰ÂÈÎÙÒÓ

CD3+ CD4+ CD8+ CD19+ NK CD4/CD8 IgA

ª¤ÁÂıÔ˜ ÛÏËÓfi˜ 0,97 -0,44 0,52** -0,75 0,18 -0,5** 0,32SGOT -0,08 -0,19 0,06 -0,04 -0,01 -0,08 0,48*SGPT 0,03 -0,24 0,36 -0,11 0,07 -0,21 0,58*Á-GT -0,41* -0,26 0,16 0,23 0,05 -0,19 0,51**IgG 0,22 -0,06 0,47* -0,1 0,21 -0,37 0,48*IgA 0,18 -0,42* 0,50** -0,2 0,19 -0,48*IgM -0,24 -0,31 0,38 0,03 -0,26 -0,39* 0,21

∆· ‰Â‰ÔÌ¤Ó· ‰›ÓÔÓÙ·È ̂ ̃Û˘ÓÙÂÏÂÛÙ‹ ̃Û˘Û¯¤ÙÈÛË ̃(r). T· p ·Ó·Ê¤ÚÔÓÙ·È fiÙ·Ó Â›Ó·È ÛËÌ·ÓÙÈÎ¿ (*p<0,05, **p<0,001)

139∞ÓÔÛÔÊ·ÈÓfiÙ˘Ô˜ ·È‰ÈÒÓ ÌÂ EBV Î·È CMV ÏÔ›ÌˆÍË

¶·È‰È·ÙÚÈÎ‹ 2008;71:135-140


∫·Ù¿ ÙÔÓ Â·Ó¤ÏÂÁ¯Ô, Ë Û˘ÓÙÚÈÙÈÎ‹ ÏÂÈÔ„ËÊ›·

ÙˆÓ ·È‰ÈÒÓ ·ÚÔ˘Û›·ÛÂ ›·ÛË. ¶·Ú·ÙËÚ‹ıËÎÂ ÙÒ-

ÛË ÙˆÓ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ Î·È ÙˆÓ CD3+/CD8+ Î·È Â¿-

ÓÔ‰Ô˜ ÙˆÓ CD3+/CD4+, CD19+ Î·È ÙÔ˘ ÏfiÁÔ˘

CD4+/CD8+. ∏ ÎÏÈÓÈÎ‹ ›·ÛË Û˘Ì‚¿‰È˙Â ÌÂ ÙËÓ ·Ô-

Î·Ù¿ÛÙ·ÛË ÙˆÓ ÙÈÌÒÓ ÙˆÓ ·ÓÔÛÔÛÊ·ÈÚÈÓÒÓ Î·È ÙˆÓ

Ë·ÙÈÎÒÓ ‰ÂÈÎÙÒÓ. ¢È·ÈÛÙÒıËÎÂ fiÙÈ Ù· CD3+/CD8+

Â›¯·Ó ÛËÌ·ÓÙÈÎ‹ ıÂÙÈÎ‹ Û˘Û¯¤ÙÈÛË ÌÂ ÙË ÛÏËÓÔÌÂ-

Á·Ï›·, Î·ıÒ˜ Î·È ÌÂ ÙÈ˜ IgG Î·È IgA. ™Â ÙÚ›· ·fi Ù· 26

·È‰È¿, Ë ÎÏÈÓÈÎ‹ ·ÔÎ·Ù¿ÛÙ·ÛË Î·ı˘ÛÙ¤ÚËÛÂ ¤ˆ˜

Î·È 8 Ì‹ÓÂ˜, Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÔÔ›ˆÓ ÔÈ ÏfiÁÔÈ

CD4+/CD8+ ·Ú¤ÌÂÓ·Ó ¯·ÌËÏÔ›. ∫·ı˘ÛÙ¤ÚËÛË ÙË˜

·Ó¿ÚÚˆÛË˜ Ì¤¯ÚÈ Î·È 18 Ì‹ÓÂ˜, Ë ÔÔ›· ‰ÂÓ Û˘Ó‰¤Â-

Ù·È fiÌˆ˜ ÌÂ Ù· ·˘ÍËÌ¤Ó· Â›Â‰· ÙˆÓ CD3+/CD8+,

·Ó·Ê¤ÚÂÙ·È Î·È ÛÂ ¿ÏÏË ÌÂÏ¤ÙË (15). ∂›Ó·È ÂÓ‰È·Ê¤-

ÚÔÓ fiÙÈ ˘ÔÛÙËÚ›˙ÂÙ·È fiÙÈ Ë ·Ú¿Ù·ÛË ÙË˜ ÏÔ›ÌˆÍË˜

‰ÂÓ ÔÊÂ›ÏÂÙ·È ÛÙÔ ·˘ÍËÌ¤ÓÔ ÈÈÎfi ÊÔÚÙ›Ô, ·ÏÏ¿ ÛÙËÓ

ÂËÚÂ·ÛÌ¤ÓË ·ÓÔÛÈ·Î‹ Î·Ù¿ÛÙ·ÛË ÙÔ˘ ÍÂÓÈÛÙ‹ (20).

™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, ‰È·ÈÛÙÒıËÎÂ fiÙÈ Ù· ·È‰È¿

Ô˘ ÌÂÏÂÙ‹Û·ÌÂ Î·Ù¿ ÙËÓ ÔÍÂ›· Ê¿ÛË ÙË˜ EBV Î·È

ÙË˜ CMV ÏÔ›ÌˆÍË˜ ··ÓÙÔ‡Ó ÌÂ ÂÍ·ÈÚÂÙÈÎ¿ ÌÂÁ¿ÏË

·‡ÍËÛË ÙˆÓ CD3+/CD8+. ∏ ‡ÊÂÛË ÙˆÓ Û˘ÌÙˆÌ¿-

ÙˆÓ ÙË˜ ÔÍÂ›·˜ ÏÔ›ÌˆÍË˜ Ê·›ÓÂÙ·È fiÙÈ Â›Ó·È ÙÔ ·Ô-

Ù¤ÏÂÛÌ· ÙË˜ Â˘ÚÂ›·˜ Î˘ÙÙ·ÚÔÙÔÍÈÎ‹˜ ∆ ÏÂÌÊÔÎ˘Ù-

Ù·ÚÈÎ‹˜ (CTL) ·¿ÓÙËÛË˜ ÛÙ· ·ÓÙÈÁfiÓ· ÙÔ˘ ÈÔ‡. ™˘-

ÓÂÒ˜, Ë ÂÎÙ›ÌËÛË ÙÔ˘ ·ÓÔÛÔÊ·ÈÓfiÙ˘Ô˘ Î·È ÙÔ˘

ÏfiÁÔ˘ CD4+/CD8+ Â›Ó·È ¯Ú‹ÛÈÌË ÛÙËÓ ÎÏÈÓÈÎ‹ Ú¿ÍË

ÁÈ· ÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ·È‰ÈÒÓ ÌÂ ¯ÚfiÓÈ· EBV

‹ CMV ÏÔ›ÌˆÍË.


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25. Lima M, Teixeira Mdos A, Queirfis ML, Santos AH, Gon-çalves C, Correia J, et al. Immunophenotype and TCR-Vbeta repertoire of peripheral blood T-cells in acute infec-tious mononucleosis. Blood Cells Mol Dis 2003;30:1-12.

140 ∂. ¶··‰ÔÔ‡ÏÔ˘-∞Ï·Ù¿ÎË Î·È Û˘Ó.



ªÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜ ÛÙ· ·È‰È¿: ÂÌÂÈÚ›· 15 ÂÙÒÓ ÛÂ ¤Ó·

Î¤ÓÙÚÔ

Ÿ. µÚ¿ÓË1, ª. ¶·ÓÙÈÎ›‰Ô˘1, °. ÿÌ‚ÚÈÔ˜2, π. •˘ÓÈ¿˜1, µ. ¢ÂÌÂÚÙ˙›‰Ô˘1, ∫. ∫¿ÓÙ˙ÈÔ˘1, ∞. ª·˘ÚÔ˘‰‹1,

¢. ∆·ÎÔ‡‰·˜2, £. ¶··ÛÙ·‡ÚÔ˘1, ∫. ™‡ÚÔÁÏÔ˘1

¶ÂÚ›ÏË„Ë

∂ÈÛ·ÁˆÁ‹: ∏ ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜ (ª∏) ÛÙ· ·È‰È¿ ·ÔÙÂÏÂ› ÙË ÌÔÓ·‰ÈÎ‹ ıÂÚ·Â›· ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛËÙË˜ ÌË ·Ó·ÛÙÚ¤„ÈÌË˜ Ë·ÙÈÎ‹˜ ·ÓÂ¿ÚÎÂÈ·˜ ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘. ™ÎÔfi˜ ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ ‹Ù·Ó Ë ·Ó·-ÊÔÚ¿ ÙË˜ ÂÌÂÈÚ›·˜ Ì·˜ ·fi ÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË ·È‰ÈÒÓ Ô˘ ¤¯Ô˘Ó ˘Ô‚ÏËıÂ› ÛÂ ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ∞fi ÙÔ 1990 Ì¤¯ÚÈ Û‹ÌÂÚ·, 16 ·ÛıÂÓÂ›˜ ÙË˜ °’ ¶·È‰È·ÙÚÈÎ‹˜ ∫ÏÈÓÈÎ‹˜, ËÏÈÎ›·˜ 6 ÌË-ÓÒÓ ¤ˆ˜ 13 ÂÙÒÓ, ˘Ô‚Ï‹ıËÎ·Ó ÛÂ ª∏. ∞fi Ù· ·È‰È¿ ·˘Ù¿, 9 Â›¯·Ó ·ÙÚËÛ›· ÂÍˆË·ÙÈÎÒÓ ¯ÔÏËÊfiÚˆÓfiÚˆÓ, 2 ÔÍÂ›· Ë·ÙÈÎ‹ Ó¤ÎÚˆÛË ÌÂÙ¿ ÙË ‚ÚÒÛË ÙÔÍÈÎÒÓ Ì·ÓÈÙ·ÚÈÒÓ, 1 Û‡Ó‰ÚÔÌÔ Alagille, 1 ÂÓ‰ÔË·-ÙÈÎ‹ ˘ÔÏ·Û›· ÙˆÓ ¯ÔÏËÊfiÚˆÓ fiÚˆÓ ÌË Û˘Ó‰ÚÔÌÈÎÔ‡ Ù‡Ô˘, 1 ÓfiÛÔ ÙÔ˘ Wilson, 1 ÚˆÙÔ·ı‹ ˘Â-ÚÔÍ·ÏÔ˘Ú›· Î·È 1 Ë·ÙÔ‚Ï¿ÛÙˆÌ·. ¢¤Î· ·È‰È¿ ˘Ô‚Ï‹ıËÎ·Ó ÛÂ ª∏ ÛÙË ÃÂÈÚÔ˘ÚÁÈÎ‹ ∫ÏÈÓÈÎ‹ ªÂÙ·-ÌÔÛ¯Â‡ÛÂˆÓ ÙÔ˘ ∞¶£ Î·È Ù· ˘fiÏÔÈ· ÛÂ Î¤ÓÙÚ· ÙÔ˘ ÂÍˆÙÂÚÈÎÔ‡. ∆ÚÂÈ˜ ÌÂÙ·ÌÔÛ¯Â‡ÛÂÈ˜ ¤ÁÈÓ·Ó ·fi ˙Ò-ÓÙ· Û˘ÁÁÂÓ‹ ‰fiÙË Î·È 13 ·fi ÙˆÌ·ÙÈÎfi ‰fiÙË. ŒÍÈ ·È‰È¿ ¤Ï·‚·Ó ·ÓÔÛÔÎ·Ù·ÛÙ·ÏÙÈÎ‹ ·ÁˆÁ‹ ÌÂ Î˘ÎÏÔ-ÛÔÚ›ÓË, MMF Î·È ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹ Î·È 7 ·È‰È¿ tacrolimus ·ÓÙ› Î˘ÎÏÔÛÔÚ›ÓË˜.

∞ÔÙÂÏ¤ÛÌ·Ù·: ∞fi Ù· 16 ·È‰È¿ Ô˘ ˘Ô‚Ï‹ıËÎ·Ó ÛÂ ÌÂÙ·ÌfiÛ¯Â˘ÛË, 3 Î·Ù¤ÏËÍ·Ó ÙÔÓ ÚÒÙÔ ÌÂÙÂÁ¯ÂÈÚË-ÙÈÎfi Ì‹Ó·. ∞fi Ù· ˘fiÏÔÈ· Ô˘ ·Ú·ÎÔÏÔ˘ıÔ‡ÌÂ ¤ˆ˜ Û‹ÌÂÚ·, 3 ·ÚÔ˘Û›·Û·Ó ÔÍÂ›· Î·È 1 ¯ÚfiÓÈ· ·fiÚ-ÚÈ„Ë ÙÔ˘ ÌÔÛ¯Â‡Ì·ÙÔ˜. ¶¤ÓÙÂ ·È‰È¿ ÂÌÊ¿ÓÈÛ·Ó ÏÔ›ÌˆÍË ·fi CMV, 5 ·fi EBV, 2 ÏÔ›ÌˆÍË ·fi HSV, 2 ·fiÈfi Parvo µ19, 1 ·fi Èfi Coxsackie Î·È 1 ·fi Candida albicans. ∂›ÛË˜, ¤Ó· ·È‰› ·ÚÔ˘Û›·ÛÂ ·ÈÌÔÚÚ·Á›· ÙÔ˘·ÓÒÙÂÚÔ˘ °∂™ Î·È ¤Ó· ·ÚÔ˘Û›·ÛÂ ÓfiÛÔ ÂÍ·Ê¿ÓÈÛË˜ ÙˆÓ ÌÈÎÚÒÓ ¯ÔÏËÊfiÚˆÓ fiÚˆÓ. ∏ ¤Î‚·ÛË ÛÙÈ˜ ÂÚÈÛ-ÛfiÙÂÚÂ˜ ÂÚÈÙÒÛÂÈ˜ ‹Ù·Ó Î·Ï‹, ÌÂ Î·Ï‹ ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ Ë·ÙÈÎÒÓ ÌÔÛ¯Â˘Ì¿ÙˆÓ, ÂÎÙfi˜ ·fi ÙËÓ ÂÚ›ÙˆÛËÙÔ˘ ·È‰ÈÔ‡ ÌÂ ÙË ÓfiÛÔ ÂÍ·Ê¿ÓÈÛË˜ ÙˆÓ ÌÈÎÚÒÓ ¯ÔÏËÊfiÚˆÓ Ô˘ ¯ÚÂÈ¿ÛÙËÎÂ Ó¤· ÌÂÙ·ÌfiÛ¯Â˘ÛË.

™˘ÌÂÚ¿ÛÌ·Ù·: ∏ Ì·ÎÚÔ¯ÚfiÓÈ· ÔÚÂ›· Î·È ¤Î‚·ÛË ·È‰ÈÒÓ ÌÂ Ë·ÙÈÎ‹ ÌÂÙ·ÌfiÛ¯Â˘ÛË Â›Ó·È Û¯ÂÙÈÎ¿ Î·-Ï‹ ÌÂ ÙËÓ ÚÔ¸fiıÂÛË Ó· ·Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·È ÛÂ ÂÍÂÈ‰ÈÎÂ˘Ì¤Ó· Î¤ÓÙÚ·.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ªÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜, ·È‰È¿.

Liver transplantation in children: 15 years experience in one center

O. Vrani1, M. Pantikidou1, G. Imvrios2, I. Xinias1, V. Demertzidou1, K. Kantziou1, A. Mavroudi1,

D. Takoudas2, T. Papastaurou1, K. Spyroglou1

Abstract

Background: Liver transplantation (LT) is the only treatment for children with irreversible liver failure. Thisis a report of the follow-up of a series of 16 children who underwent LT.

Methods: Since 1990, 16 patients of the 3rd Paediatric Clinic of the Hippocration General Hospital of Thes-saloniki, aged 6 months to 13 years, underwent LT. Nine children presented initially with extrahepatic bil-iary atresia, 2 with acute liver failure following toxic mushroom ingestion, 1 with Alagille syndrome, 1 withnon-syndromic intrahepatic biliary paucity, 1 with Wilson’s disease, 1 with primary hyperoxaluria and 1with hepatoblastoma. Ten children underwent LT in the Organ Transplantation Unit of the Aristotle Univer-sity of Thessaloniki and the others in various medical centers in other countries. Three transplants came fromliving-related donors and 13 from deceased donors. Six children went under immunosuppressive treatmentwith cyclosporine, MMF and corticosteroids and seven with tacrolimus, MMF and corticosteroids.

Results: Three of the 16 children died within the first month after transplantation due to post-transplantcomplications, and eleven have survived. Three children presented with acute rejection and one with chron-ic organ rejection, which was successfully managed. Five children developed CMV infection, 5 EBV infection,2 HSV infection, 2 Parvo B19 virus and 1 Candida Albicans infection. One child had upper GI haemorrhageand one presented with small biliary paucity. The outcome was satisfactory in most cases, with good graftfunction, except in the case of the patient with small biliary paucity, who required retransplantation.

Conclusions: The long-term clinical course of children following LT is good, provided that they are moni-tored in specialized centres.

Key words: Liver transplantation, children.

141∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞ ORIGINAL ARTICLE

1 °’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹∞¶£, πÔÎÚ¿ÙÂÈÔ °ÂÓÈÎfi¡ÔÛÔÎÔÌÂ›Ô£ÂÛÛ·ÏÔÓ›ÎË˜

2 ÃÂÈÚÔ˘ÚÁÈÎ‹ ∫ÏÈÓÈÎ‹ªÂÙ·ÌÔÛ¯Â‡ÛÂˆÓ ∞¶£,πÔÎÚ¿ÙÂÈÔ °ÂÓÈÎfi¡ÔÛÔÎÔÌÂ›Ô£ÂÛÛ·ÏÔÓ›ÎË˜


∫ÏÂÔÌ¤ÓË˜ ™‡ÚÔÁÏÔ˘[email protected]°’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ∞¶£,πÔÎÚ¿ÙÂÈÔ °ÂÓÈÎfi¡ÔÛÔÎÔÌÂ›Ô £ÂÛÛ·ÏÔÓ›ÎË˜∫ˆÓÛÙ·ÓÙÈÓÔ˘fiÏÂˆ˜ 49∆.∫. 546 39, £ÂÛÛ·ÏÔÓ›ÎË

1. 3rd Department ofPaediatrics, AristotleUniversity,Hippokration GeneralHospital, Thessaloniki,Greece

2. Department of Surgery,Organ TransplantationUnit, Aristotle University,Hippokration GeneralHospital, Thessaloniki,Greece

Correspondence:

∫leomenis [email protected] Department of Paediatrics, Aristotle University,Hippokration GeneralHospital of Thessaloniki49 Konstantinoupoleos St.,546 39, Thessaloniki,Greece

¶·È‰È·ÙÚÈÎ‹ 2008;71:141-147


∂ÈÛ·ÁˆÁ‹

∏ ÚÒÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜ (ª∏) Ú·ÁÌ·-

ÙÔÔÈ‹ıËÎÂ ÙÔ 1963 ·fi ÙÔÓ Starzl (1) ÛÙÔ ¶·ÓÂÈ-

ÛÙ‹ÌÈÔ ÙÔ˘ ∫ÔÏÔÚ¿ÓÙÔ ÛÂ ·È‰› 3 ÂÙÒÓ Ô˘ ¤·Û¯Â

·fi ·ÙÚËÛ›· ¯ÔÏËÊfiÚˆÓ fiÚˆÓ. √ ·ÛıÂÓ‹˜ ·˘Ùfi˜

Î·Ù¤ÏËÍÂ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ Â¤Ì‚·ÛË˜ ÏfiÁˆ

·ıÚfi·˜ ·ÈÌÔÚÚ·Á›·˜. ∆¤ÛÛÂÚ· ¯ÚfiÓÈ· ·ÚÁfiÙÂÚ·,

Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ ·fi ÙÔÓ ›‰ÈÔ È·ÙÚfi Ë ÚÒÙË

ÂÈÙ˘¯‹˜ ª∏ ÛÂ ¤Ó· Ó‹ÈÔ 18 ÌËÓÒÓ ÌÂ Ë·ÙÔ‚Ï¿-

ÛÙˆÌ·, ÙÔ ÔÔ›Ô Â¤˙ËÛÂ ÁÈ· 400 ËÌ¤ÚÂ˜ (2). ∆ËÓ

›‰È· ÂÚ›Ô‰Ô ¿Ú¯ÈÛÂ Ë ÎÏÈÓÈÎ‹ ÂÊ·ÚÌÔÁ‹ ÙË˜ ª∏

Î·È ÛÙËÓ ∂˘ÚÒË ÌÂ ˘„ËÏ¿, fiÌˆ˜, ÔÛÔÛÙ¿ ıÓËÛÈ-

ÌfiÙËÙ·˜ Î·Ù¿ ÙËÓ ÚÒÙË ‰ÂÎ·ÂÙ›·, Ô˘ ¤ÊÙ·Ó·Ó ÙÔ

60-70% (3,4). ŒÎÙÔÙÂ, Ë ‚ÂÏÙ›ˆÛË ÙˆÓ ̄ ÂÈÚÔ˘ÚÁÈÎÒÓ

ÙÂ¯ÓÈÎÒÓ Î·È Ë ·Ó¿Ù˘ÍË Ó¤ˆÓ ·ÓÔÛÔÎ·Ù·ÛÙ·ÏÙÈ-

ÎÒÓ Ê·ÚÌ¿ÎˆÓ Â›¯·Ó ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·‡ÍËÛË

ÙÔ˘ ÔÛÔÛÙÔ‡ ÂÈ‚›ˆÛË˜ ÙˆÓ ·ÛıÂÓÒÓ ·˘ÙÒÓ, ÙÔ

ÔÔ›Ô Û‹ÌÂÚ·, ÛÙ· ÂÚÈÛÛfiÙÂÚ· Î¤ÓÙÚ·, ÍÂÂÚÓ¿ ÙÔ

90% ÙÔ ÚÒÙÔ ¤ÙÔ˜ ÌÂÙ¿ ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË ÛÙË ̄ Úfi-

ÓÈ· Ë·ÙÈÎ‹ ·ÓÂ¿ÚÎÂÈ· Î·È ÙÔ 70% ÛÙËÓ ÔÍÂ›·, ÂÓÒ

Ë Ì·ÎÚÔ¯ÚfiÓÈ· ÂÈ‚›ˆÛË (10-15 ¤ÙË) ÍÂÂÚÓ¿ ÙÔ

80% (5-8). ª¿ÏÈÛÙ·, ÏfiÁˆ ÙˆÓ ÔÏ‡ Î·ÏÒÓ ·ÔÙÂ-

ÏÂÛÌ¿ÙˆÓ ÙË˜ ÌÂÙ·ÌfiÛ¯Â˘ÛË˜ ÂÂÎÙ¿ıËÎ·Ó ÁÚ‹ÁÔ-

Ú· Î·È ÔÈ ÂÓ‰Â›ÍÂÈ˜ ÙË˜, ÌÂ ·ÔÙ¤ÏÂÛÌ· Ó· ÂÌÊ·ÓÈ-

ÛÙÂ› ¤Ó‰ÂÈ· ÌÔÛ¯Â˘Ì¿ÙˆÓ, Ë ÔÔ›· ÂÚÈfiÚÈ˙Â ÙËÓ

ÔÚıÔÙÔÈÎ‹ ª∏ ÛÙ· ·È‰È¿. ™ËÌ·ÓÙÈÎ‹ ÒıËÛË

ÛÙËÓ Â¤ÎÙ·ÛË ÙˆÓ ª∏, È‰›ˆ˜ ÛÂ ‚Ú¤ÊË Î¿Ùˆ ÙÔ˘

ÂÓfi˜ ¤ÙÔ˘˜ Î·È ‚¿ÚÔ˘˜ Î¿Ùˆ ÙˆÓ 10 kg, ¤‰ˆÛ·Ó ÔÈ

ÙÂ¯ÓÈÎ¤˜ ÙË˜ ÙÌËÌ·ÙÈÎ‹˜ ÌÂÙ·ÌfiÛ¯Â˘ÛË˜ (split

liver) Î·È ÙË˜ ÌÂıfi‰Ô˘ ÂÏ·ÙÙÒÛÂˆ˜ ÙÔ˘ ÌÔÛ¯Â‡Ì·-

ÙÔ˜ (reduced size), Î·ıÒ˜ Â›ÛË˜ Î·È Ë ÌÂÙ·ÌfiÛ¯Â˘-

ÛË ·fi ˙ÒÓÙ· Û˘ÁÁÂÓ‹ ‰fiÙË. ∏ Ì¤ıÔ‰Ô˜ ÂÏ·ÙÙÒÛÂ-

ˆ˜ ÙÔ˘ ÌÔÛ¯Â‡Ì·ÙÔ˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ ÁÈ· ÚÒÙË

ÊÔÚ¿ ÙÔ 1984 ÛÂ ·È‰› ·fi ÙÔ˘˜ Bismuth Î·È

Houssin (9). ∆Ô 1989 ÔÈ Pichlmayr Î·È Û˘Ó. (10) ·Ó·-

ÎÔ›ÓˆÛ·Ó ÙËÓ ÚÒÙË ÂÈÙ˘¯ËÌ¤ÓË ÙÌËÌ·ÙÈÎ‹ ª∏,

ÂÓÒ ÔÈ ÚÒÙÂ˜ ÛÂÈÚ¤˜ ·ÛıÂÓÒÓ Ô˘ ˘Ô‚Ï‹ıËÎ·Ó

ÛÂ ÌÂÙ·ÌfiÛ¯Â˘ÛË ·fi ˙ˆÓÙ·Ófi ‰fiÙË ÂÚÈÁÚ¿ÊÔ-

ÓÙ·È ·fi ÙÔ˘˜ Broelsch Î·È Û˘Ó. (11). ™‹ÌÂÚ·, Ë ª∏

ÛÙ· ·È‰È¿ ·ÔÙÂÏÂ› ıÂÚ·Â›· ÂÎÏÔÁ‹˜ ÁÈ· ÙËÓ

·ÓÙÈÌÂÙÒÈÛË ÙË˜ Ë·ÙÈÎ‹˜ ·ÓÂ¿ÚÎÂÈ·˜ ÙÂÏÈÎÔ‡

ÛÙ·‰›Ô˘, fiÙ·Ó ‰ÂÓ ˘¿Ú¯ÂÈ ·ÓÙ¤Ó‰ÂÈÍË -fiˆ˜ Î·-

ÎÔ‹ıÂÈ· ÂÎÙfi˜ ‹·ÙÔ˜, Û˘ÁÎÂÎÚÈÌ¤ÓÂ˜ ÓÂÔÏ·Û›Â˜

ÙÔ˘ ‹·ÙÔ˜, fiˆ˜ ¯ÔÏ·ÁÁÂÈÔÎ·ÚÎ›ÓˆÌ·- ‹ ·ÎfiÌË

Û˘Óı‹ÎÂ˜ ÛÙÔ ÂÚÈ‚¿ÏÏÔÓ ÙÔ˘ ·È‰ÈÔ‡, Ô˘ Ó· ÌËÓ

ÂÍ·ÛÊ·Ï›˙Ô˘Ó ÙË Û˘ÌÌfiÚÊˆÛË ÌÂ Ù· ÚˆÙfiÎÔÏÏ·

ÙË˜ ·ÁˆÁ‹˜ ÌÂÙ¿ ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË (12).

™ÙË ¯ÒÚ· Ì·˜ Ú·ÁÌ·ÙÔÔÈÔ‡ÓÙ·È ÌÂÙ·ÌÔÛ¯Â‡-

ÛÂÈ˜ ‹·ÙÔ˜ ÛÂ ·È‰È¿ ·fi ÙÔ 1990, ÛÙË ÃÂÈÚÔ˘ÚÁÈÎ‹

∫ÏÈÓÈÎ‹ ªÂÙ·ÌÔÛ¯Â‡ÛÂˆÓ ÙÔ˘ ∞¶£, ÂÓÒ ·Ú¿ÏÏË-

Ï· ÙÔ ¶·È‰ÔÁ·ÛÙÚÂÓÙÂÚÔÏÔÁÈÎfi ∆Ì‹Ì· ÙË˜ ÎÏÈÓÈÎ‹˜

Ì·˜ ¤¯ÂÈ ·ÔÎÔÌ›ÛÂÈ ÛËÌ·ÓÙÈÎ‹ ÂÌÂÈÚ›· ·fi ÙËÓ

·Ú·ÎÔÏÔ‡ıËÛË 16 ·È‰ÈÒÓ ÌÂ ÙÂÏÈÎfi ÛÙ¿‰ÈÔ Ë·-

ÙÈÎ‹˜ ·ÓÂ¿ÚÎÂÈ·˜, ÛÙ· ÔÔ›· ÙÂÏÈÎÒ˜ Ù¤ıËÎÂ ¤Ó‰ÂÈ-

ÍË ÁÈ· ª∏. ¶·ÚÔ˘ÛÈ¿˙Ô˘ÌÂ Ù· ·›ÙÈ· Ô˘ Ô‰‹ÁËÛ·Ó

ÛÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË, ÙÈ˜ ¯ÂÈÚÔ˘ÚÁÈÎ¤˜ ÌÂıfi‰Ô˘˜ Ô˘

¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó, ÙËÓ ¤Î‚·Û‹ ÙË˜, Î·ıÒ˜ Î·È Ù·

·ÔÙÂÏ¤ÛÌ·Ù· ·fi ÙËÓ Ù·ÎÙÈÎ‹ ·Ú·ÎÔÏÔ‡ıËÛË

ÙˆÓ ·È‰ÈÒÓ ·˘ÙÒÓ ÌÂÙ¿ ÙË ª∏.


∞fi ÙÔ 1990 Ì¤¯ÚÈ Û‹ÌÂÚ·, 16 ·È‰È¿ (8 ·ÁfiÚÈ· Î·È 8 ÎÔ-

Ú›ÙÛÈ·) ˘Ô‚Ï‹ıËÎ·Ó ÛÂ ª∏, 10 ÛÙË ÃÂÈÚÔ˘ÚÁÈÎ‹ ∫ÏÈÓÈÎ‹

ªÂÙ·ÌÔÛ¯Â‡ÛÂˆÓ ÙÔ˘ ∞¶£ Î·È 6 ÛÂ Î¤ÓÙÚ· ÙÔ˘ ÂÍˆÙÂÚÈÎÔ‡.

∆· ‰ËÌÔÁÚ·ÊÈÎ¿ ÛÙÔÈ¯Â›· ÙˆÓ ·ÛıÂÓÒÓ Ì·˜ Î·È Ù· ·›ÙÈ· Ô˘

Ô‰‹ÁËÛ·Ó ÛÂ ª∏, Î·ıÒ˜ Î·È Ë ÔÛÔÛÙÈ·›· ·Ó·ÏÔÁ›· ÙÔ˘˜ ·-

ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1 Î·È ÛÙËÓ ∂ÈÎfiÓ· 1. ∏ ·ÙÚËÛ›· ÙˆÓ

ÂÍˆË·ÙÈÎÒÓ ¯ÔÏËÊfiÚˆÓ ·ÔÙÂÏÂ› ÙÔ ÚÒÙÔ ÛÂ Û˘¯ÓfiÙËÙ· ·›ÙÈÔ.

∞ÎÔÏÔ˘ıÔ‡Ó Ë ÂÓ‰ÔË·ÙÈÎ‹ ̄ ÔÏfiÛÙ·ÛË (Û‡Ó‰ÚÔÌÔ Alagille, ÌË Û˘Ó-

‰ÚÔÌÈÎ‹ ̆ ÔÏ·Û›· ÂÓ‰ÔË·ÙÈÎÒÓ ̄ ÔÏËÊfiÚˆÓ fiÚˆÓ), Ù· ÌÂÙ·‚Ô-

ÏÈÎ¿ ÓÔÛ‹Ì·Ù· (ÓfiÛÔ ̃Wilson, ÚˆÙÔ·ı‹˜ ˘ÂÚÔÍ·ÏÔ˘Ú›·) Î·È

142 Ÿ. µÚ¿ÓË Î·È Û˘Ó.


¶›Ó·Î·˜ 1. ¢ËÌÔÁÚ·ÊÈÎ¿ ÛÙÔÈ¯Â›· ÙˆÓ ·ÛıÂÓÒÓ Ì·˜ Î·È ·›ÙÈ· ª∏

∏ÏÈÎ›·ª¤ÛË 5 ¤ÙË (6 Ì‹ÓÂ˜ - 13 ¤ÙË)<1 ¤ÙÔ˘˜ 31-6 ÂÙÒÓ 97-13 ÂÙÒÓ 4º‡ÏÔ ∞ÁfiÚÈ· 8∫ÔÚ›ÙÛÈ· 8∞›ÙÈ·∞ÙÚËÛ›· ÂÍˆË·ÙÈÎÒÓ ¯ÔÏËÊfiÚˆÓ 9√ÍÂ›· Ë·ÙÈÎ‹ ·ÓÂ¿ÚÎÂÈ· ÌÂÙ¿ ÙË ‚ÚÒÛË ÙÔÍÈÎÒÓ Ì·ÓÈÙ·ÚÈÒÓ 2∂Ó‰ÔË·ÙÈÎ‹ ¯ÔÏfiÛÙ·ÛË (Û‡Ó‰ÚÔÌÔ Alagille, ÌË Û˘Ó‰ÚÔÌÈÎÔ‡ Ù‡Ô˘) 2ªÂÙ·‚ÔÏÈÎ¿ ÓÔÛ‹Ì·Ù· (ÓfiÛÔ˜ Wilson, ÚˆÙÔ·ı‹˜ ˘ÂÚÔÍ·ÏÔ˘Ú›·) 2ŸÁÎÔÈ ‹·ÙÔ˜ (Ë·ÙÔ‚Ï¿ÛÙˆÌ·) 1

∞ÙÚËÛ›·

56%

∂Ó‰ÔË·ÙÈÎ‹

¯ÔÏfiÛÙ·ÛË

13%

ªÂÙ·‚ÔÏÈÎ¿

ÓÔÛ‹Ì·Ù·

13%

ŸÁÎÔÈ

‹·ÙÔ˜

5%

√ÍÂ›·

Ë·ÙÈÎ‹

·ÓÂ¿ÚÎÂÈ·

13%

∂ÈÎfiÓ· 1. ¶ÔÛÔÛÙÈ·›· ·Ó·ÏÔÁ›· ÙˆÓ ·ÈÙÈÒÓ Ô˘ Ô‰‹ÁËÛ·Ó ÛÂª∏ ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ Ì·˜.


Ë ÔÍÂ›· Ë·ÙÈÎ‹ ·ÓÂ¿ÚÎÂÈ· ÌÂÙ¿ ·fi ‚ÚÒÛË ÙÔÍÈÎÒÓ Ì·ÓÈÙ·-

ÚÈÒÓ, Î·È, Ù¤ÏÔ˜, ÔÈ fiÁÎÔÈ ÙÔ˘ ‹·ÙÔ˜.

∞fi Ù· 9 ·È‰È¿ ÌÂ ·ÙÚËÛ›· ÙˆÓ ÂÍˆË·ÙÈÎÒÓ ¯ÔÏËÊfi-

ÚˆÓ, 3 Â›¯·Ó ˘Ô‚ÏËıÂ› ÛÂ Â¤Ì‚·ÛË Kasai (Ë·ÙÔ˘ÏÔÂÓÙÂ-

ÚÔ·Ó·ÛÙfiÌˆÛË) ÚÈÓ ·fi ÙË ª∏ ÛÂ ËÏÈÎ›· 1, 2 Î·È 4 ÌËÓÒÓ.

™Â 2 ·È‰È¿ Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ Â¤Ì‚·ÛË Kasai Ù‡Ô˘ II,

Î·Ù¿ ÙËÓ ÔÔ›· ‰ËÌÈÔ˘ÚÁÂ›Ù·È ÂÓÙÂÚÔÛÙÔÌ›· ÁÈ· ÙÔ ÂÓ‰Â¯fi-

ÌÂÓÔ ·Ú¤Ì‚·ÛË˜ Ì¤Ûˆ ·˘Ù‹˜ ÛÙË ¯ÔÏÔÂÙÈÎ‹ ·Ó·ÛÙfiÌˆ-

ÛË, Î·È ÛÂ ¤Ó· ·È‰› Kasai Ù‡Ô˘ I. ™Â fiÏ· Ù· ·È‰È¿, ÚÈÓ ·fi

ÙË ª∏, Ù·ÍÈÓÔÌ‹ıËÎÂ Ë Ë·ÙÈÎ‹ ÏÂÈÙÔ˘ÚÁ›· Û‡ÌÊˆÓ· ÌÂ Ù·

ÎÚÈÙ‹ÚÈ· Î·Ù¿ Child-Pugh (9). ŒÓ· ·È‰› ‹Ù·Ó ÛÙ·‰›Ô˘ ∞, 7

ÛÙ·‰›Ô˘ µ, Î·È 8 ÛÙ·‰›Ô˘ C.

™Â 3 ·È‰È¿ ‰fiÙË˜ ‹Ù·Ó Ë ÌËÙ¤Ú·, ·fi ÙËÓ ÔÔ›· ÂÏ‹-

ÊıËÛ·Ó Ù· ÙÌ‹Ì·Ù· II & III ÙÔ˘ ‹·ÙÔ˜. ™Ù· ˘fiÏÔÈ· 13

·È‰È¿ ÙÔ ÌfiÛ¯Â˘Ì· ÚÔÂÚ¯fiÙ·Ó ·fi ÙˆÌ·ÙÈÎfi ‰fiÙË. ™Â 7

ÂÚÈÙÒÛÂÈ˜ Ô ‰fiÙË˜ ‹Ù·Ó ·È‰›, ÂÓÒ ÛÂ 6 ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ

ÌfiÛ¯Â˘Ì· ·fi ÂÓ‹ÏÈÎ· ‰fiÙË. ∞fi ·˘Ù¤˜ ÙÈ˜ 6 ÂÚÈÙÒÛÂÈ˜,

ÛÙÈ˜ 4 ÂÊ·ÚÌfiÛÙËÎÂ Ë ÙÂ¯ÓÈÎ‹ split liver, Û‡ÌÊˆÓ· ÌÂ ÙËÓ

ÔÔ›· ÌÂÙ·ÌÔÛ¯Â‡ıËÎ·Ó Ù· ÙÌ‹Ì·Ù· ππ & πππ ÙÔ˘ ‹·ÙÔ˜, ÂÓÒ

Ô ‰ÂÍÈfi˜ ÏÔ‚fi˜ ÌÂÙ·ÌÔÛ¯Â‡ıËÎÂ ÛÂ ÂÓ‹ÏÈÎ· Ï‹ÙË, Î·È ÛÙÈ˜

¿ÏÏÂ˜ 2 ÌÂÙ·ÌÔÛ¯Â‡ıËÎ·Ó Â›ÛË˜ Ù· ÙÌ‹Ì·Ù· ππ & πππ, ÁÈ· ÙÔ

‰È·¯ˆÚÈÛÌfi ÙˆÓ ÔÔ›ˆÓ, fiÌˆ˜, ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë ÙÂ¯ÓÈÎ‹

reduced-size, Î·Ù¿ ÙËÓ ÔÔ›· ÙÔ ÂÓ·ÔÌÂ›Ó·Ó ÙÌ‹Ì· ÙÔ˘

‹·ÙÔ˜ Â›Ó·È ÌË ¯ÚËÛÈÌÔÔÈ‹ÛÈÌÔ.

ªÂÙ¿ ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË ÔÈ ·ÛıÂÓÂ›˜ ·Ú¤ÌÂÈÓ·Ó Û˘Ó‰Â-

‰ÂÌ¤ÓÔÈ ÌÂ ÙÔÓ ·Ó·ÓÂ˘ÛÙ‹Ú· ÁÈ· 24 ¤ˆ˜ 48 ÒÚÂ˜ Î·È ‚Ú›ÛÎÔ-

ÓÙ·Ó ˘fi ÛÙÂÓ‹ ·Ú·ÎÔÏÔ‡ıËÛË ÚÔÎÂÈÌ¤ÓÔ˘ Ó· ·ÓÙÈÌÂÙˆ-

ÈÛÙÔ‡Ó ÔÈ ·ÈÌÔ‰˘Ó·ÌÈÎ¤˜, ÌÂÙ·‚ÔÏÈÎ¤˜ Î·È ËÏÂÎÙÚÔÏ˘ÙÈÎ¤˜

‰È·Ù·Ú·¯¤˜, Ë ·ÒÏÂÈ· ·›Ì·ÙÔ˜ Î·È ÔÈ ÏÔÈÌÒÍÂÈ˜. ø˜ ·ÓÔÛÔ-

Î·Ù·ÛÙ·ÏÙÈÎ‹ ·ÁˆÁ‹ ¯ÔÚËÁ‹ıËÎÂ ·Ú¯ÈÎÒ˜ methylpredni-

zolone (2 mg/kg IV) Î·È ·ÎÔÏÔ‡ıˆ˜ prednizolone (0,2 mg/kg,

per os), ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ mycophenolate mofetil/ MMF

(CellCept) Î·È Î˘ÎÏÔÛÔÚ›ÓË (Neoral) ÛÂ 6 ·È‰È¿, ÂÓÒ ÛÂ 7

·È‰È¿, ·ÓÙ› ÙË˜ Î˘ÎÏÔÛÔÚ›ÓË˜, ¯ÔÚËÁ‹ıËÎÂ FK506/

tacrolimus (Prograf).


∆Ú›· ·È‰È¿ Î·Ù¤ÏËÍ·Ó ÙÔÓ ÚÒÙÔ ÌÂÙÂÁ¯ÂÈÚËÙÈ-

Îfi Ì‹Ó· ·fi ÌÂÙÂÁ¯ÂÈÚËÙÈÎ¤˜ ÂÈÏÔÎ¤˜: ¤Ó· ·fi

ıÚfiÌ‚ˆÛË ÙË˜ Ë·ÙÈÎ‹˜ ·ÚÙËÚ›·˜, ¤Ó· ·fi ıÚfiÌ-

‚ˆÛË ÙË˜ ˘Ï·›·˜ ÊÏ¤‚·˜ Î·È ¤Ó· ·fi Î·Ú‰ÈÔ·Ó·-

ÓÂ˘ÛÙÈÎ‹ ·ÓÂ¿ÚÎÂÈ·. ∞fi Ù· 13 ·È‰È¿ Ô˘ ·Ú·-

ÎÔÏÔ˘ıÔ‡ÌÂ ¤ˆ˜ Û‹ÌÂÚ·, 4 ÂÌÊ¿ÓÈÛ·Ó ÙÔ˘Ï¿¯ÈÛÙÔÓ

¤Ó· ÂÂÈÛfi‰ÈÔ ÔÍÂ›·˜ ·fiÚÚÈ„Ë˜ ÙÔ˘ ÌÔÛ¯Â‡Ì·ÙÔ˜

ÌÂ Ì¤ÛÔ fiÚÔ ¯ÚfiÓÔ ÂÌÊ¿ÓÈÛË˜ ÙÔ˘˜ 25,7 Ì‹ÓÂ˜ ÌÂÙ¿

ÙË ª∏. ™Ù· ‰‡Ô ·È‰È¿ Ù· ÂÂÈÛfi‰È· ·ÓÙÈÌÂÙˆ›-

ÛÙËÎ·Ó ÂÈÙ˘¯Ò˜ ÌÂ ÒÛÂÈ˜ ÎÔÚÙÈ˙fiÓË˜. ™Ù· ˘fiÏÔÈ-

· ‰‡Ô ··ÈÙ‹ıËÎÂ ¯ÔÚ‹ÁËÛË ·ÓÙÈı˘ÌÔÎ˘ÙÙ·ÚÈÎÔ‡

ÔÚÔ‡ (ATG), ÏfiÁˆ ·ÓıÂÎÙÈÎfiÙËÙ·˜ ÙË˜ ·ÔÚÚÈÙÈ-

Î‹˜ ‰È·‰ÈÎ·Û›·˜ ÛÙ· ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹. ™ÙË Ì›· Â-

Ú›ÙˆÛË Ë ·ÓÙ›ÛÙ·ÛË ÛÙË Ê·ÚÌ·ÎÂ˘ÙÈÎ‹ ·ÁˆÁ‹

ÔÊÂ›ÏÂÙÔ ÛÙÔ fiÙÈ Ô ‰fiÙË˜ ‹Ù·Ó Û˘Ì‚·Ù‹˜ Î·È fi¯È

›‰È·˜ ÔÌ¿‰·˜ ·›Ì·ÙÔ˜. √ ·ÛıÂÓ‹˜ ·˘Ùfi˜ ·ÚÔ˘Û›·ÛÂ

¯ÚfiÓÈ· ·fiÚÚÈ„Ë ÙÔ˘ ÌÔÛ¯Â‡Ì·ÙÔ˜, Ë ÔÔ›· fiÌˆ˜

ÌÂÙÚÈ¿ÛÙËÎÂ ÌÂ ·ÏÏ·Á‹ ÙË˜ ·ÓÔÛÔÎ·Ù·ÛÙ·ÏÙÈÎ‹˜

·ÁˆÁ‹˜ ·fi Î˘ÎÏÔÛÔÚ›ÓË ÛÂ tacrolimus.

∆ÚÔÔÔ›ËÛË ÙË˜ ·ÓÔÛÔÎ·Ù·ÛÙ·ÏÙÈÎ‹˜ ·ÁˆÁ‹˜

ÎÚ›ıËÎÂ ··Ú·›ÙËÙË ÛÂ 3 Û˘ÓÔÏÈÎ¿ ·ÛıÂÓÂ›˜. ™ÙÔ˘˜

2 ¤ÁÈÓÂ ·ÏÏ·Á‹ ÙÔ˘ Û¯‹Ì·ÙÔ˜ ·fi cyclosporine ÛÂ

tacrolimus, ÂÍ·ÈÙ›·˜ ¯ÚfiÓÈ·˜ ·fiÚÚÈ„Ë˜ ÛÙË Ì›· Â-

Ú›ÙˆÛË -Ë ÔÔ›· ‰ÈÂÁÓÒÛıË ÌÂ ÎÏÂÈÛÙ‹ ‚ÈÔ„›· ÙÔ˘

ÌÔÛ¯Â‡Ì·ÙÔ˜-, Î·È ÓÂÊÚÔÙÔÍÈÎfiÙËÙ·˜ ÛÙËÓ ¿ÏÏË. ∏

ÓÂÊÚÔÙÔÍÈÎfiÙËÙ· ÂÎ‰ËÏÒıËÎÂ ÌÂ ·‡ÍËÛË ÙË˜ ·ÚÙË-

ÚÈ·Î‹˜ ›ÂÛË˜, ·‡ÍËÛË ÙË˜ Ô˘Ú›·˜ Î·È ÙË˜ ÎÚÂ·ÙÈÓ›-

ÓË˜ ÙÔ˘ ÔÚÔ‡ Î·È ÂÏ¿ÙÙˆÛË ÙÔ˘ GFR Î·Ù¿ ÙË Ú·‰ÈÔ˚-

ÛÔÙÔÈÎ‹ ÌÂÏ¤ÙË. ∆¤ÏÔ˜, ÛÂ ¤Ó· ·È‰› Ú·ÁÌ·ÙÔ-

ÔÈ‹ıËÎÂ ·ÏÏ·Á‹ ·fi tacrolimus ÛÂ Î˘ÎÏÔÛÔÚ›ÓË,

ÏfiÁˆ ·Ú¯fiÌÂÓË˜ ·ÁÎÚÂ·Ù›ÙÈ‰·˜.

™Â fi,ÙÈ ·ÊÔÚ¿ ÙÈ˜ ÏÔÈÌÒÍÂÈ˜ (¶›Ó·Î·˜ 2), ·ÓÈ-

¯ÓÂ‡ıËÎ·Ó Î˘Ú›ˆ˜ ÔÈ ÈÔ› CMV, EBV Î·È Parvo µ19 ÌÂ

ÙË Ì¤ıÔ‰Ô ÙË˜ ·Ï˘ÛÈ‰ˆÙ‹˜ ·ÓÙ›‰Ú·ÛË˜ ÙË˜ ÔÏ˘ÌÂ-

Ú¿ÛË˜ (PCR). ∂›ÛË˜, 2 ·È‰È¿ ·ÚÔ˘Û›·Û·Ó ÏÔ›Ìˆ-

ÍË ·fi HSV, 1 ·fi Coxsackie Î·È 1 ·fi Candida

albicans. √È ÏÔÈÌÒÍÂÈ˜ ·˘Ù¤˜ ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó ÂÈ-

Ù˘¯Ò˜ ÌÂ ÂÏ¿ÙÙˆÛË ÙË˜ ·ÓÔÛÔÎ·Ù·ÛÙÔÏ‹˜ Î·È ÙË

¯ÔÚ‹ÁËÛË gancyclovir, acyclovir ‹ amphotericin B.

ªÈÎÚÔ‚È·Î‹ ÏÔ›ÌˆÍË ‰ÂÓ ÂÌÊ¿ÓÈÛÂ Î·Ó¤Ó·˜ ·fi

ÙÔ˘˜ ·ÛıÂÓÂ›˜ Ì·˜.

ÕÏÏÂ˜ ÂÈÏÔÎ¤˜ ÙË˜ ·ÓÔÛÔÎ·Ù·ÛÙ·ÏÙÈÎ‹˜ ·Áˆ-

Á‹˜, ‹Ù·Ó Á·ÛÙÚÔÚÚ·Á›· Î·È ˘ÂÚÔ˘ÚÈ¯·ÈÌ›·. ∆¤ÏÔ˜,

¤Ó·˜ ·ÛıÂÓ‹˜ ÂÌÊ¿ÓÈÛÂ ÓfiÛÔ ÂÍ·Ê¿ÓÈÛË˜ ÙˆÓ ÌÈ-

ÎÚÒÓ ¯ÔÏËÊfiÚˆÓ fiÚˆÓ ‡ÛÙÂÚ· ·fi ‰È·‰Ô¯ÈÎ¤˜

ÏÔÈÌÒÍÂÈ˜ ·fi ÙÔ˘˜ ÈÔ‡˜ Parvo B19, CMV Î·È EBV

Î·Ù¿ ÙËÓ ÚÒÙË ÌÂÙÂÁ¯ÂÈÚËÙÈÎ‹ ÂÚ›Ô‰Ô, Ë ÔÔ›·

Ô‰‹ÁËÛÂ ÛÂ Î›ÚÚˆÛË Î·È ˘Ï·›· ˘¤ÚÙ·ÛË, ÌÂ ·Ô-

Ù¤ÏÂÛÌ· Ó· ¯ÚÂÈ·ÛÙÂ› Â·Ó·ÌÂÙ·ÌfiÛ¯Â˘ÛË.

™Â fi,ÙÈ ·ÊÔÚ¿ ÙË ÛˆÌ·ÙÈÎ‹ ·Ó¿Ù˘ÍË, ¤ÍÈ ·È‰È¿

¤¯Ô˘Ó Û‹ÌÂÚ· ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜ ¿Óˆ ·fi ÙËÓ 50‹

ÂÎ·ÙÔÛÙÈ·›· ı¤ÛË ÌÂ ‚¿ÛË ÙÈ˜ Î·Ì‡ÏÂ˜ ·Ó¿Ù˘ÍË˜,

2 ÌÂÙ·Í‡ 50‹˜ Î·È 25Ë˜ ∂£ Î·È Ù· ˘fiÏÔÈ· Î¿Ùˆ

·fi ÙË 10Ë ∂£. ∆· ·È‰È¿ Ô˘ ‚Ú›ÛÎÔÓÙ·È ¿Óˆ ·fi

ÙËÓ 50‹ ∂£ ˘Ô‚Ï‹ıËÎ·Ó ÛÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË ÛÂ

ËÏÈÎ›Â˜ ·fi 3 ¤ˆ˜ 8 ÂÙÒÓ Î·È ‚Ú›ÛÎÔÓÙ·Ó ÛÙÈ˜ ›‰ÈÂ˜

∂£ ÚÈÓ ·fi ÙË ª∏. ŸÛÔÓ ·ÊÔÚ¿ ÙÔ ‡„Ô˜, 7 ·È‰È¿

‚Ú›ÛÎÔÓÙ·È Û‹ÌÂÚ· ¿Óˆ ·fi ÙË 50‹ ∂£, ÂÓÒ 6

¤¯Ô˘Ó ‡„Ô˜ ›ÛÔ ‹ Î¿Ùˆ ·fi ÙËÓ 10Ë ∂£. ∆· ·È‰È¿

143ªÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜ ÛÙ· ·È‰È¿

¶·È‰È·ÙÚÈÎ‹ 2008;71:141-147

¶›Ó·Î·˜ 2. ∂ÈÏÔÎ¤˜ Ô˘ ·Ú·ÙËÚ‹ıËÎ·Ó Î·Ù¿ ÙËÓ ·Ú·ÎÔÏÔ‡-ıËÛË ÙˆÓ ·ÛıÂÓÒÓ Ì·˜

∂ÈÏÔÎ‹ ∞ÚÈıÌfi˜ ·ÛıÂÓÒÓ

§Ô›ÌˆÍËñ CMV 5ñ EBV 5ñ Parvo B19 2ñ HSV1,2 2ñ Coxsackie 1ñ Candida albicans 1

∞fiÚÚÈ„Ë ÌÔÛ¯Â‡Ì·ÙÔ˜ 4∞ÈÌÔÚÚ·Á›· ·ÓÒÙÂÚÔ˘ °∂™ 1ÀÂÚÔ˘ÚÈ¯·ÈÌ›· 1∂Í·Ê¿ÓÈÛË ÌÈÎÚÒÓ ¯ÔÏËÊfiÚˆÓ fiÚˆÓ 1


Ô˘ Û‹ÌÂÚ· Â›Ó·È ËÏÈÎ›·˜ ¿Óˆ ÙˆÓ 10 ÂÙÒÓ ‚Ú›ÛÎÔ-

ÓÙ·È ÛÙËÓ ›‰È· ∂£ Ô˘ ‚Ú›ÛÎÔÓÙ·Ó ÚÈÓ ·fi ÙË ª∏,

‰ËÏ·‰‹ Ë ·Ó¿Ù˘Í‹ ÙÔ˘˜ ‰ÂÓ ÂËÚÂ¿ÛÙËÎÂ ·fi ÙËÓ

·ÓÔÛÔÎ·Ù·ÛÙ·ÏÙÈÎ‹ ·ÁˆÁ‹.

