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¢ÈÌËÓÈ·›· ¤Î‰ÔÛË Ù˘
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∂. °·Ï·Ó¿Î˘
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ª. ∆ÛÔÏÈ¿
ÀÔ‚ÔÏ‹ ∂ÚÁ·ÛÈÒÓ
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xviii ∫. ™ÙÂÊ·Ó›‰Ë˜
∞¡∞™∫O¶∏™∂π™
1 New Methods and Trends in Paediatric
Education. Undergraduate Training
K. Sostmann, J. Hoeffe, S. Mueller, H. Krude, G. Gaedicke
5 ¶·È‰È¿ ÌÂ Û˘¯Ó¤˜ ÏÔÈÌÒÍÂȘ: ÎÚÈÙ‹ÚÈ·
ÂÍÂȉÈÎÂ˘Ì¤ÓÔ˘ ·ÓÔÛÔÏÔÁÈÎÔ‡ ÂϤÁ¯Ô˘
¢. Ã. ∫·Û›ÌÔ˜, ª. §È¿ÙÛ˘, ∞. ™ÙÔÁÈ·ÓÓ›‰Ô˘, ª. ∫·Ó¿ÚÈÔ˘
14 ¶ÚˆÙÔ·ı‹˜ ‰˘ÛÎÈÓËÛ›· ÙˆÓ ÎÚÔÛÛÒÓ
ª. ªÔ˘ÛÙ¿ÎË, ∞. ºÚÂÙ˙¿ÁÈ·˜
21 ¡ÂÎÚˆÙÈ΋ ÂÓÙÂÚÔÎÔÏ›Ùȉ·: ÓÂfiÙÂÚ·
‰Â‰Ô̤ӷ ÁÈ· ÙËÓ ·ıÔÊ˘ÛÈÔÏÔÁ›· Ù˘ ÓfiÛÔ˘
Ã. ∆۷ηϛ‰Ë˜, ∞. ∆Ú·ÁÈ·ÓÓ›‰Ë˜, ¡. ¡ÈÎÔÏ·˝‰Ë˜
29 ƒÂ˘Ì·ÙÈÎfi˜ ˘ÚÂÙfi˜: Â›Ó·È ·ÎfiÌ· ‰Ò!
Ã. ∆Ú¿·ÏË, ª. ¶··Ê˘Ï·ÎÙÔ‡, °. ¶··‰fiÔ˘ÏÔ˜
µƒ∞µ∂Àª∂¡∏ ∂ƒ°∞™π∞
38 ∫ÏÈÓÈ΋ Î·È ÌÔÚȷ΋ ÌÂϤÙË ÙÔ˘ ÁÔÓȉ›Ô˘
MMEECCPP22 Û ·È‰È¿ Ì ÓÔËÙÈ΋ ̆ ÛÙ¤ÚËÛË ÛÙÔÓ
ÂÏÏËÓÈÎfi ÏËı˘ÛÌfi
™. æÒÓË, J. Traeger-Synodinos, Ã. ™ÔÊÔÎÏ¤Ô˘˜, ™. ∫›ÙÛÈÔ˘-∆˙¤ÏË, ∞. ª·‡ÚÔ˘, ∂. ∫·Ó·‚¿Î˘, Œ. ºÚ˘Û›Ú·
∂ƒ∂À¡∏∆π∫∂™ ∂ƒ°∞™π∂™
48 ¢È·Ù·Ú·¯¤˜ ÙÔ˘ ‡ÓÔ˘ Û ·È‰È¿ Û¯ÔÏÈ΋˜
ËÏÈΛ·˜
π. ∫·Ï¤ÁÈ·˜, µ. ƒÔ‡ÏË, ∞. ∫·Ú·Ù˙·Ê¤ÚË, ∫. ¢·ÎÔÚÒÓÈ·˜, ª. ¶··˚ˆ¿ÓÓÔ˘, £. ¢·Ó›‰Ë, √. ¢. ¶··ÁˆÚÁ›Ô˘, ∫. ¶·Ô˘ÙÛ‹, °. ∫ÚÔÎȉ¿˜, ¡. ¢È·Ì·ÓÙfiÔ˘ÏÔ˜
55 √È Û˘Ó¤ÂȘ Ù˘ Áڛ˘ ÛÙ· ·È‰È¿ ÛÙËÓ
ÎÔÈÓfiÙËÙ·
ª. ∆ÛÔÏÈ¿, π. §ÔÁÔı¤ÙË, ¡. ¶··‰fiÔ˘ÏÔ˜, ª. ª·˘Ú›ÎÔ˘, ¡. ™˘Ú›‰Ë˜, ¶. ¢ÚÔÛ¿ÙÔ˘, ¢. ∫·ÊÂÙ˙‹˜, ∞. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜ Î·È Ë ÔÌ¿‰·ÌÂϤÙ˘ Ù˘ Áڛ˘ ÛÙËÓ ÎÔÈÓfiÙËÙ·
¶ƒ∞∫∆π∫√ £∂ª∞
62 ™˘ÁÎÔÙÈο ÂÂÈÛfi‰È· ÛÙËÓ ·È‰È΋ ηÈ
ÂÊË‚È΋ ËÏÈΛ·: ‰È¿ÁÓˆÛË - ·ÓÙÈÌÂÙÒÈÛË
¢. π. °ÂˆÚÁ·ÎfiÔ˘ÏÔ˜
∂¡¢π∞º∂ƒ√À™∂™ ¶∂ƒπ¶∆ø™∂π™
68 µÚ¤ÊÔ˜ Ì ˈÛÈÓÔÊÈÏÈ΋ ÂÓÙÂÚ›Ùȉ·
Ã. ∫Ô˘ÙÛ·˘Ù›ÎË, ∂. ª¿ÓÙ˙ÈÔ˘, ¢. ÷Ù˙‹˜, ∫. ¶··ÓÙ˙›Ì·˜, ∫. ™ÙÂÊ·Ó¿ÎË, ¡. ª˘ÚÈÔÎÂÊ·ÏÈÙ¿Î˘, ∂. ƒÒÌ·-°È·ÓÓ›ÎÔ˘
74 ƒ·‚‰ÔÌ˘fiÏ˘ÛË ÌÂÙ¿ ·fi Ïԛ̈ÍË ·fi
influenza A
√. ºÈÏ›Ô˘, ª. ¢ÔÏÈ·Ó›ÙË, ∫. ¢ÈÁ·Ï¿ÎË-£¤ÌÂÏË, ª. ∑‹‚·-¶ÂÙÚÔÔ‡ÏÔ˘, ™. ¶··‰¿ÎÔ˘-§·ÁÔÁÈ¿ÓÓË
79 ∫§π¡π∫√ ∫√Àπ∑
∞. ™·‚‚›‰Ô˘, °. ªÚÈ·ÛÔ‡Ï˘, ª. ƒ·˚Û¿ÎË, Õ. ª. ™·Ó¿ÎË, ¡. º˘ÙÚÔÏ¿ÎË, ∂. °·Ï·Ó¿Î˘, ª. ∫·ÏÌ·ÓÙ‹
80 ™À¡∆√ª∞ ¶∞π¢π∞∆ƒπ∫∞ ¡∂∞
∂ÏÏËÓÈ΋ ·È‰È·ÙÚÈ΋ ¤Ú¢ӷ
Û ‰ÈÂıÓ‹ ÂÚÈÔ‰Èο, 2007
E. °·Ï·Ó¿Î˘
83 ¡∂∞ ∞¶√ ∆√ ¢π∞¢π∫∆À√
Ã. ™Î¢¿ÎË
¶·È‰È·ÙÚÈ΋∆fiÌÔ˜ 71 ñ ∆‡¯Ô˜ 1 ñ π·ÓÔ˘¿ÚÈÔ˜-ºÂ‚ÚÔ˘¿ÚÈÔ˜ 2008
∫ˆ‰ÈÎfi ̃¢È‡ı˘ÓÛË ̃∂ÔÙ›· ̃ªª∂: 3889
ISSN 0377-2551
Pediatri Jan-Feb 08 15-02-08 10:59 ™ÂÏ›‰·1
Bimonthly Publication of
the Greek Paediatric Society
President
A. Constantopoulos
Editorial Board
Editor-in-Chief
C. Stefanidis
Members
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A. Vazeou-Gerasimidi
G. Varlamis
∂. Galanakis
L. Thomaidou
M. Kanariou
∂. Katsarou-Pectasides
A. Kattamis
S. Kitsiou-Tzeli
∞. Papadopoulou
N. Papadopoulos
A. Siamopoulou-Mavridou
M. Tsolia
Manuscript submission
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Instructions to authors:
http://www.e-child.gr/paediatriki/
iae.pdf
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Contents
EDITORIAL COMMENTARY
xviii C. Stefanidis
REVIEW ARTICLES
1 New Methods and Trends in Paediatric
Education. Undergraduate Training
K. Sostmann, J. Hoeffe, S. Mueller, H. Krude, G. Gaedicke
5 Children with frequent infections: criteria
for specialized immunological
investigations
D. C. Cassimos, ª. Liatsis, ∞. Stogiannidou, ª. ∫·nariou
14 Primary ciliary dyskinesia
ª. ªoustaki, ∞. Fretzayas
21 Necrotizing enterocolitis: recent evidence
on the pathophysiology of the disease
C. Tsakalidis, ∞. Tragiannidis, ¡. Nikolaidis
29 Rheumatic fever: it is still here!
C. Trapali, ª. Papafylaktou, G. Papadopoulos
AWARD-WINNING ARTICLE
38 Clinical studies and analysis of the MMEECCPP22gene in children with mental retardation in
the Greek population
S. Psoni, J. Traeger-Synodinos, C. Sofokleous, S. Kitsiou-Tzeli, ∞. ªavrou, ∂. ∫anavakis, H. Fryssira
ORIGINAL ARTICLES
48 Sleep problems in school-age children
J. Kaleyias, V. Rouli, ∞. Karatzaferi, ∫. Dakoronias,ª. Papaioannou, T. Danidi, U. D. Papageorgiou,∫. Papoutsi, G. ∫rokidas, ¡. Diamantopoulos
55 The impact of influenza in children on the
community
ª. ∆solia, π. Logotheti, ¡. Papadopoulos, ª. Mavrikou, ¡. Spyridis, P. Drossatou, D. Kafetzis, ∞. Konstantopoulos and theoutpatient flu study group
PRACTICAL ISSUES
62 Syncopal episodes in childhood and
adolescence: diagnosis - management
D. I. Georgakopoulos
CASE REPORTS
68 An infant with eosinophilic enteritis
C. ∫outsaftiki, ∂. Mantziou, D. Hatzis, ∫. Papantzimas, ∫. Stefanaki, ¡. ªyriokefalitakis,∂. Roma-Giannikou
74 Rhabdomyolysis following influenza A
infection
√. Filippou, ª. Dolianiti, ∫. Digalaki-Themeli, ª. Ziva-Petropoulou, S. Papadakou-Lagogianni
79 CLINICAL QUIZ
∞. Savvidou, G. Briassoulis, ª. Raisaki, A. ª. Spanaki, ¡. Fytrolaki, ∂. Galanakis, ª. Kalmandi
80 PAEDIATRIC NEWS IN BRIEF
Greek paediatric research in international
journals, 2007
E. Galanakis
83 NEWS FROM THE INTERNET
C. Skevaki
PaediatrikiVolume 71 ñ Number 1 ñ January-February 2008
Pediatri Jan-Feb 08 15-02-08 10:59 ™ÂÏ›‰·3
v™À¡∆∞∫∆π∫∏ E¶π∆ƒ√¶∏ EDITORIAL BOARD
ª¤ÏË Ù˘ ¢ÈÂıÓÔ‡˜ ™˘ÓÙ·ÎÙÈ΋˜ ∂ÈÙÚÔ‹˜ ñ Members of the International Editorial Board
¢È¢ı˘ÓÙ‹˜ ™‡ÓÙ·Í˘
∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ™ÙÂÊ·Ó›‰Ë˜, ∞ı‹Ó·
∂ȉÈÎÔ› ™˘ÓÙ¿ÎÙ˜
™Ù¤ÏÏ· ∞Ó‰ÚfiÓÈÎÔ˘, ¡ÂÔÁÓÔÏÔÁ›·, πˆ¿ÓÓÈÓ·
¶ÂÚÛÂÊfiÓË ∞˘ÁÔ˘ÛÙ›‰Ô˘-™·‚‚ÔÔ‡ÏÔ˘, MÂÙ·‚ÔÏÈο ÓÔÛ‹Ì·Ù·,£ÂÛÛ·ÏÔÓ›ÎË
∞Ó‰ÚÈ·Ó‹ µ·˙·›Ô˘-°ÂÚ·ÛÈÌ›‰Ë, ∂Ó‰ÔÎÚÈÓÔÏÔÁ›·, ∞ı‹Ó·
°ÂÒÚÁÈÔ˜ µ·ÚÏ¿Ì˘, ∫·Ú‰ÈÔÏÔÁ›·, £ÂÛÛ·ÏÔÓ›ÎË
∂ÌÌ·ÓÔ˘‹Ï °·Ï·Ó¿Î˘, ∏ıÈ΋ Î·È ¢ÂÔÓÙÔÏÔÁ›·, ∏Ú¿ÎÏÂÈÔ
§ˆÚ¤ÙÙ· £ˆÌ·˚‰Ô˘, ∞Ó·Ù˘ÍȷΤ˜ ‰È·Ù·Ú·¯¤˜, ∞ı‹Ó·
ª·Ú›· ∫·Ó¿ÚÈÔ˘, ∞ÓÔÛÔÏÔÁ›·, ∞ı‹Ó·
∂˘ÛÙ·ı›· ∫·ÙÛ·ÚÔ‡-¶ÂÎÙ·Û›‰Ë, ¡Â˘ÚÔÏÔÁ›·, ∞ı‹Ó·
∞ÓÙÒÓ˘ ∫·ÙÙ¿Ì˘, ∞ÈÌ·ÙÔÏÔÁ›· - OÁÎÔÏÔÁ›·, ∞ı‹Ó·
™ÔÊ›· ∫›ÙÛÈÔ˘-∆˙¤ÏË, °ÂÓÂÙÈ΋, ∞ı‹Ó·
∞ÏÂÍ¿Ó‰Ú· ¶··‰ÔÔ‡ÏÔ˘, °·ÛÙÚÂÓÙÂÚÔÏÔÁ›· - ¢È·ÙÚÔÊ‹, ∞ı‹Ó·
¡ÈÎfiÏ·Ô˜ ¶··‰fiÔ˘ÏÔ˜, ∞ÏÏÂÚÁÈÔÏÔÁ›· - ¶Ó¢ÌÔÓÔÏÔÁ›·, ∞ı‹Ó·
∞ÓÙÈÁfiÓË ™È·ÌÔÔ‡ÏÔ˘-ª·˘Ú›‰Ô˘, ƒÂ˘Ì·ÙÔÏÔÁ›·, πˆ¿ÓÓÈÓ·
ª·Ú›˙· ∆ÛÔÏÈ¿, §ÔÈ̈ÍÈÔÏÔÁ›·, ∞ı‹Ó·
Editor-in-Chief
Constantinos Stefanidis, Athens
Section Editors
Stella Andronikou, Neonatology, Ioannina
Persefoni Avgoustides-Savvopoulou, Metabolic Disorders, Thessaloniki
Andriani Vazaiou-Gerasimidi, Endocrinology, Athens
George Varlamis, Cardiology, Thessaloniki
Emmanouil Galanakis, Ethics and Deontology, Heraklion
Loretta Thomaidou, Developmental Pediatrics, Athens
Maria Kanariou, Immunology, Athens
Eustathia Katsarou-Pektasides, Neurology, Athens
Antonis Kattamis, Haematology - √ncology, Athens
Sophia Kitsiou-Tzeli, Genetics, Athens
Alexandra Papadopoulou, Gastroenterology - Nutrition, Athens
Nicos Papadopoulos, Allergology - Pneumonology, Athens
Antigoni Siamopoulou-Mavridou, Rheumatology, Ioannina
Marisa Tsolia, Infectious Diseases, Athens
Alexis Arzimanoglou, Paris, France
Ellis D. Avner, Milwaukee, USA
Swati Bhave, New Delhi, India
Alberto Bissot, Panama, Panama
David Branski, Jerusalem, Israel
Francesco Chiarelli, Chieti, Italy
Chok-Wan Chan, Hong Kong, China
Denis Daneman, Toronto, Canada
Jochen Ehrich, Hannover, Germany
Demetrius Ellis, Pittsburgh, USA
Yoshikatsu Eto, Tokyo, Japan
Richard N. Fine, Stony Brook, USA
Margaret C. Fisher, Philadelphia, USA
Raif Geha, Boston, USA
Adenike Grange, Lagos, Nigeria
Judith G. Hall, Vancouver, Canada
Patricia Hamilton, London, UK
Enver Hasanoglu, Ankara, Turkey
Christer Holmberg, Helsinki, Finland
Peter Hoyer, Essen, Germany
Jan Janda, Prague, Czech Republic
Jan Kimpen, Ultrecht, Netherlands
Craig B. Langman, Chicago, USA
John Manis, Boston, USA
Manuel Moya, Alicante, Spain
Hugh O'Brodovich, Toronto, Canada
Ross Petty, Vancouver, Canada
Willem Proesmans, Leuven, Belgium
Jose Ramet, Antwerp, Belgium
Alan Sinaiko, Minneapolis, USA
Nick J. Spencer, Coventry, UK
Alfred Tenore, Udine, Italy
Alkis Togias, Bethesda, USA
Eva Tsalikian, Iowa City, USA
Catherine Weil-Olivier, Paris, France
Max Zach, Graz, Austria
Zheng-Yan Zhao, Hangzhou, China
Johannes Zschocke, Heidelberg, Germany
Pediatri Jan-Feb 08 15-02-08 10:59 ™ÂÏ›‰·5
xi√¢∏°π∂™ ¶ƒ√™ ∆√À™ ™À°°ƒ∞º∂π™
A. °ÂÓÈΤ˜ ¶ÏËÚÔÊÔڛ˜∆Ô ÂÚÈÔ‰ÈÎfi “¶·È‰È·ÙÚÈ΋” Â›Ó·È Ë ÂÈÛÙËÌÔÓÈ΋ ¤Î-
‰ÔÛË Î·È È‰ÈÔÎÙËÛ›· Ù˘ EÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ EÙ·ÈÚ›-·˜, Ô˘ ‰È·Ó¤ÌÂÙ·È ÛÙ· ̤ÏË Ù˘. Œ¯ÂÈ ˆ˜ ‚·ÛÈÎÔ‡˜ ÛÙfi-¯Ô˘˜ ÙËÓ ·ÔÙ‡ˆÛË ÙÔ˘ ·È‰È·ÙÚÈÎÔ‡ ÂÈÛÙËÌÔÓÈÎÔ‡ ¤Ú-ÁÔ˘ Î·È ÙË Û˘Ó¯‹ ÂÓË̤ڈÛË ÙˆÓ ¶·È‰È¿ÙÚˆÓ. °È· ÙÔÛÎÔfi ·˘Ùfi ‰¤¯ÂÙ·È ÁÈ· ‰ËÌÔÛ›Â˘ÛË ÔÈÎÈÏ›· ¿ÚıÚˆÓ Î·ÈÛ˘ÁÎÂÎÚÈ̤ӷ:
1. ÕÚıÚ· Û‡ÓÙ·Í˘ (ÌÂÙ¿ ·fi ÚfiÛÎÏËÛË Ù˘ ™˘ÓÙ·-ÎÙÈ΋˜ EÈÙÚÔ‹˜).
2. ∞Ó·ÛÎÔ‹ÛÂȘ.3. µÚ·‚Â˘Ì¤Ó˜ ÂÚÁ·Û›Â˜.4. ∂Ú¢ÓËÙÈΤ˜ ÌÂϤÙ˜.5. ∫ÏÈÓÈο ∫Ô˘›˙.6. ∂ÈÏÂÁ̤Ó˜ Û˘˙ËÙ‹ÛÂȘ ÛÙÚÔÁÁ˘ÏÒÓ ÙÚ·Â˙ÒÓ.7. ∂›Î·ÈÚ· ı¤Ì·Ù·.8. £¤Ì·Ù· Âη›‰Â˘Û˘ Î·È ÔÚÁ¿ÓˆÛ˘ ˘Á›·˜.9. ∂ӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ.
10. ™‡ÓÙÔÌ· Ó¤·.11. µÚ·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ.12. ∂ÈÛÙÔϤ˜ ÚÔ˜ ÙË Û‡ÓÙ·ÍË.13. ¶ÂÚÈÏ‹„ÂȘ Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜.14. ∞Ó·ÎÔÈÓÒÛÂȘ ÚÔÛ¯ÒÓ Û˘Ó‰ڛˆÓ Î·È ÂÈÛÙËÌÔÓÈ-
ÎÒÓ ÂΉËÏÒÛˆÓ15. ∞Ó·ÊÔÚ¤˜ Î·È ÎÚÈÙÈ΋ Ó¤ˆÓ ÂΉfiÛˆÓ, ÂÏÏËÓÈÎÒÓ Î·È
ͤӈÓ, ·È‰È·ÙÚÈÎÔ‡ ÂӉȷʤÚÔÓÙÔ˜.
H ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ‰È·ÙËÚ› ÙÔ ‰Èη›ˆÌ· Ó· ‰Ë-ÌÔÛȇÂÈ ¿ÚıÚ· Ì ȉȷ›ÙÂÚÔ ÂÈÛÙËÌÔÓÈÎfi ÂӉȷʤÚÔÓ,ηıÒ˜ Î·È ¿ÚıÚ· Ì ›ηÈÚ· ı¤Ì·Ù· ¯ˆÚ›˜ Ó· ÙËÚÂ›Ù·È ËÛÂÈÚ¿ ˘Ô‚ÔÏ‹˜. ∂›Û˘, ÌÔÚ› Ó· ·ÔÊ·Û›˙ÂÈ ÁÈ· ÙË ‰Ë-ÌÔÛ›Â˘ÛË ÂÚÁ·ÛÈÒÓ Ô˘ ¤¯Ô˘Ó ·ÚÔ˘ÛÈ·ÛÙ› ÛÙÔ ÂÙ‹ÛÈÔ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ, ÙËÓ ÔÏÈ΋ ‹ ÌÂÚÈ΋ ‰ËÌÔÛ›Â˘ÛË·ÚÔ˘ÛÈ¿ÛÂˆÓ È‰È·›ÙÂÚÔ˘ ÂӉȷʤÚÔÓÙÔ˜ Î·È ÙËÓ ÔÏÈ΋ ‹ÌÂÚÈ΋ ‰ËÌÔÛ›Â˘ÛË ÂÈÛÙÔÏÒÓ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È Û ‰ËÌÔ-ÛÈÂ˘Ì¤Ó· ÂÈÛÙËÌÔÓÈο ¿ÚıÚ· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡.
™ÙȘ ÂÚÁ·Û›Â˜ Ì ›ηÈÚ· ı¤Ì·Ù· Ú¤ÂÈ Ó· ·Ó·ÁÚ¿-ÊÂÙ·È ÛÙËÓ ÚÒÙË ÛÂÏ›‰· Ë ÚfiıÂÛË ÙˆÓ Û˘ÁÁڷʤˆÓ ÁÈ·ÙËÓ ·Ó·ÁηÈfiÙËÙ· Ù˘ Ù·¯Â›·˜ ‰ËÌÔÛ›Â˘Û˘. ∏ ∂ÈÙÚÔ‹™‡ÓÙ·Í˘ ‰È·ÙËÚ› ÙÔ ‰Èη›ˆÌ· Ù˘ ·Ô‰Ô¯‹˜ Ù˘ Ù·¯Â›-·˜ ‰ËÌÔÛ›Â˘Û˘.
ŸÏ˜ ÔÈ ÂÚÁ·Û›Â˜ Ú¤ÂÈ Ó· ÌËÓ ¤¯Ô˘Ó ÂÓ Ì¤ÚÂÈ ‹ ÂÍÔÏÔÎÏ‹ÚÔ˘ ‰ËÌÔÛÈ¢ı› ‹ ˘Ô‚ÏËı› ÁÈ· ÎÚ›ÛË Û ¿ÏÏÔÂÚÈÔ‰ÈÎfi. ∂ÈϤÔÓ, ÛÙËÓ ÂÚÁ·Û›· ı· Ú¤ÂÈ Ó· ·Ó·Ê¤-ÚÔÓÙ·È Ù˘¯fiÓ ÂȉÔÙ‹ÛÂȘ-¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘Ô-ÛÙ‹ÚÈ͢. ŸÏ˜ ÔÈ ÎÏÈÓÈΤ˜ ¤Ú¢Ó˜ Ú¤ÂÈ Ó· ¤¯Ô˘Ó Á›ÓÂÈÌÂÙ¿ ·fi ÏËÚÔÊÔÚË̤ÓË Û˘Ó·›ÓÂÛË ÙˆÓ ÌÂÙ¯fiÓÙˆÓ ‹ÙˆÓ ÓÔÌ›ÌˆÓ ÂÎÚÔÛÒˆÓ ÙÔ˘˜, Û‡Ìʈӷ Ì ÙȘ ‰È·ÎË-Ú‡ÍÂȘ ÙÔ˘ EÏÛ›ÓÎÈ Î·È ÙÔ˘ TfiÎÈÔ. E›Û˘, Ú¤ÂÈ Ó·¤¯Ô˘Ó ÙËÚËı› ÔÈ Ô‰ËÁ›Â˜ ÁÈ· ÙË ÊÚÔÓÙ›‰· ÂÈÚ·Ì·Ùfi˙ˆ-ˆÓ ÙÔ˘ ∂ıÓÈÎÔ‡ πÓÛÙÈÙÔ‡ÙÔ˘ ÀÁ›·˜ ÙˆÓ ∏¶∞ (DHEWPublication, NIH, 80-23). OÈ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ Ú¤ÂÈ Ó·¤¯Ô˘Ó ÂÁÎÚÈı› ·fi ÙËÓ ÂÈÙÚÔ‹ ∏ıÈ΋˜ Î·È ¢ÂÔÓÙÔÏÔ-Á›·˜ ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ.
OÈ ·fi„ÂȘ Î·È Ù· Û˘ÌÂÚ¿ÛÌ·Ù· ÙˆÓ Û˘ÁÁڷʤˆÓÔ˘ ‰È·Ù˘ÒÓÔÓÙ·È ÛÙȘ ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ÂÚÁ·Û›Â˜ ‰ÂÓ·ÓÙÈηÙÔÙÚ›˙Ô˘Ó ··Ú·›ÙËÙ· ·˘Ù¤˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. Hηٷ¯ÒÚÈÛË ‰È·ÊËÌ›ÛÂˆÓ ÛÙÔ ÂÚÈÔ‰ÈÎfi ‰ÂÓ ˘Ô‰ËÏÒÓÂÈÔˆÛ‰‹ÔÙ ¤ÁÎÚÈÛË ÙˆÓ ÂÚȯÔÌ¤ÓˆÓ ÙÔ˘˜ ·fi ÙËÓEÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ EÙ·ÈÚ›·, ÙË ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹‹ ·fi ÙÔÓ EΉfiÙË ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡.
ŸÏ˜ ÔÈ ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ÂÚÁ·Û›Â˜ ıˆÚÔ‡ÓÙ·È È‰ÈÔÎÙË-Û›· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ “¶·È‰È·ÙÚÈ΋” Î·È Ë ÔÏÈ΋ ‹ ÌÂÚÈ΋
·Ó·‰ËÌÔÛ›Â˘Û‹ ÙÔ˘˜ ÂÈÙÚ¤ÂÙ·È ÌfiÓÔ ÌÂÙ¿ ·fi ¤ÁÁÚ·ÊË
Û˘ÁηٿıÂÛË ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡.
µ. ™‡ÓÙ·ÍË ÙˆÓ ∂ÚÁ·ÛÈÒӟϘ ÔÈ ÂÚÁ·Û›Â˜ Ú¤ÂÈ Ó· ·ÎÔÏÔ˘ıÔ‡Ó “∫ÔÈÓ¤˜ ¶ÚÔ-
‰È·Áڷʤ˜ ÁÈ· ÃÂÈÚfiÁÚ·Ê· Ô˘ ̆ Ô‚¿ÏÏÔÓÙ·È Û µÈÔ˚·ÙÚÈ-
ο ¶ÂÚÈÔ‰Èο” (Uniform Requirements for Manuscripts
Submitted to Biomedical Journals), ÔÈ Ôԛ˜ ÙÚÔÔÔÈ‹-
ıËÎ·Ó ÚfiÛÊ·Ù· Î·È ‰ËÌÔÛȇÔÓÙ·È ÛÙȘ ‰È¢ı‡ÓÛÂȘ:
http://www.icmje.org Î·È http://www.icmje.org/icmje.pdf
TÔ Û‡ÓÔÏÔ Ù˘ ÂÚÁ·Û›·˜ (Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ ÙˆÓ
ÈÓ¿ÎˆÓ Î·È ÙˆÓ Ù›ÙÏˆÓ ÙˆÓ ÂÈÎfiÓˆÓ) Ú¤ÂÈ Ó· Â›Ó·È Ù˘-
ˆÌ¤ÓÔ ÛÙË ÌÈ· fi„Ë Ï¢ÎÔ‡ ¯·ÚÙÈÔ‡ ÌÂÁ¤ıÔ˘˜ A4
(21x29,7 cm), Ì ‰ÈÏfi ‰È¿ÛÙËÌ· ÌÂٷ͇ ÙˆÓ ÁÚ·ÌÌÒÓ Î·È
ÂÚÈıÒÚÈ· ÙÔ˘Ï¿¯ÈÛÙÔÓ 2,5 cm ÛÙȘ ‰‡Ô Ï¢ڤ˜.
TÔ Î›ÌÂÓÔ Ú¤ÂÈ Ó· ¤¯ÂÈ ÙËÓ ·ÎfiÏÔ˘ıË ‰È¿Ù·ÍË: ÛÂ-
Ï›‰· Ù›ÙÏÔ˘, ‚Ú·¯‡˜ Ù›ÙÏÔ˜, ÂÚ›ÏË„Ë ÛÙ· ÂÏÏËÓÈο Î·È Ù·
·ÁÁÏÈο, ηٿÏÔÁÔ˜ Û˘ÓÙÔÌÔÁÚ·ÊÈÒÓ, ΛÌÂÓÔ, ¢¯·ÚÈ-
Ûٛ˜ ηıÒ˜ Î·È ·Ó·ÊÔÚ¿ Û ÂȉÔÙ‹ÛÂȘ-¯ÔÚËÁ›Â˜ ‹ ¿Ï-
Ϙ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢, ‚È‚ÏÈÔÁÚ·Ê›·, ›Ó·Î˜, ÂÈÎfiÓ˜,
Ù›ÙÏÔÈ ÂÈÎfiÓˆÓ. K¿ı ¤Ó· ·fi Ù· ·Ú·¿Óˆ ÛÙÔȯ›· Ú¤-
ÂÈ Ó· ·Ú¯›˙ÂÈ Û ¯ˆÚÈÛÙfi ʇÏÏÔ Î·È ÔÈ ÛÂÏ›‰Â˜ Ó· ·ÚÈı-
ÌÔ‡ÓÙ·È ‰È·‰Ô¯Èο ·Ú¯›˙ÔÓÙ·˜ Ì ÙË ÛÂÏ›‰· Ù›ÙÏÔ˘.
H ¤ÎÙ·ÛË ÚÔÛ‰ÈÔÚ›˙ÂÙ·È ÁÈ·:
ñ ÙȘ ·Ó·ÛÎÔ‹ÛÂȘ Û 2000-3000 ϤÍÂȘ.
ñ ÙȘ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜ Û 1500-2500 ϤÍÂȘ Î·È ÙȘ
ÂӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ Û 1000-1500 ϤÍÂȘ.
ñ ÙȘ ‚Ú·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ Û 1000-1500 ϤÍÂȘ.
ñ ÙȘ ÂÈÛÙÔϤ˜ Û 250-500 ϤÍÂȘ.
™ÂÏ›‰· Ù›ÙÏÔ˘
¶Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ:ñ ÙÔÓ Ù›ÙÏÔ (<14 ϤÍÂȘ), ηıÒ˜ Î·È ÙÔ ‚Ú·¯‡ Ù›ÙÏÔ (<5
ϤÍÂȘ) ÙÔ˘ ¿ÚıÚÔ˘. ¢ÂÓ ÂÈÙÚ¤ÔÓÙ·È Û˘ÓÙÌ‹ÛÂȘ.
ñ ÙÔ fiÓÔÌ· Î·È ÙÔ ÂÒÓ˘ÌÔ Î¿ıÂ Û˘ÁÁڷʤ· ÛÙËÓ ÔÓÔ-
Ì·ÛÙÈ΋.
ñ ÙÔ ÂÈÛÙËÌÔÓÈÎfi ΤÓÙÚÔ (›‰Ú˘Ì·, ÎÏÈÓÈ΋, ÂÚÁ·ÛÙ‹-
ÚÈÔ) ·fi fiÔ˘ ÚÔ¤Ú¯ÂÙ·È Ë ÂÚÁ·Û›·. ™Â ÂÚ›ÙˆÛË
¤ÏÏÂȄ˘ Û˘ÓÂÚÁ·Û›·˜ ÌÂ Û˘ÁÎÂÎÚÈ̤ӷ ΤÓÙÚ·, Ú¤-
ÂÈ Ó· ·Ó·Ê¤ÚÂÙ·È Ë È‰ÈfiÙËÙ· ÙÔ˘/ÙˆÓ Û˘ÁÁڷʤ·/ˆÓ
(.¯. ȉÈÒÙ˘ ·È‰›·ÙÚÔ˜) Î·È Ô ÙfiÔ˜ ‰È·ÌÔÓ‹˜
ÙÔ˘/ÙÔ˘˜.
ñ ÙËÓ Ï‹ÚË ‰È‡ı˘ÓÛË, e-mail Î·È ÙÔ ÙËϤʈÓÔ ÙÔ˘
Û˘ÁÁڷʤ· Ì ÙÔÓ ÔÔ›Ô Á›ÓÂÙ·È Ë ·ÏÏËÏÔÁÚ·Ê›·.
¶ÂÚÈÏ‹„ÂȘH ÂÚ›ÏË„Ë Ú¤ÂÈ Ó· ·Ó·ÎÂÊ·Ï·ÈÒÓÂÈ ÙÔ˘˜ ÛÙfi¯Ô˘˜
Ù˘ ÂÚÁ·Û›·˜, ÙË ÌÂıÔ‰ÔÏÔÁ›·, Ù· ΢ÚÈfiÙÂÚ· ·ÔÙÂϤÛÌ·-
Ù· Î·È Ù· Û˘ÌÂÚ¿ÛÌ·Ù· Ù˘ ÌÂϤÙ˘.
ñ £· Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÔ˘Ï¿¯ÈÛÙÔÓ 200 ϤÍÂȘ,
fï˜ ‰ÂÓ ı· Ú¤ÂÈ Ó· ˘ÂÚ‚·›ÓÂÈ ÙȘ 250 ϤÍÂȘ.
ñ ∏ ÂÚ›ÏË„Ë ÙˆÓ ÂÚÁ·ÛÈÒÓ Ú¤ÂÈ Ó· Â›Ó·È ‰ÔÌË̤ÓË
ÛÙȘ ÂÍ‹˜ ·Ú·ÁÚ¿ÊÔ˘˜: ÂÈÛ·ÁˆÁ‹, ̤ıÔ‰ÔÈ, ·ÔÙÂϤ-
ÛÌ·Ù· Î·È Û˘ÌÂÚ¿ÛÌ·Ù·.
™ÙËÓ ÂÚ›ÏË„Ë ÛÙ· ·ÁÁÏÈο Ú¤ÂÈ Ó· ·Ó·ÁÚ¿ÊÔ-
ÓÙ·È ÛÙËÓ ·Ú¯‹ ÙÔ˘ ÎÂÈ̤ÓÔ˘ Ô Ù›ÙÏÔ˜ Ù˘ ÂÚÁ·Û›·˜ Î·È Ù·
ÔÓfiÌ·Ù· ÙˆÓ Û˘ÁÁڷʤˆÓ ÛÙ· ·ÁÁÏÈο. TÔ ÂÚȯfiÌÂÓÔ
ÙÔ˘ ·ÁÁÏÈÎÔ‡ ÎÂÈ̤ÓÔ˘ Ú¤ÂÈ Ó· Â›Ó·È ‰ÔÌË̤ÓÔ ÛÂ: ÂÈ-
Û·ÁˆÁ‹ (background), ̤ıÔ‰ÔÈ (methods), ·ÔÙÂϤÛÌ·-
Ù· (results) Î·È Û˘ÌÂÚ¿ÛÌ·Ù· (conclusions). H ÂÚ›ÏË-
„Ë ÛÙ· ·ÁÁÏÈο ‰ÂÓ Ú¤ÂÈ Ó· ‰È·Ê¤ÚÂÈ ·fi ÙËÓ ·ÓÙ›-
ÛÙÔÈ¯Ë ÛÙ· ÂÏÏËÓÈο.
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·11
K¿Ùˆ ·fi ÙËÓ ÂÏÏËÓÈ΋ Î·È ÙËÓ ·ÁÁÏÈ΋ ÂÚ›ÏË„Ë ÛËÌÂÈÒ-ÓÔÓÙ·È ÙÚÂȘ ¤ˆ˜ ¤ÓÙ ϤÍÂȘ ÎÏÂȉȿ Ô˘ ı· ¯ÚËÛÈÌÔÔÈËıÔ‡ÓÁÈ· ÙÔ ıÂÌ·ÙÈÎfi ¢ÚÂÙ‹ÚÈÔ.
K›ÌÂÓÔOÈ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó: ÂÈÛ·ÁˆÁ‹, ÌÂıfi-
‰Ô˘˜, ·ÔÙÂϤÛÌ·Ù· Î·È Û˘˙‹ÙËÛË. H ÂÈÛ·ÁˆÁ‹ ÂÚÈÏ·Ì‚¿ÓÂÈÙ· ÙÂÏÂ˘Ù·›· ‰Â‰Ô̤ӷ Ù˘ ¤Ú¢ӷ˜ ÛÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ ı¤Ì· ÌÂÙȘ ΢ÚÈfiÙÂÚ˜ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·Ô̤˜ Î·È ÙÔ ÛÎÔfi Ù˘ÂÚÁ·Û›·˜. H ÂÚÈÁÚ·Ê‹ ÙˆÓ ÌÂıfi‰ˆÓ Ú¤ÂÈ Ó· Â›Ó·È ·ÎÚÈ‚‹˜Î·È ·ÚÎÂÙ¿ ÏÂÙÔÌÂÚ‹˜, ÒÛÙ ӷ ÂÈÙÚ¤ÂÈ ÙËÓ ·Ó··Ú·ÁˆÁ‹ÙÔ˘˜ ·fi ¿ÏÏÔ˘˜ ÂÚ¢ÓËÙ¤˜. ∂›Û˘, Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·ÈÌ ÏÂÙÔ̤ÚÂȘ ÔÈ ÛÙ·ÙÈÛÙÈΤ˜ ̤ıÔ‰ÔÈ ·Ó¿Ï˘Û˘ Î·È ·ÍÈÔÏfi-ÁËÛ˘ ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ. T· ·ÔÙÂϤÛÌ·Ù· Ú¤ÂÈ Ó· ·-ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ì ۷ʋÓÂÈ· Î·È Ó· Û˘Óԉ‡ÔÓÙ·È ·fi ÙËÓ ··-Ú·›ÙËÙË ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË. H Û˘˙‹ÙËÛË Ú¤ÂÈ Ó· ÂÚÈÏ·Ì-‚¿ÓÂÈ Ù· Û˘ÌÂÚ¿ÛÌ·Ù· Ô˘ ÚÔ·ÙÔ˘Ó ·fi ÙËÓ ÂÚÁ·Û›·, ÙËÛËÌ·Û›· Ô˘ ÌÔÚ› Ó· ¤¯Ô˘Ó Î·È ÙËÓ Èı·Ó‹ Û˘Û¯¤ÙÈÛ‹ ÙÔ˘˜Ì ·Ú·ÙËÚ‹ÛÂȘ ¿ÏÏˆÓ ÂÚ¢ÓËÙÒÓ.
OÈ ÂӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Û‡ÓÙÔÌËÂÈÛ·ÁˆÁ‹, ÂÚÈÁÚ·Ê‹ Ù˘ ÂÚ›ÙˆÛ˘ Î·È ‚Ú·¯Â›· Û˘˙‹ÙËÛË,Ì ¤ÌÊ·ÛË ÛÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË.
T· ˘fiÏÔÈ· ı¤Ì·Ù· ¤¯Ô˘Ó ÂχıÂÚË ‰ÔÌ‹ ηٿ ÙËÓ ÎÚ›ÛËÙˆÓ Û˘ÁÁڷʤˆÓ ÙÔ˘˜.
∂˘¯·ÚÈÛٛ˜ ‹ ·Ó·ÁÓˆÚ›ÛÂȘ (·Ó·ÊÔÚ¿ Û ÂȉÔÙ‹ÛÂȘ-¯Ô-ÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢) ı· Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·ÈÛÙÔ Ù¤ÏÔ˜ ÙÔ˘ ÎÂÈ̤ÓÔ˘ Î·È ÚÈÓ ·fi ÙȘ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·-Ô̤˜.
TÈ̤˜ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛˆÓOÈ ÙÈ̤˜ ÙˆÓ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛÂˆÓ Ú¤ÂÈ Ó· ÂÎÊÚ¿˙Ô-
ÓÙ·È ÛÙÔ ¢ÈÂıÓ¤˜ ™‡ÛÙËÌ· MÔÓ¿‰ˆÓ (SI Units) Î·È ÛÙÔ MÂÙÚÈÎfi(Conventional-™˘Ì‚·ÙÈÎfi) ™‡ÛÙËÌ· ̤۷ Û ·Ú¤ÓıÂÛË. ¶›Ó·-Θ ÌÂÙ·ÙÚÔ‹˜ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÛÙȘ ‰È¢ı‡ÓÛÂȘ:http://www.icmje.org Î·È http://www.icmje.org/icmje.pdf
™˘ÓÙÔÌÔÁڷʛ˜OÈ Û˘ÓÙÔÌÔÁڷʛ˜ Ô˘ ¤¯Ô˘Ó ÂÈ‚ÏËı› ‰ÈÂıÓÒ˜,
‰ËÌÔÛȇÔÓÙ·È Û οı Ù‡¯Ô˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. ™‡ÓıÂÙÔÈ Î·ÈÌ·ÎÚÔÛÎÂÏ›˜ fiÚÔÈ Ô˘ ·ӷϷ̂¿ÓÔÓÙ·È Û˘¯Ó¿ ÛÙÔ Î›ÌÂÓÔÌÔÚÔ‡Ó Ó· ·ÓÙÈηı›ÛÙ·ÓÙ·È ·fi Û˘ÓÙÔÌÔÁڷʛ˜ Ô˘ ÂÂÍË-ÁÔ‡ÓÙ·È ·fi ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ Û ÂȉÈÎfi ηٿÏÔÁÔ, Ô ÔÔ›Ô˜˘Ô‚¿ÏÏÂÙ·È Ì·˙› Ì ÙËÓ ÂÚÁ·Û›·. OÈ Û˘ÓÙÔÌÔÁڷʛ˜ ·Ó·Ê¤-ÚÔÓÙ·È Û ·Ú¤ÓıÂÛË ÌfiÓÔ ÛÙȘ ÂÚÈÏ‹„ÂȘ.
BÈ‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·Ô̤˜™ÙÔ ÙÌ‹Ì· Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜ ηٷ¯ˆÚÔ‡ÓÙ·È fiϘ
ÔÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·Ô̤˜ Ì ÙË ÛÂÈÚ¿ Ô˘ ·Ó·Ê¤ÚÔÓÙ·ÈÛÙÔ Î›ÌÂÓÔ. ™ÙÔ Î›ÌÂÓÔ, ÔÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·Ô̤˜ ·Ó·-ʤÚÔÓÙ·È Ì ·Ú·‚ÈÎÔ‡˜ ·ÚÈıÌÔ‡˜ Û ·Ú¤ÓıÂÛË. OÈ ‚È‚ÏÈÔÁÚ·-ÊÈΤ˜ ·Ú·Ô̤˜ ‰ÂÓ Ú¤ÂÈ Ó· ˘ÂÚ‚·›ÓÔ˘Ó:
ñ ÙȘ 70 ÛÙȘ ·Ó·ÛÎÔ‹ÛÂȘ. ñ ÙȘ 30 ÛÙȘ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜. ñ ÙȘ 12 ÛÙ· ›ηÈÚ· ı¤Ì·Ù· Î·È ÙȘ ÂӉȷʤÚÔ˘Û˜ ÂÚÈ-
ÙÒÛÂȘ. ñ ÙȘ 5 ÛÙȘ ‚Ú·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ Î·È ÙȘ ÂÈÛÙÔϤ˜.
H Û‡ÓÙ·ÍË ÙˆÓ ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·ÔÌÒÓ Á›ÓÂÙ·ÈÛ‡Ìʈӷ Ì ÙȘ ÚfiÛÊ·Ù· ÙÚÔÔÔÈË̤Ó˜ ÚԉȷÁڷʤ˜ Ù˘International Committee of Medical Journal Editors/Uniform Re-quirements for Manuscripts Submitted to Biomedical Journals,(http://www.icmje.org Î·È http://www.icmje.org/icmje.pdf). OÈÛ˘ÓÙÌ‹ÛÂȘ ÙˆÓ Ù›ÙÏˆÓ ÙˆÓ ÂÚÈÔ‰ÈÎÒÓ Á›ÓÔÓÙ·È Ì ‚¿ÛË ÙÔ Cu-mulated Index Medicus [List of Journals Indexed in Index Medicus(http://www.nlm.nih.gov/bsd/uniform_requirements.html)].
¶·Ú·‰Â›ÁÌ·Ù· ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·ÔÌÒÓ
I. ¶∂ƒπO¢π∫∞
AÓ ÔÈ Û˘ÁÁÚ·Ê›˜ Â›Ó·È ¤ˆ˜ ¤ÍÈ, ·Ó·ÁÚ¿ÊÔÓÙ·È fiÏÔÈ, ÂÓÒ ·Ó
Â›Ó·È ÂÙ¿ ‹ ÂÚÈÛÛfiÙÂÚÔÈ, ·Ó·ÁÚ¿ÊÔÓÙ·È ÔÈ ÚÒÙÔÈ ¤ÍÈ Î·È ÚÔ-
ÛÙ›ıÂÙ·È “et al” ‹ “Î·È Û˘Ó”.
T·ÎÙÈ΋ ¤Î‰ÔÛË ÂÚÈÔ‰ÈÎÔ‡:
∞ÓÙˆÓ›Ô˘ ¢, ª¿Ú· Ã, °È·ÓÓ¿ÙÔ˘ Ã. ∂Ì‚fiÏÈ·: ›‰Ú·ÛË
ÛÙËÓ ÂȉËÌÈÔÏÔÁ›· ÙˆÓ ÏÔÈ̈‰ÒÓ ÓÔÛËÌ¿ÙˆÓ Î·È ÙËÓ ·È‰È·-
ÙÚÈ΋ Ú¿ÍË. ¶·È‰È·ÙÚÈ΋ 1999;59:272-279.
Proesmans W. Bartter syndrome and its neonatal variant. Eur
J Pediatr 1997;156:669-679.
™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜ ÂÚÈÔ‰ÈÎÔ‡:
Flyvbjerg A. Role of growth hormone, insulin-like growth fac-
tors (IGFs) and IGF-binding proteins in the renal complications of
diabetes. Kidney Int 1997;52 (60 Suppl):S12-S19.
Èڛ˜ Û˘ÁÁڷʤ·:
National Institutes of Health Consensus Development
Conference. Neurofibromatosis conference statement. Arch
Neurol 1988;45:575-578.
¶ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù‡Ô˘ ¿ÚıÚÔ˘:
Schreiner GF, Lange L. Ethanol modulation of macrophage
influx in glomerulonephritis [Abstract]. J Am Soc Nephrol
1991;2:562.
Should antileukotriene therapies be used instead of inhaled
corticosteroids in asthma? [Editorial]. Am J Respir Crit Care Med
1998;158:1697-1701.
Laux-End R, Inaebnit D, Gerber HA, Bianchetti MG. Vasculi-
tis associated with levamisole and circulating autoantibodies [Let-
ter]. Arch Dis Child 1996;75:355-356.
II. µπµ§π∞
∫ÂÊ¿Ï·ÈÔ Û ‚È‚Ï›Ô:
Clark AG, Barratt TM. Steroid-responsive nephrotic syn-
drome. In: Barratt TM, Arner ED, Harmon WE, editors. Pediatric
Nephrology. 4th ed. Baltimore: Lippincott William Wilkins; 1999.
p. 742.
™‡ÁÁÚ·ÌÌ· ‹ ÌÔÓÔÁÚ·Ê›·:
Gorlin RJ, Cohen MM, Levin LS. Syndromes of the head and
neck. 3rd ed. New York: Oxford University Press; 1990.
¢ËÌÔÛ›Â˘ÛË Û ÙfiÌÔ Ú·ÎÙÈÎÒÓ:
Bauer AW. The two definitions of bacterial resistance. In:
Smith AJ, Rogers CA, eds. Proceedings of the Third International
Congress of Chemotherapy; 1962 May 29-31; New York: Interna-
tional Society of Chemotherapy; 1963. p. 484-500.
¢È‰·ÎÙÔÚÈ΋ ‰È·ÙÚÈ‚‹:
¶··‰fiÔ˘ÏÔ˜ Ã. ∏ ıÂڷ›· ÙÔ˘ ÛÙÚ·‚ÈÛÌÔ‡ [‰È‰·ÎÙÔÚÈ-
΋ ‰È·ÙÚÈ‚‹]. ∞ı‹Ó·: ¶·ÓÂÈÛÙ‹ÌÈÔ ∞ıËÓÒÓ; 1979.
Kaplan SJ. Post hospital home health care: the elderly’s access
and utilization [dissertation]. St. Louis (Mo): Washington Univ.;
1995.
πππ. CD-ROM
Anderson SC, Poulsen KB. Anderson’s electronic atlas of
hematology [CD-ROM]. Philadelphia: Lippincott Williams &
Wilkins; 2002.
xii
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xiii
IV. ™∆O ¢π∞¢π∫∆ÀOÕÚıÚÔ Û ÂÚÈÔ‰ÈÎfi:
Abood S. Quality improvement initiative in nursing homes:the ANA acts in an advisory role. Am J Nurs [Internet]. 2002 Jun:Webpage:http://www.nursingworld.org/AJN/2002/june/Wawatch.htm
ªÔÓÔÁÚ·Ê›·:Foley KM, Gelband H, editors. Improving palliative care for
cancer [Monograph, Internet]. Washington: National AcademyPress; 2001. Webpage: http://www.nap.edu/books/0309074029/html
πÛÙÔÛÂÏ›‰Â˜:Cancer-Pain.org [Webpage, Internet]. New York: Association
of Cancer Online Resources, Inc.; 2002: http://www.cancer-pain.org/
¶›Ó·Î˜ Î·È EÈÎfiÓ˜AÔÛÙ¤ÏÏÔÓÙ·È ÂȘ ÙÚÈÏÔ‡Ó (¤Ó· ÚˆÙfiÙ˘Ô Î·È ‰‡Ô ʈÙÔ-
·ÓÙ›ÁÚ·Ê·). ¶Ú¤ÂÈ Ó· ¤¯Ô˘Ó Ï¿ÙÔ˜ ›ÛÔ Ì ÙÔ Ï¿ÙÔ˜ ÙÔ˘ ÌÔ-ÓfiÛÙËÏÔ˘ (7,5 cm) ‹ Ì ÙÔ Ï¿ÙÔ˜ fiÏ˘ Ù˘ ÛÂÏ›‰·˜ (15,5 cm).TÔ Ì¤ÁÈÛÙÔ Ì‹ÎÔ˜ ÙÔ˘˜, Ì·˙› Ì ÙÔ˘˜ Ù›ÙÏÔ˘˜, ‰ÂÓ Ú¤ÂÈ Ó· ›-Ó·È ÂÚÈÛÛfiÙÂÚÔ ·fi 22 cm.
OÈ ›Ó·Î˜ ·ÚÈıÌÔ‡ÓÙ·È Ì ·Ú·‚ÈÎÔ‡˜ ·ÚÈıÌÔ‡˜ Ì ÙË ÛÂÈÚ¿Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÔ Î›ÌÂÓÔ. ¶ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ‚Ú·¯‡ Ù›ÙÏÔ Î·ÈÂÂÍ‹ÁËÛË ÙˆÓ Û˘ÓÙÌ‹ÛÂˆÓ ÛÙÔ Î¿Ùˆ ̤ÚÔ˜. ™ÙÔ˘˜ ›Ó·Î˜ڤÂÈ Ó· ·ÔʇÁÔÓÙ·È ÔÈ Î¿ıÂÙ˜ ÁÚ·Ì̤˜.
ŸÏÔ ÙÔ ·ÂÈÎÔÓÈÛÙÈÎfi ˘ÏÈÎfi (Û¯‹Ì·Ù·, ‰È·ÁÚ¿ÌÌ·Ù·, ʈÙÔ-Áڷʛ˜, Î.Ï.) ̄ ·Ú·ÎÙËÚ›˙ÂÙ·È ̂ ˜ ÂÈÎfiÓ˜ Î·È ı· Ú¤ÂÈ Ó· ›ӷȿÚÈÛÙ˘ ÔÈfiÙËÙ·˜. ™ÙÔ ›Ûˆ ̤ÚÔ˜ ÙˆÓ ÂÈÎfiÓˆÓ Ú¤ÂÈ Ó· ÛË-ÌÂÈÒÓÂÙ·È Ì ÌÔχ‚È Ô ·ÚÈıÌfi˜ Ù˘ ÂÈÎfiÓ·˜ Î·È ÙÔ fiÓÔÌ· ÙÔ˘ÚÒÙÔ˘ Û˘ÁÁڷʤ·, ηıÒ˜ Î·È ¤Ó· ‚¤ÏÔ˜, ÙÔ ÔÔ›Ô Ó· ‰Â›¯ÓÂÈ ÙÔ¿Óˆ ̤ÚÔ˜ Ù˘ ÂÈÎfiÓ·˜. ™ÙȘ ʈÙÔÁڷʛ˜ ·ÛıÂÓÒÓ ‰ÂÓ Ú¤ÂÈÓ· ·Ó·ÁÓˆÚ›˙ÂÙ·È Ë Ù·˘ÙfiÙËÙ¿ ÙÔ˘˜. OÈ ·ÛıÂÓ›˜ ‰ÂÓ Ú¤ÂÈ Ó··Ó·Ê¤ÚÔÓÙ·È ÔÓÔÌ·ÛÙÈο.
°. ÀÔ‚ÔÏ‹ Î·È ¢ËÌÔÛ›Â˘ÛË ÙˆÓ ∂ÚÁ·ÛÈÒӟϘ ÔÈ ÂÚÁ·Û›Â˜ Ú¤ÂÈ Ó· ˘Ô‚¿ÏÏÔÓÙ·È ÂȘ ÙÚÈÏÔ‡Ó Î·È
Ó· Û˘Óԉ‡ÔÓÙ·È ·fi ‰ÈÛΤٷ ‹ CD, ηıÒ˜ Î·È ·fi ÂÈÛÙÔÏ‹, ËÔÔ›· ı· Û˘Ó˘ÔÁÚ¿ÊÂÙ·È ·fi fiÏÔ˘˜ ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜, ÛÙËÓÔÔ›· ı· ‰ËÏÒÓÂÙ·È fiÙÈ Ë ÂÚÁ·Û›· ‰ÂÓ ¤¯ÂÈ ÂÓ Ì¤ÚÂÈ ‹ ÂÍ ÔÏÔÎÏ‹-ÚÔ˘ ‰ËÌÔÛÈ¢ı› ‹ ˘Ô‚ÏËı› ÁÈ· ÎÚ›ÛË Û ¿ÏÏÔ ÂÚÈÔ‰ÈÎfi ηÈfiÙÈ ÔÈ Û˘ÁÁÚ·Ê›˜ ÂÁÎÚ›ÓÔ˘Ó ÙË ‰ËÌÔÛ›Â˘Û‹ Ù˘ ÛÙÔ ÂÚÈÔ‰ÈÎfi“¶·È‰È·ÙÚÈ΋”. ∂ÈϤÔÓ, ı· Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È Ù˘¯fiÓ ÂÈ-‰ÔÙ‹ÛÂȘ-¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢.
EÊfiÛÔÓ Ë ÂÚÁ·Û›· Á›ÓÂÈ ·Ô‰ÂÎÙ‹, ÙÔ ‰ÈÔÚıˆÌ¤ÓÔ Û‡ÌʈӷÌ ÙȘ ˘Ô‰Â›ÍÂȘ ÙˆÓ ÎÚÈÙÒÓ Î·È ÂÎ Ó¤Ô˘ ‰·ÎÙ˘ÏÔÁÚ·ÊË̤ÓÔΛÌÂÓÔ Ú¤ÂÈ Ó· ˘Ô‚¿ÏÂÙ·È ÛÙË ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹, Û˘ÓÔ-‰Â˘fiÌÂÓÔ ·fi ‰ÈÛΤٷ ‹ CD Ô˘ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ÂÚÁ·Û›·Û ÚfiÁÚ·ÌÌ· Word, ηıÒ˜ Î·È ÂÈÛÙÔÏ‹ fiÔ˘ Ó· ·Ó·Ê¤ÚÔÓÙ·È·Ó·Ï˘ÙÈο ÔÈ ÙÚÔÔÔÈ‹ÛÂȘ ‹ ÔÈ ·ÓÙÈÚÚ‹ÛÂȘ ÛÙȘ ÚÔÙ¿ÛÂÈ˜ÙˆÓ ÎÚÈÙÒÓ.
H ηı˘ÛÙ¤ÚËÛË Ù˘ ·ӢԂÔÏ‹˜ ÙÔ˘ ÙÚÔÔÔÈË̤ÓÔ˘ÎÂÈ̤ÓÔ˘ ¤Ú·Ó ÙˆÓ 30 ËÌÂÚÒÓ Û˘Ó¿ÁÂÙ·È Ó¤· ˘Ô‚ÔÏ‹.
T· ¤ÍÔ‰· ÙˆÓ ÊÈÏÌ Î·È ÙˆÓ ·Ó·Ù‡ˆÓ ‚·Ú‡ÓÔ˘Ó ÙÔ˘˜ Û˘Á-ÁÚ·Ê›˜ Î·È Ú¤ÂÈ Ó· ÏËÚÒÓÔÓÙ·È Ì ÙËÓ ·ÔÛÙÔÏ‹ ÙÔ˘ ÚÒ-ÙÔ˘ ‰ÔÎÈÌ›Ô˘ ηÙ¢ı›·Ó ÛÙÔÓ Ù˘ÔÁÚ¿ÊÔ.
T· ΛÌÂÓ· ÙˆÓ ÂÚÁ·ÛÈÒÓ Ô˘ ‰ÂÓ Á›ÓÔÓÙ·È ·Ô‰ÂÎÙ¤˜ ÁÈ·‰ËÌÔÛ›Â˘ÛË, ‰ÂÓ ÂÈÛÙÚ¤ÊÔÓÙ·È. MÔÚ› Ó· ÂÈÛÙÚ·ÊÔ‡Ó, ÂÊfi-ÛÔÓ ˙ËÙËı› ÂÓÙfi˜ ÂÍ·Ì‹ÓÔ˘, Ù· Û¯‹Ì·Ù· Î·È ÔÈ ÊˆÙÔÁÚ·Ê›Â˜Ô˘ Ù· Û˘Óԉ‡ԢÓ.
OÈ ÂÚÁ·Û›Â˜ Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È ÚÔ˜ ÎÚ›ÛË ÁÈ· ‰ËÌÔÛ›Â˘ÛËÛÙÔ ÂÚÈÔ‰ÈÎfi “¶·È‰È·ÙÚÈ΋” ·ÔÛÙ¤ÏÏÔÓÙ·È ÂȘ ÙÚÈÏÔ‡Ó ÛÙˉȇı˘ÓÛË:
™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹, EÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ EÙ·ÈÚ›·Mȯ·Ï·ÎÔÔ‡ÏÔ˘ 92, 115 28 Aı‹Ó·
¶ÚÈÓ ·ÔÛÙ›ÏÂÙ ÙËÓ ÂÚÁ·Û›· Û·˜, ‚‚·Èˆı›Ù fiÙÈ ÂÚÈ-Ï·Ì‚¿ÓÂÈ:
1. 3 ·ÓÙ›ÁÚ·Ê· ÙÔ˘ ÎÂÈ̤ÓÔ˘ Ù˘ ÂÚÁ·Û›·˜, Ù˘ˆÌ¤Ó· Û‡Ì-ʈӷ Ì ÙȘ Ô‰ËÁ›Â˜.
2. ¢ÈÛΤٷ ‹ CD Ì fiÏÔ ÙÔ ˘ÏÈÎfi Ù˘ ÂÚÁ·Û›·˜ (ΛÌÂÓÔ, ›Ó·Î˜, ÂÈÎfiÓ˜).
3. ∂ÈÛÙÔÏ‹ ˘Ô‚ÔÏ‹˜ Î·È ‰‹ÏˆÛË ÌË ÚÔÁÂÓ¤ÛÙÂÚ˘ ‰ËÌÔ-Û›Â˘Û˘ Ù˘ ÂÚÁ·Û›·˜.
4. ™ÂÏ›‰· Ù›ÙÏÔ˘ (¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) ÂÚÈÏ·Ì‚¿ÓÂÈ: ·.Ù›ÙÏÔ Î·È ‚Ú·¯‡ Ù›ÙÏÔ ÂÚÁ·Û›·˜ ‚.fiÓÔÌ· Î·È ÂÒÓ˘ÌÔ Û˘ÁÁڷʤˆÓ (ÔÏÔÁڿʈ˜) Á. ÂÈÛÙËÌÔÓÈÎfi/¿ ΤÓÙÚÔ/· fiÔ˘ ¤ÁÈÓÂ Ë ÂÚÁ·Û›· ‰.fiÓÔÌ·, ‰È‡ı˘ÓÛË Î·È ÙËϤʈÓÔ Û˘ÁÁڷʤ· ÁÈ· ·ÏÏËÏÔ-
ÁÚ·Ê›·. 5. ¶ÂÚ›ÏË„Ë ÂÏÏËÓÈ΋-·ÁÁÏÈ΋, ‰ÔÌË̤ÓË ÛÙȘ ÂÍ‹˜ ·Ú·-
ÁÚ¿ÊÔ˘˜: ÂÈÛ·ÁˆÁ‹, ̤ıÔ‰ÔÈ, ·ÔÙÂϤÛÌ·Ù· Î·È Û˘ÌÂÚ¿-ÛÌ·Ù·, ηıÒ˜ Î·È Ï¤ÍÂȘ ÎÏÂȉȿ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈ-ÛÙ‹ ÛÂÏ›‰·).
6. ∫·Ù¿ÏÔÁÔ Û˘ÓÙÔÌÔÁÚ·ÊÈÒÓ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ÛÂÏ›‰·).
7. ∫›ÌÂÓÔ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·).8. ∂˘¯·ÚÈÛٛ˜ ‹ ·Ó·ÁÓˆÚ›ÛÂȘ (·Ó·ÊÔÚ¿ Û ÂȉÔÙ‹ÛÂȘ-¯Ô-
ÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢).9. µÈ‚ÏÈÔÁÚ·Ê›· (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·).
10. ¶›Ó·Î˜ (Ô Î·ı¤Ó·˜ Û ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) ÂȘ ÙÚÈÏÔ‡Ó.11. ∂ÈÎfiÓ˜, Ì ‚¤ÏÔ˜ ÛÙÔ ›Ûˆ ̤ÚÔ˜, ÙÔ ÔÔ›Ô Ó· ‰Â›¯ÓÂÈ
ÚÔ˜ Ù· ¿ӈ, ·ÚÈıÌË̤Ó˜, ÂȘ ÙÚÈÏÔ‡Ó.12. ∆›ÙÏÔ˘˜ ÂÈÎfiÓˆÓ (‰ÈÏfi ‰È¿ÛÙËÌ· - Ô Î·ı¤Ó·˜ Û ¯ˆÚÈÛÙ‹
ÛÂÏ›‰·) ÂȘ ÙÚÈÏÔ‡Ó.
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·13
xiv ™À¡∆√ª√°ƒ∞ºπ∂™ ABBREVIATIONS
Ao
angstrom angstromcal ıÂÚÌ›‰· caloriecm ÂηÙÔÛÙfi centimetercm2 ÙÂÙÚ·ÁˆÓÈÎfi ÂηÙÔÛÙfi square centimetercm3 ΢‚ÈÎfi ÂηÙÔÛÙfi cubic centimeteroC ‚·ıÌfi˜ ∫ÂÏÛ›Ô˘ degree Celsiusg ÁÚ·ÌÌ¿ÚÈÔ gramh ÒÚ· hourIU ‰ÈÂıÓ‹˜ ÌÔÓ¿‰· international unitkg ¯ÈÏÈfiÁÚ·ÌÌÔ kilograml Ï›ÙÚÔ literm ̤ÙÚÔ metermg ¯ÈÏÈfiÁÚ·ÌÌÔ milligrammin ÏÂÙfi minutemm ¯ÈÏÈÔÛÙfiÌÂÙÚÔ millimetermol ÁÚ·ÌÌÔÌfiÚÈÔ molen ·ÚÈıÌfi˜ numberNS ‹ ª™ ÌË ÛËÌ·ÓÙÈÎfi not significantosm ÔÛÌÒÏÈÔ osmole
p Èı·ÓfiÙËÙ· probabilitySD ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË standard deviationSE ÛÙ·ıÂÚfi ÛÊ¿ÏÌ· standard errorsec ‰Â˘ÙÂÚfiÏÂÙÔ secondU ÌÔÓ¿‰· unit
™˘Ó‰˘·˙fiÌÂÓ· ÚÔı¤Ì·Ù· Combining prefixes
tera- (1012) Tgiga- (109) Gmega- (106) Mkilo- (103) khector- (102) hdeca- (101) dadeci- (10-1) dcenti- (10-2) cmilli- (10-3) mmicro- (10-6) Ìnano- (10-9) npico- (10-12) pfemto- (10-15) fatto- (10-18) a
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·14
xvINSTRUCTIONS TO AUTHORS
A. General InformationThe Greek Paediatric Society is the owner of “Paediatri-
ki”, its official scientific journal, which is distributed to its
members. Its objectives are the publication of paediatric
scientific work and the continuing education of paediatri-
cians. For this purpose, it publishes a variety of articles, and
in particular:
1. Editorials (upon invitation by the Editorial Board).
2. Review articles.
3. Award-winning articles.
4. Original articles.
5. Clinical Quiz.
6. Round tables.
7. Current issues.
8. Issues of healthcare management and education.
9. Case reports.
10. News.
11. Brief reports.
12. Letters to the editor.
13. Abstracts.
14. Future congresses and events.
15. Book reviews.
The Editorial Board reserves the right to publish articles
of special scientific interest and articles on current issues
without observing submission order. In addition, it publish-
es upon decision original papers presented at the Annual
Paediatric Conference, presentations of special interest - in
whole or in part, and letters - in whole or in part - referring
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Regarding papers on current issues, the author’s request
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tives according to the Declarations of Helsinki and Tokyo.
In addition, the US National Institute of Health guide for
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NIH, 80-23) should have been observed. Clinical trials
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Authors’ opinions and conclusions expressed in the pub-
lished papers do not necessarily reflect those of the journal.
The Greek Paediatric Society, the Editorial Board and the
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tent of the advertisements appearing in the journal.
The copyright of all published papers is held by “Paedia-
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B. Manuscript Preparation“Paediatriki” suggests compliance with the “Uniform
Requirements for Manuscripts Submitted to Biomedical
Journals”, recently modified and published on the web-
sites:
http://www.icmje.org and http://www.icmje.org/icmje.pdf
The entire paper (including figure legends and tables)
should be typed on one side of blank paper format A4(21x29.7 cm), double line spacing and minimum indent 2.5cm on both sides.
The paper should have the following structure: title page,short title, abstract in Greek and English, list of abbrevia-tions, text, acknowledgements and quoting of grants, spon-sorships or other financial support sources, references, ta-bles, figures, figure legends. Each of these sections should bestarted on a new page. Pages should be numbered consecu-tively, beginning with the title page.
Text length shall be: ñ review articles 2000-3000 words;ñ original articles 1500-2500 words and case reports
1000-1500 words; ñ brief reports 1000-1500 words; ñ letters 250-500 words.
The title page should include:ñ the title (<14 words) and the short title (<5 words) of
the article. No abbreviations are permitted in the title;ñ the name and surname of all authors; ñ the centre (institution, clinic, laboratory) of origin of the
paper. If there is no affiliation with a specific centre, thestatus of the author(s) should be cited (e.g., private pae-diatrician) and home address;
ñ the complete address, e-mail and telephone number of theauthor to whom correspondence should be addressed.
Abstracts
The abstract should summarize the objectives, method-ology, main results and conclusions of the study.
ñ It should contain at least 200 words, and not exceed 250words.
ñ It should consist of the following paragraphs: back-ground, methods, results and conclusions.
The English abstract should cite at the beginning the ti-tle of the paper and the authors’ names in English. The con-tent of the text should consist of the following paragraphs:background, methods, results and conclusions. The abstractin English should not differ in content from the correspond-ing Greek abstract.
Beneath the Greek and English abstracts, three to five key
words in the respective language should be supplied, to beused in the thematic index.
Text
Original articles include: introduction, methods, resultsand discussion. The introduction includes the latest researchdata on the subject and the main references and the objec-tives of the paper. The description of the methods should beprecise and detailed so as to enable reproduction by other re-searchers. In addition, the statistical methods of analysis andevaluation of the results should be described. Results shouldbe presented clearly, together with the appropriate statisticalanalysis. Discussion should cover the results ensuing fromthe research, their significance and possible associations withthe observations of other researchers.
Case reports comprise a short introduction, case de-scription and brief discussion, with emphasis on differentialdiagnosis.
The structure of all other articles is free, according to thejudgment of the authors.
Thanks or acknowledgements (reference to grants, spon-sorships or other sources of financial support) should bequoted at the end of the text, before references.
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xvi
Units of measures of laboratory analysesLaboratory analyses should be expressed in the Système In-
ternational (SI) units and in the metric (Conventional) system inparentheses. See conversion tables on the websites: http://www.icmje.org and http://www.icmje.org/icmje.pdf
AbbreviationsAll issues of the journal contain internationally established ab-
breviations. Complex or long terms often repeated in the text maybe replaced by abbreviations explained by the authors in a list sub-mitted with the paper. Abbreviations are reported in parenthesesonly in abstracts.
ReferencesThe reference section contains all references numbered in the
order in which they appear in the text. In the text, references are tobe indicated by Arabic numerals in parentheses. References shouldbe no more than:
ñ 70 in review articles; ñ 30 in original articles; ñ 12 in current issues and case reports; ñ 5 in brief reports and letters.
In listing references follow the recently modified standards ofthe International Committee of Medical Journal Editors/UniformRequirements for Manuscripts Submitted to Biomedical Journals,(http://www.icmje.org and http:// www.icmje.org/icmje.pdf). Ab-breviated names of journals should conform to the Cumulated In-dex Medicus [List of Journals Indexed in Index Medicus (http://www.nlm.nih.gov/bsd/uniform_requirements.html)].
Examples of reference style
I. JOURNALSAll authors are cited if they are six or less; if they are 7 or more,
the first six are cited, followed by “et al”.
Regular edition:Proesmans W. Bartter syndrome and its neonatal variant. Eur
J Pediatr 1997;156:669-679.
Supplement issue:Flyvbjerg A. Role of growth hormone, insulin-like growth fac-
tors (IGFs) and IGF-binding proteins in the renal complications ofdiabetes. Kidney Int 1997;52 (60 Suppl):S12-S19.
No author:National Institutes of Health Consensus Development Con-
ference. Neurofibromatosis conference statement. Arch Neurol1988;45:575-578.
Article type specification:Schreiner GF, Lange L. Ethanol modulation of macrophage in-
flux in glomerulonephritis [Abstract]. J Am Soc Nephrol 1991;2:562.
Should antileukotriene therapies be used instead of inhaledcorticosteroids in asthma? [Editorial]. Am J Respir Crit Care Med1998;158:1697-1701.
Laux-End R, Inaebnit D, Gerber HA, Bianchetti MG. Vasculi-tis associated with levamisole and circulating autoantibodies [Let-ter]. Arch Dis Child 1996;75:355-356.
II. BOOKSChapter in book:
Clark AG, Barratt TM. Steroid-responsive nephrotic syndrome.
In: Barratt TM, Arner ED, Harmon WE, editors. PediatricNephrology. 4th ed. Baltimore: Lippincott William Wilkins; 1999.p. 742.
Book or monograph:Gorlin RJ, Cohen MM, Levin LS. Syndromes of the head and
neck. 3rd ed. New York: Oxford University Press; 1990.
Publication in a volume of proceedings:Bauer AW. The two definitions of bacterial resistance. In:
Smith AJ, Rogers CA, eds. Proceedings of the Third InternationalCongress of Chemotherapy; 1962 May 29-31; New York: Interna-tional Society of Chemotherapy; 1963. p. 484-500.
Doctoral dissertation:Kaplan SJ. Post hospital home health care: the elderly’s access
and utilization [dissertation]. St. Louis (Mo): Washington Univ.;1995.
πππ. CD-ROMAnderson SC, Poulsen KB. Anderson’s electronic atlas of
hematology [CD-ROM]. Philadelphia: Lippincott Williams &Wilkins; 2002.
IV. ON THE INTERNETArticle in journal
Abood S. Quality improvement initiative in nursing homes: theANA acts in an advisory role. Am J Nurs [Internet]. 2002 Jun: Web-page: http://www.nursingworld.org/ AJN/2002/june/Wawatch.htm
MonographFoley KM, Gelband H, editors. Improving palliative care for
cancer [Monograph, Internet]. Washington: National AcademyPress; 2001. Webpage: http://www.nap.edu/books/0309074029/html
WebsitesCancer-Pain.org [Webpage, Internet]. New York: Association
of Cancer Online Resources, Inc.; 2002: http://www.cancer-pain.org/
Tables and FiguresThree copies should be submitted (original plus 2 copies).
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Tables are numbered with Arabic numerals in the order inwhich they appear in the text. They should have a short title andabbreviations should be listed at the bottom. Vertical lines in tablesshould be avoided.
All illustration material is considered as figures (graphs, pic-tures, etc.). They should be of excellent quality. Also, at the back ofevery picture, the number of the picture and the name of the firstauthor should be noted in pencil, with an arrow showing the top ofthe picture. The identity of patients should not be recognizablefrom their pictures nor should their names be stated.
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Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·16
Once the manuscript has been accepted, the corrected version,rewritten according to the reviewers’ recommendations, should besubmitted to the Editorial Board accompanied by a floppy disk orCD, containing the paper in Word format, along with a coveringletter specifying in detail the modifications or objections to the re-viewers’ suggestions.
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Authors will be charged film and reprint expenses, paid upondispatch of the first proof directly to the printer.
Manuscripts of papers, which have not been approved for pub-lication, are not returned to the author. The accompanying figuresand photographs can be returned upon request within six months.
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Before submitting your paper, make sure it contains:1. 3 copies of the text of the paper, printed according to instruc-
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4. The title page (on a separate page), which includes: a. the title and short title of the paper; b. the name and surname (full name) of the author(s); c. the academic centre(s) of origin; d. the corresponding authors’ name, address and telephone
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10. Tables (one per page) in three copies.11. Figures with an arrow at the back showing the top, numbered,
in two copies.12. Figure titles (double space - on separate pages) in three
copies.
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Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·17
xviii ∂¶π™∆√§∏ ∞¶√ ∆∏ ™À¡∆∞•∏ EDITORIAL
Paediatriki 2007;70:18-000
∞Á·ËÙÔ› Û˘Ó¿‰ÂÏÊÔÈ,
∂Π̤ÚÔ˘˜ Ù˘ ™˘ÓÙ·ÎÙÈ΋˜ ∂ÈÙÚÔ‹˜ Ù˘ “¶·È‰È·ÙÚÈ΋˜” Û·˜ ‡¯ÔÌ·È Â˘Ù˘¯ÈṲ̂ÓÔ, ‰ËÌÈÔ˘Ú-ÁÈÎfi Î·È Ì ˘Á›· ÙÔ 2008.
ªÂ ÙËÓ Â˘Î·ÈÚ›· ·˘Ù‹, ı· ı¤Ï·Ì ӷ ¢¯·ÚÈÛÙ‹ÛÔ˘Ì fiÛÔ˘˜ Û˘ÓÂÈÛ¤ÊÂÚ·Ó ÛÙËÓ ÂÈÙ˘¯›· ÙÔ˘ÂÚÈÔ‰ÈÎÔ‡. ∆ÔÓ ÙÂÏÂ˘Ù·›Ô ¯ÚfiÓÔ, Ô ·ÚÈıÌfi˜ ÙˆÓ ÂÚÁ·ÛÈÒÓ Ô˘ ˘Ô‚Ï‹ıËÎ·Ó ÛÙËÓ “¶·È‰È·ÙÚÈ΋”·˘Í‹ıËΠÛËÌ·ÓÙÈο Û ۯ¤ÛË Ì ٷ ÚÔËÁÔ‡ÌÂÓ· ¯ÚfiÓÈ·. ∞˘Ùfi Ì·˜ ¤‰ˆÛ ÙËÓ Â˘Î·ÈÚ›· Ó· ‚ÂÏ-ÙÈÒÛÔ˘Ì ٷ ÔÈÔÙÈο ÎÚÈÙ‹ÚÈ· Î·È ÔÈ ‰ËÌÔÛȇÛÂȘ Ó· Â›Ó·È ‰ÈÂıÓÔ‡˜ ·ÚÔ˘˜.
∏ ËÏÂÎÙÚÔÓÈ΋ ˘Ô‚ÔÏ‹ Î·È Ë ÂΉÔÙÈ΋ ‰ÈÂÎÂÚ·›ˆÛË ÙˆÓ ÂÚÁ·ÛÈÒÓ Â›¯·Ó ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙËÓÂÈÙ¿¯˘ÓÛË Ù˘ ÎÚ›Û˘ Î·È Ù˘ ‰ËÌÔÛ›Â˘Û‹˜ ÙÔ˘˜. §ÂÙÔ̤ÚÂȘ ÁÈ· ÙËÓ ËÏÂÎÙÚÔÓÈ΋ ˘Ô‚ÔÏ‹ ÂÚ-Á·ÛÈÒÓ ı· ‚Ú›Ù ÛÙȘ “√‰ËÁ›Â˜ ÚÔ˜ ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜”. °È· Ó· ÂÍÔÈÎÔÓÔÌËı› ¯ÒÚÔ˜ ÛÙÔ ÂÚÈÔ‰È-Îfi, ÔÈ Ô‰ËÁ›Â˜ ·˘Ù¤˜ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÌfiÓÔ ÛÙÔ ÚÒÙÔ Ù‡¯Ô˜ οı ¯ÚfiÓÔ˘ Î·È ÛÙËÓ ÈÛÙÔÛÂÏ›‰·Ù˘ “¶·È‰È·ÙÚÈ΋˜”. ™·˜ ˘ÂÓı˘Ì›˙Ô˘Ì fiÙÈ ÌÔÚ›Ù ӷ ‚Ú›Ù ÙȘ ‰ËÌÔÛȇÛÂȘ Ù˘ “¶·È‰È·ÙÚÈ-΋˜” ¯ˆÚ›˜ ¯Ú¤ˆÛË ÛÙËÓ ÈÛÙÔÛÂÏ›‰· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ (http://www.paediatriki.edu.gr).
™Ù· ÂfiÌÂÓ· Ù‡¯Ë ı· Û˘Ó¯›ÛÔ˘ÌÂ, ·Ú¿ÏÏËÏ· Ì ÙË ‰ËÌÔÛ›Â˘ÛË ÂÚ¢ÓËÙÈÎÒÓ ÂÚÁ·ÛÈÒÓ, ÙˉËÌÔÛ›Â˘ÛË ·Ó·ÛÎÔ‹ÛÂˆÓ Ì ÂÚˆÙ‹ÛÂȘ ÔÏÏ·ÏÒÓ ··ÓÙ‹ÛˆÓ, ÙˆÓ “™‡ÓÙÔÌˆÓ ·È‰È·ÙÚÈÎÒÓÓ¤ˆÓ” Ì ۯÔÏÈ·ÛÌfi ÚfiÛÊ·ÙˆÓ ÂÚÁ·ÛÈÒÓ ∂ÏÏ‹ÓˆÓ ÂÚ¢ÓËÙÒÓ ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›·, ηıÒ˜Î·È ÓÂfiÙÂÚˆÓ ·fi ·È‰È·ÙÚÈο Û˘Ó¤‰ÚÈ· Î·È ·fi ÙÔ ‰È·‰›ÎÙ˘Ô. ¶ÂÚÈ̤ÓÔ˘Ì ÂÚˆÙ‹Ì·Ù· Ô˘ Û·˜··Û¯ÔÏÔ‡Ó ÛÙËÓ Î·ıËÌÂÚÈÓ‹ ÎÏÈÓÈ΋ Ú¿ÍË. ∆· ÂÚˆÙ‹Ì·Ù· ·˘Ù¿ ı· ·ÔÙÂϤÛÔ˘Ó Ù· ı¤Ì·Ù· ÁÈ·ÙË Ó¤· ÛÂÈÚ¿ ¿ÚıÚˆÓ: “ƒˆÙ‹ÛÙ ÙÔÓ ÂȉÈÎfi”.
∆¤ÏÔ˜, Û·˜ ˘ÂÓı˘Ì›˙Ô˘Ì fiÙÈ ı· Ú¤ÂÈ Ó· ‰ËÏÒÓÂÙ·È ÛÙȘ ÂÚÁ·Û›Â˜ Ô˘ ˘Ô‚¿ÏÏÂÙ οı È-ı·Ófi ·ÓÙÈÎÚÔ˘fiÌÂÓÔ Û˘ÌʤÚÔÓ, fiˆ˜ ¤¯ÂÈ ‰ÈÂıÓÒ˜ ηıÈÂÚˆı›.
ªÂ ıÂÚÌÔ‡˜ ¯·ÈÚÂÙÈÛÌÔ‡˜,
∫ˆÓÛÙ·ÓÙ›ÓÔ˜ I. ™ÙÂÊ·Ó›‰Ë˜¢È¢ı˘ÓÙ‹˜ ™‡ÓÙ·Í˘
Dear colleagues,
On behalf of the Editorial Board of “Paediatriki”, I wish you a happy, creative and healthy 2008.On this occasion, we would like to thank all who have contributed to the success of the journal.
Submissions to the journal increased significantly during the past year. This gave us the opportunityto further improve the quality standards to achieve a world-class level.
The submission of papers by e-mail and the electronic handling of the editorial processcontributed so as to shorten the time to access the important information our articles provide.Detailed information about the submission of articles is included in the “Instructions to authors” ofthis issue. To save space, you will find the “Instructions to authors” only in the first issue of each yearand at the web page of the journal. In addition, we would like to remind you that you can find the pastpublications free of charge at the web page of the journal (http://www.paediatriki.edu.gr).
In the next issues we will continue, additionally to the original research studies, the publication ofContinuing Medical Education papers with multiple choice questions, the “Paediatric news in brief” withcomments on recent pediatric articles of Greek researchers, as well as brief information on news fromCongresses, Seminars and from the Internet. Also, we would like to invite you to send us questions that arisefrom your every day practice. These questions will become the topics of the new section: “Ask the expert”.
Finally, we remind that authors are required to declare any possible conflict of interest.
Warm greetings,
Constantinos J. Stefanidis, M.D., Ph.D.Editor-in-Chief
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·18
New Methods and Trends in Paediatric Education.
Undergraduate Training
K. Sostmann, J. Hoeffe, S. Mueller, H. Krude, G. Gaedicke
Abstract: According to the most recent amendment to medical training in Germany, lessons in the formof lectures have been reduced considerably in favour of practical instruction and bedside teaching in smallgroups. Because of these changes, it became necessary to develop a new concept for paediatricundergraduate training. The faculty introduced the learning management system Blackboard© as aplatform for providing scripts, videos, slides, and podcasts of all paediatric lectures. The students use thismaterial to prepare for their practical training. A blended learning scenario was chosen to support bedsideteaching with E-learning-elements under the supervision of tutors. During their self-study time studentsare provided with paediatric virtual patients for learning about cases that cannot be shown during wardrounds. E-tutors are available at the disposal of the students. In addition, the students have theopportunity to attend regular lectures during which case studies derived from the most important clinicalpaediatric fields are discussed. An audience response system, Mobi-Ted©, is used, which allows students toinput questions into an auditory monitor and to get back the individual answer electronically. The resultsare immediately evaluated and presented on the screen to the audience, and can thus be interpreted anddiscussed interactively. This makes learning easy and discussions more fruitful. Making European HigherEducation a “world quality reference” is a very ambitious goal for the year 2010. The Bologna process isan exciting development for undergraduate medical training and the widespread use of moderncomputer-based technologies will become mandatory for academic teaching.
Key words: Paediatric undergraduate training, blended learning, E-learning, trends in medical education,
education technology, interactive learning.
1REVIEW ARTICLE ∞¡∞™∫√¶∏™∏
Charité-UniversitaetsmedizinBerlin, Campus Virchow-Klinikum
Correspondence:
Prof. Dr. Gerhard [email protected] Klinik für AllgemeinePaediatrie undArbeitsbereich/ProjektELWIS-MEDCharité UniversitaetsmedizinBerlin,Campus Virchow Augustenburgerplatz 1,133 53 Berlin
¶·È‰È·ÙÚÈ΋ 2008;71:1-4
Introduction
“I hear - I forget I see - I rememberI do - I understand”This 4000 year-old Chinese proverb has been
translated into English but never into German. Itcontains information that has been demonstratedby recent studies. A lecture alone is not a very effec-tive method for transferring knowledge. To learneffectively we need to open other channels for in-formation transfer (ears, eyes, senses) as well. Thisis particularly necessary because modern medicalcurricula are no longer knowledge-based alone, butalso demand development of the students’ compe-tence and skills. At present the Charité, MedicalFaculty of Berlin (Figure 1), is in a state of transi-tion. It runs a conventional curriculum (600 stu-dents per year), which has recently been amendedby law, and a reformed curriculum (63 studentsper year), which represents a field of experimenta-tion and development of new methodologies inteaching, learning and assessment.
Lectures: Past and present situations
The process of teaching medicine by lectureshas largely remained unchanged during the lasthundred years. In clinical lectures for students,
the live demonstration of patients is still a key ele-ment. Although the methods of presenting datahave been considerably refined by the introduc-tion of computer programmes, it is easy to seethat the mediation of knowledge in lectures fol-lows the same pattern as if data and facts had beenwritten on a blackboard. One advantage of lec-tures is the instruction of a large number of stu-dents by a single lecturer (Figure 2). Proponentsof this method say this would make a lecture eco-nomically attractive. But is this really the case? Ofcourse a skilled teacher can act as a role model for
Figure 1. Charité, Medical Faculty of Berlin.
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·1
the students. These examples, however, are rare. We allhave been taught by such leaders in their field, but findthat most lecturers do not meet up our expectations (1).
The popularity of clinical lectures has steadily de-creased during the last two decades among students inGermany. They would describe this type of learningclinical medicine as being outdated. This fact is re-flected by the very low attendance, with less than 10%of students in a class attending clinical lectures regu-larly. The reasons given for this phenomenon vary:
1. Lectures are unsuitable for teaching clinicalskills and knowledge
2. Exercises, seminars and examinations require asignificant time investment
3. Students must work to earn a living4. Students have family obligationsA description follows of the ways being introduced
for dealing with the new requirements of teachingclinical medicine to undergraduate medical students.
Reinvention of lectures
This mode of pedagogical practice seeks to bridgethe gap between theory-based instruction on the onehand and practical application on the other. It requiresthe development of a new way of thinking for medicalfaculties. The expansion of the space of learning cross-es traditional borders. Educators must accept that theirrole will change from that of providing owner-basedknowledge to becoming knowledge managers whomust stimulate students to acquire that knowledge andskills. The students need to achieve an understandingof the conceptual and propositional knowledge thateducators would formerly have transferred in the class-room setting. Now students from different universitiescan visit online course modules and collect their ownelectronic portfolios from the material in the learningenvironments of the universities.
Podcasts as a teaching tool
There is already extensive experience in the use ofaudio and videorecordings of teaching sessions (2).Podcasts represent a new and easy way of producingdigital recordings from teaching units, which com-
bine the spoken word with the visual slides in one da-ta-package (Figure 3). Podcasts also represent a newway of storing and distributing these files through theInternet to different kinds of players (computers,MP3-players). The user can subscribe to the files andhis/her computer will automatically receive newtransmissions. Production and distribution of pod-casts have become much easier through the wide-spread use of portable MP3-Players.
Students are able to use the podcasts at their ownpace. They can access the files whenever they wish anduse them. Digital storage of their data allows students tosearch the content and to select and include their collect-ed and preferred data in their lifelong-learning tracks.
Teachers are able to provide life-data from theirclass sessions and combine these with additional teach-ing material for their students simply by uploading thefiles to a server. They can edit and delete the files at anytime and secure entry to the site by passwords.
Bedside teaching with virtual patients (Case
based teaching)
Contextual learning plays an important role in thedevelopment of expert knowledge. During the currentrenewal of the paediatric curriculum at German uni-versities in general and at the Charité in particular, thefocus on face-to-face teaching has shifted from theoret-ical systematic learning to bedside teaching with realpatients. Bedside teaching as a method focuses on theconveying of practical clinical skills to students in anauthentic environment (3). It aims to foster clinicaldecision-making skills, which correlate with the devel-opment of clinical expertise. The new German licens-ing rules for doctors obligate teaching of a maximumof three students at the patient’s bedside (4). Clinicalcase presentations can be held with a maximum of sixstudents. Therefore, by the predefinition of learninggoals, clinical learning in paediatrics is placed in thecontext of typical paediatric patients and clinical cases.Students can start to integrate their theoretical knowl-edge and earlier understanding of basic clinical scienceswith practical demands. The challenge consists in thecase mix of a university hospital, where the typical cas-es cannot be provided as standard to all of the 1,000students who rotate through the wards each year. The
Figure 2. A clinical lecture.
2 K. Sostmann et al.
Paediatriki 2008;71:1-4
Figure 3. Portable digital audio player (MP3-Player).
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·2
duration of stay of the patients in the hospital is usual-ly very short and the typical initial symptoms that led tothe first diagnostic steps disappear very quickly. To re-solve these problems, a blended learning scenario waschosen, where the traditional bedside teaching is sup-plemented (blended) with eLearning modules (Figure4), on which the students are required to work beforeand after they visit the paediatric ward.
Didactics
Blended learning represents a shift in instruction-al strategy. The most useful parts of each teachingmethod are combined to reach the maximum teach-ing effort. This system merges the advantages of tech-nology-based teaching methods, e.g. e-Learning, withtraditional teaching (face-to-face), and small-groupteaching methods such as problem-based learning.Blended learning makes possible self-directed learn-ing by shifting the choice of teaching methods andmaterials used from the teacher to the student. Ithelps students choose the learning materials thatmatch their learning types and needs (5). The addi-tional use of virtual communication tools stresses thelearner-centred role of these scenarios. The introduc-tion of new communication tools helps partners toaccess teaching from multiple perspectives.
Blended learning is achieved through the follow-ing steps: Students rotate through ten paediatric sub-specialities during their paediatric semester in the 5thclinical semester. They receive four hours of bedsideteaching time. Every 14 days they visit a new paedi-atric specialty with a new teacher. In order to providecontinuity for the students, the e-Tutor was intro-duced. E-Tutors are physicians on the hospital staffwho are trained to operate the different communica-tion tools offered by the Blackboard© learning man-agement system. Their role is to moderate the onlinediscussions students are required to participate induring the semester. Online discussions can be heldasynchronously which allows students and physicians
to participate in accordance with their daily commit-
ments and at a distance.
Learning goals for each ward are predefined, to en-
sure that the students get standardized teaching from
all the different 60 teachers in the departments. Case-
based interactive learning software called CAMPUS
(6) is used, which enables the authors to represent
digitally complete clinical cases in the form of virtual
patient, with all kinds of multimedia materials (video,
audio, photographs, hyperlinks) that are useful from
the didactic perspective, and to distribute them as
CDs or through the Internet to their teaching and
learning community. Learners approach the cases
from a constructivist point of view, and they have to
accomplish the same steps as they would in an outpa-
tient department or on a clinical ward. As a construc-
tivist learning intervention this provides learners with
an opportunity to discover information and to make
meaningful decisions collaboratively. The students
are respected in this setting as unique individuals and
the physicians act as facilitators rather than teachers.
Thus the software offers the possibility of approach-
ing the virtual patient from individual perspectives.
E-Learning
Six learning cases, so called virtual patients, were
provided for the students (Table 1).
Students can reach the learning cases online
through the learning management system Black-
board©. The cases were passed through a peer review
process and were chosen to represent typical and
common problems of paediatric patients. The cases
were supplemented with videos and sound materials
that reproduce the patients’ major problems and
symptoms even at an acute stage of their illness. For
example, one video shows a patient with severe dehy-
dration with ketoacidosis and Kussmaul-breathing.
This method generates a surplus of information
for the students using the learning cases. It should be
realized in this context that additional information
will put an additional study load on the students (7),
but the key advantages of eLearning are flexibility and
the possibility for the students to work in any place
3Methods in paediatric undergraduate education
¶·È‰È·ÙÚÈ΋ 2008;71:1-4
Figure 4. E-learning module (CAMPUS© Case based teachingsoftware).
Table 1. Virtual paediatric cases
Six common or severe paediatric problems as virtual learningpatients
GastroenteritisFebrile seizureIntussusceptionPseudocroupMeningococcal meningitisOsteomyelitis
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·3
where an Internet connection is available. A further ad-vantage is the fact that teachers can use the learningcases to present the acute clinical situations with symp-toms not available at the moment of teaching. Patientsthemselves are relieved of stress because the studentsare better prepared when attending the bedside teach-ing sessions.
Assessment
A variety of elements are considered in assessingthe students:
Recent studies have shown the advantages for stu-dent motivation and have proved positive learning ef-fects from the use of formative tests during a clinicalrotation (8). When completing study of the virtualcases, the students have to complete 12 formative tests(case-related multiple-choice tests with three to sixquestions, at the end of each case). After finishing thetests, the students receive direct online feedback andhints about how to complete their knowledge gaps.They can do the tests as often as they wish, and theydo not have to pass them. These tests are provided tooffer the students a tool of self-assessment, and as apreparation for the final multiple-choice test at theend of the rotation, which consists of 40 questions.
Students are asked to complete case-related tasks,e.g., discuss the differential diagnoses or therapeuticoptions of the virtual cases online with their tutorsand colleagues.
During the interdisciplinary course on pain man-agement students are faced with an objective struc-tured clinical examination (OSCE) where they aretested in practical tasks. In the future, it could proveuseful to expand the use of the OSCE to assess furtheraspects of the students’ practical competence.
The introduction of different test methods aims atassessing not only cognitive but also contextualknowledge, and thus to test in a more reliable way thestudents’ development of clinical reasoning skills (9).New methods are being developed at present for as-sessing students’ clinical decision-making skills.
Outlook
Triggered by the recent advances in technical teach-ing infrastructure and by the introduction of newteaching methods, the structure of medical educationhas changed. These changes have to be adopted by bothteachers and students. Blended learning can overcomesome of the constraints caused by the compression ofworkflow in the wards for staff and the reduction ofhospitalization for the patients. The emphasis on clini-cal bedside teaching means that more students meetfewer patients with acute illnesses and see more pa-tients with chronic diseases. Blended learning can help
to disburden the patients and allow questions to be an-
swered, from the audiovisual point of view, which can-
not be discussed at the bedside. Students are better pre-
pared in this way for the clinical ward round. The
adoption of the new didactic concepts is essential to de-
velop a surplus of learning material by means of the
eLearning environment for students and teaching staff.
The learner-centred design of eLearning environ-
ments can help students to choose the right media for
their learning types and the particular learning situa-
tions, but it demands more initial preparation time
from the teacher. New distributional technologies,
such as podcasts and audience response systems, can
help to make traditional classroom sessions more at-
tractive. By introducing the new technologies as ex-
tensions of the operating learning environment, cur-
riculum integration should be assured.
Finally, eLearning materials demand a higher ef-
fort in the area of technical support for teaching staff
from their faculties. It must be taken into account that
a higher learning load is an extra burden for the stu-
dents, when new eLearning materials are integrated
into a curriculum.
References
1. Brown G, Manogue M. AMEE Medical Education Guide
No. 22: Refreshing lecturing: a guide for lecturers. Med
Teach 2001;23:231-244.
2. Tomlinson DR. Independent learning packages (audio
tape/pamphlet) for a course in cell excitation: evidence that
they can be at least as effective as conventional lectures.
Med Educ 1979;13:257-262.
3. Lacombe MA. On bedside teaching. Ann Intern Med
1997;126:217-220.
4. German licensing order for medical doctors: Approbation-
sordnung für Aerzte - Bundesministerium für Gesundheit.
Gesetztestext: htpp://www.bmg.bund.de/cln_040/nn_
603274/SharedDocs/Gesetzestexte/Gesundheitsberufe/
5. Gordon DL, Issenberg SB, Gordon MS, LaCombe D,
McGaghie WC, Petrusa ER. Stroke training of prehospital
providers: an example of simulation-enhanced blended
learning and evaluation. Med Teach 2005;27:114-121.
6. Garde S, Heid J, Haag M, Bauch M, Weires T, Leven FJ.
Can design principles of traditional learning theories be
fulfilled by computer-based training systems in medicine:
the example of CAMPUS. Int J Med Inform 2007;76:124-
129. (doi:10.1016/j.ijmedinf.2006.07.009)
7. De Leng B, Dolmans D, van de Wiel M, Muijtjens A, van
der Vleuten C. How video cases should be used as authen-
tic stimuli in problem-based medical education. Med Educ
2007;41:181-188.
8. Lewis DJ, Sewell RD. Providing formative feedback from a
summative computer-aided assessment. Am J Pharm Educ
2007;71:33.
9. Wass V, McGibbon D, Van der Vleuten C. Composite un-
dergraduate clinical examinations: how should the compo-
nents be combined to maximize reliability? Med Educ
2001;35:326-330.
4 K. Sostmann et al.
Paediatriki 2008;71:1-4
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·4
¶·È‰È¿ ÌÂ Û˘¯Ó¤˜ ÏÔÈÌÒÍÂȘ: ÎÚÈÙ‹ÚÈ· ÂÍÂȉÈÎÂ˘Ì¤ÓÔ˘ ·ÓÔ-
ÛÔÏÔÁÈÎÔ‡ ÂϤÁ¯Ô˘
¢. X. ∫·Û›ÌÔ˜1, ª. §È¿ÙÛ˘2, ∞. ™ÙÔÁÈ·ÓÓ›‰Ô˘1, ª. ∫·Ó¿ÚÈÔ˘2
¶ÂÚ›ÏË„Ë: ¶ÔÏÏ¿ ·È‰È¿ ÂÌÊ·Ó›˙Ô˘Ó Û˘¯Ó¤˜ ÏÔÈÌÒÍÂȘ, ·ÏÏ¿ Ï›Á· Â›Ó·È ÂΛӷ Ô˘ ¤¯Ô˘Ó ‰È·Ù·Ú·¯‹ÙˆÓ ·Ì˘ÓÙÈÎÒÓ ÙÔ˘˜ Ì˯·ÓÈÛÌÒÓ. ™˘¯Ó¤˜, ˘ÔÙÚÔÈ¿˙Ô˘Û˜, ›ÌÔÓ˜, ‚·ÚȤ˜ ‹ ·Û˘Ó‹ıÈÛÙ˜ ÏÔÈÌÒÍÂȘ·Ó·Ù‡ÛÛÔÓÙ·È Û ·È‰È¿ Ì ·Ó¿ÚÎÂÈ· ÙÔ˘ ·Ì˘ÓÙÈÎÔ‡ Î·È ÂȉÈÎfiÙÂÚ· ÙÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·-ÙÔ˜. ∆Ô ÈÛÙÔÚÈÎfi Î·È Ë Ê˘ÛÈ΋ ÂͤٷÛË ı¤ÙÔ˘Ó ÙËÓ ˘Ô„›· οÔÈ·˜ ˘ÔΛÌÂÓ˘ ·ÓÔÛÔ·Ó¿ÚÎÂÈ·˜. ™Â‰Â‡ÙÂÚÔ ¯ÚfiÓÔ, Á›ÓÂÙ·È ‚·ÛÈÎfi˜, ÂÚÁ·ÛÙËÚÈ·Îfi˜, ·ÓÔÛÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ηÈ, ·Ó οÙÈ Â›Ó·È ·ıÔÏÔÁÈÎfi ‹ÙÂı› ˘Ô„›· ÁÈ· οÔÈÔ ·ÓÔÛÔÏÔÁÈÎfi ¤ÏÏÂÈÌÌ·, Á›ÓÂÙ·È ÂÚ·ÈÙ¤Úˆ ¤ÏÂÁ¯Ô˜ Ì ÂÍÂȉÈÎÂ˘Ì¤Ó˜ ·ÓÔÛÔÏÔ-ÁÈΤ˜ ÂÍÂÙ¿ÛÂȘ, ÔÈÔÙÈΤ˜ Î·È ÏÂÈÙÔ˘ÚÁÈΤ˜ ‰ÔÎÈ̷ۛ˜. ™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ·Ó·ÛÎfiËÛ˘ Â›Ó·È Ó· ‰Ò-ÛÔ˘Ì ٷ ÂÊfi‰È· ÛÙÔÓ ÎÏÈÓÈÎfi ÁÈ·ÙÚfi ÁÈ· ÙË ÌÂıÔ‰È΋ ÚÔÛ¤ÁÁÈÛË ÂÓfi˜ ÔÏ˘Û‡ÓıÂÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜ ηÈÙËÓ ÔÚıÔÏÔÁÈ΋ ‰ÈÂÚ‡ÓËÛË ÙˆÓ ·È‰ÈÒÓ Ô˘ ¤¯Ô˘Ó ¤Ó‰ÂÈÍË ˘ÔΛÌÂÓ˘ ·ÓÔÛÔÏÔÁÈ΋˜ ‰È·Ù·Ú·¯‹˜.
§¤ÍÂȘ ÎÏÂȉȿ: ∞ÓÔÛÔ·Ó¿ÚÎÂÈ·, ·ÓÔÛ›·, ¤ÏÂÁ¯Ô˜, ÏÔÈÌÒÍÂȘ, ·È‰È¿, ·Ó·ÛÎfiËÛË.
Children with frequent infections: criteria for specialized
immunological investigations
D. C. Cassimos1, M. Liatsis2, A. Stogiannidou1, M. Kanariou2
Abstract: Although many children develop frequent infections, only a few have an underlying immunedisorder. Children with dysfunction of the defense mechanisms of the immune system develop not onlyfrequent infections but also recurrent, persistent, severe and rare infections. The medical history andphysical examination provide a hint and should give rise to suspicion of an immune disorder. Theapproach to these patients starts with a primary diagnostic work up which, in relation to the clinical pictureand the initial findings, should be extended to include more specialized investigations (qualitative andfunctional). The aim of this review is to provide paediatricians with the tools for approaching this problemand to propose an optimal method for investigating children with possible immune dysfunction.
Key words: Immunodeficiency, immunity, investigation, infections, children, review.
5∞¡∞™∫√¶∏™∏ REVIEW ARTICLE
1 ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋,¢ËÌÔÎÚ›ÙÂÈÔ ¶·ÓÂÈÛÙ‹ÌÈÔ£Ú¿Î˘
2 ∆Ì‹Ì· ∞ÓÔÛÔÏÔÁ›·˜-πÛÙÔÛ˘Ì‚·ÙfiÙËÙ·˜,¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ“∞Á›· ™ÔÊ›·”
AÏÏËÏÔÁÚ·Ê›·:
ª·Ú›· °. ∫·Ó¿ÚÈÔ˘ [email protected]∆Ì‹Ì· ∞ÓÔÛÔÏÔÁ›·˜-πÛÙÔÛ˘Ì‚·ÙfiÙËÙ·˜,¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”£Ë‚ÒÓ Î·È¶··‰È·Ì·ÓÙÔÔ‡ÏÔ˘, ∆.∫. 115 27, °Ô˘‰‹, ∞ı‹Ó·
1 Department of Paediatrics,Democritus University ofThrace
2 Department ofImmunology andHistocompatibility, “Aghia Sophia” Children’sHospital, Athens, Greece
Correspondence:
Maria G. [email protected] of Immunologyand Histocompatibility,“Aghia Sofia” Children’sHospitalThivon & Papadiaman-topoulou St.,115 27, Goudi, Athens,Greece
¶·È‰È·ÙÚÈ΋ 2008;71:5-13
™˘ÓÙÔÌÔÁڷʛ˜
BMAA µ·ÚÈ¿ ªÈÎÙ‹ ∞ÓÔÛÔ·Ó¿ÚÎÂÈ·
C Complement / ™˘Ìϋڈ̷
CD Cluster Differentiation / ¢Â›ÎÙ˘ ¢È·ÊÔÚÔ-
Ô›ËÛ˘
CMV Cytomegalovirus / ∫˘ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi˜
DHR Dihydrorodamine / ¢È˘‰ÚÔÚÔ‰·Ì›ÓË
HPV Human Papilloma Virus / πfi˜ ·ÓıÚˆ›ÓˆÓ
ıËψ̿وÓ
Ig Immunoglobulin / ∞ÓÔÛÔÛÊ·ÈÚ›ÓË
MHC Major Histocompatibility Complex / ªÂ›-
˙ÔÓ ™‡ÛÙËÌ· πÛÙÔÛ˘Ì‚·ÙfiÙËÙ·˜
NBT Nitro Blue Tetrazolium / ¢ÔÎÈÌ·Û›· ¯ÚÒÛ˘
ÙÔ˘ ΢·ÓÔ‡ ÙÔ˘ ÙÂÙÚ·˙ÔÏ›Ô˘
NK Natural Killer / º˘ÛÈο ∫˘ÙÙ·ÚÔÎÙfiÓ·
¶∞∞ ¶ÚˆÙÔ·ı›˜ ∞ÓÔÛÔ·Ó¿ÚÎÂȘ
∂ÈÛ·ÁˆÁ‹
µ·ÛÈÎfi ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÙÔ˘ Ê˘ÛÈÔÏÔÁÈÎÔ‡
·ÓÔÛÈ·ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Â›Ó·È Ë ·Ó·ÁÓÒÚÈÛË Î·È
‰È¿ÎÚÈÛË ÙˆÓ ‰ÈÎÒÓ ÙÔ˘ ȉ›ˆÓ ÛÙÔȯ›ˆÓ ·fi Ù·
ͤӷ, Ì ÛÎÔfi Ó· ·Ó¤¯ÂÙ·È Ù· ‰Èο ÙÔ˘ Î·È Ó·
ÂÈÙ›ıÂÙ·È ‹ ·ÔÚÚ›ÙÂÈ Ù· ͤӷ, ÒÛÙ ӷ ÚÔ-
ÛٷهÂÈ ÙËÓ ÔÌÔÈÔÛÙ·Û›· Î·È ÙËÓ ·ÎÂÚ·ÈfiÙËÙ·
ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡. ∆· ÈÔ Û˘Ó‹ıË Í¤Ó·, ÂÈÙÈı¤-
ÌÂÓ· ÛÙÔÓ ·ÓıÚÒÈÓÔ ÔÚÁ·ÓÈÛÌfi ÛÙÔȯ›· ›ӷÈ
ÔÈ ÏÔÈÌÔÁfiÓÔÈ ·Ú¿ÁÔÓÙ˜. √È ÏÔÈÌÒÍÂȘ ›ӷÈ
ÓÔÛ‹Ì·Ù· Ô˘ Û˘Ó‰¤ÔÓÙ·È ÙfiÛÔ ÛÙÂÓ¿ Ì ÙÔ
·ÓÔÛÔÔÈËÙÈÎfi Û‡ÛÙËÌ·, ÒÛÙÂ Â›Ó·È ‰˘Ó·Ùfi ÌÂ
‚¿ÛË ÙË Ïԛ̈ÍË Î·È ÙÔ˘˜ ÙÔÈÎÔ‡˜ ‹ Û˘ÛÙË-
Ì·ÙÈÎÔ‡˜, ÂȉÈÎÔ‡˜ ‹ ÌË ÂȉÈÎÔ‡˜ Î·È Î˘ÙÙ·ÚÈ-
ÎÔ‡˜ ‹ ¯˘ÌÈÎÔ‡˜ ·ÓÔÛÈ·ÎÔ‡˜ Ì˯·ÓÈÛÌÔ‡˜ Ó·
·Ó·ÁÓˆÚÈÛı› ÙÔ ¤ÏÏÂÈÌÌ· Î·È Ó· Ù·ÍÈÓÔÌËı› Ë
Ù˘¯fiÓ ·Ó¿ÚÎÂÈ·. √ÔÈÔÛ‰‹ÔÙ ÏÔÈÌÔÁfiÓÔ˜
·Ú¿ÁÔÓÙ·˜ ÁÈ· Ó· ÂΉËÏÒÛÂÈ ÓfiÛÔ ÚÔ¸Ôı¤-
ÙÂÈ ÙËÓ ÂÈÙ˘¯Ë̤ÓË ‰È¿Û·ÛË ÙÔ˘ ·ÓÔÛÈ·ÎÔ‡
·Ì˘ÓÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜.
∞fi ÙË ÛÙÈÁÌ‹ Ô˘ ÙÔ ÓÂÔÁÓfi ÂÁηٷÏ›ÂÈ
ÙÔ ÛÙ›ÚÔ ÂÚÈ‚¿ÏÏÔÓ Ù˘ Ì‹ÙÚ·˜ ·ÔÈΛ˙ÂÙ·È ÌÂ
ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜. ∏ ÌÈÎÚԂȷ΋ ¯ÏˆÚ›‰· Ô˘
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·5
·Ó·Ù‡ÛÛÂÙ·È fi¯È ÌfiÓÔ ‰ÂÓ Â›Ó·È ·ıÔÁfiÓÔ˜, ·ÏÏ¿
ÏÂÈÙÔ˘ÚÁ› Û˘Ì‚ÈÔÙÈο ˆ˜ ·Û›‰· ÌË ÂÈÙÚ¤ÔÓÙ·˜ ÛÂ
ͤÓÔ˘˜ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜ Ó· ·Ó·Ù˘¯ıÔ‡Ó. ŸÙ·Ó ÙÔ
·È‰› ÚˆÙÔÛ˘Ó·ÓÙ‹ÛÂÈ Î¿ÔÈÔ ·ıÔÁfiÓÔ ÌÈÎÚÔÔÚ-
Á·ÓÈÛÌfi Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÓÔÛ‹ÛÂÈ. ªÂ ÙËÓ ÂͤÏÈÍË Ù˘
ÓfiÛÔ˘ ·Ó·Ù‡ÛÛÔÓÙ·È ·Ú¿ÏÏËÏ· ·ÓÔÛÔÏÔÁÈÎÔ› ·Ì˘-
ÓÙÈÎÔ› Ì˯·ÓÈÛÌÔ› Ô˘ ηıÈÛÙÔ‡Ó ÙÔ ¿ÙÔÌÔ ÈηÓfi Ó·
ÂÈ˙‹ÛÂÈ Î·È Ó· ·ÔÎÙ‹ÛÂÈ ÌÓËÌÔÓÈ΋ ·ÓÔÛ›· ηٿ
ÙÔ˘ ·ıÔÁfiÓÔ˘ ÏÔÈÌÔÁfiÓÔ˘ ·Ú¿ÁÔÓÙ·. §ÔÈÌÒÍÂȘ
·fi Û˘ÁÎÂÎÚÈ̤ÓÔ˘˜ ÔÚÁ·ÓÈÛÌÔ‡˜, fiˆ˜ Ë §ÈÛÙ¤ÚÈ· Ë
ÌÔÓÔ΢ÙÙ·ÚÈ΋ (Listeria monocytogenes) Î·È Ë ¶Ó¢ÌÔ-
·ÛÙË jiroveci (carinii), ‰ÂÓ Û˘Ó·ÓÙÒÓÙ·È ·Ú¿ ÌfiÓÔ ÛÂ
¿ÙÔÌ· Ì ˘ÔΛÌÂÓË ·ÓÔÛÔ·Ó¿ÚÎÂÈ·, ÂÓÒ ÌÂÚÈÎÔ›
ÏÔÈÌÔÁfiÓÔÈ ·Ú¿ÁÔÓÙ˜, fiˆ˜ Ô ÌÂÁ·ÏÔ΢ÙÙ·ÚÔ˚fi˜
(CMV), ÚÔηÏÔ‡Ó ·ÓÔÛÔηٷÛÙÔÏ‹. ∆Ô Â›Â‰Ô
ıÚ¤„˘ ÂËÚ¿˙ÂÈ Û ÌÂÁ¿ÏÔ ‚·ıÌfi ÙËÓ ·Ì˘ÓÙÈ΋
ÈηÓfiÙËÙ· ÙÔ˘ ·È‰ÈÔ‡, ÂÓÒ ÙÔ ÂÚÈ‚¿ÏÏÔÓ ÛÙÔ ÔÔ›Ô
ÌÂÁ·ÏÒÓÂÈ Î·ıÔÚ›˙ÂÈ ÙÔ˘˜ ÏÔÈÌÔÁfiÓÔ˘˜ ·Ú¿ÁÔÓÙ˜
ÛÙÔ˘˜ ÔÔ›Ô˘˜ ÂÎÙ›ıÂÙ·È.
º˘ÛÈÔÏÔÁÈο, fiÏ· Ù· ·È‰È¿ ÂÌÊ·Ó›˙Ô˘Ó ÏÔÈÌÒ-
ÍÂȘ. ∫·Ù¿ ÙË ÓËȷ΋ ËÏÈΛ· ÛÙË ‰È¿ÚÎÂÈ· ÂÓfi˜
¯ÚfiÓÔ˘ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÂÌÊ·Ó›ÛÔ˘Ó 8-10 ÏÔÈÌÒ-
ÍÂȘ ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Î·È 1-2 ÙÔ˘ Á·-
ÛÙÚÂÓÙÂÚÈÎÔ‡. øÛÙfiÛÔ, ··ÈÙÂ›Ù·È Ë ¿ÚÔ‰Ô˜ ÔÏ-
ÏÒÓ ÂÙÒÓ ÁÈ· Ó· ‰ËÌÈÔ˘ÚÁ‹ÛÂÈ ÈηÓÔÔÈËÙÈ΋ ·ÓÔ-
Ûȷ΋ ÌÓ‹ÌË Î·È Ó· ÌÂȈı› Ë Û˘¯ÓfiÙËÙ· ÙˆÓ
ÏÔÈÌÒ͈Ó. √ ·ÚÈıÌfi˜ ÙˆÓ ÏÔÈÌÒÍÂˆÓ ÌÂÈÒÓÂÙ·È
ÌÂÙ¿ Ù· ÙÚ›· ÚÒÙ· ¯ÚfiÓÈ· ˙ˆ‹˜, ÂÊfiÛÔÓ ÙÔ ·È‰›
‰ÂÓ ·Ú·ÎÔÏÔ˘ı› ·È‰ÈÎfi ÛÙ·ıÌfi Î·È ‰ÂÓ ˘¿Ú¯ÂÈ
¿ÏÏÔ ·È‰› ÛÙÔ ÂÚÈ‚¿ÏÏÔÓ ÙÔ˘ Ô˘ Ó· ËÁ·›ÓÂÈ
Û¯ÔÏÂ›Ô (1).
∆Ô ÂÚÒÙËÌ· Ô˘ ÚÔ·ÙÂÈ Â›Ó·È ÔÈfi˜ ·ÚÈıÌfi˜
ÏÔÈÌÒÍÂˆÓ ı· ıˆÚËı› ÛËÌ·ÓÙÈÎfi˜ Î·È Û ÔÈ¿
·È‰È¿ ı· ˘ÔÙ¢ıԇ̠‰È·Ù·Ú·¯‹ Ù˘ ¿Ì˘Ó·˜ ηÈ
Û ÙÈ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô ı· ÚÔ¯ˆÚ‹ÛÔ˘ÌÂ. °È·
Ó· ··ÓÙ‹ÛÔ˘Ì ے ·˘Ù¿ Ù· ÂÚˆÙ‹Ì·Ù· ı· Ú¤ÂÈ
Ó· ˘ÂÓı˘Ì›ÛÔ˘Ì ÙÔ˘˜ Ê˘ÛÈÔÏÔÁÈÎÔ‡˜ ·Ì˘ÓÙÈÎÔ‡˜
Ì˯·ÓÈÛÌÔ‡˜.
∆Ô ‰¤ÚÌ·, ÔÈ ‚ÏÂÓÓÔÁfiÓÔÈ Î·È Ù· ÚÔ˚fiÓÙ· Ô˘ ·˘-
ÙÔ› ÂÎÎÚ›ÓÔ˘Ó Â›Ó·È ÔÈ ÚÒÙÔÈ ÊÚ·ÁÌÔ› ÛÙË Ïԛ̈ÍË.
6 ¢. X. ∫·Û›ÌÔ˜ Î·È Û˘Ó.
Paediatriki 2008;71:5-13
ª˘ÂÏfi˜ ÙˆÓ ÔÛÙÒÓ
¶ÔÏ˘‰‡Ó·ÌÔ ·Ú¯¤ÁÔÓÔ
·ÙÙ·ÚÔ¡∫ ·ÙÙ·ÚÔ
√˘‰ÂÙÂÚfiÊÈÏÔ
∞Ú¯¤ÁÔÓÔ ÏÂÌÊÔÂȉ¤˜ ∞Ú¯¤ÁÔÓÔ Ì˘ÂÏÔÂȉ¤˜ªÔÓÔ·ÙÙ·ÚÔ
¶ÚÔ ∆ ·ÙÙ·ÚÔ¶ÚÔ µ ·ÙÙ·ÚÔ
∏ˆÛÈÓfiÊÈÏÔ
£‡ÌÔ˜ ª˘ÂÏfi˜ ÙˆÓ ÔÛÙÒÓ
µ·ÛÂfiÊÈÏÔ
flÚÈÌÔ ∆ ·ÙÙ·ÚÔ flÚÈÌÔ µ ·ÙÙ·ÚÔ
¶Ï·ÛÌ·ÙÔ·ÙÙ·ÚÔ
∞ÓÔÛÔÛÊ·ÈÚ›Ó˜
∂ÈÎfiÓ· 1. ™¯ËÌ·ÙÈ΋ ·ÂÈÎfiÓÈÛË ÙÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜.
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·6
ŸÙ·Ó ÔÈ ÏÔÈÌÔÁfiÓÔÈ ·Ú¿ÁÔÓÙ˜ ˘ÂÚÈÛ¯‡ÛÔ˘Ó Î·È
ÂÈÛ¤ÏıÔ˘Ó ÛÙËÓ Î˘ÎÏÔÊÔÚ›·, ÌË ÂȉÈÎÔ› Î·È ÂȉÈÎÔ›
·ÓÔÛÔÏÔÁÈÎÔ› ·Ú¿ÁÔÓÙ˜ Î·È Ì˯·ÓÈÛÌÔ› ÎÈÓËÙÔ-
ÔÈÔ‡ÓÙ·È ÁÈ· Ó· ÂÌÔ‰›ÛÔ˘Ó ÙËÓ ·Ó¿Ù˘Í‹ ÙÔ˘˜. ∞Ó
Î·È Ô Î¿ı ·ÓÔÛÔÏÔÁÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ¤¯ÂÈ Í¯ˆÚÈ-
ÛÙ¤˜ ÏÂÈÙÔ˘ÚÁ›Â˜, ˘¿Ú¯ÂÈ Î·È ·ÍÈfiÏÔÁË ·ÏÏËÏ›-
‰Ú·ÛË Î·È ·ÏÏËÏÂÍ¿ÚÙËÛË ÁÈ· Ó· ÙÂÏÂÛÊÔÚ‹ÛÂÈ Ë
¿Ì˘Ó· ÙÔ˘ ÍÂÓÈÛÙ‹.
