Παιδιατρική | Τόμος 72 • Τεύχος 2 • Απρίλιος - Μάιος - Ιούνιος 2009

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¶·È‰È·ÙÚÈÎ‹∆fiÌÔ˜ 72 ñ ∆Â‡¯Ô˜ 2 ñ ª¿ÚÙÈÔ˜-∞Ú›ÏÈÔ˜ 2009

∫ˆ‰ÈÎfi ¢ÈÂ‡ı˘ÓÛË ∂ÔÙÂ›· ªª∂: 3889

ISSN 0377-2551

Pediatri Mar-Apr 09 10-04-09 15:35 ™ÂÏ›‰·1

Bimonthly Publication of

the Greek Paediatric Society

President

A. Constantopoulos

Editorial Board

Editor-in-Chief

C. Stefanidis

Members

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ª. ∞nthracopoulos

P. Augoustides-Savvopoulou

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S. Kitsiou-Tzeli

∞. Papadopoulou

V. Papaevagelou

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Manuscript submission


Instructions to authors:

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iae.pdf

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Communications In Practice S.∞.

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Contents

REVIEW ARTICLES

75 Acute lymphoblastic leukaemia in children

and adolescents

E. Stiakaki, M. Kalmanti

82 Childhood lymphomas - Novel therapeutic

approaches

V. Danilatou, M. Kalmanti

89 Haemophagocytic lymphohistiocytosis - HLH

C. Koutsaftiki, E. Mantziou, N. Myriokefalitakis

97 Current data on congenital diaphragmatic

hernia

C. Tsakalidis, E. Ourgantzoglou, N. Nikolaidis

ORIGINAL ARTICLES

109 The effect of paediatric bone-marrow-

derived stromal cells on the ex-vivo

expansion of cord-blood haemopoietic

stem cells

I. Pelagiadis, H. Dimitriou, E. Stiakaki, C. Perdikogianni, E. Hatzidaki, M. Kalmanti

117 Seroepidemiological study of hepatitis A in

Greek children aged 0-14 years

V. Papaevagelou, A. Kyrka, A. Tragiannidis, D. Kassimos, K. Pantelaki, E. Pavlou, M. Tzoufi,M. Mavrokosta, A. Tzivaras, X. Pedeli, A. Hatzimichail, F. Athanassiadou, D. Kafetzis, A. Konstantopoulos

123 Hodgkin’s lymphoma in children:

28 years of experience

A. Pourtsidis, D. Doganis, M. Baka, D. Bouhoutsou, M. Varvoutsi, M. Synodinou, A. Michael-Strantzia, E. Kosmidi

PRACTICAL ISSUES

132 Cardiovascular consequences of

adenotonsillar hypertrophy in children

K. Papadopoulou-Legbelou, G. Varlamis

139 Defining obesity in children and

adolescents: methodological dilemmas

P. Pervanidou

CASE REPORT

145 Bochdalek congenital diaphragmatic

hernia with intrathoracic ectopic kidney -

a case report

C. Takalidis, V. Lampropoulos, E. Ourgantzoglou,D. Rallis, A. Petropoulos, N. Nikolaidis

CLINICAL QUIZ

150 Thirteen-year-old boy with recurrent

episodes of painful ankle joint

¡. Markeas, π. Papachristos

PAEDIATRIC NEWS IN BRIEF

151 News on paediatric infections

N. Spyridis

HELLENIC RESEARCH IN THEINTERNATIONAL LITERATURE

154 Hellenic paediatric research in

international journals, 2008

E. Galanakis

NEWS FROM THE INTERNET

156 Site of the 2nd Department of Paediatrics

of the University of Athens

S. Kehagias, D. Anagnostou

PaediatrikiVolume 72 ñ Number 2 ñ March-April 2009


75∞¡∞™∫√¶∏™∏ REVIEW ARTICLE

¶·È‰È·ÙÚÈÎ‹ 2009;72:75-000

√ÍÂ›· ÏÂÌÊÔ‚Ï·ÛÙÈÎ‹ ÏÂ˘¯·ÈÌ›· ÛÂ ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜

∂. ™ÙÂÈ·Î¿ÎË, M. ∫·ÏÌ·ÓÙ‹

¶ÂÚ›ÏË„Ë: ∏ ÔÍÂ›· ÏÂÌÊÔ‚Ï·ÛÙÈÎ‹ ÏÂ˘¯·ÈÌ›· Â›Ó·È Ë Û˘¯ÓfiÙÂÚË Î·ÎÔ‹ıÂÈ· ÛÙ· ·È‰È¿. ∏ ÚfiÔ‰Ô˜ ÛÙË‰È¿ÁÓˆÛË Î·È Ë ıÂÚ·Â›· Û‡ÌÊˆÓ· ÌÂ ÙËÓ ÔÌ¿‰· ÎÈÓ‰‡ÓÔ˘ ÙÔ˘ Î¿ıÂ ·È‰ÈÔ‡ ¤¯Ô˘Ó ‰ÒÛÂÈ ÔÛÔÛÙ¿ ›·-ÛË˜ Ô˘ ÏËÛÈ¿˙Ô˘Ó ÙÔ 90%. ∏ Î˘ÙÙ·ÚÔÁÂÓÂÙÈÎ‹ ÌÂÏ¤ÙË ÙˆÓ ‚Ï·ÛÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ ·›˙ÂÈ ÛËÌ·ÓÙÈÎfi Úfi-ÏÔ ÛÙËÓ ÚÔÛ·ÚÌÔÁ‹ ÙË˜ ıÂÚ·Â›·˜ Î·È ÛÙËÓ ·Ó·˙‹ÙËÛË Ó¤ˆÓ ıÂÚ·Â˘ÙÈÎÒÓ ÛÙfi¯ˆÓ. ∏ Î·Ù¿Ù·ÍË ÛÂÔÌ¿‰Â˜ ÎÈÓ‰‡ÓÔ˘ ‚·Û›˙ÂÙ·È ÛÂ ÎÏÈÓÈÎ¿ Î·È Î˘ÙÙ·ÚÔÁÂÓÂÙÈÎ¿ ‰Â‰ÔÌ¤Ó·, Î·ıÒ˜ Î·È ÛÙËÓ ÂÎÙ›ÌËÛË ÙË˜ ÂÏ¿-¯ÈÛÙË˜ ˘ÔÏÂÈfiÌÂÓË˜ ÓfiÛÔ˘, Ô˘ Ê·›ÓÂÙ·È Ó· ·ÔÙÂÏÂ› ¤Ó·Ó ·fi ÙÔ˘˜ ÈÛ¯˘ÚfiÙÂÚÔ˘˜ ÚÔÁÓˆÛÙÈÎÔ‡˜·Ú¿ÁÔÓÙÂ˜ Î·È ·Ú¤¯ÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· ÁÈ· Û¯Â‰fiÓ ÂÍ·ÙÔÌÈÎÂ˘Ì¤ÓË ıÂÚ·Â›·. ∂ÈÚfiÛıÂÙ·, ÚfiÛÊ·ÙÂ˜ÌÂÏ¤ÙÂ˜ ‰Â›¯ÓÔ˘Ó fiÙÈ ÔÈ ¤ÊË‚ÔÈ Î·È ÔÈ ÓÂ·ÚÔ› ÂÓ‹ÏÈÎÂ˜ ¤¯Ô˘Ó ÔÏ‡ ÌÂÁ·Ï‡ÙÂÚ· ÔÛÔÛÙ¿ ›·ÛË˜ fiÙ·Ó ıÂ-Ú·Â‡ÔÓÙ·È ÌÂ ·È‰È·ÙÚÈÎ¿ ÚˆÙfiÎÔÏÏ·, Û˘ÁÎÚÈÙÈÎ¿ ÌÂ ÂÎÂ›ÓÔ˘˜ Ô˘ ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È ÌÂ ıÂÚ·Â˘ÙÈÎ¿Û¯‹Ì·Ù· ÙˆÓ ÂÓËÏ›ÎˆÓ.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: √ÍÂ›· ÏÂÌÊÔ‚Ï·ÛÙÈÎ‹ ÏÂ˘¯·ÈÌ›·, ·È‰È¿, ¤ÊË‚ÔÈ.

Acute lymphoblastic leukaemia in children and adolescents

E. Stiakaki, M. Kalmanti

Abstract: Acute lymphoblastic leukaemia is the most common malignancy in childhood. Progress indiagnosis and treatment according to risk classification have produced cure rates that now approach 90%.Molecular genetics of the blasts plays a crucial role in tailoring therapy and identifying new targets forspecific treatment. Current risk classification schemes are based on clinical characteristics and cytogeneticfeatures, and on minimal residual disease assessment, which appears to be among the strongestprognostic factors and provides an opportunity for more precise risk tailored treatments. Recent studieshave shown that adolescents and young adults have a much better outcome when treated with paediatricthan with adult protocols.

Key words: Acute lymphoblastic leukaemia, children, adolescents

¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹∞ÈÌ·ÙÔÏÔÁ›·˜-√ÁÎÔÏÔÁ›·˜¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹ÙË˜

AÏÏËÏÔÁÚ·Ê›·:

∂˘Ù˘¯›· ™ÙÂÈ·Î¿ÎË[email protected]¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹∞ÈÌ·ÙÔÏÔÁ›·˜-√ÁÎÔÏÔÁ›·˜,¶·ÓÂÈÛÙËÌÈ·Îfi ¡ÔÛÔÎÔÌÂ›Ô∏Ú·ÎÏÂ›Ô˘, 71110 ∏Ú¿ÎÏÂÈÔ∫Ú‹ÙË˜

Department of PaediatricHaematology/Oncology,University of Crete, Greece

Correspondence:

Eftichia [email protected] of PaediatricHaematology/Oncology,University Hospital ofHeraklion, 71110 Heraklion,Crete, Greece

™˘ÓÙÔÌÔÁÚ·Ê›Â˜:

ALL acute lymphoblastic leukemia

BFM Berlin-Frankfurt-Muenster

CCG Children’s Cancer Group

COG Children’s Oncology Group

DFCI Dana-Farber Cancer Institute

MRD Minimal Residual Disease (ÂÏ¿¯ÈÛÙË

˘ÔÏÂÈfiÌÂÓË ÓfiÛÔ˜)

NCI National Cancer Institute

POG Pediatric Oncology Group

√§§ ÔÍÂ›· ÏÂÌÊÔ‚Ï·ÛÙÈÎ‹ ÏÂ˘¯·ÈÌ›·

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¯ÒÓ ÛÙË ÏÂ˘¯·ÈÌÔÁ¤ÓÂÛË, ÛÂ Ê·ÚÌ·ÎÔÁÂÓÂÙÈ-

Î¤˜ ÌÂÏ¤ÙÂ˜ Î·È ÛÙËÓ ÂÎÙ›ÌËÛË ÙÔ˘ ÚfiÏÔ˘ ÙË˜

˘ÔÏÂÈfiÌÂÓË˜ ÓfiÛÔ˘.

¶·Ú¿ ÙËÓ ÚfiÔ‰Ô Ô˘ ¤¯ÂÈ ÂÈÙÂ˘¯ıÂ›, ¤Ó·

ÔÛÔÛÙfi ·È‰ÈÒÓ Ï·Ì‚¿ÓÂÈ ›Ûˆ˜ ÂÚÈÛÛfiÙÂÚË

ıÂÚ·Â›· ·fi ÂÎÂ›ÓË Ô˘ Ú·ÁÌ·ÙÈÎ¿ ¯ÚÂÈ¿˙Â-

Ù·È ÁÈ· Ó· È·ıÂ›, 10-20% ÙˆÓ ·È‰ÈÒÓ ÌÂ ·Ú¯ÈÎ¿

Â˘ÓÔ˚ÎÔ‡˜ ÚÔÁÓˆÛÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜ ÛÙË


76 ∂. ™ÙÂÈ·Î¿ÎË, M. ∫·ÏÌ·ÓÙ‹

Paediatriki 2009;72:76-000

Û˘Ó¤¯ÂÈ· ˘ÔÙÚÔÈ¿˙Ô˘Ó, ÂÓÒ ˘¿Ú¯ÂÈ Â›ÛË˜ ÌÈ·

ÔÌ¿‰· ·ÛıÂÓÒÓ ÌÂ ÓfiÛÔ ·ÓıÂÎÙÈÎ‹ ÛÙË ıÂÚ·Â›·.

∂ÂÈ‰‹ Ë ÂÚ·ÈÙ¤Úˆ ÂÓÙ·ÙÈÎÔÔ›ËÛË ÙË˜ ıÂÚ·Â›·˜

‰ÂÓ Ê·›ÓÂÙ·È Ó· ‚ÂÏÙÈÒÓÂÈ ÙËÓ ÚfiÁÓˆÛË, ÙÔ ÂÓ‰È·-

Ê¤ÚÔÓ ¤¯ÂÈ ÛÙÚ·ÊÂ› ÛÂ Ó¤Ô˘˜ ·Ú¿ÁÔÓÙÂ˜ Ô˘ ·-

ÚÂÌ‚·›ÓÔ˘Ó ÛÙË ÏÂ˘¯·ÈÌÔÁ¤ÓÂÛË Î·È ÛÙËÓ ·ÓÙÔ¯‹

ÛÙ· Ê¿ÚÌ·Î·, Î·ıÒ˜ Î·È ÛÙËÓ ·Ó·ÁÓÒÚÈÛË ÂÈÚfi-

ÛıÂÙˆÓ ÚÔÁÓˆÛÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ, ¤ÙÛÈ ÒÛÙÂ Ë Ù·-

ÍÈÓfiÌËÛË ÛÂ ÔÌ¿‰Â˜ ÎÈÓ‰‡ÓÔ˘ Ó· Â›Ó·È ÈÔ ·ÎÚÈ‚‹˜.

∆·ÍÈÓfiÌËÛË ÛÂ ÔÌ¿‰Â˜ ÎÈÓ‰‡ÓÔ˘

°È· ÔÏÏ¤˜ ‰ÂÎ·ÂÙ›Â˜, Ë ıÂÚ·Â›· ‚·Û›ÛÙËÎÂ ÛÂ

ÚÔÁÓˆÛÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜, fiˆ˜ Ë ËÏÈÎ›·, ÙÔ Ê‡-

ÏÔ, Ô ·ÚÈıÌfi˜ ÙˆÓ ÏÂ˘ÎÒÓ ÛÙË ‰È¿ÁÓˆÛË, Ë ·ÚÔ˘-

Û›· ÓfiÛÔ˘ ÛÙÔ ∫¡™, Ô ·ÓÔÛÔÊ·ÈÓfiÙ˘Ô˜ Î·È ÔÈ Î˘Ù-

Ù·ÚÔÁÂÓÂÙÈÎ¤˜ ·ÓˆÌ·Ï›Â˜ ÙˆÓ ‚Ï·ÛÙÒÓ, Î·È, ÌÂÙ·ÁÂ-

Ó¤ÛÙÂÚ·, Ë ÚÒÈÌË ·¿ÓÙËÛË ÛÙË ıÂÚ·Â›· (4,5).

™Ù· ÙÚ¤¯ÔÓÙ· ÚˆÙfiÎÔÏÏ· ıÂÚ·Â›·˜ ¤¯ÂÈ ÚÔ-

ÛÙÂıÂ› Ë ÂÎÙ›ÌËÛË ÙË˜ ÔÏÂÈfiÌÂÓË˜ ÓfiÛÔ˘. ∏ ËÏÈ-

Î›· Î·È Ô ·ÚÈıÌfi˜ ÙˆÓ ÏÂ˘ÎÒÓ ÛÙË ‰È¿ÁÓˆÛË ·Ú·-

Ì¤ÓÔ˘Ó ‰È·¯ÚÔÓÈÎ¿ ÛÙ·ıÂÚÔ› Î·È ·ÓÂÍ¿ÚÙËÙÔÈ ÚÔ-

ÁÓˆÛÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ ÛÂ fiÏ· Ù· ÚˆÙfiÎÔÏÏ· ıÂÚ·-

Â›·˜. ™‡ÌÊˆÓ· ÌÂ Ù· ÎÚÈÙ‹ÚÈ· ÙÔ˘ NCI, Ù· ·È‰È¿

ÌÂ √§§ µ-ÛÂÈÚ¿˜, ËÏÈÎ›·˜ 1-9 ÂÙÒÓ Î·È ÌÂ ÏÂ˘Î¿

<50.000 ÎÎ¯ ıÂˆÚÔ‡ÓÙ·È ÛÙ·ıÂÚÔ‡ ÎÈÓ‰‡ÓÔ˘, ÂÓÒ Ù·

˘fiÏÔÈ· ·È‰È¿ Î·Ù·Ù¿ÛÛÔÓÙ·È ÛÙËÓ ÔÌ¿‰· ˘„Ë-

ÏÔ‡ ÎÈÓ‰‡ÓÔ˘ (4). ∞ÓÙ›ÛÙÔÈ¯·, Î·È ÛÙ· ÚˆÙfiÎÔÏÏ·

BFM Ì¤¯ÚÈ Î·È ÙÔ 1995, Ë ËÏÈÎ›· 1-6 ÂÙÒÓ Î·È Ô ·ÚÈı-

Ìfi˜ ÏÂ˘ÎÒÓ <20.000 ÎÎ¯ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÁÈ· ÙËÓ

Î·Ù¿Ù·ÍË ÙˆÓ ·ÛıÂÓÒÓ ÛÙËÓ ÔÌ¿‰· ÛÙ·ıÂÚÔ‡ ÎÈÓ-

‰‡ÓÔ˘ (5).

∏ Û˘ÌÌÂÙÔ¯‹ ÙÔ˘ ∫¡™ ÛÙË ‰È¿ÁÓˆÛË (¶›Ó·Î·˜

1) ¤¯ÂÈ Â›ÛË˜ ·Ô‰ÂÈ¯ıÂ› ÛËÌ·ÓÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜

ÛÙËÓ ÚfiÁÓˆÛË ÙË˜ ÓfiÛÔ˘ (∂ÈÎfiÓ· 1). ∞Ú¯ÈÎ¿, Ë

·Ó·ÁÓÒÚÈÛË ÙÔ˘ ÚfiÏÔ˘ ÙË˜ ÚÔÊ‡Ï·ÍË˜ ÙÔ˘ ∫¡™ ‹

-ÈÔ ÛˆÛÙ¿- Ë ıÂÚ·Â›· ÙË˜ ˘ÔÎÏÈÓÈÎ‹˜ ÓfiÛÔ˘,

·fi Ù· Ù¤ÏË ÙË˜ ‰ÂÎ·ÂÙ›·˜ ÙÔ˘ 1960, Û˘Ó¤‚·ÏÂ Ù·

Ì¤ÁÈÛÙ· ÛÙË ‚ÂÏÙ›ˆÛË ÙË˜ ÂÈ‚›ˆÛË˜/›·ÛË˜. ™‹ÌÂ-

Ú·, Ë ıÂÚ·Â›· ÙË˜ ˘ÔÎÏÈÓÈÎ‹˜ ÓfiÛÔ˘ ‚·Û›˙ÂÙ·È

ÛÙËÓ ÂÈıÂÙÈÎ‹ Û˘ÛÙËÌ·ÙÈÎ‹ ¯ËÌÂÈÔıÂÚ·Â›·

(HDMTX ) Î·È ÛÙËÓ ÂÓ‰ÔÚÚ·¯È·›· ¯ÔÚ‹ÁËÛË ÌÂıÔ-

ÙÚÂÍ¿ÙË˜ ÛÙÔ 80-90% ÙˆÓ ·È‰ÈÒÓ. ™ÙÔ˘˜ ·ÛıÂÓÂ›˜

˘„ËÏÔ‡ ‹ ÔÏ‡ „ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÔÚËÁÂ›Ù·È ÙÚÈÏ‹

ÂÓ‰ÔÚÚ·¯È·›· ¯ËÌÂÈÔıÂÚ·Â›· Î·È ·ÎÙÈÓÔ‚ÔÏ›· ÎÚ·-

Ó›Ô˘ (12Gy) ÛÂ fiÏ· Û¯Â‰fiÓ Ù· Î¤ÓÙÚ·, Ù·ÎÙÈÎ‹ Ô˘

¤¯ÂÈ ÌÂÈÒÛÂÈ ÙÔ ÔÛÔÛÙfi ÙˆÓ ˘ÔÙÚÔÒÓ ÌÂ Û˘ÌÌÂ-

ÙÔ¯‹ ÙÔ˘ ∫¡™ ÛÂ <5% Î·È ÙˆÓ ÌÂÌÔÓˆÌ¤ÓˆÓ ˘Ô-

ÙÚÔÒÓ ∫¡™ ÛÙÔ 1,1%. ∂Í·›ÚÂÛË ·ÔÙÂÏÂ› ÙÔ St.

Jude, ÛÙ· ÙÚ¤¯ÔÓÙ· ÚˆÙfiÎÔÏÏ· ÙÔ˘ ÔÔ›Ô˘ ‰ÂÓ ¯Ô-

ÚËÁÂ›Ù·È ·ÎÙÈÓÔ‚ÔÏ›· Ô‡ÙÂ ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ˘„ËÏÔ‡

ÎÈÓ‰‡ÓÔ˘ (6,7). ∆ËÓ ÙÂÏÂ˘Ù·›· ‰ÂÎ·ÂÙ›· ·Ó·ÁÓˆÚ›-

ÛÙËÎÂ fiÙÈ Ë ÙÚ·˘Ì·ÙÈÎ‹ ÔÛÊ˘ÔÓˆÙÈ·›· ·Ú·Î¤ÓÙË-

ÛË ÛÙË ‰È¿ÁÓˆÛË ÂÈ‚·Ú‡ÓÂÈ ÙËÓ ÙÂÏÈÎ‹ ÂÎ‚·ÛË ÙˆÓ

·ÛıÂÓÒÓ, ÌÂ ÔÛÔÛÙfi ˘ÔÙÚÔÒÓ ÙÔ˘ ∫¡™ ÛÙ· Â-

ÚÈÛÙ·ÙÈÎ¿ ·˘Ù¿ ÂÚ›Ô˘ 8% (8). ŒÙÛÈ, ‹‰Ë ÛÙ· Úˆ-

ÙfiÎÔÏÏ· BFM -95 Î·È St. Jude XIII ·˘Í‹ıËÎÂ Ô ·ÚÈı-

Ìfi˜ ÙˆÓ ÂÓ‰ÔÚÚ·¯È·›ˆÓ ¯ÔÚËÁ‹ÛÂˆÓ ÛÙÈ˜ ÂÚÈÙÒ-

ÛÂÈ˜ ·˘Ù¤˜.

∞ÓÔÛÔÊ·ÈÓfiÙ˘Ô˜

∏ ÌÂÏ¤ÙË ÙÔ˘ ·ÓÔÛÔÊ·ÈÓfiÙ˘Ô˘ ÙˆÓ ‚Ï·ÛÙÒÓ

ÛÙË ‰È¿ÁÓˆÛË ÙË˜ √§§ ¤¯ÂÈ ·ÚÔ˘ÛÈ¿ÛÂÈ ÙÂÚ¿ÛÙÈ·

ÚfiÔ‰Ô Ù· ÙÂÏÂ˘Ù·›· ÚfiÓÈ·, ÌÂ ÙË ‰È¿ıÂÛË ÌÂÁ¿ÏÔ˘

·ÚÈıÌÔ‡ ÌÔÓÔÎÏˆÓÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÏÂ˘ÎÔ-

Î˘ÙÙ·ÚÈÎÒÓ ·ÓÙÈÁfiÓˆÓ Î·È ÙÔ Û¯Â‰È·ÛÌfi Â˘·›ÛıËÙË˜

Î·È ·ÍÈfiÈÛÙË˜ Î˘ÙÙ·ÚÔÌÂÙÚ›·˜ ÚÔ‹˜. ¢Â›ÎÙÂ˜ È‰È·›-

ÙÂÚ· Â˘·›ÛıËÙÔÈ ÁÈ· ÙË µ Î·È ∆ ÛÂÈÚ¿ ·ÓÙ›ÛÙÔÈ¯· Â›-

Ó·È Ù· CD19 Î·È CD7 Î·È ‰Â›ÎÙÂ˜ ÌÂ ÌÂÁ¿ÏË ÂÈ‰ÈÎfi-

ÙËÙ· Ù· Î˘ÙÙ·ÚÔÏ·ÛÌ·ÙÈÎ¿ CD79a, CD3 ÁÈ· µ Î·È

∆ ÏÂÌÊÔÎ‡ÙÙ·Ú·, ·ÓÙ›ÛÙÔÈ¯·. ªÂ ÙÔÓ ·ÓÔÛÔÊ·ÈÓfi-

Ù˘Ô ÌfiÓÔ, Ë ‰È¿ÁÓˆÛË ÌÔÚÂ› Ó· ÙÂıÂ› ÛÙÔ 99% ÙˆÓ

ÂÚÈÙÒÛÂˆÓ (9).

ªÂ ‚¿ÛË ÙÔÓ ·ÓÔÛÔÊ·ÈÓfiÙ˘Ô ÙˆÓ ‚Ï·ÛÙÒÓ, Ë

Î‡ÚÈ· ‰È¿ÎÚÈÛË Â›Ó·È ÌÂÙ·Í‡ √§§ B-Î˘ÙÙ·ÚÈÎ‹˜

ÚÔ¤ÏÂ˘ÛË˜ (µ-lineage ‹ µ-precursor ALL) (85%

ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÛÙ· ·È‰È¿) Î·È ∆-

√§§, Ô˘ ·ÔÙÂÏÂ› ÙÔ ˘fiÏÔÈÔ 15%. ∏ √§§ B-

Î˘ÙÙ·ÚÈÎ‹˜ ÚÔ¤ÏÂ˘ÛË˜ ÌÔÚÂ› Ó· ‰È·ÎÚÈıÂ› ÂÚ·È-

Ù¤Úˆ ÛÂ ÚÒÈÌË ÚÔ-µ, ÚÔ-µ, ÌÂÙ·‚·ÙÈÎ‹ ÚÔ-µ

∂ÈÎfiÓ· 1. §ÂÌÊÔ‚Ï¿ÛÙÂ˜ ÛÂ Î˘ÙÙ·ÚÔÊ˘ÁÔÎ¤ÓÙÚËÛË ∂¡À.

¶›Ó·Î·˜ 1. ∆·ÍÈÓfiÌËÛË ÙË˜ Û˘ÌÌÂÙÔ¯‹˜ ÙÔ˘ ∫¡™ ÛÙËÓ √§§

¡fiÛÔ˜ ÛÙÔ ∫¡™ñ CNS 1

∞Ô˘Û›· ‚Ï·ÛÙÒÓ ÛÙËÓ Î˘ÙÙ·ÚÔÊ˘ÁÔÎ¤ÓÙÚËÛË ÙÔ˘ ∂¡Àñ CNS 2

<5 WBC/Ìl ÛÙËÓ Î˘ÙÙ·ÚÔÊ˘ÁÔÎ¤ÓÙÚËÛË ÌÔÚÊÔÏÔÁÈÎ¿‚Ï¿ÛÙÂ˜

ñ CNS 3≥5 WBC/Ìl ÌÔÚÊÔÏÔÁÈÎ¿ ‚Ï¿ÛÙÂ˜


77√ÍÂ›· ÏÂÌÊÔ‚Ï·ÛÙÈÎ‹ ÏÂ˘¯·ÈÌ›·

¶·È‰È·ÙÚÈÎ‹ 2009;72:10-15

Î·È µ-√§§ (10). ŸÛÔÓ ·ÊÔÚ¿ ÙÔÓ Û¯Â‰È·ÛÌfi ÙË˜ ıÂ-

Ú·Â›·˜ ÙË˜ √§§ µ-ÛÂÈÚ¿˜, Ë ÌfiÓË ÛËÌ·ÓÙÈÎ‹ ‰È¿-

ÎÚÈÛË Â›Ó·È ÌÂÙ·Í‡ ÒÚÈÌˆÓ µ Î·È Úfi‰ÚÔÌˆÓ µ-Î˘Ù-

Ù¿ÚˆÓ. ∞Ó¿ÏÔÁ·, Ë ∆-√§§ ÌÔÚÂ› Ó· Ù·ÍÈÓÔÌËıÂ› ÌÂ

‚¿ÛË ÙÔ ÛÙ¿‰ÈÔ ‰È·ÊÔÚÔÔ›ËÛË˜ ÙˆÓ ı˘ÌÔÎ˘ÙÙ¿ÚˆÓ

‹ ÙÔ ÛÙ¿‰ÈÔ ¤ÎÊÚ·ÛË˜ ÙÔ˘ ˘Ô‰Ô¯¤· ÙÔ˘ ∆-Î˘ÙÙ¿-

ÚÔ˘, ·ÏÏ¿ ·˘Ù‹ Ë Ù·ÍÈÓfiÌËÛË ¤¯ÂÈ ÂÚÈÔÚÈÛÌ¤ÓË

ÎÏÈÓÈÎ‹ ¯ÚËÛÈÌfiÙËÙ·.

∫˘ÙÙ·ÚÔÁÂÓÂÙÈÎ¿ ·Ú·ÎÙËÚÈÛÙÈÎ¿

™ÙÔ 90% ÙË˜ √§§ ·Ú·ÙËÚÔ‡ÓÙ·È ÂÈ‰ÈÎ¤˜ Î˘ÙÙ·-

ÚÔÁÂÓÂÙÈÎ¤˜ ·ÓˆÌ·Ï›Â˜, ·ÚÈıÌËÙÈÎ¤˜ ‹ ‰ÔÌÈÎ¤˜. ∏

Î˘ÙÙ·ÚÔÁÂÓÂÙÈÎ‹ ·Ó¿Ï˘ÛË ÙˆÓ ‚Ï·ÛÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ

¤¯ÂÈ ÌÂÁ¿ÏË ÛËÌ·Û›· ÛÙË ‰È¿ÁÓˆÛË, ıÂÚ·Â›· Î·È

ÚfiÁÓˆÛË ÙË˜ ÓfiÛÔ˘ (11). ∫ÏÈÓÈÎ¿ ÛËÌ·ÓÙÈÎ¤˜ Î˘Ù-

Ù·ÚÔÁÂÓÂÙÈÎ¤˜ ‰È·Ù·Ú·¯¤˜ Â›Ó·È Ô ˘ÂÚ‰ÈÏÔÂÈ‰È-

ÛÌfi˜, Ô ˘Ô‰ÈÏÔÂÈ‰ÈÛÌfi˜, ÔÈ ¯ÚˆÌÔÛˆÌÈÎ¤˜ ÌÂÙ·-

ı¤ÛÂÈ˜ fiˆ˜ t(12;21), t(1;19), t(9;22), ÌÂ ·ÓÙ›ÛÙÔÈ¯·

ÚÔ˚fiÓÙ· Û‡ÓÙËÍË˜ ÙˆÓ ÁÔÓÈ‰›ˆÓ TEL-AML1, E2A-

PBX1, BCR-ABL Î·È ÌÈ· ÔÈÎÈÏ›· ·Ó·‰È·Ù¿ÍÂˆÓ ÙÔ˘

MLL ÁÔÓÈ‰›Ô˘. √ ˘ÂÚ‰ÈÏÔÂÈ‰ÈÛÌfi˜ (>50 ¯ÚˆÌÔ-

ÛÒÌ·Ù· ‹ DNA index ≥1,16 ), Î·ıÒ˜ Î·È ÔÈ ÙÚÈÛˆ-

Ì›Â˜ 4,10,17 ·ÏÏ¿ Î˘Ú›ˆ˜ Ë ÙÚÈÏ‹ ÙÚÈÛˆÌ›· 4,10,17,

¤¯Ô˘Ó ıÂÙÈÎ‹ Â›ÙˆÛË ÛÙËÓ ¤Î‚·ÛË, ÂÓÒ Ô ˘Ô‰È-

ÏÔÂÈ‰ÈÛÌfi˜ (<45 ¯ÚˆÌÔÛÒÌ·Ù· ÌÂ DI <0,95 ‹ <44

¯ÚˆÌÔÛÒÌ·Ù· Î·È DI <0,81) Û¯ÂÙ›˙ÂÙ·È ÌÂ Î·Î‹

ÚfiÁÓˆÛË (12-14) (∂ÈÎfiÓ· 2).

∏ ÌÂÙ¿ıÂÛË t(12;21) ·Ú·ÙËÚÂ›Ù·È ÛÙÔ 25% ÙË˜

√§§ Î˘Ú›ˆ˜ µ ÛÂÈÚ¿˜ Î·È Ô ÚÔÁÓˆÛÙÈÎfi˜ ÙË˜ ÚfiÏÔ˜

‹Ù·Ó ÁÈ· ÔÏÏ¿ ¯ÚfiÓÈ· ·ÌÊÈÏÂÁfiÌÂÓÔ˜. ∞Ú¯ÈÎ¿ ıÂˆ-

Ú‹ıËÎÂ Â˘ÓÔ˚Îfi˜, ÌÂ ÂÈ‚›ˆÛË >90% ÛÙËÓ ÔÌ¿‰·

·˘Ù‹, ÂÓÒ ·ÎÔÏÔ‡ıËÛ·Ó ·Ó·ÊÔÚ¤˜ ÁÈ· ·˘ÍËÌ¤ÓË Û˘-

¯ÓfiÙËÙ· fi„ÈÌˆÓ ˘ÔÙÚÔÒÓ, ¤ÙÛÈ ÒÛÙÂ Ë ÂÈ‚›ˆÛË

Ó· ÌË ‰È·Ê¤ÚÂÈ ÌÂÙ¿ ·fi Ì·ÎÚ¿ ÂÚ›Ô‰Ô ·Ú·ÎÔ-

ÏÔ‡ıËÛË˜ (15,16). ¶ÚfiÛÊ·Ù·, ÔÈ ‰È·ÊÔÚ¤˜ ÛÙËÓ

¤Î‚·ÛË ·Ô‰›‰ÔÓÙ·È ÛÙÔ Â›‰Ô˜ Î·È ÙËÓ ÂÈıÂÙÈÎfiÙË-

Ù· ÙˆÓ ıÂÚ·Â˘ÙÈÎÒÓ ÚˆÙÔÎfiÏÏˆÓ. ∫·Ï‡ÙÂÚË

¤Î‚·ÛË Û¯ÂÙ›˙ÂÙ·È ÌÂ ˘„ËÏ¤˜ ‰fiÛÂÈ˜ ÌÂıÔÙÚÂÍ¿ÙË˜

Î·È L-·Û·Ú·ÁÈÓ¿ÛË˜. ¶ÚÔÔÙÈÎ‹ ÌÂÏ¤ÙË ¤‰ÂÈÍÂ fiÙÈ

ÌÂ ÂÈıÂÙÈÎ‹ ¯ËÌÂÈÔıÂÚ·Â›· ÛÙ· ·È‰È¿ ·˘Ù¿, Ë

5ÂÙ‹˜ Û˘ÓÔÏÈÎ‹ ÂÈ‚›ˆÛË ÊÙ¿ÓÂÈ ÙÔ 97%, ¯ˆÚ›˜

fiÌˆ˜ Ë ÌÂÙ¿ıÂÛË TEL-AML1 Ó· ·Ô‰ÂÈÎÓ‡ÂÙ·È ·ÓÂ-

Í¿ÚÙËÙÔ˜ ÚÔÁÓˆÛÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ fiÙ·Ó Ï·Ì‚¿ÓÔ-

ÓÙ·È ˘fi„Ë Ë ËÏÈÎ›· Î·È Ô ·ÚÈıÌfi˜ ÏÂ˘ÎÒÓ (17).

∏ ‰Â‡ÙÂÚË ÛÂ Û˘¯ÓfiÙËÙ· ÌÂÙ¿ıÂÛË ÛÙËÓ √§§

ÛÙ· ·È‰È¿, Ë t(1;19), Û¯ÂÙ›˙ÂÙ·È ÌÂ ÔÛÔÛÙ¿ ›·ÛË˜

Ì¤¯ÚÈ 90%, ·ÚfiÏÔ Ô˘ ÛÙÔ ·ÚÂÏıfiÓ Â›¯Â ıÂˆÚË-

ıÂ› ‰˘ÛÌÂÓ‹˜ ÚÔÁÓˆÛÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ (18).

∏ t(9;22) ·Ú·ÙËÚÂ›Ù·È ÛÙÔ 3% ÂÚ›Ô˘ ÙˆÓ ·È-

‰ÈÒÓ ÌÂ √§§, ·ÔÙÂÏÂ› ‰˘ÛÌÂÓ‹ ÚÔÁÓˆÛÙÈÎfi ·-

Ú¿ÁÔÓÙ· Î·È Û¯ÂÙ›˙ÂÙ·È ÌÂ ¯·ÌËÏ¿ ÔÛÔÛÙ¿ Â›ÙÂ˘-

ÍË˜ ‡ÊÂÛË˜, Û˘¯Ó¤˜ Î·È ÚÒÈÌÂ˜ ˘ÔÙÚÔ¤˜ Î·È

ÊÙˆ¯‹ Û˘ÓÔÏÈÎ‹ ÂÈ‚›ˆÛË (19). ™Ù· ·È‰È¿ ·˘Ù¿, Ë

ÌÂÙ·ÌfiÛ¯Â˘ÛË Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ, ·ÎfiÌ· Î·È ·fi

ÌË Û˘ÁÁÂÓ‹ ‰fiÙË, ıÂˆÚÂ›Ù·È ıÂÚ·Â›· ÂÎÏÔÁ‹˜ ÁÈ·

›·ÛË, ÂÓÒ Ë ¯ÔÚ‹ÁËÛË ÈÌ·ÙÈÓ›ÌË˜ Û˘ÓÈÛÙ¿Ù·È Û˘Á-

¯ÚfiÓˆ˜ ÌÂ ÙË ¯ËÌÂÈÔıÂÚ·Â›· (20).

√È ·Ó·‰È·Ù¿ÍÂÈ˜ ÙÔ˘ ÁÔÓÈ‰›Ô˘ MLL ·Ú·ÙËÚÔ‡-

ÓÙ·È ÛÙÔ 8% ÙˆÓ ·È‰ÈÒÓ ÌÂ √§§, ÂÓÒ ·ÔÙÂÏÔ‡Ó

ÙËÓ ÈÔ Û˘¯Ó‹ ÁÂÓÂÙÈÎ‹ ‰È·Ù·Ú·¯‹ ÛÙ· ‚Ú¤ÊË. ∏ ÌÂ-

Ù¿ıÂÛË t(4;11) [MLL-AF4] Â›Ó·È Ë ÈÔ Û˘¯Ó‹ ÛÙËÓ

ÔÌ¿‰· ·˘Ù‹ Î·È Û¯ÂÙ›˙ÂÙ·È ÌÂ ‰˘ÛÌÂÓ‹ ÚfiÁÓˆÛË

(21). ∞Ó Î·È ÛÙÔ ·ÚÂÏıfiÓ Ë √§§ ÛÙ· ‚Ú¤ÊË ÁÂÓÈÎ¿

Û˘Û¯ÂÙ›ÛÙËÎÂ ÌÂ Î·Î‹ ÚfiÁÓˆÛË, Û‹ÌÂÚ· ÁÓˆÚ›-

˙Ô˘ÌÂ fiÙÈ, ÌÂÙ¿ ÙË ¯Ú‹ÛË ÂÈ‰ÈÎÒÓ ÈÔ ÂÈıÂÙÈÎÒÓ

ÚˆÙÔÎfiÏÏˆÓ ÁÈ· Ù· ‚Ú¤ÊË, Î·Î‹ ÚfiÁÓˆÛË ¤¯Ô˘Ó

ÌfiÓÔ ÂÎÂ›Ó· ÌÂ MLL ·Ó·‰È·Ù¿ÍÂÈ˜ (22,23).

∆Ô 12%-14% ÙË˜ √§§ ÛÙ· ·È‰È¿ Â›Ó·È ∆- ÛÂÈ-

Ú¿˜. ∏ ∆-√§§ Â›Ó·È ÈÔ Û˘¯Ó‹ ÛÙÔ˘˜ ÂÊ‹‚Ô˘˜ Î·È

ÓÂ·ÚÔ‡˜ ÂÓ‹ÏÈÎÂ˜ ÌÂ ˘„ËÏfi ·ÚÈıÌfi ÏÂ˘ÎÒÓ Î·È Â›-

ÛË˜ Û˘ÓÔ‰Â‡ÂÙ·È Û˘¯ÓfiÙÂÚ· ·fi ‰ÈÂ‡Ú˘ÓÛË ÌÂÛÔ-

ıˆÚ·Î›Ô˘, ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ·, Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›·

Î·È ‰È‹ıËÛË ∫¡™. ªÂ ÙË ¯ÔÚ‹ÁËÛË ÂÈıÂÙÈÎ‹˜ ¯Ë-

ÌÂÈÔıÂÚ·Â›·˜, Ë ‰˘ÛÌÂÓ¤ÛÙÂÚË ÚfiÁÓˆÛË ÛÂ Û¯¤-

ÛË ÌÂ ÙËÓ √§§ µ-ÛÂÈÚ¿˜ ¤¯ÂÈ ‚ÂÏÙÈˆıÂ›, ÌÂ ÔÛÔÛÙ¿

›·ÛË˜ 75% (24,25). ™ÙËÓ ÔÌ¿‰· ·˘Ù‹, Ë ËÏÈÎ›· Î·È Ô

·ÚÈıÌfi˜ ÏÂ˘ÎÒÓ ‰ÂÓ Ê·›ÓÂÙ·È Ó· ¤¯Ô˘Ó ÈÛ¯˘Ú‹ ÚÔ-

ÁÓˆÛÙÈÎ‹ ·Í›·, fiˆ˜ Â›ÛË˜ ‰ÂÓ Â›Ó·È Û·Ê‹˜ Ô ÚÔ-

ÁÓˆÛÙÈÎfi˜ ÚfiÏÔ˜ ÙˆÓ Î˘ÙÙ·ÚÔÁÂÓÂÙÈÎÒÓ ‰È·Ù·Ú·-

¯ÒÓ (24). ªÂÙ·ÏÏ¿ÍÂÈ˜ ÙÔ˘ ÁÔÓÈ‰›Ô˘ NOTCH ¤¯Ô˘Ó

·Ú·ÙËÚËıÂ› ÛÙÔ 50% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ∆-√§§,

·ÏÏ¿ Ë ÚÔÁÓˆÛÙÈÎ‹ ÙÔ˘˜ ÛËÌ·Û›· Â›Ó·È ·Û·Ê‹˜

(27-28).

¶ÚÒÈÌË ·¿ÓÙËÛË ÛÙË ıÂÚ·Â›· Î·È ÂÏ¿¯ÈÛÙË

˘ÔÏÂÈfiÌÂÓË ÓfiÛÔ˜

∏ ÚÒÈÌË ·¿ÓÙËÛË ÛÙË ıÂÚ·Â›· ·ÔÙÂÏÂ›

ÈÛ¯˘Úfi ÚÔÁÓˆÛÙÈÎfi ·Ú¿ÁÔÓÙ·, ÁÈ·Ù› Û¯ÂÙ›˙ÂÙ·È ÌÂ

ÙËÓ Â˘·ÈÛıËÛ›· ÙˆÓ ‚Ï·ÛÙÒÓ ÛÙ· Ê¿ÚÌ·Î·, Î·ıÒ˜

Î·È ÌÂ Ù· Ê·ÚÌ·ÎÔ‰˘Ó·ÌÈÎ¿-Ê·ÚÌ·ÎÔÁÂÓÂÙÈÎ¿ ¯·-

Ú·ÎÙËÚÈÛÙÈÎ¿ ÙÔ˘ ·ÛıÂÓÔ‡˜ (29). ¶·Ú¿ÌÂÙÚÔÈ Ô˘

¤¯Ô˘Ó ¯ÚËÛÈÌÔÔÈËıÂ› ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË ÙË˜ ·¿-

ÓÙËÛË˜ ÛÙË ıÂÚ·Â›· Â›Ó·È Ô ·ÚÈıÌfi˜ ÙˆÓ ‚Ï·ÛÙÒÓ

ÛÙÔ ·›Ì· ÙËÓ 8Ë ËÌ¤Ú· ıÂÚ·Â›·˜, Ô Ì˘ÂÏfi˜ ÙËÓ 7Ë ‹

14Ë ËÌ¤Ú· Î·È, ÚfiÛÊ·Ù·, Ë ÂÎÙ›ÌËÛË ÙË˜ ÂÏ¿¯ÈÛÙË˜

˘ÔÏÂÈfiÌÂÓË˜ ÓfiÛÔ˘ (30-34).

∏ ÔÌ¿‰· ÙÔ˘ BFM ÂÈÛ‹Á·ÁÂ ·fi ÙÔ 1983 ÙËÓ

ÚÔÁÓˆÛÙÈÎ‹ ·Í›· ÙË˜ ·¿ÓÙËÛË˜ ÛÙËÓ ÚÂ‰ÓÈ˙fiÓË.

∆· ÚˆÙfiÎÔÏÏ· BFM ¯ÚËÛÈÌÔÔÈÔ‡Ó ÙË ÌÂ›ˆÛË ÙÔ˘

·ÚÈıÌÔ‡ ÙˆÓ ‚Ï·ÛÙÒÓ ÛÂ <1000/Ìl ÙËÓ 8Ë ËÌ¤Ú·, ÌÂ-

Ù¿ ·fi ¯ÔÚ‹ÁËÛË ÚÂ‰ÓÈ˙fiÓË˜ Î·È ÌÈ·˜ ÂÓ‰ÔÚÚ·¯È-

·›·˜ ¤Á¯˘ÛË˜ MTX, ˆ˜ ÎÚÈÙ‹ÚÈÔ ÁÈ· Â˘ÓÔ˚Î‹ Úfi-

ÁÓˆÛË (35). √ Ú˘ıÌfi˜ Î¿ı·ÚÛË˜ ÙˆÓ ‚Ï·ÛÙÒÓ ÛÙÔ

ÂÚÈÊÂÚÈÎfi ·›Ì· ¤¯ÂÈ ÚÔÁÓˆÛÙÈÎ‹ ·Í›· ÛÂ ∆- Î·È µ-

ÛÂÈÚ¿˜ √§§. √ ·ÚÈıÌfi˜ ÙˆÓ ‚Ï·ÛÙÒÓ ÛÙÔ ·›Ì· 7 ËÌ¤-

ÚÂ˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË ÔÏ˘·Ú·ÁÔÓÙÈÎ‹˜ ıÂÚ·Â›·˜


·ÔÙÂÏÂ› Â›ÛË˜ ÚÔÁÓˆÛÙÈÎfi ·Ú¿ÁÔÓÙ· ÛÂ ¿ÏÏ·

ÚˆÙfiÎÔÏÏ· (32).

ŸÛÔÓ ·ÊÔÚ¿ ÙËÓ ·¿ÓÙËÛË ÛÙÔÓ Ì˘ÂÏfi ÙˆÓ

ÔÛÙÒÓ, ÔÈ ·ÛıÂÓÂ›˜ Ô˘ ¤¯Ô˘Ó ÌÂ›ˆÛË ÙˆÓ ‚Ï·ÛÙÒÓ

ÛÂ <5% ÛÂ 7-14 ËÌ¤ÚÂ˜ ·fi ÙËÓ ¤Ó·ÚÍË ÙË˜ ÔÏ˘-

·Ú·ÁÔÓÙÈÎ‹˜ ¯ËÌÂÈÔıÂÚ·Â›·˜ ¤¯Ô˘Ó È‰È·›ÙÂÚ· Â˘-

ÓÔ˚Î‹ ÚfiÁÓˆÛË. ∏ ÌÔÚÊÔÏÔÁÈÎ‹ ·¿ÓÙËÛË ÛÙË ıÂ-

Ú·Â›· ÂÍ·ÎÔÏÔ˘ıÂ› Ó· ¤¯ÂÈ ÚÔÁÓˆÛÙÈÎ‹ ÛËÌ·Û›·

Î·È ÛÙ· ÙÚ¤¯ÔÓÙ· ÚˆÙfiÎÔÏÏ· ÙÔ˘ COG (37).

∏ ÂÎÙ›ÌËÛË ÙË˜ ÚÒÈÌË˜ ·¿ÓÙËÛË˜ ÛÙË ıÂÚ·Â›·,

ÌÂ ÙÔÓ ˘ÔÏÔÁÈÛÌfi ÙË˜ MRD ÛÙÔÓ Ì˘ÂÏfi, ·ÔÙÂÏÂ›

Û‹ÌÂÚ· ÙÔÓ ÈÔ ÈÛ¯˘Úfi ›Ûˆ˜ ÚÔÁÓˆÛÙÈÎfi ·Ú¿ÁÔÓÙ·,

Ô˘ ‰›ÓÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· ÁÈ· ·ÎÚÈ‚‹ Ù·ÍÈÓfiÌËÛË ÛÂ

ÔÌ¿‰Â˜ ÎÈÓ‰‡ÓÔ˘ Î·È ÂÍ·ÙÔÌ›ÎÂ˘ÛË ÙË˜ ıÂÚ·Â›·˜

(34,38-40). √È ·ÛıÂÓÂ›˜ Ô˘ ÂÈÙ˘Á¯¿ÓÔ˘Ó ·ÓÔÛÔÏÔÁÈ-

Î‹ ‹ ÌÔÚÈ·Î‹ ‡ÊÂÛË, Ô˘ ÚÔÛ‰ÈÔÚ›˙ÂÙ·È ˆ˜ ÌÂ›ˆÛË

ÙˆÓ ‚Ï·ÛÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ ÛÂ <0,01% ÙˆÓ ÂÌ‡ÚËÓˆÓ

Î˘ÙÙ¿ÚˆÓ ÙÔ˘ Ì˘ÂÏÔ‡ ÛÙÔ Ù¤ÏÔ˜ ÙË˜ Â·ÁˆÁ‹˜ ÛÙËÓ

‡ÊÂÛË, ¤¯Ô˘Ó ÂÍ·ÈÚÂÙÈÎ‹ ÚfiÁÓˆÛË (41,42).

√§§ ÛÂ ÂÊ‹‚Ô˘˜ Î·È ÓÂ·ÚÔ‡˜ ÂÓ‹ÏÈÎÂ˜

πÛÙÔÚÈÎ¿, Ù· ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿ Î·È ÔÈ ¤ÊË‚ÔÈ ÌÂ

√§§ ¤¯Ô˘Ó ¯ÂÈÚfiÙÂÚË ÚfiÁÓˆÛË, ÛÂ Û¯¤ÛË ÌÂ Ù· ÌÈ-

ÎÚfiÙÂÚ· ·È‰È¿. µÈÔÏÔÁÈÎ¿, ÔÈ ¤ÊË‚ÔÈ ‰È·Ê¤ÚÔ˘Ó

·fi Ù· ÌÈÎÚfiÙÂÚ· ·È‰È¿ Î·È ÚÔÛ¤Ú¯ÔÓÙ·È ÌÂ ‰˘-

ÛÌÂÓÂ›˜ ÚÔÁÓˆÛÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜ Î·Ù¿ ÙË ‰È¿-

ÁÓˆÛË, fiˆ˜ ˘„ËÏfi˜ ·ÚÈıÌfi˜ ÏÂ˘ÎÒÓ, ∆ ·ÓÔÛÔÊ·È-

ÓfiÙ˘Ô˜ Î·È ÌÂÁ·Ï‡ÙÂÚË Û˘¯ÓfiÙËÙ· ‰˘ÛÌÂÓÒÓ Î˘Ù-

Ù·ÚÔÁÂÓÂÙÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ (43). √È ‰È·ÊÔÚ¤˜, fiÌˆ˜,

ÛÙËÓ ¤Î‚·ÛË ·Ô‰›‰ÔÓÙ·È Î·È ÛÙË ÏÈÁfiÙÂÚÔ ÂÈıÂÙÈ-

Î‹ ıÂÚ·Â›· Ô˘ Ï·Ì‚¿ÓÔ˘Ó fiÙ·Ó ıÂÚ·Â‡ÔÓÙ·È ÌÂ

ÚˆÙfiÎÔÏÏ· ÂÓËÏ›ÎˆÓ. ¶ÚfiÛÊ·Ù· ‰ËÌÔÛÈÂ‡ÙËÎ·Ó 3

·Ó·‰ÚÔÌÈÎ¤˜ ÌÂÏ¤ÙÂ˜ ·fi ÙËÓ ∂˘ÚÒË Î·È Ì›· ÚÔ-

‰ÚÔÌÈÎ‹ ·fi ÙÔ DFCI ÛÙÈ˜ ∏¶∞, Ô˘ ‰Â›¯ÓÔ˘Ó fiÙÈ ÔÈ

¤ÊË‚ÔÈ Î·È ÔÈ ÓÂ·ÚÔ› ÂÓ‹ÏÈÎÂ˜ ÌÂ √§§ ¤¯Ô˘Ó ÛËÌ·-

ÓÙÈÎ¿ Î·Ï‡ÙÂÚ· ÔÛÔÛÙ¿ ›·ÛË˜ fiÙ·Ó ıÂÚ·Â‡ÔÓÙ·È

ÌÂ ·È‰È·ÙÚÈÎ¿ ÚˆÙfiÎÔÏÏ· (44-47). ∏ Û‡ÁÎÚÈÛË

ÙË˜ 5ÂÙÔ‡˜ ÂÈ‚›ˆÛË˜ ·ÛıÂÓÒÓ 15-21 ÂÙÒÓ ¤‰ÂÈÍÂ

Ì¤¯ÚÈ Î·È 30% ˘„ËÏfiÙÂÚ· ÔÛÔÛÙ¿ ›·ÛË˜ ÌÂ Ù·

121086420

100

90

80

70

60

50

40

30

20

10

0

ŒÙË ÌÂÙ¿ ÙË ‰È¿ÁÓˆÛË

∂

È‚›ˆ

ÛË

ÂÏ

Â‡ı

ÂÚË

Û˘

Ì‚

·Ì

¿Ù

ˆÓ

(%

)

E2A-PXB1 (n=19)Hyperdiploidy >50 chromosomes (n=112)

Other subtypes (n=148)

T-cell ALL (n=78)

MLL-AF4 (n=15)BCR-AµL (n=14)

TEL-AML1 (n=81)

∂ÈÎfiÓ· 2. ∫·Ì‡ÏÂ˜ ÂÈ‚›ˆÛË˜ ˘ÔÔÌ¿‰ˆÓ ÌÂ ‚¿ÛË Ù· Î˘ÙÙ·ÚÔÁÂÓÂÙÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ (∞fi Pui C et al. NEJM 2004).

78 ∂. ™ÙÂÈ·Î¿ÎË, M. ∫·ÏÌ·ÓÙ‹


¶›Ó·Î·˜ 2. ∞ÓÔÛÔÏÔÁÈÎ‹ Ù·ÍÈÓfiÌËÛË √§§

ÀÔÔÌ¿‰· ŒÎÊÚ·ÛË ·ÓÙÈÁfiÓˆÓ ™˘¯ÓfiÙËÙ· (%)

¶ÚÒÈÌË ÚÔ-B CD19+, CD22+, CD79a+, CD10+/-, CD7-, CD3-a, 57-65%cIgÌ-, sIgÎ-, sIgÏ-

¶ÚÔ-µ CD19+, CD22+, CD79a+,CD10+/-, CD7-,CD3-a, 20-25%cIgÌ+, sIgÌ-, sIgÎ-, sIgÏ-

ªÂÙ·‚·ÙÈÎ‹ ÚÔ-µ CD19+, CD22+, CD79a+, CD10+/-b, CD7-, CD3-a, 2-3%cIgÌ+, sIgÌ+, sIgÎ-, sIgÏ-

B- √§§ CD19+, CD22+, CD79a+, CD10+/-b, CD7-, CD3-a, 2-3%cIgÌ+, sIgÌ+, sIgÎ+, sIgÏ+

T- √§§ CD19+/-c, CD22-, CD79a-, CD10+/-b, 13-15%CD7+, CD3+a, cIgÌ-, sIgÌ-, sIgÎ-, sIgÏ-



¶·È‰È·ÙÚÈÎ‹ 2009;72:10-15

·È‰È·ÙÚÈÎ¿ ÚˆÙfiÎÔÏÏ· ıÂÚ·Â›·˜. ∞Ó Î·È ÔÈ ‰È·-

ÊÔÚ¤˜ ·˘Ù¤˜ ‰ÂÓ ÌÔÚÔ‡Ó Ó· ÂÚÌËÓÂ˘ıÔ‡Ó ÌfiÓÔ

·fi Ù· ‚ÈÔÏÔÁÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ Î·È ÙÈ˜ ÁÂÓÂÙÈÎ¤˜

‰È·Ù·Ú·¯¤˜, Â›Ó·È È‰È·›ÙÂÚ· ·ÍÈÔÛËÌÂ›ˆÙÔ ÙÔ fiÙÈ ÔÈ

¤ÊË‚ÔÈ Î·È ÔÈ ÓÂ·ÚÔ› ÂÓ‹ÏÈÎÂ˜, fiÙ·Ó ÂÓÙ¿ÛÔÓÙ·È ÛÂ

ÎÏÈÓÈÎ¤˜ ÌÂÏ¤ÙÂ˜ Î·È ıÂÚ·Â‡ÔÓÙ·È ÌÂ ·È‰È·ÙÚÈÎ¿

ÚˆÙfiÎÔÏÏ·, ÌÔÚÂ› Ó· ÂÈÙ‡¯Ô˘Ó ÔÛÔÛÙ¿ ›·ÛË˜

Ô˘ Êı¿ÓÔ˘Ó ÙÔ 70%.

∆Ú¤¯Ô˘Û· ıÂÚ·Â˘ÙÈÎ‹ ÛÙÚ·ÙËÁÈÎ‹ Î·È Ó¤Â˜

ÚÔÁÓˆÛÙÈÎ¤˜ ÔÌ¿‰Â˜

H Ù·ÍÈÓfiÌËÛË ÙˆÓ ·È‰ÈÒÓ ÛÂ ÔÌ¿‰Â˜ ÎÈÓ‰‡ÓÔ˘

¤¯ÂÈ ˆ˜ ÛÙfi¯Ô ÙËÓ ÂÍ·ÙÔÌ›ÎÂ˘ÛË ÙË˜ ıÂÚ·Â›·˜, ¤ÙÛÈ

ÒÛÙÂ ÈÔ ÂÈıÂÙÈÎ‹ Î·È, ÂÔÌ¤Óˆ˜, ÈÔ ÙÔÍÈÎ‹ ıÂÚ·-

Â›· Ó· Ï·Ì‚¿ÓÔ˘Ó ÌfiÓÔ Ù· ·È‰È¿ Ô˘ ÙË ¯ÚÂÈ¿˙Ô-

ÓÙ·È ÁÈ· Ó· È·ıÔ‡Ó.

∏ ÚfiÔ‰Ô˜ ÛÙË ÌÔÚÈ·Î‹ Ù·ÍÈÓfiÌËÛË Î·È ÙËÓ ·Ó›-

¯ÓÂ˘ÛË ÁÂÓÂÙÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ Ô‰ËÁÂ› ÛÙËÓ ·Ó·˙‹-

ÙËÛË Ô‰ÒÓ Ô˘ ÂÓ¤¯ÔÓÙ·È ÛÙËÓ ·ÓÙ›ÛÙ·ÛË ÛÙË ıÂÚ·-

Â›·, ·ÏÏ¿ Î·È Ó¤ˆÓ ıÂÚ·Â˘ÙÈÎÒÓ ÛÙfi¯ˆÓ (48). ™Ë-

Ì·ÓÙÈÎfi ·Ú¿‰ÂÈÁÌ· ·ÔÙÂÏÂ› Ë ¯ÔÚ‹ÁËÛË ÙÔ˘

imatinib mesylate ÛÙ· ·È‰È¿ ÌÂ √§§ Î·È Û‡ÓÙËÍË

ÙˆÓ bcr-abl ÁÔÓÈ‰›ˆÓ (20).

∆· ÚˆÙfiÎÔÏÏ· ÙÔ˘ BFM Î·Ù·Ù¿ÛÛÔ˘Ó ÛÙËÓ

ÔÌ¿‰· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ Ù· ·È‰È¿ ÌÂ ÊÙˆ¯‹ ·¿-

ÓÙËÛË ÛÙËÓ ÚÂ‰ÓÈ˙fiÓË, Î·ıÒ˜ Î·È Ù· ·È‰È¿ Ô˘

¤¯Ô˘Ó ÙÈ˜ ÌÂÙ·ı¤ÛÂÈ˜ t(9;22) Î·È t(4;11). ™ÙÔ ÚˆÙfi-

ÎÔÏÏÔ ALL BFM 2000, ÔÈ ·ÛıÂÓÂ›˜ Ù·ÍÈÓÔÌÔ‡ÓÙ·È ÌÂ

‚¿ÛË fi¯È ÌfiÓÔ ÙËÓ ·¿ÓÙËÛË ÛÙËÓ ÚÂ‰ÓÈ˙fiÓË Î·È

ÙÈ˜ Î˘ÙÙ·ÚÔÁÂÓÂÙÈÎ¤˜ ‰È·Ù·Ú·¯¤˜, ·ÏÏ¿ Î·È ÙËÓ

MRD ÙËÓ Â‚‰ÔÌ¿‰· 4 Î·È 12. ŒÙÛÈ, ˜ ÛÙ·ıÂÚÔ‡ ÎÈÓ-

‰‡ÓÔ˘ Î·Ù·Ù¿ÛÛÔÓÙ·È Ù· ·È‰È¿ ÌÂ ·ÚÓËÙÈÎ‹ MRD

ÙËÓ 4Ë Î·È 12 Â‚‰ÔÌ¿‰·, ÂÓ‰È¿ÌÂÛÔ˘ ÎÈÓ‰‡ÓÔ˘ Ù·

·È‰È¿ ÌÂ MRD <10-3 Î·È ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ Ù· ·È-

‰È¿ ÌÂ MRD ≥10-3 ÙË 12Ë Â‚‰ÔÌ¿‰·. ∆· ·È‰È¿ ÌÂ

ÊÙˆ¯‹ ·¿ÓÙËÛË ÛÙËÓ ÚÂ‰ÓÈ˙fiÓË ıÂˆÚÔ‡ÓÙ·È

˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙÔÓ ÚÔÛ‰ÈÔÚÈ-

ÛÌfi ÙË˜ MRD, ÂÓÒ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ Â›ÛË˜ ıÂˆ-

ÚÔ‡ÓÙ·È ÔÈ ·ÛıÂÓÂ›˜ ÌÂ ÌÂÙ¿ıÂÛË t(9;22) Î·È t(4;11),

·ÓÂÍ¿ÚÙËÙ· ·fi ÙËÓ ·¿ÓÙËÛË ÛÙË ıÂÚ·Â›· (49).

∞fi ÙÔ DFCI ¤¯ÂÈ ÚÔÙ·ıÂ› Â›ÛË˜ Ó¤Ô Û‡ÛÙËÌ·

Ù·ÍÈÓfiÌËÛË˜ ÁÈ· ÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ √§§ µ-ÛÂÈÚ¿˜. √È

·ÛıÂÓÂ›˜ ·Ú¯ÈÎ¿ Ù·ÍÈÓÔÌÔ‡ÓÙ·È ˆ˜ ÛÙ·ıÂÚÔ‡ ‹ ˘„Ë-

ÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÌÂ ‚¿ÛË ÙËÓ ËÏÈÎ›·, ÙÔÓ ·ÚÈıÌfi ÙˆÓ

ÏÂ˘ÎÒÓ Î·È ÙËÓ ·ÚÔ˘Û›· ÓfiÛÔ˘ ÛÙÔ ∫¡™. ªÂÙ¿ ÙË

¯ÔÚ‹ÁËÛË ÙˆÓ 4 Â‚‰ÔÌ¿‰ˆÓ ÙË˜ ıÂÚ·Â›·˜ Â·Áˆ-

Á‹˜ ÛÙËÓ ‡ÊÂÛË, ÔÈ ·ÛıÂÓÂ›˜ ÌÂ MRD ≥0,1% Ù·ÍÈÓÔ-

ÌÔ‡ÓÙ·È ˆ˜ ÔÏ‡ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘, ÂÓÒ ÂÎÂ›ÓÔÈ ÌÂ

MRD <0,1% Û˘ÓÂ¯›˙Ô˘Ó fiˆ˜ Ù·ÍÈÓÔÌ‹ıËÎ·Ó ·Ú¯È-

Î¿. ™Ùfi¯Ô˜ Â›Ó·È Ó· ÚÔÛ‰ÈÔÚÈÛıÂ› Â¿Ó Ë ÂÓÙ·ÙÈÎÔ-

Ô›ËÛË ÙË˜ ıÂÚ·Â›·˜ ı· ‚ÔËı‹ÛÂÈ ÙÔ˘˜ ·ÛıÂÓÂ›˜

ÌÂ ˘ÔÏÂÈfiÌÂÓË ÓfiÛÔ ÛÙÔ Ù¤ÏÔ˜ ÙË˜ Â·ÁˆÁ‹˜

ÛÙËÓ ‡ÊÂÛË. √È ·ÛıÂÓÂ›˜ ÌÂ ∆-√§§ Ï·Ì‚¿ÓÔ˘Ó ıÂ-

Ú·Â›· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ·ÓÂÍ¿ÚÙËÙ· ·fi ÙËÓ MRD

ÛÙË Ê¿ÛË ·˘Ù‹. ø˜ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ·ÓÙÈÌÂÙˆ›˙Ô-

ÓÙ·È Â›ÛË˜ ÔÈ ·ÛıÂÓÂ›˜ ÌÂ ˘Ô‰ÈÏÔÂÈ‰ÈÛÌfi, ·ÓÂ-

Í¿ÚÙËÙ· ·fi ÙÔÓ ·ÓÔÛÔÊ·ÈÓfiÙ˘Ô ‹ ÙËÓ ÂÏ¿¯ÈÛÙË

˘ÔÏÂÈfiÌÂÓË ÓfiÛÔ.

™ÙÔ St. Jude Children’s Research Hospital, Ë Ù·ÍÈ-

ÓfiÌËÛË Â›ÛË˜ ‚·Û›˙ÂÙ·È Î˘Ú›ˆ˜ ÛÙ· Â›Â‰· ÙË˜

MRD ÌÂÙ¿ ·fi 6 Â‚‰ÔÌ¿‰Â˜ ıÂÚ·Â›·˜ Â·ÁˆÁ‹˜

ÛÙËÓ ‡ÊÂÛË Î·È ‰È·ÎÚ›ÓÂÈ ÙÔ˘˜ ·ÛıÂÓÂ›˜ ÛÂ ¯·ÌËÏÔ‡

(MRD <0,01%), ÛÙ·ıÂÚÔ‡ (MRD 0,01% ¤ˆ˜ <1%)

Î·È ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ (MRD >1%).

To 2000, Ë ‰ËÌÈÔ˘ÚÁ›· ÙÔ˘ COG ·fi ÙË Û˘Ó¤Óˆ-

ÛË ÙÔ˘ CCG Î·È ÙÔ˘ POG ¤‰ˆÛÂ ÙË ‰˘Ó·ÙfiÙËÙ· Ó·

·Ó·Ï˘ıÔ‡Ó ·Ó·‰ÚÔÌÈÎ¿ Ù· ÎÏÈÓÈÎ¿ ‚ÈÔÏÔÁÈÎ¿ ‰Â‰Ô-

Ì¤Ó· Î·È Ë ÚÒÈÌË ·¿ÓÙËÛË ÛÙË ıÂÚ·Â›· 18.000

·ÛıÂÓÒÓ ÌÂ √§§, ËÏÈÎ›·˜ 1-21.99 ÂÙÒÓ, Î·È Ó· ÚÔ-

Ù·ıÂ› ¤Ó· Ó¤Ô Û‡ÛÙËÌ· Ù·ÍÈÓfiÌËÛË˜ (37). ªÂ ‚¿ÛË

ÙÔ ÚÔÙÂÈÓfiÌÂÓÔ Û‡ÛÙËÌ·, ÔÈ ·ÛıÂÓÂ›˜ ÌÂ √§§ µ-

ÛÂÈÚ¿˜ ‰È·ÎÚ›ÓÔÓÙ·È ÛÂ ¯·ÌËÏÔ‡, ÛÙ·ıÂÚÔ‡, ˘„ËÏÔ‡

Î·È ÔÏ‡ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘, ·Ó¿ÏÔÁ· ÌÂ ÙËÓ ËÏÈÎ›·,

ÙÔÓ ·ÚÈıÌfi ÙˆÓ ÏÂ˘ÎÒÓ, ÙÈ˜ Î˘ÙÙ·ÚÔÁÂÓÂÙÈÎ¤˜ ‰È·-

Ù·Ú·¯¤˜, ÙÔÓ Ì˘ÂÏfi ÙË˜ ËÌ¤Ú·˜ 14 Î·È ÙËÓ MRD ÛÙÔ

Ù¤ÏÔ˜ ÙË˜ Â·ÁˆÁ‹˜ ÛÙËÓ ‡ÊÂÛË.

∞Ú¯ÈÎ¿ ‰È·ÎÚ›ÓÔÓÙ·È ÛÂ ÛÙ·ıÂÚÔ‡ Î·È ˘„ËÏÔ‡

ÎÈÓ‰‡ÓÔ˘ ÌÂ ‚¿ÛË ÙËÓ ËÏÈÎ›· Î·È ÙÔÓ ·ÚÈıÌfi ÙˆÓ

ÏÂ˘ÎÒÓ. √È ·ÛıÂÓÂ›˜ ÌÂ ÌÂÙ¿ıÂÛË t(12;21) ‹ ÙÚÈÛˆ-

Ì›Â˜ 4, 10 Î·È 17 ıÂˆÚÔ‡ÓÙ·È "standard risk-low".

ŸÏ· Ù· ·È‰È¿ ÌÂ ∆-√§§ Ù·ÍÈÓÔÌÔ‡ÓÙ·È ˆ˜ ˘„ËÏÔ‡

ÎÈÓ‰‡ÓÔ˘, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙÔÓ ·ÚÈıÌfi ÙˆÓ ÏÂ˘ÎÒÓ.

∏ ÙÂÏÈÎ‹ Ù·ÍÈÓfiÌËÛË ÛÙË Û˘Ó¤¯ÂÈ· ‚·Û›˙ÂÙ·È ÛÙËÓ

ÚÒÈÌË ·¿ÓÙËÛË ÛÙË ıÂÚ·Â›· Î·È ÛÙ· Î˘ÙÙ·ÚÔÁÂ-

ÓÂÙÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿. ∏ ÔÌ¿‰· ÙˆÓ ÔÏ‡ ˘„ËÏÔ‡

ÎÈÓ‰‡ÓÔ˘ ÂÚÈÏ·Ì‚¿ÓÂÈ ·ÛıÂÓÂ›˜ ÌÂ t(9;22), ˘Ô‰È-

ÏÔÂÈ‰ÈÛÌfi (<44 ¯ÚˆÌÔÛÒÌ·Ù·), MLL ·Ó·‰È·Ù¿-

ÍÂÈ˜, ·ÚÁ‹ ÌÔÚÊÔÏÔÁÈÎ‹ ·¿ÓÙËÛË, ª3 Ì˘ÂÏfi ÙËÓ

ËÌ¤Ú· 29 ‹ ª2 Ì˘ÂÏfi ‹/Î·È MRD >1% ÙÈ˜ ËÌ¤ÚÂ˜ 29

Î·È 43.

ŸÏ· Ù· Û˘ÛÙ‹Ì·Ù· Ù·ÍÈÓfiÌËÛË˜ ¤¯Ô˘Ó ˆ˜ ÛÙfi¯Ô

Ó· ‚ÂÏÙÈÒÛÔ˘Ó Ù· ÔÛÔÛÙ¿ ›·ÛË˜ ÙˆÓ ·ÛıÂÓÒÓ Ô˘

‰È·ÙÚ¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚÔ Î›Ó‰˘ÓÔ ˘ÔÙÚÔ‹˜ ÌÂ ÙËÓ

ÂÓÙ·ÙÈÎÔÔ›ËÛË ÙË˜ ıÂÚ·Â›·˜ ÙÔ˘˜ Î·È Ó· ÂÚÈÔÚ›-

ÛÔ˘Ó ÙËÓ ÙÔÍÈÎfiÙËÙ· ÙË˜ ıÂÚ·Â›·˜ ÛÂ ·ÛıÂÓÂ›˜ ¯·-

ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘, ÌÂÈÒÓÔÓÙ·˜ ÂÚ·ÈÙ¤Úˆ ÙË ¯ËÌÂÈÔ-

ıÂÚ·Â›·.

µÈ‚ÏÈÔÁÚ·Ê›·

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82 ∞¡∞™∫√¶∏™∏ REVIEW ARTICLE


§ÂÌÊÒÌ·Ù· ÛÙ· ·È‰È¿ - ¡ÂfiÙÂÚ· ıÂÚ·Â˘ÙÈÎ¿ ‰Â‰ÔÌ¤Ó·

µ. ¢·ÓËÏ¿ÙÔ˘, ª. ∫·ÏÌ·ÓÙ‹

¶ÂÚ›ÏË„Ë: ∆· ÏÂÌÊÒÌ·Ù· ÛÙ· ·È‰È¿ ·ÔÙÂÏÔ‡Ó ÙËÓ 3Ë ÈÔ Û˘¯Ó‹ Î·ÎÔ‹ıÂÈ· ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜. ¢È·-ÎÚ›ÓÔÓÙ·È ÛÂ ‰‡Ô Ù‡Ô˘˜, Ù· ÌË-Hodgkin Ô˘ Â›Ó·È Î·È ÈÔ Û˘¯Ó¿ Î·È ·ÔÙÂÏÔ‡Ó ÙÔ 60% ÙÔ˘ Û˘ÓfiÏÔ˘,Î·È Ù· Hodgkin ÏÂÌÊÒÌ·Ù·. ∏ ıÂÚ·Â›· ÙÔ˘˜ ÂÚÈÏ·Ì‚¿ÓÂÈ Û˘Ó‰˘·ÛÌfi ¯ËÌÂÈÔıÂÚ·Â˘ÙÈÎÒÓ Ê·ÚÌ¿-ÎˆÓ Î·È ·ÎÙÈÓÔıÂÚ·Â›·˜ Î·È Ë ÚfiÁÓˆÛË Û˘Ó‹ıˆ˜ Â›Ó·È ÂÍ·ÈÚÂÙÈÎ¿ Î·Ï‹, ÛÂ ·ÓÙ›ıÂÛË ÌÂ ÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜.¶·ÚfiÏ· ·˘Ù¿, Î¿ÔÈ· ·È‰È¿ ÂÍ·ÎÔÏÔ˘ıÔ‡Ó Ó· ˘ÔÙÚÔÈ¿˙Ô˘Ó ‹ Ó· ÂÌÊ·Ó›˙Ô˘Ó ·ÒÙÂÚÂ˜ ÂÈÏÔÎ¤˜·fi ÙË ıÂÚ·Â›·. √È ÓÂfiÙÂÚÂ˜ ÎÏÈÓÈÎ¤˜ ÌÂÏ¤ÙÂ˜ ¤¯Ô˘Ó ˆ˜ ÛÙfi¯Ô ÙËÓ ·Ó·ÁÓÒÚÈÛË ÚÔÁÓˆÛÙÈÎÒÓ ·Ú·Áfi-ÓÙˆÓ, ÙËÓ ÂÍ·ÙÔÌ›ÎÂ˘ÛË ÙË˜ ıÂÚ·Â˘ÙÈÎ‹˜ ÚÔÛ¤ÁÁÈÛË˜ ·Ó¿ÏÔÁ· ÌÂ ÙËÓ ÔÌ¿‰· ÎÈÓ‰‡ÓÔ˘ Î·È ÙËÓ ·ÓÙ·-fiÎÚÈÛË ÛÙË ıÂÚ·Â›· Î¿ıÂ ·ÛıÂÓÔ‡˜, ¤ÙÛÈ ÒÛÙÂ Ó· ‚ÂÏÙÈˆıÂ› Ë ÂÈ‚›ˆÛË, ÌÂ Ù·˘Ùfi¯ÚÔÓË ÂÏ¿ÙÙˆÛË ÙË˜Ì·ÎÚÔ¯ÚfiÓÈ·˜ ÙÔÍÈÎfiÙËÙ·˜ ÙË˜ ıÂÚ·Â›·˜. ∏ ·Ó·Î¿Ï˘„Ë Ó¤ˆÓ Ê·ÚÌ¿ÎˆÓ Ô˘ ÛÙÔ¯Â‡Ô˘Ó ÂÈ‰ÈÎ¿ ÛÂ ÌÔ-ÚÈ·Îfi Â›Â‰Ô ·Ó·Ì¤ÓÂÙ·È Ó· Û˘Ì‚¿ÏÂÈ ÛËÌ·ÓÙÈÎ¿ ÛÙÔÓ ÙÔÌ¤· ·˘Ùfi. ¶·Ú¿ÏÏËÏ·, Ë ·Ó¿Ù˘ÍË Â˘·›ÛıË-ÙˆÓ ÌÂıfi‰ˆÓ ÁÈ· ÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË ÙË˜ ·¿ÓÙËÛË˜ ÛÙË ıÂÚ·Â›· Î·È ÙË˜ ¤ÁÎ·ÈÚË˜ ‰È¿ÁÓˆÛË˜ ÙË˜˘ÔÙÚÔ‹˜ Î·È Ë ·Ó›¯ÓÂ˘ÛË ÂÏ¿¯ÈÛÙË˜ ˘ÔÏÂÈfiÌÂÓË˜ ÓfiÛÔ˘ ı· ‚ÔËı‹ÛÔ˘Ó ÛÙËÓ ÚÒÈÌË ·Ó·ÁÓÒÚÈÛËÙË˜ ¯ËÌÂÈÔ-Â˘·ÈÛıËÛ›·˜ ‹ ·ÓıÂÎÙÈÎfiÙËÙ·˜ ÙË˜ ÓfiÛÔ˘ Î·È ÛÙËÓ ÂÈÏÔÁ‹ ÙÔ˘ Î·Ù·ÏÏËÏfiÙÂÚÔ˘ ıÂÚ·Â˘ÙÈ-ÎÔ‡ Û¯‹Ì·ÙÔ˜. ∏ ¯Ú‹ÛË Û‡Á¯ÚÔÓˆÓ ‚ÈÔÏÔÁÈÎÒÓ ÌÂÏÂÙÒÓ Ô˘ ÂÚÈÏ·Ì‚¿ÓÂÈ Î·È ÂÎÙÂÓ‹ ÁÔÓÈ‰È·Î‹ Î·ÈÚˆÙÂ˚ÓÈÎ‹ ·Ó¿Ï˘ÛË ı· ‰ÒÛÂÈ Ó¤· ‰È¿ÛÙ·ÛË ÛÙËÓ Î·Ù·ÓfiËÛË ÙˆÓ ·ıÔÁÂÓÂÙÈÎÒÓ ÌË¯·ÓÈÛÌÒÓ, ÛÙËÓ Ù·-ÍÈÓfiÌËÛË ÙˆÓ ÏÂÌÊˆÌ¿ÙˆÓ Î·È ÛÙË ‚ÂÏÙÈÛÙÔÔ›ËÛË ÙˆÓ ıÂÚ·Â˘ÙÈÎÒÓ ÌÂıfi‰ˆÓ.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: §¤ÌÊˆÌ·, ·È‰ÈÎ‹ ËÏÈÎ›·, Hodgkin, non-Hodgkin, ¯ËÌÂÈÔıÂÚ·Â›·, ·ÎÙÈÓÔıÂÚ·Â›·.

Childhood lymphomas - Novel therapeutic approaches

V. Danilatou, M. Kalmanti

Abstract: Childhood lymphoma is the third most common paediatric malignancy. Non-Hodgkinlymphoma accounts for approximately 60% of all lymphomas and Hodgkin’s disease for the rest.Combined chemotherapy and radiotherapy is the treatment of choice and the prognosis is excellent forchildren and adolescents, in contrast with that for adults. However, some patients relapse or suffer fromlong-term toxicity. πn order to improve the overall survival, the aims of current clinical trials are theidentification of prognostic markers and the individualization of treatment according to risk group andtreatment response. Targeted therapies directed against tumour-characteristic molecules will probablycontribute to the reduction of toxicity. The development of sensitive methods for monitoring minimalresidual disease and early diagnosis of relapse will assist in choosing the appropriate treatment schedulefor each patient. Genomic and proteomic analysis will provide new dimensions in the understanding ofthe pathogenetic mechanisms, in disease classification and in the optimization of treatment strategies.

Key words: Lymphoma, childhood, Hodgkin, non-Hodgkin, chemotherapy, radiotherapy.

¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹∞ÈÌ·ÙÔÏÔÁ›·˜/√ÁÎÔÏÔÁ›·˜,¶·ÓÂÈÛÙËÌÈ·Îfi¡ÔÛÔÎÔÌÂ›Ô ∏Ú·ÎÏÂ›Ô˘∫Ú‹ÙË˜


µ·ÛÈÏÈÎ‹ ¢·ÓËÏ¿ÙÔ˘[email protected]@gmail.com¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹∞ÈÌ·ÙÔÏÔÁ›·˜/√ÁÎÔÏÔÁ›·˜,¶·ÓÂÈÛÙËÌÈ·Îfi ¡ÔÛÔÎÔÌÂ›Ô∏Ú·ÎÏÂ›Ô˘ ∫Ú‹ÙË˜, ∆.∫. 71110

Department of PaediatricHematology/Oncology,University Hospital ofHeraklion, Crete, Greece

Correspondence:

Vassiliki [email protected]@gmail.comDepartment of PaediatricHematology/Oncology,University Hospital ofHeraklion, 71110 Crete,Greece


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∞. MË Hodgkin §ÂÌÊÒÌ·Ù· (ª∏§)

™Â ·ÓÙ›ıÂÛË ÌÂ ÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜ Ô˘ ·Ó·-Ù‡ÛÛÔ˘Ó ÈÔ Û˘¯Ó¿ ‚Ú·‰¤ˆ˜ ·Ó·Ù˘ÛÛfiÌÂÓ·,


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ÛÙ· ·È‰È¿ Â›Ó·È ÈÔ Û˘¯Ó¿ ÂÈıÂÙÈÎ¿ ÏÂÌÊÒÌ·Ù·

˘„ËÏÔ‡ ‚·ıÌÔ‡ Î·ÎÔ‹ıÂÈ·˜ (1). ∆Ô ÈÔ Û˘¯Ófi Ï¤Ì-

ÊˆÌ· ÛÙ· ·È‰È¿ Â›Ó·È ÙÔ Ï¤ÌÊˆÌ· Burkitt (µ§) Î·È

·ÎÔÏÔ˘ıÔ‡Ó ÙÔ ÏÂÌÊÔ‚Ï·ÛÙÈÎfi Ï¤ÌÊˆÌ· (§§), ÙÔ

‰È¿¯˘ÙÔ Ï¤ÌÊˆÌ· ·fi ÌÂÁ¿Ï· µ-ÏÂÌÊÔÎ‡ÙÙ·Ú·

(¢§ªµ§) Î·È ÙÔ ·Ó·Ï·ÛÙÈÎfi Ï¤ÌÊˆÌ· ·fi ÌÂÁ¿Ï·

Î‡ÙÙ·Ú· (∞§ª∫). √È ˘fiÙ˘ÔÈ ª∏§ ¯·Ú·ÎÙËÚ›˙Ô-

ÓÙ·È ·fi ‰È·ÊÔÚÂÙÈÎ¤˜ ÎÏÈÓÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜, fiˆ˜

ÔÈÎ›ÏÔ˘ ‚·ıÌÔ‡ ÚÔ‰È¿ıÂÛË ÁÈ· ‰È‹ıËÛË ÙÔ˘ Ì˘Â-

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ÁÂÓÂÙÈÎ‹ ÂÙÂÚÔÁ¤ÓÂÈ·, ÌÂ ·ÔÙ¤ÏÂÛÌ· Ó· ··ÈÙÔ‡Ó

‰È·ÊÔÚÂÙÈÎ¤˜ ıÂÚ·Â˘ÙÈÎ¤˜ ÚÔÛÂÁÁ›ÛÂÈ˜ (3).

ª¤¯ÚÈ ÚfiÛÊ·Ù·, ˘‹Ú¯·Ó ‰‡Ô ‰È·ÊÔÚÂÙÈÎ¤˜

ÚÔÛÂÁÁ›ÛÂÈ˜ ÁÈ· ÙÔÓ ‰È·¯ˆÚÈÛÌfi ÙˆÓ ıÂÚ·Â˘ÙÈÎÒÓ

ÔÌ¿‰ˆÓ: ·Ó¿ÏÔÁ· ÌÂ ÙËÓ ÈÛÙÔÏÔÁÈÎ‹ ÔÌ¿‰· Î·È ·Ó¿-

ÏÔÁ· ÌÂ ÙÔ ÛÙ¿‰ÈÔ ÙË˜ ÓfiÛÔ˘ (4). ¶Ùˆ¯Ô› ÚÔÁÓˆ-

ÛÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ Â›Ó·È Ë ˘„ËÏ‹ LDH ÔÚÔ‡, Ë ËÏÈ-

Î›· >15 ÂÙÒÓ, Ë ÌË ·¿ÓÙËÛË ÛÙË ıÂÚ·Â›· ÚfiÊ·-

ÛË˜ ÌÂ Î˘ÎÏÔÊˆÛÊ·Ì›‰Ë, ‚ÈÓÎÚÈÛÙ›ÓË Î·È ÚÂ‰ÓÈ˙Ô-

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˙ÂÈ Ó· ·Ó·ÊÂÚıÂ› fiÙÈ ÚfiÛÊ·Ù· ·Ó·ÁÓˆÚ›ÛÙËÎ·Ó Û˘-

ÁÎÂÎÚÈÌ¤ÓÔÈ ÔÏ˘ÌÔÚÊÈÛÌÔ› ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ

«·Ú¿ÁÔÓÙ· ı·Ó¿ÙˆÛË˜ fiÁÎˆÓ» (TNF) Î·È ÏÂÌÊÔ-

ÙÔÍ›ÓË˜-· (LT-·) Ô˘ Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÙËÓ ÚfiÁÓˆÛË

ÙˆÓ ·ÛıÂÓÒÓ ÌÂ µ§ (6).

ªÂ ‚¿ÛË ·˘Ù¿ Ù· ÎÚÈÙ‹ÚÈ·, ˘¿Ú¯Ô˘Ó ÙÚÂÈ˜ ÔÌ¿-

‰Â˜ ıÂÚ·Â˘ÙÈÎ‹˜ ·ÓÙÈÌÂÙÒÈÛË˜. ∏ ÚÒÙË ÔÌ¿‰·

·ÊÔÚ¿ Ù· §§, Ô˘ ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È ÌÂ ÚˆÙfiÎÔÏ-

Ï· Ù‡Ô˘ ÔÍÂ›·˜ ÏÂÌÊÔ‚Ï·ÛÙÈÎ‹˜ ÏÂ˘¯·ÈÌ›·˜ Î·È

‚·Û›˙ÔÓÙ·È ÛÂ Û˘ÓÂ¯‹ ¤ÎıÂÛË ÛÂ Î˘ÙÙ·ÚÔÛÙ·ÙÈÎ¿

Ê¿ÚÌ·Î· ÁÈ· Ì·ÎÚfi ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·. ∏ ‰Â‡ÙÂÚË

ÔÌ¿‰· ·ÊÔÚ¿ Ù· µ§ Î·È ¢§ªµ§, Ô˘ ·ÓÙÈÌÂÙˆ›˙Ô-

ÓÙ·È ÌÂ ‚Ú·¯Â›·˜ ‰È¿ÚÎÂÈ·˜ Â·Ó·Ï·Ì‚·ÓfiÌÂÓÔ˘˜

Î‡ÎÏÔ˘˜ ÂÓÙ·ÙÈÎ‹˜ Û˘Ó‰˘·ÛÌ¤ÓË˜ ¯ËÌÂÈÔıÂÚ·Â›-

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ÔÔ›·, ·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ·Ú¯ÈÎ¿ ·ÓÙÈÌÂÙˆ›ÛÙË-

Î·Ó ÂÈÙ˘¯Ò˜ ÌÂ ÚˆÙfiÎÔÏÏ· Î·È ·fi ÙÈ˜ ‰‡Ô ÔÌ¿-

‰Â˜, ÙÂÏÈÎ¿ ·Ó·Ù‡¯ıËÎ·Ó ÍÂ¯ˆÚÈÛÙ¿ ıÂÚ·Â˘ÙÈÎ¿

ÚˆÙfiÎÔÏÏ· (4). ∂ÂÈ‰‹ Ë ÚÒÙË ÔÌ¿‰· ¯ÚËÛÈÌÔ-

ÔÈÂ› ÚˆÙfiÎÔÏÏ· ıÂÚ·Â›·˜ Ù‡Ô˘ ÏÂ˘¯·ÈÌ›·˜, ı·

Á›ÓÂÈ ·Ó·ÊÔÚ¿ ÌfiÓÔ ÁÈ· ÙÈ˜ ‰‡Ô ÙÂÏÂ˘Ù·›Â˜ ÔÌ¿‰Â˜.

∆Ô µ§ ·ÔÙÂÏÂ› ÙÔ 50% ÙˆÓ ª∏§ ÛÙ· ·È‰È¿ Î·È

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CD10+, CD19+, CD20+, sIg+, CD22+ (4). ™Â ÔÛÔ-

ÛÙfi 25% ·ÓÈ¯ÓÂ‡ÂÙ·È ÁÔÓÈ‰›ˆÌ· ÙÔ˘ ÈÔ‡ Epstein-Barr

(EB). ¶ÈÔ Û˘¯Ó¿ ·ÓÈ¯ÓÂ‡ÂÙ·È Ë ¯ÚˆÌÔÛˆÌÈÎ‹ ÌÂÙ¿-

ıÂÛË t(8;14) Î·È Û·ÓÈfiÙÂÚ· Ë t(8;22) ‹ Ë t(2;8), ÌÂ

·Ó·‰È¿Ù·ÍË ÙÔ˘ c-myc. ∏ ÓfiÛÔ˜ Û˘Ó‹ıˆ˜ ÂÓÙÔ›˙Â-

Ù·È ÛÙËÓ ÎÔÈÏÈ¿, ÙÔ ∫¡™, ÙËÓ øƒ§ ÂÚÈÔ¯‹ Î·È ÙÔÓ

Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ. ∆Ô Û‡Ó‰ÚÔÌÔ Ï‡ÛË˜ fiÁÎÔ˘, Ô˘

·ÔÙÂÏÔ‡ÛÂ ÛËÌ·ÓÙÈÎfi Úfi‚ÏËÌ· ·Ï·ÈfiÙÂÚ· Î·Ù¿

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ÎÔÛÙÂÚÔÂÈ‰‹ Î·È ¯·ÌËÏ‹ ‰fiÛË Î˘ÎÏÔÊˆÛÊ·Ì›‰Ë˜)

Î·È ÙË ¯Ú‹ÛË ÙË˜ Ú·Û‚Ô˘ÚÈÎ¿ÛË˜ ÌÂ ÂÓÙ·ÙÈÎ‹ ÂÓ˘-

‰¿ÙˆÛË. ∏ ·ÎÙÈÓÔıÂÚ·Â›· Î·È Ë ÂÎÙÂÙ·Ì¤ÓË ¯ÂÈ-

ÚÔ˘ÚÁÈÎ‹ ·Ê·›ÚÂÛË ‰ÂÓ ¤¯Ô˘Ó Ï¤ÔÓ ı¤ÛË ÛÙË ıÂÚ·-

Â˘ÙÈÎ‹ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ÓfiÛÔ˘ (7,8).

∆· ¢§ªµ§ ·ÔÙÂÏÔ‡Ó ÙÔ 10-20% ÙˆÓ ª∏§ ÛÙ·

·È‰È¿ Î·È ÂÌÊ·Ó›˙ÔÓÙ·È ÈÔ Û˘¯Ó¿ ÙË 2Ë ‰ÂÎ·ÂÙ›·

ÙË˜ ˙ˆ‹˜. ™˘Ó‹ıˆ˜ Â›Ó·È ÂÓÙÔÈÛÌ¤Ó· Î·È Û·ÓÈfiÙÂ-

Ú· ÂÌÊ·Ó›˙Ô˘Ó ÂÍˆÏÂÌÊ·‰ÂÓÈÎ¤˜ ÂÓÙÔ›ÛÂÈ˜ ÛÙÔÓ

Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ Î·È ÙÔ ∫¡™. À¿Ú¯ÂÈ ‚ÈÔÏÔÁÈÎ‹

‰È·ÊÔÚ¿ ÙË˜ ÓfiÛÔ˘ ÌÂ ·˘Ù‹Ó ÙˆÓ ÂÓËÏ›ÎˆÓ. ¶ÈÔ Û˘-

ÁÎÂÎÚÈÌ¤Ó·, ·ÓÈ¯ÓÂ‡ÂÙ·È Û¿ÓÈ· Ë ¯ÚˆÌÔÛˆÌÈÎ‹ ÌÂ-

Ù¿ıÂÛË t(14;18) [IgH/bcl-2] ÌÂ ·Ó·‰È¿Ù·ÍË ÙÔ˘ bcl-2

ÛÙËÓ ÂÚÈÔ¯‹ ÙË˜ ‚·ÚÈ¿˜ ·Ï‡ÛÔ˘ ÙˆÓ ·ÓÔÛÔÛÊ·ÈÚÈ-

ÓÒÓ, ÂÓÒ ÈÔ Û˘¯Ó¿ ·ÓÈ¯ÓÂ‡ÔÓÙ·È ·Ó·‰È·Ù¿ÍÂÈ˜ ÙÔ˘

c-myc. ∏ ÛËÌ·Û›· ÙˆÓ ÛˆÌ·ÙÈÎÒÓ ˘ÂÚÌÂÙ·ÏÏ¿ÍÂ-

ˆÓ ÙˆÓ ·ÓÔÛÔÛÊ·ÈÚÈÓÒÓ, Ô˘ Â›Ó·È ÁÓˆÛÙ‹ ÛÙÔ˘˜

ÂÓ‹ÏÈÎÂ˜, ÛÙ· ·È‰È¿ ‰ÂÓ ¤¯ÂÈ ·ÔÛ·ÊËÓÈÛÙÂ›. ∏ Â-

ÓÙ·ÂÙ‹˜ ÂÈ‚›ˆÛË Â›Ó·È ÔÏ‡ Î·Ï‹ Î·È Î˘Ì·›ÓÂÙ·È

ÛÂ ÔÛÔÛÙfi 90%. ∂Í·›ÚÂÛË ·ÔÙÂÏÂ› ÙÔ ÚˆÙÔ·-

ı¤˜ Ï¤ÌÊˆÌ· ·fi µ-Î‡ÙÙ·Ú· ÙÔ˘ ÌÂÛÔıˆÚ·Î›Ô˘,

Ô˘ ¤¯ÂÈ ¯ÂÈÚfiÙÂÚË ÚfiÁÓˆÛË (9).

√È ˘¿Ú¯Ô˘ÛÂ˜ Î‡ÚÈÂ˜ ıÂÚ·Â˘ÙÈÎ¤˜ ÂÈÏÔÁ¤˜ ÁÈ·

Ù· B§ Î·È ¢§ªµ§ Â›Ó·È ‚Ú·¯Â›·˜ ‰È¿ÚÎÂÈ·˜ ÂÓÙ·ÙÈÎ¿

¯ËÌÂÈÔıÂÚ·Â˘ÙÈÎ¿ ÚˆÙfiÎÔÏÏ· (8). ∆· ÚˆÙfiÎÔÏ-

Ï· ¯ÚËÛÈÌÔÔÈÔ‡Ó ¤Ó· Û˘Ó‰˘·ÛÌfi ¯ËÌÂÈÔıÂÚ·Â˘ÙÈ-

ÎÒÓ Ê·ÚÌ¿ÎˆÓ ÌÂ ‰È·ÊÔÚÂÙÈÎ‹ Î˘ÙÙ·ÚÔÙÔÍÈÎ‹ ‰Ú¿-

ÛË Î·È ‰È·ÊÔÚÂÙÈÎ‹ ÙÔÍÈÎfiÙËÙ· Î·È ¤¯Ô˘Ó ˆ˜ ÊÈÏÔÛÔ-

Ê›· ÙË Û˘ÓÂ¯‹ ‹ ÎÏ·ÛÌ·ÙÔÔÈËÌ¤ÓË ¤ÎıÂÛË ÙˆÓ

˘„ËÏ¿ ÔÏÏ·Ï·ÛÈ·˙fiÌÂÓˆÓ Î·ÎÔËıÒÓ Î˘ÙÙ¿ÚˆÓ

ÛÂ Î˘ÙÙ·ÚÔÙÔÍÈÎ¿ Ê¿ÚÌ·Î·. ¶ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Â·Ó·-

Ï·Ì‚·ÓfiÌÂÓÂ˜ Û˘ÓÂ‰Ú›Â˜ ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰ÒÓ, ‚ÈÓÎÚÈ-

ÛÙ›ÓË˜, Î˘ÎÏÔÊˆÛÊ·Ì›‰Ë˜ ‹ ÈÊˆÛÊ·Ì›‰Ë˜, ˘„ËÏ‹˜

‰fiÛË˜ ÌÂıÔÙÚÂÍ¿ÙË˜, Î˘Ù·Ú·‚›ÓË˜, ·‰ÚÈ·Ì˘Î›ÓË˜ Î·È

ÂÙÔÔÛ›‰Ë˜, Û˘Ó‹ıˆ˜ ÛÂ Î‡ÎÏÔ˘˜ ÙˆÓ 3 Â‚‰ÔÌ¿‰ˆÓ,

ÌÂ ÔÏ‡ Î·Ï¿ ·ÔÙÂÏ¤ÛÌ·Ù· (ÂÈ‚›ˆÛË ÂÏÂ‡ıÂÚË

Û˘Ì‚·Ì¿ÙˆÓ ÛÙ· 3-5 ¤ÙË 77-91%). ∂ÈÏ¤ÔÓ, ÏfiÁˆ

ÙË˜ ÂÍ·ÈÚÂÙÈÎ‹˜ Ù¿ÛË˜ ÙÔ˘ µ§ ÁÈ· ‰È‹ıËÛË ÙÔ˘ ∫¡™,

Á›ÓÔÓÙ·È ÂÓ‰ÔÚÚ·¯È·›Â˜ ÂÁ¯‡ÛÂÈ˜ Ê·ÚÌ¿ÎˆÓ (4,10).

¢Â‰ÔÌ¤ÓÔ˘ fiÙÈ ÔÈ ·ÛıÂÓÂ›˜ ¯·ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ¤¯Ô˘Ó

ÂÍ·ÈÚÂÙÈÎ¿ Î·Ï‹ ÚfiÁÓˆÛË Î·È ÂÈ‚›ˆÛË, Û‡Á¯ÚÔÓÂ˜

ÔÏ˘ÎÂÓÙÚÈÎ¤˜ ÌÂÏ¤ÙÂ˜ ÚÔÛ¿ıËÛ·Ó Ó· ÂÏ·ÙÙÒ-

ÛÔ˘Ó ÙË ‰fiÛË Î·È ÙË ‰È¿ÚÎÂÈ· ÙË˜ ıÂÚ·Â›·˜. ŒÙÛÈ,

¤ÁÈÓÂ ÚÔÛ¿ıÂÈ· Ó· ÂÏ·ÙÙˆıÂ› Ë ‰fiÛË ÙË˜ ËÌÂÈÔıÂ-

Ú·Â›·˜ ÛÂ ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘, ÌÂ

·ÚÓËÙÈÎfi fiÌˆ˜ ·ÔÙ¤ÏÂÛÌ· ÛÙË Û˘ÓÔÏÈÎ‹ ÂÈ‚›ˆÛË,

ÂÓÒ ÛÂ ÂÓ‰È·Ì¤ÛÔ˘ ÎÈÓ‰‡ÓÔ˘ ·ÛıÂÓÂ›˜ ÂÏ·ÙÙÒıËÎÂ ÌÂ

ÂÈÙ˘¯›· Ë ‰fiÛË ÙË˜ ¯ËÌÂÈÔıÂÚ·Â›·˜, ¯ˆÚ›˜ ·ÚÓËÙÈ-

Î¿ ·ÔÙÂÏ¤ÛÌ·Ù· ÛÙË Û˘ÓÔÏÈÎ‹ ÂÈ‚›ˆÛË (11-13).

Ÿˆ˜ ·Ó·Ê¤ÚıËÎÂ, ÔÈ ·ÛıÂÓÂ›˜ ÌÂ µ§ ¤¯Ô˘Ó ·˘-

ÍËÌ¤ÓË Èı·ÓfiÙËÙ· ÓfiÛÔ˘ ÛÙÔ ∫¡™. ∏ Û˘ÛÙËÌ·ÙÈÎ‹


84 µ. ¢·ÓËÏ¿ÙÔ˘, ª. ∫·ÏÌ·ÓÙ‹


¯ÔÚ‹ÁËÛË ˘„ËÏ‹˜ ‰fiÛË˜ ÌÂıÔÙÚÂÍ¿ÙË˜ Î·È ÙÚÈÏ‹˜

ÂÓ‰ÔÚÚ·¯È·›·˜ ıÂÚ·Â›·˜ ÂÏ·ÙÙÒÓÂÈ ÙËÓ Èı·ÓfiÙË-

Ù· ˘ÔÙÚÔ‹˜ ÛÙÔ ∫¡™ ÛÂ ·ÛıÂÓÂ›˜ Ô˘ ‹Ù·Ó ·ÚÓË-

ÙÈÎÔ› ÁÈ· ÓfiÛÔ ÛÙÔ ∫¡™ Î·Ù¿ ÙË ‰È¿ÁÓˆÛË. ∞ÓÙ›ıÂÙ·,

Ë ÚfiÁÓˆÛË Â›Ó·È ¯ÂÈÚfiÙÂÚË ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ Ô˘

¤¯Ô˘Ó ÚÔÛ‚ÔÏ‹ ÙÔ˘ ∫¡™ Î·Ù¿ ÙË ‰È¿ÁÓˆÛË (14).

¢ÂÓ ˘¿Ú¯Ô˘Ó ·ÎfiÌË Ù˘¯·ÈÔÔÈËÌ¤ÓÂ˜ ÌÂÏ¤ÙÂ˜ Ô˘

Ó· Û˘ÁÎÚ›ÓÔ˘Ó ÙÔÓ ÚfiÏÔ ÙË˜ ·ÎÙÈÓÔıÂÚ·Â›·˜ ÛÙÔ˘˜

·ÛıÂÓÂ›˜ ÌÂ ÚÔÛ‚ÔÏ‹ ∫¡™ (4).

∞Í›˙ÂÈ Ó· ÛËÌÂÈˆıÂ› fiÙÈ ÙÂÏÂ˘Ù·›· ¤¯ÂÈ ÂÓÛˆÌ·-

ÙˆıÂ› Ë ÌÂÏ¤ÙË ÙÔ˘ ÁÔÓÈ‰È·ÎÔ‡ ÚÔÊ›Ï ÙˆÓ ÏÂÌÊˆ-

Ì¿ÙˆÓ ÛÙ· ·È‰È¿ ÌÂ ¢§ªµ§ Î·È B§ (8). Ÿˆ˜ Â›-

Ó·È ÁÓˆÛÙfi, Ù· ¢§ªµ§ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÌÂÁ¿ÏË ÎÏÈ-

ÓÈÎ‹ Î·È ‚ÈÔÏÔÁÈÎ‹ ÂÙÂÚÔÁ¤ÓÂÈ· ÛÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜, Ë

ÔÔ›· ·ÓÙ·Ó·ÎÏ¿Ù·È ÛÂ ‰È·ÊÔÚÂÙÈÎ‹ ÚfiÁÓˆÛË Î·È

·ÓÙ·fiÎÚÈÛË ÛÙË ıÂÚ·Â›·. √È Alizadeh Î·È Û˘Ó.,

¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÙËÓ ÙÂ¯ÓÈÎ‹ ÁÔÓÈ‰È·Î‹˜ ·Ó¿Ï˘ÛË˜

ÌÂ ÌÈÎÚÔÛ˘ÛÙÔÈ¯›Â˜ DNA, Î·Ù¿ÊÂÚ·Ó Ó· ·Ó·ÁÓˆÚ›-

ÛÔ˘Ó ‰‡Ô ‰È·ÊÔÚÂÙÈÎ¤˜ ˘Ô-ÔÌ¿‰Â˜ ÌÂ ÚÔÁÓˆÛÙÈ-

Î‹ ÛËÌ·Û›·, ÙËÓ «Ù‡Ô˘ ‚Ï·ÛÙÈÎÔ‡ Î¤ÓÙÚÔ˘ µ-ÏÂÌ-

ÊÔÎ˘ÙÙ¿ÚˆÓ» Î·È ÙËÓ «ÂÓÂÚÁÔÔÈËÌ¤ÓË», ÂÓÒ ·ÚÁfi-

ÙÂÚ· ÔÈ Rosenwald Î·È Û˘Ó. ÂÈ‚Â‚·›ˆÛ·Ó ÙËÓ ‡·Ú-

ÍË ÙˆÓ ‰‡Ô ˘Ô-ÔÌ¿‰ˆÓ Î·È ·Ó·Î¿Ï˘„·Ó Î·È Ì›·

ÙÚ›ÙË ÔÌ¿‰· «Ù‡Ô˘ 3» (15,16). ¶·ÚfiÌÔÈÂ˜ ÌÂÏ¤ÙÂ˜

‰ÂÓ ¤¯Ô˘Ó ·ÎfiÌË ‰ËÌÔÛÈÂ˘ıÂ› ÁÈ· ·È‰È¿ ÌÂ

¢§ªµ§. ¶·ÚfiÏ· ·˘Ù¿, ÚfiÛÊ·ÙË ÌÂÏ¤ÙË, ¯ÚËÛÈ-

ÌÔÔÈÒÓÙ·˜ ·ÓÔÛÔ˚ÛÙÔ¯ËÌÂ›· Î·È «Â› ÙfiÔ˘»

˘‚ÚÈ‰ÈÛÌfi ÊıÔÚÈÛÌÔ‡ (FISH), Î·Ù¤‰ÂÈÍÂ fiÙÈ ÛÙ·

·È‰È¿ Ù· ¢§ªµ§ Â›Ó·È ÈÔ Û˘¯Ó¿ «Ù‡Ô˘ ‚Ï·ÛÙÈ-

ÎÔ‡ Î¤ÓÙÚÔ˘ µ-ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ» Î·È ÁÈ’ ·˘Ùfi ¤¯Ô˘Ó

Î·È Î·Ï‡ÙÂÚË ¤Î‚·ÛË (17).

™Â ÂÚÈÙÒÛÂÈ˜ ˘ÔÙÚÔ‹˜ ÙÔ˘ µ§, Ë ÚfiÁÓˆÛË

·Ú·Ì¤ÓÂÈ ‰˘ÛÙ˘¯Ò˜ ÂÍ·ÈÚÂÙÈÎ¿ ‰˘ÛÌÂÓ‹˜. H ÌÂÙ·-

ÌfiÛ¯Â˘ÛË Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ ·ÔÙÂÏÂ› ÁÈ· ÔÏÏÔ‡˜

ıÂÚ·Â›· ÂÎÏÔÁ‹˜ Ô˘ ›Ûˆ˜ ‚ÂÏÙÈÒÓÂÈ ÙËÓ ÂÈ‚›ˆ-

ÛË, ÂÓÒ ·Ú¿ÏÏËÏ· Á›ÓÔÓÙ·È Î·È ÂÈÚ·Ì·ÙÈÎ¤˜ ÛÙÔ-

¯Â˘Ì¤ÓÂ˜ ıÂÚ·Â›Â˜ (18). ¶ÔÏ‡ ÛËÌ·ÓÙÈÎfi˜ ÚÔ-

ÁÓˆÛÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÛÂ ÂÚ›ÙˆÛË ˘ÔÙÚÔ‹˜

Â›Ó·È Ë Â›ÙÂ˘ÍË ‰Â‡ÙÂÚË˜ ‡ÊÂÛË˜ Î·È Ë ·¿ÓÙËÛË

ÛÙË ıÂÚ·Â›· ‰È¿ÛˆÛË˜ (19,20).

T· ∞§ª∫ ·ÔÙÂÏÔ‡Ó ÙÔ 10% ÙˆÓ ª∏§ ÛÙ· ·È-

‰È¿. ™˘Ó‹ıˆ˜ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ∆-Ê·ÈÓfiÙ˘Ô ÌÂ

ÁÂÓÈÎÂ˘Ì¤ÓË ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ· Î·È µ-Û˘ÌÙÒÌ·Ù·,

ÂÓÒ ‰ÂÓ Â›Ó·È Û¿ÓÈÂ˜ Î·È ÔÈ ÂÍˆÏÂÌÊ·‰ÂÓÈÎ¤˜ ÂÓÙÔ-

›ÛÂÈ˜ ÛÙÔ ‰¤ÚÌ·, ÙÔ˘˜ ÓÂ‡ÌÔÓÂ˜, ÙÔ ‹·Ú, Ù· ÔÛÙ¿

Î·È Ù· Ì·Ï·Î¿ ÌfiÚÈ·. ™Â ÔÛÔÛÙfi 90%, ·ÓÈ¯ÓÂ‡ÂÙ·È Ô

·ÓÔÛÔÊ·ÈÓÔÙ˘ÈÎfi˜ ‰Â›ÎÙË˜ CD30+ Î·È Ë ¯ÚˆÌÔÛˆ-

ÌÈÎ‹ ÌÂÙ¿ıÂÛË t(2;5)(p23;q35) Ô˘ Ô‰ËÁÂ› ÛÙÔ Úˆ-

ÙÂ˚ÓÈÎfi Û‡ÌÏÂÁÌ· NPM/ALK ÌÂ ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘-

ÚÔÛÈÓÈÎ‹˜ ÎÈÓ¿ÛË˜ Î·È ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi Â˘ÓÔ˚Îfi-

ÙÂÚË ÚfiÁÓˆÛË, ÛÂ ·ÓÙ›ıÂÛË ÌÂ ÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜. ∆Ô

Û‡ÌÏÂÁÌ· ·˘Ùfi Ô‰ËÁÂ› ÛÂ ÂÏ·ÙÙˆÌ¤ÓË ·fiÙˆÛË,

Ì¤Ûˆ ÙˆÓ ÌÔÓÔ·ÙÈÒÓ PI3K Î·È PKB/AKT, Î·ıÒ˜ Î·È

ÛÂ ÂÓ›Û¯˘ÛË ÙÔ˘ ÔÏÏ·Ï·ÛÈ·ÛÌÔ‡, Ì¤Ûˆ ÙˆÓ ÌÔÓÔ-

·ÙÈÒÓ JAK/STAT Î·È ÙÔ˘ ÔÁÎÔÁÔÓÈ‰›Ô˘ myc (3,7).

¢È¿ÊÔÚ· ¯ËÌÂÈÔıÂÚ·Â˘ÙÈÎ¿ ÚˆÙfiÎÔÏÏ· ¤¯Ô˘Ó

¯ÚËÛÈÌÔÔÈËıÂ› ÌÂ ÔÏ‡ Î·Ï¿ ·ÔÙÂÏ¤ÛÌ·Ù· (ÂÈ-

‚›ˆÛË ÂÏÂ‡ıÂÚË ÓfiÛÔ˘ 65-75%) (21-23). ∂›Ó·È ·Ú·-

ÎÙËÚÈÛÙÈÎfi fiÙÈ Ù· ıÂÚ·Â˘ÙÈÎ¿ ÚˆÙfiÎÔÏÏ· Â›Ó·È

ÂÙÂÚÔÁÂÓ‹ Î·È ÂÔÌ¤Óˆ˜ Â›Ó·È ‰‡ÛÎÔÏÔ Ó· ÂÍ·¯ıÔ‡Ó

Û˘ÌÂÚ¿ÛÌ·Ù· Û¯ÂÙÈÎ¿ ÌÂ ÙÔÓ ÚfiÏÔ Î¿ıÂ Ê·ÚÌ·-

ÎÂ˘ÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ÍÂ¯ˆÚÈÛÙ¿. ¶Èı·ÓÒ˜ Ë ‰ÔÍÔ-

ÚÔ˘ÌÈÎ›ÓË, Ë ‚ÈÓÎÚÈÛÙ›ÓË Î·È Ù· ÛÙÂÚÔÂÈ‰‹ Ó· ·Ô-

ÙÂÏÔ‡Ó ÛËÌ·ÓÙÈÎ¿ Ê¿ÚÌ·Î· ÛÙË ıÂÚ·Â›· (4). ∂›-

ÛË˜, ÛÂ ·ÓÙ›ıÂÛË ÌÂ Ù· ¿ÏÏ· ª∏§, Ë ‰È·ÛÙÚˆÌ¿Ùˆ-

ÛË ÙË˜ ıÂÚ·Â›·˜ ·Ó¿ÏÔÁ· ÌÂ ÙÔ ÛÙ¿‰ÈÔ ÙË˜ ÓfiÛÔ˘

Î·È ÙËÓ ÔÌ¿‰· ÎÈÓ‰‡ÓÔ˘ ‰ÂÓ Ê·›ÓÂÙ·È Ó· Â›Ó·È ÛËÌ·-

ÓÙÈÎ‹ ÛÙÔ ∞§ª∫. ∂Í·›ÚÂÛË ›Ûˆ˜ ·ÔÙÂÏÔ‡Ó ÔÈ

·ÛıÂÓÂ›˜ ÌÂ Ï‹Úˆ˜ ¯ÂÈÚÔ˘ÚÁÈÎ¿ ÂÍ·ÈÚ¤ÛÈÌÔ fiÁÎÔ,

Ô˘ Ê·›ÓÂÙ·È Ó· ¯ÚÂÈ¿˙ÔÓÙ·È ÏÈÁfiÙÂÚË ıÂÚ·Â›·, Î·È

Ë ÂÓÙ·ÙÈÎÔÔ›ËÛË ÙË˜ ıÂÚ·Â›·˜ ÛÂ ·ÚÔ˘Û›· ·-

Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ (.¯. ÚÔÛ‚ÔÏ‹ ‰¤ÚÌ·ÙÔ˜, ÌÂ-

ÛÔıˆÚ·Î›Ô˘, ÛÏ¿¯ÓˆÓ) Ô˘ ‚Ú›ÛÎÂÙ·È ˘fi ÌÂÏ¤ÙË.

∆¤ÏÔ˜, ·Í›˙ÂÈ Ó· ÛËÌÂÈˆıÂ› fiÙÈ ÔÈ Û‡Á¯ÚÔÓÂ˜ ÌÂÏ¤ÙÂ˜

ÂÓÛˆÌ·ÙÒÓÔ˘Ó ‰È¿ÊÔÚÂ˜ ‚ÈÔÏÔÁÈÎ¤˜ ·Ú·Ì¤ÙÚÔ˘˜,

fiˆ˜ ·ÓÔÛÔÊ·ÈÓfiÙ˘Ô, Â›Â‰· Î˘ÙÔÎÈÓÒÓ, ÚÔÛ-

‰ÈÔÚÈÛÌfi ÙÔ˘ CD30 ÛÙÔ Ï¿ÛÌ·, ÌÂÏ¤ÙË ˘ÔÏÂÈfi-

ÌÂÓË˜ ÓfiÛÔ˘ Î·È ÁÔÓÈ‰È·ÎÒÓ ÌÈÎÚÔÛ˘ÛÙÔÈ¯ÈÒÓ DNA,

ÌÂ ÛÙfi¯Ô ÙËÓ ·ÍÈÔÏfiÁËÛ‹ ÙÔ˘˜ ˆ˜ ‰È·ÁÓˆÛÙÈÎÔ‡˜ ‹

ÚÔÁÓˆÛÙÈÎÔ‡˜ ‰Â›ÎÙÂ˜ (24,25). ¶Úfi‰ÚÔÌ· ·ÔÙÂ-

Ï¤ÛÌ·Ù· ·Ó·Ê¤ÚÔ˘Ó fiÙÈ ÙÔ ÁÔÓ›‰ÈÔ clusterin ÂÎÊÚ¿-

˙ÂÙ·È ÂÈ‰ÈÎ¿ ÛÂ ∞§ª∫, ÂÓÒ Â›Ó·È ·ÚÓËÙÈÎfi ÛÂ ¿ÏÏ·

ÏÂÌÊÒÌ·Ù· Î·È Èı·ÓÒ˜ Ó· ·ÔÙÂÏ¤ÛÂÈ ‰È·ÁÓˆÛÙÈÎfi

ÎÚÈÙ‹ÚÈÔ ÌÂÏÏÔÓÙÈÎ¿ (26).

√È ÂÚÈÛÛfiÙÂÚÂ˜ ˘ÔÙÚÔ¤˜ Û˘Ì‚·›ÓÔ˘Ó Û¯ÂÙÈ-

Î¿ ÓˆÚ›˜, Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÚÒÙˆÓ 15 ÌËÓÒÓ.

™Â ÂÚ›ÙˆÛË ˘ÔÙÚÔ‹˜, Ë ÚfiÁÓˆÛË ÙˆÓ ∞§ª∫

Â›Ó·È ÂÍ·ÈÚÂÙÈÎ¿ Ùˆ¯‹. ™Â ÌÂÚÈÎ¤˜ ÂÚÈÙÒÛÂÈ˜ Á›-

ÓÂÙ·È Î·È ‰È¿ÛˆÛË ÌÂ ·˘ÙfiÏÔÁË ‹ ·ÏÏÔÁÂÓ‹ ÌÂÙ·Ìfi-

Û¯Â˘ÛË Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ (4,27).

µ. Hodgkin §ÂÌÊÒÌ·Ù· (∏§)

H ÓfiÛÔ˜ ÙÔ˘ Hodgkin ÂÚÈÁÚ¿ÊËÎÂ ÁÈ· ÚÒÙË

ÊÔÚ¿ ·fi ÙÔÓ Thomas Hodgkin (1832). ∆Ô ¯·Ú·ÎÙË-

ÚÈÛÙÈÎfi ·ıÔÁÓˆÌÔÓÈÎfi Î‡ÙÙ·ÚÔ Â›Ó·È ÙÔ Reed-

Sternberg (R-S), Ô˘ ¤¯ÂÈ µ-Î˘ÙÙ·ÚÈÎ‹ ÚÔ¤ÏÂ˘ÛË.

™Â ÔÛÔÛÙfi 30% ·ÓÈ¯ÓÂ‡ÂÙ·È Ô Èfi˜ ∂µ. ∆fiÛÔ ÛÙÔ EB

ıÂÙÈÎfi fiÛÔ Î·È ÛÙÔ ·ÚÓËÙÈÎfi ∏§, ·Ú·ÙËÚÂ›Ù·È ÂÓÂÚ-

ÁÔÔ›ËÛË ÙˆÓ ÌÂÙ·ÁÚ·ÊÈÎÒÓ ·Ú·ÁfiÓÙˆÓ STAT6

Î·È NfkB, Ô˘ Ô‰ËÁÔ‡Ó ÛÂ ÂÓ›Û¯˘ÛË ÙÔ˘ ÔÏÏ·Ï·-

ÛÈ·ÛÌÔ‡ Î·È ÙË˜ ÂÈ‚›ˆÛË˜ ÙˆÓ ÓÂÔÏ·ÛÌ·ÙÈÎÒÓ

Î˘ÙÙ¿ÚˆÓ R-S. ™ÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ ÌÂÙ·ÁÚ·ÊÈ-

ÎÒÓ ·˘ÙÒÓ ·Ú·ÁfiÓÙˆÓ Û˘ÌÌÂÙ¤¯Ô˘Ó ‰È¿ÊÔÚÂ˜

Î˘ÙÙ·ÚÔÎ›ÓÂ˜, fiˆ˜ Ë IL-13 Î·È Ô TNF-·, ÂÓÒ ˘¿Ú-

¯ÂÈ ·ÏÏËÏÂ›‰Ú·ÛË Î·È ÌÂ ËˆÛÈÓfiÊÈÏ· Î·È ÏÂÌÊÔ-

Î‡ÙÙ·Ú·, Ì¤Ûˆ ÙˆÓ ˘Ô‰Ô¯¤ˆÓ CD30L Î·È CD40L.



¶·È‰È·ÙÚÈÎ‹ 2009;72:1-9

∏ ÚˆÙÂ˝ÓË LMP1ÙÔ˘ ÈÔ‡ EB ÂÓÂÚÁÔÔÈÂ› ·Â˘ıÂ›·˜

ÙÔÓ ÌÂÙ·ÁÚ·ÊÈÎfi ·Ú¿ÁÔÓÙ· NfkB (28-30).

∏ ÈÛÙÔÏÔÁÈÎ‹ Ù·ÍÈÓfiÌËÛË ÙˆÓ ∏§ Û‡ÌÊˆÓ· ÌÂ

ÙËÓ International Lymphoma Study Group, REAL Î·È

ÙÔÓ WHO (31) Û˘ÓÔ„›˙ÂÙ·È ÛÙÔÓ ¶›Ó·Î· 1.

∆Ô ∏§ ÂÌÊ·Ó›˙ÂÙ·È ÈÔ Û˘¯Ó¿ ÛÂ ËÏÈÎ›Â˜ ÌÂÁ·Ï‡-

ÙÂÚÂ˜ ÙˆÓ 10 ÂÙÒÓ. √È ˘fiÙ˘ÔÈ ÏÂÌÊÔÂÈÎÚ·ÙÔ‡-

ÓÙÔ˜ Î·È ÌÈÎÙ‹˜ Î˘ÙÙ·ÚÔ‚Ú›ıÂÈ·˜ ¤¯Ô˘Ó ÙËÓ Î·Ï‡ÙÂ-

ÚË ÚfiÁÓˆÛË, ÂÓÒ Ù· ÏÂÌÊÔÂÓÈÎ¿ ¤¯Ô˘Ó ÙË ¯ÂÈÚfi-

ÙÂÚË ÚfiÁÓˆÛË.

∏ ‰È¿ÁÓˆÛË Ù›ıÂÙ·È ÌÂ ‚ÈÔ„›· ÙË˜ Ì¿˙·˜. ∞ÂÈÎÔ-

ÓÈÛÙÈÎ¤˜ ÂÍÂÙ¿ÛÂÈ˜ Ô˘ Û˘ÓÂÈÎÔ˘ÚÔ‡Ó Â›Ó·È Ë ·ÎÙÈ-

ÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜, ÙÔ ˘ÂÚË¯ÔÁÚ¿ÊËÌ·, Ë ·ÍÔÓÈÎ‹

(CT) Î·È Ì·ÁÓËÙÈÎ‹ ÙÔÌÔÁÚ·Ê›· (MRI), ÙÔ ÛÈÓıË-

ÚÔÁÚ¿ÊËÌ· ÌÂ Á¿ÏÏÈÔ Î·È Ë ÔÛÈÙÚÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›·

(FDP-PET). H ÔÛÈÙÚÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›· ÙÂ›ÓÂÈ Ó·

·ÓÙÈÎ·Ù·ÛÙ‹ÛÂÈ ÙÔ ÛÈÓıËÚÔÁÚ¿ÊËÌ· ÌÂ Á¿ÏÏÈÔ, Î·-

ıÒ˜ ‰È·ı¤ÙÂÈ ˘„ËÏfiÙÂÚË ‰È·ÎÚÈÙÈÎ‹ ÈÎ·ÓfiÙËÙ· Î·È

Â˘·ÈÛıËÛ›·, ¯·ÌËÏfiÙÂÚË ‰fiÛË ·ÎÙÈÓÔ‚ÔÏ›·˜ ÁÈ· ÙÔÓ

·ÛıÂÓ‹, ÌÈÎÚfiÙÂÚÔ ¯ÚfiÓÔ ÂÍ¤Ù·ÛË˜ Î·È ·ÔÙÂÏÂÛÌ·-

ÙÈÎfiÙÂÚË ·Ó›¯ÓÂ˘ÛË ÙË˜ ÛÏËÓÈÎ‹˜ ÚÔÛ‚ÔÏ‹˜. ∏

ÔÛÈÙÚÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›· ÌÔÚÂ› Ó· ·ÏÏ¿ÍÂÈ ÙÔ ÛÙ¿-

‰ÈÔ ÙË˜ ÓfiÛÔ˘ ÛÂ ÔÛÔÛÙfi 15-20% ÙˆÓ ·ÛıÂÓÒÓ. ¶·-

ÚfiÏ· ·˘Ù¿, ¤¯ÂÈ ¯·ÌËÏ‹ Â˘·ÈÛıËÛ›· ÛÙËÓ ·Ó›¯ÓÂ˘ÛË

ÙË˜ Ì˘ÂÏÈÎ‹˜ Û˘ÌÌÂÙÔ¯‹˜ Î·È ‰ÂÓ ÌÔÚÂ› Ó· ·ÓÙÈÎ·-

Ù·ÛÙ‹ÛÂÈ ÙË ‚ÈÔ„›· Ì˘ÂÏÔ‡. À¿Ú¯Ô˘Ó, fiÌˆ˜, ÂÚÈ-

ÙÒÛÂÈ˜ ÌÂ ıÂÙÈÎfi PET Î·È ·ÚÓËÙÈÎ‹ ‚ÈÔ„›· Ì˘ÂÏÔ‡.

