Transcript
Page 1: Παιδιατρική | Τόμος 69 • Τεύχος 1 • Ιανουάριος - Φεβρουάριος 2006

1∂¶π∫∞πƒ√ £∂ª∞ CURRENT ISSUE

°Ú›Ë ÙˆÓ ÙËÓÒÓ: ·ÂÈÏ‹ ÌÈ·˜ Ó¤·˜ ·Ó‰ËÌ›·˜;

ª. ∆ÛÔÏÈ¿, π. §ÔÁÔı¤ÙË, ∞. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜

¶ÂÚ›ÏË„Ë: ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ 20Ô‡ ·ÈÒÓ· Ë ·ÓıÚˆfiÙËÙ· ‰ÔÎÈÌ¿ÛÙËΠ·fi ÙÚÂȘ ·Ó‰Ë̛˜Áڛ˘. ™ÙËÓ ·˘Á‹ ÙÔ˘ 21Ô˘ ·ÈÒÓ·, Ë ÂÌÊ¿ÓÈÛË ÌÈ·˜ Ó¤·˜ ·Ó‰ËÌ›·˜ ÌÔÈ¿˙ÂÈ ·Ó·fiÊ¢ÎÙË. ∆· ÙÂ-ÏÂ˘Ù·›· ¯ÚfiÓÈ·, ¤Ó·˜ Û˘Ó¯Ҙ ·˘Í·ÓfiÌÂÓÔ˜ ·ÚÈıÌfi˜ ÂȉËÌÈÒÓ Áڛ˘ ÙˆÓ ÙËÓÒÓ ÂΉËÏÒÓÔÓÙ·È΢ڛˆ˜ ÛÙȘ ·ÛÈ·ÙÈΤ˜ ¯ÒÚ˜, ηıÒ˜ Î·È Û ¿ÏÏ· ̤ÚË ÙÔ˘ ÎfiÛÌÔ˘. ∞˘Ù¤˜ ÚÔηÏÔ‡ÓÙ·È ·fi ÈÔ‡˜Ô˘ ¤¯Ô˘Ó ·˘ÍË̤ÓË ÏÔÈÌÔÁfiÓÔ ‰‡Ó·ÌË Î·È ÚÔηÏÔ‡Ó ˘„ËÏ‹˜ ·ıÔÁÔÓÈÎfiÙËÙ·˜ ÁÚ›Ë ÛÙ· ÙË-Ó¿. π‰È·›ÙÂÚË ·ÓËÛ˘¯›· ¤¯ÂÈ ÚÔηϤÛÂÈ Ë Â˘Ú›· ÂͿψÛË ÙÔ˘ ÈÔ‡ Ù˘ Áڛ˘ ∏5¡1 Û ¿ÁÚÈ· ηÈÔÈÎfiÛÈÙ· ÙËÓ¿ ÛÙËÓ ∞Û›·. ∆Ô Û٤ϯԘ ·˘Ùfi ÌÔÚ› Ó· ÌÂÙ·‰Ôı› ·fi Ù· ÙËÓ¿ ÛÙÔÓ ¿ÓıÚˆÔÎ·È Ó· ÚÔηϤÛÂÈ Ïԛ̈ÍË Î·È ı¿Ó·ÙÔ. ∞Ó Î·È ¤¯ÂÈ ·Ú·ÙËÚËı› ÌÂÙ¿‰ÔÛË ÙÔ˘ ÈÔ‡ ·fi ¿ÓıÚˆÔÛ ¿ÓıÚˆÔ, Ê·›ÓÂÙ·È fiÙÈ ÙÔ Û٤ϯԘ ·˘Ùfi ‰ÂÓ ÌÔÚ› Ó· ÌÂÙ·‰Ôı› ‡ÎÔÏ· ÌÂٷ͇ ·ÓıÚÒˆÓ.øÛÙfiÛÔ, ÌÔÚ› Ó· ·ÔÎÙ‹ÛÂÈ ÙËÓ ÈηÓfiÙËÙ· ·˘Ù‹ Ì ·Ó¿ÌÈÍË Î·È ·ÓÙ·ÏÏ·Á‹ ÙÔ˘ ÁÂÓÂÙÈÎÔ‡ ÙÔ˘˘ÏÈÎÔ‡ (reassortment) Ì ÙÔ ÁÂÓÂÙÈÎfi ˘ÏÈÎfi ·ÓıÚÒÈÓÔ˘ ÛÙÂϤ¯Ô˘˜ ‹ Ì ‰È·‰Ô¯ÈΤ˜ ÌÂÙ·ÏÏ¿ÍÂȘ.™Â ·˘Ù‹Ó ÙËÓ ÂÚ›ÙˆÛË, ÙÔ Û٤ϯԘ ∏5¡1 ı· Âͷψı› Û ÔÏfiÎÏËÚÔ ÙÔÓ ÎfiÛÌÔ Î·È ı· ÂΉË-ψı› ÌÈ· Ó¤· ·Ó‰ËÌ›·. °È· Ó· ÂÚÈÔÚÈÛÙ› Ë ÂͿψÛË ÙÔ˘ ÈÔ‡ Â›Ó·È ··Ú·›ÙËÙË Ë Û˘ÓÙÔÓÈṲ̂-ÓË ÚÔÛ¿ıÂÈ· ÙˆÓ Î˘‚ÂÚÓ‹ÛÂˆÓ ·ÏÏ¿ Î·È fiÛˆÓ ·Û¯ÔÏÔ‡ÓÙ·È Ì ÙËÓ ÂÎÙÚÔÊ‹ ÙËÓÒÓ ÒÛÙ ӷÂÊ·ÚÌÔÛıÔ‡Ó Ù· ηٿÏÏËÏ· ÂÎ·È‰Â˘ÙÈο ÚÔÁÚ¿ÌÌ·Ù· Î·È Ó· ‚ÂÏÙȈı› Ë ‚ÈÔÏÔÁÈ΋ ·ÛÊ¿ÏÂÈ·.∫¿ı ¯ÒÚ· Ú¤ÂÈ Ó· ‰È·ı¤ÙÂÈ ¤Ó· Û¯¤‰ÈÔ ·ÓÙÈÌÂÙÒÈÛ˘ ÌÈ·˜ ÂӉ¯fiÌÂÓ˘ ·Ó‰ËÌ›·˜, fiˆ˜ ›-Û˘ Î·È ·fiıÂÌ· ÈηÓÒÓ ÔÛÔÙ‹ÙˆÓ ·ÓÙÈ-ÈÈÎÒÓ Ê·ÚÌ¿ÎˆÓ Ô˘ Ó· ·ÓÙ·ÔÎÚ›ÓÔÓÙ·È ÛÙȘ ·Ó¿ÁΘÙÔ˘ ÏËı˘ÛÌÔ‡. √ ÈÔ ·ÔÙÂÏÂÛÌ·ÙÈÎfi˜ ÙÚfiÔ˜, fï˜, ÁÈ· Ó· ÂÚÈÔÚÈÛÙ› Ë ·Ó‰ËÌ›·, ·Ú·Ì¤ÓÂÈÔ ÂÌ‚ÔÏÈ·ÛÌfi˜. ™‹ÌÂÚ·, Á›ÓÂÙ·È ÂÓÙ·ÙÈ΋ ÂÚ¢ÓËÙÈ΋ ÚÔÛ¿ıÂÈ· ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ÂÌ‚ÔÏ›Ô˘ η-Ù¿ ÙÔ˘ ÛÙÂϤ¯Ô˘˜ ∏5¡1.

§¤ÍÂȘ ÎÏÂȉȿ: °Ú›Ë, ÁÚ›Ë ÙËÓÒÓ, ·Ó‰ËÌ›·.

Avian flu: a new pandemic threat?

M. Tsolia, I. Logotheti, A. Konstantopoulos

Abstract: During the course of the 20th century the world experienced three influenza pandemics.Today, at the dawn of the 21st century the emergence of a new pandemic seems inevitable. In recentyears, an increasing number of epidemics caused by high pathogenicity avian influenza viruses haveoccurred, mainly in Asian countries but also in other parts of the world. The current widespreaddissemination of H5N1 avian virus in wild and domestic birds in Asia is unprecedented and has causedglobal concern. What is more troubling is the fact that this virus has been transmitted from birds tohumans causing disease and death. Although human-to-human transmission is known to haveoccurred, the virus cannot be transmitted between humans with great efficiency. However, it mayacquire this capacity either by reassortment with a human strain or through adaptive mutations. In thiscase, the H5N1 strain will cause explosive global spread and a new influenza pandemic will occur. Aneffort should be made by governments and poultry producers to improve biosecurity and conducteducation programmes with a view to restriction of the spread of avian influenza. An operationalpandemic plan should be available in every country and an adequate amount of antiviral medicationstockpiled. Immunization will be the most effective way to reduce the impact of a pandemic andresearchers are currently trying to develop a vaccine against the H5N1 strain.

Key words: Influenza, avian influenza, pandemic.

µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ,¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. Î·È ∞. ∫˘ÚÈ·ÎÔ‡”

AÏÏËÏÔÁÚ·Ê›·:

§ÔÁÔı¤ÙË πˆ¿ÓÓ·§˘Î›·˜ 5, ¡. ™Ì‡ÚÓË, ∆.∫. 171 23e-mail: [email protected]

2nd Paediatric Clinic,University of Athens, “P. & A. Kyriakou” Children’sHospital

Correspondence:

Logotheti Ioanna5 Lykeias Str., N. Smyrni, 171 23, Athense-mail:[email protected]

¶·È‰È·ÙÚÈ΋ 2006;69:1-9

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Page 2: Παιδιατρική | Τόμος 69 • Τεύχος 1 • Ιανουάριος - Φεβρουάριος 2006

∂ÈÛ·ÁˆÁ‹

∫¿ı ¯ÚfiÓÔ, ηٿ ÙÔ˘˜ ¯ÂÈÌÂÚÈÓÔ‡˜ Ì‹Ó˜,

ÂÌÊ·Ó›˙ÔÓÙ·È ÂȉËÌÈΤ˜ ÂÍ¿ÚÛÂȘ ÙÔ˘ ÈÔ‡ Ù˘

Áڛ˘ Ô˘ ÚÔηÏÔ‡Ó ÛËÌ·ÓÙÈ΋ ÓÔÛËÚfiÙË-

Ù· Î·È ıÓËÙfiÙËÙ· ÛÙÔÓ ÏËı˘ÛÌfi, ȉȷ›ÙÂÚ·

ÛÙȘ ¢·ı›˜ ÔÌ¿‰Â˜. √ Èfi˜ Ù˘ Áڛ˘ ÌÔ-

Ú›, fï˜, Ó· ÚÔηϤÛÂÈ Î·È ·Ó‰Ë̛˜ ηٿ

ÙȘ Ôԛ˜ Ë ÓÔÛËÚfiÙËÙ· Î·È Ô ·ÚÈıÌfi˜ ÙˆÓ

ı·Ó¿ÙˆÓ ·˘Í¿ÓÔÓÙ·È ‰Ú·Ì·ÙÈο, ·ÎfiÌË Î·È

ÌÂٷ͇ Ó¤ˆÓ Î·È ˘ÁÈÒÓ ·ÙfïÓ. ∫·Ù¿ ÙË ‰È¿Ú-

ÎÂÈ· ÙÔ˘ 20Ô‡ ·ÈÒÓ· Ë ·ÓıÚˆfiÙËÙ· ‰ÔÎÈÌ¿-

ÛÙËΠ·fi ÙÚÂȘ ·Ó‰Ë̛˜ Áڛ˘, ÔÈ Ôԛ˜

ÚÔοÏÂÛ·Ó ÂÚÈÛÛfiÙÂÚÔ˘˜ ı·Ó¿ÙÔ˘˜ ·fi

ÔÔÈ·‰‹ÔÙ ¿ÏÏË Ê˘ÛÈ΋ ‹ ÚÔηÏÔ‡ÌÂÓË

·fi ÙÔÓ ¿ÓıÚˆÔ Î·Ù·ÛÙÚÔÊ‹, Û˘ÌÂÚÈÏ·Ì-

‚·ÓÔÌ¤ÓˆÓ Î·È ÙˆÓ ‰‡Ô ·ÁÎoÛÌ›ˆÓ ÔϤ̈Ó

(1-3). ™ÙËÓ ·˘Á‹ ÙÔ˘ 21Ô˘ ·ÈÒÓ·, Ë Ì¿¯Ë ÌÂ

ÙÔÓ Èfi ·˘Ùfi Û˘Ó¯›˙ÂÙ·È Ì ÛÎÔfi ÙËÓ ·ÔÙÚÔ-

‹ ÌÈ·˜ Ó¤·˜ ·Ó‰ËÌ›·˜. π‰È·›ÙÂÚË ·ÓËÛ˘¯›·

¤¯ÂÈ ‰ËÌÈÔ˘ÚÁËı› Á‡Úˆ ·fi ÙËÓ Èı·ÓfiÙËÙ·

ÂΉ‹ÏˆÛ˘ ·Ó‰ËÌ›·˜ ·fi ÙÔ Û٤ϯԘ

H5N1, Ô˘ Û‹ÌÂÚ· ÂÓ‰ËÌ› ÛÙ· ÙËÓ¿ Û ÔÏ-

Ϥ˜ ·ÛÈ·ÙÈΤ˜ ¯ÒÚ˜ (3-6). ∏ ‰ÈÂıÓ‹˜ ÂÈÛÙË-

ÌÔÓÈ΋ ÎÔÈÓfiÙËÙ· ÂÎÊÚ¿˙ÂÈ ÙË ‚‚·ÈfiÙËÙ· fiÙÈ

ÌÈ· Ó¤· ·Ó‰ËÌ›· Áڛ˘ ı· ÂΉËψı› ÛÙÔ

ÚÔÛ¯¤˜ ̤ÏÏÔÓ, ‰ÂÓ Â›Ó·È fï˜ ‰˘Ó·Ùfi Ó·

ÚÔ‚ÏÂÊı› Ô ·ÎÚÈ‚‹˜ ¯ÚfiÓÔ˜ ¤Ó·ÚÍ‹˜ Ù˘.

∞fi ÙfiÙ Ԣ ÂÌÊ·Ó›ÛÙËΠÙÔ Û٤ϯԘ ·˘Ùfi

Î·È Ì¤¯ÚÈ Û‹ÌÂÚ·, ¤¯Ô˘Ó ÂΉËψı› ·ÚÎÂÙ¤˜

ÂÚÈÙÒÛÂȘ ÓfiÛÔ˘ ·fi ÌÂÙ¿‰ÔÛË ÙÔ˘ ÈÔ‡

ÛÙÔ˘˜ ·ÓıÚÒÔ˘˜ Ì ÛËÌ·ÓÙÈ΋ ıÓËÙfiÙËÙ·.

∆Ô Û٤ϯԘ ∏5¡1 ‰ÂÓ ÌÔÚ› Ó· ÌÂÙ·‰Ôı›

‡ÎÔÏ· ·fi ¿ÓıÚˆÔ Û ¿ÓıÚˆÔ Î·È ÁÈ· ÙÔÓ

ÏfiÁÔ ·˘Ùfi, ‰ÂÓ ¤¯ÂÈ ÚÔ·„ÂÈ Ì¤¯ÚÈ Û‹ÌÂÚ·

ÌÈ· Ó¤· ·Ó‰ËÌ›·. √È Ì˯·ÓÈÛÌÔ› Ô˘ Û˘Ì‚¿Ï-

ÏÔ˘Ó ÛÙË ‰ËÌÈÔ˘ÚÁ›· ÌÈ·˜ ·Ó‰ËÌ›·˜, Ù· ÛËÌÂ-

ÚÈÓ¿ ÂȉËÌÈÔÏÔÁÈο ‰Â‰Ô̤ӷ Î·È ÔÈ ÛÙÚ·ÙË-

ÁÈΤ˜ Ô˘ ı· Ú¤ÂÈ Ó· ÂÊ·ÚÌÔÛıÔ‡Ó ÁÈ· ÙËÓ

·ÓÙÈÌÂÙÒÈÛ‹ Ù˘ ÂÚÈÁÚ¿ÊÔÓÙ·È ·Ú·Î¿Ùˆ.

√ Èfi˜ Ù˘ Áڛ˘ Î·È ÔÈ ·ÓÙÈÁÔÓÈΤ˜ ÙÔ˘

ÌÂÙ·‚ÔϤ˜

√ Èfi˜ Ù˘ Áڛ˘ ·Ó‹ÎÂÈ ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ·

ÙˆÓ ÔÚıÔÌ˘ÍÔ˚ÒÓ Î·È ·ÔÙÂÏÂ›Ù·È ·fi 8 ÙÌ‹-

Ì·Ù· ÌÔÓ‹˜ ¤ÏÈη˜ RNA, Ô˘ ÂÚȤ¯Ô˘Ó ÙȘ ÁÂ-

ÓÂÙÈΤ˜ ÏËÚÔÊÔڛ˜ ÁÈ· 10 ÚˆÙ½Ó˜. √ Èfi˜

ÂÚÈ‚¿ÏÏÂÙ·È ·fi ‰ÈÛÙڈ̷ÙÈÎfi ÏÈȉȷÎfi Â-

Ú›‚ÏËÌ· ·fi ÙÔ ÔÔ›Ô ÚÔÛÂ΂¿ÏÏÔ˘Ó ˆ˜ ·Î›-

‰Â˜ ÔÈ ÁÏ˘ÎÔÚˆÙ½Ó˜ ·ÈÌÔÛ˘ÁÎÔÏÏËÙ›ÓË (∏)

Î·È Ó¢ڷÌÈÓȉ¿ÛË (¡) (∂ÈÎfiÓ· 1) (1-3) . ∏ ·È-

ÌÔÛ˘ÁÎÔÏÏËÙ›ÓË Â›Ó·È ˘Â‡ı˘ÓË ÁÈ· ÙËÓ ÚÔ-ÛÎfiÏÏËÛË Û ÌfiÚÈ· ÛÈ·ÏÈÎÔ‡ ÔͤԘ Ô˘ ‚Ú›-ÛÎÔÓÙ·È Û ÁÏ˘ÎÔÚˆÙ½Ó˜ Î·È ÁÏ˘ÎÔÏÈ›‰È·ÛÙËÓ ÂÈÊ¿ÓÂÈ· ÙÔ˘ ΢ÙÙ¿ÚÔ˘. ∏ Ó¢ڷÌÈÓȉ¿-ÛË ‰È¢ÎÔχÓÂÈ ÙË ‰Ú¿ÛË Ù˘ ·ÈÌÔÛ˘ÁÎÔÏÏËÙ›-Ó˘ Î·È ÂÈÚfiÛıÂÙ·, ·›˙ÂÈ ÚfiÏÔ ÛÙËÓ ·Â-Ï¢ı¤ÚˆÛË ÙÔ˘ ÈÔ‡ ·fi ÙÔ Î‡ÙÙ·ÚÔ.

√È ÈÔ› Ù˘ Áڛ˘ ‰È·ÎÚ›ÓÔÓÙ·È ÛÂ Ù‡Ô˘˜ ∞,µ, C. ∆· ÛÙÂϤ¯Ë C ‰ÂÓ ÚÔηÏÔ‡Ó ÛËÌ·ÓÙÈ΋ÓÔÛËÚfiÙËÙ·. ∆· ÛÙÂϤ¯Ë Ù‡Ô˘ ∞ Â›Ó·È ·˘Ù¿Ô˘ ÚÔηÏÔ‡Ó ÙË ÌÂÁ·Ï‡ÙÂÚË ÓÔÛËÚfiÙËÙ· ηÈÙ·ÍÈÓÔÌÔ‡ÓÙ·È Û ˘ÔÙ‡Ô˘˜, ·Ó¿ÏÔÁ· Ì ÙȘÂÈÊ·ÓÂȷΤ˜ ÁÏ˘ÎÔÚˆÙ½Ó˜ H Î·È N. À¿Ú-¯Ô˘Ó 16 Ù‡ÔÈ ∏ Î·È 9 ¡. √È ˘fiÙ˘ÔÈ ∞ ÚÔ-Û‚¿ÏÏÔ˘Ó ÂÎÙfi˜ ·fi ÙÔÓ ¿ÓıÚˆÔ, Ù· ÙËÓ¿Î·È ‰È¿ÊÔÚ· ˙Ò·, fiˆ˜ ¯Ô›ÚÔ˘˜, ¿ÏÔÁ·, ÊÒÎÈÂ˜Î·È Ê¿Ï·ÈÓ˜. ∆· ÙËÓ¿ ÚÔÛ‚¿ÏÏÔÓÙ·È ·fiÛÙÂϤ¯Ë fiÏˆÓ ÙˆÓ ˘ÔÙ‡ˆÓ ∏ Î·È ¡, ÂÓÒ Ù·ıËÏ·ÛÙÈο, ÌÂٷ͇ ÙˆÓ ÔÔ›ˆÓ Î·È ÔÈ ¿ÓıÚˆ-ÔÈ, ÚÔÛ‚¿ÏÏÔÓÙ·È ·fi ÂÚÈÔÚÈṲ̂ÓÔ ·ÚÈıÌfi˘ÔÙ‡ˆÓ. °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi, Ù· ÙËÓ¿ ıˆ-ÚÔ‡ÓÙ·È fiÙÈ Â›Ó·È Ô Ê˘ÛÈÎfi˜ ÍÂÓÈÛÙ‹˜ Ù˘ Áڛ˘∞. √È 144 (16 x 9) ‰˘Ó·ÙÔ› Û˘Ó‰˘·ÛÌÔ› ÙˆÓ Ù‡-ˆÓ ∏ Î·È ¡ ¤¯Ô˘Ó ˆ˜ ·ÔÙ¤ÏÂÛÌ· Ó· ΢ÎÏÔ-ÊÔÚ› ÛÙ· ¿ÁÚÈ· ÙËÓ¿ ¤Ó·˜ ÌÂÁ¿ÏÔ˜ ·ÚÈıÌfi˜˘ÔÙ‡ˆÓ ÙˆÓ ÈÒÓ ·˘ÙÒÓ. ∆· ¿ÁÚÈ· ÌÂÙ·Ó·-ÛÙ¢ÙÈο ÙËÓ¿ ÈÛÙ‡ÂÙ·È fiÙÈ ·ÔÙÂÏÔ‡Ó ÙˉÂÍ·ÌÂÓ‹ ÁÈ· ÙË ÌÂÙ¿‰ÔÛË Ù˘ Ïԛ̈͢ Û η-ÙÔÈΛ‰È· ÙËÓ¿, ¯Ô›ÚÔ˘˜ ‹ ·ÓıÚÒÔ˘˜ (2,3).∞ÓÙ›ıÂÙ· Ì ٷ ÛÙÂϤ¯Ë Ù‡Ô˘ ∞, Ù· ÛÙÂϤ¯Ë

∂ÈÎfiÓ· 1. √ Èfi˜ Ù˘ Áڛ˘. TÚÔÔÔÈË̤ÓË ·fi (2).

O Èfi˜ Ù˘ Áڛ˘

ıÂ̤ÏÈÔ˜ Ô˘Û›· ·ÈÌÔÛ˘ÁÎÔÏÏËÙ›ÓË

ÚˆÙ½ÓË ª2

RNAÚˆÙ½ÓË ÙÔ˘ ˘Ú‹Ó·

Î·È ÔÏ˘ÌÂÚ¿Û˜

Ó¢ڷÌÈÓȉ¿ÛË

2 ª. ∆ÛÔÏÈ¿ Î·È Û˘Ó.

¶·È‰È·ÙÚÈ΋ 2006;69:1-9

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3°Ú›Ë ÙˆÓ ÙËÓÒÓ

ÙÔ˘ Ù‡Ô˘ µ ¤¯Ô˘Ó ÛÙ·ıÂÚ¤˜ ∏ Î·È ¡, ‰ÂÓ ‰È·È-

ÚÔ‡ÓÙ·È Û ˘ÔÙ‡Ô˘˜ Î·È ÚÔÛ‚¿ÏÏÔ˘Ó ÌfiÓÔ

ÙÔÓ ¿ÓıÚˆÔ. ∂Ó‰¤¯ÂÙ·È fï˜, Ó· ˘¿Ú¯Ô˘Ó

·ÓÙÈÁÔÓÈΤ˜ ‰È·ÊÔÚ¤˜ ·fi ÙÔ ¤Ó· Û٤ϯԘ ÛÙÔ

¿ÏÏÔ, fiˆ˜ Î·È ÌÂٷ͇ ÙˆÓ ‰È·ÊfiÚˆÓ ÛÙÂÏÂ-

¯ÒÓ Áڛ˘ ∞ Ô˘ ·Ó‹ÎÔ˘Ó ÛÙÔÓ ›‰ÈÔ ˘fiÙ˘Ô.

√È ÈÔ› Ù˘ Áڛ˘ ˘Ê›ÛÙ·ÓÙ·È ·ÓÙÈÁÔÓÈΤ˜

ÌÂÙ·‚ÔϤ˜ Î·È ‰ÂÓ ·Ó·ÁÓˆÚ›˙ÔÓÙ·È ˆ˜ ÔÈΛÔÈ

·fi ÙÔ ·ÓÔÛÈ·Îfi Û‡ÛÙËÌ·, Ì ·ÔÙ¤ÏÂÛÌ· Ô

¿ÓıÚˆÔ˜ Ó· ·Ú·Ì¤ÓÂÈ Â˘¿ÏˆÙÔ˜ ÛÙË Ïԛ̈-

ÍË ÁÈ· fiÏË ÙË ‰È¿ÚÎÂÈ· Ù˘ ˙ˆ‹˜ ÙÔ˘. √È ·ÓÙÈ-

ÁÔÓÈΤ˜ ·˘Ù¤˜ ÌÂÙ·‚ÔϤ˜ Á›ÓÔÓÙ·È Ì ‰‡Ô ÙÚfi-

Ô˘˜. √ ÚÒÙÔ˜ ÂÚÈÏ·Ì‚¿ÓÂÈ ‰È·‰Ô¯ÈΤ˜ ÌÂ-

Ù·ÏÏ¿ÍÂȘ Ô˘ ¤¯Ô˘Ó ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙËÓ Âͤ-

ÏÈÍË ÙÔ˘ ÈÔ‡ Î·È ·ÔÙÂÏÔ‡Ó ÙËÓ ÂÏ¿ÛÛÔÓ·

·ÓÙÈÁÔÓÈ΋ ÌÂÙ·‚ÔÏ‹ (antigenic drift) (1-3).

√ ‰Â‡ÙÂÚÔ˜ ÙÚfiÔ˜ ·Ú·ÙËÚÂ›Ù·È Ôχ ÈÔ

Û¿ÓÈ· Î·È ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ÂÌÊ¿ÓÈÛË ÌÈ·˜

Ì›˙ÔÓÔ˜ ·ÓÙÈÁÔÓÈ΋˜ ÌÂÙ·‚ÔÏ‹˜ (antigenic

shift) Ù˘ ·ÈÌÔÛ˘ÁÎÔÏÏËÙ›Ó˘ (∏) ‹/Î·È Ù˘

Ó¢ڷÌÈÓȉ¿Û˘ (¡), ÒÛÙ ӷ ÂÌÊ·Ó›˙ÂÙ·È ¤Ó·

Ó¤Ô ÌfiÚÈÔ ∏ ‹ Î·È ¡ Î·È Ó· ÚÔ·ÙÂÈ Ó¤Ô˜

˘fiÙ˘Ô˜. ™ÙËÓ ÙÂÏÂ˘Ù·›· ·˘Ù‹ ÂÚ›ÙˆÛË, Ô

ÏËı˘ÛÌfi˜ Û ÔÏfiÎÏËÚÔ ÙÔÓ ÎfiÛÌÔ Â›Ó·È Â˘¿-

ψÙÔ˜ ·ÊÔ‡ ‰ÂÓ ‰È·ı¤ÙÂÈ ·ÓÙÈÛÒÌ·Ù· ηٿ ÙˆÓ

Ó¤ˆÓ ·˘ÙÒÓ ∏ Î·È ¡ Î·È ÌÔÚ› Ó· ÚÔ·„ÂÈ

·Ó‰ËÌ›· (1-3).

ªÈ· Ì›˙ˆÓ ·ÓÙÈÁÔÓÈ΋ ÌÂÙ·‚ÔÏ‹ ‰ÂÓ Â›Ó·È

‰˘Ó·Ùfi Ó· Á›ÓÂÈ ‰È· ̤ÛÔ˘ ·ÏÒÓ ÁÂÓÂÙÈÎÒÓ

ÌÂÙ·ÏϿ͈Ó. ªÈ· ÙfiÛÔ ‰Ú·ÛÙÈ΋ ÌÂÙ·ÌfiÚʈ-

ÛË ÙÔ˘ ÈÔ‡ ÂÓ‰¤¯ÂÙ·È Ó· Ú·ÁÌ·ÙÔÔÈËı› ÌÂ

ÙËÓ ·ÓÙ·ÏÏ·Á‹ ÁÂÓÂÙÈÎÔ‡ ˘ÏÈÎÔ‡ ÌÂٷ͇ ‰‡Ô

‰È·ÊÔÚÂÙÈÎÒÓ ÛÙÂϯÒÓ Áڛ˘, fiÙ·Ó ÌÔχ-

ÓÔ˘Ó Ù·˘Ùfi¯ÚÔÓ· Ù· ·ÙÙ·Ú· ÂÓfi˜ ÍÂÓÈÛÙ‹.

™ÙËÓ ÂÚ›ÙˆÛË ·˘Ù‹, ·Ú¿ÁÂÙ·È Û٤ϯԘ Ô˘

ÂÚȤ¯ÂÈ ÌÈÎÙfi ÁÂÓÂÙÈÎfi ˘ÏÈÎfi (reassortant) (3).

ŒÓ· ‹ ÂÚÈÛÛfiÙÂÚ· ·fi Ù· 8 ÙÌ‹Ì·Ù· ÙÔ˘ ÛÙÂ-

Ϥ¯Ô˘˜ ·˘ÙÔ‡ ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙÔ ¤Ó· ·Ú¯ÈÎfi

Û٤ϯԘ Î·È Ù· ˘fiÏÔÈ· ·fi ÙÔ ¿ÏÏÔ. ∏ η-

Ù·ÓÔÌ‹ ÙÔ˘ ÁÂÓÂÙÈÎÔ‡ ˘ÏÈÎÔ‡ ÙÔ˘ ÈÔ‡ Ù˘ ÁÚ›-

˘ Û 8 ÙÌ‹Ì·Ù·, ÙÔ Î·ı¤Ó· ·fi Ù· ÔÔ›· Â-

ÚȤ¯ÂÈ ÙȘ ÏËÚÔÊÔڛ˜ ÁÈ· ÌÈ· ‹ ‰‡Ô Úˆ-

Ù½Ó˜, ¢ÓÔ› ÙËÓ ·Ó¿ÌÈÍË Î·È ·ÓÙ·ÏÏ·Á‹ ÙˆÓ

ÙÌËÌ¿ÙˆÓ ·˘ÙÒÓ (reassortment), ÌÂٷ͇ ‰‡Ô

‰È·ÊÔÚÂÙÈÎÒÓ ÛÙÂϯÒÓ fiÙ·Ó ÌÔχÓÔ˘Ó Ù·˘Ùfi-

¯ÚÔÓ· ÙÔ ›‰ÈÔ Î‡ÙÙ·ÚÔ. ∂¿Ó ÙÔ Û٤ϯԘ Ô˘

ÚÔ·ÙÂÈ ÌÔÚ› Ó· ÚÔÛ‚¿ÏÂÈ ÙÔÓ ¿ÓıÚˆÔ

Î·È Ó· ÌÂÙ·‰›‰ÂÙ·È ·ÔÙÂÏÂÛÌ·ÙÈο ·fi ÙÔÓ

¤Ó·Ó ÛÙÔÓ ¿ÏÏÔ, ‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È ÔÈ ÚÔ¸Ôı¤-

ÛÂȘ ÁÈ· Ó· ÂΉËψı› ÌÈ· Ó¤· ·Ó‰ËÌ›·. ¶Úfi-

ÛÊ·Ù· ‰È·ÈÛÙÒıËΠfiÙÈ ·Ó‰ËÌ›· Áڛ˘ ÌÔ-

Ú› Ó· ÚÔ·„ÂÈ Î·È Ì ¤Ó·Ó ‰Â‡ÙÂÚÔ Ì˯·ÓÈ-

ÛÌfi, fiÙ·Ó ¤Ó· Û٤ϯԘ Ô˘ Û˘Ó‹ıˆ˜ ÚÔÛ‚¿Ï-

ÏÂÈ Ù· ÙËÓ¿, ·ÔÎÙ‹ÛÂÈ ÙËÓ ÈηÓfiÙËÙ· Ó· ÚÔ-

Û‚¿ÏÂÈ Î·È ÙÔÓ ¿ÓıÚˆÔ.

¶ÚfiÛÊ·Ù· ‰È·ÈÛÙÒıËΠfiÙÈ Ù· ÔÈÎfiÛÈÙ·

ÙËÓ¿ (fiÚÓÈı˜ Î·È Á·ÏÔԇϘ) ÚÔÛ‚¿ÏÏÔ-

ÓÙ·È ·fi ÈÔ‡˜ Áڛ˘ Ô˘ ¤¯Ô˘Ó ÙÔ ‰˘Ó·ÌÈÎfi Ó·

ÚÔÛ‚¿ÏÔ˘Ó Î·È ÙÔÓ ¿ÓıÚˆÔ (6). ¶ÂÈÚ·Ì·ÙÈ-

Τ˜ ÌÂϤÙ˜ ¤‰ÂÈÍ·Ó fiÙÈ ÌÂÚÈο ÔÈÎfiÛÈÙ· ÙËÓ¿

‰ÚÔ˘Ó ˆ˜ ·Ê·Ó›˜ ÔÏÏ·Ï·ÛÈ·ÛÙ¤˜ ÛÙÂϯÒÓ

Áڛ˘ Ì ‰˘Ó·ÌÈÎfi Ó· ÚÔηϤÛÔ˘Ó ·Ó‰Ë-

Ì›·, ¯ˆÚ›˜ Ó· ÂΉËÏÒÓÔ˘Ó Û˘ÌÙÒÌ·Ù·. ¶·Ú¿-

‰ÂÈÁÌ· ·ÔÙÂÏÔ‡Ó ÔÈ ¿È˜, ÔÈ Ôԛ˜ ʤÚÔ˘Ó

ÈÔ‡˜ Áڛ˘ Ì ·ÈÌÔÛ˘ÁÎÔÏÏËÙ›ÓË ∏5 ¯ˆÚ›˜ ÔÈ

›‰È˜ Ó· ÓÔÛÔ‡Ó. ∞ÚÎÂÙ¿ ÚfiÛÊ·Ù· ·Ú·‰Â›Á-

Ì·Ù· ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ Ô ¿ÓıÚˆÔ˜ ÌÔÚ› Ó·

ÚÔÛ‚ÏËı› ·fi ÛÙÂϤ¯Ë ÈÒÓ Áڛ˘ ÙˆÓ ÙË-

ÓÒÓ Î·È ÂÔ̤ӈ˜, Ô ÚfiÏÔ˜ ÙÔ˘ ·ÓıÚÒÔ˘ ˆ˜

ÍÂÓÈÛÙ‹ Ô ÔÔ›Ô˜ ÌÔÚ› Ó· ˘ÔÛÙËÚ›ÍÂÈ ÙËÓ

·ÓÙ·ÏÏ·Á‹ ÁÂÓÂÙÈÎÔ‡ ˘ÏÈÎÔ‡ ÌÂٷ͇ ‰È·ÊfiÚˆÓ

ÛÙÂϯÒÓ Áڛ˘, ‰ÂÓ Ú¤ÂÈ Ó· ˘ÔÙÈÌ¿Ù·È

(¶›Ó·Î·˜ 1).

∆Ô Û˘Ì¤Ú·ÛÌ· ·fi fiÛ· ÂϤ¯ıËÛ·Ó ·Ú·-

¿Óˆ Â›Ó·È fiÙÈ Ë ‰ËÌÈÔ˘ÚÁ›· ÛÙÂϯÒÓ Áڛ˘

ÈηÓÒÓ Ó· ÚÔηϤÛÔ˘Ó ·Ó‰ËÌ›· Â›Ó·È ÌÈ·

‰È·‰Èηۛ· Ô˘ ··ÈÙ› ·ÚÎÂÙfi ¯ÚfiÓÔ Î·È ÂÚ-

Ó¿ ·fi ÔÏÏ¿ ‰È·‰Ô¯Èο ÛÙ¿‰È·. ™Â ÔÚÈṲ̂Ó˜

ÂÚÈÙÒÛÂȘ ÌÔÚ› Ó· ¤¯ÂÈ ÚÔËÁËı› ·ÓÙ·Ï-

Ï·Á‹ ÁÂÓÂÙÈÎÔ‡ ˘ÏÈÎÔ‡ ÌÂٷ͇ ‰È·ÊfiÚˆÓ ˘Ô-

Ù‡ˆÓ ‹ ÛÙÂϯÒÓ ÙÔ˘ ÈÔ‡ Ô˘ ΢ÎÏÔÊÔÚÔ‡Ó

Û ‰È¿ÊÔÚ· ˙ˆÈο ›‰Ë Ù·˘Ùfi¯ÚÔÓ·.

√È ÚÔËÁÔ‡ÌÂÓ˜ ·Ó‰Ë̛˜ Áڛ˘

∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ 20Ô‡ ·ÈÒÓ· ÂΉËÏÒ-

ıËÎ·Ó ÙÚÂȘ ·Ó‰Ë̛˜ Áڛ˘. ™ÙȘ ·Ó‰Ë̛˜

·˘Ù¤˜ ¤¯Ô˘Ó ‰Ôı› ‰È·ÊÔÚÂÙÈο ÔÓfiÌ·Ù·, ·Ó¿-

ÏÔÁ· Ì ÙÔÓ ÙfiÔ ÛÙÔÓ ÔÔ›Ô Î¿ı ÊÔÚ¿ Ê·ÈÓfi-

Ù·Ó Ó· ·Ú¯›˙ÂÈ Ë ·Ó‰ËÌ›·. ™‹ÌÂÚ· ıˆÚ›ٷÈ

¶·È‰È·ÙÚÈ΋ 2006;69:1-9

¶›Ó·Î·˜ 1. ¶·Ú·‰Â›ÁÌ·Ù· ÚfiÛÊ·ÙˆÓ ÂȉËÌÈÒÓ Áڛ˘ÛÙ· ÙËÓ¿ Ì ÌÂÙ¿‰ÔÛË ÛÙÔÓ ¿ÓıÚˆÔ

ŒÙÔ˜, ÃÒÚ· πfi˜

1995, ∏ӈ̤ÓÔ µ·Û›ÏÂÈÔ ∏7¡7

1997, ÃÔÓÁÎ ∫ÔÓÁÎ ∏5¡1

1999, ÃÔÓÁÎ ∫ÔÓÁÎ ∏9¡2

2003, ÃÔÓÁÎ ∫ÔÓÁÎ ∏5¡1

2003, √ÏÏ·Ó‰›· ∏7¡7

2003, ÃÔÓÁÎ ∫ÔÓÁÎ H9N2

2004, µÈÂÙÓ¿Ì ∏5¡1

2004, ∆·˚Ï¿Ó‰Ë ∏5¡1

2004, ∫·Ó·‰¿˜ ∏7¡3

2004, ∞›Á˘ÙÔ˜ ∏10¡7

Pediatr Jan-Feb 06 final allges 27-01-06 15:34 ™ÂÏ›‰·3

Page 4: Παιδιατρική | Τόμος 69 • Τεύχος 1 • Ιανουάριος - Φεβρουάριος 2006

4 ª. ∆ÛÔÏÈ¿ Î·È Û˘Ó.

ÂÚÈÛÛfiÙÂÚÔ Èı·Ófi fiÙÈ fiϘ ÚÔ‹Ïı·Ó ·fi

ÙËÓ ∫›Ó·, fiÔ˘ ¿ÓıÚˆÔÈ, ÙËÓ¿ Î·È ¯Ô›ÚÔÈ

Û˘Á¯ÚˆÙ›˙ÔÓÙ·È (2,4). ∏ ÚÒÙË ‹Ù·Ó Ë ·Ó‰Ë-

Ì›· Ù˘ πÛ·ÓÈ΋˜ Áڛ˘ (1918) Î·È ÔÊÂÈÏfiÙ·Ó

ÛÙÔÓ ˘fiÙ˘Ô ∏1¡1. ∏ ·Ó‰ËÌ›· ·˘Ù‹ ‹Ù·Ó Ë

ÛÔ‚·ÚfiÙÂÚË Î·È ÈÔ Î·Ù·ÛÙÚÔÊÈ΋ ÂȉËÌ›·

ÏÔÈÌÒ‰Ô˘˜ ÓfiÛÔ˘ Ô˘ ÂΉËÏÒıËΠÛÙË ÓÂfiÙÂ-

ÚË ·ÓıÚÒÈÓË ÈÛÙÔÚ›· Î·È ÛÙÔ›¯ÈÛ ÙË ˙ˆ‹ ÛÂ

ÂÚÈÛÛfiÙÂÚÔ˘˜ ·fi 20 ÂηÙÔÌ̇ÚÈ· ·ÓıÚÒ-

Ô˘˜ (5). √È ‰‡Ô ÂfiÌÂÓ˜ ·Ó‰Ë̛˜ ‹Ù·Ó ·˘-

Ù¤˜ Ù˘ ∞ÛÈ·ÙÈ΋˜ Áڛ˘ ÙÔ 1957, ·fi ÙÔ ÛÙ¤-

ϯԘ ∏2¡2, Î·È Ù˘ Áڛ˘ ÙÔ˘ ÃÔÓÁÎ ∫ÔÓÁÎ

ÙÔ 1968, Ô˘ ÚÔÎÏ‹ıËΠ·fi ÙÔ Û٤ϯԘ

∏3¡2. √È ‰‡Ô ÙÂÏÂ˘Ù·›Â˜ ·Ó‰Ë̛˜ ‹Ù·Ó

ËÈfiÙÂÚ˜ ·fi ·˘Ù‹Ó ÙÔ˘ 1918 Î·È ÚÔοÏÂÛ·Ó

ÂÚ› ÙÔ ¤Ó· ÂηÙÔÌ̇ÚÈÔ ı·Ó¿ÙÔ˘˜ Ë Î·ıÂÌ›·.

™‹ÌÂÚ·, ÈÛÙ‡ÂÙ·È fiÙÈ Î·È ÛÙȘ ‰‡Ô ·˘Ù¤˜ Â-

ÚÈÙÒÛÂȘ Ù· ÛÙÂϤ¯Ë Ô˘ ÙȘ ÚÔοÏÂÛ·Ó

ÚÔ‹Ïı·Ó ·fi ·Ó¿ÌÈÍË Î·È ·ÓÙ·ÏÏ·Á‹ ÁÂÓÂÙÈ-

ÎÔ‡ ˘ÏÈÎÔ‡ (reassortment) ÌÂٷ͇ ·ÓıÚÒÈÓˆÓ

ÛÙÂϯÒÓ Î·È ÛÙÂϯÒÓ ÙˆÓ ÙËÓÒÓ (7). ∆· ÙÂ-

ÏÂ˘Ù·›· ¯ÚfiÓÈ· ΢ÎÏÔÊÔÚ› ΢ڛˆ˜ Ô ˘fiÙ˘Ô˜

∏3¡2, Ô˘ Û˘Ó¤¯È˙ ӷ ˘Ê›ÛÙ·Ù·È ÂÏ¿ÛÛÔÓ˜

·ÓÙÈÁÔÓÈΤ˜ ÌÂÙ·‚ÔϤ˜, Î·È ÏÈÁfiÙÂÚÔ Ô ∏1¡1

ηıÒ˜ Î·È ÙÔ Û٤ϯԘ µ. °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi, Ù·

ÂÌ‚fiÏÈ· Áڛ˘ οı ¯ÚfiÓÔ, ÂÚȤ¯Ô˘Ó ÙÚ›·

ÛÙÂϤ¯Ë ÈÒÓ Áڛ˘ ∏3¡2, ∏1¡1 Î·È µ.

™Â ·ÓÙ›ıÂÛË Ì ÙȘ ·Ó‰Ë̛˜ ÙÔ˘ 1957 ηÈ

ÙÔ˘ 1968, ·˘Ù‹ ÙÔ˘ 1918 ‰ÂÓ ÚÔ‹Ïı ·fi ·Ó¿-

ÌÈÍË Î·È ·ÓÙ·ÏÏ·Á‹ ÁÂÓÂÙÈÎÔ‡ ˘ÏÈÎÔ‡

(reassortment) ÌÂٷ͇ ‰‡Ô ÛÙÂϯÒÓ (7). ∏

ÚfiÛÊ·ÙË ·Ó¿Ï˘ÛË ÙÔ˘ ÁÔÓȉÈÒÌ·ÙÔ˜ ÙÔ˘ ÛÙÂ-

Ϥ¯Ô˘˜ ∏1¡1 Ù˘ Áڛ˘ ÙÔ˘ 1918 ·fi ÙÔ˘˜

Taubeneberger Î·È Û˘Ó, ¤‰ÂÈÍ fiÙÈ Î·È Ù· 8 ÁÔÓ›-

‰È· ÙÔ˘ ÈÔ‡ ÌÔÈ¿˙Ô˘Ó ÂÚÈÛÛfiÙÂÚÔ Ì ÛÙÂϤ¯Ë

Áڛ˘ ÙËÓÒÓ ·Ú¿ Ì ÛÙÂϤ¯Ë Ô˘ ÚÔ¤Ú¯Ô-

ÓÙ·È ·fi ¿ÏÏ· ˙ˆÈο ›‰Ë ‹ ÙÔÓ ¿ÓıÚˆÔ (8).

∆Ô Â‡ÚËÌ· ·˘Ùfi ‰Â›¯ÓÂÈ fiÙÈ Î¿ÔÈÔ Û٤ϯԘ

ÙˆÓ ÙËÓÒÓ ÌfiÚÂÛ ӷ ÚÔÛ‚¿ÏÂÈ ÙÔ˘˜ ·Ó-

ıÚÒÔ˘˜ Î·È Ó· ÚÔÛ·ÚÌÔÛÙ› Û ·˘ÙÔ‡˜, ÒÛÙÂ

Ó· ÌÔÚ› Ó· ÌÂÙ·‰›‰ÂÙ·È ·ÔÙÂÏÂÛÌ·ÙÈο ·fi

¿ÓıÚˆÔ ÛÂ ¿ÓıÚˆÔ.

™ËÌ·ÓÙÈÎfiÙ·ÙÔ Â›Ù¢ÁÌ· Ù˘ ÌÔÚȷ΋˜

‚ÈÔÏÔÁ›·˜ ·ÔÙ¤ÏÂÛÂ Ë ÚfiÛÊ·ÙË ·Ó·Û‡ÛÙ·ÛË

ÙÔ˘ ÈÔ‡ Ù˘ Áڛ˘ ÙÔ˘ 1918 ÛÙÔ ÂÚÁ·ÛÙ‹ÚÈÔ

Î·È ÙÒÚ· ÙÔ Û٤ϯԘ ‚Ú›ÛÎÂÙ·È ÛÙË ‰È¿ıÂÛË

ÙˆÓ ÂÚ¢ÓËÙÒÓ ÁÈ· ÂÚ·ÈÙ¤Úˆ ·Ó¿Ï˘ÛË (9). ∏

̤¯ÚÈ Û‹ÌÂÚ· ÌÂϤÙË Û ΢ÙÙ·ÚÔηÏÏȤÚÁÂȘ

ηıÒ˜ Î·È Û ˙Ò· ÛÙÔ ÂÚÁ·ÛÙ‹ÚÈÔ, ¤‰ÂÈÍ fiÙÈ

ÙÔ Û٤ϯԘ ·˘Ùfi ¤¯ÂÈ ÙÔ˘Ï¿¯ÈÛÙÔÓ ‰‡Ô ÌÔÓ·-

‰ÈΤ˜ ȉÈfiÙËÙ˜. ∏ ı·Ó·ÙËÊfiÚÔ˜ ‰Ú¿ÛË ÙÔ˘

ÛÙ· ÔÓÙ›ÎÈ· Â›Ó·È ÙÔ˘Ï¿¯ÈÛÙÔÓ 100 ÊÔÚ¤˜

˘„ËÏfiÙÂÚË Û ۇÁÎÚÈÛË Ì ¿ÏÏÔ˘˜ ÈÔ‡˜ ÁÚ›-

˘. ∫·Ù¿ ‰Â‡ÙÂÚÔ ÏfiÁÔ, Ô Èfi˜ ·˘Ùfi˜ ¤¯ÂÈ ÙËÓ

ÈηÓfiÙËÙ· Ó· ÂÓÂÚÁÔÔÈ› ÌfiÓÔ˜ ÙÔ˘ ÙËÓ ·ÈÌÔ-

Û˘ÁÎÔÏÏËÙ›ÓË ÙÔ˘ ̤ۈ Ù˘ ‰Ú¿Û˘ Ù˘ Ó¢-

Ú·ÌÈÓȉ¿Û˘ (9). ∏ Û˘Ó¯È˙fiÌÂÓË ÌÂϤÙË ı·

·˘Í‹ÛÂÈ ÙȘ ÁÓÒÛÂȘ Ô˘ Û‹ÌÂÚ· ¤¯Ô˘Ì ۯÂÙÈ-

ο Ì ÙÔÓ ÙÚfiÔ Ô˘ ‰Ú· ÙÔ Û٤ϯԘ ·˘Ùfi ηÈ

ÚÔηÏ› ÛÔ‚·Ú‹ ÓfiÛÔ, Î·È ı· ‚ÔËı‹ÛÂÈ ÛÙËÓ

·Ó¿Ù˘ÍË Ó¤ˆÓ ıÂڷ¢ÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ.

¡¤ÔÈ ·Ú¿ÁÔÓÙ˜, fiˆ˜ ·˘ÙÔ› Ô˘ ·Ó·ÛÙ¤Ï-

ÏÔ˘Ó ÙË ‰Ú¿ÛË ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ, ÌÔÚÔ‡Ó

ÙÒÚ· Ó· ÌÂÏÂÙËıÔ‡Ó ˆ˜ ıÂڷ›˜ Ô˘ ÂÓ‰¤-

¯ÂÙ·È Ó· ÌÂÈÒÛÔ˘Ó ÙË ıÓËÙfiÙËÙ· Ù˘ Áڛ˘ ÛÂ

ÂÚ›ÙˆÛË ·Ó‰ËÌ›·˜. ∏ ÚfiÛÊ·ÙË ÌÂϤÙË

ÙˆÓ ÛÙÂϯÒÓ Áڛ˘ Ô˘ ÚÔοÏÂÛ·Ó ÙȘ

ÚÔËÁÔ‡ÌÂÓ˜ ·Ó‰Ë̛˜, ηٿÊÂÚ ӷ ÚÔÛ-

‰ÈÔÚ›ÛÂÈ ÛËÌ·ÓÙÈΤ˜ ÁÂÓÂÙÈΤ˜ ÌÂÙ·‚ÔϤ˜ Ô˘

Â›Ó·È ··Ú·›ÙËÙ˜ ÒÛÙ ٷ ÛÙÂϤ¯Ë ÙˆÓ ÙË-

ÓÒÓ Ó· ÌÔÚÔ‡Ó Ó· ÌÂÙ·‰›‰ÔÓÙ·È Â‡ÎÔÏ·

ÛÙÔ˘˜ ·ÓıÚÒÔ˘˜. √È ÁÓÒÛÂȘ ·˘Ù¤˜ Î·È ÂΛ-

Ó˜ Ô˘ ı· ·ÔÎÙËıÔ‡Ó ·fi ÙË Û˘Ó¯È˙fiÌÂÓË

¤Ú¢ӷ, ı· ÌÔÚ¤ÛÔ˘Ó Ó· ‚ÔËı‹ÛÔ˘Ó ÙÔ˘˜

ÂÚ¢ÓËÙ¤˜ ÛÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË Ù˘ ÂͤÏÈ͢

ÙˆÓ ÈÒÓ ÙˆÓ ÙËÓÒÓ Î·È ÛÙËÓ Úfi‚ÏÂ„Ë ÙÔ˘

ÎÈÓ‰‡ÓÔ˘ ·Ó¿Ù˘Í˘ ·Ó‰ËÌ›·˜ (7).

∏ ·ÂÈÏ‹ ÌÈ·˜ Ó¤·˜ ·Ó‰ËÌ›·˜ ·fi ÙÔ

Û٤ϯԘ ∏5¡1 Ù˘ Áڛ˘ ÙˆÓ ÙËÓÒÓ

Ÿˆ˜ ·Ó·Ê¤ÚıËΠ·Ú·¿Óˆ, Ù· ˘‰Úfi‚È·

Î·È ÌÂÙ·Ó·ÛÙ¢ÙÈο ÙËÓ¿ ·ÔÙÂÏÔ‡Ó ÙÔ˘˜

Ê˘ÛÈÎÔ‡˜ ÍÂÓÈÛÙ¤˜ ÙˆÓ ÈÒÓ Ù˘ Áڛ˘ Ù‡Ô˘

∞ Î·È Û˘¯Ó¿ ÚÔÛ‚¿ÏÏÔÓÙ·È ·fi ÛÙÂϤ¯Ë Ô˘

Û˘Ó‹ıˆ˜ ¤¯Ô˘Ó ¯·ÌËÏ‹ ÏÔÈÌÔÁfiÓÔ ‰‡Ó·ÌË. √È

ÈÔ› Áڛ˘ ÔÏÏ·Ï·ÛÈ¿˙ÔÓÙ·È ÛÙÔ Á·ÛÙÚÂÓÙÂ-

ÚÈÎfi Û‡ÛÙËÌ· ÙˆÓ ÙËÓÒÓ Î·È ·Ô‚¿ÏÏÔÓÙ·È

Ì ٷ ÎfiÚ·Ó· ÛÙÔ ÓÂÚfi ÚÔηÏÒÓÙ·˜ ¤Ó·Ó

·ÎÏÔ ÂÓÙÂÚÔ-ÛÙÔÌ·ÙÈ΋˜ ÌÂÙ¿‰ÔÛ˘ (10).

∞fi Ù· ˘‰Úfi‚È· ÙËÓ¿, ÔÈ ÈÔ› Ù˘ Áڛ˘ ÌÂÚÈ-

Τ˜ ÊÔÚ¤˜ ÌÂÙ·‰›‰ÔÓÙ·È Û ¿ÏÏ· ›‰Ë ÙËÓÒÓ,

fiˆ˜ ÔÈ fiÚÓÈı˜ ‹ ÔÈ Á·ÏÔԇϘ, ·ÏÏ¿ Î·È ÛÂ

ıËÏ·ÛÙÈο. ∏ ‚·Ú‡ÙËÙ· Ù˘ Ïԛ̈͢ ÛÙ·

Ô˘ÏÂÚÈο ÔÈΛÏÏÂÈ ·fi ‹È· ‹ Î·È ·Û˘ÌÙˆ-

Ì·ÙÈ΋ ¤ˆ˜ ÛÔ‚·Ú‹, ÂÓÒ ÌÂÚÈΤ˜ ÊÔÚ¤˜ Ë ÏÔ›-

̈ÍË Â›Ó·È ı·Ó·ÙËÊfiÚÔ˜. ¶ÚÔÛ‚¿ÏÏÂÙ·È Û˘-

Ó‹ıˆ˜ ÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi Û‡ÛÙËÌ· ·ÏÏ¿ Û ÔÚÈ-

Ṳ̂Ó˜ ÂÚÈÙÒÛÂȘ ÌÔÚ› Ó· ÚÔÛ‚ÏËı›

Î·È ÙÔ ·Ó·Ó¢ÛÙÈÎfi, fiˆ˜ Û˘Ì‚·›ÓÂÈ Ì ٷ

ıËÏ·ÛÙÈο. ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ¤¯ÂÈ ·Ú·ÙË-

ÚËı› fiÙÈ Ù· ÙËÓ¿ ÚÔÛ‚¿ÏÏÔÓÙ·È ·fi ÛÙÂϤ-

¯Ë ÈÒÓ Áڛ˘ Ì ÂÈÊ·ÓÂȷΤ˜ ·ÈÌÔÛ˘ÁÎÔÏÏË-

Ù›Ó˜ ∏5 ΢ڛˆ˜, ·ÏÏ¿ Î·È ∏7, Ô˘ ÂÌÊ·Ó›˙Ô˘Ó

·˘ÍË̤ÓË ÏÔÈÌÔÁfiÓÔ ‰‡Ó·ÌË Î·È ÚÔηÏÔ‡Ó

¶·È‰È·ÙÚÈ΋ 2006;69:1-9

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5°Ú›Ë ÙˆÓ ÙËÓÒÓ

˘„ËÏ‹˜ ·ıÔÁÔÓÈÎfiÙËÙ·˜ ÁÚ›Ë ÙˆÓ ÙËÓÒÓ(high patho-genicity avian influenza, HPAI).

¶ÚÈÓ ·fi ÙÔ 1997, ÂÈÎÚ·ÙÔ‡ÛÂ Ë ¿Ô„ËfiÙÈ ÔÈ ˘„ËÏ‹˜ ·ıÔÁÔÓÈÎfiÙËÙ·˜ ÈÔ› Áڛ˘ ÙˆÓÙËÓÒÓ (HPAI) ‰ÂÓ ÌÔÚÔ‡Ó Ó· ÚÔÛ‚¿ÏÔ˘ÓÙÔ˘˜ ·ÓıÚÒÔ˘˜ ‰ÈfiÙÈ ˘¿Ú¯Ô˘Ó ÂÚÈÔÚÈÛÌÔ›Û ÌÔÚÈ·Îfi Â›Â‰Ô Ô˘ ‰ÂÓ ÂÈÙÚ¤Ô˘Ó ÙËÓÌÂÙ¿‰ÔÛË ·fi Ù· ÙËÓ¿ ÛÙÔ˘˜ ·ÓıÚÒÔ˘˜. ∫È·˘Ùfi ÁÈ·Ù› ÔÈ ¿ÓıÚˆÔÈ ¤¯Ô˘Ó ˘Ô‰Ô¯Â›˜ ÁÈ··ÓıÚÒÈÓÔ˘˜ ÈÔ‡˜ Î·È Ù· ÙËÓ¿ ‰È·ı¤ÙÔ˘Ó˘Ô‰Ô¯Â›˜ ÁÈ· ÙÔ˘˜ ÈÔ‡˜ ÙˆÓ ÙËÓÒÓ. ∏ ÂΉ‹-ψÛË ÂȉËÌÈÒÓ Áڛ˘ ˘„ËÏ‹˜ ·ıÔÁÔÓÈÎfi-ÙËÙ·˜ ÛÙ· ÙËÓ¿ ÂÚÈÁÚ¿ÊËΠÁÈ· ÚÒÙË ÊÔÚ¿ÙÔ 1878 ˆ˜ “·ÓÒÏË ÙˆÓ ÙËÓÒÓ”, ·ÏÏ¿ ‰ÂÓ Â›-¯Â ˘¿ÚÍÂÈ ÔÙ¤ ¤Ó‰ÂÈÍË fiÙÈ ÌÔÚ› Ó· ÌÂÙ·‰Ô-ı› ÛÙÔ˘˜ ·ÓıÚÒÔ˘˜, ·Ó Î·È ˘‹ÚÍ·Ó ·ÚÎÂÙ¤˜Â˘Î·Èڛ˜ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÔÏÏ·ÏÒÓÂȉËÌÈÎÒÓ ÂÍ¿ÚÛÂˆÓ ÛÙ· ÙËÓ¿ Ô˘ ¤¯Ô˘ÓηٷÁÚ·Ê› ÛÙËÓ ÈÛÙÔÚ›· (6). √ÚÔÏÔÁÈΤ˜ fï˜ÌÂϤÙ˜ ÛÙËÓ ∂˘ÚÒË Î·È ÙȘ ∏.¶.∞. ¤¯Ô˘Ó ‰Â›-ÍÂÈ fiÙÈ ˘‹ÚÍ ·Û˘Ìو̷ÙÈ΋ Ïԛ̈ÍË ÛÙÔ˘˜·ÓıÚÒÔ˘˜, Ì ‰È·ÊfiÚÔ˘˜ ˘ÔÙ‡Ô˘˜ ÁÚ›Ë˜ÙˆÓ ÙËÓÒÓ. ∂Í·›ÚÂÛË ÛÙ· fiÛ· ·Ó·Ê¤ÚıËηÓ

ÈÔ ¿Óˆ ˘‹ÚÍ ›Û˘ Ë ÌÂÙ¿‰ÔÛË ÛÙÂϯÒÓÌ ·ÈÌÔÛ˘ÁÎÔÏÏËÙ›ÓË ∏7 Ô˘ ÚÔοÏÂÛ·Ó ÂÈ-ÂÊ˘Î›Ùȉ· Û ·ÓıÚÒÔ˘˜.

∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, Èı·Ófiٷٷ ÏfiÁˆ ηÈÙÔ˘ Û‡Á¯ÚÔÓÔ˘ ÙÚfiÔ˘ ˙ˆ‹˜, ¤¯ÂÈ ·˘ÍËı› ËÛ˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ÂȉËÌÈÒÓ Áڛ˘ ÛÙ·ÙËÓ¿. √È ÂȉË̛˜ ·˘Ù¤˜ ¤¯Ô˘Ó ÙÂÚ¿ÛÙȘÔÈÎÔÓÔÌÈΤ˜ Û˘Ó¤ÂȘ Î·È Ï‹ÙÙÔ˘Ó ÛÔ‚·Ú¿ÙȘ ÔÈÎÔÓƠ̂˜ ÙˆÓ ¯ˆÚÒÓ ÛÙȘ Ôԛ˜ ÂΉË-ÏÒÓÔÓÙ·È.

π‰È·›ÙÂÚË ÛËÌ·Û›· ¤¯ÂÈ Ë ¯ˆÚ›˜ ÚÔËÁÔ‡ÌÂ-ÓÔ ‰È¿‰ÔÛË ÙÔ˘ ÛÙÂϤ¯Ô˘˜ ∏5¡1 ÛÙ· ¿ÁÚÈ·ÙËÓ¿ Î·È Ù· Ô˘ÏÂÚÈο Û ÔÏϤ˜ ·ÛÈ·ÙÈΤ˜¯ÒÚ˜ (11-13). Èڛ˜ ÚÔËÁÔ‡ÌÂÓÔ Â›Ó·È Â›-Û˘ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ô Èfi˜ ·˘Ùfi˜ ·¤ÎÙËÛ ÙËÓÈηÓfiÙËÙ· Ó· ÌÂÙ·‰›‰ÂÙ·È ·fi Ù· Ô˘ÏÂÚÈοÛÙÔÓ ¿ÓıÚˆÔ. √ Èfi˜ ∏5¡1 Ê·›ÓÂÙ·È fiÙÈ ÚÔ-¤Ú¯ÂÙ·È ·fi ÙË ÓÔÙÈÔ·Ó·ÙÔÏÈ΋ ∫›Ó· fiÔ˘‰È·ÈÛÙÒıËÎÂ Ë ·ÚÔ˘Û›· ÙÔ˘ ÁÈ· ÚÒÙË ÊÔÚ¿ÙÔ 1996. ∆Ô 1997 ÚÔοÏÂÛ ÌÂÁ¿ÏË ÂȉËÌ›·ÛÙ· Ô˘ÏÂÚÈο ÛÙÔ ÃÔÓÁÎ ∫ÔÓÁÎ Î·È ÁÈ· ÚÒ-ÙË ÊÔÚ¿ ‰È·ÈÛÙÒıËΠÌÂÙ¿‰ÔÛË Û ·ÓıÚÒ-Ô˘˜. ∫·Ù·ÁÚ¿ÊËÎ·Ó 18 ÂÚÈÙÒÛÂȘ ·fi ÙȘ

¶·È‰È·ÙÚÈ΋ 2006;69:1-9

∂ÈÎfiÓ· 2. ¢ËÌÈÔ˘ÚÁ›· ÂÓfi˜ ÛÙÂϤ¯Ô˘˜ ÈÔ‡ Áڛ˘ Ì ‰˘Ó·ÌÈÎfi Ó· ÚÔηϤÛÂÈ ·Ó‰ËÌ›·.∏ ·Ó¿ÌÈÍË Î·È ·ÓÙ·ÏÏ·Á‹ ÁÂÓÂÙÈÎÔ‡ ˘ÏÈÎÔ‡ (reassortment) ÌÂٷ͇ ·ÓıÚÒÈÓˆÓ ÛÙÂϯÒÓ ÈÔ‡ Áڛ˘ Î·È ÛÙÂϯÒÓÔ˘ ÚÔÛ‚¿ÏÏÔ˘Ó Ù· ÙËÓ¿ ‰È¢ÎÔχÓÂÙ·È ·fi ÙË ‰È·›ÚÂÛË ÙÔ˘ ÁÂÓÒÌ·ÙÔ˜ ÙÔ˘ ÈÔ‡ Ù˘ Áڛ˘ ∞ Û 8 ÙÌ‹Ì·Ù· ηÈÌÔÚ› Ó· Û˘Ì‚Â› ηٿ ÙË ‰È¿ÚÎÂÈ· Ù·˘Ùfi¯ÚÔÓ˘ Ïԛ̈͢ ÂÓfi˜ ΢ÙÙ¿ÚÔ˘ Î·È Ì ٷ ‰‡Ô ÛÙÂϤ¯Ë. ∏ Ù·˘Ùfi¯ÚÔÓË·˘Ù‹ Ïԛ̈ÍË ÌÔÚ› Ó· Û˘Ì‚Â› ÛÙÔ˘˜ ¯Ô›ÚÔ˘˜ - ÔÈ ÔÔ›ÔÈ ÌÔÚÔ‡Ó Ó· ÚÔÛ‚ÏËıÔ‡Ó Î·È ·fi ·ÓıÚÒÈÓÔ Èfi Î·È ·fiÈfi ÙˆÓ ÙËÓÒÓ - ‹ ÛÙÔ˘˜ ·ÓıÚÒÔ˘˜. ∆ÚÔÔÔÈË̤ÓË ·fi (5).

¶ÙËÓ¿ ÕÓıÚˆÔ˜

ÃÔ›ÚÔ˜

¶ÙËÓ¿ Ì ÁÚ›Ë ∞ (∏5¡1)

∫‡ÙÙ·ÚÔ Ô˘ ¤¯ÂÈ ÌÔÏ˘Óı› Ù·˘Ùfi¯ÚÔÓ· Î·È ·fi ÙÔ˘˜ ‰‡Ô ÈÔ‡˜

¡¤Ô Û٤ϯԘ Ì ÌÈÎÙfi ÁÂÓÂÙÈÎfi ˘ÏÈÎfi

¡¤Ô˜ Èfi˜ Ô˘ ÌÂÙ·‰›‰ÂÙ·È ÛÙÔÓ ¿ÓıÚˆÔ

∫‡ÙÙ·ÚÔ ¯Ô›ÚÔ˘ Ô˘ ¤¯ÂÈ ÌÔÏ˘Óı›ٷ˘Ùfi¯ÚÔÓ· Î·È ·fi ÙÔ˘˜ ‰‡Ô ÈÔ‡˜ ¡¤Ô Û٤ϯԘ Ì ÌÈÎÙfi ÁÂÓÂÙÈÎfi ˘ÏÈÎfi

∞ÓıÚÒÈÓÔ Û٤ϯԘ Áڛ˘ ∞

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6 ª. ∆ÛÔÏÈ¿ Î·È Û˘Ó.

Ôԛ˜ ÔÈ 6 ‹Ù·Ó ı·Ó·ÙËÊfiÚ˜. ∏ ¯ÒÚ· ·˘Ù‹

‹Ù·Ó Û ı¤ÛË Ó· Ï¿‚ÂÈ ¿ÌÂÛ· ̤ÙÚ· ı·Ó·ÙÒÓÔ-

ÓÙ·˜ 1,6 ÂηÙÔÌ̇ÚÈ· Ô˘ÏÂÚÈο Ì ·ÔÙ¤ÏÂ-

ÛÌ· Ó· ÂÏÂÁ¯ı› Ï‹Úˆ˜ Ë ÂȉËÌ›·. ∂ÎÙfi˜

·fi ÙË ı·Ó¿ÙˆÛË ÙˆÓ ÙËÓÒÓ ÂÊ·ÚÌfiÛÙËηÓ

Ù·˘Ùfi¯ÚÔÓ· Î·È ·˘ÛÙËÚ¿ ÚÔÏËÙÈο ̤ÙÚ·.

¢˘ÛÙ˘¯Ò˜, ·ÚfiÌÔÈ· ̤ÙÚ· ‰ÂÓ ‹Ù·Ó ‰˘Ó·Ùfi

Ó· ÂÊ·ÚÌÔÛÙÔ‡Ó Û ¿ÏϘ ·ÛÈ·ÙÈΤ˜ ¯ÒÚ˜ ÌÂ

·ÔÙ¤ÏÂÛÌ· ÔÈ ÈÔ› ∏5¡1 Ó· ΢ÎÏÔÊÔÚÔ‡Ó ÛÙ·

ÙËÓ¿, ȉȷ›ÙÂÚ· ÛÙȘ ¿È˜ Î·È ÛÙȘ ¯‹Ó˜,

Î·È Ó· ÌÔÚÔ‡Ó Ó· ˘Ê›ÛÙ·ÓÙ·È ÁÂÓÂÙÈ΋ ηÈ

·ÓÙÈÁÔÓÈ΋ ÂͤÏÈÍË Î·È Ó· ÂÂÎÙ›ÓÔ˘Ó ÙË Áˆ-

ÁÚ·ÊÈ΋ ÙÔ˘˜ ηٷÓÔÌ‹ Î·È ÙÔ Â‡ÚÔ˜ ÙˆÓ ÍÂÓÈ-

ÛÙÒÓ ÙÔ˘˜ ÔÔ›Ô˘˜ ÌÔÚÔ‡Ó Ó· ÚÔÛ‚¿ÏÔ˘Ó.

ŒÙÛÈ ÙÔ 2003 Ô Èfi˜ ÂÌÊ·Ó›ÛÙËÎÂ Î·È ¿ÏÈ ÛÂ

¿ÁÚÈ·, Â͈ÙÈο Î·È ÔÈÎfiÛÈÙ· ÙËÓ¿ ÛÂ Ê˘ÛÈο

¿Úη ÙÔ˘ ÃÔÓÁÎ ∫ÔÓÁÎ (11,13). ∂ΉËÏÒıË-

Î·Ó Ì¿ÏÈÛÙ· Î·È ‰‡Ô ÎÚÔ‡ÛÌ·Ù· Û ·ÓıÚÒ-

Ô˘˜, ·fi Ù· ÔÔ›· ÙÔ ¤Ó· ‹Ù·Ó ı·Ó·ÙËÊfiÚÔ.

∞fi ÙÔ Ù¤ÏÔ˜ ÙÔ˘ 2003 ¤¯ÂÈ ÛËÌÂȈı› Ë ÌÂÁ·-

χÙÂÚË ÛÙËÓ ÈÛÙÔÚ›· ÂȉËÌÈ΋ ¤ÎÚËÍË Áڛ˘

ÛÙ· ÙËÓ¿, ÛÙȘ ·ÛÈ·ÙÈΤ˜ ΢ڛˆ˜ ¯ÒÚ˜. ∂È-

‰Ë̛˜ ¤¯Ô˘Ó ÛËÌÂȈı› ÛÙÔ µÈÂÙÓ¿Ì, ÙËÓ ∆·˚-

Ï¿Ó‰Ë, ÙËÓ πÓ‰ÔÓËÛ›·, ÙËÓ ∫·ÌfiÙ˙Ë, ÙÔ §¿Ô˜,

ÙË ª·Ï·ÈÛ›·, ÙËÓ ∫›Ó·, ÙËÓ ∫ÔÚ¤· Î·È ÙËÓ π·-

ˆÓ›·, ÙË ƒˆÛ›· (‰˘ÙÈ΋ ™È‚ËÚ›· Î·È ∫·˙·Î-

ÛÙ¿Ó), ÙËÓ ∆Ô˘ÚΛ·, ÙË ƒÔ˘Ì·Ó›· Î·È ÙËÓ ∫ÚÔ-

·Ù›· (15). ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÙÂÏÂ˘Ù·›ˆÓ

ÂÙÒÓ ‰È·ÈÛÙÒıËΠfiÙÈ Ù· ÛÙÂϤ¯Ë ∏5¡1

¤¯Ô˘Ó ·ÔÎÙ‹ÛÂÈ ÙËÓ ÈηÓfiÙËÙ· Ó· ÚÔÛ‚¿-

ÏÔ˘Ó Î·È Ù· ıËÏ·ÛÙÈο. ™ÙËÓ ∆·˚Ï¿Ó‰Ë ·Ú·-

ÙËÚ‹ıËΠÈfi˜ Áڛ˘ ∏5¡1 Û ¯Ô›ÚÔ˘˜ Û ‰‡Ô

·ÁÚÔÎÙ‹Ì·Ù·, Û ٛÁÚÂȘ Î·È ÏÂÔ·Ú‰¿ÏÂȘ ÛÂ

¤Ó· ˙ˆÔÏÔÁÈÎfi ΋Ô, ηıÒ˜ Î·È Û Á¿Ù˜ ÛÙËÓ

›‰È· ¯ÒÚ· (6).

¶ÚfiÛÊ·Ù˜ ÌÂϤÙ˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ Ù· ÌÂ-

Ù·Ó·ÛÙ¢ÙÈο ˘‰Úfi‚È· ÙËÓ¿ ·›˙Ô˘Ó ÛËÌ·-

ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ÂͿψÛË ÙˆÓ ÈÒÓ ∏5¡1

·ÊÔ‡ ÌÔÚÔ‡Ó Ó· ‰È¢ÎÔχÓÔ˘Ó ÙË ÌÂÙ¿‰ÔÛ‹

ÙÔ˘˜ ÛÙÔ˘˜ ˘‰Ô‚ÈfiÙÔÔ˘˜ Î·È ¤ÙÛÈ Ó· ÙË ÌÂÙ·-

ʤÚÔ˘Ó ·fi ÙÔ ¤Ó· ̤ÚÔ˜ Ù˘ Á˘ ÛÙÔ ¿ÏÏÔ (5).

∂¿Ó Ù· ÛÙÂϤ¯Ë ∏5¡1 ÚÔÛ·ÚÌÔÛıÔ‡Ó Ï‹Úˆ˜

ÛÙ· ˘‰Úfi‚È· ÙËÓ¿, ÙfiÙÂ Ë Ë ÁˆÁÚ·ÊÈ΋ ÂÍ¿-

ψۋ ÙÔ˘˜ ı· ÂÂÎÙ·ı› ·ÎfiÌË ÂÚÈÛÛfiÙÂÚÔ

Î·È Ë ·ÂÈÏ‹ Ù˘ ·Ó‰ËÌ›·˜ ı· ·˘ÍËı›.

¶ÂÚÈÙÒÛÂȘ Áڛ˘ ∏5¡1 Û ·ÓıÚÒÔ˘˜

¤¯Ô˘Ó ÛËÌÂȈı› Û ·ÚÎÂÙ¤˜ ·fi ÙȘ ·Ú·¿Óˆ

¯ÒÚ˜ (14). ∏ ÌÂÙ¿‰ÔÛË ÙÔ˘ ÈÔ‡ ¤ÁÈÓ Û ¿ÙÔ-

Ì· Ô˘ ›¯·Ó ·ʋ Ì ÌÔÏ˘Ṳ̂ӷ Ô˘ÏÂÚÈο

̤ۈ ÂÈÛÓÔ‹˜ ÌÔÏ˘ÛÌ¤ÓˆÓ ÛÙ·ÁÔÓȉ›ˆÓ ·fi

Ù· Ô˘ÏÂÚÈο ‹ Ù· ÎfiÚ·Ó¿ ÙÔ˘˜ ‹ ηٿ ÙËÓ

·Ú·Û΢‹ ÙÚÔÊ‹˜. µ¤‚·È·, Ë ÌÂÙ¿‰ÔÛË ·fi

Ù· ÙËÓ¿ ÛÙÔÓ ¿ÓıÚˆÔ Â›Ó·È ÂÍ·ÈÚÂÙÈο Û¿-

ÓÈÔ Ê·ÈÓfiÌÂÓÔ ·Ó ÏËÊı› ˘ã fi„ÈÓ fiÙÈ Ì¤¯ÚÈ Û‹-

ÌÂÚ· ¤¯Ô˘Ó ηٷÁÚ·Ê› 3300 ÂȉË̛˜ ÙÔ˘ ÈÔ‡

∏5 ÛÙ· ÙËÓ¿ Î·È 150 ÂηÙÔÌ̇ÚÈ· ¤¯Ô˘Ó ÊÔ-

Ó¢ı›, ÂÓÒ ¤¯Ô˘Ó ÛËÌÂȈı› ÌfiÏȘ 142 ÂÚÈ-

ÙÒÛÂȘ ÛÙÔÓ ¿ÓıÚˆÔ. ∏ ÓfiÛÔ˜ ¤¯ÂÈ Î·È ˘„Ë-

Ï‹ ıÓËÙfiÙËÙ· ·ÊÔ‡ ·fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ 142 ÂÚ-

Á·ÛÙËÚȷο ÂȂ‚·ÈˆÌ¤ÓˆÓ ÂÚÈÙÒÛÂˆÓ ÛË-

ÌÂÈÒıËÎ·Ó 74 ı¿Ó·ÙÔÈ ·Ó‚¿˙ÔÓÙ·˜ ÙË ıÓËÙfi-

ÙËÙ· ÛÙÔ 52% (15). √ ı¿Ó·ÙÔ˜ ÛÙÔ˘˜ ·ÛıÂÓ›˜

·˘ÙÔ‡˜ ¤گÂÙ·È ÏfiÁˆ Ó¢ÌÔÓ›·˜ Î·È Ô-

Ï˘oÚÁ·ÓÈ΋˜ ·Ó¿ÚÎÂÈ·˜. ªÂÙ¿‰ÔÛË ·fi ¿Ó-

ıÚˆÔ Û ¿ÓıÚˆÔ ‰ÂÓ ¤¯ÂÈ ·Ô‰Âȯı› ÂÚÁ·-

ÛÙËÚȷο, ıˆÚÂ›Ù·È fï˜ ۯ‰fiÓ ‚¤‚·ÈË

(14,16). ¶·Ú·ÙËÚ‹ıËÎ·Ó Û˘ÁÎÂÓÙÚÒÛÂȘ ÂÚÈ-

ÛÙ·ÙÈÎÒÓ Û ÌÂÚÈΤ˜ ÔÈÎÔÁ¤ÓÂȘ ηıÒ˜ Î·È ÌÈ·

ÂÚ›ÙˆÛË ÌÂÙ¿‰ÔÛ˘ ·fi ÙÔ ¿ÚÚˆÛÙÔ ·È‰›

ÛÙË ÌËÙ¤Ú· ÙÔ˘ (17). ™ÙȘ ÂÚÈÙÒÛÂȘ ·˘Ù¤˜,

˘‹ÚÍ ÛÙÂÓ‹ ·ʋ ¯ˆÚ›˜ ÚÔÊ˘Ï¿ÍÂȘ ηÈ

Û η̛· ÂÚ›ÙˆÛË ‰ÂÓ ·Ú·ÙËÚ‹ıËΠÌÂÙ¿-

‰ÔÛË Ì ÌÈÎÚ¿ ÛÙ·ÁÔÓ›‰È·, ‰ËÏ·‰‹ ·ÂÚÔÁÂÓ‹˜.

ª¤¯ÚÈ Û‹ÌÂÚ· ‰ÂÓ ¤¯ÂÈ ·Ú·ÙËÚËı› ÌÂÙ¿‰ÔÛË

Û ȷÙÚÔÓÔÛËÏ¢ÙÈÎfi ÚÔÛˆÈÎfi ·ÎfiÌË Î·È ÛÂ

ÂÚÈÙÒÛÂȘ fiÔ˘ Ù· ̤ÙÚ· ÚÔʇϷ͢ ‹Ù·Ó

ÂÏÏÈ‹.

º·›ÓÂÙ·È ÂÔ̤ӈ˜ fiÙÈ, ÚÔ˜ ÙÔ ·ÚfiÓ

ÙÔ˘Ï¿¯ÈÛÙÔÓ, Ô Èfi˜ ∏5¡1 ‰ÂÓ ÌÔÚ› Ó· ÌÂÙ·-

‰Ôı› ·ÔÙÂÏÂÛÌ·ÙÈο ·fi ¿ÓıÚˆÔ Û ¿Ó-

ıÚˆÔ Î·È ÂÔ̤ӈ˜ ‰ÂÓ ÌÔÚ› Ó· ÚÔηϤ-

ÛÂÈ ·Ó‰ËÌ›·. ªÔÚ› fï˜ Ô Èfi˜ Ó· ·ÔÎÙ‹-

ÛÂÈ ÙËÓ ÈηÓfiÙËÙ· ·˘Ù‹ ·Ó¿ ¿Û· ÛÙÈÁÌ‹, ̤-

Ûˆ ÌÈ·˜ ÚÔԉ¢ÙÈ΋˜ ‰È·‰Èηۛ·˜ ÚÔÛ·ÚÌÔ-

ÛÙÈÎÒÓ ÁÂÓÂÙÈÎÒÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ ‹ Ì ·ÓÙ·ÏÏ·-

Á‹ ÁÂÓÂÙÈÎÔ‡ ˘ÏÈÎÔ‡ ·fi ¤Ó· Û٤ϯԘ ·ÓıÚÒ-

ÈÓÔ˘ ÈÔ‡ Áڛ˘ (5). ∏ ‰È·‚›ˆÛË ÙˆÓ ·ÓıÚÒ-

ˆÓ ˘fi Û˘Óı‹Î˜ Û˘Á¯ÚˆÙÈÛÌÔ‡ ÎÔÓÙ¿ ÛÂ

Ô˘ÏÂÚÈο Î·È ¯Ô›ÚÔ˘˜ ÛÙȘ ·ÛÈ·ÙÈΤ˜ ¯ÒÚ˜

·˘Í¿ÓÂÈ ÙËÓ Èı·ÓfiÙËÙ· ÂΉ‹ÏˆÛ˘ ÙÔ˘ Ê·È-

ÓÔ̤ÓÔ˘ ·˘ÙÔ‡. ™ÙËÓ ÂÚ›ÙˆÛË Ô˘ Ô Èfi˜ η-

Ù·ÛÙ› ÈηÓfi˜ Ó· ÌÂÙ·‰›‰ÂÙ·È Ù·¯¤ˆ˜ ·fi ¿Ó-

ıÚˆÔ Û ¿ÓıÚˆÔ ÌÔÚ› Ó· ‰È·‰Ôı› Û ÌÈ-

ÎÚfi ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· Û ÔÏfiÎÏËÚÔ ÙÔÓ ÎfiÛÌÔ

Î·È Ó· ÚÔÎÏËı› ·Ó‰ËÌ›·.

¶ÚÔÂÙÔÈÌ·Û›· ÁÈ· ÙËÓ ÚfiÏË„Ë Î·È

·ÓÙÈÌÂÙÒÈÛË ÌÈ·˜ ·Ó‰ËÌ›·˜

∞ÚÎÂÙ¤˜ ·ÓÂÙ˘Á̤Ó˜ ¯ÒÚ˜, ÌÂٷ͇ ÙˆÓ

ÔÔ›ˆÓ Î·È Ë ¯ÒÚ· Ì·˜, ¤¯Ô˘Ó ‹‰Ë ‰È·ÌÔÚÊÒÛÂÈ

Û¯¤‰ÈÔ ·ÓÙÈÌÂÙÒÈÛ˘ ÌÈ·˜ ÂӉ¯fiÌÂÓ˘ ·Ó-

‰ËÌ›·˜ Áڛ˘. ∫¿ÙÈ Ù¤ÙÔÈÔ fï˜, ‰ÂÓ Â›Ó·È ÂÊÈ-

ÎÙfi Û ·Ó·Ù˘ÛÛfiÌÂÓ˜ ÂÚÈÔ¯¤˜ ÙÔ˘ ÎfiÛÌÔ˘

Ô˘ ‹‰Ë ·ÓÙÈÌÂÙˆ›˙Ô˘Ó ÛÔ‚·Ú¿ ÎÔÈÓˆÓÈο,

¶·È‰È·ÙÚÈ΋ 2006;69:1-9

Pediatr Jan-Feb 06 final allges 27-01-06 15:34 ™ÂÏ›‰·6

Page 7: Παιδιατρική | Τόμος 69 • Τεύχος 1 • Ιανουάριος - Φεβρουάριος 2006

7°Ú›Ë ÙˆÓ ÙËÓÒÓ

ÔÈÎÔÓÔÌÈο ‹ ÔÏÈÙÈο ÚÔ‚Ï‹Ì·Ù·. ∏ ÚÔÂ-

ÙÔÈÌ·Û›· ÁÈ· ÙËÓ ¿ÌÂÛË ·ÓÙÈÌÂÙÒÈÛË Ù˘ ·Ó-

‰ËÌ›·˜ ÂÚÈÏ·Ì‚¿ÓÂÈ Ì¤ÙÚ· ÚÔʇϷ͢ ηٿ

Ù˘ ÌÂÙ¿‰ÔÛ˘ Ù˘ ÓfiÛÔ˘, ÙËÓ ‡·ÚÍË ‰È·ı¤ÛÈ-

ÌˆÓ ÌÂÁ¿ÏˆÓ ÔÛÔÙ‹ÙˆÓ ·ÓÙÈ-ÈÈÎÒÓ ·Ú·Áfi-

ÓÙˆÓ Î·È ÙËÓ ·Ó¿Ù˘ÍË ÂÓfi˜ ·ÔÙÂÏÂÛÌ·ÙÈÎÔ‡

ÂÌ‚ÔÏ›Ô˘ (10,11,13,16).

™‹ÌÂÚ·, ÚÔÙÂÚ·ÈfiÙËÙ· Ú¤ÂÈ Ó· ‰Ôı›

ÛÙË Ï‹„Ë Ì¤ÙÚˆÓ Ô˘ ı· ¤¯Ô˘Ó ˆ˜ ·ÔÙ¤ÏÂ-

ÛÌ· ÙÔÓ ÂÚÈÔÚÈÛÌfi Î·È ÙÔÓ ¤ÏÂÁ¯Ô Ù˘ Áڛ˘

∏5¡1 ÛÙ· ÙËÓ¿. ∆Ô ¤ÚÁÔ fï˜ ·˘Ùfi Â›Ó·È È‰È-

·›ÙÂÚ· ‰‡ÛÎÔÏÔ, Â¿Ó ÏËÊıÔ‡Ó ˘ã fi„ÈÓ ÔÈ Û˘Ó-

ı‹Î˜ Ô˘ ÂÈÎÚ·ÙÔ‡Ó ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜

·ÛÈ·ÙÈΤ˜ ¯ÒÚ˜. ∆· ̤ÙÚ· Ô˘ ˘ÈÔıÂÙ‹ıËηÓ

ÛÙÔ ÃÔÓÁÎ ∫ÔÓÁÎ ·ÔÙÂÏÔ‡Ó ·Ú¿‰ÂÈÁÌ· ÚÔ˜

Ì›ÌËÛË ·ÏÏ¿ ¤¯Ô˘Ó ·˘ÍË̤ÓÔ ÎfiÛÙÔ˜ ηÈ

··ÈÙÔ‡Ó ˘„ËÏfi Â›Â‰Ô ÔÚÁ¿ÓˆÛ˘ Ô˘ ‰ÂÓ

˘¿Ú¯ÂÈ ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ¯ÒÚ˜ (16). ™Â

ÔÏϤ˜ ·ÛÈ·ÙÈΤ˜ ¯ÒÚ˜, ÔÈ ÌÂÁ¿Ï˜ ÙËÓÔ-

ÙÚÔÊÈΤ˜ ÌÔÓ¿‰Â˜ Û˘Ó˘¿Ú¯Ô˘Ó Ì ÌÈÎÚÔ‡˜

·Ú·ÁˆÁÔ‡˜, ÔÏϤ˜ ·ÁÚÔÙÈΤ˜ ÔÈÎÔÁ¤ÓÂȘ

ÂÎÙÚ¤ÊÔ˘Ó Ô˘ÏÂÚÈο ÛÙËÓ ·˘Ï‹ ÙÔ˘˜, ÂÓÒ

Û˘Á¯ÚfiÓˆ˜ ˙ˆÓÙ·Ó¿ Ô˘ÏÂÚÈο ‰È·ÎÈÓÔ‡ÓÙ·È

ÛÙȘ ·ÁÔÚ¤˜. √ ÂÌ‚ÔÏÈ·ÛÌfi˜ ÙˆÓ ÙËÓÒÓ ÌÂ

·‰Ú·ÓÔÔÈË̤ÓÔ Èfi ∏5¡1 Â›Ó·È ·ÌÊÈÏÂÁfiÌÂÓÔ

̤ÙÚÔ. ∆· ÂÌ‚fiÏÈ· Ô˘ ˘¿Ú¯Ô˘Ó Û‹ÌÂÚ· η-

Ù¿ ÙÔ˘ ∏5¡1 ÁÈ· Ù· ÙËÓ¿ ·ÔÙÚ¤Ô˘Ó ÙËÓ

ÂΉ‹ÏˆÛË Û˘ÌÙˆÌ¿ÙˆÓ ·ÏÏ¿ fi¯È Î·È ÙËÓ

˘ÔÎÏÈÓÈ΋ Ïԛ̈ÍË. √ Èfi˜ Û˘Ó¯›˙ÂÈ Ó· ·Ô-

‚¿ÏÏÂÙ·È Î·È Ë Ïԛ̈ÍË ÌÔÚ› Ó· ÌÂÙ·‰›‰ÂÙ·È

·fi ·Û˘Ìو̷ÙÈο ÙËÓ¿ (16). Œ¯ÂÈ Â›Û˘

ÂÎÊÚ·Ûı› Ô Êfi‚Ô˜, fiÙÈ Ì ÙË ¯Ú‹ÛË ÙÔ˘˜ ¢-

ÓÔÂ›Ù·È Ë ÂÈÏÔÁ‹ ÌÂÙ·ÏÏ¿ÍÂˆÓ ÛÙÔ˘˜ ÈÔ‡˜

Ô˘ ΢ÎÏÔÊÔÚÔ‡Ó, ¤ÙÛÈ ÒÛÙ ӷ ·˘Í¿ÓÂÙ·È Ô

ΛӉ˘ÓÔ˜ Ù˘ Ïԛ̈͢ ÛÙ· ›‰È· Ù· ÙËÓ¿ ‹ ÛÂ

¿ÏÏ· ›‰Ë. ∂Í¿ÏÏÔ˘, Ì·˙È΋ ı·Ó¿ÙˆÛË ¿ÁÚȈÓ

ÙËÓÒÓ ‰ÂÓ Â›Ó·È ‰˘Ó·Ùfi Ó· ÂȯÂÈÚËı› ‰ÈfiÙÈ

ı· ‰ËÌÈÔ˘ÚÁ‹ÛÂÈ Ì›˙ÔÓ· ÔÈÎÔÏÔÁÈο ÚÔ‚Ï‹-

Ì·Ù· Î·È ‰ÂÓ Â›Ó·È ·Ô‰ÂÎÙ‹ ·fi ÔÏÏÔ‡˜ ‰ÈÂ-

ıÓ›˜ ÔÚÁ·ÓÈÛÌÔ‡˜.

∏ ÚÔÂÙÔÈÌ·Û›· ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘

·Ó‰ËÌ›·˜ ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ‡·ÚÍË ‰È·ı¤ÛÈ-

ÌˆÓ Â·ÚÎÒÓ ÔÛÔÙ‹ÙˆÓ ·ÓÙÈ-ÈÈÎÒÓ Ê·ÚÌ¿-

ΈÓ. ∆· ·Ï·ÈfiÙÂÚ· ·ÓÙÈÁÚÈÈο Ê¿Ú̷η ›-

Ó·È ÔÈ ·‰·Ì·ÓÙ¿Ó˜ (·Ì·ÓÙ·‰›ÓË Î·È ÚÈÌ·ÓÙ·-

‰›ÓË) Ô˘ ·Ó·ÛÙ¤ÏÏÔ˘Ó ÙËÓ ÚˆÙ½ÓË ª2. ¢˘-

ÛÙ˘¯Ò˜, Ù· ÛÙÂϤ¯Ë ∏5¡1 Ô˘ ΢ÎÏÔÊÔÚÔ‡Ó

ÛÙËÓ ∞Û›· ‰ÂÓ Â›Ó·È Â˘·›ÛıËÙ· ÛÙ· Ê¿Ú̷η

·˘Ù¿. ∆· ÓÂfiÙÂÚ· ·ÓÙÈÁÚÈÈο Ê¿Ú̷η ›ӷÈ

ÙÔ oseltamivir (Tamiflu) Î·È zanamivir

(Relenza) Ô˘ ‰ÚÔ˘Ó ˆ˜ ·Ó·ÛÙÔÏ›˜ Ù˘ Ó¢ڷ-

ÌÈÓȉ¿Û˘. ªÂ ÙÔÓ ÙÚfiÔ ·˘Ùfi, ÂÌÔ‰›˙ÂÙ·È Ë

›ÛÔ‰Ô˜ ÙÔ˘ ÈÔ‡ ÛÙÔ Î‡ÙÙ·ÚÔ Î·È Ë ·ÂÏ¢ı¤-

ÚˆÛ‹ ÙÔ˘ ·fi ·˘Ùfi. √È ÈÔ› ∏5¡1 Â›Ó·È Â˘·›-

ÛıËÙÔÈ ÛÙÔ˘˜ ·ÓÙÈ-ÈÈÎÔ‡˜ ·˘ÙÔ‡˜ ·Ú¿ÁÔÓÙ˜

ÔÈ ÔÔ›ÔÈ Â›Ó·È Î·Ù¿ÏÏËÏÔÈ Ó· ¯ÚËÛÈÌÔÔÈË-

ıÔ‡Ó ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÌÈ·˜ ·Ó‰ËÌ›·˜,

·ÚfiÏÔ Ô˘ ÙÂÏÂ˘Ù·›· ‰Â‰Ô̤ӷ ÂÈÛËÌ·›-

ÓÔ˘Ó ÙËÓ ÂÚÈÁÚ·Ê‹ ·ÓıÂÎÙÈÎfiÙËÙ·˜ Î·È Û ·˘-

Ù‹ ÙËÓ Î·ÙËÁÔÚ›· Ê·ÚÌ¿ÎˆÓ (18). ∞˜ ÛËÌÂȈ-

ı› fiÙÈ Î·Ó¤Ó· ·fi Ù· Ê¿Ú̷η ·˘Ù¿ ‰ÂÓ ¤¯ÂÈ

ÂÁÎÚÈı› ÁÈ· ¯ÔÚ‹ÁËÛË Û ·È‰È¿ ÌÈÎÚfiÙÂÚ· ÙÔ˘

ÂÓfi˜ ¤ÙÔ˘˜.