°È· ÏfiÁÔ˘˜ ÌÂϤÙ˘ Î·È Î·Ù·ÓfiËÛ˘, ÙÔ ·ÓÔÛÔ-
ÔÈËÙÈÎfi Û‡ÛÙËÌ· ‰È·ÈÚÂ›Ù·È ÛÙ· “Û˘ÛÙ·ÙÈο” ÙÔ˘
(∂ÈÎfiÓ· 1), ÙÔ ÏÂÌÊÈÎfi Û‡ÛÙËÌ·, ÙÔ Ê·ÁÔ΢ÙÙ·ÚÈÎfi
Î·È ÙÔ Û‡ÛÙËÌ· ÙÔ˘ Û˘ÌÏËÚÒÌ·ÙÔ˜ (2,3,4).
∆Ô ∞ÓÔÛÔÔÈËÙÈÎfi ™‡ÛÙËÌ·
§ÂÌÊÔ·ÙÙ·Ú·: ∆· ÏÂÌÊÔ·ÙÙ·Ú· ‰È·ÎÚ›ÓÔÓÙ·È ÛÂ
‰‡Ô ‚·ÛÈΤ˜ ÔÌ¿‰Â˜, Ù· ∆ Î·È Ù· µ, Ì ‚¿ÛË ÙËÓ ·ÓÔ-
ÛÔÏÔÁÈ΋ ÙÔ˘˜ ÏÂÈÙÔ˘ÚÁ›· Î·È Ù· Ê·ÈÓÔÙ˘Èο ÙÔ˘˜
¯·Ú·ÎÙËÚÈÛÙÈο. √ Ê·ÈÓfiÙ˘fi˜ ÙÔ˘˜ ÚÔÛ‰ÈÔÚ›˙Â-
Ù·È Ì ‚¿ÛË ÂȉÈÎÔ‡˜ ‰Â›ÎÙ˜ (ÁÏ˘ÎÔÚˆÙ½Ó˜) Ô˘
ÂÎÊÚ¿˙Ô˘Ó ÛÙËÓ ÂÈÊ¿ÓÂÈ¿ ÙÔ˘˜ ·Ó¿ÏÔÁ· Ì ÙÔ ÛÙ¿-
‰ÈÔ ˆÚ›Ì·ÓÛ˘ Î·È ‰È·ÊÔÚÔÔ›ËÛ‹˜ ÙÔ˘˜ Î·È Ô˘
·ÓȯÓ‡ÔÓÙ·È Ì ٷ ÌÔÓÔÎψÓÈο ·ÓÙÈÛÒÌ·Ù·.
∆· ∆ ÏÂÌÊÔ·ÙÙ·Ú· ÂÍÂÏ›ÛÛÔÓÙ·È ÛÙÔ ı‡ÌÔ ÛÂ
ÒÚÈÌ· ∆ ÏÂÌÊÔ·ÙÙ·Ú·. ∞ÔÙÂÏÔ‡Ó ÙËÓ ÏÂÈÔ„Ë-
Ê›· ÙÔ˘ ÏÂÌÊÔ΢ÙÙ·ÚÈÎÔ‡ ÏËı˘ÛÌÔ‡ ÙÔ˘ ÂÚÈÊÂ-
ÚÈÎÔ‡ ·›Ì·ÙÔ˜ Î·È Â›Ó·È ‰˘Ó·Ù‹ Ë ·ÓÔÛÔÊ·ÈÓÔÙ˘È΋
ÙÔ˘˜ ‰È¿ÎÚÈÛË ÛÙÔ˘˜ ˘ÔÏËı˘ÛÌÔ‡˜ ÙÔ˘˜. ∆Ô 70%
ÙˆÓ ∆ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Ê¤ÚÂÈ ÛÙËÓ ÂÈÊ¿ÓÂÈ¿ ÙÔ˘ ÙË
CD4 ÁÏ˘ÎÔÚˆÙ›ÓË Î·È Ë ÏÂÈÔ„ËÊ›· ÙÔ˘˜ ¤¯ÂÈ
‚ÔËıËÙÈ΋/·ÁˆÁÈ΋ ÏÂÈÙÔ˘ÚÁ›·.
∆Ô ˘fiÏÔÈÔ 30% Â›Ó·È CD8+ ·ÙÙ·Ú· ηÈ
¤¯Ô˘Ó ηٷÛÙ·ÏÙÈ΋/΢ÙÙ·ÚÔÙÔÍÈ΋ ÏÂÈÙÔ˘ÚÁ›·. √
∆ ‚ÔËıËÙÈÎfi˜ ÏËı˘ÛÌfi˜ ÌÂÙ¿ ÙÔÓ ·ÓÙÈÁÔÓÈÎfi ÂÚÂ-
ıÈÛÌfi ·Ú¿ÁÂÈ Û˘ÁÎÂÎÚÈ̤Ó˜ ‰È·Ï˘Ù¤˜ Ô˘Û›Â˜, ÙȘ
ÏÂÌÊÔΛÓ˜. ∞˘Ù¤˜ ·ÊÂÓfi˜ ¿ÁÔ˘Ó ÙËÓ ·Ó¿Ù˘ÍË
Î·È ‰È·ÊÔÚÔÔ›ËÛË ÙˆÓ µ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ÁÈ· ·-
Ú·ÁˆÁ‹ ÂȉÈÎÒÓ ·ÓÙÈۈ̿وÓ, ·ÊÂÙ¤ÚÔ˘ ¢ԉÒ-
ÓÔ˘Ó ÌË ÂȉÈÎÔ‡˜ ÁÈ· ÙÔ ·ÓÙÈÁfiÓÔ Ì˯·ÓÈÛÌÔ‡˜, ÂÓÂÚ-
ÁÔÔÈÒÓÙ·˜ Ù· Ì·ÎÚÔÊ¿Á·, Ù· ÔÏ˘ÌÔÚÊÔ‡ÚËÓ·
Î·È ¿ÏÏ· Ï¢ÎÔ·ÙÙ·Ú·. ∆Ô ∆ ‚ÔËıËÙÈÎfi ·ÙÙ·ÚÔ
7∞ÓÔÛÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ Û ÏÔÈÌÒÍÂȘ
¶·È‰È·ÙÚÈ΋ 2008;71:5-13
∞ÓÙÈÁfiÓÔ
∞ÓÙÈÁÔÓÔ·ÚÔ˘ÛÈ·ÛÙÈÎfi
·ÙÙ·ÚÔ (APC)
AÓ·ÁÓÒÚÈÛË, ÂÂÍÂÚÁ·Û›·
·ÚÔ˘Û›·ÛË ·ÓÙÈÁfiÓÔ˘
¶Úfi‰ÚÔÌÔ ·ÈÌÔÔÈËÙÈÎfi
·ÙÙ·ÚÔ
µ ·ÙÙ·ÚÔTH (T4)
CD4
∫‡ÙÙ·ÚÔ ¡∫
flÚÈÌÔ µ ∫‡ÙÙ·ÚÔ Ts (T8)
CD8
Tc (T8)
CD8
IgM, IgD, IgG, IgA, IgE
∂ÈÎfiÓ· 2. ™¯ËÌ·ÙÈ΋ ·ÂÈÎfiÓÈÛË Ù˘ ·ÏÏËÏ›‰Ú·Û˘ ÙˆÓ ·ÓÙÈÁÔÓÔ·ÚÔ˘ÛÈ·ÛÙÈÎÒÓ, ∆, µ, Î·È NK ΢ÙÙ¿ÚˆÓ Ì ÎÂÓÙÚÈÎfi ÚfiÏÔ ÙÔ˘ ‚ÔË-ıËÙÈÎÔ‡ ∆ ΢ÙÙ¿ÚÔ˘ (CD4) ÛÙËÓ ·ÓÔÛȷ΋ ·¿ÓÙËÛË (ÙÚÔÔÔÈË̤ÓÔ ·fi Ã. ∫·Û›ÌÔ˜, °ÂÓÈ΋ ¶·È‰È·ÙÚÈ΋, 1995).
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·7
η٤¯ÂÈ ÎÂÓÙÚÈÎfi ÚfiÏÔ ÛÙËÓ Â˘fi‰ˆÛË Î·È ÔÏÔÎÏ‹-
ÚˆÛË Ù˘ ·ÓÔÛÔ·¿ÓÙËÛ˘. ™Â ·ÓÙ›ıÂÛË, Ô ∆ ηٷ-
ÛÙ·ÏÙÈÎfi˜ ˘ÔÏËı˘ÛÌfi˜ ¯·ÏÈÓ·ÁˆÁ› ÙËÓ ·ÓÔÛÔ·-
¿ÓÙËÛË. ∆ÔÓ CD4 ‰Â›ÎÙË ¤¯Ô˘Ó Î·È Ù· ∆ ÏÂÌÊÔ-
·ÙÙ·Ú· Ô˘ Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÙȘ ÏÂÈÙÔ˘ÚÁ›Â˜ ÂÈ‚Ú·-
‰˘ÓfiÌÂÓ˘ ˘ÂÚ¢·ÈÛıËÛ›·˜, ÂÓÒ ÙÔÓ CD8 ¤¯Ô˘Ó
Ù· ∆ ·ÙÙ·Ú· Ô˘ ÌÂÙ¤¯Ô˘Ó ÛÙËÓ ·fiÚÚÈ„Ë ÌÔ-
ۯ‡̷ÙÔ˜, ÙËÓ “ÂÈÙ‹ÚËÛË” ÙˆÓ Î·ÚÎÈÓÈÎÒÓ Î˘Ù-
Ù¿ÚˆÓ Î·È ÙËÓ Î·Ù·ÛÙÚÔÊ‹ ÙˆÓ ÌÔÏ˘ÛÌ¤ÓˆÓ ·fi
ÙÔ˘˜ ÈÔ‡˜ ΢ÙÙ¿ÚˆÓ (5,6).
∆· µ ÏÂÌÊÔ·ÙÙ·Ú· Â›Ó·È Ô ¿ÏÏÔ˜ ÌÂÁ¿ÏÔ˜ ÏÂÌÊÔ-
΢ÙÙ·ÚÈÎfi˜ ÏËı˘ÛÌfi˜, Ô ÔÔ›Ô˜ ‰È·ÊÔÚÔÔÈ›ٷÈ
Î·È ˆÚÈÌ¿˙ÂÈ ÛÙÔ ÂÚÈ‚¿ÏÏÔÓ ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ
ÔÛÙÒÓ. ∆· ÂÚÈÛÛfiÙÂÚ· ·fi ·˘Ù¿, ÌÂÙ¿ ·fi οÔÈÔ
·ÓÙÈÁÔÓÈÎfi ÂÚÂıÈÛÌfi, ÂÍÂÏ›ÛÛÔÓÙ·È Û ϷÛÌ·ÙÔ-
·ÙÙ·Ú·, Ù· ÔÔ›· Û˘Óı¤ÙÔ˘Ó Î·È ÂÎÎÚ›ÓÔ˘Ó ·ÓÔÛÔ-
ÛÊ·ÈÚ›Ó˜. ∫¿ı ¿ÙÔÌÔ ¤¯ÂÈ ÙËÓ ÈηÓfiÙËÙ· Ó· ·Ú¿-
ÁÂÈ ÂηÙÔÌ̇ÚÈ· µ ΢ÙÙ·ÚÈÎÒÓ ÎÏÒÓˆÓ, ηı¤Ó·˜
·fi ÙÔ˘˜ ÔÔ›Ô˘˜ Û˘Óı¤ÙÂÈ ¤Ó· ÂȉÈÎfi ·Óٛۈ̷. ªÂ
·˘Ùfi ÙÔÓ ÙÚfiÔ, ÙÔ ¿ÙÔÌÔ Â›Ó·È ¤ÙÔÈÌÔ Ó· ·ÓÙÈÌÂÙˆ-
›ÛÂÈ ÙËÓ ÔÈÎÈÏ›· ÙˆÓ ·ÓÙÈÁÔÓÈÎÒÓ ÂÚÂıÈÛÌ¿ÙˆÓ
Ô˘ ı· Û˘Ó·ÓÙ‹ÛÂÈ ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ˙ˆ‹˜ ÙÔ˘. ªÂ-
ÚÈο ·fi Ù· ÂÓÂÚÁÔÔÈË̤ӷ µ ·ÙÙ·Ú· ‰ÂÓ ‰È·ÊÔ-
ÚÔÔÈÔ‡ÓÙ·È Û ϷÛÌ·ÙÔ·ÙÙ·Ú·, ·ÏÏ¿ ·Ú·Ì¤-
ÓÔ˘Ó ÁÈ· Ì·ÎÚfi ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ˆ˜ ÌÓËÌÔÓÈο
·ÙÙ·Ú·. ∂›Ó·È ·˘Ù¿ Ô˘ ı· ‰ÒÛÔ˘Ó ÙË ÁÚ‹ÁÔÚË
·ÓÙÈۈ̷ÙÈ΋ ·¿ÓÙËÛË Û ÂÚ›ÙˆÛË ·Ó·ÌfiÏ˘Ó-
Û˘. Ÿˆ˜ Ù· ∆, ¤ÙÛÈ Î·È Ù· µ ·ÙÙ·Ú· ¤¯Ô˘Ó ÂÈÊ·-
ÓÂÈ·ÎÔ‡˜ ‰Â›ÎÙ˜, ‚¿ÛÂÈ ÙˆÓ ÔÔ›ˆÓ Ù·˘ÙÔÔÈÔ‡-
ÓÙ·È. √È ÏÂÌÊÔ΢ÙÙ·ÚÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜ ‰È·ÎÚ›ÓÔÓÙ·È
·‰Ú¿ Û ÂΛӘ ÙˆÓ ∆ ΢ÙÙ¿ÚˆÓ (΢ÙÙ·ÚÈΤ˜) Î·È ÛÂ
ÂΛӘ ÙˆÓ µ (·ÓÙÈۈ̷ÙÈΤ˜), ·ÚfiÏÔ Ô˘ ˘¿Ú-
¯ÂÈ Î·È ÌÂÁ¿ÏË ·ÏÏËÏ›‰Ú·ÛË ÌÂٷ͇ ÙˆÓ ‰‡Ô ·˘-
ÙÒÓ Î˘ÙÙ·ÚÈÎÒÓ ÏËı˘ÛÌÒÓ (∂ÈÎfiÓ· 2). ™ÙËÓ ÎÏÈÓÈ-
΋ Ú¿ÍË ·˘Ù‹ Ë ÂÈÎ¿Ï˘„Ë Î·È ·ÏÏËÏ›‰Ú·ÛË ‰ÂÓ
Ú¤ÂÈ Ó· ˘ÔÙÈÌ¿Ù·È. ∂ÓÙÔ‡ÙÔȘ, ˆ˜ ÁÂÓÈÎfi ηÓfiÓ·
ÌÔÚԇ̠ӷ ıˆڋÛÔ˘Ì fiÙÈ Ù· ∆ ·ÙÙ·Ú· ›ӷÈ
ÈÔ ÛËÌ·ÓÙÈο ÛÙËÓ ¿Ì˘Ó· ¤Ó·ÓÙÈ ÙˆÓ ÈÒÓ, ÙˆÓ Ì˘-
΋وÓ, ÙˆÓ ·Ú·Û›ÙˆÓ, fiˆ˜ Î·È ¤Ó·ÓÙÈ ÙˆÓ fiÁΈÓ
Î·È ÙˆÓ Í¤ÓˆÓ ÈÛÙÈÎÒÓ ÌÔÛ¯Â˘Ì¿ÙˆÓ, ÂÓÒ Ù· µ ·Ù-
Ù·Ú· ¤¯Ô˘Ó ηıÔÚÈÛÙÈÎfi ÚfiÏÔ ÛÙËÓ ¿Ì˘Ó· ηٿ ÙˆÓ
‚·ÎÙËÚȉ›ˆÓ.
∆¤ÏÔ˜, ÌÈ· ÙÚ›ÙË ÔÌ¿‰· ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Â›Ó·È Ù·
Ê˘ÛÈο ΢ÙÙ·ÚÔÎÙfiÓ· (NK) ·ÙÙ·Ú·. ∆· Ê˘ÛÈο
΢ÙÙ·ÚÔÎÙfiÓ· ÚÔ¤Ú¯ÔÓÙ·È ·fi Úfi‰ÚÔÌ· ·ÙÙ·Ú·
ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ, Ù· ÂÚÈÛÛfiÙÂÚ· ÙˆÓ ÔÔ›ˆÓ
ÌÂÙ·Ó·ÛÙÂ‡Ô˘Ó ÛÙÔÓ ÛÏ‹Ó· ‹ ΢ÎÏÔÊÔÚÔ‡Ó ÛÙÔ
ÂÚÈÊÂÚÈÎfi ·›Ì· Î·È ·ÔÙÂÏÔ‡Ó ¤Ó· ÌÈÎÚfi ÔÛÔÛÙfi
ÙˆÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ (ÂÚ›Ô˘ 10%). ∆· ¡∫ ÏÂÌÊÔ-
·ÙÙ·Ú· ‰ÂÓ ¤¯Ô˘Ó ÂȉÈÎÔ‡˜ ˘Ô‰Ô¯Â›˜ Î·È ÛÙÂÚÔ‡-
ÓÙ·È ·ÓÔÛÔÏÔÁÈ΋˜ ÂȉÈÎfiÙËÙ·˜ Î·È ÌÓ‹Ì˘. ∆· NK
·ÙÙ·Ú· Ï‡Ô˘Ó Ù· ÌÔÏ˘Ṳ̂ӷ Ì ÈÔ‡˜ Î·È Î·ÚÎÈÓÈο
·ÙÙ·Ú·. ¢ÂÓ ··ÈÙÂ›Ù·È ÚÔËÁÔ‡ÌÂÓË Â˘·ÈÛıËÙÔ-
Ô›ËÛ‹ ÙÔ˘˜ Î·È ‰ÂÓ ÂÚÈÔÚ›˙ÔÓÙ·È ·fi Ù· ·ÓÙÈÁfiÓ·
ÙÔ˘ MHC, ¤ÙÛÈ Ë ÎÈÓËÙÔÔ›ËÛË Î·È Ë ‰Ú¿ÛË ÙÔ˘˜ ›-
Ó·È ¿ÌÂÛË.
∆Ô Ê·ÁÔ΢ÙÙ·ÚÈÎfi Û‡ÛÙËÌ·: ∆Ô Ê·ÁÔ΢ÙÙ·ÚÈÎfi
ÛΤÏÔ˜ ÙÔ˘ ·ÓÔÛÔÏÔÁÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÂÚÈÏ·Ì‚¿ÓÂÈ
ÔÈÎÈÏ›· ΢ÙÙ¿ÚˆÓ, Ô˘ ¤¯Ô˘Ó ÙËÓ ÈηÓfiÙËÙ· Ù˘
ÚfiÛÏ˄˘ Î·È Î·Ù·ÛÙÚÔÊ‹˜ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÒÓ. ∆¤-
ÙÔÈ· ·ÙÙ·Ú· Â›Ó·È Ù· ÔÏ˘ÌÔÚÊÔ‡ÚËÓ·, Ù· ˈÛÈ-
ÓfiÊÈÏ· Î·È Ù· ÌÔÓÔ·ÙÙ·Ú·, Ù· ÔÔ›·, ˘fi ÙËÓ Â›-
‰Ú·ÛË ¯ËÌÂÈÔÙ·ÎÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ, ÌÂÙ·Ó·ÛÙ‡ԢÓ
ÛÙÔ˘˜ ÈÛÙÔ‡˜. ∂Λ Ù· ÌÔÓÔ·ÙÙ·Ú· ÂÍÂÏ›ÛÛÔÓÙ·È ÛÂ
¶›Ó·Î·˜ 2. ∫ÏÈÓÈο ÛËÌ›· ·È‰ÈÒÓ Ì Èı·Ó‹ ·ÓÔÛÔ·Ó¿ÚÎÂÈ·
¢˘ÛÙÚÔÊ›·¢˘ÛÌÔÚÊ›·ÕÎÚ·: ÏËÎÙÚÔ‰·ÎÙ˘Ï›·, ˆ¯ÚfiÙ˘™ÙÔÌ·ÙÔÊ¿Ú˘ÁÁ·˜: Ô˘Ï›ÙȘ, ›ÌÔÓË Ô˘ÏÔÛÙÔÌ·Ù›Ùȉ·, ÂÚÈÔ-‰ÔÓÙ›Ùȉ·, ηı˘ÛÙÂÚË̤ÓË ·fiÙˆÛË ÓÂÔÁÈÏÒÓ Ô‰fiÓÙˆÓ∫·Ú‰È·ÁÁÂÈ·Îfi: Û˘ÁÁÂÓ‹˜ ηډÈÔ¿ıÂÈ·∞Ó·Ó¢ÛÙÈÎfi: ¯ÚfiÓÈ· Ó¢ÌÔÓÔ¿ıÂÈ·, ‚ÚÔÁ¯ÂÎٷۛ˜,ÓÂ˘Ì·ÙÔ΋Ϙ°·ÛÙÚÂÓÙÂÚÈÎfi: Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›· §ÂÌÊÈÎfi˜ ÈÛÙfi˜ (·Ì˘Á‰·Ï¤˜, ÏÂÌÊ·‰¤Ó˜, ı‡ÌÔ˜): ·Ô˘Û›· ‹ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ·, ı‡ÌˆÌ· ¢¤ÚÌ·-ÙÚ›¯Â˜: ¤Î˙ÂÌ·, ÂÙ¤¯ÂȘ, Ô˘Ï¤˜, ÎÔÎÎÈÒÌ·Ù·, ·ÁÁÂÈ-ÔÔ›‰ËÌ·, ·ÏÊÈÛÌfi˜, ·ÏˆÂΛ·√Êı·ÏÌÔ›: ·ÓˆÌ·Ï›Â˜ ·ÌÊÈ‚ÏËÛÙÚÔÂȉԇ˜, ÙËÏ·ÁÁÂÈÂÎٷۛ˜¡Â˘ÚÈÎfi Û‡ÛÙËÌ·: ·Ù·Í›·
¶›Ó·Î·˜ 1. ™ÙÔȯ›· ·fi ÙÔ ÈÛÙÔÚÈÎfi Û ·È‰È¿ Ì Èı·Ó‹ ·ÓÔÛÔ-·Ó¿ÚÎÂÈ·
∞ÙÔÌÈÎfi πÛÙÔÚÈÎfi§ÔÈÌÒÍÂȘ: ‚·ÚȤ˜ (.¯. ÌËÓÈÁÁ›Ùȉ·, ÔÛÙÂÔÌ˘ÂÏ›Ùȉ·)
˘ÔÙÚÔÈ¿˙Ô˘Û˜Ì ÔÏϷϤ˜ ÂÓÙÔ›ÛÂȘÌ ÂÈÏÔΤ˜Ì ·Ú·ÙÂٷ̤ÓË ‰È¿ÚÎÂÈ·Ì و¯‹ ·ÓÙ·fiÎÚÈÛË ÛÙË ıÂڷ›··ÔÛÙ‹Ì·Ù·
§ÔÈÌÔÁfiÓÔÈ ·Ú¿ÁÔÓÙ˜: ¢ηÈÚÈ·ÎÔ›∂Ì‚ÔÏÈ·ÛÌÔ›: Ì ÂÈÏÔ΋/Ïԛ̈ÍË∞ÏÏÂÚÁ›·: ›ÌÔÓ˵ÚÔÁ¯ÈÎfi ¿ÛıÌ·: ‚·Ú‡, ·ÓıÂÎÙÈÎfi ‹ ÎÔÚÙÈÎÔÂÍ·ÚÙÒÌÂÓÔÃ∞¶, ‚ÚÔÁ¯ÔÂÎٷۛ˜∞˘ÙÔ¿ÓÔÛ˜ ÂΉËÏÒÛÂȘ: ΢ÙÙ·ÚÔÂӛ˜, ·ÁÁÂÈ›Ùȉ· ∫·ı˘ÛÙÂÚË̤ÓË ·fiÙˆÛË ÔÌÊ¿ÏÈÔ˘ ÏÒÚÔ˘∫·ı˘ÛÙ¤ÚËÛË ÛˆÌ·ÙÈ΋˜ ·Ó¿Ù˘Í˘¢˘ÛÌÔÚÊ›·, ÌÈÎÚÔÎÂÊ·Ï›·ÃÚfiÓÈ· ‰È¿ÚÚÔÈ·
√ÈÎÔÁÂÓÂÈ·Îfi πÛÙÔÚÈÎfi¡ÂÔÁÓÈÎfi˜/µÚÂÊÈÎfi˜ ı¿Ó·ÙÔ˜ ·ÁÓÒÛÙÔ˘ ·ÈÙÈÔÏÔÁ›·˜°ÓˆÛÙ‹/¶Èı·Ó‹ ·ÓÔÛÔ·Ó¿ÚÎÂÈ·™˘ÁÁ¤ÓÂÈ· ÁÔÓ¤ˆÓ§ÔÈÌÒÍÂȘ ÛÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÂÚÈ‚¿ÏÏÔÓ (HIV)
8 ¢. X. ∫·Û›ÌÔ˜ Î·È Û˘Ó.
Paediatriki 2008;71:5-13
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·8
Ì·ÎÚÔÊ¿Á· ÁÓˆÛÙ¿ Î·È ˆ˜ ÈÛÙÈÔ·ÙÙ·Ú·. ∞ÚÎÂÙ¿
fiÚÁ·Ó· ¤¯Ô˘Ó ·Ó·Ù‡ÍÂÈ ÂȉÈÎÔ‡˜ ˘ÔÏËı˘ÛÌÔ‡˜
Ì·ÎÚÔÊ¿ÁˆÓ. ∆· ·ÙÙ·Ú· ÙÔ˘ Kupffer ÛÙÔ ‹·Ú,
ÙÔ˘ Langerhans ÛÙÔ ‰¤ÚÌ·, Ù˘ ÌÈÎÚÔÁÏÔ›·˜ ÛÙÔÓ
ÂÁΤʷÏÔ Î·È Ù· ÌÂÛ·ÁÁÂȷο ·ÙÙ·Ú· ÙˆÓ ÓÂÊÚÒÓ.
∆Ô ·Ú¯ÈÎfi ÁÂÁÔÓfi˜ Ù˘ Ê·ÁÔ΢ÙÙ¿ÚˆÛ˘ Â›Ó·È Ë ¯Ë-
ÌÂÈÔÙ·Í›·, ÏÂÈÙÔ˘ÚÁ›· Ì ÙËÓ ÔÔ›· ÚÔÛÂÏ·ÔÓÙ·È
Ù· Ô˘‰ÂÙÂÚfiÊÈÏ· ÛÙÔÓ ÙfiÔ Ù˘ ÊÏÂÁÌÔÓ‹˜. ∞˘Ùfi
ÂÈÙ˘Á¯¿ÓÂÙ·È Ì ‰È¿ÊÔÚÔ˘˜ ¯ËÌÂÈÔÙ·ÎÙÈÎÔ‡˜ ·-
Ú¿ÁÔÓÙ˜, Ì ΢ÚÈfiÙÂÚÔ ÙÔ ÎÏ¿ÛÌ· C5· ÙÔ˘ Û˘-
ÌÏËÚÒÌ·ÙÔ˜. ∆· Ê·ÁÔ·ٷڷ ·Ó·ÁÓˆÚ›˙Ô˘Ó Î·È
ÚÔÛÎÔÏÏÒÓÙ·È Û ÔÏÏÔ‡˜ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜. ªÂ
ÙËÓ Ô„ˆÓÈÓÔÔ›ËÛË ÙˆÓ ·ÓÙÈÁfiÓˆÓ, ÙË Û‡Ó‰ÂÛË ‰Ë-
Ï·‰‹ ÙÔ˘ ·ÓÙÈÁfiÓÔ˘ Ì ٷ ‹‰Ë Û¯ËÌ·ÙÈṲ̂ӷ ·ÓÙÈ-
ÛÒÌ·Ù· ‹/Î·È ÙÔ C3, Î·È Ì¤Ûˆ ·˘ÙÒÓ Î·È ÙˆÓ ˘Ô-
‰Ô¯¤ˆÓ ÙÔ˘˜ Ì ÙÔ Ê·ÁÔ·ÙÙ·ÚÔ, ·˘Í¿ÓÂÙ·È Ë
·Ó·ÁÓÒÚÈÛË Î·È Ë ÚÔÛÎfiÏÏËÛË ÙˆÓ Ê·ÁÔ΢ÙÙ¿ÚˆÓ
ÛÙÔ˘˜ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜, ÒÛÙ ӷ Ê·ÁÔ΢ÙÙ·Úˆ-
ıÔ‡Ó Î·È Ó· Á›ÓÂÈ Ë ‚·ÎÙËÚÈÔÎÙÔÓ›·. ªÂ ·˘Ùfi ÙÔÓ
ÙÚfiÔ, ÙÔ Ê·ÁÔ΢ÙÙ·ÚÈÎfi Û‡ÛÙËÌ· ·›˙ÂÈ ÛËÌ·ÓÙÈ-
Îfi ÚfiÏÔ ÛÙËÓ ¿Ì˘Ó·, ȉȷÈÙ¤Úˆ˜ ηٿ ‚·ÎÙËÚȉȷ-
ÎÒÓ ÏÔÈÌÒÍÂˆÓ (7,8).
∆Ô Û‡ÛÙËÌ· ÙÔ˘ Û˘ÌÏËÚÒÌ·ÙÔ˜: ∆Ô Û‡ÛÙËÌ· ÙÔ˘
Û˘ÌÏËÚÒÌ·ÙÔ˜ Û˘ÌÌÂÙ¤¯ÂÈ Î·È ÂÓÈÛ¯‡ÂÈ ÙËÓ ÔÈÎÈ-
Ï›· ÂȉÈÎÒÓ Î·È ÌË ÂȉÈÎÒÓ ·Ì˘ÓÙÈÎÒÓ ÏÂÈÙÔ˘ÚÁÈÒÓ,
fiˆ˜ Ë ¯ËÌÂÈÔÙ·Í›· Î·È Ë Ô„ˆÓÈÓÔÔ›ËÛË. ∞ÔÙÂ-
ÏÂ›Ù·È ·fi ÂÚÈÛÛfiÙÂÚ˜ ·fi 20 ÚˆÙ½Ó˜, Ô˘ ÌÂ-
Ù¿ ·fi ÂÓÂÚÁÔÔ›ËÛË, ·ÏÏËÏÂȉÚÔ‡Ó Ì ηıÔÚÈ-
Ṳ̂ÓË ÛÂÈÚ¿ ÁÈ· Ó· ·Ú¿ÁÔ˘Ó ÂÓÂÚÁ¿ ÚÔ˚fiÓÙ·. ∆·
ÎÏ¿ÛÌ·Ù· ÙÔ˘ Û˘ÌÏËÚÒÌ·ÙÔ˜ ÂÓÂÚÁÔÔÈÔ‡Ó Ù·
Ô˘‰ÂÙÂÚfiÊÈÏ· Î·È Ù· Ì·ÎÚÔÊ¿Á·, Ù· ÔÔ›· Ï‡Ô˘Ó
·Â˘ı›·˜ Ù· ‚·ÎÙËÚ›‰È· Î·È Ù· ·ÙÙ·Ú· ÛÙfi¯Ô˘˜
Î·È ·˘Í¿ÓÔ˘Ó ÙË ‰È·‚·ÙfiÙËÙ· ÙˆÓ ·ÁÁ›ˆÓ. ∏ ÂÓÂÚ-
ÁÔÔ›ËÛË Î·È ÙˆÓ ‰‡Ô Ô‰ÒÓ ÙÔ˘ Û˘ÌÏËÚÒÌ·ÙÔ˜,
Ù˘ ÎÏ·ÛÈ΋˜ Î·È Ù˘ ÂÓ·ÏÏ·ÎÙÈ΋˜, Ô‰ËÁ› ÙÂÏÈο
ÛÙË ‰Ú·ÛÙËÚÈÔÔ›ËÛË ÙÔ˘ C3 Î·È ÙËÓ ·Ú·ÁˆÁ‹ ÙˆÓ
›‰ÈˆÓ ÂÓÂÚÁÒÓ ‚ÈÔÏÔÁÈÎÒÓ ÎÏ·ÛÌ¿ÙˆÓ. ™ÙÔÓ ¿ÓıÚˆ-
Ô, ÔÈ ·Ó¿ÚÎÂȘ ÙˆÓ ÎÏ·ÛÌ¿ÙˆÓ ÙÔ˘ Û˘ÌÏËÚÒ-
Ì·ÙÔ˜ Û˘Ó‰¤ÔÓÙ·È Ì ¯·Ú·ÎÙËÚÈÛÙÈο ÎÏÈÓÈο Û‡Ó-
‰ÚÔÌ·. ∞ÛıÂÓ›˜ Ì ·Ó¿ÚÎÂÈ· ÙÔ˘ C1, C4 ‹ C2 Û˘-
Ó‹ıˆ˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÎÏÈÓÈ΋ ÂÈÎfiÓ· Û˘Ó‰ÚfiÌÔ˘
Ô˘ ÌÔÈ¿˙ÂÈ Ì ÂÚ˘ıËÌ·ÙÒ‰Ë Ï‡ÎÔ (ÂÍ¿ÓıËÌ· ·-
ÚÂÈÒÓ, ·ÚıÚ·ÏÁ›·, ÛÂÈÚ·Ì·ÙÔÓÂÊÚ›Ùȉ·, ˘ÚÂÙfi ‹
¯ÚfiÓÈ· ·ÁÁÂÈ›Ùȉ·) Î·È Û·Ó›ˆ˜ Ì ̆ ÔÙÚÔÈ¿˙Ô˘Û˜
˘ÔÁÂÓ›˜ ÏÔÈÌÒÍÂȘ. ∞ÛıÂÓ›˜ Ì ·Ó¿ÚÎÂÈ· ÙÔ˘
C3 ˘ÔʤÚÔ˘Ó ·fi ‚·ÚȤ˜, ˘ÔÙÚÔÈ¿˙Ô˘Û˜, ˘Ô-
ÁfiÓÔ˘˜ ÏÔÈÌÒÍÂȘ, ÂÓÒ ·Ú·ÙËÚÂ›Ù·È ÂÓÙ˘ˆÛȷ΋
Û˘Û¯¤ÙÈÛË ÙˆÓ ·Ó·ÚÎÂÈÒÓ ÙˆÓ ÎÏ·ÛÌ¿ÙˆÓ ÙÔ˘ ÙÂ-
ÏÈÎÔ‡ ÛΤÏÔ˘˜ (C5, C6, C7, C8) Ì ˘ÔÙÚÔÈ¿˙Ô˘-
Û˜ ÏÔÈÌÒÍÂȘ ·fi Ó·˚ÛÛ¤ÚȘ (ÁÔÓfiÎÎÔÎÔ, ÌËÓÈÁÁÈ-
ÙȉfiÎÔÎÎÔ) (3,8,9).
∞ÓÔÛÔ·Ó¿ÚÎÂȘ Î·È ÏÔÈÌÒÍÂȘ
√ˆ˜ ‹‰Ë ·Ó·Ê¤ÚıËÎÂ, fiÏ· Ù· ·È‰È¿ ¤¯Ô˘Ó ÙËÓ
ÂÌÂÈÚ›· ÙˆÓ ÏÔÈÌÒ͈Ó. ∆Ô ̄ ·Ú·ÎÙËÚÈÛÙÈÎfi Ô˘ ı·
·ÔÙÂϤÛÂÈ ÎÚÈÙ‹ÚÈÔ ÂÍÂȉÈÎÂ˘Ì¤ÓÔ˘ ÂϤÁ¯Ô˘ ÁÈ·
·ÓÔÛÔ·Ó¿ÚÎÂÈ· Â›Ó·È Ë ·˘ÍË̤ÓË Â˘·ÈÛıËÛ›·
ÛÙȘ ÏÔÈÌÒÍÂȘ. ∞˘Ùfi ÌÔÚ› Ó· ÛËÌ·›ÓÂÈ ·˘ÍË̤ÓË
9∞ÓÔÛÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ Û ÏÔÈÌÒÍÂȘ
¶·È‰È·ÙÚÈ΋ 2008;71:5-13
¶›Ó·Î·˜ 3. ™˘Ó‹ıË ·ıÔÁfiÓ· ˘Â‡ı˘Ó· ÁÈ· ÏÔÈÌÒÍÂȘ ·Ó¿ÏÔÁ· Ì ÙÔ ·ÓÔÛÈ·Îfi ¤ÏÏÂÈÌÌ·
∞ÓÔÛÈ·Îfi ŒÏÏÂÈÌÌ· ™˘Ó‹ıË ¶·ıÔÁfiÓ·
∞ÓÙÈۈ̷ÙÈ΋ ·Ó¿ÚÎÂÈ· µ·ÎÙËÚ›‰È·: ¯Ú˘Û›˙ˆÓ ÛÙ·Ê˘ÏfiÎÔÎÎÔ˜, ·ÈÌfiÊÈÏÔ˜ ÈÓÊÏÔ˘¤ÓÙÛ· Ù‡Ô˘ b,ÛÙÚÂÙfiÎÔÎÎÔ˜
∂ÓÙÂÚÔÈÔ›: ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜, echo
∞Ó¿ÚÎÂÈ· ∆ ΢ÙÙ¿ÚˆÓ ∂Ó‰Ô΢ÙÙ·ÚÈο ‚·ÎÙËÚ›‰È·: Ì˘ÎÔ‚·ÎÙËÚ›‰È·, ÏÈÛÙ¤ÚÈ·
πÔ› ª‡ÎËÙ˜: Candida, ·Û¤ÚÁÈÏÏÔ˜
ªÈÎÙ‹ ·Ó¿ÚÎÂÈ· ∆ & µ ΢ÙÙ¿ÚˆÓ µ·ÎÙËÚ›‰È·(¯˘ÌÈ΋ & ΢ÙÙ·ÚÈ΋) ª‡ÎËÙ˜
πÔ›: CMV, ¤Ú˘, ÈÏ·Ú¿˜¶·Ú¿ÛÈÙ·: ÎÚ˘ÙfiÎÔÎÎÔ˜, ÎÚ˘ÙÔÛÔÚ›‰ÈÔ¶ÚˆÙfi˙ˆ·: pneumocystis carinii
∞Ó¿ÚÎÂȘ Ê·ÁÔ΢ÙÙ¿ÚˆÓ µ·ÎÙËÚ›‰È·: ÛÙ·Ê˘ÏfiÎÔÎÎÔ˜ ¯Ú˘Û›˙ˆÓ, Gram (-)ª‡ÎËÙ˜: ·Û¤ÚÁÈÏÏÔ˜ ÕÙ˘· Ì˘ÎÔ‚·ÎÙËÚ›‰È·
∞Ó¿ÚÎÂȘ Ê˘ÛÈ΋˜ ·ÓÔÛ›·˜ µ·ÎÙËÚ›‰È· (˘ÔÁfiÓ·)ª˘ÎÔ‚·ÎÙËÚ›‰È·πfi˜ ·ÓıÚˆ›ÓˆÓ ıËÏˆÌ¿ÙˆÓ (HPV)
∞Ó¿ÚÎÂȘ ÙÔ˘ Û˘ÌÏËÚÒÌ·ÙÔ˜ µ·ÎÙËÚ›‰È·: Ó·˚ÛÛ¤ÚÈ· ÌËÓÈÁÁ›Ùȉ·˜
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·9
Û˘¯ÓfiÙËÙ· (ÂÚÈÛÛfiÙÂÚ˜ ·fi 8-10 ·Ó¿ ¤ÙÔ˜), ·˘-
ÍË̤ÓË ÛÔ‚·ÚfiÙËÙ· ηÈ/‹ ·Ú·ÙÂٷ̤ÓË ‰È¿ÚÎÂÈ·
ÙˆÓ ÏÔÈÌÒ͈Ó, ‚·ÚȤ˜ ÂÈÏÔΤ˜, ÏÔÈÌÒÍÂȘ ·fi
·Û˘Ó‹ıÂȘ ‹ ¢ηÈÚÈ·ÎÔ‡˜ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜ (¯ˆ-
Ú›˜ Ï‹ÚË ·ÔηٿÛÙ·ÛË), Ì ·˘ÍË̤ÓË ÂÍ¿ÚÙËÛË
·fi Ù· ·ÓÙÈ‚ÈÔÙÈο Î·È Ù¤ÏÔ˜ Ì و¯‹ ·ÓÙ·fiÎÚÈ-
ÛË ÛÙË ıÂڷ¢ÙÈ΋ ·ÁˆÁ‹ (10).
ÀÔ„›· ·ıÔÏÔÁÈÎÔ‡ ·ÓÔÛÔÏÔÁÈÎÔ‡ ˘ÔÛÙÚÒÌ·-
ÙÔ˜ Ù›ıÂÙ·È Â›Û˘ ÛÂ: ÔÚÈṲ̂Ó˜ ‰ÂÚÌ·ÙÈΤ˜ ÂΉË-
ÏÒÛÂȘ (ÂÙ¤¯ÂȘ, ‚·Ú‡ ¤Î˙ÂÌ·, ηÓÙÈÓÙ›·ÛË), ¯Úfi-
ÓÈ· ‰È¿ÚÚÔÈ·, ÌÂȈ̤ÓË ·Ó¿Ù˘ÍË, ‡·ÚÍË Ë·ÙÔ-
ÛÏËÓÔÌÂÁ·Ï›·˜, ˘ÔÙÚÔÈ¿˙ÔÓÙ· ·ÔÛÙ‹Ì·Ù·,
˘ÔÙÚÔÈ¿˙Ô˘Û· ÔÛÙÂÔÌ˘ÂÏ›Ùȉ· Î·È ‚·ÚÈ¿ ·ÏÏÂÚÁÈ-
ο ‹ ·˘ÙÔ¿ÓÔÛ· ÓÔÛ‹Ì·Ù·. ∞ÎfiÌË, ¤ÏÂÁ¯Ô˜ ··ÈÙ›-
Ù·È ÛÂ Û˘ÁÎÂÎÚÈ̤Ó˜ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ (·Ù·Í›·,
ÙËÏ·ÁÁÂÈÂÎÙ·Û›·, ıÚÔÌ‚ÔÂÓ›·, ¤Î˙ÂÌ·, ÙÂÙ·Ó›·), ÔÈ
Ôԛ˜ Î·È Û˘Ó‰¤ÔÓÙ·È ÌÂ Û˘ÁÎÂÎÚÈ̤ӷ Û‡Ó‰ÚÔÌ·.
¶·Ú¿ÏÏËÏ· Ì ÙÔ ÂÓ‰Âϯ¤˜ ÈÛÙÔÚÈÎfi, Î·È Ë ÚÔ-
ÛÂÎÙÈ΋ Ê˘ÛÈ΋ ÂͤٷÛË ‚ÔËı¿ÂÈ ÛÙËÓ ÂÎÙ›ÌËÛË ÙÔ˘
ÚÔ‚Ï‹Ì·ÙÔ˜. ªÂÁ¿ÏË ÛËÌ·Û›· ÛÙËÓ ·ÍÈÔÏfiÁËÛË
ÙÔ˘ ·ÚÚÒÛÙÔ˘ ¤¯ÂÈ Ë Ù˘¯fiÓ ÛÔ‚·Ú‹ ·ÓÙ›‰Ú·ÛË ÛÙ·
ÂÌ‚fiÏÈ·, ȉ›ˆ˜ Ì ˙ÒÓÙ˜ ÈÔ‡˜, Ë ‡·ÚÍË ı·Ó¿ÙÔ˘ ÛÂ
ÓËȷ΋ ËÏÈΛ· ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ· ‹ Ë ‡·ÚÍË Û˘ÁÁÂ-
ÓÒÓ Ì ·˘ÙÔ¿ÓÔÛ· ÓÔÛ‹Ì·Ù·, ·ÏÏÂÚÁ›Â˜ ‹ ηÎÔ‹ıÂÈ-
˜ ÙÔ˘ ÏÂÌÊÈÎÔ‡ ÈÛÙÔ‡ (¶›Ó·Î˜ 1 Î·È 2).
¡ÔÛÔÏÔÁÈ΋ ÔÓÙfiÙËÙ· - ™˘¯ÓfiÙËÙ·: √È ·ÓÔÛÔ·ÓÂ-
¿ÚÎÂȘ ‰È·ÎÚ›ÓÔÓÙ·È ·ÊÂÓfi˜ Û ڈÙÔ·ı›˜ ‹
‰Â˘ÙÂÚÔ·ı›˜, ·ÊÂÙ¤ÚÔ˘ Û ·˘Ù¤˜ Ô˘ ÂÌϤÎÔ-
ÓÙ·È Ì˯·ÓÈÛÌÔ› Ù˘ ÂȉÈ΋˜ (¯˘ÌÈ΋˜, ΢ÙÙ·ÚÈ΋˜)
‹ ÌË ÂȉÈ΋˜ (.¯. Ê·ÁÔ·ÙÙ·Ú·, Û˘Ìϋڈ̷) ·ÓÔ-
Û›·˜. ™ÙËÓ ·È‰È΋ ËÏÈΛ· ΢ÚÈ·Ú¯Ô‡Ó ÔÈ ÚˆÙÔ·-
ı›˜ ·ÓÔÛÔ·Ó¿ÚÎÂȘ (¶∞∞), ÂÓÒ ÛÙËÓ ÂÓ‹ÏÈÎË
˙ˆ‹ ÔÈ ‰Â˘ÙÂÚÔ·ı›˜ (11).
√È ¶∞∞ Â›Ó·È Û¿ÓÈ· ÓÔÛ‹Ì·Ù·. ∏ Û˘¯ÓfiÙËÙ¿
ÙÔ˘˜ Â›Ó·È 1:10.000 ¿ÙÔÌ· ÛÙÔÓ ÁÂÓÈÎfi ÏËı˘ÛÌfi, ·Ó
ÂÍ·ÈÚ¤ÛÂÈ Î·Ó›˜ ÙËÓ ·ÓÙÈۈ̷ÙÈ΋ ·Ó¿ÚÎÂÈ· Ù˘
·ÓÔÛÔÛÊ·ÈÚ›Ó˘ ∞ (IgA), Ô˘ ¤¯ÂÈ ÂÚ›Ô˘ 20Ï¿-
ÛÈ· Û˘¯ÓfiÙËÙ·. À¿Ú¯ÂÈ ÌÂÁ¿ÏË ÂÙÂÚÔÁ¤ÓÂÈ· ˆ˜
ÚÔ˜ ÙËÓ ·ÈÙÈÔ·ıÔÁ¤ÓÂÈ· Î·È ÙË ÁÂÓÂÙÈ΋ ‰È·Ù·Ú·-
¯‹. ª¤¯ÚÈ Û‹ÌÂÚ· ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ÂÚÈÛÛfiÙÂÚ˜
·fi 150 ¶∞∞ Ì ‰È·ÊÔÚÂÙÈÎfi Ë Î·ıÂÌ›· ·ÓÔÛÔÏÔÁÈ-
Îfi ˘fiÛÙڈ̷, ·ÏÏ¿ Î·È Ì ÌÂÁ¿ÏË ÔÈÎÈÏÔÌÔÚÊ›·
fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ· Î·È ÙË ‚·Ú‡ÙËÙ·
ÙˆÓ ÂΉËÏÒÛÂˆÓ (12-14).
∂ÚÁ·ÛÙËÚȷ΋ ‰ÈÂÚ‡ÓËÛË
∆Ô ·È‰› ÌÂ Û˘¯Ó¤˜ ÏÔÈÌÒÍÂȘ ÌÔÚ› Ó· ηٷٷ-
¯ı› Û ÂΛÓÔ Ô˘ ¯ÚÂÈ¿˙ÂÙ·È Ï‹ÚË ·ÓÔÛÔÏÔÁÈ΋
ÂÎÙ›ÌËÛË, ÂΛÓo Ô˘ ‰ÈηÈÔ‡Ù·È ‚·ÛÈÎfi ¤ÏÂÁ¯Ô ηÈ
ÛÙË ÌÂÁ¿ÏË ÏÂÈÔ„ËÊ›· ÙˆÓ ·È‰ÈÒÓ Ô˘ ·ÏÒ˜
¯ÚÂÈ¿˙ÔÓÙ·È ·Ú·ÎÔÏÔ‡ıËÛË. ∏ ηı˘ÛÙ¤ÚËÛË Ù˘
‰È¿ÁÓˆÛ˘ ¤¯ÂÈ ÛÔ‚·Úfiٷ٘ Û˘Ó¤ÂȘ ÁÈ· ÙÔÓ ·ÛıÂ-
Ó‹, ÂÓÒ Ë ‰È¿ÁÓˆÛË ÛÙË ÌÈÎÚfiÙÂÚË ‰˘Ó·Ù‹ ËÏÈΛ·
‚ÔËı¿ ÛÙËÓ “·ÈÙÈÔÏÔÁÈ΋” ıÂڷ›· Î·È ÙËÓ ÚfiÏË„Ë
ÙˆÓ ÂÈÏÔÎÒÓ, Ì ÙËÓ ¿ÌÂÛË Î·È ÛˆÛÙ‹ Û˘Ìو̷-
ÙÈ΋ ·ÁˆÁ‹. ∂ÈϤÔÓ, Ë ‰È·Ù‹ÚËÛË ÙÔ˘ ¿Û¯ÔÓÙÔ˜
Û ηϋ ηٿÛÙ·ÛË ı· ÂÈÙÚ¤„ÂÈ ÌÂÏÏÔÓÙÈο ÙËÓ
ÂÊ·ÚÌÔÁ‹ Èı·ÓÒÓ ÚÈ˙ÈÎÒÓ ·ÈÙÈÔÏÔÁÈÎÒÓ ıÂÚ·ÂÈÒÓ.
Œ¯ÔÓÙ·˜ ÁÓÒÛË ÙˆÓ ·ÓÔÛÔÏÔÁÈÎÒÓ Ì˯·ÓÈÛÌÒÓ
Î·È ÙÔ˘ ÙÚfiÔ˘ ¿Ì˘Ó·˜ ¤Ó·ÓÙÈ ÙˆÓ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÒÓ,
ηÙ¢ı˘ÓfiÌ·ÛÙ ÛÙÔ˘˜ ÏÔÈÌÔÁfiÓÔ˘˜ ·Ú¿ÁÔÓÙ˜,
·fi ÙÔ˘˜ ÔÔ›Ô˘˜ ÎÈÓ‰˘Ó‡ÂÈ Ô ¿ÚÚˆÛÙÔ˜ Ì ·ÓÔÛÔ·-
Ó¿ÚÎÂÈ· (¶›Ó·Î·˜ 3) (3,11). ∞ÎÔÏÔ˘ıÒÓÙ·˜ ·Ó¿ÏÔ-
ÁÔ ÙÚfiÔ ÛΤ„˘ Î·È ·ÓÙ›ÛÙÚÔÊË Ô‰fi, ÚÔÛ·Ó·ÙÔÏÈ-
˙fiÌ·ÛÙ ÛÙÔ Èı·Ófi, ¿Û¯ÔÓ, ·ÓÔÛÔÏÔÁÈÎfi ÛΤÏÔ˜.
“¶˘Í›‰·” Â›Ó·È ÙÔ Â›‰Ô˜ Ù˘ Ïԛ̈͢ Î·È Ë ÎÏÈÓÈ΋
ÚÔ‚ÔÏ‹ Ù˘. ∏ ÂÌÊ¿ÓÈÛË ·ÔÛÙËÌ¿ÙˆÓ Î·È “ÂÓ Ùˆ
‚¿ıÂÈ” ÏÔÈÌÒÍÂˆÓ ·fi ÛÙ·Ê˘ÏfiÎÔÎÎÔ, ÛÂÚÚ¿ÙÈ· ‹
·Û¤ÚÁÈÏÏÔ Î·Ù¢ı‡ÓÔ˘Ó ÙË ÛΤ„Ë Ì·˜ Û ·Ó¿Ú-
ÎÂÈ· ÙˆÓ ÔÏ˘ÌÔÚÊÔ˘Ú‹ÓˆÓ. √È ˘ÔÙÚÔÈ¿˙Ô˘Û˜
ÏÔÈÌÒÍÂȘ ·fi Ó·˚ÛÛ¤ÚÈ· (ÁÔÓfiÎÔÎÎÔ ‹ ÌËÓÈÁÁÈÙȉfi-
ÎÔÎÎÔ) ÂÌÊ·Ó›˙ÔÓÙ·È Û ¿ÙÔÌ· Ì ·Ó¿ÚÎÂÈ· ÙˆÓ
ÎÏ·ÛÌ¿ÙˆÓ ÙÔ˘ ÙÂÏÈÎÔ‡ ÛΤÏÔ˘˜ ÙÔ˘ Û˘ÌÏËÚÒ-
Ì·ÙÔ˜, ÂÓÒ Ù· ˘ÔÁfiÓ· ‚·ÎÙËÚ›‰È· (·ÈÌfiÊÈÏÔ˜,
Ó¢ÌÔÓÈfiÎÔÎÎÔ˜, „¢‰ÔÌÔÓ¿‰·) ·Ó·Ù‡ÛÛÔ˘Ó Ófi-
ÛÔ Û ˘fiÛÙڈ̷ ·ÓÙÈۈ̷ÙÈ΋˜ ·Ó¿ÚÎÂÈ·˜ (1).
10 ¢. X. ∫·Û›ÌÔ˜ Î·È Û˘Ó.
Paediatriki 2008;71:5-13
¶›Ó·Î·˜ 4. ¢ÈÂÚ‡ÓËÛË ·ÓÔÛÔ·Ó¿ÚÎÂÈ·˜ Û ·È‰È¿ ÌÂ Û˘¯Ó¤˜ ÏÔÈÌÒÍÂȘ
∞Ú¯ÈÎfi˜ ∂ÚÁ·ÛÙËÚÈ·Îfi˜ ŒÏÂÁ¯Ô˜°ÂÓÈ΋ ·›Ì·ÙÔ˜ ∞ÓÔÛÔÛÊ·ÈÚ›Ó˜ ÔÚÔ‡: IgG, IgA, IgM, IgEπÛÔ·ÈÌÔÛ˘ÁÎÔÏÏËÙ›Ó˜ ™˘Ìϋڈ̷ C3, C4
∂ȉÈÎfi˜ ∂ÚÁ·ÛÙËÚÈ·Îfi˜ ŒÏÂÁ¯Ô˜ÀÔÙ¿ÍÂȘ ·ÓÔÛÔÛÊ·ÈÚÈÓÒÓ ÛÂ Û˘¯Ó¤˜ ‚·ÎÙËÚȉȷΤ˜ ÏÔÈÌÒÍÂȘŒÏÂÁ¯Ô˜ Û˘ÌÏËÚÒÌ·ÙÔ˜ Û ‚·ÚȤ˜ ‚·ÎÙËÚȉȷΤ˜ ÏÔÈÌÒÍÂȘ, fiˆ˜ ·fi Ó·˚ÛÛ¤ÚÈ· ÌËÓÈÁÁ›Ùȉ·˜ŒÏÂÁ¯Ô˜ Ê·ÁÔ΢ÙÙ¿Úˆv Û ÏÔÈÌÒÍÂȘ ·fi ¯Ú˘Û›˙ÔÓÙ· ÛÙ·Ê˘ÏfiÎÔÎÎÔ, Gram (-) ‚·ÎÙËÚ›‰È·, ̇ÎËÙ˜ÀÔÏËı˘ÛÌÔ› ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Û ‚·ÚȤ˜ ÈÔÁÂÓ›˜ ‹ ¢ηÈÚȷΤ˜ ÏÔÈÌÒÍÂȘ ŒÏÂÁ¯Ô˜ ÁÈ· HIV Û ¢ηÈÚȷΤ˜ ÏÔÈÌÒÍÂȘ, TBC, ‚·ÚȤ˜ ÏÔÈÌÒÍÂȘ
∂ÍÂȉÈÎÂ˘Ì¤ÓÔ˜ ŒÏÂÁ¯Ô˜ (‚Ϥ ¶›Ó·Î· 5)
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·10
∞ÓÙ›ıÂÙ·, Ë ·Ó¿Ù˘ÍË ÂÓ‰Ô΢ÙÙ¿ÚÈˆÓ ÔÚÁ·ÓÈÛÌÒÓ
ÂÓÔ¯ÔÔÈ› ¤ÏÏÂÈÌÌ· ÛÙÔ Î˘ÙÙ·ÚÈÎfi ÛΤÏÔ˜ Ù˘ ·ÓÔ-
Û›·˜ Î·È È‰È·›ÙÂÚ· ÛÙ· ∆ ÏÂÌÊÔ·ÙÙ·Ú·.
¶ÔÈfiÓ ¤ÏÂÁ¯Ô ı· ·ÎÔÏÔ˘ı‹ÛÂÈ Ô ·È‰›·ÙÚÔ˜ ÛÙÔ
¿ÚÚˆÛÙÔ ·È‰› Ô˘ ı· ÙÂı› Ë ̆ Ô„›· Ù˘ ·ÓÔÛÔ·ÓÂ-
¿ÚÎÂÈ·˜ (9,11,15-17); √ ·Ú¯ÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÂÚÈÏ·Ì-
‚¿ÓÂÈ: ÁÂÓÈ΋ ·›Ì·ÙÔ˜, ·ÓÔÛÔÛÊ·ÈÚ›Ó˜ ÔÚÔ‡, Û˘-
Ìϋڈ̷ Î·È ÂȉÈÎfiÙÂÚ· ÛÙ· ‚Ú¤ÊË ÈÛÔ·ÈÌÔÛ˘-
ÁÎÔÏÏËÙ›Ó˜ (¶›Ó·Î·˜ 4). √ ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙÔ˘
·ÚÈıÌÔ‡ ÙˆÓ Ï¢ÎÒÓ Î·È ÙÔ˘ Ù‡Ô˘ ÙÔ˘˜ ·ÔÎÏ›ÂÈ
11∞ÓÔÛÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ Û ÏÔÈÌÒÍÂȘ
¶·È‰È·ÙÚÈ΋ 2008;71:5-13
¶›Ó·Î·˜ 5. ∞ÏÁfiÚÈıÌÔ˜ ·ÓÔÛÔÏÔÁÈÎÔ‡ ÂϤÁ¯Ô˘ ·È‰ÈÒÓ Ì ‚¿ÛË ÙȘ ÏÔÈÌÒÍÂȘ
¶·ıÔÁfiÓ· µ·ÎÙËÚ›‰È· ™Ù·Ê˘ÏfiÎÔÎÎÔ˜ ¡·˚ÛÛ¤ÚÈ· ÌËÓÈÁÁ›Ùȉ·˜ ∂Ó‰Ô΢ÙÙ¿ÚÈ·:ª˘ÎÔ‚·ÎÙËÚ›‰È·, ÏÈÛÙ¤ÚÈ·, ÈÔ›, ÚˆÙfi˙ˆ·, ̇ÎËÙ˜
∫ÏÈÓÈ΋ ÂÈÎfiÓ· ÀÔÙÚÔÈ¿˙Ô˘Û˜ ÀÔÙÚÔÈ¿˙Ô˘Û˜ ¶ÔÏϷϤ˜ ÌËÓÈÁÁ›Ùȉ˜ ¶ÔÈΛÏÏÂÈÏÔÈÌÒÍÂȘ ‹ ‚·ÚȤ˜ ÏÔÈÌÒÍÂȘ,.¯. ·Ó·Ó¢ÛÙÈÎÔ‡ ·ÔÛÙ‹Ì·Ù·
¶Èı·Ó¤˜ ∞Á·ÌÌ·ÛÊ·ÈÚÈÓ·ÈÌ›· ∞Ó¿ÚÎÂÈ· ∞Ó¿ÚÎÂÈ· ¢È·Ù·Ú·¯‹ ΢ÙÙ·ÚÈ΋˜‰È·ÁÓÒÛÂȘ ÀÂÚ IgM Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ Û˘ÌÏËÚÒÌ·ÙÔ˜ ·ÓÔÛ›·˜
∞Ó¿ÚÎÂÈ· ¢È·Ù·Ú·¯‹ ¢È·Ù·Ú·¯‹ ™˘Ó‰˘·Ṳ̂ÓË
˘ÔÙ¿ÍÂˆÓ IgG ·ÓÙÈۈ̷ÙÈ΋˜ ·ÓÙÈۈ̷ÙÈ΋˜ ·ÓÔÛÔ·Ó¿ÚÎÂÈ·
∞Ó¿ÚÎÂÈ· ·¿ÓÙËÛ˘ ·¿ÓÙËÛ˘
·ÓÙÈۈ̷ÙÈ΋˜·¿ÓÙËÛ˘
∞Ú¯ÈÎfi˜ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜(¶›Ó·Î·˜ 4)
∞ÓÔÛÔÏÔÁÈÎfi˜¤ÏÂÁ¯Ô˜
∂ȉÈÎfi˜ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ (¶›Ó·Î·˜ 4)
¶¿Û¯ÔÓ ŒÏÏÂÈÌÌ· ŒÏÏÂÈÌÌ· ¢È·Ù·Ú·¯‹ ∞Ó¿ÚÎÂȘ ÙÔ˘ ∆ ΢ÙÙ¿ÚÔ˘·ÓÔÛÈ·Îfi ·ÓÙÈۈ̷ÙÈ΋˜ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ Û˘ÌÏËÚÒÌ·ÙÔ˜ ªÈÎÙ¤˜ ·Ó¿ÚÎÂȘÛΤÏÔ˜ ·¿ÓÙËÛ˘
∂ÍÂȉÈÎÂ˘Ì¤ÓÔ˜ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜§ÂÈÙÔ˘ÚÁ›Â˜ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ, ·ÓÔÛÔ΢ÙÙ¿ÚˆÓ
ÌÔÚÈ·Îfi˜ Î·È ÁÂÓÂÙÈÎfi˜ ¤ÏÂÁ¯Ô˜
¶·Ú·‰Â›ÁÌ·Ù· Btk ÛÂ Ê˘ÏÔÛ‡Ó‰ÂÙË πÛÔ¤Ó˙˘ÌÔ Ác ·Ï˘Û›‰· ÁÈ· µª∞∞
ÂÍÂȉÈÎÂ˘Ì¤ÓÔ˘ ·-Á-ÛÊ·ÈÚÈÓ·ÈÌ›· ΢ÙÙÔ¯ÚÒÌ·ÙÔ˜ ¶ÚˆÙ½ÓË/ÁÔÓ›‰ÈÔ Û˘Ó‰ÚfiÌÔ˘ ÂϤÁ¯Ô˘ CD40L Û ˘ÂÚ IgM I °ÔÓ›‰ÈÔ gp 91 phox Wiskott-Aldrich (WASP)
™˘¯ÓfiÙÂÚ˜ º˘ÏÔÛ‡Ó‰ÂÙË ÃÚfiÓÈ· ∞Ó¿ÚÎÂÈ· ·Ú·ÁfiÓÙˆÓ ªÈÎÙ‹ ·ÓÔÛÔ·Ó¿ÚÎÂÈ·‰È·ÁÓÒÛÂȘ ·Á·ÌÌ·ÛÊ·ÈÚÈÓ·ÈÌ›· ÎÔÎÎȈ̷Ù҉˘ Û˘ÌÏËÚÒÌ·ÙÔ˜ (c) ¢È·Ù·Ú·¯‹ ΢ÙÙ·ÚÈ΋˜
∞Ó¿ÚÎÂÈ· ÓfiÛÔ˜ ·ÓÔÛ›·˜˘ÔÙ¿ÍÂˆÓ IgG ∞Ó¿ÚÎÂÈ· ÌÔÚ›ˆÓ ™‡Ó‰ÚÔÌÔ Di GeorgeÀÂÚ πgM Û‡Ó‰ÚÔÌ· ÚÔÛÎfiÏÏËÛ˘ (LAD)
∞Ù·Í›· ÙËÏ·ÁÁÂÈÂÎÙ·Û›·∂ȉÈÎfi ·ÓÙÈۈ̷ÙÈÎfi ™‡Ó‰ÚÔÌÔ Wiskott-Aldrich¤ÏÏÂÈÌÌ·
AIDS∫ÔÈÓ‹ ÔÈΛÏË ·ÓÔÛÔ·Ó¿ÚÎÂÈ·
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·11
Ù˘¯fiÓ Ô˘‰ÂÙÂÚÔÂÓ›· ‹ ÏÂÌÊÔÂÓ›· Î·È Ë ÌÔÚÊÔÏÔ-
Á›· ÙÔ˘˜ ÌÔÚ› Ó· Ì·˜ ηÙ¢ı‡ÓÂÈ ÛÙË ‰È¿ÁÓˆÛË
(.¯. Û‡Ó‰ÚÔÌÔ Chediak-Higashi). H ·ÈÌÔÛÊ·ÈÚ›ÓË, Ô
·ÈÌ·ÙÔÎÚ›Ù˘ Î·È Ë ÌÔÚÊÔÏÔÁ›· ÙˆÓ ÂÚ˘ıÚÒÓ Â›Ó·È
ηÏÔ› ‰Â›ÎÙ˜ ÁÈ· ˘ÔΛÌÂÓÔ ¯ÚfiÓÈÔ ÓfiÛËÌ·. ∆· ·È-
ÌÔÂÙ¿ÏÈ·, Ô˘ Â›Ó·È ¤Ó·˜ ·ÎfiÌË Î·Ïfi˜ ‰Â›ÎÙ˘ Ù˘
ÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘ Ì˘ÂÏÔ‡, ÌÔÚ› Ó· Â›Ó·È ÌÂȈ̤ӷ ÛÂ
·˘ÙÔ¿ÓÔÛ· ÓÔÛ‹Ì·Ù· Î·È ÛÙÔ Û‡Ó‰ÚÔÌÔ Wiskott-
Aldrich. √ ‚·ÛÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ ÙˆÓ µ
΢ÙÙ¿ÚˆÓ ÂÚÈÏ·Ì‚¿ÓÂÈ ÚÔÛ‰ÈÔÚÈÛÌfi ÙˆÓ ÂȤ‰ˆÓ
ÙˆÓ ·ÓÔÛÔÛÊ·ÈÚÈÓÒÓ. ∞Ó¿ÏÔÁ· Ì ÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ·
Î·È ÙÔ˘˜ ·ıÔÁfiÓÔ˘˜ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜, Ô ÂÚÁ·ÛÙË-
ÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ÂÂÎÙ›ÓÂÙ·È (¶›Ó·Î˜ 4 Î·È 5).
°È· ÙËÓ ÂÎÙ›ÌËÛË Ù˘ ·ÓÙÈۈ̷ÙÈ΋˜ ÏÂÈÙÔ˘Ú-
Á›·˜, Ô ÈÔ ÂȉÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÂÚÈÏ·Ì‚¿ÓÂÈ ÚÔÛ‰ÈÔ-
ÚÈÛÌfi ÔÚÈṲ̂ӈÓ, Û˘ÁÎÂÎÚÈ̤ӈÓ, ÂȉÈÎÒÓ ·ÓÙÈÛˆ-
Ì¿ÙˆÓ Î·È ÂȤ‰ˆÓ ÙˆÓ ˘ÔÙ¿ÍÂˆÓ Ù˘ ·ÓÔÛÔ-
ÛÊ·ÈÚ›Ó˘ G (IgG) Î·È Ù›ÙÏÔ˘ ÈÛÔ·ÈÌÔÛ˘ÁÎÔÏÏËÙÈ-
ÓÒÓ (·ÓÙÈ-∞, ·ÓÙÈ-µ) ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô Ù˘ ·ÓÔÛÔÛÊ·È-
Ú›Ó˘ ª (IgM) (8,18). ∞Í›˙ÂÈ Ó· ˘ÂÓı˘Ì›ÛÔ˘Ì fiÙÈ
Ù· ‚Ú¤ÊË ÙˆÓ 6-8 ÌËÓÒÓ Û˘¯Ó¿ ÂÌÊ·Ó›˙Ô˘Ó ÙË ÁÓˆ-
ÛÙ‹ ·ÚÔ‰È΋ ˘ÔÁ·ÌÌ·ÛÊ·ÈÚÈÓ·ÈÌ›· Î·È Ú¤ÂÈ Ó·
ÙÔÓÈÛÙ› fiÙÈ ‰ÂÓ ÂÚÈ̤ÓÔ˘Ì ·ÓÙÈۈ̷ÙÈ΋ ·¿-
ÓÙËÛË Û ÔÏ˘Û·Î¯·ÚȉÈο ·ÓÙÈÁfiÓ·, .¯. ·ÈÌfiÊÈÏÔ˜
Ù˘ influenza-b Û Ӌȷ οو ÙˆÓ 24 ÌËÓÒÓ (19).
°È· ÙÔ ÏfiÁÔ ·˘Ùfi, ÁÈ· Ù· Û˘ÁÎÂÎÚÈ̤ӷ ÓÔÛ‹Ì·Ù· ηÈ
ÁÈ’ ·˘Ù¤˜ ÙȘ ËÏÈ˘, ‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È ÂÌ‚fiÏÈ· Û˘Ó-
‰Â‰Â̤ӷ Ì ڈÙÂ˚ÓÈο ·ÓÙÈÁfiÓ·, Ù· ÔÔ›· ¢ԉÒ-
ÓÔ˘Ó ÈηÓÔÔÈËÙÈ΋ ·ÓÔÛÔ·¿ÓÙËÛË (·-Ó¢ÌÔÓÈÔ-
ÎÔÎÎÈÎfi, ·-·ÈÌÔÊ›ÏÔ˘, ·-ÌËÓÈÁÁÈÙȉÔÎfiÎÎÔ˘) (20).
∏ ΢ÙÙ·ÚÈ΋ ·ÓÔÛ›· ÂÎÙÈÌ¿Ù·È ·ÊÂÓfi˜ Ì ÙË Ì¤ÙÚË-
ÛË ÙˆÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Î·È ÙˆÓ ˘ÔÏËı˘ÛÌÒÓ
ÙÔ˘˜, ·ÊÂÙ¤ÚÔ˘ Ì ÙËÓ ·ÍÈÔÏfiÁËÛË ÙˆÓ ‰ÂÚÌ·ÙÈÎÒÓ
‰ÔÎÈÌ·ÛÈÒÓ ÂÈ‚Ú·‰˘ÓÔ̤Ó˘ ˘ÂÚ¢·ÈÛıËÛ›·˜ ÛÂ
ÎÔÈÓ¿ ·ÓÙÈÁfiÓ·. ∆¤ÙÔÈ· ·ÓÙÈÁfiÓ· Â›Ó·È ·˘Ù¿ ÙˆÓ ÂÌ-
‚ÔÏ›ˆÓ (ÙÂÙ¿ÓÔ˘ Î·È ‰ÈÊıÂÚ›Ùȉ·˜) Î·È Ù· ÎÔÈÓ¿
·ÓÙÈÁfiÓ· ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜, fiˆ˜ ÙÚȯfiÊ˘Ù·,
candida, ÚˆÙ¤·˜. °È· ÙËÓ ÂÎÙ›ÌËÛË Ù˘ Ê·ÁÔ΢ÙÙ·-
ÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜, ηÙ' ·Ú¯‹Ó ·ÚΛ Ô ÚÔÛ‰ÈÔÚÈ-
ÛÌfi˜ ÙˆÓ Ï¢ÎÔ΢ÙÙ¿ÚˆÓ Î·È Ù˘ ÌÔÚÊÔÏÔÁ›·˜
ÙÔ˘˜. °È· ÙÔÓ ÔÏÔÎÏËڈ̤ÓÔ ¤ÏÂÁ¯Ô ÙˆÓ Ê·ÁÔ΢Ù-
Ù¿ÚˆÓ, ‚ÔËı¿ÂÈ Ô ¤ÏÂÁ¯Ô˜ Ù˘ ÔÍÂȉˆÙÈ΋˜ ÈηÓfiÙË-
Ù·˜ ÙˆÓ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ Ì ÙËÓ ÎÏ·ÛÈ΋ ‰ÔÎÈÌ·Û›·
¯ÚÒÛ˘ ÙÔ˘ ΢·ÓÔ‡ ÙÔ˘ ÙÂÙÚ·˙ÔÏ›Ô˘ (NBT) ‹ Ì ÙËÓ
΢ÙÙ·ÚÔÌÂÙÚ›· ÚÔ‹˜ (DHR), ηıÒ˜ Î·È Ô ¤ÏÂÁ¯Ô˜
Ù˘ ¯ËÌÂÈÔÙ·Í›·˜ Î·È Ù˘ Ê·ÁÔ΢ÙÙ¿ÚˆÛ˘. °È· ÙÔ
Û˘ÓÔÏÈÎfi ¤ÏÂÁ¯Ô Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘ Û˘ÌÏËÚÒÌ·-
ÙÔ˜, Ë ÈÔ ÚÔÛÈÙ‹ ̤ıÔ‰Ô˜ Â›Ó·È Ë Ì¤ÙÚËÛË ÙˆÓ
ÎÏ·ÛÌ¿ÙˆÓ C3, C4. ¶ÈÔ ¯Ú‹ÛÈÌÔ˜, ˆÛÙfiÛÔ, Â›Ó·È Ô
ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙÔ˘ ÔÏÈÎÔ‡ ·ÈÌÔÏ˘ÙÈÎÔ‡ Û˘ÌÏËÚÒ-
Ì·ÙÔ˜ (CH50), ̤ıÔ‰Ô˜ Ô˘ ··ÈÙ› ÙËÓ ·ÚÔ˘Û›·
fiÏˆÓ ÙˆÓ ÎÏ·ÛÌ¿ÙˆÓ ÙÔ˘ Û˘ÌÏËÚÒÌ·ÙÔ˜.
∂¿Ó οÔÈ· ·fi ÙȘ ‚·ÛÈΤ˜ ‰ÔÎÈ̷ۛ˜ Â›Ó·È ·-
ıÔÏÔÁÈ΋, Ú¤ÂÈ Ó· ÚÔ¯ˆÚ‹ÛÔ˘Ì Û ÈÔ ÂȉÈÎfi
¤ÏÂÁ¯Ô. √È ÂÍÂȉÈÎÂ˘Ì¤Ó˜ ̤ıÔ‰ÔÈ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó
ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙÔ˘ ·ÓÔÛÔÊ·ÈÓÔÙ‡Ô˘ ÙˆÓ ∆ ηÈ
µ ÏÂÌÊÔ΢ÙÙ·ÚÈÎÒÓ ÏËı˘ÛÌÒÓ, ÙËÓ ÈηÓfiÙËÙ·
·ÓÙÈÁÔÓÈ΋˜ ‰È¤ÁÂÚÛ˘, ηÏÏȤÚÁÂȘ ÏÂÌÊÔ΢ÙÙ¿-
ÚˆÓ, ÂȉÈÎfiÙÂÚ˜ ‰ÔÎÈ̷ۛ˜ ÁÈ· Ù· ÔÏ˘ÌÔÚÊÔ‡-
ÚËÓ· Î·È Ì¤ÙÚËÛË fiÏˆÓ ÙˆÓ ÎÏ·ÛÌ¿ÙˆÓ ÙÔ˘ Û˘-
ÌÏËÚÒÌ·ÙÔ˜. ™Â Ôχ ÂÍÂȉÈÎÂ˘Ì¤Ó˜ ÂÚÈÙÒ-
ÛÂȘ ··ÈÙÔ‡ÓÙ·È ÂȉÈΤ˜ ηÏÏȤÚÁÂȘ, ÂȉÈÎÔ› ÂÓ˙˘-
ÌÈÎÔ› ÚÔÛ‰ÈÔÚÈÛÌÔ›, ·Ó¿Ï˘ÛË ÙˆÓ ÁÏ˘ÎÔÚˆÙ½ÓÒÓ
ÙˆÓ Ï¢ÎÔ΢ÙÙ¿ÚˆÓ Î·È ÁÔÓȉȷÎfi˜ ¤ÏÂÁ¯Ô˜ Ì DNA
‹ RNA ·Ó·Ï‡ÛÂȘ. ∂¿Ó ˆ˜ ·ÈÙ›· ÙˆÓ ÎÏÈÓÈÎÒÓ ÂΉË-
ÏÒÛÂˆÓ Èı·ÓÔÏÔÁÂ›Ù·È ·ÏÏÂÚÁÈÎfi ÓfiÛËÌ·, ÚÔÛ-
‰ÈÔÚ›˙ÔÓÙ·È Ù· ›‰· Ù˘ ÔÏÈ΋˜ ·ÓÔÛÔÛÊ·ÈÚ›Ó˘
∂ (IgE) ÛÙÔÓ ÔÚfi Î·È ÙˆÓ ÂȉÈÎÒÓ IgE (RAST) ¤Ó·ÓÙÈ
Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ·ÏÏÂÚÁÈÔÁfiÓˆÓ.
¶ÚfiÁÓˆÛË
∏ ÚfiÁÓˆÛË ÙˆÓ ·È‰ÈÒÓ Ì ·ÓÔÛÔ·Ó¿ÚÎÂÈ· ›-
Ó·È Î·Ù¿ Ôχ ηχÙÂÚË ÙËÓ ÙÂÏÂ˘Ù·›· ‰ÂηÂÓÙ·Â-
Ù›· Î·È Ë ÚfiÔ‰Ô˜ ·˘Ù‹ Â›Ó·È ‚¤‚·ÈÔ fiÙÈ ı· Û˘Ó¯È-
ÛÙ›, ·ÊÔ‡ ÔÈ ÏÂÙÔ̤ÚÂȘ ÙˆÓ ·ÓÔÛÔÏÔÁÈÎÒÓ Ì˯·-
ÓÈÛÌÒÓ Î·È Ù˘ ÁÂÓÂÙÈ΋˜ ÙÔ˘˜ ‚¿Û˘ ηıËÌÂÚÈÓ¿ ‰È-
¢ÎÚÈÓ›˙ÔÓÙ·È Î·È ÚÔÔÙÈο Ë ıÂڷ¢ÙÈ΋ ·Ú¤Ì-
‚·ÛË Á›ÓÂÙ·È ÈÔ ·ÔÙÂÏÂÛÌ·ÙÈ΋. øÛÙfiÛÔ, ηıÔÚÈ-
ÛÙÈ΋ ·Ú·Ì¤ÓÂÈ Ë ¤ÁηÈÚË ‰È¿ÁÓˆÛË ·˘ÙÒÓ ÙˆÓ ·Ú-
ÚÒÛÙˆÓ Î·È Ë ¤ÁηÈÚË, ¿ÌÂÛË Î·È “ÂÈıÂÙÈ΋” ıÂÚ·-
›· ¤Ó·ÓÙÈ ÙÔ˘ ÓÔÛ‹Ì·ÙÔ˜ Ô˘ ı· ÂΉËψı› ÛÙÔ
·È‰› Ì ·ÓÔÛÔ·Ó·ÚÎÔ‡Ó ̆ fiÛÙڈ̷. ™Ùfi¯Ô˜ ›ӷÈ
Ó· ÌËÓ ÂÁηٷÛÙ·ıÔ‡Ó ÌfiÓÈ̘ ‚Ï¿‚˜ ‹ ·ÂÈÏËı› Ë
˙ˆ‹ ÙÔ˘, Û˘Ó‹ıˆ˜ ·fi οÔÈ· ÛÔ‚·Ú‹ Ïԛ̈ÍË.
√È ¶∞∞ ·ÔÙÂÏÔ‡Ó ¤Ó· ÔÏ˘Û‡ÓıÂÙÔ ÎÏÈÓÈÎfi
Úfi‚ÏËÌ· Ì ÔÈΛϘ ÂΉËÏÒÛÂȘ Î·È ÌÈ· ‰È·ÁÓˆ-
ÛÙÈ΋ ÚfiÎÏËÛË ÁÈ· ÙÔÓ ÎÏÈÓÈÎfi È·ÙÚfi.
∂›ÏÔÁÔ˜
∏ ÌÂıÔ‰È΋, ·Ó·Ï˘ÙÈ΋ Î·È Û˘ÓıÂÙÈ΋ ÚÔÛ¤ÁÁÈ-
ÛË ÙˆÓ ·È‰ÈÒÓ Ì Èı·Ó‹ ¶∞∞ ı· ‚ÔËı‹ÛÂÈ ÛÙË
ÛˆÛÙ‹ ‰È·ÁÓˆÛÙÈ΋ ÚÔۤϷÛË, ·ÔÎÏ›ÔÓÙ·˜ ¿Ï-
Ϙ ·ıÔÏÔÁÈΤ˜ ηٷÛÙ¿ÛÂȘ Î·È ı· Ô‰ËÁ‹ÛÂÈ ÛÙËÓ
ÔÚı‹ ‰È¿ÁÓˆÛË, ÙËÓ Î·Ù¿ÏÏËÏË ıÂڷ›· Î·È ·ÓÙÈ-
ÌÂÙÒÈÛË (21).
∂˘¯·ÚÈÛٛ˜
∂˘¯·ÚÈÛÙԇ̠ÙÔÓ ∫·ıËÁËÙ‹ ∆¿ÎË ¶·Ó·ÁȈÙfiÔ˘ÏÔ ÁÈ·
ÙËÓ Î·ıÔÚÈÛÙÈ΋ Û˘Ì‚ÔÏ‹ ÙÔ˘ ÛÙË Û˘ÁÁÚ·Ê‹ Ù˘ ÂÚÁ·Û›·˜.
µÈ‚ÏÈÔÁÚ·Ê›·
1. Bird AG. Diagnosis of antibody deficiency states. In: Levinsky
RJ, editor. IgG subclass deficiencies. London: Royal Society of
Medicine Services; 1989. p. 3-12.
2. °ÂÚÌÂÓ‹˜ ∞. §ÂÈÙÔ˘ÚÁÈ΋ ‰ÔÌ‹ ÙÔ˘ ·ÓÔÛÈ·ÎÔ‡ Û˘ÛÙ‹Ì·-
ÙÔ˜. ™ÙÔ: °ÂÚÌÂÓ‹˜ ∞, ÂΉfiÙ˘. π·ÙÚÈ΋ ∞ÓÔÛÔÏÔÁ›·. ∞ı‹-
Ó·: ∂ΉfiÛÂȘ ¶··˙‹ÛË; 2000. Û. 13-21.
12 ¢. X. ∫·Û›ÌÔ˜ Î·È Û˘Ó.
Paediatriki 2008;71:5-13
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3. Chapel H, Haeney M, Misbah S and Snowden N. Basic Com-ponents: structure and function. In: Chapel H, Haeney M,Misbah S and Snowden N, editors. Essentials of Clinical Im-munology. 5th ed. Oxford: Blackwell Publishing; 2006. p. 1-32.
4. ∫·Ó¿ÚÈÔ˘ M. ¢È·Ù·Ú·¯¤˜ ·ÓÔÛÈ·ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ™ÙÔ:∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜ A., ÂΉfiÙ˘. ∫ÏÈÓÈ΋ ¶·È‰È·ÙÚÈ΋.Aı‹Ó·: ∂ΉfiÛÂȘ ∑‹Ù·; 2006-2007. Û. 199-211.
5. Report of a WHO scientific group. Primary immunodefi-ciency diseases. Clin Exp Immunol 1997;109 Suppl 1:1-28.
6. De Vries E, Noordzij JG, Kuijpers TW, van Dongen JJ. Flowcytometric immunophenotyping in the diagnosis and fol-low-up of immunodeficient children. Eur J Pediatr 2001;160:583-591.
7. Golub ES. Immunity, infections and tumors. In: Golub ES,editor. Immunology: A Synthesis. Sunderland, Massachus-sets: Sinauer Associates, Inc.; 1987. p. 439-460.
8. Wood RA, Sampson HA. The child with frequent infections.Curr Probl Pediatr 1989;19:229-284.
9. Fleisher TA. Immune function. Pediatr Rev 1997;18:351-356.10. Stiehm ER. Clinical and laboratory evaluation of the child
with suspected immunodeficiency. Pediatr Rev 1985;7:53-61.11. De Vries E; Clinical Working Party of the European Society
for Immunodeficiencies (ESID). Patient-centred screeningfor primary immunodeficiency: a multi-stage diagnostic pro-tocol designed for non-immunologists. Clin Exp Immunol2006;145:204-214.
12. Bonilla FA, Geha RS. 12. Primary immunodeficiency dis-eases. J Allergy Clin Immunol 2003;111:S571-581.
13. Notarangelo L, Casanova JL, Conley ME, Chapel H, FischerA, Puck J, et al. Primary immunodeficiency diseases: an up-date from the International Union of Immunological Soci-eties Primary Immunodeficiency Diseases ClassificationCommittee Meeting in Budapest, 2005. J Allergy Clin Im-munol 2006;117:883-896.
14. Smith CIE, Ochs HD, Puck JM. Genetically determined im-munodeficiency diseases: a perspective. In: Ochs HD, SmithCIE, Puck JM, editors. Primary Immunodeficiency Diseases:A Molecular and Genetic Approach. 2nd ed. Oxford: OxfordUniversiry Press; 2007. p. 3-15.
15. Pacheco SE, Shearer WT. Laboratory aspects of immunology.Pediatr Clin North Am 1994;41:623-655.
16. Sewell WA, Khan S, Doré PC. Early indicators of immunod-eficiency in adults and children: protocols for screening forprimary immunological defects. Clin Exp Immunol2006;145:201-203.
17. Bonilla FA, Bernstein IL, Khan DA, Ballas ZK, Chinen J,Frank MM, et al. Practice parameter for the diagnosis andmanagement of primary immunodeficiency. Ann AllergyAsthma Immunol 2005;94:S1-63.
18. Pachman LM, Lynch PA, Silver RK, Ozog DL, Poznanski AK.Primary immunodeficiency disease in children: an update.Curr Probl Pediatr 1989;19:1-64.
19. Umetsu DT, Ambrosino DM, Quinti I, Siber GR, Geha RS.Recurrent sinopulmonary infection and impaired antibodyresponse to bacterial capsular polysaccharide antigen in chil-dren with selective IgG-subclass deficiency. N Engl J Med1985;313:1247-1251.
20. Sorensen RU, Moore C. Immunology in the pediatrician’soffice. Pediatr Clin North Am 1994;41:691-714.
21. Buckley RH. Primary immunodeficiency or not? Making thecorrect diagnosis. J Allergy Clin Immunol 2006;117:756-8.
13∞ÓÔÛÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ Û ÏÔÈÌÒÍÂȘ
¶·È‰È·ÙÚÈ΋ 2008;71:5-13
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·13
14 ∞¡∞™∫√¶∏™∏ REVIEW ARTICLE
Paediatriki 2008;71:14-20
¶ÚˆÙÔ·ı‹˜ ‰˘ÛÎÈÓËÛ›· ÙˆÓ ÎÚÔÛÛÒÓ
ª. ªÔ˘ÛÙ¿ÎË1, ∞. ºÚÂÙ˙¿ÁÈ·˜2
¶ÂÚ›ÏË„Ë: H ÚˆÙÔ·ı‹˜ ‰˘ÛÎÈÓËÛ›· ÙˆÓ ÎÚÔÛÛÒÓ Â›Ó·È ÔÏ˘Û˘ÛÙËÌ·ÙÈ΋ ÓfiÛÔ˜. ∂ΉËÏÒÓÂÙ·È ·fiÙÔ ·Ó·Ó¢ÛÙÈÎfi Î·È ÙȘ ·Ú·ÚÚ›ÓȘ ÎÔÈÏfiÙËÙ˜, fiÔ˘ ·Ú·ÙËÚÔ‡ÓÙ·È ˘ÔÙÚÔÈ¿˙Ô˘Û˜ ·Ó·Ó¢ÛÙÈΤ˜ÏÔÈÌÒÍÂȘ, ‚ÚÔÁ¯ÂÎٷۛ˜ Î·È ÂÂÈÛfi‰È· ̂ Ù›Ùȉ·˜ Î·È ÈÁÌÔÚ›Ùȉ·˜. ∞fi ÙÔ ÁÂÓÓËÙÈÎfi Û‡ÛÙËÌ· ·ÌÊÔÙ¤ÚˆÓÙˆÓ Ê‡ÏˆÓ ·Ú·ÙËÚÂ›Ù·È ˘ÔÁÔÓÈÌfiÙËÙ·. ∆Ô Û‡Ó‰ÚÔÌÔ Û˘Ó‰¤ÂÙ·È Û 50% ÂÚ›Ô˘ ÙˆÓ ·ÛıÂÓÒÓ Ì·ӷÛÙÚÔÊ‹ ÙˆÓ ÛÏ¿Á¯ÓˆÓ (Û‡Ó‰ÚÔÌÔ Kartagener). ∏ ‰È¿ÁÓˆÛË Á›ÓÂÙ·È Ì ÌÈ· ÛÂÈÚ¿ ÌË ÂȉÈÎÒÓ ÂÍÂ-Ù¿ÛˆÓ, fiˆ˜ ‰ÔÎÈÌ·Û›· ۷ί·Ú›Ó˘, ̤ÙÚËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ ΛÓËÛ˘ ÙˆÓ ÎÚÔÛÛÒÓ Î·È ·ÂÈÎfiÓÈÛËÙ˘ ÌÔÚÊÔÏÔÁ›·˜ ÙˆÓ ÎÚÔÛÛÒÓ Î·È ÙÔ˘ ÚÔÛ·Ó·ÙÔÏÈÛÌÔ‡ ÙÔ˘˜ Ì ÙÔ ËÏÂÎÙÚÔÓÈÎfi ÌÈÎÚÔÛÎfiÈÔ. ∞Ó Î·Èοı ÂÚÁ·ÛÙ‹ÚÈÔ ¤¯ÂÈ ÙȘ ‰ÈΤ˜ ÙÔ˘ Ê˘ÛÈÔÏÔÁÈΤ˜ ÙÈ̤˜, ÔÈ Î·Ù¿ ÚÔÛ¤ÁÁÈÛË Ê˘ÛÈÔÏÔÁÈΤ˜ ÙÈ̤˜ ÁÈ· ÙË Û˘-¯ÓfiÙËÙ· ΛÓËÛ˘ ÙˆÓ ÎÚÔÛÛÒÓ Â›Ó·È 11-16 Hz. ∆Ô ËÏÂÎÙÚÔÓÈÎfi ÌÈÎÚÔÛÎfiÈÔ Â›Ó·È ÛËÌ·ÓÙÈÎfi ÙÌ‹Ì· وӉȷÁÓˆÛÙÈÎÒÓ ‰ÔÎÈÌ·ÛÈÒÓ. ÃÚÂÈ¿˙ÂÙ·È ÁÈ· ÙËÓ ·ÔÙ‡ˆÛË Ù˘ ‰ÔÌ‹˜ ÙˆÓ ÎÚÔÛÛÒÓ Î·È ÙÔ˘ ÚÔÛ·Ó·ÙÔ-ÏÈÛÌÔ‡ ÙÔ˘˜. ∞ӈ̷ϛ˜ Û 10% ÙˆÓ ÎÚÔÛÛÒÓ ·Ú·ÙËÚÔ‡ÓÙ·È Î·È ÛÂ Ê˘ÛÈÔÏÔÁÈο ‰Â›ÁÌ·Ù·. ™ËÌÂÈÒÓÂ-Ù·È fiÙÈ ÙÔ ÚÈÓÈÎfi ÂÎÓÂfiÌÂÓÔ ÔÍ›‰ÈÔ ÙÔ˘ ·˙ÒÙÔ˘ (¡√) Â›Ó·È ¯·ÌËÏfi Î·È ÌÔÚ› ÛÙÔ Ì¤ÏÏÔÓ Ó· ·ÔÙÂϤ-ÛÂÈ ÂͤٷÛË ‰ÂÈÁÌ·ÙÔÏË„›·˜ ÁÈ· ÙË ‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘, ·ÏÏ¿ ÚÔ˜ ÙÔ ·ÚfiÓ ‰ÂÓ ˘¿Ú¯ÂÈ Â›ÛËÌË Û‡-ÛÙ·ÛË ÁÈ· ÙË ¯Ú‹ÛË ÙÔ˘. ¢ÂÓ ˘¿Ú¯ÂÈ ÂȉÈ΋ ıÂڷ›· ·ÔηٿÛÙ·Û˘ Ù˘ ‰ÔÌ‹˜ ‹ Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ ÙˆÓÎÚÔÛÛÒÓ. ÃÚËÛÈÌÔÔÈÂ›Ù·È ·Ó·Ó¢ÛÙÈ΋ Ê˘ÛÈÔıÂڷ›· Î·È Û˘ÛÙËÌ·ÙÈ΋ ¯ÔÚ‹ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ fiÙ·ÓÂӉ›ÎÓ˘Ù·È.
§¤ÍÂȘ ÎÏÂȉȿ: ¢˘ÛÎÈÓËÛ›· ÎÚÔÛÛÒÓ, ·Ó·Ó¢ÛÙÈΤ˜ ÏÔÈÌÒÍÂȘ, ˘ÔÁÔÓÈÌfiÙËÙ·, ·Ó·ÛÙÚÔÊ‹ ÛÏ¿Á¯ÓˆÓ.
Primary ciliary dyskinesia
M. Moustaki1, A. Fretzayas2
Abstract: Primary ciliary dyskinesia is a multisystem disease characterized by recurrent respiratory tractinfections, bronchiectasis, otitis, sinusitis and subfertility in both sexes. It is associated in about 50% ofpatients with situs inversus (Kartagener syndrome). It is a genetic disorder characterized by abnormalitiesin ciliary structural function. Diagnosis is made by a series of investigations, starting with the saccharin test,ciliary beat frequency, and electron microscopy, in order to reveal ciliary morphology and orientation.Although it is recommended that each laboratory has its own normal range, the approximate normalrange for beat frequency is 11-16 Hz. Electron microscopy is an essential part of diagnostic testing,necessary for the assessment of cilia structure and possible disorientation. Abnormalities in up to 10% ofcilia may be seen in normal samples. Nasal nitric oxide (NO) is low and this measurement may be used infuture as a screening tool but at present a definite clinical role for NO measurement in the diagnosis ofprimary ciliary dyskinesia is not recommended. There is no specific treatment. And the cornerstone ofmanagement is physiotherapy, with administration of systematic antibiotics when appropriate.
Key words: Ciliary dyskinesia, respiratory tract infections, subfertility, situs inversus.
1 µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ
2 °’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ
AÏÏËÏÔÁÚ·Ê›·:
ª·Ú›· ªÔ˘ÛÙ¿ÎË[email protected]µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋,¶·ÓÂÈÛÙ‹ÌÈÔ ∞ıËÓÒÓ
1 2nd Paediatric Clinic,University of Athens
2 3rd Paediatric Clinic,University of Athens
Correspondence:
Maria [email protected] Paediatric Clinic,University of Athens
∂ÈÛ·ÁˆÁ‹
∆Ô Û‡Ó‰ÚÔÌÔ Ù˘ ÚˆÙÔ·ıÔ‡˜ ‰˘ÛÎÈÓË-
Û›·˜ ÙˆÓ ÎÚÔÛÛÒÓ ÂÚÈÁÚ¿ÊËÎÂ ÁÈ· ÚÒÙË ÊÔ-
Ú¿ ÙÔ 1904 ·fi ÙÔÓ Siewert Î·È ·ÚÁfiÙÂÚ· ÙÔ
1935 ·fi ÙÔÓ Kartagener ˆ˜ Ë ÙÚÈ¿‰· ·Ó·ÛÙÚÔ-
Ê‹˜ ÙˆÓ ÛÏ¿Á¯ÓˆÓ, ÈÁÌÔÚ›Ùȉ·˜ Î·È ‚ÚÔÁ¯Â-
ÎÙ·Û›·˜ (1). ŒÎÙÔÙÂ, Ë ·ıÔÏÔÁ›· Ù˘ ÚˆÙÔ-
·ıÔ‡˜ ‰˘ÛÎÈÓËÛ›·˜ ÙˆÓ ÎÚÔÛÛÒÓ ¤¯ÂÈ ÂÚÈ-
ÁÚ·Ê› ÏÂÙÔÌÂÚ¤ÛÙÂÚ· Î·È Û‹ÌÂÚ· Ë ‰È¿ÁÓˆ-
ÛË Ù›ıÂÙ·È ·ÎfiÌË Î·È Â› ·Ô˘Û›·˜ ·Ó·ÛÙÚÔ-
Ê‹˜ ÙˆÓ ÛÏ¿Á¯ÓˆÓ (1-3). ∏ ı¤ÛË ÙˆÓ ÛÏ¿Á-
¯ÓˆÓ ηٿ ÙÔ ÛÙ¿‰ÈÔ Ù˘ ÂÌ‚Ú˘ÔÁ¤ÓÂÛ˘ ηıÔ-
Ú›˙ÂÙ·È ·fi ÙË Ê˘ÛÈÔÏÔÁÈ΋ ΛÓËÛË ÙˆÓ ÎÚÔÛ-
ÛÒÓ Î·È Â› ‰˘ÛÎÈÓËÛ›·˜ ÙˆÓ ÎÚÔÛÛÒÓ ·fiÏÏ˘-
Ù·È Ô ¯ˆÚÔÙ·ÍÈÎfi˜ ÚÔÛ·Ó·ÙÔÏÈÛÌfi˜ Î·È ˘¿Ú-
¯ÂÈ Èı·ÓfiÙËÙ· 50% ·Ó·ÛÙÚÔÊ‹˜ ÙˆÓ ÛÏ¿Á-
¯ÓˆÓ (1,4,5).
∞Ó Î·È Û¿ÓÈ· ÁÂÓÂÙÈο ηıÔÚÈ˙fiÌÂÓË Ófi-
ÛÔ˜, Ë ÚˆÙÔ·ı‹˜ ‰˘ÛÎÈÓËÛ›· ÙˆÓ ÎÚÔÛÛÒÓ
·ÔÙÂÏ› ¯ÚfiÓÈÔ ÛÔ‚·Úfi ÓfiÛËÌ·, ÂÓÒ Ô ·È-
‰›·ÙÚÔ˜ ¯ÚÂÈ¿˙ÂÙ·È Ó· Â›Ó·È ÂÍÔÈÎÂȈ̤ÓÔ˜ ÌÂ
ÙËÓ ÚÒÈÌË ‰È¿ÁÓˆÛË Î·È ÙËÓ ·Ú·ÎÔÏÔ‡ıË-
ÛË ·˘ÙÔ‡ ÙÔ˘ ÓÔÛ‹Ì·ÙÔ˜. ™ÎÔfi˜ Ù˘ ·ÚÔ‡-
Û·˜ ·Ó·ÛÎfiËÛ˘ Â›Ó·È Ë ·ÚÔ˘Û›·ÛË ÙˆÓ
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·14
ÎÏÈÓÈÎÒÓ Î·È ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ‰Â‰ÔÌ¤ÓˆÓ Ô˘ ·ÊÔ-ÚÔ‡Ó ÙËÓ ÚˆÙÔ·ı‹ ‰˘ÛÎÈÓËÛ›· ÙˆÓ ÎÚÔÛÛÒÓ, Ù·ÔÔ›· ¤¯Ô˘Ó ÂÌÏÔ˘ÙÈÛÙ› Ì ٷ ÛÙÔȯ›· Ù˘ Úfi-ÛÊ·Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜.
∫ÚÔÛÛˆÙfi ÂÈı‹ÏÈÔ
∞fi ÎÚÔÛÛˆÙfi ÂÈı‹ÏÈÔ Î·Ï‡ÙÔÓÙ·È ÔÈ ‚ÏÂÓÓÔ-ÁfiÓÔÈ ÙˆÓ ·Ú·ÚÚÈÓ›ˆÓ ÎfiψÓ, ÔÈ ·ÓÒÙÂÚÔÈ Î·È Î·-ÙÒÙÂÚÔÈ ·ÂÚ·ÁˆÁÔ›, ÔÈ ÛÂÚÌ·ÙÈΤ˜ Ô‰Ô› Ì ٷ ÛÂÚ-Ì·ÙÔ˙ˆ¿ÚÈ·, ÔÈ Û¿ÏÈÁÁ˜ Î·È ÙÔ Â¤Ó‰˘Ì· ÙˆÓ ÎÔÈ-ÏÈÒÓ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ (4,5). ∫¿ı ÎÚÔÛÛfi˜ ·ÔÙÂÏ›ٷȷfi ÙË Ú›˙·, ÙÔ ‚·ÛÈÎfi ۈ̿ÙÈÔ Î·È ÙÔ ÂχıÂÚÔ ÛÙ¤-ϯԘ. ∆Ô Ì¤ÁÂıfi˜ ÙÔ˘˜ Â›Ó·È 5-15 nm Î·È Ë ‰È¿ÌÂ-ÙÚfi˜ ÙÔ˘˜ 0,2 nm. ∆Ô Û٤ϯԘ ·ÔÙÂÏÂ›Ù·È ·fi 9 Â-ÚÈÊÂÚÈο ˙‡ÁË ÌÈÎÚÔÛˆÏËÓ›ÛÎˆÓ Î·È ‰‡Ô ÎÂÓÙÚÈ-ÎÔ‡˜ ÌÈÎÚÔÛˆÏËÓ›ÛÎÔ˘˜ (1) (∂ÈÎfiÓ˜ 1, 2, 3). ¢‡Ô‚Ú·¯›ÔÓ˜ ·ÔÙÂÏÔ‡ÌÂÓÔÈ ·fi ÚˆÙ½ÓË (‰˘Ó½ÓË)ÂÎÙ›ÓÔÓÙ·È ·fi ÙÔÓ ∞ ÌÈÎÚÔÛˆÏËÓ›ÛÎÔ Î¿ı ÂÚÈÊÂ-ÚÈÎÔ‡ ˙‡ÁÔ˘˜ ÚÔ˜ ÙÔ µ ÌÈÎÚÔÛˆÏËÓ›ÛÎÔ ÙÔ˘ ·Ú·-ΛÌÂÓÔ˘ ˙‡ÁÔ˘˜ (1,6). √ ¤Ó·˜ ‚Ú·¯›ÔÓ·˜ ÂÎÙ›ÓÂÙ·ÈÂÛˆÙÂÚÈο Î·È Ô ¿ÏÏÔ˜ Â͈ÙÂÚÈο. ÕÏÏÔÈ, ·ÎÙÈÓÔÂÈ-‰Ò˜ ÊÂÚfiÌÂÓÔÈ, ‚Ú·¯›ÔÓ˜ (·ÎÙÈÓÔÂȉ¤˜ ÓËÌ¿ÙÈÔ)ÂÂÎÙ›ÓÔÓÙ·È ·fi ÙÔ˘˜ ÂÚÈÊÂÚÈÎÔ‡˜ ÌÈÎÚÔÛˆÏËÓ›-ÛÎÔ˘˜ ÚÔ˜ ÙÔ ÎÂÓÙÚÈÎfi ˙‡ÁÔ˜, ÂÓÒ Ô ‚Ú·¯›ÔÓ·˜ Ù˘ÓÂ͛Ӣ ÂÓÒÓÂÈ ÌÂٷ͇ ÙÔ˘˜ Ù· ˙‡ÁË ÙˆÓ ÂÚÈÊÂÚÈ-ÎÒÓ ÌÈÎÚÔÛˆÏËÓ›ÛÎˆÓ (∂ÈÎfiÓ˜ 1, 2, 3).
√È ÎÈÓ‹ÛÂȘ ÙˆÓ ÎÚÔÛÛÒÓ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi¤Ó· ·Ú¯Èο Ù·¯‡ ÎÙ‡ËÌ·, ηٿ ÙÔ ÔÔ›Ô ·Ú·Ì¤-ÓÔ˘Ó ¿Î·ÌÙÔÈ, Î·È ·fi ·ÎfiÏÔ˘ıË ‚Ú·‰Â›· ¿ÓÔ‰ÔÛÙË ı¤ÛË ÙÔ˘˜, fiÔ˘ fiÏÔ ÙÔ Û٤ϯԘ οÌÙÂÙ·È ¯·-Ï·Úfi. √È ÎÈÓ‹ÛÂȘ ÙˆÓ ÎÚÔÛÛÒÓ ÛÙËÓ ÂÈıËÏȷ΋ÂÈÊ¿ÓÂÈ· Â›Ó·È Û˘Á¯ÚÔÓÈṲ̂Ó˜, ÌÂÙ·ÎÈÓÒÓÙ·˜ ¤ÙÛÈÙË ‚ϤÓÓ· ·fi ÙËÓ ÂÈÊ¿ÓÂÈ· ÙˆÓ Î˘ÙÙ¿ÚˆÓ (1).
∂ȉËÌÈÔÏÔÁ›·
¶ÚfiÎÂÈÙ·È ÁÈ· Û¿ÓÈ· ÁÂÓÂÙÈ΋ ÓfiÛÔ ÌÂ Û˘¯ÓfiÙË-Ù· 1:20.000 (1,2). ÀÔÏÔÁ›˙ÂÙ·È fiÙÈ Ë Û˘¯ÓfiÙËÙ· Ù˘·Ï‹˜ ·Ó·ÛÙÚÔÊ‹˜ ÙˆÓ ÛÏ¿Á¯ÓˆÓ Â›Ó·È 1:10.000Î·È ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Kartagener 1:40.000 (1,2). ∂Âȉ‹·˘Ù‹ Ë Û˘¯ÓfiÙËÙ· ÙˆÓ 1:20.000 ÛÙËÚ›˙ÂÙ·È ÛÙËÓ
˘fiıÂÛË fiÙÈ fiÏÔÈ ÔÈ ·ÛıÂÓ›˜ Ì ÙÔ Û‡Ó‰ÚÔÌÔ ı·
·Ó·Ù‡ÍÔ˘Ó ‚ÚÔÁ¯ÂÎÙ·Û›·, Â›Ó·È Û·Ê¤˜ fiÙÈ Ë Û˘¯Ófi-
ÙËÙ· ·˘Ù‹ ˘ÔÂÎÙÈÌ¿ ÙÔÓ Ú·ÁÌ·ÙÈÎfi ÂÈÔÏ·ÛÌfi
Ù˘ ÓfiÛÔ˘. ªÂ ‚¿ÛË ·˘ÙÔ‡˜ ÙÔ˘˜ ˘ÔÏÔÁÈÛÌÔ‡˜,
3.000 ¿ÙÔÌ· ÛÙË ª. µÚÂÙ·Ó›· Ú¤ÂÈ Ó· ¿Û¯Ô˘Ó
·fi ÙÔ Û‡Ó‰ÚÔÌÔ. ™Â ÌÈ· ÔÌ¿‰·, fï˜, ÛÙ‹ÚÈ͢ ÙˆÓ
·ÛıÂÓÒÓ Ì ÙË ÓfiÛÔ Â›Ó·È ÂÁÁÂÁÚ·Ì̤ӷ 130-150
¿ÙÔÌ· (1) ‰ËÏÒÓÔÓÙ·˜ ÙË ‰˘ÛÎÔÏ›· Ó· ÙÂı› Ë ‰È¿-
ÁÓˆÛË, ηıÒ˜ ÂÏ¿¯ÈÛÙ· ΤÓÙÚ· ¤¯Ô˘Ó ÙË ‰˘Ó·ÙfiÙË-
Ù· Ó· ı¤ÛÔ˘Ó ÙË ‰È¿ÁÓˆÛË Ì ÂÓ‰Âϯ‹ ¤ÏÂÁ¯Ô Ù˘
·Ó·ÙÔÌ›·˜ Î·È Ù˘ ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ·˜ ÙˆÓ ÎÚÔÛÛÒÓ.
∫ÏÈÓÈ΋ ÂÈÎfiÓ·
∏ ÚˆÙÔ·ı‹˜ ‰˘ÛÎÈÓËÛ›· ÙˆÓ ÎÚÔÛÛÒÓ ‰ÂÓ ¯·-
Ú·ÎÙËÚ›˙ÂÙ·È ·fi ηıÔÚÈÛÙÈο ÁÈ· ÙË ‰È¿ÁÓˆÛË Û˘-
ÌÙÒÌ·Ù·. ∞Ó¿ÏÔÁ· Ì ÙËÓ ËÏÈΛ·, ÚÔÂÍ¿Ú¯Ô˘Ó
οÔÈ· Û˘ÌÙÒÌ·Ù· Î·È ÛËÌ›· Ô˘ ı¤ÙÔ˘Ó ÙËÓ
˘Ô„›· Ù˘ ÓfiÛÔ˘, fiˆ˜ Â›Ó·È ÛÙË ÓÂÔÁÓÈ΋ ËÏÈΛ· Ë
›ÌÔÓË ÚÈÓ›Ùȉ· ·fi ÙËÓ ÚÒÙË Ë̤ڷ Ù˘ ˙ˆ‹˜ (7-
11), ÙÔ Û‡Ó‰ÚÔÌÔ ·ÚÔ‰È΋˜ Ù·¯‡ÓÔÈ·˜ Û ·Ô˘Û›·
∂ÈÎfiÓ· 3. ∫ÚÔÛÛfi˜ ·fi ·ÛıÂÓ‹ Ì ڈÙÔ·ı‹ ‰˘ÛÎÈÓËÛ›· ÙˆÓÎÚÔÛÛÒÓ, fiÔ˘ ·Ô˘ÛÈ¿˙Ô˘Ó ÔÈ ÎÏ¿‰ÔÈ Ù˘ ‰˘Ó½Ó˘.
15¶ÚˆÙÔ·ı‹˜ ‰˘ÛÎÈÓËÛ›· ÙˆÓ ÎÚÔÛÛÒÓ
¶·È‰È·ÙÚÈ΋ 2008;71:14-20
∞ÎÙÈÓˆÙ‹ Û‡Ó‰ÂÛË
∂͈ÙÂÚÈ΋ ‰˘Ó½ÓË
∂ÛˆÙÂÚÈ΋ ‰˘Ó½ÓË
™‡Ó‰ÂÛÌÔÈ ÓÂ͛Ӣ
™ˆÏËÓ¿ÚÈÔ ∞
™ˆÏËÓ¿ÚÈÔ µ
∂ÈÎfiÓ· 1. ∂ÁοÚÛÈ· Û¯ËÌ·ÙÈ΋ ÙÔÌ‹ ÎÚÔÛÛÔ‡ fiˆ˜ Ê·›ÓÂÙ·È ÛÙÔËÏÂÎÙÚÔÓÈÎfi ÌÈÎÚÔÛÎfiÈÔ.
∂ÈÎfiÓ· 2. º˘ÛÈÔÏÔÁÈÎfi˜ ÎÚÔÛÛfi˜ fiˆ˜ Ê·›ÓÂÙ·È ÛÙÔ ËÏÂÎÙÚÔÓÈÎfiÌÈÎÚÔÛÎfiÈÔ.
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·15
ÚԉȷıÂÛÈÎÒÓ ·Ú·ÁfiÓÙˆÓ (7,8) Î·È Ë ÓÂÔÁÓÈ΋ Ó¢-
ÌÔÓ›· (7,8) ¯ˆÚ›˜ ÈÛÙÔÚÈÎfi ÓfiÛÔ˘ Ù˘ ÌËÙ¤Ú·˜ ‹ ·-
Ú·ÙÂٷ̤Ó˘ ڋ͢ ÙÔ˘ ı˘Ï·Î›Ô˘. ∏ ›ÌÔÓË ÚÈÓ›ÙÈ-
‰· ·fi ÙËÓ ÚÒÙË Ë̤ڷ Ù˘ ˙ˆ‹˜ ‰È·Ê¤ÚÂÈ ·fi ÙË
‰È·ÏÂ›Ô˘Û· ÚÈÓ›Ùȉ· Ô˘ ÂÌÊ·Ó›˙ÂÙ·È ÌÂÙ¿ ÙȘ ÚÒ-
Ù˜ ‚‰ÔÌ¿‰Â˜ Ù˘ ˙ˆ‹˜ ÂÍ·ÈÙ›·˜ ÈÔÁÂÓÒÓ ÏÔÈÌÒ͈Ó
(10,11). ™Â ÌÈ· ÛÂÈÚ¿ 30 ·ÛıÂÓÒÓ Ì ڈÙÔ·ı‹ ‰˘-
ÛÎÈÓËÛ›· ÙˆÓ ÎÚÔÛÛÒÓ, ÔÈ 13 ÂÌÊ¿ÓÈÛ·Ó Û˘ÌÙÒÌ·Ù·
·fi ÙË ÓÂÔÁÓÈ΋ ÂÚ›Ô‰Ô (9). ¢ÂÍÈÔηډ›· ·Ú·ÙË-
ÚÂ›Ù·È ÛÙÔ 50% ÙˆÓ ÓÂÔÁÓÒÓ, ÂÓÒ ÛÙÔ 23% ·˘ÙÒÓ ÌÂ
‰ÂÍÈÔηډ›· ̆ ¿Ú¯ÂÈ Û‡Ó‰ÚÔÌÔ ‰˘ÛÎÈÓ‹ÙˆÓ ÎÚÔÛÛÒÓ
(12). ™ÙË ‰ÂÍÈÔηډ›· Î·È ÛÙË Û˘ÓÔ‰fi ·Ó·ÛÙÚÔÊ‹
ÙˆÓ ÛÏ¿Á¯ÓˆÓ Ë Î·Ú‰È¿ ·Ó·ÙÔÌÈο Â›Ó·È Ê˘ÛÈÔÏÔÁÈ-
΋. Œ¯Ô˘Ó ·Ú·ÙËÚËı› ÌÂÌÔӈ̤Ó˜ ÂÚÈÙÒÛÂȘ
ÓÂÔÁÓÒÓ ÌÂ Û˘ÁÁÂÓ‹ ηډÈÔ¿ıÂÈ·, ·ÙÚËÛ›· ÙÔ˘ ÔÈ-
ÛÔÊ¿ÁÔ˘ ‹ ÙˆÓ ¯ÔÏËÊfiÚˆÓ, ˘‰ÚÔΤʷÏÔ Î·È ıÂÙÈÎfi
ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi (13-15).
™ÙËÓ ·È‰È΋ ËÏÈΛ·, ¤Ú· ·fi ÙËÓ Èı·ÓfiÙËÙ·
Ù˘ ‰ÂÍÈÔηډ›·˜, ·Ú·ÙËÚÔ‡ÓÙ·È ‚ÚÔÁ¯ÂÎٷۛ˜,
ÂÈÎfiÓ· ÛÔ‚·ÚÔ‡ ‹ ¿Ù˘Ô˘ ¿ÛıÌ·ÙÔ˜ ÌË ·ÓÙ·ÔÎÚÈ-
ÓfiÌÂÓÔ˘ ÈηÓÔÔÈËÙÈο ÛÙËÓ ·ÁˆÁ‹, ˆÙ›Ùȉ· ÂÎÎÚÈ-
ÙÈ΋, ÈÁÌÔÚ›Ùȉ· Ì ‹ ¯ˆÚ›˜ Û˘ÓÔ‰Ô‡˜ Ôχԉ˜
(1,10). øÙ›Ùȉ· Ì ÔÏϷϤ˜ ÂÂÌ‚¿ÛÂȘ ·Ú·ÙË-
Ú‹ıËΠÛÙÔ 95% ÌÈ·˜ ÔÌ¿‰·˜ 110 ·ÛıÂÓÒÓ Ì ۇÓ-
‰ÚÔÌÔ ‰˘ÛÎÈÓ‹ÙˆÓ ÎÚÔÛÛÒÓ (16). ∏ ÂÌÊ¿ÓÈÛË ÙˆÓ
‚ÚÔÁ¯ÂÎÙ·ÛÈÒÓ ·˘Í¿ÓÂÈ Ì ÙËÓ ËÏÈΛ· ÏfiÁˆ Ù˘ ·-
ıÔÏÔÁ›·˜ ·fi ÙÔÓ Ó‡ÌÔÓ·. ¶·Ú·ÙËÚ‹ıËΠfiÙÈ Ë
̤ÛË ËÏÈΛ· ÂÌÊ¿ÓÈÛ˘ ‚ÚÔÁ¯ÂÎÙ·ÛÈÒÓ ‹Ù·Ó 30±2,2
¤ÙË Û ·ÓÙ›ıÂÛË ÙȘ ËÏÈ˘ 10±4,4 ¤ÙË (16), Ô˘
‹Ù·Ó Ë Ì¤ÛË ËÏÈΛ· ηٿ ÙËÓ ÔÔ›· ‰ÂÓ Â›¯·Ó ·Ú·-
ÙËÚËı› ·ÎfiÌË ‚ÚÔÁ¯ÂÎٷۛ˜. ¶ÏËÎÙÚÔ‰·ÎÙ˘Ï›·
·Ú·ÙËÚÂ›Ù·È Û˘Ó‹ıˆ˜ ÌÂÙ¿ ÙËÓ ËÏÈΛ· ÙˆÓ 18 ÂÙÒÓ
(16). ∏ Ó¢ÌÔÓÈ΋ ÏÂÈÙÔ˘ÚÁ›· Â›Ó·È ·ÔÊÚ·ÎÙÈÎÔ‡
Ù‡Ô˘ ¯ˆÚ›˜ ‹ Ì ÌÂÚÈ΋ ·Ó·ÛÙÚ„ÈÌfiÙËÙ· ÌÂÙ¿
·fi ¯ÔÚ‹ÁËÛË ‚2 ‰ÈÂÁ¤ÚÙË. ™Â ÚÔ¯ˆÚË̤ӷ ÛÙ¿‰È·
·Ú·ÙËÚÂ›Ù·È ˘ÔÍ›· Î·È ˘ÂÚηӛ·.
™ÙÔ˘˜ ÂÓ‹ÏÈΘ, ÂÎÙfi˜ ·fi Ù· Û˘ÌÙÒÌ·Ù· ·fi
ÙÔ ·Ó·Ó¢ÛÙÈÎfi, ˘Ô„›· Ù˘ ÓfiÛÔ˘ Ù›ıÂÙ·È Û Â-
ÚÈÙÒÛÂȘ ·Ó‰ÚÈ΋˜ ÛÙÂÈÚfiÙËÙ·˜, fiÙ·Ó Ù· ÛÂÚÌ·-
ÙÔ˙ˆ¿ÚÈ· Â›Ó·È ·Î›ÓËÙ· ‹ ¤¯Ô˘Ó ÌÂȈ̤ÓË ÎÈÓËÙÈÎfi-
ÙËÙ· (17), ¯ˆÚ›˜ Ë ÁÔÓÈÌfiÙËÙ· Ó· ·ÔÎÏ›ÂÈ ÙË ‰È¿-
ÁÓˆÛË ÛÙÔ˘˜ ¿ÚÚÂÓ˜. ∞Ó¿ÏÔÁ· ÈÛ¯‡Ô˘Ó ÁÈ· ÙË ÛÙÂÈ-
ÚfiÙËÙ· ÙˆÓ Á˘Ó·ÈÎÒÓ, fiÙ·Ó ‰ÂÓ ˘¿Ú¯Ô˘Ó ·Ó·ÙÔÌÈ-
ÎÔ› ‹ ÔÚÌÔÓÈÎÔ› ÏfiÁÔÈ Ù˘ ˘ÔÁÔÓÈÌfiÙËÙ·˜ (4).
¢È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË
¢È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘ Á›ÓÂÙ·È ·fi ÙËÓ
ÈÓÔ΢ÛÙÈ΋ ÓfiÛÔ, ÙÔ ¿ÛıÌ·, ÙȘ ·ÓÔÛÔ·Ó¿ÚÎÂȘ
Î·È ¿ÏϘ ¯ÚfiÓȘ Ó¢ÌÔÓÈΤ˜ ÓfiÛÔ˘˜. °È· ÙÔ ÏfiÁÔ
·˘Ùfi, Ë ÚÒÙË ÛÂÈÚ¿ ÂÍÂÙ¿ÛÂˆÓ ÂÚÈÏ·Ì‚¿ÓÂÈ ‰ÔÎÈ-
Ì·Û›· ȉÚÒÙ·, ·ÓÔÛÔÛÊ·ÈÚ›Ó˜, Û˘ÌÂÚÈÏ·Ì‚·ÓfiÌÂ-
Ó˘ Ù˘ IgE, ˘ÔÔÌ¿‰Â˜ ·ÓÔÛÔÛÊ·ÈÚÈÓÒÓ, ÚÔÛ‰ÈÔ-
ÚÈÛÌfi ·ÓÙÈۈ̷ÙÈÎÒÓ ··ÓÙ‹ÛÂˆÓ Û ÚÔËÁËı¤-
ÓÙ˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡˜ ‹ Ïԛ̈ÍË Ì ·‰ÂÓÔ˚fi ‹ Ì˘Îfi-
Ï·ÛÌ·, ·˘ÙÔ·ÓÙÈÛÒÌ·Ù· Î·È Â›Â‰· ·1-·ÓÙÈıÚ˘-
„›Ó˘. ™Â ·È‰È¿ Ì ¿ÛıÌ· Ô˘ ‰ÂÓ ··ÓÙÔ‡Ó ÛÙËÓ
ηٿÏÏËÏË ·ÁˆÁ‹ Ú¤ÂÈ Ó· Á›ÓÔÓÙ·È ÂÍÂÙ¿ÛÂȘ Ô˘
ÂȂ‚·ÈÒÓÔ˘Ó ÙË ‰È¿ÁÓˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ‰˘ÛÎÈ-
Ó‹ÙˆÓ ÎÚÔÛÛÒÓ.