∆Ô PET ‰ÂÓ ÌÔÚÂ› Ó· ·ÓÙÈÎ·Ù·ÛÙ‹ÛÂÈ ÙË CT. √ Û˘Ó-

‰˘·ÛÌfi˜ ƒ∂∆/CT ¤¯ÂÈ ÌÂÁ·Ï‡ÙÂÚË ‰È·ÁÓˆÛÙÈÎ‹ ·Í›·.

¢ÂÓ ¯ÚÂÈ¿˙ÂÙ·È ÁÈ· ÙË ÛÙ·‰ÈÔÔ›ËÛË ÙË˜ ÓfiÛÔ˘ ÚÈÓ

ÙËÓ ¤Ó·ÚÍË ÙË˜ ıÂÚ·Â›·˜, Î·ıÒ˜ ¤¯ÂÈ Ù¿ÛË ÁÈ·

˘ÂÚ-ÛÙ·‰ÈÔÔ›ËÛË ÙˆÓ ·ÛıÂÓÒÓ (28,32-37).

∏ ÛÙ·‰ÈÔÔ›ËÛË ÙË˜ ÓfiÛÔ˘ Î·Ù¿ Ann-Arbor Á›ÓÂ-

Ù·È ÛÂ Ù¤ÛÛÂÚ· ÛÙ¿‰È· I-IV, ·Ó¿ÏÔÁ· ÌÂ ÙËÓ ¤ÎÙ·ÛË

ÙË˜ ÓfiÛÔ˘, Î·È Î·ÙËÁÔÚÈÔÔÈÂ›Ù·È ÛÂ A Î·È µ ·Ó¿ÏÔÁ·

ÌÂ ÙËÓ ·ÚÔ˘Û›· ‹ fi¯È µ-Û˘ÌÙˆÌ¿ÙˆÓ (Î·ÎÔ˘¯›·,

˘ÚÂÙfi˜), ÛÂ Ã ÛÂ ÂÚÈÙÒÛÂÈ˜ ÌÂÁ¿ÏË˜ Ì¿˙·˜ (>10

cm), ÛÂ ∂ ÛÂ ·ÚÔ˘Û›· ÂÍˆÏÂÌÊ·‰ÂÓÈÎÒÓ Ì·˙ÒÓ Î·È

ÛÂ S ÛÂ ÂÚÈÙÒÛÂÈ˜ ÛÏËÓÈÎ‹˜ ÚÔÛ‚ÔÏ‹˜ (38).

∏ ÚfiÁÓˆÛË ÙË˜ ÓfiÛÔ˘ ¤¯ÂÈ ‚ÂÏÙÈˆıÂ› ÛËÌ·ÓÙÈ-

Î¿ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÌÂ ÙË ¯Ú‹ÛË Û˘Ó‰˘·ÛÌ¤ÓË˜

¯ËÌÂÈÔıÂÚ·Â›·˜ Î·È ·ÎÙÈÓÔıÂÚ·Â›·˜ Î·È ÙËÓ ÚÔ-

Û·ÚÌÔÁ‹ ÙË˜ ıÂÚ·Â›·˜ ·Ó¿ÏÔÁ· ÌÂ ÙÔ ÛÙ¿‰ÈÔ ÙË˜

ÓfiÛÔ˘. ∆· Û˘Ó‹ıË ¯ËÌÂÈÔıÂÚ·Â˘ÙÈÎ¿ Û¯‹Ì·Ù· Ô˘

¯ÔÚËÁÔ‡ÓÙ·È ÛÂ ·È‰È¿ Î·È ÂÓ‹ÏÈÎÂ˜ ÌÂ Ï¤ÌÊˆÌ·

Hodgkin Â›Ó·È Û˘Ó‰˘·ÛÌfi˜ Ê·ÚÌ¿ÎˆÓ Ô˘ ÂÚÈ¤¯ÂÈ

·ÓıÚ·Î˘ÎÏ›ÓÂ˜ Î·È ·ÏÎ˘ÏÈÔ‡ÓÙÂ˜ ·Ú¿ÁÔÓÙÂ˜. ªÂ-

ÚÈÎ¿ ·Ú·‰Â›ÁÌ·Ù· Â›Ó·È: ABVD (‰ÔÍÔÚÔ˘ÌÈÎ›ÓË,

ÌÏÂÔÌ˘Î›ÓË, ‚ÈÓÌÏ·ÛÙ›ÓË ÓÙ·Î·Ú‚·˙›ÓË),

OPPA±COPP ÛÂ ı‹ÏÂ· (‚ÈÓÎÚÈÛÙ›ÓË, ÚÂ‰ÓÈ˙fiÓË,

ÚÔÎ·Ú‚·˙›ÓË, ‰ÔÍÔÚÔ˘ÌÈÎ›ÓË, Î˘ÎÏÔÊˆÛÊ·Ì›‰Ë,

ÚÂ‰ÓÈ˙fiÓË, ÚÔÎ·Ú‚·˙›ÓË), OEPA±COPP ÛÂ ¿ÚÚÂ-

ÓÂ˜ (‚ÈÓÎÚÈÛÙ›ÓË, ÚÂ‰ÓÈ˙fiÓË, ÂÙÔÔÛ›‰Ë, ‰ÔÍÔÚÔ˘-

ÌÈÎ›ÓË, Î˘ÎÏÔÊˆÛÊ·Ì›‰Ë, ÚÂ‰ÓÈ˙fiÓË, ÚÔÎ·Ú‚·-

˙›ÓË), BEACOPP (ÌÏÂÔÌ˘Î›ÓË, ÂÙÔÔÛ›‰Ë, ‰ÔÍÔ-

ÚÔ˘ÌÈÎ›ÓË, Î˘ÎÏÔÊˆÛÊ·Ì›‰Ë, ‚ÈÓÎÚÈÛÙ›ÓË, ÚÂ‰ÓÈ-

˙fiÓË, ÚÔÎ·Ú‚·˙›ÓË), DBVE-PC (‰ÔÍÔÚÔ˘ÌÈÎ›ÓË,

ÌÏÂÔÌ˘Î›ÓË, ‚ÈÓÎÚÈÛÙ›ÓË, ÂÙÔÔÛ›‰Ë, ÚÂ‰ÓÈ˙fiÓË,

Î˘ÎÏÔÊˆÛÊ·Ì›‰Ë), MOPP/ABV (ÌÂ¯ÏˆÚ·Èı·Ì›ÓË,

‚ÈÓÎÚÈÛÙ›ÓË, ÚÔÎ·Ú‚·˙›ÓË, ÚÂ‰ÓÈ˙fiÓË, ‰ÔÍÔÚÔ˘-

ÌÈÎ›ÓË, ÌÏÂÔÌ˘Î›ÓË, ‚ÈÓÌÏ·ÛÙ›ÓË) (39). ∏ ıÂÚ·-

Â›· Á›ÓÂÙ·È ·Ó¿ÏÔÁ· ÌÂ ÙÔ ÛÙ¿‰ÈÔ ÙË˜ ÓfiÛÔ˘ Î·È

ÌÔÚÂ› Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ Û˘Ó‰˘·ÛÌfi ·ÎÙÈÓÔıÂÚ·Â›·˜

ÚÔÛ‚Â‚ÏËÌ¤ÓˆÓ Â‰›ˆÓ, Ë ‰Â ÂÈ‚›ˆÛË Â›Ó·È ÔÏ‡

˘„ËÏ‹ Î·È ÔÈÎ›ÏÏÂÈ ·Ó¿ÏÔÁ· ÌÂ ÙËÓ ÔÌ¿‰· ÎÈÓ‰‡-

ÓÔ˘ (¯·ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘: ÔÏÈÎ‹ ÂÈ‚›ˆÛË 96-100%,

ÂÓ‰È·Ì¤ÛÔ˘ Î·È ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘: 85-100%).

¶·ÚfiÏÔ Ô˘ Ë ÂÈ‚›ˆÛË Â›Ó·È ÔÏ‡ Î·Ï‹, Ë ÙÔÍÈ-

ÎfiÙËÙ· ÙfiÛÔ ·fi ÙË ¯ËÌÂÈÔıÂÚ·Â›· fiÛÔ Î·È ·fi

ÙËÓ ·ÎÙÈÓÔıÂÚ·Â›· ·Ú·Ì¤ÓÔ˘Ó ÛÔ‚·Ú¤˜. ¶ÈÔ Û˘-

ÁÎÂÎÚÈÌ¤Ó·, ÔÈ ·ÏÎ˘ÏÈÔ‡ÓÙÂ˜ ·Ú¿ÁÔÓÙÂ˜ Ô‰ËÁÔ‡Ó

ÛÂ ÛÙÂ›ÚˆÛË Î·È ˘ÔÁÔÓÈÌfiÙËÙ·, ÔÈ ·ÏÎ˘ÏÈÔ‡ÓÙÂ˜

·Ú¿ÁÔÓÙÂ˜ Î·È Ë ÂÙÔÔÛ›‰Ë ÂÓÔ¯ÔÔÈÔ‡ÓÙ·È ÁÈ·

ÂÌÊ¿ÓÈÛË ‰Â˘ÙÂÚÔ·ıÔ‡˜ ÏÂ˘¯·ÈÌ›·˜, Ë ÌÏÂÔÌ˘Î›-

ÓË Ô‰ËÁÂ› ÛÂ ‰Â˘ÙÂÚÔ·ı‹ ›ÓˆÛË Î·È ÔÈ ·ÓıÚ·Î˘ÎÏ›-

ÓÂ˜ ÛÂ Î·Ú‰ÈÔÌ˘Ô¿ıÂÈ·. ∏ ·ÎÙÈÓÔıÂÚ·Â›· Â˘ı‡-

ÓÂÙ·È ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË Û˘Ì·ÁÒÓ fiÁÎˆÓ, ÏÂ˘¯·È-

ÌÈÒÓ Î·È Ì˘ÂÏÔ‰˘ÛÏ·ÛÙÈÎÒÓ Û˘Ó‰ÚfiÌˆÓ, ·ıËÚÔ-

ÛÎÏËÚ˘ÓÙÈÎ‹˜ Î·Ú‰È·Î‹˜ ÓfiÛÔ˘, ‰˘ÛÏÂÈÙÔ˘ÚÁÈÒÓ

ÙˆÓ ‚·Ï‚›‰ˆÓ, ÓÂ˘ÌÔÓÈÎ‹˜ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·˜, ÛÙÂ›-

ÚˆÛË˜, ˘ÔÁÔÓÈÌfiÙËÙ·˜ Î·È ˘Ôı˘ÚÂÔÂÈ‰ÈÛÌÔ‡/ Ca

ı˘ÚÂÔÂÈ‰Ô‡˜ (39).

°È· ÙÔ ÏfiÁÔ ·˘Ùfi, Ù· Û‡Á¯ÚÔÓ· ıÂÚ·Â˘ÙÈÎ¿

ÚˆÙfiÎÔÏÏ· ÚÔÛ·ıÔ‡Ó Ó· ÚÔÛ‰ÈÔÚ›ÛÔ˘Ó ÙË

‚¤ÏÙÈÛÙË ‰fiÛË ¯ËÌÂÈÔıÂÚ·Â›·˜ Î·È/‹ ·ÎÙÈÓÔıÂÚ·-

Â›·˜ ‹ Ó· ·ÔÊ‡ÁÔ˘Ó ÙËÓ ·ÎÙÈÓÔıÂÚ·Â›· ÚÔÎÂÈ-

Ì¤ÓÔ˘ Ó· ÂÏ·¯ÈÛÙÔÔÈ‹ÛÔ˘Ó ÙËÓ ÙÔÍÈÎfiÙËÙ·. ŒÙÛÈ,

ÔÈ Nachman Î·È Û˘Ó. ¯ÔÚ‹ÁËÛ·Ó ¯ËÌÂÈÔıÂÚ·Â›·

·Ó¿ÏÔÁ· ÌÂ ÙÔ ÛÙ¿‰ÈÔ ÙË˜ ÓfiÛÔ˘ Î·È Â¤ÏÂÍ·Ó Ù˘-

¯·›· ÙÔ˘˜ ·ÛıÂÓÂ›˜ ÁÈ· Ó· Ï¿‚Ô˘Ó ‹ fi¯È ·ÎÙÈÓÔıÂÚ·-

Â›·, ·Ó¿ÏÔÁ· ÌÂ ÙËÓ ·¿ÓÙËÛË ÛÙË ¯ËÌÂÈÔıÂÚ·-

Â›· (40). √È ·ÛıÂÓÂ›˜ ÌÂ Ï‹ÚË ·ÓÙ·fiÎÚÈÛË ÛÙË

¯ËÌÂÈÔıÂÚ·Â›· Ô˘ ¤Ï·‚·Ó ·ÎÙÈÓÔıÂÚ·Â›· ·ÎÔ-

ÏÔ‡ıˆ˜ ‰ÂÓ Â›¯·Ó Î·Ó¤Ó· ÏÂÔÓ¤ÎÙËÌ· ÛÙË Û˘ÓÔ-

ÏÈÎ‹ ÂÈ‚›ˆÛË. ¶·ÚÔÌÔ›ˆ˜, ÔÈ Rühl Î·È Û˘Ó. ‰ÂÓ

¶›Ó·Î·˜ 1. ∏ ÈÛÙÔÏÔÁÈÎ‹ Ù·ÍÈÓfiÌËÛË ÙˆÓ ÏÂÌÊˆÌ¿ÙˆÓ Hodgkin

1. Hodgkin ÎÏ·ÛÈÎfi Ï¤ÌÊˆÌ· ñ √˙Ò‰Ë˜ ÛÎÏ‹Ú˘ÓÛË - √™ [nodular sclerosis (NS)]ñ §ÂÌÊÔÂÈÎÚ·Ù¤˜ - §∂ [lymphocyte rich classical

Hodgkin’s lymphoma (LRCHD)]ñ §ÂÌÊÔÂÓÈÎfi - §¶ [lymphocyte depleted subtypes (LD)]ñ ªÈÎÙ‹˜ Î˘ÙÙ·ÚÔ‚Ú›ıÂÈ·˜ - ª∫ [mixed cellularity (MC)]

2. √˙Ò‰Â˜ §ÂÌÊÔÂÈÎÚ·Ù¤˜ - √§∂∏§ [nodular lymphocytepredominance type (¡LPHD)]

3. ∞Ù·ÍÈÓfiÌËÙ· [unclassifiable cases (UC)]


‰È·›ÛÙˆÛ·Ó ˘ÂÚÔ¯‹ ÛÙËÓ ÂÈ‚›ˆÛË ÌÂÙ¿ ·fi Û˘-

ÌÏËÚˆÌ·ÙÈÎ‹ ¯ÔÚ‹ÁËÛË ·ÎÙÈÓÔıÂÚ·Â›·˜ ÛÂ ¯·-

ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ·ÛıÂÓÂ›˜ (41). ŸÌˆ˜, ÛÙÔ˘˜ ·ÛıÂ-

ÓÂ›˜ ÂÓ‰È·Ì¤ÛÔ˘ Î·È ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘, Ë ¯ÔÚ‹ÁËÛË

·ÎÙÈÓÔıÂÚ·Â›·˜ ÚÔÛ‚Â‚ÏËÌ¤ÓÔ˘ Â‰›Ô˘ Û˘ÌÏË-

ÚˆÌ·ÙÈÎ¿ ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË ¯ËÌÂÈÔıÂÚ·Â›·˜ ‚ÂÏ-

Ù›ˆÛÂ ÛËÌ·ÓÙÈÎ¿ ÙË Û˘ÓÔÏÈÎ‹ ÂÈ‚›ˆÛË ÙˆÓ ·ÛıÂ-

ÓÒÓ. ∞ÓÙ›ıÂÙ·, Ì›· ÈÔ ÚfiÛÊ·ÙË ÌÂÏ¤ÙË ·Ó·Ê¤ÚÂÈ

·ÚfiÌÔÈ· ÂÈ‚›ˆÛË ÙfiÛÔ ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ¯·ÌËÏÔ‡

fiÛÔ Î·È ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ (42). ∞fi

ÙÈ˜ ÌÂÏ¤ÙÂ˜ ·˘Ù¤˜ ÚÔÎ‡ÙÂÈ fiÙÈ Ë ¯ÔÚ‹ÁËÛË ·ÎÙÈÓÔ-

ıÂÚ·Â›·˜ ÚÔÛ‚Â‚ÏËÌ¤ÓÔ˘ Â‰›Ô˘ ÌÂÙ¿ ·fi ¯ËÌÂÈ-

ÔıÂÚ·Â›·, Ô˘ ÚÔÛ·ÚÌfi˙ÂÙ·È ·Ó¿ÏÔÁ· ÌÂ ÙÔ ÛÙ¿-

‰ÈÔ ÙË˜ ÓfiÛÔ˘, ‚ÂÏÙÈÒÓÂÈ ÙËÓ ÂÈ‚›ˆÛË ÂÏÂ‡ıÂÚË

Û˘Ì‚·Ì¿ÙˆÓ, fi¯È fiÌˆ˜ Î·È ÙË Û˘ÓÔÏÈÎ‹ ÂÈ‚›ˆÛË. ∏

‰Â ¯ÔÚ‹ÁËÛË ÈÛ¯˘ÚfiÙÂÚË˜ ¯ËÌÂÈÔıÂÚ·Â›·˜ ÚÔÎÂÈ-

Ì¤ÓÔ˘ Ó· ·ÔÊÂ˘¯ıÂ› Ë ¯ÔÚ‹ÁËÛË ·ÎÙÈÓÔıÂÚ·Â›·˜

‰ÂÓ ÛËÌ·›ÓÂÈ fiÙÈ ¤¯ÂÈ Î·È ÏÈÁfiÙÂÚË ÙÔÍÈÎfiÙËÙ·. ¶¿-

ÓÙˆ˜, Ë ¯ÔÚ‹ÁËÛË ¯·ÌËÏfiÙÂÚË˜ ‰fiÛË˜ ¯ËÌÂÈÔıÂÚ·-

Â›·˜ ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ·ÎÙÈÓÔıÂÚ·Â›· ÚÔÛ‚Â‚ÏË-

Ì¤ÓÔ˘ Â‰›Ô˘ ¤¯ÂÈ ·ÚfiÌÔÈ· ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·

ÌÂ ÙË ¯ÔÚ‹ÁËÛË ÌfiÓÔ ¯ËÌÂÈÔıÂÚ·Â›·˜ ˘„ËÏfiÙÂÚË˜

‰fiÛË˜, ·ÏÏ¿ ·ÚÔ˘ÛÈ¿˙ÂÈ ÏÈÁfiÙÂÚË ÙÔÍÈÎfiÙËÙ·.

πÛÙÔÚÈÎ¿, Ô Û¯Â‰È·ÛÌfi˜ ÙË˜ ¯ËÌÂÈÔıÂÚ·Â›·˜

·Ï·ÈfiÙÂÚ· ÂÚÈÂÏ¿Ì‚·ÓÂ Â˘Ú‡ÙÂÚ· Â‰›· ·ÎÙÈÓÔ-

‚fiÏËÛË˜ Ù‡Ô˘ Ì·Ó‰‡·, Ô˘ ¤¯Ô˘Ó Î·Ù·ÚÁËıÂ› Î·È

·ÓÙÈÎ·Ù·ÛÙ·ıÂ› ·fi ·ÎÙÈÓÔ‚fiÏËÛË ÚÔÛ‚Â‚ÏËÌ¤-

ÓÔ˘ Â‰›Ô˘. ª¿ÏÈÛÙ·, Ë Û‡Á¯ÚÔÓË Ù¿ÛË ÙˆÓ ·ÎÙÈÓÔ-

ıÂÚ·Â˘ÙÒÓ Â›Ó·È Ó· ·ÎÙÈÓÔ‚ÔÏÔ‡Ó ÌfiÓÔ ÙÔ˘˜ ÚÔ-

Û‚Â‚ÏËÌ¤ÓÔ˘˜ ÏÂÌÊ·‰¤ÓÂ˜, ÌÂ ·ÔÙ¤ÏÂÛÌ· Ë ‰fiÛË

·ÎÙÈÓÔ‚fiÏËÛË˜ ÛÙÔ˘˜ Ê˘ÛÈÔÏÔÁÈÎÔ‡˜ ÈÛÙÔ‡˜ Ó· Â›-

Ó·È ÂÚÈÔÚÈÛÌ¤ÓË (43).

∏ Û‡Á¯ÚÔÓË Ù¿ÛË ÙˆÓ ÓÂfiÙÂÚˆÓ ıÂÚ·Â˘ÙÈÎÒÓ

ÚˆÙÔÎfiÏÏˆÓ Â›Ó·È Ë ÚÔÛ·ÚÌÔÁ‹ ÙË˜ ıÂÚ·Â›·˜

·Ó¿ÏÔÁ· ÌÂ ÙËÓ Ù·¯Â›· ‹ ‚Ú·‰Â›· ÚÒÈÌË ·¿ÓÙËÛË

ÛÙË ıÂÚ·Â›·. ™Ùfi¯Ô˜ Â›Ó·È Ë ·Ó·ÁÓÒÚÈÛË ·ÛıÂÓÒÓ

ÌÂ Â˘ÓÔ˚ÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜ Î·È Ë ÂÏ¿ÙÙˆÛË ÙË˜ ¤ÓÙ·-

ÛË˜ ÙË˜ ıÂÚ·Â›·˜ ÛÂ ·˘ÙÔ‡˜ ÙÔ˘˜ ·ÛıÂÓÂ›˜. ª›·

·fi ÙÈ˜ ÚÒÙÂ˜ ÌÂÏ¤ÙÂ˜ ·Ó·Ê¤ÚÂÈ Î·Ï¿ ·ÔÙÂÏ¤-

ÛÌ·Ù· ÛÂ ·È‰È¿ ÌÂ ÂÓÙÔÈÛÌ¤ÓÔ ∏§ Ô˘ ··ÓÙÔ‡Ó

Î·Ï¿ ÛÙË ¯ËÌÂÈÔıÂÚ·Â›·, ÌÂ ¯ÔÚ‹ÁËÛË ¯ËÌÂÈÔıÂ-

Ú·Â›·˜ ¯ˆÚ›˜ ·ÏÎ˘ÏÈÔ‡ÓÙÂ˜ ·Ú¿ÁÔÓÙÂ˜ Î·È ·ÓıÚ·-

Î˘ÎÏ›ÓÂ˜ Î·È ·ÎÔÏÔ‡ıˆ˜ ¯·ÌËÏ‹ ‰fiÛË ·ÎÙÈÓÔıÂÚ·-

Â›·˜ (44). ¶·ÚÔÌÔ›ˆ˜, Ì›· ¿ÏÏË ÌÂÏ¤ÙË ÚÔÛ¿ıË-

ÛÂ Ó· ÂÍ·ÙÔÌÈÎÂ‡ÛÂÈ ÙË ıÂÚ·Â›· ·Ó¿ÏÔÁ· ÌÂ ÙËÓ

ÚÒÈÌË ·¿ÓÙËÛË ÛÂ ·ÛıÂÓÂ›˜ ¯·ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘,

ÌÂ Î·Ï¿ ·ÔÙÂÏ¤ÛÌ·Ù· (45). ™‡Á¯ÚÔÓË Ù¿ÛË ÙˆÓ

ÎÏÈÓÈÎÒÓ ÌÂÏÂÙÒÓ Â›Ó·È Ë ÂÍ·ÙÔÌ›ÎÂ˘ÛË ÙË˜ ıÂÚ·-

Â›·˜ ·Ó¿ÏÔÁ· ÌÂ ÙËÓ Ù·¯Â›· ‹ ‚Ú·‰Â›· ·¿ÓÙËÛË

Î·È ÙËÓ Ï‹ÚË ‹ ÌÂÚÈÎ‹ ·ÓÙ·fiÎÚÈÛË. ¶ÚÔÎÂÈÌ¤ÓÔ˘

Ó· ‚ÂÏÙÈˆıÂ› Ë Ù·ÍÈÓfiÌËÛË ÙˆÓ ·ÛıÂÓÒÓ ÛÂ ÔÌ¿‰Â˜

ÎÈÓ‰‡ÓÔ˘, ÚfiÛÊ·Ù· ¤¯ÂÈ ¯ÚËÛÈÌÔÔÈËıÂ› ÌÈ· Ì¤ıÔ-

‰Ô˜ ÂÎÙÂÙ·Ì¤ÓË˜ ÌÂÏ¤ÙË˜ ÚˆÙÂ˚ÓÈÎÒÓ ‰ÂÈÎÙÒÓ ÛÙÔ

·›Ì· (surface enhanced laser desorption/ionization,

SELDI), ÛÂ ÌÈ· ÚÔÛ¿ıÂÈ· ·Ó·ÁÓÒÚÈÛË˜ ÌÈ·˜ Úˆ-

ÙÂˆÌÈÎ‹˜ ˘ÔÁÚ·Ê‹˜ Ô˘ ‰È·¯ˆÚ›˙ÂÈ Ù· ‰È¿ÊÔÚ·

ÎÏÈÓÈÎ¿ ÛÙ¿‰È· ÙË˜ ÓfiÛÔ˘ (47). ∏ ÌÂÏ¤ÙË ÙˆÓ ÁÔÓÈ-

‰È·ÎÒÓ ˘ÔÁÚ·ÊÒÓ ÛÂ 29 ·ÛıÂÓÂ›˜ ÌÂ ÎÏ·ÛÛÈÎfi ∏§

·Ó¤‰ÂÈÍÂ Û˘ÁÎÂÎÚÈÌ¤Ó· ÁÔÓ›‰È· Ô˘ Û¯ÂÙ›˙ÔÓÙ·È ÌÂ

ÙËÓ ·¿ÓÙËÛË ÛÙË ıÂÚ·Â›· (48). ªÂÏÏÔÓÙÈÎ¿, Ë

·Ó·ÁÓÒÚÈÛË ‚ÈÔÏÔÁÈÎÒÓ ‰ÂÈÎÙÒÓ ÂÓ‰¤¯ÂÙ·È Ó· ·Ô-

ÙÂÏ¤ÛÂÈ ÛËÌ·ÓÙÈÎfi ÂÚÁ·ÏÂ›Ô ÁÈ· ÙËÓ ¤ÁÎ·ÈÚË Úfi-

ÁÓˆÛË ÙË˜ ·¿ÓÙËÛË˜ ÛÙË ıÂÚ·Â›·, ÙËÓ ·Ó›¯ÓÂ˘ÛË

ÂÏ¿¯ÈÛÙË˜ ˘ÔÏÂÈfiÌÂÓË˜ ÓfiÛÔ˘ Î·È ÙËÓ Úfi‚ÏÂ„Ë

Èı·ÓÒÓ ÌÂÏÏÔÓÙÈÎÒÓ ˘ÔÙÚÔÒÓ.

∆Ô √§∂∏§ Â›Ó·È ÍÂ¯ˆÚÈÛÙ‹ ÔÓÙfiÙËÙ· ·fi ÙÔ

ÎÏ·ÛÈÎfi ∏§, ÌÂ ‰È·ÊÔÚÂÙÈÎ¿ ÈÛÙÔ·ıÔÏÔÁÈÎ¿ Î·È

·ÓÔÛÔÊ·ÈÓÔÙ˘ÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿, Â˘ÓÔ˚ÎfiÙÂÚË

ÚfiÁÓˆÛË, ·ÏÏ¿ Î·È Û˘¯ÓfiÙÂÚË ÂÌÊ¿ÓÈÛË ˘ÔÙÚÔ-

ÒÓ Î·È ‰Â˘ÙÂÚÔ·ıÒÓ ª∏§. ∏ ‰˘Ó·ÙfiÙËÙ· ÌfiÓÔ

¯ÂÈÚÔ˘ÚÁÈÎ‹˜ ÂÎÙÔÌ‹˜ ÛÂ ¯·ÌËÏÔ‡ ÛÙ·‰›Ô˘ ÓfiÛÔ

‚Ú›ÛÎÂÙ·È ˘fi ÌÂÏ¤ÙË (49).

∆¤ÏÔ˜, Ë ÌÂÏ¤ÙË ÔÏ˘ÌÔÚÊÈÛÌÒÓ ÛÂ ÁÔÓ›‰È· Ô˘

Îˆ‰ÈÎÔÔÈÔ‡Ó ¤Ó˙˘Ì· ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙˆÓ Ê·ÚÌ¿-

ÎˆÓ, fiˆ˜ ÙÔ Î˘Ùfi¯ÚˆÌ· P450, Î·È ·ÔÙÔÍ›ÓˆÛË˜

ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡, fiˆ˜ Ë S-ÙÚ·ÓÛÊÂÚ¿ÛË ÙË˜ ÁÏÔ˘-

Ù·ıÂÈfiÓË˜, ¤¯ÂÈ ˆ˜ ÛÙfi¯Ô ÙËÓ ·Ó·ÁÓÒÚÈÛË ·ÛıÂÓÒÓ

Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·˘ÍËÌ¤ÓÔ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛË˜

ÙÔÍÈÎfiÙËÙ·˜ ·fi ÙË ıÂÚ·Â›·. ∆Ú¤¯Ô˘ÛÂ˜ ÌÂÏ¤ÙÂ˜

¤¯Ô˘Ó ÂÈÛ·Á¿ÁÂÈ ÙËÓ ÂÊ·ÚÌÔÁ‹ Ê·ÚÌ·ÎÔÁÂÓˆÌÈÎÒÓ

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∞ÈÌÔÊ·ÁÔÎ˘ÙÙ·ÚÈÎ‹ ÏÂÌÊÔ˚ÛÙÈÔÎ˘ÙÙ¿ÚˆÛË

Ã. ∫Ô˘ÙÛ·˘Ù›ÎË, ∂. ª¿ÓÙ˙ÈÔ˘, ¡. ª˘ÚÈÔÎÂÊ·ÏÈÙ¿ÎË˜

¶ÂÚ›ÏË„Ë: ∏ ·ÈÌÔÊ·ÁÔÎ˘ÙÙ·ÚÈÎ‹ ÏÂÌÊÔ˚ÛÙÈÔÎ˘ÙÙ¿ÚˆÛË ·ÔÙÂÏÂ› Û¿ÓÈÔ Û‡Ó‰ÚÔÌÔ, fiÔ˘ ÙÔ ÚÔÂÍ¿Ú¯ÔÓ¯·Ú·ÎÙËÚÈÛÙÈÎfi Â›Ó·È Ë ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ÌÔÓÔ˘ÚËÓÈÎÔ‡ Ê·ÁÔÎ˘ÙÙ·ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, ÌÂ ·ÔÙ¤ÏÂÛÌ· ÙËÓÎ·ÏÔ‹ıË ÁÂÓÈÎÂ˘Ì¤ÓË ÈÛÙÈÔÎ˘ÙÙ·ÚÈÎ‹ ‰È‹ıËÛË ‰È·ÊfiÚˆÓ ÔÚÁ¿ÓˆÓ ÌÂ ·ÈÌÔÊ·ÁÔÎ˘ÙÙ¿ÚˆÛË. ∆· Û˘ÌÙÒÌ·Ù·Ô˘ ·Ú·¤ÌÔ˘Ó ÛÙË ‰È¿ÁÓˆÛË ÙË˜ ÓfiÛÔ˘ Â›Ó·È Ô Â›ÌÔÓÔ˜ ˘ÚÂÙfi˜ (100%), ÔÈ Î˘ÙÙ·ÚÔÂÓ›Â˜ (95%), ËË·ÙÈÎ‹ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· (96%), Ë Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›· (84%), Ô ›ÎÙÂÚÔ˜ (55%), Ë ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ· (43%),ÔÈ ‰È·Ù·Ú·¯¤˜ ÙË˜ ‹ÍË˜ (75%) Î·È ÙÔ˘ ∫¡™ (32%) Î·È Ë ÏÂÌÊÔ˚ÛÙÈÔÎ˘ÙÙ¿ÚˆÛË ÌÂ ·ÈÌÔÊ·ÁÔÎ‡ÙÙ·Ú· ÛÙÔÓÌ˘ÂÏfi ÙˆÓ ÔÛÙÒÓ Î·È ÛÂ fiÚÁ·Ó· ÙÔ˘ ‰ÈÎÙ˘ÔÂÓ‰ÔıËÏÈ·ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÛÂ fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓÂ›˜. ∆· ÂÚÁ·ÛÙË-ÚÈ·Î¿ Â˘Ú‹Ì·Ù· Ô˘ ·Ú·ÙËÚÔ‡ÓÙ·È Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ˘ÂÚÊÏÂÁÌÔÓÒ‰Ô˘˜ ‰È·‰ÈÎ·Û›·˜ Î·È Û˘Ó›ÛÙ·ÓÙ·È ÛÂ·‡ÍËÛË ÛÙÔ ·›Ì· ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ, ÙË˜ ÊÂÚÚÈÙ›ÓË˜, ÙË˜ Á·Ï·ÎÙÈÎ‹˜ ·Ê˘‰ÚÔÁoÓ¿ÛË˜, ÙˆÓ ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ,ÙˆÓ ÙÚ·ÓÛ·ÌÈÓ·ÛÒÓ Î·È ÙË˜ ÔÏÂÚ˘ıÚ›ÓË˜, Î·ıÒ˜ Î·È ÛÂ ÂÏ¿ÙÙˆÛË ÙÔ˘ ÈÓˆ‰ÔÁfiÓÔ˘. ¢È·ÎÚ›ÓÂÙ·È ÛÂ ÔÈÎÔÁÂÓ¤˜‹ ÚˆÙÔ·ı¤˜ Î·È ÛÂ ‰Â˘ÙÂÚÔ·ı¤˜, Ô˘ ‰È·ÎÚ›ÓÔÓÙ·È ‰‡ÛÎÔÏ· ÌÂÙ·Í‡ ÙÔ˘˜ ÂÂÈ‰‹ Î·È ÛÙÈ˜ ‰‡Ô ÌÔÚÊ¤˜ ÌÔ-ÚÔ‡Ó Ó· ·ÓÂ˘ÚÂıÔ‡Ó ÔÈ ›‰ÈÂ˜ ÌÂÙ·ÏÏ¿ÍÂÈ˜, ÂÓÒ ¤¯Ô˘Ó ·ÚfiÌÔÈ· ÎÏÈÓÈÎÔÂÚÁ·ÛÙËÚÈ·Î¿ Â˘Ú‹Ì·Ù· Î·È ÚfiÁÓˆ-ÛË. ∂›ÛË˜, ·ÊÔÚÌ‹ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË Î·È ÙˆÓ ‰‡Ô ÌÔÚÂ› Ó· ·ÔÙÂÏÂ› Î¿ÔÈ· ÏÔ›ÌˆÍË. ™˘¯Ó¿ Ë ‰È¿ÁÓˆÛË‰È·ÊÂ‡ÁÂÈ, Î·ıÒ˜ Ë ÓfiÛÔ˜ ÌÈÌÂ›Ù·È ÔÈÎ›ÏÂ˜ ÓÔÛÔÏÔÁÈÎ¤˜ ÔÓÙfiÙËÙÂ˜, Î¿ÙÈ Ô˘ ÌÔÚÂ› Ó· ·Ô‚Â› ÌÔÈÚ·›Ô, ·ÊÔ‡¯ˆÚ›˜ ıÂÚ·Â›· Â›Ó·È ÔÏ‡ Èı·Ó‹ Ë Î·Ù¿ÏËÍË ÙÔ˘ ·ÛıÂÓÔ‡˜, ÂÓÒ ÌÂ ÙËÓ Î·Ù¿ÏÏËÏË ·ÁˆÁ‹ Î·È, Î˘Ú›ˆ˜, ÌÂ ÙËÌÂÙ·ÌfiÛ¯Â˘ÛË Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ ¤¯ÂÈ ÂÈÙÂ˘¯ıÂ› ›·ÛË ÛÂ ˘„ËÏ¿ ÔÛÔÛÙ¿.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ∞ÈÌÔÊ·ÁÔÎ˘ÙÙ·ÚÈÎ‹ ÏÂÌÊÔ˚ÛÙÈÔÎ˘ÙÙ¿ÚˆÛË, ·ÈÌÔÊ·ÁÔÎ˘ÙÙ·ÚÈÎfi Û‡Ó‰ÚÔÌÔ, ·È‰È¿.

Haemophagocytic lymphohistiocytosis - HLH

C. Koutsaftiki, E. Mantziou, N. Myriokefalitakis

Abstract: Haemophagocytic lymphÔhistiocytosis is a rare syndrome characterized by a reactive disorderof the mononuclear phagocytic system which gives rise to benign, generalized histiocytic proliferation inmany organs, with marked haemophagocytosis. The symptoms and signs that are associated with thediagnosis, along with their frequency of appearance, are: persistent fever (100%), cytopenia (96%), liverdysfunction (96%), hepatosplenomegaly (84%), jaundice (55%), lymphadenopathy (43%),coagulopathy (75%) and central nervous system symptoms (32%). Lymphohistiocytosis, with thepresence of haemophagocytes in the bone marrow and the reticuloendothelial system, is observed in allcases. The laboratory findings that are usually present are due to the associated hyperinflammatoryprocess and usually consist of hypercytokinaemia, hyperferritinaemia, elevated blood levels of lactatedehydrogenase, hypertriglyceridaemia, hypofibrinogenaemia, transaminasaemia, hyperbilirubinaemia,etc. Two types of haemophagocytic lymphÔhistiocytosis have been identified, the familial or primarysyndrome and the secondary, but there is difficulty in distinguishing between them, as similar mutationsand clinical and laboratory findings may be observed in both, and they have roughly the same prognosis.In addition, the triggering factor for both can be, and is in most cases, an infection. It is easy for diagnosis tobe delayed, because the syndrome can mimic a variety of diseases. Delay in diagnosis can be fatal, sinceprompt treatment, specifically bone marrow transplantation, can achieve a cure in most cases.

Key words: ∏aemophagocytic lymphÔhistiocytosis, haemophagocytic syndrome, children.


∞’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹,°ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ¶ÂÓÙ¤ÏË˜


ÃÚ˘Û‹ ∫Ô˘ÙÛ·˘Ù›ÎË[email protected]∞’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹,°ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ¶ÂÓÙ¤ÏË˜, 152 36, ¶. ¶ÂÓÙ¤ÏË

1st Department ofPaediatrics, GeneralChildren’s Hospital ofPenteli, Athens, Greece

Correspondence:

Chryssie [email protected] Department ofPaediatrics, GeneralChildren’s Hospital ofPenteli, Palaia Penteli 152 36,Athens, Greece

¶·È‰È·ÙÚÈÎ‹ 2009;72:89-000

∂ÈÛ·ÁˆÁ‹ - √ÚÈÛÌÔ›

∏ ·ÈÌÔÊ·ÁÔÎ˘ÙÙ·ÚÈÎ‹ ÏÂÌÊÔ˚ÛÙÈÔÎ˘ÙÙ¿Úˆ-ÛË ‹ ·ÈÌÔÊ·ÁÔÎ˘ÙÙ·ÚÈÎfi Û‡Ó‰ÚÔÌÔ (∞º™)·ÓÙÈÚÔÛˆÂ‡ÂÈ ¤Ó· Ê¿ÛÌ· ·fi ÎÏËÚÔÓÔÌÔ‡-ÌÂÓÂ˜ Î·È Â›ÎÙËÙÂ˜ Î·Ù·ÛÙ¿ÛÂÈ˜, ÌÂ ¿ÏÏÔÙÂ¿ÏÏË ‚·Ú‡ÙËÙ· ÛÙË ‰È·Ù·Ú·¯‹ ÙË˜ ·ÓÔÛÔÏÔÁÈ-Î‹˜ ÏÂÈÙÔ˘ÚÁ›·˜ (1).

¶ÂÚÈÏ·Ì‚¿ÓÂÈ ‰‡Ô Î‡ÚÈÂ˜ Î·Ù·ÛÙ¿ÛÂÈ˜, ÌÂÎÔÈÓ¿ ÎÏÈÓÈÎ¿ Î·È ·ıÔÏÔÁÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿:

ÙÔ ÚˆÙÔ·ı¤˜ ‹ ÔÈÎÔÁÂÓ¤˜ ∞º™ (Familial

Haemophagocytic Lymphoistiocytosis, FHL) Î·È

ÙÔ ‰Â˘ÙÂÚÔ·ı¤˜ ∞º™ (secondary Haemo-

phagocytic Lymphoistiocytosis, HLH) (1).

∏ ·ÈÌÔÊ·ÁÔÎ˘ÙÙ¿ÚˆÛË ·ÔÙÂÏÂ› ·ıÔÏÔÁÔ-

·Ó·ÙÔÌÈÎfi Â‡ÚËÌ·, fiÔ˘ ÂÓÂÚÁÔÔÈËÌ¤Ó· Ì·-

ÎÚÔÊ¿Á· Ê·ÁÔÎ˘ÙÙ·ÚÒÓÔ˘Ó Î·È Î·Ù·ÛÙÚ¤ÊÔ˘Ó

ÂÚ˘ıÚÔÎ‡ÙÙ·Ú·, ÏÂ˘ÎÔÎ‡ÙÙ·Ú·, ¿ÏÏ· Ì·ÎÚÔÊ¿-

Á·, Î·ıÒ˜ Î·È Úfi‰ÚÔÌ· Î‡ÙÙ·Ú¿ ÙÔ˘˜ (2).


∆Ô ∏LH, ÚˆÙÔ·ı¤˜ Î·È ‰Â˘ÙÂÚÔ·ı¤˜, ÌÔÚÂ›

Ó· Â›Ó·È ı·Ó·ÙËÊfiÚÔ, ÙfiÛÔ ÁÈ· Ù· ·È‰È¿ fiÛÔ Î·È ÁÈ·

ÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜, È‰È·›ÙÂÚ· ·Ó ·Ú·ÌÂ›ÓÂÈ ·‰È¿ÁÓˆÛÙÔ

Î·È ‰ÂÓ ·ÓÙÈÌÂÙˆÈÛÙÂ› (3).

™˘¯ÓfiÙËÙ·

∏ Û˘¯ÓfiÙËÙ· ÙË˜ ÓfiÛÔ˘ ‰È·Ê¤ÚÂÈ ·fi ¯ÒÚ· ÛÂ

¯ÒÚ·, ÂÓÒ, ÂÍ ·ÈÙ›·˜ ÙˆÓ ‰˘ÛÎÔÏÈÒÓ Ô˘ ·ÚÔ˘ÛÈ¿˙ÂÈ

ÛÙË ‰È¿ÁÓˆÛË, Â›Ó·È Èı·Ófi ÔÈ ·ÚÈıÌÔ› Ô˘ ·Ó·Ê¤ÚÔ-

ÓÙ·È Ó· ÌËÓ ·ÓÙ·ÔÎÚ›ÓÔÓÙ·È ÛÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ·.

™ÙË ™Ô˘Ë‰›·, Ë Â›ÙˆÛË ÙÔ˘ FLH ÔÏÔÁ›˙ÂÙ·È

ÛÂ 1:50.000 ÁÂÓÓ‹ÛÂÈ˜ ˙ÒÓÙˆÓ ‚ÚÂÊÒÓ, ÌÂ ·Ó·ÏÔÁ›·

·ÚÚ¤ÓˆÓ:ıËÏ¤ˆÓ ~1:1 ‹ 1,2 ÂÚÈÙÒÛÂÈ˜:1.000.000

·È‰È¿ ÙÔ ÚfiÓÔ (1,4). ªÂÁ¿ÏÂ˜ ÛÂÈÚ¤˜ ÂÚÈÙÒÛÂˆÓ

ÌÂ ∞º™ ¤¯Ô˘Ó ·Ó·ÎÔÈÓˆıÂ› ·fi ÙËÓ π·ˆÓ›· Î·È

ÙËÓ ∆·˚‚¿Ó, ·ÏÏ¿ ‰ÂÓ Â›Ó·È ÁÓˆÛÙfi ·Ó Ë Û˘¯ÓfiÙËÙ·

Â›Ó·È ˘„ËÏfiÙÂÚË ÛÙÔ˘˜ ∞ÛÈ¿ÙÂ˜ ·fi fi,ÙÈ ÛÙÔ˘˜ ∂˘-

Úˆ·›Ô˘˜ (5).

™Â ÌÂÏ¤ÙË ·fi ¤Ó· Î¤ÓÙÚÔ ÛÙËÓ ∆Ô˘ÚÎ›·, ÛÂ ‰È¿-

ÛÙËÌ· 7 ÂÙÒÓ, ‰È·ÈÛÙÒıËÎÂ HLH ÛÂ 18 ·ÛıÂÓÂ›˜

Î·È FHL ÛÂ 19 ·ÛıÂÓÂ›˜, ·fi 34.250 Ô˘ ÓÔÛËÏÂ‡ÙË-

Î·Ó ÛÙÔ ›‰ÈÔ ‰È¿ÛÙËÌ· (0,052% Î·È 0,055% ·ÓÙÈÛÙÔ›-

¯ˆ˜) (6).

°ÂÓÈÎ¿ ÁÈ· ÙÔ FHL

¶ÂÚ›Ô˘ 25% fiÏˆÓ ÙˆÓ ÂÚÈÙÒÛÂˆÓ ∞º™ Â›Ó·È

ÚˆÙÔ·ıÂ›˜-ÔÈÎÔÁÂÓÂ›˜ Î·È Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÙË Û˘-

¯ÓfiÙËÙ· Û˘ÁÁ¤ÓÂÈ·˜ ÌÂÙ·Í‡ ÙˆÓ ÁÔÓ¤ˆÓ.

¶ÚÒÙË ÂÚÈÁÚ·Ê‹ ÙÔ˘ FLH ¤ÁÈÓÂ ÙÔ 1952 (7).

¶ÚfiÎÂÈÙ·È ÁÈ· ·˘ÙÔÛˆÌ·ÙÈÎ‹ ˘ÔÏÂÈfiÌÂÓË ‰È·Ù·-

Ú·¯‹ Ô˘ ÚÔÛ‚¿ÏÏÂÈ Î˘Ú›ˆ˜ ‚Ú¤ÊË, ·ÏÏ¿ Î·È ·È-

‰È¿ ÌÈÎÚ‹˜ ËÏÈÎ›·˜, ÂÓÒ ¤¯Ô˘Ó ·Ó·ÊÂÚıÂ› Î·È ÛÔÚ·-

‰ÈÎ¤˜ ÂÚÈÙÒÛÂÈ˜. ∂Î‰ËÏÒÓÂÙ·È Û˘¯ÓfiÙÂÚ· ÛÙÔÓ

ÚÒÙÔ ¯ÚfiÓÔ ÙË˜ ˙ˆ‹˜ Î·È Û¯Â‰fiÓ ¿ÓÙ· ÚÈÓ ÙÔÓ

¤‚‰ÔÌÔ (7,8,9,10,11,12).

∏ ¤Î‚·ÛË Â›Ó·È ÌÔÈÚ·›·, Â¿Ó Ë ÓfiÛÔ˜ ‰ÂÓ ·ÓÙÈÌÂ-

ÙˆÈÛÙÂ›. ∏ Ì¤ÛË ÂÈ‚›ˆÛË ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ‰ÂÓ

˘Ô‚¿ÏÏÔÓÙ·È ÛÂ ıÂÚ·Â›· Â›Ó·È 2 Ì‹ÓÂ˜, ÁÂÁÔÓfi˜

Ô˘ ‰Â›¯ÓÂÈ ÙËÓ ¤ÌÊ·ÛË Ô˘ Ú¤ÂÈ Ó· ‰ÔıÂ› ÛÙËÓ

¤ÁÎ·ÈÚË ‰È¿ÁÓˆÛË Î·È ıÂÚ·Â›· (12).

¶ÚfiÛÊ·Ù· ¤ÁÈÓÂ Ù·ÍÈÓfiÌËÛË ÙË˜ FHL ÛÂ FHL-1,

FHL-2, FHL-3, Î·ıÒ˜ Î·È ¿ÏÏÔ˘˜ ÔÙ‡Ô˘˜, ÌÂ ‚¿-

ÛË ÙÈ˜ ÂÎ¿ÛÙÔÙÂ Â˘ÚÈÛÎfiÌÂÓÂ˜ ÁÂÓÂÙÈÎ¤˜ ·ÓˆÌ·Ï›Â˜

(10). ∏ ÁÂÓÂÙÈÎ‹ ·ÓˆÌ·Ï›· ÌÔÚÂ› Ó· ·ÊÔÚ¿ ÙËÓ

ÚˆÙÂ˝ÓË ÂÚÊÔÚ›ÓË, Ë ÔÔ›· Û˘ÓÙÂÏÂ› ÛÙËÓ Î˘ÙÙ·-

ÚÔÙÔÍÈÎ‹ ‰Ú·ÛÙËÚÈfiÙËÙ· ÙˆÓ Ê˘ÛÈÎÒÓ Î˘ÙÙ¿ÚˆÓ

ÊÔÓ¤ˆÓ (natural killers ‹ NK) Î·È ÙˆÓ Î˘ÙÙ¿ÚˆÓ ∆

(13). √ ˘Â‡ı˘ÓÔ˜ ÁÔÓÈ‰È·Îfi˜ ÙfiÔ˜ ‚Ú›ÛÎÂÙ·È ÛÙÔ

¯ÚˆÌfiÛˆÌ· 10q21-22, ¯·Ú·ÎÙËÚ›˙ÂÈ ÙËÓ FHL-2 Î·È

··ÓÙ¿Ù·È ÛÙÔ 20-30% ÙˆÓ ·ÛıÂÓÒÓ (10).

√È ÌÂÙ·ÏÏ¿ÍÂÈ˜ ÛÙÔ ÁÔÓ›‰ÈÔ MUNC 13-4, Ô˘

Â‰Ú¿˙ÂÙ·È ÛÙÔ ¯ÚˆÌfiÛˆÌ· 17q25, Ô‰ËÁÔ‡Ó ÛÙËÓ ÂÎ-

‰‹ÏˆÛË ÙË˜ FHL-3, ÛÙËÓ ÔÔ›· ˘¿Ú¯ÂÈ ·ÓÂ¿ÚÎÂÈ·

ÙË˜ ÚˆÙÂ˝ÓË˜ Munc 13-4, Ë ÔÔ›· ÂÌÏ¤ÎÂÙ·È Â›-

ÛË˜ ÛÙÔÓ ÌË¯·ÓÈÛÌfi Î·Ù·ÛÙÚÔÊ‹˜ (10).

∆¤ÏÔ˜, ÛÙËÓ FHL-1 ¤¯Ô˘Ó ·Ó·ÊÂÚıÂ› ÌÂÙ·ÏÏ¿-

ÍÂÈ˜ ÛÙÔ 9q21.3-22, ÂÓÒ ˘¿Ú¯Ô˘Ó Î·È ÂÚÈÙÒÛÂÈ˜

ÛÙÈ˜ ÔÔ›Â˜ ‰ÂÓ ·ÓÂ˘Ú›ÛÎÂÙ·È Î·Ì›· ·fi ÙÈ˜ ·Ú·-

¿Óˆ ÌÂÙ·ÏÏ¿ÍÂÈ˜. ∏ ÌÔÚÊ‹ ·˘Ù‹ ¯·Ú·ÎÙËÚ›˙ÂÙ·È

ˆ˜ non FHL-2/3, ¯ˆÚ›˜ Ó· ¤¯ÂÈ ‰ÈÂ˘ÎÚÈÓÈÛıÂ› Ë Û¯¤-

ÛË ÙË˜ ÌÂ ÙËÓ FHL-1 ‹ ÌÂ ¿ÏÏÂ˜ Ó¤Â˜ ÁÔÓÈ‰È·Î¤˜ ÌÂ-

Ù·ÏÏ¿ÍÂÈ˜ (10).

∆ÂÏÂ˘Ù·›·, Á›ÓÂÙ·È ÏfiÁÔ˜ ÁÈ· ÙËÓ FHL-4, fiÔ˘

˘¿Ú¯ÂÈ ÌÂÙ¿ÏÏ·ÍË ÛÙÔ ¯ÚˆÌfiÛˆÌ· 6q24, ‰ËÏ·‰‹

ÛÙÔ ÁÔÓ›‰ÈÔ ÙË˜ Û˘ÓÙ·Í›ÓË˜ 11 Ô˘ ÂËÚÂ¿˙ÂÈ ÙÔ Û‡-

ÛÙËÌ· Ê·ÁÔÎ˘ÙÙ¿ÚˆÛË˜, Ë ÔÔ›· ÂÓÙÔ›ÛÙËÎÂ ÛÂ

ÌÈÎÚ‹ ÔÌ¿‰· ∫Ô‡Ú‰ˆÓ ·ÛıÂÓÒÓ (14).

°ÂÓÈÎ¿ ÁÈ· ÙÔ ‰Â˘ÙÂÚÔ·ı¤˜ ∏LH

∆Ô ∏LH ·Ó·Ê¤ÚÂÙ·È Î˘Ú›ˆ˜ ÛÙË ‰Â˘ÙÂÚÔ·ı‹

ÌÔÚÊ‹ ÙË˜ ÓfiÛÔ˘, fiÔ˘ Ë ÎÏÈÓÈÎÔÂÚÁ·ÛÙËÚÈ·Î‹ ÂÈ-

ÎfiÓ· Â›Ó·È ·ÚfiÌÔÈ· ÌÂ ÙË˜ FHL, ‰ÂÓ ˘¿Ú¯Ô˘Ó

fiÌˆ˜ Û¯ÂÙÈÎ¤˜ ÏËÚÔÊÔÚ›Â˜ ·fi ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi

ÈÛÙÔÚÈÎfi. ™˘Ó‹ıˆ˜ ÂÌÊ·Ó›˙ÂÙ·È ÛÂ ÌÂÁ·Ï‡ÙÂÚÂ˜ ËÏÈ-

Î›Â˜ ·’ fi,ÙÈ Ë FHL Î·È ÌÔÚÂ› Ó· ·Ó·Î¿Ì„ÂÈ ·˘Ùfi-

Ì·Ù·. ∂›Ó·È Û·Ê¤˜ fiÙÈ Û¯ÂÙ›˙ÂÙ·È ÌÂ ÏÔÈÌÒÍÂÈ˜, Ï‹„Ë

Ê·ÚÌ¿ÎˆÓ, Û˘ÛÙËÌ·ÙÈÎ¤˜ ÓfiÛÔ˘˜ (.¯. ™∂§, ¡ƒ∞)

Î·È ÁÂÓÂÙÈÎ¿ ‹ ·ÎfiÌ· Î·È Î·ÎÔ‹ıË ÓÔÛ‹Ì·Ù·

(1,2,3,13,15,16,17,18,19).

√È ÏÔÈÌÔÁfiÓÔÈ ·Ú¿ÁÔÓÙÂ˜ Ô˘ ÂÓÔ¯ÔÔÈÔ‡ÓÙ·È

ÁÈ· ÙËÓ ÚfiÎÏËÛË HLH, ·ÏÏ¿ ÂÓ›ÔÙÂ ˘ÚÔ‰ÔÙÔ‡Ó

Î·È ÂÓÂÚÁÔÔÈÔ‡Ó ÙËÓ FLH, Â›Ó·È Ô EBV (Î·Ù¿ Î‡ÚÈÔ

ÏfiÁÔ), Ô CMV, ¿ÏÏÔÈ ÂÚËÙÔ˚Ô›, Ô Èfi˜ ·ÓÂÌÂ˘ÏÔÁÈ¿˜-

¤ÚËÙ· ˙ˆÛÙ‹Ú·, Ô Èfi˜ ÙË˜ ÈÏ·Ú¿˜, ÙË˜ ÂÚ˘ıÚ¿˜, Ô

·Ú‚Ô˚fi˜ µ-19, Ô Èfi˜ ÙË˜ ÁÚ›Ë˜ ∞, ÔÈ ÈÔ› ∂CHO,

Arbo, Î·ıÒ˜ Î·È ÙÔ Ì˘ÎÔ‚·ÎÙËÚ›‰ÈÔ ÙË˜ Ê˘Ì·Ù›ˆ-

ÛË˜, ÙÔ Ì˘ÎfiÏ·ÛÌ·, Ë ‚ÚÔ˘Î¤ÏÏ·, Ë Û·ÏÌÔÓ¤ÏÏ·

ÙÔ˘ Ù‡ÊÔ˘, Ë ÏÂ˚ÛÌ¿ÓÈ·, Ë ÚÈÎ¤ÙÛÈ· Coxiella burnetti

Î·È ‰È¿ÊÔÚÔÈ Ì‡ÎËÙÂ˜ (9,20,21,22,23,24,25).

∆¤ÏÔ˜, HLH ÌÔÚÂ› Ó· ÂÎ‰ËÏˆıÂ› ‡ÛÙÂÚ· ·fi

HIV ÏÔ›ÌˆÍË ‹/Î·È ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ÙÔÓ ·ÓıÚÒÈÓÔ

ÂÚËÙÔ˚fi 8, ·ÏÏ¿ Î·È Ï›ÁÔ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË ÙË˜ ·ÓÙÈ-

ÚÂÙÚÔ˚Î‹˜ ıÂÚ·Â›·˜ Î·Ù¿ ÙÔ˘ ∏πV-AIDS (26).

∏ ÏËıÒÚ· ÙˆÓ ˘Â‡ı˘ÓˆÓ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÒÓ

Î¿ÓÂÈ ÈÔ Â‡ÎÔÏ· Î·Ù·ÓÔËÙfi ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ô ·Ú¯È-

Îfi˜ fiÚÔ˜ (1979) «HLH Û¯ÂÙÈ˙fiÌÂÓÔ ÌÂ ›ˆÛË» (virus-

associated haemophagocytic syndrome, VAHS) ¿Ï-

Ï·ÍÂ ·ÚÁfiÙÂÚ· ÛÂ «HLH Û¯ÂÙÈ˙fiÌÂÓÔ ÌÂ ÏÔ›ÌˆÍË»

(infection-associated haemophagocytic syndrome,

IAHS). ∆Ô IAHS ÂÌÊ·Ó›˙ÂÈ ıÓËÙfiÙËÙ· Ì¤¯ÚÈ Î·È 50%

(18,27,28,29).

∆Ô HLH ÌÔÚÂ› Ó· ÂÎ‰ËÏˆıÂ› Î·È ‡ÛÙÂÚ· ·fi

¯ÔÚ‹ÁËÛË Ê·ÚÌ¿ÎˆÓ, fiˆ˜ ·ÓÙÈÂÈÏËÙÈÎÒÓ (Ê·È-

Ó˘ÙÔ˝ÓË, Ï·ÌÔÙÚÈÁ›ÓË), ·ÓÙÈ‚ÈÔÙÈÎÒÓ (ÁÏ˘ÎÔÂÙ›-

‰È·, ÎÔÙÚÈÌÔÍ·˙fiÏË) Î·È ÂÓ‰Â¯ÔÌ¤Óˆ˜ ÌÂÊ·ÈÓ·ÌÈ-

ÎÔ‡ ÔÍ¤Ô˜ (2,30,31).

90 Ã. ∫Ô˘ÙÛ·˘Ù›ÎË Î·È Û˘Ó.



√È Î·ÎÔ‹ıÂÈÂ˜ ÌÂ ÙÈ˜ ÔÔ›Â˜ Û˘Ó‰¤ÂÙ·È ÙÔ HLH

·ÊÔÚÔ‡Ó Î˘Ú›ˆ˜ ÙÔ ·ÈÌÔÔÈËÙÈÎfi Û‡ÛÙËÌ· (ÏÂ˘¯·È-

Ì›Â˜-ÏÂÌÊÒÌ·Ù·) Î·È ÌÔÚÂ› Ó· Â¤ÏıÂÈ ÚÈÓ ‹ Î·Ù¿

ÙË ‰È¿ÚÎÂÈ· ÙË˜ ıÂÚ·Â›·˜, Ó· Û¯ÂÙ›˙ÂÙ·È ÌÂ ÏÔ›Ìˆ-

ÍË ‹ Ó· Â¤Ú¯ÂÙ·È ¯ˆÚ›˜ ÂÌÊ·Ó‹ ÏfiÁÔ (32,33,34,

35,36).

∆Ô HLH, ·ÏÏ¿ Î·È ÙÔ FLH, ¤¯ÂÈ ‰È·ÈÛÙˆıÂ› fiÙÈ

Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÔÚÈÛÌ¤ÓÂ˜ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈÂ˜, fiˆ˜

ÙÔ Ê˘ÏÔÛ‡Ó‰ÂÙÔ ÏÂÌÊÔÔÏÏ·Ï·ÛÈ·ÛÙÈÎfi Û‡Ó‰ÚÔ-

ÌÔ (X-linked lymphoproliferative syndrome: XLP),

ÙÔ Û‡Ó‰ÚÔÌÔ Griscelli, ÙÔ Û‡Ó‰ÚÔÌÔ Hermansky-

Pudlak type II, Ë ÓfiÛÔ˜ Kawasaki Î·È ÙÔ Û‡Ó‰ÚÔÌÔ

Chediak- Higashi. ∆¤ÏÔ˜, HLH ÌÔÚÂ› Ó· ÂÎ‰ËÏˆ-

ıÂ› ‡ÛÙÂÚ· ·fi ÌÂÙ·ÌfiÛ¯Â˘ÛË ÓÂÊÚÒÓ-‹·ÙÔ˜ Î·È

ÌÔÚÂ› Ó· Û˘ÓÔ‰Â‡ÂÈ ÏÂÌÊÔ¸ÂÚÏ·ÛÙÈÎfi Û‡Ó-

‰ÚÔÌÔ Ô˘ Û¯ÂÙ›˙ÂÙ·È ÌÂ ÙÔÓ EBV (37,38,39,40,

41,42).

∞ÓÙ›ÛÙÚÔÊ·, ÙÔ HLH Ô˘ Û¯ÂÙ›˙ÂÙ·È ÌÂ ÙÔÓ EBV

ÌÈÌÂ›Ù·È ‚ÈÔÏÔÁÈÎ¿ ÙÔ Ï¤ÌÊˆÌ· ∆, ÂÓÒ ·Ú·ÙËÚÂ›Ù·È

Û˘¯Ó¿ ÂÍ¤ÏÈÍË ÙÔ˘ HLH ÛÂ Ï¤ÌÊˆÌ· ∆ (5,36).

∂›ÛË˜, ÛÂ ·ÚÎÂÙ¤˜ ÂÓ‰ÔÁÂÓÂ›˜ ‰È·Ù·Ú·¯¤˜ ÙÔ˘

ÌÂÙ·‚ÔÏÈÛÌÔ‡ ¤¯ÂÈ ÂÚÈÁÚ·ÊÂ› ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· Ô˘

ÌÔÈ¿˙ÂÈ ÌÂ HLH (43,44).

π‰È·›ÙÂÚÔ˜ ÏfiÁÔ˜ Ú¤ÂÈ Ó· Á›ÓÂÈ ÁÈ· ÙÔ Û‡Ó‰ÚÔ-

ÌÔ ÙˆÓ ÂÓÂÚÁÔÔÈËÌ¤ÓˆÓ Ì·ÎÚÔÊ¿ÁˆÓ (MAS:

macrophage activation syndrome), Ô˘ ·Ó·Ê¤ÚÂÙ·È

ÛÙË ÌÔÚÊ‹ ÂÎÂ›ÓË ÙÔ˘ ‰Â˘ÙÂÚÔ·ıÔ‡˜ HLH Ô˘

Û¯ÂÙ›˙ÂÙ·È ÌÂ ÓÔÛ‹Ì·Ù· ÙÔ˘ Û˘Ó‰ÂÙÈÎÔ‡ ÈÛÙÔ‡. ∞·-

ÓÙ¿Ù·È ÈÔ Û˘¯Ó¿ Î·Ù¿ ÙËÓ ¤Ó·ÚÍË ÙË˜ Û˘ÛÙËÌ·ÙÈ-

Î‹˜ ÓÂ·ÓÈÎ‹˜ ÚÂ˘Ì·ÙÔÂÈ‰Ô‡˜ ·ÚıÚ›ÙÈ‰·˜ (™¡ƒ∞) Î·È

Û·ÓÈfiÙÂÚ· ÌÂ ¿ÏÏ· ÓÔÛ‹Ì·Ù· ÙÔ˘ Û˘Ó‰ÂÙÈÎÔ‡

ÈÛÙÔ‡ ÛÙ· ·È‰È¿, Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓÔ˘ ÙÔ˘ Û˘-

ÛÙËÌ·ÙÈÎÔ‡ ÂÚ˘ıËÌ·ÙÒ‰Ô˘˜ Ï‡ÎÔ˘ (15).

∏ Û˘¯ÓfiÙËÙ· ÙÔ˘ MAS ÛÙË ™¡ƒ∞ ·Ó¤Ú¯ÂÙ·È ÛÂ

6,7%-13% (45,46,47). ªÔÚÂ› Ó· ÂÎ‰ËÏˆıÂ› ÔÔÙÂ-

‰‹ÔÙÂ Î·Ù¿ ÙËÓ ÔÚÂ›· ÙË˜ ÓfiÛÔ˘, ·Ó Î·È Ë ÏÂÈÔ-

„ËÊ›· ÙˆÓ ·È‰ÈÒÓ ¤¯ÂÈ ÂÓ‰Â›ÍÂÈ˜ ÂÓÂÚÁÔ‡ ÓfiÛÔ˘

Î·Ù¿ ÙË ‰È¿ÁÓˆÛË ÙÔ˘ MAS. ¢ÂÓ ˘¿Ú¯ÂÈ ÔÌÔÊˆÓ›·

ˆ˜ ÚÔ˜ ÙÔ ·Ó ÙÔ MAS ı· Ú¤ÂÈ Ó· ÂÍÂÙ¿˙ÂÙ·È ˆ˜

ÍÂ¯ˆÚÈÛÙ‹ ÎÏÈÓÈÎ‹ ÔÓÙfiÙËÙ· ‹ ˆ˜ ÌÔÚÊ‹ ÙÔ˘ ‰Â˘ÙÂ-

ÚÔ·ıÔ‡˜ HLH. £ÂˆÚÂ›Ù·È fiÙÈ ı· ˘¿ÚÍÂÈ ÂÈÙ˘¯‹˜

·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ÌfiÓÔ fiÙ·Ó Á›ÓÂÈ ¯Ú‹-

ÛË ÙˆÓ ‰È·ı¤ÛÈÌˆÓ ıÂÚ·Â˘ÙÈÎÒÓ Û¯ËÌ¿ÙˆÓ Ô˘

˘¿Ú¯Ô˘Ó ÁÈ· ÙÔ HLH (15).

¶·Ú¿ÁÔÓÙÂ˜ Ô˘ ÌÔÚÔ‡Ó Ó· ˘ÚÔ‰ÔÙ‹ÛÔ˘Ó ÙËÓ

ÂÎ‰‹ÏˆÛË ÙÔ˘ MAS ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ™¡ƒ∞ Â›Ó·È ‰È¿-

ÊÔÚÂ˜ ÏÔÈÌÒÍÂÈ˜ (EBV, Coxsackie, Parvo B-19,

Varicella, ∏epatitis A, Salmonella, Pneumocystis

carinii, Enterococcus), Ê¿ÚÌ·Î· (·ÛÈÚ›ÓË, ª™∞º,

ÌÂıÔÙÚÂÍ¿ÙË, etanercept, anakinra, ¿Ï·Ù· ¯Ú˘ÛÔ‡,

ÛÔ˘ÏÊ·Û·Ï·˙›ÓË Î.¿.), Î·ıÒ˜ Î·È Ë ·˘ÙfiÏÔÁË ÌÂÙ·-

ÌfiÛ¯Â˘ÛË ·Ú¯¤ÁÔÓˆÓ Î˘ÙÙ¿ÚˆÓ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ·Ó-

ıÂÎÙÈÎ‹ ÌÔÚÊ‹ ™¡ƒ∞ (15,45,48).

∫ÏÈÓÈÎ‹ ÂÈÎfiÓ·

∏ ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· ÙÔ˘ HLH (ÚˆÙÔ·ıÔ‡˜ Î·È

‰Â˘ÙÂÚÔ·ıÔ‡˜) ÂÚÈÏ·Ì‚¿ÓÂÈ Â›ÌÔÓÔ ˘ÚÂÙfi,

Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›·, ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ·, ÂÍ¿ÓıË-

Ì· Î·È ÔÈÎÈÏ›· ÓÂ˘ÚÔÏÔÁÈÎÒÓ Û˘ÌÙˆÌ¿ÙˆÓ, fiˆ˜

Â˘ÂÚÂıÈÛÙfiÙËÙ·, Û·ÛÌÔ‡˜, ·Ú¿Ï˘ÛË ÎÚ·ÓÈ·ÎÒÓ

ÓÂ‡ÚˆÓ, ·Ù·Í›·, Ó˘ÛÙ·ÁÌfi, ‰˘Û¯¤ÚÂÈ· ÛÙË ‚¿‰ÈÛË,

„˘¯ÔÎÈÓËÙÈÎ‹ Î·ı˘ÛÙ¤ÚËÛË, ËÌÈÏËÁ›·, ÙÂÙÚ·ÏË-

Á›·, ÔÙÈÎ¤˜ ‰È·Ù·Ú·¯¤˜, ÂÌ¤ÙÔ˘˜, ·˘¯ÂÓÈÎ‹ ‰˘-

ÛÎ·Ì„›· Î·È ÛËÌÂ›· ·˘ÍËÌ¤ÓË˜ ÂÓ‰ÔÎÚ¿ÓÈ·˜ ›Â-

ÛË˜ (8,49). ∏ ÓÂ˘ÌÔÓÈÎ‹ Û˘ÌÌÂÙÔ¯‹ Â›Ó·È Â›ÛË˜

Û˘¯Ó‹ (4).

∂È‰ÈÎfiÙÂÚ· ÁÈ· ÙËÓ ÂÈÓ¤ÌÂÛË ÙÔ˘ ∫¡™ ÛÂ ¿-

Û¯ÔÓÙÂ˜ ·fi HLH, Ú¤ÂÈ Ó· ˘ÔÁÚ·ÌÌÈÛÙÂ› fiÙÈ Ù·

ÓÂ˘ÚÔ·ıÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù· Â›Ó·È ‰‡ÛÎÔÏÔ Ó·

·ÍÈÔÏÔÁËıÔ‡Ó, Î˘Ú›ˆ˜ ·Ó Ë ‰È¿ÁÓˆÛË Á›ÓÂÈ ÌÂÙ¿ ÙÔ

ı¿Ó·Ùfi ÙÔ˘˜. ∂ÈÏ¤ÔÓ, ÛÂ Î¿ÔÈÔ˘˜ ·fi ·˘ÙÔ‡˜

ÙÔ˘˜ ·ÛıÂÓÂ›˜, Ù· Â˘Ú‹Ì·Ù· ÛÙÔÓ ÂÁÎ¤Ê·ÏÔ Â›¯·Ó

·Ô‰oıÂ› ÛÂ ÚÔÛ‚ÔÏ‹ ·fi Î¿ÔÈÔÓ Èfi ‹ ÛÂ ÌË ÂÈ-

‰ÈÎ‹ ÌËÓÈÁÁÔÂÁÎÂÊ·Ï›ÙÈ‰· (8). ∏ Û˘¯ÓfiÙËÙ· ÂÌÊ¿-

ÓÈÛË˜ ‰È·Ù·Ú·¯ÒÓ ·fi ÙÔ ∫¡™ ·Ó¤Ú¯ÂÙ·È ÛÂ 20-

100% (8). ªÔÚÂ› Ó· ·Ú·ÙËÚËıÔ‡Ó ·ÈÌÔÚÚ·Á›Â˜

ÛÙÔÓ ·ÌÊÈ‚ÏËÛÙÚÔÂÈ‰‹, Û·ÛÌÔ›, ÎÒÌ·, ‰ËÏ·‰‹

ÛÙÔÈ¯Â›· Ô˘ ‰˘ÓËÙÈÎ¿ Ô‰ËÁÔ‡Ó ÛÙËÓ ÂÛÊ·ÏÌ¤ÓË

‰È¿ÁÓˆÛË ÙË˜ Î·ÎÔÔ›ËÛË˜, ÚÔÎ·ÏÒÓÙ·˜ ‰˘ÛÌÂ-

ÓÂ›˜ Û˘Ó¤ÂÈÂ˜ ÁÈ· ÙËÓ ÔÈÎÔÁ¤ÓÂÈ·, ·ÏÏ¿ Î˘Ú›ˆ˜ Î·-

ı˘ÛÙÂÚÒÓÙ·˜ ÂÈÎ›Ó‰˘Ó· ÙË ÛˆÛÙ‹ ‰È¿ÁÓˆÛË Î·È

ıÂÚ·Â›· (50).

¢ÂÓ ˘¿Ú¯ÂÈ Û·Ê‹˜ Û˘Û¯¤ÙÈÛË ÌÂÙ·Í‡ ÙˆÓ ÓÂ˘-

ÚÔ·ıÔÏÔÁÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ Î·È ÙˆÓ ÈÛÙÔ·ıÔÏÔÁÈ-

ÎÒÓ ‚Ï·‚ÒÓ ÛÂ ¿ÏÏ· fiÚÁ·Ó·, ÂÓÒ ¤¯ÂÈ ÂÚÈÁÚ·ÊÂ›

ÂÚ›ÙˆÛË HLH ÌÂ ·ÔÎÏÂÈÛÙÈÎ‹ ÂÓÙfiÈÛË ÛÙÔ

∫¡™ (8,11).

¶·ıÔÊ˘ÛÈÔÏÔÁ›·

√È ˘Â‡ı˘ÓÔÈ ·ıÔÊ˘ÛÈÔÏÔÁÈÎÔ› ÌË¯·ÓÈÛÌÔ› ‰ÂÓ

Â›Ó·È ·ÔÏ‡Ùˆ˜ ÁÓˆÛÙÔ› Î·È Î·Ù·ÓÔËÙÔ›, ¤¯Ô˘Ó ·Ô-

Î·Ï˘ÊıÂ› fiÌˆ˜ ÔÏÏ¤˜ ·fi ÙÈ˜ ·ÏÏ·Á¤˜ Ô˘ Û˘Ì-

‚·›ÓÔ˘Ó ÛÂ Î˘ÙÙ·ÚÈÎfi Î·È ÌÔÚÈ·Îfi Â›Â‰Ô (12).

£ÂˆÚÂ›Ù·È Û‡Ó‰ÚÔÌÔ ˘ÂÚÊÏÂÁÌÔÓ‹˜, fiˆ˜ Û·-

ÊÒ˜ ÚÔÎ‡ÙÂÈ ·fi ÙË ‰È·›ÛÙˆÛË ˘ÂÚÎ˘ÙÙ·ÚÔÎÈ-

Ó·ÈÌ›·˜, Î·ıÒ˜ Î·È ÙËÓ ·‡ÍËÛË ¿ÏÏˆÓ ÚÔÊÏÂÁÌÔ-

Óˆ‰ÒÓ ÌÂÛÔÏ·‚ËÙÒÓ, fiˆ˜ Ô ·Ú¿ÁÔÓÙ·˜ Ó¤ÎÚˆ-

ÛË˜ ÙˆÓ fiÁÎˆÓ (TNF-·), ÔÈ ÈÓÙÂÚÏÂ˘Î›ÓÂ˜ 6-8-12-18

(IL-6, IL-8, IL-12, IL-18 Î.¿.), Ô ‰È·Ï˘Ùfi˜ ˘Ô‰Ô¯¤·˜

ÙË˜ ÈÓÙÂÚÏÂ˘Î›ÓË˜ 2 (sCD25), Ë ÊÏÂÁÌÔÓÒ‰Ë˜ Úˆ-

ÙÂ˝ÓË ÙˆÓ Ì·ÎÚÔÊ¿ÁˆÓ (macrophage inflammatory

protein: MIP-·), Ë ÈÓÙÂÚÊÂÚfiÓË Á (INF-Á) Î·È Ï‹-

ıÔ˜ ·ÈÌÔÔÈËÙÈÎÒÓ ·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ Ô˘

·ÂÏÂ˘ıÂÚÒÓÔÓÙ·È ·fi ÂÓÂÚÁÔÔÈËÌ¤Ó· ÏÂÌÊÔÎ‡Ù-

Ù·Ú· Î·È ÈÛÙÈÔÎ‡ÙÙ·Ú· ÛÂ ÔÏÏ¿ fiÚÁ·Ó· (51-52).

™ËÌ·ÓÙÈÎfi˜ ÚfiÏÔ˜ ·Ô‰›‰ÂÙ·È Î·È ÛÂ ·ıÔÏÔ-

ÁÈÎ¤˜ ÚˆÙÂ˝ÓÂ˜ Ô˘ Îˆ‰ÈÎÔÔÈÔ‡ÓÙ·È ·fi Ù·

91∞ÈÌÔÊ·ÁÔÎ˘ÙÙ·ÚÈÎ‹ ÏÂÌÊÔ˚ÛÙÈÔÎ˘ÙÙ¿ÚˆÛË

¶·È‰È·ÙÚÈÎ‹ 2009;72:16-22


ÌÂÙ·ÏÏ·ÁÌ¤Ó· ÁÔÓ›‰È· Ù· ÔÔ›· ˘¿Ú¯Ô˘Ó ÛÂ ¿ÙÔÌ·

ÌÂ FHL, ·ÏÏ¿ Î·È ÛÙÔ HLH, ÌÂ Î˘ÚÈfiÙÂÚÔ ÂÎÚfiÛˆ-

Ô ÙËÓ ÂÚÊÔÚ›ÓË.

∏ INF-Á ·ÚÔ˘ÛÈ¿˙ÂÈ ·ÚÎÂÙ¿ „ËÏfiÙÂÚÂ˜ Û˘ÁÎÂ-

ÓÙÚÒÛÂÈ˜ ÛÙÔ Ï¿ÛÌ· Î·Ù¿ ÙËÓ ÂÓÂÚÁfi Ê¿ÛË ÙË˜ Ófi-

ÛÔ˘, ·fi fi,ÙÈ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ÛË„·ÈÌ›· ‹ ·˘ÙÔ¿ÓÔÛÂ˜

·ı‹ÛÂÈ˜. √È Î˘ÙÙ·ÚÔÎ›ÓÂ˜ Â˘ı‡ÓÔÓÙ·È ÁÈ· ÙÈ˜ ·Ú·-

ÙËÚÔ‡ÌÂÓÂ˜ Î·Ù·ÛÙ¿ÛÂÈ˜ ÙË˜ ÓfiÛÔ˘, fiˆ˜ ÔÈ Î˘ÙÙ·-

ÚÔÂÓ›Â˜, Ë ˘ÂÚÙÚÈÁÏ˘ÎÂÚÈ‰·ÈÌ›· Î·È ÔÈ ‰È·Ù·Ú·¯¤˜

ÙË˜ ‹ÍË˜. ∏ ÊÏÂÁÌÔÓÒ‰Ë˜ Î˘ÙÙ·ÚÔÎ›ÓË IL-1‚ ‰ÂÓ

Â›Ó·È ·˘ÍËÌ¤ÓË ÛÙÈ˜ ÎÏ·ÛÈÎ¤˜ ÂÚÈÙÒÛÂÈ˜ HLH,

ÂÓÒ ·ÓÙÈı¤Ùˆ˜ ÔÏ‡ ·˘ÍËÌ¤Ó· Â›Â‰· sCD-25

(>10000 U/ml) ‰ËÏÒÓÔ˘Ó ‰˘ÛÌÂÓ‹ ÚfiÁÓˆÛË ÁÈ·

fiÏÂ˜ ÙÈ˜ Î·ÙËÁÔÚ›Â˜ ·ÛıÂÓÒÓ (13,10,60).

∏ ÊÂÚÚÈÙ›ÓË, Â›ÛË˜ ÛËÌ·ÓÙÈÎfi˜ ‰Â›ÎÙË˜, ·˘Í¿-

ÓÂÙ·È ÏfiÁˆ ÙÔ˘ ÔÍÂÈ‰ˆÙÈÎÔ‡ stress Î·È ÌÔÚÂ› Ó·

Û¯ÂÙ›˙ÂÙ·È ÌÂ ·ÓÙÈÛÙ·ıÌÈÛÙÈÎ‹ ·ÓÔÛÔÏÔÁÈÎ‹ ·¿-

ÓÙËÛË ÛÙÔ HLH.

∏ ·ÓÂÍ¤ÏÂÁÎÙË ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ ·ÓÔÛÔÏÔÁÈÎÒÓ

Î˘ÙÙ¿ÚˆÓ Á›ÓÂÙ·È Èı·ÓÒ˜ ÏfiÁˆ ·Ó·ÔÙÂÏÂÛÌ·ÙÈ-

Î‹˜ ·ÓÔÛÔÏÔÁÈÎ‹˜ ·¿ÓÙËÛË˜ Ô˘ ˘ÚÔ‰ÔÙÂ›Ù·È

·fi ÂÍˆÁÂÓ‹ ÂÚÂı›ÛÌ·Ù·, fiˆ˜ Â›Ó·È ÔÈ ÏÔÈÌÔÁfiÓÔÈ

ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ› Î·È ÔÈ ÙÔÍ›ÓÂ˜, ‹ ·fi ÂÓ‰ÔÁÂÓÂ›˜

·Ú¿ÁÔÓÙÂ˜, fiˆ˜ ÙÔ ÔÍÂÈ‰ˆÙÈÎfi stress, Ë ÈÛÙÈÎ‹ Î·-

Ù·ÛÙÚÔÊ‹ ‹ ÚÔ˚fiÓÙ· ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ (13).

∆Ô ˘ÔÎÂ›ÌÂÓÔ ·ÓÔÛÔÏÔÁÈÎfi ¤ÏÏÂÈÌÌ· Ô˘ Û˘Ì-

‚¿ÏÏÂÈ ÛÙËÓ ·Ó¿Ù˘ÍË HLH ÌÔÚÂ› Ó· Â›Ó·È ÎÏËÚÔ-

ÓÔÌÔ‡ÌÂÓË ‰È·Ù·Ú·¯‹ ÙˆÓ ·ÓÔÛÔ˚Î·ÓÒÓ Î˘ÙÙ¿ÚˆÓ

‹ Â›ÎÙËÙË, fiˆ˜ .¯. È·ÙÚÔÁÂÓ¤˜ ·ÓÔÛÔÏÔÁÈÎfi ¤Ï-

ÏÂÈÌÌ· Î·ÙfiÈÓ ÌÂÙ·ÌfiÛ¯Â˘ÛË˜ ‹ Î˘ÙÙ·ÚÔÙÔÍÈÎ‹˜

ıÂÚ·Â›·˜. ∆Ô Â›ÎÙËÙÔ ¤ÏÏÂÈÌÌ· ÛÙËÓ ·ÓÔÛ›· ÌÔ-

ÚÂ› Â›ÛË˜ Ó· Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ÏÔ›ÌˆÍË˜ ÙˆÓ ·ÓÔ-

ÛÔ˚Î·ÓÒÓ Î˘ÙÙ¿ÚˆÓ ‹ Ó· ÚÔÎ·ÏÂ›Ù·È ¤ÌÌÂÛ· Ì¤Ûˆ

·ÓÔÛÔÎ·Ù·ÛÙ·ÏÙÈÎ‹˜ ‰Ú¿ÛË˜ ÙˆÓ ÊÏÂÁÌÔÓˆ‰ÒÓ ÌÂ-

ÛÔÏ·‚ËÙÒÓ.

°ÂÓÈÎ¿, ÙÔ HLH Â›Ó·È ˘ÂÚÊÏÂÁÌÔÓÒ‰Â˜ Û‡Ó‰ÚÔ-

ÌÔ, Ô˘ ˘Ô‰È·ÁÈÁÓÒÛÎÂÙ·È Î·È ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi

˘ÂÚ‰Ú·ÛÙ‹ÚÈ· Ê·ÁÔÎ‡ÙÙ·Ú·, ÌË ·ÔÙÂÏÂÛÌ·ÙÈÎ‹

¤Ó·ÚÍË ÙË˜ ·fiÙˆÛË˜ Î·È ÌÂÈˆÌ¤ÓË ‰Ú·ÛÙËÚÈfiÙË-

Ù· ÙˆÓ Î˘ÙÙ¿ÚˆÓ ∆ Î·È ¡∫, Ô˘ Â›Ó·È ÌfiÓÈÌË ÛÙÔ˘˜

ÚˆÙÔ·ıÂ›˜ ÁÂÓÂÙÈÎ¿ Ù‡Ô˘˜ (5,13).

∏ ·Ó·ÔÙÂÏÂÛÌ·ÙÈÎ‹ ‰Ú¿ÛË ÙˆÓ ¡∫ Î·È ÙË˜ Î˘Ù-

Ù·ÚÔÙÔÍÈÎfiÙËÙ·˜ ÙˆÓ ∆, Û‡ÌÊ˘ÙË ‹ Â›ÎÙËÙË, ÌÔ-

ÚÂ› Ó· Â›Ó·È ÎÔÈÓfi˜ ÌË¯·ÓÈÛÌfi˜ ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ

HLH, Ô˘ Ô‰ËÁÂ› ÛÂ ·ÚfiÌÔÈÂ˜ ÎÏÈÓÈÎ¤˜ ÂÎ‰ËÏÒ-

ÛÂÈ˜ (13).

¢˘ÛÙ˘¯Ò˜, ÔÈ ÂÍÂÙ¿ÛÂÈ˜ Ô˘ ÌÔÚÔ‡Ó Ó· ·ÔÎ·-

Ï‡„Ô˘Ó ÙÔ˘˜ ÂÎ¿ÛÙÔÙÂ ÂÌÏÂÎfiÌÂÓÔ˘˜ ÌË¯·ÓÈ-

ÛÌÔ‡˜, Á›ÓÔÓÙ·È ÌfiÓÔ ÛÂ Î¤ÓÙÚ· ÌÂ ˘„ËÏ‹ ÂÍÂÈ‰›-

ÎÂ˘ÛË Î·È Ù· ·ÔÙÂÏ¤ÛÌ·Ù¿ ÙÔ˘˜ Û¿ÓÈ· Â›Ó·È ‰È·-

ı¤ÛÈÌ· ÛÙËÓ ¤Ó·ÚÍË ÙË˜ ÓfiÛÔ˘, ÙfiÙÂ ‰ËÏ·‰‹ Ô˘

Ú¤ÂÈ Ó· ÏËÊıÔ‡Ó ·ÔÊ¿ÛÂÈ˜ ÁÈ· ÙË ıÂÚ·Â›· Î·È

ÙËÓ ÂÚ·ÈÙ¤Úˆ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ·ÛıÂÓÔ‡˜ (53).

∂ÚÁ·ÛÙËÚÈ·Î¿ - ÈÛÙÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù·

∆· ÂÚÁ·ÛÙËÚÈ·Î¿ Â˘Ú‹Ì·Ù· Ô˘ ˘ÔÛÙËÚ›˙Ô˘Ó

ÙË ‰È¿ÁÓˆÛË ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1

(13,28,50). ∏ ÔÌ¿‰· ÌÂÏ¤ÙË˜ ÙÔ˘ 1994 (HLH-94)

ıÂˆÚÂ› fiÙÈ Ù· Â›Â‰· ÊÂÚÚÈÙ›ÓË˜ >500 Ìg/L ‰È·ı¤-

ÙÔ˘Ó ÂÈ‰ÈÎfiÙËÙ· 80% ÁÈ· ÙË ‰È¿ÁÓˆÛË HLH. ∂›-

ÛË˜, ·Ú·ÙËÚÔ‡ÓÙ·È ·˘ÍËÌ¤ÓÂ˜ ÙÈÌ¤˜ ÛÂ Î˘ÙÙ·ÚÔ-

Î›ÓÂ˜, INF-Á, ∆¡F-· Î·È ÌÂÈˆÌ¤ÓË ‰Ú·ÛÙÈÎfiÙËÙ·

ÙˆÓ Î˘ÙÙ¿ÚˆÓ ¡∫ Î·È ÌÂÈˆÌ¤ÓË Î˘ÙÙ·ÚÔÙÔÍÈÎ‹

‰Ú¿ÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ ∆.

∆· ·ıÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù· ÛÙÔ HLH Â›Ó·È ·fiÚ-

ÚÔÈ· ÙÔ˘ ÂÈıÂÙÈÎÔ‡ ÔÏÏ·Ï·ÛÈ·ÛÌÔ‡ ÙˆÓ Î·Ù¿ Ù·

¿ÏÏ· Ê˘ÛÈÔÏÔÁÈÎÒÓ ÈÛÙÈÔÎ˘ÙÙ¿ÚˆÓ Î·È ÏÂÌÊÔÎ˘ÙÙ¿-

ÚˆÓ ∆ ÛÙÔ˘˜ ‰È¿ÊÔÚÔ˘˜ ÈÛÙÔ‡˜. ∆Ô Ô˘ÛÈ·ÛÙÈÎfiÙÂÚÔ

‰È·ÁÓˆÛÙÈÎfi Â‡ÚËÌ· Â›Ó·È Ë ·ÈÌÔÊ·ÁÔÎ˘ÙÙ¿ÚˆÛË

ÙˆÓ ÂÚ˘ıÚÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ, ¿ÏÏˆÓ ÏÂ˘ÎÒÓ ·ÈÌÔ-

ÛÊ·ÈÚ›ˆÓ ‹ ·ÈÌÔÂÙ·Ï›ˆÓ Ì¤Û· ÛÙÔÓ Ì˘ÂÏfi ÙˆÓ

ÔÛÙÒÓ, ÛÙÔÓ ÛÏ‹Ó· Î·È ÛÙÔ˘˜ ÏÂÌÊ·‰¤ÓÂ˜, Ô˘

ÌÔÚÂ› Ó· ÌËÓ Â›Ó·È ÂÌÊ·Ó‹˜ ·fi ÙËÓ ·Ú¯‹ Î·È Ó·

¯ÚÂÈ·ÛÙÔ‡Ó Â·Ó·Ï·Ì‚·ÓfiÌÂÓÂ˜ ÂÍÂÙ¿ÛÂÈ˜ ÙˆÓ

ÈÛÙÒÓ ·˘ÙÒÓ. ™Â ·ÛıÂÓÂ›˜ ·fi ÙË °ÂÚÌ·Ó›·, ·ÈÌÔ-

Ê·ÁÔÎ˘ÙÙ¿ÚˆÛË ‹Ù·Ó ·ÚÔ‡Û· ÌfiÓÔ ÛÙÔ 32% ÙˆÓ



¶›Ó·Î·˜ 1. ¢È·ÁÓˆÛÙÈÎ¿ ÎÚÈÙ‹ÚÈ· ·ÈÌÔÊ·ÁÔÎ˘ÙÙ·ÚÈÎ‹˜ ÏÂÌÊÔ˚-ÛÙÈÔÎ˘ÙÙ¿ÚˆÛË˜ (28)

1. ªÔÚÈ·Î‹ ‰È¿ÁÓˆÛË Û˘Ì‚·Ù‹ ÌÂ ∞º™2. ¢È·ÁÓˆÛÙÈÎ¿ ÎÚÈÙ‹ÚÈ· ∞º™: Ú¤ÂÈ Ó· ÏËÚÔ‡ÓÙ·È 5 ‹

ÂÚÈÛÛfiÙÂÚ· ·fi Ù· ·ÎfiÏÔ˘ı· 8: i) ¶˘ÚÂÙfi˜

ii) ™ÏËÓÔÌÂÁ·Ï›·iii) ∫˘ÙÙ·ÚÔÂÓ›Â˜ (Ó· ÂËÚÂ¿˙ÔÓÙ·È ≥2 Î˘ÙÙ·ÚÈÎ¤˜

ÛÂÈÚ¤˜ ÛÙÔ ÂÚÈÊÂÚÈÎfi ·›Ì·) - ∞ÈÌÔÛÊ·ÈÚ›ÓË <90 g/L (ÓÂÔÁÓ¿ <4 Â‚‰ÔÌ¿‰ˆÓ:

·ÈÌÔÛÊ·ÈÚ›ÓË <100 g/L)- ∞ÈÌÔÂÙ¿ÏÈ· <100x109/L- √˘‰ÂÙÂÚfiÊÈÏ· <1,0x109/L

iv) ÀÂÚÙÚÈÁÏ˘ÎÂÚÈ‰·ÈÌ›· Î·È/‹ ˘Ô˚Óˆ‰ÔÁÔÓ·ÈÌ›·:- ∆ÚÈÁÏ˘ÎÂÚ›‰È· Ó‹ÛÙÂˆ˜ ≥265 mg/dl- πÓˆ‰ÔÁfiÓÔ ≤1,5 g/L

Ó) ∞ÈÌÔÊ·ÁÔÎ˘ÙÙ¿ÚˆÛË ÛÂ: Ì˘ÂÏfi ÔÛÙÒÓ, ÛÏ‹Ó·, ÏÂÌÊ·‰¤ÓÂ˜ ‹ ∂¡À: ¯ˆÚ›˜ ÂÓ‰Â›ÍÂÈ˜ Î·ÎÔ‹ıÂÈ·˜

vi) ∂Ï·ÙÙˆÌ¤ÓË ‹ Ï‹ÚË˜ ¤ÏÏÂÈ„Ë ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÙˆÓÎ˘ÙÙ¿ÚˆÓ ¡∫ (Û‡ÌÊˆÓ· ÌÂ ÙÈ˜ ÙÈÌ¤˜ ·Ó·ÊÔÚ¿˜ ÙÔ˘ÂÎ¿ÛÙÔÙÂ ÂÚÁ·ÛÙËÚ›Ô˘)

vii) ∞˘ÍËÌ¤Ó· Â›Â‰· ÊÂÚÚÈÙ›ÓË˜ (≥500 Ìg/L)viii) ¢È·Ï˘Ùfi˜ ˘Ô‰Ô¯¤·˜ ÙË˜ ÈÓÙÂÚÏÂ˘Î›ÓË˜ 2 (sCD25)

¿Óˆ ·fi Ù· Ê˘ÛÈÔÏÔÁÈÎ¿ fiÚÈ· ÁÈ· ÙËÓ ËÏÈÎ›·

∂ÈÎÔ˘ÚÈÎ¤˜ ∂Ó‰Â›ÍÂÈ˜:ñ ™˘ÌÙÒÌ·Ù· ∫¡™ Î·È ∂˘Ú‹Ì·Ù· ∂¡À: ·)Ì¤ÙÚÈ· ÏÂÈÔÎ˘Ù-

Ù¿ÚˆÛË 20-80 ÏÂÌÊÔÎ‡ÙÙ·Ú·/ÌL ENY (Î˘Ú›ˆ˜ ∆ ÏÂÌÊÔ-Î‡ÙÙ·Ú·) ‚) ·‡ÍËÛË ÏÂ˘ÎÒÌ·ÙÔ˜ ÛÂ 0,5-1 g/L ENY Á) ·ÈÌÔ-Ê·ÁÔÎ˘ÙÙ¿ÚˆÛË ÛÙ· ÈÛÙÈÔÎ‡ÙÙ·Ú·-Ì·ÎÚÔÊ¿Á· ÙÔ˘ ∂¡À

ñ ∆Ú·ÓÛ·ÌÈÓ·Û·ÈÌ›·ñ ÃÔÏÂÚ˘ıÚÈÓ·ÈÌ›·ñ LDH ÔÚÔ‡ >1000 U/L


ÂÚÈÙÒÛÂˆÓ ÛÙËÓ ÚÒÙË Ï‹„Ë Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ

Î·È ÛÙÔ 85% ÙË ÛÙÈÁÌ‹ ÙË˜ ‰È¿ÁÓˆÛË˜ (13).

∏ Ë·ÙÈÎ‹ ·ÓÂ¿ÚÎÂÈ· (ÏfiÁˆ ‰È‹ıËÛË˜ ÙÔ˘ ‹·-

ÙÔ˜ Î·È ÙË˜ ‰Ú¿ÛË˜ ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ) Â›Ó·È ÂÍ¤¯ÔÓ

¯·Ú·ÎÙËÚÈÛÙÈÎfi ÛÂ ÔÏÏÔ‡˜ ·ÛıÂÓÂ›˜, Ô˘ ÌÔÚÂ›

Ó· ÂÌÊ·Ó›˙Ô˘Ó È‰È·ÈÙ¤Úˆ˜ ·˘ÍËÌ¤Ó· Â›Â‰· Ë·ÙÈ-

ÎÒÓ ÂÓ˙‡ÌˆÓ, ¯ÔÏÂÚ˘ıÚ›ÓË˜, ·ÏÏ¿ Î·È ˘ÔÏÂ˘ÎˆÌ·-

ÙÈÓ·ÈÌ›· Î·È ÌÂÈˆÌ¤ÓË ‰Ú·ÛÙËÚÈfiÙËÙ· ÔÏÏÒÓ ·fi

ÙÔ˘˜ ·Ú¿ÁÔÓÙÂ˜ ‹ÍË˜ (54).

∏ ÙÂÎÌËÚ›ˆÛË ÙË˜ ·ÈÌÔÊ·ÁÔÎ˘ÙÙ¿ÚˆÛË˜ ÛÙÔ

ÚÒÙÔ ‰Â›ÁÌ· Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ, ÛÂ ÂÚ›Ô˘ 20%

ÙˆÓ ÂÚÈÙÒÛÂˆÓ, Â›Ó·È ‰‡ÛÎÔÏË ‹ Î·È ·‰‡Ó·ÙË,

fiÌˆ˜ ÙÔ ÁÂÁÔÓfi˜ ·˘Ùfi ‰ÂÓ ı· Ú¤ÂÈ Ó· ·ÔÙÂÏÂ›

ÂÌfi‰ÈÔ ÛÙËÓ ¿ÌÂÛË ¤Ó·ÚÍË ÙË˜ ıÂÚ·Â›·˜, ÂÊfiÛÔÓ

ÏËÚÔ‡ÓÙ·È Ù· ¿ÏÏ· ‰È·ÁÓˆÛÙÈÎ¿ ÎÚÈÙ‹ÚÈ·

(13,15,28). ∂›ÛË˜, Â¿Ó ‰È·ÈÛÙˆıÂ› ÌÂÙ¿ÏÏ·ÍË ÛÙÔ

ÁÔÓ›‰ÈÔ ÙË˜ ÂÚÊÔÚ›ÓË˜, ÙfiÙÂ ‰ÂÓ ¯ÚÂÈ¿˙ÔÓÙ·È ¿ÏÏ·

‰È·ÁÓˆÛÙÈÎ¿ ÎÚÈÙ‹ÚÈ·.

∂ÈÏ¤ÔÓ, ˘ÔÛÙËÚ›˙ÂÙ·È fiÙÈ ÁÈ· ÙË ‰È¿ÁÓˆÛË

HLH Ú¤ÂÈ Ó· Û˘Ó˘¿Ú¯ÂÈ Ï‹ÚË˜ ¤ÏÏÂÈ„Ë ‰Ú·-

ÛÙËÚÈfiÙËÙ·˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ¡∫, ÌÂ Û˘ÁÎÂÓÙÚÒÛÂÈ˜

ÊÂÚÚÈÙ›ÓË˜ >500 Ìg/L Î·È sCD25 >2400 U/ml

(15,28). √ ‰È·Ï˘Ùfi˜ ˘Ô‰Ô¯¤·˜ ·ÈÌÔÛÊ·ÈÚ›ÓË˜-

·ÙÔÛÊ·ÈÚ›ÓË˜ CD163, Ô˘ Â›Ó·È ÂÈ‰ÈÎfi˜ ÁÈ· Ù· Ì·-

ÎÚÔÊ¿Á·, ·ÔÙÂÏÂ› Ó¤Ô ‰Â›ÎÙË ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô ÙË˜

‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÙÔ˘ HLH. ∆· Â›Â‰¿ ÙÔ˘ Û¯ÂÙ›˙Ô-

ÓÙ·È ÛÙÂÓ¿ ÌÂ ÙË ‰Ú·ÛÙËÚÈfiÙËÙ· ÙË˜ ÓfiÛÔ˘ Î·È Â›-

ÛË˜ ÌÂ ÙË ÊÂÚÚÈÙ›ÓË ÙÔ˘ ÔÚÔ‡.

∏ ÛÙ·‰ÈÔÔ›ËÛË ÙˆÓ ÎÏÈÓÈÎÒÓ Î·È ÈÛÙÔÏÔÁÈÎÒÓ

Â˘ÚËÌ¿ÙˆÓ Û˘ÓÔ„›˙ÂÙ·È ÛÙÔ˘˜ ¶›Ó·ÎÂ˜ 2 Î·È 3 (8).

¶ÚÔÛ‚ÔÏ‹ ÙÔ˘ ∫¡™

ŸÙ·Ó ˘¿Ú¯ÂÈ ÂÈÓ¤ÌÂÛË ÙÔ˘ ∫¡™, ÙÔ Î˘ÚÈfiÙÂÚÔ

ÈÛÙÔ·ıÔÏÔÁÈÎfi ¯·Ú·ÎÙËÚÈÛÙÈÎfi Â›Ó·È Ë ÂÎÙÂÙ·Ì¤-

ÓË, ÌË Î·ÎÔ‹ıË˜ ‰È‹ıËÛË ·fi ÏÂÌÊÔÎ‡ÙÙ·Ú· Î·È

Ì·ÎÚÔÊ¿Á·, Ù˘ÈÎfiÙÂÚ· ÌÂ ·ÈÌÔÊ·ÁÔÎ˘ÙÙ¿ÚˆÛË,

Û˘Ó‹ıˆ˜ ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ‰È‹ıËÛË Î·È ÛÂ ¿ÏÏ· fiÚ-

Á·Ó·, fiˆ˜ ÛÏ¿¯Ó·, ÏÂÌÊ·‰¤ÓÂ˜, Ì˘ÂÏfi˜ ÙˆÓ

ÔÛÙÒÓ Î.¿. (55). ªÔÚÂ› Ó· ˘¿Ú¯ÂÈ ÂÈÓ¤ÌËÛË Î·È

ÙˆÓ ÂÚÈÊÂÚÈÎÒÓ ÓÂ‡ÚˆÓ (8).

∂›ÛË˜, Â›Ó·È ÂÓ‰È·Ê¤ÚÔÓ fiÙÈ ¤¯ÂÈ ‰È·ÈÛÙˆıÂ›

Û˘Û¯¤ÙÈÛË ÙË˜ ÎÏÈÓÈÎ‹˜ ‚·Ú‡ÙËÙ·˜ ÙË˜ ÚÔÛ‚ÔÏ‹˜

ÙÔ˘ ∫¡™ Î·È ÙˆÓ ÓÂ˘ÚÔ·ıÔÏÔÁÔ·Ó·ÙÔÌÈÎÒÓ ·Ï-

ÏÔÈÒÛÂˆÓ (8).

∏ ÓfiÛÔ˜ ÙÔ˘ ∫¡™ Ê·›ÓÂÙ·È fiÙÈ Â›Ó·È ÈÔ Û˘¯Ó‹

ÛÙ· ¿ÙÔÌ· Ô˘ Ê¤ÚÔ˘Ó ÙË ÌÂÙ¿ÏÏ·ÍË ªunc 13-4

(FHL-3) (56).

√È ·ÛıÂÓÂ›˜ ÌÂ ÚÔÛ‚ÔÏ‹ ÙÔ˘ ∫¡™ ÌÔÚÔ‡Ó Ó·

Ù·ÍÈÓÔÌËıÔ‡Ó ˆ˜ ¿Û¯ÔÓÙÂ˜ Â›ÙÂ ·fi ÏÂÌÊÔÎ˘ÙÙ·-

ÚÈÎ‹ ÌËÓÈÁÁ›ÙÈ‰·/ÂÁÎÂÊ·Ï›ÙÈ‰·, fiÔ˘ ‰ÂÓ ˘¿Ú¯ÂÈ

Î·Ó¤Ó· ¿ÏÏÔ ÓÂ˘ÚÔÏÔÁÈÎfi Û‡ÌÙˆÌ· ÂÎÙfi˜ ·fi ÌË-

ÓÈÁÁÈÛÌfi Î·È ·ıÔÏÔÁÈÎfi ∂¡À, Â›ÙÂ ·fi «ÓÂ˘ÚÔÏÔÁÈ-

Î‹ Û˘ÌÙˆÌ·ÙÔÏÔÁ›·», ‰ËÏ·‰‹ ÔÔÈÔ‰‹ÔÙÂ ÓÂ˘-

ÚÔÏÔÁÈÎfi Úfi‚ÏËÌ· ‹ Û·ÛÌÔ‡˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È ÌÂ

‰È·Ù·Ú·¯¤˜ ÙÔ˘ ∫¡™ (55).

∆· Â˘Ú‹Ì·Ù· ·fi ÙÔ ∂¡À ÛÙË ÏÂÌÊÔÎ˘ÙÙ·ÚÈÎ‹

ÌËÓÈÁÁ›ÙÈ‰· ÙÔ˘ ∞º™ Û˘ÓÔ„›˙ÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 4.

∂›ÛË˜, Â›Ó·È Ú‹ÛÈÌË Ë Ì¤ÙÚËÛË ∂¡À Î˘ÙÙ·ÚÔÎ›ÓË˜

Î·È ÓÂÔÙÂÚ›ÓË˜ ÛÙÔ ∂¡À (8,55).

∆Ô Î˘ÙÙ·ÚÈÎfi ÂÚÈÂ¯fiÌÂÓÔ ÙÔ˘ ∂¡À ‰ÂÓ Ê·›ÓÂ-

Ù·È fiÙÈ ·ÔÙÂÏÂ› È‰È·›ÙÂÚ· ¯Ú‹ÛÈÌÔ ‰Â›ÎÙË ÙË˜ ‚·-

Ú‡ÙËÙ·˜ ÂÈÓ¤ÌËÛË˜ ÙÔ˘ ∫¡™, ÛÂ ·ÓÙ›ıÂÛË ÌÂ ÙÔ

ÏÂ‡ÎˆÌ·, ÙÔ ÔÔ›Ô ‹Ù·Ó È‰È·›ÙÂÚ· ·˘ÍËÌ¤ÓÔ ÛÂ

·È‰È¿ ÌÂ ÈÔ ÛÔ‚·Úfi ÎÏÈÓÈÎfi ÛÙ¿‰ÈÔ (ÛÙ¿‰ÈÔ 3),

Î·ıÒ˜ Î·È ÌÂ ÙËÓ ÈÔ ÛÔ‚·Ú‹ ÓÂ˘ÚÔ·ıÔÏÔÁÔ·Ó·-

ÙÔÌÈÎ‹ ÛÙ·‰ÈÔÔ›ËÛË (ÛÙ¿‰ÈÔ πππ) (8). ¶·ÚfiÏ· ·˘-

Ù¿, ÙÔ ∂¡À ÌÔÚÂ› Ó· Â›Ó·È Ê˘ÛÈÔÏÔÁÈÎfi, ·ÎfiÌ· Î·È

¶›Ó·Î·˜ 4. ∂˘Ú‹Ì·Ù· ·fi ÙÔ ∂¡À ÛÙË ÏÂÌÊÔÎ˘ÙÙ·ÚÈÎ‹ ÌËÓÈÁÁ›-ÙÈ‰· ÙÔ˘ ∞º™

i) ª¤ÙÚÈ· ÏÂÈÔÎ˘ÙÙ¿ÚˆÛË: 20-80 ÏÂÌÊÔÎ‡ÙÙ·Ú·/ÌL ∂¡À(Î˘Ú›ˆ˜ ÏÂÌÊÔÎ‡ÙÙ·Ú· ∆)

ii) ∞‡ÍËÛË ÙË˜ Û˘ÁÎ¤ÓÙÚˆÛË˜ ÙÔ˘ ÏÂ˘ÎÒÌ·ÙÔ˜ 0,5-1 g/L∂¡À

iii) ∞ÈÌÔÊ·ÁÔÎ˘ÙÙ¿ÚˆÛË ÛÙ· ÈÛÙÈÔÎ‡ÙÙ·Ú· Î·È Ì·ÎÚÔÊ¿Á·ÙÔ˘ ∂¡À (Û¿ÓÈÔ Â‡ÚËÌ·, ·ÏÏ¿ ÈÛ¯˘Ú¿ ‰ËÏˆÙÈÎfi ÁÈ· ÙËÓfiÛÔ)


¶·È‰È·ÙÚÈÎ‹ 2009;72:16-22

¶›Ó·Î·˜ 2. ∫ÏÈÓÈÎ‹ ÛÙ·‰ÈÔÔ›ËÛË ÙˆÓ ÓÂ˘ÚÔÏÔÁÈÎÒÓ Û˘ÌÙˆÌ¿-ÙˆÓ ÛÙÔ ∫¡™-∞º™

™Ù¿‰ÈÔ 0: ¶Ï‹ÚË˜ ¤ÏÏÂÈ„Ë ÓÂ˘ÚÔÏÔÁÈÎÒÓ ÂÎ‰ËÏÒÛÂˆÓ ‹ÌË ÂÈ‰ÈÎ¤˜ ÓÂ˘ÚÔÏÔÁÈÎ¤˜ ·ÓˆÌ·Ï›Â˜

™Ù¿‰ÈÔ 1: ªË ÂÈ‰ÈÎ¿ ÓÂ˘ÚÔÏÔÁÈÎ¿ ÛËÌÂ›·, fiˆ˜ ÛÊ‡˙Ô˘-Û· ËÁ‹ ‹ ˘ÔÙÔÓ›·

™Ù¿‰ÈÔ 2: ∂È‰ÈÎ¿ ÓÂ˘ÚÔÏÔÁÈÎ¿ ÛËÌÂ›·, fiˆ˜ ·˘¯ÂÓÈÎ‹‰˘ÛÎ·Ì„›·, Û·ÛÌÔ›, ·Ú¤ÛÂÈ˜

™Ù¿‰ÈÔ 3: ™Ô‚·Ú‹ ÓÂ˘ÚÔÏÔÁÈÎ‹ ÓfiÛÔ˜, fiˆ˜ ÚÔÔ‰Â˘ÙÈ-Î‹ „˘¯ÔÎÈÓËÙÈÎ‹ Î·ı˘ÛÙ¤ÚËÛË ‹ ·ÒÏÂÈ· Û˘-ÓÂ›‰ËÛË˜ (ÎÒÌ·)

¶›Ó·Î·˜ 3. πÛÙÔÏÔÁÈÎ‹ ÛÙ·‰ÈÔÔ›ËÛË ÙˆÓ Â˘ÚËÌ¿ÙˆÓ ÛÙÔ ∫¡™-∞º™ (8)

™Ù¿‰ÈÔ 0: ¶Ï‹ÚË˜ ¤ÏÏÂÈ„Ë ÓÂ˘ÚÔ-·ıÔÏÔÁÔ·Ó·ÙÔÌÈÎÒÓÂ˘ÚËÌ¿ÙˆÓ

™Ù¿‰ÈÔ π: ªfiÓÔ ÏÂÙÔÌËÓÈÁÁÈÎ¤˜ ‰ÈËı‹ÛÂÈ˜ ·fi ÏÂÌÊÔ-Î‡ÙÙ·Ú· Î·È ÈÛÙÈÔÎ‡ÙÙ·Ú· /Ì·ÎÚÔÊ¿Á·. ¶ÂÚÈ-ÛÙ·ÛÈ·Î¿ ÂÚÈ·ÁÁÂÈ·Î‹ ‰È‹ıËÛË.

™Ù¿‰ÈÔ ππ: ◊È· ·ÚÂÁ¯˘Ì·ÙÈÎ‹ Û˘ÌÌÂÙÔ¯‹ ÌÂ ÂÓÙÔÓfiÙÂ-ÚË ÂÚÈ·ÁÁÂÈ·Î‹ ‰È‹ıËÛË, ·ÏÏ¿ Î·È ÂÓÙÔÓfiÙÂ-ÚË ‰È‹ıËÛË ÙˆÓ ÌËÓ›ÁÁˆÓ, Ô˘ ÂÓ›ÔÙÂ ÂÚÈ-Ï·Ì‚¿ÓÂÈ Î·È ÙÔÓ ˘ÔÎÂ›ÌÂÓÔ ÂÁÎÂÊ·ÏÈÎfi ÈÛÙfi.

™Ù¿‰ÈÔ πππ: ∂ÈÏ¤ÔÓ ÙË˜ ¤ÓÙÔÓË˜ Ì·˙ÈÎ‹˜ ÈÛÙÈÎ‹˜ ‰È‹ıË-ÛË˜ ·fi ÏÂÌÊÔÎ‡ÙÙ·Ú· Î·È ÈÛÙÈÔÎ‡ÙÙ·Ú·/Ì·-ÎÚÔÊ¿Á·, ·ÓÂ˘Ú›ÛÎÂÙ·È Ó¤ÎÚˆÛË ÙÔ˘ ÂÁÎÂÊ·-ÏÈÎÔ‡ ÈÛÙÔ‡ ÌÂ ÛËÌ·ÓÙÈÎ‹ ·ÛÙÚÔÁÏÔ›ˆÛË Î·ÈÛ¯ÂÙÈÎ¿ Ï›Á· ·ÊÚÒ‰Ë Ì·ÎÚÔÊ¿Á·. ªÔÚÂ› Ó·˘¿Ú¯Ô˘Ó Â·Û‚ÂÛÙÒÛÂÈ˜.


Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÎÏÈÓÈÎ¿ ÚÔ¯ˆÚËÌ¤ÓË˜ ÓfiÛÔ˘ ÙÔ˘

∫¡™ (8).

∞ÂÈÎÔÓÈÛÙÈÎ¿ Â˘Ú‹Ì·Ù·

ÀÂÚË¯ÔÁÚ·ÊÈÎ¿ Â˘Ú‹Ì·Ù· Î·Ù¿ ÙËÓ ·Ú¯ÈÎ‹

ÚÔÛ¤ÏÂ˘ÛË ÙˆÓ ·ÛıÂÓÒÓ Â›Ó·È (ÌÂ Êı›ÓÔ˘Û· ÛÂÈ-

Ú¿ Û˘¯ÓfiÙËÙ·˜): ·) ÛÏËÓÔÌÂÁ·Ï›·, ‚) Ë·ÙÔÌÂ-

Á·Ï›·, Á) ·ÛÎ›ÙË˜, ‰) ¿¯˘ÓÛË ÙÔ˘ ÙÔÈ¯ÒÌ·ÙÔ˜ ÙË˜

¯ÔÏË‰fi¯Ô˘ Î‡ÛÙË˜, Â) ·˘ÍËÌ¤ÓË ÂÚÈ˘Ï·›· Ë¯Ô-

Á¤ÓÂÈ·, ÛÙ) ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ·, ˙) ÏÂ˘ÚÈÙÈÎfi ÂÍ›-

‰ÚˆÌ· Î·È, Û·ÓÈfiÙÂÚ·, Ë) ÔÏÏ·Ï¤˜ ˘fiË¯Â˜

ÂÚÈÔ¯¤˜ ÛÙÔÓ ÛÏ‹Ó·, ÓÂÊÚÔÌÂÁ·Ï›·, Ï›ıÔÈ ÛÙË

¯ÔÏË‰fi¯Ô Î‡ÛÙË, ·˘ÍËÌ¤ÓË Ë¯ÔÁ¤ÓÂÈ· ÙÔ˘ ÊÏÔÈÔ‡

ÙˆÓ ÓÂÊÚÒÓ Î·È ¿¯˘ÓÛË ÙÔ˘ ÙÔÈ¯ÒÌ·ÙÔ˜ ÙÔ˘ ‰ˆ-

‰ÂÎ·‰·ÎÙ‡ÏÔ˘ (12).

™ÙËÓ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜, Â›Ó·È Èı·Ófi Ó·

˘¿Ú¯Ô˘Ó Î˘„ÂÏÈ‰ÈÎ¤˜ Î·È ‰È¿ÌÂÛÂ˜ ÛÎÈ¤˜ ÌÂ ÏÂ˘ÚÈ-

ÙÈÎ‹ Û˘ÏÏÔÁ‹, Û˘¯Ó¿ ÌÂ Ù·¯Â›· ÂÍ¤ÏÈÍË Î·È ·ÔÎ·Ù¿-

ÛÙ·ÛË-Ï‡ÛË, Ô˘ ÔÊÂ›ÏÔÓÙ·È ÛÂ ‰ÈËı‹ÛÂÈ˜ Î˘Ú›ˆ˜ ÙÔ˘

ÂÚÈ·ÁÁÂÈ·ÎÔ‡, ÙÔ˘ ÂÚÈ‚ÚÔÁ¯ÈÎÔ‡ ÈÛÙÔ‡ Î·È ÙÔ˘ ÂÓ‰Ô-

Î˘„ÂÏÈ‰ÈÎÔ‡ ‰È·ÊÚ¿ÁÌ·ÙÔ˜ (57). ∆· ·Ú·¿Óˆ Â˘Ú‹-

Ì·Ù· ÌÔÚÂ› Ó· ·Ú·¤ÌÔ˘Ó ÛÂ SARS ‹ ARDS (57).

™ÙËÓ ˘ÔÏÔÁÈÛÙÈÎ‹ Î·È Ì·ÁÓËÙÈÎ‹ ÙÔÌÔÁÚ·Ê›·, Ù·

Â˘Ú‹Ì·Ù· ÔÈÎ›ÏÏÔ˘Ó Î·È ÌÔÚÂ› Ó· Â›Ó·È ·ÎfiÌ· Î·È

Ê˘ÛÈÔÏÔÁÈÎ¿, ·Ú¿ Ù· ¤ÓÙÔÓ· Û˘ÌÙÒÌ·Ù· ·fi ÙÔ

∫¡™ (8). ÕÏÏÔÙÂ ÌÔÚÂ› Ó· ¿Ú¯Ô˘Ó ÂÓ‰Â›ÍÂÈ˜ ·˘ÍË-

Ì¤ÓË˜ ÂÓ‰ÔÎÚ¿ÓÈ·˜ ›ÂÛË˜, ·ÓÒÌ·ÏË ÏÂÙÔÌËÓÈÁÁÈÎ‹

ÂÓ›Û¯˘ÛË, ÂÛÙÈ·Î‹ Ó¤ÎÚˆÛË Î·È ˘fi˘ÎÓÂ˜ ÓÂÎÚˆÙÈ-

Î¤˜ ÂÚÈÔ¯¤˜, ÌÂ ·ÒÏÂÈ· ·ÚÂÁ¯˘Ì·ÙÈÎÔ‡ fiÁÎÔ˘ Î·È

·ÙÚÔÊ›· (8,50). ™ÙË Û˘Ó¤¯ÂÈ·, ÌÔÚÂ› Ó· ÂÌÊ·ÓÈÛÙÔ‡Ó

ÂÚÈÔ¯¤˜ ÌÂ Ó¤ÎÚˆÛË Î·È ÂÛÙÈ·Î‹ ‹ ‰È¿¯˘ÙË ·ÔÌ˘Â-

Ï›ÓˆÛË. ∂›ÛË˜, ÂÚÈÁÚ¿ÊÔÓÙ·È ÂÛÙÈ·Î¤˜ ·ÈÌÔÚÚ·Á›Â˜

Î·È ‰È¿Ù·ÛË ÙÔ˘ ˘ÔÛÎÏËÚ›‰ÈÔ˘ ¯ÒÚÔ˘ (50). ™ÙÔ˘˜

·ÛıÂÓÂ›˜ ÌÂ ÌËÓÈÁÁ›ÙÈ‰· ÌfiÓÔ, ÌÔÚÂ› Ó· ·ÓÈ¯ÓÂ‡ÔÓÙ·È

ÌfiÓÔ ·ÓˆÌ·Ï›Â˜ ÛÙË ÏÂ˘Î‹ Ô˘Û›· (55).

¢È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË

∆Ô ∞º™ ÌÔÚÂ› Ó· ÌÈÌÂ›Ù·È ‰È¿ÊÔÚ· ÓÔÛ‹Ì·Ù·

Î·È ÁÈ’ ·˘Ùfi Ú¤ÂÈ Ó· ‰È·ÊÔÚÔ‰È·ÁÓˆÛıÂ› ·fi ÔÏ-

Ï·Ï‹ ·ÓÂ¿ÚÎÂÈ· ÔÚÁ¿ÓˆÓ, ˘ÚÂÙfi ·ÁÓÒÛÙÔ˘ ·È-

ÙÈÔÏÔÁ›·˜, ÛË„·ÈÌ›·, Ë·Ù›ÙÈ‰·, ÔÏÏ·Ï‹ ÛÎÏ‹-

Ú˘ÓÛË, Û‡Ó‰ÚÔÌÔ Reye, ARDS, SARS, ÔÍÂ›· ÓÂÎÚˆÙÈ-

Î‹ ÂÁÎÂÊ·ÏÔ¿ıÂÈ·, ÂÁÎÂÊ·ÏÔ¿ıÂÈ· ÙÔ˘ Leigh, Î·-

ÎfiËıÂ˜ ÁÏÔ›ˆÌ·, ÔÍÂ›· ·ÈÌÔÚÚ·ÁÈÎ‹ ÏÂ˘ÎÔÂÁÎÂÊ·-

Ï›ÙÈ‰·, ÛˆÌ·ÙÈÎ‹ Î·ÎÔÔ›ËÛË, ·ÏÏÂÚÁÈÎ‹ ÔÚÊ‡Ú·,

ÈÛÙÈÔÎ˘ÙÙ¿ÚˆÛË ·fi Î‡ÙÙ·Ú· ÙÔ˘ Langerhans, Ï¤Ì-

ÊˆÌ· ‹ ¿ÏÏÂ˜ Î·ÎÔ‹ıÂÈÂ˜ (3,11,12,49,50,61).

∞fi Ù· ·Ú·¿Óˆ Á›ÓÂÙ·È Î·Ù·ÓÔËÙfi ÁÈ·Ù› Ë ‰È¿-

ÁÓˆÛË Û˘Ó‹ıˆ˜ Î·ı˘ÛÙÂÚÂ› Î·È Á›ÓÂÙ·È Û˘Ó‹ıˆ˜ ÌÂ-

Ù¿ ÙÔ ı¿Ó·ÙÔ.

£ÂÚ·Â›·

√ ¿ÌÂÛÔ˜ ÛÙfi¯Ô˜ ÙË˜ ıÂÚ·Â›·˜ Â›Ó·È Ë Î·Ù·ÛÙÔ-

Ï‹ ÙË˜ ÛÔ‚·Ú‹˜ ˘ÂÚÊÏÂÁÌÔÓ‹˜, Ô˘ ıÂˆÚÂ›Ù·È

˘Â‡ı˘ÓË ÁÈ· Ù· ·ÂÈÏËÙÈÎ¿ ÁÈ· ÙË ˙ˆ‹ Û˘ÌÙÒÌ·-

Ù·. ¢Â˘ÙÂÚÂ˘fiÓÙˆ˜, ÛÎÔfi˜ Â›Ó·È Ë Î·Ù·ÛÙÚÔÊ‹ ÙˆÓ

·Û¯fiÓÙˆÓ ·ÓÙÈÁÔÓÔ·ÚÔ˘ÛÈ·ÛÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ Î·È

Ë ÂÍÔ˘‰ÂÙ¤ÚˆÛË ÌÂ ÙÔÓ ÙÚfiÔ ·˘Ùfi ÙÔ˘ ÂÚÂı›ÛÌ·ÙÔ˜

ÁÈ· ¤ÓÙÔÓË ·ÏÏ¿ ·Ó·ÔÙÂÏÂÛÌ·ÙÈÎ‹ ‰Ú·ÛÙËÚÈÔÔ›Ë-

ÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ ¡∫ Î·È Î·Ù·ÛÙ·ÏÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ

∆. ™ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ ÌÂ ÁÂÓÂÙÈÎfi ˘fiÛÙÚˆÌ·, Ô ·fi-

Ï˘ÙÔ˜ ÛÙfi¯Ô˜ ı· Ú¤ÂÈ Ó· Â›Ó·È Ë ·ÓÙÈÎ·Ù¿ÛÙ·ÛË

ÙÔ˘ ÌÂÈÔÓÂÎÙÈÎÔ‡ ·Ì˘ÓÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ·fi Î‡ÙÙ·-

Ú· Ê˘ÛÈÔÏÔÁÈÎ‹˜ ·ÓÔÛÔÏÔÁÈÎ‹˜ Î·Ù¿ÛÙ·ÛË˜ (13).