√ ÚÒÙÔ˜ ·ÛıÂÓ‹˜ Ô˘ ˘Ô‚Ï‹ıËÎÂ ÛÂ ª∏ ÛÂ

ËÏÈÎ›· 6 ÌËÓÒÓ, ÚÈÓ ·fi 15 ¯ÚfiÓÈ·, ÛÙÔ ªÂÙ·ÌÔ-

Û¯Â˘ÙÈÎfi ∫¤ÓÙÚÔ ÙÔ˘ πÔÎÚ·ÙÂ›Ô˘ ÂÈ‚ÈÒÓÂÈ Ì¤¯ÚÈ

Û‹ÌÂÚ·, ÌÂ Ê˘ÛÈÔÏÔÁÈÎ‹ ÛˆÌ·ÙÈÎ‹ Î·È „˘¯ÔÎÈÓËÙÈ-

Î‹ ·Ó¿Ù˘ÍË Î·È ·Ú·ÎÔÏÔ˘ıÂ›Ù·È Î¿ıÂ 6 Ì‹ÓÂ˜

ÛÙËÓ °ã ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹.

™˘˙‹ÙËÛË

∏ ª∏ ÛÙ· ·È‰È¿ ·ÔÙÂÏÂ› Û‹ÌÂÚ· ıÂÚ·Â›·

ÚÔ˘Ù›Ó·˜ ÛÙÈ˜ ·Ó·Ù˘ÁÌ¤ÓÂ˜ ¯ÒÚÂ˜ ‰›ÓÔÓÙ·˜ ÙË ‰˘-

Ó·ÙfiÙËÙ· ÂÈ‚›ˆÛË˜ ÛÙËÓ ÏÂÈÔÓfiÙËÙ· ÙˆÓ ·È‰ÈÒÓ

ÌÂ ÓÔÛ‹Ì·Ù· Ô˘ ÚÔËÁÔ˘Ì¤Óˆ˜ ‹Ù·Ó ı·Ó·ÙËÊfiÚ·.

∆· ÓÔÛ‹Ì·Ù· Ô˘ Â›Ó·È ‰˘Ó·Ùfi Ó· Ô‰ËÁ‹ÛÔ˘Ó ÛÂ

ª∏ Î·È ÙÔ ÔÛÔÛÙfi Ô˘ Î·Ù·Ï·Ì‚¿ÓÔ˘Ó ‰ÈÂıÓÒ˜

·ÂÈÎÔÓ›˙ÔÓÙ·È ÛÙËÓ ∂ÈÎfiÓ· 2. ™‡ÌÊˆÓ· ÌÂ ÙÔ ¢ÈÂ-

ıÓ¤˜ ¢›ÎÙ˘Ô ¢È¿ıÂÛË˜ √ÚÁ¿ÓˆÓ, Ë ·ÙÚËÛ›· ÙˆÓ ÂÍˆ-

Ë·ÙÈÎÒÓ ¯ÔÏËÊfiÚˆÓ Â›Ó·È Ë ÈÔ Û˘¯Ó‹ ·ÈÙ›·, ÂÚ›-

Ô˘ 50%, ÛÙÈ˜ ‰ËÌÔÛÈÂ‡ÛÂÈ˜ fiÏˆÓ ÙˆÓ ÌÂÙ·ÌÔÛ¯Â˘-

ÙÈÎÒÓ Î¤ÓÙÚˆÓ. ª¿ÏÈÛÙ·, ÛÙ· ·È‰È¿ ËÏÈÎ›·˜ Î¿Ùˆ

ÙˆÓ 2 ÂÙÒÓ Ô˘ ¤¯Ô˘Ó ˘Ô‚ÏËıÂ› ÛÂ ÌÂÙ·ÌfiÛ¯Â˘ÛË,

ÙÔ ÔÛÔÛÙfi ·˘Ùfi ÊÙ¿ÓÂÈ ÙÔ 76% ÛÙËÓ ∂˘ÚÒË Î·È

ÙËÓ ∞ÌÂÚÈÎ‹ (8). ÕÏÏÂ˜ ·ı‹ÛÂÈ˜ ÔÈ ÔÔ›Â˜ ÌÔÚÂ›

Ó· Ô‰ËÁ‹ÛÔ˘Ó ÛÂ Ë·ÙÈÎ‹ ·ÓÂ¿ÚÎÂÈ· ÙÂÏÈÎÔ‡ ÛÙ·-

‰›Ô˘ Â›Ó·È Ù· ÌÂÙ·‚ÔÏÈÎ¿ ÓÔÛ‹Ì·Ù· Î·È Ë ÂÓ‰ÔË·-

ÙÈÎ‹ ¯ÔÏfiÛÙ·ÛË. ∞fi Ù· ÌÂÙ·‚ÔÏÈÎ¿ ÓÔÛ‹Ì·Ù· Û˘-

¯ÓfiÙÂÚ· Â›Ó·È Ë ÓfiÛÔ˜ ÙÔ˘ Wilson, Ë ·ÓÂ¿ÚÎÂÈ· ·1-

·ÓÙÈıÚ˘„›ÓË˜, Ë Ù˘ÚÔÛÈÓ·ÈÌ›· Î·È Ë ·ÈÌÔ¯ÚˆÌ¿Ùˆ-

ÛË. ¢ÈÂıÓÒ˜, ÔÛÔÛÙfi ÂÚ›Ô˘ 11% ÙˆÓ ·È‰È·ÙÚÈ-

ÎÒÓ ·ÛıÂÓÒÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÎÂÚ·˘ÓÔ‚fiÏÔ Ë·ÙÈÎ‹

·ÓÂ¿ÚÎÂÈ·, Ë ÔÔ›· Ô‰ËÁÂ› ÛÂ ª∏, ÂÍ·ÈÙ›·˜ ÈÔÁÂ-

ÓÒÓ ÏÔÈÌÒÍÂˆÓ, Ê·ÚÌ¿ÎˆÓ ‹ ÙÔÍÈÎÒÓ Ô˘ÛÈÒÓ. √È ÌË

¯ÂÈÚÔ˘ÚÁÈÎ¿ ÂÍ·ÈÚ¤ÛÈÌÔÈ fiÁÎÔÈ ÙÔ˘ ‹·ÙÔ˜ ·ÔÙÂ-

ÏÔ‡Ó ¤Ó‰ÂÈÍË ÁÈ· ª∏ ÛÂ ÔÛÔÛÙfi 2% (6,7,12,13).

∞fi Ù· ÂÚÈÛÙ·ÙÈÎ¿ Ì·˜, ·Ó Î·È Ô ·ÚÈıÌfi˜ Â›Ó·È ÌÈ-

ÎÚfi˜, Ù· ·›ÙÈ· ‰ÂÓ ‰È·Ê¤ÚÔ˘Ó ·fi ·˘Ù¿ Ô˘ ¤¯Ô˘Ó

‹‰Ë ‰ËÌÔÛÈÂ˘ıÂ› ·fi ¿ÏÏ· Î¤ÓÙÚ·.

∏ ‰˘Û·ÔÚÚfiÊËÛË ÙÔ˘ Ï›Ô˘˜ Î·È ÙˆÓ ÏÈÔ‰È·-

Ï˘ÙÒÓ ‚ÈÙ·ÌÈÓÒÓ ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ·ÓÂ·ÚÎ‹

ÚfiÛÏË„Ë ıÂÚÌ›‰ˆÓ Î·È ÂÔÌ¤Óˆ˜ ‰È·Ù·Ú·¯‹ ÙË˜

ıÚ¤„Ë˜. •ÂÎÈÓÒÓÙ·˜ ¤ÁÎ·ÈÚ· ÙÔÓ ÚÔÌÂÙ·ÌÔÛ¯Â˘-

ÙÈÎfi ¤ÏÂÁ¯Ô, Ë ÔÌ¿‰· ÙˆÓ ÂÈ‰ÈÎÒÓ È·ÙÚÒÓ ÌÔÚÂ› Ó·

ÂÈÎÂÓÙÚˆıÂ› ·Ú¯ÈÎ¿ ÛÙË ‚ÂÏÙ›ˆÛË ÙË˜ ıÚ¤„Ë˜ ÙÔ˘

·ÛıÂÓÔ‡˜, Ô˘ Â›Ó·È ÂËÚÂ·ÛÌ¤ÓË ÏfiÁˆ ÙË˜ ‰˘Û·-

ÔÚÚfiÊËÛË˜ (14). ∏ ‚ÂÏÙ›ˆÛË ÙË˜ ıÚ¤„Ë˜ ÙÔ˘ ·È-

‰È·ÙÚÈÎÔ‡ ·ÛıÂÓÔ‡˜ ÚÈÓ ·fi ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË Â›-

Ó·È ÛËÌ·ÓÙÈÎ‹ ·Ú¿ÌÂÙÚÔ˜ ÂÈÙ˘¯›·˜ ÙË˜ ÌÂÙ·Ìfi-

Û¯Â˘ÛË˜, Î·ıÒ˜ Ë ‚ÂÏÙ›ˆÛË ·˘Ù‹ ÌÂÙ·ÊÚ¿˙ÂÙ·È ÛÂ

ÌÂ›ˆÛË ÙˆÓ ÂÁ¯ÂÈÚËÙÈÎÒÓ ÂÈÏÔÎÒÓ Î·È ÙˆÓ ÏÔÈ-

ÌÒÍÂˆÓ Î·È Û˘ÓÔÏÈÎ¿ ÛÂ Î·Ï‡ÙÂÚË ÂÈ‚›ˆÛË ÌÂÙ¿

ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË (15). ª¿ÏÈÛÙ·, ÛÂ ÌÈ· ÛÂÈÚ¿ ·ÛıÂ-

ÓÒÓ ÌÂ ÔÍÂ›· Ë·ÙÈÎ‹ ·ÓÂ¿ÚÎÂÈ· Ô˘ ˘Ô‚Ï‹ıË-

Î·Ó ÂÂÈÁfiÓÙˆ˜ ÛÂ ª∏, ·ÚÓËÙÈÎfi˜ ÚÔÁÓˆÛÙÈÎfi˜

·Ú¿ÁÔÓÙ·˜ ‹Ù·Ó Ë ÌÈÎÚ‹ ËÏÈÎ›·, Ë ÔÔ›· Ê·›ÓÂÙ·È

Ó· Û¯ÂÙ›˙ÂÙ·È ÌÂ ÙÔ ¯·ÌËÏfi ‚¿ÚÔ˜ (16). ™ÙË ‰ÈÎ‹

Ì·˜ ÛÂÈÚ¿, 4 ·È‰È¿ Â›¯·Ó ÛËÌ·ÓÙÈÎ‹ ‰È·Ù·Ú·¯‹ ÙË˜

ıÚ¤„Ë˜ Î·Ù¿ ÙËÓ ·Ú·ÔÌ‹ ÙÔ˘˜ ÛÙËÓ ÎÏÈÓÈÎ‹

Ì·˜. ∆· ·È‰È¿ ·˘Ù¿ ˘Ô‚Ï‹ıËÎ·Ó ÛÙËÓ Î·Ù¿ÏÏËÏË

‰È·ÙÚÔÊÈÎ‹ ˘ÔÛÙ‹ÚÈÍË, ÌÂ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ËÌ¤Ú·

ÙË˜ ÌÂÙ·ÌfiÛ¯Â˘ÛË˜ ÙÔ ‚¿ÚÔ˜ ÙÔ˘˜ Ó· ¤¯ÂÈ ·˘ÍËıÂ›

Î·Ù¿ 20-30%.

∏ Î·Ï‹ ÛˆÌ·ÙÈÎ‹ Î·È „˘¯ÔÎÈÓËÙÈÎ‹ ·Ó¿Ù˘ÍË

·ÔÙÂÏÔ‡Ó ÛËÌ·ÓÙÈÎfi ÛÙfi¯Ô ÁÈ· ÙÔ˘˜ È·ÙÚÔ‡˜ Ô˘

·Û¯ÔÏÔ‡ÓÙ·È ÌÂ ÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË ·È‰ÈÒÓ ÌÂ

ª∏. ∏ ÌÂÙ·ÌfiÛ¯Â˘ÛË Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ·Ó·ÛÙÚ¤„ÂÈ

ÙË ÛÙ·ÛÈÌfiÙËÙ· ÙË˜ ÛˆÌ·ÙÈÎ‹˜ ·Ó¿Ù˘ÍË˜ Ô˘ ÚÔ-

¸‹Ú¯Â ÏfiÁˆ ÙË˜ ÓfiÛÔ˘, ÂÓÒ Ê˘ÛÈÔÏÔÁÈÎ‹ Â›Ó·È Î·È

Ë ÓÂ˘Ì·ÙÈÎ‹ ·Ó¿Ù˘ÍË ÙˆÓ ·È‰ÈÒÓ ·˘ÙÒÓ (17,18).

∂ÓÙÔ‡ÙÔÈ˜, ÚfiÛÊ·ÙÂ˜ ÌÂÏ¤ÙÂ˜ ‰Â›¯ÓÔ˘Ó ˆ˜ ÌÔ-

ÚÂ› Ó· ˘¿Ú¯Ô˘Ó ÁÓˆÛÙÈÎ¤˜ ‰È·Ù·Ú·¯¤˜, ·ÏÏ¿ Î·È

Î·ı˘ÛÙ¤ÚËÛË ÙË˜ ·Ó¿Ù˘ÍË˜ ÌÂÙ¿ ÙË ª∏ (19).

™ÙÔ˘˜ ·Ú¿ÁÔÓÙÂ˜ Ô˘ ÌÔÚÂ› Ó· Â˘ı‡ÓÔÓÙ·È Û˘-

ÁÎ·Ù·Ï¤ÁÔÓÙ·È Ë ÚÔÂÁ¯ÂÈÚËÙÈÎ‹ Î·Ù¿ÛÙ·ÛË, Ë ·-

Ú·ÙÂÙ·Ì¤ÓË ÓÔÛËÏÂ›· Î·È Ë ·ÓÔÛÔÎ·Ù·ÛÙ·ÏÙÈÎ‹

·ÁˆÁ‹, Î˘Ú›ˆ˜ ÌÂ ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹. ∏ Ú·ÎÙÈÎ‹

Ô˘ ÂÊ·ÚÌfi˙ÂÙ·È ‰ÈÂıÓÒ˜ -Î·È ·fi ÂÌ¿˜- ÌÂ ÔÏ‡

Î·Ï¿ ·ÔÙÂÏ¤ÛÌ·Ù·, Â›Ó·È Ë Î·Ù¿ ÙÔ ‰˘Ó·ÙfiÓ Ù·¯‡-

ÙÂÚË ÌÂ›ˆÛË Î·È ‰È·ÎÔ‹ ÙË˜ ÎÔÚÙÈ˙fiÓË˜ (20-24).

∆Ô ÌÂÁ¿ÏÔ Úfi‚ÏËÌ· ÛÙË ª∏ Â›Ó·È fiÙÈ Ô ·ÚÈı-

Ìfi˜ ÙˆÓ ˘Ô„‹ÊÈˆÓ ·È‰ÈÒÓ ˘ÂÚ‚·›ÓÂÈ Î·Ù¿ ÔÏ‡

ÙÔÓ ·ÚÈıÌfi ÙˆÓ Ë·ÙÈÎÒÓ ÌÔÛ¯Â˘Ì¿ÙˆÓ. ∏ ·Ó¿ÁÎË



∞ÙÚËÛ›·

¯ÔÏËÊfiÚˆÓ

44%

ªÂÙ·‚ÔÏÈÎ¿

ÓÔÛ‹Ì·Ù·

13%

∫ÂÚ·˘ÓÔ‚fiÏÔ˜

Ë·ÙÈÎ‹

·ÓÂ¿ÚÎÂÈ·

11%

∂Ó‰ÔË·ÙÈÎ‹

˘ÔÏ·Û›·

6%

¶ÚˆÙÔ·ı‹˜

¯ÔÏ·ÁÁÂÈ›ÙÈ‰·

5%

¡ÂÔÁÓÈÎ‹

Ë·Ù›ÙÈ‰·

3%

∞˘ÙÔ¿ÓÔÛË

Ë·Ù›ÙÈ‰·

2%

ŸÁÎÔÈ

2%

∫˘ÛÙÈÎ‹ ›ÓˆÛË

2%ÕÏÏ·

12%

∂ÈÎfiÓ· 2. ∞›ÙÈ· ª∏ ÛÙÔ˘˜ ·È‰È·ÙÚÈÎÔ‡˜ ·ÛıÂÓÂ›˜ ‰ÈÂıÓÒ˜ (¢ÈÂ-ıÓ¤˜ ¢›ÎÙ˘Ô ¢È¿ıÂÛË˜ √ÚÁ¿ÓˆÓ) (41).


ÌÈÎÚÔ‡ ÌÂÁ¤ıÔ˘˜ ÌÔÛ¯Â˘Ì¿ÙˆÓ ÛÂ Û˘Ó¿ÚÙËÛË ÌÂ

ÙËÓ ¤ÏÏÂÈ„Ë ÙˆÌ·ÙÈÎÒÓ ‰ÔÙÒÓ ÌÈÎÚ‹˜ ËÏÈÎ›·˜

ÚÔÎ¿ÏÂÛÂ ÙËÓ ·Ó·˙‹ÙËÛË ÂÓ·ÏÏ·ÎÙÈÎÒÓ ËÁÒÓ

ÌÔÛ¯Â˘Ì¿ÙˆÓ. ¢‡Ô ÂÁ¯ÂÈÚËÙÈÎ¤˜ Ì¤ıÔ‰ÔÈ Ô˘ ÚÔ-

ÛÊ¤ÚÔ˘Ó ÂÓı·ÚÚ˘ÓÙÈÎ¿ ·ÔÙÂÏ¤ÛÌ·Ù·, Â›Ó·È Ë Ï‹„Ë

ÙÌ‹Ì·ÙÔ˜ ÙÔ˘ ‹·ÙÔ˜ ·fi ˙ÒÓÙ· ‰fiÙË Î·È Ë ¯ÂÈ-

ÚÔ˘ÚÁÈÎ‹ ‰È·›ÚÂÛË ÛÂ ‰‡Ô ÏÂÈÙÔ˘ÚÁÈÎ¿ ÙÌ‹Ì·Ù· ÙÔ˘

ÙˆÌ·ÙÈÎÔ‡ ÌÔÛ¯Â‡Ì·ÙÔ˜ ÂÓ‹ÏÈÎ· ‰fiÙË, ÒÛÙÂ Ó·

ÌÂÙ·ÌÔÛ¯Â˘ıÂ› ÛÂ ‰‡Ô Ï‹ÙÂ˜ (11,25). √È Ì¤ıÔ‰ÔÈ

·˘Ù¤˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Î·Ïfi ÔÛÔÛÙfi ÂÈ‚›ˆÛË˜ ÙÔ˘

ÌÔÛ¯Â‡Ì·ÙÔ˜ Î·È ÙÔ˘ Ï‹ÙË Î·È ¤¯Ô˘Ó Ï¤ÔÓ Î·ıÈÂ-

ÚˆıÂ› ÛÙÔ˘˜ ·È‰È·ÙÚÈÎÔ‡˜ ·ÛıÂÓÂ›˜ (26-30). ∆Ô ÁÂ-

ÁÔÓfi˜ ·˘Ùfi ÂÈ‚Â‚·ÈÒÓÂÈ ÌÈ· ÌÂÁ¿ÏË ÌÂÙ·-·Ó¿Ï˘ÛË,

Ë ÔÔ›· ‰Â›¯ÓÂÈ fiÙÈ Ë ÂÈ‚›ˆÛË Â›Ó·È Î·Ï‡ÙÂÚË ÁÈ·

ÙÔ˘˜ ·ÛıÂÓÂ›˜ ‡ÛÙÂÚ· ·fi ÌÂÙ·ÌfiÛ¯Â˘ÛË ·fi ˙Ò-

ÓÙ· ‰fiÙË Û˘ÁÎÚÈÙÈÎ¿ ÌÂ ·˘Ù‹ ·fi ÙˆÌ·ÙÈÎfi ‰fiÙË,

·ÊÂÓfi˜ ‰ÈfiÙÈ ÔÈ ·ÛıÂÓÂ›˜ ‰ÂÓ ÂÈ‚·Ú‡ÓÔ˘Ó ÙË ÁÂÓÈÎ‹

ÙÔ˘˜ Î·Ù¿ÛÙ·ÛË ·Ó·Ì¤ÓÔÓÙ·˜ ÙˆÌ·ÙÈÎfi ÌfiÛ¯Â˘Ì·

Î·È ·ÊÂÙ¤ÚÔ˘ ÁÈ·Ù› ÔÈ ¯ÚfiÓÔÈ ıÂÚÌ‹˜ Î·È „˘¯Ú‹˜

ÈÛ¯·ÈÌ›·˜ Â›Ó·È ÌÈÎÚfiÙÂÚÔÈ (31). ∂ÓÙÔ‡ÙÔÈ˜, ı· Ú¤-

ÂÈ Ó· ÂÈÏ¤ÁÔÓÙ·È ÔÏ‡ ÚÔÛÂÎÙÈÎ¿ ÔÈ ˘Ô„‹ÊÈÔÈ

˙ÒÓÙÂ˜ ‰fiÙÂ˜ Ë·ÙÈÎÔ‡ ÌÔÛ¯Â‡Ì·ÙÔ˜, ÂÍ·ÈÙ›·˜ ÙˆÓ

ÂÈÏÔÎÒÓ Ô˘ ÌÔÚÂ› Ó· ·ÚÔ˘ÛÈ·ÛÙÔ‡Ó ÛÙÔ ‰fiÙË

ÌÂÙ¿ ÙËÓ Ë·ÙÂÎÙÔÌ‹ (.¯. ¯ÔÏfiÚÚÔÈ·, ıÚfiÌ‚ˆÛË

˘Ï·›·˜ ‹ Û‡ÛÙÔÈ¯Ë ÓÂ˘ÌÔÓÈÎ‹ Û˘ÏÏÔÁ‹), ·ÏÏ¿ Î·È

ÙË˜ ıÓËÛÈÌfiÙËÙ·˜ ·ÎfiÌË, Ë ÔÔ›·, fiÌˆ˜, Â›Ó·È ÂÍ·È-

ÚÂÙÈÎ¿ ÌÈÎÚ‹ (0,01%).

ªÂ ÙË Û˘ÓÂ¯fiÌÂÓË ·‡ÍËÛË ÙˆÓ ˘Ô„ËÊ›ˆÓ ÁÈ·

ª∏ -Î·ıÒ˜ ÌÂ ÙËÓ ·‡ÍËÛË ÙË˜ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙË-

Ù·˜ ÙË˜ ‰ÈÂ˘Ú‡ÓıËÎ·Ó Î·È ÔÈ ÂÓ‰Â›ÍÂÈ˜ ÙË˜-, ÚÔ¤Î˘-

„Â ¤Ó· ·ÎfiÌË ˙‹ÙËÌ·: Ë ÛˆÛÙ‹ ¯Ú‹ÛË ÙˆÓ ‰È·ÙÈı¤-

ÌÂÓˆÓ ÔÚÁ¿ÓˆÓ. ŸÙ·Ó ¿Ú¯ÈÛÂ Ó· ÂÊ·ÚÌfi˙ÂÙ·È Ë ª∏,

Ë ‰È¿ıÂÛË ÙˆÓ ÔÚÁ¿ÓˆÓ ÁÈÓfiÙ·Ó ÌÂ ‚¿ÛË ÙÔ ¯ÚfiÓÔ

·Ó·ÌÔÓ‹˜. °Ú‹ÁÔÚ·, fiÌˆ˜, ¤ÁÈÓÂ ·ÈÛıËÙ‹ Ë ·Ó¿ÁÎË

‡·ÚÍË˜ ÂÓfi˜ Û˘ÛÙ‹Ì·ÙÔ˜ ·ÍÈÔÏfiÁËÛË˜ Ô˘ ı· Î·-

ıfiÚÈ˙Â ÙËÓ ÚÔÙÂÚ·ÈfiÙËÙ· ÙˆÓ ˘Ô„‹ÊÈˆÓ ÏËÙÒÓ.

∏ ·ÍÈÔÏfiÁËÛË ‚·Û›ÛÙËÎÂ ÛÙÔ ÛÙ¿‰ÈÔ ÙË˜ Ë·ÙÈÎ‹˜

ÓfiÛÔ˘ Î·Ù¿ Child-Turcotte-Pugh Î·È ÛÙÈ˜ Ù˘¯fiÓ Û˘-

Ó˘¿Ú¯Ô˘ÛÂ˜ ÂÈÏÔÎ¤˜ ÙË˜, fiˆ˜ ·ÛÎ›ÙË˜, ÎÈÚÛÔÚ-

Ú·Á›· ‹ Ë·ÙÔÎ˘ÙÙ·ÚÈÎfi˜ Î·ÚÎ›ÓÔ˜ (32). ∏ ÏÂÈÔÓfi-

ÙËÙ· ÙˆÓ ÌÂÙ·ÌÔÛ¯Â˘ÙÈÎÒÓ Î¤ÓÙÚˆÓ ÛÙËÓ ∂˘ÚÒË

-Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓË˜ Î·È ÙË˜ ∫ÏÈÓÈÎ‹˜ ªÂÙ·ÌÔ-

Û¯Â‡ÛÂˆÓ ÙÔ˘ ∞¶£- Î·È ÛÙËÓ ∞˘ÛÙÚ·Ï›·, Û˘ÓÂ¯›-

˙Ô˘Ó Ó· ¯ÚËÛÈÌÔÔÈÔ‡Ó ·˘Ùfi ÙÔ Û‡ÛÙËÌ·. ™ÙÈ˜ ∏¶∞

ÂÈÛ‹¯ıË ·fi ÙÈ˜ ·Ú¯¤˜ ÙÔ˘ 2002 ¤Ó· Ó¤Ô Û‡ÛÙËÌ·, ÙÔ

ÔÔ›Ô ‚·Û›˙ÂÙ·È ÛÙËÓ ·ÍÈÔÏfiÁËÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ Ô˘

·ÔÚÚ¤ÂÈ ·fi ÙË ÌË ‰ÈÂÓ¤ÚÁÂÈ· ÌÂÙ·ÌfiÛ¯Â˘ÛË˜, ÙÔ

ÏÂÁfiÌÂÓÔ MELD (Model for End-Stage Liver Disease)

ÁÈ· ÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜ Î·È PELD (Pediatric End-Stage

Liver Disease) ÁÈ· Ù· ·È‰È¿. ∆Ô ·Ó ·˘Ùfi ÙÔ Û‡ÛÙËÌ·

Á›ÓÂÈ Î·ıÔÏÈÎ¿ ·Ô‰ÂÎÙfi ·fi ÙË ÌÂÙ·ÌÔÛ¯Â˘ÙÈÎ‹

ÎÔÈÓfiÙËÙ·, Ì¤ÓÂÈ Ó· ·Ô‰ÂÈ¯ıÂ› ÛÙÔ Ì¤ÏÏÔÓ (33,34).

√È ÏÔÈÌÒÍÂÈ˜ ·ÔÙÂÏÔ‡Ó ÙËÓ ÈÔ ÛËÌ·ÓÙÈÎ‹ ÂÈ-

ÏÔÎ‹ ÙË˜ ª∏ ÌÂÙ¿ ÙË ıÚfiÌ‚ˆÛË ÙË˜ Ë·ÙÈÎ‹˜ ·Ú-

ÙËÚ›·˜, Ë ÔÔ›· ÂÌÊ·Ó›˙ÂÙ·È Î·Ù¿ ÙÈ˜ ÚÒÙÂ˜ ÌÂÙÂÁ-

¯ÂÈÚËÙÈÎ¤˜ ËÌ¤ÚÂ˜. ∆ËÓ ÚÒÙË ÌÂÙÂÁ¯ÂÈÚËÙÈÎ‹ Â-

Ú›Ô‰Ô Î˘ÚÈ·Ú¯Ô‡Ó ÔÈ ÌÈÎÚÔ‚È·Î¤˜ ÏÔÈÌÒÍÂÈ˜, ÂÓÒ Â-

Ú›Ô˘ 2 Â‚‰ÔÌ¿‰Â˜ ·ÚÁfiÙÂÚ· ˘¿Ú¯ÂÈ ÌÂÁ·Ï‡ÙÂÚÔ˜

Î›Ó‰˘ÓÔ˜ ÏÔÈÌÒÍÂˆÓ ·fi Ì‡ÎËÙÂ˜. ™ÙË Û˘Ó¤¯ÂÈ·, ÌÂ-

Ù¿ ÙÈ˜ 6 Â‚‰ÔÌ¿‰Â˜ Î·È ÁÈ· fiÏË ÙË ‰È¿ÚÎÂÈ· ˙ˆ‹˜ ÙÔ˘

·ÛıÂÓÔ‡˜, ÂÈÎÚ·ÙÂ› Ô Î›Ó‰˘ÓÔ˜ ÈÔÁÂÓÒÓ ÏÔÈÌÒÍÂˆÓ.

°È· ÙÔ ÏfiÁÔ ·˘Ùfi, ÔÏÏÔ› ·ÛıÂÓÂ›˜ Ï·Ì‚¿ÓÔ˘Ó ¯ËÌÂÈ-

ÔÚÔÊ‡Ï·ÍË ÌÂÙ¿ ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË. ∆· ·ÓÙÈ‚ÈÔÙÈÎ¿

Î·È Ù· ·ÓÙÈÌ˘ÎËÙÈ·ÛÈÎ¿ ‰È·ÎfiÙÔÓÙ·È ÌÂÚÈÎ¤˜ Â‚‰Ô-

Ì¿‰Â˜ ÌÂÙ¿ ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË, Â¿Ó ‰ÂÓ ˘¿Ú¯Ô˘Ó ÂÓ-

‰Â›ÍÂÈ˜ ÏÔ›ÌˆÍË˜, ÂÓÒ Ù· ·ÓÙÈ-ÈÈÎ¿ ¤¯Ô˘Ó ı¤ÛË ÙÔ˘˜

ÚÒÙÔ˘˜ Ì‹ÓÂ˜. √È ÈÔ Û˘¯ÓÔ› ÈÔ› Â›Ó·È Ô CMV, o

EBV, ÔÈ ·‰ÂÓÔ˚Ô› Î·È Ô RSV (35). √ EBV Â›Ó·È È‰È·›ÙÂ-

Ú· ÛËÌ·ÓÙÈÎfi˜ Èfi˜, Î·ıÒ˜ Û¯ÂÙ›˙ÂÙ·È ÌÂ ÙË ÏÂÌÊÔ¸-

ÂÚÏ·ÛÙÈÎ‹ ÓfiÛÔ (post transplant lympho-

proliferative disease, PTLD) (36). ™‡ÌÊˆÓ· ÌÂ Ù· Â-

ÚÈÛÙ·ÙÈÎ¿ Ì·˜, Û˘¯ÓfiÙÂÚË ÂÌÊ¿ÓÈÛË ¤¯Ô˘Ó ÔÈ ÈÔ› EBV

Î·È CMV Î·È ·ÎÔÏÔ˘ıÔ‡Ó Ô Parvo B19, Ô HSV1,2, Ô

Coxsackie Î·È Ë Candida albicans.

∂ÎÙfi˜ ·fi ÙÔÓ Î›Ó‰˘ÓÔ ÙË˜ ·fiÚÚÈ„Ë˜ ÙÔ˘ ÌÔ-

Û¯Â‡Ì·ÙÔ˜, ¿ÏÏÔÈ ·Ú¿ÁÔÓÙÂ˜ Ô˘ ·˘Í¿ÓÔ˘Ó ÙË ÓÔ-

ÛËÚfiÙËÙ· ÙˆÓ ·È‰ÈÒÓ ÌÂÙ¿ ÙË ª∏ Â›Ó·È ÔÈ ÂÈÏÔ-

Î¤˜ ÙË˜ ·ÓÔÛÔÎ·Ù·ÛÙ·ÏÙÈÎ‹˜ ·ÁˆÁ‹˜, fiˆ˜ Ë ÓÂ-

ÊÚÔÙÔÍÈÎfiÙËÙ· ÙˆÓ ·Ó·ÛÙÔÏ¤ˆÓ ÙË˜ Î·ÏÛÈÓÂ˘Ú›ÓË˜

(Neoral, Prograf), Ë ÓÂ˘ÚÔÙÔÍÈÎfiÙËÙ·, Ë ÔÛÙÂÔ-

fiÚˆÛË Î·È Ë Î·Ú‰È·ÁÁÂÈ·Î‹ ÓfiÛÔ˜ (37-39). ∏ ‰È·-

Ù‹ÚËÛË Î·Ï‹˜ ÓÂÊÚÈÎ‹˜ ÏÂÈÙÔ˘ÚÁ›·˜ Ï·Ì‚¿ÓÂÙ·È ÛÔ-

‚·Ú¿ ˘fi„Ë ÛÙÔÓ Î·ıÔÚÈÛÌfi ÙË˜ ·ÓÔÛÔÎ·Ù·ÛÙ·ÏÙÈ-

Î‹˜ ·ÁˆÁ‹˜. ∆· ÓÂfiÙÂÚ· Ê¿ÚÌ·Î·, mycophenolate

mofetil (CellCept) Î·È Ù· ÈÔ ÚfiÛÊ·Ù· mycopheno-

late sodium (Myfortic) Î·È sirolimus (Rapamycin), Ù·

ÔÔ›· ‰ÂÓ ÂËÚÂ¿˙Ô˘Ó ÙË ÓÂÊÚÈÎ‹ ÏÂÈÙÔ˘ÚÁ›·, ¤‰ˆ-

Û·Ó ÙË ‰˘Ó·ÙfiÙËÙ· Ó· ¯ÔÚËÁÔ‡ÓÙ·È ÔÈ ·Ó·ÛÙÔÏÂ›˜

Î·ÏÛÈÓÂ˘Ú›ÓË˜ ÛÂ ÌÈÎÚfiÙÂÚÂ˜ ‰fiÛÂÈ˜, ÌÂ ·ÔÙ¤ÏÂÛÌ·

ÙÔÓ ÂÚÈÔÚÈÛÌfi ÙˆÓ ·ÚÂÓÂÚÁÂÈÒÓ ÙÔ˘˜ (40-43). ∞fi

Ù· ÂÚÈÛÙ·ÙÈÎ¿ Ì·˜, 1 ·È‰›, ÙÔ ÔÔ›Ô Ï¿Ì‚·ÓÂ Î˘-

ÎÏÔÛÔÚ›ÓË ÁÈ· ¤Ó· ¤ÙÔ˜, ·ÚÔ˘Û›·ÛÂ ÚÔÔ‰Â˘ÙÈÎ‹

¤ÎÙˆÛË ÙË˜ ÓÂÊÚÈÎ‹˜ ÏÂÈÙÔ˘ÚÁ›·˜, ·‡ÍËÛË ÙË˜ Ô˘-

Ú›·˜ ÙÔ˘ ÔÚÔ‡ Î·È ·‡ÍËÛË ÙË˜ ·ÚÙËÚÈ·Î‹˜ ›ÂÛË˜.

∞ÓÙÈÌÂÙˆ›ÛÙËÎÂ ·Ú¯ÈÎÒ˜ ÌÂ ÌÂ›ˆÛË ÙË˜ ‰fiÛË˜ ÙË˜

Î˘ÎÏÔÛÔÚ›ÓË˜ Î·È ÛÙË Û˘Ó¤¯ÂÈ· ÌÂ ·ÏÏ·Á‹ ÙË˜ ·ÓÔ-

ÛÔÎ·Ù·ÛÙ·ÏÙÈÎ‹˜ ·ÁˆÁ‹˜ ÛÂ tacrolimus.

™Â ·ÓÙ›ıÂÛË ÌÂ ÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜, ÔÈ ÔÔ›ÔÈ Â›Ó·È È-

ı·Ófi Ó· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó ˘ÔÙÚÔ‹ ÙË˜ Ë·ÙÈÎ‹˜ Ófi-

ÛÔ˘ ÌÂÙ¿ ÙË ª∏, ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ÙˆÓ ·È-

‰ÈÒÓ ‰ÂÓ ÎÈÓ‰˘ÓÂ‡ÂÈ ·fi ˘ÔÙÚÔ‹ ÙË˜ ÚˆÙ·Ú¯È-

Î‹˜ ÓfiÛÔ˘. ∏ ·Ú·Ù‹ÚËÛË ·˘Ù‹ ÂÈ‚Â‚·ÈÒÓÂÙ·È Î·È

·fi Ù· Î·Ï‡ÙÂÚ· ÔÛÔÛÙ¿ ÂÈ‚›ˆÛË˜ ÙˆÓ ÌÔÛ¯Â˘-

Ì¿ÙˆÓ ÛÙÔ˘˜ ·È‰È·ÙÚÈÎÔ‡˜ ·ÛıÂÓÂ›˜ (44).

™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, Ë ª∏ ·ÔÙÂÏÂ› Û‹ÌÂÚ· ÙË Ìfi-

ÓË ‰È·ı¤ÛÈÌË ıÂÚ·Â›· ÛÂ ·È‰È¿ ÌÂ ÌË ·Ó·ÛÙÚ¤„ÈÌË


¶·È‰È·ÙÚÈÎ‹ 2008;71:141-147


Ë·ÙÈÎ‹ ·ÓÂ¿ÚÎÂÈ· Ô˘ ÚÔÎ·ÏÂ›Ù·È ·fi ÏÂÈ¿‰·ÓÔÛËÌ¿ÙˆÓ, Ù· ÔÔ›· ÛÙÔ ·ÚÂÏıfiÓ ‹Ù·Ó ‰‡ÛÎÔÏÔÓ· ÂÏÂÁ¯ıÔ‡Ó Î·È Ó· ·ÓÙÈÌÂÙˆÈÛÙÔ‡Ó. ∏ Î·Ï‹ Û˘-ÓÂÚÁ·Û›· ÙË˜ ÔÌ¿‰·˜ ÂÈ‰ÈÎÒÓ (¯ÂÈÚÔ˘ÚÁÒÓ, ·È‰Ô-Á·ÛÙÚÂÓÙÂÚÔÏfiÁˆÓ, ·È‰Ô„˘¯È¿ÙÚˆÓ, ÓÔÛËÏÂ˘-ÙÚÈÒÓ, ÎÔÈÓˆÓÈÎÒÓ ÏÂÈÙÔ˘ÚÁÒÓ) ÌÂ ÙËÓ ÔÈÎÔÁ¤ÓÂÈ·Â›Ó·È ıÂÌÂÏÈÒ‰Ô˘˜ ÛËÌ·Û›·˜ ÁÈ· ÙËÓ ÔÌ·Ï‹ ÔÚÂ›·ÙˆÓ ·È‰ÈÒÓ ·˘ÙÒÓ. √È ÌÂÏÏÔÓÙÈÎ¤˜ ÂÍÂÏ›ÍÂÈ˜ ÛÙË¯Ú‹ÛË ÂÙÂÚÔÌÔÛ¯Â˘Ì¿ÙˆÓ ‹ Ë·ÙÔÎ˘ÙÙ¿ÚˆÓ, Î·-ıÒ˜ Î·È ÔÈ È‰ÈfiÙËÙÂ˜ Ô˘ ‰È·Ê·›ÓÔÓÙ·È ÛÙ· ‚Ï·ÛÙÔ-Î‡ÙÙ·Ú·, ›Ûˆ˜ ÂÚÈÔÚ›ÛÔ˘Ó ÙÔÓ ·ÚÈıÌfi ÙˆÓ ·È‰ÈÒÓÔ˘ ·Ó·Ì¤ÓÔ˘Ó Ë·ÙÈÎfi ÌfiÛ¯Â˘Ì·.


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¶·È‰È·ÙÚÈÎ‹ 2008;71:141-147


√ÈÎÔÓÔÌÈÎ‹ ·ÍÈÔÏfiÁËÛË ÙˆÓ Ó¤ˆÓ ÂÌ‚ÔÏ›ˆÓ ÙË˜ ·ÓÂÌÂ˘ÏÔÁÈ¿˜,

ÙÔ˘ ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˘ Ù‡Ô˘ C Î·È ÙÔ˘ ÓÂ˘ÌÔÓÈfiÎÔÎÎÔ˘

µ. ∆ÛÈ¿ÓÙÔ˘1, ∞. ∫·ÚfiÎË˜2, ∂. ¶¿‚Ë1, °. ∫˘ÚÈfiÔ˘ÏÔ˜1

¶ÂÚ›ÏË„Ë

∂ÈÛ·ÁˆÁ‹: ∆· ÂÌ‚fiÏÈ· ·ÔÙÂÏÔ‡Ó ¤Ó· ·fi Ù· ÛËÌ·ÓÙÈÎfiÙÂÚ· ÂÚÁ·ÏÂ›· ÚˆÙÔÁÂÓÔ‡˜ ÚfiÏË„Ë˜. øÛÙfi-ÛÔ, ÔÈ Û˘ÓÂ¯Ò˜ ·˘Í·ÓfiÌÂÓÂ˜ ·Ó¿ÁÎÂ˜, ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ÙÔ˘˜ ÂÚÈÔÚÈÛÌ¤ÓÔ˘˜ ÔÈÎÔÓÔÌÈÎÔ‡˜ fiÚÔ˘˜,ÂÈ‚¿ÏÏÔ˘Ó ÂÚÈÔÚÈÛÌÔ‡˜ ÛÙÈ˜ ·ÔÊ¿ÛÂÈ˜ ¤ÓÙ·Í‹˜ ÙÔ˘˜ ÛÙ· ∂ıÓÈÎ¿ ¶ÚÔÁÚ¿ÌÌ·Ù· ∂Ì‚ÔÏÈ·ÛÌÒÓ. ™ÎÔ-fi˜ ÙË˜ ÂÚÁ·Û›·˜ ·˘Ù‹˜ Â›Ó·È Ó· ·Ó·‰Â›ÍÂÈ ÙË Û˘Ì‚ÔÏ‹ ÙË˜ ÔÈÎÔÓÔÌÈÎ‹˜ ·ÍÈÔÏfiÁËÛË˜ ÛÙË Ï‹„Ë ·ÔÊ¿-ÛÂˆÓ ÛÙÔÓ Â˘·›ÛıËÙÔ ÙÔÌ¤· ÙˆÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ ·ÓÔÛÔÔ›ËÛË˜ Î·È ÂÌ‚ÔÏÈ·ÛÌÔ‡.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ŒÁÈÓÂ Û˘ÛÙËÌ·ÙÈÎ‹ ·Ó·ÛÎfiËÛË ÂÈÛÙËÌÔÓÈÎÒÓ ¿ÚıÚˆÓ Ô˘ ·ÊÔÚÔ‡Ó ÛÂ ÌÂÏ¤ÙÂ˜ÔÈÎÔÓÔÌÈÎ‹˜ ·ÍÈÔÏfiÁËÛË˜ ÙˆÓ Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ÂÌ‚ÔÏ›ˆÓ Î·Ù¿ ÙËÓ ÂÚ›Ô‰Ô 1999-2006. ø˜ ·Ú¯ÈÎ‹ ËÁ‹Â‡ÚÂÛË˜ ¿ÚıÚˆÓ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë ËÏÂÎÙÚÔÓÈÎ‹ ‚È‚ÏÈÔı‹ÎË PubMed.

∞ÔÙÂÏ¤ÛÌ·Ù·: ™ÙÈ˜ ÂÚÈÛÛfiÙÂÚÂ˜ ·ÓÂÙ˘ÁÌ¤ÓÂ˜ ¯ÒÚÂ˜ ‰ËÌÔÛÈÂ‡ÙËÎ·Ó ÌÂÏ¤ÙÂ˜ ÔÈÎÔÓÔÌÈÎ‹˜ ·ÍÈÔÏfiÁËÛË˜ÚÈÓ ·fi ÙË Ï‹„Ë ÙË˜ ·fiÊ·ÛË˜ ÁÈ· ÙËÓ ¤ÓÙ·ÍË ‹ ÌË ÙˆÓ Ó¤ˆÓ ÂÌ‚ÔÏ›ˆÓ ÛÙ· ∂ıÓÈÎ¿ ¶ÚÔÁÚ¿ÌÌ·Ù· ∂Ì‚Ô-ÏÈ·ÛÌÒÓ. ∫·Ù¿ ÙË ‰ÈÂÍ·ÁˆÁ‹ ÙÔ˘˜ ÌÂÏÂÙ‹ıËÎ·Ó fiÏ· Ù· Èı·Ó¿ ÛÂÓ¿ÚÈ· Î·È ÔÈ ·Ú¿ÁÔÓÙÂ˜ Ô˘ ÂËÚÂ¿-˙Ô˘Ó ÙÔ ‰Â›ÎÙË ÎfiÛÙÔ˘˜-·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ ·fi ‰È¿ÊÔÚÂ˜ ·Ó·Ï˘ÙÈÎ¤˜ ÚÔÔÙÈÎ¤˜.

™˘ÌÂÚ¿ÛÌ·Ù·: ∞Ó Î·È ÔÏÏ¤˜ ·fi ÙÈ˜ ÌÂÏ¤ÙÂ˜ ÔÈÎÔÓÔÌÈÎ‹˜ ·ÍÈÔÏfiÁËÛË˜ ‰ÂÓ ‹Ù·Ó ¿ÓÙÔÙÂ ‹ ·ÔÏ‡Ùˆ˜ Â˘-ÓÔ˚Î¤˜ ÁÈ· ÙËÓ ¿ÌÂÛË ¤ÓÙ·ÍË ÙˆÓ ÂÌ‚ÔÏ›ˆÓ ÛÙ· ∂ıÓÈÎ¿ ¶ÚÔÁÚ¿ÌÌ·Ù· ∂Ì‚ÔÏÈ·ÛÌÒÓ, ÂÓ Î·ÈÚÒ, ÔÈ ¯ÒÚÂ˜ÚÔ¤‚ËÎ·Ó ÛÙËÓ ¤ÓÙ·Í‹ ÙÔ˘˜, ·ÊÔ‡ ·ÍÈÔÏfiÁËÛ·Ó ·fi ÎÔÈÓÔ‡ ÙÔ˘˜ ‰Â›ÎÙÂ˜ ÓÔÛËÚfiÙËÙ·˜ Î·È ıÓËÛÈÌfiÙË-Ù·˜, ÙËÓ ·ÓËÛ˘¯›· ÙÔ˘ ÎÔÈÓÔ‡ Î·È ÙÔ ÎÔÈÓˆÓÈÎfi Î·È ÔÈÎÔÓÔÌÈÎfi ÊÔÚÙ›Ô ÙË˜ ÓfiÛÔ˘. √È ÌÂÏ¤ÙÂ˜ ÔÈÎÔÓÔÌÈÎ‹˜·ÍÈÔÏfiÁËÛË˜ Û˘Ó¤‚·Ï·Ó ÛÙËÓ ÙÂÎÌËÚÈˆÌ¤ÓË ·ÔÙ›ÌËÛË ÙˆÓ ‰È·ÊÔÚÂÙÈÎÒÓ ÛÙÚ·ÙËÁÈÎÒÓ ÂÌ‚ÔÏÈ·ÛÌÔ‡.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: √ÈÎÔÓÔÌÈÎ‹ ·ÍÈÔÏfiÁËÛË, ÂÌ‚fiÏÈ·, ·ÓÂÌÂ˘ÏÔÁÈ¿, ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˜ Ù‡Ô˘ C, ÓÂ˘ÌÔÓÈfiÎÔÎÎÔ˜.

Economic evaluation of new vaccines against varicella, serogroup C

meningococcus and pneumococcus

V. Tsiantou1, A. Karokis2, E. Pavi1, G. Kyriopoulos1

Abstract

Background: Vaccines are one of the most important tools for the primary prevention of infectiousdiseases. Decisions on the inclusion of new vaccines in the National Immunization Schedule need toaddress competing priorities, which stem from the lack of health care resources and the growing healthcare needs of the population. The objective of this study is to highlight the importance of economicevaluation in the sensitive field of immunization programs and vaccines.

Methods: A systematic review of papers on the economic evaluation of new vaccines published inscientific journals between 1999 and 2006 was conducted through PubMed.

Results: In the majority of the health care systems of developed countries, ex ante economic evaluationswere published, which evaluated all the possible scenarios and factors influencing the cost-effectivenessratio of the vaccines before their introduction.

Conclusions: Economic evaluations were not always clearly in favour of the introduction of new vaccinesinto the vaccination schedules. However, countries usually adopted the vaccines for inclusion in theNational Immunization Schedules after assessing additional parameters, such as the mortality andmorbidity ratios, the economic and social burden of disease and the anxiety of the population regardingthe risk of infection.

Key words: Economic evaluation, vaccines, varicella, serogroup meningococcus, pneumococcus vaccination.

148 ∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞ ORIGINAL ARTICLE

1 ∆ÔÌ¤·˜ √ÈÎÔÓÔÌÈÎÒÓ ÙË˜ÀÁÂ›·˜, ∂ıÓÈÎ‹ ™¯ÔÏ‹¢ËÌfiÛÈ·˜ ÀÁÂ›·˜

2 ∂Ù·ÈÚÈÎ¤˜ ÀÔı¤ÛÂÈ˜,Wyeth Hellas A.E.B.E.


µ·ÛÈÏÈÎ‹ ∆ÛÈ¿ÓÙÔ˘[email protected]∆ÔÌ¤·˜ √ÈÎÔÓÔÌÈÎÒÓ ÙË˜ÀÁÂ›·˜,∂ıÓÈÎ‹ ™¯ÔÏ‹ ¢ËÌfiÛÈ·˜ÀÁÂ›·˜§ÂˆÊ. ∞ÏÂÍ¿Ó‰Ú·˜ 196∆.∫. 115 21, ∞ı‹Ó·

1 Department of HealthEconomics, NationalSchool of Public Health

2 Corporate Affairs, WyethHellas S.A.

Correspondence:

Vasiliki [email protected] Economics Sector,National School of PublicHealth196, Alexandras Avenue 115 21, Athens, Greece


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ÛËÌ¿ÙˆÓ, Û˘ÓÂÈÛÊ¤ÚÔÓÙ·˜ ıÂÙÈÎ¿ ÛÙË ‰ËÌfiÛÈ·

˘ÁÂ›· Î·È ÙËÓ ÔÈÎÔÓÔÌÈÎ‹ ˙ˆ‹. ∏ ¯ÔÚ‹ÁËÛË ÙˆÓ

ÂÌ‚ÔÏ›ˆÓ Ô‰ËÁÂ› ÛÙË ÌÂ›ˆÛË ‹ ·ÎfiÌ· Î·È ÛÙËÓ


ÂÎÚ›˙ˆÛË ÙˆÓ ÏÔÈÌˆ‰ÒÓ ÓÔÛËÌ¿ÙˆÓ Î·È ÛÙËÓ ÂÍÔÈ-

ÎÔÓfiÌËÛË ÔÈÎÔÓÔÌÈÎÒÓ fiÚˆÓ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈ-

ÛË ÙˆÓ ˘ÁÂÈÔÓÔÌÈÎÒÓ ·Ó·ÁÎÒÓ (1). ∫·Ù¿ Û˘Ó¤ÂÈ·,

ÂÎÙfi˜ ·fi ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Î·È ÙËÓ ·ÛÊ¿-

ÏÂÈ¿ ÙÔ˘˜ ı· Ú¤ÂÈ Ó· ÂÏ¤Á¯ÂÙ·È Î·È Ë ÔÈÎÔÓÔÌÈÎ‹

ÙÔ˘˜ ·Ô‰ÔÙÈÎfiÙËÙ·. ∞˘Ùfi ÂÈÙ˘Á¯¿ÓÂÙ·È ÌÂ ÙÈ˜ ÌÂ-

Ï¤ÙÂ˜ ÔÈÎÔÓÔÌÈÎ‹˜ ·ÍÈÔÏfiÁËÛË˜.