∆· Ê¿Ú̷η ·˘Ù¿ ı· Ú¤ÂÈ Ó· ¯ÚËÛÈÌÔ-

ÔÈËıÔ‡Ó ˆ˜ ıÂڷ›· Ì ÙËÓ ÂÌÊ¿ÓÈÛË ÙˆÓ

ÚÒÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Î·È fi¯È ˆ˜ ÚÔʇϷÍË,

‰ÈfiÙÈ Ë Ú·ÎÙÈ΋ ·˘Ù‹ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ

ÛÙËÓ ·Ó¿Ù˘ÍË ·ÓÙÔ¯‹˜. ∆Ô Tamiflu ¯ÔÚËÁ›-

Ù·È ·fi ÙÔ ÛÙfiÌ· Î·È ¤ÙÛÈ Â›Ó·È ÈÔ Â‡ÎÔÏÔ Ó·

¯ÚËÛÈÌÔÔÈËı› Û ۇÁÎÚÈÛË Ì ÙÔ Relenza

Ô˘ ΢ÎÏÔÊÔÚ› Û ÌÔÚÊ‹ ÛÎfiÓ˘ ÁÈ· ÂÈÛÓÔ-

¤˜. ¶ÔÏϤ˜ Â˘Úˆ·˚Τ˜ ¯ÒÚ˜, ÌÂٷ͇ ÙˆÓ

ÔÔ›ˆÓ Î·È Ë ∂ÏÏ¿‰·, ¤¯Ô˘Ó ‹‰Ë ·Ú·ÁÁ›ÏÂÈ

ÛÙË ‚ÈÔÌ˯·Ó›· οÔȘ ÔÛfiÙËÙ˜ ·ÓÙÈÁÚÈÈ-

ÎÒÓ Ê·ÚÌ¿ÎˆÓ Î·È Î˘Ú›ˆ˜ ÙÔ˘ Tamiflu. ∏ ·-

Ú·ÁˆÁ‹ ÌÂÁ¿ÏˆÓ ÔÛÔÙ‹ÙˆÓ ÙˆÓ ·Ú·ÁfiÓÙˆÓ

·˘ÙÒÓ, ÈηÓÒÓ Ó· ηχ„Ô˘Ó Ì¤ÚÔ˜ ÙÔ˘ ÏËı˘-

ÛÌÔ‡, ·ÚÔ˘ÛÈ¿˙ÂÈ ÛËÌ·ÓÙÈο ÂÌfi‰È·

(19,20). ∏ ·Ú·Û΢‹ ÙÔ˘˜ Â›Ó·È ·ÚÎÂÙ¿ Ôχ-

ÏÔÎË Î·È ··ÈÙÔ‡ÓÙ·È 12 ÂÚ›Ô˘ Ì‹Ó˜, ÂÓÒ

ÙÔ ÎfiÛÙÔ˜ Â›Ó·È ÌÂÁ¿ÏÔ. ª¤¯ÚÈ Û‹ÌÂÚ·, Ë ¯Ú‹-

ÛË ÙˆÓ ·Ú·ÁfiÓÙˆÓ ·˘ÙÒÓ ÛÙËÓ Î·ıËÌÂÚÈÓ‹

Ú¿ÍË, ÙÔ˘Ï¿¯ÈÛÙÔÓ ÛÙËÓ ∂˘ÚÒË, ‹Ù·Ó Ôχ

ÂÚÈÔÚÈṲ̂ÓË. ŒÙÛÈ, Ë ‚ÈÔÌ˯·Ó›· ‰ÂÓ Â›Ó·È ÛÂ

ı¤ÛË Ó· ·Ú·Û΢¿ÛÂÈ ÙÂÚ¿ÛÙȘ ÔÛfiÙËÙ˜

Û ‚Ú·¯‡ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· Î·È Ó· ·ÓÙÂÂͤÏ-

ıÂÈ ÛÙȘ ·Ó¿ÁΘ ÙÔ˘ ÎÔÈÓˆÓÈÎÔ‡ Û˘ÓfiÏÔ˘. ŒÓ·

¿ÏÏÔ ˙‹ÙËÌ· Ô˘ Ù›ıÂÙ·È, Â›Ó·È ÙÔ ÁÂÁÔÓfi˜ fiÙÈ

ÂÏ¿¯ÈÛÙ˜ ÌfiÓÔ ¯ÒÚ˜ ·Ú¿ÁÔ˘Ó ·ÓÙÈÁÚÈÈο

Ê¿Ú̷η Î·È Û ÂÚ›ÙˆÛË ·Ó‰ËÌ›·˜ ÚÔÙÂ-

Ú·ÈfiÙËÙ· ı· ‰Ôı›, ÂӉ¯Ô̤ӈ˜, ÛÙËÓ ÂÁ¯ÒÚÈ·

ηٷӿψÛË Î·È fi¯È ÛÙȘ ÂÍ·ÁˆÁ¤˜. ∆¤ÏÔ˜, ‰ÂÓ

Â›Ó·È ·ÎÚÈ‚Ò˜ ÁÓˆÛÙfi fiÛÔ ·ÔÙÂÏÂÛÌ·ÙÈο

ı· Â›Ó·È Ù· Ê¿Ú̷η ·˘Ù¿ ÁÈ· ÙÔÓ Èfi Ù˘ ·Ó-

‰ËÌ›·˜ Î·È fiÛÔ ÌÂÁ¿ÏÔ˜ Ô Î›Ó‰˘ÓÔ˜ ·Ó¿Ù˘-

͢ ·ÓÙÔ¯‹˜.

∞Ó Î·È Ù· ·ÓÙÈ-ÈÈο Ê¿Ú̷η ÌÔÚÔ‡Ó ÚÔ-

ÛˆÚÈÓ¿ Ó· ‚ÔËı‹ÛÔ˘Ó, ÙÔ ÈÔ ·ÔÙÂÏÂÛÌ·ÙÈÎfi

̤ÛÔ ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô ÌÈ·˜ ÂӉ¯fiÌÂÓ˘ ·Ó‰Ë-

Ì›·˜ Â›Ó·È Ô ÂÌ‚ÔÏÈ·ÛÌfi˜. ∏ Ù¯ÓÈ΋ Ù˘ ·Ó¿-

ÛÙÚÔÊ˘ ÁÂÓÂÙÈ΋˜ Ô˘ ·Ó·Ù‡¯ıËΠٷ ÙÂÏ¢-

Ù·›· ¯ÚfiÓÈ· ÂÈÙÚ¤ÂÈ Û‹ÌÂÚ· ÛÙÔ˘˜ ÂÚ¢ÓËÙ¤˜

ÙÔÓ Â‡ÎÔÏÔ ¯ÂÈÚÈÛÌfi ÙÔ˘ ÁÂÓÂÙÈÎÔ‡ ˘ÏÈÎÔ‡ ÙÔ˘

ÈÔ‡ Î·È ÙË ÁÚ‹ÁÔÚË ‰ËÌÈÔ˘ÚÁ›· ÂÓfi˜ ÛÙÂϤ¯Ô˘˜

ÛÙÔ ÂÚÁ·ÛÙ‹ÚÈÔ Ô˘ ı· ¤¯ÂÈ ÙËÓ ÂÈı˘ÌËÙ‹ ÁÂ-

ÓÂÙÈ΋ Û‡ÓıÂÛË (20). ¶·Ú¿ÁÂÙ·È Ì ÙÔÓ ÙÚfiÔ

¶·È‰È·ÙÚÈ΋ 2006;69:1-9

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Page 8: Παιδιατρική | Τόμος 69 • Τεύχος 1 • Ιανουάριος - Φεβρουάριος 2006

8 ª. ∆ÛÔÏÈ¿ Î·È Û˘Ó.

·˘Ùfi, ÙÔ Ó¤Ô Û٤ϯԘ ÈÔ‡ Ô˘ ÛÙË Û˘Ó¤¯ÂÈ·

ηÏÏÈÂÚÁÂ›Ù·È Û ·‚Á¿ ÁÈ· Ì·˙È΋ ·Ú·ÁˆÁ‹.

™‹ÌÂÚ· ¤¯Ô˘Ó ۯ‰ȷÛÙ› ÙÔ˘Ï¿¯ÈÛÙÔÓ 10

ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ ÂÌ‚ÔÏ›ˆÓ ηٿ ÙÔ˘ ∏5¡1 ÛÂ

‰È¿ÊÔÚ˜ ¯ÒÚ˜ Î·È ÛÙȘ ∏.¶.∞., fiÔ˘ ¤¯ÂÈ ‹‰Ë

ÍÂÎÈÓ‹ÛÂÈ Ë ‰ÈÂÍ·ÁˆÁ‹ ÔÚÈÛÌ¤ÓˆÓ ·fi ·˘Ù¤˜

(19). ¶ÈÛÙ‡ÂÙ·È fiÙÈ ·ÎfiÌË ÎÈ ·Ó Ô Èfi˜ Ô˘ ı·

ÚÔηϤÛÂÈ ÙËÓ ·Ó‰ËÌ›· Â›Ó·È Î¿ˆ˜ ‰È·ÊÔ-

ÚÂÙÈÎfi˜ ·fi ·˘ÙfiÓ Ô˘ Û‹ÌÂÚ· ¯ÚËÛÈÌÔÔÈ›-

Ù·È ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ÂÌ‚ÔÏ›Ô˘, ı· Â›Ó·È ÙÔ˘Ï¿-

¯ÈÛÙÔÓ ·ÚfiÌÔÈÔ˜ Î·È ÙÔ ÂÌ‚fiÏÈÔ ·Ó·Ì¤ÓÂÙ·È

fiÙÈ ı· ·Ú¤¯ÂÈ Î¿ÔÈ· ÚÔÛÙ·Û›·. ∏ ·Ú·Áˆ-

Á‹ ÂÌ‚ÔÏ›ˆÓ Û˘Ó·ÓÙ¿ ÚÔ‚Ï‹Ì·Ù· ‰ÈfiÙÈ Ë ‰È·-

‰Èηۛ· Â›Ó·È ¯ÚÔÓÔ‚fiÚ· Î·È Ì ÙȘ ˘¿Ú¯Ô˘-

Û˜ Û˘Óı‹Î˜ ‰ÂÓ Â›Ó·È ‰˘Ó·Ù‹ Ë ·Ú·Û΢‹

ÌÂÁ¿ÏˆÓ ÔÛÔÙ‹ÙˆÓ ÈηÓÒÓ Ó· ηχ„Ô˘Ó ÛË-

Ì·ÓÙÈÎfi ̤ÚÔ˜ ÙÔ˘ ÏËı˘ÛÌÔ‡. ∞Ó·˙ËÙÔ‡ÓÙ·È

Û‹ÌÂÚ· ‰È¿ÊÔÚ˜ Ù¯ÓÈΤ˜ ‚ÂÏÙ›ˆÛ˘ Ù˘ Èη-

ÓfiÙËÙ·˜ Î·È Ù˘ Ù·¯‡ÙËÙ·˜ ·Ú·ÁˆÁ‹˜, fiˆ˜

Â›Ó·È Ë ¯Ú‹ÛË Î˘ÙÙ·ÚÔηÏÏÈÂÚÁÂÈÒÓ ·ÓÙ› ÙˆÓ

·‚ÁÒÓ. Œ¯ÂÈ ‚ÚÂı› fiÙÈ ÁÈ· Ó· ˘¿ÚÍÂÈ ÈÛ¯˘Ú‹

·ÓÔÛȷ΋ ·¿ÓÙËÛË ··ÈÙÔ‡ÓÙ·È ‰‡Ô ‰fiÛÂȘ

ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ Û οı ¿ÙÔÌÔ. ™‹ÌÂÚ· fï˜, Á›-

ÓÔÓÙ·È ÚÔÛ¿ıÂȘ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ÂÌ‚ÔÏ›-

Ô˘ Ô˘ ı· ÂÚȤ¯ÂÈ ˙ˆÓÙ·Ófi ÂÍ·ÛıÂÓË̤ÓÔ

Û٤ϯԘ Î·È ¤ÙÛÈ ı· Â›Ó·È ·ÚÎÂÙ‹ Ì›· ÌfiÓÔ ‰fi-

ÛË. ªÂÏÂÙ¿Ù·È Â›Û˘, Ë ¯Ú‹ÛË ·ÓÔÛÔÂÓÈÛ¯˘-

ÙÒÓ (adjuvants) (20,21) Ô˘ ı· ‚ÂÏÙÈÒÛÔ˘Ó ÙËÓ

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1. Treanor G. Influenza virus. In: Mandell GL, BennettJE, Dolin R (eds). Mandel, Douglas and Bennett'sPrinciples and practice of infectious diseases. 5thedition. Churchill Livingstone, Philadelphia, 2000:1823-1849.

2. Laver WG, Bischofberger N, Webster RG. Disarm-ing flu viruses. Sci Am 1999;280:78-87.

3. Osterhaus A. H5N1: the lessons to be learned. In:Zambon MC, ed. United Kingdom: Advances in in-fluenza. Blackwell Science; 1999. p. 11-17.

4. Laver G, Garman E. Virology. The origin and controlof pandemic influenza. Science 2001;293:1776-1777.

5. Hien TT, De Jong M, Farrar J. Avian influenza - AChallenge to global health care structures. N Engl JMed 2004;351:2363-2365.

6. Perez DR, Sorrell EM, Donis RO. Avian influenza:an omnipresent pandemic threat. Pediatr Infect DisJ 2005;24 (11 Suppl):S208-S216.

7. Belshe RB. The Origins of Pandemic Influenza -lessons from the 1918 Virus. N Eng J Med 353;21:2209-2211.

8. Taubenberger JK, Reid AH, Lourens RM, Wang R,Jin G, Fanning TG. Characterization of the 1918 in-fluenza virus polymerase genes. Nature 2005;437:889-893.

9. Tumpey TM. Basler CF, Aguilar PV, Zeng H,Solorzano A, Swayne DE et al. Characterization ofthe reconstructed 1918 Spanish influenza pandemicvirus. Science 2005;310:77-80.

10. Centers for Disease Control and Prevention Influen-za (flu): information about Avian influenza andAvian influenza A [Internet]. 2005: Webpage:http://www.cdc.gov/flu.

11. Macfarlane JT, Lim WS. Bird flu and pandemic flu.BMJ 2005;331:975-976.

12. Monto AS. The threat of an avian influenza pan-demic. N Eng J Med 2005;352:323-325.

13. Stohr K. Avian influenza and pandemics-Researchneeds and opportunities. N Eng J Med 2005;352:405-407.

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9°Ú›Ë ÙˆÓ ÙËÓÒÓ

14. Beigel JH, Farrar J, Han AM, Hayden FG, Hyer R, de

Jong MD et al; Writing Committee of the World

Health Organization (WHO) Consultation on Hu-

man Influenza A/H5. Avian influenza A (H5N1) in-

fections in humans. N Eng J Med 2005;353:1374-

1385.

15. World Health Organization. Cumulative number of

confirmed human cases of avian influenza A H5N1.

[Internet, Webpage] www.who.int/csr/disease/

avian_influenza/country/cases_table_2005_12_30/

en/index.html

16. Webster R, Hulse D Controlling avian flu at the

source. Nature 2005;435:415-416.

17. Ungchusak K, Auewarakul P, Dowell SF, Kitphati R,

Auwanit W, Puthavathana P et al. Probable person-

to-person transmission of avian influenza A

(H5N1). N Eng J Med 2005;352:333-340.

18. Le QM, Kiso M, Someya K, Sakai YT, Nguyen TH,

Nguyen KH et al. Isolation of drug resistant H5N1

virus. Nature 2005;437:1108.

19. Fleming D. Influenza pandemics and Avian flu. BMJ

2005;331:1066-1069.

20. Check E. Avian flu special: is this our best shot? Na-

ture 2005;437:404-406.

21. Wood JM, Robertson JS. From lethal virus to life-sav-

ing vaccine: developing inactivated vaccines for pan-

demic influenza. Nat Rev Microbiol 2004;2:842-847.

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Webster RG. A DNA transfection system for gener-

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10 REVIEW ARTICLE

Director of Pediatric Nephrology, Children'sHospital of Pittsburghand the University of Pittsburgh School of Medicine

Correspondence:

Demetrius Ellis, M.D.Children's Hospital of Pittsburgh3705 Fifth AvenuePittsburgh, PA 15213e-mail: [email protected]

¶·È‰È·ÙÚÈ΋ 2006;69:10-17

Evaluation and management of hypertensive

crisis in childhood

D. Ellis

Abstract: Hypertensive crisis is relatively uncommon in the paediatric age group and many emer-gency departments are poorly prepared to manage children with this potentially lethal disorder. Thisreview provides guidelines aimed at facilitating the evaluation and management of children with thisdisorder.

Key words: Hypertension, paediatrics, hypertensive crisis, hypertensive emergencies.

Abbreviations

BP blood pressureHTN hypertension

Introduction

Normal blood pressure (BP) levels differ byage, gender and height; accordingly no single BPlevel defines hypertension (HTN) in all children.Updated BP norms and definitions of HTN inchildren are provided in the latest of four com-prehensive reports (1). HTN is generally definedas the average of three manually obtained sys-tolic BP and/or diastolic BP measurements being≥95th percentile for age, gender and height.

There are several recent reviews of hyperten-sive crisis in adults (2-8), but the clinical ap-proach to this topic has been rarely addressedfor the paediatric age group (9,10). For purpos-es of this review, hypertensive crisis is a syn-drome classified as either a) hypertensive emer-gency if there are clinical manifestations of on-going organ injury, or, b) hypertensive urgencyif there are no acute clinical symptoms and evi-dence for end-organ damage is minimal or ab-sent. The implication is that the former requiresimmediate reduction in BP, while in the latterBP reduction may take place over hours or days.Although the large majority of children whopresent in the emergency department with hy-pertensive crisis have BP above the 99th per-centile, hypertensive crisis is not strictly definedby absolute BP levels.

In the absence of known preexisting renaldisorder, which often predisposes to hyperten-sive crisis, the possibility must be considered ofpreviously unrecognized cardiac and endocrino-

logic aetiologies of HTN, which may strongly in-

fluence the therapeutic choice for individuals in

the emergency department. This brief report de-

scribes a practical clinical approach to the diag-

nosis and immediate management of the child

presenting with hypertensive crisis, which may

be facilitated by means of an algorithm, along

with a table of potentially useful agents and

dosage guidelines suitable for the paediatric age

group. The goal of therapy is to prevent the cat-

astrophic consequences of this potentially lethal

disorder.

Symptoms and signs

Unlike adults, in whom hypertensive crises

usually occur in individuals with known and of-

ten severe preexisting HTN, in children the dis-

covery of HTN is often made at the time of pre-

sentation with a hypertensive crisis. Symptoms

of HTN in children depend on the acute nature

of the development of HTN as well as on the

magnitude of the BP elevation. Hence, in a child

with chronic HTN secondary to renal artery

stenosis, mild to moderate HTN is usually well

tolerated whereas the same BP level may cause

severe headache or seizures in a child with acute

glomerulonephritis. Similarly children with car-

diac outlet obstruction or cardiomyopathy may

become symptomatic despite mild HTN.

The most common symptoms of HTN in the

majority of older children who present in the

emergency department are those of hyperten-

sive encephalopathy, namely headache, nausea,

vomiting, mental confusion, blurred vision, ag-

itation or frank seizures. Other manifestations

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11Hypertensive crisis in childhood

may include cerebral infarction, intracerebral or

retinal haemorrhage, congestive heart failure,

acute pulmonary oedema (with shortness of

breath), acute renal insufficiency, and microan-

giopathic haemolytic anaemia. Less common

sequelae of hypertensive crisis in children in-

clude myocardial infarction and aortic dissec-

tion. Newborns and infants with severe hyper-

tension may present with congestive heart fail-

ure, hypertensive retinopathy, respiratory dis-

tress, apnoea or cyanosis, extreme irritability,

hypotonia, convulsions or coma. Vomiting, di-

arrhoea and failure to thrive may be among the

chronic manifestations of hypertension in the

younger age group.

Causes of hypertensive crisis

Table 1 lists the main causes of hypertensive

crisis in children. Renal disorders predominate

and these include renovascular hypertension (in-

cluding renal artery stenosis and aortic coarcta-

tion), accelerated HTN in children with renal

failure and fluid overload together with pre-ex-

isting HTN, acute glomerulonephritis, haemolyt-

ic-uremic syndrome and other renal parenchy-

mal disorders. Less common causes are vasculi-

tis, head injury and phaeochromocytoma.

Pathophysiology of hypertensive

emergencies

The ability to maintain almost constant per-

fusion to an organ over a wide range of mean

arterial pressures ranging from 60-150 mmHg

is known as autoregulation of blood flow. This

process is mediated by multiple neurohumoral

mechanisms which affect vascular resistance,

and is particularly effective and well guarded in

the cerebral and renal circulations. Chronic

HTN leads to compensatory, functional and

structural changes in arterial vessels, which

maintain perfusion to these organs while pro-

tecting against injury that may otherwise result

from organ hyperperfusion due to HTN (11).

When the systemic BP surpasses the compen-

satory limits of autoregulation, arterial injury,

such as fibrinoid necrosis and organ ischaemia,

may follow (5, 12). Conversely when the BP is

suddenly reduced below the new steady state

limits of compensation, ischaemic injury may

be enhanced, particularly in individuals with

structural hypertensive arterial changes. Most

children with hypertensive emergencies do not

have structural vascular lesions and are, there-

fore, less susceptible to organ ischaemia after

lowering of the BP. Conversely, the lack of

adaptive responses in children with an acute

and rapid rise in BP may predispose to symp-

toms at BP levels which may not be gauged

as being sufficiently high to produce such

symptoms.

Evaluation of hypertensive emergencies

The algorithm shown in the Figure may facil-

itate the clinical assessment and management of

the symptomatic child with hypertensive emer-

gency. A similar approach may be applied in the

child with hypertensive urgency, in which case the

¶·È‰È·ÙÚÈ΋ 2006;69:10-17

Table 1. Causes of hypertensive crisis

ñ Abrupt increase in blood pressure in children withchronic hypertension (most common in those withrenal disorders or on dialysis)

ñ Renovascular hypertension, including renal arterystenosis, partial arterial thrombosis especially inneonates with umbilical arterial lines, aorticcoarctation

ñ Parenchymal renal disease (polycystic kidney disease,vasculitis, acute glomerulonephritis, hemolyticuraemic syndrome, renal scarring associated withpyelonephritis or reflux nephropathy)

ñ Renin-secreting tumour (Wilm's tumour,nephroblastomatosis, Drash syndrome)

ñ Ingestion of drugs (sympathomimetic agents [cocaine,amphetamines, phencyclidine hydrochloride, lysergicacid diethylamide, diet pills], tricyclic anti-depressants, anabolic steroids, chlorpromazine, oralcontraceptives, erythropoietin, cyclosporine,monoamine oxidase inhibitors, corticosteroids, non-steroidal anti-inflammatory agents)

ñ Acute withdrawal of antihypertensive drugs (clonidineor centrally acting agents and ‚-antagonists)

ñ Ingestion of tyramine in conjunction with use of amonoamine oxidase-inhibitor

ñ Cushing's syndrome, syndrome of apparentmineralocorticoid excess, or glucocorticoid-excessstates

ñ Phaeochromocytoma, neuroblastoma organglioneuroma

ñ Head injury, brain tumours, increased intracranialpressure

ñ Autonomic hyperactivity in patient with Guillain-Barre or other spinal-cord syndromes

ñ Porphyriañ Hypercalcaemia

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12 D. Ellis

time course needed to obtain the diagnostic stud-

ies or to implement therapeutic measures can be

prolonged.

Initial evaluation includes inspection of the

optic fundi for hypertensive arterial changes,

mental status and neurologic assessment, and

careful cardiac, pulmonary and abdominal exam-

ination to uncover cardiac dysfunction, pul-

monary oedema or masses. Physical examination

should include auscultation for carotid and ab-

dominal bruits along with assessment of pulses in

the radial, femoral and pedal arteries, and BP mea-

surement in both the upper and lower extremities.

These examinations, together with inspection of

the skin for café au lait spots, striae, adenoma se-

baceum or malar rash, may provide clues as to the

aetiology of HTN. The medical history may indi-

cate pre-existing renal disorders, urinary tract in-

fections, or other infectious illnesses which may be

associated with renal involvement, such as acute

¶·È‰È·ÙÚÈ΋ 2006;69:10-17

Figure. Hypertensive crisis management guidelines.

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13Hypertensive crisis in childhood

glomerulonephritis. A history of illicit or pre-scribed drug use which may precipitate or aggra-vate pre-existing HTN may be helpful.

Urinalysis and measurement of BUN, serumcreatinine, electrolytes, calcium, phosphorus,magnesium and uric acid may provide evidenceof renal involvement. Because anti-hypertensivetherapy may alter plasma levels of renin, corti-sol and aldosterone, as well as urinary VMA ex-cretion, in undiagnosed cases, these measure-ments should be obtained before administeringanti-hypertensive drugs. A plasma toxicologyscreen may be useful in children with suspectedsubstance abuse. Chest X-ray and EKG orechocardiogram should also be done as early aspossible. Once the BP improves, children withsevere encephalopathy or focal neurologicdeficit may be escorted by an emergency depart-ment physician to the radiology department,where computerized cranial tomography maybe done to diagnose or eliminate thrombotic orhaemorrhagic events.

General principles of management

There have been no controlled clinical trialsof treatment of hypertensive emergencies or hypertensive urgencies in children. A review ofmultiple adult studies failed to produce statisti-cal superiority of any single therapeutic agentand the outcome was not uniform between stud-ies (6). Experience is accruing from clinical trialson adults with hypertensive emergencies of thecalcium channel inhibitor lacidipine or the ·1-adrenergic receptor blocker urapidil, adminis-tered for specific indications (6,13). However, itis the author's opinion that the newer vasculardopamine receptor agonist (DA1), fenoldopam(14) shows the most promise, particularly in re-placing intravenous nitroprusside in childrenwith renal dysfunction. Employment of the new-er agents may be more appropriate for hyperten-sive emergencies due to disorders not frequentlyencountered in childhood, such as atheroscle-rotic cerebrovascular and renal arterial disease,HTN associated with pregnancy, or aortic dis-section. Hence, reliance on older agents is stillpreferred.

As a general rule agents with a short durationof action are employed, so that if BP reduction isgauged as excessive, the effect can be quickly re-versed by stopping the agent and/or administer-ing normal saline. A major long-term objective

is to assure compliance with antihypertensive

therapy during follow-up (7,8).

The goal of emergency therapy is to achieve a

gradual decrease in systolic and diastolic BP to

near the 99th percentile, or to reduce the mean

arterial pressure (one third of the pulse pressure

difference added to the diastolic BP) by 25%.

With such reduction in BP over a period of min-

utes or hours the symptoms and signs of hyper-

tension tend to improve or resolve. Further low-

ering in BP may be effected more slowly over

several days or weeks in such a way that the BP

remains below the 90th percentile for age, gen-

der and height percentile (1).

Choice of oral vs. intravenous therapy in

hypertensive crisis

In general, if a renal aetiology for the HTN

can be readily ascertained and the child is capa-

ble of swallowing, the initial therapy in the

emergency department may consist of oral

agents. If the aetiology of HTN cannot be estab-

lished, the initial agent could be intravenous hy-

drallazine, with oral or trans-dermal clonidine

as an adjunctive agent. If HTN persists, the child

is admitted to the intensive care unit (ICU)

where more powerful parenteral agents may be

urgently administered and BP can be monitored

continuously and directly through an intra-arte-

rial transducer. A list of antihypertensive agents

and the recommended dosages for children with

hypertensive crisis are shown in Table 2.

Specific disorders such phaeochromocytoma

or drug-induced HTN from catecholamine ex-

cess (cocaine intoxication, monoamine oxidase

inhibitor crisis) may be managed with an alpha

adrenergic blocker such as phentolamine, while

avoiding initial use of beta blockers which may

potentiate the alpha adrenergic action of cate-

cholamines. Intravenous diuretics may be very

useful as adjunctive agents in the case of con-

gestive heart failure in disorders accompanied

by fluid overload, such as acute glomeru-

lonephritis.

Oral agents used to manage

hypertensive crisis

Assuming that the child does not have se-

vere neurological symptoms and is capable of

¶·È‰È·ÙÚÈ΋ 2006;69:10-17

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14 D. Ellis

¶·È‰È·ÙÚÈ΋ 2006;69:10-17

Table 2. Pharmacologic management of hypertensive crisis in infants and in children

Action Agents Dose Route Comments(trade names)

Vasodilator Hydrallazine 0.1-0.2 mg/kg IV Administer at <0.2 mg/kg/minute; (Apresoline, others) (maximum onset 5-20 minutes; lower dose can

20 mg/dose) be repeated after 5-20 minutes.Duration is 2-6 hours. Can cause reflex tachycardia. Available in 20 mg/ml ampoule.

Minoxidil 0.1-0.2 mg/kg Oral Onset ≤30 minutes; maximum effect (Loniten) (maximum @ 2-8 hours; long duration of effect,

50 mg/day) once daily dosing, contraindicated in phaeochromocytoma.

Diazoxide 1-3 mg/kg IV push Administer IV push over 10-30 (Hyperstat) (maximum seconds, maximum effect within

150 mg dose) 5 minutes, can be repeated after 5 minutes, duration of effect 3-12 hours. Available in 300 mg/30 ml ampule. Alternative dosage is 1 mg/kg every 5-15 minutes until BP control is achieved.

Sodium nitroprusside 0.25-8 mcg/kg/min IV drip Administer by continuous infusion (Nipride) only; onset within 2 minutes,

duration <10 minutes. Start at 0.25 mcg/kg/minute and increasedose by 25% every 5-10 minutes until BP control is obtained. Obtain thiocyanate levels if used for more than 48 hours; protect from light. Available in 50 mg/ 5 ml vial.

Adrenergic alpha Labetalol 0.2-0.5 mg/kg/dose IV Administer IV over 2-3 minutes; and beta (Normodyne, (maximum onset 2-5 minutes; maximum effect blocking agents Trandate) 1mg/kg) in 5-15 minutes, duration 2-4 hours;

lower dose can be doubled and repeated at 15 minute intervals x 2; can also be given at same dose by IV infusion over 1 hr. Avoid if child has history of asthma / bronchospasm. Contraindicated in congestive heart failure, sinus tachycardia, heart block. Available as 5 mg/ml.

Clonidine 5-10 mcg/kg/day Oral Divide dose and administer q 6-12 (Catapres) (maximum hours. Also available in transdermal

25 mcg/kg/day) formulation. Avoid in cerebrovascular disorders. May cause agitation, insomnia, drowsiness, rebound hypertension after rapid withdrawal.

Esmolol Loading dose: IV drip Use for postoperative hypertension; (Brevibloc) 500 mcg/kg IV, administer loading dose over 1

then use as minute; followed by continuous continuous infusion infusion; onset: beta blockade occurs 50-250 mcg/kg/min in 2-10 minutes; duration 10-30

minutes (short). Contraindicated in congestive heart failure, sinus tachycardia, heart block.

continued...

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15Hypertensive crisis in childhood

swallowing medications, the use of oral medica-tion may be limited to children with hyperten-sive emergencies or urgencies associated withknown or suspected renal disorders.

Short-acting nifedipine is currently a verypopular drug for use in this situation. Unlikeadults, where studies show that the use of thisagent may be associated with a precipitous fall inBP and increased risk of myocardial infarction,stroke and death (15), data on children indicatethat use of nifedipine is safe and effective (16,17). However, both the clinical situation and theinitial dose may modify safety. Guidelines foravoidance of the use of short acting nifedipine inchildren include:

1. Congestive heart failure, presence of my-ocardial ischaemia, after cardiac arrest, severeleft ventricular hypertrophy, left ventricular out-flow obstruction, or cardiac arrhythmia.

2. Acute hypertension with high cardiac out-

put states, such as sickle cell crisis or other chron-ic anaemias.

3. Cyanotic heart disease.4. Hypovolaemic states including children

with anasarca, those undergoing acute diuresis,or those with acute haemorrhage.

5. Acute hypertension associated with severepain. The BP should be reassessed after adminis-tration of appropriate analgesics such as mor-phine.

6. Acute central nervous system injury. 7. Children receiving large dosages of beta

blockers, such as atenolol or labetolol. 8. Infants less than one year of age. In the absence of such conditions, orthostatic

hypotension is usually avoided when the startingdose of nifedipine is 0.2 to 0.25 mg/kg bodyweight. Although it is often given sublingually,very little of the agent is actually absorbed via theoral mucosa. Thus, if the entire 10 mg nifedipine

¶·È‰È·ÙÚÈ΋ 2006;69:10-17

Table 2. Pharmacologic management of hypertensive crisis in infants and in children

Action Agents Dose Route Comments(trade names)

Isradipine 0.2-0.9 mg/kg/day Oral Available in capsules (2.5 and 5 mg) (DynaCirc) (maximum and in liquid formulation

0.6 mg/kg/day) (1 mg/mL). May cause tachycardia or congestive heart failure.

Calcium-channel Nifedipine 0.2-0.5 mg/kg Oral Swallow whole, or bite capsule and blocking agents (Procardia, others) (Initial dose should swallow, or remove liquid from

not exceed capsule with syringe; not effective by 0.25 mg/kg) sublingual route (actual effect due to

swallowing the drug with subsequent rapid oral absorption); initial dose can be repeated once within 30 minutes. Onset of effect within 1-5 minutes after bite and swallow, contraindicated in patients with heart disease; available in 10 and 20 mg capsules.

Nicardipine 1 mcg/kg/min IV drip Onset 10 minutes; duration (Cardene IV) (maximum 2-6 hours; available as 2.5 mg/ml

5 mcg/kg/min)

Alpha-adrenergic Phentolamine 0.05-0.1 mg/kg/dose IV Diagnostic test for blocker (Regitine) (maximum 5 mg) phaeochromocytoma. Onset

immediate; maximum effect in 2 minutes, duration 30 minutes; available in 5 mg vial.

ACE inhibitors Enalaprilat 5-10 mcg/kg/dose IV Administer undiluted over 5 minutes; onset ≤15 minutes; maximum effect in 1 hour; duration 4-6 hours. Severe hypotension can occur in sodium or volume depleted patients. Use lower dosages in neonates.

Pediatr Jan-Feb 06 final allges 27-01-06 15:34 ™ÂÏ›‰·15

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16 D. Ellis

capsule is to be used the “bite and swallow”

method is recommended. If lesser amounts are

needed, the contents of the 10 mg capsule are

drawn into a 1 mL graded syringe and the portion

needed (0.034 mL = 1 mg) may be administered

orally so as to speed up gastrointestinal uptake

and onset of action. This dose may be repeated

once within 30 minutes. All subsequent dosages

should not exceed 0.5 mg/kg body weight, with a

maximum of 10 mg, and the frequency of admin-

istration may be every 4-6 hours. Close BP moni-

toring is mandatory and such children should not

ambulate after receiving the medication unless

they are completely free of orthostatic hypoten-

sion, dizziness or mental disturbances.

Minoxidil is an alternative oral agent, with

properties of smooth arterial muscle relaxation

(leading to vasodilation), which may be effective

in overcoming hypertensive emergencies. Close

BP monitoring and avoidance of ambulation is

recommended after its use also.

Intravenous agents used to manage

hypertensive crisis

In children who are unable to take oral short-

acting nifedipine or minoxidil, or in those with

severe neurological symptoms, intravenous

medications are preferred. Diozoxide is rarely

used for this purpose because of unpredictable

or precipitous drops in BP. Hydrallazine has be-

come less popular because of the common side-

effects of flushing, tachycardia, nausea and

headache, although it is still useful in the emer-

gency department setting. With more severe or

refractory symptomatic HTN more potent intra-

venous medications are indicated.

In all instances in which intravenous medica-

tions other than hydrallazine are administered,

the child should have an arterial line inserted for

BP monitoring. In addition co-administered

medications must be reviewed for possible syn-

ergism or drug interaction, which may exacer-

bate adverse effects of antihypertensive agents.

The most useful parenteral agents in children

include sodium nitroprusside (9,18,19), nicardip-

ine (20-22), and labetalol (23,24); esmolol may be

a preferred drug for use in infants (9,23,25,26).

These agents may be given as a constant infusion

and have an onset of action of less than 5 minutes.

Generally, these medications should be started

with the lower dosages and increased stepwise by

25% every 5-10 minutes until the desired BP isreached.

Sodium nitroprusside may be the initial intra-venous agent in any child presenting with hyper-tensive emergency, with the exception of closedhead injury or suspected high intracranial pres-sure. With long-term use of this agent, accumula-tion of its metabolic end products, comprisingcyanide and thiocyanate, may cause nausea, vom-iting, neurological symptoms, hypothyroidism,dyspnoea and metabolic acidosis. Nicardipinemay be more suitable for use in individuals withrenal insufficiency who are unable to excretethese metabolites effectively. Less frequently,nicardipine may also be given as mini-boluses.Fenoldopan is a newer agent which is also effec-tive and uniquely suitable for managing HTN inthe case of renal insufficiency (5,6,14). Esmolol,labetalol (23,24) and enlaprilat (10,27) may beparticularly useful in infants. Esmolol can be giv-en by constant infusion while all three agents canbe administered on an intermittent basis. Intra-venous labetalol is particularly useful in the man-agement of HTN after transplantation, associatedwith cyclosporine or tacrolimus given in conjunc-tion with glucocorticoids. It can also be adminis-tered as an infusion over 1-hr. As with esmololand other beta blockers, labetalol should beavoided or be used with caution in children withreactive airway disease, and with consideration ofother contraindications to their use (Table 2). In-fants are particularly susceptible to enalaprilat-in-duced inhibition of angiotensin II, and may de-velop significant reduction in renal blood flowand glomerular filtration rate. Hence, enalaprilat(IV enalapril) should be used with caution in in-fants with known or suspected renal artery steno-sis. However, this agent may be used to managerenovascular HTN due to microthrombi associat-ed with intubation of the umbilical vessels.

Acknowledgements

My gratitude to Dr. Bill McGhee and for confirmingthe paediatric drug dosages shown in Table 2, and toMrs. Anne Spence who aided in the preparation of thealgorithm.

References

1. National High Blood Pressure Education ProgramWorking Group on High Blood Pressure in Chil-dren and Adolescents. The Fourth Report on the

¶·È‰È·ÙÚÈ΋ 2006;69:10-17

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17Hypertensive crisis in childhood

¶·È‰È·ÙÚÈ΋ 2006;69:10-17

Diagnosis, Evaluation and Treatment of High BloodPressure in Children and Adolescents. Pediatrics2004;114:555-576.

2. Kitiyakara C, Guzman NJ. Malignant hypertensionand hypertensive emergencies. J Am Soc Neph 1998;133-142.

3. Vaughan CJ, Delanty N. Hypertensive emergencies.Lancet 2000;356:411-417.

4. Vidt DG. Emergency room management of hyper-tensive urgencies and emergencies. J Clin Hypertens2001;3:158-164.

5. Elliott WJ. Hypertensive emergencies. Crit Care Clin2001;17:435-451.

6. Cherney D, Straus S. Management of patients withhypertensive urgencies and emergencies. J Gen In-tern Med 2002;17:937-945.

7. Phillips RA, Greenblatt J, Krakoff LR. Hypertensiveemergencies: Diagnosis and management. Prog Car-diovasc Dis 2002;45:33-48.

8. Mansoor GA, Frishman WH. Comprehensive man-agement of hypertensive emergencies and urgencies.Heart Dis 2002;4:358-371.

9. Fivush B, Neu A, Furth S. Acute hypertensive crisisin children: emergencies and urgencies. Curr OpinPediatr 1996;9:233-236.

10. Adelman RD, Coppo R, Dillon MJ. The emergencymanagement of severe hypertension. PediatrNephrol 2000;14:422-427.

11. Traon AP, Costes-Salon MC, Galinier M, FourcadeJ, Larrue V. Dynamics of cerebral blood flow au-toregulation in hypertensive patients. J Neurol Sci2002;195:139-144.

12. Kase CS. Hypertensive vascular disease and cerebralmicrocirculation. Neurologia 1999;14 (Suppl 2):S22-S30.

13. Alijotas-Reig J, Bove-Farre I, de Cabo-Frances F,Angles-Coll R. Effectiveness and safety of prehospi-tal urapidil for hypertensive emergencies. Am JEmerg Med 200;19:130-133.

14. Tumlin JA, Dunbar LM, Oparil S, Buckalew V, RamCV, Mathur V, et al. Fenoldopam, a dopamine ago-nist, for hypertensive emergency: a multicenter ran-domized trial. Fenoldopam Study Group. AcadEmerg Med 2000;7:653-662.

15. Grosssman E, Messerli FH, Grodzicki T, Kowey P.

Should a moratorium be placed on sublingualnifedipine capsules given for hypertensive emergen-cies and pseudoemergencies? JAMA 1996;276:1328-1331.

16. Egger DW, Deming DD, Hamada N, Perkin RM,Sahney S. Evaluation of the safety of short-actingnifedipine in children with hypertension. PediatrNephrol 2002;17:35-40.

17. Blaszak RT, Savage JA, Ellis EN. The use of short-acting nifedipine in pediatric patients with hyper-tension. J Pediatr 2001;139:34-37.

18. Gordillo Paniagua G, Velasquez Jones L, Martini R,Valdez Bolanos E. Sodium nitroprusside treatmentof severe arterial hypertension in children. J Pediatr1975;87:799-802.

19. Luderer JR, Hayes AH Jr, Dubnsky O, Cerlin CM.Long-term administration of sodium nitroprussidein childhood. J Pediatr 1977;91:490-491.

20. Treluyer JM, Hubert P, Jouvet P, Couderc S, CloupM. Intravenous nicardipine in hypertensive chil-dren. Eur J Pediatr 1993;152:712-714.

21. Flynn JT, Mottes TA, Brophy PD, Kershaw DB,Smoyer WE, Bunchman TE. Intravenous nicardip-ine for treatment of severe hypertension in children.J Pediatr 2001;139:38-43.

22. Michael J, Groshong T, Tobias JD. Nicardipine forhypertensive emergencies in children with renal dis-ease. Pediatr Nephrol 1998;12:40-42.

23. Sinaiko AR. Treatment of hypertension in children.Pediatr Nephrol 1994;6:603-660.

24. Bunchman TE, Lynch RE, Wood EG. Intravenouslyadministered labetalol for treatment of hyperten-sion in children. J Pediatr 1992;120:140-144.

25. Trippel DL, Wiest DB, Gillette PC. Cardiovascularand antiarrhythmic effects of esmolol in children. JPediatr 1991;119:142-147.

26. Wiest DB, Garner SS, Uber WE, Sade RM. Esmololfor the management of pediatric hypertension aftercardiac operations. J Thorac Cardiovasc Surg 1998;115:890-897.

27. Hirschl MM, Binder M, Bur A, Herkner H, BrunnerM, Mullner M, et al. Clinical evaluation of differentdoses of intravenous enalaprilat in patients with hy-pertensive crisis. Arch Intern Med 1995;155:2217-2223.

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18 ∞¡∞™∫√¶∏™∏ REVIEW ARTICLE

¢’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋∞.¶.£., ¡ÔÛÔÎÔÌ›Զ··ÁˆÚÁ›Ô˘£ÂÛÛ·ÏÔӛ΢

AÏÏËÏÔÁÚ·Ê›·:

÷ϤÌ˘ ∑·¯·Ú›·˜™. ∫·Ú·Ù˙¿ 25 ∫·Ï·Ì·ÚÈ¿∆.∫. 551 32, £ÂÛÛ·ÏÔÓ›ÎËE-mail: [email protected]

∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 07-06-2005∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 30-09-2005

4th Pediatric Clinic of theAristotle University,Papageorgiou Hospital,Thessaloniki

Correspondence:

Chalemis Zacharias25, S. Karatza Str., Kalamaria551 32, ThessalonikiE-mail: [email protected]

Date of submission: 07-06-2005 Date of approval: 30-09-2005

¶·È‰È·ÙÚÈ΋ 2006;69:18-24

∏ ›‰Ú·ÛË Ù˘ ·¤ÚÈ·˜ Ú‡·ÓÛ˘ Î·È Ô ÚfiÏÔ˜

ÙˆÓ ·ÈˆÚÔ‡ÌÂÓˆÓ ÛˆÌ·Ùȉ›ˆÓ ÛÙÔ Î˘ÎÏÔÊÔÚÈÎfi

Û‡ÛÙËÌ·

∑. ÷ϤÌ˘, °. µ·ÚÏ¿Ì˘

¶ÂÚ›ÏË„Ë: ∏ ·¤ÚÈ· Ú‡·ÓÛË (·ÙÌÔÛÊ·ÈÚÈÎÔ› Ú‡ÔÈ) Î·È Î˘Ú›ˆ˜ Ù· ·ÈˆÚÔ‡ÌÂÓ· ۈ̷ٛ‰È· Ô˘·ÓȯÓ‡ÔÓÙ·È ÛÙÔ Ó¤ÊÔ˜ ÙˆÓ ÌÂÁ·ÏÔ˘fiÏÂˆÓ ¤¯Ô˘Ó ÂÓÔ¯ÔÔÈËı› ÁÈ· ·Ó·Ó¢ÛÙÈο ÚÔ‚Ï‹Ì·Ù·,ÂÌÊ¿ÓÈÛË Î·ÚΛÓÔ˘ ·ÏÏ¿ Î·È Î·Ú‰È·Î¿ ÚÔ‚Ï‹Ì·Ù·, ÙfiÛÔ Û ÂÓ‹ÏÈΘ fiÛÔ Î·È Û ·È‰È¿, Û ‚·ı-Ìfi Ô˘ Ó· ıˆÚÔ‡ÓÙ·È ˘Â‡ı˘Ó· ÁÈ· ·˘ÍË̤ÓË ıÓËÛÈÌfiÙËÙ· Û ÂÚÈfi‰Ô˘˜ ·˘ÍË̤Ó˘ ·ÙÌÔÛÊ·È-ÚÈ΋˜ Ú‡·ÓÛ˘. ™ÙÔ ¿ÚıÚÔ ·˘Ùfi Á›ÓÂÙ·È Û‡ÓÙÔÌË ·Ó·ÛÎfiËÛË ÙˆÓ ÂȉڿÛÂˆÓ ÙˆÓ ·ÈˆÚÔ‡ÌÂÓˆÓۈ̷Ùȉ›ˆÓ ÛÙÔÓ ·ÓıÚÒÈÓÔ ÔÚÁ·ÓÈÛÌfi, Ì ¤ÌÊ·ÛË ÛÙÔ Î·Ú‰È·ÁÁÂÈ·Îfi Û‡ÛÙËÌ·. ∂ȉÈ΋ ÂÈÛ‹-Ì·ÓÛË Á›ÓÂÙ·È ÁÈ· ÙÔ˘˜ ÎÈÓ‰‡ÓÔ˘˜ Ô˘ ‰È·ÙÚ¤¯Ô˘Ó Ù· ·È‰È¿, Ù· ÔÔ›· ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÂÚÈÔÚÈṲ̂-Ó˜ ‰˘Ó·ÙfiÙËÙ˜ ·˘ÙÔÚÔÛÙ·Û›·˜. ∆· ϤÔÓ ÂÈΛӉ˘Ó· ·ÈˆÚÔ‡ÌÂÓ· ۈ̷ٛ‰È· Â›Ó·È Ù· ÌÈÎÚ¿(ƒª2,5) Î·È Ù· Ôχ ÌÈÎÚ¿ ÂÈÛÓ‡ÛÈÌ· (ƒª0,1), ηıÒ˜ Â›Ó·È ‰È·Ï˘Ù¿, ÌÂٷʤÚÔÓÙ·È Â‡ÎÔÏ· ·fi ÙÈ˜Î˘„ÂÏ›‰Â˜ ÛÙË ÁÂÓÈ΋ ΢ÎÏÔÊÔÚ›· Î·È ¤¯Ô˘Ó ·Â˘ı›·˜ ‰Ú¿ÛË Û ‰È¿ÊÔÚ· fiÚÁ·Ó· Î·È ÛÙËÓ Î·Ú-‰È¿, fiÔ˘ ÚÔηÏÔ‡Ó ·ÚÚ˘ı̛˜, ‰È·Ù·Ú·¯¤˜ Ù˘ ·ӷfiψÛ˘, ‚Ú·‰˘Î·Ú‰›·, ·ÁÁÂÈÔÛ‡Û·ÛË·ÎfiÌË Î·È ¤ÌÊÚ·ÁÌ·. ∏ ·Â˘ı›·˜ ‰Ú¿ÛË ÙÔ˘˜ ÛÙÔ ·˘ÙfiÓÔÌÔ Ó¢ÚÈÎfi Û‡ÛÙËÌ· ÌÔÚ› Ó· Ô‰ËÁ‹-ÛÂÈ Û ÂÈΛӉ˘Ó˜ Ù·¯˘Î·Ú‰›Â˜, ̤¯ÚÈ Î·È ÈÓȉÈÛÌfi. ∆· Ì·ÎÚÔÊ¿Á· ÙˆÓ Î˘„ÂÏ›‰ˆÓ, ÌÂÙ¿ ÙËÓ Ê·-ÁÔ·ÙÙˆÛË ÙˆÓ ·ÈˆÚÔ‡ÌÂÓˆÓ ÛˆÌ·Ùȉ›ˆÓ, ÂÎÎÚ›ÓÔ˘Ó Î˘ÙÔΛÓ˜, ÔÈ Ôԛ˜ -ÌÂٷ͇ ¿ÏψÓ- ÚÔ-ηÏÔ‡Ó ·‡ÍËÛË Ù˘ ÂÓ‰ÔıËÏ›Ó˘ (∂∆-1) ÛÙÔ ·›Ì·, Ì ·ÔÙ¤ÏÂÛÌ· ·ÁÁÂÈÔÛ‡Û·ÛË, ·‡ÍËÛË Ù˘ ·Ú-ÙËÚȷ΋˜ ›ÂÛ˘ Î·È ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ Î·È ÂÌÊÚ¿ÁÌ·ÙÔ˜. ∆· ·È‰È¿ Â›Ó·È ÈÔ¢·›ÛıËÙ· ÛÙËÓ ·¤ÚÈ· Ú‡·ÓÛË, Ì·˙› Ì ÙÔ˘˜ ˘ÂÚ‹ÏÈΘ, ÙÔ˘˜ ¯ÚfiÓÈÔ˘˜ Ó¢ÌÔÓÔ·ı›˜ Î·È ÙÔ˘˜Î·Ú‰ÈÔ·ı›˜, ÂÓÒ ÚfiÛÊ·Ù· ·Ó·Ê¤ÚıËΠ·ÎfiÌË Î·È ÂÓ‰ÔÌ‹ÙÚÈÔ˜ ı¿Ó·ÙÔ˜ ÂÌ‚Ú‡ˆÓ.

§¤ÍÂȘ ÎÏÂȉȿ: ∞¤ÚÈ· Ú‡·ÓÛË, ·ÈˆÚÔ‡ÌÂÓ· ۈ̷ٛ‰È·, ηډȷÁÁÂÈ·Îfi Û‡ÛÙËÌ·.

The effect of air pollution and the effects of fine particulate matter

on the circulatory system

Z. Chalemis, G. Varlamis

Abstract: Inhaled air pollutants and especially ambient air particulate matter (PM) have beenidentified as causing respiratory problems, cancer and heart disease, in both adults and children, evento the extent that increased mortality is observed in periods of increased PM air pollution. Here a briefreview is made of PM and its effects in humans, with emphasis on the cardiovascular system. Specialemphasis has been given to the dangers in childhood, when the mechanisms of autoprotection are lesswell developed. The most dangerous particles are the “fine” (aerodynamic diameter <2.5 Ìm, PM2.5) andthe “ultrafine” (aerodynamic diameter <0.1 Ìm, PM0.1) particles, as they are solvable, can be transmittedeasily into the circulation and exert immediate action on various systems, including the heart. In thecardiovascular system they may cause arrhythmias, exacerbation of ST-segment, bradycardia, arterialvasoconstriction even myocardial infarction. The direct effect on the autonomic nervous system canlead to dangerous tachycardia or even inidism. When alveolar macrophages are exposed to PM producecytokines, which promote increase of the levels of endothelin-1 (ET-1) in the blood. This results invasoconstriction, a rise in blood pressure and increased risk of coronary heart disease and myocardialinfarction. Children, the elderly and patients with chronic cardiovascular disease are the groups mostsensitive to air pollution, but recently even intrauterine fetal death has been reported.

Key words: Air pollution, particulate matter, cardiovascular system.

Pediatr Jan-Feb 06 final allges 27-01-06 15:34 ™ÂÏ›‰·18

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19∏ ›‰Ú·ÛË Ù˘ ·¤ÚÈ·˜ Ú‡·ÓÛ˘ ÛÙÔ Î˘ÎÏÔÊÔÚÈÎfi

¶·È‰È·ÙÚÈ΋ 2006;69:18-24

∂ÈÛ·ÁˆÁ‹

∏ Û¯¤ÛË ÙˆÓ ·ÈˆÚÔ‡ÌÂÓˆÓ ÛˆÌ·Ùȉ›ˆÓ ÙÔ˘

·¤Ú· ÛÙËÓ ·ıÔÏÔÁ›· ÓfiÛˆÓ ÙÔ˘ ·Ó·Ó¢ÛÙÈ-

ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Î·È ÙÔ˘ ηÚΛÓÔ˘ ÙÔ˘ Ó‡ÌÔ-

Ó· ¤¯ÂÈ ·Ô‰Âȯı› Â‰Ò Î·È ·ÚÎÂÙ¿ ¯ÚfiÓÈ·

(1-4). ∆ËÓ ÙÂÏÂ˘Ù·›· ‰ÂηÂÙ›· ¤¯ÂÈ ·Ó·ÁÓˆÚÈ-

Ûı› Ô ÚfiÏÔ˜ ÙÔ˘˜ Î·È Û ·ı‹ÛÂȘ ÙÔ˘ ηÚ-

‰È·ÁÁÂÈ·ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, ÙfiÛÔ Ì ÂȉËÌÈÔÏÔ-

ÁÈΤ˜ ÌÂϤÙ˜, fiÛÔ Î·È Ì ÂÈÚ·Ì·ÙÈΤ˜ ÂÚÁ·-

ۛ˜ (5-7), ÛÙȘ Ôԛ˜ ·Ô‰ÂÈÎÓ‡ÂÙ·È fiÙÈ Ë ·‡-

ÍËÛË Ù˘ ·¤ÚÈ·˜ Ú‡·ÓÛ˘ Û¯ÂÙ›˙ÂÙ·È Ì ·‡ÍË-

ÛË Ù˘ ÓÔÛËÚfiÙËÙ·˜, ÙˆÓ ÂÈÛ·ÁˆÁÒÓ Û ÓÔÛÔ-

ÎÔÌ›· Î·È Ù˘ ıÓËÛÈÌfiÙËÙ·˜ ·fi ηډȷÁÁÂÈ·-

ο ·›ÙÈ·. ∫¿ı ÁˆÁÚ·ÊÈ΋ ÂÚÈÔ¯‹ Î·È Î¿ıÂ

fiÏË ¤¯ÂÈ ÙË ‰È΋ Ù˘ ÔÈÎÈÏ›· Ú‡ˆÓ. ŒÙÛÈ ÔÈ

ı¿Ó·ÙÔÈ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ·¤ÚÈ· Ú‡·ÓÛË

‰È·Ê¤ÚÔ˘Ó ÛÙȘ ‰È¿ÊÔÚ˜ ÛÙ·ÙÈÛÙÈΤ˜ (2-7).

∂›‰Ë ۈ̷Ùȉ›ˆÓ

∆· ∞ȈÚÔ‡ÌÂÓ· ™ˆÌ·Ù›‰È· (∞™), Ù· ÔÔ›·

ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›· ·Ó·Ê¤ÚÔÓÙ·È ˆ˜

Particulate Matter (PM), Â›Ó·È ÛÙÂÚ¿ ‹ ˘ÁÚ¿

ۈ̷ٛ‰È· (ÛÙ·ÁÔÓ›‰È·), Ô˘ ‚Ú›ÛÎÔÓÙ·È Û ‰È·-

ÛÔÚ¿ ÛÙËÓ ·ÙÌfiÛÊ·ÈÚ· Î·È Î·Ï‡ÙÔ˘Ó Â˘Ú‡

Ê¿ÛÌ· ÌÂÁÂıÒÓ, Ì ·ÂÚÔ‰˘Ó·ÌÈ΋ ‰È¿ÌÂÙÚÔ d

·fi <0,1 Ìm ̤¯ÚÈ >100 Ìm. ∞ÔÙÂÏÔ‡ÓÙ·È ·fi

Ì›ÁÌ· ÚÔ˚fiÓÙˆÓ Î·‡ÛˆÓ, ‚·Ú¤ˆÓ ÌÂÙ¿ÏψÓ,

¯ËÌÈÎÒÓ ·Ï¿ÙˆÓ Î·È ‚ÈÔÏÔÁÈÎÒÓ ˘ÏÈÎÒÓ fiˆ˜

ÌÈÎÚfi‚È·, ÈÔ› Î·È ÂÓ‰ÔÙÔ͛Ә (8). ∏ ¯ËÌÈ΋ ÙÔ˘˜

Û‡ÛÙ·ÛË ‰È·Ê¤ÚÂÈ ·Ó¿ÏÔÁ· Ì ÙËÓ ËÁ‹ ÂÎÔ-

Ì‹˜ ÙÔ˘˜. ¢È·ÎÚ›ÓÔÓÙ·È ·Ó¿ÏÔÁ· Ì ÙÔ Ì¤ÁÂıfi˜

ÙÔ˘˜ ·) Û “·Ó¿ÈÙ·”, Ì ÌÂÁ¿ÏÔ Ì¤ÁÂıÔ˜ (>10

Ìm) Î·È ÌÈÎÚfi ¯ÚfiÓÔ ·ÈÒÚËÛ˘, Ô˘ ηٷÎÚ·-

ÙÔ‡ÓÙ·È ·fi ÙÔÓ ÚÈÓÈÎfi ‚ÏÂÓÓÔÁfiÓÔ Î·È ‰ÂÓ ÂÈ-

Û¤Ú¯ÔÓÙ·È ÛÙÔÓ ÔÚÁ·ÓÈÛÌfi, ‚) Û “·Ó·Ó‡ÛÈ-

Ì·” (coarce, PM10 2,5-10 Ìm), Ù· ÔÔ›· ·Ó¿ÏÔÁ·

Ì ÙË ¯ËÌÈ΋ ÙÔ˘˜ Û‡ÛÙ·ÛË ÂÓÔ¯ÔÔÈÔ‡ÓÙ·È ÁÈ·

·ÛıÌ·ÙÈΤ˜ ÎÚ›ÛÂȘ, ̤¯ÚÈ Î·ÚΛÓÔ ÙÔ˘ Ó‡ÌÔ-

Ó·, Á) ÛÂ “ÏÂÙ¿” ‹ “ÌÈÎÚ¿” (fine PM2,5 <2,5 Ìm)

Î·È ‰) Û “Ôχ ÏÂÙ¿” ‹ “Ôχ ÌÈÎÚ¿” (ultra-

fine PM0,1 <0,1 Ìm) ۈ̷ٛ‰È·. √È ‰‡Ô ÙÂÏÂ˘Ù·›-

˜ ηÙËÁÔڛ˜ ۈ̷Ùȉ›ˆÓ ÂÓÔ¯ÔÔÈÔ‡ÓÙ·È ÁÈ·

ÙȘ ‚Ï¿‚˜ ÛÙÔ Î˘ÎÏÔÊÔÚÈÎfi Û‡ÛÙËÌ·, ηıÒ˜

Â›Ó·È ‰È·Ï˘Ù¿ Î·È ·fi ÙȘ ΢„ÂÏ›‰Â˜ ÌÂٷʤÚÔ-

ÓÙ·È ·Â˘ı›·˜ ÛÙË ÁÂÓÈ΋ ΢ÎÏÔÊÔÚ›· (8). ∆·

ÈÔ ÂÈΛӉ˘Ó· ∞™ Â›Ó·È ÙÔ˘ ÌÔχ‚‰Ô˘ (·fi

‚ÂÓ˙›Ó˜ Ì ·ÓÙÈÎÚÔÙÈο), ÙÔ˘ ·ÌÈ¿ÓÙÔ˘ (˘ÏÈο

ÊÚ¤ÓˆÓ ·˘ÙÔÎÈÓ‹ÙˆÓ) ηıÒ˜ Î·È ÛˆÌ·Ù›‰È· ¯Ë-

ÌÈÎÒÓ ·Ï¿ÙˆÓ Î·È ¿ÏÏˆÓ ÌÂÙ¿ÏÏˆÓ ·fi ‰Â˘ÙÂ-

ÚÔÁÂÓ›˜ ¯ËÌÈΤ˜ ·ÓÙȉڿÛÂȘ. ÕÏÏ· ÙÔÍÈο ∞™

Â›Ó·È ·˘Ù¿ Ô˘ ÂÚȤ¯Ô˘Ó ηÚÎÈÓÔÁfiÓÔ˘˜ Ô-

Ï˘·ÚˆÌ·ÙÈÎÔ‡˜ ˘‰ÚÔÁÔÓ¿ÓıڷΘ. √È ËÁ¤˜

Ú‡·ÓÛ˘ Ù˘ ·ÙÌfiÛÊ·ÈÚ·˜ Ì ∞™ Â›Ó·È ÔÈ ‚ÈÔ-

Ì˯·Ó›Â˜ (ÙÛÈÌÂÓÙÔ·Ú·ÁˆÁ‹˜, Ï·ÙÔÌ›·, ÂÚÁÔ-

ÛÙ¿ÛÈ· ·Ú·ÁˆÁ‹˜ ËÏÂÎÙÚÈÎÔ‡ Ú‡̷ÙÔ˜, ¯·Ï˘-

‚Ô˘ÚÁ›·), ÔÈ ÎÂÓÙÚÈΤ˜ ıÂÚÌ¿ÓÛÂȘ ÔÈÎÈÒÓ Î·È

ÔÏ˘Î·ÙÔÈÎÈÒÓ, ÔÈ ÂÍ·ÙÌ›ÛÂȘ ·˘ÙÔÎÈÓ‹ÙˆÓ, Ë

ÙÚÈ‚‹ ÂÏ·ÛÙÈÎÒÓ Î·È Ë ÛÎfiÓË ÙÔ˘ ‰¿ÊÔ˘˜. ∫˘-

ÚÈfiÙÂÚË ËÁ‹ ·ÛÙÈÎÒÓ Ú‡ˆÓ Â›Ó·È Ù· ·˘ÙÔΛÓË-

Ù· (ÔÛÔÛÙfi ·fi 46,7-64,3%) Î·È Ë Î·‡ÛË Â-

ÙÚÂÏ·›Ô˘ (ÔÛÔÛÙfi 8,4-28%) (9).

∞ÙÌÔÛÊ·ÈÚÈÎÔ› Ú‡ÔÈ

√È Î˘ÚÈfiÙÂÚÔÈ ·ÙÌÔÛÊ·ÈÚÈÎÔ› Ú‡ÔÈ Â›Ó·È ÙÔ

‰ÈÔÍ›‰ÈÔ ÙÔ˘ ı›Ԣ (SO2, ηÙ' ÂÍÔ¯‹Ó ‚ÈÔÌ˯·-

ÓÈÎfi˜ Ú‡Ô˜), Ù· ·˙ˆÍ›‰È·, Ô˘ ‰È·ÎÚ›ÓÔÓÙ·È

Û ÓÈÙÚÈο ÔÍ›‰È· (NOx) Î·È ‰ÈÔÍ›‰ÈÔ ÙÔ˘ ·˙Ò-

ÙÔ˘ (NO2) Î·È Â›Ó·È Î˘Ú›ˆ˜ ÚÔ˚fiÓÙ· η‡ÛˆÓ,

ÙÔ ÌÔÓÔÍ›‰ÈÔ ÙÔ˘ ¿Óıڷη (C√, ÚÔ˚fiÓ Î·‡-

ÛÂˆÓ Â›Û˘), Ë Ù¤ÊÚ· (ÂÚȤ¯ÂÈ ÔÍ›‰È· ÌÂ-

Ù¿ÏÏˆÓ ·fi η‡ÛË ÏÈÁÓ›ÙË ÁÈ· ·Ú·ÁˆÁ‹ ËÏÂ-

ÎÙÚÈÎÔ‡ Ú‡̷ÙÔ˜), ÔÈ ˘‰ÚÔÁÔÓ¿ÓıڷΘ (∏C,

·fi ·ÙÂÏ‹ η‡ÛË ·˘ÙÔÎÈÓ‹ÙˆÓ) Î·È ÙÔ fi˙ÔÓ

(O3, ÚÔ˚fiÓ ÊˆÙÔ¯ËÌÈÎÒÓ ·ÓÙȉڿÛÂˆÓ ÛÙËÓ

·ÙÌfiÛÊ·ÈÚ· ·fi NOx, O2 Î·È ËÏȷ΋ ·ÎÙÈÓÔ‚Ô-

Ï›·). √ ηı¤Ó·˜ ·fi ÙÔ˘˜ Ú‡Ô˘˜ ·˘ÙÔ‡˜ ¤¯ÂÈ

‰È·ÊÔÚÂÙÈ΋ ›‰Ú·ÛË ÛÙÔÓ ·ÓıÚÒÈÓÔ ÔÚÁ·-

ÓÈÛÌfi (¶›Ó·Î·˜ 1).

∞Ó·Ó¢ÛÙÈÎfi

∏ Û¯¤ÛË ÙˆÓ ·ÙÌÔÛÊ·ÈÚÈÎÒÓ Ú‡ˆÓ Î·È ÙˆÓ

∞™ Ì ·ı‹ÛÂȘ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ ¤¯ÂÈ ÌÂÏÂ-

ÙËı› Î·È ÂÚÈÁÚ·Ê› ‰ÈÂÍÔ‰Èο. ∆· ÌÂÁ·Ï‡ÙÂ-

Ú· ∞™ Ô˘ ηٷÎÚ·ÙÔ‡ÓÙ·È ÛÙÔÓ ÚÈÓÈÎfi ‚ÏÂÓ-

ÓÔÁfiÓÔ, ÙËÓ ÙÚ·¯Â›· Î·È ÙÔ˘˜ ‚ÚfiÁ¯Ô˘˜ ÚÔη-

ÏÔ‡Ó ·ÏÏÂÚÁÈ΋ ÚÈÓ›Ùȉ·, ÙÚ·¯ÂÈ›Ùȉ·, ¯ÚfiÓÈ·

‚ÚÔÁ¯›Ùȉ· Î·È ‚ÚÔÁ¯ÈÎfi ¿ÛıÌ·. √È ÂÚÂıÈÛÙÈΤ˜

Ô˘Û›Â˜ fiˆ˜ SO2, NOx, O3 Î·È ·ÏÏÂÚÁÈÔÁfiÓ·

ۈ̷ٛ‰È· ÚÔηÏÔ‡Ó ¿ÛıÌ· Î·È ¯ÚfiÓȘ ·Ô-

ÊÚ·ÎÙÈΤ˜ Ó¢ÌÔÓÔ¿ıÂȘ, ÂÓÒ ÙÔ ‚ÂÓ˙fiÏÈÔ,

Ô ·Ì›·ÓÙÔ˜ Î·È ¿ÏÏ· ‚·Ú¤· ̤ٷÏÏ· ÚÔη-

ÏÔ‡Ó Î·ÚΛÓÔ ÙÔ˘ Ó‡ÌÔÓ· (∂ÈÎfiÓ· 1) (1).

∆· ۈ̷ٛ‰È· Ì ‰È¿ÌÂÙÚÔ <10 Ìm ‰ÈÂÈÛ‰‡-

Ô˘Ó ÛÙÔÓ ‰È¿ÌÂÛÔ ÈÛÙfi Î·È ÚÔηÏÔ‡Ó ›ÓˆÛË Î·È

‰ËÌÈÔ˘ÚÁ›· ÎÔÎÎȈ̿وÓ. ∆· ÌÈÎÚ¿ (<2,5 Ìm)

Î·È Ù· Ôχ ÌÈÎÚ¿ ∞™ (<0,1 Ìm) Â›Ó·È Î·È Ù· ÈÔ

ÂÈΛӉ˘Ó·, ÁÈ·Ù› ·ÊÂÓfi˜ ‰ÈÂÈÛ‰‡Ô˘Ó ·Â˘ı›·˜

ÛÙËÓ Î˘ÎÏÔÊÔÚ›· ÙÔ˘ ·›Ì·ÙÔ˜ Î·È ‰ÚÔ˘Ó ÛÂ

‰È¿ÊÔÚ· fiÚÁ·Ó·, ·ÊÂÙ¤ÚÔ˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙË

Pediatr Jan-Feb 06 final allges 27-01-06 15:34 ™ÂÏ›‰·19

Page 20: Παιδιατρική | Τόμος 69 • Τεύχος 1 • Ιανουάριος - Φεβρουάριος 2006

20 ∑. ÷ϤÌ˘, °. µ·ÚÏ¿Ì˘

‰Ú·ÛÙËÚÈÔÔ›ËÛË ÙˆÓ Ì·ÎÚÔÊ¿ÁˆÓ ÙˆÓ Î˘„Â-

Ï›‰ˆÓ. ™ÙȘ ÂÚÈÙÒÛÂȘ ·˘Ù¤˜ ‚Ú¤ıËÎ·Ó ·˘ÍË-

̤ÓÔÈ ÔÈ “‰Â›ÎÙ˜ ÊÏÂÁÌÔÓ‹˜”, fiˆ˜ Ë CRP ηÈ

Ô ·ÚÈıÌfi˜ ÙˆÓ Ï¢ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ, ηıÒ˜ ηÈ

‰È¿ÊÔÚ˜ ΢ÙÔΛÓ˜ Î·È Ô TNF, Ô˘ ÂÎÎÚ›ÓÔÓÙ·È

·fi Ù· ÂÓÂÚÁÔÔÈË̤ӷ Ì·ÎÚÔÊ¿Á· (8,10).

∫·Ú‰È·ÁÁÂÈ·Îfi Î·È ∞˘ÙfiÓÔÌÔ ¡Â˘ÚÈÎfi

™‡ÛÙËÌ·

∂ȉËÌÈÔÏÔÁÈΤ˜ ¤Ú¢Ó˜ ¤¯Ô˘Ó ·Ô‰Â›ÍÂÈ

ÙË Û˘Û¯¤ÙÈÛË Ù˘ ·¤ÚÈ·˜ Ú‡·ÓÛ˘ Ì ÙË ÓÔÛË-

ÚfiÙËÙ· Î·È ÙË ıÓËÛÈÌfiÙËÙ· ·fi ·ı‹ÛÂȘ ÙÔ˘

ηډÈÔ·Ó·Ó¢ÛÙÈÎÔ‡ ·ÏÏ¿ Î·È ÙÔ˘ ηډȷÁ-

ÁÂÈ·ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ (11).

∏ ·Â˘ı›·˜ ›ÛÔ‰Ô˜ ÙˆÓ ÂÈÛÓÂfiÌÂÓˆÓ

ۈ̷Ùȉ›ˆÓ ·fi ÙȘ ΢„ÂÏ›‰Â˜ ÛÙËÓ Î˘ÎÏÔÊÔ-

Ú›· ÙÔ˘ ·›Ì·ÙÔ˜ ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙË ‰È·-

ÛÔÚ¿ Î·È ÙË ‰Ú¿ÛË ÙÔ˘˜ Û ‰È¿ÊÔÚ· fiÚÁ·Ó·

(‹·Ú, ÓÂÊÚÔ›, ı˘ÚÂÔÂȉ‹˜ ·‰¤Ó·˜, ÛÈÂÏÔÁfiÓÔÈ,

ÛÙfiÌ·¯Ô˜) (10), ÂÓÒ ·Ú·ÙËÚ‹ıËΠfiÙÈ ÚÔη-

ÏÔ‡ÓÙ·È ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ·˘ÙfiÓÔÌÔ˘ Ó¢ÚÈÎÔ‡

Û˘ÛÙ‹Ì·ÙÔ˜ Ì ·ÔÙ¤ÏÂÛÌ· Ù·¯˘Î·Ú‰›· ‹ ‚Ú·-

‰˘Î·Ú‰›·, ·ÁÁÂÈÔÛ‡Û·ÛË, ηډȷΤ˜ ·ÚÚ˘ı-

̛˜ ·ÎfiÌË Î·È Î·Ú‰È·Îfi ¤ÌÊÚ·ÁÌ· ‹ ÌfiÓÔ

¶·È‰È·ÙÚÈ΋ 2006;69:18-24

∂ÈÎfiÓ· 1. ∂·ÁÁÂÏÌ·ÙÈο ÓÔÛ‹Ì·Ù· ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡. √È ·Ó·ÙÔÌÈΤ˜ ı¤ÛÂȘ ÙÔ˘˜ ÛÙÔ ·Ó·Ó¢ÛÙÈÎfi Û‡ÛÙËÌ·,·Ú·‰Â›ÁÌ·Ù· ÙˆÓ Û˘ÓËı¤ÛÙÂÚˆÓ ÛˆÌ·Ùȉ›ˆÓ-·ÈÙ›ˆÓ Î·È Ë ·ıÔÊ˘ÛÈÔÏÔÁÈ΋ ÙÔ˘˜ ‰Ú¿ÛË (∆ÚÔÔÔÈË̤ÓÔ ·fi:William S Beckett, MD N Engl J Med 2000;342:406-412)(1).

ƒÈÓ›Ùȉ· - Ï·Ú˘ÁÁ›Ùȉ· ∆· ÌÂÁ¿Ï· ۈ̷ٛ‰È· Û˘ÁÎÚ·ÙÒÓÙ·È ÛÙË Ì‡ÙË, ÙÔÓ Ê¿Ú˘ÁÁ· Î·È ÙÔÓ Ï¿Ú˘ÁÁ·. ∆·‰È·Ï˘Ù¿ ·¤ÚÈ· (SO2) ·ÔÚÚÔÊÒÓÙ·È ·fi ÙÔ ·ÓÒÙÂÚÔ ·Ó·Ó¢ÛÙÈÎfi Î·È ÚÔηÏÔ‡ÓÔ›‰ËÌ· Î·È ˘ÂÚ¤ÎÎÚÈÛË ‚ϤÓÓ˘.

ƒÈÓÈ΋ ÎÔÈÏfiÙËÙ·

º¿Ú˘ÁÁ·˜

§¿Ú˘ÁÁ·˜

∆Ú·¯Â›·

µÚfiÁ¯ÔÈ

µÚÔÁ¯ÈfiÏÈ·

∫˘„ÂÏ›‰Â˜

∆Ú·¯ÂÈ›Ùȉ· - ‚ÚÔÁ¯›Ùȉ· - ‚ÚÔÁ¯ÈÔÏ›Ùȉ·™ˆÌ·Ù›‰È· ‰È·Ì¤ÙÚÔ˘ >10 Ìm Û˘ÁÎÚ·ÙÒÓÙ·È Î·È ·ÔÌ·ÎÚ‡ÓÔÓÙ·È ·fi ÙÔ˘˜ ÎÚÔÛÛÔ‡˜. ªÈÎÚfiÙÂڷۈ̷ٛ‰È· Û˘ÁÎÚ·ÙÒÓÙ·È ÛÙ· ‚ÚÔÁ¯ÈfiÏÈ·. §ÈÁfiÙÂÚÔ ‰È·Ï˘Ù¿ ·¤ÚÈ· ‰ÈÂÈÛ‰‡Ô˘Ó ‚·ı‡ÙÂÚ·.

ÕÛıÌ· Î·È ¯ÚfiÓÈ· ·ÔÊÚ. Ó¢ÌÔÓÔ¿ıÂÈ·∞ÏÏÂÚÁÈÔÁfiÓ· Î·È ÂÚÂıÈÛÙÈΤ˜ Ô˘Û›Â˜ ÂÓ·ÔÙ›ıÂÓÙ·È ÛÙÔ˘˜ ·ÂÚ·ÁˆÁÔ‡˜ ÚÔηÏÒÓÙ·˜¯ÚfiÓȘ ÊÏÂÁÌÔÓÒ‰ÂȘ ·ÏÏÔÈÒÛÂȘ.

∫·ÚΛÓÔ˜ ∫·ÚÎÈÓÔÁfiÓ· ۈ̷ٛ‰È· (·Ì›·ÓÙÔ˜, ÔÏ˘Î˘ÎÏÈÎÔ› ·ÚˆÌ·ÙÈÎÔ› ˘‰ÚÔÁÔÓ¿ÓıڷΘ) ÂȉÚÔ‡ÓÛÙ· ÂÈıËÏȷο ·ÙÙ·Ú· ÚÔηÏÒÓÙ·˜ ÌÂÙ·ÏÏ¿ÍÂȘ Î·È Î·ÎÔ‹ıË ÂÍ·ÏÏ·Á‹.

¢È¿ÌÂÛË ÓfiÛÔ˜™ˆÌ·Ù›‰È· <10 Ìm Î·È ›Ó˜ Êı¿ÓÔ˘Ó ÛÙ· ÙÂÏÈο ‚ÚÔÁ¯ÈfiÏÈ· Î·È ÙȘ ΢„ÂÏ›‰Â˜ Î·È ‰ÈÂÈÛ‰‡Ô˘Ó ÛÙÔÓ ‰È¿ÌÂÛÔ ÈÛÙfi ÚÔηÏÒÓÙ·˜ ›ÓˆÛË Î·È ‰ËÌÈÔ˘ÚÁ›· ÎÔÎÎȈ̿وÓ.

¶›Ó·Î·˜ 1. ∞ÙÌÔÛÊ·ÈÚÈÎÔ› Ú‡ÔÈ, ËÁ‹ ÚÔ¤Ï¢Û˘ Î·È Â›‰Ú·ÛË ÛÙËÓ ˘Á›· (46)

ƒ‡ÔÈ ∫‡ÚÈ· ËÁ‹ ™˘Ó¤ÂȘ

µÂÓ˙fiÏÈÔ ∞˘ÙÔΛÓËÙ· ∫·ÚΛÓÔ˜ ÃËÌÈ΋ ‚ÈÔÌ˯·Ó›· ¶ÚÔÛ‚ÔÏ‹ ∫¡™

µ·Ú¤· ̤ٷÏÏ· µÈÔÌ˯·Ó›· ∫·ÚΛÓÔ˜ñ ·ÚÛÂÓÈÎfi ∞˘ÙÔΛÓËÙ· µÏ¿‚˜ ÂÙÈÎÔ‡ñ ο‰ÌÈÔ µÏ¿‚˜ ∫¡™ñ ÌfiÏ˘‚‰Ô˜ñ ˘‰Ú¿ÚÁ˘ÚÔ˜ñ ÓÈΤÏÈÔ¢ÈÔÍ›‰ÈÔ ÙÔ˘ ·˙ÒÙÔ˘ ∞˘ÙÔΛÓËÙ· µÏ¿‚˜ ·Ó·Ó¢ÛÙÈÎÔ‡

∫·‡ÛÂȘŸ˙ÔÓ ¡√x ·fi ·˘ÙÔΛÓËÙ· µÏ¿‚˜ ·Ó·Ó¢ÛÙÈÎÔ‡

+√2 ÕÛıÌ·, ·ÏÏÂÚÁÈ΋ ÚÈÓ›Ùȉ·+ ËÏȷ΋ ·ÎÙÈÓÔ‚ÔÏ›· ∂Ï¿ÙÙˆÛË ·ÓÙ›ÛÙ·Û˘ Û ÏÔÈÌÒÍÂȘ

¢ÈÔÍ›‰ÈÔ ÙÔ˘ ı›Ԣ ∫·‡ÛÂȘ µÏ¿‚˜ ·Ó·Ó¢ÛÙÈÎÔ‡∞ȈÚÔ‡ÌÂÓ· ۈ̷ٛ‰È· ∫·‡ÛÂȘ ∫·ÚΛÓÔ˜

µÈÔÌ˯·Ó›· µÏ¿‚˜ ·Ó·Ó¢ÛÙÈÎÔ‡µÏ¿‚˜ ηډȷÁÁÂÈ·ÎÔ‡µÚÂÊÈ΋ ıÓËÛÈÌfiÙËÙ·

Pediatr Jan-Feb 06 final allges 27-01-06 15:34 ™ÂÏ›‰·20

Page 21: Παιδιατρική | Τόμος 69 • Τεύχος 1 • Ιανουάριος - Φεβρουάριος 2006

21∏ ›‰Ú·ÛË Ù˘ ·¤ÚÈ·˜ Ú‡·ÓÛ˘ ÛÙÔ Î˘ÎÏÔÊÔÚÈÎfi

‰È·Ù·Ú·¯¤˜ Ù˘ ·ӷfiψÛ˘ (12-18). ¶Èı·-

ÓÔÏÔÁÂ›Ù·È Ë ÂÏ¿ÙÙˆÛË ÙÔ˘ ÙfiÓÔ˘ ÙÔ˘ Ó¢ÌÔ-

ÓÔÁ·ÛÙÚÈÎÔ‡ Ó‡ÚÔ˘ (14), ¯ˆÚ›˜ Ó· ·ÔÎÏ›Â-

Ù·È Â›Û˘ Ë ·Â˘ı›·˜ ‰Ú¿ÛË ÙˆÓ ∞™ ÛÙÔ ·˘-

ÙfiÓÔÌÔ Ó¢ÚÈÎfi Û‡ÛÙËÌ·, Ë ÔÔ›· ÚÔηÏ›

¢ÂÚÂıÈÛÙfiÙËÙ· ÙˆÓ Î·Ú‰È·ÎÒÓ Î˘ÙÙ¿ÚˆÓ Î·È

ÈÓÒÓ Î·È ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û ÂÈΛӉ˘Ó˜

ÁÈ· ÙË ˙ˆ‹ Ù·¯˘Î·Ú‰›Â˜, ̤¯ÚÈ Î·È Û ·ÈÊÓ›‰ÈÔ

ı¿Ó·ÙÔ (14-18) (∂ÈÎfiÓ· 2).

∞›Ì·

∞‡ÍËÛË Ù˘ ËÎÙÈÎfiÙËÙ·˜ ÙÔ˘ ·›Ì·ÙÔ˜ ÌÂÙ¿

·fi ÂÈÛÓÔ‹ ·ÂÚ›ˆÓ Ú‡ˆÓ ›¯Â ·Ú·ÙËÚËı›

·fi ∂˘Úˆ·›Ô˘˜ ÂÚ¢ÓËÙ¤˜ Û ÂÓ‹ÏÈΘ ·fi ÙÔ

1985 (19). ∏ ÊÏÂÁÌÔÓ҉˘ ‰ÈÂÚÁ·Û›·, Ô˘ ¤¯ÂÈ

·ÊÂÙËÚ›· ÙÔ˘˜ Ó‡ÌÔÓ˜ Ì ÙËÓ ·ÂÏ¢ı¤Úˆ-

ÛË Î˘ÙÔÎÈÓÒÓ (IL-1-beta, IL-6) Î·È TNF-alfa

·fi Ù· Ì·ÎÚÔÊ¿Á·, ÌÂÙ¿ ·fi ÂÈÛÓÔ‹ ∞™, ¤¯ÂÈ

·Ô‰Âȯı› fiÙÈ Â˘ÓÔ› ÙËÓ ·Ó¿Ù˘ÍË ·ıËڈ̷-

ÙÈÎÒÓ ‚Ï·‚ÒÓ Î·È ÙËÓ ·‡ÍËÛË Ù˘ CRP ÙÔ˘

ÔÚÔ‡, ¯ˆÚ›˜ Ó· ÂËÚ¿˙ÔÓÙ·È ÔÈ ÙÈ̤˜ ÙˆÓ ÏÈÈ-

‰›ˆÓ ÙÔ˘ ÔÚÔ‡ (20). ¶·Ï·ÈfiÙÂÚ˜, ·ÏÏ¿ ηÈ

ÚfiÛÊ·Ù˜ ÌÂϤÙ˜, ¤¯Ô˘Ó ·Ô‰Â›ÍÂÈ ıÂÙÈ΋

Û˘Û¯¤ÙÈÛË ÙˆÓ Î˘ÙÔÎÈÓÒÓ Ì ÌÂÙ·‚ÔϤ˜ ÛÙË

Û˘ÁΤÓÙÚˆÛË ÙˆÓ ÂÚ˘ıÚÒÓ Î·È Ï¢ÎÒÓ ·ÈÌÔ-

ÛÊ·ÈÚ›ˆÓ ÛÙÔ ·›Ì·, ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÌÂÙ·‚Ô-

Ϥ˜ ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ, Ì ÛËÌ›· ‰È·Ù·Ú·¯‹˜

Ù˘ ËÎÙÈÎfiÙËÙ·˜ ÙÔ˘ ·›Ì·ÙÔ˜ (·‡ÍËÛË ÈÓˆ‰Ô-

ÁfiÓÔ˘ Ï¿ÛÌ·ÙÔ˜) (21,22) Î·È ÂÔ̤ӈ˜ Ì ·˘-

ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÈÛ¯·ÈÌÈÎÒÓ ‚Ï·‚ÒÓ (19-23).

∂Ó‰ÔıËÏ›ÓË-1

¶ÚfiÛÊ·Ù˜ ÌÂϤÙ˜ ·¤‰ÂÈÍ·Ó ÙËÓ ¤ÓÙÔÓË

·ÁÁÂÈÔÛ‡Û·ÛË Û ˘ÁÈ‹ ¿ÙÔÌ· ÌÂÙ¿ ·fi

¶·È‰È·ÙÚÈ΋ 2006;69:18-24

∂ÈÎfiÓ· 2. ÀÔıÂÙÈÎÔ› Ì˯·ÓÈÛÌÔ› Ì ÙÔ˘˜ ÔÔ›Ô˘˜ Ù· ÂÈÛÓÂfiÌÂÓ· ۈ̷ٛ‰È· ÌÔÚÔ‡Ó Ó· ÂËÚ¿ÛÔ˘Ó ÙË Ó¢ÚÈ-΋ Ú‡ıÌÈÛË Ù˘ ηډȿ˜ (∆ÚÔÔÔÈË̤ÓÔ ·fi Stone PH and Godleski JJ, Am Heart J 1999;138:804-807)(13).

∂ÈÛÓÂfiÌÂӷۈ̷ٛ‰È·

ÂÚÈ‚¿ÏÏÔÓÙÔ˜

¶ÚÔ¿ÁÔ˘Ó ÌÈ· Û˘ÛÙËÌ·ÙÈ΋

·¿ÓÙËÛË stressÙÔ˘ Û˘Ì·ıËÙÈÎÔ‡

¢È¤ÁÂÚÛË Â˘·›ÛıËÙˆÓ˘Ô‰Ô¯¤ˆÓ ÛÙÔ˘˜

·ÂÚ·ÁˆÁÔ‡˜

∞·ÓÙ‹ÛÂȘ ∫¡™

µÚ·‰˘·ÚÚ˘ı̛˜

ºÏÂÁÌÔÓ‹ ÛÙÔÓ Ó‡ÌÔÓ·

ÁÚ‹ÁÔÚ˜ &ÂÈfiϷȘ·Ó·ÓÔ¤˜

∆·¯˘·ÚÚ˘ıÌ›· & ∫ÔÈÏÈ·Îfi˜

ÈÓȉÈÛÌfi˜

� ∫·Ú‰È·Î‹ Û˘¯ÓfiÙËÙ·

� ¢È·Î‡Ì·ÓÛË Ù˘ ηډȷ΋˜ Û˘¯ÓfiÙËÙ·˜

� ¶ÂÚÈÔ¯‹ ˘„ËÏ‹˜ Û˘¯ÓfiÙËÙ·˜ Ù˘‰È·Î‡Ì·ÓÛ˘ Ù˘ ηډ. Û˘¯ÓfiÙËÙ·˜

� ™˘ÛÙËÌ·ÙÈ΋ ÊÏÂÁÌÔÓ‹

� ∞ÓÙ›‰Ú·ÛË ÙÔ˘ Ó¢ÌÔÓÔÁ·ÛÙÚÈÎÔ‡ÛÙË Î·Ú‰È¿

� ÕÓÔÈ·

� ‚ÚÔÁ¯fiÛ·ÛÌÔ˜

�¢È·Î‡Ì·ÓÛ˘Ù˘ ηډȷ΋˜Û˘¯ÓfiÙËÙ·˜

�™¯¤ÛË Ã·ÌËÏ‹˜ Û˘¯ÓfiÙËÙ·˜ /˘„ËÏ‹ Û˘¯ÓfiÙËÙ·

Pediatr Jan-Feb 06 final allges 27-01-06 15:34 ™ÂÏ›‰·21

Page 22: Παιδιατρική | Τόμος 69 • Τεύχος 1 • Ιανουάριος - Φεβρουάριος 2006

22 ∑. ÷ϤÌ˘, °. µ·ÚÏ¿Ì˘

ÂÈÛÓÔ‹ ۈ̷Ùȉ›ˆÓ ƒª2,5 Î·È fi˙ÔÓÙÔ˜ √3

(24,25). ™Â ·˘Ù‹Ó ÂÓÔ¯ÔÔÈÂ›Ù·È Ô Ì˯·ÓÈÛÌfi˜

·Ú·ÁˆÁ‹˜ ÌÈ·˜ ÈÛ¯˘ÚfiÙ·Ù˘ ·ÁÁÂÈÔÛ˘Û·ÛÙÈ-

΋˜ Ô˘Û›·˜, Ù˘ ÂÓ‰ÔıËÏ›Ó˘-1 (∂∆-1). ∞Ó¿ÏÔ-

ÁÔ˜ Ì˯·ÓÈÛÌfi˜ ·Ú·ÁˆÁ‹˜ Ù˘ ∂∆-1 ·Ú·ÙË-

Ú‹ıËΠ۠ηÓÈÛÙ¤˜ (26). ™‡Ìʈӷ Ì ÙÔÓ ÌË-

¯·ÓÈÛÌfi ·˘ÙfiÓ, ÔÈ ÂχıÂÚ˜ Ú›˙˜ ¿Óıڷη ηÈ

√2, Ô˘ ÂÚȤ¯ÔÓÙ·È Û ˘„ËϤ˜ Û˘ÁÎÂÓÙÚÒÛÂȘ

ÛÙÔÓ ÂÈÛÓÂfiÌÂÓÔ Î·Ófi, ·ÔÙÂÏÔ‡Ó ÙÔÓ ·ÈÙÈÔ-

ÏÔÁÈÎfi ·Ú¿ÁÔÓÙ·. ∞˘Ù¤˜ ‰ÚÔ˘Ó ÛÙ· ÂÓ‰ÔıËÏÈ·-

ο ·ÙÙ·Ú· Î·È ·ÊÂÓfi˜ ÂȉÚÔ‡Ó ·ÚÓËÙÈο ÛÙË

‚ÈԉȷıÂÛÈÌfiÙËÙ· Ù˘ L-·ÚÁÈÓ›Ó˘, ·ÊÂÙ¤ÚÔ˘

·Ô‰ÔÌÔ‡Ó ÙÔ Û˘ÓÙÈı¤ÌÂÓÔ ¡√, οÓÔÓÙ¿˜ ÙÔ ÌË

‰È·ı¤ÛÈÌÔ ÚÔ˜ ·ÁÁÂÈԉȷÛÙÔÏ‹. ¶·Ú¿ÏÏËÏ·

·Ó·ÛÙ¤ÏÏÔ˘Ó ÙÔ ¤Ó˙˘ÌÔ Û˘ÓıÂÙ¿ÛË Ù˘ ÚÔÛÙ·-

΢ÎÏ›Ó˘, ÚÔηÏÒÓÙ·˜ ¤ÙÛÈ ÙË Ì›ˆÛË Ù˘ Û˘-

ÓÙÈı¤ÌÂÓ˘ ÚÔÛÙ·Î˘ÎÏ›Ó˘, Ô˘ Â›Ó·È ÚÔÛÙ·-

Ù¢ÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜, Ì ·ÁÁÂÈԉȷÛÙ·ÏÙÈ΋ ηÈ

·ÓÙÈ·ÈÌÔÂÙ·Ïȷ΋ ‰Ú¿ÛË (26). ∞ÔÙ¤ÏÂÛÌ· Ù˘

‰˘ÛÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘ ÂÓ‰ÔıËÏ›Ô˘ Â›Ó·È Ë ·Ú·Áˆ-

Á‹ ∂∆-1, Ô˘ ÚÔηÏ› ·ÁÁÂÈÔÛ‡Û·ÛË (27).