∆Ô 1994, Ë πÛÙÈÔÎ˘ÙÙ·ÚÈÎ‹ ∂Ù·ÈÚÂ›· (Histiocyte

Society), ÍÂÎ›ÓËÛÂ ÚÔÔÙÈÎ‹ ıÂÚ·Â˘ÙÈÎ‹ ¤ÚÂ˘Ó·

Û˘ÓÂÚÁ·Û›·˜ (ÙÔ ÚˆÙfiÎÔÏÏÔ HLH-94), ÌÂ ÛÙfi¯Ô ÙË

‚ÂÏÙ›ˆÛË ÙÔ˘ ÔÛÔÛÙÔ‡ ÂÈ‚›ˆÛË˜ (1,28).

ª¤¯ÚÈ ÙfiÙÂ, Ë ıÓËÙfiÙËÙ· ·ÓÂÚ¯fiÙ·Ó ÛÂ >90%. ∆Ô

2004 ÍÂÎ›ÓËÛÂ Ë ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ÚˆÙÔÎfiÏÏÔ˘ HLH-

2004, ÌÈ·˜ Ó¤·˜ ¤Î‰ÔÛË˜ ÙÔ˘ ·Ï·ÈfiÙÂÚÔ˘ (58).

™Ù· ÚˆÙfiÎÔÏÏ· ·˘Ù¿ Û˘Ó‰˘¿˙ÔÓÙ·È Ë ¯ËÌÂÈÔ-

ıÂÚ·Â›· Î·È Ë ·ÓÔÛÔıÂÚ·Â›·, ÌÂ Û˘Ó·ÎfiÏÔ˘ıË

ÌÂÙ·ÌfiÛ¯Â˘ÛË Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ ÁÈ· ÙÈ˜ Â›ÌÔÓÂ˜,

˘ÔÙÚÔÈ¿˙Ô˘ÛÂ˜ ‹/Î·È ÔÈÎÔÁÂÓÂ›˜ ÌÔÚÊ¤˜ (1).

∏ ıÂÚ·Â›· ¤Ó·ÚÍË˜ ÂÚÈÏ·Ì‚¿ÓÂÈ ÙË ¯ÔÚ‹ÁËÛË

‰ÂÍ·ÌÂı·˙fiÓË˜ Î·È ÂÙÔÔÛ›‰Ë˜, Ô˘ ·ÎÔÏÔ˘ıÔ‡-

ÓÙ·È ·fi Û˘ÓÂ¯‹ ıÂÚ·Â›· ÌÂ Î˘ÎÏÔÛÔÚ›ÓË ∞, Ì·˙›

ÌÂ ÒÛÂÈ˜ ‰ÂÍ·ÌÂı·˙fiÓË˜ Î·È ÂÙÔÔÛ›‰Ë˜, ÁÈ· ÂÚ›-

Ô˘ 1 ÚfiÓÔ. ∞˘Ù‹ Ë ıÂÚ·Â›· ÌÔÚÂ› Ó· Â›Ó·È Â·Ú-

Î‹˜ ÁÈ· ·È‰È¿ ¯ˆÚ›˜ ÂÏÏÂ›ÌÌ·Ù· ÛÙ· Î‡ÙÙ·Ú· ¡∫,

¯ˆÚ›˜ ÂÓ‰Â›ÍÂÈ˜ HLH ‹ fiÙ·Ó ÙÔ HLH Â›Ó·È Î·ı·Ú¿

·ÔÙ¤ÏÂÛÌ· ÏÔ›ÌˆÍË˜, Î˘Ú›ˆ˜ ·fi ÙÔÓ EBV (59).

∏ ÂÙÔÔÛ›‰Ë Â›Ó·È ¤Ó· ÂÍ·ÈÚÂÙÈÎfi Ê¿ÚÌ·ÎÔ ÁÈ·

Ó· ÚÔÎ·Ï¤ÛÂÈ ¤Ó·ÚÍË ÙË˜ ·fiÙˆÛË˜, ÌÂ ·ÚÂÓ¤Ú-

ÁÂÈÂ˜ ÙË ÛÔ‚·Ú‹ Ô˘‰ÂÙÂÚÔÂÓ›· Î·È, Û·ÓÈfiÙÂÚ·, ÙË

‰ËÌÈÔ˘ÚÁ›· ÔÍÂ›·˜ Ì˘ÂÏÔÁÂÓÔ‡˜ ÏÂ˘¯·ÈÌ›·˜ Î·È Ì˘Â-

ÏÔ‰˘ÛÏ·ÛÙÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ (1).

∏ ‰ÂÍ·ÌÂı·˙fiÓË ‰ÈÂÈÛ‰‡ÂÈ ÛÙÔÓ ·ÈÌ·ÙÂÁÎÂÊ·ÏÈ-

Îfi ÊÚ·ÁÌfi ÌÂ Î·Ï¤˜ ·ÓÙÈÊÏÂÁÌÔÓÒ‰ÂÈ˜ Î·È ÚÔ·Ô-

ÙˆÙÈÎ¤˜ È‰ÈfiÙËÙÂ˜, ÂÓÒ Ë Î˘ÎÏÔÛÔÚ›ÓË ∞ ÌÂÈÒÓÂÈ

ÙË ‰Ú·ÛÙËÚÈfiÙËÙ· ÙˆÓ Î˘ÙÙ¿ÚˆÓ ∆, Ô˘ Â›Ó·È ·˘ÍË-

Ì¤ÓË ÛÙÔ HLH Î·È ÌÔÚÂ› Ó· ÌÂÈÒÛÂÈ ÙË Û˘¯ÓfiÙËÙ·

ÙˆÓ ı·Ó·ÙËÊfiÚˆÓ ÏÔÈÌÒÍÂˆÓ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È ÌÂ

ÙËÓ Ô˘‰ÂÙÂÚÔÂÓ›· (1,60).

™ÙË ÁÂÓÈÎfiÙÂÚË ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ÓfiÛÔ˘ ¤¯Ô˘Ó

¯ÚËÛÈÌÔÔÈËıÂ› Ï·ÛÌ·Ê·›ÚÂÛË, ·Ê·ÈÌ·ÍÔÌÂÙ¿ÁÁÈ-

ÛË, ·ÈÌÔ‰È‡ÏÈÛË Î·È ¯ÔÚ‹ÁËÛË ·ÓÔÛÔÛÊ·ÈÚÈÓÒÓ, ÂÓÒ

·ÌÊÈÏÂÁfiÌÂÓË ·Ú·Ì¤ÓÂÈ Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·

ÙË˜ ÂÓ‰ÔÚÚ·¯È·›·˜ ¤Á¯˘ÛË˜ ÌÂıÔÙÚÂÍ¿ÙË˜ (3,59).

™ÙÈ˜ ‹ÈÂ˜ ÌÔÚÊ¤˜ HLH ·fi ÏÔÈÌÒ‰Â˜ ·›ÙÈÔ, ·Ú-

ÎÂ› ÌfiÓÔ ·ÓÙÈÏÔÈÌÒ‰Ë˜ ·ÁˆÁ‹, fiˆ˜ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ

ÏÂ˚ÛÌ·Ó›·ÛË.

∏ ÂÙÂÚfiÏÔÁË ÌÂÙ·ÌfiÛ¯Â˘ÛË ·ÈÌÔÔÈËÙÈÎÒÓ Î˘Ù-

Ù¿ÚˆÓ ·Ú¤¯ÂÈ Ù· Î·Ï‡ÙÂÚ· ıÂÚ·Â˘ÙÈÎ¿ ·ÔÙÂÏ¤-

ÛÌ·Ù· (3,11,50,55,56). ∞Ó·Ê¤ÚÂÙ·È ÂÈ‚›ˆÛË 62% ÛÂ




‰È¿ÊÔÚÂ˜ ÌÂÏ¤ÙÂ˜, ÔÛÔÛÙfi Û¯Â‰fiÓ ·ÓÔÌÔÈfiÙ˘Ô

(62%±12%) ÌÂ ÙËÓ ÙÚÈÂÙ‹ ÂÈ‚›ˆÛË ·È‰ÈÒÓ (¿-

Û¯ÔÓÙ· ·fi FHL ‹ Â›ÌÔÓÂ˜-˘ÔÙÚÔÈ¿˙Ô˘ÛÂ˜ ÌË

ÔÈÎÔÁÂÓÂ›˜ ÌÔÚÊ¤˜) Ô˘ ·ÎÔÏÔ‡ıËÛ·Ó ÙÔ HLH-94

ÚˆÙfiÎÔÏÏÔ (1,13). ∫·ıÒ˜ Ë ‰È¿ÁÓˆÛË Û˘¯Ó¿ Î·ı˘-

ÛÙÂÚÂ› Î·È Ë ÓfiÛÔ˜ Â›Ó·È ·ÚÎÂÙ¿ ÂÈıÂÙÈÎ‹, ·ÚÎÂÙÔ›

·ÛıÂÓÂ›˜ Î·Ù·Ï‹ÁÔ˘Ó ÚÈÓ Ï¿‚Ô˘Ó HCT. ∞˘Ù‹ Ë ıÂ-

Ú·Â›· ·ÊÔÚ¿ ÔÌÔ˙˘ÁÒÙÂ˜ ÁÈ· ÌÂÙ·ÏÏ¿ÍÂÈ˜ ‰È·Êfi-

ÚˆÓ ÁÔÓÈ‰›ˆÓ Û¯ÂÙÈÎ¿ ÌÂ ÙÔ ∞º™, ·ÛıÂÓÂ›˜ Ô˘

··ÓÙÔ‡Ó ·ÓÂ·ÚÎÒ˜ ÛÙËÓ ·Ú¯ÈÎ‹ ıÂÚ·Â›· Î·È

ÂÎÂ›ÓÔ˘˜ ÌÂ ÓfiÛÔ ÙÔ˘ ∫¡™.

√È ÂÚÈÛÛfiÙÂÚÔÈ ÂÈ‰ÈÎÔ› ıÂˆÚÔ‡Ó fiÙÈ Ë ¿ÌÂÛË

¤Ó·ÚÍË ·ÓÔÛÔ¯ËÌÂÈÔıÂÚ·Â›·˜, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜

ÙÔ˘˜ ·Ú¿ÁÔÓÙÂ˜ Ô˘ ÚÔ·Ó·Ê¤ÚıËÎ·Ó, ·ÎÔÏÔ˘ıÔ‡-

ÌÂÓË ·fi HCT, Ê·›ÓÂÙ·È ˆ˜ Ë ÌfiÓË ıÂÚ·Â˘ÙÈÎ‹ ‰È·-

‰ÈÎ·Û›· Ô˘ Â›Ó·È ÈÎ·Ó‹ Ó· ·Ó·ÛÙÂ›ÏÂÈ ÙËÓ ÂÍ¤ÏÈÍË ÙË˜

ÓfiÛÔ˘ ÙÔ˘ ∫¡™ Î·È Ó· ÂÈÊ¤ÚÂÈ ÙËÓ ›·ÛË, ·Ó Á›ÓÂÈ Û¯Â-

ÙÈÎ¿ ÓˆÚ›˜, ·ÊÔ‡ ÚÒÙ· ÂÈÙÂ˘¯ıÂ› ‡ÊÂÛË (12,55).

∆ÂÏÂÈÒÓÔÓÙ·˜, ˘ÔÁÚ·ÌÌ›˙ÂÙ·È Ë ·Ó¿ÁÎË ÁÈ· ÙËÓ

Â˘·ÈÛıËÙÔÔ›ËÛË ÙˆÓ È·ÙÚÒÓ ÚÔ˜ ÙË ÓfiÛÔ Î·È ÙËÓ

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Ã. ∆Û·Î·Ï›‰Ë˜1, ∂. √˘ÚÁÎ·ÓÙ˙fiÁÏÔ˘2, ¡. ¡ÈÎÔÏ·˝‰Ë˜1

¶ÂÚ›ÏË„Ë: ∏ Û˘ÁÁÂÓ‹˜ ‰È·ÊÚ·ÁÌ·ÙÔÎ‹ÏË (™¢∫) ·ÔÙÂÏÂ› ¤Ó· ÛËÌ·ÓÙÈÎfi Úfi‚ÏËÌ· ÙˆÓ ÓÂÔÁÓÒÓ, ÌÂ˘„ËÏ‹ ÓÔÛËÚfiÙËÙ· Î·È ıÓËÙfiÙËÙ·. ∫·Ù·Ù¿ÛÛÂÙ·È ÛÂ ‰È¿ÊÔÚÔ˘˜ Ù‡Ô˘˜, ·Ó¿ÏÔÁ· ÌÂ ÙÈ˜ ˘¿Ú¯Ô˘ÛÂ˜·Ó·ÙÔÌÈÎ¤˜ ·ÓˆÌ·Ï›Â˜. ∏ Û˘¯ÓfiÙËÙ· ÙË˜ ™¢∫ Â›Ó·È 1 ·Ó¿ 2.000 ÁÂÓÓ‹ÛÂÈ˜ ˙ÒÓÙˆÓ ÓÂÔÁÓÒÓ. ∆È˜ ÙÂÏÂ˘-Ù·›Â˜ ‰‡Ô ‰ÂÎ·ÂÙ›Â˜, Ù· ÔÛÔÛÙ¿ ÚÔÁÂÓÓËÙÈÎ‹˜ ‰È¿ÁÓˆÛË˜ ¤¯Ô˘Ó ·˘ÍËıÂ›, Ë ·ıÔÊ˘ÛÈÔÏÔÁ›· ÙË˜ ™¢∫¤¯ÂÈ Î·Ù·ÓÔËıÂ› Î·Ï‡ÙÂÚ· Î·È Ë ÎÏÈÓÈÎ‹ ·ÓÙÈÌÂÙÒÈÛË ¤¯ÂÈ ‚ÂÏÙÈˆıÂ›. ∆· ÓÂÔÁÓ¿ ÌÂ ™¢∫ Û˘¯Ó¿ ¤¯Ô˘Ó ·Ó¿-ÁÎË ÂÓÙ·ÙÈÎ‹˜ ıÂÚ·Â›·˜ Î·È ·Ú·ÙÂÙ·Ì¤ÓË˜ ÓÔÛËÏÂ›·˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË Î·È ÂÌÊ·Ó›˙Ô˘Ó Û˘Ó˘¿Ú¯Ô˘-ÛÂ˜ ·ÓˆÌ·Ï›Â˜. √È ÛËÌ·ÓÙÈÎfiÙÂÚÔÈ ·Ú¿ÁÔÓÙÂ˜ Ô˘ Â›Ó·È ˘Â‡ı˘ÓÔÈ ÁÈ· ÙËÓ Î·Î‹ ÚfiÁÓˆÛË Â›Ó·È Ë˘ÔÏ·Û›· ÙˆÓ ÓÂ˘ÌfiÓˆÓ Î·È Ë ÓÂ˘ÌÔÓÈÎ‹ ˘¤ÚÙ·ÛË, ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ÙÔ˘˜ È·ÙÚÔÁÂÓÂ›˜ ÙÚ·˘Ì·ÙÈ-ÛÌÔ‡˜ Ô˘ ÚÔÎ·ÏÔ‡ÓÙ·È ·fi ÙÔÓ ÌË¯·ÓÈÎfi ·ÂÚÈÛÌfi. ∂ÓÙÔ‡ÙÔÈ˜, ÓÂfiÙÂÚ· ‰Â‰ÔÌ¤Ó· ÙË˜ ·ıÔÊ˘ÛÈÔÏÔ-Á›·˜ ÙË˜ ÓfiÛÔ˘ Î·È ÙˆÓ ÌË¯·ÓÈÛÌÒÓ Ô˘ ÂÚÌËÓÂ‡Ô˘Ó ÙËÓ ·Ó·ÓÂ˘ÛÙÈÎ‹ ·ÓÂ¿ÚÎÂÈ· ¤¯Ô˘Ó Ô‰ËÁ‹ÛÂÈ ÛÂÛËÌ·ÓÙÈÎ¤˜ ·ÏÏ·Á¤˜ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÓÂÔÁÓÒÓ ÌÂ ™¢∫.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ™˘ÁÁÂÓ‹˜ ‰È·ÊÚ·ÁÌ·ÙÔÎ‹ÏË, ÓÂÔÁÓfi, ıÂÚ·Â›·.

Current data on congenital diaphragmatic hernia

C. Tsakalidis1, E. Ourgantzoglou2, N. Nikolaidis1

Abstract: Congenital diaphragmatic hernia (CDH) is considered a serious problem of the newborns,associated with high mortality and morbidity. It can be subdivided into several different types,depending on the affected anatomical structures. The incidence of CDH may be as high as 1 in 2,000of living births. Over the past two decades, antenatal diagnosis rates have increased, thepathophysiology of CDH has become better understood and advances in clinical care have occurred.Infants with CDH often have other congenital anomalies and require intensive treatment after birth,leading to prolonged hospitalisation. The major factors which are associated with poor prognosis arepersistent pulmonary hypertension and lung hypoplasia in combination with iatrogenic injuriescaused by the mechanical ventilation. However, newer data of pathophysiology of the disease andthe mechanisms of the respiratory distress have resulted in improving the treatment of newbornswith CDH.

Key words: Congenital diaphragmatic hernia, neonate, treatment.


1 µ’ ¡ÂÔÁÓÔÏÔÁÈÎ‹ ∫ÏÈÓÈÎ‹,∞ÚÈÛÙÔÙ¤ÏÂÈÔ ¶·ÓÂÈÛÙ‹ÌÈÔ£ÂÛÛ·ÏÔÓ›ÎË˜,¡ÔÛÔÎÔÌÂ›Ô«¶··ÁÂˆÚÁ›Ô˘»,£ÂÛÛ·ÏÔÓ›ÎË

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ÃÚ‹ÛÙÔ˜ ∆Û·Î·Ï›‰Ë˜[email protected]µ’ ¡ÂÔÁÓÔÏÔÁÈÎ‹ ∫ÏÈÓÈÎ‹,∞ÚÈÛÙÔÙ¤ÏÂÈÔ ¶·ÓÂÈÛÙ‹ÌÈÔ£ÂÛÛ·ÏÔÓ›ÎË˜, ¡ÔÛÔÎÔÌÂ›Ô«¶··ÁÂˆÚÁ›Ô˘»,£ÂÛÛ·ÏÔÓ›ÎË

1 2nd Department ofNeonatal Paediatrics,“Aristotelio” University ofThessaloniki,“Papageorgiou” Hospital,Thessaloniki, Greece

2 2nd Department ofPaediatrics, “Aristotelio”University of Thessaloniki,“AHEPA” Hospital,Thessaloniki, Greece

Correspondence:

Christos [email protected] Department of NeonatalPaediatrics, “Aristotelio”University of Thessaloniki,“Papageorgiou” Hospital,Thessaloniki, Greece

¶·È‰È·ÙÚÈÎ‹ 2009;72:97-000

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ÂÚ›Ô˘ ÛÙÔ 90-95% (2). T· ÔÛÔÛÙ¿ ÙˆÓ ‰ÂÍÈ¿

Î·È ·ÚÈÛÙÂÚ¿ ÂÓÙÔÈ˙fiÌÂÓˆÓ ™¢∫ ÔÈÎ›ÏÏÔ˘Ó,


ÌÂ ÙËÓ ·ÚÈÛÙÂÚ‹ Ó· ·Ó¤Ú¯ÂÙ·È ÛÙÔ 73-90%, ÙË ‰ÂÍÈ¿ÛÙÔ 8-24% Î·È ÙËÓ ·ÌÊÔÙÂÚfiÏÂ˘ÚË ‹ ÎÂÓÙÚÈÎ‹ ÛÙÔ1,2-4,6% (3-5). √È ·ÓˆÌ·Ï›Â˜ ÙÔ˘ ‰È·ÊÚ¿ÁÌ·ÙÔ˜Ô˘ ‰ÂÓ ÂÓÙÔ›˙ÔÓÙ·È ÛÙ· Ï¿ÁÈ· Â›Ó·È Û¿ÓÈÂ˜ Î·ÈÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÔ 1-6% ÙˆÓ ·ÛıÂÓÒÓ. √È ÏÈÁfiÙÂÚÔÛ˘¯ÓÔ› Ù‡ÔÈ ™¢∫ ·ÊÔÚÔ‡Ó ÙËÓ ÔÈÛıÔÛÙÂÚÓÈÎ‹‰È·ÊÚ·ÁÌ·ÙÔÎ‹ÏË ‹ Î‹ÏË ÙÔ˘ Morgagni, ÙËÓ Úfi-ÛıÈ· ‹ ÂÁÎ¿ÚÛÈ· ‰È·ÊÚ·ÁÌ·ÙÔÎ‹ÏË, ÙËÓ ÎÂÓÙÚÈÎ‹‰È·ÊÚ·ÁÌ·ÙÔÎ‹ÏË, ÙËÓ ·Ó‡„ˆÛË ‹ Ï¤Ù˘ÓÛË ÙÔ˘‰È·ÊÚ¿ÁÌ·ÙÔ˜ Î·È ÙËÓ ·ÁÂÓÂÛ›· ·˘ÙÔ‡ (1) (∂ÈÎfiÓ·1). ∫ËÏÈÎfi˜ Û¿ÎÔ˜ ·ÔÙÂÏÔ‡ÌÂÓÔ˜ ·fi ÏÂÙ‹ ÌÂ-ÛÔıËÏÈ·Î‹ ÌÂÌ‚Ú¿ÓË ÂÌÊ·Ó›˙ÂÙ·È ÛÂ ÏÈÁfiÙÂÚÔ ·fi10% ÙˆÓ ÂÚÈÙÒÛÂˆÓ. ™ÙËÓ ·ÚÈÛÙÂÚ‹ ™¢∫, Ù· ÎÔÈ-ÏÈ·Î¿ ÛÏ¿¯Ó· Ô˘ ÚÔÛ›ÙÔ˘Ó ÛÙÔÓ ıÒÚ·Î· Â›-Ó·È ÙÔ ÛÙÔÌ¿¯È, ÙÔ ÏÂÙfi ¤ÓÙÂÚÔ, ÙÔ ÎfiÏÔÓ, Ô ÛÏ‹-Ó·˜ Î·È Ô ·ÚÈÛÙÂÚfi˜ ÏÔ‚fi˜ ÙÔ˘ ‹·ÙÔ˜. ¶ÂÚÈÛÙ·ÛÈ·-Î¿ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÙÔ ¿ÁÎÚÂ·˜, Ô ÓÂÊÚfi˜ Î·È ÙÔ·ÚÈÛÙÂÚfi ÂÈÓÂÊÚ›‰ÈÔ. ™ÙË ‰ÂÍÈ¿ ™¢∫, ÔÏ‡ ÏÈÁfiÙÂ-ÚÔ ¤ÓÙÂÚÔ ‚Ú›ÛÎÂÙ·È ÛÙÔÓ ıÒÚ·Î·, ‰ÈfiÙÈ ÙÔ ‹·Ú·ÔÊÚ¿ÛÛÂÈ ÙÔ ¤ÏÏÂÈÌÌ·.

™˘¯ÓfiÙËÙ·

∏ Û˘¯ÓfiÙËÙ· ÙË˜ ™¢∫ ·Ó¤Ú¯ÂÙ·È ·fi 1 ÛÙÈ˜ 2.000¤ˆ˜ 1 ÛÙÈ˜ 4.000 ÁÂÓÓ‹ÛÂÈ˜ ˙ÒÓÙˆÓ ÓÂÔÁÓÒÓ Î·È ·Ô-ÙÂÏÂ› ÙÔ 8% fiÏˆÓ ÙˆÓ Û˘ÁÁÂÓÒÓ ‰˘ÛÏ·ÛÈÒÓ (6). ∆·ÂÚÈÛÛfiÙÂÚ· ÓÂÔÁÓ¿ Â›Ó·È ÙÂÏÂÈfiÌËÓ·. §›ÁÂ˜ ‰ËÌÔ-ÛÈÂ‡ÛÂÈ˜ ·Ó·Ï‡Ô˘Ó ÙË ‰È·ÊÔÚ¿ Ê‡ÏÔ˘ ÛÙË ™¢∫. ∏Û¯¤ÛË ¿ÚÚÂÓ·:ı‹ÏÂ· ˘ÔÏÔÁ›˙ÂÙ·È ÛÂ 1:1,25 (7), 3:2(8), ÂÓÒ ¿ÏÏÂ˜ ‰ËÌÔÛÈÂ‡ÛÂÈ˜ ‰ÂÓ ·Ó·Ê¤ÚÔ˘Ó ‰È·ÊÔ-Ú¿ fiÛÔÓ ·ÊÔÚ¿ ÙÔ Ê‡ÏÔ (9). √È ·Ó·ÊÔÚ¤˜ ÂÚÈÛÙ·ÙÈ-ÎÒÓ ÂÌÊ¿ÓÈÛË˜ ‰È·ÊÚ·ÁÌ·ÙÔÎ‹ÏË˜ ÛÂ ‰È‰‡ÌÔ˘˜,Û˘ÁÁÂÓÂ›˜ Î·È ·ÔÁfiÓÔ˘˜ ÙˆÓ ·ÛıÂÓÒÓ Â›Ó·È ÛÔÚ·-‰ÈÎ¤˜. ™Â ÔÈÎÔÁ¤ÓÂÈÂ˜ Ô˘ ·Ú·ÙËÚ‹ıËÎÂ Ï‹ÚË˜·ÁÂÓÂÛ›· ÙÔ˘ ‰È·ÊÚ¿ÁÌ·ÙÔ˜, ‚Ú¤ıËÎÂ ÎÏËÚÔÓÔÌÈÎfi˜·˘ÙÔÛˆÌ·ÙÈÎfi˜ ˘ÔÏÂÈfiÌÂÓÔ˜ ¯·Ú·ÎÙ‹Ú·˜.

™˘ÓÔ‰¤˜ ·ÓˆÌ·Ï›Â˜

∂ÎÙfi˜ ·fi ÙÈ˜ Î·Ù·ÛÙ¿ÛÂÈ˜ Ô˘ ıÂˆÚÔ‡ÓÙ·È fiÙÈ·ÔÙÂÏÔ‡Ó Ì¤ÚÔ˜ ÙÔ˘ «Û˘Ó‰ÚfiÌÔ˘ ÙË˜ ‰È·ÊÚ·ÁÌ·-ÙÔÎ‹ÏË˜» (ÓÂ˘ÌÔÓÈÎ‹ ˘ÔÏ·Û›·, ·ÓÔÈ¯Ùfi˜ ·ÚÙË-ÚÈ·Îfi˜ fiÚÔ˜, ·ÓÔÈ¯Ùfi ÔÂÈ‰¤˜ ÙÚ‹Ì· Î·È ·ÙÂÏ‹˜ Û˘-ÛÙÚÔÊ‹ ÙÔ˘ ÂÓÙ¤ÚÔ˘), ÂÚ›Ô˘ ÙÔ 40% ÙˆÓ ˙ÒÓÙˆÓ

ÓÂÔÁÓÒÓ ÌÂ ™¢∫ ¤¯Ô˘Ó Ì›· ‹ ÂÚÈÛÛfiÙÂÚÂ˜ Û˘ÓÔ‰¤˜

‰È·Ì·ÚÙ›Â˜, Û˘¯Ó¿ ˆ˜ Ì¤ÚÔ˜ ÂÓfi˜ ·Ó·ÁÓˆÚÈÛÌ¤ÓÔ˘

Û˘Ó‰ÚfiÌÔ˘ ‹ ¯ÚˆÌ·ÙÔÛˆÌÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ (¶›Ó·-

Î·˜ 1) (10,2). ™ÙÔ 60% ÙˆÓ ÂÚÈÙÒÛÂˆÓ Û˘Ó˘¿Ú-

¯Ô˘Ó Î·Ú‰È·Î¤˜ ‰È·Ì·ÚÙ›Â˜, ÂÓÒ ·ÓˆÌ·Ï›Â˜ ÙÔ˘ Ô˘-

ÚÔÁÂÓÓËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ··ÓÙÔ‡Ó ÛÙÔ 15% ÙˆÓ

ÛÔÚ·‰ÈÎÒÓ Î·È ÛÙÔ 18% ÙˆÓ ÔÈÎÔÁÂÓÒÓ ÂÚÈÙÒÛÂ-

ˆÓ (11). ∞ÓˆÌ·Ï›Â˜ ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜

ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÔ 17% ÙˆÓ ÂÚÈÙÒÛÂˆÓ, ÙÔ˘ ∫¡™

ÛÙÔ 14%, ÂÓÒ ÛÙÔ 10% Û˘Ó˘¿Ú¯Ô˘Ó ¯ÚˆÌÔÛˆÌ·ÙÈ-

Î¤˜ ·ÓˆÌ·Ï›Â˜. ∆Ô Û‡Ó‰ÚÔÌÔ ÙË˜ ˘ÔÏ·ÛÙÈÎ‹˜ ·ÚÈ-

ÛÙÂÚ‹˜ Î·Ú‰›·˜ ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÌÂ ¤Ó· Â˘Ú‡ Ê¿ÛÌ·

·ÓˆÌ·ÏÈÒÓ, Ô˘ Î˘Ì·›ÓÂÙ·È ·fi ÙËÓ ˘ÔÏ·ÛÙÈÎ‹

·ÚÈÛÙÂÚ‹ Î·Ú‰È¿ ¤ˆ˜ ÙËÓ ·Ó·ÙÔÌÈÎ¿ Ê˘ÛÈÔÏÔÁÈÎ‹

Î·Ú‰È¿, Ë ÔÔ›· fiÌˆ˜ ÛÙÔ Û‡ÓÔÏfi ÙË˜ Â›Ó·È ˘ÔÏ·-

ÛÙÈÎ‹ (3). ¢ÂÓ ¤¯ÂÈ ‰ÈÂ˘ÎÚÈÓÈÛÙÂ› ÁÈ·Ù› Û˘Ì‚·›ÓÂÈ ·˘-

Ùfi. ª›· ıÂˆÚ›· Â›Ó·È fiÙÈ Ë ÂÈÛÙÚÔÊ‹ ÙÔ˘ ÂÌ‚Ú˘˚ÎÔ‡

ÊÏÂ‚ÈÎÔ‡ ·›Ì·ÙÔ˜ ‰È·Ì¤ÛÔ˘ ÙÔ˘ ˆÔÂÈ‰Ô‡˜ ÙÚ‹Ì·ÙÔ˜

ÛÙËÓ ·ÚÈÛÙÂÚ‹ ÏÂ˘Ú¿ ÙË˜ Î·Ú‰È¿˜ ÌÔÚÂ› Ó· ÂÏ·Ù-

ÙˆıÂ› ·fi ÙË ÌÂÙ·ÙfiÈÛË ÙË˜ Î·Ú‰È¿˜ Ì¤Û· ÛÙÔÓ ıÒ-

Ú·Î·, ÔfiÙÂ Ë ·ÏÏ·Á‹ ÛÙË ÚÔ‹ ÙÔ˘ ·›Ì·ÙÔ˜ ÌÔÚÂ›

Ó· ÚÔÎ·Ï¤ÛÂÈ ˘ÔÏ·Û›· ÙË˜ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜

(12). ¢˘ÛÌÔÚÊÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ Î·È ·ÓˆÌ·Ï›Â˜

ÙˆÓ ¿ÎÚˆÓ Â›Ó·È Û˘¯ÓfiÙÂÚ· ÛÙËÓ ·ÚÈÛÙÂÚ¿ ÂÓÙÔÈ˙fi-

ÌÂÓË ™¢∫ (13). ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, Ë Û˘¯ÓfiÙËÙ·

ÙˆÓ Û˘ÓÔ‰ÒÓ ·ÓˆÌ·ÏÈÒÓ ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ ÓÂ˘ÚÈÎÔ‡

Î·È ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÌÂÈÒıËÎÂ ÛË-

Ì·ÓÙÈÎ¿ Î·È ·˘Ùfi ÌÔÚÂ› Ó· ÔÊÂ›ÏÂÙ·È ÛÙË ‚ÂÏÙ›ˆÛË

ÙÔ˘ ÚÔÁÂÓÓËÙÈÎÔ‡ ÂÏ¤Á¯Ô˘ ÌÂ ÙË ¯Ú‹ÛË ÙˆÓ ˘ÂÚ‹-

¯ˆÓ. ∏ ÌÂ›ˆÛË, fiÌˆ˜, ÙˆÓ Û˘ÓÔ‰ÒÓ ·ÓˆÌ·ÏÈÒÓ ÛÙ·

‰‡Ô ·˘Ù¿ Û˘ÛÙ‹Ì·Ù· ÂÈÛËÁÂ›Ù·È Â›ÛË˜ fiÙÈ Ë Â›Ùˆ-

ÛË ÙˆÓ Û˘ÓÔ‰ÒÓ ·ÓˆÌ·ÏÈÒÓ ¤¯ÂÈ ·ÏÏ¿ÍÂÈ Ù· ÙÂÏÂ˘-

Ù·›· ¯ÚfiÓÈ· (9).

98 Ã. ∆Û·Î·Ï›‰Ë˜ Î·È Û˘Ó.


¶›Ó·Î·˜ 1. ∞Ó·ÙÔÌÈÎ¤˜ ·ÓˆÌ·Ï›Â˜ Ô˘ Û˘ÓÔ‰Â‡Ô˘Ó ÙË ™¢∫

™‡ÛÙËÌ· ∫‡ÚÈ· ·ÓˆÌ·Ï›·

∫·Ú‰È·ÁÁÂÈ·Îfi ªÂÛÔÎÔÏÈÎ‹ ÂÈÎÔÈÓˆÓ›·ªÂÛÔÎÔÈÏÈ·Î‹ ÂÈÎÔÈÓˆÓ›·™Ù¤ÓˆÛË ·ÔÚÙ‹˜∞ÓˆÌ·Ï›· EbsteinÀÔÏ·ÛÙÈÎ‹ ·ÚÈÛÙÂÚ‹ Î·Ú‰›·

°·ÛÙÚÂÓÙÂÚÈÎfi °·ÛÙÚfiÛ¯ÈÛË√ÌÊ·ÏÔÎ‹ÏË∞ÙÚËÛ›· ÔÈÛÔÊ¿ÁÔ˘

√˘ÚÔÁÂÓÓËÙÈÎfi À‰ÚÔÓ¤ÊÚˆÛË¶ÔÏ˘Î˘ÛÙÈÎÔ› ÓÂÊÚÔ›

∫¡™ À‰ÚÔÎÂÊ·Ï›·¢ÈÛ¯È‰‹˜ Ú¿¯Ë

™ÎÂÏÂÙÔ‡-ÚÔÛÒÔ˘ ŒÏÏÂÈ„Ë ÏÂ˘ÚÒÓ¶ÔÏ˘‰·ÎÙ˘Ï›·™˘Ó‰·ÎÙ˘Ï›·¶ÚÔ¤¯oÓ Ì¤ÙˆÔµÚ·¯˘ÎÂÊ·Ï›·¶Ï·ÁÈÔÎÂÊ·Ï›·

∂ÈÎfiÓ· 1. ™˘ÁÁÂÓ‹˜ ‰È·ÊÚ·ÁÌ·ÙÔÎ‹ÏË: ·) Ù‡Ô˘ Bochdalec, ‚) Ù‡-Ô˘ Morgagni Î·È ÚfiÛıÈ· ‹ ÂÁÎ¿ÚÛÈ· ™¢∫, Á) ÎÂÓÙÚÈÎ‹ ™¢∫.

Ù‡Ô˘ MorgagniÚfiÛıÈ· ‹ ÂÁÎ¿ÚÛÈ· ™¢∫

· ‚ Á


°ÂÓÂÙÈÎ‹

∏ ™¢∫ ¯ˆÚ›˜ Û˘ÓÔ‰¤˜ ·ÓˆÌ·Ï›Â˜ ÂÌÊ·Ó›˙ÂÙ·ÈÛÔÚ·‰ÈÎ¿. √ÈÎÔÁÂÓÂ›˜ ÂÚÈÙÒÛÂÈ˜ ··ÓÙÔ‡Ó ÛÙÔ2% (14,15), Û˘Ó‹ıˆ˜ ‰ÂÓ Û˘ÓÔ‰Â‡ÔÓÙ·È ·fi ¿ÏÏÂ˜Û˘ÁÁÂÓÂ›˜ ·ÓˆÌ·Ï›Â˜ Î·È ¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚË Û˘¯Ófi-ÙËÙ· ·ÌÊÔÙÂÚfiÏÂ˘ÚË˜ ÂÓÙfiÈÛË˜. √ Î›Ó‰˘ÓÔ˜Â·ÓÂÌÊ¿ÓÈÛË˜ ˘ÔÏÔÁ›˙ÂÙ·È Î·Ù¿ ÚÔÛ¤ÁÁÈÛË ÛÂ2% Â› ·Ô˘Û›·˜ ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÈÛÙÔÚÈÎÔ‡ (16). ∏™¢∫ ÌÔÚÂ› Ó· ··ÓÙ¿Ù·È ˆ˜ Ì¤ÚÔ˜ ÂÓfi˜ Û˘Ó‰Úfi-ÌÔ˘ (17). ∆Ô˘Ï¿¯ÈÛÙÔÓ ÙÔ 10% ÙˆÓ ·ÛıÂÓÒÓ ÌÂ ™¢∫Î·È Û˘ÓÔ‰¤˜ ·ÓˆÌ·Ï›Â˜ ·Ó‹ÎÂÈ ÛÂ Î¿ÔÈÔ ÁÓˆÛÙfiÛ‡Ó‰ÚÔÌÔ (18) (¶›Ó·Î·˜ 2), fiˆ˜ ÙÔ Û‡Ó‰ÚÔÌÔFryns (19,20). ¶Èı·ÓÔÏÔÁÂ›Ù·È fiÙÈ ÛÙÔ ¯ÚˆÌfiÛˆÌ·1q41-q42.12 ‚Ú›ÛÎÔÓÙ·È ¤Ó· ‹ ÂÚÈÛÛfiÙÂÚ· ÁÔÓ›‰È·Ô˘ ··ÈÙÔ‡ÓÙ·È ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ ‰È·ÊÚ¿ÁÌ·-ÙÔ˜. ∆· ·ÔÙÂÏ¤ÛÌ·Ù· ÁÂÓÂÙÈÎÒÓ ÌÂÏÂÙÒÓ ‰Â›¯ÓÔ˘ÓfiÙÈ ÛÙÔ ÛËÌÂ›Ô Û‡Ó‰ÂÛË˜ ÙˆÓ ÂÚÈÔ¯ÒÓ 1q41 Î·È1q42.11 ‚Ú›ÛÎÂÙ·È Ô ÁÂÓÂÙÈÎfi˜ ÙfiÔ˜ Ô˘ Â›Ó·È˘Â‡ı˘ÓÔ˜ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ™¢∫ Î·È Û˘Ó‰ÚfiÌÔ˘Fryns (19). À¿Ú¯Ô˘Ó ÌÂÌÔÓˆÌ¤ÓÂ˜ ·Ó·ÊÔÚ¤˜ ÂÚÈ-ÙÒÛÂˆÓ ™¢∫ ÌÂ Ê·ÈÓfiÙ˘Ô Ù‡Ô˘ Û˘Ó‰ÚfiÌÔ˘Fryns Ô˘ Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ‰ÈÏ·ÛÈ·ÛÌfi ÙÔ˘ 1q24-q31.2, ÂÍ¿ÏÂÈ„Ë ÙÔ˘ ÙÂÏÈÎÔ‡ ÙÌ‹Ì·ÙÔ˜ ÙˆÓ 6q,8p23.1, 15q26 ¯ÚˆÌ·ÙÔÛˆÌ¿ÙˆÓ Î·È ÌÂÚÈÎ‹ ÙÚÈÛˆ-Ì›· 22 (21,22,23). √ ÌË¯·ÓÈÛÌfi˜ ‰ËÌÈÔ˘ÚÁ›·˜ ÙË˜‰È·ÊÚ·ÁÌ·ÙÔÎ‹ÏË˜ ÛÙ· Û‡Ó‰ÚÔÌ· ·˘Ù¿ ·Ú·Ì¤ÓÂÈ·‰ÈÂ˘ÎÚ›ÓÈÛÙÔ˜. ∞ÚÎÂÙ¿ Û‡Ó‰ÚÔÌ· Ô˘ Û¯ÂÙ›˙ÔÓÙ·ÈÌÂ ™¢∫ ÂÌÊ·Ó›˙Ô˘Ó ÌÂÓ‰¤ÏÂÈ· ÎÏËÚÔÓÔÌÈÎfiÙËÙ·Î·È ÛÂ ÌÂÚÈÎ¤˜ ÂÚÈÙÒÛÂÈ˜ Ë ÂÚÈÔ¯‹ Ô˘ Â‰Ú¿˙Ô-ÓÙ·È Ù· ÁÔÓ›‰È· ·˘Ù¿ ‹ Î·È Ë Ù·˘ÙfiÙËÙ· ÙˆÓ ÁÔÓÈ‰›ˆÓ·˘ÙÒÓ Â›Ó·È ÁÓˆÛÙ¤˜. ∏ ‡·ÚÍË ÁÂÓÂÙÈÎÒÓ Û˘Ó‰Úfi-ÌˆÓ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ™¢∫ ·ÔÙÂÏÂ› ÈÛ¯˘Ú‹ ·fi-‰ÂÈÍË fiÙÈ ÛÙËÓ ÂÌÊ¿ÓÈÛ‹ ÙË˜ ·›˙Ô˘Ó ÚfiÏÔ ÁÂÓÂÙÈÎÔ›·Ú¿ÁÔÓÙÂ˜. ∆Ô ÁÔÓ›‰ÈÔ WT1 ·›˙ÂÈ ÚfiÏÔ ÛÙË Ê˘-ÛÈÔÏÔÁÈÎ‹ ·Ó¿Ù˘ÍË ÙÔ˘ Ô˘ÚÔÁÂÓÓËÙÈÎÔ‡ Û˘ÛÙ‹Ì·-ÙÔ˜. ∞fi ÌÂÏ¤ÙÂ˜ ÛÂ ÔÓÙ›ÎÈ· ÔÌÔ˙˘ÁÒÙÂ˜ ÁÈ· ÙÈ˜ÌÂÙ·ÏÏ¿ÍÂÈ˜ ÙÔ˘ ÁÔÓÈ‰›Ô˘ WT1 ‚Ú¤ıËÎÂ fiÙÈ ÔÈ ÌÂ-Ù·ÏÏ¿ÍÂÈ˜ ÙÔ˘ Â˘ı‡ÓÔÓÙ·È ÁÈ· ·ÓˆÌ·Ï›Â˜ ÙÔ˘ Ô˘ÚÔ-

ÁÂÓÓËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, ÙÔ˘ ıˆÚ·ÎÈÎÔ‡ ÙÔÈ¯ÒÌ·-

ÙÔ˜ Î·È ÙÔ˘ ‰È·ÊÚ¿ÁÌ·ÙÔ˜ Ô˘ Ô‰ËÁÔ‡Ó ÛÙË ‰ËÌÈ-

Ô˘ÚÁ›· ™¢∫. ∫¿ÙÈ ·ÓÙ›ÛÙÔÈ¯Ô ‰ÂÓ ·Ô‰Â›¯ıËÎÂ ÛÂ

·ÓıÚÒÔ˘˜ (24). À¿Ú¯Ô˘Ó ·˘Í·ÓfiÌÂÓ· ÛÙÔÈ¯Â›·

Ô˘ ‰Â›¯ÓÔ˘Ó fiÙÈ ÙÔ Ì·ÎÚ‡ ÛÎ¤ÏÔ˜ ÙÔ˘ ¯ÚˆÌ·ÙÔÛÒ-

Ì·ÙÔ˜ 15 ‰È·‰Ú·Ì·Ù›˙ÂÈ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ÂÌÊ¿-

ÓÈÛË ™¢∫ Î·È ÔÚÈÛÌ¤ÓˆÓ Û˘ÓÔ‰ÒÓ ·ÓˆÌ·ÏÈÒÓ. ∏ Â-

ÚÈÔ¯‹ ·˘Ù‹ ÙÔ˘ ¯ÚˆÌ·ÙÔÛÒÌ·ÙÔ˜ 15 Îˆ‰ÈÎÔÔÈÂ›

ÙËÓ Î˘ÙÙ·ÚÈÎ‹ ÚˆÙÂ˝ÓË-1 Ô˘ ‰ÂÛÌÂ‡ÂÈ ÙÔ ÚÂÙÈÓÔ˚-

Îfi ÔÍ‡ (25,26,27). √È ÙÚÈÛˆÌ›Â˜ 13, 18, 21 Î·È 45Ã Â›-

Ó·È ÔÈ ÈÔ Û˘¯Ó¤˜ ·ÓÂ˘ÏÔÂÈ‰›Â˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È ÌÂ

™¢∫ (9). ∞ÓˆÌ·Ï›Â˜ fiˆ˜ ÂÍ·ÏÂ›„ÂÈ˜, ‰ÈÏ·ÛÈ·-

ÛÌÔ›, ·Ó·ÛÙÚÔÊ¤˜ Î·È ÌÂÙ·ı¤ÛÂÈ˜ Û¯Â‰fiÓ fiÏˆÓ ÙˆÓ

¯ÚˆÌ·ÙÔÛˆÌ¿ÙˆÓ ¤¯Ô˘Ó ÂÚÈÁÚ·ÊÂ› ÛÂ Û¯¤ÛË ÌÂ ÙË

™¢∫ (28,29,18) Î·È ¤¯Ô˘Ó ·Ó·ÁÓˆÚÈÛÙÂ› ˆ˜ ÛÔ˘‰·›-

Ô˜ ·ÈÙÈÔÏÔÁÈÎfi˜ ·Ú¿ÁÔÓÙ·˜, ÌÂ Û˘ÓÔ‰¤˜ ·ÓˆÌ·Ï›Â˜

Ô˘ ··ÓÙÔ‡Ó ÛÙÔ 33% ÙˆÓ ÂÚÈÙÒÛÂˆÓ (18). ∫·-

Ú˘fiÙ˘Ô˜ ı· Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÛÂ Î¿ıÂ ·È‰› ÌÂ

™¢∫ Î·È Û˘ÓÔ‰¤˜ ·ÓˆÌ·Ï›Â˜ Ô˘ ‰ÂÓ ·ÔÙÂÏÔ‡Ó

‰Â˘ÙÂÚÂ‡Ô˘ÛÂ˜ Û˘Ó¤ÂÈÂ˜ ·˘Ù‹˜.

¶·ıÔÊ˘ÛÈÔÏÔÁ›·

∏ ·ıÔÁ¤ÓÂÈ· ÙË˜ ™¢∫ ‰ÂÓ Â›Ó·È ·fiÏ˘Ù· Î·Ù·-

ÓÔËÙ‹ ¤ˆ˜ Û‹ÌÂÚ·. ∏ ıÂˆÚ›· ÙË˜ ·ÔÙ˘¯ËÌ¤ÓË˜ Û‡-

ÁÎÏÂÈÛË˜ ÙË˜ ÏÂ˘ÚÔÂÚÈÙÔÓ·˚Î‹˜ Ù˘¯‹˜ Â›Ó·È Â˘-

Ú¤ˆ˜ ·Ô‰ÂÎÙ‹. ∏ ·Ó¿Ù˘ÍË ÙÔ˘ ‰È·ÊÚ¿ÁÌ·ÙÔ˜ ·Ú-

¯›˙ÂÈ ·fi ÙÔ ÚfiÛıÈÔ ÙÌ‹Ì· ÙÔ˘, ˆ˜ ¤Ó· ¯ÒÚÈÛÌ· ÌÂ-

Ù·Í‡ ÙË˜ Î·Ú‰È¿˜ Î·È ÙÔ˘ ‹·ÙÔ˜, Î·È ÚÔ¯ˆÚ¿ÂÈ

ÚÔ˜ Ù· ›Ûˆ ÁÈ· Ó· ÎÏÂ›ÛÂÈ ÙÂÏÈÎ¿ ÚÔ˜ ÙÔ ·ÚÈÛÙÂÚfi

ÙÚ‹Ì· ÙÔ˘ Bochdalek, Á‡Úˆ ÛÙËÓ 8Ë ÌÂ 10Ë Â‚‰ÔÌ¿-

‰· Î‡ËÛË˜. ∆Ô ¤ÓÙÂÚÔ ÌÂÙ·Ó·ÛÙÂ‡ÂÈ ·fi ÙÔÓ ÏÂÎÈıÈ-

Îfi Û¿ÎÔ ÂÚ›Ô˘ ÙË 10Ë Â‚‰ÔÌ¿‰· Î‡ËÛË˜ Î·È, ·Ó

ÊÙ¿ÛÂÈ ÚÈÓ ÙÔ ÎÏÂ›ÛÈÌÔ ÙÔ˘ ÙÚ‹Ì·ÙÔ˜, ‰ËÌÈÔ˘ÚÁÂ›-

Ù·È Ë Î‹ÏË. ¶ÈÛÙÂ‡ÂÙ·È fiÙÈ fiÙ·Ó Û˘Ó˘¿Ú¯ÂÈ ·ÓÒÌ·-

ÏË ÛÙÚÔÊ‹ ÙÔ˘ ÂÓÙ¤ÚÔ˘, ·˘Ù‹, ÏfiÁˆ ı¤ÛË˜, ‰ÂÓ ÂÈ-

ÙÚ¤ÂÈ ÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ ‰È·ÊÚ¿ÁÌ·ÙÔ˜, ÌÂ Û˘Ó¤-

ÂÈ· ÙË ‰È·ÊÚ·ÁÌ·ÙÔÎ‹ÏË. ¢ÂÓ Â›Ó·È ÁÓˆÛÙfi ÔÈÂ˜

·ÈÙ›Â˜ Ô‰ËÁÔ‡Ó ÛÙËÓ ·ÔÙ˘¯›· Û‡ÁÎÏÂÈÛË˜ ÙË˜ ÏÂ˘-

ÚÔÂÚÈÙÔÓ·˚Î‹˜ Ù˘¯‹˜. ¢Â‰ÔÌ¤Ó· ·fi ¤ÚÂ˘ÓÂ˜ ÛÂ

˙Ò· Ô‰ËÁÔ‡Ó ÛÙËÓ ˘fiıÂÛË ˆ˜ ¤Ó· ÌË Ì˘˚Îfi, ÌÂ-

ÛÂÁ¯˘Ì·ÙÈÎfi ÛÙÔÈ¯Â›Ô ÙË˜ ÏÂ˘ÚÔÂÚÈÙÔÓ·˚Î‹˜ Ù˘-

¯‹˜ Â›Ó·È ÂÏ·ÙÙˆÌ·ÙÈÎfi Î·È ‰ÂÓ ÚÔ¿ÁÂÈ ÙÔÓ Û¯ËÌ·-

ÙÈÛÌfi ÙÔ˘ ‰È·ÊÚ¿ÁÌ·ÙÔ˜. ∞˘Ù‹ Ë ˘fiıÂÛË ÂÍËÁÂ› ÙË

‰È·Ù·Ú·¯‹ ÛÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ ‰È·ÊÚ¿ÁÌ·ÙÔ˜, ·ÏÏ¿

‰ÂÓ ‰ÈÎ·ÈÔÏÔÁÂ› ÙÈ˜ Û˘ÓÔ‰¤˜ ·ÓˆÌ·Ï›Â˜ (9).

√ Aderson ÙÔ 1941 ·Ú·Ù‹ÚËÛÂ fiÙÈ Ë ·ÓÂ¿Ú-

ÎÂÈ· ÙË˜ ‚ÈÙ·Ì›ÓË˜ ∞ ·˘Í¿ÓÂÈ ÙËÓ Â›ÙˆÛË ÙË˜

™¢∫. ÕÏÏ· ‰Â‰ÔÌ¤Ó· ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ ÙÔ Û‡ÛÙËÌ·

ÙË˜ ‚ÈÙ·Ì›ÓË˜ ∞ Û˘ÌÌÂÙ¤¯ÂÈ ÛÙË ‰ËÌÈÔ˘ÚÁ›· ‰È·-

ÊÚ·ÁÌ·ÙÔÎ‹ÏË˜, ÓÂ˘ÌÔÓÈÎ‹˜ ˘ÔÏ·Û›·˜ Î·È Î·Ú-

‰È·ÎÒÓ ·ÓˆÌ·ÏÈÒÓ (30,31,26). ªÂÏ¤ÙÂ˜ ÙÔ˘ Major

(1998) ¤‰ÂÈÍ·Ó fiÙÈ ÔÈ ÌËÙ¤ÚÂ˜ Î·È Ù· ÓÂÔÁÓ¿ ÌÂ ™¢∫

Â›¯·Ó ¯·ÌËÏfiÙÂÚ· Â›Â‰· ÚÂÙÈÓfiÏË˜ ÛÙÔ Ï¿ÛÌ·,

99™˘ÁÁÂÓ‹˜ ‰È·ÊÚ·ÁÌ·ÙÔÎ‹ÏË

¶·È‰È·ÙÚÈÎ‹ 2009;72:99-000

¶›Ó·Î·˜ 2. ™‡Ó‰ÚÔÌ· Ô˘ Û¯ÂÙ›˙ÔÓÙ·È ÌÂ Û˘ÁÁÂÓ‹ ‰È·ÊÚ·ÁÌ·-ÙÔÎ‹ÏË

ñ ™‡Ó‰ÚÔÌÔ Frynsñ ™‡Ó‰ÚÔÌÔ Beckwith-Wiedemannñ ™‡Ó‰ÚÔÌÔ Brachman-de Langeñ ™‡Ó‰ÚÔÌÔ Simpson-Golabi-Behmelñ ™‡Ó‰ÚÔÌÔ Donnaiñ ™‡Ó‰ÚÔÌÔ Denys-Drashñ ™‡Ó‰ÚÔÌÔ Perlmanñ ™‡Ó‰ÚÔÌÔ Craniofrontonasalñ ™‡Ó‰ÚÔÌÔ Spondylocostalñ ™‡Ó‰ÚÔÌÔ Marfanñ ™‡Ó‰ÚÔÌÔ ™‡Ó‰ÚÔÌÔ Donnai-Barrowñ ™‡Ó‰ÚÔÌÔ Gershoni-Baruchñ ™‡Ó‰ÚÔÌÔ Matthew-Wood


ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÂÎÂ›Ó· ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÌËÙ¤ÚˆÓ

Î·È ÓÂÔÁÓÒÓ (32).

¶ÚfiÛÊ·Ù· Ë ™¢∫ Û¯ÂÙ›ÛÙËÎÂ ÁÂÓÂÙÈÎ¿ ÌÂ ÙÔ˘˜

·˘ÍËÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜ 10 (FGF-10) Î·È 18 (FGF-

18) ÙË˜ ÊÈÌÚÔÏ·ÛÙ›ÓË˜, Ô˘ ÂÎÎÚ›ÓÔÓÙ·È ·fi ÙÔ

¿ˆ ÓÂ˘ÌÔÓÈÎfi ÌÂÛ¤Á¯˘Ì·. √ ·Ú¿ÁÔÓÙ·˜ FGF-10

ÚÔ¿ÁÂÈ ÙË ‰È·ÊÔÚÔÔ›ËÛË ÙˆÓ ÌÂÛÂÁ¯˘Ì·ÙÈÎÒÓ

Î˘ÙÙ¿ÚˆÓ ÛÂ Î‡ÙÙ·Ú· ÙˆÓ ÏÂ›ˆÓ Ì˘˚ÎÒÓ ÈÓÒÓ ÙˆÓ

·ÂÚÔÊfiÚˆÓ Ô‰ÒÓ Ô˘ ·›˙Ô˘Ó ÚfiÏÔ ÛÙË ‰È·Ù‹ÚËÛË

ÙË˜ ÂÓ‰Ô·˘ÏÈÎ‹˜ ›ÂÛË˜ ÙˆÓ ·ÂÚ·ÁˆÁÒÓ Î·Ù¿ ÙËÓ

ÚÒÈÌË Ê¿ÛË ÙË˜ ·Ó¿Ù˘ÍË˜ ÙˆÓ ÓÂ˘ÌfiÓˆÓ Î·È

ÛÙË Ú‡ıÌÈÛË ÙË˜ Â˘ÂÓ‰ÔÙfiÙËÙ·˜ ÙˆÓ ÓÂ˘ÌfiÓˆÓ

ÛÙ· ÙÂÏÂ˘Ù·›· ÛÙ¿‰È· ÙË˜ Î‡ËÛË˜ (33). ∏ ·ÓÂ¿Ú-

ÎÂÈ¿ ÙÔ˘ ÌÔÚÂ› Ó· ·˘Í‹ÛÂÈ ÙËÓ Â˘¿ıÂÈ· ÙˆÓ ÓÂ˘-

ÌfiÓˆÓ ÛÙÔÓ ÙÚ·˘Ì·ÙÈÛÌfi ·fi Ù· ÂÓ‰ÔÎÔÈÏÈ·Î¿

ÛÏ¿¯Ó· Ô˘ ÚÔÛ›ÙÔ˘Ó. √ ·Ú¿ÁÔÓÙ·˜ FGF-18

ÚÔ¿ÁÂÈ ÙËÓ ·Ú·ÁˆÁ‹ ÂÏ·ÛÙÈÎÒÓ ÈÓÒÓ Î·È Ë ·ÓÂ-

¿ÚÎÂÈ¿ ÙÔ˘ ÌÔÚÂ› Ó· Ô‰ËÁ‹ÛÂÈ ÛÂ ÂÏ·ÙÙˆÌ¤ÓË ·-

Ú·ÁˆÁ‹ ·˘ÙÒÓ (34).

√ ÌË¯·ÓÈÛÌfi˜ ÙË˜ ÓÂ˘ÌÔÓÈÎ‹˜ ˘ÔÏ·Û›·˜ ÛÙË

™¢∫ ·ÔÙÂÏÂ› ÛËÌÂ›Ô ‰È¯ÔÁÓˆÌ›·˜. ™‡ÌÊˆÓ· ÌÂ ÙËÓ

ÈÔ ·Ô‰Â¯Ù‹ ¿Ô„Ë, Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÂÓ‰ÔÌ‹-

ÙÚÈ·˜ ·Ó¿Ù˘ÍË˜, Ù· ÂÓÙfi˜ ÙÔ˘ ıÒÚ·Î· ÎÔÈÏÈ·Î¿

ÛÏ¿¯Ó· È¤˙Ô˘Ó ÙÔÓ Û‡ÛÙÔÈ¯Ô ÓÂ‡ÌÔÓ·, ÁÂÁÔÓfi˜

Ô˘ ÌÔÚÂ› Ó· ÂËÚÂ¿ÛÂÈ ÛÂ ÌÈÎÚfiÙÂÚÔ ‚·ıÌfi Î·È

ÙÔÓ ÂÙÂÚfiÏÂ˘ÚÔ ÓÂ‡ÌÔÓ·, ÏfiÁˆ ÙË˜ ÎÈÓËÙÈÎfiÙË-

Ù·˜ ÙÔ˘ ÌÂÛÔıˆÚ·Î›Ô˘ ÛÙÔ ¤Ì‚Ú˘Ô. ∞˘Ù‹ Ë ¿Ô„Ë

¤¯ÂÈ ÂÈ‚Â‚·ÈˆıÂ› ÂÈÚ·Ì·ÙÈÎ¿ ÛÂ ÔÓÙÈÎÔ‡˜ Î·È

·ÌÓÔ‡˜ (35). ™‡ÌÊˆÓ· ÌÂ ÙËÓ ˘fiıÂÛË ÙˆÓ «‰‡Ô

¯Ù˘ËÌ¿ÙˆÓ», ÙÔ «ÚÒÙÔ ¯Ù‡ËÌ·» Â¤Ú¯ÂÙ·È Óˆ-

Ú›˜ ÛÙËÓ ·Ó¿Ù˘ÍË Î·È ÂËÚÂ¿˙ÂÈ ÂÍ›ÛÔ˘ ÙËÓ ·Ó¿-

Ù˘ÍË ÙˆÓ ‚ÚfiÁ¯ˆÓ Î·È ÙˆÓ ‰‡Ô ÓÂ˘ÌfiÓˆÓ. ∆Ô

«‰Â‡ÙÂÚÔ ¯Ù‡ËÌ·» Û˘Ì‚·›ÓÂÈ ÛÙ· ÙÂÏÂ˘Ù·›· ÛÙ¿‰È·

·Ó¿Ù˘ÍË˜ Î·È ÚÔ¤Ú¯ÂÙ·È Î˘Ú›ˆ˜ ·fi ÙÔ ‰È¿ÊÚ·Á-

Ì·, Ô˘ Ì·˙› ÌÂ Ù· ÂÓ‰ÔÎÔÈÏÈ·Î¿ ÛÏ¿¯Ó· Ô˘ ÚÔ-

Û›ÙÔ˘Ó ÂËÚÂ¿˙ÂÈ ÙÔÓ Û‡ÛÙÔÈ¯Ô ÓÂ‡ÌÔÓ·. ∞˘Ùfi

Ô‰ËÁÂ› ÛÂ ÌÂ›ˆÛË ÙˆÓ ·Ó·ÓÂ˘ÛÙÈÎÒÓ ÎÈÓ‹ÛÂˆÓ ÙÔ˘

ÂÌ‚Ú‡Ô˘ Î·È ÂÏ¿ÙÙˆÛË ÙÔ˘ Ú˘ıÌÔ‡ ·Ú·ÁˆÁ‹˜

ÓÂ˘ÌÔÓÈÎÔ‡ ˘ÁÚÔ‡ (36). ŸÙ·Ó Ù· Û˘ÌÙÒÌ·Ù· ÂÌ-

Ê·Ó›˙ÔÓÙ·È ÓˆÚ›˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË, Ë ˘ÔÏ·Û›· Î·È

ÙˆÓ ‰‡Ô ÓÂ˘ÌfiÓˆÓ Â›Ó·È ¤Ó· ÛÙ·ıÂÚfi Â‡ÚËÌ·. ∏

·ÌÊÔÙÂÚfiÏÂ˘ÚË ÓÂ˘ÌÔÓÈÎ‹ ˘ÔÏ·Û›· Â›Ó·È ÛË-

Ì·ÓÙÈÎ¿ ·˘ÍËÌ¤ÓË ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ‰ÂÍÈ¿ ™¢∫. √È

ÓÂ‡ÌÔÓÂ˜ ¤¯Ô˘Ó ÂÏ·ÙÙˆÌ¤ÓÔ ·ÚÈıÌfi ‚ÚfiÁ¯ˆÓ, ÏÈ-

ÁfiÙÂÚ· ‚ÚÔÁ¯ÈfiÏÈ· (Ù˘ÈÎ¿ 6-8 ÁÂÓÂ¤˜ ‚ÚfiÁ¯ˆÓ,

¤Ó·ÓÙÈ ÙˆÓ 15 ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÓÂÔÁ¤ÓÓËÙˆÓ ‚ÚÂ-

ÊÒÓ) Î·È ÂÏ·ÙÙˆÌ¤ÓË Î˘„ÂÏÈ‰ÈÎ‹ ÂÈÊ¿ÓÂÈ· (37). ∏

·ÁÁÂ›ˆÛË ÙˆÓ ÓÂ˘ÌfiÓˆÓ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ·‡-

ÍËÛË ÙÔ˘ ¿¯Ô˘˜ ÙÔ˘ ÏÂ›Ô˘ Ì˘˚ÎÔ‡ ¯ÈÙÒÓ· ÙˆÓ ·Á-

ÁÂ›ˆÓ, Ë ÔÔ›· ÂÂÎÙÂ›ÓÂÙ·È ¤ˆ˜ Î·È ÙÔ Â›Â‰Ô ÙˆÓ

ÙÚÈ¯ÔÂÈ‰ÒÓ ÙˆÓ Î˘„ÂÏ›‰ˆÓ. √ ·ÚÈıÌfi˜ ÙˆÓ ·ÚÙËÚÈ-

‰›ˆÓ Â›Ó·È Î·Ù¿ ·Ó·ÏÔÁ›· ÂÏ·ÙÙˆÌ¤ÓÔ˜ (38). √È ™¢∫

Ô˘ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Î·Ù¿ ÙËÓ ÂÓ‰ÔÌ‹ÙÚÈ· Î·È ¿ÌÂ-

ÛË ÌÂÙ·ÁÂÓÓËÙÈÎ‹ ÂÚ›Ô‰Ô Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÌÂ›ˆÛË

ÙË˜ ÓÂ˘ÌÔÓÈÎ‹˜ ÏÂÈÙÔ˘ÚÁ›·˜, ÂÓÒ ·˘Ù¤˜ Ô˘ ÂÌÊ·-

Ó›˙ÔÓÙ·È ·ÚÁfiÙÂÚ· Û¿ÓÈ· Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÓÂ˘ÌÔÓÈ-

Î‹ ˘ÔÏ·Û›· (39,40). ∏ ÓÂ˘ÌÔÓÈÎ‹ ÏÂÈÙÔ˘ÚÁ›·

ÂÏ·ÙÙÒÓÂÙ·È ·ÎfiÌË ÂÚÈÛÛfiÙÂÚÔ ·fi ÙËÓ ·˘Í·Ófi-

ÌÂÓË ›ÂÛË ÛÙËÓ ÓÂ˘ÌÔÓÈÎ‹ ·ÚÙËÚ›·, ÌÂ ·ÔÙ¤ÏÂ-

ÛÌ· ÙË ‰ÂÍÈÔ-·ÚÈÛÙÂÚ‹ ‰È·Ê˘Á‹ (41). ™Ù· ÓÂÔÁÓ¿

·˘Ù¿, Ë ÓÂ˘ÌÔÓÈÎ‹ ˘¤ÚÙ·ÛË Â›Ó·È Û¯Â‰fiÓ Î·ıÔÏÈ-

Îfi Â‡ÚËÌ· Î·È Ë ·Ó·ÓÂ˘ÛÙÈÎ‹ ‹ ÌÂÙ·‚ÔÏÈÎ‹ ÔÍ¤ˆ-

ÛË ÙËÓ ÂÈ‰ÂÈÓÒÓÂÈ. ∏ ÌÂÙ·‚ÔÏÈÎ‹ ÔÍ¤ˆÛË Û˘Ó‹ıˆ˜

ÔÊÂ›ÏÂÙ·È ÛÙËÓ ÂÏ·ÙÙˆÌ¤ÓË Î·Ú‰È·Î‹ ·ÚÔ¯‹ Ô˘

ÚÔÎ·ÏÂ›Ù·È ·fi ÙËÓ ˘ÔÍ›· Î·È ÙËÓ ˘ÔÏ·ÛÙÈÎ‹

·ÚÈÛÙÂÚ‹ ÎÔÈÏ›· (42,43).

™Â ¿ÙÔÌ· ÌÂ ™¢∫, Ë ‚ÈÔ¯ËÌÈÎ‹ ·ÓˆÚÈÌfiÙËÙ· ÙˆÓ

ÓÂ˘ÌfiÓˆÓ ¤¯ÂÈ ·ÍÈÔÏÔÁËıÂ› ÛÂ ÓÂ‡ÌÔÓÂ˜ ·Ôı·-

ÓfiÓÙˆÓ ·ÙfiÌˆÓ (44), ÛÙÔ ·ÌÓÈ·Îfi ÁÚfi Î·È, ÈÔ Úfi-

ÛÊ·Ù·, ÛÙÔ ‚ÚÔÁ¯ÔÎ˘„ÂÏÈ‰ÈÎfi ¤ÎÏ˘Ì· (45). ™ÙÔÓ

ÓÂ˘ÌÔÓÈÎfi ÈÛÙfi ÓÂÔÁÓÒÓ ÌÂ ™¢∫, Ë Û˘ÁÎ¤ÓÙÚˆÛË

ÊˆÛÊ·ÙÈ‰Ô¯ÔÏ›ÓË˜ Â›Ó·È ¯·ÌËÏfiÙÂÚË ÛÙ· ÂÚÈÛÛfi-

ÙÂÚ· ¿ÙÔÌ· (44). ™ÙÔ ·ÌÓÈ·Îfi ÁÚfi ¤¯Ô˘Ó ·Ó·ÊÂÚıÂ›

ÌÂÈˆÌ¤ÓË ·Ó·ÏÔÁ›· ÏÂÎÈı›ÓË˜/ÛÊÈÁÁÔÌ˘ÂÏ›ÓË˜ Î·È

ÂÏ·ÙÙˆÌ¤ÓÂ˜ Û˘ÁÎÂÓÙÚÒÛÂÈ˜ ÊˆÛÊ·ÙÈ‰Ô¯ÔÏ›ÓË˜ Î·È

ÚˆÙÂ˝ÓË˜ ∞ ÙÔ˘ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ·

(46,47), ÂÓÒ ¿ÏÏÔÈ ÂÚÂ˘ÓËÙ¤˜ ·Ó·Ê¤ÚÔ˘Ó Ê˘ÛÈÔÏÔÁÈ-

Î¤˜ ·Ó·ÏÔÁ›Â˜ ÏÂÎÈı›ÓË˜/ÛÊÈÁÁÔÌ˘ÂÏ›ÓË˜ Î·È Ê˘ÛÈÔ-

ÏÔÁÈÎ‹ Û˘ÁÎ¤ÓÙÚˆÛË ÙË˜ ÊˆÛÊ·ÙÈ‰ÔÁÏ˘ÎÂÚfiÏË˜

(48). ™ÙÔ ‚ÚÔÁ¯ÔÎ˘„ÂÏÈ‰ÈÎfi ¤ÎÏ˘Ì· ÓÂÔÁÓÒÓ ÌÂ

™¢∫, ÌÈ· ÚfiÛÊ·ÙË ÌÂÏ¤ÙË ÙˆÓ Ijsselstijn Î·È Û˘Ó.

·Ó·Ê¤ÚÂÈ fiÙÈ ÔÈ Û˘ÁÎÂÓÙÚÒÛÂÈ˜ ÊˆÛÊ·ÙÈ‰Ô¯ÔÏ›ÓË˜

Î·È ÊˆÛÊ·ÙÈ‰ÔÁÏ˘ÎÂÚfiÏË˜, Î·È ÔÈ ·Ó·ÏÔÁ›Â˜ ÏÂÎÈı›-

ÓË˜/ÛÊÈÁÁÔÌ˘ÂÏ›ÓË˜ Â›Ó·È ·ÚfiÌÔÈÂ˜ ÌÂ ÂÎÂ›ÓÂ˜ ÓË-

›ˆÓ ›‰È·˜ ËÏÈÎ›·˜ Ô˘ ·Ó‹Î·Ó ÛÙËÓ ÔÌ¿‰· ÙˆÓ Ì·Ú-

Ù‡ÚˆÓ (45) Î·È ÚÔÙÂ›ÓÂÈ fiÙÈ ÌÈ· ÚfiˆÚË ·ÓÂ¿Ú-

ÎÂÈ· ÙÔ˘ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· Â›Ó·È Ì¿Ï-

ÏÔÓ ·›ı·ÓË ÛÙ· ‚Ú¤ÊË ÌÂ ™¢∫. ÕÏÏË ÌÂÏ¤ÙË (49)

·Ó·Ê¤ÚÂÈ fiÙÈ Ù· ÓÂÔÁÓ¿ ÌÂ ™¢∫ ¤¯Ô˘Ó ÛËÌ·ÓÙÈÎ¿ ·-

ÌËÏfiÙÂÚ· Â›Â‰· ÊˆÛÊ·ÙÈ‰ÔÁÏ˘ÎÂÚfiÏË˜ Î·È Úˆ-

ÙÂ˝ÓË˜ ∞ ÛÙÔ ˘ÏÈÎfi ·fi ·Ó·ÚÚfiÊËÛË ÙË˜ ÙÚ·¯Â›·˜.

∞˘Ù¿ Ù· Â›Â‰· ÌÂÈÒÓÔÓÙ·È ·ÎfiÌË ÂÚÈÛÛfiÙÂÚÔ

Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÌÂÏ¤ÙË˜, ÛÂ Û‡ÁÎÚÈÛË ÌÂ ·˘Ù¿

ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÓÂÔÁÓÒÓ ›‰È·˜ ËÏÈÎ›·˜ Ô˘ ·Ô-

Ù¤ÏÂÛ·Ó ÙËÓ ÔÌ¿‰· ÙˆÓ Ì·ÚÙ‡ÚˆÓ. ∞˘Ù¿ Ù· Û˘ÌÂ-

Ú¿ÛÌ·Ù· ‰ËÏÒÓÔ˘Ó ÙËÓ ‡·ÚÍË ·ÓÂ¿ÚÎÂÈ·˜ ÙÔ˘

ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ÛÂ ·ÛıÂÓÂ›˜ ÌÂ

™¢∫, Ë ÔÔ›· ı· ÌÔÚÔ‡ÛÂ Ó· ÔÊÂ›ÏÂÙ·È ÛÙËÓ ‡·Ú-

ÍË ÌÈÎÚfiÙÂÚË˜ Î˘„ÂÏÈ‰ÈÎ‹˜ ÂÈÊ¿ÓÂÈ·˜ ÛÙÔ˘˜ ÂË-

ÚÂ·Ûı¤ÓÙÂ˜ ÓÂ‡ÌÔÓÂ˜ ‹ ÛÙË ÌÂÈˆÌ¤ÓË Û‡ÓıÂÛË ‹

ÛÙÔÓ ·˘Í·ÓfiÌÂÓÔ Î·Ù·‚ÔÏÈÛÌfi ÙÔ˘ (50).

∫¿ÔÈ· Ê¿ÚÌ·Î· ¤¯Ô˘Ó Û¯ÂÙÈÛÙÂ› ÌÂ ÙËÓ ÂÌÊ¿ÓÈ-

ÛË ™¢∫, fiˆ˜ Ë ı·ÏÈ‰ÔÌ›‰Ë, Ë ÎÈÓ›ÓË Î·È Ù· ·ÓÙÈÂÈ-

ÏËÙÈÎ¿ (51,52). ∂›ÛË˜, ™¢∫ ¤¯ÂÈ ·Ó·ÊÂÚıÂ› ÛÂ ÓÂ-

ÔÁÓfi ‰È·‚ËÙÈÎ‹˜ ÌËÙ¤Ú·˜ (53). ∏ ÔÚ‹ÁËÛË ÔÚÌÔÓÒÓ

ÌÔÚÂ› Ó· Â›Ó·È ÛËÌ·ÓÙÈÎ‹. ∆· ÁÏ˘ÎÔÎÔÚÙÈÎÔÂÈ‰‹

100 Ã. ∆Û·Î·Ï›‰Ë˜ Î·È Û˘Ó.



ÚÔ¿ÁÔ˘Ó ÙËÓ ˆÚ›Ì·ÓÛË ÙˆÓ ÓÂ˘ÌfiÓˆÓ Î·È ÛÙ·ıÂ-

ÚÔÔÈÔ‡Ó ÙÔ ÓÂ˘ÌÔÓÈÎfi ·ÁÁÂÈ·Îfi ÙÔ›¯ˆÌ·, ÚÔÎ·-

ÏÒÓÙ·˜ ·‡ÍËÛË ÙÔ˘ ¿¯Ô˘˜ ÙÔ˘ ÙÔÈ¯ÒÌ·Ùfi˜ ÙÔ˘˜

ÛÙ· ˙Ò· ÌÂ ™¢∫ Î·È ·˘Í¿ÓÔ˘Ó ÙÔ˘˜ ˘Ô‰Ô¯Â›˜ ÙˆÓ

ÁÏ˘ÎÔÎÔÚÙÈÎÔÂÈ‰ÒÓ ÛÙ· ·È‰È¿ ÌÂ ™¢∫ (54).

¶ÚÔÁÂÓÓËÙÈÎ‹ ‰È¿ÁÓˆÛË

™ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi, ÔÈ ‰È·ÊÚ·ÁÌ·ÙÔÎ‹-

ÏÂ˜ ‰È·ÁÈÁÓÒÛÎÔÓÙ·È ÚÔÁÂÓÓËÙÈÎ¿ Î·Ù¿ ÙÔÓ ˘Â-

ÚË¯ÔÁÚ·ÊÈÎfi ¤ÏÂÁ¯Ô ÙÔ˘ ÂÌ‚Ú‡Ô˘. ∆Ô ÔÛÔÛÙfi

ÚÔÁÂÓÓËÙÈÎ‹˜ ‰È¿ÁÓˆÛË˜ ‰È·Ê¤ÚÂÈ ÛËÌ·ÓÙÈÎ¿ ÛÙÈ˜

‰È¿ÊÔÚÂ˜ ‰ËÌÔÛÈÂ‡ÛÂÈ˜, ·ÏÏ¿ Î·Ù¿ Ì¤ÛÔ fiÚÔ ‚Ú›-

ÛÎÂÙ·È ÛÙÔ 50-54% (55,7,9), ÌÂ Â‡ÚÔ˜ Ô˘ Î˘Ì·›ÓÂ-

Ù·È ·fi 29-100% (56,57).∆Ô ÔÛÔÛÙfi ·˘Ùfi ·˘Í¿ÓÂ-

Ù·È ÛÙÔ 72% fiÙ·Ó Û˘Ó˘¿Ú¯Ô˘Ó ÂÈÚfiÛıÂÙÂ˜ ·Óˆ-

Ì·Ï›Â˜ ‹ ·ıÔÏÔÁÈÎfi˜ Î·Ú˘fiÙ˘Ô˜ (56). ŒÓ· ÛËÌ·-

ÓÙÈÎfi˜ ·ÚÈıÌfi˜ ™¢∫ ‰È·ÁÈÁÓÒÛÎÂÙ·È ÌÂÙ¿ ÙËÓ 24Ë

Â‚‰ÔÌ¿‰· Î‡ËÛË˜. ∏ Ì¤ÛË ËÏÈÎ›· Î‡ËÛË˜ ÁÈ· ÙË

‰È¿ÁÓˆÛË ÙË˜ ·Ï‹˜ ‰È·ÊÚ·ÁÌ·ÙÔÎ‹ÏË˜ Â›Ó·È Ë

25Ë Â‚‰ÔÌ¿‰· Î‡ËÛË˜ (55). √È ‰È·ÊÚ·ÁÌ·ÙÔÎ‹ÏÂ˜

ÌÂ ·ÌÊÔÙÂÚfiÏÂ˘ÚË ÂÓÙfiÈÛË ·ÚÔ˘ÛÈ¿˙Ô˘Ó Û˘-

¯ÓfiÙÂÚ· Û˘ÓÔ‰¤˜ ·ÓˆÌ·Ï›Â˜, Ô˘ Ô‰ËÁÔ‡Ó ÛÂ ˘„Ë-

ÏfiÙÂÚÔ ÔÛÔÛÙfi ÚÔÁÂÓÓËÙÈÎ‹˜ ‰È¿ÁÓˆÛË˜ Î·È

Ùˆ¯‹ ¤Î‚·ÛË (55). ∏ ™¢∫ ‰È·ÁÈÁÓÒÛÎÂÙ·È ˘ÂÚË-

¯ÔÁÚ·ÊÈÎ¿ ÌÂ ÙËÓ ·ÓÂ‡ÚÂÛË ÂÓ‰ÔÎÔÈÏÈ·ÎÒÓ ÔÚÁ¿-

ÓˆÓ ÂÓÙfi˜ ÙË˜ ıˆÚ·ÎÈÎ‹˜ ÎÔÈÏfiÙËÙ·˜. ŒÌÌÂÛÔÈ ‰Â›-

ÎÙÂ˜ Â›Ó·È ÙÔ ÔÏ˘˘‰Ú¿ÌÓÈÔ, Ô ·ÓÒÌ·ÏÔ˜ Î·Ú‰È·-

Îfi˜ ¿ÍÔÓ·˜ Î·È Ë ÌÂÙ·ÙfiÈÛË ÙÔ˘ ÌÂÛÔıˆÚ·Î›Ô˘.

¶ÂÚÈÛÙ·ÏÙÈÎ¤˜ ÎÈÓ‹ÛÂÈ˜ ÙÔ˘ ÛÙÔÌ¿¯Ô˘ Î·È ÙÔ˘ ÏÂ-

ÙÔ‡ ÂÓÙ¤ÚÔ˘ ÂÓÙfi˜ ÙÔ˘ ıÒÚ·Î· ÌÔÚÂ› Ó· Á›ÓÔ˘Ó

·ÓÙÈÏËÙ¤˜ ˘ÂÚË¯ÔÁÚ·ÊÈÎ¿ ÛÙ· ÙÂÏÈÎ¿ ÛÙ¿‰È·

ÙË˜ Î‡ËÛË˜. √È ‰È·ÊÚ·ÁÌ·ÙÔÎ‹ÏÂ˜ Ô˘ ÂÓÙÔ›˙Ô-

ÓÙ·È ‰ÂÍÈ¿ ‰È·ÁÈÁÓÒÛÎÔÓÙ·È ÚÔÁÂÓÓËÙÈÎ¿ ÈÔ ‰‡-

ÛÎÔÏ·, ‰ÈfiÙÈ ÙÔ ‹·Ú ¤¯ÂÈ ·ÚfiÌÔÈ· Ë¯ÔÁ¤ÓÂÈ· ÌÂ

ÙÔ˘˜ ÂÌ‚Ú˘˚ÎÔ‡˜ ÓÂ‡ÌÔÓÂ˜ Î·È ÌÔÚÂ› Ó· Â›Ó·È ÙÔ

ÌfiÓÔ fiÚÁ·ÓÔ Ô˘ ÚÔÛ›ÙÂÈ ÂÓÙfi˜ ÙÔ˘ ıÒÚ·Î·. ∏

ı¤ÛË ÙË˜ ¯ÔÏË‰fi¯Ô˘ Î‡ÛÙË˜ Î·È ÔÈ ¤ÌÌÂÛÔÈ ‰Â›ÎÙÂ˜

ÌÔÚÂ› Ó· Ê·ÓÔ‡Ó È‰È·›ÙÂÚ· ¯Ú‹ÛÈÌÔÈ ÛÂ ·˘Ù‹ ÙËÓ

ÂÚ›ÙˆÛË (55).

∫ÏÈÓÈÎ‹ ÂÈÎfiÓ·

∏ Û˘ÁÁÂÓ‹˜ ‰È·ÊÚ·ÁÌ·ÙÔÎ‹ÏË ·ÚÔ˘ÛÈ¿˙ÂÙ·È

Û˘¯ÓfiÙÂÚ· ÛÙË ÓÂÔÁÓÈÎ‹ ÂÚ›Ô‰Ô ÌÂ ÛÔ‚·Ú‹ ·Ó·-

ÓÂ˘ÛÙÈÎ‹ ‰˘Û¯¤ÚÂÈ· (39). ™ÙÔ 5-30% ÙˆÓ ÂÚÈ-

ÙÒÛÂˆÓ, Ë ‰È¿ÁÓˆÛË Î·ı˘ÛÙÂÚÂ› ¤Ú·Ó ÙË˜ ÓÂÔ-

ÁÓÈÎ‹˜ ÂÚÈfi‰Ô˘ (58,59) Î·È ÌÔÚÂ› Ó· ÂÎ‰ËÏˆıÂ›

·ÚÁfiÙÂÚ· ÌÂ ÔÈÎ›ÏË ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· (60). ªÂÙ¿ ÙË

Á¤ÓÓËÛË, fiÙ·Ó Ë Î‹ÏË ÁÂÌ›˙ÂÈ ÌÂ ·¤Ú·, Ë Û˘Ì›ÂÛË

ÙˆÓ ÓÂ˘ÌfiÓˆÓ ÂÈ‰ÂÈÓÒÓÂÙ·È. ∏ ÚfiÁÓˆÛË ÂÍ·Ú-

Ù¿Ù·È ·fi ÙÔÓ ‚·ıÌfi ÙË˜ ÓÂ˘ÌÔÓÈÎ‹˜ ˘ÔÏ·Û›·˜

(61) Î·È ÙË Û˘Ó˘¿Ú¯Ô˘Û· ÂÏ¿ÙÙˆÛË ÙˆÓ Î˘„ÂÏÈ-

‰ÈÎÒÓ Î·È ·ÁÁÂÈ·ÎÒÓ ÂÈÊ·ÓÂÈÒÓ. ªÔÚÂ› Ó· Û˘Ó˘-

¿Ú¯ÂÈ ÛÔ‚·Ú‹ ˘ÂÚÎ·Ó›· Î·È ˘ÔÍ·ÈÌ›·, Ì·˙› ÌÂ

‚·ÚÈ¿ ÓÂ˘ÌÔÓÈÎ‹ ˘¤ÚÙ·ÛË, ÌÂ ·ÔÙ¤ÏÂÛÌ· ‰Â-

ÍÈÔ-·ÚÈÛÙÂÚ‹ ‰È·Ê˘Á‹ ÛÙÔ Â›Â‰Ô ÙˆÓ ÎfiÏˆÓ Î·È

ÙÔ˘ ·ÚÙËÚÈ·ÎÔ‡ fiÚÔ˘. ∆· Û˘¯ÓfiÙÂÚ· Û˘ÌÙÒÌ·-

Ù· ·ÊÔÚÔ‡Ó ÙÔ ·Ó·ÓÂ˘ÛÙÈÎfi (43%), ÙÔ Á·ÛÙÚÂÓÙÂ-

ÚÈÎfi (33%), ÙÔ ·Ó·ÓÂ˘ÛÙÈÎfi Î·È Á·ÛÙÚÂÓÙÂÚÈÎfi

Û‡ÛÙËÌ· (13%), ÂÓÒ ·Û˘ÌÙˆÌ·ÙÈÎ¤˜ ÂÚÈÙÒÛÂÈ˜

·Ó·Ê¤ÚÔÓÙ·È ÛÂ ÔÛÔÛÙfi 11%. °È· Ù· ÓÂÔÁÓ¿ ÛÙ·

ÔÔ›· ‰ÂÓ Á›ÓÂÙ·È Ë ‰È¿ÁÓˆÛË ÂÓ‰ÔÌ‹ÙÚÈ·, Ë ¤Ó·Ú-

ÍË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Û˘Ì‚·›ÓÂÈ Û˘Ó‹ıˆ˜ ÌÂ ·Ó·-

ÓÂ˘ÛÙÈÎ‹ ‰˘Û¯¤ÚÂÈ· Ì¤Û· ÛÙÈ˜ ÚÒÙÂ˜ ÒÚÂ˜ ‹

ËÌ¤ÚÂ˜ ˙ˆ‹˜. ∆· ÓÂÔÁÓ¿ ÌÂ ÙËÓ ÈÔ ‚·ÚÈ¿ Û˘ÌÙˆ-

Ì·ÙÔÏÔÁ›· ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙËÓ ·›ıÔ˘Û· ÙÔÎÂÙÔ‡ ÌÂ

‰˘Û¯¤ÚÂÈ· ÛÙËÓ ·Ó¿ÓË„Ë Î·È ÌÂ ˘„ËÏ¿ ÔÛÔÛÙ¿

ÓÂ˘ÌÔıÒÚ·Î·. √È ·Ó·ÓÂ˘ÛÙÈÎÔ› ‹¯ÔÈ Â›Ó·È ·fi-

ÓÙÂ˜ ÛÙËÓ ¿Û¯Ô˘Û· ÏÂ˘Ú¿, Ô ıÒÚ·Î·˜ ¤¯ÂÈ Î˘-

ÏÈÓ‰ÚÈÎfi Û¯‹Ì·, Ë ÎÔÈÏÈ¿ Â›Ó·È ÛÎ·ÊÔÂÈ‰‹˜ Î·È ÔÈ

Î·Ú‰È·ÎÔ› ÙfiÓÔÈ ÌÂÙ·ÙÔ›˙ÔÓÙ·È ‰ÂÍÈ¿. ∏ ÏÂÈÔÓfi-

ÙËÙ· ÙˆÓ ‰ÂÍÈ¿ ÂÓÙÔÈ˙fiÌÂÓˆÓ ™¢∫ ÂÎ‰ËÏÒÓÂÙ·È

ÌÂ Û˘ÌÙÒÌ·Ù· ·fi ÙÔ ·Ó·ÓÂ˘ÛÙÈÎfi (62). ∏ Û‡-

ÁÎÏÂÈÛË ÙÔ˘ ·Ó·ÙÔÌÈÎÔ‡ ÂÏÏÂ›ÌÌ·ÙÔ˜ ·fi ÙÔ ‹·Ú

·ÔÙÚ¤ÂÈ ÙË ÌÂÙ¤ÂÈÙ· ÚfiÙˆÛË ÎÔ›ÏˆÓ ÔÚÁ¿-

ÓˆÓ Î·È ÙËÓ ÂÌÊ¿ÓÈÛË Û˘ÌÙˆÌ¿ÙˆÓ ·fi ÙÔ Á·-

ÛÙÚÂÓÙÂÚÈÎfi.

¢ÈÂÚÂ‡ÓËÛË

∏ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·Î· Î·È ÎÔÈÏ›·˜ ·ÔÙÂÏÂ› ÙËÓ

ÚÒÙË ÂÍ¤Ù·ÛË ÛÂ fiÏ· Ù· ·È‰È¿ ÌÂ ·ÓÂÍ‹ÁËÙ· Û˘-

ÌÙÒÌ·Ù· ·fi ÙÔ ·Ó·ÓÂ˘ÛÙÈÎfi ‹ Á·ÛÙÚÂÓÙÂÚÈÎfi Û‡-

ÛÙËÌ· (60,62). ¢˘ÛÎÔÏ›· ÛÙËÓ ·ÎÙÈÓÔÏÔÁÈÎ‹ ‰È¿ÁÓˆ-

ÛË ··ÓÙ¿ ÛÂ ÔÛÔÛÙfi 25%, ÌÂ ÙÔÓ ÓÂ˘ÌÔıÒÚ·Î·

Î·È ÙÔÓ ˘‰ÚÔıÒÚ·Î· ˆ˜ ÈÔ ÎÔÈÓ¤˜ Ï·Óı·ÛÌ¤ÓÂ˜ ‰È·-

ÁÓÒÛÂÈ˜ (62). ∏ ÙÔÔı¤ÙËÛË ÛÙÔÌ·ÙÔÁ·ÛÙÚÈÎÔ‡ Î·-

ıÂÙ‹Ú· ÁÈ· ÙË ‰È·›ÛÙˆÛË ÙË˜ ı¤ÛË˜ ÙÔ˘ ÛÙÔÌ¿¯Ô˘

Î·È Ô ·ÎÙÈÓÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÌÂ ÛÎÈ·ÛÙÈÎfi ÙÔ˘ ·ÓÒÙÂ-

ÚÔ˘ ÂÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ‚ÔËıÔ‡Ó ÛÙË ÛˆÛÙ‹ ‰È¿-

ÁÓˆÛË ÙË˜ ·ÚÈÛÙÂÚ‹˜ ™¢∫. ∏ CT ıÒÚ·Î· Â›Ó·È Ú‹ÛÈ-

ÌË ÁÈ· ÙË ‰È¿ÁÓˆÛË ÙË˜ ‰ÂÍÈ¿˜ ™¢∫, fiÙ·Ó ÚÔÛ›ÙÂÈ

ÙÔ ‹·Ú ÂÓÙfi˜ ÙË˜ ıˆÚ·ÎÈÎ‹˜ ÎÔÈÏfiÙËÙ·˜ (62).

¢È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË

∏ ‚Ï¿‚Ë ÙˆÓ ÓÂ˘ÌfiÓˆÓ Ô˘ Û˘Ì‚·›ÓÂÈ Î·Ù¿ ÙË

‰È¿ÚÎÂÈ· ÙË˜ ÂÌ‚Ú˘˚Î‹˜ ˙ˆ‹˜ ÌÔÚÂ› Ó· Ô‰ËÁ‹ÛÂÈ

ÛÙËÓ ÂÌÊ¿ÓÈÛË Û˘ÁÁÂÓÒÓ ·ÓˆÌ·ÏÈÒÓ, fiˆ˜ Û˘ÁÁÂÓ‹

·‰ÂÓˆÌ·ÙÒ‰Ë Î˘ÛÙÈÎ‹ ‰˘ÛÏ·Û›·, Û˘ÁÁÂÓ¤˜ ÏÔ‚Ò-

‰Â˜ ÂÌÊ‡ÛËÌ·, ‰È¿¯˘ÙÂ˜ ÓÂ˘ÌÔÓÈÎ¤˜ Î‡ÛÙÂÈ˜ Î·È,

Û·ÓÈfiÙÂÚ·, ÓÂ˘ÌÔÓÈÎ‹ ·ÁÂÓÂÛ›·, ˘‰ÚÔıÒÚ·Î·,

Î·È ÙÂÏÈÎ¿ ÛÙÔÓ ı¿Ó·ÙÔ ÙÔ˘ ÂÌ‚Ú‡Ô˘ ‹ ÙÔ˘ ÓÂÔÁÓÔ‡

·ÚÁfiÙÂÚ·. ∏ ‰È¿ÁÓˆÛË ÙˆÓ Û˘ÁÁÂÓÒÓ ·˘ÙÒÓ ·ÓˆÌ·-

ÏÈÒÓ ÚÔÁÂÓÓËÙÈÎ¿ Â›Ó·È ‰‡ÛÎÔÏË. ªÂÙ·ÁÂÓ¤ÛÙÂÚ·,

Ë CT ıÒÚ·Î· ÌÔÚÂ› Ó· ı¤ÛÂÈ ÙË ‰È¿ÁÓˆÛË. ªÂÙ¿ ÙË

Á¤ÓÓËÛË, Ë ‰È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË ÂÚÈÏ·Ì‚¿ÓÂÈ Â›-

ÛË˜ ÙÔÓ ÓÂ˘ÌÔıÒÚ·Î·, ÙË ‰ÂÍÈÔÎ·Ú‰›· Î·È ÙË Ï·-

Ú˘ÁÁÔÙÚ·¯ÂÈ·Î‹ ·fiÊÚ·ÍË.


¶·È‰È·ÙÚÈÎ‹ 2009;72:101-000


£ÂÚ·Â›·

∏ ‡·ÚÍË ÂÍˆÛˆÌ·ÙÈÎ‹˜ ÌÂÌ‚Ú¿ÓË˜ ÔÍ˘ÁfiÓˆ-

ÛË˜ (ECMO), Ë ‰˘Ó·ÙfiÙËÙ· ÚÔÂÁ¯ÂÈÚËÙÈÎ‹˜ ÛÙ·-

ıÂÚÔÔ›ËÛË˜ ÙÔ˘ ÓÂÔÁÓÔ‡ Î·È Ë ÚfiÔ‰Ô˜ fiÛÔÓ ·ÊÔ-

Ú¿ ÛÙËÓ ÂÓ‰ÔÌ‹ÙÚÈÔ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ Û˘ÁÁÂÓÔ‡˜

‰È·ÊÚ·ÁÌ·ÙÔÎ‹ÏË˜ ÛÙËÚ›˙Ô˘Ó ÙËÓ ÚÔÛ¿ıÂÈ· ÌË

ÂÈıÂÙÈÎ‹˜ ·ÔÎ·Ù¿ÛÙ·ÛË˜ ÙˆÓ ‚Ï·‚ÒÓ. ¶·Ï·ÈfiÙÂ-

Ú·, Ë ‰È·ÊÚ·ÁÌ·ÙÔÎ‹ÏË ıÂˆÚÔ‡ÓÙ·Ó ÂÂ›ÁÔ˘Û· Î·-

Ù¿ÛÙ·ÛË, ÛÙËÓ ÔÔ›· Â›¯Â ·fiÏ˘ÙË ¤Ó‰ÂÈÍË Ë ¿ÌÂÛË

¯ÂÈÚÔ˘ÚÁÈÎ‹ ·Ú¤Ì‚·ÛË, ÒÛÙÂ Ó· ÂÈÙÂ˘¯ıÂ› ÙÔ Î·-

Ï‡ÙÂÚÔ ‰˘Ó·Ùfi ·ÔÙ¤ÏÂÛÌ·. ∞˘Ù‹ Ë ÛÙÚ·ÙËÁÈÎ‹ ¤¯ÂÈ

Â·ÓÂÎÙÈÌËıÂ›, ÏfiÁˆ ÙË˜ Î·Ù·ÓfiËÛË˜ ÙÔ˘ ÚfiÏÔ˘ ÙË˜

ÓÂ˘ÌÔÓÈÎ‹˜ ˘¤ÚÙ·ÛË˜, ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ÙËÓ

ÓÂ˘ÌÔÓÈÎ‹ ˘ÔÏ·Û›· Î·È ÙËÓ Â›‰Ú·ÛË ÙË˜ ¯ÂÈ-

ÚÔ˘ÚÁÈÎ‹˜ ·Ú¤Ì‚·ÛË˜ ÛÙËÓ ÓÂ˘ÌÔÓÈÎ‹ ÏÂÈÙÔ˘Ú-

Á›·. ∂›Ó·È Ï¤ÔÓ ÍÂÎ¿ı·ÚÔ fiÙÈ ÙÔ Î‡ÚÈÔ Úfi‚ÏËÌ·

Ô˘ ÚÔÎ·ÏÂ› Î·Ú‰ÈÔ·Ó·ÓÂ˘ÛÙÈÎ‹ ·ÓÂ¿ÚÎÂÈ· Â›-

Ó·È Ë ÓÂ˘ÌÔÓÈÎ‹ ˘¤ÚÙ·ÛË Î·È Ë ˘ÔÏ·Û›· ÙˆÓ

ÓÂ˘ÌfiÓˆÓ Î·È fi¯È Ë Û˘Ì›ÂÛË Ô˘ ÚÔÎ·ÏÔ‡Ó Ù·

ÂÓ‰ÔÂÚÈÙÔÓ·˚Î¿ ÛÏ¿¯Ó· Ô˘ ¤¯Ô˘Ó ÂÈÛ¤ÏıÂÈ ÛÙË

ıˆÚ·ÎÈÎ‹ ÎÔÈÏfiÙËÙ·.

™Â ÓÂÔÁÓ¿ ÌÂ ÚÔÁÂÓÓËÙÈÎ‹ ‰È¿ÁÓˆÛË Î·È ÛÂ ·˘Ù¿

Ô‡ Ù›ıÂÙ·È ¤ÁÎ·ÈÚ· Ë ˘fiÓÔÈ· ÙË˜ ‰È·ÊÚ·ÁÌ·ÙÔÎ‹-

ÏË˜ ÙÔÔıÂÙÂ›Ù·È ÛÙÔÌ·ÙÔÁ·ÛÙÚÈÎfi˜ Î·ıÂÙ‹Ú·˜ Î·È

Á›ÓÂÙ·È Û˘ÓÂ¯Ò˜ ·Ó·ÚÚfiÊËÛË ÙÔ˘ ÛÙÔÌ¿¯Ô˘, ÒÛÙÂ Ó·

ÂÏ·ÙÙˆıÂ› Ë ÔÛfiÙËÙ· ÙÔ˘ ·¤Ú· Ì¤Û· ÛÙËÓ Î‹ÏË Î·È

Ó· ÌÂÈˆıÂ› Ë Û˘Ì›ÂÛË ÙˆÓ ÓÂ˘ÌfiÓˆÓ. ∆Ô ÓÂÔÁÓfi

Ú¤ÂÈ Ó· ‰È·ÛˆÏËÓÒÓÂÙ·È ·Ì¤Ûˆ˜ Î·È Ó· ÂÊ·ÚÌfi-

˙ÔÓÙ·È ıÂÙÈÎ¤˜ È¤ÛÂÈ˜. √ ÌË¯·ÓÈÎfi˜ ·ÂÚÈÛÌfi˜ ·Ô-

ÙÂÏÂ› ÙË ‚¿ÛË ÙË˜ ·ÓÙÈÌÂÙÒÈÛË˜ ÙË˜ ™¢∫. ™ÙËÓ

ÚÔÛ¿ıÂÈ· ÂÏ¿ÙÙˆÛË˜ ÙÔ˘ ‚·ÚÔÙÚ·‡Ì·ÙÔ˜ Î·È ÙÔ˘

ÓÂ˘ÌÔıÒÚ·Î· ÚÔÙÈÌ¿Ù·È Ô ‹ÈÔ˜ ·ÂÚÈÛÌfi˜

(63,65). ™Â ÂÚÈÙÒÛÂÈ˜ ·ÓıÂÎÙÈÎ‹˜ ·Ó·ÓÂ˘ÛÙÈÎ‹˜

·ÓÂ¿ÚÎÂÈ·˜ Î·È ·Ú·Ì¤ÓÔ˘Û·˜ ÓÂ˘ÌÔÓÈÎ‹˜ ˘¤Ú-

Ù·ÛË˜ ÂÓ‰Â›ÎÓ˘Ù·È Ë ÂÊ·ÚÌÔÁ‹ „›Û˘¯ÓÔ˘ ·ÂÚÈÛÌÔ‡,

ÌfiÓÔ˘ ‹ ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ÂÈÛÓÂfiÌÂÓÔ ÌÔÓÔÍÂ›‰ÈÔ

ÙÔ˘ ·˙ÒÙÔ˘ (65). °È· Ù· ÓÂÔÁÓ¿ ÌÂ ‚·ÚÈ¿ ·Ó·ÓÂ˘ÛÙÈ-

Î‹ ·ÓÂ¿ÚÎÂÈ·, ÌÂ ÌÂÁ¿ÏË ˘ÔÛÙ‹ÚÈÍË ÛÙÔÓ Û˘Ì‚·-

ÙÈÎfi ÌË¯·ÓÈÎfi ·ÂÚÈÛÌfi, Ô˘ ÏËÚÔ‡Ó Ù· ÎÚÈÙ‹ÚÈ· ÁÈ·

ECMO, Ô ‚·ıÌfi˜ ÂÈÙ˘¯›·˜ ÙÔ˘ „›Û˘¯ÓÔ˘ ·ÂÚÈÛÌÔ‡

ÚÈÓ ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ECMO ÊÙ¿ÓÂÈ ÙÔ 33% (67).

∆Ô ÂÈÛÓÂfiÌÂÓÔ ÌÔÓÔÍÂ›‰ÈÔ ÙÔ˘ ·˙ÒÙÔ˘ ¤¯ÂÈ ¯ÚËÛÈ-

ÌÔÔÈËıÂ› Â›ÛË˜ ÌÂ ÂÈÙ˘¯›· ÛÙË ıÂÚ·Â›· ÙË˜ ‚·-

ÚÈ¿˜ ÓÂ˘ÌÔÓÈÎ‹˜ ˘¤ÚÙ·ÛË˜ ÙÔ˘ ÓÂÔÁÓÔ‡ Î·È ‰È¿-

ÊÔÚÔÈ ÂÚÂ˘ÓËÙ¤˜ ‰ÔÎ›Ì·Û·Ó ·˘Ù‹Ó ÙË ıÂÚ·Â›· ÛÂ

ÓÂÔÁÓ¿ ÌÂ ÛÔ‚·Ú‹ ÓÂ˘ÌÔÓÈÎ‹ ˘¤ÚÙ·ÛË Ô˘ ÂÈ-

Ï¤ÎÂÈ ÙËÓ ÔÚÂ›· ÙË˜ ‰È·ÊÚ·ÁÌ·ÙÔÎ‹ÏË˜ (64).

∏ ¯ÔÚ‹ÁËÛË ÓÙÔ·Ì›ÓË˜ ‹ ÓÙÔÌÔ˘Ù·Ì›ÓË˜ Û˘-

Ó‹ıˆ˜ ‚ÂÏÙÈÒÓÂÈ ÙËÓ Î·Ú‰È·Î‹ ·ÚÔ¯‹ Î·È ÙË Û˘-

ÛÙËÌ·ÙÈÎ‹ ›ÂÛË, ÂÏ·ÙÙÒÓÂÈ ÙË ÌÂÙ·‚ÔÏÈÎ‹ ÔÍ¤ˆÛË

Î·È ¤ÌÌÂÛ· ÌÂÈÒÓÂÈ ÙËÓ ·˘ÍËÌ¤ÓË ›ÂÛË ÛÙ· ÓÂ˘-

ÌÔÓÈÎ¿ ·ÁÁÂ›·. ∏ ÂÊ¿·Í ¯ÔÚ‹ÁËÛË ‰ÈÙÙ·ÓıÚ·ÎÈÎÔ‡

Ó·ÙÚ›Ô˘ ÌÔÚÂ› Ó· Ê·ÓÂ› ¯Ú‹ÛÈÌË. ¶¿ÓÙˆ˜, Ô Â·Ú-

Î‹˜ ·ÂÚÈÛÌfi˜, Ë ÔÍ˘ÁfiÓˆÛË Î·È ÔÈ ·Ú¿ÁÔÓÙÂ˜ Ô˘

·˘Í¿ÓÔ˘Ó ÙË Û˘ÛÙËÌ·ÙÈÎ‹ ›ÂÛË ·ÔÙÂÏÔ‡Ó ÙËÓ

Â·ÚÎ‹ ıÂÚ·Â›·. ∏ ¯ÔÚ‹ÁËÛË ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡

·Ú¿ÁÔÓÙ· ÌÔÚÂ›, fi¯È ÌfiÓÔ Ó· ·ÓÙÈÌÂÙˆ›ÛÂÈ ÙËÓ

·ÓÂ¿ÚÎÂÈ¿ ÙÔ˘, ·ÏÏ¿ Î·È Ó· ‚ÂÏÙÈÒÛÂÈ ÙËÓ Â˘ÂÓ‰Ô-

ÙfiÙËÙ·, Ó· ÂÏ·ÙÙÒÛÂÈ ÙÈ˜ ÓÂ˘ÌÔÓÈÎ¤˜ ·ÁÁÂÈ·Î¤˜

·ÓÙÈÛÙ¿ÛÂÈ˜ Î·È Ó· ‚ÂÏÙÈÒÛÂÈ ÙË ÚÔ‹ ÙÔ˘ ·›Ì·ÙÔ˜

ÛÙÔÓ ÓÂ‡ÌÔÓ· (68,69).

∏ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ™¢∫ ‰ÂÓ Â›Ó·È ¿ÌÔÈÚË ÂÈ-

ÏÔÎÒÓ. ¶ÓÂ˘ÌÔıÒÚ·Î·˜ ÛÙËÓ ·ÓÙ›ıÂÙË ÏÂ˘Ú¿

ÌÔÚÂ› Ó· ÂÌÊ·ÓÈÛÙÂ› Ï›Á· ÏÂÙ¿ ÌÂÙ¿ ÙËÓ ÂÊ·ÚÌÔ-

Á‹ ·ÂÚÈÛÌÔ‡ ÌÂ ˘„ËÏ¤˜ È¤ÛÂÈ˜. ∆· ÓÂÔÁÓ¿ ÌÂ ˘Ô-

Ï·ÛÙÈÎÔ‡˜ ÓÂ‡ÌÔÓÂ˜ Â›Ó·È ÈÔ ÂÈÚÚÂ‹ ÛÙËÓ

·Ó¿Ù˘ÍË ÓÂ˘ÌÔıÒÚ·Î·. ÕÌÂÛË ·Ó Î·È Û¿ÓÈ· ÌÂ-

ÙÂÁ¯ÂÈÚËÙÈÎ‹ ÂÈÏÔÎ‹ ·ÔÙÂÏÂ› Ô ¯˘ÏÔıÒÚ·Î·˜,

Èı·ÓÒ˜ ÔÊÂÈÏfiÌÂÓÔ˜ ÛÂ ÌË¯·ÓÈÎfi ÙÚ·˘Ì·ÙÈÛÌfi

ÙˆÓ ÏÂÌÊ·ÁÁÂ›ˆÓ Á‡Úˆ ·fi ÙÔ ‰È¿ÊÚ·ÁÌ· (70,71).

¶ÚÔÁÓˆÛÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜

∏ ÚfiÁÓˆÛË ÂÍ·ÚÙ¿Ù·È ·fi Ù· ÚÔÁÂÓÓËÙÈÎ¿ Â˘-

Ú‹Ì·Ù·, Ù· ÔÔ›· ÔÚÈÔıÂÙÔ‡Ó ÙË ÛÔ‚·ÚfiÙËÙ· ÙË˜

™¢∫ Î·È ·ÔÙÂÏÔ‡Ó ÙË ‚¿ÛË ÙË˜ ÂÓËÌ¤ÚˆÛË˜ Î·È

ÚÔÁÂÓÓËÙÈÎ‹˜ Î·ıÔ‰‹ÁËÛË˜ ÙˆÓ ÁÔÓ¤ˆÓ. ∏ ¤Î‚·ÛË

ÂÍ·ÚÙ¿Ù·È ·fi ·Ú¿ÁÔÓÙÂ˜ fiˆ˜ Ë ·ÚÔ˘Û›· Û˘ÓÔ-

‰ÒÓ ·ÓˆÌ·ÏÈÒÓ, ÙÔ ÛÙ¿‰ÈÔ Î‡ËÛË˜ ÛÙÔ ÔÔ›Ô Û˘Ó¤-

‚Ë Ë ÚfiÙˆÛË ÙˆÓ ÂÓ‰ÔÎÔÈÏÈ·ÎÒÓ ÔÚÁ¿ÓˆÓ ÂÓÙfi˜

ÙÔ˘ ıÒÚ·Î·, Ô fiÁÎÔ˜ ÙˆÓ ÛÏ¿Á¯ÓˆÓ Ô˘ ÚÔÛÙ›-

ÙÔ˘Ó ÂÓÙfi˜ ÙÔ˘ ıÒÚ·Î· Î·È Ô ‚·ıÌfi˜ ÙË˜ ÓÂ˘ÌÔ-

ÓÈÎ‹˜ ˘ÔÏ·Û›·˜ Î·È ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ·ÏÏ·ÁÒÓ

Ô˘ ¤¯Ô˘Ó ÂÈÛ˘Ì‚Â› (¶›Ó·Î·˜ 3).

√È ¯ÚˆÌÔÛˆÌ·ÙÈÎ¤˜ ·ÓˆÌ·Ï›Â˜ Î·ıÒ˜ Î·È ÔÈ

ÛÔ‚·Ú¤˜ ·ÓˆÌ·Ï›Â˜ ÙÔ˘ Î·Ú‰È·ÁÁÂÈ·ÎÔ‡, ·›˙Ô˘Ó

ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ¤Î‚·ÛË. ¶Ùˆ¯Ô› ÚÔÁÓˆÛÙÈ-

ÎÔ› ‰Â›ÎÙÂ˜ ıÂˆÚÔ‡ÓÙ·È: Ë ‰È¿ÁÓˆÛË ÚÈÓ ·fi ÙËÓ

25Ë Â‚‰ÔÌ¿‰· Î‡ËÛË˜, Ë ·ÚÔ˘Û›· ÙÔ˘ ÛÙÔÌ¿¯Ô˘

ÂÓÙfi˜ ÙÔ˘ ıÒÚ·Î· (Ë ÂÈ‚›ˆÛË Â›Ó·È ˘„ËÏfiÙÂÚË

·fi 90% Â¿Ó ÙÔ ÛÙÔÌ¿¯È ‚Ú›ÛÎÂÙ·È Î¿Ùˆ ·fi ÙÔ

‰È¿ÊÚ·ÁÌ·) (72), ÙÔ ÔÏ˘˘‰Ú¿ÌÓÈÔ (ÔÊÂÈÏfiÌÂÓÔ

ÛÙËÓ ›ÂÛË ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘ ·fi ÙÔÓ ÌÂÁ¿ÏÔ ÂÓ‰Ô-

ıˆÚ·ÎÈÎfi fiÁÎÔ), Ë ÚfiÙˆÛË ÙÔ˘ ‹·ÙÔ˜ (fiÙ·Ó ÙÔ

‹·Ú ‰ÂÓ Û˘ÁÎ·Ù·Ï¤ÁÂÙ·È ÛÙ· fiÚÁ·Ó· Ô˘ ÚÔÛ›-

ÙÔ˘Ó Ë ÚfiÁÓˆÛË Â›Ó·È Î·Ï‡ÙÂÚË, ·ÏÏ¿, Î·ıÒ˜

ÛÙÔ 75% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ¤Ó· ÌÈÎÚfi Ì¤ÚÔ˜ ÙÔ˘

‹·ÙÔ˜ ÂÚÈÏ·Ì‚¿ÓÂÙ·È ÛÙËÓ Î‹ÏË, Ë ·Í›· ÙÔ˘ ·-

Ú¿ÁÔÓÙ· ·˘ÙÔ‡ ıÂˆÚÂ›Ù·È ÌÈÎÚ‹) (73), Ô ‡‰Úˆ·˜

(Û¯ÂÙ›˙ÂÙ·È ÌÂ Ùˆ¯‹ ÚfiÁÓˆÛË) Î·È Ô ÏfiÁÔ˜ ÓÂ‡-

ÌÔÓ· ÚÔ˜ ÎÂÊ·Ï‹ (lung to head ratio, LHR) ÌÈÎÚfi-

ÙÂÚÔ˜ ·fi 1. √ ÏfiÁÔ˜ LRH ÚÔÛ‰ÈÔÚ›˙ÂÙ·È Î·Ù¿ ÙÔ

˘ÂÚË¯ÔÁÚ¿ÊËÌ· ÙÔ˘ ÂÌ‚Ú‡Ô˘ Î·È ÈÛÔ‡Ù·È ÌÂ ÙÔÓ

ÏfiÁÔ ÙË˜ ÂÈÊ¿ÓÂÈ·˜ ÙÔ˘ ÓÂ‡ÌÔÓ· ÙË˜ Ê˘ÛÈÔÏÔÁÈ-

Î‹˜ ÏÂ˘Ú¿˜ ÙÔ˘ ÛÒÌ·ÙÔ˜ ÚÔ˜ ÙËÓ ÂÚÈÊ¤ÚÂÈ·

ÙË˜ ÎÂÊ·Ï‹˜ ÙÔ˘ ÂÌ‚Ú‡Ô˘ (74). √ LHR ÂÌÊ·Ó›˙Â-

Ù·È Ó· Â›Ó·È Ô Î·Ï‡ÙÂÚÔ˜ ÚÔÁÓˆÛÙÈÎfi˜ ‰Â›ÎÙË˜.

102 Ã. ∆Û·Î·Ï›‰Ë˜ Î·È Û˘Ó.



LHR <1 Û¯ÂÙ›˙ÂÙ·È ÌÂ ıÓËÙfiÙËÙ· 100%, ÂÓÒ LHR>1,4 Û¯ÂÙ›˙ÂÙ·È ÌÂ ÂÈ‚›ˆÛË 100% (75,76).

∆Ô ÚÔÁÂÓÓËÙÈÎfi ˘ÂÚË¯ÔÁÚ¿ÊËÌ· Î·Ú‰È¿˜ÌÔÚÂ› Ó· ·Ó·ÁÓˆÚ›ÛÂÈ Û˘ÓÔ‰¤˜ ·ÓˆÌ·Ï›Â˜ ÙË˜ Î·Ú-‰È¿˜. ¶·Ú¿ÁÔÓÙÂ˜ Ùˆ¯‹˜ ¤Î‚·ÛË˜ ıÂˆÚÔ‡ÓÙ·È Ë˘ÔÏ·Û›· ÙË˜ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ (77) Î·È Ô ·˘ÍË-Ì¤ÓÔ˜ fiÁÎÔ˜ ·›Ì·ÙÔ˜ ÛÙËÓ ÓÂ˘ÌÔÓÈÎ‹ ·ÚÙËÚ›· (78).

√ ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙÔ˘ ÂÌ‚Ú‡Ô˘ ÌÂ Ì·-ÁÓËÙÈÎ‹ ÙÔÌÔÁÚ·Ê›· ÏÂÔÓÂÎÙÂ›. ¢ÂÓ ÂÚÈÔÚ›˙ÂÙ·È·fi ÙÔ ¿¯Ô˜ ÙˆÓ ÎÔÈÏÈ·ÎÒÓ ÙÔÈ¯ˆÌ¿ÙˆÓ ÙË˜ ÌËÙ¤-Ú·˜ ‹ ÙÔ ÔÏÈÁÔ¸‰Ú¿ÌÓÈÔ ÌÂ Î·Ï‡ÙÂÚË ·ÂÈÎfiÓÈÛËÙˆÓ Ì·Ï·ÎÒÓ ÈÛÙÒÓ, ÌÔÚÂ› Ó· ÂÈ‚Â‚·ÈÒÛÂÈ ÙËÓ·ÚÔ˘Û›· Û˘ÓÔ‰ÒÓ ·ÓˆÌ·ÏÈÒÓ (79) Î·È Â›Ó·È ·ÔÙÂ-ÏÂÛÌ·ÙÈÎfi˜ ÛÙË ‰È¿ÁÓˆÛË ‰ÂÍÈ¿˜ ™¢∫ ÌÂ ÚfiÙˆÛËÙÔ˘ ‹·ÙÔ˜.

∞ÚÎÂÙÔ› ÌÂÙ·ÁÂÓÓËÙÈÎÔ› ÚÔÁÓˆÛÙÈÎÔ› ·Ú¿ÁÔ-ÓÙÂ˜ ¤¯Ô˘Ó ÂÚÂ˘ÓËıÂ›, Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓÔ˘ Î·ÈÙÔ˘ Ùˆ¯Ô‡ ·ÂÚÈÛÌÔ‡ ÙˆÓ ÓÂ˘ÌfiÓˆÓ ÛÙËÓ ·ÎÙÈÓÔ-ÁÚ·Ê›· ıÒÚ·Î· (80).

¡ÔÛËÚfiÙËÙ·

∂ÎÙÈÌ¿Ù·È fiÙÈ ÏÈÁfiÙÂÚÔ ·fi ÙÔ 1/3 ÙˆÓ ÂÌ‚Ú‡ˆÓÌÂ ™¢∫ Ô˘ ‰ÈÂÁÓÒÛıË ÚÔÁÂÓÓËÙÈÎ¿ ı· ÂÈ‚ÈÒÛÂÈ¯ˆÚ›˜ ·˘ÍËÌ¤ÓË ÓÔÛËÚfiÙËÙ·, Ë ÔÔ›· ÛÂ ÌÂÚÈÎ¤˜ÂÚÈÙÒÛÂÈ˜ ÔÊÂ›ÏÂÙ·È ÛÂ ·Ó·ÙÔÌÈÎ¿ ·›ÙÈ· Î·È Â›Ó·È·Ó·fiÊÂ˘ÎÙË, ÂÓÒ ÛÂ ¿ÏÏÂ˜ ·ÔÙÂÏÂ› Û˘Ó¤ÂÈ· ÙˆÓıÂÚ·Â˘ÙÈÎÒÓ ¯ÂÈÚÈÛÌÒÓ Î·È Â›Ó·È ‰˘Ó·Ùfi Ó· ÂÚÈÔ-ÚÈÛÙÂ› ÛÙÔ Ì¤ÏÏÔÓ.

∞Ó·ÓÂ˘ÛÙÈÎ‹ ÏÂÈÙÔ˘ÚÁ›·

∏ ·Ó·ÓÂ˘ÛÙÈÎ‹ ·ÓÂ¿ÚÎÂÈ· ·ÔÙÂÏÂ› ÙËÓ ÈÔÛËÌ·ÓÙÈÎ‹ ·ÈÙ›· ÓÔÛËÚfiÙËÙ·˜.

™ÙÈ˜ ·ÒÙÂÚÂ˜ ÂÈÏÔÎ¤˜ ÙË˜ ™¢∫ ÂÚÈÏ·Ì‚¿-

ÓÔÓÙ·È Ë ÂÚÈÔÚÈÛÙÈÎ‹ ÓfiÛÔ˜ ÙÔ˘ ÓÂ‡ÌÔÓ·, Ô˘

·ÓÙ·Ó·ÎÏ¿ ÙËÓ ÓÂ˘ÌÔÓÈÎ‹ ˘ÔÏ·Û›·, fiˆ˜ Ê·›-

ÓÂÙ·È ·fi ÙË ÏÂÈÙÔ˘ÚÁÈÎ‹ ˘ÔÏÂÈfiÌÂÓË ¯ˆÚËÙÈÎfi-

ÙËÙ·, Î·È Ë ·˘Í·ÓfiÌÂÓË Â›ÙˆÛË ÙË˜ ‚ÚÔÁ¯ÈÎ‹˜

˘ÂÚ·ÓÙÈ‰Ú·ÛÙÈÎfiÙËÙ·˜. ∆Ô 1/3 ÙˆÓ ·ÛıÂÓÒÓ ÌÂ

Û˘ÁÁÂÓ‹ ‰È·ÊÚ·ÁÌ·ÙÔÎ‹ÏË ¤¯ÂÈ ÎÏÈÓÈÎ¿ Î·È ·ÎÙÈÓÔ-

ÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù· ‚ÚÔÁ¯ÔÓÂ˘ÌÔÓÈÎ‹˜ ‰˘ÛÏ·Û›·˜,

Ô˘ Â›Ó·È Û˘¯ÓfiÙÂÚ· ÛÂ ÓÂÔÁÓ¿ Ô˘ ·Ú¤ÌÂÈÓ·Ó ÁÈ·

ÌÂÁ·Ï‡ÙÂÚÔ ‰È¿ÛÙËÌ· ÛÂ ÌË¯·ÓÈÎfi ·ÂÚÈÛÌfi Î·È ÌÂ

¯ÔÚ‹ÁËÛË ÔÍ˘ÁfiÓÔ˘ (81). ªÂÙ¿ ÙË ¯ÂÈÚÔ˘ÚÁÈÎ‹

·ÔÎ·Ù¿ÛÙ·ÛË, ·Ú·ÙËÚÂ›Ù·È ÛËÌ·ÓÙÈÎ‹ ‚ÂÏÙ›ˆÛË

ÙË˜ ·Ó¿Ù˘ÍË˜ Î·È ÙË˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÙˆÓ ÓÂ˘ÌfiÓˆÓ,

Ô˘ Â›Ó·È È‰È·›ÙÂÚ· ÂÌÊ·Ó‹˜ ÌÂÙ¿ ÙÔ˘˜ ÚÒÙÔ˘˜ 6

Ì‹ÓÂ˜ ˙ˆ‹˜ (82). ∆· ˘„ËÏ¿ ÔÛÔÛÙ¿ ‰˘ÛÏÂÈÙÔ˘Ú-

Á›·˜ ÙˆÓ ÓÂ˘ÌfiÓˆÓ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ¿ÌÂÛË˜

ÌÂÙ·ÁÂÓÓËÙÈÎ‹˜ ÂÚÈfi‰Ô˘ ·ÎÔÏÔ˘ıÔ‡ÓÙ·È ·fi Î·-

ÓÔÓÈÎ‹ ‹ Û¯Â‰fiÓ Î·ÓÔÓÈÎ‹ ÓÂ˘ÌÔÓÈÎ‹ ÏÂÈÙÔ˘ÚÁ›·

ÛÙË ÌÂÙ¤ÂÈÙ· ·È‰ÈÎ‹ Î·È ÂÊË‚ÈÎ‹ ˙ˆ‹ (82,83). √È

‰Â›ÎÙÂ˜ ÙË˜ ÓÂ˘ÌÔÓÈÎ‹˜ ÏÂÈÙÔ˘ÚÁ›·˜ ‚ÂÏÙÈÒÓÔÓÙ·È

ÛËÌ·ÓÙÈÎ¿ ÌÂ ÙËÓ ·‡ÍËÛË ÙË˜ ËÏÈÎ›·˜, ÙÔ˘ ‡„Ô˘˜

Î·È ÙÔ˘ ‚¿ÚÔ˘˜ ÙˆÓ ·ÛıÂÓÒÓ. ∏ ÌÂÈˆÌ¤ÓË ÚfiÛÏË-

„Ë ‚¿ÚÔ˘˜ Â›Ó·È Û˘¯Ó¿ ÙÔ Î‡ÚÈÔ Úfi‚ÏËÌ· ÛÂ ÓÂÔ-

ÁÓ¿ ÌÂ Û˘ÁÁÂÓ‹ ‰È·ÊÚ·ÁÌ·ÙÔÎ‹ÏË, Èı·ÓÒ˜ ÂÂÈ‰‹

ÙÔ ·˘Í·ÓfiÌÂÓÔ ¤ÚÁÔ ·Ó·ÓÔ‹˜ ··ÈÙÂ› ˘„ËÏ‹ Î·Ù·-

Ó¿ÏˆÛË ÂÓ¤ÚÁÂÈ·˜, ÂÓÒ ÂÚÈÔÚ›˙ÂÈ ÙËÓ ÈÎ·ÓfiÙËÙ·

ÙÔ˘ ·ÛıÂÓÔ‡˜ Ó· ‰È·ÙÚ·ÊÂ› Â·ÚÎÒ˜. ∞ÓÙ›ıÂÙ·, Ë

‚ÂÏÙ›ˆÛË ÙË˜ ÓÂ˘ÌÔÓÈÎ‹˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÂÈÙÚ¤ÂÈ

Î·Ï‡ÙÂÚË ·Ó¿Ù˘ÍË (82). ™˘¯Ó¤˜ ÏÔÈÌÒÍÂÈ˜ ÙÔ˘

·Ó·ÓÂ˘ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÔ 24%

ÙˆÓ ·ÛıÂÓÒÓ ÌÂ ‹È· ¤ˆ˜ ÌÂÙÚ›Ô˘ ‚·ıÌÔ‡ ÓÂ˘ÌÔ-

ÓÈÎ‹ ˘ÔÏ·Û›· (84).