∏ ÔÈÎÔÓÔÌÈÎ‹ ·ÍÈÔÏfiÁËÛË ÛÙËÓ ÂÚ›ÙˆÛË ÙˆÓ

ÚÔÁÚ·ÌÌ¿ÙˆÓ ·ÓÔÛÔÔ›ËÛË˜ ÂÚÈÏ·Ì‚¿ÓÂÈ ¤Ó·

Û‡ÓÔÏÔ ÙÂ¯ÓÈÎÒÓ, ÙÔ ÔÔ›Ô ÂÎÙÈÌ¿ ÙË Û¯ÂÙÈÎ‹ ·Í›·

·˘ÙÒÓ ˆ˜ ÚÔ˜ ÙÔ ÎfiÛÙÔ˜ Î·È ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfi-

ÙËÙ¿ ÙÔ˘˜, Û˘ÁÎÚ›ÓÔÓÙ·˜ ‰È·ÊÔÚÂÙÈÎ¤˜ ÛÙÚ·ÙËÁÈÎ¤˜

·ÓÔÛÔÔ›ËÛË˜, ÌÂÙ·Í‡ ÙˆÓ ÔÔ›ˆÓ Î·È ÂÎÂ›ÓË ÙÔ˘

ÌË ÂÌ‚ÔÏÈ·ÛÌÔ‡ (2,3). ∏ ÔÈÎÔÓÔÌÈÎ‹ ·ÍÈÔÏfiÁËÛË

Û˘Ì‚¿ÏÏÂÈ ÛÙË Ï‹„Ë ÌÈ·˜ ·fiÊ·ÛË˜, fiÙ·Ó Ú¤ÂÈ

Ó· Á›ÓÂÈ ÈÂÚ¿Ú¯ËÛË ÚÔÙÂÚ·ÈÔÙ‹ÙˆÓ (3) Î·È ÂÓÈÛ¯‡-

ÂÈ ÙËÓ ÔÚıÔÏÔÁÈÎ‹ Î·Ù·ÓÔÌ‹ ÙˆÓ ‰È·ı¤ÛÈÌˆÓ Û¿-

ÓÈˆÓ fiÚˆÓ.

√È ÚÒÙÂ˜ ÌÂÏ¤ÙÂ˜ ÔÈÎÔÓÔÌÈÎ‹˜ ·ÍÈÔÏfiÁËÛË˜ ÙˆÓ

ÂÌ‚ÔÏ›ˆÓ ÂÌÊ·Ó›ÛÙËÎ·Ó ÛÙÈ˜ ·Ú¯¤˜ ÙË˜ ‰ÂÎ·ÂÙ›·˜

ÙÔ˘ 1980 (4). ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· Ô ·ÚÈıÌfi˜ ÙÔ˘˜

·˘Í‹ıËÎÂ, Ë ÔÈfiÙËÙ¿ ÙÔ˘˜ ‚ÂÏÙÈÒıËÎÂ Î·È Ù· ÌÂıÔ-

‰ÔÏÔÁÈÎ¿ ÚÔ‚Ï‹Ì·Ù· ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó Ì¤Ûˆ ÙË˜

¤Î‰ÔÛË˜ Î·ÙÂ˘ı˘ÓÙ‹ÚÈˆÓ Ô‰ËÁÈÒÓ (guidelines). ∆Â-

ÏÈÎ¿, Ë Ê·ÚÌ·ÎÔÔÈÎÔÓÔÌÈÎ‹ ·ÍÈÔÏfiÁËÛË ÂÓÙ¿¯ıËÎÂ

ÛÙË ‰È·‰ÈÎ·Û›· Ï‹„Ë˜ ·ÔÊ¿ÛÂˆÓ ÙˆÓ Û˘ÛÙËÌ¿ÙˆÓ

˘ÁÂ›·˜ ÔÏÏÒÓ ·ÓÂÙ˘ÁÌ¤ÓˆÓ ¯ˆÚÒÓ.

√ ÙÔÌ¤·˜ ÙˆÓ ÂÌ‚ÔÏ›ˆÓ Â›Ó·È È‰È·›ÙÂÚ· Â˘·›ÛıË-

ÙÔ˜ ‰ÈfiÙÈ ·Ó·Ê¤ÚÂÙ·È ÛÙËÓ ÚfiÏË„Ë ÙˆÓ ÓÔÛËÌ¿-

ÙˆÓ Î·È Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÌÈ·˜ Ù¤ÙÔÈ·˜ ·Ú¤Ì‚·ÛË˜

‰ÂÓ Â›Ó·È ¿ÌÂÛ· ÔÚ·Ù¿. ∂ÈÏ¤ÔÓ, ÔÏÏ¿ ·fi Ù· Ó¤·

ÂÌ‚fiÏÈ· ·ÊÔÚÔ‡Ó ·Ûı¤ÓÂÈÂ˜ ÔÈ ÔÔ›Â˜ ‰ÂÓ ¤¯Ô˘Ó

·˘ÍËÌ¤ÓË ıÓËÙfiÙËÙ·, ·ÏÏ¿ ÛËÌ·ÓÙÈÎ‹ ÓÔÛËÚfiÙËÙ·

ÛÙÔÓ ÏËı˘ÛÌfi, ÌÂ ·ÔÙ¤ÏÂÛÌ· Ë ¯ÚËÛÈÌfiÙËÙ¿

ÙÔ˘˜ Î·È Ë Û˘Ì‚ÔÏ‹ ÙÔ˘˜ ÛÙË ‚ÂÏÙ›ˆÛË ÙË˜ ˘ÁÂ›·˜

ÙÔ˘ ÏËı˘ÛÌÔ‡ Û˘¯Ó¿ Ó· ˘ÔÙÈÌ¿Ù·È ‹ Î·È Ó· ·ÌÊÈ-

Û‚ËÙÂ›Ù·È (4,5).

™ÎÔfi˜ ÙË˜ ÂÚÁ·Û›·˜ ·˘Ù‹˜ Â›Ó·È Ó· ·Ó·‰Â›ÍÂÈ ÙË

ÛËÌ·Û›· ÙË˜ ÔÈÎÔÓÔÌÈÎ‹˜ ·ÍÈÔÏfiÁËÛË˜ ÛÙË Ï‹„Ë

·ÔÊ¿ÛÂˆÓ ÛÙÔÓ Â˘·›ÛıËÙÔ ÙÔÌ¤· ÙˆÓ ÚÔÁÚ·ÌÌ¿-

ÙˆÓ ·ÓÔÛÔÔ›ËÛË˜, ÌÂÏÂÙÒÓÙ·˜ Ù· Ó¤· ÂÌ‚fiÏÈ· Î·-

Ù¿ ÙË˜ ·ÓÂÌÂ˘ÏÔÁÈ¿˜, ÙÔ˘ ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˘ Ù‡Ô˘

C Î·È ÙÔ˘ ÓÂ˘ÌÔÓÈfiÎÔÎÎÔ˘, ÁÈ·Ù› ·˘Ù¿ ·ÂÈÎÔÓ›-

˙Ô˘Ó Î·Ï‡ÙÂÚ· ÙÔ ‰›ÏËÌÌ· Ô˘ ·ÓÙÈÌÂÙˆ›˙Ô˘Ó ÔÈ

˘Â‡ı˘ÓÔÈ Î·Ù¿ ÙË Ï‹„Ë ·ÔÊ¿ÛÂˆÓ ÁÈ· ÙËÓ Î·Ù·-

ÓÔÌ‹ ÙˆÓ fiÚˆÓ. ∆· ÂÌ‚fiÏÈ· ·˘Ù¿ ÚfiÛÊ·Ù· ÂÓÙ¿-

¯ıËÎ·Ó ÛÙÔ ∂ıÓÈÎfi ¶ÚfiÁÚ·ÌÌ· ∂Ì‚ÔÏÈ·ÛÌÒÓ ÙË˜

∂ÏÏ¿‰·˜. ∏ ˘„ËÏ‹ ÙÈÌ‹ ÙˆÓ ÂÌ‚ÔÏ›ˆÓ ÛÂ Û˘Ó‰˘·-

ÛÌfi ÌÂ ÙËÓ ·Ó¿ÁÎË ¤ÓÙ·Í‹˜ ÙÔ˘˜ ÛÙÔ ¶ÚfiÁÚ·ÌÌ·

∂Ì‚ÔÏÈ·ÛÌÒÓ ÁÈ· ÙËÓ ÂÈÙ˘¯‹ ¿ÛÎËÛË ÂÌ‚ÔÏÈ·ÛÙÈ-

Î‹˜ ÔÏÈÙÈÎ‹˜ Â›Ó·È ÌÂÚÈÎ¿ ·fi Ù· È‰È·›ÙÂÚ· ¯·Ú·-

ÎÙËÚÈÛÙÈÎ¿ Ô˘ ÂÚÈÏ¤ÎÔ˘Ó ·ÎfiÌ· ÂÚÈÛÛfiÙÂÚÔ ÙË

‰È·‰ÈÎ·Û›· Ï‹„Ë˜ ·ÔÊ¿ÛÂˆÓ.


ÃÚËÛÈÌÔÔÈ‹ıËÎÂ Ë Ì¤ıÔ‰Ô˜ ÙË˜ ·Ó·ÛÎfiËÛË˜ ÂÈÛÙË-

ÌÔÓÈÎÒÓ ¿ÚıÚˆÓ ÌÂ ÙË ¯Ú‹ÛË ÙË˜ ÌË¯·Ó‹˜ ·Ó·˙‹ÙËÛË˜ ÙË˜

ËÏÂÎÙÚÔÓÈÎ‹˜ ‚È‚ÏÈÔı‹ÎË˜ PubMed (www.pubmed.com). ø˜

Ï¤ÍÂÈ˜ ÎÏÂÈ‰È¿ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÔÈ fiÚÔÈ: economic evalua-

tion, vaccines, pharmacoeconomic studies, cost-effectiveness

of vaccines, varicella vaccine, meningococcal vaccine,

pneumococcus vaccine Î·È Û˘Ó‰˘·ÛÌfi˜ ·˘ÙÒÓ. ∂ÈÏ¤¯ÙËÎ·Ó

Ù· ¿ÚıÚ· Ô˘ ·ÊÔÚÔ‡Û·Ó ÔÈÎÔÓÔÌÈÎ¤˜ ·ÍÈÔÏÔÁ‹ÛÂÈ˜ ÙˆÓ

ÚÔ·Ó·ÊÂÚı¤ÓÙˆÓ ÂÌ‚ÔÏ›ˆÓ. ∆· ¿ÚıÚ· Ô˘ ·ÓÙÏ‹ıËÎ·Ó

·ÊÔÚÔ‡Û·Ó ÙËÓ ÂÚ›Ô‰Ô 1999-2006 Î·È Ë ÁÏÒÛÛ· Û˘ÁÁÚ·Ê‹˜

‹Ù·Ó Ë ·ÁÁÏÈÎ‹.

∂ÈÏ¤ÔÓ, Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ ‚È‚ÏÈÔÁÚ·ÊÈÎ‹ ·Ó·˙‹ÙËÛË

‰ËÌÔÛÈÂ‡ÛÂˆÓ ÛÙ· ÂÈÛÙËÌÔÓÈÎ¿ ÂÚÈÔ‰ÈÎ¿ Ù· ÔÔ›· Î·ÙÂ-

ÍÔ¯‹Ó ·Û¯ÔÏÔ‡ÓÙ·È ÌÂ ÙÔ ı¤Ì· ÙË˜ ÔÈÎÔÓÔÌÈÎ‹˜ ·ÍÈÔÏfiÁËÛË˜

Î·È ÙˆÓ ÂÌ‚ÔÏ›ˆÓ, fiˆ˜ Ù·: Vaccines, The Lancet, Journal of

Infectious Diseases, Health Economics, Pharmacoeconomics

Î·È Pediatrics.

√ÈÎÔÓÔÌÈÎ‹ ·ÍÈÔÏfiÁËÛË ÙˆÓ ÂÌ‚ÔÏ›ˆÓ

ªÂ ÙÔÓ fiÚÔ ÔÈÎÔÓÔÌÈÎ‹ ·ÍÈÔÏfiÁËÛË (economic evaluation)

ÔÚ›˙ÂÙ·È Ë Û˘ÁÎÚÈÙÈÎ‹ ·ÔÙ›ÌËÛË ÂÓ·ÏÏ·ÎÙÈÎÒÓ ıÂÚ·Â˘ÙÈ-

ÎÒÓ ‹ ÚÔÏËÙÈÎÒÓ ·ÚÂÌ‚¿ÛÂˆÓ ˆ˜ ÚÔ˜ ÙÔ ÎfiÛÙÔ˜ Î·È Ù·

·ÔÙÂÏ¤ÛÌ·Ù¿ ÙÔ˘˜ (6). ™ÎÔfi˜ ÙË˜ Â›Ó·È Ó· ÂÓÙÔ›ÛÂÈ, Ó· ÌÂ-

ÙÚ‹ÛÂÈ Î·È Ó· ÂÎÙÈÌ‹ÛÂÈ ÙÔ ÎfiÛÙÔ˜ Î·È Ù· ÔÊ¤ÏË Ô˘ ÚÔÎ‡-

ÙÔ˘Ó ·fi ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ÂÎ¿ÛÙÔÙÂ ÚÔÁÚ¿ÌÌ·ÙÔ˜. ¢Â›-

¯ÓÂÈ, ¤ÙÛÈ, ÔÈÔ ÚfiÁÚ·ÌÌ· ÚÔÛÊ¤ÚÂÈ ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ‰˘Ó·Ùfi

fiÊÂÏÔ˜ ÌÂ ÙÔ ÌÈÎÚfiÙÂÚÔ ‰˘Ó·Ùfi ÎfiÛÙÔ˜. ∏ ∂ÈÎfiÓ· 1 ‰Â›¯ÓÂÈ Ù·

Èı·Ó¿ ÛÂÓ¿ÚÈ· ÙË˜ Û¯¤ÛË˜ ÎfiÛÙÔ˘˜-·ÔÙÂÏ¤ÛÌ·ÙÔ˜ ÛÂ ÌÈ·

Ó¤· ·Ú¤Ì‚·ÛË ˘ÁÂ›·˜ Î·È ÙÈ˜ ·ÓÙ›ÛÙÔÈ¯Â˜ ·ÔÊ¿ÛÂÈ˜.

∫·Ù¿ ÙË ‰ÈÂÍ·ÁˆÁ‹ ÙˆÓ ÌÂÏÂÙÒÓ ÔÈÎÔÓÔÌÈÎ‹˜ ·ÍÈÔÏfiÁË-

ÛË˜ ÙˆÓ ÂÌ‚ÔÏ›ˆÓ, ÙÔ ÎfiÛÙÔ˜ ‰È·ÎÚ›ÓÂÙ·È ÛÂ ÙÚÂÈ˜ Î·ÙËÁÔ-

Ú›Â˜. ∆Ô ¿ÌÂÛÔ È·ÙÚÈÎfi ÎfiÛÙÔ˜ ·ÊÔÚ¿ ‰·¿ÓÂ˜ ÙÔ˘ Û˘ÛÙ‹Ì·-

ÙÔ˜ ˘ÁÂ›·˜ Ô˘ Â›Ó·È Û¯ÂÙÈÎ¤˜ ÌÂ ÙËÓ ·Ûı¤ÓÂÈ· (Ê¿ÚÌ·Î·,

ÂÍÂÙ¿ÛÂÈ˜, Î.Ù.Ï.) ‹ ÌÂ ÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi, fiˆ˜ Â›Ó·È Ë ÙÈÌ‹

·ÁÔÚ¿˜ ÙÔ˘ ÂÌ‚ÔÏ›Ô˘, ÔÈ ‰·¿ÓÂ˜ ¯ÔÚ‹ÁËÛË˜ Î·È Ë ·ÓÙÈÌÂÙÒ-

ÈÛË ÙˆÓ Èı·ÓÒÓ ·ÚÂÓÂÚÁÂÈÒÓ. ∆Ô ¿ÌÂÛÔ ÌË È·ÙÚÈÎfi Îfi-

ÛÙÔ˜ ·ÊÔÚ¿ È‰ÈˆÙÈÎ¤˜ ÏËÚˆÌ¤˜ Î·È Ù· ¤ÍÔ‰· ÌÂÙ·Î›ÓËÛË˜

ÙÔ˘ ·ÛıÂÓ‹ ÚÔ˜ Î·È ·fi ÙÔ ÓÔÛÔÎÔÌÂ›Ô. √È ‰·¿ÓÂ˜ ·˘Ù‹˜

ÙË˜ Î·ÙËÁÔÚ›·˜ ·ÔÙÂÏÔ‡Ó ÎfiÛÙÔ˜ ÌfiÓÔ ÁÈ· ÙÔÓ ›‰ÈÔ ÙÔÓ

·ÛıÂÓ‹ Î·È ÙËÓ ÔÈÎÔÁ¤ÓÂÈ¿ ÙÔ˘. ∆Ô ¤ÌÌÂÛÔ ÎfiÛÙÔ˜ ·Ó·Ê¤ÚÂ-

Ù·È ÛÙËÓ ·ÒÏÂÈ· ·Ú·ÁˆÁÈÎfiÙËÙ·˜ ÏfiÁˆ ·Ô˘Û›·˜ ‹ ÌÂÈˆ-

Ì¤ÓË˜ ÈÎ·ÓfiÙËÙ·˜ ÂÍ·ÈÙ›·˜ ÙË˜ ·Ûı¤ÓÂÈ·˜ Î·È ÛÙËÓ ·ÒÏÂÈ·

∞¶√∆∂§∂™ª∞¶ÂÚÈÔ¯‹ ∞∏ ·Ú¤Ì‚·ÛË Ô‰ËÁÂ› ÛÂ ∏ ·Ú¤Ì‚·ÛË Ô‰ËÁÂ› ÛÂ Î·Ï‡ÙÂÚ· ·ÔÙÂÏ¤ÛÌ·Ù· Î·Ï‡ÙÂÚ· ·ÔÙÂÏ¤ÛÌ·Ù· ÌÂÌÂ ÌÈÎÚfiÙÂÚÔ ÎfiÛÙÔ˜. ÌÂÁ·Ï‡ÙÂÚÔ ÎfiÛÙÔ˜.°›ÓÂÙ·È ‰ÂÎÙ‹ ∏ ·fiÊ·ÛË ‰ÂÓ Â›Ó·È

ÍÂÎ¿ı·ÚË

∏ ·Ú¤Ì‚·ÛË Ô‰ËÁÂ› ÛÂ ¶ÂÚÈÔ¯‹ µ¯ÂÈÚfiÙÂÚ· ·ÔÙÂÏ¤ÛÌ·Ù· ∏ ·Ú¤Ì‚·ÛË Ô‰ËÁÂ› ÛÂ ÌÂ ÌÈÎÚfiÙÂÚÔ ÎfiÛÙÔ˜. ¯ÂÈÚfiÙÂÚ· ·ÔÙÂÏ¤ÛÌ·Ù· ∏ ·fiÊ·ÛË ‰ÂÓ Â›Ó·È ÌÂ ÌÂÁ·Ï‡ÙÂÚÔ ÎfiÛÙÔ˜.ÍÂÎ¿ı·ÚË. ∞ÔÚÚ›ÙÂÙ·È

∂ÈÎfiÓ· 1. ™ÂÓ¿ÚÈ· ÎfiÛÙÔ˘˜-·ÔÙÂÏ¤ÛÌ·ÙÔ˜ ÌÈ·˜ Ó¤·˜ ·Ú¤Ì-‚·ÛË˜ ˘ÁÂ›·˜ Î·È ÔÈ ·ÓÙ›ÛÙÔÈ¯Â˜ ·ÔÊ¿ÛÂÈ˜.

+

∫√™∆√™

+

149√ÈÎÔÓÔÌÈÎ‹ ·ÍÈÔÏfiÁËÛË Ó¤ˆÓ ÂÌ‚ÔÏ›ˆÓ

¶·È‰È·ÙÚÈÎ‹ 2008;71:148-156


·Ú·ÁˆÁÈÎfiÙËÙ·˜, ¯ÚfiÓÔ˘ Î·È ÂÈÛÔ‰‹Ì·ÙÔ˜ ÙˆÓ Û˘ÁÁÂÓÒÓ

Î·È Ê›ÏˆÓ ÚÔÎÂÈÌ¤ÓÔ˘ Ó· ÊÚÔÓÙ›ÛÔ˘Ó ÙÔÓ ·ÛıÂÓ‹ (2,3). ∆Ô

¤ÌÌÂÛÔ ÎfiÛÙÔ˜ ıÂˆÚÂ›Ù·È Î·È ÎÔÈÓˆÓÈÎfi ÎfiÛÙÔ˜, Î·ıÒ˜ ·Ó·-

Ê¤ÚÂÙ·È ÛÂ ÔÈÎÔÓÔÌÈÎ¤˜ ·ÒÏÂÈÂ˜ ÙË˜ ÎÔÈÓˆÓ›·˜.

∏ ÚÔÔÙÈÎ‹ ÙË˜ ÌÂÏ¤ÙË˜ Î·ıÔÚ›˙ÂÈ ÔÈÂ˜ ‰·¿ÓÂ˜ ı·

ÂÚÈÏËÊıÔ‡Ó ÛÂ ÌÈ· ÌÂÏ¤ÙË Î·È ı· ·Ó·Ï˘ıÔ‡Ó (2,6). ∏ ÎÔÈ-

ÓˆÓÈÎ‹ ÚÔÔÙÈÎ‹ ÂÚÈÏ·Ì‚¿ÓÂÈ fiÏÂ˜ ÙÈ˜ Î·ÙËÁÔÚ›Â˜ Îfi-

ÛÙÔ˘˜ Î·È Û˘Ó˘ÔÏÔÁ›˙ÂÈ fiÏ· Ù· ÔÊ¤ÏË, ÂÓÒ ·Ú¿ÏÏËÏ·

ıÂˆÚÂ›Ù·È Î·Ù·ÏÏËÏfiÙÂÚË ÁÈ· ÙËÓ ÔÈÎÔÓÔÌÈÎ‹ ·ÍÈÔÏfiÁËÛË

ÙˆÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ ·ÓÔÛÔÔ›ËÛË˜ ÏfiÁˆ ÙË˜ Û˘ÏÏÔÁÈÎ‹˜

·ÓÔÛ›·˜, Ë ÔÔ›· ¤¯ÂÈ ıÂÙÈÎ¤˜ ÂÈÙÒÛÂÈ˜ ÛÂ fiÏÔ ÙÔÓ ÏË-

ı˘ÛÌfi (7,8).

√È ÙÂ¯ÓÈÎ¤˜ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÁÈ· ÙËÓ ÔÈÎÔÓÔÌÈÎ‹

·ÍÈÔÏfiÁËÛË ÙˆÓ ÂÌ‚ÔÏ›ˆÓ Â›Ó·È ÔÈ ·ÎfiÏÔ˘ıÂ˜ (1-3,7-9):

1. ∞Ó¿Ï˘ÛË ÂÏ·¯ÈÛÙÔÔ›ËÛË˜ ÎfiÛÙÔ˘˜. √È ÂÓ·ÏÏ·ÎÙÈÎ¤˜

ÛÙÚ·ÙËÁÈÎ¤˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Û˘ÁÎÚ›ÓÔÓÙ·È ÌfiÓÔ ˆ˜ ÚÔ˜ ÙÔ Îfi-

ÛÙÔ˜, ÂÊfiÛÔÓ ¤¯Ô˘Ó ·Ô‰Â‰ÂÈÁÌ¤Ó· ›‰È· ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙË-

Ù·, ÒÛÙÂ Ó· ÂÈÏÂÁÂ› Ë ÊıËÓfiÙÂÚË ·fi ·˘Ù¤˜.

2. ∞Ó¿Ï˘ÛË ÎfiÛÙÔ˘˜-ÔÊ¤ÏÔ˘˜. ∞ÔÙÈÌ¿ ÙfiÛÔ ÙÔ ÎfiÛÙÔ˜

fiÛÔ Î·È Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÙˆÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ ÂÌ‚ÔÏÈ·ÛÌÔ‡

ÛÂ ÓÔÌÈÛÌ·ÙÈÎ¤˜ ÌÔÓ¿‰Â˜ Î·È ·ÍÈÔÏÔÁÂ› ·Ó ÌÈ· ·Ú¤Ì‚·ÛË

˘ÁÂ›·˜ ·Í›˙ÂÈ Ó· ¯ÚËÌ·ÙÔ‰ÔÙËıÂ›.

3. ∞Ó¿Ï˘ÛË ÎfiÛÙÔ˘˜-·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜. ∂›Ó·È Ë

Û˘¯ÓfiÙÂÚ· ÂÊ·ÚÌÔ˙fiÌÂÓË ÙÂ¯ÓÈÎ‹, fiÔ˘ ÙÔ ÎfiÛÙÔ˜ ·ÔÙÈÌ¿-

Ù·È ÛÂ ÓÔÌÈÛÌ·ÙÈÎ¤˜ ÌÔÓ¿‰Â˜ Î·È Ù· ÔÊ¤ÏË ÛÂ Ê˘ÛÈÎ¤˜ ÌÔÓ¿-

‰Â˜ ·Ú·ÁfiÌÂÓÔ˘ ¤ÚÁÔ˘, fiˆ˜ ¤ÙË ˙ˆ‹˜ Ô˘ ÛÒ˙ÔÓÙ·È ‹ Â-

ÚÈÛÙ·ÙÈÎ¿ Ô˘ ·ÔÙÚ¤ÔÓÙ·È.

4. ∞Ó¿Ï˘ÛË ÎfiÛÙÔ˘˜-¯ÚËÛÈÌfiÙËÙ·˜. ∂‰Ò ÙÔ fiÊÂÏÔ˜ ÌÂ-

ÙÚ¿Ù·È ˆ˜ Û˘Ó‰˘·ÛÌfi˜ ·Ú¿Ù·ÛË˜ ÙË˜ ÂÈ‚›ˆÛË˜ Î·È ‚ÂÏÙ›ˆ-

ÛË˜ ÙË˜ ÔÈfiÙËÙ·˜ ˙ˆ‹˜. ∞˘Ù‹ Ë ÚÔÛ¤ÁÁÈÛË Â›Ó·È È‰È·›ÙÂÚ·

¯Ú‹ÛÈÌË ÁÈ· ÙÈ˜ ·ÚÂÌ‚¿ÛÂÈ˜ ˘ÁÂ›·˜ Ô˘ ·Ú¿ÁÔ˘Ó ÔÊ¤ÏË fi¯È

ÌfiÓÔ fiÛÔÓ ·ÊÔÚ¿ ÙË ıÓËÛÈÌfiÙËÙ·, ·ÏÏ¿ Î·È ÙË ÓÔÛËÚfiÙËÙ·.

√ÈÎÔÓÔÌÈÎ‹ ·ÍÈÔÏfiÁËÛË ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ ÙÔ˘ ÌËÓÈÁÁÈÙÈ‰fi-

ÎÔÎÎÔ˘ Ù‡Ô˘ C

∏ ÌËÓÈÁÁ›ÙÈ‰· Â›Ó·È ÌÈ· ÊÏÂÁÌÔÓ‹ ÙˆÓ ÌËÓ›ÁÁˆÓ Ô˘ Â-

ÚÈÎÏÂ›Ô˘Ó ÙÔÓ ÂÁÎ¤Ê·ÏÔ Î·È ÙÔ ÓˆÙÈ·›Ô Ì˘ÂÏfi, Ë ÔÔ›· Û˘Ó‹-

ıˆ˜ ÚÔÎ·ÏÂ›Ù·È ·fi ‚·ÎÙ‹ÚÈ· ‹ ÈÔ‡˜. ¶¤ÓÙÂ ÔÚfiÙ˘ÔÈ ÙÔ˘

‚·ÎÙËÚ›Ô˘ Neisseria meningitidis (A, B, C, Y Î·È W-135) ÚÔ-

Î·ÏÔ‡Ó ÂÚÈÛÛfiÙÂÚ· ·fi ÙÔ 90% ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ ÌËÓÈÁÁ›ÙÈ-

‰·˜ ·ÁÎÔÛÌ›ˆ˜ (10). ™‡ÌÊˆÓ· ÌÂ ÙÔÓ ¶·ÁÎfiÛÌÈÔ √ÚÁ·ÓÈ-

ÛÌfi ÀÁÂ›·˜ (¶√À), ÔÈ Ù‡ÔÈ ∞ Î·È C Â›Ó·È ÔÈ Î‡ÚÈÂ˜ ·ÈÙ›Â˜ ÙË˜

ÂÈ‰ËÌÈÎ‹˜ ÌËÓÈÁÁ›ÙÈ‰·˜. ÃˆÚ›˜ ıÂÚ·Â˘ÙÈÎ‹ ·ÁˆÁ‹, ÂÚÈÛ-

ÛfiÙÂÚ· ·fi ÙÔ 50% ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ Î·Ù·Ï‹ÁÔ˘Ó ÛÂ ı¿Ó·ÙÔ.

∞ÎfiÌ· fiÌˆ˜ Î·È ÌÂ ¤ÁÎ·ÈÚË ‰È¿ÁÓˆÛË Î·È Î·Ù¿ÏÏËÏË ıÂÚ·-

Â˘ÙÈÎ‹ ·ÁˆÁ‹, ÂÚ›Ô˘ 5-10% ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ Î·Ù·Ï‹-

ÁÔ˘Ó ÛÂ ı¿Ó·ÙÔ, ÂÓÒ ÂÚ›Ô˘ ÙÔ 15-20% fiÛˆÓ ÂÈ‚ÈÒÓÔ˘Ó

˘ÔÊ¤ÚÔ˘Ó ·fi ÓÂ˘ÚÔÏÔÁÈÎ¤˜ ‰È·Ù·Ú·¯¤˜, fiˆ˜ ÎÒÊˆÛË

Î·È ÓÂ˘Ì·ÙÈÎ‹ Î·ı˘ÛÙ¤ÚËÛË. ∆Ô Ó¤Ô Û˘˙Â˘ÁÌ¤ÓÔ ÂÌ‚fiÏÈÔ

Î·Ù¿ ÙÔ˘ ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˘ Ù‡Ô˘ C, ÚÔÛÊ¤ÚÂÈ ÚÔÛÙ·Û›·

ÌfiÓÔ ¤Ó·ÓÙÈ ·˘ÙÔ‡ ÙÔ˘ Ù‡Ô˘ (11,12). ™ÙËÓ ∂ÏÏ¿‰·, Ë Î˘ÎÏÔ-

ÊÔÚ›· ÙÔ˘ ÂÁÎÚ›ıËÎÂ ÙÔ ™ÂÙ¤Ì‚ÚÈÔ ÙÔ˘ 2000, ÌÂ ‰ÂÛÌÂ‡ÛÂÈ˜

ÁÈ· ‰ÈÂÚÂ‡ÓËÛË ÙË˜ ·Ó·ÁÎ·ÈfiÙËÙ·˜ ·Ó·ÌÓËÛÙÈÎÔ‡ ÂÌ‚ÔÏÈ·-

ÛÌÔ‡ Î·È ÁÈ· Û˘ÛÙËÌ·ÙÈÎ‹ ˘Ô‚ÔÏ‹ ÛÙÔÈ¯Â›ˆÓ ·Ó·ÊÔÚÈÎ¿ ÌÂ

ÙÈ˜ ·ÓÂÈı‡ÌËÙÂ˜ ÂÓ¤ÚÁÂÈÂ˜ (13).

™ÙÔÓ ¶›Ó·Î· 1 ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ù· ‚·ÛÈÎ¿ ÛÙÔÈ¯Â›· ÙˆÓ

ÔÈÎÔÓÔÌÈÎÒÓ ·ÍÈÔÏÔÁ‹ÛÂˆÓ ÙÔ˘ Û˘ÁÎÂÎÚÈÌ¤ÓÔ˘ ÂÌ‚ÔÏ›Ô˘. ∏

ÙÂ¯ÓÈÎ‹ ÔÈÎÔÓÔÌÈÎ‹˜ ·ÍÈÔÏfiÁËÛË˜ Ô˘ Î˘Ú›ˆ˜ ¯ÚËÛÈÌÔÔÈ‹-

ıËÎÂ ‹Ù·Ó Ë ·Ó¿Ï˘ÛË ÎfiÛÙÔ˘˜-·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ Î·È Ë

·Ó¿Ï˘ÛË Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ ˘fi ÙËÓ ÚÔÔÙÈÎ‹ ÙË˜ ÎÔÈÓˆ-

Ó›·˜ Î·È ÙˆÓ ·ÛÊ·ÏÈÛÙÈÎÒÓ Ù·ÌÂ›ˆÓ. √È Û˘ÁÎÚÈÓfiÌÂÓÂ˜ ÛÙÚ·-

ÙËÁÈÎ¤˜ ·ÓÔÛÔÔ›ËÛË˜ ‹Ù·Ó ÛÂ ÁÂÓÈÎ¤˜ ÁÚ·ÌÌ¤˜ ›‰ÈÂ˜ ÛÂ fiÏÂ˜

ÙÈ˜ ¯ÒÚÂ˜ Ô˘ ‰ÈÂÓ‹ÚÁËÛ·Ó Ù¤ÙÔÈÂ˜ ÌÂÏ¤ÙÂ˜ Î·È ·ÊÔÚÔ‡Û·Ó

Î˘Ú›ˆ˜, ÂÓ·ÏÏ·ÎÙÈÎ¤˜ ÂÈÏÔÁ¤˜ Û¯ÂÙÈÎ¿ ÌÂ ÙÔÓ ·ÚÈıÌfi ÙˆÓ

¯ÔÚËÁÔ‡ÌÂÓˆÓ ‰fiÛÂˆÓ. £· Ú¤ÂÈ Ó· ÛËÌÂÈˆıÂ› fiÙÈ, ÂÓÒ ÛÂ

ÔÏÏ¤˜ ÂÚÈÙÒÛÂÈ˜ Ë ÔÈÎÔÓÔÌÈÎ‹ ·ÍÈÔÏfiÁËÛË Ô‰ËÁÔ‡ÛÂ ÛÂ

ÂÈÏÔÁ¤˜ ÚÔÁÚ·ÌÌ¿ÙˆÓ Ì›·˜ ‰fiÛË˜, Ù· ÎÏÈÓÈÎ¿ ‰Â‰ÔÌ¤Ó·

Â¤‚·ÏÏ·Ó ÙËÓ ˘ÈÔı¤ÙËÛË ÛÙÚ·ÙËÁÈÎÒÓ 2 Û˘Ó 1 ‰fiÛÂˆÓ ÛÙ·

ÂÚÈÛÛfiÙÂÚ· Û˘ÛÙ‹Ì·Ù· ˘ÁÂ›·˜.

√ÈÎÔÓÔÌÈÎ‹ ·ÍÈÔÏfiÁËÛË ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ ÙÔ˘

ÓÂ˘ÌÔÓÈfiÎÔÎÎÔ˘

ªÂ ÙÔÓ fiÚÔ ÓÂ˘ÌÔÓÈÔÎÔÎÎÈÎ‹ ÓfiÛÔ˜ ÔÚ›˙ÂÙ·È ÌÈ· ÔÌ¿‰·

ÓÔÛËÌ¿ÙˆÓ Ô˘ ÚÔÎ·ÏÔ‡ÓÙ·È ·fi ÙÔ ‚·ÎÙ‹ÚÈÔ Streptococcus

pneumoniae. ™Ù· ÓÔÛ‹Ì·Ù· ·˘Ù¿ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ‰ÈÂÈÛ‰˘ÙÈ-

Î¤˜ ÏÔÈÌÒÍÂÈ˜, fiˆ˜ ‚·ÎÙËÚÈ·ÈÌ›·, ÌËÓÈÁÁ›ÙÈ‰· Î·È ‚·ÎÙËÚÈ-

·ÈÌÈÎ‹ ÓÂ˘ÌÔÓ›·. √ ÓÂ˘ÌÔÓÈfiÎÔÎÎÔ˜ ÚÔÎ·ÏÂ› Â›ÛË˜ ÌË

‰ÈÂÈÛ‰˘ÙÈÎ¤˜ ÓÂ˘ÌÔÓÈÔÎÔÎÎÈÎ¤˜ ·Ûı¤ÓÂÈÂ˜, fiˆ˜ Ë Ì¤ÛË

ˆÙ›ÙÈ‰· (10). √ ÓÂ˘ÌÔÓÈfiÎÔÎÎÔ˜ Â›Ó·È Î‡ÚÈ· ·ÈÙ›· ÓÔÛËÚfi-

ÙËÙ·˜ Î·È ıÓËÛÈÌfiÙËÙ·˜ ·ÁÎÔÛÌ›ˆ˜ Î·È Â˘ı‡ÓÂÙ·È ÁÈ· Â-

ÚÈÛÛfiÙÂÚÔ˘˜ ·fi 1 ÂÎ·ÙÔÌÌ‡ÚÈÔ ı·Ó¿ÙÔ˘˜ ÛÂ ‚Ú¤ÊË Î·È ·È-

‰È¿ Î¿Ùˆ ÙˆÓ 2 ÂÙÒÓ (18).

™ÙËÓ ∂ÏÏ¿‰·, Ë Â›ÙˆÛË ÙË˜ ÓÂ˘ÌÔÓÈÔÎÔÎÎÈÎ‹˜ ÓfiÛÔ˘

ÛÂ ·È‰È¿ Î¿Ùˆ ÙˆÓ 5 ÂÙÒÓ Â›Ó·È 43-100 ·Ó¿ 100.000 ·È‰È¿,

ÔÛÔÛÙfi ˘„ËÏfiÙÂÚÔ ·fi ¿ÏÏÂ˜ Â˘Úˆ·˚Î¤˜ ¯ÒÚÂ˜. ∆· ·Ô-

ÙÂÏ¤ÛÌ·Ù· ÌÈ·˜ ·ÓÂÏÏ‹ÓÈ·˜ ÌÂÏ¤ÙË˜ ¤‰ÂÈÍ·Ó fiÙÈ ÛÙ· ·È‰È¿

ÌÈÎÚfiÙÂÚ· ÙˆÓ 2 ÂÙÒÓ, 88% ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ ÓÂ˘ÌÔÓÈÔÎÔÎ-

ÎÈÎ‹˜ ÓfiÛÔ˘ ÚÔÎ·ÏÔ‡ÓÙ·È ·fi ÙÔ˘˜ ÔÚfiÙ˘Ô˘˜ Ô˘ ÂÚÈ-

Ï·Ì‚¿ÓÔÓÙ·È ÛÙÔ ÂÌ‚fiÏÈÔ. ∂ÓÒ ÁÈ· Ù· ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿, ÙÔ

ÔÛÔÛÙfi ·˘Ùfi ÌÂÈÒÓÂÙ·È ÛÙÔ 50% (19). ∂ÈÏ¤ÔÓ, ÙÔ ÂÌ‚fiÏÈÔ

ÚÔÛÙ·ÙÂ‡ÂÈ ¤Ó·ÓÙÈ ÙË˜ ÔÍÂ›·˜ Ì¤ÛË˜ ˆÙ›ÙÈ‰·˜ Î·È ÙË˜ ÓÂ˘-

ÌÔÓ›·˜ Ô˘ ÔÊÂ›ÏÔÓÙ·È ÛÙÔ˘˜ ÔÚfiÙ˘Ô˘˜, ÔÈ ÔÔ›ÔÈ ÂÚÈ¤¯Ô-

ÓÙ·È ÛÙÔ ÂÌ‚fiÏÈÔ.

™ÙÔÓ ¶›Ó·Î· 2 ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ù· ‚·ÛÈÎ¿ ÛÙÔÈ¯Â›· ÙˆÓ

ÌÂÏÂÙÒÓ ÔÈÎÔÓÔÌÈÎ‹˜ ·ÍÈÔÏfiÁËÛË˜ ÁÈ· ÙÔ ÂÌ‚fiÏÈÔ ÙÔ˘ ÓÂ˘-

ÌÔÓÈfiÎÔÎÎÔ˘. ∏ ·Ó¿Ï˘ÛË ÎfiÛÙÔ˘˜-·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜

Î·È Ë ÎÔÈÓˆÓÈÎ‹ ÚÔÔÙÈÎ‹ ÙË˜ ·Ó¿Ï˘ÛË˜ Â›Ó·È Ù· Î‡ÚÈ· ¯·-

Ú·ÎÙËÚÈÛÙÈÎ¿ ÙˆÓ ÌÂÏÂÙÒÓ ·˘ÙÒÓ.

√ÈÎÔÓÔÌÈÎ‹ ·ÍÈÔÏfiÁËÛË ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ ÙË˜ ·ÓÂÌÂ˘ÏÔÁÈ¿˜

∏ ·ÓÂÌÂ˘ÏÔÁÈ¿ Â›Ó·È ¤Ó· ÓfiÛËÌ· ÌÂ ÌÂÁ¿ÏË ÌÂÙ·‰ÔÙÈÎfi-

ÙËÙ· Î·È Â˘Ú‡ Ê¿ÛÌ· ÂÈÏÔÎÒÓ. ŸÛÔ ÌÂÁ·Ï‡ÙÂÚË Â›Ó·È Ë

ËÏÈÎ›· ÓfiÛËÛË˜ ÙfiÛÔ ÛÔ‚·ÚfiÙÂÚÂ˜ ÂÈÏÔÎ¤˜ ·ÚÔ˘ÛÈ¿˙Ô-

ÓÙ·È. ∂›ÛË˜, ÛÔ‚·Ú¤˜ ÂÈÏÔÎ¤˜ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ·Ó ÌÈ·

¤ÁÎ˘Ô˜ ÓÔÛ‹ÛÂÈ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÚÒÙÔ˘ ‹ ÙÔ˘ ‰Â‡ÙÂÚÔ˘

ÙÚÈÌ‹ÓÔ˘ Î‡ËÛË˜. ™‡ÌÊˆÓ· ÌÂ ¤ÚÂ˘ÓÂ˜ ÂÚ›Ô˘ ÙÔ 90% ÙÔ˘

ÏËı˘ÛÌÔ‡ Â›Ó·È Èı·Ófi Ó· ÚÔÛ‚ÏËıÂ› ·fi ÙË ÓfiÛÔ (10).

∆Ô ÂÌ‚fiÏÈÔ ÙË˜ ·ÓÂÌÂ˘ÏÔÁÈ¿˜ ÂÚÈ¤¯ÂÈ ˙ÒÓÙÂ˜ ÂÍ·ÛıÂÓË-

Ì¤ÓÔ˘˜ ·ıÔÁfiÓÔ˘˜ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜. ∏ ‰È¿ÚÎÂÈ· ÙË˜ ·ÓÔ-

Û›·˜ Ô˘ ÚÔÛÊ¤ÚÂÈ ÙÔ ÂÌ‚fiÏÈÔ ‰ÂÓ ¤¯ÂÈ ·ÎfiÌ· ÂÍ·ÎÚÈ‚ˆıÂ›,

·ÏÏ¿ Ë ÂÌÂÈÚ›· ·fi ¿ÏÏ· ÂÌ‚fiÏÈ· ·˘Ù‹˜ ÙË˜ Î·ÙËÁÔÚ›·˜

‰Â›¯ÓÂÈ fiÙÈ Ë ·ÓÔÛ›· ·Ú·Ì¤ÓÂÈ ̆ „ËÏ‹ ÛÂ fiÏË ÙË ‰È¿ÚÎÂÈ· ÙË˜

˙ˆ‹˜. ∏ ̄ ÔÚ‹ÁËÛË ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ Ô‰ËÁÂ› ÛÂ ‹ÈÂ˜ ·ÓÙÈ‰Ú¿ÛÂÈ˜

Ô˘ ·ÊÔÚÔ‡Ó Î¿ÔÈ· ÂÍ·Óı‹Ì·Ù· ‹ ÂÎ‰‹ÏˆÛË ˘ÚÂÙÔ‡.

™·ÓÈfiÙÂÚ· ÂÌÊ·Ó›˙ÔÓÙ·È ÛÔ‚·ÚfiÙÂÚÂ˜ ·ÓÙÈ‰Ú¿ÛÂÈ˜ fiˆ˜

ÂÁÎÂÊ·Ï›ÙÈ‰Â˜, ÓÂ˘ÌÔÓ›·, Û·ÛÌÔ› ·ÎfiÌË Î·È ı¿Ó·ÙÔ˜. ∆Ô

Û˘ÁÎÂÎÚÈÌ¤ÓÔ ÂÌ‚fiÏÈÔ ÂÓ‰Â›ÎÓ˘Ù·È ÁÈ· ÂÓÂÚÁËÙÈÎ‹ ·ÓÔÛÔ-

Ô›ËÛË ÂÓ·ÓÙ›ÔÓ ÙË˜ ·ÓÂÌÂ˘ÏÔÁÈ¿˜ ÛÂ ¿ÙÔÌ· Ô˘ Ë ÚÔÛ‚Ô-

Ï‹ ÙÔ˘˜ ·fi ÙË ÓfiÛÔ ÌÔÚÂ› Ó· ÚÔÎ·Ï¤ÛÂÈ ÛÔ‚·Ú¤˜ ÂÈÏÔ-

Î¤˜ (13,30).

∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ¤¯Ô˘Ó ‰ËÌÔÛÈÂ˘ÙÂ› ÔÏÏ¤˜ ·Ó·Ï‡-

ÛÂÈ˜ ÎfiÛÙÔ˘˜-·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ ÙˆÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ ÂÌ-

‚ÔÏÈ·ÛÌÔ‡ ¤Ó·ÓÙÈ ÙË˜ ·ÓÂÌÂ˘ÏÔÁÈ¿˜. √È ‚·ÛÈÎfiÙÂÚÂ˜ ÌÂÏ¤ÙÂ˜

·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 3.

150 µ. ∆ÛÈ¿ÓÙÔ˘ Î·È Û˘Ó.




√È ÌÂÏ¤ÙÂ˜ ÔÈÎÔÓÔÌÈÎ‹˜ ·ÍÈÔÏfiÁËÛË˜ ÙÔ˘ ÂÌ‚Ô-Ï›Ô˘ Î·Ù¿ ÙÔ˘ ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˘ Ù‡Ô˘ C, ·ÏÏ¿ Î·ÈÙ· ‰È·ı¤ÛÈÌ· ÂÈ‰ËÌÈÔÏÔÁÈÎ¿ ‰Â‰ÔÌ¤Ó· ÚÈÓ Î·È ÌÂ-Ù¿ ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡, Û˘ÓËÁÔÚÔ‡Ó˘¤Ú ÙË˜ ¿Ô„Ë˜ fiÙÈ Ë ÂÊ·ÚÌÔÁ‹ ÙÔ˘ Ì·˙ÈÎÔ‡ ÂÌ-‚ÔÏÈ·ÛÌÔ‡ ÛÙËÓ ÂÚ›ÙˆÛË ·˘Ù‹ Â›Ó·È ·ÔÙÂÏÂÛÌ·-ÙÈÎ‹ Î·È ÔÈÎÔÓÔÌÈÎ¿ ·Ô‰ÔÙÈÎ‹. ∆Ô ÂÌ‚fiÏÈÔ Â›Ó·È·ÔÙÂÏÂÛÌ·ÙÈÎfi Î·ıÒ˜ ÚÔÎ·ÏÂ› ¿ÌÂÛË ÚÔÛÙ·Û›·ÛÙ· ÂÌ‚ÔÏÈ·ÛÌ¤Ó· ¿ÙÔÌ·, ·ÏÏ¿ Î·È ¤ÌÌÂÛË ÚÔÛÙ·-Û›· Ì¤Ûˆ ÙË˜ ÂÏ¿ÙÙˆÛË˜ ÙË˜ ‰È·ÛÔÚ¿˜ ÙÔ˘ ÌÈÎÚÔ-ÔÚÁ·ÓÈÛÌÔ‡ (36). ¢ÂÓ ·ÚÔ˘ÛÈ¿˙ÂÈ ·ÚÂÓ¤ÚÁÂÈÂ˜,ÁÂÁÔÓfi˜ Ô˘ ı· ‰ËÌÈÔ˘ÚÁÔ‡ÛÂ ÌÂÁ·Ï‡ÙÂÚ· ÚÔ‚Ï‹-Ì·Ù· ˘ÁÂ›·˜ Î·È ÂÈÏ¤ÔÓ ÎfiÛÙÔ˜ ÁÈ· ÙË ÛÙÚ·ÙËÁÈÎ‹·ÓÔÛÔÔ›ËÛË˜. ª¿ÏÈÛÙ·, fiÛÔ ÌÂÁ·Ï‡ÙÂÚÔ ÙÔ ÔÛÔ-ÛÙfi ÂÌ‚ÔÏÈ·ÛÙÈÎ‹˜ Î¿Ï˘„Ë˜, ÙfiÛÔ Î·Ï‡ÙÂÚ· Ù··ÔÙÂÏ¤ÛÌ·Ù·, Î·ıÒ˜ ÂÈÙ˘Á¯¿ÓÂÙ·È Ì·ÎÚÔ¯ÚfiÓÈ·Û˘ÏÏÔÁÈÎ‹ ·ÓÔÛ›·. °È· ÙÔ ÏfiÁÔ ·˘Ùfi, ÔÏÏ¤˜ ¯ÒÚÂ˜·ÔÊ¿ÛÈÛ·Ó Ó· ÂÓÙ·¯ıÂ› ÙÔ ÂÓ ÏfiÁˆ ÂÌ‚fiÏÈÔ ÛÙ· Ù·-ÎÙÈÎ¿ ÚÔÁÚ¿ÌÌ·Ù· ÂÌ‚ÔÏÈ·ÛÌÔ‡.

√È ex ante ÌÂÏ¤ÙÂ˜ ÔÈÎÔÓÔÌÈÎ‹˜ ·ÍÈÔÏfiÁËÛË˜1 ÙÔ˘ÓÂ˘ÌÔÓÈÔÎÔÎÎÈÎÔ‡ ÂÌ‚ÔÏ›Ô˘ Î·Ù·Ï‹ÁÔ˘Ó ÛÙÔ Û˘-Ì¤Ú·ÛÌ· fiÙÈ ·Ó Î·È ÙÔ ÂÌ‚fiÏÈÔ Â›Ó·È ÔÏ‡ ‰Ú·ÛÙÈ-Îfi Î·È ÌÂÈÒÓÂÈ ÙËÓ Â›ÙˆÛË ÙË˜ ÓfiÛÔ˘, ˆÛÙfiÛÔ, ÌÂÙÈ˜ ‰Â‰ÔÌ¤ÓÂ˜ ÙÈÌ¤˜ ÙÔ˘ ÂÌ‚ÔÏ›Ô˘, Ë Â˘ÚÂ›· ¯Ú‹ÛËÙÔ˘ ‰ÂÓ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ¿ÓÙÔÙÂ ˆ˜ ÔÈÎÔÓÔÌÈÎ¿·Ô‰ÔÙÈÎ‹. √È ex post2 ÔÈÎÔÓÔÌÈÎ¤˜ ·ÍÈÔÏÔÁ‹ÛÂÈ˜¤‰ÂÈÍ·Ó fiÙÈ ·Ó ÏËÊıÂ› ̆ fi„Ë Ë Â›‰Ú·ÛË ÙË˜ Û˘ÏÏÔ-ÁÈÎ‹˜ ·ÓÔÛ›·˜, ÙfiÙÂ Ë ÛÙÚ·ÙËÁÈÎ‹ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Â›Ó·ÈÈ‰È·›ÙÂÚ· ·ÔÙÂÏÂÛÌ·ÙÈÎ‹ ˆ˜ ÚÔ˜ ÙÔ ÎfiÛÙÔ˜ (36).øÛÙfiÛÔ, Ù· ¤ÌÌÂÛ· ·ÔÙÂÏ¤ÛÌ·Ù· ÙÔ˘ Ì·˙ÈÎÔ‡ ÂÌ-‚ÔÏÈ·ÛÌÔ‡ Á›ÓÔÓÙ·È Ê·ÓÂÚ¿ Ì·ÎÚÔ¯ÚfiÓÈ· Î·È ÁÈ· ÙÔÏfiÁÔ ·˘Ùfi ‰ÂÓ ÌÔÚÔ‡Ó Ó· Û˘Ó˘ÔÏÔÁÈÛÙÔ‡Ó ÛÙÈ˜ exante ÔÈÎÔÓÔÌÈÎ¤˜ ·ÍÈÔÏÔÁ‹ÛÂÈ˜.