Œ¯ÂÈ ‚ÚÂı› ÂÍ¿ÏÏÔ˘, fiÙÈ Ë ÂÈÛÓÔ‹ ƒª2,5

ÚÔηÏ› Û˘ÛÙËÌ·ÙÈ΋ ÊÏÂÁÌÔÓÒ‰Ë ‰ÈÂÚÁ·Û›·

Î·È ·Ú·ÁˆÁ‹ ΢ÙÔÎÈÓÒÓ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È ÌÂ

ÙËÓ ·Ú·ÁˆÁ‹ Î·È ‰Ú¿ÛË ÂÏ¢ı¤ÚˆÓ ÚÈ˙ÒÓ, ÔÈ

Ôԛ˜ Ì ÙË ÛÂÈÚ¿ ÙÔ˘˜ ÂÓÂÚÁÔÔÈÔ‡Ó ÙÔ˘˜ ÌË-

¯·ÓÈÛÌÔ‡˜ ·Ú·ÁˆÁ‹˜ Ù˘ ∂∆-1 Ì ·ÔÙ¤ÏÂÛÌ·

·˘ÍË̤ÓË ·ıËÚÔÁ¤ÓÂÛË ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ ·Ú-

ÙËÚÈÒÓ Î·È Ù˘ ·ÔÚÙ‹˜.

∆Ô ÂÓ‰Ôı‹ÏÈÔ ÙˆÓ ·ÁÁ›ˆÓ ·ÔÙÂÏ› ÙÔÓ

·Ô‰¤ÎÙË ‚Ï·ÙÈÎÒÓ ÂȉڿÛÂˆÓ ÙˆÓ ·Ú·-

ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘, ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ÛÙÂÊ·ÓÈ·›-

·˜ ÓfiÛÔ˘. √È ·Ú¿ÁÔÓÙ˜ ·˘ÙÔ› (˘¤ÚÙ·ÛË,

˘ÂÚÏÈȉ·ÈÌ›·, οÓÈÛÌ·, stress) ÚÔηÏÔ‡Ó

“ÂÓ‰ÔıËÏȷ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·” Ì ‰È¿ÊÔÚÔ˘˜

‚ÈÔ¯ËÌÈÎÔ‡˜ Ì˯·ÓÈÛÌÔ‡˜, ÎÔÈÓ‹ ηٿÏËÍË

ÙˆÓ ÔÔ›ˆÓ Â›Ó·È ·) Ë ·˘ÍË̤ÓË ÂÓ‰Ô΢ÙÙ¿ÚÈ·

Û˘ÛÛÒÚ¢ÛË ÂÏ¢ı¤ÚˆÓ ÚÈ˙ÒÓ Î·È ‚) Ë ·‡ÍËÛË

ÙÔ˘ ÂÓ‰Ô΢ÙÙ¿ÚÈÔ˘ ·Û‚ÂÛÙ›Ô˘. ∏ ÂÓ‰ÔıËÏȷ΋

‰˘ÛÏÂÈÙÔ˘ÚÁ›· Â›Ó·È ÙÔ ·Ú¯ÈÎfi ‚ÈÔ¯ËÌÈÎfi ÁÂÁÔ-

Ófi˜, Ô˘ Ô‰ËÁ› ÛÙËÓ ·Ó¿Ù˘ÍË ˘ÂÚÏ·ÛÙÈ-

ÎÒÓ ·ÏÏ·ÁÒÓ Î·È ·ıËڈ̿وÛ˘ ÛÙÔ ÙÔ›¯ˆÌ·

ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ Î·È ¿ÏÏˆÓ ·ÚÙËÚÈÒÓ (27).

Œ¯ÂÈ ·Ô‰Âȯı› ›Û˘ Ô ·˘ÍË̤ÓÔ˜ ΛӉ˘-

ÓÔ˜ ÂÌÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘Ôηډ›Ô˘, ÌÂÙ¿ ·fi

ÌÂÚÈΤ˜ ÒÚ˜ ̤¯ÚÈ Î·È Ë̤Ú˜ ÂÈÛÓÔ‹˜ ۈ̷-

Ùȉ›ˆÓ ƒª2,5 (28).

ƒ‡·ÓÛË Î·È ·È‰›

∆· ·È‰È¿ Â›Ó·È ÈÔ Â˘·›ÛıËÙ· ÛÙËÓ Â›‰Ú·-

ÛË Ù˘ ·¤ÚÈ·˜ Ú‡·ÓÛ˘, Û˘ÁÎÚÈÙÈο Ì ÙÔ˘˜

ÂÓ‹ÏÈΘ, ‰ÈfiÙÈ Ô Ì˯·ÓÈÛÌfi˜ ‚ÏÂÓÓÔÎÚÔÛÛˆÙ‹˜

οı·ÚÛ˘ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ ÂÈıËÏ›Ô˘ ÛÙ·

ÂÚÈÛÛfiÙÂÚ· ·È‰È¿ Ù˘ ÚÔÛ¯ÔÏÈ΋˜ ‹ Î·È Û¯Ô-

ÏÈ΋˜ ËÏÈΛ·˜ - ÏfiÁˆ ÙˆÓ Û˘¯ÓÒÓ ÏÔÈÌÒÍÂˆÓ ‹

Ù˘ ·ÏÏÂÚÁÈ΋˜ ÚԉȿıÂÛ˘ - Â›Ó·È ‰È·Ù·Ú·Á-

̤ÓÔ˜. ∏ ‚Ï¿‚Ë ÂΉËÏÒÓÂÙ·È Ì ‰È·Ù·Ú·¯‹ Ù˘

¤ÎÎÚÈÛ˘ Î·È ·ÔÌ¿ÎÚ˘ÓÛ˘ Ù˘ ‚ϤÓÓ˘, ÏfiÁˆ

ηٷÛÙÚÔÊ‹˜ ÙˆÓ ÎÚÔÛÛÒÓ (29,30). ∞˘Ùfi ¤¯ÂÈ

ˆ˜ ·ÔÙ¤ÏÂÛÌ· Ù· ۈ̷ٛ‰È· Ó· ‰ÈÂÈÛ‰‡Ô˘Ó ‚·-

ı‡ÙÂÚ· ÛÙÔ ·Ó·Ó¢ÛÙÈÎfi ‰¤Ó‰ÚÔ. ∆· ·È‰È¿,

›Û˘, ÂÚÓÔ‡Ó ÌÂÁ·Ï‡ÙÂÚÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·

¤Íˆ ·fi ÙÔ Û›ÙÈ, ÎÈÓÔ‡ÓÙ·È ÂÚÈÛÛfiÙÂÚÔ Î·È

ÈÔ ¤ÓÙÔÓ·, ·ÚÔ˘ÛÈ¿˙ÔÓÙ·˜ ÂÚÈÛÛfiÙÂÚË

˘¤ÚÓÔÈ·, ÂÓÒ ‰ÂÓ ÌÔÚÔ‡Ó Ó· ·Ó·ÁÓˆÚ›ÛÔ˘Ó

‡ÎÔÏ· ÙÔ˘˜ ÎÈÓ‰‡ÓÔ˘˜ ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜. ¶·-

Ú¿ÏÏËÏ·, ÂÍ·ÈÙ›·˜ ÙÔ˘ ¯·ÌËÏfiÙÂÚÔ˘ ·Ó·ÛÙ‹Ì·-

Ùfi˜ ÙÔ˘˜, ‚Ú›ÛÎÔÓÙ·È ÏËÛȤÛÙÂÚ· ÛÙÔ ¤‰·ÊÔ˜,

fiÔ˘ ÔÚÈṲ̂ÓÔÈ Ú‡ÔÈ Â›Ó·È Û˘ÁÎÂÓÙڈ̤ÓÔÈ Î·È

ÙÔ˘˜ ·Ó·Ó¤Ô˘Ó ¢ÎÔÏfiÙÂÚ· (31).

™Ù· ÌÈÎÚ¿ ·È‰È¿ Â›Ó·È ÌÂȈ̤ÓË Ë ¯˘ÌÈ΋

·ÓÔÛ›·, Î·È ÙÔ ÁÂÁÔÓfi˜ ·˘Ùfi ·ÓÙÈÚÚÔÂ›Ù·È Ìfi-

ÓÔ ÌÂÚÈÎÒ˜ ·fi ÙËÓ Î˘ÙÙ·ÚÈ΋ ·ÓÔÛ›·. ŸÙ·Ó

ÂÎÙ›ıÂÓÙ·È Û ˘„ËÏ‹ ·ÙÌÔÛÊ·ÈÚÈ΋ Ú‡·ÓÛË,

Ù· Ì·ÎÚÔÊ¿Á· ÂÍ·ÓÙÏÔ‡ÓÙ·È ÛÙË ‰¤ÛÌ¢ÛË ÙˆÓ

ÏÂÙÒÓ ÌÔÚ›ˆÓ ÛÎfiÓ˘, Ì ·ÔÙ¤ÏÂÛÌ· Ù· ·È-

‰È¿ Ó· Á›ÓÔÓÙ·È ÏÈÁfiÙÂÚÔ ·ÓıÂÎÙÈο Û ÏÔÈÌÔÁfi-

ÓÔ˘˜ ·Ú¿ÁÔÓÙ˜, ·ÏÏ¿ Î·È Û ‰È¿ÊÔÚ˜ ÌÔÚ-

ʤ˜ ηÚΛÓÔ˘ (32,33).

√È Ì¤¯ÚÈ Û‹ÌÂÚ· ÌÂϤÙ˜ Î·È ÂÈÚ·Ì·ÙÈΤ˜

ÂÚÁ·Û›Â˜ ·Ó·Ê¤ÚÔÓÙ·È Î˘Ú›ˆ˜ Û ÂÓ‹ÏÈΘ

ÛÙÔ˘˜ ÔÔ›Ô˘˜ ÌÂÏÂÙ‹ıËÎÂ Ë Â›ÙˆÛË Ù˘

‚Ú·¯˘¯ÚfiÓÈ·˜ ¤ÎıÂÛ‹˜ ÙÔ˘˜ Û ∞™. ∏ ‰ÈÂıÓ‹˜

‚È‚ÏÈÔÁÚ·Ê›· Â›Ó·È Ôχ ÊÙˆ¯‹ Û ·Ó¿ÏÔÁ˜ ÌÂ-

ϤÙ˜ Û ·È‰È¿ Î·È Ôχ ÂÚÈÛÛfiÙÂÚÔ Ì ̷-

ÎÚÔ¯ÚfiÓÈ· ¤ÎıÂÛ‹ ÙÔ˘˜ Û ‚‚·ÚË̤ÓÔ ÂÚÈ-

‚¿ÏÏÔÓ (30,32). ∏ ÚfiÛÊ·ÙË Û˘Û¯¤ÙÈÛË Ù˘ ·¤-

ÚÈ·˜ Ú‡·ÓÛ˘ Ì ÌÂÙ·ÏÏ¿ÍÂȘ, ·È‰ÈÎfi ηÚΛÓÔ

·ÏÏ¿ Î·È Ì ÂÓ‰ÔÌ‹ÙÚÈÔ ı¿Ó·ÙÔ, ηıÈÛÙ¿ ÙËÓ

fiÏË ˘fiıÂÛË ¿ÎÚˆ˜ ·ÓËÛ˘¯ËÙÈ΋ (33,35). ™Â

ÌÈ· ÂÚÈÔ¯‹ Ù˘ ¶Ôψӛ·˜ Ì Ôχ ˘„ËÏ‹ Ú‡-

·ÓÛË, ÙË ™ÈÏÂÛ›·, Ë Û˘¯ÓfiÙËÙ· ÙˆÓ ÌÂÙ·ÏÏ¿ÍÂ-

ˆÓ ‚Ú¤ıËΠÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚË ·fi ·ÓÙÔ‡

(36,37). ™ÙȘ ™Î·Ó‰ÈÓ·‚ÈΤ˜ ¯ÒÚ˜ ÌÂϤÙ˜ Û˘-

Û¯¤ÙÈÛ·Ó ÙËÓ ÂÈÛÓÔ‹ η˘Û·ÂÚ›ˆÓ ·˘ÙÔÎÈÓ‹ÙˆÓ

Ì ÏÂÌÊÒÌ·Ù·, Ï¢¯·ÈÌ›· Î·È fiÁÎÔ˘˜ ÙÔ˘ ÎÂ-

ÓÙÚÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ (38), ÂÓÒ ÛÙË

µÚ·˙ÈÏ›· ÂÚ¢ÓËÙ¤˜ ·¤‰ÂÈÍ·Ó fiÙÈ Ë ÂÈÛÓÔ‹

ÌÔÏ˘Ṳ̂ÓÔ˘ ·¤Ú·, ȉ›ˆ˜ ·fi ÌË Î·Ó›ÛÙÚȘ

ÌËÙ¤Ú˜, ‹Ù·Ó ·ÈÙ›· ·˘ÍË̤Ó˘ Û˘¯ÓfiÙËÙ·˜ ÂÓ-

‰ÔÌ‹ÙÚÈÔ˘ ı·Ó¿ÙÔ˘, ÏfiÁˆ Û¯ËÌ·ÙÈÛÌÔ‡ ÌÂı·È-

ÌÔÛÊ·ÈÚ›Ó˘ Î·È ·ÓıÚ·Î˘Ï·ÈÌÔÛÊ·ÈÚ›Ó˘ (35).

ªÂϤÙ˜ Ô˘ ¤¯Ô˘Ó Á›ÓÂÈ Î·Ù¿ ηÈÚÔ‡˜ ÛÙË

¯ÒÚ· Ì·˜, ·ÊÔÚÔ‡Û·Ó Î˘Ú›ˆ˜ ÛÙËÓ Â›‰Ú·ÛË

¶·È‰È·ÙÚÈ΋ 2006;69:18-24

Pediatr Jan-Feb 06 final allges 27-01-06 15:34 ™ÂÏ›‰·22

Page 23: Παιδιατρική | Τόμος 69 • Τεύχος 1 • Ιανουάριος - Φεβρουάριος 2006

Ù˘ ·¤ÚÈ·˜ Ú‡·ÓÛ˘ ÛÙÔ ·Ó·Ó¢ÛÙÈÎfi Û‡-

ÛÙËÌ· ÙˆÓ ·È‰ÈÒÓ (39,40). ∆· ·ÔÙÂϤÛÌ·Ù¿

ÙÔ˘˜ ·Ó·Ê¤ÚÔÓÙ·È Î˘Ú›ˆ˜ ÛÙËÓ ·˘ÍË̤ÓË Û˘-

¯ÓfiÙËÙ· ¿ÛıÌ·ÙÔ˜, ¯ÚfiÓÈ·˜ ‚ÚÔÁ¯›Ùȉ·˜ ηÈ

ÏÔÈÌÒÍÂˆÓ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ (41-44). §fiÁˆ

Ù˘ ·ÁÎÔÛÌÈfiÙËÙ·˜ ÙÔ˘ Ê·ÈÓÔ̤ÓÔ˘ Ù˘ ·¤-

ÚÈ·˜ Ú‡·ÓÛ˘ Î·È ÙˆÓ ÂÈÙÒÛˆÓ, fi¯È ÌfiÓÔ

ÛÙËÓ ˘Á›· ·ÏÏ¿ ·ÎfiÌË Î·È ÛÙȘ ÔÈÎÔÓƠ̂˜ ÙˆÓ

ÎÚ·ÙÒÓ ÙÔ˘ ÎfiÛÌÔ˘, ÙÔ ı¤Ì· ı· Â›Ó·È ¿ÓÙ·

›ηÈÚÔ ÙȘ ÂfiÌÂÓ˜ ‰ÂηÂٛ˜ (45).

µÈ‚ÏÈÔÁÚ·Ê›·

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view article]. N Engl J Med 2000;342:406-413.

2. Dockery DW, Pope CA 3rd, Xu X, Spengler JD,

Ware JH, Fay ME et al. An association between air

pollution and mortality in six U.S. cities. N Engl J

Med 1993;329:1753-1759.

3. Pope CA 3rd, Burnett RT, Thun MJ, Calle EE,

Krewski D, Ito K. et al. Lung cancer, cardiopul-

monary mortality, and long-term exposure to fine

particulate air pollution. JAMA 2002;287:1132-1141.

4. Beeson LW, Abbey DE, Knutsen SF. Long-term con-

centrations of ambient air pollutants and incident

lung cancer in California adults: results from the

AHSMOG study. Adventist Health Study on Smog.

Environ Health Perspect 1998;106:813-823.

5. Schwartz J. Air pollution and Hospital admissions

for heart disease in eight U.S. counties. Epidemiolo-

gy 1999;10:17-22.

6. Samet JM, Dominici F, Curriero FC, Coursac I,

Zeger SL. Fine particulate air pollution and mortal-

ity in 20 U.S. cities, 1987-1994. N Engl J Med 2000;

343:1742-1749.

7. Touloumi G, Katsouyanni K, Zmirou D, Schwartz J,

Spix C, de Leon AP et al. Short-term effects of am-

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1997,146:177-185.

8. Verrier RL, Mittleman MA, Stone PH. Air pollution,

an insidious and pervasive component of cardiac

risk. Circulation 2002;106:890-892.

9. ∫Ô˘˚ÌÙ˙‹˜ £, ™·Ì·Ú¿ ∫, ∆ÛÈÙÔ˘Ú›‰Ô˘ ƒ, ¡ÈÎÔÏ¿Ô˘

∫, µÔ˘ÙÛ¿ ¢, ª·ÓÒÏË ∂ Î·È Û˘Ó. ¶ÔÛÔÛÙÔÔ›ËÛË

Ù˘ Û˘ÌÌÂÙÔ¯‹˜ ÙˆÓ ËÁÒÓ ÂÎÔÌ‹˜ ÂÈÛÓ‡ÛÈ-

ÌˆÓ ·ÈˆÚÔ‡ÌÂÓˆÓ ÛˆÌ·Ùȉ›ˆÓ ÛÙËÓ Â˘Ú‡ÙÂÚË Â-

ÚÈÔ¯‹ Ù˘ £ÂÛÛ·ÏÔӛ΢. ∞Ó¿ÏÂÎÙ· ÙˆÓ ÂÚ¢ÓÒÓ

[ÂÚÈÔ‰È΋ ¤Î‰ÔÛË ∞¶£] 2003;7:34-39.

10. Moon C, Naef R, Koller T. Reactions of macrophages

exposed to particles <10 Ìm. Environ Research

2003;91:35-44.

11. Samoli E, Touloumi G, Zanobetti A, Tertre A,

Schindler C, Atkinson R et al. Investigating the

dose-response relation between air pollution and to-

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cup Environ Med 2003;60:977-982.

12. Nemmar A, Hoet PH, Vanquickenborne B, Dins-

dale D, Thomeer M, Hoylaerts MF et al. Passage of

inhaled particles into the blood circulation in hu-

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ª·ÎÚÔÊ¿Á·¶¡∂Àª√¡ø¡

΢ÙÔΛÓ˜∞¡™ ∞πª∞

¶ËÎÙÈÎÔ›Ì˯·ÓÈÛÌÔ›

∫˘ÎÏÔÊÔÚÈÎfi

∆·¯˘Î·Ú‰›· ∞ıËڈ̿وÛË

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∂ªºƒ∞°ª∞

∂ÈÎfiÓ· 3. ™¯ËÌ·ÙÈÎfi ‰È¿ÁÚ·ÌÌ· Ù˘ ‰Ú¿Û˘ ÙˆÓ ∞™ÛÙ· ‰È¿ÊÔÚ· Û˘ÛÙ‹Ì·Ù·.

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25∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞ ORIGINAL ARTICLE

1 ¶·È‰È·ÙÚÈ΋ KÏÈÓÈ΋,TÔ̤·˜ YÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡,I·ÙÚÈ΋ ™¯ÔÏ‹¶·ÓÂÈÛÙËÌ›Ô˘ Iˆ·ÓÓ›ÓˆÓ

2 EÚÁ·ÛÙ‹ÚÈÔ ¶·È‰È·ÙÚÈ΋˜,TÔ̤·˜ YÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡,I·ÙÚÈ΋ ™¯ÔÏ‹¶·ÓÂÈÛÙËÌ›Ô˘ Iˆ·ÓÓ›ÓˆÓ

3 √ÚıÔ‰È΋ KÏÈÓÈ΋,I·ÙÚÈ΋ ™¯ÔÏ‹¶·ÓÂÈÛÙËÌ›Ô˘ Iˆ·ÓÓ›ÓˆÓ

AÏÏËÏÔÁÚ·Ê›·:

AÓ. K·ıËÁ‹ÙÚÈ· ÕÓÓ· X¿ÏÏ·TÔ̤·˜ YÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡I·ÙÚÈ΋ ™¯ÔÏ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ Iˆ·ÓÓ›ÓˆÓT.K. 451 10, Iˆ¿ÓÓÈÓ·E-mail: [email protected]

∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 03-09-2004∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 28-11-2005

¶·È‰È·ÙÚÈ΋ 2006;69:25-36

À¿Ú¯ÂÈ ‹ fi¯È ·Ó¿ÚÎÂÈ· ‚ÈÙ·Ì›Ó˘ D ÛÂ

·È‰È¿ Î·È Ó¤Ô˘˜ ̤¯ÚÈ 18 ¯ÚfiÓˆÓ ÛÙËÓ ∂ÏÏ¿‰·;

¢. §··ÙÛ¿Ó˘1, A. MÔ˘Ï¿˜2, B. XÔϤ‚·˜2, ¶. ™Ô˘Î¿ÎÔ˜3, Z. ¶··‰ÔÔ‡ÏÔ˘ - KÔ˘ÏÔ˘Ì‹1, Õ. X¿ÏÏ·2

¶ÂÚ›ÏË„Ë

∂ÈÛ·ÁˆÁ‹: H ÂÔ¯‹ Î·È ÔÈ ·ÏÏ·Á¤˜ ÛÙÔÓ ÙÚfiÔ ˙ˆ‹˜ ÂËÚ¿˙Ô˘Ó ÙËÓ ¤ÎıÂÛË ÙÔ˘ ·ÓıÚÒÔ˘ ÛÙÔÓ‹ÏÈÔ, Ô˘ Â›Ó·È ··Ú·›ÙËÙÔ˜ ÁÈ· ÙË Û‡ÓıÂÛË ‚ÈÙ·Ì›Ó˘ D ÛÙÔ ‰¤ÚÌ·. ¶·È‰È¿ Î·È ¤ÊË‚ÔÈ Ì ·˘ÍË-̤ÓÔ Ú˘ıÌfi ÔÛÙÈÎÔ‡ ·Ó·Û¯ËÌ·ÙÈÛÌÔ‡ ·ÔÙÂÏÔ‡Ó ÏËı˘ÛÌfi ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÂÌÊ¿ÓÈÛË ·ÓÂ-¿ÚÎÂÈ·˜ ‚ÈÙ·Ì›Ó˘ D.

ÀÏÈÎfi Î·È ª¤ıÔ‰ÔÈ: ¢Â›ÁÌ· 210 ÎÏÈÓÈο ˘ÁÈÒÓ ·È‰ÈÒÓ 3 ¤ˆ˜ 18 ¯ÚfiÓˆÓ, ηٷٿ¯ıËÎ·Ó Û ÙÚÂȘËÏÈÎȷΤ˜ ÔÌ¿‰Â˜ (√Ì¿‰· I: 3-10, √Ì¿‰· II: 11-14 Î·È √Ì¿‰· III: 15-18 ¯ÚfiÓˆÓ). §‹„Ë ‰ÂÈÁÌ¿ÙˆÓ¤ÁÈÓ ÙÔ˘˜ ¯ÂÈÌÂÚÈÓÔ‡˜ Î·È Î·ÏÔηÈÚÈÓÔ‡˜ Ì‹Ó˜ ÁÈ· ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ·Û‚ÂÛÙÈÔÙÚfiˆÓ ÔÚÌÔÓÒÓ,·Û‚ÂÛÙ›Ô˘, ʈÛÊÔÚÈÎÒÓ Î·È ‚ÈÔ¯ËÌÈÎÒÓ ‰ÂÈÎÙÒÓ ÔÛÙÈ΋˜ Û‡ÓıÂÛ˘.

∞ÔÙÂϤÛÌ·Ù·: TÔ 47% ÙˆÓ ·ÙfiÌˆÓ ËÏÈΛ·˜ 15-18 ¯ÚfiÓˆÓ Â›¯·Ó ›‰· 25OHD <10 ng/ml ÙÔÓ¯ÂÈÌÒÓ·, ÂÓÒ Ù· ÔÛÔÛÙ¿ ÛÙȘ ËÏÈ˘ 3-14 ¯ÚfiÓˆÓ ‹Ù·Ó ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚ· (13-14%). TÔ Î·-ÏÔη›ÚÈ fiÏÔÈ Â›¯·Ó 25OHD>10 ng/ml. ∏ Û˘¯ÓfiÙËÙ· ˘Ô‚Èٷ̛ӈÛ˘ D ‹Ù·Ó ·ÎfiÌË ˘„ËÏfiÙÂÚË ÛÙ·ÎÔÚ›ÙÛÈ· 15-18 ¯ÚfiÓˆÓ Î·È Û˘Ó‰˘·˙fiÙ·Ó Ì ¯·ÌËÏfiÙÂÚ· ›‰· ʈÛÊÔÚÈÎÒÓ ÙÔÓ ¯ÂÈÌÒÓ· (¯ÂÈÌ.:1,19±0,03, ηÏ.: 1,39±0,03 mmol/l, p<0,001). ™ÙË ÌÂÁ·Ï‡ÙÂÚË ËÏÈÎȷ΋ ÔÌ¿‰·, ÔÈ Û˘ÁÎÂÓÙÚÒÛÂȘÙ˘ 24,25(OH)2D ÙÔÓ ¯ÂÈÌÒÓ· ‹Ù·Ó ηٿ Ù· 2/3 ¯·ÌËÏfiÙÂÚ˜ ·fi ÙÔ˘ ηÏÔηÈÚÈÔ‡ (0,73±0,10 ¤Ó·-ÓÙÈ 2,41±0,20 ng/ml, p<0,001). √È ‚ÈÔ¯ËÌÈÎÔ› ‰Â›ÎÙ˜ ÔÛÙÈ΋˜ ·Ú·ÁˆÁ‹˜ ÔÛÙÂÔηÏÛ›Ó˘ (OC) ηȷÏηÏÈ΋˜ ʈÛÊ·Ù¿Û˘ (ALP), ‚Ú¤ıËÎ·Ó ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚÔÈ ÛÙ· ÎÔÚ›ÙÛÈ· Ù˘ ÔÌ¿‰·˜ III, ÁÈ·¯ÂÈÌÒÓ· Î·È Î·ÏÔη›ÚÈ ·ÓÙ›ÛÙÔȯ· (OC: 5,8±0,3 ¤Ó·ÓÙÈ 8,7±0,6 Î·È 4,6±0,3 ¤Ó·ÓÙÈ 7,3±0,5 ng/ml,p<0,001, ALP: 108±5 ¤Ó·ÓÙÈ 212±28 Î·È 116±7 ¤Ó·ÓÙÈ 248±31 IU/l, p<0,001).

™˘ÌÂÚ¿ÛÌ·Ù·: ™ÙËÓ ∂ÏÏ¿‰·, ÔÈ Ó¤ÔÈ 15-18 ¯ÚfiÓˆÓ ‚Ú›ÛÎÔÓÙ·È Û ˘„ËÏfi ΛӉ˘ÓÔ ·Ó¿ÚÎÂÈ·˜‚ÈÙ·Ì›Ó˘ D ÙÔÓ ¯ÂÈÌÒÓ·. EÌÏÔ˘ÙÈÛÌfi˜ Ì ‚ÈÙ·Ì›ÓË D ÙÚÔÊÒÓ fiˆ˜ ÙÔ Á¿Ï· Î·È ÌÂÚÈο ·Ó·„˘-ÎÙÈο ı· ‚ÔËıÔ‡Û Û ÛËÌ·ÓÙÈ΋ Ì›ˆÛË ·˘ÙÔ‡ ÙÔ˘ ÎÈÓ‰‡ÓÔ˘.

§¤ÍÂȘ ÎÏÂȉȿ: ∞Ó¿ÚÎÂÈ· ‚ÈÙ·Ì›Ó˘ D, ·È‰È¿ Î·È ¤ÊË‚ÔÈ.

Is there or not vitamin D deficiency in children and adolescents in

Greece?

D. Lapatsanis1, A. Moulas2, V. Cholevas2, P. Soukakos3, Z. Papadopoulou1, A. Challa2

Abstract

Background: Season and changes in the way of living significantly modify exposure to the sun,which is important for vitamin D synthesis in the skin. Children and adolescents who have high boneturnover may comprise a high-risk population for vitamin D deficiency.

Methods: A sample of 210 clinically healthy children aged 3 to 18 years, were assigned into three agegroups: 3-10, 11-14 and 15-18 years of age. Blood samples were taken during winter and summer fordetermining calciotropic hormones, calcium, phosphate (Pi) and biochemical markers of bonesynthesis.

Results: The 47% of the subjects aged 15-18 years, and 13-14% of the 3-14 years, had 25OHD levels<10 ng/ml in the winter. In the summer all had 25OHD>10 ng/ml. The prevalence ofhypovitaminosis D was higher in the older girls, accompanied by lower Pi concentrations in thewinter (win.: 1.19±0.03, sum.: 1.39±0.03 mmol/l, p<0.001). The 24,25(OH)2D levels in the oldersubjects were lower by 2/3 in the winter than in the summer (0.73±0.10 vs 2.41±0.20 ng/ml, p<0.001).The biochemical markers of bone synthesis, osteocalcin (OC) and total alkaline phosphatase (ALP)were significantly lower in the older girls in both winter and summer, respectively (OC: 5.8±0.3 vs

1 Department of Paediatrics,Medical School, University of Ioannina

2 Laboratory of Paediatrics,Medical School, University of Ioannina

3 Department ofOrthopedics, MedicalSchool, University of Ioannina

Correspondence:

Anna ChalaDepartment of Paediatrics, Medical School, University of Ioannina451 10, IoanninaE-mail: [email protected]

Date of submission: 03-09-2004Date of approval: 28-11-2005

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26 ¢. §··ÙÛ¿Ó˘ Î·È Û˘Ó.

¶·È‰È·ÙÚÈ΋ 2006;69:25-36

8.7±0.6 and 4.6±0.3 vs 7.3±0.5 ng/ml, p<0.001; ALP: 108±5 vs 212±28 and 116±7 vs 248±31 IU/l,p<0.001).

Conclusions: In Greece young people aged 15-18 years, are at increased risk of vitamin D deficiencyduring the winter. Vitamin D supplementation of milk and popular beverages would be of help incounteracting this.

Key words: Vitamin D deficiency, children and adolescents.

∂ÈÛ·ÁˆÁ‹

∏ ÛËÌ·Û›· ÙˆÓ ËÏÈ·ÎÒÓ ·ÎÙ›ÓˆÓ ÛÙÔÓ Û¯Ë-

Ì·ÙÈÛÌfi Ù˘ ‚ÈÙ·Ì›Ó˘ D ·Ó·ÁÓˆÚ›ÛÙËΠÁÈ·

ÚÒÙË ÊÔÚ¿ ÙÔ 1919 fiÙ·Ó ÔÈ Huldschinki ηÈ

Û˘Ó. ¤Ù˘¯·Ó ›·ÛË ÙÔ˘ Ú·¯ÈÙÈÛÌÔ‡ ÌÂÙ¿ ·fi

¤ÎıÂÛË Û ˘ÂÚÈÒ‰Ë ·ÎÙÈÓÔ‚ÔÏ›· (1). ∏ ‡·Ú-

ÍË ÌÈ·˜ ÏÈÔ‰È·Ï˘Ù‹˜ Ô˘Û›·˜, Ô˘ ·ÚÁfiÙÂÚ·

ÔÓÔÌ¿ÛÙËΠ‚ÈÙ·Ì›ÓË D Î·È Ô˘ ÌÔÚÔ‡Û ӷ

ıÂڷ‡ÛÂÈ ÙÔÓ Ú·¯ÈÙÈÛÌfi ¤ÁÈÓ ÁÓˆÛÙ‹ ·fi

ÙÔ˘˜ Mellanby Î·È Û˘Ó. ÙÔ 1919 (2). ∏ ÂÌÊ¿ÓÈ-

ÛË Ú·¯ÈÙÈÛÌÔ‡ ÛÙÔ˘˜ ·ÓıÚÒÔ˘˜ ÁÈ· ÚÒÙË

ÊÔÚ¿ ·Ó·Ê¤ÚıËΠ̠ÙËÓ ¤Ó·ÚÍË Ù˘ ‚ÈÔÌ˯·-

ÓÈ΋˜ ·ӿÛÙ·Û˘ ÛÙÔ Ù¤ÏÔ˜ ÙÔ˘ 17Ô˘ ·ÈÒÓ·.

∏ Û˘¯ÓfiÙËÙ· Ú·¯ÈÙÈÛÌÔ‡ ÛÙ· ·È‰È¿ Ô˘

ηÙÔÈÎÔ‡Û·Ó ÛÙ· ·Ó‹ÏÈ· Û›ÙÈ· Î·È ‰ÚfiÌÔ˘˜

Ù˘ µfiÚÂÈ·˜ ∂˘ÚÒ˘ Î·È ∞ÌÂÚÈ΋˜ ·Ó¤Ú¯Ô-

ÓÙ·Ó ÛÙÔ 90% (3). ™ÙȘ ‰ÂηÂٛ˜ ÙÔ˘ 1930 ηÈ

1940 Ô ÂÌÏÔ˘ÙÈÛÌfi˜ ÙÚÔÊÒÓ Î·È Á¿Ï·ÙÔ˜ ÌÂ

‚ÈÙ·Ì›ÓË D ¤ÁÈÓ ‰ËÌÔÊÈÏ‹˜. ªÂÙ¿ ÙÔ 1960 ¿Ú-

¯ÈÛ·Ó Ó· ÂÚ¢ÓÒÓÙ·È Î·È Ó· Á›ÓÔÓÙ·È Î·Ù·ÓÔË-

ÙÔ› ÔÈ Ì˯·ÓÈÛÌÔ› ÂÓÂÚÁÔÔ›ËÛ˘ Ù˘ ‚ÈÙ·Ì›-

Ó˘ D ÛÙÔ ‹·Ú (25-˘‰ÚÔÍ˘Ï›ˆÛË) Î·È ÛÙÔ˘˜

ÓÂÊÚÔ‡˜ (1·-˘‰ÚÔÍ˘Ï›ˆÛË) ·ÏÏ¿ Î·È ÔÈ ‰Ú¿-

ÛÂȘ Ù˘, ÒÛÙ ӷ ÌÔÚÔ‡Ó Ó· ·Ó··Ú¿ÁÔÓÙ·È

Î·È ÛÙÔ ÂÚÁ·ÛÙ‹ÚÈÔ (4,5).

∂ÎÙfi˜ Ù˘ ıÂڷ¢ÙÈ΋˜ ‰Ú¿Û˘ Ù˘ ‚ÈÙ·-

Ì›Ó˘ D Û ·ıÔÏÔÁÈΤ˜ ηٷÛÙ¿ÛÂȘ, ˘fi Ê˘-

ÛÈÔÏÔÁÈΤ˜ Û˘Óı‹Î˜ Â›Ó·È ··Ú·›ÙËÙË ÁÈ· ÙËÓ

·ÔÚÚfiÊËÛË ÙÔ˘ ·Û‚ÂÛÙ›Ô˘ ·fi ÙÔ ¤ÓÙÂÚÔ,

ÙËÓ Â·Ó·ÚÚfiÊËÛ‹ ÙÔ˘ ÛÙ· ÓÂÊÚÈο ÛˆÏËÓ¿-

ÚÈ· Î·È ÙË ÌÂÙ¿ÏψÛË ÙˆÓ ÔÛÙÒÓ (6). ™Ù· Ó‹-

È·, ‚Ú¤ÊË Î·È ·È‰È¿ ̤¯ÚÈ ÙËÓ ÂÓËÏÈΛˆÛË,

fiÔ˘ ˘¿Ú¯ÂÈ Û˘Ó¯‹˜ ·‡ÍËÛË ÙÔ˘ ÛÎÂÏÂÙÔ‡, Ë

‚ÈÙ·Ì›ÓË D Î·È Ë Â¿ÚÎÂÈ¿ Ù˘ ·ÔÎÙÔ‡Ó È‰È·›-

ÙÂÚË ÛËÌ·Û›·. ™Â ·˘Ù¤˜ ÙȘ ËÏÈ˘ Î·È Ï›ÁÔ ÌÂ-

Ù¿, ·ÔÎÙ¿Ù·È Ë Ì¤ÁÈÛÙË ÔÛÙÈ΋ ˘ÎÓfiÙËÙ·

Ô˘ fiÛÔ ÌÂÁ·Ï‡ÙÂÚË Â›Ó·È ÙfiÛÔ Î·Ï‡ÙÂÚ· ÁÈ·

ÙË ÌÂÙ¤ÂÈÙ· ˙ˆ‹ (7,8,9).

∞Ó Î·È Ë ∂ÏÏ¿‰· Â›Ó·È ¯ÒÚ· Ì ÌÂÁ¿ÏË ËÏÈÔ-

Ê¿ÓÂÈ·, Ì›· ÌÂϤÙË Ô˘ Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ

ÚÈÓ ·fi 35 ¯ÚfiÓÈ· ·Ó¤ÊÂÚ ¤ÏÏÂÈ„Ë ‚ÈÙ·Ì›Ó˘

D ÛÙ· Ó‹È· (10). ∞fi ÙfiÙ fiÏ· Ù· ÂÌÔÚÈο

Á¿Ï·Ù· ÁÈ· ‚Ú¤ÊË ÂÌÏÔ˘Ù›ÛÙËÎ·Ó Ì ‚ÈÙ·Ì›ÓË

D (40 IU/100 ml) Î·È Ù· ÎÏÈÓÈο ÛËÌ›· ÙÚÔÊÈ-

ÎÔ‡ Ú·¯ÈÙÈÛÌÔ‡ ۯ‰fiÓ ÂÍ·Ê·Ó›ÛÙËÎ·Ó ·fi Ù·

Ó‹È·. ™Ù· ∂ÏÏËÓfiÔ˘Ï· ËÏÈΛ·˜ ÌÂÁ·Ï‡ÙÂÚ˘

ÙˆÓ 3 ÂÙÒÓ ‰ÂÓ ¯ÔÚËÁÂ›Ù·È Û˘ÛÙËÌ·ÙÈο ‚ÈÙ·-

Ì›ÓË D Î·È ÔÈ ÙÚÔʤ˜ ÛÙËÓ ∂ÏÏ¿‰· ‰ÂÓ ÂÌÏÔ˘-

Ù›˙ÔÓÙ·È Ì ‚ÈÙ·Ì›ÓË D.

√È ˙ˆÈÎÔ› ÔÚÁ·ÓÈÛÌÔ› ÌÔÚÔ‡Ó Ó· ·ÔÎÙ‹-

ÛÔ˘Ó ÙÔ 90%-100% Ù˘ ‚ÈÙ·Ì›Ó˘ D Ô˘ ¯ÚÂÈ-

¿˙ÔÓÙ·È ·fi ÙËÓ ¤ÎıÂÛ‹ ÙÔ˘˜ ÛÙËÓ ËÏȷ΋

·ÎÙÈÓÔ‚ÔÏ›· (6). ŸÌˆ˜, Ë ÂÔ¯‹, Ô ÙÚfiÔ˜ ˙ˆ-

‹˜ (‰È·ÌÔÓ‹ Î·È ÂÚÁ·Û›· ÁÈ· ÔÏϤ˜ ÒÚ˜ ÛÂ

ÎÏÂÈÛÙÔ‡˜ ¯ÒÚÔ˘˜) ηıÒ˜ Î·È Ë Â˘Ú›· ¯Ú‹ÛË

ÙˆÓ ·ÓÙÈËÏÈ·ÎÒÓ Ô˘ÛÈÒÓ, ¤‰Ú·Û·Ó ÛËÌ·ÓÙÈ-

ο ÛÙËÓ ·Ó·Ú΋ ÌÂÙ·ÙÚÔ‹ Ù˘ ÚÔ‚ÈÙ·Ì›-

Ó˘ D ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ Û ‰Ú·ÛÙÈ΋ ‚ÈÙ·Ì›ÓË D.

∂›Û˘, ÔÈ Û˘Ó‹ıÂȘ ‰È·ÙÚÔÊ‹˜ ·›˙Ô˘Ó ÛËÌ·-

ÓÙÈÎfi ÚfiÏÔ ÁÈ· ÙËÓ Â·Ú΋ ‹ ÌË ÚfiÛÏË„Ë ‚È-

Ù·Ì›Ó˘ D. ∏ ·Ó·Áη›· ÔÛfiÙËÙ· ‚ÈÙ·Ì›Ó˘ D

Ì ÙËÓ ÙÚÔÊ‹ ÔÈΛÏÂÈ ÌÂٷ͇ ÙˆÓ ¯ˆÚÒÓ ·ÏÏ¿

Î·È ÌÂٷ͇ ËÏÈÎÈ·ÎÒÓ ÔÌ¿‰ˆÓ. ∏ ∞ÌÂÚÈηÓÈ΋

∞η‰ËÌ›· ¶·È‰È·ÙÚÈ΋˜ Û˘ÓÈÛÙ¿ 400 ‰ÈÂıÓ›˜

ÌÔÓ¿‰Â˜ (IU) ËÌÂÚËÛ›ˆ˜ ÁÈ· Ó‹È·, ·È‰È¿ ηÈ

ÂÊ‹‚Ô˘˜ (11). ™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘

‹Ù·Ó Ó· ÂÎÙÈÌËı› Ë Â¿ÚÎÂÈ· ‹ ÌË Ù˘ ‚ÈÙ·Ì›-

Ó˘ D Û ¤Ó· ·ÓÙÈÚÔÛˆÂ˘ÙÈÎfi ‰Â›ÁÌ· ÎÏÈÓÈ-

ο ˘ÁÈÒÓ ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ ËÏÈΛ·˜ 3-18

ÂÙÒÓ, Ô˘ ηÙÔÈÎÔ‡Ó ÛÙË ‚ÔÚÂÈÔ‰˘ÙÈ΋ ∂ÏÏ¿‰·

ÙËÓ Î·ÏÔηÈÚÈÓ‹ Î·È ÙË ¯ÂÈÌÂÚÈÓ‹ ÂÚ›Ô‰Ô. ™ÙË

Û˘Ó¤¯ÂÈ·, ¤ÁÈÓ ÚÔÛ¿ıÂÈ· Ó· Û˘Û¯ÂÙÈÛıÔ‡Ó

Ù· ·ÔÙÂϤÛÌ·Ù· Ì ÙËÓ ËÏÈΛ·, ÙÔ Ê‡ÏÔ Î·È

ÙËÓ ÂÔ¯‹ ÙÔ˘ ¤ÙÔ˘˜ Î·È Ì ‚ÈÔ¯ËÌÈÎÔ‡˜ ‰Â›-

ÎÙ˜ ÔÛÙÈ΋˜ Û‡ÓıÂÛ˘.

ÀÏÈÎfi Î·È ª¤ıÔ‰ÔÈ

¢Â›ÁÌ· ·fi 210 ·È‰È¿ ËÏÈΛ·˜ 3 ̤¯ÚÈ 18 ÂÙÒÓ

Ô˘ ‰ÂÓ Â›¯·Ó ÎÏÈÓÈο Û˘ÌÙÒÌ·Ù· ÔÛÙÈ΋˜ Î·È Ë·ÙÈ-

΋˜ ÓfiÛÔ˘ Û˘ÌÂÚÈÏ‹ÊıËÎ·Ó ÛÙË ÌÂϤÙË Î·È ¯ˆÚ›-

ÛıËÎ·Ó Û ÙÚÂȘ ÔÌ¿‰Â˜: ™ÙËÓ ÔÌ¿‰· π (¡ 75) ‹Ù·Ó

·È‰È¿ ËÏÈΛ·˜ 3-10 ÂÙÒÓ, ÛÙËÓ ÔÌ¿‰· ππ (¡ 49) 11-14

¯ÚfiÓˆÓ Î·È ÛÙËÓ ÔÌ¿‰· πππ (¡ 86) 15-18 ¯ÚfiÓˆÓ. ∆· ÌÈ-

Û¿ ·È‰È¿ ·fi οı ÔÌ¿‰· ÌÂÏÂÙ‹ıËÎ·Ó ÙË ¯ÂÈÌÂÚÈÓ‹

Pediatr Jan-Feb 06 final allges 27-01-06 15:34 ™ÂÏ›‰·26

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27µÈÙ·Ì›ÓË D Û ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜

ÂÚ›Ô‰Ô (ºÂ‚ÚÔ˘¿ÚÈÔ - ª¿ÚÙÈÔ) Î·È Ù· ˘fiÏÔÈ· ÙË

ıÂÚÈÓ‹ ÂÚ›Ô‰Ô (™Â٤̂ÚÈÔ - √ÎÙÒ‚ÚÈÔ). ∆Ô ÛÙ¿‰ÈÔ

Ù˘ ÂÊ˂›·˜ ηٿ Tanner ÛÙ· ·È‰È¿ Ù˘ ÔÌ¿‰·˜ πππ

ÚÔÛ‰ÈÔÚ›ÛÙËΠ̠ÚÔÛÂÎÙÈ΋ ÂͤٷÛË ÙˆÓ ‰Â˘ÙÂÚÔ-

ÁÂÓÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ÙÔ˘ ʇÏÔ˘ Î·È ÙˆÓ ¤Íˆ ÁÂÓÓË-

ÙÈÎÒÓ ÔÚÁ¿ÓˆÓ (12). ™ÙËÓ ÔÌ¿‰· πππ ÙÔ ¯ÂÈÌÒÓ·, 11

·È‰È¿ ‹Ù·Ó ÛÙ·‰›Ô˘ πππ ÚÔ˜ IV, 12 ÛÙÔ ÛÙ¿‰ÈÔ IV ηÈ

22 ÛÙÔ ÛÙ¿‰ÈÔ IV ÚÔ˜ V, ÂÓÒ ÙÔ Î·ÏÔη›ÚÈ 7 ·È‰È¿

‹Ù·Ó ÛÙÔ ÛÙ¿‰ÈÔ πππ ÚÔ˜ IV, 18 ÛÙÔ ÛÙ¿‰ÈÔ IV Î·È 16

ÛÙÔ ÛÙ¿‰ÈÔ IV ÚÔ˜ V.

∆· ·È‰È¿ ÛÙȘ ÔÌ¿‰Â˜ ππ Î·È πππ ¤ÈÓ·Ó Îfiη-ÎfiÏ·

ÂÓ›ÔÙÂ Î·È ‰ÂÓ ¤Î·Ó·Ó Û˘ÛÙËÌ·ÙÈ΋ ¯Ú‹ÛË ÔÈÓÔÓ¢-

Ì·Ùˆ‰ÒÓ ÔÙÒÓ.

√È ·Ú¿ÌÂÙÚÔÈ Ô˘ ÚÔÛ‰ÈÔÚ›ÛÙËÎ·Ó ÛÙÔÓ ÔÚfi

‹Ù·Ó ·Û‚¤ÛÙÈÔ ÔÚÔ‡ (Ca), ·ÓfiÚÁ·ÓÔ˜ ʈÛÊfiÚÔ˜ (Pi),

ÔÏÈ΋ ·ÏηÏÈ΋ ʈÛÊ·Ù¿ÛË (ÔÏÈ΋ ALP), ÔÛÙÂÔηÏÛ›-

ÓË (OC), ÔÈ ÙÚÂȘ ·ÚÈÔÈ ÌÂÙ·‚Ôϛ٘ Ù˘ ‚ÈÙ·Ì›Ó˘ D

[25OHD, 24,25 (√∏)2D Î·È 1,25 (√∏)2D] Î·È ÙÔ Î·Ú-

‚Ô͢ÙÂÏÈÎfi ¿ÎÚÔ Ù˘ ·Ú·ıÔÚÌfiÓ˘ (C-PTH).

∆· ·Ôı¤Ì·Ù· Ù˘ ‚ÈÙ·Ì›Ó˘ D ÛÙÔÓ ÔÚÁ·ÓÈÛÌfi

ÂÎÙÈÌ‹ıËÎ·Ó ·fi ÙȘ Û˘ÁÎÂÓÙÚÒÛÂȘ Ù˘ 25√∏D ÛÙÔÓ

ÔÚfi. ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ¤ÏÏÂÈ„Ë ‚ÈÙ·Ì›Ó˘ D ıˆ-

Ú‹ıËΠfiÙ·Ó Ù· ›‰· Ù˘ 25OHD ÛÙÔÓ ÔÚfi ‚Ú¤ıË-

Î·Ó Ó· Â›Ó·È ÌÈÎÚfiÙÂÚ· ·fi 10 ng/ml Î·È ·Ó¿ÚÎÂÈ·,

fiÙ·Ó Ë ÙÈÌ‹ Ù˘ 25OHD ‹Ù·Ó ÌÂٷ͇ 10-20 ng/ml (13).

To Ca ÙÔ˘ ÔÚÔ‡ ÚÔÛ‰ÈÔÚ›ÛÙËΠ̠ÙËÓ ÙÈÙÏÔ‰ÔÙÈ-

΋ ÌÈÎÚÔ̤ıÔ‰Ô ÙÔ˘ ÔÚÁ¿ÓÔ˘ Calcette, Model 4008,

Precision Systems Inc, MA, ∏.¶.∞. √ ·ÓfiÚÁ·ÓÔ˜ ʈ-

ÛÊfiÚÔ˜ ÚÔÛ‰ÈÔÚ›ÛÙËΠ̠ʈÙÔÌÂÙÚÈ΋ ̤ıÔ‰Ô (14).

√ ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù˘ ÔÏÈ΋˜ ·ÏηÏÈ΋˜ ʈÛÊ·Ù¿Û˘

¤ÁÈÓ Ì ʈÙÔÌÂÙÚÈ΋ ̤ıÔ‰Ô ÎÈÓËÙÈ΋˜, ¯ÚËÛÈÌÔÔÈ-

ÒÓÙ·˜ ·ÓÙȉڷÛÙ‹ÚÈ· Ù˘ Elitech Diagnostics, Sees,

France. √È ÚÔÛ‰ÈÔÚÈÛÌÔ› ÙÔ˘ ηڂÔ͢ÙÂÏÈÎÔ‡ ¿ÎÚÔ˘

Ù˘ ·Ú·ıÔÚÌfiÓ˘ (C-PTH) Î·È Ù˘ ÔÛÙÂÔηÏÛ›Ó˘

¤ÁÈÓ·Ó Ì ڷ‰ÈÔ·ÓÔÛÔÏÔÁÈΤ˜ ÌÂıfi‰Ô˘˜ (RIA) ¯ÚËÛÈ-

ÌÔÔÈÒÓÙ·˜ ·ÓÙȉڷÛÙ‹ÚÈ· ·fi ÙËÓ Incstar Co, ∏.¶.∞.

√È ÌÂÙ·‚Ôϛ٘ Ù˘ ‚ÈÙ·Ì›Ó˘ D [25(OH)D, 24,25

(OH)2D Î·È 1,25(√∏)2D] ÚÔÛ‰ÈÔÚ›ÛÙËÎ·Ó Ì Ù¯ÓÈ-

Τ˜ Ô˘ ·Ó·Ù‡¯ıËÎ·Ó ÛÙÔ ÂÚÁ·ÛÙ‹ÚÈÔ Ù˘ ¶·È‰È·ÙÚÈ-

΋˜ ·fi ÙÔ˘˜ ªÔ˘Ï¿ Î·È Û˘Ó (15). ∆ÚÔÔÔÈ‹ıËηÓ

·fi ‹‰Ë ˘¿Ú¯Ô˘Û˜ ÌÂıfi‰Ô˘˜ ÙˆÓ Shepard Î·È Û˘Ó

(1979) Î·È Reinhardt Î·È Û˘Ó (1984) ·ÍÈÔÔÈÒÓÙ·˜ ·-

Ú¿ÏÏËÏ· Î·È ÓÂfiÙÂÚ˜ Ù¯ÓÈΤ˜ ˘ÁÚ‹˜ ¯ÚˆÌ·ÙÔÁÚ·Ê›·˜

˘„ËÏ‹˜ ›ÂÛ˘ (HPLC) ÁÈ· ÙÔÓ ‰È·¯ˆÚÈÛÌfi ÙˆÓ ÌÂÙ·-

‚ÔÏÈÙÒÓ ÌÂٷ͇ ÙÔ˘˜ (16,17). MÂÙ¿ ÙËÓ Âί‡ÏÈÛË ·fi

ÙÔÓ ÔÚfi Î·È ÙÔÓ ‰È·¯ˆÚÈÛÌfi ÙÔ˘˜, ÔÈ ÌÂÙ·‚Ôϛ٘ Ù˘

25(OH)D Î·È 24,25(OH)2D ÛÙË Û˘Ó¤¯ÂÈ· ÚÔÛ‰ÈÔÚ›-

ÛÙËÎ·Ó Ì ڷ‰ÈÔ·ÓÔÛÔÏÔÁÈ΋ ̤ıÔ‰Ô (RIA) ¯ÚËÛÈÌÔ-

ÔÈÒÓÙ·˜ ‰ÂÛÌ¢ÙÈ΋ ÚˆÙ½ÓË (DBP) ·ÓıÚÒÔ˘ ηÈ

Ù˘ 1,25(√∏)2D Ì RIA ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÚˆÙÂ˚ÓÈÎfi

˘Ô‰Ô¯¤· ·fi ı‡ÌÔ ·‰¤Ó· ÌfiÛ¯Ô˘.

™Ù·ÙÈÛÙÈ΋

∏ ÛÙ·ÙÈÛÙÈ΋ ÂÂÍÂÚÁ·Û›· ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ

¤ÁÈÓ Û ˘ÔÏÔÁÈÛÙ‹, Ì ÙË ¯Ú‹ÛË ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜

StatView Ù˘ SAS Institute Inc. ∏ Û‡ÁÎÚÈÛË ÙˆÓ Ì¤ÛˆÓ

fiÚˆÓ ÙˆÓ ÙÈÌÒÓ ÙˆÓ ‚ÈÔ¯ËÌÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ ¤ÁÈÓ ÌÂ

Student's t-test Î·È ÙËÓ Ì¤ıÔ‰Ô Ù˘ ·Ó¿Ï˘Û˘ Ù˘ ÌÂÙ·-

‚ÏËÙfiÙËÙ·˜ ηٿ Ì›· ‰È‡ı˘ÓÛË (ANOVA). °È· ÙË Û‡-

ÁÎÚÈÛË ÙˆÓ Ì¤ÛˆÓ fiÚˆÓ ÌÂٷ͇ ¯ÂÈÌÒÓ· Î·È Î·ÏÔηÈ-

ÚÈÔ‡ ÛÙËÓ ›‰È· ÔÌ¿‰· ·È‰ÈÒÓ ¯ÚËÛÈÌÔÔÈ‹ıËΠÙÔ

paired t-test Ì fiÚÈÔ ÛËÌ·ÓÙÈÎfiÙËÙ·˜ ÙÔ 5%. √È Û˘ÓÙÂ-

ÏÂÛÙ¤˜ Û˘Û¯¤ÙÈÛ˘ ÌÂٷ͇ ÙˆÓ ·Ú·Ì¤ÙÚˆÓ Ô˘ ÌÂÏÂ-

Ù‹ıËÎ·Ó ˘ÔÏÔÁ›ÛÙËÎ·Ó Ì ÙË Ì¤ıÔ‰Ô Ù˘ ÁÚ·ÌÌÈ΋˜

Û˘ÌÌÂÙ·‚ÔÏ‹˜ (linear regression).

∞ÔÙÂϤÛÌ·Ù·

∫·È ÛÙȘ ÙÚÂȘ ÔÌ¿‰Â˜ ÙˆÓ ·È‰ÈÒÓ Ô˘ ÌÂ-

ÏÂÙ‹ıËÎ·Ó Ù· ›‰· Ù˘ 25OHD ÛÙÔÓ ÔÚfi

‚Ú¤ıËÎ·Ó ¯·ÌËÏfiÙÂÚ· ÙË ¯ÂÈÌÂÚÈÓ‹ ÂÚ›Ô‰Ô ÛÂ

Û‡ÁÎÚÈÛË Ì ÙË ıÂÚÈÓ‹ (¶›Ó·Î·˜ 1). √ ̤ÛÔ˜

fiÚÔ˜ ÙˆÓ ÙÈÌÒÓ ·ÓÙ›ÛÙÔȯ· ‹Ù·Ó 18,5±1,3 ¤Ó·-

ÓÙÈ 29,8±1,8 ng/ml (p<0,01) ÁÈ· ÙËÓ ÔÌ¿‰· π,

21,0±1,9 ¤Ó·ÓÙÈ 26,6±1,4 ng/ml (p<0,05) ÁÈ·

ÙËÓ ÔÌ¿‰· ππ, Î·È 12,7±0,9 ¤Ó·ÓÙÈ 27,7±1,3

ng/ml (p<0,01) ÁÈ· ÙËÓ ÔÌ¿‰· πππ. √È ‰È·ÊÔÚ¤˜

ÌÂٷ͇ ÙˆÓ ‰‡Ô ÂÔ¯ÒÓ ‹Ù·Ó ÈÔ ¤Î‰ËϘ ÛÙ·

ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿ (ÔÌ¿‰· πππ). ∂›Û˘, ÙË ¯ÂÈ-

ÌÂÚÈÓ‹ ÂÚ›Ô‰Ô ÛÙ· ·È‰È¿ Ù˘ ÙÚ›Ù˘ ÔÌ¿‰·˜

Ù· ›‰· Ù˘ 25OHD ‚Ú¤ıËÎ·Ó Ó· Â›Ó·È Ô-

χ ¯·ÌËÏfiÙÂÚ· (p<0,01) ·fi ÙˆÓ ¿ÏÏˆÓ ‰‡Ô

ÔÌ¿‰ˆÓ (¶›Ó·Î·˜ 1). TÔ Î·ÏÔη›ÚÈ ÔÈ Ì¤ÛÔÈ

fiÚÔÈ fiÏˆÓ ÙˆÓ ÔÌ¿‰ˆÓ ‰ÂÓ ‰È¤ÊÂÚ·Ó ÌÂٷ͇

ÙÔ˘˜ (¶›Ó·Î·˜ 1).

¶·È‰È·ÙÚÈ΋ 2006;69:25-36

¶›Ó·Î·˜ 1. TÔ ËÏÈÎÈ·Îfi ‡ÚÔ˜, Ô ·ÚÈıÌfi˜ (N) Î·È ÔÈ Ì¤Û˜ ÙÈ̤˜ (±SEM) ÛÙÔÓ ÔÚfi ÙˆÓ ÌÂÙ·‚ÔÏÈÙÒÓ Ù˘ ‚ÈÙ·Ì›Ó˘ D[25OHD, 24,25(OH)2D Î·È 1,25(OH)2D] Î·È Ù˘ ·Ú·ıÔÚÌfiÓ˘ (C-PTH) ÛÙȘ ÙÚÂȘ ÔÌ¿‰Â˜ ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ ̤¯ÚÈ ÙËÓËÏÈΛ· ÙˆÓ 18 ¯ÚfiÓˆÓ, Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó ¯ÂÈÌÒÓ· (X) Î·È Î·ÏÔη›ÚÈ (K)

∏ÏÈÎÈ·Îfi ‡ÚÔ˜ N 25OHD 24,25(OH)2D 1,25(OH)2D C-PTH(¯ÚfiÓÈ·) (ng/ml) (ng/ml) (pg/ml) (ng/ml)

3-10 X: 43 18,5±1,3c 1,31±0,12c 23,0±1,9 0,73±0,07a

K: 32 29,4±1,8** 2,17±0,19+ 26,9±1,9 0,70±0,07

11-14 X: 22 21,0±1,9e 1,47±0,17c 25,8±3,4 0,74±0,04a

K: 27 26,6±1,4* 1,79±0,16c 32,4±3,0a 0,80±0,14

15-18 X: 45 12,7±0,9d 0,73±0,10d 26,7±1,5 0,47±0,06b

K: 41 27,7±1,3** 2,41±0,20+,d 25,7±1,9b 0,60±0,06

*p<0,05, **p<0,01, +p<0,001: Û ۇÁÎÚÈÛË Ì ÙȘ ÙÈ̤˜ ÙÔ˘ ¯ÂÈÌÒÓ·avs bp<0,05, cvs dp<0,01, dvs ep<0,001: Û‡ÁÎÚÈÛË ÌÂٷ͇ ÙˆÓ ËÏÈÎÈ·ÎÒÓ ÔÌ¿‰ˆÓ

Pediatr Jan-Feb 06 final allges 27-01-06 15:35 ™ÂÏ›‰·27

Page 28: Παιδιατρική | Τόμος 69 • Τεύχος 1 • Ιανουάριος - Φεβρουάριος 2006

∆Ë ¯ÂÈÌÂÚÈÓ‹ ÂÚ›Ô‰Ô, ÙÔ 47% ÙˆÓ ÂÊ‹‚ˆÓ

ËÏÈΛ·˜ 15-18 ¯ÚfiÓˆÓ Â›¯·Ó ÙÈ̤˜ 25OHD <10

ng/ml, ÂÓÒ ÁÈ· Ù· ·È‰È¿ ÙˆÓ ÔÌ¿‰ˆÓ π Î·È ππ Ë

ÂηÙÔÛÙÈ·›· ·Ó·ÏÔÁ›· ‹Ù·Ó 14% Î·È 13% ·ÓÙ›-

ÛÙÔȯ·. ∂ÈϤÔÓ, Ô ·ÚÈıÌfi˜ ÙˆÓ ÎÔÚÈÙÛÈÒÓ ÌÂ

·Ó¿ÚÎÂÈ· ‚ÈÙ·Ì›Ó˘ D ÛÙËÓ ÔÌ¿‰· πππ, ‹Ù·Ó

‰ÈÏ¿ÛÈÔ˜ ·' fi,ÙÈ ÙˆÓ ·ÁÔÚÈÒÓ, ÂÓÒ Ë Î·Ù·ÓÔ-

Ì‹ ÛÙȘ ¿ÏϘ ‰‡Ô ÔÌ¿‰Â˜ ‹Ù·Ó ›ÛË ÁÈ· Ù· ‰‡Ô

ʇϷ. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ηÏÔηÈÚÈÔ‡ fiÏ·

Ù· ·È‰È¿ ‚Ú¤ıËÎ·Ó Ó· ¤¯Ô˘Ó ›‰· 25OHD

¿Óˆ ·fi 10 ng/ml. ŸÌˆ˜, Û fiϘ ÙȘ ÔÌ¿‰Â˜,

¤Ó· ÔÛÔÛÙfi ·È‰ÈÒÓ Ô˘ ‹Ù·Ó 15%, 9,4% ηÈ

21% ÁÈ· ÙȘ ÔÌ¿‰Â˜ π, ππ Î·È πππ ·ÓÙ›ÛÙÔȯ·, ›¯·Ó

Û˘ÁÎÂÓÙÚÒÛÂȘ Ô˘ Î˘Ì·›ÓÔÓÙ·Ó ÌÂٷ͇ 10 ηÈ

20 ng/ml. °È· ÙÔÓ ¯ÂÈÌÒÓ·, ·˘Ù¿ Ù· ÔÛÔÛÙ¿

·Ó¤Ú¯ÔÓÙ·Ó Û 37%, 35% Î·È 33% ·ÓÙ›ÛÙÔȯ·.

ªÂ ÙË ¯ÚÔÓÔÏÔÁÈ΋ ·‡ÍËÛË Ù˘ ËÏÈΛ·˜,

·Ú·ÙËÚ‹ıËΠ̛· Ù¿ÛË Ì›ˆÛ˘ ÙˆÓ ÙÈÌÒÓ

Ù˘ 25OHD ÛÙÔÓ ÔÚfi ÁÈ· ¯ÂÈÌÒÓ· Î·È Î·ÏÔη›-

ÚÈ (∂ÈÎfiÓ· 1).

√È Û˘ÁÎÂÓÙÚÒÛÂȘ Ù˘ 24,25 ‰È˘‰ÚÔ͢‚ÈÙ·-

Ì›Ó˘ D [24,25(OH)2D] Î·È ÛÙȘ ÙÚÂȘ ÔÌ¿‰Â˜

·ÚÔ˘Û›·Û·Ó Âԯȷ΋ ‰È·Î‡Ì·ÓÛË ·Ú¿ÏÏË-

Ï· Ì ·˘Ù‹ Ù˘ 25OHD. √ ̤ÛÔ˜ fiÚÔ˜ ÙˆÓ ÙÈ-

ÌÒÓ ‹Ù·Ó 1,31±0,12 ÙÔÓ ¯ÂÈÌÒÓ· ¤Ó·ÓÙÈ

2,17±0,19 ng/ml ÙÔ˘ ηÏÔηÈÚÈÔ‡ (p<0,001)

ÛÙËÓ ÔÌ¿‰· π, 1,47±0,17 ¤Ó·ÓÙÈ 1,79±0,19 ng/ml

ÛÙËÓ ÔÌ¿‰· ππ Î·È 0,73±0,10 ¤Ó·ÓÙÈ 2,41±0,20

ng/ml (p<0,001), ÛÙËÓ ÔÌ¿‰· πππ (¶›Ó·Î·˜ 1).

Ÿˆ˜ Î·È Ì ÙËÓ 25OHD Ë ‰È·ÊÔÚ¿ ÌÂٷ͇

ÂÔ¯ÒÓ ‹Ù·Ó ÈÔ ÂÌÊ·Ó‹˜ ÛÙËÓ ÔÌ¿‰· ÙˆÓ ÌÂ-

Á·Ï‡ÙÂÚˆÓ ·È‰ÈÒÓ (¶›Ó·Î·˜ 1). °È· ÙËÓ

24,25(√∏)2D ‰È·ÊÔÚ¤˜ ·Ú·ÙËÚ‹ıËÎ·Ó ÌÂÙ·-

͇ ÙˆÓ ÔÌ¿‰ˆÓ Û¯ÂÙÈο Ì ÙȘ ÙÈ̤˜ Î·È ÁÈ· ÙȘ

‰‡Ô ÂÔ¯¤˜ (¶›Ó·Î·˜ 1). √È ÙÈ̤˜ ÙÔÓ ¯ÂÈÌÒÓ·

ÛÙËÓ ÔÌ¿‰· πππ ‹Ù·Ó ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚ˜

·' fi,ÙÈ ÛÙȘ ÔÌ¿‰Â˜ ππ Î·È π (0,73±0,10 ¤Ó·ÓÙÈ

1,47±0,17 Î·È 1,31±0,12 ng/ml, p<0,01), ·ÏÏ¿

ÌÂÁ·Ï‡ÙÂÚ˜ ÙÔ Î·ÏÔη›ÚÈ (2,41±0,20 ¤Ó·ÓÙÈ

1,79±0,16, p<0,01 Î·È 2,17±0,19 ng/ml). πÛ¯˘Ú‹

ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÙˆÓ Û˘ÁÎÂÓÙÚÒÛˆÓ

ÛÙÔÓ ÔÚfi Ù˘ 25OHD Î·È Ù˘ 24,25(√∏)2D

‚Ú¤ıËΠ۠fiÏ· Ù· ·È‰È¿ Ô˘ ÌÂÏÂÙ‹ıËηÓ

Î·È ÁÈ· ÙȘ ‰‡Ô ÂÔ¯¤˜ (R=0,61 p<0,001). A˘Ù‹

Ë Û˘Û¯¤ÙÈÛË ‹Ù·Ó ÈÛ¯˘ÚfiÙÂÚË ÙÔÓ ¯ÂÈÌÒÓ·

R=0,68, p<0,0001) ·' fi,ÙÈ ÙÔ Î·ÏÔη›ÚÈ

(R=0,37, p<0,001) (∂ÈÎfiÓ· 2).

¢ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ‰È·ÊÔÚ¤˜ ÛÙȘ ÙÈ̤˜

Ù˘ 1,25 ‰È˘‰ÚÔ͢‚ÈÙ·Ì›Ó˘ D [1,25(OH)2D]

ÌÂٷ͇ ÙˆÓ ‰‡Ô ÂÔ¯ÒÓ Î·È ÛÙȘ ÙÚÂȘ ÔÌ¿‰Â˜

(¶›Ó·Î·˜ 1). ª›· Û¯ÂÙÈο ÌÈÎÚ‹ ‰È·ÊÔÚ¿ ·Ú·-

ÙËÚ‹ıËΠÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ ππ Î·È πππ ˆ˜ ÚÔ˜

ÙȘ Û˘ÁÎÂÓÙÚÒÛÂȘ ÙÔ˘ ÌÂÙ·‚ÔÏ›ÙË ÙÔ Î·ÏÔη›-

ÚÈ (32,4±3,0 ¤Ó·ÓÙÈ 25,7±1,9 pg/ml, p<0,05).

√È ÙÈ̤˜ Ù˘ C-PTH ÛÙÔÓ ÔÚfi ‰ÂÓ ‰È¤ÊÂÚ·Ó

ÌÂٷ͇ ÙˆÓ ‰‡Ô ÂÔ¯ÒÓ Û fiϘ ÙȘ ÔÌ¿‰Â˜

(¶›Ó·Î·˜ 1). ∆ÔÓ ¯ÂÈÌÒÓ·, Ù· ›‰· Ù˘ C-

PTH ‚Ú¤ıËÎ·Ó ÛÙ·ÙÈÛÙÈο ¯·ÌËÏfiÙÂÚ· ÛÙÔ˘˜

Ó¤Ô˘˜ Ù˘ ÔÌ¿‰·˜ πππ Û ۇÁÎÚÈÛË Ì ٷ ·È‰È¿

ÙˆÓ ÔÌ¿‰ˆÓ π Î·È ππ (0,47±0,06 ¤Ó·ÓÙÈ

0,73±0,07 Î·È 0,74±0,04 ng/ml, p<0,05).

√È ÙÈ̤˜ ÙÔ˘ Ca ÛÙÔÓ ÔÚfi Î˘Ì·›ÓÔÓÙ·Ó ÛÂ

Ê˘ÛÈÔÏÔÁÈο fiÚÈ· ÁÈ· ÙȘ ‰‡Ô ÂÔ¯¤˜ Î·È ÛÙȘ

ÙÚÂȘ ˘fi ÌÂϤÙË ÔÌ¿‰Â˜ (¶›Ó·Î·˜ 2). ªÂÚÈ-

Τ˜ ‰È·ÊÔÚ¤˜ ·Ú·ÙËÚ‹ıËÎ·Ó ÌÂٷ͇ ÙˆÓ

‰‡Ô ÂÔ¯ÒÓ ÛÙËÓ ÔÌ¿‰· π (2,43±0,3 ÙÔÓ ¯ÂÈ-

ÌÒÓ· ¤Ó·ÓÙÈ 2,28±0,08 mml/L ÙÔ Î·ÏÔη›ÚÈ,

p<0,01) Î·È ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ π Î·È ππ ÙÔ Î·-

ÏÔη›ÚÈ (2,28±0,08 ¤Ó·ÓÙÈ 2,40±0,03 mml/L,

p<0,01).

60

50

40

30

20

10

02 4 6 8 10

∏ÏÈΛ· (¤ÙË)

25

0H

D (

ng/

mL

)

12 14 16 18 20

∂ÈÎfiÓ· 1. ™˘Û¯¤ÙÈÛË ÌÂٷ͇ ÙˆÓ Û˘ÁÎÂÓÙÚÒÛÂˆÓ Ù˘25OHD ÛÙÔÓ ÔÚfi Ì ÙËÓ ËÏÈΛ· Û ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜3-18 ¯ÚfiÓˆÓ, ÁÈ· ÙÔÓ ¯ÂÈÌÒÓ· Î·È ÙÔ Î·ÏÔη›ÚÈ Ì·˙›(N=209, R=-0,23, p<0,001).

6

5

4

3

2

1

00 10 20

250HD (ng/mL)

ÃÂÈÌÒÓ·˜∫·ÏÔη›ÚÈ

24

,25

(OH

) 2 D

(n

g/m

L)

30 40 50

∂ÈÎfiÓ· 2. ™˘Û¯¤ÙÈÛË ÙˆÓ Û˘ÁÎÂÓÙÚÒÛÂˆÓ Ù˘ 25OHDÎ·È Ù˘ 24,25(OH)2D ÛÙÔÓ ÔÚfi Û ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜3-18 ¯ÚfiÓˆÓ, ÙÔÓ ¯ÂÈÌÒÓ· (N=102, R=0,68, p<0,0001)Î·È ÙÔ Î·ÏÔη›ÚÈ (N=87, R=0,37, p<0,001).

28 ¢. §··ÙÛ¿Ó˘ Î·È Û˘Ó.

¶·È‰È·ÙÚÈ΋ 2006;69:25-36

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Page 29: Παιδιατρική | Τόμος 69 • Τεύχος 1 • Ιανουάριος - Φεβρουάριος 2006

√È Û˘ÁÎÂÓÙÚÒÛÂȘ ÙˆÓ ·ÓfiÚÁ·ÓˆÓ ʈÛÊÔ-ÚÈÎÒÓ (Pi) ÛÙÔÓ ÔÚfi ‹Ù·Ó ÛÙ· Ê˘ÛÈÔÏÔÁÈο fiÚÈ·Î·È ÛÙȘ ÙÚÂȘ ÔÌ¿‰Â˜ (¶›Ó·Î·˜ 2). ŸÌˆ˜, ÔȤÊË‚ÔÈ Ù˘ ÔÌ¿‰·˜ πππ ›¯·Ó ÙÈ̤˜ ʈÛÊfiÚÔ˘ÛÙÔÓ ÔÚfi ÙÔÓ ¯ÂÈÌÒÓ· ÌÈÎÚfiÙÂÚ˜ ·fi ÙˆÓ ·È-‰ÈÒÓ ÙˆÓ ¿ÏÏˆÓ ‰‡Ô ÔÌ¿‰ˆÓ (1,26±0,03 ¤Ó·ÓÙÈ1,45±0,06 mmol/L, p<0,05). ™ÙËÓ ›‰È· ÔÌ¿‰· ÙÔηÏÔη›ÚÈ, ÔÈ ÙÈ̤˜ ÙÔ˘ Pi ‚Ú¤ıËÎ·Ó Ó· ›ӷȄËÏfiÙÂÚ˜ ·fi ÙÔÓ ¯ÂÈÌÒÓ· (1,39±0,03 ¤Ó·ÓÙÈ1,26±0,03 mmol/L, p<0,01) (¶›Ó·Î·˜ 2). ∏ Ì›-ˆÛË ÙˆÓ ÙÈÌÒÓ ÙÔÓ ¯ÂÈÌÒÓ· ‚Ú¤ıËΠӷ ›ӷÈÈÔ ¤Î‰ËÏË ÛÙ· ÎÔÚ›ÙÛÈ· ËÏÈΛ·˜ 15-18 ÂÙÒÓ(1,19±0,03 ¤Ó·ÓÙÈ 1,39±0,03 mmol/L, p<0,001)·' fi,ÙÈ ÛÙ· ·ÁfiÚÈ· (1,29±0,06 ¤Ó·ÓÙÈ 1,39±0,03mmol/L), ÂÓÒ ‰ÂÓ ‚Ú¤ıËÎ·Ó ‰È·ÊÔÚ¤˜ ÛÙȘ ÙÈ-̤˜ ÙÔ˘ Pi ÛÙÔÓ ÔÚfi ÌÂٷ͇ ÙˆÓ ‰‡Ô Ê‡ÏˆÓ ÙÔηÏÔη›ÚÈ (¶›Ó·Î·˜ 3). ¶·Ú¿ÏÏËÏ· Ì ÙËÓ ·‡-ÍËÛË Ù˘ ËÏÈΛ·˜ ·Ú·ÙËÚ‹ıËΠ̛ˆÛË ÙˆÓÙÈÌÒÓ ÙÔ˘ Pi ÛÙÔÓ ÔÚfi Î·È ÁÈ· Ù· ‰‡Ô ʇϷ وӷȉÈÒÓ 3-18 ÂÙÒÓ (∂ÈÎfiÓ· 3).

∆· ›‰· Ù˘ ÔÏÈ΋˜ ALP ÛÙÔÓ ÔÚfi ÛÙËÓÔÌ¿‰· ππ ‹Ù·Ó ˘„ËÏfiÙÂÚ· ·fi ÙˆÓ ¿ÏÏˆÓ ‰‡ÔÔÌ¿‰ˆÓ Î·È Ë ‰È·ÊÔÚ¿ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·-ÓÙÈ΋ ÙÔ Î·ÏÔη›ÚÈ, fiˆ˜ Ê·›ÓÂÙ·È ÛÙÔÓ ¶›Ó·-η 2. √ ·ÓÙ›ÛÙÔȯԘ ̤ÛÔ˜ fiÚÔ˜ ÙˆÓ ÙÈÌÒÓ ÙÔηÏÔη›ÚÈ ‹Ù·Ó 264±30 ¤Ó·ÓÙÈ 187±17 IU/L,p<0,05 ÛÙËÓ ÔÌ¿‰· π Î·È 180±18 IU/L, p<0,01ÛÙËÓ ÔÌ¿‰· πππ Î·È ‰ÂÓ ·Ú·ÙËÚ‹ıËΠÂԯȷ-΋ ‰È·Î‡Ì·ÓÛË.

√È ÙÈ̤˜ Ù˘ ÔÛÙÂÔηÏÛ›Ó˘ ÛÙÔÓ ÔÚfi Ù˘ÔÌ¿‰·˜ πππ ‚Ú¤ıËÎ·Ó ¯·ÌËÏfiÙÂÚ˜ ·fi ÂÎ›Ó˜Ù˘ ÔÌ¿‰·˜ ππ Î·È ÛÙȘ ‰‡Ô ÂÔ¯¤˜ (7,0±0,4 ¤Ó·-ÓÙÈ 9,4±1,2, p<0,05 ÙÔÓ ̄ ÂÈÌÒÓ· Î·È 5,9±0,3 ¤Ó·-ÓÙÈ 12,7±1.2 ng/ml, p<0,001 ÙÔ Î·ÏÔη›ÚÈ), ÂÓÒ·fi Ù˘ ÔÌ¿‰·˜ π, ÌfiÓÔ ÙÔ Î·ÏÔη›ÚÈ (5,9±0,3¤Ó·ÓÙÈ 10,3±1,0 ng/ml, p<0,001) (¶›Ó·Î·˜ 2).

™ÙȘ ‰‡Ô ÚÒÙ˜ ÔÌ¿‰Â˜ ·È‰ÈÒÓ, ‰È·ÊÔÚ¤˜·Ú·ÙËÚ‹ıËÎ·Ó Î·È ÌÂٷ͇ ÙˆÓ ÂÔ¯ÒÓ fiÔ˘ÔÈ Û˘ÁÎÂÓÙÚÒÛÂȘ Ù˘ ÔÛÙÂÔηÏÛ›Ó˘ ‹Ù·Ó ¯·-ÌËÏfiÙÂÚ˜ ÙÔÓ ¯ÂÈÌÒÓ· ·fi ÂΛӘ ÙÔ˘ ηÏÔ-ηÈÚÈÔ‡ (7,5±0,7 ¤Ó·ÓÙÈ 10,3±1,0 ng/ml, p<0,01ÛÙËÓ ÔÌ¿‰· π Î·È 9,4±1,2 ¤Ó·ÓÙÈ 12,7±1,2ng/ml, p<0,01 ÛÙËÓ ÔÌ¿‰· ππ) (¶›Ó·Î·˜ 2).

£ÂÙÈ΋ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÙˆÓ ÙÈÌÒÓ Ù˘ÔÛÙÂÔηÏÛ›Ó˘ Î·È Ù˘ ÔÏÈ΋˜ ALP ÛÙÔÓ ÔÚfi·Ú·ÙËÚ‹ıËΠÛÙ· ·È‰È¿ Î·È ÙˆÓ ÙÚÈÒÓ ÔÌ¿-‰ˆÓ ËÏÈΛ·˜ 3-18 ÂÙÒÓ Î·È ÁÈ· ÙȘ ‰‡Ô ÂÔ¯¤˜(R=0,35, p<0,001) (∂ÈÎfiÓ· 4).

¢È·ÊÔÚ¤˜ ÛÙȘ ÙÈ̤˜ ÌÂÚÈÎÒÓ ·Ú·Ì¤ÙÚˆÓÙÔ˘ ÔÛÙÈÎÔ‡ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ·Ú·ÙËÚ‹ıËηÓÌÂٷ͇ ÙˆÓ ‰‡Ô Ê‡ÏˆÓ ÛÙÔ˘˜ Ó¤Ô˘˜ 15-18ÂÙÒÓ, fiˆ˜ Ê·›ÓÂÙ·È ÛÙÔÓ ¶›Ó·Î· 3. √È ÙÈ̤˜ÙˆÓ ‚ÈÔ¯ËÌÈÎÒÓ ‰ÂÈÎÙÒÓ Ù˘ Û‡ÓıÂÛ˘ ÙˆÓÔÛÙÒÓ (ÔÏÈ΋ ALP Î·È ÔÛÙÂÔηÏÛ›ÓË) ‚Ú¤ıË-Î·Ó ¯·ÌËÏfiÙÂÚ˜ ÛÙ· ÎÔÚ›ÙÛÈ· ·' fi,ÙÈ ÛÙ··ÁfiÚÈ· ÙË ¯ÂÈÌÂÚÈÓ‹ Î·È ÙË ıÂÚÈÓ‹ ÂÚ›Ô‰Ô (¶›-ӷη˜ 3). √È ·ÓÙ›ÛÙÔȯÔÈ Ì¤ÛÔÈ fiÚÔÈ ÙˆÓ ÙÈÌÒÓÙ˘ ÔÏÈ΋˜ ALP ‹Ù·Ó 108±48 ¤Ó·ÓÙÈ 212±28IU/L p<0,001 ÙÔÓ ¯ÂÈÌÒÓ· Î·È 116±7 ¤Ó·ÓÙÈ248±39 IU/L p<0,001 ÙÔ Î·ÏÔη›ÚÈ (¶›Ó·Î·˜3). √ ̤ÛÔ˜ fiÚÔ˜ ÙˆÓ ÙÈÌÒÓ Ù˘ ÔÛÙÂÔηÏÛ›Ó˘‚Ú¤ıËΠ5,8±0,3 ¤Ó·ÓÙÈ 8,7±0,6 ng/ml p<0,001ÁÈ· ÙÔÓ ¯ÂÈÌÒÓ· Î·È 4,6±0,3 ¤Ó·ÓÙÈ 7,3±0,5ng/ml p<0,001 ÁÈ· ÙÔ Î·ÏÔη›ÚÈ (¶›Ó·Î·˜ 3).¢ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ‰È·ÊÔÚ¤˜ ÌÂٷ͇ ÙˆÓ ‰‡ÔÊ‡ÏˆÓ ÁÈ· ÙÔ˘˜ Ó¤Ô˘˜ ËÏÈΛ·˜ 15-18 ¯ÚfiÓˆÓfiÛÔÓ ·ÊÔÚ¿ ÙÔ˘˜ ÌÂÙ·‚Ôϛ٘ Ù˘ ‚ÈÙ·Ì›Ó˘ D,C-PTH Î·È Ca (¶›Ó·Î·˜ 3).

™ÙËÓ ÔÌ¿‰· III, Û ·ÙÔÌÈÎfi ›‰Ô, ÙÔ 61%ÙˆÓ ÎÔÚÈÙÛÈÒÓ Â›¯·Ó ÙÈ̤˜ 25√HD ÛÙÔÓ ÔÚfi ÌÈ-ÎÚfiÙÂÚ˜ ·fi 10 ng/ml ¤Ó·ÓÙÈ ÙÔ˘ 35% ÙˆÓ ·ÁÔ-ÚÈÒÓ, ÂÓÒ Ù¤ÙÔȘ ‰È·ÊÔÚ¤˜ ‰ÂÓ ·Ú·ÙËÚ‹ıËηÓ

2,0

1,8

1,6

1,4

1,2

1,0

0,82 4 6 8 10

∏ÏÈΛ· (¤ÙË)

Pi

ÔÚ

Ô‡

( m

mo

l/L

)

12 14 16 18 20

∂ÈÎfiÓ· 3. ™˘Û¯¤ÙÈÛË ÙˆÓ Û˘ÁÎÂÓÙÚÒÛÂˆÓ ÙÔ˘ ʈÛÊfi-ÚÔ˘ (Pi) ÛÙÔÓ ÔÚfi Ì ÙËÓ ËÏÈΛ· Û ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜3-18 ¯ÚfiÓˆÓ ÁÈ· ÙÔÓ ¯ÂÈÌÒÓ· Î·È ÙÔ Î·ÏÔη›ÚÈ Ì·˙›(N=159, R=0,18, p<0,02).

700

600

500

400

300

200

100

00 5 10

√ÛÙÂÔηÏÛ›ÓË (ng/mL)

AL

P (

IU/L

)

15 20 25

∂ÈÎfiÓ· 4. ™˘Û¯¤ÙÈÛË ÙˆÓ Û˘ÁÎÂÓÙÚÒÛÂˆÓ ÛÙÔÓ ÔÚfi Ù˘·ÏηÏÈ΋˜ ʈÛÊ·Ù¿Û˘ Î·È Ù˘ ÔÛÙÂÔηÏÛ›Ó˘ Û·ȉȿ Î·È ÂÊ‹‚Ô˘˜ 3-18 ¯ÚfiÓˆÓ ÁÈ· ¯ÂÈÌÒÓ· Î·È Î·-ÏÔη›ÚÈ Ì·˙› (N=138, R=0,35, p<0,0001).

29µÈÙ·Ì›ÓË D Û ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜

¶·È‰È·ÙÚÈ΋ 2006;69:25-36

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Page 30: Παιδιατρική | Τόμος 69 • Τεύχος 1 • Ιανουάριος - Φεβρουάριος 2006

30 ¢. §··ÙÛ¿Ó˘ Î·È Û˘Ó.

ÛÙ· ·È‰È¿ ÙˆÓ ÔÌ¿‰ˆÓ π Î·È ππ. ∂›Û˘, ÔÈ Û˘-

ÁÎÂÓÙÚÒÛÂȘ ÙÔ˘ Pi ÛÙÔÓ ÔÚfi ÛÙ· ÎÔÚ›ÙÛÈ· Ù˘

ÔÌ¿‰·˜ πππ ‚Ú¤ıËÎ·Ó ¯·ÌËÏfiÙÂÚ˜ ÙÔÓ ¯ÂÈÌÒÓ·

·' fi,ÙÈ ÙÔ Î·ÏÔη›ÚÈ (1,19±0,03 ¤Ó·ÓÙÈ

1,39±0,03 mmol/L, p<0,001).

™˘˙‹ÙËÛË

∏ ·ÚÔ‡Û· ÌÂϤÙË ‰Â›¯ÓÂÈ fiÙÈ ·ÎfiÌË Î·È

Û ¯ÒÚ˜ Ì ÌÂÁ¿ÏË ËÏÈÔÊ¿ÓÂÈ· fiˆ˜ Ë ∂ÏÏ¿-

‰·, ÛËÌ·ÓÙÈ΋ ·Ó·ÏÔÁ›· ·È‰ÈÒÓ ËÏÈΛ·˜ 3-14

ÂÙÒÓ (14%) ·ÏÏ¿ ΢ڛˆ˜ Ó¤ˆÓ ËÏÈΛ·˜ 15-18

ÂÙÒÓ (47%) ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·Ó¿ÚÎÂÈ· ‚ÈÙ·Ì›-

Ó˘ D (<10 ng/ml) ηٿ ÙË ¯ÂÈÌÂÚÈÓ‹ ÂÚ›Ô‰Ô.

¶·ÚfiÌÔÈ· Â˘Ú‹Ì·Ù· ¤¯Ô˘Ó ‰ËÌÔÛÈ¢ı›

·fi ¿ÏϘ Â˘Úˆ·˚Τ˜ Î·È ÌÂÛÔÁÂȷΤ˜ ¯ÒÚ˜.

OÈ Ala Houhala Î·È Û˘Ó (18) ·fi ÙË ºÈÓÏ·Ó‰›·

·Ó·Ê¤ÚÔ˘Ó fiÙÈ ÙÔ 22,4% ÙˆÓ ·È‰ÈÒÓ ËÏÈΛ·˜

11-17 ÂÙÒÓ ·ÚÔ˘Û›·Û·Ó ˘Ô‚Èٷ̛ӈÛË D

(25OHD <5 ng/ml) ηı' fiÏË ÙË ‰È¿ÚÎÂÈ· ÙÔ˘

¤ÙÔ˘˜ Û ۇÁÎÚÈÛË Ì ÙÔ 16,8% ÙˆÓ ·È‰ÈÒÓ 6-

10 ÂÙÒÓ Î·È ÙÔ 7,5% ·È‰ÈÒÓ ËÏÈΛ·˜ 2-5 ¯Úfi-

ÓˆÓ. ™Â Ì›· ·ÛÙÈ΋ ÂÚÈÔ¯‹ Ù˘ ‚fiÚÂÈ·˜ °·Ï-

Ï›·˜ ‚Ú¤ıËΠfiÙÈ ÛÙÔ 24% ÙˆÓ ·È‰ÈÒÓ ËÏÈΛ·˜

10-17 ÂÙÒÓ ÔÈ ÙÈ̤˜ ÔÚÔ‡ Ù˘ 25OHD ‹Ù·Ó ¯·-

ÌËÏfiÙÂÚ˜ ·fi 6 ng/ml (19). ∞fi Ì›· ÔÌ¿‰·

Ì·ıËÙÒÓ ÛÙÔÓ §›‚·ÓÔ ËÏÈΛ·˜ 10-16 ÂÙÒÓ ÙÔ

52% (65% ÙÔÓ ¯ÂÈÌÒÓ· Î·È 40% ÙÔ Î·ÏÔη›ÚÈ)

›¯·Ó ›‰· 25OHD ÛÙÔÓ ÔÚfi οو ·fi 10

ng/ml (20). ™Â Ì›· ÔÌ¿‰· ·È‰ÈÒÓ ËÏÈΛ·˜ 7-10

ÂÙÒÓ Ô˘ ηÙÔÈÎÔ‡Û·Ó ÛÙË ÓÔÙÈÔ·Ó·ÙÔÏÈ΋

πÛ·Ó›· Ù· ›‰· 25OHD ÛÙÔÓ ÔÚfi ÙÔ˘˜,

ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ¯ÂÈÌÒÓ·, ‹Ù·Ó οو ·fi

12 ng/ml Î·È ÛÙ· ÂÚÈÛÛfiÙÂÚ· ·fi ·˘Ù¿ ΢-

Ì·›ÓÔÓÙ·Ó ÌÂٷ͇ 12 Î·È 20 ng/ml (21). ™ÙË

µÚÂÙ·Ó›·, ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ §ÔÓ‰›ÓÔ˘, Ë ÏÂÈ-

ÔÓfiÙËÙ· ÙˆÓ ·È‰ÈÒÓ Ô˘ ÂÌÊ¿ÓÈÛ·Ó ˘·Û‚Â-

ÛÙÈ·ÈÌ›· ‹ Ú·¯ÈÙÈÛÌfi ‹Ù·Ó ËÏÈΛ·˜ οو ÙˆÓÙÚÈÒÓ ‹ ¿Óˆ ÙˆÓ 10 ÂÙÒÓ (22). ¶·ÚfiÌÔÈ· ηÈÛÙËÓ KÔÂÁ¯¿ÁË (¢·Ó›·), ÔÈ ËÏÈ˘ ·È‰ÈÒÓÔ˘ ÂÌÊ¿ÓÈÛ·Ó Ú·¯ÈÙÈÛÌfi ‹Ù·Ó 0,5-4 Î·È 9-15¯ÚfiÓÈ· (23). ∂›Û˘, ·Ó·Ê¤ÚÔÓÙ·È Î·È ÌÂÁ¿Ï·ÔÛÔÛÙ¿ ·È‰ÈÒÓ ÌÂÙ·Ó·ÛÙÒÓ Ì ˘Ô‚ÈÙ·Ì›-ÓˆÛË D, ·ÚfiÙÈ ¤¯Ô˘Ó ÁÂÓÓËı› Î·È ˙Ô˘Ó ÛÙË¢·Ó›·. ∞˘Ù¿ ·Ó¤Ú¯ÔÓÙ·È Û 46% Î·È 81% ·ÓÙ›-ÛÙÔȯ·, ÁÈ· ÙȘ ËÏÈ˘ 0-8 Î·È 9-16 ¯ÚfiÓˆÓ(24). ™ÙȘ H.¶.A., fiÔ˘ ÙÚÔʤ˜ fiˆ˜ ÙÔ Á¿Ï·Î·È Ù· ‰ËÌËÙÚȷο (cereals) Â›Ó·È ÂÌÏÔ˘ÙÈ-Ṳ̂Ó˜ Ì ‚ÈÙ·Ì›ÓË D, Ú·¯ÈÙÈÛÌfi˜ ·Ó·Ê¤ÚÂÙ·ÈÓ· ··ÓÙ¿Ù·È ÛÙȘ ËÏÈ˘ 0,4-4,5 ¯ÚfiÓˆÓ Î·È΢ڛˆ˜ Û ·ÊÚÈηÓÈ΋˜ ηٷÁˆÁ‹˜ ·È‰È¿ Ԣ›Û˘ ›¯·Ó ıËÏ¿ÛÂÈ ÁÈ· Ì·ÎÚ‡ ¯ÚÔÓÈÎfi ‰È¿-ÛÙËÌ·, ¯ˆÚ›˜ Û˘ÌÏËڈ̷ÙÈ΋ ¯ÔÚ‹ÁËÛË ‚È-Ù·Ì›Ó˘ D (25).