¢È·ÁÓˆÛÙÈΤ˜ ÂÍÂÙ¿ÛÂȘ
¢ÔÎÈÌ·Û›· ۷ί·Ú›Ó˘™Â ·È‰È¿ Ô˘ ÌÔÚÔ‡Ó Ó· Û˘ÓÂÚÁ·ÛÙÔ‡Ó, ËÏÈ-
Λ·˜ Û˘Ó‹ıˆ˜ ÌÂÁ·Ï‡ÙÂÚ˘ ÙˆÓ 12 ÂÙÒÓ, ÙÂÌ¿¯ÈÔ 1-
2 mm ۷ί·Ú›Ó˘ Ù›ıÂÙ·È ÛÙÔ ÚfiÛıÈÔ ¿ÎÚÔ Ù˘ ο-
Ùˆ ÚÈÓÈ΋˜ ÎfiÁ¯Ë˜ (18,19). √ ·ÛıÂÓ‹˜ οıÂÙ·È ‹ÚÂ-
ÌÔ˜ Ì ÙÔ ÎÂÊ¿ÏÈ ÁÂṲ́ÓÔ ÚÔ˜ Ù· ÂÌÚfi˜ ¯ˆÚ›˜ Ó·
‚‹¯ÂÈ, Ó· ÙÚÒÂÈ ‹ Ó· ›ÓÂÈ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ‰Ô-
ÎÈÌ·Û›·˜. ∂¿Ó ÌÂÙ¿ ÙËÓ ¿ÚÔ‰Ô Ì›·˜ ÒÚ·˜ ‰ÂÓ ·È-
Ûı·Óı› ÙË Á‡ÛË Ù˘ ۷ί·Ú›Ó˘ ÛËÌ·›ÓÂÈ fiÙÈ Úfi-
ÎÂÈÙ·È ÁÈ· ·ıÔÏÔÁÈ΋ οı·ÚÛË Ù˘ ‚ϤÓÓ·˜ ·fi
ÙÔ˘˜ ÎÚÔÛÛÔ‡˜. ™ÙÔÓ ·ÛıÂÓ‹ ÙÔÔıÂÙÂ›Ù·È Û·Î¯·Ú›-
ÓË Î·Ù¢ı›·Ó ÛÙË ÁÏÒÛÛ· ÁÈ· Ó· ÂȂ‚·Èˆı› fiÙÈ
ÌÔÚ› Ó· ·ÈÛı·Óı› ÙË Á‡ÛË Ù˘.
ª¤ÙÚËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ ΛÓËÛ˘ ÙˆÓ ÎÚÔÛÛÒÓ∂¿Ó Ë ‰ÔÎÈÌ·Û›· ۷ί·Ú›Ó˘ Â›Ó·È Ê˘ÛÈÔÏÔÁÈ΋
(<Ì›· ÒÚ·), ÙfiÙ ‰ÂÓ ̄ ÚÂÈ¿˙ÂÙ·È ÂÚ·ÈÙ¤Úˆ ÂͤٷÛË.
∞Ó fï˜ Â›Ó·È ·ıÔÏÔÁÈ΋, ··ÈÙÂ›Ù·È Ó· Á›ÓÂÈ Ì¤-
ÙÚËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ Ù˘ ΛÓËÛ˘ ÙˆÓ ÎÚÔÛÛÒÓ
Î·È ·ÂÈÎfiÓÈÛË Ù˘ ÌÔÚÊÔÏÔÁ›·˜ Ù˘ ΛÓËÛ˘. °È· ÙÔ
ÏfiÁÔ ·˘Ùfi, Ï·Ì‚¿ÓÂÙ·È ÂÈı‹ÏÈÔ ·fi ÙÔ ÚÈÓÔÊ¿Ú˘Á-
Á· Ì ΢ÙÙ·ÚÔÏÔÁÈ΋ ‚Ô‡ÚÙÛ· ·ÔÛÙÂÈڈ̤ÓË ‹
ÌÈ·˜ ¯Ú‹Ûˆ˜ (20). ∆Ô ‰Â›ÁÌ· Ô˘ Ï·Ì‚¿ÓÂÙ·È ÌÂ
·˘Ùfi ÙÔÓ ÙÚfiÔ, ·ÎfiÌË Î·È fiÙ·Ó ÙÔ ·È‰› ‰ÂÓ Û˘ÓÂÚ-
Á¿˙ÂÙ·È, Â›Ó·È ÈηÓÔÔÈËÙÈÎfi ÛÙÔ 80% ÙˆÓ ÂÚÈÙÒ-
ÛÂˆÓ (21). ∂¿Ó Á›ÓÂÈ ‚ÚÔÁ¯ÔÛÎfiËÛË ÁÈ· ¿ÏÏÔ ÏfiÁÔ,
ηÏfi Â›Ó·È Ó· ÏËÊı› Î·È ·fi ÙÔ˘˜ ‚ÚfiÁ¯Ô˘˜ ‰Â›ÁÌ·,
ÁÓˆÚ›˙ÔÓÙ·˜ fiÙÈ ·Ó·ÈÛıËÙÈο, fiˆ˜ Ë ·ÏÔı¿ÓË Î·È Ë
ÏȉÔη˝ÓË, ÌÂÈÒÓÔ˘Ó ÙË Û˘¯ÓfiÙËÙ· ΛÓËÛ˘ ÙˆÓ
ÎÚÔÛÛÒÓ (22). ∆Ô ‰Â›ÁÌ· ηÓÔÓÈο Ú¤ÂÈ Ó· ÌÂÙ·-
ÊÂÚı› ÂÓÙfi˜ 2 ̂ ÚÒÓ ÛÙÔ Î¤ÓÙÚÔ Ô˘ ı· οÓÂÈ ÙË Ì¤-
ÙÚËÛË, ·ÏÏ¿ Î·È ‰Â›ÁÌ·Ù· ÌÂÙ·ÊÂÚfiÌÂÓ· ÂÓÙfi˜ 24
ˆÚÒÓ ÌÂÙÚÒÓÙ·È Û˘Ó‹ıˆ˜ ¯ˆÚ›˜ Úfi‚ÏËÌ· (7).
¶ÔÏÏÔ› ÚÔÛı¤ÙÔ˘Ó ÛÙÔ ‰Â›ÁÌ· Ô˘ ÚfiÎÂÈÙ·È Ó·
ηı˘ÛÙÂÚ‹ÛÂÈ ¤Ú·Ó ÙˆÓ ‰‡Ô ˆÚÒÓ Î·È ÂÓÈÎÈÏÏ›ÓË
‹ ÛÙÚÂÙÔÌ˘Î›ÓË ÁÈ· Ó· ηٷȤÛÔ˘Ó ÙËÓ ·Ó¿Ù˘ÍË
Ù˘ ̄ ψڛ‰·˜ ÙÔ˘ ÂÈıËÏ›Ô˘. ∫¿ı ΤÓÙÚÔ Ú¤ÂÈ Ó·
ÚÔÛ‰ÈÔÚ›˙ÂÈ ÙȘ ‰ÈΤ˜ ÙÔ˘ Ê˘ÛÈÔÏÔÁÈΤ˜ ÙÈ̤˜ ‰ÈfiÙÈ
ÂÍ·ÚÙÒÓÙ·È ·fi ÙËÓ ËÏÈΛ· Î·È ·fi ÙË Ì¤ıÔ‰Ô. √È
Û˘Ó‹ıÂȘ Ê˘ÛÈÔÏÔÁÈΤ˜ ÙÈ̤˜ Â›Ó·È 11-16 Hz (7).
∂Âȉ‹ Ë Û˘¯ÓfiÙËÙ· Ù˘ ΛÓËÛ˘ ÂËÚ¿˙ÂÙ·È ·Îfi-
ÌË Î·È ·fi Û˘Ó‹ıÂȘ ÏÔÈÌÒÍÂȘ, ÙÔ ‰Â›ÁÌ· ı· Ú¤ÂÈ
Ó· Ï·Ì‚¿ÓÂÙ·È 4-6 ‚‰ÔÌ¿‰Â˜ ÌÂÙ¿ ·fi ·Ó¿ÏÔÁÔ
ÂÂÈÛfi‰ÈÔ Ô˘ ÂÈÓ¤ÌÂÙ·È ÙÔ ·Ó·Ó¢ÛÙÈÎfi (1,23,24).
°È· ÙË Ì¤ÙÚËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ ¯ÚËÛÈÌÔÔÈ›ٷÈ
16 ª. ªÔ˘ÛÙ¿ÎË, ∞. ºÚÂÙ˙¿ÁÈ·˜
Paediatriki 2008;71:14-20
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·16
Û˘Ó‹ıˆ˜ Ë ÊˆÙÔ‰ÈÔ‰È΋ ̤ıÔ‰Ô˜, Ì ÙËÓ ÔÔ›· ‰ÂÓ
ÂϤÁ¯ÂÙ·È Ô ÙÚfiÔ˜ Ù˘ ΛÓËÛ˘ ÙˆÓ ÎÚÔÛÛÒÓ. °È·
ÙËÓ ·ÂÈÎfiÓÈÛË ÙÔ˘ ÙÚfiÔ˘ Ù˘ ΛÓËÛ˘, ··ÈÙ›ٷÈ
Ë ·Ó¿Ï˘ÛË Ì video ˘„ËÏ‹˜ ¢ÎÚ›ÓÂÈ·˜ Î·È ˘„ËÏ‹˜
Ù·¯‡ÙËÙ·˜. ∏ ηٷÁÚ·Ê‹ ÙÔ˘ ÙÚfiÔ˘ ΛÓËÛ˘ ›ӷÈ
··Ú·›ÙËÙË, ÁÈ·Ù› ·Ó¿ÏÔÁ· Ì ÙÔ ‰ÔÌÈÎfi ÂÏ¿Ùو̷
ÌÔÚ› Ë Û˘¯ÓfiÙËÙ· ΛÓËÛ˘ Ó· Â›Ó·È Ê˘ÛÈÔÏÔÁÈ΋,
·ÏÏ¿ Ë ÌÔÚÊ‹ Ù˘ ΛÓËÛ˘ ·ıÔÏÔÁÈ΋ (1,4,7). √ ÙÂ-
ÏÂ˘Ù·›Ô˜ Û˘Ó‰˘·ÛÌfi˜ ·Ú·ÙËÚÂ›Ù·È Û ·ÛıÂÓ›˜ ÌÂ
ÌÂÙ·ÙfiÈÛË ÙˆÓ ÎÚÔÛÛÒÓ ‹ ÌÂ ·ÁÂÓÂÛ›· ÙˆÓ ÎÂÓÙÚÈ-
ÎÒÓ ÌÈÎÚÔÛˆÏËÓ·Ú›ˆÓ. ™ÙȘ ̆ fiÏÔȘ ÂÚÈÙÒÛÂȘ
‚Ï¿‚˘ Ù˘ Â͈ÙÂÚÈ΋˜ ‹ Ù˘ ÂÛˆÙÂÚÈ΋˜ ‰˘Ó½Ó˘
‹ ÙÔ˘ ·ÎÙÈÓÔÂȉԇ˜ ÓËÌ·Ù›Ô˘ (radial spoke), ÂËÚÂ-
¿˙ÂÙ·È ¿ÓÙÔÙÂ Î·È Ë Û˘¯ÓfiÙËÙ·, ÂÓÒ Ë Î›ÓËÛË Î·Ù¿
ÙËÓ ·Ó¿Ï˘ÛË Ì video Â›Ó·È ·ıÔÏÔÁÈ΋.
∞Ó Ë Î›ÓËÛË Î·È Ë Û˘¯ÓfiÙËÙ· Â›Ó·È Ê˘ÛÈÔÏÔÁÈΤ˜,
‰ÂÓ ˘¿Ú¯ÂÈ ÓfiÛÔ˜ ‰˘ÛÎÈÓ‹ÙˆÓ ÎÚÔÛÛÒÓ Î·È Ë ‰ÈÂ-
Ú‡ÓËÛË ÛÙ·Ì·Ù¿ ‰Ò. ∞Ó Â›Ó·È ·ıÔÏÔÁÈ΋ ÌÈ· ·fi
ÙȘ ‰‡Ô ‹ ·Ó Ë Û˘¯ÓfiÙËÙ· Â›Ó·È ÌÂÓ Ê˘ÛÈÔÏÔÁÈ΋, ·Ï-
Ï¿ ¯ˆÚ›˜ Ó· ¤¯ÂÈ Á›ÓÂÈ Î·È ·Ó¿Ï˘ÛË Ù˘ ΛÓËÛ˘, Ë
ÂͤٷÛË Û˘Ó¯›˙ÂÙ·È Ì ËÏÂÎÙÚÔÓÈ΋ ÌÈÎÚÔÛÎfiËÛË
(∂ÈÎfiÓ· 4).
∏ÏÂÎÙÚÔÓÈÎfi ÌÈÎÚÔÛÎfiÈÔ°È· ÙËÓ ÂͤٷÛË Ù˘ ‰ÔÌ‹˜ ÙˆÓ ÎÚÔÛÛÒÓ Ì ËÏÂ-
ÎÙÚÔÓÈÎfi ÌÈÎÚÔÛÎfiÈÔ Â›Ó·È ÚÔÙÈÌËÙ¤· Ë Ï‹„Ë
‰Â›ÁÌ·ÙÔ˜ Ì ‚ÈÔ„›· ·fi ‰‡Ô ‰È·ÊÔÚÂÙÈΤ˜ ÂÚÈÔ-
¯¤˜, ÒÛÙ ӷ ·ÔÎÏÂÈÛÙ› Î·È Ë ÂÚ›ÙˆÛË ‰Â˘ÙÂÚÔ-
ÁÂÓÒÓ ‚Ï·‚ÒÓ ÂÍ·ÈÙ›·˜ Ïԛ̈͢ ‹ ÊÏÂÁÌÔÓ‹˜. ∆·
ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÁÈ· ÙÔÓ ·ÔÎÏÂÈÛÌfi Ù˘ Ïԛ̈͢
¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÎÚÔÛÛÔ› ÌÂÙ¿ ·fi ÂȉÈΤ˜ ηÏ-
ÏȤÚÁÂȘ ÛÂ Û˘Óı‹Î˜ ·ÂÚ›Ô˘-˘ÁÚ¿˜ Ê¿Ûˆ˜ (25),
·ÏÏ¿ ·˘Ù¤˜ ÔÈ Î·ÏÏȤÚÁÂȘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÛÂ
ÂÚÈÔÚÈṲ̂ÓÔ ·ÚÈıÌfi ΤÓÙÚˆÓ. ™˘ÓÔÏÈο, Ú¤ÂÈ Ó·
ÌÂÏÂÙËıÔ‡Ó ÙÔ˘Ï¿¯ÈÛÙÔÓ 50 ÎÚÔÛÛÔ› (26). ∞ӈ̷-
ϛ˜ ÌÔÚ› Ó· ·Ú·ÙËıÔ‡Ó ÛÙÔ 10% Î·È ÛÂ Ê˘ÛÈÔ-
ÏÔÁÈÎfi ÂÈı‹ÏÈÔ Î·È ÁÈ· ÙÔ ÏfiÁÔ ·˘Ùfi ÔÈ ·ÓˆÌ·Ï›Â˜
Ú¤ÂÈ Ó· ÂÎÊÚ·ÛÙÔ‡Ó Î·È ÔÛÔÙÈο (26,27). √È Û˘-
¯ÓfiÙÂÚ˜ ‰È·Ù·Ú·¯¤˜ (28) Â›Ó·È Ë ‰˘ÛÌÔÚÊ›· ‹
·Ô˘Û›· ÙˆÓ ÂÛˆÙÂÚÈÎÒÓ ‹ ÙˆÓ Â͈ÙÂÚÈÎÒÓ ‚Ú·¯Èfi-
ÓˆÓ Ù˘ ‰˘Ó½Ó˘ (80%), ÌÂÙ·ÙfiÈÛË ÙˆÓ ÎÂÓÙÚÈÎÒÓ
ÌÈÎÚÔÛˆÏËÓ·Ú›ˆÓ (10%) Î·È ‚Ï¿‚Ë ÙÔ˘ ·ÎÙÈÓÔÂÈ-
‰Ô‡˜ ÓËÌ·Ù›Ô˘ (6%). ÕÏϘ, ÏÈÁfiÙÂÚÔ Û˘¯Ó¤˜ ·Óˆ-
̷ϛ˜ Â›Ó·È Ë ·Ï·Û›· ÙˆÓ ÎÚÔÛÛÒÓ, ‰È·ÊÔÚÔÔÈ‹-
ÛÂȘ ÙÔ˘ ‚·ÛÈÎÔ‡ ÛˆÌ·Ù›Ô˘, ¤ÏÏÂÈ„Ë ÙÔ˘ ·ÍÔÓÈÎÔ‡
ÛˆÌ·Ù›Ô˘ ‹ ÎÚÔÛÛÔ› ÌÂÁ¿ÏÔ˘ Ì‹ÎÔ˘˜. √ÚÈṲ̂Ó˜
·fi ÙȘ ‚Ï¿‚˜, fiˆ˜ Ë ÌÂÙ·ÙfiÈÛË ÙˆÓ ÎÂÓÙÚÈÎÒÓ
ÌÈÎÚÔÛˆÏËÓ·Ú›ˆÓ, ÌÔÚ› Ó· ·Ú·ÙËÚËıÔ‡Ó ÌÂÙ¿
·fi ‰Â˘ÙÂÚÔÁÂÓ›˜ ÌÂÙ·‚ÔϤ˜ ÏfiÁˆ Ïԛ̈͢ ‹
ÊÏÂÁÌÔÓ‹˜. ™ÙÔ 3% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ‰ÂÓ ·Ú·ÙË-
ÚÂ›Ù·È ·ÓˆÌ·Ï›· (28), ÔfiÙÂ Ë ‰È¿ÁÓˆÛË ÌÔÚ› Ó·
ÛÙÔȯÂÈÔıÂÙËı› ÌfiÓÔ Ì ÙËÓ ·ıÔÏÔÁÈ΋ ΛÓËÛË
ÙˆÓ ÎÚÔÛÛÒÓ. °È· ÙÔ ÏfiÁÔ ·˘Ùfi Â›Ó·È ÛËÌ·ÓÙÈÎfi Ó·
Á›ÓÂÙ·È Î·È ÌÂϤÙË ÚÔÛ·Ó·ÙÔÏÈÛÌÔ‡ ÙˆÓ ÎÚÔÛÛÒÓ
(29,30), ‰ÈfiÙÈ ¤¯Ô˘Ó ·Ú·ÙËÚËı› ÂÚÈÙÒÛÂȘ ÌÂ
Ê˘ÛÈÔÏÔÁÈÎÔ‡˜ ·Ó·ÙÔÌÈο ÎÚÔÛÛÔ‡˜, ·ÏÏ¿ Ì ·ıÔ-
ÏÔÁÈÎfi ÚÔÛ·Ó·ÙÔÏÈÛÌfi ηٿ ÙËÓ Î›ÓËÛË, fiÔ˘ Ë
̤ÛË ·fiÎÏÈÛË ÙˆÓ Û¯ËÌ·ÙÈ˙fiÌÂÓˆÓ ÁˆÓÈÒÓ (7) ›-
Ó·È ÌÂÁ·Ï‡ÙÂÚË ÙˆÓ 20Æ.
¢ÔÎÈÌ·Û›· ÚÈÓÈÎÔ‡ ÂÎÓÂfiÌÂÓÔ˘ ¡√√È ÙÈ̤˜ ÙÔ˘ ÚÈÓÈÎÔ‡ ÂÎÓÂfiÌÂÓÔ˘ ¡√ Û ·ÛıÂ-
Ó›˜ Ì ڈÙÔ·ı‹ ‰˘ÛÎÈÓËÛ›· ÙˆÓ ÎÚÔÛÛÒÓ Â›Ó·È
Ôχ ¯·ÌËϤ˜ (14,31) Î·È ‰ÂÓ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ
ËÏÈΛ·. ™Â ÌÈ· ÔÌ¿‰· 64 ·ÛıÂÓÒÓ Ì ÂȂ‚·ÈˆÌ¤ÓË
‰È¿ÁÓˆÛË ‹Ù·Ó 19±17 nl/minute Û ۯ¤ÛË ÌÂ
376±124 nl/minute ÛÙ· Ê˘ÛÈÔÏÔÁÈο ¿ÙÔÌ· ηÈ
184±109 nl/minute ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ÈÓÔ΢ÛÙÈ΋
ÓfiÛÔ (16). √È ÙÈ̤˜ ÙÔ˘ ¡√ Û ·ÛıÂÓ›˜ Ì ‚·Ú‡
¿ÛıÌ· ‹ Ì ‚ÚÔÁ¯ÂÎٷۛ˜ ¿ÏÏ˘ ·ÈÙÈÔÏÔÁ›·˜ ›ӷÈ
˘„ËϤ˜ (7,16,32)Î·È ÁÈ· ÙÔ ÏfiÁÔ ·˘Ùfi ¯·ÌËÏfi ¡√ ÛÂ
·ÛıÂÓ‹ Ì ¿ÛıÌ· Ô˘ ‰ÂÓ ·ÓÙ·ÔÎÚ›ÓÂÙ·È ÛÙËÓ
·ÁˆÁ‹ ı¤ÙÂÈ ÙËÓ ̆ Ô„›· Ù˘ ÚˆÙÔ·ıÔ‡˜ ‰˘ÛÎÈÓË-
Û›·˜ ÙˆÓ ÎÚÔÛÛÒÓ. ÷ÌËÏfi, ̂ ÛÙfiÛÔ, Â›Ó·È ÙÔ ¡√ ηÈ
Û ·ÛıÂÓ›˜ Ì ÈÓÔ΢ÛÙÈ΋ ÓfiÛÔ Î·È Û ·ÛıÂÓ›˜ ÌÂ
ÚÈÓÈÎÔ‡˜ Ôχԉ˜ ¿ÏÏ˘ ·ÈÙÈÔÏÔÁ›·˜ (33). µ¤‚·È·,
ÔÈ ÙÈ̤˜ Û ڈÙÔ·ı‹ ‰˘ÛÎÈÓËÛ›· ÙˆÓ ÎÚÔÛÛÒÓ Â›-
Ó·È Ôχ ÈÔ ¯·ÌËϤ˜, ·ÏÏ¿ ˘¿Ú¯ÂÈ ÌÈÎÚÔ‡ ‚·ıÌÔ‡
·ÏÏËÏÔÂÈÎ¿Ï˘„Ë Ì ÙËÓ ÈÓÔ΢ÛÙÈ΋ ÓfiÛÔ (33). °È’
·˘Ùfi ÙÔ ÏfiÁÔ, ··ÈÙÂ›Ù·È Ô ·ÔÎÏÂÈÛÌfi˜ Ù˘ ‰È¿ÁÓˆ-
Û˘ Ù˘ ÈÓÔ΢ÛÙÈ΋˜ Û ·ÛıÂÓ›˜ Ì ̄ ·ÌËÏfi ¡√. ¢ÂÓ
¤¯ÂÈ ·Ú·ÙËÚËı› Û˘Û¯¤ÙÈÛË ÙˆÓ ÙÈÌÒÓ ÙÔ˘ ¡√ ÌÂ
ÙÔ Â›‰Ô˜ Ù˘ ÈÛÙÔÏÔÁÈ΋˜ ‚Ï¿‚˘ Ô‡ÙÂ Â›Ó·È ÁÓˆ-
ÛÙfi˜ Ô ·ıÔÊ˘ÛÈÔÏÔÁÈÎfi˜ Ì˯·ÓÈÛÌfi˜ Ù˘ ÂÎÓÔ‹˜
ÙfiÛÔ ¯·ÌËÏÒÓ ÂȤ‰ˆÓ ¡√. ™ËÌÂÈÒÓÂÙ·È fiÙÈ ÔÈ ÙÈ-
̤˜ ÙˆÓ ˘Ô¯ÚˆÙÈÎÒÓ ÂÙÂÚÔ˙˘ÁˆÙÒÓ, ÁÔÓ¤ˆÓ ÙˆÓ
17¶ÚˆÙÔ·ı‹˜ ‰˘ÛÎÈÓËÛ›· ÙˆÓ ÎÚÔÛÛÒÓ
¶·È‰È·ÙÚÈ΋ 2008;71:14-20
¢ÔÎÈÌ·Û›· ۷ί·Ú›Ó˘ ‹ ÚÈÓÈÎÔ‡ ¡√
(Û ·È‰È¿ ÌÂÁ·Ï‡ÙÂÚ· ÙˆÓ 12 Î·È 6 ÂÙÒÓ, ·ÓÙ›ÛÙÔȯ·)
ª¤ÙÚËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ Î·È ·Ó¿Ï˘ÛË Î›ÓËÛ˘
º˘ÛÈÔÏÔÁÈ΋ ¶·ıÔÏÔÁÈ΋
∏ÏÂÎÙÚÔÓÈÎfi ÌÈÎÚÔÛÎfiÈÔ
º˘ÛÈÔÏÔÁÈ΋ ¶·ıÔÏÔÁÈ΋
∂ÈÎfiÓ· 4. ∞ÏÁfiÚÈıÌÔ˜ ‰È·ÁÓˆÛÙÈ΋˜ ÚÔÛ¤ÁÁÈÛ˘ ·ÛıÂÓÔ‡˜ Ì¢Ԅ›· ÚˆÙÔ·ıÔ‡˜ ‰˘ÛÎÈÓËÛ›·˜ ÙˆÓ ÎÚÔÛÛÒÓ.
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·17
·È‰ÈÒÓ Ì ÂȂ‚·ÈˆÌ¤ÓË ‰È¿ÁÓˆÛË, Â›Ó·È ÂӉȿÌÂ-
Û˜ 285±101 nl/minute, Ì ‡ÚÔ˜ 37-613 nl/minute,
˘Ô‰ËÏÒÓÔÓÙ·˜ fiÙÈ ˘¿Ú¯ÂÈ Î¿ÔÈ· Û¯¤ÛË ÌÂٷ͇
ÙˆÓ ÂÙÂÚÔ˙˘ÁˆÙÒÓ Î·È Ù˘ ·Ú·ÁˆÁ‹˜ ¡√ (14).
∞Ó Î·È ‰ÂÓ ¤¯ÂÈ Â›ÛËÌ· ηıÈÂÚˆı› ˆ˜ ÂͤٷÛË
‰È·ÏÔÁ‹˜ ÁÈ· ·ÛıÂÓ›˜ Ì ˘Ô„›· ÁÈ· ÚˆÙÔ·ı‹
‰˘ÛÎÈÓËÛ›· ÙˆÓ ÎÚÔÛÛÒÓ, ÚÔÙ›ÓÂÙ·È ·fi ÔÚÈṲ̂-
ÓÔ˘˜ ÂÚ¢ÓËÙ¤˜ (34,35) ˆ˜ ¯Ú‹ÛÈÌÔ ÂÚÁ·ÏÂ›Ô ÁÈ· ÙËÓ
·Ó›¯Ó¢ÛË ·ÛıÂÓÒÓ Ì ڈÙÔ·ı‹ ‰˘ÛÎÈÓËÛ›· ÙˆÓ
ÎÚÔÛÛÒÓ.
°ÂÓÂÙÈ΋ ·Ó¿Ï˘ÛË∏ ÚˆÙÔ·ı‹˜ ‰˘ÛÎÈÓËÛ›· ÙˆÓ ÎÚÔÛÛÒÓ Â›Ó·È
ÁÂÓÂÙÈο ÎÏËÚÔÓÔÌÔ‡ÌÂÓË ÓfiÛÔ˜ Ì ·˘ÙfiÛˆÌÔ ˘Ô-
ÏÂÈfiÌÂÓÔ Ù‡Ô, ·Ó Î·È ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› Î·È Û¿-
ÓȘ ÂÚÈÙÒÛÂȘ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜ Ì ·˘ÙfiÛˆÌÔ
ÂÈÎÚ·ÙËÙÈÎfi ‹ Î·È ÌÂ Ê˘ÏÔÛ‡Ó‰ÂÙÔ (7,36,37). ∂ÂÈ-
‰‹ ÔÈ ÈÛÙÔÏÔÁÈΤ˜ ‚Ï¿‚˜ Â›Ó·È ÔÈΛÏÔ˘ Ù‡Ô˘, ‰ÂÓ
¤¯ÂÈ ‚ÚÂı› ¤Ó·˜ ›ÙÔÔ˜ ÁÂÓÂÙÈο ˘Â‡ı˘ÓÔ˜ ÁÈ·
ÙË ÓfiÛÔ. ÕÏψÛÙÂ, Î·È Û ·ÛıÂÓ›˜ Ì ÙȘ ›‰È˜ ÈÛÙÔ-
ÏÔÁÈΤ˜ ‚Ï¿‚˜ ·Ú·ÙËÚÂ›Ù·È ÁÂÓÂÙÈ΋ ÂÙÂÚÔÁ¤ÓÂÈ·.
ª¤¯ÚÈ Û‹ÌÂÚ·, ÔÈ Î˘ÚÈfiÙÂÚ˜ ÌÂÙ·ÏÏ¿ÍÂȘ Ô˘
¤¯Ô˘Ó Ù·˘ÙÔÔÈËı› Â›Ó·È ÔÈ ·ÎfiÏÔ˘ı˜. ªÂÙ¿ÏÏ·ÍË
Ô˘ Έ‰ÈÎÔÔÈ› ÙËÓ ÚˆÙ½ÓË (4,38) DNAI1
(dynein axonemal intermediate chain 1) Ô˘ ‰ڿ˙Â-
Ù·È ÛÙÔ ¯ÚˆÌfiۈ̷ 9p13-21, ·˘Ù‹ Ô˘ Έ‰ÈÎÔÔÈ›
ÙËÓ ÚˆÙ½ÓË (4,37) DNAH5 (dynein axonemal
heavy chain 5) Ô˘ ‰ڿ˙ÂÙ·È ÛÙÔ ¯ÚˆÌfiۈ̷ 5p15-
5p14 Î·È ·˘Ù‹ Ô˘ Έ‰ÈÎÔÔÈ› ÙËÓ ÚˆÙ½ÓË (4,37)
DNAH11 Ô˘ Έ‰ÈÎÔÔÈ› ›Û˘ ÙË ‚·Ú›· ¿Ï˘ÛÔ
Ù˘ ‰˘Ó½Ó˘ Î·È ÂÓÙÔ›˙ÂÙ·È ÛÙÔ ¯ÚˆÌfiۈ̷
17p21. ∏ ÙÂÏÂ˘Ù·›· ÌÂÙ¿ÏÏ·ÍË ¤¯ÂÈ Û˘Ó‰Âı› ΢ڛˆ˜
Ì ÙÔ Û‡Ó‰ÚÔÌÔ ·Ó·ÛÙÚÔÊ‹˜ ÙˆÓ ÛÏ¿Á¯ÓˆÓ. ∂›-
Û˘, ÌÂÙ¿ÏÏ·ÍË ¤¯ÂÈ ·Ú·ÙËÚËı› Î·È ÁÈ· ÙË ‚·Ú›·
¿Ï˘ÛÔ Ù˘ ÂÛˆÙÂÚÈ΋˜ ‰˘Ó½Ó˘ (4,38) DNAH7 Ô˘
‰ڿ˙ÂÙ·È ÛÙÔ ¯ÚˆÌfiۈ̷ 2q32. ™Â ÌÂÌÔӈ̤ӷ
ÂÚÈÛÙ·ÙÈο ¤¯ÂÈ ·Ú·ÙËÚËı› ÌÂÙ¿ÏÏ·ÍË Ù˘ Úˆ-
Ù½Ó˘ RPGR (37,39)Ô˘ ‰ڿ˙ÂÙ·È ÛÙÔ ¯ÚˆÌfiۈ̷
Ãp21 Î·È Ù˘ ÚˆÙ½Ó˘ √FD1 Ô˘ ‰ڿ˙ÂÙ·È ÛÙÔ
¯ÚˆÌfiۈ̷ Ãp22 (40).
¶ÂÚ·ÈÙ¤Úˆ ÁÂÓÂÙÈΤ˜ ÌÂϤÙ˜ ··ÈÙÔ‡ÓÙ·È ÁÈ· Ó·
·Ô‰Âȯı› Â¿Ó Ë ·Ó·ÛÙÚÔÊ‹ ÙˆÓ ÛÏ¿Á¯ÓˆÓ Û˘ÓÙÂ-
ÏÂ›Ù·È Ù˘¯·›· ÛÙÔ˘˜ ÌÈÛÔ‡˜ ·ÛıÂÓ›˜ Ì ÙË ÓfiÛÔ Ïfi-
Áˆ ¤ÏÏÂȄ˘ ÙÔ˘ ÚÔÛ·Ó·ÙÔÏÈÛÌÔ‡ ÙˆÓ ÎÚÔÛÛÒÓ ‹
ÔÚÈṲ̂ӷ ÁÔÓ›‰È· Â›Ó·È ÈÔ ÛÙÂÓ¿ Û˘Ó‰Â‰Â̤ӷ ÌÂ
ÙËÓ ·Ó·ÛÙÚÔÊ‹ ÙˆÓ ÛÏ¿Á¯ÓˆÓ.
£Âڷ›·
∏ ıÂڷ¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ,
Ù· ÔÔ›· Û˘Ó¿ÁÂÙ·È Ë ÚˆÙÔ·ı‹˜ ‰˘ÛÎÈÓËÛ›· ÙˆÓ
ÎÚÔÛÛÒÓ, ÏfiÁˆ ¤ÏÏÂȄ˘ ÌÂÏÂÙÒÓ, Á›ÓÂÙ·È ·fi ÎÏÈÓÈ-
Τ˜ ÌÂϤÙ˜ Î·È ·fi ÙËÓ ÂÌÂÈÚ›· Ô˘ ˘¿Ú¯ÂÈ ÛÂ
·ÛıÂÓ›˜ Ì ÈÓÔ΢ÛÙÈ΋ ÓfiÛÔ Î·È ‚ÚÔÁ¯ÂÎٷۛ˜ ¿Ï-
Ï˘ ·ÈÙÈÔÏÔÁ›·˜. ∏ ıÂڷ¢ÙÈ΋ ÙÔ˘˜ ·ÓÙÈÌÂÙÒÈÛË
ÚÔÙ›ÓÂÙ·È Ó· Á›ÓÂÙ·È Û ÂȉÈο ΤÓÙÚ·, ÛÙ· ÔÔ›· ÙÔ
·È‰› ÌÔÚ› Ó· ·Ú·ÎÔÏÔ˘ıÂ›Ù·È Û ٷÎÙ¿ ÌÂÛԉȷ-
ÛÙ‹Ì·Ù·, ÂÊfiÛÔÓ Ì¤ÓÂÈ Ì·ÎÚÈ¿, Î·È Ë ÂӉȿÌÂÛË ·-
Ú·ÎÔÏÔ‡ıËÛË Ó· Á›ÓÂÙ·È ÛÂ Û˘ÓÂÓÓfiËÛË Ì ÙÔ ıÂÚ¿-
ÔÓÙ· ·È‰›·ÙÚÔ (11). ™ËÌÂÈÒÓÂÙ·È fiÙÈ ÛÙË ¯ÒÚ· Ì·˜
˘¿Ú¯ÂÈ ·Ó¿ÁÎË ÔÚÁ·ÓˆÌ¤ÓˆÓ ΤÓÙÚˆÓ ‰È¿ÁÓˆÛ˘,
·Ú·ÎÔÏÔ‡ıËÛ˘ Î·È ·ÓÙÈÌÂÙÒÈÛ˘ ÙˆÓ ·È‰ÈÒÓ ÌÂ
ÚˆÙÔ·ı‹ ‰˘ÛÎÈÓËÛ›· ÙˆÓ ÎÚÔÛÛÒÓ.
∏ ÚÒÙÈÛÙË ÊÚÔÓÙ›‰· ÁÈ· ÙË ‰È·Ù‹ÚËÛË ÈηÓÔ-
ÔÈËÙÈ΋˜ ·Ó·Ó¢ÛÙÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ Â›Ó·È Ë ·Ó·-
Ó¢ÛÙÈ΋ Ê˘ÛÈÎÔıÂڷ›· (1,7). ¶Ú¤ÂÈ Ó· Á›ÓÂÙ·È
‰‡Ô ÊÔÚ¤˜ ÙËÓ Ë̤ڷ › ›ÎÔÛÈ ÙÔ˘Ï¿¯ÈÛÙÔÓ ÏÂÙ¿.
∏ Ê˘ÛÈÎÔıÂڷ›· Ú¤ÂÈ Ó· Û˘Ó‰˘¿˙ÂÙ·È Ì ¯Ú‹ÛË
‚2 ‰ÈÂÁ¤ÚÙË, ÂÊfiÛÔÓ Â›Ó·È ıÂÙÈ΋ Ë ‰ÔÎÈÌ·Û›· ·ÓÙÈ-
ÛÙÚ„ÈÌfiÙËÙ·˜, ηıÒ˜ Î·È Ì ¿ÛÎËÛË. √ ‚‹¯·˜
¯ÚÂÈ¿˙ÂÙ·È Ó· ÂÓı·ÚÚ‡ÓÂÙ·È Î·È fi¯È Ó· ηٷȤ˙ÂÙ·È,
‰ÈfiÙÈ ‚ÔËı¿ ÛÙË ‚ÏÂÓÓÒ‰Ë Î¿ı·ÚÛË. ™Â ÂÚ›ÙˆÛË
ÏÔÈÌÒÍÂˆÓ ·fi ÙÔ ·Ó·Ó¢ÛÙÈÎfi, ··ÈÙÂ›Ù·È Ë ¯Ô-
Ú‹ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ, ·Ó¿ÏÔÁ· Ì ÙÔ˘˜ ÌÈÎÚÔÔÚÁ·-
ÓÈÛÌÔ‡˜ Ô˘ ·ÔÌÔÓÒÓÔÓÙ·È. ¶ÚÔÏËÙÈο ¯ÔÚËÁ›-
Ù·È ÂÙËÛ›ˆ˜ ÙÔ ·ÓÙÈÁÚÈÈÎfi ÂÌ‚fiÏÈÔ Î·È Á›ÓÂÙ·È ÂÌ-
‚ÔÏÈ·ÛÌfi˜ ηٿ ÙÔ˘ Ó¢ÌÔÓÈÔÎfiÎÎÔ˘ ÙfiÛÔ Ì ÙÔ
Û˘ÓÂ˙¢Á̤ÓÔ 7‰‡Ó·ÌÔ fiÛÔ Î·È Ì ÙÔ ÔÏ˘Û·Î¯·ÚÈ-
‰ÈÎfi 23‰‡Ó·ÌÔ ÂÌ‚fiÏÈÔ, ÒÛÙ ӷ ·Ú¤¯ÂÙ·È Î¿Ï˘„Ë
ÁÈ· ηٿ ÙÔ ‰˘Ó·ÙfiÓ ÂÚÈÛÛfiÙÂÚ· ÛÙÂϤ¯Ë ÙÔ˘
Ó¢ÌÔÓÈÔÎfiÎÎÔ˘ (10).
∞ÓÙÈ‚›ˆÛË ·Ó¿ÏÔÁ· Ì ÙÔ ÛÙ¿‰ÈÔ Ù˘ Ïԛ̈͢
‰›‰ÂÙ·È ·fi ÙÔ ÛÙfiÌ· ‹ ÂÓ‰ÔÊϤ‚È·. ∏ ·ÔÌfiÓˆÛË
ÙˆÓ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÒÓ Á›ÓÂÙ·È Â›Ù Ì ηÏÏȤÚÁÂÈ·
ÂÎÎÚ›ÛÂˆÓ ·fi ÙÔ ‚‹¯· ‹ Ì ηÏÏȤÚÁÂÈ· ÙÔ˘ Ê·-
Ú˘ÁÁÈÎÔ‡ ÂȯڛÛÌ·ÙÔ˜, ·Ó¿ÏÔÁ· Ì ÙËÓ ËÏÈΛ·. √È
ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ› Ô˘ Û˘Ó‹ıˆ˜ ·ÔÌÔÓÒÓÔÓÙ·È Â›-
Ó·È ·ÈÌfiÊÈÏÔ˜ Ù˘ Áڛ˘, ¯Ú˘Û›˙ÔÓÙ·˜ ÛÙ·Ê˘Ïfi-
ÎÔÎÎÔ˜ Î·È Ó¢ÌÔÓÈfiÎÔÎÎÔ˜ (41,42). 梉ÔÌÔÓ¿-
‰· ·ÂÚÈÔÁÂÓ‹˜ ·ÔÌÔÓÒÓÂÙ·È Û˘Ó‹ıˆ˜ ÛÙËÓ ÂÓ‹ÏÈ-
ÎË ˙ˆ‹ ¯ˆÚ›˜ Ó· ·ÔÎÏ›ÂÙ·È Ë Î·ÏÏȤÚÁÂÈ¿ Ù˘ ηÈ
ÛÙËÓ ·È‰È΋ ‹ ÂÊË‚È΋ ËÏÈΛ· (14,41). ™ÙÔ˘˜ ÂÓ‹ÏÈ-
Θ Ì ڈÙÔ·ı‹ ‰˘ÛÎÈÓËÛ›· ÙˆÓ ÎÚÔÛÛÒÓ ¤¯Ô˘Ó
·ÔÌÔÓˆı› ¿Ù˘· Ì˘ÎÔ‚·ÎÙËÚ›‰È·.
∞ÓÙÈ‚ÈÔÙÈο ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Â›Û˘ Î·È ÁÈ·
ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÔÍ›·˜ ̤Û˘ ˆÙ›Ùȉ·˜. ∏ Ì˘-
ÚÈÁÁÔÙÔÌ‹ Î·È Ë ÙÔÔı¤ÙËÛË ÛˆÏËÓ›ÛÎˆÓ ·ÂÚÈÛÌÔ‡
·Ú·Ì¤ÓÂÈ ı¤Ì· ˘fi Û˘˙‹ÙËÛË, ÁÈ·Ù›, ·Ó Î·È ·ÔÙÂ-
Ï› ̤ıÔ‰Ô ·ÓÙÈÌÂÙÒÈÛ˘ Ù˘ ¯ÚfiÓÈ·˜ ̤Û˘ ˆÙ›ÙÈ-
‰·˜ Ì ̆ ÁÚfi, ÌÔÚ› Ó· ·Ú·ÙËÚËı› ̄ ÚfiÓÈ· ¤ÎÎÚÈÛË
‹ Î·È Ù˘Ì·ÓÔÛÎÏ‹Ú˘ÓÛË (4). ∂›Ó·È ·ÌÊ›‚ÔÏÔ Î·Ù¿
fiÛÔ Ë ¯Ú‹ÛË ÙÔ˘˜ ‚ÔËı¿ ÛÙÔ ÙÂÏÈÎfi ·ÔÙ¤ÏÂÛÌ·
Ù˘ ·ÎÔ‹˜, Ë ÔÔ›· fiÙ·Ó ÂËÚ¿˙ÂÙ·È Ú¤ÂÈ Ó·
˘Ô‚ÔËıÂ›Ù·È Ì ·ÎÔ˘ÛÙÈο ‚·ÚËÎÔ˝·˜ (4). ™ÙȘ Â-
ÚÈÙÒÛÂȘ Ô˘ ¯ÚÂÈ·ÛÙ› Ù˘Ì·ÓÔÏ·ÛÙÈ΋, fiÙ·Ó
ÂӉ›ÎÓ˘Ù·È, ÌÔÚ› Ó· Û˘Ì‚Â›, ηıÒ˜ ¤¯ÂÈ ¯ÚËÛÈÌÔ-
ÔÈËı› Ì ÂÈÙ˘¯›· (43).
18 ª. ªÔ˘ÛÙ¿ÎË, ∞. ºÚÂÙ˙¿ÁÈ·˜
Paediatriki 2008;71:14-20
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·18
∏ ¯ÚfiÓÈ· ·Ú·ÚÈÓÔÎÔÏ›Ùȉ· ·ÓÙÈÌÂÙˆ›˙ÂÙ·È
Ì χÛÂȘ ÙˆÓ ÎfiψÓ, ÚÈÓÈο ÛÙÂÚÔÂȉ‹ Î·È Û˘-
ÛÙËÌ·ÙÈ΋ ¯ÔÚ‹ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ. ¢ÂÓ ˘¿Ú¯Ô˘Ó
ÂȉÈο Ê¿Ú̷η ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÚˆÙÔ-
·ıÔ‡˜ ‰˘ÛÎÈÓËÛ›·˜ ÙˆÓ ÎÚÔÛÛÒÓ Î·È Ë ¯ÂÈÚÔ˘ÚÁÈ-
΋ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ‚ÚÔÁ¯ÂÎÙ·ÛÈÒÓ ‰ÂÓ Û˘ÓÈÛÙ¿-
Ù·È ÁÈ·Ù› Â›Ó·È ÂÓ ‰˘Ó¿ÌÂÈ ÁÂÓÈÎÂ˘Ì¤ÓÔ Úfi‚ÏËÌ· ÁÈ·
ÙË ÓfiÛÔ Î·È Û˘˙ËÙÂ›Ù·È ÌfiÓÔ Û ÂÚÈÙÒÛÂȘ ÌÔÓ‹-
ÚÔ˘˜ ‚ÚÔÁ¯ÂÎÙ·Û›·˜ ÌË ·ÓÙÈÌÂÙˆÈ˙fiÌÂÓ˘ ÈηÓÔ-
ÔÈËÙÈο Û˘ÓÙËÚËÙÈο (44). ∂›Û˘, Û ·ÛıÂÓ›˜ ÌÂ
ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘ ·Ó·Ó¢ÛÙÈ΋ ·Ó¿ÚÎÂÈ· ¤¯ÂÈ Á›-
ÓÂÈ ÌÂÙ·ÌfiÛ¯Â˘ÛË Î·Ú‰È¿˜-Ó¢ÌfiÓˆÓ ‹ ÌÂÙ·Ìfi-
Û¯Â˘ÛË Ó¢ÌfiÓˆÓ (45). ∆Ô ÚÔÛ‰fiÎÈÌÔ ÂÈ‚›ˆÛ˘
·˘ÙÒÓ ÙˆÓ ·ÛıÂÓÒÓ Â›Ó·È ·Ó¿ÏÔÁÔ Ì ·˘Ùfi ÙˆÓ ÌÂ-
Ù·ÌÔÛ¯Â˘ı¤ÓÙˆÓ ÁÈ· ¿ÏϘ ·Èٛ˜.
µÈ‚ÏÈÔÁÚ·Ê›·
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10.∫˘Ú‚·Û›Ï˘ ºµ, ∆۷ӿη˜ π¡. ∫ÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ηÈ
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ªÔÓÔÁÚ·Ê›· ·È‰È·ÙÚÈ΋˜ Ó¢ÌÔÓÔÏÔÁ›·˜. ™ÙÔ:
∞ÓıÚ·ÎfiÔ˘ÏÔ˜ ª, ¶Ú›ÊÙ˘ ∫, ÂÈ̤ÏÂÈ· ¤Î‰ÔÛ˘.
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20 ª. ªÔ˘ÛÙ¿ÎË, ∞. ºÚÂÙ˙¿ÁÈ·˜
Paediatriki 2008;71:14-20
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·20
21∞¡∞™∫√¶∏™∏ REVIEW ARTICLE
¶·È‰È·ÙÚÈ΋ 2008;71:21-28
¡ÂÎÚˆÙÈ΋ ÂÓÙÂÚÔÎÔÏ›Ùȉ·: ÓÂfiÙÂÚ· ‰Â‰Ô̤ӷ ÁÈ· ÙËÓ ·ıÔ-
Ê˘ÛÈÔÏÔÁ›· Ù˘ ÓfiÛÔ˘
Ã. ∆۷ηϛ‰Ë˜1, ∞. ∆Ú·ÁÈ·ÓÓ›‰Ë˜2, ¡. ¡ÈÎÔÏ·˝‰Ë˜1
¶ÂÚ›ÏË„Ë: ∏ ÓÂÎÚˆÙÈ΋ ÂÓÙÂÚÔÎÔÏ›Ùȉ· (¡∂∫) ·ÔÙÂÏ› ÓfiÛÔ Î˘Ú›ˆ˜ ÙˆÓ ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ Î·È Û˘¯Ó¿¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ‚·ÚÈ¿ ÎÏÈÓÈ΋ ÂÈÎfiÓ·, ÛÔ‚·Ú¤˜ ÂÈÏÔΤ˜ Î·È ˘„ËÏ‹ ıÓËÙfiÙËÙ·. ∞Ó Î·È ·ÚÎÂÙÔ› ÚÔ-‰È·ıÂÛÈÎÔ› ·Ú¿ÁÔÓÙ˜ ¤¯Ô˘Ó ÂÓÔ¯ÔÔÈËı› ÁÈ· ÙËÓ ÂΉ‹ÏˆÛ‹ Ù˘, Ì ΢ÚÈfiÙÂÚÔ˘˜ ÙËÓ ÚÔˆÚfiÙËÙ·, ÙËÓÚÒÈÌË ¤Ó·ÚÍË Ù˘ ÂÓÙÂÚÈ΋˜ Û›ÙÈÛ˘ Î·È ÙË Ïԛ̈ÍË, ÂÓÙÔ‡ÙÔȘ, ̤¯ÚÈ Û‹ÌÂÚ· ‰ÂÓ ¤¯ÂÈ Ï‹Úˆ˜ ‰È¢ÎÚÈ-ÓÈÛÙ› Ë ·ıÔÁ¤ÓÂÛ‹ Ù˘. ∆· ÙÂÏÂ˘Ù·›· 20 ¯ÚfiÓÈ·, ¤¯ÂÈ ÂÎÙÂÓÒ˜ ÌÂÏÂÙËı›, ΢ڛˆ˜ Û ÂÈÚ·Ì·ÙÈο ÌÔÓÙ¤-Ï·, Ë Â›‰Ú·ÛË Ù˘ ˘ÔÍ›·˜ Î·È Ù˘ ÌÈÎÚԂȷ΋˜ ÚÔÛ‚ÔÏ‹˜ ÛÙËÓ ÚfiÎÏËÛË ‚Ï¿‚˘ ÙÔ˘ ‚ÏÂÓÓÔÁfiÓÔ˘ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡. ∞˘Ù¤˜, Î·È ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙËÓ ·Ô˘Û›· ÚÔÛٷ٢ÙÈÎÒÓ Ì˯·ÓÈÛÌÒÓ ÛÙÔ ÌÈÎÚÔ-·ÁÁÂÈ·Îfi ÂÓÙÂÚÈÎfi ÂÓ‰Ôı‹ÏÈÔ, fiˆ˜ ÙÔ ÌÔÓÔÍ›‰ÈÔ ÙÔ˘ ·˙ÒÙÔ˘ (NO) Î·È Ë ·ÓˆÚÈÌfiÙËÙ· ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ÊÚ·ÁÌÔ‡, ÚÔηÏÔ‡Ó ‰È·Ù·Ú·¯‹ Ù˘ ·Ì˘ÓÙÈ΋˜ ÈÛÔÚÚÔ›·˜ Î·È Û˘Ó·ÎfiÏÔ˘ıË ‚Ï¿‚Ë. ∂ÈϤÔÓ, Û‹-ÌÂÚ· Â›Ó·È ÁÓˆÛÙ‹ Ë ‰Ú¿ÛË ÙˆÓ ÚÔÊÏÂÁÌÔÓˆ‰ÒÓ ÌÂÛÔÏ·‚ËÙÒÓ, fiˆ˜ Ô ·Ú¿ÁÔÓÙ·˜ ‰È¤ÁÂÚÛ˘ ÙˆÓ·ÈÌÔÂÙ·Ï›ˆÓ (platelet activating factor - PAF) Î·È ÔÈ Î˘ÙÔΛÓ˜, ÛÙËÓ ÚfiÎÏËÛË ÈÛ¯·ÈÌ›·˜ Î·È ·ÎÔÏÔ‡ıˆ˜Ó¤ÎÚˆÛ˘ ÙÔ˘ ÂÓÙ¤ÚÔ˘. ™ÙÔ ¿ÚıÚÔ ·˘Ùfi, ·Ó·ÛÎÔÔ‡ÓÙ·È ÔÈ ÛËÌ·ÓÙÈÎfiÙÂÚÔÈ ·Ú¿ÁÔÓÙ˜ Ô˘ Û˘Ì‚¿Ï-ÏÔ˘Ó ÛÙËÓ ÂΉ‹ÏˆÛË Ù˘ ÓfiÛÔ˘ Î·È Ù· ÓÂfiÙÂÚ· ‰Â‰Ô̤ӷ ÁÈ· ÙËÓ ·ıÔÁ¤ÓÂÛ‹ Ù˘.
§¤ÍÂȘ ÎÏÂȉȿ: ¡ÂÎÚˆÙÈ΋ ÂÓÙÂÚÔÎÔÏ›Ùȉ·, ÚÔˆÚfiÙËÙ·, ·Ú¿ÁÔÓÙ·˜ ‰È¤ÁÂÚÛ˘ ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ, ÂÓÙÂÚÈ΋ Û›ÙÈÛË,
Ïԛ̈ÍË.
Necrotizing enterocolitis: recent evidence on the pathophysiology of
the disease
C. Tsakalidis1, A. Tragiannidis2, N. Nikolaidis1
Abstract: Necrotizing enterocolitis (NEC) is a disease affecting predominantly premature infants. It has asevere clinical presentation and many complications and is a leading cause of mortality in pretermneonates. Although many predisposing factors have been identified, such as prematurity, enteral feedingand infection, its pathogenesis is not fully understood. In the past 20 years, the role of hypoxia andinfection in causing damage to the intestinal mucosa has been studied, mainly in animals. The lack ofprotective mechanisms in the vascular enteric endothelium, such as nitric oxide, and the immaturity of theintestinal epithelial barrier in premature infants affect the balance between protective and injuriousmechanisms. It is now known that proinflammatory mediators play an important role in intestinalischaemia and necrosis. This review focuses on the main contributing factors in NEC and recent data on itspathogenesis.
Key words: Necrotizing enterocolitis, prematurity, platelet activating factor, enteral feeding, infection.
∂ÈÛ·ÁˆÁ‹
∏ ÓÂÎÚˆÙÈ΋ ÂÓÙÂÚÔÎÔÏ›Ùȉ· (¡∂∫) ›ӷÈÊÏÂÁÌÔÓ҉˘ ÓfiÛÔ˜ ÙÔ˘ ·ÓÒÚÈÌÔ˘ ÂÓÙ¤ÚÔ˘ ÙˆÓÓÂÔÁÓÒÓ Î·È ·ÔÙÂÏ› ÙÔ Û˘¯ÓfiÙÂÚÔ ·›ÙÈÔ ıÓË-ÛÈÌfiÙËÙ·˜ Î·È ÓÔÛËÚfiÙËÙ·˜ ·fi ÙÔ Á·ÛÙÚÂÓÙÂ-ÚÈÎfi ÙÔ˘˜ Û‡ÛÙËÌ·. ¶ÚÒÙÔ˜ Ô Paltauf ÂÚȤÁÚ·-„ ÎÏÈÓÈΤ˜ ÂÚÈÙÒÛÂȘ ÓÂÔÁÓÒÓ Ì ¡∂∫ ÙÔ1888, fï˜ Ô fiÚÔ˜ “ÓÂÎÚˆÙÈ΋ ÂÓÙÂÚÔÎÔÏ›Ùȉ·”¯ÚËÛÈÌÔÔÈ‹ıËΠÁÈ· ÚÒÙË ÊÔÚ¿ ·fi ÙÔ˘˜Schmid Î·È Quaiser ÙÔ 1953 (1,2). ™ÙË Û˘Ó¤¯ÂÈ·ÔÈ Mizrahi Î·È Û˘Ó. ÂÚȤÁÚ·„·Ó ÙÔ 1965 ÙË Û˘-ÁÎÂÎÚÈ̤ÓË ÎÏÈÓÈ΋ ÔÓÙfiÙËÙ· ˆ˜ “Û‡Ó‰ÚÔÌÔÔ˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi Â̤ÙÔ˘˜, ‰È¿Ù·ÛË ÎÔÈ-
Ï›·˜, ·ÈÌÔÚÚ·Á›· ·fi ÙÔ ÂÙÈÎfi Î·È shock ÛÂ
ÚfiˆÚ· ÓÂÔÁÓ¿” (3). ∆Ô ÚÔÂͤ¯ÔÓ ¯·Ú·ÎÙËÚÈ-
ÛÙÈÎfi Ù˘ ¡∂∫ Â›Ó·È Ë ÊÏÂÁÌÔÓ‹ ÙÔ˘ ÂÓÙÂÚÈÎÔ‡
ÙÔȯÒÌ·ÙÔ˜ Û˘Óԉ¢fiÌÂÓË ·fi Ó¤ÎÚˆÛË, Ô˘
Û˘¯Ó¿ Ô‰ËÁ› Û ·ÂÈÏËÙÈΤ˜ ÁÈ· ÙË ˙ˆ‹ ÙÔ˘ ÓÂ-
ÔÁÓÔ‡ ÂÈÏÔΤ˜, fiˆ˜ Ë ‰È¿ÙÚËÛË. ∏ ¡∂∫
ÚÔÛ‚¿ÏÏÂÈ Î˘Ú›ˆ˜ ÓÂÔÁÓ¿ Ô˘ ÓÔÛËχÔÓÙ·È
Û ª∂¡¡ Î·È Ë Â›ÙˆÛ‹ Ù˘ ÔÈΛÏÏÂÈ Û‡Ì-
ʈӷ Ì ٷ Â˘Ú‹Ì·Ù· ÌÂÏÂÙÒÓ. ™˘ÁÎÂÎÚÈ̤ӷ,
Ë Â›ÙˆÛ‹ Ù˘ ÛÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi ·ÁÁ›˙ÂÈ
ÙȘ 1-2,4 ÂÚÈÙÒÛÂȘ ÛÙ· 1.000 ˙ÒÓÙ· ÓÂÔÁÓ¿
(4,5). ¶ÚfiÛÊ·Ù· ‚È‚ÏÈÔÁÚ·ÊÈο ‰Â‰Ô̤ӷ ·Ó·-
ʤÚÔ˘Ó fiÙÈ ÔÛÔÛÙfi 1-7,7% ÙˆÓ ÓÂÔÁÓÒÓ Ô˘
1 µ’ ¡ÂÔÁÓÔÏÔÁÈ΋ ∫ÏÈÓÈ΋∞¶£, ¡ÔÛÔÎÔÌ›Զ··ÁˆÚÁ›Ô˘,£ÂÛÛ·ÏÔÓ›ÎË
2 µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋∞¶£, ¡ÔÛÔÎÔÌÂ›Ô ∞Ã∂¶∞,£ÂÛÛ·ÏÔÓ›ÎË
AÏÏËÏÔÁÚ·Ê›·:
∞ı·Ó¿ÛÈÔ˜ ∆Ú·ÁÈ·ÓÓ›‰Ë˜[email protected] &[email protected]µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ∞¶£,¡ÔÛÔÎÔÌÂ›Ô ∞Ã∂¶∞,£ÂÛÛ·ÏÔÓ›ÎË
1 2nd Department ofNeonatology, AristotleUniversity of Thessaloniki,Papageorgiou Hospital,Thessaloniki, Greece
2 2nd Department ofPaediatrics, AristotleUniversity of Thessaloniki,AHEPA Hospital,Thessaloniki, Greece
Correspondence:
Athanassios [email protected] &[email protected] Department ofPaediatrics,Aristotle University ofThessaloniki,AHEPA Hospital, Thessaloniki,Greece
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·21
ÂÈÛ¿ÁÔÓÙ·È Û ª∂¡¡ Î·È 10% ÂÎÂ›ÓˆÓ Ì ¯·ÌËÏfi
‚¿ÚÔ˜ Á¤ÓÓËÛ˘ (VLBW) ı· ÂΉËÏÒÛÔ˘Ó ¡∂∫ (4-6).
∂ÈϤÔÓ, fiÛÔÓ ·ÊÔÚ¿ Ù· ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿, Ë Â›-
ÙˆÛË Ù˘ ÓfiÛÔ˘ ·Ó¤Ú¯ÂÙ·È ÛÙÔ 5-25ò Î·È Û˘Ó‹ıˆ˜
ÂΉËÏÒÓÂÙ·È ÌÂٷ͇ Ù˘ 2˘ Î·È 3˘ Ë̤ڷ˜ ˙ˆ‹˜ ÛÂ
·ÓÙ›ıÂÛË Ì ٷ ÚfiˆÚ· ÛÙ· ÔÔ›· ·Ú¯›˙ÂÈ ÌÂٷ͇
Ù˘ 10˘ Î·È Ù˘ 15˘ Ë̤ڷ˜ ˙ˆ‹˜ (7).
¶ÔÏϤ˜ ÂÚ¢ÓËÙÈΤ˜ ÔÌ¿‰Â˜ ¤¯Ô˘Ó ÂÈÎÂÓÙÚÒÛÂÈ
Û‹ÌÂÚ· ÙÔ ÂӉȷʤÚÔÓ ÙÔ˘˜ ÛÙËÓ ÂȉËÌÈÔÏÔÁ›·,
ÙËÓ ·ıÔÊ˘ÛÈÔÏÔÁ›· Î·È ÙȘ ıÂڷ¢ÙÈΤ˜ ÚÔÛÂÁ-
Á›ÛÂȘ Ù˘. ∞Ú¯Èο, Ë ¡∂∫ ›¯Â ·Ô‰Ôı› Û ÔÈÎÈÏ›·
·Ú·ÁfiÓÙˆÓ Ô˘ ÚÔηÏÔ‡Ó ÂÚÈÁÂÓÓËÙÈÎfi stress,
ÂÓÒ ·ÚÎÂÙ¤˜ ÂȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜ ¤¯Ô˘Ó Û˘Û¯Â-
Ù›ÛÂÈ ÙËÓ ÂΉ‹ÏˆÛ‹ Ù˘ Ì Â͈ÁÂÓ›˜ ·Ú¿ÁÔÓÙ˜,
fiˆ˜ Ô ¯ÚfiÓÔ˜ ηÈ/‹ Ë Ù·¯‡ÙËÙ· ¯ÔÚ‹ÁËÛ˘ ÙÔ˘ Á¿-
Ï·ÎÙÔ˜, Ô Ù‡Ô˜ ÙÔ˘ Á¿Ï·ÎÙÔ˜ (ÌËÙÚÈÎfi ¤Ó·ÓÙÈ ÙÚÔ-
ÔÔÈË̤ÓÔ˘ Á¿Ï·ÎÙÔ˜ ·ÁÂÏ¿‰·˜) (8-12). ™‹ÌÂÚ·,
·ÚfiÏÔ Ô˘ Ô ·ÎÚÈ‚‹˜ ·ıÔÁÂÓÂÙÈÎfi˜ Ì˯·ÓÈÛÌfi˜
ÚfiÎÏËÛ‹˜ Ù˘ ‰ÂÓ ¤¯ÂÈ Ï‹Úˆ˜ ‰È¢ÎÚÈÓÈÛÙ›, ¤¯ÂÈ
ÔÌÔÊÒÓˆ˜ ηٷÛÙ› ·Ô‰ÂÎÙ‹ Ë Û˘Ó¤ÚÁÂÈ· Î·È Ë
Û˘ÌÌÂÙÔ¯‹ ÔÏÏÒÓ ·Ú·ÁfiÓÙˆÓ (13). ™ËÌ·ÓÙÈ΋
ı¤ÛË ÌÂٷ͇ ·˘ÙÒÓ Î·Ù¤¯Ô˘Ó Ë ÚÔˆÚfiÙËÙ·, Ë
ÈÛ¯·ÈÌ›· ÙÔ˘ ÂÓÙ¤ÚÔ˘, Ô ·ÔÈÎÈÛÌfi˜ ÙÔ˘ ÌÂ ·ıÔÁfi-
Ó· ÌÈÎÚfi‚È· Î·È Ë ÚÒÈÌË ¤Ó·ÚÍË Ù˘ ÂÓÙÂÚÈ΋˜ Û›-
ÙÈÛ˘ (14,15). ∆· ¯·Ú·ÎÙËÚÈÛÙÈο ·ıÔÏÔÁÔ·Ó·ÙÔ-
ÌÈο Â˘Ú‹Ì·Ù· Ù˘ ¡∂∫ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙË ÊÏÂÁÌÔ-
Ó‹ ÙÔ˘ ÂÓÙ¤ÚÔ˘, ÙËÓ ÈÛ¯·ÈÌÈ΋ Ó¤ÎÚˆÛË, ÙÔÓ ·ÔÈÎÈ-
ÛÌfi Î·È ÔÏÏ·Ï·ÛÈ·ÛÌfi ÙˆÓ ‚·ÎÙËÚ›ˆÓ Î·È Ù¤ÏÔ˜,
ÙËÓ ·Ó·‰fiÌËÛË ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ÂÈıËÏ›Ô˘ Û˘Óԉ¢fi-
ÌÂÓË Û˘Ó‹ıˆ˜ ·fi ›ÓˆÛË.
™ÙÔ ¿ÚıÚÔ ·˘Ùfi ·Ó·ÛÎÔÔ‡ÓÙ·È Ô Èı·Ófi˜ ·ıÔ-
ÁÂÓÂÙÈÎfi˜ Ì˯·ÓÈÛÌfi˜ Î·È ÙÔ ÚÔÙÂÈÓfiÌÂÓÔ ÌÔÓÙ¤ÏÔ
Û˘ÌÌÂÙÔ¯‹˜ Î·È ‰Ú¿Û˘ ÙˆÓ ·ÈÙÈÔÏÔÁÈÎÒÓ ·Ú·Áfi-
ÓÙˆÓ ÛÙËÓ ÂΉ‹ÏˆÛË Ù˘ ¡∂∫.
¶ÚÔˆÚfiÙËÙ·
∏ ÚÔˆÚfiÙËÙ· ·ÔÙÂÏ› ÙÔ ÛËÌ·ÓÙÈÎfiÙÂÚÔ ÚÔ-
‰È·ıÂÛÈÎfi ·Ú¿ÁÔÓÙ· Ô˘ Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ÂΉ‹-
ψÛË ¡∂∫, ·Ó Î·È Â›Ó·È Â˘Ú¤ˆ˜ ÁÓˆÛÙfi fiÙÈ Ë Û˘ÁÎÂ-
ÎÚÈ̤ÓË ÎÏÈÓÈ΋ ÔÓÙfiÙËÙ· ÌÔÚ› Ó· ÂΉËψı› ηÈ
Û ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿ (4,6,7). ¶ÂÚ›Ô˘ 5-10% ÙˆÓ
ÓÂÔÁÓÒÓ Ì ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ <1.500g ı· ÂΉËÏÒÛÂÈ
¡∂∫ Î·È Ë Â›ÙˆÛË ·˘Í¿ÓÂÈ ·ÓÙÈÛÙÚfiʈ˜ ·Ó¿ÏÔÁ·
Ì ÙËÓ ËÏÈΛ· ·ËÛ˘ (4-6). ™ÙȘ ·Ú¯¤˜ Ù˘ ‰ÂηÂ-
Ù›·˜ ÙÔ˘ ’60, Ô Santulli ÂÚȤÁÚ·„ ÛÙË ‰ÈÂıÓ‹ ‚È-
‚ÏÈÔÁÚ·Ê›· ÙË Û˘ÁÎÂÎÚÈ̤ÓË ÎÏÈÓÈ΋ ÔÓÙfiÙËÙ· ÛÂ
ÚfiˆÚ· ÓÂÔÁÓ¿ Ì ¯·ÌËÏ‹ ‚·ıÌÔÏfiÁËÛË Apgar η-
Ù¿ ÙË Á¤ÓÓËÛË Î·È ÓfiÛÔ Ù˘ ˘·ÏÔÂȉԇ˜ ÌÂÌ‚Ú¿Ó˘
(16). ™Ù· ÓÂÔÁÓ¿ Ù˘ Û˘ÁÎÂÎÚÈ̤Ó˘ ÌÂϤÙ˘ Û˘Ó˘-
‹Ú¯·Ó ÂÈϤÔÓ Ù· ÂÍ‹˜ ¯·Ú·ÎÙËÚÈÛÙÈο: ¯Ú‹ÛË
Ì˯·ÓÈÎÔ‡ ·ÂÚÈÛÌÔ‡, ηıÂÙËÚÈ·ÛÌfi˜ ÙˆÓ ÔÌÊ·ÏÈ-
ÎÒÓ ·ÁÁ›ˆÓ, ÂÌÊ¿ÓÈÛË ÛËÌ›ˆÓ Î·È Û˘Ìو̿وÓ
·fi ÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi Û‡ÛÙËÌ·, fiˆ˜ ÌÂÙˆÚÈÛÌfi˜
ÎÔÈÏ›·˜ Î·È ¯ÔÏÒ‰Ë ˘fiÏÔÈ· ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘
ÂÓÙÂÚÈ΋˜ Û›ÙÈÛ˘ (16). √È ·ÛıÂÓ›˜ ·˘ÙÔ› ·ÔÙ¤ÏÂ-
Û·Ó ÙË ‚¿ÛË ÁÈ· ÙÔÓ ÔÚÈÛÌfi Ù˘ ¡∂∫, Ô˘ ¯·Ú·ÎÙË-
Ú›˙ÂÙ·È ·fi ÙÔÓ ·ÔÈÎÈÛÌfi Î·È ÔÏÏ·Ï·ÛÈ·ÛÌfi ÌÈ-
ÎÚÔ‚›ˆÓ, ÙËÓ ÈÛ¯·ÈÌ›· Î·È ÙËÓ ·ÚÔ˘Û›· ÚԉȷıÂ-
ÛÈÎÒÓ ·Ú·ÁfiÓÙˆÓ (.¯. ¤Ó·ÚÍË ÂÓÙÂÚÈ΋˜ Û›ÙÈÛ˘).
™‹ÌÂÚ·, ¯¿ÚË ÛÙËÓ ÚfiÔ‰Ô Ô˘ ¤¯ÂÈ ÂÈÙ¢¯ı› ÛÙË
ÓÂÔÁÓÔÏÔÁ›· ¤¯ÂÈ ·ÊÂÓfi˜ ÌÂȈı› Ô ·ÚÈıÌfi˜ ÙˆÓ
·ÛÊ˘ÎÙÈÎÒÓ ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ Î·È Ë ·Ú·ÌÔÓ‹
ÙÔ˘˜ Û Ì˯·ÓÈÎfi ·ÂÚÈÛÌfi Î·È ·ÊÂÙ¤ÚÔ˘ ÂÚÈÔÚÈÛÙ›
Ë Ú·ÎÙÈ΋ ηıÂÙËÚÈ·ÛÌÔ‡ ÙˆÓ ÔÌÊ·ÏÈÎÒÓ ·ÁÁ›-
ˆÓ. ∂ÈϤÔÓ, Â›Ó·È Â˘Ú¤ˆ˜ ·Ô‰ÂÎÙfi fiÙÈ Ù· Úfiˆ-
Ú· ÓÂÔÁÓ¿ ÂÎÙ›ıÂÓÙ·È ÔÏÔ¤Ó· Î·È ÏÈÁfiÙÂÚÔ Û ·Ú¿-
ÁÔÓÙ˜ Ô˘ ÚÔηÏÔ‡Ó ÂÚÈÁÂÓÓËÙÈÎfi stress, fiˆ˜
˘fiÙ·ÛË, ˘ÔıÂÚÌ›·, ˘ÔÍ›· Î·È ·Ó·ÈÌ›·, ÔÈ ÔÔ›ÔÈ
Ì ÙË ÛÂÈÚ¿ ÙÔ˘˜ ¢ı‡ÓÔÓÙ·È ÁÈ· ÙËÓ ÚfiÎÏËÛË
ÈÛ¯·ÈÌÈ΋˜ ‚Ï¿‚˘ ÙÔ˘ ÂÓÙ¤ÚÔ˘.
∏ ¤Ú¢ӷ ¤¯ÂÈ, ÂÔ̤ӈ˜, ÂÈÎÂÓÙÚˆı› ÛÙÔ Úfi-
ÏÔ ÙÔ˘ ·ÓÒÚÈÌÔ˘ ÂÓÙÂÚÈÎÔ‡ ‚ÏÂÓÓÔÁfiÓÔ˘ ÛÂ Û˘Ó-
‰˘·ÛÌfi Ì ÙËÓ Ùˆ¯‹ ·ÓÔÛÔÏÔÁÈ΋ ·¿ÓÙËÛË ÛÙËÓ
ÂÈÛ‚ÔÏ‹ ÂÓÙÂÚÈÎÒÓ ·ıÔÁfiÓˆÓ. ∞Ó Î·È Ë ÂÎÎÚÈÙÈ΋
·ÓÔÛÔÛÊ·ÈÚ›ÓË ∞ (sIgA) ‰ÂÓ Û˘ÌÌÂÙ¤¯ÂÈ ÛÙË ÊÏÂÁ-
ÌÔÓÒ‰Ë ‰ÈÂÚÁ·Û›·, Ë ¤ÏÏÂÈ„‹ Ù˘ ¢ÓÔ› ÙË ÌÂÙ·Ó¿-
ÛÙ¢ÛË Î·È ÙÔÓ ·ÔÈÎÈÛÌfi ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ‚ÏÂÓÓÔÁfi-
ÓÔ˘ ·fi ‚·ÎÙ‹ÚÈ·. ™˘ÁÎÂÎÚÈ̤ӷ, Ë sIgA ‰È·‰Ú·Ì·-
Ù›˙ÂÈ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ¿Ì˘Ó· ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ÂÈ-
ıËÏ›Ô˘, ·ÊÔ‡ Û˘Ó‰¤ÂÙ·È Ì ٷ ÂÈÊ·ÓÂȷο ·ÓÙÈÁfiÓ·
ÙˆÓ ·ıÔÁfiÓˆÓ, ÚÔˆıÒÓÙ·˜ ÙËÓ ·ÔÚÚfiÊËÛ‹
ÙÔ˘˜ ·fi Ù· ÂÓÙÂÚÔ·ÙÙ·Ú· (17,18). ŒÓ·˜ ‰Â‡ÙÂÚÔ˜
Èı·ÓÔÏÔÁÔ‡ÌÂÓÔ˜ Ì˯·ÓÈÛÌfi˜ ÂÓÔ¯ÔÔÈ› ÙË ÌÂȈ-
̤ÓË ‰Ú·ÛÙËÚÈfiÙËÙ· ÙˆÓ ∆ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ, Î·È Î·-
Ù¿ Û˘Ó¤ÂÈ· ÙËÓ ·‰˘Ó·Ì›· ·Ó·ÁÓÒÚÈÛ˘ Ù˘ ‚Ï¿‚˘
ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ‚ÏÂÓÓÔÁfiÓÔ˘ Ô˘ ÚÔηÏÂ›Ù·È ·fi
·ıÔÁfiÓÔ˘˜ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜ (17).
™›ÙÈÛË
∏ ¡∂∫ ¤¯ÂÈ Û˘Û¯ÂÙÈÛı› Ì ÙËÓ ÚÒÈÌË ¤Ó·ÚÍË
Ù˘ ÂÓÙÂÚÈ΋˜ Û›ÙÈÛ˘ Î·È ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÊÔÚ¤˜
ÂΉËÏÒÓÂÙ·È ÌÂÙ¿ ·fi ÚfiÛÊ·ÙË ·‡ÍËÛË ‹ ·Ӥ-
Ó·ÚÍ‹ Ù˘ ÌÂÙ¿ ·fi ‰È·ÎÔ‹ (19-21). ∏ ¯ÔÚ‹ÁËÛË
ÌËÙÚÈÎÔ‡ Á¿Ï·ÎÙÔ˜ ÂÏ·ÙÙÒÓÂÈ ÙËÓ Â›ÙˆÛ‹ Ù˘,
·ÏÏ¿ ‰ÂÓ ÚÔÏ·Ì‚¿ÓÂÈ ÂÓÙÂÏÒ˜ ÙËÓ ÂΉ‹ÏˆÛ‹ Ù˘.
¶ÚÒÙÔ˜ Ô Barlow ‰ËÌÔÛ›Â˘Û ÙÔ 1974 ÌÂϤÙË ·Ó·-
‰ÂÈÎÓ‡ÔÓÙ·˜ ÙË ÛËÌ·Û›· ÙÔ˘ ÌËÙÚÈÎÔ‡ Á¿Ï·ÎÙÔ˜ ÛÙË
Ì›ˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÂΉ‹ÏˆÛ˘ ¡∂∫ Î·È ÙÔÓ ÚÔ-
Ûٷ٢ÙÈÎfi ÚfiÏÔ Ù˘ sIgA (8). ÕÏϘ ÌÂϤÙ˜ ÂÈÎÂ-
ÓÙÚÒıËÎ·Ó ÛÙËÓ Â›‰Ú·ÛË Ù˘ ˆÛ̈ÙÈÎfiÙËÙ·˜ ÙÔ˘
Á¿Ï·ÎÙÔ˜ ÛÙËÓ ÚfiÎÏËÛË ‚Ï¿‚˘ ÙÔ˘ ÂÓÙÂÚÈÎÔ‡
ÂÈıËÏ›Ô˘, ¯ˆÚ›˜ fï˜ Ó· ·ÏËı¢ÙÔ‡Ó Ù· ·ÔÙÂ-
ϤÛÌ·Ù¿ ÙÔ˘˜.
™‹ÌÂÚ·, ·Ó Î·È ˘¿Ú¯ÂÈ ‰È¯ÔÁӈ̛·, fiÛÔÓ ·ÊÔ-
Ú¿ ÙËÓ “·ÛÊ·Ï‹” ·‡ÍËÛË Ù˘ ÂÓÙÂÚÈ΋˜ Û›ÙÈÛ˘, ÔÈ
ÂÚÈÛÛfiÙÂÚÔÈ ÌÂÏÂÙËÙ¤˜ ÙËÓ ·Ô‰¤¯ÔÓÙ·È (22-24).
22 Ã. ∆۷ηϛ‰Ë˜ Î·È Û˘Ó.
Paediatriki 2008;71:21-28
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·22
™˘ÁÎÂÎÚÈ̤ӷ, Ë ·‡ÍËÛË Î·Ù¿ 20 ml/kg/ËÌÂÚËÛ›ˆ˜
·ÔÙÂÏ› ·ÛÊ·Ï‹ Ú·ÎÙÈ΋ ÛÙȘ ª∂¡¡ (22,31).
∆ËÓ ÙÂÏÂ˘Ù·›· ‰ÂηÂÙ›· ¤¯ÂÈ ·Ó·ÁÓˆÚÈÛÙ› Ô ÛË-
Ì·ÓÙÈÎfi˜ ÚfiÏÔ˜ ÙfiÛÔ ÙˆÓ Úo‚ÈÔÙÈÎÒÓ fiÛÔ Î·È ÙˆÓ
Ú‚ÈÔÙÈÎÒÓ ÛÙË Ì›ˆÛË Ù˘ ›وÛ˘ Ù˘ ¡∂∫ ÛÂ
ÂÈÚ·Ì·ÙÈο ÌÔÓ٤Ϸ, ·ÏÏ¿ Î·È Û ÎÏÈÓÈΤ˜ ÌÂϤÙ˜.
∆· ÚÔ‚ÈÔÙÈο ·ÔÙÂÏÔ‡Ó ÌÈ· ÂÙÂÚÔÁÂÓ‹ ηÙËÁÔÚ›·
‚·ÎÙËÚ›ˆÓ Î·È ÔÊ›ÏÔ˘Ó ÙËÓ ÔÓÔÌ·Û›· ÙÔ˘˜ ÛÙËÓ ·-
Ú·ÁˆÁ‹ ÙÔ˘ Á·Ï·ÎÙÈÎÔ‡ ÔͤԘ ̂ ˜ ÙÔ˘ ÙÂÏÈÎÔ‡ ÚÔ˚fi-
ÓÙÔ˜ ˙‡ÌˆÛ˘. ™ËÌ·ÓÙÈ΋ ı¤ÛË ÌÂٷ͇ ·˘ÙÒÓ Î·Ù¤-
¯Ô˘Ó Ù· Bifidobacterium Î·È ÔÈ Lactobacillus Ô˘ ·Ô-
ÙÂÏÔ‡Ó Ê˘ÛÈÔÏÔÁÈ΋ ¯ÏˆÚ›‰· ÙˆÓ ˘ÁÈÒÓ ÓÂÔÁÓÒÓ. ∆·
Ú‚ÈÔÙÈο Â›Ó·È ÔÏÈÁÔ۷ί·Ú›Ù˜ Ô˘ ‰ÂÓ ¤ÙÔ-
ÓÙ·È Î·È Â˘ÓÔÔ‡Ó ÙËÓ ·Ó¿Ù˘ÍË Ù˘ Ê˘ÛÈÔÏÔÁÈ΋˜ ÌÈ-
ÎÚԂȷ΋˜ ¯ÏˆÚ›‰·˜ Î·È Û˘ÁÎÂÎÚÈ̤ӷ ÙÔ˘
Bifidobacterium Î·È ÙÔ˘ Lactobacillus. ™‡Ìʈӷ Ì ٷ
Â˘Ú‹Ì·Ù· ÙˆÓ ÌÂÏÂÙÒÓ ·˘ÙÒÓ, Â›Ó·È Èı·Ófi Ó· ·›-
˙Ô˘Ó ÚfiÏÔ ÛÙËÓ ÚfiÏË„Ë Ù˘ ÓfiÛÔ˘, ·ÊÔ‡ ·Ú·ÙË-
Ú‹ıËΠÛËÌ·ÓÙÈ΋ Ì›ˆÛË Ù˘ ›وÛ˘, ·ÏÏ¿ ηÈ
Ù˘ ‚·Ú‡ÙËÙ·˜ Ù˘ ‹‰Ë ÂÁηÙÂÛÙË̤Ó˘ ¡∂∫, ·Ó¿-
ÏÔÁ· ‚¤‚·È· Ì ÙÔ ¯ÚfiÓÔ ¯ÔÚ‹ÁËÛ‹˜ ÙÔ˘˜ (27-31).
§Ô›ÌˆÍË
∂›Ó·È ¢ڤˆ˜ ÁÓˆÛÙ‹ Ë ÛËÌ·Û›· ÙÔ˘ ·Ú¿ÁÔÓÙ·
Ïԛ̈ÍË ÛÙËÓ ÂΉ‹ÏˆÛË Ù˘ ¡∂∫ (14,15). ∏ ÌÈÎÚÔ-
‚ȷ΋ ‰È‹ıËÛË ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ‚ÏÂÓÓÔÁfiÓÔ˘ ·ÔÙÂÏ›
·Ó·ÌÊ›‚ÔÏ· ‰Â˘ÙÂÚÔ·ı‹ ·Ú¿ÁÔÓÙ· ÛÙËÓ ·ıÔÁ¤-
ÓÂÈ¿ Ù˘. ª¤¯ÚÈ Û‹ÌÂÚ· ¤¯Ô˘Ó ÂÓÔ¯ÔÔÈËı› ·ÚÎÂÙÔ›
ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ›, ÌÂٷ͇ ÙˆÓ ÔÔ›ˆÓ ÙËÓ ÚÒÙË ı¤-
ÛË Î·Ù¤¯Ô˘Ó Ù· Gram ·ÚÓËÙÈο ‚·ÎÙ‹ÚÈ· (΢ڛˆ˜
ÂÓÙÂÚÔ‚·ÎÙËÚÈÔÂȉ‹) Î·È ·ÎÔÏÔ˘ıÔ‡Ó ÔÈ Gram ıÂÙÈ-
ÎÔ› ÎfiÎÎÔÈ, Ù· ·Ú¿ÛÈÙ· Î·È ÔÈ ÈÔ›. ¶ÔÈΛϷ ‚·ÎÙ‹ÚÈ·
¤¯Ô˘Ó ·ÔÌÔÓˆı› ·fi ηÏÏȤÚÁÂȘ ÎÔÚ¿ÓˆÓ ÓÂÔ-
ÁÓÒÓ Ì ¡∂∫ fiˆ˜: Escherichia coli, Klebsiella,
Enterobacter, Pseudomonas, Salmonella, Clostridium
difficile, Coagulase-negative staphylococci Î·È ¿ÏÏ·. ∆·
ÂÚÈÛÙ·ÙÈο ÓÂÔÁÓÒÓ Ô˘ ÂΉËÏÒÓÔ˘Ó ¡∂∫ Â›Ó·È Û˘-
Ó‹ıˆ˜ ÛÔÚ·‰Èο, ÂÓÙÔ‡ÙÔȘ, ÔÏϤ˜ ÌÂϤÙ˜ ·Ó·Ê¤-
ÚÔ˘Ó fiÙÈ Ô ·ÔÈÎÈÛÌfi˜ ª∂¡¡ Ì ‚·ÎÙ‹ÚÈ· ¢ı‡ÓÂÙ·È
ÁÈ· ÙËÓ ÂΉ‹ÏˆÛË ÌÈÎÚÔÂȉËÌÈÒÓ. ∞Ó Î·È ÌfiÓÔ ÛÙÔ
1/3 ÙˆÓ ÓÂÔÁÓÒÓ Ì ¡∂∫ ı· Û˘Ó˘¿Ú¯ÂÈ ıÂÙÈ΋ ηÏ-
ÏȤÚÁÂÈ· ·›Ì·ÙÔ˜, Ë ÌÈÎÚÔ‚È·ÈÌ›· ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙ› ÌÂ
‚·Ú‡ÙÂÚË ÎÏÈÓÈ΋ ÂÈÎfiÓ· Î·È ÚÔ¯ˆÚË̤ÓË ÓfiÛÔ.
πÛ¯·ÈÌ›·
∆Ô ˘ÔÍ·ÈÌÈÎfi-ÈÛ¯·ÈÌÈÎfi ÙÚ·‡Ì· ‰È·‰Ú·Ì·Ù›˙ÂÈ
ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ·ıÔÁ¤ÓÂÛË Ù˘ ¡∂∫ (32-34).
∞Ó Î·È ÚÔÛ‚¿ÏÏÂÈ Î˘Ú›ˆ˜ ÚfiˆÚ· ÓÂÔÁÓ¿, ÂÓÙÔ‡-
ÙÔȘ, Î·È Ù· ÙÂÏÂÈfiÌËÓ· ÂÌÊ·Ó›˙Ô˘Ó ·˘ÍË̤ÓÔ Î›Ó-
‰˘ÓÔ ÂΉ‹ÏˆÛ˘ ¡∂∫, fiÙ·Ó Û˘Ó˘¿Ú¯Ô˘Ó Î·È ¿ÏϘ
·ıÔÏÔÁÈΤ˜ ηٷÛÙ¿ÛÂȘ Ô˘ ÚÔηÏÔ‡Ó ÈÛ¯·ÈÌ›·
ÙÔ˘ ÂÓÙ¤ÚÔ˘, fiˆ˜ ÔÈ Î˘·ÓˆÙÈΤ˜ Û˘ÁÁÂÓ›˜ ηډÈÔ-
¿ıÂȘ, Ë ÔÏ˘Î˘ÙÙ·Ú·ÈÌ›·, Ë ˘fiÙ·ÛË Î·È Ë ¯ÔÚ‹-
ÁËÛË ÈÓ‰ÔÌÂı·Î›Ó˘ (10,12,34). ∆Ô ˘ÔÍ·ÈÌÈÎfi-
ÈÛ¯·ÈÌÈÎfi stress Â›Ó·È ÁÓˆÛÙfi fiÙÈ ÚÔηÏ› ‚Ï¿‚Ë
ÙÔ˘ ÂÓÙ¤ÚÔ˘, ·ÏÏ¿ Ë ˘fiıÂÛË fiÙÈ ·˘Ùfi ·ÔÙÂÏ› ÙÔ
ÁÂÁÔÓfi˜ Ô˘ “˘ÚÔ‰ÔÙ›” ÙËÓ ÚfiÎÏËÛË Ù˘ ÓfiÛÔ˘
¤¯ÂÈ ÂÓÙfiÓˆ˜ ·ÌÊÈÛ‚ËÙËı›. ™‹ÌÂÚ·, Ë ÂÈÎÚ·ÙÔ‡Û·
¿Ô„Ë ÁÈ· ÙËÓ ·ıÔÁ¤ÓÂÛË Ù˘ ÓfiÛÔ˘ ÂÓÔ¯ÔÔÈ› ÛÂ
ÌÂÁ·Ï‡ÙÂÚÔ ‚·ıÌfi ÙËÓ ÚÔˆÚfiÙËÙ·, ÙËÓ ÚÒÈÌË
Î·È “ÂÈıÂÙÈ΋” ¤Ó·ÚÍË Ù˘ ÂÓÙÂÚÈ΋˜ Û›ÙÈÛ˘ Î·È ÙË
ÊÏÂÁÌÔÓÒ‰Ë ‰ÈÂÚÁ·Û›· Û ۯ¤ÛË Ì ÙËÓ ÈÛ¯·ÈÌ›·.
™˘ÁÎÂÎÚÈ̤ӷ, Èı·ÓÔÏÔÁÂ›Ù·È fiÙÈ Ë ·ÓÒÚÈÌË Ú‡ıÌÈ-
ÛË Ù˘ ÂÓÙÂÚÈ΋˜ ΢ÎÏÔÊÔÚ›·˜ Ô‰ËÁ› Û ˘ÔÍ›·-
ÈÛ¯·ÈÌ›· ˆ˜ ·¿ÓÙËÛË ÛÙËÓ ÂÓÙÂÚÈ΋ Û›ÙÈÛË ‹ ÛÙÔÓ
·ÔÈÎÈÛÌfi Ì ·ıÔÁfiÓ· ‚·ÎÙ‹ÚÈ·. √ÚÈṲ̂Ó˜ ÌÂϤ-
Ù˜ Û ·ÓÒÚÈÌ· ÂÈÚ·Ì·Ùfi˙ˆ· ‰Â›¯ÓÔ˘Ó Î¿ÔÈ· ‰È·-
Ù·Ú·¯‹ Ù˘ Ú‡ıÌÈÛ˘ Ù˘ ÂÓÙÂÚÈ΋˜ ΢ÎÏÔÊÔÚ›·˜
ÌÂÙ¿ ·fi ˘ÔÍ›· ‹ ÈÛ¯·ÈÌ›·, Â˘Ú‹Ì·Ù· Ô˘ ‰ÂÓ ÂÈ-
‚‚·ÈÒÓÔÓÙ·È ·fi ¿ÏϘ ÌÂϤÙ˜. ÕÏÏÔÈ ÂÚ¢ÓËÙ¤˜
ÂÓÔ¯ÔÔÈÔ‡Ó ÙË ÌÂȈ̤ÓË ·Ú·ÁˆÁ‹ ÓÈÙÚÈÎÔ‡ ÔÍÂÈ-
‰›Ô˘ (NO) ·fi ÙÔ ·ÁÁÂÈ·Îfi ÂÓ‰Ôı‹ÏÈÔ ˆ˜ ÚԉȷıÂ-
ÛÈÎfi ·Ú¿ÁÔÓÙ· ÁÈ· ÙËÓ ÚfiÎÏËÛË ÈÛ¯·ÈÌÈ΋˜ ‚Ï¿-
‚˘ (32,35,36). ∆Ô NO ·ÔÙÂÏ› ÂχıÂÚË Ú›˙· Ô˘
·Ú¿ÁÂÙ·È ·fi ÙÔ ·Î¤Ú·ÈÔ ÂÓ‰Ôı‹ÏÈÔ Î·È ÚÔ¿ÁÂÈ
ÙËÓ ·ÁÁÂÈԉȷÛÙÔÏ‹ (32). ∂Ô̤ӈ˜, ˘fi Ê˘ÛÈÔÏÔ-
ÁÈΤ˜ Û˘Óı‹Î˜, ΢Úȷگ› ÛÙÔ ÌÈÎÚÔ·ÁÁÂÈ·Îfi ÂÓ‰Ô-
ı‹ÏÈÔ Ë ·ÁÁÂÈԉȷÛÙÔÏ‹. °ÂÁÔÓfiÙ· Ô˘ ‰È·Ù·Ú¿Û-
ÛÔ˘Ó ÙË Û˘ÁÎÂÎÚÈ̤ÓË ÈÛÔÚÚÔ›·, fiˆ˜ Ë ÂÚÈÁÂÓ-
ÓËÙÈ΋ ·ÛÊ˘Í›· ‹ Ë ·Ú·ÙÂٷ̤ÓË ¯·ÌËÏ‹ ·ÈÌ·ÙÈ΋
ÚÔ‹ Û ÓÂÔÁÓ¿ Ì ÂÓ‰ÔÌ‹ÙÚÈ· ηı˘ÛÙ¤ÚËÛË ·Ó¿Ù˘-
͢, ¢ı‡ÓÔÓÙ·È ÁÈ· ÙË ÌÂȈ̤ÓË ·Ú·ÁˆÁ‹ ÙÔ˘ ¡√,
Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·‡ÍËÛË ÙˆÓ ·ÁÁÂÈ·ÎÒÓ ·ÓÙÈÛÙ¿-
ÛÂˆÓ Î·È, ÂÔ̤ӈ˜, ÙË Ì›ˆÛË Ù˘ ·ÈÌ·ÙÈ΋˜ ÚÔ‹˜
Î·È Ù˘ ·ÚÔ¯‹˜ Ô͢ÁfiÓÔ˘. (35,36). ªÂϤÙ˜ ˘Ô-
ÛÙËÚ›˙Ô˘Ó ÙÔ ÚfiÏÔ ÙÔ˘ ¡√ ÛÙË ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Ù˘
ÂÓÙÂÚÈ΋˜ ΢ÎÏÔÊÔÚ›·˜, ̤ۈ ‰È·Ù·Ú·¯‹˜ Ù˘ ·-
Ú·ÁˆÁ‹˜ ÙÔ˘. ¶ÂÚ·ÈÙ¤Úˆ ÌÂϤÙ˜ ··ÈÙÔ‡ÓÙ·È,
ÒÛÙ ӷ ‰È¢ÎÚÈÓÈÛÙ› Ô Â·ÎÚÈ‚‹˜ ÚfiÏÔ˜ Ù˘ ÈÛ¯·È-
Ì›·˜ ˆ˜ ÚÒÈÌÔ ‹ ·ÒÙÂÚÔ ·ÔÙ¤ÏÂÛÌ· Ù˘ ‰È·Ù·-
Ú·¯‹˜ Ù˘ ÂÓÙÂÚÈ΋˜ ΢ÎÏÔÊÔÚ›·˜.
ºÏÂÁÌÔÓ҉˘ ‰ÈÂÚÁ·Û›·
∆· ÙÂÏÂ˘Ù·›· ̄ ÚfiÓÈ·, Ô ÚfiÏÔ˜ Ù˘ ÂÓÂÚÁÔÔ›ËÛ˘
Ù˘ ÊÏÂÁÌÔÓÒ‰Ô˘˜ ‰ÈÂÚÁ·Û›·˜ Î·È Ù˘ ·Ó·ÚÎÔ‡˜
·ÓÙÈÊÏÂÁÌÔÓÒ‰Ô˘˜ ·¿ÓÙËÛ˘ ÛÙË ‰È·Ù·Ú·¯‹ Ù˘
·ÎÂÚ·ÈfiÙËÙ·˜ ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ÊÚ·ÁÌÔ‡ ¤¯Ô˘Ó ·ÔÙÂ-
ϤÛÂÈ ÛËÌ·ÓÙÈÎfi ‰›Ô ¤Ú¢ӷ˜ ÛÙËÓ ·ıÔÁ¤ÓÂÛË
Ù˘ ¡∂∫. ™Â ÔÏϤ˜ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ ¤¯ÂÈ Î·Ù·ÁÚ·-
Ê› ·‡ÍËÛË ÊÏÂÁÌÔÓˆ‰ÒÓ ÌÂÛÔÏ·‚ËÙÒÓ Î·È ¤¯ÂÈ Á›-
ÓÂÈ ÚÔÛ¿ıÂÈ· Û˘Û¯ÂÙÈÛÌÔ‡ ÙÔ˘˜ Ì ÙËÓ ÂΉ‹ÏˆÛË
Î·È ÙËÓ ÔÚ›· Ù˘ ÓfiÛÔ˘ (37-42).
∆· ÂÓÙÂÚÈο ÂÈıËÏȷο ·ÙÙ·Ú· ·Ú¿ÁÔ˘Ó ÔÏ-
Ϥ˜ ΢ÙÙÔΛÓ˜ Ô˘ ÂÌϤÎÔÓÙ·È ÛÙË Ïԛ̈ÍË Î·È ÙË
‚Ï¿‚Ë ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ÊÚ·ÁÌÔ‡. ªÂٷ͇ ·˘ÙÒÓ, ÛË-
Ì·ÓÙÈÎfi˜ Â›Ó·È Ô ÚfiÏÔ˜ Ù˘ IL-6 ÛÙËÓ ·Ú·ÁˆÁ‹
23¡ÂÎÚˆÙÈ΋ ÂÓÙÂÚÔÎÔÏ›Ùȉ·
¶·È‰È·ÙÚÈ΋ 2008;71:21-28
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·23
ÚˆÙÂ˚ÓÒÓ ÔÍ›·˜ Ê¿Û˘, ÛÙËÓ ÚÔ·ÁˆÁ‹ ÙˆÓ ∆
ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Î·È ÛÙËÓ ·Ú·ÁˆÁ‹ ·ÓÙÈۈ̿وÓ
·fi Ù· µ ÏÂÌÊÔ·ÙÙ·Ú· (37). ∏ ·Ú·ÁˆÁ‹ ÙÔ˘
TNF-a ¿ÁÂÙ·È ·fi ÙÔ˘˜ ÌÈÎÚÔ‚È·ÎÔ‡˜ ·Ú¿ÁÔ-
ÓÙ˜ Î·È ¿ÏϘ ΢ÙÙÔΛÓ˜, ÂÓÒ Ì ÙË ÛÂÈÚ¿ ÙÔ˘ ÚÔ-
¿ÁÂÈ ÙËÓ Î˘ÙÙ·ÚÔÙÔÍÈ΋ ·¿ÓÙËÛË Î·È ÙÔÓ ÚÔÁÚ·Ì-
Ì·ÙÈṲ̂ÓÔ Î˘ÙÙ·ÚÈÎfi ı¿Ó·ÙÔ (41).
√ ·Ú¿ÁÔÓÙ·˜ ÂÓÂÚÁÔÔ›ËÛ˘ ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ
(platelet activating factor - PAF) ·ÔÙÂÏ› ¤Ó·Ó ·fi
ÙÔ˘˜ ÛËÌ·ÓÙÈÎfiÙÂÚÔ˘˜ Î·È ÂÚÈÛÛfiÙÂÚÔ ÌÂÏÂÙË̤-
ÓÔ˘˜ ÌÂÛÔÏ·‚ËÙ¤˜ Ù˘ ÊÏÂÁÌÔÓ‹˜ Ô˘ ÂÌϤÎÔÓÙ·È
ÛÙËÓ ·ıÔÁ¤ÓÂÛË Ù˘ ¡∂∫ (41,43). ∞ÔÙÂÏ› ¤Ó·Ó
ʈÛÊÔÏÈȉÈÎfi ·Ú¿ÁÔÓÙ· Ô˘ ·Ú¿ÁÂÙ·È ·fi Ù·
ÊÏÂÁÌÔÓÒ‰Ë, Ù· ÂÓ‰ÔıËÏȷο ·ÙÙ·Ú·, Ù· ·ÈÌÔÂÙ¿-
ÏÈ· Î·È Ù· ‚·ÎÙ‹ÚÈ· Î·È ‰È·‰Ú·Ì·Ù›˙ÂÈ ÛËÌ·ÓÙÈÎfi Úfi-
ÏÔ ÛÙËÓ ·ıÔÊ˘ÛÈÔÏÔÁ›· Ù˘ ÓfiÛÔ˘. ™˘ÓÙ›ıÂÙ·È ÌÂÙ¿
·fi ÂÓÂÚÁÔÔ›ËÛË Ù˘ ʈÛÊÔÏÈ¿Û˘ ∞2ππ (PLA2)
Î·È ‰È·Û¿Ù·È ·fi ÙÔ ¤Ó˙˘ÌÔ PAF-·ÎÂÙ˘ÏÔ¸‰ÚÔÏ¿-
ÛË. Àԉԯ›˜ ÁÈ· ÙÔÓ PAF ˘¿Ú¯Ô˘Ó Û ÔÏÏ¿ ·Ù-
Ù·Ú· Î·È Ë ‰Ú¿ÛË ÙÔ˘ ·ÛÎÂ›Ù·È Ì¤Ûˆ Ù˘ ÂÓÂÚÁÔÔ›Ë-
Û˘ ÙÔ˘ ˘Ô‰Ô¯¤· G-ÚˆÙ½ÓË-˙‡ÁÔ˜ PAF Ô˘ ‚Ú›-
ÛÎÂÙ·È Û ˘„ËϤ˜ Û˘ÁÎÂÓÙÚÒÛÂȘ, ΢ڛˆ˜ ÛÙ· ·ÙÙ·-
Ú· ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ÂÈıËÏ›Ô˘ Î·È Û˘ÁÎÂÎÚÈ̤ӷ ÛÙÔÓ
ÂÈÏÂfi, Ô˘ ·ÔÙÂÏ› Î·È ÙË Û˘¯ÓfiÙÂÚË ı¤ÛË ÚÔÛ‚Ô-
Ï‹˜ Ù˘ ¡∂∫. ∏ ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ ˘Ô‰Ô¯¤ˆÓ ÙÔ˘
PAF ÚÔ¿ÁÂÈ ÙËÓ ·Ú·ÁˆÁ‹ ¿ÏÏˆÓ Î˘ÙÙÔÎÈÓÒÓ Î·È
‰Â˘ÙÂÚ¢fiÓÙˆÓ ÌÂÛÔÏ·‚ËÙÒÓ, fiˆ˜ Ô TNF-a, Ë IL-6,
Ë IL-8, Ë IL-1, ÙÔ ¡√ Î·È ÔÈ Ï¢ÎÔÙÚȤÓ˜. ∂ÈϤÔÓ,
Û‡Ìʈӷ Ì ÌÂϤÙ˜, Ë ‰Ú¿ÛË ÙÔ˘ ·ÛÎÂ›Ù·È Î·È Ì¤Ûˆ
Ù˘ ·fiÙˆÛ˘ ÙˆÓ ÂÓÙÂÚÈÎÒÓ ÂÈıËÏÈ·ÎÒÓ Î˘ÙÙ¿-
ÚˆÓ. ªÂ ‚¿ÛË ÙËÓ ˘fiıÂÛË ·˘Ù‹, Ë ·fiÙˆÛË ÙˆÓ
΢ÙÙ¿ÚˆÓ ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ÂÈıËÏ›Ô˘ ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂ-
ÛÌ· ÙËÓ ·ÒÏÂÈ· Ù˘ ·ÎÂÚ·ÈfiÙËÙ·˜ ÙÔ˘ ÂÈıËÏ›Ô˘,
ÙËÓ ·‡ÍËÛË Ù˘ ‰È·ÂÚ·ÙfiÙËÙ·˜ ÙÔ˘ ‚ÏÂÓÓÔÁfiÓÔ˘
Î·È ÙËÓ Â›ÛÔ‰Ô ÙˆÓ ‚·ÎÙËÚ›ˆÓ ÛÙÔ ÂÓÙÂÚÈÎfi ÙÔ›¯ˆÌ·.
™Â ÂÈÚ·Ì·ÙÈο ÌÔÓ٤Ϸ ¤¯ÂÈ ·Ô‰Âȯı› fiÙÈ Ô PAF
ÚÔηÏ› ‚Ï¿‚Ë ÛÙ· ÙÚȯÔÂȉ‹, ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ÙÔ˘
Ì˘Ôηډ›Ô˘ Î·È ÙˆÓ ÓÂÊÚÒÓ, Ô˘‰ÂÙÂÚÔÂÓ›·, ıÚÔÌ-
‚ÔÂÓ›· Î·È ˘fiÙ·ÛË (41,43). ∆Ô ¤Ó˙˘ÌÔ PAF-·ÎÂÙ˘-
ÏÔ¸‰ÚÔÏ¿ÛË, Ô˘ ÙÔÓ ·‰Ú·ÓÔÔÈ›, ‚Ú›ÛÎÂÙ·È Û ¯·-
ÌËÏ‹ Û˘ÁΤÓÙÚˆÛË ÛÙ· ÚfiˆÚ· ΢ڛˆ˜ ÓÂÔÁÓ¿ ηÈ
ÛÙÔ ÙÚÔÔÔÈË̤ÓÔ Á¿Ï· Ì ÙÔ ÔÔ›Ô ÛÈÙ›˙ÔÓÙ·È, ÛÂ
·ÓÙ›ıÂÛË Ì ÙÔ ÌËÙÚÈÎfi, Ô˘ ¤¯ÂÈ ·Ô‰Âȯı› fiÙÈ Â-
ÚȤ¯ÂÈ ˘„ËÏ‹ Û˘ÁΤÓÙÚˆÛË (41,43). ∆¤ÏÔ˜, Û ÓÂÔÁÓ¿
Ô˘ ÂΉ‹ÏˆÛ·Ó ¡∂∫ ‰È·ÈÛÙÒıËÎ·Ó ·˘ÍË̤ӷ ›-
‰· ÙÔ˘ PAF ÛÙÔ Ï¿ÛÌ· Î·È Ù· ÎfiÚ·Ó·, Â˘Ú‹Ì·Ù·
Ô˘ ÂÓÈÛ¯‡Ô˘Ó ¤ÌÌÂÛ· ÙÔ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÙÔ˘ ÛÙËÓ
·ıÔÁ¤ÓÂÛË Ù˘ ÓfiÛÔ˘ (41).
Toll-like receptors (TLRs)
√È TLRs ‚Ú›ÛÎÔÓÙ·È ÛÙËÓ Î˘ÙÙ·ÚÈ΋ ÂÈÊ¿ÓÂÈ·
Î·È ‰ÚÔ˘Ó ˆ˜ ·ÈÛıËÙ‹Ú˜ Ù˘ ÌÈÎÚԂȷ΋˜ Ïԛ̈-
͢, ‰È·‰Ú·Ì·Ù›˙ÔÓÙ·˜ Û˘Á¯ÚfiÓˆ˜ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ
ÛÙËÓ ¤Ó·ÚÍË Ù˘ ÊÏÂÁÌÔÓ‹˜ Î·È Ù˘ ·ÓÔÛȷ΋˜ ·¿-
ÓÙËÛ˘. ∆· ÌÈÎÚfi‚È· ÂÎÎÚ›ÓÔ˘Ó ÌfiÚÈ· Ô˘ ‰ÚÔ˘Ó ˆ˜
˘Ô‰Ô¯Â›˜ ÛÙÔ˘˜ TLRs, fiˆ˜ ÔÈ ÏÈÔÔÏ˘Û·Î¯·Ú›-
Ù˜ (LPS) Î·È ÙÔ ÏÈÔÙ¯Ô˚Îfi Ô͇ (LTA). ™˘ÁÎÂÎÚÈ-
̤ӷ, ÔÈ LPS ·ÓÙȉÚÔ‡Ó Ì ÙȘ TLR4 Î·È ÙÔ LTA ÌÂ
ÙȘ TLR2. ¶ÂÈÚ·Ì·ÙÈΤ˜ ÌÂϤÙ˜ ÙˆÓ Rakoff-
Nahoum Î·È Û˘Ó. ‰Â›¯ÓÔ˘Ó fiÙÈ Ë ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ
TLRs ·fi ÙË Ê˘ÛÈÔÏÔÁÈ΋ ÂÓÙÂÚÈ΋ ÌÈÎÚԂȷ΋
¯ÏˆÚ›‰· Û˘Ì‚¿ÏÏÂÈ ÛÙËÓ ·ÎÂÚ·ÈfiÙËÙ· ÙÔ˘ ÂÓÙÂÚÈ-
ÎÔ‡ ÂÈıËÏ›Ô˘, ÂÓÒ Û˘Á¯ÚfiÓˆ˜ ÙÔ ÚÔÛٷهÂÈ ·fi
ÙÔ ÙÚ·‡Ì· Î·È Î·Ù·Ï‹ÁÔ˘Ó ÛÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ ÔÈ
TLRs Â›Ó·È ··Ú·›ÙËÙÔÈ ÁÈ· ÙËÓ ÔÌÔÈfiÛÙ·ÛË ÙÔ˘
ÂÓÙÂÚÈÎÔ‡ ÂÈıËÏ›Ô˘ ÌÂÙ¿ ·fi ‚Ï¿‚Ë ‹ ÙÚ·˘Ì·ÙÈ-
ÛÌfi (44). ∂ÈϤÔÓ, Û‡Ìʈӷ Ì ÌÈ· ¿ÏÏË ˘fiıÂÛË,
Ë ˘ÂÚ¤ÎÊÚ·ÛË ÔÚÈÛÌ¤ÓˆÓ TLRs, fiˆ˜ ÔÈ TLR4, ¢-
ı‡ÓÂÙ·È ÁÈ· ÙËÓ ÚfiÎÏËÛË ÚÔÊÏÂÁÌÔÓÒ‰Ô˘˜ ·¿-
ÓÙËÛ˘ ÛÙÔ ÂÓÙÂÚÈÎfi ÂÈı‹ÏÈÔ ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ, ÌÂ
·Ô˘Û›· Ê˘ÛÈÔÏÔÁÈ΋˜ ÌÈÎÚԂȷ΋˜ ¯ÏˆÚ›‰·˜ (33).
∞ÓˆÚÈÌfiÙËÙ· ÂÓÙÂÚÈÎÔ‡ ÊÚ·ÁÌÔ‡
∏ ·ÎÂÚ·ÈfiÙËÙ· Î·È ÌË ‰È·ÂÚ·ÙfiÙËÙ· ÙÔ˘ ÂÓÙÂÚÈ-
ÎÔ‡ ÊÚ·ÁÌÔ‡ ‰È·ÙËÚÂ›Ù·È Ì¤Ûˆ ÛÂÈÚ¿˜ Ì˯·ÓÈÎÒÓ Î·È
ÌË ·Ú·ÁfiÓÙˆÓ, Ô˘ ‰ÚÔ˘Ó Û˘ÓÂÚÁÈο, Ì ·ÒÙÂÚÔ
ÛÎÔfi ÙËÓ ÚÔÛÙ·Û›· ÙÔ˘ ·fi ÙËÓ ÂÈÛ‚ÔÏ‹ ·ıÔÁfi-
ÓˆÓ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÒÓ (17,45,46). √È ·Ú¿ÁÔÓÙ˜ ·˘-
ÙÔ› ›ӷÈ: ·. ÔÈ ÛÙ·ıÂÚ¤˜ Û˘Ó‰¤ÛÂȘ, ‚. Ô ÂÚÈÛÙ·ÏÙÈ-
ÛÌfi˜ Î·È Á. Ù· Û˘ÛÙ·ÙÈο ÙÔ˘ ÛÙÚÒÌ·ÙÔ˜ Ù˘ ‚ϤÓÓ·˜,
Û˘ÌÂÚÈÏ·Ì‚·ÓÔ̤Ó˘ Ù˘ ÂÎÎÚÈÙÈ΋˜ sIgA.
¶ÔÏÏÔ› ·fi ÙÔ˘˜ Ì˯·ÓÈÛÌÔ‡˜ ·˘ÙÔ‡˜ Â›Ó·È ·ÓÒ-
ÚÈÌÔÈ ÛÙ· ÚfiˆÚ· ÓÂÔÁÓ¿ ηıÈÛÙÒÓÙ·˜ Ù· ÂÚÈÛÛfi-
ÙÂÚÔ Â˘¿ÏˆÙ· ÛÙËÓ ÂΉ‹ÏˆÛË ¡∂∫. ∏ ·ÓÒÚÈÌË
ÂÓÙÂÚÈ΋ ÎÈÓËÙÈÎfiÙËÙ· Î·È ¤„Ë ·ÔÙÂÏÔ‡Ó ÂÈϤ-
ÔÓ ÚԉȷıÂÛÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ÁÈ· ÙËÓ ÂΉ‹ÏˆÛË
¡∂∫ Û ÚfiˆÚ· ÓÂÔÁÓ¿. ªÂϤÙ˜ ÙfiÛÔ Û ÓÂÔÁÓ¿
fiÛÔ Î·È Û ÂÈÚ·Ì·ÙÈο ÌÔÓ٤Ϸ ¤¯Ô˘Ó ·Ô‰Â›ÍÂÈ
fiÙÈ Ë ÂÓÙÂÚÈ΋ ÎÈÓËÙÈÎfiÙËÙ· ·Ú¯›˙ÂÈ ÛÙÔ ‰Â‡ÙÂÚÔ Î·È
ˆÚÈÌ¿˙ÂÈ ÛÙÔ ÙÚ›ÙÔ ÙÚ›ÌËÓÔ Ù˘ ÂÁ΢ÌÔÛ‡Ó˘ (47-
49). ™‡Ìʈӷ Ì ٷ Â˘Ú‹Ì·Ù· Û˘ÁÎÚÈÙÈÎÒÓ ÌÂÏÂÙÒÓ
ÌÂٷ͇ ÚfiˆÚˆÓ Î·È ÙÂÏÂÈfiÌËÓˆÓ ÓÂÔÁÓÒÓ, ÚÔ¤-
΢„ fiÙÈ Ë ÂÓÙÂÚÈ΋ ÎÈÓËÙÈÎfiÙËÙ· ÙˆÓ ÚfiˆÚˆÓ ›-
Ó·È ·ÓÒÚÈÌË, fï˜ Ë ¤Ó·ÚÍË Ù˘ ÂÓÙÂÚÈ΋˜ Û›ÙÈÛ˘
ÚÔ¿ÁÂÈ ÙËÓ ˆÚ›Ì·ÓÛ‹ Ù˘ (50-53). ¶·Ú¿ÁÔÓÙ˜,
fiˆ˜ Ë ÂÓ‰ÔÌ‹ÙÚÈ· ηı˘ÛÙ¤ÚËÛË Ù˘ ·Ó¿Ù˘Í˘,
Û˘Ì‚¿ÏÏÔ˘Ó ÛÙËÓ ·ÓˆÚÈÌfiÙËÙ· Ù˘ ÂÓÙÂÚÈ΋˜ ÎÈ-
ÓËÙÈÎfiÙËÙ·˜, ÂÓÒ ‰Â‰Ô̤ӷ ÌÂÏÂÙÒÓ Û ·ÓıÚÒ-
Ô˘˜ Î·È ˙Ò· ·¤‰ÂÈÍ·Ó fiÙÈ Ë ÂÌ‚Ú˘˚΋ ˘ÔÍ›· ‹ Ë
ÂÚÈÁÂÓÓËÙÈ΋ ·ÛÊ˘Í›· ÂÏ·ÙÙÒÓÔ˘Ó ÙË ÌÂÙ·ÁÂÓÓË-
ÙÈ΋ ÂÓÙÂÚÈ΋ ÎÈÓËÙÈÎfiÙËÙ· (53,55). ∆¤ÏÔ˜, Ù· Úfi-
ˆÚ· ÓÂÔÁÓ¿ ‰ÂÓ ¤¯Ô˘Ó ·Ó·Ù‡ÍÂÈ Ï‹Úˆ˜ ÙËÓ Èη-
ÓfiÙËÙ· ¤„˘ Î·È ·ÔÚÚfiÊËÛ˘ ÙˆÓ ıÚÂÙÈÎÒÓ
Û˘ÛÙ·ÙÈÎÒÓ ÙÔ˘ Á¿Ï·ÎÙÔ˜, Ì ·ÔÙ¤ÏÂÛÌ· ¿ÂÙ·
ÌfiÚÈ¿ ÙÔ˘ Ó· ÚÔηÏÔ‡Ó ÙÚ·˘Ì·ÙÈÛÌfi ÛÙÔ ¤ÓÙÂÚÔ,
Û˘Ì‚¿ÏÏÔÓÙ·˜ ÛÙËÓ ÚfiÎÏËÛË Ù˘ ¡∂∫ (56,57).
24 Ã. ∆۷ηϛ‰Ë˜ Î·È Û˘Ó.
Paediatriki 2008;71:21-28
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·24
¶ÚÔ·ÙÂÈ, ÂÔ̤ӈ˜, fiÙÈ Ë ÂÏ·Ùو̤ÓË ¤„Ë/
·ÔÚÚfiÊËÛË Î·È Ë ·Ú¿Ù·ÛË ÙÔ˘ ¯ÚfiÓÔ˘ ·Ú·ÌÔ-
Ó‹˜ Ù˘ ÙÚÔÊ‹˜ ÛÙÔ ¤ÓÙÂÚÔ Û˘Ì‚¿ÏÏÂÈ ÛÙËÓ ÚfiÎÏË-
ÛË ÙÚ·‡Ì·ÙÔ˜, ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙËÓ ·ÓÒÚÈÌË ¿Ì˘Ó·
Î·È ÙÔ˘˜ ÌÂȈ̤ÓÔ˘˜ ÂÓÙÂÚÈÎÔ‡˜ ÊÚ·ÁÌÔ‡˜.
∞. Tight junctions (™Ù·ıÂÚ¤˜ Û˘Ó‰¤ÛÂȘ)™ÎÔfi˜ ÙÔ˘˜ Â›Ó·È Ë ‰ËÌÈÔ˘ÚÁ›· ÊÚ·ÁÌÔ‡, ̤ۈ
Û‡Ó‰ÂÛ˘ ÙˆÓ Ï·Á›ˆÓ ÂÈÊ·ÓÂÈÒÓ ÙˆÓ ÂÓÙÂÚÔ΢Ù-
Ù¿ÚˆÓ. √È tight junctions ‹ ÛÙ·ıÂÚ¤˜ Û˘Ó‰¤ÛÂȘ ·Ô-
ÙÂÏÔ‡ÓÙ·È ·fi ÔÏϷϤ˜ ÔÈÎÔÁ¤ÓÂȘ ÚˆÙÂ˚ÓÒÓ
(‰È·ÌÂÌ‚Ú·ÓÈΤ˜ ÚˆÙ½Ó˜, fiˆ˜ Ë ÔÎÏÔ˘‰›ÓË, Ë
ÎÏ·Ô˘‰›ÓË Î·È ÔÈ ÚˆÙ½Ó˜ ÚÔÛÎfiÏÏËÛ˘) (58).
¶ÚfiÛÊ·Ù· ‰Â‰Ô̤ӷ ·Ó·Ê¤ÚÔ˘Ó fiÙÈ ÔÈ ÛÙ·ıÂÚ¤˜
Û˘Ó‰¤ÛÂȘ ‰ÂÓ Â›Ó·È ÛÙ·ÙÈΤ˜ ‰Ô̤˜, ·ÏÏ¿ ÌÂÙ·‚¿Ï-
ÏÔÓÙ·È Î·Ù¿ ÙË ‰È·‰ÚÔÌ‹ ‰È·ÊfiÚˆÓ ÎÏÈÓÈÎÒÓ Î·Ù·-
ÛÙ¿ÛÂˆÓ (45). ∆fiÛÔ in vivo fiÛÔ Î·È in vitro ÌÂϤÙ˜
¤¯Ô˘Ó ·Ô‰Â›ÍÂÈ fiÙÈ Ë ÂÓ‰ÔÙÔÍÈÓ·ÈÌ›· ÚÔηÏ› Ì›-
ˆÛË ÛÙËÓ ¤ÎÊÚ·ÛË ÚˆÙÂ˚ÓÒÓ ÙˆÓ ÛÙÂÚÂÒÓ ÂÓÒÛÂ-
ˆÓ, fiˆ˜ ÔÈ ZO-1, ZO-2, ZO-3 Î·È Ë ÔÎÏÔ˘‰›ÓË, ̤-
Ûˆ Ù˘ ‰Ú¿Û˘ ÙÔ˘ ¡√, Ì ·ÔÙ¤ÏÂÛÌ· ÙË ‰È¿Û·ÛË
Ù˘ ·ÎÂÚ·ÈfiÙËÙ·˜ ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ÊÚ·ÁÌÔ‡ (56,58).