™ÙÈ˜ ∏¶∞ ÙÔ ÂÙ·‰‡Ó·ÌÔ Û˘˙Â˘ÁÌ¤ÓÔ ÂÌ‚fiÏÈÔÎ˘ÎÏÔÊfiÚËÛÂ ÙÔ ºÂ‚ÚÔ˘¿ÚÈÔ ÙÔ˘ 2000 Î·È ˆ˜ ÂÎÙÔ‡ÙÔ˘, ÔÈ ¤ÌÌÂÛÂ˜ ÂÈ‰Ú¿ÛÂÈ˜ ÙÔ˘ Ì·˙ÈÎÔ‡ ÂÌ‚ÔÏÈ·-ÛÌÔ‡ Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ ÂÌÊ·ÓÂ›˜. ™˘ÁÎÂÎÚÈÌ¤Ó·,ÌÂÙ¿ ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÌÂÈÒıËÎ·Ó ÔÈÏÔÈÌÒÍÂÈ˜ Ô˘ ÚÔ¤Ú¯ÔÓÙ·Ó ·fi ÙÔ˘˜ ÔÚfiÙ˘Ô˘˜


¶·È‰È·ÙÚÈÎ‹ 2008;71:148-156

¶›Ó·Î·˜ 1. ªÂÏ¤ÙÂ˜ ÔÈÎÔÓÔÌÈÎ‹˜ ·ÍÈÔÏfiÁËÛË˜ ÁÈ· ÙÔ ÂÌ‚fiÏÈÔ ÙÔ˘ ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˘ Ù‡Ô˘ C

ÃÒÚ· Î·È ª¤ıÔ‰Ô˜ ¶ÚÔÔÙÈÎ‹ ™˘ÁÎÚÈÓfiÌÂÓÂ˜ ∞ÔÙÂÏ¤ÛÌ·Ù·¯ÚfiÓÔ˜ ·Ó¿Ï˘ÛË˜ ÛÙÚ·ÙËÁÈÎ¤˜‰ÈÂÍ·ÁˆÁ‹˜

∞ÁÁÏ›· ∞Ó¿Ï˘ÛË ∫fiÛÙÔ˘˜- ™‡ÛÙËÌ· ÀÁÂ›·˜ ¢È¿ÊÔÚÂ˜ ÛÙÚ·ÙËÁÈÎ¤˜ 1. √ ÂÌ‚ÔÏÈ·ÛÌfi˜ Â›Ó·È ÈÔ ·ÔÙÂÏÂÛÌ·ÙÈÎfi˜ ˆ˜ 2002 ∞ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Ô˘ ‰È¤ÊÂÚ·Ó ÚÔ˜ ÙÔ ÎfiÛÙÔ˜ fiÙ·Ó Ë Â›ÙˆÛË ÙË˜ ÓfiÛÔ˘ (14) ÛÙÔÓ ÙÚfiÔ ¯ÔÚ‹ÁËÛ‹˜ ÙÔ˘ Â›Ó·È ˘„ËÏ‹

Î·È ÛÙËÓ ËÏÈÎ›· ¤Ó·ÚÍË˜ 2. °È· ÙÈ˜ ËÏÈÎ›Â˜ 1-4 ÂÙÒÓ, Ë ¯ÔÚ‹ÁËÛË ÙÔ˘ ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÂÌ‚ÔÏ›Ô˘ Â›Ó·È ÈÔ ·ÔÙÂÏÂÛÌ·ÙÈÎ‹ ˆ˜ ÚÔ˜ ÙÔ

ÎfiÛÙÔ˜ fiÙ·Ó Á›ÓÂÙ·È ·fi ÙÔ˘˜ ÁÂÓÈÎÔ‡˜ È·ÙÚÔ‡˜3. °È· ÙÈ˜ ÌÂÁ·Ï‡ÙÂÚÂ˜ ËÏÈÎ›Â˜ (5-17 ÂÙÒÓ), Ë ¯Ô-

Ú‹ÁËÛË ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ Â›Ó·È ÈÔ ·ÔÙÂÏÂÛÌ·ÙÈ-Î‹ ˆ˜ ÚÔ˜ ÙÔ ÎfiÛÙÔ˜ fiÙ·Ó Á›ÓÂÙ·È ÛÙ· Û¯ÔÏÂ›·

∂Ï‚ÂÙ›· ∞Ó¿Ï˘ÛË ∫fiÛÙÔ˘˜- ∞ÛÊ·ÏÈÛÙÈÎ¿ 1. ∂Ì‚ÔÏÈ·ÛÌfi˜ 3 ‰fiÛÂˆÓ 1. ÀÔı¤ÙÔÓÙ·˜ ÂÌ‚ÔÏÈ·ÛÙÈÎ‹ Î¿Ï˘„Ë 80% Î·È 2003 ÃÚËÛÈÌfiÙËÙ·˜ ∆·ÌÂ›· 2. ∂Ì‚ÔÏÈ·ÛÌfi˜ 1 ‰fiÛË˜ ·ÚÈıÌfi ÁÂÓÓ‹ÛÂˆÓ 80.000, Ë ¤ÓÙ·ÍË ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ (15) ÛÙÔÓ Ù·ÎÙÈÎfi ÂÌ‚ÔÏÈ·ÛÌfi Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈ-

Î‹ ˆ˜ ÚÔ˜ ÙÔ ÎfiÛÙÔ˜2. ∏ ÛÙÚ·ÙËÁÈÎ‹ 3 ‰fiÛÂˆÓ ÂÈÙ˘Á¯¿ÓÂÈ ÙÔ ÌÂÁ·-

Ï‡ÙÂÚÔ fiÊÂÏÔ˜ ÁÈ· ÙËÓ ˘ÁÂ›·√ÏÏ·Ó‰›· ∞Ó¿Ï˘ÛË ∫fiÛÙÔ˘˜- ∫ÔÈÓˆÓ›·, 1. ∂Ì‚ÔÏÈ·ÛÌfi˜ 3 ‰fiÛÂˆÓ 1. √ ÂÌ‚ÔÏÈ·ÛÌfi˜ Ô˘ Á›ÓÂÙ·È Ì¤¯ÚÈ ÙËÓ ‡ÊÂÛË 2004 ∞ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ ∞ÛÊ·ÏÈÛÙÈÎ¿ 2. ∂Ì‚ÔÏÈ·ÛÌfi˜ 2 ‰fiÛÂˆÓ ÙË˜ ÂÈ‰ËÌ›·˜ Â›Ó·È Ô ÈÔ ·ÔÙÂÏÂÛÌ·ÙÈÎfi˜ ˆ˜ (16) ∆·ÌÂ›· 3. ∂Ì‚ÔÏÈ·ÛÌfi˜ 1 ‰fiÛË˜ ÚÔ˜ ÙÔ ÎfiÛÙÔ˜

4. ∂Ì‚ÔÏÈ·ÛÌfi˜ Ì¤¯ÚÈ ÙËÓ 2. ∞fi ÙÈ˜ ÛÙÚ·ÙËÁÈÎ¤˜ ÙÔ˘ Ù·ÎÙÈÎÔ‡ ÂÌ‚ÔÏÈ·ÛÌÔ‡,‡ÊÂÛË ÙË˜ ÂÈ‰ËÌ›·˜ Ë ÈÔ ·ÔÙÂÏÂÛÌ·ÙÈÎ‹ ˆ˜ ÚÔ˜ ÙÔ ÎfiÛÙÔ˜ Â›Ó·È

·˘Ù‹ ÙË˜ Ì›·˜ ‰fiÛË˜, ·Ó Î·È Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfi-ÙËÙ· ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ ‹Ù·Ó Ï›ÁÔ ÂÚÈÔÚÈÛÌ¤ÓË ÛÂÛ¯¤ÛË ÌÂ ÙÈ˜ ˘fiÏÔÈÂ˜ ÛÙÚ·ÙËÁÈÎ¤˜

Quebec ∞Ó¿Ï˘ÛË ∫fiÛÙÔ˘˜- ∫ÔÈÓˆÓ›· 1. ∂Ì‚ÔÏÈ·ÛÌfi˜ Ì¤¯ÚÈ ÙËÓ 1. ¶ÈÔ ·ÔÙÂÏÂÛÌ·ÙÈÎ‹ ˆ˜ ÚÔ˜ ÙÔ ÎfiÛÙÔ˜ ∫·Ó·‰¿˜ ∞ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ ‡ÊÂÛË ÙË˜ ÂÈ‰ËÌ›·˜ ÛÙÚ·ÙËÁÈÎ‹ ·ÓÔÛÔÔ›ËÛË˜ Â›Ó·È Ô Ù·ÎÙÈÎfi˜ 2004 2. ∆·ÎÙÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ 1 ‰fiÛË˜ (17) 3 ‰fiÛÂˆÓ 2. ¶ÈÔ ·ÔÙÂÏÂÛÌ·ÙÈÎ‹ ÎÏÈÓÈÎ¿ Â›Ó·È Ë

3. ∆·ÎÙÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ ÛÙÚ·ÙËÁÈÎ‹ ÙÔ˘ Ù·ÎÙÈÎÔ‡ ÂÌ‚ÔÏÈ·ÛÌÔ‡ 1 ‰fiÛË˜ 3 ‰fiÛÂˆÓ

1 ªÂÏ¤ÙÂ˜ Ô˘ Ú·ÁÌ·ÙÔÔÈÔ‡ÓÙ·È ÚÈÓ ·fi ÙË Ï‹„Ë ÙË˜ ·fiÊ·ÛË˜ ÁÈ· ÙËÓ ˘ÏÔÔ›ËÛË ÙË˜ ·Ú¤Ì‚·ÛË˜.2 ªÂÏ¤ÙÂ˜ Ô˘ Ú·ÁÌ·ÙÔÔÈÔ‡ÓÙ·È ÌÂÙ¿ ÙË Ï‹„Ë ÙË˜ ·fiÊ·ÛË˜ ÁÈ· ÙËÓ ˘ÏÔÔ›ËÛË ÙË˜ ·Ú¤Ì‚·ÛË˜.


ÙÔ˘ ÂÌ‚ÔÏ›Ô˘, ÌÂ›ˆÛË Ô˘ Î˘Ì·ÈÓfiÙ·Ó ÛÙÔ 80% Â-

Ú›Ô˘ ÛÙ· ·È‰È¿ Î¿Ùˆ ÙˆÓ 2 ÂÙÒÓ (20), ÂÓÒ ÂÈÏ¤-

ÔÓ, Î·Ù·ÁÚ¿ÊËÎÂ ÂÏ¿ÙÙˆÛË ÙˆÓ ‰ÈÂÈÛ‰˘ÙÈÎÒÓ ÓÂ˘-

ÌÔÓÈÔÎÔÎÎÈÎÒÓ ÏÔÈÌÒÍÂˆÓ Î·Ù¿ 54% ÛÂ ¿ÙÔÌ· 20-

39 ÂÙÒÓ, Î·Ù¿ 25% ÛÂ ¿ÙÔÌ· 40-64 ÂÙÒÓ Î·È Î·Ù¿

39% ÛÂ ¿ÙÔÌ· ¿Óˆ ÙˆÓ 65 ÂÙÒÓ (37).

ŒÓ· ¿ÏÏÔ ÛËÌ·ÓÙÈÎfi fiÊÂÏÔ˜ ‹Ù·Ó Ë ÌÂ›ˆÛË ÙË˜

·ÓÙÈÌÈÎÚÔ‚È·Î‹˜ ·ÓÙÔ¯‹˜, Î·ıÒ˜ Ù· ÙÂÏÂ˘Ù·›· ¯Úfi-

ÓÈ· Ù· ÛÙÂÏ¤¯Ë ÙË˜ ÓÂ˘ÌÔÓÈÔÎÔÎÎÈÎ‹˜ ÓfiÛÔ˘ ·-

ÚÔ˘ÛÈ¿˙Ô˘Ó ·ÓıÂÎÙÈÎfiÙËÙ· ÛÙ· ·ÓÙÈ‚ÈÔÙÈÎ¿, ÌÂ

·ÔÙ¤ÏÂÛÌ· Ó· Á›ÓÂÙ·È ‰‡ÛÎÔÏË Ë ·ÓÙÈÌÂÙÒÈÛ‹

ÙÔ˘˜ Î·È Ë Èı·ÓfiÙËÙ· ÂÈÏÔÎÒÓ Ó· Â›Ó·È ÌÂÁ·Ï‡-

ÙÂÚË (20). ∆Ô 2006 ‰ËÌÔÛÈÂ‡ÙËÎÂ ÌÈ· ÌÂÏ¤ÙË ÔÈÎÔ-

ÓÔÌÈÎ‹˜ ·ÍÈÔÏfiÁËÛË˜ ÙÔ˘ ÓÂ˘ÌÔÓÈÔÎÔÎÎÈÎÔ‡ ÂÌ-

‚ÔÏ›Ô˘, Ë ÔÔ›· ‚·Û›ÛÙËÎÂ ÛÂ ÛÙÔÈ¯Â›· ·fi ÙËÓ Â-

ÓÙ·ÂÙ‹ ÂÌÂÈÚ›· ÙË˜ ÂÊ·ÚÌÔÁ‹˜ ÙÔ˘ ÛÙÈ˜ ∏¶∞ (22).

∏ ex ante ÌÂÏ¤ÙË ÎfiÛÙÔ˘˜-·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜

ÂÎÙÈÌÔ‡ÛÂ fiÙÈ ÙÔ ÂÌ‚fiÏÈÔ ı· ÎfiÛÙÈ˙Â 176.000 ‰ÔÏ¿-

ÚÈ· ·Ó¿ ¤ÙÔ˜ ˙ˆ‹˜ Ô˘ ÛÒ˙ÂÙ·È, fiÙ·Ó ˘ÔÏÔÁÈ˙fiÙ·Ó

ÌfiÓÔ ÙÔ ¿ÌÂÛÔ È·ÙÚÈÎfi ÎfiÛÙÔ˜, ÂÓÒ ·Ó Û˘Ó˘ÔÏÔÁÈ-

˙fiÙ·Ó ÙÔ ¤ÌÌÂÛÔ ÎfiÛÙÔ˜ Î·È ÙÔ ÌË È·ÙÚÈÎfi ¿ÌÂÛÔ Îfi-

ÛÙÔ˜, ÙfiÙÂ ÙÔ ÂÌ‚fiÏÈÔ ı· ÎfiÛÙÈ˙Â 80.000 ‰ÔÏ¿ÚÈ·

·Ó¿ ¤ÙÔ˜ ˙ˆ‹˜ Ô˘ ÛÒ˙ÂÙ·È. ∆· ÛÙÔÈ¯Â›· Ô˘ ÚÔ¤-

Î˘„·Ó ·fi ÙËÓ ÂÓÙ·ÂÙ‹ ¯Ú‹ÛË ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ ¤‰ÂÈ-

Í·Ó fiÙÈ ÙÔ ÂÌ‚fiÏÈÔ Â¤‰Ú·ÛÂ Î·È ÛÙ· ÌË ÂÌ‚ÔÏÈ·-

ÛÌ¤Ó· ¿ÙÔÌ·, ÛÙ· ÔÔ›· ·ÚÔ˘ÛÈ¿ÛÙËÎÂ ÌÂ›ˆÛË ÙˆÓ

ÎÚÔ˘ÛÌ¿ÙˆÓ ÙË˜ ÓÂ˘ÌÔÓÈÔÎÔÎÎÈÎ‹˜ ÓfiÛÔ˘ Ô˘

¤ÊÙ·ÛÂ ÙÔ 68%. µ¿ÛÂÈ ·˘ÙÒÓ ÙˆÓ ÛÙÔÈ¯Â›ˆÓ ÙÔ Îfi-

ÛÙÔ˜ ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ ·Ó¿ ¤ÙÔ˜ ˙ˆ‹˜ Ô˘ ÛÒ˙ÂÙ·È ˘Ô-

ÏÔÁ›ÛÙËÎÂ ÛÙ· 7.500 ‰ÔÏ¿ÚÈ·.

∆· ·ÔÙÂÏ¤ÛÌ·Ù· ÙˆÓ ÌÂÏÂÙÒÓ ÔÈÎÔÓÔÌÈÎ‹˜ ·ÍÈÔ-

ÏfiÁËÛË˜ Û¯ÂÙÈÎ¿ ÌÂ ÙÔ ÂÌ‚fiÏÈÔ ÙË˜ ·ÓÂÌÂ˘ÏÔÁÈ¿˜ ‰ÂÓ



¶›Ó·Î·˜ 2. ªÂÏ¤ÙÂ˜ ÔÈÎÔÓÔÌÈÎ‹˜ ·ÍÈÔÏfiÁËÛË˜ ÁÈ· ÙÔ ÂÌ‚fiÏÈÔ ÙÔ˘ ÓÂ˘ÌÔÓÈfiÎÔÎÎÔ˘

ÃÒÚ· Î·È ª¤ıÔ‰Ô˜ ¶ÚÔÔÙÈÎ‹ ™˘ÁÎÚÈÓfiÌÂÓÂ˜ ∞ÔÙÂÏ¤ÛÌ·Ù·¯ÚfiÓÔ˜ ·Ó¿Ï˘ÛË˜/ ÛÙÚ·ÙËÁÈÎ¤˜‰ÈÂÍ·ÁˆÁ‹˜ ÀÔÏÔÁÈÛÌfi˜

ÎfiÛÙÔ˘˜

2001 ∞Ó¿Ï˘ÛË ∫fiÛÙÔ˘˜- ∫ÔÈÓˆÓ›·, 1. ∆·ÎÙÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ 1. √ Ù·ÎÙÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ ÌÔÚÂ› Ó· ÌÂÙ·‚¿ÏÂÈ Kaiser ∞ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ ™‡ÛÙËÌ· ÀÁÂ›·˜ 4 ‰fiÛÂˆÓ ÛÂ ‚Ú¤ÊË ÙËÓ ÂÈ‰ËÌÈÔÏÔÁ›· ÙË˜ ÓfiÛÔ˘Permanente, (2-15 ÌËÓÒÓ) Î·È 2. ∞ÎfiÌ· ÌÔÚÂ› Ó· ·Ô‰ÂÈ¯ıÂ› ·ÔÙÂÏÂÛÌ·ÙÈÎfi˜ Oakland ÂÌ‚ÔÏÈ·ÛÌfi˜ Ì›·˜ ‰fiÛË˜ ˆ˜ ÚÔ˜ ÙÔ ÎfiÛÙÔ˜ ·Ó¿ÏÔÁ· ÌÂ ÙÔ ÎfiÛÙÔ˜ ÙÔ˘ ∫·ÏÈÊfiÚÓÈ·, ÛÂ ·È‰È¿ 2-5 ÂÙÒÓ Û˘ÓÔÏÈÎÔ‡ ÂÌ‚ÔÏÈ·ÛÌÔ‡∏¶∞ (20) 2. ªË ÂÌ‚ÔÏÈ·ÛÌfi˜

2003 ∞Ó¿Ï˘ÛË ∫fiÛÙÔ˘˜- ∫ÔÈÓˆÓ›· 1. ∆·ÎÙÈÎfi˜ ∂Ì‚ÔÏÈ·ÛÌfi˜ 1. ¶ÈÔ ·ÔÙÂÏÂÛÌ·ÙÈÎfi˜ ˆ˜ ÚÔ˜ ÙÔ ÎfiÛÙÔ˜ Â›Ó·È ∫·Ó·‰¿˜ ∞ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ 4 ‰fiÛÂˆÓ Ô Ù·ÎÙÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜(21) 2. ŒÎÙ·ÎÙÔ˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ 2. øÛÙfiÛÔ, Ô ÂÌ‚ÔÏÈ·ÛÌfi˜ ı· Â›Ó·È ÈÔ ·Ô‰ÔÙÈÎfi˜

3 ‰fiÛÂˆÓ ÁÈ· ÙËÓ ÎÔÈÓˆÓ›·, ·Ó Ë ÙÈÌ‹ ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ 3. ŒÎÙ·ÎÙÔ˜ 2 ‰fiÛÂˆÓ ÌÂÈˆıÂ› ÛÙ· $30/‰fiÛË4. ŒÎÙ·ÎÙÔ˜ 1 ‰fiÛË˜

2003 ∞Ó¿Ï˘ÛË ∫fiÛÙÔ˘˜- ∫ÔÈÓˆÓ›· 1. ªË ÂÌ‚ÔÏÈ·ÛÌfi˜ 1. √ Ù·ÎÙÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ ÌÔÚÂ› Ó· ·ÔÙÚ¤„ÂÈ √ÏÏ·Ó‰›· ÃÚËÛÈÌfiÙËÙ·˜ 2. ∆·ÎÙÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ ÌÂÁ¿ÏÔ ·ÚÈıÌfi ÓÂ˘ÌÔÓÈÔÎÔÎÎÈÎÒÓ ÏÔÈÌÒÍÂˆÓ (22) Î·È Ó· ÌÂÈÒÛÂÈ ÙË ıÓËÛÈÌfiÙËÙ· Î·È ÙË

ÓÔÛËÚfiÙËÙ·2. √ ‰Â›ÎÙË˜ ÎfiÛÙÔ˘˜- ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ ‰ÂÓ

Â›Ó·È Â˘ÓÔ˚Îfi˜ (83.226 – ·Ó¿ ¤ÙÔ˜ ˙ˆ‹˜ Ô˘ ÛÒ-˙ÂÙ·È), ÁÈ’ ·˘Ùfi ÚÔÙÂ›ÓÂÙ·È Ó· ÌËÓ ÂÓÙ·¯ıÂ› ÙÔÂÌ‚fiÏÈÔ ÛÙÔÓ Ù·ÎÙÈÎfi ÂÌ‚ÔÏÈ·ÛÌfi

2003 ∞Ó¿Ï˘ÛË ∫fiÛÙÔ˘˜- ∞ÛÊ·ÏÈÛÙÈÎ¿ 1. ∆·ÎÙÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ 1. ∞fi ÙËÓ ÚÔÔÙÈÎ‹ ÙˆÓ ·ÛÊ·ÏÈÛÙÈÎÒÓ Ù·ÌÂ›ˆÓ °ÂÚÌ·Ó›· ∞ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ ∆·ÌÂ›·, ∫ÔÈÓˆÓ›· ‚ÚÂÊÒÓ Î·È ·È‰ÈÒÓ ÙÔ ÂÌ‚fiÏÈÔ ÂÍÔÈÎÔÓÔÌÂ› 51,1% ÙˆÓ ‰··ÓÒÓ ÙÔ˘(23) ÌÈÎÚfiÙÂÚ· ÙˆÓ 2 ÂÙÒÓ 2. √ ÂÌ‚ÔÏÈ·ÛÌfi˜ Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈÎfi˜ ˆ˜ ÚÔ˜

2. ªË ÂÌ‚ÔÏÈ·ÛÌfi˜ ÙÔ ÎfiÛÙÔ˜ ·fi ÙËÓ ÎÔÈÓˆÓÈÎ‹ ÚÔÔÙÈÎ‹

2004 ∞Ó¿Ï˘ÛË ∫fiÛÙÔ˘˜- ™‡ÛÙËÌ· ÀÁÂ›·˜, 1. ∆·ÎÙÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ 1. ∏ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ÓÂ˘ÌÔÓÈÔÎÔÎÎÈÎÔ‡ ÂÌ‚ÔÏ›Ô˘ πÛ·Ó›· ∞ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ ∫ÔÈÓˆÓ›· fiÏˆÓ ÙˆÓ ‚ÚÂÊÒÓ ËÏÈÎ›·˜ ÛÙÔ ∂ıÓÈÎfi ¶ÚfiÁÚ·ÌÌ· ∂Ì‚ÔÏÈ·ÛÌÒÓ ı· ÌÂÈÒÛÂÈ (24) 6 Â‚‰ÔÌ¿‰ˆÓ-7 ÌËÓÒÓ ÛËÌ·ÓÙÈÎ¿ ÙË ıÓËÛÈÌfiÙËÙ· Î·È ÙË ÓÔÛËÚfiÙËÙ·

2. ∆·ÎÙÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ Ô˘ Û¯ÂÙ›˙ÂÙ·È ÌÂ ÙËÓ ÓÂ˘ÌÔÓÈÔÎÔÎÎÈÎ‹ fiÏˆÓ ÙˆÓ ·È‰ÈÒÓ Î¿Ùˆ ÏÔ›ÌˆÍË ÛÙ· ·È‰È¿ÙˆÓ 5 ÂÙÒÓ 2. √ Ù·ÎÙÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ fiÏˆÓ ÙˆÓ ·È‰ÈÒÓ <5

ÂÙÒÓ Â›Ó·È ·Ô‰ÔÙÈÎfi˜ ·fi ÙËÓ ÎÔÈÓˆÓÈÎ‹ ÛÎÔÈ¿ Î·È ·ÔÙÂÏÂÛÌ·ÙÈÎ‹ ˆ˜ ÚÔ˜ ÙÔ ÎfiÛÙÔ˜·fi ÙË ÛÎÔÈ¿ ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ˘ÁÂ›·˜


Â›Ó·È È‰È·›ÙÂÚ· ÂÓı·ÚÚ˘ÓÙÈÎ¿ Û¯ÂÙÈÎ¿ ÌÂ ÙËÓ ÔÈÎÔ-ÓÔÌÈÎ‹ ·Ô‰ÔÙÈÎfiÙËÙ· ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ Î·È ÙË Û˘Ì‚Ô-Ï‹ ÙÔ˘ ÛÙËÓ ÂÍÔÈÎÔÓfiÌËÛË fiÚˆÓ. ∂È‰ÈÎfiÙÂÚ·, ÛÙÈ˜ÌÂÏ¤ÙÂ˜ ÔÈÎÔÓÔÌÈÎ‹˜ ·ÍÈÔÏfiÁËÛË˜ Ô˘ ÂÍÂÙ¿ÛÙË-Î·Ó ÛÙËÓ ·ÚÔ‡Û· ÂÚÁ·Û›·, Ë ÂÊ·ÚÌÔÁ‹ ÂÓfi˜ ·ÓÔ-ÛÔÔÈËÙÈÎÔ‡ ÚÔÁÚ¿ÌÌ·ÙÔ˜ Î·Ù¿ ÙË˜ ·ÓÂÌÂ˘ÏÔÁÈ¿˜ÛÂ fiÏ· Ù· ·È‰È¿ Î¿Ùˆ ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜, ·fi ÙËÓÏÂ˘Ú¿ ÙˆÓ ÂıÓÈÎÒÓ Û˘ÛÙËÌ¿ÙˆÓ ˘ÁÂ›·˜, ‰ÂÓ Â›Ó·ÈÛÂ Î·Ì›· ÂÚ›ÙˆÛË ÂˆÊÂÏ‹˜. ∞fi ÙËÓ ÎÔÈÓˆÓÈÎ‹ÚÔÔÙÈÎ‹, fiÔ˘ Ï·Ì‚¿ÓÂÙ·È ˘fi„Ë ÙÔ ¤ÌÌÂÛÔ Îfi-ÛÙÔ˜, Ù· ÚÔÁÚ¿ÌÌ·Ù· ÂÌÊ·Ó›˙ÔÓÙ·È ÂÚÈÛÛfiÙÂÚÔ·Ô‰ÔÙÈÎ¿ (38).

øÛÙfiÛÔ Ë ‰Ú·ÛÙÈÎfiÙËÙ· ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ Â›Ó·È ÈÎ·-ÓÔÔÈËÙÈÎ‹ Î·È Ë ¯ÔÚ‹ÁËÛ‹ ÙÔ˘ ÌÂÈÒÓÂÈ ÛËÌ·ÓÙÈÎ¿ÙËÓ Â›ÙˆÛË ÙË˜ ÓfiÛÔ˘ Î·È ÙˆÓ ı·Ó¿ÙˆÓ Ô˘ Û¯Â-Ù›˙ÔÓÙ·È ¿ÌÂÛ· Î·È ¤ÌÌÂÛ· ÌÂ ·˘Ù‹. ™˘ÁÎÂÎÚÈÌ¤Ó·,

ÌÂÏ¤ÙË Ô˘ Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ ÛÙÈ˜ ∏¶∞ ÌÂÙ¿ ·fi4 ¯ÚfiÓÈ· Î˘ÎÏÔÊÔÚ›·˜ ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ ÛÙËÓ ·ÁÔÚ¿,¤‰ÂÈÍÂ fiÙÈ ÔÈ ı¿Ó·ÙÔÈ ÂÍ·ÈÙ›·˜ ÙË˜ ÓfiÛÔ˘ ÌÂÈÒıËÎ·Ó·fi 145 ÛÂ 66 Î·Ù’ ¤ÙÔ˜ (39).

∏ ·ÓÂÌÂ˘ÏÔÁÈ¿ Â›Ó·È ÌÈ· ÓfiÛÔ˜ Ô˘ ÂÈÊ¤ÚÂÈ ÌÂ-Á¿ÏË ÔÈÎÔÓÔÌÈÎ‹ ÂÈ‚¿Ú˘ÓÛË ÛÙËÓ ÎÔÈÓˆÓ›·, Î˘Ú›ˆ˜ÏfiÁˆ ÙÔ˘ ¤ÌÌÂÛÔ˘ ÎfiÛÙÔ˘˜. ∆Ô ÁÂÁÔÓfi˜ ·˘Ùfi ‰ÈÎ·È-ÔÏÔÁÂ› ÂÓ Ì¤ÚÂÈ ÙËÓ ·fiÊ·ÛË ÔÏÏÒÓ ¯ˆÚÒÓ Ó·ÂÂÓ‰‡ÛÔ˘Ó ÛÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi Î·Ù¿ ÙË˜ ·ÓÂÌÂ˘ÏÔ-ÁÈ¿˜. ∂ÈÏ¤ÔÓ, ÙÔ ¤ÌÌÂÛÔ ÎfiÛÙÔ˜ Â›Ó·È Î·È Ô Î·ıÔ-ÚÈÛÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ Ô˘ Ô‰ËÁÂ› ÛÂ ÌË ÂÓı·ÚÚ˘ÓÙÈ-Î¿ ·ÔÙÂÏ¤ÛÌ·Ù· ·fi ÙËÓ ÏÂ˘Ú¿ ÙˆÓ ·ÛÊ·ÏÈÛÙÈ-ÎÒÓ Ù·ÌÂ›ˆÓ ‹ ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ˘ÁÂ›·˜, ÂÓÒ Ù· ·Ô-ÙÂÏ¤ÛÌ·Ù¿ ÙÔ˘ Â›Ó·È È‰È·›ÙÂÚ· Â˘ÓÔ˚Î¿, ·Ó Ë ÔÈÎÔÓÔ-ÌÈÎ‹ ·ÍÈÔÏfiÁËÛË ‰ÈÂÍ¿ÁÂÙ·È ˘fi ÙËÓ ÎÔÈÓˆÓÈÎ‹ÚÔÔÙÈÎ‹ (40).


¶·È‰È·ÙÚÈÎ‹ 2008;71:148-156

¶›Ó·Î·˜ 2. (Û˘Ó¤¯ÂÈ·)

ÃÒÚ· Î·È ª¤ıÔ‰Ô˜ ¶ÚÔÔÙÈÎ‹ ™˘ÁÎÚÈÓfiÌÂÓÂ˜ ∞ÔÙÂÏ¤ÛÌ·Ù·¯ÚfiÓÔ˜ ·Ó¿Ï˘ÛË˜/ ÛÙÚ·ÙËÁÈÎ¤˜‰ÈÂÍ·ÁˆÁ‹˜ ÀÔÏÔÁÈÛÌfi˜

ÎfiÛÙÔ˘˜

2004 ∞Ó¿Ï˘ÛË ∫fiÛÙÔ˘˜- ∫ÔÈÓˆÓ›· 1. ªË ÂÌ‚ÔÏÈ·ÛÌfi˜ 1. ∏ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ Ù·ÎÙÈÎÔ‡ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ∞˘ÛÙÚ·Ï›· ∞ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ 2. ∆·ÎÙÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ Â›Ó·È ·Û‡ÌÊÔÚË(25) Î·È ∞Ó¿Ï˘ÛË ∫fiÛÙÔ˘˜- ÛÂ 4 ‰fiÛÂÈ˜ 2. ∆Ô ÎfiÛÙÔ˜ ·Ó¿ DALY Â›Ó·È ÛÙ· ˘„ËÏfiÙÂÚ·

ÃÚËÛÈÌfiÙËÙ·˜ Â›Â‰· Û˘ÁÎÚÈÙÈÎ¿ ÌÂ ÙÔ fiÚÈÔ Ô˘ ÂÈÙÚ¤Ô˘ÓÔÈ Î·ÙÂ˘ı˘ÓÙ‹ÚÈÂ˜ Ô‰ËÁ›Â˜ ÙË˜ ∞˘ÛÙÚ·Ï›·˜

2005 ∞Ó¿Ï˘ÛË ∫fiÛÙÔ˘˜- ∂ıÓÈÎfi ™‡ÛÙËÌ· ∆·ÎÙÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ ™˘Ó˘ÔÏÔÁ›˙ÔÓÙ·˜ Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ ∏ÓˆÌ¤ÓÔ ∞ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ ÀÁÂ›·˜ 4 ‰fiÛÂˆÓ ÛÂ ·È‰È¿ Û˘ÏÏÔÁÈÎ‹˜ ·ÓÔÛ›·˜ ·fi ÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi ÙÔ µ·Û›ÏÂÈÔ ÂÌ‚fiÏÈÔ ÙÔ˘ ÓÂ˘ÌÔÓÈfiÎÔÎÎÔ˘ Ê·›ÓÂÙ·È Ó· Â›Ó·È (26) È‰È·›ÙÂÚ· ·ÔÙÂÏÂÛÌ·ÙÈÎfi ˆ˜ ÚÔ˜ ÙÔ ÎfiÛÙÔ˜

2005 ∞Ó¿Ï˘ÛË ∫fiÛÙÔ˘˜- ∫ÔÈÓˆÓ›·, 1. ∆·ÎÙÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ 1. ∞fi ÙËÓ ÎÔÈÓˆÓÈÎ‹ ÚÔÔÙÈÎ‹ πÙ·Ï›· ∞ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ ∞ÛÊ·ÏÈÛÙÈÎ¿ 3 ‰fiÛÂˆÓ ÂÍÔÈÎÔÓÔÌÔ‡ÓÙ·È 52–/·ÛıÂÓ‹(27) ∆·ÌÂ›· 2. ªË ÂÌ‚ÔÏÈ·ÛÌfi˜ 2. ∞fi ÙËÓ ÚÔÔÙÈÎ‹ ÙˆÓ ·ÛÊ·ÏÈÛÙÈÎÒÓ Ù·ÌÂ›ˆÓ

ÂÍÔÈÎÔÓÔÌÔ‡ÓÙ·È 23–/·ÛıÂÓ‹3. ™˘ÌÂÚ·›ÓÂÙ·È fiÙÈ ÙÔ ÂÌ‚fiÏÈÔ Â›Ó·È ·ÔÙÂÏÂ-

ÛÌ·ÙÈÎfi ˆ˜ ÚÔ˜ ÙÔ ÎfiÛÙÔ˜ Î·È ı· Ú¤ÂÈ Ó·Û˘ÌÂÚÈÏËÊıÂ› ÛÙÔ ÚfiÁÚ·ÌÌ· ÂÌ‚ÔÏÈ·ÛÌÒÓ

2006 ∞Ó¿Ï˘ÛË ∫fiÛÙÔ˘˜- ™ÙÔÓ ˘ÔÏÔÁÈÛÌfi 1. ∆·ÎÙÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ 1. √ Ù·ÎÙÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ 4 ‰fiÛÂˆÓ ‰ÂÓ Â›Ó·È ¡ÔÚ‚ËÁ›· ∞ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ ÙÔ˘ ÎfiÛÙÔ˘˜ 4 ‰fiÛÂˆÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfi˜ ˆ˜ ÚÔ˜ ÙÔ ÎfiÛÙÔ˜, Û‡ÌÊˆÓ· (28) Î·È ∞Ó¿Ï˘ÛË ∫fiÛÙÔ˘˜ - Û˘ÓÂÎÙÈÌ‹ıËÎ·Ó ÙÔ 2. ∆·ÎÙÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ ÌÂ ÙÈ˜ ÚÔ¸Ôı¤ÛÂÈ˜ Ô˘ ı¤ÙÂÈ Ë ¡ÔÚ‚ËÁ›·,

ÃÚËÛÈÌfiÙËÙ·˜ ¤ÌÌÂÛÔ ÎfiÛÙÔ˜ Î·È 3 ‰fiÛÂˆÓ ·ÎfiÌ· ÎÈ ·Ó Û˘Ó˘ÔÏÔÁÈÛÙÔ‡Ó ÙÔ ¤ÌÌÂÛÔ ÎfiÛÙÔ˜ Ù· ·ÔÙÂÏ¤ÛÌ·Ù· Î·È ÔÈ ÂÈÙÒÛÂÈ˜ ÙË˜ Û˘ÏÏÔÁÈÎ‹˜ ·ÓÔÛ›·˜ÙË˜ Û˘ÏÏÔÁÈÎ‹˜ 2. ∞Ó ÙÔ Û¯‹Ì· ÙˆÓ 3 ‰fiÛÂˆÓ Â›Ó·È ÂÍ›ÛÔ˘ ·ÓÔÛ›·˜ ‰Ú·ÛÙÈÎfi, fiˆ˜ ·˘Ùfi ÙˆÓ 4, ÙfiÙÂ Ë ÛÙÚ·ÙËÁÈÎ‹

Â›Ó·È ·Ô‰ÔÙÈÎ‹ ˆ˜ ÚÔ˜ ÙÔ ÎfiÛÙÔ˜ (cost saving) ·Ó Û˘Ó˘ÔÏÔÁÈÛÙÂ› Î·È ÙÔ ¤ÌÌÂÛÔÎfiÛÙÔ˜

2006 ∞Ó¿Ï˘ÛË ∫fiÛÙÔ˘˜- ∫ÔÈÓˆÓ›· ∆·ÎÙÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ fiÏˆÓ ªÂ ‰Â‰ÔÌ¤Ó· Ù· ÛÙÔÈ¯Â›· ÙË˜ Â›‰Ú·ÛË˜ ÙÔ˘ ∏¶∞ ∞ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ ÙˆÓ ·È‰ÈÒÓ ÌÈÎÚfiÙÂÚ· ÂÌ‚ÔÏ›Ô˘ ÛÙ· ÌË ÂÌ‚ÔÏÈ·ÛÌ¤Ó· ¿ÙÔÌ·, ¤ÂÈÙ· (29) ÙˆÓ 23 ÌËÓÒÓ ·fi 5 ¯ÚfiÓÈ· ¯Ú‹ÛË˜, ÙÔ ÎfiÛÙÔ˜ ÙÔ˘ ÂÌ‚ÔÏ›Ô˘

Â›Ó·È $7.500 ·Ó¿ ¤ÙÔ˜ ˙ˆ‹˜ Ô˘ ÛÒ˙ÂÙ·È. ∏ ·Ó·ÏÔÁ›· ·˘Ù‹ Â›Ó·È Î·Ù¿ ÔÏ‡ ÌÈÎÚfiÙÂÚË·fi ÙËÓ ·Ú¯ÈÎ‹ Ô˘ ‹Ù·Ó $80.000 ·Ó¿ ¤ÙÔ˜ ˙ˆ‹˜Ô˘ ÛÒ˙ÂÙ·È


¶›Ó·Î·˜ 3. ªÂÏ¤ÙÂ˜ ÔÈÎÔÓÔÌÈÎ‹˜ ·ÍÈÔÏfiÁËÛË˜ ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ ÙË˜ ·ÓÂÌÂ˘ÏÔÁÈ¿˜

ÃÒÚ· Î·È ª¤ıÔ‰Ô˜ ¶ÚÔÔÙÈÎ‹ ·Ó¿Ï˘ÛË˜/ ™˘ÁÎÚÈÓfiÌÂÓÂ˜ ∞ÔÙÂÏ¤ÛÌ·Ù·¯ÚfiÓÔ˜ ÀÔÏÔÁÈÛÌfi˜ ÛÙÚ·ÙËÁÈÎ¤˜‰ÈÂÍ·ÁˆÁ‹˜ ÎfiÛÙÔ˘˜

1999 ∞Ó¿Ï˘ÛË ∂ıÓÈÎfi 1. ∆·ÎÙÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ 1. ∏ ÈÔ ·ÔÙÂÏÂÛÌ·ÙÈÎ‹ ˆ˜ ÚÔ˜ ÙÔ ÎfiÛÙÔ˜ ∞˘ÛÙÚ·Ï›· ∫fiÛÙÔ˘˜- ™‡ÛÙËÌ· ÀÁÂ›·˜ fiÏˆÓ ÙˆÓ ·È‰ÈÒÓ ÛÙÚ·ÙËÁÈÎ‹ ‹Ù·Ó ·˘Ù‹ ÙÔ˘ Ù·ÎÙÈÎÔ‡ (31) ∞ÔÙÂÏÂÛÌ·ÙÈ- 2. ∂Ì‚ÔÏÈ·ÛÌfi˜ ÂÊ‹‚ˆÓ Ô˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ fiÏˆÓ ÙˆÓ ·È‰ÈÒÓ

ÎfiÙËÙ·˜ ‰ÂÓ Â›¯·Ó ÓÔÛ‹ÛÂÈ ·fi ·ÓÂÌÂ˘- 2. ¶ÈÔ ‰Ú·ÛÙÈÎ‹ ÛÙÚ·ÙËÁÈÎ‹ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒ-ÏÔÁÈ¿ ÛÂ ÌÈÎÚfiÙÂÚË ËÏÈÎ›· ÈÛË ÙË˜ ·Ûı¤ÓÂÈ·˜ ‹Ù·Ó ·˘Ù‹ ÙÔ˘ Û˘Ó‰˘·-

3. ™˘Ó‰˘·ÛÌfi˜ ÙˆÓ ‰‡Ô ·Ú·¿Óˆ ÛÌÔ‡ (ÂÌ‚ÔÏÈ·ÛÌfi˜ ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ), 4. ªË ÂÌ‚ÔÏÈ·ÛÌfi˜ ·ÏÏ¿ ‰ÂÓ ‹Ù·Ó ÔÈÎÔÓÔÌÈÎ¿ ·Ô‰ÔÙÈÎ‹

2002 ∞Ó¿Ï˘ÛË ∫ÔÈÓˆÓ›·, 1. ªË ÂÌ‚ÔÏÈ·ÛÌfi˜ 1. ∆È˜ Î·Ï‡ÙÂÚÂ˜ ÂÈÙÒÛÂÈ˜ ÛÙËÓ ˘ÁÂ›· Â›¯Â Ë ∫·Ó·‰¿˜ ∫fiÛÙÔ˘˜- ™‡ÛÙËÌ· ÀÁÂ›·˜ 2. ∆·ÎÙÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ ÛÙÚ·ÙËÁÈÎ‹ ÙÔ˘ ÌÈÎÙÔ‡ ÂÌ‚ÔÏÈ·ÛÌÔ‡, ·ÏÏ¿ ‰ÂÓ (32) ∞ÔÙÂÏÂÛÌ·ÙÈ- fiÏˆÓ ÙˆÓ ·È‰ÈÒÓ ‹Ù·Ó ·ÔÙÂÏÂÛÌ·ÙÈÎ‹ ˆ˜ ÚÔ˜ ÙÔ ÎfiÛÙÔ˜ ·fi

ÎfiÙËÙ·˜ 3. ∂Ì‚ÔÏÈ·ÛÌfi˜ ÂÊ‹‚ˆÓ Ô˘ ÙË ÛÎÔÈ¿ ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ˘ÁÂ›·˜‰ÂÓ Â›¯·Ó ÓÔÛ‹ÛÂÈ ·fi 2. ∞fi ÙËÓ ÔÙÈÎ‹ ÙË˜ ÎÔÈÓˆÓ›·˜, Ë ÈÔ·ÓÂÌÂ˘ÏÔÁÈ¿ ÛÂ ÌÈÎÚfiÙÂÚË ·ÔÙÂÏÂÛÌ·ÙÈÎ‹ ˆ˜ ÚÔ˜ ÙÔ ÎfiÛÙÔ˜ ËÏÈÎ›· ÛÙÚ·ÙËÁÈÎ‹ ‹Ù·Ó ·˘Ù‹ ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ fiÏˆÓ

4. ™˘Ó‰˘·ÛÌfi˜ ÙˆÓ ‰‡Ô ÙˆÓ ·È‰ÈÒÓ ÛÙËÓ ËÏÈÎ›· ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜·Ú·¿Óˆ 3. ∏ ÛÙÚ·ÙËÁÈÎ‹ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÌfiÓÔ ÙˆÓ ÂÊ‹‚ˆÓ

·ÚÔ˘ÛÈ¿˙ÂÙ·È ·ÔÙÂÏÂÛÌ·ÙÈÎ‹ ̂ ̃ÚÔ ̃ÙÔ ÎfiÛÙÔ˜ÌfiÓÔ ·fi ÙËÓ ÔÙÈÎ‹ ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ˘ÁÂ›·˜

2003 ∞Ó¿Ï˘ÛË ∫ÔÈÓˆÓ›·, 1. ∆·ÎÙÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ 1. √ ÂÌ‚ÔÏÈ·ÛÌfi˜ ÙˆÓ ÂÊ‹‚ˆÓ Â›Ó·È Ô ÈÔ ·ÛÊ·Ï‹˜ ∞ÁÁÏ›·- ∫fiÛÙÔ˘˜- ™‡ÛÙËÌ· ÀÁÂ›·˜ ‚ÚÂÊÒÓ Î·È Ô ÈÔ ·ÔÙÂÏÂÛÌ·ÙÈÎfi˜ ˆ˜ ÚÔ˜ ÙÔ ÎfiÛÙÔ˜ √˘·Ï›· ÃÚËÛÈÌfiÙËÙ·˜ 2. ŒÎÙ·ÎÙÔ˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ ·fi ÙËÓ ÚÔÔÙÈÎ‹ ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ˘ÁÂ›·˜(33) ·È‰ÈÒÓ 2-11 ÂÙÒÓ 2. √ Ù·ÎÙÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ ÙˆÓ ‚ÚÂÊÒÓ Â›Ó·È

3. ∂Ì‚ÔÏÈ·ÛÌfi˜ ÂÊ‹‚ˆÓ ·›ı·ÓÔ Ó· Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈÎfi˜ ˆ˜ ÚÔ˜ ¿Óˆ ÙˆÓ 11 ÂÙÒÓ ÙÔ ÎfiÛÙÔ˜

2004 ∞Ó¿Ï˘ÛË ∫ÔÈÓˆÓ›·, 1. ∆·ÎÙÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ 1. √ Ù·ÎÙÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ ¯ˆÚ›˜ ·ÌÊÈ‚ÔÏ›· πÙ·Ï›· ∫fiÛÙÔ˘˜- ™‡ÛÙËÌ· ÀÁÂ›·˜ ·È‰ÈÒÓ ËÏÈÎ›·˜ 1-2 ÂÙÒÓ ¤¯ÂÈ ıÂÙÈÎ‹ Â›‰Ú·ÛË ÛÙË ÓÔÛËÚfiÙËÙ· ÏfiÁˆ (34) √Ê¤ÏÔ˘˜ (Ï·Ì‚¿ÓÔÓÙ·˜ ˘fi„Ë ·ÓÂÌÂ˘ÏÔÁÈ¿˜. ∆· ÌÂÁ·Ï‡ÙÂÚ· ıÂÙÈÎ¿

‰È·ÊÔÚÂÙÈÎ¿ Â›Â‰· ·ÔÙÂÏ¤ÛÌ·Ù· ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È fiÙ·Ó ÙÔ ÔÛÔ-ÂÌ‚ÔÏÈ·ÛÙÈÎ‹˜ Î¿Ï˘„Ë˜ ÛÙfi ÙË˜ ÂÌ‚ÔÏÈ·ÛÙÈÎ‹˜ Î¿Ï˘„Ë˜ Â›Ó·È 90%

2. ∆·ÎÙÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ ·È‰ÈÒÓ 2. ∆Ô ÛÂÓ¿ÚÈÔ ÙÔ˘ Ù·ÎÙÈÎÔ‡ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÌÂ ËÏÈÎ›·˜ (1-2 ÂÙÒÓ) ÛÂ Û˘Ó‰˘·- ÔÛÔÛÙfi ÂÌ‚ÔÏÈ·ÛÙÈÎ‹˜ Î¿Ï˘„Ë˜ 90%, Â›Ó·È ÛÌfi ÌÂ ¤Ó· ÚfiÁÚ·ÌÌ· ÂÌ‚Ô- ·Ô‰ÔÙÈÎfi ˆ˜ ÚÔ˜ ÙÔ ÎfiÛÙÔ˜, ÙfiÛÔ ·fi ÙËÓ ÏÈ·ÛÌÔ‡ ÙˆÓ ·ÙfiÌˆÓ Ô˘ ‰ÂÓ ÎÔÈÓˆÓÈÎ‹ ÚÔÔÙÈÎ‹, fiÛÔ Î·È ·fi ÙËÓ Â›¯·Ó ÂÌ‚ÔÏÈ·ÛÙÂ› ÛÙË Û˘ÓÈ- ÚÔÔÙÈÎ‹ ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ˘ÁÂ›·˜ÛÙÒÌÂÓË ËÏÈÎ›· (ÙÔ ÔÔ›Ô ı· 3. ŸÛÔ ÌÂÈÒÓÂÙ·È ÙÔ Â›Â‰Ô ÙË˜ ÂÌ‚ÔÏÈ·ÛÙÈÎ‹˜ ‰È·ÚÎÔ‡ÛÂ Ù· 5 ÚÒÙ· ¤ÙË ÙË˜ Î¿Ï˘„Ë˜ ÙfiÛÔ ÏÈÁfiÙÂÚÔ ·Ô‰ÔÙÈÎfi ˆ˜ ÚÔ˜ ÙÔ Î˘ÎÏÔÊÔÚ›·˜ ÙÔ˘ ÂÌ‚ÔÏ›Ô˘) ÎfiÛÙÔ˜ Á›ÓÂÙ·È ÙÔ ÚfiÁÚ·ÌÌ· ÂÌ‚ÔÏÈ·ÛÌÔ‡.