™ÙË ÌÂϤÙË ÙˆÓ πˆ·ÓÓ›ÓˆÓ, Ë ÌÂÁ¿ÏË ‰È·-ÊÔÚ¿ ÌÂٷ͇ ÙˆÓ ÌÈÎÚfiÙÂÚˆÓ Î·È ÙˆÓ ÌÂÁ·Ï‡-ÙÂÚˆÓ ·È‰ÈÒÓ ÌÔÚ› Ó· ·Ô‰Ôı› Û ‰È·ÊÔ-Ú¤˜ Û˘ÌÂÚÈÊÔÚ¿˜ ˆ˜ ÚÔ˜ ÙË ‰È·ÙÚÔÊ‹ ηÈÙÔÓ ÙÚfiÔ ‰È·‚›ˆÛ˘. ∆· ÌÂÁ¿Ï· ·È‰È¿ ·Ô-ʇÁÔ˘Ó Ó· Ï·Ì‚¿ÓÔ˘Ó ÚˆÈÓfi ‹ ÙÚÒÓ ÙÚÔʤ˜Ù·¯Â›·˜ ·Ú·Û΢‹˜ (fast food) Î·È ÏÈÁfiÙÂÚ·Á·Ï·ÎÙÔÎÔÌÈο, ÂÓÒ ÙȘ ÈÔ ÔÏϤ˜ ÒÚ˜ ‰È·-̤ÓÔ˘Ó ÛÙÔ Û›ÙÈ ‹ ÎÈÓÔ‡ÓÙ·È Û ÎÏÂÈÛÙÔ‡˜ ¯Ò-ÚÔ˘˜. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ Û¯ÔÏÈÎÔ‡ ¤ÙÔ˘˜(™Â٤̂ÚÈÔ˜ - πÔ‡ÓÈÔ˜), ΢ڛˆ˜ ‰È·Ì¤ÓÔ˘ÓÂÓÙfi˜ ÙÔ˘ Û¯ÔÏ›Ԣ Î·È ÙÔ˘ ÛÈÙÈÔ‡ ÌÂÏÂÙÒ-ÓÙ·˜ › ÒÚ˜ ÁÈ· Ó· ÚÔÂÙÔÈÌ·ÛıÔ‡Ó ÁÈ· ÙȘÂÈÛ·ÁˆÁÈΤ˜ ÂÍÂÙ¿ÛÂȘ ÛÙ· ¶·ÓÂÈÛÙ‹ÌÈ·.∞ÎfiÌË Î·È ÁÈ· ÙË ‰È·ÛΤ‰·Û‹ ÙÔ˘˜ ÂÈϤÁÔ˘ÓÎÏÂÈÛÙÔ‡˜ ¯ÒÚÔ˘˜, ηıÒ˜ Û' ·˘Ù‹ ÙËÓ ËÏÈΛ·ÙÔ˘˜ ÂÏ·ÂÈ Ë Ó˘¯ÙÂÚÈÓ‹ ˙ˆ‹ ÂÚÈÛÛfiÙÂÚÔ.∞ıÏËÙÈΤ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜ ÛÙÔ ‡·ÈıÚÔ Â›Ó·ÈÂÚÈÔÚÈṲ̂Ó˜ Û ·˘Ù¤˜ ÙȘ ËÏÈ˘, ȉ›ˆ˜ ÛÙ·ÎÔÚ›ÙÛÈ·, ÂÔ̤ӈ˜ Ë ¤ÎıÂÛË ÛÙÔÓ ‹ÏÈÔ Û·Ó›-˙ÂÈ ÙË ¯ÂÈÌÂÚÈÓ‹ ÂÚ›Ô‰Ô. ∞fi Ù· Â˘Ú‹Ì·Ù· Ù˘ÌÂϤÙ˘ Ê·›ÓÂÙ·È fiÙÈ Ù· ıÂÚÈÓ¿ ·Ôı¤Ì·Ù· Ù˘

¶·È‰È·ÙÚÈ΋ 2006;69:25-36

¶›Ó·Î·˜ 2. OÈ Ì¤Û˜ ÙÈ̤˜ ÛÙÔÓ ÔÚfi (±SEM) ÙÔ˘ ·Û‚ÂÛÙ›Ô˘ (Ca), ʈÛÊÔÚÈÎÒÓ (Pi), ·ÏηÏÈ΋˜ ʈÛÊ·Ù¿Û˘ (ALP) Î·È ÔÛÙÂ-ÔηÏÛ›Ó˘ (OC) ÛÙȘ ÙÚÂȘ ÔÌ¿‰Â˜ ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ ̤¯ÚÈ ÙËÓ ËÏÈΛ· ÙˆÓ 18 ¯ÚfiÓˆÓ, Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó ¯ÂÈÌÒÓ· (X) ηÈηÏÔη›ÚÈ (K)

∏ÏÈÎÈ·Îfi ‡ÚÔ˜ Ca Pi ALP OC(¯ÚfiÓÈ·) (mmol/L) (mmol/L) (IU/L) (ng/ml)

3-10 X: 2,43±0,03 1,45±0,06d 203±10 7,5±0,7K: 2,28±0,08**,c 1,35±0,06 187±17a 10,3±1,0**,d

11-14 X: 2,35±0,05 1,45±0,06a 240±37 9,4±1,2a

K: 2,35±0,03 1,39±0,06 264±30b,c 12,7±1,2**,d

15-18 X: 2,43±0,03 1,26±0,03b,e 156±15 7,0±0,4b

K: 2,40±0,03d 1,39±0,03+ 180±18d 5,9±0,3e

**p<0,01, +p<0,001: Û ۇÁÎÚÈÛË Ì ÙȘ ÙÈ̤˜ ÙÔ˘ ¯ÂÈÌÒÓ·avs bp<0,05, cvs dp<0,01, dvs ep<0,001: Û‡ÁÎÚÈÛË ÌÂٷ͇ ÙˆÓ ËÏÈÎÈ·ÎÒÓ ÔÌ¿‰ˆÓ

Pediatr Jan-Feb 06 final allges 27-01-06 15:35 ™ÂÏ›‰·30

Page 31: Παιδιατρική | Τόμος 69 • Τεύχος 1 • Ιανουάριος - Φεβρουάριος 2006

31µÈÙ·Ì›ÓË D Û ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜

25OHD ‰ÂÓ Â·ÚÎÔ‡Ó Ó· ‰È·ÙËÚ‹ÛÔ˘Ó Ê˘ÛÈÔ-ÏÔÁÈΤ˜ ÙÈ̤˜ Ù˘ ‚ÈÙ·Ì›Ó˘ D ηٿ ÙË ‰È¿Ú-ÎÂÈ· ÙÔ˘ ¯ÂÈÌÒÓ·. ∂›Ó·È ÁÓˆÛÙfi fiÙÈ ÔÈ ·ÓÙËÏÈ·-Τ˜ Îڤ̘ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÙÔ Î·ÏÔη›-ÚÈ ÂÚÈÔÚ›˙Ô˘Ó ÙËÓ Û‡ÓıÂÛË Ù˘ ‰ÂÚÌ·ÙÈ΋˜ ‚È-Ù·Ì›Ó˘ D, ÂÔ̤ӈ˜ ‰ÂÓ ·ÔÎÏ›ÂÙ·È Ó· ›ӷÈÛ˘Ó˘Â‡ı˘Ó˜ ÁÈ· ÙËÓ ˘Ô‚Èٷ̛ӈÛË D (26).∞ÓÙ›ıÂÙ·, Ù· ·È‰È¿ ËÏÈΛ·˜ 3-14 ÂÙÒÓ ÙÔÓ ¯ÂÈ-ÌÒÓ· Â›Ó·È ÂÚÈÛÛfiÙÂÚ˜ ÒÚ˜ ÛÙÔÓ ‹ÏÈÔ ·'fi,ÙÈ Ù· ·È‰È¿ ËÏÈΛ·˜ 15-18 ÂÙÒÓ.

¶·Ú¿ ÙË ÌÂÁ¿ÏË ÛËÌ·Û›· Ù˘ Ï‹„˘ ÙÔ˘Á¿Ï·ÙÔ˜ ÛÙËÓ ·È‰È΋ Î·È ÂÊË‚È΋ ËÏÈΛ· (8),ÛÙ· Û¯ÔÏ›· ÙˆÓ ∏.¶.∞. ˘¿Ú¯ÂÈ Ë Ù¿ÛË Ó·ÂÈÙÚ¤Ô˘Ó ÔÙ¿ Ì ¯·ÌËÏ‹ ÂÚÈÂÎÙÈÎfiÙËÙ·Û Ca Î·È Û¯Â‰fiÓ Î·ıfiÏÔ˘ Á¿Ï·. ¶·ÚfiÌÔÈ· η-Ù¿ÛÙ·ÛË ˘¿Ú¯ÂÈ Î·È ÛÙËÓ ∂ÏÏ¿‰·. ∆· ÙÚfiÊÈ-Ì· ÛÙËÓ ∂ÏÏ¿‰· Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ Î·ÈÙˆÓ Á·Ï¿ÙˆÓ (ÂÎÙfi˜ ·fi Ù· Á¿Ï·Ù· ÁÈ· Ù· ‚Ú¤-ÊË) ‰ÂÓ ÂÌÏÔ˘Ù›˙ÔÓÙ·È Ì ‚ÈÙ·Ì›ÓË D. ¶Úfi-ÛÊ·Ù· ¿Ú¯ÈÛÂ Ô ÂÌÏÔ˘ÙÈÛÌfi˜ ÔÚÈÛÌ¤ÓˆÓ Á·-Ï¿ÙˆÓ Ì ‚ÈÙ·Ì›ÓË D, ·ÏÏ¿ Ë ÂÚÈÂÎÙÈÎfiÙËÙ¿ÙÔ˘˜ Â›Ó·È ¯·ÌËÏ‹. ŒÓ· ·È‰› ÛÙËÓ ∂ÏÏ¿‰·,ËÏÈΛ·˜ ÌÂÁ·Ï‡ÙÂÚ˘ ÙˆÓ 3 ÂÙÒÓ, ÁÈ· Ó· ¿ÚÂÈ400 IU ‚ÈÙ·Ì›Ó˘ D ËÌÂÚËÛ›ˆ˜ Ú¤ÂÈ Ó· ›ÓÂÈ1,5-2 Ï›ÙÚ· ·fi ÙÔ ÂÌÏÔ˘ÙÈṲ̂ÓÔ Á¿Ï·. ™Â¿ÏϘ ‰˘ÙÈΤ˜ ¯ÒÚ˜ ÂÎÙfi˜ ÙÔ˘ Á¿Ï·ÙÔ˜ ηȿÏϘ ÙÚÔʤ˜ fiˆ˜ Ë Ì·ÚÁ·Ú›ÓË, ÂÌÏÔ˘Ù›˙Ô-ÓÙ·È Ì ‚ÈÙ·Ì›ÓË D. ™ÙÔÓ §›‚·ÓÔ Ô ÂÌÏÔ˘ÙÈ-ÛÌfi˜ ÙÔ˘ Á¿Ï·ÙÔ˜ Ì ‚ÈÙ·Ì›ÓË D ‰ÂÓ Â›Ó·È˘Ô¯ÚˆÙÈÎfi˜ (20) Î·È ÛÙËÓ ∂ÏÏ¿‰· ηÌÈ¿·fi ÙȘ ÙÚÔʤ˜ ‰ÂÓ ÂÌÏÔ˘Ù›˙ÂÙ·È Ì ‚ÈÙ·Ì›ÓËD. ∂Ô̤ӈ˜ ÂÌÏÔ˘ÙÈÛÌfi˜ ÙˆÓ Á·Ï¿ÙˆÓ Ì·Ú΋ ÔÛfiÙËÙ· ‚ÈÙ·Ì›Ó˘ D ‹/Î·È ·Û‚ÂÛÙ›-

Ô˘, ηıÒ˜ Î·È Ë ›ÂÛË ÚÔ˜ Ù· Û¯ÔÏ›· Ó·ÚÔÛı¤ÛÔ˘Ó ÛÙ· ÚÔ˚fiÓÙ· ΢ÏÈΛԢ Á·Ï·ÎÙÔ-ÎÔÌÈο (Á¿Ï·, ÁÈ·Ô‡ÚÙÈ) ÂÎÙfi˜ ·fi ·Ó·„˘ÎÙÈ-ο ÔÙ¿ ˘„ËÏÒÓ ıÂÚÌ›‰ˆÓ, Èı·ÓfiÓ Ó· Û˘Ì‚¿-ÏÔ˘Ó ÛÙÔ Ó· ·ÔÎÙ‹ÛÔ˘Ó Ù· ·È‰È¿ Î·È ÔÈ Ó¤ÔÈÌÂÁ·Ï‡ÙÂÚË ÔÛÙÈ΋ Ì¿˙·. ∞˘Ùfi ı· ¤¯ÂÈ Î·Ï‡-ÙÂÚ˜ ÚÔÔÙÈΤ˜ ÁÈ· ÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹ Î·È Î˘-Ú›ˆ˜ ÁÈ· ÙȘ Á˘Ó·›Î˜ Ô˘ ÚÔÛ‚¿ÏÏÔÓÙ·È ·fiÔÛÙÂÔfiÚˆÛË. ∆ÂÏÂ˘Ù·›·, ¤¯ÂÈ ÚÔÙ·ı› Ëȉ¤· ÂÌÏÔ˘ÙÈÛÌÔ‡ Ì ‚ÈÙ·Ì›ÓË D Î·È ¿ÏψÓÔÙÒÓ, fiˆ˜ ÙÔ ·Ô‚Ô˘Ù˘ÚˆÌ¤ÓÔ Á¿Ï· Î·È ËÔÚÙÔηϿ‰· (9). TÔ ÙÂÏÂ˘Ù·›Ô ÌÔÚ› Ó·‚ÔËı‹ÛÂÈ Î·È Ù· ¿ÙÔÌ· Ì ·ÏÏÂÚÁ›· ÛÙÔ Á¿Ï· ‹‰˘Û·ÓÂÍ›· ÛÙË Á·Ï·ÎÙfi˙Ë, ·ÓÙÈηıÈÛÙÒÓÙ·˜ ÙÔÁ¿Ï· ˆ˜ ËÁ‹ ‚ÈÙ·Ì›Ó˘ D.

ª›· ÚfiÛÊ·ÙË ÌÂϤÙË ·fi ÙËÓ ∂ÏÏ¿‰· ÙˆÓª·ÓÈÔ‡ Î·È Û˘Ó (27), ‚ڋΠfiÙÈ ÌfiÓÔ ÙÔ 48,4%ÙˆÓ ·ÁÔÚÈÒÓ Î·È ÙÔ 42,7% ÙˆÓ ÎÔÚÈÙÛÈÒÓ ËÏÈ-Λ·˜ 10-15 ¯ÚfiÓˆÓ Â›¯·Ó ËÌÂÚ‹ÛÈ· ÚfiÛÏË„Ë·Û‚ÂÛÙ›Ô˘ ¿Óˆ ·fi ÙÔ 80% Ù˘ Û˘ÓÈÛÙÒÌÂ-Ó˘. ∂›Û˘, ÔÈ MϤÙÛ· Î·È Û˘Ó (28) ·Ó·Ê¤-ÚÔ˘Ó fiÙÈ ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ·˘ÙÒÓ ÙˆÓ·È‰ÈÒÓ Â›¯·Ó ËÌÂÚ‹ÛÈ· ÚfiÛÏË„Ë ‚ÈÙ·Ì›Ó˘D οو ÙˆÓ 10 Ìg/Ë̤ڷ (400 IU/Ë̤ڷ).

∏ ˘Ô‚Èٷ̛ӈÛË D Úԉȷı¤ÙÂÈ Û ÔÛÙÈ΋‚Ï¿‚Ë Î·È Î·ıÈÛÙ¿ ÙÔÓ ÏËı˘ÛÌfi ÂÈÚÚ‹ÛÙËÓ ÂÌÊ¿ÓÈÛË Ú·¯ÈÙÈÛÌÔ‡ ‹ ÔÛÙÂÔÌ·Ï¿Î˘ÓÛ˘ÛÙÔ˘˜ ÂÓ‹ÏÈΘ (29). ªÂϤÙ˜ Ô˘ ·Ó·Ê¤ÚÔÓÙ·ÈÛ ÂÊ‹‚Ô˘˜ Î·È ÂÓ‹ÏÈΘ ‰È·ÈÛÙÒÓÔ˘Ó ¤ÏÏÂÈ-„Ë ‚ÈÙ·Ì›Ó˘ D Û˘¯Ó¿ Û ¿ÙÔÌ· Ó·ڋ˜ ËÏÈ-Λ·˜, ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ¯ÂÈÌÒÓ· (13). ™ÙËÓÔÙÈÔ‰˘ÙÈ΋ ∂˘ÚÒË Ë ˘Ô‚Èٷ̛ӈÛË D ·Ó·-ʤÚÂÙ·È Û ÔÛÔÛÙfi 40% Û Ó·ÚÔ‡˜ ÂÓ‹ÏÈΘ

¶·È‰È·ÙÚÈ΋ 2006;69:25-36

¶›Ó·Î·˜ 3. OÈ Ì¤Û˜ ÙÈ̤˜ (±SEM) ËÏÈΛ·˜ Î·È ÙˆÓ Û˘ÁÎÂÓÙÚÒÛÂˆÓ ÛÙÔÓ ÔÚfi ÙÔ˘ ·Û‚ÂÛÙ›Ô˘ (Ca), ÙˆÓ ÊˆÛÊÔÚÈÎÒÓ (Pi), Ù˘·ÏηÏÈ΋˜ ʈÛÊ·Ù¿Û˘ (ALP), Ù˘ ÔÛÙÂÔηÏÛ›Ó˘ (OC), ÙˆÓ ÌÂÙ·‚ÔÏÈÙÒÓ Ù˘ ‚ÈÙ·Ì›Ó˘ D Î·È Ù˘ ·Ú·ıÔÚÌfiÓ˘ (C-PTH)Û ·ÁfiÚÈ· Î·È ÎÔÚ›ÙÛÈ· ËÏÈΛ·˜ 15-18 ¯ÚfiÓˆÓ ¯ÂÈÌÒÓ· Î·È Î·ÏÔη›ÚÈ

XÂÈÌÒÓ· K·ÏÔη›ÚÈAÁfiÚÈ· KÔÚ›ÙÛÈ· AÁfiÚÈ· KÔÚ›ÙÛÈ·

N 21 24 19 22

HÏÈΛ· (¯ÚfiÓÈ·) 16,5±0,2 16,9±0,2 16,0±0,2 16,4±0,2

Ca (mmol/L) 2,43±0,03 2,45±0,03 2,38±0,03 2,43±0,03

Pi (mmol/L) 1,29±0,06 1,19±0,03a 1,39±0,03 1,39±0,03b

ALP (IU/L) 212±28 108±48* 248±39 116±7*

OC (ng/ml) 8,7±0,6 5,8±0,3*,c 7,3±0,5 4,6±0,3*,d

25OHD (ng/ml) 13,4±15a 12,4±1,2a 28,4±0,2b 26,7±1,5b

24,25(OH)2D (ng/ml) 0,7±0,1a 0,7±0,1a 2,8±0,3b 2,2±0,3b

1,25(OH)2D (pg/ml) 27,0±2,1 23,4±1,3 23,2±2,2 24,0±1,8

C-PTH (ng/ml) 0,6±0,1 0,6±0,1 0,5±0,1 0,5±0,1

*p<0,001: Û‡ÁÎÚÈÛË ÌÂٷ͇ ·ÁÔÚÈÒÓ Î·È ÎÔÚÈÙÛÈÒÓ ÙËÓ ›‰È· ÂÔ¯‹avs bp<0,001, cvs dp<0,02: Û‡ÁÎÚÈÛË ÌÂٷ͇ ÂÔ¯ÒÓ ÁÈ· ÙÔ ›‰ÈÔ Ê‡ÏÔ

Pediatr Jan-Feb 06 final allges 27-01-06 15:35 ™ÂÏ›‰·31

Page 32: Παιδιατρική | Τόμος 69 • Τεύχος 1 • Ιανουάριος - Φεβρουάριος 2006

32 ¢. §··ÙÛ¿Ó˘ Î·È Û˘Ó.

ÙË ¯ÂÈÌÂÚÈÓ‹ ÂÚ›Ô‰Ô (30). ∞fi ÙËÓ ·ÚÔ‡Û·

ÌÂϤÙË Ê·›ÓÂÙ·È fiÙÈ Ù· ÎÔÚ›ÙÛÈ· ËÏÈΛ·˜ 15-18

ÂÙÒÓ ÚԉȷٛıÂÓÙ·È Ó· ·Ó·Ù‡ÍÔ˘Ó ·Ó¿Ú-

ÎÂÈ· ‚ÈÙ·Ì›Ó˘ D ÙÔÓ ¯ÂÈÌÒÓ·, ‡ÚËÌ· Ô˘

·Ó·Ê¤ÚÂÙ·È Î·È ·fi ¿ÏÏÔ˘˜ ÂÚ¢ÓËÙ¤˜ (18,31).

™ÙË ™·Ô˘‰È΋ ∞Ú·‚›· ·fi ÙÔ˘˜ 21 Û˘Ìو̷-

ÙÈÎÔ‡˜ ÂÊ‹‚Ô˘˜ (ËÏÈΛ·˜ 10-15 ÂÙÒÓ) Ì ڷ¯È-

ÙÈÛÌfi ÔÈ 20 ‹Ù·Ó ÎԤϘ (32).

∆· ›‰· Ù˘ 24,25(√∏)2D ÛÙÔÓ ÔÚfi ·-

ÚÔ˘Û›·Û·Ó Âԯȷ΋ ‰È·Î‡Ì·ÓÛË fiˆ˜ Î·È Ë

25OHD, ÂÓÒ ·Ú·ÙËÚ‹ıËΠÈÛ¯˘Ú‹ ıÂÙÈ΋ Û˘-

Û¯¤ÙÈÛË ÌÂٷ͇ 25OHD Î·È 24,25(√∏)2D ÛÙÔÓ

ÔÚfi, Ë ÔÔ›· ‹Ù·Ó ÈÛ¯˘ÚfiÙÂÚË ÙÔÓ ¯ÂÈÌÒÓ·. ∞Ó

Î·È Ô Ê˘ÛÈÔÏÔÁÈÎfi˜ ÚfiÏÔ˜ Ù˘ 24,25(√∏)2D ›-

Ó·È ·Û·Ê‹˜, Ë ÛËÌ·Û›· Ù˘ ÛÙË ÌÂÙ¿ÏψÛË

ÙˆÓ ÔÛÙÒÓ ¤¯ÂÈ ·Ó·ÁÓˆÚÈÛı› ·fi ÔÚÈṲ̂ÓÔ˘˜

ÂÚ¢ÓËÙ¤˜ (33). ™Â Ó¤Ô˘˜ ËÏÈΛ·˜ 15-18 ÂÙÒÓ

ÛÙÔ˘˜ ÔÔ›Ô˘˜ ÌÂÏÂÙ‹ıËÎÂ Ë Î˘ÎÏÔÊÔÚ›· ÙˆÓ

ÂȤ‰ˆÓ Ù˘ 24,25(√∏)2D, ‚Ú¤ıËΠηٿ Ù·

‰‡Ô ÙÚ›Ù· ¯·ÌËÏfiÙÂÚË ÙÔÓ ¯ÂÈÌÒÓ· ·' fi,ÙÈ ÙÔ

ηÏÔη›ÚÈ Ô˘ ÌÔÚ› Ó· ¤¯ÂÈ Î¿ÔÈ· ÛËÌ·Û›·.

∞˘Ùfi ‰ÂÓ ¤¯ÂÈ ÂÈÛËÌ·Óı› ·fi ¿ÏϘ ÌÂϤÙ˜.

√È ÙÈ̤˜ Ù˘ 1,25(√∏)2D ÛÙÔÓ ÔÚfi ÙˆÓ ·È-

‰ÈÒÓ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó ‰ÂÓ ‰È¤ÊÂÚ·Ó ÌÂٷ͇

ÙˆÓ ÙÚÈÒÓ ÔÌ¿‰ˆÓ. ¶·ÚfiÌÔÈ· Â˘Ú‹Ì·Ù· ·Ó·-

ʤÚÔÓÙ·È Î·È ·fi ¿ÏÏÔ˘˜ Û˘ÁÁÚ·Ê›˜ (34,35).

√È ÌÂÁ·Ï‡ÙÂÚ˜ ÙÈ̤˜ Ù˘ 1,25(√∏)2D ηٿ ÙË

‰È¿ÚÎÂÈ· ÙÔ˘ ηÏÔηÈÚÈÔ‡, ÛÙ· ·È‰È¿ ËÏÈΛ·˜

11-14 ¯ÚfiÓˆÓ, ÌÔÚ› Ó· ÔÊ›ÏÔÓÙ·È ÛÙË ÌÂÁ·-

χÙÂÚË Ù·¯‡ÙËÙ· ·‡ÍËÛ˘ (34,36). √È Û˘ÁÎÂ-

ÓÙÚÒÛÂȘ ·Û‚ÂÛÙ›Ô˘ ÛÙÔÓ ÔÚfi ÙˆÓ ·È‰ÈÒÓ

Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó ‚Ú¤ıËÎ·Ó ÂÓÙfi˜ Ê˘ÛÈÔÏÔÁÈ-

ÎÒÓ ÔÚ›ˆÓ.

√È ÙÈ̤˜ ÙÔ˘ ʈÛÊfiÚÔ˘ ÛÙÔÓ ÔÚfi ‹Ù·Ó ÛÙ·

Ê˘ÛÈÔÏÔÁÈο fiÚÈ· ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒ-

ÛÂȘ. ŸÌˆ˜, Ù· ÎÔÚ›ÙÛÈ· ËÏÈΛ·˜ 15-18 ¯ÚfiÓˆÓ

‚Ú¤ıËÎ·Ó Ó· ¤¯Ô˘Ó ̤Û˜ ÙÈ̤˜ ¯·ÌËÏfiÙÂÚ˜

ÙÔÓ ¯ÂÈÌÒÓ· ·' fi,ÙÈ ÙÔ Î·ÏÔη›ÚÈ, ÂÓÒ ‰ÂÓ ·-

Ú·ÙËÚ‹ıËΠÙÔ ›‰ÈÔ ÛÙ· ·ÁfiÚÈ·. ÕÏÏÔÈ ÂÚ¢ÓË-

Ù¤˜ ·fi ÙËÓ ÎÂÓÙÚÈ΋ ∂˘ÚÒË ¤¯Ô˘Ó ·Ó·Ê¤ÚÂÈ

Âԯȷ΋ ‰È·Î‡Ì·ÓÛË ÙÔ˘ Pi ÔÚÔ‡ Ì ˘„ËÏfiÙÂ-

Ú˜ ÙÈ̤˜ ÙÔ Î·ÏÔη›ÚÈ (37). OÈ Round Î·È Û˘Ó

(1973) ·Ó·Ê¤ÚÔ˘Ó ¯·ÌËÏfiÙÂÚ˜ ÙÈ̤˜ ʈÛÊÔ-

ÚÈÎÒÓ ÛÙ· ÎÔÚ›ÙÛÈ· ·' fi,ÙÈ ÛÙ· ·ÁfiÚÈ· ËÏÈΛ·˜

¿Óˆ ÙˆÓ 13 ÂÙÒÓ, ·ÏÏ¿ ‰ÂÓ ‰È·›ÛÙˆÛ·Ó ÂÔ-

¯È·Î‹ ‰È·ÊÔÚ¿ ÙÔ˘ Pi Û ·È‰È¿ ËÏÈΛ·˜ 7-17

ÂÙÒÓ (38). ∆Ô ›‰ÈÔ ÈÛ¯‡ÂÈ Î·È ÁÈ· Ù· ·È‰È¿ Ù˘

·ÚÔ‡Û·˜ ÌÂϤÙ˘ ËÏÈΛ·˜ 3-14 ¯ÚfiÓˆÓ.

™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, ÔÈ ¯·ÌËϤ˜ ÙÈ̤˜ ÙÔ˘

ʈÛÊfiÚÔ˘ ÛÙÔÓ ÔÚfi ÙÔÓ ¯ÂÈÌÒÓ· Û˘Ó˘‹Ú¯·Ó

Ì ¯·ÌËϤ˜ Û˘ÁÎÂÓÙÚÒÛÂȘ Ù˘ 25√∏D. ∂Ô-

̤ӈ˜, Û ·˘Ù‹ ÙËÓ ËÏÈÎȷ΋ ÔÌ¿‰· ÌÔÚ› Ó·

‰È·Ù˘ˆı› Ë ¿Ô„Ë fiÙÈ Ë ‚ÈÔ¯ËÌÈ΋ ¤ÏÏÂÈ„Ë

‚ÈÙ·Ì›Ó˘ D ÌÔÚ› Ó· ¤¯ÂÈ ‰˘ÛÌÂÓ‹ ›‰Ú·ÛË

ÛÙÔÓ ÛÎÂÏÂÙfi. ∞Ó Î·È ÌÂÚÈΤ˜ ÌÂϤÙ˜, Ô˘

ÚÔÛ¿ıËÛ·Ó Ó· Û˘Û¯ÂÙ›ÛÔ˘Ó Ù· ›‰· Ù˘

25OHD ÛÙÔÓ ÔÚfi Ì ÙËÓ ÔÛÙÈ΋ ˘ÎÓfiÙËÙ· ‹

ÙÔÓ ÔÛÙÈÎfi ·Ó·Û¯ËÌ·ÙÈÛÌfi Û ÂÊ‹‚Ô˘˜ Î·È ÓÂ-

·ÚÔ‡˜ ÂÓ‹ÏÈΘ, ·Ú·Ù‹ÚËÛ·Ó ÌÈÎÚ‹ ‹ ηıfi-

ÏÔ˘ ‰˘ÛÌÂÓ‹ ›‰Ú·ÛË ÛÙÔÓ ÛÎÂÏÂÙfi, ‰ÂÓ Ìfi-

ÚÂÛ·Ó Î·È Ó· ÙÔ ·ÔÎÏ›ÛÔ˘Ó (39,40). ¶·Ú·Ù‹-

ÚËÛ·Ó fï˜, fiÙÈ ÙÔ ‡„Ô˜ ·ÌÊÔÙ¤ÚˆÓ ÙˆÓ Ê‡-

ÏˆÓ Ì ¯·ÌËϤ˜ ÙÈ̤˜ 25OHD ÛÙÔÓ ÔÚfi ηٿ

ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ¯ÂÈÌÒÓ·, ‚Ú¤ıËΠÛËÌ·ÓÙÈο

¯·ÌËÏfiÙÂÚÔ ·fi ÂΛÓÔ ÙˆÓ ·È‰ÈÒÓ Ù˘ ›‰È·˜

ËÏÈΛ·˜ Ì ¿ÚÎÂÈ· ‚ÈÙ·Ì›Ó˘ ÙÔÓ ¯ÂÈÌÒÓ·.

E›Û˘, ÔÈ Oliveri Î·È Û˘Ó ·Ó·Ê¤ÚÔ˘Ó ¯·ÌËÏ‹

ÔÛÙÈ΋ ˘ÎÓfiÙËÙ· Û Ó·ڤ˜ ÎԤϘ Ì ¯·ÌË-

Ϥ˜ ÙÈ̤˜ 25OHD ÛÙÔÓ ÔÚfi ÙÔÓ ¯ÂÈÌÒÓ· Î·È ¯·-

ÌËÏ‹ ÚfiÛÏË„Ë ·Û‚ÂÛÙ›Ô˘ ¯ˆÚ›˜ ·˘Ùfi Ó· ·-

Ú·ÙËÚÂ›Ù·È ÛÙ· ·ÁfiÚÈ· (39).

™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, ÔÈ Ì¤Û˜ ÙÈ̤˜ ÙˆÓ

ÂȤ‰ˆÓ ÔÛÙÂÔηÏÛ›Ó˘ ‚Ú¤ıËÎ·Ó ¯·ÌËÏfi-

ÙÂÚ˜ ÙÔÓ ¯ÂÈÌÒÓ· ·' fi,ÙÈ ·˘Ù¤˜ ÙÔ˘ ηÏÔηÈ-

ÚÈÔ‡ ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜ ÙˆÓ ÌÈÎÚfiÙÂÚˆÓ ËÏÈ-

ÎÈÒÓ. ¢ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ‰È·ÊÔÚ¤˜ ÌÂٷ͇

ÂÔ¯ÒÓ ÛÙ· ›‰· Ù˘ ·ÏηÏÈ΋˜ ʈÛÊ·-

Ù¿Û˘ Û fiϘ ÙȘ ÔÌ¿‰Â˜. øÛÙfiÛÔ, Â›Ó·È ‰‡-

ÛÎÔÏÔ Ó· ‰È·ÎÚ›ÓÔ˘ÌÂ Ù˘¯fiÓ ÂÈÙÒÛÂȘ Ù˘

·Ó¿ÚÎÂÈ·˜ ‚ÈÙ·Ì›Ó˘ D ÛÙËÓ ÔÛÙÈ΋ Û‡ÓıÂ-

ÛË Î·È ÙȘ ·ÏÏ·Á¤˜ Ô˘ ÔÊ›ÏÔÓÙ·È ÛÙËÓ ·‡ÍË-

ÛË ÏfiÁˆ ËÏÈΛ·˜.

ŸÌˆ˜, ˘¿Ú¯Ô˘Ó ÂӉ›ÍÂȘ fiÙÈ Ô ÔÛÙÈÎfi˜

·Ó·Û¯ËÌ·ÙÈÛÌfi˜ ÛÙȘ ËÏÈ˘ 15-18 ¯ÚfiÓˆÓ

‹Ù·Ó ¯·ÌËÏfiÙÂÚÔ˜ ÛÙ· ÎÔÚ›ÙÛÈ· ·' fi,ÙÈ ÛÙ·

·ÁfiÚÈ·. √È Asknes Î·È Aarskog (1982) ·Ó·Ê¤-

ÚÔ˘Ó fiÙÈ ÔÈ ˘„ËÏfiÙÂÚ˜ ÙÈ̤˜ ·ÏηÏÈ΋˜ ʈ-

ÛÊ·Ù¿Û˘ ·Ú·ÙËÚÔ‡ÓÙ·È ÛÙ· ÎÔÚ›ÙÛÈ· 11

ÂÙÒÓ Î·È ÛÙ· ·ÁfiÚÈ· 13 ¯ÚfiÓˆÓ (41). ™Ù· ÎÔÚ›-

ÙÛÈ·, ÛÙ·ıÂÚ‹ Ì›ˆÛË ÙÔ˘ ÂÓ˙‡ÌÔ˘ ·Ú·ÙËÚ›-

Ù·È ·fi ÙÔ ‰Â‡ÙÂÚÔ Ì¤¯ÚÈ ÙÔ Ù¤Ù·ÚÙÔ ÛÙ¿‰ÈÔ

Ù˘ ÂÊ˂›·˜ Î·È ÛÙ· ·ÁfiÚÈ· ·fi ÙÔ ÙÚ›ÙÔ Ì¤-

¯ÚÈ ÙÔ ¤ÌÙÔ. √È Round Î·È Û˘Ó (1973) ·Ó·-

ʤÚÔ˘Ó ·‡ÍËÛË Ù˘ ALP ÛÙ· ·È‰È¿ ËÏÈΛ·˜

13-14 ¯ÚfiÓˆÓ Ô˘ ‹Ù·Ó ÌÈÎÚfiÙÂÚË ÛÙ· ÎÔÚ›-

ÙÛÈ· (38). ªÂ›ˆÛË ÙˆÓ ÂȤ‰ˆÓ Ù˘ ÔÏÈ΋˜

ALP ÙÔ˘ ÔÚÔ‡ ·Ó·Ê¤ÚıËΠÁÈ· ·ÌÊfiÙÂÚ· Ù·

ʇϷ ÌÂÙ¿ ÙËÓ ËÏÈΛ· ÙˆÓ 14 ÂÙÒÓ. ™Ù· ·È‰È¿

˘fi ÌÂϤÙË, Ù· Â˘Ú‹Ì·Ù· Û˘ÌʈÓÔ‡Ó Ì ·˘Ù¿

ÚÔËÁÔ‡ÌÂÓˆÓ ÌÂÏÂÙÒÓ Ì ÙȘ ÙÈ̤˜ Ù˘ ALP

Ó· Â›Ó·È ˘„ËÏfiÙÂÚ˜ ÛÙȘ ËÏÈ˘ 11-14 ¯Úfi-

ÓˆÓ Î·È Ó· ÌÂÈÒÓÔÓÙ·È ÛÙȘ ÌÂÁ·Ï‡ÙÂÚ˜ ËÏÈ-

˘ (15-18 ÂÙÒÓ). √È ‰È·ÊÔÚ¤˜ ÌÂٷ͇ ÙˆÓ

‰‡Ô Ê‡ÏˆÓ Ô˘ ‚Ú¤ıËÎ·Ó ÛÙÔ˘˜ ÂÊ‹‚Ô˘˜ Ù˘

ÌÂϤÙ˘ ÌÔÚ› Ó· ÔÊ›ÏÔÓÙ·È ÛÙËÓ ÚÒÈÌË

Ì›ˆÛË ÛÙ· ÎÔÚ›ÙÛÈ· Û˘ÁÎÚÈÙÈο Ì ٷ ·ÁfiÚÈ·.

¶·È‰È·ÙÚÈ΋ 2006;69:25-36

Pediatr Jan-Feb 06 final allges 27-01-06 15:35 ™ÂÏ›‰·32

Page 33: Παιδιατρική | Τόμος 69 • Τεύχος 1 • Ιανουάριος - Φεβρουάριος 2006

33µÈÙ·Ì›ÓË D Û ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜

¶·ÚfiÌÔÈ· Â˘Ú‹Ì·Ù· ·Ú·ÙËÚ‹ıËÎ·Ó Î·È

Ì ÙËÓ ÔÛÙÂÔηÏÛ›ÓË. ª›· ÈÛ¯˘Ú‹ ıÂÙÈ΋ Û˘-

Û¯¤ÙÈÛË ‚Ú¤ıËΠÌÂٷ͇ ÔÛÙÂÔηÏÛ›Ó˘ ηÈ

ÔÏÈ΋˜ ALP, ·ÊÔ‡ Î·È ÔÈ ‰‡Ô Â›Ó·È ‚ÈÔ¯ËÌÈÎÔ›

‰Â›ÎÙ˜ Ù˘ ÔÛÙÈ΋˜ Û‡ÓıÂÛ˘. ∞˘Ù‹ Ë ·Ú·-

Ù‹ÚËÛË ¤¯ÂÈ ÂÈÛËÌ·Óı› Î·È ·fi ¿ÏÏÔ˘˜

ÂÚ¢ÓËÙ¤˜ Û ÂÓ‹ÏÈΘ Î·È ·È‰È¿ ËÏÈΛ·˜ 7-18

ÂÙÒÓ (42,43).

∫·È ÔÈ ‰‡Ô ‰Â›ÎÙ˜ ÁÈ· ¯ÂÈÌÒÓ· Î·È Î·ÏÔ-

η›ÚÈ ·Ú·¤ÌÔ˘Ó Û ¯·ÌËÏfiÙÂÚÔ ÔÛÙÈÎfi

·Ó·Û¯ËÌ·ÙÈÛÌfi Î·È ¯·ÌËÏfi Ú˘ıÌfi ÔÛÙÈ΋˜

Û‡ÓıÂÛ˘ ÛÙ· ÎÔÚ›ÙÛÈ·. ∞˘Ù¿ Ù· Â˘Ú‹Ì·Ù·

Û˘ÌʈÓÔ‡Ó Ì ÚfiÛÊ·ÙË ÌÂϤÙË Ô˘ ¤‰ÂÈÍÂ

fiÙÈ Ë Ì¤ÛË ËÏÈΛ· Ù˘ ̤ÁÈÛÙ˘ Û˘ÛÛÒÚ¢Û˘

Ca ÛÙËÓ ‹‚Ë Â›Ó·È Ù· 14 ¤ÙË ÁÈ· Ù· ·ÁfiÚÈ· ηÈ

ÛÙ· 12,5 ¤ÙË ÁÈ· Ù· ÎÔÚ›ÙÛÈ· (44). ∂›Û˘, ÂÎÙÈ-

ÌÔ‡Ó fiÙÈ, ηٿ ÚÔÛ¤ÁÁÈÛË, ÙÔ 26% ÙÔ˘ Ca ÙˆÓ

ÂÓËÏ›ÎˆÓ ·ÔÎÙ¿Ù·È ÛÙ· ‰‡Ô ¯ÚfiÓÈ· Ù˘ Ù·¯Â›-

·˜ ÛÎÂÏÂÙÈ΋˜ ·‡ÍËÛ˘. √È ˘„ËϤ˜ ·Ó·ÏÔÁ›Â˜

Ù˘ ·‡ÍËÛ˘ ÙˆÓ ÔÛÙÈÎÒÓ ÌÂÙ¿ÏÏˆÓ ÛÙËÓ ‹‚Ë

‰Â›¯ÓÔ˘Ó fiÙÈ ¤Ó· ·ÍÈfiÏÔÁÔ ÎÏ¿ÛÌ· Ù˘ ÂÚÈÂ-

ÎÙÈÎfiÙËÙ·˜ ÙˆÓ ÌÂÙ¿ÏÏˆÓ ÙÔ˘ ÔÛÙÔ‡ ÂÈÙ˘Á-

¯¿ÓÂÙ·È ÛÙ· Ï›Á· ¯ÚfiÓÈ· Ù˘ ÂÊ˂›·˜. √È ˘„Ë-

Ϥ˜ ·Ó·ÏÔÁ›Â˜ ηٷÎÚ¿ÙËÛ˘ ·Û‚ÂÛÙ›Ô˘ ÛÙËÓ

‹‚Ë ÌÔÚÔ‡Ó Ó· ÂÈÙ¢¯ıÔ‡Ó Ì ·‡ÍËÛË Ù˘

‰È·ÈÙËÙÈ΋˜ ÚfiÛÏ˄˘, ηıÒ˜ Î·È Ì ÙËÓ

·Ú΋ ·ÔÚÚfiÊËÛË Î·È Î·Ù·ÎÚ¿ÙËÛË. ∆Ô

‰Â‡ÙÂÚÔ ÂÍ·ÚÙ¿Ù·È Î·Ù¿ ÌÂÁ¿ÏÔ Ì¤ÚÔ˜ ·fi

ÙËÓ Â¿ÚÎÂÈ· ‚ÈÙ·Ì›Ó˘ D.

°Ú·ÌÌÈ΋ ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË ‚Ú¤ıËΠηÈ

ÌÂٷ͇ ÙÔ˘ ‰Â›ÎÙË ÔÛÙÈ΋˜ Û‡ÓıÂÛ˘, Ù˘

ÔÛÙÂÔηÏÛ›Ó˘ Î·È ÙˆÓ ÂȤ‰ˆÓ Ù˘

1,25(OH)2D ÛÙÔÓ ÔÚfi. °ÓˆÛÙfi Â›Ó·È fiÙÈ Ë Î·Ï-

ÛÈÙÚÈfiÏË ÚÔ¿ÁÂÈ ÙË Û‡ÓıÂÛË Ù˘ ÔÛÙÂÔηÏÛ›-

Ó˘ Î·È ·Ó·Ê¤ÚÂÙ·È fiÙÈ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘

ÂÊ˂›·˜, ˘¿Ú¯ÂÈ ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË Î·ÏÛÈ-

ÙÚÈfiÏ˘ Î·È ÔÛÙÂÔηÏÛ›Ó˘ (45). ∂›Û˘ ÛÙËÓ

ÂÊ˂›· ·Ó·Ê¤ÚÂÙ·È Û˘Û¯¤ÙÈÛË Î·È ÌÂٷ͇

ηÏÛÈÙÚÈfiÏ˘ Î·È Û˘ÁΤÓÙÚˆÛ˘ ·Û‚ÂÛÙ›Ô˘

ÛÙÔÓ ÛÎÂÏÂÙfi ‹ ·‡ÍËÛ˘ Ù˘ ÔÛÙÈ΋˜ Ì¿˙·˜

(36). £ÂˆÚËÙÈο, Ê·›ÓÂÙ·È fiÙÈ Ù· Â˘Ú‹Ì·Ù·

Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ı· ÌÔÚÔ‡Û·Ó Ó· ÂÚ-

ÌËÓ¢ıÔ‡Ó ˆ˜ Û¯¤ÛË ÂȤ‰ˆÓ ηÏÛÈÙÚÈfiÏ˘

Î·È ÔÛÙÈ΋˜ Ì¿˙·˜, Èı·ÓfiÓ ÏfiÁˆ Ù˘ ›‰Ú·-

Û‹˜ Ù˘ ÛÙËÓ ·ÔÚÚfiÊËÛË Î·È Î·Ù·ÎÚ¿ÙËÛË

ÙÔ˘ Ca ÛÙÔ ÛÒÌ·. ªÂϤÙ˜ ÌÂÙ·-·Ó¿Ï˘Û˘

ÈÛÔ˙˘Á›ˆÓ ·Û‚ÂÛÙ›Ô˘ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ Ë ·ÔÚ-

ÚfiÊËÛË Î·È Ë Î·Ù·ÎÚ¿ÙËÛË Ca ÛÙÔ ÛÒÌ· ›ӷÈ

˘„ËÏfiÙÂÚ˜ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÊ˂›·˜

Î·È ÛÙ· ‰‡Ô ʇϷ (46).

™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ‰ÂÓ ·Ú·ÙËÚ‹ıËηÓ

ÛËÌ·ÓÙÈΤ˜ ·ÏÏ·Á¤˜ ÛÙËÓ C-PTH ÌÂٷ͇ ÙˆÓ

ÂÔ¯ÒÓ Î·È ÛÙȘ 3 ÔÌ¿‰Â˜ ·È‰ÈÒÓ Î·È ÔÈ ÙÈ̤˜

‚Ú¤ıËÎ·Ó ÛÙ· Ê˘ÛÈÔÏÔÁÈο fiÚÈ·, Ì ÌÈÎÚfiÙÂ-

Ú˜ ÙÈ̤˜ ÛÙËÓ ÔÌ¿‰· ÙˆÓ ÌÂÁ¿ÏˆÓ ·È‰ÈÒÓ

(15-18 ÂÙÒÓ). ÕÏÏÔÈ ÂÚ¢ÓËÙ¤˜ ·Ó·Ê¤ÚÔ˘Ó ·‡-

ÍËÛË Ù˘ PTH Û ·È‰È¿ Ì ˘Ô‚Èٷ̛ӈÛË D

(20). ™ËÌ·ÓÙÈ΋ ·ÚÓËÙÈ΋ Û˘Û¯¤ÙÈÛË ÌÂٷ͇

ÂȤ‰ˆÓ ÛÙÔÓ ÔÚfi 25√HD Î·È ƒ∆∏ ¤¯ÂÈ ·Ó·-

ÊÂÚı› Û ·ÁfiÚÈ· ÂÊ‹‚Ô˘˜ (47). ∆¤ÙÔÈ· Û˘-

Û¯¤ÙÈÛË ‰ÂÓ ·Ú·ÙËÚ‹ıËΠÛÙ· ·È‰È¿ Ô˘

ÌÂÏÂÙ‹ıËηÓ.

∆· ·ÔÙÂϤÛÌ·Ù· ·˘Ù‹˜ Ù˘ ÌÂϤÙ˘ fiÛÔÓ

·ÊÔÚ¿ ÛÙ· ›‰· Ù˘ C-PTH ‰ÂÓ Â›Ó·È ‰˘Ó·-

ÙfiÓ Ó· ÙËÓ ·ÔÎÏ›ÛÔ˘Ó ˆ˜ ¢·›ÛıËÙÔ ‰Â›ÎÙË

·Ó¿ÚÎÂÈ·˜ ‚ÈÙ·Ì›Ó˘ D. √‡Ù ÌÔÚ› Ó·

·ÁÓÔËı› fiÙÈ ÂÓ‰¤¯ÂÙ·È Ó· ˘¿Ú¯Ô˘Ó ÎÏÈÓÈο

·ÍÈÔÏÔÁ‹ÛÈ̘ ÂÈÙÒÛÂȘ ·fi ÙËÓ ·Ó¿Ú-

ÎÂÈ· ‚ÈÙ·Ì›Ó˘ D. ∂Ó‰¤¯ÂÙ·È Ó· ˘¿Ú¯ÂÈ ¤Ó·˜

Ô˘‰fi˜ ÁÈ· Ù· ›‰· Ù˘ 25OHD, οو ·fi

ÙÔÓ ÔÔ›Ô ÌÔÚ› Ó· ÂËÚ¿˙ÔÓÙ·È Ù· ›‰·

C-PTH. ™Â ÌÂÙ·-ÂÌÌËÓÔ·˘ÛȷΤ˜ Á˘Ó·›Î˜ Ô

Ô˘‰fi˜ ·˘Ùfi˜ ·Ó·Ê¤ÚÂÙ·È Ó· Î˘Ì·›ÓÂÙ·È ÛÙ· 30-

44 ng/ml Î·È Â›Û˘ Ó· Û¯ÂÙ›˙ÂÙ·È Ì ÙÔÓ ‚·ı-

Ìfi ·ÔÚÚfiÊËÛ˘ ÙÔ˘ ·Û‚ÂÛÙ›Ô˘ (48,49). ™Ù·

·È‰È¿ ·˘Ùfi˜ Ô Ô˘‰fi˜ ‰ÂÓ ¤¯ÂÈ ˘ÔÏÔÁÈÛı› ·Ï-

Ï¿ Ú¤ÂÈ Ó· ‚Ú›ÛÎÂÙ·È ·ÚÎÂÙ¿ ¯·ÌËÏfiÙÂÚ·.

™˘ÌÂÚ·ÛÌ·ÙÈο, Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘

·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‰Â›¯ÓÔ˘Ó fiÙÈ ·ÎfiÌË Î·È ÛÂ

ÌÈ· ËÏÈfiÏÔ˘ÛÙË ¯ÒÚ· fiˆ˜ Ë ∂ÏÏ¿‰·, ÔÈ Ó¤ÔÈ

ËÏÈΛ·˜ 15-18 ¯ÚfiÓˆÓ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘

¯ÂÈÌÒÓ· ¤¯Ô˘Ó ·Ó¿ÁÎË Ï‹„˘ ‚ÈÙ·Ì›Ó˘ D,

·ÊÔ‡ Ù· ·Ôı¤Ì·Ù· Û ‚ÈÙ·Ì›ÓË D ÙÔ˘ ηÏÔ-

ηÈÚÈÔ‡ ‰ÂÓ Â·ÚÎÔ‡Ó. ∆· ÎÔÚ›ÙÛÈ· ·˘Ù‹˜ Ù˘

ËÏÈΛ·˜ ·ÔÙÂÏÔ‡Ó ÈÔ Â˘·›ÛıËÙÔ ÏËı˘ÛÌfi

·ÚfiÙÈ ‰ÂÓ ¤¯Ô˘Ó ÙÔ˘˜ ÂÚÈÔÚÈÛÌÔ‡˜ Ù˘ ÂÓ-

‰˘Ì·Û›·˜ fiˆ˜ ÛÙȘ ÌÔ˘ÛÔ˘ÏÌ·ÓÈΤ˜ ¯ÒÚ˜, Ô

ΛӉ˘ÓÔ˜ ‰Â Â›Ó·È ÌÂÁ·Ï‡ÙÂÚÔ˜ ÁÈ· ÙË ¯ÂÈÌÂÚÈ-

Ó‹ ÂÚ›Ô‰Ô. ∫·Ù¿ fiÛÔÓ ˘¿Ú¯Ô˘Ó Ì·ÎÚÔ¯Úfi-

ÓȘ ÂÈÙÒÛÂȘ › Ù˘ ÔÛÙÈ΋˜ Ì¿˙·˜ ÙÔ˘˜

‰ÂÓ ÌÔÚ› Ó· ÂȂ‚·Èˆı› ·fi Ù· ·ÔÙÂϤ-

ÛÌ·Ù· Ù˘ ÌÂϤÙ˘ ·ÏÏ¿ ‰ÂÓ ÌÔÚ› Î·È Ó·

·ÁÓÔËı›, ÂȉÈο Ì ¯·ÌËϤ˜ ÙÈ̤˜ ‰ÂÈÎÙÒÓ

ÔÛÙÈ΋˜ Û‡ÓıÂÛ˘ ÙË ¯ÂÈÌÂÚÈÓ‹ ÂÚ›Ô‰Ô.

∂›Û˘, ηٿ ÙËÓ ÙÂÏÂ˘Ù·›· ‰ÂηÂÙ›·,

¤¯Ô˘Ó ‰È·ÈÛÙˆı› ÂÚ¢ÓËÙÈο Î·È ¿ÏϘ ‰Ú¿-

ÛÂȘ Ù˘ ‚ÈÙ·Ì›Ó˘ D ÂÎÙfi˜ ·fi ·˘Ù‹ ÛÙÔ ÌÂ-

Ù·‚ÔÏÈÛÌfi ÙÔ˘ ·Û‚ÂÛÙ›Ô˘ (50). ŒÙÛÈ, Ù˘¯fiÓ

ÂÈÙÒÛÂȘ ·fi Ì·ÎÚÔ¯ÚfiÓÈ· ·Ó¿ÚÎÂÈ· ‚È-

Ù·Ì›Ó˘ D ÛÙÔÓ ¿ÓıÚˆÔ Ì¿ÏÏÔÓ ‰ÂÓ ÌÔÚ›

Ó· ·ÔÎÏÂÈÛı›. √È ÈÔ Û˘ÓËıÈṲ̂Ó˜ ‰È·Ù·-

Ú·¯¤˜ Ô˘ ÔÊ›ÏÔÓÙ·È Û ·˘ÙÔ¿ÓÔÛ· ÓÔÛ‹Ì·-

Ù· fiˆ˜ Ô Û·Î¯·Ú҉˘ ‰È·‚‹Ù˘ Ù‡Ô˘ I, Ë

ÚÂ˘Ì·ÙÔÂȉ‹˜ ·ÚıÚ›Ùȉ· Î·È Ë ÛÎÏ‹Ú˘ÓÛË Î·-

Ù¿ Ͽη˜ ¤¯ÂÈ ‚ÚÂı› fiÙÈ ÌÔÚÔ‡Û·Ó Ó· ÚÔ-

ÏËÊıÔ‡Ó ÛÂ ÂÈÚ·Ì·Ùfi˙ˆ· Ô˘ ¤·ÈÚÓ·Ó

¶·È‰È·ÙÚÈ΋ 2006;69:25-36

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34 ¢. §··ÙÛ¿Ó˘ Î·È Û˘Ó.

1,25(OH)2D ·fi ÙËÓ ·Ú¯‹ Ù˘ ˙ˆ‹˜ ÙÔ˘˜

(51,52,53). √È Hypponen Î·È Û˘Ó (2001) Û ̛·

ÂȉËÌÈÔÏÔÁÈ΋ ÌÂϤÙË, ‚Ú‹Î·Ó fiÙÈ Ù· ·È‰È¿

Ô˘ ¤·ÈÚÓ·Ó 2000 IU ‚ÈÙ·Ì›Ó˘ D ·fi ÙÔÓ 1Ô

¯ÚfiÓÔ ˙ˆ‹˜ Ì›ˆÓ·Ó ÙËÓ Èı·ÓfiÙËÙ· ÂÌÊ¿ÓÈ-

Û˘ ۷ί·ÚÒ‰Ô˘˜ ‰È·‚‹ÙË Ù‡Ô˘ I ηٿ 80%

(54). ÀÂÚÙ·ÛÈÎÔ› ·ÛıÂÓ›˜ Ô˘ ÂÎÙ¤ıËÎ·Ó ÛÂ

˘ÂÚÈÒ‰Ë ·ÎÙÈÓÔ‚ÔÏ›· (UVB) ÁÈ· ÌÂÚÈÎÔ‡˜

Ì‹Ó˜ Î·È ·‡ÍËÛ·Ó Ù· ›‰· Ù˘ ΢ÎÏÔÊÔ-

ÚÔ‡Û·˜ 25OHD, ‚Ú¤ıËÎ·Ó Ó· ÌÂÈÒÓÔ˘Ó ÙË Û˘-

ÛÙÔÏÈ΋ Î·È ‰È·ÛÙÔÏÈ΋ ›ÂÛ‹ ÙÔ˘˜ Û·Ó Ó·

¤·ÈÚÓ·Ó ·ÓÙÈ˘ÂÚÙ·ÛÈ΋ ·ÁˆÁ‹, ÂÓÒ ‰ÂÓ Û˘-

Ó¤‚·ÈÓ ÙÔ ›‰ÈÔ Ì ·˘ÙÔ‡˜ Ô˘ ‰ÂÓ ·‡ÍËÛ·Ó

ÙËÓ 25OHD (55).

ª¤Ûˆ Ì˯·ÓÈÛÌÒÓ Ô˘ ‰ÚÔ˘Ó ·ÚÓËÙÈο

ÛÙÔÓ ÔÏÏ·Ï·ÛÈ·ÛÌfi ÙˆÓ Î˘ÙÙ¿ÚˆÓ ‹ Ì ÙËÓ

ÂÓÂÚÁÔÔ›ËÛË Ù˘ ·fiÙˆÛ˘, Ë ‚ÈÙ·Ì›ÓË D

ÌÔÚ› Ó· ÂËÚ¿˙ÂÈ Î·È Ì¿ÏÈÛÙ· ·ÔÙÂÏÂÛÌ·-

ÙÈο ÙËÓ Î˘ÙÙ·ÚÈ΋ ·‡ÍËÛË, ÚÔÛٷهÔÓÙ·˜

¤ÙÛÈ ·fi ÌÂÚÈÎÔ‡˜ Ù‡Ô˘˜ ηÚΛÓÔ˘ (56). ∆Ș

ÙÂÏÂ˘Ù·›Â˜ ‰‡Ô ‰ÂηÂٛ˜, ÂÚ¢ÓËÙ¤˜ ÂÈ‚Â-

‚·›ˆÛ·Ó ·ÏÈfiÙÂÚ˜ ·Ú·ÙËÚ‹ÛÂȘ fiÙÈ ¿ÓıÚˆ-

ÔÈ ·fi ÙȘ H.¶.A. Î·È ÙËÓ E˘ÚÒË Ô˘ ˙Ô‡-

Û·Ó Û ˘„ËÏfi ÁˆÁÚ·ÊÈÎfi Ï¿ÙÔ˜ ‹ ‰ÂÓ ÂÎÙ›-

ıÂÓÙÔ ·ÚÎÂÙ¿ ÛÂ UVB ·ÎÙÈÓÔ‚ÔÏ›·, ‚Ú›ÛÎÔ-

ÓÙ·Ó Û ˘„ËÏfiÙÂÚÔ Î›Ó‰˘ÓÔ ı·Ó¿ÙÔ˘ ·fi ηÚ-

ΛÓÔ ÙÔ˘ ·¯¤Ô˜ ÂÓÙ¤ÚÔ˘, ÙÔ˘ ÚÔÛÙ¿ÙË Î·È

ÙÔ˘ Ì·ÛÙÔ‡ (57). ™˘ÓÂÒ˜, Ô ÂÌÏÔ˘ÙÈÛÌfi˜ ÌÂ

ÈηÓÔÔÈËÙÈ΋ ÔÛfiÙËÙ· ‚ÈÙ·Ì›Ó˘ D ÙˆÓ Á·-

Ï¿ÙˆÓ Î·È ÙˆÓ ¿ÏÏˆÓ ·Ú·ÁÒÁˆÓ Á¿Ï·ÙÔ˜ ηÈ

ÛÙËÓ ∂ÏÏ¿‰· Û›ÁÔ˘Ú· ı· Â›Ó·È Â˘ÂÚÁÂÙÈÎfi˜.

µÈ‚ÏÈÔÁÚ·Ê›·

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37∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞ ORIGINAL ARTICLE

¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋,¶·ÓÂÈÛÙËÌÈ·Îfi °ÂÓÈÎfi¡ÔÛÔÎÔÌÂ›Ô ∏Ú·ÎÏ›Ԣ

AÏÏËÏÔÁÚ·Ê›·:

∂ÌÌ·ÓÔ˘‹Ï °·Ï·Ó¿Î˘∆Ô̤·˜ ªËÙ¤Ú·˜-¶·È‰ÈÔ‡,∆Ì‹Ì· π·ÙÚÈ΋˜¶·ÓÂÈÛÙ‹ÌÈÔ ∫Ú‹Ù˘∆.£. 2208, T.K. 710 03 ∏Ú¿ÎÏÂÈÔ ∫Ú‹Ù˘∂-mail: [email protected]

∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 10-01-2005∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 14-10-2005

Paediatric Department,General University Hospitalof Heraklion, Crete

Correspondence:

Emmanouil GalanakisSchool of Medicine, Mother-Child Department University of CreteP.O. Box 2208, 710 03, Heraklion, Crete∂-mail: [email protected]

Date of submission: 10-01-2005Date of approval: 14-10-2005

¶·È‰È·ÙÚÈ΋ 2006;69:37-44

¡ÔÛËÚfiÙËÙ· Î·È ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ

Ù˘ ‚ÚԢΤÏψÛ˘ ÛÙËÓ ∂ÏÏ¿‰·

ª. ª·˘ÚfiΈÛÙ·, ∂. °·Ï·Ó¿Î˘

¶ÂÚ›ÏË„Ë: ¶·Ú¿ Ù· ̤ÙÚ· ÁÈ· ÙÔÓ ÂÚÈÔÚÈÛÌfi Ù˘, Ë ‚ÚԢΤÏψÛË ÂÍ·ÎÔÏÔ˘ı› Ó· ÂÓ‰ËÌ› Û ÔÏ-Ϥ˜ ÂÚÈÔ¯¤˜ ÙÔ˘ ÎfiÛÌÔ˘. ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ·Ó·ÛÎÔ‹ıËÎ·Ó ÔÈ Ì·ÎÚÔ¯ÚfiÓȘ Ù¿ÛÂȘ Ù˘ ÓÔÛË-ÚfiÙËÙ·˜ ÛÙËÓ ∂ÏÏ¿‰· ηٿ ÙËÓ 25ÂÙ›· 1979-2003, Ì ¤ÌÊ·ÛË ÛÙÔÓ ·È‰ÈÎfi ÏËı˘ÛÌfi, Î·È Ì ‚¿ÛË Ù·‰Â‰Ô̤ӷ Ù˘ ∂ıÓÈ΋˜ ™Ù·ÙÈÛÙÈ΋˜ ÀËÚÂÛ›·˜ Î·È ÙȘ ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ÌÂϤÙ˜. ∫·Ù¿ ÙË ‰ÂηÂÙ›· ÙÔ˘1980, Ë Â›ÙˆÛË ÂÌÊ¿ÓÈÛ ÛÙ·‰È·Î‹ Ì›ˆÛË, fï˜ ÛÙ· ̤۷ Ù˘ ‰ÂηÂÙ›·˜ ÙÔ˘ 1990, ·Ú·ÙËÚ‹ıË-ÎÂ Ó¤Ô ·˘ÍËÙÈÎfi ·̷. ∏ ̤ÛË Â›ÙˆÛË Ù˘ ÓfiÛÔ˘ ‹Ù·Ó 4,38 ‰Ëψı¤ÓÙ· ÎÚÔ‡ÛÌ·Ù· Î·È 7,76 ÓÔÛË-Ï›˜ / 100.000 ÁÂÓÈÎÔ‡ ÏËı˘ÛÌÔ‡ / ¤ÙÔ˜. ∆Ô 11,2% ÙˆÓ ÓÔÛËÏÂÈÒÓ ·ÊÔÚÔ‡Û ·È‰È¿ ËÏÈΛ·˜ Î¿ÙˆÙˆÓ 14 ÂÙÒÓ, Ì ̤ÛË ÙÈÌ‹ 5,08 ÓÔÛËÏ›˜ / 100.000 ·È‰ÈÎÔ‡ ÏËı˘ÛÌÔ‡ / ¤ÙÔ˜. ™Ù· ·È‰È¿ ·Ú·ÙË-Ú‹ıËΠ·‡ÍËÛË Ù˘ ÓÔÛËÚfiÙËÙ·˜ ·Ó¿ÏÔÁ· Ì ÙËÓ ËÏÈΛ·. ¢ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ‰È·ÊÔÚ¤˜ ·Ó¿ÌÂÛ· ÛÙ·‰‡Ô ʇϷ ηٿ ÙË ‚ÚÂÊÈ΋ Î·È ÙË ÓËȷ΋ ËÏÈΛ·, fï˜ ÛÙ· ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿ Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜, ËÓfiÛÔ˜ ÚÔÛ¤‚·ÏÂ Û˘¯ÓfiÙÂÚ· Ù· ·ÁfiÚÈ·. ∏ ÓfiÛÔ˜ ‹Ù·Ó Ôχ ÈÔ Û˘¯Ó‹ ÛÙËÓ ◊ÂÈÚÔ Î·È ÙË £Ú¿ÎË Î·ÈÏÈÁfiÙÂÚÔ Û˘¯Ó‹ Û ÓËÛȈÙÈΤ˜ Î·È ·ÛÙÈΤ˜ ÂÚÈÔ¯¤˜. √È ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ÂÏÏËÓÈΤ˜ ÌÂϤÙ˜ ÂȂ‚·È-ÒÓÔ˘Ó ÙËÓ ·Ù˘›· Î·È ÙËÓ ÔÈÎÈÏÔÌÔÚÊ›· ÙˆÓ ÎÏÈÓÈÎÒÓ ÂΉËÏÒÛˆÓ. ™˘ÌÂÚ·ÛÌ·ÙÈο, Ë ÂÈÌÔÓ‹ ηÈË ÚfiÛÊ·ÙË ·Ó·˙ˆ‡ÚˆÛË Ù˘ ‚ÚԢΤÏψÛ˘ ÂÈ‚¿ÏÏÔ˘Ó ¤ÏÂÁ¯Ô ÙˆÓ ˙ÒˆÓ ÂÎÙÚÔÊ‹˜ Î·È Ù˘ ·-Ú·Û΢‹˜ Î·È ‰È¿ıÂÛ˘ ÙˆÓ Á·Ï·ÎÙÔÎÔÌÈÎÒÓ ÚÔ˚fiÓÙˆÓ, ηıÒ˜ Î·È ÙÔÓ ¤ÏÂÁ¯Ô ÙˆÓ ÔÈÎÔÁÂÓÂÈÒÓ Ì¿ۯÔÓ Ì¤ÏÔ˜. √È ÁÈ·ÙÚÔ› ÛÙËÓ ∂ÏÏ¿‰· ÔÊ›ÏÔ˘Ó Ó· ÛΤÊÙÔÓÙ·È ÙË ‚ÚԢΤÏψÛË Û ·ÛıÂÓ›˜ Ì ¿Ù˘-˜ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ Î·È È‰È·›ÙÂÚ· Û ÂÓ‰ËÌÈΤ˜ ÂÚÈÔ¯¤˜ Î·È Û ÏËı˘ÛÌÔ‡˜ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘.

§¤ÍÂȘ ÎÏÂȉȿ: µÚԢΤÏψÛË, ·ÁÁÂÏÌ·ÙÈΤ˜ ÓfiÛÔÈ, ÙÚÔÊÈÌÔÁÂÓ›˜ ÓfiÛÔÈ, ˙ˆÔ·ÓıÚˆÔÓfiÛÔÈ.

Morbidity and clinical manifestations of brucellosis in Greece

M. Mavrokosta, E. Galanakis

Abstract: Despite the preventive efforts, brucellosis remains endemic in many areas worldwide. ∆helong-term morbidity of the disease in Greece was investigated in the present study, with an emphasison childhood morbidity. The study was based on the data reported from 1979 through 2003 by theGreek National Statistical Service and in the relevant published studies. During the 1980s, brucellosispresented with a decrease in morbidity, but a reemergence was observed in the mid 1990s. Theaverage annual incidence was 4.38 reported cases and 7.76 admissions / 100,000 population. Amongthe hospitalized patients, 11,2% were children aged less than 14 years, and average annual incidencewas calculated at 5.08 admissions / 100,000 child population. The morbidity in childhood andadolescence increased with age. Male and female infants and toddlers were equally affected, but malespresented with a considerably higher morbidity during late childhood and adolescence. Endemicareas were identified, mainly in Northern Greece. The lowest incidence rates were observed in theislands and in urban areas. The protean clinical manifestations of brucellosis were confirmed in theGreek published studies. The persistence and the recent reemergence of brucellosis in Greece stressthe need of animal control and pasteurization of milk and dairy products, and of screening thefamilies of index cases. Physicians should think of brucellosis when caring for patients who reside inor have traveled to endemic areas and who present with atypical manifestations.

Key words: Brucellosis, endemic areas, Greece, occupational diseases, food-borne diseases, zoonoticdiseases.

Pediatr Jan-Feb 06 final allges 27-01-06 15:35 ™ÂÏ›‰·37

Page 38: Παιδιατρική | Τόμος 69 • Τεύχος 1 • Ιανουάριος - Φεβρουάριος 2006

38 ª. ª·˘ÚfiΈÛÙ·, ∂. °·Ï·Ó¿Î˘

∂ÈÛ·ÁˆÁ‹

∏ ‚ÚԢΤÏψÛË, ·ÏÈfiÙÂÚ· ÁÓˆÛÙ‹ Î·È ˆ˜

ÌÂÏÈÙ·›Ô˜ ˘ÚÂÙfi˜ (1), Â›Ó·È ˙ˆÔ·ÓıÚˆÔÓfi-

ÛÔ˜ ÂÓ‰ËÌÈ΋ Û ÔÏÏ¿ ÛËÌ›· ÙÔ˘ ÎfiÛÌÔ˘,

fiˆ˜ Û ¯ÒÚ˜ Ù˘ §·ÙÈÓÈ΋˜ ∞ÌÂÚÈ΋˜, Ù˘

∞ÊÚÈ΋˜, Ù˘ ª¤Û˘ ∞Ó·ÙÔÏ‹˜ Î·È Û ¯ÒÚ˜

Ù˘ ªÂÛÔÁ›Ԣ, fiˆ˜ Ë °·ÏÏ›·, Ë πÙ·Ï›·, Î·È Ë

∂ÏÏ¿‰· (1-9). ∞fi ÙË ‰ÂηÂÙ›· ÙÔ˘ 1960, Ë Û˘-

ÛÙËÌ·ÙÈ΋ ÚfiÏË„Ë Â›¯Â ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙËÓ

‡ÊÂÛË Ù˘ ÓÔÛËÚfiÙËÙ·˜ Û ˙Ò· Î·È ·ÓıÚÒ-

Ô˘˜, ·ÎfiÌË Î·È ÙËÓ ÂÍ¿ÏÂÈ„Ë Ù˘ ÓfiÛÔ˘ ÛÂ

·ÚÎÂÙ¤˜ ¯ÒÚ˜, fiˆ˜ ÔÈ ÛηӉÈÓ·‚ÈΤ˜, Ë ªÂ-

Á¿ÏË µÚÂÙ·Ó›·, Ë ∂Ï‚ÂÙ›·, Î·È Ë ∫‡ÚÔ˜, Ô˘

ıˆÚÔ‡ÓÙ·È ÂχıÂÚ˜ ‚ÚԢΤÏψÛ˘ (3).

∏ ‚ÚԢΤÏψÛË ·ÔÙÂÏÔ‡Û ·fi ·ÏÈ¿ ÛË-

Ì·ÓÙÈÎfi Úfi‚ÏËÌ· ‰ËÌfiÛÈ·˜ ˘Á›·˜ ÛÙËÓ ∂ÏÏ¿-

‰· (8-21). ¶·Ú¿ ÙËÓ ·Ó·ÌÊ›‚ÔÏË ¿ÓÔ‰Ô ÙÔ˘

˘ÁÂÈÔÓÔÌÈÎÔ‡ ÂȤ‰Ô˘ Î·È ·Ú¿ Ù· ̤ÙÚ· Ô˘

¤¯Ô˘Ó ÏËÊı›, Ë ÓfiÛÔ˜ ‰ÂÓ ¤¯ÂÈ ÂÍ·Ê·ÓÈÛı›

fiˆ˜ ·ÏÏÔ‡. ™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘

‹Ù·Ó Ë ·Ó·ÛÎfiËÛË Ù˘ ÓÔÛËÚfiÙËÙ·˜ Ù˘ ‚ÚÔ˘-

ΤÏψÛ˘ ÛÙËÓ ∂ÏÏ¿‰· ηٿ ÙȘ ÙÂÏÂ˘Ù·›Â˜ ‰Â-

ηÂٛ˜, Ì ¤ÌÊ·ÛË ÛÙÔÓ ·È‰ÈÎfi ÏËı˘ÛÌfi.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ

¶ÚfiÎÂÈÙ·È ÁÈ· ·Ó·‰ÚÔÌÈ΋ ÌÂϤÙË, Ù· ‰Â‰Ô̤ӷ

Ù˘ ÔÔ›·˜ ÛÙËÚ›¯ıËÎ·Ó ·ÊÂÓfi˜ ÛÙ· ÂÙ‹ÛÈ· ‰ÂÏÙ›· Ù˘

∂ıÓÈ΋˜ ™Ù·ÙÈÛÙÈ΋˜ ÀËÚÂÛ›·˜ Ù˘ ∂ÏÏ¿‰·˜ (∂™À∂)

Î·È ÛÙ· ‰È·ı¤ÛÈÌ· ÛÙÔȯ›· ÙÔ˘ ∫¤ÓÙÚÔ˘ ∂ϤÁ¯Ô˘ ∂ȉÈ-

ÎÒÓ §ÔÈÌÒÍÂˆÓ (∫∂∂§) ÁÈ· ÙÔ 25ÂÙ¤˜ ‰È¿ÛÙËÌ· 1979-

2003, Î·È ·ÊÂÙ¤ÚÔ˘ ÛÙËÓ ·Ó·ÛÎfiËÛË Ù˘ Û¯ÂÙÈ΋˜ ‚È-

‚ÏÈÔÁÚ·Ê›·˜.

∞fi ÙÔÓ Û˘Ó‰˘·ÛÌfi ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ Ù˘ ∂™À∂ (22)

Î·È ÙÔ˘ ∫∂∂§ (23) ηٷÁÚ¿ÊËÎ·Ó Ù· ‰Ëψı¤ÓÙ· ÎÚÔ‡-

ÛÌ·Ù· ‚ÚԢΤÏψÛ˘ ÛÙȘ ¢È¢ı‡ÓÛÂȘ Î·È Ù· ∆Ì‹Ì·Ù·

ÀÁÈÂÈÓ‹˜ ÙˆÓ ¡ÔÌ·Ú¯ÈÒÓ ÁÈ· fiÏË ÙË ¯ÒÚ·, ·ÓÂÍ·Úًو˜

ÂÈÛ·ÁˆÁ‹˜ Û ÓÔÛÔÎÔÌ›Ô. ™ÙËÓ ∂ÏÏ¿‰· οı ÎÚÔ‡ÛÌ·

‚ÚԢΤÏψÛ˘ ÔÊ›ÏÂÈ Ó· ‰ËÏÒÓÂÙ·È ·fi ÙÔÓ ÁÈ·ÙÚfi,

ÂÚÁ·ÛÙËÚÈ·Îfi ‹ ÎÏÈÓÈÎfi, Ô˘ ‰È·ÁÈÁÓÒÛÎÂÈ ÙË ÓfiÛÔ,

ˆÛÙfiÛÔ Ë ‰‹ÏˆÛË ·˘Ù‹ Û˘¯Ó¿ ·Ú·Ï›ÂÙ·È Î·È Ô Ú·Á-

Ì·ÙÈÎfi˜ ·ÚÈıÌfi˜ ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ Â›Ó·È ·ÚÎÂÙ¿ ÌÂÁ·Ï‡-

ÙÂÚÔ˜, ÁÂÁÔÓfi˜ Ô˘ ¤¯ÂÈ ÂÈÛËÌ·Óı› Î·È Û ¿ÏϘ ̄ ÒÚ˜

(2,4-5). ø˜ ÂÎ ÙÔ‡ÙÔ˘, ·˘Ù‹ Ë Î·Ù·ÁÚ·Ê‹ Â͢ËÚÂÙ›

ÙËÓ ÂÈÛÎfiËÛË ÙˆÓ Ì·ÎÚÔ¯ÚfiÓÈˆÓ Ù¿ÛÂˆÓ Ì¿ÏÏÔÓ, ·-

Ú¿ ÙÔÓ ·ÎÚÈ‚‹ ˘ÔÏÔÁÈÛÌfi Ù˘ ›وÛ˘ Ù˘ ÓfiÛÔ˘.

∞fi Ù· ‰ÂÏÙ›· Ù˘ ∂™À∂ ηٷÁÚ¿ÊËÎ·Ó ÔÌÔ›ˆ˜, ÔÈ ÓÔ-

ÛËÏ›˜ ÁÈ· ‚ÚԢΤÏψÛË Ô˘ ¤ÁÈÓ·Ó Û fiÏ· Ù· ÓÔÛË-

Ï¢ÙÈο ȉڇ̷ٷ Ù˘ ¯ÒÚ·˜ ηٿ ÙËÓ ÂÚ›Ô‰Ô 1980-

1997, ηıÒ˜ ‰ÂÓ ¤¯Ô˘Ó ‰ËÌÔÛÈ¢ı› Ù· ·ÓÙ›ÛÙÔȯ· ‰Â‰Ô-

̤ӷ ÁÈ· Ù· ¤ÙË ÌÂÙ¿ ÙÔ 1997. ∆· ÌÂÈÔÓÂÎÙ‹Ì·Ù· ·˘Ù‹˜

Ù˘ ηٷÁÚ·Ê‹˜ Â›Ó·È fiÙÈ ‰ÂÓ ÂÚÈÏ¿Ì‚·Ó ٷ ÎÚÔ‡ÛÌ·-

Ù· Ô˘ ıÂڷ‡ıËÎ·Ó ÂÎÙfi˜ ÓÔÛËÏ¢ÙÈÎÒÓ È‰Ú˘Ì¿ÙˆÓ

Î·È fiÙÈ ÙÔ ›‰ÈÔ ÎÚÔ‡ÛÌ· ÌÔÚ› Ó· ηٷÌÂÙÚËı› ÂÚÈÛ-

ÛfiÙÂÚ˜ ·fi 1 ÊÔÚ¤˜, ÛÙËÓ ÂÚ›ÙˆÛË ÔÏÏ·ÏÒÓ

ÓÔÛËÏÂÈÒÓ ÙÔ˘ ›‰ÈÔ˘ ·ÛıÂÓÔ‡˜. ∆· ÏÂÔÓÂÎÙ‹Ì·Ù¿ Ù˘

Â›Ó·È fiÙÈ Â¤ÙÚ„ ÙËÓ ·Ó·Ï˘ÙÈ΋ ÌÂϤÙË ÙˆÓ ·ÛıÂÓÒÓ

ηٿ ʇÏÔ, ËÏÈΛ· Î·È ÁˆÁÚ·ÊÈÎfi ‰È·Ì¤ÚÈÛÌ·, ¿Ú· ηÈ

ÙÔÓ ·‰Úfi ¤ÛÙˆ ˘ÔÏÔÁÈÛÌfi ÙˆÓ ·ÓÙ›ÛÙÔȯˆÓ ÂÈÙÒÛÂ-

ˆÓ Ù˘ ÓfiÛÔ˘. ø˜ ÏËı˘ÛÌfi˜ Ù˘ ¯ÒÚ·˜ ıˆڋıËÎÂ

ÂΛÓÔ˜ Ù˘ ·ÔÁÚ·Ê‹˜ ÙÔ˘ 1991 (Û‡ÓÔÏÔ ÏËı˘ÛÌÔ‡:

10.259.000, ·È‰È¿ 0-14 ÂÙÒÓ: 1.974.867), Ô˘ ·ÔÙÂÏ›

Î·È ÙÔÓ ÂӉȿÌÂÛÔ ÏËı˘ÛÌfi ÁÈ· ÙË ¯ÚÔÓÈ΋ ÂÚ›Ô‰Ô

Ô˘ ηχÙÂÙ·È ·fi ÙË ÌÂϤÙË (24).

∏ ·Ó·ÛÎfiËÛË Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜ ¤ÁÈÓ Ì ÙȘ Ϥ-

ÍÂȘ-ÎÏÂȉȿ “‚ÚԢΤÏÏ·”, “‚ÚԢΤÏψÛË”, Î·È “ÌÂÏÈ-

Ù·›Ô˜ ˘ÚÂÙfi˜” ÛÙȘ ËÏÂÎÙÚÔÓÈΤ˜ ‚¿ÛÂȘ π∞∆ƒ√∆∂∫

ÁÈ· Ù· ÂÏÏËÓÈο ‰ËÌÔÛȇ̷ٷ Î·È PubMed ÁÈ· Ù· ‰ÈÂ-

ıÓ‹. ∂ÈϤÔÓ, ¤ÁÈÓ ·Ó·ÛÎfiËÛË ÙˆÓ ÂÚÈÔ‰ÈÎÒÓ π·-

ÙÚÈ΋, ∞گ›· ∂ÏÏËÓÈ΋˜ π·ÙÚÈ΋˜, ¢ÂÏÙ›ÔÓ ∂ÏÏËÓÈ΋˜

ªÈÎÚÔ‚ÈÔÏÔÁÈ΋˜ ∂Ù·ÈÚ›·˜, ¶·È‰È·ÙÚÈ΋, ¶·È‰È·ÙÚÈ΋

µÔÚ›Ԣ ∂ÏÏ¿‰Ô˜, ∞گ›· ∞ã ¶·È‰È·ÙÚÈ΋˜ ∫ÏÈÓÈ΋˜

¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ Î·È ¶·È‰È·ÙÚÈο ÃÚÔÓÈο. ∆¤-

ÏÔ˜, ·Ó·ÛÎÔ‹ıËÎ·Ó Ù· Ú·ÎÙÈο ÙˆÓ ¶·ÓÂÏÏ‹ÓȈÓ

¶·È‰È·ÙÚÈÎÒÓ ™˘Ó‰ڛˆÓ ÁÈ· ÙËÓ ÂÚ›Ô‰Ô 1988-2003.

∏ ·Ó·‰ÚÔÌÈ΋ ʇÛË Ù˘ ÌÂϤÙ˘ ‰ÂÓ Â¤ÙÚ„ ÙËÓ

ÂÍ·ÎÚ›‚ˆÛË Ù˘ ÔÚıfiÙËÙ·˜ Ù˘ ‰È¿ÁÓˆÛ˘. Ÿˆ˜ ›ӷÈ

ÁÓˆÛÙfi, Ë ÎÏÈÓÈ΋ ‰È¿ÁÓˆÛË ·ÚÔ˘ÛÈ¿˙ÂÈ ‰˘ÛÎÔϛ˜,

ÏfiÁˆ ÙˆÓ Û˘¯Ó¿ ¿Ù˘ˆÓ ÂΉËÏÒÛÂˆÓ Ù˘ ÓfiÛÔ˘ ηÈ

ÂÈϤÔÓ Â›Ó·È Â˘ÓfiËÙÔ fiÙÈ Î·Ù¿ ÙË ÌÂÁ¿ÏË ¯ÚÔÓÈ΋

ÂÚ›Ô‰Ô Ô˘ ηχÙÂÙ·È ·fi ÙË ÌÂϤÙË, Ë ÂÚÁ·ÛÙË-

Úȷ΋ ÂȂ‚·›ˆÛË ¤ÁÈÓ Û ‰È·ÊÔÚÂÙÈο ÂÚÁ·ÛÙ‹ÚÈ·

Î·È Ì ÌÂıfi‰Ô˘˜ ÔÈΛÏ˘ ·ÍÈÔÈÛÙ›·˜ (2-8,25-26).

∞ÔÙÂϤÛÌ·Ù·

™ÙËÓ ∂ÈÎfiÓ· 1 ·ÚÔ˘ÛÈ¿˙ÂÙ·È Ë ÂÙ‹ÛÈ· η-

Ù·ÓÔÌ‹ ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ 11.240 ‰Ëψı¤ÓÙˆÓ

ÎÚÔ˘ÛÌ¿ÙˆÓ ‚ÚԢΤÏψÛ˘ ηٿ Ù· ¤ÙË 1979-

2003. ∞fi ÙËÓ ∂ÈÎfiÓ· ηٷ‰ÂÈÎÓ‡ÂÙ·È ÛÙ·‰È·-

΋ Ì›ˆÛË ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ Î·Ù¿ ÙË ‰ÂηÂÙ›·

ÙÔ˘ 1980 Î·È Ó¤· ·‡ÍËÛË ·fi Ù· ̤۷ Ù˘ ‰Â-

ηÂÙ›·˜ ÙÔ˘ 1990 Ô˘ ‰È‹ÚÎÂÛ › ·ÚÎÂÙ¿ ¤ÙË.

ŒÙÛÈ, Ù· ‰Ëψı¤ÓÙ· ÎÚÔ‡ÛÌ·Ù· ηٿ ÙË ‰ÈÂÙ›·

1999-2000 ¤ÊÙ·Ó·Ó ÛÙ· ›‰· Ù˘ ‰ÈÂÙ›·˜

1983-1984. ∏ ̤ÛË Â›ÙˆÛË ‹Ù·Ó 4,38 ‰Ëψ-

ı¤ÓÙ· ÎÚÔ‡ÛÌ·Ù· / 100.000 ÏËı˘ÛÌÔ‡ / ¤ÙÔ˜.

™ÙÔ ‰È¿ÛÙËÌ· 1980-1997 ηٷÁÚ¿ÊËÎ·Ó Û˘-

ÓÔÏÈο 14.811 ÓÔÛËÏ›˜ ÁÈ· ‚ÚԢΤÏψÛË

ÛÙËÓ ∂ÏÏ¿‰·. √È 9.545 ·ÊÔÚÔ‡Û·Ó ¿Ó‰Ú˜ ηÈ

ÔÈ 5.266 Á˘Ó·›Î˜ (·Ó·ÏÔÁ›· ·Ó‰ÚÒÓ-Á˘Ó·ÈÎÒÓ

1,81:1). √ ·ÚÈıÌfi˜ ÙˆÓ ÓÔÛËÏÂÈÒÓ ÙˆÓ ·È‰ÈÒÓ

‹Ù·Ó 1.660, ‰ËÏ·‰‹ 11,2% ÙÔ˘ Û˘ÓfiÏÔ˘ ηٿ

ÙË ¯ÚÔÓÈ΋ ·˘Ù‹ ÂÚ›Ô‰Ô. ∏ ̤ÛË Û˘¯ÓfiÙËÙ·

ÓÔÛËÏÂÈÒÓ ‹Ù·Ó 7,76 ÁÈ· ÙÔ Û‡ÓÔÏÔ ÙÔ˘ ÏËı˘-

ÛÌÔ‡ Î·È 5,08 ÁÈ· Ù· ·È‰È¿ 0-14 ÂÙÒÓ.

∏ ÓÔÛËÚfiÙËÙ· ·fi ‚ÚԢΤÏψÛË ÛÙ· ·È-

‰È¿ Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜, ·Ó¿ÏÔÁ· Ì ÙËÓ ËÏÈÎÈ·-

΋ ÔÌ¿‰·, ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1. ∫·-

Ù¿ ÙËÓ ÂÚ›Ô‰Ô 1980-1997 ηٷÁÚ¿ÊËÎ·Ó 4 ÓÔ-

ÛËÏ›˜ ÓÂÔÁÓÒÓ Î·È 46 ‚ÚÂÊÒÓ ËÏÈΛ·˜ 1-11

¶·È‰È·ÙÚÈ΋ 2006;69:37-44

Pediatr Jan-Feb 06 final allges 27-01-06 15:35 ™ÂÏ›‰·38

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39∏ ‚ÚԢΤÏψÛË ÛÙËÓ ∂ÏÏ¿‰·

ÌËÓÒÓ. ™ÙȘ ÌÈÎÚ¤˜ ËÏÈ˘, Ë ÓÔÛËÚfiÙËÙ· ÙˆÓ

‰˘Ô Ê‡ÏˆÓ ‰ÂÓ ·ÚÔ˘Û›·˙ ·ÍÈÔÛËÌ›ˆÙ˜ ‰È·-

ÊÔÚ¤˜. ŸÌˆ˜, ·fi ÙËÓ ËÏÈΛ· ÙˆÓ 5 ÂÙÒÓ Î·È

ÌÂÙ¿, Ô ·ÚÈıÌfi˜ ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ ·˘Í¿ÓÂÙ·È Î˘-

Ú›ˆ˜ ÛÙ· ·ÁfiÚÈ·, Ô˘ ÛÙËÓ ÂÊ˂›· ÓÔÛÔ‡Ó Û¯Â-

‰fiÓ 3 ÊÔÚ¤˜ ÂÚÈÛÛfiÙÂÚÔ ·’ fi,ÙÈ Ù· ÎÔÚ›ÙÛÈ·.

™ÙÔÓ ¶›Ó·Î· 2 Î·È ÛÙËÓ ∂ÈÎfiÓ· 2, ·ÚÔ˘-

ÛÈ¿˙ÔÓÙ·È ÔÈ ÓÔÛËÏ›˜ ·ÛıÂÓÒÓ / 100.000 ÏË-

ı˘ÛÌÔ‡ / ¤ÙÔ˜ ÛÙ· ÁˆÁÚ·ÊÈο ‰È·ÌÂÚ›ÛÌ·Ù·

Ù˘ ∂ÏÏ¿‰Ô˜ ηٿ ÙÔ ‰È¿ÛÙËÌ· 1980-1997. ∏

ÁˆÁÚ·ÊÈ΋ ηٷÓÔÌ‹ ÙˆÓ ÓÔÛËÏ¢fiÌÂÓˆÓ

·ÛıÂÓÒÓ ÛÙËÚ›˙ÂÙ·È ÛÙÔÓ ÙfiÔ ÓÔÛËÏ›·˜ ηÈ

fi¯È ÛÙÔÓ ÙfiÔ ‰È·ÌÔÓ‹˜. ™ÙÔÓ ¶›Ó·Î· 3 ·ÚÔ˘-

ÛÈ¿˙ÔÓÙ·È ÔÈ ·Û˘Ó‹ıÈÛÙ˜ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ

Ù˘ ‚ÚԢΤÏψÛ˘ Ô˘ ·Ó·Ê¤ÚıËÎ·Ó ÛÙË ¯Ò-

Ú· Ì·˜ ·fi ÙȘ ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ÂÚÁ·Û›Â˜ Î·È ÙȘ

·Ó·ÎÔÈÓÒÛÂȘ. ™‡Ìʈӷ Ì ٷ ‰ÂÏÙ›· Ù˘

∂™À∂, 22 ı¿Ó·ÙÔÈ ·Ô‰fiıËÎ·Ó ÛÙË ÓfiÛÔ Î·Ù¿

ÙËÓ ÂÚ›Ô‰Ô 1980-1997.

™˘˙‹ÙËÛË

∏ Ú·ÁÌ·ÙÈ΋ ÓÔÛËÚfiÙËÙ· Ù˘ ‚ÚԢΤÏψ-

Û˘ Û ˙Ò· Î·È ·ÓıÚÒÔ˘˜ ·Ú·Ì¤ÓÂÈ ¿ÁÓˆ-

ÛÙË, ηıÒ˜ Û˘¯Ó¿ Ë ‰‹ÏˆÛË ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ

Â›Ó·È ÂÏÏÈ‹˜ (2,4). ∆· ÚÔÁÚ¿ÌÌ·Ù· ÚfiÏË-

„˘ ÛÙËÚ›˙ÔÓÙ·È ÛÙÔÓ ¤ÏÂÁ¯Ô ÙˆÓ ˙ÒˆÓ, ÛÙȘ

ÚÔÊ˘Ï¿ÍÂȘ ηٿ ÙËÓ Â·ÁÁÂÏÌ·ÙÈ΋ ¤ÎıÂÛË,

Î·È ÛÙËÓ Î·Ù¿ÏÏËÏË ·Ú·Û΢‹ ÙÔ˘ Á¿Ï·ÎÙÔ˜,

ÙˆÓ Á·Ï·ÎÙÔÎÔÌÈÎÒÓ Î·È ¿ÏÏˆÓ ‰˘ÓËÙÈο ÌÔ-

Ï˘ÛÌ·ÙÈÎÒÓ ÙÚÔÊ›ÌˆÓ (3,9). ™Â ·ÚÎÂÙ¤˜ ¯ÒÚ˜,

Ì ٷ ̤ÙÚ· ·˘Ù¿ Ë ÂȉËÌÈÔÏÔÁ›· Ù˘ ÓfiÛÔ˘

¤¯ÂÈ ·ÏÏ¿ÍÂÈ ·fi ÂÓ‰ËÌÈ΋ ‹ ·ÁÁÂÏÌ·ÙÈ΋ ÛÂ

ÓfiÛÔ ÙˆÓ Ù·ÍȉȈÙÒÓ.

∞fi Ù· 6 ÁÓˆÛÙ¿ ̤ÏË ÙÔ˘ Á¤ÓÔ˘˜ Brucella,

(B. melitensis, B. abortus, B. suis, B. canis, B.

neotomae Î·È B. ovis), ÌfiÓÔ Ù· 4 ÚÒÙ· ¤¯Ô˘Ó

ÎÏÈÓÈ΋ ÛËÌ·Û›· ÁÈ· ÙÔÓ ¿ÓıÚˆÔ (2). ™ÙËÓ

∂ÏÏ¿‰·, ÙÔ Û¯Â‰fiÓ ·ÔÎÏÂÈÛÙÈο ·ıÔÁfiÓÔ Â›-

‰Ô˜ ÁÈ· ÙÔÓ ¿ÓıÚˆÔ Â›Ó·È Ë B. melitensis. §ÔÈ-

ÌÒÍÂȘ ·fi B. abortus ·Ó·Ê¤ÚÔÓÙ·È Û·ÓÈfiÙ·-

Ù·, Î·È ·ÎfiÌË Î·È Ë ‡·ÚÍ‹ ÙÔ˘˜ ÛÙË ¯ÒÚ· Ì·˜,

·ÔÙÂÏ› ·ÓÙÈΛÌÂÓÔ Û˘˙‹ÙËÛ˘ (5,27-32). ∏

¶·È‰È·ÙÚÈ΋ 2006;69:37-44

¶›Ó·Î·˜ 1. ¡ÔÛËÏ›˜ ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ ÁÈ· ‚ÚԢΤÏ-ψÛË Î·Ù¿ ÙÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· 1980-1997 ·Ó¿ÏÔÁ· Ì ÙËÓËÏÈÎȷ΋ ÔÌ¿‰· Î·È ÙÔ Ê‡ÏÔ

∏ÏÈÎȷ΋ ™‡ÓÔÏÔ ÕÚÚÂÓ˜ £‹ÏÂȘ ∞Ó·ÏÔÁ›· ÔÌ¿‰· ∞/£

0-4 ÂÙÒÓ 317 182 135 1,35/15-9 ÂÙÒÓ 470 294 176 1,67/110-14 ÂÙÒÓ 873 571 302 1,89/115-19 ÂÙÒÓ 1026 760 266 2,86/1™‡ÓÔÏÔ 2686 1.807 879 2,06/10-19 ÂÙÒÓ

1600

1400

1200

1000

800

600

400

200

0

ŒÙÔ˜

¢Ë

ψ

ı¤Ó

Ù· Î

ÚÔ

‡Û

Ì·

Ù· ‚

ÚÔ

˘Î

¤ÏÏ

ˆÛ

˘

1979

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

∂ÈÎfiÓ· 1. ¢Ëψı¤ÓÙ· ÎÚÔ‡ÛÌ·Ù· ‚ÚԢΤÏψÛ˘ ηٿ ÙËÓ ÂÚ›Ô‰Ô 1979-2003 ÁÈ· fiϘ ÙȘ ËÏÈ˘ Î·È ÁÈ· ÙÔ Û‡ÓÔ-ÏÔ Ù˘ ∂ÏÏ¿‰·˜.