µ. ∂ÓÙÂÚÈÎfi˜ ÂÚÈÛÙ·ÏÙÈÛÌfi˜√ ÂÚÈÛÙ·ÏÙÈÛÌfi˜ Î·È ÔÈ ÎÈÓ‹ÛÂȘ ÙÔ˘ ÂÓÙ¤ÚÔ˘
ÚÔηÏÔ‡Ó ÌÂٷΛÓËÛË ÙÔ˘ ÂÚȯÔ̤ÓÔ˘ ÌÂ Î˘Ì·-
ÙÔÂȉ›˜ Û˘Û¿ÛÂȘ (59). ™ÎÔfi˜ ÙÔ˘˜ Â›Ó·È Ë ¤„Ë
ÙˆÓ ÙÚÔÊÒÓ, ÂÓÒ, ÂÈϤÔÓ, ‰ÚÔ‡Ó Û˘ÓÂÚÁÈο ÛÙË
‰È·Ù‹ÚËÛË Ù˘ ÂÈıËÏȷ΋˜ ·ÎÂÚ·ÈfiÙËÙ·˜. √ ÂÚÈ-
ÛÙ·ÏÙÈÛÌfi˜ ÌÂÈÒÓÂÈ Û˘Á¯ÚfiÓˆ˜ ÙÔ ¯ÚfiÓÔ Ì ÙÔÓ
ÔÔ›Ô Ù· ·ÓÙÈÁfiÓ· ÙˆÓ ·ıÔÁfiÓˆÓ ÌÈÎÚÔÔÚÁ·ÓÈ-
ÛÌÒÓ ‚Ú›ÛÎÔÓÙ·È Û ·ʋ Ì ÙÔ ÎÔÚ˘Ê·›Ô ÙÌ‹Ì·
ÙˆÓ ÂÓÙÂÚÔ΢ÙÙ¿ÚˆÓ, ÌË ÂÈÙÚ¤ÔÓÙ·˜ ÙËÓ ·ÓÙ›-
‰Ú·ÛË ·ÓÙÈÁfiÓÔ˘-·ÓÙÈÛÒÌ·ÙÔ˜ (59). ∆· ÚfiˆÚ· ÓÂ-
ÔÁÓ¿ ‰ÂÓ ¤¯Ô˘Ó Ï‹Úˆ˜ ·Ó·Ù˘Á̤ÓÔ ÂÚÈÛÙ·ÏÙÈ-
ÛÌfi, ·ÊÔ‡ Ô Ì˯·ÓÈÛÌfi˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘ ‰ÂÓ ̂ ÚÈÌ¿-
˙ÂÈ ÚÈÓ ·fi ÙÔÓ 8Ô Ì‹Ó· Ù˘ ·ËÛ˘ (60). ∆¤ÏÔ˜, ÙÔ
ÚÔÙÂÈÓfiÌÂÓÔ ÌÔÓÙ¤ÏÔ Û‹ÌÂÚ· ÂÓÔ¯ÔÔÈ› ÙËÓ ¤Ï-
ÏÂÈ„Ë ÂÚÈÛÙ·ÏÙÈÛÌÔ‡ ÁÈ· ÙËÓ ÚfiÎÏËÛË stress ÛÙÔÓ
ÂÓÙÂÚÈÎfi ÊÚ·ÁÌfi Î·È ‰Â˘ÙÂÚÔ·ı‹ ÌÈÎÚԂȷ΋ ÚÔ-
Û‚ÔÏ‹ Î·È ÊÏÂÁÌÔÓÒ‰Ë ·¿ÓÙËÛË.
°. ™‡ÛÙ·ÛË ÙÔ˘ ÛÙÚÒÌ·ÙÔ˜ ‚ϤÓÓ·˜∆Ô ÛÙÚÒÌ· Ù˘ ‚ϤÓÓ·˜ Ô˘ ÂÈηχÙÂÈ Ù·
ÂÓÙÂÚÔ·ÙÙ·Ú· ‰È·‰Ú·Ì·Ù›˙ÂÈ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ
·ÎÂÚ·ÈfiÙËÙ· Î·È ÚÔÛÙ·Û›· ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ÊÚ·ÁÌÔ‡
(61). √È ÂÈÊ¿ÓÂȘ ÙÔ˘ ÂÈıËÏ›Ô˘ ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈ-
ÎÔ‡, ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Î·È ÙÔ˘ ·Ó··Ú·ÁˆÁÈÎÔ‡
Û˘ÛÙ‹Ì·ÙÔ˜ ÙˆÓ ıËÏ·ÛÙÈÎÒÓ ·ÔÙÂÏÂ›Ù·È ·fi ÓÂÚfi,
‚ÏÂÓÓ›ÓË Î·È ÏÈ›‰È· (46). ∏ ‚ÏÂÓÓ›ÓË ·ÔÙÂÏ› ÁÏ˘-
ÎÔÚˆÙ½ÓË ˘„ËÏÔ‡ ÌÔÚÈ·ÎÔ‡ ‚¿ÚÔ˘˜ Ô˘ ¤¯ÂÈ ÙËÓ
ÈηÓfiÙËÙ· Ó· Û¯ËÌ·Ù›˙ÂÈ ·¯‡ÚÚ¢ÛÙË Á¤ÏË ÛÙËÓ
ÂÈÊ¿ÓÂÈ· ÙˆÓ ÂÓÙÂÚÔ΢ÙÙ¿ÚˆÓ. √ ‚·ıÌfi˜ ÚÔÛÙ·-
Û›·˜ ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ·fi ÙȘ ‚ÏÂÓ-
Ó›Ó˜ Û¯ÂÙ›˙ÂÙ·È Ì ÙÔ ‚·ıÌfi ˆÚ›Ì·ÓÛ‹˜ ÙÔ˘˜, Ë
ÔÔ›· ÂÍ·ÚÙ¿Ù·È Î˘Ú›ˆ˜ ·fi ÙËÓ ËÏÈΛ· ·ËÛ˘
(62). ™˘ÁÎÂÎÚÈ̤ӷ, ÔÈ ˆÚÈÌfiÙÂÚ˜ Â›Ó·È ÈÔ ·¯‡Ú-
Ú¢ÛÙ˜, Ô͇ÙÂÚ˜ Î·È ÂÚÈÛÛfiÙÂÚÔ ·ÓıÂÎÙÈΤ˜ ÛÙË
‰Ú¿ÛË ÙˆÓ ‚·ÎÙËÚÈ·ÎÒÓ ÂÓ˙‡ÌˆÓ, Û ·ÓÙ›ıÂÛË ÌÂ
ÂΛӘ Ô˘ ··ÓÙÒÓÙ·È ÛÙ· ÚfiˆÚ· (63-65).
¶ÔÏϤ˜ ÌÂϤÙ˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ Ë ¤ÏÏÂÈ„Ë
‚ϤÓÓ˘ ‰È·‰Ú·Ì·Ù›˙ÂÈ ÚfiÏÔ Û ÓÔÛ‹Ì·Ù· ÙÔ˘ Á·-
ÛÙÚÂÓÙÂÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Ô˘ ÌÈÌÔ‡ÓÙ·È ÙË ¡∂∫,
fiˆ˜ Ë ÌÂÙ·Ï·Û›· ÙÔ˘ ÂÓÙ¤ÚÔ˘, Ë Á·ÛÙÚ›Ùȉ·, Ô˘
Ô‰ËÁ› Û ¤ÏÎÔ˜, Î·È ÔÈ ÊÏÂÁÌÔÓÒ‰ÂȘ ÓfiÛÔÈ ÙÔ˘
ÂÓÙ¤ÚÔ˘ (61-62).
∏ IgA ·ÔÙÂÏ› ÙËÓ ·ÓÔÛÔÛÊ·ÈÚ›ÓË Ô˘ ·Ú¿ÁÂ-
Ù·È Û ÌÂÁ·Ï‡ÙÂÚË ÔÛfiÙËÙ· ÛÙÔÓ ·ÓıÚÒÈÓÔ ÔÚÁ·-
ÓÈÛÌfi (66). ™ÙÔ ¤ÓÙÂÚÔ, Ë sIgA ‰Ú· ·ÊÂÓfi˜ ̤ۈ Ù˘
Û‡Ó‰ÂÛ‹˜ Ù˘ Ì ٷ ‚·ÎÙ‹ÚÈ· Î·È ·ÊÂÙ¤ÚÔ˘ ̤ۈ
Ù˘ ÂÍÔ˘‰ÂÙ¤ÚˆÛ˘ ÙˆÓ ‚·ÎÙËÚÈ·ÎÒÓ ÂÓ‰ÔÙÔÍÈÓÒÓ,
ÙˆÓ ÚÔÙ·˚ÒÓ Î·È ÙÔ˘ ÈÔ‡ Ù˘ Áڛ˘, Ô˘ ÂÓÔ¯ÔÔÈ-
Ô‡ÓÙ·È ÛÙËÓ ·ıÔÁ¤ÓÂÛË Ù˘ ¡∂∫ (67). ¶·Ú¿ ÙÔÓ
·Ú¯ÈÎfi ÂÓıÔ˘ÛÈ·ÛÌfi ÁÈ· ÙËÓ Èı·Ó‹ ÚÔÛٷ٢ÙÈ΋
Ù˘ ‰Ú¿ÛË, ÚfiÛÊ·ÙË ÌÂÙ·Ó¿Ï˘ÛË 3 ÎÏÈÓÈÎÒÓ ÌÂÏÂ-
ÙÒÓ Ì 2.095 ÂÓÙ·¯ı¤ÓÙ· ÓÂÔÁÓ¿ ‰ÂÓ ·¤‰ÂÈÍ Ì›ˆ-
ÛË Ù˘ ›وÛ˘ Ù˘ ¡∂∫ ÌÂÙ¿ ÙËÓ ÚÔÊ˘Ï·ÎÙÈ΋
¯ÔÚ‹ÁËÛË Û˘Ó‰˘·ÛÌÔ‡ IgG/IgA ‹ ÌfiÓÔ IgG (68).
¶ÚfiÏË„Ë - ∞ÓÙÈÌÂÙÒÈÛË
∏ ıÂڷ¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÓÂÔÁÓÒÓ ÌÂ
¡∂∫ ‚·Û›˙ÂÙ·È ÛÙË Û˘Ó¯‹ ·ÔÛ˘ÌÊfiÚËÛË ÙÔ˘ Â-
ÙÈÎÔ‡ ۈϋӷ, ÛÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ˙ˆÙÈÎÒÓ
ÛËÌ›ˆÓ Î·È ‰È·Ù‹ÚËÛË ÙÔ˘ ÈÛÔ˙˘Á›Ô˘ ÙˆÓ ˘ÁÚÒÓ
ηÈ, Ù¤ÏÔ˜, ÛÙË ¯ÔÚ‹ÁËÛË ·ÓÙÈÌÈÎÚÔ‚È·ÎÒÓ. ∏ Û‡Á-
¯ÚÔÓË ÛÙÚ·ÙËÁÈ΋ ÚfiÏ˄˘ Î·È ·ÓÙÈÌÂÙÒÈÛ˘
¤¯ÂÈ Û˘Ì‚¿ÏÏÂÈ ÛËÌ·ÓÙÈο ÛÙË ‚ÂÏÙ›ˆÛË ÙˆÓ ÚÒÈ-
ÌˆÓ Î·È ·ÒÙÂÚˆÓ ÂÈÏÔÎÒÓ ÙˆÓ Ôχ ¯·ÌËÏÔ‡
‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓÒÓ (¶Ãµ¡) Ì ¡∂∫. ∏ Û›ÙÈ-
ÛË Ì ÌËÙÚÈÎfi Á¿Ï·, ΢ڛˆ˜ ÛÙ· ÓÂÔÁÓ¿ ˘„ËÏÔ‡ ÎÈÓ-
‰‡ÓÔ˘, ¤¯ÂÈ ·Ô‰Âȯı› fiÙÈ Û˘Ì‚¿ÏÏÂÈ ÛËÌ·ÓÙÈο
ÛÙË Ì›ˆÛË Ù˘ ›وÛ˘ (69-71). ¶·ÚfiÏ· ·˘Ù¿,
˘¿Ú¯ÂÈ ·ÎfiÌË ‰È¯ÔÁӈ̛· ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·-
Ê›·, fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ÚÔÛÙ·Û›· Ô˘ ÚÔÛʤÚÂÈ Ë
¯ÔÚ‹ÁËÛË Í¤ÓÔ˘ ÌËÙÚÈÎÔ‡ Á¿Ï·ÎÙÔ˜ (72). ∏ ÚÔÁÂ-
ÓÂÙÈ΋ ¯ÔÚ‹ÁËÛË ÎÔÚÙÈÎÔÛÙÂÚÔÂȉÒÓ, Ë Û˘ÌÏËÚˆ-
Ì·ÙÈ΋ ¯ÔÚ‹ÁËÛË IgA, ·ÓıÚÒÈÓ˘ ·Ó·Û˘Ó‰˘·Ṳ̂-
Ó˘ ÂÚ˘ıÚÔÔÈËÙ›Ó˘ (rhEPO), ·ÚÁÈÓ›Ó˘ ηÈ, Ù¤ÏÔ˜,
Ë ÚÔÊ˘Ï·ÎÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË Ì ·ÓÙÈ‚ÈÔÙÈο ·fi
ÙÔ˘ ÛÙfiÌ·ÙÔ˜ Û˘Ì‚¿ÏÏÔ˘Ó ÛÙË Ì›ˆÛË Ù˘ ›و-
Û‹˜ Ù˘, ̄ ˆÚ›˜ fï˜ Ó· ¤¯Ô˘Ó ̤¯ÚÈ Û‹ÌÂÚ· ‰Ôı› Û·-
Ê›˜ Û˘ÛÙ¿ÛÂȘ ÁÈ· ÙȘ Û˘ÁÎÂÎÚÈ̤Ó˜ Ú·ÎÙÈΤ˜ ·ÓÙÈ-
ÌÂÙÒÈÛ˘ (68,73-76). ∏ ¢ÂÚÁÂÙÈ΋ ‰Ú¿ÛË Ù˘ EPO
ÛÙË Ì›ˆÛË Ù˘ ›وÛ˘ Ù˘ ¡∂∫ ¤¯ÂÈ ·Ô‰Âȯı›
ÙfiÛÔ Û ÂÈÚ·Ì·ÙÈο fiÛÔ Î·È Û ÌË ÌÔÓ٤Ϸ (75,77).
√ ÚfiÏÔ˜ Ù˘ ÛÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡
25¡ÂÎÚˆÙÈ΋ ÂÓÙÂÚÔÎÔÏ›Ùȉ·
¶·È‰È·ÙÚÈ΋ 2008;71:21-28
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·25
Û˘ÛÙ‹Ì·ÙÔ˜ ‚·Û›ÛÙËΠÛÙËÓ ·Ó‡ÚÂÛ‹ Ù˘ ÛÙÔ ·Ó-
ıÚÒÈÓÔ Á¿Ï· Î·È ÛÙËÓ ¤ÎÊÚ·ÛË ̆ Ô‰Ô¯¤ˆÓ Ù˘ ÛÙ·
ÂÓÙÂÚÔ·ÙÙ·Ú·.
ŸÛÔÓ ·ÊÔÚ¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ Ù˘ ÙÚÔÊ‹˜, ›ӷÈ
ÁÓˆÛÙfi fiÙÈ ·Ó ‰Ôı› ÚÒÈÌ· Û¯ÂÙ›˙ÂÙ·È Ì ˘„ËÏfiÙÂ-
ÚË ·ÓÔ¯‹, ηχÙÂÚË ·Ó¿Ù˘ÍË, ÌÈÎÚfiÙÂÚÔ ‰È¿ÛÙËÌ·
ÂÓ‰ÔÓÔÛÔÎÔÌÂȷ΋˜ ÓÔÛËÏ›·˜ Î·È ÌÂȈ̤ÓÔ ÔÛÔ-
ÛÙfi ÛË„·ÈÌ›·˜ (78,79). ∂ÈϤÔÓ, Ë ÚÒÈÌË ¤Ó·ÚÍË
Ù˘ Û›ÙÈÛ˘ ‰ÂÓ ·˘Í¿ÓÂÈ ÙËÓ Èı·ÓfiÙËÙ· ÂΉ‹ÏˆÛ˘
¡∂∫ (78,79). ∂ÓÙÔ‡ÙÔȘ, ̤¯ÚÈ Û‹ÌÂÚ· ‰ÂÓ ¤¯ÂÈ ‰È¢-
ÎÚÈÓÈÛÙ› Ï‹Úˆ˜ ·fi ÙȘ ÌÂϤÙ˜ Ë ÔÚı‹ ÛÙÚ·ÙËÁÈ-
΋ Û›ÙÈÛ˘ ÙˆÓ ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ.
∂›Ó·È ÁÓˆÛÙfi fiÙÈ Ô ‚·ÎÙËÚÈ·Îfi˜ ·ÔÈÎÈÛÌfi˜ ÌÂ
ÚÔ‚ÈÔÙÈο Û˘Ì‚¿ÏÏÂÈ ÛÙËÓ ÚfiÏË„Ë ÔÏÏÒÓ Á·-
ÛÙÚÂÓÙÂÚÈÎÒÓ ÓÔÛËÌ¿ÙˆÓ Î·È, ÂÔ̤ӈ˜, ·ÔÙÂÏÔ‡Ó
ÌÈ· ÔÏÏ¿ ˘ÔÛ¯fiÌÂÓË ·Ú¤Ì‚·ÛË ÛÙËÓ ÚfiÏË„Ë
Î·È ıÂڷ›· Ù˘ ÓfiÛÔ˘. √È ÌÂϤÙ˜ ¤¯Ô˘Ó ÂȂ‚·ÈÒ-
ÛÂÈ fiÙÈ Ë ̄ ÔÚ‹ÁËÛË ÚÔ‚ÈÔÙÈÎÒÓ Û¯ÂÙ›˙ÂÙ·È Ì Ì›ˆÛË
Ù˘ ›وÛ˘ Î·È Ù˘ ‚·Ú‡ÙËÙ·˜ Ù˘ ¡∂∫ (80,81).
∂Ó·ÏÏ·ÎÙÈΤ˜ ‹ Û˘ÌÏËڈ̷ÙÈΤ˜ ÛÙÚ·ÙËÁÈΤ˜ Úfi-
Ï˄˘ ·ÔÙÂÏÔ‡Ó Ë ¯ÔÚ‹ÁËÛË ÙˆÓ Ú‚ÈÔÙÈÎÒÓ Ô˘,
fiˆ˜ Â›Ó·È ÁÓˆÛÙfi, ÚÔ¿ÁÔ˘Ó ÙËÓ ·Ó¿Ù˘ÍË Ù˘ Ê˘-
ÛÈÔÏÔÁÈ΋˜ ÌÈÎÚԂȷ΋˜ ¯ÏˆÚ›‰·˜, ηıÒ˜ Î·È ÙˆÓ ÌÂ-
Ù·‚ÈÔÙÈÎÒÓ (postbiotics), fiˆ˜ ÙÔ ‚Ô˘Ù˘ÚÈÎfi Ô͇ Ô˘
¤¯ÂÈ Û˘Û¯ÂÙÈÛÙ› Û ÂÈÚ·Ì·ÙÈο ÌÔÓ٤Ϸ Ì ÙËÓ ·Ó¿-
Ù˘ÍË Î·È ‰È·ÊÔÚÔÔ›ËÛË ÙÔ˘ ÂÓÙ¤ÚÔ˘, ÙËÓ Î·Ù·ÛÙÔ-
Ï‹ Ù˘ ÊÏÂÁÌÔÓÒ‰Ô˘˜ ‰ÈÂÚÁ·Û›·˜ Î·È ÙËÓ ·fiÙˆÛË
(82-86). ∏ ¯ÔÚ‹ÁËÛ‹ ÙÔ˘ ¤¯ÂÈ ÌÂÏÂÙËı› Û ·È‰È¿ ÌÂ
ÊÏÂÁÌÔÓÒ‰Ë ÓÔÛ‹Ì·Ù· ÙÔ˘ ÂÓÙ¤ÚÔ˘, fï˜ ‰ÂÓ ¤¯ÂÈ
̤¯ÚÈ Û‹ÌÂÚ· ¯ÔÚËÁËı› Û ÓÂÔÁÓ¿ (87).
∆¤ÏÔ˜, fiÛÔÓ ·ÊÔÚ¿ Ù· ¶Ãµ¡ Ô˘ ÂÈ˙Ô‡Ó ·fi
¡∂∫, ¤¯ÂÈ ‰È·ÈÛÙˆı› fiÙÈ ÂÌÊ·Ó›˙Ô˘Ó ·˘ÍË̤ÓÔ
ΛӉ˘ÓÔ Ó¢ÚÔ·Ó·Ù˘ÍÈ·ÎÒÓ, ΢ڛˆ˜, ‰È·Ù·Ú·¯ÒÓ
(88,89). ™‡Ìʈӷ Ì ٷ Â˘Ú‹Ì·Ù· Ù˘ ÌÂϤÙ˘ ÙˆÓ
Stoll Î·È Û˘Ó., ÚԤ΢„ fiÙÈ Ù· ·È‰È¿ Ì ¡∂∫ ÂÌÊ¿-
ÓÈ˙·Ó Û ̆ „ËÏfiÙÂÚ· ÔÛÔÛÙ¿ ηı˘ÛÙ¤ÚËÛË ·Ó¿Ù˘-
͢, ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË, ÚÔ‚Ï‹Ì·Ù· fiÚ·Û˘
Î·È ·ÎÔ‹˜ (90). ™Â ÌÂϤÙË 3.000 ¶Ãµ¡ (<1.000g) ÂÎ
ÙˆÓ ÔÔ›ˆÓ ¤˙ËÛ·Ó 245 ÌÂÙ¿ ·fi ¡∂∫, ‰È·ÈÛÙÒ-
ıËΠfiÙÈ fiÛ· ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó ¯ÂÈÚÔ˘ÚÁÈο ÂÌÊ¿-
ÓÈ˙·Ó Û ˘„ËÏfiÙÂÚ· ÔÛÔÛÙ¿ ηı˘ÛÙ¤ÚËÛË Ù˘ Ûˆ-
Ì·ÙÈ΋˜ ·Ó¿Ù˘Í˘ Î·È Ó¢ÚÔ·Ó·Ù˘ÍȷΤ˜ ‰È·Ù·-
Ú·¯¤˜ Û ۇÁÎÚÈÛË Ì ÂΛӷ Ô˘ ·ÓÙÈÌÂÙˆ›ÛÙËηÓ
Û˘ÓÙËÚËÙÈο (91).
¶ÚfiÔ‰ÔÈ, ÂÚˆÙ‹Ì·Ù· Î·È ÌÂÏÏÔÓÙÈÎÔ› ÛÙfi¯ÔÈ
™‡Ìʈӷ Ì ٷ ÚÔ·Ó·ÊÂÚfiÌÂÓ·, ÚÔ·ÙÂÈ
fiÙÈ Ë ÂΉ‹ÏˆÛË ¡∂∫ ·ÓÙ·Ó·ÎÏ¿ ÙÔ Û˘Ó‰˘·ÛÌfi ηÈ
ÙË Û˘ÓÂÚÁÈ΋ ‰Ú¿ÛË ÔÏÏÒÓ ·Ú·ÁfiÓÙˆÓ Ô˘ Ô‰Ë-
ÁÔ‡Ó ÛÙËÓ Î·Ù·ÛÙÚÔÊ‹ Ù˘ ·ÎÂÚ·ÈfiÙËÙ·˜ ÙÔ˘ ÂÓÙÂ-
ÚÈÎÔ‡ ÊÚ·ÁÌÔ‡, ÛÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ ·Ì˘ÓÙÈÎÒÓ
Ì˯·ÓÈÛÌÒÓ Î·È Ù˘ Û˘ÛÙËÌ·ÙÈ΋˜ ÊÏÂÁÌÔÓÒ‰Ô˘˜
·¿ÓÙËÛ˘.
∏ Ï‹Ú˘ ηٷÓfiËÛË ÙˆÓ ÌÔÚÈ·ÎÒÓ Ì˯·ÓÈÛÌÒÓÔ˘ ¢ı‡ÓÔÓÙ·È ÁÈ· ÙË ‚Ï¿‚Ë Î·È ÙËÓ ÈÛ¯·ÈÌ›· ÙÔ˘ÂÓÙ¤ÚÔ˘, ÛÂ Û˘Ó‰˘·ÛÌfi Ì Ӥ˜ ıÂڷ¢ÙÈΤ˜ ÛÙÚ·-ÙËÁÈΤ˜ Ô˘ ı· ¤¯Ô˘Ó ˆ˜ ÛÙfi¯Ô ÙËÓ ·ÔηٿÛÙ·Û‹Ù˘, ı· Û˘Ì‚¿ÏÏÔ˘Ó ÛËÌ·ÓÙÈο ÛÙËÓ ·‡ÍËÛË Ù˘ÂÈ‚›ˆÛ˘ ÙˆÓ ÓÂÔÁÓÒÓ Ô˘ ÂΉËÏÒÓÔ˘Ó ¡∂∫.
∆¤ÏÔ˜, Ë ÂÈΤÓÙÚˆÛË Ù˘ ÌÂÏÏÔÓÙÈ΋˜ ¤Ú¢ӷ˜ÛÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ Ô˘ Èı·ÓÒ˜ Ó· Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÁÂÓÂÙÈ΋ ÚԉȿıÂÛË ÂΉ‹ÏˆÛ˘ ¡∂∫ ı· ÌÔÚÔ‡ÛÂÓ· Û˘Ì‚¿ÏÏÂÈ ÛÙËÓ ÂÍ·ÙƠ̂΢ÛË Ù˘ ıÂڷ›·˜ ηÈÛÙËÓ ÚÒÈÌË ÂÊ·ÚÌÔÁ‹ ÚÔÏËÙÈÎÒÓ Ì¤ÙÚˆÓ ÛÙ·ÓÂÔÁÓ¿ Ì ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÂΉ‹ÏˆÛ‹˜ Ù˘.
µÈ‚ÏÈÔÁÚ·Ê›·
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28 Ã. ∆۷ηϛ‰Ë˜ Î·È Û˘Ó.
Paediatriki 2008;71:21-28
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·28
29∞¡∞™∫√¶∏™∏ REVIEW ARTICLE
¶·È‰È·ÙÚÈ΋ 2008;71:29-37
ƒÂ˘Ì·ÙÈÎfi˜ ˘ÚÂÙfi˜: Â›Ó·È ·ÎfiÌ· ‰Ò!
Ã. ∆Ú¿·ÏË, ª. ¶··Ê˘Ï·ÎÙÔ‡, °. ¶··‰fiÔ˘ÏÔ˜
¶ÂÚ›ÏË„Ë: √ ÚÂ˘Ì·ÙÈÎfi˜ ˘ÚÂÙfi˜ (ƒ¶), ·Ó Î·È Û˘Û¯ÂÙ›˙ÂÙ·È Ì ÌÈÎÚԂȷ΋ Ïԛ̈ÍË, ·Ú·Ì¤ÓÂÈ ¤Ó· ÛË-Ì·ÓÙÈÎfi Úfi‚ÏËÌ· 2500 ¯ÚfiÓÈ· ·fi ÙËÓ ÂÚÈÁÚ·Ê‹ ÙÔ˘ ·fi ÙÔÓ πÔÎÚ¿ÙË. ∆Ô Úfi‚ÏËÌ· ·˘Ùfi ÔÊ›ÏÂ-Ù·È ÛÙȘ ÂÈÏÔΤ˜ Ù˘ ÚÂ˘Ì·ÙÈ΋˜ ηډ›Ùȉ·˜ (ƒ∫) Ô˘ ÚÔηÏ› ÛËÌ·ÓÙÈ΋ ÓÔÛËÚfiÙËÙ· Î·È ıÓËÙfiÙËÙ·.™Â οı ÏËı˘ÛÌfi ÂÎÙÈÌ¿Ù·È fiÙÈ ˘¿Ú¯Ô˘Ó ¿ÙÔÌ· ¢¿ÏˆÙ· Û ƒ¶. ∆· ÂÌ‚fiÏÈ· Â›Ó·È ·ÎfiÌ· Ì·ÎÚÈ¿ ·fi ÙÔÓ· Ù‡¯Ô˘Ó ÂÊ·ÚÌÔÁ‹˜ ÛÙËÓ ÎÏÈÓÈ΋ Ú¿ÍË Î·È Ë ıÂڷ›· ÙˆÓ ÏÔÈÌÒÍÂˆÓ ÙÔ˘ Ê¿Ú˘ÁÁ· ·fi ‚-·ÈÌÔÏ˘ÙÈ-Îfi ÛÙÚÂÙfiÎÔÎÎÔ ÔÌ¿‰·˜ ∞ ·Ú·Ì¤ÓÂÈ Ë ‚¿ÛË Ù˘ ÚˆÙÔÁÂÓÔ‡˜ ÚfiÏ˄˘. ∏ ‰È¿ÁÓˆÛË ÂÍ·ÎÔÏÔ˘ı› Ó·‚·Û›˙ÂÙ·È ÛÙ· ÎÏ·ÛÈο ÎÚÈÙ‹ÚÈ· Jones Ì ÙÚÔÔÔÈ‹ÛÂȘ Î·È ÂÈÛËÌ¿ÓÛÂȘ. ∏ ıÂڷ›· ÙÔ˘ ÔͤԘ ƒ¶ ÂÍ·-ÎÔÏÔ˘ı› Ó· ‚·Û›˙ÂÙ·È Û ÎÏ·ÛÈΤ˜ Ú·ÎÙÈΤ˜, ·Ú¿ Û ÙÂÎÌËÚȈ̤Ó˜ Ô‰ËÁ›Â˜ ·fi Ù· ·ÔÙÂϤÛÌ·Ù· ÌÂ-Á¿ÏˆÓ Ù˘¯·ÈÔÔÈËÌ¤ÓˆÓ ÌÂÏÂÙÒÓ. ∏ ‰Â˘ÙÂÚÔÁÂÓ‹˜ ÚfiÏË„Ë Ì ̷ÎÚÔ¯ÚfiÓÈ· ̄ ÔÚ‹ÁËÛË Î·Ù¿ÏÏËÏ˘ ·ÓÙÈ-ÌÈÎÚԂȷ΋˜ ·ÁˆÁ‹˜ Â›Ó·È Ô ·ÎÚÔÁˆÓÈ·›Ô˜ Ï›ıÔ˜ ÁÈ· ÙËÓ ·ÔÊ˘Á‹ Ù˘ ƒ∫. ∫·ÈÓÔ‡ÚÁÈ· ÂȉËÌÈÔÏÔÁÈο ‰Â-‰Ô̤ӷ, Èı·ÓÔ› ·ıÔÁÂÓÂÙÈÎÔ› Ì˯·ÓÈÛÌÔ› Î·È ÓÂfiÙÂÚ· ÛÙÔȯ›· ÁÈ· ÙËÓ ÚfiÏË„Ë, ÙË ‰È¿ÁÓˆÛË Î·È ÙË ıÂ-ڷ›· Ù˘ ÓfiÛÔ˘ Û˘ÓÔ„›˙ÔÓÙ·È, Ì ¤ÌÊ·ÛË ÛÙËÓ Èı·Ó‹ ÎÏÈÓÈ΋ ÙÔ˘˜ ·ÍÈÔÔ›ËÛË.
§¤ÍÂȘ ÎÏÂȉȿ: ƒÂ˘Ì·ÙÈÎfi˜ ˘ÚÂÙfi˜, ÚÂ˘Ì·ÙÈ΋ ηډ›Ùȉ·, ıÂڷ›·, ÚfiÏË„Ë.
Rheumatic fever: it is still here!
C. Trapali, M. Papafylaktou, G. Papadopoulos
Abstract: Acute rheumatic fever (RF), although related to infection, remains a major health problem 2500years since it was first described by Hippocrates. Its main problem derives from the chronic sequelae ofrheumatic heart disease, which causes considerable morbidity and mortality. It is estimated that in anypopulation some individuals are more susceptible to RF. Vaccines are still far away from being availableand the effective treatment of group A beta-haemolytic streptococcal pharyngitis remains the cornerstoneof primary prevention. The Jones criteria modified and revised are still the main diagnostic tool for RF. Thetreatment of acute RF is still based more on traditional practice than on the use of optimal agents tested inrandomized controlled trials. Secondary prevention of RF is essential and is focused on the long-termadministration of the appropriate antibiotic agent. New epidemiological findings, pathogeneticmechanisms and current views on prevention, diagnosis and treatment of RF are reviewed, with specialconsideration given to their potential clinical application.
Key words: Rheumatic fever, rheumatic heart disease, treatment, prevention.
∫·Ú‰ÈÔÏÔÁÈÎfi ∆Ì‹Ì·,¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ∞ıËÓÒÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”
AÏÏËÏÔÁÚ·Ê›·:
ÃÚÈÛÙ›Ó· ∆Ú¿·ÏË[email protected]∫·Ú‰ÈÔÏÔÁÈÎfi ∆Ì‹Ì·,¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ ∞ıËÓÒÓ«¶. & ∞. ∫˘ÚÈ·ÎÔ‡»
Cardiology Department, “P. & A. Kyriakou”Children’s Hospital, Athens,Greece
Correspondence:
Christina [email protected] Department,“P. & A. Kyriakou” Children’s Hospital,Athens, Greece
™˘ÓÙÔÌÔÁڷʛ˜
ƒ¶ ƒÂ˘Ì·ÙÈÎfi˜ ¶˘ÚÂÙfi˜ƒ∫ ƒÂ˘Ì·ÙÈ΋ ∫·Ú‰›Ùȉ·∏Ã∫ ∏¯ÔηډÈÔÁÚ¿ÊËÌ·ASTO ∆›ÙÏÔ˜ ∞ÓÙÈÛÙÚÂÙÔÏ˘Û›Ó˘∆∫∂ ∆·¯‡ÙËÙ· ∫·ı›˙ËÛ˘ ∂Ú˘ıÚÒÓCRP C-∞ÓÙȉÚÒÛ· ¶ÚˆÙ½ÓËi.m. ÂÓ‰ÔÌ˘Èοi.v. ÂÓ‰ÔÊϤ‚È·p.os ·fi ÙÔ ÛÙfiÌ·µ™ µ¿ÚÔ˜ ™ÒÌ·ÙÔ˜¶√À ¶·ÁÎfiÛÌÈÔ˜ √ÚÁ·ÓÈÛÌfi˜ ÀÁ›·˜RF Rheumatic Fever ª∫ ªÂ›˙ÔÓ· ∫ÚÈÙ‹ÚÈ·∂∫ ∂Ï¿ÛÛÔÓ· ∫ÚÈÙ‹ÚÈ·
∂ÈÛ·ÁˆÁ‹
√ ƒ¶ ·Ú·Ì¤ÓÂÈ ÛÙÔ Â›ÎÂÓÙÚÔ ÙÔ˘ ÂӉȷ-ʤÚÔÓÙÔ˜, ΢ڛˆ˜ ÏfiÁˆ ÙˆÓ Ì·ÎÚÔ¯ÚfiÓÈˆÓ ÂÈ-
ÙÒÛÂˆÓ Ù˘ ƒ∫. ∆Ș ÙÂÏÂ˘Ù·›Â˜ ‰ÂηÂٛ˜, Ë
‚ÂÏÙ›ˆÛË ÙˆÓ Û˘ÓıËÎÒÓ ‰È·‚›ˆÛ˘ Î·È ˘ÁÈÂÈ-
Ó‹˜, Ë ‰˘Ó·ÙfiÙËÙ· ÚfiÛ‚·Û˘ ÛÙȘ ˘ËÚÂۛ˜
˘Á›·˜, ·ÏÏ¿ Î·È Ë ¯Ú‹ÛË ÙˆÓ ·ÓÙÈ‚ÈÔÙÈÎÒÓ Û˘-
Ó¤‚·Ï·Ó ÛÙË ÛËÌ·ÓÙÈ΋ Ì›ˆÛË Ù˘ ›وÛ˘
Ù˘ ÓfiÛÔ˘, Ô˘ ÛÙȘ ·Ó·Ù˘Á̤Ó˜ ÎÔÈӈӛ˜
˘ÔÏÔÁ›˙ÂÙ·È ÛÂ ÏÈÁfiÙÂÚÔ ·fi 0,05% (1). ∞ÓÙ›-
ıÂÙ·, Ô ƒ¶ ·ÔÙÂÏ› ÛËÌ·ÓÙÈÎfi Úfi‚ÏËÌ· ‰Ë-
ÌfiÛÈ·˜ ˘Á›·˜ ÛÙȘ ·Ó·Ù˘ÛÛfiÌÂÓ˜ ¯ÒÚ˜, η-
ıÒ˜ Î·È Û ÏËı˘ÛÌÔ‡˜ Èı·ÁÂÓÒÓ ÛÙȘ ·Ó·-
Ù˘Á̤Ó˜ ¯ÒÚ˜ (.¯. ∞˘ÛÙÚ·Ï›·, ¡¤· ∑ËÏ·Ó-
‰›·). ÀÔÏÔÁ›˙ÂÙ·È, fiÙÈ ÂÚ›Ô˘ 3-6% οıÂ
ÏËı˘ÛÌÔ‡ Â›Ó·È ÂÈÚÚ¤˜ ÛÙËÓ ·Ó¿Ù˘ÍË ƒ¶
(1). ™˘ÓÂÒ˜, Â›Ó·È ÛËÌ·ÓÙÈÎfi Ô È·ÙÚÈÎfi˜ Îfi-
ÛÌÔ˜ Ó· ‰È·ÙËÚ› ÙËÓ ÂÙÔÈÌfiÙËÙ· ÙÔ˘ ÁÈ· ÙËÓ
¤ÁηÈÚË ‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘. ∞Í›˙ÂÈ Ó· ÛËÌÂÈ-
ˆı› fiÙÈ ‰ËÌÔÛȇÙËΠÚfiÛÊ·Ù· ÛÙÔ Lancet Ë
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·29
ı·Ó·ÙËÊfiÚÔ˜ ηٿÏËÍË ÂÊÙ¿¯ÚÔÓ˘ Ì ƒ¶, ÛÙËÓ
ÔÔ›· ÁÈ· ‰‡Ô ¯ÚfiÓÈ· ‰ÂÓ Î·Ù¤ÛÙË ‰˘Ó·Ùfi Ó· ÙÂı› Ë
‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘ (2).
™ÙËÓ ·Ó·ÛÎfiËÛË ·˘Ù‹ ·Ó·Ê¤ÚÔÓÙ·È ÓÂÒÙÂÚ·
‰Â‰Ô̤ӷ Û¯ÂÙÈο Ì ÙË ‰È¿ÁÓˆÛË Î·È ÙËÓ ·ÓÙÈÌÂÙÒ-
ÈÛË Ù˘ ÓfiÛÔ˘, Û‡Ìʈӷ Ì ÙȘ ˘¿Ú¯Ô˘Û˜ ηÙ¢-
ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜. ∂›Û˘, ÙÔÓ›˙ÔÓÙ·È Ù· ·ÌÊÈÏÂÁfi-
ÌÂÓ· ‰›· Î·È ÔÈ ÌÂÏÏÔÓÙÈΤ˜ ÚÔÔÙÈΤ˜.
∂ȉËÌÈÔÏÔÁ›·
√ ¶·ÁÎfiÛÌÈÔ˜ √ÚÁ·ÓÈÛÌfi˜ ÀÁ›·˜ (¶√À) ·Ó·-
ʤÚÂÈ fiÙÈ ÙÔ 2004 ÂÚÈÛÛfiÙÂÚÔÈ ·fi 15,6 ÂηÙÔÌ̇-
ÚÈ· ¿ÓıÚˆÔÈ ¤·Û¯·Ó ·fi ƒ¶ Î·È ¿Óˆ ·fi
230.000 ¿ÓıÚˆÔÈ Î¿ı ¯ÚfiÓÔ Âı·›ÓÔ˘Ó ·fi ƒ¶.
∫¿ı ¯ÚfiÓÔ ˘ÔÏÔÁ›˙ÔÓÙ·È 500.000 Ӥ˜ ÂÚÈÙÒ-
ÛÂȘ ƒ¶ Î·È ÂÚ›Ô˘ ÔÈ 300.000 ηٷϋÁÔ˘Ó Û ƒ∫.
∏ ÛËÌ·ÓÙÈ΋ ÓÔÛËÚfiÙËÙ· Ù˘ ƒ∫ ·ÊÔÚ¿ ΢ڛˆ˜
ÙÔ˘˜ Ó¤Ô˘˜ ·ÓıÚÒÔ˘˜ Ì ÙÂÚ¿ÛÙȘ ÎÔÈÓˆÓÈÎÔÔÈÎÔ-
ÓÔÌÈΤ˜ ÂÈÙÒÛÂȘ. ∏ ›وÛË Î·È ıÓËÙfiÙËÙ· ÙÔ˘
ƒ¶ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÙÂÚ¿ÛÙȘ ‰È·ÊÔÚ¤˜ ÌÂٷ͇ ·Ó·-
Ù˘ÁÌ¤ÓˆÓ Î·È ˘·Ó¿Ù˘ÎÙˆÓ ¯ˆÚÒÓ (1). ™ÙȘ ·Ó·-
Ù˘Á̤Ó˜ ¯ÒÚ˜, Ë Â›ÙˆÛË Û ·È‰È¿ ËÏÈΛ·˜ 5-
14 ÂÙÒÓ ˘ÔÏÔÁ›˙ÂÙ·È ÛÂ ÏÈÁfiÙÂÚÔ ·fi 0,5ò, ÂÓÒ
ÛÙȘ ˘·Ó¿Ù˘ÎÙ˜ ¯ÒÚ˜ Â›Ó·È È‰È·›ÙÂÚ· ·˘ÍË̤ÓË,
ÂÎÙÈÌÒÌÂÓË ÛÙÔ˘˜ ·˘Ùfi¯ıÔÓ˜ Ù˘ ∞˘ÛÙÚ·Ï›·˜ ÛÂ
5ò (1). ∆Ô ¯·ÌËÏfi ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎfi ›‰Ô
Î·È Ù· ·ÎfiÏÔ˘ı¿ ÙÔ˘ (ηΤ˜ Û˘Óı‹Î˜ ‰È·‚›ˆÛ˘,
Û˘ÓˆÛÙÈÛÌfi˜, ˘ÔÛÈÙÈÛÌfi˜, ‰˘Û¯ÂÚ‹˜ ÚfiÛ‚·ÛË ÛÂ
˘ËÚÂۛ˜ ˘Á›·˜) ÔÏÏ·Ï·ÛÈ¿˙Ô˘Ó ÙËÓ Èı·ÓfiÙË-
Ù· ƒ¶, fiˆ˜ Ê·›ÓÂÙ·È ÛÙËÓ ∂ÈÎfiÓ· 1.
∏ ÓfiÛÔ˜ Â›Ó·È Û¯Â‰fiÓ ·Ó‡·ÚÎÙË ÚÈÓ ·fi ÙÔ 2Ô
¤ÙÔ˜ Ù˘ ˙ˆ‹˜, ÂÓÒ ÌfiÓÔ ÙÔ 5% ÙÔ˘ ÚÒÙÔ˘ ÂÂÈÛÔ-
‰›Ô˘ ƒ¶ ·Ú·ÙËÚÂ›Ù·È Û ·È‰È¿ ÌÈÎÚfiÙÂÚ· ÙˆÓ 5
ÂÙÒÓ (3). ∏ ˘„ËÏfiÙÂÚË Â›ÙˆÛË Ù˘ ÓfiÛÔ˘ ·Ú·-
ÙËÚÂ›Ù·È ÚÔ Ù˘ ÂÊ˂›·˜ Î·È ·ÎÔÏÔ˘ı› ÚÔԉ¢-
ÙÈ΋ Ì›ˆÛË Ì¤¯ÚÈ ÙËÓ ËÏÈΛ· ÙˆÓ 20 ÂÙÒÓ. ∏ ÓfiÛÔ˜
Â›Ó·È Û¿ÓÈ· ÌÂÙ¿ ÙËÓ ËÏÈΛ· ÙˆÓ 35 ÂÙÒÓ (1). √ ÂÈ-
ÔÏ·ÛÌfi˜ Ù˘ ƒ∫ ·˘Í¿ÓÂÈ Ì ÙËÓ ËÏÈΛ·, Êı¿ÓÔÓÙ·˜
ÛÙË Ì¤ÁÈÛÙË ÙÈÌ‹ Û ËÏÈΛ· 25-35 ÂÙÒÓ, ·ÓÙÈηÙÔ-
ÙÚ›˙ÔÓÙ·˜ ÙËÓ ÚÔÛ‚ÔÏ‹ ·fi ƒ¶ Û ÓÂfiÙÂÚË ËÏÈ-
Λ·. ∞ÎfiÌ· ÎÈ ¤Ó· ÌÂÌÔӈ̤ÓÔ ÂÂÈÛfi‰ÈÔ ƒ¶ ÌÔÚ›
Ó· Ô‰ËÁ‹ÛÂÈ Û ƒ∫ (4), ÂÓÙÔ‡ÙÔȘ, ηٿ ηÓfiÓ· ··È-
ÙÔ‡ÓÙ·È ÂÚÈÛÛfiÙÂÚ· ÂÂÈÛfi‰È·. ™ÙÔ˘˜ Ó·ÚÔ‡˜
·ÛıÂÓ›˜, Ë ·Ó¿ÚÎÂÈ· Ù˘ ÌÈÙÚÔÂȉԇ˜ ‚·Ï‚›‰·˜
Â›Ó·È Ë Û˘ÓËı¤ÛÙÂÚË ‚Ï¿‚Ë. ¶ÚÔ˚Ô‡Û˘ Ù˘ ËÏÈΛ·˜,
Ë ‚Ï¿‚Ë Û˘Ó‹ıˆ˜ ÂÍÂÏ›ÛÛÂÙ·È ÚÔ˜ ÛÙ¤ÓˆÛË.
¶·ıÔÁ¤ÓÂÈ·
√ ƒ¶ ıˆÚÂ›Ù·È ·ÔÙ¤ÏÂÛÌ· ηı˘ÛÙÂÚË̤Ó˘
·ÓÔÛÔ·¿ÓÙËÛ˘ ÛÂ Ê·Ú˘ÁÁÈΤ˜ ÏÔÈÌÒÍÂȘ ·fi ‚-
·ÈÌÔÏ˘ÙÈÎfi ÛÙÚÂÙfiÎÔÎÎÔ ÔÌ¿‰·˜ ∞, ·Ó Î·È Ô ·ÎÚÈ-
‚‹˜ Ì˯·ÓÈÛÌfi˜ ‰ÂÓ Â›Ó·È ÁÓˆÛÙfi˜. √È ‚-·ÈÌÔÏ˘ÙÈ-
ÎÔ› ÛÙÚÂÙfiÎÔÎÎÔÈ ¯ˆÚ›˙ÔÓÙ·È Û ÔÌ¿‰Â˜ Ì ‚¿ÛË
ÙÔ ÔÏ˘Û·Î¯·ÚȉÈÎfi ·ÓÙÈÁfiÓÔ ÙÔ˘ ÙÔȯÒÌ·Ùfi˜ ÙÔ˘˜
Î·È ÔÈ ÛÙÚÂÙfiÎÔÎÎÔÈ Ù˘ ÔÌ¿‰·˜ ∞ Â›Ó·È ˘Â‡ı˘ÓÔÈ
ÁÈ· ÙË Û˘ÓÙÚÈÙÈ΋ ÏÂÈÔ„ËÊ›· ÙˆÓ ÛÙÚÂÙÔÎÔÎÎÈ-
ÎÒÓ ÏÔÈÌÒÍÂˆÓ ÛÙÔÓ ¿ÓıÚˆÔ (5). ∞fi ÙËÓ ÏËıÒ-
Ú· ÙˆÓ ÏÔÈÌÒÍÂˆÓ ·˘ÙÒÓ, ÌfiÓÔ Ë Ê·Ú˘ÁÁ›Ùȉ· ¤¯ÂÈ
Û˘Ó‰Âı› ·ÈÙÈÔ·ıÔÏÔÁÈο Ì ƒ¶ (6). ŸÌˆ˜, ˘¿Ú-
¯Ô˘Ó ÂӉ›ÍÂȘ fiÙÈ Î·È ÏÔÈÌÒÍÂȘ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ ·fi
ÛÙÚÂÙfiÎÔÎÎÔ ÔÌ¿‰·˜ ∞ ›Ù ·Â˘ı›·˜ ›Ù ̤ۈ
ÚfiÎÏËÛ˘ Ê·Ú˘ÁÁÈ΋˜ Ïԛ̈͢ ¢ı‡ÓÔÓÙ·È ÁÈ·
ÙËÓ ÚfiÎÏËÛË ƒ¶ (7). ∂›Ó·È Èı·Ófi Î·È ÔÈ ÛÙÚÂÙfi-
ÎÔÎÎÔÈ ÙˆÓ ÔÌ¿‰ˆÓ C Î·È G Ó· ¤¯Ô˘Ó ·ıÔÁÂÓÂÙÈÎfi
1Ô ÂÂÈÛfi‰ÈÔ
Ħ
∂˘·ı‹˜
ÔÚÁ·ÓÈÛÌfi˜ ∞¡√™√∞¶∞¡∆∏™∏
ƒÂ˘Ì·ÙÈ΋
ηډ›Ùȉ·
∫·ÈÓÔ‡ÚÁÈ·
ÂÂÈÛfi‰È· ƒ¶
∂ÓÂÚÁÔÔ›ËÛË ·˘ÙÔ¿ÓÔÛÔ˘
Ì˯·ÓÈÛÌÔ‡
ªÔÚȷ΋ ÔÌÔÈfiÙËÙ·
·ÓÙÈÁfiÓÔ˘ -ÈÛÙÒÓ ÍÂÓÈÛÙ‹
°ÂÓÂÙÈ΋ ÚԉȿıÂÛË
∂·ÓÂÈÏËÌ̤Ó˜
ÏÔÈÌÒÍÂȘ
¶ÂÚÈ‚·ÏÏÔÓÙÈÎÔ›
·Ú¿ÁÔÓÙ˜
∂·ÓÂÈÏËÌ̤Ó˜
ÏÔÈÌÒÍÂȘ
∂ÈÎfiÓ· 1. ¶·ıÔÁÂÓÂÙÈÎfi˜ Ì˯·ÓÈÛÌfi˜ ÚÂ˘Ì·ÙÈÎÔ‡ ˘ÚÂÙÔ‡ Î·È ÚÂ˘Ì·ÙÈ΋˜ ηډ›Ùȉ·˜.
30 Ã. ∆Ú¿·ÏË Î·È Û˘Ó.
Paediatriki 2008;71:29-37
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·30
ÚfiÏÔ ÛÙÔ ƒ¶ (8), ηıÒ˜ Û˘¯Ó¿ ¤¯Ô˘Ó ·ÔÌÔÓˆı› ÛÂ
ηÏÏȤÚÁÂȘ Ê·Ú˘ÁÁÈÎÔ‡ ÂȯڛÛÌ·ÙÔ˜ ·fi ÏËı˘-
ÛÌÔ‡˜ Ì ˘„ËÏ‹ ›وÛË ƒ¶. ¶Èı·ÓÔÏÔÁÂ›Ù·È fiÙÈ
ÔÈ ÛÙÚÂÙfiÎÔÎÎÔÈ C Î·È G ·ÔÎÙÔ‡Ó ÏÔÈÌÔÁfiÓÔ ‰Ú¿-
ÛË (9,10). ™˘ÓÂÒ˜, Â›Ó·È ÛÎfiÈÌÔ Ó· ˘¿Ú¯ÂÈ ÂÁÚ‹-
ÁÔÚÛË Î·È ÁÈ· ÙȘ ÂÚÈÙÒÛÂȘ Ì ÈÛÙÔÚÈÎfi ‰ÂÚÌ·ÙÈ-
΋˜ Ïԛ̈͢ ‹ Ê·Ú˘ÁÁ›Ùȉ·˜ Ì ηÏÏȤÚÁÂÈ· ıÂÙÈ΋
ÁÈ· ÛÙÚÂÙfiÎÔÎÎÔ ÔÌ¿‰·˜ C ‹ G.
™ÙËÓ EÈÎfiÓ· 1, Û˘ÓÔ„›˙ÂÙ·È Ô ·ıÔÁÂÓÂÙÈÎfi˜ ÌË-
¯·ÓÈÛÌfi˜ ƒ¶ Î·È ƒ∫. ¶Ú¤ÂÈ Ó· ÚÔËÁËıÔ‡Ó Â·-
ÓÂÈÏËÌ̤Ó˜ ÏÔÈÌÒÍÂȘ ÚÈÓ ·fi ÌÈ· Ê·Ú˘ÁÁ›Ùȉ·
·fi ÛÙÚÂÙfiÎÎÔ ÔÌ¿‰·˜ ∞ Ô˘ ı· ÂÓÂÚÁÔÔÈ‹ÛÂÈ
ÙËÓ ·ÓÔÛÔ·¿ÓÙËÛË Û ¢·›ÛıËÙÔ ÍÂÓÈÛÙ‹, Ô‰ËÁÒ-
ÓÙ·˜ ÛÙÔ ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ƒ¶ (11). ∏ ·ÈÙ›· Ù˘
ÂÓÂÚÁÔÔ›ËÛ˘ Ù˘ ·ÓÔÛÔ·¿ÓÙËÛ˘ ·Ô‰›‰ÂÙ·È ÛÂ
‰ÔÌÈΤ˜ Î·È ·ÓÔÛÔÏÔÁÈΤ˜ ÔÌÔÈfiÙËÙ˜ ÌÂٷ͇ ·Ó-
ıÚÒÈÓˆÓ ÈÛÙÒÓ Î·È Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ÂÈÙfiˆÓ Ù˘
ÛÙÚÂÙÔÎÔÎÎÈ΋˜ ÚˆÙ½Ó˘ ª. ™˘ÁÎÂÎÚÈ̤ӷ, Ë
ÔÌÔÈfiÙËÙ· Ù˘ ÚˆÙ½Ó˘ ª Ì ÙË Ì˘Ôηډȷ΋
Ì˘ÔÛ›ÓË ıˆÚÂ›Ù·È ˘Â‡ı˘ÓË ÁÈ· ·˘Ù‹ ÙËÓ ÂÓÂÚÁÔ-
Ô›ËÛË (12). ∂Ó·ÓÙ›ÔÓ ·˘Ù‹˜ Ù˘ ¿Ô„˘ Â›Ó·È ÙÔ
ÁÂÁÔÓfi˜ fiÙÈ Ë Î·Ú‰›Ùȉ· ÙÔ˘ ÔͤԘ ƒ¶ Â›Ó·È ‚·Ï‚ȉ›-
Ùȉ· ÎÈ fi¯È Ì˘Ôηډ›Ùȉ·. ∞Ó Ë Ì˘ÔÛ›ÓË ÂÌÏÂÎfiÙ·Ó
ÛÙÔÓ Ì˯·ÓÈÛÌfi, ı· ·Ó·ÌÂÓfiÙ·Ó Ì˘Ôηډ›Ùȉ· ÌÂ
·‡ÍËÛË ÙˆÓ ÂÓ˙‡ÌˆÓ Î·È fi¯È ‚·Ï‚ȉ›Ùȉ·, ·ÊÔ‡ ÔÈ
‚·Ï‚›‰Â˜ ‰ÂÓ ¤¯Ô˘Ó Ì˘ÔÛ›ÓË (13). ∞fi ¿ÏÏÔ˘˜ ÂÚ¢-
ÓËÙ¤˜ ¤¯ÂÈ ˘ÔÛÙËÚȯı› fiÙÈ Ë ·ÈÙ›· Ù˘ ‚·Ï‚ȉ›ÙÈ-
‰·˜ Â›Ó·È Ë Â˘·ÈÛıËÙÔÔ›ËÛË ÙˆÓ ∆ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ
¤Ó·ÓÙÈ Ù˘ ÛÙÚÂÙÔÎÔÎÎÈ΋˜ ÚˆÙ½Ó˘ ª. ™Â Ì›·
ÂfiÌÂÓË Ê¿ÛË ÚÔηÏÂ›Ù·È ·ÓÔÛÔ·ÓÙ›‰Ú·ÛË ·fi
ÙËÓ ·Ó·ÁÓÒÚÈÛË Ù˘ Ï·ÌÈÓ›Ó˘ ÙˆÓ ‚·Ï‚›‰ˆÓ ·fi Ù·
¢·ÈÛıËÙÔÔÈË̤ӷ ∆ ÏÂÌÊÔ·ÙÙ·Ú· (14). ∆¤ÏÔ˜,
˘¿Ú¯Ô˘Ó ÓÂÒÙÂÚ· ‰Â‰Ô̤ӷ Ô˘ ˘ÔÛÙËÚ›˙Ô˘Ó
ÙËÓ ¿Ô„Ë ‰È·ÛÙ·˘ÚÔ‡ÌÂÓ˘ ·ÓÙ›‰Ú·Û˘ Ì ÙË ¡-
·ÎÂÙ˘ÏÔÁÏ˘ÎÔ˙·Ì›ÓË (15). ŸÔÈÔ˜ ÎÈ ·Ó Â›Ó·È Ô ·-
Ú¿ÁÔÓÙ·˜ Ô˘ ÂÓÂÚÁÔÔÈ› ÙËÓ ·ÓÔÛÔ·ÓÙ›‰Ú·ÛË, ·˘-
Ùfi Ô˘ ¤¯ÂÈ È‰È·›ÙÂÚË ÎÏÈÓÈ΋ ÛËÌ·Û›· Â›Ó·È Ë Úfi-
ÎÏËÛË ‚·Ï‚›Ùȉ·˜. ªÂÙ¿ ÙËÓ ·Ú¯È΋ Ú‹ÍË Ù˘ ·ÎÂ-
Ú·ÈfiÙËÙ·˜ ÙÔ˘ ÂÓ‰ÔıËÏ›Ô˘, ÚÔηÏÂ›Ù·È ‚·Ï‚›Ùȉ·
·fi Ì›· ·Ï˘ÛȉˆÙ‹ ·ÓÙ›‰Ú·ÛË Ì ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ
∆ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ, ‰È‹ıËÛË ·fi Ì·ÎÚÔÊ¿Á· Î·È ÓÂ-
Ô·ÁÁ›ˆÛË (16,17).
¶ÚfiÏË„Ë
™ÙËÓ ∂ÈÎfiÓ· 2, ·ÂÈÎÔÓ›˙ÔÓÙ·È ÔÈ ıˆÚËÙÈΤ˜ ‰˘-
Ó·ÙfiÙËÙ˜ ·Ú¤Ì‚·Û˘, Ì ÛÎÔfi ÙËÓ ÚfiÏË„Ë ÙÔ˘
ƒ¶. √È ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈΤ˜ ·ÚÂÌ‚¿ÛÂȘ ·ÊÔ-
ÚÔ‡Ó Î˘Ú›ˆ˜ ÙËÓ ÔÏÈÙ›·. ∏ ¯Ú‹ÛË ÙÔ˘ ·ÓÙÈÛÙÚÂ-
ÙÔÎÔÎÎÈÎÔ‡ ÂÌ‚ÔÏ›Ô˘ ÛÙÂÚÂ›Ù·È Ú·ÎÙÈ΋˜ ÛËÌ·-
Û›·˜, ·ÊÔ‡ ·Ú·Ì¤ÓÔ˘Ó ·Ó·¿ÓÙËÙ· ÔÏÏ¿ ÂÚˆÙ‹-
Ì·Ù· Û¯ÂÙÈο Ì ÙÔ Ì˯·ÓÈÛÌfi, ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈ-
ÎfiÙËÙ·, ÙËÓ ·ÛÊ¿ÏÂÈ· Î·È ÙÔ ÎfiÛÙÔ˜ ÙÔ˘ (18). ÕÏψ-
ÛÙÂ, ıˆÚÂ›Ù·È ·›ı·ÓÔ Ó· Â›Ó·È ‰È·ı¤ÛÈÌÔ ÚÈÓ ·fi
ÙÔ 2015 (19).
∏ ÚˆÙÔÁÂÓ‹˜ ÚfiÏË„Ë ÂÛÙÈ¿˙ÂÙ·È ÛÙË ıÂÚ·-
›· Ì ·ÓÙÈ‚ÈÔÙÈο Ù˘ Û˘Ìو̷ÙÈ΋˜ Ê·Ú˘ÁÁ›ÙÈ-
‰·˜ ·fi ÛÙÚÂÙfiÎÔÎÎÔ ÔÌ¿‰·˜ ∞. ∆· ÂÚÈÛÛfiÙÂÚ·
ÂÂÈÛfi‰È· ƒ¶ Â›Ó·È ‰˘Ó·Ùfi Ó· ÚÔÏËÊıÔ‡Ó, fiÙ·Ó Ë
·ÁˆÁ‹ ‰Ôı› ÂÓÙfi˜ 9 ËÌÂÚÒÓ ·fi ÙËÓ ¤Ó·ÚÍË Û˘-
ÌÙˆÌ¿ÙˆÓ Ê·Ú˘ÁÁ›Ùȉ·˜ (20). ¶ÚÔÙ›ÓÂÙ·È Ë ‰ÈÂ-
Ó¤ÚÁÂÈ· Ù·¯Â›·˜ ÂͤٷÛ˘ ·Ó›¯Ó¢Û˘ ÙÔ˘ ·ÓÙÈÁfiÓÔ˘
ηÈ, › ·ÌÊÈ‚ÔÏ›·˜, ηÏÏȤÚÁÂÈ· Ê·Ú˘ÁÁÈÎÔ‡ Âȯڛ-
ÛÌ·ÙÔ˜ ÚÈÓ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂڷ›·˜, ‰Â‰Ô̤-
ÓÔ˘ fiÙÈ ÌfiÓÔ ÙÔ 20% ÙˆÓ Ê·Ú˘ÁÁ›ÙȉˆÓ ÔÊ›ÏÂÙ·È ÛÂ
1Ô ÂÂÈÛfi‰ÈÔ
Ħ
∂˘·ı‹˜
ÔÚÁ·ÓÈÛÌfi˜ ∞¡√™√∞¶∞¡∆∏™∏
ƒÂ˘Ì·ÙÈ΋
ηډ›Ùȉ·
∫·ÈÓÔ‡ÚÁÈ·
ÂÂÈÛfi‰È· ƒ¶
∂ÓÂÚÁÔÔ›ËÛË ·˘ÙÔ¿ÓÔÛÔ˘
Ì˯·ÓÈÛÌÔ‡
ªÔÚȷ΋ ÔÌÔÈfiÙËÙ·
·ÓÙÈÁfiÓÔ˘ -ÈÛÙÒÓ ÍÂÓÈÛÙ‹
°ÂÓÂÙÈ΋ ÚԉȿıÂÛË
∂·ÓÂÈÏËÌ̤Ó˜
ÏÔÈÌÒÍÂȘ
¶ÂÚÈ‚·ÏÏÔÓÙÈÎÔ›
·Ú¿ÁÔÓÙ˜
∂·ÓÂÈÏËÌ̤Ó˜
ÏÔÈÌÒÍÂȘ
1
2
33
4
5
6
∂ÈÎfiÓ· 2. £ÂˆÚËÙÈο ÛËÌ›· ·Ú¤Ì‚·Û˘ ÁÈ· ·ÔÙÚÔ‹ ÚÂ˘Ì·ÙÈÎÔ‡ ˘ÚÂÙÔ‡ Î·È ÚÂ˘Ì·ÙÈ΋˜ ηډ›Ùȉ·˜.
1) µÂÏÙ›ˆÛË Û˘ÓıËÎÒÓ ‰È·‚›ˆ-Û˘-ÂÚ›ı·Ï„˘ (ÎÔÈÓˆÓÈÎÔÔÈ-ÎÔÓÔÌÈΤ˜ ·ÚÂÌ‚¿ÛÂȘ).
2) ∞ÓÔÛÔÔ›ËÛË-ÂÌ‚fiÏÈ·. 3) £Âڷ›· ÛÙÚÂÙÔÎÔÎÎÈÎÒÓ
ÏÔÈÌÒÍÂˆÓ Ì ·ÓÙÈ‚ÈÔÙÈο. 4) ª·ÎÚÔ¯ÚfiÓÈ· ‰Â˘ÙÂÚÔÁÂÓ‹˜
ÚfiÏË„Ë Ì ·ÓÙÈ‚ÈÔÙÈο. 5) °ÂÓÂÙÈ΋ ·Ú¤Ì‚·ÛË. 6) ∫·Ù·ÛÙÔÏ‹ Ù˘ ÂÓÂÚÁÔÔ›ËÛ˘
ÙÔ˘ ·˘ÙÔ¿ÓÔÛÔ˘ Ì˯·ÓÈÛÌÔ‡.
31ƒÂ˘Ì·ÙÈÎfi˜ ˘ÚÂÙfi˜
¶·È‰È·ÙÚÈ΋ 2008;71:29-37
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·31
ÛÙÚÂÙfiÎÔÎÎÔ ÔÌ¿‰·˜ ∞ (21). √ ¤ÏÂÁ¯Ô˜ Ù›ÙÏÔ˘
·ÓÙÈۈ̿وÓ, fiˆ˜ ASTO Î·È anti-DNase µ, ‰ÂÓ
Û˘Ì‚¿ÏÏÂÈ ÛÙËÓ ¤ÁηÈÚË ‰È¿ÁÓˆÛË, ‰Â‰Ô̤ÓÔ˘ fiÙÈ ÔÈ
̤ÁÈÛÙ˜ ÙÈ̤˜ ·Ú·ÙËÚÔ‡ÓÙ·È 3-4 ‚‰ÔÌ¿‰Â˜ ÌÂÙ¿
ÙË Ïԛ̈ÍË.
∆Ô Â›‰Ô˜, Ë ‰fiÛË, Ô ·ÚÈıÌfi˜ ‰fiÛÂˆÓ ÙÔ˘ ηٿÏ-
ÏËÏÔ˘ ÁÈ· ÙË ıÂڷ›· Ù˘ Ê·Ú˘ÁÁ›Ùȉ·˜ ·ÓÙÈ‚ÈÔÙÈ-
ÎÔ‡ ¤¯Ô˘Ó Á›ÓÂÈ ·ÓÙÈΛÌÂÓÔ ÌÂÏÂÙÒÓ. ™ÙÔÓ ¶›Ó·Î· 1
ηٷÁÚ¿ÊÂÙ·È Ë ÚfiÙ·ÛË ÙÔ˘ ¶√À (22). °È· ÙÔ˘˜
·ÛıÂÓ›˜ Ì ÔÍ›· Ê·Ú˘ÁÁ›Ùȉ· Î·È ÈÛÙÔÚÈÎfi ƒ¶ ÔÈ
Ô‰ËÁ›Â˜ Â›Ó·È ›‰È˜. ŸÌˆ˜, ÛÙËÓ ÂÚ›ÙˆÛË ·˘Ù‹,
fiˆ˜ Î·È Â› ˘ÔÙÚÔ‹˜ Ù˘ Ê·Ú˘ÁÁ›Ùȉ·˜, Û˘ÛÙ‹-
ÓÂÙ·È Î·ÏÏȤÚÁÂÈ· Ê·Ú˘ÁÁÈÎÔ‡ ÂȯڛÛÌ·ÙÔ˜ Î·È ÌÂ-
Ù¿ ÙËÓ ÔÏÔÎÏ‹ÚˆÛË Ù˘ 10‹ÌÂÚ˘ ·ÁˆÁ‹˜ (22). ∂›
˘ÔÙÚÔ‹˜, ¯ÔÚËÁÔ‡ÓÙ·È 1.200.000 IU ‚ÂÓ˙·ıÈÓÈ΋˜
‚ÂÓ˙˘ÏÔÂÓÈÎÈÏÏ›Ó˘ (i.m.) Û ÌÈ· ‰fiÛË Î·È, ·Ó
˘¿Ú¯Ô˘Ó ˘Ô„›Â˜ ÁÈ· ·Ú·ÁˆÁ‹ ÂÓÈÎÈÏÏÈÓ¿Û˘
·fi ÙÔ ÛÙÚÂÙfiÎÔÎÎÔ, ÚÔÙ›ÓÂÙ·È Ë ¯ÔÚ‹ÁËÛË
ÎÏÈÓ‰·Ì˘Î›Ó˘ ‹ ·ÌÔ͢ÎÈÏÏ›Ó˘-ÎÏ·‚Ô˘Ï·ÓÈÎÔ‡
ÔͤԘ (22).
ø˜ ‰Â˘ÙÂÚÔÁÂÓ‹˜ ÚfiÏË„Ë ÔÚ›˙ÂÙ·È Ë Ù·ÎÙÈ΋
¯ÔÚ‹ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ Û ·ÛıÂÓ›˜ Ì ÈÛÙÔÚÈÎfi ƒ¶,
ÚÔÎÂÈ̤ÓÔ˘ Ó· ·ÔÊ¢¯ı› ÛÙÚÂÙÔÎÔÎÎÈ΋ Ê·-
Ú˘ÁÁ›Ùȉ· Î·È ˘ÔÙÚÔ‹ ÂÂÈÛÔ‰›Ô˘ ÔͤԘ ƒ¶. ◊‰Ë
·fi ÙË ‰ÂηÂÙ›· ÙÔ˘ ã60 ‹Ù·Ó ÁÓˆÛÙfi fiÙÈ ÂÚ›Ô˘ ÙÔ
60% ÙˆÓ ÚÂ˘Ì·ÙÈÎÒÓ ‚·Ï‚ȉÈÎÒÓ ‚Ï·‚ÒÓ ˘ÔÛÙÚ¤-
ÊÔÓÙ·È ÛÙË 10ÂÙ›·, ·Ó ‰ÂÓ ˘¿ÚÍÂÈ ˘ÔÙÚÔ‹ ƒ¶
(23). ¡ÂfiÙÂÚ· ‰Â‰Ô̤ӷ Ì ∏Ã∫ ‰Â›¯ÓÔ˘Ó ‚ÂÏÙ›ˆÛË
ÌÂÙ¿ ÙÔ ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ƒ¶ ·ÎfiÌ· Î·È ÛÙÔ 24%
ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ›¯·Ó ÛÔ‚·Ú‹ ηډ›Ùȉ· (24). ∏
·ÔÊ˘Á‹, ÂÔ̤ӈ˜, Ó¤Ô˘ ÂÂÈÛÔ‰›Ô˘ ƒ¶ Â›Ó·È ÌÂ-
Á¿Ï˘ ÛËÌ·Û›·˜, ‰Â‰Ô̤ÓÔ˘ fiÙÈ, ηٿ ηÓfiÓ·, ˯ÚfiÓÈ· ƒ∫ Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ÔÏÏÒÓ ÂÂÈÛÔ‰›ˆÓ ƒ¶(4). ∏ ÚfiÙ·ÛË ÙÔ˘ ¶√À (22) ÁÈ· ‰Â˘ÙÂÚÔÁÂÓ‹ Úfi-ÏË„Ë Î·Ù·ÁÚ¿ÊÂÙ·È ÛÙÔÓ ¶›Ó·Î· 2. ∏ ¯ÔÚ‹ÁËÛË Â-ÓÈÎÈÏ›Ó˘ ÂÓ‰ÔÌ˘˚ο ¤¯ÂÈ Ê·Ó› ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂ-ÚË Ù˘ ·ÁˆÁ‹˜ ·fi ÙÔ ÛÙfiÌ·, ÂÓÒ ·ÔÙÂÏÂÛÌ·ÙÈÎfi-ÙÂÚË, ›Û˘, Â›Ó·È Î·È Ë ¯ÔÚ‹ÁËÛË Î¿ı 3 ‚‰ÔÌ¿‰Â˜(25). ¶·Ú¿ Ù·‡Ù·, ÙÔ ·Ó¿ 3 ‚‰ÔÌ¿‰Â˜ Û¯‹Ì· ÚÔÙ›-ÓÂÙ·È Î˘Ú›ˆ˜ ÁÈ· ÙÔ˘˜ ·ÛıÂÓ›˜ Ì ÛÔ‚·Ú‹ ƒ∫, ÂÓÒÁÈ· ÙÔ˘˜ ˘fiÏÔÈÔ˘˜ ÚÔÙÈÌ¿Ù·È Ë ¯ÔÚ‹ÁËÛË Î¿ı 4‚‰ÔÌ¿‰Â˜ (19).
∂›Ó·È ÛÎfiÈÌÔ Ó· ÂÊ·ÚÌfi˙ÔÓÙ·È ÔÈ ·Ï¤˜ Ô‰ËÁ›Â˜ÁÈ· Ì›ˆÛË ÙÔ˘ fiÓÔ˘, fiˆ˜ Ë ı¤ÚÌ·ÓÛË ÙÔ˘ Ê·Ú-Ì¿ÎÔ˘ Û ıÂÚÌÔÎÚ·Û›· ÂÚÈ‚¿ÏÏÔÓÙÔ˜, ÙÔ ÛÙ¤Áӈ̷ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ ÚÈÓ ·fi ÙË ¯ÔÚ‹ÁËÛË Î·È Ë ·ÚÁ‹ ¯Ô-Ú‹ÁËÛË (ÁÈ· ÂÚÈÛÛfiÙÂÚÔ ·fi 3 ÏÂÙ¿) (19). ∂›-Û˘, ¤¯ÂÈ ÚÔÙ·ı› Û˘Á¯ÔÚ‹ÁËÛË Ì ÏȉÔη˝ÓË (26),ÂÓÒ Ê·›ÓÂÙ·È Ó· ‚ÔËı¿ Ë ÁÓˆÛÙ‹ ÛÙË ¯ÒÚ· Ì·˜ Ú·-ÎÙÈ΋ Ì ÂÈı¤Ì·Ù· ÙÔÈÎÔ‡ ·Ó·ÈÛıËÙÈÎÔ‡, Ô˘ÚÔËÁÂ›Ù·È Ù˘ ¯ÔÚ‹ÁËÛ˘.
¶Ú¤ÂÈ Ó· ÂÈÛËÌ·Óı› fiÙÈ Ë ¯ÚfiÓÈ· ¯ÔÚ‹ÁËÛËÂÓÈÎÈÏ›Ó˘ ‰ÂÓ ·ÔÙÚ¤ÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ‚·ÎÙËÚȉȷ-΋˜ ÂÓ‰Ôηډ›Ùȉ·˜, ÁÈ· ÙËÓ ·ÔÊ˘Á‹ Ù˘ ÔÔ›·˜ÈÛ¯‡Ô˘Ó Ù· ÁÓˆÛÙ¿ ÁÈ· Ô‰ÔÓÙÈ·ÙÚÈΤ˜ Î·È ¯ÂÈÚÔ˘ÚÁÈ-Τ˜ ÂÂÌ‚¿ÛÂȘ.
¢È¿ÁÓˆÛË
°È· ÙË ‰È¿ÁÓˆÛË ÙÔ˘ ƒ¶ ‰ÂÓ ˘¿Ú¯ÂÈ ÂȉÈ΋ Âͤ-Ù·ÛË. ∆Ô 1944 ıÂÛ›ÛÙËÎ·Ó Ù· ÁÓˆÛÙ¿ ÎÚÈÙ‹ÚÈ·Jones (27), Ô˘ ¤ÎÙÔÙ ÙÚÔÔÔÈ‹ıËÎ·Ó ¤ÓÙ ÊÔ-Ú¤˜. √È ÙÂÏÂ˘Ù·›Â˜ ÙÚÔÔÔÈ‹ÛÂȘ ·fi ÙËÓ American
32 Ã. ∆Ú¿·ÏË Î·È Û˘Ó.
Paediatriki 2008;71:29-37
¶›Ó·Î·˜ 1. ¶ÚˆÙÔÁÂÓ‹˜ ÚfiÏË„Ë ÚÂ˘Ì·ÙÈÎÔ‡ ˘ÚÂÙÔ‡: ÚÔÙÂÈÓfiÌÂÓË ıÂڷ›· ÁÈ· ÙË ÛÙÚÂÙÔÎÔÎÎÈ΋ Ê·Ú˘ÁÁ›Ùȉ· (22)
∞ÓÙÈ‚ÈÔÙÈÎfi ÃÔÚ‹ÁËÛË ¢ÔÛÔÏÔÁ›· ™¯fiÏÈ·
µÂÓ˙·ıÈÓÈ΋ i.m. 1.200.000 IU ™˘ÓÈÛÙ¿Ù·È Û ·ÛıÂÓ›˜ Ì Èı·ÓfiÙËÙ· ÂÓÈÎÈÏ›ÓË G ÂÊ¿·Í 600.000 IU ÌË Û˘ÌÌfiÚʈÛ˘ ÛÙÔ 10‹ÌÂÚÔ Û¯‹Ì·
ÁÈ· µ™ < 27 kgº·ÈÓÔ͢ÌÂı˘ÏÔ p.os ¶·È‰È¿: 250 mg ¢ÂÓ ¤¯ÂÈ ·Ó·ÊÂÚı› ·ÓÙÔ¯‹ ÛÙËÓ ÂÓÈÎÈÏ›ÓË ·fi ÂÓÈÎÈÏ›ÓË ÁÈ· 10 ̤Ú˜ 2-3 ÊÔÚ¤˜/24ˆÚÔ ÛÙÚÂÙfiÎÔÎÎÔ ÔÌ¿‰·˜ ∞ (¶ÂÓÈÎÈÏ›ÓË V) ∂Ó‹ÏÈΘ: 250 mg
3-4 ÊÔÚ¤˜/24ˆÚÔ‹ 500 mg
2 ÊÔÚ¤˜/24ˆÚÔ ∞ÌÔ͢ÎÈÏÏ›ÓË p.os 25-50mg/kg/24ˆÚÔ ∂Ó·ÏÏ·ÎÙÈο Ù˘ p.os ÂÓÈÎÈÏ›Ó˘, ÏfiÁˆ Á‡Û˘
ÁÈ· 10 ̤Ú˜ Û 3 ‰fiÛÂȘ(̤ÁÈÛÙË ‰fiÛË: 750-1500 mg/24ˆÚÔ)
¶ÚÒÙ˘ ÁÂÓÈ¿˜ p.os ¶ÔÈΛÏÏÂÈ ·Ó¿ÏÔÁ· Ì ∂Ó·ÏÏ·ÎÙÈο Ù˘ p.os ÂÓÈÎÈÏ›Ó˘**ÎÂÊ·ÏÔÛÔÚ›Ó˜* ÁÈ· 10 Ë̤Ú˜ ÙÔ Û··ÛÌ·∂Ú˘ıÚÔÌ˘Î›ÓË p.os ¶ÔÈΛÏÏÂÈ ·Ó¿ÏÔÁ· Ì ∂Ó·ÏÏ·ÎÙÈο Û ·ÛıÂÓ›˜ Ì ·ÏÏÂÚÁ›· ÛÙËÓ ÂÓÈÎÈÏ›ÓË
ÁÈ· 10 Ë̤Ú˜ ÙÔ Û··ÛÌ·
*¢ÂÓ Ú¤ÂÈ Ó· ¯ÔÚËÁÔ‡ÓÙ·È Û ·ÛıÂÓ›˜ Ô˘ ÂÌÊ¿ÓÈÛ·Ó ¿ÌÂÛÔ˘ Ù‡Ô˘ ˘ÂÚ¢·ÈÛıËÛ›· ÛÙ· ‚-Ï·ÎÙ·ÌÈο ·ÓÙÈ‚ÈÔÙÈο**5% ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ÂÌÊ¿ÓÈÛ ¤ÛÙˆ Î·È ‹È· ·ÏÏÂÚÁÈ΋ ·ÓÙ›‰Ú·ÛË ÛÙËÓ ÂÓÈÎÈÏ›ÓË, ÌÔÚ› Ó· ÂÌÊ·Ó›ÛÂÈ Î·È ÛÙȘ ÎÂÊ·ÏÔ-ÛÔÚ›Ó˜
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·32
Heart Association (AHA) ¤ÁÈÓ·Ó ÙÔ 1992 (28) Î·È ·fi
ÙÔÓ ¶√À ÙÔ 2003, Ô˘ ‰È·ÊÔÚÔÔÈ› Ù· ÎÚÈÙ‹ÚÈ· ÙÔ˘
1992 ÌfiÓÔ ÁÈ· ̆ ÔÙÚÔ‹ ƒ¶, ı¤ÙÔÓÙ·˜ ÏÈÁfiÙÂÚÔ “·˘-
ÛÙËÚ¿” ÎÚÈÙ‹ÚÈ·, Ì ·ÔÙ¤ÏÂÛÌ· Ó· ·˘Í¿ÓÔ˘Ó ÙËÓ
¢·ÈÛıËÛ›· Û ‚¿ÚÔ˜ Ù˘ ÂȉÈÎfiÙËÙ·˜. ∆· ÎÚÈÙ‹ÚÈ·
‰È·ÎÚ›ÓÔÓÙ·È Û Ì›˙ÔÓ· (ª∫) Î·È ÂÏ¿ÛÛÔÓ· (∂∫) ηÈ
·Ó·Ê¤ÚÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 3.
°È· ÙË ‰È¿ÁÓˆÛË ÙÔ˘ ÚÒÙÔ˘ ÂÂÈÛÔ‰›Ô˘ ̆ ¿Ú¯ÂÈ
ÔÌÔʈӛ· AHA Î·È ¶√À. ∞·ÈÙÔ‡ÓÙ·È 2 ª∫ ‹ 1 ª∫
Î·È 2 ∂∫ Î·È ÂÈÚfiÛıÂÙ· ·fi‰ÂÈÍË ÚÔËÁËı›۷˜
ÛÙÚÂÙÔÎÔÎÎÈ΋˜ ∞ Ïԛ̈͢ (ÚfiÛÊ·ÙË ÔÛÙÚ·ÎÈ¿,
ÙÂÎÌËÚȈ̤ÓË ÛÙÚÂÙÔÎÔÎÎÈ΋ Ê·Ú˘ÁÁ›Ùȉ·, ˘„Ë-
Ïfi˜ Ù›ÙÏÔ˜ ·ÓÙÈÛÙÚÂÙÔÎÔÎÎÈÎÒÓ ·ÓÙÈۈ̿وÓ).
ÀÂÓı˘Ì›˙ÂÙ·È fiÙÈ ÛÙÔ 20% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÚÒ-
ÙÔ˘ ÂÂÈÛÔ‰›Ô˘ ƒ¶ Î·È ÛÙÔ˘˜ ÂÚÈÛÛfiÙÂÚÔ˘˜ ·ÛıÂ-
Ó›˜ Ì ¯ÔÚ›· ·Ú·ÙËÚÂ›Ù·È ¯·ÌËÏfi˜ Ù›ÙÏÔ˜ ASTO.
∂È‚¿ÏÏÂÙ·È ÏÔÈfiÓ ¤ÏÂÁ¯Ô˜ Î·È ÙÔ˘ Ù›ÙÏÔ˘ anti-
DNase µ. ¶Ú¤ÂÈ Ó· ÙÔÓÈÛÙ› fiÙÈ Ô Û˘Ó‰˘·ÛÌfi˜ ¯Ô-
Ú›·˜ Î·È ˘ÔÎÏÈÓÈ΋˜ ηډ›Ùȉ·˜, Û‡Ìʈӷ Ì ÙËÓ
∞∏∞ (28) Î·È Ì ÙÔÓ ¶√À (22), ‰ÂÓ ··ÈÙ› ·fi‰ÂÈ-
ÍË ÚÔËÁËı›۷˜ ÛÙÚÂÙÔÎÔÎÎÈ΋˜ Ïԛ̈͢ ÁÈ·
ÙËÓ ÙÂÎÌËÚ›ˆÛË ƒ¶.
°È· ˘ÔÙÚÔ‹ ƒ¶, Ô ¶√À ·ÚÎÂ›Ù·È Û 2 ∂∫ ÎÚÈ-
Ù‹ÚÈ· Î·È ÂÈÚfiÛıÂÙ· ·fi‰ÂÈÍË ÚÔËÁËı›۷˜
ÛÙÚÂÙÔÎÔÎÎÈ΋˜ Ïԛ̈͢, ÂÓÒ Ë ∞∏∞ ··ÈÙ› Â-
ÚÈÛÛfiÙÂÚ· ∂∫ ÎÚÈÙ‹ÚÈ· (·‡ÍËÛË ÂȉÈÎfiÙËÙ·˜, Ì›ˆ-
ÛË Â˘·ÈÛıËÛ›·˜) (28). ∂Ӊ¯Ô̤ӈ˜, ·˘Ù‹ Ë Ú·ÎÙÈ-
΋ Ó· Â›Ó·È ÚÔÙÈÌfiÙÂÚË ÛÙË ¯ÒÚ· Ì·˜. ™ÎfiÈÌÔ Â›-
Ó·È Ó· ÂÈÛËÌ·Óı› fiÙÈ Ù· ÎÚÈÙ‹ÚÈ· Jones Â›Ó·È ‰È·-
ÁÓˆÛÙÈο ÂÚÁ·Ï›· ÎÈ fi¯È ·fiÏ˘ÙÔÈ Ô‰ËÁÔ› ÎÈ fiˆ˜
ۯ‰fiÓ Û οı ÂÚ›ÙˆÛË ÛÙËÓ È·ÙÚÈ΋ Û˘ÓÈÛٿٷÈ
ÂÍ·ÙƠ̂΢ÛË.
√ ÔÚÈÛÌfi˜ Ù˘ ηډ›Ùȉ·˜ › ƒ¶ ·ÔÙÂÏ› ÛË-
ÌÂ›Ô ÙÚÈ‚‹˜ ÛÙËÓ ÚfiÛÊ·ÙË ‚È‚ÏÈÔÁÚ·Ê›·. ∂›ÛËÌ·,
··ÈÙÂ›Ù·È Ë ·ÚÔ˘Û›· Ê˘Û‹Ì·ÙÔ˜ ÁÈ· ÙÂÎÌËÚ›ˆÛË
‚·Ï‚ȉ›Ùȉ·˜ (22,28), ·ÏÏ¿ fiÏÔ Î·È ÂÚÈÛÛfiÙÂÚÔ
˘ÔÛÙËÚ›˙ÂÙ·È fiÙÈ Ë ∏Ã∫ÊÈ΋ ‰È·›ÛÙˆÛË ‚·Ï‚ȉ›-
Ùȉ·˜, ¤ÛÙˆ Î·È ¯ˆÚ›˜ ʇÛËÌ·, Ú¤ÂÈ Ó· ıˆÚ›ٷÈ
·Ô‰ÂÈÎÙÈ΋ ηډ›Ùȉ·˜. ∆· ÛÙÔȯ›· Ô˘ ‚·Û›˙ÂÙ·È
Ë ¿Ô„Ë ·˘Ù‹ ›ӷÈ:
(1) ∞ÛıÂÓ›˜ Ì ƒ¶ ¯ˆÚ›˜ ηډ›Ùȉ· (¯ˆÚ›˜ ʇ-
ÛËÌ·) ·Ó¤Ù˘Í·Ó ÛÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË ƒ∫ (29,30),
Ô˘ ÛËÌ·›ÓÂÈ fiÙÈ Î·È Ì “¯Ú˘Û¿ ·˘ÙÈ¿” οÔȘ ‚·Ï-
‚ȉ›Ùȉ˜ ¯¿ÓÔÓÙ·È.
(2) ¢È·ÈÛÙÒıËÎ·Ó ‚·Ï‚ȉÈΤ˜ ‚Ï¿‚˜ 6 Ì‹Ó˜
ˆ˜ 8 ¯ÚfiÓÈ· ÌÂÙ¿ ·fi ˘ÔÎÏÈÓÈ΋ ƒ∫ (31-33).
(3) ™Â 452 ·ÛıÂÓ›˜ Ì ƒ¶, ‰È·ÁÓˆṲ̂ÓÔ Ì ‚¿ÛË
Ù· ›ÛËÌ· ÎÚÈÙ‹ÚÈ·, ‰È·ÈÛÙÒıËΠ̠∏Ã∫ fiÙÈ ÛÂ
οÔÈÔ˘˜ ·ÛıÂÓ›˜ ÙÔ Ê‡ÛËÌ· Ô˘ ›¯Â ·Ô‰Ôı› ÛÂ
ηډ›Ùȉ· ÔÊÂÈÏfiÙ·Ó Û ¿ÏÏË ·ÈÙ›· (.¯. ÌÂÛÔÎÔÈ-
Ïȷ΋ ÂÈÎÔÈÓˆÓ›·) Î·È ÔÈ ·ÛıÂÓ›˜ ·˘ÙÔ› ‰ÂÓ Â›¯·Ó
ƒ¶. ¶·Ú¿ÏÏËÏ·, Û οÔÈÔ˘˜ ¿ÏÏÔ˘˜ ·ÛıÂÓ›˜, ¯ˆ-
Ú›˜ ÎÏÈÓÈ΋ ¤Ó‰ÂÈÍË Î·Ú‰›Ùȉ·˜, Ì ∏Ã∫ ‰È·ÈÛÙÒ-
ıËΠ‚·Ï‚ȉ›Ùȉ·, ÁÂÁÔÓfi˜ Ô˘ ¿ÏÏ·Í ÙËÓ ÚÔÛ¤Á-
ÁÈÛ‹ ÙÔ˘˜ (34).
Œ¯ÂÈ ‰È·Ù˘ˆı› Î·È Ô ·ÓÙ›ıÂÙÔ˜ ÚÔ‚ÏËÌ·ÙÈ-
ÛÌfi˜, Ì‹ˆ˜ ‰ËÏ·‰‹, ÏfiÁˆ Ù˘ Û˘¯Ó‹˜ ·Ó›¯Ó¢Û˘
‹È·˜ ‰È·Ê˘Á‹˜ ÌÈÙÚÔÂȉԇ˜ ‚·Ï‚›‰·˜ ÛÂ Ê˘ÛÈÔÏÔ-
ÁÈÎfi ÏËı˘ÛÌfi, Ë ı¤ÛÈÛË ÛÙ· ÎÚÈÙ‹ÚÈ· Ù˘ ∏Ã∫ÊÈ-
΋˜ ·Ó›¯Ó¢Û˘ ·Ó¿ÚÎÂÈ·˜ ı· Ô‰ËÁ‹ÛÂÈ Û ˘ÂÚ-
‰È¿ÁÓˆÛË ƒ¶. ÀÔÛÙËÚ›˙ÂÙ·È fiÙÈ ˘¿Ú¯Ô˘Ó ÈÛ¯˘Ú¿
ÎÚÈÙ‹ÚÈ· ∏Ã∫ ‰È·ÊÔÚÔÔ›ËÛ˘ Ê˘ÛÈÔÏÔÁÈ΋˜ ·fi
·ıÔÏÔÁÈ΋ “ÛȈËÏ‹” ·Ó¿ÚÎÂÈ· ÌÈÙÚÔÂȉԇ˜
‚·Ï‚›‰·˜ (35), fï˜ ·˘Ùfi ‰ÂÓ Â›Ó·È Î·ıÔÏÈο ·Ô-
‰ÂÎÙfi. ¶Ú¤ÂÈ Ó· ÙÔÓÈÛı› fiÙÈ fiÙ·Ó Ô ·È‰›·ÙÚÔ˜
˘ÔÙ‡ÂÙ·È ƒ¶ Î·È ‰ÂÓ ·ÎÔ‡ÂÈ Ê‡ÛËÌ· Ú¤ÂÈ Ó·
Û˘ÓÂÎÙÈÌ‹ÛÂÈ Ù· ‰Â‰Ô̤ӷ Ì ÙÔÓ ·È‰ÔηډÈÔÏfiÁÔ.
∏ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ˘ÔÎÏÈÓÈ΋˜ ‚·Ï‚ȉ›Ùȉ·˜ ·-
ڷ̤ÓÂÈ ÌÈ· ÚfiÎÏËÛË Î·È, fiˆ˜ ÚfiÛÊ·Ù· ‰ËÌÔÛÈ-
‡ıËÎÂ: “fiÔ˘ Ô Î›Ó‰˘ÓÔ˜ ƒ¶ Â›Ó·È ÌÂÁ¿ÏÔ˜, Ë ˘Ô-
ÎÏÈÓÈ΋ ηډ›Ùȉ· ı· Ú¤ÂÈ Ó· ˘ÔÏÔÁ›˙ÂÙ·È Ì¤ÚÔ˜
ÙÔ˘ Ê¿ÛÌ·ÙÔ˜ ÙÔ˘ ƒ¶” (19).
™Â ÚfiÛÊ·ÙË ÌÂϤÙË ‰È·ÈÛÙÒıËΠfiÙÈ ÛËÌ·-
ÓÙÈÎfi˜ ·ÚÈıÌfi˜ ‚·Ï‚›‰ˆÓ, Ô˘ ·Ê·ÈÚ¤ıËÎ·Ó ·fi
33ƒÂ˘Ì·ÙÈÎfi˜ ˘ÚÂÙfi˜
¶·È‰È·ÙÚÈ΋ 2008;71:29-37
¶›Ó·Î·˜ 2. ¢Â˘ÙÂÚÔÁÂÓ‹˜ ÚfiÏË„Ë: Ì·ÎÚÔ¯ÚfiÓÈ· ıÂڷ›· Û ·ÛıÂÓ›˜ Ì ÈÛÙÔÚÈÎfi ÚÂ˘Ì·ÙÈÎÔ‡ ˘ÚÂÙÔ‡ ‹ ÚÂ˘Ì·ÙÈ΋˜ ηډ›Ùȉ·˜ (22)
∞ÓÙÈ‚ÈÔÙÈÎfi ÃÔÚ‹ÁËÛË ¢ÔÛÔÏÔÁ›· ™¯fiÏÈ·
µÂÓ˙·ıÈÓÈ΋ i.m. 1-2 ÂηÙÔÌ̇ÚÈ· IU - ™Â ƒ¶ ¯ˆÚ›˜ ηډ›Ùȉ·: ÂÓÈÎÈÏ›ÓË G οı 3-4 ‚‰ÔÌ¿‰Â˜ 5 ¯ÚfiÓÈ· ·fi ÙÂÏÂ˘Ù·›Ô ÂÂÈÛfi‰ÈÔ ƒ¶ ‹ ̤¯ÚÈ 18 ¯ÚÔÓÒÓ
600.000 IU - ™Â ‹È· ‹ ıÂڷ¢ı›۷ ηډ›Ùȉ·:οı 3-4 ‚‰ÔÌ¿‰Â˜ 10 ¯ÚfiÓÈ· ·fi ÙÔ ÙÂÏÂ˘Ù·›Ô ÂÂÈÛfi‰ÈÔ ƒ¶ ‹ ̤¯ÚÈ 25 ¯ÚÔÓÒÓ**ÁÈ· µ™ < 27 kg* - ™Â ÈÔ ÛÔ‚·Ú‹ ηډ›Ùȉ· ‹ ¯ÂÈÚÔ˘ÚÁÈ΋ ·Ôηٿ-
ÛÙ·ÛË ‚·Ï‚›‰·˜: ÂÊ' fiÚÔ˘ ˙ˆ‹˜º·ÈÓÔ͢ÌÂı˘ÏÔ p.os 250 mgÂÓÈÎÈÏ›ÓË (¶ÂÓÈÎÈÏ›ÓË V) 2 ÊÔÚ¤˜/24ˆÚÔ∂Ú˘ıÚÔÌ˘Î›ÓË p.os 250 mg
2 ÊÔÚ¤˜/24ˆÚÔ
* º·ÚÌ·ÎÔÎÈÓËÙÈΤ˜ ÌÂϤÙ˜ ¤‰ÂÈÍ·Ó fiÙÈ Èı·ÓÒ˜ Ë ‰fiÛË Â›Ó·È ·Ó·Ú΋˜ ÁÈ· οÔÈ· ·È‰È¿ Î·È ÚÔÙ›ÓÂÙ·È Ë ÌÈÎÚ‹ ‰fiÛËÌfiÓÔ ·Ó ÙÔ µ™ <20 kg (19)
** ◊ fiÛÔ ˘¿Ú¯Ô˘Ó ·È‰È¿ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ ÛÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÂÚÈ‚¿ÏÏÔÓ (52)
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·33
Ó·ÚÔ‡˜ ·ÛıÂÓ›˜ (ËÏÈΛ· <40 ÂÙÒÓ) ÏfiÁˆ ƒ¶, ›¯·Ó
·˘ÍË̤ÓÔ Ì˘ÍˆÌ·ÙÒ‰Ë ÈÛÙfi (36). √È Ì˘ÍˆÌ·ÙÒ‰ÂȘ
‚·Ï‚›‰Â˜ ¤¯Ô˘Ó ·˘ÍË̤ÓÔ ˘·ÏÔ˘ÚÔÓÈÎfi. ™ÙÂϤ¯Ë
ÛÙÚÂÙÔÎfiÎÎˆÓ ˘„ËÏ‹˜ ÏÔÈÌÔÁfiÓÔ˘ ‰‡Ó·Ì˘, ›-
Û˘, ¤¯Ô˘Ó ·˘ÍË̤ÓÔ ˘·ÏÔ˘ÚÔÓÈÎfi Î·È ·˘Ùfi Èı·Ó¿
Ô‰ËÁ› Û ‰È·ÛÙ·˘ÚÔ‡ÌÂÓË ·ÓÙ›‰Ú·ÛË. ∫·Ù¿ Û˘Ó¤-
ÂÈ·, ı· Ú¤ÂÈ Ó· ‰›ÓÂÙ·È È‰È·›ÙÂÚË ÚÔÛÔ¯‹ ÛÂ
·È‰È¿ ÌÂ Ê·Ú˘ÁÁ›Ùȉ· Î·È ÚfiÙˆÛË ÌÈÙÚÔÂȉԇ˜
(ÌÂ Ì˘ÍˆÌ·ÙÒ‰ÂȘ ‚·Ï‚›‰Â˜).
£Âڷ›·
√È ÂÚÈÛÛfiÙÂÚ˜ ıÂڷ¢ÙÈΤ˜ Ú·ÎÙÈΤ˜ ÁÈ· ÙÔ
ƒ¶ ‰ÂÓ ‚·Û›˙ÔÓÙ·È ÛÂ Ù˘¯·ÈÔÔÈË̤Ó˜ ÌÂϤÙ˜, ·Ï-
Ï¿ Û ÎÔÈÓ‹ ÎÏÈÓÈ΋ ·›ÛıËÛË ÁÈ· ÙËÓ Î·Ù·ÏÏËÏfiÙËÙ·
Ù˘ ·ÁˆÁ‹˜, Ì ·Ú¿ÏÏËÏË ‰È·Ù‹ÚËÛË ˘„ËÏÔ‡ ÂÈ-
¤‰Ô˘ ·ÛÊ¿ÏÂÈ·˜. ÷ڷÎÙËÚÈÛÙÈο ÙÔÓ›˙ÂÙ·È ÛÂ
ÚfiÛÊ·ÙË ‰ËÌÔÛ›Â˘ÛË ÛÙÔ British Medical Journal
fiÙÈ “ÙfiÛ· ¯ÚfiÓÈ· ÎÈ ·ÎfiÌ· ‰ÂÓ Í¤ÚÔ˘ÌÂ, ·Ó Ú¤ÂÈ
ÛÙÔ ƒ¶ Ó· ¯ÚËÛÈÌÔÔÈԇ̠ÛÙÂÚÔÂȉ‹” (37). ™Â ÌÂ-
Ù··Ó·Ï‡ÛÂȘ ‰ÂÓ ‰È·ÈÛÙÒıËΠ˘ÂÚÔ¯‹ οÔÈ·˜
ıÂڷ›·˜, fiÛÔÓ ·ÊÔÚ¿ ÙËÓ Â›ÙˆÛË ƒ∫ 1-10 ¯Úfi-
ÓÈ· ÌÂÙ¿ ·fi ƒ¶ (23). ∂›Û˘, ‰ÂÓ ‰È·ÈÛÙÒıËÎÂ
˘ÂÚÔ¯‹ Ù˘ ıÂڷ›·˜ Ì ·ÎÂÙ˘ÏÔÛ·ÏÈ΢ÏÈÎfi ÛÂ
Û‡ÁÎÚÈÛË Ì ÙÔÓ ÎÏÈÓÔÛÙ·ÙÈÛÌfi (38-40), fiÛÔÓ ·ÊÔÚ¿
ÙËÓ Â›ÙˆÛË ˘ÔÏÂÈfiÌÂÓ˘ ƒ∫, Ô‡Ù ‰È·ÈÛÙÒ-
ıËΠ˘ÂÚÔ¯‹ Ù˘ ·ÛÈÚ›Ó˘ ¤Ó·ÓÙÈ ÙˆÓ ÎÔÚÙÈÎÔÂÈ-
‰ÒÓ Ô‡ÙÂ Î·È ÙÔ ·ÓÙ›ıÂÙÔ (41,42). ∆¤ÏÔ˜, Û Úfi-
ÛÊ·ÙË ÌÂϤÙË ‰ÂÓ ‰È·ÈÛÙÒıËΠ‰È·ÊÔÚ¿ ÛÙË ‚·Ú‡-
ÙËÙ· ÙˆÓ ÂΉËÏÒÛÂˆÓ Ù˘ ÔÍ›·˜ ‚·Ï‚ȉ›Ùȉ·˜ Ô‡ÙÂ
ÛÙËÓ Â›ÙˆÛË ¯ÚfiÓÈ·˜ ƒ∫ Û ·Ú·ÎÔÏÔ‡ıËÛË ÂÓfi˜
¤ÙÔ˘˜ ÌÂÙ¿ ·fi ÙËÓ ÂÓ‰ÔÊϤ‚ÈÔ ¯ÔÚ‹ÁËÛË ·ÓÔÛÔ-
ÛÊ·ÈÚ›Ó˘ ¤Ó·ÓÙÈ placebo (43). ¶Ú¤ÂÈ Ó· Á›ÓÔ˘Ó ÌÂ-
Á¿Ï˜, ÔÏ˘ÎÂÓÙÚÈΤ˜, Ù˘¯·ÈÔÔÈË̤Ó˜ ÌÂϤÙ˜ ÁÈ·
Ó· ηٷ‰ÂȯıÔ‡Ó Ù· Èı·Ó¿ ÔʤÏË ÎÔÚÙÈÎÔÂȉÒÓ Î·È
ÙˆÓ Î·ÈÓÔ‡ÚÁÈˆÓ ·ÓÙÈÊÏÂÁÌÔÓˆ‰ÒÓ ·Ú·ÁfiÓÙˆÓ
ÛÙËÓ ÔÍ›· Î·È ¯ÚfiÓÈ· ƒ∫ (19).
∏ ·ÏÈ¿ Ô‰ËÁ›· ÁÈ· ÎÏÈÓÔÛÙ·ÙÈÛÌfi “ʈٛ˙ÂÙ·È”
·fi Ó¤· ‰Â‰Ô̤ӷ, Û‡Ìʈӷ Ì ٷ ÔÔ›·, Ë ·Ú¯È΋
‚Ï¿‚Ë ÛÙÔÓ ƒ¶ ·ÊÔÚ¿ ÙÔ ‰·ÎÙ‡ÏÈÔ Î·È ÙȘ ¯ÔÚ‰¤˜, Ë
‰Â Ù¿ÛË ÛÙȘ ¯ÔÚ‰¤˜ Â›Ó·È ·Ó¿ÏÔÁË Ù˘ ›ÂÛ˘ ÛÙËÓ
·ÚÈÛÙÂÚ‹ ÎÔÈÏ›· (44). ™˘ÓÂÒ˜, ÂÏ·ÙÙÒÓÔÓÙ·˜ ÙËÓ
›ÂÛË ›Ûˆ˜ ·ÏÏ¿˙ÂÈ Ë ÔÚ›· ÙÔ˘ ƒ¶ ÏfiÁˆ Ù˘ Û˘Ó·-
ÎfiÏÔ˘ı˘ ÂÏ¿ÙÙˆÛ˘ Ù˘ Ù¿Û˘ ÛÙȘ ¯ÔÚ‰¤˜. ∏ ÁÓˆ-
ÛÙ‹ Ì·˜ Ô‰ËÁ›· ÁÈ· ÎÏÈÓÔÛÙ·ÙÈÛÌfi › ƒ¶, ›Ûˆ˜ ‚ÔË-
ı¿, ÁÈ·Ù› Ë ›ÂÛË Î·È Û˘ÓÂÒ˜ Î·È Ë Ù¿ÛË Â›Ó·È ̄ ·ÌË-
ÏfiÙÂÚË ÛÂ ÎÏÈÓÔÛÙ·ÙÈÛÌfi ·’ fiÙÈ ÛÂ ‰Ú·ÛÙËÚÈfiÙËÙ·.
ÀÂÓı˘Ì›˙ÂÙ·È, ›Û˘, fiÙÈ Ù· ·È‰È¿ Ì ƒ¶ Î·È ÛÔ-
‚·Ú‹ ·ÚıÚ›Ùȉ· ÛÙ·ÙÈÛÙÈο ¤¯Ô˘Ó ÏÈÁfiÙÂÚÔ ÛÔ‚·Ú‹
ηډ›Ùȉ·, ÂÂȉ‹, Èı·ÓfiÓ, ηıÒ˜ ÂÚÈÔÚ›˙ÂÙ·È Ë
‰Ú·ÛÙËÚÈfiÙËÙ¿ ÙÔ˘˜, ÂÍ·ÈÙ›·˜ ÙÔ˘ ¿ÏÁÔ˘˜ Ù˘ ·Ú-
ıÚ›Ùȉ·˜, ÂÏ·ÙÙÒÓÂÙ·È Ë ›ÂÛË ÛÙËÓ ·ÚÈÛÙÂÚ‹ ÎÔÈÏ›·
Î·È ÙÂÏÈο Ë Ù¿ÛË ÛÙȘ ¯ÔÚ‰¤˜. ŸÏ· Ù· ·Ú·¿Óˆ
Ô‰ËÁÔ‡Ó ÛÙÔ Ú·ÎÙÈÎfi ÂÚÒÙËÌ· Ì‹ˆ˜ ¯ÔÚËÁÒÓÙ·˜
Ê¿Ú̷η Ô˘ ÂÏ·ÙÙÒÓÔ˘Ó ÙÔ ÌÂÙ·ÊfiÚÙÈÔ, ¿Ú· ÙËÓ
›ÂÛË Î·È ÙÂÏÈο Î·È ÙËÓ Ù¿ÛË, ÙÚÔÔÔÈËı› Ë Âͤ-
ÏÈÍË Ù˘ ‚·Ï‚ȉ›Ùȉ·˜.
√È Û˘ÛÙ¿ÛÂȘ ÙÔ˘ ¶√À ÁÈ· ÙÔ˘˜ ·ÛıÂÓ›˜ Ì Ô͇
ƒ¶ Û˘ÓÔ„›˙ÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 4. ¶Ú¤ÂÈ Ó· ÛËÌÂȈ-
ı› fiÙÈ Ë ¯ÔÚ‹ÁËÛË ÌÂı˘ÏÚ‰ÓÈ˙ÔÏfiÓ˘ ÂÓ‰ÔÊÏÂ-
‚›ˆ˜ ÂӉ›ÎÓ˘Ù·È Û ÂÈΛӉ˘Ó˜ ηٷÛÙ¿ÛÂȘ ÁÈ· ÙË
˙ˆ‹ ÙÔ˘ ·ÛıÂÓÔ‡˜, fï˜ Û ÚfiÛÊ·ÙË ÌÂϤÙË ‰È·-
ÈÛÙÒıËΠfiÙÈ ‹Ù·Ó ÏÈÁfiÙÂÚÔ ·ÔÙÂÏÂÛÌ·ÙÈ΋ Û˘-
ÁÎÚÈÙÈο Ì ÙËÓ p.os ¯ÔÚ‹ÁËÛË Ú‰ÓÈ˙fiÓ˘ (45).
∆¤ÏÔ˜, Û ·ÛıÂÓ›˜ Ì ÂÌ̤ÓÔ˘Û· ÔÍ›· ηډ›Ùȉ·
Ì ÛÔ‚·Ú‹ ηډȷ΋ ·Ó¿ÚÎÂÈ· Ë ¯ÂÈÚÔ˘ÚÁÈ΋
·ÔηٿÛÙ·ÛË ˘ÂÚ¤¯ÂÈ ¤Ó·ÓÙÈ Ù˘ Ì·ÎÚÔ¯ÚfiÓÈ·˜
¯ÔÚ‹ÁËÛ˘ ÎÔÚÙÈÎÔÂȉÒÓ.
∏ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ·È‰ÈÔ‡ Ì ¯ÚfiÓÈ· ƒ∫ ÂÍ·Ú-
Ù¿Ù·È ·fi ÙÔ ÔÈ· ‹ ÔȘ ‚·Ï‚›‰Â˜ ¿Û¯Ô˘Ó (ÌÈ-
ÙÚÔÂȉ‹˜, ·ÔÚÙ‹ ‹ Î·È ÔÈ ‰‡Ô), ·fi ÙÔÓ Ù‡Ô Ù˘
34 Ã. ∆Ú¿·ÏË Î·È Û˘Ó.
Paediatriki 2008;71:29-37
¶›Ó·Î·˜ 3. ∫ÚÈÙ‹ÚÈ· Jones ÁÈ· ÙË ‰È¿ÁÓˆÛË ÙÔ˘ ÚÂ˘Ì·ÙÈÎÔ‡ ˘-ÚÂÙÔ‡ (27)
ªÂ›˙ÔÓ· ÎÚÈÙ‹ÚÈ· 1. ∫·Ú‰›Ùȉ· (ÚÔÊ·Ó‹˜ ÎÏÈÓÈο)2. ¶ÔÏ˘·ÚıÚ›Ùȉ·3. ÃÔÚ›·4. ¶ÔχÌÔÚÊÔ ÂÚ‡ıËÌ·5. ÀÔ‰fiÚÈ· Ô˙›‰È·
∂Ï¿ÛÛÔÓ· ÎÚÈÙ‹ÚÈ·:1. ∫ÏÈÓÈο (˘ÚÂÙfi˜, ·ÚıÚ·ÏÁ›·)2. ∂ÚÁ·ÛÙËÚȷο (Ï¢ÎÔ΢ÙÙ¿ÚˆÛË, ·Ú¿Ù·ÛË ÙÔ˘ ‰È·-
ÛÙ‹Ì·ÙÔ˜ PR, ·˘ÍË̤ÓË ∆∫∂, ·˘ÍË̤ÓË CRP)
¶›Ó·Î·˜ 4. ∞ÓÙÈÌÂÙÒÈÛË ·ÛıÂÓÒÓ Ì Ô͇ ÚÂ˘Ì·ÙÈÎfi ˘ÚÂÙfi (22)
1. ∞ÔÊ˘Á‹ ¯ÔÚ‹ÁËÛ˘ ÎÔÚÙÈÎÔÂȉÒÓ ‹ Û·ÏÈ΢ÏÈÎÒÓ Ì¤¯ÚÈÙËÓ ÂȂ‚·›ˆÛË Ù˘ ‰È¿ÁÓˆÛ˘ ƒ¶
2. ∫ÏÈÓÔÛÙ·ÙÈÛÌfi˜, Ô˘ ·Ó ˘¿Ú¯ÂÈ Î·Ú‰›Ùȉ·, ·Ú·Ù›ÓÂÙ·ÈÁÈ· ÂÚÈÛÛfiÙÂÚÔ ·fi 4 ‚‰ÔÌ¿‰Â˜
3. ∞ÓÙÈ‚›ˆÛË ÁÈ· ÂÎÚ›˙ˆÛË ÙÔ˘ ÛÙÚÂÙÔÎfiÎÎÔ˘4. ∞ÓÙÈÊÏÂÁÌÔÓÒ‰Ë: ·) ∞ÛÈÚ›ÓË 100 mg/kg/24ˆÚÔ Û 4-5 ‰fiÛÂȘ ÁÈ· 2 ‚‰ÔÌ¿‰Â˜,
Ì›ˆÛË Û 60-70 mg/kg/24ˆÚÔ ÁÈ· ¿ÏϘ 3-6 ‚‰ÔÌ¿‰Â˜™ËÌ›ˆÛË: π. ™˘¯Ófi˜ ¤ÏÂÁ¯Ô˜ ÂȤ‰ˆÓ ÒÛÙ ӷ ÂÍ·ÛÊ·Ï›˙Ô-
ÓÙ·È ıÂڷ¢ÙÈο ›‰· Î·È Ó· ·ÔʇÁÂÙ·ÈË ÙÔÍÈÎfiÙËÙ·
ππ. ∂› ·ÏÏÂÚÁ›·˜, Ó·ÚÔͤÓË 10-20 mg/kg/24ˆÚÔ‚) ¶Ú‰ÓÈ˙fiÓË 1-2 mg/kg/24ˆÚÔ (̤ÁÈÛÙË: 80 mg) ÁÈ· 2-3
‚‰ÔÌ¿‰Â˜, Ì›ˆÛË 20-25% οı ‚‰ÔÌ¿‰· ˘fi Û˘Á¯ÔÚ‹-ÁËÛË ·ÛÈÚ›Ó˘
™ËÌ›ˆÛË: ∏ Ú‰ÓÈ˙fiÓË ¤¯ÂÈ ¤Ó‰ÂÈÍË Û ÂÚÈÙÒÛÂȘ ηÚ-‰È·Î‹˜ ·Ó¿ÚÎÂÈ·˜ ‹ ÌË ·ÓÙ·fiÎÚÈÛ˘ ÛÙ· Û·-ÏÈ΢ÏÈο
Á) ªÂı˘ÏÚ‰ÓÈ˙ÔÏfiÓË ÂÓ‰ÔÊÏ‚›ˆ˜™ËÌ›ˆÛË: ∏ ÌÂı˘ÏÚ‰ÓÈ˙ÔÏfiÓË ÂӉ›ÎÓ˘Ù·È Û ηٷÛÙ¿-
ÛÂȘ ÂÈΛӉ˘Ó˜ ÁÈ· ÙË ˙ˆ‹5. ÃÂÈÚÔ˘ÚÁÈ΋ ·ÔηٿÛÙ·ÛË Û ·ÛıÂÓ›˜ Ì ÂÌ̤ÓÔ˘Û·
ÔÍ›· ηډ›Ùȉ· Ì ÛÔ‚·Ú‹ ηډȷ΋ ·Ó¿ÚÎÂÈ·
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·34
‚·Ï‚ȉԿıÂÈ·˜ (ÛÙ¤ÓˆÛË, ·Ó¿ÚÎÂÈ· ‹ ÌÈÎÙ‹ Ófi-ÛÔ˜), ·fi ÙË ÛÔ‚·ÚfiÙËÙ· Ù˘ ‚Ï¿‚˘ Î·È ÙȘ ÂÈ-ÙÒÛÂȘ Ù˘ ÛÙË Ì˘Ôηډȷ΋ ÏÂÈÙÔ˘ÚÁ›·. ∏ ·ÓÙÈ-ÌÂÙÒÈÛË Ú¤ÂÈ Ó· Á›ÓÂÙ·È ·fi ·È‰ÔηډÈÔÏfiÁÔ.
ÃÔÚ›·
∞Ó·ÊÔÚÈο Ì ÙË ıÂڷ›· Ù˘ ¯ÔÚ›·˜, Ô ¶√À(22) ÙÔÓ›˙ÂÈ fiÙÈ ‰ÂÓ ˘¿Ú¯Ô˘Ó ÂӉ›ÍÂȘ fiÙÈ Ù· ÎÔÚ-ÙÈÎÔÂȉ‹ ˆÊÂÏÔ‡Ó, ÂÓÒ Û ÌÈÎÚ¤˜ ÛÂÈÚ¤˜ ηٷÁÚ¿-ÊÔÓÙ·È ‰Â‰Ô̤ӷ ÁÈ· ÙÔ ·ÓÙ›ıÂÙÔ (46). ∏ ¯ÔÚ‹ÁËÛË‚·ÏÚÔ˚ÎÔ‡, ηڂ·Ì·˙›Ó˘, ·ÏÔÂÚȉfiÏ˘,·ÔÙÂÏ› ›Û˘ ·ÓÙÈΛÌÂÓÔ ‰È·ÊˆÓÈÒÓ (47,48).∂ÈϤÔÓ, ·ÌÊÈÛ‚ËÙÂ›Ù·È Î·È Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙË-Ù· Ù˘ ¯ÔÚ‹ÁËÛ˘ ·ÓÔÛÔÛÊ·ÈÚ›Ó˘ (49,50). ∏ ÂÍ·-ÛÊ¿ÏÈÛË ‹Û˘¯Ô˘ Î·È ‹ÚÂÌÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ ıˆ-ÚÂ›Ù·È fiÙÈ ‚ÔËı¿ ÙÔ˘Ï¿¯ÈÛÙÔÓ ÛÙȘ ‹È˜ ÂÚÈÙÒ-ÛÂȘ ¯ÔÚ›·˜ (19). ∞fi Ú·ÎÙÈ΋˜ ÏÂ˘Ú¿˜, Ì ‰Â-‰Ô̤Ó˜ fiϘ ÙȘ ·Ú·¿Óˆ ·ÓÙÈÊ¿ÛÂȘ, Ë Û˘ÓÂÚ-Á·Û›· Ó¢ÚÔÏfiÁÔ˘ Ì ÙÔÓ ·È‰›·ÙÚÔ Â›Ó·È ··Ú·›-ÙËÙË ÁÈ· ÙËÓ ÂÈÏÔÁ‹ ÙÔ˘ ηٿÏÏËÏÔ˘ ıÂڷ¢ÙÈ-ÎÔ‡ Û¯‹Ì·ÙÔ˜.
ªÂÙ·ÛÙÚÂÙÔÎÔÎÎÈ΋ ·ÚıÚ›Ùȉ· (ª™∞)
∆· ¯·Ú·ÎÙËÚÈÛÙÈο Ù˘ ª™∞, Ô˘ ÙË ‰È·ÊÔÚÔ-ÔÈÔ‡Ó ·fi ÙÔÓ ÎÏ·ÛÈÎfi ƒ¶, ›ӷÈ: Ë ·Ú·ÌÔÓ‹ Ù˘·ÚıÚ›Ùȉ·˜ ÁÈ· ÌÂÚÈÎÔ‡˜ Ì‹Ó˜, Ô ÌË ÌÂÙ·Ó·ÛÙ¢ÙÈ-Îfi˜ ¯·Ú·ÎÙ‹Ú·˜, Ë ÂÓȯڋ ·ÓÙ·fiÎÚÈÛË ÛÙ· ÌËÛÙÂÚÈÓÔÂȉ‹ ·ÓÙÈÊÏÂÁÌÔÓÒ‰Ë, ηıÒ˜ Î·È Ë ˘ÂÚÔ¯‹ÙÔ˘ Á˘Ó·ÈΛԢ ʇÏÔ˘ ÌÂٷ͇ ÙˆÓ ÂÓ‹ÏÈÎˆÓ ·ÛıÂ-ÓÒÓ. ¢ÂÓ Û˘Óԉ‡ÂÙ·È ·fi ΛӉ˘ÓÔ ÁÈ· ηډ›Ùȉ·,·Ú¿ Ù·‡Ù·, ·Ó·Ê¤ÚÔÓÙ·È ·ÛıÂÓ›˜ Ô˘ ·ÚÔ˘Û›·-Û·Ó ƒ∫ ηٿ ÙËÓ ÂÚ›Ô‰Ô ·Ú·ÎÔÏÔ‡ıËÛ˘. ¶ÚÔ-Ê·ÓÒ˜ ÛÙÔ˘˜ ·ÛıÂÓ›˜ ·˘ÙÔ‡˜ ˘‹ÚÍ ‰È·ÁÓˆÛÙÈ΋·ÛÙÔ¯›· Î·È ÂÚfiÎÂÈÙÔ ÁÈ· ƒ¶ Î·È fi¯È ª™∞ (51).¶ÚÔÙ›ÓÂÙ·È ÁÈ· ÙË ª™∞ ÚÔʇϷÍË Ì i.m ÂÓÈÎÈ-Ï›ÓË ÁÈ· ¤Ó· ̄ ÚfiÓÔ Û ÏËı˘ÛÌÔ‡˜ Ì ̄ ·ÌËÏfi ΛӉ˘-ÓÔ ÁÈ· ƒ¶ Î·È ÁÈ· ¤ÓÙ ¯ÚfiÓÈ· Û ÏËı˘ÛÌÔ‡˜ Ì¢„ËÏfi ΛӉ˘ÓÔ ÁÈ· ƒ¶ (19,22).