∞ÎÔ‹

∂ËÚÂ·ÛÌfi˜ ÙË˜ ·ÈÛıËÙËÚÈ·Î‹˜ ·ÎÔ‹˜ ¤¯ÂÈ Â-

ÚÈÁÚ·ÊÂ› ÛÂ ÓÂÔÁÓ¿ ÌÂ ™¢∫ Î·È ·ÚÔ˘ÛÈ¿˙ÂÈ ¤Ó·

Â˘Ú‡ Ê¿ÛÌ· Â›ÙˆÛË˜. ¢˘ÛÏÂÈÙÔ˘ÚÁ›· ÙË˜ ·ÎÔ‹˜

·Ó·Ê¤ÚıËÎÂ ÛÂ ÓÂÔÁÓ¿, Â›ÙÂ ıÂÚ·Â‡ÙËÎ·Ó ÌÂ

ECMO Â›ÙÂ fi¯È (85). ∏ ·Ú·ÙÂÙ·Ì¤ÓË ¯Ú‹ÛË ÙÔ˘

·ÓÎÔ˘Ú·Ó›Ô˘ (86) Î·È ‰ÈÔ˘ÚËÙÈÎÒÓ ÛÂ ÓÂÔÁÓ¿ ÌÂ

¯ÚfiÓÈ· ÓÂ˘ÌÔÓÈÎ‹ ÓfiÛÔ (85) ¤¯ÂÈ ·Ó·ÊÂÚıÂ› ˆ˜

Èı·Ófi˜ ·ÈÙÈÔÏÔÁÈÎfi˜ ·Ú¿ÁÔÓÙ·˜. ø˜ ·Ú¿ÁÔÓÙÂ˜

ÎÈÓ‰‡ÓÔ˘ ıÂˆÚÔ‡ÓÙ·È ÔÈ ·Ú·Î¿Ùˆ: Ë ‰È¿ÚÎÂÈ· ıÂ-

Ú·Â›·˜ ÙÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, Û˘ÌÂÚÈ-

Ï·Ì‚·ÓÔÌ¤ÓË˜ Î·È ÙË˜ ECMO, Î·È Ë ‰È¿ÚÎÂÈ· ¯Ô-

Ú‹ÁËÛË˜ ˆÙÔÙÔÍÈÎÒÓ Ê·ÚÌ¿ÎˆÓ, fiˆ˜ Â›Ó·È Ù· ‰È-

Ô˘ÚËÙÈÎ¿ ÙË˜ ·ÁÎ‡ÏË˜ Î·È ÙÔ ·ÓÎÔ˘Ú¿ÓÈÔ, Ô˘

ÂËÚÂ¿˙ÂÈ ÙË ÓÂÊÚÈÎ‹ ÏÂÈÙÔ˘ÚÁ›· (87). √È Ù·ÎÙÈÎÔ›

¤ÏÂÁ¯ÔÈ ÙË˜ ·ÎÔ‹˜ ˆ˜ ÙËÓ ËÏÈÎ›· ÙˆÓ 3 ÂÙÒÓ ıÂˆ-

ÚÔ‡ÓÙ·È ··Ú·›ÙËÙÔÈ. ∏ ¤ÁÎ·ÈÚË ‰È¿ÁÓˆÛË ÙË˜ ÌÂÈ-

ˆÌ¤ÓË˜ ·ÎÔ‹˜ ·ÔÙÚ¤ÂÈ ÙËÓ Î·ı˘ÛÙ¤ÚËÛË ¤Ó·Ú-

ÍË˜ ÙË˜ ÔÌÈÏ›·˜ Î·È ÙËÓ ÂÌÊ¿ÓÈÛË ‰È·Ù·Ú·¯ÒÓ ÂÈ-

ÎÔÈÓˆÓ›·˜.


¶·È‰È·ÙÚÈÎ‹ 2009;72:103-000

¶›Ó·Î·˜ 3. ¶ÚÔÁÓˆÛÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ ÛÙË ™¢∫

ñ ¶ÚÔÁÂÓÓËÙÈÎ‹ ÂÎÙ›ÌËÛË ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙÔ˘ ÓÂ‡ÌÔÓ·- √ ÏfiÁÔ˜ LRH- √ ÏfiÁÔ˜ ‰È·Ì¤ÙÚÔ˘ ÙÔ˘ ÓÂ‡ÌÔÓ· ÚÔ˜ ÙËÓ ÂÚÈÊ¤ÚÂÈ·

ÙÔ˘ ıÒÚ·Î·- √ fiÁÎÔ˜ ÓÂ‡ÌÔÓ· ˘ÔÏÔÁÈ˙fiÌÂÓÔ˜ ÌÂ ˘ÂÚË¯ÔÁÚ¿ÊË-

Ì· Î·È Ì·ÁÓËÙÈÎ‹ ÙÔÌÔÁÚ·Ê›· ñ ¶ÚÔÁÂÓÓËÙÈÎ‹ ÂÎÙ›ÌËÛË ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙË˜ ‰È·ÊÚ·ÁÌ·ÙÔ-

Î‹ÏË˜- ∂Ó‰ÔıˆÚ·ÎÈÎ‹ ÂÓÙfiÈÛË ÙÔ˘ ÛÙÔÌ¿¯Ô˘ ÛÙËÓ ·ÚÈÛÙÂÚ‹

™¢∫- ¶ÚfiÙˆÛË ÙÔ˘ ‹·ÙÔ˜- ¶ÚfiÙˆÛË ÂÓ‰ÔÎÔÈÏÈ·ÎÒÓ ÛÏ¿¯ÓˆÓ- ¶ÚÒÈÌË ‰È¿ÁÓˆÛË ÙË˜ ™¢∫ (<25Ë Â‚‰ÔÌ¿‰· Î‡ËÛË˜)- ªÂÙ·ÙfiÈÛË ÙÔ˘ ÌÂÛÔıˆÚ·Î›Ô˘- ¢È¿ÌÂÙÚÔ˜ ÙË˜ ÎÔÈÏÈ¿˜

ñ ™˘ÓÔ‰¤˜ ·ÓˆÌ·Ï›Â˜ñ ÃÚˆÌÔÛˆÌ·ÙÈÎ¤˜ ·ÓˆÌ·Ï›Â˜ñ ¶ÔÏ˘˘‰Ú¿ÌÓÈÔñ À‰ÚÔıÒÚ·Î·˜ñ ÀÔÏ·Û›· ÙË˜ ·ÚÈÛÙÂÚ‹˜ Î·Ú‰›·˜ñ ¶ÓÂ˘ÌÔÓÈÎ‹ ˘ÔÏ·Û›·


¶ÚÔ‚Ï‹Ì·Ù· ÔÚıÔÂ‰ÈÎ¿

√È ·ÓˆÌ·Ï›Â˜ ÙÔ˘ ÛÎÂÏÂÙÔ‡, fiˆ˜ Â›Ó·È Ë ·Û˘Ì-

ÌÂÙÚ›·, ÔÈ ·Ú·ÌÔÚÊÒÛÂÈ˜ ÙÔ˘ ıÒÚ·Î· Î·È Ë ÛÎÔ-

Ï›ˆÛË (88,89), Â›Ó·È Ù· ÈÔ Û˘ÓËıÈÛÌ¤Ó· ÔÚıÔÂ‰ÈÎ¿

ÚÔ‚Ï‹Ì·Ù· Î·È ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Û˘¯ÓfiÙÂÚ· ÛÂ ÌÂ-

Á¿ÏÂ˜ ™¢∫ Î·È Â›Ó·È Èı·ÓfiÓ Ó· ÂÌÊ·ÓÈÛÙÔ‡Ó ·ÚÁfi-

ÙÂÚ· ÌÂ ÙËÓ ·Ó¿Ù˘ÍË. Ÿˆ˜ ·Ó·Ê¤ÚÂÙ·È ·fi ÙÔÓ

Lund, Ë ÛÎÔÏ›ˆÛË Î·È ÔÈ ·ÓˆÌ·Ï›Â˜ ÙÔ˘ ıÒÚ·Î·

ÌÔÚÂ› Ó· Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÙËÓ ·‡ÍËÛË ÙˆÓ ÂÓ‰Ôıˆ-

Ú·ÎÈÎÒÓ Î·È ÂÓ‰ÔÎÔÈÏÈ·ÎÒÓ È¤ÛÂˆÓ Î·Ù¿ ÙË ¯ÂÈ-

ÚÔ˘ÚÁÈÎ‹ ·ÔÎ·Ù¿ÛÙ·ÛË. √È ÂÚÈÛÛfiÙÂÚÂ˜ ·fi ÙÈ˜

·Ú·ÌÔÚÊÒÛÂÈ˜ ·˘Ù¤˜ Â›Ó·È ‹ÈÂ˜ Î·È ‰ÂÓ ¯Ú‹˙Ô˘Ó

¯ÂÈÚÔ˘ÚÁÈÎ‹˜ ·ÔÎ·Ù¿ÛÙ·ÛË˜ (90).

£Ú¤„Ë Î·È ·Ó¿Ù˘ÍË

√È ‰È·Ù·Ú·¯¤˜ ·Ó¿Ù˘ÍË˜ ÔÊÂ›ÏÔÓÙ·È ÛÙÈ˜ ·˘ÍËÌ¤-

ÓÂ˜ ÂÓÂÚÁÂÈ·Î¤˜ ··ÈÙ‹ÛÂÈ˜ (·˘ÍËÌ¤ÓÔ ¤ÚÁÔ ·Ó·ÓÔ‹˜

ÛÂ ¯ÚfiÓÈ· ÓÂ˘ÌÔÓÈÎ‹ ÓfiÛÔ) Î·È ÛÙË Á·ÛÙÚÔÔÈÛÔÊ·ÁÈ-

Î‹ ·ÏÈÓ‰ÚfiÌËÛË (°√¶), Ô˘ ·Ó·Ê¤ÚÂÙ·È ÛÙÔ 89%

ÙˆÓ ·ÛıÂÓÒÓ (91,88,92,90). ¶·Ú·ÙËÚÔ‡ÓÙ·È Û˘¯ÓfiÙÂ-

Ú· ÛÂ ·ÛıÂÓÂ›˜ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ (Ô˘ ·ÚÔ˘Û›·Û·Ó

Û˘ÌÙÒÌ·Ù· ÂÓÙfi˜ ÙˆÓ ÚÒÙˆÓ 6 ÚÒÓ ·fi ÙË Á¤ÓÓË-

ÛË) ÌÂ ‰È¿Ù·ÛË ÔÈÛÔÊ¿ÁÔ˘ Î·È ÛÂ ·ÛıÂÓÂ›˜ ÛÙÔ˘˜ ÔÔ›-

Ô˘˜ ··ÈÙ‹ıËÎÂ ÂÊ·ÚÌÔÁ‹ ECMO (93,88). ∏ ‰È¿Ù·ÛË

ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘ Û¯ÂÙ›˙ÂÙ·È ÌÂ ÙËÓ ÂÁÁÂÓ‹ ‰˘ÛÎÈÓËÛ›·

ÙÔ˘ ÔÚÁ¿ÓÔ˘, Ô˘ ·ÓÙ·Ó·ÎÏ¿ ÙËÓ Î·ı˘ÛÙÂÚËÌ¤ÓË Î¤-

ÓˆÛË ÙÔ˘ Á·ÛÙÚÈÎÔ‡ ÂÚÈÂ¯ÔÌ¤ÓÔ˘ (100). À¿Ú¯Ô˘Ó

Ì·ÎÚÔÚfiıÂÛÌ· ÚÔ‚Ï‹Ì·Ù· ·fi ÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi,

fiˆ˜ ¯ÚfiÓÈ· ÔÈÛÔÊ·Á›ÙÈ‰· (Û¯ÂÙÈ˙fiÌÂÓË ÌÂ °√¶) Î·È

Î·ı˘ÛÙÂÚËÌ¤ÓË ÂÓÙÂÚÈÎ‹ Î¤ÓˆÛË. ∏ ˘„ËÏ‹ Â›ÙˆÛË

ÙË˜ ÔÈÛÔÊ·Á›ÙÈ‰·˜ Î·È ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘ Barrett ÛÙÔ˘˜

ÂÓ‹ÏÈÎÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ ÈÛÙÔÚÈÎfi Û˘ÁÁÂÓÔ‡˜ ‰È·ÊÚ·Á-

Ì·ÙÔÎ‹ÏË˜ Î·ıÈÛÙ¿ ·Ó·ÁÎ·›· ÙËÓ ÂÊ·ÚÌÔÁ‹ ÚÔÁÚ¿Ì-

Ì·ÙÔ˜ ÂÚ·ÈÙ¤Úˆ ·Ú·ÎÔÏÔ‡ıËÛ‹˜ ÙÔ˘˜ Î·Ù¿ ÙË ‰È¿Ú-

ÎÂÈ· ÙË˜ ÂÓ‹ÏÈÎË˜ ˙ˆ‹˜ ÙÔ˘˜ (90). ¶ÚÔÙÂ›ÓÔÓÙ·È ‰È·-

ÙÚÔÊ‹ ÏÔ‡ÛÈ· ÛÂ ıÂÚÌ›‰Â˜ Î·È Ê·ÚÌ·ÎÂ˘ÙÈÎ‹ ·ÓÙÈÌÂ-

ÙÒÈÛË ÙË˜ Á·ÛÙÚÔÔÈÛÔÊ·ÁÈÎ‹˜ ·ÏÈÓ‰ÚfiÌËÛË˜ ÌÂ

∏2-·ÔÎÏÂÈÛÙ¤˜ ˆ˜ ıÂÚ·Â˘ÙÈÎ¿ Ì¤ÙÚ· (61).

¡Â˘ÚÔ·Ó·Ù˘ÍÈ·Î‹ ÂÍ¤ÏÈÍË

∆· ÓÂÔÁÓ¿ ÌÂ ™¢∫ ‚Ú›ÛÎÔÓÙ·È ÛÂ ·˘ÍËÌ¤ÓÔ Î›Ó-

‰˘ÓÔ ˘ÔÍÈÎ‹˜-ÈÛ¯·ÈÌÈÎ‹˜ ÂÁÎÂÊ·ÏÔ¿ıÂÈ·˜. ∆· ÓÂ-

ÔÁÓ¿ ÌÂ ÛÔ‚·Ú‹ ÓÂ˘ÌÔÓÈÎ‹ ˘ÔÏ·Û›· ·ÓÙÈÌÂÙˆ-

›˙Ô˘Ó Î›Ó‰˘ÓÔ ˘ÔÍ·ÈÌ›·˜, ÔÍ¤ˆÛË˜ Î·È Ùˆ¯Ô‡

·ÂÚÈÛÌÔ‡. ∂ÁÎÂÊ·ÏÈÎ‹ ·Ú¿Ï˘ÛË ¤¯ÂÈ ·Ú·ÙËÚËıÂ›

ÛÙÔ 4% (89) ÛÙÔ 5% (95) Î·È ÛÙÔ 9% ÙˆÓ ·ÛıÂÓÒÓ

(96) ÛÂ ‰È¿ÊÔÚÂ˜ ÌÂÏ¤ÙÂ˜. ÕÏÏÂ˜ ÓÂ˘ÚÔ·Ó·Ù˘ÍÈ·-

Î¤˜ ÂÈÏÔÎ¤˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Û·ÛÌÔ‡˜, Ì·ıËÛÈ·-

Î¤˜ ‰˘ÛÎÔÏ›Â˜, ·ÒÏÂÈ· ·ÎÔ‹˜ Î·È Î·ı˘ÛÙ¤ÚËÛË

·fiÎÙËÛË˜ ÎÈÓËÙÈÎÒÓ ‰ÂÍÈÔÙ‹ÙˆÓ (97).

ŒÎ‚·ÛË

∂›Ó·È ÁÂÓÈÎ¿ ·o‰ÂÎÙfi fiÙÈ ÔÈ ·ÛıÂÓÂ›˜ ÌÂ ‰È·-

ÊÚ·ÁÌ·ÙÔÎ‹ÏË ˙Ô˘Ó ÌÈ· Ê˘ÛÈÔÏÔÁÈÎ‹ ˙ˆ‹. øÛÙfiÛÔ,Û¯ÂÙÈÎ¤˜ ‰˘ÛÏÂÈÙÔ˘ÚÁ›Â˜, fiˆ˜ Î·ı˘ÛÙ¤ÚËÛË ·Ó¿-Ù˘ÍË˜, Ùˆ¯‹ ·Ó¿Ù˘ÍË, Á·ÛÙÚÔÔÈÛÔÊ·ÁÈÎ‹ ·ÏÈÓ-‰ÚfiÌËÛË, ·ÒÏÂÈ· ·ÎÔ‹˜, Ì˘ÔÛÎÂÏÂÙÈÎ¤˜ ·ÓˆÌ·Ï›Â˜Î·È ·Ó·ÓÂ˘ÛÙÈÎ¿ ÚÔ‚Ï‹Ì·Ù·, ·Ú·Ì¤ÓÔ˘Ó ÛÂ ·Ú-ÎÂÙÔ‡˜ ·fi ·˘ÙÔ‡˜ (88,61,94). ∏ ·Ô˘Û›· Û˘ÓÙÔÓÈ-ÛÌ¤ÓÔ˘ Ï¿ÓÔ˘ ·Ú·ÎÔÏÔ‡ıËÛË˜ ÙˆÓ ·ÛıÂÓÒÓ ·˘-ÙÒÓ Ô‰ËÁÂ› ÛÂ ˘ÔÙ›ÌËÛË ÙË˜ ÂÈÎÚ¿ÙËÛË˜ Û˘ÁÎÂ-ÎÚÈÌ¤ÓˆÓ ÂÈÏÔÎÒÓ ÛÂ ·ÛıÂÓÂ›˜ ÌÂÁ·Ï‡ÙÂÚË˜ ËÏÈ-Î›·˜ ÌÂ ÈÛÙÔÚÈÎfi Û˘ÁÁÂÓÔ‡˜ ‰È·ÊÚ·ÁÌ·ÙÔÎ‹ÏË˜ (61).

™Â ÚfiÛÊ·ÙË ¤ÚÂ˘Ó· ‚Ú¤ıËÎÂ ˆ˜ Ù· ÓÂÔÁÓ¿ Ù·ÔÔ›· ¯ÚÂÈ¿˙ÔÓÙ·Ó ıÂÚ·Â›· Ì¤Û· ÛÙÈ˜ ÚÒÙÂ˜ 6ÒÚÂ˜ ÙË˜ ˙ˆ‹˜ ÙÔ˘˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ıÓËÙfiÙËÙ· ÛÂÔÛÔÛÙfi 44%, ÂÓÒ ÌË‰ÂÓÈÎ‹ ıÓËÙfiÙËÙ· ·ÚÔ˘ÛÈ¿-˙Ô˘Ó ·˘Ù¿ Ô˘ ¯ÚÂÈ¿˙ÔÓÙ·Ó ıÂÚ·Â›· ÌÂÙ¿ ÙÈ˜ ÚÒ-ÙÂ˜ 6 ÒÚÂ˜ ÙË˜ ˙ˆ‹˜ ÙÔ˘˜ (98,99). √È Û˘ÓÔ‰¤˜ ·Óˆ-Ì·Ï›Â˜ ‰ÂÓ Â›Ó·È ˘Ô¯ÚÂˆÙÈÎ¿ ‰Â˘ÙÂÚÂ‡Ô˘ÛÂ˜ Î·È ËÛ˘Ó‡·ÚÍ‹ ÙÔ˘˜ ÌÔÚÂ› Ó· ¯ÂÈÚÔÙÂÚÂ‡ÂÈ ÙËÓ Úfi-ÁÓˆÛË. ∫·ıÔÚÈÛÙÈÎ‹˜ ÛËÌ·Û›·˜ ÁÈ· ÙËÓ ¤Î‚·ÛË ÙˆÓÓÂÔÁÓÒÓ ·˘ÙÒÓ Â›Ó·È Ë Û˘Ó‡·ÚÍË ÌÂÈ˙fiÓˆÓ ·Ó·ÙÔ-ÌÈÎÒÓ ‹ ¯ÚˆÌÔÛˆÌ·ÙÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ, Ô˘ ·˘Í¿ÓÂÈÙË ıÓËÙfiÙËÙ· ÛÙÔ 89% (36). ™ÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·-Ê›·, Ù· ÔÛÔÛÙ¿ ÂÈ‚›ˆÛË˜ ÛÂ Û¯¤ÛË ÌÂ ÙËÓ ÂÓÙfiÈ-ÛË ÙË˜ ™¢∫ ÔÈÎ›ÏÏÔ˘Ó. ŸÙ·Ó Ë ‚Ï¿‚Ë ÂÓÙÔ›˙ÂÙ·ÈÛÙÔ ·ÚÈÛÙÂÚfi ËÌÈıˆÚ¿ÎÈÔ Ë ÂÈ‚›ˆÛË ·Ó¤Ú¯ÂÙ·È ÛÂ78%, fiÙ·Ó ÂÓÙÔ›˙ÂÙ·È ÛÙÔ ‰ÂÍÈfi ÛÂ 21%, ÂÓÒ ÛÂ ·Ì-ÊÔÙÂÚfiÏÂ˘ÚË ÂÓÙfiÈÛË ·Ó¤Ú¯ÂÙ·È ÛÂ 1% (101).¶ÈÔ ÚfiÛÊ·ÙÂ˜ ÌÂÏ¤ÙÂ˜ ‰Â›¯ÓÔ˘Ó ·‡ÍËÛË (102,103)Î·È ÔÚÈÛÌ¤ÓÂ˜ ÂÏ¿ÙÙˆÛË ÙË˜ ıÓËÙfiÙËÙ·˜ (103) ÛÙË‰ÂÍÈ¿ ‰È·ÊÚ·ÁÌ·ÙÔÎ‹ÏË, ÂÓÒ ¿ÏÏÂ˜ ‰Â›¯ÓÔ˘Ó fiÙÈ ËÂÓÙfiÈÛË ÙË˜ ·ÓˆÌ·Ï›·˜ ‰ÂÓ ÂËÚÂ¿˙ÂÈ ÙËÓ ¤Î‚·ÛË(55). ∆· ÔÛÔÛÙ¿ ÂÈ‚›ˆÛË˜ ÁÈ· ·Ï‹ ‰È·ÊÚ·ÁÌ·ÙÔ-Î‹ÏË Â›Ó·È ÂÚ›Ô˘ 47% Î·È ·˘Í¿ÓÔÓÙ·È ÛÙË ‰È¿Ú-ÎÂÈ· ÙÔ˘ ¯ÚfiÓÔ˘, ·Ú·Ì¤ÓÔ˘Ó fiÌˆ˜ ¯·ÌËÏ¿ ÁÈ· ÙÈ˜ÂÚÈÙÒÛÂÈ˜ fiÔ˘ Û˘Ó˘¿Ú¯Ô˘Ó Û˘ÓÔ‰¤˜ ·ÓˆÌ·-Ï›Â˜ (55). ÕÏÏÂ˜ ÌÂÏ¤ÙÂ˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ˘„ËÏfiÙÂÚ·ÔÛÔÛÙ¿ ÂÈ‚›ˆÛË˜ Ô˘ Î˘Ì·›ÓÔÓÙ·È ·fi 67% (89)¤ˆ˜ 82% (104).

∏ ÚÔÛ¤ÁÁÈÛË ÙÔ˘ ÓÂÔÁÓÔ‡ ÌÂ ™¢∫ ¤¯ÂÈ Û·ÊÒ˜·ÏÏ¿ÍÂÈ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·. ∏ ÚÔÁÂÓÓËÙÈÎ‹ ‰È¿-ÁÓˆÛË ÂÈÙÚ¤ÂÈ ÙËÓ ÂÎÙ›ÌËÛË ÙÔ˘ ÂÌ‚Ú‡Ô˘ ÁÈ· È-ı·Ó¤˜ ÂÈÚfiÛıÂÙÂ˜ ·ÓˆÌ·Ï›Â˜, Î·ıÒ˜ Î·È ÙËÓ ÂÓË-Ì¤ÚˆÛË ÙˆÓ ÁÔÓ¤ˆÓ ÁÈ· ÙÈ˜ Èı·Ó¤˜ ıÂÚ·Â˘ÙÈÎ¤˜ÚÔÛÂÁÁ›ÛÂÈ˜ Î·È ÙËÓ ÚfiÁÓˆÛË. ∏ ÂÈÎÔÈÓˆÓ›· ÌÂÙÔ˘˜ ÁÔÓÂ›˜ Ú¤ÂÈ Ó· ·Ú¯›˙ÂÈ ·fi ÙË ÛÙÈÁÌ‹ ÙË˜ÚÔÁÂÓÓËÙÈÎ‹˜ ‰È¿ÁÓˆÛË˜ Î·È Ó· Û˘ÓÂ¯›˙ÂÙ·È ÛÂ fiÏËÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›·.


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104 Ã. ∆Û·Î·Ï›‰Ë˜ Î·È Û˘Ó.



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¶·È‰È·ÙÚÈÎ‹ 2009;72:107-000


108 Ã. ∆Û·Î·Ï›‰Ë˜ Î·È Û˘Ó.


Quiz

1. H ÚÔÁÂÓÓËÙÈÎ‹ ‰È¿ÁÓˆÛË ÙË˜ Û˘ÁÁÂÓÔ‡˜ ‰È·ÊÚ·ÁÌ·ÙÔÎ‹ÏË˜:·. ¢ÂÓ Â›Ó·È ‰˘Ó·Ù‹‚. °›ÓÂÙ·È ÌÂÙ¿ ÙËÓ 24Ë Â‚‰ÔÌ¿‰· Î‡ËÛË˜ ÌÂ ¯Ú‹ÛË ˘ÂÚ‹¯ˆÓÁ. °›ÓÂÙ·È ÌfiÓÔ ÛÙÔ 10% ÙˆÓ ÂÚÈÙÒÛÂˆÓ‰. √È Û˘ÓÔ‰¤˜ ·ÓˆÌ·Ï›Â˜ ‰˘ÛÎÔÏÂ‡Ô˘Ó ÙË ‰È¿ÁÓˆÛË

2. ∏ ·Ó·ÓÂ˘ÛÙÈÎ‹ ·ÓÂ¿ÚÎÂÈ· ÓÂÔÁÓÔ‡ ÌÂ Û˘ÁÁÂÓ‹ ‰È·ÊÚ·ÁÌ·ÙÔÎ‹ÏË ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË ÔÊÂ›ÏÂÙ·È ÛÂ:·. ¶ÓÂ˘ÌÔÓÈÎ‹ ˘ÔÏ·Û›·‚. §Ô›ÌˆÍËÁ. ¶ÓÂ˘ÌÔıÒÚ·Î·‰. ¶ÓÂ˘ÌÔÓÈÎ‹ ·ÈÌÔÚÚ·Á›·

3. ∏ Û˘ÁÁÂÓ‹˜ ‰È·ÊÚ·ÁÌ·ÙÔÎ‹ÏË Ù‡Ô˘ Bochdalek ÂÓÙÔ›˙ÂÙ·È Û˘¯ÓfiÙÂÚ·:·. ¢ÂÍÈ¿‚. ∞ÚÈÛÙÂÚ¿Á. ∞ÌÊÔÙÂÚfiÏÂ˘Ú·‰. ∫ÂÓÙÚÈÎ¿

4. ∏ Û˘ÁÁÂÓ‹˜ ‰È·ÊÚ·ÁÌ·ÙÔÎ‹ÏË ÂÎ‰ËÏÒÓÂÙ·È Û˘¯ÓfiÙÂÚ· ÌÂ Û˘ÌÙÒÌ·Ù· ·fi:·. ∆Ô Á·ÛÙÚÂÓÙÂÚÈÎfi Û‡ÛÙËÌ·‚. ∆Ô ÎÂÓÙÚÈÎfi ÓÂ˘ÚÈÎfi Û‡ÛÙËÌ·Á. ∂›Ó·È ·Û˘ÌÙˆÌ·ÙÈÎ‹‰. ∆Ô ·Ó·ÓÂ˘ÛÙÈÎfi Û‡ÛÙËÌ·

5. ™ÙË Û˘ÁÁÂÓ‹ ‰È·ÊÚ·ÁÌ·ÙÔÎ‹ÏË Û˘¯ÓfiÙÂÚ· Û˘Ó˘¿Ú¯Ô˘Ó ·ÓˆÌ·Ï›Â˜ ·fi:·. ∆Ô Á·ÛÙÚÂÓÙÂÚÈÎfi Û‡ÛÙËÌ·‚. ∆Ô Ô˘ÚÔÁÂÓÓËÙÈÎfi Û‡ÛÙËÌ·Á. ∆Ô Î·Ú‰È·ÁÁÂÈ·Îfi Û‡ÛÙËÌ·‰. ∆ÔÓ ÛÎÂÏÂÙfi

√È ÛˆÛÙ¤˜ ··ÓÙ‹ÛÂÈ˜ ÛÙË ÛÂÏ. 122


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π. ¶ÂÏ·ÁÈ¿‰Ë˜, ∂. ¢ËÌËÙÚ›Ô˘, ∂. ™ÙÂÈ·Î¿ÎË, Ã. ¶ÂÚ‰ÈÎÔÁÈ¿ÓÓË, ∂. Ã·Ù˙Ë‰¿ÎË, ª. ∫·ÏÌ·ÓÙ‹

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∂ÈÛ·ÁˆÁ‹: ∆· ÌÂÛÂÁ¯˘Ì·ÙÈÎ¿ Î‡ÙÙ·Ú·, ˆ˜ Ì¤ÚÔ˜ ÙÔ˘ Ê˘ÛÈÔÏÔÁÈÎÔ‡ Ì˘ÂÏÈÎÔ‡ ÌÈÎÚÔÂÚÈ‚¿ÏÏÔÓÙÔ˜, ı·ÌÔÚÔ‡Û·Ó Ó· ÚÔ¿ÁÔ˘Ó ÙË ‰È·‰ÈÎ·Û›· ¤ÎÙ˘ÍË˜ ·Ú¯¤ÁÔÓˆÓ/ÚÔÁÔÓÈÎÒÓ Î˘ÙÙ¿ÚˆÓ ·›Ì·ÙÔ˜ ÔÌÊ¿ÏÈÔ˘ÏÒÚÔ˘, Ô˘ ·ÔÙÂÏÂ› Â‡ÎÔÏ· ÚÔÛ‚¿ÛÈÌË ËÁ‹ Î˘ÙÙ¿ÚˆÓ ÁÈ· ÌÂÙ·ÌfiÛ¯Â˘ÛË, ·ÏÏ¿ ··ÈÙÂ›Ù·È ex vivo

¤ÎÙ˘Í‹ ÙÔ˘˜ ÁÈ· ¯Ú‹ÛË ÛÂ ·È‰È¿ ÌÂÁ·Ï‡ÙÂÚÔ˘ ÛˆÌ·ÙÈÎÔ‡ ‚¿ÚÔ˘˜ Î·È ÛÂ ÂÓ‹ÏÈÎÂ˜. ™ÎÔfi˜ ÙË˜ ÌÂÏ¤ÙË˜‹Ù·Ó Ë ‰ÈÂÚÂ‡ÓËÛË ÙË˜ ·ÏÏËÏÂ›‰Ú·ÛË˜ ÙˆÓ CD34+ Î˘ÙÙ¿ÚˆÓ ·›Ì·ÙÔ˜ ÔÌÊ¿ÏÈÔ˘ ÏÒÚÔ˘ (√§) ÌÂ ÌÂÛÂÁ-¯˘Ì·ÙÈÎ¿ Î‡ÙÙ·Ú· (ª∫) Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ (ª√) ·È‰ÈÒÓ Î·È Ë Û‡ÁÎÚÈÛË ÌÂ ÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë Â›‰Ú·ÛËÛ˘Ó‰˘·ÛÌÔ‡ ·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ÛÙËÓ ¤ÎÙ˘ÍË ÙˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ÃÚËÛÈÌÔÔÈ‹ıËÎ·Ó Î‡ÙÙ·Ú· CD34+ Ô˘ ·ÔÌÔÓÒıËÎ·Ó ·fi ·›Ì· √§ (n=10) Î·È ª∫Ô˘ ·ÔÌÔÓÒıËÎ·Ó ·fi ª√ ·È‰ÈÒÓ ÌÂ Î·ÏÔ‹ıË ·ÈÌ·ÙÔÏÔÁÈÎ¿ ÓÔÛ‹Ì·Ù· (n=9). ∆· Î‡ÙÙ·Ú· Ù¤ıËÎ·ÓÛÂ ‰È·ÊÔÚÂÙÈÎ¤˜ Û˘Óı‹ÎÂ˜ Û˘ÁÎ·ÏÏÈ¤ÚÁÂÈ·˜, ·ÚÔ˘Û›· ‹ ÌË Û˘Ó‰˘·ÛÌÒÓ ·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ, Î·È¤ÁÈÓÂ ·ÓÔÛÔÊ·ÈÓÔÙ˘ÈÎfi˜ ¯·Ú·ÎÙËÚÈÛÌfi˜, ·ÍÈÔÏfiÁËÛË ÙË˜ ¤ÎÙ˘ÍË˜ Î·È ÂÎÙ›ÌËÛË ÙË˜ ÎÏˆÓÔÁÔÓÈÎfiÙËÙ·˜(·Ó¿Ù˘ÍË ·ÔÈÎÈÒÓ CFU-GM Î·È BFU-E) ÙˆÓ CD34+ Î˘ÙÙÙ¿ÚˆÓ.

∞ÔÙÂÏ¤ÛÌ·Ù·: ∏ ·ÚÔ˘Û›· ª∫ ÛÙËÓ Î·ÏÏÈ¤ÚÁÂÈ· ÙˆÓ CD34+, ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ·˘ÍËÙÈÎÔ‡˜ ·Ú¿ÁÔ-ÓÙÂ˜, Â›¯Â ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙË ÌÂÁ·Ï‡ÙÂÚË ¤ÎÙ˘ÍË ÙfiÛÔ ÙÔ˘ Û˘ÓÔÏÈÎÔ‡ ·ÚÈıÌÔ‡ ÙˆÓ Î˘ÙÙ¿ÚˆÓ fiÛÔ Î·ÈÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ CD34+. ∏ ·ÚÔ˘Û›· ª∫ ·Ô˘Û›· ·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ¤‰ˆÛÂ ÙÔ ˘„ËÏfiÙÂÚÔ ÔÛÔ-ÛÙfi ÙˆÓ ˘ÔÏËı˘ÛÌÒÓ CD34+CD38-, CD34+CD33-, Î·ıÒ˜ Î·È CD34 Ô˘ ıÂˆÚÔ‡ÓÙ·È Î·È ÔÈ Ï¤ÔÓ ·Ú-¯¤ÁÔÓÔÈ. ∂ÈÏ¤ÔÓ, ÛÂ ·˘Ù‹ ÙË Û˘Óı‹ÎË Ù· ÂÎÙ˘ÁÌ¤Ó· Î‡ÙÙ·Ú· ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ˘„ËÏ‹ ÎÏˆÓÔÁÔ-ÓÈÎfiÙËÙ·, ·ÊÔ‡ ¤‰ˆÛ·Ó ÙÔÓ ÌÂÁ·Ï‡ÙÂÚÔ ·ÚÈıÌfi ·ÔÈÎÈÒÓ ÙfiÛÔ ÎÔÎÎÈÒ‰Ô˘˜ fiÛÔ Î·È ÂÚ˘ıÚ¿˜ ÛÂÈÚ¿˜.

™˘ÌÂÚ¿ÛÌ·Ù·: ™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, Ù· ÌÂÛÂÁ¯˘Ì·ÙÈÎ¿ Î‡ÙÙ·Ú· ª√ ˘ÔÛÙËÚ›˙Ô˘Ó ÙËÓ ¤ÎÙ˘ÍË Î·È Û˘Ì-‚¿ÏÏÔ˘Ó ÛÙË ‰È·Ù‹ÚËÛË ÙË˜ ·ˆÚfiÙËÙ·˜ ÙˆÓ CD34+ Î˘ÙÙ¿ÚˆÓ ÛÂ Û˘Óı‹ÎÂ˜ Û˘ÁÎ·ÏÏÈ¤ÚÁÂÈ·˜, ·Ú¤¯Ô-ÓÙ·˜ ÏËı˘ÛÌfi Ô˘ Ê·›ÓÂÙ·È Ó· ‰È·ı¤ÙÂÈ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ Ô˘ ÙÔÓ Î·ıÈÛÙÔ‡Ó Î·Ù¿ÏÏËÏÔ ÁÈ· ¯Ú‹ÛË ÙÔ˘ÛÂ ÌÂÙ·ÌfiÛ¯Â˘ÛË.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: CD34+, ÌÂÛÂÁ¯˘Ì·ÙÈÎ¿ Î‡ÙÙ·Ú·, ex vivo ¤ÎÙ˘ÍË, ·›Ì· ÔÌÊ¿ÏÈÔ˘ ÏÒÚÔ˘, Ì˘ÂÏfi˜ ÔÛÙÒÓ ·È‰ÈÒÓ.

The effect of paediatric bone-marrow-derived stromal cells on the

ex-vivo expansion of cord-blood haemopoietic stem cells

I. Pelagiadis, H. Dimitriou, E. Stiakaki, C. Perdikogianni, E. Hatzidaki, M. Kalmanti

Abstract

Background: A major limitation of the use of umbilical cord blood (UCB) haematopoietic stem cells (HSC)for allogeneic transplantation is the insufficient numbers of cells available in the graft. In order to overcomethis restriction, ex-vivo expansion of HSC has been considered. Mesenchymal stromal cells (MSC)constitute an essential element of the normal bone marrow (BM) microenvironment, participating in theregulation of haematopoiesis. The aim of this study was to evaluate the interaction between UCB CD34+

cells and MSC used as a feeder layer and to compare it with the corresponding effect of different growthfactor (GF) combinations on the expansion of HSC.

Methods: CD34+ HSC from the UCB of full term deliveries (n=10) and MSC isolated and expanded fromthe BM of children were co-cultured under different conditions in the presence or absence of GFcombinations. The expansion capability was evaluated, the various populations were immuno-phenotypically characterized and HSC clonogenicity (expressed as the development-formation of CFU-GM/BFU-E colonies) was assessed after 10 days of culture.

Results: CD34+ UCB cells cultured in the presence of both MSC and either GF combination resulted in ahigher expansion of both total cell number and CD34+ cells. Those cultured on the MSC feeder layer onlyyielded a higher percentage of CD34+, CD34+CD38- and CD34+CD33- subpopulations, and enhanced CFU-GM and BFU-E colony development.

109∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞ ORIGINAL ARTICLE

¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹∞ÈÌ·ÙÔÏÔÁ›·˜-√ÁÎÔÏÔÁ›·˜.¶·ÓÂÈÛÙËÌÈ·Îfi¡ÔÛÔÎÔÌÂ›Ô ∏Ú·ÎÏÂ›Ô˘,∆Ì‹Ì· π·ÙÚÈÎ‹˜¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹ÙË˜,∏Ú¿ÎÏÂÈÔ, ∫Ú‹ÙË


ª·Ú›· ∫·ÏÌ·ÓÙ‹ [email protected]¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹∞ÈÌ·ÙÔÏÔÁ›·˜-√ÁÎÔÏÔÁ›·˜,¶·ÓÂÈÛÙËÌÈ·Îfi ¡ÔÛÔÎÔÌÂ›Ô∏Ú·ÎÏÂ›Ô˘, 71110 ∏Ú¿ÎÏÂÈÔ∫Ú‹ÙË˜

Department of PaediatricHaematology-Oncology,University Hospital ofHeraklion, University of CreteMedical School, Heraklion,Crete, Greece

Correspondence:

Maria [email protected] of PaediatricHaematology-Oncology,University Hospital ofHeraklion, 71110, Heraklion,Crete, Greece

¶·È‰È·ÙÚÈÎ‹ 2009;72:109-000

* ∏ ÂÚÁ·Û›· ·˘Ù‹ ‚Ú·‚Â‡ıËÎÂ ÌÂ ÙÔ A’ XˆÚ¤ÌÂÈÔ Œ·ıÏÔ, Î·Ù¿ ÙÔ 46Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ, ∫¤ÚÎ˘Ú· 2008


∂ÈÛ·ÁˆÁ‹

∆Ô ÔÌÊ·ÏÈÔÏ·ÎÔ˘ÓÙÈ·Îfi ·›Ì· (√§) ·Ô-

ÙÂÏÂ› Â‡ÎÔÏ· ÚÔÛ‚¿ÛÈÌË ËÁ‹ ÁÈ· ÌÂÙ·Ìfi-

Û¯Â˘ÛË Î·È ‰È·ı¤ÙÂÈ ÛËÌ·ÓÙÈÎ¿ ÏÂÔÓÂÎÙ‹Ì·-

Ù·, ‰ËÏ. ÌÂÁ·Ï‡ÙÂÚË ÂÚÈÂÎÙÈÎfiÙËÙ· ÛÂ ÚÔÁÔ-

ÓÈÎ¿ ·ÈÌÔÔÈËÙÈÎ¿ Î‡ÙÙ·Ú·, ÌÈÎÚfiÙÂÚÔ ÔÛÔ-

ÛÙfi ÂÌÊ¿ÓÈÛË˜ GVHD Î·È ‰˘Ó·ÙfiÙËÙ· ÌÂÙ·Ìfi-

Û¯Â˘ÛË˜ ÛÂ ÌË Û˘Ì‚·Ùfi ‰¤ÎÙË (1-2 HLA ·ÓÙÈ-

ÁfiÓ·) (1-3). ∆·˘Ùfi¯ÚÔÓ·, fiÌˆ˜, Ô Û¯ÂÙÈÎ¿ ÌÈ-

ÎÚfi˜ ·ÚÈıÌfi˜ Î˘ÙÙ¿ÚˆÓ Ô˘ ÂÚÈ¤¯ÔÓÙ·È ·Ó¿

ÌÔÓ¿‰· ·›Ì·ÙÔ˜ ÏÒÚÔ˘ Î·ıÈÛÙ¿ Ú·ÎÙÈÎ¿ ·‰‡-

Ó·ÙË ÙË ¯ÔÚ‹ÁËÛ‹ ÙÔ˘ ÛÂ ·È‰È¿ ÌÂ ÛˆÌ·ÙÈÎfi

‚¿ÚÔ˜ ÌÂÁ·Ï‡ÙÂÚÔ ÙˆÓ 30 ÎÈÏÒÓ (4,5).

ªÂ ÛÎÔfi ÙËÓ Â˘Ú‡ÙÂÚË ¯Ú‹ÛË ·›Ì·ÙÔ˜ √§

ÛÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË, Á›ÓÔÓÙ·È ÚÔÛ¿ıÂÈÂ˜ ÁÈ· ex

vivo ¤ÎÙ˘ÍË Î˘ÙÙ¿ÚˆÓ. √È ‰È·‰ÈÎ·Û›Â˜ ¤ÎÙ˘-

ÍË˜ Ì¤¯ÚÈ ÚfiÛÊ·Ù· ÂÚÈÏ¿Ì‚·Ó·Ó ÙË ¯Ú‹ÛË

‰È·ÊÔÚÂÙÈÎÒÓ Û˘Ó‰˘·ÛÌÒÓ ·˘ÍËÙÈÎÒÓ ·Ú·Áfi-

ÓÙˆÓ, ÔÈ ÔÔ›Â˜ fiÌˆ˜ Î·Ù·Ï‹ÁÔ˘Ó ÛÂ Û¯ÂÙÈÎ¿

‰È·ÊÔÚÔÔÈËÌ¤ÓÔ˘˜ Î˘ÙÙ·ÚÈÎÔ‡˜ ˘ÔÏËı˘-

ÛÌÔ‡˜ (6-8). ¶ÚfiÛÊ·Ù· ÍÂÎ›ÓËÛÂ Ë ‰ÈÂÚÂ‡ÓËÛË

ÙË˜ ‰˘Ó·ÙfiÙËÙ·˜ ¯Ú‹ÛË˜ ÌÂÛÂÁ¯˘Ì·ÙÈÎÒÓ Î˘Ù-

Ù¿ÚˆÓ (ª∫) ÛÙÚÒÌ·ÙÔ˜ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ

(ª√), Î·ıÒ˜ Î·È ÂÓ‰ÔıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ, ÁÈ·

ÙË ‚ÂÏÙ›ˆÛË ÙË˜ ex vivo ¤ÎÙ˘ÍË˜ (9-13).

∆· ª∫ ·ÔÙÂÏÔ‡Ó Ì¤ÚÔ˜ ÙÔ˘ ÌÈÎÚÔÂÚÈ-

‚¿ÏÏÔÓÙÔ˜ ÙÔ˘ ª√, ÙÔ ÔÔ›Ô Û˘ÌÌÂÙ¤¯ÂÈ ÛÙË

Ú‡ıÌÈÛË ÙË˜ ·ÈÌÔÔ›ËÛË˜. √ ª√ ·ÔÙÂÏÂ› ÙËÓ

ÂÚÈÛÛfiÙÂÚÔ ÌÂÏÂÙËıÂ›Û·, ÈÔ ÚÔÛ‚¿ÛÈÌË Î·È

·Ú¿ÏÏËÏ· ÏÔ˘ÛÈfiÙÂÚË ËÁ‹ ·Ú¯¤ÁÔÓˆÓ ª∫

(14,15).

H Û˘Á¯ÔÚ‹ÁËÛË ·˘ÙfiÏÔÁˆÓ ª∫ ÌÂ ÚÔÁÔ-

ÓÈÎ¿ ·ÈÌÔÔÈËÙÈÎ¿ Î‡ÙÙ·Ú· ÛÂ ·ÛıÂÓÂ›˜ ÌÂ

Î·ÚÎ›ÓÔ ÙÔ˘ Ì·ÛÙÔ‡ Î·È ·ÈÌ·ÙÔÏÔÁÈÎ¤˜ Î·ÎÔ‹-

ıÂÈÂ˜ ¤‰ÂÈÍÂ Ù·¯‡ÙÂÚË ·ÔÎ·Ù¿ÛÙ·ÛË ÙˆÓ ÂÈ-

¤‰ˆÓ ÙˆÓ Ô˘‰ÂÙÂÚfiÊÈÏˆÓ Î·È ÙˆÓ ·ÈÌÔÂÙ·-

Ï›ˆÓ, ÂÓÒ ·Ú¿ÏÏËÏ· Ë Ì¤ıÔ‰Ô˜ Ê¿ÓËÎÂ Ó· Â›-

Ó·È ·ÛÊ·Ï‹˜, ¯ˆÚ›˜ ·ÓÂÈı‡ÌËÙÂ˜ ÂÓ¤ÚÁÂÈÂ˜

(16,17).

™ÎÔfi˜ ÙË˜ ÌÂÏ¤ÙË˜ ‹Ù·Ó Ë ‰ÈÂÚÂ‡ÓËÛË ÙË˜

Â›‰Ú·ÛË˜ ÙˆÓ ª∫ ÛÙÚÒÌ·ÙÔ˜ Ì˘ÂÏÔ‡ ÙˆÓ

ÔÛÙÒÓ ÛÙË ‰˘Ó·ÙfiÙËÙ· ¤ÎÙ˘ÍË˜ CD34+ Î˘ÙÙ¿-

ÚˆÓ ·›Ì·ÙÔ˜ ÔÌÊ¿ÏÈÔ˘ ÏÒÚÔ˘ Î·È Ë Û‡ÁÎÚÈÛË

ÌÂ ÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë Â›‰Ú·ÛË Û˘Ó‰˘·ÛÌÒÓ ·˘-

ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ

™˘ÏÏÔÁ‹ / ‰È·¯ˆÚÈÛÌfi˜ CD34+ Î˘ÙÙ¿ÚˆÓ ·fi ·›Ì·

ÔÌÊ¿ÏÈÔ˘ ÏÒÚÔ˘

∞›Ì· √§ (n=10) Û˘ÏÏ¤¯ıËÎÂ ÌÂÙ¿ ÙËÓ ÔÏÔÎÏ‹Úˆ-

ÛË ÙÔ˘ ÙÔÎÂÙÔ‡ (ŒÁÎÚÈÛË ∂ÈÙÚÔ‹˜ ¢ÂÔÓÙÔÏÔÁ›·˜

ÙÔ˘ ÓÔÛÔÎÔÌÂ›Ô˘ Ì·˜). ∆· ÌÔÓÔ‡ÚËÓ· Î‡ÙÙ·Ú·

(ª¡¶) ‰È·¯ˆÚ›ÛÙËÎ·Ó ÌÂ Â›ÛÙÚˆÛË ÛÂ Ficoll

Hypaque (Lymphoprep-Nycomed d=1077 g/ml) Î·È Ë

·ÔÌfiÓˆÛË ÙˆÓ CD34+ Î˘ÙÙ¿ÚˆÓ ¤ÁÈÓÂ ÌÂ ·ÓÔÛÔ-Ì·-

ÁÓËÙÈÎfi ‰È·¯ˆÚÈÛÌfi (Mini MACS-Separation

Columns), Û‡ÌÊˆÓ· ÌÂ ÙÈ˜ Ô‰ËÁ›Â˜ ÙÔ˘ Î·Ù·ÛÎÂ˘·ÛÙ‹

(Miltenyi Biotec), ÂÓÙfi˜ 24 ˆÚÒÓ ·fi ÙË Ï‹„Ë ÙÔ˘

‰Â›ÁÌ·ÙÔ˜.

AÔÌfiÓˆÛË ÌÂÛÂÁ¯˘Ì·ÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ (ª∫) ·fi

Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ

∏ Û˘ÏÏÔÁ‹ ÙˆÓ ‰ÂÈÁÌ¿ÙˆÓ ª√ ¤ÁÈÓÂ ·fi ·È‰È¿

ÌÂ Î·ÏÔ‹ıË ·ÈÌ·ÙÔÏÔÁÈÎ¿ ÓÔÛ‹Ì·Ù· (È‰ÈÔ·ı‹ ıÚÔÌ-

‚ÔÂÓÈÎ‹ ÔÚÊ‡Ú·, n=9). ∆· MN¶ Î·ÏÏÈÂÚÁ‹ıËÎ·Ó

ÛÂ a-MEM, ÂÌÏÔ˘ÙÈÛÌ¤ÓÔ ÌÂ ÂÈÏÂÁÌ¤ÓÔ ÔÚfi ÂÌ-

‚Ú‡Ô˘ ‚Ôfi˜ (FCS), ÂÓÈÎÈÏÏ›ÓË/ÛÙÚÂÙÔÌ˘Î›ÓË 10%,

ÁÏÔ˘Ù·Ì›ÓË 10% Î·È ·˘ÍËÙÈÎfi ·Ú¿ÁÔÓÙ· ÈÓÔ‚Ï·-

ÛÙÒÓ (FGF-2) 1 ng/ml. ŸÙ·Ó ‰ËÌÈÔ˘ÚÁ‹ıËÎÂ ÛÙÚÒÌ·

>75%, ¤ÁÈÓÂ ıÚ˘„ÈÓÔÔ›ËÛË (ıÚ˘„›ÓË 0,25% +

EDTA) Î·È Ù· Î‡ÙÙ·Ú· Â·Ó·Î·ÏÏÈÂÚÁ‹ıËÎ·Ó ÛÂ Î·-

Ù¿ÏÏËÏË Û˘ÁÎ¤ÓÙÚˆÛË (P1). ∏ ‰È·‰ÈÎ·Û›· Â·Ó·Ï‹-

ÊıËÎÂ Ì¤¯ÚÈ ƒ4.

∞Ó¿Ù˘ÍË CFU-F ·ÔÈÎÈÒÓ - ¯ÚfiÓÔ˜ Î˘ÙÙ·ÚÈÎÔ‡ ‰ÈÏ·-

ÛÈ·ÛÌÔ‡: °È· ÙËÓ ·Ó¿Ù˘ÍË CFU-F ·ÔÈÎÈÒÓ 10 ª∫/cm2

ÙÔÔıÂÙ‹ıËÎ·Ó ÛÂ ÙÚ˘‚Ï›· Petri 20 cm2 ÛÂ ·-ª∂ª (ÂÈ˜

‰ÈÏÔ‡Ó). ªÂÙ¿ ·fi 14 ËÌ¤ÚÂ˜ Î·ÏÏÈ¤ÚÁÂÈ·˜, ¤ÁÈÓÂ

¯ÚÒÛË ÌÂ Giemsa Î·È Î·Ù·ÌÂÙÚ‹ıËÎ·Ó ÔÈ ·ÔÈÎ›Â˜ ÛÂ

·Ó¿ÛÙÚÔÊÔ ÌÈÎÚÔÛÎfiÈÔ.

√ ¯ÚfiÓÔ˜ Î˘ÙÙ·ÚÈÎÔ‡ ‰ÈÏ·ÛÈ·ÛÌÔ‡ [cell doubling

time (DT)] ˘ÔÏÔÁ›ÛÙËÎÂ ‚¿ÛÂÈ ÙÔ˘ Ù‡Ô˘:

DT = t / n = t x log2 / log (·ÚÈıÌfi˜ Î˘ÙÙ¿ÚˆÓ Ô˘

ÚÔ¤Î˘„·Ó ·fi ÙË ıÚ˘„ÈÓÔÔ›ËÛË/ ·ÚÈıÌfi Î˘ÙÙ¿ÚˆÓ

Ô˘ ¿Ú¯ÈÛÂ ÙËÓ Î·ÏÏÈ¤ÚÁÂÈ·) (t : Ô ¯ÚfiÓÔ˜ Ô˘ ÌÂÛÔÏ¿-

‚ËÛÂ ·fi ÙËÓ ¤Ó·ÚÍË ÙË˜ Î·ÏÏÈ¤ÚÁÂÈ·˜ Ì¤¯ÚÈ ÙË ıÚ˘„È-

ÓÔÔ›ËÛË).

∫·ÏÏÈ¤ÚÁÂÈÂ˜ ‰È·ÊÔÚÔÔ›ËÛË˜ ª∫: ™ÙËÓ ƒ2 ‹ ƒ3 ¤ÁÈÓÂ

Â·ÁˆÁ‹ ÙˆÓ ª∫ ÚÔ˜ ÏÈÔÎ‡ÙÙ·Ú· (§), ÔÛÙÂÔÎ‡ÙÙ·Ú·

(√) Î·È ¯ÔÓ‰ÚÔÎ‡ÙÙ·Ú· (Ã) ÛÂ ÂÈ‰ÈÎfi ıÚÂÙÈÎfi ˘ÏÈÎfi.

ªÂ ÈÛÙÔ¯ËÌÈÎ‹ ¯ÚÒÛË ÂÏ¤Á¯ıËÎÂ Ë ‰È·ÊÔÚÔÔ›ËÛË

ÚÔ˜ § (Oil red O), √: (Von Kossa) Î·È Ã (Alcian Blue).

ªÂ RT-PCR ·ÓÈ¯ÓÂ‡ıËÎÂ Ë ¤ÎÊÚ·ÛË ÁÔÓÈ‰›ˆÓ ¯·Ú·ÎÙË-

ÚÈÛÙÈÎÒÓ ÁÈ· § (LPL, aP2), ÁÈ· √ (Osteocalcin,

Osteoprotegerin) Î·È ÁÈ· Ã (Aggrecan, Collagen II).

∫·ÏÏÈ¤ÚÁÂÈ· CD34+ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ

·ÚÔ˘Û›· ª∫

°È· ÙË Û˘ÁÎ·ÏÏÈ¤ÚÁÂÈ· ÙˆÓ ª∫ ÌÂ Ù· ·Ú¯¤ÁÔÓ·

110 π. ¶ÂÏ·ÁÈ¿‰Ë˜ Î·È Û˘Ó.


Conclusions: MSC derived from BM of children, used as a feeder layer, supports the ex-vivo expansionand preserves the characteristics of ‘stemness’ of CD34+ HSC in co-culture conditions, providing apopulation large enough to overcome the problems caused by limited HSC numbers for CBtransplants.

Key words: CD34+, mesenchymal stromal cells, ex vivo expansion, cord blood, children bone marrow.


CD34+ ·ÈÌÔÔÈËÙÈÎ¿ Î‡ÙÙ·Ú· ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ª∫ ƒ3 ‹ ƒ4Ô˘ ÙÔÔıÂÙ‹ıËÎ·Ó ÛÂ ÙÚ˘‚Ï›· 24 ‚ÔıÚ›ˆÓ ÂÈÛÙÚˆÌ¤Ó· ÌÂ˙ÂÏ·Ù›ÓË, ÛÂ Û˘ÁÎ¤ÓÙÚˆÛË 3x104/‚ÔıÚ›Ô. ŸÙ·Ó Ù· ª∫ ‰ËÌÈÔ‡Ú-ÁËÛ·Ó ÛÙÚÒÌ·, ÚÔÛÙ¤ıËÎ·Ó CD34+ Î‡ÙÙ·Ú· (2,5x103/‚ÔıÚ›Ô )Î·È Âˆ¿ÛÙËÎ·Ó ÁÈ· 10 ËÌ¤ÚÂ˜ ÛÂ 37ÔC 5% CO2, ÌÂ ÚÔÛı‹ÎËıÚÂÙÈÎÔ‡ ˘ÏÈÎÔ‡ Î·È ·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ÙËÓ 5Ë ËÌ¤Ú·.∆Ô Î·ÏÏÈÂÚÁËÙÈÎfi ˘ÏÈÎfi ·ÔÙÂÏÂ›ÙÔ ·fi a-MEM + 10% FCS +10% ÂÓÈÎÈÏÏ›ÓË /ÛÙÚÂÙÔÌ˘Î›ÓË + 10% ÁÏÔ˘Ù·Ì›ÓË, ·ÚÔ˘-Û›· ‹ ·Ô˘Û›· ·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ. ÃÚËÛÈÌÔÔÈ‹ıËÎ·Ó‰‡Ô Û˘Ó‰˘·ÛÌÔ› ·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ GFmix1 Î·È GFmix2.

GFmix1: SCF: 10 ng/ml, IL-3: 5 ng/ml, G-CSF: 100 ng/mlÎ·È GM-CSF: 1 ng/ml Î·È GFmix2: SCF: 20 ng/ml, TPO: 25ng/ml, IL-6: 20 ng/ml, Flt-3 ligand: 50 ng/ml.

√È Û˘Óı‹ÎÂ˜ Î·ÏÏÈ¤ÚÁÂÈ·˜ Ô˘ ÂÍÂÙ¿ÛıËÎ·Ó ‹Ù·Ó: ™˘Óı‹ÎË ∞: MK+CD34+

™˘Óı‹ÎË µ: MK+CD34+ +GFmix1 ™˘Óı‹ÎË °: MK+CD34+ +GFmix2™˘Óı‹ÎË ¢: CD34+ +GFmix1 ™˘Óı‹ÎË ∂: CD34+ +GFmix2 ∆Ë 10Ë ËÌ¤Ú· ÙË˜ Û˘ÁÎ·ÏÏÈ¤ÚÁÂÈ·˜ Û˘ÏÏ¤¯ıËÎ·Ó Ù· Î‡Ù-

Ù·Ú· ÙÔ˘ ˘ÂÚÎÂÈÌ¤ÓÔ˘, ÂÓÒ Ù· ÚÔÛÎÔÏÏËÌ¤Ó· Î‡ÙÙ·Ú··ÔÌ·ÎÚ‡ÓıËÎ·Ó ÌÂ ıÚ˘„ÈÓÔÔ›ËÛË.

∏ ¤ÎÙ˘ÍË ÙˆÓ Î˘ÙÙ¿ÚˆÓ ˘ÔÏÔÁ›ÛÙËÎÂ Û˘ÁÎÚ›ÓÔÓÙ·˜ÙÔÓ ·ÚÈıÌfi ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÙË ‰¤Î·ÙË ËÌ¤Ú· Û˘ÁÎ·ÏÏÈ¤ÚÁÂÈ·˜ÌÂ ÙÔÓ ·Ú¯ÈÎfi ·ÚÈıÌfi ÙˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ.

∞ÓÔÛÔÊ·ÈÓÔÙ˘ÈÎfi˜ ·Ú·ÎÙËÚÈÛÌfi˜

ªÂÙ¿ ·fi Û‹Ì·ÓÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÌÂ Û˘˙Â˘ÁÌ¤Ó· ÊıÔÚ›-˙ÔÓÙ· ÌÔÓÔÎÏˆÓÈÎ¿ ·ÓÙÈÛÒÌ·Ù· ·ÎÔÏÔ‡ıËÛÂ Î˘ÙÙ·ÚÔÌÂÙÚ›·ÚÔ‹˜. ŒÁÈÓÂ ·Ó¿Ï˘ÛË ÁÈ·: CD34-PE, CD45-FITC, CD33-PC5,CD38-PC5, CD105-PE, CD146-P∂ Î·È Ë ‰È¿ÎÚÈÛË ÙˆÓ ª∫·fi Ù· ·ÈÌÔÔÈËÙÈÎ¿ Î‡ÙÙ·Ú· ‚·Û›ÛÙËÎÂ ÛÙËÓ ¤ÎÊÚ·ÛË ÙÔ˘CD45 Î·È ÛÙÈ˜ ‰È·ÊÔÚ¤˜ ÙˆÓ ‰‡Ô Î˘ÙÙ·ÚÈÎÒÓ Ù‡ˆÓ ·Ó¿ÏÔÁ·ÌÂ ÙÔ Ì¤ÁÂıÔ˜ Î·È ÙËÓ ÎÔÎÎ›ˆÛË (FS/SS).

∞Ó¿Ù˘ÍË ·ÔÈÎÈÒÓ ÎÔÎÎÈÒ‰Ô˘˜ (CFU-GM) Î·È ÂÚ˘ıÚ¿˜

(BFU-E) ÛÂÈÚ¿˜ - Î·ÏÏÈ¤ÚÁÂÈÂ˜ ÌÂı˘ÏÔÎ˘ÙÙ·Ú›ÓË˜

™Â Î·ÏÏÈÂÚÁËÙÈÎfi ˘ÏÈÎfi 1% ÌÂı˘ÏÔÎ˘ÙÙ·Ú›ÓË˜ (STEMCELL Technologies HCC4230) ÚÔÛÙ¤ıËÎ·Ó 5x103 Î‡ÙÙ·Ú·Î·È ÔÈ ·˘ÍËÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ G-CSF: 100 ng/ml, IL-3: 5 ng/ml,GM-CSF: 1 ng/ml Î·È ÂÚ˘ıÚÔÔÈËÙ›ÓË (EPO): 4 πU/ml.

√È Î˘ÙÙ·ÚÔÎ·ÏÏÈ¤ÚÁÂÈÂ˜ Âˆ¿ÛÙËÎ·Ó ÁÈ· 14 ËÌ¤ÚÂ˜ ÛÂ37ÔC 5% CO2 Î·È Ë Î·Ù·Ì¤ÙÚËÛË ·ÔÈÎÈÒÓ ¤ÁÈÓÂ ÛÂ ·Ó¿-ÛÙÚÔÊÔ ÌÈÎÚÛÎfiÈÔ. ŸÏ· Ù· ÂÈÚ¿Ì·Ù· ¤ÁÈÓ·Ó ÂÈ˜ ‰ÈÏÔ‡Ó.

™Ù·ÙÈÛÙÈÎ‹ ∞Ó¿Ï˘ÛË

∆· ·ÔÙÂÏ¤ÛÌ·Ù· ÂÎÊÚ¿˙ÔÓÙ·È ˆ˜ Ì¤ÛË ÙÈÌ‹±ÛÙ·ıÂÚfi

ÛÊ¿ÏÌ· ÙË˜ Ì¤ÛË˜ ÙÈÌ‹˜ (SEM). √È ÌÂÙ·‚ÏËÙ¤˜ ÌÂ ÌË Î·ÓÔ-ÓÈÎ‹ Î·Ù·ÓÔÌ‹ Û˘ÁÎÚ›ıËÎ·Ó ÌÂ Mann-Whitney U test. ŸÏÂ˜ÔÈ Û˘ÁÎÚ›ÛÂÈ˜ Â›Ó·È ‰ÈÏ‹˜ Î·ÙÂ‡ı˘ÓÛË˜. ™Ù·ÙÈÛÙÈÎÒ˜ ÛËÌ·-ÓÙÈÎ¿ ıÂˆÚ‹ıËÎ·Ó Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÌÂ p<0,05. ∏ ·Ó¿Ï˘ÛË¤ÁÈÓÂ ÌÂ ÙÔ Statistical Package for Social Sciences (SPSS).

∞ÔÙÂÏ¤ÛÌ·Ù·

Ã·Ú·ÎÙËÚÈÛÙÈÎ¿ ÌÂÛÂÁ¯˘Ì·ÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ

∆· ª∫ ÂÌÊ¿ÓÈÛ·Ó ÛÙËÓ ÚÒÙË Î·ÏÏÈ¤ÚÁÂÈ· Î·È‰È·Ù‹ÚËÛ·Ó ÛÙÈ˜ ÂfiÌÂÓÂ˜ Â·Ó·Î·ÏÏÈ¤ÚÁÂÈÂ˜ ÙÔ¯·Ú·ÎÙËÚÈÛÙÈÎfi ·ÙÚ·ÎÙÔÂÈ‰¤˜ Û¯‹Ì· (∂ÈÎfiÓ· 1).∞ÓÔÛÔÊ·ÈÓÔÙ˘ÈÎ¿, ‹‰Ë ·fi ÙËÓ ÚÒÙË Â·Ó·Î·Ï-ÏÈ¤ÚÁÂÈ· ‰ÂÓ ·Ú·ÙËÚ‹ıËÎÂ ¤ÎÊÚ·ÛË ÙˆÓ ·ÈÌÔÔÈË-ÙÈÎÒÓ ‰ÂÈÎÙÒÓ CD34 Î·È CD45, ÂÓÒ ÔÈ Û¯ÂÙÈ˙fiÌÂÓÔÈÌÂ Ù· MK ‰Â›ÎÙÂ˜, Ô˘ ÂÎÊÚ¿˙ÔÓÙ·Ó ÛÂ ÔÏ‡ ÌÈÎÚfiÔÛÔÛÙfi ÛÙÔÓ ÏËı˘ÛÌfi ÙˆÓ M¶¡ (CD105:1,85±0,3%, CD146: 0,93±0,3%), ÂÎÊÚ¿˙ÔÓÙ·Ó ÛÂ˘„ËÏfi ÔÛÔÛÙfi ÛÙÈ˜ Â·Ó·Î·ÏÏÈ¤ÚÁÂÈÂ˜ ÙˆÓ ª∫(CD105: 99,4±0,23% Î·È CD146: 94,05±1,45%).

™ÙËÓ ƒ2 ÙÔ Û‡ÓÔÏÔ ÙˆÓ ·ÔÈÎÈÒÓ CFU-F ‹Ù·Ó38,05±3,7 Î·È ÛÙËÓ P4 ‹Ù·Ó 24,03±3. √ ¯ÚfiÓÔ˜ Î˘Ù-Ù·ÚÈÎÔ‡ ‰ÈÏ·ÛÈ·ÛÌÔ‡ ÛÙËÓ ƒ2 ‹Ù·Ó 1,93±0,1 ËÌ¤-ÚÂ˜ Î·È ÛÙËÓ ƒ4 2,6±0,2 ËÌ¤ÚÂ˜.

∞fi ÙËÓ ÈÛÙÔ¯ËÌÈÎ‹ ¯ÚÒÛË Ê¿ÓËÎÂ fiÙÈ Ù· ª∫¤¯Ô˘Ó ÈÎ·ÓfiÙËÙ· ‰È·ÊÔÚÔÔ›ËÛË˜ ÚÔ˜ ÔÛÙÂÔÎ‡Ù-Ù·Ú·, ÏÈÔÎ‡ÙÙ·Ú·, ¯ÔÓ‰ÚÔÎ‡ÙÙ·Ú· (∂ÈÎfiÓ· 2). ∏·Ó¿Ï˘ÛË ÌÂ RT-PCR ¤‰ÂÈÍÂ fiÙÈ Ù· Î‡ÙÙ·Ú· ·˘Ù¿ ÂÎ-ÊÚ¿˙Ô˘Ó ÌÔÚÈ·ÎÔ‡˜ ‰Â›ÎÙÂ˜ ÂÈ‰ÈÎÔ‡˜ ÁÈ· ÔÛÙÂÔÎ‡Ù-Ù·Ú·, ÏÈÔÎ‡ÙÙ·Ú· Î·È ¯ÔÓ‰ÚÔÎ‡ÙÙ·Ú· (‰ÂÓ ·Ú·Ù›-ıÂÓÙ·È Ù· ‰Â‰ÔÌ¤Ó·).

∞ÔÌfiÓˆÛË CD34+ Î˘ÙÙ¿ÚˆÓ

√ Ì¤ÛÔ˜ fiÁÎÔ˜ Û˘ÏÏÔÁ‹˜ √§ ‹Ù·Ó 39,8±2,2 ml,ÂÓÒ ÌÂÙ¿ ÙËÓ Â›ÛÙÚˆÛË ÛÂ Ficoll-Hypaque ·ÔÌÔ-ÓÒıËÎ·Ó 2,9±0,5x108 ª¡¶. ªÂÙ¿ ÙÔÓ ·ÓÔÛÔÌ·ÁÓË-ÙÈÎfi ‰È·¯ˆÚÈÛÌfi, Ù· Î‡ÙÙ·Ú· ‹Ù·Ó 54,3±2,1x104 Î·ÈÂÍ¤ÊÚ·˙·Ó CD34 ÛÂ ÔÛÔÛÙfi 93±1,43%.

∂›‰Ú·ÛË ÙË˜ ·ÚÔ˘Û›·˜ ª∫ ÛÙËÓ ¤ÎÙ˘ÍË ÙÔ˘

Û˘ÓÔÏÈÎÔ‡ ·ÚÈıÌÔ‡ Î˘ÙÙ¿ÚˆÓ

∏ Ù·˘Ùfi¯ÚÔÓË ·ÚÔ˘Û›· ª∫ Î·È ·˘ÍËÙÈÎÒÓ

111ªÂÛÂÁ¯˘Ì·ÙÈÎ¿ Î·È ¤ÎÙ˘ÍË ÔÌÊ·ÏÔÏ·ÎÔ˘ÓÙÈ·ÎÔ‡ ·›Ì·ÙÔ˜

¶·È‰È·ÙÚÈÎ‹ 2009;72:111-000

∂ÈÎfiÓ· 1. ·) ªÂÛÂÁ¯˘Ì·ÙÈÎ¿ Î‡ÙÙ·Ú·, ‚) ·ÈÌÔÔÈËÙÈÎ¿ Î‡ÙÙ·Ú· ÌÂÙ¿ ·fi ‰¤Î· ËÌ¤ÚÂ˜ Î·ÏÏÈ¤ÚÁÂÈ·˜ ·ÚÔ˘Û›· ÌfiÓÔ ·˘ÍËÙÈÎÒÓ ·Ú·Áfi-ÓÙˆÓ, Á) ·ÈÌÔÔÈËÙÈÎ¿ Î‡ÙÙ·Ú· ÛÂ ÌÂÛÂÁ¯˘Ì·ÙÈÎ¿ Î‡ÙÙ·Ú· ÛÙÚÒÌ·ÙÔ˜ ÙË ‰¤Î·ÙË ËÌ¤Ú· Û˘ÁÎ·ÏÏÈ¤ÚÁÂÈ·˜.

· ‚ Á


·Ú·ÁfiÓÙˆÓ ÛÙËÓ Î·ÏÏÈ¤ÚÁÂÈ· Â›¯Â ˆ˜ ·ÔÙ¤ÏÂÛÌ·

ÙË ÌÂÁ·Ï‡ÙÂÚË ¤ÎÙ˘ÍË ÙÔ˘ Û˘ÓÔÏÈÎÔ‡ ·ÚÈıÌÔ‡ ÙˆÓ

Î˘ÙÙ¿ÚˆÓ (Û˘Óı‹ÎË B/° ÛÂ Û‡ÁÎÚÈÛË ÌÂ Û˘Óı‹ÎÂ˜

¢/∂) (∂ÈÎfiÓ· 1), ÂÓÒ ÔÈ Û˘Ó‰˘·ÛÌÔ› ÙˆÓ ·˘ÍËÙÈÎÒÓ

·Ú·ÁfiÓÙˆÓ Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ‰ÂÓ ‰È¤ÊÂÚ·Ó

ÛÙËÓ Â›‰Ú·ÛË Ô˘ Â›¯·Ó ÛÙËÓ ¤ÎÙ˘ÍË ÙˆÓ Î˘ÙÙ¿-

ÚˆÓ (¶›Ó·Î·˜ 1, Û˘Óı‹ÎË µ Î·È °). ∆· ·ÈÌÔÔÈËÙÈÎ¿

Î‡ÙÙ·Ú· Ô˘ Î·ÏÏÈÂÚÁ‹ıËÎ·Ó ·ÔÎÏÂÈÛÙÈÎ¿ ·ÚÔ˘-

Û›· Î˘ÙÙ¿ÚˆÓ ÛÙÚÒÌ·ÙÔ˜ (Û˘Óı‹ÎË ∞) ·˘Í‹ıËÎ·Ó

Î·Ù¿ 10,9±5,73 ÊÔÚ¤˜ Î·È ·˘Ù‹ Ë Û˘Óı‹ÎË ·¤ÊÂÚÂ

ÙË ÌÈÎÚfiÙÂÚË ¤ÎÙ˘ÍË (p≤0,05) ÛÂ Û‡ÁÎÚÈÛË ÌÂ fiÏÂ˜

ÙÈ˜ ˘fiÏÔÈÂ˜ (¶›Ó·Î·˜ 1).

∂›‰Ú·ÛË ÙË˜ ·ÚÔ˘Û›·˜ ª∫ ÛÙËÓ ¤ÎÙ˘ÍË ÙˆÓ

·Ú¯¤ÁÔÓˆÓ/ÚÔÁÔÓÈÎÒÓ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ

∏ Ù·˘Ùfi¯ÚÔÓË ·ÚÔ˘Û›· ·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ

-·ÓÂÍ·ÚÙ‹Ùˆ˜ Û˘Ó‰˘·ÛÌÔ‡- Î·È ÛÙÚÒÌ·ÙÔ˜ (Û˘Óı‹-

ÎË µ Î·È °, ¶›Ó·Î·˜ 1) Â¤ÊÂÚÂ ÙË ÌÂÁ·Ï‡ÙÂÚË ¤Î-

Ù˘ÍË ÛÙ· CD34+ Î‡ÙÙ·Ú·, ÂÓÒ ÙÔ Ùˆ¯fiÙÂÚÔ ÔÛÔ-

ÙÈÎ¿ ·ÔÙ¤ÏÂÛÌ· Â›¯Â Ë Û˘Óı‹ÎË ∞ (p=0,025). ∏

Î·ÏÏÈ¤ÚÁÂÈ· ÙˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ ÌÂ ·˘ÍË-

ÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜ ÌfiÓÔ (Û˘Óı‹ÎÂ˜ ¢ Î·È ∂) Â¤ÊÂ-

ÚÂ ÈÎ·ÓÔÔÈËÙÈÎ‹ ¤ÎÙ˘Í‹ ÙÔ˘˜, Ë ÔÔ›·, ·Ó Î·È

·ÚÈıÌËÙÈÎ¿ ‹Ù·Ó ÌÈÎÚfiÙÂÚË ·˘Ù‹˜ Ô˘ ÚÔÎ‡ÙÂÈ

·ÚÔ˘Û›· ÛÙÚÒÌ·ÙÔ˜, ÂÓ ÙÔ‡ÙÔÈ˜ ‰ÂÓ ÊÙ¿ÓÂÈ ÛÙ·

fiÚÈ· ÙË˜ ÛÙ·ÙÈÛÙÈÎ‹˜ ÛËÌ·ÓÙÈÎfiÙËÙ·˜.

∞ÓÔÛÔÊ·ÈÓÔÙ˘ÈÎ¿ ·Ú·ÎÙËÚÈÛÙÈÎ¿ Î˘ÙÙ¿ÚˆÓ

ÛÙÚÒÌ·ÙÔ˜ Î·È ÂÎÙ˘ÁÌ¤ÓˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ

Î˘ÙÙ¿ÚˆÓ

√ ÚÔÛ‰ÈÔÚÈÛÌfi˜ ¤ÎÊÚ·ÛË˜ ÙÔ˘ CD34 ¤‰ÂÈÍÂ

ˆ˜ Ë ·Ô˘Û›· ·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ·fi ÙËÓ Î·Ï-ÏÈ¤ÚÁÂÈ· ¤¯ÂÈ ˆ˜ Û˘Ó¤ÂÈ· ÌÂÁ·Ï‡ÙÂÚÔ ÂÎ·ÙÔÛÙÈ·›ÔÔÛÔÛÙfi Î˘ÙÙ¿ÚˆÓ Ô˘ ÙÔ ÂÎÊÚ¿˙Ô˘Ó (¶›Ó·Î·˜ 1).

∆· ÔÛÔÛÙ¿ ÙˆÓ ÏËı˘ÛÌÒÓ CD34+38- Î·ÈCD34+33- Ô˘ Ô‰ÂÈÎÓ‡Ô˘Ó Î‡ÙÙ·Ú· ÌÂ ·Ú·ÎÙËÚÈ-ÛÙÈÎ¿ ·ˆÚfiÙËÙ·˜ ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚ· ÛÙË Û˘Óı‹ÎË ∞(·ÚÔ˘Û›· ÌfiÓÔ ª∫), ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙÈ˜ ˘fiÏÔÈÂ˜Û˘Óı‹ÎÂ˜ Î·ÏÏÈ¤ÚÁÂÈ·˜ (µ/°/¢ Î·È ∂). ∆Ô ÔÛÔÛÙfiÙˆÓ CD34+33- Î˘ÙÙ¿ÚˆÓ ‹Ù·Ó 40,5±3,6% ÛÙË Û˘Óı‹-ÎË ∞, 4,1±0,9% ÛÙË Û˘Óı‹ÎË µ Î·È 4±1,1% ÛÙË Û˘Ó-ı‹ÎË ¢. (∂ÈÎfiÓ· 3). ∆· ·ÓÙ›ÛÙÔÈ¯· ÔÛÔÛÙ¿ ÁÈ· Ù·CD34+38- Î‡ÙÙ·Ú· ‹Ù·Ó 5,6±3,4%, 1,3±0,9% Î·È4,2±3,8%. ¢ÂÓ ·Ú·ÙËÚ‹ıËÎÂ ‰È·ÊÔÚ¿ ·˘ÙÒÓ ÙˆÓÎ˘ÙÙ·ÚÈÎÒÓ ˘ÔÏËı˘ÛÌÒÓ ÂÍ·ÚÙÒÌÂÓË ·fi ÙÔÓÛ˘Ó‰˘·ÛÌfi ÙˆÓ ·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ (Û˘Óı‹ÎÂ˜µ ÚÔ˜ ° Î·È ¢ ÚÔ˜ ∂) (∂ÈÎfiÓ· 3).

∞Ó¿Ù˘ÍË ·ÔÈÎÈÒÓ ÎÔÎÎÈÒ‰Ô˘˜ (CFU-GM) Î·È

ÂÚ˘ıÚ¿˜ (BFU-E) ÛÂÈÚ¿˜

∞Ó¿Ù˘ÍË ÌÂÁ·Ï‡ÙÂÚÔ˘ ·ÚÈıÌÔ‡ ·ÔÈÎÈÒÓ CFU-GM (186,81±9,9) ·Ú·ÙËÚ‹ıËÎÂ ·ÚÔ˘Û›· ÌfiÓÔÎ˘ÙÙ¿ÚˆÓ ÛÙÚÒÌ·ÙÔ˜ (∂ÈÎfiÓ· 4). ™˘ÁÎÚ›ÓÔÓÙ·˜ ÌÂfiÏÂ˜ ÙÈ˜ ˘fiÏÔÈÂ˜ Û˘Óı‹ÎÂ˜, Ê·›ÓÂÙ·È ˆ˜ Ë ·-ÚÔ˘Û›· ÌfiÓÔ ª∫ ÛÙËÓ Î·ÏÏÈ¤ÚÁÂÈ·, ÌÔÏÔÓfiÙÈ ‰ÂÓÚÔ¿ÁÂÈ ÙÔÓ ÔÏÏ·Ï·ÛÈ·ÛÌfi ÙˆÓ Î˘ÙÙ¿ÚˆÓ (ÌÈÎÚfi-ÙÂÚË ¤ÎÙ˘ÍË ÙÔ˘ ÔÏÈÎÔ‡ ·ÚÈıÌÔ‡ Î·È ÙÔ˘ ·ÚÈıÌÔ‡ÙˆÓ CD34+), ÂÓ ÙÔ‡ÙÔÈ˜ ·Ú¤¯ÂÈ Î‡ÙÙ·Ú· ÌÂ ·˘ÍËÌ¤-ÓË ÎÏˆÓÔÁÔÓÈÎ‹ ÈÎ·ÓfiÙËÙ·. ∂›ÛË˜, ·Ú·ÙËÚÂ›Ù·È‰È·ÊÔÚÂÙÈÎfi˜ Ú˘ıÌfi˜ ·Ó¿Ù˘ÍË˜ ·ÔÈÎÈÒÓ ·Ó¿ÏÔÁ·ÌÂ ÙÔÓ Û˘Ó‰˘·ÛÌfi ÙˆÓ ·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ Î·È ÔGFmix1 (Û˘Óı‹ÎË ¢) ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ·Ó¿Ù˘ÍËÌÂÁ·Ï‡ÙÂÚÔ˘ ·ÚÈıÌÔ‡ ·ÔÈÎÈÒÓ (147,0±12,9), ÛÂ

¶›Ó·Î·˜ 1. ∞ÔÙÂÏ¤ÛÌ·Ù· ¤ÎÙ˘ÍË˜ ÙÔ˘ Û˘ÓÔÏÈÎÔ‡ ·ÚÈıÌÔ‡ ÙˆÓ Î˘ÙÙ¿ÚˆÓ Î·È ÙˆÓ CD34+ Î˘ÙÙ¿ÚˆÓ Î·È ÔÛÔÛÙfi ¤ÎÊÚ·ÛË˜ ÙÔ˘ CD34 ·ÓÙÈ-ÁfiÓÔ˘ ÂÈÊ·ÓÂ›·˜ ÌÂÙ¿ ·fi ‰¤Î· ËÌ¤ÚÂ˜ Û˘ÁÎ·ÏÏÈ¤ÚÁÂÈ·˜

™˘Óı‹ÎË ŒÎÙ˘ÍË ÔÏÈÎÔ‡ ·ÚÈıÌÔ‡ ŒÎÙ˘ÍË CD34+ % CD34Î˘ÙÙ¿ÚˆÓ (x)

∞ CD34∆ + ª∫ 10,9 ± 5,7 2,2 ± 0 ,7 50,6 ± 5,5µ CD34∆ + ª∫ + GFmix1 164,4 ± 42,7* 20,9 ± 5,9* 13,1± 0,9*° CD34∆ + ª∫ + GFmix2 165,8 ± 35,8* 16,8 ± 0,5* 11,4 ± 2,0*¢ CD34∆ + + GFmix1 101, 9 ± 36,3* 13,7 ± 9,7 10,9 ± 5,5∂ CD34∆ + + GFmix2 134,2 ± 10,8* 14,2 ± 1,7* 10,5 ± 0,4

*Î·Ù·‰ÂÈÎÓ‡ÂÈ ÛÙ·ÙÈÛÙÈÎ‹ ÛËÌ·ÓÙÈÎfiÙËÙ·, p<0,05 ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙË Û˘Óı‹ÎË ∞

∂ÈÎfiÓ· 2. πÛÙÔ¯ËÌÈÎ¤˜ ¯ÚÒÛÂÈ˜ ·fi ‰È·ÊÔÚÔÔÈËÌ¤Ó· ÌÂÛÂÁ¯˘Ì·ÙÈÎ¿ Î‡ÙÙ·Ú·: ·) ÏÈÔÎ‡ÙÙ·Ú·, ‚) ÔÛÙÂÔÎ‡ÙÙ·Ú·, Á) ¯ÔÓ‰ÚÔÎ‡ÙÙ·Ú·.

112 π. ¶ÂÏ·ÁÈ¿‰Ë˜ Î·È Û˘Ó.


· ‚ Á


Û‡ÁÎÚÈÛË ÌÂ ÙÔ GFmix2 (Û˘Óı‹ÎË ∂) (58,5±11,9)

(p=0,02) (∂ÈÎfiÓ· 4).

∞Ó·ÊÔÚÈÎ¿ ÌÂ ÙÈ˜ ·ÔÈÎ›Â˜ ÙË˜ ÂÚ˘ıÚ¿˜ ÛÂÈÚ¿˜, Ë

·ÚÔ˘Û›· ÁÂÓÈÎ¿ ª∫ Â›¯Â ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·Ó¿-

Ù˘ÍË ÌÂÁ·Ï‡ÙÂÚÔ˘ ·ÚÈıÌÔ‡ ·ÔÈÎÈÒÓ. ™˘ÁÎÂÎÚÈÌ¤-

Ó·, ÔÈ ÂÚÈÛÛfiÙÂÚÂ˜ ·ÔÈÎ›Â˜ ‰ËÌÈÔ˘ÚÁ‹ıËÎ·Ó ·fi Ù·

·ÈÌÔÔÈËÙÈÎ¿ Î‡ÙÙ·Ú· ·ÚÔ˘Û›· ÌfiÓÔ ª∫ (Û˘Óı‹ÎË

∞), ÂÓÒ ÔÈ ÏÈÁfiÙÂÚÂ˜ ÛÙÈ˜ Û˘Óı‹ÎÂ˜ ¢ Î·È ∂ fiÔ˘

·Ô˘Û›·˙·Ó ÙÂÏÂ›ˆ˜ Ù· ÌÂÛÂÁ¯˘Ì·ÙÈÎ¿ (p=0,03 Î·È

p=0,01, ·ÓÙ›ÛÙÔÈ¯·, ÛÂ Û‡ÁÎÚÈÛË ÌÂ ™˘Óı‹ÎË ∞) (∂ÈÎfi-

Ó· 4). ¶·ÚÔÌÔ›ˆ˜, fiˆ˜ Î·È ÁÈ· ÙÈ˜ ·ÔÈÎ›Â˜ ÙË˜ ÎÔÎ-

ÎÈÒ‰Ô˘˜ ÛÂÈÚ¿˜, Ô Û˘Ó‰˘·ÛÌfi˜ ·Ú·ÁfiÓÙˆÓ GMix1

¤‰ˆÛÂ ÂÚÈÛÛfiÙÂÚÂ˜ ·ÔÈÎ›Â˜ ÂÚ˘ıÚ¿˜ ÛÂÈÚ¿˜, ÛÂ Û¯¤-

ÛË ÌÂ ÙÔÓ Û˘Ó‰˘·ÛÌfi GMix 2 (Û˘Óı‹ÎË µ/° Î·È ¢/∂).

™˘˙‹ÙËÛË

∆· Î‡ÙÙ·Ú· ÛÙÚÒÌ·ÙÔ˜ ·ÔÙÂÏÔ‡Ó Ì¤ÚÔ˜ ÙÔ˘ ÌÈ-

ÎÚÔÂÚÈ‚¿ÏÏÔÓÙÔ˜ ÙÔ˘ ª√ Î·È Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÙË

Ú‡ıÌÈÛË ÙË˜ ·˘ÙÔ·Ó·Ó¤ˆÛË˜, ÙÔ˘ ÔÏÏ·Ï·ÛÈ·ÛÌÔ‡

Î·È ÙË˜ ‰È·ÊÔÚÔÔ›ËÛË˜ ÙˆÓ ·Ú¯¤ÁÔÓˆÓ/ÚÔÁÔÓÈÎÒÓ

·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ. √ ·ÎÚÈ‚‹˜ ÌË¯·ÓÈÛÌfi˜ ·˘-

Ù‹˜ ÙË˜ ‰È·‰ÈÎ·Û›·˜ ‰ÂÓ ¤¯ÂÈ ·ÔÛ·ÊËÓÈÛÙÂ›, ·ÏÏ¿

A

E

A

E

A AA

40,48% 27,45%

E¢¢¢°

B

4,15%

BB

15,20%

CD

33

PC

5

CD34 PE

1,40% 4,00% 17,95% 0,45%

A

E

A

E

A AA

5,63% 7,15%

E¢¢¢°

B

1,35%

BB

2,83%

CD

38

PC

5

CD34 PE

0,40% 4,20% 20,18% 0,45%

∂ÈÎfiÓ· 3. ∞ÓÔÛÔÊ·ÈÓÔÙ˘ÈÎ‹ ·Ó¿Ï˘ÛË ÙˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ √§ ÌÂÙ¿ ·fi ‰¤Î· ËÌ¤ÚÂ˜ Î·ÏÏÈ¤ÚÁÂÈ·˜ ÌÂ ÌÂÛÂÁ¯˘Ì·ÙÈÎ¿ Î‡ÙÙ·Ú·ÛÙÚÒÌ·ÙÔ˜. ∏ ·Ó¿Ï˘ÛË ¤ÁÈÓÂ ˆ˜ ÚÔ˜ ÙËÓ ¤ÎÊÚ·ÛË CD34 CD33 Î·È CD34CD38 ÛÙÔÓ CD45+ ÏËı˘ÛÌfi.


¶·È‰È·ÙÚÈÎ‹ 2009;72:113-000


Èı·ÓÒ˜ ÂÈÙ˘Á¯¿ÓÂÙ·È Ì¤Ûˆ ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ Î·È

¿ÏÏˆÓ ÂÎÎÚÈÓfiÌÂÓˆÓ ·fi Ù· ª∫ ·Ú·ÁfiÓÙˆÓ, Î·ıÒ˜

Î·È ÌÂ ÙËÓ Â·Ê‹ Î‡ÙÙ·ÚÔ-Î‡ÙÙ·ÚÔ (18).

∆ËÓ ÙÂÏÂ˘Ù·›· 15ÂÙ›· ·ÂÙ¤ÏÂÛÂ ·ÓÙÈÎÂ›ÌÂÓÔ

ÂÎÙÂÙ·Ì¤ÓË˜ ÌÂÏ¤ÙË˜ Ë ex vivo ¤ÎÙ˘ÍË ·›Ì·ÙÔ˜ √§,

ÛÙËÓ ÚÔÛ¿ıÂÈ· ·ÓÙÈÌÂÙÒÈÛË˜ ÙˆÓ ÌÂÈÔÓÂÎÙËÌ¿-

ÙˆÓ ÙÔ˘ ·›Ì·ÙÔ˜ √§ ˆ˜ ÌÔÛ¯Â‡Ì·ÙÔ˜, ÒÛÙÂ Ó· ·ÍÈÔ-

ÔÈËıÔ‡Ó Ù· ÏÂÔÓÂÎÙ‹Ì·Ù· Ô˘ ·Ú¤¯ÂÈ ˆ˜ ËÁ‹

·Ú¯¤ÁÔÓˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ. ™Ù· Ï·›ÛÈ·

·˘Ù¿ ‰ÔÎÈÌ¿ÛÙËÎ·Ó ‰È¿ÊÔÚÂ˜ Û˘Óı‹ÎÂ˜ Î·ÏÏÈ¤ÚÁÂÈ-

·˜, ÔÈ ÔÔ›Â˜ ÂÚÈÂÏ¿Ì‚·Ó·Ó Î˘Ú›ˆ˜ ‰È·ÊÔÚÂÙÈÎÔ‡˜

Û˘Ó‰˘·ÛÌÔ‡˜ ·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ (6-8,19).

™ÎÔfi˜ ‹Ù·Ó Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ È‰·ÓÈÎÒÓ Û˘Ó-

ıËÎÒÓ Î·È ÙË˜ Â›‰Ú·ÛË˜ Û˘Ó‰˘·ÛÌÔ‡ ·Ú·ÁfiÓÙˆÓ

Ô˘, ÌÂÙ¿ ·fi Û¯ÂÙÈÎ¿ Û‡ÓÙÔÌË Î·ÏÏÈ¤ÚÁÂÈ·, ı·

ÌÔÚÔ‡ÛÂ Ó· ·Ú¤¯ÂÈ ·Ú¯¤ÁÔÓ· ·ÈÌÔÔÈËÙÈÎ¿ Î‡ÙÙ·-

Ú· ÛÂ ·˘ÍËÌ¤ÓÔ ·ÚÈıÌfi Î·È ÌÂ ‰È·Ù‹ÚËÛË -ÛÂ fiÛÔ ÙÔ

‰˘Ó·ÙfiÓ ÌÂÁ·Ï‡ÙÂÚÔ ‚·ıÌfi- ÙˆÓ È‰ÈÔÙ‹ÙˆÓ ÙÔ˘ «·Ú-

¯¤ÁÔÓÔ˘» Î˘ÙÙ¿ÚÔ˘. ∆· ‰Â‰ÔÌ¤Ó· ÔÏÏÒÓ ÌÂÏÂÙÒÓ,

·Ó Î·È ·ÚÂ›¯·Ó ÂÓı·ÚÚ˘ÓÙÈÎ¿ ·ÔÙÂÏ¤ÛÌ·Ù·, ‰ÂÓ

ÌÔÚÂ› Ó· ıÂˆÚËıÂ› fiÙÈ ·ÓÙÈÌÂÙÒÈÛ·Ó ÈÎ·ÓÔÔÈËÙÈ-

Î¿ ÙÔ Úfi‚ÏËÌ·, ·ÊÔ‡, Û‡ÌÊˆÓ· ÌÂ ÎÏÈÓÈÎ¤˜ ÌÂÏ¤-

ÙÂ˜ Ê¿ÛË˜ π, ‰ÂÓ ·Ú·ÙËÚ‹ıËÎÂ ÛÙ·ıÂÚ‹ ·ÔÎ·Ù¿-

ÛÙ·ÛË ÙË˜ ·ÈÌÔÔ›ËÛË˜, Èı·ÓÒ˜ ÁÈ·Ù› Î·Ù¿ ÙË ‰È¿Ú-

ÎÂÈ· ÙË˜ ¤ÎÙ˘ÍË˜ ÔÈ Î·ÏÏÈÂÚÁËÙÈÎ¤˜ Û˘Óı‹ÎÂ˜ Ô‰Ë-

ÁÔ‡Û·Ó ÛÂ ÈÔ ‰È·ÊÔÚÔÔÈËÌ¤Ó· Î‡ÙÙ·Ú· (20-21).

¶ÈÔ ÚfiÛÊ·Ù·, ÂÍÂÙ¿ÛÙËÎÂ Â¿Ó Ù· ª∫ ı· ÌÔ-

ÚÔ‡Û·Ó Ó· Û˘ÁÎ·ÏÏÈÂÚÁËıÔ‡Ó ÌÂ ·Ú¯¤ÁÔÓ· ·ÈÌÔÔÈ-

ËÙÈÎ¿ Î‡ÙÙ·Ú· ÁÈ· Ó· ÂÈÙÂ˘¯ıÂ› Î·Ï‡ÙÂÚË ex vivo

¤ÎÙ˘ÍË ÙˆÓ ÙÂÏÂ˘Ù·›ˆÓ (22).

™ÎÔfi˜ ÙË˜ ·ÚÔ‡Û·˜ ÂÚÁ·Û›·˜ ‹Ù·Ó Ë in vitro

ÌÂÏ¤ÙË ÙË˜ Â›‰Ú·ÛË˜ ÙˆÓ ª∫ ·fi ª√ ·È‰ÈÒÓ ÌÂ

Î·ÏÔ‹ıË ·ÈÌ·ÙÔÏÔÁÈÎ¿ ÓÔÛ‹Ì·Ù· ÛÂ CD34+ Î‡ÙÙ·Ú·

·›Ì·ÙÔ˜ √§ Î·È Ë Û‡ÁÎÚÈÛË ÙˆÓ ·ÔÙÂÏ¤ÛÌ·ÙˆÓ ÌÂ

·ÓÙ›ÛÙÔÈ¯Â˜ Î·ÏÏÈ¤ÚÁÂÈÂ˜, ·ÚÔ˘Û›· Û˘Ó‰˘·ÛÌÔ‡

·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ.

∆· ·ÔÙÂÏ¤ÛÌ·Ù· ¤‰ÂÈÍ·Ó fiÙÈ Ë ·ÚÔ˘Û›· ÌfiÓÔ

ª∫ ÛÙËÓ Î·ÏÏÈ¤ÚÁÂÈ· Û˘Ì‚¿ÏÏÂÈ ÛÂ Û¯ÂÙÈÎ¿ ÂÚÈÔÚÈ-

ÛÌ¤ÓË ¤ÎÙ˘ÍË ÙˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ/ÚÔÁÔÓÈÎÒÓ Î˘Ù-

Ù¿ÚˆÓ, ·ÏÏ¿ ·ÔÊ¤ÚÂÈ ÏËı˘ÛÌfi Ô˘ ÂÎÊÚ¿˙ÂÈ ÛÂ

ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ÙÔ ·ÓÙÈÁfiÓÔ ÂÈÊ·ÓÂ›·˜ CD34.

∆· ·ÔÙÂÏ¤ÛÌ·Ù· ·˘Ù¿ Û˘ÁÎÏ›ÓÔ˘Ó ÌÂ ·˘Ù¿ Ô˘

·Ó·Ê¤ÚÔÓÙ·È ·fi ÙÔ˘˜ Jang et al. (23), ÔÈ ÔÔ›ÔÈ fiÌˆ˜

¯ÚËÛÈÌÔÔ›ËÛ·Ó ª∫ ·fi ·›Ì· √§. ∞Í›˙ÂÈ Ó· ÛËÌÂÈ-

ˆıÂ› fiÙÈ Ë ÂÈÙ˘¯‹˜ ·ÔÌfiÓˆÛË ª∫ ·fi ·›Ì· √§

·Ú·Ì¤ÓÂÈ ‰‡ÛÎÔÏË ÛÙËÓ ÂÊ·ÚÌÔÁ‹ ÙË˜ Î·È ·ÎfiÌË

·ÌÊÈÏÂÁfiÌÂÓË ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· (24-26). ™ÙËÓ ›‰È·

ÌÂÏ¤ÙË ¤ÁÈÓÂ Â›ÛË˜ Û‡ÁÎÚÈÛË ÙË˜ ¤ÎÙ˘ÍË˜ CD34+

ÌÂ Ù· ·ÔÙÂÏ¤ÛÌ·Ù· Ô˘ ÚÔ¤Î˘„·Ó ·fi ÙËÓ ¤Î-

Ù˘ÍË CD34+ ÛÂ Û˘Óı‹ÎÂ˜ Î·ÏÏÈ¤ÚÁÂÈ·˜ ÌÂ ª∫ Ì˘Â-

ÏÔ‡ ÙˆÓ ÔÛÙÒÓ ·fi ˘ÁÈÂ›˜ ÂÓ‹ÏÈÎÂ˜. ∞fi Ù· ·ÔÙÂ-

Ï¤ÛÌ·Ù· Ê·›ÓÂÙ·È fiÙÈ Ù· ÙÂÏÂ˘Ù·›· ˘ÛÙÂÚÔ‡Ó ÛÙËÓ

·fi‰ÔÛË CD34+ ÏËı˘ÛÌÔ‡, ÛÂ Û‡ÁÎÚÈÛË ÌÂ ·˘Ù¿

ÙÔ˘ √§ Î·È Û˘ÁÎÚÈÙÈÎ¿ ÌÂ Ù· ª∫ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ

·È‰ÈÒÓ Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÛÙËÓ ·ÚÔ‡Û· ÌÂ-

Ï¤ÙË. √È Yamaguchi et al. (10) Â›ÛË˜ ·Ó·Ê¤ÚÔ˘Ó

·Ó¿ÏÔÁË ¤ÎÙ˘ÍË CD34+ ÌÂ ÙË ¯Ú‹ÛË ÌfiÓÔ Î˘ÙÙ¿-

ÚˆÓ ÛÙÚÒÌ·ÙÔ˜ ·fi ª√ ÂÓ‹ÏÈÎˆÓ ‰ÔÙÒÓ ‹ ÂÓ‹ÏÈ-

ÎˆÓ ·ÛıÂÓÒÓ ÌÂ ·ÈÌ·ÙÔÏÔÁÈÎ¿ ÓÔÛ‹Ì·Ù·, ¯ˆÚ›˜ Ó·

ÚÔÛ‰ÈÔÚ›˙ÂÙ·È ÙÔ Â›‰Ô˜ ÙÔ˘ ·ÈÌ·ÙÔÏÔÁÈÎÔ‡ ÓÔÛ‹Ì·-

ÙÔ˜. ∆· Î‡ÙÙ·Ú· ÛÙÚÒÌ·ÙÔ˜ ·fi ª√, ÂÓ ÙÔ‡ÙÔÈ˜, ‰ÂÓ

·ÚÔ˘ÛÈ¿˙Ô˘Ó ÙËÓ ÔÌÔÈÔÁ¤ÓÂÈ· ÙÔ˘ ÏËı˘ÛÌÔ‡ ÙˆÓ

ª∫ Î·È Èı·Ó¿ ÚÔÛı¤ÙÔ˘Ó Î·È ¿ÏÏÂ˜ ·Ú·Ì¤ÙÚÔ˘˜,

ÂÚÈÔÚ›˙ÔÓÙ·˜ ÙË ‰˘Ó·ÙfiÙËÙ· Û‡ÁÎÚÈÛË˜ ÙˆÓ ·ÔÙÂ-

ÏÂÛÌ¿ÙˆÓ. ∂ÈÏ¤ÔÓ, ÛÙË ÌÂÏ¤ÙË ·˘Ù‹ ‰ÂÓ ·Ó·Ê¤ÚÂ-

Ù·È ·Ó ˘‹ÚÍ·Ó ‰È·ÊÔÚ¤˜ ÌÂÙ·Í‡ ˘ÁÈÒÓ Î·È ·ÛıÂÓÒÓ

ÛÙËÓ ¤ÎÙ˘ÍË ÙÔ˘ ˘ÔÏËı˘ÛÌÔ‡ ÙˆÓ ÚÔÁÔÓÈÎÒÓ

·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ (10).

114 π. ¶ÂÏ·ÁÈ¿‰Ë˜ Î·È Û˘Ó.


180

150

120

90

60

30

0A B ° ¢ ∂

™˘Óı‹ÎË

∞Ú

ÈıÌ

fi˜

·

ÔÈÎ

ÈÒÓ/

5x1

03 Î

‡ÙÙ

·Ú

·

CFU-GM

BFU-E

∂ÈÎfiÓ· 4. ∞Ó¿Ù˘ÍË ·ÔÈÎÈÒÓ CFU-GM Î·È BFU-E ÛÙÈ˜ ‰È·ÊÔÚÂÙÈÎ¤˜ Û˘Óı‹ÎÂ˜ Û˘ÁÎ·ÏÏÈ¤ÚÁÂÈ·˜.


°È· Ó· ÂÏÂÁ¯ıÔ‡Ó ·ÊÂÓfi˜ Ë ÈÎ·ÓfiÙËÙ· ÙˆÓ ª∫ Ó·

ÂÓÈÛ¯‡ÛÔ˘Ó ÙËÓ ¤ÎÙ˘ÍË ÙˆÓ ·Ú¯¤ÁÔÓˆÓ ·ÈÌÔÔÈËÙÈ-

ÎÒÓ Î˘ÙÙ¿ÚˆÓ Î·È ·ÊÂÙ¤ÚÔ˘ Ù· ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙˆÓ

ÏËı˘ÛÌÒÓ Ô˘ ÚÔ‹Ïı·Ó ·fi ÙËÓ Î·ÏÏÈ¤ÚÁÂÈ· ¤Î-

Ù˘ÍË˜, ¤ÁÈÓ·Ó Î·ÏÏÈ¤ÚÁÂÈÂ˜ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË CFU-

GM Î·È BFU-E ·ÔÈÎÈÒÓ. ¶·Ú·ÙËÚ‹ıËÎÂ ÌÂÁ·Ï‡ÙÂ-

ÚÔ˜ ·ÚÈıÌfi˜ Î·È ÙˆÓ ‰‡Ô Ù‡ˆÓ ·ÔÈÎÈÒÓ ÛÙÈ˜ Û˘Ó-

ı‹ÎÂ˜ fiÔ˘ ˘‹Ú¯·Ó ÌfiÓÔ ª∫. ™ÙË ‚È‚ÏÈÔÁÚ·Ê›·

·Ó·Ê¤ÚÂÙ·È (23) ÌË ·Ó¿Ù˘ÍË CFU-GM ÌÂÙ¿ ÙËÓ 7Ë

ËÌ¤Ú· Î·ÏÏÈ¤ÚÁÂÈ·˜, Ô˘ Èı·ÓÔÏÔÁÂ›Ù·È fiÙÈ ÔÊÂ›ÏÂ-

Ù·È ÛÙÔ fiÙÈ Ù· Î‡ÙÙ·Ú· fi ÙÈ˜ Û˘ÁÎÂÎÚÈÌ¤ÓÂ˜ Û˘Óı‹-

ÎÂ˜ ˆı‹ıËÎ·Ó ÛÂ ‰È·ÊÔÚÔÔ›ËÛË ·ÊÔ‡ Â‹ÏıÂ Î·-

Ù·Ó¿ÏˆÛË ‹ ·Ú·›ˆÛË ÙˆÓ ·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ

Ô˘ ÚÔ¿ÁÔ˘Ó ÙËÓ ·˘ÙÔ·Ó·Ó¤ˆÛË. ∞ÓÙ›ÛÙÔÈ¯Ë ÌË

·Ó¿Ù˘ÍË ·ÔÈÎÈÒÓ ·Ú·ÙËÚ‹ıËÎÂ Â›ÛË˜ Î·È ·-

ÚÔ˘Û›· ÌfiÓÔ Î˘ÙÙ¿ÚˆÓ ÛÙÚÒÌ·ÙÔ˜ ÌÂÙ¿ ÙËÓ 7Ë ËÌ¤-

Ú· Î·ÏÏÈ¤ÚÁÂÈ·˜ (23). ∞Í›˙ÂÈ Ó· ÙÔÓÈÛÙÂ› fiÙÈ ÔÈ Û˘Óı‹-

ÎÂ˜ Î·ÏÏÈ¤ÚÁÂÈ·˜ ‰ÂÓ Â›Ó·È Ù·˘ÙfiÛËÌÂ˜ ÛÙÈ˜ Û˘ÁÎÚÈ-

ÓfiÌÂÓÂ˜ ÌÂÏ¤ÙÂ˜, Î·ıÒ˜, ¤Ú·Ó ÙË˜ ÌÂÁ·Ï‡ÙÂÚË˜

‰È¿ÚÎÂÈ·˜ ÙË˜ Î·ÏÏÈ¤ÚÁÂÈ·˜, ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÔÈÔ-

ÙÈÎ¿ Î·È ÔÛÔÙÈÎ¿ ‰È·ÊÔÚÂÙÈÎÔ› Û˘Ó‰˘·ÛÌÔ› ·˘ÍËÙÈ-

ÎÒÓ ·Ú·ÁfiÓÙˆÓ, Î·ıÒ˜ Î·È ª∫ Î˘Ú›ˆ˜ √§, ·ÏÏ¿

Î·È ÂÓËÏ›ÎˆÓ. ∞fi Ù· ‰Â‰ÔÌ¤Ó· ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤-

ÙË˜ Ê·›ÓÂÙ·È, ÏÔÈfiÓ, fiÙÈ Ë ¯Ú‹ÛË ª∫ ÛÙËÓ ¤ÎÙ˘ÍË

·¤‰ˆÛÂ ÙÔÓ ÌÂÁ·Ï‡ÙÂÚÔ ·ÚÈıÌfi ·ÔÈÎÈÒÓ ÙfiÛÔ ÙË˜

ÎÔÎÎÈÒ‰Ô˘˜ fiÛÔ Î·È ÙË˜ ÂÚ˘ıÚ¿˜ ÛÂÈÚ¿˜ ·fi ÔÔÈ·-

‰‹ÔÙÂ ¿ÏÏË Û˘Óı‹ÎË Î·ÏÏÈ¤ÚÁÂÈ·˜ Ô˘ ‰ÔÎÈÌ¿ÛÙË-

ÎÂ, ÂÓ‰ÂÈÎÙÈÎfi Èı·Ó‹˜ «ÔÈÔÙÈÎ‹˜» ‰È·ÊÔÚ¿˜ ÙˆÓ

ª∫ ·È‰ÈÒÓ, ·ÊÔ‡ Ë ·ÚÔ˘Û›· ÙÔ˘˜ ÚÔ¿ÁÂÈ ÙËÓ ¤Î-

Ù˘ÍË ÏËı˘ÛÌÔ‡ ÌÂ ·˘ÍËÌ¤ÓË ÎÏˆÓÔÁÔÓÈÎfiÙËÙ·.

∏ ·ÓÔÛÔÊ·ÈÓÔÙ˘ÈÎ‹ ·Ó¿Ï˘ÛË ¤‰ÂÈÍÂ fiÙÈ Ù·

CD34+CD38- Î·È CD34+CD33-, Ô˘ ·ÔÙÂÏÔ‡Ó ˘Ô-

ÏËı˘ÛÌÔ‡˜ ÚÔÁÔÓÈÎÒÓ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ,

·ÚÔ˘Û›·Û·Ó ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ¤ÎÊÚ·ÛË˜ Â›-

ÛË˜ ÛÙËÓ Î·ÏÏÈ¤ÚÁÂÈ· fiÔ˘ Ù· CD34+ ·ÈÌÔÔÈËÙÈÎ¿

Û˘Ó˘‹Ú¯·Ó ÌÂ ª∫ ÌfiÓÔ. √È Chute et al. (27) ¤‰ÂÈ-

Í·Ó ÂÈ‰ÈÎfiÙÂÚ· fiÙÈ Ù· CD34+CD38- ÌÔÚÔ‡Ó, Â·Áfi-

ÌÂÓ· ÛÂ Î˘ÙÙ·ÚÈÎfi Î‡ÎÏÔ, Ó· ÂÎÙ˘¯ıÔ‡Ó in vitro. T·

Î‡ÙÙ·Ú· Ô˘ ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙËÓ ¤ÎÙ˘ÍË ‰È·ÙË-

ÚÔ‡Ó ÙËÓ ¤ÎÊÚ·ÛË ÌÔÚ›ˆÓ ÚÔÛÎfiÏÏËÛË˜, Ù· ÔÔ›·

Èı·ÓÒ˜ ¤¯Ô˘Ó ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ÂÁÎ·Ù¿ÛÙ·ÛË

ÙˆÓ ·Ú¯¤ÁÔÓˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ ÙÔ˘ ÌÔ-

Û¯Â‡Ì·ÙÔ˜ Î·È ÛÙËÓ ·ÔÎ·Ù¿ÛÙ·ÛË ÙË˜ ·ÈÌÔÔ›Ë-

ÛË˜. ∏ È‰ÈfiÙËÙ· ·˘Ù‹ ÙˆÓ ª∫ ÌÔÚÂ› Ó· ·ÍÈÔÔÈË-

ıÂ› ÎÏÈÓÈÎ¿ ÛÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË.

∞Ó Î·È Ô ÌË¯·ÓÈÛÌfi˜ ·ÏÏËÏÂ›‰Ú·ÛË˜ ÙˆÓ ª∫

ÌÂ Ù· ÚÔÁÔÓÈÎ¿ ·ÈÌÔÔÈËÙÈÎ¿ Î‡ÙÙ·Ú· ‰ÂÓ ¤¯ÂÈ ‰È-

Â˘ÎÚÈÓÈÛÙÂ› (18), Â›Ó·È ÁÓˆÛÙfi fiÙÈ Ù· Î‡ÙÙ·Ú·

ÛÙÚÒÌ·ÙÔ˜ ·Ú¿ÁÔ˘Ó ¤Ó· Û‡ÓÔÏÔ Î˘ÙÙ·ÚÔÎÈÓÒÓ,

ÌÂÙ·Í‡ ÙˆÓ ÔÔ›ˆÓ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÔÈ SCF, IL-1,

IL-3, IL-6, IL-7, IL-11, IL-12, TPO, Flt-3L, G-CSF,

GM-CSF Î·È LIF (28,29). ∞fi Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÙË˜

·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ Ê·›ÓÂÙ·È fiÙÈ ÔÈ ‰‡Ô ‰È·ÊÔÚÂÙÈ-

ÎÔ› Û˘Ó‰˘·ÛÌÔ› ·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ Ô˘ ¯ÚË-

ÛÈÌÔÔÈ‹ıËÎ·Ó ‰ÂÓ ÚÔÎ·ÏÔ‡Ó ÙÔ ›‰ÈÔ ·ÔÙ¤ÏÂÛÌ·

ÌÂ ÙÔ˘˜ ·˘ÍËÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜ Ô˘ ÂÎÎÚ›ÓÔÓÙ·È

·fi Ù· ª∫ ÛÙËÓ Î·ÏÏÈ¤ÚÁÂÈ·. ™˘ÁÎÂÎÚÈÌ¤Ó·, ·-

ÚÔ˘Û›· ·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ, ·Ú·ÙËÚ‹ıËÎÂ

·Ó¿Ù˘ÍË-‰È·ÊÔÚÔÔ›ËÛË ÛÂ Ï¤ÔÓ ÒÚÈÌ· ÛÙÔÈ-

¯Â›· ÙË˜ Î·ÏÏÈ¤ÚÁÂÈ·˜ (ÔÏÈÎfi˜ ·ÚÈıÌfi˜ Î˘ÙÙ¿ÚˆÓ,

CD34+ ÌÂ ÌÈÎÚfiÙÂÚË ÎÏˆÓÔÁÔÓÈÎfiÙËÙ· Î.Ï.), ·ÓÂ-

Í¿ÚÙËÙ· ·fi ÙÔ Â¿Ó Ô Û˘Ó‰˘·ÛÌfi˜ Î˘ÙÙ·ÚÔÎÈÓÒÓ

Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ ÂÈ‰Ú¿ Î˘Ú›ˆ˜ ÛÂ ·Ú¯¤ÁÔÓ·

‹ ÈÔ ÒÚÈÌ· ‰ÂÛÌÂ˘Ì¤Ó· ÚÔÁÔÓÈÎ¿ ·ÈÌÔÔÈËÙÈÎ¿

Î‡ÙÙ·Ú· (30).

™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, Ù· ª∫ ÛÙÚÒÌ·ÙÔ˜ Ì˘ÂÏÔ‡ ÙˆÓ

ÔÛÙÒÓ ·È‰ÈÒÓ ÌÂ Î·ÏÔ‹ıË ·ÈÌ·ÙÔÏÔÁÈÎ¿ ÓÔÛ‹Ì·Ù·

ÚÔ¿ÁÔ˘Ó ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂÚ· ÙËÓ ex vivo ¤ÎÙ˘ÍË

·Ú¯¤ÁÔÓˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ ·fi ·›Ì· √§,

ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙËÓ ¤ÎÙ˘ÍË ·ÚÔ˘Û›· ·˘ÍËÙÈÎÒÓ

·Ú·ÁfiÓÙˆÓ, ·Ô‰›‰ÔÓÙ·˜ ¤Ó·Ó ÏËı˘ÛÌfi ÌÂ ¯·Ú·-

ÎÙËÚÈÛÙÈÎ¿ ·ˆÚfiÙËÙ·˜ Î·È È‰ÈfiÙËÙÂ˜ Î·Ù¿ÏÏËÏÂ˜ ÁÈ·

ÙËÓ ·ÔÎ·Ù¿ÛÙ·ÛË ÙË˜ ·ÈÌÔÔ›ËÛË˜ ÌÂÙ¿ ·fi ÌÂ-

Ù·ÌfiÛ¯Â˘ÛË.


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4. Cohen Y, Nagler A. Umbilical cord blood transplantation:

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5. Cohen Y, Kreiser D, Mayorov M, Nagler A. Unrelated and

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6. Gammaitoni L, Bruno S, Sanavio F, Gunetti M, Kollet O,

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8. Piacibello W, Sanavio F, Garetto L, Severino A, Dané A,

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26. Mareschi K, Biasin E, Piacibello W, Aglietta M, Madon E,Fagioli F. Isolation of human mesenchymal stem cells:bone marrow versus umbilical cord blood. Haematologica2001;86:1099-1100.

27. Chute JP, Saini AA, Kampen RL, Wells MR, Davis TA. Acomparative study of the cell cycle status and primitive celladhesion molecule profile of human CD34+ cells culturedin stromal-free versus porcine microvascular endothelialcell cultures. Exp Hematol 1999;27:370-379.

28. Haynesworth SE, Baber MA, Caplan AI. Cytokineexpression by human marrow-derived mesenchymalprogenitor cells in vitro: effects of dexamethasone and IL-1alpha. J Cell Physiol 1996;166:585-592.

29. Dormady SP, Bashayan O, Dougherty R, Zhang XM, BaschRS. Immortalized multipotential mesenchymal cells andthe hematopoietic microenvironment. J Hematother StemCell Res 2001;10:125-140.

30. Ueda T, Tsuji K, Yoshino H, Ebihara Y, Yagasaki H,Hisakawa H, et al. Expansion of human NOD/SCID-repopulating cells by stem cell factor, Flk2/Flt3 ligand,thrombopoietin, IL-6, and soluble IL-6 receptor. J ClinInvest 2000;105:1013-1021.

116 π. ¶ÂÏ·ÁÈ¿‰Ë˜ Î·È Û˘Ó.



¶·ÓÂÏÏ‹ÓÈ· ÔÚÔÂÈ‰ËÌÈÔÏÔÁÈÎ‹ ÌÂÏ¤ÙË Ë·Ù›ÙÈ‰·˜ ∞ ÛÂ ·È‰È¿

ËÏÈÎ›·˜ 0-14 ÂÙÒÓ*

µ. ¶··Â˘·ÁÁ¤ÏÔ˘1, ∞. ∫‡ÚÎ·1, ∞. ∆Ú·ÁÈ·ÓÓ›‰Ë˜2, ¢. ∫·Û›ÌÔ˜3, ∫. ¶·ÓÙÂÏ¿ÎË4, ∂. ¶·‡ÏÔ˘2, ª. ∆˙Ô‡ÊË5,

ª. ª·˘ÚÔÎÒÛÙ·6, ∞. ∆˙È‚¿Ú·˜4, •. ¶Â‰¤ÏË7, ∞. Ã·Ù˙ËÌÈ¯·‹Ï3, º. ∞ı·Ó·ÛÈ¿‰Ô˘2, ¢. ∫·ÊÂÙ˙‹˜1,

∞. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜7

¶ÂÚ›ÏË„Ë

∂ÈÛ·ÁˆÁ‹: ∏ Ë·Ù›ÙÈ‰· ∞ ·ÔÙÂÏÂ› ÂÓ‰ËÌÈÎfi ÓfiÛËÌ· ÛÂ ÔÏÏ¤˜ ÂÚÈÔ¯¤˜ ÙÔ˘ ÎfiÛÌÔ˘. ∏ ∂ÏÏ¿‰· Î·Ù·-Ù¿ÛÛÂÙ·È ÛÙÈ˜ ¯ÒÚÂ˜ ÂÓ‰È¿ÌÂÛË˜ ÂÓ‰ËÌÈÎfiÙËÙ·˜, ·ÏÏ¿ ‰ÂÓ ˘¿Ú¯Ô˘Ó Â·ÚÎ‹ ÚfiÛÊ·Ù· ÔÚÔÂÈ‰ËÌÈÔ-ÏÔÁÈÎ¿ ‰Â‰ÔÌ¤Ó· ÁÈ· ÙË ÓfiÛÔ. ™ÎÔfi˜ ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ ‹Ù·Ó Ë ·ÍÈÔÏfiÁËÛË ÙË˜ ÔÚÔÂÈ‰ËÌÈÔÏÔÁ›·˜ÙÔ˘ ÈÔ‡ ÙË˜ Ë·Ù›ÙÈ‰·˜ ∞, ·Ó¿ ËÏÈÎ›· Î·È ÁÂˆÁÚ·ÊÈÎfi ‰È·Ì¤ÚÈÛÌ· ÙË˜ ¯ÒÚ·˜, ÛÂ ·ÓÙÈÚÔÛˆÂ˘ÙÈÎfi ‰Â›Á-Ì· ·È‰ÈÒÓ ËÏÈÎ›·˜ 0-14 ÂÙÒÓ.

ÀÏÈÎfi Î·È ª¤ıÔ‰ÔÈ: ™˘ÏÏ¤¯ıËÎ·Ó 100 ‰Â›ÁÌ·Ù· ÔÚÒÓ ·Ó¿ ËÏÈÎÈ·Î‹ ÔÌ¿‰·, ‚¿ÛÂÈ ·ÔÁÚ·ÊÈÎÒÓ ‰Â‰Ô-Ì¤ÓˆÓ, ·fi fiÏ· Ù· ÁÂˆÁÚ·ÊÈÎ¿ ‰È·ÌÂÚ›ÛÌ·Ù· ÙË˜ ¯ÒÚ·˜, Û‡ÌÊˆÓ· ÌÂ ÙÔ Û¯‹Ì· Û˘ÏÏÔÁ‹˜ ÂÓ·ÔÌÂÈ-Ó¿ÓÙˆÓ ÔÚÒÓ Ô˘ ¯ÚËÛÈÌÔÔÈÂ› ÙÔ Â˘Úˆ·˚Îfi ‰›ÎÙ˘Ô ÔÚÔÂÈÙ‹ÚËÛË˜ ÓÔÛËÌ¿ÙˆÓ Ô˘ ÚÔÏ·Ì‚¿ÓÔÓÙ·ÈÌÂ ÂÌ‚ÔÏÈ·ÛÌfi (∂SEN II), ÛÙÔ˘˜ ÔÔ›Ô˘˜ ¤ÁÈÓÂ ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ IgG ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÙÔ˘ ÈÔ‡ ÙË˜Ë·Ù›ÙÈ‰·˜ ∞ (AXSYM, Abbott). ∫·Ù·ÁÚ¿ÊËÎ·Ó Î·È ·Ó·Ï‡ıËÎ·Ó Ù· ÛÙÔÈ¯Â›· 1.393 ·È‰ÈÒÓ.