Pediatr Jan-Feb 06 final allges 27-01-06 15:35 ™ÂÏ›‰·39

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40 ª. ª·˘ÚfiΈÛÙ·, ∂. °·Ï·Ó¿Î˘

‚ÚԢΤÏψÛË ÚÔÛ‚¿ÏÏÂÈ Û˘¯ÓfiÙÂÚ· ÙȘ ÔÌ¿-

‰Â˜ Ô˘ ·Û¯ÔÏÔ‡ÓÙ·È Ì ÙË ÊÚÔÓÙ›‰· ÙˆÓ ˙ÒˆÓ

(12, 33-36), Î·È ¤ÙÛÈ Ú¤ÂÈ Ó· ÂÚÌËÓ¢ı› ηÈ

Ë ·˘ÍË̤ÓË ÚÔÛ‚ÔÏ‹ ÙˆÓ ÌÂÁ·Ï‡ÙÂÚˆÓ ·ÁÔ-

ÚÈÒÓ Ô˘ ·Ú·ÙËÚ‹ıËΠÛÙËÓ ·ÚÔ‡Û· ÌÂϤ-

ÙË. ∏ ›‰È· ÓÔÛËÚfiÙËÙ· ÙˆÓ ‰‡Ô Ê‡ÏˆÓ ÛÙ· ‚Ú¤-

ÊË Î·È Ù· Ó‹È·, ÚÔÊ·ÓÒ˜ ÔÊ›ÏÂÙ·È ÛÙË ÌÂ-

Ù¿‰ÔÛË Ù˘ ÓfiÛÔ˘ Û ·˘Ù¤˜ ÙȘ ËÏÈ˘ Ì ÌÔ-

Ï˘Ṳ̂ÓÔ Á¿Ï· Ì¿ÏÏÔÓ, ·Ú¿ Ì ¿ÌÂÛË Â·Ê‹

Ì ˙Ò· (37-38). ™ÙË ¯ÒÚ· Ì·˜ ¤¯Ô˘Ó ·Ó·ÊÂÚı›

ÂÓ‰ÔÔÈÎÔÁÂÓÂȷΤ˜ ÂȉË̛˜ Û ÎÔÈÓfiÙËÙ˜

ÎÙËÓÔÙÚfiÊˆÓ (34,39) ηıÒ˜ Î·È ÌÂÙ¿‰ÔÛË Ù˘

ÓfiÛÔ˘ ‰È·Ï·ÎÔ˘ÓÙȷο Î·È Ì ÌËÙÚÈÎfi ıËÏ·-

ÛÌfi (31,37,40).

√È Û˘Ó‹ıÂȘ ÂΉËÏÒÛÂȘ Ù˘ ‚ÚԢΤÏψÛ˘

ÛÙÔÓ ¿ÓıÚˆÔ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ˘ÚÂÙfi, ·ÓÔÚÂ-

Í›·, ·ÒÏÂÈ· ‚¿ÚÔ˘˜, ‡ÎÔÏË ÎfiˆÛË, ÂÊ›‰Úˆ-

ÛË, ·ÚıÚ·ÏÁ›Â˜ ‹ Î·È ·ÚıÚ›Ùȉ·, ÎÂÊ·Ï·ÏÁ›·,

Ì˘·ÏÁ›Â˜, Ë·ÙÔ-ÛÏËÓÔÌÂÁ·Ï›·, Î·È ÏÂÌÊ·-

‰ÂÓÔ¿ıÂÈ· (2-4). øÛÙfiÛÔ, Ë ÓfiÛÔ˜ Â›Ó·È ÁÓˆ-

ÛÙ‹ ÁÈ· ÙËÓ ÈηÓfiÙËÙ· ÚÔÛ‚ÔÏ‹˜ ÔÔÈÔ˘‰‹-

ÔÙ ۯ‰fiÓ ÔÚÁ¿ÓÔ˘ Î·È Û˘ÛÙ‹Ì·ÙÔ˜ Î·È Ë

ÂÓÙ˘ˆÛȷ΋ ÔÏ˘ÌÔÚÊ›· ÙˆÓ ÎÏÈÓÈÎÒÓ ÂΉË-

ÏÒÛÂˆÓ ‰ÈηÈÔÏÔÁ› ÙÔÓ ¯·Ú·ÎÙËÚÈÛÌfi Ù˘ ˆ˜

“ÚˆÙÂ˚΋˜” ÓfiÛÔ˘. Ÿˆ˜ ÚÔ·ÙÂÈ ·fi ÙÔÓ

¶›Ó·Î· 3, ÔÈ ÂÏÏËÓÈΤ˜ ÌÂϤÙ˜ ÂȂ‚·ÈÒÓÔ˘Ó

ÙËÓ ÔÏ˘ÌÔÚÊ›· ·˘Ù‹ ÙˆÓ ÎÏÈÓÈÎÒÓ ÂΉËÏÒÛÂ-

ˆÓ Û ·È‰È¿ Î·È Û ÂÓ‹ÏÈΘ. ∏ ıÓËÙfiÙËÙ·

˘‹ÚÍ ¯·ÌËÏ‹ ÁÈ· ÙË ¯ÒÚ· Ì·˜ ηٿ ÙËÓ Â-

Ú›Ô‰Ô Ù˘ ÌÂϤÙ˘. ø˜ ΢ÚÈfiÙÂÚË ·ÈÙ›· ı·Ó¿-

ÙÔ˘ ıˆÚÂ›Ù·È Ë ÂÓ‰Ôηډ›Ùȉ· (41-42).

™Ù· ˙Ò· Ë ‚ÚԢΤÏψÛË ÚÔηÏ› ¯ÚfiÓÈ·

Ïԛ̈ÍË, ·˘ÙfiÌ·Ù˜ ·Ô‚ÔϤ˜ Î·È ÛÙÂÈÚfiÙËÙ·.

∆Ô ÂÌ‚fiÏÈÔ µ19 Ô˘ Á›ÓÂÙ·È ÛÙ· ‚ÔÔÂȉ‹ ·Ú¤-

¯ÂÈ ÚÔÛÙ·Û›· ÌfiÓÔ ·fi ÙË B. abortus Î·È ÙÔ ÂÌ-

‚fiÏÈÔ Rev-1 ÁÈ· ÙË B. melitensis Ô˘ Á›ÓÂÙ·È ÛÙ·

·ÈÁÔÚfi‚·Ù· ‰ÂÓ ¤¯ÂÈ ÌÂÏÂÙËı› ÛÙ· ‚ÔÔÂȉ‹

(2,9,33). ∏ ÂÎÚ›˙ˆÛË Ù˘ ÓfiÛÔ˘ ÛÙ· ‚ÔÔÂȉ‹

¤¯ÂÈ ÂÈÙ¢¯ı› Û ·ÚÎÂÙ¤˜ ¯ÒÚ˜, ÂÓÒ, ·ÓÙ›ıÂ-

Ù·, Ù· ÚÔÁÚ¿ÌÌ·Ù· ÂϤÁ¯Ô˘ ÛÙ· ·ÈÁÔÚfi‚·Ù·

¶·È‰È·ÙÚÈ΋ 2006;69:37-44

¶›Ó·Î·˜ 2. ¡ÔÛËÏ›˜ ÁÈ· ‚ÚԢΤÏψÛË Î·Ù¿ ÁˆÁÚ·ÊÈÎfi ‰È·Ì¤ÚÈÛÌ· ηٿ ÙÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· 1980-1997

¢È·Ì¤ÚÈÛÌ· ¡ÔÛËÏ¢ı¤ÓÙ˜ ¶ÏËı˘ÛÌfi˜ ¡ÔÛËÏ›˜ ·Ó¿ ·ÛıÂÓ›˜ (·ÔÁÚ·Ê‹ 1991) 100.000 ÏËı˘ÛÌÔ‡/¤ÙÔ˜

◊ÂÈÚÔ˜ 1.166 339.728 19,1£Ú¿ÎË 968 338.005 15,9¶ÂÏÔfiÓÓËÛÔ˜ 2.269 1.086.935 11,6ª·Î‰ÔÓ›· 4.472 2.236.019 11,1£ÂÛÛ·Ï›· 1.338 734.846 10,1§ÔÈ‹ ™ÙÂÚ¿ Î·È ∂‡‚ÔÈ· 2.123 1.260.945 9,35∫Ú‹ÙË 403 540.054 4,14¶ÂÚÈʤÚÂÈ· ¶ÚˆÙ¢ԇÛ˘ 1.366 3.072.922 2,47πfiÓÈÔÈ ¡‹ÛÔÈ 86 193.734 2,46¡‹ÛÔÈ ∞ÈÁ·›Ô˘ 132 456.712 1,61°ÂÓÈÎfi Û‡ÓÔÏÔ 14.323 10.259.900 7,76

¶›Ó·Î·˜ 3. ∞Û˘Ó‹ıÈÛÙ˜ ÂΉËÏÒÛÂȘ ‚ÚԢΤÏψÛ˘ Ô˘ ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ÛÙËÓ ∂ÏÏ¿‰·

∂ÓÙfiÈÛË ∂ΉËÏÒÛÂȘ Ô˘ ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ÛÙËÓ ∂ÏÏ¿‰·

¡Â˘ÚÈÎfi Û‡ÛÙËÌ· ∫ÂÊ·Ï·ÏÁ›· (34,47), ÌËÓÈÁÁ›Ùȉ· (29,39,47-52), ˘ÔÙÚÔÈ¿˙Ô˘Û· ÌËÓÈÁÁÔÂÁÎÂÊ·Ï›Ùȉ·(42,53), ÂÁÎÂÊ·ÏÈÎfi ·fiÛÙËÌ· (29), ÚÈ˙›Ùȉ· (12,54), ÂÚÈÊÂÚÈ΋ Ó¢ÚÔ¿ıÂÈ· (13,21,48),¿ÚÂÛË ÚÔÛˆÈÎÔ‡ Ó‡ÚÔ˘ (39), ÈۯȷÏÁ›· (55), „˘¯ÈΤ˜ ‰È·Ù·Ú·¯¤˜ (34,55)

∞ÈÛıËÙ‹ÚÈ· πÚȉÔ΢ÎÏ›Ùȉ· (39)∫·Ú‰È¿ ¶ÂÚÈηډ›Ùȉ· (41), ÂÓ‰Ôηډ›Ùȉ· (42)∞Ó·Ó¢ÛÙÈÎfi ¶Ó¢ÌÔÓÈΤ˜ ‰ÈËı‹ÛÂȘ (29)¶ÂÙÈÎfi √Í›· ÎÔÈÏ›· (57), ·ÛΛÙ˘ (58), ¯ÔÏÔ΢ÛÙ›Ùȉ· (57), Ë·ÙÈ΋ ·Ó¿ÚÎÂÈ· Û ¤‰·ÊÔ˜

·ÏÎÔÔÏÈ΋˜ Ë·ÙÔ¿ıÂÈ·˜ (59), Ë·ÙÔÓÂÊÚÈÎfi Û‡Ó‰ÚÔÌÔ (60)√ÛÙ¿ Î·È ·ÚıÚÒÛÂȘ √ÛÙÂÔÌ˘ÂÏ›Ùȉ· (60, 61), ÛÔÓ‰˘Ï›Ùȉ· (62)√˘ÚÔÔÈÔÁÂÓÓËÙÈÎfi √Ú¯›Ùȉ· (35), ÔÚ¯ÂÔÂȉȉ˘Ì›Ùȉ· (44,56,63-65), ÚÔÛÙ·Ù›Ùȉ· (55)∞ÈÌÔÔÈËÙÈÎfi ∞Ó·ÈÌ›·, Ô˘‰ÂÙÂÚÔÂÓ›·, ÏÂÌÊÔÂÓ›·, ıÚÔÌ‚ÔÂÓ›· (21,29,39,66), ·Ó΢ÙÙ·ÚÔÂÓ›· (67-68),

Ï¢¯·ÈÌÔÂȉ‹˜ ·ÓÙ›‰Ú·ÛË, ˈÛÈÓÔÊÈÏ›·, ÌÔÓÔ΢ÙÙ¿ÚˆÛË (39,68), ıÚÔÌ‚ÔÂÓÈ΋ ÔÚʇڷ (39,69)

∫‡ËÛË §Ô›ÌˆÍË ÓÂÔÁÓÔ‡ (31,37,40)ÕÏϘ ÂÓÙÔ›ÛÂȘ ∂̇ËÌ· ‚Ú·Á¯È·Î‹˜ ·ÛÙ˘ (70), ·fiÛÙËÌ· Ì·ÛÙÔ‡ (71), ÂÍ¿ÓıËÌ· (29), ÂÈÎfiÓ· ÚÂ˘Ì·-

ÙÔÂȉԇ˜ ·ÚıÚ›Ùȉ·˜ (60)

Pediatr Jan-Feb 06 final allges 27-01-06 15:35 ™ÂÏ›‰·40

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¤¯Ô˘Ó ÂÚÈÔÚÈṲ̂ÓË ÂÈÙ˘¯›· (3,31). ™ÙËÓ

∂ÏÏ¿‰· Ô ÂÌ‚ÔÏÈ·ÛÌfi˜ ÙˆÓ ‚ÔÔÂȉÒÓ Î·È ÙˆÓ

·ÈÁÔÚÔ‚¿ÙˆÓ ËÏÈΛ·˜ οو ÙÔ˘ ¤ÙÔ˘˜ ¿Ú¯ÈÛÂ

·fi ÙÔ 1975 (8,9). ∆Ô ÚfiÁÚ·ÌÌ· ·˘Ùfi ·ÓÙÈη-

Ù·ÛÙ¿ıËΠÙÔ 1994 ·fi ÙÔÓ ÔÚÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô

ÁÈ· ÙËÓ ÂÓÙfiÈÛË ÙˆÓ ÌÔÏ˘ÛÌ¤ÓˆÓ ˙ÒˆÓ (5-6,

8,33), ˆÛÙfiÛÔ ·fi ÙÔ 1997 Î·È ÌÂÙ¿, ÙÔ Úfi-

ÁÚ·ÌÌ· ÂÌ‚ÔÏÈ·ÛÌÔ‡ Ì Rev-1 ηıÈÂÚÒıËÎÂ

¿ÏÈ, ÛÙËÓ ËÂÈÚˆÙÈ΋ ÙÔ˘Ï¿¯ÈÛÙÔÓ ∂ÏÏ¿‰·

Î·È ¤¯ÂÈ ÚÔÁÚ·ÌÌ·ÙÈÛÙ› Ó· ‰È·ÚΤÛÂÈ ¤ˆ˜ ηÈ

ÙÔ 2004, ·ÎÔÏÔ˘ıÒÓÙ·˜ ÙȘ Ô‰ËÁ›Â˜ Ù˘ ∂˘Úˆ-

·˚΋˜ ∫ÔÈÓfiÙËÙ·˜ (5). ™ÙȘ ÂÚÈÔ¯¤˜ ÌÈÎÚfi-

ÙÂÚ˘ ›وÛ˘, fiˆ˜ Â›Ó·È Ë ÓËÛȈÙÈ΋

∂ÏÏ¿‰·, ÂÍ·ÎÔÏÔ˘ı› Ë Ù·ÎÙÈ΋ ÙÔ˘ ÔÚÔÏÔÁÈ-

ÎÔ‡ ÂϤÁ¯Ô˘ ÙˆÓ ˙ÒˆÓ Î·È Ù˘ ÛÊ·Á‹˜ ÙˆÓ ÓÔ-

ÛÔ‡ÓÙˆÓ (5). Ÿˆ˜ ÚÔ·ÙÂÈ ·fi ÙËÓ ∂ÈÎfiÓ·

1, Ë ÓÔÛËÚfiÙËÙ· ÛÙÔÓ ¿ÓıÚˆÔ Û¯ÂÙ›˙ÂÙ·È ÌÂ

ÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi ÙˆÓ ˙ÒˆÓ (9). ∫·È ÔÈ ‰‡Ô ÂÌ-

Ê·Ó›˜ ˘Ê¤ÛÂȘ Ù˘ ›وÛ˘, ÛÙË ‰ÂηÂÙ›·

ÙÔ˘ 1980 Î·È ÌÂÙ¿ ÙÔ 2000, ·ÎÔÏÔ˘ıÔ‡Ó ÙËÓ

ÂÊ·ÚÌÔÁ‹ ÚÔÁÚ·ÌÌ¿ÙˆÓ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÙˆÓ

˙ÒˆÓ Î·È Ë ·‡ÍËÛË ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ ÌÂÙ¿ ÙÔ

1995 ·ÎÔÏÔ˘ı› ÙËÓ ·Ó·ÛÙÔÏ‹ ÙÔ˘ ÚÔÁÚ¿Ì-

Ì·ÙÔ˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡. ¶ÚfiÛÊ·ÙË ·Ó·˙ˆ‡ÚˆÛË

Ù˘ ÓfiÛÔ˘ ¤¯ÂÈ ÂÚÈÁÚ·Ê› ÛÙË ª¿ÏÙ· Î·È ÛÙÔ

√Ì¿Ó (3).

∂› ÙÔ˘ ·ÚfiÓÙÔ˜, η̛· ÂÚÈÔ¯‹ ÛÙËÓ

∂ÏÏ¿‰· ‰ÂÓ ¤¯ÂÈ ÎËÚ˘¯ı› ÂχıÂÚË ‚ÚԢΤÏ-

ψÛ˘ (5) Î·È ÚÔÊ·ÓÒ˜ ı· ¯ÚÂÈ·ÛÙÔ‡Ó ·ÎfiÌË

·ÚÎÂÙ¿ ¯ÚfiÓÈ· ÁÈ· ÙËÓ Â›Ù¢ÍË ·˘ÙÔ‡ ÙÔ˘

ÛÎÔÔ‡. ∂ÎÙfi˜ ·fi ÙË ÁˆÁÚ·ÊÈ΋, ·Ú·ÙË-

ÚÂ›Ù·È Î·È Âԯȷ΋ ηٷÓÔÌ‹ Ù˘ ÓfiÛÔ˘, ÌÂ

ÂÍ¿ÚÛÂȘ ηٿ ÙËÓ ÂÚ›Ô‰Ô Á·Ï·ÎÙÔ·Ú·ÁˆÁ‹˜(29,44). √ ¤ÏÂÁ¯Ô˜ fiÏˆÓ ÙˆÓ ÌÂÏÒÓ Ù˘ ÔÈÎÔ-Á¤ÓÂÈ·˜ Â›Ó·È ··Ú·›ÙËÙÔ˜, ‰Â‰Ô̤ÓÔ˘ fiÙÈ ÛÂοı ÁÓˆÛÙfi ÎÚÔ‡ÛÌ· ÌÔÚ› Ó· ·ÓÙÈÛÙÔȯԇӷÚÎÂÙ¿ ·‰È¿ÁÓˆÛÙ· (45-46). ∞Í›˙ÂÈ Ó· ˘Ô-ÁÚ·ÌÌÈÛÙ› fiÙÈ ÙÔ ÚÔÛÂÎÙÈÎfi ÈÛÙÔÚÈÎfi, ηٿηÓfiÓ·, ·Ó·‰ÂÈÎÓ‡ÂÈ È‰È·›ÙÂÚË Û¯¤ÛË ÙÔ˘ ·ÛıÂ-ÓÔ‡˜ Ì ˙Ò· (16,28) Î·È fiÙÈ Û˘ÓÂÒ˜ Ô Î›Ó‰˘-ÓÔ˜ ÌfiÏ˘ÓÛ˘ ·fi Ù· Á·Ï·ÎÙÔÎÔÌÈο Ô˘ ‰È·-ÎÈÓÔ‡ÓÙ·È ÛÙÔ ÂÌfiÚÈÔ Â›Ó·È ·ÌÂÏËÙ¤Ô˜. °È·ÙÔÓ ¿ÓıÚˆÔ ‰ÂÓ ¤¯ÂÈ ·Ú·Û΢·ÛÙ› ̤¯ÚÈÛ‹ÌÂÚ· οÔÈÔ ÈηÓÔÔÈËÙÈÎfi ÂÌ‚fiÏÈÔ (2,3),ÌÔÏÔÓfiÙÈ ·ÚÎÂÙ¿ ¤¯Ô˘Ó ‰ÔÎÈÌ·ÛÙ› (3,43).

∞fi ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ÚÔ·ÙÂÈ fiÙÈ Î·-Ù¿ ÙȘ ÙÂÏÂ˘Ù·›Â˜ ‰ÂηÂٛ˜, Ë ‚ÚԢΤÏψÛË·ÔÙÂÏÔ‡Û ˘ÔÏÔÁ›ÛÈÌÔ Úfi‚ÏËÌ· ˘Á›·˜ÛÙËÓ ∂ÏÏ¿‰·. ŒÓ· ·ÍÈfiÏÔÁÔ ÔÛÔÛÙfi ÙˆÓ ÎÚÔ˘-ÛÌ¿ÙˆÓ ·ÊÔÚÔ‡Û ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜. ∏ ·Ô-ÙÂÏÂÛÌ·ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛ‹ Ù˘ ı· Á›ÓÂÈ ÂÊÈÎÙ‹ÌfiÓÔ Ì ÙËÓ Â·ÁÚ‡ÓËÛË Î·È ÙˆÓ ÁÈ·ÙÚÒÓ Î·ÈÙˆÓ ÎÙËÓÈ¿ÙÚˆÓ. ∆Ô ·Ú¿‰ÂÈÁÌ· ¿ÏÏˆÓ ¯ˆÚÒÓ·Ô‰ÂÈÎÓ‡ÂÈ fiÙÈ Ë ‚ÚԢΤÏψÛË ÌÔÚ› Ó· ÂÍ·-ÏÂÈÊı› Ï‹Úˆ˜ Î·È ·fi ÙËÓ ∂ÏÏ¿‰·. Œˆ˜ ÙfiÙÂ,Ë ÓfiÛÔ˜ ÂÈ‚¿ÏÏÂÙ·È Ó· Û˘ÌÂÚÈÏ·Ì‚¿ÓÂÙ·ÈÛÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ¿Ù˘ˆÓ ÎÏÈÓÈÎÒÓ ÂÎ-‰ËÏÒÛˆÓ, Û ·È‰È¿ Î·È ÂÓ‹ÏÈΘ, Î·È Ì¿ÏÈÛÙ·Û ÂÓ‰ËÌÈΤ˜ ÂÚÈÔ¯¤˜.

µÈ‚ÏÈÔÁÚ·Ê›·

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6. ∫·ÓÛÔ˘˙›‰Ô˘-∫·Ó·ÎÔ‡‰Ë ∞. µÚÔ˘ÎÂÏÏÒÛÂȘ. ¢ÂÏ-Ù›ÔÓ ∂ÏÏËÓÈ΋˜ ªÈÎÚÔ‚ÈÔÏÔÁÈ΋˜ ∂Ù·ÈÚ›·˜ 1997;42:37-41.

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‚ÈfiÙ˘ÔÈ ‚ÚÔ˘ÎÂÏÏÒÓ Ô˘ ·ÔÌÔÓÒıËÎ·Ó ·fi ·Ó-

ıÚÒÔ˘˜. ¢ÂÏÙ›ÔÓ ∂ÏÏËÓÈ΋˜ ªÈÎÚÔ‚ÈÔÏÔÁÈ΋˜

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8. ∫·ÓÛÔ˘˙›‰Ô˘-∫·Ó·ÎÔ‡‰Ë ∞. µÚԢΤÏψÛË. ªÈ·

ÓfiÛÔ˜ Ô˘ Û˘Ó¯›˙ÂÈ Ó· ·ÔÙÂÏ› Úfi‚ÏËÌ· ÛÙËÓ

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∂ÈÎfiÓ· 2. ¡ÔÛËÏ›˜ ÁÈ· ‚ÚԢΤÏψÛË ·Ó¿ 100.000ÏËı˘ÛÌÔ‡, ·Ó¿ ¤ÙÔ˜ ÛÙ· ÂÈ̤ÚÔ˘˜ ÁˆÁÚ·ÊÈο ‰È·-ÌÂÚ›ÛÌ·Ù· Ù˘ ∂ÏÏ¿‰Ô˜ ηٿ ÙÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·1980-1997.

ª·Î‰ÔÓ›·11,1

£ÂÛÛ·Ï›·10,1

◊ÂÈÚÔ˜19,1‰

£Ú¿ÎË15,9

§ÔÈ‹ ™ÙÂÚ¿ Î·È ∂‡‚ÔÈ·9,35

¶ÂÚÈÊ. ¶ÚˆÙ¢ԇÛ˘

2,47

πfiÓÈÔÈ ¡‹ÛÔÈ2,46

¶ÂÏÔfiÓÓËÛÔ˜11,6

∫Ú‹ÙË4,14

¡‹ÛÔÈ ∞ÈÁ·›Ô˘1,61

41∏ ‚ÚԢΤÏψÛË ÛÙËÓ ∂ÏÏ¿‰·

¶·È‰È·ÙÚÈ΋ 2006;69:37-44

Pediatr Jan-Feb 06 final allges 27-01-06 15:35 ™ÂÏ›‰·41

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42 ª. ª·˘ÚfiΈÛÙ·, ∂. °·Ï·Ó¿Î˘

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™. ∏ ‚ÚԢΤÏψÛË ÂȘ ˆÚÈṲ̂ӷ˜ ÂÚÈÔ¯¿˜ Ù˘

µÔÚÂÈÔ‰˘ÙÈ΋˜ ∂ÏÏ¿‰Ô˜. π·ÙÚÈ΋ ∂ÈıÂÒÚËÛȘ

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∂ȉËÌÈÔÏÔÁÈΤ˜, ÎÏÈÓÈΤ˜, ÂÚÁ·ÛÙËÚȷΤ˜ Î·È ¿Ï-

Ϙ ÂӉȷʤÚÔ˘Û˜ ·Ú·ÙËÚ‹ÛÂȘ Û 157 ÂÚÈÙÒ-

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12. °ÈˆÙ¿ÎË ∂, ∫ÔÎΛÓË °, ¶··¯·Ú›Û˘ °, ¢fiÓÔ˜ ∞,

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14. ∫ÈÔÛ¤˜ µ, ¶¿ÁηÏÔ˜ ∂, ª·ÚÎfiÔ˘ÏÔ˜ ∞, ª·Ó¤˜ Ã,

∫·ÏÏÈÁοÙÛ˘ Ã, ¶··¯Ú‹ÛÙÔ˘ ∞, µÔ˘ÁÈԇη˜ ∞.

∏ ÂȉËÌÈÔÏÔÁ›· ÙˆÓ ÏÔÈ̈‰ÒÓ ÓfiÛˆÓ ÛÙË µfiÚ.

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15. ∫·‚Ô‡Ú˘ ∫, ∫ÚÔΛ‰·˜ °, §fiÓÙÔ˜ µ, ™‰Ô‡ÁÎÔ˜ °,

¶ÂÙÚÔÔ‡ÏÔ˘ ∂, ªÈıÔ‡Ïη ª, º›ÏÈ·˜ ¡. ∞Ó·-

‰ÚÔÌÈ΋ ÂȉËÌÈÔÏÔÁÈ΋ ÌÂϤÙË ÙÔ˘ ÌÂÏÈÙ·›Ô˘ ÛÙ·

·È‰È¿ Ù˘ ¡.¢. ∂ÏÏ¿‰·˜. ¶Ú·ÎÙÈο 30Ô˘ ¶·ÓÂÏ-

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43∏ ‚ÚԢΤÏψÛË ÛÙËÓ ∂ÏÏ¿‰·

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45∂¡¢π∞º∂ƒ√À™∞ ¶∂ƒπ¶∆ø™∏ CASE REPORT

∆˘ÚÔÛÈÓ·ÈÌ›· Ù‡Ô˘ π: ·ÛıÂÓ‹˜ Ì ¤ÓÙ ¯ÚfiÓÈ·

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˘ÔÏÂÈfiÌÂÓÔ ·˘ÙÔۈ̷ÙÈÎfi ÓfiÛËÌ· ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ Ù˘ Ù˘ÚÔÛ›Ó˘ Ô˘ ÔÊ›ÏÂÙ·È ÛÙËÓ ·ÓÂ-

¿ÚÎÂÈ· ÙÔ˘ ÂÓ˙‡ÌÔ˘ ÊÔ˘Ì·Ú˘Ï·ÎÂÙÔÍÂÈ΋ ˘‰ÚÔÏ¿ÛË (fumaryloacetoacetate hydrolase, FAH) ηÈ

ÚÔÛ‚¿ÏÏÂÈ Î˘Ú›ˆ˜ ÙÔ ‹·Ú (ÔÍ›· Ë·ÙÈ΋ ·Ó¿ÚÎÂÈ· ·fi ‚ÚÂÊÈ΋ ËÏÈΛ·, ÂÍÂÏÈÛÛfiÌÂÓË Ë·-

ÙÈ΋ ΛÚÚˆÛË, Ë·ÙÔ΢ÙÙ·ÚÈÎfi ηÚΛÓÔ), ÙÔ˘˜ ÓÂÊÚÔ‡˜ (Û‡Ó‰ÚÔÌÔ Fanconi) Î·È Ù· ÂÚÈÊÂÚÈο

Ó‡ڷ (ÎÚ›ÛÂȘ ÂÚÈÊÂÚÈ΋˜ Ó¢ÚÔ¿ıÂÈ·˜ Ù‡Ô˘ ÔÚÊ˘Ú›·˜). ¶·ıÔÁÓˆÌÔÓÈ΋ ÁÈ· ÙËÓ ¿ıËÛË Â›-

Ó·È Ë ·ÚÔ˘Û›· ÛÔ˘ÎÈÓ˘Ï·ÎÂÙfiÓ˘ ÛÙÔ Ï¿ÛÌ· ‹ ÛÙ· Ô‡Ú·. ∏ Ë·ÙÔÓÂÊÚÈ΋ Ù˘ÚÔÛÈÓ·ÈÌ›· Â›Ó·È ÙÔ

ÎÏËÚÔÓÔÌÈÎfi ÌÂÙ·‚ÔÏÈÎfi ÓfiÛËÌ· Ì ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi Ë·ÙÔ΢ÙÙ·ÚÈÎÔ‡ ηÚΛÓÔ˘ Î·È Ì¤-

¯ÚÈ ÚfiÙÈÓÔ˜, Ë ÌfiÓË ıÂڷ¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ‹Ù·Ó Ë ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜ Î·È Ë ÌÂȈ̤ÓË ‰È-

·ÈÙËÙÈ΋ ÚfiÛÏË„Ë Ê·ÈÓ˘Ï·Ï·Ó›Ó˘ Î·È Ù˘ÚÔÛ›Ó˘. ∏ ÂÊ·ÚÌÔÁ‹ Ù˘ ıÂڷ›·˜ Ì NTBC [2-(2-

nitro 4 -trifluoromethylbenzoyl)-1,3-cyclohexanedione] Û ·ÛıÂÓ›˜ ÌÂ Ù˘ÚÔÛÈÓ·ÈÌ›· Ù‡Ô˘ 1 ¤¯ÂÈ

·˘Í‹ÛÂÈ ı·̷ÙÈο ÙÔ ÔÛÔÛÙfi ÂÈ‚›ˆÛ˘ Ì ·Ú¿ÏÏËÏË Ì›ˆÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÌÂÙ·ÌÔۯ‡ÛÂ-

ˆÓ ‹·ÙÔ˜, ÒÛÙ ۋÌÂÚ· Ó· ÂÓÙ¿ÛÛÂÙ·È ÛÙË ıÂڷ›· ÚÒÙ˘ ÁÚ·ÌÌ‹˜ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘

ÓfiÛÔ˘. ¶ÂÚÈÁÚ¿ÊÂÙ·È ŒÏÏËÓ·˜ ·ÛıÂÓ‹˜ ÌÂ Ù˘ÚÔÛÈÓ·ÈÌ›· Ù‡Ô˘ π Ô˘ ‰È·ÁÓÒÛÙËΠ۠ËÏÈΛ· 5 ÌË-

ÓÒÓ Î·È ÛÙÔÓ ÔÔ›Ô ¯ÔÚËÁ‹ıËΠNTBC, ·Ú¿ÏÏËÏ· Ì ÙËÓ ÂȉÈ΋ ‰È·ÈÙËÙÈ΋ ·ÁˆÁ‹. ª›· ‚‰ÔÌ¿-

‰· ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂڷ›·˜, ÙÔ ‚Ú¤ÊÔ˜ ·ÚÔ˘Û›·Û ÂÓÙ˘ˆÛȷ΋ ÎÏÈÓÈ΋ ‚ÂÏÙ›ˆÛË Î·È ÔÈ

‚ÈÔ¯ËÌÈÎÔ› ·Ú¿ÌÂÙÚÔÈ Ù˘ Ë·ÙÈ΋˜ ÙÔ˘ ÏÂÈÙÔ˘ÚÁ›·˜ ·ӋÏı·Ó ÛÙ· Ê˘ÛÈÔÏÔÁÈο fiÚÈ·. ™‹ÌÂÚ·,

¤ÓÙ ¯ÚfiÓÈ· ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ·ÁˆÁ‹˜ Ì NTBC, Ô ·ÛıÂÓ‹˜ ‚Ú›ÛÎÂÙ·È Û ¿ÚÈÛÙË ÁÂÓÈ΋ ηٿ-

ÛÙ·ÛË Î·È ·' fi,ÙÈ ÁÓˆÚ›˙Ô˘ÌÂ, ·ÔÙÂÏ› ÙËÓ ÚÒÙË ÂÚ›ÙˆÛË Ù˘ÚÔÛÈÓ·ÈÌ›·˜ Ù‡Ô˘ π ÛÙËÓ ∂ÏÏ¿-

‰· Ô˘ ·ÓÙÈÌÂÙˆ›˙ÂÙ·È Ì NTBC.

§¤ÍÂȘ ÎÏÂȉȿ: ∆˘ÚÔÛÈÓ·ÈÌ›· Ù‡Ô˘ π, Ë·ÙÔÓÂÊÚÈ΋ Ù˘ÚÔÛÈÓ·ÈÌ›·, ıÂڷ›·, NTBC.

Five years effective therapy of a patient with tyrosinaemia type I

without transplantation

P. Augoustides - Savvopoulou1, S. Karyda - Kavalioti1, E. Hatzipantelis1, ∂. Zafeiriadou2, K. Fotiadou3,

N. Kozeis4, K. Patsiaoura5, S. Moussiou1, E. Holme6, K. Malaka - Zafeiriou1, F. Kanakoudi - Tsakalidou1

Abstract: Tyrosinaemia type I or hepatorenal tyrosinaemia (OMIM 276700) is a rare autosomal

recessive inborn error of tyrosine metabolism caused by deficiency of fumarylacetoacetate hydrolase

(FAH) and involving mainly the liver (acute liver failure in infancy, cirrhosis, hepatocellular

carcinoma), kidneys (renal Fanconi syndrome) and peripheral nerves (porphyria-like crises). The

presence of succinylacetone in plasma or urine is diagnostic for this disorder. Tyrosinaemia type I is

the inborn error of metabolism with the highest incidence of hepatocellular carcinoma and till

relatively recently, the only treatment for this disorder was liver transplantation in combination with

dietary restriction of phenylalanine and tyrosine. Treatment with NTBC (2-(2-nitro-4-

trifluoromethylbenzoyl)-1,3-cyclohexanedione) has greatly increased survival and has reduced the

need for liver transplantation during early childhood establishing NTBC as first-line treatment for

patients with tyrosinemia type I. We present a Greek boy with hepatorenal tyrosinaemia who was

diagnosed at the age of 5 months and immediately started on a regimen of NTBC in parallel with the

dietary therapy indicated in this disorder. Significant clinical improvement with normalization of

liver function tests was apparent after one week of treatment. Currently, after five years treatment

1 ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋∞.¶.£., °. ¡. £ÂÛÛ·ÏÔӛ΢“πÔÎÚ¿ÙÂÈÔ”

2 ∞ÎÙÈÓÔÏÔÁÈÎfi ∂ÚÁ·ÛÙ‹ÚÈÔ,°. ¡. £ÂÛÛ·ÏÔӛ΢“πÔÎÚ¿ÙÂÈÔ”

3 ∆Ì‹Ì· ¢È·ÙÚÔÊ‹˜, °. ¡.£ÂÛÛ·ÏÔӛ΢“πÔÎÚ¿ÙÂÈÔ”

4 √Êı·ÏÌÔÏÔÁÈ΋ ∫ÏÈÓÈ΋, °.¡. £ÂÛÛ·ÏÔӛ΢“πÔÎÚ¿ÙÂÈÔ”

5 ¶·ıÔÏÔÁÔ-AÓ·ÙÔÌÈÎfi∂ÚÁ·ÛÙ‹ÚÈÔ, °. ¡.£ÂÛÛ·ÏÔӛ΢“πÔÎÚ¿ÙÂÈÔ”,

6 Dept. of Clinical Chemistry,Sahlgrenska UniversityHospital, Gothenburg,Sweden

AÏÏËÏÔÁÚ·Ê›·:

¶ÂÚÛÂÊfiÓË ∞˘ÁÔ˘ÛÙ›‰Ô˘-™·‚‚ÔÔ‡ÏÔ˘µÈÔ¯ËÌÈÎfi-ªÂÙ·‚ÔÏÈÎfi∂ÚÁ·ÛÙ‹ÚÈÔ∞’ ¶·È‰È·ÙÚÈ΋˜ ∫ÏÈÓÈ΋˜ ∞.¶.£.°ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô £ÂÛ/ӛ΢“πÔÎÚ¿ÙÂÈÔ”∫ˆÓ/fiψ˜ 49T.K. 546 42, £ÂÛÛ·ÏÔÓ›ÎË∂-mail: [email protected]

∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 21-03-2005∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 28-11-2005

1 1st Paediatric Clinic ofAristotle University,“Ippokration” GeneralHospital Thessaloniki

2 Laboratory of Radiology,“Ippokration” GeneralHospital Thessaloniki

3 Department of Nutrition,“Ippokration” GeneralHospital Thessaloniki

4 Department ofOphtalmology,“Ippokration” GeneralHospital Thessaloniki

5 Laboratory of Pathology,“Ippokration” GeneralHospital Thessaloniki

6 Dept. of Clinical Chemistry,Sahlgrenska UniversityHospital, Gothenburg,Sweden

¶·È‰È·ÙÚÈ΋ 2006;69:45-51

Pediatr Jan-Feb 06 final allges 27-01-06 15:35 ™ÂÏ›‰·45

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46 ¶. ∞˘ÁÔ˘ÛÙ›‰Ô˘-™·‚‚ÔÔ‡ÏÔ˘ Î·È Û˘Ó.

Correspondence:

P. Augoustides-SavvopoulouBiochemistry-MetabolismLaboratory1st Paediatric Clinic of Aristotle University“Ippokration” General Hospital Thessaloniki49, Konstantinoupoleos Str., 546 42, Thessaloniki ∂-mail: [email protected]

Date of submission: 21-03-2005Date of approval: 28-11-2005

¶·È‰È·ÙÚÈ΋ 2006;69:45-51

with NTBC, the patient is in excellent clinical condition. As far as we are aware, he is the firsttyrosinaemia type I patient on a therapeutic regimen of NTBC in Greece.

Key words: ∆yrosinaemia type I, therapy, NTBC, hepato-renal.

∂ÈÛ·ÁˆÁ‹

∏ Ù˘ÚÔÛÈÓ·ÈÌ›· Ù‡Ô˘ π ‹ Ë·ÙÔÓÂÊÚÈ΋

Ù˘ÚÔÛÈÓ·ÈÌ›· (√ªπª 276700) Â›Ó·È Û¿ÓÈÔ

(1:100.000-120.000 ÁÂÓÓ‹ÛÂȘ) ˘ÔÏÂÈfiÌÂÓÔ

·˘ÙÔۈ̷ÙÈÎfi ÓfiÛËÌ· ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ Ù˘

Ù˘ÚÔÛ›Ó˘ Ô˘ ÔÊ›ÏÂÙ·È ÛÙËÓ ·Ó¿ÚÎÂÈ·

˘‰ÚÔÏ¿Û˘ ÙÔ˘ ÊÔ˘Ì·Ú˘Ï·ÎÂÙÔÍÂÈÎÔ‡ ÔͤԘ

(fumarylacetate hydrolase-FAH), ¤Ó˙˘ÌÔ Ô˘

Έ‰ÈÎÔÔÈÂ›Ù·È ·fi ÁÔÓ›‰ÈÔ Ô˘ ‚Ú›ÛÎÂÙ·È ÛÙÔ

¯ÚˆÌfiۈ̷ 15q23-q25 (1). ¶ÚÔÛ‚¿ÏÏÔÓÙ·È

΢ڛˆ˜ ÙÔ ‹·Ú (ÂÍÂÏÈÛÛfiÌÂÓË Ë·ÙÈ΋ ·ÓÂ-

¿ÚÎÂÈ·, ΛÚÚˆÛË, Ë·ÙÔ΢ÙÙ·ÚÈÎfi ηÚΛÓÔ),

ÔÈ ÓÂÊÚÔ› (ÓÂÊÚÈ΋ ÛˆÏËÓ·Úȷ΋ ‚Ï¿‚Ë, ˘Ô-

ʈÛÊ·Ù·ÈÌÈ΋ Ú·¯›Ùȉ·) Î·È Ù· ÂÚÈÊÂÚÈο

Ó‡ڷ (Ó¢ÚÔÏÔÁÈÎfi Û‡Ó‰ÚÔÌÔ Ù‡Ô˘ ÔÚÊ˘-

Ú›·˜). ∞fi Ù· ÎÏËÚÔÓÔÌÈο ÌÂÙ·‚ÔÏÈο ÓÔÛ‹-

Ì·Ù·, Ë Ë·ÙÔÓÂÊÚÈ΋ Ù˘ÚÔÛÈÓ·ÈÌ›· ·ÚÔ˘ÛÈ¿-

˙ÂÈ ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ÂÌÊ¿ÓÈÛ˘ Ë·ÙÔ-

΢ÙÙ·ÚÈÎÔ‡ ηÚΛÓÔ˘. ª¤¯ÚÈ ÙÔ 1980, Ë ÌfiÓË

·ÓÙÈÌÂÙÒÈÛË Ù˘ Ù˘ÚÔÛÈÓ·ÈÌ›·˜ π ‹Ù·Ó Ë ÌÂȈ-

̤ÓË ‰È·ÈÙËÙÈ΋ ÚfiÛÏË„Ë Ê·ÈÓ˘Ï·Ï·Ó›Ó˘

Î·È Ù˘ÚÔÛ›Ó˘ Î·È ÌÂÙ¿ ·fi ÙÔ 1980, ÚÔÛÙ¤-

ıËÎÂ Ë ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜ (1-5). ∂·Ó¿-

ÛÙ·ÛË ÛÙË ıÂڷ›· Ù˘ ÓfiÛÔ˘ ·ÔÙ¤ÏÂÛ Ë

·Ó·Î¿Ï˘„Ë Ù˘ ‰Ú¿Û˘ ÌÈ·˜ ÙÚÈÎÂÙfiÓ˘, ÙÔ˘

NTBC (2-(2-nitro 4 -trifluoromethylbenzoyl)-

1,3-cyclohexanedione) ÛÙÔ ÌÂÙ·‚ÔÏÈÎfi ÌÔÓÔ-

¿ÙÈ Ù˘ Ù˘ÚÔÛ›Ó˘ (∂ÈÎfiÓ· 1) (1,2,5-9). ∏

™Ô˘Ë‰È΋ ÂÚ¢ÓËÙÈ΋ ÔÌ¿‰· ÙˆÓ Lindstedt ηÈ

Û˘Ó (ÔÌ¿‰· ÙÔ˘ Gothenburg), ‹Ù·Ó ÔÈ ÚÒÙÔÈ

Ô˘ ·Ú·Ù‹ÚËÛ·Ó ÙȘ ıÂڷ¢ÙÈΤ˜ ȉÈfiÙËÙ˜

ÙÔ˘ NTBC Û ·ÛıÂÓ›˜ Ì ˷ÙÔÓÂÊÚÈ΋ Ù˘ÚÔ-

ÛÈÓ·ÈÌ›· ÙÔ 1991 (8).

¶ÂÚÈÁÚ¿ÊÂÙ·È ŒÏÏËÓ·˜ ·ÛıÂÓ‹˜ ÌÂ Ù˘ÚÔÛÈ-

Ó·ÈÌ›· π, Ô ÔÔ›Ô˜ Â‰Ò Î·È ¤ÓÙ ¯ÚfiÓÈ·, ·ÓÙÈ-

ÌÂÙˆ›˙ÂÙ·È ÂÈÙ˘¯Ò˜ Ì NTBC. ∞' fi,ÙÈ ÁÓˆ-

Ú›˙Ô˘ÌÂ, Â›Ó·È Ô ÚÒÙÔ˜ ·ÛıÂÓ‹˜ Ì ˷ÙÔÓÂ-

ÊÚÈ΋ Ù˘ÚÔÛÈÓ·ÈÌ›· ÛÙËÓ ∂ÏÏ¿‰· Ô˘ ·ÓÙÈÌÂ-

Ùˆ›˙ÂÙ·È Ì NTBC.

4-˘‰ÚÔÍ˘Ê·ÈÓ˘ÏÔ˘ÚÔ˘‚ÈÎfi Ô͇

·Ó·ÛÙÔÏ‹ ·fi NTBC

4-˘‰ÚÔÍ˘Ê·ÈÓ˘ÏÔÁ·Ï·ÎÙÈÎfi Ô͇

ÔÌÔÁÂÓÙÈÛÈÎfi Ô͇

ÛÔ˘ÎÈÓ˘ÏÔ·ÎÂÙÔÍÂÈÎfi Ô̷͇ϸÏÔ·ÎÂÙÔÍÂÈÎfi Ô͇

∆ÔÍÈÎÔ› ÌÂÙ·‚Ôϛ٘

∆˘ÚÔÛÈÓ·ÈÌ›· Ù‡Ô˘ π

ÊÔ˘Ì·ÚÈÎfi Ô͇ Î·È ·ÎÂÙÔÍÂÈÎfi Ô͇ÔÚÊÔ¯ÔÏÈÓÔÁfiÓÔ‰-·ÌÈÓÔÏ‚ԢÏÈÓÈÎfi Ô͇

ÊÔ˘Ì·Ú˘ÏÔ·ÎÂÙÔÍÂÈÎfi Ô͇ÛÔ˘ÎÈÓ˘ÏÔ·ÎÂÙfiÓË

∆˘ÚÔÛ›ÓË

∂ÈÎfiÓ· 1. ªÂÙ·‚ÔÏÈÎfi ÌÔÓÔ¿ÙÈ Ù˘ ·Ô‰fiÌËÛ˘ Ù˘ Ù˘ÚÔÛ›Ó˘, fiÔ˘ Ê·›ÓÔÓÙ·È ÔÈ ÙÔÍÈÎÔ› ÌÂÙ·‚Ôϛ٘, ÙÔ ÛË-ÌÂ›Ô ·Ú¤Ì‚·Û˘ ÙÔ˘ NTBC Î·È ÙÔ ÛËÌÂ›Ô ·Ó·ÛÙÔÏ‹˜ Ù˘ Û˘ÓıÂÙ¿Û˘ ÙÔ˘ ÔÚÊÔ¯ÔÏÈÓÔÁfiÓÔ˘ (‹ 5-∞§∞ ˘‰Ú·Ù¿-Û˘) ·fi ÙË ÛÔ˘ÎÈÓ˘Ï·ÎÂÙfiÓË (·fi Holme Î·È Lindstedt, Clinics in Liver Disease 2000;4:806).

Pediatr Jan-Feb 06 final allges 27-01-06 15:35 ™ÂÏ›‰·46

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47£Âڷ›· Ù˘ÚÔÛÈÓ·ÈÌ›·˜ Ù‡Ô˘ π

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘

¶ÚfiÎÂÈÙ·È ÁÈ· ·ÁfiÚÈ ËÏÈΛ·˜ 5 ÌËÓÒÓ, Ô˘

ÂÈÛ‹Ïı ÛÙËÓ ÎÏÈÓÈ΋ Ì·˜ ÏfiÁˆ ÂÎÛÂÛËÌ·Ṳ̂-

Ó˘ Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›·˜, ‰˘ÛÙÚÔÊ›·˜ ηÈ

·ÈÌÔÚÚ·ÁÈ΋˜ ‰È¿ıÂÛ˘. ∂›Ó·È ÙÔ 2Ô ·È‰› Ê·È-

ÓÔÙ˘Èο ˘ÁÈÒÓ ÁÔÓ¤ˆÓ ÌÂ Û˘ÁÁ¤ÓÂÈ· 4Ô˘ ‚·ı-

ÌÔ‡. ∆Ô Ì·È¢ÙÈÎfi Î·È ÂÚÈÁÂÓÓËÙÈÎfi ÈÛÙÔÚÈÎfi

ÙÔ˘ ·ÛıÂÓÔ‡˜ ‹Ù·Ó ÂχıÂÚ·. ∞fi ÙÔ ·ÙÔÌÈÎfi

ÈÛÙÔÚÈÎfi ·Ó·Ê¤ÚÂÙ·È ·ÈÌÔÚÚ·Á›· ·fi ÙÔ ÔÌÊ·-

ÏÈÎfi ÎÔÏfi‚ˆÌ· ÙË 10Ë Ë̤ڷ ˙ˆ‹˜, Ô˘ ·ÓÙÈ-

ÌÂÙˆ›ÛÙËΠ̠ÂÓ‰ÔÌ˘˚΋ ¯ÔÚ‹ÁËÛË ‚ÈÙ·Ì›-

Ó˘ K. ∞fi ÙÔÓ 3Ô Ì‹Ó· ˙ˆ‹˜ ·Ú·ÙËÚ‹ıËÎÂ

˘ÔÏÂÈfiÌÂÓË ÛˆÌ·ÙÈ΋ ·Ó¿Ù˘ÍË. ªÂ Èı·-

Ó‹ ‰È¿ÁÓˆÛË “·ÏÏÂÚÁ›· ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜”

¯ÔÚËÁ‹ıËÎÂ ˘Ô·ÏÏÂÚÁÈÎfi Á¿Ï·. ∆ÔÓ 4Ô Ì‹Ó·

˙ˆ‹˜, ÛÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÚÔÛÙ¤ıËÎ·Ó ‚ÏÂÓ-

ÓÔ·ÈÌ·ÙËÚ¤˜ ÎÂÓÒÛÂȘ. ∞ÎÔÏÔ‡ıËÛ ·ÏÏ·Á‹

Ù˘ ‰È·ÙÚÔÊ‹˜ Û Á¿Ï· Ï‹ÚÔ˘˜ ˘‰ÚfiÏ˘Û˘

ÙˆÓ ÚˆÙÂ˚ÓÒÓ ¯ˆÚ›˜ η̛· ‚ÂÏÙ›ˆÛË. ∫·Ù¿

ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ÛÙËÓ ∫ÏÈÓÈ΋ Ì·˜, ¯·Ú·ÎÙË-

ÚÈÛÙÈ΋ ‹Ù·Ó Ë ¤ÓÙÔÓË ‰˘ÛÙÚÔÊ›· (‚¿ÚÔ˜, Ì‹-

ÎÔ˜ Î·È ÂÚ›ÌÂÙÚÔ˜ ÎÂÊ·Ï‹˜ <3Ë ÂηÙÔÛÙÈ·›·

ı¤ÛË) ÂÓÒ ‰È·ÈÛÙÒıËΠˆ¯ÚfiÙËÙ·, ÛÙÔÌ·Ù›-

Ùȉ· Î·È ·Ú¿ÙÚÈÌÌ·. ∏ ÎÔÈÏÈ¿ ‹Ù·Ó ÌÂÙˆÚÈ-

Ṳ̂ÓË, Ì „ËÏ·ÊËÙfi ÛÎÏËÚfi ‹·Ú Î·È ÛÏ‹Ó·

8 Î·È 5 cm οو ·fi Ù· Ï¢ÚÈο ÙfiÍ· ·ÓÙ›-

ÛÙÔȯ·. ∏ ÂͤٷÛË ÙˆÓ ˘ÔÏÔ›ˆÓ Û˘ÛÙËÌ¿-

ÙˆÓ Î·ıÒ˜ Î·È Ë Ó¢ÚÔÏÔÁÈ΋ ÂͤٷÛË ‹Ù·Ó

¯ˆÚ›˜ ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·. ∞fi ÙÔÓ ÚÒÙÔ

ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô ‰È·ÈÛÙÒıËÎ·Ó ıÚÔÌ‚Ô-

ÂÓ›·, ·Ó·ÈÌ›·, ˘ÔÁÏ˘Î·ÈÌ›·, ÌÈÎÚ‹ ·‡ÍËÛË

ÙˆÓ ÙÚ·ÓÛ·ÌÈÓ·ÛÒÓ Î·È Ù˘ ¯ÔÏÂÚ˘ı˘Ú›Ó˘,

̤ÙÚÈ· ·‡ÍËÛË Ù˘ ·ÏηÏÈ΋˜ ʈÛÊ·Ù¿Û˘,

¯·ÌËÏ¿ ›‰· ʈÛÊÒÚÔ˘, ÛËÌ·ÓÙÈ΋ ·Ú¿-

Ù·ÛË ÙÔ˘ ¯ÚfiÓÔ˘ ÚÔıÚÔÌ‚›Ó˘ Î·È Ù˘ ÌÂÚÈ-

΋˜ ıÚÔÌ‚ÔÏ·ÛÙ›Ó˘ Î·È Ôχ ˘„ËÏ¿ ›Â-

‰· ·-ÊÂÙÔÚˆÙ½Ó˘ ÔÚÔ‡ (¶›Ó·Î·˜ 1). ∞fi

ÙÔÓ ·ÂÈÎÔÓÈÛÙÈÎfi ¤ÏÂÁ¯Ô, ÙÔ ˘ÂÚ˯ÔÁÚ¿ÊË-

Ì· ÎÔÈÏ›·˜ ¤‰ÂÈÍ ·‡ÍËÛË ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙÔ˘

‹·ÙÔ˜ Ì ·‰Ú‹ ˯ԉÔÌ‹, ·‡ÍËÛË ÙÔ˘ ÌÂÁ¤-

ıÔ˘˜ ÙÔ˘ ÛÏËÓfi˜ Ì ÔÌÔÈÔÁÂÓ‹ ˯ԉÔÌ‹ ηÈ

·‡ÍËÛË ÙÔ˘ ÌÂÁ¤ıÔ˘˜ Î·È ÙˆÓ ‰‡Ô ÓÂÊÚÒÓ ÌÂ

·˘ÍË̤ÓË Ë¯ÔÁ¤ÓÂÈ·. ∏ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›·

(CT) ÎÔÈÏ›·˜ ¤‰ÂÈÍ ÔÏ˘Ô˙Ò‰Ë ·ÂÈÎfiÓÈÛË

ÙÔ˘ ‹·ÙÔ˜, ÛÏËÓÔÌÂÁ·Ï›·, ·‡ÍËÛË ÙÔ˘ ÌÂ-

Á¤ıÔ˘˜ ÙˆÓ ÓÂÊÚÒÓ Î·È ·Ô˘Û›· ÏÂÌÊ·‰¤ÓˆÓ,

ÂÓÒ ÛÙË Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· (MRI) ÎÔÈÏ›·˜

‰È·ÈÛÙÒıËΠÂÈÎfiÓ· ΛÚÚˆÛ˘ ‹·ÙÔ˜ ÌÂ

ÔÏÏ·ÏÔ‡˜ ·Ó·ÁÂÓÓËÙÈÎÔ‡˜ fi˙Ô˘˜ ÂÓÙfi˜ ·˘-

ÙÔ‡, ¯ˆÚ›˜ ÛÙÔȯ›· Ë·ÙÔ΢ÙÙ·ÚÈÎÔ‡ ηÚΛ-

ÓÔ˘ (∂ÈÎfiÓ˜ 2· Î·È 2‚). ∏ ÈÛÙÔÏÔÁÈ΋ ÂͤٷÛË

‚ÈÔ„›·˜ ‹·ÙÔ˜ ÂȂ‚·›ˆÛ ÙË ‰È¿ÁÓˆÛË Ù˘

ΛÚÚˆÛ˘ (∂ÈÎfiÓ· 3). ¶·Ú¿ÏÏËÏ· Ì ÙÔÓ ·ÂÈ-

ÎÔÓÈÛÙÈÎfi ¤ÏÂÁ¯Ô, ¤ÁÈÓ ÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜

ÁÈ· CMV, EBV, HBV, HAV, HCV Î·È ÙÔÍÔÏ¿-

Û̈ÛË Ì ·ÚÓËÙÈο ·ÔÙÂϤÛÌ·Ù· Î·È ¤ÏÂÁ¯Ô˜

ÁÈ· ÎÏËÚÔÓÔÌÈο ÌÂÙ·‚ÔÏÈο ÓÔÛ‹Ì·Ù·. √ Ô-

ÛÔÙÈÎfi˜ ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ ·ÌÈÓÔͤˆÓ ÛÙÔ

Ï¿ÛÌ· ¤‰ÂÈÍ ˘„ËÏ¿ ›‰· Ù˘ÚÔÛ›Ó˘, ÌÂ-

ıÂÈÔÓ›Ó˘, Ê·ÈÓ˘Ï·Ï·Ó›Ó˘, ÂÓ‰ÂÈÎÙÈο Ù˘ ‚·-

Ú‡ÙËÙ·˜ Ù˘ Ë·ÙÈ΋˜ ·Ó¿ÚÎÂÈ·˜, Î·È ÂÎÛÂ-

ÛËÌ·Ṳ̂ÓË ÁÂÓÈÎÂ˘Ì¤ÓË ·ÌÈÓÔÍÔ˘Ú›· Ô˘ Û˘-

ÓËÁÔÚÔ‡Û ÁÈ· Û‡Ó‰ÚÔÌÔ Fanconi. √ ¤ÏÂÁ¯Ô˜

Ù˘ ÓÂÊÚÈ΋˜ ÛˆÏËÓ·Úȷ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ ¤‰ÂÈ-

Í οı·ÚÛË ÎÚ·ÙÈÓ›Ó˘ ÛÙ· Ê˘ÛÈÔÏÔÁÈο fiÚÈ·,

ÂÓÒ ‰ÂÓ ‰È·ÈÛÙÒıËΠ·Û‚ÂÛÙÈÔ˘Ú›· ‹ ʈ-

ÛÊ·ÙÔ˘Ú›· ‹ ÁÏ˘ÎÔ˙Ô˘Ú›·.

∏ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÛÂ Û˘Ó‰˘·ÛÌfi Ì ٷ ¢-

Ú‹Ì·Ù· ÙˆÓ ·ÌÈÓÔͤˆÓ Û˘ÓËÁÔÚÔ‡Û·Ó ÁÈ· Ù˘-

ÚÔÛÈÓ·ÈÌ›· Ù‡Ô˘ I Î·È Ë ‰È¿ÁÓˆÛË ÂȂ‚·È-

ÒıËΠ̠ÙËÓ ÂͤٷÛË ÁÈ· ÔÚÁ·ÓÈο Ôͤ· Ô‡-

ÚˆÓ Ô˘ ·ÔÎ¿Ï˘„ ÙËÓ ·˘ÍË̤ÓË Û˘ÁΤ-

ÓÙÚˆÛË ÛÔ˘ÎÈÓ˘Ï·ÎÂÙfiÓ˘. ∏ ¯·ÌËÏ‹ ‰Ú·ÛÙÈ-

ÎfiÙËÙ· Ù˘ Û˘ÓıÂÙ¿Û˘ ÙÔ˘ ÔÚÊÔ¯ÔÏÈÓÔÁfi-

ÓÔ˘ (PBGS) ÛÙ· ÂÚ˘ıÚ¿ ·ÈÌÔÛÊ·›ÚÈ·, Ë ·‡ÍË-

ÛË ÙÔ˘ ‰-·ÌÈÓÔÏ‚ԢÏÈÓÈÎÔ‡ ÔͤԘ ÛÙ· Ô‡Ú·

Î·È Ë ·˘ÍË̤ÓË Û˘ÁΤÓÙÚˆÛË ÛÔ˘ÎÈÓ˘Ï·ÎÂÙfi-

Ó˘ ÛÙÔ Ï¿ÛÌ· ÂÓ›Û¯˘Û·Ó ÂÈϤÔÓ ÙË

‰È¿ÁÓˆÛË Ù˘ Ë·ÙÔÓÂÊÚÈ΋˜ Ù˘ÚÔÛÈÓ·ÈÌ›·˜

¶·È‰È·ÙÚÈ΋ 2006;69:45-51

¶›Ó·Î·˜ 1. ∞ÔÙÂϤÛÌ·Ù· ·Ú¯ÈÎÔ‡ ÂÚÁ·ÛÙËÚÈ·ÎÔ‡ ÂϤÁ¯Ô˘

∞›Ì·∞ÈÌÔÛÊ·ÈÚ›ÓË (g/dl, Ê.Ù.: 9,5-11 ) 9,8∞ÈÌÔÂÙ¿ÏÈ· (k/ml, Ê.Ù.: 150-300) 83ƒ∆ (sec) 17,7/12PTT (sec) 74.4/36∞ÏÎ. ʈÛÊ·Ù¿ÛË 1677(U/L, Ê.Ù.: 1-3 x ÂÓËϛΈÓ)SGOT (U/L, Ê.Ù.: 20-40) 152SGPT (U/L, Ê.Ù.: 20-40) 80ÃÔÏÂÚ˘ıÚ›ÓË ÔÏ. (mg/dl, Ê.Ù.: 0,1-0,5) 2,2(Ìmol/L, Ê.Ù.: 1,71-8,55) 37,62ÁGT (mU/L, Ê.Ù.: 6-26) 199ºˆÛÊfiÚÔ˜ (mg/dl, Ê.Ù.: 3,5-5,5) 2,1(Ìmol/L, Ê.Ù.: 1,71-8,55) 1,03·-ÊÂÙÔÚˆÙ½ÓË (ng/ml, Ê.Ù. <12) 151000∆˘ÚÔÛ›ÓË (Ìmol/L, Ê.Ù.: 50-130) 354(mg/dl, Ê.Ù.: 0,90-2,35) 6,41ªÂıÂÈÔÓ›ÓË (Ìmol/L, Ê.Ù.: 20-50) 220(mg/dl, Ê.Ù.: 0,45-0,95) 3,28º·ÈÓ˘Ï·Ï·Ó›ÓË (Ìmol/L, Ê.Ù.: 40-120) 193(mg/dl, Ê.Ù.: 0,07- 0,20) 0,318

Pediatr Jan-Feb 06 final allges 27-01-06 15:35 ™ÂÏ›‰·47

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48 ¶. ∞˘ÁÔ˘ÛÙ›‰Ô˘-™·‚‚ÔÔ‡ÏÔ˘ Î·È Û˘Ó.

(¶›Ó·Î·˜ 2). √ ¤ÏÂÁ¯Ô˜ ÙÔ˘ DNA ÙÔ˘ ·ÛıÂÓ‹

·ÂÎ¿Ï˘„ ÔÌÔ˙˘ÁˆÙ›· ÁÈ· ÙËÓ ÌÂÙ¿ÏÏ·ÍË

Met 1 Val ÛÙÔ ÚÒÙÔ ÂÍfiÓÈÔ ÙÔ˘ ÁÔÓȉ›Ô˘ Ô˘

Έ‰ÈÎÔÔÈ› ÙÔ ¤Ó˙˘ÌÔ FAH. ™ÙÔÓ ˘fiÏÔÈÔ

ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô Ô˘ ·ÎÔÏÔ‡ıËÛÂ, ÔÈ Ù·-

¯‡ÙËÙ˜ ·ÁˆÁÈÌfiÙËÙ·˜ ÓÂ‡ÚˆÓ ¤‰ÂÈÍ·Ó Â˘Ú‹-

Ì·Ù· ‹È·˜ ÂÚÈÊÂÚÈ΋˜ Ó¢ÚÔ¿ıÂÈ·˜, ÂÓÒ

Ê˘ÛÈÔÏÔÁÈο Â˘Ú‹Ì·Ù· ¤‰ÂÈÍ·Ó Ë ‚˘ıÔÛÎfiË-

ÛË, Ë ÔÊı·ÏÌÔÏÔÁÈ΋ ÂͤٷÛË Ì ۯÈÛÌÔÂȉ‹

Ï˘¯Ó›·, ÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ηډȿ˜ Î·È Ë

·ÎÙÈÓÔÁÚ·Ê›· Ì·ÎÚÒÓ ÔÛÙÒÓ. ªÂÙ¿ ÙË ‰È¿ÁÓˆ-

ÛË Ù˘ ÓfiÛÔ˘, Ô ·ÛıÂÓ‹˜ Ù¤ıËΠ۠ÂȉÈ΋ ‰›·È-

Ù· ÂÚÈÔÚÈṲ̂Ó˘ ÂÚÈÂÎÙÈÎfiÙËÙ·˜ Û ڈ-

Ù½ÓË, Ù˘ÚÔÛ›ÓË Î·È Ê·ÈÓ˘Ï·Ï·Ó›ÓË. ∆·˘Ùfi¯ÚÔ-

Ó· ÍÂΛÓËÛ ·ÁˆÁ‹ Ì NTBC ·fi ÙÔ ÛÙfiÌ·, 1

mg/kg/24ˆÚÔ Û ‰‡Ô ‰fiÛÂȘ, Û‡Ìʈӷ Ì ÙÔ

ÚˆÙfiÎÔÏÏÔ Ù˘ ™Ô˘Ë‰È΋˜ ÔÌ¿‰·˜. ∏ ·¿-

ÓÙËÛË ÛÙË ıÂڷ›· Ì NTBC ‹Ù·Ó ÂÓÙ˘ˆ-

Ûȷ΋. ª›· ‚‰ÔÌ¿‰· ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ·Áˆ-

Á‹˜, ·Ú·ÙËÚ‹ıËΠÛËÌ·ÓÙÈ΋ ‚ÂÏÙ›ˆÛË Ù˘

ÁÂÓÈ΋˜ ηٿÛÙ·Û˘ Î·È Ù˘ fiÚÂ͢ ÙÔ˘ ·ÛıÂ-

ÓÔ‡˜, Ë ÎÔÈÏÈ¿ ÙÔ˘ ‹Ù·Ó ̷Ϸ΋ Î·È ÙÔ ‹·Ú

„ËÏ·ÊËÙfi 5 cm οو ·fi ÙÔ Ï¢ÚÈÎfi ÙfiÍÔ

(Ì›ˆÛË Î·Ù¿ 3 cm), ÂÓÒ Ù· ·ÔÙÂϤÛÌ·Ù· ·fi

ÙÔÓ ·ÈÌ·ÙÔÏÔÁÈÎfi, ‚ÈÔ¯ËÌÈÎfi Î·È ÌÂÙ·‚ÔÏÈÎfi

¤ÏÂÁ¯Ô ›¯·Ó ‚ÂÏÙȈı› ÂÓÙ˘ˆÛȷο (¶›Ó·Î·˜

2). π‰È·›ÙÂÚË ÂÓÙ‡ˆÛË ¤Î·ÓÂ Ë ÌÂÁ¿ÏË ÙÒÛË

ÙˆÓ ÂȤ‰ˆÓ Ù˘ ·-ÊÂÙÔÚˆÙ½Ó˘. ŒÍÈ Ì‹Ó˜

·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂڷ›·˜, Ô ·ÛıÂÓ‹˜ ‹Ù·Ó

Û ηϋ ÁÂÓÈ΋ ηٿÛÙ·ÛË, Ë ÛˆÌ·ÙÈ΋ Î·È „˘-

¯ÔÎÈÓËÙÈ΋ ÙÔ˘ ·Ó¿Ù˘ÍË ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋

(‚¿ÚÔ˜, Ì‹ÎÔ˜, ÂÚ›ÌÂÙÚÔ˜ ÎÂÊ·Ï‹˜ ÛÙËÓ 50Ë

ÂηÙÔÛÙÈ·›· ı¤ÛË), ÂÓÒ ÙÔ „ËÏ·ÊËÙfi ̤ÁÂıÔ˜

ÙÔ˘ ‹·ÙÔ˜ ÌÂÈÒıËΠÛÙ· 4 cm οو ·fi ÙÔ

Ï¢ÚÈÎfi ÙfiÍÔ. √ ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙÔ˘

‹·ÙÔ˜ Î·È Ë ‚ÈÔ„›· ‹·ÙÔ˜ Ô˘ ¤ÁÈÓ·Ó ÙËÓ

›‰È· ¯ÚÔÓÈ΋ ÂÚ›Ô‰Ô, ¤‰ÂÈÍ·Ó ·Ú·ÌÔÓ‹ ÙˆÓ

·ÏÏÔÈÒÛÂˆÓ ·ÏÏ¿ ¯ˆÚ›˜ ÛËÌ›· ηÎÔ‹ıÂÈ·˜.

™‹ÌÂÚ·, ¤ÓÙ ¯ÚfiÓÈ· ·fi ÙË ‰È¿ÁÓˆÛË Î·È

ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂڷ›·˜, Ô ·ÛıÂÓ‹˜ Û˘Ó¯›˙ÂÈ

ÙËÓ ›‰È· ·ÁˆÁ‹, Ë ÁÂÓÈ΋ ÙÔ˘ ηٿÛÙ·ÛË ·Ú·-

̤ÓÂÈ ¿ÚÈÛÙË, Ë ÛˆÌ·ÙÈ΋ ·Ó¿Ù˘ÍË Î·È Ô ·Ó·-

Ù˘ÍÈÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ Â›Ó·È Ê˘ÛÈÔÏÔÁÈο ηÈ

ÙÔ ‹·Ú ۯ‰fiÓ ·„ËÏ¿ÊËÙÔ (1 cm). ™ÙÔÓ ¶›-

ӷη 2 Ê·›ÓÂÙ·È Ë Ï‹Ú˘ ·ÔηٿÛÙ·ÛË ÙˆÓ

ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ·Ú·Ì¤ÙÚˆÓ. ™ÙÔÓ ·ÂÈÎÔÓÈ-

ÛÙÈÎfi ¤ÏÂÁ¯Ô ÙÔ˘ ‹·ÙÔ˜ (CT spiral) Ô˘ ¤ÁÈÓÂ

ÙÔ 2Ô Î·È 3Ô ¯ÚfiÓÔ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·-

›·˜, ‰È·ÈÛÙÒıËΠÛËÌ·ÓÙÈ΋ ‚ÂÏÙ›ˆÛË Ù˘

ÂÈÎfiÓ·˜ ÙÔ˘ ‹·ÙÔ˜ (∂ÈÎfiÓ· 4).

¶·È‰È·ÙÚÈ΋ 2006;69:45-51

∂ÈÎfiÓ· 2. ∞ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ηٿ ÙË ‰È¿ÁÓˆÛË, fiÔ˘ Ê·›ÓÂÙ·È Ë ÔÏ˘Ô˙҉˘ ˘Ê‹ ÙÔ˘ ‹·ÙÔ˜ Û ·ÍÔÓÈ΋ÙÔÌÔÁÚ·Ê›· 2·) Î·È Û ̷ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· (MRI - gradient echo) 2‚).

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49£Âڷ›· Ù˘ÚÔÛÈÓ·ÈÌ›·˜ Ù‡Ô˘ π

™˘˙‹ÙËÛË

∏ Ù˘ÚÔÛÈÓ·ÈÌ›· Ù‡Ô˘ π ÂÚÈÁÚ¿ÊËÎÂ ÁÈ·

ÚÒÙË ÊÔÚ¿ ÚÈÓ ·fi 50 ̄ ÚfiÓÈ· Î·È Â›Ó·È ·fi Ù·

ÈÔ Î·Ï¿ ÙÂÎÌËÚȈ̤ӷ ÎÏËÚÔÓÔÌÈο ÌÂÙ·‚ÔÏÈ-

ο ÓÔÛ‹Ì·Ù· (1). ∆Ô ‹·Ú Â›Ó·È ÙÔ Î‡ÚÈÔ fiÚÁ·-

ÓÔ Ô˘ ÚÔÛ‚¿ÏÏÂÙ·È ÛÙËÓ Ù˘ÚÔÛÈÓ·ÈÌ›· Ù‡Ô˘

1 Î·È Û ‰ÈÂıÓ‹ ÌÂϤÙË, 69% ÙˆÓ ı·Ó¿ÙˆÓ ·Ô-

‰fiıËÎ·Ó ÛÙËÓ Ë·ÙÈ΋ ·Ó¿ÚÎÂÈ· Î·È ·ÈÌÔÚ-

Ú·Á›· Î·È 16% ÛÙÔÓ Ë·ÙÔ΢ÙÙ·ÚÈÎfi ηÚΛÓÔ

(10). ™‡Ìʈӷ Ì ÙÔ˘˜ van Spronsen Î·È Û˘Ó,‚·ÛÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÁÈ· ÙË ‚·Ú‡ÙËÙ· Î·È Úfi-ÁÓˆÛË Ù˘ ¿ıËÛ˘ Â›Ó·È Ë ËÏÈΛ· ¤Ó·Ú͢ ÙˆÓÛ˘ÌÙˆÌ¿ÙˆÓ (10). √ ·ÛıÂÓ‹˜ Ì·˜ ÚÔÛ‹ÏıÂÌ ÙËÓ Ù˘È΋ ‚·ÚÈ¿ ÂÈÎfiÓ· Ù˘ ÔÍ›·˜ Ë·ÙÔ-ÓÂÊÚÈ΋˜ Ù˘ÚÔÛÈÓ·ÈÌ›·˜, Û ËÏÈΛ· 5 ÌËÓÒÓ, ÌÂηı˘ÛÙ¤ÚËÛË Ù˘ ·Ó¿Ù˘Í˘, ¤ÓÙÔÓË ‰˘ÛÙÚÔ-Ê›·, Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›·, Ë·ÙÈ΋ ·Ó¿Ú-ÎÂÈ· Ì ΛÚÚˆÛË, ˘ÂÚÙ˘ÚÔÛÈÓ·ÈÌ›·, ˘ÂÚÌÂ-ıÂÈÔÓÈÓ·ÈÌ›·, ÁÂÓÈÎÂ˘Ì¤ÓË ·ÌÈÓÔÍÔ˘Ú›· Î·È˘„ËÏ¿ ›‰· ÛÔ˘ÎÈÓ˘Ï·ÎÂÙfiÓ˘ ÛÙ· Ô‡Ú·.

¶·È‰È·ÙÚÈ΋ 2006;69:45-51

∂ÈÎfiÓ· 4. Spiral CT ‹·ÙÔ˜ 3 ̄ ÚfiÓÈ· ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ıÂڷ›·˜, fiÔ˘ Û˘ÁÎÚÈÙÈο Ì ÙȘ ÂÈÎfiÓ˜ 2‚ Î·È 2‚ ·-Ú·ÙËÚÂ›Ù·È ÛËÌ·ÓÙÈ΋ ‚ÂÏÙ›ˆÛË Ù˘ ÂÈÎfiÓ·˜ - fiÛÔÓ ·ÊÔ-Ú¿ ÙËÓ ·ÓÔÌÔÈÔÁ¤ÓÂÈ· - ÙÔ˘ Ë·ÙÈÎÔ‡ ·ÚÂÁ¯‡Ì·ÙÔ˜.

¶›Ó·Î·˜ 2. ¶·Ú¿ÌÂÙÚÔÈ ·Ú·ÎÔÏÔ‡ıËÛ˘ Ù˘ ıÂڷ›·˜ Ì NTBC Û‡Ìʈӷ Ì ÙÔ ÂȉÈÎfi ÚˆÙfiÎÔÏÏÔ ÙˆÓ ™Ô˘Ë‰ÒÓ Û˘ÓÂÚÁ·ÙÒÓ

¶·Ú·ÎÔÏÔ‡ıËÛË ¶ÚÔ- +1 ‚‰. +1Ì 12Ì +24Ì +36Ì +48Ì + 60ÌNTBC

∏Ì. 000214 000225 000317 010217 020217 030217 040217 050217ÚˆÙÔÎfiÏÏÔ˘

¢È¿ÚÎÂÈ· ∏̤Ú˜ıÂڷ›·˜∞›Ì· ªÔÓ¿‰Â˜ ∆È̤˜

·Ó·ÊÔÚ¿˜

PBG synthase, Nkat/g Hb 0,58-1,25 0,03 1,05 0,8 0,72 0,6 0,67 0,75 0,69ÂÚ˘ıÚ¿™Ô˘ÎÈÓ˘Ï·ÎÂÙfiÓË, Ìg/ml <0,4 42 7,8 2,5 <0,1 <0,1 <0,1 <0,1 <0,1Ï¿ÛÌ··-ÊÂÙÔÚˆÙ½ÓË, Ìmol/L <12 151000 51000 26400 100 21 19 20 15ÔÚfi˜∆˘ÚÔÛ›ÓË, Ìmol/L 50-130 354 136 121 335 479 450 657 550Ï¿ÛÌ·º·ÈÓ˘Ï·Ï·Ó›ÓË Ìmol/L 40-120 193 30 46 55 55 92 68 63Ï¿ÛÌ·ªÂıÂÈÔÓ›ÓË, Ìmol/L 20-50 220 22 38 18 19 28 15 15Ï¿ÛÌ·√‡Ú·‰-·ÌÈÓÔÏ‚ԢÏÈÓÈÎfi mmol/mol 0-3 160 6,7 6,3 8,1 3 5,5 6,3 3,6Ô͇ ÎÚ·ÙÈÓ›Ó˘™Ô˘ÎÈÓ˘Ï·ÎÂÙfiÓË mmol/mol <1 320 <1 <1 <1 <1 <1 <1 <1

ÎÚ·ÙÈÓ›Ó˘™Ô˘ÎÈÓ˘ÏÔ·ÎÂÙÔÍÂÈÎfi mmol/mol <1 330 <1 <1 <1 <1 <1 <1 <1Ô͇ ÎÚ·ÙÈÓ›Ó˘NBTC, ÔÚfi˜ Ìmol/L 31,9 46,1 50,7 50,2 46,9 47,1 48,1

∂ÈÎfiÓ· 3. µÈÔ„›· ‹·ÙÔ˜ ÚÈÓ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·-›·˜: ¶˘Ï·›Ô ‰È¿ÛÙËÌ· Ì ¤ÓÙÔÓË ›ÓˆÛË Î·È ˘ÂÚ-Ï·Û›· ¯ÔÏËÊfiÚˆÓ fiÚˆÓ (ÙÚ›¯ÚˆÌË Masson x 200).

Pediatr Jan-Feb 06 final allges 27-01-06 15:35 ™ÂÏ›‰·49

Page 50: Παιδιατρική | Τόμος 69 • Τεύχος 1 • Ιανουάριος - Φεβρουάριος 2006

50 ¶. ∞˘ÁÔ˘ÛÙ›‰Ô˘-™·‚‚ÔÔ‡ÏÔ˘ Î·È Û˘Ó.

™ÙÔ˘˜ ·ÛıÂÓ›˜ ÌÂ Ù˘ÚÔÛÈÓ·ÈÌ›· Ù‡Ô˘ 1, ‰È·-

Ù·Ú¿ÛÛÂÙ·È Î˘Ú›ˆ˜ Ë Û˘ÓıÂÙÈ΋ ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘

‹·ÙÔ˜ Ì Ôχ ·Ú·ÙÂٷ̤ÓÔ˘˜ ¯ÚfiÓÔ˘˜

ÚÔıÚÔÌ‚›Ó˘ Î·È ÌÂÚÈ΋˜ ıÚÔÌ‚ÔÏ·ÛÙ›Ó˘,

ÂÓÒ Ù· ›‰· ÙˆÓ ÙÚ·ÓÛ·ÌÈÓ·ÛÒÓ Î·È ¯ÔÏÂ-

Ú˘ıÚ›Ó˘ ÌÔÚ› Ó· Â›Ó·È Ê˘ÛÈÔÏÔÁÈο ‹ Ï›ÁÔ

·˘ÍË̤ӷ, ÁÂÁÔÓfi˜ Ô˘ ‰È·ÈÛÙÒıËÎÂ Î·È ÛÙÔÓ

‰ÈÎfi Ì·˜ ·ÛıÂÓ‹ (1). ∆· Ôχ ˘„ËÏ¿ ›‰·

Ù˘ ·-ÊÂÙÔÚˆÙ½Ó˘ Û˘Ó‹ıˆ˜ Û¯ÂÙ›˙ÔÓÙ·È ÌÂ

ÙË ‚·Ú‡ÙËÙ· Ù˘ Ë·ÙÈ΋˜ ÓfiÛÔ˘ ηıÒ˜ Î·È Ù·

˘„ËÏ¿ ›‰· Ù˘ ÌÂıÂÈÔÓ›Ó˘, ·Ú¿ÁˆÁÔ

Ù˘ ÔÔ›·˜ ¢ı‡ÓÂÙ·È ÁÈ· ÙË ¯·Ú·ÎÙËÚÈÛÙÈ΋

Ì˘Úˆ‰È¿ ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ı˘Ì›˙ÂÈ ‚Ú·Ṳ̂ÓÔ

Ï¿¯·ÓÔ. ™ÙÔÓ ·ÛıÂÓ‹ Ì·˜ Ù· ›‰· ·-ÊÂÙÔ-

ÚˆÙ›Ó˘ ÛÙË ‰È¿ÁÓˆÛË ‹Ù·Ó Ôχ ˘„ËÏ¿ ηÈ

Û˘ÌʈÓÔ‡Û·Ó Ì ٷ ·ÂÈÎÔÓÈÛÙÈο Î·È ·ıÔ-

ÏÔÁÔ-·Ó·ÙÔÌÈο Â˘Ú‹Ì·Ù· ÙÔ˘ ‹·ÙÔ˜. ∏ ˘Ô-

ÁÏ˘Î·ÈÌ›· Ô˘ ·Ú·ÙËÚ‹ıËΠ›Û˘ ÛÙÔÓ

·ÛıÂÓ‹ Ì·˜, ·Ô‰›‰ÂÙ·È ÛÙË ‚·ÚÈ¿ Ë·ÙÈ΋ ‰˘-

ÛÏÂÈÙÔ˘ÚÁ›· Î·È ÛÙËÓ ˘ÂÚÙÚÔÊ›· Ù˘ ÂÓ‰ÔÎÚÈ-

ÓÔ‡˜ ÌÔ›Ú·˜ ÙÔ˘ ·ÁÎÚ¤·ÙÔ˜ Ô˘ ·Ú·ÙËÚ›-

Ù·È ÛÙËÓ Ù˘ÚÔÛÈÓ·ÈÌ›· 1 (1).

ª¤¯ÚÈ Û‹ÌÂÚ· ¤¯Ô˘Ó ‚ÚÂı› ÂÚÈÛÛfiÙÂÚ˜

·fi 34 ÌÂÙ·ÏÏ¿ÍÂȘ ÛÙÔ ÁÔÓ›‰ÈÔ Ô˘ Έ‰ÈÎÔ-

ÔÈ› ÙÔ ¤Ó˙˘ÌÔ FAH. √ ¤ÏÂÁ¯Ô˜ ÙÔ˘ DNA ÙÔ˘

·ÛıÂÓ‹ Ì·˜ ·ÔÎ¿Ï˘„ ÔÌÔ˙˘ÁˆÙ›· ÁÈ· ÙËÓ

ÌÂÙ¿ÏÏ·ÍË Met 1 Val ÛÙÔ ÚÒÙÔ ÂÍÒÓÈÔ ÙÔ˘ ÁÔ-

Óȉ›Ô˘ Ô˘ Έ‰ÈÎÔÔÈ› ÙÔ ¤Ó˙˘ÌÔ FAH. ∏ ÌÂ-

Ù¿ÏÏ·ÍË ·˘Ù‹, Ô˘ Â›Ó·È ÌÂÙ¿ÏÏ·ÍË “Ì ϿıÔ˜

ÓfiËÌ·” (missense), ÂÈʤÚÂÈ ‰È·Ù·Ú·¯‹ ÛÙËÓ

¤Ó·ÚÍË Ù˘ ÚˆÙÂ˚ÓÈ΋˜ Û‡ÓıÂÛ˘ (ÙÔ˘ ÂÓ˙‡-

ÌÔ˘) (1,12).

§fiÁˆ ÙˆÓ ÊÙˆ¯ÒÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ Ù˘ ‰È·È-

ÙËÙÈ΋˜ ıÂڷ›·˜ Î·È Ù˘ ˘„ËÏ‹˜ ıÓËÛÈÌfiÙË-

Ù·˜ Ù˘ ÌÂÙ·ÌfiÛ¯Â˘Û˘ ‹·ÙÔ˜ (10-15% ·ÎfiÌË

Î·È Û ȉ·ÓÈΤ˜ Û˘Óı‹Î˜), Ë ·Ó·Î¿Ï˘„Ë Ù˘

‰Ú¿Û˘ ÙÔ˘ NTBC ıˆڋıËΠ·ӿÛÙ·ÛË ÛÙË

ıÂڷ›· Ù˘ Ù˘ÚÔÛÈÓ·ÈÌ›·˜ Ù‡Ô˘ 1. ∆Ô Ê¿ÚÌ·-

ÎÔ ÌÂÏÂÙ‹ıËΠ·Ú¯Èο ·fi ÙÔ ∂ÚÁ·ÛÙ‹ÚÈÔ ∆ÔÍÈ-

ÎÔÏÔÁ›·˜ Zeneca Central Toxicology Laboratory

ÛÙÔ ∏ӈ̤ÓÔ µ·Û›ÏÂÈÔ Û·Ó ˙È˙·ÓÈÔÎÙfiÓÔ, ·ÏÏ¿

ÛÙȘ ÙÔÍÈÎÔÏÔÁÈΤ˜ ÌÂϤÙ˜ ÛÂ Â›Ì˘Â˜, ·Ú·ÙË-

Ú‹ıËΠfiÙÈ ÙÔ 80% ÂÌÊ¿ÓÈÛ·Ó ÔÊı·ÏÌÔÏÔÁÈΤ˜

‚Ï¿‚˜ ÏfiÁˆ ÂÓ·fiıÂÛ˘ ÎÚ˘ÛÙ¿ÏÏˆÓ Ù˘ÚÔÛ›-

Ó˘ ÛÙÔÓ ÎÂÚ·ÙÔÂȉ‹ ¯ÈÙÒÓ·. ∏ ÈÛ¯˘Ú‹ ·Ó·-

ÛÙ·ÏÙÈ΋ ‰Ú¿ÛË ÙÔ˘ NTBC ÛÙËÓ 4-˘‰ÚÔ͢ Ê·È-

Ó˘ÏÔ˘ÚÔ˘‚È΋ ‰ÈÔ͢ÁÂÓ¿ÛË (HPPD), Ô˘ ›ӷÈ

ÙÔ ÚÒÙÔ ¤Ó˙˘ÌÔ ÛÙÔ ÌÂÙ·‚ÔÏÈÎfi ÌÔÓÔ¿ÙÈ Ù˘

Ù˘ÚÔÛ›Ó˘, ·Ô‰Â›¯ÙËÎÂ Î·È Û ·ÓıÚÒÈÓÔ Ë·-

ÙÈÎfi ÈÛÙfi (7). ∆Ô ÛÎÂÙÈÎfi ÁÈ· ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘

NTBC ‚·Û›˙ÂÙ·È ÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ë ·Ó·ÛÙÔÏ‹

ÙÔ˘ ÂÓ˙‡ÌÔ˘ HPPD ÌÂÈÒÓÂÈ ÙËÓ ·Ú·ÁˆÁ‹ ÙˆÓ

ÙÔÍÈÎÒÓ ÌÂÙ·‚ÔÏÈÙÒÓ Ô˘ ·Ú¿ÁÔÓÙ·È ÌÂÙ¿ ·fi

ÙÔ HPPD Ì ÌfiÓË Â›ÙˆÛË Ù· ·˘ÍË̤ӷ ›-

‰· Ù˘ÚÔÛ›Ó˘ Ô˘ ‰ÂÓ ıˆÚÂ›Ù·È Ì›˙ÔÓ Úfi-

‚ÏËÌ· Û ·ÛıÂÓ›˜ Ô˘ ‹‰Ë ‚Ú›ÛÎÔÓÙ·È Û ‰›·È-

Ù· ÌÂȈ̤Ó˘ ÚfiÛÏ˄˘ Ù˘ÚÔÛ›Ó˘ (∂ÈÎfiÓ· 1).

ŒÙÛÈ, ÙÔ 1991 ¯ÔÚËÁ‹ıËΠÙÔ NTBC ÁÈ· ÚÒÙË

ÊÔÚ¿ Û ‚Ú¤ÊÔ˜ 2 ÌËÓÒÓ ÌÂ Ù˘ÚÔÛÈÓ·ÈÌ›· Ù‡Ô˘

1 Î·È ÔÍ›· Ë·ÙÈ΋ ·Ó¿ÚÎÂÈ· (7). ∆· ·ÔÙÂ-

ϤÛÌ·Ù· ‹Ù·Ó ÂÓÙ˘ˆÛȷο Î·È ¿ÌÂÛ· ÙfiÛÔ ÛÂ

ÎÏÈÓÈÎfi fiÛÔ Î·È Û ‚ÈÔ¯ËÌÈÎfi Â›Â‰Ô Î·È Ë ¯Ô-

Ú‹ÁËÛË NTBC Û 4 ·ÎfiÌ· ·ÛıÂÓ›˜ ËÏÈΛ·˜ 2-7

¯ÚÔÓÒÓ Â›¯Â ÂÍ›ÛÔ˘ ηϿ ·ÔÙÂϤÛÌ·Ù·. ŸÏÔÈ ÔÈ

·ÛıÂÓ›˜ ÂÌÊ¿ÓÈÛ·Ó ÛËÌ·ÓÙÈ΋ ‚ÂÏÙ›ˆÛË Ù˘

Ë·ÙÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ Î·È ÛÙ·‰È·Î‹ ÙÒÛË Ù˘

·-ÊÂÙÔÚˆÙ½Ó˘. ªÂÙ¿ ·fi ÙË ‰ËÌÔÛ›Â˘ÛË

ÙˆÓ ÚÒÙˆÓ ·˘ÙÒÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ, ‰ÈÂÍ‹¯ıË

ÔÏ˘ÎÂÓÙÚÈ΋ ÌÂϤÙË ·fi ÙË ÛԢˉÈ΋ ÔÌ¿‰·

ÙÔ˘ Gothenburg, Ô˘ Û˘ÓÙfiÓÈÛÂ ÙfiÛÔ ÙË ¯ÔÚ‹-

ÁËÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ fiÛÔ Î·È ÙË Ì¤ÙÚËÛË ÙˆÓ ÂÚ-

Á·ÛÙËÚÈ·ÎÒÓ ·Ú·Ì¤ÙÚˆÓ Î·È ÙËÓ Î·Ù·ÁÚ·Ê‹

ÙˆÓ Â˘ÚËÌ¿ÙˆÓ Û ÎÔÈÓ‹ ‚¿ÛË ‰Â‰ÔÌ¤ÓˆÓ ÙÔ˘

Gothenburg. ™ÙÔ ÚˆÙfiÎÔÏÏÔ ·˘Ùfi Û˘ÌÂÚÈ-

Ï·Ì‚¿ÓÔÓÙ·È ¿Óˆ ·fi 300 ·ÛıÂÓ›˜, ·fi ÙÔ˘˜

ÔÔ›Ô˘˜ ÂÚÈÛÛfiÙÂÚÔÈ ·fi 100 Ï·Ì‚¿ÓÔ˘Ó

NTBC ÁÈ· ¿Óˆ ·fi 5 ¯ÚfiÓÈ· (9). ªÂÙ¿ ·fi 9

¯ÚfiÓÈ· ·Ú·ÎÔÏÔ‡ıËÛ˘ ÙˆÓ ·ÛıÂÓÒÓ Ô˘ Û˘Ì-

ÌÂÙ›¯·Ó ÛÙÔ ÚˆÙfiÎÔÏÏÔ, ÔÈ Holme ηÈ

Lindstedt ·Ó·ÎÔ›ÓˆÛ·Ó fiÙÈ ‰ÂÓ ˘¿Ú¯Ô˘Ó ¿ÏÏ·

ÂÚÈÛÙ·ÙÈο Ë·ÙÔ΢ÙÙ·ÚÈÎÔ‡ ηÚΛÓÔ˘ ÛÙ·

¿ÙÔÌ· ÛÙ· ÔÔ›· ÍÂΛÓËÛ·Ó ·ÁˆÁ‹ ¤ÁηÈÚ·,

ÂÎÙfi˜ ·fi ‰‡Ô ·ÛıÂÓ›˜ (1%) Ô˘ ÂÌÊ¿ÓÈÛ·Ó

Ë·ÙÔ΢ÙÙ·ÚÈÎfi ηÚΛÓÔ ÚÈÓ ·fi ÙËÓ ËÏÈΛ·

ÙˆÓ 2 ¯ÚfiÓˆÓ, Ô ¤Ó·˜ ·fi ·˘ÙÔ‡˜ ηٿ ÙË ‰È¿-

ÁÓˆÛË Ù˘ ÓfiÛÔ˘. ∞ÓÙ›ıÂÙ·, ÛÙÔ˘˜ ·ÛıÂÓ›˜ ÌÂ

ηı˘ÛÙÂÚË̤ÓË ıÂڷ›· Ì NTBC, ıˆÚÔ‡Ó

fiÙÈ Ô Î›Ó‰˘ÓÔ˜ ÂÌÊ¿ÓÈÛ˘ Ë·ÙÔ΢ÙÙ·ÚÈÎÔ‡

ηÚΛÓÔ˘ Â›Ó·È ÛËÌ·ÓÙÈο ·˘ÍË̤ÓÔ˜ Î·È ı·

Ú¤ÂÈ Ó· Û˘ÓÂÎÙÈÌ¿Ù·È Ì ÙÔÓ Ê·ÈÓfiÙ˘Ô Î·È

ÙË ÁÂÓÈ΋ ÎÏÈÓÈ΋ ηٿÛÙ·ÛË Î¿ı ·ÛıÂÓ‹. ∂È-

ϤÔÓ, ηӤӷ˜ ·fi ÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ·ÓÙÈÌÂ-

Ùˆ›˙ÔÓÙ·È Ì NTBC ‰ÂÓ ÂÌÊ¿ÓÈÛ Ó¢ÚÔÏÔÁÈ-

Τ˜ ÎÚ›ÛÂȘ Ù‡Ô˘ ÔÚÊ˘Ú›·˜, Ô˘ ·ÔÙÂÏÔ‡Ó

ÙËÓ ÈÔ ‰Ú·Ì·ÙÈ΋ Î·È ‰˘ÓËÙÈο ı·Ó·ÙËÊfiÚ·

ÂÈÏÔ΋ Ù˘ Ù˘ÚÔÛÈÓ·ÈÌ›·˜. √È ·ÓÂÈı‡ÌËÙ˜

ÂÓ¤ÚÁÂȘ ·fi ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ‹Ù·Ó

ÂÏ¿¯ÈÛÙ˜, ÌÂ Û˘¯ÓfiÙÂÚ˜ ÙËÓ ÂÌÊ¿ÓÈÛË ıÔÏÂ-

ÚfiÙËÙ·˜ ÛÙÔÓ ÎÂÚ·ÙÔÂȉ‹ ÏfiÁˆ ÂÓ·fiıÂÛ˘

ÎÚ˘ÛÙ¿ÏÏˆÓ Ù˘ÚÔÛ›Ó˘ (9).