∫·Ù·Ï‹ÁÔÓÙ·˜, ÛËÌÂÈÒÓÔ˘Ì fiÙÈ, ·ÚfiÙÈ Û¯ÂÙÈ-˙fiÌÂÓÔ˜ Ì ÌÈÎÚԂȷ΋ Ïԛ̈ÍË, Ô ƒ¶ 2.500 ¯ÚfiÓÈ··fi ÙËÓ ÂÚÈÁÚ·Ê‹ ÙÔ˘ ·fi ÙÔÓ πÔÎÚ¿ÙË (53)ÂÍ·ÎÔÏÔ˘ı› Ó· ·ÊÔÚ¿ ÙËÓ ·ÁÎfiÛÌÈ· ÎÔÈÓfiÙËÙ· ÌÂÛÔ‚·Ú¤˜ ÂÈÙÒÛÂȘ. ª¤¯ÚÈ Ó· ‰ÔıÔ‡Ó ÔÚÈÛÙÈÎfiÙÂ-Ú˜ χÛÂȘ ̤ۈ ÂÌ‚ÔÏÈ·ÛÌÒÓ ‹ ¿ÏÏ˘ ·Ú¤Ì‚·Û˘,ÂÈ‚¿ÏÏÂÙ·È Ë Â·ÁÚ‡ÓËÛË ÙˆÓ ÁÈ·ÙÚÒÓ, ÒÛÙ ËÓfiÛÔ˜ Ó· ·ÔʇÁÂÙ·È Î·Ù¿ ÙÔ ‰˘Ó·ÙfiÓ ‹ ¤ÛÙˆ Ó··Ó·ÁÓˆÚ›˙ÂÙ·È Î·È Ó· ·ÓÙÈÌÂÙˆ›˙ÂÙ·È Î·Ù¿ ÙÔÓÚÔÛÊÔÚfiÙÂÚÔ ÙÚfiÔ.
µÈ‚ÏÈÔÁÚ·Ê›·
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36 Ã. ∆Ú¿·ÏË Î·È Û˘Ó.
Paediatriki 2008;71:29-37
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37ƒÂ˘Ì·ÙÈÎfi˜ ˘ÚÂÙfi˜
¶·È‰È·ÙÚÈ΋ 2008;71:29-37
Quiz
1. ∏ ˘„ËÏfiÙÂÚË Â›ÙˆÛË ÙÔ˘ ƒ¶ ·Ú·ÙËÚ›ٷÈ: ·. ™Ù· ·È‰È¿ ÚÈÓ ·fi ÙËÓ ÂÊ˂›· ‚. ™Â ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ·Á. ™Â Ó·ÚÔ‡˜ ÂÓ‹ÏÈΘ
2. √ ÂÈÔÏ·ÛÌfi˜ Ù˘ ƒ∫ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚÔ˜:·. ™Ù· ·È‰È¿‚. ™ÙÔ˘˜ ÂÊ‹‚Ô˘˜Á. ™ÙÔ˘˜ ÂÓ‹ÏÈΘ
3. ∏ ‰È¿ÚÎÂÈ· ıÂڷ›·˜ Ù˘ ÛÙÚÂÙÔÎÔÎÎÈ΋˜ Ê·Ú˘ÁÁ›Ùȉ·˜ ›ӷÈ:·. 10 Ë̤Ú˜ ‚. 1 ‚‰ÔÌ¿‰· Á. 2-3 Ë̤Ú˜ ÌÂÙ¿ ÙËÓ ˘Ô¯ÒÚËÛË ÙˆÓ Û˘Ìو̿وÓ
4. ŒÊË‚Ô˜ 17 ÂÙÒÓ Ì ‹È· ·Ó¿ÚÎÂÈ· ÌÈÙÚÔÂȉԇ˜, ÏfiÁˆ ÔͤԘ ƒ¶, ÂÊfiÛÔÓ ‰ÂÓ ·ÚÔ˘ÛÈ¿ÛÂÈ ¿ÏÏÔ ÂÂÈÛfi-‰ÈÔ, ı· Ú¤ÂÈ Ó· ¿ÚÂÈ ÚfiÏË„Ë:·. °È· ÌÈ· 5ÂÙ›·‚. °È· ÌÈ· 10ÂÙ›·Á. ø˜ ÙÔ 25Ô ¤ÙÔ˜‰. ∂Ê’ fiÚÔ˘ ˙ˆ‹˜
5. ¶ÔÈfi˜ ·fi ÙÔ˘˜ ·Ú·Î¿Ùˆ ¤¯ÂÈ ÙÂÎÌËÚȈ̤ÓÔ ƒ¶:·. 9¯ÚÔÓÔ˜ Ì ÈÛÙÔÚÈÎfi ÔÛÙÚ·ÎÈ¿˜, Ô˘ ¤¯ÂÈ ¯ÔÚ›· Î·È Ì¤ÙÚÈ· ·Ó¿ÚÎÂÈ· ÌÈÙÚÔÂȉԇ˜‚. 9¯ÚÔÓÔ˜ Ì ¯ÔÚ›· Î·È ‹È· ·Ó¿ÚÎÂÈ· ÌÈÙÚÔÂȉԇ˜Á. ∫·È ÔÈ ‰‡Ô‰. ∫·Ó¤Ó·˜
6. 10¯ÚÔÓÔ˜ Ì ˘ÚÂÙfi, ·ÚıÚ·ÏÁ›·, Û˘Ìو̷ÙÔÏÔÁ›· ηډȷ΋˜ ·Ó¿ÚÎÂÈ·˜ Î·È Û˘ÛÙÔÏÈÎfi ʇÛËÌ· 3/6ÛÙËÓ ÎÔÚ˘Ê‹ Ì ¤ÎÙ·ÛË ÛÙË Ì·Û¯¿ÏË ¤¯ÂÈ ÙÂÎÌËÚȈ̤ӷ ƒ¶, ÂÊfiÛÔÓ Û˘Ó˘¿Ú¯ÂÈ:·. ∞˘ÍË̤ÓË ∆∫∂ ‚. ™ÙÚÂÙÔÎÔÎÎÈ΋ Ê·Ú˘ÁÁ›Ùȉ· ÚÔ 2-3 ‚‰ÔÌ¿‰ˆÓÁ. ∞˘ÍË̤ÓË CRP‰. ¶·Ú¿Ù·ÛË ÙÔ˘ ‰È·ÛÙ‹Ì·ÙÔ˜ PR ÛÙÔ ∏∫°
√È ÛˆÛÙ¤˜ ··ÓÙ‹ÛÂȘ ÛÙË ÛÂÏ›‰· 61
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·37
38 µƒ∞µ∂Àª∂¡∏ ∂ƒ°∞™π∞ AWARD-WINNING ARTICLE
Paediatriki 2008;71:38-47
∫ÏÈÓÈ΋ Î·È ÌÔÚȷ΋ ÌÂϤÙË ÙÔ˘ ÁÔÓȉ›Ô˘ MECP2 Û ·È‰È¿
Ì ÓÔËÙÈ΋ ˘ÛÙ¤ÚËÛË ÛÙÔÓ ÂÏÏËÓÈÎfi ÏËı˘ÛÌfi
™. æÒÓË, J. Traeger-Synodinos, Ã. ™ÔÊÔÎÏ¤Ô˘˜, ™. ∫›ÙÛÈÔ˘-∆˙¤ÏË, ∞. ª·‡ÚÔ˘, ∂. ∫·Ó·‚¿Î˘, Œ. ºÚ˘Û›Ú·
¶ÂÚ›ÏË„Ë
∂ÈÛ·ÁˆÁ‹: ªÂÙ·ÏÏ¿ÍÂȘ ÛÙÔ ÁÔÓ›‰ÈÔ MECP2 ¢ı‡ÓÔÓÙ·È ÁÈ· ÙÔ 60-95% ÙˆÓ ÂÚÈÙÒÛÂˆÓ Û˘Ó‰ÚfiÌÔ˘Rett (RS), ÌÈ·˜ Ê˘ÏÔÛ‡Ó‰ÂÙ˘, ÂÈÎÚ·ÙËÙÈ΋˜, Ó¢ÚÔ·Ó·Ù˘Íȷ΋˜ ‰È·Ù·Ú·¯‹˜ Ô˘ ÂËÚ¿˙ÂÈ Î˘Ú›ˆ˜ÎÔÚ›ÙÛÈ·. ∆Ô ÎÏ·ÛÈÎfi RS ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi Ê˘ÛÈÔÏÔÁÈ΋ ÚÒÈÌË ·Ó¿Ù˘ÍË, ·ÎÔÏÔ˘ıÔ‡ÌÂÓË ·fi „˘-¯ÔÎÈÓËÙÈ΋ ·ÏÈÓ‰ÚfiÌËÛË Î·È ÛÙ·‰È·Î‹ ¤Ó·ÚÍË ÌÈÎÚÔÎÂÊ·Ï›·˜, ÂÓÒ ·Ú·ÙËÚÔ‡ÓÙ·È ·ÚÎÂÙ¤˜ ¿Ù˘Â˜ÌÔÚʤ˜. ∆Ô MECP2 ÂÌϤÎÂÙ·È Â›Û˘ Û ÌÈ· ÔÈÎÈÏ›· Ê·ÈÓÔÙ‡ˆÓ Ì „˘¯ÔÎÈÓËÙÈ΋ ηı˘ÛÙ¤ÚËÛË (æ∫∫),fiˆ˜ Ê˘ÏÔÛ‡Ó‰ÂÙË ÔÈÎÔÁÂÓ‹ æ∫∫ Î·È ÂÈÎfiÓ˜ ÔÌÔÈ¿˙Ô˘Û˜ Ì ۇӉÚÔÌÔ Â‡ıÚ·˘ÛÙÔ˘-à (FXS) Î·È Û‡Ó-‰ÚÔÌÔ Angelman (AS). ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ Â›Ó·È Ë ‰ÈÂÚ‡ÓËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ Î·È ÙÔ˘ Ê¿ÛÌ·ÙÔ˜ ÙˆÓMECP2 ÌÂÙ·ÏÏ¿ÍÂˆÓ ÛÙÔÓ ÂÏÏËÓÈÎfi ÏËı˘ÛÌfi Î·È Ë Û˘Û¯¤ÙÈÛË ÁÔÓÔÙ‡Ô˘-Ê·ÈÓÔÙ‡Ô˘. ª¤ıÔ‰ÔÈ: ∞ӷχıËÎ·Ó Ù· ÂÍfiÓÈ· 3 Î·È 4 Ì ËÏÂÎÙÚÔÊfiÚËÛË Û ‹Îو̷ Ì ÎÏ›ÛË ·Ô‰È·Ù·ÎÙÈÎÔ‡(DGGE - Denaturant Gradient Gel Electrophoresis), ¿ÌÂÛÔ ÚÔÛ‰ÈÔÚÈÛÌfi ·ÏÏËÏÔ˘¯›·˜ DNA Î·È GAP-PCR ÛÂ: ∞. 124 ·È‰È¿ (102 ·ÁfiÚÈ·-22 ÎÔÚ›ÙÛÈ·) Î·È 41 ·È‰È¿ (14 ·ÁfiÚÈ·-27 ÎÔÚ›ÙÛÈ·) Ì ʷÈÓfiÙ˘Ô·ÚfiÌÔÈÔ Ì FXS Î·È AS ·ÓÙ›ÛÙÔȯ·, ·ÏÏ¿ ·ÚÓËÙÈÎfi ÌÔÚÈ·Îfi ¤ÏÂÁ¯Ô, µ. 23 Î·È 25 ÎÔÚ›ÙÛÈ· Ì ÎÏ·ÛÈÎfi Î·È¿Ù˘Ô RS, ·ÓÙ›ÛÙÔȯ· Î·È °. 11 ·ÁfiÚÈ· Ô˘ ÚÔÛ‹Ïı·Ó Ì Èı·Ófi RS. ŒÁÈÓ ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ÁÈ· Û˘-Û¯¤ÙÈÛË ÙÔ˘ ÎÏÈÓÈÎÔ‡ score ‚·Ú‡ÙËÙ·˜ (Kerr, 2001) Ì ÙÔÓ Ù‡Ô ÙˆÓ MECP2 ÌÂÙ·ÏϿ͈Ó. ∞ÔÙÂϤÛÌ·Ù·: ªÂÙ·ÏÏ¿ÍÂȘ ·ÓȯÓ‡ıËÎ·Ó Û 78,3% Î·È 20% ÂÚÈÙÒÛÂȘ ÎÏ·ÛÈÎÔ‡ Î·È ¿Ù˘Ô˘ RS,·ÓÙ›ÛÙÔȯ·. ŒÓ· ·ÁfiÚÈ ·ÚÔ˘Û›·Û ÙË ÌÂÙ¿ÏÏ·ÍË p.R106W Î·È ¤Ó· ¿ÏÏÔ ÌÂÁ¿ÏË ÁÔÓȉȷ΋ ·Ó·Î·Ù¿Ù·-ÍË Ô˘ ··ÈÙ› ÂÚ·ÈÙ¤Úˆ ‰ÈÂÚ‡ÓËÛË. 7,3% Î·È 2,4% ÙˆÓ FXS Î·È AS ÔÌ¿‰ˆÓ, ·ÓÙ›ÛÙÔȯ·, ›¯·Ó ÌÂÙ·Ï-Ï¿ÍÂȘ, ÂÚÈÏ·Ì‚¿ÓÔÓÙ·˜ Î·È Ì›· ÂÚ›ÙˆÛË Ê˘ÏÔÛ‡Ó‰ÂÙ˘ ÔÈÎÔÁÂÓÔ‡˜ æ∫∫. ™˘ÌÂÚ¿ÛÌ·Ù·: ∏ ·Ó¿Ï˘ÛË ÙÔ˘ ÁÔÓȉ›Ô˘ MECP2 ·Ú¤¯ÂÈ ¤Ó· ηٿÏÏËÏÔ ‰È·ÁÓˆÛÙÈÎfi ÂÚÁ·ÏÂ›Ô ÁÈ· ÙÔ RSÎ·È Û˘ÓÂÈÛʤÚÂÈ ÛÙËÓ ¤Ú¢ӷ Ù˘ ÓÔËÙÈ΋˜ ˘ÛÙ¤ÚËÛ˘.
§¤ÍÂȘ ÎÏÂȉȿ: MECP2, Û‡Ó‰ÚÔÌÔ Rett, ÓÔËÙÈ΋ ˘ÛÙ¤ÚËÛË.
Clinical studies and analysis of the MECP2 gene in children with
mental retardation in the Greek population
S. Psoni, J. Traeger-Synodinos, C. Sofokleous, S. Kitsiou-Tzeli, A. Mavrou, E. Kanavakis, H. Fryssira
Abstract
Background: Mutations in the MECP2 gene (methyl-CpG-binding protein 2) are responsible for 70-95% ofcases of Rett syndrome (RS), an X-linked dominant neurodevelopmental disorder, affecting mostly girls.Classical RS is characterized by normal early development, followed by psychomotor regression andgradual onset of microcephaly, although variable atypical forms are also observed. MECP2 has also beenimplicated in a variety of other mental retardation (MR) phenotypes, including X-linked MentalRetardation (XLMR), Fragile-X Syndrome (FXS) -like and Angelman Syndrome (AS) -like phenotypes. Theaim of the study was: a) To evaluate the incidence and spectrum of MECP2 mutations in children with RSand atypical MR; b) ∆o make phenotype-genotype correlation. Methods: Exons 3 and 4 were analysed using Denaturant Gradient Gel Electrophoresis, sequencing andGAP-PCR in: A. 124 FXS-like children (102 males-22 females) and 41 AS-like children (14 males-27females) negative for gene variation at FXS and AS loci, respectively; B. 23 classic and 25 atypical RS girls;C. 11 boys referred with possible RS. Statistical analysis included correlation of the RS clinical severity score(Kerr, 2001) with MECP2 mutations, and frequency of MECP2 mutations in the various patient categories. Results: Mutations were detected in 78.3% of classic and 20% of atypical RS cases respectively. One boycarried the p.R106W mutation, and another boy showed a large rearrangement requiring furthercharacterization. Amongst AS- and FXS-like cases, 7.3% and 2.4% had MECP2 mutations respectively,including an XLMR case. Conclusions: MECP2 gene analysis provides an appropriate diagnostic tool for RS and contributes furtherinformation for research into MR.
Key words: MECP2, Rett syndrome, mental retardation.
∆Ì‹Ì· π·ÙÚÈ΋˜ °ÂÓÂÙÈ΋˜¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ,ÈڤÌÂÈÔ ∂Ú¢ÓËÙÈÎfi∂ÚÁ·ÛÙ‹ÚÈÔ, ¡ÔÛÔÎÔÌ›Զ·›‰ˆÓ “∞Á›· ™ÔÊ›·”
AÏÏËÏÔÁÚ·Ê›·:
™Ù·˘ÚԇϷ æÒÓË[email protected]∆Ì‹Ì· π·ÙÚÈ΋˜ °ÂÓÂÙÈ΋˜¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ,ÈڤÌÂÈÔ ∂Ú¢ÓËÙÈÎfi∂ÚÁ·ÛÙ‹ÚÈÔ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”£Ë‚ÒÓ Î·È §Â‚·‰Â›·˜,∆.∫. 115 27, ∞ı‹Ó·
Medical Genetics, University of Athens,Choremio ResearchLaboratory, “Aghia Sophia” Children’sHospital, Athens, Greece
Correspondence:
Stavroula [email protected] Genetics, University of Athens, Choremio Research Laboratory,“Aghia Sophia” Children’sHospitalThivon & Levadias St.,115 27, Athens, Greece
∞’ ÈڤÌÂÈÔ Œ·ıÏÔ, 45Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ, 25-27 ª·˝Ô˘ 2007, ÷ÏÎȉÈ΋
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·38
™˘ÓÙÔÌÔÁڷʛ˜
RS Rett Syndrome
ª∂CP2 ªethyl-CpG-Binding-Protein 2
Kb Kilobases
ªµP Methyl-Binding-Proteins
MBD Methyl-Binding-Domain
TRD Transcription-Repression-Domain
NLS Nuclear-Localization-Signal
æ∫∫ æ˘¯ÔÎÈÓËÙÈ΋ ∫·ı˘ÛÙ¤ÚËÛË
AS Angelman Syndrome
FXS Fragile-X Syndrome
PCR Polymerase Chain Reaction
DGGE Denaturant Gradient Gel Electrophoresis
CDKL5 Cyclin Dependent Kinase-Like 5
HDAC Histone Deacetylase
Ac Acetyl
æ∫∂ æ˘¯ÔÎÈÓËÙÈ΋ ∂ͤÏÈÍË
¶∫ ¶ÂÚ›ÌÂÙÚÔ˜ ∫ÂÊ·Ï‹˜
πVF In Vitro Fertilization
EEG ∂lectroencephalogram
SMA II Spinal Muscular ∞trophy II
XLMR X-Linked Mental Retardation
·· ·ÌÈÓÔͤ·
∂ÈÛ·ÁˆÁ‹
∆Ô Û‡Ó‰ÚÔÌÔ Rett (RS) Â›Ó·È Ê˘ÏÔÛ‡Ó‰ÂÙË, ÂÈ-
ÎÚ·ÙËÙÈ΋, ÎÏËÚÔÓÔÌÈ΋, Ó¢ÚÔ·Ó·Ù˘Íȷ΋ ‰È·Ù·-
Ú·¯‹ Î·È ·ÔÙÂÏ› ÙË ‰Â‡ÙÂÚË ·ÈÙ›· ÓÔËÙÈ΋˜ ˘ÛÙ¤-
ÚËÛ˘ ÛÙ· ÎÔÚ›ÙÛÈ· ÌÂÙ¿ ÙÔ Û‡Ó‰ÚÔÌÔ Down (1).
∂ÌÊ·Ó›˙ÂÙ·È ÛÔÚ·‰Èο ÌÂ Û˘¯ÓfiÙËÙ· 1/10.000-
15.000 ÁÂÓÓ‹ÛÂȘ ·ÁÎÔÛÌ›ˆ˜ (2). ÷ڷÎÙËÚ›˙ÂÙ·È
·fi ÔÌ·Ï‹ „˘¯ÔÎÈÓËÙÈ΋ ÂͤÏÈÍË Ì¤¯ÚÈ ÙÔ˘˜ 6-12
Ì‹Ó˜ ˙ˆ‹˜, ÂÓ Û˘Ó¯›· ÛÙ·‰È·Î‹ ÌÈÎÚÔÎÂÊ·Ï›·,
·ÏÈÓ‰ÚfiÌËÛË ÙˆÓ ·ÔÎÙËıÂÈÛÒÓ ÁÓˆÛÙÈÎÒÓ Î·È ÎÈ-
ÓËÙÈÎÒÓ ÈηÓÔÙ‹ÙˆÓ Ì ÂÁηٿÛÙ·ÛË Ù˘ÈÎÒÓ ÛÙÂ-
ÚÂÔÙ˘ÈÎÒÓ ÎÈÓ‹ÛÂˆÓ ÙˆÓ ¯ÂÚÈÒÓ, ·˘ÙÈÛÙÈÎÒÓ Ù¿ÛÂ-
ˆÓ Î·È ‰˘ÛÚ·Í›·˜ ‚¿‰ÈÛ˘. ªÂÙ¿ ÙÔ ÛÙ¿‰ÈÔ Ù˘ ·-
ÏÈÓ‰ÚfiÌËÛ˘, Û˘Ó‹ıˆ˜ ·Ú·ÙËÚÂ›Ù·È ÂÚ›Ô‰Ô˜ ÛÙ·-
ÛÈÌfiÙËÙ·˜. ™˘ÓÔ‰¤˜ ÂΉËÏÒÛÂȘ Â›Ó·È ÂÂÈÛfi‰È·
¿ÓÔÈ·˜-˘¤ÚÓÔÈ·˜, ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊÈΤ˜
·ÓˆÌ·Ï›Â˜, Û·ÛÌÔ›, ˘ÂÚÙÔÓ›·-·ÙÚÔÊ›· ¿ÎÚˆÓ Î·È
ÛÎÔÏ›ˆÛË (3) (¶›Ó·Î·˜ 1·).
∏ ÌÔÚȷ΋ ‚Ï¿‚Ë ÔÊ›ÏÂÙ·È Û ÌÂÙ·ÏÏ¿ÍÂȘ ÙÔ˘
ÁÔÓȉ›Ô˘ MECP2 (ªethyl-CpG-Binding-Protein 2),
ÙÔ ÔÔ›Ô ¤¯ÂÈ ¯·ÚÙÔÁÚ·ÊËı› ÛÙÔ ÁÂÓÂÙÈÎfi ÙfiÔ
Ãq28 (4). Œ¯ÂÈ Ì¤ÁÂıÔ˜ 76 kb Î·È ·ÔÙÂÏÂ›Ù·È ·fi 4
ÂÍfiÓÈ·, Ù· ÔÔ›· ˘fiÎÂÈÓÙ·È ÛÂ ÂÓ·ÏÏ·ÎÙÈÎfi Ì¿ÙÈ-
ÛÌ·, ‰›‰ÔÓÙ·˜ Á¤ÓÂÛË Û ‰‡Ô ÚˆÙÂ˚ÓÈΤ˜ ÈÛÔÌÔÚ-
ʤ˜ (ªeCP2∞-486 ··, ªeCP2B-449 ··) (∂ÈÎfiÓ· 1).
∏ ªeCP2B ΢Úȷگ› ÛÙÔ˘˜ ÂÁÎÂÊ·ÏÈÎÔ‡˜ ÈÛÙÔ‡˜
Î·È Â˘ı‡ÓÂÙ·È ÂÚÈÛÛfiÙÂÚÔ ÁÈ· ÙÔ Ê·ÈÓfiÙ˘Ô (5).
5' 3'1 2 3 ∂ÍfiÓÈÔ 4
¡LS
(·· 255-271)
ªBD
(·· 78-162)
TRD
(·· 207-310)
C-terminus
(·· 311-486)
∂ÈÎfiÓ· 1. To ÁÔÓ›‰ÈÔ MECP2 Î·È ÔÈ ÏÂÈÙÔ˘ÚÁÈÎÔ› ÙÔÌ›˜ ÙÔ˘. MBD: ªethyl-Binding-Domain, TRD: Transcription-Repression-Domain,NLS: Nuclear-Localisation-Signal, C-Terminus: ηڂÔ͢ÙÂÏÈÎfi ¿ÎÚÔ, ··: ·ÌÈÓÔͤ·.
¶›Ó·Î·˜ 1·. ∞Ó·Óˆ̤ӷ ÎÏÈÓÈο ÎÚÈÙ‹ÚÈ· ÁÈ· ÙÔ ÎÏ·ÛÈÎfi RS (3)
∫Ï·ÛÈÎfi RSªÂ›˙ÔÓ· ∫ÚÈÙ‹ÚÈ·1. º˘ÛÈÔÏÔÁÈ΋ ÚÔÁÂÓÓËÙÈ΋ Î·È ÂÚÈÁÂÓÓËÙÈ΋ ÂÚ›Ô‰Ô˜2. º˘ÛÈÔÏÔÁÈ΋ æ∫∂ ÙÔ˘˜ ÚÒÙÔ˘˜ 6 Ì‹Ó˜3. º˘ÛÈÔÏÔÁÈ΋ ¶∫ ÛÙË Á¤ÓÓËÛË4. ∂È‚Ú¿‰˘ÓÛË ÙÔ˘ Ú˘ıÌÔ‡ ·Ó¿Ù˘Í˘ Ù˘ ¶∫5. ∞ÒÏÂÈ· ÛÎfiÈÌˆÓ ÎÈÓ‹ÛÂˆÓ ¯ÂÚÈÒÓ ÌÂٷ͇ 6 ÌËÓÒÓ Î·È
2 1/2 ÂÙÒÓ6. ™ÙÂÚÂÔÙ˘›Â˜ ¯ÂÚÈÒÓ7. ∂ÍÂÏÈÛÛfiÌÂÓË ÎÈÓËÙÈ΋ ·fiÛ˘ÚÛË, ‰˘ÛÎÔÏ›· ÂÈÎÔÈÓˆ-
Ó›·˜, ·ÒÏÂÈ· ·ÔÎÙËı¤ÓÙÔ˜ ÏfiÁÔ˘ Î·È ÁÓˆÛÙÈο ÂÏÏ›ÌÌ·Ù·
∂Ï¿ÛÛÔÓ· ÎÚÈÙ‹ÚÈ·1. ¢È·Ù·Ú·¯‹ ·Ó·ÓÔ‹˜ ηٿ ÙËÓ ÂÁÚ‹ÁÔÚÛË2. ∆ÚÈÛÌfi˜ Ô‰fiÓÙˆÓ3. ∞ÓÒÌ·ÏÔ ÚfiÙ˘Ô ‡ÓÔ˘ ·fi ÙË ÓÂÔÁÓÈ΋ ÂÚ›Ô‰Ô4. ∞ÓÒÌ·ÏÔ˜ Ì˘˚Îfi˜ ÙfiÓÔ˜ Û˘Ó‰ÂfiÌÂÓÔ˜ Ì ·ÙÚÔÊ›· Î·È ‰˘-
ÛÙÔÓ›·5. ¶ÂÚÈÊÂÚÈΤ˜ ·ÁÁÂÈÔÎÈÓËÙÈΤ˜ ‰È·Ù·Ú·¯¤˜6. ¶ÚÔԉ¢ÙÈ΋ ·ʈÛË-ÛÎÔÏ›ˆÛË7. ∫·ı˘ÛÙ¤ÚËÛË ·Ó¿Ù˘Í˘8. ÀÔÙÚÔÊÈο ÌÈÎÚ¿ Î·È ÎÚ‡· ¿ÎÚ·∫ÚÈÙ‹ÚÈ· ·ÔÎÏÂÈÛÌÔ‡1. ŒÓ‰ÂÈÍË ·ÔıËÛ·˘ÚÈÛÙÈ΋˜ ÓfiÛÔ˘ Î·È ÔÚÁ·ÓÔÌÂÁ·Ï›·2. ∫·Ù·ÚÚ¿ÎÙ˘, ·ÌÊÈ‚ÏËÛÙÚÔÂȉԿıÂÈ· ‹ Î·È ·ÙÚÔÊ›·
ÔÙÈÎÔ‡ Ó‡ÚÔ˘3. πÛÙÔÚÈÎfi ÂÁÎÂÊ·ÏÈ΋˜ ‚Ï¿‚˘ ÚÔ- ‹ Î·È ÌÂÙ·ÁÂÓÓËÙÈο4. ∂Ȃ‚·ÈˆÌ¤ÓË ÌÂÙ·‚ÔÏÈ΋ ‰È·Ù·Ú·¯‹ ‹ Ó¢ÚÔÂÎÊ˘ÏÈ-
ÛÙÈ΋ ÓfiÛÔ˜5. ∂›ÎÙËÙË Ó¢ÚÔÏÔÁÈ΋ ‰È·Ù·Ú·¯‹ ÏfiÁˆ ÂÁÎÂÊ·ÏÈÎÔ‡
ÙÚ·‡Ì·ÙÔ˜ ‹ Ïԛ̈͢
∞·ÈÙÔ‡ÓÙ·È Î·È Ù· 6 Ì›˙ÔÓ· ÎÚÈÙ‹ÚÈ· ‹ 4/6 Ì›˙ÔÓ· ηÈÙÔ˘Ï¿¯ÈÛÙÔÓ 2 ÂÏ¿ÛÛÔÓ·
39∫ÏÈÓÈ΋ Î·È ÌÔÚȷ΋ ÌÂϤÙË ÙÔ˘ ÁÔÓȉ›Ô˘ MECP2
¶·È‰È·ÙÚÈ΋ 2008;71:38-47
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·39
∆Ô MECP2 ·Ó‹ÎÂÈ ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ· ªBP(Methyl-Binding Proteins), Û˘Ó‰¤ÂÙ·È Û ÌÂı˘ÏȈ-̤Ó˜ ·ÏÏËÏÔ˘¯›Â˜ DNA Î·È Î·Ù·ÛÙ¤ÏÏÂÈ ÙË ÁÔÓÈ-‰È·Î‹ ÌÂÙ·ÁÚ·Ê‹ (6). ¶ÂÚȤ¯ÂÈ ÙÔ˘˜ ÏÂÈÙÔ˘ÚÁÈÎÔ‡˜ÙÔÌ›˜ ªBD, ∆RD Î·È ¡LS (EÈÎfiÓ· 2). ∞Ú¯Èο ıˆ-Ú‹ıËΠÁÂÓÈÎfi˜ ÌÂÙ·ÁÚ·ÊÈÎfi˜ ηٷÛÙÔϤ·˜. øÛÙfi-ÛÔ, ÂÚ¢ÓËÙÈο ‰Â‰Ô̤ӷ ˘Ô‰ÂÈÎÓ‡Ô˘Ó fiÙÈ Û˘Ó‰¤Â-Ù·È ÌÂ Û˘ÁÎÂÎÚÈ̤ӷ ÁÔÓ›‰È·-ÛÙfi¯Ô˘˜ ÛÙÔÓ ÂÁΤʷ-ÏÔ, Ú˘ıÌ›˙ÔÓÙ·˜ ÙËÓ ¤ÎÊÚ·Û‹ ÙÔ˘˜ (7,8). ™Â ÎÏÈÓÈÎfi›‰Ô, oÈ ÂΉËÏÒÛÂȘ ÙÔ˘ RS Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÛ˘Ó·ÙÈ΋ ÏÂÈÙÔ˘ÚÁ›· ÛÙÔÓ ·Ó·Ù˘ÛÛfiÌÂÓÔ ÂÁΤ-Ê·ÏÔ Î·È ÙËÓ ̂ ڛ̷ÓÛË ÙˆÓ Ó¢ÚÒÓˆÓ (9). ∞Ô̤ÓÂÈÓ· ·Ô‰Âȯı› ÔÈ· Â›Ó·È ·ÎÚÈ‚Ò˜ Ù· ÁÔÓ›‰È·-ÛÙfi¯ÔÈÎ·È Ò˜ ηıÔÚ›˙Ô˘Ó ÙËÓ ·Ó¿Ù˘ÍË Î·È ‰È·Ù‹ÚËÛËÙˆÓ ÂÁÎÂÊ·ÏÈÎÒÓ Û˘Ó¿„ˆÓ.
ªÂÙ¿ÏÏ·ÍË ÙÔ˘ MECP2 ‰ÂÓ ÈÛÔ‰˘Ó·Ì› ¿ÓÙ·Ì ‰È¿ÁÓˆÛË RS. Œ¯Ô˘Ó ·Ó·ÁÓˆÚÈÛı› ·ÚÎÂÙ¤˜ ¿Ù˘-˜ ÌÔÚʤ˜ RS: ·. ÓÂÔÁÓÈÎfi˜ Ù‡Ô˜ Ì ۷ÛÌÔ‡˜, ‚.Û˘ÁÁÂÓ‹˜ Ù‡Ô˜, Á. ÂÎÙÚˆÙÈ΋ ÌÔÚÊ‹, ‰. ‰È·Ù‹ÚËÛ˘ÛÙÔȯ›ˆÓ ÏfiÁÔ˘ Î·È Â. fi„ÈÌ˘ ·ÏÈÓ‰ÚfiÌËÛ˘ (10)(¶›Ó·Î·˜ 1‚). ªÂÙ·ÏÏ¿ÍÂȘ ¤¯Ô˘Ó ·Ú·ÙËÚËı› ηÈÛ ÏËıÒÚ· Ê·ÈÓÔÙ‡ˆÓ Ì „˘¯ÔÎÈÓËÙÈ΋ ηı˘ÛÙ¤-ÚËÛË (æ∫∫) Ô˘ ‰ÂÓ Û¯ÂÙ›˙ÔÓÙ·È Ì RS, fiˆ˜ Û·ÛıÂÓ›˜ Ì ÂÈÎfiÓ· Û˘Ó‰ÚfiÌÔ˘ Angelman (∞S), ÌËÛ˘Ó‰ÚÔÌÈ΋ Ê˘ÏÔÛ‡Ó‰ÂÙË æ∫∫ Î·È ·˘ÙÈÛÙÈο ÛÙÔÈ-¯Â›· (11-13). MECP2 ÌÂÙ·ÏÏ¿ÍÂȘ Û ·ÁfiÚÈ· ıˆ-ÚÔ‡ÓÙ·Ó ¤ˆ˜ ÚfiÛÊ·Ù· ı·Ó·ÙËÊfiÚ˜. øÛÙfiÛÔ,¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ÂÚÈÙÒÛÂȘ ·ÁÔÚÈÒÓ ÌÂ: i) ÛÔ‚·-
Ú‹ ÓÂÔÁÓÈ΋ ÂÁÎÂÊ·ÏÔ¿ıÂÈ·, ii) ÂÈÎfiÓ· ·ÚfiÌÔÈ·
Ì RS, ÔÊÂÈÏfiÌÂÓË Û ̈۷˚ÎÈÛÌfi ‹ ˘ÂÚ¿ÚÈıÌÔ X
¯ÚˆÌfiۈ̷ Î·È iii) ÌË ÂȉÈ΋, ÌË ÂÍÂÏÈÛÛfiÌÂÓË
æ∫∫ (14,15).
¡ËÛ›‰Â˜ CpG ÃÚˆÌfiۈ̷ Ã
¡ËÛ›‰Â˜ CpG ÃÚˆÌfiۈ̷ Ã
Sin3A HDAC1
HDAC2MeCP2
∞c ∞c ∞c ∞c ∞c
Sin3A
HDAC1
HDAC2
MeCP2
∂ÈÎfiÓ· 2. H MeCP2 Û˘Ó‰¤ÂÙ·È Ì¤Ûˆ ÙÔ˘ ÙÔ̤· MBD Û ÂȉÈΤ˜ ÌÂı˘ÏȈ̤Ó˜ ÓËÛ›‰Â˜ ÙÔ˘ DNA (CpG-ÓËÛ›‰Â˜), ÂÓÂÚÁÔÔÈÒÓÙ·˜ ¤Ó·‚ÔËıËÙÈÎfi ηٷÛÙ·ÏÙÈÎfi ÌfiÚÈÔ, ÙÔ mSin3A, ÙÔ ÔÔ›Ô Û˘Ó‰¤ÂÙ·È Î·ÙfiÈÓ Ì ÙÔÓ ÙÔ̤· TRD. ∆Ô Û‡ÌÏÂÁÌ· ·˘Ùfi ÂÓÂÚÁÔÔÈ› ÙȘ ·Ô·-ÎÂÙ˘Ï¿Û˜ ÙˆÓ ÈÛÙÔÓÒÓ 2 Î·È 2 (HDAC1, HDAC2), Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·Ô·ÎÂÙ˘Ï›ˆÛË ÙˆÓ ˘ÚËÓÈÎÒÓ ÈÛÙÔÓÒÓ Î·È ÙË Û˘Ì›ÂÛË ÙÔ˘DNA Û ·ÓÂÓÂÚÁ‹ ÂÙÂÚԯڈ̷ٛÓË, ÌÂ Û˘Ó¤ÂÈ· ÙË ‰È·ÎÔ‹ Ù˘ ÌÂÙ·ÁÚ·Ê‹˜. Ac: ∞ÎÂÙ˘ÏÔÌ¿‰Â˜.
40 ™. æÒÓË Î·È Û˘Ó.
Paediatriki 2008;71:38-47
¶›Ó·Î·˜ 1‚. ∞Ó·Óˆ̤ӷ ÎÏÈÓÈο ÎÚÈÙ‹ÚÈ· ÁÈ· ÙÔ ¿Ù˘Ô RS (3)
ÕÙ˘Ô RS∫‡ÚÈ· ÎÚÈÙ‹ÚÈ·1. ªÂ›ˆÛË ‹ ·ÒÏÂÈ· ÙˆÓ ÈηÓÔÙ‹ÙˆÓ ÙˆÓ ¯ÂÚÈÒÓ2. ªÂ›ˆÛË ‹ ·ÒÏÂÈ· ÙˆÓ ÏÂÎÙÈÎÒÓ ÈηÓÔًوÓ3. ™ÙÂÚÂÔÙ˘›Â˜ ¯ÂÚÈÒÓ4. ªÂ›ˆÛË ‹ ·ÒÏÂÈ· ÙˆÓ ÈηÓÔÙ‹ÙˆÓ ÂÈÎÔÈÓˆÓ›·˜5. ∂È‚Ú¿‰˘ÓÛË ÙÔ˘ Ú˘ıÌÔ‡ ·Ó¿Ù˘Í˘ Ù˘ ¶∫ ·fi ÙËÓ
ÚÒÈÌË ·È‰È΋ ËÏÈΛ·6. ¶·ÏÈÓ‰ÚfiÌËÛË ·ÎÔÏÔ˘ıÔ‡ÌÂÓË ·fi ÌÂÚÈ΋ ‚ÂÏÙ›ˆÛËÀÔÛÙËÚÈÎÙÈο ÎÚÈÙ‹ÚÈ·1. ∞ӈ̷ϛ˜ ·Ó·ÓÔ‹˜2. ªÂÙˆÚÈÛÌfi˜ ÎÔÈÏ›·˜ ‹ Î·È Î·Ù¿ÔÛË ·¤Ú·3. ∆ÚÈÛÌfi˜ Ô‰fiÓÙˆÓ4. ∞ÓÒÌ·ÏË ÎÈÓËÙÈÎfiÙËÙ·5. ∫‡ÊˆÛË ‹ Î·È ÛÎÔÏ›ˆÛË6. ∞ÙÚÔÊ›· οو ¿ÎÚˆÓ 7. ∫Ú‡·, ·Ô¯ÚˆÌ·ÙÈṲ̂ӷ Î·È Û˘Ó‹ıˆ˜ ˘ÔÙÚÔÊÈο fi‰È·8. ¢È·Ù·Ú·¯¤˜ ‡ÓÔ˘9. ∞ÓÂÍ‹ÁËÙ· ÂÂÈÛfi‰È· ÎÚ·˘ÁÒÓ ‹ Á¤ÏˆÙÔ˜10. ∂ÌÊ·ÓÒ˜ ÌÂȈ̤ÓË Â˘·ÈÛıËÛ›· ÛÙÔÓ fiÓÔ11. ŒÓÙÔÓË ‚ÏÂÌÌ·ÙÈ΋ ·ʋ ‹ Î·È ÚÔۋψÛË
∞·ÈÙÔ‡ÓÙ·È 3 ·fi Ù· 6 ·ÚÈ· Î·È ÙÔ˘Ï¿¯ÈÛÙÔÓ 5 ˘ÔÛÙËÚÈ-ÎÙÈο ÎÚÈÙ‹ÚÈ·
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·40
H ÂÎÙÂÓ‹˜ ·Ó¿Ï˘ÛË ÙÔ˘ ÁÔÓȉ›Ô˘ MECP2 ·fi ÙÔ
1999 ¤ˆ˜ Û‹ÌÂÚ· ¤¯ÂÈ ·Ôηχ„ÂÈ ÂÚÈÛÛfiÙÂÚ˜
·fi 255 ÌÂÙ·ÏÏ¿ÍÂȘ (16). √È ÔÎÙÒ Û˘¯ÓfiÙÂÚ˜ η-
χÙÔ˘Ó ÙÔ 65% fiÏˆÓ ÙˆÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ (17). 10%
Â›Ó·È ÌÈÎÚ¿ ÂÏÏ›ÌÌ·Ù· (20-150 bp) ÛÙÔ Î·Ú‚Ô͢ÙÂ-
ÏÈÎfi ¿ÎÚÔ, Û ÌÈ· ÂÚÈÔ¯‹ Ì ÔÏÏ¿ ·ӷÏËÙÈο
ÛÙÔȯ›· ÌÂٷ͇ ÙˆÓ Îˆ‰ÈÎÔÓ›ˆÓ 1040-1200 ηÈ
ÂÈÚÚ¤ÂÈ· ÁÈ· ıÚ·‡ÛË ÙÔ˘ DNA (18). ªÔÚȷ΋ ‰È¿-
ÁÓˆÛË, Ì Ù¯ÓÈΤ˜ ‚·ÛÈṲ̂Ó˜ ÛÙËÓ PCR, ÚÔÛʤ-
ÚÂÙ·È ÛÙÔ 60-85% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÙÔ˘ ÎÏ·ÛÈÎÔ‡
Î·È ÛÙÔ 30-45% ÙÔ˘ ¿Ù˘Ô˘ RS (16). ∏ ¯ÚËÛÈÌÔÔ›-
ËÛË ÓÂfiÙÂÚˆÓ ÌÂıfi‰ˆÓ ÁÈ· ·Ó›¯Ó¢ÛË ÌÂÁ¿ÏˆÓ ·Ó·-
ηٷٿÍÂˆÓ ·Ó‚¿˙ÂÈ ÙÔ ÔÛÔÛÙfi ‰È¿ÁÓˆÛ˘ ÛÙÔ
95% (19). ∆Ô ÂÍfiÓÈÔ 1 ¤¯ÂÈ ·Ú¯›ÛÂÈ Ó· ÌÂÏÂٿٷÈ
ÚfiÛÊ·Ù· Î·È Ê·›ÓÂÙ·È Ó· Û˘Ì‚¿ÏÏÂÈ ÌfiÓÔ Î·Ù¿
0,5%, ÂÓÒ ÛÙÔ ÂÍfiÓÈÔ 2 ‰ÂÓ ¤¯Ô˘Ó ·Ú·ÙËÚËı› ÌÂ-
Ù·ÏÏ¿ÍÂȘ (16).
™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‹Ù·Ó Ë ‰ÈÂÚ‡ÓË-
ÛË ÛÙÔÓ ÂÏÏËÓÈÎfi ÏËı˘ÛÌfi ÙÔ˘ ›‰Ô˘˜ Î·È ÙÔ˘
·ÚÈıÌÔ‡ ÙˆÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ ÛÙÔ ÁÔÓ›‰ÈÔ MECP2, ÛÂ
·ÛıÂÓ›˜ Ì RS, ·ÏÏ¿ Î·È ¿ÏÏÔ˘˜ Ê·ÈÓÔÙ‡Ô˘˜. ŒÁÈ-
Ó ÚÔÛ¿ıÂÈ·: ·. ηٷÁÚ·Ê‹˜ Ù˘ Û˘¯ÓfiÙËÙ·˜ ηÈ
Û‡ÁÎÚÈÛ˘ ÙÔ˘ ÚÔÙ‡Ô˘ ÙˆÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ Û ۯ¤-
ÛË Ì ÙȘ ·Ó·ÊÔÚ¤˜ ·ÁÎÔÛÌ›ˆ˜, ‚. Û˘Û¯¤ÙÈÛ˘ ÁÔ-
ÓÔÙ‡Ô˘-Ê·ÈÓÔÙ‡Ô˘, Á. ‰ÈÂÚ‡ÓËÛ˘ Ù˘ ÛËÌ·Û›·˜
ÙˆÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ Û ·È‰È¿ Ì ‰È¿ÊÔÚÔ˘˜ æ∫∫ Ê·È-
ÓÔÙ‡Ô˘˜ Î·È ‰. ÌÂϤÙ˘ ÙˆÓ ·ÁÔÚÈÒÓ Ì ÌÂÙ·ÏÏ¿-
ÍÂȘ. ∏ ÛËÌ·Û›· Ù˘ ÌÂϤÙ˘ ¤ÁÎÂÈÙ·È, ›Û˘, ÛÙËÓ
ÚÔÛ¿ıÂÈ· ÁÈ· ηٷÓfiËÛË Î¿ÔÈˆÓ ·fi Ù· ·›ÙÈ·
Ù˘ ÎÏÈÓÈο ·‰È¢ÎÚ›ÓÈÛÙ˘ æ∫∫.
ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ
∆Ô ˘ÏÈÎfi ·ÔÙ¤ÏÂÛ·Ó ‰‡Ô ÔÌ¿‰Â˜ ·È‰ÈÒÓ, ηÙfiÈÓ ¤Á-
ÁÚ·Ê˘ Û˘ÁηٿıÂÛ˘ ÙˆÓ ÁÔÓ¤ˆÓ ÙÔ˘˜. ™ÙËÓ ÚÒÙË ÔÌ¿‰·
ÂÈϤÁËÛ·Ó ·Ó·‰ÚÔÌÈο 180 ‰Â›ÁÌ·Ù· ·›Ì·ÙÔ˜ ·fi ·È‰È¿
Ô˘ ›¯·Ó ÂÏÂÁ¯ı› ÌÔÚȷο ÙËÓ ÙÂÏÂ˘Ù·›· ‰ÂηÂÙ›· ÛÙÔ
∆Ì‹Ì· °ÂÓÂÙÈ΋˜ ÁÈ· Û‡Ó‰ÚÔÌÔ Fragile-X (FÃS) (n=137) ηÈ
AS (n=43) Ì ·ÚÓËÙÈο ·ÔÙÂϤÛÌ·Ù·. ∂ÎÙfi˜ ·fi ÙËÓ æ∫∫,
¤Ú ӷ ˘¿Ú¯ÂÈ ÙÔ˘Ï¿¯ÈÛÙÔÓ ¤Ó· ·fi Ù· ·Ú·Î¿Ùˆ ÎÚÈ-
Ù‹ÚÈ·: ·. Ê·ÈÓfiÙ˘Ô˜ ·ÚfiÌÔÈÔ˜ Ì FÃS ‹ AS, ‚. Ó¢ÚÔÏÔÁÈο
ÚÔ‚Ï‹Ì·Ù· ¯ˆÚ›˜ ‰ÔÌÈΤ˜ ·ÓˆÌ·Ï›Â˜ ÂÁÎÂÊ¿ÏÔ˘ ÛÙÔ Ó¢-
ÚÔ·ÂÈÎÔÓÈÛÙÈÎfi ¤ÏÂÁ¯Ô, Á. ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊÈΤ˜ ·Óˆ-
̷ϛ˜ Ì ‹ ¯ˆÚ›˜ Û·ÛÌÔ‡˜, ‰. ·Ô˘Û›· ÌÂÈ˙fiÓˆÓ ÌÔÚÊÔÏÔ-
ÁÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ Î·È Â. ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi æ∫∫. ªÔÚÈ·-
΋ ·Ó¿Ï˘ÛË Î·Ù¤ÛÙË ‰˘Ó·Ù‹ Û 124 ·È‰È¿ (102 ·ÁfiÚÈ·-22
ÎÔÚ›ÙÛÈ·) Ù˘ FÃS-ÔÌ¿‰·˜. 16/124 ·È‰È¿ ›¯·Ó ·‰¤ÏÊÈ· ÌÂ
æ∫∫, Ù· ÔÔ›· ÂϤÁ¯ıËηÓ. ™ÙËÓ AS-ÔÌ¿‰· ÌÔÚȷ΋ ·Ó¿Ï˘-
ÛË ¤ÁÈÓ Û 41 ·È‰È¿ (14 ·ÁfiÚÈ·-27 ÎÔÚ›ÙÛÈ·). ™˘ÓÔÏÈο,
ÂϤÁ¯ıËÎ·Ó 165 ·ÛıÂÓ›˜, ËÏÈΛ·˜ 1-27 ÂÙÒÓ.
™ÙË ‰Â‡ÙÂÚË ÔÌ¿‰· ÂÍÂÙ¿ÛıËÎ·Ó ·È‰È¿ ÚÔÛÂÚ¯fiÌÂÓ·
Ì ‰È¿ÁÓˆÛË RS ÙÔ ‰È¿ÛÙËÌ· 2000-2006 (n=69). §fiÁÔ˘˜
∂ÈÎfiÓ· 3·. DGGE ·Ó¿Ï˘ÛË. ∏ ̤ıÔ‰Ô˜ ‚·Û›˙ÂÙ·È ÛÙË ‰ËÌÈÔ˘Ú-Á›· ÂÙÂÚÔ‰›ÎÏˆÓˆÓ ÙÌËÌ¿ÙˆÓ DNA, ÂÓfi˜ ÌÂÙ·ÏÏ·Á̤ÓÔ˘ ηÈÂÓfi˜ Ê˘ÛÈÔÏÔÁÈÎÔ‡, ηıÒ˜ ÌÂÙ·Ó·ÛÙÂ‡Ô˘Ó ‰È·Ì¤ÛÔ˘ ÂÓfi˜ οıÂ-ÙÔ˘ ËÎÙÒÌ·ÙÔ˜ ÔÏ˘·ÎÚ˘Ï·Ìȉ›Ô˘ Ì ·˘Í·ÓfiÌÂÓË ¯ËÌÈ΋ ÎÏ›-ÛË ÂÓfi˜ ·Ô‰È·Ù·ÎÙÈÎÔ‡. ∫·ıÒ˜ ÙÔ ÙÌ‹Ì· ÙÔ˘ DNA ÂÈÛ¤Ú¯ÂÙ·ÈÛÙË Û˘ÁΤÓÙÚˆÛË ÂΛÓË ÙÔ˘ ·Ô‰È·Ù·ÎÙÈÎÔ‡ ̤ÛÔ˘, fiÔ˘ Ë Â-ÚÈÔ¯‹ ÙÔ˘ Ì ÙÔ ¯·ÌËÏfiÙÂÚÔ ÛËÌÂ›Ô Ù‹Í˘ ·Ú¯›˙ÂÈ Ó· ·Ô‰È·-Ù¿ÛÛÂÙ·È, ÙÔ ÙÌ‹Ì· “·ÓÔ›ÁÂÈ” ‰ËÌÈÔ˘ÚÁÒÓÙ·˜ ¤Ó· ÌfiÚÈÔ DNA ̉ȷÎÏ·‰ÈṲ̂ÓË ‰ÔÌ‹. ∆Ô ‰È·ÎÏ·‰ÈṲ̂ÓÔ ·˘Ùfi DNA ¤¯ÂÈ ÂÍ·ÈÚÂ-ÙÈο ηı˘ÛÙÂÚË̤ÓË ÎÈÓËÙÈÎfiÙËÙ· ÛÙÔ ÛÙÚÒÌ· ÙÔ˘ ËÎÙÒÌ·-ÙÔ˜. ∞Ó ¤Ó· ‰Â›ÁÌ· DNA ÂÚȤ¯ÂÈ ÌÈ· ÛËÌÂȷ΋ ÌÂÙ¿ÏÏ·ÍË ÛÙËÓÂÚÈÔ¯‹ ·˘Ù‹, ÙÔ ÛËÌÂ›Ô Ù‹Í˘ Ù˘ ÂÚÈÔ¯‹˜ ı· Â›Ó·È ‰È·ÊÔÚÂÙÈ-Îfi, ÔfiÙ ÙÔ ÌÂÙ·ÏÏ·Á̤ÓÔ ÌfiÚÈÔ ÙÔ˘ DNA ı· ˘ÔÛÙ› Ù‹ÍË ÛÂÂÏ·ÊÚ¿ ‰È·ÊÔÚÂÙÈ΋ ıÂÚÌÔÎÚ·Û›· Î·È Û˘ÓÂÒ˜ ı· ¤¯ÂÈ ‰È·ÊÔ-ÚÂÙÈ΋ ÎÈÓËÙÈÎfiÙËÙ· ÛÙÔ ‹Îو̷ Û˘ÁÎÚÈÙÈο Ì ÙÔ DNA ÂϤÁ-¯Ô˘. °È· ÙÔ Û¯Â‰È·ÛÌfi ÙˆÓ ÂÈÚ·Ì·ÙÈÎÒÓ Û˘ÓıËÎÒÓ ̄ ÚËÛÈÌÔÔÈ-‹ıËΠÙÔ ÚfiÁÚ·ÌÌ· Meltmap (21).
º˘ÛÈÔÏÔÁÈÎfi˜ª·ÚÙ˘Ú·˜
¶·ıÔÏÔÁÈÎfi˜ª·ÚÙ˘Ú·˜
∞ÛıÂÓ‹˜ ªËÙ¤Ú·
¶›Ó·Î·˜ 2. ¶·Ú¿ÌÂÙÚÔÈ Ô˘ ÂÍÂÙ¿˙ÔÓÙ·È ÛÙËÓ Îϛ̷η ÎÏÈÓÈ΋˜·ÍÈÔÏfiÁËÛ˘ RS
1. ¶ÂÚ›ÌÂÙÚÔ˜ ÎÂÊ·Ï‹˜ (¶∫) ηٿ ÙË Á¤ÓÓËÛË2. ¶ÚÒÈÌË ·Ó·Ù˘Íȷ΋ ÂͤÏÈÍË (0-12 ÌËÓÒÓ)3. ¶·ÚÔ‡Û· (¶∫)4. µ¿ÚÔ˜5. ⁄„Ô˜6. ª˘˚Îfi˜ ÙfiÓÔ˜7. ∫·Ù¿ÛÙ·ÛË ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘8. ™˘Áο̄ÂȘ ·ÚıÚÒÛˆÓ9. ∞‰Ú‹ ÎÈÓËÙÈÎfiÙËÙ· - µ¿‰ÈÛË
10. ™ÙÂÚÂfiÙ˘Â˜ ÎÈÓ‹ÛÂȘ ¯ÂÚÈÒÓ11. ÕÏϘ ·ÎÔ‡ÛȘ ÎÈÓ‹ÛÂȘ (ÙÚfiÌÔ˜, ‰˘ÛÙÔÓ›·, ¯ÔÚ›·,
·ı¤ÙˆÛË)12. ∂ÎÔ‡ÛÈ· ¯Ú‹ÛË ÙˆÓ ¯ÂÚÈÒÓ13. ¢˘ÛÎÔÏ›· ÛÙËÓ ÎÈÓËÙÈÎfiÙËÙ· ÙˆÓ Ì˘ÒÓ Ù˘ ÛÙÔÌ·ÙÔÊ·-
Ú˘ÁÁÈ΋˜ ÂÚÈÔ¯‹˜ - ™›ÙÈÛË14. ¢È·ÓÔËÙÈ΋ ÈηÓfiÙËÙ· - πηÓfiÙËÙ· Ì¿ıËÛ˘15. §fiÁÔ˜16. ∂ÈÏË„›· - ™·ÛÌÔ›17. ¢È·Ù·Ú·Á̤ÓÔ˜ ·Ó·Ó¢ÛÙÈÎfi˜ Ú˘ıÌfi˜
(˘ÂÚ·ÂÚÈÛÌÔ›-¿ÓÔȘ)18. ¶ÂÚÈÊÂÚÈ΋ ΢ÎÏÔÊÔÚ›· ¿ÎÚˆÓ19. ¢È·Ù·Ú·¯¤˜ Û˘Ó·ÈÛı‹Ì·ÙÔ˜ (·Ó·›ÙÈ· Á¤ÏÈ·, ÎÚ·˘Á¤˜,
ÎÏ¿Ì·Ù·)20. ¢È·Ù·Ú·¯‹ ÚÔÙ‡Ô˘ ‡ÓÔ˘
µ·ıÌÔÏÔÁ›·: 3 ‚·ıÌ›‰Â˜ ‚·Ú‡ÙËÙ·˜ (2, 1, 0)Score: 0-40
41∫ÏÈÓÈ΋ Î·È ÌÔÚȷ΋ ÌÂϤÙË ÙÔ˘ ÁÔÓȉ›Ô˘ MECP2
¶·È‰È·ÙÚÈ΋ 2008;71:38-47
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·41
·ÔÎÏÂÈÛÌÔ‡ Û˘ÓÔÏÈο 10 ·È‰ÈÒÓ ·ÔÙ¤ÏÂÛ·Ó: ·Ó·ÙÔÌÈΤ˜·ÓˆÌ·Ï›Â˜ ÂÁÎÂÊ¿ÏÔ˘, ·ıÔÏÔÁÈÎfi˜ ηڢfiÙ˘Ô˜, ‰˘ÛÌÔÚ-ÊÈο ¯·Ú·ÎÙËÚÈÛÙÈο, ∞S Î·È ¤ÏÏÂÈ„Ë ÎÏÈÓÈÎÒÓ ÛÙÔȯ›ˆÓ.∆· ˘fiÏÔÈ· 59 ·È‰È¿ ηÙËÁÔÚÈÔÔÈ‹ıËÎ·Ó ˆ˜ ÂÍ‹˜: ·.ÎÏ·ÛÈÎfi RS (n1=23 ÎÔÚ›ÙÛÈ·), ‚. ¿Ù˘Ô RS (n2=25 ÎÔÚ›ÙÛÈ·)Î·È Á. ·ÁfiÚÈ· Ì Èı·Ó¤˜ MECP2 ÌÂÙ·ÏÏ¿ÍÂȘ (n3=11). ∏ Ù·-ÍÈÓfiÌËÛË Û ÎÏ·ÛÈÎfi ‹ ¿Ù˘Ô RS ¤ÁÈÓ ‚¿ÛÂÈ ‰È·ÁÓˆÛÙÈÎÒÓÎÚÈÙËÚ›ˆÓ (¶›Ó·Î˜ 1·, 1‚) (3). ™ÙȘ ÔÌ¿‰Â˜ ·-‚ Û˘ÌÏËÚÒ-ıËΠÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ÎÏÈÓÈ΋˜ ·ÍÈÔÏfiÁËÛ˘ (¶›Ó·Î·˜ 2)(20). √È ··ÓÙ‹ÛÂȘ ‚·ıÌÔÏÔÁ‹ıËÎ·Ó Ì 2-1-0. ™ÙËÓ ÔÌ¿‰·ÙˆÓ ·ÁÔÚÈÒÓ ‰ÂÓ ¯ÚËÛÈÌÔÔÈ‹ıËΠۇÛÙËÌ· ·ÍÈÔÏfiÁËÛ˘,ÏfiÁˆ Ù˘ ÌË Î·Ï¿ ÙÂÎÌËÚȈ̤Ó˘ Ê·ÈÓÔÙ˘È΋˜ ÂÈÎfiÓ·˜ ηÈÛ·ÓÈfiÙËÙ·˜ ÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ.
∞fi ÙÔ˘˜ ÂÈÏÂÁ̤ÓÔ˘˜ ·ÛıÂÓ›˜ Î·È Î·Ù¿ ÂÚ›ÙˆÛË·fi ̤ÏË Ù˘ ÔÈÎÔÁ¤ÓÂÈ¿˜ ÙÔ˘˜, ÌÂÏÂÙ‹ıËΠ‰Â›ÁÌ· DNA ·fiÂÚÈÊÂÚÈο ÏÂÌÊÔ·ÙÙ·Ú· ·›Ì·ÙÔ˜. ™ÙË Û˘Ó¤¯ÂÈ·, Ù· ÂÍfiÓÈ· 3Î·È 4 Î·È ÔÈ ·Ú¿Ï¢Ú˜ Û˘Ó‰ÂÙÈΤ˜ ÂÚÈÔ¯¤˜ ÂÍÔÓ›ˆÓ-ÂÓ‰Ô-Ó›ˆÓ ÂÓÈÛ¯‡ıËÎ·Ó Ì PCR, Ì ¯ÚËÛÈÌÔÔ›ËÛË ÂȉÈο ۯ‰ȷ-
ÛÌ¤ÓˆÓ ÂÎÎÈÓËÙÒÓ (¶›Ó·Î·˜ 3). ∆· ÚÔ˚fiÓÙ· ÂÓ›Û¯˘Û˘ ÙÔ˘
ÂÍÔÓ›Ô˘ 4 ˘Ô‚Ï‹ıËÎ·Ó Û ËÏÂÎÙÚÔÊfiÚËÛË Û ‹Îو̷ ÌÂ
ÎÏ›ÛË ·Ô‰È·Ù·ÎÙÈÎÔ‡ (DGGE - Denaturant Gradient Gel
Electrophoresis), Ë ÔÔ›· Â›Ó·È ÈÛ¯˘Ú‹ ̤ıÔ‰Ô˜ ‰È·ÏÔÁ‹˜, η-
ıÒ˜ ÂÈÙÚ¤ÂÈ ÙËÓ ÂͤٷÛË ÔÏÏÒÓ ‰ÂÈÁÌ¿ÙˆÓ Ù·˘Ùfi¯ÚÔÓ·
Î·È ·ÓȯÓ‡ÂÈ ÛËÌÂȷΤ˜ ÌÂÙ·ÏÏ¿ÍÂȘ Û ÔÛÔÛÙfi ¤ˆ˜ ηÈ
100% (∂ÈÎfiÓ· 3·) (21). ∆Ô ÂÍfiÓÈÔ 3 ‰ÂÓ ·Ó·Ï‡ıËΠ̠DGGE,
ÏfiÁˆ Ù¯ÓÈÎÒÓ È‰ÈÔÌÔÚÊÈÒÓ (˘„ËÏ¿ ÛËÌ›· Ù‹Í˘), ηıÈÛÙÒ-
ÓÙ·˜ ‰‡ÛÎÔÏÔ ÙÔ Û¯Â‰È·ÛÌfi ÙˆÓ ÂÈÚ·Ì·ÙÈÎÒÓ Û˘ÓıËÎÒÓ.
™Â fiÛ· ÚÔ˚fiÓÙ· ·ÚÔ˘ÛÈ¿ÛıËΠ·ÓÒÌ·ÏÔ ÚfiÙ˘Ô ÌÂÙ·-
Ó¿ÛÙ¢Û˘ ÛÙË DGGE ·Ó¿Ï˘ÛË, ηıÒ˜ Î·È ÛÙ· ÚÔ˚fiÓÙ· PCR
ÙÔ˘ ÂÍÔÓ›Ô˘ 3, ¤ÁÈÓ ¿ÌÂÛÔ˜ ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù˘ ·ÏÏËÏÔ˘¯›·˜
DNA (∂ÈÎfiÓ· 3‚). ™Ù· ·ÚÓËÙÈο ‰Â›ÁÌ·Ù· ÙˆÓ RS ·È‰ÈÒÓ (ÎÔ-
Ú›ÙÛÈ· Ì ÎÏ·ÛÈÎfi ‹ ¿Ù˘Ô RS, ·ÁfiÚÈ·) ÂÊ·ÚÌfiÛıËÎÂ Ë Ì¤ıÔ-
‰Ô˜ GAP-PCR, ˆ˜ ÚÒÙË ÚÔÛ¿ıÂÈ· ·ÔÎ¿Ï˘„˘ ÌÂÁ¿ÏˆÓ
ÁÔÓȉȷÎÒÓ ·Ó·Î·Ù·Ù¿ÍˆÓ, Ì ¯ÚËÛÈÌÔÔ›ËÛË 6 ˙¢ÁÒÓ ·Ï-
ÏËÏÔÂÈÎ·Ï˘ÙfiÌÂÓˆÓ ÂÎÎÈÓËÙÒÓ ÁÈ· Ù· ÂÍfiÓÈ· 3-4.
∂ÈÎfiÓ· 3‚. ¶ÚÔÛ‰ÈÔÚÈÛÌfi˜ ·ÏÏËÏÔ˘¯›·˜ DNA (sequencing). ÃÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÂȉÈο ÛÂÛËÌ·Ṳ̂ÓÔÈ Ì ÊıÔÚ›˙Ô˘Û· ¯ÚˆÛÙÈ΋ M13 ÂÎ-ÎÈÓËÙ¤˜ (forward Cy5.0: 5ã-GTAAAACGACGGCCAGT-3ã; reverse Cy5.5: 5ã-CAGGAAACAGCTATGAC-3ã) Î·È ÙÔ kit Ù˘ Visible Genetics.∏ ·Ó¿Ï˘ÛË ¤ÁÈÓ ÛÙÔ ·˘ÙfiÌ·Ùo Û‡ÛÙËÌ· sequencing Opengeneì (Visible Genetics, Ontario, Canada).
R106W (397C>T) R306C (916C>T)
del 806G (G269fs)
¶›Ó·Î·˜ 3. ™˘Óı‹Î˜ PCR Î·È DGGE ·Ó¿Ï˘Û˘ ÁÈ· ÙÔ ÂÍfiÓÈÔ 4 ÙÔ˘ MECP2 ÁÔÓȉ›Ô˘
∆Ì‹Ì· ∞ÏÏËÏÔ˘¯›· ª‹ÎÔ˜ (bp) £. ·Ó·‰È¿Ù·Í˘ ∫Ï›ÛË ™˘ÁΤÓÙÚˆÛË £. Ú˘ıÌÈÛÙÈÎÔ‡ ÂÎÎÈÓËÙÒÓ DNA (oC) Û˘ÁΤÓÙÚˆÛ˘ ·ÎÚ˘Ï·Ì›‰Ë˜ ‰È·Ï‡Ì·ÙÔ˜
·Ô‰È·Ù·ÎÙÈÎÔ‡ (%) Û˘Û΢‹˜(%) DGGE (oC)
4.1 4.1F: 5ã-GC45-TGA CAT 430 60 20-60 6-12 60TGC TAT GGA GAG CC-3ã4.1R:5ã-CGT TTG ATC ACC ATG ACC TG-3ã
4.2 4.2F:5ã-GC57-AGG GGG CAA 410 60 20-80 6 60GGC TGA GGG GG-3ã4.2R:5ã-GGT GCT CCT TCT TGG GGG GT-3ã
4.3 4.3F:5ã-AGG ACT GAA GAC 488 56 40-70 6 63CTG TAA GAG C-3ã4.3R: 5ã-GC45-CCC TTT GCT TTG CAA TCC GCT CC-3ã
*XÚfiÓÔ˜ ËÏÂÎÙÚÔÊfiÚËÛ˘: 18 ÒÚ˜, ∆¿ÛË: 65 Volts
42 ™. æÒÓË Î·È Û˘Ó.
Paediatriki 2008;71:38-47
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·42
∞ÔÙÂϤÛÌ·Ù·
∆· ·ÔÙÂϤÛÌ·Ù· Û˘ÁÎÚ›ıËÎ·Ó Ì ÙËÓ InterRett
ËÏÂÎÙÚÔÓÈ΋ ‚¿ÛË MECP2 ÌÂÙ·ÏÏ¿ÍÂˆÓ (http://
mecp2.chw.edu.au/). ªÔÚȷ΋ ·Ó¿Ï˘ÛË ¤ÁÈÓÂ Û˘ÓÔ-
ÏÈο Û ¤ÓÙ ÔÌ¿‰Â˜ (n=221):
1. ∫Ï·ÛÈÎfi RS: µÚ¤ıËÎ·Ó ·ÏÏ·Á¤˜ Û 18/23 ÎÔÚ›-
ÙÛÈ· (78,3%). ™˘ÓÔÏÈο, fï˜, ‚Ú¤ıËÎ·Ó 19 ·ÏÏ·-
Á¤˜, ηıÒ˜ Ë ·ÛıÂÓ‹˜ R22 ¤ÊÂÚ ÙË ÌÂÙ¿ÏÏ·ÍË
p.R168X Î·È ÙÔ ÛȈËÏfi ÔÏ˘ÌÔÚÊÈÛÌfi p.F142F.
12/19 ·ÏÏ·Á¤˜ ‹Ù·Ó ·ÚÂÚÌËÓ‡ÛÈ̘ (missense)
(66,7%), 3 ·ÓÂÚÌËÓ‡ÛÈ̘ (nonsense) (16,7%) ηÈ
3 Ï·ÈÛÈÔÙÚÔÔÔÈËÙÈΤ˜ (frameshift) (16,7%).
™ÙȘ missense ·ÏÏ·Á¤˜ ÂÚÈÏ‹ÊıËÎ·Ó 10 ÌÂÙ·ÏÏ¿-
ÍÂȘ Î·È 3 ÚÔ·Ó·ÊÂÚı¤ÓÙ˜ ηÏÔ‹ıÂȘ ÔÏ˘ÌÔÚ-
ÊÈÛÌÔ› Ô˘ ·Ú·ÙËÚ‹ıËÎ·Ó Î·È Û ·Û˘Ìو̷ÙÈο
̤ÏË ÙˆÓ ÔÈÎÔÁÂÓÂÈÒÓ. O ÔÏ˘ÌÔÚÊÈÛÌfi˜ p.T197M
·Ú·ÙËÚ‹ıËÎÂ ÛÙËÓ ·ÛıÂÓ‹ R67, Ô p.L328L ÛÙËÓ
R58 Î·È Ô p.F142F ÛÙËÓ R22. E›Û˘, ÛÙËÓ ·ÛıÂÓ‹
R13 Ô˘ ¤·Û¯Â ·fi ‰È·ÁÓˆṲ̂ÓË ÎÏÈÓÈο Î·È ÙÂÎ-
ÌËÚȈ̤ÓË ÌÔÚȷο NˆÙÈ·›· ª˘˚΋ ∞ÙÚÔÊ›·, ·ÓÈ-
¯Ó‡ıËÎÂ Ë p.R306C (22).
2. ÕÙ˘Ô RS: ™ÙËÓ ÔÌ¿‰· ·˘Ù‹ ÂÍÂÙ¿ÛıËÎ·Ó 25
ÎÔÚ›ÙÛÈ·. ∞ÏÏ·Á¤˜ ÛÙË ÓÔ˘ÎÏÂÔÙȉÈ΋ ·ÏÏËÏÔ˘¯›·
‚Ú¤ıËÎ·Ó ÛÙÔ 20% (5/25). ¢‡Ô ·ÏÏ·Á¤˜ ·Ó‹Î·Ó ÛÙȘ
8 ÈÔ Û˘¯Ó¤˜ ·ıÔÁfiÓ˜ ÌÂÙ·ÏÏ¿ÍÂȘ ÁÈ· ÙÔ ÎÏ·ÛÈÎfi
RS (p.R106W, p.R306C). ∏ ÙÚ›ÙË ·ÏÏ·Á‹ ‹Ù·Ó Ô ÛȈ-
ËÏfi˜ ÔÏ˘ÌÔÚÊÈÛÌfi˜ p.T299T ÛÙËÓ ·ÛıÂÓ‹ R46
Î·È ÙÔÓ ·Ù¤Ú· Ù˘. ™ÙËÓ ÂÚ›ÙˆÛË ·˘Ù‹, Ë ÌÂÙ·-
‚ÔÏ‹ ÛÙË ÓÔ˘ÎÏÂÔÙȉÈ΋ ·ÏÏËÏÔ˘¯›· ‰ÂÓ Î·Ù¤ÏËÍÂ
Û ÌÂÙ·‚ÔÏ‹ ÛÙËÓ ·Ï˘Û›‰· ÙˆÓ ·ÌÈÓÔͤˆÓ. ∏ ٤ٷÚ-
ÙË ·ÏÏ·Á‹ (R61) ‹Ù·Ó ÌÈ· Ó¤· Û‡ÓıÂÙË ÌÂÙ¿ÏÏ·ÍË
(del318insA), ηٿ ÙËÓ ÔÔ›· ·Ú·ÙËÚ‹ıËΠٷ˘Ùfi-
¯ÚÔÓ· ¤ÏÏÂÈÌÌ· Î·È ¤ÓıÂÛË ‚¿ÛˆÓ. ∏ ·ÛıÂÓ‹˜ ·˘-
Ù‹ ·ÚÔ˘Û›·˙ ›Û˘ ÙË ¯ÚˆÌÔÛˆÌÈ΋ ·ÓˆÌ·Ï›·
46,ÃXdel(13)(q11→pter), ÙËÓ ÔÔ›· ›¯Â ÎÏËÚÔÓÔ-
Ì‹ÛÂÈ ·fi ÙÔÓ ·Ù¤Ú· Ù˘. ∏ ÙÂÏÂ˘Ù·›· ÂÚ›ÙˆÛË
(R64) ÂÌÊ¿ÓÈÛ ·ıÔÏÔÁÈÎfi ·ÔÙ¤ÏÂÛÌ· ÛÙËÓ GAP-
PCR, ·Ú¤¯ÔÓÙ·˜ ÂӉ›ÍÂȘ ÁÈ· ÌÂÁ¿ÏË ·Ó·Î·Ù¿Ù·-
ÍË ÛÙ· ÂÍfiÓÈ· 3-4. ™‡Ìʈӷ Ì ÙËÓ ÔÛÔÙÈ΋ ·˘Ù‹
̤ıÔ‰Ô ÔÏÏ·Ï·ÛÈ¿˙ÔÓÙ·È Î·È Û˘ÁÎÚ›ÓÔÓÙ·È ÌÂÁ¿-
Ï· ·ÏÏËÏÔÂÈÎ·Ï˘ÙfiÌÂÓ· ÙÌ‹Ì·Ù· ÙÔ˘ ÁÔÓȉ›Ô˘,
ÔfiÙ ·ÔηχÙÔÓÙ·È ÂÏÏ›ÌÌ·Ù· Î·È ÂÓı¤ÛÂȘ
Ô˘ ·ÊÔÚÔ‡Ó ·ÎfiÌË Î·È ÔÏfiÎÏËÚ· ÂÍfiÓÈ·.
3. ∞ÁfiÚÈ· Ì Èı·Ó¤˜ MECP2 ÌÂÙ·ÏÏ¿ÍÂȘ: ™ÙËÓ
ÔÌ¿‰· ÙˆÓ ·ÁÔÚÈÒÓ ‚Ú¤ıËÎ·Ó ‰‡Ô ·ÏÏ·Á¤˜ (2/11,
18,1%). ∏ ÚÒÙË ·ÊÔÚÔ‡ÛÂ ·ÛıÂÓ‹ 11 ÂÙÒÓ (R11)
Î·È ‹Ù·Ó Ù˘È΋ RS ÌÂÙ¿ÏÏ·ÍË (p.R106W). ∆Ô ‰Â‡-
ÙÂÚÔ ·ÁfiÚÈ (R59), ËÏÈΛ·˜ 4 ÂÙÒÓ, ·ÚÔ˘Û›·Û ·ıÔ-
ÏÔÁÈÎfi GAP-PCR (¶›Ó·Î·˜ 4).
4. AS-·ÚÓËÙÈο ‰Â›ÁÌ·Ù·: ∞fi Ù· 41 ‰Â›ÁÌ·Ù·, ¢-
Ú‹Ì·Ù· ˘‹ÚÍ·Ó Û ÙÚ›· ÎÔÚ›ÙÛÈ· (7,3%). √È ‰‡Ô
ÚÒÙ˜ (RA1, RA28) ›¯·Ó ÙȘ Ù˘ÈΤ˜ ÌÂÙ·ÏÏ¿ÍÂȘ
p.R306C Î·È p.R133C, ·ÓÙ›ÛÙÔȯ·, ÂÓÒ Ë RA35 ÂÌÊ¿-
ÓÈÛ de novo ¤ÏÏÂÈÌÌ· 6 ‚¿ÛÂˆÓ ÛÙÔ Î·Ú‚Ô͢ÙÂÏÈÎfi
¿ÎÚÔ (c.1159del6).
5. FXS-·ÚÓËÙÈο ‰Â›ÁÌ·Ù·: ™Â 3/124 ‰Â›ÁÌ·Ù·
(2,4%) ÛËÌÂÈÒıËÎ·Ó ·ÏÏ·Á¤˜. H ÚÒÙË ·ÊÔÚÔ‡ÛÂ
ÔÈÎÔÁÂÓ‹ ÂÚ›ÙˆÛË æ∫∫. ™˘ÁÎÂÎÚÈ̤ӷ, ÂÚfiÎÂÈ-
ÙÔ ÁÈ· ‰‡Ô ·‰¤ÏÊÈ· (FR108), (·ÁfiÚÈ· 5 Î·È 3 ÂÙÒÓ,
·ÓÙ›ÛÙÔȯ·) Ì æ∫∫ Î·È Ó¢ÚÔÏÔÁÈο ÚÔ‚Ï‹Ì·Ù·
Î·È ÙËÓ ·Û˘Ìو̷ÙÈ΋ ÌËÙ¤Ú· ÙÔ˘˜. ŸÏÔÈ ÂÌÊ¿ÓÈ-
Û·Ó de novo ¤ÏÏÂÈÌÌ· ÛÙÔ Î·Ú‚Ô͢ÙÂÏÈÎfi ¿ÎÚÔ
(c.1140del86). ∏ ‰Â‡ÙÂÚË ÂÚ›ÙˆÛË ·ÊÔÚÔ‡Û ¤Ó·
·ÁfiÚÈ (FR120), ÌÂ ÙËÓ p.∆203ª ·ÏÏ·Á‹, Ë ÔÔ›·
ıˆÚÂ›Ù·È Î·ÏÔ‹ı˘ ÔÏ˘ÌÔÚÊÈÛÌfi˜. ∏ ÌËÙ¤Ú·
ÙÔ˘, fï˜, ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋. ∏ ÙÚ›ÙË ÌÂÙ¿ÏÏ·ÍË
43∫ÏÈÓÈ΋ Î·È ÌÔÚȷ΋ ÌÂϤÙË ÙÔ˘ ÁÔÓȉ›Ô˘ MECP2
¶·È‰È·ÙÚÈ΋ 2008;71:38-47
¶›Ó·Î·˜ 4. ∫ÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο ·ÁÔÚÈÒÓ Ì Èı·Ó¤˜ ÌÂÙ·ÏÏ¿ÍÂȘ MECP2 (n=11)
∞ÛıÂÓ‹˜ ∏ÏÈΛ· ∫ÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ªÂÙ¿ÏÏ·ÍË
1 R11 11 ÂÙÒÓ æ∫∫ ·fi 18 ÌËÓÒÓ, ·˘ÙÈÛÙÈο ÛÙÔȯ›·, ÌÂÁ¿Ï˜ ۈ̷ÙÔÌÂÙÚÈΤ˜ ·Ú¿ÌÂÙÚÔÈ R106W2 R18 13 ÌËÓÒÓ ¡ÂÔÁÓÈ΋ ÂÁÎÂÊ·ÏÔ¿ıÂÈ· (ηÏfi ÂÚÈÁÂÓÓËÙÈÎfi ÈÛÙÔÚÈÎfi, ‚·ÚËÎÔ˝·, -
˘ÂÚÙÔÓ›· ¿ÎÚˆÓ, ·‡ÚÂÙÔÈ Û·ÛÌÔ› ·fi 8,5 ÌËÓÒÓ, æ∫∫, ›ÎÙËÙË ÌÈÎÚÔÎÂÊ·Ï›·)
3 R23 9 ÌËÓÒÓ ¡ÂÔÁÓÈ΋ ÂÁÎÂÊ·ÏÔ¿ıÂÈ· (IVF, ‰›‰˘ÌÔ, ÌÈÎÚÔÎÂÊ·Ï›·, ˘ÂÚÙÔÓ›· ¿ÎÚˆÓ- -˘ÔÙÔÓ›· ÎÔÚÌÔ‡, ÛÙÂÚÂÔÙ˘ÈΤ˜ ÎÈÓ‹ÛÂȘ ÛÙÔÓ ‡ÓÔ, ¤ÓÙÔÓË æ∫∫)
4 R29 6 ÂÙÒÓ ÀÔÙÔÓ›·, æ∫∫, ÛÙÂÚÂfiÙ˘Â˜ ÎÈÓ‹ÛÂȘ ¯ÂÚÈÒÓ ÚÔ˜ ÙÔ ÛÙfiÌ· -5 R39 14 ÌËÓÒÓ ªÈÎÚÔÎÂÊ·Ï›·, ˘ÔÙÔÓ›· ÎÔÚÌÔ‡, ÛÙÂÚÂÔÙ˘›Â˜, ÎÈÓËÙÈ΋ -
·ÓˆÚÈÌfiÙËÙ· ÛÙ· ¯¤ÚÈ·6 R417 R53 14 ÌËÓÒÓ ™‡Ó‰ÚÔÌÔ West, ÛÙÂÚÂÔÙ˘›Â˜, æ∫∫, ÙÚfiÌÔ˜ ÎÔÚÌÔ‡ -8 R54 5 ÂÙÒÓ æ∫∫, Û·ÛÌÔ›, ÌÈÎÚÔÎÂÊ·Ï›· -9 R56 4 ÂÙÒÓ æ∫∫, ∂∂G (+) ¯ˆÚ›˜ Û·ÛÌÔ‡˜, ÛÈÙÈÛÙÈο ÚÔ‚Ï‹Ì·Ù· ˆ˜ ÓÂÔÁÓfi-‚Ú¤ÊÔ˜ -10 R59 æ∫∫, ·˘ÙÈÛÙÈο ÛÙÔȯ›· ªÂÁ¿ÏË
ÁÔÓȉȷ΋ ·Ó·Î·Ù¿Ù·ÍËÛÙ· ÂÍfiÓÈ· 3, 4
11 R65 14 ÌËÓÒÓ ∫Ú›ÛÂȘ ‘∂’, ÛÙÂÚÂÔÙ˘›Â˜, ·Ù·Í›·, æ∫∫, ·˘ÙÈÛÙÈο ÛÙÔȯ›· -
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·43
·Ú·ÙËÚ‹ıËΠ۠ÎÔÚ›ÙÛÈ (FR36) Î·È ‹Ù·Ó Î·È ·˘Ù‹
de novo ηڂÔ͢ÙÂÏÈÎfi ¤ÏÏÂÈÌÌ· (c.1163del44).
™˘ÓÔÏÈο, ÔÈ ·ÏÏ·Á¤˜ ÛÙÔ ÁÔÓ›‰ÈÔ MECP2 ‹Ù·Ó
32 (27 ÌÂÙ·ÏÏ¿ÍÂȘ, 5 ÔÏ˘ÌÔÚÊÈÛÌÔ›). 14/32
(43,75%) ·ÏÏ·Á¤˜ ÂÓÙÔ›˙ÔÓÙ·Ó ÂÓÙfi˜ ÙÔ˘ MBD,
5/32 (15,625%) ÂÓÙfi˜ ÙÔ˘ TRD, 4/32 (12,5%) ÛÙË
MBD-TRD ÂÚÈÔ¯‹, 1/32 (3,125%) ÛÙË NLS, 6/32
(18,75%) ÛÙÔ Î·Ú‚Ô͢ÙÂÏÈÎfi ¿ÎÚÔ Î·È 2/32 (6,25%)
44 ™. æÒÓË Î·È Û˘Ó.
Paediatriki 2008;71:38-47
¶›Ó·Î·˜ 5. ™˘ÁÎÂÓÙÚˆÙÈο ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘. ªÂÙ·ÏÏ¿ÍÂȘ Î·È ·ÏÏ·Á¤˜ ·ÏÏËÏÔ˘¯›·˜ ηٿ ÛÂÈÚ¿ Û˘¯ÓfiÙËÙ·˜
∞ÛıÂÓ›˜ ∆‡Ô˜ To̤·˜ ∂ÍfiÓÈÔ ¡Ô˘ÎÏÂÔÙȉÈ΋ ∞ÏÏ·Á‹ ∫ÏÈÓÈο ÛÙÔȯ›·ÌÂÙ¿ÏÏ·Í˘ ·ÏÏ·Á‹ ·· - ¶·Ú·ÙËÚ‹ÛÂȘ
R4 missense MBD 3 c.316C>T R106W ÕÙ˘Ô RS, 21 ÌËÓÒÓ, R5 missense MBD 3 c.316C>T R106W ∫Ï·ÛÈÎfi RS, 7,5 ÂÙÒÓ, R9 missense MBD 3 c.316C>T R106W ∫Ï·ÛÈÎfi RS, 18 ÌËÓÒÓ, R11 missense MBD 3 c.316C>T R106W , 11 ÂÙÒÓ, ·˘ÙÈÛÙÈο ÛÙÔȯ›·, æ∫∫R8 missense MBD 4 c.397C>T R133C ∫Ï·ÛÈÎfi RS, 3 ÂÙÒÓ, R12 missense MBD 4 c.397C>T R133C ∫Ï·ÛÈÎfi RS, 14 ÂÙÒÓ, R35 missense MBD 4 c.397C>T R133C ∫Ï·ÛÈÎfi RS, 3 ÂÙÒÓ, RA28 missense MBD 4 c.397C>T R133C AS Ê·ÈÓfiÙ˘Ô˜, 2 ÂÙÒÓ, R21 missense MBD 4 c.473C>T T158M ∫Ï·ÛÈÎfi RS, 2,5 ÂÙÒÓ, R28 missense MBD 4 c.473C>T T158M ∫Ï·ÛÈÎfi RS, 11 ÂÙÒÓ, R36 missense MBD 4 c.473C>T T158M ∫Ï·ÛÈÎfi RS, 3 ÂÙÒÓ, R66 missense MBD 4 c.473C>T T158M ∫Ï·ÛÈÎfi RS, 11 ÂÙÒÓ, R2 missense TRD 4 c.916C>T R306C ∫Ï·ÛÈÎfi RS, 3 ÂÙÒÓ, R13 missense TRD 4 c.916C>T R306C ∫Ï·ÛÈÎfi RS, 8,5 ÂÙÒÓ, ,
¿Û¯ÂÈ Î·È ·fi SMA IIRA1 missense TRD 4 c.916C>T R306C AS Ê·ÈÓfiÙ˘Ô˜, 2 ÂÙÒÓ,
R7 nonsense ªÂٷ͇ 4 c.502C>T R168X ∫Ï·ÛÈÎfi RS, 7 ÂÙÒÓ, MBD-TRD
R22 nonsense ªÂٷ͇ 4 c.502C>T R168X ∫Ï·ÛÈÎfi RS, 19 ÌËÓÒÓ, MBD-TRD
R1 nonsense TRD 4 c.880C>T R294X ∫Ï·ÛÈÎfi RS, 2 ÂÙÒÓ,
R61 frameshift MBD 3 c.del318insA ÕÙ˘Ô RS + ¯ÚˆÌÔÛˆÌÈ΋ ·ÓˆÌ·Ï›· ÎÏËÚÔÓÔÌË̤ÓË ·fi ÙÔÓ ·Ù¤Ú·, 4 ÂÙÒÓ, , Ó¤· ÌÂÙ¿ÏÏ·ÍË
R47 frameshift TRD-NLS 4 c.806delG G269fs ∫Ï·ÛÈÎfi RS, 19 ÌËÓÒÓ,R3 frameshift C-term. 4 c.1117del87 ∫Ï·ÛÈÎfi RS, 22 ÌËÓÒÓ, , Ó¤· ÌÂÙ¿ÏÏ·ÍËR62 frameshift C-term. 4 c.1159insAGGGG P387fs ∫Ï·ÛÈÎfi RS, 16 ÂÙÒÓ, , ‚·Ú‡Ù·ÙË
TGGdel41 ÛÎÔÏ›ˆÛË, Ó¤· ÌÂÙ¿ÏÏ·ÍËRA35 frameshift C-term. 4 c.1159del6 P387fs ∞S Ê·ÈÓfiÙ˘Ô˜, 2 ÂÙÒÓ, , Ó¤· ÌÂÙ¿ÏÏ·ÍËFR36 frameshift C-term. 4 c.1163del44 P388fs FXS Ê·ÈÓfiÙ˘Ô˜, 5 ÂÙÒÓ, ÙÂÏÈÎfi˜ ÙÚfiÌÔ˜
¿Óˆ ¿ÎÚˆÓ, , Ó¤· ÌÂÙ¿ÏÏ·ÍËFR108 frameshift C-term. 4 c.1140del86 XLMR, ·‰¤ÏÊÈ· , 5 Î·È 3 ÂÙÒÓ, ·+‚ ÌËÙ¤Ú· ·Û˘Ìو̷ÙÈ΋ ÊÔÚ¤·˜
R59 ªÂÁ¿ÏË ÁÔÓȉȷ΋ ·Ó·Î·Ù¿Ù·ÍË æ∫∫, ·˘ÙÈÛÙÈο ÛÙÔȯ›·R64 ªÂÁ¿ÏË ÁÔÓȉȷ΋ ·Ó·Î·Ù¿Ù·ÍË ∞Ù˘Ô RS, 2 ÂÙÒÓ,
R67 ÔÏ˘ÌÔÚÊÈÛÌfi˜ ªÂٷ͇ 4 c.590C>T T197M ∫Ï·ÛÈÎfi RS, 22 ÌËÓÒÓ, , ·Ù¤Ú·˜ MBD-TRD ·Û˘Ìو̷ÙÈÎfi˜ ÊÔÚ¤·˜
FR120 ÔÏ˘ÌÔÚÊÈÛÌfi˜ ªÂٷ͇ 4 c.608C>T ∆203ª FXS Ê·ÈÓfiÙ˘Ô˜ (æ∫∫, ÚÔ‚Ï‹Ì·Ù· MBD-TRD Û˘ÌÂÚÈÊÔÚ¿˜, Ì·ÎÚ‡ ÚfiÛˆÔ,
ÚÔ¤¯ÔÓÙ· ·˘ÙÈ¿), 16 ÂÙÒÓ, ,Ë ÌËÙ¤Ú· ‰ÂÓ Ê¤ÚÂÈ ÙËÓ ·ÏÏ·Á‹
R22 ™ÈˆËÏfi˜ ªµD 4 c.426C>T F142F KÏ·ÛÈÎfi RS Ì ÌÂÙ¿ÏÏ·ÍË R168XÔÏ˘ÌÔÚÊÈÛÌfi˜
R46 ™ÈˆËÏfi˜ TRD 4 c.897C>T ∆299∆ ∞Ù˘Ô RS, 7 ÂÙÒÓ, , ·Ù¤Ú·˜ ÔÏ˘ÌÔÚÊÈÛÌfi˜ ·Û˘Ìو̷ÙÈÎfi˜ ÊÔÚ¤·˜
R58 ™ÈˆËÏfi˜ C-term. 4 c.984C>T L328L ∫Ï·ÛÈÎfi RS, , ÔÈ ÁÔÓ›˜ ‰ÂÓ ¤¯Ô˘Ó ÔÏ˘ÌÔÚÊÈÛÌfi˜ ÂÏÂÁ¯ı›
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·44
·ÔÙÂÏÔ‡Û·Ó ÌÂÁ¿Ï˜ ·Ó·Î·Ù·Ù¿ÍÂȘ. 18/32 ·ÏÏ·-
Á¤˜ (56,25%) ·Ó‹Î·Ó ÛÙȘ ÔÎÙÒ Ù˘ÈÎfiÙÂÚ˜ ÌÂ Û˘-
¯ÓfiÙËÙ˜: p.T158M, p.R106W Î·È p.R133C (4/18,
22,2%), ·ÎÔÏÔ˘ıÔ‡ÌÂÓ˜ ·fi ÙȘ p.R168X ηÈ
p.R294X Ì ÔÛÔÛÙ¿ 13,7% Î·È 5,5%, ·ÓÙ›ÛÙÔȯ·.
∏ Û˘ÓÙÚÈÙÈ΋ ÏÂÈÔ„ËÊ›· ·Ú·ÙËÚ‹ıËΠÛÙÔ
ÂÍfiÓÈÔ 4 (27/32, 84,375%) Î·È ÌfiÓÔ 5/32 (15,625%)
ÛÙÔ ÂÍfiÓÈÔ 3 (¶›Ó·Î·˜ 5).
ŒÁÈÓ ÚÔÛ¿ıÂÈ· ÁÈ· ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ÙˆÓ
·ÔÙÂÏÂÛÌ¿ÙˆÓ, ÒÛÙ ӷ ÂÍ·¯ıÔ‡Ó Û˘ÌÂÚ¿ÛÌ·Ù·
ÁÈ· ÙË Û˘Û¯¤ÙÈÛË ÁÔÓÔÙ‡Ô˘-Ê·ÈÓÔÙ‡Ô˘. ™ÙËÓ
·Ó¿Ï˘ÛË ÂÚÈÏ‹ÊıËÎ·Ó ÌfiÓÔ ÎÔÚ›ÙÛÈ· fiÏˆÓ ÙˆÓ
Ê·ÈÓÔÙ˘ÈÎÒÓ ÔÌ¿‰ˆÓ. ¢ËÌÈÔ˘ÚÁ‹ıËÎ·Ó 2 ÔÌ¿‰Â˜,
Ë ÚÒÙË Ì ÎÔÚ›ÙÛÈ· Ì ÌÂÙ¿ÏÏ·ÍË (n=24) Î·È Ë
‰Â‡ÙÂÚË Ì ÎÔÚ›ÙÛÈ· Ì ÔÏ˘ÌÔÚÊÈÛÌÔ‡˜ ‹ ·ÚÓËÙÈ-
Îfi ÌÔÚÈ·Îfi ¤ÏÂÁ¯Ô (n=28). √È ÔÌ¿‰Â˜ Û˘ÁÎÚ›ıËηÓ
ÌÂٷ͇ ÙÔ˘˜ ·) ˆ˜ ÚÔ˜ ÙËÓ Ù˘ÈÎfiÙËÙ· ÙÔ˘ Ê·ÈÓÔ-
Ù‡Ô˘, Ë ÔÔ›· ÂÎÊÚ¿˙ÂÙ·È ÌÂ ÙÔÓ ·ÚÈıÌfi ÙˆÓ ÌÂÈ-
˙fiÓˆÓ ÎÚÈÙËÚ›ˆÓ Ô˘ ÏËÚÔ‡ÓÙ·È (0 ¤ˆ˜ 6) Î·È ‚)
ˆ˜ ÚÔ˜ ÙË ÛÔ‚·ÚfiÙËÙ· ÙÔ˘ Ê·ÈÓÔÙ‡Ô˘, fiˆ˜ ÂÎ-
ÊÚ¿˙ÂÙ·È ·fi ÙË ‚·ıÌÔÏÔÁ›· (0 ¤ˆ˜ 40) ÛÙËÓ Îϛ̷-
η ·ÍÈÔÏfiÁËÛ˘. ∏ ‰ÔÎÈÌ·Û›· t-test ÁÈ· ·ÓÂÍ¿ÚÙËÙ·
‰Â›ÁÌ·Ù· ¤‰ˆÛÂ Î·È ÛÙȘ ‰‡Ô ÂÚÈÙÒÛÂȘ ÛÙ·ÙÈÛÙÈ-
ο ÛËÌ·ÓÙÈο ·ÔÙÂϤÛÌ·Ù· ÛÙÔ Â›Â‰Ô ÙÔ˘ 1%
(ta=3,54, dfa=50, Pa=0,000438 Î·È tb=4,94, dfb=50,
P<0,0001, ·ÓÙ›ÛÙÔȯ·).
™ÙË Û˘Ó¤¯ÂÈ·, ·Ó¿ÏÔÁ· Ì ÙËÓ ÎÏÈÓÈ΋ ÛÔ‚·Úfi-
ÙËÙ·, Ù· ıÂÙÈο ÎÔÚ›ÙÛÈ· (n=24) Ù·ÍÈÓÔÌ‹ıËÎ·Ó ÛÂ
¤¯Ô˘Û˜ ̤ÙÚÈ·˜ (score 0-19) Î·È ÌÂÁ¿Ï˘ ‚·Ú‡ÙË-
Ù·˜ Ê·ÈÓfiÙ˘Ô (score 20-40), ·ÓÙ›ÛÙÔȯ·. √È ÌÂÙ·Ï-
Ï¿ÍÂȘ ¯ˆÚ›ÛıËÎ·Ó Û ÙÚÂȘ ÔÌ¿‰Â˜: ∞. missense, µ.
ÚÒÈÌ· ‰È·ÎfiÙÔ˘Û˜ ÙËÓ ÚˆÙ½ÓË (early-
truncating), ÂÓÙÔÈ˙fiÌÂÓ˜ ¤ˆ˜ Î·È ÙËÓ ÂÚÈÔ¯‹
TRD-NLS Î·È °. late-truncating, οوıÂÓ ÙÔ˘ TRD.
¢ÂÓ ‚Ú¤ıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ Û˘Û¯¤ÙÈÛË ÌÂÙ·-
͇ ÙÔ˘ Ù‡Ô˘ Ù˘ ÌÂÙ¿ÏÏ·Í˘ Î·È Ù˘ ‚·Ú‡ÙËÙ·˜ ÙÔ˘
Ê·ÈÓÔÙ‡Ô˘, Û‡Ìʈӷ Ì ÙË ‰ÔÎÈÌ·Û›· Fisher-Exact-
Test ÁÈ· ÌÈÎÚfi ·ÚÈıÌfi ‰ÂÈÁÌ¿ÙˆÓ (Pa=0,3535,
Pb=0,304). ∂›Û˘, Ë Û‡ÁÎÚÈÛË ÙˆÓ scores ÌÂٷ͇ ÙˆÓ
missense Î·È ÙˆÓ nonsense-frameshift ÌÂÙ·ÏϿ͈Ó,
Ì ÙË ‰ÔÎÈÌ·Û›· Wilcoxon-Mann-Whitney, ‰ÂÓ ¤‰ˆ-
Û ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ·ÔÙÂϤÛÌ·Ù· (U=31,5 ÌÂ
fiÚÈ· 15-53 ÛÙÔ Â›Â‰Ô ÙÔ˘ 5%). °È· ÙȘ ‰ÔÎÈ̷ۛ˜
¯ÚËÛÈÌÔÔÈ‹ıËÎÂ ÙÔ ÏÔÁÈÛÌÈÎfi VassarStats (http://
faculty.vassar.edu/lowry/VassarStats.html).
™˘˙‹ÙËÛË
™ÙÔ ÎÏ·ÛÈÎfi RS, ÙÔ ÔÛÔÛÙfi ÌÂÙ·ÏÏ¿ÍÂˆÓ Î˘Ì·›-
ÓÂÙ·È ·fi 60 ¤ˆ˜ 95%. ∏ ‰È·Î‡Ì·ÓÛË ·˘Ù‹ ÔÊ›ÏÂÙ·È
ÛÙȘ ·Ú·Ì¤ÙÚÔ˘˜ ÂÈÏÔÁ‹˜ ÙˆÓ ÂÍÂÙ·˙ÔÌ¤ÓˆÓ Î·È
ÛÙȘ ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓ˜ ÌÔÚȷΤ˜ ÌÂıfi‰Ô˘˜. ¢È¿-
ÁÓˆÛË ÂÈÙ˘Á¯¿ÓÂÙ·È ÛÙÔ 95% Ì ÙËÓ ÂÊ·ÚÌÔÁ‹ Ô-
ÛÔÙÈ΋˜ ÌÂıfi‰Ô˘ ÁÈ· ·Ó›¯Ó¢ÛË ÌÂÁ¿ÏˆÓ ·Ó·Î·Ù·-
Ù¿ÍÂˆÓ Ô˘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÔÏfiÎÏËÚ· ÂÍfiÓÈ· ‹ ηÈ
ÙÌ‹Ì·Ù· ·Ú·Î›ÌÂÓˆÓ ÁÔÓȉ›ˆÓ Î·È ÂͤٷÛË ÂÈ-
ϤÔÓ Î·È ÙÔ˘ ÂÍÔÓ›Ô˘ 1 (16,19). ™ÙËÓ ·ÚÔ‡Û· ÌÂ-
ϤÙË, ÙÔ ÔÛÔÛÙfi 78,3% Â›Ó·È ÛÙ· Ï·›ÛÈ· ÙÔ˘ Û˘Ó‹-
ıÔ˘˜ Ê¿ÛÌ·ÙÔ˜ (60-85%) (17). ™ÙÔ ¿Ù˘Ô RS, ÙÔ Ô-
ÛÔÛÙfi ‹Ù·Ó ·ÚÎÂÙ¿ ¯·ÌËÏfi (20%) Û ۯ¤ÛË Ì ÙË ‚È-
‚ÏÈÔÁÚ·Ê›· (30-45%) (23), ÁÂÁÔÓfi˜ Ô˘ ÌÔÚ› Ó·
·Ô‰Ôı› ÛÙËÓ ÎÏÈÓÈ΋ ÂÙÂÚÔÁ¤ÓÂÈ· ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜
Î·È ÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ Î·È ¿ÏÏ· ÁÔÓ›‰È· ¢ı‡ÓÔÓÙ·È ÁÈ·
ÙÔ RS, fiˆ˜ ÙÔ CDKL5, Û‡Ìʈӷ Ì ÚfiÛÊ·Ù· ‰Â-
‰Ô̤ӷ (24). ∞Ó ÛÙËÓ ÔÌ¿‰· ÙÔ˘ ¿Ù˘Ô˘ RS ÚÔÛÙ›-
ıÂÓÙÔ Î·È ÔÈ ÌÂÙ·ÏÏ¿ÍÂȘ ÙˆÓ ÎÔÚÈÙÛÈÒÓ ÙˆÓ ÔÌ¿‰ˆÓ
AS-FXS, ÙÔ ÔÛÔÛÙfi ı· ·ÓÂÚ¯fiÙ·Ó ÛÙÔ 31% (9/29).
∏ ÏÂÈÔ„ËÊ›· ÙˆÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ ÂÓÙÔ›ÛıËΠÛÙÔ
ÂÍfiÓÈÔ 4, Û˘ÓÂÒ˜ ı· Ú¤ÂÈ Ó· ÌÂÏÂÙ¿Ù·È ÚÒÙÔ. ∆˘-
ÈΤ˜ ÌÂÙ·ÏÏ¿ÍÂȘ ‚Ú¤ıËÎ·Ó ÛÙÔ 56,25%, ÔÛÔÛÙfi
Ô˘ ÚÔÛÂÁÁ›˙ÂÈ ˘¿Ú¯Ô˘Û˜ ÌÂϤÙ˜ (58-72%) (17).
∂ÓÙo‡ÙÔȘ, ‰ÂÓ ÂÎÚÔÛˆ‹ıËÎ·Ó Î·ıfiÏÔ˘ ÔÈ p.R255X
Î·È p.R270X (NLS). ∞ÓÙ›ıÂÙ·, ·Ú·ÙËÚ‹ıËÎ·Ó ÔÏ-
Ϥ˜ MBD ÌÂÙ·ÏÏ¿ÍÂȘ, ¯ˆÚ›˜ οÔÈ· Ó· ÚÔÂÍ¿Ú¯ÂÈ.
™Â ÌÂÁ¿Ï˜ ÏËı˘ÛÌȷΤ˜ ÌÂϤÙ˜ Û˘¯ÓfiÙÂÚ· ·Ó¢ڛ-
ÛÎÂÙ·È Ë p.R168X Î·È Ë p.∆158ª. 6/32 (18,75%) ÙˆÓ
·ÏÏ·ÁÒÓ ‹Ù·Ó de novo, fiˆ˜ Ë del318insA ÛÙÔ ÂÍfiÓÈÔ
3 Î·È Ù· ¤ÓÙ ηڂÔ͢ÙÂÏÈο ÂÏÏ›ÌÌ·Ù·, ÙˆÓ ÔÔ›-
ˆÓ Ë Û˘¯ÓfiÙËÙ· (5/32, 15,625%) Û˘Ì‚¿‰È˙ Ì ÙË ‚È-
‚ÏÈÔÁÚ·Ê›· (10-15%) (16,17).
∏ ÚÔÛ¿ıÂÈ· Û˘Û¯¤ÙÈÛ˘ ÁÔÓÔÙ‡Ô˘-Ê·ÈÓÔÙ‡-
Ô˘ ·ÚÔ˘Û›·Û ‰˘ÛÎÔϛ˜, ÏfiÁˆ ÙÔ˘ ÌÈÎÚÔ‡ ‰Â›Á-
Ì·ÙÔ˜. ¶Ú¿ÁÌ·ÙÈ, ÔÏϤ˜ ÌÂϤÙ˜ Ì ÌÈÎÚ¤˜ ÛÂÈÚ¤˜
·ÛıÂÓÒÓ ¤¯Ô˘Ó Ô‰ËÁËı› Û ·ÓÙÈÎÚÔ˘fiÌÂÓ· Û˘ÌÂ-
Ú¿ÛÌ·Ù· Î·È ÌË ÛÙ·ÙÈÛÙÈÎÒ˜ ÛËÌ·ÓÙÈο ·ÔÙÂϤ-
ÛÌ·Ù·. ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ‚Ú¤ıËΠÛÙ·ÙÈÛÙÈÎÒ˜
ÈÛ¯˘Ú¿ ÛËÌ·ÓÙÈ΋ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ Ù˘ Ù˘ÈÎfiÙË-
Ù·˜ Î·È Ù˘ ‚·Ú‡ÙËÙ·˜ ÙÔ˘ Ê·ÈÓÔÙ‡Ô˘ Ì ÙËÓ Èı·-
ÓfiÙËÙ· ÌÂÙ¿ÏÏ·Í˘. ∂›Ó·È ÚÔÊ·Ó¤˜ fiÙÈ Ú¤ÂÈ Ó·
Á›ÓÂÙ·È ·ÍÈÔÏfiÁËÛË ÙˆÓ ·ÛıÂÓÒÓ ‚¿ÛÂÈ ÎÚÈÙËÚ›ˆÓ,
ÚÔÙÔ‡ ·Ú·ÂÌÊıÔ‡Ó ÁÈ· DNA ·Ó¿Ï˘ÛË, ÒÛÙ ӷ
·˘Í¿ÓÔÓÙ·È ÔÈ Èı·ÓfiÙËÙ˜ ·Ó‡ÚÂÛ˘ ÌÂÙ¿ÏÏ·Í˘.
∏ Û‡ÁÎÚÈÛË ÙÔ˘ Ù‡Ô˘ ÙˆÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ ÌÂٷ͇
ÙÔ˘˜ Î·È Û ۯ¤ÛË Ì ÙÔ ‚·ıÌfi Ê·ÈÓÔÙ˘È΋˜ ‚·Ú‡-
ÙËÙ·˜ ‰ÂÓ ¤‰ˆÛ ÛÙ·ÙÈÛÙÈÎÒ˜ ÛËÌ·ÓÙÈο ·ÔÙÂϤ-
ÛÌ·Ù·. ÕÏÏÔÈ ÙÚÔÔÔÈËÙ¤˜ Ù˘ ÁÔÓÔÙ˘È΋˜-Ê·È-
ÓÔÙ˘È΋˜ Û˘Û¯¤ÙÈÛ˘ ›ӷÈ: 1. Ô ‚·ıÌfi˜ ·‰Ú·ÓÔ-
Ô›ËÛ˘ ÙÔ˘ X ¯ÚˆÌÔÛÒÌ·ÙÔ˜, Ô ÔÔ›Ô˜ Â›Ó·È Û˘Ó‹-
ıˆ˜ Ù˘¯·›Ô˜ Ì ·ÔÙ¤ÏÂÛÌ· ÎÏÈÓÈ΋ ÂÙÂÚÔÁ¤ÓÂÈ·, 2.
Ë ËÏÈΛ· ÂͤٷÛ˘, ηıÒ˜ Ô Ï‹Ú˘ Ê·ÈÓfiÙ˘Ô˜
·ÔηχÙÂÙ·È ÌÂÙ¿ Ù· 3-4 ¤ÙË, 3. Ù· ÎÚÈÙ‹ÚÈ· Ô˘
ÂÈϤÁÔÓÙ·È ÁÈ· ÙË ‰ËÌÈÔ˘ÚÁ›· ÙˆÓ Ê·ÈÓÔÙ˘ÈÎÒÓ
scores, 4. Ô ‚·ıÌfi˜ Ù˘ÈÎfiÙËÙ·˜ ÙÔ˘ Ê·ÈÓÔÙ‡Ô˘ ηÈ
5. ¿ÁÓˆÛÙÔÈ ÂÈÁÂÓÂÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ (25).
øÛÙfiÛÔ, ÓÂfiÙÂÚ˜ ÌÂϤÙ˜ ηٷϋÁÔ˘Ó fiÙÈ ÌÂ-
Ù·ÏÏ¿ÍÂȘ ÚÈÓ Î·È ÂÓÙfi˜ Ù˘ NLS ÂÚÈÔ¯‹˜, Ô‰Ë-
ÁÔ‡Ó Û ÛÔ‚·Úfi Ê·ÈÓfiÙ˘Ô, ‰ÈfiÙÈ ÂȉÚÔ‡Ó ÛÙËÓ
45∫ÏÈÓÈ΋ Î·È ÌÔÚȷ΋ ÌÂϤÙË ÙÔ˘ ÁÔÓȉ›Ô˘ MECP2
¶·È‰È·ÙÚÈ΋ 2008;71:38-47
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·45
ÈηÓfiÙËÙ· Ù˘ ÚˆÙ½Ó˘ Ó· ÂÈÛ·¯ı› ÛÙÔÓ ˘Ú‹Ó·
Î·È Ó· ÚÔÛ‰Âı› ÛÙÔ ÌÂı˘ÏȈ̤ÓÔ DNA (25,26). √È
ÌÂÙ·ÏÏ¿ÍÂȘ ¤Ú· ·fi ÙÔ NLS Î·È Ù· ηڂÔ͢ÙÂÏÈο
ÂÏÏ›ÌÌ·Ù· ¤¯Ô˘Ó ‹È·, ¿Ù˘Ë ¤ÎÊÚ·ÛË, ηıÒ˜ Ë
ÚˆÙ½ÓË ·ÏÒ˜ ¯¿ÓÂÈ Î¿ÔÈ· ÈηÓfiÙËÙ· ÌÂÙ·ÁÚ·-
ÊÈ΋˜ ηٷÛÙÔÏ‹˜ (26).
∞fi ÙȘ ÎÏ·ÛÈΤ˜ ÌÂÙ·ÏÏ¿ÍÂȘ ÂӉȷʤÚÔÓ ·-
ÚÔ˘ÛÈ¿˙Ô˘Ó Ë p.R133C Î·È Ë p.R306C. ∏ ÚÒÙË Û¯Â-
Ù›˙ÂÙ·È Ì ÌÈÎÚ‹ ‚·Ú‡ÙËÙ·, ÌÂÁ·Ï‡ÙÂÚË ËÏÈΛ· ¤Ó·Ú-
͢ ·ÏÈÓ‰ÚfiÌËÛ˘ Î·È ÎÏÈÓÈ΋ ÔÈÎÈÏÔÌÔÚÊ›·
(25,26). ™Â Â›Â‰Ô ÚˆÙÂ˚ÓÈ΋˜ ¤ÎÊÚ·Û˘, ÌÈ· ÌÂ-
ϤÙË ¤‰ÂÈÍ in vitro ·ÚfiÌÔÈ· ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ· Ù˘
R133C Ì ÙË wild-type ÚˆÙ½ÓË (27). ∏ ‰Â‡ÙÂÚË
ÂÓÙÔ›˙ÂÙ·È ÛÙÔ Ù¤ÏÔ˜ ÙÔ˘ TRD, ofiÙ ‰ÂÓ ·Ú·-
‚Ï¿ÙÂÈ ÛËÌ·ÓÙÈο ÙÔ˘˜ ÏÂÈÙÔ˘ÚÁÈÎÔ‡˜ ÙÔÌ›˜ ηÈ
ıˆÚÂ›Ù·È ‹È· (27). ™ÙË ÌÂϤÙË, Ë p.R133C Û˘ÁΤ-
ÓÙÚˆÛ ·Ú·‰fi͈˜ ˘„ËÏfi score ‚·Ú‡ÙËÙ·˜
(mean=23,55, SD=1,2714), ·ÏÏ¿ fiˆ˜ Î·È Ë p.R306C
·Ú·ÙËÚ‹ıËÎ·Ó Î·È ÛÙËÓ ¿Ù˘Ë AS-ÔÌ¿‰·.
∆· ·ÔÙÂϤÛÌ·Ù· ·fi ÙËÓ ¤Ú¢ӷ ÙÔ˘ MECP2 ÛÂ
¿ÏÏÔ˘˜ æ∫∫ Ê·ÈÓÔÙ‡Ô˘˜ ‹Ù·Ó ÂÓı·ÚÚ˘ÓÙÈο, ·Ó
Î·È ‰ÂÓ ÂÈÙÚ¤Ô˘Ó ÙË Ì·˙È΋ ÂÊ·ÚÌÔÁ‹ ÂϤÁ¯Ô˘ ÛÂ
fiÏ· Ù· ·È‰È¿ Ì æ∫∫. ∂›Ó·È ›Ûˆ˜ ÛÎfiÈÌÔ Ó· ÂϤÁ-
¯ÔÓÙ·È AS-·ÚÓËÙÈο ·È‰È¿, ÏfiÁˆ ÂÈÎ¿Ï˘„˘ Ì ÙÔ
RS, fiˆ˜ Ê¿ÓËΠ·fi Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ AS-ÔÌ¿-
‰·˜. ™ÙËÓ FÃS-oÌ¿‰· ÂӉȷʤÚÔÓ ÚÔηÏ› Ë ÔÈÎÔ-
ÁÂÓÂȷ΋ ÂÚ›ÙˆÛË. Œ¯Ô˘Ó ‹‰Ë ·Ó·ÊÂÚı› ÂÚÈÛÙ·-
ÙÈο Ì ÎÏËÚÔÓÔÌÔ‡ÌÂÓË ÌÂÙ¿ÏÏ·ÍË ·fi ·Û˘ÌÙˆ-
Ì·ÙÈΤ˜ ÌËÙ¤Ú˜-ÊÔÚ›˜ Ì ÌÂÁ¿ÏÔ ‚·ıÌfi X ·‰Ú·ÓÔ-
Ô›ËÛ˘ (28). ø˜ ÚÔ˜ ÙË ÛËÌ·Û›· Ù˘ ÌÂÙ·ÏÏ·Á‹˜
p.T203ª (·ÁfiÚÈ FR120 Ì ·ÚÓËÙÈ΋ ÌËÙ¤Ú·), ÌÂϤÙË
ÌÂ ÙÔ ÏÔÁÈÛÌÈÎfi PolyPhen (http://genetics.
bwh.harvard.edu/pph/) ‰ÂÓ ÚÔ¤‚Ï„ ηÎÔ‹ıË
›‰Ú·ÛË ÛÙËÓ ÚˆÙ½ÓË, ˆÛÙfiÛÔ ‰ÂÓ ÌÔÚ› Ó·
·ÔÎÏÂÈÛı› Ë Â›‰Ú·ÛË ÛÙÔ Ê·ÈÓfiÙ˘Ô. ªÂϤÙ˜
Ì FÃS-·ÚÓËÙÈÎÔ‡˜ ·ÛıÂÓ›˜ ‰›ÓÔ˘Ó ıÂÙÈο ·ÔÙÂ-
ϤÛÌ·Ù· Û 0,5-2%, ÔÛÔÛÙ¿ Û˘ÁÎÚ›ÛÈÌ· Ì ÙË ÌÂ-
ϤÙË Ì·˜ (12,29).
∞fi ÙËÓ ÔÌ¿‰· ÙˆÓ 11 ·ÁÔÚÈÒÓ, Ô R11 (p.R106W)
›Ûˆ˜ ·ÚÔ˘ÛÈ¿˙ÂÈ ÛˆÌ·ÙÈÎfi ̈۷˚ÎÈÛÌfi, ˘fiıÂÛË
Û˘Ì‚·Ù‹ Ì ÙË Ê·ÈÓÔÙ˘È΋ ÙÔ˘ ÂÈÎfiÓ·, ηıÒ˜ ·Ó
¤ÊÂÚ ÙË ÌÂÙ¿ÏÏ·ÍË Û ϋÚË ÌÔÚÊ‹ ı· ÂÌÊ¿ÓÈ˙ È-
ı·Ófiٷٷ ÓÂÔÁÓÈ΋ ÂÁÎÂÊ·ÏÔ¿ıÂÈ· Î·È ‰ÂÓ ı· ÂÈ-
‚›ˆÓÂ. ∏ ÌËÙ¤Ú· ‰ÂÓ ‹Ù·Ó ‰È·ı¤ÛÈÌË ÁÈ· ÂͤٷÛË. ™ÙË
‚È‚ÏÈÔÁÚ·Ê›· ¤¯ÂÈ ·Ó·ÊÂÚı› Ì›· ·ÎfiÌË ·ÚfiÌÔÈ·
ÂÚ›ÙˆÛË (30). ∏ ÂÚ›ÙˆÛË Ì ÙÔ ÌÂÁ¿ÏÔ ¤ÏÏÂÈÌ-
Ì· (R59) ¯Ú‹˙ÂÈ ‰ÈÂÚ‡ÓËÛ˘ Ì ÔÛÔÙÈ΋ ̤ıÔ‰Ô.
∞Ó·ÎÂÊ·Ï·ÈÒÓÔÓÙ·˜, ÙÔ RS ·ÔÙÂÏ› ÛËÌ·ÓÙÈ΋
Ó¢ÚÔ·Ó·Ù˘Íȷ΋ ‰È·Ù·Ú·¯‹ Ô˘ ÁÈ· ÚÒÙË ÊÔÚ¿
ÌÂÏÂÙ‹ıËΠÛÙÔÓ ÂÏÏËÓÈÎfi ÏËı˘ÛÌfi. ∏ ‰È¿ÎÚÈÛË ÛÂ
ÎÏ·ÛÈ΋ Î·È ¿Ù˘Ë ÌÔÚÊ‹ Á›ÓÂÙ·È ‚¿ÛÂÈ ÎÚÈÙËÚ›ˆÓ
ÂÈÙÚ¤ÔÓÙ·˜ ÙËÓ ·Ó›¯Ó¢ÛË ÌÂÙ·ÏÏ¿ÍÂˆÓ Û ÌÂÁ¿ÏÔ
ÔÛÔÛÙfi. øÛÙfiÛÔ, Ë ÌË ÂÎÏ‹ÚˆÛË ÙˆÓ ÎÚÈÙËÚ›ˆÓ
ÌÔÚ› Ó· ÂÁ›ÚÂÈ ̆ Ô„›· RS, ÏfiÁˆ Ù˘ ÂÌÏÔ΋˜ ÙÔ˘˘Â‡ı˘ÓÔ˘ ÁÔÓȉ›Ô˘ Û ÏËıÒÚ· Ê·ÈÓÔÙ‡ˆÓ. ¶ÚÔ-ÛÔ¯‹ Ú¤ÂÈ Ó· ‰Ôı› ÛÙ· ·È‰È¿ Ì AS Ê·ÈÓfiÙ˘ÔÎ·È ÛÙ· ·È‰È¿ Ì ·‰È¢ÎÚ›ÓÈÛÙË æ∫∫, Ó¢ÚÔÏÔÁÈοÚÔ‚Ï‹Ì·Ù· ¯ˆÚ›˜ ‰ÔÌÈΤ˜ ÂÁÎÂÊ·ÏÈΤ˜ ·ÓˆÌ·Ï›Â˜Î·È ·Ô˘Û›· ‰˘ÛÌÔÚÊÈÎÒÓ ÛÙÔȯ›ˆÓ. ∂ȉÈÎÔ› Ê·ÈÓfi-Ù˘ÔÈ ·ÁÔÚÈÒÓ Ô˘ Ú¤ÂÈ Ó· ·Ó·ÁÓˆÚ›˙ÔÓÙ·È Â›Ó·È‚Ú¤ÊË Ì ÛÔ‚·Ú‹ ÓÂÔÁÓÈ΋ ÂÁÎÂÊ·ÏÔ¿ıÂÈ·, ·ÁfiÚÈ·Ì ÛËÌ›· RS, ÌË-ÂȉÈ΋, ÌË-ÂÍÂÏÈÛÛfiÌÂÓË æ∫∫, Û˘-Óԉ¢fiÌÂÓË ·fi Ó¢ÚÔÏÔÁÈο ÚÔ‚Ï‹Ì·Ù· Î·È ÛÙ·Ï·›ÛÈ· ÔÈÎÔÁÂÓÔ‡˜ Ê˘ÏÔÛ‡Ó‰ÂÙ˘ æ∫∫.