3. ∆·ÎÙÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ ·È‰ÈÒÓ ¶·ÚfiÏ· ·˘Ù¿ ·ÎfiÌ· Î·È ÛÙÔ ¯ÂÈÚfiÙÂÚÔ ÛÂÓ¿ÚÈÔ ËÏÈÎ›·˜ (1-2 ÂÙÒÓ) ÛÂ ÙÔ ÂÌ‚fiÏÈÔ ·Ú·Ì¤ÓÂÈ ·ÔÙÂÏÂÛÌ·ÙÈÎfi ˆ˜ Û˘Ó‰˘·ÛÌfi ÌÂ ¤Ó· ÚfiÁÚ·ÌÌ· ÚÔ˜ ÙÔ ÎfiÛÙÔ˜ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÙˆÓ ·ÙfiÌˆÓ Ô˘ ‰ÂÓ Â›¯·Ó ÂÌ‚ÔÏÈ·ÛÙÂ› ÛÙË Û˘ÓÈÛÙÒÌÂÓË ËÏÈÎ›· (ÙÔ ÔÔ›Ô ı· ‰È·ÚÎÔ‡ÛÂ ÙÔ ÚÒÙÔ ¤ÙÔ˜ ÙË˜ Î˘ÎÏÔÊÔÚ›·˜ ÙÔ˘ ÂÌ‚ÔÏ›Ô˘)

2006 Dynamic model ∫ÔÈÓˆÓ›·, 1. ∆·ÎÙÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ ÁÈ· 1. √ Ù·ÎÙÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ ¤¯ÂÈ ıÂÙÈÎ‹ Â›‰Ú·ÛË πÛ·Ó›· ∞ÛÊ·ÏÈÛÙÈÎ¿ ·È‰È¿ 1-2 ÂÙÒÓ Î·È ÛÙË ÓÔÛËÚfiÙËÙ· Ô˘ Û¯ÂÙ›˙ÂÙ·È ÌÂ ÙËÓ (35) ∆·ÌÂ›· 2. ∆·ÎÙÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ ÛÂ ·ÓÂÌÂ˘ÏÔÁÈ¿. ª¿ÏÈÛÙ· ·fi ÎÔÈÓˆÓÈÎ‹ ÛÎÔÈ¿

Û˘Ó‰˘·ÛÌfi ÌÂ ÂÌ‚ÔÏÈ·ÛÌfi Ë ÛÙÚ·ÙËÁÈÎ‹ ·˘Ù‹ ÂÌÊ·Ó›˙ÂÙ·È È‰È·›ÙÂÚ· ·ÙfiÌˆÓ Ô˘ ‰ÂÓ Â›¯·Ó ·Ô‰ÔÙÈÎ‹ ˆ˜ ÚÔ˜ ÙÔ ÎfiÛÙÔ˜ Â›ÙÂ ÏËÊıÂ› ÂÌ‚ÔÏÈ·ÛÙÂ› ÛÙË Û˘ÓÈÛÙÒÌÂÓË ˘fi„Ë ÙÔ ¤ÌÌÂÛÔ ÎfiÛÙÔ˜ Â›ÙÂ fi¯ÈËÏÈÎ›· (catch-up program) 2. ∞fi ÙË ÛÎÔÈ¿ ÙˆÓ ·ÛÊ·ÏÈÛÙÈÎÒÓ ÊÔÚ¤ˆÓ, Ô

Ù·ÎÙÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ ıÂˆÚÂ›Ù·È ·ÔÙÂÏÂ-ÛÌ·ÙÈÎfi˜ ˆ˜ ÚÔ˜ ÙÔ ÎfiÛÙÔ˜ ·Ó Î·È ·˘Í¿ÓÂÙ·ÈÏ›ÁÔ ÙÔ ÎfiÛÙÔ˜




√ ¶√À Û˘ÓÈÛÙ¿ ÙÔÓ Ù·ÎÙÈÎfi ÂÌ‚ÔÏÈ·ÛÌfi fiÏˆÓ

ÙˆÓ ·È‰ÈÒÓ ÛÙÈ˜ ¯ÒÚÂ˜ fiÔ˘ Ë ·ÓÂÌÂ˘ÏÔÁÈ¿ ·Ô-

ÙÂÏÂ› ÛËÌ·ÓÙÈÎfi Úfi‚ÏËÌ· ÙË˜ ‰ËÌfiÛÈ·˜ ˘ÁÂ›·˜

Î·È ÙË˜ ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎ‹˜ Î·Ù¿ÛÙ·ÛË˜ ÙË˜

¯ÒÚ·˜. ª¤¯ÚÈ ÙÔ 2004 ÙÔ ÂÌ‚fiÏÈÔ Î˘ÎÏÔÊÔÚÔ‡ÛÂ

ÛÙÈ˜ ÂÚÈÛÛfiÙÂÚÂ˜ Â˘Úˆ·˚Î¤˜ ¯ÒÚÂ˜ Î·È ÔÚÈÛÌ¤-

ÓÂ˜ ·fi ·˘Ù¤˜ ÙÔ Â›¯·Ó ÂÓÙ¿ÍÂÈ ÛÙÔÓ Ù·ÎÙÈÎfi ÂÌ‚Ô-

ÏÈ·ÛÌfi (40).

™˘˙‹ÙËÛË

∆· ÚÔÁÚ¿ÌÌ·Ù· ·ÓÔÛÔÔ›ËÛË˜ Â›Ó·È ¯ˆÚ›˜ ·Ì-

ÊÈ‚ÔÏ›· Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂÚË ·Ú¤Ì‚·ÛË ÁÈ· ÙË

ÌÂ›ˆÛË ÙË˜ ıÓËÛÈÌfiÙËÙ·˜, ÙË˜ ÓÔÛËÚfiÙËÙ·˜ Î·È ÙÔ˘

ÎfiÛÙÔ˘˜ Ô˘ Û¯ÂÙ›˙ÂÙ·È ÌÂ Ù· ÏÔÈÌÒ‰Ë ÓÔÛ‹Ì·Ù·.

∏ ·fiÊ·ÛË ÁÈ· ÙËÓ ¤ÓÙ·ÍË ÂÓfi˜ ÂÌ‚ÔÏ›Ô˘ ÛÙÔ

∂ıÓÈÎfi ¶ÚfiÁÚ·ÌÌ· ∂Ì‚ÔÏÈ·ÛÌÒÓ ÌÈ·˜ ¯ÒÚ·˜ Ï·Ì-

‚¿ÓÂÙ·È ‚¿ÛÂÈ ÂÈ‰ËÌÈÔÏÔÁÈÎÒÓ, ÔÈÎÔÓÔÌÈÎÒÓ, ÔÏÈ-

ÙÈÎÒÓ Î·È ÎÔÈÓˆÓÈÎÒÓ ÎÚÈÙËÚ›ˆÓ. ∏ ÙÂ¯ÓÈÎ‹ ÙË˜ ÔÈ-

ÎÔÓÔÌÈÎ‹˜ ·ÍÈÔÏfiÁËÛË˜, ·Ó Î·È ·ÊÔÚ¿ Ì›· ÌfiÓÔ

ÏÂ˘Ú¿ ·˘Ù‹˜ ÙË˜ ‰È·‰ÈÎ·Û›·˜, Â›Ó·È È‰È·›ÙÂÚ· ÛË-

Ì·ÓÙÈÎ‹ ÏfiÁˆ ·ÊÂÓfi˜ ÙË˜ Û·ÓÈfiÙËÙ·˜ ÙˆÓ ‰È·ı¤ÛÈ-

ÌˆÓ ÔÈÎÔÓÔÌÈÎÒÓ fiÚˆÓ Î·È ·ÊÂÙ¤ÚÔ˘ ÙˆÓ ·˘Í·Ófi-

ÌÂÓˆÓ ˘ÁÂÈÔÓÔÌÈÎÒÓ ·Ó·ÁÎÒÓ.

øÛÙfiÛÔ, ÔÈ ÌÂÏ¤ÙÂ˜ ÔÈÎÔÓÔÌÈÎ‹˜ ·ÍÈÔÏfiÁËÛË˜

‰ÂÓ ·ÔÙÂÏÔ‡Ó ÙÔ ÌÔÓ·‰ÈÎfi ÎÚÈÙ‹ÚÈÔ Ï‹„Ë˜ ·ÔÊ¿-

ÛÂˆÓ. ∞˘Ùfi Á›ÓÂÙ·È ÈÔ Î·Ù·ÓÔËÙfi ÛÙËÓ ÂÚ›ÙˆÛË

ÙˆÓ Ó¤ˆÓ ÂÌ‚ÔÏ›ˆÓ. ∞Ó Î·È ·fi ÔÈÎÔÓÔÌÈÎ‹˜ ÏÂ˘-

Ú¿˜ ÔÈ Û˘ÁÎÂÎÚÈÌ¤ÓÂ˜ ·ÚÂÌ‚¿ÛÂÈ˜ ‰ÂÓ ‹Ù·Ó ¿ÓÙÔ-

ÙÂ ÔÈ Ï¤ÔÓ ·Ô‰ÔÙÈÎ¤˜, ·fi È·ÙÚÈÎ‹˜ ·fi„Âˆ˜ ‹Ù·Ó

È‰È·›ÙÂÚ· ·ÔÙÂÏÂÛÌ·ÙÈÎ¤˜ Î·È ¤ÙÛÈ, ÌÔÚÔ‡Û·Ó Ó·

Î·ıËÛ˘¯¿ÛÔ˘Ó ¤Ó· ÌÂÁ¿ÏÔ ÙÌ‹Ì· ÙÔ˘ ÏËı˘ÛÌÔ‡

Ô˘ ·ÓËÛ˘¯Ô‡ÛÂ ÁÈ· ·˘Ù¿ Ù· ÏÔÈÌÒ‰Ë ÓÔÛ‹Ì·Ù·.

µÂ‚·›ˆ˜, Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÙˆÓ ÔÈÎÔÓÔÌÈÎÒÓ

·ÍÈÔÏÔÁ‹ÛÂˆÓ ‰ÂÓ Ì¤ÓÔ˘Ó ·ÓÂÎÌÂÙ¿ÏÏÂ˘Ù·. ∞ÓÙ›ıÂ-

Ù· Û˘Ì‚¿ÏÏÔ˘Ó ÛÙËÓ ÂÈÏÔÁ‹ ÙË˜ ·Ô‰ÔÙÈÎfiÙÂÚË˜

ÛÙÚ·ÙËÁÈÎ‹˜ ·ÓÔÛÔÔ›ËÛË˜ Î·È ÛÙÔÓ Û¯Â‰È·ÛÌfi ÙˆÓ

ÈÔ ·ÔÙÂÏÂÛÌ·ÙÈÎÒÓ ·ÚÂÌ‚¿ÛÂˆÓ.

∆· ‚·ÛÈÎ¿ ÂÚˆÙ‹Ì·Ù· ÛÙ· ÔÔ›· ÔÈ ‰È·ÌÔÚÊˆÙ¤˜

ÙË˜ ÔÏÈÙÈÎ‹˜ ˘ÁÂ›·˜ Î·ÏÔ‡ÓÙ·È Ó· ··ÓÙ‹ÛÔ˘Ó

ÚÈÓ Ï¿‚Ô˘Ó ÔÔÈ·‰‹ÔÙÂ ·fiÊ·ÛË Â›Ó·È (41):

1. √È ÛÙÚ·ÙËÁÈÎ¤˜ ·ÓÔÛÔÔ›ËÛË˜ ı· ÌÂÈÒÛÔ˘Ó

ÙËÓ Â›ÙˆÛË ÙË˜ ÓfiÛÔ˘;

2. ¶ÔÈÔ Â›Ó·È ÙÔ ·Ó·ÌÂÓfiÌÂÓÔ fiÊÂÏÔ˜ ÁÈ· ÙËÓ

˘ÁÂ›·;

3. ™Â fiÛÔ ¯ÚfiÓÔ ı· Á›ÓÔ˘Ó ÂÌÊ·Ó‹ ·˘Ù¿ Ù·

ÔÊ¤ÏË;

4. ¶fiÛÔ ÎÔÛÙ›˙ÂÈ Ë ÛÙÚ·ÙËÁÈÎ‹ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Î·È

ÔÈÔ ÙÔ ÎfiÛÙÔ˜ Ô˘ ·ÔÙÚ¤ÂÙ·È;

5. ∆· ·ÔÙÂÏ¤ÛÌ·Ù· ·Ú·Ì¤ÓÔ˘Ó ›‰È·, ·Ó ·ÏÏ¿-

ÍÔ˘Ó Î¿ÔÈÂ˜ ·fi ÙÈ˜ ·Ú·Ì¤ÙÚÔ˘˜;

6. ¶ÔÈÔ˜ Â›Ó·È Ô ·Ô‰ÂÎÙfi˜ ‰Â›ÎÙË˜ ÎfiÛÙÔ˘˜-

·ÔÙÂÏ¤ÛÌ·ÙÔ˜ ÁÈ· Ù· ÚÔÁÚ¿ÌÌ·Ù· ÂÌ‚ÔÏÈ·ÛÌÔ‡;

√˘ÛÈ·ÛÙÈÎ¿ ÔÈ ˘Â‡ı˘ÓÔÈ Ï‹„Ë˜ ·ÔÊ¿ÛÂˆÓ

Ú¤ÂÈ Ó· ÛÙ·ıÌ›ÛÔ˘Ó Î·È Ó· Û˘Ì‚È‚¿ÛÔ˘Ó ÙÔ˘˜ ÂÈ-

‰ËÌÈÔÏÔÁÈÎÔ‡˜, ÔÈÎÔÓÔÌÈÎÔ‡˜, ÎÔÈÓˆÓÈÎÔ‡˜ Î·È Ô-

ÏÈÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜ ÒÛÙÂ Ó· Ï¿‚Ô˘Ó ÙËÓ ÈÔ ·Ô-

ÙÂÏÂÛÌ·ÙÈÎ‹, ·Ô‰ÔÙÈÎ‹ Î·È ÎÔÈÓˆÓÈÎ¿ ·Ô‰ÂÎÙ‹

·fiÊ·ÛË.

∂˘¯·ÚÈÛÙ›Â˜

∂˘¯·ÚÈÛÙÔ‡ÌÂ ÔÏ‡ ÁÈ· ÙËÓ ÔÏ‡ÙÈÌË Û˘Ì‚ÔÏ‹ ÙÔ˘ ÛÙËÓ

·Ó·˙‹ÙËÛË ÙË˜ ‚È‚ÏÈÔÁÚ·Ê›·˜ -ÂÈ‰ÈÎ¿ fiÛÔÓ ·ÊÔÚ¿ ÛÙÔ ÂÌ‚fi-

ÏÈÔ ÙË˜ ·ÓÂÌÂ˘ÏÔÁÈ¿˜- ÙÔÓ Î. ∫ˆÙÛfiÔ˘ÏÔ ¡›ÎÔ, Health

Economics Manager ÛÙËÓ ÂÙ·ÈÚÂ›· GlaxoSmithCline.


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sources? (in other words are they cost-effective?). Vaccine

1999;17:S69-S73.

2. Van Damme P, Beutels P. Economic evaluation of vaccina-

tion. Pharmacoeconomics 1996;9:8-15.

3. Ess SM, Szucs TD. Economic evaluation of immunization

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4. Spier R, Jefferson TO, Demicheli V. An editorial policy

statement: Submission of economic evaluation of vaccines.

[Editorial]. Vaccine 2002;20:1693-1695.

5. Kimman TG, Boot HJ, Berbers GA, Vermeer-de Bondt PE,

Ardine de Wit G, de Melker HE. Developing a vaccination

evaluation model to support evidence-based decision mak-

ing on national immunization programs. Vaccine 2006;24:

4769-4778.

6. Drummond MF, O’ Brien BJ, Stoddart GL, Torrance G.

ª¤ıÔ‰ÔÈ ÔÈÎÔÓÔÌÈÎ‹˜ ·ÍÈÔÏfiÁËÛË˜ ÙˆÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ

˘ÁÂ›·˜. ∞ı‹Ó·: ∂Î‰fiÛÂÈ˜ ∫ÚÈÙÈÎ‹. 2002.

7. Szucs TD. Health economic research on vaccinations and

immunisation practices - an introductory primer. Vaccine

2005;23:2095-2103.

8. Chabot I, Goetghebeur MM, Gregoire JP. The societal val-

ue of universal childhood vaccination. Vaccine 2004;22:

1992-2005.

9. Szucs ∆. Cost-benefits of vaccination programmes. Vac-

cine 2000;18:S49-S51.

10. ¶···Ó·ÁÈÒÙÔ˘ π, ∫˘ÚÈ·˙ÔÔ‡ÏÔ˘-¢·Ï·˝Ó· µ. π·ÙÚÈÎ‹

ÌÈÎÚÔ‚ÈÔÏÔÁ›· Î·È ÈÔÏÔÁ›·. £ÂÛÛ·ÏÔÓ›ÎË: ∂Î‰fiÛÂÈ˜

University Studio Press. 2001.

11. Wyeth Hellas [Webpage, Internet]. £ÂÚ·Â˘ÙÈÎ‹ ÂÓfiÙËÙ·:

ªËÓÈÁÁ›ÙÈ‰·. http://www.wyeth.gr/th_areas/th_area_main.

asp?th_ar_id=32

12. World Health Organization [Webpage, Internet]. Menin-

gitis. http://www.who.int/topics/meningitis/en

13. ∂ıÓÈÎfi˜ √ÚÁ·ÓÈÛÌfi˜ º·ÚÌ¿ÎˆÓ, ∂√º [Webpage, Inter-

net]. http://www.eof.gr

14. Trotter CL, Edmunds WJ. Modelling cost-effectiveness of

meningococcal serogroup C conjugate vaccination cam-

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van Alphen L, Spanjaard L, et al, Economic evaluation of

meningococcal serogroup C conjugate vaccination pro-

grammes in The Netherlands and its impact on decision-

making. Vaccine 2004;23:470-479.


¶·È‰È·ÙÚÈÎ‹ 2008;71:148-156


17. De Wals P, Nguyen VH, Erickson LJ, Guay M, Drapeau J,St-Laurent J. Cost-effectiveness of immunization strategiesfor the control of serogroup C meningococcal disease. Vac-cine 2004;22:1233-1240.

18. Beutels P, Thiry N, Van Damme P. Convincing or confus-ing? Economic evaluations of childhood pneumococcalconjugate vaccination - a review (2002-2006). Vaccine 2007;25:1355-1367.

19. Zissis NP, Syriopoulou V, Kafetzis D, Daikos GL, Tsil-imingaki A, Galanakis E, et al. Serotype distribution andantimicrobial susceptibility of Streptococcus pneumoniaecausing invasive infections and acute otitis media in chil-dren. Eur J Pediatr 2004;163:364-368.

20. Black S, Lieu TA, Ray GT, Capra A, Shinefield HR. Assess-ing costs and cost effectiveness of pneumococcal diseaseand vaccination within Kaiser Permanente. Vaccine 2000;19:S83-S86.

21. De Wals P, Petit G, Erickson LJ, Guay M, Tam T, Law B, etal. Benefits and costs of immunization of children withpneumococcal conjugate vaccine in Canada. Vaccine2003;21:3757-3764.

22. Bos JM, Rumke H, Welte R, Postma MJ. Epidemiologicimpact and cost-effectiveness of universal infant vaccina-tion with a 7-valent conjugated pneumococcal vaccine inthe Netherlands. Clin Ther 2003;25:2614-2630.

23. Claes C, Schulenburg JM Graf von der. Cost effectivenessof pneumococcal vaccination for infants and children withthe conjugate vaccine PnC-7 in Germany. Pharmacoeco-nomics 2003;21:587-600.

24. Asensi F, De Jose M, Lorente M, Moraga F, Ciuryla V,Arikian S, et al. A pharmacoeconomic evaluation of seven-valent pneumococcal conjugate vaccine in Spain. ValueHealth 2004;7:36-51.

25. Butler JR, McIntyre P, MacIntyre CR, Gilmour R, HowarthAL, Sander B. The Cost- Effectiveness of pneumococcal con-jugate vaccination in Australia. Vaccine 2004;22:1138-1149.

26. McIntosh ED, Conway P, Willingham J, Hollingsworth R,Lloyd A. Pneumococcal pneumonia in the UK - how herdimmunity affects the cost-effectiveness of 7-valent pneumo-coccal conjugate vaccine (PCV). Vaccine 2005;23:1739-1745.

27. Marchetti M, Colombo GL. Cost-effectiveness of universalpneumococcal vaccination for infants in Italy. Vaccine2005;23:4565-4576.

28. Wisloff T, Abrahamsen T, Bergsaker MA, Lovoll O, MollerP, Pedersen MK, et al. Cost effectiveness of adding 7-valentpneumococcal conjugate (PCV-7) vaccine to the Norwe-gian childhood vaccination program. Vaccine 2006;24:5690-5699.

29. Ray GT, Whitney CG, Fireman BH, Ciuryla V, Black SB.Cost-effectiveness of pneumococcal conjugate vaccine: evi-dence from the first 5 years of use in the United States incor-porating herd effects. Pediatr Infect Dis J 2006;25:494-501.

30. GlaxoSmithCline [Webpage, Internet]. Varilrix http://emc.medicines.org.uk/emc/assets/c/html/displaydoc.asp?docu-mentid=9453

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32. Brisson M, Edmunds WJ. The cost-effectiveness of varicel-la vaccination in Canada. Vaccine 2002;20:1113-1125.

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34. Coudeville L, Paree F, Lebrun T, Sailly J. The value of vari-cella vaccination in healthy children: cost-benefit analysisof the situation in France. Vaccine 1999;17:142-151.

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157¶ƒ∞∫∆π∫√ £∂ª∞ PRACTICAL ISSUE

¶·È‰È·ÙÚÈÎ‹ 2008;71:157-161

¢È·ÙÚÔÊ‹ ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ ÁÈ· ÚÔ·ÁˆÁ‹ ÙË˜ ˘ÁÂ›·˜ Î·È

ÙË˜ ·Ó¿Ù˘ÍË˜ Î·È ÚfiÏË„Ë ÙˆÓ ¯ÚfiÓÈˆÓ ÓÔÛËÌ¿ÙˆÓ

∞. ∫·Ê¿ÙÔ˜

¶ÂÚ›ÏË„Ë: ∏ ÂÈ‰ËÌÈÎ‹ ¤Í·ÚÛË ÙË˜ ·È‰ÈÎ‹˜ ·¯˘Û·ÚÎ›·˜ ·fi ÙË ‰ÂÎ·ÂÙ›· ÙÔ˘ 1980 Ì¤¯ÚÈ Û‹ÌÂÚ· Î·-ıÈÛÙ¿ ·Ó·ÁÎ·›· ÙËÓ ÂÓËÌ¤ÚˆÛË ÙˆÓ ·È‰È¿ÙÚˆÓ Î·È ÙˆÓ ÁÔÓÈÒÓ ÁÈ· ÙË ÛˆÛÙ‹ ‰È·ÙÚÔÊ‹ ÙˆÓ ·È‰ÈÒÓ. ∏ÂÓËÌ¤ÚˆÛË ·˘Ù‹ ı· ‚ÔËı‹ÛÂÈ ÛÙËÓ ·ÔÊ˘Á‹ ÙÚÔÊ›ÌˆÓ ˘„ËÏ‹˜ ÂÓÂÚÁÂÈ·Î‹˜ ˘ÎÓfiÙËÙ·˜, ÁÈ· ·Ú¿-‰ÂÈÁÌ· ·Ù¿ÙÂ˜ ÙÛÈ˜ ÌÂ 530 kcal/100 ÁÚ·Ì., ÌÈÛÎfiÙ· ÌÂ ÛÔÎÔÏ¿Ù· ÌÂ 524 kcal/100 ÁÚ·Ì. Î·È ¯·ÌËÏ‹˜ÂÚÈÂÎÙÈÎfiÙËÙ·˜ ÛÂ ıÚÂÙÈÎ¿ Û˘ÛÙ·ÙÈÎ¿. ∆· ÙÚfiÊÈÌ· ·˘Ù¿ ÚÔÛÊ¤ÚÔ˘Ó ÂÏ¿¯ÈÛÙ· ıÚÂÙÈÎ¿ Û˘ÛÙ·ÙÈÎ¿Ô˘ Â›Ó·È ··Ú·›ÙËÙ· ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË Î·È ÙËÓ ÚÔ·ÁˆÁ‹ ÙË˜ ˘ÁÂ›·˜. ∆· ··Ú·›ÙËÙ· ıÚÂÙÈÎ¿ Û˘ÛÙ·-ÙÈÎ¿ ÂÍ·ÛÊ·Ï›˙ÔÓÙ·È fiÙ·Ó Ï·Ì‚¿ÓÔÓÙ·È ÔÈ Û˘ÓÈÛÙÒÌÂÓÂ˜ ÌÂÚ›‰Â˜ ·fi Î·ıÂÌÈ¿ ·fi ÙÈ˜ 5 Î·ÙËÁÔÚ›Â˜ ÙÚÔ-Ê›ÌˆÓ Î·È Î·Ù·Ó¤ÌÔÓÙ·È ÛÂ 3 Î‡ÚÈ· Î·È 2 ÌÈÎÚfiÙÂÚ· ÂÓ‰È¿ÌÂÛ· ÁÂ‡Ì·Ù·. ∞·ÈÙÂ›Ù·È È‰È·›ÙÂÚË ÚÔÛ¿-ıÂÈ· ÂÎ Ì¤ÚÔ˘˜ ÙˆÓ ÁÔÓÈÒÓ, ÒÛÙÂ Ó· ¤¯Ô˘Ó Ù· ·È‰È¿ 2-3 ÁÂ‡Ì·Ù· ÙËÓ Â‚‰ÔÌ¿‰· ÌÂ ÌÈÎÚ¿ ÏÈ·Ú¿ „¿-ÚÈ·, 2-8 ÌÂÚ›‰Â˜ Ï·¯·ÓÈÎÒÓ ËÌÂÚËÛ›ˆ˜, ·Ó¿ÏÔÁ· ÌÂ ÙËÓ ËÏÈÎ›·, 2-5 ÊÚÔ‡Ù· ÙËÓ ËÌ¤Ú·, 2-3 ÌÂÚ›‰Â˜ Á·-Ï·ÎÙÔÎÔÌÈÎÒÓ, ÂÏ¿¯ÈÛÙÔ ÎfiÎÎÈÓÔ ÎÚ¤·˜ Î·È Î·ıfiÏÔ˘ ÂÂÍÂÚÁ·ÛÌ¤ÓÔ ÎÚ¤·˜ (.¯. ˙·ÌfiÓ). ∆Ô ·Ú¿‰ÂÈÁ-Ì· ÙˆÓ ÁÔÓÈÒÓ ¯ˆÚ›˜ ÏfiÁÈ· Â›Ó·È Ô Î·Ï‡ÙÂÚÔ˜ ÙÚfiÔ˜ ‰È‰·ÛÎ·Ï›·˜ (ÛÙËÓ ¿ÛÎËÛË Î·È ÛÙÔ Ê·ÁËÙfi). ∏‰È·ÙÚÔÊ‹ ÙˆÓ ·È‰ÈÒÓ, ‚·ÛÈÛÌ¤ÓË ÛÙÔÓ ·Ú·‰ÔÛÈ·Îfi ÙÚfiÔ ‰È·ÙÚÔÊ‹˜ ÙˆÓ ∂ÏÏ‹ÓˆÓ Ì·˙› ÌÂ ÙÔ˘Ï¿¯È-ÛÙÔÓ 2-3 ÒÚÂ˜ ¤ÓÙÔÓË˜ ÛˆÌ·ÙÈÎ‹˜ ¿ÛÎËÛË˜ Î·ıËÌÂÚÈÓ¿, ı· ÂÍ·ÛÊ·Ï›ÛÂÈ ¿ÚÈÛÙË ·Ó¿Ù˘ÍË Î·È ÚfiÏË„ËÙˆÓ ¯ÚfiÓÈˆÓ ÓÔÛËÌ¿ÙˆÓ.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ¢È·ÙÚÔÊ‹ ·È‰ÈÒÓ, ·Ó¿Ù˘ÍË, ·¯˘Û·ÚÎ›·, ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù·, ıÚÂÙÈÎ¿ Û˘ÛÙ·ÙÈÎ¿, ÛˆÌ·ÙÈÎ‹

¿ÛÎËÛË.

Childhood and adolescent nutrition for promoting health and

growth and preventing chronic diseases

A. Kafatos

Abstract: Paediatric obesity has been increasing since the 1980s in an epidemic mode. Due to this fact,it has become necessary to provide information for paediatricians and parents about the dietappropriate for growth and avoidance of obesity of children. The primary target should be theelimination of foods of high energy density and low nutrient content (e.g., chips, chocolate biscuits)from the diet of children, with emphasis on the traditional Greek diet. The intake of essential nutrientsis ensured when children consume the recommended portions from each of the 5 categories of foods,and when these portions are distributed between 3 main and 2 smaller intermediate meals on a dailybasis. Particular effort is required on the part of the parents to ensure that children consume 2-3portions of small oily fish per week, 2-8 portions of vegetables daily, depending on age, and 2-5portions of fruits and 2-3 portions of dairy products on a daily basis. The best way of teaching childrenabout diet and physical activity is for parents to set an example by practising these habits themselves athome. The adoption of the traditional Greek diet, low in saturated fat and high in olive oil, vegetables,fruit and legumes, with at least 2-3 hours of daily intense physical activity will ensure excellent growthand development of the children and help in the prevention of chronic diseases.

Key words: Childhood nutrition, growth, obesity, chronic diseases, nutrients, physical activity.

∫ÏÈÓÈÎ‹ ¶ÚÔÏËÙÈÎ‹˜π·ÙÚÈÎ‹˜ Î·È ¢È·ÙÚÔÊ‹˜, ∆Ì‹Ì· π·ÙÚÈÎ‹˜, ¶·ÓÂÈÛÙ‹ÌÈÔ ∫Ú‹ÙË˜


∞ÓÙÒÓË˜ ∫·Ê¿ÙÔ˜[email protected]∫ÏÈÓÈÎ‹ ¶ÚÔÏËÙÈÎ‹˜π·ÙÚÈÎ‹˜ Î·È ¢È·ÙÚÔÊ‹˜, ∆Ì‹Ì· π·ÙÚÈÎ‹˜,¶·ÓÂÈÛÙ‹ÌÈÔ ∫Ú‹ÙË˜

Division of PreventiveMedicine and Nutrition, Faculty of Medicine, University of Crete

Correspondence:

Antonis [email protected] of PreventiveMedicine and Nutrition, Faculty of Medicine, University of Crete

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ıËÏ·ÛÌÔ‡ Ì¤¯ÚÈ ÙÔ 12Ô Ì‹Ó· ÌÂ ÚÔÔ‰Â˘ÙÈÎ‹ ÚÔ-

Ûı‹ÎË ¿ÏÏˆÓ ÙÚÔÊÒÓ. ∆Ô ÓÔÛËÏÂ˘ÙÈÎfi ÚÔÛˆÈÎfi

Î·È ÔÈ ÁÈ·ÙÚÔ› ÛÙ· Ì·ÈÂ˘Ù‹ÚÈ· ‰ÂÓ ı· Ú¤ÂÈ Ó· ÂÈ-

ÙÚ¤Ô˘Ó ÛÙÔ˘˜ ·ÓÙÈÚÔÛÒÔ˘˜ ÙˆÓ ·È‰ÈÎÒÓ ÙÚÔ-

ÊÒÓ Ó· ‰›ÓÔ˘Ó ‰ÒÚ· ÛÙÈ˜ ÌËÙ¤ÚÂ˜ Ô‡ÙÂ Ó· ‰ÔıÂ› Í¤ÓÔ

Á¿Ï· ÌÂ ÌÈÌÂÚfi ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi. ∏ ¯ÔÚ‹ÁËÛË ÌÈ-

ÌÂÚÔ‡ ÚÈÓ ·fi ÙËÓ ¤Ó·ÚÍË ÙÔ˘ ıËÏ·ÛÌÔ‡ ·ÔÎÏÂ›-

ÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· ÂÈÙ˘¯Ô‡˜ ıËÏ·ÛÌÔ‡. √ ·ÔÎÏÂÈ-

ÛÙÈÎfi˜ ıËÏ·ÛÌfi˜ ¤¯ÂÈ ÔÏÏ¿ ÏÂÔÓÂÎÙ‹Ì·Ù· ¤Ó·ÓÙÈ

ÙÔ˘ ·ÁÂÏ·‰ÈÓÔ‡ Á¿Ï·ÙÔ˜, ·ÏÏ¿ Î˘Ú›ˆ˜ ÂÏ·ÙÙÒÓÂÈ ÙËÓ

Èı·ÓfiÙËÙ· ÌÂÏÏÔÓÙÈÎ‹˜ ·¯˘Û·ÚÎ›·˜ Î·È fiÏˆÓ ÙˆÓ

Û˘ÓÔ‰ÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ (˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·˜,

˘¤ÚÙ·ÛË˜, Û·Î¯·ÚÒ‰Ô˘˜ ‰È·‚‹ÙË Ù‡Ô˘ 2 Î·È ·˘ÍË-

Ì¤ÓÔ˘ Î›Ó‰˘ÓÔ˘ ÛÂ ÔÚÈÛÌ¤ÓÔ˘˜ Î·ÚÎ›ÓÔ˘˜, Î.¿.).

ªÂÙ¿ ÙËÓ ËÏÈÎ›· ÙˆÓ 6 ÌËÓÒÓ ÙÔ˘ ·ÔÎÏÂÈÛÙÈÎÔ‡

ıËÏ·ÛÌÔ‡ Ú¤ÂÈ Ó· ·Ú¯›ÛÂÈ ÚÔÔ‰Â˘ÙÈÎ‹ ÂÈÛ·ÁˆÁ‹

fiÏˆÓ ÙˆÓ ÙÚÔÊÒÓ ÛÙË ‰È·ÙÚÔÊ‹ ÙˆÓ ·È‰ÈÒÓ Î·È Û˘-

Ó¤¯ÈÛË ÙÔ˘ ıËÏ·ÛÌÔ‡ Ì¤¯ÚÈ ÙÔ 12Ô Ì‹Ó·.

∏ Î·ıËÌÂÚÈÓ‹ ‰È·ÙÚÔÊ‹ ÙÔ˘ ·È‰ÈÔ‡ ıÂˆÚÂ›Ù·È

¿ÚÈÛÙË fiÙ·Ó ÂÚÈ¤¯ÂÈ ÙÚfiÊÈÌ· Î·È ·fi ÙÈ˜ 5 Î·ÙËÁÔ-

Ú›Â˜ ÙˆÓ ÙÚÔÊ›ÌˆÓ Ô˘ Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2 (8).

√È ··Ú·›ÙËÙÂ˜ ÌÂÚ›‰Â˜ Î·È ÙÔ Ì¤ÁÂıfi˜ ÙÔ˘˜ ÂÍ·ÚÙÒ-

ÓÙ·È ·fi ÙËÓ ËÏÈÎ›· Î·È ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÂ ·˘Ùfi ÙÔÓ

›Ó·Î·. ∏ ÂÈÏÔÁ‹ ÙˆÓ ··Ú·›ÙËÙˆÓ ÌÂÚ›‰ˆÓ ÁÈ· Î¿-

ıÂ ËÏÈÎ›· ·fi fiÏÂ˜ ÙÈ˜ Î·ÙËÁÔÚ›Â˜ ÙÚÔÊ›ÌˆÓ Î·ıËÌÂ-

ÚÈÓ¿ ÂÍ·ÛÊ·Ï›˙ÂÈ ÙË Ï‹„Ë fiÏˆÓ ÙˆÓ ··Ú·›ÙËÙˆÓ

ıÚÂÙÈÎÒÓ Û˘ÛÙ·ÙÈÎÒÓ ÛÙÈ˜ Û˘ÓÈÛÙÒÌÂÓÂ˜ ÔÛfiÙËÙÂ˜.

∆· ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙË˜ ¿ÚÈÛÙË˜ ‰È·ÙÚÔÊ‹˜ ÙÔ˘

·È‰ÈÔ‡ Î·È ÂÊ‹‚Ô˘ Â›Ó·È Ù· ·ÎfiÏÔ˘ı· (9):

1. ¶ÔÈÎÈÏ›· ÛÙË ‰È·ÙÚÔÊ‹ ÌÂ ÂÈÏÔÁ‹ ÙÚÔÊ›ÌˆÓ

Î·ıËÌÂÚÈÓ¿ ·’ fiÏÂ˜ ÙÈ˜ 5 Î·ÙËÁÔÚ›Â˜ Ô˘ ı· Î·Ù·-

Ó¤ÌÔÓÙ·È ÛÂ ÙÚ›· Î‡ÚÈ· ÁÂ‡Ì·Ù· Î·È 2-3 ÌÈÎÚfiÙÂÚ·

ÂÓ‰È¿ÌÂÛ·, .¯. Ï›ÁÔ „ˆÌ›, Ù˘Ú›, ÊÚÔ‡ÙÔ, ÁÈ·Ô‡ÚÙÈ,

¤Ó· Î·ÚfiÙÔ, ÌÈ· ÓÙÔÌ¿Ù·, Î.¿. (¶›Ó·Î·˜ 2).

2. ¡· ÌËÓ ÚÔÛÙ›ıÂÙ·È Î·ıfiÏÔ˘ ·Ï¿ÙÈ Î·È ̇ ¿¯·ÚË

Ô‡ÙÂ Î·Ù¿ ÙÔ Ì·ÁÂ›ÚÂÌ· Ô‡ÙÂ Î·Ù¿ ÙÔ ÛÂÚ‚›ÚÈÛÌ·.

3. ¡· ¯ÚËÛÈÌÔÔÈÂ›Ù·È ·ÔÎÏÂÈÛÙÈÎ¿ ·ÁÓfi ·Ú-

ı¤ÓÔ ÂÏ·ÈfiÏ·‰Ô Î·Ù¿ ÚÔÙ›ÌËÛË ˆÌfi Î·È Î·ıfiÏÔ˘

Ì·ÚÁ·Ú›ÓÂ˜, ÛÔÚ¤Ï·ÈÔ, ‚Ô‡Ù˘ÚÔ ‹ ¿ÏÏ· ˙ˆÈÎ¿ Î·È

Ê˘ÙÈÎ¿ Ï›Ë.

4. ¡· ÌËÓ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÂÂÍÂÚÁ·ÛÌ¤Ó·

ÙÚfiÊÈÌ· ÌÂ Ï‹ıÔ˜ ÚfiÛıÂÙˆÓ Ô˘ÛÈÒÓ, fiˆ˜ ÂÂ-

ÍÂÚÁ·ÛÌ¤Ó· ÎÚ¤·Ù· (·ÏÏ·ÓÙÈÎ¿, ˙·ÌfiÓ, ÏÔ˘Î¿ÓÈÎ·,

Î.¿.), ÌÈÛÎfiÙ·, ÛÔÎÔÏ¿ÙÂ˜, ¤ÙÔÈÌÂ˜ ·È‰ÈÎ¤˜ ÙÚÔ-

Ê¤˜, ·Ù·Ù¿ÎÈ·, Á·ÚÈ‰¿ÎÈ·, ÎÚÔ˘·Û¿Ó, Î.¿. ¡· ·Ô-

ÊÂ‡ÁÔÓÙ·È Ù· Ù·¯˘ÂÛÙÈ·ÙfiÚÈ· ÁÈ·Ù› Ù· Ê·ÁËÙ¿ ÙÔ˘˜

Â›Ó·È ˘„ËÏ‹˜ ÂÓÂÚÁÂÈ·Î‹˜ ˘ÎÓfiÙËÙ·˜ Î·È ¤¯Ô˘Ó


159¢È·ÙÚÔÊ‹ ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ

¶·È‰È·ÙÚÈÎ‹ 2008;71:157-161

ÌÂÁ¿ÏË ÔÛfiÙËÙ· ÏÈÒÓ Î·È È‰È·›ÙÂÚ· ÎÔÚÂÛÌ¤ÓÔ˘

Ï›Ô˘˜, Î·ıÒ˜ Î·È ÔÏ‡ ·Ï¿ÙÈ Î·È ÔÏÏ‹ ˙¿¯·ÚË.

5. ¡· ·ÔÊÂ‡ÁÔÓÙ·È ·Ó·„˘ÎÙÈÎ¿ Ô˘ ÂÚÈ¤¯Ô˘Ó

ÌfiÓÔ ˙¿¯·ÚË (˘„ËÏfi ÁÏ˘Î·ÈÌÈÎfi ÊÔÚÙ›Ô), Î·ıÒ˜ Î·È

¯˘ÌÔ› ÊÚÔ‡ÙˆÓ ÌÂ ·ÌÊ›‚ÔÏË ÂÚÈÂÎÙÈÎfiÙËÙ· Ê˘ÛÈ-

ÎÔ‡ ¯˘ÌÔ‡. ¶ÚÔÙÂÚ·ÈfiÙËÙ· Ú¤ÂÈ Ó· ¤¯Ô˘Ó Ù·

ÊÚÔ‡Ù· Î·È ÌÂÙ¿ Ô ÊÚ¤ÛÎÔ˜ ¯˘Ìfi˜ ÊÚÔ‡ÙˆÓ (Ù·

ÊÚÔ‡Ù· ¤¯Ô˘Ó ¯·ÌËÏfiÙÂÚÔ ÁÏ˘Î·ÈÌÈÎfi ÊÔÚÙ›Ô ·fi

ÙÔ˘˜ ÊÚ¤ÛÎÔ˘˜ ¯˘ÌÔ‡˜ ÊÚÔ‡ÙˆÓ).

6. ¡· ÚÔÙÈÌÒÓÙ·È ÈÛÙÔÔÈËÌ¤Ó· ‚ÈÔÏÔÁÈÎ¿

ÚÔ˚fiÓÙ·.

7. ¡· ‰›ÓÂÙ·È ÚÔÙÂÚ·ÈfiÙËÙ· ÛÂ „¿ÚÈ Î·È ı·Ï·Û-

ÛÈÓ¿ ÌÂ 3-4 ÁÂ‡Ì·Ù· ÙËÓ Â‚‰ÔÌ¿‰·, Î˘Ú›ˆ˜ ÌÈÎÚ¿ ÏÈ-

·Ú¿ „¿ÚÈ·, ÒÛÙÂ Ó· Ï·Ì‚¿ÓÔÓÙ·È Ù· ··Ú·›ÙËÙ·

ˆ-3 ÏÈ·Ú¿ ÔÍ¤· Î·È Ë ‚ÈÙ·Ì›ÓË D. ∞ÎÔÏÔ˘ıÔ‡Ó Ù·

Ô˘ÏÂÚÈÎ¿ Î·È Û·ÓÈfiÙÂÚ· ÙÔ ÎfiÎÎÈÓÔ ÎÚ¤·˜ (ÌÔ-

Û¯¿ÚÈ, Î·ÙÛ›ÎÈ, ·ÚÓ›, ¯ÔÈÚÈÓfi). ∆· fiÛÚÈ· Ú¤ÂÈ Ó·

¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Û˘¯Ó¿.

8. ¡· ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Û˘¯Ó¿ ·Ó¿Ï·ÙÔÈ ÍËÚÔ›

Î·ÚÔ›, Î˘Ú›ˆ˜ Î·Ú‡‰È·, 2-3 ÊÔÚ¤˜ ÙËÓ Â‚‰ÔÌ¿‰·.

9. ∏ ¿ÚÈÛÙË ‰È·ÙÚÔÊ‹ Ú¤ÂÈ Ó· Û˘Ó‰˘¿˙ÂÙ·È ÌÂ

Î·ıËÌÂÚÈÓ‹ Ì¤ÙÚÈ· ÚÔ˜ ¤ÓÙÔÓË ÛˆÌ·ÙÈÎ‹ ¿ÛÎËÛË

ÁÈ· 2 ÙÔ˘Ï¿¯ÈÛÙÔÓ ÒÚÂ˜. ∞ÎfiÌË Î·È Ô ıËÏ·ÛÌfi˜ ÚÔ-

ÛÊ¤ÚÂÈ ÂÚÈÛÛfiÙÂÚË ÛˆÌ·ÙÈÎ‹ ¿ÛÎËÛË ÛÙÔ ‚Ú¤ÊÔ˜,

ÁÈ·Ù› Á›ÓÂÙ·È ÚÔÛ¿ıÂÈ· Ó· ¿ÚÂÈ ÙÔ Á¿Ï· ·fi ÙË

ÌËÙ¤Ú· ÛÂ ·ÓÙ›ıÂÛË ÌÂ ÙÔ ÌÈÌÂÚfi Ô˘ ·‰ÂÈ¿˙ÂÈ

ÔÏ‡ ÁÚ‹ÁÔÚ· Î·È Â‡ÎÔÏ·.

10. ¡· ÂÎÙ›ıÂÙ·È ÙÔ ‚Ú¤ÊÔ˜ Î·È ÙÔ ·È‰› ÛÙÔÓ

‹ÏÈÔ ÌÂ Á˘ÌÓ¿ ¯¤ÚÈ· Î·È fi‰È· ÁÈ· 10-30 ÏÂÙ¿ Î·-

ıËÌÂÚÈÓ¿. ªÂ ÙË ‚Ô‹ıÂÈ· ÙÔ˘ ‹ÏÈÔ˘ ·Ú¿ÁÂÙ·È Ë

¶›Ó·Î·˜ 1.

§ÈÔ‰È·Ï˘Ù¤˜ µÈÙ·Ì›ÓÂ˜

∏ÏÈÎ›· ∂Ó¤ÚÁÂÈ· ¶ÚˆÙÂ˝ÓË µÈÙ·Ì›ÓË ∞ µÈÙ·Ì›ÓË D µÈÙ·Ì›ÓË ∂ µÈÙ·Ì›ÓË ∫(¤ÙË) (kcal) (g) (Ìg RE) (Ìg) (mg ·-TE) (Ìg)

µÚ¤ÊË 0-6 650 13 400 5 4 27-12 850 14 500 5 5 2,5

¶·È‰È¿ 1-3 1300 16 300 5 6 304-8 1800 24 400 5 7 55

∞ÁfiÚÈ· 9-13 2500 45 600 5 11 6014-18 3000 59 900 5 15 75

∫ÔÚ›ÙÛÈ· 9-13 2200 46 600 5 11 6014-18 2200 44 700 5 15 75

À‰ÚÔ‰È·Ï˘Ù¤˜ µÈÙ·Ì›ÓÂ˜∏ÏÈÎ›· µÈÙ·Ì›ÓË C £ÂÈ·Ì›ÓË ƒÈ‚ÔÊÏ·‚›ÓË ¡È·Û›ÓË µÈÙ·Ì›ÓË µ6 º˘ÏÏÈÎfi µÈÙ·Ì›ÓË µ12(¤ÙË) (mg) (mg) (mg) (mgNE) (mg) √Í‡ (Ìg) (Ìg)

µÚ¤ÊË 0-6 40 0,2 0,3 2 0,1 65 0,47-12 50 0,3 0,4 4 0,3 80 0,5

¶·È‰È¿ 1-3 40 0,5 0,5 6 0,5 150 0,94-8 45 0,6 0,6 8 0,6 200 1,2

∞ÁfiÚÈ· 9-13 45 0,9 0,9 12 1,0 300 1,814-18 75 1,2 1,3 16 1,3 400 2,4

∫ÔÚ›ÙÛÈ· 9-13 50 0,9 0,9 12 1,0 400 1,814-18 65 1,0 1,0 14 1,2 400 2,4

π¯ÓÔÛÙÔÈ¯Â›·∏ÏÈÎ›· ∞Û‚¤ÛÙÈÔ ºÒÛÊÔÚÔ˜ ª·ÁÓ‹ÛÈÔ ™›‰ËÚÔ˜ æÂ˘‰¿ÚÁ˘ÚÔ˜ πÒ‰ÈÔ ™ÂÏ‹ÓÈÔ(¤ÙË) (mg) (mg) (mg) (mg) (mg) (Ìg) (Ìg)

µÚ¤ÊË 0-6 210 100 30 0,27 2 110 157-12 270 275 75 11 3 130 20

¶·È‰È¿ 1-3 500 460 80 7 3 90 204-8 800 500 130 10 5 90 30

∞ÁfiÚÈ· 9-13 1300 1250 240 8 8 120 4014-18 1300 1250 410 11 11 150 55

∫ÔÚ›ÙÛÈ· 9-13 1300 1250 240 8 8 120 4014-18 1300 1250 360 15 9 150 55

¶ËÁ¤˜: Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride (1997). Dietary ReferenceIntakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline (1998). DietaryReference Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids (2000). Dietary Reference Intakes for Vitamin A, VitaminK, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc (2001).


160 ∞. ∫·Ê¿ÙÔ˜


¶›Ó·Î·˜ 2.

∫·ıËÌÂÚÈÓ¤˜ ·Ó¿ÁÎÂ˜ ÛÂ ÌÂÚ›‰Â˜ ·fi Î¿ıÂ ÔÌ¿‰· ÙÚÔÊ›ÌˆÓ ·Ó¿ÏÔÁ· ÌÂ ÙËÓ ËÏÈÎ›· Î·È ÙÔ Â›Â‰Ô Ê˘ÛÈÎ‹˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜*

√Ì¿‰Â˜ ÙÚÔÊ›ÌˆÓ ¶ÚÔÛ¯ÔÏÈÎ‹ ™¯ÔÏÈÎ‹ ∂ÊË‚ÈÎ‹ ÃÚ‹ÛÈÌÂ˜ ÏËÚÔÊÔÚ›Â˜ËÏÈÎ›· ËÏÈÎ›· ËÏÈÎ›·2-6 ¤ÙË 7-12 ¤ÙË 13-18 ¤ÙË

°·Ï·ÎÙÔÎÔÌÈÎ¿ 2-3 2-3 3 ñ Õ·¯Ô ‹ ¯·ÌËÏfi ÛÂ ÏÈ·Ú¿ Á¿Ï· ÌÂÙ¿ °¿Ï· ÙËÓ ËÏÈÎ›· ÙˆÓ 2 ÂÙÒÓ.°È·Ô‡ÚÙÈ ñ ∞ÔÊ˘Á‹ ÙË˜ ˘ÂÚÎ·Ù·Ó¿ÏˆÛË˜ ∆˘Ú› Á·Ï·ÎÙÔÎÔÌÈÎÒÓ.

¢ËÌËÙÚÈ·Î¿ 3-6 5-9 6-10 ñ ∆Ô Ì·‡ÚÔ „ˆÌ› Â›Ó·È ÚÔÙÈÌfiÙÂÚÔ ·fi æˆÌ› ÙÔ ÏÂ˘Îfi.¢ËÌËÙÚÈ·Î¿ ñ ∆· ÈÙ˘ÚÔ‡¯· ‹ ÔÏÈÎ‹˜ ·Ï¤ÛÂˆ˜ ª·Î·ÚfiÓÈ·, Ú‡˙È ‰ËÌËÙÚÈ·Î¿, Î·ÛÙ·Ófi Ú‡˙È Î·È ∞Ú·Î¿˜, ·Ù¿ÙÂ˜, Ì·Î·ÚfiÓÈ· ÔÏÈÎ‹˜ ·Ï¤ÛÂˆ˜ Â›Ó·È Î·Ï·ÌfiÎÈ ÚÔÙÈÌfiÙÂÚ·.

§·¯·ÓÈÎ¿ 2-5 4-7 5-8 ñ ∆· Ï·¯·ÓÈÎ¿ Ó· ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Î·È øÌ¿ ‹ Ì·ÁÂÈÚÂÌ¤Ó· Ê˘ÏÏÒ‰Ë Ï·¯·ÓÈÎ¿ Î›ÙÚÈÓ· Î·È Ú¿ÛÈÓ·, ˆÌ¿ ‹ (Ú·‰›ÎÈ·, Ì·ÚÔ‡ÏÈ, Û·Ó¿ÎÈ Î.Ï.) Ì·ÁÂÈÚÂÌ¤Ó·.∫›ÙÚÈÓ· Ï·¯·ÓÈÎ¿ (Î·ÚfiÙÔ, ÎÔ˘ÓÔ˘›‰È, ÓÙÔÌ¿Ù· Î.¿.)º·ÛÔÏ¿ÎÈ· Ú¿ÛÈÓ·, Ì¿ÌÈÂ˜, ÌÂÏÈÙ˙¿ÓÂ˜ Î.¿.

ºÚÔ‡Ù· 2-3 3-4 3-5 ñ ™Ù· ÊÚÔ‡Ù· Û˘ÌÂÚÈÏ·Ì‚¿ÓÔÓÙ·È Î·È ª‹ÏÔ, Ì·Ó¿Ó·, ÔÚÙÔÎ¿ÏÈ, ·¯Ï¿‰È Î.Ï. ÔÈ ÊÚ¤ÛÎÔÈ ¯˘ÌÔ›, ·ÏÏ¿ Â›Ó·È ºÚÔ˘ÙÔÛ·Ï¿Ù· ‹ ÊÚÔ‡Ù· Ì·ÁÂÈÚÂÌ¤Ó· ÚÔÙÈÌfiÙÂÚ· Ù· ÊÚ¤ÛÎ· ÊÚÔ‡Ù·.‹ ÊÚÔ‡Ù· ÎÔÓÛ¤Ú‚·˜ ñ Ã˘ÌÔ› ÊÚÔ‡ÙˆÓ ¯ˆÚ›˜ ÚÔÛÙÈı¤ÌÂÓË Ã˘Ìfi˜ ÊÚÔ‡ÙˆÓ ˙¿¯·ÚË.