∏ ¯ÔÚ‹ÁËÛË NTBC ÛÙÔÓ ·ÛıÂÓ‹ Ì·˜ Î·È Ë

·Ú·ÎÔÏÔ‡ıËÛ‹ ÙÔ˘ ¤ÁÈÓ ۇÌʈӷ Ì ÙÔ Úˆ-

ÙfiÎÔÏÏÔ ÙˆÓ ™Ô˘Ë‰ÒÓ ÂÚ¢ÓËÙÒÓ. ∏ ıÂڷ›·

ÍÂΛÓËÛ ·Ì¤Ûˆ˜ ÌÂÙ¿ ·fi ÙË ‰È¿ÁÓˆÛË Û ËÏÈ-

Λ· 5 ÌËÓÒÓ, Ë ÎÏÈÓÈ΋ Î·È ÂÚÁ·ÛÙËÚȷ΋ ‚ÂÏ-

Ù›ˆÛË ÙÔ˘ ·ÛıÂÓÔ‡˜ ‹Ù·Ó ÂÓÙ˘ˆÛȷ΋, ÂÓÒ Ù·

¶·È‰È·ÙÚÈ΋ 2006;69:45-51

Pediatr Jan-Feb 06 final allges 27-01-06 15:35 ™ÂÏ›‰·50

Page 51: Παιδιατρική | Τόμος 69 • Τεύχος 1 • Ιανουάριος - Φεβρουάριος 2006

51£Âڷ›· Ù˘ÚÔÛÈÓ·ÈÌ›·˜ Ù‡Ô˘ π

›‰· Ù˘ ·-ÊÂÙÔÚˆÙ½Ó˘ ·ӋÏı·Ó ÛÙ·

Ê˘ÛÈÔÏÔÁÈο fiÚÈ· ÌÂÙ¿ ·fi ¤Ó·Ó ¯ÚfiÓÔ ıÂÚ·-

›·˜. √ ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ‰‡Ô Î·È ÙÚ›·

¯ÚfiÓÈ· ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂڷ›·˜ ¤‰ÂÈÍÂ

Û·Ê‹ ‚ÂÏÙ›ˆÛË Ù˘ Ë·ÙÈ΋˜ ÂÈÎfiÓ·˜. √ ·ÛıÂ-

Ó‹˜ Ì·˜ ‰ÂÓ ¤¯ÂÈ ÂÌÊ·Ó›ÛÂÈ Ó¢ÚÔÏÔÁÈΤ˜ ÎÚ›-

ÛÂȘ Ù‡Ô˘ ÔÚÊ˘Ú›·˜, ÁÂÁÔÓfi˜ Ô˘ Û˘ÓËÁÔÚ›

fiÙÈ ÙÔ NTBC ÚÔÛٷهÂÈ ·fi ·˘Ù‹ ÙËÓ ÂÈ-

ÏÔ΋ Î·È ÂÈϤÔÓ, ‰ÂÓ ¤¯ÂÈ ·ÚÔ˘ÛÈ¿ÛÂÈ Î·-

Ì›· ·ÓÂÈı‡ÌËÙË ÂÓ¤ÚÁÂÈ· ·fi ÙË ıÂڷ›· ̤-

¯ÚÈ Û‹ÌÂÚ·.

∞Í›˙ÂÈ Ó· ÛËÌÂȈı› fiÙÈ ÂÎÙfi˜ ·fi ÙËÓ ·Ô-

ηٿÛÙ·ÛË Ù˘ ÓÂÊÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ (Ô˘ ‰È·-

ÈÛÙÒıËÎÂ Î·È ÛÙÔÓ ·ÛıÂÓ‹ Ì·˜), ÛÙfi¯Ô˜ Ù˘

‰›·ÈÙ·˜ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È

Ì NTBC Â›Ó·È Ë ‰È·Ù‹ÚËÛË ÙˆÓ ÂȤ‰ˆÓ Ù˘

Ù˘ÚÔÛ›Ó˘ οو ·fi 500 Ìmol/L, ÁÈ· Ó· ÚÔÏË-

Êı› Ë ÂÓ·fiıÂÛË ÎÚ˘ÛÙ¿ÏÏˆÓ Î˘ÛÙ›Ó˘ ÛÙÔÓ

ÎÂÚ·ÙÔÂȉ‹. √È ÂÓ·Ôı¤ÛÂȘ Ù˘ÚÔÛ›Ó˘ ÛÙÔÓ

ÎÂÚ·ÙÔÂȉ‹ ÌÔÚÔ‡Ó Ó· ÚÔηϤÛÔ˘Ó ·›ÛıËÌ·

η‡ÛÔ˘ Î·È ‰·ÎÚ‡ÚÚÔÈ·, ÁÈ' ·˘Ùfi ÔÈ ·ÛıÂÓ›˜

Ô˘ ·›ÚÓÔ˘Ó NTBC ı· Ú¤ÂÈ Ó· ÂÍÂÙ¿˙ÔÓÙ·È

ÔÊı·ÏÌÔÏÔÁÈο Û ٷÎÙ¿ ‰È·ÛÙ‹Ì·Ù· (·Ó¿ ÙÚ›-

ÌËÓÔ) Ì ۯÈÛÌÔÂȉ‹ Ï˘¯Ó›·. √ ·ÛıÂÓ‹˜ Ì·˜

‰ÂÓ ·ÚÔ˘Û›·ÛÂ Û˘Ìو̷ÙÔÏÔÁ›· Ô‡Ù ·ıÔ-

ÏÔÁÈο Â˘Ú‹Ì·Ù· ÛÙȘ ÂÚÈÔ‰ÈΤ˜ ÔÊı·ÏÌÔÏÔ-

ÁÈΤ˜ ÂÍÂÙ¿ÛÂȘ.

¶ÚÔ˜ ÙÔ ·ÚfiÓ, Ô ·ÚÈıÌfi˜ ÙˆÓ ·ÛıÂÓÒÓ Î·È

Ô ¯ÚfiÓÔ˜ ·Ú·ÎÔÏÔ‡ıËÛ˘ ‰ÂÓ Â›Ó·È ·ÚÎÂÙfi˜

ÁÈ· ÙËÓ ÂÍ·ÁˆÁ‹ ÔÚÈÛÙÈÎÒÓ Û˘ÌÂÚ·ÛÌ¿ÙˆÓ ÁÈ·

ÙËÓ ·ÔÙÚÂÙÈ΋ ‰Ú¿ÛË ÙÔ˘ NTBC ÛÙËÓ ÂÌÊ¿-

ÓÈÛË ÙÔ˘ Ë·ÙÔ΢ÙÙ·ÚÈÎÔ‡ ηÚΛÓÔ˘ ÛÙ· ·È‰È¿

ÌÂ Ù˘ÚÔÛÈÓ·ÈÌ›· Ù‡Ô˘ π. ¶·Ú¿ÏÏËÏ· ÌÂ ÙËÓ

ÔÌ¿‰· ÙÔ˘ Gothenburg, ÌÂÏÂÙ¿Ù·È Ë ·ÔÙÂÏÂ-

ÛÌ·ÙÈÎfiÙËÙ· ÙÔ˘ NTBC ·fi ÙËÓ ÔÌ¿‰· ÙÔ˘

Quebec, ÏfiÁˆ ÙˆÓ È‰È·›ÙÂÚˆÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ

ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ÂÚ¢ÓÒÓÙ·È ÂΛ (3). ∂›Ó·È

·Ó·Áη›· Ë Û˘ÌÌÂÙÔ¯‹ fiÏˆÓ ÙˆÓ ·ÛıÂÓÒÓ ÌÂ

Ë·ÙÔÓÂÊÚÈ΋ Ù˘ÚÔÛÈÓ·ÈÌ›· ÛÙ· ÚˆÙfiÎÔÏÏ·

ıÂڷ›·˜ Î·È ·Ú·ÎÔÏÔ‡ıËÛ˘, ÁÈ· ÙË Û˘ÏÏÔ-

Á‹ fiÛÔ ÙÔ ‰˘Ó·ÙfiÓ ÂÚÈÛÛfiÙÂÚˆÓ ÏËÚÔÊÔÚÈÒÓ

ÁÈ· ÙË ÓfiÛÔ Î·È ÙË Ì·ÎÚÔ¯ÚfiÓÈ· ›‰Ú·ÛË ÙÔ˘

NTBC. ∏ ·Ó¿Ù˘ÍË Ë·ÙÔ΢ÙÙ·ÚÈÎÔ‡ ηÚΛ-

ÓÔ˘, Û ÂÈÚ·Ì·ÙÈο ÌÔÓ٤Ϸ ÔÓÙÈÎÒÓ Ì ·ÓÂ-

¿ÚÎÂÈ· FAH ÛÙÔ˘˜ ÔÔ›Ô˘˜ ¯ÔÚËÁ‹ıËÎÂ

NTBC, ·ÔÙÂÏ› ·fi‰ÂÈÍË fiÙÈ ÔÈ ·ÛıÂÓ›˜ ÌÂ Ù˘-

ÚÔÛÈÓ·ÈÌ›· Ù‡Ô˘ π ̆ fi ·ÁˆÁ‹ Ì NTBC ı· Ú¤-

ÂÈ Ó· ·Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·È ÛÙÂÓ¿ ÁÈ· Ù˘¯fiÓ ·Ó¿-

Ù˘ÍË Î·ÚΛÓÔ˘ (1,13).

™˘ÌÂÚ·ÛÌ·ÙÈο, Ë Ì¤¯ÚÈ Û‹ÌÂÚ· ¿ÚÈÛÙË

ÎÏÈÓÈ΋ Î·È ÂÚÁ·ÛÙËÚȷ΋ ÔÚ›· ÙÔ˘ ·ÛıÂÓ‹

Ì·˜ ÂÓÈÛ¯‡Ô˘Ó Ù· ·ÈÛÈfi‰ÔÍ· ‚È‚ÏÈÔÁÚ·ÊÈο ‰Â-

‰Ô̤ӷ ÁÈ· Ù· ıÂڷ¢ÙÈο ·ÔÙÂϤÛÌ·Ù· ÙÔ˘

NTBC Û ·ÛıÂÓ›˜ ÌÂ Ù˘ÚÔÛÈÓ·ÈÌ›· Ù‡Ô˘ 1.

º·›ÓÂÙ·È fiÙÈ Î·ıÔÚÈÛÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ÁÈ· ÙËÓ

ηϋ ÔÚ›· ÙˆÓ ·ÛıÂÓÒÓ Â›Ó·È Ë ¤ÁηÈÚË ‰È¿-

ÁÓˆÛË Î·È ¤Ó·ÚÍË Ù˘ ıÂڷ›·˜ Ì ·Ú·ÎÔ-

ÏÔ‡ıËÛË ‚¿ÛÂÈ ÙÔ˘ Û˘ÁÎÂÎÚÈ̤ÓÔ˘ ÚˆÙÔÎfiÏ-

ÏÔ˘ Ù˘ ÔÌ¿‰·˜ ÙÔ˘ Gothenburg, Ô˘ ÚÔ¸Ô-

ı¤ÙÂÈ Î·Ï‹ Û˘ÓÂÚÁ·Û›· ÙˆÓ ‰È·ÊfiÚˆÓ ÂȉÈÎÒÓ

Ô˘ Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË.

µÈ‚ÏÈÔÁÚ·Ê›·

1. Mitchell G, Grompe M, Lambert M, Tanguay R.

Hypertyrosinemia. In: Scriver RC, Beaudet A, Sly WS,

Valle D eds. The Metabolic and Molecular Bases of

Inherited Disease. 8th ed. New York: McGrawHill;

2001. p. 1777-1806.

2. Russo PA, Mitchell GA, Tanguay RM. Tyrosinemia: a

review. Pediatr Dev Pathol 2001;4(3):212-221.

3. Paradis K. Tyrosinemia: the Quebec experience. Clin

Invest Med 1996;19:311-316.

4. Holme E, Lindstedt S. Tyrosinaemia type I and NTBC

(2-(2-nitro-4-trifluoromethylbenzoyl)-1,3-cyclo-

hexanedione). J Inherit Metab Dis 1998;21:507-517.

5. Wijburg FA, Reitsma WC, Slooff MJ, van Spronsen

FJ, Koetse HA, Reijngoud DJ et al. Liver transplanta-

tion in tyrosinaemia type I: the Groningen experi-

ence. J Inherit Metab Dis 1995;18:115-118.

6. Holme E, Lindstedt S. Diagnosis and management of

tyrosinemia type I. Curr Opin Pediatr 1995;7:726-732.

7. Lock EA, Ellis MK, Gaskin P, Robinson M, Auton TR,

Provan WM et al. From toxicological problem to

therapeutic use: the discovery of the mode of action

of 2-(2-nitro-4-trifluoromethylbenzoyl)-1,3-cyclo-

hexanedione (NTBC), its toxicology and develop-

ment as a drug. J Inher Metab Dis 1998;21:498-506.

8. Lindstedt S, Holme E, Lock EA, Hjalmarson O,

Strandvik B. Treatment of hereditary tyrosinemia

type I by inhibition of 4-hydroxyphenylpyruvate

dioxygenase. Lancet 1992;340:813-817.

9. Holme E, Lindstedt S. Nontransplant treatment of ty-

rosinemia. Clin Liver Dis 2000;4:805-814.

10. van Spronsen FJ, Thomasse Y, Smit GP, Leonard JV,

Clayton PT, Fidler V et al. Hereditary tyrosinemia

type I: a new clinical classification with difference in

prognosis on dietary treatment. Hepatology 1994; 20:

1187-1191.

11. ∆ÛÈ·Ú¿˙Ë-™Ù¿ÌÔ˘ ª, §·Ê·˙¿Ó˘ µ, ™·‚‚ÔÔ‡-

ÏÔ˘-∞˘ÁÔ˘ÛÙ›‰Ô˘ ¶, Sewell A, Berger Rª, ¶·ÈÔÓ›-

‰Ë˜ ∞. ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ∆˘ÚÔÛÈÓ·ÈÌ›·˜ Ù‡-

Ô˘ π. ¶·È‰È·ÙÚ µ ∂ÏÏ¿‰·˜ 1997;9:257-261.

12. Bergeron A, D'Astous M, Timm DE, Tanguay RM.

Structural and functional analysis of missense muta-

tions in fumarylacetoacetate hydrolase, the gene defi-

cient in hereditary tyrosinemia type 1. J Biol Chem.

2001;276:15225-15231.

13. Grompe M, Overturf K, Al-Dhalimy M, Finegold.

Therapeutic trials in the murine model of hereditary

tyrosinemia type I: A progress report. J Inherit Metab

Dis 1998;21:518-531.

¶·È‰È·ÙÚÈ΋ 2006;69:45-51

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52 ∂¡¢π∞º∂ƒ√À™∞ ¶∂ƒπ¶∆ø™∏ CASE REPORT

¶·È‰È·ÙÚÈ΋ 2006;69:52-58

1 ∂ÚÁ·ÛÙ‹ÚÈÔ π·ÙÚÈ΋˜°ÂÓÂÙÈ΋˜ ¶·ÓÂÈÛÙËÌ›Ô˘∞ıËÓÒÓ, ¡ÔÛÔÎÔÌ›Զ·›‰ˆÓ “∞Á›· ™ÔÊ›·”,∞ı‹Ó·

2 ¶·È‰ÔÓÂÊÚÔÏÔÁÈÎfi ∆Ì‹Ì·,¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›·™ÔÊ›·”, ∞ı‹Ó·

3 ∞ÓÔÛÔÏÔÁÈÎfi ∆Ì‹Ì·,¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó·

4 ¡ÂÊÚÔ·ıÔÏÔÁÔ·Ó·ÙÔÌÈÎfi∆Ì‹Ì·, ¡ÔÛÔÎÔÌ›ԓ∂˘·ÁÁÂÏÈÛÌfi˜”, ∞ı‹Ó·

AÏÏËÏÔÁÚ·Ê›·:

ŒÏÂÓ· ºÚ˘Û›Ú· ∂ÚÁ·ÛÙ‹ÚÈÔ π·ÙÚÈ΋˜ °ÂÓÂÙÈ΋˜,ÈڤÌÂÈÔ ∂Ú¢ÓËÙÈÎfi∂ÚÁ·ÛÙ‹ÚÈÔ,¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”,∆.∫. 115 27, ∞ı‹Ó· E-mail: [email protected]

∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 15-11-2004 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 21-09-2005

Schimke ·ÓÔÛÔ-ÔÛÙÈ΋ ‰˘ÛÏ·Û›·. ¶ÂÚÈÁÚ·Ê‹

ÂÚ›ÙˆÛ˘ Î·È ·Ó·ÛÎfiËÛË Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜

™. æÒÓË1, ∂. °ÂˆÚÁ¿ÎË2, ∞. ∫·fiÁÈ·ÓÓ˘2, ∞. ™·Ï·‚Ô‡Ú·3, ª. ∫·Ó¿ÚÈÔ˘3, º. ™fiÙÛÈÔ˘4, Œ. ºÚ˘Û›Ú·1

¶ÂÚ›ÏË„Ë:∏ ·ÓÔÛÔ-ÔÛÙÈ΋ ‰˘ÛÏ·Û›· Ù‡Ô˘ Schimke (Schimke immuno-osseous dysplasia -SIOD, Online Mendelian Inheritance In Man, website: http://www.ncbi.nlm.nih.gov/htbin-post/OMIM; OMIM:242900) Â›Ó·È Û¿ÓÈÔ ÁÂÓÂÙÈÎfi ÓfiÛËÌ· Ô˘ ÎÏËÚÔÓÔÌÂ›Ù·È Ì ˘ÔÏÂÈfiÌÂÓÔ·˘ÙÔۈ̷ÙÈÎfi ¯·Ú·ÎÙ‹Ú·, ÙÔ ÔÔ›Ô ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÛÔÓ‰˘ÏÔ-ÂÈÊ˘Ûȷ΋ ‰˘ÛÏ·Û›·, ÓÂ-ÊÚÈ΋ ·Ó¿ÚÎÂÈ·, ÂÏ·Ùو̷ÙÈ΋ ΢ÙÙ·ÚÈ΋ ·ÓÔÛ›· Î·È ¯·Ú·ÎÙËÚÈÛÙÈÎfi Ê·ÈÓfiÙ˘Ô Ì ‰˘Û·Ó¿ÏÔ-ÁÔ ÎÔÓÙfi ·Ó¿ÛÙËÌ·, ÙÚÈÁˆÓÈÎfi ÚfiÛˆÔ, ·ÔÛÙÚÔÁÁ˘ÏÂ̤ÓË Ì‡ÙË Î·È ˘Âگڈ̷ÙÈΤ˜ ÎËÏ›‰Â˜ÛÙËÓ ÎÔÈÏȷ΋ ¯ÒÚ·. ∆Ô ˘Â‡ı˘ÓÔ ÁÔÓ›‰ÈÔ ¤¯ÂÈ ¯·ÚÙÔÁÚ·ÊËı› ÚfiÛÊ·Ù·. ∏ SIOD Ú¤ÂÈ Ó· Â-ÚÈÏ·Ì‚¿ÓÂÙ·È ÛÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ÙˆÓ ÂÚÈÙÒÛÂˆÓ Ì ηı˘ÛÙ¤ÚËÛË ÛˆÌ·ÙÈ΋˜ ·Ó¿Ù˘ÍË˜Î·È ÔÛÙÈ΋˜ ‰˘ÛÏ·Û›·˜, ηıÒ˜ Û˘Ó‰˘¿˙ÂÙ·È Ì ‰˘ÛÌÂÓ‹ ÚfiÁÓˆÛË, ÏfiÁˆ ÛÔ‚·Ú‹˜ ‚Ï¿‚˘ ÙË˜Î˘ÙÙ·ÚÈ΋˜ ·ÓÔÛ›·˜ Î·È ÚÔÛ‚ÔÏ‹˜ ÙˆÓ ÓÂÊÚÒÓ. ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ·ÁÔÚÈÔ‡ ËÏÈΛ·˜ 3ÂÙÒÓ, ÙÔ ÔÔ›Ô ÚÔÛ‹Ïı ÏfiÁˆ ¯·ÌËÏÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜ Î·È ÏÂ˘ÎˆÌ·ÙÔ˘Ú›·˜.

§¤ÍÂȘ ÎÏÂȉȿ: Schimke ·ÓÔÛÔ-ÔÛÙÈ΋ ‰˘ÛÏ·Û›·, ÏÂ˘ÎˆÌ·ÙÔ˘Ú›·, ȉȿ˙ÔÓ ÚÔۈ›Ô.

Schimke immuno-osseous dysplasia. Case report and review of the

literature

S. Psoni1, H. Georgaki2, A. Kapogiannis2, A. Salavoura3, M. Kanariou3, F. Sotsiou4, H. Fryssira1

Abstract: Schimke immuno-osseous dysplasia (SIOD) [(Schimke immuno-osseous dysplasia -SIOD, Online Mendelian Inheritance In Man, website: http://www.ncbi.nlm.nih.gov/htbin-post/OMIM; OMIM:242900)] is a rare autosomal recessive disorder characterized by spondylo-epiphyseal dysplasia, renal failure, defective cellular immunity and distinct phenotype withdisproportionate short stature, triangular face, bulbous nose and abdominal pigmented spots. Theresponsible gene has been mapped recently. SIOD must be included in the differential diagnosis ofcases with growth retardation and osseous dysplasia, as the prognosis can be poor, because of severedamage of the cellular immunity and renal insult. A case of a three year-old boy with short stature andproteinuria, characteristic features in this condition, is described.

Key words: Schimke immuno-osseous dysplasia, proteinuria, dysmorphic features.

™˘ÓÙÔÌÔÁڷʛ˜

√ªπª Online Mendelian inheritance in man SIOD Schimke immuno-osseous dysplasia ∂∫∞ ∂Ó‰ÔÌ‹ÙÚÈ· ηı˘ÛÙ¤ÚËÛË ·Ó¿Ù˘Í˘ KO¶ ∫˘ÛÙÂÔÔ˘ÚËÙËÚÈ΋ ·ÏÈÓ‰ÚfiÌËÛË ª™ ª‹ÎÔ˜ ÛÒÌ·ÙÔ˜ ¶∫ ¶ÂÚ›ÌÂÙÚÔ˜ ÎÂÊ·Ï‹˜ ∂£ ∂ηÙÔÛÙÈ·›· ı¤ÛË µ™ µ¿ÚÔ˜ ÛÒÌ·ÙÔ˜ À™ ⁄„Ô˜ ÛÒÌ·ÙÔ˜ PHA Phytohemagglutinin FSGS Focal segmental glomerular sclerosis (ÂÛÙÈ·-

΋ ÙÌËÌ·ÙÈ΋ ÛÂÈÚ·Ì·ÙÔÛÎÏ‹Ú˘ÓÛË)

G-CSF Granulocyte-colony stimulating factor(‰ÈÂÁÂÚÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ·ÔÈÎÈÒÓ ÙˆÓÎÔÎÎÈÔ΢ÙÙ¿ÚˆÓ)

GM-CSF Granulocyte-monocyte-colony stimulatingfactor (‰ÈÂÁÂÚÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ·ÔÈÎÈÒÓÙˆÓ ÎÔÎÎÈÔ΢ÙÙ¿ÚˆÓ-ÌÔÓÔ΢ÙÙ¿ÚˆÓ)

∂ÈÛ·ÁˆÁ‹

∏ ·ÓÔÛÔ-ÔÛÙÈ΋ ‰˘ÛÏ·Û›· Ù‡Ô˘ Schimke(Schimke immuno-osseous dysplasia - SIOD,√ªπª: 242900) Â›Ó·È Ì›· Û¿ÓÈ· ÔÏ˘Û˘ÛÙËÌ·-ÙÈ΋ ÁÂÓÂÙÈ΋ ‰È·Ù·Ú·¯‹ Ô˘ ÎÏËÚÔÓÔÌÂ›Ù·È ÌÂ

1 Medical GeneticsLaboratory, University ofAthens, “Aghia Sophia”Children's Hospital, Athens

2 Department of PaediatricNephrology, “AghiaSophia” Children'sHospital, Athens

3 Department ofImmunology, “AghiaSophia” Children'sHospital, Athens

4 Department of RenalPathology, “Evaggelismos”General Hospital, Athens

Correspondence:

Helen Fryssira Medical Genetics Laboratory, Choremio Research Laboratory, “Aghia Sophia” Children'sHospital, 115 27, Athens E-mail: [email protected]

Date of submission: 15-11-2004 Date of approval: 21-09-2005

Pediatr Jan-Feb 06 final allges 27-01-06 15:35 ™ÂÏ›‰·52

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53Schimke ·ÓÔÛÔ-ÔÛÙÈ΋ ‰˘ÛÏ·Û›·

¶·È‰È·ÙÚÈ΋ 2006;69:52-58

˘ÔÏÂÈfiÌÂÓÔ ·˘ÙÔۈ̷ÙÈÎfi ¯·Ú·ÎÙ‹Ú·.

√Ê›ÏÂÙ·È Û ÌÂÙ¿ÏÏ·ÍË ÂÓfi˜ Ú˘ıÌÈÛÙÈÎÔ‡ ÁÔÓÈ-

‰›Ô˘ Ô˘ ·Ó·Î·Ï‡ÊıËΠÚfiÛÊ·Ù· Î·È ¤¯ÂÈ

Û¯¤ÛË Ì ÙËÓ ·Ó·‰ÈÔÚÁ¿ÓˆÛË Ù˘ ¯ÚˆÌ·Ù›Ó˘

(chromatin remodelling) (1). ∏ ÎÏÈÓÈ΋ ÂÈÎfiÓ·

ÂÚÈÏ·Ì‚¿ÓÂÈ ¯·Ú·ÎÙËÚÈÛÙÈÎfi Ê·ÈÓfiÙ˘Ô,

ÛÔÓ‰˘ÏÔÂÈÊ˘Ûȷ΋ ‰˘ÛÏ·Û›· Ì ·ÎfiÏÔ˘-

ıÔ ¯·ÌËÏfi ·Ó¿ÛÙËÌ·, ‰È·Ù·Ú·¯‹ Ù˘ ΢ÙÙ·ÚÈ-

΋˜ ·ÓÔÛ›·˜ Î·È ÏÂ˘ÎˆÌ·ÙÔ˘Ú›· ÓÂÊÚˆÛÈÎÔ‡

Ù‡Ô˘ (2). ¢È·¯ˆÚ›˙ÂÙ·È ·‰Ú¿ Û ‰‡Ô Ù‡Ô˘˜: ·)

‚ÚÂÊÈÎfi˜ Ù‡Ô˜, Ì ηı˘ÛÙ¤ÚËÛË ÂÓ‰ÔÌ‹ÙÚÈ·˜

·Ó¿Ù˘Í˘, ‚·ÚÈ¿ ÎÏÈÓÈ΋ ÂÈÎfiÓ· Î·È ÚÒÈÌË

ıÓËÛÈÌfiÙËÙ· Î·È ıÓËÙfiÙËÙ· Î·È ‚) ÂÊË‚ÈÎfi˜ Ù‡-

Ô˜ (8-13 ¤ÙË), Ô˘ ¤¯ÂÈ ËÈfiÙÂÚË ÎÏÈÓÈ΋ ‰È·-

‰ÚÔÌ‹, Ì ÚÔ˚Ô‡Û· ÓÂÊÚÈ΋ ‚Ï¿‚Ë, ·Ó·ÛÙÔÏ‹

·‡ÍËÛ˘ ηٿ ÙËÓ ÂÊ˂›· Î·È ÌÂÁ·Ï‡ÙÂÚË ÂÈ-

‚›ˆÛË (3). ¶·ÚÔ˘ÛÈ¿˙ÂÙ·È Ë ÂÚ›ÙˆÛË ·ÁÔÚÈÔ‡

ËÏÈΛ·˜ 3 ÂÙÒÓ Ì ÎÏÈÓÈÎÔÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·-

Ù· Û˘Ì‚·Ù¿ Ì ÙÔ ÂÍ·ÈÚÂÙÈο Û¿ÓÈÔ ·˘Ùfi ÁÂÓÂ-

ÙÈÎfi ÓfiÛËÌ·, ÂÓÒ Á›ÓÂÙ·È ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË

Î·È ·Ó·ÛÎfiËÛË Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜.

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘

∞ÁfiÚÈ ËÏÈΛ·˜ 3 ÂÙÒÓ ÚÔÛ‹Ïı ÛÙÔ ¶·È‰Ô-

ÓÂÊÚÔÏÔÁÈÎfi ∆Ì‹Ì· ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ ηÙfiÈÓ

·Ú·ÔÌ‹˜ ·fi Â͈ÙÂÚÈÎfi È·ÙÚfi ÁÈ· ¤ÏÂÁ¯Ô

΢ÛÙÂÔÔ˘ÚËÙËÚÈ΋˜ ·ÏÈÓ‰ÚfiÌËÛ˘. ™˘Á¯Úfi-

Óˆ˜, fï˜, ·Ú·ÙËÚ‹ıËΠ¯·ÌËÏfi ·Ó¿ÛÙËÌ·

Î·È Î¿ÔÈ· ȉȷ›ÙÂÚ· ÌÔÚÊÔÏÔÁÈο ¯·Ú·ÎÙËÚÈ-

ÛÙÈο. ø˜ ÂÎ ÙÔ‡ÙÔ˘, ·Ú·¤ÌÊıËΠÁÈ· ÂÚ·È-

Ù¤Úˆ ‰ÈÂÚ‡ÓËÛË ÛÙÔ È·ÙÚÂ›Ô °ÂÓÂÙÈ΋˜. ¶Úfi-

ÎÂÈÙ·È ÁÈ· ÙÔ ÚÒÙÔ ·È‰› Ê·ÈÓÔÙ˘Èο ˘ÁÈÒÓ

ÁÔÓ¤ˆÓ, ÌË Û˘ÁÁÂÓÒÓ ÌÂٷ͇ ÙÔ˘˜ Î·È Ì Âχ-

ıÂÚÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi. ∆Ô ÌÈÎÚfiÙÂÚÔ

·‰ÂÏÊ¿ÎÈ ÙÔ˘ ‹Ù·Ó ˘ÁȤ˜. ∞fi ÙÔ ·ÙÔÌÈÎfi ·Ó·-

ÌÓËÛÙÈÎfi ·Ó·Ê¤ÚÂÙ·È fiÙÈ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘

ÂÁ΢ÌÔÛ‡Ó˘ (28Ë Â‚‰ÔÌ¿‰·) ›¯Â ‰È·ÈÛÙˆı›

˘ÂÚ˯ÔÁÚ·ÊÈο ÔÏÈÁÔ¸‰Ú¿ÌÓÈÔ. √ ·ÛıÂÓ‹˜

ÁÂÓÓ‹ıËΠ̠ηÈÛ·ÚÈ΋ ÙÔÌ‹ ÙËÓ 36Ë Â‚‰ÔÌ¿-

‰· Ù˘ ΢‹Ûˆ˜, ÏfiÁˆ ∂∫∞ (‚¿ÚÔ˜ Á¤ÓÓËÛ˘:

2000 g), ÂÓÒ Ù· ˘fiÏÔÈ· ۈ̷ÙÔÌÂÙÚÈο ÛÙÔÈ-

¯Â›· ‹Ù·Ó ÛÙ· ηÙÒÙÂÚ· Ê˘ÛÈÔÏÔÁÈο fiÚÈ·

(ª™: 48 cm Î·È ¶∫: 32,5 cm ÛÙËÓ 3Ë ∂£). ™Â

ËÏÈΛ· 37 ËÌÂÚÒÓ ·ÚÔ˘Û›·Û ԢÚÔÏԛ̈ÍË. √

¤ÏÂÁ¯Ô˜ Ô˘ ·ÎÔÏÔ‡ıËÛ ¤‰ÂÈÍ ΢ÛÙÂÔÔ˘ÚË-

ÙËÚÈ΋ ·ÏÈÓ‰ÚfiÌËÛË 4Ô˘-5Ô˘ ‚·ıÌÔ‡ ‰ÂÍÈ¿

Î·È 2Ô˘ ‚·ıÌÔ‡ ·ÚÈÛÙÂÚ¿, ÁÈ· ÙËÓ ÔÔ›· ¤Ï·‚Â

¯ËÌÂÈÔÚÔʇϷÍË. ∞fi ÙÔÓ 8Ô Ì‹Ó· ·Ú·ÙË-

Ú‹ıËΠ‚Ú·¯˘ÛˆÌ›· (À™: 63 cm, <3Ë E£), ÂÓÒ

ÙÔ µ™ Î·È Ë ¶∫ ·Ú¤ÌÂÓ·Ó ÛÙËÓ 3Ë ∂£. ™Â ËÏÈ-

Λ· 1,5 ¤ÙÔ˘˜, ÏfiÁˆ ÙÔ˘ ¯·ÌËÏÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜,

¤ÁÈÓ ÂÓ‰ÔÎÚÈÓÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜, Ô ÔÔ›Ô˜ ‹Ù·Ó

Ê˘ÛÈÔÏÔÁÈÎfi˜. ∆ÔÓ ÙÂÏÂ˘Ù·›Ô ¯ÚfiÓÔ ·Ó·Ê¤ÚÔ-

ÓÙ·Ó Â›Û˘ Û˘¯Ó¿ ÂÂÈÛfi‰È· ÔÍ›·˜ ̤Û˘

ˆÙ›Ùȉ·˜ Î·È ÏÔÈÌÒÍÂˆÓ ·Ó·Ó¢ÛÙÈÎÔ‡. ∫·Ù¿

ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË Û ËÏÈΛ· 3 ÂÙÒÓ,

‰È·ÈÛÙÒıËΠfiÙÈ ÙÔ µ™ ‹Ù·Ó 10.700 g (3Ë-10Ë

∂£), ÙÔ À™ ‹Ù·Ó 81 cm (3Ë ∂£) Î·È Ë ¶∫ ‹Ù·Ó

47 cm (<3Ë ∂£). º·ÈÓÔÙ˘Èο, ·ÚÔ˘Û›·˙Â

ÙÚÈÁˆÓÈÎfi Û¯‹Ì· ÚÔÛÒÔ˘, ÂÌ‚¿ı˘ÓÛË

ÔÊı·ÏÌÒÓ, ‹ÈÔ Ô›‰ËÌ· ‚ÏÂÊ¿ÚˆÓ, ÚÔ¤¯Ô˘Û·

̇ÙË Ì ¢Ú›· Á¤Ê˘Ú· Î·È Ï·Ù‡ ·ÎÚÔÚÚ›ÓÈÔ,

ıÔψً ˘ÂÚÒ· Î·È Ì·ÎÚ‡ ÏÂÙfi ¿Óˆ ¯Â›ÏÔ˜.

√ ·˘¯¤Ó·˜ ‹Ù·Ó ÎÔÓÙfi˜, Ô ÎÔÚÌfi˜ ‚Ú·¯‡˜ ΢-

ÏÈÓ‰ÚÈÎfi˜ (barrel chest) Î·È Ë ÎÔÈÏ›· ÚÔ¤¯Ô˘-

Û·. ∂›¯Â ÔÛÊ˘˚΋ ÏfiÚ‰ˆÛË Î·È ÌÈÎÚ‹ ‰˘Û·Ó·-

ÏÔÁ›· ÎÔÚÌÔ‡-¿ÎÚˆÓ (∂ÈÎfiÓ˜ 1, 2). ™ÙÔ ‰¤ÚÌ·

ÂÌÊ¿ÓÈ˙ ˘Âگڈ̷ÙÈΤ˜ ÎËÏ›‰Â˜, ÌÈÎÚÔ‡ ÌÂ-

Á¤ıÔ˘˜ Î·È ‰È·ÊfiÚÔ˘ Û¯‹Ì·ÙÔ˜, ÂÚÈÛÛfiÙÂÚÔ

ÂÌÊ·Ó›˜ ÛÙËÓ ÂÚÈÔ¯‹ Ù˘ ÎÔÈÏ›·˜ (∂ÈÎfiÓ· 3).

∆Ô ÓÔËÙÈÎfi Â›Â‰Ô ‹Ù·Ó Ôχ ηÏfi, ÂÓÒ Ë

ʈӋ ‹Ù·Ó ˘„›Û˘¯ÓË (high pitched voice).

∞fi ÙÔÓ ·Ú¯ÈÎfi ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô, Ë ÁÂ-

ÓÈ΋ ·›Ì·ÙÔ˜ ¤‰ÂÈÍ ‹È· ÏÂÌÊÔÂÓ›· Î·È Ï¢-

ÎÔÂÓ›·: §Â˘Î¿ ·ÈÌÔÛÊ·›ÚÈ·: 4x103/ÌL, Ô˘‰Â-

ÙÂÚfiÊÈÏ·: 46%, ÏÂÌÊÔ·ÙÙ·Ú·: 36%, ÌÔÓÔ·Ù-

Ù·Ú·: 8%, ¿Ù˘· ÏÂÌÊÔ·ÙÙ·Ú·: 10%. √ ‚ÈÔ-

¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜, ÂÎÙfi˜

·fi ÙËÓ ÂÏ·ÊÚ¿ ·˘ÍË̤ÓË ¯ÔÏËÛÙÂÚfiÏË: 255

mg/dL. ∞fi ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô Î·È ÙËÓ

·Ú·ÎÔÏÔ‡ıËÛË ÙÔ˘ ·È‰ÈÔ‡ ‰È·ÈÛÙÒıËÎÂ,

ÂÎÙfi˜ Ù˘ ∫√¶, ÌÈÎÚÔÛÎÔÈ΋ ·ÈÌ·ÙÔ˘Ú›· (ÌÂ

‰È·Î˘Ì¿ÓÛÂȘ Ù˘ ٿ͈˜ ÙˆÓ 10-30 ÂÚ˘ıÚÒÓ

ηٿ ÔÙÈÎfi ‰›Ô) Î·È ÛÙË Û˘Ó¤¯ÂÈ· ÏÂ˘ÎˆÌ·-

ÙÔ˘Ú›·. ∆Ô Ï‡Έ̷ Ô‡ÚˆÓ 24ÒÚÔ˘ ‹Ù·Ó 1,2 g.

§fiÁˆ ÙÔ˘ ÎÔÓÙÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜ ¤ÁÈÓ ·ÎÙÈ-

ÓÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜: 1) ¿ÎÚ·˜ ¯ÂÈÚfi˜, Ô˘ ¤‰ÂÈÍÂ

fiÙÈ Ë ÔÛÙÈ΋ ËÏÈΛ· Û˘Ì‚¿‰È˙ Ì ÙË ¯ÚÔÓÔÏÔÁÈ-

΋. 2) ·fi ÙÔÓ ÏÔÈfi ÛÎÂÏÂÙfi ·Ú·ÙËÚ‹ıËÎÂ

ÌÈÎÚfi ‡„Ô˜ ÛÔÓ‰˘ÏÈÎÒÓ ÛˆÌ¿ÙˆÓ Ì ‚Ú·¯‡-

ÙÂÚÔ ÙÔ Ô›ÛıÈÔ ÙÌ‹Ì· ·˘ÙÒÓ, ÚfiÛıÈ· οو

ÁˆÓ›ˆÛË ÙÔ˘ √2 ÛÔÓ‰‡ÏÔ˘, ˘ÔÏ·Û›· Ï·ÁÔ-

Ó›ˆÓ, ·ÓˆÌ·Ï›· Ù˘ ·Ú˘Ê‹˜ Ù˘ ÎÔÙ‡Ï˘ ηÈ

ÙÔ˘ ¿Óˆ ¯Â›ÏÔ˘˜ ÙˆÓ ÌÂٷʇÛÂˆÓ ˆ˜ Î·È ·ÓÂ-

·Ú΋˜ Û¯ËÌ·ÙÈÛÌfi˜ ÙˆÓ ÂÈʇÛÂˆÓ ÙˆÓ ÌËÚÈ-

·›ˆÓ ÔÛÙÒÓ (∂ÈÎfiÓ˜ 4, 5, 6). §fiÁˆ Ù˘ ∫√¶

¤ÁÈÓ ·ÓÈÔ‡Û· ΢ÛÙÂÔÔ˘ÚËıÚÔÁÚ·Ê›· Ô˘ ¤‰ÂÈ-

Í ‚ÂÏÙ›ˆÛË Ù˘ ·ÏÈÓ‰ÚfiÌËÛ˘. √ ÂÓ‰ÔÎÚÈÓÔ-

ÏÔÁÈÎfi˜ ·ӤÏÂÁ¯Ô˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜. ∏

ÔÊı·ÏÌÔÏÔÁÈ΋ ÂͤٷÛË ¤‰ÂÈÍ ˘ÂÚÌÂÙÚˆ›·

Î·È ·ÛÙÈÁÌ·ÙÈÛÌfi. §fiÁˆ ÙˆÓ ·ÎÙÈÓÔÏÔÁÈÎÒÓ Â˘-

ÚËÌ¿ÙˆÓ ÂÛÙ¿ÏËÛ·Ó ‚ÏÂÓÓÔÔÏ˘Û·Î¯·Ú›Ù˜

Ô‡ÚˆÓ Ô˘ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎÔ›. √ ηڢfiÙ˘Ô˜

‹Ù·Ó 46,ÃÀ, Ê˘ÛÈÔÏÔÁÈÎÔ‡ ¿ÚÚÂÓÔ˜. §fiÁˆ ÙˆÓ

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54 ™. æÒÓË Î·È Û˘Ó.

¶·È‰È·ÙÚÈ΋ 2006;69:52-58

Û˘¯ÓÒÓ ÏÔÈÌÒÍÂˆÓ ¤ÁÈÓÂ Î·È Ï‹Ú˘ ·ÓÔÛÔÏÔÁÈ-

Îfi˜ ¤ÏÂÁ¯Ô˜: ·) √ ·ÓÔÛÔÊ·ÈÓfiÙ˘Ô˜ ÏÂÌÊÔ΢Ù-

Ù¿ÚˆÓ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜ ·ÔÎ¿Ï˘„ ÛÔ‚·-

Ú‹ Ì›ˆÛË ÙˆÓ CD4 T ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Î·È ·‡-

ÍËÛË ÙˆÓ ˘Ô‰Ô¯¤ˆÓ TCRÁ‰ (CD4: 18%,

CD3TCRÁ‰: 14% ÌÂ Ê˘ÛÈÔÏÔÁÈΤ˜ ÙÈ̤˜ <7,5).

√È ‰Â›ÎÙ˜ ÙˆÓ µ ΢ÙÙ¿ÚˆÓ Î·È ÙˆÓ Î˘ÙÙ·ÚÔ-

ÎÙfiÓˆÓ ·Ú¤ÌÂÈÓ·Ó ·ÓÂËÚ¤·ÛÙÔÈ, fiˆ˜ ›Û˘

Î·È ÔÈ ‰Â›ÎÙ˜ ‰ÈÂÁ¤ÚÛˆ˜-ÂÓÂÚÁÔÔÈ‹Ûˆ˜. ‚)

™ÙȘ ·ÓÔÛÔÛÊ·ÈÚ›Ó˜ ÔÚÔ‡ ·Ú·ÙËÚ‹ıËΠ̛ˆ-

ÛË ÙÔ˘ IgG ÎÏ¿ÛÌ·ÙÔ˜: IgG: 521 mg/dl (Ê.Ù. 700-

1622). Á) ∆¤ÏÔ˜, ¤ÁÈÓÂ Î·È ‰È¤ÁÂÚÛË Î·ÏÏȤÚÁÂÈ·˜

ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Ì ÙË ÌÈÙÔÁfiÓÔ Ô˘Û›· PHA Ë

ÔÔ›· ¤‰ÂÈÍ ÛÙÔÓ ·ÛıÂÓ‹: 16.870 bits Ú·‰ÈÂÓ¤Ú-

ÁÂÈ·˜ Î·È ÛÙÔÓ Ì¿ÚÙ˘Ú·: 110.650 bits Ú·‰ÈÂÓ¤Ú-

ÁÂÈ·˜ (Ê.Ù. 60.000-150.000), ‰ËÏ·‰‹ ·Ú·ÙËÚ‹-

ıËΠÂÚ›Ô˘ ‰¤Î· ÊÔÚ¤˜ ¯·ÌËÏfiÙÂÚË ·¿ÓÙË-

ÛË ÙÔ˘ ·ÛıÂÓÔ‡˜ Û ۯ¤ÛË Ì ÙÔÓ Ì¿ÚÙ˘Ú·. ∂Ô-

̤ӈ˜, ÂȂ‚·ÈÒıËΠÛÙÔÓ ·ÛıÂÓ‹ Ù˘ ·ÚÔ‡-

Û·˜ ÂÚ›ÙˆÛ˘ Ë Ôχ ¯·ÌËÏ‹ ΢ÙÙ·ÚÈ΋ ·ÓÔ-

Û›·, ȉ›ˆ˜ ÙˆÓ ∆ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ.

∏ ÁÂÓÈ΋ Ô‡ÚˆÓ ·Ó¿ ‰È·ÛÙ‹Ì·Ù· ¤‰ÂȯÓÂ

10-15 ÂÚ˘ıÚ¿ ηٿ ÔÙÈÎfi ‰›Ô, ÛÂÈÚ·Ì·ÙÈ-

΋˜ ÚÔ¤Ï¢Û˘, Î·È Ï‡Έ̷ (+), ÂÓÒ Û ·-

ÓÂÈÏËÌ̤Ó˜ ÌÂÙÚ‹ÛÂȘ Ï¢ÎÒÌ·ÙÔ˜ Ô‡ÚˆÓ

24ÒÚÔ˘, Ë ÙÈÌ‹ ÙÔ˘ Î˘Ì·ÈÓfiÙ·Ó ·fi 1,2 ¤ˆ˜ 1,5

g/24ˆÚÔ. ŒÏÂÁ¯Ô˜ Ù˘ ÓÂÊÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜

¤‰ÂÈÍÂ: ۿί·ÚÔ: 80 mg/dl, ÔÏÈο Ï¢ÎÒÌ·Ù·:

5,4 g/dl, ÏÂ˘ÎˆÌ·Ù›ÓË: 3,4 g/dl, ¯ÔÏËÛÙÂÚ›ÓË: 218

mg/dl, ÙÚÈÁÏ˘ÎÂÚ›‰È·: 136 mg/dl, HDL: 62 mg/dl,

LDL: 119 mg/dl, Ô˘Ú›·: 28 mg/dl, ÎÚ·ÙÈÓ›ÓË: 0,4

mg/dl, Ô˘ÚÈÎfi Ô͇: 3,6 mg/dl, SGOT: 48 mg/dl,

SGPT: 17 mg/dl, ÁGT: 19 mg/dl, ·ÏηÏÈ΋ ʈ-

ÛÊ·Ù¿ÛË: 185 IU/dl, K+:4,1 mmoll/l, Na+:140

mmol/l, Cl-: 109 mmol/l, Ca oÏÈÎfi: 9 mg/dl, P: 4,2

mg/dl, Mg: 1,7 mg/dl. ¶ÚÔÁÚ·ÌÌ·Ù›ÛÙËÎÂ ‚ÈÔ-

„›· ÓÂÊÚÔ‡, Ë ÔÔ›· ¤‰ÂÈÍ ÚÈÎÓˆÙÈΤ˜ ·ÏÏÔÈÒ-

ÛÂȘ ÛÙÔ 68% ÙˆÓ ÛÂÈÚ·Ì¿ÙˆÓ Î·È ÂÓ·Ôı¤ÛÂȘ

C3 ÛÙ· ·ÚÙËÚ›‰È· Î·È ÛÙËÓ Î¿„· ÙÔ˘ Bowman,

Â˘Ú‹Ì·Ù· ·Ú¯fiÌÂÓ˘ ÂÛÙȷ΋˜ ÙÌËÌ·ÙÈ΋˜

ÛÂÈÚ·Ì·ÙÔÛÎÏ‹Ú˘ÓÛ˘ (FSGS) (∂ÈÎfiÓ· 7).

§fiÁˆ ÙˆÓ ÎÏÈÓÈÎÒÓ, ÂÚÁ·ÛÙËÚÈ·ÎÒÓ Î·È

·ÎÙÈÓÔÏÔÁÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ Ù¤ıËÎÂ Ë ‰È¿ÁÓˆÛË

Ù˘ SIOD. °È· ÙËÓ ÙÂÎÌËÚ›ˆÛË Ù˘ ‰È¿ÁÓˆÛ˘

ÂÛÙ¿ÏË ‰Â›ÁÌ· ·›Ì·ÙÔ˜ ÛÙȘ ∏¶∞ ÁÈ· ÌÔÚȷ΋

·Ó¿Ï˘ÛË DNA ÛÙÔ ·È‰› Î·È ÛÙÔ˘˜ ÁÔÓ›˜. ∆·

ÚÒÙ· ·ÔÙÂϤÛÌ·Ù· Â›Ó·È ÂȂ‚·ÈˆÙÈο

ÁÈ· ·ÚÔ˘Û›· ÂÙÂÚfi˙˘Á˘ ÌÂÙ¿ÏÏ·Í˘ 1736C>T,

Ô˘ ·ÓȯÓ‡ıËΠÛÙÔ ÂÍÒÓÈÔ 11 ÙÔ˘ ÁÔÓÈ-

‰›Ô˘ SMARCAL1, Ì ÙË Ì¤ıÔ‰Ô ÙÔ˘ ¿ÌÂÛÔ˘

∂ÈÎfiÓ· 1. º·›ÓÂÙ·È ÙÔ ÎÔÓÙfi ·Ó¿ÛÙËÌ· ÙÔ˘ ·ÛıÂÓ‹, ÙÔȉÈfiÌÔÚÊÔ ÚÔۈ›Ô, Ô Â˘Ú‡˜ ıÒڷη˜, Ë ÔÛÊ˘˚΋ÏfiÚ‰ˆÛË, Ë ÚÔ¤¯Ô˘Û· ÎÔÈÏ›· Î·È Ù· ÌÂÁ¿Ï· ¯¤ÚÈ·.

∂ÈÎfiÓ· 2. ¶·Ú·ÙËÚÂ›Ù·È Ë ÔÛÊ˘˚΋ ÏfiÚ‰ˆÛË, Ô Î˘ÏÈÓ-‰ÚÈÎfi˜ ıÒڷη˜ Î·È Ù· ÌÂÁ¿Ï· ¯¤ÚÈ·.

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55Schimke ·ÓÔÛÔ-ÔÛÙÈ΋ ‰˘ÛÏ·Û›·

¶·È‰È·ÙÚÈ΋ 2006;69:52-58

ÚÔÛ‰ÈÔÚÈÛÌÔ‡ ·ÏÏËÏÔ˘¯›·˜ DNA (direct

sequencing). √ ·Ù¤Ú·˜ Â›Ó·È ÂÙÂÚÔ˙˘ÁÒÙ˘

ÁÈ· ÙËÓ ›‰È· ÌÂÙ¿ÏÏ·ÍË. ∏ ÂͤٷÛË ‚Ú›ÛÎÂÙ·È

·ÎfiÌË Û ÂͤÏÈÍË ÁÈ· ÙËÓ ·Ó›¯Ó¢ÛË ÌÂÙ¿ÏÏ·-

͢ Î·È ÛÙÔ ·ÏÏËÏfiÌÔÚÊÔ Ô˘ ÚÔ¤Ú¯ÂÙ·È ·fi

ÙË ÌËÙ¤Ú·.

∏ ıÂڷ›· ÙÔ˘ ·È‰ÈÔ‡ ̤¯ÚÈ Û‹ÌÂÚ· ›ӷÈ

Û˘Ìو̷ÙÈ΋ Î·È ·Ú·ÎÔÏÔ˘ıÂ›Ù·È Û˘ÛÙËÌ·-

ÙÈο ÁÈ· ÙÔ ÂӉ¯fiÌÂÓÔ ·Ó¿Ù˘Í˘ ‰Â˘ÙÂÚÔ·-

ıÒÓ ÂÈÏÔÎÒÓ.

™˘˙‹ÙËÛË

∏ ·ÓÔÛÔ-ÔÛÙÈ΋ ‰˘ÛÏ·Û›· Ù‡Ô˘ Schimke

(Schimke immuno-osseous dysplasia, SIOD,

√ªπª: 242900) ÂÚÈÁÚ¿ÊËΠÁÈ· ÚÒÙË ÊÔÚ¿

ÙÔ 1974 ·fi ÙÔÓ Schimke ÛÂ ¤Ó· ÎÔÚ›ÙÛÈ 6 ÂÙÒÓ

Ô˘ ·ÚÔ˘Û›·˙ ÛÔÓ‰˘ÏÔÂÈÊ˘Ûȷ΋ ‰˘-

ÛÏ·Û›·, ÂÍÂÏÈÛÛfiÌÂÓË ÓÂÊÚÈ΋ ÓfiÛÔ, ÂӉ›-

ÍÂȘ ‰È·Ù·Ú·Á̤Ó˘ ΢ÙÙ·ÚÈ΋˜ ·ÓÔÛ›·˜ Î·È ·˘-

ÍË̤ÓË ·Ô‚ÔÏ‹ 6-ıÂÈÈ΋˜ ¯ÔÓ‰ÚÔ˚Ù›Ó˘ ÛÙ·

Ô‡Ú· (2). §fiÁˆ ·˘ÙÔ‡ ÙÔ˘ ÙÂÏÂ˘Ù·›Ô˘ Â˘Ú‹Ì·-

ÙÔ˜, ıˆڋıËΠfiÙÈ ÚfiÎÂÈÙ·È ÁÈ· Ó¤Ô Ù‡Ô

‚ÏÂÓÓÔÔÏ˘Û·Î¯·Ú›‰ˆÛ˘, ÁÂÁÔÓfi˜ ÙÔ ÔÔ›Ô

·ÚÁfiÙÂÚ· ‰ÂÓ Â·ÏËı‡ÙËÎÂ. ∆Ô 1991, ÔÈ

Spranger Î·È Û˘Ó ÂÚȤÁÚ·„·Ó ¿ÏϘ ¤ÓÙ ·-

ÚfiÌÔȘ ÂÚÈÙÒÛÂȘ, ¯ˆÚ›˜ ·Ó›¯Ó¢ÛË ÌÂÙ·‚Ô-

ÏÈÙÒÓ ÛÙ· Ô‡Ú·, ÂÓÒ Ô Spranger ‹Ù·Ó ·˘Ùfi˜ Ô˘

¤‰ˆÛ ÙÔ fiÓÔÌ· SIOD ÛÙË ‰È·Ù·Ú·¯‹ (4). √Ê›-

ÏÂÙ·È Û ÌÂÙ¿ÏÏ·ÍË ÙÔ˘ ÁÔÓȉ›Ô˘ SMARCAL 1

(SW1/SNF2-related matrix-associated actin-

dependent regulator of chromatin, sub-family a-

like 1), ÙÔ ÔÔ›Ô Îˆ‰ÈÎÔÔÈ› Ì›· Ú˘ıÌÈÛÙÈ΋

ÚˆÙ½ÓË Ô˘ Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ Â·Ó·‰fiÌËÛË

ÙÔ˘ ÓÔ˘ÎÏÂÔÛÒÌ·ÙÔ˜ (5). ∏ ·ӷ‰fiÌËÛË ·˘-

Ù‹ ·Ú·ÙËÚÂ›Ù·È Û˘Ó‹ıˆ˜ ηٿ ÙË ÁÔÓȉȷ΋

Ú‡ıÌÈÛË, fiˆ˜ ÙÔÓ ·Ó·‰ÈÏ·ÛÈ·ÛÌfi, ÙÔÓ ·Ó·-

Û˘Ó‰˘·ÛÌfi, ÙË ÌÂı˘Ï›ˆÛË Î·È ÙËÓ ÂȉÈfiÚıˆ-

ÛË ÙÔ˘ DNA. Œ¯ÂÈ ÚfiÛÊ·Ù· ¯·ÚÙÔÁÚ·ÊËı›ÛÙË ı¤ÛË 2q34-q36 Î·È ¤¯Ô˘Ó ÌÂÏÂÙËı› ·ÚÎÂ-Ù¤˜ ÌÂÙ·ÏÏ¿ÍÂȘ (1). ∏ ‡·ÚÍË ·ÚÎÂÙÒÓ Î·È‰È·ÊfiÚˆÓ ÂȉÒÓ ÛËÌÂÈ·ÎÒÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ ÛÙÔ›‰ÈÔ ÁÔÓ›‰ÈÔ Ê·›ÓÂÙ·È fiÙÈ Û˘Ó‰¤ÂÙ·È Ì ÙËÓ ÎÏÈ-ÓÈ΋ ÔÈÎÈÏÔÌÔÚÊ›· Î·È ÙËÓ ËÏÈΛ· ÂÌÊ¿ÓÈÛ˘ÙÔ˘ ÓÔÛ‹Ì·ÙÔ˜. ∏ ‡·ÚÍË ·ÚÂÚÌËÓ‡ÛÈÌ˘(missense) ÌÂÙ¿ÏÏ·Í˘ ‚ÔËı¿ ÛÙË ‰È·Ù‹ÚËÛËοÔÈ·˜ ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ·˜ ÙÔ˘ SMARCAL1 ÁÔ-Óȉ›Ô˘ Î·È Ô‰ËÁ› Û ËÈfiÙÂÚË ÓfiÛÔ (ÂÊË‚ÈÎfi˜Ù‡Ô˜), Û ·ÓÙ›ıÂÛË Ì ÙȘ ·ÓÂÚÌËÓ‡ÛÈ̘(nonsense), Ï·ÈÛÈÔÙÚÔÔÔÈËÙÈΤ˜ (frameshift)‹ ÌÂÙ·ÏÏ¿ÍÂȘ Ì·Ù›ÛÌ·ÙÔ˜ (splicing) Ô˘ Û¯ÂÙ›-˙ÔÓÙ·È Ì ÈÔ ÛÔ‚·Ú‹ Î·È ÂȉÂÈÓÔ‡ÌÂÓË Ô-Ú›· (‚ÚÂÊÈÎfi˜ Ù‡Ô˜) (1,5). ∏ ·Ó›¯Ó¢ÛË ÛÙÔÓ·ÛıÂÓ‹ Ù˘ ·ÚÔ‡Û·˜ ÂÚ›ÙˆÛ˘ Ù˘ ·ÚÂÚ-ÌËÓ‡ÛÈÌ˘ ÌÂÙ¿ÏÏ·Í˘ 1736C>T Ô‰ËÁ› Û·ÓÙÈηٿÛÙ·ÛË ÂÓfi˜ ·ÌÈÓÔͤԘ (S579L) ÛÙËÓ

∂ÈÎfiÓ· 4. ∞ÎÙÈÓÔÁÚ·Ê›· ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘. ¶·Ú·ÙË-ÚÂ›Ù·È ÌÈÎÚfi ‡„Ô˜ ÛÔÓ‰˘ÏÈÎÒÓ ÛˆÌ¿ÙˆÓ, ÂȉÈο ÛÙÔÔ›ÛıÈÔ Ì¤ÚÔ˜ ·˘ÙÒÓ. ¶ÚfiÛıÈ· οو ÁˆÓ›ˆÛË ÙÔ˘ √2.

∂ÈÎfiÓ· 3. ¶ÚÔ¤¯Ô˘Û· ÎÔÈÏ›· Î·È ÌÂÏ·Á¯ÚˆÌ·ÙÈΤ˜ÎËÏ›‰Â˜.

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ÚˆÙ½ÓË SMARCAL1. ∂›Ó·È Ë ‰Â‡ÙÂÚË ÊÔÚ¿

Ô˘ ·ÓȯÓ‡ÂÙ·È Ë Û˘ÁÎÂÎÚÈ̤ÓË ÌÂÙ¿ÏÏ·ÍË ÛÂ

·ÛıÂÓ‹ Ì SIOD (5). ∂Âȉ‹ ÙÔ ÓfiÛËÌ· ›ӷÈ

˘ÔÏÂÈfiÌÂÓÔ, Ú¤ÂÈ Ó· ˘¿Ú¯Ô˘Ó ‰‡Ô ‹ Â-

ÚÈÛÛfiÙÂÚ˜ ‰È·ÊÔÚÂÙÈΤ˜ ÌÂÙ·ÏÏ¿ÍÂȘ ÛÙÔ ›‰ÈÔ

ÁÔÓ›‰ÈÔ. Œˆ˜ ÙÒÚ· ‰ÂÓ ¤¯ÂÈ ·ÓȯÓ¢ı› Ë ‰Â‡ÙÂ-

ÚË ÌÂÙ¿ÏÏ·ÍË, Ô˘ ˘Ô¯ÚˆÙÈο Ú¤ÂÈ Ó·

ÚÔ¤Ú¯ÂÙ·È ·fi ÙË ÌËÙ¤Ú·. °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi,

‰ÂÓ ÌÔÚ› Ó· Á›ÓÂÈ Ï‹Ú˘ Úfi‚ÏÂ„Ë Ù˘ ÎÏÈ-

ÓÈ΋˜ ¤ÎÊÚ·Û˘ ÛÙÔ ·È‰›.

∏ ·ıÔÁ¤ÓÂÈ· ÙÔ˘ ÓÔÛ‹Ì·ÙÔ˜ ‰ÂÓ Â›Ó·È

Ï‹Úˆ˜ ‰È¢ÎÚÈÓÈṲ̂ÓË. ∫·Ù¿ Ì›· ˘fiıÂÛË, Ù·

ÁÔÓ›‰È· Ô˘ ÂËÚ¿˙ÔÓÙ·È ·fi ÙȘ ÌÂÙ·ÏÏ¿ÍÂȘ

ÙÔ˘ SMARCAL1 Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ·Ó¿Ù˘ÍË

Î·È ‰È·ÊÔÚÔÔ›ËÛË ÙˆÓ ¯ÔÓ‰ÚÔ΢ÙÙ¿ÚˆÓ, ÏÂÌ-

ÊÔ΢ÙÙ¿ÚˆÓ Î·È ›Ûˆ˜ ÙˆÓ ÌÂÏ·ÓÔ΢ÙÙ¿ÚˆÓ,

ÂÓÒ ÌÂÚÈο ·fi ·˘Ù¿ ›Ûˆ˜ Â›Ó·È ··Ú·›ÙËÙ·

ÁÈ· ÙË Û˘ÓÙ‹ÚËÛË ÙÔ˘ ÓÂÊÚÈÎÔ‡ ÈÛÙÔ‡ Î·È ÙÔ˘

·ÚÙËÚÈ·ÎÔ‡ ÙÔȯÒÌ·ÙÔ˜. ø˜ ÚÔ˜ Ù· ÏÂÌÊÔ-

·ÙÙ·Ú·, ÈÛÙ‡ÂÙ·È fiÙÈ ˘¿Ú¯ÂÈ Î¿ÔÈ· ·Óˆ-

Ì·Ï›· ÛÙË ‰È·ÊÔÚÔÔ›ËÛË Î·È ‰È·ÏÔÁ‹ ÙˆÓ ∆-

΢ÙÙ¿ÚˆÓ ÛÙÔÓ ı‡ÌÔ ·‰¤Ó·, ÏfiÁˆ ·ÔÙ˘¯›·˜

Û‡Ó‰ÂÛ˘ ÙÔ˘ DNA ηٿ ÙȘ ·Ó·Î·Ù·Ù¿ÍÂȘ ÁÔ-

Óȉ›ˆÓ Ô˘ Û˘Ì‚·›ÓÔ˘Ó Ê˘ÛÈÔÏÔÁÈο Û ·˘Ù‹

ÙË ‰È·‰Èηۛ· (1). ™˘˙ËÙ›ٷÈ, ›Û˘, Ë ˘fi-

ıÂÛË fiÙÈ Ë ÓÂÊÚÈ΋ ‚Ï¿‚Ë Â›Ó·È ‰Â˘ÙÂÚÔÁÂÓ¤˜

Ê·ÈÓfiÌÂÓÔ, ÔÊÂÈÏfiÌÂÓÔ ÛÙËÓ ÂÏ·Ùو̷ÙÈ΋

΢ÙÙ·ÚÈ΋ ·ÓÔÛ›·, Ë ÔÔ›· Úԉȷı¤ÙÂÈ Û ÏÔÈ-

ÌÒÍÂȘ Î·È ·ÎÔÏÔ‡ıˆ˜ Û ÂÓ·fiıÂÛË ·ÓÔÛÔÛ˘-

ÌÏÂÁÌ¿ÙˆÓ ÛÙÔÓ ÓÂÊÚÈÎfi ÈÛÙfi (1). ™Â ÌÂÁ·Ï‡-

ÙÂÚ˜ ËÏÈ˘ ·Ú·ÙËÚÂ›Ù·È ÂÁÎÂÊ·ÏÈ΋ ÈÛ¯·È-

Ì›·, ÏfiÁˆ ·ÏÏÔ›ˆÛ˘ ÙÔ˘ Û˘Ó‰ÂÙÈÎÔ‡ ÈÛÙÔ‡, ÌÂ

Û˘Ó¤ÂÈ· ÙËÓ Â˘ıÚ·˘ÛÙfiÙËÙ· ÙÔ˘ ·ÚÙËÚÈ·ÎÔ‡

ÙÔȯÒÌ·ÙÔ˜ Î·È ·ÚÙËÚÈÔÛÎÏ‹Ú˘ÓÛË, ÛÂ Û˘Ó-

‰˘·ÛÌfi Ì ÙËÓ ˘¤ÚÙ·ÛË Î·È ÙËÓ ˘ÂÚÏÈȉ·È-

Ì›· Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙË ÓÂÊÚÈ΋ ‚Ï¿‚Ë (6,7).

ªÂ›˙ÔÓ· ÎÚÈÙ‹ÚÈ· ÁÈ· ÙË ‰È¿ÁÓˆÛË Ù˘

SIOD ·ÔÙÂÏÔ‡Ó Ë ·Ó·ÛÙÔÏ‹ Ù˘ ۈ̷ÙÈ΋˜

·Ó¿Ù˘Í˘, Ë ·Ó¿ÚÎÂÈ· Ù˘ ∆ ΢ÙÙ·ÚÈ΋˜

·ÓÔÛ›·˜, Ë ÚÔԉ¢ÙÈο ÂÍÂÏÈÛÛfiÌÂÓË ÓÂÊÚÔ-

¿ıÂÈ·, ÔÈ ˘Âگڈ̷ÙÈΤ˜ ÎËÏ›‰Â˜ ÛÙÔÓ ÎÔÚ-

Ìfi Î·È Ô ¯·Ú·ÎÙËÚÈÛÙÈÎfi˜ Ê·ÈÓfiÙ˘Ô˜. √È ÌÔÚ-

ÊÔÏÔÁÈΤ˜ ·ÓˆÌ·Ï›Â˜ Â›Ó·È ¯·Ú·ÎÙËÚÈÛÙÈΤ˜,

56 ™. æÒÓË Î·È Û˘Ó.

¶·È‰È·ÙÚÈ΋ 2006;69:52-58

∂ÈÎfiÓ· 5. ∞ÎÙÈÓÔÁÚ·Ê›· ÏÂοÓ˘-ÈÛ¯›ˆÓ. ¶·Ú·ÙËÚ›-Ù·È ˘ÔÏ·Û›· Ï·ÁÔÓ›ˆÓ, ·ÓˆÌ·Ï›· Ù˘ ·Ú˘Ê‹˜ Ù˘ÎÔÙ‡Ï˘.

∂ÈÎfiÓ· 7. µÈÔ„›· ÓÂÊÚÔ‡. ∞ÂÈÎÔÓ›˙ÂÙ·È ¤Ó· Û›ڷ-Ì· Ô˘ Û˘ÌʇÂÙ·È Ì ÙËÓ Î¿„· ÙÔ˘ Bowman Î·È ¤Ó·Ì ÚÈÎÓˆÙÈ΋ ÛÎÏ‹Ú˘ÓÛË. ∆· Ô˘ÚÔÊfiÚ· ÛˆÏËÓ¿ÚÈ·ÂÌÊ·Ó›˙Ô˘Ó ÂÛٛ˜ ·ÙÚÔÊ›·˜ Î·È ·ıÚÔ›ÛÂȘ ·ÔÊÔÏÈ-‰ˆÌ¤ÓˆÓ ΢ÙÙ¿ÚˆÓ.

∂ÈÎfiÓ· 6. ∞Ó·Ú΋˜ Û¯ËÌ·ÙÈÛÌfi˜ ÙˆÓ ÂÈʇÛˆÓÎ·È ÙˆÓ ÌÂٷʇÛÂˆÓ ÙˆÓ ÌËÚÈ·›ˆÓ ÔÛÙÒÓ.

Pediatr Jan-Feb 06 final allges 27-01-06 15:35 ™ÂÏ›‰·56

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57Schimke ·ÓÔÛÔ-ÔÛÙÈ΋ ‰˘ÛÏ·Û›·

¶·È‰È·ÙÚÈ΋ 2006;69:52-58

fiˆ˜ Ê·›ÓÂÙ·È ÛÙÔÓ ¶›Ó·Î· 1 Î·È ‰È·ÈÛÙÒıË-Î·Ó Î·È ÛÙÔÓ ·ÛıÂÓ‹ Ì·˜ (∂ÈÎfiÓ˜ 1, 2, 3) (8). ∆··ÎÙÈÓÔÏÔÁÈο Â˘Ú‹Ì·Ù· ÂȂ‚·ÈÒÓÔ˘Ó ÙËÛÔÓ‰˘ÏÔÂÈÊ˘Ûȷ΋ ‰˘ÛÏ·Û›· (ˆÔÂȉ›˜ ÔÈ-Ûı›ˆ˜ ÂȉˆÌ¤ÓÔÈ ÛfiÓ‰˘ÏÔÈ, ˘ÔÏ·ÛÙÈ΋‡ÂÏÔ˜, ·ÓÒ̷Ϙ ÎÂʷϤ˜ ÌËÚÈ·›ˆÓ, ÔÛÙÂÔÂ-Ó›·, ıˆÚ·ÎÈ΋ ·ʈÛË) (∂ÈÎfiÓ˜ 4, 5, 6).

∏ ÚˆÙÂ˚ÓÔ˘Ú›· Ô˘ ·ÚÔ˘Û›·˙Â Ô ·ÛıÂÓ‹˜Ù˘ ·ÚÔ‡Û·˜ ÂÚ›ÙˆÛ˘, ‹Ù·Ó ÛËÌ·ÓÙÈÎ‹Î·È Ë ˘ÔΛÌÂÓË ÈÛÙÔÏÔÁÈ΋ ÂÈÎfiÓ· ‹Ù·Ó Û˘Ì-‚·Ù‹ Ì ÂÛÙȷ΋ ÙÌËÌ·ÙÈ΋ ÛÂÈÚ·Ì·ÙÔÛÎÏ‹-Ú˘ÓÛË. Ÿˆ˜ Â›Ó·È ÁÓˆÛÙfi, Ô ÈÛÙÔÏÔÁÈÎfi˜ ·˘-Ùfi˜ Ù‡Ô˜ Û˘¯Ó¿ Ô‰ËÁ› Û ÓÂÊÚÈ΋ ·Ó¿Ú-ÎÂÈ·. √È ·ÁÁÂȷΤ˜ ‰È·Ù·Ú·¯¤˜ Ô˘ ÂÌÊ·Ó›˙Ô-ÓÙ·È Û˘Ó‹ıˆ˜ Û ÌÂÁ·Ï‡ÙÂÚË ËÏÈΛ·, ÚÔ‚¿Ï-ÏÔ˘Ó Ì ÎÂÊ·Ï·ÏÁ›Â˜ Ù‡Ô˘ ËÌÈÎÚ·Ó›·˜ ‹ Ì·ÚÔ‰Èο ‹ Î·È ÌfiÓÈÌ· ÈÛ¯·ÈÌÈο ÂÁÎÂÊ·ÏÈοÂÂÈÛfi‰È· (6,8-10). ∏ MRI ·Ó·‰ÂÈÎÓ‡ÂÈ ÂÍÂÏÈÛ-ÛfiÌÂÓ˜ ·ÏÏÔÈÒÛÂȘ Ù˘ Ï¢΋˜ Ô˘Û›·˜, Û˘Ì-‚·Ù¤˜ Ì ÂÁÎÂÊ·ÏÈ΋ ÈÛ¯·ÈÌ›·, ηıÒ˜ ›ÛË˜Î·È ÂÚÈÔ¯¤˜ ΢ÛÙÈ΋˜ ·ÏÏÔ›ˆÛ˘ (ÂÁÎÂÊ·ÏÔ-Ì·Ï¿Î˘ÓÛË ÌÂ Û˘Ó¤ÂÈ· οÔȘ ÊÔÚ¤˜ ÙË ÓÔË-

ÙÈ΋ ¤ÎÙˆÛË), ˆ˜ ÚÔ˚fiÓ ÂͤÏÈ͢ ÙÔ˘ ÈÛ¯·È-

ÌÈÎÔ‡ ÂÌÊÚ¿ÎÙÔ˘ (3,7). ™·ÓÈfiÙÂÚ˜ ÂΉËÏÒ-

ÛÂȘ Ô˘ ¤¯Ô˘Ó ·Ó·ÊÂÚı› ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Ê·È-

ÓfiÌÂÓ· ·˘ÙÔ·ÓÔÛ›·˜, fiˆ˜ ÂÓÙÂÚÔ¿ıÂÈ·,

·Ó·ÈÌ›·-ıÚÔÌ‚Ô΢ÙÙÔÂÓ›· Ô˘ ÌÔÚ› Ó·

Ô‰ËÁ‹ÛÂÈ ÛÂ Ì˘ÂÏÈ΋ ·Ï·Û›· Î·È ·‡ÍËÛË ÙÔ˘

Ù›ÙÏÔ˘ ·ÓÙÈʈÛÊÔÏÈȉÈÎÒÓ Î·È ·ÓÙÈÁÏÈ·‰ÈÓÈ-

ÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ (6,11). ∏ ÚÔÛ‚ÔÏ‹ ÙÔ˘ ·ÓÔ-

ÛÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Û˘Ó›ÛÙ·Ù·È Î˘Ú›ˆ˜ ÛÂ

‚Ï¿‚Ë Ù˘ ΢ÙÙ·ÚÈ΋˜ ·ÓÔÛ›·˜, ÂÓÒ ÂÓ›ÔÙ ÛË-

ÌÂÈÒÓÂÙ·È Î·È ˘ÔÁ·ÌÌ·ÛÊ·ÈÚÈÓ·ÈÌ›· (9). √

·ÛıÂÓ‹˜ Ù˘ ·ÚÔ‡Û·˜ ÂÚ›ÙˆÛ˘ ·ÚÔ˘Û›·-

Û Ì›ˆÛË ÙÔ˘ IgG ÎÏ¿ÛÌ·ÙÔ˜ ÙˆÓ ·ÓÔÛÔÛÊ·È-

ÚÈÓÒÓ. ∆Ô Â›‰Ô˜ Ù˘ ·Ó¿ÚÎÂÈ·˜ ÙˆÓ ∆ ΢ÙÙ¿-

ÚˆÓ ÙÔ˘ ·ÛıÂÓÔ‡˜ Â›Ó·È Ù˘ÈÎfi Ù˘ SIOD, η-

ıÒ˜ ·ÚÔ˘Û›·Û Ì›ˆÛË ÙˆÓ CD4+ ηÈ

CD3+/CD4+, ˘ÂÚ¤ÎÊÚ·ÛË ÙˆÓ Á‰ ˘Ô‰Ô¯¤ˆÓ

ÙˆÓ CD3 T ΢ÙÙ¿ÚˆÓ Î·È ÂÏ·Ùو̤ÓË ·ÓÙ·fi-

ÎÚÈÛË Ù˘ ηÏÏȤÚÁÂÈ·˜ ∆ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ÛÂ

∆-ÂȉÈΤ˜ ÌÈÙÔÁfiÓ˜ Ô˘Û›Â˜ (9). ∞fi ÙËÓ ÔÌ¿‰·

ÙˆÓ µ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ÌÂÈÒÓÔÓÙ·È ÌfiÓÔ Ù· µ

ÏÂÌÊÔ·ÙÙ·Ú· Ô˘ ÂÍ·ÚÙÒÓÙ·È ·fi Ù· ∆ ÏÂÌ-

ÊÔ·ÙÙ·Ú·. ∆· Ê˘ÛÈο ΢ÙÙ·ÚÔÎÙfiÓ· ·Ú·Ì¤-

ÓÔ˘Ó Î·È ·˘Ù¿ ·ÓÂËÚ¤·ÛÙ· (9). ¶Ú¤ÂÈ Ó· ÛË-

ÌÂȈı›, fï˜, fiÙÈ Ë ·ÓÔÛÔ·Ó¿ÚÎÂÈ·, ·Ó ηÈ

ÌÔÚ› Ó· Â›Ó·È ÛÔ‚·Ú‹ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘

ÓfiÛÔ˘, ‰ÂÓ Î˘Úȷگ› ÛÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ·, ·-

Ú¿ ÌfiÓÔ ÌÂÙ¿ ÙËÓ ÂÁηٿÛÙ·ÛË ·ÓıÂÎÙÈ΋˜ ÓÂ-

ÊÚÔ¿ıÂÈ·˜ (6,9).

∏ ÚfiÁÓˆÛË Â›Ó·È Î·Î‹. √È ÂÈÏÔΤ˜, fiˆ˜

Ë ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ·, Ë Ì˘ÂÏÈ΋ ·Ï·Û›·, ÔÈ

ÛÔ‚·Ú¤˜ ˘ÔÙÚÔÈ¿˙Ô˘Û˜ ÏÔÈÌÒÍÂȘ Î·È Ù·

¶›Ó·Î·˜ 1. ªÔÚÊÔÏÔÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÚÔÛÒÔ˘

1. ∂Ì‚¿ı˘ÓÛË ÔÊı·ÏÌÒÓ 2. ªÈÎÚ¤˜ ‚ÏÂÊ·ÚÈΤ˜ Û¯ÈṲ̂˜ 3. ÷ÌËÏ‹ Î·È Â˘Ú›· ÚÈÓÈ΋ Á¤Ê˘Ú· 4. ∞ÔÛÙÚÔÁÁ˘ÏÂ̤ÓÔ ·ÎÚÔÚÚ›ÓÈÔ 5. ªÈÎÚÔ‰ÔÓÙ›· 6. ª·ÎÚ‡ ¿Óˆ ¯Â›ÏÔ˜ 7. À„›Û˘¯ÓË ÊˆÓ‹ (high pitched voice) 8. ∂Ûٛ˜ ıÔÏÂÚfiÙËÙ·˜ ÛÙÔÓ ÎÂÚ·ÙÔÂȉ‹ ¯ÈÙÒÓ· 9. §ÂÙ¿ Ì·ÏÏÈ¿

¶›Ó·Î·˜ 2. ¢È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ·ÓÔÛÔ-ÔÛÙÈ΋˜ ‰˘ÛÏ·Û›·˜ Ù‡Ô˘ Schimke

¶·ı‹ÛÂȘ Ì ÛÎÂÏÂÙÈΤ˜ ·ÓˆÌ·Ï›Â˜ ¶·ı‹ÛÂȘ Ì ÛÎÂÏÂÙÈΤ˜ ·ÓˆÌ·Ï›Â˜ Î·È ÓÂÊÚÈ΋ Û˘ÌÌÂÙÔ¯‹ Î·È ·ÓÔÛÔ·Ó¿ÚÎÂÈ·

™. Jeune (asphyxiating ¢˘ÛÏ·Û›· ıÒÚ·ÎÔ˜ ∞Ó¿ÚÎÂÈ·thoracic dystrophy) ·fi ÙË Á¤ÓÓËÛË ‰Â·ÌÈÓ¿Û˘-·‰ÂÓÔÛ›Ó˘µÚ·¯˘ÌÂÛÔÌÂÏ›· Ì ™. ÌÂÙ·Ê˘Ûȷ΋˜ÓÂÊÚÈ΋ ‰˘ÛÏ·Û›· ‰˘ÛÏ·Û›·˜-(brachymesomelia-renal ‰˘Û·ÔÚÚfiÊËÛ˘-dysplasia) Ô˘‰ÂÙÂÚÔÂÓ›·˜™. ªainzer-Saldino ∞ӈ̷ϛ˜ ÀÔÏ·Û›· ¯fiÓ‰ÚˆÓ- ∞ÎÙÈÓÔÏÔÁÈΤ˜ ·ÏÏÔÈÒÛÂȘ

·ÌÊÈ‚ÏËÛÙÚÔÂȉԇ˜ ÙÚȯˆÙÔ‡ ÎÂÊ·Ï‹˜ ÌÂÙ·Ê˘Ûȷ΋˜ ‰˘ÛÏ·Û›·˜, Î·È ÔÙÈÎÔ‡ Ó‡ÚÔ˘ (cartilage-hair hypoplasia) ‰È·Ù·Ú·¯‹ ΢Ù. ·ÓÔÛ›·˜,

ÏÂÙ¿, ·Ú·È¿ Î·È ·Ô¯ÚˆÌ·ÙÈṲ̂ӷ Ì·ÏÏÈ¿

¡ÂÊÚÔÛÈ·Ï›‰ˆÛË ªÂÙ·‚ÔÏÈÎfi ÓfiÛËÌ·(‹ ÛÈ·Ï›‰ˆÛË Ù‡Ô˘ ππ)™. Wolkott-Rallison ¶ÚÒÈÌË ÂÌÊ¿ÓÈÛË

۷ί·ÚÒ‰Ô˘˜ ‰È·‚‹ÙË

¶·ı‹ÛÂȘ Ì ÔÛÙÈΤ˜ ·ÓˆÌ·Ï›Â˜, ÓÂÊÚÈ΋ Û˘ÌÌÂÙÔ¯‹ Î·È ·ÓÔÛÔÏÔÁÈÎfi ¤ÏÏÂÈÌÌ·∞ÓÔÛÔ-ÔÛÙÈ΋ ‰˘ÛÏ·Û›· Ù‡Ô˘ Schimke

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58 ™. æÒÓË Î·È Û˘Ó.

¶·È‰È·ÙÚÈ΋ 2006;69:52-58

ÂÁÎÂÊ·ÏÈο ¤ÌÊÚ·ÎÙ·, ·ÔÙÂÏÔ‡Ó ÙȘ ·Èٛ˜ ı·-

Ó¿ÙÔ˘. ∏ ÚÒÈÌË ¤Ó·ÚÍË Ù˘ ÓfiÛÔ˘ Î·È È‰›ˆ˜ Ô

‚ÚÂÊÈÎfi˜ Ù‡Ô˜ Ô˘ Û˘Ó‰¤ÂÙ·È Ì IUGR, ¤¯ÂÈ

Û˘Ó‹ıˆ˜ ‚·ÚÈ¿ ÂÍÂÏÈÛÛfiÌÂÓË ÔÚ›· Î·È ÌÈÎÚfi-

ÙÂÚË ÂÈ‚›ˆÛË. ∏ ·Ó¿Ù˘ÍË ÙÔ˘ ÓÂÊÚˆÛÈÎÔ‡

Û˘Ó‰ÚfiÌÔ˘ Â›Ó·È ¤Ó· ÛËÌÂ›Ô ÔÚfiÛËÌÔ, ÁÈ·Ù› ·fi

ÂΛ Î·È ÌÂÙ¿ Ë ÂͤÏÈÍË Ù˘ ÓÂÊÚÈ΋˜ ‚Ï¿‚˘ ›-

Ó·È ÈÔ ÁÚ‹ÁÔÚË, Ì ·Ú¿ÏÏËϘ ÂÈÏÔΤ˜ Ïfi-

Áˆ Ù˘ ·ÓÔÛÔ·Ó¿ÚÎÂÈ·˜ (1,6). ∏ ÛÂÈÚ¿ ÂÌÊ¿-

ÓÈÛ˘ ÙˆÓ ÎÏÈÓÈÎÒÓ ÂΉËÏÒÛÂˆÓ Â›Ó·È: ·Ó·ÛÙÔ-

Ï‹ ·‡ÍËÛ˘, ÏÂ˘ÎˆÌ·ÙÔ˘Ú›·, ÓÂÊÚˆÛÈÎfi Û‡Ó-

‰ÚÔÌÔ, ·˘ÍË̤ÓË Â˘·ÈÛıËÛ›· ÛÙȘ ÏÔÈÌÒÍÂȘ

Ô˘ ηٷϋÁÂÈ Û ÛÔ‚·Ú¤˜ ÏÔÈÌÒÍÂȘ Ì ‰˘ÛÌÂ-

Ó‹ ¤Î‚·ÛË.

∏ ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘, fiˆ˜ Ê·›-

ÓÂÙ·È ÛÙÔÓ ¶›Ó·Î· 2, ÂÚÈÏ·Ì‚¿ÓÂÈ Î·Ù·ÛÙ¿ÛÂȘ

fiÔ˘ ·Ú·ÙËÚÔ‡ÓÙ·È: ·) ÛÎÂÏÂÙÈΤ˜ ·ÓˆÌ·Ï›Â˜

Ì ÓÂÊÚÈ΋ Û˘ÌÌÂÙÔ¯‹ Î·È ‚) ÓÔÛ‹Ì·Ù· Ô˘

Û˘Ó‰˘¿˙Ô˘Ó ÛÎÂÏÂÙÈΤ˜ ‰˘ÛϷۛ˜ Ì ·ÓÔÛÔ-

ÏÔÁÈÎfi ¤ÏÏÂÈÌÌ·. ™ÙÔÓ ·ÛıÂÓ‹ Ì·˜ Ù¤ıËÎÂ Ë ‰È¿-

ÁÓˆÛË Ù˘ ·ÓÔÛÔ-ÔÛÙÈ΋˜ ‰˘ÛÏ·Û›·˜ Ù‡Ô˘

Schimke, ÁÈ·Ù› ‹Ù·Ó Ë ÌfiÓË ÓfiÛÔ˜ ÌÂ Û˘ÌÌÂÙÔ¯‹

·fi Ù· ÔÛÙ¿, ÙÔ˘˜ ÓÂÊÚÔ‡˜ Î·È ÙÔ ·ÓÔÛÔÏÔÁÈÎfi

Û‡ÛÙËÌ·.

∏ ÓÂÊÚÈ΋ ‚Ï¿‚Ë Â›Ó·È ·ÓıÂÎÙÈ΋ ÛÙË ıÂÚ·-

›· Ì ÛÙÂÚÔÂȉ‹ Î·È ·ÓÔÛÔηٷÛÙ·ÏÙÈο ηÈ

ÙÂÏÈο, ÌÂÙ¿ ÙËÓ ÂÁηٿÛÙ·ÛË Ù˘ ¯ÚfiÓÈ·˜ ÓÂ-

ÊÚÈ΋˜ ·Ó¿ÚÎÂÈ·˜, Ô ·ÛıÂÓ‹˜ Ô‰ËÁÂ›Ù·È ÛÙË

ÌÂÙ·ÌfiÛ¯Â˘ÛË ÓÂÊÚÔ‡. ∏ ÏÔÈ‹ ıÂڷ›· ›ӷÈ

˘ÔÛÙËÚÈÎÙÈ΋, ¯ˆÚ›˜ Ó· ˘¿Ú¯ÂÈ Ë ‰˘Ó·ÙfiÙËÙ·

·Ó·ÎÔ‹˜ Ù˘ ÂÍÂÏÈÎÙÈ΋˜ ÔÚ›·˜ Ù˘ ÓfiÛÔ˘.

°È· ÙËÓ ·ÔηٿÛÙ·ÛË ÙˆÓ ·ÈÌ·ÙÔÏÔÁÈÎÒÓ ‰È·-

Ù·Ú·¯ÒÓ ¤¯Ô˘Ó ‰ÔÎÈÌ·ÛÙ› ıÂڷ¢ÙÈο G-CSF,

GM-CSF, ÂÚ˘ıÚÔÔÈËÙ›ÓË, ÌÂÙ·ÁÁ›ÛÂȘ ÂÚ˘ıÚÒÓ

·ÈÌÔÛÊ·ÈÚ›ˆÓ Î·È ·ÈÌÔÂÙ·Ï›ˆÓ, ÂÓÒ ¯ÔÚËÁ›-

Ù·È ·ÓÙÈ˘ÂÚÙ·ÛÈ΋, ·ÓÙÈÏÈȉ·ÈÌÈ΋ ·ÁˆÁ‹ ηÈ

ÚÔÊ˘Ï·ÎÙÈ΋ ·ÓÙÈÌÈÎÚԂȷ΋, fiÔ˘ ¯ÚÂÈ¿˙Â-

Ù·È (6). √È ·ÁÁÂȷΤ˜ ‰È·Ù·Ú·¯¤˜ ·ÓÙÈÌÂÙˆ›˙Ô-

ÓÙ·È Ì ·ÓÙÈËÎÙÈο, ·ÈÌÔÚÚÂÔÏÔÁÈο Î·È Î·Ù¿

Ù˘ ËÌÈÎÚ·Ó›·˜ Ê¿Ú̷η (6,7). ∆ÂÏÂ˘Ù·›·, ·Ó·-

ʤÚÂÙ·È ÂÈÙ˘¯Ë̤ÓË ÌÂÙ·ÌfiÛ¯Â˘ÛË Ì˘ÂÏÔ‡

ÙˆÓ ÔÛÙÒÓ Û ̛· ÂÚ›ÙˆÛË SIOD Ô˘ ›¯Â ÂÌ-

Ê·Ó›ÛÂÈ Ì˘ÂÏÈ΋ ·Ï·Û›·. ™ÙË Û˘Ó¤¯ÂÈ· ¤ÁÈÓÂ

Î·È ÌÂÙ·ÌfiÛ¯Â˘ÛË ÓÂÊÚÔ‡ Î·È ·Ú·ÙËÚ‹ıËÎÂ

‚ÂÏÙ›ˆÛË Ù˘ ·ÈÌ·ÙÔÏÔÁÈ΋˜, ·ÓÔÛÔÏÔÁÈ΋˜ ηÈ

ÓÂÊÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ (12). øÛÙfiÛÔ, ¯ÚÂÈ¿˙ÂÙ·È

ÂÚ·ÈÙ¤Úˆ ÌÂϤÙË, ÌÂÁ·Ï‡ÙÂÚÔ˘ ·ÚÈıÌÔ‡ ÂÚÈ-

ÙÒÛˆÓ, ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂÍ·¯ıÔ‡Ó Û·Ê¤ÛÙÂÚ·

Û˘ÌÂÚ¿ÛÌ·Ù·.

∏ ¤ÁηÈÚË ‰È¿ÁÓˆÛË ÙÔ˘ ˘ÔÏÂÈfiÌÂÓÔ˘ ·˘-

ÙÔ‡ ÓÔÛ‹Ì·ÙÔ˜ Î·È Ë ÌÔÚȷ΋ ·Ó¿Ï˘ÛË DNA

Û˘Ì‚¿ÏÏÔ˘Ó ÛÙË ÛˆÛÙ‹ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ

·ÛıÂÓÒÓ Î·È ÛÙË ÁÂÓÂÙÈ΋ ηıÔ‰‹ÁËÛË, Ë ÔÔ›·

Û˘Ó›ÛÙ·Ù·È ÛÙËÓ ·Ó›¯Ó¢ÛË ÊÔÚ¤ˆÓ Î·È ÛÙË ‰˘-Ó·ÙfiÙËÙ· ÚÔÁÂÓÓËÙÈÎÔ‡ ÂϤÁ¯Ô˘ ÛÙȘ ÔÈÎÔÁ¤-ÓÂȘ ÙˆÓ ·Û¯fiÓÙˆÓ.