∞ÔÙÂÏ¤ÛÌ·Ù·: ∆· ·È‰È¿ ÌÂÙ·Ó·ÛÙÒÓ, Î·ıÒ˜ Î·È Ù· ·È‰È¿ Ô˘ ÚÔ¤Ú¯ÔÓÙ·Ó ·fi ·ÁÚÔÙÈÎ¤˜ ÂÚÈÔ¯¤˜, Â›¯·ÓÛÙ·ÙÈÛÙÈÎÒ˜ ÛËÌ·ÓÙÈÎ¿ ¯·ÌËÏfiÙÂÚ· ÔÛÔÛÙ¿ ·ÓÔÛÔÔ›ËÛË˜. ™Ù· ÌË ÂÌ‚ÔÏÈ·ÛÌ¤Ó· ·È‰È¿, Ë ÔÚÔıÂÙÈÎfiÙËÙ··Ó‹ÏıÂ ÛÙÔ 17,07%. ™Ù· ÌË ÂÌ‚ÔÏÈ·ÛÌ¤Ó· ·È‰È¿ ÌÂÙ·Ó·ÛÙÒÓ Î·Ù·ÁÚ¿ÊËÎÂ ˘„ËÏfiÙÂÚÔ ÔÛÔÛÙfi ÔÚÔıÂÙÈ-ÎfiÙËÙ·˜ ÏfiÁˆ Ê˘ÛÈÎ‹˜ ÓfiÛËÛË˜, ÛÂ Û‡ÁÎÚÈÛË ÌÂ Ù· ∂ÏÏËÓfiÔ˘Ï· (22,38% ¤Ó·ÓÙÈ 15,9%, OR=1,52, p=0,064).∂›ÛË˜, Î·Ù·ÁÚ¿ÊËÎ·Ó ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ¤˜ ‰È·ÊÔÚ¤˜ ÌÂÙ·Í‡ ‰È·ÊÔÚÂÙÈÎÒÓ ÁÂˆÁÚ·ÊÈÎÒÓ ÂÚÈÔ¯ÒÓ.

™˘ÌÂÚ¿ÛÌ·Ù·: ∞fi Ù· ÛÙÔÈ¯Â›· ÙË˜ ÌÂÏ¤ÙË˜ Ì·˜ ÚÔÎ‡ÙÂÈ fiÙÈ ÂÈ‚¿ÏÏÂÙ·È Ë ÂÊ·ÚÌÔÁ‹ Î·ıÔÏÈÎÔ‡ ÂÌ-‚ÔÏÈ·ÛÌÔ‡ ¤Ó·ÓÙÈ ÙË˜ Ë·Ù›ÙÈ‰·˜ ∞ ÛÙË ¯ÒÚ· Ì·˜.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ∏·Ù›ÙÈ‰· ∞, ÂÌ‚fiÏÈÔ, ÔÚÔÂÈ‰ËÌÈÔÏÔÁÈÎ‹.

Seroepidemiological study of hepatitis A in Greek children

aged 0-14 years

V. Papaevagelou1, A. Kyrka1, A. Tragiannidis2, D. Kassimos3, K. Pantelaki4, E. Pavlou2, M. Tzoufi5,

M. Mavrokosta6, A. Tzivaras4, X. Pedeli7, A. Hatzimichail3, F. Athanassiadou2, D. Kafetzis1,

A. Konstantopoulos7

Abstract

Background: Hepatitis A is a disease endemic in many areas of the world. Greece is considered a countryof intermediate endemicity, but recent data are lacking. A national cross-sectional seroprevalence surveywas conducted to evaluate the current seroepidemiology of hepatitis A in children in the age group 0-14years living in Greece.

Methods: Using the ESSEN II methodology, 100 sera per year of age, stratified by geographic region, werecollected and tested for the presence of anti-HAV IgG antibodies (AXSYM, Abbott Laboratories). Data from1,393 children were analyzed.

Results: Immigrant children and children residing in rural areas were significantly less likely to beimmunized. Among unvaccinated children, the seroprevalence was 17.07%. Nationality had a marginallysignificant effect, since nonimmunized immigrant children had a higher seroprevalence rate (22.38%versus 15.9%, OR=1.52, p=0.064). Significant differences were observed between geographic areas inboth vaccination coverage and natural immunity.

Conclusions: These data indicate that hepatitis A continues to prevail in Greece and therefore universalinfant immunization should be considered.

Key words: Hepatitis A, vaccine, seroepidemiology.


1 µ’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ,°ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ «¶. & ∞. ∫˘ÚÈ·ÎÔ‡», ∞ı‹Ó·

2 µ’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹∞.¶.£, ¡ÔÛÔÎÔÌÂ›Ô∞Ã∂¶∞, £ÂÛÛ·ÏÔÓ›ÎË

3 ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹¢.¶.£, ∞ÏÂÍ·Ó‰ÚÔ‡ÔÏË

4 ∂ÚÁ·ÛÙ‹ÚÈÔ ∞ÈÌÔ‰ÔÛ›·˜,°.¡. ¶·›‰ˆÓ «∞. ™ÔÊ›·»,∞ı‹Ó·

5 ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ

6 ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹,«µÂÓÈ˙¤ÏÂÈÔ» ¡ÔÛÔÎÔÌÂ›Ô∏Ú·ÎÏÂ›Ô˘

7 ™¯ÔÏ‹ ÀÁÈÂÈÓ‹˜ Î·È∂È‰ËÌÈÔÏÔÁ›·˜ ∂∫¶∞


µ·ÛÈÏÈÎ‹ ¶··Â˘·ÁÁ¤ÏÔ˘[email protected], [email protected] µ’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ,°ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ«¶. & ∞. ∫˘ÚÈ·ÎÔ‡», ∞ı‹Ó·

1 2nd Department ofPaediatrics, GeneralChildren’s Hospital “P. & A. Kyriakou”,University of Athens, Athens, Greece

2 2nd Department ofPaediatrics, “AHEPA”Hospital, “Aristotelio”University of Thessaloniki,Thessaloniki, Greece

3 Department of Paediatrics,“Dimokritio” University ofThrace, Alexandroupolis,Greece

4 Laboratory for BloodDonation, “Agia Sophia”General Children’s Hospital,Athens, Greece

5 Department of Paediatrics,University of Ioannina,Ioannina, Greece

6 Department of Paediatrics,“Venizelio” Hospital ofHeraklion, Heraklion, Greece

7 School of Hygiene andEpidemiology, EKPA

Correspondence:

Vassiliki Papaevagelou [email protected],[email protected] 2nd Department ofPaediatrics, General Children’sHospital “P. & A. Kyriakou”,University of Athens, Athens,Greece

¶·È‰È·ÙÚÈÎ‹ 2009;72:117-000

* ∏ ÂÚÁ·Û›· ·˘Ù‹ ‚Ú·‚Â‡ıËÎÂ ÌÂ ÙÔ Œ·ıÏÔ ¢ÔÍÈ¿‰Ë, Î·Ù¿ ÙÔ 46Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ, ∫¤ÚÎ˘Ú· 2008


∂ÈÛ·ÁˆÁ‹

∏ Ë·Ù›ÙÈ‰· ∞ ·ÔÙÂÏÂ› Û˘¯Ófi ÏÔÈÌÒ‰Â˜ ÓfiÛË-

Ì·, ·Ú¿ ÙËÓ Î˘ÎÏÔÊÔÚ›· ·ÔÙÂÏÂÛÌ·ÙÈÎÔ‡ ÂÌ‚ÔÏ›-

Ô˘ (1). ∞Ó Î·È Ù· ÔÛÔÛÙ¿ ÙË˜ Â›ÙˆÛ‹˜ ÙË˜ ¤¯Ô˘Ó

ÌÂÈˆıÂ› ÛËÌ·ÓÙÈÎ¿ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÚÔËÁÔ‡-

ÌÂÓˆÓ ‰ÂÎ·ÂÙÈÒÓ ÛÙÈ˜ ÂÚÈÛÛfiÙÂÚÂ˜ ·Ó·Ù˘ÁÌ¤ÓÂ˜

¯ÒÚÂ˜, ÛËÌ·ÓÙÈÎ‹ ·ÏÏ·Á‹ ÛÙËÓ ÂÈ‰ËÌÈÔÏÔÁ›· ¤¯ÂÈ

·Ú·ÙËÚËıÂ› ÛÙÈ˜ ÂÚÈÔ¯¤˜ fiÔ˘ ÂÊ·ÚÌfiÛÙËÎÂ Î·-

ıÔÏÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ (1-3). ™ÙËÓ ∂ÏÏ¿‰· ˘¿Ú¯Ô˘Ó

ÛÙÔÈ¯Â›· ·fi ÂÈ‰ËÌÈÔÏÔÁÈÎ¤˜ ÌÂÏ¤ÙÂ˜ ÛÂ ÔÚÈÛÌ¤ÓÂ˜

ÂÚÈÔ¯¤˜ ÙË˜ ¯ÒÚ·˜ Ô˘ ·Ô‰ÂÈÎÓ‡Ô˘Ó fiÙÈ Ù· ÔÛÔ-

ÛÙ¿ Â›ÙˆÛË˜ ÙË˜ ÓfiÛÔ˘ ¤¯Ô˘Ó ÌÂÈˆıÂ› ÛËÌ·ÓÙÈÎ¿

Î·È Ë Ì¤ÛË ËÏÈÎ›· ÙˆÓ ·ÛıÂÓÒÓ ÌÂ Ë·Ù›ÙÈ‰· ∞ ¤¯ÂÈ

·˘ÍËıÂ›, fiˆ˜ ÂÚÈÁÚ¿ÊÂÙ·È Î·È ÛÂ ¿ÏÏÂ˜ Â˘Úˆ·˚-

Î¤˜ ¯ÒÚÂ˜ (4-9). ∂ÓÙÔ‡ÙÔÈ˜, ÂıÓÈÎ¿ ÔÚÔÂÈ‰ËÌÈÔÏÔ-

ÁÈÎ¿ ÛÙÔÈ¯Â›· ‰ÂÓ Â›Ó·È ‰È·ı¤ÛÈÌ· Ì¤¯ÚÈ Û‹ÌÂÚ·, ·Ó

Î·È Ë ÔÍÂ›· Ë·Ù›ÙÈ‰· ∞ ÂÚÈÏ·Ì‚¿ÓÂÙ·È ÛÙÈ˜ ·Ûı¤-

ÓÂÈÂ˜ Ô˘ Ú¤ÂÈ Ó· ‰ËÏÒÓÔÓÙ·È ˘Ô¯ÚÂˆÙÈÎ¿ ÛÙÔ

∂ÏÏËÓÈÎfi ∫¤ÓÙÚÔ ∂Ï¤Á¯Ô˘ Î·È ¶ÚfiÏË„Ë˜ ¡ÔÛËÌ¿-

ÙˆÓ (∫∂.∂§.¶.¡√).

°È· ÙËÓ ÂÈÛ·ÁˆÁ‹ ÂÓfi˜ ÂÌ‚ÔÏ›Ô˘ ÛÙÔ˘˜ ··Ú·›-

ÙËÙÔ˘˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡˜ ÎÚ›ÓÂÙ·È ÛÎfiÈÌË Ë Û˘ÏÏÔÁ‹

‰Â‰ÔÌ¤ÓˆÓ ÁÈ· ÙÔÓ ÂÈÔÏ·ÛÌfi ÙË˜ ÓfiÛÔ˘ ÛÂ ÌÈ·

ÏËı˘ÛÌÈ·Î‹ ÔÌ¿‰·, Î·ıÒ˜ Î·È Ë Î·Ù·ÁÚ·Ê‹ ÙˆÓ

ÂÈÏÔÎÒÓ ÙË˜. ¢˘ÛÙ˘¯Ò˜, Ù· ‰Â‰ÔÌ¤Ó· ·fi ÙÔÓ ÂÏ-

ÏËÓÈÎfi ¯ÒÚÔ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÛÙÔÈ¯Â›· ÛÂ ÙÔÈÎfi Î˘-

Ú›ˆ˜ Â›Â‰Ô Î·È ÂÓ‰Â¯ÔÌ¤Óˆ˜ ı· ÌÔÚÔ‡ÛÂ Ó· Á›-

ÓÂÈ ÂÎÙ›ÌËÛË ÙË˜ ÓfiÛÔ˘ ÌfiÓÔ ÌÂ ·Ó·‰ÚÔÌÈÎ‹ Û˘ÏÏÔ-

Á‹, ‚¿ÛÂÈ ÛÙÔÈ¯Â›ˆÓ ÙˆÓ ÂÈÛ·ÁˆÁÒÓ ÛÂ ·È‰È·ÙÚÈÎ¤˜

ÎÏÈÓÈÎ¤˜.

™ÎÔfi˜, ÂÔÌ¤Óˆ˜, ÙË˜ ·ÚÔ‡Û·˜ ÔÚÔÂÈ‰ËÌÈÔ-

ÏÔÁÈÎ‹˜ ÌÂÏ¤ÙË˜ ‹Ù·Ó Ë ·ÔÙ‡ˆÛË ÙË˜ ·ÓÔÛ›·˜

¤Ó·ÓÙÈ ÙË˜ Ë·Ù›ÙÈ‰·˜ ∞, ·Ó¿ ËÏÈÎ›· Î·È ÁÂˆÁÚ·ÊÈÎfi

‰È·Ì¤ÚÈÛÌ· ÙË˜ ¯ÒÚ·˜, ÛÂ ·ÓÙÈÚÔÛˆÂ˘ÙÈÎfi ‰Â›Á-

Ì· ·È‰ÈÒÓ 0-14 ÂÙÒÓ ·fi fiÏË ÙËÓ ∂ÏÏ¿‰·. ∆· ·Ô-

ÙÂÏ¤ÛÌ·Ù· Ù¤ÙÔÈ·˜ ÌÂÏ¤ÙË˜ ı· ·Ú¿Û¯Ô˘Ó ÂÓ‰Â¯Ô-

Ì¤Óˆ˜ ¯Ú‹ÛÈÌ· ÛÙÔÈ¯Â›· ÛÙËÓ ∂ıÓÈÎ‹ ∂ÈÙÚÔ‹

∂Ì‚ÔÏÈ·ÛÌÒÓ.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ

∞ÛıÂÓÂ›˜

√Úfi˜ ·›Ì·ÙÔ˜ ·ÓÙÈÚÔÛˆÂ˘ÙÈÎÔ‡ ‰Â›ÁÌ·ÙÔ˜ ·È‰ÈÒÓ 0-

14 ÂÙÒÓ ·fi fiÏË ÙËÓ ∂ÏÏ¿‰· ÂÍÂÙ¿ÛÙËÎÂ ÁÈ· ÙËÓ ·Ó›¯ÓÂ˘ÛË

·ÓÙÈ-HAV ·ÓÙÈÛˆÌ¿ÙˆÓ. ™˘ÓÔÏÈÎ¿, ¤ÁÈÓÂ Û˘ÏÏÔÁ‹ 100 ÔÚÒÓ

ÁÈ· Î¿ıÂ ËÏÈÎÈ·Î‹ ÔÌ¿‰· ÛÂ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÂÓfi˜ ¤ÙÔ˘˜,

Û‡ÌÊˆÓ· ÌÂ ÙÔ Û‡ÛÙËÌ· ÙË˜ Û˘ÏÏÔÁ‹˜ ÂÓ·ÔÌÂÈÓ¿ÓÙˆÓ ÔÚÒÓ

Ô˘ ¯ÚËÛÈÌÔÔÈÂ› ÙÔ Â˘Úˆ·˚Îfi ‰›ÎÙ˘Ô ÔÚÔÂÈÙ‹ÚËÛË˜ ÙˆÓ

ÓÔÛËÌ¿ÙˆÓ Ô˘ ÚÔÏ·Ì‚¿ÓÔÓÙ·È ÌÂ ÂÌ‚fiÏÈ· (∂SEN II), ÌÂ

ÛÎÔfi Ó· ¤¯Ô˘ÌÂ Û˘ÁÎÚ›ÛÈÌ· ·ÔÙÂÏ¤ÛÌ·Ù· ÌÂ ·ÓÙ›ÛÙÔÈ¯Â˜

Â˘Úˆ·˚Î¤˜ ÌÂÏ¤ÙÂ˜. ∆Ô ÔÛÔÛÙfi ÙˆÓ ·È‰ÈÒÓ ·fi Î¿ıÂ ÁÂˆ-

ÁÚ·ÊÈÎ‹ ÂÚÈÔ¯‹ ˘ÔÏÔÁ›ÛÙËÎÂ ÌÂ ‚¿ÛË ÙËÓ ÂıÓÈÎ‹ ·ÔÁÚ·-

Ê‹ ÙÔ˘ 2001. ∂ÈÏ¤ÔÓ, ·fi ÙË ÌÂÏ¤ÙË ·ÔÎÏÂ›ÛÙËÎ·Ó Ù·

·È‰È¿ ÌÂ ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù·, ÚˆÙÔ·ıÂ›˜, ‰Â˘ÙÂÚÔ·ıÂ›˜

·ÓÔÛÔ·ÓÂ¿ÚÎÂÈÂ˜, Î·ıÒ˜ Î·È ÂÎÂ›Ó· ÌÂ ÚfiÛÊ·ÙË Ï‹„Ë ÎÔÈ-

Ó‹˜ Á-ÛÊ·ÈÚ›ÓË˜. ∆· ‰Â›ÁÌ·Ù· ÙˆÓ ÔÚÒÓ ÛÙ¿ÏıËÎ·Ó Ù·¯˘‰ÚÔ-

ÌÈÎ¿ ÛÙÔ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ «∞Á›· ™ÔÊ›·». ∆ËÚ‹ıËÎÂ ÙÔ

·fiÚÚËÙÔ ÙˆÓ ÚÔÛˆÈÎÒÓ ‰Â‰ÔÌ¤ÓˆÓ ÙˆÓ ·ÛıÂÓÒÓ Ô˘

Û˘ÌÌÂÙÂ›¯·Ó ÛÙË ÌÂÏ¤ÙË. ∆· ‰Â›ÁÌ·Ù· ‰È·ÙËÚ‹ıËÎ·Ó ÛÂ ıÂÚ-

ÌÔÎÚ·Û›· -20ÔC Ì¤¯ÚÈ ÙËÓ ÂÍ¤Ù·Û‹ ÙÔ˘˜. ∆· ‰Â‰ÔÌ¤Ó· ÙˆÓ

·ÛıÂÓÒÓ ÂÈÛ‹¯ıËÛ·Ó ÛÂ ÂÈ‰ÈÎ¿ ‰È·ÌÔÚÊˆÌ¤ÓË ‚¿ÛË ‰Â‰ÔÌ¤-

ÓˆÓ ÌÂ Îˆ‰ÈÎfi ·ÚÈıÌfi, ÒÛÙÂ Ó· ÂÍ·ÛÊ·ÏÈÛÙÂ› ·ÊÂÓfi˜ Ë ·Óˆ-

Ó˘Ì›· Î·È ·ÊÂÙ¤ÚÔ˘ Ë Ï‹ÚË˜ ÚÔÛÙ·Û›· ÙˆÓ ÚÔÛˆÈÎÒÓ

‰Â‰ÔÌ¤ÓˆÓ Î¿ıÂ ·ÛıÂÓÔ‡˜. °È· Î¿ıÂ ·È‰› ¤ÁÈÓÂ Î·Ù·ÁÚ·Ê‹

ÙË˜ ËÏÈÎ›·˜, ÙÔ˘ Ê‡ÏÔ˘, ÙÔ˘ ÙfiÔ˘ ‰È·ÌÔÓ‹˜, ÙË˜ ˘ËÎÔfiÙË-

Ù·˜ Î·È ÙË˜ ÂÌ‚ÔÏÈ·ÛÙÈÎ‹˜ ÙÔ˘ Î¿Ï˘„Ë˜. ∆· ‰Â›ÁÌ·Ù· ÔÚÒÓ

ÂÍÂÙ¿ÛÙËÎ·Ó ÁÈ· ÙËÓ ·ÚÔ˘Û›· ·ÓÙÈÛˆÌ¿ÙˆÓ ·ÓÙÈ-HAV IgG

ÌÂ ¯Ú‹ÛË ÙÔ˘ ÙÂÛÙ HAVAB 2.0 (AXSYM, Abbott).

ŸÛÔÓ ·ÊÔÚ¿ ÛÙ· ‚Ú¤ÊË ËÏÈÎ›·˜ <12 ÌËÓÒÓ, Ë ·ÓÂ‡ÚÂÛË

ıÂÙÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ·Ô‰fiıËÎÂ ÛÂ ·ıËÙÈÎ‹ ·ÓÔÛ›· ÏfiÁˆ

ÌËÙÚÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ.

™Ù·ÙÈÛÙÈÎ‹ ·Ó¿Ï˘ÛË

∏ ÛÙ·ÙÈÛÙÈÎ‹ ·Ó¿Ï˘ÛË ¤ÁÈÓÂ ÌÂ ÙË ¯Ú‹ÛË ÙÔ˘ ÏÔÁÈÛÌÈÎÔ‡

·Î¤ÙÔ˘ Stata (version 8) Î·È ˆ˜ fiÚÈÔ ÛÙ·ÙÈÛÙÈÎ‹˜ ÛËÌ·ÓÙÈ-

ÎfiÙËÙ·˜ ıÂˆÚ‹ıËÎÂ Ë ÙÈÌ‹ p<0,05. ªÂ ¯Ú‹ÛË ÌÔÓÔÌÂÙ·‚ÏË-

Ù‹˜ ÏÔÁÈÛÙÈÎ‹˜ ·ÏÈÓ‰ÚfiÌËÛË˜, ÂÏ¤ÁÍ·ÌÂ ÙËÓ Â›‰Ú·ÛË ÙË˜

ËÏÈÎ›·˜, ÙË˜ ÂıÓÈÎfiÙËÙ·˜ Î·È ÙÔ˘ ÙfiÔ˘ ‰È·ÌÔÓ‹˜ ÙˆÓ ·ÛıÂ-

ÓÒÓ ÛÙËÓ Â›ÙˆÛË ÙË˜ ÂÌ‚ÔÏÈ·ÛÙÈÎ‹˜ ÙÔ˘˜ Î¿Ï˘„Ë˜, ·ÏÏ¿

Î·È ÙË˜ Ê˘ÛÈÎ‹˜ ·ÓÔÛ›·˜ ÛÂ ÌË ÂÌ‚ÔÏÈ·ÛÌ¤Ó· ·È‰È¿. ∆·

·ÔÙÂÏ¤ÛÌ·Ù· ÂÎÊÚ¿ÛÙËÎ·Ó ÌÂ Odds Ratio (OR) Î·È 95%

‰È¿ÛÙËÌ· ·ÍÈÔÈÛÙ›·˜. ∏ ÛÙ·ÙÈÛÙÈÎ‹ ÛËÌ·ÓÙÈÎfiÙËÙ· (p-

value) ˘ÔÏÔÁ›ÛÙËÎÂ ÌÂ ÙÔ Wald test.


∏ Û˘ÏÏÔÁ‹ ÙˆÓ ‰ÂÈÁÌ¿ÙˆÓ ÙË˜ ÌÂÏ¤ÙË˜ ¤ÁÈÓÂ ÌÂ-Ù·Í‡ ÙÔ˘ π·ÓÔ˘·Ú›Ô˘ 2006 Î·È ÙÔ˘ ¢ÂÎÂÌ‚Ú›Ô˘ 2006,Û‡ÌÊˆÓ· ÌÂ ÙË ÌÂıÔ‰ÔÏÔÁ›· ÙË˜ ÌÂÏ¤ÙË˜, ·fi ÙÈ˜‰È¿ÊÔÚÂ˜ ÂÚÈÔ¯¤˜ ÙË˜ ∂ÏÏ¿‰·˜. ∞fi ÙËÓ ·Ó¿Ï˘ÛËÙˆÓ ‰ËÌÔÁÚ·ÊÈÎÒÓ ÛÙÔÈ¯Â›ˆÓ 1.393 ‰ÂÈÁÌ¿ÙˆÓ ÚÔ-¤Î˘„Â fiÙÈ Ù· ·È‰È¿ ·fi ÔÈÎÔÁ¤ÓÂÈÂ˜ ÌÂÙ·Ó·ÛÙÒÓ·ÓÙÈÚÔÛÒÂ˘·Ó ÙÔ 12,6% (175/1383), ÂÓÒ Û‡ÌÊˆ-Ó· ÌÂ ÚfiÛÊ·Ù· ·ÔÁÚ·ÊÈÎ¿ ‰Â‰ÔÌ¤Ó· (2001), ÔÈÌÂÙ·Ó¿ÛÙÂ˜ ·ÔÙÂÏÔ‡Ó ÂÚ›Ô˘ ÙÔ 10% ÙÔ˘ ÏËı˘-ÛÌÔ‡ ÙË˜ ¯ÒÚ·˜ Ì·˜. ™˘ÓÔÏÈÎ¿ ·Ó·Ï‡ıËÎ·Ó 1.374‰Â›ÁÌ·Ù· ·›Ì·ÙÔ˜, ·ÊÔ‡ ·fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ 1.393‰ÂÈÁÌ¿ÙˆÓ Ù· 19 ‹Ù·Ó ·ÈÌÔÏ˘Ì¤Ó· Î·È ÂÔÌ¤Óˆ˜·ÔÎÏÂ›ÛıËÎ·Ó ·fi ÙË ÌÂÏ¤ÙË.

∞fi Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ ÌÂÏ¤ÙË˜ Ì·˜ ÚÔ¤Î˘-„Â fiÙÈ ÙÔ 38% (438/1152) ÙˆÓ ·È‰ÈÒÓ ËÏÈÎ›·˜ >24ÌËÓÒÓ Â›¯Â ÂÌ‚ÔÏÈ·ÛÙÂ› ¤Ó·ÓÙÈ ÙË˜ Ë·Ù›ÙÈ‰·˜ ∞. ∆ÔÔÛÔÛÙfi ÂÌ‚ÔÏÈ·ÛÙÈÎ‹˜ Î¿Ï˘„Ë˜ (·ÓÔÛ›·˜) ÛÙ··È‰È¿ ÌÂÙ·Ó·ÛÙÒÓ ‹Ù·Ó ÛÙ·ÙÈÛÙÈÎÒ˜ ÛËÌ·ÓÙÈÎ¿ ·-ÌËÏfiÙÂÚÔ (22,3%, 35/157), ÛÂ Û¯¤ÛË ÌÂ ÙÔ ·ÓÙ›ÛÙÔÈ-¯Ô ÙˆÓ EÏÏËÓfiÔ˘ÏˆÓ (40,5%, 403/995) (OR=0,42,95%CI: 0,28-0.63, p<0,001) (∂ÈÎfiÓ· 1). ∂ÈÏ¤ÔÓ, Ù··È‰È¿ Ô˘ ÚÔ¤Ú¯ÔÓÙ·Ó ·fi ·ÁÚÔÙÈÎ¤˜ ÂÚÈÔ¯¤˜ÂÌÊ¿ÓÈ˙·Ó ¯·ÌËÏfiÙÂÚ· ÔÛÔÛÙ¿ ÂÌ‚ÔÏÈ·ÛÙÈÎ‹˜ Î¿-Ï˘„Ë˜ (·ÓÔÛ›·˜), ÛÂ Û‡ÁÎÚÈÛË ÌÂ Ù· ·ÓÙ›ÛÙÔÈ¯··ÛÙÈÎÒÓ ÂÚÈÔ¯ÒÓ (31,04% ¤Ó·ÓÙÈ 40,88%,OR=1,54, 95% CI: 1,17-2,01, p=0,002) (∂ÈÎfiÓ· 1).

™Ù· ·ÓÔÛÔÔÈËÌ¤Ó· ·È‰È¿, Ë ÔÚÔıÂÙÈÎfiÙËÙ··Ó‹ÏıÂ ÛÙÔ 90,1% (393/436) ÁÈ· ·È‰È¿ Ô˘ ¤Ï·‚·Ó

118 µ. ¶··Â˘·ÁÁ¤ÏÔ˘ Î·È Û˘Ó.



Ì›· ‰fiÛË ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ Î·È ÛÙÔ 91,2% (323/354) ÁÈ·

ÂÎÂ›Ó· Ô˘ ¤Ï·‚·Ó 2 ‰fiÛÂÈ˜. ∞fi Ù· 131 ‚Ú¤ÊË ËÏÈ-

Î›·˜ 0-12 ÌËÓÒÓ ÙË˜ ÌÂÏ¤ÙË˜, 41 (31,29%) ‹Ù·Ó ÔÚÔ-

ıÂÙÈÎ¿, ÁÂÁÔÓfi˜ ÂÓ‰ÂÈÎÙÈÎfi ·ıËÙÈÎ‹˜ ·ÓÔÛ›·˜ ÏfiÁˆ

ÌËÙÚÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÙË˜ Ë·Ù›ÙÈ‰·˜ ∞.

Ÿˆ˜ ‹Ù·Ó ·Ó·ÌÂÓfiÌÂÓÔ, Ù· ·È‰È¿ ËÏÈÎ›·˜ <12 ÌË-

ÓÒÓ Ô˘ ÚÔ¤Ú¯ÔÓÙ·Ó ·fi ÔÈÎÔÁ¤ÓÂÈÂ˜ ÌÂÙ·Ó·ÛÙÒÓ

Â›¯·Ó ÛÙ·ÙÈÛÙÈÎÒ˜ ÛËÌ·ÓÙÈÎ¿ ˘„ËÏfiÙÂÚ· ÔÛÔÛÙ¿

ÔÚÔıÂÙÈÎfiÙËÙ·˜ (23/41, 56,1%), ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙÔ

·ÓÙ›ÛÙÔÈ¯Ô ÔÛÔÛÙfi ÙˆÓ ∂ÏÏËÓfiÔ˘ÏˆÓ (18/90,

20%) (OR=5,11, 95% CI: 2,29-11,43, p<0,001).

∞fi ÙËÓ ·Ó¿Ï˘ÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ fiÛÔÓ

·ÊÔÚ¿ ÙËÓ ÂÌ‚ÔÏÈ·ÛÙÈÎ‹ Î¿Ï˘„Ë ¤Ó·ÓÙÈ ÙË˜ Ë·Ù›-

ÙÈ‰·˜ ∞ ·Ó¿ ÁÂˆÁÚ·ÊÈÎ‹ ÂÚÈÔ¯‹, ÚÔ¤Î˘„·Ó ˘„Ë-

Ï¿ ÔÛÔÛÙ¿ ·ÓÔÛÔÔ›ËÛË˜ ÛÂ ∂ÏÏËÓfiÔ˘Ï· ÚÔÂÚ-

¯fiÌÂÓ· ·fi ÙËÓ ∫ÂÓÙÚÈÎ‹ ∂ÏÏ¿‰· (54,07%), ÂÓÒ Ù·

¯·ÌËÏfiÙÂÚ· ÔÛÔÛÙ¿ Î·Ù·ÁÚ¿ÊËÎ·Ó ÛÙËÓ ÂÚÈÔ¯‹

ÙË˜ µfiÚÂÈ·˜ ∂ÏÏ¿‰·˜ (21,82%). ∆· ÔÛÔÛÙ¿ ·ÓÔÛÔ-

Ô›ËÛË˜ ∂ÏÏËÓfiÔ˘ÏˆÓ ‰È¤ÊÂÚ·Ó ÛËÌ·ÓÙÈÎ¿ ÌÂÙ·-

Í‡ ÙˆÓ ÁÂˆÁÚ·ÊÈÎÒÓ ÂÚÈÔ¯ÒÓ, fiˆ˜ Ê·›ÓÂÙ·È ÛÙÔÓ

¶›Ó·Î· 1.

∆Ô ÔÛÔÛÙfi ÔÚÔıÂÙÈÎfiÙËÙ·˜ ¤Ó·ÓÙÈ ÙË˜ Ë·Ù›ÙÈ-

‰·˜ ∞ ÛÂ ÌË ÂÌ‚ÔÏÈ·ÛÌ¤Ó· ·È‰ÈÒÓ ËÏÈÎ›·˜ >12 ÌË-

ÓÒÓ, ÏfiÁˆ Ê˘ÛÈÎ‹˜ ÓfiÛËÛË˜, ·Ó‹ÏıÂ ÛÂ 17,07%

(136/797). ∆Ô ÔÛÔÛÙfi ÙˆÓ ÌË ÂÌ‚ÔÏÈ·ÛÌ¤ÓˆÓ ÔÚÔ-

ıÂÙÈÎÒÓ ∂ÏÏËÓfiÔ˘ÏˆÓ ‹Ù·Ó ¯·ÌËÏfiÙÂÚÔ (15,90%,

104/654), ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ÛÙ· ·È‰È¿

ÌÂÙ·Ó·ÛÙÒÓ (32/143, 22,38%) (OR=1,52, 95% CI:

0,98-2,38, p=0,064), ÂÓÒ ÛÙÔÓ ¶›Ó·Î· 2 Ê·›ÓÔÓÙ·È Ù·

·ÓÙ›ÛÙÔÈ¯· ÔÛÔÛÙ¿ ·Ó¿ ÏËı˘ÛÌÈ·Î‹ ÔÌ¿‰· Î·È

ÁÂˆÁÚ·ÊÈÎfi ‰È·Ì¤ÚÈÛÌ· ÙË˜ ¯ÒÚ·˜.

∞fi ÙËÓ ·Ó¿Ï˘ÛË ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ ÙË˜ ÌÂÏ¤ÙË˜

Ì·˜ ·Ó¿ ÏËı˘ÛÌÈ·Î‹ ÔÌ¿‰·, Î·Ù·ÁÚ¿ÊËÎÂ ÛÙ·ÙÈ-

ÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿ fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ·ÓÔÛ›·

ÏfiÁˆ ÓfiÛËÛË˜ ¤Ó·ÓÙÈ ÙË˜ Ë·Ù›ÙÈ‰·˜ ∞ ÌfiÓÔ ÁÈ·

·È‰È¿ ·fi ÙËÓ ∫ÂÓÙÚÈÎ‹ ∂ÏÏ¿‰·, Ô˘ ·ÓÙÈÚÔÛˆ-

Â‡ÂÈ Î·È ÙËÓ ÂÚÈÔ¯‹ ÌÂ ÙË ÌÂÁ·Ï‡ÙÂÚË ÂÌ‚ÔÏÈ·-

ÛÙÈÎ‹ Î¿Ï˘„Ë (9/191, 4,71% ¤Ó·ÓÙÈ 14/76, 18,42%)

(OR=4,57, 95% CI: 1,88-11,07, p=0,001) (¶›Ó·Î·˜

3). ∂›ÛË˜, ·ÍÈÔÛËÌÂ›ˆÙ· Â›Ó·È Ù· ˘„ËÏ¿ ÔÛÔÛÙ¿

Ê˘ÛÈÎ‹˜ ·ÓÔÛ›·˜ ÌË ÂÌ‚ÔÏÈ·ÛÌ¤ÓˆÓ ·È‰ÈÒÓ ·fi

ÙËÓ ÂÚÈÔ¯‹ ÙË˜ µfiÚÂÈ·˜ ∂ÏÏ¿‰·˜, ÙfiÛÔ ÁÈ· Ù·

¶›Ó·Î·˜ 1. ¢È·ÊÔÚ¤˜, ·Ó¿ÏÔÁ· ÌÂ ÙÔÓ ÙfiÔ ‰È·ÌÔÓ‹˜ Î·È ÙËÓ ÂÌ‚ÔÏÈ·ÛÙÈÎ‹ Î¿Ï˘„Ë ¤Ó·ÓÙÈ ÙË˜ Ë·Ù›ÙÈ‰·˜ ∞, ÌÂÙ·Í‡ ∂ÏÏËÓfiÔ˘ÏˆÓ Î·È ÌÂÙ·Ó·ÛÙÒÓ

∂ÏÏËÓfiÔ˘Ï· ¶·È‰È¿ ÌÂÙ·Ó·ÛÙÒÓN (%) OR ∆ÈÌ‹ p N (%) OR ∆ÈÌ‹ p

(95% CI) (95% CI)

∫ÂÓÙÚÈÎ‹ ∂ÏÏ¿‰· 226/418 Ref† 26/102 Ref†

(54,07%) (25,49%)µfiÚÂÈ· ∂ÏÏ¿‰· 79/362 0,24 <0,001 5/44 0,37 0,062

(21,82%) (0,17-0,32) (11,36%) (0,13-1,05)¶ÂÏÔfiÓÓËÛÔ˜ 108/294 0,49 <0,001 4/32 0,42 0,133Î·È ÓËÛÈ¿ (36,73%) (0,36-0,67) (12,50%) (0,13-1,30)™‡ÓÔÏÔ 413/1074 35/178

(38,45%) (19,66%)

† Ref: ÔÌ¿‰· ·Ó·ÊÔÚ¿˜

119√ÚÔÂÈ‰ËÌÈÔÏÔÁÈÎ‹ ÌÂÏ¤ÙË Ë·Ù›ÙÈ‰·˜ ∞

¶·È‰È·ÙÚÈÎ‹ 2009;72:119-000

45

40

35

30

25

20

15

10

5

0

40

35

30

25

20

15

10

5

%p<0,001

∂ÏÏËÓfiÔ˘Ï· ¶·È‰È¿ ÌÂÙ·Ó·ÛÙÒÓ

40,5

22,3

p=0,002

∞ÛÙÈÎ¤˜ ÂÚÈÔ¯¤˜ ∞ÁÚÔÙÈÎ¤˜ ÂÚÈÔ¯¤˜

40,8

31

∂ÈÎfiÓ· 1. ¶ÔÛÔÛÙ¿ ·ÓÔÛÔÔ›ËÛË˜ ¤Ó·ÓÙÈ ÙË˜ Ë·Ù›ÙÈ‰·˜ ∞ ÛÂ ·È‰È¿ ËÏÈÎ›·˜ >24 ÌËÓÒÓ, ÛÂ Û¯¤ÛË ÌÂ ÙËÓ ÏËı˘ÛÌÈ·Î‹ ÔÌ¿‰· Î·È ÙÔÓÙfiÔ ‰È·ÌÔÓ‹˜.


∂ÏÏËÓfiÔ˘Ï· fiÛÔ Î·È ÁÈ· Ù· ·È‰È¿ ÌÂÙ·Ó·ÛÙÒÓ

(26,98% Î·È 41,03% ·ÓÙ›ÛÙÔÈ¯·) (¶›Ó·Î·˜ 3).

™˘˙‹ÙËÛË

√ Èfi˜ Ë·Ù›ÙÈ‰·˜ ∞ (HAV) ÌÂÙ·‰›‰ÂÙ·È ÌÂ ÙËÓ

Î·Ù¿ÔÛË ÌÔÏ˘ÛÌ¤ÓˆÓ ÙÚÔÊ›ÌˆÓ ‹ ‡‰·ÙÔ˜. ∏ Ìfi-

Ï˘ÓÛË, fiˆ˜ Â›ÛË˜ Î·È Ô ÂÌ‚ÔÏÈ·ÛÌfi˜, ·Ú¤¯Ô˘Ó

ÈÛfi‚È· ·ÓÔÛ›· (1,9). ∏ Èı·ÓfiÙËÙ· ÂÌÊ¿ÓÈÛË˜ Û˘-

ÌÙˆÌ¿ÙˆÓ ·fi ÙË ÌfiÏ˘ÓÛË ÌÂ HAV Û˘Û¯ÂÙ›˙ÂÙ·È

ÌÂ ÙËÓ ËÏÈÎ›·, ‰Â‰ÔÌ¤ÓÔ˘ fiÙÈ ÛÂ ·È‰È¿ ÌÈÎÚfiÙÂÚ·

ÙˆÓ 6 ÂÙÒÓ ÔÈ ÂÚÈÛÛfiÙÂÚÂ˜ ÌÔÏ‡ÓÛÂÈ˜ Â›Ó·È ·Û˘-

ÌÙˆÌ·ÙÈÎ¤˜ ‹ ·ÓÈÎÙÂÚÈÎ¤˜ (1,2). ∆· ·È‰È¿ ÌÂ ·Û˘-

ÌÙˆÌ·ÙÈÎ‹ ÌfiÏ˘ÓÛË ÌÔÚÔ‡Ó Ó· ·ÔÙÂÏ¤ÛÔ˘Ó Ë-

Á‹ ÌfiÏ˘ÓÛË˜ ÁÈ· Ù· ËÏÈÎÈˆÌ¤Ó· ¿ÙÔÌ· (3).

∆È˜ ÙÂÏÂ˘Ù·›Â˜ ‰ÂÎ·ÂÙ›Â˜, ÙÔ ÔÛÔÛÙfi ÙˆÓ ·Ùfi-

ÌˆÓ ÌÂ ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ ÙÔ˘ ÈÔ‡ ÙË˜ Ë·Ù›ÙÈ‰·˜ ∞

¤¯ÂÈ ÌÂÈˆıÂ› ÛÙ· ÂÚÈÛÛfiÙÂÚ· Ì¤ÚË ÙÔ˘ ÎfiÛÌÔ˘ (8).

∂Ó ÙÔ‡ÙÔÈ˜, ÂÚ›Ô˘ 1,4 ÂÎ·ÙÔÌÌ‡ÚÈ· Ó¤Â˜ ÌÔÏ‡Ó-

ÛÂÈ˜ ·fi ÙÔÓ Èfi ·Ó·Ì¤ÓÂÙ·È Ó· ÂÌÊ·ÓÈÛÙÔ‡Ó ·ÁÎÔ-

ÛÌ›ˆ˜ Î¿ıÂ ¯ÚfiÓÔ (8). ¶·Ú¿ ÙË ÌÂ›ˆÛË Ô˘ Î·Ù·-

ÁÚ¿ÊÂÙ·È ÛÙ· ÔÚÔÂÈ‰ËÌÈÔÏÔÁÈÎ¿ ÔÛÔÛÙ¿, Ë Ë·Ù›-

ÙÈ‰· ∞ Û˘ÓÂ¯›˙ÂÈ Ó· Â›Ó·È Ì›· ·fi ÙÈ˜ ÔÏ‡ Û˘¯Ó¿

·Ó·ÊÂÚfiÌÂÓÂ˜ ·Ûı¤ÓÂÈÂ˜ Ô˘ ÌÔÚÔ‡Ó Ó· ÚÔÏË-

ÊıÔ‡Ó ÌÂ ÂÌ‚ÔÏÈ·ÛÌfi ·ÁÎÔÛÌ›ˆ˜ (8).

∏ ∂ÏÏ¿‰· ıÂˆÚÂ›Ù·È ¯ÒÚ· ÌÂ ÂÓ‰È¿ÌÂÛË ÂÓ‰ËÌÈ-

ÎfiÙËÙ·, ·ÚfiÏÔ Ô˘ ‰ÂÓ ¤¯Ô˘ÌÂ ÚfiÛÊ·Ù· ‰Â‰ÔÌ¤-

Ó·. ∫¿ÔÈÂ˜ ÌÈÎÚ¤˜ ÌÂÏ¤ÙÂ˜ ·Ó·Ê¤ÚÔ˘Ó ÌÂ›ˆÛË ÙÔ˘

ÂÈÔÏ·ÛÌÔ‡ ÙË˜ ÓfiÛÔ˘ ‹‰Ë ·fi ÙË ‰ÂÎ·ÂÙ›· ÙÔ˘

’70 (5,6). ™‡ÌÊˆÓ· ÌÂ ÙÈ˜ ÌÂÏ¤ÙÂ˜ ·˘Ù¤˜, ÔÛÔÛÙfi

ÌÈÎÚfiÙÂÚÔ ·fi 10% ÙˆÓ ·È‰ÈÒÓ ·ÏÏ¿ ÌÂÁ·Ï‡ÙÂÚÔ

·fi 90% ÙˆÓ ÂÓËÏ›ÎˆÓ ¿Óˆ ÙˆÓ 45 ÂÙÒÓ ¤¯ÂÈ ·ÓÙÈ-

ÛÒÌ·Ù· ¤Ó·ÓÙÈ ÙÔ˘ ÈÔ‡ (5-7). ™Â ÌÈ· ·Ó·‰ÚÔÌÈÎ‹ ÌÂ-

Ï¤ÙË Ô˘ ‰ÈÂÓÂÚÁ‹ıËÎÂ ÛÙÔ ¡ÔÛÔÎÔÌÂ›Ô ∂È‰ÈÎÒÓ

¶·ı‹ÛÂˆÓ £ÂÛÛ·ÏÔÓ›ÎË˜, ÌÂÙ·Í‡ ÙˆÓ ÂÙÒÓ 1985-

1992 Î·Ù·ÁÚ¿ÊËÎÂ ÛÙ·ıÂÚ‹ ÌÂ›ˆÛË ÙˆÓ ÂÈÛ·ÁˆÁÒÓ

(6). ∂ÈÏ¤ÔÓ, ÛËÌÂÈÒıËÎÂ ·‡ÍËÛË ÙË˜ Ì¤ÛË˜ ËÏÈ-

Î›·˜ ÙˆÓ ·ÛıÂÓÒÓ, ·fi 0-5 ¤ÙË ÙÔ 1985 ÛÂ 21-25 ¤ÙË

ÙÔ 1992 (6). ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÚÔËÁÔ‡ÌÂÓË˜ ‰Â-

Î·ÂÙ›·˜, ˘‹ÚÍÂ ÌÂÁ¿ÏË ÏËı˘ÛÌÈ·Î‹ ·ÏÏ·Á‹ ÛÙËÓ

∂ÏÏ¿‰·, ÏfiÁˆ ÙË˜ ÂÈÛfi‰Ô˘ ÛÙË ¯ÒÚ· ÔÈÎÔÓÔÌÈÎÒÓ

ÚÔÛÊ‡ÁˆÓ ·fi ÙËÓ ∞Ó·ÙÔÏÈÎ‹ ∂˘ÚÒË Î·È Ù· µ·Ï-

Î¿ÓÈ·. ™‡ÌÊˆÓ· ÌÂ ÙËÓ ÚfiÛÊ·ÙË ·ÔÁÚ·Ê‹ ÙÔ˘

2001, ÔÈ ÌÂÙ·Ó¿ÛÙÂ˜ Û˘Óı¤ÙÔ˘Ó ÂÚ›Ô˘ ÙÔ 10% ÙÔ˘

ÏËı˘ÛÌÔ‡ ÙË˜ ¯ÒÚ·˜. ™‡ÌÊˆÓ· ÌÂ ÙÔ˘˜ Frosner

Î·È Û˘Ó., ˘¿Ú¯Ô˘Ó ‰Â‰ÔÌ¤Ó· fiÙÈ ÔÈ ÌÂÙ·Ó¿ÛÙÂ˜

¤¯Ô˘Ó ÛËÌ·ÓÙÈÎ¿ ˘„ËÏfiÙÂÚ· ÔÛÔÛÙ¿ HAV ·ÓÙÈÛˆ-

Ì¿ÙˆÓ (10). ∆¤ÏÔ˜, ·Ó Î·È Ë Ë·Ù›ÙÈ‰· ∞ ·ÔÙÂÏÂ›

¤Ó· ·fi Ù· ÓÔÛ‹Ì·Ù· Ô˘ ‰ËÏÒÓÔÓÙ·È ˘Ô¯ÚÂˆÙÈÎ¿

¶›Ó·Î·˜ 3. ¢È·ÊÔÚ¤˜, ·Ó¿ÏÔÁ· ÌÂ ÙËÓ ÏËı˘ÛÌÈ·Î‹ ÔÌ¿‰· Î·È ÙË Ê˘ÛÈÎ‹ ·ÓÔÛ›· ÌË ÂÌ‚ÔÏÈ·ÛÌ¤ÓˆÓ ·È‰ÈÒÓ >12 ÌËÓÒÓ, ÌÂÙ·Í‡ ÁÂˆÁÚ·-ÊÈÎÒÓ ÂÚÈÔ¯ÒÓ

∫ÂÓÙÚÈÎ‹ ∂ÏÏ¿‰· µfiÚÂÈ· ∂ÏÏ¿‰· ¶ÂÏÔfiÓÓËÛÔ˜ Î·È ÓËÛÈ¿N (%) OR p N (%) OR p N (%) OR p

(95% CI) (95% CI) (95% CI)

∂ÏÏËÓfiÔ˘Ï· 9/191 Ref† 75/278 Ref† 20/185 Ref†

(4,71%) (26,98%) (10,81%)ªÂÙ·Ó¿ÛÙÂ˜ 14/76 4,57 0,001 16/39 1,88 0,073 2/28 0,63 0,555

(18,42%) (1,88-11,07) (41,03%) (0,94-3,76) (7,14%) (0,14-2,88)™‡ÓÔÏÔ 23/267 91/317 22/213

(8,61%) (28,71%) (10,33%)


120 µ. ¶··Â˘·ÁÁ¤ÏÔ˘ Î·È Û˘Ó.


¶›Ó·Î·˜ 2. ¢È·ÊÔÚ¤˜, ·Ó¿ÏÔÁ· ÌÂ ÙÔÓ ÙfiÔ ‰È·ÌÔÓ‹˜ Î·È ÙË Ê˘ÛÈÎ‹ ·ÓÔÛ›· ¤Ó·ÓÙÈ ÙË˜ Ë·Ù›ÙÈ‰·˜ ∞ ÌË ÂÌ‚ÔÏÈ·ÛÌ¤ÓˆÓ ·È‰ÈÒÓ ËÏÈÎ›·˜>12 ÌËÓÒÓ, ÌÂÙ·Í‡ ∂ÏÏËÓfiÔ˘ÏˆÓ Î·È ÌÂÙ·Ó·ÛÙÒÓ

∂ÏÏËÓfiÔ˘Ï· ¶·È‰È¿ ÌÂÙ·Ó·ÛÙÒÓN (%) OR ∆ÈÌ‹ p N (%) OR ∆ÈÌ‹ p

(95% CI) (95% CI)

∫ÂÓÙÚÈÎ‹ ∂ÏÏ¿‰· 9/191 Ref† 14/76 Ref†

(4,71%) (18,42%)µfiÚÂÈ· ∂ÏÏ¿‰· 75/278 7,47 <0,001 16/39 3,08 0,011

(26,98%) (3,64-15,35) (41,03%) (1,30-7,30) 0,174¶ÂÏÔfiÓÓËÛÔ˜ 20/185 2,45 0,031 2/28 0,34Î·È ÓËÛÈ¿ (10,81%) (1,09-5,53) (7,14%) (0,07-1,61)™‡ÓÔÏÔ 104/654 32/143

(15,90%) (22,38%)



·fi Ù· Ù¤ÏË ÙÔ˘ ’90, Ë Î·Ù·ÁÚ·Ê‹ Â›Ó·È ÂÏÏÈ‹˜.

™ÙÔÈ¯Â›· ·fi ÙÔ ∫∂∂§ ‰Â›¯ÓÔ˘Ó fiÙÈ Ë Ë·Ù›ÙÈ‰· ∞

·ÔÙÂÏÂ› Úfi‚ÏËÌ· ‰ËÌfiÛÈ·˜ ˘ÁÂ›·˜ ÁÈ· ÙËÓ ∂ÏÏ¿-

‰· Î·È ÙÔ 25-50% ÙˆÓ ÂÚÈÙÒÛÂˆÓ Ô˘ ‰ËÏÒÓÔ-

ÓÙ·È ÂÙËÛ›ˆ˜ Â›Ó·È ·È‰È¿.

∆Ô ÂÌ‚fiÏÈÔ Ë·Ù›ÙÈ‰·˜ ∞ ¤¯ÂÈ ¿‰ÂÈ· ¯ÔÚ‹ÁËÛË˜

ÛÂ ·È‰È¿ >2 ÂÙÒÓ Î·È ÛÂ ÂÓ‹ÏÈÎÂ˜ (2). ¶ÚfiÛÊ·Ù·,

ÙÔ FDA ÂÓ¤ÎÚÈÓÂ ÙË ¯Ú‹ÛË ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ VAQTA

ÛÙ· Ó‹È· 12-24 ÌËÓÒÓ (11). ∞Ó Î·È ·Ú¯ÈÎ¿ Ô ÂÌ‚Ô-

ÏÈ·ÛÌfi˜ Û˘ÛÙ‹ıËÎÂ ÁÈ· ÙÈ˜ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÔÌ¿-

‰Â˜ ÌfiÓÔ, ¤¯Ô˘Ó Á›ÓÂÈ ÚÔÁÚ¿ÌÌ·Ù· Ì·˙ÈÎÔ‡ ÂÌ‚Ô-

ÏÈ·ÛÌÔ‡ ÛÙÈ˜ ÂÚÈÔ¯¤˜ ÌÂ ÂÓ‰È¿ÌÂÛË ÂÓ‰ËÌÈÎfiÙËÙ·

·fi ÙÔ 1997, fiˆ˜ ÁÂˆÁÚ·ÊÈÎ¿ ‰È·ÌÂÚ›ÛÌ·Ù· ÛÙËÓ

πÙ·Ï›·, πÛ·Ó›· Î·È ∞˘ÛÙÚ·Ï›· (12). ¶ÚfiÛÊ·Ù·, ÙÔ

πÛÚ·‹Ï ·ÚÔ˘Û›·ÛÂ ÌÈ· ÛËÌ·ÓÙÈÎ‹ ÌÂ›ˆÛË (>95%)

ÙÔ˘ ÂÙ‹ÛÈÔ˘ ÔÛÔÛÙÔ‡ Â›ÙˆÛË˜ ÙË˜ Ë·Ù›ÙÈ‰·˜ ∞,

5 ¯ÚfiÓÈ· ÌÂÙ¿ ÙËÓ ÂÊ·ÚÌÔÁ‹ ˘Ô¯ÚÂˆÙÈÎÔ‡ ÂÌ‚Ô-

ÏÈ·ÛÌÔ‡ ÙˆÓ ÌÈÎÚÒÓ ·È‰ÈÒÓ ÙÔ 1999 (13). ¶ÚfiÛÊ·-

Ù· ‰ËÌÔÛÈÂ˘Ì¤Ó· ·ÔÙÂÏ¤ÛÌ·Ù· ÂÌÊ·Ó›˙Ô˘Ó ÛËÌ·-

ÓÙÈÎ‹ ÌÂ›ˆÛË ÙË˜ Ë·Ù›ÙÈ‰·˜ ∞ ÛÂ ÔÏÈÙÂ›Â˜ ÙˆÓ

∏¶∞ fiÔ˘ ÂÊ·ÚÌfiÛÙËÎÂ Ë ÔÏÈÙÈÎ‹ ÙÔ˘ Ì·˙ÈÎÔ‡

ÂÌ‚ÔÏÈ·ÛÌÔ‡ (88%) (ÂÌ‚ÔÏÈ·ÛÙÈÎ‹ Î¿Ï˘„Ë 50%)

(14). ∏ ÌÂÁ·Ï‡ÙÂÚË ÌÂ›ˆÛË ·Ú·ÙËÚ‹ıËÎÂ ÛÂ ·È-

‰È¿ 2-9 ÂÙÒÓ, ·ÏÏ¿ Ë Â›ÙˆÛË ¤¯ÂÈ ÌÂÈˆıÂ› ÛËÌ·-

ÓÙÈÎ¿ Î·È ÛÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜, Î·Ù·‰ÂÈÎÓ‡ÔÓÙ·˜ ÌÂÈˆÌ¤-

ÓË ÌÂÙ¿‰ÔÛË ÙÔ˘ ÈÔ‡ Ì¤Û· ÛÙËÓ ÎÔÈÓfiÙËÙ· (14).

∞fi Ù· ‰Â‰ÔÌ¤Ó· ÙË˜ ÌÂÏ¤ÙË˜ Ì·˜ ÚÔ¤Î˘„Â fiÙÈ

¤Ó· ÛËÌ·ÓÙÈÎfi ÔÛÔÛÙfi ·È‰ÈÒÓ ËÏÈÎ›·˜ ¿Óˆ ÙˆÓ 2

ÂÙÒÓ (38%) ÂÌ‚ÔÏÈ¿˙ÂÙ·È ¤Ó·ÓÙÈ ÙË˜ Ë·Ù›ÙÈ‰·˜ ∞,

·ÚfiÏÔ Ô˘ Ì¤¯ÚÈ Û‹ÌÂÚ· ÙÔ Û˘ÁÎÂÎÚÈÌ¤ÓÔ ÂÌ‚fiÏÈÔ

‰ÂÓ ÂÚÈÏ·Ì‚¿ÓÂÙ·È ÛÙÔ ∂ıÓÈÎfi ¶ÚfiÁÚ·ÌÌ· ∂Ì‚Ô-

ÏÈ·ÛÌÒÓ. ∂ÔÌ¤Óˆ˜, Ë ·ÁÔÚ¿ ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ ÂÈ‚·-

Ú‡ÓÂÈ ÙÔÓ ÁÔÓ¤·, ÂÓÒ Ë Û˘Ì‚ÔÏ‹ ÙÔ˘ ·È‰È¿ÙÚÔ˘ ÎÚ›-

ÓÂÙ·È Ô˘ÛÈ·ÛÙÈÎ‹ ÛÙËÓ ˘„ËÏ‹ ÁÈ· Ù· ÂıÓÈÎ¿ ‰Â‰ÔÌ¤-

Ó· ÂÌ‚ÔÏÈ·ÛÙÈÎ‹ Î¿Ï˘„Ë.

∞fi Ù· ·ÔÙÂÏ¤ÛÌ·Ù¿ Ì·˜ ÚÔ¤Î˘„Â, fiˆ˜ ¿Ï-

ÏˆÛÙÂ ·Ó·ÌÂÓfiÙ·Ó, fiÙÈ Ù· ·È‰È¿ ÂÏÏËÓÈÎ‹˜ Î·Ù·-

ÁˆÁ‹˜, Î·ıÒ˜ Î·È ÂÎÂ›Ó· ·ÛÙÈÎÒÓ ÂÚÈÔ¯ÒÓ, Â›¯·Ó

˘„ËÏfiÙÂÚ· ÔÛÔÛÙ¿ ÂÌ‚ÔÏÈ·ÛÙÈÎ‹˜ Î¿Ï˘„Ë˜, ÛÂ

Û‡ÁÎÚÈÛË ÌÂ Ù· ·ÓÙ›ÛÙÔÈ¯· ÌÂÙ·Ó·ÛÙÒÓ ‹ ∂ÏÏËÓfi-

Ô˘ÏˆÓ Ô˘ ‰È·‚ÈÔ‡Ó ÛÙËÓ ÂÚÈÊ¤ÚÂÈ·.

∏ ·Ó›¯ÓÂ˘ÛË ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÙË˜ Ë·Ù›ÙÈ‰·˜

∞ ÛÂ ÌË ÂÌ‚ÔÏÈ·ÛÌ¤Ó· ·È‰È¿ <12 ÌËÓÒÓ ˘Ô‰ËÏÒ-

ÓÂÈ ·ÓÔÛ›· ÌÂÙ¿ ·fi Ê˘ÛÈÎ‹ ÏÔ›ÌˆÍË. ™‡ÌÊˆÓ· ÌÂ

Ù· ·ÔÙÂÏ¤ÛÌ·Ù¿ Ì·˜, 17% ÙˆÓ ÌË ÂÌ‚ÔÏÈ·ÛÌ¤ÓˆÓ

·È‰ÈÒÓ Â›¯·Ó ÓÔÛ‹ÛÂÈ ·fi Ë·Ù›ÙÈ‰· ∞. ∆Ô ÔÛÔ-

ÛÙfi ·˘Ùfi Â›Ó·È ÂÍ·ÈÚÂÙÈÎ¿ ·˘ÍËÌ¤ÓÔ Î·È ‰ÂÓ ÌÔÚÂ›

Ó· ·Ô‰ÔıÂ› ÛÙËÓ ÂÈÏÔÁ‹ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜.

™ËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿ ÙfiÛÔ ÛÙËÓ ÂÌ‚ÔÏÈ·ÛÙÈÎ‹ Î¿-

Ï˘„Ë fiÛÔ Î·È ÛÙË Ê˘ÛÈÎ‹ ·ÓÔÛ›· ‚Ú¤ıËÎÂ ÌÂÙ·Í‡ ÙˆÓ

‰È·ÊfiÚˆÓ ÁÂˆÁÚ·ÊÈÎÒÓ ÂÚÈÔ¯ÒÓ ÙË˜ ¯ÒÚ·˜ (¶›Ó·-

Î·˜ 3). ™˘ÁÎÂÎÚÈÌ¤Ó·, ÛÙËÓ ∫ÂÓÙÚÈÎ‹ ∂ÏÏ¿‰· Î·Ù·-

ÁÚ¿ÊËÎÂ Ë ˘„ËÏfiÙÂÚË ÂÌ‚ÔÏÈ·ÛÙÈÎ‹ Î¿Ï˘„Ë Î·È Ù·

¯·ÌËÏfiÙÂÚ· ÔÛÔÛÙ¿ ÔÚÔıÂÙÈÎfiÙËÙ·˜ ÏfiÁˆ Ê˘ÛÈÎ‹˜ÓfiÛËÛË˜. √È ‰È·ÊÔÚ¤˜ ‹Ù·Ó ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ¤˜ÌfiÓÔ ÁÈ· Ù· ∂ÏÏËÓfiÔ˘Ï·, ÏfiÁˆ ÙË˜ ¯·ÌËÏ‹˜ ÂÌ‚Ô-ÏÈ·ÛÙÈÎ‹˜ Î¿Ï˘„Ë˜ ÙˆÓ ·È‰ÈÒÓ ÌÂÙ·Ó·ÛÙÒÓ.

∞Í›˙ÂÈ ÂÈÏ¤ÔÓ Ó· ÙÔÓÈÛÙÂ› fiÙÈ, ÂÓÒ ÛÙÔ Û˘ÓÔÏÈ-Îfi ‰Â›ÁÌ· Ë ‰È·ÊÔÚ¿ ÔÚÔıÂÙÈÎfiÙËÙ·˜ ÌÂÙ·Í‡ ∂ÏÏË-ÓfiÔ˘ÏˆÓ Î·È ·È‰ÈÒÓ ÌÂÙ·Ó·ÛÙÒÓ ‰ÂÓ ‹Ù·Ó ÛÙ·ÙÈ-ÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹, ÛÙ· ·È‰È¿ Ô˘ ‰È·‚ÈÔ‡Ó ÛÙËÓ ∫Â-ÓÙÚÈÎ‹ ∂ÏÏ¿‰· (fiÔ˘ Î·Ù·ÁÚ¿ÊËÎÂ Ë ˘„ËÏfiÙÂÚËÂÌ‚ÔÏÈ·ÛÙÈÎ‹ Î¿Ï˘„Ë) Ë ‰È·ÊÔÚ¿ ‹Ù·Ó ÛËÌ·ÓÙÈÎ‹(¶›Ó·Î·˜ 3). ∏ ‰È·ÊÔÚ¿ ÛÙËÓ Â›ÙˆÛË ÙË˜ Ê˘ÛÈÎ‹˜·ÓÔÛ›·˜ Ô˘ Î·Ù·ÁÚ¿ÊÂÙ·È ÌÂÙ·Í‡ ÂÚÈÔ¯ÒÓ ·Ó¿ÏÔ-Á· ÌÂ ÙËÓ ÂÌ‚ÔÏÈ·ÛÙÈÎ‹ Î¿Ï˘„Ë ÂÍËÁÂ›Ù·È Èı·ÓÒ˜·fi ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÛÂ ÂÚÈÔ¯¤˜ ¯·ÌËÏ‹˜ ÂÌ‚ÔÏÈ·-ÛÙÈÎ‹˜ Î¿Ï˘„Ë˜ Ë ‰È·ÛÔÚ¿ ÙÔ˘ ÈÔ‡ ÙË˜ Ë·Ù›ÙÈ‰·˜∞ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË Î·È ÌÔÏ‡ÓÔÓÙ·È Â›ÓÔÛ· ·È‰È¿·ÓÂÍ·ÚÙ‹Ùˆ˜ Î·Ù·ÁˆÁ‹˜.

∆· ·ÔÙÂÏ¤ÛÌ·Ù¿ Ì·˜ ¤Ú¯ÔÓÙ·È ÛÂ ·ÓÙ›ıÂÛË ÌÂÂÎÂ›Ó· ÌÈ·˜ ÚfiÛÊ·ÙË˜ ÔÚÔÂÈ‰ËÌÈÔÏÔÁÈÎ‹˜ ÌÂÏ¤-ÙË˜ Ô˘ ·ÊÔÚÔ‡ÛÂ ÙËÓ Ë·Ù›ÙÈ‰· µ, ÁÈ· ÙËÓ ÔÔ›·ÂÊ·ÚÌfi˙ÂÙ·È Ì·˙ÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ ÙˆÓ ‚ÚÂÊÒÓ ·fiÙÔ 1998 (15). ™ÙË Û˘ÁÎÂÎÚÈÌ¤ÓË ÌÂÏ¤ÙË, ‰ÂÓ ‚Ú¤ıËÎÂÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿ ÌÂÙ·Í‡ ÙˆÓ ‰È¿ÊÔ-ÚˆÓ ÁÂˆÁÚ·ÊÈÎÒÓ ÂÚÈÔ¯ÒÓ, ÏfiÁˆ ÙË˜ ÂÓÈ·›·˜ ÔÏÈ-ÙÈÎ‹˜ ˘ÁÂ›·˜ Ô˘ ÂÊ·ÚÌfi˙ÂÙ·È ÛÂ fiÏË ÙË ¯ÒÚ· (15).∂ÔÌ¤Óˆ˜, ·fi Ù· ·ÔÙÂÏ¤ÛÌ·Ù¿ Ì·˜, ÛÂ Û˘Ó‰˘·ÛÌfiÌÂ ÙËÓ ÚÔ·Ó·ÊÂÚfiÌÂÓË ·Ú·Ù‹ÚËÛË, ‰È·Ê·›ÓÂÙ·È Ë·Ó¿ÁÎË ÂÊ·ÚÌÔÁ‹˜ Ì·˙ÈÎÔ‡ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÙˆÓ ·È-‰ÈÒÓ Î·È ÁÈ· ÙËÓ Ë·Ù›ÙÈ‰· ∞, fiˆ˜ Û˘Ó¤‚Ë Î·È ÛÂ¿ÏÏÂ˜ ¯ÒÚÂ˜, Î·È Ì¿ÏÈÛÙ· ·fi ÙËÓ ËÏÈÎ›· ÙˆÓ 12 ÌË-ÓÒÓ (11-14). ª¿ÏÈÛÙ·, ÌÂ ‚¿ÛË Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ÌÂÏ¤ÙË˜ ·˘Ù‹˜, Ë ∂ıÓÈÎ‹ ∂ÈÙÚÔ‹ ∂Ì‚ÔÏÈ·ÛÌÒÓ ÂÈ-ÛËÁ‹ıËÎÂ ÙËÓ ¤ÓÙ·ÍË ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ ÙË˜ Ë·Ù›ÙÈ‰·˜∞ ÛÙÔ˘˜ ˘Ô¯ÚÂˆÙÈÎÔ‡˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡˜, ÌÂ ·ÔÙ¤ÏÂ-ÛÌ· ÙÔ ÂÌ‚fiÏÈÔ Ó· ÂÚÈÏ·Ì‚¿ÓÂÙ·È ÛÙÔ Ó¤Ô ∂ıÓÈÎfi¶ÚfiÁÚ·ÌÌ· ∂Ì‚ÔÏÈ·ÛÌÒÓ ÙÔ˘ 2008.


1. American Academy of Pediatrics. Hepatitis A. In:Pickering LK, ed. 2003 Red Book: Report of the Committeeon Infectious Diseases. 26th ed. Elk Grove Village, IL:American Academy of Pediatrics; 2003:309-318.

2. CDC: Prevention of Hepatitis A through Active or PassiveImmunization: Recommendations of the advisoryCommittee on Immunization Practices (ACIP). MMWR1999,48(No. RR-12).

3. Staes C, Schlenker T, Risk I, et al. Source of infectionamong persons with acute hepatitis A and no identificatiedrisk factors. Salt Lake County, Utah, 1996 [Abstract 302].Clin Infect Dis 1997;24:411.

4. Lionis C, Koulentaki M, Biziagos E, Kouroumalis E.Current prevalence of hepatitis A, B nad C in a well definedarea in rural Krete, Greece. J Viral Hepat 1997;4:55-61.

5. Kremastinou J, Kalapothaki V, Trichopoulos D. Thechanging epidemiologic pattern of hepatitis A infection inurban Greece. Am J Epidemiol 1984;120:703-706.

121√ÚÔÂÈ‰ËÌÈÔÏÔÁÈÎ‹ ÌÂÏ¤ÙË Ë·Ù›ÙÈ‰·˜ ∞

¶·È‰È·ÙÚÈÎ‹ 2009;72:121-000


6. Papadopoulou V, Stavrati A, Patsialis T, et al. Changes inthe Epidemiology of acute hepatitis A during 1985-1992period. Pediatr N Gr 1995;7:30-34.

7. Dalekos GN, Zervou E, Karabini F, Tsianos EV. Prevalenceof viral markers among refugees from southern Albania:increased incidence of infection with hepatitis A, B and Dviruses. Eur J Gastrenterol Hepatol 1995;7:553-558.

8. Jacobsen KH, Koopman JS. Declining hepatitis Aseroprevalance: a global review and analysis EpidemiolInfect 2004;132:1005-1022.

9. World Health Organization. Hepatitis A. WHO/CDS//CSR/EDC/2000.7

10. Frosner GG, Papaevangelou G, Butler R, Iwarson S,Lindholm A, Couroucé-Pauty A, et al. Antibody againsthepatitis A in seven European countries I: comparison ofprevalence data in different age groups. Am J Epidemiol1979;110:63-69.

11. FDA Approval of VAQTA (hepatitis A vaccine, inactivated)in children > 1 year. MMWR 2005;54:1026.

12. Van Damme P, Van Herck K. Effect of Hepatitis AVaccination Programs. JAMA 2005;294:246-248.

13. Dagan R, Leventha A, Anis E, Slatter P, Ashur Y, ShouvalD. Incidence of Hepatitis A in Israel Following UniversalImmunization of Toddlers. JAMA 2005;294:202-210.

14. Wasley A, Samandari T, Bell BP. Incidence of Hepatitis Ain the United States in the era of vaccination. JAMA2005;294:194-201.

15. Papaevangelou V, Hadjichristodoulou C, Cassimos D,Pantelaki K, Tzivaras A, Hatzimichael et al. Seroepi-demiology of hepatitis B in Greek children six years afterthe implementation of universal vaccination. Infection2008;36:135-139

122 µ. ¶··Â˘·ÁÁ¤ÏÔ˘ Î·È Û˘Ó.


™ˆÛÙ¤˜ ··ÓÙ‹ÛÂÈ˜ ÙÔ˘ Quiz ÁÈ· ÙÔ ¿ÚıÚÔ «¡ÂfiÙÂÚ· ‰Â‰ÔÌ¤Ó· ÁÈ· ÙË Û˘ÁÁÂÓ‹

‰È·ÊÚ·ÁÌ·ÙÔÎ‹ÏË»

1. ‚ 2. ·3. ‚4. ‰5. Á


§¤ÌÊˆÌ· Hodgkin ÛÙ· ·È‰È¿: ÂÌÂÈÚ›· 28 ÂÙÒÓ

∞. ¶Ô˘ÚÙÛ›‰Ë˜1, ¢. ¢ÔÁ¿ÓË˜1, ª. ª¿Î·1, ¢. ªÔ˘¯Ô‡ÙÛÔ˘1, ª. µ·Ú‚Ô˘ÙÛ‹1, ª. ™˘ÓÔ‰ÈÓÔ‡2,

∞ÈÎ. ªÈ¯·‹Ï-™ÙÚ¿ÓÙ˙È·3, ∂. ∫ÔÛÌ›‰Ë1

¶ÂÚ›ÏË„Ë

∂ÈÛ·ÁˆÁ‹: ∆Ô Ï¤ÌÊˆÌ· Hodgkin ·ÔÙÂÏÂ› ÂÚ›Ô˘ ÙÔ 4-5% ÙˆÓ Î·ÎÔËıÂÈÒÓ ÛÙ· ·È‰È¿. ∆· ÙÂÏÂ˘Ù·›·30 ¯ÚfiÓÈ·, Ë ¯Ú‹ÛË Û˘Ó‰˘·ÛÌÔ‡ ¯ËÌÂÈÔıÂÚ·Â˘ÙÈÎÒÓ ÚˆÙÔÎfiÏÏˆÓ, ÌÂ ‹ ¯ˆÚ›˜ ·ÎÙÈÓÔıÂÚ·Â›·, Ô‰‹-ÁËÛÂ ÛÂ ÛËÌ·ÓÙÈÎ‹ ‚ÂÏÙ›ˆÛË ÙË˜ ÚfiÁÓˆÛË˜ Î·È ¤Î‚·ÛË˜ ÙˆÓ ·È‰ÈÒÓ ·˘ÙÒÓ.

∞ÛıÂÓÂ›˜ Î·È Ì¤ıÔ‰ÔÈ: ∆· ÙÂÏÂ˘Ù·›· 28 ¯ÚfiÓÈ·, ·ÓÙÈÌÂÙˆ›ÛıËÎ·Ó ÛÙÔ ÙÌ‹Ì· Ì·˜ 73 ·È‰È¿ ÌÂ ÓfiÛÔHodgkin. ™Ù· ·È‰È¿ ·˘Ù¿ ÌÂÏÂÙ‹ıËÎ·Ó ÂÈ‰ËÌÈÔÏÔÁÈÎ¿, ÎÏÈÓÈÎ¿ Î·È ÈÛÙÔÏÔÁÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿, Ô ÙÚfi-Ô˜ ıÂÚ·Â›·˜ Î·È Ë ¤Î‚·ÛË Î·È ·ÍÈÔÏÔÁ‹ıËÎ·Ó ‰˘ÓËÙÈÎÔ› ÚÔÁÓˆÛÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ Ô˘ ÂÈ‰ÚÔ‡Ó ÛÙËÓÚfiÁÓˆÛË.

AÔÙÂÏ¤ÛÌ·Ù·: ∏ ËÏÈÎ›· ÙˆÓ ·ÛıÂÓÒÓ (46 ·ÁfiÚÈ·, 27 ÎÔÚ›ÙÛÈ·) Î˘Ì·ÈÓfiÙ·Ó ·fi 3,5 ¤ˆ˜ 15 ¤ÙË. ™ÙË Û˘-ÓÙÚÈÙÈÎ‹ ÏÂÈÔ„ËÊ›·, Ë ·ÈÙ›· ÙË˜ ·Ú¯ÈÎ‹˜ ÚÔÛ¤ÏÂ˘ÛË˜ ‹Ù·Ó Ë ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ· (81%), ÂÓÒ Ë ‰È¿Ú-ÎÂÈ· ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÚÈÓ ÙË ‰È¿ÁÓˆÛË Î˘Ì·ÈÓfiÙ·Ó ·fi Ï›ÁÂ˜ Ì¤ÚÂ˜ ¤ˆ˜ Î·È 12 Ì‹ÓÂ˜. ªÂÙ·Í‡ ÙˆÓÈÛÙÔÏÔÁÈÎÒÓ ˘fiÙ˘ˆÓ ˘ÂÚÂ›¯Â Ë Ô˙Ò‰Ë˜ ÛÎÏ‹Ú˘ÓÛË (63%), ÂÓÒ 44% ÙˆÓ ·ÛıÂÓÒÓ Â›¯·Ó ÚÔ¯ˆÚË-Ì¤ÓË ÓfiÛÔ (ÛÙ·‰›Ô˘ πππ-IV). ∏ ıÂÚ·Â›· ÂÚÈÂÏ¿Ì‚·ÓÂ ÌfiÓÔ ¯ËÌÂÈÔıÂÚ·Â›· ÛÂ 5 ·ÛıÂÓÂ›˜, ÌfiÓÔ ·ÎÙÈ-ÓÔıÂÚ·Â›· ÛÂ 9 Î·È Û˘Ó‰˘·ÛÌfi ÛÂ 59. ∏ Û˘ÓÔÏÈÎ‹ ÂÈ‚›ˆÛË ·Ó¤Ú¯ÂÙ·È ÛÂ 97,3%. OÎÙÒ ·È‰È¿ ˘Ô-ÙÚÔ›·Û·Ó 20-65 Ì‹ÓÂ˜ ·fi ÙË ‰È¿ÁÓˆÛË Î·È ·fi ·˘Ù¿ ˙Ô˘Ó Ù· 7, ÂÓÒ ‰Â‡ÙÂÚË ‹ ÙÚ›ÙË Î·ÎÔ‹ıÂÈ· ‰È·-ÈÛÙÒıËÎÂ ÛÂ 4 ·È‰È¿, ·fi Ù· ÔÔ›· ˙Ô˘Ó Ù· 3. ¢ÂÓ ‰È·ÈÛÙÒıËÎ·Ó ÚÔÁÓˆÛÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ Ô˘ Ó·Û˘Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÙËÓ ¤Î‚·ÛË ÙˆÓ ·ÛıÂÓÒÓ.

™˘ÌÂÚ¿ÛÌ·Ù·: ∏ ¤Î‚·ÛË ÙˆÓ ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ ÌÂ ÓfiÛÔ Hodgkin Â›Ó·È ÂÍ·ÈÚÂÙÈÎ‹ ÌÂ Û˘Ó‰˘·ÛÌfi¯ËÌÂÈÔıÂÚ·Â›·˜ Î·È ·ÎÙÈÓÔıÂÚ·Â›·˜. ∏ Û˘ÓÂ¯È˙fiÌÂÓË ·Ú·ÎÔÏÔ‡ıËÛË ÌÂÁ·Ï‡ÙÂÚÔ˘ ·ÚÈıÌÔ‡ ·È‰ÈÒÓÎÚ›ÓÂÙ·È ··Ú·›ÙËÙË ÁÈ· Ó· ‰ÈÂ˘ÎÚÈÓÈÛÙÂ› ·Ó ˘¿Ú¯Ô˘Ó ‰˘ÓËÙÈÎ¿ ÚÔÁÓˆÛÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ ÙË˜ ¤Î‚·ÛË˜ÙˆÓ ·È‰ÈÒÓ ÌÂ ÓfiÛÔ Hodgkin.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: §¤ÌÊˆÌ· ∏odgkin, ·È‰ÈÎ‹ ËÏÈÎ›·, ÚÔÁÓˆÛÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜.

Hodgkin’s lymphoma in children: 28 years of experience

A. Pourtsidis1, D. Doganis1, M. Baka1, D. Bouhoutsou1, M. Varvoutsi1, M. Synodinou2,

A. Michael-Strantzia3, E. Kosmidi1

Abstract

Background: In the past 30 years the use of combined chemotherapy regimes, with or withoutradiotherapy, has improved significantly the prognosis for patients with Hodgkin’s lymphoma.

Methods: A retrospective study was made of 73 children with Hodgkin’s lymphoma treated at this centreover the past 28 years. The following data were analyzed and correlated with the outcome: age, sex, stage,histology, treatment, follow-up period.

Results: Among patients, there were 46 boys and 27 girls. The age at diagnosis varied from 3.3 to 15 years,and 15 patients were 8 years old or younger. Most of the patients (81%) presented withlymphadenopathy, with a time interval of 3 days to 12 months between the first appearance of clinicalsigns and the diagnosis. Nodular sclerosis was the predominant histological subtype (63%), and 44% ofpatients had advanced disease (stage III or IV). Chemotherapy alone was used in 5 patients, radiation in9 and combined treatment in 59. Relapses occurred in 8 children and 4 developed second or thirdmalignancies. The overall survival was 97.3%. One patient died from the disease and one after a thirdmalignancy. No specific factors related to the outcome were detected.

Conclusions: The outcome of children with Hodgkin’s disease is excellent with chemotherapy combinedwith low dose radiation. A longer follow-up of a greater number of patients is necessary to detectprognostic factors related to the outcome of children and adolescents with Hodgkin’s disease.

Key words: Hodgkin’s lymphoma, children, prognostic factors.


1 √ÁÎÔÏÔÁÈÎfi ∆Ì‹Ì·,¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ «¶. & ∞. ∫˘ÚÈ·ÎÔ‡», ∞ı‹Ó·

2 ∞ÎÙÈÓÔıÂÚ·Â˘ÙÈÎfi ∆Ì‹Ì·,¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ «¶. & ∞. ∫˘ÚÈ·ÎÔ‡», ∞ı‹Ó·

3 ¶·ıÔÏÔÁÔ·Ó·ÙÔÌÈÎfi∂ÚÁ·ÛÙ‹ÚÈÔ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ «¶. & ∞. ∫˘ÚÈ·ÎÔ‡», ∞ı‹Ó·


∞fiÛÙÔÏÔ˜ ¶Ô˘ÚÙÛ›‰Ë˜[email protected]√ÁÎÔÏÔÁÈÎfi ∆Ì‹Ì·,¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ «¶. & ∞. ∫˘ÚÈ·ÎÔ‡», ∞ı‹Ó·

1 Department of Oncology,“P. & A. Kyriakou”Children’s Hospital,Athens, Greece

2 Department ofRadiotherapy, “P. & A. Kyriakou”Children’s Hospital,Athens, Greece

3 Laboratory of Pathology,“P. & A. Kyriakou”Children’s Hospital,Athens, Greece

Correspondence:

Apostolos [email protected] of Oncology, “P. & A. Kyriakou” Children’sHospital, Athens, Greece

¶·È‰È·ÙÚÈÎ‹ 2009;72:123-000


∂ÈÛ·ÁˆÁ‹

∆Ô Ï¤ÌÊˆÌ· Hodgkin ·ÔÙÂÏÂ› ÙÔ 4-5% ÙˆÓ Î·-

ÎÔËıÂÈÒÓ ÛÙ· ·È‰È¿ Î·È ÙÔ ¤ÎÙÔ Î·Ù¿ ÛÂÈÚ¿ Û˘¯Ófi-

ÙËÙ·˜ ÓÂÔÏ·ÛÌ·ÙÈÎfi ÓfiÛËÌ· ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜

ÛÙËÓ ∂˘ÚÒË Î·È ÛÙÈ˜ ∏.¶.∞., ÌÂÙ¿ ÙË ÏÂ˘¯·ÈÌ›·,

ÙÔ˘˜ fiÁÎÔ˘˜ ÂÁÎÂÊ¿ÏÔ˘, ÙÔ ÓÂ˘ÚÔ‚Ï¿ÛÙˆÌ·, ÙÔ ÓÂ-

ÊÚÔ‚Ï¿ÛÙˆÌ· Î·È ÙÔ ÌË Hodgkin Ï¤ÌÊˆÌ·. ∏ Â›-

ÙˆÛË ÙË˜ ÓfiÛÔ˘ ‰È·Ê¤ÚÂÈ ·Ó¿ÏÔÁ· ÌÂ ÙËÓ ËÏÈÎ›·,

ÙÔ Ê‡ÏÔ, ÙËÓ ÂıÓÈÎfiÙËÙ· Î·È ÙÔÓ ÈÛÙÔÏÔÁÈÎfi Ù‡Ô.

™‡ÌÊˆÓ· ÌÂ Ù· ‰Â‰ÔÌ¤Ó· ÙË˜ International Agency

for Research on Cancer (πARC), Ë ÂÙ‹ÛÈ· Â›ÙˆÛË

ÙÔ˘ ÏÂÌÊÒÌ·ÙÔ˜ Hodgkin ÛÂ ·È‰È¿ ËÏÈÎ›·˜ Î¿Ùˆ

ÙˆÓ 15 ¯ÚfiÓˆÓ ˘ÔÏÔÁ›˙ÂÙ·È ÛÂ 5,5 ÂÚÈÙÒÛÂÈ˜ ·Ó¿

ÂÎ·ÙÔÌÌ‡ÚÈÔ ÛÙÔÓ ·ÓÂÙ˘ÁÌ¤ÓÔ ÎfiÛÌÔ, ·ÏÏ¿ ÛÙÔ˘˜

ÂÊ‹‚Ô˘˜ Î·È ÓÂ·ÚÔ‡˜ ÂÓ‹ÏÈÎÂ˜ ËÏÈÎ›·˜ 15-20 ¯Úfi-

ÓˆÓ Êı¿ÓÂÈ ÙÈ˜ 12,1. ∞ÓÙÈı¤Ùˆ˜, ÛÙË ¢˘ÙÈÎ‹ ∞Û›· Ë

Â›ÙˆÛË ÛÙ· ·È‰È¿ Â›Ó·È ÛÙ·ıÂÚ¿ ¿Óˆ ·fi ÙÈ˜ 7

ÂÚÈÙÒÛÂÈ˜ ·Ó¿ ÂÎ·ÙÔÌÌ‡ÚÈÔ (1). ™ÙËÓ ∂ÏÏ¿‰·, Ë

Â›ÙˆÛË ÛÙ· ·È‰È¿ ·Ó¤Ú¯ÂÙ·È ÛÂ 7,2 ·Ó¿ ÂÎ·ÙÔÌ-

Ì‡ÚÈÔ ¿ÓıÚˆÔ-¤ÙË. ÀÔÏÔÁ›ÛÙËÎÂ ÁÈ· ÚÒÙË ÊÔÚ¿

ÛÙË ¯ÒÚ· Ì·˜ ÌÂ ‚¿ÛË Ù· ·Ó·Ï˘ÙÈÎ¿ ‰Â‰ÔÌ¤Ó· Ô˘

Û˘ÁÎÂÓÙÚÒÓÔÓÙ·È ÛÙÔ ∂ÏÏËÓÈÎfi ∞Ú¯Â›Ô ¶·È‰ÈÎÒÓ

∞ÈÌ·ÙÔÏÔÁÈÎÒÓ ∫·ÎÔËıÂÈÒÓ, Ô˘ ÏÂÈÙÔ˘ÚÁÂ› ÛÙÔ

∂ÚÁ·ÛÙ‹ÚÈÔ ÀÁÈÂÈÓ‹˜ Î·È ∂È‰ËÌÈÔÏÔÁ›·˜ Î·È Û˘ÁÎÂ-

ÓÙÚÒÓÂÈ ÂıÓÈÎ¿ ‰Â‰ÔÌ¤Ó· (2). ∞·ÓÙ¿Ù·È Û˘¯ÓfiÙÂÚ·

ÛÙÔ˘˜ ∫·˘Î¿ÛÈÔ˘˜, ÂÓÒ ˘¿Ú¯Ô˘Ó ÙÚÂÈ˜ ‰È·ÎÚÈÙÔ›

Ù‡ÔÈ fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ËÏÈÎ›·: ·˘Ùfi˜ Ô˘ ·ÊÔÚ¿ ·È-

‰È¿ ÌÈÎÚfiÙÂÚ· ÙˆÓ 15 ÂÙÒÓ, ·˘Ùfi˜ ÙˆÓ ÓÂ·ÚÒÓ ÂÓË-

Ï›ÎˆÓ Î·È ·˘Ùfi˜ ÙˆÓ ÌÂÁ·Ï‡ÙÂÚˆÓ ÂÓËÏ›ÎˆÓ (·ÛıÂ-

ÓÂ›˜ ¿Óˆ ÙˆÓ 55 ÂÙÒÓ). ∏ ÓfiÛÔ˜ ·ÚÔ˘ÛÈ¿˙ÂÈ ÌÈ· ‰È-

ÎfiÚ˘ÊË ËÏÈÎÈ·Î‹ Î·Ù·ÓÔÌ‹, ÌÂ Ì›· ·È¯Ì‹ ÛÙËÓ ÂÊË-

‚Â›· Î·È Ì›· ÛÂ ·ÛıÂÓÂ›˜ ¿Óˆ ÙˆÓ 50 ÂÙÒÓ, ÂÓÒ Â›Ó·È

Û·ÓÈfiÙ·ÙË ÛÂ ·È‰È¿ ÌÈÎÚfiÙÂÚ· ÙˆÓ 5 ÂÙÒÓ (3).

∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÙÂÏÂ˘Ù·›ˆÓ 30 ¯ÚfiÓˆÓ, Ë

¯Ú‹ÛË Û˘Ó‰˘·ÛÌ¤ÓˆÓ ¯ËÌÂÈÔıÂÚ·Â˘ÙÈÎÒÓ Û¯ËÌ¿-

ÙˆÓ, ÌÂ ‹ ¯ˆÚ›˜ ·ÎÙÈÓÔıÂÚ·Â›·, Ô‰‹ÁËÛÂ ÛÂ ÛËÌ·-

ÓÙÈÎ‹ ‚ÂÏÙ›ˆÛË ÙË˜ ÚfiÁÓˆÛË˜ ÙˆÓ ·È‰ÈÒÓ ÌÂ Ï¤Ì-

ÊˆÌ· Hodgkin, ·‡ÍËÛË ÙˆÓ ÔÛÔÛÙÒÓ ›·ÛË˜ Î·È

Û˘Á¯ÚfiÓˆ˜ ÌÂ›ˆÛË ÙË˜ ·ÒÙÂÚË˜ ÙÔÍÈÎfiÙËÙ·˜. H

ÂÓÙ·ÂÙ‹˜ ÂÏÂ‡ıÂÚË Û˘Ì‚¿Ì·ÙÔ˜ ÂÈ‚›ˆÛË (EFS)

ÛÙËÓ ·È‰ÈÎ‹ Î·È ÂÊË‚ÈÎ‹ ËÏÈÎ›· ˘ÂÚ‚·›ÓÂÈ ÙÔ 90%

ÁÈ· ÙÔ˘˜ ·ÛıÂÓÂ›˜ ·ÌËÏÔ‡ Î·È ÂÓ‰È¿ÌÂÛÔ˘ ÎÈÓ‰‡ÓÔ˘

ÌÂ ÂÓÙÔÈÛÌ¤ÓË ÓfiÛÔ (4) Î·È ÙÔ 60-70% ÁÈ· ·ÛıÂÓÂ›˜

˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÌÂ ÚÔ¯ˆÚËÌ¤ÓË ÓfiÛÔ - Û˘Ó‹ıˆ˜

ÛÙ·‰›Ô˘ IV (5, 6).

∏ ·ÚÔ‡Û· ÌÂÏ¤ÙË Î·Ù·ÁÚ¿ÊÂÈ ÂÈ‰ËÌÈÔÏÔÁÈÎ¿,

ÂÚÁ·ÛÙËÚÈ·Î¿, ÈÛÙÔÏÔÁÈÎ¿ Î·È ·ÂÈÎÔÓÈÛÙÈÎ¿ ¯·Ú·-

ÎÙËÚÈÛÙÈÎ¿, Î·ıÒ˜ Â›ÛË˜ ÙÔ Â›‰Ô˜ ıÂÚ·Â›·˜ Î·È ÙËÓ

¤Î‚·ÛË ÙˆÓ ·È‰ÈÒÓ Ô˘ ·ÓÙÈÌÂÙˆ›ÛıËÎ·Ó ÛÙÔ ÙÌ‹-

Ì· Ì·˜. ∆·˘Ùfi¯ÚÔÓ·, ¤¯ÂÈ ˆ˜ ÛÙfi¯Ô Ó· ÚÔÛ‰ÈÔÚ›ÛÂÈ

ÚÔÁÓˆÛÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜ Ô˘ ‰˘ÓËÙÈÎ¿ Û¯ÂÙ›˙Ô-

ÓÙ·È ÌÂ ÙËÓ ÙÂÏÈÎ‹ ¤Î‚·ÛË Î·È ÙÈ˜ ·ÒÙÂÚÂ˜ Û˘Ó¤ÂÈ-

Â˜ ÙË˜ ıÂÚ·Â›·˜ ÙˆÓ ·È‰ÈÒÓ ÌÂ Ï¤ÌÊˆÌ· Hodgkin.

∞ÛıÂÓÂ›˜ Î·È Ì¤ıÔ‰ÔÈ

∏ ÌÂÏ¤ÙË Â›Ó·È ·Ó·‰ÚÔÌÈÎ‹ Î·È ÂÚÈÏ·Ì‚¿ÓÂÈ fiÏ· Ù· ·È-

‰È¿ ÌÂ Ï¤ÌÊˆÌ· Hodgkin Ô˘ ·ÓÙÈÌÂÙˆ›ÛıËÎ·Ó ÛÙÔ √ÁÎÔ-

ÏÔÁÈÎfi ÙÌ‹Ì· ÙÔ˘ ¡ÔÛÔÎÔÌÂ›Ô˘ ¶·›‰ˆÓ «¶. & ∞. ∫˘ÚÈ·ÎÔ‡»

·fi ÙÔ 1978 ¤ˆ˜ ÙÔ 2005. ∏ ÛÙ·‰ÈÔÔ›ËÛË ÙˆÓ ·ÛıÂÓÒÓ ¤ÁÈ-

ÓÂ ÌÂ ¯Ú‹ÛË ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ Î·Ù¿ Ann Arbor (7), ÂÓÒ Ë ‰È¿-

ÎÚÈÛË ÙˆÓ ÈÛÙÔÏÔÁÈÎÒÓ ˘fiÙ˘ˆÓ ¤ÁÈÓÂ Û‡ÌÊˆÓ· ÌÂ ÙËÓ Ù·-

ÍÈÓfiÌËÛË Î·Ù¿ Rye (8).

T· Û¯‹Ì·Ù· ¯ËÌÂÈÔıÂÚ·Â›·˜ Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó

ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ·ÛıÂÓÒÓ ÂÚÈÁÚ¿ÊÔÓÙ·È ÛÙÔÓ ¶›Ó·-

Î· 1. ∏ ıÂÚ·Â˘ÙÈÎ‹ ÚÔÛ¤ÁÁÈÛË ‰È¤ÊÂÚÂ ·Ó¿ÏÔÁ· ÌÂ ÙË ÚÔ-

ÓÈÎ‹ ÂÚ›Ô‰Ô. ¶ÂÚ›Ô‰Ô˜ ∞ (1979-1988, 19 ·ÛıÂÓÂ›˜): ·ÓÙÈÌÂ-

Ùˆ›ÛıËÎ·Ó ÌÂ ·ÎÙÈÓÔıÂÚ·Â›· ÌfiÓÔ, ¯ËÌÂÈÔıÂÚ·Â›· ÌfiÓÔ

(MOPP ‹ ABVD) ‹ Û˘Ó‰˘·ÛÌfi ¯ËÌÂÈÔıÂÚ·Â›·˜ (ªOPP ‹

ABVD) Î·È ·ÎÙÈÓÔıÂÚ·Â›·˜ 30-40 Gy. ¶ÂÚ›Ô‰Ô˜ µ (1989-

1993, 26 ·ÛıÂÓÂ›˜): ÔÈ ·ÛıÂÓÂ›˜ ÌÂ ÛÙ¿‰ÈÔ π ‹ ππ∞ ¤Ï·‚·Ó 4 Î‡-

ÎÏÔ˘˜ ∞µVD Î·È ·ÎÔÏÔ‡ıˆ˜ ·ÎÙÈÓÔıÂÚ·Â›· ÌÂ 20 Gy ÛÙÈ˜

·Ú¯ÈÎ¿ ÚÔÛ‚Â‚ÏËÌ¤ÓÂ˜ ÂÚÈÔ¯¤˜, ÂÓÒ ÔÈ ·ÛıÂÓÂ›˜ ÌÂ ÛÙ¿‰ÈÔ

ππµ, III ‹ πV ¤Ï·‚·Ó ·fi 3 Î‡ÎÏÔ˘˜ MOPP Î·È ABVD ÂÓ·ÏÏ¿Í

Î·È ÛÙË Û˘Ó¤¯ÂÈ· ·ÎÙÈÓÔıÂÚ·Â›· 20 Gy ÛÙÈ˜ ·Ú¯ÈÎ¿ ÚÔÛ‚Â-

‚ÏËÌ¤ÓÂ˜ ÂÚÈÔ¯¤˜, ÙÔ ÛÏ‹Ó· Î·È ÙÔ˘˜ ·Ú·ÔÚÙÈÎÔ‡˜ ÏÂÌ-

Ê·‰¤ÓÂ˜ (9). ¶ÂÚ›Ô‰Ô˜ ° (1994-2005, 28 ·ÛıÂÓÂ›˜): Ù· ·È‰È¿

·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó Û‡ÌÊˆÓ· ÌÂ ÙÔ ÚˆÙfiÎÔÏÏÔ ÙË˜ °·ÏÏÈ-

Î‹˜ ∂Ù·ÈÚÂ›·˜ ¶·È‰È·ÙÚÈÎ‹˜ √ÁÎÔÏÔÁ›·˜, MDH 90 (10): ÁÈ·

ÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ ÛÙ¿‰ÈÔ π ‹ ππ ¯ÔÚËÁ‹ıËÎ·Ó 4 Î‡ÎÏÔÈ VBVP

Î·È ·ÎÙÈÓÔ‚ÔÏ›· ÌÂ 20 Gy ÛÙÈ˜ ·Ú¯ÈÎ¿ ÚÔÛ‚Â‚ÏËÌ¤ÓÂ˜ Â-

ÚÈÔ¯¤˜. √È ·ÛıÂÓÂ›˜ ÌÂ ÛÙ¿‰ÈÔ πππ ¤Ï·‚·Ó ·fi 2 Î‡ÎÏÔ˘˜

MOPP Î·È ABVP ÂÓ·ÏÏ¿Í Î·È ·ÎÙÈÓÔıÂÚ·Â›· ÌÂ 20 Gy ÛÙÈ˜

·Ú¯ÈÎ¿ ÚÔÛ‚Â‚ÏËÌ¤ÓÂ˜ ÂÚÈÔ¯¤˜, ÙÔ ÛÏ‹Ó· Î·È ÙÔ˘˜ ·Ú·-

ÔÚÙÈÎÔ‡˜ ÏÂÌÊ·‰¤ÓÂ˜. √È ·ÛıÂÓÂ›˜ ÌÂ ÛÙ¿‰ÈÔ IV ¤Ï·‚·Ó 2 Î‡-

ÎÏÔ˘˜ OPPA Î·È 4 Î‡ÎÏÔ˘˜ COPP Î·È ÛÙË Û˘Ó¤¯ÂÈ· ·ÎÙÈÓÔ-

ıÂÚ·Â›· ÌÂ 20 Gy ÛÙÔ˘˜ ·Ú¯ÈÎ¿ ÚÔÛ‚Â‚ÏËÌ¤ÓÔ˘˜ ÏÂÌÊ·-

‰¤ÓÂ˜ Î·È Ù· ·Ú¯ÈÎ¿ ÚÔÛ‚Â‚ÏËÌ¤Ó· fiÚÁ·Ó·. ∏ ‰fiÛË ÙË˜

·ÎÙÈÓÔıÂÚ·Â›·˜ ‹Ù·Ó ÛÂ fiÏÂ˜ ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ 20 Gy, ÂÊfi-

ÛÔÓ Ë ·ÂÈÎÔÓÈÛÙÈÎ‹ ·¿ÓÙËÛË ˘ÂÚ¤‚·ÈÓÂ ÙÔ 70%. ∂È‰ÈÎ¿

ÁÈ· ÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ ÛÙ¿‰ÈÔ IV, ÁÈ· ÙÔ ‹·Ú ¯ÔÚËÁ‹ıËÎ·Ó 12

¶›Ó·Î·˜ 1. £ÂÚ·Â›· ÙˆÓ ·ÛıÂÓÒÓ ÌÂ ÓfiÛÔ Hodgkin

1978-1988 A£ ª√¡√ (9*)Ã£ ª√¡√ (5) ª√PP:2*

ABVD:1∞§§√:2

X£ & ∞£ (5) ª√PP:2ABVD:3

1989-1993 Ã£ & ∞£ (26) ª√PP & ABVD: 15ABVD: 10A§§√: 1

1994-2005 X£ & ∞£ (28) ª√PP & ABVP:8VBVP:11

√PPA & COPP: 8ABVP/COP: 1

* ·ÚÈıÌfi˜ ·ÛıÂÓÒÓMOPP (mustine, vincristine, procarbazine, prednisone) ABVD/P (doxorubicin, bleomycin, vinblastine, DTIC/prednisone)VBVP (vinblastine, bleomycin, etoposide, prednisone), OPPA (vincristine, prednisone, procarbazine, doxorubicin) COPP (cyclophosfamide, vincristine, procarbazine,prednisone)

124 ∞. ¶Ô˘ÚÙÛ›‰Ë˜ Î·È Û˘Ó.



Gy, ÁÈ· Ù· ÔÛÙ¿ 20-30 Gy, ÂÓÒ ÁÈ· ÙÔ˘˜ ÓÂ‡ÌÔÓÂ˜ ¯ÔÚËÁ‹ıË-

Î·Ó 12 Gy ÌfiÓÔ ·Ó ‰ÂÓ ˘‹Ú¯Â Ï‹ÚË˜ ‡ÊÂÛË ÌÂÙ¿ ·fi ‰‡Ô

Û¯‹Ì·Ù· √PPA. ÃÚËÛÈÌÔÔÈ‹ıËÎÂ Ë Ì¤ıÔ‰Ô˜ Kaplan-Meier

ÁÈ· ÙÔÓ Î·ıÔÚÈÛÌfi ÙË˜ Û˘ÓÔÏÈÎ‹˜ ÂÈ‚›ˆÛË˜ Î·È ÙË˜ ¯ˆÚ›˜

ÓfiÛÔ ‹ Û‡Ì‚·Ì· ÂÈ‚›ˆÛË˜. ø˜ Û‡Ì‚·Ì· ıÂˆÚ‹ıËÎÂ Ô ı¿Ó·-

ÙÔ˜, Ë ˘ÔÙÚÔ‹ Î·È Ë ‰Â‡ÙÂÚË Î·ÎÔ‹ıÂÈ·. °È· ÙË ÛÙ·ÙÈÛÙÈÎ‹

·Ó¿Ï˘ÛË ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÔÈ ÂÍ‹˜ ÛÙ·ÙÈ-

ÛÙÈÎ¤˜ ‰ÔÎÈÌ·Û›Â˜: (1) ÌË ·Ú·ÌÂÙÚÈÎ‹ ‰ÔÎÈÌ·Û›· Mann-

Witney, (2) chi-square test Î·È (3) Fisher’s exact test.


™˘ÓÔÏÈÎ¿ ·ÓÙÈÌÂÙˆ›ÛıËÎ·Ó ÛÙÔ ÙÌ‹Ì· Ì·˜ 73

·È‰È¿, 46 ·ÁfiÚÈ· Î·È 27 ÎÔÚ›ÙÛÈ· (·ÁfiÚÈ·/ÎÔÚ›ÙÛÈ·:

1,7/1). ∏ ËÏÈÎ›· ÙˆÓ ·ÛıÂÓÒÓ Î˘Ì·ÈÓfiÙ·Ó ·fi 3,5-15

ÂÙÒÓ (‰È¿ÌÂÛË ÙÈÌ‹ 12 ¤ÙË) (Ù· ·ÁfiÚÈ· ·fi 3,5-15

ÂÙÒÓ Î·È Ù· ÎÔÚ›ÙÛÈ· ·fi 7,5-15 ÂÙÒÓ) (∂ÈÎfiÓ· 1). √

¯ÚfiÓÔ˜ ·fi ÙËÓ ÂÌÊ¿ÓÈÛË ÙÔ˘ ÚÒÙÔ˘ Û˘ÌÙÒÌ·ÙÔ˜

‹ ÎÏÈÓÈÎÔ‡ ÛËÌÂ›Ô˘ ¤ˆ˜ ÙË ‰È¿ÁÓˆÛË ÙË˜ ÓfiÛÔ˘ Î˘-

Ì·ÈÓfiÙ·Ó ·fi 3 ËÌ¤ÚÂ˜ ¤ˆ˜ 12 Ì‹ÓÂ˜ (¢∆ 2 Ì‹ÓÂ˜),

¯ˆÚ›˜ Ó· ‰È·ÈÛÙˆıÂ› Û˘Û¯¤ÙÈÛË ·˘ÙÔ‡ ÌÂ ÙËÓ ËÏÈÎ›·

‹ ÙÔ Ê‡ÏÔ. ™ÙËÓ ÏÂÈÔ„ËÊ›·, Ë ·ÈÙ›· ÙË˜ ·Ú¯ÈÎ‹˜

‰ÈÂÚÂ‡ÓËÛË˜ ÙÔ˘ ·ÛıÂÓÔ‡˜ ‹Ù·Ó Ë ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ·

(59 ·È‰È¿, 81%), ÂÓÒ 4 ·È‰È¿ ‰ÈÂÁÓÒÛıËÛ·Ó ÛÙ·

Ï·›ÛÈ· ‰ÈÂÚÂ‡ÓËÛË˜ ÂÌ˘Ú¤ÙÔ˘, 2 ÏfiÁˆ ¯ÚfiÓÈÔ˘

‚‹¯·, 3 ÏfiÁˆ Ù˘¯·›Ô˘ ·ÂÈÎÔÓÈÛÙÈÎÔ‡ ÂÏ¤Á¯Ô˘ Î·È 5

ÏfiÁˆ ¿ÏÏË˜ Û˘ÌÙˆÌ·ÙÔÏÔÁ›·˜ ‹ ÛËÌÂÈÔÏÔÁ›·˜ (ÛÂ

‰‡Ô ·È‰È¿ Ë ‰È¿ÁÓˆÛË ÂÙ¤ıË ÛÙ· Ï·›ÛÈ· ‰ÈÂÚÂ‡ÓË-

ÛË˜ ÓÂÊÚˆÛÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘, Ô˘ ·ÔÙÂÏÂ› ·Ú·ÓÂ-

ÔÏ·ÛÌ·ÙÈÎ‹ ÂÎ‰‹ÏˆÛË ÙË˜ ÓfiÛÔ˘ Hodgkin). ™Â 50

·È‰È¿ (68,5%) ‰ÂÓ ‰È·ÈÛÙÒıËÎ·Ó Û˘ÓÔ‰¿ Û˘ÌÙÒ-

Ì·Ù·, ÂÓÒ ÛÙ· ˘fiÏÔÈ·, ÂÎÙfi˜ ÙÔ˘ Î‡ÚÈÔ˘ Û˘ÌÙÒ-

Ì·ÙÔ˜/ÛËÌÂ›Ô˘, Û˘Ó˘‹Ú¯·Ó ·Ó·ÓÂ˘ÛÙÈÎ‹ ‰˘Û¯¤-

ÚÂÈ·, ‚‹¯·˜-ÏÂ˘ÚÔ‰˘Ó›·, ÂÌ‡ÚÂÙÔ, ÏÂÌÊ·‰ÂÓÔ¿-

ıÂÈ· ‹ Û˘Ó‰˘·ÛÌfi˜ ÙˆÓ ·ÓˆÙ¤Úˆ. ™˘ÌÙÒÌ·Ù· Ù‡-

Ô˘ µ ‰È·ÈÛÙÒıËÎ·Ó ÛÂ 21 ·È‰È¿ (28,8%) Î·È ÂÈ‰È-

ÎfiÙÂÚ· ·Ú·ÙÂÈÓfiÌÂÓÔ ˘Ú¤ÙÈÔ (¿Óˆ ÙˆÓ 10 ËÌÂ-

ÚÒÓ) ‰È·ÈÛÙÒıËÎÂ ÛÂ 10, ·ÒÏÂÈ· ‚¿ÚÔ˘˜ >10% ÛÂ

10, ÂÊÈ‰ÚÒÛÂÈ˜ ÛÂ 7 Î·È ÎÓËÛÌfi˜ ÛÂ ¿ÏÏ· 2. §ÂÌÊ·-

‰ÂÓÔ¿ıÂÈ· Î·Ù¿ ÙËÓ ÎÏÈÓÈÎ‹ ÂÍ¤Ù·ÛË ‰È·ÈÛÙÒıËÎÂ

ÛÂ 68 ·ÛıÂÓÂ›˜ (93%). ™Â 12 ÂÍ ·˘ÙÒÓ ‹Ù·Ó ·ÌÊÔÙÂ-

ÚfiÏÂ˘ÚË Î·È ÛÂ 56 ÂÙÂÚfiÏÂ˘ÚË. ∂ÓÙfiÈÛË ÛÙÔÓ

ÙÚ¿¯ËÏÔ ‰È·ÈÛÙÒıËÎÂ ÛÂ 55 ·È‰È¿, ÛÙÔ˘˜ ˘ÂÚ-

ÎÏÂ›‰ÈÔ˘˜ ‚fiıÚÔ˘˜ ÛÂ 41, ÛÙÈ˜ Ì·Û¯·ÏÈ·›Â˜ ÎÔÈÏfiÙË-

ÙÂ˜ ÛÂ 13 Î·È ÛÙË ‚Ô˘‚ˆÓÈÎ‹ ¯ÒÚ· ÛÂ 4. ∫·Ù¿ ÙË Ê˘-

ÛÈÎ‹ ÂÍ¤Ù·ÛË, Ë·ÙÔÌÂÁ·Ï›· ‰È·ÈÛÙÒıËÎÂ ÛÂ 2 ·È-

‰È¿ Î·È ÛÏËÓÔÌÂÁ·Ï›· ÛÂ 5. ∆· ÂÚÁ·ÛÙËÚÈ·Î¿ Â˘Ú‹-

Ì·Ù· ÙˆÓ ·ÛıÂÓÒÓ Ì·˜ Î·Ù¿ ÙË ‰È¿ÁÓˆÛË ÂÚÈÁÚ¿-

ÊÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2.

∞ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜

ŸÏÔÈ ÔÈ ·ÛıÂÓÂ›˜ ˘Ô‚Ï‹ıËÎ·Ó ÛÂ ·ÂÈÎÔÓÈÛÙÈÎ¤˜

ÂÍÂÙ¿ÛÂÈ˜ ÁÈ· ÛÙ·‰ÈÔÔ›ËÛË ÙË˜ ÓfiÛÔ˘. ∆Ô ˘ÂÚË¯Ô-

ÁÚ¿ÊËÌ· ÙÚ·¯‹ÏÔ˘ ‹Ù·Ó ıÂÙÈÎfi ÁÈ· Â˘Ú‹Ì·Ù· ÛÂ ·Ó·-

ÏÔÁ›· 86%, Ë ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ ÛÂ 43% Î·È Ë

˘ÔÏÔÁÈÛÙÈÎ‹ ÙÔÌÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ ÛÂ ·Ó·ÏÔÁ›·

67%. MÂÁ¿ÏË ‹ Ì¤ÙÚÈ· ‰ÈÂ‡Ú˘ÓÛË ÙÔ˘ ÌÂÛÔıˆÚ·Î›Ô˘

¶›Ó·Î·˜ 2. ∂ÚÁ·ÛÙËÚÈ·Î¤˜ ·Ú¿ÌÂÙÚÔÈ ÙˆÓ ·ÛıÂÓÒÓ ÙË˜ ÌÂÏ¤ÙË˜ Î·Ù¿ ÙË ‰È¿ÁÓˆÛË

™‡ÓÔÏÔ º‡ÏÔ∞ÁfiÚÈ· ∫ÔÚ›ÙÛÈ·

¢∆* ŸÚÈ· ¢∆* ¢∆* ƒ

∏ÏÈÎ›· (¤ÙË) 12 3,5-12 10,3 13 0,001WBC (x 103/mm3) 10,2 4,2-25 9,3 11,25 0,183¶ÔÏ˘ (%) 66 39-91 64,3 74 0,044∏ˆÛ (%) 3 0-11 3 2,5 0,768Hb (g/dl) 11,1 7,6-15 11,1 11,1 0,35∆∫∂ (mm 1Ë˜ ÒÚ·˜) 61 5-150 52 82 0,123PLT (x 103/mm3) 383 200-820 367 387 0,614CRP (mg/l) 72 0-173 51,8 81 0,577LDH (mg/dl) 380 206-1300 381 335 0,672

*¢∆: ‰È¿ÌÂÛË ÙÈÌ‹

125§¤ÌÊˆÌ· Hodgkin ÛÙ· ·È‰È¿

¶·È‰È·ÙÚÈÎ‹ 2009;72:125-000

151413121110987654

%

20

10

0

∫ÔÚ›ÙÛÈ·

∞ÁfiÚÈ·

3

7

6

5

3

2

1 23

10

43

8

21

33

6

1

∏ÏÈÎ›· (¤ÙË)

∂ÈÎfiÓ· 1. ¢ËÌÔÁÚ·ÊÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿.

¶›

19

19

19

* ·MABVBOPCO


‰È·ÈÛÙÒıËÎÂ ÛÂ Û˘¯ÓfiÙËÙ· 37% (7/19) Î·È 78%

(36/46) ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ ÈÛÙÔÏÔÁÈÎfi ˘fiÙ˘Ô ÌÈ-

ÎÙ‹˜ Î˘ÙÙ·ÚÔ‚Ú›ıÂÈ·˜ Î·È Ô˙Ò‰Ô˘˜ ÛÎÏ‹Ú˘ÓÛË˜

·ÓÙ›ÛÙÔÈ¯·. ™Â ÂÚ›ÙˆÛË ‰ÈÂ‡Ú˘ÓÛË˜ ÌÂÛÔıˆÚ·Î›-

Ô˘ Î·Ù·‰ÂÈÎÓ˘fiÌÂÓË˜ ÌÂ ˘ÔÏÔÁÈÛÙÈÎ‹ ÙÔÌÔÁÚ·Ê›·

(100%), Ë ·Ï‹ ·ÎÙÈÓÔÁÚ·Ê›· ·ÔÎ¿Ï˘ÙÂ ÙË ‰ÈÂ‡-

Ú˘ÓÛË ÛÙÔ 86%. ∆Ô ˘ÂÚË¯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜ Î·È Ë

˘ÔÏÔÁÈÛÙÈÎ‹ ÙÔÌÔÁÚ·Ê›· ÎÔÈÏ›·˜ ·ÔÎ¿Ï˘„·Ó ·-

ıÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù· ÛÙÔ 49% Î·È 40%, ·ÓÙ›ÛÙÔÈ¯·.

∏·ÙÔÌÂÁ·Ï›· ‰È·ÈÛÙÒıËÎÂ ÛÂ 7 ·È‰È¿, ÛÏËÓÔ-

ÌÂÁ·Ï›· ÛÂ 13, Ô˙Ò‰ÂÈ˜ ‰ÈËı‹ÛÂÈ˜ ¯·Ú·ÎÙËÚÈÛÙÈÎ¤˜

ÏÂÌÊÒÌ·ÙÔ˜ ∏odgkin ‰È·ÈÛÙÒıËÎ·Ó ÛÙÔ ‹·Ú ÛÂ 3

·È‰È¿, ÛÙÔ ÛÏ‹Ó· ÛÂ 14 ·È‰È¿, ÂÓÒ ·ÓÔÌÔÈÔÁ¤ÓÂÈ·

ÓÂÊÚÒÓ ‰È·ÈÛÙÒıËÎÂ ÛÂ ¤Ó· ·È‰›. ™Â 12 ·È‰È¿

‰È·ÈÛÙÒıËÎÂ Û˘Ó‰˘·ÛÌfi˜ 2 ‹ 3 ÂÎ ÙˆÓ ·ÓˆÙ¤Úˆ

Â˘ÚËÌ¿ÙˆÓ, Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓË˜ Î·È ÙË˜ ÏÂÌÊ·-

‰ÂÓÔ¿ıÂÈ·˜. ∆¤ÏÔ˜, ÏÂÌÊ·ÁÁÂÈÔÁÚ·Ê›· (ÎÏ·ÛÈÎ‹ ‹

Ú·‰ÈÔ˚ÛÔÙÔÈÎ‹) Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ ÛÂ 17 ·È‰È¿

Î·È ‹Ù·Ó ·ıÔÏÔÁÈÎ‹ ÛÂ 6.

™Ù·‰ÈÔÔ›ËÛË

ªÂ ‚¿ÛË ÎÏÈÓÈÎ¿ Î·È ·ÂÈÎÔÓÈÛÙÈÎ¿ Â˘Ú‹Ì·Ù·, 16

(22%) ·È‰È¿ Ù·ÍÈÓÔÌ‹ıËÎ·Ó ˜ ÛÙ·‰›Ô˘ π, 25 (34%)

ˆ˜ ÛÙ·‰›Ô˘ ππ (II∞: 11, IIB: 14), 20 (27,5%) ˆ˜ ÛÙ·‰›-

Ô˘ πππ (III∞: 6, IIIB: 14) Î·È 12 (16,5%) ˆ˜ ÛÙ·‰›Ô˘ IV

(IV∞: 5, IVB: 7).

™Â ¯ÂÈÚÔ˘ÚÁÈÎ‹ ÛÙ·‰ÈÔÔ›ËÛË ÌÂ ÛÏËÓÂÎÙÔÌ‹

˘Ô‚Ï‹ıËÎ·Ó 3 ·È‰È¿ ÛÙ· ÚÒÙ· ¯ÚfiÓÈ· ÙË˜ ÌÂÏ¤-

ÙË˜. ¢È‹ıËÛË ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ ‰È·ÈÛÙÒıËÎÂ

ÌÂ ÔÛÙÂÔÌ˘ÂÏÈÎ‹ ‚ÈÔ„›· ÛÙÔ 5% ÙˆÓ ·È‰ÈÒÓ. ™Â

‚ÈÔ„›· ‹·ÙÔ˜ ˘Ô‚Ï‹ıËÎ·Ó 5 ·È‰È¿ Î·È ÛÂ fiÏ·

‹Ù·Ó ·ÚÓËÙÈÎ‹. ™˘ÌÌÂÙÔ¯‹ ·fi Ù· ÔÛÙ¿ ‰È·ÈÛÙÒ-

ıËÎÂ ÌÂ ÛÈÓıËÚÔÁÚ¿ÊËÌ· ÔÛÙÒÓ ÛÂ 4/73 ·È‰È¿

Î·È ·ÂÈÎÔÓÈÛÙÈÎ¿ ÔÚ·Ù¤˜ ÓÂ˘ÌÔÓÈÎ¤˜ ‰ÈËı‹ÛÂÈ˜

ÛÂ 3/73.

πÛÙÔÏÔÁÈÎfi˜ Ù‡Ô˜

™ÙËÓ ÏÂÈÔ„ËÊ›· ÙˆÓ ·È‰ÈÒÓ (46/73, 63%) ‰È·-

ÈÛÙÒıËÎÂ Ô ÈÛÙÔÏÔÁÈÎfi˜ ˘fiÙ˘Ô˜ ÙË˜ Ô˙Ò‰Ô˘˜

ÛÎÏ‹Ú˘ÓÛË˜. √ ˘fiÙ˘Ô˜ ÙË˜ ÌÈÎÙ‹˜ Î˘ÙÙ·ÚÔ‚Ú›-

ıÂÈ·˜ ‰È·ÈÛÙÒıËÎÂ Û˘¯ÓfiÙÂÚ· ÛÂ ·ÛıÂÓÂ›˜ ÛÙ·‰›-

Ô˘ π & ππI, Ë Ô˙Ò‰Ë˜ ÛÎÏ‹Ú˘ÓÛË ÛÂ ·ÛıÂÓÂ›˜ ÛÙ·‰›-

Ô˘ ππ, Ô ÏÂÌÊÔÂÈÎÚ·ÙÒÓ ÛÂ ·ÛıÂÓÂ›˜ ÛÙ·‰›Ô˘ π, ÂÓÒ

Ù· ‰‡Ô ·È‰È¿ ÌÂ ÏÂÌÊÔÂÓÈÎfi ˘fiÙ˘Ô ‹Ù·Ó ÛÙ·-

‰›Ô˘ πV (¶›Ó·Î·˜ 3). ∏ Û˘Û¯¤ÙÈÛË ÙÔ˘ ÈÛÙÔÏÔÁÈÎÔ‡

˘ÔÙ‡Ô˘ Î·È ÙÔ˘ ÛÙ·‰›Ô˘ ÙË˜ ÓfiÛÔ˘ ÌÂ ÂÈ‰ËÌÈÔ-

ÏÔÁÈÎ¿ Î·È ÂÚÁ·ÛÙËÚÈ·Î¿ ‰Â‰ÔÌ¤Ó· ÂÚÈÁÚ¿ÊÂÙ·È

ÛÙÔÓ ¶›Ó·Î· 4.

¶›Ó·Î·˜ 4. ™˘Û¯¤ÙÈÛË ÂÈ‰ËÌÈÔÏÔÁÈÎÒÓ Î·È ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ·Ú·Ì¤ÙÚˆÓ ÌÂ ÙÔ ÛÙ¿‰ÈÔ Î·È ÙËÓ ÈÛÙÔÏÔÁ›·

™Ù¿‰ÈÔ πÛÙÔÏÔÁ›·***π ππ πππ πV P ª §¶ §∂ √™ ƒ

º‡ÏÔ (·Á:ÎÔ)* 13:3 13:12 12:8 8:4 0,393 18:1 2:0 6:0 20:26 0,000∏ÏÈÎ›· (¤ÙË)** 9,3 12,1 12,1 13 0,102 10 11,6 10,5 12,7 0,017WBC (x 103/mm3)** 8,75 12,19 9 10,4 0,027 8,4 4,7 8,5 11,4 0,007¶ÔÏ˘ (%)** 55 74 62 77 0,002 63 60,5 57 70 ns#

∏ˆÛ (%)** 3 2 3 2,4 0,173 2,8 2,5 3 3 nsHb (g/dl)** 12,9 11,1 11,1 10,9 0,014 11,1 10,6 13,8 11,1 nsPLT (x 103/mm3)** 200 400 403 383 0,022 367 384 301 393 ns∆∫∂ (mm 1Ë˜ ÒÚ·˜)** 16,5 70 75 115 0,001 59 65 16 70 nsCRP (mg/l)** 20 57 80 110 0,398 57 - 27 74 nsLDH (mg/dl)** 498 330 380 404 0,44 323 - 380 383 ns

* ·Á: ·ÁfiÚÈ·, ÎÔ: ÎÔÚ›ÙÛÈ·** ‰È¿ÌÂÛÂ˜ ÙÈÌ¤˜

*** ª: ÌÈÎÙ‹˜ Î˘ÙÙ·ÚÔ‚Ú›ıÂÈ·˜, §¶: ÏÂÌÊÔÂÓÈÎfi˜, §∂: ÏÂÌÊÔÂÈÎÚ·ÙÒÓ, √™: Ô˙Ò‰Ô˘˜ ÛÎÏ‹Ú˘ÓÛË˜# ÌË ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿, ¶√§À: ÔÏ˘ÌÔÚÊÔ‡ÚËÓ·, ∏ø™: ËˆÛÈÓfiÊÈÏ·

126 ∞. ¶Ô˘ÚÙÛ›‰Ë˜ Î·È Û˘Ó.