∫Ú¤·˜-∞˘Á¿-æ¿ÚÈ-∫ÔÙfiÔ˘ÏÔ- 1 1-2 2 ñ ∫ÔÙfiÔ˘ÏÔ: 2-3 ÊÔÚ¤˜ ÙËÓ Â‚‰ÔÌ¿‰·.ŸÛÚÈ·-•ËÚÔ› Î·ÚÔ› ñ æ¿ÚÈ-ı·Ï·ÛÛÈÓ¿: 2-3 ÊÔÚ¤˜ ÙËÓ Â‚‰ÔÌ¿‰·.∫Ú¤·˜ ñ ŸÛÚÈ·: 2-3 ÊÔÚ¤˜ ÙËÓ Â‚‰ÔÌ¿‰·.æ¿ÚÈ ñ ∫fiÎÎÈÓÔ ÎÚ¤·˜: 1-2 ÊÔÚ¤˜ ÙËÓ Â‚‰ÔÌ¿‰·.£·Ï·ÛÛÈÓ¿ ñ ¡· ·Ê·ÈÚÂ›Ù·È ÙÔ ÔÚ·Ùfi Ï›Ô˜ ·fi Ù· ∫ÔÙfiÔ˘ÏÔ Ô˘ÏÂÚÈÎ¿ Î·È ÙÔ ÎÚ¤·˜.ŸÛÚÈ· ñ ó ÌÂÚ›‰· Û˘ÎÒÙÈ (40 ÁÚ.) 1 ÊÔÚ¿ ÙËÓ Â‚‰ÔÌ¿‰·.∞˘Áfi ñ ∞˘Áfi Û¯Â‰fiÓ Î¿ıÂ Ì¤Ú·.•ËÚÔ› Î·ÚÔ› ñ •ËÚÔ› Î·ÚÔ›: .¯. 2-3 Î·Ú‡‰È· Î¿ıÂ ‰Â‡ÙÂÚË

Ì¤Ú· (ÙÚÈÌÌ¤Ó· ¿Óˆ ·fi ÌÈ· ÊÚÔ˘ÙÔÛ·Ï¿Ù· ‹ÌÈ· ÎÚ¤Ì· ÁÈ· Ù· ÌÈÎÚ¿ ·È‰È¿).

√Ì¿‰Â˜ ÙÚÔÊ›ÌˆÓ & Ì¤ÁÂıÔ˜ ÌÂÚ›‰·˜

°·Ï·ÎÙÔÎÔÌÈÎ¿ 1 ÌÂÚ›‰· = 1 ÊÏÈÙ˙. Á¿Ï·, 40 ÁÚ. Ù˘Ú›, 1 ÊÏÈÙ˙. ÁÈ·Ô‡ÚÙÈ ∏ Î·ÙËÁÔÚ›· ·˘Ù‹ ‰›ÓÂÈ 12 ıÚÂÙÈÎ¿ Û˘ÛÙ·ÙÈÎ¿.

¢ËÌËÙÚÈ·Î¿ 1 ÌÂÚ›‰· = 1 Ê¤Ù· „ˆÌ›, 1 ÊÏÈÙ˙. ‰ËÌËÙÚÈ·Î¿ (ÎÔÚÓ ÊÏ¤ÈÎ˜), ∏ Î·ÙËÁÔÚ›· ·˘Ù‹ ‰›ÓÂÈ 14 ıÚÂÙÈÎ¿ Û˘ÛÙ·ÙÈÎ¿ ó ÊÏÈÙ˙. Ì·Î·ÚfiÓÈ·, ÈÏ¿ÊÈ, Ì·ÁÂÈÚÂÌ¤Ó·, Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ ÙˆÓ ‰È·ÈÙËÙÈÎÒÓ ÈÓÒÓ.ó ÊÏÈÙ˙. ·Ù¿ÙÂ˜ Ì·ÁÂÈÚÂÌ¤ÓÂ˜

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1. ∫·Ê¿ÙÔ˜ ∞°, §·Ì·‰¿ÚÈÔ˜ ¢. ∆ÂÏÂ˘Ù·›Â˜ ÂÍÂÏ›ÍÂÈ˜ ÛÙËÓÎÏÈÓÈÎ‹ ‰È·ÙÚÔÊ‹ Î·È ÂÈ‰ËÌÈÔÏÔÁ›· ÙˆÓ ÓÔÛËÌ¿ÙˆÓ ‰È·-ÙÚÔÊ‹˜. ∆Ì‹Ì· π·ÙÚÈÎ‹˜, ∆ÔÌ¤·˜ ∫ÔÈÓˆÓÈÎ‹˜ π·ÙÚÈÎ‹˜,∫ÏÈÓÈÎ‹ ¶ÚÔÏËÙÈÎ‹˜ π·ÙÚÈÎ‹˜ Î·È ¢È·ÙÚÔÊ‹˜, ¶·ÓÂÈ-ÛÙ‹ÌÈÔ ∫Ú‹ÙË˜. ∏Ú¿ÎÏÂÈÔ: 1990.

2. Dietary Reference Intakes for Calcium, Phosphorus, Mag-nesium, Vitamin D, and Fluoride. National Academy ofSciences; 1997.

3. Dietary Reference Intakes for Thiamin, Riboflavin, Niacin,Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin,and Choline. Washington DC: Food and Nutrition Board,Institute of Medicine, National Academy Press; 1998.

4. Dietary Reference Intakes for Vitamin C, Vitamin E, Seleni-um, and Carotenoids. National Academy of Sciences; 2000.

5. Dietary Reference Intakes for Vitamin A, Vitamin K,Arsenic, Boron, Chromium, Copper, Iodine, Iron, Man-ganese, Molybdenum, Nickel, Silicon, Vanadium, andZinc National Academy of Sciences; 2001.

6. Williams SR. Nutrition and Diet Therapy. 8th ed. St Louis:Mosby Publishing Co.; 1997.

7. ¢È·ÙÚÔÊ‹ ÁÈ· ¶ÚÔ·ÁˆÁ‹ ÙË˜ ˘ÁÂ›·˜ Î·È ÚfiÏË„Ë ÙˆÓ¯ÚfiÓÈˆÓ ·ÛıÂÓÂÈÒÓ. ∏Ú¿ÎÏÂÈÔ: ∆À¶√∫ƒ∂∆∞ ∞µ∂; πÔ‡-ÏÈÔ˜ 2007.

8. Kafatos A, Codrington CA. Nutrition and diet for healthylifestyles in Europe: the ‘Eurodiet’ Project. Public HealthNutr.1999;2:327-328.

9. ∫·Ê¿ÙÔ˜ ∞°. ÀÁÂ›·, ‰È·ÙÚÔÊ‹ Î·È ·Ó¿Ù˘ÍË ·È‰ÈÒÓÚÔÛ¯ÔÏÈÎ‹˜ ËÏÈÎ›·˜. ∫Ú‹ÙË: ¡ÔÌ·Ú¯È·Î‹ ∞˘ÙÔ‰ÈÔ›ÎËÛËÃ·Ó›ˆÓ; 2004.


162 ∂¡¢π∞º∂ƒ√À™∞ ¶∂ƒπ¶∆ø™∏ CASE REPORT


Recurrent Respiratory Papillomatosis: case report and

literature review

D. A. Nunez

Abstract: Juvenile onset recurrent respiratory papillomatosis (RRP) is a rare but potentially lifethreatening disease caused by Human papilloma virus (HPV) infection, primarily HPV types 6 and 11. Ittypically presents in children with an onset at 3-4 years. The incidence estimates vary widely, but inEurope a rate of approximately 3.5 cases per million is reported. The vocal folds are the commonest siteof involvement. Dysphonia and/or stridor are the main clinical features of respiratory papillomatosis. Atypical case in a 3 year-old boy is presented. Laryngoscopy to visualise the larynx is required to arrive atthe diagnosis. The mainstay of treatment is surgical resection using the CO2 laser or the laryngeal micro-shaver (microdebrider) under micro-laryngoscopic control. It is not unusual for a typical case to require3 surgical interventions a year over a period of several years. In more aggressive cases adjuvanttreatment is indicated, which includes systemic interferon and intra-lesional Cidofovir. Fatality isassociated with loss of the airway, distal spread into the lungs or malignant transformation. An overviewof the clinical condition and current treatment is presented.

Key words: Larynx, papilloma, Human papilloma virus 6, Human papilloma virus 11, voice disorders.

Academic Unit ofOtolaryngology,North Bristol NHS Trust, Southmead Hospital,

Correspondence:

D. A. Nunez [email protected] Unit of Otolaryngology, North Bristol NHS Trust, Southmead Hospital, Bristol BS10 5NB, United Kingdom

Case Report

A 3 year-old boy presented to his paediatri-

cian with a 4-month history of a persistent

hoarse voice, with no history of preceding upper

respiratory tract infection or trauma. He had no

dysphagia or dyspnoea. His single mother re-

ported that he was her first child, delivered nor-

mally at full term when she was 19 years old, af-

ter an uncomplicated pregnancy and delivery.

On examination he was apyrexial and not

distressed, and he was not jaundiced. He

weighed 15 kg and was 105 cm tall. There was no

stridor or cyanosis, his respiratory rate was 24

per minute, the trachea was central and the chest

clear on auscultation. There were no abnormal

heart sounds. Anterior rhinoscopy and oral cav-

ity examination were normal.

He was referred to an otolaryngologist who

undertook a micro-laryngoscopic examination.

The laryngoscopic appearance is as illustrated in

the clinical photograph (Figure 1).

Discussion

Figure 1 shows a larynx of grossly abnormal

appearance, in stark contrast to the appearance of

the normal larynx, Figure 2. The mucosa of the

vocal folds and vestibular folds is oedematous and

polypoid in keeping with the typical appearance

of widespread laryngeal papillomatosis. This pat-

tern of presentation is to be distinguished from

the single solitary often pedunculated upper aero-

digestive tract papilloma. The latter is more com-

mon and often presents in the oropharynx arising

from the soft palate, uvula or palatopharyngeal

arches. Excision is usually curative.

The laryngeal papilloma is the commonest

benign neoplasm of the larynx (1). Laryngeal in-

volvement when widespread, as demonstrated in

this case, is not easily cured and the condition is

known as recurrent laryngeal papillomatosis or

recurrent respiratory papillomatosis (RRP). The

term RRP is to be preferred because while the

larynx at the level of the vocal cords (glottis) is

the site predominantly affected, the papillomata

may extend above and below this level into the

trachea and bronchi. RRP is an uncommon con-

dition with a bimodal peak age incidence of 3-5

years in children and in the third decade in

adults (2). The distribution of age of onset has

lead to the condition being sub-classified as ju-

venile onset RRP or adult onset RRP.

RRP can be life threatening because of airway

compromise, especially in children, or due to ma-

lignant degeneration (3). The reported prevalence

of juvenile onset laryngeal papillomatosis is lower

in Europe (approximately 3.5 per million) than in

the US (4.3 per 100,000) (4,5). The presenting fea-

tures are hoarseness and stridor (2). Males and fe-

males are equally affected in childhood but in the

adult onset disease males are more commonly af-

fected in the ratio of 2-4 to 1 (6,7).

The Human papilloma (wart) virus (HPV) is


163Recurrent Respiratory Papillomatosis

¶·È‰È·ÙÚÈÎ‹ 2008;71:162-164

the causative agent for RRP, and specifically HPV sub-

types 6 and 11 (8). There are reports that HPV 11 la-

ryngeal disease is more aggressive, with a greater

predilection for relapse and malignant degeneration

(9). Malignant degeneration is usually associated with

other cofactors such as tobacco use (10), or irradiation,

which was an early therapy for RRP, however some cas-

es undergo malignant change in the absence of any

known cofactors (11). HPV subtypes 6 and 11 are not

associated with a high risk of malignant change, in con-

trast to other subtypes such as 16 and 18, which have

been established as causative agents of cancer of the

uterine cervix (12,13). In the head and neck region high

risk types of HPV have been isolated, predominantly

from cancers of the oral cavity and oropharynx but al-

so from the larynx. The degree of positivity, depending

on the identification method, varies between 0% and

75% (14). This is in contrast to uterine cervical invasive

squamous cell carcinoma, where the level of positivity

is 86-94% (15). It would therefore seem that HPV has a

causative role only in certain anatomical sites in the

head and neck or in particular subgroups of patients.

The mechanism of HPV transmission is uncertain

but vertical materno-fetal transmission is the most

favoured route. This is supported by the 231-fold in-

crease in risk of juvenile onset recurrent respiratory

papillomatosis in children born to mothers with cer-

vical condoylomata (16). The birth canal is not the

only route of transmission, as Armbruster-Moraes

and colleagues demonstrated that HPV DNA can be

isolated in amniotic fluid aspirates from women who

had clinical and slot hybridisation evidence of cervical

papilloma, providing evidence of in-utero transmis-

sion (17). This can explain the failure of Caesarean

section to abolish the development of juvenile onset

laryngeal papilloma disease (18,19).

The presence of HPV6 and/or 11 is not in itself suf-

ficient to cause the development of laryngeal papillo-

matosis, as up to 25% of histologically normal larynges

are positive for HPV6 and 11 DNA (20). Restricted

host immune response is believed to play a role.

The mainstay of treatment is surgery. Microlaryn-

goscopy provides the opportunity not only for tissue

diagnosis by biopsy but also for excision of the papil-

lomata. The surgeon must exercise caution in the pur-

suit of disease eradication in order to avoid damage to

the laryngeal structure and thus irreversible impair-

ment of laryngeal function. Stenosis and webbing of

the anterior glottis can leave the patient with the same

symptoms that the therapy is intended to treat, name-

ly a restricted airway and a life-long hoarse voice. A

CO2 laser beam controlled by a micromanipulator

gives the surgeon microscopic guided accuracy in the

control of papilloma excision. The 10,600 nm wave-

length CO2 provides the advantage of haemostasis

and this is the technique most widely used for treat-

ment of laryngeal papillomata in the UK (21). A num-

ber of other laser types are also used, including the

potassium titanyl phosphate laser delivered by a flexi-

ble fibre that facilitates treatment of papillomata in

the tracheobronchial tree (1).

A recent survey of members of American Society

of Paediatric Otolaryngologists demonstrated the

popularity of the laryngeal shaver (microdebrider)

(22). This is a sleeved rotating blade with continuous

saline irrigation and suction allowing for almost

bloodless removal of laryngeal papillomata.

RRP is a difficult condition to treat in many pa-

tients and in some patients it follows a relentless

course requiring multiple surgeries with only short in-

tervals between treatment schedules when the patient

is clinically free of disease. This is due to the difficulty

Figure 1. Figure 2.


of eradicating the papilloma virus, which is presenteven in normal appearing laryngeal tissue of the affect-ed patients (19). For this reason a number of adjuvanttreatments have been tried and put into use with theaim of reducing the relapse rate. Alpha interferon andindole-3-carbinol are two popular adjuvant therapiesbut they are not always effective (1,22). Intra-lesionalCidofovir is gaining in popularity because of the goodearly results obtained with this antimetabolite by someclinicians in controlling the disease (23). Photodynam-ic therapy is also under investigation (24). The launchof a highly efficacious HPV vaccine that targets HPV 6and 11 in addition to 16 and 18 (25) offers the potentialto eradicate this disease for future generations.

References

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25. Ault KA; Future II Study Group. Effect of prophylactic hu-man papillomavirus L1 virus-like-particle vaccine on riskof cervical intraepithelial neoplasia grade 2, grade 3, andadenocarcinoma in situ: a combined analysis of four ran-domised clinical trials. Lancet. 2007;369:1861-1868.

164 D. A. Nunez



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¯ÚÂÈ¿ÛÙËÎÂ ·Ó¿ÓË„Ë. ∏ ÂÁÎ˘ÌÔÛ‡ÓË ‹Ù·Ó ÔÌ·Ï‹

Î·È Ô ÎÏÈÓÈÎfi˜ Î·È ·Ú·ÎÏÈÓÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ê˘ÛÈÔ-

ÏÔÁÈÎfi˜, ÌÂ ÂÍ·›ÚÂÛË ÙËÓ ·ÌÊÔÙÂÚfiÏÂ˘ÚË ‰È¿-

Ù·ÛË ÙˆÓ ˘ÂÏÔÎ·Ï˘ÎÈÎÒÓ Û˘ÛÙËÌ¿ÙˆÓ ÙÔ˘ ÂÌ-

‚Ú‡Ô˘ ÛÙÔ ˘ÂÚË¯ÔÁÚ¿ÊËÌ· µ ÂÈ¤‰Ô˘. ™ÙËÓ

·Ú¯ÈÎ‹ ÎÏÈÓÈÎ‹ ÂÍ¤Ù·ÛË ÙÔ˘ ÓÂÔÁÓÔ‡ ‰ÂÓ ‰È·È-

ÛÙÒıËÎ·Ó ‰˘ÛÌÔÚÊ›Â˜ ‹ ¿ÏÏ· ·ıÔÏÔÁÈÎ¿ Â˘Ú‹-

Ì·Ù·. ™ÙÔ Ù¤ÏÔ˜ ÙÔ˘ 1Ô˘ 24ÒÚÔ˘ ̇ ˆ‹˜, ·ÚÔ˘Û›·-

ÛÂ ‡ÔÙÔ ÂÂÈÛfi‰ÈÔ Û·ÛÌÒÓ ‰È¿ÚÎÂÈ·˜ ‰‡Ô Â-

Ú›Ô˘ ÏÂÙÒÓ. ∆Ô ÂÂÈÛfi‰ÈÔ ÂÚÈÏ¿Ì‚·ÓÂ ‚Ú·-

¯Â›Â˜ Û˘Û¿ÛÂÈ˜ ÙˆÓ ¿Óˆ, Î˘Ú›ˆ˜, ·ÏÏ¿ Î·È ÙˆÓ

Î¿Ùˆ ¿ÎÚˆÓ. ∏ ÛÙÔÈ¯ÂÈÒ‰Ë˜ Ì˘ÔÛÎÂÏÂÙÈÎ‹ ‰Ú·-

ÛÙËÚÈfiÙËÙ· ÚÔÛÔÌÔ›·˙Â ÌÂ Ù· «ÙÈÓ¿ÁÌ·Ù·» ÙˆÓ

ÓÂÔÁÓÒÓ, ‰Ú·ÛÙËÚÈfiÙËÙ· Ô˘ fiÌˆ˜ Â›¯Â Û˘ÚÚ¤Ô-

ÓÙ· ¯·Ú·ÎÙ‹Ú·, ÌÂ ÙËÓ ·ÚÂÌ‚ÔÏ‹ ‚Ú·¯‡Ù·ÙË˜

Ê¿ÛË˜ Ì˘˚Î‹˜ ËÚÂÌ›·˜ ÛÙ· ÌÂÛÔ‰È·ÛÙ‹Ì·Ù·. √È

ÎfiÚÂ˜ Î·È Ë ı¤ÛË ÙˆÓ ‚ÔÏ‚ÒÓ ‰ÂÓ ‹Ù·Ó ÔÚ·Ù¿,

·ÊÔ‡ ÙÔ ÓÂÔÁÓfi ÎÔÈÌfiÙ·Ó Î·Ù¿ ÙÔ ÂÂÈÛfi‰ÈÔ. ¶·-

ÚfiÌÔÈ· ÂÂÈÛfi‰È· Â·Ó·Ï‹ÊıËÎ·Ó Î·È ÛÙÈ˜ Âfi-

ÌÂÓÂ˜ Ì¤ÚÂ˜, ¯ˆÚ›˜ Ó· Û˘ÓÔ‰Â‡ÔÓÙ·È ÌÂ Î·Ú‰ÈÔ·-

Ó·ÓÂ˘ÛÙÈÎ‹ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· (ÙÒÛË ÎÔÚÂÛÌÔ‡ ‹

‚Ú·‰˘Î·Ú‰›·). ∆Ô ÓÂÔÁÓfi Û˘Ó¤¯ÈÛÂ Ó· ÛÈÙ›˙ÂÙ·È

ÌÂ ÌËÙÚÈÎfi Á¿Ï· Î·È ÙÂ¯ÓËÙ‹ ‰È·ÙÚÔÊ‹ Î·È ¿Ú¯ÈÛÂ

Ó· ÎÂÚ‰›˙ÂÈ ‚¿ÚÔ˜. ∫·ı’ fiÏË ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÓÔ-

ÛËÏÂ›·˜ ÙÔ˘ ‰ÂÓ ‰È·ÈÛÙÒıËÎÂ ·ıÔÏÔÁÈÎ‹ ÓÂ˘-

ÚÔÏÔÁÈÎ‹ ÛËÌÂÈÔÏÔÁ›· (.¯. ‰È·Ù·Ú·¯¤˜ Ì˘˚ÎÔ‡ÙfiÓÔ˘, ·ÓÙ·Ó·ÎÏ·ÛÙÈÎÒÓ Î.Ï.).

∆Ô U/S ÂÁÎÂÊ¿ÏÔ˘ Ô˘ ¤ÁÈÓÂ ÙÔ 2Ô 24ˆÚÔ ˙ˆ-‹˜ ¤‰ÂÈÍÂ ˘¤ÚË¯Â˜ ÂÚÈÔ¯¤˜ ÛÙÈ˜ ÁˆÓ›Â˜ ÙÔ˘ÛÒÌ·ÙÔ˜. ™ÙË CT ÂÁÎÂÊ¿ÏÔ˘, ÙÔ 8Ô 24ˆÚÔ, ‰ÂÓ·Ú·ÙËÚ‹ıËÎ·Ó ·ıÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù·. √ ¤ÏÂÁ-¯Ô˜ ÙË˜ ÁÏ˘Îfi˙Ë˜, ÙˆÓ ËÏÂÎÙÚÔÏ˘ÙÒÓ Î·È ÙÔ˘·Û‚ÂÛÙ›Ô˘-Ì·ÁÓËÛ›Ô˘ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜, ÂÓÒ·˘ÍËÌ¤ÓÂ˜ ‹Ù·Ó ÔÈ CPK, LDH Î·È SGOT (884U/L, 624 U/L Î·È 47 U/L, ·ÓÙÈÛÙÔ›¯ˆ˜) ÛÙÔ 2Ô24ˆÚÔ ÙË˜ ˙ˆ‹˜.

ªÂÙ¿ ÙÔ 2Ô 24ˆÚÔ ÙË˜ ˙ˆ‹˜ ÙÔ˘, ÙÔ ÓÂÔÁÓfiÛ˘Ó‰ÂfiÙ·Ó ÂÚÈÔ‰ÈÎ¿ ÌÂ CFM (CerebralFunction Monitor). ∏ ‚·ÛÈÎ‹ Î·Ù·ÁÚ·Ê‹ ‹Ù·ÓÊ˘ÛÈÔÏÔÁÈÎ‹ Î·È Ë ·Ó¿Ï˘ÛË ÙË˜ Î·Ù·ÁÚ·Ê‹˜ ÛÙË‰È¿ÚÎÂÈ· ÂÓfi˜ ÎÏÈÓÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘ ‰ÂÓ ‹Ù·Ó ÂÓ-‰ÂÈÎÙÈÎ‹ ÂÈÏËÙÈÎ‹˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜. ∆Ô ∏∂°Ô˘ ¤ÁÈÓÂ ÛÙÈ˜ 30 Ì¤ÚÂ˜ ÙË˜ ˙ˆ‹˜ (Î·È ÂÓfiÛˆ Û˘-ÓÂ¯›˙ÔÓÙ·Ó Ù· ÂÂÈÛfi‰È·) ¤‰ÂÈÍÂ Ê˘ÛÈÔÏÔÁÈÎ‹‚·ÛÈÎ‹ ‰Ú·ÛÙËÚÈfiÙËÙ· Î·È ·Ô˘Û›· ·ıÔÏÔÁÈ-ÎÒÓ ÂÎÊÔÚÙ›ÛÂˆÓ.

∏ ‰È¿ÁÓˆÛË Ù¤ıËÎÂ ÌÂ ¤Ó·Ó ·Ïfi ¯ÂÈÚÈÛÌfi.

¶Èı·Ó¤˜ ‰È·ÁÓÒÛÂÈ˜:

1. ™·ÛÌÔ› 5Ë˜ Ì¤Ú·˜2. ™·ÛÌÔ› Â› Â‰¿ÊÔ˘˜ ˘ÔÍÈÎ‹˜-ÈÛ¯·ÈÌÈÎ‹˜

‚Ï¿‚Ë˜3. ¶ÚÒÈÌË Ì˘ÔÎÏÔÓÈÎ‹ ÂÁÎÂÊ·ÏÔ¿ıÂÈ·4. ∫·ÏÔ‹ıÂÈ˜ Ì˘ÔÎÏÔÓ›Â˜ ‡ÓÔ˘

∏ ·¿ÓÙËÛË ·ÎÔÏÔ˘ıÂ› ÛÙË ÛÂÏ›‰· 176

1 ¡ÂÔÁÓÔÏÔÁÈÎfi ∆Ì‹Ì·,°.¡.-ª·ÈÂ˘Ù‹ÚÈÔ “ŒÏÂÓ· µÂÓÈ˙¤ÏÔ˘”

2 ¡Â˘ÚÔÏÔÁÈÎfi ∆Ì‹Ì·,¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”


¶fiË ™ËÊÈ·ÓÔ‡[email protected]¡ÂÔÁÓÔÏÔÁÈÎfi ∆Ì‹Ì·,°.¡.-ª·ÈÂ˘Ù‹ÚÈÔ “ŒÏÂÓ· µÂÓÈ˙¤ÏÔ˘”¶Ï·ÙÂ›· ŒÏÂÓ·˜ µÂÓÈ˙¤ÏÔ˘ 2, ∆.∫. 115 21, ∞ı‹Ó·


166 ∂¶π∫∞πƒ√ £∂ª∞ CURRENT ISSUE


“¡¤Ô ∂ıÓÈÎfi ¶ÚfiÁÚ·ÌÌ· ∂Ì‚ÔÏÈ·ÛÌÒÓ

(2008)”

™ÙÈ˜ 4/12/2007 Û˘Ó‹ÏıÂ ÛÙËÓ ∞ı‹Ó· (¢ÈÂ‡-ı˘ÓÛË ¢ËÌfiÛÈ·˜ ÀÁÂ›·˜) Ë ∂ıÓÈÎ‹ ∂ÈÙÚÔ‹∂Ì‚ÔÏÈ·ÛÌÒÓ (∂∂∂) ÁÈ· Ó· ·Ó·ıÂˆÚ‹ÛÂÈ ÙÔ ∂ıÓÈ-Îfi ¶ÚfiÁÚ·ÌÌ· ∂Ì‚ÔÏÈ·ÛÌÒÓ (∂¶∂) Î·È Ó· ÚÔ-ÙÂ›ÓÂÈ ÔÚÈÛÌ¤ÓÂ˜ ·ÏÏ·Á¤˜ Û‡ÌÊˆÓ· ÌÂ ÙÈ˜ ÙÚ¤-¯Ô˘ÛÂ˜ ÂÈ‰ËÌÈÔÏÔÁÈÎ¤˜ Û˘Óı‹ÎÂ˜ ÙË˜ ¯ÒÚ·˜,ÙÈ˜ ‰ÈÂıÓÂ›˜ Ù¿ÛÂÈ˜ Î·È ÙËÓ Î˘ÎÏÔÊÔÚ›· Ó¤ˆÓ, Ô-Ï‡ ÛËÌ·ÓÙÈÎÒÓ ÁÈ· ÙË ¢ËÌfiÛÈ· ÀÁÂ›· ∂Ì‚ÔÏ›ˆÓ.

ªÂÙ¿ ·fi ÂÈÛÙ·Ì¤ÓË ÌÂÏ¤ÙË ÙˆÓ ÚÔ·Ó·-ÊÂÚı¤ÓÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ Î·È ÂÎÙÂÓ‹ Û˘˙‹ÙËÛËÌÂÙ·Í‡ ÙˆÓ ÌÂÏÒÓ ÙË˜ ∂ÈÙÚÔ‹˜ Â› ÙˆÓ ‰Â-‰ÔÌ¤ÓˆÓ ·˘ÙÒÓ ‰È·ÌÔÚÊÒıËÎÂ ÙÔ Ó¤Ô ∂¶∂, ÙÔÔÔ›Ô ¤ÁÈÓÂ ·Ô‰ÂÎÙfi ·fi ÙËÓ ÔÏÈÙÈÎ‹ ËÁÂÛ›·ÙÔ˘ ÀÔ˘ÚÁÂ›Ô˘ ÀÁÂ›·˜ Î·È ∫ÔÈÓˆÓÈÎ‹˜ ∞ÏÏË-ÏÂÁÁ‡Ë˜, fiˆ˜ ·ÎÚÈ‚Ò˜ ÚÔÙ¿ıËÎÂ. √È ·ÏÏ·-Á¤˜ Ô˘ ¤ÁÈÓ·Ó ÛÙÔ ∂¶∂ Û˘ÓÔ„›˙ÔÓÙ·È ˆ˜ ÂÍ‹˜:

1. ∂Ì‚fiÏÈÔ ‰ÈÊıÂÚ›ÙÈ‰·˜, ÙÂÙ¿ÓÔ˘, ÎÔÎÎ‡-ÙË (DTaP). ¶ÚÔÛÙ›ıÂÙ·È Ì›· ÂÈÏ¤ÔÓ ‰fiÛËÛÙËÓ ËÏÈÎ›· 11-12 ÂÙÒÓ ÌÂ ÙÔ ÛÎÂ‡·ÛÌ· TdaP(‚Ï¤Â ÂÂÍ‹ÁËÛË 2·, 2‚).

2. ∂Ì‚fiÏÈÔ ·ÓÂÌÂ˘ÏÔÁÈ¿˜ (Var). ¶ÚÔÛÙ›ıÂ-Ù·È 2Ë ‰fiÛË ÛÙËÓ ËÏÈÎ›· 4-6 ÂÙÒÓ.

3. ∂Ì‚fiÏÈÔ Î·Ù¿ ÙÔ˘ ÈÔ‡ ÙˆÓ ·ÓıÚÒÈÓˆÓıËÏˆÌ¿ÙˆÓ (Human Papilloma Virus ‹HPV). ¶ÚÔÛÙ›ıÂÙ·È Ó¤Ô ÂÌ‚fiÏÈÔ Î·Ù¿ ÙÔ˘ HPVÔ˘ Û˘ÓÈÛÙ¿Ù·È ÌfiÓÔ ÁÈ· Ù· ÎÔÚ›ÙÛÈ· ËÏÈÎ›·˜12-15 ÂÙÒÓ ‹ Ì¤¯ÚÈ 26 ÂÙÒÓ, ÂÊfiÛÔÓ ‰ÂÓ ÂÌ‚Ô-ÏÈ¿ÛÙËÎ·Ó ÛÙË Û˘ÓÈÛÙÒÌÂÓË ËÏÈÎ›· (‚Ï¤ÂÂÂÍ‹ÁËÛË 9 Î·È ÙË Û¯ÂÙÈÎ‹ ÂÁÎ‡ÎÏÈÔ Ô˘

·ÊÔÚ¿ ÙÔ ÂÌ‚fiÏÈÔ ·˘Ùfi ÛÙË ÛÙ‹ÏË ÙË˜ ¢ËÌfi-ÛÈ·˜ ÀÁÂ›·˜).

4. ∂Ì‚fiÏÈÔ Î·Ù¿ ÙË˜ Ë·Ù›ÙÈ‰·˜ ∞ (Hep A).¶ÂÚÈÏ·Ì‚¿ÓÂÙ·È ÛÙ· ··Ú·›ÙËÙ· Ï¤ÔÓ ÂÌ‚fi-ÏÈ· ÙÔ˘ ∂¶∂ ·fi ÙÔ 12Ô Ì‹Ó· Î·È ÌÂÙ¿ (‚Ï¤ÂÂÂÍ‹ÁËÛË 10) Î·È Û˘ÓÂ¯›˙ÂÈ Ó· Á›ÓÂÙ·È ÛÙÈ˜ÔÌ¿‰Â˜ ·˘ÍËÌ¤ÓÔ˘ ÎÈÓ‰‡ÓÔ˘ (¶›Ó·Î·˜ 3).

°È· ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ ÙˆÓ ·È‰ÈÒÓ, Ô˘ ÁÈ·‰È¿ÊÔÚÔ˘˜ ÏfiÁÔ˘˜ ‰ÂÓ ÂÌ‚ÔÏÈ¿ÛÙËÎ·Ó ÛÙË Û˘-ÓÈÛÙÒÌÂÓË ·fi ÙÔ ∂¶∂ ËÏÈÎ›·, ˘¿Ú¯Ô˘Ó ÂÈ‰È-Î¿ ¯ÚÔÓÔ‰È¿ÁÚ·ÌÌ·Ù· (¶›Ó·ÎÂ˜ 5 Î·È 6) ÌÂ ÙÈ˜Û¯ÂÙÈÎ¤˜ ÂÂÍËÁ‹ÛÂÈ˜.

∆Ô Ó¤Ô ∂¶∂, fiˆ˜ ‰È·ÌÔÚÊÒıËÎÂ ÁÈ· ÙÔ2008, Û˘ÓÔ„›˙ÂÙ·È ÛÙËÓ ∂ÈÎfiÓ· 1 Î·È ÛÙÔ˘˜ ¶›-Ó·ÎÂ˜ 5 Î·È 6.

∏ ∂ıÓÈÎ‹ ∂ÈÙÚÔ‹ ∂Ì‚ÔÏÈ·ÛÌÒÓ√ ¶ÚfiÂ‰ÚÔ˜: ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜ ∞Ó‰Ú¤·˜∆· Ì¤ÏË: µÈÔÏ¿ÎË ª., £ÂÔ‰ˆÚ›‰Ô˘ ª.,

∫·Ó·ÎÔ‡‰Ë-∆Û·Î·Ï›‰Ô˘ º., ∫·ÊÂÙ˙‹˜ ¢., ∫Â¯·ÁÈ·‰¿ÎË˜ °., ∫‡ÚÏÂÛË ∞., ™¿Ï· °.,™ÙÚ·ÙËÁ¿ÎË ̃ª., ™˘ÚÈÔÔ‡ÏÔ ̆µ., ÃÚÔ‡ÛÔ˜ °.

∏ °Ú·ÌÌ·Ù¤·˜: ™ˆÙ‹Ú¯Ô˘ ∞.

¶›Ó·Î·˜ 3. ∂Ó‰Â›ÍÂÈ˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Î·Ù¿ ÙË˜ ∏·Ù›ÙÈ‰·˜ ∞ÛÂ ¯ÒÚÂ˜ ÌÂ ¯·ÌËÏ‹ Î·È Ì¤ÛË ÂÓ‰ËÌÈÎfiÙËÙ·

ñ ∆·ÍÈ‰ÈÒÙÂ˜.ñ ∂·ÁÁÂÏÌ·Ù›Â˜ ˘ÁÂ›·˜.ñ ∂·ÁÁÂÏÌ·Ù›Â˜ ‰È·Î›ÓËÛË˜ ÙÚÔÊ›ÌˆÓ.ñ ¶ÚÔÛˆÈÎfi È‰Ú˘Ì¿ÙˆÓ.ñ ¶ÚÔÛˆÈÎfi Î·ı·ÚÈfiÙËÙ·˜ ‰ËÌfiÛÈˆÓ Î·È È‰ÈˆÙÈÎÒÓ

ÂÎ·È‰Â˘ÙÈÎÒÓ È‰Ú˘Ì¿ÙˆÓ.ñ ∫ÏÂÈÛÙÔ› ÏËı˘ÛÌÔ›*.ñ √ÌÔÊ˘ÏfiÊÈÏÔÈ - ∆ÔÍÈÎÔÌ·ÓÂ›˜.ñ ÕÙÔÌ· ÌÂ ¯ÚfiÓÈ· ÏÔ›ÌˆÍË ÌÂ ÙÔÓ Èfi ÙË˜ ∏µ.

* ‚Ï¤Â ˘ÔÛËÌÂ›ˆÛË ¶›Ó·Î· 4

¶›Ó·Î·˜ 1. ÕÙÔÌ· ÌÂ ·˘ÍËÌ¤ÓÔ Î›Ó‰˘ÓÔ ÁÈ· ÛÔ‚·Ú¤˜ ÓÂ˘-ÌÔÓÈÔÎÔÎÎÈÎ¤˜ ÏÔÈÌÒÍÂÈ˜

ñ ªÈÎÚ¿ ·È‰È¿ ¿Óˆ ÙˆÓ 2 ÂÙÒÓ Î·È ÂÓ‹ÏÈÎÂ˜ >60 ÂÙÒÓ.ñ ÕÙÔÌ· ÌÂ Û˘ÁÁÂÓÂ›˜ ·ÓÙÈÛˆÌ·ÙÈÎ¤˜ ·ÓÂ¿ÚÎÂÈÂ˜

(Î˘Ú›ˆ˜ ¤ÏÏÂÈ„Ë ÙË˜ IgG2).ñ ÕÙÔÌ· Ô˘ ¤¯Ô˘Ó ÌÔÏ˘ÓıÂ› ÌÂ ÙÔÓ Èfi HIV.ñ ÕÙÔÌ· ÌÂ Â›ÎÙËÙË ·ÓÔÛÔÎ·Ù·ÛÙÔÏ‹, ÂÍ·ÈÙ›·˜

ÓÔÛ‹Ì·ÙÔ˜ ‹ ıÂÚ·Â›·˜ ‹ ¿ÏÏË˜ (ÂÎÙfi˜ ÙÔ˘ HIV)ÈÔÁÂÓÔ‡˜ ÏÔ›ÌˆÍË˜.

ñ ÕÙÔÌ· ÌÂ ÌÂÈÔÓÂÎÙÈÎ‹ ÛÏËÓÈÎ‹ ÏÂÈÙÔ˘ÚÁ›· ‹ ·ÛÏËÓ›·.¯. ÌÂ ‰ÚÂ·ÓÔÎ˘ÙÙ·ÚÈÎ‹ ÓfiÛÔ, ÌÂ ˘ÂÚÛÏËÓÈÛÌfi, ÌÂ¯ÂÈÚÔ˘ÚÁÈÎ‹ ·Ê·›ÚÂÛË ÙÔ˘ ÛÏ‹Ó·.

ñ ÕÙÔÌ· ÌÂ ÓÂÊÚˆÛÈÎfi Û‡Ó‰ÚÔÌÔ ‹ ¯ÚfiÓÈ· ÓÂÊÚÈÎ‹·ÓÂ¿ÚÎÂÈ·.

ñ ÕÙÔÌ· ÌÂ Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË.ñ ÕÙÔÌ· ÌÂ ¯ÚfiÓÈ· Û˘ÌÊÔÚËÙÈÎ‹ Î·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ·.ñ ÕÙÔÌ· ÌÂ ¯ÚfiÓÈÂ˜ ÓÂ˘ÌÔÓÔ¿ıÂÈÂ˜.ñ ÕÙÔÌ· ÌÂ ‰È·Ê˘Á‹ ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô˘ ˘ÁÚÔ‡ ·fi

Û˘ÁÁÂÓÂ›˜ ‹ Â›ÎÙËÙÂ˜ ·ÈÙ›Â˜.

¶›Ó·Î·˜ 2. ¶·È‰È¿ Ô˘ ·Ó‹ÎÔ˘Ó ÛÂ ÔÌ¿‰Â˜ ·˘ÍËÌ¤ÓÔ˘ ÎÈÓ-‰‡ÓÔ˘ ÁÈ· Ê˘Ì·ÙÈÎ‹ ÌfiÏ˘ÓÛË/Ê˘Ì·Ù›ˆÛË

ñ ªÂÙ·Ó¿ÛÙÂ˜ ·fi ¯ÒÚÂ˜ ÌÂ ˘„ËÏfi ‹ Ì¤ÛÔ ‰Â›ÎÙËÂÓ‰ËÌÈÎfiÙËÙ·˜.

ñ ∫·Ù·˘ÏÈÛÌÔ› ·ıÈÁÁ¿ÓˆÓ Î·È ¿ÏÏˆÓ ÏËı˘ÛÌÈ·ÎÒÓÔÌ¿‰ˆÓ Ô˘ ˙Ô˘Ó ÛÂ Û˘Óı‹ÎÂ˜ ÔÌ·‰ÈÎ‹˜ ‰È·‚›ˆÛË˜.

ñ ¶·È‰È¿ ÌÂ Mantoux (-) ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ· ÙˆÓ ÔÔ›ˆÓ˘¿Ú¯ÂÈ ¿ÙÔÌÔ ÌÂ Ê˘Ì·Ù›ˆÛË (ıÂÙÈÎ¿ Ù‡ÂÏ·).

ñ ¡ÂÔÁÓ¿ ÌËÙ¤ÚˆÓ Ô˘ ¤¯Ô˘Ó ÌÔÏ˘ÓıÂ› ÌÂ ÙÔÓ Èfi HIV(fi¯È ‚Ú¤ÊË Û˘ÌÙˆÌ·ÙÈÎ¿ ÁÈ· AIDS).

ñ ¡ÂÔÁÓ¿, ÛÙÔ ¿ÌÂÛÔ ÂÚÈ‚¿ÏÏÔÓ ÙˆÓ ÔÔ›ˆÓ ˘¿Ú¯ÂÈ¿ÙÔÌÔ ÌÂ Ê˘Ì·Ù›ˆÛË (ÂÌ‚ÔÏÈ¿˙ÔÓÙ·È Î·Ù¿ ÙË Á¤ÓÓËÛË).

∂ıÓÈÎfi ¶ÚfiÁÚ·ÌÌ· ∂Ì‚ÔÏÈ·ÛÌÒÓ

∂ıÓÈÎ‹ ∂ÈÙÚÔ‹ ∂Ì‚ÔÏÈ·ÛÌÒÓ


167∂ıÓÈÎfi ¶ÚfiÁÚ·ÌÌ· ∂Ì‚ÔÏÈ·ÛÌÒÓ

¶·È‰È·ÙÚÈÎ‹ 2008;71:166-170

∂ÂÍËÁ‹ÛÂÈ˜ ∂ÈÎfiÓ·˜ 1

1. HepB = ∞Ó·Û˘Ó‰˘·ÛÌ¤ÓÔ ÂÌ‚fiÏÈÔ Î·Ù¿ ÙË˜ ∏·Ù›ÙÈ‰·˜ µ.

1·. ∏ 1Ë ‰fiÛË ÙÔ˘ HepB ¯ÔÚËÁÂ›Ù·È ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË ÌfiÓÔÓ fiÙ·Ó Ë ÌËÙ¤Ú· Â›Ó·È ÊÔÚ¤·˜ ÙÔ˘ ÂÈÊ·ÓÂÈ·ÎÔ‡ ·ÓÙÈÁfiÓÔ˘

(HBsAg) ‹ fiÙ·Ó Â›Ó·È ¿ÁÓˆÛÙÔ ·Ó Ë ÌËÙ¤Ú· Â›Ó·È ÊÔÚ¤·˜ ‹ fi¯È. ™ÙËÓ ÂÚ›ÙˆÛË ·˘Ù‹ ·Ó·ÁÎ·ÛÙÈÎ¿ Ë 1Ë ‰fiÛË ÙÔ˘ HepB ¯ÔÚËÁÂ›-

Ù·È ˆ˜ ÌÔÓÔ‰‡Ó·ÌÔ ÂÌ‚fiÏÈÔ.

1‚. ™ÙËÓ ÂÚ›ÙˆÛË Ô˘ Ë 1Ë ‰fiÛË ¯ÔÚËÁÂ›Ù·È ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË, Ô ‚·ÛÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ ÂÚÈÏ·Ì‚¿ÓÂÈ Û˘ÓÔÏÈÎ¿ 4

‰fiÛÂÈ˜ ·ÓÙ› ÁÈ· 3 ‰fiÛÂÈ˜ (Ë 2Ë ÛÙÔ Ù¤ÏÔ˜ ÙÔ˘ 1Ô˘ Ì‹Ó· Î·È Ë 3Ë ÛÙÔ Ù¤ÏÔ˜ ÙÔ˘ 2Ô˘ Ì‹Ó·). ∆Ô ÂÏ¿¯ÈÛÙÔ ÌÂÛÔ‰È¿ÛÙËÌ· ÌÂÙ·Í‡ 1Ë˜

Î·È 2Ë˜ Î·ıÒ˜ Î·È 2Ë˜ Î·È 3Ë˜ ‰fiÛË˜ Â›Ó·È 4 Â‚‰ÔÌ¿‰Â˜. ∆Ô ÂÏ¿¯ÈÛÙÔ ÌÂÛÔ‰È¿ÛÙËÌ· ÌÂÙ·Í‡ ÚÔÙÂÏÂ˘Ù·›·˜ (3Ë˜) Î·È ÙÂÏÂ˘Ù·›-

·˜ (4Ë˜) ‰fiÛË˜ ÙÔ˘ ‚·ÛÈÎÔ‡ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Â›Ó·È 8-16 Â‚‰ÔÌ¿‰Â˜ Î·È ‰ÂÓ ¯ÔÚËÁÂ›Ù·È ÓˆÚ›ÙÂÚ· ·fi ÙËÓ ËÏÈÎ›· ÙˆÓ 24 Â‚‰ÔÌ¿‰ˆÓ

(6 ÌËÓÒÓ).

¶ƒ√™√Ã∏! ™Â ÂÚ›ÙˆÛË Ô˘ ÙÔ ÂÌ‚fiÏÈÔ ÙË˜ ∏·Ù›ÙÈ‰·˜ µ ¯ÔÚËÁËıÂ› ˆ˜ Û˘Ó‰˘·ÛÌ¤ÓÔ ÂÌ‚fiÏÈÔ, Ô ÁÈ·ÙÚfi˜ Ú¤ÂÈ Ó·

ÁÓˆÚ›˙ÂÈ fiÙÈ Ù· Û˘Ó‰˘·ÛÌ¤Ó· ÂÌ‚fiÏÈ· ‰ÂÓ ¯ÔÚËÁÔ‡ÓÙ·È ÚÈÓ ·fi ÙËÓ 6Ë Â‚‰ÔÌ¿‰· ÙË˜ ˙ˆ‹˜. ∂ÔÌ¤Óˆ˜, ÙÔ ÂÏ¿¯ÈÛÙÔ ÌÂÛÔ‰È¿ÛÙËÌ· Ô˘

ÌÂÛÔÏ·‚Â› ·fi ÙË Á¤ÓÓËÛË, Ô˘ ¯ÔÚËÁÂ›Ù·È ÙÔ ÌÔÓÔ‰‡Ó·ÌÔ ÂÌ‚fiÏÈÔ ÙË˜ ∏·Ù›ÙÈ‰·˜ µ, Â›Ó·È 6 Â‚‰ÔÌ¿‰Â˜ ·ÓÙ› 1 Ì‹Ó·˜.

¶·Ú¿ÏÏËÏ· ÌÂ ÙËÓ 1Ë ‰fiÛË ÙÔ˘ ÂÌ‚ÔÏ›Ô˘, Û’ fiÏ· Ù· ÓÂÔÁÓ¿ ÌËÙ¤ÚˆÓ, ÊÔÚ¤ˆÓ ÙÔ˘ ÂÈÊ·ÓÂÈ·ÎÔ‡ ·ÓÙÈÁfiÓÔ˘, Î·È Ì¤Û· ÛÙÈ˜

ÚÒÙÂ˜ 12 ÒÚÂ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË ¯ÔÚËÁÔ‡ÓÙ·È 0,5 ml ˘ÂÚ¿ÓÔÛË˜ ·ÓÔÛÔÛÊ·ÈÚ›ÓË˜ ÁÈ· ∏·Ù›ÙÈ‰· µ. ∏ ¤ÓÂÛË Á›ÓÂÙ·È ÛÂ ‰È·ÊÔÚÂÙÈ-

Îfi Ì¤ÚÔ˜ ·’ ·˘Ùfi Ô˘ ¤ÁÈÓÂ (‹ ı· Á›ÓÂÈ) ÙÔ ÂÌ‚fiÏÈÔ. ŸÏ· Ù· ·È‰È¿ Ô˘ ÁÂÓÓ‹ıËÎ·Ó ·fi ÌËÙ¤ÚÂ˜ ÊÔÚÂ›˜ Î·È ‹Ú·Ó ÙÔ ÂÌ‚fi-

ÏÈÔ Î·È ÙËÓ ˘ÂÚ¿ÓÔÛË ·ÓÔÛÔÛÊ·ÈÚ›ÓË Ú¤ÂÈ Ó· ÂÏ¤Á¯ÔÓÙ·È ÁÈ· ÂÈÊ·ÓÂÈ·Îfi ·ÓÙÈÁfiÓÔ (HBsAg) Î·È ·ÓÙÈÛÒÌ·Ù· (·ÓÙÈ-HBs)

ÛÙËÓ ËÏÈÎ›· ÙˆÓ 9 ¤ˆ˜ 15 ÌËÓÒÓ.

ŸÙ·Ó Ë ÌËÙ¤Ú· Â›Ó·È ¿ÁÓˆÛÙÔ ·Ó Â›Ó·È ‹ fi¯È ÊÔÚ¤·˜ ÙÔ˘ ÂÈÊ·ÓÂÈ·ÎÔ‡ ·ÓÙÈÁfiÓÔ˘ Î·Ù¿ ÙÔÓ ÙÔÎÂÙfi Î·È ÛÙË Û˘Ó¤¯ÂÈ· ·Ô-

‰ÂÈ¯ÙÂ› fiÙÈ ‰ÂÓ Â›Ó·È, ·fi ÙË 2Ë ‰fiÛË Î·È ¤ÂÈÙ· ·ÎÔÏÔ˘ıÂ›Ù·È ÙÔ Û¯‹Ì· ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Ô˘ ÈÛ¯‡ÂÈ ÁÈ· Ù· ÓÂÔÁÓ¿ ÌËÙ¤ÚˆÓ

Ô˘ ‰ÂÓ Â›Ó·È ÊÔÚÂ›˜ ÙÔ˘ HbsAg, ‰ËÏ·‰‹ ·ÁÓÔÂ›Ù·È Ë 1Ë ‰fiÛË.

1Á. ŸÙ·Ó Ë ÌËÙ¤Ú· Â›Ó·È ·ÚÓËÙÈÎ‹ ÁÈ· ÂÈÊ·ÓÂÈ·Îfi ·ÓÙÈÁfiÓÔ, Ô ‚·ÛÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ ÂÚÈÏ·Ì‚¿ÓÂÈ 3 ‰fiÛÂÈ˜ (‰‡Ô ·Ú¯ÈÎ¤˜

∏ÏÈÎ›· °¤ÓÓËÛË 1 2 4 6 12 15 18 24 4-6 11-12 13-18∂Ì‚fiÏÈÔ ÌËÓfi˜ ÌËÓÒÓ ÌËÓÒÓ ÌËÓÒÓ ÌËÓÒÓ ÌËÓÒÓ ÌËÓÒÓ ÌËÓÒÓ ÂÙÒÓ ÂÙÒÓ ÂÙÒÓ

Hep B1· Hep B1‚ (1-2 ‰fiÛÂÈ˜) Hep B∏·Ù›ÙÈ‰·˜ µ (∏ep µ)1

Hep B1Á Hep B Hep B Hep B (fiÏÂ˜ ÔÈ ‰fiÛÂÈ˜)

¢ÈÊıÂÚ›ÙÈ‰·˜, ∆ÂÙ¿ÓÔ˘, DTaP DTaP DTaP DTaP DTaP D∆aP2·,2‚

∫ÔÎÎ‡ÙË (D∆aP)2

¶ÔÏÈÔÌ˘ÂÏ›ÙÈ‰·˜ IPV(IPV)3 IPV IPV IPV IPV

AÈÌfiÊÈÏÔ˘ Ù‡Ô˘ µ4 Hib Hib Hib Hib

MËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˘ C (MCC)5 MCC MCC MCC

¶ÓÂ˘ÌÔÓÈfiÎÔÎÎÔ˘ (PCV)6 PCV PCV PCV PCV PCV (PPV)6·

πÏ·Ú¿˜, ¶·ÚˆÙ›ÙÈ‰·˜,MMR MMR

∂Ú˘ıÚ¿˜ (MMR)7

AÓÂÌÂ˘ÏÔÁÈ¿˜ (Var)8 Var Var

HPVπfi˜ ∞ÓıÚÒÈÓˆÓ ÎÔÚ›ÙÛÈ·£ËÏˆÌ¿ÙˆÓ (∏PV)9 12-15 ÂÙ.

3 ‰fiÛÂÈ˜

∏·Ù›ÙÈ‰·˜ A (Hep A)10 Hep A (2 ‰fiÛÂÈ˜)

º˘Ì·Ù›ˆÛË˜ (BCG)11 MantouxMantoux11·

Mantoux11‚

BCG

°Ú›Ë˜ (πNFL)12 π¡FL (ÂÙËÛ›ˆ˜)

∂ÈÎfiÓ· 1. ÃÚÔÓÔ‰È¿ÁÚ·ÌÌ· ÂÌ‚ÔÏÈ·ÛÌÒÓ ÁÈ· ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜.------ ∆· ÂÌ‚fiÏÈ· Î¿Ùˆ ·fi ÙË ‰È·ÎÂÎÔÌÌ¤ÓË ÁÚ·ÌÌ‹ Û˘ÓÈÛÙÒÓÙ·È ÁÈ· ÂÈÏÂÎÙÈÎfi ÂÌ‚ÔÏÈ·ÛÌfi (‚Ï¤Â ÂÂÍËÁ‹ÛÂÈ˜ ÙË˜ ∂ÈÎfiÓ·˜ 1).