∂˘¯·ÚÈÛٛ˜

£ÂṲ́˜ ¢¯·ÚÈÛٛ˜ ÛÙÔÓ Assistant Professor C.F.Boerkoel ·fi ÙÔ ∆Ì‹Ì· ªÔÚȷ΋˜ °ÂÓÂÙÈ΋˜ ÙÔ˘∞ÓıÚÒÔ˘ ÙÔ˘ Baylor College of Medicine, USA.

µÈ‚ÏÈÔÁÚ·Ê›·

1. Lou S, Lamfers P, McGuire N, Boerkoel CF. Longevi-ty in Schimke immuno-osseous dysplasia. J MedGenet 2002;39:922-925.

2. Schimke RN, Horton WA, King CR, Martin NL.Chondroitin-6-sulfate mucopoly-saccharidosis inconjunction with lymphopenia, defective cellular im-munity and the nephrotic syndrome. Birth DefectsOrig Artic Ser 1974;10:258-266.

3. Sigurdardorttir S, Myers SM, Woodworth JM, Ray-mond GV. Mental retardation and seizure disorder inSchimke immunoosseous dysplasia. Am J Med Genet2000;90:294-298.

4. Spranger J, Hinkel GK, Stoss H, Thoenes W, War-gowski D, Zepp F. Schimke immuno-osseous dyspla-sia: a newly recognized multisystem disease. J Pediatr1991;119:64-72.

5. Boerkoel CF, Takashima H, John J, Yan J, StankiewiczP, Rosenbarker L et al. Mutant chromatin remodelingprotein SMARCAL1 causes Schimke immuno-os-seous dysplasia. Nat Genet 2002;30:215-220.

6. Boerkoel CF, O'Neill S, Andre JL, Benke PJ, Bog-danovic R, Bulla M et al. Manifestations and treat-ment of Schimke immuno-osseous dysplasia: 14 newcases and a review of the literature. Eur J Pediatr2000;159:1-7.

7. Schmidt B, Christen HJ, Herkenrath P, Benz-BohmG, Muller-Berghaus J, Querfeld U. Cerebral compli-cations in Schimke immuno-osseous dysplasia. Eur JPediatr 1997;156:789-791.

8. Ludman MD, Cole DE, Crocker JF, Cohen MM Jr.Schimke immuno-osseous dysplasia: case report andreview. Am J Med Genet 1993;47:793-796.

9. Saraiva JM, Dinis A, Resende C, Faria E, Gomes C,Correia AJ et al. Schimke immuno-osseous dysplasia:case report and review of 25 patients. J Med Genet1999;36:786-789.

10. Tylki-Szymanska A, Pyrkosz A, Krajewska-WalasekM, Michalkiewicz J, Kowalska A, Rokicki D. Schimkeimmuno-osseous dysplasia: two cases. Pediatr Radiol2003;33:216-218.

11. Stormon M, Friedman J, King S, Cutz E, Furuya KN.An unusual case of diarrhea in schimke immuno-os-seous dysplasia. J Pediatr Gastroenterol Nutr2002;35:369-371.

12. Petty EM, Yanik GA, Hutchinson RJ, Alter BP, Sch-malstieg FC, Levine JE et al. Successful bone marrowtransplantation in a patient with Schimke immuno-osseous dysplasia. J Pediatr 2000;137:882-886.

Pediatr Jan-Feb 06 final allges 27-01-06 15:35 ™ÂÏ›‰·58

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59¶ƒ∞∫∆π∫√ £∂ª∞ PRACTICAL ISSUE

H ÛËÌ·Û›· ÙÔ˘ ÂϤÁ¯Ô˘ Ù˘ fiÚ·Û˘

ÛÙËÓ ÚÔÛ¯ÔÏÈ΋ Î·È Û¯ÔÏÈ΋ ËÏÈΛ·

ÛÙÔ ÚˆÙÔ‚¿ıÌÈÔ ·È‰È·ÙÚÈÎfi È·ÙÚ›Ô

∞. •ÂηϿÎË, π. ∞ÓÙˆÓÈ¿‰Ô˘ - ∫Ô˘Ì¿ÙÔ˘

¶ÂÚ›ÏË„Ë: ∞‰È¿ÁÓˆÛÙ· ÚÔ‚Ï‹Ì·Ù· fiÚ·Û˘ Û ·È‰È¿ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÔ˘Ó Û ¤Ó· Ï‹ıÔ˜ Û˘-ÓÂÂÈÒÓ. √È ÈÔ ÛËÌ·ÓÙÈΤ˜ Â›Ó·È Ë ·Ì‚Ï˘ˆ›· Î·È Ù· ÚÔ‚Ï‹Ì·Ù· ÛÙËÓ ·fi‰ÔÛË ÛÙÔ Û¯ÔÏ›Ô. ∏ÂÎÙ›ÌËÛË Ù˘ fiÚ·Û˘ ÔÊ›ÏÂÈ Ó· Â›Ó·È Ì¤ÚÔ˜ Ù˘ Ù·ÎÙÈ΋˜ ·È‰È·ÙÚÈ΋˜ ·Ú·ÎÔÏÔ‡ıËÛ˘. ∫·Ù¿Ï-ÏËÏ· ·ÓȯÓ¢ÙÈο ÂÚÁ·Ï›· (screening tests) ··ÈÙÔ‡ÓÙ·È ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË Ù˘ fiÚ·Û˘ ÙˆÓ ·È‰ÈÒÓÛÙȘ ‰È¿ÊÔÚ˜ ËÏÈ˘.

§¤ÍÂȘ ÎÏÂȉȿ ¶·È‰È¿, ¤ÏÂÁ¯Ô˜ fiÚ·Û˘, ·Ì‚Ï˘ˆ›·.

The importance of vision tests in pre-school and school age children

in the primary paediatric setting

A. Xekalaki, I. Antoniadou - Koumatou

Abstract: Undetected vision problems in children can lead to a variety of adverse consequences. Themost serious of these are amblyopia and inadequate school performance. Vision assessment shouldbe carried out as part of the regular paediatric examination. Screening tests for vision need to beappropriate for the various ages of children.

Key words Children, vision screening, amblyopia.

¢È‡ı˘ÓÛË ∫ÔÈÓˆÓÈ΋˜¶·È‰È·ÙÚÈ΋˜, πÓÛÙÈÙÔ‡ÙÔÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡

AÏÏËÏÔÁÚ·Ê›·:

π. ∞ÓÙˆÓÈ¿‰Ô˘-∫Ô˘Ì¿ÙÔ˘¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∏ ∞Á›· ™ÔÊ›·”∆.∫. 115 27, ∞ı‹Ó·E-mail: [email protected]

∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 28-01-2005 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 21-09-2005

Department of SocialPaediatrics, Institute of Child Health, Athens

Correspondence:

I. Antoniadou-KoumatouInstitute of Child Health“Aghia Sofia” Children'sHospital 115 27, Athens, GreeceE-mail: [email protected]

Date of submission: 28-01-2005Date of approval: 21-09-2005

¶·È‰È·ÙÚÈ΋ 2006;69:59-64

∏ ÚÔÛ¿ıÂÈ· ¤ÁηÈÚ˘ ·Ó›¯Ó¢Û˘ ÚÔ-‚ÏËÌ¿ÙˆÓ fiÚ·Û˘ ¤¯ÂÈ ÍÂÎÈÓ‹ÛÂÈ Â‰Ò Î·È ¤Ó·Ó·ÈÒÓ· ÂÚ›Ô˘. ∆Ô ÚÒÙÔ ·ÓȯÓ¢ÙÈÎfi ÂÚÁ·-ÏÂ›Ô ÂÊ·ÚÌfiÛÙËΠÙÔ 1899 (1). ™ÙȘ ÂfiÌÂÓ˜‰ÂηÂٛ˜ ÂÌÊ·Ó›ÛÙËÎ·Ó ÔÏϤ˜ ‰ÔÎÈ̷ۛ˜ÁÈ· ÙËÓ ·Ó›¯Ó¢ÛË ÚÔ‚ÏËÌ¿ÙˆÓ fiÚ·Û˘ (2),·ÏÏ¿ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ‰ÂηÂÙ›·˜ ÙÔ˘ 1960ÛËÌÂÈÒÓÂÙ·È ÌÈ· ·ÏÌ·Ù҉˘ ·‡ÍËÛË Ù˘ ÚÔ-Û¿ıÂÈ·˜ Û˘Ì‚·Ù‹ Ì ÙËÓ «¤ÎÚËÍË» ÙˆÓ ÂÊ·Ú-ÌÔÁÒÓ ÙˆÓ ·ÓȯÓ¢ÙÈÎÒÓ ‰ÔÎÈÌ·ÛÈÒÓ ÂΛÓËÙËÓ ÂÚ›Ô‰Ô. TÔ ·ÚfiÓ ¿ÚıÚÔ ¤¯ÂÈ ÛÙfi¯Ô Ó···ÓÙ‹ÛÂÈ Û ÙÚÂȘ ‚·ÛÈΤ˜ ÂÚˆÙ‹ÛÂȘ:

ñ °È·Ù› ¤¯ÂÈ ÛËÌ·Û›· Ë ¤ÁηÈÚË ‰È¿ÁÓˆÛ˷ӈ̷ÏÈÒÓ ÛÙËÓ fiÚ·ÛË Î·È Ì¿ÏÈÛÙ· Û ÔχÌÈÎÚ‹ ËÏÈΛ·;

ñ ∏ ¤ÁηÈÚË ‰È¿ÁÓˆÛË ÂÍ·ÛÊ·Ï›˙ÂÈ Î·Ï‡ÙÂ-ÚÔ ıÂڷ¢ÙÈÎfi ·ÔÙ¤ÏÂÛÌ·, ‰ËÏ·‰‹ ηχÙÂ-ÚË fiÚ·ÛË;

ñ ªÂ ÔÈÔ «ÂÚÁ·Ï›Ի ÌÔÚ› Ô ÚˆÙÔ‚¿ı-ÌÈÔ˜ ·ÁÁÂÏÌ·Ù›·˜ ˘Á›·˜ Ó· ÂϤÁÍÂÈ ·ÍÈfiÈÛÙ·ÙËÓ ÔÙÈ΋ ÈηÓfiÙËÙ· ÙÔ˘ ·È‰ÈÔ‡;

√ÚfiÛËÌÔ ÁÈ· ÙËÓ Î·Ù·ÓfiËÛË Ù˘ Ê˘ÛÈÔÏÔ-Á›·˜ Ù˘ fiÚ·Û˘ ·ÔÙ¤ÏÂÛ·Ó ÔÈ ÂÚÁ·Û›Â˜ ÙˆÓÓ¢ÚÔ‚ÈÔÏfiÁˆÓ. ∏. Hubel Î·È T.M. Wiesel (¡fi-ÌÂÏ π·ÙÚÈ΋˜ 1981) (3), ÔÈ ÔÔ›ÔÈ Î·Ù¤‰ÂÈÍ·ÓÙÔÓ ˘„ËÏfi ‚·ıÌfi Ï·ÛÙÈÎfiÙËÙ·˜ ÙÔ˘ ÔÙÈÎÔ‡ÊÏÔÈÔ‡ ÛÙȘ ÌÈÎÚ¤˜ ËÏÈ˘ Î·È ˆ˜ ÂÎ ÙÔ‡ÙÔ˘ ÙËÛËÌ·Û›· Ù˘ ‡·Ú͢ Î·È Ù˘ ÔÈÎÈÏ›·˜ ÙˆÓÔÙÈÎÒÓ ÂÚÂıÈÛÌ¿ÙˆÓ.

∏ ÚÒÈÌË ‰È¿ÁÓˆÛË ·ÓˆÌ·ÏÈÒÓ ÛÙËÓ fiÚ·-ÛË ¤¯ÂÈ ˆ˜ ÛÙfi¯Ô, fi¯È ÌfiÓÔ ÙËÓ ÚfiÏË„Ë Ù˘·Ì‚Ï˘ˆ›·˜, ·ÏÏ¿ Î·È ÙˆÓ ‰Â˘ÙÂÚÔÁÂÓÒÓ Û˘-ÓÂÂÈÒÓ Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙ· ÌÈÎÚ¿ ·È‰È¿Ì ̷ÎÚÔ¯ÚfiÓÈ· ·‰È¿ÁÓˆÛÙ· ÚÔ‚Ï‹Ì·Ù·fiÚ·Û˘ (.¯. ÚÔ‚Ï‹Ì·Ù· Û˘ÌÂÚÈÊÔÚ¿˜, ›-‰ÔÛ˘ ÛÙÔ Û¯ÔÏÂ›Ô ÎÏ.). ŒÙÛÈ, Ù· ™˘ÛÙ‹Ì·Ù·ÀÁ›·˜ ·ÚÎÂÙÒÓ ¯ˆÚÒÓ ˘ÈÔı¤ÙËÛ·Ó Î·È ÂÊ¿Ú-ÌÔÛ·Ó ÚÔÁÚ¿ÌÌ·Ù· ¤ÁηÈÚ˘ ·Ó›¯Ó¢Û˘ÚÔ‚ÏËÌ¿ÙˆÓ fiÚ·Û˘ (screening) ÛÙ· ·È‰È¿ÚÔÛ¯ÔÏÈ΋˜ Î·È Û¯ÔÏÈ΋˜ ËÏÈΛ·˜. ∏ ÂÎÙ›ÌË-ÛË Ù˘ ÔÙÈ΋˜ ÈηÓfiÙËÙ·˜ fï˜, Û Ôχ ÌÈ-ÎÚ¿ Î·È ÌÂÚÈΤ˜ ÊÔÚ¤˜ ÌË Û˘ÓÂÚÁ¿ÛÈÌ· ·È‰È¿

Pediatr Jan-Feb 06 final allges 27-01-06 15:35 ™ÂÏ›‰·59

Page 60: Παιδιατρική | Τόμος 69 • Τεύχος 1 • Ιανουάριος - Φεβρουάριος 2006

60 ∞. •ÂηϿÎË, π. ∞ÓÙˆÓÈ¿‰Ô˘-∫Ô˘Ì¿ÙÔ˘

¤¯ÂÈ ‰˘ÛÎÔϛ˜, Î·È ¤ÙÛÈ, ÔÈ ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓ˜

̤ıÔ‰ÔÈ Û˘¯Ó¿ ·ÏÏ¿˙Ô˘Ó ÛÙËÓ ÚÔÛ¿ıÂÈ· Ó·

·˘ÍËı› Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ¿ ÙÔ˘˜.

™‹ÌÂÚ·, ¯ÒÚ˜ Ô˘ ¤¯Ô˘Ó Û˘ÛÙËÌ·ÙÈο

ÂÊ·ÚÌfiÛÂÈ ÌÂıfi‰Ô˘˜ screening ÁÈ· ÙËÓ fiÚ·ÛË

(∏¶∞, ∏ӈ̤ÓÔ µ·Û›ÏÂÈÔ, ™Î·Ó‰ÈÓ·‚Èο ÎÚ¿-

ÙË) Û˘Ó¯›˙Ô˘Ó Ó· ÂÈÛËÌ·›ÓÔ˘Ó ÚÔ‚Ï‹Ì·Ù·

ÛÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù¤ÙÔÈˆÓ ÚÔÁÚ·Ì-

Ì¿ÙˆÓ (fiˆ˜ Ô ÙÚfiÔ˜ ÂÊ·ÚÌÔÁ‹˜ Î·È Ë Î·ıÔ-

ÏÈÎfiÙËÙ· ÂÊ·ÚÌÔÁ‹˜) Î·È Î·Ù¿ Û˘Ó¤ÂÈ· ÚÔ-

‚Ï‹Ì·Ù· ÛÙË Û¯¤ÛË ÎfiÛÙÔ˘˜/·ÔÙÂÏÂÛÌ·ÙÈÎfi-

ÙËÙ·˜ (4-9). ∏ ÂÌÂÈÚ›· ·˘ÙÒÓ ÙˆÓ ¯ˆÚÒÓ ¤¯ÂÈ

‰Â›ÍÂÈ fiÙÈ Ë Ù·ÎÙÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË Î·È Ë

¤ÁηÈÚË ·Ó›¯Ó¢ÛË ÌÂÈÒÓÔ˘Ó ÛËÌ·ÓÙÈο ÙËÓ

›وÛË Ù˘ ·Ì‚Ï˘ˆ›·˜ (1,21,32), ¤ÙÛÈ ÛÂ

η̛· ·fi ·˘Ù¤˜ ÙȘ ¯ÒÚ˜ ‰ÂÓ ¤¯ÂÈ Î·Ù·ÚÁË-

ı› Ô Ì·˙ÈÎfi˜ ÚÔÏËÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÁÈ· ÚÔ-

‚Ï‹Ì·Ù· fiÚ·Û˘ ·ÚfiÏÔ Ô˘ Û˘Ó¯Ҙ ·Ó·˙Ë-

ÙÔ‡ÓÙ·È ÙÚfiÔÈ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂÚ˘ ÂÊ·Ú-

ÌÔÁ‹˜ ÙÔ˘ (2,9-13).

™ÙËÓ ∂ÏÏ¿‰·, ÂÓÒ ˘¿Ú¯ÂÈ ıÂÛÌÔıÂÙË̤ÓË

Ú·ÎÙÈ΋ ÁÈ· ¤ÏÂÁ¯Ô fiÚ·Û˘ (ÙÔ˘Ï¿¯ÈÛÙÔÓ ÁÈ·

Ù· ·È‰È¿ ÚÔÛ¯ÔÏÈ΋˜ Î·È Û¯ÔÏÈ΋˜ ËÏÈΛ·˜

̤ۈ ÙÔ˘ ∞ÙÔÌÈÎÔ‡ ¢ÂÏÙ›Ô˘ ÀÁ›·˜ ÙÔ˘ ª·ıË-

Ù‹), ‰ÂÓ ˘¿Ú¯ÂÈ Î·Ù¿ÏÏËÏÔ ÂÚÁ·ÏÂ›Ô Ô˘ Ó·

ÌÔÚ› Ó· ¯ÚËÛÈÌÔÔÈËı› ·fi ÚˆÙÔ‚¿ıÌÈ-

Ô˘˜ ·ÁÁÂÏ̷ٛ˜ ˘Á›·˜.

¶fiÛÔ ÛËÌ·ÓÙÈ΋ Â›Ó·È Ë ÚÒÈÌË

‰È¿ÁÓˆÛË Ù˘ ·Ì‚Ï˘ˆ›·˜;

∞Ì‚Ï˘ˆ›· Â›Ó·È Ë ÂÏ·Ùو̤ÓË ÔÙÈ΋

Ô͇ÙËÙ· ÛÙÔ ¤Ó· ‹ Î·È ÛÙ· ‰‡Ô Ì¿ÙÈ·. £ÂˆÚ›-

Ù·È ÌÈ· ‰È·Ù·Ú·¯‹ ·Ó·Ù˘ÍÈ·ÎÔ‡ ¯·Ú·ÎÙ‹Ú·

Ô˘ Û˘Ó‰¤ÂÙ·È Ì ÙËÓ «Â˘·›ÛıËÙË-ÎÚ›ÛÈÌË»

ÂÚ›Ô‰Ô ÙÔ˘ Ì·ÙÈÔ‡ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË Ê˘ÛÈÔ-

ÏÔÁÈ΋˜ fiÚ·Û˘, ÁÂÁÔÓfi˜ Ô˘ ·ÔÙ¤ÏÂÛ ηÈ

ÙËÓ ÚˆÙ·Ú¯È΋ ·ÈÙ›· ÁÈ· ÙËÓ ¤ÁηÈÚË ·Ó›¯Ó¢-

ÛË ·ÓˆÌ·ÏÈÒÓ Ù˘ fiÚ·Û˘ (3,32).

™˘Ó‹ıÂȘ ·Èٛ˜ ·Ì‚Ï˘ˆ›·˜ Â›Ó·È Ô Î·Ù·Ú-

Ú¿ÎÙ˘, Ô ÛÙÚ·‚ÈÛÌfi˜, Ë ÙÒÛË ÙÔ˘ ‚ÏÂÊ¿ÚÔ˘,

Ë ÛËÌ·ÓÙÈ΋ ·ÓÈÛÔÌÂÙÚˆ›· (28) Î·È ÔÈ ‰È·-

ıÏ·ÛÙÈΤ˜ ·ÓˆÌ·Ï›Â˜. ™ÙÔÓ ÛÙÚ·‚ÈÛÌfi ÔÊ›ÏÔ-

ÓÙ·È ÂÚ›Ô˘ ÙÔ 48% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ·Ì-

‚Ï˘ˆ›·˜, ÂÓÒ ÛÙȘ ‰È·ıÏ·ÛÙÈΤ˜ ·ÓˆÌ·Ï›Â˜ ÙÔ

20% (32). ™ËÌÂÈÒÓÂÙ·È fiÙÈ ÛÙÔÓ ÁÂÓÈÎfi ÏËı˘-

ÛÌfi Ë Û˘¯ÓfiÙËÙ· ÙˆÓ ‰È·ıÏ·ÛÙÈÎÒÓ ·ÓˆÌ·-

ÏÈÒÓ Â›Ó·È Ôχ ˘„ËÏfiÙÂÚË ·fi ·˘Ù‹ ÙÔ˘

ÛÙÚ·‚ÈÛÌÔ‡.

∏ ÂÌÊ¿ÓÈÛË Ù˘ ·Ì‚Ï˘ˆ›·˜ Û˘Ó‰¤ÂÙ·È ÌÂ

ÔÙÈΤ˜ ·ÓˆÌ·Ï›Â˜ Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È Û Ôχ

ÌÈÎÚ‹ ËÏÈΛ·. ∞Ó ÔÈ ›‰È˜ ·ÓˆÌ·Ï›Â˜ ·ÚÔ˘ÛÈ·-

ÛÙÔ‡Ó ÌÂÙ¿ ÙËÓ ËÏÈΛ· ÙˆÓ 6-8 ÂÙÒÓ Û˘Ó‹ıˆ˜

‰ÂÓ ÚÔ·ÙÂÈ ·Ì‚Ï˘ˆ›· (32).

ŒÙÛÈ, Û ·Ì‚Ï˘ˆ›· ÌÔÚ› Ó· Ô‰ËÁ‹ÛÔ˘Ó ÔÈ

‰È·ıÏ·ÛÙÈΤ˜ ·ÓˆÌ·Ï›Â˜ (Ì˘ˆ›·-˘ÂÚÌÂÙÚˆ-

›·-·ÛÙÈÁÌ·ÙÈÛÌfi˜), Ë ·ÓÈÛÔÌÂÙÚˆ›· (ÌÂÁ¿ÏË

‰È·ÊÔÚ¿ ÛÙË ‰È·ıÏ·ÛÙÈ΋ ÈηÓfiÙËÙ· ÌÂٷ͇ ÙˆÓ

‰‡Ô Ì·ÙÈÒÓ) ‹ Ë ·Ó¿Ù˘ÍË ÛÙÚ·‚ÈÛÌÔ‡. ∏ ·ÍÈÔ-

ÏfiÁËÛ‹ ÙÔ˘˜ fï˜, ÛÙ· Ôχ ÌÈÎÚ¿ ·È‰È¿ ¤¯ÂÈ

Î·È ÌÈ· ÚfiÛıÂÙË ÛËÌ·Û›·. ∫·ıÒ˜ Ù· ·È‰È¿ ÌÂ-

Á·ÏÒÓÔ˘Ó, ·ÏÏ¿˙ÂÈ Ë ‰È·ıÏ·ÛÙÈ΋ ÈηÓfiÙËÙ· ÙÔ˘

Ì·ÙÈÔ‡. ∆Ô Ì¤ÁÂıÔ˜ ÙÔ˘ Ì·ÙÈÔ‡ ·˘Í¿ÓÂÈ ÛËÌ·ÓÙÈ-

ο ̤¯ÚÈ Ù· 3 ¯ÚfiÓÈ· ˙ˆ‹˜, ÂÓÒ Ô Ú˘ıÌfi˜ ·‡ÍË-

Û˘ ÛÙË Û˘Ó¤¯ÂÈ· ÂÏ·ÙÙÒÓÂÙ·È. ªÂ ÛÙfi¯Ô ÙË ‰È·-

Ù‹ÚËÛË ÈηÓÔÔÈËÙÈ΋˜ fiÚ·Û˘, ηٿ ÙË ‰È¿Ú-

ÎÂÈ· Ù˘ ÂÚÈfi‰Ô˘ Ù˘ ÁÚ‹ÁÔÚ˘ ·‡ÍËÛ˘, ·ÏÏ¿-

˙ÂÈ ÙÔ ·ÍÔÓÈÎfi Ì‹ÎÔ˜ Î·È Ì¤ÁÂıÔ˜ ÙÔ˘ ÔÊı·ÏÌÔ‡

Î·È Ô Ê·Îfi˜ ÙÔ˘ Ì·ÙÈÔ‡ ·ÏÏ¿˙ÂÈ ÁˆÌÂÙÚ›·

(emmetropization). ¶ÂÈÚ¿Ì·Ù· Û ˙Ò· ¤‰ÂÈÍ·Ó

fiÙÈ Ë ÂͤÏÈÍË ·˘Ù‹ ‰ÂÓ ÚÔ·ÙÂÈ ·Ó ÙÔ Ì¿ÙÈ ‰ÂÓ

‰¤¯ÂÙ·È Èηӿ ÔÙÈο ÂÚÂı›ÛÌ·Ù· (32).

∂Í·ÈÙ›·˜ Ù˘ ÌÂÁ¿Ï˘ ÂÙÂÚÔÁ¤ÓÂÈ·˜ ÙˆÓ ·È-

Ù›ˆÓ Ô˘ ÚÔηÏÔ‡Ó ·Ì‚Ï˘ˆ›·, ÙˆÓ ‰È·ÊÔ-

ÚÒÓ ÛÙË ‰È¿ÚÎÂÈ· Î·È ÙÔ Â›‰Ô˜ Ù˘ ıÂڷ›·˜,

ÙÔ˘ ‚·ıÌÔ‡ Ù˘ Û˘ÌÌfiÚʈÛ˘ ÙÔ˘ ·ÛıÂÓ‹ ηÈ

ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ÌÂÙ¿ ÙË ıÂڷ›· ·Ú·ÎÔ-

ÏÔ‡ıËÛ˘ (follow-up), ÔÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ó·-

ÊÔÚ¤˜ ‰ÂÓ Â›Ó·È Â‡ÎÔÏ· Û˘ÁÎÚ›ÛÈ̘ ˆ˜ ÚÔ˜

ÙÔ ıÂڷ¢ÙÈÎfi ·ÔÙ¤ÏÂÛÌ·.

¶¿ÓÙˆ˜ ·Ó·Ê¤ÚÂÙ·È ‚ÂÏÙ›ˆÛË Ù˘ ÔÙÈ΋˜

Ô͇ÙËÙ·˜ ÙˆÓ ·È‰ÈÒÓ Û ÔÛÔÛÙfi 41%-96%

(ÚÔÔÙÈΤ˜ ÌÂϤÙ˜) Î·È Û ÔÛÔÛÙfi 40%-

95% (·Ó·‰ÚÔÌÈΤ˜ ÌÂϤÙ˜) (32).

™ËÌ·ÓÙÈÎfi ›Û˘, Â›Ó·È ÙÔ Û˘Ì¤Ú·ÛÌ·

ÌÂÚÈÎÒÓ ÌÂÏÂÙÒÓ fiÙÈ Ë ÂÈÙ˘¯›· Ù˘ ıÂڷ›·˜

ÂÍ·ÚÙ¿Ù·È ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂڷ›·˜ ÛÂ

ÌÈÎÚ‹ ËÏÈΛ·. ŒÙÛÈ, Ê·›ÓÂÙ·È fiÙÈ ·˘Í¿ÓÂÙ·È Ë

·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ıÂڷ›·˜ Û ·È‰È¿

ÌÈÎÚfiÙÂÚ· ÙˆÓ 3 ÂÙÒÓ. √ Ú˘ıÌfi˜ ·ÔÙÂÏÂÛÌ·-

ÙÈÎfiÙËÙ·˜ Ù˘ ıÂڷ›·˜ ÂÏ·ÙÙÒÓÂÙ·È ÌÂÙ¿ Ù·

5 ¯ÚfiÓÈ· ˙ˆ‹˜, ÂÓÒ Û ·È‰È¿ 12 ÂÙÒÓ Â›Ó·È

·Ó·ÔÙÂÏÂÛÌ·ÙÈ΋ (32).

™˘ÌÂÚ·ÛÌ·ÙÈο, Ë ¤ÁηÈÚË ‰È¿ÁÓˆÛË Ù˘

·Ì‚Ï˘ˆ›·˜ ȉȷ›ÙÂÚ· Û ËÏÈΛ· <5 ¯ÚfiÓˆÓ ÌÔÈ-

¿˙ÂÈ Ó· ¤¯ÂÈ ıÂÙÈÎfi ·ÔÙ¤ÏÂÛÌ· ÛÙËÓ Î·Ï‹ fiÚ·-

ÛË, ÂÊfiÛÔÓ Ë ıÂڷ›· Â›Ó·È ‰˘ÛÎÔÏfiÙÂÚË Î·È

ÙÂÏÈο ·Ó·ÔÙÂÏÂÛÌ·ÙÈ΋ Ì ÙËÓ ·‡ÍËÛË Ù˘

ËÏÈΛ·˜. ∏ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙÔ˘ screening

fiÚ·Û˘ ÛÙÔÓ ÁÂÓÈÎfi ÏËı˘ÛÌfi Ì ÛÙfi¯Ô ÙË Ì›-

ˆÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ Ù˘ ·Ì‚Ï˘ˆ›·˜ Ê·›ÓÂÙ·È

·fi Ù· ‰‡Ô ·Ú·Î¿Ùˆ ·Ú·‰Â›ÁÌ·Ù·.

∏ ™Ô˘Ë‰›· ‰È·ı¤ÙÂÈ ¤Ó· ÂÈıÂÙÈÎfi ·ÓȯÓ¢ÙÈ-

Îfi ÚfiÁÚ·ÌÌ· Ì ·ӷϷ̂·ÓfiÌÂÓ· screening

tests ·fi ÙË ‚ÚÂÊÈ΋ ËÏÈΛ· ̤¯ÚÈ ÙËÓ ËÏÈΛ·

¶·È‰È·ÙÚÈ΋ 2006;69:59-64

Pediatr Jan-Feb 06 final allges 27-01-06 15:35 ™ÂÏ›‰·60

Page 61: Παιδιατρική | Τόμος 69 • Τεύχος 1 • Ιανουάριος - Φεβρουάριος 2006

61H ÛËÌ·Û›· ÙÔ˘ ÂϤÁ¯Ô˘ Ù˘ fiÚ·Û˘

ÙˆÓ 10 ¯ÚfiÓˆÓ. ªÈ· ·Ó·‰ÚÔÌÈ΋ ÌÂϤÙË ¤‰ÂÈÍÂ

fiÙÈ ÛÙËÓ ËÏÈΛ· ÙˆÓ 10 ÂÙÒÓ, Ë Â›ÙˆÛË

(prevalence) Ù˘ ·Ì‚Ï˘ˆ›·˜ ‹Ù·Ó 0,03% -Ô-

χ ÌÈÎÚfiÙÂÚË ·fi ÙÔ 3% ¿ÏÏˆÓ ÌÂÏÂÙÒÓ Â›-

ÙˆÛ˘ Ù˘ ·Ì‚Ï˘ˆ›·˜ Û ÏËı˘ÛÌÔ‡˜ Ô˘

‰ÂÓ ˘fiÎÂÈÓÙ·È ÛÂ Û˘ÛÙËÌ·ÙÈÎfi screening. ¶·-

ÚfiÌÔÈ· ·ÔÙÂϤÛÌ·Ù· ÛÙÔ πÛÚ·‹Ï ¤‰ÂÈÍ·Ó fiÙÈ

Ë Â›ÙˆÛË Ù˘ ·Ì‚Ï˘ˆ›·˜ ÛÙ· ·È‰È¿ ËÏÈ-

Λ·˜ 8 ÂÙÒÓ Ô˘ ›¯·Ó ÂÏÂÁ¯ı› Ì screening ÛÂ

ÌÈÎÚfiÙÂÚË ËÏÈΛ· ‹Ù·Ó 1% Û˘ÁÎÚÈÓfiÌÂÓË Ì ÙÔ

2,6% Û ËÏÈÎȷΤ˜ ʤÙ˜ Ô˘ ‰ÂÓ Â›¯·Ó ˘Ô-

ÛÙ› ·ÓȯÓ¢ÙÈΤ˜ ‰ÔÎÈ̷ۛ˜ (32).

∞ÓȯÓ¢ÙÈο ÂÚÁ·Ï›· ÂϤÁ¯Ô˘ ÔÙÈ΋˜

ÈηÓfiÙËÙ·˜ (ÔÙfiÙ˘·)

°È· ÙËÓ ÂÎÙ›ÌËÛË Ù˘ ÔÙÈ΋˜ ÈηÓfiÙËÙ·˜

ÂÓfi˜ ‚Ú¤ÊÔ˘˜ ‹ ÂÓfi˜ ÌÈÎÚÔ‡ ·È‰ÈÔ‡ Â›Ó·È ÛË-

Ì·ÓÙÈΤ˜ ÔÈ Û¯ÂÙÈΤ˜ ÏËÚÔÊÔڛ˜ ·fi ÙÔ ÔÈ-

ÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi Î·È ÔÈ ·Ó·ÊÂÚfiÌÂÓ˜ Û¯Â-

ÙÈΤ˜ ·ÓËÛ˘¯›Â˜ ÙˆÓ ÁÔÓ¤ˆÓ. ∂›Û˘, ÛËÌ·ÓÙÈ-

ο Â›Ó·È Î·È Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ Ê˘ÛÈ΋˜

ÂͤٷÛ˘ fiˆ˜ Ë Úfi‰ÈÓË ·ÓÙ·‡ÁÂÈ· ÙÔ˘ ·ÌÊÈ-

‚ÏËÛÙÚÔÂȉ‹ (red reflex) Û ‚Ú¤ÊË ÁÈ· ÙËÓ

·Ó·˙‹ÙËÛË Î·Ù·ÚÚ¿ÎÙË ‹ Ë ‰ÔÎÈÌ·Û›· Î¿Ï˘-

„˘ ‹ ÙÔ Hirschberg test ÁÈ· ÙËÓ ·Ó·˙‹ÙËÛË

ÛÙÚ·‚ÈÛÌÔ‡.

™Â ·È‰È¿ fï˜ ËÏÈΛ·˜ ÌÂÁ·Ï‡ÙÂÚ˘ ÙˆÓ

ÙÚÈÒÓ ¯ÚfiÓˆÓ, Ô ¤ÏÂÁ¯Ô˜ Ù˘ ÔÙÈ΋˜ ÈηÓfiÙË-

Ù·˜ Û˘ÌÏËÚÒÓÂÙ·È Ì ÙËÓ ÂÎÙ›ÌËÛË Ù˘ ÔÙÈ-

΋˜ Ô͇ÙËÙ·˜ ÙÔ˘ ·È‰ÈÔ‡. °È· ÙÔÓ ÛÎÔfi ·˘Ùfi

¯ÚËÛÈÌÔÔÈÂ›Ù·È ¤Ó· ÂÚÁ·ÏÂ›Ô (ÙÂÛÙ fiÚ·Û˘) ÌÂ

ÙË ‚Ô‹ıÂÈ· ÙÔ˘ ÔÔ›Ô˘ ‰È·ÈÛÙÒÓÂÙ·È ·Ó ÙÔ ·È-

‰› ¤¯ÂÈ ÙËÓ ·Ó·ÌÂÓfiÌÂÓË ÁÈ· ÙËÓ ËÏÈΛ· ÙÔ˘

ÔÙÈ΋ Ô͇ÙËÙ·. ∏ ÂÈÏÔÁ‹ ÙÔ˘ ÂÚÁ·Ï›Ԣ ÔÊ›-

ÏÂÈ Ó· Û˘ÌÌÔÚÊÒÓÂÙ·È Ì ÔÚÈṲ̂ӷ ÎÚÈÙ‹ÚÈ·.

∞Ó fï˜ ˙ËÙ‹ÛÔ˘Ì ·fi ¤Ó· ·È‰› ÚÔÛ¯Ô-

ÏÈ΋˜ ËÏÈΛ·˜ Ó· ·Ó·ÁÓˆÚ›ÛÂÈ Î·È Ó· ÔÓÔÌ¿ÛÂÈ

ۇ̂ÔÏ· Ô˘ ˘¿Ú¯Ô˘Ó ¿Óˆ Û ¤Ó· ÙÂÛÙ fiÚ·-

Û˘ ÁÈ· Ó· ‰È·ÈÛÙÒÛÔ˘Ì fiÛÔ Î·Ï¿ ‚ϤÂÈ,

˘Ôı¤ÙÔ˘Ì fiÙÈ Û οı ÂÍÂÙ·˙fiÌÂÓÔ ¿ÙÔÌÔ,

ÚÔ¸¿Ú¯Ô˘Ó ÂÍ›ÛÔ˘ fiϘ ÔÈ ··Ú·›ÙËÙ˜ ÁÓˆ-

ÛÙÈΤ˜, ·ÓÙÈÏËÙÈΤ˜, ÂÈÎÔÈÓˆÓȷΤ˜ ηÈ

ÔÊı·ÏÌÔÎÈÓËÙÈΤ˜ ÈηÓfiÙËÙ˜. ∫·È ÂÂȉ‹ ·˘-

Ùfi ‰ÂÓ Â›Ó·È ‰˘Ó·Ùfi Ó· ÈÛ¯‡ÂÈ ÂÍ›ÛÔ˘ ÁÈ· fiÏ· Ù·

·È‰È¿ Î·È È‰È·›ÙÂÚ· ÁÈ· Ù· ÌÈÎÚfiÙÂÚ·, ÙÔ ÔÔÈ-

Ô‰‹ÔÙ ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓÔ ÙÂÛÙ ¯¿ÓÂÈ ÙËÓ ÂÈ-

‰ÈÎfiÙËÙ¿ ÙÔ˘. ¶Ú¿ÁÌ· Ô˘ ÛËÌ·›ÓÂÈ fiÙÈ ÙÔ

·ÔÙ¤ÏÂÛÌ· Ù˘ ‰ÔÎÈÌ·Û›·˜ ‰ÂÓ Û˘Û¯ÂÙ›˙ÂÙ·È

Ì ÙËÓ Ú·ÁÌ·ÙÈ΋ ÔÙÈ΋ Ô͇ÙËÙ· ÙÔ˘ ·È‰È-

Ô‡, ·ÏÏ¿ ÙËÓ ˘ÔÂÎÙÈÌ¿ ÂÍ·ÈÙ›·˜ ·Ó·Ù˘ÍÈ·-

ÎÒÓ ‰È·ÊÔÚÒÓ.

ŒÓ· ηٿÏÏËÏÔ ÙÂÛÙ fiÚ·Û˘ ı· Ú¤ÂÈ Ó·

¤¯ÂÈ ˘„ËÏ‹ ÂȉÈÎfiÙËÙ· (ÌÈÎÚfi ÔÛÔÛÙfi „¢-

‰Ò˜ ıÂÙÈÎÒÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ, ‰ËÏ·‰‹ Ó· ÌÂ-

ÙÚ¿ÂÈ ÌfiÓÔ ÔÙÈ΋ Ô͇ÙËÙ·) Î·È ˘„ËÏ‹ ¢·È-

ÛıËÛ›· (ÌÈÎÚfi ÔÛÔÛÙfi „¢‰Ò˜ ·ÚÓËÙÈÎÒÓ

·ÔÙÂÏÂÛÌ¿ÙˆÓ, ‰ËÏ·‰‹ Ó· ·ÓȯÓ‡ÂÈ Î·È ÌÈ-

ÎÚ¤˜ ÔÙÈΤ˜ ‰È·Ù·Ú·¯¤˜). ∏ ·fi‰ÔÛË ÙÔ˘

ÔÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ (visual performance)

ÂÍ·ÚÙ¿Ù·È ·fi:

1. ¶ÔÏϤ˜ ÔÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜ fiˆ˜ ÙËÓ

ÔÙÈ΋ Ô͇ÙËÙ·, ÙËÓ Â˘·ÈÛıËÛ›· ·ÓÙ›ıÂÛ˘,

ÙËÓ ·ÓÙ›ÏË„Ë ¯ÚˆÌ¿ÙˆÓ, ÙËÓ ÚÔÛ·ÚÌÔÁ‹ ÛÙÔ

ʈ˜ Î·È ÛÙÔ ÛÎÔÙ¿‰È, ÙË ‰ÈfiÊı·ÏÌË fiÚ·ÛË.

2. ¶ÔÏϤ˜ ÔÙÈÎÔ-ÓÔËÙÈΤ˜ ‰˘Ó·ÙfiÙËÙ˜,

fiˆ˜ ÙËÓ ·ÓÙÈÏËÙÈÎfiÙËÙ· ÙÔ˘ ¯ÒÚÔ˘ Î·È ÙˆÓ

Û¯ËÌ¿ÙˆÓ, ÙËÓ ÔÙÈ΋ ÌÓ‹ÌË Î·È

3. ∆Ș ÔÊı·ÏÌÔ-ÎÈÓËÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜.

™ÙȘ ¯ÒÚ˜ ÙÔ˘ ‰˘ÙÈÎÔ‡ ÎfiÛÌÔ˘ Ô˘ ÂÊ·Ú-

Ìfi˙ÔÓÙ·È screening test fiÚ·Û˘ ·fi ÙȘ ÚˆÙÔ-

‚¿ıÌȘ ˘ËÚÂۛ˜ ˘Á›·˜, ¤¯ÂÈ ÏËÊı› ̤ÚÈÌÓ·

ÒÛÙ ٷ ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓ· ÂÚÁ·Ï›· Ó· ÙËÚÔ‡Ó

ÙȘ ‰ÈÂıÓ›˜ Û˘ÛÙ¿ÛÂȘ ηٷÛ΢‹˜ ÔÙÔÙ‡ˆÓ

Î·È ÙÔ ·ÔÙ¤ÏÂÛÌ· ÙÔ˘ ÙÂÛÙ Ó· ÂÎÊÚ¿˙ÂÈ ÔÙÈ-

΋ Ô͇ÙËÙ· Î·È fi¯È ÁÓˆÛÙÈ΋ ÈηÓfiÙËÙ·.

¢ÈÂıÓÒ˜ (32), ¤¯Ô˘Ó ¯ÚËÛÈÌÔÔÈËı› ÔÏÏ¿

ÙÂÛÙ (ȉ›ˆ˜ ÁÈ· ÙËÓ ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ·) Ô˘ ›-

¯·Ó ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÌÂٷ͇ ÙÔ˘˜ (22)

(.¯. ÛÙË ‰È¿Ù·ÍË ÙˆÓ ¯·Ú·ÎÙ‹ÚˆÓ, ÙËÓ ·fi-

ÛÙ·ÛË ÌÂٷ͇ ÙÔ˘˜, ÙÔÓ ÙÚfiÔ ÂÊ·ÚÌÔÁ‹˜ ÙÔ˘˜

ÎÏ.). √ÙfiÙ˘ÔÈ Ô˘ ¤¯Ô˘Ó ¢ڤˆ˜ ¯ÚËÛÈÌÔ-

ÔÈËı› ‰ÈÂıÓÒ˜ Â›Ó·È ÙÔ Kay Picture Test, ÙÔ

Sheridan Gardirer Test, ÙÔ Stycar Test ÙÔ

Cambridge Crowded Cards, ÙÔ Snellen Test, ÙÔ

Sonksen-Silver Acuity System Test (SSAS), Ù·

test Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡Ó LEA ¯·Ú·ÎÙ‹Ú˜ ÎÏ.

∏ ‰ÈÂÚ‡ÓËÛË Ù˘ Û¯ÂÙÈ΋˜ ‚È‚ÏÈÔÁÚ·Ê›·˜

(14,22-25) ¤‰ÂÈÍ fiÙÈ ÛÙȘ ÙÂÏÂ˘Ù·›Â˜ ‰ÂηÂ-

ٛ˜ ˘¿Ú¯ÂÈ ‰ÈÂıÓÒ˜ Ë Ù¿ÛË ÛÙ· ·È‰È¿ ÚÔ-

Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ Ó· ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ‰ÔÎÈ-

̷ۛ˜ Ù‡Ô˘ «Ù·ÈÚÈ¿ÛÌ·ÙÔ˜» ‹ «Ù·‡ÙÈÛ˘»

(matching test) fiˆ˜ Â›Ó·È ÙÔ SSAS ‹ ÌÂÚÈο

·fi Ù· LEA tests. °È· Ù· ·È‰È¿ Û¯ÔÏÈ΋˜ ËÏÈ-

Λ·˜ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÙÂÛÙ fiÚ·Û˘ Ì ·ÚÈı-

ÌÔ‡˜, Ô˘ fï˜ ÏËÚÔ‡Ó Û˘ÁÎÂÎÚÈ̤Ó˜ ÚÔ-

¸Ôı¤ÛÂȘ ηٷÛ΢‹˜.

™ÙȘ ˘ËÚÂۛ˜ ÚˆÙÔ‚¿ıÌÈ·˜ ÊÚÔÓÙ›‰·˜

˘Á›·˜ ÛÙËÓ ∂ÏÏ¿‰· ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ·Ú·-

‰ÔÛȷο 3 ÔÙfiÙ˘· (‰‡Ô ÁÈ· ÙËÓ ÚÔÛ¯ÔÏÈ΋

ËÏÈΛ· ÙÔ ÙÂÛÙ Ì ۯ‹Ì·Ù· Î·È ÙÔ «E» test ηÈ

¤Ó· ÁÈ· ÙËÓ Û¯ÔÏÈ΋ ËÏÈΛ· Ì ·ÚÈıÌÔ‡˜). ∆·

·È‰È¿ ÂÍÂÙ¿˙ÔÓÙ·È ·fi ·fiÛÙ·ÛË 5 ̤ÙÚˆÓ

Î·È ÙÔ˘˜ ˙ËÙÂ›Ù·È Ó· ·Ó·ÁÓˆÚ›ÛÔ˘Ó Î·È Ó· ÔÓÔ-

Ì¿ÛÔ˘Ó ÙÔÓ ˙ËÙÔ‡ÌÂÓÔ ¯·Ú·ÎÙ‹Ú·.

¶·È‰È·ÙÚÈ΋ 2006;69:59-64

Pediatr Jan-Feb 06 final allges 27-01-06 15:35 ™ÂÏ›‰·61

Page 62: Παιδιατρική | Τόμος 69 • Τεύχος 1 • Ιανουάριος - Φεβρουάριος 2006

62 ∞. •ÂηϿÎË, π. ∞ÓÙˆÓÈ¿‰Ô˘-∫Ô˘Ì¿ÙÔ˘

∫ÚÈÙ‹ÚÈ· ηٷÏÏËÏfiÙËÙ·˜ ·ÓȯÓ¢ÙÈÎÒÓ

ÂÚÁ·Ï›ˆÓ (ÔÙÔÙ‡ˆÓ)

∫¿ı ÙÂÛÙ fiÚ·Û˘ ÁÈ· ·È‰È¿ ı· Ú¤ÂÈ Ó·

ÏËÚÔ› ÔÚÈṲ̂ӷ ÎÚÈÙ‹ÚÈ· Ô˘ Ó· ÙÔ Î¿ÓÔ˘Ó

ηٿÏÏËÏÔ ÁÈ· ¯Ú‹ÛË ÛÂ Û˘ÁÎÂÎÚÈ̤ÓË ËÏÈÎÈ·-

΋ ÔÌ¿‰· (33). ŒÙÛÈ:

∞) ¶ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ·

√ÔÈÔ‰‹ÔÙ ÙÂÛÙ fiÚ·Û˘ ÁÈ· ÙËÓ ÚÔÛ¯Ô-

ÏÈ΋ ËÏÈΛ· ı· Ú¤ÂÈ Ó· ÂÍ·ÛÊ·Ï›˙ÂÈ fiÙÈ:

1. ∆Ô ·È‰› ηٷϷ‚·›ÓÂÈ ÙÔ ˘ÏÈÎfi Î·È ÙË

‰È·‰Èηۛ· ÙÔ˘ ÙÂÛÙ.

2. ¢ÈÂÁ›ÚÂÙ·È ÙÔ Î›ÓËÙÚÔ, Ë ÚÔÛÔ¯‹ Î·È Ë

Û˘ÓÂÚÁ·Û›· ÙÔ˘ ·È‰ÈÔ‡.

3. ∆Ô ·È‰› ÌÔÚ› ‡ÎÔÏ· Ó· «‰Â›ÍÂÈ» ÛÙÔÓ

ÂÍÂÙ·ÛÙ‹ fiÙÈ Â›‰Â ÙÔ ˙ËÙÔ‡ÌÂÓÔ.

4. ∆Ô ÙÂÛÙ Â›Ó·È “ÂȉÈÎfi”, ‰ËÏ·‰‹ ÌÂÙÚ¿ ÙËÓ

ÔÙÈ΋ Ô͇ÙËÙ· ·ÓÂÍ·Úًو˜ ¿ÏÏˆÓ ·Ú·Áfi-

ÓÙˆÓ (.¯. ·Ó·Ù˘ÍÈ·ÎÒÓ ‰È·ÊÔÚÒÓ).

°È· Ó· Û˘Ì‚·›ÓÂÈ ·˘Ùfi ı· Ú¤ÂÈ:

1. ∆· ۇ̂ÔÏ· ÙÔ˘ ÙÂÛÙ Ó· Â›Ó·È Û·Ê‹. ¢ÂÓ

ı· Ú¤ÂÈ ‰ËÏ·‰‹ Ó· Ì·ÓÙ‡ÂÈ ÙÔ ·È‰› (¯ÚËÛÈ-

ÌÔÔÈÒÓÙ·˜ ¿ÏϘ ÓÔËÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜) ·fi

ÙÔ ·‰Úfi ÂÚ›Ô˘ “ÁÓˆÛÙfi ÂÚ›ÁÚ·ÌÌ·”.

2. ∏ Ù·˘ÙÔÔ›ËÛË ÙˆÓ Û˘Ì‚fiÏˆÓ ÙÔ˘ ÙÂÛÙ

Ó· ÌËÓ Â›Ó·È ‰‡ÛÎÔÏË ÒÛÙ ӷ ÌËÓ ÂÍ·ÚٿٷÈ

·fi ·Ó·Ù˘ÍȷΤ˜ ‰˘Ó·ÙfiÙËÙ˜.

3. ∏ ‰˘Ó·ÙfiÙËÙ· Ó· ‰È·ÎÚ›ÓÂÈ ÙÔ ·È‰› ¤Ó·

ۇ̂ÔÏÔ ˆ˜ ͯˆÚÈÛÙfi ·fi ¿ÏÏ· ۇ̂ÔÏ·

Ô˘ ˘¿Ú¯Ô˘Ó ‰›Ï· ÙÔ˘, ·Ó·Ù‡ÛÛÂÙ·È ÚÔ-

ԉ¢ÙÈο Î·È Û ÌÂÚÈο ·È‰È¿, fi¯È ̤¯ÚÈ ÙËÓ

ËÏÈΛ· ÙˆÓ 4 ¯ÚfiÓˆÓ. ŸÛÔ ÈÔ ÎÔÓÙ¿ Â›Ó·È ÙÔ-

ÔıÂÙË̤ӷ Ù· ۇ̂ÔÏ· ÙÔ ¤Ó· Û ۯ¤ÛË ÌÂ

ÙÔ ¿ÏÏÔ, ÙfiÛÔ ÈÔ ‰‡ÛÎÔÏÔ˜ Á›ÓÂÙ·È Ô ‰È·¯ˆ-

ÚÈÛÌfi˜ ÙÔ˘˜ ·fi Ù· ÌÈÎÚ¿ ·È‰È¿. ∞˘Ùfi ¤¯ÂÈ

Û¯¤ÛË Ì ÙÔÓ ·Ú¿ÁÔÓÙ· Û˘Á¯ÚˆÙÈÛÌÔ‡ (14)

(crowding factor) fiÚÔ˜ Ô˘ ¯ÚËÛÈÌÔÔÈ›ٷÈ

ÛÙȘ Û¯ÂÙÈΤ˜ Ì ÔÙfiÙ˘· ‚È‚ÏÈÔÁÚ·ÊÈΤ˜

·Ó·ÊÔÚ¤˜. ŒÙÛÈ, Ô Û˘Á¯ÚˆÙÈÛÌfi˜ ÔÏÏÒÓ Û˘Ì-

‚fiÏˆÓ Û ÛÂÈÚ¿ Û ¤Ó· ÙÂÛÙ fiÚ·Û˘, ÌÔÚ› Ó·

Ô‰ËÁ‹ÛÂÈ Û ÛÊ¿ÏÌ·Ù· ÛÙË Ì¤ÙÚËÛË Ù˘ ÔÙÈ-

΋˜ Ô͇ÙËÙ·˜ ÛÙ· Ôχ ÌÈÎÚ¿ ·È‰È¿. ¢È·-

ÛÙ·˘ÚˆÌ¤Ó˜ ÌÂϤÙ˜ (22) ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ

ÛÙȘ ÌÈÎÚ¤˜ ËÏÈ˘ Ë ÔÙÈ΋ Ô͇ÙËÙ· ˘ÂÚÂ-

ÎÙÈÌ¿Ù·È fiÙ·Ó ‰Â›¯ÓÔÓÙ·È Í¯ˆÚÈÛÙ¿ ۇ̂ÔÏ·

·' fi,ÙÈ fiÙ·Ó ‰Â›¯ÓÔÓÙ·È ÂÚÈÛÛfiÙÂÚ· ۇ̂Ô-

Ï· ÛÂ ÛÂÈÚ¿ (crowding phenomenon).

∆· ÙÂÛÙ Ù‡Ô˘ “Ù·ÈÚÈ¿ÛÌ·ÙÔ˜” (matching

test) Ê·›ÓÂÙ·È fiÙÈ ÏËÚÔ‡Ó Ù· ·Ú·¿Óˆ ÎÚÈ-

Ù‹ÚÈ·. ™Ù· ÙÂÛÙ ·˘Ù¿ ˙ËÙÈ¤Ù·È ·fi ÙÔ ·È‰›,

Ô˘ ‚Ú›ÛÎÂÙ·È Û ·fiÛÙ·ÛË 3 ̤ÙÚˆÓ ·fi ÙÔÓ

ÂÍÂÙ·ÛÙ‹, Ó· ÎÔÈÙ¿ÍÂÈ ÙÔ ˙ËÙÔ‡ÌÂÓÔ Û‡Ì‚ÔÏÔ

Î·È Ó· ÙÔ ‰Â›ÍÂÈ ÛÙË Û˘Ó¤¯ÂÈ· ¿Óˆ Û ÌÈ· οÚ-

Ù· Ô˘ ‚Ú›ÛÎÂÙ·È ÌÚÔÛÙ¿ ÙÔ˘ Î·È Ë ÔÔ›· ʤ-

ÚÂÈ fiÏ· Ù· ÂÍÂÙ·˙fiÌÂÓ· ۇ̂ÔÏ·. ¢ÂÓ ÙÔ˘ ˙Ë-

ÙÈ¤Ù·È Ó· ·Ó·ÁÓˆÚ›ÛÂÈ Î·È Ó· ÔÓÔÌ¿ÛÂÈ ÙÔ Û‡Ì-

‚ÔÏÔ ·ÏÏ¿ ÌfiÓÔ Ó· ÙÔ “Ù·ÈÚÈ¿ÍÂÈ”. ™Â οı ÙÂ-

ÛÙ ˘¿Ú¯Ô˘Ó οÚÙ˜ ÁÈ· ÙÔÓ ‰ÈfiÊı·ÏÌÔ ‹ ÂÙÂ-

ÚfiÊı·ÏÌÔ ¤ÏÂÁ¯Ô Ù˘ ÎÔÓÙÈÓ‹˜ Î·È Ì·ÎÚÈÓ‹˜

fiÚ·Û˘.

∆ËÓ Î·Ù·ÏÏËÏfiÙËÙ· ·˘ÙÒÓ ÙˆÓ ‰ÔÎÈÌ·ÛÈÒÓ

“Ù·ÈÚÈ¿ÛÌ·ÙÔ˜” ÁÈ· ÙËÓ ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ·

¤¯Ô˘Ó ÚÔÛ·ı‹ÛÂÈ Ó· ‰Â›ÍÔ˘Ó ÔÏϤ˜ ÌÂϤ-

Ù˜. √È Sonksen et al (22) ÂÊ¿ÚÌÔÛ·Ó matching

test Û ·È‰È¿ ÚÔÛ¯ÔÏÈ΋˜ ËÏÈΛ·˜. ∏ ÌÂϤÙË

·˘Ù‹ ‰›ÓÂÈ ¯Ú‹ÛÈÌ· ÛÙÔȯ›· ÁÈ· Ù· ÙÂÛÙ Ù‡Ô˘

“Ù·ÈÚÈ¿ÛÌ·ÙÔ˜”, fiˆ˜:

1. ∏ ÂͤٷÛË Ù˘ ‰ÈfiÊı·ÏÌ˘ fiÚ·Û˘ ›ӷÈ

¯Ú‹ÛÈÌË Û ·È‰È¿ <4 ÂÙÒÓ. ¶Ôχ ÌÈÎÚfi ÔÛÔ-

ÛÙfi ·È‰ÈÒÓ ı· ¤¯Ô˘Ó Ì›˙ÔÓ Úfi‚ÏËÌ· fiÚ·-

Û˘ ÛÙÔ ¤Ó· Ì¿ÙÈ, ·Ó Ë ‰ÈfiÊı·ÏÌË fiÚ·ÛË Â›Ó·È

ηϋ. ŒÙÛÈ, ‰ÂÓ ¯ÚÂÈ¿˙ÂÙ·È Ó· ·Ú·ÂÌÊıÔ‡Ó

ÁÈ· ÂÚ·ÈÙ¤Úˆ ¤ÏÂÁ¯Ô ·Ó ‰ÂÓ ‰Â¯ÙÔ‡Ó ÙË ÌÔÓfi-

Êı·ÏÌË ÂͤٷÛË. ∆Ô ·Ú·¿Óˆ Â›Ó·È ÛËÌ·ÓÙÈ-

Îfi ÁÈ·Ù› fiÛÔ ÌÈÎÚfiÙÂÚÔ Â›Ó·È ÙÔ ·È‰›, ÙfiÛÔ ‰˘-

ÛÎÔÏfiÙÂÚ· ‰¤¯ÂÙ·È ÙÔÓ ·ÔÎÏÂÈÛÌfi ÙÔ˘ Ì·ÙÈÔ‡.

2. ŒÓ· ÔÛÔÛÙfi ·È‰ÈÒÓ Î¿ÓÂÈ “Ù·›ÚÈ·ÛÌ·”

ÛÙËÓ ÚÔÂÙÔÈÌ·Û›· ÙÔ˘ ÙÂÛÙ, ·ÏÏ¿ fiÙ·Ó Ô ÂÍÂ-

Ù·ÛÙ‹˜ ·ÔÌ·ÎÚ‡ÓÂÙ·È ÛÙ· 3 ̤ÙÚ· ‰ÂÓ ÌÔÚ›

Ó· ÙÔ Î·Ù·Ê¤ÚÂÈ. ÿÛˆ˜ ·˘Ùfi ¤¯ÂÈ Û¯¤ÛË Ì ÙÔ

fiÙÈ Î·Ù¿ ÙËÓ ÚÔÂÙÔÈÌ·Û›· ‰Â›¯ÓÂÙ·È ¤Ó·-¤Ó·

ۇ̂ÔÏÔ ·fi ÙÔ ÂÎ·È‰Â˘ÙÈÎfi Ê˘ÏÏ¿‰ÈÔ. ∂ÓÒ

ÛÙËÓ ·fiÛÙ·ÛË ÙˆÓ 3 Ì. ÙÔ ÙÂÛÙ ¤¯ÂÈ 5 ۇ̂ÔÏ·

ÛÙË ÛÂÈÚ¿. ÿÛˆ˜ fï˜, Ó· ¤¯ÂÈ Ó· οÓÂÈ Ì ÙÔ ÁÂ-

ÁÔÓfi˜ fiÙÈ Ù· ÈÔ ÌÈÎÚ¿ ·È‰È¿ ‰ÂÓ ÌÔÚÔ‡Ó Ó·

Û˘ÁÎÂÓÙÚˆıÔ‡Ó fiÙ·Ó Ô ÂÍÂÙ·ÛÙ‹˜ Â›Ó·È Ì·ÎÚÈ¿.

3. ™Â οı ËÏÈΛ· Ë ‰ÈfiÊı·ÏÌË fiÚ·ÛË ‰È·-

ÈÛÙÒıËΠηχÙÂÚË ·fi ÙË ÌÔÓfiÊı·ÏÌË ÌÂ

ÙË ‰È·ÊÔÚ¿ Ó· ÌÂÈÒÓÂÙ·È Î·ıÒ˜ ÌÂÁ·ÏÒÓÂÈ Ë

ËÏÈΛ·. √È ÂÚ¢ÓËÙ¤˜ Û˘Ì¤Ú·Ó·Ó fiÙÈ Ë Û˘Ì-

ÌÔÚʈÙÈÎfiÙËÙ· ÛÙÔ ÙÂÛÙ Â›Ó·È Î·Ï‹ ÁÈ· Ù· ·È-

‰È¿ ËÏÈΛ·˜ 2,5-6 ¯ÚfiÓˆÓ Î·È ÙÔ Î·ıÈÛÙ¿ ηٿÏ-

ÏËÏÔ ÁÈ· ÙËÓ ·Ó›¯Ó¢ÛË ÔÙÈÎÒÓ ÚÔ‚ÏËÌ¿-

ÙˆÓ. √ ¯ÚfiÓÔ˜ ÂÊ·ÚÌÔÁ‹˜ ÙÔ˘ ›Û˘, ÙÔ Î¿ÓÂÈ

Û˘Ì‚·Ùfi Ì ÙȘ Û˘ÁÎÂÎÚÈ̤Ó˜ ËÏÈ˘.

µ) ™¯ÔÏÈ΋ ËÏÈΛ·

∆Ô ‚·ÛÈÎfi ÙÂÛÙ Â›Ó·È ÙÔ ÁÚ·ÌÌÈÎfi ÙÂÛÙ ÌÂ

ÙÔ˘Ï¿¯ÈÛÙÔÓ ¤ÓÙ ۇ̂ÔÏ· Û οı ÛÂÈÚ¿ ÙÔ˘

ÙÂÛÙ (26). µ·ÛÈ΋ ηٷÛ΢·ÛÙÈ΋ ÚÔ¸fiıÂ-

ÛË Â›Ó·È:

1. √È ·ÔÛÙ¿ÛÂȘ ÌÂٷ͇ ÙˆÓ Û˘Ì‚fiÏˆÓ Ó·

Â›Ó·È ›Û˜ Ì ÙÔ Ï¿ÙÔ˜ ÙÔ˘ οıÂ Û˘Ì‚fiÏÔ˘ ·˘-

Ù‹˜ Ù˘ ÛÂÈÚ¿˜.

2. ∏ ·fiÛÙ·ÛË ÌÂٷ͇ ÙˆÓ ÛÂÈÚÒÓ ÙÔ˘ ÙÂÛÙ

¶·È‰È·ÙÚÈ΋ 2006;69:59-64

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63H ÛËÌ·Û›· ÙÔ˘ ÂϤÁ¯Ô˘ Ù˘ fiÚ·Û˘

Ó· Â›Ó·È ›ÛË Ì ÙÔ ‡„Ô˜ ÙˆÓ Û˘Ì‚fiÏˆÓ Ù˘ η-

ÙÒÙÂÚ˘ ÛÂÈÚ¿˜. ∞˘Ùfi Á›ÓÂÙ·È ÒÛÙÂ Ô ·Ú¿ÁÔ-

ÓÙ·˜ Û˘Á¯ÚˆÙÈÛÌÔ‡ Ó· ‰È·ÙËÚÂ›Ù·È ÛÙ·ıÂÚfi˜.

ŒÙÛÈ ÙÔ ÙÂÛÙ ·›ÚÓÂÈ ÌÈ· ¯·Ú·ÎÙËÚÈÛÙÈ΋ ÌÔÚ-

Ê‹ Ô˘ ÌÔÈ¿˙ÂÈ Ó· ÛÙÂÓ‡ÂÈ ÚÔ˜ Ù· οو (η-

Ù·ÚÚ¿ÎÙ˘).

∆· ·Ú·¿Óˆ ÎÚÈÙ‹ÚÈ· ÈÛ¯‡Ô˘Ó Î·È ÁÈ· Ù·

¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓ· ÙÂÛÙ ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô Ù˘ ÎÔ-

ÓÙÈÓ‹˜ fiÚ·Û˘. ™‡Ìʈӷ Ì ٷ ·Ú·¿Óˆ ÎÚÈ-

Ù‹ÚÈ·, Ù· ÔÙfiÙ˘· Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È

ÛÙËÓ ∂ÏÏ¿‰· ÛÙÔ˘˜ ÚˆÙÔ‚¿ıÌÈÔ˘˜ ¯ÒÚÔ˘˜

˘Á›·˜ Â›Ó·È ·Î·Ù¿ÏÏËÏ· ÚÔ˜ ¯Ú‹ÛË ‰ÈfiÙÈ:

∞/ ¶ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ·: ∆Ô ÔÙfiÙ˘Ô ÌÂ

Û¯‹Ì·Ù· Ô˘ ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÛÙËÓ ÚÔÛ¯ÔÏÈ-

΋ ËÏÈΛ·:

1. ¢ÂÓ Â›Ó·È ÙÂÛÙ “Ù·ÈÚÈ¿ÛÌ·ÙÔ˜” (matching

test).

2. À¿Ú¯ÂÈ Û·Ê‹˜ Û˘Û¯¤ÙÈÛË Ì ·Ó·Ù˘ÍÈ·-

Τ˜ ‰˘Ó·ÙfiÙËÙ˜ (ÙÔ ·È‰› Ú¤ÂÈ Ó· ÔÓÔÌ¿˙ÂÈ

ÙÔ Û‡Ì‚ÔÏÔ).

3. ∆· ۇ̂ÔÏ· ¤¯Ô˘Ó ·‰Úfi ÂÚ›ÁÚ·ÌÌ· Ô˘

·Ú·¤ÌÔ˘Ó Ù· ·È‰È¿ Û ‰È·ÊÔÚÂÙÈο ·ÓÙÈ-

ΛÌÂÓ· Î·È Ô‰ËÁÔ‡Ó ÙÔÓ ÂÍÂÙ·ÛÙ‹ “Ó· ÂÚ¿ÛÂÈ

ÙÔ ÙÂÛÙ” ηÙ' ÂÎÙ›ÌËÛË.

4. ¢›ÓÂÙ·È ·fi ·fiÛÙ·ÛË 5 ̤ÙÚˆÓ. Œ¯ÂÈ

‰Âȯı› fiÙÈ fiÛÔ ÌÂÁ·Ï‡ÙÂÚË Â›Ó·È Ë ·fiÛÙ·ÛË,

ÙfiÛÔ ÏÈÁfiÙÂÚÔ Û˘ÌÌÔÚÊÒÓÔÓÙ·È Ù· ·È‰È¿ (22).

∂ÈϤÔÓ, Ë ·fiÛÙ·ÛË ÙˆÓ 5 ̤ÙÚˆÓ Â›Ó·È

··ÁÔÚ¢ÙÈ΋ ÁÈ· ÙȘ ‰Â‰Ô̤Ó˜ ‰È·ÛÙ¿ÛÂȘ

ÙˆÓ ÂÚÈÛÛfiÙÂÚˆÓ È·ÙÚ›ˆÓ.

5. ¢ÂÓ Û˘Óԉ‡ÂÙ·È ·fi Û·Ê›˜ Ô‰ËÁ›Â˜

¯Ú‹Û˘ Ô˘ Ó· ÔÚ›˙Ô˘Ó ÙÔ ÛËÌÂ›Ô ·Ú·ÔÌ‹˜

Û ÂȉÈÎfi ÙfiÛÔ ÌÂÙ¿ ·fi ÙËÓ ÂͤٷÛË Ù˘ ÎÔ-

ÓÙÈÓ‹˜ fiÛÔ Î·È Ù˘ Ì·ÎÚÈÓ‹˜ fiÚ·Û˘.

µ/ ™¯ÔÏÈ΋ ËÏÈΛ·: ∆Ô ÔÙfiÙ˘Ô Ì ÙÔ˘˜

·ÚÈıÌÔ‡˜ ÁÈ· ¯Ú‹ÛË ÛÙË Û¯ÔÏÈ΋ ËÏÈΛ·:

1. ¢ÂÓ ÏËÚÔ› ÙȘ ‰ÈÂıÓ›˜ Û˘ÛÙ¿ÛÂȘ ηٷ-

Û΢‹˜ ÔÙÔÙ‡ˆÓ fiˆ˜ ·Ó·Ê¤ÚıËÎ·Ó ÛÙ·

ÎÚÈÙ‹ÚÈ· (ÙÂÛÙ Ù‡Ô˘ “ηٷÚÚ¿ÎÙË”).

2. ¢›ÓÂÙ·È ·fi ·fiÛÙ·ÛË 5 ̤ÙÚˆÓ (··ÁÔ-

Ú¢ÙÈ΋ ÁÈ· ¯ÒÚÔ˘˜ ˘Á›·˜, .¯. È·ÙÚ›·).

3. ¢ÂÓ Û˘Óԉ‡ÂÙ·È Û˘Ó‹ıˆ˜ ·fi Ô‰ËÁ›Â˜

¯Ú‹Û˘ Ô˘ Ó· ÔÚ›˙Ô˘Ó Î·È ÙÔ ÛËÌÂ›Ô ·Ú·Ô-

Ì‹˜ Û ÂȉÈÎfi.

™ÙËÓ ∂ÏÏ¿‰· ‰ÂÓ ˘¿Ú¯ÂÈ ÙÂÛÙ ÁÈ· ÙÔÓ ¤ÏÂÁ-

¯Ô Ù˘ ÎÔÓÙÈÓ‹˜ fiÚ·Û˘ Û ¯ÒÚÔ˘˜ ÚˆÙÔ‚¿ı-

ÌÈ·˜ ÊÚÔÓÙ›‰·˜ ˘Á›·˜.

™˘ÌÂÚ·ÛÌ·ÙÈο ÏÔÈfiÓ, Ì ‚¿ÛË ÙË ÛËÌ·-

Û›· Ù˘ ¤ÁηÈÚ˘ ‰È¿ÁÓˆÛ˘ ÛËÌ·ÓÙÈÎÒÓ ÚÔ-

‚ÏËÌ¿ÙˆÓ ÔÙÈ΋˜ ÈηÓfiÙËÙ·˜, ÙË Û˘¯ÓfiÙËÙ·

ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜ ÛÙ· ·È‰È¿ Î·È ÙËÓ ¤ÏÏÂÈ„Ë

ηٿÏÏËÏÔ˘ ·ÓȯÓ¢ÙÈÎÔ‡ ÂÚÁ·Ï›Ԣ ÛÙËÓ

ÚˆÙÔ‚¿ıÌÈ· ÊÚÔÓÙ›‰· ˘Á›·˜, ‰È·ÌÔÚÊÒÓÂÙ·È

Ë ·Ó¿ÁÎË ‡·Ú͢/·Ó·˙‹ÙËÛ˘ Û˘ÁÎÂÎÚÈ̤ӈÓÙÂÛÙ fiÚ·Û˘ ηٿÏÏËÏˆÓ ÁÈ· ¯Ú‹ÛË ÛÙËÓ ÚÔ-Û¯ÔÏÈ΋ Î·È Û¯ÔÏÈ΋ ËÏÈΛ· ÙfiÛÔ ÁÈ· ÙÔÓ ¤ÏÂÁ-¯Ô Ù˘ ÎÔÓÙÈÓ‹˜ fiÛÔ Î·È Ù˘ Ì·ÎÚÈÓ‹˜ fiÚ·Û˘.∆¤ÙÔÈ· ÙÂÛÙ fiÚ·Û˘ ΢ÎÏÔÊÔÚÔ‡Ó Â˘Ú¤ˆ˜ Û¯ÒÚ˜ ÙÔ˘ Â͈ÙÂÚÈÎÔ‡. ∏ ÂÈÏÔÁ‹ fï˜ ÙÔ˘Î·Ù¿ÏÏËÏÔ˘ ÙÂÛÙ fiÚ·Û˘, ·ÏÏ¿ Î·È Ë ·fiÎÙË-Û‹ ÙÔ˘ (ÌfiÓÔ Î·ÙfiÈÓ ·Ú·ÁÁÂÏ›·˜) ·ÔÙÂÏ›Úfi‚ÏËÌ· ÁÈ· ÙÔÓ ÚˆÙÔ‚¿ıÌÈÔ Â·ÁÁÂÏÌ·Ù›·˘Á›·˜ Ô˘ ÂÚÁ¿˙ÂÙ·È ÛÙËÓ ∂ÏÏ¿‰·.

µÈ‚ÏÈÔÁÚ·Ê›·

1. Appelboom TM. A history of vision screening. J SchHealth 1985;55:138-141.

2. Hartmann EE, Dobson V, Hainline L, Marsh-TootleW, Quinn GE, Ruttum MS, et al. Preschool visionscreening: summary of a Task Force report. Behalfof the Maternal and Child Health Bureau and theNational Eye Institute Task Force on Vision Screen-ing in the Preschool Child. Pediatrics 2000;106:1105-1161.

3. The Official Website of the Nobel Foundation. The1981 Prize in Physiology or Medicine. [Webpage, In-ternet]. The Nobel Assembly of Karolinska Institutet.www.nobel.se/medicine/laureates/1981/press.html.

4. Snowdon SK, Stewart Brown SL. Preschool visionscreening [Executive Summary]. Health TechnolAssess 1997;1:1-83.

5. Stewart-Brown SL, Snowdon SK. Evidence basedilemmas in preschool vision screening. Arch DisChild 1998;78:406-407.

6. Moseley MJ. Preschool vision screening: a recent re-port calls for a halt [Commentary]. Br J Opthalmol1998;82:722-723.

7. Rahi JS, Dezateux C. The future of preschool visionscreening services in Britain [Editorials]. BMJ 1997;315:1247-1248.

8. Ciner EB, Schmidt PP, Orel-Bixler D, Dobson V,Maguire M, Cyert L, et al. Vision screening ofpreschool children: evaluating the past, looking to-ward the future. Optom Vis Sci 1998;75:571-584.

9. Wasserman RC, Croft CA, Brotherton SE. Preschoolvision screening in pediatric practice: A study fromthe pediatric research in office setting (PROS) Net-work. Pediatrics 1992;89:834-838.

10. Newman DK, Hitchcock A, McCarthy H, Keast-Butler J, Moore AT. Preschool vision screening: out-come of children referred to the hospital eye service.Br J Ophthalmol 1996;80:1077-1082.

11. Preslan MW, Novak A. Baltimore Vision ScreeningProject. Ophthalmology 1996;103:105-109.

12. Bolger PG, Stewart-Brown SL, Newcombe E, Star-buck A. Vision screening in preschool children: com-parison of orthoptists and clinical medical officers asprimary screeners. BMJ 1997;303:1291-1294.

13. Yang YF. Visual acuity testing in schools: what needsto be done [Paper]. BMJ 1996;313:1053.

14. Hall DBM, ed. Health for all children. Report of the

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64 ∞. •ÂηϿÎË, π. ∞ÓÙˆÓÈ¿‰Ô˘-∫Ô˘Ì¿ÙÔ˘

third joint working party on child Health Surveil-lance. 3rd ed. Oxford: Oxford University Press;1996. p. 164.

15. AAP Policy statement: Eye examination and Visionscreening in infants, children and young adults. Pe-diatrics 1996;98:153-157.

16. Polnay L, Hull D, eds. Community Paediatrics, 2nded. London: Churchill Livingstone, 1993

17. American Optometric Association. Pediatric eyeand vision examination. Reference guide for clini-cians. Prepared by the American Optometric Asso-ciation Consensus Approved by the AOA Board ofTrustees. 1994 June 23, 2nd ed. 1997.

18. ∫Ô˘ÛÔ˘Ú‹ ª, ∆˙ˆÚÙ˙¿ÙÔ˘ °, ™ÌÒÎÔ˘ ¢, °ÎÈÒÓ˘¢, ¡ÈÎÔÏ¿Ô˘-¶·Ó·ÁÈÒÙÔ˘ ∞. ∞ÍÈÔÏfiÁËÛË Ù˘ ·-Ú¯fiÌÂÓ˘ ÚˆÙÔ‚¿ıÌÈ·˜ ÂÚ›ı·Ï„˘ Û ·È‰È¿Û¯ÔÏÈ΋˜ ËÏÈΛ·˜. 4Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ «ÀÁ›·Î·È ¶ÔÈfiÙËÙ· ∑ˆ‹˜»: ŸÚ·Ì· Î·È Âȉ›ˆÍË ÁÈ· ÙԷȉ› ÙÔ˘ ¢ËÌÔÙÈÎÔ‡ ™¯ÔÏ›Ԣ. ∂ÏÏËÓÈ΋ ∂Ù·ÈÚ›·∫ÔÈÓˆÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ Î·È ¶ÚÔ·ÁˆÁ‹˜ Ù˘ÀÁ›·˜ 1992;12.

19. ∆۷ӿη˜ π, ƒÔËÏ›‰Ë˜ ª, ÷Ù˙ËÌȯ·‹Ï ∞, £Ò‰Ë˜™, µ¿ÚÓ·Ï˘ ¶, ∫·ÚÔ‡˙·˜ π. ∏ ÛËÌ·Û›· ÙˆÓ ÚÔ-ÏËÙÈÎÒÓ ÂϤÁ¯ˆÓ ÛÙ· ·È‰È¿ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜.¶·È‰È·ÙÚÈ΋ 1986;49:154-164.

20. ¶Ï·Ù‹˜ √, ™ÎÔ‡ÊË ∂. ¶ÚÔÏËÙÈ΋ ÂͤٷÛË ·È-‰ÈÒÓ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ Û ·ÁÚÔÙÈ΋ ÂÚÈÔ¯‹. 18Ô∂Ù‹ÛÈÔ ¶·ÓÂÏÏ‹ÓÈÔ π·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ. π·ÙÚÈ΋∂Ù·ÈÚ›· ∞ıËÓÒÓ 1991;519.

21. ¶·Ó·ÁȈÙfiÔ˘Ïo˜ ∆. ÀÁ›· ÛÙËÓ ÚÔÛ¯ÔÏÈ΋ ËÏÈ-Λ· [EÌÂÈÚÈ΋ ŒÚ¢ӷ]. ÿ‰Ú˘Ì· ∂Ú¢ÓÒÓ ÁÈ· ÙÔ¶·È‰›, ∞ı‹Ó· 1991.

22. Salt AT, Sonksen PM, Wade A, Jayatunga R. Thematuration of linear acuity and compliance with theSonksen-Silver Acuity System in young children.Dev Med Child Neurol 1995;37:505-514.

23. Jayatunga R, Sonksen PM, Bhide, A, Wade A. Mea-sures of acuity in primary-school children and their

ability to detect minor errors of vision. Dev MedChild Neurology 1995;37:515-527.

24. Hered RW, Murphy S, Clancy M. Comparison ofthe HOTV and LEA Symbols charts for preschoolvision screening. J Ophthalmic Nurs Technol 1997;16:68-73.

25. Wade AM, Ades AE, Salt AT, Jayatunga R, SonksenPM. Age-related standards for ordinal data: model-ing the changes in visual acuity form 2 to 9 years ofage. Stat Med 1995;15,14(3):257-266.

26. Lea Huvärinen MD. Precision Vision. InstructionManual for vision testing products. http://www.lea-test.sgic.fi ‹ http://med-apos.bu.edu/leaweb/index.html. 2001; p. 4.

27. Newman, East MM. Preschool vision screening: neg-ative predictive value for amblyopia. Br J Opthalmol1999;83:676-679.

28. Simons K. Preschool vision screening: rationale,methodology, and outcome. Surv Ophthalmol 1996;41:3-30.

29. Morad Y, Werker E, Nemet P. Visual acuity tests us-ing chart, line and single optotype in healthy ambly-opic children. J AAPOS 1999;3:94-97.

30. Fern KD, Manny RE. Visual acuity of the preschoolchild: a review. Am J Optom Physiol Opt 1986;63:319-345.

31. Kohler L. Early detection and screening evaluationof preventive programmes. Pediatriki 1983;46 (Sup-pl):S337-S341.

32. U.S. Department of Health and Human Services.Agency for Healthcare Research and Quality. Screen-ing for Visual Impairment in Children Younger thanAge 5 Years. Systematic Evidence Review for the U.S.Preventive Services Task Force. May 2004.

33. Lindstedt E. What is a vision test. Presented Oct26th 1991 at the opening of the Eva Lindstedt EarlyIntervention Programme at the Eye Clinic-SantaCasa Hospital-SaoPaulo, Brazil.

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65¶ƒ∞∫∆π∫√ £∂ª∞ PRACTICAL ISSUE

∏ ·Í›· Ù˘ ÂͤٷÛ˘ Ù˘ Úfi‰ÈÓ˘ ·ÓÙ·‡ÁÂÈ·˜

Û ÓÂÔÁÓ¿ Î·È ‚Ú¤ÊË

∞. ¡ÈÎÔÏ·˝‰Ô˘, °. ∆ÛfiÏ·˜

¶ÂÚ›ÏË„Ë: ∏ ÂͤٷÛË Ù˘ Úfi‰ÈÓ˘ ·ÓÙ·‡ÁÂÈ·˜ ÙÔ˘ ·ÌÊÈ‚ÏËÛÙÚÔÂȉԇ˜ Û˘ÓÈÛÙ¿Ù·È Û fiÏ· Ù· ÓÂ-ÔÁÓ¿ Î·È Ù· ‚Ú¤ÊË. ∆Ô Û‡ÓÙÔÌÔ ·˘Ùfi ¿ÚıÚÔ ·ÔÛÎÔ› ÛÙÔÓ Î·ıÔÚÈÛÌfi ÙˆÓ ÂӉ›ÍÂˆÓ Î·È Ù˘ ÙÂ-¯ÓÈ΋˜ Ô˘ Ú¤ÂÈ Ó· ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÁÈ· ÙË ÛˆÛÙ‹ ‰ÈÂÓ¤ÚÁÂÈ· ·˘Ù‹˜ Ù˘ ÂͤٷÛ˘, ηıÒ˜ ›ÛË˜Î·È ÙˆÓ ÂӉ›ÍÂˆÓ ÁÈ· ‰È·ÛÙÔÏ‹ Ù˘ ÎfiÚ˘, ·ÏÏ¿ Î·È ÙˆÓ ÂÚÈÙÒÛÂˆÓ Ô˘ ηıÈÛÙÔ‡Ó ·Ó·Áη›·ÙËÓ ·Ú·ÔÌ‹ ÙÔ˘ ·È‰ÈÔ‡ ÛÙÔÓ ÔÊı·ÏÌ›·ÙÚÔ.

§¤ÍÂȘ ÎÏÂȉȿ: ƒfi‰ÈÓË ·ÓÙ·‡ÁÂÈ·, ·ÓˆÌ·Ï›Â˜ ·ÌÊÈ‚ÏËÛÙÚÔÂȉԇ˜, ¤ÏÂÁ¯Ô˜ fiÚ·Û˘, ÔÊı·ÏÌÔÏÔÁÈ΋ÂͤٷÛË.

Red reflex examination in newborn babies and infants as a basic

part of the physical examination

A. Nikolaidou, G. Tsolas

Abstract: The red reflex examination is recommended for all newborn babies and infants. This articledescribes the indications for and the technique of performing this examination, including the indicationsfor dilation of the pupils before examination and the indications for referral to an ophthalmologist.

Key words: Red reflex, retinal abnormalities, vision screening, eye examination.

¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋, °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ¡›Î·È·˜“ÕÁÈÔ˜ ¶·ÓÙÂÏ‹̈Ӕ,¶ÂÈÚ·È¿˜

AÏÏËÏÔÁÚ·Ê›·:

°ÂÒÚÁÈÔ˜ ∆ÛfiÏ·˜ ¶¿ÚÓËıÔ˜ 32, ∆.∫. 190 13, ™·ÚˆÓ›‰· ∞ÙÙÈ΋˜ E-mail: [email protected]

∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 17-09-2004 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 13-04-2005

Department of Pediatrics,“Aghios Panteleimon”General Hospital of Nikea,Piraeus

Correspondence:

Georgios Tsolas 32 Parnithos Str., 190 13, Saronida, Attica E-mail: [email protected]

Date of submission: 17-09-2004 Date of approval: 13-04-2005

¶·È‰È·ÙÚÈ΋ 2006;69:65-68

∂ÈÛ·ÁˆÁ‹

OÈ ÔÊı·ÏÌÔ› ·ÔÙÂÏÔ‡Ó fi¯È ÌfiÓÔ ÙÔ ÛËÌ·-

ÓÙÈÎfiÙÂÚÔ ·ÈÛıËÙ‹ÚÈÔ fiÚÁ·ÓÔ, ·ÏÏ¿ Ù·˘Ùfi¯ÚÔÓ·

ÙÔ ·Ú¿ı˘ÚÔ ÁÈ· ÙËÓ ÂͤٷÛË ÙÔ˘ ÎÂÓÙÚÈÎÔ‡

Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ∂›Ó·È, ›Û˘, ÁÓˆÛÙfi fiÙÈ

ÂΉËÏÒÛÂȘ ·fi ÙÔ˘˜ ÔÊı·ÏÌÔ‡˜, ȉȷ›ÙÂÚ˘

Ì¿ÏÈÛÙ· ‰È·ÁÓˆÛÙÈ΋˜ ·Í›·˜, ·Ó¢ڛÛÎÔÓÙ·È Î·È

Û ·ÚÎÂÙ¿ Û˘ÛÙËÌ·ÙÈο ÓÔÛ‹Ì·Ù·. ∂Ô̤ӈ˜, Ë

ÂͤٷÛË ÙˆÓ ÔÊı·ÏÌÒÓ, ÏÔÁÈ˙fiÌÂÓË ˆ˜ ̤ÚÔ˜

Ù˘ Ê˘ÛÈ΋˜ ÂͤٷÛ˘ ÙˆÓ ‰È·ÊfiÚˆÓ Û˘ÛÙËÌ¿-

ÙˆÓ, ·ÔÎÙ¿ ͯˆÚÈÛÙ‹ ÛËÌ·Û›· Î·È ÔÊ›ÏÂÈ Ó·

Á›ÓÂÙ·È ‹‰Ë ·fi ÙËÓ ÚÒÙË Â›ÛÎÂ„Ë ÙÔ˘ ·È-

‰È¿ÙÚÔ˘ ÛÙÔ ÓÂÔÁ¤ÓÓËÙÔ (1-4).

™‡Ìʈӷ Ì ÙËÓ ÙÚ¤¯Ô˘Û· ÔÏÈÙÈ΋ Ù˘

∞ÌÂÚÈηÓÈ΋˜ ∞η‰ËÌ›·˜ ¶·È‰È·ÙÚÈ΋˜ (5),

Û˘ÓÈÛÙ¿Ù·È ÔÊı·ÏÌÔÏÔÁÈ΋ ÂͤٷÛË ÁÈ· Ù·

‚Ú¤ÊË Î·È Ù· ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿ ÛÂ Û˘ÁÎÂÎÚÈ-

̤ӷ ¯ÚÔÓÈο ‰È·ÛÙ‹Ì·Ù· ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘

·Ó¿Ù˘Í‹˜ ÙÔ˘˜, Û˘ÌÂÚÈÏ·Ì‚·ÓÔ̤Ó˘ Ì›·˜

ÂͤٷÛ˘ ̤۷ ÛÙ· ÚÒÙ· ‰‡Ô ¯ÚfiÓÈ· Ù˘ ˙ˆ-

‹˜. O “·ÓȯÓ¢ÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ù˘ fiÚ·Û˘”

(vision screening) Î·È Ë ÔÊı·ÏÌÔÏÔÁÈ΋ Âͤٷ-

ÛË Â›Ó·È ˙ˆÙÈ΋˜ ÛËÌ·Û›·˜ ÁÈ· ÙËÓ ·Ó·ÁÓÒÚÈÛË

ηٷÛÙ¿ÛÂˆÓ Ô˘ ‰È·ÛÙÚ‚ÏÒÓÔ˘Ó ‹ ·ÚÂ-

ÌÔ‰›˙Ô˘Ó ÙÔÓ Û¯ËÌ·ÙÈÛÌfi Ê˘ÛÈÔÏÔÁÈÎÔ‡

ÔÙÈÎÔ‡ ÂȉÒÏÔ˘, ÁÂÁÔÓfi˜ Ô˘ ı· ÌÔÚÔ‡Û ӷ

Ô‰ËÁ‹ÛÂÈ Û ·Ó·Ú΋ Û¯ÔÏÈ΋ ›‰ÔÛË, ÂÊfi-

ÛÔÓ ÙÔ Úfi‚ÏËÌ· Â›Ó·È ·ÌÊÔÙÂÚfiÏ¢ÚÔ, ÂÓÒ

ÛÙȘ ϤÔÓ ÛÔ‚·Ú¤˜ ÂÚÈÙÒÛÂȘ ¤ˆ˜ Î·È ÛÂ

Ï‹ÚË ·ÒÏÂÈ· Ù˘ fiÚ·Û˘ ÙÔ˘ ·È‰ÈÔ‡. ¶·-

ıÔÏÔÁÈΤ˜ ηٷÛÙ¿ÛÂȘ ÙÔ˘ ·ÌÊÈ‚ÏËÛÙÚÔÂÈ-

‰Ô‡˜, Ô Î·Ù·ÚÚ¿ÎÙ˘, ÙÔ ÁÏ·‡ÎˆÌ·, ÙÔ ÚÂÙÈÓÔ-

‚Ï¿Ûو̷, ÔÈ ‰È·Ù·Ú·¯¤˜ ÙˆÓ ÔÊı·ÏÌÈÎÒÓ

Ì˘ÒÓ Î·È ÔÈ Û˘ÛÙËÌ·ÙÈΤ˜ ÓfiÛÔÈ Ì ÂΉËÏÒÛÂȘ

·fi ÙÔ˘˜ ÔÊı·ÏÌÔ‡˜, ı· ÌÔÚÔ‡Û·Ó Ó· ·Ó·-

ÁÓˆÚÈÛÙÔ‡Ó Ì ÚÔÛÂÎÙÈ΋ ÂͤٷÛË, ÙËÓ ÔÔ›·

- Û ÌÂÁ¿ÏÔ ‚·ıÌfi - ÔÊ›ÏÂÈ Ó· Â›Ó·È Û ı¤ÛË Ó·

Ú·ÁÌ·ÙÔÔÈ‹ÛÂÈ Ô ›‰ÈÔ˜ Ô ·È‰›·ÙÚÔ˜. ∏ ∞ÌÂ-

ÚÈηÓÈ΋ ∞η‰ËÌ›· ¶·È‰È·ÙÚÈ΋˜ ÚÔÙ›ÓÂÈ fiÙÈ

Ë ÔÊı·ÏÌÔÏÔÁÈ΋ ·ÍÈÔÏfiÁËÛË ÙˆÓ ‚ÚÂÊÒÓ Î·È

ÙˆÓ ÓË›ˆÓ ¤ˆ˜ ÙËÓ ËÏÈΛ· ÙˆÓ 2 ÂÙÒÓ Ú¤ÂÈ

Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ¤ÏÂÁ¯Ô (5): ·) ÙˆÓ ‚ÏÂÊ¿ÚˆÓ

Î·È ÙˆÓ ÔÊı·ÏÌÈÎÒÓ ÎfiÁ¯ˆÓ, ‚) ÙÔ˘ ÚfiÛıÈÔ˘

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66 ∞. ¡ÈÎÔÏ·˝‰Ô˘, °. ∆ÛfiÏ·˜

ÙÌ‹Ì·ÙÔ˜ ÙˆÓ ÔÊı·ÏÌÒÓ (ÂÈÂÊ˘ÎfiÙ·˜, ÎÂÚ·-

ÙÔÂȉ‹˜), Á) Ù˘ ÎÈÓËÙÈÎfiÙËÙ·˜ ÙˆÓ ÔÊı·ÏÌÈÎÒÓ

Ì˘ÒÓ, ‰) Ù˘ ÈÛÔÚÚÔ›·˜ ÙˆÓ ÔÊı·ÏÌÈÎÒÓ Ì˘ÒÓ,

Â) ÙˆÓ ÎÔÚÒÓ Î·È ÛÙ) Ù˘ Úfi‰ÈÓ˘ ·ÓÙ·‡ÁÂÈ·˜.

ªÂ ÙËÓ ·Ó·˙‹ÙËÛË, ÂȉÈÎfiÙÂÚ·, Ù˘ Úfi‰ÈÓ˘

·ÓÙ·‡ÁÂÈ·˜, Ë ÔÔ›· ·ÔÙÂÏ› ‚·ÛÈÎfi ÙÌ‹Ì· Ù˘

ÂͤٷÛ˘ ÙÔ˘ ÓÂÔÁÓÔ‡ Î·È ÙÔ˘ ‚Ú¤ÊÔ˘˜, ·ÓÈ-

¯Ó‡ÔÓÙ·È ·ÓˆÌ·Ï›Â˜ ÙÔ˘ Ô›ÛıÈÔ˘ ‰È·ÌÂÚ›ÛÌ·-

ÙÔ˜ ÙÔ˘ ÔÊı·ÏÌÔ‡ ‹ ıÔÏÂÚfiÙËÙ˜ ηٿ Ì‹ÎÔ˜

ÙÔ˘ ÔÙÈÎÔ‡ ¿ÍÔÓ·, fiˆ˜ Â›Ó·È Ô Î·Ù·ÚÚ¿ÎÙ˘,

Ë ·‰È·Ê¿ÓÂÈ· ÙÔ˘ ÎÂÚ·ÙÔÂȉԇ˜ ‹ ÙÔ ÚÂÙÈÓÔ‚Ï¿-

Ûو̷ (6).