¶›Ó·Î·˜ 3. πÛÙÔÏÔÁÈÎfi˜ ˘fiÙ˘Ô˜ Î·È ÛÙ¿‰ÈÔ ÙË˜ ÓfiÛÔ˘

™‡ÓÔÏÔ ™Ù¿‰ÈÔπ ππ πππ IV

ªÈÎÙ‹˜ Î˘ÙÙ·ÚÔ‚Ú›ıÂÈ·˜ 19* (26)** 6 (37,5) 4 (16) 7 (35) 2 (16,7)§ÂÌÊÔÂÓÈÎfi˜ 2 (2,7) - - - 2 (16,7)§ÂÌÊÔÂÈÎÚ·ÙÒÓ 6 (8,2) 4 (25) 1 (4) 1 (5) -√˙Ò‰Ë˜ ÛÎÏ‹Ú˘ÓÛË 46 (63) 6 (37,5) 20 (80) 12 (60) 8 (66,6)™‡ÓÔÏÔ 73 (100) 16 (22) 25 (34) 20 (27,5) 12 (16,5)

*·ÚÈıÌfi˜ ·ÛıÂÓÒÓ, **(%) ·Ó·ÏÔÁ›· ·ÛıÂÓÒÓ


£ÂÚ·Â›·

∏ ıÂÚ·Â›· ÎÚ›ıËÎÂ ˆ˜ Â·ÚÎ‹˜ ÛÂ 68 ·ÛıÂÓÂ›˜

Î·È ·ÓÂ·ÚÎ‹˜ ÛÂ 5. ™Â 68 ·È‰È¿ Ô˘ ¤Ï·‚·Ó ·ÎÙÈ-

ÓÔıÂÚ·Â›·, ·˘Ù‹ ‹Ù·Ó Â·ÚÎ‹˜ ÛÂ 66. ™Â fiÏÔ˘˜

ÙÔ˘˜ ·ÛıÂÓÂ›˜ Ô˘ ¤Ï·‚·Ó ∞£, ·˘Ù‹ ‹Ù·Ó ÂÛÙÈ·Î‹,

ÂÓÒ ÔÈ 56 ÂÍ ·˘ÙÒÓ ¤Ï·‚·Ó 20 Gy, ÔÈ 4 30 Gy Î·È ÔÈ 8

40 Gy ÛÙ· ÚÒÙ· ¯ÚfiÓÈ· ÙË˜ ÌÂÏ¤ÙË˜.

ŒÎ‚·ÛË

™ÙÔ˘˜ 73 ·ÛıÂÓÂ›˜ ÙË˜ ÌÂÏ¤ÙË˜ ÛËÌÂÈÒıËÎ·Ó 8

˘ÔÙÚÔ¤˜ (11%), 20-65 Ì‹ÓÂ˜ ·fi ÙË ‰È¿ÁÓˆÛË (¢∆

30). ∆· ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ·ÚÔ˘Û›·-

Û·Ó ˘ÔÙÚÔ‹ ÂÚÈÁÚ¿ÊÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 5. ∏ ·Ú-

¯ÈÎ‹ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ˘ÔÙÚÔ‹˜ ÂÚÈÂÏ¿Ì‚·ÓÂ

ÌfiÓÔ Ã£ ‰Â‡ÙÂÚË˜ ÁÚ·ÌÌ‹˜ ÛÂ 3 ÂÚÈÙÒÛÂÈ˜ Î·È

Û˘Ó‰˘·ÛÌfi Ã£ & ∞£ ÛÂ 5. ™Â 6/8 ·È‰È¿ ¤ÁÈÓÂ Î·È

·˘ÙfiÏÔÁË ÌÂÙ·ÌfiÛ¯Â˘ÛË Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ. ∞fi Ù·

8 ·È‰È¿ Ô˘ ·ÚÔ˘Û›·Û·Ó ˘ÔÙÚÔ‹ ˙Ô˘Ó Ù· 7, 12-

270 Ì‹ÓÂ˜ (¢∆ 95) ·fi ÙË ‰È¿ÁÓˆÛË ÙË˜ ˘ÔÙÚÔ‹˜

Î·È 32-310 Ì‹ÓÂ˜ (¢∆ 125) ·fi ÙË ‰È¿ÁÓˆÛË ÙË˜ Ófi-

ÛÔ˘ (ÂÈ‚›ˆÛË ÛÂ 2Ë ‡ÊÂÛË: 89%). ¢Â‡ÙÂÚË ‹ ÙÚ›ÙË

Î·ÎÔ‹ıÂÈ· ‰È·ÈÛÙÒıËÎÂ ÛÂ 4 ·È‰È¿, ·fi Ù· ÔÔ›·

˙Ô˘Ó Ù· 3. ∆· ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ÂÌ-

Ê¿ÓÈÛ·Ó ‰Â‡ÙÂÚË ‹ ÙÚ›ÙË Î·ÎÔ‹ıÂÈ· ÂÚÈÁÚ¿ÊÔÓÙ·È

ÛÙÔÓ ¶›Ó·Î· 6. ™˘ÓÔÏÈÎ¿ ˙Ô˘Ó 71/73 ·ÛıÂÓÂ›˜ (Û˘ÓÔ-

ÏÈÎ‹ ÂÈ‚›ˆÛË: 97,3%), 24-366 Ì‹ÓÂ˜ ·fi ÙË ‰È¿ÁÓˆ-

ÛË (¢∆ 156 Ì‹ÓÂ˜) (ÂÈ‚›ˆÛË ÂÏÂ‡ıÂÚË Û˘Ì‚¿Ì·ÙÔ˜:

83,6% - 61/73) (∂ÈÎfiÓÂ˜ 2, 3). ∆· 64 ·fi Ù· 73 ·È‰È¿

(87,7%) ˙Ô˘Ó ÛÂ Ï‹ÚË ÚÒÙË ‡ÊÂÛË.

¶ÚÔÁÓˆÛÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜

∏ Û˘Û¯¤ÙÈÛË ÂÈ‰ËÌÈÔÏÔÁÈÎÒÓ, ÎÏÈÓÈÎÒÓ, ·ÂÈ-

ÎÔÓÈÛÙÈÎÒÓ, ÂÚÁ·ÛÙËÚÈ·ÎÒÓ Î·È ıÂÚ·Â˘ÙÈÎÒÓ ·-

Ú·Ì¤ÙÚˆÓ ÌÂ ÙËÓ ¤Î‚·ÛË ÙË˜ ÓfiÛÔ˘ ÂÚÈÁÚ¿ÊÂÙ·È

ÛÙÔÓ ¶›Ó·Î· 7.

™˘˙‹ÙËÛË

∆Ô Ï¤ÌÊˆÌ· ‹ ÓfiÛÔ˜ ÙÔ˘ Hodgkin ÂÚÈÁÚ¿ÊËÎÂ

¶›Ó·Î·˜ 6. Ã·Ú·ÎÙËÚÈÛÙÈÎ¿ ·ÛıÂÓÒÓ ÌÂ ‰Â‡ÙÂÚË ‹ ÙÚ›ÙË Î·ÎÔ‹ıÂÈ·

Ãƒ√ ºÀ ∏§π ™∆ π™∆ £ÂÚ·Â›· ∂›‰Ô˜ ∂›‰Ô˜ ∞£ ŒÎ‚·ÛË ÃÚfiÓÔ˜Â·ÚÎ‹˜ ıÂÚ·Â›·˜ Ã£ ∂·ÚÎ‹˜ ¢fiÛË ∂ÓÙfiÈÛË

1 204* ∞° 13** π §∂ ¡∞π ∞£ ¡∞π 40Gy ∂ÛÙÈ·Î‹ ¢ÂÓ ˙ÂÈ2 144 ∞° 4,9 π √™ ¡∞π Ã£ & ∞£ ∞µVD ¡∞π 20 Gy ∂ÛÙÈ·Î‹ ∑ÂÈ 178*3 48 ∫√ 12,2 ππ √™ ¡∞π Ã£ & ∞£ VBVP + OPPA ¡∞π 20 Gy ∂ÛÙÈ·Î‹ ∑ÂÈ 614 71 ∫√ 11,2 ππ √™ ¡∞π Ã£ & ∞£ ABVD + MOPP ¡∞π 20 Gy ∂ÛÙÈ·Î‹ ∑ÂÈ 175

Ãƒ√: ¯ÚfiÓÔ˜ ·fi ÙË ‰È¿ÁÓˆÛË, ºÀ: Ê‡ÏÔ, ∞°: ·ÁfiÚÈ·, ∫√: ÎÔÚ›ÙÛÈ·, ∏§π: ËÏÈÎ›·, ™∆: ÛÙ¿‰ÈÔ, I™∆: ÈÛÙÔÏÔÁÈÎfi˜ ˘fiÙ˘Ô˜, §∂:ÏÂÌÊÔÂÈÎÚ·ÙÒÓ, √™: Ô˙Ò‰Ë˜ ÛÎÏ‹Ú˘ÓÛË*Ì‹ÓÂ˜ ·fi ‰È¿ÁÓˆÛË, **¤ÙË1. ∞‰ÂÓÔÎ·ÚÎ›ÓˆÌ· ÛÙÔÌ¿¯Ô˘ (2Ë) Î·È Î·ÚÎ›ÓÔ˜ Ì·ÛÙÔ‡ (3Ë) 228 Ì‹ÓÂ˜ ·fi ÙË ‰È¿ÁÓˆÛË, ÏfiÁˆ ÙÔ˘ ÔÔ›Ô˘ Î·Ù¤ÏËÍÂ2. ∫·ÚÎ›ÓÔ˜ ı˘ÚÂÔÂÈ‰Ô‡˜3. ∫·ÚÎ›ÓÔ˜ ı˘ÚÂÔÂÈ‰Ô‡˜4. ∫·ÚÎ›ÓÔ˜ ı˘ÚÂÔÂÈ‰Ô‡˜ (2Ë) Î·È ÔÛÙÂÔÛ¿ÚÎˆÌ· (3Ë) 94 Ì‹ÓÂ˜ ·fi ÙË ‰È¿ÁÓˆÛË


¶·È‰È·ÙÚÈÎ‹ 2009;72:127-000

¶›Ó·Î·˜ 5. Ã·Ú·ÎÙËÚÈÛÙÈÎ¿ ·ÛıÂÓÒÓ ÌÂ ˘ÔÙÚÔ‹

Ãƒ√ ºÀ ∏§π ™∆ π™∆ £ÂÚ·Â›· ∂›‰Ô˜ ∂›‰Ô˜ ∞£ ŒÎ‚·ÛË ÃÚfiÓÔ˜Â·ÚÎ‹˜ ıÂÚ·Â›·˜ Ã£ ∂·ÚÎ‹˜ ¢fiÛË ∂ÓÙfiÈÛË

1 20* ∫√ 13.5** πV √™ ¡∞π Ã£ & ∞£ OPPA + ¡∞π 20 Gy ∂ÛÙÈ·Î‹ ∑ÂÈ 32*COPP

2 30 ∞° 4.5 π ª∫ ¡∞π ∞£ ¡∞π 40 Gy ∂ÛÙÈ·Î‹ ∑ÂÈ 2533 24 A° 8 ππ ª∫ ¡∞π Ã£ & ∞£ VBVP ¡∞π 20 Gy ∂ÛÙÈ·Î‹ ∑ÂÈ 904 40 ∫√ 14.2 πππ √™ √Ãπ Ã£ §√π¶∞ ¢ÂÓ ˙ÂÈ5 40 ∫√ 14 πππ √™ √Ãπ Ã£ MOPP ∑ÂÈ 3106 30 ∞° 13.2 πππ √™ ¡∞π Ã£ & ∞£ ABVD + ¡∞π 20 Gy ∂ÛÙÈ·Î‹ ∑ÂÈ 125

MOPP7 25 ∞° 6 πV √™ √Ãπ Ã£ & ∞£ ABVD + ¡∞π 20 Gy ∂ÛÙÈ·Î‹ ∑ÂÈ 223

MOPP8 65 ∞° 14 πV √™ √Ãπ Ã£ & ∞£ OPPA + √Ãπ 20 Gy ∂ÛÙÈ·Î‹ ∑ÂÈ 78

COPP

Ãƒ√: ¯ÚfiÓÔ˜ ·fi ÙË ‰È¿ÁÓˆÛË, ºÀ: Ê‡ÏÔ, ∞°: ·ÁfiÚÈ·, ∫√: ÎÔÚ›ÙÛÈ·, ∏§π: ËÏÈÎ›· ™∆: ÛÙ¿‰ÈÔ. I™∆: ÈÛÙÔÏÔÁÈÎfi˜ ˘fiÙ˘Ô˜, √™: Ô˙Ò‰Ë˜ ÛÎÏ‹Ú˘ÓÛË, ª∫: ÌÈÎÙ‹˜ Î˘ÙÙ·ÚÔ‚Ú›ıÂÈ·˜, §∂: ÏÂÌÊÔÂÈÎÚ·ÙÒÓ*Ì‹ÓÂ˜ ·fi ‰È¿ÁÓˆÛË, **¤ÙË


ÁÈ· ÚÒÙË ÊÔÚ¿ ·fi ÙÔÓ Thomas Hodgkin ÙÔ 1932.

∏ ·ÈÙÈÔÏÔÁ›· ÙË˜ ÓfiÛÔ˘ ·Ú·Ì¤ÓÂÈ ·‰ÈÂ˘ÎÚ›ÓÈÛÙË.

∞ÔÙ¤ÏÂÛÂ ÁÈ· ÔÏÏ¤˜ ‰ÂÎ·ÂÙ›Â˜ ·ÓÙÈÎÂ›ÌÂÓÔ ÂÈ-

‰ËÌÈÔÏÔÁÈÎÒÓ ÂÚÂ˘ÓÒÓ, Ù· Â˘Ú‹Ì·Ù· ÙˆÓ ÔÔ›ˆÓ

Ê·›ÓÂÙ·È Ó· Ô‰ÂÈÎÓ‡Ô˘Ó ‰È·ÊÔÚÂÙÈÎÔ‡˜ ·ÈÙÈÔÏÔÁÈ-

ÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜ ·Ó¿ÏÔÁ· ÌÂ ÙËÓ ËÏÈÎ›·. ™‡ÌÊˆÓ·

ÌÂ ÙÔ ™‡ÛÙËÌ· ∆·ÍÈÓfiÌËÛË˜ ÙÔ˘ ¶·ÁÎfiÛÌÈÔ˘ √ÚÁ·-

ÓÈÛÌÔ‡ ÀÁÂ›·˜ (¶√À), Î·ıÔÚ›˙ÔÓÙ·È ‰‡Ô Î‡ÚÈÔÈ Ù‡-

ÔÈ ÏÂÌÊˆÌ¿ÙˆÓ Hodgkin, Î·ı¤Ó·˜ ·fi ÙÔ˘˜ ÔÔ›-

Ô˘˜ ¤¯ÂÈ ÂÈ‰ÈÎ¿ ÎÏÈÓÈÎ¿ Î·È ÚÔÁÓˆÛÙÈÎ¿ ¯·Ú·ÎÙËÚÈ-

ÛÙÈÎ¿: Ë ÎÏ·ÛÈÎ‹ ÓfiÛÔ˜ (Classical Hodgkin’s

lymphoma, CHL) Î·È Ô Ù‡Ô˜ Ô˙Ò‰Ô˘˜ ÏÂÌÊÔÎ˘Ù-

Ù·ÚÈÎ‹˜ ÂÈÎÚ¿ÙËÛË˜ (Nodular lymphocyte

predominance Hodgkin’s lymphoma, NLPHL) (11).

√È ÎÏ·ÛÈÎÔ› ˘fiÙ˘ÔÈ ÙË˜ ÓfiÛÔ˘ Û˘Ó‰¤ÔÓÙ·È Û˘Ó‹-

ıˆ˜ ÌÂ ÛÙ¿‰ÈÔ ππ-πππ (63-78% ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· Î·È

62% ÛÙË ÌÂÏ¤ÙË Ì·˜). O Ù‡Ô˜ ÙË˜ Ô˙Ò‰Ô˘˜ ÏÂÌÊÔ-

Î˘ÙÙ·ÚÈÎ‹˜ ÂÈÎÚ¿ÙËÛË˜ ··ÓÙ¿Ù·È ÛÂ ËÏÈÎ›Â˜ 25-

45 ÂÙÒÓ, ÌÂ ÂÈÎÚ¿ÙËÛË ÙÔ˘ ¿ÚÚÂÓÔ˜ Ê‡ÏÔ˘, Î·È

·ÔÙÂÏÂ› ÙÔ 5% ÙˆÓ ÏÂÌÊˆÌ¿ÙˆÓ Hodgkin (12).

∞fi ÙÔ ÎÏ·ÛÈÎfi Ï¤ÌÊˆÌ· Hodgkin, Ô ÏÂÌÊÔÂÈÎÚ·-

ÙÒÓ ˘fiÙ˘Ô˜ ‰È·ÈÛÙÒÓÂÙ·È ÛÙÔ 10-15% ÙˆÓ ·ÛıÂ-

ÓÒÓ, Â›Ó·È ÈÔ Û˘¯Ófi˜ ÛÙÔ ¿ÚÚÂÓ Ê‡ÏÔ Î·È ÙÔ˘˜ ÌÈ-

ÎÚfiÙÂÚÔ˘˜ ÛÂ ËÏÈÎ›· ·ÛıÂÓÂ›˜, ÂÓÒ Û˘Ó‰¤ÂÙ·È Û˘-

¯ÓfiÙÂÚ· ÌÂ ÂÓÙÔÈÛÌ¤ÓË ÓfiÛÔ (3). √ ÏÂÌÊÔÂÓÈÎfi˜

˘fiÙ˘Ô˜ Â›Ó·È ÂÍ·ÈÚÂÙÈÎ¿ Û¿ÓÈÔ˜ ÛÙ· ·È‰È¿

(~5%), ÂÓÒ Û˘Ó‰¤ÂÙ·È Û˘¯Ó¿ ÌÂ HIV ÏÔ›ÌˆÍË.

∞ÛıÂÓÂ›˜ ÌÂ ·˘ÙfiÓ ÙÔÓ Ù‡Ô Û˘Ó‹ıˆ˜ ¤¯Ô˘Ó Û˘-

ÌÙÒÌ·Ù· Ù‡Ô˘ µ, ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÌÂ Ù·¯¤ˆ˜ ÂÍÂ-

ÏÈÛÛfiÌÂÓË ÓfiÛÔ Ô˘ ÂÚÈÏ·Ì‚¿ÓÂÈ Ù· ÔÛÙ¿ Î·È ÙÔÓ

Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ Î·È ·ÚÔ˘ÛÈ¿˙ÂÈ ÙË ¯ÂÈÚfiÙÂÚË

ÚfiÁÓˆÛË ·fi fiÏÔ˘˜ ÙÔ˘˜ ˘fiÙ˘Ô˘˜ (3,5). √ ˘fi-

Ù˘Ô˜ ÙË˜ ÌÈÎÙ‹˜ Î˘ÙÙ·ÚÔ‚Ú›ıÂÈ·˜ ÂÌÊ·Ó›˙ÂÙ·È ÛÙÔ

14-38% ÙˆÓ ·ÛıÂÓÒÓ (5,6,11), ‰È·ÈÛÙÒÓÂÙ·È Û˘¯Ófi-

ÙÂÚ· ÛÂ ·È‰È¿ 10 ÂÙÒÓ ‹ ÌÈÎÚfiÙÂÚ· Î·È ÂÌÊ·Ó›˙ÂÙ·È

Û˘¯Ó¿ ˆ˜ ÚÔ¯ˆÚËÌ¤ÓË ÓfiÛÔ˜ ÌÂ ÂÍˆÏÂÌÊ·‰ÂÓÈÎ‹

ÂÓÙfiÈÛË. ∏ Ô˙Ò‰Ë˜ ÛÎÏ‹Ú˘ÓÛË ·ÔÙÂÏÂ› ÙÔÓ ÈÔ

Û˘¯Ófi ˘fiÙ˘Ô ÛÙÈ˜ ·ÓÂÙ˘ÁÌ¤ÓÂ˜ ¯ÒÚÂ˜ Î·È ÂÌÊ·-

Ó›˙ÂÙ·È Û˘¯ÓfiÙÂÚ· ÛÙÔ˘˜ ÂÊ‹‚Ô˘˜ Î·È ÙÔ˘˜ ÓÂ·ÚÔ‡˜

ÂÓ‹ÏÈÎÂ˜. ¶·Ú·ÙËÚÂ›Ù·È ÛÙÔ 40% ÙˆÓ ÓÂfiÙÂÚˆÓ

·ÛıÂÓÒÓ Î·È ÛÙÔ 70% ÙˆÓ ÂÊ‹‚ˆÓ. ∞ÔÙÂÏÂ› ÙÔÓ

ÌfiÓÔ ˘fiÙ˘Ô ÛÙÔÓ ÔÔ›Ô ‰ÂÓ ÂÈÎÚ·ÙÂ› ÙÔ ¿ÚÚÂÓ

Ê‡ÏÔ, Î·ıÒ˜ ‰È·ÈÛÙÒÓÂÙ·È ÌÂ ›ÛË Û˘¯ÓfiÙËÙ· ÛÂ ¿Ú-

ÚÂÓ· Î·È ı‹ÏÂ· (13). °ÂÓÈÎ¿, Ô ÏÂÌÊÔÂÈÎÚ·ÙÒÓ

˘fiÙ˘Ô˜ Î·È ·˘Ùfi˜ ÙË˜ Ô˙Ò‰Ô˘˜ ÛÎÏ‹Ú˘ÓÛË˜ Û¯Â-

Ù›˙ÔÓÙ·È ÌÂ ÓfiÛÔ ¯·ÌËÏÔ‡ ÛÙ·‰›Ô˘, Ô ÏÂÌÊÔÂÓÈÎfi˜

ÌÂ ÚÔ¯ˆÚËÌ¤Ó· ÛÙ¿‰È·, ÂÓÒ Ô ˘fiÙ˘Ô˜ ÙË˜ ÌÈ-

ÎÙ‹˜ Î˘ÙÙ·ÚÔ‚Ú›ıÂÈ·˜ ÌÂ ÂÓ‰È¿ÌÂÛ·. ™ÙÔ˘˜ ·ÛıÂ-

ÓÂ›˜ Ì·˜ ÂÈÎÚ·ÙÂ› Ë Ô˙Ò‰Ë˜ ÛÎÏ‹Ú˘ÓÛË (63%), ÂÓÒ

ÌfiÓÔ ÛÂ ‰‡Ô ·È‰È¿ ‰È·ÈÛÙÒıËÎÂ ÏÂÌÊÔÂÓÈÎfi˜

˘fiÙ˘Ô˜. ∆¤ÏÔ˜, fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ¤Î‚·ÛË ‰ÂÓ ‰È·-

ÈÛÙÒıËÎÂ Â›‰Ú·ÛË ÙË˜ ÈÛÙÔÏÔÁ›·˜, ÛÂ Û˘ÌÊˆÓ›·

ÌÂ Ù· Â˘Ú‹Ì·Ù· ¿ÏÏˆÓ ÌÂÏÂÙÒÓ (5,6). º·›ÓÂÙ·È ˆ˜

ÌÂÙ¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙˆÓ Û‡Á¯ÚÔÓˆÓ Û¯ËÌ¿ÙˆÓ ËÌÂÈ-

ÔıÂÚ·Â›·˜, Ù· ÈÛÙÔÏÔÁÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ¤¯Ô˘Ó

ÌÈÎÚfiÙÂÚË ÚÔÁÓˆÛÙÈÎ‹ ÛËÌ·Û›· (14).

∏ ‰È¿ÌÂÛË ÙÈÌ‹ ËÏÈÎ›·˜ ÙˆÓ ·ÛıÂÓÒÓ ÙË˜ ÌÂÏ¤-

ÙË˜ Ì·˜ ‹Ù·Ó 12 ¤ÙË, ÂÓÒ ·ÍÈÔÛËÌÂ›ˆÙË Â›Ó·È Ë Û˘-

¯ÓfiÙËÙ· ÙˆÓ ·ÛıÂÓÒÓ ËÏÈÎ›·˜ 5 ÂÙÒÓ ‹ ÌÈÎÚfiÙÂÚË˜

(9,6%, 7 ·ÛıÂÓÂ›˜). ∆Ô ÔÛÔÛÙfi ·È‰ÈÒÓ ÌÂ ËÏÈÎ›·

Î¿Ùˆ ÙˆÓ 5 ÂÙÒÓ ÛÙËÓ ÌÂÏ¤ÙË Ì·˜ Â›Ó·È ˘„ËÏfiÙÂÚÔ

·fi ·ÓÙ›ÛÙÔÈ¯· ÛÂ ·ÓÂÙ˘ÁÌ¤ÓÂ˜ ¯ÒÚÂ˜ (4), ·ÏÏ¿

ÚÔÛÂÁÁ›˙ÂÈ ‹ Û·ÊÒ˜ ÔÏÂ›ÂÙ·È ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô Ô-

ÛÔÛÙfi ¯ˆÚÒÓ ÙË˜ ¢˘ÙÈÎ‹˜ ∞Û›·˜ Î·È ¿ÏÏˆÓ ·Ó·-

Ù˘ÛÛfiÌÂÓˆÓ ¯ˆÚÒÓ (15,16). ø˜ ÚÔ˜ ÙÔ Ê‡ÏÔ, ÛÙË

‚È‚ÏÈÔÁÚ·Ê›· ‰È·ÈÛÙÒÓÂÙ·È ÌÈ· ÂÏ·ÊÚ¿ ÂÈÎÚ¿ÙË-

ÛË ÙˆÓ ·ÚÚ¤ÓˆÓ (1.5:1), Ô˘ fiÌˆ˜ Êı›ÓÂÈ ÌÂ ÙËÓ ¿-

ÚÔ‰Ô ÙË˜ ËÏÈÎ›·˜, ÌÂ ÙËÓ ·Ó·ÏÔÁ›· Ó· Â›Ó·È ·Úfi-

ÌÔÈ· ÛÙÔ˘˜ ÂÊ‹‚Ô˘˜ (3). ™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË ‰È·-

ÈÛÙÒÓÂÙ·È Û·Ê‹˜ ÂÈÎÚ¿ÙËÛË ÙÔ˘ ¿ÚÚÂÓÔ˜ Ê‡ÏÔ˘,

ÌÂ Ù· ÎÔÚ›ÙÛÈ· Ó· ¤¯Ô˘Ó ÛÂ ÛËÌ·ÓÙÈÎfi ‚·ıÌfi ÌÂÁ·-

Ï‡ÙÂÚË ËÏÈÎ›·. Ã·Ú·ÎÙËÚÈÛÙÈÎ¿ ‰È·ÈÛÙÒÓÔ˘ÌÂ ˆ˜

128 ∞. ¶Ô˘ÚÙÛ›‰Ë˜ Î·È Û˘Ó.


ª‹ÓÂ˜4003002001000

¯1

00

%1,00

0,80

0,60

0,40

0,20

0,00

∂ÈÎfiÓ· 2. ∫·Ì‡ÏË Û˘ÓÔÏÈÎ‹˜ ÂÈ‚›ˆÛË˜.

ª‹ÓÂ˜4003002001000

¯1

00

%

1,00

0,80

0,60

0,40

0,20

0,00

∂ÈÎfiÓ· 3. ∫·Ì‡ÏË ÂÈ‚›ˆÛË˜ ÂÏÂ‡ıÂÚË˜ Û˘Ì‚¿Ì·ÙÔ˜.


fiÏÔÈ ÔÈ ·ÛıÂÓÂ›˜ ËÏÈÎ›·˜ 7 ÂÙÒÓ ‹ ÌÈÎÚfiÙÂÚË˜ ‹Ù·Ó

·ÁfiÚÈ· (∂ÈÎfiÓ· 1). ∏ ÓfiÛÔ˜ ÛÙ· ·È‰È¿ ¤¯ÂÈ Û˘Ó‰ÂıÂ›

ÌÂ ˘„ËÏfi ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎfi Â›Â‰Ô (ÛÙÈ˜ ‚ÈÔ-

ÌË¯·ÓÈÎ¤˜ ¯ÒÚÂ˜), ·ÏÏ¿ Î·È ÌÂ ¤ÎıÂÛË ÛÂ ÏÔÈÌÒ‰ÂÈ˜

·Ú¿ÁÔÓÙÂ˜ (EBV, ÂÚËÙÔ˚fi˜ 6, CMV) ‹ ÌÂ ·ÓÔÛÔ·-

ÓÂ¿ÚÎÂÈ· (3). ™ËÌ·ÓÙÈÎ‹ ·Ó·ÏÔÁ›· ÙˆÓ ·ÛıÂÓÒÓ ÌÂ

ÓfiÛÔ ∏odgkin ¤¯Ô˘Ó ˘„ËÏÔ‡˜ Ù›ÙÏÔ˘˜ ·ÓÙÈÛˆÌ¿ÙˆÓ

¤Ó·ÓÙÈ ÙÔ˘ EBV (17). ™ÙËÓ ÂÚ›ÙˆÛË ÙË˜ ÎÏ·ÛÈÎ‹˜

ÓfiÛÔ˘ Hodgkin, ÛÙÈ˜ ¢˘ÙÈÎ¤˜ ¯ÒÚÂ˜ Ë Û‡Ó‰ÂÛË ÌÂ

EBV ÏÔ›ÌˆÍË Êı¿ÓÂÈ ÙÔ 50% (18). ™ÙÔ˘˜ ·ÛıÂÓÂ›˜

Ì·˜, Ë ·Ó·ÏÔÁ›· ·˘ÙÒÓ ÌÂ ·ÚÔ˘Û›· EBV-IgG ¤Êı·-

ÓÂ ÙÔ 41%, ¯ˆÚ›˜ Ó· ·Ô‰›‰Ô˘ÌÂ È‰È·›ÙÂÚË ÛËÌ·Û›·

ÛÙÔ Â‡ÚËÌ¿ Ì·˜, Î·ıÒ˜ ˘„ËÏfi ÔÛÔÛÙfi ·È‰ÈÒÓ Î·È

ÂÊ‹‚ˆÓ ÛÙË ¯ÒÚ· Ì·˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·ÓÙÈÛÒÌ·Ù·

¤Ó·ÓÙÈ ÙÔ˘ EBV. ∂›ÛË˜, Ë ÓfiÛÔ˜ ∏odgkin ¤¯ÂÈ Û˘Ó-

‰ÂıÂ› Î·È ÌÂ ·˘ÙÔ¿ÓÔÛ· ÓÔÛ‹Ì·Ù· (19).

∆Ô Û˘¯ÓfiÙÂÚÔ ÎÏÈÓÈÎfi ÛËÌÂ›Ô ÙË˜ ÓfiÛÔ˘

Hodgkin Â›Ó·È Ë ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ·, ÌÂ ·ÚÔ˘Û›· ÛÙÔ

90% ÙˆÓ ·ÛıÂÓÒÓ (20), ·Ó Î·È Û¯Â‰fiÓ Î¿ıÂ fiÚÁ·ÓÔ

ÌÔÚÂ› Ó· ÚÔÛ‚ÏËıÂ›. ™ÙÔ˘˜ ·ÛıÂÓÂ›˜ Ì·˜ ‰È·È-

ÛÙÒıËÎÂ ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ· ÛÂ ÔÛÔÛÙfi 93%. ªË ÂÈ-

‰ÈÎ¿ Û˘ÌÙÒÌ·Ù· ÙË˜ ÓfiÛÔ˘ ·ÔÙÂÏÔ‡Ó Ë Î·ÎÔ˘¯›·,

Ë ·ÓÔÚÂÍ›·, ÙÔ ·Ú·ÙÂÈÓfiÌÂÓÔ ˘Ú¤ÙÈÔ Î·È Ë ·Ò-

ÏÂÈ· ‚¿ÚÔ˘˜ (3). ∂›ÛË˜, ÌÔÚÂ› Ó· Û˘Ó˘¿Ú¯ÂÈ ÌË

·Ú·ÁˆÁÈÎfi˜ ¯ÚfiÓÈÔ˜ ‚‹¯·˜ ‹ ¿ÏÏ· Û˘ÌÙÒÌ·Ù·

·fi ÙÔ ·Ó·ÓÂ˘ÛÙÈÎfi, ÏfiÁˆ ÙË˜ ‰ÈÂ‡Ú˘ÓÛË˜ ÙÔ˘ ÌÂ-

ÛÔıˆÚ·Î›Ô˘, Ô˘ ÚÔÎ·ÏÂ› ›ÂÛË ÙË˜ ÙÚ·¯Â›·˜ Î·È

ÙˆÓ ‚ÚfiÁ¯ˆÓ. ∏ ·ÚÔ˘Û›· µ-Û˘ÌÙˆÌ¿ÙˆÓ, fiˆ˜

·Ó·Ê¤ÚıËÎÂ ‹‰Ë, ıÂˆÚÂ›Ù·È ˆ˜ ¤¯ÂÈ ÛËÌ·ÓÙÈÎ‹

ÚÔÁÓˆÛÙÈÎ‹ ÛËÌ·Û›· Î·È Û˘Ó‰¤ÂÙ·È ÌÂ ÂÈıÂÙÈÎfi-

ÙÂÚË ÓfiÛÔ (21). ™ÙÔ˘˜ ·ÛıÂÓÂ›˜ Ì·˜ ·Ó·Ê¤ÚıËÎ·Ó

ÛÂ ·Ó·ÏÔÁ›· 29%, ÌÂ ÛËÌ·ÓÙÈÎ¿ ÌÂÁ·Ï‡ÙÂÚË ·Ó·ÏÔ-

Á›· ÛÂ ÚÔ¯ˆÚËÌ¤Ó· ÛÙ¿‰È· (44% ÛÂ ÛÙ¿‰ÈÔ πππ ‹

IV), ·ÏÏ¿ ‰ÂÓ ‰È·ÈÛÙÒıËÎÂ Û˘Û¯¤ÙÈÛË ÌÂ ÙËÓ ¤Î‚·-

ÛË ÙË˜ ÓfiÛÔ˘, ÛÂ Û˘ÌÊˆÓ›· ÌÂ ¿ÏÏÔ˘˜ ÂÚÂ˘ÓËÙ¤˜

(5). ∞ÓÙ›ıÂÙ·, ÔÈ Smith Î·È Û˘Ó. ‰È·›ÛÙˆÛ·Ó Û˘Û¯¤-

ÙÈÛË ÙË˜ ·ÚÔ˘Û›·˜ µ-Û˘ÌÙˆÌ¿ÙˆÓ ÌÂ ‰˘ÛÌÂÓ¤-

ÛÙÂÚË ÚfiÁÓˆÛË (13). ™ÙË ÌÂÏ¤ÙË Ì·˜ ‰ÂÓ ÚÔ¤Î˘-

„Â Û˘Û¯¤ÙÈÛË ÂÚÁ·ÛÙËÚÈ·ÎÒÓ Â˘ÚËÌ¿ÙˆÓ Î·Ù¿ ÙË

‰È¿ÁÓˆÛË, fiˆ˜ ÏÂ˘ÎÔÎ˘ÙÙ¿ÚˆÛË, ËˆÛÈÓÔÊÈÏ›·,


¶·È‰È·ÙÚÈÎ‹ 2009;72:129-000

¶›Ó·Î·˜ 7. ¶ÚÔÁÓˆÛÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ ˆ˜ ÚÔ˜ ÙËÓ ¤Î‚·ÛË ÙË˜ ÓfiÛÔ˘

∞ÚÈıÌfi˜ % ƒ·ÛıÂÓÒÓ % DFS EFS OS DFS EFS OS

∏ÏÈÎ›· (¤ÙË≤ 8 15 20,5 80 73,3 100 ns ns ns> 8 58 79,5 91,4 86,2 96,6

º‡ÏÔ∞ÁfiÚÈ· 46 63 89,1 84,8 97,8 ns ns ns∫ÔÚ›ÙÛÈ· 27 37 88,9 81,5 96,3

™Ù¿‰ÈÔπ 16 22 93,8 81,3 93,8ππ 25 34,2 96 92 100 ns ns nsπππ 20 27,4 85 80 95IV 12 16,4 75 75 100

πÛÙÔÏÔÁÈÎfi˜ ˘fiÙ˘Ô˜ªÈÎÙ‹˜ Î˘ÙÙ·ÚÔ‚Ú›ıÂÈ·˜ 19 26,1 89,5 89,5 100§ÂÌÊÔÂÓÈÎfi˜ 2 2,7 100 100 100 ns ns ns§ÂÌÊÔÂÈÎÚ·ÙÒÓ 6 8,2 100 83,3 83,3√˙Ò‰Ë˜ ÛÎÏ‹Ú˘ÓÛË 46 63 87 80,4 97,8

µ-Û˘ÌÙÒÌ·Ù·¶·ÚfiÓÙ· 21 29 90,5 90,5 95,2 ns ns ns∞fiÓÙ· 52 71 88,5 80,8 98,1

ªÂÛÔıˆÚ¿ÎÈÔªÂÁ¿ÏË ‰ÈÂ‡Ú˘ÓÛË 13 17,8 92,3 84,6 100ª¤ÙÚÈ· ‰ÈÂ‡Ú˘ÓÛË 33 45,2 87,9 84,8 97 ns ns nsŸ¯È ‰ÈÂ‡Ú˘ÓÛË 27 37 88,9 81,5 96,3

§Â˘Î¿ ·ÈÌÔÛÊ·›ÚÈ· (x103/mm3)≤10,2 34 50,7 88,2 82,4 94,1 ns ns ns>10,2 33 49,3 90,9 84,8 100

Hb (g/dl)≤11,1 36 53 88,9 80,6 100 ns ns ns>11,1 32 47 90,6 87,5 93,8

TKE (mm 1Ë˜ ÒÚ·˜)≤61 34 50 88,2 82,4 94,1 ns ns ns>61 34 50 91,2 85,3 100


·Ó·ÈÌ›·, ·˘ÍËÌ¤ÓË ÙÈÌ‹ ∆∫∂ Î·È ·˘ÍËÌ¤ÓË ÙÈÌ‹

LDH, ÌÂ ÙËÓ ¤Î‚·ÛË ÙË˜ ÓfiÛÔ˘. ™Â Û¯¤ÛË ÌÂ Ù·

·ÂÈÎÔÓÈÛÙÈÎ¿ Â˘Ú‹Ì·Ù·, Ë ¤Î‚·ÛË ‰ÂÓ ‰È·ÈÛÙÒıË-

ÎÂ Ó· ÂËÚÂ¿˙ÂÙ·È ·fi ÙËÓ ·ÚÔ˘Û›· ‰ÈÂ‡Ú˘ÓÛË˜

ÙÔ˘ ÌÂÛÔıˆÚ·Î›Ô˘, ·ÎfiÌË Î·È ÂÎÙÂÙ·Ì¤ÓË˜, ·Ó Î·È

ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· ·Ó·Ê¤ÚÂÙ·È ˆ˜ Ì¿˙· ÌÂÛÔıˆÚ·-

Î›Ô˘ Ô˘ ˘ÂÚ‚·›ÓÂÈ ÙÔ 1/3 ÙË˜ ÌÂÁ·Ï‡ÙÂÚË˜ ÂÓ‰Ô-

ıˆÚ·ÎÈÎ‹˜ ‰È·Ì¤ÙÚÔ˘ Û˘Ó‰¤ÂÙ·È ÌÂ ÚÔ¯ˆÚËÌ¤ÓË

ÓfiÛÔ, Ùˆ¯fiÙÂÚË ÚfiÁÓˆÛË Î·È ·Ó¿ÁÎË ÂÈıÂÙÈÎfi-

ÙÂÚË˜ ıÂÚ·Â›·˜ (22).

™˘ÓÔÏÈÎ¿, Ë ¤Î‚·ÛË ÙˆÓ ·ÛıÂÓÒÓ Ì·˜ ‹Ù·Ó ÂÍ·È-

ÚÂÙÈÎ‹ ÛÂ fiÏÂ˜ ÙÈ˜ ¯ÚÔÓÈÎ¤˜ ÂÚ›Ô‰Ô˘˜ ·ÓÙÈÌÂÙÒÈ-

ÛË˜ ·˘ÙÒÓ Î·È ·ÓÂÍ¿ÚÙËÙË ·fi ÙÔ Â›‰Ô˜ ÙË˜ ıÂÚ·Â›-

·˜. ∏ Û˘ÓÔÏÈÎ‹ ÂÈ‚›ˆÛË Êı¿ÓÂÈ ÙÔ 97,3%, ÂÓÒ ÂÍ·È-

ÚÂÙÈÎ‹ Â›Ó·È Î·È Ë ¤Î‚·ÛË ÙˆÓ ·ÛıÂÓÒÓ ÌÂ ˘ÔÙÚÔ‹

- ÂÈ‚ÈÒÓÔ˘Ó ÔÈ 7/8. ∏ ÂÈ‚›ˆÛË ÌÂÙ¿ ·fi ˘ÔÙÚÔ‹

ÁÂÓÈÎ¿ Î˘Ì·›ÓÂÙ·È ÛÙÔ 50-80% (3). ™ÙË ÌÂÏ¤ÙË Ì·˜, ÔÈ

˘ÔÙÚÔ¤˜ ¤Ï·‚·Ó ¯ÒÚ· 20-65 Ì‹ÓÂ˜ ·fi ÙË ‰È¿ÁÓˆ-

ÛË. √È ˘ÔÙÚÔ¤˜ Û˘Ì‚·›ÓÔ˘Ó Û˘Ó‹ıˆ˜ Ù· ÚÒÙ· 3

¤ÙË, ·ÏÏ¿ ÔÚÈÛÌ¤ÓÔÈ ·ÛıÂÓÂ›˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Î·È fi„È-

ÌÂ˜ ˘ÔÙÚÔ¤˜ (¿Óˆ ·fi 10 ¤ÙË) (23).

√È ·ÏÏ·Á¤˜ ÛÙÔÓ ÙÚfiÔ ·ÓÙÈÌÂÙÒÈÛË˜ ÙË˜ ÓfiÛÔ˘

‰È·¯ÚÔÓÈÎ¿ ÔÊÂ›ÏÔÓÙ·È ÛÙËÓ ÂÌÂÈÚ›· ·fi ÙËÓ ÂÊ·Ú-

ÌÔÁ‹ ·ÚfiÌÔÈˆÓ ıÂÚ·Â˘ÙÈÎÒÓ ÚÔÛÂÁÁ›ÛÂˆÓ. ™ÙËÓ

ÚÒÙË ¯ÚÔÓÈÎ‹ ÂÚ›Ô‰Ô, Ù· ·È‰È¿ ·ÓÙÈÌÂÙˆ›ÛÙË-

Î·Ó ˆ˜ ÂÓ‹ÏÈÎÂ˜ Î·È ÛÙË ıÂÚ·Â›· Î˘ÚÈ¿Ú¯ËÛ·Ó ÔÈ

˘„ËÏ¤˜ ‰fiÛÂÈ˜ ·ÎÙÈÓÔ‚ÔÏ›·˜ (Ì¤¯ÚÈ Î·È 40 Gy) ‹ Ë

·ÓÙÈÌÂÙÒÈÛË ÌÂ ÔÏÏ¿ Û¯‹Ì·Ù· ¯ËÌÂÈÔıÂÚ·Â›·˜

¯ˆÚ›˜ ·ÎÙÈÓÔıÂÚ·Â›·. ªÂÙ¿ Ù· ÚÒÙ· ÌËÓ‡Ì·Ù· ÁÈ·

ÛÔ‚·Ú¤˜ ·ÒÙÂÚÂ˜ Û˘Ó¤ÂÈÂ˜, fiÛÔÓ ·ÊÔÚ¿ Î˘Ú›ˆ˜

ÛÎÂÏÂÙÈÎ¤˜ ·ÓˆÌ·Ï›Â˜ Î·È ÚÔ‚Ï‹Ì·Ù· ÂÓ‰ÔÎÚÈÓÔ-

ÏÔÁÈÎ¿, ‹ÚÍÂ ·ÏÏ·Á‹ ÛÙË ıÂÚ·Â˘ÙÈÎ‹ ÛÙÚ·ÙËÁÈÎ‹

Î·È Ù· ·È‰È¿-·ÛıÂÓÂ›˜ ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó ÌÂ ÌÂ›ˆÛË

ÙË˜ ¯ËÌÂÈÔıÂÚ·Â›·˜ ÛÙËÓ ÂÓÙÔÈÛÌ¤ÓË ÓfiÛÔ Î·È,

‚¤‚·È·, ÌÂ Î·ıÈ¤ÚˆÛË ¯·ÌËÏÒÓ ‰fiÛÂˆÓ ·ÎÙÈÓÔ‚Ô-

Ï›·˜ (20 Gy) ÌfiÓÔ ÛÙÈ˜ ·Ú¯ÈÎ¿ ÚÔÛ‚Â‚ÏËÌ¤ÓÂ˜ Â-

ÚÈÔ¯¤˜. ∆¤ÏÔ˜, ÛÙËÓ ÙÚ›ÙË ¯ÚÔÓÈÎ‹ ÂÚ›Ô‰Ô, Ë ıÂÚ·-

Â˘ÙÈÎ‹ ÔÌ¿‰·, ‰È·ÙËÚÒÓÙ·˜ ÙÈ˜ ¯·ÌËÏ¤˜ ‰fiÛÂÈ˜

·ÎÙÈÓÔ‚ÔÏ›·˜, ÚÔ¯ÒÚËÛÂ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ

·È‰ÈÒÓ ÌÂ ÂÓÙÔÈÛÌ¤ÓË ¯·ÌËÏÔ‡ Î·È ÂÓ‰È¿ÌÂÛÔ˘

ÎÈÓ‰‡ÓÔ˘ ÓfiÛÔ ÌÂ ¯ËÌÂÈÔıÂÚ·Â˘ÙÈÎ¿ Û¯‹Ì·Ù· ¯ˆ-

Ú›˜ ·ÏÎ˘ÏÈÔ‡ÓÙÂ˜ ·Ú¿ÁÔÓÙÂ˜ Î·È ·ÓıÚ·Î˘ÎÏ›ÓÂ˜,

Ô˘ Â›Ó·È Ê¿ÚÌ·Î· ˘Â‡ı˘Ó· ÁÈ· ÛËÌ·ÓÙÈÎ‹ ·ÒÙÂ-

ÚË ÙÔÍÈÎfiÙËÙ·. °ÂÓÈÎ¿, fiÏ· ·˘Ù¿ Ù· ¯ÚfiÓÈ· ÔÈ ÛÙfi¯ÔÈ

ÙË˜ ·ÓÙÈÌÂÙÒÈÛË˜ ÙˆÓ ·ÛıÂÓÒÓ Ì·˜ ÌÂ ÓfiÛÔ

∏odgkin ‹Ù·Ó Ë ‰È·Ù‹ÚËÛË ÙˆÓ ˘„ËÏÒÓ ÔÛÔÛÙÒÓ

ÂÈ‚›ˆÛË˜, ÌÂ Ù·˘Ùfi¯ÚÔÓË ÌÂ›ˆÛË ÙË˜ Ì·ÎÚÔÚfiıÂ-

ÛÌË˜ ÙÔÍÈÎfiÙËÙ·˜ (Î·Ú‰ÈÔÙÔÍÈÎfiÙËÙ·, ÓÂ˘ÌÔÓÔ¿-

ıÂÈ·, ÛÎÂÏÂÙÈÎ¤˜ ‰È·Ù·Ú·¯¤˜, ÂÓ‰ÔÎÚÈÓÔÏÔÁÈÎ¤˜ ‰È·-

Ù·Ú·¯¤˜, ‰Â‡ÙÂÚÂ˜ Î·ÎÔ‹ıÂÈÂ˜) (24). ∞fi ÙÔ˘˜ ·ÛıÂ-

ÓÂ›˜ Ì·˜, Ù¤ÛÛÂÚÈ˜ ·ÚÔ˘Û›·Û·Ó ‰Â‡ÙÂÚË ‹ Î·È ÙÚ›ÙË

Î·ÎÔ‹ıÂÈ·. ∏ Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛË˜ ‰Â‡ÙÂÚË˜ Î·-

ÎÔ‹ıÂÈ·˜ ÂÍ·ÚÙ¿Ù·È ·fi ÙËÓ ÂÊ·ÚÌÔÁ‹ ‹ fi¯È ·ÎÙÈÓÔ-

ıÂÚ·Â›·˜ Î·È ÙË ‰fiÛË ·˘Ù‹˜, ÙÔ ÛÙ¿‰ÈÔ ÙË˜ ÓfiÛÔ˘ ‹ÙËÓ ‡·ÚÍË ˘ÔÙÚÔ‹˜ Î·È ÙËÓ ·ÚÔ˘Û›· ·ÓÔÛÔÎ·-Ù·ÛÙÔÏ‹˜. π‰È·›ÙÂÚÔ ÚfiÏÔ Ê·›ÓÂÙ·È Ó· ·›˙ÂÈ Ë Ú‹ÛË·ÏÎ˘ÏÈˆÙÈÎÒÓ ·Ú·ÁÒÁˆÓ (ª√PP), Î·ıÒ˜ Î·È ÔÈ ‰fi-ÛÂÈ˜ ÙË˜ ¯ËÌÂÈÔıÂÚ·Â›·˜ (25). √ Î›Ó‰˘ÓÔ˜ ÁÈ· ÂÌ-Ê¿ÓÈÛË ÌË ÏÂÌÊÔ‚Ï·ÛÙÈÎ‹˜ ÏÂ˘¯·ÈÌ›·˜ ‹ ÌË∏odgkin ÏÂÌÊÒÌ·ÙÔ˜ Êı¿ÓÂÈ ÙÔ 8,1% ÌÂÙ¿ ·fi ıÂ-Ú·Â›· ÁÈ· ÓfiÛÔ Hodgkin, ÂÓÒ Ô Î›Ó‰˘ÓÔ˜ ÁÈ· Û˘Ì·-Á‹ fiÁÎÔ Êı¿ÓÂÈ ÙÔ 13,1% ÛÙ· 20 ¤ÙË (26).

ª¤¯ÚÈ Û‹ÌÂÚ·, Ë ıÂÚ·Â˘ÙÈÎ‹ ÚÔÛ¤ÁÁÈÛË ÙË˜ÓfiÛÔ˘ ÛÙËÚ›˙ÂÙ·È ÛÂ ÚÔÛÂÁÁ›ÛÂÈ˜ ÚÔÛ·ÚÌÔÛÌ¤ÓÂ˜ÛÙËÓ ·¿ÓÙËÛË ÛÙËÓ ·Ú¯ÈÎ‹ ıÂÚ·Â›·, ÛÙÔ Ê‡ÏÔ Î·ÈÙËÓ ËÏÈÎ›·. √ Û‡Á¯ÚÔÓÔ˜ ÙÚfiÔ˜ ·ÓÙÈÌÂÙÒÈÛË˜ ÙˆÓ·ÛıÂÓÒÓ ÌÂ ÂÓÙÔÈÛÌ¤ÓË ·ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÓfiÛÔ Â-ÚÈÏ·Ì‚¿ÓÂÈ ÏÈÁfiÙÂÚÔ ÙÔÍÈÎ‹ ıÂÚ·Â›· ÌÂ 2-4 Î‡ÎÏÔ˘˜¯ËÌÂÈÔıÂÚ·Â›·˜ Î·È ¯·ÌËÏ¤˜ ‰fiÛÂÈ˜ ·ÎÙÈÓÔ‚ÔÏ›·˜,ÂÓÒ ÁÈ· ÙÔ˘˜ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ Î·È ÌÂ ÚÔ¯ˆÚËÌ¤ÓËÓfiÛÔ ·ÛıÂÓÂ›˜ ‰ÔÎÈÌ¿˙ÔÓÙ·È ÂÚÈÛÛfiÙÂÚÔ ÂÓÙ·ÙÈÎ¿Û¯‹Ì·Ù· ıÂÚ·Â›·˜ (27). ∆ÂÏÂ˘Ù·›·, ÙÔ Î˘Ú›·Ú¯ÔÂÚÒÙËÌ· ÙˆÓ ÌÂÁ¿ÏˆÓ Û˘ÓÂÚÁ·ÙÈÎÒÓ ÌÂÏÂÙÒÓ Â›Ó·È«ÔÈÔÈ ·fi ÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÔÚÔ‡Ó Ó· È·ıÔ‡Ó ¯ˆÚ›˜ÙË Ú‹ÛË ·ÎÙÈÓÔıÂÚ·Â›·˜;». √ Â·Ó·ÚÔÛ‰ÈÔÚÈÛÌfi˜ÙˆÓ ÔÌ¿‰ˆÓ ÎÈÓ‰‡ÓÔ˘ ÌÂ Ó¤Ô˘˜ ‚ÈÔÏÔÁÈÎÔ‡˜ Î·È ÌÔ-ÚÈ·ÎÔ‡˜ ÚÔÁÓˆÛÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜ ‰˘ÓËÙÈÎ¿ ı·Ô‰ËÁ‹ÛÂÈ ÛÂ ÂÚ·ÈÙ¤Úˆ ÂÚÈÔÚÈÛÌfi ÙË˜ ıÂÚ·Â›·˜ ‹ÛÂ ÂÓÙ·ÙÈÎÔÔ›ËÛË ·˘Ù‹˜. √È ÚfiÔ‰ÔÈ ÛÙË ıÂÚ·Â›·ÙÔ˘ ÏÂÌÊÒÌ·ÙÔ˜ Hodgkin ¤¯Ô˘Ó ÌÂÈÒÛÂÈ ÙËÓ ÚÔ-ÁÓˆÛÙÈÎ‹ ·Í›· ·Ú·‰ÔÛÈ·ÎÒÓ ÚÔÁÓˆÛÙÈÎÒÓ ·Ú·-ÁfiÓÙˆÓ, fiˆ˜ Ë ËÏÈÎ›·, ÙÔ Ê‡ÏÔ, Ë ÈÛÙÔÏÔÁ›·, ÙÔ ÛÙ¿-‰ÈÔ Î·È Ù· Û˘ÌÙÒÌ·Ù· Ù‡Ô˘ µ. ∏ ·¿ÓÙËÛË ÛÙËÓ·Ú¯ÈÎ‹ ıÂÚ·Â›· ıÂˆÚÂ›Ù·È Û‹ÌÂÚ· ÚÔÛ‰ÈÔÚÈÛÙÈÎfi˜·Ú¿ÁÔÓÙ·˜ ÁÈ· ÙËÓ Â·ÎfiÏÔ˘ıË ıÂÚ·Â˘ÙÈÎ‹ ÚÔ-Û¤ÁÁÈÛË. √È ÚfiÔ‰ÔÈ ÛÙÈ˜ ·ÂÈÎÔÓÈÛÙÈÎ¤˜ ÌÂıfi‰Ô˘˜,fiˆ˜ Ë ¯Ú‹ÛË ˘ÔÏÔÁÈÛÙÈÎ‹˜ ÙÔÌÔÁÚ·Ê›·˜ ˘„ËÏ‹˜Â˘ÎÚ›ÓÂÈ·˜ (HRCT), Ì·ÁÓËÙÈÎ‹˜ ÙÔÌÔÁÚ·Ê›·˜ (MRI),·ÏÏ¿, ÙÂÏÂ˘Ù·›·, Î·È Ë Ú‹ÛË ÙÔÌÔÁÚ·Ê›·˜ ÂÎÔÌ‹˜Ô˙ÈÙÚÔÓ›ˆÓ (PET) [ÂÎÙÈÌ¿ ÙËÓ ˘ÂÚÏ·ÛÙÈÎ‹ ‰Ú·-ÛÙËÚÈfiÙËÙ· ÙˆÓ ÏÂÌÊ·‰¤ÓˆÓ ‰È· Ì¤ÛÔ˘ ÙË˜ ·˘ÍËÌ¤-ÓË˜ ÚfiÛÏË„Ë˜ ÙÔ˘ 18-fluoro-2-deoxyglucose(FDG)] ¤¯Ô˘Ó Ê¤ÚÂÈ Â·Ó¿ÛÙ·ÛË ÛÙË ÛÙ·‰ÈÔÔ›ËÛËÙÔ˘ ÏÂÌÊÒÌ·ÙÔ˜ Hodgkin. ∏ ÙÔÌÔÁÚ·Ê›· ÂÎÔÌ‹˜Ô˙ÈÙÚÔÓ›ˆÓ Î·È ÂÈ‰ÈÎ¿ Ô Û˘Ó‰˘·ÛÌfi˜ ÙË˜ ÌÂ ·ÍÔÓÈÎ‹ÙÔÌÔÁÚ·Ê›· (PET-CT) ·ÚÔ˘ÛÈ¿˙ÂÈ ÌÂÁ¿ÏË Â˘·ÈÛıË-Û›· ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË ÙË˜ ·ÓÙ·fiÎÚÈÛË˜ Î·È ÙËÓ ÔÚıfi-ÙÂÚË ¤ˆ˜ Î·È ÂÍ·ÙÔÌÈÎÂ˘Ì¤ÓË ıÂÚ·Â›·, ÌÂ ÚÔÔÙÈ-Î‹ ÙËÓ ·ÔÊ˘Á‹ ÙË˜ ·ÎÙÈÓÔıÂÚ·Â›·˜ ÛÂ ÛËÌ·ÓÙÈÎfiÔÛÔÛÙfi ·ÛıÂÓÒÓ (28).


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¶·È‰È·ÙÚÈÎ‹ 2009;72:131-000


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·Ì˘Á‰·ÏÒÓ ÛÙËÓ Î·Ú‰È·Î‹ ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ ·È‰ÈÒÓ

∫. ¶··‰ÔÔ‡ÏÔ˘-§ÂÁÌ¤ÏÔ˘, °. µ·ÚÏ¿ÌË˜

¶ÂÚ›ÏË„Ë: ∏ ÂÚÙÚÔÊ›· ÙˆÓ ·‰ÂÓÔÂÈ‰ÒÓ Î·È ·Ì˘Á‰·ÏÒÓ ·ÔÙÂÏÂ› ÙÔ Û˘¯ÓfiÙÂÚÔ ·›ÙÈÔ ·fiÊÚ·ÍË˜ ÙˆÓ·ÓÒÙÂÚˆÓ ·ÂÚÔÊfiÚˆÓ Ô‰ÒÓ, Ô˘ ÌÔÚÂ› Ó· ¤¯ÂÈ ÛÔ‚·Ú¤˜ ÂÈÙÒÛÂÈ˜ ÛÙËÓ Î·Ú‰ÈÔÓÂ˘ÌÔÓÈÎ‹ ÏÂÈÙÔ˘Ú-Á›· ÙˆÓ ·È‰ÈÒÓ. ∏ ·fiÊÚ·ÍË ÂÈ‰ÂÈÓÒÓÂÙ·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘, ÏfiÁˆ ÂÏ¿ÙÙˆÛË˜ ÙÔ˘ ÓÂ˘ÚÔ-Ì˘˚ÎÔ‡ ÙfiÓÔ˘, Î·È Ô‰ËÁÂ› ÛÂ ˘fiÓÔÈ· ‹ ¿ÓÔÈÂ˜ ·ÔÊÚ·ÎÙÈÎÔ‡ Ù‡Ô˘. √È ÙÂÏÂ˘Ù·›Â˜ Û˘ÓÔ‰Â‡ÔÓÙ·È ·fiÂÂÈÛfi‰È· ˘ÔÍ˘ÁÔÓ·ÈÌ›·˜, ˘ÂÚÎ·Ó›·˜ Î·È ·Ó·ÓÂ˘ÛÙÈÎ‹˜ ÔÍ¤ˆÛË˜ (Û‡Ó‰ÚÔÌÔ ·ÔÊÚ·ÎÙÈÎ‹˜ ¿ÓÔÈ·˜‡ÓÔ˘). ∆· ˘ÔÙÚÔÈ¿˙ÔÓÙ· ÂÂÈÛfi‰È· ˘ÔÍ˘ÁÔÓ·ÈÌ›·˜ Î·È ˘ÂÚÎ·Ó›·˜ ÚÔÎ·ÏÔ‡Ó ÓÂ˘ÌÔÓÈÎ‹ ·ÁÁÂÈ-ÔÛ‡Û·ÛË, Ë ÔÔ›· Ô‰ËÁÂ› ÛÂ ÌfiÓÈÌÂ˜ ·ÏÏÔÈÒÛÂÈ˜ ÙˆÓ ÓÂ˘ÌÔÓÈÎÒÓ ·ÁÁÂ›ˆÓ. √È ÂÈÙÒÛÂÈ˜ ÙÔ˘ Û˘Ó-‰ÚfiÌÔ˘ ·ÔÊÚ·ÎÙÈÎ‹˜ ¿ÓÔÈ·˜ ‡ÓÔ˘ ÛÙÔ Î·Ú‰È·ÁÁÂÈ·Îfi Û‡ÛÙËÌ· ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÂÂÈÛfi‰È· ˘ÂÚÙ·-ÛÈÎÒÓ ÎÚ›ÛÂˆÓ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘, ‰È·Ù·Ú·¯¤˜ ÙÔ˘ Î·Ú‰È·ÎÔ‡ Ú˘ıÌÔ‡ Î·È, ÛÂ ·Ú·ÌÂÏËÌ¤ÓÂ˜ÂÚÈÙÒÛÂÈ˜, ÙËÓ ÂÌÊ¿ÓÈÛË ÓÂ˘ÌÔÓÈÎ‹˜ ˘¤ÚÙ·ÛË˜ Î·È ¯ÚfiÓÈ·˜ ÓÂ˘ÌÔÓÈÎ‹˜ Î·Ú‰È¿˜. ∞Ó Î·È Ë ¯ÚfiÓÈ·ÓÂ˘ÌÔÓÈÎ‹ Î·Ú‰È¿ Â›Ó·È Û¿ÓÈ· Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, ÌÔÚÂ› Ó· ˘¿Ú¯ÂÈ ·Û˘ÌÙˆÌ·ÙÈÎ‹ ÓÂ˘ÌÔÓÈÎ‹˘¤ÚÙ·ÛË ÛÂ ·˘ÙÔ‡˜ ÙÔ˘˜ ·ÛıÂÓÂ›˜. ª¤¯ÚÈ Û‹ÌÂÚ·, ˆ˜ ıÂÚ·Â›· ÚÒÙË˜ ÂÎÏÔÁ‹˜ ÛÂ ·È‰È¿ ÌÂ Û‡Ó-‰ÚÔÌÔ ·ÔÊÚ·ÎÙÈÎ‹˜ ¿ÓÔÈ·˜ ‡ÓÔ˘ ·Ú·Ì¤ÓÂÈ Ë ¯ÂÈÚÔ˘ÚÁÈÎ‹ ·Ê·›ÚÂÛË ÙˆÓ ·‰ÂÓÔÂÈ‰ÒÓ-·Ì˘Á‰·ÏÒÓ.√È ·ÛıÂÓÂ›˜ ÌÂ ÛÔ‚·Ú‹ ·fiÊÚ·ÍË Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÓÂ˘ÌÔÓÈÎ‹ ˘¤ÚÙ·ÛË ‹/Î·È Î·Ú‰È·Î‹ ‰˘ÛÏÂÈ-ÙÔ˘ÚÁ›· ¤¯Ô˘Ó ·˘ÍËÌ¤ÓÔ Î›Ó‰˘ÓÔ ÁÈ· ¿ÌÂÛÂ˜ ÌÂÙÂÁ¯ÂÈÚËÙÈÎ¤˜ ÂÈÏÔÎ¤˜, fiˆ˜ ÂÈ‰Â›ÓˆÛË ÙÔ˘ Û˘Ó‰Úfi-ÌÔ˘ ·ÔÊÚ·ÎÙÈÎ‹˜ ¿ÓÔÈ·˜ ‹ ÂÎ‰‹ÏˆÛË ÓÂ˘ÌÔÓÈÎÔ‡ ÔÈ‰‹Ì·ÙÔ˜. ŸÛÔÓ ·ÊÔÚ¿ ÛÙÈ˜ ·ÒÙÂÚÂ˜ ÌÂÙÂÁ¯ÂÈ-ÚËÙÈÎ¤˜ ÂÈÏÔÎ¤˜, ·˘Ù¤˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ·Ú·ÌÔÓ‹ Î˘„ÂÏÈ‰ÈÎÔ‡ ˘Ô·ÂÚÈÛÌÔ‡ (Ô˘ ÌÔÚÂ› Ó· ¯ÚÂÈ·-ÛıÂ› Ì¤¯ÚÈ ÌË¯·ÓÈÎfi ·ÂÚÈÛÌfi ‹ ÙÚ·¯ÂÈÔÛÙÔÌ›·), Â›ÌÔÓË ˘ÔÍ·ÈÌ›·, ‰È·Ù·Ú·¯¤˜ ‡ÓÔ˘ ‹ Î·È Û˘Ó‰˘·-ÛÌfi ·˘ÙÒÓ. °È· ÙÔ˘˜ ·ÓˆÙ¤Úˆ ÏfiÁÔ˘˜, ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ÛÔ‚·Ú‹ ˘ÂÚÙÚÔÊ›· Û˘ÓÈÛÙ¿Ù·È ˘ÂÚË¯ÔÎ·Ú‰ÈÔ-ÁÚ·ÊÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÚÈÓ ·fi ÙË ¯ÂÈÚÔ˘ÚÁÈÎ‹ Â¤Ì‚·ÛË. ÃÚÂÈ¿˙ÂÙ·È Â›ÛË˜ ÎÏÈÓÈÎ‹ Â·ÓÂÎÙ›ÌËÛË ·˘ÙÒÓÙˆÓ ·ÛıÂÓÒÓ ÌÂÙ¿ ·fi 6-8 Â‚‰ÔÌ¿‰Â˜ ·fi ÙËÓ ·‰ÂÓÔÂÈ‰ÂÎÙÔÌ‹-·Ì˘Á‰·ÏÂÎÙÔÌ‹, ÁÈ· Ó· ‰È·ÈÛÙˆıÂ› ·Ó··ÈÙÂ›Ù·È ÂÈÚfiÛıÂÙË ıÂÚ·Â›·.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ÀÂÚÙÚÔÊ›· ·‰ÂÓÔÂÈ‰ÒÓ Î·È ·Ì˘Á‰·ÏÒÓ, Û‡Ó‰ÚÔÌÔ ·ÔÊÚ·ÎÙÈÎ‹˜ ¿ÓÔÈ·˜ ‡ÓÔ˘, ÓÂ˘ÌÔÓÈÎ‹

˘¤ÚÙ·ÛË, ¯ÚfiÓÈ· ÓÂ˘ÌÔÓÈÎ‹ Î·Ú‰È¿.

Cardiovascular consequences of adenotonsillar hypertrophy in

children

K. Papadopoulou-Legbelou, G. Varlamis

Abstract: Adenotonsillar hypertrophy is the most common cause of upper airway obstruction, which maylead to serious cardiopulmonary complications in children. Upper airway obstruction can be exacerbatedby the decrease in neuromuscular tone that occurs during sleep, leading to hypopnoea or obstructivesleep apnoea. Obstructive sleep apnoea produces episodic hypoxia, hypercapnia and respiratory acidosis(obstructive sleep apnoea syndrome). Episodes of recurrent hypoxia and hypercapnia are potentmediators of pulmonary vasoconstriction that can lead to chronic changes in the pulmonary vasculature.Cardiovascular consequences of adenotonsillar hypertrophy include repetitive nocturnal surges in bloodpressure, breathing rhythm disturbances and, particularly in severe cases, pulmonary hypertension andcor pulmonale. Although overt right heart failure now occurs less often, asymptomatic degrees ofpulmonary hypertension can occur. To date, adenotonsillectomy is the first line of treatment for childrenwith obstructive sleep apnoea syndrome. Children with significant airway obstruction associated withpulmonary hypertension and/or cardiac dysfunction are at greater risk for perioperative complications,such as worsening of their obstructive sleep apnoea, and pulmonary oedema. Potential postoperativecomplications are persistent airway obstruction (including the need for reintubation or tracheostomy),desaturation, sleep disturbances, or a combination of these. Thus, patients with severe obstruction shouldbe screened by echocardiography preoperatively. Clinical reevaluation is also recommended 6 to 8 weeksafter adenotonsillectomy, to determine whether additional treatment is required.

Key words: Adenotonsillar hypertrophy, obstructive sleep apnoea syndrome, pulmonary hypertension, cor

pulmonale.

132 ¶ƒ∞∫∆π∫√ £∂ª∞ PRACTICAL ISSUE

¢’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹∞ÚÈÛÙÔÙ¤ÏÂÈÔ˘ ¶·ÓÂÈÛÙ‹ÌÈÔ˘£ÂÛÛ·ÏÔÓ›ÎË˜, ¡ÔÛÔÎÔÌÂ›Ô«¶··ÁÂˆÚÁ›Ô˘»


∫˘ÚÈ·Î‹ ¶··‰ÔÔ‡ÏÔ˘-§ÂÁÌ¤ÏÔ˘[email protected]¢’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ∞¶£,¡ÔÛÔÎÔÌÂ›Ô «¶··ÁÂˆÚÁ›Ô˘»¶ÂÚÈÊÂÚÂÈ·Î‹ Ô‰fi˜£ÂÛ/Ó›ÎË˜, ¡. ∂˘Î·Ú›·,56403, £ÂÛÛ·ÏÔÓ›ÎË

4th Department ofPaediatrics, “Aristotelio”University of Thessaloniki,“PapageÔrgiou” Hospital,Thessaloniki, Greece

Correspondence:

Kyriaki [email protected] Department ofPaediatrics, “Aristotelio”University of Thessaloniki,“PapageÔrgiou” HospitalRing Road, N. Efkarpia,56403, Thessaloniki, Greece




∞¶ ·ÚÙËÚÈ·Î‹ ›ÂÛË¡™ ÓÂ˘ÚÈÎfi Û‡ÛÙËÌ·™∞∞À Û‡Ó‰ÚÔÌÔ ·ÔÊÚ·ÎÙÈÎ‹˜ ¿ÓÔÈ·˜ ‡ÓÔ˘

∂ÈÛ·ÁˆÁ‹

∏ ˘ÂÚÙÚÔÊ›· ÙˆÓ ·‰ÂÓÔÂÈ‰ÒÓ Î·È ·Ì˘Á‰·ÏÒÓ·ÔÙÂÏÂ› ÙÔ Û˘¯ÓfiÙÂÚÔ ·›ÙÈÔ ¯ÚfiÓÈ·˜ ·fiÊÚ·ÍË˜ÙˆÓ ·ÂÚÔÊfiÚˆÓ Ô‰ÒÓ, Ô˘ ÌÔÚÂ› Ó· ¤¯ÂÈ ÛÔ‚·Ú¤˜ÂÈÙÒÛÂÈ˜ ÛÙËÓ Î·Ú‰ÈÔÓÂ˘ÌÔÓÈÎ‹ ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ·È‰ÈÒÓ. ∏ ·fiÊÚ·ÍË ÂÈ‰ÂÈÓÒÓÂÙ·È Î·Ù¿ ÙË ‰È¿Ú-ÎÂÈ· ÙÔ˘ ‡ÓÔ˘, fiÔ˘ ¯·Ï·ÚÒÓÔ˘Ó ÔÈ Ê·Ú˘ÁÁÈÎÔ›Ì‡Â˜, Î·ıÒ˜ Â›ÛË˜ ·fi Û˘Ó˘¿Ú¯Ô˘ÛÂ˜ Î·Ù·ÛÙ¿-ÛÂÈ˜, fiˆ˜ ˘ÔÙÚÔÈ¿˙Ô˘ÛÂ˜ ÏÔÈÌÒÍÂÈ˜ ÙÔ˘ ·ÓÒÙÂ-ÚÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡ ‹ ·¯˘Û·ÚÎ›· (1). ™Â ÛÔ‚·Ú‹˘ÂÚÙÚÔÊ›·, ·Ú·ÙËÚÔ‡ÓÙ·È Â›ÛË˜ ·ÔÊÚ·ÎÙÈÎÔ‡Ù‡Ô˘ ¿ÓÔÈÂ˜ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘, ÔÈ ÔÔ›-Â˜ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ·‰˘Ó·Ì›· ÂÈÛfi‰Ô˘ ·¤Ú· ·-Ú¿ ÙËÓ ‡·ÚÍË ·Ó·ÓÂ˘ÛÙÈÎ‹˜ ÚÔÛ¿ıÂÈ·˜ Î·È‰È·ÎÔ‹ ÙÔ˘ Ê˘ÛÈÔÏÔÁÈÎÔ‡ ·ÂÚÈÛÌÔ‡ Î·È ÙË˜ ·Ú¯ÈÙÂ-ÎÙÔÓÈÎ‹˜ ÙÔ˘ ‡ÓÔ˘ (Û‡Ó‰ÚÔÌÔ ·ÔÊÚ·ÎÙÈÎ‹˜¿ÓÔÈ·˜ ‡ÓÔ˘) (2).

∆Ô Û‡Ó‰ÚÔÌÔ ·ÔÊÚ·ÎÙÈÎ‹˜ ¿ÓÔÈ·˜ ‡ÓÔ˘(™∞∞À) ÛÙ· ·È‰È¿ Â›Ó·È ÈÔ Û˘¯Ófi ÛÂ ËÏÈÎ›· 2-8¯ÚfiÓˆÓ, fiÔ˘ ˘¿Ú¯ÂÈ Î·È Ë ÌÂÁ·Ï‡ÙÂÚË ˘ÂÚÙÚÔ-Ê›· ÙˆÓ ·‰ÂÓÔÂÈ‰ÒÓ Î·È ÙˆÓ ·Ì˘Á‰·ÏÒÓ (2,3). ¶Ú¤-ÂÈ Ó· ‰È·ÊÔÚÔ‰È·ÁÓˆÛÙÂ› ·fi ÙÔ ÚˆÙÔ·ı¤˜ ÚÔ-¯·ÏËÙfi, ÛÙÔ ÔÔ›Ô ‰ÂÓ Û˘Ó˘¿Ú¯Ô˘Ó ·ÔÊÚ·ÎÙÈÎÔ‡Ù‡Ô˘ ¿ÓÔÈÂ˜, Û˘¯Ó¤˜ ·Ê˘Ó›ÛÂÈ˜ ‹ ‰È·Ù·Ú·¯¤˜ÙË˜ ·ÓÙ·ÏÏ·Á‹˜ ÙˆÓ ·ÂÚ›ˆÓ ÙÔ˘ ·›Ì·ÙÔ˜ (2). ªÂÏ¤-ÙÂ˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ ‰ÂÓ ˘¿Ú¯ÂÈ Û˘Û¯¤ÙÈÛË ÌÂÙ·Í‡ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙˆÓ ·‰ÂÓÔÂÈ‰ÒÓ Î·È ·Ì˘Á‰·ÏÒÓ Î·ÈÙË˜ ‡·ÚÍË˜ ™∞∞À (4,5). ∞˘Ùfi Û˘Ì‚·›ÓÂÈ ‰ÈfiÙÈ ÙÔ™∞∞À Â›Ó·È Û˘Ó‰˘·ÛÌfi˜ ‰ÔÌÈÎÒÓ Î·È ÓÂ˘ÚÔÌ˘˚ÎÒÓ·Ú·ÁfiÓÙˆÓ (3).

∏ Û˘¯ÓfiÙËÙ· ÙÔ˘ ™∞∞À ˘ÔÏÔÁ›˙ÂÙ·È ÛÂ 2%(2,6-8), ÂÓÒ Ë Û˘¯ÓfiÙËÙ· ÙÔ˘ ÚÔ¯·ÏËÙÔ‡ Â›Ó·È ÔÏ‡ÌÂÁ·Ï‡ÙÂÚË Î·È Î˘Ì·›ÓÂÙ·È ÛÂ ‰È¿ÊÔÚÂ˜ ÌÂÏ¤ÙÂ˜ ÌÂ-Ù·Í‡ 8-27% (6,7,9-11). ŸÛÔÓ ·ÊÔÚ¿ ÛÙÔ Ê‡ÏÔ, Ë Û˘-¯ÓfiÙËÙ· Â›Ó·È ›ÛË ÌÂÙ·Í‡ ÙˆÓ ‰‡Ô Ê‡ÏˆÓ (2,3).

H ·¯˘Û·ÚÎ›·, Ô˘ ·˘Í¿ÓÂÙ·È ÛËÌ·ÓÙÈÎ¿ Ù· ÙÂ-ÏÂ˘Ù·›· ¯ÚfiÓÈ· ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›·, ·ÔÙÂÏÂ› Ï¤ÔÓ¤Ó· ÛËÌ·ÓÙÈÎfi ÚÔ‰È·ıÂÛÈÎfi ·Ú¿ÁÔÓÙ· ÙÔ˘ ™∞∞À.ŒÙÛÈ, ÙÔ ™∞∞À ‰È·ÎÚ›ÓÂÙ·È ÛÙÈ˜ ÂÍ‹˜ Î·ÙËÁÔÚ›Â˜: Ù‡-Ô˘ π, ÛÙËÓ ÔÔ›· ·Ú·ÙËÚÂ›Ù·È ÛÔ‚·Ú‹ ˘ÂÚÙÚÔÊ›·ÙˆÓ ·‰ÂÓÔÂÈ‰ÒÓ Î·È ·Ì˘Á‰·ÏÒÓ, Ù‡Ô˘ ππ, ÛÙËÓÔÔ›· ˘¿Ú¯ÂÈ ËÈfiÙÂÚË ·fiÊÚ·ÍË ÙË˜ ·ÓÒÙÂÚË˜·Ó·ÓÂ˘ÛÙÈÎ‹˜ Ô‰Ô‡ ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ·¯˘Û·ÚÎ›·,Î·È Ù‡Ô˘ πππ, ÛÙËÓ ÔÔ›· ÙÔ ™∞∞À ÔÊÂ›ÏÂÙ·È ÛÂ ÎÚ·-ÓÈÔÚÔÛˆÈÎ¤˜ ·ÓˆÌ·Ï›Â˜ ‹ ÓÂ˘ÚÔÌ˘˚Î¤˜ ‰È·Ù·Ú·-¯¤˜ (Û‡Ó‰ÚÔÌ· Crouzon, Apert, Teacher Collins,Pierre Robin, Down, ·¯ÔÓ‰ÚÔÏ·Û›·, ÌËÓÈÁÁÔÌ˘ÂÏÔ-Î‹ÏË, ÂÁÎÂÊ·ÏÈÎ‹ ·Ú¿Ï˘ÛË) (12).

√È ·ÛıÂÓÂ›˜ ÌÂ ™∞∞À Ô˘ ‰ÂÓ ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È

¤ÁÎ·ÈÚ· ¤¯Ô˘Ó ·˘ÍËÌ¤ÓÔ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛË˜ ÛÔ‚·-

ÚÒÓ ¯ÚfiÓÈˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ Î·È ÌÂÙ·‚ÔÏÈÎÒÓ ‰È·-

Ù·Ú·¯ÒÓ. ∞˘Ù¤˜ Û˘Ó›ÛÙ·ÓÙ·È ÛÂ ˘„ËÏfiÙÂÚ· Â›Â‰·

·ÚÙËÚÈ·Î‹˜ ›ÂÛË˜, ·‡ÍËÛË ÙË˜ C ·ÓÙÈ‰ÚÒÛ·˜ Úˆ-

ÙÂ˝ÓË˜ (Ë ÔÔ›· Û˘Û¯ÂÙ›˙ÂÙ·È ÌÂ Î·Ú‰È·ÁÁÂÈ·Î¤˜ Ófi-

ÛÔ˘˜), ·ÓÙ›ÛÙ·ÛË ÛÙËÓ ÈÓÛÔ˘Ï›ÓË Î·È ˘ÂÚÙÚÔÊ›·

ÙË˜ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ (13).

ŸÛÔÓ ·ÊÔÚ¿ ÛÙÔÓ Ù‡Ô π (ÌÂÌÔÓˆÌ¤ÓË ˘ÂÚÙÚÔ-

Ê›· ÙˆÓ ·‰ÂÓÔÂÈ‰ÒÓ Î·È ·Ì˘Á‰·ÏÒÓ), ¤¯ÂÈ ‰È·ÈÛÙˆ-

ıÂ› fiÙÈ Ë ¯ÚfiÓÈ· ‰È·ÏÂ›Ô˘Û· ˘ÔÍ·ÈÌ›· Î·È ÙÔ ÔÍÂÈ-

‰ˆÙÈÎfi stress Ô‰ËÁÔ‡Ó ÛÙËÓ ·Ú·ÁˆÁ‹ ‰È·ÊfiÚˆÓ

ÊÏÂÁÌÔÓˆ‰ÒÓ Î˘ÙÔÎÈÓÒÓ Î·È ÛÂ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ÙÔ˘

ÂÓ‰ÔıËÏ›Ô˘ ÙˆÓ ·ÁÁÂ›ˆÓ (13). ∏ Û˘Ó‡·ÚÍË ÙÔ˘

™∞∞À Î·È ÙË˜ ·¯˘Û·ÚÎ›·˜ ÛÙÔÓ Ù‡Ô ππ ÂÈ‰ÂÈÓÒ-

ÓÂÈ ÙÔ ÔÍÂÈ‰ˆÙÈÎfi stress Î·È ÙË Û˘ÛÙËÌ·ÙÈÎ‹ ÊÏÂÁÌÔ-

ÓÒ‰Ë ·ÓÙ›‰Ú·ÛË Î·È ÂÈÙ·¯‡ÓÂÈ ÙËÓ ÂÌÊ¿ÓÈÛË ÙË˜

·ÓÙ›ÛÙ·ÛË˜ ÛÙËÓ ÈÓÛÔ˘Ï›ÓË Î·È, Î·Ù¿ Û˘Ó¤ÂÈ·, ÙÔ˘

ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ (14).

∞ÈÌÔ‰˘Ó·ÌÈÎ¤˜ ÂÈÙÒÛÂÈ˜ ÙÔ˘ ™∞∞À

∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘, Ù· Â·ÓÂÈÏËÌÌ¤Ó·

ÂÂÈÛfi‰È· ÌÂÚÈÎ‹˜ ‹ Ï‹ÚÔ˘˜ ·fiÊÚ·ÍË˜ ÙË˜ ·ÓÒ-

ÙÂÚË˜ ·Ó·ÓÂ˘ÛÙÈÎ‹˜ Ô‰Ô‡ ÚÔÎ·ÏÔ‡Ó ˘Ô·ÂÚÈÛÌfi

(˘fiÓÔÈ·) ‹ ·ÔÊÚ·ÎÙÈÎÔ‡ Ù‡Ô˘ ¿ÓÔÈÂ˜. √È ÙÂ-

ÏÂ˘Ù·›Â˜ ÚÔÎ·ÏÔ‡Ó ÂÂÈÛfi‰È· ˘ÔÍ˘ÁÔÓ·ÈÌ›·˜, ÌÂ

Û˘ÓÔ‰fi ˘ÂÚÎ·Ó›· Î·È ·Ó·ÓÂ˘ÛÙÈÎ‹ ÔÍ¤ˆÛË (15).

1) √ÍÂ›Â˜ ·ÈÌÔ‰˘Ó·ÌÈÎ¤˜ ÂÈÙÒÛÂÈ˜: √È ·ÔÊÚ·-

ÎÙÈÎ¤˜ ¿ÓÔÈÂ˜ ÚÔÎ·ÏÔ‡Ó Â·Ó·Ï·Ì‚·ÓfiÌÂÓ·

ÂÂÈÛfi‰È· ÙÒÛË˜ ÙË˜ ÂÓ‰ÔıˆÚ·ÎÈÎ‹˜ ›ÂÛË˜, Ô˘

¤¯Ô˘Ó ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·‡ÍËÛË ÙÔ˘ ÌÂÙ·ÊÔÚÙ›Ô˘

ÙË˜ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜, ÂÏ¿ÙÙˆÛË ÙÔ˘ fiÁÎÔ˘ ·ÏÌÔ‡

Î·È ÙË˜ Î·Ú‰È·Î‹˜ ·ÚÔ¯‹˜. ∆·˘Ùfi¯ÚÔÓ· ·˘Í¿ÓÂÙ·È

Ë ÊÏÂ‚ÈÎ‹ ÂÈÛÙÚÔÊ‹ ·›Ì·ÙÔ˜, ÏfiÁˆ ÂÏ¿ÙÙˆÛË˜ ÙË˜

ÎÂÓÙÚÈÎ‹˜ ÊÏÂ‚ÈÎ‹˜ ›ÂÛË˜, ÌÂ Â·ÎfiÏÔ˘ıÔ ÙËÓ ·‡-

ÍËÛË ÙÔ˘ ÙÂÏÔ‰È·ÛÙÔÏÈÎÔ‡ fiÁÎÔ˘ ÙË˜ ‰ÂÍÈ¿˜ ÎÔÈ-

Ï›·˜. ªÂ ÙËÓ ·Ê‡ÓÈÛË ‰È·ÎfiÙÂÙ·È Ë ¿ÓÔÈ· Î·È

·˘Í¿ÓÂÙ·È Ë Û˘ÛÙËÌ·ÙÈÎ‹ ·ÚÙËÚÈ·Î‹ ›ÂÛË Î·È Ë

Î·Ú‰È·Î‹ ·ÚÔ¯‹ (15).

2) ÃÚfiÓÈÂ˜ ·ÈÌÔ‰˘Ó·ÌÈÎ¤˜ ÂÈÙÒÛÂÈ˜: ∏ ¯ÚfiÓÈ·

˘ÔÍ·ÈÌ›· ÚÔÎ·ÏÂ› ·ÁÁÂÈÔÛ‡Û·ÛË ÙˆÓ ÎÏ¿‰ˆÓ

ÙË˜ ÓÂ˘ÌÔÓÈÎ‹˜ ·ÚÙËÚ›·˜. ∆· Â·ÓÂÈÏËÌÌ¤Ó· ÂÂÈ-

Ûfi‰È· ·ÁÁÂÈÔÛ‡Û·ÛË˜ Î·Ù·ÛÙÚ¤ÊÔ˘Ó ÙÔ ÓÂ˘ÌÔÓÈ-

Îfi ·ÁÁÂÈ·Îfi ÂÓ‰Ôı‹ÏÈÔ, ÌÂ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·Ó¿Ù˘-

ÍË ÓÂ˘ÌÔÓÈÎ‹˜ ˘¤ÚÙ·ÛË˜ Î·È ¯ÚfiÓÈ·˜ ÓÂ˘ÌÔÓÈ-

Î‹˜ Î·Ú‰È¿˜ (15).

∫ÏÈÓÈÎ‹ Û˘ÌÙˆÌ·ÙÔÏÔÁ›· ÙÔ˘ ™∞∞À

™Â ·Ú¯ÈÎfi ÛÙ¿‰ÈÔ ·Ú·ÙËÚÂ›Ù·È ·‰ÂÓÔÂÈ‰¤˜ ÚÔ-

ÛˆÂ›Ô, ÛÙÔÌ·ÙÈÎ‹ ·Ó·ÓÔ‹ Î·È ÚÔ¯·ÏËÙfi ÛÙÔÓ

‡ÓÔ. ™Â ÈÔ ÚÔ¯ˆÚËÌ¤ÓÔ ÛÙ¿‰ÈÔ ÂÌÊ·Ó›˙ÔÓÙ·È

·ÔÊÚ·ÎÙÈÎÔ‡ Ù‡Ô˘ ¿ÓÔÈÂ˜ ÛÙÔÓ ‡ÓÔ, ‰È·Ù·Ú·¯¤˜

‡ÓÔ˘ (Û˘¯Ó¤˜ ·Ê˘Ó›ÛÂÈ˜, Ó˘¯ÙÂÚÈÓÔ› È‰ÚÒÙÂ˜), Ó˘-

¯ÙÂÚÈÓ‹ ÂÓÔ‡ÚËÛË, ÎÂÊ·Ï·ÏÁ›· Î·Ù¿ ÙËÓ ·Ê‡ÓÈÛË,

133∫·Ú‰ÈÔÏÔÁÈÎ¤˜ ÂÈÙÒÛÂÈ˜ ˘ÂÚÙÚÔÊ›·˜ ·‰ÂÓÔÂÈ‰ÒÓ-·Ì˘Á‰·ÏÒÓ

¶·È‰È·ÙÚÈÎ‹ 2009;72:133-000


ËÌÂÚ‹ÛÈ· ˘ÓËÏ›· Î·È Ì·ıËÛÈ·Î¤˜ ‰È·Ù·Ú·¯¤˜. ™Â

ÙÂÏÈÎfi ÛÙ¿‰ÈÔ ·Ú·ÙËÚÂ›Ù·È ˘ÔıÚÂ„›·, ·Ó·ÓÂ˘-

ÛÙÈÎ‹ ‰˘Û¯¤ÚÂÈ·, Î˘¿ÓˆÛË Î·È Û˘ÌÙÒÌ·Ù· ‰ÂÍÈ¿˜

‹ ·ÚÈÛÙÂÚ‹˜ Î·Ú‰È·Î‹˜ ·ÓÂ¿ÚÎÂÈ·˜ (2,3).

™ËÌ·ÓÙÈÎ‹ ËÌÂÚ‹ÛÈ· ˘ÓËÏ›· ‰ÂÓ ·Ú·ÙËÚÂ›Ù·È

Û˘¯Ó¿ ÛÂ ·È‰È¿ Ô˘ ¤¯Ô˘Ó ·ÔÊÚ·ÎÙÈÎÔ‡ Ù‡Ô˘

¿ÓÔÈÂ˜ (16). ¶·ÚfiÏ· ·˘Ù¿, ·ÎfiÌË Î·È ·È‰È¿ ÌÂ

·Ïfi ÚÔ¯·ÏËÙfi ÌÔÚÂ› Ó· ¤¯Ô˘Ó ‰È·Ù·Ú·¯¤˜ Û˘ÌÂ-

ÚÈÊÔÚ¿˜ Î·È Ì·ıËÛÈ·Î¤˜ ‰È·Ù·Ú·¯¤˜ (17,18), ÔÈ

ÔÔ›Â˜ Â›Ó·È ÌÂÚÈÎÒ˜ ·Ó·ÛÙÚ¤„ÈÌÂ˜, ÌÂ ÙËÓ ¿ÚÛË

ÙË˜ ·fiÊÚ·ÍË˜ (19,20).

ŸÛÔÓ ·ÊÔÚ¿ ÛÙË ÌÂÈˆÌ¤ÓË ÛˆÌ·ÙÈÎ‹ ·Ó¿Ù˘ÍË,

Û‡ÌÊˆÓ· ÌÂ ÙÔ˘˜ Marcus et al. (21) ·˘Ù‹ ÔÊÂ›ÏÂÙ·È

ÛÙËÓ ÂÚÁÒ‰Ë ·Ó·ÓÔ‹, Ë ÔÔ›· Ô‰ËÁÂ› ÛÂ ·˘ÍËÌ¤ÓÂ˜

ÌÂÙ·‚ÔÏÈÎ¤˜ ·Ó¿ÁÎÂ˜, ÂÓÒ ÛÂ ÌÈ· ¿ÏÏË ÌÂÏ¤ÙË ıÂˆ-

Ú‹ıËÎÂ ˆ˜ Èı·Ófi˜ ÔÚÌÔÓÈÎfi˜ ÌË¯·ÓÈÛÌfi˜ (ÂÏ¿ÙÙˆ-

ÛË ÙÔ˘ ·Ú¿ÁÔÓÙ· IGF-I) (22). ∞Ó Î·È Ë ÌÂÈˆÌ¤ÓË

ÛˆÌ·ÙÈÎ‹ ·Ó¿Ù˘ÍË ‰ÂÓ Â›Ó·È Û˘¯Ó‹ Ù· ÙÂÏÂ˘Ù·›·

¯ÚfiÓÈ·, Ù· ·È‰È¿ Ô˘ Î¿ÓÔ˘Ó ·‰ÂÓÔÂÈ‰ÂÎÙÔÌ‹ Î·È

·Ì˘Á‰·ÏÂÎÙÔÌ‹ ÏfiÁˆ ™∞∞À ÂÌÊ·Ó›˙Ô˘Ó ·‡ÍËÛË

ÙÔ˘ ÛˆÌ·ÙÈÎÔ‡ ÙÔ˘˜ ‚¿ÚÔ˘˜ ÌÂÙ¿ ·fi ·˘Ù‹Ó

(21,22).

∏ ¯ÚfiÓÈ· ÓÂ˘ÌÔÓÈÎ‹ Î·Ú‰È¿ (cor pulmonale) ÌÂ

Û˘ÓÔ‰fi Î·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ· Â›Ó·È Û¿ÓÈ· Ù· ÙÂ-

ÏÂ˘Ù·›· ¯ÚfiÓÈ·. ¶·ÚfiÏ· ·˘Ù¿, Û˘¯Ó¿ ˘¿Ú¯ÂÈ ·Û˘-

ÌÙˆÌ·ÙÈÎ‹ ÓÂ˘ÌÔÓÈÎ‹ ˘¤ÚÙ·ÛË (3).

¢È¿ÁÓˆÛË ÙÔ˘ ™∞∞À

∂ÎÙfi˜ ·fi ÙÔ ÈÛÙÔÚÈÎfi Î·È ÙËÓ ÎÏÈÓÈÎ‹ ÂÍ¤Ù·ÛË, ÔÈ

‰È·ÁÓˆÛÙÈÎ¤˜ Ì¤ıÔ‰ÔÈ Ô˘ ÌÔÚÔ‡Ó Ó· ‚ÔËı‹ÛÔ˘Ó

ÛÙË ‰È¿ÁÓˆÛË Â›Ó·È Ë ÔÍ˘ÌÂÙÚ›· Î·È Ë ÔÏ˘Î·Ù·ÁÚ·-

ÊÈÎ‹ ÌÂÏ¤ÙË ‡ÓÔ˘. ™Ùfi¯Ô˜ ÙË˜ ‰È¿ÁÓˆÛË˜ ÙË˜ ‡·Ú-

ÍË˜ ™∞∞À Â›Ó·È Ë ·Ó›¯ÓÂ˘ÛË ·ÛıÂÓÒÓ ˘„ËÏÔ‡ ÎÈÓ‰‡-

ÓÔ˘ ÁÈ· ÙËÓ ÂÎ‰‹ÏˆÛË ÛÔ‚·ÚÒÓ ÂÈÏÔÎÒÓ.

øÛÙfiÛÔ ÙÔ ÈÛÙÔÚÈÎfi ‰ÂÓ ÌÔÚÂ› Ó· ‰ÒÛÂÈ ·ÍÈfiÈ-

ÛÙÂ˜ ÏËÚÔÊÔÚ›Â˜ ÁÈ· ÙËÓ ‡·ÚÍË ‹ fi¯È ·ÔÊÚ·ÎÙÈ-

ÎÔ‡ Ù‡Ô˘ ·ÓÔÈÒÓ, ÁÈ· ÙÔ˘˜ ÂÍ‹˜ ÏfiÁÔ˘˜: ÚÒÙÔÓ, Ë

¤ÓÙ·ÛË ÙÔ˘ ÚÔ¯·ÏËÙÔ‡ ‰ÂÓ Û¯ÂÙ›˙ÂÙ·È ÌÂ ÙËÓ ‡·ÚÍË

·ÔÊÚ·ÎÙÈÎÔ‡ Ù‡Ô˘ ·ÓÔÈÒÓ. ∂›ÛË˜, ÔÈ ÔÏ˘Î·Ù·-

ÁÚ·ÊÈÎ¤˜ ÌÂÏ¤ÙÂ˜ ‡ÓÔ˘ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ ÔÈ ¿ÓÔÈÂ˜

·Ú·ÙËÚÔ‡ÓÙ·È Î·Ù¿ ÙÈ˜ ÚÒÙÂ˜ ÚˆÈÓ¤˜ ÒÚÂ˜, ÛÙË

Ê¿ÛË REM ÙÔ˘ ‡ÓÔ˘, fiÔ˘ ÔÈ ÁÔÓÂ›˜ ÎÔÈÌÔ‡ÓÙ·È.

∞ÎfiÌË, ÌÂÚÈÎ¿ ·È‰È¿ ¤¯Ô˘Ó ÌÈ· ÌfiÓÈÌË ·fiÊÚ·ÍË

ÙË˜ ·ÓÒÙÂÚË˜ ·Ó·ÓÂ˘ÛÙÈÎ‹˜ Ô‰Ô‡, Ô˘ Û˘ÓÔ‰Â‡ÂÙ·È

·fi ‰È·Ù·Ú·¯‹ ÙË˜ ·ÓÙ·ÏÏ·Á‹˜ ·ÂÚ›ˆÓ Î·È ‰ÂÓ ÂÌÊ·-

Ó›˙Ô˘Ó ÙÈ˜ Ù˘ÈÎ¤˜ Î˘ÎÏÈÎÔ‡ Ù‡Ô˘ ¿ÓÔÈÂ˜, ÒÛÙÂ Ó·

Á›ÓÔ˘Ó ·ÓÙÈÏËÙ¤˜ ·fi ÙÔ˘˜ ÁÔÓÂ›˜ (2).

∏ ÔÏÔÓ‡ÎÙÈ· Î·Ù·ÁÚ·Ê‹ ÙË˜ ÔÍ˘ÌÂÙÚ›·˜ ÌÔÚÂ›

Â›ÛË˜ Ó· ‰Â›ÍÂÈ ÂÂÈÛfi‰È· Î˘ÎÏÈÎ‹˜ ÙÒÛË˜ ÙÔ˘

ÎÔÚÂÛÌÔ‡, ·ÏÏ¿ ÌÔÚÂ› Ó· ¤¯ÂÈ „Â˘‰Ò˜ ıÂÙÈÎ¿ ·Ô-

ÙÂÏ¤ÛÌ·Ù· ÛÂ ·È‰È¿ ÌÂ ·¯˘Û·ÚÎ›· ‹ ¿ÛıÌ·. ∏ Ìfi-

ÓË Û›ÁÔ˘ÚË ‰È·ÁÓˆÛÙÈÎ‹ Ì¤ıÔ‰Ô˜, ÏÔÈfiÓ, Â›Ó·È Ë

ÔÏ˘Î·Ù·ÁÚ·ÊÈÎ‹ ÌÂÏ¤ÙË ‡ÓÔ˘, Ë ÔÔ›· ÌÔÚÂ› Ó·

‰È·ÎÚ›ÓÂÈ ÙÔ ·Ïfi ÚÔ¯·ÏËÙfi ·fi ÙÔ Û‡Ó‰ÚÔÌÔ ·Ô-

ÊÚ·ÎÙÈÎ‹˜ ¿ÓÔÈ·˜ ‡ÓÔ˘ (2). ø˜ ÚÔ˜ ÙÔ fiÙÂ Ú¤-

ÂÈ Ó· ıÂÚ·Â‡ÂÙ·È ¤Ó· ·È‰› ÌÂ Û‡Ó‰ÚÔÌÔ ÙË˜ ·Ô-

ÊÚ·ÎÙÈÎ‹˜ ¿ÓÔÈ·˜, ·˘Ùfi Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÔˆÛ-

‰‹ÔÙÂ fiÙ·Ó ˘¿Ú¯Ô˘Ó ¿Óˆ ·fi 10 ·ÔÊÚ·ÎÙÈÎ¿

·ÓÔ˚Î¿ ÂÂÈÛfi‰È· ·Ó¿ ÒÚ· (23).

∫ÏÈÓÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ ÙÔ˘ ™∞∞À ÛÙÔ Î·Ú‰È·ÁÁÂÈ·Îfi

Û‡ÛÙËÌ·

√È ÎÏÈÓÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙËÓ ÂÎ-

‰‹ÏˆÛË ˘ÂÚÙ·ÛÈÎÒÓ ÎÚ›ÛÂˆÓ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ·

·ÓÔÈÒÓ, ‰È·Ù·Ú·¯ÒÓ ÙÔ˘ Î·Ú‰È·ÎÔ‡ Ú˘ıÌÔ‡, ÓÂ˘-

ÌÔÓÈÎ‹˜ ˘¤ÚÙ·ÛË˜, ¯ÚfiÓÈ·˜ ÓÂ˘ÌÔÓÈÎ‹˜ Î·Ú‰È¿˜

Î·È Û˘ÌÊÔÚËÙÈÎ‹˜ Î·Ú‰È·Î‹˜ ·ÓÂ¿ÚÎÂÈ·˜.

™∞∞À Î·È ¤ÚÙ·ÛË

∏ ·fiÊÚ·ÍË Ô‰ËÁÂ› ÛÂ Â·Ó·Ï·Ì‚·ÓfiÌÂÓ· ÂÂÈ-

Ûfi‰È· ˘ÂÚÙ·ÛÈÎÒÓ ÎÚ›ÛÂˆÓ Î·Ù¿ ÙÔÓ ‡ÓÔ, Ô˘

Û˘Ó‰˘¿˙ÔÓÙ·È ÌÂ Ù· ·ÓÔ˚Î¿ ÂÂÈÛfi‰È·. ∂›ÛË˜

˘¿Ú¯ÂÈ ·˘ÍËÌ¤ÓÔ˜ Î›Ó‰˘ÓÔ˜ Û˘ÛÙËÌ·ÙÈÎ‹˜ ˘¤Ú-

Ù·ÛË˜ ÛÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹ (24). √È ·ıÔÁÂÓÂÙÈÎÔ› ÌË-

¯·ÓÈÛÌÔ› Ô˘ Èı·ÓÔÏÔÁÔ‡ÓÙ·È Â›Ó·È: ·) ·˘ÍËÌ¤ÓË

‰Ú·ÛÙËÚÈfiÙËÙ· ÙÔ˘ Û˘Ì·ıËÙÈÎÔ‡ ÓÂ˘ÚÈÎÔ‡ Û˘ÛÙ‹-

Ì·ÙÔ˜ (¡™), ÌÂ ·ÔÙ¤ÏÂÛÌ· ·ÂÏÂ˘ı¤ÚˆÛË Î·ÙÂ¯Ô-

Ï·ÌÈÓÒÓ (25), ‚) ·˘ÍËÌ¤ÓË ·Ú·ÁˆÁ‹ ·ÁÁÂÈÔÛ˘Û·-

ÛÙÈÎÒÓ Ô˘ÛÈÒÓ ·fi ÙÔ ÂÓ‰Ôı‹ÏÈÔ ÙˆÓ ÓÂ˘ÌÔÓÈÎÒÓ

·ÁÁÂ›ˆÓ, fiˆ˜ ÙË˜ ÂÓ‰ÔıËÏ›ÓË˜ 1 (26), Î·È Á) ‰È¤-

ÁÂÚÛË ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ÚÂÓ›ÓË˜-·ÁÁÂÈÔÙÂÓÛ›ÓË˜-·Ï-

‰ÔÛÙÂÚfiÓË˜ ÏfiÁˆ ˘ÔÍ›·˜ (27).

∆Ô ™∞∞À ÛÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜ Û¯ÂÙ›˙ÂÙ·È ÌÂ ·˘ÍËÌ¤-

ÓË Èı·ÓfiÙËÙ· ÂÌÊ¿ÓÈÛË˜ Û˘ÛÙËÌ·ÙÈÎ‹˜ ˘¤ÚÙ·ÛË˜

(28,29). §›ÁÂ˜ ·Ó¿ÏÔÁÂ˜ ÌÂÏ¤ÙÂ˜ ˘¿Ú¯Ô˘Ó Î·È ÛÙ·

·È‰È¿. √ Marcus et al. (30) ‰È·›ÛÙˆÛ·Ó ·‡ÍËÛË

ÙË˜ ‰È·ÛÙÔÏÈÎ‹˜ ·ÚÙËÚÈ·Î‹˜ ›ÂÛË˜ Î·Ù¿ ÙË ‰È¿Ú-

ÎÂÈ· ÙÔ˘ ‡ÓÔ˘, Ë ÔÔ›· Â¤ÌÂÓÂ Î·È ÌÂÙ¿ ÙËÓ ¤ÁÂÚ-

ÛË. √È Amin et al. (31) ‚Ú‹Î·Ó ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ¿

·˘ÍËÌ¤ÓË ‰È·Î‡Ì·ÓÛË ÙË˜ ·ÚÙËÚÈ·Î‹˜ ›ÂÛË˜ (∞¶)

Î·Ù¿ ÙËÓ ÂÁÚ‹ÁÔÚÛË Î·È ÙÔÓ ‡ÓÔ, ˘„ËÏfiÙÂÚË Û¯¤-

ÛË Ó˘¯ÙÂÚÈÓ‹˜/ËÌÂÚ‹ÛÈ·˜ ∞¶ Î·È ÌÈÎÚfiÙÂÚË ÙÒÛË

ÙË˜ Ì¤ÛË˜ ∞¶ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ Ó‡¯Ù·˜. ∂›ÛË˜,

ÛÂ ¿ÏÏË ÌÂÏ¤ÙË ÙˆÓ Amin et al. (32) Ê¿ÓËÎ·Ó ÌÂÙ·-

‚ÔÏ¤˜ ÙÔ˘ ¿¯Ô˘˜ ÙÔ˘ ÙÔÈ¯ÒÌ·ÙÔ˜ ÙË˜ ·ÚÈÛÙÂÚ‹˜

ÎÔÈÏ›·˜ Ô˘ Â›Ó·È ÂÓ‰ÂÈÎÙÈÎ¤˜ ·˘ÍËÌ¤ÓˆÓ ÙÈÌÒÓ Û˘-

ÛÙÔÏÈÎ‹˜ ·ÚÙËÚÈ·Î‹˜ ›ÂÛË˜. ∞Ó Î·È ¯ÚÂÈ¿˙ÔÓÙ·È

ÂÚÈÛÛfiÙÂÚÂ˜ ÌÂÏ¤ÙÂ˜ ÛÂ ·È‰È¿, Â›Ó·È ÚÔÊ·Ó¤˜ fiÙÈ

ÔÈ ÌÂÙ·‚ÔÏ¤˜ ÙÔ˘ ÙfiÓÔ˘ ÙÔ˘ ·˘ÙfiÓÔÌÔ˘ ¡™ Ô˘ ·-

Ú·ÙËÚÔ‡ÓÙ·È ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ™∞∞À ÚÔ‰È·ı¤ÙÔ˘Ó ÛÂ

ÚÒÈÌË ÂÌÊ¿ÓÈÛË ˘¤ÚÙ·ÛË˜ (8).

™∞∞À Î·È ‰È·Ù·Ú·¯¤˜ ÙÔ˘ Ú˘ıÌÔ‡

™Â ¿ÙÔÌ· Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·ÔÊÚ·ÎÙÈÎÔ‡ Ù‡-

Ô˘ ¿ÓÔÈÂ˜ ·Ú·ÙËÚÂ›Ù·È ÂÈ‰ÂÈÓÔ‡ÌÂÓË ‚Ú·‰˘-

Î·Ú‰›· Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ·ÓÔ˚ÎÔ‡ ÂÂÈÛÔ‰›Ô˘,

134 ∫. ¶··‰ÔÔ‡ÏÔ˘-§ÂÁÌ¤ÏÔ˘, °. µ·ÚÏ¿ÌË˜



Ô˘ ·ÎÔÏÔ˘ıÂ›Ù·È ·fi Ù·¯˘Î·Ú‰›·. ∂ÈÚfiÛıÂÙ·,

ÌÔÚÂ› Ó· ·Ú·ÙËÚËıÔ‡Ó ¤ÎÙ·ÎÙÂ˜ ÎÔÈÏÈ·Î¤˜ Û˘-

ÛÙÔÏ¤˜, Î·Ú‰È·Î¤˜ ·‡ÛÂÈ˜ >3 sec Î·È 2Ô˘ ‚·ıÌÔ‡

ÎÔÏÔÎÔÈÏÈ·Îfi˜ ·ÔÎÏÂÈÛÌfi˜ Ù‡Ô˘ Mobitz II (33).

ø˜ ·ıÔÁÂÓÂÙÈÎÔ› ÌË¯·ÓÈÛÌÔ› ıÂˆÚÔ‡ÓÙ·È: ·) ÔÈ

·˘ÍËÌ¤ÓÂ˜ ·Ó¿ÁÎÂ˜ ÛÂ ÔÍ˘ÁfiÓÔ Ô˘ ·Ú·ÙËÚÔ‡ÓÙ·È

Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ·ÓÔ˚ÎÔ‡ ÂÂÈÛÔ‰›Ô˘ Î·È Ô‰Ë-

ÁÔ‡Ó ÛÂ ÈÛ¯·ÈÌ›· ÙÔ˘ Ì˘ÔÎ·Ú‰›Ô˘ (34) Î·È ‚) Ë ¯ÚfiÓÈ·

˘ÔÍ·ÈÌ›· Î·È Ë ˘ÂÚÎ·Ó›·, ÔÈ ÔÔ›Â˜ ÚÔÎ·ÏÔ‡Ó

‰È¤ÁÂÚÛË ÙÔ˘ Û˘Ì·ıËÙÈÎÔ‡ ¡™ Î·È ·ÂÏÂ˘ı¤ÚˆÛË

Î·ÙÂ¯ÔÏ·ÌÈÓÒÓ Ô˘ ¤¯Ô˘Ó ·ÚÚ˘ıÌÈÔÁfiÓÔ ‰Ú¿ÛË (35).

¶ÓÂ˘ÌÔÓÈÎ‹ ¤ÚÙ·ÛË - ÚfiÓÈ· ÓÂ˘ÌÔÓÈÎ‹

Î·Ú‰È¿ (cor pulmonale)

∆Ô ‚·ÛÈÎfi ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÙË˜ ÓÂ˘ÌÔÓÈÎ‹˜

Î·Ú‰È¿˜ Â›Ó·È Ë ÓÂ˘ÌÔÓÈÎ‹ ¤ÚÙ·ÛË, Ë ÔÔ›· Â›Ó·È

˘Â‡ı˘ÓË ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ÙË˜ ˘ÂÚÙÚÔÊ›·˜ ÙË˜

‰ÂÍÈ¿˜ ÎÔÈÏ›·˜ Î·È ÙËÓ Î·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ· ÙË˜ ‰Â-

ÍÈ¿˜ (36). ø˜ ÓÂ˘ÌÔÓÈÎ‹ ˘¤ÚÙ·ÛË ¯·Ú·ÎÙËÚ›˙ÂÙ·È

Ë ·‡ÍËÛË ÙË˜ Ì¤ÛË˜ ›ÂÛË˜ ÛÙËÓ ÓÂ˘ÌÔÓÈÎ‹ ·ÚÙË-

Ú›· >25 mm Hg ÛÂ ËÚÂÌ›· Î·È >30 mm Hg Î·Ù¿ ÙËÓ

¿ÛÎËÛË (37).

∞ÈÙÈÔÏÔÁ›· ÓÂ˘ÌÔÓÈÎ‹˜ ¤ÚÙ·ÛË˜

√È ·ÈÙÈÔÏÔÁÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ Ô˘ Ô‰ËÁÔ‡Ó ·fi ÙË

¯ÚfiÓÈ· ·fiÊÚ·ÍË ÛÙËÓ ÂÎ‰‹ÏˆÛË ÓÂ˘ÌÔÓÈÎ‹˜

˘¤ÚÙ·ÛË˜ ‰ÂÓ Â›Ó·È Ï‹Úˆ˜ ‰ÈÂ˘ÎÚÈÓÈÛÌ¤ÓÔÈ. ∏

¯ÚfiÓÈ· ·fiÊÚ·ÍË Î·È Ë Û˘ÓÔ‰fi˜ ˘ÔÍ·ÈÌ›·, ˘ÂÚÎ·-

Ó›· Î·È ÔÍ¤ˆÛË Ô‰ËÁÔ‡Ó ÛÂ ÓÂ˘ÌÔÓÈÎ‹ ·ÁÁÂÈÔÛ‡-

Û·ÛË (ÔÍÂ›· ‹ ¯ÚfiÓÈ·) (1). ∏ ÔÍÂ›· Á›ÓÂÙ·È Ì¤Û· ÛÂ

Ï›Á· ÏÂÙ¿ Î·È Â›Ó·È ·Ó·ÛÙÚ¤„ÈÌË ÌÂ ÙËÓ ¿ÚÛË ÙË˜

·fiÊÚ·ÍË˜. ∏ ¯ÚfiÓÈ· ÔÊÂ›ÏÂÙ·È ÛÂ ‰ÔÌÈÎ¤˜ ·ÓˆÌ·-

Ï›Â˜ ÙˆÓ ÓÂ˘ÌÔÓÈÎÒÓ ·ÁÁÂ›ˆÓ (˘ÂÚÙÚÔÊ›· ÙÔ˘ Ì˘-

˚ÎÔ‡ ¯ÈÙÒÓ· ÙˆÓ ÓÂ˘ÌÔÓÈÎÒÓ ·ÚÙËÚÈÒÓ Ì¤ÛÔ˘ Î·È

ÌÈÎÚÔ‡ ÌÂÁ¤ıÔ˘˜). ªÂ ÙËÓ ¿ÚÛË ÙË˜ ·fiÊÚ·ÍË˜, ÔÈ

ÌÂÙ·‚ÔÏ¤˜ ·˘Ù¤˜ ‰ÂÓ Â›Ó·È Ï‹Úˆ˜ ·Ó·ÛÙÚ¤„ÈÌÂ˜

(1). ∏ ÓÂ˘ÌÔÓÈÎ‹ ·ÁÁÂÈÔÛ‡Û·ÛË Ô‰ËÁÂ› ÛÂ ·‡ÍËÛË

ÙˆÓ ÓÂ˘ÌÔÓÈÎÒÓ ·ÁÁÂÈ·ÎÒÓ ·ÓÙÈÛÙ¿ÛÂˆÓ Î·È ·‡ÍË-

ÛË ÙÔ˘ Î·Ú‰È·ÎÔ‡ ÌÂÙ·ÊÔÚÙ›Ô˘ ÙË˜ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜.

∏ ÙÂÏÂ˘Ù·›· Ô‰ËÁÂ› ÌÂ ÙËÓ ¿ÚÔ‰Ô ÙÔ˘ ¯ÚfiÓÔ˘ ÛÂ

˘ÂÚÙÚÔÊ›· ÙË˜ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜ Î·È ÛÂ ‰ÂÍÈ¿ Î·Ú‰È·-

Î‹ ·ÓÂ¿ÚÎÂÈ· (1). ™ÙË Û˘Ó¤¯ÂÈ·, Â¿Ó ‰ÂÓ ·ÓÙÈÌÂÙˆ-

ÈÛÙÂ› Ë Î·Ù¿ÛÙ·ÛË, ÌÔÚÂ› Ó· ·ÎÔÏÔ˘ı‹ÛÂÈ ‰˘ÛÏÂÈ-

ÙÔ˘ÚÁ›· Î·È ÙË˜ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜, ÌÂ ÂÏ¿ÙÙˆÛË ÙÔ˘

fiÁÎÔ˘ ·ÏÌÔ‡ Î·È Û˘ÌÊÔÚËÙÈÎ‹ Î·Ú‰È·Î‹ ·ÓÂ¿Ú-

ÎÂÈ·. √ Û˘Ó‰˘·ÛÌfi˜ ÙË˜ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·˜ ÙË˜ ·ÚÈÛÙÂ-

Ú‹˜ Î·È ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜ ÌÔÚÂ› Ó· ÂÈ‚·Ú‡ÓÂÈ ÙËÓ

ÓÂ˘ÌÔÓÈÎ‹ ÏÂÈÙÔ˘ÚÁ›· Î·È Èı·ÓfiÓ Ó· Ô‰ËÁ‹ÛÂÈ

ÛÙËÓ ÂÎ‰‹ÏˆÛË ÓÂ˘ÌÔÓÈÎÔ‡ ÔÈ‰‹Ì·ÙÔ˜ (1).

¶ÚÔ˜ ÙÔ ·ÚfiÓ ‰ÂÓ ˘¿Ú¯Ô˘Ó ÌÂÏ¤ÙÂ˜ Ô˘ Ó·

·Ô‰ÂÈÎÓ‡Ô˘Ó fiÙÈ ÛÂ ·Ô˘Û›· ËÌÂÚ‹ÛÈ·˜ ˘ÔÍ·È-

Ì›·˜ ÌÔÚÂ› Ó· ÚÔÎÏËıÂ› ÌË ·Ó·ÛÙÚ¤„ÈÌË ÓÂ˘ÌÔ-

ÓÈÎ‹ ¤ÚÙ·ÛË. ∞ÓÙ›ıÂÙ·, Ë Û˘Ó‡·ÚÍË ÛÔ‚·Ú‹˜ Ó˘-

¯ÙÂÚÈÓ‹˜ ˘ÔÍ·ÈÌ›·˜ ÌÂ ‹È· ¤ˆ˜ Ì¤ÙÚÈ· ËÌÂÚ‹ÛÈ·

˘ÔÍ·ÈÌ›· ‹/Î·È ˘ÂÚÎ·Ó›· ÌÔÚÂ› Ó· Ô‰ËÁ‹ÛÂÈ

ÛÙËÓ ÂÁÎ·Ù¿ÛÙ·ÛË ÓÂ˘ÌÔÓÈÎ‹˜ ˘¤ÚÙ·ÛË˜ (38).

™˘ÌÙˆÌ·ÙÔÏÔÁ›· ÚfiÓÈ·˜ ÓÂ˘ÌÔÓÈÎ‹˜ Î·Ú‰È¿˜

∆· Û˘ÌÙÒÌ·Ù· ÙË˜ ÂÍÂÏÈÛÛfiÌÂÓË˜ ÓÂ˘ÌÔÓÈÎ‹˜

˘¤ÚÙ·ÛË˜ ·Ú¯ÈÎ¿ Â›Ó·È ·Û‹Ì·ÓÙ·, Ì¤¯ÚÈ Ó· Û˘Ì‚Â›

ÛÔ‚·Ú‹ Î·Ú‰È·Î‹ ·ÔÚÚ‡ıÌÈÛË (39). ™ÙÈ˜ Û¿ÓÈÂ˜

ÂÚÈÙÒÛÂÈ˜ Ô˘ ¤¯ÂÈ Î·Ù·Ï‹ÍÂÈ ÛÂ ¯ÚfiÓÈ· ÓÂ˘ÌÔ-

ÓÈÎ‹ Î·Ú‰È¿, ÂÌÊ·Ó›˙ÂÙ·È ‰‡ÛÓÔÈ· (·fi ÂÏ¿ÙÙˆÛË

ÙË˜ ‰È·Ù·ÛÈÌfiÙËÙ·˜ ÙˆÓ ÓÂ˘ÌfiÓˆÓ), Â‡ÎÔÏË Îfiˆ-

ÛË (·fi ÂÏ¿ÙÙˆÛË ÙË˜ Î·Ú‰È·Î‹˜ ·ÚÔ¯‹˜), Û˘ÁÎÔ-

ÈÎ¿ ÂÂÈÛfi‰È· (·fi ·ÚÔ‰ÈÎ‹ ÂÁÎÂÊ·ÏÈÎ‹ ÈÛ¯·È-

Ì›·), ÚÔÎ¿Ú‰È· ¿ÏÁË ÛÙËı·Á¯ÈÎÔ‡ ¯·Ú·ÎÙ‹Ú· Î·È

·›ÛıËÌ· ·ÏÌÒÓ. ∂›ÛË˜, ÙÔ Û‡Ó‰ÚÔÌÔ ·ÔÊÚ·ÎÙÈ-

Î‹˜ ¿ÓÔÈ·˜ Î·Ù¿ ÙÔÓ ‡ÓÔ Ú¤ÂÈ Ó· ÙÔ ˘Ô„È·ÛÙÂ›

Î·ÓÂ›˜ ÛÂ ·È‰› Ô˘ ·ÚÔ˘ÛÈ¿˙ÂÈ ·ÓÂÍ‹ÁËÙË Î·Ú‰È·-

Î‹ ·ÓÂ¿ÚÎÂÈ· Î·È ¤¯ÂÈ ÛÔ‚·ÚÔ‡ ‚·ıÌÔ‡ ˘ÂÚÙÚÔ-

Ê›· ÙˆÓ ·‰ÂÓÔÂÈ‰ÒÓ Î·È ·Ì˘Á‰·ÏÒÓ (36).

∫ÏÈÓÈÎ¿ Â˘Ú‹Ì·Ù· ÚfiÓÈ·˜ ÓÂ˘ÌÔÓÈÎ‹˜ Î·Ú‰È¿˜

∫·Ù¿ ÙËÓ ·ÎÚfi·ÛË ÙË˜ Î·Ú‰È¿˜ ·Ú·ÙËÚÂ›Ù·È

·˘ÍËÌ¤ÓÔ ÙÔ ÓÂ˘ÌÔÓÈÎfi ÛÙÔÈ¯Â›Ô ÙÔ˘ 2Ô˘ ÙfiÓÔ˘,

Û˘ÛÙÔÏÈÎfi Ê‡ÛËÌ· ·ÓÂ¿ÚÎÂÈ·˜ ÙË˜ ÙÚÈÁÏÒ¯ÈÓ·˜ ‹

‰È·ÛÙÔÏÈÎfi Ê‡ÛËÌ· ·ÓÂ¿ÚÎÂÈ·˜ ÙË˜ ÓÂ˘ÌÔÓÈÎ‹˜,

3Ô˜ ‹ 4Ô˜ ÙfiÓÔ˜. ∂›ÛË˜, ÌÔÚÂ› Ó· ˘¿Ú¯ÂÈ ‰È¿Ù·ÛË

ÙˆÓ ÊÏÂ‚ÒÓ ÙÔ˘ ÙÚ·¯‹ÏÔ˘, Ë·ÙÔÌÂÁ·Ï›· Î·È ÂÚÈ-

ÊÂÚÈÎ¿ ÔÈ‰‹Ì·Ù· (1).

∞ÎÙÈÓÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù· ÚfiÓÈ·˜ ÓÂ˘ÌÔÓÈÎ‹˜

Î·Ú‰È¿˜

™ÙËÓ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ ·Ú·ÙËÚÂ›Ù·È ‰È¿-

Ù·ÛË ÙË˜ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜ Î·È ÙÔ˘ ‰ÂÍÈÔ‡ ÎfiÏÔ˘, ‰È¿-

Ù·ÛË ÙË˜ ÓÂ˘ÌÔÓÈÎ‹˜ ·ÚÙËÚ›·˜ Î·È ÓÂ˘ÌÔÓÈÎ‹

Û˘ÌÊfiÚËÛË.

∏ÏÂÎÙÚÔÎ·Ú‰ÈÔÁÚ·ÊÈÎ¿ Â˘Ú‹Ì·Ù· ÚfiÓÈ·˜

ÓÂ˘ÌÔÓÈÎ‹˜ Î·Ú‰È¿˜

∂›Ó·È ÂÌÊ·Ó‹ ÛÂ ÚÔ¯ˆÚËÌ¤Ó· ÛÙ¿‰È·, fiÔ˘

˘¿Ú¯ÂÈ ˘ÂÚÙÚÔÊ›· ÙË˜ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜ Î·È Î·Ú‰È·-

Î‹ ·ÓÂ¿ÚÎÂÈ· ÙË˜ ‰ÂÍÈ¿˜. ¶·Ú·ÙËÚÔ‡ÓÙ·È ‰ÂÍÈ¿

ÛÙÚÔÊ‹ ÙÔ˘ ¿ÍÔÓ·, ˘„ËÏ¿ ÔÍ˘ÎfiÚ˘Ê· P, È‰›ˆ˜ ÛÙÈ˜

··ÁˆÁ¤˜ II, V1 Î·È V2 (·fi ÙËÓ ˘ÂÚÙÚÔÊ›· ÙÔ˘ ‰Â-

ÍÈÔ‡ ÎfiÏÔ˘), ˘„ËÏ¿ R ÛÙÈ˜ ‰ÂÍÈ¤˜ ÚÔÎ¿Ú‰ÈÂ˜ ··-

ÁˆÁ¤˜ Î·È ‚·ıÈ¿ S ÛÙÈ˜ ·ÚÈÛÙÂÚ¤˜ ÚÔÎ¿Ú‰ÈÂ˜ ··-

ÁˆÁ¤˜ (·fi ˘ÂÚÙÚÔÊ›· ÙË˜ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜). ªÔ-

ÚÂ› Â›ÛË˜ Ó· ·Ú·ÙËÚËıÔ‡Ó ‰˘ÛÚ˘ıÌ›Â˜.

∏¯ÔÎ·Ú‰ÈÔÁÚ·ÊÈÎ¿ Â˘Ú‹Ì·Ù· ÚfiÓÈ·˜

ÓÂ˘ÌÔÓÈÎ‹˜ Î·Ú‰È¿˜

™ÙÔ ˘ÂÚË¯ÔÁÚ¿ÊËÌ· Î·Ú‰È¿˜, ˘¿Ú¯ÂÈ ‰È¿Ù·ÛË

Î·È ˘ÂÚÙÚÔÊ›· ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜ Î·È ‰ÂÍÈÔ‡ ÎfiÏÔ˘ Î·È

‰È¿Ù·ÛË ÙË˜ ÓÂ˘ÌÔÓÈÎ‹˜ ·ÚÙËÚ›·˜. ªÂ ÙË ÌÂÏ¤ÙË


¶·È‰È·ÙÚÈÎ‹ 2009;72:135-000


Doppler ‰È·ÈÛÙÒÓÂÙ·È ·ÓÂ¿ÚÎÂÈ· ÙÚÈÁÏÒ¯ÈÓ·˜ Î·È

ÓÂ˘ÌÔÓÈÎ‹˜ ‚·Ï‚›‰·˜ Î·È ÌÂÙÚ¿Ù·È Ë ›ÂÛË ÛÙËÓ

ÓÂ˘ÌÔÓÈÎ‹ ·ÚÙËÚ›·, Ë ÔÔ›· Â›Ó·È ·˘ÍËÌ¤ÓË (1).