∂‡ÚÔ˜ ËÏÈÎÈÒÓ ‰ÈÂÓ¤ÚÁÂÈ·˜ ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡. ™ÙËÓ ·Ú¤ÓıÂÛË ·Ó·ÁÚ¿ÊÔÓÙ·È ÔÈ ‰fiÛÂÈ˜ ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ Ô˘ Á›ÓÔÓÙ·È Û’ ·˘Ùfi ÙÔ Â‡ÚÔ˜ ËÏÈ-ÎÈÒÓ, fiÙ·Ó Â›Ó·È ÂÚÈÛÛfiÙÂÚÂ˜ ·fi Ì›·. ∆Ô Â‡ÚÔ˜ ËÏÈÎÈÒÓ ‰ÈÂÓ¤ÚÁÂÈ·˜ ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ‰›ÓÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· Ó· ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÌÔ-ÓÔ‰‡Ó·Ì· ‹ ÔÏ˘‰‡Ó·Ì· (Û˘Ó‰˘·ÛÌ¤Ó·) ÂÌ‚fiÏÈ· ‹/Î·È Û˘Ó‰˘·ÛÌfi˜ ÌÔÓÔ‰‡Ó·ÌˆÓ-Û˘Ó‰˘·ÛÌ¤ÓˆÓ.∂‡ÚÔ˜ ËÏÈÎÈÒÓ ‰ÈÂÓ¤ÚÁÂÈ·˜ ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ fiÙ·Ó ·˘Ùfi˜ ‰ÂÓ ¤¯ÂÈ ÚÔËÁËıÂ› Î·Ù¿ ÙÔ Û˘ÓÈÛÙÒÌÂÓÔ Û¯‹Ì· ˆ˜ ÚÔ˜ ÙËÓ ËÏÈÎ›· Î·È ÙÈ˜ ‰fiÛÂÈ˜(‚Ï¤Â ÂÂÍËÁ‹ÛÂÈ˜ ¶ÈÓ¿ÎˆÓ 5 Î·È 6).

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∂£¡π∫√ ¶ƒ√°ƒ∞ªª∞ ∂ªµ√§π∞™ªø¡ - ÃÚÔÓÔ‰È¿ÁÚ·ÌÌ· ∂Ì‚ÔÏÈ·ÛÌÒÓ ÁÈ· ¶·È‰È¿ Î·È ∂Ê‹‚Ô˘˜


168 ∂ıÓÈÎ‹ ∂ÈÙÚÔ‹ ∂Ì‚ÔÏÈ·ÛÌÒÓ


ÌÂ ÌÂÛÔ‰È¿ÛÙËÌ· 6-8 Â‚‰ÔÌ¿‰ˆÓ Î·È ÌÈ· ÙÚ›ÙË ÛÂ ËÏÈÎ›· 6-18 ÌËÓÒÓ ÌÂ ÂÏ¿¯ÈÛÙÔ ÌÂÛÔ‰È¿ÛÙËÌ· ·fi ÙË 2Ë ‰fiÛË 8-16 Â‚‰ÔÌ¿-

‰Â˜ Î·È fi¯È ÓˆÚ›ÙÂÚ· ·fi ÙËÓ ËÏÈÎ›· ÙˆÓ 6 ÌËÓÒÓ).

2. DTaP = ∂Ì‚fiÏÈÔ Î·Ù¿ ÙË˜ ‰ÈÊıÂÚ›ÙÈ‰·˜, ÙÔ˘ ÙÂÙ¿ÓÔ˘, ÙÔ˘ ÎÔÎÎ‡ÙË Ô˘ ÂÚÈ¤¯ÂÈ Ù· ÙÔÍÔÂÈ‰‹ (‹ ·ÙÔÍ›ÓÂ˜) ÙÔ˘ ÎÔÚ˘ÓÔ-

‚·ÎÙËÚÈ‰›Ô˘ ÙË˜ ‰ÈÊıÂÚ›ÙÈ‰·˜ Î·È ÙÔ˘ ÎÏˆÛÙËÚÈ‰›Ô˘ ÙÔ˘ ÙÂÙ¿ÓÔ˘ Î·È ÌfiÓÔ ·ÓÙÈÁfiÓ· ÙË˜ µ. pertussis (fi¯È ÔÏfiÎÏËÚÔ ÙÔ ÌÈÎÚÔ-

ÔÚÁ·ÓÈÛÌfi ÓÂÎÚfi, fiˆ˜ Ù· ·Ï·ÈfiÙÂÚ· “ÔÏÔÎ˘ÙÙ·ÚÈÎ¿” ÂÌ‚fiÏÈ·), ÁÈ’ ·˘Ùfi Î·È Î·ÏÂ›Ù·È “·Î˘ÙÙ·ÚÈÎfi” Î·Ù¿ ÙÔ˘ ÎÔÎÎ‡ÙË

(acellular pertussis ‹ ·P) ÂÌ‚fiÏÈÔ.

2·. TdaP = ∂Ì‚fiÏÈÔ Î·Ù¿ ÙË˜ ‰ÈÊıÂÚ›ÙÈ‰·˜, ÙÔ˘ ÙÂÙ¿ÓÔ˘, ÙÔ˘ ÎÔÎÎ‡ÙË, ÌÂ ÌÈÎÚfiÙÂÚË ‰fiÛË ‰ÈÊıÂÚÈÙÈÎ‹˜ ·ÙÔÍ›ÓË˜. ™ÙË ¯Ò-

Ú· Ì·˜ ÂÚÈ¤¯ÂÈ Î·È IPV Î·È ‰‡Ó·Ù·È Ó· ¯ÔÚËÁËıÂ› Ì¤¯ÚÈ ÙËÓ ËÏÈÎ›· ÙˆÓ 18 ÂÙÒÓ. ∆Ô TdaP Û˘ÓÈÛÙ¿Ù·È Ó· Á›ÓÂÙ·È ÁÈ· Â·Ó·ÏË-

ÙÈÎ‹ ‰fiÛË ÛÙËÓ ËÏÈÎ›· ÙˆÓ 11-12 ÂÙÒÓ ‹ Î·È ·ÚÁfiÙÂÚ· (Ì¤¯ÚÈ ÙËÓ ËÏÈÎ›· ÙˆÓ 64 ÂÙÒÓ) Î·Ù¿ ÚÔÙ›ÌËÛË fiÙ·Ó ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ·

·ÔÎÙ¿Ù·È ÓÂÔÁ¤ÓÓËÙÔ. ™˘ÓÈÛÙ¿Ù·È Ó· ·¤¯ÂÈ 5 ¯ÚfiÓÈ· ·fi ÙÔ DTaP ‹ ÙÔ ∆d ÁÈ· ÏÈÁfiÙÂÚÂ˜ ÙÔÈÎ¤˜ ·ÓÙÈ‰Ú¿ÛÂÈ˜, ÌÔÚÂ› fiÌˆ˜

Ó· ¯ÔÚËÁËıÂ› ÌÂ ÂÏ¿¯ÈÛÙÔ ÌÂÛÔ‰È¿ÛÙËÌ· Î·È ‰‡Ô ÂÙÒÓ. ∂¿Ó ‰ÂÓ Î˘ÎÏÔÊÔÚÂ› ÙÔ TdaP ÌfiÓÔ ÙÔ˘ (¯ˆÚ›˜ IPV) ¯ÔÚËÁÂ›Ù·È ÙÔ Td

ÂÓËÏ›ÎˆÓ. √È ˘fiÏÔÈÂ˜ ‰fiÛÂÈ˜ ı· Â›Ó·È Î¿ıÂ 10 ¯ÚfiÓÈ· ÌÂ Td ÂÓËÏ›ÎˆÓ.

2‚. Td = ∂Ì‚fiÏÈÔ Î·Ù¿ ÙÔ˘ ÙÂÙ¿ÓÔ˘ Î·È ÙË˜ ‰ÈÊıÂÚ›ÙÈ‰·˜ ÌÂ ÌÈÎÚfiÙÂÚË ‰fiÛË ‰ÈÊıÂÚÈÙÈÎ‹˜ ·ÙÔÍ›ÓË˜. ™˘ÓÈÛÙ¿Ù·È Ó· Á›ÓÂÙ·È Î¿-

ıÂ 10 ¯ÚfiÓÈ· ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ TdaP ÛÙËÓ ÂÊË‚ÈÎ‹ ËÏÈÎ›·. ∆Ô ÂÌ‚fiÏÈÔ ÙÔ˘ ÙÂÙ¿ÓÔ˘ ÌÔÚÂ› Ó· Á›ÓÂÙ·È ‰È· ‚›Ô˘ ÌÂ ·ÛÊ¿ÏÂÈ·.

3. IPV = ∂Ó¤ÛÈÌÔ ÂÓÈÛ¯˘Ì¤ÓÔ ÂÌ‚fiÏÈÔ Î·Ù¿ ÙË˜ ÔÏÈÔÌ˘ÂÏ›ÙÈ‰·˜.

4. Hib = ™˘˙Â˘ÁÌ¤ÓÔ ÂÌ‚fiÏÈÔ Î·Ù¿ ÙÔ˘ ·ÈÌfiÊÈÏÔ˘ Ù‡Ô˘ ‚. ∂¿Ó Ë ÚˆÙÂ˝ÓË Û‡˙Â˘ÍË˜ Â›Ó·È Ë PRP-OMP (ÚˆÙÂ˚ÓÈÎfi Û‡-

ÌÏÂÁÌ· ÙË˜ ÂÍˆÙÂÚÈÎ‹˜ ÌÂÌ‚Ú¿ÓË˜ ÙÔ˘ ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˘), ÙfiÙÂ Ë 3Ë ·fi ÙÈ˜ 3 ·Ú¯ÈÎ¤˜ ‰fiÛÂÈ˜ ÌÔÚÂ› Ó· ·Ú·ÏËÊıÂ› Î·È ÙÔ

Û¯‹Ì· Ó· Â›Ó·È (2Ô˜, 4Ô˜ Î·È 12Ô˜-15Ô˜ Ì‹Ó·˜).

5. MCC = ™˘˙Â˘ÁÌ¤ÓÔ, ÔÏ˘Û·Î¯·ÚÈ‰ÈÎfi ÂÌ‚fiÏÈÔ Î·Ù¿ ÙÔ˘ ÌËÓÈÁÁÈÙÈ‰fiÎÔÎÎÔ˘ ÔÚÔÔÌ¿‰·˜ C. ™˘ÓÈÛÙ¿Ù·È Ë ¤Ó·ÚÍË ÂÌ‚Ô-

ÏÈ·ÛÌÔ‡ ÛÂ ËÏÈÎ›· 2 ÌËÓÒÓ Î·È ·ÎÔÏÔ˘ıÂ›Ù·È Û¯‹Ì· 3 ‰fiÛÂˆÓ - ÔÈ 2 ÚÒÙÂ˜ ‰fiÛÂÈ˜ ÌÂ ÌÂÛÔ‰È¿ÛÙËÌ· 2 ÌËÓÒÓ Î·È Â·Ó·ÏËÙÈ-

Î‹ ‰fiÛË ÛÂ ËÏÈÎ›· 15-18 ÌËÓÒÓ. ™Â ÂÚ›ÙˆÛË ¤Ó·ÚÍË˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÛÂ ËÏÈÎ›· >12 ÌËÓÒÓ, ·ÎÔÏÔ˘ıÂ›Ù·È Û¯‹Ì· 1 ‰fiÛË˜.

6. PCV = ¡ÂÎÚfi, Û˘˙Â˘ÁÌ¤ÓÔ, ÔÏ˘Û·Î¯·ÚÈ‰ÈÎfi, ÂÙ·‰‡Ó·ÌÔ ÂÌ‚fiÏÈÔ Î·Ù¿ ÙÔ˘ ÛÙÚÂÙfiÎÔÎÎÔ˘ ÙË˜ ÓÂ˘ÌÔÓ›·˜ (ÓÂ˘ÌÔ-

ÓÈfiÎÔÎÎÔ˘). ™˘ÓÈÛÙ¿Ù·È Û’ fiÏ· Ù· ·È‰È¿ ËÏÈÎ›·˜ 2-23 ÌËÓÒÓ. ∏ ÙÂÏÂ˘Ù·›· ‰fiÛË (4Ë) Á›ÓÂÙ·È ÛÂ ËÏÈÎ›· ≥12 ÌËÓÒÓ. ∆Ô ÂÌ‚fiÏÈÔ

ÌÔÚÂ› Ó· Á›ÓÂÈ Î·È ÛÂ ÌÂÁ·Ï‡ÙÂÚË ËÏÈÎ›· Î·È È‰È·›ÙÂÚ· ÛÂ ¿ÙÔÌ· Ô˘ ·Ó‹ÎÔ˘Ó ÛÂ ÔÌ¿‰Â˜ ·˘ÍËÌ¤ÓÔ˘ ÎÈÓ‰‡ÓÔ˘ (‚Ï¤Â ˘ÔÛË-

ÌÂÈÒÛÂÈ˜ 6,7 ÛÙÔ ÚfiÁÚ·ÌÌ· ÂÌ‚ÔÏÈ·ÛÌÒÓ ÁÈ· ·È‰È¿ Ô˘ ‰ÂÓ ÂÌ‚ÔÏÈ¿ÛıËÎ·Ó ÛÙË ‚ÚÂÊÈÎ‹ ËÏÈÎ›·, ¶›Ó·ÎÂ˜ 5 Î·È 6). ™ÙËÓ ÙÂ-

ÏÂ˘Ù·›· ÂÚ›ÙˆÛË, ÔÈ Â·Ó·ÏËÙÈÎ¤˜ ‰fiÛÂÈ˜ ÌÔÚÂ› Ó· Á›ÓÔÓÙ·È Î·È ÌÂ ÙÔ 23‰‡Ó·ÌÔ ÔÏ˘Û·Î¯·ÚÈ‰ÈÎfi ÌË Û˘˙Â˘ÁÌ¤ÓÔ ÂÌ‚fi-

ÏÈÔ (PPV).

6·. PPV = ªË Û˘˙Â˘ÁÌ¤ÓÔ, ÔÏ˘Û·Î¯·ÚÈ‰ÈÎfi ÂÌ‚fiÏÈÔ (23‰‡Ó·ÌÔ) Î·Ù¿ ÙÔ˘ ÛÙÚÂÙfiÎÔÎÎÔ˘ ÙË˜ ÓÂ˘ÌÔÓ›·˜ (ÓÂ˘ÌÔÓÈÔ-

ÎfiÎÎÔ˘). ™˘ÓÈÛÙ¿Ù·È ÁÈ· Â·Ó·ÏËÙÈÎ¤˜ ‰fiÛÂÈ˜ ÛÂ ·È‰È¿ Ô˘ ·Ó‹ÎÔ˘Ó ÛÂ ÔÌ¿‰Â˜ ·˘ÍËÌ¤ÓÔ˘ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÛÔ‚·Ú‹ ÓÂ˘ÌÔ-

ÓÈÔÎÔÎÎÈÎ‹ ÏÔ›ÌˆÍË (¶›Ó·Î·˜ 1), ÂÎÙfi˜ ·fi ˘ÁÈ‹ ‚Ú¤ÊË Î·È ·È‰È¿ ËÏÈÎ›·˜ 2-23 ÌËÓÒÓ.

7. MMR = ∂Ì‚fiÏÈÔ Ô˘ ÂÚÈ¤¯ÂÈ ˙ÒÓÙÂ˜ ÂÍ·ÛıÂÓËÌ¤ÓÔ˘˜ ÈÔ‡˜ ÙË˜ ÈÏ·Ú¿˜, ·ÚˆÙ›ÙÈ‰·˜ Î·È ÂÚ˘ıÚ¿˜. ÃÔÚËÁÂ›Ù·È ÛÙËÓ ËÏÈ-

Î›· ÙˆÓ 12-15 ÌËÓÒÓ. ™˘ÓÈÛÙ¿Ù·È 2Ë ‰fiÛË ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ ÛÙËÓ ËÏÈÎ›· ÙˆÓ 4-6 ÂÙÒÓ, ·ÏÏ¿ Î·È ÛÂ ÔÔÈ·‰‹ÔÙÂ ¿ÏÏË ËÏÈÎ›·, ·Ú-

ÎÂ› Ó· ·¤¯ÂÈ 2 Ì‹ÓÂ˜ ·fi ÙËÓ 1Ë ‰fiÛË. √ ·È‰›·ÙÚÔ˜ Ú¤ÂÈ Ó· ÂÏ¤Á¯ÂÈ ·Ó ¤ÁÈÓÂ ‹ fi¯È Ë 2Ë ‰fiÛË Î·È ·Ó fi¯È ¯ÔÚËÁÂ›Ù·È Ë 2Ë ‰fi-

ÛË ÛÂ ÔÔÈ·‰‹ÔÙÂ ËÏÈÎ›·.

8. Var = ∂Ì‚fiÏÈÔ Ô˘ ÂÚÈ¤¯ÂÈ ˙ÒÓÙ· ÂÍ·ÛıÂÓËÌ¤ÓÔ Èfi ÙË˜ ·ÓÂÌÂ˘ÏÔÁÈ¿˜. ÃÔÚËÁÂ›Ù·È Û’ fiÏ· Ù· ·È‰È¿ ÛÙËÓ ËÏÈÎ›· ÙˆÓ 12-

18 ÌËÓÒÓ (Î·Ù¿ ÚÔÙ›ÌËÛË ÌÂÙ¿ ÙÔ 15Ô Ì‹Ó·), ·ÏÏ¿ Î·È Û’ ÔÔÈ·‰‹ÔÙÂ ¿ÏÏË ËÏÈÎ›·, ÂÊfiÛÔÓ ÙÔ ¿ÙÔÌÔ ‰ÂÓ ¤¯ÂÈ ÓÔÛ‹ÛÂÈ. ™˘ÓÈ-

ÛÙ¿Ù·È 2Ë ‰fiÛË ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ ÛÙËÓ ËÏÈÎ›· ÙˆÓ 4-6 ÂÙÒÓ, ·ÏÏ¿ Î·È ÛÂ ÔÔÈ·‰‹ÔÙÂ ¿ÏÏË ËÏÈÎ›· ·ÚÎÂ› Ó· ·¤¯ÂÈ 2 Ì‹ÓÂ˜ ·fi ÙËÓ

1Ë ‰fiÛË. √ ·È‰›·ÙÚÔ˜ Ú¤ÂÈ Ó· ÂÏ¤Á¯ÂÈ ·Ó ¤ÁÈÓÂ ‹ fi¯È Ë 2Ë ‰fiÛË Î·È ·Ó fi¯È ¯ÔÚËÁÂ›Ù·È Ë 2Ë ‰fiÛË ÛÂ ÔÔÈ·‰‹ÔÙÂ ËÏÈÎ›·.

9. HPV = ∞Ó·Û˘Ó‰˘·ÛÌ¤ÓÔ ÂÌ‚fiÏÈÔ Î·Ù¿ ÙÔ˘ ÈÔ‡ ÙˆÓ ·ÓıÚÒÈÓˆÓ ıËÏˆÌ¿ÙˆÓ. ™‡ÌÊˆÓ· ÌÂ Ù· Ì¤¯ÚÈ ÛÙÈÁÌ‹˜ ÂÈÛÙËÌÔÓÈ-

Î¿ ‰Â‰ÔÌ¤Ó·, ÌÔÚÂ› Ó· ¯ÔÚËÁËıÂ› ·fi ÙËÓ ËÏÈÎ›· ÙˆÓ 9-26 ÂÙÒÓ. ™ÙË ¯ÒÚ· Ì·˜ Û˘ÓÈÛÙ¿Ù·È ÌfiÓÔ ÛÂ ÎÔÚ›ÙÛÈ· ËÏÈÎ›·˜ 12-15

ÂÙÒÓ, ·ÏÏ¿ Î·È ÛÂ ÎÔÚ›ÙÛÈ· ËÏÈÎ›·˜ 15-26 ÂÙÒÓ, Â¿Ó ‰ÂÓ ¤¯Ô˘Ó ÂÌ‚ÔÏÈ·ÛÙÂ› ÛÙË Û˘ÓÈÛÙÒÌÂÓË ËÏÈÎ›· (¯ˆÚ›˜ Ó· ‰È·ÛÊ·Ï›˙ÂÙ·È Ë

ÚÔÊ‡Ï·Í‹ ÙÔ˘˜, Â¿Ó ‹‰Ë ¤¯Ô˘Ó ÌÔÏ˘ÓıÂ› ·fi Ù‡Ô ÙÔ˘ ÈÔ‡ Ô˘ ÂÚÈ¤¯ÂÙ·È ÛÙÔ ÂÌ‚fiÏÈÔ, È‰È·›ÙÂÚ· ·Ó ¤¯Ô˘Ó ·ÏÏ¿ÍÂÈ 3-4 ÛÂ-

ÍÔ˘·ÏÈÎÔ‡˜ Û˘ÓÙÚfiÊÔ˘˜). ™ÙË ¯ÒÚ· Ì·˜ Î˘ÎÏÔÊÔÚÔ‡Ó ‰‡Ô ÂÌ‚fiÏÈ·. ∆Ô ¤Ó· Â›Ó·È ‰È‰‡Ó·ÌÔ Î·È ÙÔ ¿ÏÏÔ ÙÂÙÚ·‰‡Ó·ÌÔ. ∫·È Ù·

‰‡Ô ÂÌ‚fiÏÈ· ÂÚÈ¤¯Ô˘Ó Ù· ÔÁÎÔÁfiÓ· ÛÙÂÏ¤¯Ë 16 Î·È 18. ∆Ô ÙÂÙÚ·‰‡Ó·ÌÔ ÂÚÈ¤¯ÂÈ ÂÈÏ¤ÔÓ ‰‡Ô ·ÎfiÌ· Ù‡Ô˘˜ ÈÒÓ (6 Î·È 11),

Ô˘ ·ÛÎÔ‡Ó ÚÔÛÙ·ÙÂ˘ÙÈÎ‹ ‰Ú¿ÛË Î·Ù¿ ÙˆÓ ıËÏˆÌ¿ÙˆÓ (ÎÔÓ‰˘ÏˆÌ¿ÙˆÓ). ∆Ô ‰ÔÛÔÏÔÁÈÎfi Û¯‹Ì· Î·È ÁÈ· Ù· ‰‡Ô ÂÌ‚fiÏÈ· ÂÚÈ-

Ï·Ì‚¿ÓÂÈ 3 ‰fiÛÂÈ˜. °È· ÌÂÓ ÙÔ ‰È‰‡Ó·ÌÔ, ÔÈ ‰fiÛÂÈ˜ Â›Ó·È 0-1-6 Ì‹ÓÂ˜, ÂÓÒ ÁÈ· ÙÔ ÙÂÙÚ·‰‡Ó·ÌÔ Â›Ó·È 0-2-6 Ì‹ÓÂ˜. ™Â ÂÚ›ÙˆÛË

Ô˘ ‰ÂÓ ÙËÚËıÂ› ÙÔ ·ÎÚÈ‚¤˜ ¯ÚÔÓÔ‰È¿ÁÚ·ÌÌ·, Ô ÁÈ·ÙÚfi˜ ÌÔÚÂ› Ó· Û˘ÓÂ¯›ÛÂÈ ÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi, ¯ˆÚ›˜ Ó· ¯¿ÓÔÓÙ·È ÔÈ ÚÔËÁÔ‡-

ÌÂÓÂ˜ ‰fiÛÂÈ˜. ∆¤ÏÔ˜, Ë Û˘Á¯ÔÚ‹ÁËÛË ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ ÌÂ ¿ÏÏ· ÂÌ‚fiÏÈ· ¤¯ÂÈ ·Ô‰ÂÈ¯ıÂ› Ì¤¯ÚÈ ÛÙÈÁÌ‹˜ ·ÛÊ·Ï‹˜ ÌfiÓÔ fiÛÔÓ ·ÊÔÚ¿

ÙÔ ÂÌ‚fiÏÈÔ ÙË˜ ∏·Ù›ÙÈ‰·˜ µ.

10. Hep A = ∞‰Ú·ÓÔÔÈËÌ¤ÓÔ ÔÏÔÎ˘ÙÙ·ÚÈÎfi ÂÌ‚fiÏÈÔ Î·Ù¿ ÙË˜ ∏·Ù›ÙÈ‰·˜ ∞. ÃÔÚËÁÂ›Ù·È ÛÂ ÔÔÈ·‰‹ÔÙÂ ËÏÈÎ›· ¿Óˆ ÙÔ˘

ÂÓfi˜ (1) ¤ÙÔ˘˜ ÛÂ 2 ‰fiÛÂÈ˜, ÌÂ ÂÏ¿¯ÈÛÙÔ ÌÂÛÔ‰È¿ÛÙËÌ· 6 ÌËÓÒÓ, Î·ıÒ˜ Î·È ÛÂ fiÏÂ˜ ÙÈ˜ ÔÌ¿‰Â˜ ·˘ÍËÌ¤ÓÔ˘ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ∏·Ù›-

ÙÈ‰· ∞ (¶›Ó·Î·˜ 3).

11. BCG = ∑ˆÓ ÂÍ·ÛıÂÓËÌ¤ÓÔ ÂÌ‚fiÏÈÔ Î·Ù¿ ÙË˜ Ê˘Ì·Ù›ˆÛË˜. ™‡ÌÊˆÓ· ÌÂ ÙÈ˜ ÚfiÛÊ·ÙÂ˜ Ô‰ËÁ›Â˜ ÙË˜ ¢ÈÂıÓÔ‡˜ ŒÓˆÛË˜ Î·-

Ù¿ ÙË˜ Ê˘Ì·Ù›ˆÛË˜ Î·È ÙË˜ ¶·ÁÎfiÛÌÈ·˜ √ÚÁ¿ÓˆÛË˜ ÀÁÂ›·˜, Ë ¯ÒÚ· Ì·˜ ‰ÂÓ ÏËÚÔ› ÙÈ˜ ÚÔ¸Ôı¤ÛÂÈ˜ ÁÈ· ÙË ‰È·ÎÔ‹ ÙÔ˘ ·ÓÙÈ-

Ê˘Ì·ÙÈÎÔ‡ ÂÌ‚ÔÏÈ·ÛÌÔ‡, Ô ÔÔ›Ô˜ ÂÍ·ÎÔÏÔ˘ıÂ› Ó· Á›ÓÂÙ·È ÛÙËÓ ËÏÈÎ›· ÙˆÓ 6 ÂÙÒÓ. π‰È·›ÙÂÚË ¤ÌÊ·ÛË Ú¤ÂÈ Ó· ‰ÔıÂ› Î˘Ú›ˆ˜

ÛÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi ÙˆÓ ·È‰ÈÒÓ Ô˘ ·Ó‹ÎÔ˘Ó ÛÙÈ˜ ÔÌ¿‰Â˜ ·˘ÍËÌ¤ÓÔ˘ ÎÈÓ‰‡ÓÔ˘ (¶›Ó·Î·˜ 2). ¶·Ú¿ÏÏËÏ·, Û˘ÓÈÛÙ¿Ù·È Ì·˙ÈÎfi˜

ÚÔÏËÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÌÂ ‰ÂÚÌÔ·ÓÙ›‰Ú·ÛË Mantoux ÛÙÈ˜ ËÏÈÎ›Â˜ 1, 4-6 ÂÙÒÓ (ÚÈÓ ·fi ÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi ÌÂ BCG, 11·) Î·È ÛÙ·

·ÓÂÌ‚ÔÏ›·ÛÙ· ·È‰È¿, ÛÙËÓ ËÏÈÎ›· 11-12 ÂÙÒÓ (fiÙ·Ó Á›ÓÂÙ·È Ë ÂÎÙ›ÌËÛË ÙË˜ ÂÌ‚ÔÏÈ·ÛÙÈÎ‹˜ ÙÔ˘˜ Î¿Ï˘„Ë˜, 11‚).

12. INFL = ∞‰Ú·ÓÔÔÈËÌ¤ÓÔ ÔÏÔÎ˘ÙÙ·ÚÈÎfi ‹ ·Î˘ÙÙ·ÚÈÎfi (ÙÌËÌ·ÙÈÎfi) ÂÌ‚fiÏÈÔ Î·Ù¿ ÙË˜ ÁÚ›Ë˜ Ô˘ Û˘ÓÈÛÙ¿Ù·È Ó· Á›ÓÂÙ·È

ÂÙËÛ›ˆ˜, ÛÂ 1 ‰fiÛË Î·È ÛÂ ËÏÈÎ›· ¿Óˆ ·fi 6 ÌËÓÒÓ. ¶ÚÔ˜ ÙÔ ·ÚfiÓ, ÂÓ‰Â›ÎÓ˘Ù·È ÌfiÓÔ ÁÈ· ·È‰È¿ Ô˘ ·Ó‹ÎÔ˘Ó ÛÂ ÔÌ¿‰Â˜ ·˘-

ÍËÌ¤ÓÔ˘ ÎÈÓ‰‡ÓÔ˘ Ó· ÓÔÛ‹ÛÔ˘Ó ÛÔ‚·Ú¿ ·fi ÁÚ›Ë (¶›Ó·Î·˜ 4). ¶·È‰È¿ Î¿Ùˆ ÙˆÓ 8 ÂÙÒÓ Ô˘ ı· ÂÌ‚ÔÏÈ·ÛıÔ‡Ó ÁÈ· ÚÒÙË ÊÔ-

Ú¿ ı· ¿ÚÔ˘Ó 2 ‰fiÛÂÈ˜ ÂÌ‚ÔÏ›Ô˘ (0,25 ml <3 ÂÙÒÓ Î·È 0,5 ml ≥3 ÂÙÒÓ) ÌÂ ÂÏ¿¯ÈÛÙÔ ÌÂÛÔ‰È¿ÛÙËÌ· 4 Â‚‰ÔÌ¿‰ˆÓ.


169∂ıÓÈÎfi ¶ÚfiÁÚ·ÌÌ· ∂Ì‚ÔÏÈ·ÛÌÒÓ

¶·È‰È·ÙÚÈÎ‹ 2008;71:166-170

¶›Ó·Î·˜ 4. ∂Ó‰Â›ÍÂÈ˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Î·Ù¿ ÙË˜ ÁÚ›Ë˜

¶·ÚÔ˘Û›· ÂÓfi˜ ‹ ÂÚÈÛÛÔÙ¤ÚˆÓ ·fi ÙÔ˘˜ ·Ú·Î¿Ùˆ ÂÈ‚·Ú˘ÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜ ‹ ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù·: ñ ÕÛıÌ· ‹ ¿ÏÏÂ˜ ¯ÚfiÓÈÂ˜ ÓÂ˘ÌÔÓÔ¿ıÂÈÂ˜.ñ ∫·Ú‰È·Î‹ ÓfiÛÔ˜ ÌÂ ÛÔ‚·Ú¤˜ Î·Ú‰ÈÔ‰˘Ó·ÌÈÎ¤˜ ‰È·Ù·Ú·¯¤˜.ñ ∞ÓÔÛÔÎ·Ù·ÛÙÔÏ‹ (ÂÍ·ÈÙ›·˜ ÓÔÛ‹Ì·ÙÔ˜ ‹ ıÂÚ·Â›·˜).ñ ¢ÚÂ·ÓÔÎ˘ÙÙ·ÚÈÎ‹ ÓfiÛÔ˜ (Î·È ¿ÏÏÂ˜ ·ÈÌÔÛÊ·ÈÚÈÓÔ¿ıÂÈÂ˜).ñ ¶·È‰È¿ Ô˘ ·›ÚÓÔ˘Ó ·ÛÈÚ›ÓË Ì·ÎÚÔ¯ÚfiÓÈ· (.¯. ÓfiÛÔ˜ Kawasaki) ÁÈ· Ó· ÂÏ·ÙÙˆıÂ› Ô Î›Ó‰˘ÓÔ˜ ÂÌÊ¿ÓÈÛË˜ Û˘Ó‰ÚfiÌÔ˘ Reye

ÌÂÙ¿ ·fi ÁÚ›Ë.ñ ™·Î¯·ÚÒ‰Ë˜ ‰È·‚‹ÙË˜ ‹ ¿ÏÏÔ ¯ÚfiÓÈÔ ÌÂÙ·‚ÔÏÈÎfi ÓfiÛËÌ·.ñ ÃÚfiÓÈ· ÓÂÊÚÔ¿ıÂÈ·.ñ ∫ÏÂÈÛÙÔ› ÏËı˘ÛÌÔ›*.ñ ∂·ÁÁÂÏÌ·Ù›Â˜ ˘ÁÂ›·˜.ñ ∂·ÁÁÂÏÌ·Ù›Â˜ Ô˘ ·Û¯ÔÏÔ‡ÓÙ·È ÌÂ Ô˘ÏÂÚÈÎ¿**.ñ ÕÙÔÌ· ËÏÈÎ›·˜ 60 ÂÙÒÓ Î·È ¿Óˆ.

* ¶ÚÔÛˆÈÎfi Î·È ÂÛˆÙÂÚÈÎÔ› ÛÔ˘‰·ÛÙ¤˜ Á˘ÌÓ·Û›ˆÓ-Ï˘ÎÂ›ˆÓ, ÛÙÚ·ÙÈˆÙÈÎÒÓ Î·È ·ÛÙ˘ÓÔÌÈÎÒÓ Û¯ÔÏÒÓ, ÂÈ‰ÈÎÒÓ Û¯ÔÏÂ›ˆÓ ‹Û¯ÔÏÒÓ, ÙÚfiÊÈÌÔÈ Î·È ÚÔÛˆÈÎfi È‰Ú˘Ì¿ÙˆÓ Î.¿.** √ Èfi˜ ÙË˜ ÁÚ›Ë˜ ÙˆÓ Ô˘ÏÂÚÈÎÒÓ Î·ÓÔÓÈÎ¿ ‰ÂÓ ÚÔÎ·ÏÂ› ÓfiÛËÛË ÛÙÔÓ ¿ÓıÚˆÔ. ∂›Ó·È ‰˘Ó·ÙfiÓ fiÌˆ˜, ÛÂ ÂÚ›ÙˆÛË Û˘ÏÏÔ›Ìˆ-ÍË˜ ÌÂ ÙÔÓ Èfi ÙË˜ ÁÚ›Ë˜ ÙˆÓ ·ÓıÚÒˆÓ, Ó· ÚÔÎ‡„ÂÈ ÌÂÙ·ÏÏ·ÁÌ¤ÓÔ˜ Èfi˜ Ô˘ Ó· ÚÔÛ‚¿ÏÏÂÈ Î·È ÙÔÓ ¿ÓıÚˆÔ. °È· ÙÔ ÏfiÁÔ ·˘Ùfi,Û˘ÓÈÛÙ¿Ù·È Ô ÂÌ‚ÔÏÈ·ÛÌfi˜ ·ÙfiÌˆÓ Ô˘ ·Û¯ÔÏÔ‡ÓÙ·È ÌÂ Ô˘ÏÂÚÈÎ¿.

∂›ÛË˜, Û˘ÓÈÛÙ¿Ù·È ÂÙ‹ÛÈÔ˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ fiÏˆÓ ÙˆÓ˘ÁÈÒÓ ·ÙfiÌˆÓ ËÏÈÎ›·˜ ¿Óˆ ÙˆÓ 60 ÂÙÒÓ Î·È ÙˆÓ ·ÙfiÌˆÓÔ˘ ·Ó‹ÎÔ˘Ó ÛÂ ÔÌ¿‰Â˜ ·˘ÍËÌ¤ÓÔ˘ ÎÈÓ‰‡ÓÔ˘, ·ÓÂÍ·ÚÙ‹-Ùˆ˜ ËÏÈÎ›·˜.

™Â ÂÚ›ÙˆÛË ·ÏÏ·Á‹˜ ÙˆÓ ÂÈ‰ËÌÈÔÏÔÁÈÎÒÓ Û˘ÓıË-ÎÒÓ (.¯. ÂÈ‰ËÌ›·, ·Ó‰ËÌ›·) ÔÈ Û˘ÛÙ¿ÛÂÈ˜ ·ÏÏ¿˙Ô˘Ó.

ŸÏ· Ù· ·È‰È¿ Ú¤ÂÈ Ó· ÂÈÛÎ¤ÙÔÓÙ·È ÙÔ ÁÈ·ÙÚfi ÙÔ˘˜ÛÙËÓ ËÏÈÎ›· ÙˆÓ 11-12 ÂÙÒÓ (Ù¤ÏÔ˜ ‰ËÌÔÙÈÎÔ‡, ¤Ó·ÚÍË ÊÔ›-ÙËÛË˜ ÛÙÔ Á˘ÌÓ¿ÛÈÔ), ÒÛÙÂ Ó· Á›ÓÂÙ·È ¤ÏÂÁ¯Ô˜ ÙË˜ ÂÌ‚Ô-

ÏÈ·ÛÙÈÎ‹˜ ÙÔ˘˜ Î¿Ï˘„Ë˜ Î·È Î·Ù·ÁÚ·Ê‹ ÙË˜ ÛÙËÓ ÂÈ‰ÈÎ‹ ÛÂ-Ï›‰· ÙÔ˘ ·ÙÔÌÈÎÔ‡ ‚È‚ÏÈ·Ú›Ô˘ ˘ÁÂ›·˜.

∫¿ıÂ ÛÔ‚·Ú‹ ·ÓÂÈı‡ÌËÙË ÂÓ¤ÚÁÂÈ· ÌÂÙ¿ ÙÔÓ ÂÌ‚ÔÏÈ·-ÛÌfi Ô˘ ÂÈÛËÌ·›ÓÂÈ Ô ÎÏÈÓÈÎfi˜ ÁÈ·ÙÚfi˜, Ú¤ÂÈ Ó· ·Ó·Ê¤-ÚÂÙ·È ÛÙÔÓ ∂√º (Ó· Û˘ÌÏËÚÒÓÂÙ·È Ë Î›ÙÚÈÓË Î¿ÚÙ·).

™ÙÔ˘˜ ¶›Ó·ÎÂ˜ 5 Î·È 6 Û˘ÓÔ„›˙ÂÙ·È ÙÔ ¯ÚÔÓÔ‰È¿ÁÚ·Ì-Ì· ÙˆÓ ÂÌ‚ÔÏÈ·ÛÌÒÓ ÁÈ· Ù· ·È‰È¿ Ô˘ Î·ı˘ÛÙ¤ÚËÛ·Ó Ó·ÂÌ‚ÔÏÈ·ÛÙÔ‡Ó.

¶›Ó·Î·˜ 5. ¶ÚfiÁÚ·ÌÌ· ÂÌ‚ÔÏÈ·ÛÌÒÓ ÁÈ· ·È‰È¿ ËÏÈÎ›·˜ Ì¤¯ÚÈ 6 ÂÙÒÓ Ô˘ ‰ÂÓ ÂÌ‚ÔÏÈ¿ÛıËÎ·Ó ÛÙË Û˘ÓÈÛÙÒÌÂÓË ·fi ÙÔ ∂ıÓÈÎfi ¶Úfi-ÁÚ·ÌÌ· ËÏÈÎ›·

∂Ì‚fiÏÈÔ 1Ë ‰fiÛË 2Ë ‰fiÛË 3Ë ‰fiÛË 4Ë ‰fiÛË 5Ë ‰fiÛËËÌ/Ó›· 1Ë-2Ë ËÌ/Ó›· 2Ë-3Ë ËÌ/Ó›· 3Ë-4Ë ËÌ/Ó›· 4Ë-5Ë ËÌ/Ó›·

‰fiÛË1 ‰fiÛË1 ‰fiÛË1 ‰fiÛË1

∏·Ù›ÙÈ‰·˜ µ (Hep B) 4 Â‚‰. 3 ÌËÓ.¢ÈÊıÂÚ›ÙÈ‰·˜, ∆ÂÙ¿ÓÔ˘, ∫ÔÎÎ‡ÙË (D∆aP)Ç 4 Â‚‰. 4 Â‚‰. 6 ÌËÓ. 3-4 ¯ÚfiÓÈ·¶ÔÏÈÔÌ˘ÂÏ›ÙÈ‰·˜ IPV3 4 Â‚‰. 4 Â‚‰. 4 Â‚‰.∞ÈÌfiÊÈÏÔ˘ Ù‡Ô˘ ‚ (Hib)4 4 Â‚‰. 4 Â‚‰. 8 Â‚‰.ªËÓÈÁÁÈÙÈ‰ÔÎfiÎÎÔ˘ C (MCC)5 4 Â‚‰. 4 Â‚‰. 8 Â‚‰.¶ÓÂ˘ÌÔÓÈoÎfiÎÎÔ˘ (7‰‡Ó·ÌÔ) (PCV)6 4 Â‚‰. 4 Â‚‰. 8 Â‚‰.πÏ·Ú¿˜, ¶·ÚˆÙ›ÙÈ‰·˜, ∂Ú˘ıÚ¿˜ (MMR)7 4 Â‚‰.∞ÓÂÌÂ˘ÏÔÁÈ¿˜ (Var)8 8 Â‚‰.∏·Ù›ÙÈ‰·˜ ∞ (Hep ∞)9 6 ÌËÓ.º˘Ì·Ù›ˆÛË˜ (BCG)10

º˘Ì·ÙÈÓ·ÓÙ›‰Ú·ÛË11 (Mantoux)°Ú›Ë˜ (INFL)12 4 Â‚‰.


170 ∂ıÓÈÎ‹ ∂ÈÙÚÔ‹ ∂Ì‚ÔÏÈ·ÛÌÒÓ


ÀÔÛËÌÂÈÒÛÂÈ˜/ÂÂÍËÁ‹ÛÂÈ˜ ÙˆÓ ¶ÈÓ¿ÎˆÓ 5 Î·È 6

1. ÃÚÔÓÈÎfi ‰È¿ÛÙËÌ· ·fi ÙËÓ ÚÔËÁÔ‡ÌÂÓË ‰fiÛË.2. ∏ 5Ë ‰fiÛË ÌÔÚÂ› Ó· ·Ú·ÏËÊıÂ› fiÙ·Ó Ë 4Ë Á›ÓÂÈ ÌÂÙ¿ ÙÔ 4Ô ¤ÙÔ˜ ÙË˜ ËÏÈÎ›·˜. √ ÂÌ‚ÔÏÈ·ÛÌfi˜ Û˘ÓÂ¯›˙ÂÙ·È ÌÂ Td. To TdaP

Á›ÓÂÙ·È ÛÂ Ì›· ‰fiÛË ÛÙËÓ ÂÊË‚Â›·, Î·Ù¿ ÚÔÙ›ÌËÛË ÛÂ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÌÂÁ·Ï‡ÙÂÚÔ ÙˆÓ 5 ÂÙÒÓ ·fi ÙÔ Td. (µÏ¤Â ÂÂÍËÁ‹-ÛÂÈ˜ 2·, 2‚ ÛÙËÓ ∂ÈÎfiÓ· 1).

3. ÃÔÚËÁÔ‡ÓÙ·È 4 ‰fiÛÂÈ˜ IPV. 4. °›ÓÂÙ·È ÛÂ 2 ‰fiÛÂÈ˜ ÛÂ ¿ÙÔÌ· ≤12 ÌËÓÒÓ ‹ ÛÂ 1 ‰fiÛË ÛÙ· ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿. ∂¿Ó Á›ÓÂÈ Î¿Ï˘„Ë ÙÔ˘ ‚Ú¤ÊÔ˘˜ ÌÂ 2 ‰fiÛÂÈ˜

ÛÂ ËÏÈÎ›· ÌÈÎÚfiÙÂÚË ÙˆÓ 12 ÌËÓÒÓ, ÙfiÙÂ Á›ÓÂÙ·È , ÌÂÙ¿ ÙÔ 1Ô ¤ÙÔ˜, Î·È Ì›· Â·Ó·ÏËÙÈÎ‹ ‰fiÛË. ¢ÂÓ Û˘ÓÈÛÙ¿Ù·È Ë ¯ÔÚ‹ÁËÛË ÙÔ˘ÂÌ‚ÔÏ›Ô˘ Î·Ù¿ ÙÔ˘ ·ÈÌfiÊÈÏÔ˘, ÛÂ ·È‰È¿ ÌÂÁ·Ï‡ÙÂÚ· ÙˆÓ 5 ÂÙÒÓ, ÌÂ ÂÍ·›ÚÂÛË ¿ÙÔÌ· Ô˘ ·Ó‹ÎÔ˘Ó ÛÂ ÔÌ¿‰Â˜ ̆ „ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘,fiˆ˜ ¿ÙÔÌ· ÌÂ ÛÏËÓÂÎÙÔÌ‹ ‹ ÏÂÈÙÔ˘ÚÁÈÎ‹ ·ÛÏËÓ›·.

5. ∂¿Ó Ë ¤Ó·ÚÍË ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Á›ÓÂÈ ÛÂ ËÏÈÎ›· ÌÂÁ·Ï‡ÙÂÚË ÙˆÓ 12 ÌËÓÒÓ, ¯ÔÚËÁÂ›Ù·È Ì›· ÌfiÓÔ ‰fiÛË MCC. ∂¿Ó ÔÈ ÚÒ-ÙÂ˜ 2 ‰fiÛÂÈ˜ ¤ÁÈÓ·Ó ÛÂ ËÏÈÎ›· ÌÈÎÚfiÙÂÚË ÙˆÓ 12 ÌËÓÒÓ Á›ÓÂÙ·È Ì›· 3Ë ‰fiÛË.

6. ∂¿Ó Ë ¤Ó·ÚÍË ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Á›ÓÂÈ Ì¤¯ÚÈ ÙËÓ ËÏÈÎ›· ÙˆÓ 7 ÌËÓÒÓ, ¯ÔÚËÁÔ‡ÓÙ·È 4 ‰fiÛÂÈ˜ ÙÔ˘ PCV Î·Ù¿ ÙÔ Û¯‹Ì· Ô˘·Ó·Ê¤ÚÂÙ·È ÛÙËÓ ∂ÈÎfiÓ· 1 (Ë 4Ë ‰fiÛË Ì¤¯ÚÈ ÙËÓ ËÏÈÎ›· ÙˆÓ 18 ÌËÓÒÓ).

∂¿Ó Ë ¤Ó·ÚÍË Á›ÓÂÈ ÌÂÙ·Í‡ 12Ô˘ Î·È 23Ô˘ Ì‹Ó·, ¯ÔÚËÁÔ‡ÓÙ·È 2 ‰fiÛÂÈ˜ ÌÂ ÌÂÛÔ‰È¿ÛÙËÌ· 6-8 Â‚‰ÔÌ¿‰Â˜. ∂¿Ó Ë ¤Ó·ÚÍË Á›ÓÂÈ ·fi ÙÔÓ 24Ô Ì‹Ó· Î·È ÌÂÙ¿, ÛÙ· ˘ÁÈ‹ ·È‰È¿ ¯ÔÚËÁÂ›Ù·È Ì›· ÌfiÓÔ ‰fiÛË. ™Ù· ·ÓÔÛÔÎ·Ù·ÛÙ·ÏÌ¤Ó· Î·È Û’

·˘Ù¿ Ô˘ ·Ó‹ÎÔ˘Ó ÁÂÓÈÎ¿ ÛÙÈ˜ ÔÌ¿‰Â˜ ·˘ÍËÌ¤ÓÔ˘ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÓÂ˘ÌÔÓÈÔÎÔÎÎÈÎ¤˜ ÏÔÈÌÒÍÂÈ˜ (¶›Ó·Î·˜ 1) ¯ÔÚËÁÔ‡ÓÙ·È 2 ‰fi-ÛÂÈ˜ ÌÂ ÌÂÛÔ‰È¿ÛÙËÌ· 6-8 Â‚‰ÔÌ¿‰Â˜.

7. ∏ 2Ë ‰fiÛË ÙÔ˘ MMR Û˘ÓÈÛÙ¿Ù·È Ó· Á›ÓÂÙ·È ÛÙËÓ ËÏÈÎ›· ÙˆÓ 4-6 ÂÙÒÓ. ∂¿Ó fiÌˆ˜ Ë ¤Ó·ÚÍË ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Á›ÓÂÈ Û’ ·˘Ù‹ÙËÓ ËÏÈÎ›·, Ë 2Ë ‰fiÛË ÌÔÚÂ› Ó· Á›ÓÂÈ Û‡ÓÙÔÌ· ÌÂ ÂÏ¿¯ÈÛÙÔ ÌÂÛÔ‰È¿ÛÙËÌ· 8 Â‚‰ÔÌ¿‰Â˜.

8. ŸÙ·Ó Ô ÂÌ‚ÔÏÈ·ÛÌfi˜ Î·Ù¿ ÙË˜ ·ÓÂÌÂ˘ÏÔÁÈ¿˜ Á›ÓÂÈ ÛÂ ËÏÈÎ›· ÌÂÁ·Ï‡ÙÂÚË ÙˆÓ 12 ÂÙÒÓ Û˘ÓÈÛÙÒÓÙ·È 2 ‰fiÛÂÈ˜ ÌÂ ÌÂÛÔ‰È¿-ÛÙËÌ· 2 ÌËÓÒÓ.

9. µÏ¤Â ÂÂÍ‹ÁËÛË 10 ÛÙËÓ ∂ÈÎfiÓ· 1.10,11. µÏ¤Â ÂÂÍ‹ÁËÛË 11 (11·, 11‚) ÛÙËÓ ∂ÈÎfiÓ· 1.12. µÏ¤Â ÂÂÍ‹ÁËÛË 12 ÛÙËÓ ∂ÈÎfiÓ· 1.13. ªfiÓÔ ÁÈ· ÎÔÚ›ÙÛÈ· ËÏÈÎ›·˜ 15-26 ÂÙÒÓ Ô˘ ‰ÂÓ ÂÌ‚ÔÏÈ¿ÛÙËÎ·Ó ÛÙË Û˘ÓÈÛÙÒÌÂÓË ËÏÈÎ›· (‚Ï¤Â ÂÂÍ‹ÁËÛË 9 ÛÙËÓ ∂ÈÎfiÓ· 1).

¶›Ó·Î·˜ 6. ¶ÚfiÁÚ·ÌÌ· ÂÌ‚ÔÏÈ·ÛÌÒÓ ÁÈ· ·È‰È¿ ËÏÈÎ›·˜ 7-18 ÂÙÒÓ Ô˘ ‰ÂÓ ÂÌ‚ÔÏÈ¿ÛıËÎ·Ó ÛÙË Û˘ÓÈÛÙÒÌÂÓË ·fi ÙÔ ∂ıÓÈÎfi ¶Úfi-ÁÚ·ÌÌ· ËÏÈÎ›·

∂Ì‚fiÏÈÔ 1Ë ‰fiÛË 2Ë ‰fiÛË 3Ë ‰fiÛË 4Ë ‰fiÛËËÌ/Ó›· 1Ë-2Ë ËÌ/Ó›· 2Ë-3Ë ËÌ/Ó›· 3Ë-4Ë ËÌ/Ó›·

‰fiÛË1 ‰fiÛË1 ‰fiÛË1

∏·Ù›ÙÈ‰·˜ µ (Hep B) 4 Â‚‰. 3 ÌËÓ.¢ÈÊıÂÚ›ÙÈ‰·˜, ∆ÂÙ¿ÓÔ˘ (Td) 4 Â‚‰. 6 ÌËÓ. 6 ÌËÓ.Tdap 5 ¯ÚfiÓÈ·¶ÔÏÈÔÌ˘ÂÏ›ÙÈ‰·˜ IPV 4 Â‚‰. 4 Â‚‰. 6 ÌËÓ.ªËÓÈÁÁÈÙÈ‰ÔÎfiÎÎÔ˘ C (MCC)πÏ·Ú¿˜, ¶·ÚˆÙ›ÙÈ‰·˜, ∂Ú˘ıÚ¿˜ (MMR) 4 Â‚‰.∞ÓÂÌÂ˘ÏÔÁÈ¿˜ (Var) 8 Â‚‰.πfi˜ ∞ÓıÚÒÈÓˆÓ £ËÏˆÌ¿ÙˆÓ (HPV)13 4-8 Â‚‰. 4-5 ÌËÓ.∏·Ù›ÙÈ‰·˜ ∞ (Hep ∞) 6 ÌËÓ.°Ú›Ë˜ (INFL)


171™À¡∆√ª∞ ¶∞π¢π∞∆ƒπ∫∞ ¡∂∞

¶·È‰È·ÙÚÈÎ‹ 2008;71:171-172

¶ÚÈÓ ·fi Ï›ÁÂ˜ Â‚‰ÔÌ¿‰Â˜ ·Ó·ÎÔÈÓÒıËÎÂ

·fi ÙÔ ÀÔ˘ÚÁÂ›Ô ÀÁÂ›·˜ Î·È ∫ÔÈÓˆÓÈÎ‹˜

∞ÏÏËÏÂÁÁ‡Ë˜ ÙÔ “¡¤Ô ∂ıÓÈÎfi ¶ÚfiÁÚ·ÌÌ·

∂Ì‚ÔÏÈ·ÛÌÒÓ” (À1.°.¶.158238, 23 π·Ó. 2008)

ÌÂ ÙÈ˜ Û¯ÂÙÈÎ¤˜ ÁÓˆÌÔ‰ÔÙ‹ÛÂÈ˜ ÙË˜ ∂ıÓÈÎ‹˜

∂ÈÙÚÔ‹˜ ∂Ì‚ÔÏÈ·ÛÌÒÓ. ∏ ·fiÊ·ÛË Û˘ÓÔ-

‰Â‡ÂÙ·È ·fi ¶›Ó·ÎÂ˜ ÌÂ ¯ÚÔÓÔ‰È·ÁÚ¿ÌÌ·Ù·

‚·ÛÈÎÔ‡ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Î·È ÂÌ‚ÔÏÈ·ÛÌÔ‡ ·È-

‰ÈÒÓ Ô˘ ‰ÂÓ ¤¯Ô˘Ó ÂÌ‚ÔÏÈ·ÛıÂ› ÛÙË Û˘ÓÈÛÙÒ-

ÌÂÓË ËÏÈÎ›·. ∞Ó·Ï˘ÙÈÎ¤˜ √‰ËÁ›Â˜ Â›Ó·È ‰È·ı¤-

ÛÈÌÂ˜ ÛÙËÓ ˘Ô˘ÚÁÈÎ‹ ·fiÊ·ÛË ÙÔ˘ ÀÀÎ∫∞

Î·È ÛÙËÓ ÈÛÙÔÛÂÏ›‰· ÙÔ˘ (www.mohaw.gr →

ÛÙÔ ·‡ÚÈÔ → ·Ó·ÎÔÈÓÒÛÂÈ˜-ÂÁÎ‡ÎÏÈÔÈ) Î·ıÒ˜

Î·È ÛÙÔ ·ÚfiÓ ÙÂ‡¯Ô˜ ÙË˜ ¶∞π¢π∞∆ƒπ∫∏™.