™ÙË Û˘Ó¤¯ÂÈ· ·Ó·Ï‡ÔÓÙ·È ÙfiÛÔ Ë Ù¯ÓÈ΋

‰ÈÂÓ¤ÚÁÂÈ·˜ Ù˘ ÂͤٷÛ˘ Ù˘ Úfi‰ÈÓ˘ ·ÓÙ·‡ÁÂÈ-

·˜, fiÛÔ Î·È Ë ·Í›· Ù˘ fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ¤ÁηÈÚË

·Ó›¯Ó¢ÛË ÛÔ‚·ÚÒÓ ÔÊı·ÏÌÈÎÒÓ ÓfiÛˆÓ.

∆¯ÓÈ΋ ÂͤٷÛ˘ Î·È ·ÍÈÔÏfiÁËÛË Ù˘

Úfi‰ÈÓ˘ ·ÓÙ·‡ÁÂÈ·˜

∏ Úfi‰ÈÓË ·ÓÙ·‡ÁÂÈ·, ÁÓˆÛÙ‹ Î·È ˆ˜ ‰ÔÎÈÌ·-

Û›· ÙÔ˘ Bruckner (Bruckner test), ‚·Û›˙ÂÙ·È ÛÙÔ

·Ó·ÎÏÒÌÂÓÔ Â› ÙÔ˘ ·ÌÊÈ‚ÏËÛÙÚÔÂȉԇ˜ ʈ˜

ÙÔ˘ ÔÊı·ÏÌÔÛÎÔ›Ô˘ ÌÂÙ¿ ÙËÓ Â›ÛÔ‰fi ÙÔ˘ ̤۷

ÛÙÔ Ì¿ÙÈ. ∏ Ï‹„Ë ÂͤڢıÚ˘ ·ÓÙ·Ó¿ÎÏ·Û˘ ÙÔ˘

ʈÙfi˜ Ì ÙË Ì¤ıÔ‰Ô ·˘Ù‹ ‰Â›¯ÓÂÈ Ô˘ÛÈ·ÛÙÈο

ÙËÓ ‡·ÚÍË Î·ı·ÚÔ‡ ÎÂÚ·ÙÔÂȉԇ˜, Ê·ÎÔ‡ ηÈ

·ÌÊÈ‚ÏËÛÙÚÔÂȉԇ˜ (7) (∂ÈÎfiÓ· 1). ∏ ÂͤٷÛË

Ù˘ Úfi‰ÈÓ˘ ·ÓÙ·‡ÁÂÈ·˜ ı· Ú¤ÂÈ Ó· ‰ÈÂÓÂÚÁ›-

Ù·È Û ۯÂÙÈο ÛÎÔÙÂÈÓfi ̄ ÒÚÔ, ÒÛÙ ӷ ÂÈÙ˘Á¯¿-

ÓÂÙ·È Ë Ì¤ÁÈÛÙË ‰˘Ó·Ù‹ Ì˘‰Ú›·ÛË Ù˘ ÎfiÚ˘, ÂÓÒ

·Ú¿ÏÏËÏ· ·˘Í¿ÓÂÙ·È Î·È Ë Â˘·ÈÛıËÛ›· ÙˆÓ Ì·-

ÙÈÒÓ ÙÔ˘ ÂÍÂÙ·ÛÙ‹. ∫Ú·ÙÒÓÙ·˜ ÙÔ ÔÊı·ÏÌÔÛÎfi-

ÈÔ ÎÔÓÙ¿ ÛÙÔ Ì¿ÙÈ Î·È ÂÛÙÈ¿˙ÔÓÙ·˜ ÛÙËÓ ÎfiÚË, Ô

ÂÍÂÙ·ÛÙ‹˜ ÂÈÛÎÔ› Î·È Ù· ‰‡Ô Ì¿ÙÈ· ÙÔ˘ ·È‰È-

Ô‡ ·fi ·fiÛÙ·ÛË 30-45 cm ·fi ÙÔ ‰ÈÎfi ÙÔ˘

ÚfiÛˆÔ. ∏ ÂͤٷÛË Ù˘ Úfi‰ÈÓ˘ ·ÓÙ·‡ÁÂÈ·˜

¯·Ú·ÎÙËÚ›˙ÂÙ·È ˆ˜ ·ÚÓËÙÈ΋ fiÙ·Ó Ë ·ÓÙ·‡ÁÂÈ·

Â›Ó·È Û˘ÌÌÂÙÚÈ΋ Î·È ÈÛfiÙÈÌË Î·È ÛÙ· ‰‡Ô Ì¿ÙÈ·.

™˘ÓÂÒ˜, fiÙ·Ó Ë Úfi‰ÈÓË ·ÓÙ·‡ÁÂÈ· Â›Ó·È Û˘ÌÌÂ-

ÙÚÈ΋ Û ¤ÓÙ·ÛË Î·È ·fi ÙÔ˘˜ ‰‡Ô ÔÊı·ÏÌÔ‡˜,

ÙfiÙÂ Ë fiÚ·ÛË Â›Ó·È Èı·Ófiٷٷ Ê˘ÛÈÔÏÔÁÈ΋ ηÈ

ÌÔÚ› Ì ‚‚·ÈfiÙËÙ· Ó· ·ÔÎÏÂÈÛÙ› ÔÔÈ·‰‹-

ÔÙÂ Û˘ÁÁÂÓ‹˜ ·Ó·ÙÔÌÈ΋ ·ÓˆÌ·Ï›· ‹ ¿ÏÏË ·-

ıÔÏÔÁÈ΋ ηٿÛÙ·ÛË Ô˘ Âȉڿ ÛÙËÓ ÔÌ·Ï‹

·Ó·ÙÔÌ›· Ù˘ ÂÚÈÔ¯‹˜, fiˆ˜ ÁÈ· ·Ú¿‰ÂÈÁÌ· ÙÔ

ÚÂÙÈÓÔ‚Ï¿Ûو̷, ÙÔ ÔÔ›Ô Î·Ï‡ÙÂÈ Ì¤ÚÔ˜ Ù˘

ÎfiÚ˘. ∂›Û˘, ·ÔÎÏ›ÔÓÙ·È Û ÌÂÁ¿ÏÔ ‚·ıÌfi

‰È·Ù·Ú·¯¤˜ Ù˘ ·ÎÂÚ·ÈfiÙËÙ·˜ ÙÔ˘ ÎÂÚ·ÙÔÂȉԇ˜,

ÙÔ˘ Ê·ÎÔ‡ Î·È ÙÔ˘ ·ÌÊÈ‚ÏËÛÙÚÔÂȉԇ˜.

øÛÙfiÛÔ, ˘¿Ú¯Ô˘Ó ·ı‹ÛÂȘ, ÔÈ Ôԛ˜ -

·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÂËÚ¿˙Ô˘Ó ÙËÓ fiÚ·ÛË -

‰ÂÓ ·ÓȯÓ‡ÔÓÙ·È Ì ÙËÓ ·Ï‹ ÂÈÛÎfiËÛË Ù˘Úfi‰ÈÓ˘ ·ÓÙ·‡ÁÂÈ·˜, fiˆ˜ Ë ÂÚ›ÙˆÛË ‰˘-ÛÙÚÔÊ›·˜ ÙÔ˘ ·ÌÊÈ‚ÏËÛÙÚÔÂȉԇ˜. OÈ ÛÎÔÙÂÈ-Ó¤˜ ÎËÏ›‰Â˜ ̤۷ ÛÙË Úfi‰ÈÓË ·ÓÙ·‡ÁÂÈ·, ÔÔÈ-·‰‹ÔÙ ·Û˘ÌÌÂÙÚ›· ÛÙËÓ ¤ÓÙ·ÛË Ù˘ Úfi‰ÈÓ˘·ÓÙ·‡ÁÂÈ·˜ ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÊı·ÏÌÒÓ, ·ÓÙÂ-Ï‹˜ ·Ô˘Û›· Ù˘ ·fi ÙÔ ¤Ó· Ì¿ÙÈ ‹ ·ÚÔ˘Û›·Ï¢΋˜ ·ÓÙ·Ó¿ÎÏ·Û˘, ˘Ô‰ËÏÒÓÔ˘Ó ˘ÔΛ-ÌÂÓË ·ıÔÏÔÁ›· ηٿ ÙÔÓ ÔÙÈÎfi ¿ÍÔÓ· ηÈÂÈ‚¿ÏÏÔ˘Ó ÙËÓ ¿ÌÂÛË ·Ú·ÔÌ‹ ÙÔ˘ ·È‰È-Ô‡ ÛÙÔÓ ÔÊı·ÏÌ›·ÙÚÔ (∂ÈÎfiÓ˜ 2 Î·È 3).

∞fi Ù· ·Ú·¿Óˆ ηı›ÛÙ·Ù·È Û·Ê‹˜ Ë ÙÂ-Ú¿ÛÙÈ· ÛËÌ·Û›· Ù˘ ÂͤٷÛ˘ Ù˘ Úfi‰ÈÓ˘·ÓÙ·‡ÁÂÈ·˜ ÙÔ˘ ·ÌÊÈ‚ÏËÛÙÚÔÂȉԇ˜, Ë ÔÔ›·Ì¿ÏÈÛÙ· ı· Ú¤ÂÈ Î·Ù¿ ‰È·ÛÙ‹Ì·Ù· Ó· ·ÓÂ-ÍÂÙ¿˙ÂÙ·È ÛÙË ‚ÚÂÊÈ΋ ËÏÈΛ·, ·ÎfiÌË Î·È fiÙ·Ó¤¯ÂÈ ıˆÚËı› Ê˘ÛÈÔÏÔÁÈ΋ ÛÙË ÓÂÔÁÓÈ΋ Â-Ú›Ô‰Ô. ÕÏψÛÙÂ, ÔÈ ÂȉÈÎÔ› ÂÊÈÛÙÔ‡Ó ÙËÓ ÚÔ-ÛÔ¯‹ ˆ˜ ÚÔ˜ ÙËÓ ¤ÁηÈÚË ‰È¿ÁÓˆÛË ÛÔ‚·ÚÒÓ·ı‹ÛˆÓ, fiˆ˜ ÙÔ˘ ÚÂÙÈÓÔ‚Ï·ÛÙÒÌ·ÙÔ˜ ηÈÙÔ˘ Û˘ÁÁÂÓÔ‡˜ ηٷÚÚ¿ÎÙË, Ë ¤ÁηÈÚË ·ÓÙÈÌÂ-ÙÒÈÛË ÙˆÓ ÔÔ›ˆÓ Â›Ó·È Ô˘ÛÈ·ÛÙÈ΋˜ ÛËÌ·-Û›·˜ fiÛÔÓ ·ÊÔÚ¿ ÛÙË ‰È¿ÛˆÛË Ù˘ fiÚ·Û˘, ÔÚÈ-Ṳ̂Ó˜ ‰Â ÊÔÚ¤˜ Î·È ÁÈ' ·˘Ù‹ ηı·˘Ù‹ ÙËÓ ÂÈ-‚›ˆÛË ÙÔ˘ ·ÛıÂÓÔ‡˜.

ªÔÏÔÓfiÙÈ ÛÙ· ‚Ú¤ÊË ÔÈ ÎfiÚ˜ ‰È·ÛÙ¤ÏÏÔÓٷȇÎÔÏ· ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÔÈΛÏÔ˘˜ ·Ú¿ÁÔ-ÓÙ˜, ÛÔÚ·‰Èο ¤¯Ô˘Ó ηٷÁÚ·Ê› ÛÔ‚·Ú¤˜·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ ·fi Ù· ¯ÚËÛÈÌÔÔÈÔ‡-ÌÂÓ· Ì˘‰ÚÈ·ÙÈο Û΢¿ÛÌ·Ù·, ÙfiÛÔ Ù· Û˘Ì·-ıËÙÈÎÔÌÈÌËÙÈο, fiˆ˜ Ë Ê·ÈÓ˘ÏÂÊÚ›ÓË, fiÛÔ Î·ÈÙ· ·ÓÙȯÔÏÈÓÂÚÁÈο, fiˆ˜ Ë ˘‰ÚԯψÚÈ΋ ΢-ÎÏÔÂÓÙÔÏ¿ÙË Î·È Ë ÙÚÔÈη̛‰Ë. ™ÙȘ ·ÓÂÈı‡-ÌËÙ˜ ÂÓ¤ÚÁÂȘ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È Ë ·‡ÍËÛË Ù˘·ÚÙËÚȷ΋˜ ›ÂÛ˘ Î·È ÙÔ˘ ηډȷÎÔ‡ Ú˘ıÌÔ‡,

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∂ÈÎfiÓ· 1. º˘ÛÈÔÏÔÁÈ΋ Úfi‰ÈÓË ·ÓÙ·‡ÁÂÈ·.

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ÔÈ ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ηډȷÎÔ‡ Ú˘ıÌÔ‡, Ë ÔÍ›·ÎÓ›‰ˆÛË, ηıÒ˜ Î·È Ë ‰ÂÚÌ·Ù›Ùȉ· ÂÍ Â·Ê‹˜(8-12). ¶·Ú' fiÏ· ·˘Ù¿, Ë ‰È·ÛÙÔÏ‹ Ù˘ ÎfiÚË˜ÙˆÓ ÌÈÎÚÒÓ ·È‰ÈÒÓ ·ÔÙÂÏ› ‰È·‰Èηۛ· ÚÔ˘-Ù›Ó·˜ Â‰Ò Î·È ÔÏÏ¿ ¯ÚfiÓÈ· ÛÙ· ÂÚÈÛÛfiÙÂÚ··È‰Ô-ÔÊı·ÏÌÔÏÔÁÈο È·ÙÚ›·, ¯ˆÚ›˜ Ó· ·Ú·-ÙËÚÔ‡ÓÙ·È ÙfiÛÔ Û˘¯Ó¤˜ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂÈ-˜, ηıÈÛÙÒÓÙ·˜ ·˘Ù‹ ÙË ‰È·‰Èηۛ· ·ÛÊ·Ï‹,fiÙ·Ó Á›ÓÂÙ·È Û ¯ÒÚÔ ÔÚÁ·ÓˆÌ¤ÓÔ˘ È·ÙÚ›Ԣ, Û‚ڤÊË, ·ÎfiÌË Î·È Û ÓÂÔÁÓ¿ ËÏÈΛ·˜ ÌÂÁ·Ï‡ÙÂ-Ú˘ ÙˆÓ ‰‡Ô ‚‰ÔÌ¿‰ˆÓ. ∆¤ÏÔ˜, fiÛÔÓ ·ÊÔÚ¿ÛÙ· ÚfiˆÚ· ÓÂÔÁÓ¿, ·˘Ù¿ ÂÍÂÙ¿˙ÔÓÙ·È ÂÓÒ ·Îfi-ÌË ÓÔÛËχÔÓÙ·È ÛÙË ªÔÓ¿‰· ¡ÂÔÁÓÒÓ, Ô‡Ùˆ˜ÒÛÙÂ Ë Ì˘‰Ú›·ÛË Ó· Â›Ó·È Û¯ÂÙÈÎÒ˜ ·ÛÊ·Ï‹˜,·ÎfiÌË Î·È Û ·˘Ù‹ ÙËÓ ÔÌ¿‰· ·È‰ÈÒÓ.

∏ ÚÔ·Ó·ÊÂÚı›۷ ÔÏÈÙÈ΋ ÛÙԯ‡ÂÈ ÛÙËÛ‡ÓÙ·ÍË Î·Ù¢ı˘ÓÙ‹ÚÈˆÓ Ô‰ËÁÈÒÓ-Û˘ÛÙ¿ÛˆÓ,‚·ÛÈÛÌ¤ÓˆÓ ÙfiÛÔ ÛÙË ÁÓÒÛË fiÛÔ Î·È ÛÙËÓ Â›-Ú· Ô˘ ¤¯ÂÈ ·ÔÎÙËı› Û¯ÂÙÈο Ì ÙÔ ı¤Ì· Ù˘ÔÊı·ÏÌÔÏÔÁÈ΋˜ ÂͤٷÛ˘ ÓÂÔÁ¤ÓÓËÙˆÓ Î·ÈÌÈÎÚÒÓ ‚ÚÂÊÒÓ, ÒÛÙ ӷ ÂÏ·¯ÈÛÙÔÔÈËı› ÔΛӉ˘ÓÔ˜ ·fi ÙËÓ Î·ı˘ÛÙ¤ÚËÛË ‰È¿ÁÓˆÛ˘·ÂÈÏËÙÈÎÒÓ - ÁÈ· ÙËÓ fiÚ·ÛË ‹ Î·È ÙË ˙ˆ‹ ÙÔ˘·È‰ÈÔ‡ - ηٷÛÙ¿ÛˆÓ.

™˘ÛÙ¿ÛÂȘ

·) ŸÏ· Ù· ‚Ú¤ÊË ı· Ú¤ÂÈ Ó· ˘Ô‚¿ÏÏÔ-ÓÙ·È ÛÙËÓ ÂͤٷÛË Ù˘ Úfi‰ÈÓ˘ ·ÓÙ·‡ÁÂÈ·˜ η-

Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ‰‡Ô ÚÒÙˆÓ ÌËÓÒÓ Ù˘ ˙ˆ-‹˜ ÙÔ˘˜ ·fi ÙÔÓ ·È‰›·ÙÚÔ ‹ ¿ÏÏÔ È·ÙÚfi Úˆ-ÙÔ‚¿ıÌÈ·˜ ÊÚÔÓÙ›‰·˜ ˘Á›·˜, Èı·Ófiٷٷ ÁÂÓÈ-Îfi È·ÙÚfi, Ô ÔÔ›Ô˜ fï˜ ı· ¤¯ÂÈ ÂÎ·È‰Â˘ı›ηٿÏÏËÏ·. ∏ ÂͤٷÛË ı· Ú¤ÂÈ Ó· ‰ÈÂÓÂÚÁ›-Ù·È Û ÛÎÔÙÂÈÓfi ¯ÒÚÔ, ÒÛÙ ӷ ÌÂÁÈÛÙÔÔÈ›ٷÈË Ì˘‰Ú›·ÛË Ù˘ ÎfiÚ˘ Î·È Ó· ·˘Í¿ÓÂÙ·È Ë Â˘·È-ÛıËÛ›· ÙˆÓ Ì·ÙÈÒÓ ÙÔ˘ ÂÍÂÙ·ÛÙ‹. ∏ ÂͤٷÛËÁ›ÓÂÙ·È Î·Ù¿ ÙÔÓ ÎÏ·ÛÈÎfi ÌÔÓfiÊı·ÏÌÔ ÙÚfiÔ,¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÔÊı·ÏÌÔÛÎfiÈÔ, ÙÔ ÔÔ›Ô ÔÂÍÂÙ·ÛÙ‹˜ ÎÚ·Ù¿ ÎÔÓÙ¿ ÛÙÔ Ì¿ÙÈ ÙÔ˘ Î·È Û·fiÛÙ·ÛË ·fi Ù· Ì¿ÙÈ· ÙÔ˘ ‚Ú¤ÊÔ˘˜ fiÛÔ ÂÚ›-Ô˘ ÙÔ Ì‹ÎÔ˜ ÂÓfi˜ ‚Ú·¯›ÔÓ·.

‚) ∆Ô ·ÔÙ¤ÏÂÛÌ· Ù˘ ÂͤٷÛ˘ ¯·Ú·ÎÙËÚ›-˙ÂÙ·È ˆ˜ ·ÚÓËÙÈÎfi ‹ Ê˘ÛÈÔÏÔÁÈÎfi fiÙ·Ó Ë ·ÓÙ·-Ó¿ÎÏ·ÛË Î·È ·fi Ù· ‰‡Ô Ì¿ÙÈ· Â›Ó·È Û˘ÌÌÂÙÚÈ-΋ Î·È ÈÛÔ‰‡Ó·ÌË Û ¯ÚÒÌ·, ¤ÓÙ·ÛË Î·È Î·ı·-ÚfiÙËÙ· Î·È ‰ÂÓ ˘¿Ú¯Ô˘Ó ıÔÏÂÚfiÙËÙ˜ ‹ Ï¢-Τ˜ ÎËÏ›‰Â˜ ̤۷ ÛÙÔ Â‰›Ô Ù˘ Úfi‰ÈÓ˘ ·ÓÙ·‡-ÁÂÈ·˜ ÙÔ˘ οı ÔÊı·ÏÌÔ‡, Ô‡Ù ‚‚·›ˆ˜ Ï¢΋·ÓÙ·Ó¿ÎÏ·ÛË ·fi ÙËÓ ÎfiÚË (Ï¢ÎÔÎÔÚ›·).

Á) ∆Ô ıÂÙÈÎfi ‹ ·ıÔÏÔÁÈÎfi ·ÔÙ¤ÏÂÛÌ· Ù˘ÂͤٷÛ˘ (·Û˘ÌÌÂÙÚ›· ÛÙËÓ ¤ÓÙ·ÛË Ù˘ Úfi‰È-Ó˘ ·ÓÙ·‡ÁÂÈ·˜, ‰È·ÊÔÚ¿ ÛÙÔ ¯ÚÒÌ· ‹ ÙË ‰È·‡-ÁÂÈ· ‹, Ù¤ÏÔ˜, ·ÒÏÂÈ· ‹ Ï¢΋ ·ÓÙ·Ó¿ÎÏ·ÛË)ı· Ú¤ÂÈ, ̤۷ Û ‡ıÂÙÔ ¯ÚfiÓÔ, Ó· ‰ÈÂÚÂ˘Ó¿-Ù·È ÂÚ·ÈÙ¤Úˆ: i) ›Ù Ì ·ӤÏÂÁ¯Ô Ù˘ Úfi‰È-Ó˘ ·ÓÙ·‡ÁÂÈ·˜, 15 ÂÚ›Ô˘ ÏÂÙ¿ ÌÂÙ¿ ÙËÓ ÂÓ-ÛÙ¿Ï·ÍË ÛÙÔ Î¿ı ̿ÙÈ Ì˘‰ÚÈ·ÙÈÎÔ‡ ÎÔÏÏ˘Ú›Ô˘(ÙÚÔÈη̛‰Ë <1% ‹ Ì›ÁÌ· ÙÚÔÈη̛‰Ë˜<1% Î·È Ê·ÈÓ˘ÏÂÊÚ›Ó˘ 2,5% ‹ Ì›ÁÌ· ΢ÎÏÔ-ÂÓÙÔÏ¿Ù˘ 0,25% Î·È Ê·ÈÓ˘ÏÂÊÚ›Ó˘ 2,5%),‰Â‰Ô̤ÓÔ˘ fiÙÈ, ·ÎfiÌË Î·È ÛÂ Ê˘ÛÈÔÏÔÁÈ΋ fiÚ·-ÛË, Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ·Ô˘ÛÈ¿˙ÂÈ Ë Úfi‰ÈÓË·ÓÙ·‡ÁÂÈ· („¢‰Ò˜ ıÂÙÈ΋ ‰ÔÎÈÌ·Û›·), ȉ›ˆ˜

67∂ͤٷÛË Úfi‰ÈÓ˘ ·ÓÙ·‡ÁÂÈ·˜

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∂ÈÎfiÓ· 2. ∫·Ù·ÚÚ¿ÎÙ˘.

∂ÈÎfiÓ· 3. §Â˘ÎÔÎÔÚ›·.

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68 ∞. ¡ÈÎÔÏ·˝‰Ô˘, °. ∆ÛfiÏ·˜

fiÙ·Ó ‰ÂÓ ÂÛÙÈ¿˙ÂÙ·È ÙÔ ‚ϤÌÌ· ÛÙË ÊˆÙÂÈÓ‹ËÁ‹, ÂÓÒ ·ÓÙÈı¤Ùˆ˜ Ô˘‰¤ÔÙ ˘¿Ú¯ÂÈ „¢-‰Ò˜ ·ÚÓËÙÈ΋ ‰ÔÎÈÌ·Û›· Úfi‰ÈÓ˘ ·ÓÙ·‡ÁÂÈ·˜,ii) ›Ù Ì ÙËÓ ·Ú·ÔÌ‹ ÙÔ˘ ·È‰ÈÔ‡ Û¤ÌÂÈÚÔ ·È‰Ô-ÔÊı·ÏÌ›·ÙÚÔ, Ô ÔÔ›Ô˜ - ÂÎÙfi˜ÙˆÓ ¿ÏÏˆÓ - ı· ÚԂ› Î·È Û ÂͤٷÛË ÙÔ˘ ‚˘-ıÔ‡ Ì ¤ÌÌÂÛË ÔÊı·ÏÌÔÛÎfiËÛË ÌÂÙ¿ ·fi Ì˘-‰Ú›·ÛË Ù˘ ÎfiÚ˘ ÙÔ˘ ÔÊı·ÏÌÔ‡.

™ÙÔ ÛËÌÂ›Ô ·˘Ùfi ·Í›˙ÂÈ Ó· ·Ó·ÊÂÚı› fiÙÈÔÏÏ¿ ·fi Ù· ÚÔ·Ó·ÊÂÚı¤ÓÙ· Ì˘‰ÚÈ·ÙÈοÎÔÏχÚÈ· ΢ÎÏÔÊÔÚÔ‡Ó Ì ÙȘ ·Ú·¿Óˆ ·Ó·-ÁÚ·ÊfiÌÂÓ˜ Û˘ÁÎÂÓÙÚÒÛÂȘ ÛÙȘ ∏.¶.∞. Î·È Û¿ÏϘ ¯ÒÚ˜ ÙÔ˘ Â͈ÙÂÚÈÎÔ‡. ¶ÚÔÎÂÈ̤ÓÔ˘ ÁÈ·ÙË ¯ÒÚ· Ì·˜, Â›Ó·È ¯Ú‹ÛÈÌÔ Ó· ÁÓˆÚ›˙Ô˘Ì fiÙȯÚÂÈ¿˙ÂÙ·È Ó· Á›ÓÂÈ ·Ú·›ˆÛË ÙˆÓ ˘·Ú¯fiÓÙˆÓÎÔÏÏ˘Ú›ˆÓ.

‰) ∏ Ï‹„Ë ÏÂÙÔÌÂÚÔ‡˜ ÎÏËÚÔÓÔÌÈÎÔ‡ ÈÛÙÔ-ÚÈÎÔ‡ ı· Ú¤ÂÈ ¿ÓÙ· Ó· ÚÔËÁÂ›Ù·È Ù˘ ÎÏÈÓÈ-΋˜ ÂͤٷÛ˘, Ì ÛÎÔfi ÙËÓ ·ÔÎ¿Ï˘„Ë ÔÈÎÔ-ÁÂÓÒÓ ÓfiÛˆÓ ‹ ¿ÏÏˆÓ Î·Ù·ÛÙ¿ÛˆÓ, fiˆ˜ ËÚÔˆÚfiÙËÙ·, Ô˘ ÂȉÚÔ‡Ó ÛÙÔ˘˜ ÔÊı·ÏÌÔ‡˜.ŒÙÛÈ, ‚Ú¤ÊË Ô˘ ·Ó‹ÎÔ˘Ó Û ηÙËÁÔÚ›· ˘„ËÏÔ‡ÎÈÓ‰‡ÓÔ˘, ÁÈ· ·Ú¿‰ÂÈÁÌ· ÌÂ Û˘ÁÁÂÓ›˜ ¿Û¯Ô-ÓÙ˜ ·fi ÚÂÙÈÓÔ‚Ï¿Ûو̷ ‹ Û˘ÁÁÂÓ‹ ηٷÚÚ¿-ÎÙË ‹ Û˘ÁÁÂÓ‹ ‰˘ÛÏ·Û›· ÙÔ˘ ·ÌÊÈ‚ÏËÛÙÚÔÂÈ-‰Ô‡˜ ‹ Î·È ¿ÏϘ ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ·ÌÊÈ‚ÏËÛÙÚÔ-Âȉԇ˜ ‹ ÙÔ˘ Ê·ÎÔ‡, ı· Ú¤ÂÈ ÂÍ·Ú¯‹˜ Ó· ˘Ô-‚¿ÏÏÔÓÙ·È Û ÂͤٷÛË Úfi‰ÈÓ˘ ·ÓÙ·‡ÁÂÈ·˜ η-ÙfiÈÓ Ì˘‰ÚÈ¿Ûˆ˜ ‹ Ó· ÂÍÂÙ¿˙ÔÓÙ·È Î·Ù¢ı›·Ó·fi ¤ÌÂÈÚÔ ·È‰Ô-ÔÊı·ÏÌ›·ÙÚÔ.

Â) µÚ¤ÊË Ì Ï¢ÎÔÎÔÚ›· ÛÙÔ ¤Ó· ‹ Î·È Ù· ‰‡ÔÌ¿ÙÈ·, ηıÒ˜ Î·È ·˘Ù¿ ÛÙ· ÔÔ›· ·Ô˘ÛÈ¿˙ÂÈ ËÚfi‰ÈÓË ·ÓÙ·‡ÁÂÈ·, ı· Ú¤ÂÈ Ó· ·Ú·¤ÌÔÓٷȷ̤ۈ˜ Û ¤ÌÂÈÚÔ ·È‰Ô-ÔÊı·ÏÌ›·ÙÚÔ.

™˘ÌÂÚ¿ÛÌ·Ù·

∏ ÂͤٷÛË Ù˘ Úfi‰ÈÓ˘ ·ÓÙ·‡ÁÂÈ·˜ ÙÔ˘ ·Ì-ÊÈ‚ÏËÛÙÚÔÂȉԇ˜ ·ÔÙÂÏ› ‚·ÛÈÎfi ̤ÚÔ˜ ÙË˜Ê˘ÛÈ΋˜ ÂͤٷÛ˘ ÙÔ˘ ÓÂÔÁÓÔ‡ Î·È ÙÔ˘ ‚Ú¤-ÊÔ˘˜, ηıÒ˜ Û˘Ì‚¿ÏÏÂÈ ÛÙËÓ ¤ÁηÈÚË ·Ó›¯Ó¢ÛËÔÊı·ÏÌÈÎÒÓ ·ı‹ÛÂˆÓ Ô˘ ı¤ÙÔ˘Ó Û ÛÔ‚·ÚfiΛӉ˘ÓÔ ÙËÓ fiÚ·ÛË, ·ÏÏ¿ ÂÓ›ÔÙÂ Î·È ÙËÓ ›‰È· ÙË˙ˆ‹ ÙÔ˘ ·È‰ÈÔ‡. ∏ ÂͤٷÛË ·˘Ù‹ ı· Ú¤ÂÈ Ó·

Á›ÓÂÙ·È - fi¯È ÌfiÓÔ Ì›· ÊÔÚ¿ - ·fi ÙÔÓ ›‰ÈÔ ÙÔӷȉ›·ÙÚÔ, Ô ÔÔ›Ô˜ ÔÊ›ÏÂÈ Ó· Â›Ó·È ÂÍÔÈÎÂȈ-̤ÓÔ˜ Ì ÙËÓ ÔÚı‹ Î·È Û˘Ó‹ ‰ÈÂÓ¤ÚÁÂÈ¿ Ù˘.

∂˘¯·ÚÈÛٛ˜

OÈ ÊˆÙÔÁڷʛ˜ ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙÔ ·Ú¯Â›Ô Ù˘ ΢-Ú›·˜ ∫ˆÓÛÙ·ÓÙ›Ó·˜ µÏ¿¯Ô˘, ∂ÈÌÂÏ‹ÙÚÈ·˜ ∞' Ù˘OÊı·ÏÌÔÏÔÁÈ΋˜ ∫ÏÈÓÈ΋˜ ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ“¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ÙËÓ ÔÔ›· Î·È Â˘¯·ÚÈÛÙԇ̠ıÂÚÌ¿.

µÈ‚ÏÈÔÁÚ·Ê›·

1. Calhoun JH. Consultation with the specialist. Eyeexaminations in infants and children. Pediatr Rev1997;18:28-31.

2. Mills MD. The eye in childhood. Am Fam Physician1999;60:907-916.

3. Olitsky SE, Nelson LB. Common ophthalmologicconcerns in infants and children. Pediatr Clin NorthAm 1998;45:993-1012.

4. Curnyn KM, Kaufman LM. The eye examination inthe pediatrician's office. Pediatr Clin North Am2003;50:25-40.

5. American Academy of Pediatrics, Committee onPractice and Ambulatory Medicine, Section onOphthalmology. Eye examination and visionscreening in infants, children, and young adults. Pe-diatrics 1996;98:153-157.

6. American Academy of Pediatrics, Section on Oph-thalmology. Red reflex examination in infants. Pedi-atrics 2002;109:980-981.

7. Tongue AC, Cibis GW. Bruckner test. Ophthalmol-ogy 1981;88:1041-1044.

8. Ogut MS, Bozkurt N, Ozek E, Birgen H, KazokogluH, Ogut M. Effects and side effects of mydriatic eye-drops in neonates. Eur J Ophthalmol 1996;6:192-196.

9. Fraunfelder FT. Pupil dilation using phenylephrinealone or in combination with tropicamide. Ophthal-mology 1999;106:4.

10. Gaynes BI. Monitoring drug safety; cardiac events inroutine mydriasis. Optom Vis Sci 1998;75:245-246.

11. Resano A, Esteve C, Fernandez Benitez M. Allergiccontact blepharoconjunctivitis due to phenylephrineeye drops. J Investig Allergol Clin Immunol 1999;9:55-57.

12. Boukhman MP, Maibach HI. Allergic contact der-matitis from tropicamide ophthalmic solution. Con-tact Dermatitis 1999;41:47-48.

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69∂π™∏°∏™∏ RECOMMENDATION

EÈ̤ÏÂÈ·:

Dr ™ÔÊ›· ¶ÂÙÌÂ˙¿Î˶·È‰›·ÙÚÔ˜-¡ÂÔÁÓÔÏfiÁÔ˜À‡ı˘ÓË ª∂¡ ¡ÂÔÁÓÒÓª·È¢ÙËÚ›Ô˘ “ªËÙ¤Ú·”

∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 27-06-2005∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 15-09-2005

¶·È‰È·ÙÚÈ΋ 2006;69:69-71

™ÎÔfi˜ Ù˘ ÂÈÛËÁ‹Ûˆ˜ ·˘Ù‹˜ Â›Ó·È Ó· η-

ıÔÚÈÛÙÔ‡Ó ÔÈ ÂӉ›ÍÂȘ ÁÈ· ÙË ¯Ú‹ÛË ÙÔ˘

Synagis ÁÈ· ÚfiÏË„Ë Ù˘ ÓfiÛÔ˘ ·fi ÙÔÓ ·Ó·-

Ó¢ÛÙÈÎfi Û˘Á΢ÙÈ·Îfi Èfi (RSV) ‚¿ÛÂÈ Ù˘ ÚÔ-

ÛÈÙ‹˜ Û ̷˜ ‚È‚ÏÈÔÁÚ·Ê›·˜.

√ RSV (·Ó·Ó¢ÛÙÈÎfi˜ Û˘Á΢ÙÈ·Îfi˜ Èfi˜) ›-

Ó·È Ë Î˘ÚÈfiÙÂÚË ·ÈÙ›· Ïԛ̈͢ ÙÔ˘ ηÙÒÙÂÚÔ˘

·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÁÈ· Ù· 2 ÚÒÙ·

¯ÚfiÓÈ· ˙ˆ‹˜. ¶ÂÚ›Ô˘ 70% ÙˆÓ ·È‰ÈÒÓ ÌÔχ-

ÓÔÓÙ·È ÛÙÔÓ 1Ô ¯ÚfiÓÔ ˙ˆ‹˜ Î·È 95% ı· ¤¯Ô˘Ó

ÚÔÛ‚ÏËı› ̤¯ÚÈ ÙÔÓ 2Ô ¯ÚfiÓÔ ˙ˆ‹˜. ∞fi ·˘-

Ù¿, 15-22% ı· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó ‚ÚÔÁ¯›Ùȉ·,

Ó¢ÌÔÓ›Ùȉ·, Ó¢ÌÔÓ›·, ÂÓÒ 0,5-2% ı· ¯ÚÂÈ-

·ÛÙ› ÂÈÛ·ÁˆÁ‹ Û ÓÔÛÔÎÔÌ›Ô. ∆Ô ÔÛÔÛÙfi

ıÓËÛÈÌfiÙËÙ·˜ ·fi RSV Î˘Ì·›ÓÂÙ·È ·fi 0,5-

3,5% (1,2). ∂·Ó·ÌfiÏ˘ÓÛË ÌÔÚ› Ó· Û˘Ì‚Â›

ÛÙÔ 50% ÙˆÓ ·È‰ÈÒÓ (2).

√ RSV ¤¯ÂÈ Âԯȷ΋ ÂÌÊ¿ÓÈÛË. ∏ ÂÔ¯‹

∂ÈÛ‹ÁËÛË ÁÈ· ¯ÔÚ‹ÁËÛË Synagis ÁÈ· ÚfiÏË„Ë

ÓfiÛÔ˘ ·fi ·Ó·Ó¢ÛÙÈÎfi Û˘Á΢ÙÈ·Îfi Èfi (RSV)

∂ÏÏËÓÈ΋ ¡ÂÔÁÓÔÏÔÁÈ΋ ∂Ù·ÈÚ›·

Recommendation on administration of Palivizumab (Synagis) for the

prevention of disease caused by respiratory syncytial virus (RSV)

Hellenic Society of Neonatology

Abstract: The aim of this article is to make recommendations about the use of Palivizumab(Synagis) for the disease caused by respiratory syncytial virus (RSV), according to the literatureaccessible to the Hellenic Society of Neonatology at the present time.RSV is the main cause of lower respiratory tract infection in the first two years of life. Seventy per centof infants are infected during their first year of life and 95% by the end of their second year. Of thoseinfected, 15-22% will present with bronchiolitis, pneumonitis or pneumonia, and 0.5-2% will needhospitalization. The mortality from RSV ranges between 0.5-3.5% (1,2). Reinfection occurs in 50%of infants. The presentation of RSV is seasonal, differing between countries. In Greece it is reportedmainly from November until March. The infants at highest risk are premature infants ≤28 weeks of gestation, with or without chronicbronchopulmonary disease (BPD), or more mature infants with BPD, congenital heart disease orimmunodeficiencies. Synagis is a monoclonal antibody against RSV.The prophylactic administration of Synagis at a dose of 15 mg/kg i.m. during the season of RSVinfection has been reported to reduce the rates of hospitalization for RSV infections by 55%.According to this information, Synagis is recommended for the following groups:

a) Infants ≤2 years of age with BPD, if they have been on treatment in the last 6 months before thestart of the RSV season.

b) Premature infants without BPD, if they have been born at:1. gestational age ≤28 weeks and are aged <1 year during the RSV season2. gestational age 29-32 weeks and are aged <6 months during the RSV season3. gestational age 33-35 weeks, if they have additional risk factors and are aged <6 months during

the RSV season.c) Infants with congenital heart disease, with or without cyanosis, if they are aged <1 year, or if

they need surgery or hospitalization during the RSV season. Also infants with cardiomyopathies, ifthey are aged <1 year of age during the RSV season.

d) Infants with immunodeficiencies.

Editor:

Dr Sofia Petmezaki Paediatrician-NeonatologistHead of Neonatal ICU,“Mitera” Maternity Clinic

Date of submission: 27-06-2005Date of approval: 15-09-2005

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70 ∂ÏÏËÓÈ΋ ¡ÂÔÁÓÔÏÔÁÈ΋ ∂Ù·ÈÚ›·

¶·È‰È·ÙÚÈ΋ 2006;69:69-71

‰È·Ê¤ÚÂÈ ·fi ¯ÒÚ· Û ¯ÒÚ·. ™ÙËÓ ∂ÏÏ¿‰· ÂÌÊ·-

Ó›˙ÂÙ·È Î˘Ú›ˆ˜ ÌÂٷ͇ ¡ÔÂÌ‚Ú›Ô˘ Î·È ª·ÚÙ›Ô˘.

¶Ï¤ÔÓ ÂÈÚÚ‹ ÁÈ· ÛÔ‚·Ú‹ ÓfiÛËÛË ·fi

ÙÔÓ RSV ›ӷÈ:

- Ù· ÚfiˆÚ· Î·È Î˘Ú›ˆ˜ ÂΛӷ Ô˘ ÂͤگÔ-

ÓÙ·È ·fi ÙË ªÔÓ¿‰· ∂ÓÙ·ÙÈ΋˜ ¡ÔÛËÏ›·˜ ¡Â-

ÔÁÓÒÓ, ÙËÓ ÂÔ¯‹ Ù˘ ¤Í·ÚÛ˘ ÙÔ˘ ÈÔ‡

- ·È‰È¿ Ì ¯ÚfiÓÈ· Ó¢ÌÔÓÈ΋ ÓfiÛÔ, .¯.

‚ÚÔÁ¯ÔÓ¢ÌÔÓÈ΋ ‰˘ÛÏ·Û›· (B¶¢), ΢ÛÙÈ΋

›ÓˆÛË, ‰È·ÊÚ·ÁÌ·ÙÔ΋ÏË

- ·È‰È¿ ÌÂ Û˘ÁÁÂÓ‹ ηډÈÔ¿ıÂÈ·

- ·È‰È¿ Ì ڈÙÔ·ı‹ ‹ ‰Â˘ÙÂÚÔ·ı‹ ‰È·-

Ù·Ú·¯‹ ÙÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜

- ·È‰È¿ Ì ·ÓÔÛÔηٷÛÙÔÏ‹

- ·È‰È¿ Ì Ó¢ÚÔÌ˘˚΋ ÓfiÛÔ (3)

∂ÈϤÔÓ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÓfiÛËÛË

·fi RSV ›ӷÈ: (2,4)

- ŒÍÔ‰Ô˜ ·fi ªÔÓ¿‰· ∂ÓÙ·ÙÈ΋˜ ¡ÔÛËÏ›-

·˜ ¡ÂÔÁÓÒÓ, ÚÈÓ ‹ ηٿ ÙËÓ ÂÔ¯‹ ¤Í·ÚÛ˘

ÙÔ˘ RSV

- ¶·ÚÔ˘Û›· ¿ÏÏˆÓ ·‰ÂÏÊÒÓ - Û˘Á¯ÚˆÙÈÛÌfi˜

- ∞Ó ËÁ·›ÓÂÈ ÛÂ ‚ÚÂÊÔÓËÈ·Îfi ÛÙ·ıÌfi

- ∞Ó ÚÔ¤Ú¯ÂÙ·È ·fi Ôχ‰˘ÌË Î‡ËÛË

- ∞Ó ÚfiÎÂÈÙ·È Ó· ¯ÂÈÚÔ˘ÚÁËı› ÁÈ· ηډÈÔ-

¿ıÂÈ·

- ¡Â˘ÚÔÏÔÁÈΤ˜ ·ı‹ÛÂȘ

- ªÂÁ¿ÏË ·fiÛÙ·ÛË ·fi ÓÔÛÔÎÔÌÂ›Ô (·˘-

ÍË̤ÓË ÓÔÛËÚfiÙËÙ·)

- ¶·ıËÙÈÎfi οÓÈÛÌ·

- ÷ÌËÏfi ÎÔÈÓˆÓÈÎÔ-ÔÈÎÔÓÔÌÈÎfi ›‰Ô

£Âڷ¢ÙÈο, ÛÙË ÓfiÛËÛË ·fi RSV ¤¯Ô˘Ó

¯ÚËÛÈÌÔÔÈËı› ÂÎÙfi˜ ·fi Ù· ÎÔÈÓ¿ ̤ÙÚ· ·Ô-

Ê˘Á‹˜ ‰È·ÛÔÚ¿˜ ÏÔÈÌÒÍÂˆÓ (χÛÈÌÔ ¯ÂÚÈÒÓ,

Ì¿ÛΘ, ·ÔÊ˘Á‹ Û˘Á¯ÚˆÙÈÛÌÔ‡) Î·È ‚ÚÔÁ¯Ô-

‰È·ÛÙ·ÏÙÈο, ÛÙÂÚÔÂȉ‹, O2, πgGIV, ¯ˆÚ›˜ ȉȷ›-

ÙÂÚ· ηϿ ·ÔÙÂϤÛÌ·Ù·.

¶ÚÔÏËÙÈο, ¯ÔÚËÁ‹ıËΠÂȉÈ΋ RSV IgGIV,

·ÏÏ¿ ··ÈÙ›ÙÔ IV ÌfiÓÔ ¯ÔÚ‹ÁËÛË, ÂÌÊ¿ÓÈÛÂ

ÙÔ˘˜ ÎÈÓ‰‡ÓÔ˘˜ ÙˆÓ ·Ú·ÁÒÁˆÓ ·›Ì·ÙÔ˜ ηÈ

ÂÓ›ÔÙ ·Ú·ÙËÚ‹ıËÎÂ Î·È ‚·Ú‡ÙÂÚË ÓfiÛËÛË ÛÂ

·ӷÌfiÏ˘ÓÛË ÛÙ· ·È‰È¿ Ô˘ ›¯·Ó Ï¿‚ÂÈ RSV

IgGIV (2).

∆Ô 1998, ÙÔ FDA ¤ÙÚ„ ÙË ¯Ú‹ÛË Ù˘

palivizumab (Synagis) ÁÈ· ÚfiÏË„Ë ÌfiÏ˘ÓÛ˘

·fi ÙÔÓ RSV. ∏ ¯Ú‹ÛË ÙÔ˘ Synagis Ì›ˆÛ η-

Ù¿ 55% ÙËÓ ·Ó¿ÁÎË ÁÈ· ÂÈÛ·ÁˆÁ‹ ÛÙÔ ÓÔÛÔÎÔ-

ÌÂ›Ô ÁÈ· Ïԛ̈ÍË ·fi RSV (5). ™Ù· ÚfiˆÚ· ¯ˆ-

Ú›˜ B¶¢, ÙÔ ÔÛÔÛÙfi Ì›ˆÛ˘ ‹Ù·Ó 78% ÂÓÒ ÛÂ

·˘Ù¿ Ì B¶¢ ‹Ù·Ó 39% (1).

∆Ô Synagis Â›Ó·È ÂÍ·ÓıÚˆÔÔÈË̤ÓÔ ÌÔÓÔ-

ÎψÓÈÎfi ·Óٛۈ̷ ÂÓ·ÓÙ›ÔÓ Ù˘ F-ÁÏ˘ÎÔÚˆ-

Ù½Ó˘ ÙÔ˘ RSV. ∏ ¯ÔÚ‹ÁËÛË ÙÔ˘ Synagis ˘ÂÚ-

ÙÂÚ› Ù˘ RSV IgGIV, ‰ÈfiÙÈ ·Â‰Â›¯ıË ·ÔÙÂ-

ÏÂÛÌ·ÙÈÎfiÙÂÚË ÛÙËÓ ÚfiÏË„Ë, Â›Ó·È Â‡ÎÔÏË

ÛÙËÓ ¯ÔÚ‹ÁËÛ‹ Ù˘, ‰ÂÓ ¤¯ÂÈ ÙÔ˘˜ ÎÈÓ‰‡ÓÔ˘˜

ÙˆÓ ·Ú·ÁÒÁˆÓ ·›Ì·ÙÔ˜ Î·È Â›Û˘, ‰‡Ó·Ù·È

Ó· ¯ÔÚËÁËı› Û˘Á¯ÚfiÓˆ˜ Ì ÂÌ‚fiÏÈ· Ì ˙ÒÓÙ˜

ÈÔ‡˜ .¯. ªªR (6,7).

∆o Synagis ¯ÔÚËÁÂ›Ù·È πª Û ‰fiÛË 15 mg/kg

·Ó¿ Ì‹Ó· Û maximum 5 ‰fiÛÂȘ, ÛÙËÓ ÂÔ¯‹

¤Í·ÚÛ˘ ÙÔ˘ RSV. ™Â ‚·ÚȤ˜ ÂÚÈÙÒÛÂȘ ÌÔ-

Ú› Ó· ¯ÚÂÈ·ÛÙ› ¯ÔÚ‹ÁËÛË Î·È ÛÙÔÓ 2Ô ¯ÚfiÓÔ

˙ˆ‹˜, ÛÙËÓ ÂÔ¯‹ ¤Í·ÚÛ˘ ÙÔ˘ ÈÔ‡ (4).

™˘ÌÂÚ·ÛÌ·ÙÈο, ‚¿ÛÂÈ ÙˆÓ ·ÓˆÙ¤Úˆ, Ë

∂ÏÏËÓÈ΋ ¡ÂÔÁÓÔÏÔÁÈ΋ ∂Ù·ÈÚ›· ÂÈÛËÁÂ›Ù·È ÙË

¯ÔÚ‹ÁËÛË ÙÔ˘ Synagis:

·) ™Â ·È‰È¿ ≤2 ÂÙÒÓ, ·Ó ¿Û¯Ô˘Ó ·fi ¯Úfi-

ÓÈ· Ó¢ÌÔÓÔ¿ıÂÈ· (µ¶¢) Î·È Ï·Ì‚¿ÓÔ˘Ó

ıÂڷ›· ÁÈ' ·˘Ù‹, ÙÔ˘˜ ÙÂÏÂ˘Ù·›Ô˘˜ 6 Ì‹Ó˜

ÚÈÓ ÙËÓ ¤Í·ÚÛË ÙÔ˘ RSV.

‚) ™Â ÚfiˆÚ· ¯ˆÚ›˜ µ¶¢ ·Ó ›ӷÈ:

1. ∏.∫. ≤28 ‚‰. Î·È ÙËÓ ÂÔ¯‹ Ù˘ ¤Í·ÚÛ˘

ÙÔ˘ RSV Â›Ó·È ËÏÈΛ·˜ ≤1 ¤ÙÔ˘˜,

2. ∏.∫. 29-32 ‚‰. Î·È ÙËÓ ÂÔ¯‹ Ù˘ ¤Í·ÚÛ˘

ÙÔ˘ RSV Â›Ó·È ËÏÈΛ·˜ <6 ÌËÓÒÓ,

3. ∏.∫. 33-35 ‚‰. ·Ó Û˘Ó˘¿Ú¯Ô˘Ó ÂÈϤ-

ÔÓ ÂÈ‚·Ú˘ÓÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ Î·È ·Ó ÙËÓ ÂÔ¯‹

Ù˘ ¤Í·ÚÛ˘ ÙÔ˘ RSV Â›Ó·È ËÏÈΛ·˜ <6 ÌËÓÒÓ.

Á) ™Â Û˘ÁÁÂÓ›˜ ηډÈÔ¿ıÂȘ Ì ·ÈÌÔ‰˘-

Ó·ÌÈο ÛËÌ·ÓÙÈ΋ ·ÓˆÌ·Ï›·, Ì ΢¿ÓˆÛË ‹ ÌË,

·Ó Â›Ó·È <1 ¤ÙÔ˘˜ ÛÙËÓ ÂÔ¯‹ ¤Í·ÚÛ˘ ÙÔ˘

RSV. ∂›Û˘, ÛÂ Û˘ÁÁÂÓ›˜ ηډÈÔ¿ıÂȘ Ô˘

ÚfiÎÂÈÙ·È Ó· ¯ÂÈÚÔ˘ÚÁËıÔ‡Ó ‹ ¯ÚÂÈ¿˙ÔÓÙ·È ÓÔ-

ÛÔÎÔÌÂȷ΋ ÂÚ›ı·Ï„Ë ÙËÓ ÂÔ¯‹ ¤Í·ÚÛ˘

ÙÔ˘ RSV, fiˆ˜ ›Û˘ Û ηډÈÔÌ˘Ô¿ıÂȘ

Ô˘ ¯ÚÂÈ¿˙ÔÓÙ·È ıÂڷ›· Û ‚Ú¤ÊË ËÏÈΛ·˜ <1

¤ÙÔ˘˜ ÙËÓ ÂÔ¯‹ ¤Í·ÚÛ˘ ÙÔ˘ RSV (8).

‰) ™Â ·È‰È¿ ÌÂ Û˘ÁÁÂÓ‹ ‹ ›ÎÙËÙË ‰È·Ù·-

Ú·¯‹ ÙÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜.

√È Û˘ÛÙ¿ÛÂȘ ·˘Ù¤˜ ÂÊ·ÚÌfi˙ÔÓÙ·È ÛÙȘ

∏¶∞ (4), IÛ·Ó›· (1), πÙ·Ï›· (5), µÚÂÙ·Ó›· (3),

∂˘ÚÒË (6), ∫·Ó·‰¿˜ (7), °ÂÚÌ·Ó›· (9), §·ÙÈÓÈ-

΋ ∞ÌÂÚÈ΋ (2), √ÏÏ·Ó‰›· (10), ¶Ôψӛ· (11),

√˘ÁÁ·Ú›· (12).

µÈ‚ÏÈÔÁÚ·Ê›·

1. Spanish Consensus Committee: Prevention of Res-

piratory Syncytial Virus Infection in Spain. Pediatric

Infectious Diseases Journal en Espan~ol, Octubre

1999.

2. Azar P, Broglia B, Miceli INP, Parga L, Castillo S,

Edwin A et al. Guidelines for the use of Palivizumab

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71∂ÏÏËÓÈ΋ ¡ÂÔÁÓÔÏÔÁÈ΋ ∂Ù·ÈÚ›·

in the prevention of RSV disease. A consensus opin-ion. Pediatrics in Review en Espan

~ol, Abril 2000;

21(2):62-68.3. U.K. Guidelines for the use of Synagis. Document is-

sued by Abbott U.K., 1999.4. American Academy of Pediatrics Committee on In-

fectious Diseases and Committee on Fetus and New-born. Prevention of Respiratory Syncytial Virus In-fections: Indications for the use of Palivizumab andUpdate on the use of RSV-IGIV. Pediatrics 1998;102(5):1211-1216.

5. Giovannini M, Giuffre L, Marini A, Rondini G, Ros-si G, Salvioli GP. Respiratory Syncytial Virus Infec-tions in children. State of the Art. Neonatologica1999;13(2):89-92.

6. Carbonell-Estrany X, Giuffre L, Kimpen Jan LL,Adan D, Calenius H, Devlieger H et al. Guidelinesfor the use of Synagis® (Palivizumab), a HumanisedMonoclonal Antibody for the prevention of Respi-ratory Syncytial Virus (RSV) Disease in High RiskInfants. A consensus opinion. Supplement to Infec-tions in Medicine, December 1999;16(G):29-33.

7. A joint statement of the Canadian Paediatric Societyand the Fetus and Newborn Committee. Palivizum-ab and respiratory syncytial virus immune globulinintravenously for the prophylaxis of respiratory syn-cytial virus infection in high risk infants. Paediatricsand Child Health 1999;4(7):474-480.

8. Tulloh R, Marsh M, Blackburn M, Casey F, LennenW, Weller P et al. Recommendations for the use ofPalivizumab as prophylaxis against respiratory syn-cytial virus in infants with congenital cardiac dis-ease. Cardiol Young 2003;13(5):420-423.

9. Prophylaxis of RSV Infections with immunoglobulin.Statement / report of the German Society of PediatricInfectology. Coordinator Prof. Dr. J. Foster. Monatss-chrift Kinderheilkunde, October 1999;971-972.

10. Duiverman EJ, Lafeber HN, Hartwig N. The stand-point of the pediatric pulmonary diseases, neonatol-ogy and infectious diseases divisions of the PediatricAssociation of the Netherlands (NVK) regarding theindication in children for the use of Palivizumab.Groningen, 21 September 2001.

11. The National Consultant for Pediatrics and the Na-tional Consultant for Neonatology. Guidelines forthe Prevention of Respiratory Syncytial Virus (RSV)Infections in High Risk Infants. Prepared by P.Januszewicz et al. Warszawa 2000.

12. Pinter S, Adamovich K, Hajdu J, Katona M, MegyeriP, Nobilis A et al. Professional Guidelines for the useof SYNAGISTM (Palivizumab) for the Prevention ofRespiratory Syncytial Virus Infections in Infants, 15December 1999.

¶·È‰È·ÙÚÈ΋ 2006;69:69-71

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72 ∫§π¡π∫O ∫OÀπ∑

∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋,¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”

AÏÏËÏÔÁÚ·Ê›·:

∞. ¶··‰ÔÔ‡ÏÔ˘E-mail: [email protected]

¶·È‰È·ÙÚÈ΋ 2006;69:72,76

∞. µ·˙·›Ô˘, ¡. ºÈÔÏÈÙ¿Î˘, ∞. ¶··‰ÔÔ‡ÏÔ˘

∞ÁfiÚÈ 11 ÂÙÒÓ ÂÈÛ‹¯ıË ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô ÏfiÁˆÎ·Ù·‚ÔÏ‹˜ Î·È ‰ÂηÙÈ΋˜ ˘ÚÂÙÈ΋˜ ΛÓËÛ˘ ·fi15Ë̤ÚÔ˘ Î·È ‹È·˜ ÂÈÁ·ÛÙÚ·ÏÁ›·˜ ·fi 6Ì‹ÓÔ˘.∞ÙÔÌÈÎfi Î·È ÔÈÎÔÁÂÓÂÈ·Îfi ·Ó·ÌÓËÛÙÈÎfi ÂχıÂÚÔ.∞fi ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË Î·Ù¿ ÙËÓ ÂÈÛ·Áˆ-Á‹ ‰ÂÓ ÚԤ΢„·Ó ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù· ¤Ú·ÓÙ˘ ˆ¯ÚfiÙËÙ·˜. ∞fi ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯ÔÚԤ΢„·Ó Ù· ·Ú·Î¿Ùˆ: ∏b: 7,3g/dl, Ht: 25,5%,MCV: 56,7, RDW: 19, WBC: 9.900 (N: 46%, L:26%, M:11% ), PLT: 849.000, ∆∫∂: 118 ¯ÈÏ./1ËÒÚ·, CRP: 129 mg/L, Fe ÔÚÔ‡: 15Ìg/dl, ÊÂÚÚÈÙ›ÓË:22 ng/ml (º™ 20-250 ng/ml), ªayer ÎÔÚ¿ÓˆÓ:·ÚÓËÙÈ΋. BÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜: ÎÊ. ∞ÓÙÈÛÒÌ·Ù·¤Ó·ÓÙÈ ÁÏÔÈ·‰›Ó˘, ÚÂÙÈÎÔ˘Ï›Ó˘, ÂÓ‰ÔÌ˘˝Ô˘: ·Ú-ÓËÙÈο, ·˘ÙÔ·ÓÙÈÛÒÌ·Ù·, ·ÙÙ·Ú· χÎÔ˘, Ra test:·ÚÓËÙÈο, VMA, · - ÊÂÙÔÚˆÙ½ÓË: ·ÚÓËÙÈο,·ÓÔÛÔÛÊ·ÈÚ›Ó˜: IgG: 2050 mg/dl (↑), IgA: 460mg;dl (↑), C3: 231 mg/dl (↑). ¢ÂÚÌ·ÙÔ·ÓÙ›‰Ú·ÛËMantoux (-). ∞ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜: ∞/· ıÒÚ·-ÎÔ˜, U/S ÎÔÈÏ›·˜, ‚·ÚÈÔ‡¯Ô˜ ‰È¿‚·ÛË ÏÂÙÔ‡ÂÓÙ¤ÚÔ˘: fiÏ· ÎÊ. CT ÎÔÈÏ›·˜: Î.Ê. ª˘ÂÏfiÁÚ·ÌÌ·:ŸÏ˜ ÔÈ Î˘ÙÙ·ÚÈΤ˜ ÛÂÈÚ¤˜ ·ÚÔ‡Û˜. EÚ˘ıÚ¿ ÛÂÈ-Ú¿ ˆÚÈÌ¿˙ÂÈ Ì ÌÈÎÚÔ-ÔÚıÔ‚Ï·ÛÙÈÎfi ¯·Ú·ÎÙ‹Ú·,ÛȉËÚ·Ôı‹Î˜ ÎÂÓ¤˜. °·ÛÙÚÔÛÎfiËÛË: ÛÔ‚·Ú‹

Á·ÛÙÚ›Ùȉ· - ‰ˆ‰Âη‰·ÎÙ˘Ï›Ùȉ· Î·È ·Ó‡ÚÂÛËHelicobacter pylori ÛÙËÓ ÈÛÙÔÏÔÁÈ΋ ÂͤٷÛË Î·È ÙÔCLO test Ì ηϋ ·Ú¯ÈÙÂÎÙÔÓÈ΋ ÙˆÓ Ï·¯ÓÒÓ ÙÔ˘‰ˆ‰Âη‰·ÎÙ‡ÏÔ˘. ∆Ô ·È‰› ÂÍ‹Ïı Ì ‰È¿ ÛÙfiÌ·-ÙÔ˜ ¯ÔÚ‹ÁËÛË Fe (Hb ÂÍfi‰Ô˘: 9 g/dl) Î·È ·ÁˆÁ‹ÂÎÚ›˙ˆÛ˘ ÙÔ˘ Helicobacter pylori.

∂·ÓÂͤٷÛË ÌÂÙ¿ 45 Ë̤Ú˜

∆Ô ·È‰› ÚÔÛ‹Ïı ÁÈ· ÚÔÁÚ·ÌÌ·ÙÈṲ̂ÓÔ·ӤÏÂÁ¯Ô. ∏ ÂÈÁ·ÛÙÚ·ÏÁ›· ›¯Â Ï‹Úˆ˜ ˘Ô-¯ˆÚ‹ÛÂÈ, fï˜ ÙÔ ·È‰› ·ÚÔ˘Û›·Û ‹ÈÔ ‚‹¯·.∞fi ÙËÓ ÎÏÈÓÈ΋ ÂͤٷÛË ‚Ú¤ıËΠÌfiÓÔ ‹È·ˆ¯ÚfiÙËÙ·. ∞fi ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô ÚÔ¤-΢„·Ó Ù· ·Ú·Î¿Ùˆ: ∏b:10g/dl, ∆∫∂ >100mm/1Ë ÒÚ·, CRP >100 mg/L. §fiÁˆ ÙÔ˘ ‚‹¯·, ÙԷȉ› ˘Ô‚Ï‹ıËΠ۠Ӥ· ·/· ıÒÚ·ÎÔ˜: ‰È‡ڢÓ-ÛË ÌÂÛÔıˆÚ·Î›Ô˘ (ÂÈÎfiÓ· 1), CT ıÒÚ·ÎÔ˜: Ì¿˙·ÛÙÔ Ô›ÛıÈÔ ÌÂÛÔıˆÚ¿ÎÈÔ (ÂÈÎfiÓ· 2), MIBG ·Ú-ÓËÙÈÎfi ÁÈ· Ó¢ÚÔ‚Ï¿Ûو̷, ÂͤٷÛË Á·ÛÙÚÈÎÔ‡˘ÁÚÔ‡ ÁÈ· ÔÍ¿ÓÙÔ¯· (-), ‰ÂÚÌ·ÙÈΤ˜ ‰ÔÎÈ̷ۛ˜ÁÈ· ¿Ù˘· (-), Ì˘ÎÔ‚·ÎÙËÚ›‰È· VMA, HVA (-).

∏ ‰È‡ڢÓÛË ÙÔ˘ Ô›ÛıÈÔ˘ ÌÂÛÔıˆÚ·Î›Ô˘ÛÙËÓ ÚÔÎÂÈ̤ÓË ÂÚ›ÙˆÛË ÔÊ›ÏÂÙ·È ÛÂ:1. §¤Ìʈ̷2. ¡Â˘ÚÔ‚Ï¿Ûو̷3. ¡fiÛÔ Castelman4. ∆Âڿو̷5. ∫˘ÛÙÈÎfi ‡Áڈ̷

∂ÈÎfiÓ· 2. CT ıÒÚ·ÎÔ˜: ∂ÍÂÚÁ·Û›· ÛÙÔ Ô›ÛıÈÔ ÌÂÛÔıˆ-Ú¿ÎÈÔ, ‰ÂÍÈ¿ Ù˘ ̤Û˘ ÁÚ·ÌÌ‹˜. ÕÚ¯ÂÙ·È ÂÚ›Ô˘ ·fiÙÔ ‡„Ô˜ Ù˘ ÌÂÛfiÙËÙÔ˜ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ÎfiÏÔ˘ Î·È ÚÔ˜Ù· ¿Óˆ ÂÎÙ›ÓÂÙ·È Ì¤¯ÚÈ ÙÔ ‡„Ô˜ Ù˘ ÙÚfiȉԘ. ¢È·ÛÙ¿-ÛÂȘ: 6 x 5 cm.∂ÈÎfiÓ· 1.

∏ ·¿ÓÙËÛË ·ÎÔÏÔ˘ı› ÛÙË ÛÂÏ›‰· 76

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73¡∂∞ ∞¶√ ∆√ ¢π∞¢π∫∆À√

µ' ¶·È‰È·ÙÚÈ΋¶·ÓÂÈÛÙËÌȷ΋ ∫ÏÈÓÈ΋, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”,∞ı‹Ó·

AÏÏËÏÔÁÚ·Ê›·:

¡›ÎÔ˜ ¶··‰fiÔ˘ÏÔ˜E-mail: [email protected]

¶·È‰È·ÙÚÈ΋ 2006;69:73-75

¡›ÎÔ˜ ¶··‰fiÔ˘ÏÔ˜, ¶·È‰›·ÙÚÔ˜ - ∞ÏÏÂÚÁÈÔÏfiÁÔ˜

∞ÏÏÂÚÁ›Â˜, ˘ÂÚ¢·ÈÛıËۛ˜ Î·È ¿ÛıÌ· ÛÙÔ ÛÙfi¯·ÛÙÚÔ Ù˘ “ÕÓÔÈ͢” -

http://www.allergyped.gr

∏ ÕÓÔÈÍË Â›Ó·È Ì›· ·ÛÙÈ΋ ÂÙ·ÈÚ›· ÌË ÎÂÚ‰ÔÛÎÔÈ-ÎÔ‡ ¯·Ú·ÎÙ‹Ú·, Ô˘ ÛÙfi¯Ô ¤¯ÂÈ Ó· Û˘Ì‚¿ÏÂÈ ÛÙËÓ Î·Ù·-ÔϤÌËÛË ÙˆÓ ·ÏÏÂÚÁÈÒÓ Î·È ÙÔ˘ ¿ÛıÌ·ÙÔ˜ ̤ۈ Ù˘ÂÓË̤ڈÛ˘, Ù˘ Âη›‰Â˘Û˘, Ù˘ ÎÔÈÓˆÓÈ΋˜ ·ÚÔ˘-Û›·˜ Î·È Ù˘ ¤Ú¢ӷ˜. H ·ÚÔ˘Û›· Ù˘ ÕÓÔÈ͢ ÂÚÈÏ·Ì-‚¿ÓÂÈ ‰Ú¿ÛÂȘ ÁÈ· ÙËÓ Î·Ï‡ÙÂÚË ÔÈfiÙËÙ· ˙ˆ‹˜ ÙˆÓ ·Ùfi-̈Ó, Î·È ÂȉÈο ÙˆÓ ·È‰ÈÒÓ Ô˘ ¿Û¯Ô˘Ó ·fi ·ÏÏÂÚ-Á›Â˜, ˘ÂÚ¢·ÈÛıËۛ˜ Î·È ¿ÛıÌ·, fiˆ˜ ÛÂÌÈÓ¿ÚÈ· ηÈËÌÂÚ›‰Â˜ ÛÂ Û˘ÓÂÚÁ·Û›· ÌÂ Â˘Úˆ·˚Τ˜ ÔÚÁ·ÓÒÛÂȘ,(EFA), Î·È ÂÚ¢ÓËÙÈο ‰›ÎÙ˘· (GA2LEN) Î·È ÂΉËÏÒÛÂȘÌ ÂÎ·È‰Â˘ÙÈÎfi ÂÚȯfiÌÂÓÔ, fiˆ˜ ÙËÓ ¶·ÁÎfiÛÌÈ·∏̤ڷ ÕÛıÌ·ÙÔ˜. √ ‰ÈÎÙ˘·Îfi˜ ÙfiÔ˜ Ù˘ ÕÓÔÈ͢ ·Ô-ÙÂÏ› ‚·ÛÈÎfi ÂÚÁ·ÏÂ›Ô ÂÈÎÔÈÓˆÓ›·˜ Ì ٷ ̤ÏË Ù˘.

∂ÎÙfi˜ ·fi ÙËÓ ÂÏÏËÓÈ΋ ¤Î‰ÔÛË, Ì ϋÚ˜ ÂÚȯfiÌÂÓÔ, ˘¿Ú¯ÂÈ Î·È Ë ·ÁÁÏÈ΋, Ô˘ ¤¯ÂÈ ÂÚÈ-ÏËÙÈÎfi ¯·Ú·ÎÙ‹Ú·.

∆Ô Î‡ÚÈÔ ‚¿ÚÔ˜ Ù˘ ÈÛÙÔÛÂÏ›‰·˜ ‰›ÓÂÙ·È ÛÙËÓ ÏËÚÔÊfiÚËÛË ÛÙÔ Â˘Ú‡ ‰›Ô Ù˘ ·ÏÏÂÚÁÈÔÏÔ-Á›·˜, Ì ÏÔ‡ÛÈÔ ÂÓËÌÂÚˆÙÈÎfi ˘ÏÈÎfi Û¯ÂÙÈο Ì ٷ ‚·ÛÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ ÓÔÛË-Ì¿ÙˆÓ, Ô‰ËÁ›Â˜ ÚÔʇϷ͢ Î·È ÚfiÏ˄˘ ηıÒ˜ Î·È ¯Ú‹ÛÈ̘ Û˘Ì‚Ô˘Ï¤˜ ÁÈ· ÙËÓ Î·Ï‡ÙÂÚË ÔÈ-fiÙËÙ· ˙ˆ‹˜ ÙˆÓ ·ÙfiÌˆÓ Ì ·ÏÏÂÚÁ›Â˜ Î·È ¿ÛıÌ·. À¿Ú¯Ô˘Ó ›Û˘ ÏËÚÔÊÔڛ˜ Û¯ÂÙÈο Ì ÙȘ ÂÎ-‰ËÏÒÛÂȘ Ù˘ ÔÚÁ¿ÓˆÛ˘. ∞ÈÛıËÙÈο Ô ÙfiÔ˜ Â›Ó·È fiÌÔÚÊÔ˜ Î·È Ë Î›ÓËÛË ·Ó¿ÌÂÛ· ÛÙȘ ÂÓfiÙËÙ˜·ÚfiÛÎÔÙË.

º§√°∞ - ™˘Ó¯‹˜ ºÚÔÓÙ›‰· ÁÈ· ÙÔ ·È‰› - http://www.floga.org.gr

µ·ÛÈṲ̂ÓÔ˜ ÛÙËÓ ·Ú¯‹ ÙÔ˘ ÂıÂÏÔÓÙÈÛÌÔ‡, Ë ºÏfiÁ· ›-Ó·È Û‡ÏÏÔÁÔ˜ ÌË-ÎÂÚ‰ÔÛÎÔÈÎÔ‡ ¯·Ú·ÎÙ‹Ú· ÁÔÓ¤ˆÓ ·È-‰ÈÒÓ Ì ÓÂÔÏ·ÛÌ·ÙÈ΋ ·Ûı¤ÓÂÈ·. ∆Ô Â‰›Ô ‰Ú¿Û˘ ›ӷÈË ˘ÔÛÙ‹ÚÈÍË ¿Û˘ ʇÛˆ˜ Î·È Ë Û˘Ì·Ú¿ÛÙ·ÛË ÙˆÓ·È‰ÈÒÓ Ô˘ ¿Û¯Ô˘Ó ·fi ηÚΛÓÔ. ∆Ô ¤ÚÁÔ ÙÔ˘ Û˘ÏÏfi-ÁÔ˘, Ô ÔÔ›Ô˜ ÌÂÙÚ¿ 20 ¯ÚfiÓÈ· ·ÚÔ˘Û›·˜, ·ÊÔÚ¿ ·ÚÂÌ-‚¿ÛÂȘ Î·È ÂÈÛËÁ‹ÛÂȘ Û ·ÚÌfi‰È˜ ·Ú¯¤˜ Ù˘ ÔÏÈÙ›·˜,ÂÓË̤ڈÛË ÙˆÓ ÁÔÓ¤ˆÓ ÁÈ· ÙȘ Ӥ˜ ıÂڷ›˜ ÛÂ Û˘ÓÂÚ-Á·Û›· Ì ÂÈÛÙËÌÔÓÈο ΤÓÙÚ·, ËÌÂÚ›‰Â˜ Î·È ÂΉËÏÒÛÂȘÁÈ· ÙËÓ Î·Ï‡ÙÂÚË ‰˘Ó·Ù‹ È·ÙÚÈ΋, „˘¯È΋ Î·È ÎÔÈÓˆÓÈ΋ÊÚÔÓÙ›‰· ÙˆÓ ·È‰ÈÒÓ Î·È ÙË ÁÂÓÈÎfiÙÂÚË Â˘·ÈÛıËÙÔÔ›Ë-ÛË ÛÙȘ ¢·ı›˜ ·˘Ù¤˜ ÔÌ¿‰Â˜. ∂ÈϤÔÓ, Ë ºÏfiÁ· ‰Ú·-ÛÙËÚÈÔÔÈÂ›Ù·È Î·È ÁÈ· ÙËÓ ÔÈÎÔÓÔÌÈ΋ ÂÓ›Û¯˘ÛË ÙˆÓ ·‰‡-

Ó·ÌˆÓ ÔÌ¿‰ˆÓ, ̤ۈ È·ÙÚÈÎÒÓ ÂÍÂÙ¿ÛÂˆÓ Î·È Î·Ï‡ÙÔÓÙ·˜ ÙȘ ‚·ÛÈΤ˜ ·Ó¿ÁΘ ‰È·‚›ˆÛ˘.

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74 ¡∂∞ ∞¶√ ∆√ ¢π∞¢π∫∆À√

¶·È‰È·ÙÚÈ΋ 2006;69:73-75

√ ‰ÈÎÙ˘·Îfi˜ ÙfiÔ˜ ÙÔ˘ Û˘ÏÏfiÁÔ˘ ºÏfiÁ· Â›Ó·È ·ÚÎÂÙ¿ ·Ïfi˜ ÛÙËÓ ÏÔ‹ÁËÛË Î·È ÏÈÙfi˜ ÛÙÔ Â-ÚȯfiÌÂÓÔ, Ì ٤ÛÛÂÚȘ ıÂÌ·ÙÈΤ˜ ηÙËÁÔڛ˜. ¶ÂÚȤ¯ÂÈ ¯Ú‹ÛÈ̘ ÏËÚÔÊÔڛ˜ ÁÈ· ÙÔ˘˜ ÙÚfiÔ˘˜ ηÈÙ· ̤۷ Ì ٷ ÔÔ›· ÌÔÚ› Ó· ‚ÔËı‹ÛÂÈ Î·È Ó· Û˘ÓÂÈÛʤÚÂÈ ÔÈÎÔÓÔÌÈο Ô Î·ı ÂӉȷÊÂÚfiÌÂÓÔ˜.

ºπ§√π ∆√À ¶∞π¢π√À - °›Ó ÎÈ ÂÛ‡ Ê›ÏÔ˜ - http://www.filoitoupediou.gr/

√È º›ÏÔÈ ÙÔ˘ ¶·È‰ÈÔ‡ Â›Ó·È ¤Ó· ÊÈÏ·ÓıÚˆÈÎfi ÌË ÎÂÚ-‰ÔÛÎÔÈÎfi ۈ̷ÙÂ›Ô Ì ·ÓÙÈΛÌÂÓÔ ÙËÓ ÚÔÛÙ·Û›· ηÈÙË ÊÚÔÓÙ›‰· ÙÔ˘ ·È‰ÈÔ‡ Ô˘ ›Ù ·ÓÙÈÌÂÙˆ›˙ÂÈ ÚÔ-‚Ï‹Ì·Ù· ˘Á›·˜, ›Ù ÌÂÁ·ÏÒÓÂÈ Û ÌÔÓÔÁÔÓÂ˚΋ ÔÈÎÔÁ¤-ÓÂÈ·, ›Ù Û ›‰Ú˘Ì·, ›Ù ·ÓÙÈÌÂÙˆ›˙ÂÈ ÁÂÓÈÎfiÙÂÚ· ÎÔÈ-ÓˆÓÈο, „˘¯ÔÏÔÁÈο Î·È ÔÈÎÔÓÔÌÈο ÚÔ‚Ï‹Ì·Ù·. ∞Ò-ÙÂÚÔ˜ ÛÙfi¯Ô˜ ÙÔ˘ ۈ̷Ù›Ԣ Â›Ó·È Ë Û˘Ì‚ÔÏ‹, Ì οıÂ̤ÛÔ, ÛÙËÓ ÔÌ·Ï‹ ÂͤÏÈÍË Î·È „˘¯ÔÎÔÈÓˆÓÈ΋ ·Ó¿Ù˘ÍËÙˆÓ ·È‰ÈÒÓ. °È· ÙÔÓ ÛÎÔfi ·˘Ùfi, ÙÔ ÛˆÌ·ÙÂ›Ô ‰›ÓÂÈ ¤Ì-Ê·ÛË ÛÙËÓ ·Í›· Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ˆ˜ ÙÔ È‰·ÓÈÎfi ÂÚÈ‚¿Ï-ÏÔÓ ·Ó¿Ù˘Í˘ ÙÔ˘ ·È‰ÈÔ‡. ∏ ‰Ú¿ÛË ÙÔ˘ ÂÚÈÏ·Ì‚¿ÓÂÈÙË ‰ÈÔÚÁ¿ÓˆÛË ÊÈÏ·ÓıÚˆÈÎÒÓ ÂΉËÏÒÛˆÓ, Û˘Ó·˘ÏÈÒÓ,bazaar, Î·È ÂÎı¤ÛÂˆÓ ¿ÓÙ· Ì ›ÎÂÓÙÚÔ ÙÔ ·È‰›. ™Ù·

ÌÂÏÏÔÓÙÈο ÙÔ˘ Û¯¤‰È· ÂÚÈÏ·Ì‚¿ÓÂÙ·È Î·È Ë ÔÏÔÎÏ‹ÚˆÛË ¶·È‰ÈÎÔ‡ ™Ù·ıÌÔ‡ ÁÈ· ÙË ÛÙ¤Á·ÛË ·È-‰ÈÒÓ ·Ó‡·ÓÙÚˆÓ ÌËÙ¤ÚˆÓ, ¤ÚÁÔ Ô˘ ‚Ú›ÛÎÂÙ·È Û ÂͤÏÈÍË.

√ ‰ÈÎÙ˘·Îfi˜ ÙfiÔ˜ º›ÏÔÈ ÙÔ˘ ¶·È‰ÈÔ‡ ÂÎÙfi˜ ·fi ÙȘ ‚·ÛÈΤ˜ ÂÓfiÙËÙ˜ Ì ÏËÚÔÊÔÚÈ·Îfi ΢ڛˆ˜ÂÚȯfiÌÂÓÔ, ÚÔÛʤÚÂÈ Î·È ·ÓÔȯً ÁÚ·ÌÌ‹ ÂÈÎÔÈÓˆÓ›·˜ Ì ηı ÂӉȷÊÂÚfiÌÂÓÔ ÁÈ· ÙËÓ ·ÚÔ-¯‹ Û˘Ì‚Ô˘ÏÒÓ Î·È ˘Ô‰Â›ÍˆÓ. Œ¯ÂÈ ÌÔÓÙ¤ÚÓÔ Û¯Â‰È·ÛÌfi Û ˙ˆËÚ¿ ¯ÚÒÌ·Ù· Î·È Â‡ÎÔÏË ÏÔ‹ÁË-ÛË. ∏ ηÙËÁÔÚ›· “∂ΉËÏÒÛÂȘ” ÂÚÈÏ·Ì‚¿ÓÂÈ Î·È Â‡ÎÔÏË Ì˯·Ó‹ ·Ó·˙‹ÙËÛ˘ ÙˆÓ ÂΉËÏÒÛˆÓÔ˘ ¤¯Ô˘Ó Ï¿‚ÂÈ ¯ÒÚ· ÛÙÔ ·ÚÂÏıfiÓ ÂÓÒ ÂÓËÌÂÚÒÓÂÙ·È Û ٷÎÙ¿ ¯ÚÔÓÈο ‰È·ÛÙ‹Ì·Ù·.

¶¡√∏ - ∞Ó¿Û· ·Ó·ÎÔ‡ÊÈÛ˘ ÁÈ· Ù· ·È‰È¿ - http://www.pnoe.gr/

∏ ¶¡√∏ - º›ÏÔÈ ∂ÓÙ·ÙÈ΋˜ £Âڷ›·˜ ¶·È‰ÈÔ‡ ›ӷȤӷ ۈ̷ÙÂ›Ô ÌË ÎÂÚ‰ÔÛÎÔÈÎÔ‡ ¯·Ú·ÎÙ‹Ú·, Ì ¤‰Ú· ÙËÓ∂ÏÏ¿‰· ÙÔ ÔÔ›Ô È‰Ú‡ıËΠÙÔ 1991 ·fi ÁÔÓ›˜, ·È‰È¿-ÙÚÔ˘˜ Î·È Ê›ÏÔ˘˜ ÂıÂÏÔÓÙ¤˜. ™Ùfi¯Ô˜ ÙÔ˘ Â›Ó·È Ô È·ÙÚÈÎfi˜ÂÍÔÏÈÛÌfi˜ ÙˆÓ ªÔÓ¿‰ˆÓ ∂ÓÙ·ÙÈ΋˜ £Âڷ›·˜ ·È‰ÈÒÓÎ·È ÓÂÔÁÓÒÓ, Ë ÔÈÎÔÓÔÌÈ΋ ÂÓ›Û¯˘ÛË Î·È ËıÈ΋ Û˘Ì·Ú¿-ÛÙ·ÛË ÙˆÓ ÁÔÓ¤ˆÓ Ù· ·È‰È¿ ÙˆÓ ÔÔ›ˆÓ ÓÔÛËχÔÓÙ·È ÛªÔÓ¿‰Â˜ ∂ÓÙ·ÙÈ΋˜ £Âڷ›·˜, Ë ·ÔηٿÛÙ·ÛË ÙˆÓ›‰ÈˆÓ ÙˆÓ ·È‰ÈÒÓ fiÙ·Ó ‚ÁÔ˘Ó ·fi ÙËÓ ∂ÓÙ·ÙÈ΋ ÁÈ· ÙȘηχÙÂÚ˜ Û˘Óı‹Î˜ ‰È·‚›ˆÛ˘. ∂ÈϤÔÓ, ÂÎÙfi˜ ·fi Ù·

·È‰È¿-·ÛıÂÓ›˜, Ë ‰Ú¿ÛË ÙÔ˘ ۈ̷Ù›Ԣ ÂÂÎÙ›ÓÂÙ·È Î·È Û ı¤Ì·Ù· Âη›‰Â˘Û˘ Î·È ÂÈÌfiÚʈÛ˘ÙÔ˘ È·ÙÚÈÎÔ‡, ÓÔÛËÏ¢ÙÈÎÔ‡ Î·È ·Ú·˚·ÙÚÈÎÔ‡ ÚÔÛˆÈÎÔ‡ ÙˆÓ ªÔÓ¿‰ˆÓ. ™ÙË ‰È¿ÚÎÂÈ· Ù˘ ‰Âη-ÂÓÙ·ÂÙÔ‡˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘, ÙÔ ÛˆÌ·ÙÂ›Ô ¤¯ÂÈ Ú·ÁÌ·ÙÔÔÈ‹ÛÂÈ ÛÂÈÚ¿ ‰Ú¿ÛˆÓ, fiˆ˜ ÛÂÌÈÓ¿ÚÈ·

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Page 75: Παιδιατρική | Τόμος 69 • Τεύχος 1 • Ιανουάριος - Φεβρουάριος 2006

∫·Ú‰ÈÔ·Ó·Ó¢ÛÙÈ΋˜ ∞Ó¿Ó˄˘ (Ì·Ï¿ÍÂȘ, ÊÈÏ› Ù˘ ˙ˆ‹˜) Ù· ÔÔ›· Á›ÓÔÓÙ·È ·fi ÂÎ·È‰Â˘Ì¤ÓÔ˘˜ÁÈ·ÙÚÔ‡˜ Û ÂȉÈο ‰È·ÌÔÚʈ̤ÓÔ˘˜ ¯ÒÚÔ˘˜ ·ÏÏ¿ Î·È Û ۯÔÏ›·, Á˘ÌÓ·ÛÙ‹ÚÈ· Î·È ÂȯÂÈÚ‹ÛÂȘ. ∆·Ì·ı‹Ì·Ù· ·ӷϷ̂¿ÓÔÓÙ·È Û ٷÎÙ¿ ¯ÚÔÓÈο ‰È·ÛÙ‹Ì·Ù· ÒÛÙ ӷ ÂÍ·ÛÊ·Ï›˙ÂÙ·È Ë Û˘Ó¯‹ ·ʋÌ ÙÔ ·ÓÙÈΛÌÂÓÔ. ™ÙË Û¯ÂÙÈ΋ ÛÂÏ›‰· ÙÔ˘ ‰ÈÎÙ˘·ÎÔ‡ ÙfiÔ˘ ˘¿Ú¯ÂÈ Î·È Ë ÊfiÚÌ· ÂΉ‹ÏˆÛ˘ ÂÓ-‰È·Ê¤ÚÔÓÙÔ˜ ÁÈ· ÙË Û˘ÌÌÂÙÔ¯‹ ÛÙÔ ÚfiÁÚ·ÌÌ·.

√ ‰ÈÎÙ˘·Îfi˜ ÙfiÔ˜ ¶¡√∏ ÚÔÛʤÚÂÈ ÏËÚÔÊÔڛ˜ Û¯ÂÙÈο Ì ÙȘ ‰Ú¿ÛÂȘ ÙÔ˘ ۈ̷Ù›Ԣ ÛÙÔ·ÚÂÏıfiÓ, fiˆ˜ ÂΉËÏÒÛÂȘ, ËÌÂÚ›‰Â˜, ÂÍÔÏÈÛÌfi È·ÙÚÈÎÒÓ È‰Ú˘Ì¿ÙˆÓ ÂÓÒ ·Ó·Ê¤ÚÔÓÙ·È Î·È Ù·ÌÂÏÏÔÓÙÈο Û¯¤‰È·. √ ۯ‰ȷÛÌfi˜ Â›Ó·È ÌÔÓÙ¤ÚÓÔ˜ Ì ȉȷ›ÙÂÚË ¤ÌÊ·ÛË ÛÙ· ÓÂÔÁÓ¿, ÂÓÒ Û οıÂÂÓfiÙËÙ· Â›Ó·È ÂÌÊ·Ó¤˜ ÙÔ ÌfiÙÔ ÙÔ˘ ۈ̷Ù›Ԣ ŒÓ· ¶·È‰› ˙ËÙ¿ ÙË µÔ‹ıÂÈ¿ Û·˜.

75NEWS FROM THE INTERNET

¶·È‰È·ÙÚÈ΋ 2006;69:73-75

ª·Ú›· ¶··Ê›ÏË

°È· ÏËÚÔÊÔڛ˜:www.euran.com

ªaria Papafili

For information:www.euran.com

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Page 76: Παιδιατρική | Τόμος 69 • Τεύχος 1 • Ιανουάριος - Φεβρουάριος 2006

76 CLINICAL QUIZ

¶·È‰È·ÙÚÈ΋ 2006;69:72,76

∫ÏÈÓÈÎfi QUIZ

∞¶∞¡∆∏™∏

™ÙÔ ·È‰› ¤ÁÈÓ ‚ÈÔ„›· ‰È¿ ÏÂÙ‹˜ ‚ÂÏfiÓ˘(FNA) ˘fi ÙËÓ Î·ıÔ‰‹ÁËÛË ·ÍÔÓÈÎÔ‡ ÙÔÌÔ-ÁÚ¿ÊÔ˘, Ë ÔÔ›· ‰ÂÓ Â›¯Â ‰È·ÁÓˆÛÙÈÎfi ·ÔÙ¤-ÏÂÛÌ· ÁÈ’ ·˘Ùfi Î·È ˘Ô‚Ï‹ıËΠ۠ıˆÚ·ÎÔÙÔ-Ì‹ Î·È ¯ÂÈÚÔ˘ÚÁÈ΋ ·Ê·›ÚÂÛË Ù˘ Ì¿˙·˜ ·fi ÙÔÌÂÛÔıˆÚ¿ÎÈÔ. ∏ ÈÛÙÔÏÔÁÈ΋ ÂͤٷÛË ¤‰ÂÈÍ fiÙÈÚfiÎÂÈÙ·È ÁÈ· ¡fiÛÔ Castleman ÌÈÎÙÔ‡ Ù‡Ô˘.ªÂÙ¿ ÙË ¯ÂÈÚÔ˘ÚÁÈ΋ ÂÍ·›ÚÂÛË ÙÔ ·È‰› ‰ÂÓ·ÚÔ˘Û›·Û ηӤӷ Úfi‚ÏËÌ·.

∏ ÓfiÛÔ˜ Castleman Â›Ó·È ÏÂÌÊÔ¸ÂÚÏ·-ÛÙÈ΋ ‰È·Ù·Ú·¯‹ ·ÁÓÒÛÙÔ˘ ·ÈÙÈÔÏÔÁ›·˜. ∂ΉË-ÏÒÓÂÙ·È Û˘Ó‹ıˆ˜ ÛÙËÓ 4Ë ‰ÂηÂÙ›· Ù˘ ˙ˆ‹˜Î·È Û¿ÓÈ· ÛÙ· ·È‰È¿. ∏ ÓfiÛÔ˜ ·ÚÔ˘ÛÈ¿˙ÂÙ·ÈÌ ‰‡Ô ÌÔÚʤ˜: ÙËÓ ÂÓÙÔÈṲ̂ÓË Î·È ÙËÓ Ô-Ï˘ÂÛÙÈ΋ Î·È ÈÛÙÔÏÔÁÈο Ì ÙÚÂȘ Ù‡Ô˘˜: ÙÔÓ˘·ÏÈÓÔ·ÁÁÂÈÒ‰Ë ÙÔÓ Ï·ÛÌ·ÙÔ΢ÙÙ·ÚÈÎfi ηÈÙÔÓ ÌÈÎÙfi Ù‡Ô. ∏ ÂÓÙÔÈṲ̂ÓË ÌÔÚÊ‹ (85%)¯·Ú·ÎÙËÚ›˙ÂÙ·È Û˘Ó‹ıˆ˜ ·fi ÌÈ· ·ÚÁ¿ ·˘Í·-

ÓfiÌÂÓË Ì¿˙· Ô˘ ÂÓÙÔ›˙ÂÙ·È ÛÙÔ Ô›ÛıÈÔ ÌÂ-ÛÔıˆÚ¿ÎÈÔ (Û ·ÓÙ›ıÂÛË Ì ÙÔ ÙÂڿو̷ Ô˘ÂÓÙÔ›˙ÂÙ·È ÛÙÔ Ì¤ÛÔ Î·È ÙÔ Ï¤Ìʈ̷ Î·È ÙÔ΢ÛÙÈÎfi ‡Áڈ̷ Ô˘ ÂÓÙÔ›˙ÔÓÙ·È Û˘Ó‹ıˆ˜ÛÙÔ ÚfiÛıÈÔ ÌÂÛÔıˆÚ¿ÎÈÔ), ÙËÓ ÎÔÈÏȷ΋ ¯ÒÚ·‹ ÙÔ˘˜ ÂÚÈÊÂÚÈÎÔ‡˜ ÏÂÌÊ·‰¤Ó˜. ∏ ‰È·ÊÔÚÈ΋‰È¿ÁÓˆÛË ı· Ú¤ÂÈ Ó· Á›ÓÂÈ Â›Û˘ ·fi ÙÔÓ¢ÚÔ‚Ï¿Ûو̷ Î·È ÙÔ˘˜ ÂÚÈÊÂÚÈÎÔ‡˜ fiÁÎÔ˘˜Ó¢ÚÔÂ͈‰ÂÚÌÈ΋˜ ÚÔ¤Ï¢Û˘. ∏ ÎÏÈÓÈ΋ Ô-Ú›· Â›Ó·È ‹È· Ì ·ÚÈ· ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔÓ˘ÚÂÙfi, ÙË ÛȉËÚÔÂÓÈ΋ ·Ó·ÈÌ›·, ÙËÓ ˘ÂÚ-Á·ÌÌ·ÛÊ·ÈÚÈÓ·ÈÌ›·, ÙÔ˘˜ ·˘ÍË̤ÓÔ˘˜ ‰Â›ÎÙ˜ÊÏÂÁÌÔÓ‹˜. ∏ ÚfiÁÓˆÛË ÌÂÙ¿ ÙË ¯ÂÈÚÔ˘ÚÁÈ΋·Ê·›ÚÂÛË Â›Ó·È Î·Ï‹. ∏ ÔÏ˘ÂÛÙȷ΋ ÌÔÚÊ‹··ÓÙ¿Ù·È Û fiÁÎÔ˘˜ Ì ÔÏϷϤ˜ ÂÓÙÔ›-ÛÂȘ, ·ÓÙÈÌÂÙˆ›˙ÂÙ·È Ì ÎÔÚÙÈÎÔÂȉ‹ Î·È ·ÓÔ-ÛÔηٷÛÙ·ÏÙÈο Î·È ¤¯ÂÈ ¯ÂÈÚfiÙÂÚË ÚfiÁÓˆÛË,ηıÒ˜ ÌÔÚ› Ó· ÂÈϷΛ Ì ηÎÔ‹ıÂȘ ‹ÛÔ‚·Ú¤˜ ÏÔÈÌÒÍÂȘ.

µÈ‚ÏÈÔÁÚ·Ê›·

1. Parez N, Bader-Meunier B, Roy CC, Dommergues JP.Paediatric Castleman disease: report of seven casesand review of the literature. Eur J Pediatr. 1999Aug;158(8):631-7.

2. Salisbury JR. Castleman's disease in childhood andadolescence: report of a case and review of literature.Pediatr Pathol. 1990;10(4):609-15.

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