∏ ÁÂÓÂÙÈ΋ Û˘Ì‚Ô˘Ï¢ÙÈ΋ Â›Ó·È ÔχÏÔÎË, η-ıÒ˜ 99% ÙˆÓ ÎÔÚÈÙÛÈÒÓ ¤¯ÂÈ de novo ÌÂÙ·ÏÏ¿ÍÂȘ Ïfi-Áˆ ̈۷˚ÎÈÛÌÔ‡ ÙˆÓ ÁÔÓ¿‰ˆÓ ÙÔ˘ ·Ù¤Ú· Î·È ÌfiÓÔ1% Â›Ó·È ÔÈÎÔÁÂÓ›˜ ÂÚÈÙÒÛÂȘ. ™ÙȘ ÂÚÈÙÒÛÂȘıÂÙÈÎÒÓ ·ÁÔÚÈÒÓ, Ú¤ÂÈ Ó· ÂϤÁ¯ÂÙ·È Î·È Ë ÌËÙ¤Ú·,‰ÈfiÙÈ Û˘Ó‹ıˆ˜ Â›Ó·È ·Û˘Ìو̷ÙÈÎfi˜ ÊÔÚ¤·˜. °È· ÙËÓÂÍ·ÛÊ¿ÏÈÛË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ Ì ¿Û¯ÔÓ Ì¤ÏÔ˜, Û˘ÓÈ-ÛÙ¿Ù·È ¤ÏÂÁ¯Ô˜ Ù˘ ÌËÙ¤Ú·˜ Î·È ÚÔÁÂÓÓËÙÈÎfi˜ ¤ÏÂÁ-¯Ô˜ Û ÌÂÏÏÔÓÙÈ΋ ·ËÛË. ∏ ·Ó·ÁÓÒÚÈÛË ÙÔ˘ RS ηÈÙˆÓ ¿Ù˘ˆÓ ÌÔÚÊÒÓ Î·È Ë ¤Ú¢ӷ Û ÁÔÓȉȷÎfi ›-Â‰Ô Û˘Ì‚¿ÏÏÔ˘Ó ÛÙË ‰ÈÂÚ‡ÓËÛË ÙˆÓ ÌÔÚÊÒÓ Ù˘ÓÔËÙÈ΋˜ ˘ÛÙ¤ÚËÛ˘ ÛÙÔÓ ·È‰ÈÎfi ÏËı˘ÛÌfi Î·È ÛÙËÁÂÓÂÙÈ΋ ηıÔ‰‹ÁËÛË ÙˆÓ ÔÈÎÔÁÂÓÂÈÒÓ.
µÈ‚ÏÈÔÁÚ·Ê›·:
1. Kim IJ, Kim YJ, Son BH, Nam SO, Kang HC, Kim HD, etal. Diagnostic mutational analysis of MECP2 in Korean pa-tients with Rett syndrome. Exp Mol Med 2006;38:119-125.
2. Hagberg B, Hagberg G. Rett syndrome: epidemiology andgeographical variability. Eur Child Adolesc Psychiatry1997;6 Suppl 1:5-7.
3. Hagberg B, Hanefeld F, Percy A, Skjeldal O. An update onclinically applicable diagnostic criteria in Rett syndrome.Comments to Rett Syndrome Clinical Criteria ConsensusPanel Satellite to European Paediatric Neurology SocietyMeeting, Baden Baden, Germany, 11 September 2001. EurJ Paediatr Neurol 2002;6:293-297.
4. Amir RE, Van den Veyver IB, Wan M, Tran CQ, FranckeU, Zoghbi HY. Rett syndrome is caused by mutations in X-linked MECP2, encoding methyl-CpG-binding protein 2.Nat Genet 1999;23:185-188.
5. Mnatzakanian GN, Lohi H, Munteanu I, Alfred SE, Yama-da T, MacLeod PJ, et al. A previously unidentified MECP2open reading frame defines a new protein isoform relevantto Rett syndrome. Nat Genet 2004;36:339-341.
6. Van den Veyver IB, Zoghbi HY. Methyl-CpG-binding pro-tein 2 mutations in Rett syndrome. Curr Opin Genet Dev2000;10:275-279.
7. Horike S, Cai S, Miyano M, Cheng JF, Kohwi-ShigematsuT. Loss of silent-chromatin looping and impaired imprint-ing of DLX5 in Rett syndrome. Nat Genet 2005;37:31-40.
8. Martinowich K, Hattori D, Wu H, Fouse S, He F, Hu Y, etal. DNA methylation-related chromatin remodeling in ac-tivity-dependent BDNF gene regulation. Science 2003;302:890-893.
9. Shahbazian MD, Antalffy B, Armstrong DL, Zoghbi HY.Insight into Rett syndrome: M∂CP2 levels display tissue-
46 ™. æÒÓË Î·È Û˘Ó.
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Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·46
47∫ÏÈÓÈ΋ Î·È ÌÔÚȷ΋ ÌÂϤÙË ÙÔ˘ ÁÔÓȉ›Ô˘ MECP2
¶·È‰È·ÙÚÈ΋ 2008;71:38-47
and cell-specific differences and correlate with neuronalmaturation. Hum Mol Genet 2002;11:115-124.
10. Hagberg BA, Skjeldal OH. Rett variants: a suggested modelfor inclusion criteria. Pediatr Neurol 1994;11:5-11.
11. Hitchins MP, Rickard S, Dhalla F, Fairbrother UL, de VriesBB, Winter R, et al. Investigation of UBE3A and MECP2 inAngelman syndrome (AS) and patients with features of AS.Am J Med Genet A 2004;125:167-172.
12. Gomot M, Gendrot C, Verloes A, Raynaud M, David A,Yntema HG, et al. MECP2 gene mutations in non-syn-dromic X-linked mental retardation: phenotype-genotypecorrelation. Am J Med Genet A 2003;123:129-139.
13. Erlandson A, Hagberg B. MECP2 abnormality phenotypes:clinicopathologic area with broad variability. J Child Neu-rol 2005;20:727-732.
14. Moog U, Smeets EE, van Roozendaal KE, Schoenmakers S,Herbergs J, Schoonbrood-Lenssen AM, et al. Neurodevel-opmental disorders in males related to the gene causingRett syndrome in females (MECP2). Eur J Paediatr Neurol2003;7:5-12.
15. Orrico A, Lam C, Galli L, Dotti MT, Hayek G, Tong SF, etal. MECP2 mutation in male patients with non-specific X-linked mental retardation. FEBS Lett 2000;481:285-288.
16. Philippe C, Villard L, De Roux N, Raynaud M, BonnefondJP, Pasquier L, et al. Spectrum and distribution of MECP2mutations in 424 Rett syndrome patients: a molecular up-date. Eur J Med Genet 2006;49:9-18.
17. Miltenberger-Miltenyi G, Laccone F. Mutations and poly-morphisms in the human methyl CpG-binding proteinMECP2. Human Mutat 2003;22:107-115.
18. Lee SS, Wan M, Francke U. Spectrum of MECP2 muta-tions in Rett syndrome. Brain Dev 2001;23 Suppl 1:S138-S143.
19. Laccone F, Jünemann I, Whatley S, Morgan R, Butler R,Huppke P, et al. Large deletions of the MECP2 gene detect-ed by gene dosage analysis in patients with Rett syndrome.Hum Mutat 2004;23:234-244.
20. Kerr AM, Nomura Y, Armstrong D, Anvret M, BelichenkoPV, Budden S, et al. Guidelines for reporting clinical fea-tures in cases with MECP2 mutations. Brain Dev 2001;23:208-211.
21. Myers RM, Maniatis T, Lerman LS. Detection and localiza-tion of single base changes by denaturing gradient gel elec-trophoresis. Methods Enzymol 1987;155:501-527.
22. Voutoufianakis S, Psoni S, Vorgia P, Tsekoura F, Kekou K,Traeger-Synodinos J, et al. Coinheritance of mutatedSMN1 and MECP2 genes in a child with phenotypic fea-tures of spinal muscular atrophy (SMA) type II and Rettsyndrome. Eur J Paediatr Neurol 2007;11:235-239.
23. Schanen C, Houwink EJ, Dorrani N, Lane J, Everett R,Feng A, et al. Phenotypic manifestations of MECP2 muta-tions in classical and atypical Rett syndrome. Am J MedGenet A 2004;126:129-140.
24. Mari F, Azimonti S, Bertani I, Bolognese F, Colombo E,Caselli R, et al. CDKL5 belongs to the same molecularpathway of MECP2 and it is responsible for the early-onsetseizure variant of Rett syndrome. Hum Mol Genet,2005;14:1935-1946.
25. Charman T, Neilson TC, Mash V, Archer H, Gardiner MT,Knudsen GP, et al. Dimensional phenotypic analysis andfunctional categorisation of mutations reveal novel geno-type-phenotype associations in Rett syndrome. Eur J HumGenet 2005;13:1121-1130.
26. Ham AL, Kumar A, Deeter R, Schanen NC. Does genotypepredict phenotype in Rett syndrome? J Child Neurol2005;20:768-778.
27. Yusufzai TM, Wolffe AP. Functional consequences of Rettsyndrome mutations on human MECP2. Nucleic AcidsRes 2000;28:4172-4179.
28. Dayer AG, Bottani A, Bouchardy I, Fluss J, Antonarakis SE,Haenggeli CA, et al. MECP2 mutant allele in a boy withRett syndrome and his unaffected heterozygous mother.Brain Dev 2007;29:47-50.
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48 ∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞ ORIGINAL ARTICLE
Paediatriki 2008;71:48-54
¢È·Ù·Ú·¯¤˜ ÙÔ˘ ‡ÓÔ˘ Û ·È‰È¿ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜
π. ∫·Ï¤ÁÈ·˜1, µ. ƒÔ‡ÏË2, ∞. ∫·Ú·Ù˙·Ê¤ÚË3, ∫. ¢·ÎÔÚÒÓÈ·˜2, ª. ¶··˚ˆ¿ÓÓÔ˘2, £. ¢·Ó›‰Ë1,
√. ¢. ¶··ÁˆÚÁ›Ô˘2, ∫. ¶·Ô˘ÙÛ‹2, °. ∫ÚÔÎȉ¿˜2, ¡. ¢È·Ì·ÓÙfiÔ˘ÏÔ˜1
¶ÂÚ›ÏË„Ë
™ÎÔfi˜: ™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‹Ù·Ó Ë ‰ÈÂÚ‡ÓËÛË Ù˘ ›وÛ˘ ÙˆÓ ‰È·Ù·Ú·¯ÒÓ ÙÔ˘ ‡ÓÔ˘Û ·È‰È¿ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ Î·È Ë Èı·Ó‹ Û˘Û¯¤ÙÈÛË ÙˆÓ ‰È·Ù·Ú·¯ÒÓ ·˘ÙÒÓ Ì ÔÈΛÏÔ˘˜ ÎÔÈÓˆÓÈÎÔ‡˜ ηÈÂÚÈ‚·ÏÏÔÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜.
ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ÃÔÚËÁ‹ıËÎÂ Ù˘ÔÔÈË̤ÓÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Û 166 ÁÔÓ›˜ ·È‰ÈÒÓ ËÏÈΛ·˜ 6-12ÂÙÒÓ Ô˘ ÂÈÛΤÊıËÎ·Ó ÙÔ ¡ÔÛÔÎÔÌ›Ô.
∞ÔÙÂϤÛÌ·Ù·: ∂·Ú΋˜ ‡ÓÔ˜ (≥10 ÒÚ˜) ÙȘ ηıËÌÂÚÈÓ¤˜ ·Ó·Ê¤ÚÂÙ·È ÛÙÔ 39% ÙˆÓ ·È‰ÈÒÓ 6-9 ÂÙÒÓÎ·È ÛÙÔ 9% ÙˆÓ ·È‰ÈÒÓ 10-12 ÂÙÒÓ (p=0,0001), ÂÓÒ Ù· ™·‚‚·ÙÔ·Úȷη ÛÙÔ 74% Î·È 57%, ·ÓÙ›ÛÙÔȯ·(p=0,025). ∆Ô 24,7% ÙˆÓ ·È‰ÈÒÓ ·ÚÔ˘Û›·˙·Ó Û˘ÓÔÏÈο ÙȘ ÂÍ‹˜ ‰È·Ù·Ú·¯¤˜ ‡ÓÔ˘:
I. ¢˘Û˘ÓÈΤ˜ ‰È·Ù·Ú·¯¤˜ (dysomnias): ·ÓÙ›ÛÙ·ÛË Ó· ¿ÂÈ ÛÙÔ ÎÚ‚¿ÙÈ (31%), ·Ó¿ÁÎË ÁÈ· Û˘Óԉ›· ÁÈ·‡ÓÔ (26%), ËÌÂÚ‹ÛÈ· ˘ÓËÏ›· (14%), Ó˘¯ÙÂÚÈÓ‹ ·Ê‡ÓÈÛË (9,6%), ‡ÓÔ ÛÙÔ ÎÚ‚¿ÙÈ ÙˆÓ ÁÔÓÈÒÓ(9%), ÚÔ¯·ÏËÙfi (7,2%) Î·È ‰˘ÛÎÔÏ›· Ó· ·ÔÎÔÈÌËı› (6,6%).
ππ. ¶·Ú·¸ÓÈΤ˜ ‰È·Ù·Ú·¯¤˜ (parasomnia): ·Ú·ÌÈÏËÙfi (11,4%), ÙÚÈÛÌfi˜ ‰ÔÓÙÈÒÓ (10,2%), Û˘Á¯˘ÙÈΤ˜·Ê˘Ó›ÛÂȘ (7,2%), ÂÊÈ¿ÏÙ˜ (5%), Ú˘ıÌÈΤ˜ ÎÈÓ‹ÛÂȘ (3%), Ó˘¯ÙÂÚÈÓ‹ ÂÓÔ‡ÚËÛË (2,4%), Ó˘¯ÙÂÚÈÓfi˜ÙÚfiÌÔ˜ (1,8%) Î·È ˘ÓÔ‚·Û›· (1,8%). ªfiÓÔ ÙÔ 10% ÙˆÓ ÁÔÓ¤ˆÓ ·Ó·ÁÓˆÚ›˙Ô˘Ó ÙËÓ ‡·ÚÍË ‰È·Ù·-Ú·¯‹˜ ‡ÓÔ˘, ÂÓÒ ÌfiÏȘ ÔÈ ÌÈÛÔ› ·fi ·˘ÙÔ‡˜ ÈÛÙÂ‡Ô˘Ó fiÙÈ ·˘Ùfi ¤¯ÂÈ ‰˘ÛÌÂÓ‹ ›‰Ú·ÛË ÛÙËÓ ÔÈÎÔ-Á¤ÓÂÈ·, ηıÒ˜ Î·È ÛÙË Û¯ÔÏÈ΋ ·fi‰ÔÛË ÙÔ˘ ·È‰ÈÔ‡.
™˘ÌÂÚ¿ÛÌ·Ù·: ™ÙËÓ ·ÚÔ‡Û· ÛÂÈÚ¿ ·È‰ÈÒÓ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜, ÔÈ ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ‡ÓÔ˘ ‹Ù·Ó Û˘¯Ó¤˜(25%). ŸÌˆ˜, ÌfiÓÔ ÙÔ 10% ÙˆÓ ÁÔÓ¤ˆÓ ÈÛÙÂ‡Ô˘Ó fiÙÈ Ù· ·È‰È¿ ÙÔ˘˜ ¤¯Ô˘Ó οÔÈÔ Úfi‚ÏËÌ· ÛÙÔÓ‡ÓÔ. ŒÙÛÈ, Ë ¯Ú‹ÛË Ù˘ÔÔÈË̤ÓÔ˘ ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘ ı· ÌÔÚÔ‡Û ӷ ‰È¢ÎÔχÓÂÈ ÛÙÔÓ ÂÓÙÔÈÛÌfi·È‰ÈÒÓ Ì ‰È·Ù·Ú·¯¤˜ ÛÙÔÓ ‡ÓÔ Î·È ÙËÓ ·Ú·ÔÌ‹ ÙÔ˘˜ ÁÈ· ÂÚ·ÈÙ¤Úˆ ·ÓÙÈÌÂÙÒÈÛË.
§¤ÍÂȘ ÎÏÂȉȿ: ¢È·Ù·Ú·¯¤˜ ÙÔ˘ ‡ÓÔ˘, ·È‰È¿, ÁÔÓ›˜, ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ.
Sleep problems in school-age children
J. Kaleyias1, V. Rouli2, A. Karatzaferi3, K. Dakoronias2, M. Papaioannou2, T. Danidi2,
U. D. Papageorgiou2, K. Papoutsi2, G. Krokidas2, N. Diamantopoulos1
Abstract
Objectives: To survey the prevalence of sleep problems in school-age children and to explore theassociation between sleep disorders and various social and environmental factors.
Methods: Sleep questionnaires were administrated to the parents of 166 children aged between 6 and 12years.
Results: Sufficient sleep (≥10 hours) was reported during the week for 39% of children aged 6-9 years and9% of those aged 10-12 years (p=0.0001), while at the weekends the corresponding percentages were74% and 57% respectively (p=0.025). The overall prevalence of sleep problems was 24.7%, andspecifically:
I. Dysomnia-related sleep-wake behaviour: bedtime resistance (31%), needing to be accompanied bysomeone (26%), daytime sleepiness (14%), night waking (9.6%), coming to parents’ bed (9%),snoring (7.2%), and difficulty in falling asleep (6.6%).
II. Parasomnia-related sleep behaviour: talking in the sleep (11.4%), teeth grinding (10.2%), confusedarousals (7.2%), nightmares (5%), rhythmical movements (3%), bed wetting (2.4%), night terrors(1.8%), and sleepwalking (1.8%). Ten percent of parents admitted that their child had a sleepproblem, of which only 50% considered that this was a burden for the family.
Conclusions: Sleep problems are common among school-age children, with an overall incidence of 25%,although only 10% of the parents reported that their children might have a sleep problem. The sleepquestionnaire could help for the identification of children with sleep problems.
Key words: Sleep problems, children, parents, questionnaire.
1 ¶·È‰ÔÓ¢ÚÔÏÔÁÈÎfi ∆Ì‹Ì·,¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ¶¿ÙÚ·˜ “∫·Ú·Ì·Ó‰¿ÓÂÈÔ”
2 ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋,¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ¶¿ÙÚ·˜ “∫·Ú·Ì·Ó‰¿ÓÂÈÔ”
3 ∂ȉÈ΋ ¶·ıÔÏfiÁÔ˜
AÏÏËÏÔÁÚ·Ê›·:
¢Ú. πˆÛ‹Ê ∫·Ï¤ÁÈ·˜[email protected]¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ ¶¿ÙÚ·˜“∫·Ú·Ì·Ó‰¿ÓÂÈÔ”∂Ú˘ıÚÔ‡ ™Ù·˘ÚÔ‡ 40,∆.∫. 263 31, ¶¿ÙÚ·
1 Paediatric NeurologyDepartment,“Karamandanion”Children’s Hospital ofPatras, Patras, Greece
2 Paediatric Department,“Karamandanion”Children’s Hospital ofPatras, Patras, Greece
3 Internist
Correspondence:
J. [email protected]“Karamandanion”Children’s Hospital of Patras40, Erythrou Stavrou St.,263 31, Patras, Greece
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·48
49¢È·Ù·Ú·¯¤˜ ÙÔ˘ ‡ÓÔ˘
¶·È‰È·ÙÚÈ΋ 2008;71:48-54
∂ÈÛ·ÁˆÁ‹
√ ‡ÓÔ˜ Â›Ó·È ÎÔÈÓ¿ ·Ô‰ÂÎÙfi fiÙÈ Û˘Ì‚¿ÏÏÂÈ
ÛÙËÓ Â˘ÂÍ›· ÙˆÓ ·È‰ÈÒÓ Î·È ·ÔÙÂÏ› ÛËÌ·ÓÙÈÎfi
‰Â›ÎÙË “ηϋ˜ ˘Á›·˜”, fiˆ˜ ›¯Â ‰È·Ù˘ÒÛÂÈ Î·È Ô
πÔÎÚ¿Ù˘ (1). ∆· ·È‰È¿ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ ¯ÚÂÈ¿-
˙ÔÓÙ·È Û˘ÓÔÏÈο 10-11 ÒÚ˜ ‡ÓÔ ÙËÓ Ë̤ڷ (2).
∞Ó·Ú΋˜ Û ‰È¿ÚÎÂÈ· ‡ÓÔ˜ Û˘Û¯ÂÙÈ˙fiÌÂÓÔ˜ ÌÂ
˘ÓËÏ›· ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ Ë̤ڷ˜ (daytime
sleepiness) ·ÔÙÂÏ› ¤Ó· Û˘¯Ófi ‡ÚËÌ· Û ·È‰È¿
Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ Î·È ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙ› Ì ‰˘ÛÌÂÓ›˜
ÂÈÙÒÛÂȘ ÛÙȘ ÓÔËÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜, ÙË Ê˘ÛÈ΋
Î·È Û˘Ó·ÈÛıËÌ·ÙÈ΋ ˘Á›·, ηıÒ˜ ›Û˘ Ì ÚÔ-
‚Ï‹Ì·Ù· ÂÈÎÔÈÓˆÓ›·˜ Î·È Î·Ù¿¯ÚËÛË Ô˘ÛÈÒÓ (1,3).
√È ‰È·Ù·Ú·¯¤˜ ÛÙÔÓ ‡ÓÔ Â›Ó·È Û˘¯Ó¤˜ ηı’ fiÏË
ÙË ‰È¿ÚÎÂÈ· Ù˘ ˙ˆ‹˜, ·Ó Î·È Ë Â›ÙˆÛË ÙˆÓ Û˘ÁÎÂ-
ÎÚÈÌ¤ÓˆÓ ‰È·Ù·Ú·¯ÒÓ ÂÍ·ÚÙ¿Ù·È ·fi ÙËÓ ËÏÈΛ· (1).
°È· ·Ú¿‰ÂÈÁÌ·, Ù· ·È‰È¿ ÓËȷ΋˜ ËÏÈΛ·˜ ·ÚÔ˘-
ÛÈ¿˙Ô˘Ó Û˘¯Ó¿ ·ÓÙ›ÛÙ·ÛË ÁÈ· Ó· ¿Ó ÛÙÔ ÎÚ‚¿ÙÈ
ÙÔ˘˜ ÙËÓ ÒÚ· ÙÔ˘ ‡ÓÔ˘, ÂÓÒ Ù· ·È‰È¿ Ù˘ ÚÔÂÊË-
‚È΋˜ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ ¤¯Ô˘Ó Û˘¯ÓfiÙÂÚ· ‰È·Ù·Ú·-
¯¤˜ ‡ÓÔ˘, fiˆ˜ ˘ÓÔ‚·Û›·, ÂÊÈ¿ÏÙ˜ Î·È ÙÚÈÛÌfi
ÙˆÓ ‰ÔÓÙÈÒÓ (4). √È ¤ÊË‚ÔÈ Î·È ÔÈ ÂÓ‹ÏÈΘ ·ÚÔ˘-
ÛÈ¿˙Ô˘Ó Û˘¯ÓfiÙÂÚ· ÚÔ‚Ï‹Ì·Ù·, fiˆ˜ ·¸Ó›· ηÈ
˘ÓËÏ›· ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ Ë̤ڷ˜ (5).
√È ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ‡ÓÔ˘ ÛÙËÓ ·È‰È΋ ËÏÈΛ·
·ÔÙÂÏÔ‡Ó ÛËÌ·ÓÙÈÎfi ‰›Ô ÌÂϤÙ˘, ·ÊÔ‡ Ù·
˘¿Ú¯ÔÓÙ· ‚È‚ÏÈÔÁÚ·ÊÈο ‰Â‰Ô̤ӷ Â›Ó·È ·Ó·Ú-
΋. ∆· ·È‰È¿, Û ·ÓÙ›ıÂÛË Ì ÙÔ˘˜ ÂÓ‹ÏÈΘ, Û¿-
ÓÈ· ·ÈÙÈÒÓÙ·È ÁÈ· ÚÔ‚Ï‹Ì·Ù· ÛÙÔÓ ‡ÓÔ Î·È ÔÈ ÁÔ-
Ó›˜, Ô˘ Â›Ó·È Î·È ÔÈ ÌÔÓ·‰ÈÎÔ› “·Ú·ÙËÚËÙ¤˜” ÙÔ˘
‡ÓÔ˘ ÙˆÓ ·È‰ÈÒÓ, Â›Ó·È ÔÈ ÌfiÓÔÈ Ô˘ ÌÔÚÔ‡Ó Ó·
‰ÒÛÔ˘Ó ÈηÓÔÔÈËÙÈΤ˜ ÏËÚÔÊÔڛ˜ (6). ∆· ÚÔ-
‚Ï‹Ì·Ù· ÙÔ˘ ‡ÓÔ˘ ÌÔÚ› Ó· Â›Ó·È ·ÔÙ¤ÏÂÛÌ·
ÛËÌ·ÓÙÈÎÒÓ È·ÙÚÈÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ, fiˆ˜ ÂÈÏË-
„›·, ‰È¿¯˘ÙË ·Ó·Ù˘Íȷ΋ ‰È·Ù·Ú·¯‹, ¿ÓÔÈ·, Ï‹-
„Ë Ê·ÚÌ¿ÎˆÓ (5). ¶ÚfiÛÊ·Ù·, ÔÈ ∫·Ï¤ÁÈ·˜ Î·È Û˘Ó.
(7) ¤‰ÂÈÍ·Ó fiÙÈ Ë ·¸Ó›· ÌÔÚ› Ó· Â›Ó·È ÂΉ‹ÏˆÛË
‰È¿¯˘ÙˆÓ ·Ó·Ù˘ÍÈ·ÎÒÓ ‰È·Ù·Ú·¯ÒÓ. ¶ÈÔ Û˘ÁÎÂ-
ÎÚÈ̤ӷ, Û ÌÈ· ÛÂÈÚ¿ 48 ·ÛıÂÓÒÓ ËÏÈΛ·˜ 1,5-18
ÂÙÒÓ Ô˘ ·ÍÈÔÏÔÁ‹ıËÎ·Ó ÏfiÁˆ Û˘ÌÙˆÌ¿ÙˆÓ ·¸-
Ó›·˜ Û ·È‰È·ÙÚÈÎfi ΤÓÙÚÔ ‡ÓÔ˘ ÛÙȘ ∏¶∞, ÔÈ 9
(19%) ›¯·Ó ·˘ÙÈÛÌfi Ô˘ ‰È¤Ï·ı Ù˘ ‰È¿ÁÓˆÛ˘.
∞‰È·ÌÊÈÛ‚‹ÙËÙ·, Ù· ÚÔ‚Ï‹Ì·Ù· ÙÔ˘ ‡ÓÔ˘ ¿-
ÁÔÓÙ·È ‹ ÂËÚ¿˙ÔÓÙ·È ·fi ÂÚÈ‚·ÏÏÔÓÙÈÎÔ‡˜ ·-
Ú¿ÁÔÓÙ˜, fiˆ˜ Ë ·Ô˘Û›· ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÛÙËÓ ÔÈ-
ÎÔÁ¤ÓÂÈ· Î·È Ë ÌË ÂÊ·ÚÌÔÁ‹ ÙˆÓ Î·ÓfiÓˆÓ ˘ÁÈÂÈÓ‹˜
ÙÔ˘ ‡ÓÔ˘.
ªÈ· Û˘¯Ó‹ Ù·ÍÈÓfiÌËÛË ÙˆÓ ‰È·Ù·Ú·¯ÒÓ ÙÔ˘
‡ÓÔ˘ Â›Ó·È Û ‰˘Û˘ÓÈΤ˜ (dysomnias) Î·È ·Ú·¸ÓÈ-
Τ˜ (parainsomnias) (8). ¢˘Û˘ÓÈΤ˜ ÔÓÔÌ¿˙ÔÓÙ·È ÔÈ
‰È·Ù·Ú·¯¤˜ ÙÔ˘ ‡ÓÔ˘ Ô˘ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi
·ÓÂÈÙ˘¯‹, ·Ó·Ú΋, ‹ ˘ÂÚ‚ÔÏÈ΋˜ ‰È¿ÚÎÂÈ·˜
‡ÓÔ, fiˆ˜ Ë ·¸Ó›· (‰˘ÛÎÔÏ›· ÛÙËÓ Â¤Ï¢ÛË ÙÔ˘
‡ÓÔ˘) ‹/Î·È Ë Ó˘¯ÙÂÚÈÓ‹ ·Ê‡ÓÈÛË (·¸Ó›·-
insomnia) (9). √È ·Ú·¸ÓÈΤ˜ ‰È·Ù·Ú·¯¤˜ Ô˘ Ï·Ì-
‚¿ÓÔ˘Ó ¯ÒÚ· ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘ Â›Ó·È ÔÈ
Ó˘¯ÙÂÚÈÓÔ› ÂÊÈ¿ÏÙ˜, Ô Ó˘¯ÙÂÚÈÓfi˜ ÙÚfiÌÔ˜, Ë Ó˘¯ÙÂ-
ÚÈÓ‹ ÂÓÔ‡ÚËÛË, Î.¿. ∂ȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜ ¤¯Ô˘Ó
ηٷ‰Â›ÍÂÈ fiÙÈ ÙfiÛÔ ÔÈ ‰˘Û˘ÓÈΤ˜, fiÛÔ Î·È ÔÈ ·Ú·-
¸ÓÈΤ˜ ‰È·Ù·Ú·¯¤˜, Â›Ó·È Û˘¯Ó¤˜ ÛÙËÓ ·È‰È΋ ËÏÈ-
Λ· (8,10,11).
H ̤ıÔ‰Ô˜ ÂÎÏÔÁ‹˜ (gold standard) ÁÈ· ÙËÓ ·ÍÈÔ-
ÏfiÁËÛË ÙˆÓ ‰È·Ù·Ú·¯ÒÓ ÙÔ˘ ‡ÓÔ˘ Â›Ó·È Ë ÔÏ˘¸-
ÓÔÁÚ·ÊÈ΋ ÌÂϤÙË (overnight polysomnography -
PSG) (12). ∏ ÌÂϤÙË ‡ÓÔ˘ ·ÓÙÈÎÂÈÌÂÓÔÔÈ› Ù· ¢-
Ú‹Ì·Ù·, ··ÈÙ› fï˜ ¤Ó· ¿ÚÙÈ· ÔÚÁ·ÓˆÌ¤ÓÔ Î¤ÓÙÚÔ
·È‰È·ÙÚÈ΋˜ ÎÏÈÓÈ΋˜ ‡ÓÔ˘. √ ·ÚÈÔ˜ ÏfiÁÔ˜, ÁÈ·
ÙÔÓ ÔÔ›Ô Ë ÔÏ˘¸ÓÔÁÚ·ÊÈ΋ ÌÂϤÙË ‰ÂÓ ÂÊ·ÚÌfi-
˙ÂÙ·È ÛÙËÓ Ú¿ÍË ‹ ÛÙË ‰ÈÂÚ‡ÓËÛË Ù˘ ·¸Ó›·˜ ÙˆÓ
·È‰ÈÒÓ, Â›Ó·È ÁÈ·Ù› ··ÈÙ› Û˘Óı‹Î˜ ÓÔÛÔÎÔÌ›Ԣ
Î·È Û‡Ó‰ÂÛË ÙÔ˘ ·È‰ÈÔ‡ Ì ÔÏÏ·Ï¿ ËÏÂÎÙÚfi‰È·.
ø˜ ÂÎ ÙÔ‡ÙÔ˘, ˘¿Ú¯ÂÈ ·‰˘Ó·Ì›· ›Ù¢Í˘ ȉ·ÓÈ-
ÎÒÓ Û˘ÓıËÎÒÓ ÁÈ· ÙË ÌÂϤÙË Ù˘ ·¸Ó›·˜ (12) ηÈ
ÂӉ›ÎÓ˘Ù·È ÌfiÓÔ Û ÂÚÈÙÒÛÂȘ, fiÔ˘ ˘Ô„È·˙fi-
Ì·ÛÙ ·ÔÊÚ·ÎÙÈΤ˜ ¿ÓÔȘ (Obstructive Sleep
Apnea Syndrome - OSAS), ÂÚÈÔ‰ÈΤ˜ ÎÈÓ‹ÛÂȘ ÛÙÔÓ
‡ÓÔ (periodic leg movements - PLMs), ‰È·Ù·Ú·¯¤˜
Ù˘ Ê¿Û˘ REM, ·Ó Ë ‰È¿ÁÓˆÛË Ù˘ ·¸Ó›·˜ ·ÌÊÈ-
Û‚ËÙÂ›Ù·È ‹ ·Ó Ë ıÂڷ›· ·ÔÙ‡¯ÂÈ (13). ∂›Û˘,
·ÔÙÂÏ› ÛËÌ·ÓÙÈÎfi ÂÚ¢ÓËÙÈÎfi ÂÚÁ·ÏÂ›Ô ÛÙË ÌÂϤ-
ÙË ÙˆÓ ‰È·Ù·Ú·¯ÒÓ ÙÔ˘ ‡ÓÔ˘, fiˆ˜ ÚfiÛÊ·Ù·
¤‰ÂÈÍ·Ó ÔÈ ∫·Ï¤ÁÈ·˜ Î·È Û˘Ó. (14), fiÙ·Ó ‰ÈÂÚ‡ÓËÛ·Ó
ÙȘ Ó˘¯ÙÂÚÈÓ¤˜ ·Ê˘Ó›ÛÂȘ Û ·È‰È¿, Ì ÙË ¯Ú‹ÛË
ÂÈÚfiÛıÂÙˆÓ ÌÂوȷ›ˆÓ ËÏÂÎÙÚÔ‰›ˆÓ ÂÎÙfi˜ ÙˆÓ
Û˘Ì‚·ÙÈÎÒÓ ÎÂÓÙÚÈÎÒÓ, ÚÔÎÂÈ̤ÓÔ˘ Ó· ‰È¢ÎÚÈÓÈ-
ÛıÔ‡Ó ÔÈ Ì˯·ÓÈÛÌÔ› Ù˘ ·Ê‡ÓÈÛ˘ Û ·È‰È¿ ÌÂ
‰È·Ù·Ú·¯¤˜ ÛÙÔÓ ‡ÓÔ.
√È ÁÔÓ›˜, ˆ˜ ·ÚÈÔÈ Ì¿ÚÙ˘Ú˜ ÙÔ˘ ·È‰ÈÎÔ‡
‡ÓÔ˘, ÌÔÚ› Ó· Û˘Ì‚¿ÏÏÔ˘Ó ÛËÌ·ÓÙÈο ÛÙË ÌÂϤ-
ÙË ÙˆÓ ‰È·Ù·Ú·¯ÒÓ ÙÔ˘ ‡ÓÔ˘ ÛÙ· ·È‰È¿ ̤ۈ Ù˘-
ÔÔÈË̤ÓÔ˘ ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘, Ì ÛËÌ·ÓÙÈÎÔ‡˜
fï˜ ÂÚÈÔÚÈÛÌÔ‡˜, ·ÊÔ‡ ÛÙËÚ›˙ÂÙ·È ÛÙËÓ ˘ÔÎÂÈ-
ÌÂÓÈÎfiÙËÙ¿ ÙÔ˘˜ (6,15).
™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‹Ù·Ó Ë ‰ÈÂÚ‡ÓË-
ÛË ÙˆÓ ‰È·Ù·Ú·¯ÒÓ ÙÔ˘ ‡ÓÔ˘ Û ˘ÁÈ‹ ·È‰È¿ Û¯ÔÏÈ-
΋˜ ËÏÈΛ·˜ (6-12 ÂÙÒÓ) Ì ÙË ¯ÔÚ‹ÁËÛË Ù˘ÔÔÈË-
̤ÓÔ˘ ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘ ÛÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘˜ Î·È Ë Û˘-
Û¯¤ÙÈÛË ÙˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ ·˘ÙÒÓ Ì ÔÈΛÏÔ˘˜ ·-
Ú¿ÁÔÓÙ˜ (ÎÔÈÓˆÓÈÎÔ‡˜, Û˘Óı‹Î˜ ‰È·‚›ˆÛ˘ Î·È Û˘-
Ó‹ıÂȘ) Ô˘ ·ÏÏ¿˙Ô˘Ó ÛËÌ·ÓÙÈο Ì ÙËÓ ¿ÚÔ‰Ô
ÙÔ˘ ¯ÚfiÓÔ˘ ÛÙËÓ ÂÏÏËÓÈ΋ ÎÔÈÓˆÓ›· Î·È ÂËÚ¿˙Ô˘Ó
ÙÔÓ ‡ÓÔ ÙˆÓ ·È‰ÈÒÓ ÛÙË ¯ÒÚ· Ì·˜ ¯ˆÚ›˜ Ó· ˘¿Ú-
¯Ô˘Ó ·Ú΋ ·Ó¿ÏÔÁ· ‚È‚ÏÈÔÁÚ·ÊÈο ‰Â‰Ô̤ӷ
(16). ∂›Û˘, Û˘Û¯ÂÙ›Û·Ì ÙȘ ‰È·Ù·Ú·¯¤˜ ·˘Ù¤˜ ÌÂ
ÙË ÛÊ·ÈÚÈ΋ ¿Ô„Ë ÙˆÓ ÁÔÓ¤ˆÓ Û¯ÂÙÈο Ì ÙËÓ
‡·ÚÍË ÚÔ‚Ï‹Ì·ÙÔ˜ ‡ÓÔ˘ ÛÙ· ·È‰È¿ ÙÔ˘˜.
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·49
50 π. ∫·Ï¤ÁÈ·˜ Î·È Û˘Ó.
Paediatriki 2008;71:48-54
ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ
π. ÀÏÈÎfi™ÙË ÌÂϤÙË Û˘ÌÂÚÈÂÏ‹ÊıËÛ·Ó 166 ·È‰È¿. ∫ÚÈÙ‹ÚÈ·
ÂÈÏÔÁ‹˜ ‹Ù·Ó:
1. ∏ÏÈΛ· 6-12 ÂÙÒÓ.
2. ∂ÏÏËÓÈ΋ ηٷÁˆÁ‹.
∂ÓÒ ÎÚÈÙ‹ÚÈ· ·ÔÎÏÂÈÛÌÔ‡ ‹Ù·Ó:
1. ∏ ‡·ÚÍË ÛÔ‚·ÚÔ‡ Ó¢ÚÔÏÔÁÈÎÔ‡ ÚÔ‚Ï‹Ì·ÙÔ˜ (ÂÁÎÂ-
Ê·ÏÈ΋ ·Ú¿Ï˘ÛË, ÓÔËÙÈ΋ ˘ÛÙ¤ÚËÛË, ‰È¿¯˘ÙË ·Ó·Ù˘Íȷ΋
‰È·Ù·Ú·¯‹, ‰È¿Û·ÛË ÚÔÛÔ¯‹˜-˘ÂÚÎÈÓËÙÈÎfiÙËÙ·, ÂÈÏË-
„›· ˘fi ·ÁˆÁ‹).
2. ∏ Ï‹„Ë ÔÔÈ·Û‰‹ÔÙ ̷ÎÚÔ¯ÚfiÓÈ·˜ ·ÁˆÁ‹˜.
∏ ÂÈÏÔÁ‹ ÙˆÓ ·È‰ÈÒÓ ‰ÈÂÓÂÚÁ‹ıËΠÛÙ· Ù·ÎÙÈο Â͈-
ÙÂÚÈο È·ÙÚ›· Ù˘ ∫ÏÈÓÈ΋˜.
ππ. ∂ÚˆÙËÌ·ÙÔÏfiÁÈÔ∆Ô ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ·˘Ùfi ›¯Â ¯ÔÚËÁËı› ÛÙÔ ·ÚÂÏıfiÓ
·fi ÙÔ˘˜ Smedje et al. (15) Û ·È‰È¿ ËÏÈΛ·˜ 5-7 ÂÙÒÓ ÛÙË
™Ô˘Ë‰›·.
∆Ô ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Â›¯Â 4 ̤ÚË:
1. ™ÙÔ ÚÒÙÔ Ì¤ÚÔ˜ Û˘ÌÂÚÈÂÏ‹ÊıËÛ·Ó ÏËÚÔÊÔڛ˜
Ô˘ ·ÊÔÚÔ‡Û·Ó ÙÔ ·È‰› (ʇÏÔ, ËÏÈΛ·, ÚÔˆÚfiÙËÙ·, ‰Â›-
ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜, ·¯˘Û·ÚΛ·), ÙȘ Û˘Óı‹Î˜ ‰È·‚›ˆÛ˘
(fiÛ· ¿ÙÔÌ· ̤ÓÔ˘Ó ÛÙÔ ›‰ÈÔ Û›ÙÈ, ·Ó ÙÔ ·È‰› ¤¯ÂÈ ‰ÈÎfi ÙÔ˘
˘ÓÔ‰ˆÌ¿ÙÈÔ, ·Ó fi¯È Ì fiÛ· ¿ÙÔÌ· ÙÔ ÌÔÈÚ¿˙ÂÙ·È, ·Ó ̤-
ÓÔ˘Ó Û ÌÔÓÔηÙÔÈΛ· ‹ ÔÏ˘Î·ÙÔÈΛ·, ·Ó Â›Ó·È Û ΤÓÙÚÔ ‹
Û ÚÔ¿ÛÙÈÔ, ·Ó ˘¿Ú¯ÂÈ Ê·Û·Ú›· ÙË Ó‡¯Ù· ‹ fi¯È), ÙÔ˘˜ ÁÔ-
Ó›˜ (ÌÔÚʈÙÈÎfi ›‰Ô, ¿ÁÁÂÏÌ·) Î·È ÙÔ ·ÙÔÌÈÎfi ·Ó·-
ÌÓËÛÙÈÎfi ÙÔ˘ ·È‰ÈÔ‡.
2. ™ÙÔ ‰Â‡ÙÂÚÔ Ì¤ÚÔ˜ Û˘ÌÂÚÈÂÏ‹ÊıËÛ·Ó ÁÂÓÈΤ˜ ÏËÚÔ-
ÊÔڛ˜ ÁÈ· ÙÔÓ ‡ÓÔ ÙÔ˘ ·È‰ÈÔ‡ (ÙÈ ÒÚ· ËÁ·›ÓÂÈ ÁÈ· ‡ÓÔ
ÙȘ ηıËÌÂÚÈÓ¤˜ Î·È Ù· ™·‚‚·ÙÔ·Úȷη, ÙÈ ÒÚ· Í˘Ó¿ÂÈ ÙȘ
ηıËÌÂÚÈÓ¤˜ Î·È Ù· ™·‚‚·ÙÔ·Úȷη, fiÛ˜ ÒÚ˜ ÈÛÙ‡ԢÓ
fiÙÈ ÎÔÈÌ¿Ù·È Û˘ÓÔÏÈο ÙȘ ηıËÌÂÚÈÓ¤˜ Î·È Ù· ™·‚‚·ÙÔ·ÚÈ·-
η, ·Ó ËÁ·›ÓÂÈ ÁÈ· ‡ÓÔ ÌÂÙ¿ ÙȘ 11 ÙÔ ‚Ú¿‰˘, ·Ó ¤¯ÂÈ ÙËÏÂ-
fiÚ·ÛË ÛÙÔ ‰ˆÌ¿ÙÈÔ ÙÔ˘, ·Ó ÎÔÈÌ¿Ù·È ÙÔ ÌÂÛË̤ÚÈ).
3. ™ÙÔ ÙÚ›ÙÔ Ì¤ÚÔ˜ Û˘ÌÂÚÈÂÏ‹ÊıËÛ·Ó 21 ÂÚˆÙ‹ÛÂȘ Ô˘
·ÊÔÚÔ‡Û·Ó ÙË Û˘ÌÂÚÈÊÔÚ¿ ÙÔ˘ ·È‰ÈÔ‡ ˆ˜ ÚÔ˜ ÙËÓ ÂÁÚ‹-
ÁÔÚÛË Î·È ÙÔÓ ‡ÓÔ. √È ÂÚˆÙ‹ÛÂȘ ·˘Ù¤˜ ·ÓȯÓÂ‡Ô˘Ó ‰˘Û˘-ÓÈΤ˜ (∂1-∂12) Î·È ·Ú·¸ÓÈΤ˜ (∂13-∂21) ‰È·Ù·Ú·¯¤˜ ηȂ·ıÌÔÏÔÁÔ‡ÓÙ·È ·fi 1 ¤ˆ˜ Î·È 5 (ÔÙ¤, ÂÚÈÛÙ·Ûȷο, 1-2ÊÔÚ¤˜ ÙËÓ Â‚‰ÔÌ¿‰·, 3-4 ÊÔÚ¤˜ ÙËÓ Â‚‰ÔÌ¿‰·, ÂÚÈÛÛfiÙÂÚÔ·fi ¤ÓÙ ÊÔÚ¤˜ ÙËÓ Â‚‰ÔÌ¿‰·). ∏ οı ÂÚÒÙËÛË ‚·ıÌÔÏÔ-Á‹ıËΠͯˆÚÈÛÙ¿ Î·È ÙÔ ·È‰› ‚·ıÌÔÏÔÁ‹ıËΠ̠‚¿ÛË fiϘÙȘ ··ÓÙ‹ÛÂȘ (score: 21-105).
4. ∆Ô Ù¤Ù·ÚÙÔ Ì¤ÚÔ˜ ·ÔÙÂÏ›ÙÔ ·fi 4 ÂÚˆÙ‹ÛÂȘ Ì ÛÎÔ-fi ÙËÓ ·ÔÙ‡ˆÛË Ù˘ ÛÊ·ÈÚÈ΋˜ ¿Ô„˘ (global aspect)ÙˆÓ ÁÔÓ¤ˆÓ ÁÈ· ÙËÓ ‡·ÚÍË ‹ fi¯È ÔÔÈÔ˘‰‹ÔÙ ÚÔ‚Ï‹Ì·-ÙÔ˜ ÛÙÔÓ ‡ÓÔ. ∏ ÚÒÙË ‹Ù·Ó ÛÊ·ÈÚÈ΋ ÂÚÒÙËÛË Û¯ÂÙÈο ÌÂÙÔ ·Ó ÈÛÙÂ‡Ô˘Ó fiÙÈ ÙÔ ·È‰› ÙÔ˘˜ ¤¯ÂÈ ‰È·Ù·Ú·¯‹ ÛÙÔÓ ‡ÓÔ‹ fi¯È. ŸÙ·Ó ··ÓÙÔ‡Û·Ó Î·Ù·Ê·ÙÈο, Û˘Ó¤¯È˙·Ó ÛÙȘ ¿ÏϘÙÚÂȘ ÂÚˆÙ‹ÛÂȘ Ô˘ ·ÊÔÚÔ‡Û·Ó ÙËÓ Â›ÙˆÛË ÙÔ˘ ÚÔ‚Ï‹-Ì·ÙÔ˜ ·˘ÙÔ‡ ÛÙÔ ›‰ÈÔ ÙÔ ·È‰›, ÛÙË Û¯ÔÏÈ΋ ÙÔ˘ ·fi‰ÔÛË Î·ÈÙ¤ÏÔ˜ ÛÙËÓ ›‰È· ÙËÓ ÔÈÎÔÁ¤ÓÂÈ·.
∏ Û˘ÌÏ‹ÚˆÛË ÙÔ˘ ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘ ‰ÈÂÓÂÚÁ‹ıËΠ·fiÙÔ˘˜ Û˘ÌÌÂÙ¤¯ÔÓÙ˜ ÛÙË ÌÂϤÙË È·ÙÚÔ‡˜ Ì ‚¿ÛË ÙȘ ··-ÓÙ‹ÛÂȘ Ô˘ ¤‰ÈÓ·Ó ÔÈ ÁÔÓ›˜.
πππ. ™Ù·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË∆· ÔÈÔÙÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÂÎÊÚ¿ÛÙËÎ·Ó Û ·fiÏ˘ÙÔ
·ÚÈıÌfi (¡) Î·È ÂηÙÔÛÙÈ·›Ô ÔÛÔÛÙfi (%), ÂÓÒ Ù· ÔÛÔÙÈο¯·Ú·ÎÙËÚÈÛÙÈο Û ̤ÛË ÙÈÌ‹ (SD). ¢ÈÂÓÂÚÁ‹ıËΠÌÔÓÔ·Ú·-ÁÔÓÙÈ΋ ·Ó¿Ï˘ÛË (‰ÔÎÈÌ·Û›· χ2 Î·È student t-test). ÃÚËÛÈÌÔ-ÔÈ‹ıËΠÙÔ ÛÙ·ÙÈÛÙÈÎfi ÚfiÁÚ·ÌÌ· SPSS (version 12).
∞ÔÙÂϤÛÌ·Ù·
π. ÷ڷÎÙËÚÈÛÙÈο ÙˆÓ ·È‰ÈÒÓ (¶›Ó·Î·˜ 1)™˘ÌÏËÚÒıËÎ·Ó Ù· 166 (92%) ÂÚˆÙËÌ·ÙÔÏfiÁÈ·
·fi Ù· 180 Ô˘ ¯ÔÚËÁ‹ıËηÓ.ππ. ™˘Ó‹ıÂȘ ÂÁÚ‹ÁÔÚÛ˘-‡ÓÔ˘∆Ô Û‡ÓÔÏÔ ÙˆÓ ·È‰ÈÒÓ ÙȘ ηıËÌÂÚÈÓ¤˜ ÎÔÈÌ¿-
Ù·È ÓˆÚ›ÙÂÚ· (10±0,8) Û ۯ¤ÛË Ì ٷ ™·‚‚·ÙÔ·-Úȷη (11±0,8) (p=0,01).
ªÂÙ¿ ÙȘ 11:00 Ì.Ì. ÙȘ ηıËÌÂÚÈÓ¤˜ ÎÔÈÌ¿Ù·È ÙÔ24% ÙˆÓ ·È‰ÈÒÓ Î·È Ù· ™·‚‚·ÙÔ·Úȷη ÙÔ 68%.
¶›Ó·Î·˜ 1. ÷ڷÎÙËÚÈÛÙÈο ·È‰ÈÒÓ
÷ڷÎÙËÚÈÛÙÈο
º‡ÏÔ ∞ÁfiÚÈ· ¡ (%) 74 (44,5%)∫ÔÚ›ÙÛÈ· ¡ (%) 92 (55,5%)
∏ÏÈΛ· ª¤ÛË ÙÈÌ‹ ± SD (¤ÙË) 9±2(min-max) (6-12)
¶ÚfiˆÚ· (<37 ‚‰ÔÌ¿‰ˆÓ) ¡ (%) 9 (5,4%)BMI (̤ÛË ± SD) 19,1±3,8
(25Ë-75Ë ∂£) (16-22)¶·¯˘Û·ÚΛ· (>95Ë ∂£) ¡ (%) 23 (13,9%)∆Ô ·È‰› ¤¯ÂÈ ‰ÈÎfi ÙÔ˘ ˘ÓÔ‰ˆÌ¿ÙÈÔ ¡ (%) 92 (55,4%)ªÔÓÔηÙÔÈΛ· ¡ (%) 110 (66%)¢È·ÌÔÓ‹ Û ÚÔ¿ÛÙÈÔ ¡ (%) 115 (69%)£fiÚ˘‚Ô˜ ÙË Ó‡¯Ù· ¡ (%) 21 (17,5%)ªÔÚʈÙÈÎfi Â›Â‰Ô ÌËÙ¤Ú·˜ π 24 (14,5%)
ππ 83 (50%)πππ 59 (35,5%)
ªÔÚʈÙÈÎfi Â›Â‰Ô ·Ù¤Ú· π 22 (13,3%)ππ 82 (49,4%)πππ 62 (37,3%)
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·50
∆· ·È‰È¿ ËÏÈΛ·˜ 6-9 ÂÙÒÓ ÎÔÈÌÔ‡ÓÙ·È ÌÂÙ¿ ÙȘ
11:00 Ì.Ì. ÙȘ ηıËÌÂÚÈÓ¤˜ ÏÈÁfiÙÂÚÔ Û˘¯Ó¿ Û ۯ¤ÛË
Ì ٷ ÌÂÁ·Ï‡ÙÂÚ· (11% Î·È 36% ·ÓÙ›ÛÙÔȯ·,
p<0,0001). ¶·ÚfiÌÔÈ·, Ù· ™·‚‚·ÙÔ·Úȷη ÎÔÈÌ¿Ù·È
ÌÂÙ¿ ÙȘ 11:00 Ì.Ì. ÙÔ 53% Î·È 81% ÙˆÓ ·È‰ÈÒÓ
·ÓÙ›ÛÙÔȯ· (p<0,0001).
∆Ô 75% ÙˆÓ ·È‰ÈÒÓ ÎÔÈÌ¿Ù·È Û˘ÓÔÏÈο ÏÈÁfiÙÂÚÔ
·fi 10 ÒÚ˜ ηıËÌÂÚÈÓ¿, ÂÓÒ Ù· ™·‚‚·ÙÔ·Úȷη
ÙÔ 33% ÎÔÈÌ¿Ù·È ÏÈÁfiÙÂÚÔ ·fi 10 ÒÚ˜. ∏ ÏÂÈÔÓfi-
ÙËÙ· ÙˆÓ ÌÂÁ¿ÏˆÓ ·È‰ÈÒÓ ‰ÂÓ ÎÔÈÌ¿Ù·È ÂÚÈÛÛfiÙÂ-
ÚÔ ·fi 10 ÒÚ˜ (90%) ÙȘ ηıËÌÂÚÈÓ¤˜, ÂÓÒ ÙÔ 60%
ÙˆÓ ·È‰ÈÒÓ 6-9 ÂÙÒÓ ÎÔÈÌÔ‡ÓÙ·È ÏÈÁfiÙÂÚÔ ·fi 10
ÒÚ˜ ÙȘ ηıËÌÂÚÈÓ¤˜ (p<0,0001). ∏ ‰È·ÊÔÚ¿ ·˘Ù‹
ÂÍ·ÎÔÏÔ˘ı› Ó· ˘Ê›ÛÙ·Ù·È Ù· ™·‚‚·ÙÔ·Úȷη, ·Ï-
Ï¿ Â›Ó·È ·ÛıÂÓ¤ÛÙÂÚË (25% 6-9 ÂÙÒÓ Î·È 42% 10-12
ÂÙÒÓ, p=0,02).
ªÔÓÔ·Ú·ÁÔÓÙÈ΋ Û˘Û¯¤ÙÈÛË Ù˘ ̤Û˘ ‰È¿ÚÎÂÈ·˜
‡ÓÔ˘, ÙfiÛÔ ÙȘ ηıËÌÂÚÈÓ¤˜ fiÛÔ Î·È Ù· ™·‚‚·ÙÔ·-
Úȷη, ‰ÂÓ ·Ó¤‰ÂÈÍÂ Û˘Û¯¤ÙÈÛË Ì ÙÔ Ê‡ÏÔ (p=0,55),
ÙËÓ ÚÔˆÚfiÙËÙ· (p=0,89),ÙËÓ ‡·ÚÍË ‰ÈÎÔ‡ ÙÔ˘ ‰ˆ-
Ì·Ù›Ô˘ (p=0,96), ÙË ‰È·ÌÔÓ‹ ÛÙÔ Î¤ÓÙÚÔ (p=0,48), ÙËÓ
·Ó·ÊÔÚ¿ ıÔÚ‡‚Ô˘ ÛÙË Î·ÙÔÈΛ· (p=0,56), ÙËÓ ‡·ÚÍË
ÙËÏÂfiÚ·Û˘ ÛÙÔ ˘ÓÔ‰ˆÌ¿ÙÈÔ (p=0,84) Î·È ÙË ÌfiÚ-
ʈÛË Ù˘ ÌËÙ¤Ú·˜ (p=0,19) Î·È ÙÔ˘ ·Ù¤Ú· (p=0,13).
∆· ·¯‡Û·Úη ·È‰È¿ ÎÔÈÌfiÓÙÔ˘Û·Ó ÏÈÁfiÙÂÚÔ ·fi Ù·
ÌË-·¯‡Û·Úη, ¯ˆÚ›˜ fï˜ Ë ‰È·ÊÔÚ¿ ·˘Ù‹ Ó· ›ӷÈ
ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ (p=0,09, Ù¿ÛË).
πππ. ∂ȉÈΤ˜ ‰È·Ù·Ú·¯¤˜ ‡ÓÔ˘
∏ ›وÛË ÙˆÓ ÂÈ̤ÚÔ˘˜ ‰È·Ù·Ú·¯ÒÓ ‡ÓÔ˘
Ì ‚¿ÛË ÙȘ ··ÓÙ‹ÛÂȘ ÙˆÓ ÁÔÓ¤ˆÓ ηٷÁÚ¿ÊÂÙ·È
ÛÙÔÓ ¶›Ó·Î· 2.
πV. ∫ϛ̷η ‰È·Ù·Ú·¯ÒÓ ‡ÓÔ˘ (¶›Ó·Î·˜ 3)
∏ ̤ÛË ÙÈÌ‹ (± SD) Ù˘ Îϛ̷η˜ ‹Ù·Ó 31,1
(±8,8) [25Ë ∂£ 27% Î·È 75Ë ∂£ 37%].
¢ÈÂÓÂÚÁ‹ıËÎÂ Û˘Û¯¤ÙÈÛË (ÌÔÓÔ·Ú·ÁÔÓÙÈ΋)
Ù˘ Îϛ̷η˜ ‰È·Ù·Ú·¯ÒÓ ÙÔ˘ ‡ÓÔ˘ Ì ‰È¿ÊÔÚ˜
ÌÂÙ·‚ÏËÙ¤˜. ¢È·ÈÛÙÒıËÎÂ Û˘Û¯¤ÙÈÛË Ì ÙËÓ ·Ó·-
ÊÔÚ¿ ıÔÚ‡‚Ô˘ ÙË Ó‡¯Ù· ÛÙÔ Û›ÙÈ (p=0,018), ÙËÓ
·ÚÔ˘Û›· ÙËÏÂfiÚ·Û˘ ÛÙÔ ˘ÓÔ‰ˆÌ¿ÙÈÔ ÙÔ˘ ·È‰È-
Ô‡ (p=0,001) Î·È ÙËÓ ËÏÈΛ· (p=0,001). ¢ÂÓ ‰È·È-
ÛÙÒıËÎÂ Û˘Û¯¤ÙÈÛË Ì ÙÔ Ê‡ÏÔ, ÙËÓ ÚÔˆÚfiÙËÙ·,
ÙËÓ ·¯˘Û·ÚΛ·, ÙË ‰È·ÌÔÓ‹, ÙÔ ÌÔÚʈÙÈÎfi ›‰Ô
ÌËÙ¤Ú·˜ Î·È ·Ù¤Ú· ‹ Ì ÙÔ ·Ó ÙÔ ·È‰› ›¯Â ‰ÈÎfi ÙÔ˘
˘ÓÔ‰ˆÌ¿ÙÈÔ.
V. ™Ê·ÈÚÈ΋ ¿Ô„Ë ÙˆÓ ÁÔÓ¤ˆÓ ÁÈ· ÙËÓ ‡·ÚÍË ‰È·-
Ù·Ú·¯ÒÓ ‡ÓÔ˘
™ÙËÓ ÂÚÒÙËÛË “ÈÛÙ‡ÂÙ fiÙÈ ÙÔ ·È‰› Û·˜ ÙÔ˘˜
ÙÂÏÂ˘Ù·›Ô˘˜ 6 Ì‹Ó˜ ·ÚÔ˘ÛÈ¿˙ÂÈ Î¿ÔÈ· ‰È·Ù·Ú·¯‹
ÛÙÔÓ ‡ÓÔ” ÙÔ 10% ÙˆÓ ÁÔÓ¤ˆÓ ·¿ÓÙËÛ ηٷʷÙÈ-
ο. ∏ ̤ÛË ‚·ıÌÔÏÔÁ›· ‰È·Ù·Ú·¯ÒÓ ‡ÓÔ˘ ÙˆÓ ·È-
‰ÈÒÓ, ÔÈ ÁÔÓ›˜ ÙˆÓ ÔÔ›ˆÓ ·Ó·Ê¤ÚÔ˘Ó fiÙÈ ¤¯Ô˘Ó Úfi-
‚ÏËÌ·, Â›Ó·È ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚË Û ۯ¤ÛË Ì ·˘Ù‹
ÙˆÓ ·È‰ÈÒÓ, ÙˆÓ ÔÔ›ˆÓ ÔÈ ÁÔÓ›˜ ÈÛÙÂ‡Ô˘Ó fiÙÈ ‰ÂÓ
¤¯Ô˘Ó Úfi‚ÏËÌ· (45±11 ¤Ó·ÓÙÈ 31,7±7,4, p<0,0001).
51¢È·Ù·Ú·¯¤˜ ÙÔ˘ ‡ÓÔ˘
¶·È‰È·ÙÚÈ΋ 2008;71:48-54
¶›Ó·Î·˜ 2. ¢È·Ù·Ú·¯¤˜ ÙÔ˘ ‡ÓÔ˘
™‡ÓÔÏÔ 6-9 10-12¡=186 ÂÙÒÓ ÂÙÒÓ
¡=80 ¡=86 p-value
¢˘Û˘ÓÈΤ˜ ‰È·Ù·Ú·¯¤˜¢˘ÛÎÔÏ›· Ó· ·ÔÎÔÈÌËı› 6,6% 10% 3,5% 0,04¡˘¯ÙÂÚÈÓ‹ ·Ê‡ÓÈÛË 9,6% 15% 4,6% 0,024∞Ó‹Û˘¯Ô Î·È ÎÔ˘ÓÈ¤Ù·È ÛÙÔÓ ‡ÓÔ ÙÔ˘ 17,4% 24% 11,6% 0,039¶fiÓÔÈ ÛÙ· fi‰È· ‹ Ù· ÎÔ˘Ó¿ÂÈ Î·È Í˘Ó¿ÂÈ 3% 5% 0,1% 0,19ƒÔ¯·Ï›˙ÂÈ 7,3% 10% 4,7% 0,18¢˘ÛÎÔÏ›· ÛÙËÓ ·Ó·ÓÔ‹ ÙÔ˘ 4,2% 6,2% 2,3% 0,26¡˘ÛÙ¿˙ÂÈ ÙËÓ Ë̤ڷ 14% 15% 12,7% 0,67∞ÓÙ›ÛÙ·ÛË Ó· ¿ÂÈ ÛÙÔ ÎÚ‚¿ÙÈ ÙÔ˘ ÙËÓ ÒÚ· ÙÔ˘ ‡ÓÔ˘ 31% 34% 29% 0,51¡Â˘ÚÈÎfi ‹ ·Ó‹Û˘¯Ô ÙËÓ ÒÚ· ÙÔ˘ ‡ÓÔ˘ 15,6% 25% 7% 0,002™˘Óԉ‡ÂÙ·È ·fi οÔÈÔÓ ÁÈ· Ó· ¿ÂÈ ÛÙÔ ÎÚ‚¿ÙÈ 26,5% 36,2% 17,4% 0,006∫ÔÈÌ¿Ù·È Ì¤ÚÔ˜ ÙÔ˘ ‡ÓÔ˘ Ì ÙÔ˘˜ ÁÔÓ›˜ 9% 16,2% 2,3% 0,002ÃÚÂÈ¿˙ÂÙ·È ÊÒÙ· ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ Ó‡¯Ù·˜ 36% 49% 24% 0,01
¶·Ú·¸ÓÈΤ˜ ‰È·Ù·Ú·¯¤˜ƒ˘ıÌÈΤ˜ ÎÈÓ‹ÛÂȘ 3% 2,5% 3,5% 0,72¡˘¯ÙÂÚÈÓ‹ ÂÓÔ‡ÚËÛË 2,4% 3,7% 1,2% 0,48∆ÚÈÛÌfi˜ ‰ÔÓÙÈÒÓ 10,2% 11,2% 9,3% 0,67ªÈÏ¿ÂÈ ÛÙÔÓ ‡ÓÔ ÙÔ˘ 11,4% 12,5% 10,5% 0,69ÀÓÔ‚·Û›· 1,8% 1,2% 2,3% 0,85™˘Á¯˘ÙÈΤ˜ ·Ê˘Ó›ÛÂȘ 7,2% 10% 4,6% 0,04¡˘¯ÙÂÚÈÓfi˜ ÙÚfiÌÔ˜ 1,8% 2,5% 1,2% 0,86∂ÊÈ¿ÏÙ˜ 5% 7,5% 2,3% 0,15
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·51
∆Ô 41% ÙˆÓ ÁÔÓ¤ˆÓ Ô˘ ÈÛÙÂ‡Ô˘Ó fiÙÈ ÙÔ ·È‰›ÙÔ˘˜ ¤¯ÂÈ ‰È·Ù·Ú·¯‹ ‡ÓÔ˘ ıˆÚ› fiÙÈ ÙÔ Úfi‚ÏËÌ··˘Ùfi ÂËÚ¿˙ÂÈ ‰˘ÛÌÂÓÒ˜ ÙÔ ·È‰›, ÙÔ 53% fiÙÈ ÙÔÚfi‚ÏËÌ· ·˘Ùfi ÂËÚ¿˙ÂÈ ÙËÓ Î·ıËÌÂÚÈÓ‹ ÙÔ˘ ‰Ú·-ÛÙËÚÈfiÙËÙ· ÛÙÔ Û¯ÔÏÂ›Ô Î·È ÙÔ 53% fiÙÈ ÙÔ Úfi‚ÏË-Ì· ·˘Ùfi ÂËÚ¿˙ÂÈ fiÏË ÙËÓ ÔÈÎÔÁ¤ÓÂÈ·.
™˘˙‹ÙËÛË
∏ ·ÚÔ‡Û· ÌÂϤÙË Û˘Ì‚¿ÏÏÂÈ ÛÙË ÁÓÒÛË Ì·˜ ÁÈ·ÙËÓ ¿Ô„Ë ÙˆÓ ÁÔÓ¤ˆÓ fiÛÔÓ ·ÊÔÚ¿ ÙȘ ‰È·Ù·Ú·¯¤˜ÙÔ˘ ‡ÓÔ˘ Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ù· ·È‰È¿ Û¯ÔÏÈ΋˜ËÏÈΛ·˜. ∏ ÛÊ·ÈÚÈ΋ ¿Ô„Ë ÙˆÓ ÁÔÓ¤ˆÓ Ô˘ ·¿-ÓÙËÛ·Ó ÛÙË ÌÂϤÙË ·˘Ù‹ ÁÈ· ÙËÓ ‡·ÚÍË ‰È·Ù·Ú·-¯ÒÓ ÛÙÔÓ ‡ÓÔ ÛÙ· ·È‰È¿ ÙÔ˘˜ ‰Â›¯ÓÂÈ fiÙÈ ÙÔ 10%ÈÛÙ‡ÂÈ fiÙÈ ÙÔ ·È‰› ÙÔ˘˜ ·ÚÔ˘ÛÈ¿˙ÂÈ Î¿ÔÈ· ‰È·-Ù·Ú·¯‹ ÛÙÔÓ ‡ÓÔ. ¶ÂÚÈÛÛfiÙÂÚÔ ·fi ÙÔ ¤Ó· ¤ÌÙÔÙˆÓ ·È‰ÈÒÓ ÛÙËÓ ·ÚÔ‡Û· ÛÂÈÚ¿ Ê·›ÓÂÙ·È Ó· ·-ÚÔ˘ÛÈ¿˙ÂÈ Î¿ÔÈ· ‰È·Ù·Ú·¯‹ ÙÔ˘Ï¿¯ÈÛÙÔÓ Ì›· ÊÔÚ¿ÙËÓ Â‚‰ÔÌ¿‰·, Ô˘ ÂÌ›ÙÂÈ Î˘Ú›ˆ˜ ÛÙËÓ Î·ÙËÁÔÚ›·ÙˆÓ ‰˘Û˘ÓÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ (fiˆ˜ ·ÓÙ›ÛÙ·ÛË ÙËÓÒÚ· ÙÔ˘ ‡ÓÔ˘ Î·È ·¸Ó›·) Î·È ÏÈÁfiÙÂÚÔ Û˘¯Ó¿ ÛÂÂΛÓË ÙˆÓ ·Ú·¸ÓÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ. ∂ÈÚfiÛıÂ-Ù·, Ë ·ÚÔ‡Û· ÌÂϤÙË ·Ó·‰ÂÈÎÓ‡ÂÈ ÙË ÛËÌ·ÓÙÈ΋ÛÙ¤ÚËÛË ÙˆÓ ·È‰ÈÒÓ Ù˘ ¯ÒÚ·˜ Ì·˜, ËÏÈΛ·˜ ΢-Ú›ˆ˜ 10-12 ÂÙÒÓ, Û ·Ú΋ ‡ÓÔ, ΢ڛˆ˜ ÙȘ ηıË-ÌÂÚÈÓ¤˜, Î·È ÙÔ ÛËÌ·ÓÙÈÎfi ÔÛÔÛÙfi ·È‰ÈÒÓ Ô˘ ·-ÚÔ˘ÛÈ¿˙Ô˘Ó ˘ÓËÏ›· ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ Ë̤ڷ˜Ì ÙȘ ÁÓˆÛÙ¤˜ ÂÈÙÒÛÂȘ ÛÙË Û¯ÔÏÈ΋ ·fi‰ÔÛË.
√È Owens Î·È Û˘Ó. (17) ¤‰ÂÈÍ·Ó fiÙÈ ÙfiÛÔ ÎÔÈÓˆÓÈ-
ÎÔ› ·Ú¿ÁÔÓÙ˜ (ÊÔÚو̤ÓÔ ÚfiÁÚ·ÌÌ· ÙˆÓ ·È-‰ÈÒÓ, ÙËÏÂı¤·ÛË, stress Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜), fiÛÔ Î·È È·-ÙÚÈÎÔ› ÚԉȷıÂÛÈÎÔ› ·Ú¿ÁÔÓÙ˜ (¿ÛıÌ·, ÏÔÈÌÒ-ÍÂȘ ·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡) ÌÔÚ› Ó· Û˘Ì‚¿Ï-ÏÔ˘Ó ÛÙËÓ ·ÔÛÙ¤ÚËÛË ‡ÓÔ˘, ·ÏÏ¿ Î·È Û ¿ÏϘ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ‡ÓÔ˘. ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË Ê·›-ÓÂÙ·È fiÙÈ Ù· ·È‰È¿ ËÏÈΛ·˜ 10-12 ÂÙÒÓ ·ÚÔ˘ÛÈ¿-˙Ô˘Ó ÛËÌ·ÓÙÈ΋ ÛÙ¤ÚËÛË ‡ÓÔ˘ ÙȘ ηıËÌÂÚÈÓ¤˜.∂›Û˘, Ë ·ÚÔ˘Û›· ÙËÏÂfiÚ·Û˘ ÛÙÔ ˘ÓÔ‰ˆÌ¿ÙÈÔÛ˘Û¯ÂÙ›ÛÙËΠ̠ÙËÓ ·˘ÍË̤ÓË Îϛ̷η ‰È·Ù·Ú·¯ÒÓÛÙÔÓ ‡ÓÔ. √È Ú·ÎÙÈΤ˜ ÛÙÔÓ ‡ÓÔ, fiˆ˜ ÎÔÈÓfi˘ÓÔ‰ˆÌ¿ÙÈÔ, ı· ÌÔÚÔ‡Û·Ó Ó· ÂËÚ¿ÛÔ˘Ó Ù·ÚÔ‚Ï‹Ì·Ù· ‡ÓÔ˘, fï˜, ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙˉÂÓ ÚԤ΢„Â Û˘Û¯¤ÙÈÛË ÎÔÈÓÔ‡ ˘ÓÔ‰ˆÌ·Ù›Ô˘ ηȉȷٷڷ¯ÒÓ ‡ÓÔ˘.
π‰È·›ÙÂÚÔ ÂӉȷʤÚÔÓ ·ÚÔ˘ÛÈ¿˙ÂÈ ÙÔ Â‡ÚËÌ· fiÙÈÔÈ ‰˘Û˘ÓÈΤ˜ ‰È·Ù·Ú·¯¤˜ Ê·›ÓÂÙ·È Ó· ÂÍ·ÚÙÒÓÙ·È·fi ÙËÓ ËÏÈΛ· Û ·ÓÙ›ıÂÛË Ì ÙȘ ·Ú·¸ÓÈΤ˜. ™Â·ÚfiÌÔÈ· ·ÔÙÂϤÛÌ·Ù· η٤ÏËÍ·Ó ÔÈ Owens ηÈÛ˘Ó. (17), ÔÈ ÔÔ›ÔÈ ÌÂϤÙËÛ·Ó ÙȘ ‰È·Ù·Ú·¯¤˜ ÙÔ˘‡ÓÔ˘ Û ·È‰È¿ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜. ª›· ‡ÏÔÁË ÂÍ‹-ÁËÛË ÌÔÚ› Ó· Â›Ó·È fiÙÈ ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ÙˆÓÌÈÎÚÒÓ ·È‰ÈÒÓ (16% Û ۯ¤ÛË Ì 2%) ÎÔÈÌÔ‡ÓÙ·ÈÌ·˙› Ì ÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘˜, ÁÂÁÔÓfi˜ Ô˘ οÓÂÈ ÙȘ ‰˘-Û˘ÓÈΤ˜ ‰È·Ù·Ú·¯¤˜ ÈÔ Â‡ÎÔÏ· ·ÓȯÓ‡ÛÈ̘. ∏·¸Ó›· (insomnia) ·ÔÙÂÏ› ¤Ó· ·fi Ù· ϤÔÓ ÛË-Ì·ÓÙÈο ÚÔ‚Ï‹Ì·Ù· ‡ÓÔ˘ ÛÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹, ËÔÔ›· fï˜ ¤¯ÂÈ ÏËÌÌÂÏÒ˜ ÌÂÏÂÙËı› ÛÙËÓ ·È‰È-΋ ËÏÈΛ· (18). √È ÂÈÙÒÛÂȘ Ù˘ ·¸Ó›·˜ ÌÔÚ›
52 π. ∫·Ï¤ÁÈ·˜ Î·È Û˘Ó.
Paediatriki 2008;71:48-54
¶›Ó·Î·˜ 3. ªÔÓÔ·Ú·ÁÔÓÙÈ΋ Û˘Û¯¤ÙÈÛË Ù˘ ‚·ıÌÔÏÔÁ›·˜ ‰È·Ù·Ú·¯ÒÓ ÙÔ˘ ‡ÓÔ˘ Ì ÔÈΛÏÔ˘˜ ·Ú¿ÁÔÓÙ˜
¶·Ú¿ÁÔÓÙ˜ µ·ıÌÔÏÔÁ›· (score) p-value(̤ÛË ÙÈÌ‹ ± SD)
º‡ÏÔ ∞ÁfiÚÈ· 33,5±7,9 0,61∫ÔÚ›ÙÛÈ· 32,8±9,4
¶ÚÔˆÚfiÙËÙ· ¡·È 32,6±11 0,86Ÿ¯È 33,2±8,7
¶·¯˘Û·ÚΛ· ¡·È 33,5±8,5 0,91Ÿ¯È 33,3±8,8
¢È·ÌÔÓ‹ ∫¤ÓÙÚÔ 34,7±8,8 0,086¶ÚÔ¿ÛÙÈÔ 32,3±8,7
£fiÚ˘‚Ô˜ ¡·È 36,6±9,3 0,018Ÿ¯È 32,4±8,5
ªÔÚʈÙÈÎfi Â›Â‰Ô ÌËÙ¤Ú·˜ ∫·ÙÒÙÂÚÔ/̤ÛÔ 32,5±8,8 0,23∞ÓÒÙÂÚÔ 34,2±8,6
ªÔÚʈÙÈÎfi Â›Â‰Ô ·Ù¤Ú· ∫·ÙÒÙÂÚÔ/̤ÛÔ 32,6±9,1 0,33∞ÓÒÙÂÚÔ 34±8,2
∆Ô ·È‰› ¤¯ÂÈ ‰ÈÎfi ÙÔ˘ ˘ÓÔ‰ˆÌ¿ÙÈÔ ¡·È 33,3±8,8 0,73Ÿ¯È 32,9±7,8
¶·ÚÔ˘Û›· ÙËÏÂfiÚ·Û˘ ÛÙÔ ˘ÓÔ‰ˆÌ¿ÙÈÔ ¡·È 39±7,8 0,001Ÿ¯È 33,5±9,2
∏ÏÈΛ· ÙÔ˘ ·È‰ÈÔ‡ 6-9 ÂÙÒÓ 35,4±9,6 0,00110-12 ÂÙÒÓ 31±7,5
™Ê·ÈÚÈ΋ ¿Ô„Ë ÙˆÓ ÁÔÓ¤ˆÓ ÁÈ· ÙËÓ ‡·ÚÍË ‰È·Ù·Ú·¯ÒÓ ¡·È 45±11 <0,0001Ÿ¯È 31,7±7,4
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·52
Ó· Â›Ó·È ‰Ú·Ì·ÙÈΤ˜ ÁÈ· ÙËÓ ·fi‰ÔÛË ÙÔ˘ ·È‰ÈÔ‡.
∂ÈÚfiÛıÂÙ·, ‰È·›ÛÙˆÛË ·¸Ó›·˜ Û ·È‰È¿ ÌÔ-
Ú› Ó· ÂÈ‚¿ÏÏÂÈ ¤ÏÂÁ¯Ô ¿ÏÏˆÓ ‰È·Ù·Ú·¯ÒÓ, fiˆ˜
Û˘Ó‰ÚfiÌÔ˘ ‰È¿Û·Û˘ ÚÔÛÔ¯‹˜-˘ÂÚÎÈÓËÙÈÎfiÙË-
Ù·˜ ‹ ‰È¿¯˘ÙˆÓ ·Ó·Ù˘ÍÈ·ÎÒÓ ‰È·Ù·Ú·¯ÒÓ (7). ¶Úfi-
ÛÊ·Ù·, ÔÈ Ivanenko Î·È Û˘Ó. (19) ÌÂϤÙËÛ·Ó ÙÔ „˘-
¯È·ÙÚÈÎfi ˘fiÛÙڈ̷ Î·È Ù· ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο
46 ·È‰ÈÒÓ Ô˘ ·ÍÈÔÏÔÁ‹ıËÎ·Ó Û ·È‰È·ÙÚÈÎfi Τ-
ÓÙÚÔ ‰È·Ù·Ú·¯ÒÓ ‡ÓÔ˘ Ì ·ÚÈ· ‰È·Ù·Ú·¯‹ ÙËÓ ·¸-
Ó›·, Ë ÔÔ›· ÔÚ›˙ÂÙ·È ˆ˜ ‰˘ÛÎÔÏ›· Ó· ·ÔÎÔÈÌËı›
ÙÔ ·È‰› ‹/Î·È Ó· ‰È·ÙËÚ‹ÛÂÈ ÙÔÓ ‡ÓÔ ÙÔ˘. ™˘ÓÔÏÈ-
ο, ÙÔ 50% ÙˆÓ ·È‰ÈÒÓ Â›¯·Ó Û˘ÁÎÂÎÚÈ̤ÓÔ ˘fi-
ÛÙڈ̷. ∞Ó¿ÌÂÛ· Û ·˘Ù¿, ÙÔ 61% ›¯Â Û‡Ó‰ÚÔÌÔ
‰È¿Û·Û˘ ÚÔÛÔ¯‹˜ Î·È ˘ÂÚÎÈÓËÙÈÎfiÙËÙ· ‹/ηÈ
„˘¯È·ÙÚÈÎfi ˘fiÛÙڈ̷, fiˆ˜ ηٿıÏÈ„Ë (30%) ηÈ
·Á¯Ò‰Ë ‰È·Ù·Ú·¯‹ (65%). ∂Ô̤ӈ˜, Ë ¯ÚfiÓÈ· ·¸-
Ó›· ÌÔÚ› Ó· ·ÔÙÂÏ› ÂΉ‹ÏˆÛË ˘ÔΛÌÂÓ˘
„˘¯È·ÙÚÈ΋˜ ‰È·Ù·Ú·¯‹˜ (18).
π‰È·›ÙÂÚË ·ÍÈÔÏfiÁËÛË ¯ÚÂÈ¿˙ÂÙ·È ÙÔ ·È‰› Ô˘
·ÚÁ› Ó· ·ÔÎÔÈÌËı›, ·ÊÔ‡ Û ·˘Ùfi ÌÔÚ› Ó· Û˘Ì-
‚¿ÏÏÔ˘Ó ·Ú¿ÁÔÓÙ˜ Â͈ÁÂÓ›˜, fiˆ˜ ·Ô˘Û›· ¯ÚÔ-
ÓÈÎÒÓ ÔÚ›ˆÓ, ÂÚÈ‚·ÏÏÔÓÙÈο ·›ÙÈ·, Û˘Ó‹ıÂȘ
‡ÓÔ˘, „˘¯ÔÏÔÁÈο ·›ÙÈ· ‹ ·ÎfiÌ· Î·È ¯ÚfiÓȘ ‹
ÔÍ›˜ È·ÙÚÈΤ˜ ηٷÛÙ¿ÛÂȘ ‹ Î·È Ê¿Ú̷η.
™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, ÙÔ 7% ÙˆÓ ·È‰ÈÒÓ ÚÔ¯·-
Ï›˙ÂÈ Î·È ÙÔ 14% Ó˘ÛÙ¿˙ÂÈ ÙËÓ Ë̤ڷ. ∆Ô ÚÔ¯·ÏËÙfi
Û˘Ì‚¿ÏÏÂÈ ÛÙËÓ ËÌÂÚ‹ÛÈ· ˘ÓËÏ›·, Û˘Û¯ÂÙ›˙ÂÙ·È ÌÂ
ÙËÓ ·ÔÊÚ·ÎÙÈ΋ ¿ÓÔÈ· ÛÙÔÓ ‡ÓÔ Î·È Û˘¯Ó¿ ÔÊ›-
ÏÂÙ·È Û ˘ÂÚÙÔÊ›· ÙˆÓ ·‰ÂÓÔÂȉÒÓ Â΂ϷÛÙ‹ÛˆÓ.
ŸÙ·Ó ÙÔ ·È‰› ÚÔ¯·Ï›˙ÂÈ, ··ÈÙÂ›Ù·È ·ÍÈÔÏfiÁËÛË,
ÚÔÎÂÈ̤ÓÔ˘ Ó· ‰È·ÊÔÚԉȷÁÓˆÛÙ› ÙÔ ÚˆÙÔ·ı¤˜
ÚÔ¯·ÏËÙfi (primary snoring) ·fi ÙÔ Û‡Ó‰ÚÔÌÔ ·Ô-
ÊÚ·ÎÙÈ΋˜ ¿ÓÔÈ·˜ ÛÙÔÓ ‡ÓÔ (obstructive sleep
apnea syndrome). ∞Ó ‰È·ÁÓˆÛÙ› ÙÔ Û‡Ó‰ÚÔÌÔ Ù˘
·ÔÊÚ·ÎÙÈ΋˜ ¿ÓÔÈ·˜ ÛÙÔÓ ‡ÓÔ, ÙfiÙÂ Ë ·ÓÙÈÌÂÙÒ-
ÈÛË ·˘ÙÔ‡ (CPAP ‹ ·‰ÂÓÔÂȉÂÎÙÔÌ‹) ÌÔÚ› Ó·
Û˘Ì‚¿ÏÏÂÈ ÛËÌ·ÓÙÈο ÛÙË ‚ÂÏÙ›ˆÛË Ù˘ ËÌÂÚ‹ÛÈ·˜
ÂÁÚ‹ÁÔÚÛ˘ ÙÔ˘ ·È‰ÈÔ‡ (20).
∏ ·ÚÔ‡Û· ÌÂϤÙË ·ÚÔ˘ÛÈ¿˙ÂÈ ÂÚÈÔÚÈÛÌÔ‡˜
Ô˘ Ú¤ÂÈ Ó· ÏËÊıÔ‡Ó ˘fi„Ë Î·Ù¿ ÙËÓ ÂÚÌËÓ›·
ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ. ŸÛÔÓ ·ÊÔÚ¿ ÙÔÓ ·ÚÈıÌfi ÙÔ˘
‰Â›ÁÌ·ÙÔ˜, Ù· ·ÔÙÂϤÛÌ·Ù· ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÛÙ·ÙÈ-
ÛÙÈ΋ ÛËÌ·ÓÙÈÎfiÙËÙ·, ̂ ÛÙfiÛÔ ··ÈÙÂ›Ù·È ÛËÌ·ÓÙÈο
ÌÂÁ·Ï‡ÙÂÚÔ˜ ·ÚÈıÌfi˜ ·È‰ÈÒÓ. ∂ÈϤÔÓ, Û˘ÌÌÂÙÔ-
¯‹ ·È‰ÈÒÓ ·fi ‰È·ÊÔÚÂÙÈΤ˜ ÂÚÈÔ¯¤˜ Ù˘ ¯ÒÚ·˜
Ì·˜ ı· ÌÔÚÔ‡Û ӷ Û˘Ì‚¿ÏÏÂÈ Û ÛÊ·ÈÚÈÎfiÙÂÚË
·ÍÈÔÏfiÁËÛË ÙˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ ÙÔ˘ ‡ÓÔ˘. ∞Í›˙ÂÈ,
fï˜, Ó· ÛËÌÂȈı› fiÙÈ ÛÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ Â‰›Ô
˘¿Ú¯ÂÈ ·Ô˘Û›· ‰Â‰ÔÌ¤ÓˆÓ Î·È ¤ÙÛÈ, Ë ·ÚÔ‡Û·
ÌÂϤÙË ı· ÌÔÚÔ‡Û ӷ ÂÎÏËÊı› ˆ˜ ÌÈ· ÚÒÙË
ÚÔÛ¿ıÂÈ· ‰ÈÂÚ‡ÓËÛ˘ ÙˆÓ ‰È·Ù·Ú·¯ÒÓ ÙÔ˘
‡ÓÔ˘ ÛÙËÓ ·È‰È΋ ËÏÈΛ·.
√ ‰Â‡ÙÂÚÔ˜ ÂÚÈÔÚÈÛÌfi˜ ÚÔ·ÙÂÈ ·fi ÙË ÌÂ-
ıÔ‰ÔÏÔÁ›· Ù˘ ÌÂϤÙ˘. ∏ ¯Ú‹ÛË ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘
Ô˘ ·Â˘ı‡ÓÂÙ·È Û ÁÔÓ›˜ ·ÔÙÂÏ› ˘ÔÎÂÈÌÂÓÈ΋
̤ıÔ‰Ô Ô˘ ¤¯ÂÈ fï˜ ¯ÚËÛÈÌÔÔÈËı› ¢ڤˆ˜ ηÈ
·fi ¿ÏÏÔ˘˜ ÂÚ¢ÓËÙ¤˜ (15,16). ∫·Ù¿ Û˘Ó¤ÂÈ·, Ë
·ÚÔ‡Û· ÌÂϤÙË Ú¤ÂÈ Ó· ÂÎÏËÊı› ̂ ˜ ·ÍÈÔÏfiÁËÛË
Ù˘ ·ÓÙ›Ï˄˘ ÙˆÓ ÁÔÓ¤ˆÓ ÁÈ· Ù· ÚÔ‚Ï‹Ì·Ù·
‡ÓÔ˘ ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜, ·Ú¿ ˆ˜ ·ÓÙÈÎÂÈÌÂÓÈ΋
·ÍÈÔÏfiÁËÛË ÙˆÓ ‰È·Ù·Ú·¯ÒÓ ‡ÓÔ˘. ¶·ÚfiÏ· Ù·‡Ù·,
ÔÈ ·Ó·ÊÔÚ¤˜ ÙˆÓ ÁÔÓ¤ˆÓ ÌÔÚ› Ó· ÂÎÏËÊıÔ‡Ó ˆ˜
·ÍÈÔÔÈ‹ÛÈ̘, ·ÊÔ‡ ÔÈ ÁÔÓ›˜ Â›Ó·È ÔÈ ÌfiÓÔÈ Ì¿ÚÙ˘-
Ú˜ ÙÔ˘ ‡ÓÔ˘ ÙˆÓ ·È‰ÈÒÓ Î·È È‰È·›ÙÂÚ· ÛÙË ¯ÒÚ·
Ì·˜, fiÔ˘ ·Ô˘ÛÈ¿˙Ô˘Ó Î¤ÓÙÚ· ·È‰È·ÙÚÈÎÒÓ ‰È·Ù·-
Ú·¯ÒÓ ‡ÓÔ˘ Ì ‰˘Ó·ÙfiÙËÙ˜ ÔÏ˘¸ÓÔÁÚ·ÊÈÎÒÓ
ÌÂÏÂÙÒÓ.
∫·Ù·Ï‹ÁÔÓÙ·˜, Ì ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ı· ı¤Ï·-
Ì ӷ ÙÔÓ›ÛÔ˘Ì ÌÂÚÈÎÔ‡˜ ÛËÌ·ÓÙÈÎÔ‡˜ ÏfiÁÔ˘˜, ÁÈ·
ÙÔ˘˜ ÔÔ›Ô˘˜ Ô ·È‰›·ÙÚÔ˜ ÔÊ›ÏÂÈ Ó· ÚˆÙ‹ÛÂÈ ÁÈ·
ÙÔÓ ‡ÓÔ ÙˆÓ ·È‰ÈÒÓ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜. ∞Ó¿ÌÂÛ· ÛÂ
·˘ÙÔ‡˜ ÙÔ˘˜ ÏfiÁÔ˘˜ Â›Ó·È Ë ÛËÌ·ÓÙÈ΋ ›وÛË
‰È·Ù·Ú·¯ÒÓ ÙÔ˘ ‡ÓÔ˘ Û ·˘Ùfi ÙÔ ËÏÈÎÈ·Îfi Ê¿ÛÌ·,
Ë Èı·ÓfiÙËÙ· ·Ó‡ÚÂÛ˘ ıÂڷ‡ÛÈÌÔ˘ ·ÈÙ›Ô˘,
fiˆ˜ ¿ÓÔÈ·˜ ‹ ÂÓÔ‡ÚËÛ˘, Î·È ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ù·
ÚÔ‚Ï‹Ì·Ù· ‡ÓÔ˘ Û˘Û¯ÂÙ›˙ÔÓÙ·È ÈÛ¯˘Ú¿ Ì ¿ÏÏ·
„˘¯ÔÏÔÁÈο Î·È È·ÙÚÈο ÚÔ‚Ï‹Ì·Ù·, fiˆ˜ Ù˘ η-
Ù¿ıÏȄ˘, ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ‰È¿Û·Û˘ Ù˘ ÚÔÛÔ¯‹˜
Î·È ˘ÂÚÎÈÓËÙÈÎfiÙËÙ·˜ Î·È Ù˘ ÓÔËÙÈ΋˜ ˘ÛÙ¤ÚËÛ˘
(21-28). ŒÙÛÈ, ·Ó·˙ËÙÒÓÙ·˜ Ù˘¯fiÓ ‰È·Ù·Ú·¯¤˜ ÛÙÔÓ
‡ÓÔ, ÌÔÚ› Ó· ·Ó·‰ÂȯıÔ‡Ó ÛËÌ·ÓÙÈΤ˜ ÏËÚÔÊÔ-
ڛ˜ Û˘ÌÂÚÈÊÔÚ¿˜ (ÌË Û˘ÌÌfiÚʈÛ˘), Û˘Ó·ÈÛıË-
Ì·ÙÈΤ˜ Î·È „˘¯È·ÙÚÈΤ˜ ‰È·Ù·Ú·¯¤˜ (ÊÔ‚›Â˜, ηٿ-
ıÏÈ„Ë, ·˘ÙÈÛÌfi˜) ‹ È·ÙÚÈο ÚÔ‚Ï‹Ì·Ù· (¿ÛıÌ·)
Ô˘ Û˘Ó˘¿Ú¯Ô˘Ó Ì ·˘Ù¤˜. §·Ì‚¿ÓÔÓÙ·˜ ˘fi„Ë
ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÂÏ¿¯ÈÛÙÔÈ ·fi ÙÔ˘˜ ÁÔÓ›˜ Ô˘ È-
ÛÙÂ‡Ô˘Ó fiÙÈ ÙÔ ·È‰› ÙÔ˘˜ ¤¯ÂÈ Î¿ÔÈ· ‰È·Ù·Ú·¯‹
ÛÙÔÓ ‡ÓÔ Û˘˙ËÙÔ‡Ó ÙÔ ı¤Ì· ·˘Ùfi Ì ÙÔÓ ·È‰›·ÙÚÔ,
·Ó·‰ÂÈÎÓ‡ÂÙ·È ·ÎfiÌ· ÂÚÈÛÛfiÙÂÚÔ Ë ÂÈÙ·ÎÙÈ΋
·Ó¿ÁÎË ÁÈ· ÌÂÁ·Ï‡ÙÂÚË Â˘·ÈÛıËÙÔÔ›ËÛË ÙÔ˘ ıÂÚ¿-
ÔÓÙ· È·ÙÚÔ‡ ¿Óˆ ÛÂ ·˘Ù¿ Ù· ÚÔ‚Ï‹Ì·Ù·. ∏ Û˘-
˙‹ÙËÛË ÙˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ ÙÔ˘ ‡ÓÔ˘ Î·È Ù˘ Û˘-
ÌÂÚÈÊÔÚ¿˜ Ì ÙÔ˘˜ ÁÔÓ›˜, ·ÏÏ¿ Î·È Ì ÙÔ ·È‰›,
ÌÔÚ› Ó· Ì·˜ ‰ÒÛÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· Ó· ηٷÓÔ‹-
ÛÔ˘Ì ηχÙÂÚ· ÙÔ ·È‰› Î·È ÙËÓ ÔÈÎÔÁ¤ÓÂÈ·, Ó·
·ÍÈÔÏÔÁ‹ÛÔ˘Ì ÙÔ ÂÚÈ‚¿ÏÏÔÓ Î·È Ó· Âηȉ‡ÛÔ˘-
Ì ÙÔ˘˜ ÁÔÓ›˜ Û ٷÎÙÈΤ˜ ˘ÁÈÂÈÓ‹˜ ÙÔ˘ ‡ÓÔ˘, ÌÂ
·ÒÙÂÚÔ ÛÙfi¯Ô ÙËÓ ÚfiÏË„Ë ÛËÌ·ÓÙÈÎfiÙÂÚˆÓ
‹/Î·È ¯ÚfiÓÈˆÓ ‰È·Ù·Ú·¯ÒÓ ÙÔ˘ ‡ÓÔ˘.
µÈ‚ÏÈÔÁÚ·Ê›·
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54 π. ∫·Ï¤ÁÈ·˜ Î·È Û˘Ó.
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55∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞ ORIGINAL ARTICLE
¶·È‰È·ÙÚÈ΋ 2008;71:55-61
√È Û˘Ó¤ÂȘ Ù˘ Áڛ˘ ÛÙ· ·È‰È¿ ÛÙËÓ ÎÔÈÓfiÙËÙ·
ª. ∆ÛÔÏÈ¿1, π. §ÔÁÔı¤ÙË1, N. ¶··‰fiÔ˘ÏÔ˜1, M. ª·˘Ú›ÎÔ˘2, N. ™˘Ú›‰Ë˜1, ¶. ¢ÚÔÛ¿ÙÔ˘3,
¢. ∫·ÊÂÙ˙‹˜1, ∞. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜1 Î·È Ë ÔÌ¿‰· ÌÂϤÙ˘ Ù˘ Áڛ˘ ÛÙËÓ ÎÔÈÓfiÙËÙ·*
¶ÂÚ›ÏË„Ë
∂ÈÛ·ÁˆÁ‹: ∏ Ï‹„Ë Ù˘ ·fiÊ·Û˘ ÁÈ· ÂÌ‚ÔÏÈ·ÛÌfi ÙˆÓ ˘ÁÈÒÓ ·È‰ÈÒÓ Î·Ù¿ Ù˘ Áڛ˘ ÚÔ¸Ôı¤ÙÂÈ ÙÔÓ·ÎÚÈ‚‹ ÚÔÛ‰ÈÔÚÈÛÌfi Ù˘ ÓÔÛËÚfiÙËÙ·˜. ∏ ÚÔÔÙÈ΋ ·˘Ù‹ ÌÂϤÙË ¤¯ÂÈ ÛÙfi¯Ô ÙËÓ ÂÎÙ›ÌËÛË Ù˘ ÂÚÁ·-ÛÙËÚȷο ÂȂ‚·ÈˆÌ¤Ó˘ Áڛ˘ Î·È ÙˆÓ ÂÈÏÔÎÒÓ Ù˘ Û ˘ÁÈ‹ ·È‰È¿ ÛÙËÓ ÎÔÈÓfiÙËÙ·.
ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ªÂÏÂÙ‹ıËÎ·Ó 1.462 ·È‰È¿ ËÏÈΛ·˜ ≥6 ÌËÓÒÓ ¤ˆ˜ <14 ÂÙÒÓ Ô˘ ÂÍÂÙ¿ÛıËÎ·Ó ÛÙ·Â͈ÙÂÚÈο È·ÙÚ›· ÙÔ˘ ÓÔÛÔÎÔÌ›Ԣ ‹ Û ȉȈÙÈο ·È‰È·ÙÚÈο È·ÙÚ›·, ÏfiÁˆ ˘ÚÂÙÔ‡ Î·È Ïԛ̈͢ ÙÔ˘·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ηٿ ÙËÓ ÂÔ¯‹ Ù˘ ÂÙ‹ÛÈ·˜ ÂȉËÌÈ΋˜ ¤Í·ÚÛ˘ Ù˘ Áڛ˘ ÁÈ· ‰‡Ô ¯ÚfiÓÈ·.
∞ÔÙÂϤÛÌ·Ù·: ∏ ÂȉËÌÈ΋ ¤Í·ÚÛË Ù˘ Áڛ˘ ‰È‹ÚÎÂÛ οı ¯ÚfiÓÔ 13-14 ‚‰ÔÌ¿‰Â˜. §Ô›ÌˆÍË ·fiÙÔÓ Èfi Ù˘ Áڛ˘ ‰È·ÈÛÙÒıËΠÛÙÔ˘˜ 573/1.462 (39%) ÙˆÓ ÂÍÂÙ·Ûı¤ÓÙˆÓ Ô˘ ·ÓÙÈÛÙÔȯ› ÛÙÔ 13,5%ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ·È‰ÈÒÓ Ô˘ ÂÈÛΤÊıËÎ·Ó Ù· ·È‰È·ÙÚÈο È·ÙÚ›· ηٿ ÙËÓ ÂÚ›Ô‰Ô ·˘Ù‹. ∏ ÔÍ›· ̤-ÛË ̂ Ù›Ùȉ· ‹Ù·Ó Ë ÈÔ Û˘¯Ó‹ ÂÈÏÔ΋ (18,5%). ∞ÓÙÈ‚ÈÔÙÈο Û˘ÓÙ·ÁÔÁÚ·Ê‹ıËÎ·Ó ÛÙÔ 40% ÙˆÓ ·ÛıÂÓÒÓÌ ÁÚ›Ë. √Í›· ̤ÛË ˆÙ›Ùȉ· Î·È Ï‹„Ë ·ÓÙÈ‚ÈÔÙÈÎÒÓ ‹Ù·Ó Û˘¯ÓfiÙÂÚ˜ ÛÙ· ·È‰È¿ ËÏÈΛ·˜ οو ÙˆÓ 5ÂÙÒÓ Ô˘ ·ÔÙÂÏÔ‡Û·Ó ÙÔ 58% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ·ÛıÂÓÒÓ Ù˘ ÌÂϤÙ˘. °È· οı ¿ÚÚˆÛÙÔ ·È‰›, ÔÈ ÁÔ-Ó›˜ ¤¯·Û·Ó 1,34 Ë̤Ú˜ ÂÚÁ·Û›·˜. ™ÙȘ ÔÈÎÔÁ¤ÓÂȘ ÙˆÓ ·È‰ÈÒÓ Ì ÁÚ›Ë Î·Ù·ÁÚ¿ÊËΠÌÂÁ·Ï‡ÙÂÚË Û˘-¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ Î·È ‰Â‡ÙÂÚÔ˘ ÂÚÈÛÙ·ÙÈÎÔ‡ ·Ó·Ó¢ÛÙÈ΋˜ Ïԛ̈͢, ÂÈÛΤ„ÂˆÓ Û ȷÙÚfi Î·È ¯Ú‹-Û˘ ·ÓÙÈ‚ÈÔÙÈÎÒÓ.
™˘ÌÂÚ¿ÛÌ·Ù·: H ÁÚ›Ë ÚÔηÏ› ÛËÌ·ÓÙÈ΋ ÓÔÛËÚfiÙËÙ· ÛÙ· ·È‰È¿ ÛÙËÓ ÎÔÈÓfiÙËÙ·. √È Û˘Ó¤ÂȤ˜ Ù˘ı· ÌÔÚÔ‡Û·Ó Ó· ÂÚÈÔÚÈÛıÔ‡Ó Ì ÙÔÓ Î·ıÔÏÈÎfi ÂÌ‚ÔÏÈ·ÛÌfi ÙˆÓ ·È‰ÈÒÓ ËÏÈΛ·˜ <5 ÂÙÒÓ.
§¤ÍÂȘ ÎÏÂȉȿ: °Ú›Ë, ·È‰È¿, Â͈ÙÂÚÈÎÔ› ·ÛıÂÓ›˜, ÎÔÈÓfiÙËÙ·.
The impact of influenza in children on the community
M. Tsolia1, I. Logotheti1, N. Papadopoulos1, M. Mavrikou2, N. Spyridis1, P. Drossatou3,
D. Kafetzis1, A. Konstantopoulos1 and the outpatient flu study group*
Abstract
Background: Decisions regarding the introduction of influenza immunization of healthy children requirean accurate evaluation of the influenza disease burden not only in the inpatient but also in the outpatientsetting.
Methods: A prospective study was made of the impact of virologically confirmed influenza on 1,462outpatient children (≥6 months to <14 years) and on their families, during two consecutive influenzaseasons.
Results: Influenza was documented in 573/1,462 (39%) outpatients with febrile respiratory illness and itaccounted for 13.5% of all outpatient visits during the 14 weeks of each season. Acute otitis media (AOM)was the most common complication (18.5%) and about 40% of influenza positive patients receivedantibiotics. AOM and antibiotic use were more common in children aged younger than 5 years, whoaccounted for 58% of all patients in the study. For each sick child with influenza, a mean of 1.34 workdayswere lost by the parents. Family members of influenza positive children were more likely to develop asecondary respiratory illness and to require medical consultations and antibiotic prescription.
Conclusions: Influenza is associated with a heavy burden of morbidity in the community that could bereduced considerably with the implementation of influenza immunization of children in the under 5 yearsage group.
Key words: Influenza, children, outpatients, community.
1 µ’ ¶·È‰È·ÙÚÈ΋¶·ÓÂÈÛÙËÌȷ΋ ∫ÏÈÓÈ΋
2 ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋,¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”,∞ı‹Ó·
3 µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋,¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”,∞ı‹Ó·
AÏÏËÏÔÁÚ·Ê›·:
πˆ¿ÓÓ· §ÔÁÔı¤ÙË[email protected]µ’ ¶·È‰È·ÙÚÈ΋¶·ÓÂÈÛÙËÌȷ΋ ∫ÏÈÓÈ΋,¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ ∞ıËÓÒÓ“¶. & ∞. ∫˘ÚÈ·ÎÔ‡”£Ë‚ÒÓ Î·È §Â‚·‰Â›·˜,∆.∫. 115 27, ∞ı‹Ó·
1 2nd Department ofPaediatrics, School of Medicine,University of Athens
2 1st Department ofPaediatrics, “P. & A. Kyriakou”Children’s Hospital,Athens
3 2nd Department ofPaediatrics, “P. & A. Kyriakou”Children’s Hospital,Athens
Correspondence:
Ioanna [email protected] Department of Paediatrics, School of Medicine, University of Athens, “P. & A. Kyriakou”Children’s HospitalThivon & Levadias St.,115 27, Athens, Greece
*√Ì¿‰· ÌÂϤÙ˘ Ù˘ Áڛ˘ ÛÙËÓ ÎÔÈÓfiÙËÙ· º. ™ÙÚȤÏË, °. ∆ÛfiÏ·˜, ª. ¶ÂÙÚ¿ÎË, ¶. ™˘Ú›‰Ë˜, ¢. ÃÔϤ‚·˜, Ã. ¶ÂÙÚÔÁÈ·ÓÓÔÔ‡ÏÔ˘, ∫. ™È·Î·‚¤Ï·˜, ¡. ª˘ÚÈÔÎÂÊ·ÏÈÙ¿Î˘
*Outpatient flu study groupF. Stripeli, G. Tsolas, M. Petraki, P. Spyridis, D. Cholevas, C. Petroyannopoulou, K. Siakavellas, N. Myriokefalitakis
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·55
56 ª. ∆ÛÔÏÈ¿ Î·È Û˘Ó.
Paediatriki 2008;71:55-61
™˘ÓÙÔÌÔÁڷʛ˜
RSV Respiratory Syncytial Virus∆∂¶ ∆Ì‹Ì· ∂ÂÈÁfiÓÙˆÓ ¶ÂÚÈÛÙ·ÙÈÎÒÓ™∞ ™Ù·ıÂÚ‹ ∞fiÎÏÈÛË
∂ÈÛ·ÁˆÁ‹
¶ÚfiÛÊ·Ù˜ ÂȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜ ¤¯Ô˘Ó ‰Â›-ÍÂÈ fiÙÈ Ë Û˘¯ÓfiÙËÙ· ÂÈÛ·ÁˆÁ‹˜ ÛÙÔ ÓÔÛÔÎÔÌ›Ô, Ïfi-Áˆ Áڛ˘ ÙˆÓ ˘ÁÈÒÓ ·È‰ÈÒÓ ÌÈÎÚ‹˜ ËÏÈΛ·˜, ›ӷÈÛ˘ÁÎÚ›ÛÈÌË Ì ·˘Ù‹ ÙˆÓ ·ÙfiÌˆÓ Ô˘ ·Ó‹ÎÔ˘Ó ÛÂÔÌ¿‰Â˜ ·˘ÍË̤ÓÔ˘ ÎÈÓ‰‡ÓÔ˘ (1,2). øÛÙfiÛÔ, Ë ·ÎÚÈ-‚‹˜ ·ÍÈÔÏfiÁËÛË ÙˆÓ Â˘ÚËÌ¿ÙˆÓ ·˘ÙÒÓ ÂËÚ¿˙ÂÙ·È·fi ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Î·Ù¿ ÙÔ˘˜ ¯ÂÈÌÂÚÈÓÔ‡˜ Ì‹Ó˜ ËÂȉËÌÈ΋ ¤Í·ÚÛË Ù˘ Áڛ˘ Û˘Ì›ÙÂÈ Ì ·˘Ù‹ÓÔ˘ ÚÔηÏÂ›Ù·È ·fi ¿ÏÏÔ˘˜ ÈÔ‡˜, fiˆ˜ Â›Ó·È Î·Ù¿Î‡ÚÈÔ ÏfiÁÔ Ô ·Ó·Ó¢ÛÙÈÎfi˜ Û˘Á΢ÙÈ·Îfi˜ Èfi˜(respiratory syncytial virus - RSV). ÕÏϘ ÌÂϤÙ˜,‚·ÛÈṲ̂Ó˜ Û ÂȉËÌÈÔÏÔÁÈ΋ ÂÈÙ‹ÚËÛË, Âȯ›-ÚËÛ·Ó Ó· ‰È·¯ˆÚ›ÛÔ˘Ó ÙËÓ Â›‰Ú·ÛË ÙÔ˘ RSV ηÈÙÔ˘ ÈÔ‡ Ù˘ Áڛ˘ ÛÙË Û˘¯ÓfiÙËÙ· ÂÈÛ·ÁˆÁ‹˜ ÙˆÓ˘ÁÈÒÓ ·È‰ÈÒÓ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô (3,4). ∆· ·ÔÙÂϤ-ÛÌ·Ù¿ ÙÔ˘˜ ÂȂ‚·›ˆÛ·Ó fiÙÈ Ù· ˘ÁÈ‹ ·È‰È¿ <2ÂÙÒÓ, Î·È Èı·ÓfiÓ Î·È ÂΛӷ ÌÂٷ͇ 2 Î·È 4 ÂÙÒÓ,·ÚÔ˘ÛÈ¿˙Ô˘Ó ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ Ó· ÓÔÛËÏ¢ıÔ‡ÓÏfiÁˆ Ù˘ Áڛ˘, Û ۇÁÎÚÈÛË Ì ٷ ÌÂÁ·Ï‡ÙÂÚ··È‰È¿. ¶ÈÔ ÚfiÛÊ·Ù˜ ÌÂϤÙ˜ Ô˘ ‚·Û›ÛÙËÎ·Ó ÛÂηÏÏȤÚÁÂȘ ÙÔ˘ ÈÔ‡ ÂȂ‚·›ˆÛ·Ó ÙËÓ ·˘ÍË̤ÓËÛ˘¯ÓfiÙËÙ· ÂÈÛ·ÁˆÁ‹˜ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô ÙˆÓ ·È‰ÈÒÓÌÈÎÚ‹˜ ËÏÈΛ·˜ (5). µ¿ÛÂÈ ·˘ÙÒÓ ÙˆÓ ÛÙÔȯ›ˆÓ Û˘-ÛÙ‹ÓÂÙ·È ÛÙȘ ∏¶∞ ·fi ÙÔ 2003 Ô Î·ıÔÏÈÎfi˜ ÂÌ‚Ô-ÏÈ·ÛÌfi˜ ηٿ Ù˘ Áڛ˘ ÙˆÓ ·È‰ÈÒÓ ËÏÈΛ·˜ 6-23ÌËÓÒÓ (6).
¶·ÚfiÏÔ Ô˘ ÔÈ Û˘ÛÙ¿ÛÂȘ ÁÈ· ÂÌ‚ÔÏÈ·ÛÌfi ‚·Û›-ÛÙËÎ·Ó ÛÙÔÓ ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÂÈÛ·ÁˆÁ‹˜ ÛÙÔ ÓÔ-ÛÔÎÔÌÂ›Ô ÙˆÓ ÌÈÎÚfiÙÂÚˆÓ ·È‰ÈÒÓ, ̆ ¿Ú¯Ô˘Ó ÂӉ›-ÍÂȘ fiÙÈ Ë Ïԛ̈ÍË ·fi ÙÔÓ Èfi Ù˘ Áڛ˘ ÚÔηÏ›ÛËÌ·ÓÙÈ΋ ÓÔÛËÚfiÙËÙ· ÛÙ· ·È‰È¿ Î·È ÙËÓ ÎÔÈÓfiÙË-Ù· (3). ÀÔÏÔÁ›˙ÂÙ·È fiÙÈ ÂÚ›Ô˘ ÙÔ 30-40% وӷȉÈÒÓ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ ÓÔÛÔ‡Ó ·fi ÁÚ›Ë Î¿ı¯ÚfiÓÔ Î·È ·ÔÙÂÏÔ‡Ó ÙËÓ Î‡ÚÈ· ËÁ‹ ÌÂÙ¿‰ÔÛ˘Ù˘ ÓfiÛÔ˘ Û ÂÓËÏ›ÎÔ˘˜, ·È‰È¿ Î·È ¿ÙÔÌ· Ô˘ ·Ó‹-ÎÔ˘Ó Û ÔÌ¿‰Â˜ ·˘ÍË̤ÓÔ˘ ÎÈÓ‰‡ÓÔ˘ (7-12). ∞fi Ù··È‰È¿ Ô˘ ·Ó·Ù‡ÛÛÔ˘Ó Û˘Ìو̷ÙÈ΋ Ïԛ̈ÍË,ÌfiÓÔ ¤Ó· ÌÈÎÚfi ÔÛÔÛÙfi ÓÔÛËχÂÙ·È, Ì ·ÔÙ¤ÏÂ-ÛÌ· Ë ÂÈÛ·ÁˆÁ‹ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô Ó· ·ÓÙÈÚÔۈ‡ÂȤӷ ÌÈÎÚfi ̤ÚÔ˜ Ù˘ Û˘ÓÔÏÈ΋˜ ÓÔÛËÚfiÙËÙ·˜ Ù˘Áڛ˘ (13,14).
∏ ÙÂÏÈ΋ ·fiÊ·ÛË ÁÈ· ÙË Û‡ÛÙ·ÛË ÂÌ‚ÔÏÈ·ÛÌÔ‡Û ˘ÁÈ‹ ·È‰È¿ ··ÈÙ› ÚÔÛÂÎÙÈ΋ ÂÎÙ›ÌËÛË ÙˆÓÂÈÙÒÛÂˆÓ Ù˘ Áڛ˘ ÙfiÛÔ ÛÙÔ˘˜ ÓÔÛËÏ¢fiÌÂ-ÓÔ˘˜ fiÛÔ Î·È ÛÙÔ˘˜ Â͈ÙÂÚÈÎÔ‡˜ ·ÛıÂÓ›˜, ηıҘ›Û˘ Î·È ÙˆÓ ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎÒÓ Û˘ÓÂÂÈÒÓÙ˘ Ïԛ̈͢ ÛÙËÓ ÎÔÈÓfiÙËÙ·. ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘·˘Ù‹˜ ‹Ù·Ó Ë ÂÎÙ›ÌËÛË ÙˆÓ Û˘ÓÂÂÈÒÓ Ù˘ ÂÚÁ·ÛÙË-
Úȷο ÂȂ‚·ÈˆÌ¤Ó˘ Áڛ˘ Û ˘ÁÈ‹ ·È‰È¿ Î·È ÙȘ
ÔÈÎÔÁ¤ÓÂȤ˜ ÙÔ˘˜ ÛÙËÓ ÎÔÈÓfiÙËÙ·.
ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ
¶ÚfiÎÂÈÙ·È ÁÈ· ÚÔÔÙÈ΋ ÌÂϤÙË Ô˘ ¤Ï·‚ ¯ÒÚ· ηٿ
ÙË ‰È¿ÚÎÂÈ· ‰‡Ô Û˘Ó¯fiÌÂÓˆÓ ÂÙÒÓ 2003-2004 Î·È 2004-2005.
ø˜ ÂÚ›Ô‰Ô˜ ÂȉËÌÈ΋˜ ¤Í·ÚÛ˘ Áڛ˘ ÔÚ›ÛÙËΠοı ¯Úfi-
ÓÔ ·˘Ù‹ Ô˘ ÔÚÈÔıÂÙÔ‡ÓÙ·Ó ·fi ÙÔ ÚÒÙÔ ¤ˆ˜ Î·È ÙÔ ÙÂÏ¢-
Ù·›Ô ıÂÙÈÎfi ‰Â›ÁÌ· ÁÈ· ÙÔÓ Èfi Ù˘ Áڛ˘, Ô˘ ηٷÁÚ¿ÊËÎÂ
ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô ·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡” ηٿ ÙË ‰È¿Ú-
ÎÂÈ· Ù˘ ÂÈÙ‹ÚËÛ˘. ∏ ÂÈÙ‹ÚËÛË ‰ÈÂÍ‹¯ıË ÛÙÔ ÙÌ‹Ì· ÂÂÈ-
ÁfiÓÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ (∆∂¶) ÙÔ˘ ÓÔÛÔÎÔÌ›Ԣ ·fi ÙËÓ 1Ë
¢ÂÎÂÌ‚Ú›Ô˘ οı ¯ÚfiÓÔ˘ Î·È Û˘Ó¯›ÛÙËΠ̤¯ÚÈ ÙËÓ Î·Ù·-
ÁÚ·Ê‹ ·ÚÓËÙÈÎÒÓ ÌfiÓÔ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ÁÈ· ‰‡Ô Û˘Ó¯fiÌÂÓ˜
‚‰ÔÌ¿‰Â˜. ∆Ô ‰Â‡ÙÂÚÔ ¤ÙÔ˜ Û˘ÌÂÚÈÏ‹ÊıËÎ·Ó ÛÙË ÌÂϤÙË
Î·È ·ÛıÂÓ›˜ Ô˘ ÂÍÂÙ¿˙ÔÓÙ·Ó Û ÂÙ¿ ȉȈÙÈο ·È‰È·ÙÚÈο
È·ÙÚ›·. ∆Ô ÚˆÙfiÎÔÏÏÔ Ù˘ ÌÂϤÙ˘ ÂÁÎÚ›ıËΠ·fi ÙËÓ ∂È-
ÙÚÔ‹ ∏ıÈ΋˜ Î·È ¢ÂÔÓÙÔÏÔÁ›·˜ ÙÔ˘ ÓÔÛÔÎÔÌ›Ԣ. √È ÁÔÓ›˜
ÂÓËÌÂÚÒÓÔÓÙ·Ó ÚÔÊÔÚÈο Î·È ¤‰ÈÓ·Ó ÙË Û˘ÁηٿıÂÛ‹ ÙÔ˘˜
ÁÈ· ÙË Û˘ÌÌÂÙÔ¯‹ ÙˆÓ ·È‰ÈÒÓ ÛÙË ÌÂϤÙË.
™ÙË ÌÂϤÙË Û˘ÌÂÚÈÏ‹ÊıËÎ·Ó ·È‰È¿ ËÏÈΛ·˜ 6 ÌËÓÒÓ
¤ˆ˜ 14 ÂÙÒÓ Ì ˘ÚÂÙfi (ıÂÚÌÔÎÚ·Û›· Ì·Û¯¿Ï˘ ≥37,8oC) ηÈ
ÂÓfi˜ ÙÔ˘Ï¿¯ÈÛÙÔÓ Û˘ÌÙÒÌ·ÙÔ˜ ‹ ÛËÌ›Ԣ Ïԛ̈͢ ÙÔ˘
·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ∂Í·ÈÚ¤ıËÎ·Ó ·fi ÙË ÌÂϤÙË
·È‰È¿ Ì ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù· ηıÒ˜ Î·È ‚Ú¤ÊË <1 ¤ÙÔ˘˜ ÌÂ
ÈÛÙÔÚÈÎfi ÚÔˆÚfiÙËÙ·˜. °È· οı ·ÛıÂÓ‹ Û˘ÌÏËÚÒıËΠÂÈ-
‰ÈÎfi ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Ô˘ ÂÚÈ›¯Â ‰ËÌÔÁÚ·ÊÈο ÛÙÔȯ›·,
Û‡ÓÙÔÌÔ ÈÛÙÔÚÈÎfi, Û˘ÌÙÒÌ·Ù· Î·È ÛËÌ›· ·fi ÙË Ê˘ÛÈ΋
ÂͤٷÛË, ·ÔÙÂϤÛÌ·Ù· ·fi ÂÚÁ·ÛÙËÚȷΤ˜ ÂÍÂÙ¿ÛÂȘ (¿Ó
¤ÁÈÓ·Ó), ÙÂÏÈ΋ ‰È¿ÁÓˆÛË, Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹, ÂÈÏÔΤ˜
Î·È ¤Î‚·ÛË. ∂›Û˘, Û˘ÏϤ¯ıËÎ·Ó ÛÙÔȯ›· Ô˘ ·ÊÔÚÔ‡Û·Ó
ÙÔÓ ·ÚÈıÌfi ÙˆÓ ·‰ÂÏÊÒÓ, ÙËÓ ¤ÎıÂÛË Û οÓÈÛÌ·, ÙË Û˘Ì-
ÌÂÙÔ¯‹ ‹ fi¯È Û ·È‰ÈÎfi ÛÙ·ıÌfi, ÙËÓ ÂÚÁ·Ûȷ΋ ηٿÛÙ·ÛË
ÙˆÓ ÁÔÓÈÒÓ Î·È ÙË ¯Ú‹ÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ. ¢‡Ô ¤ˆ˜ ÙÚÂȘ ‚‰Ô-
Ì¿‰Â˜ ÌÂÙ¿ ÙËÓ ·Ú¯È΋ ÂͤٷÛË, ηÙfiÈÓ ÙËÏÂʈÓÈ΋˜ ÂÈ-
ÎÔÈÓˆÓ›·˜ Ì ÙÔ˘˜ ÁÔÓ›˜, ηٷÁÚ¿ÊÔÓÙ·Ó ‰Â‰Ô̤ӷ Ô˘
·ÊÔÚÔ‡Û·Ó ÙËÓ ÔÚ›· Ù˘ ÓfiÛÔ˘, ÙË ‰È¿ÚÎÂÈ· ÙˆÓ Û˘ÌÙˆ-
Ì¿ÙˆÓ, ÙÔ Û˘ÓÔÏÈÎfi ·ÚÈıÌfi ÙˆÓ È·ÙÚÈÎÒÓ ÂÈÛΤ„ˆÓ, ÙËÓ
ÙÂÏÈ΋ ‰È¿ÁÓˆÛË (Â¿Ó ‹Ù·Ó ‰È·ÊÔÚÂÙÈ΋ ·fi ÙËÓ ·Ú¯È΋), ÙË
ÏËÊı›۷ ıÂڷ›·, ÙËÓ Èı·Ó‹ ÂÈÛ·ÁˆÁ‹ ÛÙÔ ÓÔÛÔÎÔÌ›Ô
Î·È ÙË ‰È¿ÚÎÂÈ· ·Ô˘Û›·˜ ·fi ÙÔ Û¯ÔÏÂ›Ô ‹ ÙÔÓ ·È‰ÈÎfi
ÛÙ·ıÌfi. ∂›Û˘, ηٷÁÚ¿ÊÔÓÙ·Ó Ë ÂΉ‹ÏˆÛË Ïԛ̈͢ ÙÔ˘
·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Û ¿ÏÏ· ̤ÏË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜, Ë
·Ó·ÁηÈfiÙËÙ· È·ÙÚÈ΋˜ ÂͤٷÛ˘ ÁÈ’ ·˘Ù¿, Ë ¯Ú‹ÛË ·ÓÙÈ‚ÈÔÙÈ-
ÎÒÓ, Ë ·Ô˘Û›· ·fi ÙËÓ ÂÚÁ·Û›· ÙÔ˘˜ Î·È Ë Ù˘¯fiÓ ÂÈÛ·ÁˆÁ‹
ÛÙÔ ÓÔÛÔÎÔÌ›Ô. ∏ ‰È¿ÁÓˆÛË Ù˘ Ó¢ÌÔÓ›·˜ ‚·Û›ÛÙËΠÛÂ
·ÂÈÎÔÓÈÛÙÈ΋ ÂȂ‚·›ˆÛË.