™Â ÈÔ ÚÔ¯ˆÚËÌ¤ÓÂ˜ Î·Ù·ÛÙ¿ÛÂÈ˜ ÌÔÚÂ› ·Îfi-

ÌË Ó· ·Ú·ÙËÚËıÂ› ‰È·ÛÙÔÏÈÎ‹ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ÙË˜

·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ ‹/Î·È ˘ÂÚÙÚÔÊ›· ÙË˜ ·ÚÈÛÙÂÚ‹˜

ÎÔÈÏ›·˜ (40,41).

£ÂÚ·Â›· ÙÔ˘ ™∞∞À

∞‰ÂÓÔÂÈ‰ÂÎÙÔÌ‹ Î·È ·Ì˘Á‰·ÏÂÎÙÔÌ‹

∏ ¯ÂÈÚÔ˘ÚÁÈÎ‹ ·Ê·›ÚÂÛË ÙˆÓ ·‰ÂÓÔÂÈ‰ÒÓ Î·È

·Ì˘Á‰·ÏÒÓ ·Ú·Ì¤ÓÂÈ Ë ıÂÚ·Â›· ÚÒÙË˜ ÂÎÏÔÁ‹˜

Î·È Â›Ó·È ·Ó·ÁÎ·›· ÛÙ· ·È‰È¿ Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó

™∞∞À (8,42,43).

∆· ÂÚÈÛÛfiÙÂÚ· ·È‰È¿ Ô˘ ¿Û¯Ô˘Ó ·fi ™∞∞À

‚ÂÏÙÈÒÓÔÓÙ·È ÛËÌ·ÓÙÈÎ¿ ÌÂÙ¿ ÙËÓ ·‰ÂÓÔÂÈ‰ÂÎÙÔÌ‹

Î·È ·Ì˘Á‰·ÏÂÎÙÔÌ‹ (3,44-47). ∂›ÛË˜, ÔÈ Sdralis Î·È

Berkovitz ÌÂÏ¤ÙËÛ·Ó ·Û˘ÌÙˆÌ·ÙÈÎ¿ ·È‰È¿ ÌÂ

˘ÂÚÙÚÔÊ›· ÙˆÓ ·‰ÂÓÔÂÈ‰ÒÓ Î·È ·Ì˘Á‰·ÏÒÓ Î·È

‰È·›ÛÙˆÛ·Ó fiÙÈ ÔÏÏ¿ ·fi ·˘Ù¿ ·ÚÔ˘Û›·˙·Ó Î˘-

„ÂÏÈ‰ÈÎfi ˘Ô·ÂÚÈÛÌfi, Ô˘ ‚ÂÏÙÈÒıËÎÂ ÌÂÙ¿ ÙË ¯ÂÈ-

ÚÔ˘ÚÁÈÎ‹ Â¤Ì‚·ÛË (48).

ŸÛÔÓ ·ÊÔÚ¿ ÛÙË ÌÂÌÔÓˆÌ¤ÓË ·‰ÂÓÔÂÈ‰ÂÎÙÔÌ‹,

Î¿ÔÈÂ˜ ÌÂÏ¤ÙÂ˜ ¤‰ÂÈÍ·Ó fiÙÈ ‰ÂÓ Â›Ó·È ·ÔÙÂÏÂÛÌ·-

ÙÈÎ‹ (42,49), ÂÓÒ ÌÈ· ÌÂÏ¤ÙË Ô˘ Û˘ÁÎÚ›ÓÂÈ ÙËÓ ·Ì˘-

Á‰·ÏÂÎÙÔÌ‹-·‰ÂÓÔÂÈ‰ÂÎÙÔÌ‹ ÌÂ ÙË ÌÂÌÔÓˆÌ¤ÓË

·‰ÂÓÔÂÈ‰ÂÎÙÔÌ‹ ‰ÂÓ ¤‰ÂÈÍÂ ÛËÌ·ÓÙÈÎ¤˜ ‰È·ÊÔÚ¤˜

·Ó¿ÌÂÛ· ÛÙÈ˜ ‰‡Ô ÔÌ¿‰Â˜ (44).

∂›ÛË˜, ¿ÏÏÔ˜ ¤Ó·˜ ÛËÌ·ÓÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÙË˜

·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ ÙË˜ Â¤Ì‚·ÛË˜ Â›Ó·È Ë ‚·Ú‡-

ÙËÙ· ÙË˜ ·fiÊÚ·ÍË˜. ªÈ· ÌÂÏ¤ÙË Ô˘ Û˘ÁÎÚ›ÓÂÈ ÙËÓ

·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙË˜ Â¤Ì‚·ÛË˜ ÌÂ ÙË ‚·Ú‡ÙË-

Ù· ÙË˜ ·fiÊÚ·ÍË˜ ¤‰ÂÈÍÂ fiÙÈ Ù· ·È‰È¿ Ô˘ Â›¯·Ó

ÛÔ‚·Ú‹ ·fiÊÚ·ÍË Û˘Ó¤¯ÈÛ·Ó Ó· ¤¯Ô˘Ó ‰È·Ù·Ú·¯¤˜

‡ÓÔ˘ Î·È ÌÂÙ¿ ÙËÓ Â¤Ì‚·ÛË (50). ÕÏÏÔÈ ·Ú¿ÁÔ-

ÓÙÂ˜ Ô˘ ÚÔ‰È·ı¤ÙÔ˘Ó ÛÂ ˘ÔÏÂÈfiÌÂÓÔ ™∞∞À ÌÂ-

Ù¿ ÙËÓ ·‰ÂÓÔÂÈ‰ÂÎÙÔÌ‹ Î·È ·Ì˘Á‰·ÏÂÎÙÔÌ‹ Â›Ó·È Ë

Û˘Ó‡·ÚÍË ·¯˘Û·ÚÎ›·˜ Î·È ÙÔ ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi

ÈÛÙÔÚÈÎfi (8,51).

√È ·ÛıÂÓÂ›˜ Ô˘ ¤¯Ô˘Ó ÛÔ‚·Ú‹ ·fiÊÚ·ÍË ÌÔ-

ÚÂ› Ó· ¤¯Ô˘Ó ÓÂ˘ÌÔÓÈÎ‹ ˘¤ÚÙ·ÛË ‹ Î·È Î·Ú‰È·Î‹

‰˘ÛÏÂÈÙÔ˘ÚÁ›·, ÁÈ’ ·˘Ùfi Î·È Â›Ó·È Èı·Ófi Ó· ¤¯Ô˘Ó

ÂÈÏÔÎ¤˜ ÌÂÙ¿ ÙË ¯ÂÈÚÔ˘ÚÁÈÎ‹ Â¤Ì‚·ÛË. √È ÂÈ-

ÏÔÎ¤˜ ÌÔÚÂ› Ó· Â›Ó·È ¿ÌÂÛÂ˜, fiˆ˜ ÂÈ‰Â›ÓˆÛË

ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ·ÔÊÚ·ÎÙÈÎ‹˜ ¿ÓÔÈ·˜ ‡ÓÔ˘ ‹

ÓÂ˘ÌÔÓÈÎfi Ô›‰ËÌ·, Î·È ·ÒÙÂÚÂ˜, fiˆ˜ ·Ú·ÌÔÓ‹

·ÚÔ‰ÈÎÔ‡ Î˘„ÂÏÈ‰ÈÎÔ‡ ˘Ô·ÂÚÈÛÌÔ‡ (Ô˘ ÌÔÚÂ›

Ó· ¯ÚÂÈ·ÛıÂ› Ì¤¯ÚÈ ÌË¯·ÓÈÎfi ·ÂÚÈÛÌfi ‹ ÙÚ·¯ÂÈÔÛÙÔ-

Ì›·) ‹ Â›ÌÔÓË ˘ÔÍ·ÈÌ›· Î·È ‰È·Ù·Ú·¯¤˜ ‡ÓÔ˘

(1,52). °È· ÙÔ˘˜ ·ÓˆÙ¤Úˆ ÏfiÁÔ˘˜, Û˘ÓÈÛÙ¿Ù·È Î·Ú-

‰ÈÔÏÔÁÈÎ‹ ÂÎÙ›ÌËÛË ÌÂ ˘ÂÚË¯ÔÁÚ¿ÊËÌ· Î·Ú‰È¿˜

ÚÔÂÁ¯ÂÈÚËÙÈÎ¿ Î·È ÂÈÛÙ·Ì¤ÓË ÌÂÙÂÁ¯ÂÈÚËÙÈÎ‹ ·-

Ú·ÎÔÏÔ‡ıËÛË ÛÂ ·˘ÙÔ‡˜ ÙÔ˘˜ ·ÛıÂÓÂ›˜.

ÕÏÏÂ˜ ıÂÚ·Â›Â˜

™Â ·È‰È¿ Ô˘ ÂÌÊ·Ó›˙Ô˘Ó ˘ÔÏÂÈfiÌÂÓÔ ™∞∞À

ÌÂÙ¿ ÙË ¯ÂÈÚÔ˘ÚÁÈÎ‹ Â¤Ì‚·ÛË Û˘ÓÈÛÙ¿Ù·È Ë ¯Ú‹ÛË

ÙÔ˘ ÚÈÓÈÎÔ‡ CPAP. ∂›ÛË˜, ¤¯ÂÈ ·Ú·ÙËÚËıÂ› ‚ÂÏ-

Ù›ˆÛË ÌÂÙ¿ ·fi ¯ÔÚ‹ÁËÛË ÎÔÚÙÈÎÔÂÈ‰ÒÓ ÂÓ‰ÔÚÚÈÓÈ-

Î¿ ÛÂ ·È‰È¿ ÌÂ ÂÏ·ÊÚ¿ ¤ˆ˜ Ì¤ÙÚÈ· ·fiÊÚ·ÍË Ô˘

‰ÂÓ ¤¯Ô˘Ó ¯ÂÈÚÔ˘ÚÁËıÂ› (53), Î·ıÒ˜ Â›ÛË˜ ÛÂ ·È-

‰È¿ ÌÂ ˘ÔÏÂÈfiÌÂÓÔ ™∞∞À ÌÂÙ¿ ÙËÓ ·‰ÂÓÔÂÈ‰ÂÎÙÔ-

Ì‹ Î·È ·Ì˘Á‰·ÏÂÎÙÔÌ‹ (54).

∏ ¯ÔÚ‹ÁËÛË ÔÍ˘ÁfiÓÔ˘ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ Ó‡-

ÎÙ·˜ ÁÈ· ÙËÓ ·ÔÊ˘Á‹ ÙË˜ Ó˘¯ÙÂÚÈÓ‹˜ ÔÍ·ÈÌ›·˜ ‰ÂÓ

‚ÔËı¿ÂÈ ÛÂ fiÏÔ˘˜ ÙÔ˘˜ Ù‡Ô˘˜ ÙÔ˘ ™∞∞À, ‰ÈfiÙÈ ‰ÂÓ

ÚÔÊ˘Ï¿ÛÛÂÈ ·fi ÙËÓ ·fiÊÚ·ÍË ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·Ó·-

ÓÂ˘ÛÙÈÎÔ‡ Î·È ÂÈÏ¤ÔÓ ÌÔÚÂ› Ó· ÂÈ‰ÂÈÓÒÛÂÈ ÙÔÓ

˘Ô·ÂÚÈÛÌfi (55). ™˘ÓÈÛÙ¿Ù·È fiÌˆ˜ Ë ¯ÔÚ‹ÁËÛË ÔÍ˘-

ÁfiÓÔ˘ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘ ÛÙÔ ™∞∞À Ù‡Ô˘

ππ, ·Ú¿ÏÏËÏ· ÌÂ ÙÔ ÚÈÓÈÎfi CPAP, ÂÓÒ Ë ¯ÔÚ‹ÁËÛË

ÔÍ˘ÁfiÓÔ˘ >18 ÒÚÂ˜ ËÌÂÚËÛ›ˆ˜ Û˘ÓÈÛÙ¿Ù·È ÛÂ ·ÛıÂ-

ÓÂ›˜ Ô˘ ÂÌÊ·Ó›˙Ô˘Ó Î·È ËÌÂÚ‹ÛÈ· ˘ÔÍ·ÈÌ›· (38).

™Â Î·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ· ÌÔÚÂ› Â›ÛË˜ Ó· ÔÚË-

ÁËıÔ‡Ó ‰·ÎÙ˘Ï›ÙÈ‰· Î·È ‰ÈÔ˘ÚËÙÈÎ¿ Ì¤¯ÚÈ ÙËÓ ¿ÚÛË

ÙË˜ ·fiÊÚ·ÍË˜ (36).

∆· ·È‰È¿ Ô˘ ¤¯Ô˘Ó ˘ÔÛÙÂ› ¯ÂÈÚÔ˘ÚÁÈÎ‹ Â¤Ì-

‚·ÛË ÁÈ· ™∞∞À Ú¤ÂÈ Ó· Â·ÓÂÎÙÈÌËıÔ‡Ó ÌÂÙ¿

·fi 6-8 Â‚‰ÔÌ¿‰Â˜ ÁÈ· Ó· Ê·ÓÂ› Â¿Ó ¤¯Ô˘Ó ‚ÂÏÙÈˆ-

ıÂ› ‹ ¯ÚÂÈ¿˙ÔÓÙ·È ÂÈÚfiÛıÂÙË ıÂÚ·Â›·, fiˆ˜ ÙÔ

ÚÈÓÈÎfi CPAP (1,2).


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138 ∫. ¶··‰ÔÔ‡ÏÔ˘-§ÂÁÌ¤ÏÔ˘, °. µ·ÚÏ¿ÌË˜



√Ú›˙ÔÓÙ·˜ ÙËÓ ·È‰ÈÎ‹ Î·È ÂÊË‚ÈÎ‹ ·¯˘Û·ÚÎ›· ÛÙËÓ Ú¿ÍË:

ÌÂıÔ‰ÔÏÔÁÈÎ¿ ‰ÈÏ‹ÌÌ·Ù·

¶. ¶ÂÚ‚·Ó›‰Ô˘

¶ÂÚ›ÏË„Ë: √ ÔÚÈÛÌfi˜ Î·È Ë Ì¤ÙÚËÛË ÙË˜ ·¯˘Û·ÚÎ›·˜ ÛÙËÓ ·È‰ÈÎ‹ Î·È ÂÊË‚ÈÎ‹ ËÏÈÎ›· ·ÊÔÚÔ‡Ó ÛÂ ÌÂ-Á¿ÏÔ ‚·ıÌfi ÙÔÓ ·È‰›·ÙÚÔ Û‹ÌÂÚ·. √È ‰ÈÂıÓÂ›˜ ÔÚÈÛÌÔ› ÙË˜ ·¯˘Û·ÚÎ›·˜, Ô˘ ‚·Û›˙ÔÓÙ·È Î·Ù¿ Î‡ÚÈÔÏfiÁÔ ÛÙÔÓ ¢Â›ÎÙË ª¿˙·˜ ™ÒÌ·ÙÔ˜ (¢ª™) Î·È ÛÙ· ÔÚÈ·Î¿ ÛËÌÂ›· ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜, ¯ÚËÛÈÌÔ-ÔÈÔ‡ÓÙ·È ÛÂ ÂÈ‰ËÌÈÔÏÔÁÈÎ¤˜ ÌÂÏ¤ÙÂ˜ Î·È Ê·›ÓÂÙ·È fiÙÈ ‰ÂÓ Â›Ó·È Î·Ù¿ÏÏËÏÔÈ ÁÈ· ÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ·È‰ÈÒÓ ÛÙËÓ ÎÏÈÓÈÎ‹ Ú¿ÍË. ∏ Û˘ÓÈÛÙÒÌÂÓË ÎÏÈÓÈÎ‹ ·ÍÈÔÏfiÁËÛË ÙÔ˘ ·È‰ÈÔ‡ ‹ ÂÊ‹‚Ô˘ ÍÂÎÈÓ¿ ÌÂ ÙËÓ ÙÔÔı¤ÙËÛË ÙË˜ ÙÈÌ‹˜ ÙÔ˘ ¢Â›-ÎÙË ª¿˙·˜ ™ÒÌ·ÙÔ˜ (¢ª™) ÛÙ· ÈÔ Û‡Á¯ÚÔÓ· ·ÓıÚˆÔÌÂÙÚÈÎ¿ ÚfiÙ˘· ‰È·ÁÚ¿ÌÌ·Ù· ÙÔ˘ ¢ª™ ·Ó¿Ê‡ÏÔ Î·È ·Ó¿ ¯ÒÚ·. ∏ ÚÔ¤ÎÙ·ÛË ÙˆÓ ÔÚÈ·ÎÒÓ ÛËÌÂ›ˆÓ ÙÔ˘ ˘¤Ú‚·ÚÔ˘ Î·È ÙÔ˘ ·¯‡Û·ÚÎÔ˘ ÁÈ· ÙÔ˘˜ÂÓ‹ÏÈÎÂ˜ ÌÔÚÂ› Ó· ¯ÚËÛÈÌÔÔÈËıÂ› ÁÈ· ÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë Î·Ù¿Ù·ÍË ÙˆÓ ·È‰ÈÒÓ ÂÏÏËÓÈÎ‹˜ Î·Ù·ÁˆÁ‹˜, ÂÓÒÁÈ· ÙËÓ ÂÎÙ›ÌËÛË ÙÔ˘ ÔÛÔÛÙÔ‡ ·¯˘Û·ÚÎ›·˜ Ì¤¯ÚÈ ÙËÓ ËÏÈÎ›· ÙˆÓ 18 ÚfiÓˆÓ, ÛÂ ¤Ó· Û˘ÁÎÂÎÚÈÌ¤ÓÔ ÏË-ı˘ÛÌfi, Û˘ÓÈÛÙ¿Ù·È Ë Ì¤ÙÚËÛË ÙÔ˘ ¢ª™ ÛÂ ÛÙ·ıÂÚ¤˜ ·ÔÎÏ›ÛÂÈ˜ ·fi ÙÔ Ì¤ÛÔ fiÚÔ (z-score). ŸÏÂ˜ ÔÈ Ì¤-ıÔ‰ÔÈ Ì¤ÙÚËÛË˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÏÂÔÓÂÎÙ‹Ì·Ù· Î·È ÌÂÈÔÓÂÎÙ‹Ì·Ù·.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ¶·¯˘Û·ÚÎ›·, ·È‰›, ‰Â›ÎÙË˜ Ì¿˙·˜ ÛÒÌ·ÙÔ˜, ÂÎ·ÙÔÛÙÈ·›Â˜ ı¤ÛÂÈ˜, z-score.

Defining obesity in children and adolescents: methodological

dilemmas

P. Pervanidou

Abstract: πn defining obesity in children and adolescents, clinicians are attempting to identify thoseindividuals with excessive adiposity. However, the accurate estimation of body fat content and of theconsequent health implications is not an easy task. International definitions of childhood obesity, based onBody Mass Index (BMI) and adult cut-off points, which are used in large epidemiologic studies are lessvaluable in clinical practice.Definitions dependent upon a reference population, based on the concept of a certain level of deviationfrom the mean BMI of the population and using centiles and z-scores, may present variable cut-off points,as the reference curves are likely to vary between countries and may change over time within one country.In monitoring patients in the clinical setting, however, this approach provides a continuous measure in thesame patient and a comparison measure of obesity status between groups.

Key words: Obesity, child, body mass index, percentiles, z-score.

139¶ƒ∞∫∆π∫√ £∂ª∞ PRACTICAL ISSUE

π·ÙÚÂ›Ô ¶·È‰ÈÎ‹˜ &∂ÊË‚ÈÎ‹˜ ¶·¯˘Û·ÚÎ›·˜, ∞’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ,¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ «∏ ∞Á›· ™ÔÊ›·»


¶·Ó·ÁÈÒÙ· ¶ÂÚ‚·Ó›‰Ô˘[email protected]∞’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ,¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ «∏ ∞Á›· ™ÔÊ›·», ∞ı‹Ó·

Childhood and AdolescenceObesity Clinic, First Department ofPediatrics, Athens UniversityMedical School, “Aghia Sophia” Children’sHospital, Athens, Greece

Correspondence:

Panagiota [email protected] for Developmental andBehavioral Paediatrics, First Department ofPaediatrics, Athens UniversityMedical School, “Aghia Sophia” Children’sHospital, Athens, Greece

¶·È‰È·ÙÚÈÎ‹ 2009;72:23-28

∏ ·¯˘Û·ÚÎ›· ÁÂÓÈÎ¿ ÔÚ›˙ÂÙ·È ˆ˜ Ë ˘ÂÚ-

‚ÔÏÈÎ‹ Û˘ÛÛÒÚÂ˘ÛË Ï›Ô˘˜ ÛÙÔÓ ÔÚÁ·ÓÈÛÌfi, ÛÂ

‚·ıÌfi Ô˘ ÂËÚÂ¿˙ÂÙ·È Ë ˘ÁÂ›· ÙÔ˘ ·ÙfiÌÔ˘

(1). ∏ ÔÛÔÙÈÎÔÔ›ËÛË, fiÌˆ˜, ÙÔ˘ ÏÈÒ‰Ô˘˜

ÈÛÙÔ‡, Î·ıÒ˜ Î·È Ô ‚·ıÌfi˜ Â›‰Ú·ÛË˜ ÙË˜ Â-

Ú›ÛÛÂÈ·˜ Ï›Ô˘˜ ÛÙËÓ ˘ÁÂ›· ÙÔ˘ ·ÙfiÌÔ˘ ‰ÂÓ Â›-

Ó·È Â‡ÎÔÏÔ Ó· ·ÍÈÔÏÔÁËıÔ‡Ó ÛÙËÓ Î·ıËÌÂÚÈÓ‹

ÎÏÈÓÈÎ‹ Ú¿ÍË. OÈ Û‡Á¯ÚÔÓÂ˜ Ì¤ıÔ‰ÔÈ Ì¤ÙÚË-

ÛË˜ ÙË˜ Ì¿˙·˜ ÙÔ˘ ÏÈÒ‰Ô˘˜ ÈÛÙÔ‡, fiˆ˜ Ë Ì¤-

ÙÚËÛË ÙË˜ ÛˆÌ·ÙÈÎ‹˜ ˘ÎÓfiÙËÙ·˜ Î¿Ùˆ ·fi ÙÔ

ÓÂÚfi, Ë ÂÚÈÂÎÙÈÎfiÙËÙ· ÛˆÌ·ÙÈÎÔ‡ Ï›Ô˘˜

fiˆ˜ ÂÎÙÈÌ¿Ù·È Ì¤Ûˆ ÙÔ˘ ·ÔÚÚÔÊËÛÈÔÌÂÙÚË-

Ù‹ ‰ÈÏ‹˜ ÂÓ¤ÚÁÂÈ·˜ ·ÎÙ›ÓˆÓ Ã (dual-energy X-

ry absorptiometer, DEXA), Î·ıÒ˜ Î·È ÔÈ Ó¤Â˜

ÙÂ¯ÓÈÎ¤˜, fiˆ˜ Â›Ó·È Ë ·ÂÈÎfiÓÈÛË Ì·ÁÓËÙÈÎÔ‡

Û˘ÓÙÔÓÈÛÌÔ‡ (ªagnetic Resonance Imaging,

MRI) Î·È Ë ˘ÔÏÔÁÈÛÙÈÎ‹ ÙÔÌÔÁÚ·Ê›·

(Computed Tomography, CT), Â¤ÙÚÂ„·Ó Ó·

ÂÚÈÁÚ·ÊÂ› ÌÂ ·ÎÚ›‚ÂÈ· Ô ÏÈÒ‰Ë˜ ÈÛÙfi˜, ·ÏÏ¿

·ÔÙÂÏÔ‡Ó ÛÙËÓ ÏÂÈÔ„ËÊ›· ÙÔ˘˜ ‰··ÓËÚ¤˜

Î·È ¯ÚÔÓÔ‚fiÚÂ˜ ÂÍÂÙ¿ÛÂÈ˜, ÁÂÁÔÓfi˜ Ô˘ ÂÚÈÔ-

Ú›˙ÂÈ ÙË ¯Ú‹ÛË ÙÔ˘˜ ÛÙËÓ ÎÏÈÓÈÎ‹ ¤ÚÂ˘Ó· (2).

√ ¢Â›ÎÙË˜ ª¿˙·˜ ™ÒÌ·ÙÔ˜

ª¤¯ÚÈ Û‹ÌÂÚ·, ÛÂ ÌÂÁ¿ÏÂ˜ ÏËı˘ÛÌÈ·Î¤˜

ÌÂÏ¤ÙÂ˜ Î·È ·ÓÈ¯ÓÂ˘ÙÈÎÔ‡˜ ÂÏ¤Á¯Ô˘˜ ¤¯Ô˘Ó ¯ÚË-

ÛÈÌÔÔÈËıÂ› ‰Â›ÎÙÂ˜ ‚¿ÚÔ˘˜ ‹ Ì¿˙·˜ ÛÒÌ·ÙÔ˜,

ÔÚÈ˙fiÌÂÓÔÈ ˜ ‰È¿ÊÔÚÔÈ Û˘Ó‰˘·ÛÌÔ› ÙÔ˘ ‚¿ÚÔ˘˜


ÚÔ˜ ÙÔ ‡„Ô˜. ∞fi ÙÔ˘˜ ‰Â›ÎÙÂ˜ ·˘ÙÔ‡˜ ·Ó·‰Â›¯ÙËÎÂ

Ô ¢Â›ÎÙË˜ ª¿˙·˜ ™ÒÌ·ÙÔ˜ (¢ª™), Ô˘ ÔÚ›˙ÂÙ·È ˆ˜

‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜ ÛÂ ÎÈÏ¿ (kg) ‰È·ÈÚÔ‡ÌÂÓÔ ‰È· ÙÔ˘ ÙÂ-

ÙÚ·ÁÒÓÔ˘ ÙÔ˘ ‡„Ô˘˜ ÛÂ Ì¤ÙÚ· (m2), ˆ˜ ¤Ó· ·Ïfi Î·È

·Ó¤ÍÔ‰Ô Ì¤ÛÔ ÔÚÈÛÌÔ‡ ÙË˜ ·¯˘Û·ÚÎ›·˜ ÙfiÛÔ ÛÙÔ˘˜

ÂÓ‹ÏÈÎÂ˜ fiÛÔ Î·È ÛÙ· ·È‰È¿ Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜. √

¢ª™ ¤¯ÂÈ ‚ÚÂıÂ› fiÙÈ ¤¯ÂÈ ÔÏ‡ ÈÛ¯˘Ú‹ ıÂÙÈÎ‹ Û˘Û¯¤-

ÙÈÛË ÌÂ ÙÔ ÛˆÌ·ÙÈÎfi Ï›Ô˜ ÛÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜ (3,4).

√ ¢ª™ ¯ÚËÛÈÌÔÔÈÂ›Ù·È Â‡ÎÔÏ· ·fi ÎÏÈÓÈÎÔ‡˜

ÁÈ·ÙÚÔ‡˜ ÔÏÏÒÓ ÂÈ‰ÈÎÔÙ‹ÙˆÓ, ÚÔÎÂÈÌ¤ÓÔ˘ Ó· ‰È·-

ÎÚ›ÓÂÈ Ù· ·¯‡Û·ÚÎ· ·fi Ù· ˘¤Ú‚·Ú· Î·È Î·ÓÔÓÈ-

ÎÔ‡ ‚¿ÚÔ˘˜ ¿ÙÔÌ·. √ ¢ª™ >25 Î·È <30 ÔÚ›˙ÂÈ Ù·

˘¤Ú‚·Ú· Î·È Ô ¢ª™ ≥ 30 Ù· ·¯‡Û·ÚÎ· ÂÓ‹ÏÈÎ·

¿ÙÔÌ· ÛÙË ÏÂ˘Î‹ Ê˘Ï‹. ™Ù· ·È‰È¿ Î·È ÙÔ˘˜ ÂÊ‹-

‚Ô˘˜, Ë ·¯˘Û·ÚÎ›· ÔÚ›˙ÂÙ·È ÌÂ ‚¿ÛË ÙÔÓ ¢ª™ ·Ó¿

Ê‡ÏÔ Î·È ËÏÈÎ›·. ∫·Ù¿ ÙËÓ ÚÔÛ¤ÁÁÈÛË ·˘Ù‹, ¤¯Ô˘Ó

ÚÔÙ·ıÂ› ÔÚÈ·Î¿ ÛËÌÂ›· (cut-off points) ÁÈ· ÙÔ

˘¤Ú‚·ÚÔ Î·È ÙËÓ ·¯˘Û·ÚÎ›·, ˆ˜ ÔÛÔÛÙ¿ ¿Óˆ

·fi ¤Ó·Ó ‰Â‰ÔÌ¤ÓÔ ¢ª™, ÁÈ· ÙËÓ ËÏÈÎ›· Î·È ÙÔ Ê‡ÏÔ

ÙÔ˘ ·ÙfiÌÔ˘. √ ‰Â‰ÔÌ¤ÓÔ˜ ·˘Ùfi˜ ¢ª™ Â›Ó·È Û˘Ó‹-

ıˆ˜ Ë Ì¤ÛË (mean) ‹ Ë ‰È¿ÌÂÛË (median) ÙÈÌ‹ ÙË˜

Î·Ù·ÓÔÌ‹˜ ÂÓfi˜ ÏËı˘ÛÌÔ‡ ·Ó·ÊÔÚ¿˜. H ·fiÛÙ·-

ÛË ·fi ÙË Ì¤ÛË ‹ ‰È¿ÌÂÛË ·˘Ù‹ ÙÈÌ‹ ÌÂÙÚÈ¤Ù·È Â›ÙÂ

Ì¤Ûˆ ÙˆÓ ÂÎ·ÙÔÛÙÈ·›ˆÓ ı¤ÛÂˆÓ Â›ÙÂ Ì¤Ûˆ ÙË˜ ÛÙ·-

ıÂÚ‹˜ ·fiÎÏÈÛË˜ (˘ÔÏÔÁÈÛÌfi˜ ÙÔ˘ z-score).

√È ÂÎ·ÙÔÛÙÈ·›Â˜ ı¤ÛÂÈ˜

∆· ‰È·ÁÚ¿ÌÌ·Ù· ·Ó·ÊÔÚ¿˜ ·‡ÍËÛË˜ (‚¿ÚÔ˘˜,

‡„Ô˘˜ Î·È ¢ª™) Ô˘ ¤¯Ô˘Ó ·Ó·Ù‡ÍÂÈ ÔÏÏ¤˜ ¯Ò-

ÚÂ˜ ‚·Û›˙ÔÓÙ·È ÛÂ Û˘Á¯ÚÔÓÈÎ¤˜ ÌÂÏ¤ÙÂ˜ ÙÔÌ‹˜

(cross sectional) ·ÓÙÈÚÔÛˆÂ˘ÙÈÎÔ‡ ‰Â›ÁÌ·ÙÔ˜

·È‰ÈÒÓ, ·fi ÙË Á¤ÓÓËÛË ˜ ÙËÓ ÂÓËÏÈÎ›ˆÛË. ∆· Â-

ÚÈÛÛfiÙÂÚ· Û˘ÛÙ‹Ì·Ù· Î·Ù¿Ù·ÍË˜ Û˘ÌÊˆÓÔ‡Ó Î·È

ÔÚ›˙Ô˘Ó ÙËÓ 85Ë ÂÎ·ÙÔÛÙÈ·›· ı¤ÛË (∂£) ÛÙÔ ‰È¿-

ÁÚ·ÌÌ· ¢ª™ ˆ˜ ÙÔ fiÚÈÔ ¿Óˆ ·fi ÙÔ ÔÔ›Ô ¤Ó·

·È‰› ‹ ¤ÊË‚Ô˜ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ˆ˜ ˘¤Ú‚·ÚÔ˜ Î·È

ÙËÓ 95Ë (‹ 97Ë) ∂£ ˆ˜ ÙÔ fiÚÈÔ ¿Óˆ ·fi ÙÔ ÔÔ›Ô

ÙÔ ¿ÙÔÌÔ Î·Ù·Ù¿ÛÛÂÙ·È ˆ˜ ·¯‡Û·ÚÎÔ (1,5-8). °È·

ÙÈ˜ ¯ÒÚÂ˜ Ô˘ ¤¯Ô˘Ó ·Ó·Ù‡ÍÂÈ ÂıÓÈÎ¿ ‰È·ÁÚ¿ÌÌ·-

Ù·, Ô ÎÏÈÓÈÎfi˜ ÔÚÈÛÌfi˜ ÙÔ˘ ˘¤Ú‚·ÚÔ˘ Î·È ÙË˜ ·-

¯˘Û·ÚÎ›·˜ Û˘ÓÈÛÙ¿Ù·È Ó· ‚·Û›˙ÂÙ·È ÛÙ· ‰È·ÁÚ¿ÌÌ·-

Ù· ·˘Ù¿ (8), ‰È·ÊÔÚÂÙÈÎ¿ ÌÔÚÔ‡Ó Ó· ¯ÚËÛÈÌÔÔÈ-

Ô‡ÓÙ·È Ù· ÏËÛÈ¤ÛÙÂÚ· ‰È·ı¤ÛÈÌ·.

∞˘Ùfi˜ Ô ÙÚfiÔ˜ Î·Ù¿Ù·ÍË˜, fiÌˆ˜, ‚·Û›˙ÂÙ·È

ÛÙËÓ È‰¤· ˆ˜ Ë ·¯˘Û·ÚÎ›· ÔÚ›˙ÂÙ·È ÌÂ ‚¿ÛË ¤Ó·

ÔÚÈÛÌ¤ÓÔ Â›Â‰Ô ÛÙ·ıÂÚ‹˜ ·fiÎÏÈÛË˜ ·fi ÙÔÓ Ì¤-

ÛÔ fiÚÔ ÛÙÔÓ Û˘ÁÎÂÎÚÈÌ¤ÓÔ ÏËı˘ÛÌfi Ô˘ ÌÂÏÂÙ¿-

Ù·È. √ Ì¤ÛÔ˜ ·˘Ùfi˜ fiÚÔ˜, fiÌˆ˜, ÌÔÚÂ› Ó· ÔÈÎ›ÏÏÂÈ

ÛÂ ‰È¿ÊÔÚÂ˜ ¯ÒÚÂ˜, Î·ıÒ˜ Î·È ÛÙËÓ ›‰È· ¯ÒÚ·, fiÙ·Ó

ÌÂ ÙËÓ ¿ÚÔ‰Ô ÙˆÓ ¯ÚfiÓˆÓ ÌÂÙ·‚¿ÏÏÔÓÙ·È Ù· ·Ó-

ıÚˆÔÌÂÙÚÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ·˘Ù‹˜.

∏ ¯Ú‹ÛË ÙˆÓ ‰È·ÁÚ·ÌÌ¿ÙˆÓ ∂£ ÂÈÙÚ¤ÂÈ Â›-

ÛË˜ ÙÔÓ ¿ÌÂÛÔ ÚÔÛ‰ÈÔÚÈÛÌfi ÙË˜ ËÏÈÎ›·˜ ·Ó·ÛÙÚÔ-

Ê‹˜ ÙÔ˘ ¢ª™ (adiposity rebound), ‰ËÏ·‰‹ ÙË˜ ËÏÈ-

Î›·˜ ‰Â‡ÙÂÚË˜ ·‡ÍËÛË˜ ÙÔ˘ ¢ª™ ÌÂÙ¿ ÙË ÌÂ›ˆÛ‹

ÙÔ˘ Î·Ù¿ ÙËÓ ÚÔÛ¯ÔÏÈÎ‹ ËÏÈÎ›·. √ ‰Â›ÎÙË˜ ·˘Ùfi˜

·ÔÙÂÏÂ› ÈÛ¯˘Úfi ÚÔÁÓˆÛÙÈÎfi ‰Â›ÎÙË ÁÈ· ÙËÓ ·Ó¿-

Ù˘ÍË ·¯˘Û·ÚÎ›·˜: fiÛÔ ÓˆÚ›ÙÂÚ· Û˘Ì‚Â› Ë ·Ó·-

ÛÙÚÔÊ‹ ÙÔ˘ ¢ª™, ÙfiÛÔ ÌÂÁ·Ï‡ÙÂÚÔ˜ Ô Î›Ó‰˘ÓÔ˜

·Ó¿Ù˘ÍË˜ ·¯˘Û·ÚÎ›·˜.

∆Ô z-score

ª›· ÈÔ ·ÎÚÈ‚‹˜ Î·È ÔÏ‡ÏÔÎË Ì¤ıÔ‰Ô˜ ÁÈ· ÙË

Ì¤ÙÚËÛË ÙË˜ ·¯˘Û·ÚÎ›·˜ ·ÔÙÂÏÂ› Ô ˘ÔÏÔÁÈÛÌfi˜

ÙÔ˘ ∑ (z-score), Ô˘ ÚÔÎ‡ÙÂÈ ·fi ÙËÓ ·Ê·›ÚÂÛË

ÙË˜ Ì¤ÛË˜ ÙÈÌ‹˜ ·Ó·ÊÔÚ¿˜ ·fi ÙÔ ÌÂÙÚÔ‡ÌÂÓÔ Ì¤-

ÁÂıÔ˜ (¢ª™ ÛÙËÓ ÚÔÎÂ›ÌÂÓË ÂÚ›ÙˆÛË) Î·È ÙË ‰È-

·›ÚÂÛË ‰È· ÙË˜ ÛÙ·ıÂÚ‹˜ ·fiÎÏÈÛË˜ ÙÔ˘ ÏËı˘ÛÌÔ‡

·Ó·ÊÔÚ¿˜ (¢ª™ ·ÙfiÌÔ˘ Ô˘ ÌÂÙÚ¿ÌÂ -- Ì¤ÛË ÙÈÌ‹

¢ª™ ÙÔ˘ ÏËı˘ÛÌÔ‡ ·Ó·ÊÔÚ¿˜ / ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË

ÏËı˘ÛÌÔ‡ ·Ó·ÊÔÚ¿˜). ∆˘ÈÎ¿, ¤Ó· z-score ÌÂÁ·Ï‡-

ÙÂÚÔ ‹ ›ÛÔ ÙÔ˘ +2 (2 ÛÙ·ıÂÚ¤˜ ·ÔÎÏ›ÛÂÈ˜ ¿Óˆ ·fi

ÙË Ì¤ÛË ÙÈÌ‹) ÔÚ›˙ÂÈ ÙËÓ ·¯˘Û·ÚÎ›·.

∏ ¯Ú‹ÛË ÙÔ˘ z-score ·ÔÙÂÏÂ› ÈÔ ·ÎÚÈ‚‹ Ì¤ıÔ-

‰Ô ÔÛÔÙÈÎÔÔ›ËÛË˜ ÙÔ˘ ¢ª™ Î·È Û˘ÓÈÛÙ¿Ù·È Ó·

¯ÚËÛÈÌÔÔÈÂ›Ù·È ÛÂ ÂÚÂ˘ÓËÙÈÎ¤˜ ÂÚÁ·Û›Â˜ Ô˘ ··È-

ÙÔ‡Ó ÙË Û‡ÁÎÚÈÛË ÔÌ¿‰ˆÓ Ô˘ ÚÔ¤Ú¯ÔÓÙ·È fiÌˆ˜

·fi ÙÔÓ ›‰ÈÔ ÏËı˘ÛÌfi (¤¯Ô˘Ó ÂÎÙÈÌËıÂ› ÌÂ ‚¿ÛË

ÙÈ˜ ›‰ÈÂ˜ Î·Ì‡ÏÂ˜) ‹ Ó· ÚËÛÈÌÔÔÈÂ›Ù·È ÁÈ· ÙËÓ ÈÔ

·ÎÚÈ‚‹ ·Ú·ÎÔÏÔ‡ıËÛË ·ÛıÂÓÒÓ Ô˘ Â›Ó·È ÛÂ Úfi-

ÁÚ·ÌÌ· ·Ú¤Ì‚·ÛË˜. øÛÙfiÛÔ, Ë Ì¤ıÔ‰Ô˜ ·˘Ù‹, ·Ó

Î·È ÈÔ ·ÎÚÈ‚‹˜ ·fi ÙÈ˜ ÂÎ·ÙÔÛÙÈ·›Â˜ ı¤ÛÂÈ˜, ·ÚÔ˘-

ÛÈ¿˙ÂÈ Ù· ›‰È· ·ÎÚÈ‚Ò˜ ÌÂÈÔÓÂÎÙ‹Ì·Ù·, ÁÈ·Ù› ‚·Û›˙Â-

Ù·È ÛÙËÓ ›‰È· È‰¤·: ·fiÛÙ·ÛË ·fi ÙË Ì¤ÛË ÙÈÌ‹ ÂÓfi˜

Û˘ÁÎÂÎÚÈÌ¤ÓÔ˘ ÏËı˘ÛÌÔ‡, ÌÈ· Û˘ÁÎÂÎÚÈÌ¤ÓË ¯ÚÔ-

ÓÈÎ‹ ÂÚ›Ô‰Ô. ∞˘Ùfi ÛËÌ·›ÓÂÈ fiÙÈ Ë ÚÔÛ¤ÁÁÈÛË ·˘Ù‹

‰ÂÓ ÌÔÚÂ› Ó· ‰Â›ÍÂÈ ÙËÓ ·‡ÍËÛË ÙÔ˘ ÂÈÔÏ·ÛÌÔ‡

ÙË˜ ·¯˘Û·ÚÎ›·˜ ÛÂ ¤Ó·Ó ÏËı˘ÛÌfi, ÁÈ·Ù› Ô Ì¤ÛÔ˜

¢ª™ ÁÈ· ÙÔ Ê‡ÏÔ Î·È ÙËÓ ËÏÈÎ›· ·˘Í¿ÓÂÙ·È ÛÙÔÓ

ÏËı˘ÛÌfi ·Ó·ÊÔÚ¿˜. ∂›ÛË˜, ÔÈ Î·Ì‡ÏÂ˜ ·Ó·ÊÔ-

Ú¿˜ ‰È·Ê¤ÚÔ˘Ó ÌÂÙ·Í‡ ÙˆÓ ‰È·ÊfiÚˆÓ ˆÚÒÓ Î·È ¿Ú·

ÔÈ ÌÂÙÚ‹ÛÂÈ˜ ÙÔ˘ z-score, fiˆ˜ Î·È ÙË˜ ÂÎ·ÙÔÛÙÈ·›·˜

ı¤ÛË˜, ‰ÂÓ Â›Ó·È Û˘ÁÎÚ›ÛÈÌÂ˜ ÌÂÙ·Í‡ ÙˆÓ ¯ˆÚÒÓ (9).

OÈ ‰ÈÂıÓÂ›˜ ÔÚÈÛÌÔ› Î·È Ë ÚÔ¤ÎÙ·ÛË ÙˆÓ

ÔÚÈ·ÎÒÓ ÛËÌÂ›ˆÓ ÙˆÓ ÂÓËÏ›ÎˆÓ

∏ ·Ó¿ÁÎË ÁÈ· ÂÓÔÔ›ËÛË ÙÔ˘ ÔÚÈÛÌÔ‡ ÙÔ˘ ˘¤Ú-

‚·ÚÔ˘ Î·È ·¯‡Û·ÚÎÔ˘ ÌÂ ·˘ÙfiÓ ÙˆÓ ÂÓËÏ›ÎˆÓ Ô‰‹-

ÁËÛÂ ÙÔÓ ¢ÈÂıÓ‹ √ÚÁ·ÓÈÛÌfi ÁÈ· ÙËÓ ∫·Ù·ÔÏ¤ÌËÛË

ÙË˜ ¶·¯˘Û·ÚÎ›·˜ (International Obesity Task Force-

IOTF) Ó· ÚÔÙÂ›ÓÂÈ ¤Ó·Ó ÎÔÈÓfi Î·È ‰ÈÂıÓ‹ ÔÚÈÛÌfi ÁÈ·

ÙËÓ ·È‰ÈÎ‹ Î·È ÂÊË‚ÈÎ‹ ·¯˘Û·ÚÎ›· (10). √È ÂÚÂ˘-

ÓËÙ¤˜ Û˘ÌÊÒÓËÛ·Ó fiÙÈ, ·ÚfiÙÈ Ô ¢ª™ ‰ÂÓ ·ÔÙÂÏÂ›

ÙÔÓ È‰·ÓÈÎfi ‰Â›ÎÙË ·¯˘Û·ÚÎ›·˜, ÚÔÙÂ›ÓÂÙ·È ˆ˜ ÙÔ

Ï¤ÔÓ Î·Ù¿ÏÏËÏÔ Ì¤ÛÔ ÔÚÈÛÌÔ‡ ÙË˜ ·È‰ÈÎ‹˜ Î·È

ÂÊË‚ÈÎ‹˜ ·¯˘Û·ÚÎ›·˜. ∂›ÛË˜, ÌÂ ‚¿ÛË ÙÔÓ ÔÚÈÛÌfi

140 ¶. ¶ÂÚ‚·Ó›‰Ô˘



ÙÔ˘ IOTF, Ù· ÔÚÈ·Î¿ ÛËÌÂ›· Î·Ù¿Ù·ÍË˜, Î·È ¿Ú· ÎÈÓ-‰‡ÓÔ˘, ÁÈ· Ù· ·È‰È¿ ‚Ú›ÛÎÔÓÙ·È ÛÙÈ˜ ÂÎ·ÙÔÛÙÈ·›Â˜ı¤ÛÂÈ˜ Ô˘ ·ÔÙÂÏÔ‡Ó ÚÔ¤ÎÙ·ÛË ÙˆÓ ÙÈÌÒÓ¢ª™=30 Î·È 25 ÙˆÓ ÂÓËÏ›ÎˆÓ ÁÈ· ÙÔÓ ÔÚÈÛÌfi ÙÔ˘·¯‡Û·ÚÎÔ˘ Î·È ÙÔ˘ ˘¤Ú‚·ÚÔ˘ ·ÓÙ›ÛÙÔÈ¯·.

ªÂ ‚¿ÛË ÙËÓ ÚfiÙ·ÛË ÙÔ˘ IOTF, oÈ Cole et al.(11) ·Ó¤Ù˘Í·Ó ›Ó·ÎÂ˜ ÌÂ ÔÚÈ·Î¿ ÛËÌÂ›·, ·Ó¿ÏÔÁ·ÌÂ ÙÔ Ê‡ÏÔ Î·È ÙËÓ ËÏÈÎ›· (·Ó¿ 6 Ì‹ÓÂ˜), Ù· ÔÔ›·ÚÔ¤Î˘„·Ó ·fi Ù· ‰Â‰ÔÌ¤Ó· ¤ÍÈ ¯ˆÚÒÓ (µÚ·˙ÈÏ›·,ªÂÁ¿ÏË µÚÂÙ·Ó›·, Hong Kong, √ÏÏ·Ó‰›·, ™ÈÁÎ·Ô‡-ÚË Î·È ∏ÓˆÌ¤ÓÂ˜ ¶ÔÏÈÙÂ›Â˜ ∞ÌÂÚÈÎ‹˜). ∆· ÎÚÈÙ‹ÚÈ·ÙÔ˘ Cole ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1. ªÂ ÙÔÓÙÚfiÔ ·˘Ùfi, Ù· ÔÚÈ·Î¿ ÛËÌÂ›· ÔÚÈÛÌÔ‡ ÙË˜ ·È‰ÈÎ‹˜·¯˘Û·ÚÎ›·˜ ‚·Û›˙ÔÓÙ·È ÛÙÔÓ ˘„ËÏfi Î›Ó‰˘ÓÔ ÓÔÛË-ÚfiÙËÙ·˜ ÛÙËÓ ÂÓ‹ÏÈÎË ˆ‹ Î·È fi¯È ÛÙÔÓ Ì¤ÛÔ fiÚÔ ÙÔ˘˘fi ÌÂÏ¤ÙË ÏËı˘ÛÌÔ‡, ÁÂÁÔÓfi˜ Ô˘ ÂÈÙÚ¤ÂÈ Î·ÈÙË Û‡ÁÎÚÈÛË ÙˆÓ ‰È·ÊfiÚˆÓ Ï·ÒÓ ÌÂÙ·Í‡ ÙÔ˘˜.

∆· ÔÚÈ·Î¿ ÛËÌÂ›· ÙÔ˘ Cole ·ÔÙÂÏÔ‡Ó Û‹ÌÂÚ·

ÙËÓ ÚÔÙÂÈÓfiÌÂÓË Ì¤ıÔ‰Ô ÔÚÈÛÌÔ‡ ÙË˜ ·È‰ÈÎ‹˜ Î·È

ÂÊË‚ÈÎ‹˜ ·¯˘Û·ÚÎ›·˜ ÛÂ Û˘ÁÎÚÈÙÈÎ¤˜ ÂÈ‰ËÌÈÔÏÔ-

ÁÈÎ¤˜ ÌÂÏ¤ÙÂ˜, Â›Ó·È fiÌˆ˜ ·Î·Ù¿ÏÏËÏË Ì¤ıÔ‰Ô˜ ‰È·-

¯ÚÔÓÈÎ‹˜ ·Ú·ÎÔÏÔ‡ıËÛË˜ ÂÓfi˜ ·È‰ÈÔ‡ ÛÙËÓ ÎÏÈÓÈ-

Î‹ Ú¿ÍË (8).

¶ÂÚÈÔÚÈÛÌÔ› ÛÙË Ú‹ÛË ÙÔ˘ ¢ª™

∞Ó Î·È Ë Û˘Û¯¤ÙÈÛË ÌÂÙ·Í‡ ¢ª™ Î·È ÛˆÌ·ÙÈÎÔ‡

Ï›Ô˘˜ Â›Ó·È ÈÛ¯˘Ú‹ ÛÙÈ˜ ÌÂÏ¤ÙÂ˜ ÂÓËÏ›ÎˆÓ, Ô ¢ª™

‰ÂÓ ÌÔÚÂ› Ó· ‰È·¯ˆÚ›ÛÂÈ ÙË ÏÈÒ‰Ë ·fi ÙË ÌË ÏÈ-

Ò‰Ë Ì¿˙·. °È· ·Ú¿‰ÂÈÁÌ·, ÁÓˆÚ›˙Ô˘ÌÂ fiÙÈ ÁÂÓÈÎ¿

ÙÔ ÔÛÔÛÙfi Ï›Ô˘˜ Â›Ó·È ˘„ËÏfiÙÂÚÔ ÛÙ· ı‹ÏÂ· ·fi

fi,ÙÈ ÛÙ· ¿ÚÚÂÓ· ÌÂ ÙÔÓ ›‰ÈÔ ¢ª™. ¶ÔÏ‡ ÂÚÈÛÛfiÙÂ-

ÚÔ, ÛÙ· ·È‰È¿ Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜ Ë ·ÍÈÔÏfiÁËÛË Ì¤Ûˆ

ÙÔ˘ ¢ª™ ‰ÂÓ Ï·Ì‚¿ÓÂÈ ˘’ fi„Ë ÙËÓ Â›‰Ú·ÛË ÙË˜

·‡ÍËÛË˜ Î·È ÙË˜ ÂÊË‚Â›·˜, Ô‡ÙÂ ÙÈ˜ Ê˘ÛÈÔÏÔÁÈÎ¤˜

·ÏÏ·Á¤˜ ÛÙË Û‡ÛÙ·ÛË ÛÒÌ·ÙÔ˜. ∂ÈÚfiÛıÂÙ·, Ë ËÏÈ-

Î›· ¤Ó·ÚÍË˜ ÙË˜ ÂÊË‚Â›·˜ Î·È ÔÈ Û¯ÂÙÈ˙fiÌÂÓÂ˜ ÌÂ ·˘-

Ù‹ ÌÂÙ·‚ÔÏ¤˜ ÔÈÎ›ÏÏÔ˘Ó ÌÂÙ·Í‡ ‰È·ÊfiÚˆÓ ÂıÓÔÏÔ-

ÁÈÎÒÓ ÔÌ¿‰ˆÓ. ∆¤ÏÔ˜, Ù· fiÚÈ· ÙÔ˘ ¢ª™ Ô˘ ÔÚ›˙Ô˘Ó

ÙËÓ ·¯˘Û·ÚÎ›· Î·È ÙÔ ˘¤Ú‚·ÚÔ ÛÙ· ·È‰È¿ ‰ÂÓ

¤¯ÂÈ ·Ô‰ÂÈ¯ıÂ› fiÙÈ Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ‚ÈÔÏÔÁÈÎfi Î›Ó‰˘-

ÓÔ Î·Ú‰ÈÔÌÂÙ·‚ÔÏÈÎÒÓ ÂÈÏÔÎÒÓ Û¯ÂÙÈ˙fiÌÂÓˆÓ ÌÂ

ÙËÓ ·¯˘Û·ÚÎ›· ÛÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹ (12,13).

H ÂÚ›ÌÂÙÚÔ˜ Ì¤ÛË˜

H ÂÚ›ÌÂÙÚÔ˜ Ì¤ÛË˜ (¶ª) ¤¯ÂÈ ÚÔÙ·ıÂ› ·fi

ÔÏÏÔ‡˜ ÂÚÂ˘ÓËÙ¤˜ ˜ ¤Ó·˜ ÂÚÈÛÛfiÙÂÚÔ ·ÍÈfiÈÛÙÔ˜

‰Â›ÎÙË˜ ÙÔ˘ ÂÈ¤‰Ô˘ ÙÔ˘ ÂÓ‰ÔÎÔÈÏÈ·ÎÔ‡ Ï›Ô˘˜ Î·È

·ÔÙÂÏÂ› ·Ú¿ÁÔÓÙ· Î·Ú‰ÈÔÌÂÙ·‚ÔÏÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘

ÛÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜. ∏ ÛÔ˘‰·ÈfiÙËÙ· ÙË˜ Ì¤ÙÚËÛË˜ ·˘-

Ù‹˜ Ê·›ÓÂÙ·È ·fi ÙË ¯Ú‹ÛË ÙË˜, ·ÓÙ› ÙÔ˘ ¢ª™, ÛÙÔÓ

ÔÚÈÛÌfi ÙÔ˘ ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ ÛÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜,

Û‡ÌÊˆÓ· ÌÂ ÙËÓ ∂ıÓÈÎ‹ √Ì¿‰· ∂ÈÌfiÚÊˆÛË˜ ÁÈ· ÙË

ÃÔÏËÛÙÂÚfiÏË (National Cholesterol Education Panel,

NCEP) Î·È ÙËÓ ¶·ÁÎfiÛÌÈ· √ÌÔÛÔÓ‰›· ¢È·‚‹ÙË

(International Diabetes Federation, IDF) (15). AÎfiÌË

ÂÚÈÛÛfiÙÂÚÔ, Ë ¯Ú‹ÛË ÙË˜ ÂÚÈÌ¤ÙÚÔ˘ Ì¤ÛË˜, ·ÓÙ›

ÙÔ˘ ¢ª™, ÂÂÎÙ¿ıËÎÂ ÚfiÛÊ·Ù· ÛÙËÓ ·È‰ÈÎ‹ Î·È

ÂÊË‚ÈÎ‹ ËÏÈÎ›·, ÌÂ ·ÔÙ¤ÏÂÛÌ· ÙË Û‡ÌÊˆÓË ‰‹Ïˆ-

ÛË (consensus statement) ÂÚÂ˘ÓËÙÒÓ Ó· ¯ÚËÛÈÌÔÔÈ-

Â›Ù·È ÛÙËÓ ·È‰ÈÎ‹ ·¯˘Û·ÚÎ›· Ë ÂÚ›ÌÂÙÚÔ˜ Ì¤ÛË˜

≥90Ë˜ ∂£, ·ÓÙ› ÙÔ˘ ¢ª™, ÛÙÔÓ ÔÚÈÛÌfi ÙÔ˘ ÌÂÙ·‚ÔÏÈ-

ÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ ÛÙ· ·È‰È¿, Û‡ÌÊˆÓ· ÌÂ ÙËÓ ÚfiÙ·-

ÛË ÙÔ˘ πDF (16).

¶·ÚfiÙÈ ‰ÂÓ Â›Ó·È ··ÁÔÚÂ˘ÙÈÎfi Ó· ¯ÚËÛÈÌÔÔÈ‹-

ÛÂÈ Î·ÓÂ›˜ ÙÈ˜ Î·Ì‡ÏÂ˜ Ô˘ ¤¯Ô˘Ó ·Ó·Ù˘¯ıÂ› ÛÂ

¿ÏÏÂ˜ ¯ÒÚÂ˜, Ë ÂÈÏÔÁ‹ ·˘Ù‹ Ú¤ÂÈ Ó· Â›Ó·È Ë ÙÂ-

ÏÂ˘Ù·›· Î·È Ó· Á›ÓÂÙ·È ÌfiÓÔ fiÙ·Ó ‰ÂÓ ˘¿Ú¯Ô˘Ó

Î·ıfiÏÔ˘ ‰È·ı¤ÛÈÌ· ÂÓ·ÏÏ·ÎÙÈÎ¿ ÛÙÔÈ¯Â›· Ô˘ Ó·

ÚÔ¤Ú¯ÔÓÙ·È ·fi ÂıÓÈÎfi ÏËı˘ÛÌfi ·Ó·ÊÔÚ¿˜. °È·

ÙÔÓ ÂÏÏËÓÈÎfi ÏËı˘ÛÌfi, ‰ËÌÔÛÈÂ‡ÙËÎ·Ó ÚfiÛÊ·Ù·

141√ÚÈÛÌfi˜ ÙË˜ ·È‰ÈÎ‹˜ Î·È ÂÊË‚ÈÎ‹˜ ·¯˘Û·ÚÎ›·˜

¶·È‰È·ÙÚÈÎ‹ 2009;72:141-000

¶›Ó·Î·˜ 1. √ÚÈ·Î¤˜ ÙÈÌ¤˜ ‰Â›ÎÙË Ì¿˙·˜ ÛÒÌ·ÙÔ˜ (¢ª™) ÁÈ·˘¤Ú‚·Ú· Î·È ·¯‡Û·ÚÎ· ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜, ·ÓÙ›ÛÙÔÈ¯Â˜ ÌÂ ÙÈ˜ÔÚÈ·Î¤˜ ÙÈÌ¤˜ ¢ª™ ÙˆÓ 25 kg/m2 Î·È ÙˆÓ 30 kg/m2 Ô˘ ¤¯Ô˘Ó ÔÚÈ-ÛıÂ› ÁÈ· ÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜ (11).

∏ÏÈÎ›· À¤Ú‚·ÚoÈ ¶·¯‡Û·ÚÎÔÈ(¯ÚfiÓÈ·) ∞ÁfiÚÈ· ∫ÔÚ›ÙÛÈ· ∞ÁfiÚÈ· ∫ÔÚ›ÙÛÈ·

2 18,4 18,0 20,1 19,82,5 18,1 17,8 19,8 19,63 17,9 17,6 19,6 19,43,5 17,7 17,4 19,4 19,24 17,6 17,3 19,3 19,24,5 17,5 17,2 19,3 19,15 17,4 17,2 19,3 19,25,5 17,5 17,2 19,5 19,36 17,6 17,3 19,8 19,76,5 17,7 17,5 20,2 20,17 17,9 17,8 20,6 20,57,5 18,2 18,0 21,1 21,08 18,4 18,4 21,6 21,68,5 18,8 18,7 22,2 22,29 19 19,1 22,8 22,89,5 19,5 19,5 23,4 23,510 19,8 19,9 24,0 24,110,5 20,2 20,3 24,6 24,811 20,6 20,7 25,1 25,411,5 20,9 21,2 25,6 26,112 21,2 21,7 26,0 26,712,5 21,6 22,1 26,4 27,213 21,9 22,6 26,8 27,813,5 22,3 23,0 27,3 28,214 22,6 23,3 27,6 28,614,5 23 23,7 28,0 28,915 23,3 23,9 28,3 29,115,5 23,6 24,2 28,6 29,316 23,9 24,4 28,9 29,416,5 24,2 24,5 29,1 29,617 24,5 24,7 29,4 29,717,5 24,7 24,9 29,7 29,818 25 25,0 30,0 30,0


Î·Ì‡ÏÂ˜ ÁÈ· ÙËÓ ÂÚ›ÌÂÙÚÔ Ì¤ÛË˜ ÛÂ ·È‰È¿ Î·È

ÂÊ‹‚Ô˘˜ ÙË˜ ∫Ú‹ÙË˜ (17). ™ÙÔ ¿ÚıÚÔ ·˘Ùfi, ·Ú¤¯Ô-

ÓÙ·È ›Ó·ÎÂ˜ ÌÂ ÙÈ˜ ∂£ ·Ó¿ Ê‡ÏÔ Î·È ËÏÈÎ›·, Ô˘

ÌÔÚÔ‡Ó Ó· ÚËÛÈÌÔÔÈËıÔ‡Ó ÛÂ ÎÏÈÓÈÎ‹ Ú‹ÛË, Ì·-

˙› ÌÂ ÙÔÓ ¢ª™, ÁÈ· ·È‰È¿ ÙË˜ ∫Ú‹ÙË˜. ¶·Ú¤¯ÂÙ·È

Â›ÛË˜ ›Ó·Î·˜ ÌÂ ÙË Ì¤ÛË ÙÈÌ‹ Î·È ÙË ÛÙ·ıÂÚ‹

·fiÎÏÈÛË ·Ó¿ Ê‡ÏÔ Î·È ËÏÈÎ›·, Ô˘ ÌÔÚÂ› Ó· ¯ÚË-

ÛÈÌÔÔÈËıÂ› ÁÈ· ÙÔÓ ÈÔ ·ÎÚÈ‚‹ ˘ÔÏÔÁÈÛÌfi ÙÔ˘ z-

score ÙË˜ ¶ª ·ÔÎÏÂÈÛÙÈÎ¿ ÛÂ ·È‰È¿ ÙË˜ ∫Ú‹ÙË˜.

øÛÙfiÛÔ, Ë ¤ÏÏÂÈ„Ë ‰ËÌÔÛÈÂ˘Ì¤ÓˆÓ ÛÙÔÈ¯Â›ˆÓ ÁÈ·

ÙËÓ ¶ª ·fi ¿ÏÏÂ˜ ÂÚÈÔ¯¤˜ ÙË˜ ∂ÏÏ¿‰·˜ ·Ó·‚¿ÏÏÂÈ

ÙË Ú‹ÛË ÙË˜ ¶ª ÛÙÔ Û‡ÓÔÏÔ ÙÔ˘ ÂÏÏËÓÈÎÔ‡ ÏËı˘-

ÛÌÔ‡ ÁÈ· ÙÔ Ì¤ÏÏÔÓ.

ÕÏÏÔÈ ‰Â›ÎÙÂ˜ ·¯˘Û·ÚÎ›·˜

∏ Ì¤ÙÚËÛË ÙÔ˘ ¿¯Ô˘˜ ÙˆÓ ‰ÂÚÌ·ÙÔÙ˘¯ÒÓ

·ÔÙÂÏÂ› ÌÈ· ·Ï‹ Ì¤ıÔ‰Ô ·ÍÈÔÏfiÁËÛË˜ ÙË˜ Î·Ù·-

ÓÔÌ‹˜ ÙÔ˘ Ï›Ô˘˜, ÁÈ·Ù› ÌÔÚÂ› Ó· ¯ÚËÛÈÌÔÔÈËıÂ›

ÛÂ ÔÏÏ¿ Ì¤ÚË ÙÔ˘ ÛÒÌ·ÙÔ˜. ∏ Ì¤ÙÚËÛË ÙË˜ ‰ÂÚÌ·-

ÙÔÙ˘¯‹˜ ÙÔ˘ ‰ÈÎÂÊ¿ÏÔ˘ ıÂˆÚÂ›Ù·È fiÙÈ Û¯ÂÙ›˙ÂÙ·È

Î·Ï¿ ÌÂ ÙË ÏÈÒ‰Ë Ì¿˙·. ∏ Ì¤ıÔ‰Ô˜ ·˘Ù‹ ÌÔÚÂ› Ó·

·Ó··Ú·¯ıÂ› Â‡ÎÔÏ·, ÏfiÁˆ ÙˆÓ Ì¤ÙÚÈˆÓ ÙÂ¯ÓÈÎÒÓ

ÈÎ·ÓÔÙ‹ÙˆÓ Ô˘ ··ÈÙÂ›, ·ÏÏ¿ ·ÚÔ˘ÛÈ¿˙ÂÈ ÌÂÁ¿ÏË

‰È·Î‡Ì·ÓÛË ·Ó¿ÌÂÛ· ÛÂ ‰È¿ÊÔÚÔ˘˜ ÂÍÂÙ·ÛÙ¤˜ Î·È

‰ÂÓ ıÂˆÚÂ›Ù·È ·ÎÚÈ‚‹˜ (18).

√ ÏfiÁÔ˜ ÙË˜ ÂÚÈÌ¤ÙÚÔ˘ Ì¤ÛË˜ ÚÔ˜ ÙËÓ ÂÚ›ÌÂ-

ÙÚÔ ÁÔÊÒÓ (Waist to Hip Ratio, W/H) ¯ÚËÛÈÌÔÔÈÂ›-

Ù·È ÁÈ· ÙËÓ ·ÍÈÔÏfiÁËÛË ÙË˜ Î·Ù·ÓÔÌ‹˜ ÙÔ˘ ÛˆÌ·ÙÈ-

ÎÔ‡ Ï›Ô˘˜ ÛÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜. ∏ ¯ÚËÛÈÌfiÙËÙ· ÙÔ˘ ‰Â›-

ÎÙË ·˘ÙÔ‡ Î·È Ë Û¯¤ÛË ÙÔ˘ ÌÂ ÙÔÓ ÌÂÏÏÔÓÙÈÎfi Î·Ú-

‰È·ÁÁÂÈ·Îfi Î›Ó‰˘ÓÔ ‰ÂÓ Â›Ó·È ÍÂÎ¿ı·ÚÂ˜ ÛÙËÓ ·È‰È-

Î‹ ËÏÈÎ›·. ∂›ÛË˜, Â›Ó·È ‰‡ÛÎÔÏÔ Ó· ÂÎÙÈÌËıÔ‡Ó ÌÂ-

Ù·‚ÔÏ¤˜ ÛÙÔ˘˜ ‰Â›ÎÙÂ˜ ·˘ÙÔ‡˜ ÛÙËÓ ·È‰ÈÎ‹ Î·È

ÂÊË‚ÈÎ‹ ËÏÈÎ›·, ÏfiÁˆ ÙˆÓ ·ÏÏ·ÁÒÓ Ô˘ Û˘Ì‚·›ÓÔ˘Ó

Î·Ù¿ ÙËÓ ·‡ÍËÛË Î·È ÙËÓ ÂÊË‚Â›·. ∆¤ÏÔ˜, ‰ÂÓ ¤¯Ô˘Ó

·Ó·Ù˘¯ıÂ› Î·Ì‡ÏÂ˜ ÁÈ· ÙËÓ ÂÚ›ÌÂÙÚÔ ÁÔÊÒÓ ‹

ÁÈ· ÙÔÓ ÏfiÁÔ W/H ÛÙ· ·È‰È¿ (18).

√È ÔÚÈÛÌÔ› Â‰Ò Î·È ÙÒÚ·: ÚËÛÈÌÔÔÈÒÓÙ·˜ Ù·

˘¿Ú¯ÔÓÙ· ÂÏÏËÓÈÎ¿ ‰Â‰ÔÌ¤Ó· ÛÙËÓ Ú¿ÍË

√È Î·Ì‡ÏÂ˜ ÙÔ˘ ¢ª™ ÁÈ· ÙÔÓ ÂÏÏËÓÈÎfi ÏËı˘-

ÛÌfi Ô˘ ‰ËÌÔÛÈÂ‡ÙËÎ·Ó ÙÔ 2004 (19) ·ÔÙÂÏÔ‡Ó ÙÔ

ÈÔ Û‡Á¯ÚÔÓÔ ÂÚÁ·ÏÂ›Ô ÁÈ· ÙÔÓ ˘ÔÏÔÁÈÛÌfi ÙË˜ ·-

¯˘Û·ÚÎ›·˜ ÛÙ· ·È‰È¿ Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜, ÙfiÛÔ ÛÂ

Â›Â‰Ô Ì·˙ÈÎ‹˜ ·Ó›¯ÓÂ˘ÛË˜ ÙˆÓ ·È‰ÈÒÓ ÌÂ ·˘ÍË-

Ì¤ÓÔ Î›Ó‰˘ÓÔ ÁÈ· Î·Ú‰ÈÔÌÂÙ·‚ÔÏÈÎ¤˜ ÂÈÏÔÎ¤˜

fiÛÔ Î·È ÁÈ· ÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË ÌÂÌÔÓˆÌ¤ÓˆÓ

·ÛıÂÓÒÓ. ™ÙË ÌÂÏ¤ÙË ·˘Ù‹ ÌÂÙÚ‹ıËÎ·Ó 10.925 ¿ÙÔ-

Ì· ËÏÈÎ›·˜ 0-18 ÂÙÒÓ, 5.537 ·ÁfiÚÈ· Î·È 5.388 ÎÔÚ›-

ÙÛÈ·, ÌÂ ÂÚ›Ô˘ ÈÛfiÙÈÌË Î·Ù·ÓÔÌ‹ ÛÙÈ˜ ‰È¿ÊÔÚÂ˜

ËÏÈÎ›Â˜. ∆· ¿ÙÔÌ· Ô˘ ÌÂÙÚ‹ıËÎ·Ó ‹Ù·Ó ·fi ÙËÓ

ÂÚÈÔ¯‹ ÙË˜ ∞ı‹Ó·˜ Î·È ‹Ù·Ó ÂÏÏËÓÈÎ‹˜ Î·Ù·ÁˆÁ‹˜

Î·È ·fi ÙÔ˘˜ ‰‡Ô ÁÔÓÂ›˜. ∏ ÂÚÈÔ¯‹ ÙË˜ ∞ı‹Ó·˜ ‰ÂÓ

Î·Ï‡ÙÂÈ fiÏË ÙËÓ ∂ÏÏ¿‰·, fiÌˆ˜ ÙfiÛÔ ·fi ÏÂ˘Ú¿˜

·Ó·ÏÔÁ›·˜ ÏËı˘ÛÌÔ‡ (ÂÚ›Ô˘ Ô ÌÈÛfi˜ ÏËı˘-

ÛÌfi˜ ÙË˜ ¯ÒÚ·˜) fiÛÔ Î·È ·fi ÏÂ˘Ú¿˜ ÁÂÓÂÙÈÎÔ‡

˘ÔÛÙÚÒÌ·ÙÔ˜ (¿ÙÔÌ· ÌÂ ÔÈÎ›ÏË ÚÔ¤ÏÂ˘ÛË),

Ê·›ÓÂÙ·È fiÙÈ ÔÈ Î·Ì‡ÏÂ˜ ÌÂ ÚÔ¤ÏÂ˘ÛË ÙËÓ Â˘Ú‡-

ÙÂÚË ÂÚÈÔ¯‹ ÙË˜ ∞ı‹Ó·˜ ·ÔÙÂÏÔ‡Ó ÈÎ·ÓÔÔÈËÙÈ-

Î¿ ·ÓÙÈÚÔÛˆÂ˘ÙÈÎfi ‰Â›ÁÌ· ÙÔ˘ ÏËı˘ÛÌÔ‡.

øÛÙfiÛÔ, ÙfiÛÔ Ë ÚÔ¤ÏÂ˘ÛË ·fi ÂıÓÈÎfi ÏËı˘ÛÌfi

fiÛÔ Î·È Ë ÚfiÛÊ·ÙË Î·Ù·ÁÚ·Ê‹ ·ÔÙÂÏÔ‡Ó ‰‡Ô

ÈÛ¯˘Ú¿ ÛÙÔÈ¯Â›· ˘¤Ú ÙË˜ ¯Ú‹ÛË˜ ÙˆÓ Î·Ì˘ÏÒÓ

·Ó·ÊÔÚ¿˜ ÙÔ˘ 2004 ÁÈ· ÙÔÓ ÔÚÈÛÌfi ÙË˜ ·È‰ÈÎ‹˜ ·-

¯˘Û·ÚÎ›·˜ ÛÙËÓ ∂ÏÏ¿‰·.

™‡ÌÊˆÓ· ÌÂ ·˘Ù¤˜, Ë 97Ë ∂£ Î·È Ë 50Ë ∂£ ÛÂ

·ÁfiÚÈ· 18 ÂÙÒÓ ÙË˜ ÂÚÈÔ¯‹˜ ÙË˜ ∞ı‹Ó·˜ ·ÓÙÈÛÙÔÈ¯Â›

Û‹ÌÂÚ· ÛÂ ‚¿ÚÔ˜ Ô˘ Â›Ó·È Î·Ù¿ 15 kg Î·È Î·Ù¿ 6 kg,

·ÓÙ›ÛÙÔÈ¯·, ÌÂÁ·Ï‡ÙÂÚÔ ·fi ÙÔ ‚¿ÚÔ˜ ÙˆÓ ı¤ÛÂˆÓ

·˘ÙÒÓ ÚÈÓ 20 ÂÚ›Ô˘ ¤ÙË. ŒÙÛÈ, Ë ¯ÚËÛÈÌÔÔ›ËÛË

ÙË˜ ÛËÌÂÚÈÓ‹˜ 97Ë˜ ∂£ ˆ˜ ÎÚÈÙËÚ›Ô˘ ÁÈ· ÙÔÓ ÔÚÈÛÌfi

ÙË˜ ·¯˘Û·ÚÎ›·˜ ˘ÔÂÎÙÈÌ¿ ÙfiÛÔ Ù· ÔÛÔÛÙ¿ ·¯˘-

Û·ÚÎ›·˜ ÛÙÔÓ ÏËı˘ÛÌfi fiÛÔ Î·È ÙËÓ ·Ó›¯ÓÂ˘ÛË ·È-

‰ÈÒÓ ÛÂ Î›Ó‰˘ÓÔ, ÛÂ Û‡ÁÎÚÈÛË ÌÂ Ù· ‰Â‰ÔÌ¤Ó· ÙË˜

ÂÚÈfi‰Ô˘ 1978 Î·È ÌÂ Ù· ‰Â‰ÔÌ¤Ó· ¿ÏÏˆÓ ¯ˆÚÒÓ. °È·

ÙÔ ÏfiÁÔ ·˘Ùfi, Î·È ÌÂ ÙÔ ÛÎÂÙÈÎfi ÙË˜ ·Ó›¯ÓÂ˘ÛË˜ Â-

ÚÈÛÛfiÙÂÚˆÓ ·È‰ÈÒÓ ÛÂ Î›Ó‰˘ÓÔ, ÛÙËÓ ›‰È· ‰ËÌÔÛ›Â˘-

ÛË ÚÔÙÂ›ÓÂÙ·È Ë ·Ó¿ÏÔÁË ÌÂ Ù· ÎÚÈÙ‹ÚÈ· ÙÔ˘ IOTF

ÚÔ¤ÎÙ·ÛË ÙˆÓ ı¤ÛÂˆÓ 25 Î·È 30 ÙˆÓ ÂÓËÏ›ÎˆÓ (∂È-

ÎfiÓ· 1) ˆ˜ ı¤ÛË ÔÚ›Ô˘ ÁÈ· ÙÔÓ ÔÚÈÛÌfi ÙÔ˘ ˘¤Ú‚·-

ÚÔ˘ Î·È ÙÔ˘ ·¯‡Û·ÚÎÔ˘ ÛÙ· ·È‰È¿ Î·È ÙÔ˘˜ ÂÊ‹-

‚Ô˘˜. ∂›Ó·È ÚÔÊ·Ó¤˜ ˆ˜ Ô ÔÚÈÛÌfi˜ ·˘Ùfi˜ ÚÔÙÂ›-

ÓÂÙ·È ÁÈ· ÙËÓ ∂ÏÏ¿‰· ÙÔ˘ Û‹ÌÂÚ·, ÁÈ·Ù› ÛÂ ¿ÏÏÔ˘˜

ÂıÓÈÎÔ‡˜ ÏËı˘ÛÌÔ‡˜ Ë ·fiÎÏÈÛË ·fi ÙË Ì¤ÛË ÙÈÌ‹

ÌÔÚÂ› Ó· ¤¯ÂÈ Ê·ÓÂ› ÂÚÈÛÛfiÙÂÚÔ ·ÓÙÈÚÔÛˆÂ˘ÙÈ-

Î‹ ÙÔ˘ ˘¤Ú‚·ÚÔ˘ Î·È ÙË˜ ·¯˘Û·ÚÎ›·˜.

™˘ÌÂÚ¿ÛÌ·Ù·

™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, Ë Ú‹ÛË ÙˆÓ ÌÂıfi‰ˆÓ Ì¤ÙÚËÛË˜

ÙË˜ ·¯˘Û·ÚÎ›·˜ ÛÙ· ·È‰È¿ Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜ ÛÙËÓ

ÎÏÈÓÈÎ‹ Ú¿ÍË ÂÍ·ÚÙ¿Ù·È ·fi ÙÔ ÂÚÒÙËÌ· Ô˘ ¤¯ÂÈ

Î·ÓÂ›˜ Ó· ··ÓÙ‹ÛÂÈ. ™ÙÔ ÂÚÒÙËÌ· ·Ó Â›Ó·È ÙÔ ·È‰›

˘¤Ú‚·ÚÔ ‹ ·¯‡Û·ÚÎÔ (Ô˘ ¤¯ÂÈ Ú·ÎÙÈÎ‹ ÛËÌ·Û›·:

·Ó Î·È ÛÂ ÙÈ ‚·ıÌfi Û˘ÓÈÛÙ¿Ù·È Ó· ‰ÈÂÚÂ˘ÓËıÂ› ÁÈ· Û¯Â-

ÙÈ˙fiÌÂÓË ÌÂ ÙËÓ ·¯˘Û·ÚÎ›· ÓÔÛËÚfiÙËÙ·), Ë ¯Ú‹ÛË

ÙˆÓ ÎÚÈÙËÚ›ˆÓ ÙÔ˘ π√∆F ÌÔÈ¿˙ÂÈ Ó· Â›Ó·È ÔÚıfiÙÂÚË ÁÈ·

Ù· ·È‰È¿ ÂÏÏËÓÈÎ‹˜ ÚÔ¤ÏÂ˘ÛË˜ ÙÔ˘ Û‹ÌÂÚ· Î·È Á›ÓÂ-

Ù·È ÛÙËÓ Ú¿ÍË Ì¤Ûˆ ÙˆÓ ÚfiÙ˘ˆÓ ‰È·ÁÚ·ÌÌ¿ÙˆÓ

¢ª™ ÙÔ˘ ÂÏÏËÓÈÎÔ‡ ÏËı˘ÛÌÔ‡ ÙÔ˘ 2004 (11), ÌÂ ÙÈ˜

ÚÔÂÎÙ¿ÛÂÈ˜ ÙˆÓ ı¤ÛÂˆÓ 25 Î·È 30 ÙÔ˘ ÂÓ‹ÏÈÎ· (∂ÈÎfi-

Ó· 1). ™ÙÔ ÂÚÒÙËÌ· fiÛÔ ·¯‡Û·ÚÎÔ Â›Ó·È ¤Ó· ·È‰›,

ÙÔ z-score, ·Ó Î·È ‚·Û›˙ÂÙ·È ÛÙËÓ ›‰È· È‰¤· ÌÂ ÙÈ˜ ÂÎ·-

ÙÔÛÙÈ·›Â˜ ı¤ÛÂÈ˜, ·ÔÙÂÏÂ› Û˘ÁÎÚÈÙÈÎ¿ ·ÎÚÈ‚¤ÛÙÂÚË

Ì¤ıÔ‰Ô. √ ˘ÔÏÔÁÈÛÌfi˜ ÙÔ˘ z-score ·Ú¤¯ÂÈ ¤Ó·Ó

·ÎÚÈ‚‹ ·ÚÈıÌfi Î·È ÁÈ· Ù· ·È‰È¿ Ô˘ ‚Ú›ÛÎÔÓÙ·È ÔÏ‡

¿Óˆ ·fi ÙËÓ 97Ë ∂£ (ÂÎÙfi˜ ÙˆÓ Î·Ì˘ÏÒÓ) - Ù·

142 ¶. ¶ÂÚ‚·Ó›‰Ô˘



ÔÔ›· ‰˘ÛÙ˘¯Ò˜ Â›Ó·È ÔÏÏ¿. ∂›ÛË˜, ·Ú¤¯ÂÈ ·ÎÚÈ‚‹

Î·È Û˘ÁÎÚ›ÛÈÌ· ÌÂÙ·Í‡ ÙÔ˘˜ ÛÙÔÈ¯Â›· ÁÈ· ÙËÓ ·Ú·ÎÔ-

ÏÔ‡ıËÛË ÙÔ˘ ¢ª™ ·È‰ÈÒÓ ÛÂ ·Ú¤Ì‚·ÛË. ∆¤ÏÔ˜, ÛÂ

ÂÚÂ˘ÓËÙÈÎfi Â›Â‰Ô, ‰›ÓÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· ÔÛÔÙÈÎ‹˜

Û‡ÁÎÚÈÛË˜ ·Ó¿ÌÂÛ· ÛÂ ÔÌ¿‰Â˜. √È ›Ó·ÎÂ˜ ÌÂ ÙÈ˜ Ì¤-

ÛÂ˜ ÙÈÌ¤˜ Î·È ÙÈ˜ ÛÙ·ıÂÚ¤˜ ·ÔÎÏ›ÛÂÈ˜ -·fi fiÔ˘ ÌÔ-

ÚÂ› Ó· ˘ÔÏÔÁÈÛÙÂ› ÙÔ z-score- ·Ó¿ Ê‡ÏÔ Î·È ËÏÈÎ›·

ÛÙËÓ ∂ÏÏ¿‰· ÙÔ˘ Û‹ÌÂÚ· ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÙÔÓ ¶›Ó·-

Î· 2 (11). ¶·ÚfiÏ· ·˘Ù¿, Î·Ù¿ ÙË Ú‹ÛË ÙÔ˘ z-score, ı·

Ú¤ÂÈ Ô ·È‰›·ÙÚÔ˜ Ó· ¤¯ÂÈ ¿ÓÙ· ÛÙÔ ÓÔ˘, Î·È Î·Ù¿

ÂÓËÌ¤ÚˆÛË ÙˆÓ ÔÈÎÔÁÂÓÂÈÒÓ, fiÙÈ ÌÈÏ¿ÂÈ ÁÈ· ¤Ó·Ó ·ÚÈı-

Ìfi Ô˘ Â›Ó·È Û¯ÂÙÈ˙fiÌÂÓÔ˜ ÌÂ ÙË Ì¤ÛË ÙÈÌ‹ ÙÔ˘ ÏË-

ı˘ÛÌÔ‡ ·Ó·ÊÔÚ¿˜, Ô ÔÔ›Ô˜ ÛÙËÓ ÚÔÎÂ›ÌÂÓË ÂÚ›-

ÙˆÛË ¤¯ÂÈ ¿ÚÂÈ ·ÓÈÔ‡Û· ÔÚÂ›·.


1. WHO: Obesity: Preventing and Managing the Global

Epidemic. Geneva, World Health Organization, 2000.

¶›Ó·Î·˜ 2. ∆ÈÌ¤˜ ¢ª™ ·Ó¿ Ê‡ÏÔ Î·È ËÏÈÎ›·, ÁÈ· ÙÔÓ ˘ÔÏÔÁÈÛÌfi ÙÔ˘ z-score (11)

∞ÁfiÚÈ· ∫ÔÚ›ÙÛÈ·∏ÏÈÎ›· ∞ÚÈıÌfi˜ ª¤ÛË ™Ù·ıÂÚ‹ ∏ÏÈÎ›· ∞ÚÈıÌfi˜ ª¤ÛË ™Ù·ıÂÚ‹

(¯ÚfiÓÈ·) ÙÈÌ‹ ·fiÎÏÈÛË (¯ÚfiÓÈ·) ÙÈÌ‹ ·fiÎÏÈÛË

1 139 14,8 2,7 1 131 14,7 2,72 114 16,9 1,6 2 111 16,1 1,73 222 15,7 2,3 3 216 15,5 1,64 268 17,7 1,7 4 267 15,6 1,75 256 15,8 1,9 5 256 15,8 2,16 249 16,3 2,2 6 237 16,4 2,57 265 16,9 2,5 7 228 16,7 2,58 282 17,7 4,4 8 248 17,5 3,29 347 18,1 3,1 9 325 18,2 3,1

10 321 18,9 3,5 10 318 18,5 3,111 327 19,3 3,4 11 342 19,1 3,312 379 20,0 3,5 12 409 19,8 3,413 453 20,7 3,7 13 423 20,5 3,714 409 21,4 3,7 14 385 21,1 3,415 443 21,8 3,7 15 428 21,4 3,316 356 22,8 4,0 16 323 21,9 3,417 387 23,1 3,7 17 370 22,1 3,118 317 23,9 4,1 18 371 22,3 3,6

143√ÚÈÛÌfi˜ ÙË˜ ·È‰ÈÎ‹˜ Î·È ÂÊË‚ÈÎ‹˜ ·¯˘Û·ÚÎ›·˜

¶·È‰È·ÙÚÈÎ‹ 2009;72:143-000

kgr

/m2

kgr

/m2

∏ÏÈÎ›· (¤ÙË)0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

34333231302928272625242322212019181716151413

34333231302928272625242322212019181716151413

∞ÁfiÚÈ·

25

10

3

75

85

95

97

50

(µMI 25)

90 (µMI 30)

kgr

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∏ÏÈÎ›· (¤ÙË)0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

33323130292827262524232221201918171615141312

33323130292827262524232221201918171615141312

∫ÔÚ›ÙÛÈ·

25

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75

50

3

10

90

97

(µMI 25)

∂ÈÎfiÓ· 1. ∂Î·ÙÔÛÙÈ·›Â˜ ı¤ÛÂÈ˜ Ô˘ ÔÚ›˙Ô˘Ó ÙÔ ˘¤Ú‚·ÚÔ Î·È ÙÔ ·¯‡Û·ÚÎÔ ·È‰›, ·Ó¿ Ê‡ÏÔ, ˆ˜ ÚÔ¤ÎÙ·ÛË ÙˆÓ ÔÚÈ·ÎÒÓ ÛËÌÂ›ˆÓ ÙˆÓÂÓËÏ›ÎˆÓ, ÛÙ· ÂÏÏËÓÈÎ¿ ÚfiÙ˘· ‰È·ÁÚ¿ÌÌ·Ù·. ∞Ó·Ê·›ÓÂÙ·È Ë ∂£ Ô˘ ‰È·¯ˆÚ›˙ÂÈ ÙÔ ·¯‡Û·ÚÎÔ (¢ª™ >30) Î·È ¤Ú‚·ÚÔ (¢ª™ >25)·È‰› (11).


2. Lee SY, Gallagher D. Assessment methods in human bodycomposition. Curr Opin Clin Nutr Metab Care 2008Sep;11(5):566-572.

3. Revicki DA, Israel RG. Relationship between body massindices and measures of body adiposity. Am J Publ Health1986;76:992-994.

4. Spiegelman D, Isrel RG, Bouchard C, Willett WC.Absolute fat mass, percent body fat, and body fatdistribution: Which is the real determinant of bloodpressure and serum glucose? Am J Clin Nutr 1992;55:1044-1044.

5. WHO: Physical Status: The use and interpretation ofAnthropometry. Geneva, World Health Organization, 1995.

6. Himes JH, Dietz WH. Guidelines for overweight inadolescent preventive services: recommendations from anexpert committee: The Expert Committee on ClinicalGuidelines for Overweigh in Adolescent PreventiveServices. Am J Clin Nutr 1994;59:307-316.

7. Guillaume M: defining obesity in childhood: currentpractice. Am J Clin Nutr 1999;70:126S-130S.

8. Speiser PW, Rudolf MCJ, Anhalt H, Camacho-Hubner C,Chiarelli F, Eliakim A, et al., on behalf of the ObesityConsensus Working Group. Consensus Statement:Childhood Obesity. JCEM 2005;90:1871-1887.

9. Lahti-Koski M, Gill T. Defining Childhood obesity. In:Obesity in childhood and adolescence / Volume Editors W.Kiess, C. Marcus, M. Wabitsch (Pediatric and adolescentMedicine, vol 9), Karger, 2004, Basel.

10. Bellizzi MC, Dietz WH. Workshop on childhood obesity:Summary of the discussion. Am J Clin Nutr 1999;70:173S-175S.

11. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing astandard definition for child overweight and obesityworldwide: International survey. BMJ 2000;320:1240-1243.

12. Pietrobelli A, Faith MS, Allison DB, et al. Body mass indexas a measure of adiposity among children and adolescents:A validation study. J Pediatr 1998;132:204-210.

13. Garn SM, Leonard WR, Hawthorne VM. Three limitationsof the body mass index. Am J Clin Nutr 1986;44:996-997.

14. Higgins PB, Gower BA, Hunter GR, Goran MI. Defininghealth-related obesity in prepubertal children. Obes Res2001;9:233-240.

15. Pervanidou P, Kanaka-Gantenbein C, Chrousos GP.Assessment of metabolic profile in a clinical setting. CurrOpin Clin Nutr Metab Care 2006;9:589-595.

16. Zimmet P, Alberti KG, Kaufman F, Tajima N, Silink M,Arslanian S, et al.; IDF Consensus Group. The metabolicsyndrome in children and adolescents - an IDF consensusreport. Pediatr Diabetes 2007;8:299-306.

17. §ÈÓ·Ú‰¿ÎË˜ ∂, µ·Ú‰·‚¿˜ ∫, ∫·Ê¿ÙÔ˜ ∞, Î·È Û˘Ó.Paediatriki 2007;70:300-307.

18. ¶ÂÚ‚·Ó›‰Ô˘ ¶, ∫·Ó·Î·-Gantenbein X, ¶··ÛˆÙËÚ›Ô˘ π,ÃÚÔ‡ÛÔ˜ °¶. ¢ÈÂÚÂ‡ÓËÛË ÙÔ˘ ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ÛÙËÓ ·È‰ÈÎ‹ Î·È ÂÊË‚ÈÎ‹ ËÏÈÎ›·: Ë ·¯˘Û·ÚÎ›· ˆ˜ Î˘-ÚÈfiÙÂÚÔ˜ ·ÈÙÈÔÏÔÁÈÎfi˜ ·Ú¿ÁÔÓÙ·˜. ¢ÂÏÙ ∞ã ¶·È‰È·ÙÚ∫ÏÈÓ ¶·ÓÂ ∞ıËÓÒÓ 2007;54:41-52.

19. Chiotis D, Krikos X, Tsiftis G, Hatzisymeaon M, Maniati-Christidi M, Dacou-Voutetakis A. Body mass index andprevalence of obesity in subjects of Hellenic origin aged 0-18years, living in the Athens area. Ann Cli Pediatr UniveAtheniensis 2004;51:139-154.

144 ¶. ¶ÂÚ‚·Ó›‰Ô˘



™˘ÁÁÂÓ‹˜ ‰È·ÊÚ·ÁÌ·ÙÔÎ‹ÏË Ù‡Ô˘ Bochdalek Î·È

ÂÓ‰ÔıˆÚ·ÎÈÎfi˜ ¤ÎÙÔÔ˜ ÓÂÊÚfi˜ - ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛË˜

Ã. ∆Û·Î·Ï›‰Ë˜1, µ. §·ÌÚfiÔ˘ÏÔ˜2, Œ. √˘ÚÁÎ·ÓÙ˙fiÁÏÔ˘3, ¢. ƒ¿ÏÏË˜4, ∞. ¶ÂÙÚfiÔ˘ÏÔ˜2, ¡. ¡ÈÎÔÏ·˝‰Ë˜1

¶ÂÚ›ÏË„Ë: ∏ Û˘ÁÁÂÓ‹˜ ‰È·ÊÚ·ÁÌ·ÙÔÎ‹ÏË (™¢∫) Â›Ó·È ‰˘ÛÏ·Û›· ÛÙËÓ ÔÔ›· ·Ú·ÙËÚÂ›Ù·È Â›ÛÔ‰Ô˜ ÂÓ-‰ÔÎÔÈÏÈ·ÎÒÓ ÛÏ¿¯ÓˆÓ Ì¤Û· ÛÙÔÓ ıÒÚ·Î·, ‰È·Ì¤ÛÔ˘ ÂÓfi˜ ÂÏÏÂ›ÌÌ·ÙÔ˜ ÂÌ‚Ú˘ÔÁ¤ÓÂÛË˜ ÙÔ˘ ‰È·ÊÚ¿ÁÌ·-ÙÔ˜, Î·È ÌÔÚÂ› Ó· ·ÊÔÚ¿ ‰È·ÊÔÚÂÙÈÎ¿ ÙÌ‹Ì·Ù· ÙÔ˘ ‰È·ÊÚ¿ÁÌ·ÙÔ˜. √ ÈÔ ÎÔÈÓfi˜ Ù‡Ô˜ ‰È·ÊÚ·ÁÌ·ÙÔÎ‹-ÏË˜ Â›Ó·È Ë ÔÈÛıÔÏ¿ÁÈ· Î‹ÏË ÙÔ˘ Bochdalek. √ ÂÓ‰ÔıˆÚ·ÎÈÎfi˜ ¤ÎÙÔÔ˜ ÓÂÊÚfi˜ Â›Ó·È Û¿ÓÈ· ·ÓˆÌ·Ï›·Î·È ·ÓÙÈÚÔÛˆÂ‡ÂÈ ÏÈÁfiÙÂÚÔ ·fi 5% fiÏˆÓ ÙˆÓ ÓÂÊÚÈÎÒÓ ÂÎÙÔÈÒÓ. ªÔÚÂ› Ó· ÂÌÊ·Ó›˙ÂÙ·È ¯ˆÚ›˜ ¿ÏÏÂ˜Û˘ÓÔ‰¤˜ ·ÓˆÌ·Ï›Â˜ ‹ Ó· Û¯ÂÙ›˙ÂÙ·È ÌÂ Û˘ÁÁÂÓ‹ ‰È·ÊÚ·ÁÌ·ÙÔÎ‹ÏË ‹ ‰È·ÊÚ·ÁÌ·ÙÔÎ‹ÏË ÌÂÙ¿ ·fi ÙÚ·˘Ì·-ÙÈÛÌfi. ¶ÂÚÈÁÚ¿ÊÔ˘ÌÂ ÙËÓ ÂÚ›ÙˆÛË ÂÓfi˜ ¿ÚÚÂÓÔ˜ ÓÂÔÁÓÔ‡ ÌÂ Û˘ÁÁÂÓ‹ ‰È·ÊÚ·ÁÌ·ÙÔÎ‹ÏË (™¢∫) Ù‡Ô˘Bochdalek Î·È Û˘ÓÔ‰fi ¤ÎÙÔÔ ÓÂÊÚfi ÛÙÔ ¿Óˆ ·ÚÈÛÙÂÚfi ËÌÈıˆÚ¿ÎÈÔ.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ™˘ÁÁÂÓ‹˜ ‰È·ÊÚ·ÁÌ·ÙÔÎ‹ÏË, ÓÂÔÁÓfi.

Bochdalek congenital diaphragmatic hernia with intrathoracic

ectopic kidney - a case report

C. Tsakalidis1, V. Lampropoulos2, E. Ourgantzoglou3, D. Rallis4, A. Petropoulos2, N. Nikolaidis1

Abstract: Congenital diaphragmatic hernia (CDH) is an abnormality in which abdominal organsenter the thorax through a developmental defect of the diaphragm. The hernia may occur in differentparts of the diaphragm, but the most common type of diaphragmatic hernia is the posterolateralBochdalek hernia. Intrathoracic ectopic kidney is a rare abnormality accounting for less than 5% of allrenal ectopia. It can occur with no other malformation or can be associated with congenitaldiaphragmatic hernia or post-traumatic diaphragmatic hernia. The case is presented of a maleneonate with a congenital diaphragmatic Bochdalek hernia, associated with renal ectopy in the leftupper hemithorax.

Key worlds: Congenital diaphragmatic hernia, neonate.

145∂¡¢π∞º∂ƒ√À™∞ ¶∂ƒπ¶∆ø™∏ CASE REPORT

1 µ’ ¡ÂÔÁÓÔÏÔÁÈÎ‹ ∫ÏÈÓÈÎ‹∞¶£, ¡ÔÛÔÎÔÌÂ›Ô¶··ÁÂˆÚÁ›Ô˘,£ÂÛÛ·ÏÔÓ›ÎË

2 µ’ ¶·È‰Ô¯ÂÈÚÔ˘ÚÁÈÎ‹∫ÏÈÓÈÎ‹ ∞¶£, ¡ÔÛÔÎÔÌÂ›Ô¶··ÁÂˆÚÁ›Ô˘,£ÂÛÛ·ÏÔÓ›ÎË

3 µ’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹∞¶£, ¡ÔÛÔÎÔÌÂ›Ô ∞Ã∂¶∞,£ÂÛÛ·ÏÔÓ›ÎË

4 ¡ÔÛÔÎÔÌÂ›Ô ∂È‰ÈÎÒÓ¶·ı‹ÛÂˆÓ, £ÂÛÛ·ÏÔÓ›ÎË


ÃÚ‹ÛÙÔ˜ ∆Û·Î·Ï›‰Ë˜[email protected]¡ÔÛÔÎÔÌÂ›Ô «¶··ÁÂˆÚÁ›Ô˘»,£ÂÛÛ·ÏÔÓ›ÎË

1 2nd Department ofNeonatal Paediatrics,“Aristotelio” University ofThessaloniki,“Papageorgiou” Hospital,Thessaloniki, Greece

2 2nd Department ofPaediatric Surgery,“Aristotelio” University ofThessaloniki,“Papageorgiou” Hospital,Thessaloniki, Greece

3 2nd Department ofPaediatrics, “Aristotelio”University of Thessaloniki,“AHEPA” Hospital,Thessaloniki, Greece

4 Infectious DiseasesHospital, Thessaloniki,Greece

Correspondence:

Christos [email protected]“Papageorgiou” Hospital,Thessaloniki, Greece

¶·È‰È·ÙÚÈÎ‹ 2009;72:29-40

∂ÈÛ·ÁˆÁ‹

ŒÎÙÔÔ˜ ÓÂÊÚfi˜ ··ÓÙ¿Ù·È ÛÂ 1:1.000 ÁÂÓ-Ó‹ÛÂÈ˜, ·ÏÏ¿ ÌfiÓÔ 1 ÛÙÈ˜ 10 ·fi ·˘Ù¤˜ ÙÈ˜ ÂÚÈ-ÙÒÛÂÈ˜ ‰È·ÁÈÁÓÒÛÎÂÙ·È (1). √ ÂÓ‰ÔıˆÚ·ÎÈÎfi˜¤ÎÙÔÔ˜ ÓÂÊÚfi˜ ÂÌÊ·Ó›˙ÂÙ·È ·ÎfiÌË ÈÔ Û¿ÓÈ·Î·È ¤¯ÂÈ ÙË ÌÈÎÚfiÙÂÚË Û˘¯ÓfiÙËÙ· ÛÂ Û¯¤ÛË ÌÂÙÈ˜ ÏÔÈ¤˜ ÂÎÙÔ›Â˜ ÙÔ˘ Ô˘ÚÔÔÈËÙÈÎÔ‡ (2,3),Â›Ó·È Î·Ù¿ Î·ÓfiÓ· ·Û˘ÌÙˆÌ·ÙÈÎfi˜ Î·È ·ÔÙÂ-ÏÂ› Ù˘¯·›Ô Â‡ÚËÌ· ÛÙËÓ ·Ï‹ ·ÎÙÈÓÔÁÚ·Ê›·ıÒÚ·ÎÔ˜. ∞ÎfiÌ· Û·ÓÈfiÙÂÚË Â›Ó·È Ë ‰È¿ÁÓˆÛËÙË˜ ‡·ÚÍË˜ ÂÓ‰ÔıˆÚ·ÎÈÎÔ‡ ¤ÎÙÔÔ˘ ÓÂÊÚÔ‡Î·Ù¿ ÙË ÓÂÔÁÓÈÎ‹ ËÏÈÎ›·. ¶ÂÚÈÁÚ¿ÊÔ˘ÌÂ ÙËÓÂÚ›ÙˆÛË ÂÓfi˜ ¿ÚÚÂÓÔ˜ ÓÂÔÁÓÔ‡ ÌÂ Û˘ÁÁÂÓ‹‰È·ÊÚ·ÁÌ·ÙÔÎ‹ÏË (™¢∫) Ù‡Ô˘ Bochdalek Î·ÈÛ˘ÓÔ‰fi ¤ÎÙÔÔ ÓÂÊÚfi ÛÙÔ ¿Óˆ ·ÚÈÛÙÂÚfi ËÌÈ-ıˆÚ¿ÎÈÔ, Ë ‰È¿ÁÓˆÛË ÙˆÓ ÔÔ›ˆÓ ¤ÁÈÓÂ ÚÔÁÂÓ-ÓËÙÈÎ¿, ÛÂ ËÏÈÎ›· Î‡ËÛË˜ 32 Â‚‰ÔÌ¿‰ˆÓ.

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛË˜

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34 Â‚‰ÔÌ¿‰ˆÓ ÌÂ Î·ÈÛ·ÚÈÎ‹ ÙÔÌ‹, ÏfiÁˆ ÚÔ-

ÁÂÓÓËÙÈÎ‹˜ ‰È¿ÁÓˆÛË˜ ™¢∫, ÓÂÊÚÈÎ‹˜ ÂÎÙÔ›·˜

Î·È ÔÏ˘·ÌÓ›Ô˘.

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Á¤ÓÓËÛË˜ ‹Ù·Ó 2770 g (50Ë-75Ë ∂£). ∞fi ÙÔ

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·ÚÍË ¤ÎÙÔÔ˘ ·ÚÈÛÙÂÚÔ‡ ÓÂÊÚÔ‡ ÛÙÔ Ô›ÛıÈÔ

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Ô˘ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ¤˜.

∏ ÌËÙ¤Ú· ÛÂ fiÏË ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÂÁÎ˘ÌÔ-

Û‡ÓË˜ ‚ÚÈÛÎfiÙ·Ó ˘fi ·ÁˆÁ‹ ÌÂ ÛÎÂ˘¿ÛÌ·Ù·


ÛÈ‰‹ÚÔ˘, ·Û‚ÂÛÙ›Ô˘, Ê˘ÏÏÈÎÔ‡ ÔÍ¤Ô˜ Î·È Ì·ÁÓËÛ›Ô˘.

¢ÂÓ Î¿ÓÈ˙Â Î·È ‰ÂÓ ‹Ù·Ó ¯Ú‹ÛÙË˜ ·ÏÎÔfiÏ ‹ ¿ÏÏˆÓ

Ô˘ÛÈÒÓ. ¶ÚÔËÁ‹ıËÎÂ ˆÚ›Ì·ÓÛË ÙˆÓ ÓÂ˘ÌfiÓˆÓ ÙÔ˘

ÂÌ‚Ú‡Ô˘ ÌÂ ¯ÔÚ‹ÁËÛË ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰ÒÓ ÛÙË ÌË-

Ù¤Ú· Ì›· Â‚‰ÔÌ¿‰· ÚÈÓ ·fi ÙÔÓ ÙÔÎÂÙfi.

∏ Ú‹ÍË ÙˆÓ ÂÌ‚Ú˘˚ÎÒÓ ˘Ì¤ÓˆÓ ¤ÁÈÓÂ Î·Ù¿ ÙËÓ

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ıÂÙ‹Ú·˜ Î·È ¤ÁÈÓÂ ‰È·ÛˆÏ‹ÓˆÛË ÁÈ· ¿ÌÂÛË ˘ÔÛÙ‹-

ÚÈÍË ÙÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡. ∆Ô Apgar score ‹Ù·Ó 17 Î·È

58 (‰È·ÛˆÏËÓˆÌ¤ÓÔ). ∆· ·¤ÚÈ· ÙÔ˘ ÔÌÊ·Ï›Ô˘ ÏÒÚÔ˘

‹Ù·Ó: p∏=7,32, pO2=23,6 mmHg, pCO2=58,6

mmHg, SBE=2,3 mmol/L. ∆Ô ÓÂÔÁÓfi ÌÂÙ·Ê¤ÚıËÎÂ

‰È·ÛˆÏËÓˆÌ¤ÓÔ ÌÂ ambu ÛÂ ÎÏÂÈÛÙ‹ ıÂÚÌÔÎÔÈÙ›‰·.

∆· ·¤ÚÈ· ·fi ÂÚÈÊÂÚÈÎ‹ ·ÚÙËÚ›· ÙÔ˘ ÓÂÔÁÓÔ‡ Ï›Á·

ÏÂÙ¿ ÌÂÙ¿ ÙË Á¤ÓÓËÛË, ˘fi ÌË¯·ÓÈÎfi ·ÂÚÈÛÌfi,

‹Ù·Ó: pH=7,25, pO2=180,6 mmHg, pCO2=46,8

mmHg, SBE=-7 mmol/L.

∏ ·ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›· ıÒÚ·Î· ÂÈ‚Â‚·›ˆÛÂ Ù·

Â˘Ú‹Ì·Ù· ÙÔ˘ ÚÔÁÂÓÓËÙÈÎÔ‡ ÂÏ¤Á¯Ô˘ (∂ÈÎfiÓ· 1).

∏ ÛÙ·ıÂÚ‹ ÎÏÈÓÈÎ‹ Î·È ÂÚÁ·ÛÙËÚÈ·Î‹ ÂÈÎfiÓ· ÙÔ˘ ÓÂ-

ÔÁÓÔ‡ Â¤ÙÚÂ„Â ÙË ¯ÂÈÚÔ˘ÚÁÈÎ‹ ·ÔÎ·Ù¿ÛÙ·ÛË ÙË˜

‰È·ÊÚ·ÁÌ·ÙÔÎ‹ÏË˜ ÙÔ ÚÒÙÔ 24ˆÚÔ, ÌÂ ÙÔÔı¤ÙË-

ÛË Ï¤ÁÌ·ÙÔ˜ Goretex Î·È ÌÂÙ·ÊÔÚ¿ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡

ÓÂÊÚÔ‡ ÛÙËÓ Ô›ÛıÈ· ¿Óˆ ·ÚÈÛÙÂÚ‹ ÎÔÈÏÈ·Î‹ ¯ÒÚ·.

ÃÔÚËÁ‹ıËÎÂ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ‰‡Ô

146 Ã. ∆Û·Î·Ï›‰Ë˜ Î·È Û˘Ó.


∂ÈÎfiÓ· 1. ™˘ÁÁÂÓ‹˜ ‰È·ÊÚ·ÁÌ·ÙÔÎ‹ÏË Ù‡Ô˘ Bochdalek Î·È ÂÓ‰ÔıˆÚ·ÎÈÎfi˜ ¤ÎÙÔÔ˜ ÓÂÊÚfi˜ - ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛË˜. AÍÔÓÈÎ‹ ÙÔÌÔ-ÁÚ·Ê›· ıÒÚ·ÎÔ˜.

A B

° ¢


ÊÔÚ¤˜, ÙËÓ 1Ë Î·È ÙË 12Ë ÒÚ· ˙ˆ‹˜, ·Ì¤Ûˆ˜ ÌÂÙ¿

ÙÔ ¯ÂÈÚÔ˘ÚÁÂ›Ô. ∏ ¤ÎÙ˘ÍË ÙÔ˘ ÓÂ‡ÌÔÓ· ‹Ù·Ó Î·-

Ï‹, fiÌˆ˜ ÏfiÁˆ ‰È·Ù·Ú·¯ÒÓ ÙË˜ Û¯¤ÛË˜ ·ÂÚÈÛÌÔ‡/

·ÈÌ¿ÙˆÛË˜ ·fi ÙË Û˘Ó˘¿Ú¯Ô˘Û· ÓÂ˘ÌÔÓÈÎ‹

˘ÔÏ·Û›·, ÙÔ ·Ó·ÓÂ˘ÛÙÈÎfi Û‡ÛÙËÌ· ˘ÔÛÙËÚ›-

¯ıËÎÂ ÌÂ ˘„›Û˘¯ÓÔ ÌË¯·ÓÈÎfi ·ÂÚÈÛÌfi, ÌÂ ¯ÔÚ‹ÁË-

ÛË ÌÔÓÔÍÂÈ‰›Ô˘ ÙÔ˘ ·˙ÒÙÔ˘. ÃÔÚËÁ‹ıËÎ·Ó ÈÓfiÙÚÔ-

· ÁÈ· ÙËÓ ÂÓ›Û¯˘ÛË ÙË˜ ÂÚÈÊÂÚÈÎ‹˜ Î˘ÎÏÔÊÔÚ›·˜

Î·È ‰ÈÏ‹ ·ÓÙÈ‚ÈÔÙÈÎ‹ ·ÁˆÁ‹. ∏ ‰È¿ÁÓˆÛË ÙË˜ ·-

Ú·Ì¤ÓÔ˘Û·˜ ÓÂ˘ÌÔÓÈÎ‹˜ ˘¤ÚÙ·ÛË˜ ÂÈ‚Â‚·ÈÒ-

ıËÎÂ ÌÂ ˘ÂÚË¯ÔÁÚ¿ÊËÌ· Doppler Î·Ú‰È¿˜ Î·È

ÓÂ˘ÌÔÓÈÎÒÓ ·ÁÁÂ›ˆÓ.

√ Â·Ó¤ÏÂÁ¯Ô˜ ÙË 12Ë ËÌ¤Ú· ˙ˆ‹˜ ¤‰ÂÈÍÂ ÛËÌ·-

ÓÙÈÎ‹ ‚ÂÏÙ›ˆÛË ÛÙÈ˜ ·ÓÙÈÛÙ¿ÛÂÈ˜ ÙˆÓ ÓÂ˘ÌÔÓÈÎÒÓ

·ÁÁÂ›ˆÓ. ∆Ë 13Ë ËÌ¤Ú· ÓÔÛËÏÂ›·˜ ÂÎ‰‹ÏˆÛÂ ÂÈÎfiÓ·

ÛË„·ÈÌ›·˜ ÌÂ ·‡ÍËÛË ÙË˜ CRP Î·È Ë Î·ÏÏÈ¤ÚÁÂÈ· ·›-

Ì·ÙÔ˜ ‹Ù·Ó ıÂÙÈÎ‹ ÁÈ· St. epidermidis. ∏ ¯ÔÚ‹ÁËÛË

·ÓÙÈ‚ÈÔÙÈÎ‹˜ ·ÁˆÁ‹˜ ‹Ù·Ó ·ÔÙÂÏÂÛÌ·ÙÈÎ‹. ∆Ë 17Ë

ËÌ¤Ú· ÓÔÛËÏÂ›·˜ ‰È·ÈÛÙÒıËÎÂ ÂÎÚÔ‹ ¯ÔÏÒ‰Ô˘˜

˘ÁÚÔ‡ ·fi ÙÔ ¯Â›ÏÔ˜ ÙÔ˘ ÎÔÈÏÈ·ÎÔ‡ ¯ÂÈÚÔ˘ÚÁÈÎÔ‡

ÙÚ·‡Ì·ÙÔ˜ Î·È, ÏfiÁˆ ÂÌÌÔÓ‹˜, ·ÔÊ·Û›ÛÙËÎÂ ÂÚÂ˘-

ÓËÙÈÎ‹ Ï··ÚÔÙÔÌ›·, fiÔ˘ Î·È ‰È·ÈÛÙÒıËÎÂ Ë

‡·ÚÍË, ·ÎÚÈ‚Ò˜ Î¿Ùˆ ·fi ÙÔ Ï¤ÁÌ·, ‰È·ÙÂÙ·Ì¤-

ÓË˜ ¤ÏÈÎ·˜ ÏÂÙÔ‡ ÂÓÙ¤ÚÔ˘, Ô˘ ¤ÊÂÚÂ ÌÔÓ‹ÚË Ú‹-

ÍË ÛÙË ÌÂÛfiÙËÙ¿ ÙË˜, ÌÂ Û˘Ú›ÁÁÈÔ ÚÔ˜ ÙÔ ÎÔÈÏÈ·Îfi

ÙÔ›¯ˆÌ·, ·fi fiÔ˘ ÂÍÂÚ¯fiÙ·Ó ÙÔ ˘ÎÓfiÚÚÂ˘ÛÙÔ

¯ÔÏÒ‰Â˜ ÂÚÈÂ¯fiÌÂÓÔ. ¶Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ ÂÎÙÔÌ‹

ÙÌ‹Ì·ÙÔ˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘ Î·È ‰ÈÂÓ¤ÚÁÂÈ· ‰ÈÏ‹˜ ÛÙÔ-

Ì›·˜, ÙÔÔıÂÙ‹ıËÎÂ ·ÚÔ¯¤ÙÂ˘ÛË ÂÓÙfi˜ ÙË˜ ÂÚÈ-

ÙÔÓ·˚Î‹˜ ÎÔÈÏfiÙËÙ·˜ Î·È ¤ÁÈÓÂ Û‡ÁÎÏÂÈÛË ÙÔ˘ ÙÚ·‡-

Ì·ÙÔ˜ ÌÂ Î·ÈÓÔ‡ÚÁÈÔ Ï¤ÁÌ· Goretex. ∏ ÈÛÙÔ·ıÔ-

ÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË ÙÔ˘ ÂÓÙ¤ÚÔ˘ ¤‰ÂÈÍÂ ÌfiÓÔ ÛËÌÂ›·

ÊÏÂÁÌÔÓ‹˜.

∏ ·ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›· ıÒÚ·Î· Ô˘ ‰ÈÂÓÂÚÁ‹ıË-

ÎÂ ÙËÓ ÂfiÌÂÓË ËÌ¤Ú· ¤‰ÂÈÍÂ ·ÙÂÏÂÎÙ·Û›· Î·È ÌÂ›ˆ-

ÛË ÙÔ˘ fiÁÎÔ˘ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ÓÂ‡ÌÔÓ·. ™ÙÔÓ ·ÛıÂ-

Ó‹ ¯ÔÚËÁ‹ıËÎ·Ó ÂÈÛÓÂfiÌÂÓ· ‚ÚÔÁ¯Ô‰È·ÛÙ·ÏÙÈÎ¿

Î·È ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹. ∆Ô ÓÂÔÁÓfi ÂÙ¤ıË ÛÂ ·ÁˆÁ‹ ÌÂ

‰ÔÌÂÚÈ‰fiÓË ÏfiÁˆ Á·ÛÙÚÔÔÈÛÔÊ·ÁÈÎ‹˜ ·ÏÈÓ‰Úfi-

ÌËÛË˜. ∫ÂÓÙÚÈÎfi˜ ÊÏÂ‚ÈÎfi˜ Î·ıÂÙ‹Ú·˜ Ù‡Ô˘

Hickmann ÙÔÔıÂÙ‹ıËÎÂ ÛÙÔ ÓÂÔÁÓfi Î·È ·Ú¤ÌÂÈÓÂ

Û˘ÓÔÏÈÎ¿ ÁÈ· 35 ËÌ¤ÚÂ˜. √ ·ÛıÂÓ‹˜ ·Ú¤ÌÂÈÓÂ ÛÂ

ÌË¯·ÓÈÎfi ·ÂÚÈÛÌfi Û˘ÓÔÏÈÎ¿ 46 ËÌ¤ÚÂ˜. ªÂÙ¿ ÙËÓ

·Ô‰¤ÛÌÂ˘ÛË ·fi ÙÔÓ ÌË¯·ÓÈÎfi ·ÂÚÈÛÌfi ¯ÚÂÈ¿ÛıË-

ÎÂ ¯ÔÚ‹ÁËÛË ÔÍ˘ÁfiÓÔ˘ ÁÈ· 9 ËÌ¤ÚÂ˜. ∆ËÓ 58Ë ËÌ¤Ú·

˙ˆ‹˜ ¤ÁÈÓÂ Â¤Ì‚·ÛË ·Ó·ÛÙfiÌˆÛË˜ ÙÔ˘ ÎÂÓÙÚÈÎÔ‡

Î·È ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ÎÔÏÔ‚ÒÌ·ÙÔ˜ ÙÔ˘ ÏÂÙÔ‡

ÂÓÙ¤ÚÔ˘.

∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÓÔÛËÏÂ›·˜ ÙÔ˘, Ô ·ÛıÂÓ‹˜

ÂÙ¤ıË ÛÂ ÔÏÈÎ‹ ·ÚÂÓÙÂÚÈÎ‹ ‰È·ÙÚÔÊ‹ ÁÈ· 11 ËÌ¤-

ÚÂ˜, ÛÙË Û˘Ó¤¯ÂÈ· ÛÂ ÌÈÎÙ‹ Û›ÙÈÛË Î·È ·fi ÙËÓ 72Ë

ËÌ¤Ú· ˙ˆ‹˜ ‚ÚÈÛÎfiÙ·Ó ÛÂ Ï‹ÚË ÂÓÙÂÚÈÎ‹ Û›ÙÈÛË,

Î·Ï¿ ·ÓÂÎÙ‹. ∆· ˘ÂÚË¯ÔÁÚ·Ê‹Ì·Ù· ÂÁÎÂÊ¿ÏÔ˘

‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ¿. √ ÔÊı·ÏÌÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ Î·Ù¿

ÙËÓ ¤ÍÔ‰fi ÙÔ˘ ·fi ÙËÓ ÎÏÈÓÈÎ‹ ‰ÂÓ ¤‰ÂÈÍÂ ·ıÔÏÔÁÈ-

Î¿ Â˘Ú‹Ì·Ù·. √ ·ÛıÂÓ‹˜ ÂÍ‹ÏıÂ ·fi ÙËÓ ÎÏÈÓÈÎ‹

ÙËÓ 85Ë ËÌ¤Ú· ˙ˆ‹˜ ÌÂ ‚¿ÚÔ˜ 3.680 g (<10Ë ∂£),

Ì‹ÎÔ˜ 54 cm (25Ë ∂£) Î·È ÂÚ›ÌÂÙÚÔ ÎÂÊ·Ï‹˜ 38 cm

(50Ë ∂£). ŒÏ·‚Â ˆ˜ ·ÁˆÁ‹ ÂÈÛÓÂfiÌÂÓ· ‚ÚÔÁ¯Ô‰È·-

ÛÙ·ÏÙÈÎ¿ Î·È ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ‰‹ ÁÈ· ÙÈ˜ ÂÎ‰ËÏÒÛÂÈ˜

ÙË˜ ‚ÚÔÁ¯ÔÓÂ˘ÌÔÓÈÎ‹˜ ÙÔ˘ ‰˘ÛÏ·Û›·˜ Î·È ÛÎÂ˘¿-

ÛÌ·Ù· ÛÈ‰‹ÚÔ˘ Î·È Û‡ÌÏÂÁÌ· ‚ÈÙ·ÌÈÓÒÓ ∞ Î·È D.

∆Ô ÛÙ·ÙÈÎfi (∂ÈÎfiÓ· 2) Î·È ‰˘Ó·ÌÈÎfi ÛÈÓıËÚÔÁÚ¿-

ÊËÌ· ÓÂÊÚÒÓ ÌÂ Tc-99m Ô˘ Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó

ÛÂ ËÏÈÎ›· 6 ÌËÓÒÓ ¤‰ÂÈÍ·Ó Ê˘ÛÈÔÏÔÁÈÎ‹ ÏÂÈÙÔ˘ÚÁ›·

Î·È ÙˆÓ ‰‡Ô ÓÂÊÚÒÓ.

™˘˙‹ÙËÛË

∏ Û˘ÁÁÂÓ‹˜ ‰È·ÊÚ·ÁÌ·ÙÔÎ‹ÏË (™¢∫) Â›Ó·È ‰˘-

ÛÏ·Û›· ÛÙËÓ ÔÔ›· ·Ú·ÙËÚÂ›Ù·È ÚfiÙˆÛË ÂÓ‰Ô-

ÎÔÈÏÈ·ÎÒÓ ÛÏ¿¯ÓˆÓ Ì¤Û· ÛÙÔ ıÒÚ·Î·, ‰È·Ì¤ÛÔ˘

ÂÓfi˜ ·Ó·ÙÔÌÈÎÔ‡ ÂÏÏÂ›ÌÌ·ÙÔ˜ ÙÔ˘ ‰È·ÊÚ¿ÁÌ·ÙÔ˜. ∏

‰È·ÊÚ·ÁÌ·ÙÔÎ‹ÏË ÌÔÚÂ› Ó· ·ÊÔÚ¿ ‰È·ÊÔÚÂÙÈÎ¿

ÙÌ‹Ì·Ù· ÙÔ˘ ‰È·ÊÚ¿ÁÌ·ÙÔ˜. √ ÈÔ ÎÔÈÓfi˜ Ù‡Ô˜ ‰È·-

ÊÚ·ÁÌ·ÙÔÎ‹ÏË˜ Â›Ó·È Ë Ï·ÁÈÔ›ÛıÈ· Î‹ÏË ÙÔ˘

Bochdalek, Ë Û˘¯ÓfiÙËÙ· ÙË˜ ÔÔ›·˜ ÂÎÙÈÌ¿Ù·È ÂÚ›-

Ô˘ ÛÙÔ 90-95% (4). ∏ ÏÂÈÔ„ËÊ›· ÙˆÓ ÂÚÈÙÒÛÂ-

ˆÓ ™¢∫ Ù‡Ô˘ Bochdalek ·ÊÔÚ¿ ÙËÓ ·ÚÈÛÙÂÚ‹ ÏÂ˘-

Ú¿ ÙÔ˘ ‰È·ÊÚ¿ÁÌ·ÙÔ˜, ·ÏÏ¿ Ù· ÔÛÔÛÙ¿ ÙˆÓ ‰ÂÍÈ¿

Î·È ·ÚÈÛÙÂÚ¿ ÂÓÙÔÈ˙fiÌÂÓˆÓ ™¢∫ ÔÈÎ›ÏÏÔ˘Ó. √È

™¢∫ ÂÓÙÔ›˙ÔÓÙ·È ·ÚÈÛÙÂÚ¿ ÛÂ ÔÛÔÛÙfi 73-90%,

147™˘ÁÁÂÓ‹˜ ‰È·ÊÚ·ÁÌ·ÙÔÎ‹ÏË Ù‡Ô˘ Bochdalek

¶·È‰È·ÙÚÈÎ‹ 2009;72:29-40

∂ÈÎfiÓ· 2. ™˘ÁÁÂÓ‹˜ ‰È·ÊÚ·ÁÌ·ÙÔÎ‹ÏË Ù‡Ô˘ Bochdalek Î·È ÂÓ‰Ô-ıˆÚ·ÎÈÎfi˜ ¤ÎÙÔÔ˜ ÓÂÊÚfi˜ - ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛË˜. ™Ù·ÙÈÎfiÛÈÓıËÚÔÁÚ¿ÊËÌ· ÓÂÊÚÒÓ.

Anterior Posterior

Left Post Oblique Right Post Oblique

Left54.5%

Right 45.5%


‰ÂÍÈ¿ ÛÂ ÔÛÔÛÙfi 8-24% Î·È ·ÌÊÔÙÂÚfiÏÂ˘Ú· ‹ ÎÂ-

ÓÙÚÈÎ¿ ÛÂ ÔÛÔÛÙfi 1,2-4,6% (5,6,7). ∏ ™¢∫ Ù‡Ô˘

Bochdalek ÂÚÈÁÚ¿ÊËÎÂ ÁÈ· ÚÒÙË ÊÔÚ¿ ÙÔ 1948 (8).