™ÙÔ Ó¤Ô ÂıÓÈÎfi ÚfiÁÚ·ÌÌ· ÂÌ‚ÔÏÈ·ÛÌÒÓ

¤¯Ô˘Ó Á›ÓÂÈ ÛËÌ·ÓÙÈÎ¤˜ ·ÏÏ·Á¤˜ ÛÙ·:

∂Ì‚fiÏÈÔ ÙÔ˘ ÈÔ‡ ÙˆÓ ·ÓıÚˆ›ÓˆÓ ıËÏˆ-

Ì¿ÙˆÓ. ¡¤Ô, ·Ó·Û˘Ó‰˘·ÛÌ¤ÓÔ ÂÌ‚fiÏÈÔ. ™˘ÓÈ-

ÛÙ¿Ù·È ÛÂ ÎÔÚ›ÙÛÈ· ËÏÈÎ›·˜ 12-15 ÂÙÒÓ Î·È ÛÂ

ÎÔÚ›ÙÛÈ· Î·È Á˘Ó·›ÎÂ˜ 15-26 ÂÙÒÓ, Ô˘ ‰ÂÓ

¤¯Ô˘Ó ÂÌ‚ÔÏÈ·ÛıÂ›. ™ÙËÓ ∂ÏÏ¿‰· Î˘ÎÏÔÊÔ-

ÚÔ‡Ó ¤Ó· ‰È‰‡Ó·ÌÔ (3 ‰fiÛÂÈ˜, 0-1-6 Ì‹ÓÂ˜) Î·È

¤Ó· ÙÂÙÚ·‰‡Ó·ÌÔ (3 ‰fiÛÂÈ˜, 0-2-6 Ì‹ÓÂ˜).

∂Ì‚fiÏÈÔ ÙË˜ ·ÓÂÌÂ˘ÏÔÁÈ¿˜: ÚÔÛı‹ÎË

‰Â‡ÙÂÚË˜ ‰fiÛË˜. ∏ 1Ë ‰fiÛË ¯ÔÚËÁÂ›Ù·È ÛÙËÓ

ËÏÈÎ›· ÙˆÓ 12-18 ÌËÓÒÓ (Î·Ù¿ ÚÔÙ›ÌËÛË ÌÂ-

Ù¿ ÙÔ 15Ô Ì‹Ó·), ·ÏÏ¿ Î·È ÛÂ Î¿ıÂ ¿ÏÏË ËÏÈÎ›·,

ÂÊfiÛÔÓ ÙÔ ¿ÙÔÌÔ ‰ÂÓ ¤¯ÂÈ ÓÔÛ‹ÛÂÈ. ∏ 2Ë ‰fiÛË

Û˘ÓÈÛÙ¿Ù·È ÛÙËÓ ËÏÈÎ›· ÙˆÓ 4-6 ÂÙÒÓ, ·ÏÏ¿ Î·È

ÛÂ Î¿ıÂ ¿ÏÏË ËÏÈÎ›·, ·ÚÎÂ› Ó· ·¤¯ÂÈ 2 Ì‹ÓÂ˜

·fi ÙËÓ 1Ë ‰fiÛË.

∂Ì‚fiÏÈÔ ÙË˜ Ë·Ù›ÙÈ‰·˜ ∞. ™˘ÓÈÛÙ¿Ù·È ÁÈ·

fiÏ· Ù· ·È‰È¿ ¿Óˆ ÙÔ˘ 1 ¤ÙÔ˘˜. ÃÔÚËÁÂ›Ù·È ÛÂ

ÔÔÈ·‰‹ÔÙÂ ËÏÈÎ›· ¿Óˆ ÙÔ˘ 1 ¤ÙÔ˘˜ ÛÂ 2 ‰fi-

ÛÂÈ˜ ÌÂ ÂÏ¿¯ÈÛÙÔ ÌÂÛÔ‰È¿ÛÙËÌ· 6 ÌËÓÒÓ.

∂Ì‚fiÏÈÔ ‰ÈÊıÂÚ›ÙÈ‰·˜-ÙÂÙ¿ÓÔ˘-ÎÔÎÎ‡ÙË

ÁÈ· ÂÊ‹‚Ô˘˜. ∂ÈÛ·ÁˆÁ‹ ÙÔ˘ ∆daP ÁÈ· Ù· ·È-

‰È¿ Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜ ¿Óˆ ÙˆÓ 11 ÂÙÒÓ. ∆Ô

TdaP ÂÚÈ¤¯ÂÈ ÌÈÎÚfiÙÂÚË ‰fiÛË ÙÔÍÔÂÈ‰Ô‡˜ ÙË˜

‰ÈÊıÂÚ›ÙÈ‰·˜ ·fi ÙÔ DTaP. ∆· ÂÌ‚fiÏÈ· TdaP

Ô˘ ‰È·Ù›ıÂÓÙ·È ÛÙËÓ ∂ÏÏ¿‰· ÂÚÈ¤¯Ô˘Ó Î·È

IPV Î·È ¯ÔÚËÁÂ›Ù·È ˆ˜ ÙËÓ ËÏÈÎ›· ÙˆÓ 18 ÂÙÒÓ.

™˘ÓÈÛÙ¿Ù·È 1 Â·Ó·ÏËÙÈÎ‹ ‰fiÛË TdaP ÛÙËÓ

ËÏÈÎ›· ÙˆÓ 12 ÂÙÒÓ ‹ Î·È ·ÚÁfiÙÂÚ· (¤ˆ˜ ÙËÓ

ËÏÈÎ›· ÙˆÓ 64 ÂÙÒÓ), Î·Ù¿ ÚÔÙ›ÌËÛË fiÙ·Ó

ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ· ˘¿Ú¯ÂÈ ÓÂÔÁ¤ÓÓËÙÔ. ™˘ÓÈ-

ÛÙ¿Ù·È ÌÂÛÔ‰È¿ÛÙËÌ· 5 ÂÙÒÓ ·fi ÙÔ DTaP ‹

ÙÔ Td ÁÈ· ÏÈÁfiÙÂÚÂ˜ ÙÔÈÎ¤˜ ·ÓÙÈ‰Ú¿ÛÂÈ˜, ÌÔ-

ÚÂ› fiÌˆ˜ Ó· ¯ÔÚËÁËıÂ› Î·È ÌÂ ÂÏ¿¯ÈÛÙÔ ÌÂÛÔ-

‰È¿ÛÙËÌ· 2 ÂÙÒÓ. ∂¿Ó ‰ÂÓ ‰È·Ù›ıÂÙ·È ÙÔ TdaP

ÌfiÓÔ ÙÔ˘ (¯ˆÚ›˜ IPV) ¯ÔÚËÁÂ›Ù·È ÙÔ Td ÂÓËÏ›-

ÎˆÓ. √È ˘fiÏÔÈÂ˜ ‰fiÛÂÈ˜ Á›ÓÔÓÙ·È ÌÂ ÌÂ Td

ÂÓËÏ›ÎˆÓ ·Ó¿ 10ÂÙ›·.

∂Ì‚fiÏÈÔ ÙË˜ Ë·Ù›ÙÈ‰·˜ µ. ªËÙ¤Ú·

HBsAg(+), ‰ËÏ·‰‹ ÊÔÚ¤·˜ ÙÔ˘ ·ÓÙÈÁfiÓÔ˘ ÂÈ-

Ê·ÓÂ›·˜ ‹ ÌËÙ¤Ú· ÌÂ ¿ÁÓˆÛÙË Î·Ù¿ÛÙ·ÛË

HBsAg: Ô ‚·ÛÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ ÂÚÈÏ·Ì‚¿ÓÂÈ

4 ‰fiÛÂÈ˜: Ë 1Ë Á›ÓÂÙ·È ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË

(ˆ˜ ÌÔÓÔ‰‡Ó·ÌÔ ÂÌ‚fiÏÈÔ, ÔÏ˘‰‡Ó·Ì· ‰ÂÓ

¯ÔÚËÁÔ‡ÓÙ·È ÚÈÓ ·fi ÙËÓ 6Ë Â‚‰ÔÌ¿‰· ˙ˆ‹˜)

Ë 2Ë ÛÙÔ Ù¤ÏÔ˜ ÙÔ˘ 1Ô˘ Ì‹Ó·, Ë 3Ë ÛÙÔ Ù¤ÏÔ˜

ÙÔ˘ 2Ô˘ Ì‹Ó· Î·È Ë 4Ë ÛÙÔ˘˜ 6-18 Ì‹ÓÂ˜ ˙ˆ‹˜

(ÂÏ¿¯ÈÛÙÔ ÌÂÛÔ‰È¿ÛÙËÌ· ÌÂÙ·Í‡ 1Ë˜-2Ë˜ Î·È

2Ë˜-3Ë˜ ‰fiÛË˜: 4 Â‚‰ÔÌ¿‰Â˜ Î·È ÌÂÙ·Í‡ 3Ë˜-

4Ë˜ ‰fiÛË˜: 8 Â‚‰ÔÌ¿‰Â˜). ™Â fiÏ· Ù· ÓÂÔÁÓ¿

ÌËÙ¤ÚˆÓ HBsAg(+) ¯ÔÚËÁÂ›Ù·È, ·Ú¿ÏÏËÏ· ÌÂ

ÙËÓ 1Ë ‰fiÛË ÙÔ˘ ÂÌ‚ÔÏ›Ô˘, ˘ÂÚ¿ÓÔÛË ·ÓÔÛÔ-

ÛÊ·ÈÚ›ÓË Ë·Ù›ÙÈ‰·˜ µ (0,5 ml, ÛÙÈ˜ 12 ÚÒÙÂ˜


∂ÌÌ·ÓÔ˘‹Ï °·Ï·Ó¿ÎË˜[email protected]¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹ÙË˜

∂ıÓÈÎfi ¶ÚfiÁÚ·ÌÌ· ∂Ì‚ÔÏÈ·ÛÌÒÓ 2008

∂. °·Ï·Ó¿ÎË˜


172 PAEDIATRIC NEWS IN BRIEF


ÒÚÂ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË, ÛÂ ‰È·ÊÔÚÂÙÈÎfi ÛËÌÂ›Ô·fi ÙÔ ÂÌ‚fiÏÈÔ). ∆· ·È‰È¿ ·˘Ù¿ Ú¤ÂÈ Ó·ÂÏ¤Á¯ÔÓÙ·È ÁÈ· HBsAg Î·È ·ÓÙÈ-HBs ÛÙËÓ ËÏÈ-Î›· ÙˆÓ 9-15 ÌËÓÒÓ. ∞Ó Î·Ù¿ ÙÔÓ ÙÔÎÂÙfi Ë ÌË-Ù¤Ú· Â›Ó·È ¿ÁÓˆÛÙÔ ·Ó Â›Ó·È ‹ fi¯È ÊÔÚ¤·˜HBsAg Î·È ·ÎÔÏÔ‡ıˆ˜ ·Ô‰ÂÈ¯ıÂ› fiÙÈ ‰ÂÓ Â›-Ó·È, ÙfiÙÂ ÙÔ ÓÂÔÁÓfi ·ÎÔÏÔ˘ıÂ› ÙÔ Û¯‹Ì· ÂÌ‚Ô-ÏÈ·ÛÌÔ‡ ÁÈ· Ù· ÓÂÔÁÓ¿ ÌËÙ¤ÚˆÓ HBsAg(-), ‰Ë-Ï·‰‹ ·ÁÓÔÂ›Ù·È Ë 1Ë ‰fiÛË.

ªËÙ¤Ú· HBsAg(-): o ‚·ÛÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ÂÚÈÏ·Ì‚¿ÓÂÈ 3 ‰fiÛÂÈ˜ (ÌÂÛÔ‰È¿ÛÙËÌ· 6-8

Â‚‰ÔÌ¿‰ˆÓ ÌÂÙ·Í‡ 1Ë˜ Î·È 2Ë˜ ‰fiÛË˜ Î·È Ë 3ËÛÙÔ˘˜ 6-18 Ì‹ÓÂ˜, ÌÂ ÂÏ¿¯ÈÛÙÔ ÌÂÛÔ‰È¿ÛÙËÌ·8 Â‚‰ÔÌ¿‰ˆÓ ·fi ÙË 2Ë ‰fiÛË).

∂Ì‚fiÏÈÔ ÁÈ· ÙË ÁÚ›Ë. ∂Í·ÎÔÏÔ˘ıÂ› Ó· Û˘-ÓÈÛÙ¿Ù·È ÌfiÓÔ ÛÂ ÔÌ¿‰Â˜ ÏËı˘ÛÌÔ‡ ˘„ËÏÔ‡ÎÈÓ‰‡ÓÔ˘ ÌÂÙ¿ ÙËÓ ËÏÈÎ›· ÙˆÓ 6 ÌËÓÒÓ, ÛÂ 1 ‰fi-ÛË ÂÙËÛ›ˆ˜. ™Â ·È‰È¿ Î¿Ùˆ ÙˆÓ 8 ÂÙÒÓ Ô˘ ÂÌ-‚ÔÏÈ¿˙ÔÓÙ·È ÁÈ· ÚÒÙË ÊÔÚ¿ Á›ÓÔÓÙ·È 2 ‰fiÛÂÈ˜ÂÌ‚ÔÏ›Ô˘ (<3 ÂÙÒÓ: 0,25 ml, ≥3 ÂÙÒÓ: 0,5 ml) ÌÂÂÏ¿¯ÈÛÙÔ ÌÂÛÔ‰È¿ÛÙËÌ· 4 Â‚‰ÔÌ¿‰ˆÓ.


173¡∂∞ ∞¶√ ∆√ ¢π∞¢π∫∆À√

¶·È‰È·ÙÚÈÎ‹ 2008;71:173-175

™‡ÓÙÔÌ· ·È‰È·ÙÚÈÎ¿ Ó¤· ÛÙÔ ‰È·‰›ÎÙ˘Ô

∫. ™ÙÂÊ·Ó›‰Ë˜

™ÙÈ˜ Ì¤ÚÂ˜ Ì·˜, ¤Ó·˜ ‰È·ÚÎÒ˜ ·˘Í·ÓfiÌÂÓÔ˜ ·ÚÈıÌfi˜ ‰ËÌÔÛÈÂ‡ÛÂˆÓ Ì·˜ Î·Ù·ÎÏ‡˙ÂÈ. ∫¿ÔÈÂ˜·fi ·˘Ù¤˜ ÌÔÚÂ› Ó· ¤¯Ô˘Ó ¿ÌÂÛË Â›‰Ú·ÛË ÛÙËÓ Î·ıËÌÂÚÈÓ‹ Ì·˜ Ú¿ÍË. ªÂÚÈÎ¤˜ ÌÔÚÂ› Ó·Ì·˜ ‚ÔËı‹ÛÔ˘Ó ÛÙËÓ Î·Ï‡ÙÂÚË ·ÓÙÈÌÂÙÒÈÛË ·È‰ÈÒÓ ÌÂ Û¿ÓÈ· ÚÔ‚Ï‹Ì·Ù·. ŸÌˆ˜ Ë ÚfiÛ‚·-ÛË ÛÂ ·˘Ù¤˜ ÙÈ˜ Ó¤Â˜ ÏËÚÔÊÔÚ›Â˜ ÌÔÚÂ› Ó· Â›Ó·È ‰˘Û¯ÂÚ‹˜ Î·È Ô ¯ÚfiÓÔ˜ Ì·˜ ÁÈ· ÏÂÙÔÌÂÚ‹ ÂÓË-Ì¤ÚˆÛË ÂÚÈÔÚÈÛÌ¤ÓÔ˜. ŒÙÛÈ, ÚfiÛÊ·Ù· ¤ÁÈÓÂ È‰È·›ÙÂÚ· ‰ËÌÔÊÈÏ‹˜ Ë Û˘ÓÔÙÈÎ‹ ·ÚÔ˘Û›·ÛË ÙˆÓ‚·ÛÈÎÒÓ ÛÙÔÈ¯Â›ˆÓ ÚfiÛÊ·ÙˆÓ ‰ËÌÔÛÈÂ‡ÛÂˆÓ. ∞Í›˙ÂÈ Ó· ÛËÌÂÈˆıÂ› fiÙÈ Ë ÛÙ‹ÏË ÙˆÓ “™‡ÓÙÔÌˆÓ¶·È‰È·ÙÚÈÎÒÓ ¡¤ˆÓ” ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ ·Ú·Ì¤ÓÂÈ Ë ÚÒÙË ÚÔÙ›ÌËÛË ÙˆÓ ·Ó·ÁÓˆÛÙÒÓ. ∞ÚÎÂÙ¤˜ÈÛÙÔÛÂÏ›‰Â˜ ÛÙÔ ‰È·‰›ÎÙ˘Ô ÂÚÈ¤¯Ô˘Ó ¯Ú‹ÛÈÌÂ˜ ÏËÚÔÊÔÚ›Â˜ ·fi ÚfiÛÊ·Ù· ¿ÚıÚ·. ª¿ÏÈÛÙ·ÔÏÏ¤˜ ÊÔÚ¤˜ ÛÙ¤ÏÓÔÓÙ·È Î·È ÌÂ ËÏÂÎÙÚÔÓÈÎ¿ ÌËÓ‡Ì·Ù· Ù· Û‡ÓÙÔÌ· ·È‰È·ÙÚÈÎ¿ Ó¤· ÛÙÔ˘˜ Û˘Ó-‰ÚÔÌËÙ¤˜, Û˘Ó‹ıˆ˜ ¯ˆÚ›˜ ÔÈÎÔÓÔÌÈÎ‹ ÂÈ‚¿Ú˘ÓÛË. ŒÁÈÓÂ ÂÈÏÔÁ‹ ÙÂÛÛ¿ÚˆÓ ÈÛÙÔÛÂÏ›‰ˆÓ, ÔÈÔÔ›Â˜ ¤¯Ô˘Ó ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ·ÚÈıÌfi ÂÈÛÎ¤„ÂˆÓ Î·È ÂÚÈ¤¯Ô˘Ó ÏËÚÔÊÔÚ›Â˜ Ô˘ ÂÏ›˙ˆ fiÙÈ ı·Û·˜ ÂÓ‰È·Ê¤ÚÔ˘Ó.

∏ ÈÛÙÔÛÂÏ›‰· “Pediatric News” - http://www.pediatricnews.com/issues

™ÙËÓ ÈÛÙÔÛÂÏ›‰· ·˘Ù‹ ÂÚÈ-Ï·Ì‚¿ÓÔÓÙ·È ÔÈ ÌËÓÈ·›Â˜ ‰ËÌÔÛÈ-Â‡ÛÂÈ˜ ÙˆÓ ÙÂÏÂ˘Ù·›ˆÓ ÂÙ¿ ÂÙÒÓ.ªÈ· ÏËıÒÚ· ·fi ¯Ú‹ÛÈÌÂ˜ ÏË-ÚÔÊÔÚ›Â˜ ·Ú¤¯ÔÓÙ·È ÛÙÔ˘˜ Û˘Ó-‰ÚÔÌËÙ¤˜. ∂›ÛË˜, ˘¿Ú¯Ô˘Ó È‰È-·›ÙÂÚ· ¯Ú‹ÛÈÌÂ˜ ÏËÚÔÊÔÚ›Â˜ ÁÈ·ÏÔÈÌÒ‰Ë ÓÔÛ‹Ì·Ù·, ÂÌ‚ÔÏÈ·-ÛÌÔ‡˜, ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ÂÊ‹‚Ô˘ÌÂ ·¯˘Û·ÚÎ›· Î·È ÁÈ· ¿ÏÏ· Û˘Ó‹-ıË ÚÔ‚Ï‹Ì·Ù·. π‰È·›ÙÂÚË ·Ó·ÊÔ-Ú¿ Á›ÓÂÙ·È ÛÙÔ ÌÂÙ·‚ÔÏÈÎfi Û‡Ó-‰ÚÔÌÔ, Ô˘ ÚÈÓ ·fi 10 ¯ÚfiÓÈ· ÔÈÂÚÈÛÛfiÙÂÚÔÈ ·È‰›·ÙÚÔÈ ‰ÂÓ ›-ÛÙÂ˘·Ó fiÙÈ Â›Ó·È Úfi‚ÏËÌ· ÛÙËÓ·È‰ÈÎ‹ Î·È ÂÊË‚ÈÎ‹ ËÏÈÎ›·. ™‹ÌÂ-Ú· ·Ó·Ê¤ÚÂÙ·È fiÙÈ ‰È·ÈÛÙÒÓÂÙ·ÈÛÙÔ 2-9% ÙˆÓ ÂÊ‹‚ˆÓ, ·Ó¿ÏÔÁ· ÌÂ

ÙÔÓ ÔÚÈÛÌfi Ô˘ ¯ÚËÛÈÌÔÔÈÂ›Ù·È. ∆Ô 8% ÙˆÓ ˘¤Ú‚·ÚˆÓ Î·È ÙÔ 44% ÙˆÓ ·¯‡Û·ÚÎˆÓ ÂÊ‹‚ˆÓ·ÚÔ˘ÛÈ¿ÛÂÈ ÙÔ Úfi‚ÏËÌ· ·˘Ùfi. ∆· ÛÙÔÈ¯Â›· ·˘Ù¿ Â›Ó·È ·ÓËÛ˘¯ËÙÈÎ¿, ÂÂÈ‰‹ Ë ·¯˘Û·ÚÎ›· ÛÙÈ˜Ì¤ÚÂ˜ Ì·˜ ¤¯ÂÈ ¿ÚÂÈ ÂÈ‰ËÌÈÎ‹ ‰È¿ÛÙ·ÛË. ∂›ÛË˜, ÙÔÓ›˙ÂÙ·È Ë ÛËÌ·Û›· ÙË˜ Ì¤ÙÚËÛË˜ ÙË˜ ÂÚÈ-Ì¤ÙÚÔ˘ ÙË˜ ÎÔÈÏÈ¿˜. ™Â ÚfiÛÊ·ÙË ÈÙ·ÏÈÎ‹ ÌÂÏ¤ÙË (Maffeis C. Î·È Û˘Ó., J Pediatr 2008;152:207-213)·Ó·Ê¤ÚÂÙ·È fiÙÈ Ù· ·¯‡Û·ÚÎ· ·È‰È¿ Î·È ÔÈ ¤ÊË‚ÔÈ ÌÂ ÂÚ›ÌÂÙÚÔ ÎÔÈÏ›·˜ ÌÂÁ·Ï‡ÙÂÚË ·fi ÙËÓ90Ë ÂÎ·ÙÔÛÙÈ·›· ı¤ÛË Â›¯·Ó 13 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚË Èı·ÓfiÙËÙ· Ó· ¤¯Ô˘Ó ‰‡Ô ·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡-ÓÔ˘ ÁÈ· ÌÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ. ∆· ˘¤Ú‚·Ú· ·È‰È¿ Î·È ÔÈ ¤ÊË‚ÔÈ ÌÂ ÂÚ›ÌÂÙÚÔ ÎÔÈÏ›·˜ ÌÂÁ·Ï‡-ÙÂÚË ·fi ÙËÓ 90Ë ÂÎ·ÙÔÛÙÈ·›· ı¤ÛË Â›¯·Ó 7 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚÔ Î›Ó‰˘ÓÔ. ∆¤ÏÔ˜, Ù· ˘¤Ú‚·Ú· ·È-‰È¿ ÌÂ ÂÚ›ÌÂÙÚÔ ÎÔÈÏ›·˜ ÌÈÎÚfiÙÂÚË ·fi ÙËÓ 90Ë ÂÎ·ÙÔÛÙÈ·›· ı¤ÛË ‰ÂÓ ·ÚÔ˘Û›·Û·Ó ÌÂÁ·Ï‡ÙÂ-ÚÔ Î›Ó‰˘ÓÔ.


∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ™ÙÂÊ·Ó›‰Ë˜[email protected]¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ ∞ıËÓÒÓ“¶. & ∞. ∫˘ÚÈ·ÎÔ‡”


∏ ÈÛÙÔÛÂÏ›‰· “Medscape Pediatrics” - http://www.medscape.com/pediatrics

™ÙËÓ ÈÛÙÔÛÂÏ›‰· ·˘Ù‹ ÂÚÈ-Ï·Ì‚¿ÓÔÓÙ·È Û¯ÔÏÈ·ÛÌ¤ÓÂ˜ ÂÚÈ-Ï‹„ÂÈ˜ ÚfiÛÊ·ÙˆÓ ‰ËÌÔÛÈÂ‡ÛÂ-ˆÓ, ·fi„ÂÈ˜ ÂÈ‰ÈÎÒÓ, ÂÓËÌÂÚˆÙÈÎ¿¿ÚıÚ· ÌÂ ÂÚˆÙ‹ÛÂÈ˜ ÁÈ· ÙËÓ ·ÍÈÔ-ÏfiÁËÛ‹ Û·˜. ∞ÚÎÂÙ¿ ÂÓ‰È·Ê¤ÚÔÓÂ›Ó·È ÙÔ ¿ÚıÚÔ ÁÈ· ÙËÓ ·ÈÙÈÔÏÔÁ›·Î·È ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ÈÓÔ-Ì˘·ÏÁ›·˜ ÛÙ· ·È‰È¿. ∂ÓÒ ·Ï·Èfi-ÙÂÚ· ÙÔ Úfi‚ÏËÌ· ·˘Ùfi ¯·Ú·ÎÙË-ÚÈ˙fiÙ·Ó ·fi Ì˘ÔÛÎÂÏÂÙÈÎÔ‡˜ fi-ÓÔ˘˜, ·Ó¿ÏÔÁÔ˘˜ ¿ÏÏˆÓ ÚÂ˘Ì·ÙÈ-ÎÒÓ ·ı‹ÛÂˆÓ, Û‹ÌÂÚ· Â›Ó·È ÁÓˆ-ÛÙfi fiÙÈ ÔÈ ·ÛıÂÓÂ›˜ ÌÂ ÈÓÔÌ˘·ÏÁ›·¤¯Ô˘Ó ¯·ÌËÏfiÙÂÚÔ Ô˘‰fi fiÓÔ˘ ÛÂÛ¯¤ÛË ÌÂ Ù· Ê˘ÛÈÔÏÔÁÈÎ¿ ¿ÙÔÌ·.∞˘Ùfi ÔÊÂ›ÏÂÙ·È ÛÂ ·ıÔÏÔÁÈÎ‹ÂÂÍÂÚÁ·Û›· ÙÔ˘ fiÓÔ˘ ÛÙÔÓ

ÂÁÎ¤Ê·ÏÔ Î·È ÙÔ ÓˆÙÈ·›Ô Ì˘ÂÏfi (Clauw DJ, J Clin Rheumatol 2007;13:102-109). ŒÙÛÈ ÂÍËÁÂ›Ù·È Î·ÈË ıÂÚ·Â˘ÙÈÎ‹ ·ÔÙ˘¯›· ÙˆÓ ÌË ÛÙÂÚÔÂÈ‰ÒÓ ·ÓÙÈÊÏÂÁÌÔÓˆ‰ÒÓ. ª¿ÏÈÛÙ· ÚfiÛÊ·Ù· ·Ó·Ê¤ÚÔ-ÓÙ·È ÂÓı·ÚÚ˘ÓÙÈÎ¿ ·ÔÙÂÏ¤ÛÌ·Ù· ÌÂ ÙË ¯Ú‹ÛË ·Ó·ÛÙÔÏ¤ˆÓ ÙˆÓ ˘Ô‰Ô¯¤ˆÓ ÙË˜ Â·Ó·ÚfiÛÏË-„Ë˜ (dual receptor reuptake inhibitors) (Rooks DS, Curr Opin Rheumat 2007;19:111-117).

∂›Ó·È ÁÓˆÛÙfi fiÙÈ Ù· ·È‰È¿ ÌÂ ÓÂÊÚˆÛÈÎfi Û‡Ó‰ÚÔÌÔ Û˘¯Ó¿ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ˘ÔÙÚÔ¤˜ ÌÂÙ¿·fi ÈÔÁÂÓÂ›˜ ÏÔÈÌÒÍÂÈ˜ ÙÔ˘ ·ÓˆÙ¤ÚÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡. ™Â ÚfiÛÊ·ÙË ÌÂÏ¤ÙË ÌÂ ·È‰È¿ ÌÂ ıÂÚ·-Â›· Û˘ÓÙ‹ÚËÛË˜ ÌÂ ÚÂ‰ÓÈ˙ÔÏfiÓË ÛÂ ‰fiÛË ÌÈÎÚfiÙÂÚË ·fi 0.6 mg/kg/48ˆÚÔ ‰È·ÈÛÙÒıËÎÂ fiÙÈÙ· ·È‰È¿ Ô˘ ÌÂ Ù· ÚÒÙ· Û˘ÌÙÒÌ·Ù· ÙË˜ ›ˆÛË˜ ÙÔ˘˜ ¯ÔÚËÁ‹ıËÎÂ Î·ıËÌÂÚÈÓ¿ 5 mg ÚÂ‰ÓÈ-˙ÔÏfiÓË˜ ÁÈ· 7 Ì¤ÚÂ˜ ·ÚÔ˘Û›·Û·Ó Û·ÓÈfiÙÂÚ· (18% ÛÂ Û¯¤ÛË ÌÂ 48%) ˘ÔÙÚÔ¤˜ ÛÂ Û¯¤ÛË ÌÂ Ù··È‰È¿ Ô˘ ‹Ú·Ó ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ (Abeyagunawardena AS, Trompeter RS, Arch Dis Child2008;93:226-228).

∏ ÈÛÙÔÛÂÏ›‰· “Pediatrics Jwatch” - http://pediatrics.jwatch.org/

∏ ÂÎ‰ÔÙÈÎ‹ ÔÌ¿‰· ÙˆÓ ‰¤Î·ÁÓˆÛÙÒÓ ∞ÌÂÚÈÎ·ÓÒÓ Î·ıËÁËÙÒÓ·È‰È·ÙÚÈÎ‹˜ ÂÈÏ¤ÁÂÈ Î·È Û¯ÔÏÈ¿-˙ÂÈ ÂÓ‰È·Ê¤ÚÔÓÙ· ¿ÚıÚ·, Ô˘ ÛÙ¤Ï-ÓÔÓÙ·È Î·ıËÌÂÚÈÓ¿ ÌÂ ËÏÂÎÙÚÔÓÈÎ¿ÌËÓ‡Ì·Ù· ÛÙÔ˘˜ Û˘Ó‰ÚÔÌËÙ¤˜. HÂÈÏÔÁ‹ ÙˆÓ ¿ÚıÚˆÓ Â›Ó·È ÂÍ·ÈÚÂ-ÙÈÎ‹ Î·È Ù· ı¤Ì·Ù· ÂÓ‰È·Ê¤ÚÔÓÙ·.™Â ÂÓÙ·ÂÙ‹ Û˘Á¯ÚÔÓÈÎ‹ ÌÂÏ¤ÙË2.216 ÂÊ‹‚ˆÓ ‰È·ÈÛÙÒıËÎÂ fiÙÈ ÔÈ¤ÊË‚ÔÈ Ô˘ ¤ÙÚˆÁ·Ó Î·ıËÌÂÚÈÓ¿ÚˆÈÓfi Â›¯·Ó ¯·ÌËÏfiÙÂÚÔ˘˜ ‰Â›-ÎÙÂ˜ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ ÛÂ Û¯¤ÛË ÌÂÂÎÂ›ÓÔ˘˜ Ô˘ ÛÔÚ·‰ÈÎ¿ Â›¯·ÓÚfiÁÂ˘Ì· (Timlin MT Î·È Û˘Ó.,Pediatrics 2008;121: e638). ∆· Â˘-Ú‹Ì·Ù· ·˘Ù¿ ‰Â›¯ÓÔ˘Ó fiÙÈ Ë ·Ú¿-ÏË„Ë ÙÔ˘ ÚˆÈÓÔ‡ Û˘Û¯ÂÙ›˙ÂÙ·È

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¡∂∞ ∞¶√ ∆√ ¢π∞¢π∫∆À√


175NEWS FROM THE INTERNET

¶·È‰È·ÙÚÈÎ‹ 2008;71:173-175

ÌÂ ·‡ÍËÛË ÙÔ˘ ‚¿ÚÔ˘˜ ÙˆÓ ÂÊ‹‚ˆÓ, Î¿ÙÈ Ô˘ ·fi ·ÏÈ¿ ‹Ù·Ó ÁÓˆÛÙfi, fiÌˆ˜ ÔÙ¤ ‰ÂÓ Â›¯Â ÂÈ-ÛÙËÌÔÓÈÎ¿ ÙÂÎÌËÚÈˆıÂ›.

∂Ó‰È·Ê¤ÚÔÓ Â›¯Â Î·È ÙÔ ¿ÚıÚÔ ÁÈ· ÙË ÛËÌ·Û›· ÙË˜ ¤ÁÎ·ÈÚË˜ ‰È¿ÁÓˆÛË˜ ÙˆÓ ‰È·Ù·Ú·¯ÒÓ ÙË˜ ‹-ÍË˜ ÛÂ ÂÊ‹‚Ô˘˜ ÌÂ ·ıÔÏÔÁÈÎ‹ ÌËÓÔÚÚ·Á›· (Kulp JL Î·È Û˘Ó., J Pediatr Adolesc Gynecol 2008;21:27),fiˆ˜ Î·È ÙÔ ¿ÚıÚÔ ÁÈ· ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙË˜ Û˘ÓÙËÚËÙÈÎ‹˜ ·ÓÙÈÌÂÙÒÈÛË˜ ÙˆÓ ‚ÚÂÊÒÓ ÌÂÁ·ÛÙÚÔÔÈÛÔÊ·ÁÈÎ‹ ·ÏÈÓ‰ÚfiÌËÛË, ¯ˆÚ›˜ Ó· ¯ÔÚËÁÔ‡ÓÙ·È Ê¿ÚÌ·Î· Ô˘ ÂÏ·ÙÙÒÓÔ˘Ó ÙË Á·ÛÙÚÈÎ‹ÔÍ‡ÙËÙ· (Hassall E, J Pediatr 2008;152:301).

∏ ÈÛÙÔÛÂÏ›‰· “Pediatric Linx” - http://www.mdlinx.com/pediatriclinx/

™ÙËÓ ÈÛÙÔÛÂÏ›‰· ·˘Ù‹ ˘ÔÛÙË-Ú›˙ÂÙ·È fiÙÈ Ì›· Î·ıËÌÂÚÈÓ‹ ÂÓÙ¿-ÏÂÙË Â›ÛÎÂ„‹ ÙË˜ ·ÚÎÂ› ÁÈ· ÙËÓÂÓËÌ¤ÚˆÛ‹ Û·˜. ™Â ·˘Ù¿ Ù· ¤ÓÙÂÏÂÙ¿ ÂÓÙÔ›ÛÙËÎ·Ó ÂÓ‰È·Ê¤ÚÔ-ÓÙ· ÛÙÔÈ¯Â›· ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛËÙÔ˘ ·È‰ÈÔ‡ ÌÂ ÙÚ·¯ËÏÈÎ‹ ÏÂÌÊ·-‰ÂÓ›ÙÈ‰·, ÓÂfiÙÂÚ· ‰Â‰ÔÌ¤Ó· ÁÈ·ÙËÓ ÔÍÂ›· ÏÂÌÊÔ‚Ï·ÛÙÈÎ‹ ÏÂ˘¯·È-Ì›·, ÙÔÓ ÙÚfiÔ ÌÂ ÙÔÓ ÔÔ›Ô ·ÓÙÈ-Ï·Ì‚¿ÓÔÓÙ·È ÔÈ ¤ÊË‚ÔÈ ÙËÓ ·¯˘-Û·ÚÎ›·, ÁÈ· ÙËÓ Ë·ÙÈÎ‹ ÌÂÙ·Ìfi-Û¯Â˘ÛË Î·È ÁÈ· ÙËÓ Â›‰Ú·ÛË ÙË˜ÌÔ˘ÛÈÎ‹˜ ÛÙÔ ¿Á¯Ô˜ ÙˆÓ ·È‰ÈÒÓÔ˘ ˘Ô‚Ï‹ıËÎ·Ó ÛÂ ÂÂÌ‚¿ÛÂÈ˜.√È ÏËÚÔÊÔÚ›Â˜ ·˘Ù¤˜ ‹Ù·Ó ·ÚÎÂ-Ù¿ Û˘ÓÔÙÈÎ¤˜ Î·È ‹Ù·Ó ··Ú·›ÙË-ÙË Ë ·Ó¿ÁÓˆÛË ÙˆÓ ¿ÚıÚˆÓ. ŒÙÛÈ

Ù· ¤ÓÙÂ ÏÂÙ¿ ¤ÊÙ·Ó·Ó ÌfiÓÔ ÁÈ· ÙËÓ ÂÓÙfiÈÛË ÂÓ‰È·ÊÂÚfiÓÙˆÓ ıÂÌ¿ÙˆÓ Î·È ¯ÚÂÈ¿ÛÙËÎÂ ÂÚÈÛÛfi-ÙÂÚË ÒÚ· ÁÈ· ÙËÓ ·ÍÈÔÏfiÁËÛË ÙÔ˘ ÂÚÈÂ¯ÔÌ¤ÓÔ˘ ÙÔ˘˜.


176 ∫§π¡π∫√ ∫√Àπ∑

Paediatriki 2008;71:165,176

∫ÏÈÓÈÎfi QUIZ

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√ ‰È·ÁÓˆÛÙÈÎfi˜ ¯ÂÈÚÈÛÌfi˜ ÂÚÈÏ¿Ì‚·ÓÂÙËÓ ·Ê‡ÓÈÛË ÙÔ˘ ÓÂÔÁÓÔ‡ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ·ÂÓfi˜ ÂÂÈÛÔ‰›Ô˘ Ô˘ Â›¯Â ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙË‰È·ÎÔ‹ ÙÔ˘. ∞˘Ùfi Â›Ó·È ÙÔ Î‡ÚÈÔ ‰È·ÁÓˆÛÙÈÎfiÎÚÈÙ‹ÚÈÔ ÁÈ· ÙÈ˜ Î·ÏÔ‹ıÂÈ˜ Ì˘ÔÎÏÔÓ›Â˜ ‡ÓÔ˘ÙˆÓ ÓÂÔÁÓÒÓ (∫ªÀ¡), ÓÔÛÔÏÔÁÈÎ‹ ÔÓÙfiÙËÙ·Ô˘ ·ÔÙÂÏÂ› ÙË ‰È¿ÁÓˆÛË ÛÙËÓ ÚÔÎÂÈÌ¤ÓËÂÚ›ÙˆÛË.

√È ∫ªÀ¡ ÂÚÈÁÚ¿ÊËÎ·Ó ·fi ÙÔ˘˜ CoulterÎ·È Allen ÙÔ 1982 (1). Ã·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi Ì˘Ô-ÎÏÔÓÈÎ¿ ÙÈÓ¿ÁÌ·Ù· (jerks) Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È·fi ÙÈ˜ ÚÒÙÂ˜ Ì¤ÚÂ˜ ÙË˜ ˙ˆ‹˜ (1Ë ˆ˜ Î·È 16ËÌ¤Ú·) (2), Û˘Ì‚·›ÓÔ˘Ó ÌfiÓÔ Î·Ù¿ ÙÔÓ ‡ÓÔ Î·ÈÛÙ·Ì·ÙÔ‡Ó ÌÂ ÙËÓ ·Ê‡ÓÈÛË. √È Ì˘ÔÎÏÔÓ›Â˜ Â›-Ó·È Û˘Ó‹ıˆ˜ ·ÌÊÔÙÂÚfiÏÂ˘ÚÂ˜ Î·È ·ÊÔÚÔ‡ÓÎ˘Ú›ˆ˜ Ù· ¿Óˆ, ·ÏÏ¿ Î·È Ù· Î¿Ùˆ ¿ÎÚ·. ¢È·Ú-ÎÔ‡Ó Ï›Á· ‰Â˘ÙÂÚfiÏÂÙ· ˆ˜ Î·È 20 ÏÂÙ¿ Î·ÈÌÔÚÂ› Ó· Â·Ó·Ï·Ì‚¿ÓÔÓÙ·È ÌÂÚÈÎ¤˜ ÊÔÚ¤˜ ÙÔ24ˆÚÔ. ∂ÌÊ·Ó‹˜ ÂÎÏ˘ÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÙˆÓÂÂÈÛÔ‰›ˆÓ, ¤Ú·Ó ÙÔ˘ ‡ÓÔ˘, ‰ÂÓ Â›Ó·È ÁÓˆ-ÛÙfi˜, ˆÛÙfiÛÔ, ÛÂ Ï›ÁÂ˜ ÂÚÈÙÒÛÂÈ˜ ¤¯ÂÈ ·Ó·-ÊÂÚıÂ› Ë ÚfiÎÏËÛË ÂÂÈÛÔ‰›ˆÓ ÌÂ ÙÔ ıfiÚ˘‚Ô ‹ÌÂ ÙÔ Ê¿ÛÎÈˆÌ· ‹ ÌÂ ÙÔ ÎÔ‡ÓËÌ· ÙÔ˘ ÓÂÔÁÓÔ‡.∆· ÂÂÈÛfi‰È· ¤¯Ô˘Ó Û˘Ó‹ıˆ˜ ÛÔÚ·‰ÈÎfi ¯·Ú·-ÎÙ‹Ú·, ˘¿Ú¯Ô˘Ó fiÌˆ˜ ‰ËÌÔÛÈÂ‡ÛÂÈ˜ ÁÈ· ÙËÓÂÌÊ¿ÓÈÛË ÂÚÈÛÛfiÙÂÚˆÓ ÙÔ˘˜ ÂÓfi˜ ÂÚÈÛÙ·ÙÈ-ÎÒÓ ÛÙËÓ ›‰È· ÔÈÎÔÁ¤ÓÂÈ· (3). ∏ ÓÂ˘ÚÔÊ˘ÛÈÔÏÔ-ÁÈÎ‹ ‚¿ÛË ÙÔ˘ Ê·ÈÓÔÌ¤ÓÔ˘ Â›Ó·È ·Û·Ê‹˜. ∞˘ÙfiÔ˘ ¤¯ÂÈ Á›ÓÂÈ ÁÓˆÛÙfi, ÌÂ ÙË ‚Ô‹ıÂÈ· ÔÏ˘ÁÚ·-Ê‹Ì·ÙÔ˜ ‡ÓÔ˘, Â›Ó·È fiÙÈ Ù· ÂÂÈÛfi‰È· Û˘Ì‚·›-ÓÔ˘Ó ÛÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‹ÚÂÌÔ˘ ‡ÓÔ˘ (quietsleep) ÙˆÓ ÓÂÔÁÓÒÓ (4), Ô˘ ·ÔÙÂÏÂ› ÙÔ ÈÛÔ‰‡-Ó·ÌÔ ÙÔ˘ NREM (Non Rapid Eye Movement)‡ÓÔ˘ ÙˆÓ ÂÓËÏ›ÎˆÓ. ∞fi ÙÔ˘˜ ÂÚÈÛÛfiÙÂÚÔ˘˜Û˘ÁÁÚ·ÊÂ›˜ ˘ÔÛÙËÚ›˙ÂÙ·È fiÙÈ Ù· ÂÂÈÛfi‰È· ·-Ú·Ì¤ÓÔ˘Ó ˆ˜ ÙÔ˘˜ 3 Ì‹ÓÂ˜ ˙ˆ‹˜ Î·È ˘Ô¯ˆÚÔ‡ÓÛÙË Û˘Ó¤¯ÂÈ·. √ ¯ÚfiÓÔ˜ ·˘Ùfi˜ Û˘Ì›ÙÂÈ ÌÂ ÙËÓˆÚ›Ì·ÓÛË ÙˆÓ ÛÙ·‰›ˆÓ ÙÔ˘ ‡ÓÔ˘ ÙÔ˘ ‚Ú¤ÊÔ˘˜Î·È ÙË ÛÙ·‰È·Î‹ ÂÌÊ¿ÓÈÛË ÙˆÓ Ê¿ÛÂˆÓ ‡ÓÔ˘REM (Rapid Eye Movement) Î·È NREM, ÛÂ ·ÓÙÈ-Î·Ù¿ÛÙ·ÛË ÙˆÓ Ê¿ÛÂˆÓ ÙÔ˘ ÂÓÂÚÁÔ‡ (active) Î·È‹ÚÂÌÔ˘ ‡ÓÔ˘ ÙˆÓ ÓÂÔÁÓÒÓ (5). ∆Ô Â‡ÚËÌ· ·˘Ùfi

·Ô‰›‰ÂÙ·È ÛÂ ÚÔÛˆÚÈÓ‹ ·ÓˆÚÈÌfiÙËÙ· ÙË˜ ÔÚ-

Á¿ÓˆÛË˜ ÙÔ˘ ‡ÓÔ˘ ÙˆÓ ÓÂÔÁÓÒÓ. øÛÙfiÛÔ,

˘¿Ú¯Ô˘Ó ‰ËÌÔÛÈÂ‡ÛÂÈ˜ Ô˘ ·Ó·Ê¤ÚÔ˘Ó ÛÂ ÔÚÈ-

ÛÌ¤Ó· ‚Ú¤ÊË ÂÈÌÔÓ‹ ÙˆÓ ÂÂÈÛÔ‰›ˆÓ Ì¤¯ÚÈ Î·È

ÙËÓ ËÏÈÎ›· ÙˆÓ 10 ÌËÓÒÓ, ¯ˆÚ›˜ fiÌˆ˜ ÂÈÙÒ-

ÛÂÈ˜ ÛÙË „˘¯ÔÎÈÓËÙÈÎ‹ ÙÔ˘˜ ÂÍ¤ÏÈÍË.

√È ∫ªÀ¡ Û˘Á¯¤ÔÓÙ·È Û˘¯Ó¿ ÌÂ Û·ÛÌÔ‡˜,

·ÎfiÌ· Î·È ÌÂ status epilepticus, ÌÔÏÔÓfiÙÈ ‰ÂÓ

ÚfiÎÂÈÙ·È ÁÈ· ÂÈÏËÙÈÎfi Ê·ÈÓfiÌÂÓÔ (6). ∏ ·Ó·-

ÁÓÒÚÈÛ‹ ÙÔ˘˜ ¤¯ÂÈ È‰È·›ÙÂÚË ÛËÌ·Û›· ÁÈ· ÙËÓ

·ÔÊ˘Á‹ ÙË˜ ·Ó·›ÙÈ·˜ ·ÓËÛ˘¯›·˜ ÙˆÓ ÁÔÓ¤ˆÓ,

ÙË˜ ·‰ÈÎ·ÈÔÏfiÁËÙË˜ Ú·ÁÌ·ÙÔÔ›ËÛË˜ ÂÍÂÈ‰È-

ÎÂ˘Ì¤ÓˆÓ ‰È·ÁÓˆÛÙÈÎÒÓ ÂÍÂÙ¿ÛÂˆÓ, ·ÏÏ¿ Î˘-

Ú›ˆ˜ ÁÈ· ÙËÓ ·ÔÊ˘Á‹ ¯ÔÚ‹ÁËÛË˜ ·ÓÙÈÂÈÏËÙÈ-

ÎÒÓ Ê·ÚÌ¿ÎˆÓ, Ù· ÔÔ›· ÌÔÚÂ› Ó· ÚÔÎ·Ï¤-

ÛÔ˘Ó ˘ÚÔ‰fiÙËÛË Ó¤ˆÓ ÂÂÈÛÔ‰›ˆÓ (6). ™˘ÌÂ-

Ú·ÛÌ·ÙÈÎ¿, ÌÔÚÔ‡Ó Ó· ıÂˆÚËıÔ‡Ó ÌÂ ‚Â‚·Èfi-

ÙËÙ· ∫ªÀ¡ ÔÈ Ì˘ÔÎÏÔÓ›Â˜ Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È

ÛÙËÓ ÚÒÈÌË ÓÂÔÁÓÈÎ‹ ËÏÈÎ›·, ·Ú·ÙËÚÔ‡ÓÙ·È

ÌfiÓÔ Î·Ù¿ ÙÔÓ ‡ÓÔ, ̆ Ô¯ˆÚÔ‡Ó ÌÂ ÙËÓ ·Ê‡ÓÈ-

ÛË ÙÔ˘ ÓÂÔÁÓÔ‡ Î·È ‰ÂÓ Û˘ÓÔ‰Â‡ÔÓÙ·È ·fi ËÏÂ-

ÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊÈÎ¿ Â˘Ú‹Ì·Ù· ÂÓ‰ÂÈÎÙÈÎ¿

ÂÈÏËÙÈÎÒÓ ÂÎÊÔÚÙ›ÛÂˆÓ. ∂ÊfiÛÔÓ ÏËÚÔ‡ÓÙ·È

Ù· ÎÚÈÙ‹ÚÈ· ·˘Ù¿, ‰ÂÓ Ú¤ÂÈ Ó· ‰ÔıÂ› Ê·ÚÌ·-

ÎÂ˘ÙÈÎ‹ ·ÁˆÁ‹ ÛÙÔ ÓÂÔÁÓfi Ô‡ÙÂ ¯ÚÂÈ¿˙ÂÙ·È Ó·

˘Ô‚ÏËıÂ› ÛÂ ÂÚ·ÈÙ¤Úˆ ‰È·ÁÓˆÛÙÈÎfi ¤ÏÂÁ¯Ô.


1. Coulter DL, Allen RJ. Benign neonatal sleep my-

oclonus. Arch Neurol 1982;39:191-192.

2. ParÔ-Panjan D, Neubauer D. Benign neonatal sleep

myoclonus: experience from the study of 38 infants.

Eur J Paediatr Neurol 2008;12:14-18.

3. Cohen R, Shuper A, Straussberg R. Familial benign

neonatal sleep myoclonus. Pediatr Neurol 2007;36:

334-337.

4. Di Capua M, Fusco L, Ricci S, Vigevano F. Benign

neonatal sleep myoclonus: clinical features and video-

polygraphic recordings. Mov Disord 1993;8:191-194.

5. °ÈˆÛ·Ê¿Ù ª, ™ËÊÈ·ÓÔ‡ ¶. º˘ÛÈÔÏÔÁ›· Î·È ‰È·Ù·-

Ú·¯¤˜ ÙÔ˘ ‡ÓÔ˘ ÛÙ· ·È‰È¿. π·ÙÚÈÎ‹ 1984;46:4-15.

6. Egger J, Grossmann G, Auchterlonie IA. Benign sleep

myoclonus in infancy mistaken for epilepsy. BMJ

2003;326:975-976.


xiii¶ƒ√™∂Ã∏ ™À¡∂¢ƒπ∞

4-6 ∞ÚÈÏ›Ô˘ 2008 2Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ ¡ÂÔÁÓÔÏÔÁ›·˜ ∞›ÁÏË ∑·Â›Ô˘,

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Παιδιατρική | Τόμος 71 • Τεύχος 2 • Μάρτιος - Απρίλιος 2008