∏ ‰È¿ÁÓˆÛË Ïԛ̈͢ ·fi ÙÔÓ Èfi Ù˘ Áڛ˘ ¤ÁÈÓ Ì ·Ó›-
¯ÓÂ˘Û‹ ÙÔ˘ Û ÚÈÓÈÎfi ›¯ÚÈÛÌ· Ô˘ ÂÏ‹ÊıË ·fi οı ·ÛıÂ-
Ó‹. °È· ÙËÓ ·Ó›¯Ó¢ÛË ÙÔ˘ ÈÔ‡ ¯ÚËÛÈÌÔÔÈ‹ıËΠ‰ÔÎÈÌ·Û›·
Ù·¯Â›·˜ ·Ó›¯Ó¢Û˘ ·ÓÙÈÁfiÓÔ˘ [QuickVue Influenza Test
(Quidel, San Diego, Ca)]. ªÂ ·˘Ù‹ ÙË ‰ÔÎÈÌ·Û›· ·Ó›¯Ó¢Û˘
ÙÔ˘ ÈÔ‡ Ù˘ Áڛ˘, ‰ÂÓ ‹Ù·Ó ‰˘Ó·Ùfi˜ Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ ˘Ô-
Ù‡ˆÓ Áڛ˘.
ŒÁÈÓ·Ó Û˘ÁÎÚ›ÛÂȘ ÌÂٷ͇ ıÂÙÈÎÒÓ Î·È ·ÚÓËÙÈÎÒÓ ÁÈ·
ÁÚ›Ë ·ÛıÂÓÒÓ. √È ıÂÙÈÎÔ› ÁÈ· ÁÚ›Ë ·ÛıÂÓ›˜ ‰È·¯ˆÚ›ÛÙË-
Î·Ó Î·È Û˘ÁÎÚ›ıËÎ·Ó Î·È Î·Ù¿ ËÏÈΛ· (≥6 ÌËÓÒÓ ¤ˆ˜ <2
ÂÙÒÓ, ≥2 ¤ˆ˜ <5 ÂÙÒÓ Î·È ≥5 ¤ˆ˜ <14 ÂÙÒÓ), ηٿ ÂÍÂÙ·ÛÙÈ-
Îfi ΤÓÙÚÔ (∆∂¶ ‹ ȉȈÙÈο ·È‰È·ÙÚÈο È·ÙÚ›·) Î·È ¤ÙÔ˜
¤ÓÙ·Í˘ ÛÙË ÌÂϤÙË. ∆Ô χ2 ‹ ÙÔ 2-tailed Fisher’s ÙÂÛÙ Î·È ÙÔ
one-way ANOVA ÙÂÛÙ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÁÈ· ÙË Û‡ÁÎÚÈÛË
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·56
ÙˆÓ Î·ÙËÁÔÚÈÎÒÓ Î·È Û˘Ó¯ÒÓ ÌÂÙ·‚ÏËÙÒÓ, ·ÓÙ›ÛÙÔȯ·. ø˜Â›Â‰Ô ÛËÌ·ÓÙÈÎfiÙËÙ·˜ ηıÔÚ›ÛÙËΠÙÔ ·=5%. ∏ ÛÙ·ÙÈÛÙÈ-΋ ·Ó¿Ï˘ÛË ¤ÁÈÓ ̄ ÚËÛÈÌÔÔÈÒÓÙ·˜ ÙÔ ÚfiÁÚ·ÌÌ· SPSS 11.5.
∞ÔÙÂϤÛÌ·Ù·
∏ ‰È¿ÚÎÂÈ· Ù˘ ÂȉËÌÈ΋˜ ¤Í·ÚÛ˘ Ù˘ Áڛ˘‹Ù·Ó 13 Î·È 14 ‚‰ÔÌ¿‰Â˜, ·ÓÙ›ÛÙÔȯ·, ÁÈ· Ù· ‰‡ÔÛ˘Ó¯fiÌÂÓ· ¤ÙË. ∆ÔÓ ÚÒÙÔ ¯ÚfiÓÔ, Ë ÂÔ¯‹ Ù˘ ÁÚ›-˘ ¿Ú¯ÈÛ ÙË ‰Â‡ÙÂÚË Â‚‰ÔÌ¿‰· ÙÔ˘ ºÂ‚ÚÔ˘·Ú›Ô˘ÂÓÒ ÙÔ ‰Â‡ÙÂÚÔ ·Ú¯¤˜ ¢ÂÎÂÌ‚Ú›Ô˘. ∞fi 1.462 ·È-‰È¿ ËÏÈΛ·˜ 6 ÌËÓÒÓ-14 ÂÙÒÓ Ô˘ ÂÍÂÙ¿ÛÙËÎ·Ó Ì¢ÚÂÙfi Î·È Ïԛ̈ÍË ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·-ÙÔ˜, 573 (39,2%) ‹Ù·Ó ıÂÙÈο ÁÈ· ÁÚ›Ë. ∆ËÓ ÂڛԉԷȯ̋˜, Ô˘ Î·È ÙȘ ‰‡Ô ¯ÚÔÓȤ˜ ‰È‹ÚÎÂÛ ÂÚ›Ô˘Ù¤ÛÛÂÚȘ ‚‰ÔÌ¿‰Â˜, >50% ÙˆÓ ·ÛıÂÓÒÓ ‹Ù·Ó ıÂÙÈ-ÎÔ› (∂ÈÎfiÓ· 1). ∆ÔÓ ÚÒÙÔ ¯ÚfiÓÔ (2002-2003) Î·È Ùԉ‡ÙÂÚÔ (2003-2004) ÂÍÂÙ¿ÛÙËÎ·Ó Ì Ô͇ Úfi‚ÏËÌ·2.553 ·È‰È¿ Î·È 2.359, ·ÓÙ›ÛÙÔȯ·, Î·È ·fi ·˘Ù¿ 759(29,7%) Î·È 946 (40%), ·ÓÙ›ÛÙÔȯ·, ÏËÚÔ‡Û·Ó Ù·ÎÚÈÙ‹ÚÈ· ¤ÓÙ·Í˘ ÛÙË ÌÂϤÙË. ¢ÔÎÈÌ·Û›· ÁÈ· ·Ó›-¯Ó¢ÛË ÙÔ˘ ÈÔ‡ Ù˘ Áڛ˘ ¤ÁÈÓ Û 608 (80%) ηÈ854 (90%) Î·È ·fi ·˘ÙÔ‡˜ 254/608 (41,8%) ηÈ319/854 (37,3%), ·ÓÙ›ÛÙÔȯ·, ‹Ù·Ó ıÂÙÈÎÔ›. ¢ÂÓ˘‹ÚÍ ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙÔ ÔÛÔÛÙfi Ïԛ̈͢ٷ ‰‡Ô Û˘Ó¯fiÌÂÓ· ¤ÙË (p=0,088). ∆Ô 13,5% ÙÔ˘ Û˘-ÓfiÏÔ˘ ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ÚÔÛ‹Ïı·Ó ÛÙ· ∆∂¶ ÙÔ˘ÓÔÛÔÎÔÌ›Ԣ ηٿ Ù· ‰‡Ô ¯ÚfiÓÈ· Ô˘ ‰È‹ÚÎÂÛ ËÌÂϤÙË Î·È ÙÔ 16,1% ·˘ÙÒÓ Ô˘ ÂÈÛΤÊÙËÎ·Ó ÙÔ˘˜È‰ÈÒÙ˜ ·È‰È¿ÙÚÔ˘˜ Ô˘ Û˘ÌÌÂÙ›¯·Ó ›¯Â Ïԛ̈ÍË·fi ÙÔÓ Èfi Ù˘ Áڛ˘. ∏ Û˘¯ÓfiÙËÙ· Ïԛ̈͢ ·fiÁÚ›Ë ‹Ù·Ó ¯·ÌËÏfiÙÂÚË ÛÙ· ·È‰È¿ <2 ÂÙÒÓ (30,9%)Û˘ÁÎÚÈÓfiÌÂÓË Ì ·˘Ù¿ ËÏÈΛ·˜ ≥2 Î·È ≤5 (42%) ηÈÂΛӷ ≥5 ÂÙÒÓ (41,5%) (p=0,004).
∆· ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ·ÛıÂÓÒÓ ÌÂ Î·È ¯ˆÚ›˜Ïԛ̈ÍË ·fi ÙÔÓ Èfi Ù˘ Áڛ˘ Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›-
ӷη 1. ∏ Ïԛ̈ÍË ·fi ÙÔÓ Èfi Ù˘ Áڛ˘ ‹Ù·Ó Û˘-
¯ÓfiÙÂÚË ÛÙ· ·È‰È¿ Ô˘ ·Ú·ÎÔÏÔ˘ıÔ‡Û·Ó ·È‰ÈÎfi
ÛÙ·ıÌfi ‹ Û¯ÔÏ›Ô. ¶ÂÚ›Ô˘ ÙÔ 60% ÙˆÓ ·È‰ÈÒÓ ÌÂ
ÁÚ›Ë ‹Ù·Ó οو ÙˆÓ 5 ÂÙÒÓ. ∏ ËÏÈÎȷ΋ ηٷÓÔÌ‹
ÙˆÓ ·ÛıÂÓÒÓ Ì ÁÚ›Ë Ê·›ÓÂÙ·È ÛÙËÓ ∂ÈÎfiÓ· 2.
∏ ÔÍ›· ̤ÛË ˆÙ›Ùȉ· ‹Ù·Ó Ë ÈÔ Û˘¯Ó‹ ÂÈÏÔ-
΋. ∫·Ù·ÁÚ¿ÊËΠÛÙÔ 15% ÙˆÓ ıÂÙÈÎÒÓ ÁÈ· ÁÚ›Ë
·ÛıÂÓÒÓ Î·Ù¿ ÙËÓ ·Ú¯È΋ ÂͤٷÛË Î·È ÛÙÔ 18,5%
ÛÙÔ follow-up (∂ÈÎfiÓ· 3). µÚÔÁ¯ÈÔÏ›Ùȉ·, ‚ÚÔÁ¯ÈÎfi
¿ÛıÌ· Î·È Ó¢ÌÔÓ›· ‹Ù·Ó ÏÈÁfiÙÂÚÔ Û˘¯Ó¤˜ ÂÈÏÔ-
Τ˜ ÛÙÔ˘˜ ıÂÙÈÎÔ‡˜ ·ÛıÂÓ›˜.
∞Ó¿Ï˘ÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ Ì ‚¿ÛË ÙËÓ ËÏÈ-
Îȷ΋ ηٷÓÔÌ‹ ÙˆÓ ıÂÙÈÎÒÓ ·ÛıÂÓÒÓ ¤‰ÂÈÍ fiÙÈ
ÔÍ›· ̤ÛË ˆÙ›Ùȉ· ‰È·ÁÓÒÛÙËΠÙÂÏÈο ÈÔ Û˘¯Ó¿
ÛÙ· ·È‰È¿ οو ÙˆÓ 2 ÂÙÒÓ Î·È Û ·˘Ù¿ ËÏÈΛ·˜ ≥2
¤ˆ˜ <5 ÂÙÒÓ Û ۇÁÎÚÈÛË Ì ٷ ÌÂÁ·Ï‡ÙÂÚ· ≥5 ¤ˆ˜
£ÂÙ
ÈÎÔ
› ·
Ûı
ÂÓ›
˜ %
∆∂¶ π‰ÈˆÙÈο π·ÙÚ›·
6 8 10 12 14 16 18 20 51 1 3 5 7 9 11
2003 ∂‚‰ÔÌ¿‰Â˜ 2004
0
10
20
30
40
50
60
70
80
90
∂ÈÎfiÓ· 1. ∫·Ù·ÓÔÌ‹ ÙˆÓ ÂÚÈÙÒÛÂˆÓ Áڛ˘ Û ·È‰È¿ Ì Â̇ÚÂÙË Ïԛ̈ÍË ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Ô˘ ÂÍÂÙ¿ÛÙËÎ·Ó ÛÙ· Â͈ÙÂÚÈο ·È-‰È·ÙÚÈο È·ÙÚ›· ‹ Û ȉȈÙÈο ·È‰È·ÙÚÈο È·ÙÚ›· ηٿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ‰‡Ô ÂȉËÌÈÒÓ Áڛ˘ Ù˘ ÌÂϤÙ˘ (2002-2004).
57√È Û˘Ó¤ÂȘ Ù˘ Áڛ˘
¶·È‰È·ÙÚÈ΋ 2008;71:55-61
¶›Ó·Î·˜ 1. ÷ڷÎÙËÚÈÛÙÈο ·ÛıÂÓÒÓ
¢ËÌÔÁÚ·ÊÈο ÛÙÔȯ›· °Ú›Ë (+) °Ú›Ë (-) PN=573 N=888
∏ÏÈΛ·, ̤ÛË ± ™∞ (Ì‹Ó˜) 62±43 55,8±43,6 0,008∞ÁfiÚÈ·/∫ÔÚ›ÙÛÈ· 1,4 1,2 0,411πÛÙÔÚÈÎfi ‚ÚÔÁ¯ÈÎÔ‡ ¿ÛıÌ·ÙÔ˜ 97 (17)· 162 (18) 0,514¶·ıËÙÈÎfi οÓÈÛÌ· 261 (46) 439 (50) 0,138™¯ÔÏ›Ô/·È‰ÈÎfi˜ ÛÙ·ıÌfi˜ 355 (61,5) 482 (55) 0,004
¶·È‰ÈÎfi˜ ÛÙ·ıÌfi˜ 180 (31,5) 245 (28) 0,116¶·Ú·ÌÔÓ‹ ÛÙÔ Û›ÙÈ 217 (38) 402 (45) 0,005™¯ÔÏÂ›Ô 175 (30,5) 237 (27) 0,110
ª¤ÁÂıÔ˜ ÔÈÎÔÁ¤ÓÂÈ·˜, ̤ÛË ± ™∞ 3,7±0,77 3,7±0,76 0,530∞‰¤ÏÊÈ·, ̤ÛË ± ™∞ 0,7±0,83 0,7±0,76 0,619
· √È ·ÚÈıÌÔ› ÛÙËÓ ·Ú¤ÓıÂÛË ·ÓÙÈÛÙÔÈ¯Ô‡Ó Û ÔÛÔÛÙ¿ %™∞ ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·57
<14 ÂÙÒÓ (p=0,001) (¶›Ó·Î·˜ 3). §·Ú˘ÁÁ›Ùȉ·(croup) ÛÙȘ ·Ú·¿Óˆ ÔÌ¿‰Â˜ ÂΉËÏÒıËÎÂ Û˘¯Ófi-ÙÂÚ· ÛÙ· ÌÈÎÚfiÙÂÚ· ·È‰È¿ (p=0,002) (¶›Ó·Î·˜ 3).∞Ó¿Ï˘ÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ Ì ‚¿ÛË ÙÔÓ ÙfiÔÂͤٷÛ˘ ÙˆÓ ·ÛıÂÓÒÓ ¤‰ÂÈÍ fiÙÈ ÙÔ ‚ÚÔÁ¯ÈÎfi¿ÛıÌ· ‹Ù·Ó Û˘¯ÓfiÙÂÚÔ ÛÙÔ˘˜ ıÂÙÈÎÔ‡˜ ·ÛıÂÓ›˜Ô˘ ÂÍÂÙ¿ÛÙËÎ·Ó ÛÙ· ȉȈÙÈο ·È‰È·ÙÚÈο È·ÙÚ›·(14/90, 15,5%), Û ۇÁÎÚÈÛË Ì ٷ ∆∂¶ ÙÔ˘ ÓÔÛÔÎÔ-Ì›Ԣ (32/483, 6,6%) (p=0,004). ¢ÂÓ ˘‹ÚÍ·Ó ¿ÏϘÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÛÙËÓ ·Ó¿Ï˘ÛË ÙˆÓ·ÔÙÂÏÂÛÌ¿ÙˆÓ Î·Ù¿ ËÏÈΛ·, ¤ÙÔ˜ Î·È ÙfiÔ Âͤٷ-Û˘ ÙÔ˘ ·ÛıÂÓÔ‡˜.
∏ ̤ÛË ‰È¿ÚÎÂÈ· ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÙˆÓ ·ÛıÂ-ÓÒÓ Ì ÁÚ›Ë ‹Ù·Ó 8,4 Ë̤Ú˜ Î·È ‹Ù·Ó ÛËÌ·ÓÙÈοÌÂÁ·Ï‡ÙÂÚË Ù˘ ·ÓÙ›ÛÙÔȯ˘ ÙˆÓ ·ÚÓËÙÈÎÒÓ ÁÈ· ÁÚ›-Ë ·ÛıÂÓÒÓ. ¢ÂÓ ˘‹ÚÍ ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙË̤ÛË ‰È¿ÚÎÂÈ· ·Ô˘Û›·˜ ·fi ÙÔ Û¯ÔÏÂ›Ô Î·È ÙÔÓ ·È-‰ÈÎfi ÛÙ·ıÌfi ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜ ÙˆÓ ·ÛıÂÓÒÓ. √È ıÂÙÈ-ÎÔ› ÁÈ· ÁÚ›Ë ·ÛıÂÓ›˜ ÂÈÛΤÊÙËÎ·Ó ÙÔÓ È·ÙÚfi 1,36ÊÔÚ¤˜ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ·Ûı¤ÓÂÈ¿˜ ÙÔ˘˜. ∂ÈÛ·-ÁˆÁ‹ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô ‹Ù·Ó ··Ú·›ÙËÙË ÁÈ· ÙÔ 5,4%ÙˆÓ ·ÛıÂÓÒÓ Ì ÁÚ›Ë Î·È ÁÈ· ÙÔ 7,7% ÙˆÓ ·ÛıÂÓÒÓÌ ¿ÏϘ ÏÔÈÌÒÍÂȘ (p=0,165) (¶›Ó·Î·˜ 2). ∫·Ù¿ ÙËÓ·Ú¯È΋ ÂͤٷÛË ÙˆÓ ·ÛıÂÓÒÓ, ·ÓÙÈ‚ÈÔÙÈο ¯ÔÚËÁ‹-
ıËÎ·Ó ÛÙÔ 18,5% ÙˆÓ ıÂÙÈÎÒÓ ÁÈ· ÁÚ›Ë ·ÛıÂÓÒÓ,
΢ڛˆ˜ ÏfiÁˆ ÔÍ›·˜ ̤Û˘ ̂ Ù›Ùȉ·˜. ∫·Ù¿ ÙËÓ ·Ú·-
ÎÔÏÔ‡ıËÛË ‰È·ÈÛÙÒıËΠfiÙÈ ·ÓÙÈ‚ÈÔÙÈο ¤Ï·‚ ÙÂ-
ÏÈο ÂÚ›Ô˘ ÙÔ 40% ÙˆÓ ·ÛıÂÓÒÓ. ∞ÓÙÈ‚ÈÔÙÈο,
‚ÚÔÁ¯Ô‰È·ÛÙ·ÏÙÈο Î·È ÂÈÛÓÂfiÌÂÓ· ÎÔÚÙÈÎÔÛÙÂÚÈ-
ÓÔÂȉ‹ ¤Ï·‚·Ó Û˘¯ÓfiÙÂÚ· ÔÈ ·ÚÓËÙÈÎÔ› ÁÈ· ÁÚ›Ë
·ÛıÂÓ›˜ (¶›Ó·Î·˜ 2). ∞Ó¿Ï˘ÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ
Ì ‚¿ÛË ÙËÓ ËÏÈΛ· ÙˆÓ ·ÛıÂÓÒÓ ¤‰ÂÈÍ fiÙÈ ·ÓÙÈ‚ÈÔ-
ÙÈο Û˘ÓÙ·ÁÔÁÚ·Ê‹ıËÎ·Ó Û˘¯ÓfiÙÂÚ· ÛÙ· ·È‰È¿ ο-
Ùˆ ÙˆÓ 2 ÂÙÒÓ Ì ÁÚ›Ë, Û ۇÁÎÚÈÛË Ì ٷ ÌÂÁ·Ï‡-
ÙÂÚ· ·È‰È¿ (p=0,027) (¶›Ó·Î·˜ 3). ∞ÓÙȂ˯Èο ÛÈ-
ÚfiÈ· ‰fiıËÎ·Ó ÏÈÁfiÙÂÚÔ Û˘¯Ó¿ ÛÙ· ÌÈÎÚfiÙÂÚ· ·È-
‰È¿ Û ۇÁÎÚÈÛË Ì ÂΛӷ ËÏÈΛ·˜ ≥2 ¤ˆ˜ <5 ÂÙÒÓ
Î·È Ù· ÌÂÁ·Ï‡ÙÂÚ· (p=0,017) (¶›Ó·Î·˜ 3). µÚÔÁ¯Ô-
‰È·ÛÙ·ÏÙÈο, ÂÈÛÓÂfiÌÂÓ· ÎÔÚÙÈÎÔÛÙÂÚÈÓÔÂȉ‹ ηÈ
·ÓÙȂ˯Èο Ê¿Ú̷η Û˘ÓÙ·ÁÔÁÚ·Ê‹ıËÎ·Ó ÂÚÈÛÛfi-
ÙÂÚÔ ·fi ÙÔ˘˜ ȉÈÒÙ˜ ·È‰È¿ÙÚÔ˘˜. ∫·Ó¤Ó·˜ ·fi
ÙÔ˘˜ 90 ıÂÙÈÎÔ‡˜ ÁÈ· ÁÚ›Ë ·ÛıÂÓ›˜ Ô˘ ÂÍÂÙ¿ÛÙË-
Î·Ó ÛÙ· ȉȈÙÈο ·È‰È·ÙÚÈο È·ÙÚ›· ‰ÂÓ ÂÈÛ‹¯ıË
ÛÙÔ ÓÔÛÔÎÔÌ›Ô, ÂÓÒ 21/302 (6,8%) Ô˘ ÂÍÂÙ¿ÛÙË-
Î·Ó ÛÙ· ›ÁÔÓÙ· Â͈ÙÂÚÈο È·ÙÚ›· ÂÈÛ‹¯ıËÛ·Ó
ÛÙÔ ÓÔÛÔÎÔÌ›Ô.
√È ÁÔÓ›˜ ¤¯·Û·Ó ηٿ ̤ÛÔ fiÚÔ 1,34 ÂÚÁ¿ÛÈ̘
Ë̤Ú˜ ÁÈ· ÙË ÊÚÔÓÙ›‰· ÙÔ˘ οı ¿ÚÚˆÛÙÔ˘ ·È‰È-
Ô‡. ∏ ‰È¿ÚÎÂÈ· ·Ô˘Û›·˜ ·fi ÙËÓ ÂÚÁ·Û›· ‹Ù·Ó ›‰È·
ÁÈ· ÙÔ˘˜ ÁÔÓ›˜ ÙˆÓ ıÂÙÈÎÒÓ Î·È ÙˆÓ ·ÚÓËÙÈÎÒÓ ÁÈ·
ÁÚ›Ë ·ÛıÂÓÒÓ. ¢Â˘ÙÂÚÔÁÂÓ‹˜ Ïԛ̈ÍË ÙÔ˘ ·Ó·-
Ó¢ÛÙÈÎÔ‡ ‹Ù·Ó Û˘¯ÓfiÙÂÚË ÛÙ· ̤ÏË ÙˆÓ ÔÈÎÔÁÂ-
ÓÂÈÒÓ ÙˆÓ ıÂÙÈÎÒÓ ÁÈ· ÁÚ›Ë ·ÛıÂÓÒÓ (58,2% ¤Ó·ÓÙÈ
40%, p<0,001). √È ‰È·ÊÔÚ¤˜ ‹Ù·Ó ÛËÌ·ÓÙÈΤ˜ ÁÈ·
ÙÔ˘˜ ÁÔÓ›˜ (·Ù¤Ú·˜ 21,9% ¤Ó·ÓÙÈ 11,8%, p<0,001,
ÌËÙ¤Ú· 27,2% ¤Ó·ÓÙÈ 14,4, p<0,001) ¿ÏÏ· fi¯È ÁÈ· Ù·
0 5 10 15 20 25 30
µÚÔÁ¯ÔÏ›Ùȉ·
∞Ì˘Á‰·Ï›Ùȉ·
ª˘ÔÛ›Ùȉ·
¶·Ú·ÚÚÈÓÔÎÔÏ›Ùȉ·
Croup
¶Ó¢ÌÔÓ›·
µÚÔÁ¯ÈÎfi ¿ÛıÌ·
√ªø
∞ÚÓËÙÈÎÔ›£ÂÙÈÎÔ›
(P=0,203)
(P=0,002) (P=0,001)
(P=0,579)
(P=0,13)
(P=0,005)
(P=0,002)
(P=0,005)
∂ÈÎfiÓ· 3. ∂ÈÏÔΤ˜ Û ıÂÙÈÎÔ‡˜ Î·È ·ÚÓËÙÈÎÔ‡˜ ÁÈ· Áڛ˷ÛıÂÓ›˜.
58 ª. ∆ÛÔÏÈ¿ Î·È Û˘Ó.
Paediatriki 2008;71:55-61
0,5-
<1
1-<
2
2-<
3
3-<
4
4-<
5
5-<
6
6-<
7
7-<
8
8-<
9
9-<
10
10-<
11
11-<
12
12-<
13
13-<
14
∏ÏÈΛ· (¤ÙË)
∞Ú
ÈıÌ
fi˜
·Û
ıÂÓ
ÒÓ
0
20
40
60
80
100
∂ÈÎfiÓ· 2. ∏ÏÈÎȷ΋ ηٷÓÔÌ‹ ÙˆÓ ıÂÙÈÎÒÓ ÁÈ· ÁÚ›Ë ·ÛıÂÓÒÓ.
¶›Ó·Î·˜ 2. ¶·Ú·ÎÔÏÔ‡ıËÛË ·ÛıÂÓÒÓ Ì ÁÚ›Ë
÷ڷÎÙËÚÈÛÙÈο °Ú›Ë (+) °Ú›Ë (-) PN=392 N=452
¢È¿ÚÎÂÈ· Û˘Ìو̿وÓ, ̤ÛË ± ™∞, Ë̤Ú˜ 8,4±5,7 7,3±4,4 0,002∞Ô˘Û›· ·fi Û¯ÔÏ›Ô, ̤ÛË ± ™∞, Ë̤Ú˜ 5,2±5,5 5,9±5,1 0,302∞Ô˘Û›· ·fi ·È‰ÈÎfi ÛÙ·ıÌfi, ̤ÛË ± ™∞, Ë̤Ú˜ 9,2±8,19 7,6±6,2 0,069¡Ô È·ÙÚÈÎÒÓ ÂÈÛΤ„ÂˆÓ 1,4±0,96 1,3±0,52 0,078∂ÈÛ·ÁˆÁ‹ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô 21 (5,4)· 35 (7,7) 0,165∞ÓÙÈ‚ÈÔÙÈο 153 (39,5) 260 (57,6) <0,0001µÚÔÁ¯Ô‰È·ÛÙ·ÏÙÈο 52 (13,3) 120 (26,5) <0,0001∂ÈÛÓÂfiÌÂÓ· ÎÔÚÙÈÎÔÛÙÂÚÈÓÔÂȉ‹ 21 (5,4) 68 (15) <0,0001™˘ÛÙËÌ·ÙÈο ÎÔÚÙÈÎÔÛÙÂÚÈÓÔÂȉ‹ 8 (2) 8 (1,8) 0,772∞ÓÙȂ˯Èο 216 (55,4) 295 (65,3) 0,003
· √È ·ÚÈıÌÔ› ÛÙËÓ ·Ú¤ÓıÂÛË ·ÓÙÈÛÙÔÈ¯Ô‡Ó Û ÔÛÔÛÙ¿ %™∞ ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·58
·‰¤ÏÊÈ· (35,3% ¤Ó·ÓÙÈ 34%, p=0,734). ™ÙȘ ÔÈÎÔÁ¤-
ÓÂȘ ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ‹Ù·Ó ıÂÙÈÎÔ› ÁÈ· ÁÚ›Ë, Ë
·Ó¿ÁÎË È·ÙÚÈ΋˜ ›Û΄˘ Î·È ¯ÔÚ‹ÁËÛ˘ ·ÓÙÈ‚ÈÔ-
ÙÈÎÒÓ ‹Ù·Ó Û˘¯ÓfiÙÂÚË. ∂›Û˘, Ïԛ̈ÍË ÙÔ˘ ·Ó·-
Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÂÌÊ¿ÓÈÛ·Ó Û˘¯ÓfiÙÂÚ· Ù·
·‰¤ÏÊÈ· ÙˆÓ ıÂÙÈÎÒÓ ·ÛıÂÓÒÓ Ô˘ ‹Ù·Ó ÌÈÎÚfiÙÂÚ·
·fi 5 ÂÙÒÓ (44/141 ·‰¤ÏÊÈ·, 31,2%) Û ۇÁÎÚÈÛË ÌÂ
Ù· ÌÂÁ·Ï‡ÙÂÚ· (24/128, 18,8%) (p=0,003).
™˘˙‹ÙËÛË
™ÙËÓ ÚÔÔÙÈ΋ ·˘Ù‹ ÌÂϤÙË, Ô˘ ‚·Û›ÛÙËÎÂ
ÛÙËÓ ÂÚÁ·ÛÙËÚȷ΋ ÂȂ‚·›ˆÛË Ù˘ Áڛ˘, ·ÂÈ-
ÎÔÓ›˙ÂÙ·È Ë Â›‰Ú·ÛË Ù˘ Ïԛ̈͢ ·fi ÙÔÓ Èfi Ù˘
Áڛ˘ ÛÙ· ·È‰È¿ Î·È ÙȘ ÔÈÎÔÁ¤ÓÂȤ˜ ÙÔ˘˜ ÛÙËÓ
ÎÔÈÓfiÙËÙ·, ηıÒ˜ Î·È Ë ÂÈ‚¿Ú˘ÓÛË ÙÔ˘ Û˘ÛÙ‹Ì·-
ÙÔ˜ ˘Á›·˜ ·fi ·˘Ù‹. ™ÙËÓ ¤Ú¢ӷ ·˘Ù‹ ¤Ï·‚ ̤-
ÚÔ˜ ¤Ó·˜ ÌÂÁ¿ÏÔ˜ ·ÚÈıÌfi˜ ·ÛıÂÓÒÓ, ÔÈ ÔÔ›ÔÈ ÂÍÂ-
Ù¿ÛÙËÎ·Ó ÛÙ· ›ÁÔÓÙ· Â͈ÙÂÚÈο È·ÙÚ›· ÙÔ˘ ÓÔ-
ÛÔÎÔÌ›Ԣ ‹ Û ȉȈÙÈο ·È‰È·ÙÚÈο È·ÙÚ›·, Î·È Ë
ÌÂϤÙË Û˘Ó¯›ÛÙËΠÁÈ· ‰‡Ô ‰È·‰Ô¯Èο ¤ÙË. ¢È·È-
ÛÙÒıËΠfiÙÈ Ë ÁÚ›Ë ÚÔηÏ› ÛËÌ·ÓÙÈ΋ ÓÔÛËÚfi-
ÙËÙ· ÛÙ· ·È‰È¿ Î·È ÙȘ ÔÈÎÔÁ¤ÓÂȤ˜ ÙÔ˘˜ ÛÙËÓ ÎÔÈ-
ÓfiÙËÙ· οı ¯ÚfiÓÔ. ∏ ‰È¿ÚÎÂÈ· Ù˘ ÂȉËÌÈ΋˜
¤Í·ÚÛ˘ Ù˘ Áڛ˘ ‹Ù·Ó 13-14 ‚‰ÔÌ¿‰Â˜ Î·È fi¯È
4-6 ‚‰ÔÌ¿‰Â˜, fiˆ˜ ‹Ù·Ó ÁÓˆÛÙfi ̤¯ÚÈ ÚfiÛÊ·Ù·.
∫·Ù¿ ÙÔ ‰È¿ÛÙËÌ· ·˘Ùfi, Ë ÓfiÛÔ˜ ÚÔοÏÂÛ ÙÔ 40%
ÙˆÓ ÂÈÛΤ„ÂˆÓ ÁÈ· Ïԛ̈ÍË ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡
Û˘ÛÙ‹Ì·ÙÔ˜ Ì ˘ÚÂÙfi Î·È ÙÔ 13,5% ÙÔ˘ Û˘ÓfiÏÔ˘
ÙˆÓ ÂÈÛΤ„ÂˆÓ ÛÙ· ›ÁÔÓÙ· ·È‰È·ÙÚÈο È·ÙÚ›·
ÙÔ˘ ÓÔÛÔÎÔÌ›Ԣ ÙˆÓ ·È‰ÈÒÓ ËÏÈΛ·˜ 6 ÌËÓÒÓ ¤ˆ˜
14 ÂÙÒÓ. ∆Ô Ì‹Ó· ̤ÁÈÛÙ˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Ù˘ Ófi-
ÛÔ˘, Ô Èfi˜ Ù˘ Áڛ˘ ¢ı˘ÓfiÙ·Ó ÁÈ· ÔÛÔÛÙfi >50%
fiÏˆÓ ÙˆÓ ·Ó·Ó¢ÛÙÈÎÒÓ ÏÔÈÌÒÍÂˆÓ Ô˘ Û˘Óԉ‡-
ÔÓÙ·È ·fi ˘ÚÂÙfi, ηıÒ˜ Î·È ÁÈ· ÙÔ 25% ÙÔ˘ Û˘Ófi-
ÏÔ˘ ÙˆÓ ÂÈÛΤ„ÂˆÓ ÛÙ· ·È‰È·ÙÚÈο È·ÙÚ›· ÙÔ˘
∆∂¶. ™Â ÚÔËÁÔ‡ÌÂÓË ÌÂϤÙË ‚·ÛÈṲ̂ÓË Û ÂȉË-
ÌÈÔÏÔÁÈο ‰Â‰Ô̤ӷ, ÙÔ ÔÛÔÛÙfi Áڛ˘ Û ·È‰È¿
οو ÙˆÓ 3 ÂÙÒÓ ‹Ù·Ó Ù˘ ٿ͈˜ ÙÔ˘ 24% ¤ˆ˜ 35%
ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ¯ÂÈÌÒÓ· (3). ∞ÎfiÌË Î·È ·Ó ¿Ï-
ÏÔÈ ÈÔ› ΢ÎÏÔÊÔÚÔ‡Ó Ù·˘Ùfi¯ÚÔÓ· ηٿ ÙÔ˘˜ ¯ÂÈÌÂ-
ÚÈÓÔ‡˜ Ì‹Ó˜, Ê·›ÓÂÙ·È fiÙÈ Ë ÁÚ›Ë ˘ÂÚ¤¯ÂÈ Î·È Â›-
Ó·È Ë Î‡ÚÈ· ·ÈÙ›· Ïԛ̈͢ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘-
ÛÙ‹Ì·ÙÔ˜, ÙÔ˘Ï¿¯ÈÛÙÔÓ Î·Ù¿ ÙȘ Ù¤ÛÛÂÚȘ ‚‰ÔÌ¿-
‰Â˜ Ù˘ ·È¯Ì‹˜ Ù˘ ÓfiÛÔ˘. ªfiÓÔ ¤Ó· ÌÈÎÚfi ÔÛÔÛÙfi
(5%) ÙˆÓ ·ÛıÂÓÒÓ Ì ÁÚ›Ë Ô˘ ÂÍÂÙ¿ÛÙËÎ·Ó ÙÂÏÈ-
ο ÓÔÛËχÙËÎ·Ó Î·È ·˘Ùfi ˘ÔÁÚ·ÌÌ›˙ÂÈ ÙÔ ÁÂÁÔ-
Ófi˜ fiÙÈ ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ Ì¤ÚÔ˜ Ù˘ ÓÔÛËÚfiÙËÙ·˜ Ô˘
ÚÔηÏÂ›Ù·È ·fi ÙË ÓfiÛÔ ·ÊÔÚ¿ ÙÔ˘˜ Â͈ÙÂÚÈÎÔ‡˜
·ÛıÂÓ›˜.
∏ Ú·ÁÌ·ÙÈ΋ ›‰Ú·ÛË Ù˘ Áڛ˘ ÛÙËÓ ÎÔÈÓfi-
ÙËÙ· Èı·ÓÒ˜ Ó· ¤¯ÂÈ ˘ÔÂÎÙÈÌËı› Û ·˘Ù‹ ÙË ÌÂ-
ϤÙË. ™ÙË ÌÂϤÙË, Û˘ÌÂÚÈÏ‹ÊıËÎ·Ó ÌfiÓÔ ·ÛıÂÓ›˜
Ì Ïԛ̈ÍË ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Î·È ˘ÚÂÙfi (14). ∏
·Ó›¯Ó¢ÛË ÙÔ˘ ·ÓÙÈÁfiÓÔ˘ ÂÍ·ÚÙ¿Ù·È ·fi ÙËÓ Â˘·È-
ÛıËÛ›· Ù˘ ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓ˘ ÌÂıfi‰Ô˘ (15,16).
∞ÎfiÌË, Ô Èfi˜ ÙË Áڛ˘ ÌÔÚ› Ó· ÌËÓ Â›Ó·È ·ÓȯÓ‡-
ÛÈÌÔ˜ ÛÙÔÓ ÚÈÓÔÊ¿Ú˘ÁÁ·, Â¿Ó ¤¯Ô˘Ó ÂÚ¿ÛÂÈ ·ÚÎÂ-
Ù¤˜ Ë̤Ú˜ ·fi ÙËÓ ¤Ó·ÚÍË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Î·È Ô
·ÛıÂÓ‹˜ ÚÔÛ¤Ú¯ÂÙ·È Ì ÂÈÏÔΤ˜ Ù˘ ÓfiÛÔ˘ (17).
∆¤ÏÔ˜, Èı·Ófiٷٷ Ó· ›¯·Ì ¤Ó· ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔ-
ÛÙfi ıÂÙÈÎÒÓ ÁÈ· ÁÚ›Ë ‰ÂÈÁÌ¿ÙˆÓ, Â¿Ó ·ÓÙ› ÁÈ· ÚÈÓÈÎfi
›¯ÚÈÛÌ· ›¯Â ¯ÚËÛÈÌÔÔÈËı› ÚÈÓÔÊ·Ú˘ÁÁÈÎfi ¤Î-
Ï˘Ì· Î·È ·Ó ›¯Â ÂÊ·ÚÌÔÛı› ̤ıÔ‰Ô˜ ·Ï˘ÛȉˆÙ‹˜
·ÓÙ›‰Ú·Û˘ ÔÏ˘ÌÂÚ¿Û˘ (PCR).
√È ·ÛıÂÓ›˜ Ô˘ ÂÌÊ¿ÓÈÛ·Ó ÁÚ›Ë ‹Ù·Ó ËÏÈÎȷο
ÌÂÁ·Ï‡ÙÂÚÔÈ ·fi ·˘ÙÔ‡˜ Ô˘ ‹Ù·Ó ·ÚÓËÙÈÎÔ› ηÈ
·Ú·ÎÔÏÔ˘ıÔ‡Û·Ó Û˘¯ÓfiÙÂÚ· ·È‰ÈÎfi ÛÙ·ıÌfi ‹
Û¯ÔÏ›Ô, ÏfiÁˆ Û˘Á¯ÚˆÙÈÛÌÔ‡. ¶ÔÛÔÛÙfi ÂÚ›Ô˘
60% ÙˆÓ ·ÛıÂÓÒÓ Ì ÁÚ›Ë ‹Ù·Ó οو ÙˆÓ 5 ÂÙÒÓ.
∏ ÈÔ Û˘¯Ó‹ ÂÈÏÔ΋ Ù˘ Áڛ˘ ‹Ù·Ó Ë ÔÍ›·
̤ÛË ˆÙ›Ùȉ· Î·È ÙÔ ‚ÚÔÁ¯ÈÎfi ¿ÛıÌ·. ∆· ÛÙÔȯ›·
·˘Ù¿ Û˘ÌʈÓÔ‡Ó Ì ÂΛӷ ÚfiÛÊ·ÙˆÓ ÌÂÏÂÙÒÓ
(13,14). ™ËÌÂÈÒÓÂÙ·È, ›Û˘, fiÙÈ ÔÍ›· ̤ÛË ˆÙ›ÙÈ-
‰·, ‚ÚÔÁ¯ÈÔÏ›Ùȉ· Î·È Ó¢ÌÔÓ›· ‹Ù·Ó ÈÔ Û˘¯Ó¤˜
ÛÙÔ˘˜ ·ÚÓËÙÈÎÔ‡˜ ÁÈ· ÁÚ›Ë ·ÛıÂÓ›˜. ¶·ÚfiÏ· ·˘Ù¿,
‰È·ÈÛÙÒıËΠfiÙÈ Ë ÁÚ›Ë ÚÔηÏ› ÙÔ 33% ÙˆÓ Â-
ÚÈÙÒÛÂˆÓ ÔÍ›·˜ ̤Û˘ ˆÙ›Ùȉ·˜, ÙÔ 40% ÙˆÓ ÂÚÈ-
ÙÒÛÂˆÓ Ï·Ú˘ÁÁÔÙÚ·¯ÂÈÔ‚ÚÔÁ¯›Ùȉ·˜, ÙÔ 25% ÙˆÓ
ÂÂÈÛÔ‰›ˆÓ ‚ÚÔÁ¯ÈÎÔ‡ ¿ÛıÌ·ÙÔ˜ Î·È ÙÔ 17% ÙˆÓ Â-
ÚÈÙÒÛÂˆÓ Ó¢ÌÔÓ›·˜ ÛÙÔ˘˜ Â͈ÙÂÚÈÎÔ‡˜ ·ÛıÂÓ›˜
ηٿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ 13-14 ‚‰ÔÌ¿‰ˆÓ ÂȉËÌÈ΋˜
¤Í·ÚÛ˘ Ù˘ Áڛ˘ ÁÈ· ‰‡Ô Û˘Ó¯fiÌÂÓ· ¤ÙË. ™Â
Û˘Ìʈӛ· Ì ٷ ˆ˜ ¿Óˆ Â˘Ú‹Ì·Ù· Â›Ó·È Î·È ·˘Ù¿
ÚÔËÁÔ‡ÌÂÓˆÓ ÌÂÏÂÙÒÓ, ÛÙȘ Ôԛ˜ ‰È·ÈÛÙÒıËÎÂ
fiÙÈ Ì ÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi ηٿ Ù˘ Áڛ˘ Ë Û˘¯ÓfiÙËÙ·
Ù˘ ÔÍ›·˜ ̤Û˘ ˆÙ›Ùȉ·˜ ÌÂÈÒÓÂÙ·È Î·Ù¿ 30%-36%
(18,19,20). ∆· ÂÚÈÛÛfiÙÂÚ· ÂÂÈÛfi‰È· ÔÍ›·˜ ̤Û˘
ˆÙ›Ùȉ·˜ (76%) Î·È 9/10 ÂÚÈÙÒÛÂȘ Ï·Ú˘ÁÁÔÙÚ·-
¯ÂÈÔ‚ÚÔÁ¯›Ùȉ·˜ ÂÌÊ·Ó›ÛÙËÎ·Ó Û ·È‰È¿ ËÏÈΛ·˜
οو ÙˆÓ 5 ÂÙÒÓ.
59√È Û˘Ó¤ÂȘ Ù˘ Áڛ˘
¶·È‰È·ÙÚÈ΋ 2008;71:55-61
¶›Ó·Î·˜ 3. ™˘ÁÎÚÈÙÈο ·ÔÙÂϤÛÌ·Ù· ÌÂٷ͇ ËÏÈÎÈ·ÎÒÓ ÔÌ¿‰ˆÓ ÙˆÓ ıÂÙÈÎÒÓ ÁÈ· ÁÚ›Ë ·È‰ÈÒÓ
√Í›· ̤ÛË ˆÙ›Ùȉ· §·Ú˘ÁÁ›Ùȉ· ∞ÓÙÈ‚ÈÔÙÈο ∞ÓÙȂ˯Èο
>6-23 ÌËÓÒÓ 20 (27,8%) 6 (8,3%) 35 (48,6%) 22 (30,6%)24-59 ÌËÓÒÓ 35 (22,6%) 3 (1,9%) 66 (42,9%) 69 (44,5%)>59 ÌËÓÒÓ 3. 17 (10,5%) 1 (0,6%) 52 (32,5%) 83 (51,2%)P 0,001 0,002 0,027 0,017
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·59
∏ Ïԛ̈ÍË ·fi ÙÔÓ Èfi Ù˘ Áڛ˘ Û˘Ó‰¤ÂÙ·È ÌÂ
·ÏfiÁÈÛÙË ̄ Ú‹ÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ. ¢È·ÈÛÙÒıËΠfiÙÈ Â-
Ú›Ô˘ 40% ÙˆÓ ·ÛıÂÓÒÓ ¤Ï·‚ ·ÓÙÈ‚ÈÔÙÈο ηٿ ÙË
‰È¿ÚÎÂÈ· Ù˘ ÓfiÛÔ˘ ÌÂ Û˘¯ÓfiÙÂÚÔ ·›ÙÈÔ ÙËÓ ÔÍ›·
̤ÛË ˆÙ›Ùȉ·. ∞˘Ù¿ Ù· ÛÙÔȯ›· Û˘ÌʈÓÔ‡Ó Ì ÛÙÔÈ-
¯Â›· ·fi ÚÔËÁÔ‡ÌÂÓ˜ ÌÂϤÙ˜ (3,13,14). ¶Èı·Ófi-
ٷٷ, Ë ¯Ú‹ÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ Ó· ‹Ù·Ó ·ÎfiÌË ÌÂÁ·Ï‡-
ÙÂÚË, Â¿Ó ÙÔ ·ÔÙ¤ÏÂÛÌ· Ù˘ ‰ÔÎÈÌ·Û›·˜ Ù·¯Â›·˜
‰È¿ÁÓˆÛ˘ ‰ÂÓ ÁÈÓfiÙ·Ó ÁÓˆÛÙfi (21).
∏ Ïԛ̈ÍË ·fi ÙÔÓ Èfi Ù˘ Áڛ˘ ¤¯ÂÈ ÛËÌ·ÓÙÈ΋
›وÛË Î·È ÛÙȘ ÔÈÎÔÁ¤ÓÂȘ ÙˆÓ ·ÛıÂÓÒÓ. ∆Ô Ô-
ÛÔÛÙfi ‰Â‡ÙÂÚÔ˘ ÂÂÈÛÔ‰›Ô˘ ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ·, Ô˘
ÂÎÙÈÌ¿Ù·È Û 17%, Â›Ó·È Û‡ÌʈÓÔ Ì ÚÔËÁÔ‡ÌÂÓ˜
ÌÂϤÙ˜ (11,22,23) Î·È Â›Ó·È ÌÂÁ·Ï‡ÙÂÚÔ Û ۇÁÎÚÈ-
ÛË Ì ÙÔ˘˜ ·ÚÓËÙÈÎÔ‡˜ ÁÈ· ÁÚ›Ë ·ÛıÂÓ›˜. ∆· ¢ڋ-
Ì·Ù· ·˘Ù¿ ̆ Ô‰ËÏÒÓÔ˘Ó ̆ „ËÏfiÙÂÚÔ ÔÛÔÛÙfi ÂÓ‰Ô-
ÔÈÎÔÁÂÓÂȷ΋˜ ÌÂÙ¿‰ÔÛ˘ Ù˘ Áڛ˘, Û ۇÁÎÚÈÛË
Ì ¿ÏϘ ÏÔÈÌÒÍÂȘ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡. °È· οıÂ
·ÛıÂÓ‹ Ì ÁÚ›Ë, ¯¿ıËΠ·fi ÙÔ˘˜ ÁÔÓ›˜ ·ÚÎÂÙfi˜
¯ÚfiÓÔ˜ ·fi ÙËÓ ÂÚÁ·Û›· ÙÔ˘˜ ÁÈ· ÙË ÊÚÔÓÙ›‰· ÙˆÓ
·È‰ÈÒÓ ·ÏÏ¿ Î·È ÏfiÁˆ ·Ûı¤ÓÂÈ·˜ ÙˆÓ ›‰ÈˆÓ.
™˘ÌÂÚ·ÛÌ·ÙÈο, Ë Ïԛ̈ÍË ·fi ÙÔÓ Èfi Ù˘ ÁÚ›-
˘ Â›Ó·È Ë Î‡ÚÈ· ·ÈÙ›· Â̇ÚÂÙ˘ Ïԛ̈͢ ÙÔ˘
·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÛÙ· ·È‰È¿ ÛÙËÓ ÎÔÈÓfi-
ÙËÙ·, ÙÔ˘Ï¿¯ÈÛÙÔÓ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ·È¯Ì‹˜ Ù˘ ÂÙ‹-
ÛÈ·˜ ÂȉËÌ›·˜ Áڛ˘ Î·È Â›Ó·È ¿ÌÂÛ· Û˘Ó‰Â‰Â̤ÓË
Ì ÛËÌ·ÓÙÈ΋ ÓÔÛËÚfiÙËÙ· Î·È ˘ÂÚ‚ÔÏÈ΋, ÔÏϤ˜
ÊÔÚ¤˜ ·ÏfiÁÈÛÙË, ¯Ú‹ÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ. ªfiÓÔ ÌÈÎÚfi
ÔÛÔÛÙfi ·È‰ÈÒÓ Ì ÁÚ›Ë ÓÔÛËχÂÙ·È ÛÙÔ ÓÔÛÔ-
ÎÔÌÂ›Ô Î·È ·˘Ùfi Ô‰ËÁ› ÛÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ ÙÔ ÌÂ-
Á·Ï‡ÙÂÚÔ ÊÔÚÙ›Ô Ù˘ ÓfiÛÔ˘ ·ÊÔÚ¿ ÙÔ˘˜ Â͈ÙÂÚÈ-
ÎÔ‡˜ ·ÛıÂÓ›˜. ∏ Ïԛ̈ÍË ·fi ÙË ÁÚ›Ë ¤¯ÂÈ ÛËÌ·-
ÓÙÈ΋ ›‰Ú·ÛË Î·È ÛÙ· ¿ÏÏ· ̤ÏË ÙˆÓ ÔÈÎÔÁÂÓÂÈÒÓ
ÙˆÓ ·È‰ÈÒÓ Ô˘ ÚÔÛ‚¿ÏÏÔÓÙ·È ÚÔηÏÒÓÙ·˜ Ófi-
ÛÔ, È·ÙÚÈΤ˜ ÂÈÛΤ„ÂȘ, ¯Ú‹ÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ Î·È
·ÒÏÂÈ· ˆÚÒÓ ÂÚÁ·Û›·˜. ∆Ô 50% ÙˆÓ ÂÚÈÙÒÛˆÓ
Áڛ˘ Î·È ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ÙˆÓ ÂÈÏÔÎÒÓ
·ÊÔÚ¿ ·È‰È¿ ËÏÈΛ·˜ οو ÙˆÓ 5 ÂÙÒÓ, ÂÔ̤ӈ˜, Ë
ÂÊ·ÚÌÔÁ‹ ηıÔÏÈÎÔ‡ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Ûã ·˘Ù‹Ó ÙËÓ
ËÏÈÎȷ΋ ÔÌ¿‰· ı· ÌÔÚÔ‡Û ӷ ÌÂÈÒÛÂÈ ÙËÓ Â›-
ÙˆÛË Ù˘ Áڛ˘ ÛÙËÓ ÎÔÈÓfiÙËÙ· Î·È ÙȘ Û˘Ó¤ÂȤ˜
Ù˘ ÛÙÔ Û‡ÛÙËÌ· ˘Á›·˜.
∂˘¯·ÚÈÛٛ˜
£ÂṲ́˜ ¢¯·ÚÈÛٛ˜ ÛÙËÓ Î˘Ú›· ŒÏÂÓ· ∫ÚÈÙÛ¤ÏË ÁÈ· ÙË
‚Ô‹ıÂÈ¿ Ù˘ ÛÙË ÛÙ·ÙÈÛÙÈ΋ ÂÂÍÂÚÁ·Û›· ÙˆÓ ‰ÈÔÚıÒÛˆÓ
ÙÔ˘ ÎÂÈ̤ÓÔ˘.
µÈ‚ÏÈÔÁÚ·Ê›·
1. Mullooly JP, Barker WH. Impact of type A influenza on
children: a retrospective study. Am J Public Health
1982;72:1008-1016.
2. Glezen WP, Decker M, Joseph SW, Mercready RG Jr.
Acute respiratory disease associated with influenza epi-
demics in Houston, 1981-1983. J Infect Dis 1987;155:1119-
1126.
3. Neuzil KM, Mellen BG, Wright PF, Mitchel EF Jr, Griffin
M. The effect of influenza on hospitalizations, outpatient
visits, and courses of antibiotics in children. N Engl J Med
2000;342:225-231.
4. Izurieta HS, Thompson WW, Kramarz P, Shay DK, Davis
RL, DeStefano F, et al. Influenza and the rates of hospital-
ization for respiratory disease among infants and young
children. N Engl J Med 2000;342:232-239.
5. Neuzil KM, Zhu Y, Griffin MR, Edwards KM, Thompson
JM, Tollefson SJ, et al. Burden of interpandemic influenza
in children younger than 5 years: a 25-year prospective
study. J Infect Dis 2002;185:147-152.
6. Bridges CB, Harper SA, Fukuda K, Uyeki TM, Cox NJ, Sin-
gleton JA; Advisory Committee on Immunization Prac-
tices. Prevention and control of influenza. Recommenda-
tions of the Advisory Committee on Immunization Prac-
tices (ACIP). MMWR Recomm Rep 2003;52(RR-8):1-34.
7. Glezen WP, Taber LH, Frank AL, Gruber WC, Piedra PA.
Influenza virus infections in infants. Pediatr Infect Dis J
1997;16:1065-1068.
8. Hurwitz ES, Haber M, Chang A, Shope T, Teo ST, Giesick
JS, et al. Studies of the 1996-1997 inactivated influenza vac-
cine among children attending day care: immunologic re-
sponse, protection against infection, and clinical effective-
ness. J Infect Dis 2000;182:1218-1221.
9. Hurwitz ES, Haber M, Chang A, Shope T, Teo S, Ginsberg
M, et al. Effectiveness of influenza vaccination of day care
children in reducing influenza-related morbidity among
household contacts. JAMA 2000;284:1677-1682.
10. Longini IM Jr, Koopman JS, Monto AS, Fox JP. Estimating
household and community transmission parameters for
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14. Principi N, Esposito S, Gasparini R, Marchisio P, Crovari
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61√È Û˘Ó¤ÂȘ Ù˘ Áڛ˘
¶·È‰È·ÙÚÈ΋ 2008;71:55-61
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™ˆÛÙ¤˜ ··ÓÙ‹ÛÂȘ ÙÔ˘ Quiz ÁÈ· ÙÔ ¿ÚıÚÔ “ƒÂ˘Ì·ÙÈÎfi˜ ˘ÚÂÙfi˜: Â›Ó·È ·ÎfiÌ· ‰Ò!”
1. ∏ ˘„ËÏfiÙÂÚË Â›ÙˆÛË ÙÔ˘ ƒ¶ ·Ú·ÙËÚ›ٷÈ: ·. ™Ù· ·È‰È¿ ÚÈÓ ·fi ÙËÓ ÂÊ˂›·
2. √ ÂÈÔÏ·ÛÌfi˜ Ù˘ ƒ∫ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚÔ˜:Á. ™ÙÔ˘˜ ÂÓ‹ÏÈΘ
3. ∏ ‰È¿ÚÎÂÈ· ıÂڷ›·˜ Ù˘ ÛÙÚÂÙÔÎÔÎÎÈ΋˜ Ê·Ú˘ÁÁ›Ùȉ·˜ ›ӷÈ:·. 10 Ë̤Ú˜
4. ŒÊË‚Ô˜ 17 ÂÙÒÓ Ì ‹È· ·Ó¿ÚÎÂÈ· ÌÈÙÚÔÂȉԇ˜, ÏfiÁˆ ÔͤԘ ƒ¶, ÂÊfiÛÔÓ ‰ÂÓ ·ÚÔ˘ÛÈ¿ÛÂÈ ¿ÏÏÔ ÂÂÈÛfi-‰ÈÔ, ı· Ú¤ÂÈ Ó· ¿ÚÂÈ ÚfiÏË„Ë:Á. ø˜ ÙÔ 25Ô ¤ÙÔ˜
5. ¶ÔÈÔ˜ ·fi ÙÔ˘˜ ·Ú·Î¿Ùˆ ¤¯ÂÈ ÙÂÎÌËÚȈ̤ÓÔ ƒ¶:Á. ∫·È ÔÈ ‰‡Ô
6. 10¯ÚÔÓÔ˜ Ì ˘ÚÂÙfi, ·ÚıÚ·ÏÁ›·, Û˘Ìو̷ÙÔÏÔÁ›· ηډȷ΋˜ ·Ó¿ÚÎÂÈ·˜ Î·È Û˘ÛÙÔÏÈÎfi ʇÛËÌ· 3/6ÛÙËÓ ÎÔÚ˘Ê‹ Ì ¤ÎÙ·ÛË ÛÙË Ì·Û¯¿ÏË ¤¯ÂÈ ÙÂÎÌËÚȈ̤ӷ ƒ¶, ÂÊfiÛÔÓ Û˘Ó˘¿Ú¯ÂÈ:‚. ™ÙÚÂÙÔÎÔÎÎÈ΋ Ê·Ú˘ÁÁ›Ùȉ· ÚÔ 2-3 ‚‰ÔÌ¿‰ˆÓ
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·61
62 ¶ƒ∞∫∆π∫√ £∂ª∞ PRACTICAL ISSUE
Paediatriki 2008;71:62-67
™˘ÁÎÔÙÈο ÂÂÈÛfi‰È· ÛÙËÓ ·È‰È΋ Î·È ÂÊË‚È΋ ËÏÈΛ·: ‰È¿-
ÁÓˆÛË - ·ÓÙÈÌÂÙÒÈÛË
¢. π. °ÂˆÚÁ·ÎfiÔ˘ÏÔ˜
¶ÂÚ›ÏË„Ë: ∆· Û˘ÁÎÔÙÈο ÂÂÈÛfi‰È· Â›Ó·È Ôχ Û˘¯Ó¿ ηٿ ÙËÓ ·È‰È΋ Î·È ÂÊË‚È΋ ËÏÈΛ·. ∆Ô Û˘¯Ófi-ÙÂÚÔ ·›ÙÈÔ Û˘ÁÎÔÙÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ Â›Ó·È Ë Ó¢ÚÔηډÈÔÁÂÓ‹˜ Û˘ÁÎÔ‹, Ë ÔÔ›· Â›Ó·È ÌÈ· ηÏÔ‹ı˘ η-Ù¿ÛÙ·ÛË, Ì Ôχ ηϋ ÚfiÁÓˆÛË ÛÙË ÌÂÁ¿ÏË ÏÂÈÔÓfiÙËÙ· ÙˆÓ ÂÚÈÙÒÛˆÓ. ∏ ‰È¿ÁÓˆÛ‹ Ù˘ ‚·Û›˙Â-Ù·È ÛÙÔ ÏÂÙÔÌÂÚ¤˜ ÔÈÎÔÁÂÓÂÈ·Îfi Î·È ·ÙÔÌÈÎfi ÈÛÙÔÚÈÎfi Î·È ÛÙËÓ ÚÔÛÂÎÙÈ΋ ÎÏÈÓÈ΋ ÂͤٷÛË. ∞fi ÙÔ ÈÛÙÔ-ÚÈÎfi ·Ó·˙ËÙ¿Ù·È È‰È·›ÙÂÚ· Ë ‡·ÚÍË ÂÂÈÛÔ‰›Ô˘ ·ÈÊÓȉ›Ô˘ ı·Ó¿ÙÔ˘ ÛÂ Û˘ÁÁÂÓÈÎfi ¿ÙÔÌÔ Ó·ڋ˜ ËÏÈΛ·˜,Ë ·ÚÔ˘Û›· ÛÙÔÓ ·ÛıÂÓ‹ ÁÓˆÛÙ‹˜ ηډȷ΋˜ ÓfiÛÔ˘, ÂÓÒ ‰ÈÂÚ¢ÓÒÓÙ·È Î·È ÔÈ ·ÎÚȂ›˜ Û˘Óı‹Î˜ ÙÔ˘ÂÂÈÛÔ‰›Ô˘ Î·È Ë Î·Ù¿ÛÙ·ÛË ÙÔ˘ ·ÛıÂÓÔ‡˜ ηٿ ÙË ‰È¿ÚÎÂÈ¿ ÙÔ˘ Î·È ·Ì¤Ûˆ˜ ÌÂÙ¿. ∏ ÎÏÈÓÈ΋ ÂͤٷÛËÂÈÎÂÓÙÚÒÓÂÙ·È ÛÙÔ Î˘ÎÏÔÊÔÚÈÎfi Î·È ÛÙÔ Ó¢ÚÈÎfi Û‡ÛÙËÌ·, ·Ó·˙ËÙÒÓÙ·˜ ÛËÌ›· ηډȷ΋˜ ‹ Ó¢ÚÔÏÔ-ÁÈ΋˜ ·ı‹Ûˆ˜. ∞fi ÙȘ ·Ú·ÎÏÈÓÈΤ˜ ÂÍÂÙ¿ÛÂȘ, ··Ú·›ÙËÙÔ ÎÚ›ÓÂÙ·È ÙÔ ∏∫°, ÂÓÒ ÔÈ ˘fiÏÔȘ ·ÔÊ·-Û›˙ÔÓÙ·È Ì ‚¿ÛË Ù· ÎÏÈÓÈο Â˘Ú‹Ì·Ù·. π‰È·›ÙÂÚË ÚÔÛÔ¯‹ ¯ÚÂÈ¿˙ÂÙ·È ÛÙËÓ ·Ó›¯Ó¢ÛË ÙˆÓ Û¿ÓÈˆÓ Â-ÚÈÙÒÛÂˆÓ Î·Ú‰ÈÔÁÂÓÔ‡˜ Û˘ÁÎÔ‹˜ Î·È ÛÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ·fi Ù· ÂÂÈÛfi‰È· Û·ÛÌÒÓ. ∏ ·ÓÙÈ-ÌÂÙÒÈÛË Ù˘ Ó¢ÚÔηډÈÔÁÂÓÔ‡˜ Û˘ÁÎÔ‹˜ Á›ÓÂÙ·È Û˘Ó‹ıˆ˜ Ì ÂÊ·ÚÌÔÁ‹ ·ÏÒÓ Ì¤ÙÚˆÓ ÚfiÏ˄˘.∫·ıÔÚÈÛÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ Â›Ó·È Ô Î·ıËÛ˘¯·ÛÌfi˜ ÙÔ˘ ·ÛıÂÓÔ‡˜ Î·È Ë Âη›‰Â˘Û‹ ÙÔ˘ ÛÙËÓ ·Ó·ÁÓÒÚÈ-ÛË Î·È ¤ÁηÈÚË ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÂÂÈÛÔ‰›ˆÓ.
§¤ÍÂȘ ÎÏÂȉȿ: ™˘ÁÎÔ‹, ·ÒÏÂÈ· Ù˘ Û˘Ó›‰ËÛ˘, Ó¢ÚÔηډÈÔÁÂÓ‹˜ Û˘ÁÎÔ‹.
Syncopal episodes in childhood and adolescence:
diagnosis - management
D. π. Georgakopoulos
Abstract: Syncopal episodes are very frequent during childhood and adolescence. The most frequent formis the common faint or neurocardiogenic syncope, which is a benign situation with excellent prognosis inthe majority of cases. The diagnosis of neurocardiogenic syncope is based on the history and the physicalexamination. From the history, it is elicited, among other information, whether there has ever been asudden death in a family member at a young age and whether the patient suffers from a known heartdisease. An effort is made to elucidate the exact circumstances of the episode and the condition of thepatient during and immediately after the syncope. Physical examination is concentrated on the circulatoryand nervous systems, to detect possible signs of a cardiac or neurological disease. An ECG is considerednecessary in all cases, with other laboratory examinations according to the clinical findings. Special caremust be given to the detection of the rare but potentially dangerous episodes of cardiogenic syncope. Thevast majority of patients are treated with simple measures aimed at avoidance of potential triggers. Thepatients must be reassured and taught how to recognize the premonitory signs and what to do to avoidevolution to full syncope.
Key words: Syncope, loss of consciousness, cardiogenic syncope.
∫·Ú‰ÈÔÏÔÁÈÎfi ∆Ì‹Ì·¡ÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ∞ıËÓÒÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”
AÏÏËÏÔÁÚ·Ê›·:
¢ËÌ‹ÙÚÈÔ˜ π. °ÂˆÚÁ·ÎfiÔ˘ÏÔ˜ [email protected] ∫·Ú‰ÈÔÏÔÁÈÎfi ∆Ì‹Ì·,¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ ∞ıËÓÒÓ“¶. & ∞. ∫˘ÚÈ·ÎÔ‡”£Ë‚ÒÓ Î·È §Â‚·‰Â›·˜, ∆.∫. 115 27, ∞ı‹Ó·
Cardiology Department, “P. & A. Kyriakou”Children’s Hospital, Athens, Greece
Correspondence:
Dimitrios π. Georgakopoulos [email protected] Cardiology Department, “P. & A. Kyriakou”Children’s HospitalThivon & Levadias St., 115 27, Athens, Greece
∂ÈÛ·ÁˆÁ‹
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Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·62
·ÁfiÚÈ·. ∏ ›وۋ Ù˘ ÛÙÔ ÁÂÓÈÎfi ·È‰È·ÙÚÈÎfi
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Ó· Â›Ó·È ·fiÙÔÎÔ˜ ·Ê˘‰¿ÙˆÛ˘ ‹ ÌÂÙ·‚ÔÏÒÓ Ù˘
ı¤Ûˆ˜ ÙÔ˘ ÛÒÌ·ÙÔ˜ (.¯. ·fi ηıÈÛÙ‹ Û fiÚıÈ· ı¤-
ÛË). ∏ ηډȿ ·ÓÙȉڿ ·˘Í¿ÓÔÓÙ·˜ ÙË Û˘ÛÙ·ÏÙÈÎfi-
ÙËÙ¿ Ù˘ Î·È ·ÔÛÙ¤ÏÏÔÓÙ·˜ ̤ۈ ÙˆÓ Ì˯·ÓÔ¸Ô-
‰Ô¯¤ˆÓ Î·È ÙˆÓ ÚÔÛ·ÁˆÁÒÓ ÈÓÒÓ C ÌËӇ̷ٷ ÛÙÔÓ
ÂÁΤʷÏÔ, Ô ÔÔ›Ô˜ ·ÓÙ·ÔÎÚ›ÓÂÙ·È Ì ÙË ÛÂÈÚ¿ ÙÔ˘
Î·È ÛÙ¤ÏÓÂÈ ··ÁˆÁ¿ ÂÚÂı›ÛÌ·Ù· ÛÙËÓ Î·Ú‰È¿ ηÈ
ÛÙ· ·ÁÁ›· ̤ۈ ÙÔ˘ ·˘ÙfiÓÔÌÔ˘ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·-
ÙÔ˜. ∆· ÂÚÂı›ÛÌ·Ù· ·˘Ù¿ ÂÏ·ÙÙÒÓÔ˘Ó ÙÔÓ ÙfiÓÔ ÙÔ˘
Û˘Ì·ıËÙÈÎÔ‡ Î·È ·˘Í¿ÓÔ˘Ó ÙÔÓ ÙfiÓÔ ÙÔ˘ ·Ú·Û˘-
Ì·ıËÙÈÎÔ‡, Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ˘fiÙ·ÛË Î·È ÙË
‚Ú·‰˘Î·Ú‰›·. ŸÙ·Ó Ë ·¿ÓÙËÛË ·˘ÙÔ‡ ÙÔ˘ Ù‡Ô˘
Â›Ó·È ˘¤ÚÌÂÙÚË Î·È ˘Âڂ› οÔÈÔ fiÚÈÔ, ÙfiÙ ÂÎ-
‰ËÏÒÓÂÙ·È Û˘ÁÎÔÙÈÎfi ÂÂÈÛfi‰ÈÔ. ™ÙË Û˘Ó¤¯ÂÈ·,
ÌfiÏȘ Ô ·ÛıÂÓ‹˜ ¤ÛÂÈ ÛÙÔ ¤‰·ÊÔ˜, ·˘Í¿ÓÂÙ·È Ë
ÊÏ‚È΋ ÂÈÛÙÚÔÊ‹ ÛÙËÓ Î·Ú‰È¿, Ô ·ÓÙ·Ó·ÎÏ·ÛÙÈ-
Îfi˜ Ì˯·ÓÈÛÌfi˜ ‰È·ÎfiÙÂÙ·È Î·È ÙÔ Â›Â‰Ô Û˘Ó›-
‰ËÛ˘ ·Ôηı›ÛٷٷÈ.
∫ÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο Ó¢ÚÔηډÈÔÁÂÓÔ‡˜
Û˘ÁÎÔ‹˜
∏ Ó¢ÚÔηډÈÔÁÂÓ‹˜ Û˘ÁÎÔ‹, fiˆ˜ ÚÔ·Ó·-
ʤÚıËÎÂ, Â›Ó·È Û˘¯ÓfiÙÂÚË ÛÙÔ˘˜ ÂÊ‹‚Ô˘˜ Î·È ÂȉÈο
ÛÙ· ÎÔÚ›ÙÛÈ·. ™˘Ó‹ıË ÂÚÂı›ÛÌ·Ù· Â›Ó·È Ë ·fiÙÔÌË
·ÏÏ·Á‹ ı¤Ûˆ˜ (·fi ηıÈÛÙ‹ ‹ ͷψ̤ÓË Û fiÚ-
ıÈ·), Ë ·Ú·ÙÂٷ̤ÓË ÔÚıÔÛÙ·Û›· Î·È Î·Ù·ÛÙ¿ÛÂȘ
Ô˘ ÚÔηÏÔ‡Ó ¤ÓÙÔÓÔ Êfi‚Ô ‹ fiÓÔ (.¯. ·ÈÌÔÏË-
„›·, ı¤· ·›Ì·ÙÔ˜). ™˘¯Ó¿, ÛÙÔ ›‰ÈÔ ¿ÙÔÌÔ, Ù· ÂÂÈÛfi-
‰È· ÚÔηÏÔ‡ÓÙ·È ¿ÏÏÔÙ Ì ÙÔ ¤Ó· Î·È ¿ÏÏÔÙ Ì ÙÔ
¿ÏÏÔ ÂÚ¤ıÈÛÌ·. ¶ÚԉȷıÂÛÈÎÔ› ·Ú¿ÁÔÓÙ˜ ÁÈ· ÙËÓ
ÂΉ‹ÏˆÛË ÙˆÓ ÂÂÈÛÔ‰›ˆÓ Â›Ó·È Ë ·Ê˘‰¿ÙˆÛË, Ë
63™˘ÁÎÔÙÈο ÂÂÈÛfi‰È· ÛÙ· ·È‰È¿
¶·È‰È·ÙÚÈ΋ 2008;71:62-67
¶›Ó·Î·˜ 2. ∞›ÙÈ· ηډÈÔÁÂÓÔ‡˜ Û˘ÁÎÔ‹˜
ñ ∆·¯˘·ÚÚ˘ı̛˜ñ µÚ·‰˘·ÚÚ˘ı̛˜ ñ ™Ù¤ÓˆÛË ·ÔÚÙ‹˜ñ ÀÂÚÙÚÔÊÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ·ñ ∆ÂÙÚ·ÏÔÁ›· Fallotñ ™Ù¤ÓˆÛË Ó¢ÌÔÓÈ΋˜ñ ¶Ó¢ÌÔÓÈ΋ ˘¤ÚÙ·ÛËñ ™ÙÂÊ·ÓÈ·›· ÓfiÛÔ˜ (Kawasaki, Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜
·ÚÙËÚÈÒÓ)ñ ¢È·Ù·ÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ·ñ ª˘Ôηډ›Ùȉ·
¶›Ó·Î·˜ 1. ∞›ÙÈ· Û˘ÁÎÔÙÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ
ñ ¡Â˘ÚÔηډÈÔÁÂÓ‹˜ Û˘ÁÎÔ‹ñ ∫·Ú‰ÈÔÁÂÓ‹˜ Û˘ÁÎÔ‹ñ ∫Ú¿ÙËÌ· ·Ó·ÓÔ‹˜ñ æ˘¯ÔÁÂÓ‹˜ Û˘ÁÎÔ‹ñ √ÚıÔÛÙ·ÙÈ΋ ˘fiÙ·ÛËñ ™‡Ó‰ÚÔÌÔ ÔÚıÔÛÙ·ÙÈ΋˜ Ù·¯˘Î·Ú‰›·˜ñ ∞ÓÙ·Ó·ÎÏ·ÛÙÈ΋ Û˘ÁÎÔ‹ (‚‹¯·˜, Ô‡ÚËÛË, ·Êfi‰Â˘ÛË)ñ ∞Ó·ÈÌ›· ñ §‹„Ë Ô˘ÛÈÒÓ
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·63
˙¤ÛÙË, Ô Û˘ÓˆÛÙÈÛÌfi˜, ÙÔ ¿Á¯Ô˜, Ë ·‰È·ıÂÛ›· Î·È Ë
·Ó·ÈÌ›·. ∆· ÂÂÈÛfi‰È· Â›Ó·È ‰˘Ó·Ùfi Ó· Û˘Ì‚Ô‡Ó Î·È
¯ˆÚ›˜ Ó· ˘¿Ú¯ÂÈ ·ÓȯÓ‡ÛÈÌÔ˜ ÂÎÏ˘ÙÈÎfi˜ ·Ú¿ÁÔ-
ÓÙ·˜ ‹ Î·È Ì ÙÔÓ ·ÛıÂÓ‹ Û ηıÈÛÙ‹ ı¤ÛË. ∂ÂÈÛfi-
‰È· ·ÒÏÂÈ·˜ Ù˘ Û˘Ó›‰ËÛ˘ Ô˘ ¤گÔÓÙ·È ÛÂ
ηٷÎÂÎÏÈÌ̤ÓË ı¤ÛË Î·È ¯ˆÚ›˜ Ó· ¤¯ÂÈ ÚÔËÁËı›
οÔÈÔ Û˘Ó·ÈÛıËÌ·ÙÈÎfi ÂÚ¤ıÈÛÌ· Â›Ó·È ·›ı·ÓÔ Ó·
ÔÊ›ÏÔÓÙ·È Û ¡∫™.
™˘Ó‹ıˆ˜ ‰È·ÎÚ›ÓÔÓÙ·È ÙÚ›· ÛÙ¿‰È·: ·) ¶ÚÔÛ˘ÁÎÔ-
ÙÈ΋ Ê¿ÛË. ∏ ¤Ó·ÚÍË Â›Ó·È ·fiÙÔÌË. √ ·ÛıÂÓ‹˜ ÂÓ-
‰¤¯ÂÙ·È Ó· ·ÈÛı·Óı› ·‰˘Ó·Ì›·, ˙¿ÏË, ‰È·Ù·Ú·¯¤˜
Ù˘ ÔÚ¿Ûˆ˜, ÎÂÊ·Ï·ÏÁ›·, ÛÈÂÏfiÚÚÔÈ· Î·È Ó·˘Ù›·,
Ô˘ ÌÔÚ› Ó· ηٷϋÍÂÈ Î·È Û ÂÌÂÙfi. ∂›Û˘ ·Ú·-
ÙËÚÔ‡ÓÙ·È ̂ ¯ÚfiÙËÙ·, ÂÊ›‰ÚˆÛË, ̆ ÂÚ·ÂÚÈÛÌfi˜, ·Ó·-
ÛÙÂÓ·ÁÌÔ›, ¯·ÛÌÔ˘ÚËÙ¿, ‚Ú·‰˘Î·Ú‰›· Î·È ˘fiÙ·ÛË.
∏ ‰È¿ÚÎÂÈ· Ù˘ ÂÚÈfi‰Ô˘ ·˘Ù‹˜ Â›Ó·È Û‡ÓÙÔÌË, Û˘Ó‹-
ıˆ˜ ·fi 10 ̤¯ÚÈ 20 ‰Â˘ÙÂÚfiÏÂÙ·. ‚) ™˘ÁÎÔ‹. √
·ÛıÂÓ‹˜ ÎÂ›Ù·È ·Ó·›ÛıËÙÔ˜, ¯·Ï·Úfi˜, ˆ¯Úfi˜, Ì ÙȘ
ÎfiÚ˜ Û ‰È·ÛÙÔÏ‹. ∆Ô ‰¤ÚÌ· Â›Ó·È ÎÚ‡Ô Î·È Î¿ıȉÚÔ,
ÂÓÒ Ô ÛÊ˘ÁÌfi˜ Â›Ó·È ‚Ú·‰‡˜ Î·È ·ÛıÂÓÈÎfi˜. ™¿ÓÈ·
ÂÓ‰¤¯ÂÙ·È Ó· ·Ú·ÙËÚËıÔ‡Ó ·ÒÏÂÈ· Ô‡ÚˆÓ Î·È ÙÔ-
ÓÈΤ˜-ÎÏÔÓÈΤ˜ ÎÈÓ‹ÛÂȘ ÙˆÓ ¿ÎÚˆÓ. ¢È·ÚΛ ÙÔ Ôχ
Ï›Á· ÏÂÙ¿. Á) ªÂÙ·Û˘ÁÎÔÙÈ΋ Ê¿ÛË. √ ·ÛıÂÓ‹˜
ÓÔÈÒıÂÈ ·‰‡Ó·ÌÔ˜, ̇ ·ÏÈṲ̂ÓÔ˜, Ì ٿÛË ÁÈ· ÂÌÂÙfi ηÈ
ÂÏ·ÊÚÈ¿ ÎÂÊ·Ï·ÏÁ›·. ∏ Ï‹Ú˘ ·ӷÊÔÚ¿ ›ӷÈ
ÁÚ‹ÁÔÚË, Û˘Ó‹ıˆ˜ ̤۷ Û ÌÈÛ‹ ÒÚ·.
¢È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË Û˘ÁÎÔÙÈÎÒÓ
ÂÂÈÛÔ‰›ˆÓ
∏ ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË Ù˘ ¡∫™ Ú¤ÂÈ Ó· Á›ÓÂ-
Ù·È ·fi Ù· ̆ fiÏÔÈ· ·›ÙÈ· ÙˆÓ Û˘ÁÎÔÙÈÎÒÓ ÂÂÈÛÔ-
‰›ˆÓ Î·È ÙˆÓ ÂÂÈÛÔ‰›ˆÓ ·ÒÏÂÈ·˜ Ù˘ Û˘Ó›‰ËÛ˘,
Û˘¯ÓfiÙÂÚÔ ÙˆÓ ÔÔ›ˆÓ Â›Ó·È ÔÈ Û·ÛÌÔ›. π‰È·›ÙÂÚË
ÚÔÛÔ¯‹ Ú¤ÂÈ Ó· ‰›‰ÂÙ·È ÛÙÔÓ ·ÔÎÏÂÈÛÌfi ·ıÔ-
ÏÔÁÈÎÒÓ Î·Ú‰ÈÔÏÔÁÈÎÒÓ Î·Ù·ÛÙ¿ÛˆÓ, (ηډÈÔÁÂ-
Ó‹˜ Û˘ÁÎÔ‹), ÔÈ Ôԛ˜ ÂÓ‰¤¯ÂÙ·È Ó· Â›Ó·È ·ÂÈÏË-
ÙÈΤ˜ ·ÎfiÌ· Î·È ÁÈ· ÙË ˙ˆ‹ ÙÔ˘ ·ÛıÂÓÔ‡˜.
∫·Ú‰ÈÔÁÂÓ‹˜ Û˘ÁÎÔ‹∏ ηډÈÔÁÂÓ‹˜ Û˘ÁÎÔ‹ ¤گÂÙ·È fiÙ·Ó Ë Î·Ú-
‰È¿, ÁÈ· ÔÈΛÏÔ˘˜ ÏfiÁÔ˘˜, ·‰˘Ó·Ù› Ó· ηχ„ÂÈ ÙȘ
··ÈÙ‹ÛÂȘ ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ Û √2, ÂȉÈο ηٿ ÙË
ۈ̷ÙÈ΋ ¿ÛÎËÛË. ŸÏ˜ ÔÈ Î·Ú‰È·Î¤˜ ·ı‹ÛÂȘ ›ӷÈ
‰˘Ó·Ùfi οو ·fi ÔÚÈṲ̂Ó˜ Û˘Óı‹Î˜ Ó· ÚÔηϤ-
ÛÔ˘Ó Û˘ÁÎÔÙÈÎfi ÂÂÈÛfi‰ÈÔ, Û˘¯ÓfiÙÂÚ· fï˜ ·˘Ùfi
ÌÔÚ› Ó· ·Ú·ÙËÚËı› Û ‰È·Ù·Ú·¯¤˜ ÙÔ˘ Ú˘ıÌÔ‡,
·ÔÊÚ·ÎÙÈΤ˜ ·ı‹ÛÂȘ ÙÔ˘ ¯ÒÚÔ˘ ÂÍfi‰Ô˘ Ù˘ ·ÚÈ-
ÛÙÂÚ‹˜ ÎÔÈÏ›·˜, ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ, ‰È·Ù·ÙÈ΋ Ì˘ÔηÚ-
‰ÈÔ¿ıÂÈ·-Ì˘Ôηډ›Ùȉ·, Ó¢ÌÔÓÈ΋ ˘¤ÚÙ·ÛË.
™ÙÔȯ›·, Ù· ÔÔ›· ı· ÛÙÚ¤„Ô˘Ó ÙËÓ ÚÔÛÔ¯‹ Ì·˜
ÚÔ˜ ÙÔ Î˘ÎÏÔÊÔÚÈÎfi Û‡ÛÙËÌ·, Â›Ó·È Ë ‡·ÚÍË ÁÓˆ-
ÛÙÔ‡ ηډȷÎÔ‡ ÚÔ‚Ï‹Ì·ÙÔ˜ ÙÔ˘ ·ÛıÂÓÔ‡˜, Ô ·ÈÊÓ›-
‰ÈÔ˜ Î·È ·ÓÂÍ‹ÁËÙÔ˜ ı¿Ó·ÙÔ˜ Ó·ÚÔ‡ Û˘ÁÁÂÓÈÎÔ‡ ÚÔ-
ÛÒÔ˘ (<40 ÂÙÒÓ), Ë ‡·ÚÍË ÔÚÁ·ÓÈÎÔ‡ Ê˘Û‹Ì·ÙÔ˜ÛÙËÓ ·ÎÚfi·ÛË Ù˘ ηډȿ˜, Ë ·›ÛıËÛË ÚÔοډȈӷÏÌÒÓ ÚÈÓ ·fi ÙÔ ÂÂÈÛfi‰ÈÔ, Ë Ôχ ÌÈÎÚ‹ ‰È¿Ú-ÎÂÈ· (<5 ‰Â˘ÙÂÚfiÏÂÙ·) ‹ Î·È Ï‹Ú˘ ·Ô˘Û›· Ù˘Úfi‰ÚÔÌ˘ Ê¿Û˘ Î·È Ê˘ÛÈο Ë Â¤Ï¢ÛË ÙÔ˘ ÂÂÈ-ÛÔ‰›Ô˘ ηٿ ÙËÓ ¿ÛÎËÛË ‹ ·Ì¤Ûˆ˜ ÌÂÙ¿ (¶›Ó·Î·˜ 3).
∫Ú¿ÙËÌ· ·Ó·ÓÔ‹˜∆· ÂÂÈÛfi‰È· ÎÚ·Ù‹Ì·ÙÔ˜ ·Ó·ÓÔ‹˜ (breath-
holding spells) Â›Ó·È ·ÚÎÂÙ¿ Û˘¯Ó¿ ÛÙȘ ÌÈÎÚ¤˜ ËÏÈ-˘ Î·È È‰È·›ÙÂÚ· ÛÙ· ·È‰È¿ 2-3 ÂÙÒÓ (6,7). ∏ ¤Ó·Ú-ÍË ÙˆÓ ÂÂÈÛÔ‰›ˆÓ Á›ÓÂÙ·È Û˘Ó‹ıˆ˜ Û ËÏÈΛ· ÌÂÙ·-͇ 6 ÌËÓÒÓ Î·È 2 ÂÙÒÓ Î·È Ù· ÂÚÈÛÛfiÙÂÚ· ÛÙ·Ì·-ÙÔ‡Ó ÌÂÙ¿ ÙËÓ ËÏÈΛ· ÙˆÓ 4 ÂÙÒÓ. ¢È·ÎÚ›ÓÔÓÙ·È ‰‡ÔÌÔÚʤ˜ Ù˘, Ë Î˘·ÓˆÙÈ΋ Î·È Ë ˆ¯Ú¿, Ô˘ Î·È ÔÈ ‰‡ÔıˆÚÂ›Ù·È fiÙÈ ·Ó‹ÎÔ˘Ó ÛÙËÓ Î·ÙËÁÔÚ›· ÙˆÓ ·Ú·Û˘-Ì·ıËÙÈÎÒÓ Û˘ÁÎÔÙÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ. ∏ ΢·ÓˆÙÈ-΋ ÌÔÚÊ‹ Â›Ó·È Ë ÈÔ Û˘¯Ó‹, ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fiÂÂÈÛfi‰ÈÔ ¤ÓÙÔÓÔ˘ ÎÏ¿Ì·ÙÔ˜, ÙÔ ÔÔ›Ô ·ÎÔÏÔ˘ı›-Ù·È ·fi ¿ÓÔÈ·, ΢¿ÓˆÛË Î·È Û‡ÓÙÔÌË ÂÚ›Ô‰Ô·ÒÏÂÈ·˜ Ù˘ Û˘Ó›‰ËÛ˘ Î·È ÔÊ›ÏÂÙ·È ÛÙËÓ ·Ú·-ÙÂٷ̤ÓË ÂÎÓÔ‹ Ì ÎÏÂÈÛÙ‹ ÙË ÁψÙÙ›‰·.
∏ ˆ¯Ú¿ ÌÔÚÊ‹ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÙËÓ ‡·ÚÍËÂÓfi˜ ·Ú¯ÈÎÔ‡ Û˘Ì‚¿Ì·ÙÔ˜, fiˆ˜ ÙÚ·˘Ì·ÙÈÛÌÔ‡ ‹¤ÓÙÔÓÔ˘ Î·È Í·ÊÓÈÎÔ‡ Êfi‚Ô˘, Ô˘ ·ÎÔÏÔ˘ıÂ›Ù·È ·fi·Û˘ÛÙÔÏ›· Î·È ·fiÙÔÌË ·ÒÏÂÈ· Ù˘ Û˘Ó›‰ËÛ˘, ËÔÔ›· Û˘Óԉ‡ÂÙ·È ·fi ˆ¯ÚfiÙËÙ·. ¶ÈÛÙ‡ÂÙ·È fiÙÈ ËÌÔÚÊ‹ ·˘Ù‹ ÎÚ·Ù‹Ì·ÙÔ˜ Ù˘ ·Ó·ÓÔ‹˜ ÔÊ›ÏÂÙ·È Û‰˘ÛÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ·˘ÙfiÓÔÌÔ˘ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜Î·È fiÙÈ Ù· ·È‰È¿ ·˘Ù¿ ¤¯Ô˘Ó ·˘ÍË̤Ó˜ Èı·ÓfiÙËÙ˜ӷ ÂÌÊ·Ó›ÛÔ˘Ó ·ÚÁfiÙÂÚ· ηٿ ÙËÓ ÂÊ˂›· ÂÂÈÛfi-‰È· Ó¢ÚÔηډÈÔÁÂÓÔ‡˜ Û˘ÁÎÔ‹˜.
æ˘¯ÔÁÂÓ‹˜ Û˘ÁÎÔ‹∆· „˘¯ÔÁÂÓ‹ ÂÂÈÛfi‰È· ‰È·ÎÚ›ÓÔÓÙ·È ÛÙȘ ÎÚ›-
ÛÂȘ ·ÓÈÎÔ‡ Î·È ÛÙȘ ˘ÛÙÂÚÈΤ˜ ÎÚ›ÛÂȘ. ™ÙËÓ ÚÒ-ÙË ÂÚ›ÙˆÛË ·Ú·ÙËÚ›ٷÈ, ÏfiÁˆ οÔÈÔ˘ Â͈ÙÂ-ÚÈÎÔ‡ ÁÂÁÔÓfiÙÔ˜, ¤ÓÙÔÓÔ˜ ·ÓÈÎfi˜ Ì ˘ÂÚ·ÂÚÈÛÌfiÎ·È ·›ÛıËÌ· ‚¿ÚÔ˘˜ Î·È ›ÂÛ˘ ÛÙÔ ÛÙ‹ıÔ˜. ∏ ˘ÛÙÂ-ÚÈ΋ ÎÚ›ÛË ·Ú·ÙËÚÂ›Ù·È Û˘Ó‹ıˆ˜ Û ÂÊ‹‚Ô˘˜, ¿-ÓÙ· ·ÚÔ˘Û›· ¿ÏÏˆÓ ÚÔÛÒˆÓ, ‰ÂÓ Û˘Ó‰˘¿˙ÂÙ·È Ìˆ¯ÚfiÙËÙ· ‹ ‚Ú·‰˘Î·Ú‰›·, Ù· ÂÂÈÛfi‰È· Â›Ó·È ÔÏ‡Û˘¯Ó¿ (̤¯ÚÈ Î·È ÔÏϤ˜ ÊÔÚ¤˜ ÙÔ ›‰ÈÔ 24ˆÚÔ) Î·È Ë‰È¿ÚÎÂÈ¿ Ù˘ Â›Ó·È ·ÚÎÂÙ¿ ÌÂÁ¿ÏË. ÷ڷÎÙËÚÈÛÙÈÎfi
64 ¢. π. °ÂˆÚÁ·ÎfiÔ˘ÏÔ˜
Paediatriki 2008;71:62-67
¶›Ó·Î·˜ 3. ∂Ӊ›ÍÂȘ ηډȷ΋˜ ÚÔ¤Ï¢Û˘ Û˘ÁÎÔÙÈÎÔ‡ ÂÂÈ-ÛÔ‰›Ô˘
ñ √ÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ·ÈÊÓȉ›Ô˘ ı·Ó¿ÙÔ˘ (<40 ÂÙÒÓ)ñ ⁄·ÚÍË ÁÓˆÛÙÔ‡ ηډȷÎÔ‡ ÚÔ‚Ï‹Ì·ÙÔ˜ ñ ¶·ÚÔ˘Û›· ÔÚÁ·ÓÈÎÔ‡ Ê˘Û‹Ì·ÙÔ˜ ñ ∞Ô˘Û›· Úfi‰ÚÔÌˆÓ Û˘Ìو̿وÓñ ∞›ÛıËÌ· ÚÔÎ¿Ú‰ÈˆÓ ·ÏÌÒÓ ÚÈÓ ·fi ÙÔ ÂÂÈÛfi‰ÈÔñ ∂Ή‹ÏˆÛË Î·Ù¿ ÙËÓ ¿ÛÎËÛË ‹ ·Ì¤Ûˆ˜ ÌÂÙ¿
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·64
ÙˆÓ ÂÂÈÛÔ‰›ˆÓ ·˘ÙÒÓ Â›Ó·È fiÙÈ Ô ·ÛıÂÓ‹˜ ¤ÊÙÂÈ
¿ÓÙ· Ì οÔÈ· ¯¿ÚË Î·È ı·ÙÚÈÎfiÙËÙ· Î·È ˘¿Ú-
¯ÂÈ ÚfiÓÔÈ· ·ÔÊ˘Á‹˜ ÙÚ·˘Ì·ÙÈÛÌÔ‡. ∂›Û˘, fiÙ·Ó
ÂÚÈÁÚ¿ÊÂÈ ÙÔ ÂÂÈÛfi‰ÈÔ Â›Ó·È ÂÍ·ÈÚÂÙÈο ‹ÚÂÌÔ˜
Î·È „‡¯Ú·ÈÌÔ˜.
∞Ú¯È΋ ÔÚıÔÛÙ·ÙÈ΋ ̆ fiÙ·ÛË™˘ÁÎÔ‹ ‹ Û˘¯ÓfiÙÂÚ· ÂÓԯϋ̷ٷ Ù˘ ÚÔÛ˘-
ÁÎÔÙÈ΋˜ Ê¿Û˘ Â›Ó·È Ôχ Û˘¯Ó¿ ηٿ ÙËÓ ·Ú¯È΋
Ê¿ÛË Ù˘ ¤ÁÂÚÛ˘ ÛÙËÓ fiÚıÈ· ı¤ÛË, ÂȉÈο ÛÙËÓ ÂÊË-
‚È΋ ËÏÈΛ· (8). ™¯Â‰fiÓ fiÏÔÈ ÔÈ ¤ÊË‚ÔÈ ·Ó·Ê¤ÚÔ˘Ó
ÂÂÈÛfi‰È· ˙¿Ï˘ ηٿ ÙËÓ ·fiÙÔÌË ¤ÁÂÚÛË, ÂȉÈο
ÌÂÙ¿ ·fi ·Ú·ÙÂٷ̤ÓË Î·Ù¿ÎÏÈÛË. ∆· ÂÓԯϋ̷ٷ
ÂÌÊ·Ó›˙ÔÓÙ·È ÂÓÙfi˜ ‰Â˘ÙÂÚÔÏ¤ÙˆÓ ·fi ÙËÓ ¤ÁÂÚÛË
Î·È ‰È·ÚÎÔ‡Ó Ï›ÁÔ (30 ‰Â˘ÙÂÚfiÏÂÙ·).
™‡Ó‰ÚÔÌÔ ÔÚıÔÛÙ·ÙÈ΋˜ Ù·¯˘Î·Ú‰›·˜ (posturalorthostatic tachycardia syndrome)÷ڷÎÙËÚ›˙ÂÙ·È ·fi Û˘ÌÙÒÌ·Ù· ·Ó·ÚÎÔ‡˜
·ÈÌ¿ÙˆÛ˘ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Î·È ÙÔ˘ ·ÌÊÈ‚ÏËÛÙÚÔÂÈ-
‰Ô‡˜ (˙¿ÏË, ·›ÛıËÌ· ÎfiˆÛ˘, ·‰˘Ó·Ì›·, ıfiψÛË
Ù˘ ÔÚ¿Ûˆ˜) ÛÂ Û˘Ó‰˘·ÛÌfi Ì ·˘ÍË̤ÓË Î·Ú‰È·Î‹
Û˘¯ÓfiÙËÙ· ÛÙËÓ fiÚıÈ· ı¤ÛË, ÂÓÒ Ë ·ÚÙËÚȷ΋ ›ÂÛË
·Ú·Ì¤ÓÂÈ ÛÙ· ηÙÒÙÂÚ· Ê˘ÛÈÔÏÔÁÈο fiÚÈ· (9). ª›·
·‡ÍËÛË Ù˘ ηډȷ΋˜ Û˘¯ÓfiÙËÙ·˜ ηٿ 35% ‹ ηÚ-
‰È·Î‹ Û˘¯ÓfiÙËÙ· ¿Óˆ ÙˆÓ 120/ÏÂÙfi ÌÂÙ¿ ·fi ‰‡Ô
ÏÂÙ¿ ÔÚıÔÛÙ·Û›·˜ ıˆÚÂ›Ù·È ·ıÔÏÔÁÈ΋. ∆Ô Û‡Ó-
‰ÚÔÌÔ Â›Ó·È Û·ÊÒ˜ Û˘¯ÓfiÙÂÚÔ ÛÙ· ÎÔÚ›ÙÛÈ· (4:1), ·Ó
Î·È Ë ·ÎÚÈ‚‹˜ ‰È¿ÁÓˆÛ‹ ÙÔ˘ ··ÈÙ› Û˘Ó‹ıˆ˜ ÙË
‚Ô‹ıÂÈ· ÂÍÂȉÈÎÂ˘Ì¤ÓÔ˘ ΤÓÙÚÔ˘.
∂ÂÈÛfi‰È· Û·ÛÌÒÓ∏ ‰È¿ÎÚÈÛË ·fi Ù· ÂÂÈÛfi‰È· Û·ÛÌÒÓ ‰ÂÓ Â›Ó·È
¿ÓÙ· ‡ÎÔÏË (10). ™ÙÔȯ›· Ô˘ Û˘ÓËÁÔÚÔ‡Ó ˘¤Ú
ÙˆÓ ÂÂÈÛÔ‰›ˆÓ Û·ÛÌÒÓ Â›Ó·È Ë ·ÚÔ˘Û›· ·ÊÚÒÓ
ÛÙÔ ÛÙfiÌ·, ÙÔ ‰¿ÁΈ̷ Ù˘ ÁÏÒÛÛ·˜, Ë ÛÙÚÔÊ‹ Ù˘
ÎÂÊ·Ï‹˜, Ë ·ÒÏÂÈ· ÎÔÚ¿ÓˆÓ, Ë ‰È¿ÚÎÂÈ· ¿Óˆ ÙˆÓ
¤ÓÙ ÏÂÙÒÓ, Ë ·Ú·ÙÂٷ̤ÓË Î·È ¿Ù˘Ë ÌÂÙ·Û˘-
ÁÎÔÙÈ΋ Ê¿ÛË Ô˘ Û˘Óԉ‡ÂÙ·È ·fi ·ÒÏÂÈ· ÙÔ˘
ÚÔÛ·Ó·ÙÔÏÈÛÌÔ‡, ÛÔ‚·Ú‹ ÎÂÊ·Ï·ÏÁ›· Î·È ·ÒÏÂÈ·
Ù˘ ÌÓ‹Ì˘ Î·È Ë ‡·ÚÍË ÂÛÙÈ·ÎÒÓ Ó¢ÚÔÏÔÁÈÎÒÓ
¢ÚËÌ¿ÙˆÓ (¶›Ó·Î·˜ 4).
∆· ˘fiÏÔÈ· ·›ÙÈ· ÂÂÈÛÔ‰›ˆÓ ·ÒÏÂÈ·˜ Ù˘
Û˘Ó›‰ËÛ˘, fiˆ˜ Ë ·Ó·ÈÌ›·, Ë ˘ÔÁÏ˘Î·ÈÌ›·, Ë
Ô‡ÚËÛË, Ô ‚‹¯·˜ Î·È Ë ·Êfi‰Â˘ÛË Â›Ó·È ÂÍ·ÈÚÂÙÈο
Û¿ÓÈ· ÛÙ· ·È‰È¿. ∂ΛÓÔ, ÙÔ ÔÔ›Ô Â›Ó·È ÌÂÓ ·Îfi-
Ì· Û¿ÓÈÔ, ·ÏÏ¿ ÚÔԉ¢ÙÈο ·˘Í¿ÓÂÙ·È Î·È Ú¤-
ÂÈ Ó· Û˘Óԉ¢Ù› Î·È ·fi ·Ó¿ÏÔÁË ·‡ÍËÛË ÙÔ˘
‚·ıÌÔ‡ ÂÁÚ‹ÁÔÚÛ‹˜ Ì·˜, Â›Ó·È Ë ¯Ú‹ÛË „˘¯ÔÙÚfi-
ˆÓ Ô˘ÛÈÒÓ.
¢È·ÁÓˆÛÙÈ΋ ÚÔۤϷÛË
∏ ÌÂÁ¿ÏË ÏÂÈÔÓfiÙËÙ· ÙˆÓ Û˘ÁÎÔÙÈÎÒÓ ÂÂÈ-
ÛÔ‰›ˆÓ ÔÊ›ÏÂÙ·È Û ηÏÔ‹ıË ·›ÙÈ· Î·È Ë ÚfiÁÓˆÛ‹
ÙÔ˘˜ Â›Ó·È Ôχ ηϋ. ∏ ·ÎÚÈ‚‹˜ fï˜ ‰È¿ÁÓˆÛË
Ù˘ ·ÈÙÈÔÏÔÁ›·˜ ¤¯ÂÈ ÌÂÁ¿ÏË ÛËÌ·Û›·, ·ÊÂÓfi˜ ÌÂÓ
ÁÈ· ÙÔÓ ·ÔÎÏÂÈÛÌfi ÙˆÓ Û¿ÓÈˆÓ ·ÏÏ¿ ÂÈΛӉ˘ÓˆÓ
ÂÚÈÙÒÛÂˆÓ Î·Ú‰ÈÔÁÂÓÔ‡˜ Û˘ÁÎÔ‹˜, ·ÊÂÙ¤ÚÔ˘ ‰Â
ÏfiÁˆ ÙˆÓ ÛÔ‚·ÚÒÓ ÂÈÙÒÛÂˆÓ Ô˘ ¤¯Ô˘Ó Ù· ÂÂÈ-
Ûfi‰È· ·˘Ù¿ ÛÙËÓ ÔÈfiÙËÙ· ˙ˆ‹˜ Î·È ÙËÓ ÎÔÈÓˆÓÈ΋
˙ˆ‹ ÙˆÓ ·ÛıÂÓÒÓ Î·È ÙˆÓ ÁÔÓ¤ˆÓ ÙÔ˘˜ (11). ∆Ô ÛË-
Ì·ÓÙÈÎfiÙÂÚÔ ÛÙÔÈ¯Â›Ô Ù˘ ‰È·ÁÓˆÛÙÈ΋˜ ‰È·‰Èηۛ·˜
Â›Ó·È ·Ó·ÌÊ›‚ÔÏ· ÙÔ ÈÛÙÔÚÈÎfi Î·È Ë ÎÏÈÓÈ΋ ÂͤٷÛË.
∞fi ÙÔ ÈÛÙÔÚÈÎfi ‰ÈÂÚ¢ÓÒÓÙ·È ·Ú¯Èο ÔÈ Û˘Óı‹-
Θ οو ·fi ÙȘ Ôԛ˜ ¤ÁÈÓ ÙÔ ÂÂÈÛfi‰ÈÔ. √ ·ÛıÂ-
Ó‹˜ ‹Ù·Ó ͷψ̤ÓÔ˜; ¶ÚÔËÁ‹ıËΠοÔÈÔ ¤ÓÙÔÓÔ
Û˘ÁÎÈÓËÛÈ·Îfi ÂÚ¤ıÈÛÌ·; ™ËÎÒıËΠ·fiÙÔÌ· ·fi
ÙËÓ Î·ıÈÛÙ‹ ÛÙËÓ fiÚıÈ· ı¤ÛË; ◊Ù·Ó ÁÈ· ÌÂÁ¿ÏÔ ‰È¿-
ÛÙËÌ· fiÚıÈÔ˜ Î·È Ì¿ÏÈÛÙ· Û ÎÏÂÈÛÙfi, ˙ÂÛÙfi ¯ÒÚÔ,
Ì ÌÂÁ¿ÏÔ Û˘ÓˆÛÙÈÛÌfi; ∆Ô ÂÂÈÛfi‰ÈÔ Û˘Ó¤‚Ë Î·Ù¿
ÙËÓ ¿ÛÎËÛË ‹ ·Ì¤Ûˆ˜ ÌÂÙ¿; ™ÙË Û˘Ó¤¯ÂÈ·, Á›ÓÂÙ·È
ÚÔÛ¿ıÂÈ· Ó· ‰È¢ÎÚÈÓÈÛı› ÔÈ· ‹Ù·Ó Ë Î·Ù¿ÛÙ·-
ÛË ÙÔ˘ ·ÛıÂÓÔ‡˜ ηٿ ÙÔ ÂÂÈÛfi‰ÈÔ. ¶ÚÔËÁ‹ıËηÓ
Úfi‰ÚÔÌ· Û˘ÌÙÒÌ·Ù·; À‹ÚÍ ·›ÛıËÌ· ÚÔηÚ-
‰›ˆÓ ·ÏÌÒÓ; À‹ÚÍ ·ÒÏÂÈ· Ù˘ Û˘Ó›‰ËÛ˘ ‹ ÙÔ
ÂÂÈÛfi‰ÈÔ ÂÚÈÔÚ›ÛıËΠÌfiÓÔ ÛÙ· Úfi‰ÚÔÌ· ÛË-
Ì›·; À‹ÚÍ·Ó Û·ÛÌÔ›; √ ·ÛıÂÓ‹˜ ‹Ù·Ó ˆ¯Úfi˜ ηÈ
¯·Ï·Úfi˜ ‹ ÛÂ Û‡Û·ÛË; À‹ÚÍÂ ·ÒÏÂÈ· Ô‡ÚˆÓ ‹
Î·È ÎÔÚ¿ÓˆÓ; À‹ÚÍ ÙÚ·˘Ì·ÙÈÛÌfi˜ ·fi ÙËÓ ÙÒ-
ÛË; ¶fiÛË ÒÚ· ‰È‹ÚÎÂÛ ÙÔ ÂÂÈÛfi‰ÈÔ; ªÂÙ¿ ÙËÓ
·ÔηٿÛÙ·ÛË ÙÔ˘ ÂȤ‰Ô˘ Û˘Ó›‰ËÛ˘, Ô ·ÛıÂ-
Ó‹˜ ‹Ù·Ó Û˘Á¯˘ÙÈÎfi˜ Î·È ÁÈ· fiÛÔ ‰È¿ÛÙËÌ·; ∂Âȉ‹
ÔÏϤ˜ ÊÔÚ¤˜ Ô ·ÛıÂÓ‹˜ ‰ÂÓ Â›Ó·È Û ı¤ÛË Ó· Ì·˜
‰ÒÛÂÈ ÈηÓÔÔÈËÙÈΤ˜ ÏËÚÔÊÔڛ˜, Ë Û˘Ó‰ÚÔÌ‹
ÙˆÓ ·ÚÈÛÙ·Ì¤ÓˆÓ ÛÙÔ ÂÂÈÛfi‰ÈÔ Â›Ó·È ÔχÙÈÌË.
∞fi ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ¤¯ÂÈ ·Í›· Ë ‡·ÚÍË
65™˘ÁÎÔÙÈο ÂÂÈÛfi‰È· ÛÙ· ·È‰È¿
¶·È‰È·ÙÚÈ΋ 2008;71:62-67
¶›Ó·Î·˜ 4. ¢È¿ÎÚÈÛË Û˘ÁÎÔ‹˜ ·fi ÂÂÈÛfi‰È· Û·ÛÌÒÓ
™˘ÁÎÔ‹ ™·ÛÌÔ›
ñ ∞Ú¯›˙ÂÈ ÌÂÙ¿ ÙËÓ ÙÒÛË ñ ∞Ú¯›˙Ô˘Ó ·fi ÙËÓ fiÚıÈ· ı¤ÛËñ ™˘Ó‹ıˆ˜ ˆ¯ÚfiÙ˘ ñ ¶Èı·Ó‹ ΢¿ÓˆÛËñ ªÈÎÚ‹˜ ‰È¿ÚÎÂÈ·˜ (1-2 ÏÂÙ¿) ñ ªÂÁ·Ï‡ÙÂÚ˘ ‰È¿ÚÎÂÈ·˜ (>5 ÏÂÙ¿)ñ ∞ÒÏÂÈ· Ô‡ÚˆÓ: Û¿ÓÈ· ñ ∞ÒÏÂÈ· Ô‡ÚˆÓ: Û˘¯Ó‹ñ Ÿ¯È ‰¿ÁΈ̷ ÁÏÒÛÛ·˜ ñ ¢¿ÁΈ̷ ÁÏÒÛÛ·˜: 25%ñ ◊È· ÌÂÙ·Û˘ÁÎÔÙÈ΋ Û˘Á¯˘ÙÈ΋ Ê¿ÛË ñ ŒÓÙÔÓË Î·È ·Ú·ÙÂٷ̤ÓË Û˘Á¯˘ÙÈ΋ Ê¿ÛË ÌÂÙ¿ ÙÔ ÂÂÈÛfi‰ÈÔ
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·65
·ÈÊÓȉ›Ô˘ ı·Ó¿ÙÔ˘, ·‰È¢ÎÚ›ÓÈÛÙ˘ ·ÈÙÈÔÏÔÁ›·˜, ÛÂ
Û˘ÁÁÂÓÈÎfi ÚfiÛˆÔ ËÏÈΛ·˜ οو ÙˆÓ 40 ÂÙÒÓ. ∞fi
ÙÔ ·ÙÔÌÈÎfi ·Ó·ÌÓËÛÙÈÎfi ·ÍÈÔÏÔÁÂ›Ù·È Ë ·ÚÔ˘Û›·
ÁÓˆÛÙ‹˜ ηډÈÔ¿ıÂÈ·˜ ‹ ¿ÏÏ˘ ·ıÔÏÔÁÈ΋˜ ηٿ-
ÛÙ·Û˘ (.¯. Ó¢ÚÔÏÔÁÈ΋ Û˘Ó‰ÚÔÌ‹), ηıÒ˜ ›Û˘
Î·È Ë Û˘¯ÓfiÙËÙ· ÙˆÓ ÂÂÈÛÔ‰›ˆÓ.
∏ ÎÏÈÓÈ΋ ÂͤٷÛË ÂÚÈÏ·Ì‚¿ÓÂÈ Ê˘ÛÈο fiÏ· Ù·
Û˘ÛÙ‹Ì·Ù·, ÂÈÎÂÓÙÚÒÓÂÙ·È fï˜ ÛÙÔ Î˘ÎÏÔÊÔÚÈÎfi
Î·È ÙÔ Ó¢ÚÔÏÔÁÈÎfi. ∞fi ÙÔ Î˘ÎÏÔÊÔÚÈÎfi Á›ÓÂÙ·È
ÚÔÛÂÎÙÈ΋ ·ÎÚfi·ÛË ÙÔ˘ ÚÔηډ›Ô˘ Û ηٷÎÂ-
ÎÏÈÌ̤ÓË Î·È fiÚıÈ· ı¤ÛË, „ËÏ¿ÊËÛË ÙˆÓ ÂÚÈÊÂÚÈ-
ÎÒÓ Ûʇ͈Ó, ̤ÙÚËÛË Ù˘ ηډȷ΋˜ Û˘¯ÓfiÙËÙ·˜
Î·È Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ Û ηٷÎÂÎÏÈÌ̤ÓË Î·È
Û fiÚıÈ· ı¤ÛË, ‰‡Ô ÏÂÙ¿ ÌÂÙ¿ ÙËÓ ¤ÁÂÚÛË. ∞fi ÙÔ
Ó¢ÚÔÏÔÁÈÎfi Á›ÓÂÙ·È ÌÈ· ·‰Ú‹ ÂÎÙ›ÌËÛË ·Ó·˙ËÙÒÓÙ·˜
ÂÛÙȷ΋ ÛËÌÂÈÔÏÔÁ›·.
∞fi ÙȘ ÂÚÁ·ÛÙËÚȷΤ˜ ÂÍÂÙ¿ÛÂȘ, Û˘ÓÈÛÙ¿Ù·È Ó·
Á›ÓÂÙ·È ∏∫° Û fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ ÚÔ˜ ·ÔÎÏÂÈ-
ÛÌfi ÔÚÈÛÌ¤ÓˆÓ Î·Ù·ÛÙ¿ÛÂˆÓ ‹ ·ı‹ÛˆÓ, fiˆ˜ Ë
˘ÂÚÙÚÔÊ›· ÙˆÓ ÎÔÈÏÈÒÓ, Ô ÎÔÏÔÎÔÈÏÈ·Îfi˜ ·Ô-
ÎÏÂÈÛÌfi˜, ÙÔ Û‡Ó‰ÚÔÌÔ Ì·ÎÚÔ‡ QT, ÙÔ Û‡Ó‰ÚÔÌÔ
Wolff-Parkinson-White ‹ ÙÔ Û‡Ó‰ÚÔÌÔ Brugada. ∂›-
Û˘, ÙÔ ∏∫° ÌÔÚ› Ó· ‚ÔËı‹ÛÂÈ ÛÙË ‰È¿ÁÓˆÛË Ù˘
˘ÂÚÙÚÔÊÈ΋˜ Ì˘ÔηډÈÔ¿ıÂÈ·˜ Î·È Ù˘ ·ÚÚ˘ıÌÈÔ-
ÁfiÓÔ˘ ‰˘ÛÏ·Û›·˜ Ù˘ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜. ŸÙ·Ó ·fi ÙÔ
ÈÛÙÔÚÈÎfi ‹ ·fi Ù· Â˘Ú‹Ì·Ù· Ù˘ ÎÏÈÓÈ΋˜ ÂͤٷÛ˘
Î·È ÙÔ˘ ∏∫° ÚÔ·ÙÔ˘Ó ÛÙÔȯ›· ÁÈ· Èı·Ó‹ ηÚ-
‰È·Î‹ ÚԤϢÛË ÙˆÓ ÂÂÈÛÔ‰›ˆÓ, ÙfiÙÂ Ô ·ÛıÂÓ‹˜
Ú¤ÂÈ Ó· ·Ú·¤ÌÂÙ·È Û ηډÈÔÏfiÁÔ ÁÈ· ÂÚ·ÈÙ¤-
Úˆ ¤ÏÂÁ¯Ô. °ÂÓÈ΋ ·›Ì·ÙÔ˜ Î·È ‚ÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ Á›-
ÓÔÓÙ·È fiÙ·Ó ˘¿Ú¯ÂÈ ˘Ô„›· ÁÈ· ·Ó·ÈÌ›· ‹ ˘ÔÁÏ˘-
ηÈÌ›·. ∂›Û˘, ÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ· Á›ÓÂÙ·È ÌÂÙ¿ ·fi
ÂÎÙ›ÌËÛË ·fi Ó¢ÚÔÏfiÁÔ, fiÙ·Ó ˘¿Ú¯ÂÈ ¤Ó‰ÂÈÍË ÁÈ·
Ó¢ÚÔÏÔÁÈ΋ ÚԤϢÛË ÙÔ˘ ÂÂÈÛÔ‰›Ô˘.
∏ ‰ÔÎÈÌ·Û›· ·Ó·ÎÏÈÓÒÌÂÓ˘ ÙÚ·¤˙˘ (tilt test)
‰ÂÓ ¤¯ÂÈ ¤Ó‰ÂÈÍË ÌÂÙ¿ ·fi ¤Ó· Ù˘ÈÎfi, ÌÂÌÔӈ̤ÓÔ
ÂÂÈÛfi‰ÈÔ. À¿Ú¯Ô˘Ó ÔÏÏ¿ ÚˆÙfiÎÔÏÏ· Ú·ÁÌ·-
ÙÔÔ›ËÛ˘ Ù˘ ‰ÔÎÈÌ·Û›·˜, fiÏ· fï˜ ÂÚÈÏ·Ì‚¿-
ÓÔ˘Ó ÌÈ· ·Ú¯È΋ Ê¿ÛË Î·Ù¿ÎÏÈÛ˘ Û ÔÚÈ˙fiÓÙÈ· ı¤ÛË
ÁÈ· 20-30 ÏÂÙ¿ Î·È ÛÙË Û˘Ó¤¯ÂÈ· ¤ÁÂÚÛË ÛÙËÓ fiÚıÈ·
ı¤ÛË ‹ Û ÎÏ›ÛË 60-70 ÌÔÈÚÒÓ Î·È ·Ú·ÌÔÓ‹ ÛÙË ı¤-
ÛË ·˘Ù‹ ÁÈ· 15-20 ÏÂÙ¿ ‹ ̤¯ÚÈ ÚÔÎÏ‹Ûˆ˜ ÙÔ˘
ÂÂÈÛÔ‰›Ô˘. ™Â ÔÚÈṲ̂ӷ ÚˆÙfiÎÔÏÏ·, ·Ó Ë ·Ú¯È΋
·˘Ù‹ Ê¿ÛË Â›Ó·È ·ÚÓËÙÈ΋, ÙfiÙ ·ÎÔÏÔ˘ı› Ì›· ‰Â‡-
ÙÂÚË, Ì Ӥ· ηٿÎÏÈÛË ÁÈ· 20-30 ÏÂÙ¿ Î·È ÛÙË Û˘-
Ó¤¯ÂÈ· ¤ÁÂÚÛË Ì ٷ˘Ùfi¯ÚÔÓË ¯ÔÚ‹ÁËÛË ÈÛÔÚÔÙÂ-
ÚÂÓfiÏ˘. ¢È·ÎÚ›ÓÔ˘Ì ÙÚÂȘ ‰È·ÊÔÚÂÙÈÎÔ‡˜ Ù‡Ô˘˜
·¿ÓÙËÛ˘ Û ÂÚ›ÙˆÛË ıÂÙÈ΋˜ ‰ÔÎÈÌ·Û›·˜, ·Ó¿-
ÏÔÁ· Ì ÙÔ ·Ó ΢Úȷگ› Ë ‚Ú·‰˘Î·Ú‰›· (ηډÈÔ·Ó·-
ÛÙ·ÏÙÈ΋), Ë ˘fiÙ·ÛË (·ÁÁÂÈÔηٷÛÙ·ÏÙÈ΋) ‹ ηÈ
Ù· ‰‡Ô (ÌÈÎÙ‹), Ô˘ Â›Ó·È Î·È Ô Û˘¯ÓfiÙÂÚÔ˜. ∆Ô ÛË-
Ì·ÓÙÈÎfiÙÂÚÔ ÌÂÈÔÓ¤ÎÙËÌ· Ù˘ ‰ÔÎÈÌ·Û›·˜ Â›Ó·È ÙÔ
Ôχ ˘„ËÏfi ÔÛÔÛÙfi „¢‰Ò˜ ·ÚÓËÙÈÎÒÓ ··ÓÙ‹-
ÛÂˆÓ (12), Ô˘ ÌÔÚ› Ó· Êı¿ÛÂÈ ÙÔ 50% Û‡Ìʈӷ
Ì ÔÚÈṲ̂Ó˜ ÌÂϤÙ˜ (13). ∂›Û˘, Ë ıÂÙÈ΋ ·¿-
ÓÙËÛË ÛÙË ‰ÔÎÈÌ·Û›· ‰ÂÓ ·ÔÙÂÏ› ηÏfi ÚÔÁÓˆÛÙÈ-
Îfi ‰Â›ÎÙË ÁÈ· ÙÔÓ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛ˘ ˘ÔÙÚÔÒÓ
(14). ª¿ÏÈÛÙ·, fiˆ˜ Ê¿ÓËΠ·fi ÙËÓ ›‰È· ÌÂϤÙË, Ô
ηχÙÂÚÔ˜ ÚÔÁÓˆÛÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ‹Ù·Ó Ô ·ÚÈı-
Ìfi˜ ÙˆÓ ÚÔËÁËı¤ÓÙˆÓ Û˘ÁÎÔÙÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ.
ªÂ ‚¿ÛË Ù· ·ÓˆÙ¤Úˆ, Ë ‰ÔÎÈÌ·Û›· ·Ó·ÎÏÈÓÒÌÂÓ˘
ÙÚ·¤˙˘ ‰ÂÓ ·ÔÙÂÏ› ÙÔ Î·Ï‡ÙÂÚÔ ‰È·ÁÓˆÛÙÈÎfi
ÂÚÁ·ÏÂ›Ô ÁÈ· ÙËÓ ·Ú¯È΋ ‰È¿ÁÓˆÛË ÙˆÓ Û˘ÁÎÔÙÈÎÒÓ
ÂÂÈÛÔ‰›ˆÓ. ªÔÚ› Ó· ¯ÚËÛÈÌÔÔÈËı› Û ·ÛıÂÓ›˜
ÌÂ Û˘¯Ó¿, ÌË Ù˘Èο ÂÂÈÛfi‰È·, Ù· ÔÔ›· ‰ÂÓ ·ÓÙ·-
ÔÎÚ›ÓÔÓÙ·È ÛÙ· ÚÔÏËÙÈο ̤ÙÚ· Ô˘ ÂÚÈÁÚ¿ÊÔ-
ÓÙ·È ·Ú·Î¿Ùˆ, ηıÒ˜ ›Û˘ Î·È fiÙ·Ó Â›Ó·È ÂÈı˘-
ÌËÙfi Ó· ηıËÛ˘¯¿ÛÔ˘Ì ÙÔÓ ·ÛıÂÓ‹ Î·È Ó· ÙÔÓ ÂÎ-
·È‰Â‡ÛÔ˘ÌÂ, ÒÛÙ ӷ ·Ó·ÁÓˆÚ›˙ÂÈ Ù· Úfi‰ÚÔÌ·
ÛËÌ›· Î·È Ó· ÌÔÚ› Ó· Ù· ÚÔÏ·Ì‚¿ÓÂÈ (15).