√ ÂÓ‰ÔıˆÚ·ÎÈÎfi˜ ¤ÎÙÔÔ˜ ÓÂÊÚfi˜ Â›Ó·È Û¿ÓÈ·

·ÓˆÌ·Ï›· Î·È ·ÓÙÈÚÔÛˆÂ‡ÂÈ ÏÈÁfiÙÂÚÔ ·fi 5%

fiÏˆÓ ÙˆÓ ÓÂÊÚÈÎÒÓ ÂÎÙÔÈÒÓ (2,9). ªÔÚÂ› Ó· ÂÌ-

Ê·Ó›˙ÂÙ·È ¯ˆÚ›˜ ¿ÏÏÂ˜ Û˘ÓÔ‰¤˜ ·ÓˆÌ·Ï›Â˜ ‹ Ó· Û¯Â-

Ù›˙ÂÙ·È ÌÂ Û˘ÁÁÂÓ‹ ‰È·ÊÚ·ÁÌ·ÙÔÎ‹ÏË ‹ ‰È·ÊÚ·ÁÌ·-

ÙÔÎ‹ÏË ÌÂÙ¿ ·fi ÙÚ·˘Ì·ÙÈÛÌfi (10). ™Â 15.919 ·˘ÙÔ-

„›Â˜ ·È‰ÈÒÓ Ô˘ Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó, ÌfiÓÔ 1 ÂÚ›-

ÙˆÛË ÂÓ‰ÔıˆÚ·ÎÈÎÔ‡ ¤ÎÙÔÔ˘ ÓÂÊÚÔ‡ ·Ú·ÙËÚ‹-

ıËÎÂ, ·Ó¿ÌÂÛ· ÛÂ 22 ÂÚÈÙÒÛÂÈ˜ ÓÂÊÚÈÎ‹˜ ÂÎÙÔ›·˜

(11). ∏ ÚÒÙË ÂÚ›ÙˆÛË ÎÏÈÓÈÎ¿ ‰È·ÁÓˆÛÌ¤ÓË˜ ÂÓ-

‰ÔıˆÚ·ÎÈÎ‹˜ ÓÂÊÚÈÎ‹˜ ÂÎÙÔ›·˜ ÂÚÈÁÚ¿ÊËÎÂ ·fi

ÙÔÓ Wolfromm ÙÔ 1940 (12). ∆Ô 1987, ÔÈ Donat Î·È

Donat ÌÂÏ¤ÙËÛ·Ó ÂÚÈÙÒÛÂÈ˜ Ô˘ ‰ËÌÔÛÈÂ‡ıËÎ·Ó

‰ÈÂıÓÒ˜ ·fi ÙÔ 1922 ¤ˆ˜ ÙÔ 1986 Î·È Î·Ù¤ÏËÍ·Ó ÛÙÔ

Û˘Ì¤Ú·ÛÌ· fiÙÈ Ë Û˘ÁÁÂÓ‹˜ ·˘Ù‹ ·ÓˆÌ·Ï›· ÂÌÊ·Ó›-

˙ÂÙ·È Û˘¯ÓfiÙÂÚ· ÛÙËÓ ·ÚÈÛÙÂÚ‹ (62%) ·fi fi,ÙÈ ÛÙË

‰ÂÍÈ¿ ÏÂ˘Ú¿ (36%). ∆Ô 2% ÙˆÓ ·ÛıÂÓÒÓ ¤¯ÂÈ ·ÌÊÔ-

ÙÂÚfiÏÂ˘ÚË ÂÓ‰ÔıˆÚ·ÎÈÎ‹ ÓÂÊÚÈÎ‹ ÂÎÙÔ›·. √ ·ÚÈ-

ÛÙÂÚfi˜ ÂÓ‰ÔıˆÚ·ÎÈÎfi˜ ÓÂÊÚfi˜ Û˘Û¯ÂÙ›˙ÂÙ·È ÌÂ ÛÎÂ-

ÏÂÙÈÎ¤˜ Î·È Î·Ú‰È·Î¤˜ ·ÓˆÌ·Ï›Â˜ (13). ∂ÈÚfiÛıÂÙ·,

Ë Û˘ÁÁÂÓ‹˜ ·˘Ù‹ ·ÓˆÌ·Ï›· ··ÓÙ¿Ù·È Û˘¯ÓfiÙÂÚ· ÛÂ

¿ÚÚÂÓÂ˜ (63%) ·fi fi,ÙÈ ÛÙ· ı‹ÏÂ· (37%). ∏ Û˘¯Ófi-

ÙËÙ· ÙÔ˘ ÂÓ‰ÔıˆÚ·ÎÈÎÔ‡ ÓÂÊÚÔ‡ ÛÙË ™¢∫ Ù‡Ô˘

Bochdalek ·Ó·Ê¤ÚÂÙ·È ÏÈÁfiÙÂÚÔ ·fi 0,25% (2).

∆· ·Ó·ÙÔÌÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙÔ˘ ÂÓ‰ÔıˆÚ·ÎÈ-

ÎÔ‡ ÓÂÊÚÔ‡ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó: ·ÓˆÌ·Ï›· ÛÙÚÔÊ‹˜ ÙË˜

‡ÏË˜ ÙÔ˘ ÓÂÊÚÔ‡ Á‡Úˆ ·fi ÙÔÓ ÂÈÌ‹ÎË ¿ÍÔÓ·,

Ì·ÎÚ‡ Ô˘ÚËÙ‹Ú·, ˘„ËÏ‹ ¤ÎÊ˘ÛË ÙˆÓ ÓÂÊÚÈÎÒÓ ·Á-

ÁÂ›ˆÓ Î·È ·fiÎÏÈÛË ÙÔ˘ Î¿Ùˆ fiÏÔ˘ ÙÔ˘ ÓÂÊÚÔ‡

·fi ÙË Ì¤ÛË ÁÚ·ÌÌ‹ (14,15). √ ÂÓ‰ÔıˆÚ·ÎÈÎfi˜ ÓÂ-

ÊÚfi˜ ÂÌÊ·Ó›˙ÂÈ Ê˘ÛÈÔÏÔÁÈÎ‹ ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ·, ‰ÂÓ

·ÚÔ˘ÛÈ¿˙ÂÈ ‰˘ÛÏ·Û›· ‹ ·fiÊÚ·ÍË ÙË˜ ÂÎÎÚÈÙÈÎ‹˜

ÙÔ˘ ÌÔ›Ú·˜ Î·È ‰ÂÓ Û˘ÓÔ‰Â‡ÂÙ·È ·fi ˘ÂÚÏ·Û›·

ÙÔ˘ ¿ÏÏÔ˘ ÓÂÊÚÔ‡ (16,22). ∏ ·ÈÙ›· ÙË˜ ÂÓ‰ÔıˆÚ·ÎÈ-

Î‹˜ ÂÎÙÔ›·˜ Â›Ó·È ¿ÁÓˆÛÙË. ∏ ıÂˆÚ›· ÙË˜ ·ÔÙ˘-

¯ËÌ¤ÓË˜ Û‡ÁÎÏÂÈÛË˜ ÙË˜ ÏÂ˘ÚÔÂÚÈÙÔÓ·˚Î‹˜ Ù˘-

¯‹˜ ÁÈ· ÙË ‰ËÌÈÔ˘ÚÁ›· ÙË˜ ™¢∫ Â›Ó·È Â˘Ú¤ˆ˜ ·Ô‰Â-

ÎÙ‹. ∏ ·Ó¿Ù˘ÍË ÙÔ˘ ‰È·ÊÚ¿ÁÌ·ÙÔ˜ ·Ú¯›˙ÂÈ ·fi ÙÔ

ÚfiÛıÈÔ ÙÌ‹Ì· ÙÔ˘ ˆ˜ ¤Ó· ¯ÒÚÈÛÌ· ÌÂÙ·Í‡ ÙË˜ Î·Ú-

‰È¿˜ Î·È ÙÔ˘ ‹·ÙÔ˜ Î·È ÚÔ¯ˆÚ¿ÂÈ ÚÔ˜ Ù· ›Ûˆ,

ÁÈ· Ó· ÎÏÂ›ÛÂÈ ÙÂÏÈÎ¿ ÚÔ˜ ÙÔ ·ÚÈÛÙÂÚfi ÙÚ‹Ì· ÙÔ˘

Bochdalek, Á‡Úˆ ÛÙËÓ 8Ë ÌÂ 10Ë Â‚‰ÔÌ¿‰· Î‡ËÛË˜.

∫·Ù¿ Ì›· ¿Ô„Ë, ıÂˆÚÂ›Ù·È fiÙÈ ÂÓ‰ÔıˆÚ·ÎÈÎ‹ ÓÂ-

ÊÚÈÎ‹ ÂÎÙÔ›· ÌÔÚÂ› Ó· ÚÔÎÏËıÂ› ·fi ÙËÓ Î·ı˘-

ÛÙÂÚËÌ¤ÓË Û‡ÁÎÏÂÈÛË ÙÔ˘ ‰È·ÊÚ¿ÁÌ·ÙÔ˜ ‹ ÙËÓ ÂÈ-

Ù¿¯˘ÓÛË ÙË˜ ·Ófi‰Ô˘ ÙÔ˘ ÓÂÊÚÔ‡ ÚÈÓ ·fi ÙËÓ Î·ÓÔ-

ÓÈÎ‹ Û‡ÁÎÏÂÈÛË (3,13). √ ÓÂÊÚfi˜ Û˘Ó‹ıˆ˜ ‚Ú›ÛÎÂÙ·È

ÛÙÔ Ï·ÁÈÔ›ÛıÈÔ ÙÌ‹Ì· ÙÔ˘ ‰È·ÊÚ¿ÁÌ·ÙÔ˜ Î·È Ô

Ô˘ÚËÙ‹Ú·˜ ÂÍ¤Ú¯ÂÙ·È Ì¤Û· ·fi ÙÔ ÛÙfiÌÈÔ ÙË˜ Î‹-

ÏË˜. ∆Ô ‰È¿ÊÚ·ÁÌ· ÛÂ ·˘Ùfi ÙÔ ÛËÌÂ›Ô ·ÔÙÂÏÂ›Ù·È

·fi ÌÈ· ÏÂÙ‹ ÌÂÌ‚Ú¿ÓË Ô˘ ÂÚÈ‚¿ÏÏÂÈ ÙÔ ÚÔ¤-

¯ÔÓ ÙÌ‹Ì· ÙÔ˘ ÓÂÊÚÔ‡ Î·È ¤ÙÛÈ Ô ÓÂÊÚfi˜ ‚Ú›ÛÎÂÙ·È

ÂÓÙfi˜ ÙË˜ ıˆÚ·ÎÈÎ‹˜ ÎÔÈÏfiÙËÙ·˜. ¢Â˘ÙÂÚÔ·ıÒ˜

ÌÔÚÂ› Ó· ˘¿Ú¯ÂÈ Î·È ˘ÔÏ·Û›· ÙÔ˘ Î·ÙÒÙÂÚÔ˘

ÏÔ‚Ô‡ ÙÔ˘ Û‡ÛÙÔÈ¯Ô˘ ÓÂ‡ÌÔÓ· (13). √È Hawass ND

et al., ÙÔ 1988, ÚfiÙÂÈÓ·Ó fiÙÈ Ë ÙÂÏÈÎ‹ ı¤ÛË ÙÔ˘ ÓÂ-

ÊÚÔ‡ Î·ıÔÚ›˙ÂÙ·È ·fi ÙÌ‹Ì· ÙÔ˘ ÁÂÓÓËÙÈÎÔ‡ ÙfiÓÔ˘

(ÙÔ Û˘Á¯ˆÓÂ˘Ì¤ÓÔ Ô˘Ú·›Ô ÙÌ‹Ì· ÙˆÓ ‰‡Ô Ô˘ÚÔÁÂÓ-

ÓËÙÈÎÒÓ ·ÎÚÔÏÔÊÈÒÓ, Î¿ıÂ Ì›· ·fi ÙÈ˜ ÔÔ›Â˜ ·Ú¤-

¯ÂÈ ¤Ó·Ó ÌÂÛÔÓÂÊÚÈÎfi Î·È ¤Ó·Ó ·Ú·ÌÂÛÔÓÂÊÚÈÎfi

fiÚÔ), ÙÔ ÔÔ›Ô ·ÔÚÚÔÊ¿Ù·È ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË ÙË˜

ÓÂÊÚÔÁ¤ÓÂÛË˜ (17). ™Â fiÏÂ˜ ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ ÂÓ‰Ô-

ıˆÚ·ÎÈÎ‹˜ ÓÂÊÚÈÎ‹˜ ÂÎÙÔ›·˜, Ô ÓÂÊÚfi˜ ‚Ú›ÛÎÂÙ·È

ÂÓÙfi˜ ÙË˜ ıˆÚ·ÎÈÎ‹˜ ÎÔÈÏfiÙËÙ·˜ Î·È fi¯È ÛÙËÓ ˘Â-

˙ˆÎÔÙÈÎ‹ ÎÔÈÏfiÙËÙ·. ∆· ÓÂÊÚÈÎ¿ ·ÁÁÂ›· Î·È Ô Ô˘ÚË-

Ù‹Ú·˜ Ù˘ÈÎ¿ ÂÍ¤Ú¯ÔÓÙ·È ·fi ÙËÓ ˘Â˙ˆÎÔÙÈÎ‹ ÎÔÈ-

ÏfiÙËÙ· ‰È·Ì¤ÛÔ˘ ÙÔ˘ ÛÙÔÌ›Ô˘ ÙË˜ Î‹ÏË˜ Î·È Û˘Ó‹-

ıˆ˜ ¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚÔ Ì‹ÎÔ˜ ·fi ÙÔ Ê˘ÛÈÔÏÔÁÈÎfi.

√ ÂÓ‰ÔıˆÚ·ÎÈÎfi˜ ÓÂÊÚfi˜ Ô˘ ‰ÂÓ Û¯ÂÙ›˙ÂÙ·È ÌÂ

™¢∫ ‚Ú›ÛÎÂÙ·È ÛÙËÓ ·Ú·ÛÔÓ‰˘ÏÈÎ‹ ·‡Ï·Î·. ∆·

ËÌÈ‰È·ÊÚ¿ÁÌ·Ù· Â›Ó·È Ê˘ÛÈÔÏÔÁÈÎ¿ Î·È ‚Ú›ÛÎÔÓÙ·È

ÛÙÔÓ Î·ÙÒÙÂÚÔ fiÏÔ ÙÔ˘ ÓÂÊÚÔ‡.

∏ ÚÔÁÂÓÓËÙÈÎ‹ ‰È¿ÁÓˆÛË Â›Ó·È ÂÊÈÎÙ‹ Î·Ù¿ ÙÔÓ

˘ÂÚË¯ÔÁÚ·ÊÈÎfi ¤ÏÂÁ¯Ô ÙÔ˘ ÂÌ‚Ú‡Ô˘ (18). √ ÚÔÁÂÓ-

ÓËÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÌÂ ¯Ú‹ÛË ÙË˜ Ì·ÁÓËÙÈÎ‹˜ ÙÔÌÔÁÚ·-

Ê›·˜ ÛÂ ÂÚ›ÙˆÛË ˘Ô„›·˜ ‡·ÚÍË˜ ™¢∫ Î·È Û˘ÓÔ-

‰ÒÓ ·ÓˆÌ·ÏÈÒÓ ¤¯ÂÈ ÚfiÛÊ·Ù· ÚÔÙ·ıÂ› (19) Î·È Û·-

ÊÒ˜ ÏÂÔÓÂÎÙÂ› ¤Ó·ÓÙÈ ÙÔ˘ ˘ÂÚË¯ÔÁÚ·Ê‹Ì·ÙÔ˜.

∞Ó Î·È Ë ™¢∫ ÂÎ‰ËÏÒÓÂÙ·È ÎÏÈÓÈÎ¿ ·Ì¤Ûˆ˜ ÌÂÙ¿

ÙË Á¤ÓÓËÛË ‹ ÙÈ˜ ÚÒÙÂ˜ Ì¤ÚÂ˜ ˙ˆ‹˜, 10-20% ÙˆÓ

ÂÚÈÙÒÛÂˆÓ ‰È·ÁÈÁÓÒÛÎÔÓÙ·È ÌÂÙ¿ ÙË ÓÂÔÁÓÈÎ‹

ÂÚ›Ô‰Ô (20,21). ∏ ÓÂÊÚÈÎ‹ ÂÎÙÔ›·, fiÙ·Ó ‰ÂÓ Û˘ÓÔ-

‰Â‡ÂÙ·È ·fi ¿ÏÏÂ˜ ·ÓˆÌ·Ï›Â˜, ‰ÂÓ ÚÔÎ·ÏÂ› Û˘-

ÌÙÒÌ·Ù·. √ ÂÓ‰ÔıˆÚ·ÎÈÎfi˜ ÓÂÊÚfi˜ ·ÚÔ˘ÛÈ¿˙ÂÈ

Ê˘ÛÈÔÏÔÁÈÎ‹ ÏÂÈÙÔ˘ÚÁ›· ¯ˆÚ›˜ ÛËÌÂ›· ‰˘ÛÏ·Û›·˜,

·fiÊÚ·ÍË˜ ÙË˜ ·ÂÎÎÚÈÙÈÎ‹˜ ÌÔ›Ú·˜ ‹ Û˘ÓÔ‰fi

˘ÂÚÏ·Û›· ÙÔ˘ ¿ÏÏÔ˘ ÓÂÊÚÔ‡ (16,22). øÛÙfiÛÔ,

˘¿Ú¯Ô˘Ó ÂÚÈÔÚÈÛÌ¤ÓÂ˜ ·Ó·ÊÔÚ¤˜ ÛÙË ‚È‚ÏÈÔÁÚ·-

Ê›· ÂÓ‰ÔıˆÚ·ÎÈÎÒÓ ¤ÎÙÔˆÓ ÓÂÊÚÒÓ ÌÂ ·fiÊÚ·ÍË

ÙË˜ ˘ÂÏÔÔ˘ÚËÙËÚÈÎ‹˜ Û˘Ì‚ÔÏ‹˜ ÙÔ˘ ÓÂÊÚÔ‡, ÌÂ

Î˘ÛÙÂÔÔ˘ÚËÙËÚÈÎ‹ ·ÏÈÓ‰ÚfiÌËÛË Î·È ÌÂ ÔÏ˘Î˘-

ÛÙÈÎ‹ ‰˘ÛÏ·Û›· ÛÙÔÓ ¤ÎÙÔÔ ÓÂÊÚfi (1). ™ÙÈ˜ ÂÚÈ-

ÙÒÛÂÈ˜ Û˘Ó‡·ÚÍË˜ ™¢∫, ÏfiÁˆ ÙË˜ ÓÂ˘ÌÔÓÈÎ‹˜

˘ÔÏ·Û›·˜ Ô˘ ÔÊÂ›ÏÂÙ·È ÛÙËÓ ›ÂÛË ÙˆÓ ÓÂ˘Ìfi-

ÓˆÓ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÂÌ‚Ú˘˚Î‹˜ ˙ˆ‹˜ ·fi Ù·

ÂÓ‰ÔÎÔÈÏÈ·Î¿ ÛÏ¿¯Ó· Ô˘ ÚÔÛ›ÙÔ˘Ó ÂÓÙfi˜ ÙÔ˘

ıÒÚ·Î·, ÔÈ ·ÛıÂÓÂ›˜ Î·Ù¿ ÙË Á¤ÓÓËÛË ÂÎ‰ËÏÒÓÔ˘Ó

ÔÍÂ›· ·Ó·ÓÂ˘ÛÙÈÎ‹ ·ÓÂ¿ÚÎÂÈ·. ™Â ·˘Ù¤˜ ÙÈ˜ ÂÚÈ-

ÙÒÛÂÈ˜ ··ÈÙÂ›Ù·È ¯ÂÈÚÔ˘ÚÁÈÎ‹ ·ÔÎ·Ù¿ÛÙ·ÛË Ìfi-

ÏÈ˜ ÛÙ·ıÂÚÔÔÈËıÂ› Ô ·ÛıÂÓ‹˜. ™Â ·Û˘ÌÙˆÌ·ÙÈ-

ÎÔ‡˜ ·ÛıÂÓÂ›˜, Ë ¯ÂÈÚÔ˘ÚÁÈÎ‹ ·ÔÎ·Ù¿ÛÙ·ÛË ÌÔ-

ÚÂ› Ó· Á›ÓÂÈ Ì¤ÚÂ˜ ‹ Î·È ¯ÚfiÓÈ· ÌÂÙ¿, ·Ó¿ÏÔÁ· ÌÂ ÙËÓ

Î·Ù¿ÛÙ·Û‹ ÙÔ˘.

148 Ã. ∆Û·Î·Ï›‰Ë˜ Î·È Û˘Ó.



¢È¿ÊÔÚÂ˜ ·ÂÈÎÔÓÈÛÙÈÎ¤˜ Ì¤ıÔ‰ÔÈ ¯ÚËÛÈÌÔÔÈ-Ô‡ÓÙ·È ÁÈ· ÙË ‰È¿ÁÓˆÛË ‡·ÚÍË˜ ÂÓ‰ÔıˆÚ·ÎÈÎÔ‡ ÓÂ-ÊÚÔ‡ Î·È ÁÈ· ÙË ‰È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË ·fi ˆÚÔÎ·Ù·-ÎÙËÙÈÎ¤˜ ÂÂÍÂÚÁ·Û›Â˜ ÙÔ˘ ıÒÚ·Î· ‹ ÙÔ˘ ÌÂÛÔıˆ-Ú·Î›Ô˘. ∏ ·Ï‹ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·Î· Û˘Ó‹ıˆ˜·ÔÎ·Ï‡ÙÂÈ ·Ú·ÛÔÓ‰˘ÏÈÎ‹ Ì¿˙· ÛÙÔ Ô›ÛıÈÔÌÂÛÔıˆÚ¿ÎÈÔ.

™ÙË ‰È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È Ë ÓÂ˘-ÚÔ˚ÓˆÌ¿ÙˆÛË, Ë ÌËÓÈÁÁÔÎ‹ÏË Î·È ÔÈ fiÁÎÔÈ ÙÔ˘ Ô›-ÛıÈÔ˘ ÌÂÛÔıˆÚ·Î›Ô˘, fiˆ˜ ÙÔ ÓÂ˘ÚÔ‚Ï¿ÛÙˆÌ·, ÙÔÁ·ÁÁÏÈÔÓÂ‡ÚˆÌ· Î·È Ë ÓÂ˘ÚÔÂÓÙÂÚÈÎ‹ Î‡ÛÙË (23). ™ÙÈ˜ÂÚÈÛÛfiÙÂÚÂ˜ ‰ËÌÔÛÈÂ˘Ì¤ÓÂ˜ ÂÚÈÙÒÛÂÈ˜, ¯ÚËÛÈÌÔ-ÔÈ‹ıËÎÂ Ë ÂÓ‰ÔÊÏ¤‚È· ˘ÂÏÔÁÚ·Ê›· ÁÈ· ÙË ‰È¿ÁÓˆ-ÛË (17,24). ∂›ÛË˜, ÙÔ ˘ÂÚË¯ÔÁÚ¿ÊËÌ· Î·È Ë CT ıÒ-Ú·Î· ÌÔÚÔ‡Ó Ó· ‚ÔËı‹ÛÔ˘Ó ÛÙË ‰È¿ÁÓˆÛË (18,25). ∏CT ıÒÚ·Î· ÌÔÚÂ› Ó· ÂÈ‚Â‚·ÈÒÛÂÈ ‚Ï¿‚Â˜ ÙË˜ ˘¤-ÏÔ˘ Î·È ÙˆÓ Î·Ï‡ÎˆÓ Î·È Ó· ‰È·ÁÓÒÛÂÈ ¿ÏÏÂ˜ ‚Ï¿‚Â˜Ô˘ ÌÈÌÔ‡ÓÙ·È ÂÓ‰ÔıˆÚ·ÎÈÎfi ¤ÎÙÔÔ ÓÂÊÚfi, fiˆ˜ ÔÈfiÁÎÔÈ ÙÔ˘ ÌÂÛ·˘Ï›Ô˘ Î·È Ë ‰È·ÊÚ·ÁÌ·ÙÔÎ‹ÏË.

£ÂÚ·Â˘ÙÈÎ‹ ·Ú¤Ì‚·ÛË ··ÈÙÂ›Ù·È ÌfiÓÔ ÛÂ Â-Ú›ÙˆÛË ·fiÊÚ·ÍË˜ ÙË˜ ·ÂÎÎÚÈÙÈÎ‹˜ ÌÔ›Ú·˜ ÙÔ˘ÓÂÊÚÔ‡ Î·È ÛÂ ÂÌÊ¿ÓÈÛË Î˘ÛÙÂÔÔ˘ÚËÙËÚÈÎ‹˜ ·ÏÈÓ-‰ÚfiÌËÛË˜. ∂¿Ó Î·Ù¿ ÙË ‰È¿ÁÓˆÛË Ô ÓÂÊÚfi˜ ‰ÂÓ Â›Ó·ÈÎ·ÙÂÛÙÚ·ÌÌ¤ÓÔ˜, Ë ·fiÊÚ·ÍË Î·È Ë Î˘ÛÙÂÔÔ˘ÚËÙË-ÚÈÎ‹ ·ÏÈÓ‰ÚfiÌËÛË ÌÔÚÂ› Ó· ‰ÈÔÚıˆıÔ‡Ó ÌÂ Â¤Ì-‚·ÛË. ∂¿Ó fiÌˆ˜ Ë ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ÓÂÊÚÔ‡ Â›Ó·È ÛÔ-‚·Ú¿ ÂËÚÂ·ÛÌ¤ÓË, ÙfiÙÂ Ë ·Ê·›ÚÂÛ‹ ÙÔ˘ ·ÔÙÂÏÂ›ÙË Ï‡ÛË ÂÈÏÔÁ‹˜ (1). ∂›ÛË˜, ¯ÂÈÚÔ˘ÚÁÈÎ‹ ‰ÈÂÚÂ‡-ÓËÛË ÂÈ‚¿ÏÏÂÙ·È fiÙ·Ó Û˘Ó˘¿Ú¯ÂÈ ™¢∫ Ù‡Ô˘Bochdalek. ™Â ·˘Ù¤˜ ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ Ô ÓÂÊÚfi˜ Û˘-Ó‹ıˆ˜ Î·Ï‡ÙÂÙ·È ·fi ÙÔ ÔÈÛıÔÂÚÈÙfiÓ·ÈÔ Î·ÈÌÔÚÂ› Â‡ÎÔÏ· Ó· ÙÔÔıÂÙËıÂ› ÛÙËÓ ÎÔÈÏÈ·Î‹ ¯ÒÚ·,¯ˆÚ›˜ ÛËÌ·ÓÙÈÎ¤˜ ·ÈÌÔ‰˘Ó·ÌÈÎ¤˜ ÂÈÏÔÎ¤˜, fiˆ˜ÛÙËÓ ÂÚ›ÙˆÛ‹ Ì·˜.

√ ÂÓ‰ÔıˆÚ·ÎÈÎfi˜ ¤ÎÙÔÔ˜ ÓÂÊÚfi˜ ·ÔÙÂÏÂ› Û¿-ÓÈ· ÎÏÈÓÈÎ‹ ÔÓÙfiÙËÙ· Î·È ı¤ÙÂÈ ÔÏÏ¿ ‰È·ÁÓˆÛÙÈÎ¿Î·È ıÂÚ·Â˘ÙÈÎ¿ ‰ÈÏ‹ÌÌ·Ù· ÛÙÔ˘˜ ÎÏÈÓÈÎÔ‡˜ ÁÈ·-ÙÚÔ‡˜. ∏ Û˘Ó‡·ÚÍË ™¢∫ Ù‡Ô˘ Bochdalek Î·È ÂÓ‰Ô-ıˆÚ·ÎÈÎÔ‡ ¤ÎÙÔÔ˘ ÓÂÊÚÔ‡ Â›Ó·È ÂÍ·ÈÚÂÙÈÎ¿ Û¿ÓÈ·.¶Ú¤ÂÈ Ó· ÙÔÓÈÛÙÂ› fiÙÈ Ë Û˘ÁÁÂÓ‹˜ ·˘Ù‹ ·ÓˆÌ·Ï›· ı·Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÂÙ·È ˘fi„Ë ÛÙË ‰È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆ-ÛË Î¿ıÂ ÊÔÚ¿ Ô˘ Ù›ıÂÙ·È ı¤Ì· ‡·ÚÍË˜ ÂÓ‰ÔıˆÚ·-ÎÈÎ‹˜ Ì¿˙·˜. ∏ ¤ÁÎ·ÈÚË ‰È¿ÁÓˆÛË Î·È ÛˆÛÙ‹ ·ÓÙÈÌÂ-ÙÒÈÛË ÌÂÈÒÓÂÈ ÙË ÓÔÛËÚfiÙËÙ· Î·È ıÓËÙfiÙËÙ·.


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149™˘ÁÁÂÓ‹˜ ‰È·ÊÚ·ÁÌ·ÙÔÎ‹ÏË Ù‡Ô˘ Bochdalek

¶·È‰È·ÙÚÈÎ‹ 2009;72:29-40


150 ∫§π¡π∫√ ∫√Àπ∑ CLINICAL QUIZ

Paediatriki 2009;72:66,71-73

∞ÁfiÚÈ 13 ÂÙÒÓ ÚÔÛÎÔÌ›ÛÙËÎÂ ÛÙ· ÂÍˆÙÂÚÈÎ¿È·ÙÚÂ›· ·Ú·ÔÓÔ‡ÌÂÓÔ ÁÈ· ‰˘ÛÎ·Ì„›· ÙË˜ Ô‰Ô-ÎÓËÌÈÎ‹˜, ¿ÏÁÔ˜ Î·È ¯ˆÏfiÙËÙ·, ÌÂÙ¿ ·fi Î·Ù·fi-ÓËÛË ÛÙË ‰È¿ÚÎÂÈ· ·ıÏÔ·È‰È¿˜. ¢ÂÓ ÂÚÈ¤ÁÚ·„ÂÛ˘ÁÎÂÎÚÈÌ¤ÓË Î¿ÎˆÛË, ÏËÓ fiÌˆ˜ ·Ó¤ÊÂÚÂ ˆ˜ ÙÔÙÂÏÂ˘Ù·›Ô ÂÍ¿ÌËÓÔ Â›¯Â Î·Ù’ Â·Ó¿ÏË„Ë ·Ú·ÙË-Ú‹ÛÂÈ Ô›‰ËÌ· ÛÙËÓ ¿ÚıÚˆÛË.

™ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈÎ‹ ÂÍ¤Ù·ÛË, ‰È·ÈÛÙÒıËÎÂ ‰˘-ÛÎ·Ì„›· ÙË˜ ·ÚÈÛÙÂÚ‹˜ Ô‰ÔÎÓËÌÈÎ‹˜ Î·È ÙÔÈÎ‹Â˘·ÈÛıËÛ›·, ¯ˆÚ›˜ Ô›‰ËÌ·, ÛÙËÓ ÂÚÈÔ¯‹ ÙˆÓ ÛÊ˘-ÚÒÓ. √ ‚ÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ ‹Ù·Ó ·ÚÓËÙÈÎfi˜. √È ‰Â›-ÎÙÂ˜ ÏÔ›ÌˆÍË˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎÔ›. √ Ï‹ÚË˜ ÚÂ˘-Ì·ÙÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ‹Ù·Ó Â›ÛË˜ ·ÚÓËÙÈÎfi˜. ∏ÔÊı·ÏÌÔÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË ÛÂ Û¯ÈÛÌÔÂÈ‰‹ Ï˘¯Ó›·, ÁÈ·ÙË ‰È·›ÛÙˆÛË Èı·Ó‹˜ ÈÚÈ‰ÔÎ˘ÎÏ›ÙÈ‰·˜, ‰ÂÓ ¤‰ÂÈ-ÍÂ ·ıÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù·.

√È ·ÎÙÈÓÔÁÚ·Ê›Â˜ ÛÙËÓ ÚÔÛıÈÔ›ÛıÈ· Î·È Ï¿-ÁÈ· ÚÔ‚ÔÏ‹ ¤‰ÂÈÍ·Ó ÔÛÙÈÎ‹ ·ÏÏÔ›ˆÛË ÛÙÔ Ô›-ÛıÈÔ-¤Ûˆ ÙÌ‹Ì· ÙÔ˘ ıfiÏÔ˘ ÙÔ˘ ·ÛÙÚ·Á¿ÏÔ˘ (EÈÎfi-Ó· 1). ∆Ô ˘ÂÚË¯ÔÁÚ¿ÊËÌ· ¤‰ÂÈÍÂ ÌÈÎÚ‹ Û˘ÏÏÔÁ‹˘ÁÚÔ‡, ÂÓ‰ÂÈÎÙÈÎ‹ ‰Ú¿ÚıÚÔ˘. ∆Ô ÛÈÓıËÚÔÁÚ¿ÊË-Ì· ÙˆÓ ÔÛÙÒÓ ÌÂ Ú·‰ÈÂÓÂÚÁfi ∆Â¯Ó‹ÙÈÔ99 ¤‰ÂÈÍÂ ·˘-ÍËÌ¤ÓÔ ÌÂÙ·‚ÔÏÈÛÌfi Î·È ÛÙÈ˜ ÙÚÂÈ˜ Ê¿ÛÂÈ˜. ∏ MRI(EÈÎfiÓÂ˜ 2 Î·È 3) ¤‰ÂÈÍÂ ÔÛÙÈÎ‹ ‚Ï¿‚Ë ÛÙÔ Ô›ÛıÈÔ-¤Ûˆ ÙÌ‹Ì· ÙÔ˘ ıfiÏÔ˘ ÙÔ˘ ·ÛÙÚ·Á¿ÏÔ˘, ÌÂ ÌÈÎÚ‹Û˘ÏÏÔÁ‹ ˘ÁÚÔ‡ Î·È Ô›‰ËÌ· ÙÔ˘ ˘ÔÎÂ›ÌÂÓÔ˘ ÙË˜‚Ï¿‚Ë˜ ÔÛÙÔ‡, ¯ˆÚ›˜ Î˘ÛÙÈÎ¤˜ ·ÏÏÔÈÒÛÂÈ˜.

∆ÔÔıÂÙ‹ıËÎÂ Á‡„ÈÓÔ˜ Ó¿ÚıËÎ·˜ ÎÓËÌÔÔ‰È-Îfi˜ Î·È ÌÂÙ¿ ·fi 3 Â‚‰ÔÌ¿‰Â˜ ‰ÂÓ ‰È·ÈÛÙÒıËÎ·ÓÙ· ·Ú¯ÈÎ¿ Û˘ÌÙÒÌ·Ù· Î·È Ù· ÎÏÈÓÈÎ¿ ÛËÌÂ›·. ∆Ô-ÔıÂÙ‹ıËÎÂ ÎÓËÌÔÔ‰ÈÎfi˜ ÎË‰ÂÌfiÓ·˜ ÁÈ· ¿ÏÏÂ˜ 3Â‚‰ÔÌ¿‰Â˜, ÂÓÒ ÛÂ fiÏÔ ·˘Ùfi ÙÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·ÙÔ ¿ÎÚÔ ‰ÂÓ ÊÔÚÙ›ÛÙËÎÂ. ∆ÚÂÈ˜ Ì‹ÓÂ˜ ÌÂÙ¿ ÙËÓ ·Ú-¯ÈÎ‹ ÂÎÙ›ÌËÛË, Ô ·ÛıÂÓ‹˜ Â›Ó·È ··ÏÏ·ÁÌ¤ÓÔ˜ ·fiÙ· ÂÓÔ¯Ï‹Ì·Ù¿ ÙÔ˘ Î·È ÔÈ ·ÎÙÈÓÔÁÚ·Ê›Â˜ Â›Ó·È Ê˘-ÛÈÔÏÔÁÈÎ¤˜.

¶Èı·Ó¤˜ ‰È·ÁÓÒÛÂÈ˜:

1. MË ÙÚ·˘Ì·ÙÈÎ‹ ÌÔÓÔ·ÚıÚ›ÙÈ‰· Ô‰ÔÎÓËÌÈÎ‹˜ 2. OÛÙÂÔÓ¤ÎÚˆÛË3. ™¯·ÏÈ‰ˆÙÈÎ‹ ÔÛÙÂÔ¯ÔÓ‰Ú›ÙÈ‰· ·ÛÙÚ·Á¿ÏÔ˘4. √ÛÙÂÔÂÈ‰¤˜ ÔÛÙ¤ˆÌ· 5. ∞ÔÛ·ÛÙÈÎfi Î¿Ù·ÁÌ·

µ’ √ÚıÔ·È‰ÈÎfi ∆Ì‹Ì·,¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ «¶. & ∞. ∫˘ÚÈ·ÎÔ‡», ∞ı‹Ó·


¡ÈÎfiÏ·Ô˜ ª·ÚÎ¤·˜[email protected]µ’ √ÚıÔ·È‰ÈÎfi ∆Ì‹Ì·,¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ «¶. & ∞. ∫˘ÚÈ·ÎÔ‡», ∞ı‹Ó·

2nd Department ofOrthopaedics, “P. & A. Kyriakou” Children’sHospital, Athens, Greece

Correspondence:

Nikolaos [email protected] Department ofOrthopaedics, “P. & A. Kyriakou” Children’sHospital, Athens, Greece

∞ÁfiÚÈ 13 ÂÙÒÓ ÌÂ Â·Ó·Ï·Ì‚·ÓfiÌÂÓ· ÂÂÈÛfi‰È· ÂÒ‰˘ÓË˜

Ô‰ÔÎÓËÌÈÎ‹˜ ¿ÚıÚˆÛË˜

¡. ª·ÚÎ¤·˜, π. ¶··¯Ú‹ÛÙÔ˜

Thirteen-year-old boy with recurrent episodes of painful

ankle joint

¡. Markeas, π. Papachristos

∏ ·¿ÓÙËÛË ÛÙË ÛÂÏ›‰· 157

∂ÈÎfiÓ· 1. ∏ ·Ú¯ÈÎ‹ ·ÎÙÈÓÔÁÚ·Ê›· ·Ó·‰ÂÈÎÓ‡ÂÈ ÔÛÙÈÎ‹·ÏÏÔ›ˆÛË ÛÙÔ ıfiÏÔ ÙÔ˘ ·ÛÙÚ·Á¿ÏÔ˘.

∂ÈÎfiÓ· 2. ∏ Ì·ÁÓËÙÈÎ‹ ÙÔÌÔÁÚ·Ê›·, ÛÙÔ ÛÙÂÊ·ÓÈ·›Ô Â›-Â‰Ô, ·ÔÎ·Ï‡ÙÂÈ ÙËÓ ·ÏÏÔ›ˆÛË ÛÙÔ Ô›ÛıÈÔ-¤Ûˆ ÙÌ‹-Ì· ÙÔ˘ ·ÛÙÚ·Á¿ÏÔ˘, ÙË ÌÈÎÚ‹ Û˘ÏÏÔÁ‹ ˘ÁÚÔ‡ Î·È ÙÔ ÔÛÙÈ-Îfi Ô›‰ËÌ·.

∂ÈÎfiÓ· 3. ∏ Ì·ÁÓËÙÈÎ‹ ÙÔÌÔÁÚ·Ê›·, ÛÙÔ Ô‚ÂÏÈ·›Ô Â›Â-‰Ô, ·Ó·‰ÂÈÎÓ‡ÂÈ Ù· ›‰È· Â˘Ú‹Ì·Ù·.


151™À¡∆√ª∞ ¶∞π¢π∞∆ƒπ∫∞ ¡∂∞ PAEDIATRIC NEWS IN BRIEF

¶·È‰È·ÙÚÈÎ‹ 2009;72:151-000

∂ËÚÂ¿˙ÂÈ Ë ıÂÚ·Â›· ÙË˜ ÔÍÂ›·˜ Ì¤ÛË˜ˆÙ›ÙÈ‰·˜ (√ªø) ÙËÓ Â›ÙˆÛË ÙË˜Ì·ÛÙÔÂÈ‰›ÙÈ‰·˜ ÛÙ· ·È‰È¿;Paula Thompson et al.Pediatrics 2009;123:424-430

™ÙÔ ÙÂ‡¯Ô˜ ºÂ‚ÚÔ˘·Ú›Ô˘ ÙÔ˘ Pediatrics ‰Ë-ÌÔÛÈÂ‡ıËÎÂ ¤Ó· ÂÓ‰È·Ê¤ÚÔÓ ¿ÚıÚÔ Ô˘ ·ÊÔÚ¿ÛÙË ¯Ú‹ÛË ÙˆÓ ·ÓÙÈ‚ÈÔÙÈÎÒÓ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒ-ÈÛË ÙË˜ ÔÍÂ›·˜ Ì¤ÛË˜ ˆÙ›ÙÈ‰·˜ Î·È Ò˜ ·˘Ù‹ ËıÂÚ·Â›· ÌÔÚÂ› Ó· ÂËÚÂ¿ÛÂÈ ÙËÓ Â›ÙˆÛËÙË˜ Ì·ÛÙÔÂÈ‰›ÙÈ‰·˜, Ô˘ ·ÔÙÂÏÂ› Ì›· ·fi ÙÈ˜ÛÔ‚·ÚfiÙÂÚÂ˜ ÂÈÏÔÎ¤˜ ÙË˜ ÓfiÛÔ˘. ∏ Û˘ÁÎÂ-ÎÚÈÌ¤ÓË ÌÂÏ¤ÙË ·ÌÊÈÛ‚ËÙÂ› Ì›· ÎÏ·ÛÈÎ‹ ıÂˆÚ›·Ô˘ Î·ıÈÛÙ¿ ··Ú·›ÙËÙË ÙË ıÂÚ·Â›· ÙË˜√ªø. ™ÙËÓ ·Ó·‰ÚÔÌÈÎ‹ ·˘Ù‹ ÌÂÏ¤ÙË, Ë ÔÔ›·¤Ï·‚Â ¯ÒÚ· ÛÙË ª. µÚÂÙ·Ó›·, ¯ÚËÛÈÌÔÔÈ‹ıË-Î·Ó ËÏÂÎÙÚÔÓÈÎÔ› Ê¿ÎÂÏÔÈ ·È‰ÈÒÓ ËÏÈÎ›·˜ 3ÌËÓÒÓ ¤ˆ˜ 15 ÂÙÒÓ ÌÂÙ·Í‡ ÙˆÓ ÂÙÒÓ 1990-2006,Ù· ÔÔ›· ·Ó¤Ù˘Í·Ó Ì·ÛÙÔÂÈ‰›ÙÈ‰·. ∞fi Ù· 854ÂÂÈÛfi‰È· Ì·ÛÙÔÂÈ‰›ÙÈ‰·˜, ÌfiÓÔ ÙÔ 1/3 (35,7%)Â›¯Â ÈÛÙÔÚÈÎfi √ªø. ∏ Èı·ÓfiÙËÙ· ·Ó¿Ù˘ÍË˜Ì·ÛÙÔÂÈ‰›ÙÈ‰·˜ ÌÂÙ¿ ·fi √ªø ÁÈ· ÙËÓ ÔÔ›·¯ÔÚËÁ‹ıËÎÂ ıÂÚ·Â›· ‹Ù·Ó 1,8/100.000 ÂÂÈÛfi-‰È· √ªø, ÂÓÒ Ë Â›ÙˆÛË Û¯Â‰fiÓ ‰ÈÏ·ÛÈ¿˙Â-Ù·È (3,8/100.000) fiÙ·Ó ‰ÂÓ Â›¯Â ‰ÔıÂ› ıÂÚ·Â›·.∞˘Ùfi ÛËÌ·›ÓÂÈ fiÙÈ ÁÈ· Ó· ÚÔÏËÊıÂ› 1 ÂÚ›Ùˆ-ÛË Ì·ÛÙÔÂÈ‰›ÙÈ‰·˜ Ú¤ÂÈ Ó· ıÂÚ·Â‡ÛÔ˘ÌÂ4.831 ÂÚÈÙÒÛÂÈ˜ √ªø. ™Â ·fiÏ˘ÙÔ˘˜ ·ÚÈı-ÌÔ‡˜, ·˘Ùfi ÌÂÙ·ÊÚ¿˙ÂÙ·È ÛÂ 255 Î·ÈÓÔ‡ÚÁÈ· Â-ÚÈÛÙ·ÙÈÎ¿ Ì·ÛÙÔÂÈ‰›ÙÈ‰·˜ ÙÔ ¯ÚfiÓÔ ÁÈ· ÙË ª.µÚÂÙ·Ó›· Â¿Ó ÛÙ·Ì·ÙÔ‡ÛÂ Ë Û˘ÓÙ·ÁÔÁÚ¿ÊËÛËÁÈ· ÙËÓ √ªø, ÂÓÒ Ë ¯Ú‹ÛË ÙˆÓ ·ÓÙÈ‚ÈÔÙÈÎÒÓ ı·ÌÂÈˆÓfiÙ·Ó Î·Ù¿ 738.775 Û˘ÓÙ·Á¤˜.

™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, ÔÈ Û˘ÁÁÚ·ÊÂ›˜ ÂÈÛËÌ·›-ÓÔ˘Ó fiÙÈ Ù· ÂÚÈÛÛfiÙÂÚ· ·È‰È¿ Ô˘ ·Ó¤Ù˘Í·ÓÌ·ÛÙÔÂÈ‰›ÙÈ‰· ‰ÂÓ Â›¯·Ó ÂÈÛÎÂÊıÂ› ÙÔÓ ÁÈ·ÙÚfiÙÔ˘˜. ∫·Ù¿ ÙÔ˘˜ Û˘ÁÁÚ·ÊÂ›˜, Ë ·‡ÍËÛË ÙË˜ Â›-ÙˆÛË˜ ÙË˜ Ì·ÛÙÔÂÈ‰›ÙÈ‰·˜ ÏfiÁˆ ÙË˜ ÌË ¯Ú‹-ÛË˜ ·ÓÙÈ‚ÈÔÙÈÎÒÓ ÁÈ· ÙË ıÂÚ·Â›· √ªø Â›Ó·ÈÌÈÎÚ‹ ÂÙËÛ›ˆ˜ Î·È ÙÔ fiÊÂÏÔ˜ ·fi ÙË ÌÂ›ˆÛË ÙË˜¯Ú‹ÛË˜ ·ÓÙÈ‚ÈÔÙÈÎÒÓ Ô˘ÛÈÒÓ ıÂˆÚÂ›Ù·È fiÙÈ Â›Ó·ÈÛËÌ·ÓÙÈÎfiÙÂÚÔ ·fi ÙÔ ÎfiÛÙÔ˜ ÙË˜ ÂÈÏÔÎ‹˜.

£ÂÚ·Â›· ÔÛÙÂÔÌ˘ÂÏ›ÙÈ‰·˜: ÊÂÏÂ› ËÌ·ÎÚÔ¯ÚfiÓÈ· ·ÚÂÓÙÂÚÈÎ‹ ıÂÚ·Â›·;Theoklis Zaoutis et al. Pediatrics 2009:2;636-642

√ Zaoutis et al. ‰ËÌÔÛ›Â˘Û·Ó ÛÙÔ PediatricsÙ· ·ÔÙÂÏ¤ÛÌ·Ù· ÌÈ·˜ ÌÂÁ¿ÏË˜ ·Ó·‰ÚÔÌÈÎ‹˜ÌÂÏ¤ÙË˜ Ô˘ Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ ÛÙÈ˜ ∏¶∞ Î·È·ÊÔÚÔ‡ÛÂ ÛÙË Û‡ÁÎÚÈÛË ÙË˜ Ì·ÎÚÔ¯ÚfiÓÈ·˜ ÂÓ-‰ÔÊÏ¤‚È·˜ ıÂÚ·Â›·˜ ÁÈ· ÔÍÂ›· ÔÛÙÂÔÌ˘ÂÏ›ÙÈ‰·ÌÂ ·˘Ù‹ ÙË˜ Ù·¯Â›·˜ ÌÂÙ¿‚·ÛË˜ ·fi ÂÓ‰ÔÊÏ¤-‚È· ıÂÚ·Â›· ÛÂ ıÂÚ·Â›· ·fi ÙÔ ÛÙfiÌ·.

™Â ·˘Ù‹ ÙËÓ ÔÏ˘ÎÂÓÙÚÈÎ‹ ÌÂÏ¤ÙË (29 ÓÔÛÔ-ÎÔÌÂ›· ÙˆÓ ∏¶∞) Û˘ÌÂÚÈÂÏ‹ÊıËÛ·Ó ·È‰È¿ 2ÌËÓÒÓ ¤ˆ˜ 17 ¯ÚÔÓÒÓ ÌÂ ÔÍÂ›· ÔÛÙÂÔÌ˘ÂÏ›ÙÈ‰·Î·Ù¿ Ù· ¤ÙË 2000-2005. ™˘ÓÔÏÈÎ¿ 1.969 ·È‰È¿ÏËÚÔ‡Û·Ó Ù· ÎÚÈÙ‹ÚÈ·, ÂÎ ÙˆÓ ÔÔ›ˆÓ 1.021¤Ï·‚·Ó Ì·ÎÚ¿˜ ‰È¿ÚÎÂÈ·˜ ÂÓ‰ÔÊÏ¤‚È· ıÂÚ·Â›·(>2 Â‚‰ÔÌ¿‰Â˜), ÂÓÒ 948 ¤Ï·‚·Ó ‚Ú·¯Â›· ÂÓ‰Ô-ÊÏ¤‚È· ıÂÚ·Â›· (<2 Â‚‰ÔÌ¿‰Â˜) Î·È ÛÙË Û˘Ó¤-¯ÂÈ· ıÂÚ·Â›· ·fi ÙÔ ÛÙfiÌ·. ∂ÈÙ˘¯‹˜ ‹Ù·Ó ËıÂÚ·Â›· ÛÙÔ 95% ÙˆÓ ·È‰ÈÒÓ Ô˘ ¤Ï·‚·Ó Ì·-ÎÚÔ¯ÚfiÓÈ· ÂÓ‰Ô‚Ï¤‚È· ıÂÚ·Â›·, ¤Ó·ÓÙÈ ÙÔ˘ 96%ÙˆÓ ·È‰ÈÒÓ Ô˘ ¤Ï·‚·Ó ‚Ú·¯Â›· ÂÓ‰ÔÊÏ¤‚È·

¡¤· ·fi ÙÔÓ ÒÚÔ ÙˆÓ ·È‰È·ÙÚÈÎÒÓ ÏÔÈÌÒÍÂˆÓ

¡. ™˘Ú›‰Ë˜

News on paediatric infections

N. Spyridis

µ’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹,¶·ÓÂÈÛÙ‹ÌÈÔ ∞ıËÓÒÓ

∞ÏÏËÏÔÁÚ·Ê›·:

¡›ÎÔ˜ ¶. ™˘Ú›‰Ë˜[email protected]µ’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹,¶·ÓÂÈÛÙ‹ÌÈÔ ∞ıËÓÒÓ

2nd Department ofPaediatrics, University ofAthens, Athens, Greece

Correspondence:

Nikos P. [email protected] Department ofPaediatrics, University ofAthens, Athens, Greece


ÂÈ ˜

ÈÎÔ‡

È¿·.Ô˘Ì·.Ô˘

˘Ù¤˜ÂÈÙÈ˜Ô˘,

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152 ™À¡∆√ª∞ ¶∞π¢π∞∆ƒπ∫∞ ¡∂∞


ıÂÚ·Â›·. Ÿˆ˜ ·Ó·ÌÂÓfiÙ·Ó, Ù· ·È‰È¿ Ô˘

¤Ï·‚·Ó ·ÚÂÓÙÂÚÈÎ‹ ıÂÚ·Â›· Â›¯·Ó ÛÂ ÔÛÔ-

ÛÙfi 3,4% ÂÈÏÔÎ¤˜ Ô˘ ÔÊÂ›ÏÔÓÙ·Ó Î˘Ú›ˆ˜

ÛÙË ¯Ú‹ÛË ÙÔ˘ ÂÓ‰ÔÊÏ¤‚ÈÔ˘ Î·ıÂÙ‹Ú·.

™˘ÓÔ„›˙ÔÓÙ·˜, ÔÈ Û˘ÁÁÚ·ÊÂ›˜ ˘ÔÛÙËÚ›˙Ô˘Ó

fiÙÈ ÁÈ· ÙË ıÂÚ·Â›· ÙË˜ ÔÍÂ›·˜ ÔÛÙÂÔÌ˘ÂÏ›ÙÈ-

‰·˜, Ë Ù·¯Â›· ÌÂÙ¿‚·ÛË ·fi ÙËÓ ÂÓ‰ÔÊÏ¤‚È·

ÛÙËÓ ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜ ·ÁˆÁ‹ Û¯ÂÙ›˙ÂÙ·È ÌÂ

¿ÚÈÛÙ· ·ÔÙÂÏ¤ÛÌ·Ù·, ÂÓÒ ·Ú¿ÏÏËÏ· ·Ô-

ÊÂ‡ÁÔÓÙ·È ÔÈ ·ÚÂÓ¤ÚÁÂÈÂ˜ ·fi ÙË ¯Ú‹ÛË Î·ıÂ-

Ù‹ÚˆÓ.

§¿ıË Î·Ù¿ ÙË Û˘ÓÙ·ÁÔÁÚ¿ÊËÛË ÛÙËÓ ·È‰ÈÎ‹

ËÏÈÎ›·

Ian Wong et al.

Archives of Diseases in Childhood 2009;94;161-164

√ Ian Wong et al. ‰ËÌÔÛ›Â˘Û·Ó ÛÙÔ Archives

of Diseases in Childhood ÌÈ· ÛÂÈÚ¿ ·fi„ÂˆÓ Ô˘

·ÊÔÚÔ‡Ó ÛÙÈ˜ ÌÂıfi‰Ô˘˜ ·ÓÙÈÌÂÙÒÈÛË˜ Ï·ıÒÓ

ÛÙË Û˘ÓÙ·ÁÔÁÚ¿ÊËÛË Ê·ÚÌ¿ÎˆÓ ÛÙËÓ ·È‰ÈÎ‹

ËÏÈÎ›·. ∆Ô Û˘ÓËı¤ÛÙÂÚÔ È·ÙÚÈÎfi ÛÊ¿ÏÌ· ·ÊÔÚ¿

ÛÙË Ï·Óı·ÛÌ¤ÓË Û˘ÓÙ·ÁÔÁÚ¿ÊËÛË. ∆· Ï¿ıË ·˘-

Ù¿ ·Ó¤Ú¯ÔÓÙ·È ÁÈ· ÙÔ ∏ÓˆÌ¤ÓÔ µ·Û›ÏÂÈÔ ÛÂ

500.000 ÂÚÈÙÒÛÂÈ˜ ÂÙËÛ›ˆ˜. ∆· Î˘ÚÈfiÙÂÚ· ·›-

ÙÈ· Â›Ó·È: 1) Ë ÔÏ˘ÏÔÎfiÙËÙ· ÛÙÔÓ ÔÏÔÁÈÛÌfi

ÙË˜ ‰fiÛË˜, Ë ÔÔ›· ÚÔÛ‰ÈÔÚ›˙ÂÙ·È ÌÂ ‚¿ÛË

ÔÏÏÔ‡˜ ·Ú¿ÁÔÓÙÂ˜, fiˆ˜ Ë ËÏÈÎ›·, ÙÔ ‚¿ÚÔ˜,

Ë ÂÈÊ¿ÓÂÈ· ÛÒÌ·ÙÔ˜, Ë ÚÔˆÚfiÙËÙ· Î·È Ë ÎÏÈ-

ÓÈÎ‹ ÂÈÎfiÓ·, 2) ·ÚÈıÌËÙÈÎ¿ Ï¿ıË, Î˘Ú›ˆ˜ ÛÙËÓ

ÙÔÔı¤ÙËÛË ‰ÂÎ·‰ÈÎÔ‡ „ËÊ›Ô˘, ÌË‰ÂÓÈÎÒÓ Î·È

ÌÔÓ¿‰ˆÓ Ì¤ÙÚËÛË˜, 3) Ë Û˘ÓÙ·ÁÔÁÚ¿ÊËÛË ·fi

Ó¤Ô˘˜ ¿ÂÈÚÔ˘˜ ÁÈ·ÙÚÔ‡˜, ÔÈ ÔÔ›ÔÈ Û˘ÓÙ·ÁÔ-

ÁÚ·ÊÔ‡Ó ÌÂ ‚¿ÛË ÙËÓ ÂÌÂÈÚ›· ÙÔ˘˜ ·fi ÙÔÓ

ÂÓ‹ÏÈÎÔ ÏËı˘ÛÌfi Î·È 4) Ë Û˘ÓÙ·ÁÔÁÚ¿ÊËÛË

Ê·ÚÌ¿ÎˆÓ Ù· ÔÔ›· ‰ÂÓ ¤¯Ô˘Ó ¿‰ÂÈ· ¯Ú‹ÛË˜

ÛÙÔÓ ·È‰È·ÙÚÈÎfi ÏËı˘ÛÌfi Î·È ˆ˜ ÂÎ ÙÔ‡ÙÔ˘

‰ÂÓ ˘¿Ú¯Ô˘Ó ·È‰È·ÙÚÈÎ¤˜ ‰fiÛÂÈ˜.

°È· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ·˘ÙÔ‡ ÙÔ˘ Ê·ÈÓÔÌ¤-

ÓÔ˘ Û˘ÓÈÛÙ¿Ù·È: 1) Ë Û˘ÓÙ·ÁÔÁÚ¿ÊËÛË Ó· Á›ÓÂ-

Ù·È Ì¤Ûˆ ËÏÂÎÙÚÔÓÈÎÒÓ ˘ÔÏÔÁÈÛÙÒÓ Ô˘ Ó·

ÂÚÈ¤¯Ô˘Ó ÂÓÙÔÏ¤˜ ·ÛÊ·ÏÂ›·˜, 2) Ó· Á›ÓÂÙ·È

¤ÏÂÁ¯Ô˜ ÙˆÓ ‰fiÛÂˆÓ ·fi ÙÔ˘˜ Ê·ÚÌ·ÎÔÔÈÔ‡˜,

3) Ë ÂÎ·›‰Â˘ÛË ÙˆÓ È·ÙÚÒÓ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ

Î·È ÂÈÌÔÚÊˆÙÈÎ¿ ÛÂÌÈÓ¿ÚÈ· Û˘ÓÙ·ÁÔÁÚ¿ÊË-

ÛË˜, 4) Ó· ÂÚÈÁÚ¿ÊÂÙ·È Ë Ì¤ıÔ‰Ô˜ ˘ÔÏÔÁÈ-

ÛÌÔ‡ ÙË˜ ‰fiÛË˜ ÛÙË Û˘ÓÙ·Á‹, 5) fiÛÔÓ ·ÊÔÚ¿ ÙË

¯ÔÚ‹ÁËÛË ÂÓ‰ÔÊÏÂ‚›ˆÓ Ê·ÚÌ¿ÎˆÓ, Ë ¯Ú‹ÛË

ËÏÂÎÙÚÔÓÈÎÒÓ Û˘ÛÎÂ˘ÒÓ ÌÔÚÂ› Ó· ·Ó·ÁÓˆÚ›-

ÛÂÈ Èı·Ófi ÛÊ¿ÏÌ· ÛÙË ‰ÔÛÔÏÔÁ›· ÙÔ˘ Ê·ÚÌ¿-

ÎÔ˘, 6) Ó· ÂÓÈÛ¯˘ıÂ› Ë ·Ó·ÊÔÚ¿ Ï·ıÒÓ ÛÙË Û˘-

ÓÙ·ÁÔÁÚ¿ÊËÛË, ÁÂÁÔÓfi˜ Ô˘ ÌÔÚÂ› Ó· Ô‰ËÁ‹-

ÛÂÈ ÛÙË Ï‹„Ë ÚÔÏËÙÈÎÒÓ Ì¤ÙÚˆÓ Î·È 7) Ó·

‚ÂÏÙÈˆıÂ› Ë ÂÈÎÔÈÓˆÓ›· ÌÂÙ·Í‡ ÙˆÓ ‰È·ÊfiÚˆÓ

ÂÌÏÂÎfiÌÂÓˆÓ Â·ÁÁÂÏÌ·ÙÈÒÓ ˘ÁÂ›·˜.

™˘Û¯¤ÙÈÛË ÙÔ˘ ÔÚfiÙ˘Ô˘ ÙÔ˘

ÓÂ˘ÌÔÓÈfiÎÔÎÎÔ˘ ÌÂ ÙË ÛÔ‚·ÚfiÙËÙ· ÙË˜

ÏÔ›ÌˆÍË˜ Î·È ÙË ı·Ó·ÙËÊfiÚÔ ¤Î‚·ÛË

Simon Ruckinger et al.

Pediatric Infectious Diseases Journal 2009;28:118-122

™ÙÔ ÙÂÏÂ˘Ù·›Ô ÙÂ‡¯Ô˜ ÙÔ˘ Pediatric Infectious

Diseases Journal ‰ËÌÔÛÈÂ‡ÂÙ·È ·Ó·‰ÚÔÌÈÎ‹ ÌÂ-

Ï¤ÙË Ô˘ ¤Ï·‚Â ¯ÒÚ· ÛÙË °ÂÚÌ·Ó›· ÌÂÙ·Í‡ ÙˆÓ

ÂÙÒÓ 1997-2003 Î·È ·ÊÔÚÔ‡ÛÂ ÛÙËÓ Ù·˘ÙÔÔ›Ë-

ÛË ÙÔ˘ ÓÂ˘ÌÔÓÈfiÎÔÎÎÔ˘ ÛÂ ·È‰È¿ Ô˘ ¤ı·-

Ó·Ó ÏfiÁˆ ÙË˜ ÏÔ›ÌˆÍË˜ ‹ ·Ó¤Ù˘Í·Ó ‚·ÚÈ¿ ÏÔ›-

ÌˆÍË (ÛË„·ÈÌ›·, ÌËÓÈÁÁ›ÙÈ‰·) ‹ ÛÔ‚·Ú¤˜ ÌfiÓÈ-

ÌÂ˜ ‚Ï¿‚Â˜. ∞fi ÙÈ˜ 559 ÂÚÈÙÒÛÂÈ˜ fiÔ˘ Ô

ÔÚfiÙ˘Ô˜ Ù·˘ÙÔÔÈ‹ıËÎÂ, 494 ‹Ù·Ó ‰È·ı¤ÛÈÌÂ˜

ÁÈ· ÛÙ·ÙÈÛÙÈÎ‹ ·Ó¿Ï˘ÛË. ∏ Û˘ÓÔÏÈÎ‹ ıÓËÙfiÙËÙ·

‹Ù·Ó 5,3%, ÂÓÒ Ë ‚·ÚÈ¿ ÏÔ›ÌˆÍË ·ÓÂÚ¯fiÙ·Ó ÛÂ

17%. √ ÔÚfiÙ˘Ô˜ 7F Û˘Û¯ÂÙÈ˙fiÙ·Ó ÌÂ ıÓËÙfiÙË-

Ù· ÛÂ ÔÛÔÛÙfi 14,8%, ·ÎÔÏÔ˘ıÔ‡ÌÂÓÔ˜ ·fi ÙÔÓ

23F (8,3%) Î·È ÙÔÓ ÔÚfiÙ˘Ô 3 ÛÂ ÔÛÔÛÙfi 3%.

µ·ÚÈ¿ ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· ·Ó¤Ù˘Í·Ó 17% ÙˆÓ ·È-

‰ÈÒÓ, ÂÎ ÙˆÓ ÔÔ›ˆÓ ÔÛÔÛÙfi 40,7% ÔÊÂÈÏfiÙ·Ó

ÛÙÔÓ ÔÚfiÙ˘Ô 7F.

™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, ÔÈ Û˘ÁÁÚ·ÊÂ›˜ ÛËÌÂÈÒ-

ÓÔ˘Ó fiÙÈ Ë ÌËÓÈÁÁ›ÙÈ‰· ·fi ÙÔÓ ÔÚfiÙ˘Ô 7F Û˘Ó-

‰¤ÂÙ·È ÌÂ ·˘ÍËÌ¤ÓË ıÓËÙfiÙËÙ· ‹ ÂÈÏÔÎ¤˜,

ÂÓÒ ÙÚÈÏ·ÛÈ¿˙ÂÙ·È Ë Èı·ÓfiÙËÙ· ·Ó¿Ù˘ÍË˜

‚·ÚÈ¿˜ ‰ÈÂÈÛ‰˘ÙÈÎ‹˜ ÏÔ›ÌˆÍË˜.

∏ ·Í›· ·˘Ù‹˜ ÙË˜ ÌÂÏ¤ÙË˜ ‚Ú›ÛÎÂÙ·È ÛÙÔ ÁÂ-

ÁÔÓfi˜ fiÙÈ Ô ÔÚfiÙ˘Ô˜ 7F ‰ÂÓ Û˘ÌÂÚÈÏ·Ì‚¿ÓÂ-

Ù·È ÛÙÔ ˘¿Ú¯ÔÓ Û˘˙Â˘ÁÌ¤ÓÔ ÓÂ˘ÌÔÓÈÔÎÔÎÎÈ-

Îfi ÂÌ‚fiÏÈÔ, ÁÈ’ ·˘Ùfi Î·È Ë ·ÚÔ˘Û›· ÙÔ˘ ‹‰Ë

·ÚÔ˘ÛÈ¿˙ÂÈ ·‡ÍËÛË ÛÂ ¯ÒÚÂ˜ fiˆ˜ Ë ∞ÁÁÏ›·,

°·ÏÏ›·, °ÂÚÌ·Ó›· Î·È ∞Ï¿ÛÎ·. ∆· ‰‡Ô Ó¤· ÓÂ˘-

ÌÔÓÈÔÎÔÎÎÈÎ¿ ÂÌ‚fiÏÈ· (10-‰‡Ó·ÌÔ Î·È 13-‰‡Ó·-

ÌÔ) Ô˘ ·Ó·Ì¤ÓÂÙ·È Ó· Î˘ÎÏÔÊÔÚ‹ÛÔ˘Ó ÛÙÔ

ÚÔÛÂ¯¤˜ Ì¤ÏÏÔÓ ı· Û˘ÌÂÚÈÏ·Ì‚¿ÓÔ˘Ó Î·È ÙÔÓ

Û˘ÁÎÂÎÚÈÌ¤ÓÔ ÔÚfiÙ˘Ô.

¡fiÛÔ˜ Kawasaki ÛÙË ª. µÚÂÙ·Ó›·: ÂıÓÈÎfiÙËÙ·,

Û˘Óı‹ÎÂ˜ ‰È·‚›ˆÛË˜ Î·È ·Ó·ÓÂ˘ÛÙÈÎÔ› ÈÔ›

Antony Hardnen et al.

Paediatric Infectious Diseases Journal 2009;28:21-24

™ÙËÓ ·Ó·‰ÚÔÌÈÎ‹ ·˘Ù‹ ÌÂÏ¤ÙË Ô˘ ¤Ï·‚Â Ò-

Ú· ÛÙË ª. µÚÂÙ·Ó›·, ·Ó·˙ËÙ‹ıËÎÂ Ë Èı·Ó‹ Û˘-

Û¯¤ÙÈÛË ÙË˜ ÓfiÛÔ˘ Kawasaki ÌÂ ÙËÓ ÂıÓÈÎfiÙËÙ·

ÙÔ˘ ·ÛıÂÓÔ‡˜, ÙÈ˜ Û˘Óı‹ÎÂ˜ ‰È·‚›ˆÛË˜ Î·È ÙËÓ

ÂÈ‰ËÌÈÔÏÔÁ›· ÙˆÓ ·Ó·ÓÂ˘ÛÙÈÎÒÓ ÈÒÓ. ÃÚËÛÈ-

ÌÔÔÈ‹ıËÎ·Ó ËÏÂÎÙÚÔÓÈÎ¿ ·Ú¯Â›· (Hospital


153PAEDIATRIC NEWS IN BRIEF

¶·È‰È·ÙÚÈÎ‹ 2009;72:153-000

Episode Statistics) Ù· ÔÔ›· ÂÚÈÁÚ¿ÊÔ˘Ó ÙÔ ·›ÙÈÔÂÈÛ·ÁˆÁ‹˜ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô, ‰ËÌÔÁÚ·ÊÈÎ¿ ÛÙÔÈ-¯Â›· ÙÔ˘ ·ÛıÂÓÔ‡˜, ·ÓÙÈÌÂÙÒÈÛË Î·È ·Ú·ÎÏÈÓÈ-Î¤˜ ÂÍÂÙ¿ÛÂÈ˜. ªÂÙ·Í‡ 1998 Î·È 2003 ·ÓÙÈÌÂÙˆ-›ÛÙËÎ·Ó 2.432 ·È‰È¿ ÌÂ ÓfiÛÔ Kawasaki, ÂÎ ÙˆÓÔÔ›ˆÓ 728 ÂÚÈÙÒÛÂÈ˜ ·ÔÙÂÏÔ‡Û·Ó Â·ÓÂÈ-Û·ÁˆÁ‹. ∞fi ÙÈ˜ 1.704 Î·ÈÓÔ‡ÚÁÈÂ˜ ÂÚÈÙÒÛÂÈ˜,ÔÈ 1.228 (72%) ‹Ù·Ó ·È‰È¿ <5 ÂÙÒÓ Î·È ÔÈ 254·È‰È¿ Î¿Ùˆ ÙÔ˘ ¤ÙÔ˘˜. √ ·ÚÈıÌfi˜ ÙˆÓ Î·ÈÓÔ‡-ÚÈˆÓ ÂÚÈÙÒÛÂˆÓ ÛÂ ¤Ó· Ì‹Ó· ÁÈ· Ù· ·È‰È¿ Î¿-Ùˆ ÙˆÓ 5 ÂÙÒÓ Î˘Ì¿ÓıËÎÂ ·fi 8 (™ÂÙ¤Ì‚ÚÈÔ˜2001) ¤ˆ˜ 41 (π·ÓÔ˘¿ÚÈÔ˜ 1999). ∏ ÂÙ‹ÛÈ· Â›-ÙˆÛË ÙË˜ ÓfiÛÔ˘ ‹Ù·Ó 8,39/100.000 ·È‰È¿. ∏ ÎÈ-ÓÂ˙ÈÎ‹ ÂıÓÈÎfiÙËÙ· (P=0,005), Ë ‰È·‚›ˆÛË ÛÂ ÌÂ-Á¿ÏÂ˜ fiÏÂÈ˜ (P=0,001) Î·È Ë ÔÈÎÔÓÔÌÈÎ‹ ·Ó¤¯ÂÈ·(P=0,016) ·ÔÙÂÏÔ‡Û·Ó ÈÛ¯˘ÚÔ‡˜ ÚÔ‰È·ıÂÛÈ-ÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ÙË˜ ÓfiÛÔ˘. ∏

˘„ËÏfiÙÂÚË Â›ÙˆÛË ·Ú·ÙËÚ‹ıËÎÂ ÙÔ˘˜ ¯ÂÈ-ÌÂÚÈÓÔ‡˜ Ì‹ÓÂ˜, ¯ˆÚ›˜ fiÌˆ˜ Î¿ÔÈÔ˜ ·fi ÙÔ˘˜Û˘Ó‹ıÂÈ˜ ÈÔ‡˜ (RSV, adenovirus, influenza) Ó·ÂÌÊ·Ó›˙ÂÙ·È Û˘¯ÓfiÙÂÚ·.

™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, ÔÈ Û˘ÁÁÚ·ÊÂ›˜ ·Ó·Ê¤ÚÔ˘ÓfiÙÈ, fiˆ˜ Â›¯Â ·Ú·ÙËÚËıÂ› Î·È ÛÙËÓ π·ˆÓ›·,Ë ÌÂÙ·Î›ÓËÛË ÛÙÈ˜ ÌÂÁ¿ÏÂ˜ fiÏÂÈ˜ Û˘Ó‰˘¿ÛÙË-ÎÂ ÌÂ ¤Í·ÚÛË ÙË˜ ÓfiÛÔ˘. √È Î·Î¤˜ Û˘Óı‹ÎÂ˜‰È·‚›ˆÛË˜ ·ÔÙÂÏÔ‡Ó ·ÚÓËÙÈÎfi ÚÔÁÓˆÛÙÈÎfi·Ú¿ÁÔÓÙ·, ÂÓÒ Ù· ÓÂÔ‰È·ÁÓˆÛı¤ÓÙ· ·È‰È¿ÂÌÊ·Ó›˙ÔÓÙ·È Î˘Ú›ˆ˜ ÙÔ˘˜ ¯ÂÈÌÂÚÈÓÔ‡˜ Ì‹ÓÂ˜.¶·ÚfiÙÈ ‰È¿ÊÔÚÔÈ ÈÔÁÂÓÂ›˜ ·Ú¿ÁÔÓÙÂ˜ ¤¯Ô˘ÓÂÓÔ¯ÔÔÈËıÂ›, ÔÈ ÂÚÂ˘ÓËÙ¤˜ ‰ÂÓ Î·Ù¿ÊÂÚ·Ó Ó·‚ÚÔ˘Ó Î¿ÔÈ· Û˘Û¯¤ÙÈÛË ÌÂ Û˘ÁÎÂÎÚÈÌ¤ÓÔ˘˜ÈÔ‡˜, ÂÓÈÛ¯‡ÔÓÙ·˜ ÙË ıÂˆÚ›· fiÙÈ Ë ÁÂÓÂÙÈÎ‹ÚÔ‰È¿ıÂÛË ·ÔÙÂÏÂ› ÙÔÓ ÈÛ¯˘ÚfiÙÂÚÔ ÚÔ‰È·-ıÂÛÈÎfi ·Ú¿ÁÔÓÙ·.


154 ∂§§∏¡π∫∞ ∂ƒ∂À¡∞ ™∆∏ ¢π∂£¡∏ µπµ§π√°ƒ∞ºπ∞


∂ÏÏËÓÈÎ‹ ·È‰È·ÙÚÈÎ‹ ¤ÚÂ˘Ó· ÛÂ ‰ÈÂıÓ‹ ÂÚÈÔ‰ÈÎ¿, 2008

∂. °·Ï·Ó¿ÎË˜

Hellenic paediatric research in international journals, 2008

E. Galanakis

¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹,¶·ÓÂÈÛÙ‹ÌÈÔ ∫Ú‹ÙË˜


∂ÌÌ·ÓÔ˘‹Ï °·Ï·Ó¿ÎË˜[email protected]¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹,¶·ÓÂÈÛÙ‹ÌÈÔ ∫Ú‹ÙË˜

Department of Paediatrics,University of Crete,Heraklion, Greece

Correspondence:

Emmanouil [email protected] of Paediatrics,University of Crete,Heraklion, Greece

¶·ÚÔ˘ÛÈ¿˙ÔÓÙ·È, ÔÏ‡ Û˘ÓÔÙÈÎ¿, Ï›ÁÂ˜·fi ÙÈ˜ ÔÏÏ¤˜ ÂÏÏËÓÈÎ¤˜ ÌÂÏ¤ÙÂ˜ ·È‰È·ÙÚÈ-ÎÔ‡ ÂÓ‰È·Ê¤ÚÔÓÙÔ˜ Ô˘ ‰ËÌÔÛÈÂ‡ıËÎ·Ó ÙÔ2008 ÛÂ ‰ÈÂıÓ‹ ÂÚÈÔ‰ÈÎ¿ Î·È Î·Ï‡ÙÔ˘Ó fiÏ·Ù· Â‰›·, ·fi ÙÔ ÂÚÁ·ÛÙËÚÈ·Îfi ˆ˜ ÙÔ ÎÏÈÓÈÎfiÎ·È ÙÔ ÎÔÈÓˆÓÈÎfi, Î·È fiÏÂ˜ ÙÈ˜ ËÏÈÎ›Â˜, ·fi ÙÔÓÂÔÁÓfi Î·È ÙÔ ‚Ú¤ÊÔ˜ ˆ˜ ÙÔ ·È‰› Î·È ÙÔÓ ¤ÊË-‚Ô. ªÂÏ¤ÙÂ˜ Ô˘ Â›¯·Ó ‰ËÌÔÛÈÂ˘ıÂ› ÙÔ˘˜ ÔÏ‡ÚÒÙÔ˘˜ Ì‹ÓÂ˜ ÙÔ˘ 2008 ¤¯Ô˘Ó ·ÚÔ˘ÛÈ·ÛıÂ›ÛÙËÓ ¶∞π¢π∞∆ƒπ∫∏ 2008;71(3):248-250.

¡ÂÊÚÈÎ‹ ·Ó¿Ù˘ÍË ÛÙ· ÌÈÎÚ¿ ÓÂÔÁÓ¿.

¶ÚÔÔÙÈÎ‹ ÌÂÏ¤ÙË ·fi Ù· πˆ¿ÓÓÈÓ· (Drougiaet al., Nephrol Dial Transplant, Epub 2008 Aug4) ·Ú·ÎÔÏÔ‡ıËÛÂ ˘ÂÚË¯ÔÁÚ·ÊÈÎ¿ ÙËÓ ·Ó¿-Ù˘ÍË ÙˆÓ ÓÂÊÚÒÓ ÛÂ 243 ÌÈÎÚ¿ ÁÈ· ÙËÓ ËÏÈ-Î›· Î‡ËÛË˜ ÓÂÔÁÓ¿ (SGA) Î·È 223 ÓÂÔÁÓ¿ ÌÂÎ·Ù¿ÏÏËÏÔ ‚¿ÚÔ˜ ÁÈ· ÙËÓ ËÏÈÎ›· Î‡ËÛË˜(AGA). ∏ ·Ú·ÎÔÏÔ‡ıËÛË ¤ÁÈÓÂ 5 ÊÔÚ¤˜ ÛÙ·2 ÚÒÙ· ¤ÙË ˙ˆ‹˜ (Û‡ÓÔÏÔ 1898 ˘ÂÚË¯ÔÁÚ·-ÊËÌ¿ÙˆÓ). ™Ù· ÙÂÏÂÈfiÌËÓ· SGA ÓÂÔÁÓ¿, Ë ÓÂ-ÊÚÈÎ‹ ·Ó¿Ù˘ÍË ‹Ù·Ó fiÌÔÈ· ÌÂ ÂÎÂ›ÓË ÙˆÓAGA, ˆÛÙfiÛÔ ÛÙ· ÌÈÎÚ¿ ÚfiˆÚ· ÓÂÔÁÓ¿, ÙÔÌ¤ÁÂıÔ˜ ÙˆÓ ÓÂÊÚÒÓ ·Ú¤ÌÂÓÂ ÌÈÎÚfiÙÂÚÔ·fi ÂÎÂ›ÓÔ ÙˆÓ AGA ÓÂÔÁÓÒÓ ÁÈ· Ù· ‰‡Ô ÚÒ-Ù· ¤ÙË ÙË˜ ˙ˆ‹˜.

°ÂÓÂÙÈÎ‹ ÚÔ‰È¿ıÂÛË ÛÙË Ì¤ÛË ˆÙ›ÙÈ‰·.

ªÂÏ¤ÙË ·fi ÙÔ ∏Ú¿ÎÏÂÈÔ (Ilia S et al., PediatrInfect Dis J 2008;27:929-33) ·Ó·ÛÎÔÂ› Ù· ¤ˆ˜ÙÒÚ· ÁÓˆÛÙ¿ ÁÈ· ÙËÓ ·¿ÓÙËÛË ÙÔ˘ ÍÂÓÈÛÙ‹ Î·ÈÙË ÁÂÓÂÙÈÎ‹ Â˘¿ıÂÈ· ÛÙËÓ ˆÙ›ÙÈ‰·. ∫·Ù·ÁÚ¿-ÊÂÙ·È ÌÈ· ÌÂÁ¿ÏË ÔÈÎÈÏ›· ·Ú·ÁfiÓÙˆÓ ÙË˜ ÂÁ-ÁÂÓÔ‡˜ Î·È ÚÔÛ·ÚÌfiÛÈÌË˜ ·ÓÔÛ›·˜ Ô˘ ÚÔ-‰È·ı¤ÙÔ˘Ó Î¿ÔÈ· ‚Ú¤ÊË Î·È ·È‰È¿ ÛÂ ÔÏÏ¤˜‹ ÛÂ ÛÔ‚·Ú¤˜ ˆÙ›ÙÈ‰Â˜.

º˘Ì·Ù›ˆÛË ‚Ú¤ÊÔ˘˜ ÌÂÙ¿ ÂÚÈÙÔÌ‹. ¶Â-ÚÈÁÚ·Ê‹ ÚˆÙÔ·ıÔ‡˜ Ê˘Ì·Ù›ˆÛË˜ ¤Ô˘˜ ÌÂÛ˘ÓÔ‰fi ‚Ô˘‚ˆÓÈÎ‹ ÏÂÌÊ·‰ÂÓ›ÙÈ‰· ÛÂ ˘ÁÈ¤˜ Î·-Ù¿ Ù· ¿ÏÏ· ·ÁfiÚÈ, ËÏÈÎ›·˜ 10 ÌËÓÒÓ, Ô˘ Â›¯ÂÂÚÈÙÌËıÂ› ÛÙÔ ¶·ÎÈÛÙ¿Ó ÚÔ 4Ì‹ÓÔ˘ (¡ÔÛÔ-

ÎÔÌÂ›Ô ¶·›‰ˆÓ ∞ıËÓÒÓ «∞ÁÏ·˝· ∫˘ÚÈ·ÎÔ‡»,Papaevangelou V et al., J Infect Epub 2008 Dec18). ∏ ÂÈ‚Â‚·›ˆÛË ¤ÁÈÓÂ ÌÂ ÔÍÂÔ¿ÓÙÔ¯Ë ¯ÚÒ-ÛË, Î·ÏÏÈ¤ÚÁÂÈ· Î·È PCR.

µÚÔ˘Î¤ÏÏˆÛË ÛÂ ÌÈÎÚfi ‚Ú¤ÊÔ˜. ¶ÂÚÈÁÚ·-Ê‹ ÎÚÔ‡ÛÌ·ÙÔ˜ ‚ÚÔ˘Î¤ÏÏ·˜ ÛÂ ‚Ú¤ÊÔ˜ 2,5 ÌË-ÓÒÓ ·fi ÙËÓ ◊ÂÈÚÔ (Makis AC et al., EmergInfect Dis 2008;141:319-20). ∆Ô ‚Ú¤ÊÔ˜ ‰ÂÓ Â›¯ÂÂ·Ê‹ ÌÂ ˙Ò·, ‰ÂÓ ı‹Ï·˙Â Î·È Ë ÌËÙ¤Ú· ÙÔ˘‰ÂÓ Â›¯Â ‚ÚÔ˘Î¤ÏÏˆÛË, ¿Ú· ·Ú·Ì¤ÓÂÈ ·ÓÔÈÎÙfiÙÔ ı¤Ì· ÙË˜ ÌÂÙ¿‰ÔÛË˜ ·fi ÌÔÏ˘ÛÌ¤Ó· ·ÓÙÈ-ÎÂ›ÌÂÓ·, Î¿ÙÈ ·Û˘Ó‹ıÈÛÙÔ ÁÈ· ÙË ÓfiÛÔ.

∞ÓıÂÎÙÈÎÔ› ÛÙ·Ê˘ÏfiÎÔÎÎÔÈ ÛÙËÓ ∞ı‹Ó·.

ªÂÏ¤ÙË 198 ÛÙÂÏÂ¯ÒÓ ÛÙ·Ê˘ÏÔÎfiÎÎˆÓ ·fi·È‰È¿ ÌÂ ÏÔÈÌÒÍÂÈ˜ ÙË˜ ÎÔÈÓfiÙËÙ·˜ (¡ÔÛÔÎÔ-ÌÂ›Ô ¶·›‰ˆÓ ∞ıËÓÒÓ «∞ÁÏ·˝· ∫˘ÚÈ·ÎÔ‡»,Niniou T et al., Eur J Clin Microbiol Infect Dis2008;27:831-7): 44% MRSA ·ÓÙÔ¯‹ (ÛÙË ÌÂıÈ-ÎÈÏÏ›ÓË).

∞ÓıÂÎÙÈÎÔ› ÛÙ·Ê˘ÏfiÎÔÎÎÔÈ ÛÙËÓ ¶¿ÙÚ·.

∞Ó¿ÏÔÁË ÌÂÏ¤ÙË ·fi ÙÔ ∫·Ú·Ì·Ó‰¿ÓÂÈÔ ¡ÔÛÔ-ÎÔÌÂ›Ô ¶·›‰ˆÓ ¶·ÙÚÒÓ (170 ·ÛıÂÓÂ›˜ ÌÂ ÏÔ›-ÌˆÍË ·fi S. aureus Î·È ˘ÁÈ‹ ·È‰È¿ ÌÂ ÚÈÓÈÎ‹ÊÔÚÂ›· S. aureus, Sdougkos G et al., ClinMicrobiol Infect 2008;14:995-1001): 62% MRSA·ÓÙÔ¯‹ ÁÈ· Ù· ÛÙÂÏ¤¯Ë ÙˆÓ ·ÛıÂÓÒÓ Î·È 5,5%MRSA ·ÓÙÔ¯‹ ÁÈ· Ù· ÚÈÓÈÎ¿ ÛÙÂÏ¤¯Ë ÙˆÓ ˘ÁÈÒÓ·È‰ÈÒÓ.

¶ÓÂ˘ÌÔÓÈfiÎÔÎÎÔ˜: ·ÓÙÔ¯‹. ªÂÏ¤ÙË 612ÛÙÂÏÂ¯ÒÓ Streptococcus pneumoniae, ‰ÈÂÈÛ‰˘ÙÈ-ÎÒÓ Î·È ÌË, ÚÈÓ ÙËÓ Â˘ÚÂ›· ÂÊ·ÚÌÔÁ‹ ÙÔ˘ÓÂ˘ÌÔÓÈÔÎÔÎÎÈÎÔ‡ ÂÌ‚ÔÏ›Ô˘ (¡ÔÛÔÎÔÌÂ›Ô¶·›‰ˆÓ ∞ıËÓÒÓ «∞Á›· ™ÔÊ›·», Daikos GL et al.,Diagn Microbiol Infect Dis 2008;60:393-8) ¤‰ÂÈÍÂ·‡ÍËÛË ÙË˜ ·ÓÙÔ¯‹˜ ÛÙ· Ì·ÎÚÔÏ›‰È· (·fi 7,4%ÙÔ 1985-1996 ÛÂ 53,7% ÙÔ 2001-2004), ·Ú¿Ï-ÏËÏË ÌÂ ÙËÓ ·‡ÍËÛË ÙË˜ Î·Ù·Ó¿ÏˆÛË˜ Ì·ÎÚÔ-ÏÈ‰›ˆÓ Î·È ÏÈÓÎÔ˙·ÌÈ‰ÒÓ ÛÙËÓ ÎÔÈÓfiÙËÙ· (·fi


155HELLENIC RESEARCH IN THE INTERNATIONAL LITERATURE

¶·È‰È·ÙÚÈÎ‹ 2009;72:155-000

4,31 DI ‰fiÛÂÈ˜ ÙÔ 1990-1996 ÛÂ 6,97 DI ‰fiÛÂÈ˜ ÙÔ2001-2004).

¶ÓÂ˘ÌÔÓÈfiÎÔÎÎÔ˜: ÌÂÙ¿ ÙÔ ÂÌ‚fiÏÈÔ. ªÂÏ¤ÙË·fi ÙË §¿ÚÈÛ· ÛÂ 1829 Ó‹È· (Grivea IN et al.,Pediatr Infect Dis J 2008;27:519-25) ¤‰ÂÈÍÂ ÌÂ›ˆÛËÙË˜ ÚÈÓÔÊ·Ú˘ÁÁÈÎ‹˜ ÊÔÚÂ›·˜ ÙˆÓ ÔÚÔÙ‡ˆÓ ÙÔ˘ ÂÌ-‚ÔÏ›Ô˘ ÌÂÙ¿ ÙÔ ÂÙ·‰‡Ó·ÌÔ Û˘˙Â˘ÁÌ¤ÓÔ ÂÌ‚fiÏÈÔ,¯ˆÚ›˜ ·‡ÍËÛË ÙË˜ ÊÔÚÂ›·˜ ÙÔ˘ ÔÚfiÙ˘Ô˘ 19∞. ™Ù·ÂÌ‚ÔÏÈ·ÛÌ¤Ó· ·È‰È¿ ·Ú·ÙËÚ‹ıËÎÂ ÌÂ›ˆÛË ÙË˜Û˘¯ÓfiÙËÙ·˜ ÛÙÂÏÂ¯ÒÓ ˘„ËÏ‹˜ ·ÓÙÔ¯‹˜ ÛÙËÓ ÂÓÈ-ÎÈÏÏ›ÓË.

£ÂÚ·Â›· Ì˘ÎËÙÈ·ÛÈÎÒÓ ÏÔÈÌÒÍÂˆÓ. ªÂÏ¤ÙË·fi ÙÔ πÔÎÚ¿ÙÂÈÔ ¡ÔÛÔÎÔÌÂ›Ô £ÂÛÛ·ÏÔÓ›ÎË˜(Filioti I et al., Expert Opin Pharmacother2008;9:3179-96) ·Ó·ÛÎÔÂ› ÙÈ˜ ıÂÚ·Â˘ÙÈÎ¤˜ ÛÙÚ·-ÙËÁÈÎ¤˜ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ‰ÈÂÈÛ‰˘ÙÈÎÒÓ ÏÔÈ-ÌÒÍÂˆÓ ·fi ∫¿ÓÙÈÓÙ· Î·È ∞Û¤ÚÁÈÏÏÔ ÛÂ ÓÂÔÁÓ¿ Î·È·È‰È¿, ÌÂ ¤ÌÊ·ÛË ÛÙ· ÓÂfiÙÂÚ· ·Ú¿ÁˆÁ·.

§Â˘¯·ÈÌ›Â˜ Î·È ÏÂÌÊÒÌ·Ù· ÛÙËÓ ∂ÏÏ¿‰·. ¶·-ÓÂÏÏ‹ÓÈ· ÌÂÏ¤ÙË 11ÂÙ›·˜ (1996-2006) Î·Ù¤ÁÚ·„Â(Petridou ET et al., Arch Dis Child 2008;93:1027-32)863 ÂÚÈÙÒÛÂÈ˜ ÏÂ˘¯·ÈÌ›·˜ Î·È 311 ÏÂÌÊÒÌ·ÙÔ˜ ÛÂ·È‰È¿ Î¿Ùˆ ÙˆÓ 15 ÂÙÒÓ. ∏ Â›ÙˆÛË ÙË˜ ÏÂ˘¯·È-Ì›·˜ (46,6 ÂÚÈÙÒÛÂÈ˜ ·Ó¿ 1.000.000 ·È‰È¿ ·Ó¿

¤ÙÔ˜) ‹Ù·Ó ·Ó¿ÌÂÛ· ÛÙÈ˜ ˘„ËÏfiÙÂÚÂ˜ ÙË˜ ∂˘Úˆ·˚-Î‹˜ ŒÓˆÛË˜ (19% ˘„ËÏfiÙÂÚË ·fi ÙË Ì¤ÛË Â˘Úˆ-·˚Î‹). ∏ Â›ÙˆÛË ÏÂÌÊÒÌ·ÙÔ˜ (16,8 ÂÚÈÙÒÛÂÈ˜·Ó¿ 1.000.000 ·È‰È¿ ·Ó¿ ¤ÙÔ˜) ‰ÂÓ ‰È¤ÊÂÚÂ ·fi ÙËÌ¤ÛË Â˘Úˆ·˚Î‹.

§ÈıÔÙÚÈ„›· ÛÙ· ·È‰È¿. ¶·ÚÔ˘Û›·ÛË ÙË˜10ÂÙÔ‡˜ ÂÌÂÈÚ›·˜ ÂÓfi˜ Î¤ÓÙÚÔ˘ ÛÙËÓ ·ÓÙÈÌÂÙÒÈ-ÛË ÙË˜ Ô˘ÚÔÏÈı›·ÛË˜ ÛÂ 125 ·È‰È¿ (πÔÎÚ¿ÙÂÈÔ¡ÔÛÔÎÔÌÂ›Ô £ÂÛÛ·ÏÔÓ›ÎË˜, Charalambous S et al., JEndourol 2008;22:2169-74): ÛÂ 93 ·È‰È¿ ¤ÁÈÓÂ ÏÈıÔ-ÙÚÈ„›· ÌÂ ˆÛÙÈÎ¿ Î‡Ì·Ù· ˘ÂÚ‹¯ˆÓ (Û‡ÓÔÏÔ 108Û˘ÓÂ‰ÚÈÒÓ), ÛÂ 12 Ô˘ÚËÙËÚÔÛÎfiËÛË Î·È ‰ÈÔ˘ÚË-ÙËÚÈÎ‹ ·Ê·›ÚÂÛË, ÛÂ 9 ‰È·‰ÂÚÌ·ÙÈÎ‹ ÓÂÊÚÔÏÈıÔÙÔ-Ì›· Î·È ÛÂ 11 ¯ÚÂÈ¿ÛÙËÎÂ ·ÓÔÈÎÙfi ¯ÂÈÚÔ˘ÚÁÂ›Ô. ™‡Ì-ÊˆÓ· ÌÂ ÙË ÌÂÏ¤ÙË, Ë ÏÈıÔÙÚÈ„›· Î·È ÔÈ ÂÓ‰ÔÔ˘ÚË-ÙËÚÈÎ¤˜ ÙÂ¯ÓÈÎ¤˜ Â›Ó·È ·ÛÊ·ÏÂ›˜ Î·È ·ÔÙÂÏÂÛÌ·ÙÈ-Î¤˜ ÛÙ· ·È‰È¿.

∆Ô ‡„Ô˜ ÙˆÓ Ó¤ˆÓ ∂ÏÏ‹ÓˆÓ. ªÂÏ¤ÙË (∞ÙÙÈÎfi¡ÔÛÔÎÔÌÂ›Ô, Papadimitriou ∞ et al., Acta Paediatr2008;97:1105-7) ÛÂ 3.982 ÓÂÔÛ‡ÏÏÂÎÙÔ˘˜ ËÏÈÎ›·˜ 18-26 ÂÙÒÓ (2006-2007) ¤‰ÂÈÍÂ Ì¤ÛÔ ‡„Ô˜ ÛÒÌ·ÙÔ˜ Ù·178,1 cm. ∞ÓÙ›ÛÙÔÈ¯Ë ÌÂÏ¤ÙË ÙÔ˘ 1990 Â›¯Â Î·Ù·ÁÚ¿-„ÂÈ Ì¤ÛÔ ‡„Ô˜ 175,7. º·›ÓÂÙ·È, Û˘ÓÂÒ˜, fiÙÈ Ô ·Ó-‰ÚÈÎfi˜ ÏËı˘ÛÌfi˜ ÙË˜ ∂ÏÏ¿‰·˜ ‰ÂÓ ¤¯ÂÈ ·ÎfiÌË ÂÍ·-ÓÙÏ‹ÛÂÈ Ù· ÂÚÈıÒÚÈ· ·‡ÍËÛË˜ ÛÂ ‡„Ô˜.


πÛÙÔÛÂÏ›‰· ÙË˜ µ’ ¶·È‰È·ÙÚÈÎ‹˜ ∫ÏÈÓÈÎ‹˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘

∞ıËÓÒÓ – http://www.2pediatric.gr/

™. ∫Â¯·ÁÈ¿˜, ¢. ∞Ó·ÁÓÒÛÙÔ˘

Site of the 2nd Department of Paediatrics of the

University of Athens – http://www.2pediatric.gr/

S. Kehagias, D. Anagnostou

√ ‰È·‰ÈÎÙ˘·Îfi˜ ÙfiÔ˜ ÙË˜ µã ¶·È‰È·ÙÚÈÎ‹˜ ∫ÏÈÓÈÎ‹˜ ÙÔ˘¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, Ô˘ Â‰Ú¿˙ÂÙ·È ÛÙÔ ¡ÔÛÔÎÔÌÂ›Ô¶·›‰ˆÓ «¶. & ∞. ∫˘ÚÈ·ÎÔ‡», ÏÂÈÙÔ˘ÚÁÂ› Î·È ·Ó·ÌÔÚÊÒÓÂÙ·ÈÛ˘ÓÂ¯Ò˜ Â‰Ò Î·È ‰‡Ô ¯ÚfiÓÈ·. ™Ùfi¯Ô˜ ÙÔ˘ Â›Ó·È Ó· Ê¤ÚÂÈ ÛÂÂ·Ê‹ ÌÂ ÙÔÓ ÒÚÔ ÙË˜ ∫ÏÈÓÈÎ‹˜ fiÏÔ˘˜ fiÛÔ˘˜ ı· ıÂÏ‹ÛÔ˘Ó Ó·¯ÚËÛÈÌÔÔÈ‹ÛÔ˘Ó ÙÈ˜ È·ÙÚÈÎ¤˜, ‰È‰·ÎÙÈÎ¤˜ Î·È ÂÚÂ˘ÓËÙÈÎ¤˜ÙË˜ ‰Ú·ÛÙËÚÈfiÙËÙÂ˜. ™ÙÈ˜ ÛÂÏ›‰Â˜ ÙÔ˘ ˘¿Ú¯Ô˘Ó ÏËÚÔÊÔ-Ú›Â˜ Ô˘ ı· ‰ÈÂ˘ÎÔÏ‡ÓÔ˘Ó ÙËÓ ÚfiÛ‚·ÛË ÛÙÈ˜ ÂÍÂÈ‰ÈÎÂ˘Ì¤ÓÂ˜˘ËÚÂÛ›Â˜ Ô˘ ·Ú¤¯Ô˘Ó Ù· ÙÌ‹Ì·Ù· ÙË˜ ∫ÏÈÓÈÎ‹˜ Î·È Ù· ÂÈ-‰ÈÎ¿ ÂÍˆÙÂÚÈÎ¿ È·ÙÚÂ›·.

™ÙËÓ ·Ú¯ÈÎ‹ ÛÂÏ›‰·, ÂÎÙfi˜ ·fi ÙËÓ Ù·¯˘‰ÚÔÌÈÎ‹ ‰ÈÂ‡ı˘Ó-ÛË ÙË˜ ÎÏÈÓÈÎ‹˜ Î·È Ù· ÙËÏ¤ÊˆÓ· ÙˆÓ ÓÔÛËÏÂ˘ÙÈÎÒÓ ÌÔÓ¿‰ˆÓ,˘¿Ú¯Ô˘Ó ·Ó·ÚÙËÌ¤ÓÂ˜ Î·È ÔÈ ·Ó·ÎÔÈÓÒÛÂÈ˜ ÙˆÓ Û˘ÓÂ‰Ú›ˆÓ,ÙˆÓ ÛÂÌÈÓ·Ú›ˆÓ, ·ÏÏ¿ Î·È ÙˆÓ ÌÂÙÂÎ·È‰Â˘ÙÈÎÒÓ ÊÚÔÓÙÈÛÙË-

Ú›ˆÓ Ô˘ ÔÚÁ·ÓÒÓÂÈ Ë ∫ÏÈÓÈÎ‹ ÛÙÔ ·ÌÊÈı¤·ÙÚÔ «∫. ¶··‰¿ÙÔ˜» ÙÔ˘ ÓÔÛÔÎÔÌÂ›Ô˘ Ì·˜. ™ÙËÓ ·Ú¯ÈÎ‹ ÛÂÏ›‰· Â›ÛË˜, ÛÙÔ˘˜ «ÃÚ‹ÛÈÌÔ˘˜ ™˘Ó‰¤ÛÌÔ˘˜», ¿Ú¯Ô˘Ó ÈÛÙfiÙÔÔÈ Ô˘ ÚÔÛÊ¤ÚÔ˘Ó

Â˘Î·ÈÚ›Â˜ ÂÓËÌ¤ÚˆÛË˜ ÁÈ· ÙË Û˘ÓÂ¯Ò˜ ÂÍÂÏÈÛÛfiÌÂÓË ÁÓÒÛË Û¯ÂÙÈÎ¿ ÌÂ ÙÔ ·È‰› Î·È ÙËÓ ˘ÁÂ›· ÙÔ˘, ·Ï-Ï¿ Î·È ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙË˜, fiˆ˜ Ê·›ÓÂÙ·È ÛÙÔÓ ÈÛÙfiÙÔÔ ÙÔ˘ ∫¤ÓÙÚÔ˘ ÙË˜ π·ÙÚÈÎ‹˜ Ô˘ µ·Û›˙ÂÙ·È ÛÂª·ÚÙ˘Ú›Â˜ (Center for Evidence Based Medicine). ™ÙËÓ ›‰È· ÛÂÏ›‰·, ·ÎÔÏÔ˘ıÂ› Ô ¯ÒÚÔ˜ fiÔ˘ ÌÔÚÂ› Ó·Á›ÓÂÈ Ë ËÏÂÎÙÚÔÓÈÎ‹ ÂÁÁÚ·Ê‹ ÛÙÔ newsletter ÙË˜ ∫ÏÈÓÈÎ‹˜.

∏ ÛÂÏ›‰· «¶ÚÔÛˆÈÎfi» ·Ú¤¯ÂÈ ÛÙÔÈ¯Â›· ÁÈ· ÙÔ ·ÓıÚÒÈ-ÓÔ ‰˘Ó·ÌÈÎfi Î·È ÙË ÛÙÂÏ¤¯ˆÛË ÙË˜ ∫ÏÈÓÈÎ‹˜. ∏ ÛÂÏ›‰· «∆Ì‹-Ì·Ù·» ‰Â›¯ÓÂÈ ÙÈ˜ ÎÏÈÓÈÎ¤˜ ‰˘Ó·ÙfiÙËÙÂ˜ ÙË˜ ∫ÏÈÓÈÎ‹˜. ∞Ó·Ê¤-ÚÔÓÙ·È, ÂÎÙfi˜ ÙˆÓ ‚·ÛÈÎÒÓ ÓÔÛËÏÂ˘ÙÈÎÒÓ ÌÔÓ¿‰ˆÓ, Ù· ÙÌ‹-Ì·Ù· Î·È Ù· ÂÈ‰ÈÎ¿ ÂÍˆÙÂÚÈÎ¿ È·ÙÚÂ›· ÁÈ· ÙÈ˜ ˘ÔÂÈ‰ÈÎfiÙËÙÂ˜ÙË˜ ·È‰È·ÙÚÈÎ‹˜. ™ÙËÓ ›‰È· ÛÂÏ›‰· Â›ÛË˜, ·Ú¤¯ÔÓÙ·È ÏË-ÚÔÊÔÚ›Â˜ ÁÈ· Ù· ˆÚ¿ÚÈ· ÏÂÈÙÔ˘ÚÁ›·˜, ·ÏÏ¿ Î·È ÙÈ˜ ‰Ú·ÛÙËÚÈfi-ÙËÙÂ˜ ÙˆÓ ÙÌËÌ¿ÙˆÓ Î·È ÙˆÓ ÂÍˆÙÂÚÈÎÒÓ È·ÙÚÂ›ˆÓ.

∞ÎÔÏÔ˘ıÂ› Ë ÛÂÏ›‰· «∂Î·›‰Â˘ÛË», Ô˘ ÂÚÈÁÚ¿ÊÂÈ ÙÔ ÂÎ-·È‰Â˘ÙÈÎfi ¤ÚÁÔ ÙË˜ µã ¶·È‰È·ÙÚÈÎ‹˜ ∫ÏÈÓÈÎ‹˜ ÙÔ˘ ¶·ÓÂÈÛÙË-Ì›Ô˘ ∞ıËÓÒÓ. ™ÙËÓ ›‰È· ÛÂÏ›‰· ·ÎÔÏÔ˘ıÔ‡Ó ·ÓÙ›ÛÙÔÈ¯ÔÈ ÈÛÙfiÙÔ-ÔÈ, ÌÂ ÏËÚÔÊÔÚ›Â˜ Û¯ÂÙÈÎ¤˜ ÌÂ ÙÈ˜ ÂÎ¿ÛÙÔÙÂ ‰Ú·ÛÙËÚÈfiÙËÙÂ˜.

∆Ô ÂÚÂ˘ÓËÙÈÎfi ¤ÚÁÔ ÙË˜ ∫ÏÈÓÈÎ‹˜ ÂÚÈÁÚ¿ÊÂÙ·È ÛÙË ÛÂÏ›‰· «ŒÚÂ˘Ó·». ∏ ÂÚÂ˘ÓËÙÈÎ‹ ‰Ú·ÛÙËÚÈfi-ÙËÙ· Ô˘ ‚Ú›ÛÎÂÙ·È ÛÂ ÂÍ¤ÏÈÍË ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ÂÎfiÓËÛË ‰È‰·ÎÙÔÚÈÎÒÓ ‰È·ÙÚÈ‚ÒÓ, ÔÏ˘ÎÂÓÙÚÈÎÒÓÌÂÏÂÙÒÓ, ÂÈ‰ËÌÈÔÏÔÁÈÎÒÓ ÌÂÏÂÙÒÓ, ÎÏÈÓÈÎÔÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÌÂÏÂÙÒÓ, ÌÂÏÂÙÒÓ ÎÏÈÓÈÎ‹˜ ·Ú·Ù‹ÚË-ÛË˜, ·ÏÏ¿ Î·È ‰È·¯ÚÔÓÈÎ¤˜ ÌÂÏ¤ÙÂ˜ Î·Ù·ÁÚ·Ê‹˜ ÓÔÛËÌ¿ÙˆÓ.

∆¤ÏÔ˜, ÛÙÔ Â‰›Ô «∞Ó·˙‹ÙËÛË», Ô ÈÛÙfiÙÔÔ˜ ÚÔÛÊ¤ÚÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· ıÂÌ·ÙÈÎ‹˜ ·Ó·˙‹ÙËÛË˜ÙˆÓ ÂÚÈÂ¯ÔÌ¤ÓˆÓ ÙÔ˘, ÌÂ ¯Ú‹ÛË Ï¤ÍÂˆÓ-ÎÏÂÈ‰ÈÒÓ.

156 ¡∂∞ ∞¶√ ∆√ ¢π∞¢π∫∆À√ NEWS FROM THE INTERNET

Paediatriki 2009;72:156

¡ÂÔÁÓÈÎfi ∆Ì‹Ì·, µ’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ,¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ «¶. & ∞. ∫˘ÚÈ·ÎÔ‡», ∞ı‹Ó·


™Ù¤Ê·ÓÔ˜ ∫Â¯·ÁÈ¿˜[email protected]¡ÂÔÁÓÈÎfi ∆Ì‹Ì·, µ’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ,¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ «¶. & ∞. ∫˘ÚÈ·ÎÔ‡», ∞ı‹Ó·

Neonatology Unit, 2nd Department of Paediatrics,University of Athens, “P. & A. Kyriakou” Children’sHospital, Athens, Greece

Correspondence:

Stefanos [email protected] Unit, 2nd Department of Paediatrics,University of Athens, “P. & A. Kyriakou” Children’sHospital, Athens, Greece


157∫§π¡π∫√ ∫√Àπ∑ CLINICAL QUIZ

¶·È‰È·ÙÚÈÎ‹ 2009;72:66,71-73

√È ÚÒÙÂ˜ ÂÚÈÁÚ·Ê¤˜ ÙË˜ Û¯·ÏÈ‰ˆÙÈÎ‹˜ÔÛÙÂÔ¯ÔÓ‰Ú›ÙÈ‰·˜ ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›·Î¿ÓÔ˘Ó ÙËÓ ÂÌÊ¿ÓÈÛ‹ ÙÔ˘˜ ‹‰Ë ·fi Ù· Ù¤ÏËÙÔ˘ 19Ô˘ ·ÈÒÓ·, ·ÏÏ¿ ÌfiÏÈ˜ ÙÔ 1959 ÔÈ BerndtÎ·È Harty (1) ÚÔ‚·›ÓÔ˘Ó ÛÙËÓ ÚÒÙË Ù·ÍÈÓfi-ÌËÛË. ∏ ÓfiÛÔ˜ ÚÔÛ‚¿ÏÏÂÈ Û˘Ó‹ıˆ˜ ÙÔ˘˜ ÌË-ÚÈ·›Ô˘˜ ÎÔÓ‰‡ÏÔ˘˜ Î·È Û·ÓÈfiÙÂÚ· ÙÔÓ ÎfiÓ‰˘-ÏÔ ÙÔ˘ ‚Ú·¯ÈfiÓÈÔ˘ ÔÛÙÔ‡. ∏ ÂÓÙfiÈÛ‹ ÙË˜ÛÙÔÓ ıfiÏÔ ÙÔ˘ ·ÛÙÚ·Á¿ÏÔ˘ ıÂˆÚÂ›Ù·È È‰È·›ÙÂ-Ú· Û¿ÓÈ· (4% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ÔÛÙÂÔ¯fiÓ‰ÚÈ-ÓˆÓ ‚Ï·‚ÒÓ ÙÔ˘ ÛÎÂÏÂÙÔ‡). ∏ ÈÛ¯·ÈÌÈÎ‹ Ó¤-ÎÚˆÛË ÙÔ˘ ˘ÔÎÂ›ÌÂÓÔ˘ ˘Ô¯fiÓ‰ÚÈÔ˘ ÔÛÙÔ‡Ê·›ÓÂÙ·È ˆ˜ ·ÈÙÈÔÏÔÁÂ› ¿ÚÈÛÙ· ÙËÓ ·ÔÎfiÏ-ÏËÛË ÙÔ˘ ÔÛÙÈÎÔ‡ ÙÂÌ·¯›Ô˘, Ì·˙› ÌÂ ÙÔÓ ˘ÂÚ-ÎÂ›ÌÂÓÔ ·ÚıÚÈÎfi ¯fiÓ‰ÚÔ.

πÛÙÔÚÈÎfi Î¿ÎˆÛË˜ ·Ó·Ê¤ÚÂÙ·È ÛÂ ¤Ó· Ô-ÛÔÛÙfi 85% ÙˆÓ ·ÛıÂÓÒÓ ÌÂ ÔÛÙÂÔ¯fiÓ‰ÚÈÓË‚Ï¿‚Ë ÛÙÔÓ ·ÛÙÚ¿Á·ÏÔ. ∂È‰ÈÎ¿, ÔÈ ‚Ï¿‚Â˜ ÛÙÔÔ›ÛıÈÔ-¤Ûˆ ÙÌ‹Ì· ÙÔ˘ ıfiÏÔ˘ ÙÔ˘ ·ÛÙÚ·Á¿-ÏÔ˘ Â›Ó·È ÙÔ ·ÔÙ¤ÏÂÛÌ· Â·Ó·Ï·Ì‚·ÓfiÌÂ-ÓÔ˘ ‚›·ÈÔ˘ ˘ÙÈ·ÛÌÔ‡ ÙÔ˘ ¿ÎÚÔ˘ Ô‰fi˜, Ì·˙›ÌÂ ÂÏÌ·ÙÈ·›· Î¿Ì„Ë Î·È ÂÍˆÙÂÚÈÎ‹ ÛÙÚÔÊ‹ÙÔ˘ ÔÛÙÔ‡ Ì¤Û· ÛÙËÓ Ô‰ÔÎÓËÌÈÎ‹. ∏ ‚Ï¿‚ËÌÔÚÂ› Ó· ÚÔÎÏËıÂ› ¯ˆÚ›˜ ··Ú·›ÙËÙ· Û˘-Ó˘¿Ú¯Ô˘Û· Ú‹ÍË ÙÔ˘ ¤Íˆ Ï·Á›Ô˘ Û˘Ó‰¤-ÛÌÔ˘, ÁÂÁÔÓfi˜ Ô˘ ‰ÈÎ·ÈÔÏÔÁÂ› ÙÔ ‡‰Ú·ÚıÚÔÙË˜ Ô‰ÔÎÓËÌÈÎ‹˜ (fiˆ˜ ÛÙËÓ ÂÚÈÁÚ·ÊÂ›Û·ÂÚ›ÙˆÛË), ‰›¯ˆ˜ ÙÔ ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÙÔ˘‰È·ÛÙÚ¤ÌÌ·ÙÔ˜ Ô›‰ËÌ· ÛÙËÓ ÂÚÈÔ¯‹ ÙˆÓÛÊ˘ÚÒÓ.

™ÙË ‰È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È¤Ó· Ï‹ıÔ˜ ·ı‹ÛÂˆÓ, ÌÂ ÂÓÙfiÈÛË ÙËÓ Ô‰Ô-ÎÓËÌÈÎ‹ ‹ ÙÔÓ ›‰ÈÔ ÙÔÓ ·ÛÙÚ¿Á·ÏÔ. ∏ ÌË ÙÚ·˘-Ì·ÙÈÎ‹ ÌÔÓÔ·ÚıÚ›ÙÈ‰· ÙË˜ Ô‰ÔÎÓËÌÈÎ‹˜ Û˘-ÓÔ‰Â‡ÂÙ·È Û˘Ó‹ıˆ˜ ·fi ¤ÓÙÔÓ· ÂÓÔ¯Ï‹Ì·Ù·Î·È ÎÏÈÓÈÎ¿ ÛËÌÂ›·, ÂÓÒ ÔÈ ‰Â›ÎÙÂ˜ ÊÏÂÁÌÔÓ‹˜Â›Ó·È Î·Ù¿ Î·ÓfiÓ· ·˘ÍËÌ¤ÓÔÈ. ∏ ÔÛÙÂÔÓ¤ÎÚˆ-ÛË ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÙËÓ ·Ô˘Û›· ·ÁÁÂ›ˆ-ÛË˜ ÙÔ˘ ˘ÔÎÂ›ÌÂÓÔ˘ ÙË˜ ‚Ï¿‚Ë˜ ÔÛÙÔ‡, ÂÓÒÛÙË Û¯·ÏÈ‰ˆÙÈÎ‹ ÔÛÙÂÔ¯ÔÓ‰Ú›ÙÈ‰· Ë ·ÁÁÂ›ˆÛËÂ›Ó·È Ê˘ÛÈÔÏÔÁÈÎ‹. ∂Í ¿ÏÏÔ˘, Ë ÔÛÙÂÔÓ¤ÎÚˆÛËÚÔÛ‚¿ÏÏÂÈ ÌÂÁ·Ï‡ÙÂÚÂ˜ ËÏÈÎ›Â˜. ∆Ô ÔÛÙÂÔÂÈ-‰¤˜ ÔÛÙ¤ˆÌ· ¤¯ÂÈ ÂÓÙÔÓfiÙÂÚ· Û˘ÌÙÒÌ·Ù· Î·È¯·Ú·ÎÙËÚÈÛÙÈÎfi fiÓÔ, Ô˘ ÂÎ‰ËÏÒÓÂÙ·È Û˘Ó‹-ıˆ˜ ÙÈ˜ Ó˘ÎÙÂÚÈÓ¤˜ ÒÚÂ˜ Î·È ˘Ê›ÂÙ·È ÌÂ ÙË Ï‹-„Ë ÌË ÛÙÂÚÔÂÈ‰ÒÓ ·ÓÙÈÊÏÂÁÌÔÓˆ‰ÒÓ Ê·ÚÌ¿-ÎˆÓ. ∆Ô ·ÔÛ·ÛÙÈÎfi Î¿Ù·ÁÌ· Â›Ó·È ·Û˘Ì‚›-‚·ÛÙÔ ÌÂ ÙËÓ ·Ó·ÙÔÌÈÎ‹ ÙÔ˘ ·ÛÙÚ·Á¿ÏÔ˘,

ÂÂÈ‰‹ Ô ıfiÏÔ˜ ÙÔ˘ ‰ÂÓ ‰¤¯ÂÙ·È ÚÔÛÊ‡ÛÂÈ˜ÈÛ¯˘ÚÒÓ Û˘Ó‰¤ÛÌˆÓ ‹ ÙÂÓfiÓÙˆÓ.

∏ ¿Ù˘Ë ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· Î·È ÙÔ ·Û·Ê¤˜ ÈÛÙÔ-ÚÈÎfi ‰ÂÓ ÈÎ·ÓÔÔÈÔ‡Ó Û˘Ó‹ıˆ˜ ÙË ‰È¿ÁÓˆÛË Î·È··ÈÙÂ›Ù·È Û˘¯Ó¿ Ô ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜. √È·ÎÙÈÓÔÁÚ·Ê›Â˜, ÔÈ ÔÔ›Â˜ Â› ÛÂÈÚ¿ ÂÙÒÓ ‹Ù·Ó ËÚÒÙË ÚÔÛ¿ıÂÈ· ‰È·ÁÓˆÛÙÈÎ‹˜ ÚÔÛ¤ÁÁÈÛË˜ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜, ÛÙ· ·Ú¯ÈÎ¿ ÛÙ¿‰È· ÙË˜ ÓfiÛÔ˘‰ÂÓ ˆÊÂÏÔ‡Ó, ÁÈ·Ù› ·‰˘Ó·ÙÔ‡Ó Ó· ·ÂÈÎÔÓ›ÛÔ˘ÓÙËÓ ÔÛÙÈÎ‹ ‚Ï¿‚Ë. ∞˘Ùfi˜ ‹Ù·Ó Ô ÏfiÁÔ˜ ÙË˜ Î·-ı˘ÛÙÂÚËÌ¤ÓË˜ ‰È¿ÁÓˆÛË˜ ÛÙË ‰ÈÎ‹ Ì·˜ ÂÚ›-ÙˆÛË. ∏ Ì·ÁÓËÙÈÎ‹ ÙÔÌÔÁÚ·Ê›· ¤¯ÂÈ ÙËÓ ÈÎ·-ÓfiÙËÙ· ÙË˜ ¤ÁÎ·ÈÚË˜ ·ÂÈÎfiÓÈÛË˜ ÙË˜ ‚Ï¿‚Ë˜,ÙË˜ ·ÎÚÈ‚Ô‡˜ ÂÓÙfiÈÛË˜ Î·È ÙË˜ ¤ÎÙ·Û‹˜ ÙË˜.∂›ÛË˜ ÌÔÚÂ› Ó· ·ÂÈÎÔÓ›ÛÂÈ ÌÂ ·ÎÚ›‚ÂÈ· ÙËÓ‡·ÚÍË ÔÛÙÈÎÔ‡ ÔÈ‰‹Ì·ÙÔ˜. ™‡ÌÊˆÓ· ÌÂ ÙËÓÈÛ¯‡Ô˘Û· Ù·ÍÈÓfiÌËÛË (2-4) (Ô˘ ÛÙËÚ›˙ÂÙ·È ÛÙ·Â˘Ú‹Ì·Ù· ÙË˜ Ì·ÁÓËÙÈÎ‹˜ ÙÔÌÔÁÚ·Ê›·˜) Î·È·Ó¿ÏÔÁ· ÌÂ ÙÔ ·ÂÈÎÔÓÈ˙fiÌÂÓÔ ÛÙ¿‰ÈÔ, ·ÔÊ·-Û›˙ÂÙ·È Ë ÂÊ·ÚÌÔÛÙ¤· ıÂÚ·Â›·.

∆Ô ÛÙ¿‰ÈÔ 1 ÂÚÈÏ·Ì‚¿ÓÂÈ ‚Ï¿‚Ë ÙÔ˘ ·Ú-ıÚÈÎÔ‡ ¯fiÓ‰ÚÔ˘ ÌfiÓÔ, Ô˘ ‰ÂÓ Á›ÓÂÙ·È ÔÚ·Ù‹ÛÙÈ˜ ·ÎÙÈÓÔÁÚ·Ê›Â˜ Î·È ‰ÂÓ ··ÈÙÂ› ¿ÏÏË ıÂ-Ú·Â›· ·fi ÙËÓ Ù·ÎÙÈÎ‹ ·Ú·ÎÔÏÔ‡ıËÛË.

∆Ô ÛÙ¿‰ÈÔ 2 ÂÚÈÏ·Ì‚¿ÓÂÈ, ÂÎÙfi˜ ·fi ÙË‚Ï¿‚Ë ÙÔ˘ ·ÚıÚÈÎÔ‡ ¯fiÓ‰ÚÔ˘, Î¿Ù·ÁÌ· ÙÔ˘˘ÔÎÂ›ÌÂÓÔ˘ ÔÛÙÔ‡, ÌÂ ÔÛÙÈÎfi Ô›‰ËÌ· (ÛÙ¿‰ÈÔ2·, fiˆ˜ ÛÙËÓ ÂÚ›ÙˆÛË Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È)‹ ¯ˆÚ›˜ Ô›‰ËÌ· (2‚). ™Ù· ÛÙ¿‰È· ·˘Ù¿, Ë ÚÔ-ÙÂÈÓfiÌÂÓË ıÂÚ·Â›· Â›Ó·È Û˘ÓÙËÚËÙÈÎ‹, ÌÂ·ÎÈÓËÙÔÔ›ËÛË ÛÂ Ó¿ÚıËÎ· Î·È ·ÔÊ˘Á‹ Ï‹-ÚÔ˘˜ ÊfiÚÙÈÛË˜ ÙÔ˘ ÛÎ¤ÏÔ˘˜ ÁÈ· 6 ÙÔ˘Ï¿¯ÈÛÙÔÓÂ‚‰ÔÌ¿‰Â˜.

™ÙÔ ÛÙ¿‰ÈÔ 3, ·Ó·Ê·›ÓÂÙ·È ‰È·¯ˆÚÈÛÌfi˜,·ÏÏ¿ fi¯È ·ÚÂÎÙfiÈÛË, ÔÛÙÂÔ¯fiÓ‰ÚÈÓÔ˘ ÙÂÌ·-¯›Ô˘. ™ÙÔ ÛÙ¿‰ÈÔ 4, ÙÔ ‰È·¯ˆÚÈÛÌ¤ÓÔ ÙÂÌ¿¯ÈÔ¤¯ÂÈ ·ÔÎÔÏÏËıÂ› Î·È Û˘ÌÂÚÈÊ¤ÚÂÙ·È ˆ˜ÂÏÂ‡ıÂÚÔ ÛÒÌ· ÛÙÔ ÂÛˆÙÂÚÈÎfi ÙË˜ ¿ÚıÚˆÛË˜.

™ÙÔ ÛÙ¿‰ÈÔ 5, ÂÎÙfi˜ ·fi Ù· ·ÓˆÙ¤Úˆ, ·Ó·-Ê·›ÓÔÓÙ·È Î˘ÛÙÈÎ¤˜ ·ÏÏÔÈÒÛÂÈ˜ ÛÙÔ ˘Ô¯fiÓ-‰ÚÈÔ ÔÛÙÔ‡Ó.

™Ù· ÛÙ¿‰È· 3-5, Ë ıÂÚ·Â›· Â›Ó·È ¯ÂÈÚÔ˘Ú-ÁÈÎ‹. ¶ÚÔÙÈÌ¿Ù·È Ë Û˘ÁÎÚ¿ÙËÛË ÙÔ˘ ·ÔÎÔÏ-ÏËÌ¤ÓÔ˘ ÙÂÌ·¯›Ô˘, ÂÊfiÛÔÓ Â›Ó·È ÌÂÁ¿ÏÔ Î·È·Ó‹ÎÂÈ ÛÂ ÊÔÚÙÈ˙fiÌÂÓË ·ÚıÚÈÎ‹ ÂÈÊ¿ÓÂÈ·, ‹Ë ·Ê·›ÚÂÛ‹ ÙÔ˘ ÂÊfiÛÔÓ Â›Ó·È ÌÈÎÚfi Î·È Ë·Ô˘Û›· ÙÔ˘ ‰ÂÓ ‰È·Ù·Ú¿ÛÛÂÈ ÙË ÏÂÈÙÔ˘ÚÁÈÎfi-ÙËÙ· ÙË˜ ¿ÚıÚˆÛË˜ (5,6).

∞¶∞¡∆∏™∏

¢È¿ÁÓˆÛË: ™¯·ÏÈ‰ˆÙÈÎ‹ ÔÛÙÂÔ¯ÔÓ‰Ú›ÙÈ‰· ·ÛÙÚ·Á¿ÏÔ˘


158 ∫§π¡π∫√ ∫√Àπ∑

Paediatriki 2009;72:66,71-73


1. Berndt AL, Harty M. Transchondral fractures(osteochondritis dissecans) of the talus. J BoneJoint Surg 1959;41A:988-1020.

2. Stroud CC, Marks RM. Imaging of osteochondrallesions of the talus. Foot Ankle Clin Mar2000;5:119-133.

3. Elias I, Jung JW, Raikin SM, Schweitzer MW,Carrino JA, Morrison WB. Osteochondral lesionsof the talus: change in MRI findings over time intalar lesions without operative intervention andimplications for staging systems. Foot Ankle Int2006;27:157-166.

4. Hepple S, Winson IG, Glew D. Osteochondrallesions of the talus: a revised classification. FootAnkle Int 1999;20:789-793.

5. Tol JL, Struijs PA, Bossuyt PM, Verhagen RA, vanDijk CN. Treatment strategies in osteochondraldefects of the talar dome: a systematic review. FootAnkle Int 2000;21:119-126.

6. Giannini S, Buda R, Faldini C, Vannini F, Bevoni R,Grandi G. Surgical treatment of osteochondrallesions of the talus in young active patients. J BoneJoint Surg Am 2005;87(Suppl 2):28-41.


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Παιδιατρική | Τόμος 72 • Τεύχος 2 • Απρίλιος - Μάιος - Ιούνιος 2009