∞ÓÙÈÌÂÙÒÈÛË
∏ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ Û˘ÁÎÔÙÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ ›-
Ó·È ·ÈÙÈÔÏÔÁÈ΋. ™ÙÔ ·ÚfiÓ ¿ÚıÚÔ ı· ·Ó·ÊÂÚıÔ‡ÌÂ
ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ¡∫™, Ô˘ Â›Ó·È Î·È Ë Û˘¯Ófi-
ÙÂÚË ÌÔÚÊ‹ ÙÔ˘˜. ∏ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ Î·Ú‰È·ÎÒÓ
·ÈÙ›ˆÓ Û˘ÁÎÔ‹˜ Î·È ÙˆÓ ÂÂÈÛÔ‰›ˆÓ Û·ÛÌÒÓ ÍÂ-
ʇÁÂÈ ·fi ÙÔ Ï·›ÛÈÔ Ù˘ ·ÚÔ‡Û·˜ ·Ó·ÛÎfiËÛ˘.
∏ ÚfiÏË„Ë Î·È Ë ·ÓÙÈÌÂÙÒÈÛË Ù˘ Ó¢ÚÔηÚ-
‰ÈÔÁÂÓÔ‡˜ Û˘ÁÎÔ‹˜ Û˘Ó‹ıˆ˜ ÂÈÙ˘Á¯¿ÓÂÙ·È Ì ‰È¿-
ÊÔÚ· ·ÓÒ‰˘Ó· Î·È Â‡ÎÔÏ· ÂÊ·ÚÌfiÛÈÌ· ̤ÙÚ· ηÈ
ÌfiÓÔ Û·Ó›ˆ˜ ··ÈÙÂ›Ù·È Ê·Ú̷΢ÙÈ΋ ıÂڷ›·.
∂ΛÓÔ, ÙÔ ÔÔ›Ô ··ÈÙ›ٷÈ, Â›Ó·È Ó· ηıËÛ˘¯·Ûı›
Ô ·ÛıÂÓ‹˜ Î·È ÔÈ ÁÔÓ›˜ ÙÔ˘, Ó· ÂÍËÁËı› Ô Ì˯·ÓÈ-
ÛÌfi˜ ÚfiÎÏËÛ˘ ÙÔ˘ ÂÂÈÛÔ‰›Ô˘, Ó· Ì¿ıÂÈ Ô ·ÛıÂ-
Ó‹˜ Ó· ·Ó·ÁÓˆÚ›˙ÂÈ Ù· Úfi‰ÚÔÌ· Û˘ÌÙÒÌ·Ù· ηÈ
Ó· ÂÎ·È‰Â˘ı› ÛÙÔ˘˜ ÙÚfiÔ˘˜ ·ÓÙ›‰Ú·Û˘, ÒÛÙ ӷ
·Ó·ÛÙ›ÏÂÈ ÙËÓ ÂͤÏÈÍË ÙÔ˘ ÂÂÈÛÔ‰›Ô˘ Î·È Ó· ·Ô-
ʇÁÂÈ ÙËÓ ·ÒÏÂÈ· Ù˘ Û˘Ó›‰ËÛ˘.
∆· ÚÔÏËÙÈο ̤ÙÚ·, Ù· ÔÔ›· ÚÔÙ›ÓÔÓÙ·È ÁÈ·
·ÔÊ˘Á‹ ˘ÔÙÚÔ‹˜ ÙÔ˘ ÂÂÈÛÔ‰›Ô˘, Â›Ó·È Ù· ÂÍ‹˜:
1. ·ÔÊ˘Á‹ ·Ê˘‰¿ÙˆÛ˘, ÂȉÈο ÙÔ˘˜ ηÏÔηÈÚÈ-
ÓÔ‡˜ Ì‹Ó˜, Ì ÙË Ï‹„Ë ÙÔ˘Ï¿¯ÈÛÙÔÓ 6-8 ÔÙËÚÈÒÓ
ÓÂÚÔ‡ ËÌÂÚËÛ›ˆ˜ (Ù· Ô‡Ú· Ú¤ÂÈ Ó· Â›Ó·È ·ÓÔȯÙfi-
¯ÚˆÌ· Î·È Ë Û˘¯ÓfiÙËÙ· Ô‡ÚËÛ˘ ÙÔ˘Ï¿¯ÈÛÙÔÓ ‰‡Ô
ÊÔÚ¤˜ ÙÔ Úˆ› Î·È ‰‡Ô ÙÔ ·fiÁÂ˘Ì·). ¡· ·Ôʇ-
ÁÔÓÙ·È ÔÈ ¯˘ÌÔ›, ÂȉÈο ÔÈ ÂÌÊȷψ̤ÓÔÈ, ‰ÈfiÙÈ ÚÔ-
ηÏÔ‡Ó ÔÛ̈ÙÈ΋ ‰ÈÔ‡ÚËÛË,
2. ·ÔÊ˘Á‹ Ï‹„˘ ηʤ,
3. ¯Ú‹ÛË ÚfiÛıÂÙÔ˘ ·Ï·ÙÈÔ‡ ÛÙÔ Ê·ÁËÙfi,
4. ·ÔÊ˘Á‹ ¯ÒÚˆÓ ÌÂ Û˘ÓˆÛÙÈÛÌfi Î·È ˙¤ÛÙË,
5. ·ÔÊ˘Á‹ ·fiÙÔÌ˘ ¤ÁÂÚÛ˘ (Ó· ÚÔËÁÔ‡ÓÙ·È
ÎÈÓ‹ÛÂȘ ÙˆÓ Ô‰ÈÒÓ ÚÈÓ ·fi ÙËÓ ¤ÁÂÚÛË, Ó· οıÂ-
Ù·È ÁÈ· Ï›ÁÔ Î·ıÈÛÙfi˜ ÛÙËÓ ¿ÎÚË ÙÔ˘ ÎÚ‚·ÙÈÔ‡),
6. ·ÔÊ˘Á‹ ·Ú·ÙÂٷ̤Ó˘ ÔÚıÔÛÙ·Û›·˜, ÂȉÈο
Û ˙ÂÛÙÔ‡˜ ¯ÒÚÔ˘˜ ÌÂ Û˘ÓˆÛÙÈÛÌfi ηÈ, fiÙ·Ó ·˘Ùfi
66 ¢. π. °ÂˆÚÁ·ÎfiÔ˘ÏÔ˜
Paediatriki 2008;71:62-67
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·66
Â›Ó·È ·Ó·fiÊ¢ÎÙÔ, Ó· Á›ÓÔÓÙ·È Û˘Ó¯›˜ ÎÈÓ‹ÛÂȘ
ÙˆÓ Ô‰ÈÒÓ ÂÈÙfiÔ˘.
ŸÙ·Ó, ·ÚfiÏ· ·˘Ù¿, ÂΉËψıÔ‡Ó Ù· Úfi‰ÚÔÌ·
Û˘ÌÙÒÌ·Ù·, Ô ·ÛıÂÓ‹˜ Ú¤ÂÈ Ó· ·ÓÙȉڿÛÂÈ „‡-
¯Ú·ÈÌ· Î·È ¤ÁηÈÚ· οÓÔÓÙ·˜ ¤Ó· ·fi Ù· ·Ú·Î¿Ùˆ:
Ó· Í·ÏÒÛÂÈ ·Ó ·˘Ùfi Â›Ó·È ‰˘Ó·Ùfi, Ó· ηı›ÛÂÈ ÔÎÏ·-
‰fiÓ, Ó· Û˘Û¿ÛÂÈ ÙÔ˘˜ ÎÔÈÏÈ·ÎÔ‡˜ ̇˜ ‹ Ó· ‚¿ÏÂÈ
ÙÔ ¤Ó· fi‰È ¿Óˆ Û οÔÈ· ηڤÎÏ· ‹ ÛηÏÔ¿ÙÈ.
√È ÂÚÈÛÛfiÙÂÚÔÈ ·ÛıÂÓ›˜ ¤¯Ô˘Ó ηϋ ·ÓÙ·fiÎÚÈÛË
Ì ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙˆÓ ·Ú·¿Óˆ ̤ÙÚˆÓ, ·Ó Î·È ÙÔ
ÔÛÔÛÙfi ˘ÔÙÚÔÒÓ ·Ú·Ì¤ÓÂÈ ˘„ËÏfi (ÂÚ›Ô˘
32%), ¯ˆÚ›˜ Ó· ˘¿Ú¯ÂÈ Î¿ÔÈÔ˜ ·ÍÈfiÈÛÙÔ˜ ÚÔ-
‚ÏÂÙÈÎfi˜ ‰Â›ÎÙ˘.
ŸÙ·Ó Ù· ÂÂÈÛfi‰È· ·ӷϷ̂¿ÓÔÓÙ·È Û˘¯Ó¿, ›-
Ó·È ‰˘Ó·Ùfi Ó· ÚÔÛʇÁÔ˘Ì ÛÙË ¯Ú‹ÛË Ê·Ú̷΢ÙÈ-
ÎÒÓ Ô˘ÛÈÒÓ, fiˆ˜ Ë ÊÏÔ˘ÔÚÔÎÔÚÙÈ˙fiÓË (‰Ú· ·˘Í¿ÓÔ-
ÓÙ·˜ ÙÔÓ ÂÓ‰Ô·ÁÁÂÈ·Îfi fiÁÎÔ), ÔÈ ‚-·Ó·ÛÙÔÏ›˜ (ÂÏ·Ù-
ÙÒÓÔ˘Ó ÙËÓ ¤ÓÙ·ÛË Ù˘ ηډȷ΋˜ Û˘ÛÙÔÏ‹˜ Î·È ÂÓ‰Â-
¯Ô̤ӈ˜ ·Ó·ÛÙ¤ÏÏÔ˘Ó ÙËÓ ·ÓÙ·Ó·ÎÏ·ÛÙÈ΋ Ô‰fi Ô˘
ηٷϋÁÂÈ ÛÙË ‰È¤ÁÂÚÛË ÙÔ˘ ·Ú·Û˘Ì·ıËÙÈÎÔ‡) ηÈ
Ë „¢‰ÔÂʉڛÓË (·-‰ÈÂÁ¤ÚÙ˘, ÚÔηÏ› ÂÚÈÊÂÚÈ΋
·ÁÁÂÈÔÛ‡Û·ÛË, ·ÏÏ¿ ¤¯ÂÈ ÔÏϤ˜ ·ÚÂÓ¤ÚÁÂȘ). ∆Ô
Úfi‚ÏËÌ· Ì ÙË Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ Â›Ó·È fiÙÈ ·ÊÂ-
Ófi˜ ÌÂÓ Ê·›ÓÂÙ·È Ó· ÌËÓ ÂÏ·ÙÙÒÓÂÈ ÙË Û˘¯ÓfiÙËÙ· ̆ Ô-
ÙÚÔÒÓ (14), ·ÊÂÙ¤ÚÔ˘ ‰Â ·Ú·Ì¤ÓÂÈ ¿ÁÓˆÛÙÔ ÁÈ· fi-
ÛÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· Ú¤ÂÈ Ó· ¯ÔÚËÁ›ٷÈ.
∏ ÙÔÔı¤ÙËÛË ÌfiÓÈÌÔ˘ ‚ËÌ·ÙÔ‰fiÙË ÂȉÈο ÛÙ·
·È‰È¿ Ú¤ÂÈ Ó· Á›ÓÂÙ·È Ì ÔÏÏ‹ ÊÂÈ‰Ò Î·È ÂÚ›-
Û΄Ë. ª¤¯ÚÈ Û‹ÌÂÚ· (16), ¤¯ÂÈ Á›ÓÂÈ Û ÂÏ¿¯ÈÛÙ˜
ÂÚÈÙÒÛÂȘ ·ÛıÂÓÒÓ Ì ·ӷϷ̂·ÓfiÌÂÓ·, ÛÔ‚·-
Ú¿ ÂÂÈÛfi‰È·, ηٿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÔÔ›ˆÓ ›¯Â ÙÂÎ-
ÌËÚȈı› Ë ‡·ÚÍË ·Ú·ÙÂٷ̤Ó˘ ηډȷ΋˜ ·‡-
Ï·˜ (>4 ‰Â˘ÙÂÚfiÏÂÙ·). Ÿˆ˜ Ê¿ÓËÎÂ Î·È ·fi ÙË
ÌÂϤÙË VPSII (17), Ë ÌfiÓÈÌË ‚ËÌ·ÙÔ‰fiÙËÛË ‰ÂÓ ÚÔ-
ÛʤÚÂÈ Î¿ÔÈÔ Û˘ÁÎÚÈÙÈÎfi ÏÂÔÓ¤ÎÙËÌ· ÛÙË ÌÂÁ¿ÏË
ÏÂÈÔÓfiÙËÙ· ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ‰ÂÓ ÂÌÊ·Ó›˙Ô˘Ó
¤ÓÙÔÓË ·Û˘ÛÙÔÏ›· ηٿ Ù· ÂÂÈÛfi‰È· Ó¢ÚÔηډÈÔ-
ÁÂÓÔ‡˜ Û˘ÁÎÔ‹˜.
™˘ÌÂÚ¿ÛÌ·Ù·
∆· Û˘ÁÎÔÙÈο ÂÂÈÛfi‰È· ÛÙËÓ ·È‰È΋ Î·È ÂÊË-
‚È΋ ËÏÈΛ· ÔÊ›ÏÔÓÙ·È Û˘Ó‹ıˆ˜ Û ηÏÔ‹ıÂȘ ηٷ-
ÛÙ¿ÛÂȘ, ÂÎ ÙˆÓ ÔÔ›ˆÓ Û˘¯ÓfiÙÂÚË Â›Ó·È Ë Ó¢ÚÔηÚ-
‰ÈÔÁÂÓ‹˜ Û˘ÁÎÔ‹. ∏ ÚfiÏË„Ë Î·È Ë ·ÓÙÈÌÂÙÒÈÛ‹
ÙÔ˘˜ ÂÈÙ˘Á¯¿ÓÂÙ·È Ì ·Ï¿ ̤ÙÚ· Î·È Û·Ó›ˆ˜ ··È-
ÙÂ›Ù·È Ê·Ú̷΢ÙÈ΋ ‹ ¿ÏÏË ·ÁˆÁ‹. ∏ ‰È¿ÁÓˆÛ‹ ÙÔ˘˜
‚·Û›˙ÂÙ·È ÛÙÔ ÏÂÙÔÌÂÚ¤˜ ÈÛÙÔÚÈÎfi Î·È ÙËÓ ÂÓ‰Âϯ‹
ÎÏÈÓÈ΋ ÂͤٷÛË, ÒÛÙ ӷ ÌË ‰È·Ê‡ÁÔ˘Ó Ù· Û¿ÓÈ·
·ÏÏ¿ ÂÈΛӉ˘Ó· ·›ÙÈ· ηډȷ΋˜ ÚÔ¤Ï¢Û˘. ∆Ô
∏∫°, Ï·Ì‚¿ÓÔÓÙ·˜ ˘fi„Ë ÙÔ˘˜ ÂÚÈÔÚÈÛÌÔ‡˜ ÙÔ˘,
ÎÚ›ÓÂÙ·È ··Ú·›ÙËÙÔ Û fiϘ ÙȘ ÂÚÈÙÒÛÂȘ, ‰ÈfiÙÈ
ÌÔÚ› Ó· ·Ôηχ„ÂÈ ‰˘ÓËÙÈο ÂÈΛӉ˘Ó˜ ηٷ-
ÛÙ¿ÛÂȘ (Û‡Ó‰ÚÔÌÔ Ì·ÎÚÔ‡ QT, Û‡Ó‰ÚÔÌÔ Wolff-
Parkinson-White, ‰È·Ù·Ú·¯¤˜ Ù˘ ·ÁˆÁÈÌfiÙËÙ·˜). √
˘fiÏÔÈÔ˜ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜, ·ÈÌ·ÙÔÏÔÁÈÎfi˜,
ηډÈÔÏÔÁÈÎfi˜ ‹ Ó¢ÚÔÏÔÁÈÎfi˜, ÚÔÁÚ·ÌÌ·Ù›˙ÂÙ·È
·Ó¿ÏÔÁ· Ì ٷ ÎÏÈÓÈο Â˘Ú‹Ì·Ù·.
µÈ‚ÏÈÔÁÚ·Ê›·
1. Johnsrude CL. Current approach to pediatric syncope. Pe-
diatr Cardiol 2000;21:522-531.
2. Driscoll DJ, Jacobsen SJ, Porter CJ, Wollan PC. Syncope in
children and adolescents. J Am Coll Cardiol 1997;29:1039-
1045.
3. Ganzeboom KS, Colman N, Reitsma JB, Shen WK, Wieling
W. Prevalence and triggers of syncope in medical students.
Am J Cardiol 2003;91:1006-1008.
4. Wallace H, Shorvon S, Tallis R. Age-specific incidence and
prevalence rates of treated epilepsy in an unselected popu-
lation of 2,052,922 and age-specific fertility rates of women
with epilepsy. Lancet 1998;352:1970-1973.
5. Sapin SO. Autonomic syncope in pediatrics: a practice-ori-
ented approach to classification, pathophysiology, diagno-
sis and management. Clin Pediatr (Phila) 2004;43:17-23.
6. Lombroso CT, Lerman P. Breathholding spells (cyanotic
and pallid infantile syncope). Pediatrics 1967;39:563-581.
7. Saul JP. Syncope: etiology, management, and when to re-
fer. J S C Med Assoc 1999;95:385-387.
8. Tanaka H, Yamaguchi H, Matushima R, Tamai H. Instan-
taneous orthostatic hypotension in children and adoles-
cents: a new entity of orthostatic intolerance. Pediatr Res
1999;46:691-696.
9. Low PA, Sandroni P, Singer W, et al. Postural tachycardia
syndrome - an update. Clin Autonom Res 2002;12:107-109.
10. Hoefnagels WA, Padberg GW, Overweg J, van der Velde
EA, Roos RA. Transient loss of consciousness: the value of
the history for distinguishing seizure from syncope. J Neu-
rol 1991;238:39-43.
11. Linzer M, Pontinen M, Gold DT, Divine GW, Felder A, Brooks
WB. Impairment of physical and psychosocial function in re-
current syncope. J Clin Epidemiol 1991;44: 1037-1043.
12. Levine MM. Neurally mediated syncope in children: re-
sults of tilt testing, treatment, and long-term follow-up.
Pediatr Cardiol 1999;20:331-335.
13. De Jong-de Vos Steenwijk CC, Wieling W, Johannes JM,
Harms MP, Kuis W, Wesseling KH. Incidence and hemo-
dynamic characteristics of near-fainting in healthy 6- to 16-
year old subjects. J Am Coll Cardiol 1995;25:1615-1621.
14. Kouakam C, Vaksmann G, Pachy E, Lacroix D, Rey C,
Kacet S. Long-term follow-up of children and adolescents
with syncope; predictor of syncope recurrence. Eur Heart J
2001;22:1618-1625.
15. Kenny RA, O’Shea D, Parry SW. The Newcastle protocols
for head-up tilt table testing in the diagnosis of vasovagal
syncope, carotid sinus hypersensitivity, and related disor-
ders. Heart 2000;83:564-569.
16. McLeod KA, Wilson N, Hewitt J, Norrie J, Stephenson JB.
Cardiac pacing for severe childhood neurally mediated syn-
cope with reflex anoxic seizures. Heart 1999;82:721-725.
17. Connolly SJ, Sheldon R, Thorpe KE, Roberts RS, Ellenbo-
gen KA, Wilkoff BL, et al. Pacemaker therapy for preven-
tion of syncope in patients with recurrent severe vasovagal
syncope: Second Vasovagal Pacemaker Study (VPS II): a
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67™˘ÁÎÔÙÈο ÂÂÈÛfi‰È· ÛÙ· ·È‰È¿
¶·È‰È·ÙÚÈ΋ 2008;71:62-67
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·67
µÚ¤ÊÔ˜ Ì ˈÛÈÓÔÊÈÏÈ΋ ÂÓÙÂÚ›Ùȉ·
Ã. ∫Ô˘ÙÛ·˘Ù›ÎË1, ∂. ª¿ÓÙ˙ÈÔ˘1, ¢. ÷Ù˙‹˜2, ∫. ¶··ÓÙ˙›Ì·˜1, ∫. ™ÙÂÊ·Ó¿ÎË3, ¡. ª˘ÚÈÔÎÂÊ·ÏÈÙ¿Î˘1,
∂. ƒÒÌ·-°È·ÓÓ›ÎÔ˘2
¶ÂÚ›ÏË„Ë: ∏ ˈÛÈÓÔÊÈÏÈ΋ Á·ÛÙÚÂÓÙÂÚ›Ùȉ· Â›Ó·È Û¿ÓÈ· ÓÔÛÔÏÔÁÈ΋ ÔÓÙfiÙËÙ·, Ë ÔÔ›· ÂÚÈÁÚ¿ÊËÎÂÁÈ· ÚÒÙË ÊÔÚ¿ ÙÔ 1937 ·fi ÙÔÓ Kaijser. ∂›Ó·È ΢ڛˆ˜ ÓfiÛÔ˜ ÙˆÓ ÂÓËϛΈÓ, ·ÊÔ‡ ··ÓÙ¿Ù·È Û ¿ÙÔÌ·ËÏÈΛ·˜ ÌÂٷ͇ ‰Â‡ÙÂÚ˘ Î·È ¤ÎÙ˘ ‰ÂηÂÙ›·˜ Ù˘ ˙ˆ‹˜, Ì ÌÈÎÚ‹ ˘ÂÚÔ¯‹ ÛÙÔ˘˜ ¿Ó‰Ú˜, ÂÓÒ ÙÂÏÂ˘Ù·›·ÏËı·›ÓÔ˘Ó ÔÈ ·Ó·ÊÔÚ¤˜ Û ÂÚÈÙÒÛÂȘ ·È‰ÈÒÓ Ì ˈÛÈÓÔÊÈÏÈ΋ Á·ÛÙÚÂÓÙÂÚ›Ùȉ· Î·È ·ÎfiÌË Û·ÓÈfi-ÙÂÚ· ‚ÚÂÊÒÓ. ∞·Ú·›ÙËÙ· ÛÙÔȯ›· ÁÈ· ÙËÓ ÙÂÎÌËÚ›ˆÛË Ù˘ ‰È¿ÁÓˆÛ˘ ›ӷÈ: 1) ™˘ÌÙÒÌ·Ù· ·fi ÙÔ Â-ÙÈÎfi Û‡ÛÙËÌ·, fiˆ˜ ÎÔÈÏÈ·Îfi ¿ÏÁÔ˜, ¤ÌÂÙÔÈ, Á·ÛÙÚÂÓÙÂÚÈ΋ ÚˆÙÂ˚ÓfiÚÚÔÈ· Î.Ù.Ï. 2) ¢È‹ıËÛË ÙÔ˘ Á·-ÛÙÚÂÓÙÂÚÈÎÔ‡ ۈϋӷ (°∂™) ·fi ˈÛÈÓfiÊÈÏ· >20 ∏PF Û ˘ÏÈÎfi ‚ÈÔ„›·˜ ‰È·ÊfiÚˆÓ ÙÌËÌ¿ÙˆÓ ÙÔ˘, Û˘-Ó‹ıˆ˜ ÛÙÔÌ¿¯Ô˘ Î·È ÏÂÙÔ‡ ÂÓÙ¤ÚÔ˘. ™Ù· ‚Ú¤ÊË Â›Ó·È Û˘¯Ó‹ Ë ‰È‹ıËÛË ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘ (ˈÛÈÓÔÊÈÏÈ΋ÔÈÛÔÊ·Á›Ùȉ·). 3) √ ·ÔÎÏÂÈÛÌfi˜ ¿ÏÏ˘ ·ÈÙ›·˜ ˈÛÈÓÔÊÈÏ›·˜ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜, ‰Â‰Ô̤ÓÔ˘ fiÙÈ >80%ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÂÌÊ·Ó›˙Ô˘Ó ÛÔ‚·ÚÔ‡ ‚·ıÌÔ‡ ˈÛÈÓÔÊÈÏ›· ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜. 4) ∏ ·ÓÙ·fiÎÚÈÛËÎ·È Ë ‚ÂÏÙ›ˆÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÌÂÙ¿ ÙË ıÂڷ›·. ∏ ˈÛÈÓÔÊÈÏÈ΋ ÔÈÛÔÊ·Á›Ùȉ· ÔÌÔÈ¿˙ÂÈ ·ÚÎÂÙ¿ ÌÂÙË Á·ÛÙÚÔÔÈÛÔÊ·ÁÈ΋ ·ÏÈÓ‰ÚfiÌËÛË (°√¶) Î·È ı· Ú¤ÂÈ Ó· Èı·ÓÔÏÔÁÂ›Ù·È ˆ˜ ‰È¿ÁÓˆÛË Î·È Ó· Á›ÓÂ-Ù·È ÂÓ‰ÔÛÎfiËÛË ÛÙȘ ÂÚÈÙÒÛÂȘ Ô˘ ‰ÂÓ ·ÓÙ·ÔÎÚ›ÓÔÓÙ·È ÛÙË Û˘Ó‹ıË ıÂڷ›·. ∞Ó¿ÏÔÁ· Ì ÙÔ ÙÌ‹-Ì· ÙÔ˘ ÙÔȯÒÌ·ÙÔ˜ ÙÔ˘ ÂÙÈÎÔ‡ ۈϋӷ Ô˘ ¤¯ÂÈ ̆ ÔÛÙ› ÙËÓ ËˆÛÈÓÔÊÈÏÈ΋ ‰È‹ıËÛË (‚ÏÂÓÓÔÁfiÓÔ˜, Ì˘-˚Îfi˜ ¯ÈÙÒÓ·˜, ÔÚÔÁfiÓÔ˜, fiÏÔ ÙÔ ÙÔ›¯ˆÌ·) ‰È·ÎÚ›ÓÂÙ·È Û 4 ÈÛÙÔÏÔÁÈÎÔ‡˜ Ù‡Ô˘˜ ‰›ÓÔÓÙ·˜ Î·È ·ÓÙ›ÛÙÔȯËÛ˘Ìو̷ÙÔÏÔÁ›·. ø˜ ̤ÙÚÔ ·ÓÙÈÌÂÙÒÈÛ˘ ·ÎÔÏÔ˘ıÂ›Ù·È ·Ú¯Èο ˘Ô·ÏÏÂÚÁÈ΋-ÛÙÔȯÂȷ΋ ‰›·ÈÙ· ηÈ,› ·ÔÙ˘¯›·˜ ·˘Ù‹˜, ¯ÔÚËÁÔ‡ÓÙ·È Î˘Ú›ˆ˜ Ù· ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹ Î·È ‰Â˘ÙÂÚ¢fiÓÙˆ˜ Ë ÌÔÓÙÂÏÔ˘Î¿ÛÙË, ÙÔ¯ÚˆÌÔÁÏ˘ÎÈÎfi Ó¿ÙÚÈÔ Î·È ¿ÏÏ·. ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ‚Ú¤ÊÔ˘˜ Ì ˈÛÈÓÔÊÈÏÈ΋ Á·ÛÙÚÂÓÙÂÚ›Ùȉ·Ô˘ ‰ÈÂÚ¢ӋıËΠÏfiÁˆ ÌÂȈ̤Ó˘ ÚfiÛÏ˄˘ ‚¿ÚÔ˘˜, ÂÌ¤ÙˆÓ Î·È ÂÎÛÂÛËÌ·Ṳ̂Ó˘ ˈÛÈÓÔÊÈÏ›·˜ ÙÔ˘ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜.
§¤ÍÂȘ ÎÏÂȉȿ: ∏ˆÛÈÓÔÊÈÏÈ΋ ÂÓÙÂÚ›Ùȉ·, ˈÛÈÓÔÊÈÏ›·, ¤ÌÂÙÔÈ, ‚Ú¤ÊÔ˜.
An infant with eosinophilic enteritis
C. Koutsaftiki1, E. Mantziou1, D. Hatzis2, K. Papantzimas1, ∫. Stefanaki3, N. Myriokefalitakis1,
E. Roma-Giannikou2
Abstract: Eosinophilic gastroenteritis is a rare disease, which was first described by Kaijser in 1937. It is adisease mainly of adults, encountered in people between the second and sixth decades of life,predominantly men, but recently there has been an increase in case reports of children, and more rarely ofinfants, with eosinophilic gastroenteritis. The diagnostic criteria are: 1) Gastrointestinal system symptoms,such as abdominal pain, vomiting, protein loss, etc. 2) Infiltration of the gastrointestinal tract byeosinophils (>20 HPF in biopsies), mainly found in the stomach and small intestine. In infants theoesophagus is most often infiltrated (eosinophilic oesophagitis). 3) Exclusion of other causes ofeosinophilia, since in >80% of cases pronounced eosinophilia is reported. 4) Relief or improvement of thesymptoms after initiation of treatment. The symptoms of eosinophilic oesophagitis resemble those ofgastrooesophageal reflux, so it should be considered as possible diagnosis and biopsy must be taken inthose cases where there is no improvement with the usual treatment. According to the layer of the entericwall that is infiltrated (mucosa, muscle layer, serosa, the whole enteric wall), 4 histological types aredescribed, with related symptoms in each type. To treat the disease, an elimination-hypoallergenic diet isintroduced, and if that fails, oral corticosteroids are the main treatment, and in some cases montelucast,sodium cromoglycate or other drugs have been proposed. The case is described of an infant that wasinvestigated due to weight loss, vomiting and marked eosinophilia, and found to have eosinophilicgastroenteritis.
Key words: Eosinophilic enteritis, eosinophilia, vomiting, infant.
68 ∂¡¢π∞º∂ƒ√À™∞ ¶∂ƒπ¶∆ø™∏ CASE REPORT
1 ∞’ ¶·È‰È·ÙÚÈÎfi ∆Ì‹Ì·,°ÂÓÈÎfi ¡ÔÛÔÎÔÌ›Զ·›‰ˆÓ ¶ÂÓÙ¤Ï˘
2 ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ,¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ“∞Á›· ™ÔÊ›·”
3 ¶·ıÔÏÔÁÔ·Ó·ÙÔÌÈÎfi∆Ì‹Ì·, ¡ÔÛÔÎÔÌ›Զ·›‰ˆÓ “∞Á›· ™ÔÊ›·”
AÏÏËÏÔÁÚ·Ê›·:
ÃÚ˘Û‹ ∫Ô˘ÙÛ·˘Ù›ÎË[email protected]∞’ ¶·È‰È·ÙÚÈÎfi ∆Ì‹Ì·, °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ¶ÂÓÙ¤Ï˘∆.∫. 152 36, ¶. ¶ÂÓÙ¤ÏË
1 1st Paediatric Department,General Children’sHospital of Penteli
2 1st Paediatric Clinic,University of Athens,Children’s Hospital “Aghia Sophia”
3 Pathology Department,Children’s Hospital “Aghia Sophia”
Correspondence:
Chrysie Koutsaftiki [email protected] Paediatric Department,General Children’s Hospitalof Penteli152 36, P. Penteli, Greece
Paediatriki 2008;71:68-73
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·68
∂ÈÛ·ÁˆÁ‹
∏ ˈÛÈÓÔÊÈÏÈ΋ Á·ÛÙÚÂÓÙÂÚ›Ùȉ· ıˆÚÂ›Ù·È Û¯Â-
ÙÈο Û¿ÓÈ· ÓfiÛÔ˜, ·Ó Î·È ÂÚÈÁÚ¿ÊÂÙ·È ÛÙË ‚È‚ÏÈÔ-
ÁÚ·Ê›· ÂÚÈÛÛfiÙÂÚÔ ·fi 30 ¯ÚfiÓÈ· (1). ∂›Ó·È ÓfiÛÔ˜
ȉÈÔ·ı‹˜, Ô˘ ÚÔ‚¿ÏÏÂÈ Ì ¢ڇ Ê¿ÛÌ· Û˘ÌÙˆ-
Ì¿ÙˆÓ ·fi ÙÔ ÂÙÈÎfi Û‡ÛÙËÌ· (¶›Ó·Î·˜ 1). ™ËÌ·-
ÓÙÈÎfi ÚfiÏÔ ·›˙ÂÈ Ë ‡·ÚÍË ·ÙÔ›·˜ ÛÙÔ ÔÈÎÔÁÂÓÂÈ-
·Îfi-·ÙÔÌÈÎfi ÈÛÙÔÚÈÎfi.
¢È·ÎÚ›ÓÂÙ·È Û 4 Ù‡Ô˘˜, Ì ‚¿ÛË ÙËÓ ËˆÛÈÓÔÊÈ-
ÏÈ΋ ‰È‹ıËÛË ÙÔ˘ ÙÔȯÒÌ·ÙÔ˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘:
1) ¶ÚÔÛ‚ÔÏ‹ ÙÔ˘ ‚ÏÂÓÓÔÁfiÓÔ˘ (Û˘ÓËı¤ÛÙÂÚÔ˜
Ù‡Ô˜), ÌÂ Û˘ÌÙÒÌ·Ù· fiˆ˜ ¤ÌÂÙÔÈ, ÎÔÈÏÈ·Îfi ¿Ï-
ÁÔ˜ (ÌÈÌÂ›Ù·È ÔÍ›· ÎÔÈÏ›·), ‰È¿ÚÚÔȘ, ·ÒÏÂÈ· ·›Ì·-
ÙÔ˜ ÛÙ· ÎfiÚ·Ó·, ÛȉËÚÔÂÓÈ΋ ·Ó·ÈÌ›·, ‰˘Û·ÔÚ-
ÚfiÊËÛË, ÚˆÙÂ˚ÓfiÚÚÔÈ·, ·Ó·ÛÙÔÏ‹ ·‡ÍËÛ˘ Î.¿. 2)
¶ÚÔÛ‚ÔÏ‹ ÙÔ˘ Ì˘˚ÎÔ‡ ¯ÈÙÒÓ·, fiÔ˘ ·¯‡ÓÂÙ·È ÙÔ
ÂÓÙÂÚÈÎfi ÙÔ›¯ˆÌ· Î·È ÚÔÂÍ¿Ú¯Ô˘Ó Î·Ù¿ Û˘Ó¤ÂÈ·
·ÔÊÚ·ÎÙÈο Û˘ÌÙÒÌ·Ù· (ÌÈÌÂ›Ù·È ˘ÏˆÚÈ΋ ÛÙ¤-
ÓˆÛË). 3) ¶ÚÔÛ‚ÔÏ‹ ÙÔ˘ ÔÚÔÁfiÓÔ˘ (Û·ÓÈfiÙÂÚÔ˜ Ù‡-
Ô˜), Ì ·ÚÈÔ Û‡Ìو̷ ÙÔÓ ·ÛΛÙË (¤¯ÂÈ ÙÔÓ ÌÂÁ·-
χÙÂÚÔ ·ÚÈıÌfi ˈÛÈÓÔÊ›ÏˆÓ ÛÙËÓ ÂÚÈʤÚÂÈ·). 4)
¶ÚÔÛ‚ÔÏ‹ fiÏÔ˘ ÙÔ˘ ÙÔȯÒÌ·ÙÔ˜, Ì ÔÈΛÏË Û˘-
Ìو̷ÙÔÏÔÁ›· (1-4). ∆· ıÂڷ¢ÙÈο ̤ÙÚ·, Ô˘
ηٿ ·ÚÈÔ ÏfiÁÔ ÂÊ·ÚÌfi˙ÔÓÙ·È, Â›Ó·È Ë ÛÙÔȯÂȷ΋
‰›·ÈÙ·, ·Ú¯Èο, ȉȷ›ÙÂÚ· ÛÙȘ ÂÚÈÙÒÛÂȘ ÂΛӘ
fiÔ˘ ˘¿Ú¯ÂÈ Û·Ê‹˜ Û˘Û¯¤ÙÈÛË Ì ÙÚÔʤ˜ (ÛÙÔȯ›·
·fi ÈÛÙÔÚÈÎfi, prick tests, patch tests, RAST tests) ηÈ
› ·ÔÙ˘¯›·˜ Ë ¯ÔÚ‹ÁËÛË ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜ ÎÔÚÙÈ-
ÎÔÛÙÂÚÔÂȉÒÓ (Ú‰ÓÈ˙fiÓË) Û ‰fiÛË 0,5-2mg/kg/
24ˆÚÔ, Ì ÛÙfi¯Ô ÙË Ì›ˆÛ‹ ÙÔ˘˜ ‹ Î·È ÙËÓ Ï‹ÚË
‰È·ÎÔ‹ ÙÔ˘˜ Û fiÛÔ ÙÔ ‰˘Ó·ÙfiÓ Û˘ÓÙÔÌfiÙÂÚÔ ¯ÚÔ-
ÓÈÎfi ‰È¿ÛÙËÌ·. ™Â ÂÈÚ·Ì·ÙÈÎfi ÛÙ¿‰ÈÔ ‚Ú›ÛÎÂÙ·È Ë
¯ÔÚ‹ÁËÛË Î·È ¿ÏÏˆÓ Ô˘ÛÈÒÓ, fiˆ˜ ÙÔ ¯ÚˆÌÔÁÏ˘ÎÈÎfi
Ó¿ÙÚÈÔ, Ë ÌÔÓÙÂÏÔ˘Î¿ÛÙË, Ë ÎÂÙÔÙÈÊ·›ÓË Î·È, Û ȉÈ-
·›ÙÂÚ· ·ÓıÂÎÙÈΤ˜ ÛÙË ıÂڷ›· ÌÔÚʤ˜, Ë Î˘ÎÏÔ-
ÛÔÚ›ÓË ‹ ¿ÏÏ· ·ÓÔÛÔÙÚÔÔÔÈËÙÈο Ê¿Ú̷η, ÌÂ
¿ÏÏÔÙ ¿ÏÏ· ·ÔÙÂϤÛÌ·Ù· (2-5,11).
¢˘ÛÙ˘¯Ò˜, ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· ‰ÂÓ ·Ó¢ڛÛÎÔÓÙ·È
ÛÙÔȯ›· ·fi ÛˆÛÙ¿ ÚÔÁÚ·ÌÌ·ÙÈṲ̂Ó˜ ÌÂϤÙ˜ ÁÈ·
ÙËÓ ·ÈÙÈÔ·ıÔÁ¤ÓÂÈ·, ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Î·È ÙËÓ ÂÈ-
‰ËÌÈÔÏÔÁ›·, ·ÏÏ¿ ÌÂÌÔӈ̤Ó˜ ·ÚÔ˘ÛÈ¿ÛÂȘ ÂÚÈ-
ÛÙ·ÙÈÎÒÓ, Ù· ÂÚÈÛÛfiÙÂÚ· ·fi Ù· ÔÔ›· ·ÊÔÚÔ‡Ó
ÂÓËÏ›ÎÔ˘˜. ¶·Ú¿ Ù·‡Ù·, ¤¯ÂÈ ÂÚÈÁÚ·Ê› Î·È ÂÚ›Ùˆ-
ÛË ÓÂÔÁÓÔ‡ Ì ˈÛÈÓÔÊÈÏÈ΋ Á·ÛÙÚÂÓÙÂÚ›Ùȉ· Ô˘ ÂÎ-
‰ËÏÒıËΠ·fi ÙËÓ ÚÒÙË Ë̤ڷ ˙ˆ‹˜ Î·È Ì¿ÏÈÛÙ· ÌÂ
·Û˘Ó‹ıÂȘ ÂÈÏÔΤ˜, fiˆ˜ ‰È¿ÙÚËÛË ÛÙÔÌ¿¯Ô˘ ηÈ
ÂÁÎÔÏ·ÛÌfi˜ (12). ÿÛˆ˜, ÙÂÏÈο, Ë ÓfiÛÔ˜ ·˘Ù‹ Ó· ÌËÓ
Â›Ó·È ÙfiÛÔ Û¿ÓÈ· (3). ∞Ó Î·È ‰ÂÓ Â›Ó·È Ï›Á˜ ÔÈ ·Ó·ÊÔ-
Ú¤˜ ÂÚÈÙÒÛÂˆÓ Ì ȉȷ›ÙÂÚ· ıÔÚ˘‚Ò‰Ë Û˘Ìو̷-
ÙÔÏÔÁ›· ηÈ, ÔÏϤ˜ ÊÔÚ¤˜, Ì ÌÔÈÚ·›· ηٿÏËÍË, Ë
ÚfiÁÓˆÛË Ù˘ ÓfiÛÔ˘ ıˆÚÂ›Ù·È ÁÂÓÈο ηϋ. ¶·Ú·ÙË-
ÚÔ‡ÓÙ·È ˘Ê¤ÛÂȘ Î·È ÂÍ¿ÚÛÂȘ, Ì ÚÔÛ‚ÔÏ‹ Û˘¯Ó¿
‰È·ÊÔÚÂÙÈÎÒÓ ÙÌËÌ¿ÙˆÓ ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡.
¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘
µÚ¤ÊÔ˜ ¿ÚÚÂÓ ËÏÈΛ·˜ 7 1/2 ÌËÓÒÓ ÂÈÛ‹¯ıË ÛÙËÓ
ÎÏÈÓÈ΋, ÏfiÁˆ ÌÂȈ̤Ó˘ ÚfiÛÏ˄˘ ‚¿ÚÔ˘˜ ·fi
‰ÈÌ‹ÓÔ˘ Î·È ¤ÓÙÔÓÔ Úfi‚ÏËÌ· ÂÌ¤ÙˆÓ ·fi ÓÂÔÁÓÈ-
΋˜ ËÏÈΛ·˜, Û˘Ó‹ıˆ˜ ÌÈÛ‹ ÒÚ· ‹ Î·È ·ÚÁfiÙÂÚ· ÌÂÙ¿
ÙË Û›ÙÈÛË, Ô˘ ÂȉÂÈÓÒıËΠȉȷ›ÙÂÚ· Ì ÙËÓ ÂÈÛ·-
ÁˆÁ‹ ÛÙÔ ‰È·ÈÙÔÏfiÁÈfi ÙÔ˘ ÛÙÂÚÂÒÓ ÙÚÔÊÒÓ Û ËÏÈΛ·
5 ÌËÓÒÓ.
∆Ô ·È‰› ·ÓÙÈÌÂÙˆÈ˙fiÙ·Ó Ì ۛÙÈÛË Ì ·ÓÙÈ·-
Ó·ÁˆÁÈο Á¿Ï·Ù·, ˆ˜ ̤ÙÚÔ ¤Ó·ÓÙÈ Èı·Ó‹˜ Á·-
ÛÙÚÔÔÈÛÔÊ·ÁÈ΋˜ ·ÏÈÓ‰ÚfiÌËÛ˘, ·Ó·ÔÙÂÏÂÛÌ·-
ÙÈÎÒ˜ fï˜.
◊Ù·Ó ÙÔ ÚÒÙÔ Î·È ÌÔÓ·‰ÈÎfi ·È‰› Ù˘ ÔÈÎÔÁ¤-
ÓÂÈ·˜, ηÏÔ‡ ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎÔ‡ ÂȤ‰Ô˘, ÌÂ
¤ÓÙÔÓË ·ÙÔÈ΋ ÚԉȿıÂÛË. √ ·Ù¤Ú·˜ ¿Û¯ÂÈ
·fi ‚ÚÔÁ¯ÈÎfi ¿ÛıÌ· Î·È Â·ÚÈÓ‹ ÚÈÓÔÂÈÂÊ˘Î›ÙÈ-
‰· Î·È Ë ÌËÙ¤Ú· ·fi ·ÏÏÂÚÁÈ΋ ÚÈÓ›Ùȉ·. ∆Ô ÂÚÈ-
ÁÂÓÓËÙÈÎfi ÈÛÙÔÚÈÎfi ÙÔ˘ ·È‰ÈÔ‡ ‹Ù·Ó ÂχıÂÚÔ,
ÂÓÒ ·fi ËÏÈΛ·˜ 5 ÌËÓÒÓ Ì¤¯ÚÈ ÙËÓ ËÏÈΛ· Ù˘
∂ÈÎfiÓ· 1. ¢È‹ıËÛË ÙÔ˘ ¯ÔÚ›Ô˘, ÙˆÓ ÎÚ˘ÙÒÓ Î·È ÂÛÙ›· ÙÔ˘ ÂÈÊ·-ÓÂÈ·ÎÔ‡ ÂÈıËÏ›Ô˘ ÙÂÌ·¯›Ô˘ ‰ˆ‰Âη‰·ÎÙ‡ÏÔ˘ ·fi ˈÛÈÓfiÊÈÏ·(·ÈÌ·ÙÔÍ˘Ï›ÓË-ˈۛÓË x200).
69µÚ¤ÊÔ˜ Ì ˈÛÈÓÔÊÈÏÈ΋ ÂÓÙÂÚ›Ùȉ·
¶·È‰È·ÙÚÈ΋ 2008;71:68-73
¶›Ó·Î·˜ 1. ™˘ÌÙÒÌ·Ù· Î·È ÛËÌ›· Ù˘ ˈÛÈÓÔÊÈÏÈ΋˜ Á·ÛÙÚÂ-ÓÙÂÚ›Ùȉ·˜ ·fi ÙÔ ÂÙÈÎfi (4)
™˘ÌÙÒÌ·Ù· ™ËÌ›·
∫ÔÈÏÈ·Îfi ¿ÏÁÔ˜ ∞ÛΛÙ˘ ∞ÓÔÚÂÍ›· ∫ÔÏ›Ùȉ·ªÂÙˆÚÈÛÌfi˜ °·ÛÙÚÂÓÙÂÚÈ΋ ÚˆÙÂ˚ÓfiÚÚÔÈ·¢È¿ÚÚÔÈ· √›‰ËÌ·¢˘ÛÊ·Á›· √ÈÛÔÊ·Á›Ùȉ·ªÂȈ̤ÓË ·Ó¿Ù˘ÍË ™˘Ú›ÁÁÈÔ ÂÓÙ¤ÚÔ˘ª¤Ï·ÈÓ˜ ÎÂÓÒÛÂȘ ¶ÂÙÈÎfi ¤ÏÎÔ˜ŒÌÂÙÔÈ ÀÔÚˆÙÂ˚Ó·ÈÌ›·∞ÒÏÂÈ· ‚¿ÚÔ˘˜ ∂ÈϽÙȉ·
¢˘Û·ÔÚÚfiÊËÛË∞fiÊÚ·ÍË ÂÓÙ¤ÚÔ˘¢È¿ÙÚËÛË ÂÓÙ¤ÚÔ˘£¿Ó·ÙÔ˜
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·69
ÂÈÛ·ÁˆÁ‹˜ ÙÔ˘ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô Â›¯Â ÓÔÛ‹ÛÂÈ ÂÚÈÛ-
ÛfiÙÂÚÔ ·fi ‰‡Ô ÊÔÚ¤˜ Ì ‚ÚÔÁ¯ÈÔÏ›Ùȉ· Î·È ÔÍ›·
̤ÛË ˆÙ›Ùȉ·.
¢ÂÓ ·Ó·ÊÂÚfiÙ·Ó ¯Ú‹ÛË Ê·Ú̷΢ÙÈÎÒÓ Ô˘ÛÈÒÓ
¤Ú·Ó Ù˘ ·ÌÈÎÈÏÏ›Ó˘ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ
ÂÂÈÛÔ‰›ˆÓ Ù˘ ˆÙ›Ùȉ·˜ Î·È Ù˘ Û·Ï‚Ô˘Ù·ÌfiÏ˘
Î·È Ù˘ ÊÏÔ˘ÙÈη˙fiÓ˘ Ì ÙË ÌÔÚÊ‹ ÂÈÛÓÔÒÓ, ÁÈ·
‰È¿ÛÙËÌ· 15 ËÌÂÚÒÓ Û˘ÓÔÏÈο .
∆Ô ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜ ‹Ù·Ó ÌÂٷ͇ 3˘-10˘ ÂηÙÔ-
ÛÙÈ·›·˜ ı¤Û˘ (∂£), ÂÓÒ Ë ÂÚ›ÌÂÙÚÔ˜ ÎÂÊ·Ï‹˜ ηÈ
ÙÔ Ì‹ÎÔ˜ ÛÒÌ·ÙÔ˜ ¿Óˆ ·fi ÙËÓ 50Ë ∂£. ™ÙËÓ Î·-
̇ÏË ·Ó¿Ù˘Í˘ ÙÔ˘ ‚¿ÚÔ˘˜ ÙÔ˘ ·È‰ÈÔ‡, ·Ú·ÙË-
ÚÔ‡ÓÙ·Ó ÙÒÛË ·fi ÙËÓ ËÏÈΛ· ÙˆÓ 5 ÌËÓÒÓ. ∂›¯Â ÂÈ-
ÎfiÓ· ‹È·˜ Ïԛ̈͢ ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡,
¯ˆÚ›˜ ¿ÏÏ· Â˘Ú‹Ì·Ù· ·fi Ù· ÏÔÈ¿ Û˘ÛÙ‹Ì·Ù·.
√ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍ ÌÂÁ¿ÏË ·‡ÍËÛË
ÙˆÓ ËˆÛÈÓÔÊ›ÏˆÓ ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜, Ô˘ ·Ú-
¯Èο ‹Ù·Ó 4.680/mm3 ηٿ ·fiÏ˘ÙÔ ·ÚÈıÌfi, ÂÓÒ ÙËÓ
ÙÚ›ÙË Ì¤Ú· ÓÔÛËÏ›·˜ ͤڷÛ ÙȘ 13.400/mm3
(50% ÙˆÓ Ï¢ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ) (¶›Ó·Î·˜ 2). ¢ÂÓ
·ÚÔ˘Û›·˙Â ·Ó·ÈÌ›· ‹ ·ıÔÏÔÁÈÎfi ·ÚÈıÌfi ·ÈÌÔÂ-
Ù·Ï›ˆÓ. ¶·ıÔÏÔÁÈ΋ ‹Ù·Ó ·ÎfiÌË Ë ÙÈÌ‹ ÙˆÓ ÏÂ˘Îˆ-
Ì¿ÙˆÓ Î·È ÈÔ Û˘ÁÎÂÎÚÈ̤ӷ ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ÛÊ·È-
ÚÈÓÒÓ Î·È ·ÚÁfiÙÂÚ· Î·È Ù˘ ÏÂ˘ÎˆÌ·Ù›Ó˘. √ ¤ÏÂÁ-
¯Ô˜ ÙˆÓ ÎÔÚ¿ÓˆÓ ‹Ù·Ó ·ÚÓËÙÈÎfi˜ ÁÈ· ‡·ÚÍË ·-
Ú·Û›ÙˆÓ ‹ ÌÈÎÚÔ‚›ˆÓ, ·ÏÏ¿ ıÂÙÈÎfi˜ ÁÈ· ·ÚÔ˘Û›· ·›-
Ì·ÙÔ˜ Û ÔÏÏ·Ï¿ ‰Â›ÁÌ·Ù·, ¯ˆÚ›˜ Ì·ÎÚÔÛÎÔÈ΋
ÂȂ‚·›ˆÛË. √ ¤ÏÂÁ¯Ô˜ ÙˆÓ ·ÓÔÛÔÛÊ·ÈÚÈÓÒÓ ·Ú¯Èο∂ÈÎfiÓ· 2. ∫Ú˘ÙÈ΋ ‰È‹ıËÛË ÙÂÌ·¯È‰›Ô˘ ‰ˆ‰Âη‰·ÎÙ‡ÏÔ˘ ·fiˈÛÈÓfiÊÈÏ· x400.
70 Ã. ∫Ô˘ÙÛ·˘Ù›ÎË Î·È Û˘Ó.
Paediatriki 2008;71:68-73
¶›Ó·Î·˜ 2. ∂ÚÁ·ÛÙËÚÈ·Îfi˜ ŒÏÂÁ¯Ô˜
∞Ú¯ÈÎfi˜ ¤ÏÂÁ¯Ô˜°ÂÓÈ΋ ·›Ì·ÙÔ˜§Â˘Î¿ ·ÈÌÔÛÊ·›ÚÈ·: 26.800 K/ÌL (¶=6%, §=42%, ª=2%, ∏=50% ·fiÏ˘ÙÔ˜ ·ÚÈıÌfi˜: 13.400)∞ÈÌÔÛÊ·ÈÚ›ÓË = 11,1 g/dl ∞ÈÌ·ÙÔÎÚ›Ù˘ = 33,6% ∞ÈÌÔÂÙ¿ÏÈ· = 530.000 K/ÌL∆∫∂ = 14 mmHg/1Ë ÒÚ· CRP = (-)√ÏÈο Ï¢ÎÒÌ·Ù· = 5,2 g/dl §Â˘ÎˆÌ·Ù›Ó˜ = 3,2 g/dl ™Ê·ÈÚ›Ó˜ = 2 g/dl§ÔÈfi˜ ‚ÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜: º˘ÛÈÔÏÔÁÈÎfi˜∞ÓÔÛÔÛÊ·ÈÚ›Ó˜: IgG=206 mg/dl ↓ IgM=26 mg/dl ↓
IgG1=85 mg/dl ↓ IgA=11,8 mg/dlIgG2=84 mg/dlIgG3=5 mg/dl ↓ IgE=130 iu/ml ↑IgG4=43 mg/dl
RAST: °¿Ï· = ∆¿ÍË 1 ∞˘Áfi-™ÈÙËÚ¿-¶ÔÚÙÔοÏÈ = 0∫˘ÙÙ·ÚÈ΋ ·ÓÔÛ›·: º˘ÛÈÔÏÔÁÈÎÔ› ÏÂÌÊÔ΢ÙÙ·ÚÈÎÔ› ÏËı˘ÛÌÔ› ÁÈ· ÙËÓ ËÏÈΛ·.
º˘ÛÈÔÏÔÁÈ΋ ÔÍÂȉˆÙÈ΋ ·Ó·Ó¢ÛÙÈ΋ ÈηÓfiÙËÙ· ÔÏ˘ÌÔÚÊÔ˘Ú‹ÓˆÓ.∫·Ú‰ÈÔÏÔÁÈ΋ ÂÎÙ›ÌËÛË: º˘ÛÈÔÏÔÁÈ΋ ‰ÔÌ‹ Î·È ÏÂÈÙÔ˘ÚÁ›· Ù˘ ηډȿ˜. RÖ ıÒÚ·ÎÔ˜: º˘ÛÈÔÏÔÁÈ΋U/S ÎÔÈÏ›·˜: ◊·Ú-ÛÏËÓ Ê˘ÛÈÔÏÔÁÈο. ¢ÂÓ ·Ú·ÙËÚÂ›Ù·È Û·Ê‹˜ ¿¯˘ÓÛË ÙÔ˘ ÙÔȯÒÌ·ÙÔ˜ ÙˆÓ ÂÓÙÂÚÈÎÒÓ ÂϛΈÓ. ¶·Ú·ÛÈÙÔÏÔÁÈ΋ ÎÔÚ¿ÓˆÓ: ∞ÚÓËÙÈ΋∫·ÏÏȤÚÁÂȘ ÎÔÚ¿ÓˆÓ: º˘ÛÈÔÏÔÁÈ΋ ¯ÏˆÚ›‰·Mayer ÎÔÚ¿ÓˆÓ: £ÂÙÈ΋∞ÔÙÂϤÛÌ·Ù· ÂÓ‰ÔÛÎfiËÛ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡: ∞Ó·ÁÚ¿ÊÔÓÙ·È ÛÙÔ Î›ÌÂÓÔ.
ŒÏÂÁ¯Ô˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ Ú‰ÓÈ˙fiÓ˘°ÂÓÈ΋ ·›Ì·ÙÔ˜§Â˘Î¿ ·ÈÌÔÛÊ·›ÚÈ·: 10.600 K/ÌL (¶=18%, §=72%, ª=10%, ∏=2% ·fiÏ˘ÙÔ˜ ·ÚÈıÌfi˜:212)∞ÈÌÔÛÊ·ÈÚ›ÓË = 14 g/dl ∞ÈÌ·ÙÔÎÚ›Ù˘ = 43,2% ∞ÈÌÔÂÙ¿ÏÈ· = 362.000 K/ÌL∆∫∂ = 5 mmHg/1Ë ÒÚ· CRP = (-)√ÏÈο Ï¢ÎÒÌ·Ù· = 5,9 g/dl §Â˘ÎˆÌ·Ù›Ó˜ = 4,2 g/dl ™Ê·ÈÚ›Ó˜ = 1,7 g/dl ↓§ÔÈfi˜ ‚ÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜: º˘ÛÈÔÏÔÁÈÎfi˜∞ÓÔÛÔÛÊ·ÈÚ›Ó˜: IgG=231 mg/dl ↓ IgM=60,4 mg/dl IgA=19,1 mg/dl IgE=<5,0 iu/ml Mayer ÎÔÚ¿ÓˆÓ: ∞ÚÓËÙÈΤ˜
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·70
·Ó¤‰ÂÈÍ ·˘ÍË̤ÓË ÙÈÌ‹ Ù˘ πgE, ·ÏÏ¿ ÌÂȈ̤ÓË Ù˘
IgG Î·È Î¿ÔȘ ·fi ÙȘ ˘ÔÙ¿ÍÂȘ Ù˘, ηıÒ˜ ηÈ
ÂÏ·Ùو̤ÓË Ù˘ IgM. √ ¤ÏÂÁ¯Ô˜ Ù˘ ΢ÙÙ·ÚÈ΋˜ ·ÓÔ-
Û›·˜ ¤‰ÂÈÍ ÏÂÌÊÔ΢ÙÙ·ÚÈÎÔ‡˜ ÏËı˘ÛÌÔ‡˜ ÂÓÙfi˜
ÙˆÓ ÚÔ‚ÏÂfiÌÂÓˆÓ ÁÈ· ÙËÓ ËÏÈΛ· ÙÔ˘ ÔÚ›ˆÓ. ∏
·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ ‰ÂÓ ·Ó¤‰ÂÈÍ ÂÓÂÚÁfi Ó¢ÌÔ-
ÓÈ΋ ·ÏÏÔ›ˆÛË Î·È ÙÔ ̆ ÂÚ˯ÔÁÚ¿ÊËÌ· ¿Óˆ Î·È Î¿Ùˆ
ÎÔÈÏ›·˜ ‹Ù·Ó ¯ˆÚ›˜ ȉȷ›ÙÂÚ· ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·.
∏ ‰È·ÁÓˆÛÙÈ΋ ÛΤ„Ë Î·Ù¢ı‡ÓıËΠ۠ÓÔÛÔÏÔ-
ÁÈΤ˜ ÔÓÙfiÙËÙ˜, fiˆ˜ Ë ·ÏÏÂÚÁ›· ÛÙÔ Á¿Ï· ·ÁÂÏ¿-
‰·˜, ÔÈ ÙÚÔÊÈΤ˜ ·ÏÏÂÚÁ›Â˜ ÁÂÓÈÎfiÙÂÚ·, Ë ·ÏÏÂÚÁÈ΋
Á·ÛÙÚÂÓÙÂÚ›Ùȉ·, ÔÈ ÊÏÂÁÌÔÓÒ‰ÂȘ ÓfiÛÔÈ ÙÔ˘ ÂÓÙ¤-
ÚÔ˘, ÔÈ ·Ú·ÛÈÙÒÛÂȘ-ÏÔÈÌÒÍÂȘ, Ù· ·ÈÌ·ÙÔÏÔÁÈο ÓÔ-
Û‹Ì·Ù· Î.¿., ·ı‹ÛÂȘ Ô˘ ÚÔÎÂÈ̤ÓÔ˘ Ó· ‰È·ÁÓˆ-
ÛıÔ‡Ó ¯ÚÂÈ¿˙ÔÓÙ·È ÂÓ‰ÔÛÎÔÈÎfi ¤ÏÂÁ¯Ô (¶›Ó·Î·˜ 3).
ªÂ ‚¿ÛË ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi Î·È ÙË ÌÈÎÚ‹
ËÏÈΛ· ÙÔ˘ ·ÛıÂÓÔ‡˜, ıˆڋıËΠˆ˜ Èı·ÓfiÙÂÚÔ˜ ·È-
ÙÈÔ·ıÔÁÂÓÂÙÈÎfi˜ Ì˯·ÓÈÛÌfi˜ οÔÈ· ·ÏÏÂÚÁÈ΋ η-
Ù¿ÛÙ·ÛË Î·È ÂÊ·ÚÌfiÛÙËΠ‰›·ÈÙ· Ì ÛÙÔȯÂÈ·Îfi Á¿Ï·,
Ï‹Ú˘ ·Ô¯‹ ·fi ÚÔ˚fiÓÙ· ·ÁÂÏ¿‰·˜ Î·È ·fi ¿ÏϘ
‰˘ÓËÙÈο ·ÏÏÂÚÁÈÔÁfiÓ˜ ÙÚÔʤ˜. ∏ ÁÂÓÈ΋ ηٿÛÙ·-
ÛË ÙÔ˘ ·È‰ÈÔ‡ ‚ÂÏÙÈÒıËÎÂ, ÛÙ·Ì¿ÙËÛ·Ó ÔÈ ¤ÌÂÙÔÈ
Î·È ¿Ú¯ÈÛ ӷ ÚÔÛÏ·Ì‚¿ÓÂÈ ‚¿ÚÔ˜ ÈηÓÔÔÈËÙÈο.
ŸÌˆ˜, ·Ú¿ ÙËÓ Î¿ÔÈÔ˘ ‚·ıÌÔ‡ ÂÏ¿ÙÙˆÛË ÙˆÓ Ëˆ-
ÛÈÓÔʛψÓ, ‰È·ÈÛÙÒıËΠÂÈϤÔÓ ÙÒÛË ÙˆÓ Ï¢-
Έ̷ÙÈÓÒÓ Î·È ÙˆÓ ÛÊ·ÈÚÈÓÒÓ (ȉ›ˆ˜ Ù˘ IgG) Î·È Û˘-
Ó¯‹˜ ·Ó›¯Ó¢ÛË ·ÈÌÔÛÊ·ÈÚ›Ó˘ ÛÙ· ÎfiÚ·Ó·.
∆Ô ‚Ú¤ÊÔ˜ ˘Ô‚Ï‹ıËΠ۠ÂÓ‰ÔÛÎÔÈÎfi ¤ÏÂÁ¯Ô
ÙÔ˘ ÂÙÈÎÔ‡, Ô˘ ¤‰ÂÈÍÂ Ê˘ÛÈÔÏÔÁÈο Â˘Ú‹Ì·Ù·
·fi ÙÔ ·ÓÒÙÂÚÔ ÂÙÈÎfi Î·È ÏÂ˘Îˆfi ›¯ÚÈÛÌ·
ÛÙÔ ÔÚıfi Î·È ÙÔ ÛÈÁÌÔÂȉ¤˜. ªÂ ÙËÓ ÈÛÙÔÏÔÁÈ΋ Âͤ-
Ù·ÛË ‰È·ÈÛÙÒıËÎ·Ó ‹È· ¯ÚfiÓÈ· ÔÈÛÔÊ·Á›Ùȉ· ηÈ
‹È· ÌË ÂȉÈ΋ Á·ÛÙÚ›Ùȉ·, Ì ·ÚÎÂÙ¿ ˈÛÈÓfiÊÈÏ·,
4-13 HPF. √ ‚ÏÂÓÓÔÁfiÓÔ˜ ÙÔ˘ ‰ˆ‰Âη‰·ÎÙ‡ÏÔ˘ ›¯Â
Ê˘ÛÈÔÏÔÁÈΤ˜ Ï¿¯Ó˜, ̤ÙÚÈ· ¯ÚfiÓÈ· 12Ï›Ùȉ· ηÈ
Û·ÊÒ˜ ·˘ÍË̤ӷ ˈÛÈÓfiÊÈÏ·, 20-39 HPF, Ì ʷÈÓfi-
ÌÂÓ· ·ÔÎÔÎΛˆÛ˘ Î·È ÛÙÔȯ›· ÂÓ‰ÔÂÈıËÏȷ΋˜
ÌÂÙ·Ó·ÛÙ‡Ûˆ˜. ™ÙÔ ÔÚıÔÛÈÁÌÔÂȉ¤˜ ‰È·ÈÛÙÒıË-
ΠÌÈÎÚÔ‡ ‚·ıÌÔ‡ ‰È·Ù·Ú·¯‹ Ù˘ ·Ú¯ÈÙÂÎÙÔÓÈ΋˜
ÙˆÓ ·‰ÂÓÈÎÒÓ ÛÙÔȯ›ˆÓ ÙÔ˘ ‚ÏÂÓÓÔÁfiÓÔ˘, ·‡ÍËÛË
ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Î·È Ï·ÛÌ·ÙÔ΢ÙÙ¿ÚˆÓ, ÂÓÒ Ù·
ˈÛÈÓfiÊÈÏ· ‹Ù·Ó ÌÂÙÚ›ˆ˜ ·˘ÍË̤ӷ, 12-20 HPF, ÌÂ
¤ÓÙÔÓ· Ê·ÈÓfiÌÂÓ· ·ÔÎÔÎΛˆÛ˘. √ ¤ÏÂÁ¯Ô˜ ÁÈ· ∏.
pylori Î·È Ï¿Ì‚ÏȘ ‹Ù·Ó ·ÚÓËÙÈÎfi˜.
™˘ÌÂÚ·ÛÌ·ÙÈο, Ë ÂÈÎfiÓ· ‹Ù·Ó Û˘Ì‚·Ù‹ Ì ·Ï-
ÏÂÚÁÈ΋ ÂÍÂÚÁ·Û›· ÛÙÔ ·ÓÒÙÂÚÔ ÂÙÈÎfi Î·È ‹È·
ˆ˜ ̤ÙÚÈ· ¯ÚfiÓÈ· ÊÏÂÁÌÔÓ‹, Ì ̤ÙÚÈ· ˈÛÈÓÔÊÈÏ›·
ÛÙÔ Î·ÙÒÙÂÚÔ ÂÙÈÎfi.
71µÚ¤ÊÔ˜ Ì ˈÛÈÓÔÊÈÏÈ΋ ÂÓÙÂÚ›Ùȉ·
¶·È‰È·ÙÚÈ΋ 2008;71:68-73
¶›Ó·Î·˜ 3. ¢ÈÂÚ‡ÓËÛË ËˆÛÈÓÔÊÈÏ›·˜ (7)
∞ÏÏÂÚÁÈΤ˜ ηٷÛÙ¿ÛÂȘ ∫·ÎÔ‹ıÂȘ∞ÏÏÂÚÁÈ΋ ÚÈÓ›Ùȉ· ŸÁÎÔÈ ÂÁÎÂÊ¿ÏÔ˘ÕÛıÌ· ¡fiÛÔ˜ Hodgkin - §ÂÌÊÒÌ·Ù· ∆√Í›· ÎÓ›‰ˆÛË √Í›· Ì˘ÂÏÔÁÂÓ‹˜ Ï¢¯·ÈÌ›·∞ÓÙ›‰Ú·ÛË ˘ÂÚ¢·ÈÛıËÛ›·˜ Û ʿÚ̷η °·ÛÙÚÂÓÙÂÚÈΤ˜ ·ı‹ÛÂȘ§ÔÈÌÒ‰ÂȘ ·Ú¿ÁÔÓÙ˜ ºÏÂÁÌÔÓ҉˘ ÓfiÛÔ˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘∂ÏÌÈÓıÈ¿ÛÂȘ ∏ˆÛÈÓÔÊÈÏÈ΋ Á·ÛÙÚÂÓÙÂÚ›Ùȉ·∆Úȯ›ÓˆÛË ∞ÓÔÛÔ·Ó¿ÚÎÂȘ∆ÔÍÔηڛ·ÛË ™‡Ó‰ÚÔÌÔ ˘ÂÚ IgE ™ÙÚÔÁÁ˘ÏÔ›‰ˆÛË ™‡Ó‰ÚÔÌÔ Wiskott-Aldrich ∞Ûηڛ·ÛË ∞ÓÙ›‰Ú·ÛË Î·Ù¿ ÌÔۯ‡̷ÙÔ˜ºÈÏ·Ú›·ÛË ¶Ó¢ÌÔÓÈΤ˜ ·ı‹ÛÂȘ™¯ÈÛÙÔۈ̛·ÛË ™‡Ó‰ÚÔÌÔ Löffler∂¯ÈÓÔÎÔÎΛˆÛË ∏ˆÛÈÓÔÊÈÏÈ΋ Ï¢¯·ÈÌ›·¶Ó¢ÌÔÓÔ·ÛÙË carinii ¶Ó¢ÌÔӛ˜ ˘ÂÚ¢·ÈÛıËÛ›·˜∆ÔÍÔÏ¿Û̈ÛË ÕÏϘ ηٷÛÙ¿ÛÂȘ∞ÌÔÈ‚¿‰ˆÛË £ÚÔÌ‚Ô΢ÙÙ·ÚÔÂÓ›· Ì ·Ô˘Û›· ÎÂÚΛ‰·˜∂ÏÔÓÔÛ›· ∞ÁÁÂÈ›Ùȉ·µÚÔÁ¯ÔÓ¢ÌÔÓÈ΋ ·ÛÂÚÁ›ÏψÛË ªÂÙ¿ ·ÎÙÈÓÔ‚ÔÏ›· ÎÔÈÏȷ΋˜ ¯ÒÚ·˜∫ÔÎÎȉÈÔÂȉÔ̇ΈÛË πÛÙÈÔ΢ÙÙ¿ÚˆÛË ÌÂ Û˘ÌÌÂÙÔ¯‹ ·fi ÙÔ ‰¤ÚÌ·
∂ÈÎfiÓ· 3. ∆ÂÌ·¯›‰ÈÔ ‚ÏÂÓÓÔÁfiÓÔ˘ ·¯¤Ô˜ ÂÓÙ¤ÚÔ˘ Ì ·˘ÍË̤ӷˈÛÈÓfiÊÈÏ· Ì ÂÓ Ùˆ ‚¿ıÂÈ Î·Ù·ÓÔÌ‹ Î·È ÎÚ˘ÙÈ΋ ‰È‹ıËÛË x400.
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·71
∏ ÙÂÏÈ΋ ‰È¿ÁÓˆÛË ‹Ù·Ó ÂΛÓË Ù˘ ˈÛÈÓÔÊÈÏÈ-
΋˜ ÂÓÙÂÚ›Ùȉ·˜. ∂Âȉ‹ οÔÈ· ·fi Ù· Û˘ÌÙÒÌ·-
Ù·, fiˆ˜ Ë ÚˆÙÂ˚ÓfiÚÚÔÈ· Î·È ÔÈ ·ÈÌÔÚÚ·ÁÈΤ˜ ÎÂ-
ÓÒÛÂȘ, ¤ÌÂÓ·Ó, ·Ú¿ ÙË ‰›·ÈÙ· Ô˘ ¤ÁÈÓ ·ÎfiÌ·
ÈÔ Û˘ÁÎÂÎÚÈ̤ÓË ‡ÛÙÂÚ· ·fi ‰ÂÚÌ·ÙÈΤ˜ ‰ÔÎÈÌ·-
ۛ˜ (patch tests), ·ÔÊ·Û›ÛÙËÎÂ Ë ¯ÔÚ‹ÁËÛË Ú‰-
ÓÈ˙fiÓ˘ ·fi ÙÔ ÛÙfiÌ·, ·Ú¯Èο Û ‰fiÛË 1,5 mg/kg/
24ˆÚÔ. √ ÚÒÙÔ˜ ·ӤÏÂÁ¯Ô˜, 7 ̤Ú˜ ÌÂÙ¿, ·Ó¤-
‰ÂÈÍ ·ÚÈıÌfi ˈÛÈÓÔÊ›ÏˆÓ <800/mm3, Ê˘ÛÈÔÏÔÁÈ΋
ÙÈÌ‹ πgE, Mayer ÎÔÚ¿ÓˆÓ ·ÚÓËÙÈ΋, ·ÏÏ¿ ¯·ÌËϤ˜
ÙÈ̤˜ ÏÂ˘ÎˆÌ·Ù›Ó˘ Î·È IgG, ÂÓÒ ÔÈ ÙÈ̤˜ ÙˆÓ IgM
Î·È IgA ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈΤ˜.
ŒÎÙÔÙÂ, ÙÔ ·È‰› ·Ú·ÎÔÏÔ˘ıÂ›Ù·È Ù·ÎÙÈο ·fi
ÔÌ¿‰· ÁÈ·ÙÚÒÓ (ÂȉÈÎfi Á·ÛÙÚÂÓÙÂÚÔÏfiÁÔ, ·ÏÏÂÚÁÈÔ-
ÏfiÁÔ Î·È ·È‰›·ÙÚÔ). ∏ Ú‰ÓÈ˙fiÓË ‰È·ÎfiÙÂÙ·È
ÛÙ·‰È·Î¿, ¯ˆÚ›˜ ˘ÔÙÚÔ‹ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ (¯ÚÔ-
ÓÈÎfi ‰È¿ÛÙËÌ· ·Ú·ÎÔÏÔ‡ıËÛ˘ 7 Ì‹Ó˜). ∏ ·Ó¿-
Ù˘Í‹ ÙÔ˘ Î·È Ë ÁÂÓÈ΋ ÙÔ˘ ‰È¿ıÂÛË Â›Ó·È ¿ÚÈÛÙË, Ë
ÚfiÛÏË„Ë ‚¿ÚÔ˘˜ ÈηÓÔÔÈËÙÈ΋ ÁÈ· ÙËÓ ËÏÈΛ·
ÙÔ˘, Ì ·ÔÙ¤ÏÂÛÌ· Ó· ‚Ú›ÛÎÂÙ·È Û‹ÌÂÚ· ÌÂٷ͇
25˘-50˘ ÂηÙÔÛÙÈ·›·˜ ı¤Û˘.
™˘˙‹ÙËÛË
∏ ÂÈÛ·ÁˆÁ‹ ‚ÚÂÊÒÓ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô ÁÈ· ÙË ‰ÈÂ-
Ú‡ÓËÛË ÌÂȈ̤Ó˘ ÚfiÛÏ˄˘ ‚¿ÚÔ˘˜, Ô˘ Û˘¯Ó¿
Û˘Óԉ‡ÂÙ·È Î·È ·fi ¿ÏÏ· Û˘ÌÙÒÌ·Ù· ·fi ÙÔ Â-
ÙÈÎfi Û‡ÛÙËÌ·, Â›Ó·È Û¯ÂÙÈο Û˘ÓËıÈṲ̂ÓË Î·Ù¿ÛÙ·-
ÛË. ∏ ‡·ÚÍË, fï˜, ˈÛÈÓÔÊÈÏ›·˜ ÛÙÔ ÂÚÈÊÂÚÈÎfi
·›Ì· Î·È Ì¿ÏÈÛÙ· ȉȷ›ÙÂÚ· ÛÔ‚·Ú‹˜ Â›Ó·È ·Û˘Ó‹ıÈ-
ÛÙË Î·È ÚÔ‚ÏËÌ·Ù›˙ÂÈ È‰È·›ÙÂÚ· ÙÔÓ ÎÏÈÓÈÎfi È·ÙÚfi.
∏ ·ÏÏÂÚÁ›· ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜ Î·È ÁÂÓÈÎfiÙÂÚ·
ÛÙȘ ÙÚÔʤ˜ ÌÔÚ› Ó· ÚÔ‚¿ÏÏÂÈ ˆ˜ ·ÒÏÂÈ· ‚¿-
ÚÔ˘˜, Û˘Ìو̷ÙÔÏÔÁ›· Á·ÛÙÚÔÔÈÛÔÊ·ÁÈ΋˜ ·ÏÈÓ-
‰ÚfiÌËÛ˘, ·ÈÌÔÚÚ·ÁÈΤ˜ ÎÂÓÒÛÂȘ Î·È ÂÓ›ÔÙÂ Û˘ÓÔ-
‰Â‡ÂÙ·È ·fi ‚ÚÔÁ¯ÈÔÏ›Ùȉ· Î·È Û˘¯Ó¿ ÂÂÈÛfi‰È· ̂ Ù›-
Ùȉ·˜. ™ÙÔ˘˜ ·ıÔÁÂÓÂÙÈÎÔ‡˜ Ì˯·ÓÈÛÌÔ‡˜ Ï·Ì‚¿-
ÓÂÈ Ì¤ÚÔ˜ Ë πgE (πgE-mediated), ·ÏÏ¿ Î·È ¿ÏÏÔÈ ÌË-
¯·ÓÈÛÌÔ› (non IgE-mediated). ™ÙËÓ ÔÍ›· Ê¿ÛË Ù˘
ÙÚÔÊÈ΋˜ ·ÏÏÂÚÁ›·˜ ÌÔÚ› Ó· ·Ú·ÙËÚËı› ¤ˆ˜ ηÈ
Ï¢¯·ÈÌÔÂȉ‹˜ ·ÓÙ›‰Ú·ÛË ÛÙ· ˈÛÈÓfiÊÈÏ· ·ÙÙ·Ú·,
Ì ·ÚÈıÌfi Ô˘ ÌÔÚ› Ó· Â›Ó·È >20.000/mm3, ·ÏÏ¿
ÛÂ Ê¿ÛË ¯ÚÔÓÈfiÙËÙ·˜ Û¿ÓÈ· ÍÂÂÚÓ¿ Ù· 2.000/mm3
(6). ™ÙËÓ ÂÚ›ÙˆÛË ÙÔ˘ Û˘ÁÎÂÎÚÈ̤ÓÔ˘ ·ÛıÂÓ‹ ‰ÂÓ
ÂÚfiÎÂÈÙÔ ÁÈ· ÔÍ›· ηٿÛÙ·ÛË, ¿Ú· ‰ÂÓ Â˘ÛÙ·ı›
ˆ˜ Èı·Ó‹ Ë ‰È¿ÁÓˆÛË ·˘Ù‹.
√È ·Ú·ÛÈÙÈΤ˜ ÓfiÛÔÈ Î·È ÏÔÈÌÔÁfiÓÔÈ ·Ú¿ÁÔ-
ÓÙ˜ ÁÂÓÈÎfiÙÂÚ· (∆oxocara canis, Strongyloides sp, H.
pylori, Echinococcus, Î.¿.) ÌÔÚÔ‡Ó Ó· ÚÔηϤÛÔ˘Ó
ÂÎÛÂÛËÌ·Ṳ̂ÓË ËˆÛÈÓÔÊÈÏ›·, ÙfiÛÔ ÛÙÔ ÂÚÈÊÂÚÈÎfi
·›Ì·, fiÛÔ Î·È ÙÔÈο ÛÙÔ˘˜ ÈÛÙÔ‡˜. ™ÙÔÓ ·ÛıÂÓ‹ Ì·˜
Ô ¤ÏÂÁ¯Ô˜ ÙˆÓ ÎÔÚ¿ÓˆÓ ‹Ù·Ó ¿ÓÙ· ·ÚÓËÙÈÎfi˜,
fiˆ˜ Î·È Ô ¤ÏÂÁ¯Ô˜ ÙˆÓ ÈÛÙÔÙÂÌ·¯›ˆÓ ÙÔ˘ ÂÙÈÎÔ‡
(6,7). ∂Í¿ÏÏÔ˘, Ë ÌÈÎÚ‹ ËÏÈΛ· ÙÔ˘ ·ÛıÂÓÔ‡˜ Î·È ÙÔ
ηÏfi ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎfi ÂÚÈ‚¿ÏÏÔÓ Î·ıÈÛÙÔ‡-
Û·Ó Ï›ÁÔ ·›ı·ÓË ÙËÓ Â·Ê‹ ÙÔ˘ Ì οÔÈÔÓ ·fi
ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ ·˘ÙÔ‡˜.
∏ ȉÈÔ·ı‹˜ ÊÏÂÁÌÔÓ҉˘ ÓfiÛÔ˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘,
Î·È È‰È·›ÙÂÚ· Ë ÌÔÚÊ‹ Ù˘ ÓfiÛÔ˘ Crohn, Ôχ Û¿-
ÓÈ· ÌÔÚ› Ó· ÚÔÛ‚¿ÏÏÂÈ Ù· ‚Ú¤ÊË ÌÈÎÚ‹˜ ËÏÈΛ·˜
Î·È Ì¿ÏÈÛÙ· Ì ÌfiÓÔ Û‡Ìو̷ ÙËÓ Î·ı˘ÛÙ¤ÚËÛË
ÛÙË ÛˆÌ·ÙÈ΋ ·Ó¿Ù˘ÍË Î·È ÙËÓ ˘ÔıÚ„›·. ¶·Ú¿
ÙÔ ÁÂÁÔÓfi˜, ›Û˘, fiÙÈ ÚÔηÏÔ‡Ó Î¿ÔÈÔ˘ ‚·ıÌÔ‡
ˈÛÈÓÔÊÈÏ›· ·›Ì·ÙÔ˜ Î·È ÙˆÓ ÈÛÙÒÓ ÙÔ˘ °∂™, ÔÙ¤
·˘Ù‹ ‰ÂÓ Â›Ó·È ÛÔ‚·ÚÔ‡ ‚·ıÌÔ‡ (·fiÏ˘ÙÔ˜ ·ÚÈıÌfi˜
ˈÛÈÓÔÊ›ÏˆÓ ·›Ì·ÙÔ˜ <1.500/mm3 Î·È ÈÛÙÒÓ <20
HPF ÛÙË ‚ÈÔ„›·) (3,6,8).
∆· ·ÈÌ·ÙÔÏÔÁÈο ÓÔÛ‹Ì·Ù· Î·È ÁÂÓÈÎfiÙÂÚ· ÔÈ Î·-
ÎÔ‹ıÂȘ (ˈÛÈÓÔÊÈÏÈ΋ Ï¢¯·ÈÌ›·, ÏÂÌÊÒÌ·Ù· ÌË
Hodgkin, Î.¿.), Û˘Ó‹ıˆ˜ ·ÊÔÚÔ‡Ó ·È‰È¿ ËÏÈΛ·˜ >2
ÂÙÒÓ, ÂÓÒ Û˘Ó˘¿Ú¯Ô˘Ó Î·È ¿ÏÏ· Â˘Ú‹Ì·Ù· ÛÙË ÁÂ-
ÓÈ΋ ·›Ì·ÙÔ˜ (.¯. ıÚÔÌ‚Ô΢ÙÙ·ÚÔÂÓ›·) (6,9).
∏ Èı·ÓfiÙËÙ· ÙÔ˘ ˘ÂÚˈÛÈÓÔÊÈÏÈÎÔ‡ Û˘Ó‰Úfi-
ÌÔ˘ ·ÔÎÏ›ÛÙËÎÂ, ηıÒ˜ ‰ÂÓ ÏËÚÔ‡Û ηӤӷ
·fi Ù· 3 ··Ú·›ÙËÙ· ÎÚÈÙ‹ÚÈ· ÁÈ· ÙË ‰È¿ÁÓˆÛ‹ ÙÔ˘:
·) ∏ˆÛÈÓÔÊÈÏ›· ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜ >1.500/mm3
ÁÈ· ÂÚÈÛÛfiÙÂÚÔ ·fi 6 Ì‹Ó˜. ‚) ªË ·Ó‡ÚÂÛË ¿Ï-
ÏÔ˘ ·ÈÙÈÔÏÔÁÈÎÔ‡ ·Ú¿ÁÔÓÙ· ˈÛÈÓÔÊÈÏ›·˜. Á)
⁄·ÚÍË Û˘ÌÙˆÌ¿ÙˆÓ Î·È ÛËÌ›ˆÓ ÛÔ‚·Ú‹˜ ‰˘-
ÛÏÂÈÙÔ˘ÚÁ›·˜ ‰È·ÊfiÚˆÓ ÔÚÁ¿ÓˆÓ (Ó¢ÌfiÓˆÓ, ÎÂ-
ÓÙÚÈÎÔ‡ Î·È ÂÚÈÊÂÚÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜,
ηډȿ˜, ÔÊı·ÏÌÒÓ, ‰¤ÚÌ·ÙÔ˜) (6).
∆¤ÏÔ˜, Ë ‰È¿ÁÓˆÛË Ù˘ ÔÈÎÔÁÂÓÔ‡˜ ˈÛÈÓÔÊÈÏ›·˜
Ù›ıÂÙ·È Î·ÙfiÈÓ ·ÔÎÏÂÈÛÌÔ‡ ¿ÏÏˆÓ ·ı‹ÛÂˆÓ Î·È
ÂÊfiÛÔÓ ˘¿Ú¯ÂÈ ÛÙÔ ¿ÌÂÛÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÂÚÈ‚¿ÏÏÔÓ
¿ÏÏÔ ¿ÙÔÌÔ Ì ·Û˘Ìو̷ÙÈ΋ ˈÛÈÓÔÊÈÏ›· (10).
√ ·ÛıÂÓ‹˜ Ì·˜ ÏËÚÔ‡Û fiÏ· Ù· ‰È·ÁÓˆÛÙÈο
ÎÚÈÙ‹ÚÈ· Ù˘ ˈÛÈÓÔÊÈÏÈ΋˜ ÂÓÙÂÚ›Ùȉ·˜ Î·È Î·Ù¿
Û˘Ó¤ÂÈ· ·˘Ù‹ Ë ‰È¿ÁÓˆÛË ‹Ù·Ó Î·È Ë ÙÂÏÈ΋.
Œ¯ÂÈ ·ÓÙÈÌÂÙˆÈÛÙ› Ì ÂÈÙ˘¯›· ˆ˜ ÙÒÚ· Ì ‰È-
·ÈÙËÙÈο ̤ÙÚ· Î·È ¯ÔÚ‹ÁËÛË Ú‰ÓÈ˙fiÓ˘, ÂÓÒ 7
Ì‹Ó˜ ÌÂÙ¿ ÙË ‰È¿ÁÓˆÛË, Ë ‰fiÛË Û˘ÓÙ‹ÚËÛ˘ ÙÔ˘
ÛÙÂÚÔÂȉԇ˜ Â›Ó·È ÂÏ¿¯ÈÛÙË Î·È ¤¯ÂÈ ·Ú¯›ÛÂÈ Ë ÂÈÙ˘-
¯‹˜ ÛÙ·‰È·Î‹ ÂÈÛ·ÁˆÁ‹ ÙÚÔÊÒÓ ÛÙË ‰È·ÙÚÔÊ‹ ÙÔ˘.
¶ÚÔ‚ÏËÌ·Ù›˙ÂÈ Ë Â›ÌÔÓ· ¯·ÌËÏ‹ ÙÈÌ‹ Ù˘ IgG,
Ë ÔÔ›· ·˘Í¿ÓÂÙ·È ·ÚÁ¿, ÂÓÒ ÔÈ ÙÈ̤˜ ÙˆÓ ˘fiÏÔÈ-
ˆÓ ·ÓÔÛÔÛÊ·ÈÚÈÓÒÓ Â›Ó·È Ê˘ÛÈÔÏÔÁÈΤ˜. ∆Ô ÙÂÏ¢-
Ù·›Ô, ηıÒ˜ Î·È ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÙÔ ·È‰› ‰ÂÓ ¤¯ÂÈ ·-
ÚÔ˘ÛÈ¿ÛÂÈ ÏÔÈÌÒÍÂȘ, οÓÂÈ Èı·Ó‹ ÙËÓ ·ÚÔ‰È΋
˘ÔÁ·ÌÌ·ÛÊ·ÈÚÈÓ·ÈÌ›· Ù˘ ‚ÚÂÊÈ΋˜ ËÏÈΛ·˜.
∆Ô ·È‰› ı· ·ӢԂÏËı› Û ÂÓ‰ÔÛÎÔÈÎfi
¤ÏÂÁ¯Ô ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂÏÂÁ¯ı› Î·È ÈÛÙÔÏÔÁÈο Ë
·ÓÙ·fiÎÚÈÛË ÛÙËÓ ·ÁˆÁ‹.
™˘ÌÂÚ·ÛÌ·ÙÈο, ÛÙ· ·È‰È¿ Î·È È‰È·›ÙÂÚ· ÛÙ·
‚Ú¤ÊË, ÔÈ ÂÂÌ‚·ÙÈΤ˜ ÂÍÂÙ¿ÛÂȘ, fiˆ˜ Ë ÂÓ‰ÔÛÎfi-
ËÛË ÙÔ˘ ÂÙÈÎÔ‡, Á›ÓÔÓÙ·È Ì ÊÂȉÒ. £· Ú¤ÂÈ
Ó· ·ÔÊ·Û›˙ÂÙ·È fï˜, ÚÔÎÂÈ̤ÓÔ˘ Ó· ‰È·ÈÛÙˆı›
72 Ã. ∫Ô˘ÙÛ·˘Ù›ÎË Î·È Û˘Ó.
Paediatriki 2008;71:68-73
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·72
Ë ËˆÛÈÓÔÊÈÏÈ΋ ‰È‹ıËÛË ÙÔ˘ °∂™ ÛÙȘ ÂÚÈÙÒÛÂȘÂΛӘ Ô˘ ˘¿Ú¯ÂÈ Û˘Ìو̷ÙÔÏÔÁ›· ·fi ÙÔ Â-ÙÈÎfi Ô˘ ÔÈ Û˘Ó‹ıÂȘ ÎÏÈÓÈΤ˜ ÔÓÙfiÙËÙ˜ (°√¶,·ÏÏÂÚÁ›· ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰Ô˜, ÙÚÔÊÈ΋ ·ÏÏÂÚÁ›·) ηÈË ·ÓÙ›ÛÙÔÈ¯Ë ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘˜ ‰ÂÓ ÂÚÌËÓ‡ԢÓ·ÚÎÒ˜ (¶›Ó·Î·˜ 1).
¢ÂÓ Ú¤ÂÈ Ó· ÏËÛÌÔÓÂ›Ù·È fiÙÈ Ë ÛÔ‚·ÚÔ‡ ‚·ı-ÌÔ‡ ÂÚÈÊÂÚÈ΋ ˈÛÈÓÔÊÈÏ›· Ô˘ ηÙ¢ı‡ÓÂÈ ÛÙˉȿÁÓˆÛË ÌÔÚ› Ó· ·Ô˘ÛÈ¿˙ÂÈ ÛÙÔ 20% ÙˆÓ ÂÚÈ-ÙÒÛˆÓ, ÙÔ˘Ï¿¯ÈÛÙÔÓ (4).
¶Èı·ÓÒ˜, ÛÙÔ Ì¤ÏÏÔÓ Ó· ÌÂÏÂÙËı› ÏËÚ¤ÛÙÂÚ·Ë Û¿ÓÈ· ·˘Ù‹ ÔÓÙfiÙËÙ·, Ó· ηٷÁÚ·Ê› Ë ·ÎÚÈ‚‹˜Û˘¯ÓfiÙËÙ¿ Ù˘ Î·È Ó· Á›ÓÔ˘Ó Î·Ù·ÓÔËÙÔ› ÔÈ ·ÈÙÈÔ·-ıÔÁÂÓÂÙÈÎÔ› Ì˯·ÓÈÛÌÔ› Ù˘, ÚÔÎÂÈ̤ÓÔ˘ Ó· ·ÓÙÈ-ÌÂÙˆÈÛÙ› Ì ÂÈÙ˘¯›·.
µÈ‚ÏÈÔÁÚ·Ê›·
1. Klein NC, Hargrove RL, Sleisenger MH, Jeffries GH.Eosinophilic gastroenteritis. Medicine (Baltimore) 1970;49:299-319.
2. Khan S, Orenstein SR. Eosinophilic gastroenteritis: epi-demiology, diagnosis and management. Paediatr Drugs2002;4:563-570.
3. Kelly KJ. Eosinophilic gastroenteritis. J Pediatr Gastroen-terol Nutr 2000;30 Suppl:S28-35.
4. Liacouras CA. Eosinophilic esophagitis in children andadults. J Pediatr Gastroenterol Nutr 2003;37 Suppl 1:S23-28.
5. Quack I, Sellin L, Buchner NJ, Theegarten D, Rump LC,Henning BF. Eosinophilic gastroenteritis in a young girl--long term remission under Montelucast. BMC Gastroen-terol 2005;5:24.
6. Boxer LA. Eosinophils: diseases associated with eosinophil-ia. In: Behrman RE, Kliegman RM, Jenson HB, editors. Nelson Textbook of Pediatrics. 17th ed. Saunders; 2004. p. 709-710.
7. Brigden ML. A practical workup for eosinophilia. You caninvestigate the most likely causes right in your office. Post-grad Med 1999;105:193-194, 199-202, 207-210.
8. Bischoff SC. Mucosal allergy: role of mast cells andeosinophil granulocytes in the gut. Baillieres Clin Gas-troenterol 1996;10:443-459.
9. Gotlib J, Cools J, Malone JM 3rd, Schrier SL, Gilliland DG,Coutré SE. The FIP1L1-PDGFRalpha fusion tyrosine ki-nase in hypereosinophilic syndrome and chroniceosinophilic leukemia: implications for diagnosis, classifi-cation, and management. Blood 2004;103:2879-2891.
10. Curnutte JT. Disorder of granulocyte function and granu-lopoiesis. In: Nathan DG, Oski FA, editors. Hematology ofinfancy and childhood. 4th ed. Philadelphia: WB SaundersCo; 1993. p. 953-957.
11. Daikh BE, Ryan CK, Schwartz RH. Montelukast reducesperipheral blood eosinophilia but not tissue eosinophiliaor symptoms in a patient with eosinophilic gastroenteritisand esophageal stricture. Ann Allergy Asthma Immunol2003;90:23-27.
12. Siahanidou T, Mandyla H, Salavoura K, Dimitriadis D,Van-Vliet C, Anagnostakis D. Eosinophilic gastroenteritisin a neonate. Paediatriki 2000;63:534-537.
73µÚ¤ÊÔ˜ Ì ˈÛÈÓÔÊÈÏÈ΋ ÂÓÙÂÚ›Ùȉ·
¶·È‰È·ÙÚÈ΋ 2008;71:68-73
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·73
ƒ·‚‰ÔÌ˘fiÏ˘ÛË ÌÂÙ¿ ·fi Ïԛ̈ÍË ·fi influenza ∞
O. ºÈÏ›Ô˘, M. ¢ÔÏÈ·Ó›ÙË, K. ¢ÈÁ·Ï¿ÎË-£¤ÌÂÏË, M. ∑‹‚·-¶ÂÙÚÔÔ‡ÏÔ˘, ™. ¶··‰¿ÎÔ˘-§·ÁÔÁÈ¿ÓÓË
¶ÂÚ›ÏË„Ë: ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ·ÁÔÚÈÔ‡ 9 ¯ÚÔÓÒÓ Ì ڷ‚‰ÔÌ˘fiÏ˘ÛË. √ ·ÛıÂÓ‹˜ ÚÔÛ‹Ïı Ïfi-Áˆ ·‰˘Ó·Ì›·˜ ‚¿‰ÈÛ˘ Î·È ¿ÏÁÔ˘˜ ÛÙȘ Á·ÛÙÚÔÎÓË̛˜ ·fi ̂ ÚÒÓ, ÂÓÒ ·fi ÂÓıË̤ÚÔ˘ ·ÚÔ˘Û›·˙Â Û˘-ÌÙÒÌ·Ù· ÈÔÁÂÓÔ‡˜ Û˘Ó‰ÚÔÌ‹˜ ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡. ∞fi ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô ‰È·ÈÛÙÒ-ıËΠfiÙÈ Ô Èfi˜ Ù˘ Áڛ˘ Ù‡Ô˘ A ‹Ù·Ó Ô ÏÔÈÌ҉˘ ·ÈÙÈÔÏÔÁÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ Ô˘ ÚÔοÏÂÛ ÙËÓ ÂÌÊ¿-ÓÈÛË ÙÔ˘ ÎÏÈÓÈÎÔÂÚÁ·ÛÙËÚÈ·ÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ Ù˘ Ú·‚‰ÔÌ˘fiÏ˘Û˘. ¶ÚfiÎÂÈÙ·È ÁÈ· Û¿ÓÈ· ÂÈÏÔ΋ Ù˘Ïԛ̈͢ ·fi influenza A, ·ÊÔ‡ ÌfiÓÔ ÛÔÚ·‰ÈΤ˜ ÂÚÈÙÒÛÂȘ ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ̤¯ÚÈ Û‹ÌÂÚ· ÛÙË ‰ÈÂ-ıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›· ÁÈ· ·È‰È¿. √ ·ÛıÂÓ‹˜ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÓÔÛËÏ›·˜ ÙÔ˘ ‰ÂÓ ·ÚÔ˘Û›·Û ÂÈÏÔ-Τ˜ Î·È ·ÓÙ·ÔÎÚ›ıËΠÈηÓÔÔÈËÙÈο ÛÙËÓ Î·Ù¿ÏÏËÏË ˘ÔÛÙËÚÈÎÙÈ΋ ·ÁˆÁ‹. §fiÁˆ Ù˘ ¿Ù˘Ë˜ ÎÏÈÓÈ΋˜ÂÈÎfiÓ·˜, ··ÈÙÂ›Ù·È ˘„ËÏÔ‡ ‚·ıÌÔ‡ ˘Ô„›· ÁÈ· Ó· ÙÂı› Ë ‰È¿ÁÓˆÛË.
§¤ÍÂȘ ÎÏÂȉȿ: ƒ·‚‰ÔÌ˘fiÏ˘ÛË, Ì˘·ÏÁ›Â˜, influenza A.
Rhabdomyolysis following influenza A infection
√. Filippou, ª. Dolianiti, ∫. Digalaki-Themeli, ª. Ziva-Petropoulou, S. Papadakou-Lagogianni
Abstract: The case of a 9 year-old boy with rhabdomyolysis is described. The patient presented muscularweakness and myalgia of the calves following an upper respiratory tract infection of 5 days duration. Thelaboratory findings showed that influenza A was the viral agent responsible for the development ofrhabdomyolysis. This is a remarkably rare complication of influenza A infection, since only occasional caseshave been reported. This patient had a good response to supportive therapy and an uneventful recovery.A high index of suspicion is required in order to make this diagnosis, because of the subtle clinicalpresentation.
Key words: Rhabdomyolysis, myalgia, influenza A.
74 ∂¡¢π∞º∂ƒ√À™∞ ¶∂ƒπ¶∆ø™∏ CASE REPORT
ªÈÎÚÔ‚ÈÔÏÔÁÈÎfi ∆Ì‹Ì·,¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋, °ÂÓÈÎfi ¡ÔÛÔÎÔÌ›ԓ∞ÛÎÏËÈÂ›Ô µÔ‡Ï·˜”
AÏÏËÏÔÁÚ·Ê›·:
ŸÏÁ· ºÈÏ›Ô˘[email protected]¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋,°ÂÓÈÎfi ¡ÔÛÔÎÔÌ›ԓ∞ÛÎÏËÈÂ›Ô µÔ‡Ï·˜”
MicrobiologicalDepartment, PaediatricClinic, “Asklipieio Voulas”General Hospital
Correspondence:
Olga [email protected] Clinic,“Asklipieio Voulas” GeneralHospital
Paediatriki 2008;71:74-78
™˘ÓÙÔÌÔÁڷʛ˜
IFA Immunofluorescence Assay
DAF Direct Assay Fluorescence
£.™. £ÂÚÌÔÎÚ·Û›· ™ÒÌ·ÙÔ˜
∞.¶. ∞ÚÙËÚȷ΋ ¶›ÂÛË
∂ÈÛ·ÁˆÁ‹
∏ Ïԛ̈ÍË ·fi ÙÔÓ Èfi Ù˘ Áڛ˘ (Ù‡ÔÈ ∞,
µ Î·È C) ·ÊÔÚ¿ fiϘ ÙȘ ËÏÈÎȷΤ˜ ÔÌ¿‰Â˜ ηÈ
ÂΉËÏÒÓÂÙ·È Î˘Ú›ˆ˜ ˆ˜ ·Ó·Ó¢ÛÙÈ΋ ÓfiÛÔ˜
ÙÔ˘˜ „˘¯ÚÔ‡˜ Ì‹Ó˜ ÙÔ˘ ¤ÙÔ˘˜. ∞fi ÙÔ˘˜ ÙÚÂȘ
Ù‡Ô˘˜, ÔÈ ∞ Î·È µ Â›Ó·È ÔÈ Î˘Ú›ˆ˜ ·ıÔÁfiÓÔÈ,
ÂÓÒ Ô C ·ÔÙÂÏ› ÛÔÚ·‰ÈÎfi ·›ÙÈÔ ÏÔÈÌÒ͈Ó
ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡. √ Èfi˜ ÌÔÚ› Ó·
ÂÓÙÔ›˙ÂÙ·È ÛÙÔ ·ÓÒÙÂÚÔ ‹ ηÙÒÙÂÚÔ ·Ó·Ó¢-
ÛÙÈÎfi ÚÔηÏÒÓÙ·˜ Â̇ÚÂÙË ÓfiÛÔ ÙˆÓ ·ÓÒ-
ÙÂÚˆÓ ·ÂÚ·ÁˆÁÒÓ, Ï·Ú˘ÁÁ›Ùȉ·, ÙÚ·¯ÂÈÔ‚ÚÔÁ-
¯›Ùȉ·, ‚ÚÔÁ¯ÈÔÏ›Ùȉ· ‹ Ó¢ÌÔÓ›·. ∏ Ïԛ̈ÍË
·fi ÈÓÊÏÔ˘¤ÓÙ˙· ÚÔηÏ› ÔÈÎÈÏ›· ÎÏÈÓÈÎÒÓ
ÂΉËÏÒÛÂˆÓ Ì ÛËÌ·ÓÙÈ΋ ÓÔÛËÚfiÙËÙ· ÛÙ·
·È‰È¿, ÂÓÒ ÔÈ Û˘¯ÓfiÙÂÚ˜ ÂÈÏÔΤ˜ Ô˘ ÂÚÈ-
ÁÚ¿ÊÔÓÙ·È Â›Ó·È Ë ÔÍÂÈ¿ ̤ÛË ˆÙ›Ùȉ· Î·È Ë ‚·-
ÎÙËÚȷ΋ Ó¢ÌÔÓ›·. øÛÙfiÛÔ, ¤¯Ô˘Ó ·Ó·ÊÂÚ-
ı› Î·È ÏÈÁfiÙÂÚÔ Û˘¯Ó¤˜, fiˆ˜ Ë Ì˘Ôηډ›Ùȉ·,Ë ÌËÓÈÁÁÔÂÁÎÂÊ·Ï›Ùȉ·, ÙÔ Û‡Ó‰ÚÔÌÔ Reye, ËÌ˘ÔÛ›Ùȉ· Î·È Ë Ú·‚‰ÔÌ˘fiÏ˘ÛË.
¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ÂÓfi˜ ·ÁÔÚÈÔ‡Ô˘ ÂΉ‹ÏˆÛ ڷ‚‰ÔÌ˘fiÏ˘ÛË ÛÙËÓ ÔÚ›·Ïԛ̈͢ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ ·fi influenza A.∞ÎfiÌË, Á›ÓÂÙ·È ·Ó·ÛÎfiËÛË Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜Î·È ·Ó·Ê¤ÚÔÓÙ·È ÔÈ Û‡Á¯ÚÔÓ˜ ·fi„ÂȘ ·Ó·ÊÔ-ÚÈο Ì ÙËÓ ·ÈÙÈÔ·ıÔÁ¤ÓÂÈ·, ÙËÓ ÎÏÈÓÈ΋ ÚÔ-‚ÔÏ‹ Î·È ÙËÓ ·ÓÙÈÌÂÙÒÈÛ‹ Ù˘.
¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘
∞ÁfiÚÈ ËÏÈΛ·˜ 9 ¯ÚÔÓÒÓ ÂÈÛ‹¯ıË ÛÙËÓ ÎÏÈÓÈ-΋ Ì·˜ Ì ˘ÚÂÙfi ¤ˆ˜ 39ÆC ÌÂ Û˘ÓÔ‰fi Ê·Ú˘Á-Á·ÏÁ›· Î·È ÚÈÓÈ΋ ηٷÚÚÔ‹ ·fi ÂÓıË̤ÚÔ˘Î·È ¿ÏÁÔ˜ ÛÙȘ Á·ÛÙÚÔÎÓË̛˜ ·fi 48ÒÚÔ˘, Ô˘ÂȉÂÈÓÒıËΠÌÂÙ¿ ·fi ¯·ÌËÏ‹˜ ¤ÓÙ·Û˘ ¿ÛÎË-ÛË. ∆Ô ·ÙÔÌÈÎfi Î·È ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ·Ó·-ʤÚÔÓÙ·È ÂχıÂÚ·. √ ·ÛıÂÓ‹˜ ‹Ù·Ó Û ηϋ ÁÂ-ÓÈ΋ ηٿÛÙ·ÛË Î·È ·fi ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ΋ Âͤ-Ù·ÛË Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÚԤ΢„·Ó Ù· ·ÎfiÏÔ˘-ı·: ıÂÚÌÔÎÚ·Û›·: 37,6ÆC, ∞.¶.: 85/46 mmHg,ÛʇÍÂȘ: 90/min, ·ÚÈıÌfi˜ ·Ó·ÓÔÒÓ: 23/min,
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·74
·Ú›ÛıÌÈ· ÂÓÙfiÓˆ˜ ÂͤڢıÚ· Î·È Ú›Ó· Û˘ÌÊÔÚË̤-
ÓË. ∞fi ÙËÓ ·ÎÚfi·ÛË ÙÔ˘ ıÒڷη ‰È·ÈÛÙÒıËηÓ
·¯Â›˜ ˘ÁÚÔ› ÚfiÁ¯ÔÈ ‰È¿Û·ÚÙÔÈ Î·È ÛÙ· ‰‡Ô Ó¢-
ÌÔÓÈο ‰›·, ÂÓÒ Î·Ù¿ ÙËÓ ÂͤٷÛË Ù˘ ÎÔÈÏ›·˜ ÙÔ
‹·Ú ‹Ù·Ó „ËÏ·ÊËÙfi ÂÚ›Ô˘ 3 cm, ¯ˆÚ›˜ ¢·ÈÛıË-
Û›·, Ì ÔÌ·Ïfi ¯Â›ÏÔ˜ Î·È Ì·Ï·Î‹ Û‡ÛÙ·ÛË Î·È ‰ÂÓ
‹Ù·Ó „ËÏ·ÊËÙfi˜ Ô ÛÏ‹Ó·˜.
√ ·ÛıÂÓ‹˜ ·ÚÔ˘Û›·˙ ·‰˘Ó·Ì›· ‚¿‰ÈÛ˘, ¢·È-
ÛıËÛ›· ηٿ ÙËÓ „ËÏ¿ÊËÛË ÛÙȘ Á·ÛÙÚÔÎÓË̛˜ ¿Ì-
ʈ Î·È ÌÂȈ̤ÓÔ Ì˘˚Îfi ÙfiÓÔ ÛÙ· οو ¿ÎÚ·. ∆· ÙÂ-
ÓfiÓÙÈ· ·ÓÙ·Ó·ÎÏ·ÛÙÈο Î·È Ë ·ÈÛıËÙÈÎfiÙËÙ· (ÂÈÔ-
Ï‹˜ Î·È ÂÓ Ùˆ ‚¿ıÂÈ) ÂϤÁ¯ıËÎ·Ó Ê˘ÛÈÔÏÔÁÈο. ∞fi
Ù· ˘fiÏÔÈ· Û˘ÛÙ‹Ì·Ù· ‰ÂÓ ‚Ú¤ıËÎ·Ó ·ıÔÏÔÁÈο
Â˘Ú‹Ì·Ù·.
√ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ÂÈÛfi‰Ô˘ ¤‰ÂÈÍÂ: ÏÂ˘Î¿
·ÈÌÔÛÊ·›ÚÈ·: 1.800/mm3, (ÔÏ˘ÌÔÚÊÔ‡ÚËÓ·: 37%
·fiÏ˘ÙÔ˜ ·ÚÈıÌfi˜: 666, ÏÂÌÊÔ·ÙÙ·Ú·: 48%, ÌÔÓÔ-
·ÙÙ·Ú·: 8%, ˈÛÈÓfiÊÈÏ·: 2%), Hb: 11,8 g/dl, Ht:
38,6%, ·ÈÌÔÂÙ¿ÏÈ·: 173.000/mm3, ∆∫∂: 9 mm/1Ë
ÒÚ·, CRP<3,13 mg/dl, SGOT: 203 U/L, SGPT: 61
U/L, LDH: 942 U/L, ÔÏÈο Ï¢ÎÒÌ·Ù·: 7 g/dl, ÏÂ˘Îˆ-
Ì·Ù›ÓË: 4 g/dl, ÔÏÈ΋/¿ÌÂÛË ¯ÔÏÂÚ˘ıÚ›ÓË: 0,3/0,1
mg/dl, ÁGT: 9 U/L, ALP: 200 U/L, CPK: 4.767 U/L
(º∆: 15-105 U/L ÁÈ· ÙËÓ ËÏÈΛ· ÙÔ˘), CPK-MB: 2
U/L <5% Ù˘ ÔÏÈ΋˜ CPK, Glu: 98 mg/dl, Ô˘Ú›·: 23
mg/dl, ÎÚ·ÙÈÓ›ÓË: 0,6 mg/dl, Na+: 137 mEq/L, K+: 3,8
mEq/L, Ca++: 8,5 mg/dl, P: 4,7 mg/dl, ÁÂÓÈ΋ Ô‡ÚˆÓ:
ÎÊ. ∏ ·/· ıÒڷη ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋ Î·È Ë ‰ÂÚÌÔ·-
ÓÙ›‰Ú·ÛË ªantoux ·ÚÓËÙÈ΋. ™ÙÔÓ ·ÛıÂÓ‹ Ù¤ıËΠË
‰È¿ÁÓˆÛË Ù˘ Ú·‚‰ÔÌ˘fiÏ˘Û˘, ÌÂ Û˘ÓÔ‰¿ Â˘Ú‹Ì·-
Ù·, Ï¢ÎÔÂÓ›· Î·È Ô˘‰ÂÙÂÚÔÂÓ›·, Û ¤‰·ÊÔ˜ Èı·-
Ó‹˜ ÈÔÁÂÓÔ‡˜ Ïԛ̈͢, Î·È Ô ¤ÏÂÁ¯Ô˜ Û˘ÌÏËÚÒıË-
Π̠·Ï‰ÔÏ¿ÛË ÔÚÔ‡: 7 U/L (º∆: 1,2-8,8 U/L ÁÈ· ÙËÓ
ËÏÈΛ· ÙÔ˘), Ì˘ÔÛÊ·ÈÚ›ÓË ÔÚÔ‡: 54 Ìg/L (º∆: 0-70
Ìg/L), Ì˘ÔÛÊ·ÈÚ›ÓË Ô‡ÚˆÓ: 154 Ìg/L (º∆: 0 Ìg/L),
Ô˘ÚÈÎfi Ô͇: 7 mg/dl, ·¤ÚÈ· ·›Ì·ÙÔ˜: ÎÊ, PT: 11 sec,
APTT: 31 sec, INR: 1, ÈÓˆ‰ÔÁfiÓÔ: 2,75 mg/dl. EÏ‹-
ÊıËÛ·Ó Î·ÏÏȤÚÁÂȘ ·›Ì·ÙÔ˜, ÔÈ Ôԛ˜ ‹Ù·Ó ÛÙ›-
Ú˜, Î·È ÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÁÈ· ·Ó‡ÚÂÛË ·ÓÙÈÛˆ-
Ì¿ÙˆÓ ¤Ó·ÓÙÈ ÙˆÓ ÈÒÓ influenza A-B, parainfluenza 1-
2-3, EBV, CMV, adenovirus, coxsackie, echo fiˆ˜
›Û˘ Î·È ÁÈ· mycoplasma.
∞fi ÙÔÓ ÈÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô ‰È·ÈÛÙÒıËÎ·Ó ·ÓÙÈÁfi-
Ó· ÁÈ· influenza A ıÂÙÈο ÛÙÔ ÚÈÓÔÊ·Ú˘ÁÁÈÎfi ›¯ÚÈ-
ÛÌ·, Ù· ÔÔ›· ·Ó·˙ËÙ‹ıËÎ·Ó Ì ÙË Ì¤ıÔ‰Ô DAF, ηÈ
·ÓÙÈÛÒÌ·Ù· Ù¿Í˘ IgM ıÂÙÈο Û ٛÙÏÔ 1/160 ¤Ó·ÓÙÈ
ÙÔ˘ ÈÔ‡ Ù˘ influenza A Ô˘ ·ÓȯÓ‡ÙËÎ·Ó ÙËÓ 3Ë Ì¤-
Ú· ÓfiÛÔ˘. ªÂÙ¿ ·fi ‰‡Ô ‚‰ÔÌ¿‰Â˜ (17Ë Ì¤Ú· Ófi-
ÛÔ˘), ·ÓȯÓ‡ÙËÎ·Ó ·ÓÙÈÛÒÌ·Ù· Ù¿Í˘ IgG ıÂÙÈο ÛÂ
Ù›ÙÏÔ 1/160 ¤Ó·ÓÙÈ ÙÔ˘ ›‰ÈÔ˘ ÈÔ‡ (ÔÚÔÌÂÙ·ÛÙÚÔÊ‹)
Ì ÙË Ì¤ıÔ‰Ô πFA. √ ·ÓÙ›ÛÙÔȯԘ ¤ÏÂÁ¯Ô˜ ÁÈ·
influenza B ‹Ù·Ó ·ÚÓËÙÈÎfi˜.
√ ·ÛıÂÓ‹˜ Ù¤ıËΠ۠·˘ÍË̤ÓË ÂÓ˘‰¿ÙˆÛË
(¤Ï·‚ ˘ÁÚ¿ 1,5 ÊÔÚ¿ ÙȘ Ê˘ÛÈÔÏÔÁÈΤ˜ ÁÈ· ÙËÓ ËÏÈ-Λ· ÙÔ˘ ·Ó¿ÁΘ) Î·È ̄ ÔÚ‹ÁËÛË ÂÓ‰ÔÊϤ‚È·˜ ÊÔ˘ÚÔ-ÛÂÌ›‰Ë˜ (‰fiÛË = 1 mg/kg/24ˆÚÔ) › ÙÚÈË̤ÚÔ˘. °È-ÓfiÙ·Ó Î·Ù·ÁÚ·Ê‹ ÙˆÓ ˙ˆÙÈÎÒÓ ÛËÌ›ˆÓ (·Ó¿ 1 ÒÚ·ÙÔ 1Ô 24ˆÚÔ ÓÔÛËÏ›·˜ Î·È ·Ó¿ 4 ÒÚ˜ Ù· ÂfiÌÂÓ·24ˆÚ·), Ù˘ ˆÚÈ·›·˜ ‰ÈÔ‡ÚËÛ˘ Î·È ÙÔ˘ ÈÛÔ˙˘Á›Ô˘ÚÔÛÏ·Ì‚·ÓÔ̤ӈÓ-·Ô‚·ÏÏÔÌ¤ÓˆÓ ˘ÁÚÒÓ. ¶Ú·Á-Ì·ÙÔÔÈÔ‡ÓÙ·Ó Î·ıËÌÂÚÈÓfi˜ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ-¯Ô˜ ÌÂ: ÁÂÓÈ΋ ·›Ì·ÙÔ˜, ·¤ÚÈ· ·›Ì·ÙÔ˜, Ô˘Ú›·, ÎÚ·-ÙÈÓ›ÓË, Ì˘ÔÛÊ·ÈÚ›ÓË ·›Ì·ÙÔ˜ Î·È Ô‡ÚˆÓ, ·Ï‰ÔÏ¿ÛË,CPK, LDH, SGOT, SGPT, Ô˘ÚÈÎfi Ô͇, Na+, K+, Ca++,P Î·È ÁÂÓÈ΋ Ô‡ÚˆÓ (¶›Ó·Î·˜ 1). ∆Ô ·È‰› ·Ú¤ÌÂÈÓÂηٷÎÂÎÏÈ̤ÓÔ Î·È Û ·ÔÌfiÓˆÛË.
√ ·ÛıÂÓ‹˜ ‹Ù·Ó ·‡ÚÂÙÔ˜ Î·È Û ηϋ ÁÂÓÈ΋ηٿÛÙ·ÛË Î·ıfiÏË ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÓı‹ÌÂÚ˘ ÓÔ-ÛËÏ›·˜ ÙÔ˘. ¶·ÚÔ˘Û›·Û ÚÔԉ¢ÙÈ΋ ‚ÂÏÙ›ˆÛËÙ˘ Ì˘˚΋˜ ÈÛ¯‡Ô˜ Î·È ‡ÊÂÛË ÙÔ˘ ¿ÏÁÔ˘˜ Ì ϋÚË˘Ô¯ÒÚËÛË Ì¤¯ÚÈ ÙËÓ ¤ÍÔ‰Ô. ¢ÂÓ ÂÌÊ¿ÓÈÛ ‰È·Ù·-Ú·¯‹ Ù˘ ÔÍÂÔ‚·ÛÈ΋˜ ÈÛÔÚÚÔ›·˜ Î·È Ù˘ ÓÂÊÚÈ΋˜ÏÂÈÙÔ˘ÚÁ›·˜, ÂÓÒ ·Ú·ÙËÚ‹ıËΠÚÔԉ¢ÙÈ΋ ·Ô-ηٿÛÙ·ÛË ÛÙÔ Ê˘ÛÈÔÏÔÁÈÎfi fiÏˆÓ ÙˆÓ ·ıÔÏÔÁÈÎÒÓÂÚÁ·ÛÙËÚÈ·ÎÒÓ Â˘ÚËÌ¿ÙˆÓ.
™˘˙‹ÙËÛË
∏ Ú·‚‰ÔÌ˘fiÏ˘ÛË ·ÔÙÂÏ› ¤Ó· Û¯ÂÙÈο Û¿ÓÈÔÓfiÛËÌ· ÛÙ· ·È‰È¿ Î·È ÔÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ó·ÊÔÚ¤˜Ô˘ ˘¿Ú¯Ô˘Ó Â›Ó·È ÂÚÈÔÚÈṲ̂Ó˜. ¶ÚfiÎÂÈÙ·È ÁÈ·¤Ó· ÎÏÈÓÈÎÔÂÚÁ·ÛÙËÚÈ·Îfi Û‡Ó‰ÚÔÌÔ Ô˘ ÂΉËÏÒÓÂ-Ù·È ÌÂÙ¿ ·fi ηٷÛÙÚÔÊ‹ ÙˆÓ ÁÚ·Ì̈ÙÒÓ Ì˘ÒÓ Î·È·ÂÏ¢ı¤ÚˆÛË ÛÙËÓ Î˘ÎÏÔÊÔÚ›· ÙÔÍÈÎÒÓ Î˘ÙÙ·ÚÈ-ÎÒÓ ÚÔ˚fiÓÙˆÓ. ∆Ô ÎÂÓÙÚÈÎfi ÁÂÁÔÓfi˜ ÛÙËÓ ·ıÔÁ¤-ÓÂÈ· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Â›Ó·È Ë ·‡ÍËÛË Ù˘ Û˘ÁΤÓÙÚˆ-Û˘ ÙÔ˘ ÂÓ‰Ô΢ÙÙ¿ÚÈÔ˘ Ca++, Ë ÔÔ›· ÔÊ›ÏÂÙ·È ÛÂÙÚ·˘Ì·ÙÈÛÌfi Ù˘ ÌÂÌ‚Ú¿Ó˘ ÙÔ˘ Ì˘˚ÎÔ‡ ΢ÙÙ¿ÚÔ˘,‹/Î·È Û ÂÍ¿ÓÙÏËÛË ÙˆÓ ÂÓ‰Ô΢ÙÙ¿ÚÈˆÓ ·ÔıÂÌ¿ÙˆÓ∞∆ƒ. √ ηٷÚÚ¿ÎÙ˘ ÙˆÓ ÁÂÁÔÓfiÙˆÓ Ô˘ ·ÎÔÏÔ˘-ıÔ‡Ó ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·Ú·ÁˆÁ‹ ÚˆÙÂÔÏ˘-ÙÈÎÒÓ ÂÓ˙‡ÌˆÓ Î·È ÂÏ¢ı¤ÚˆÓ ÚÈ˙ÒÓ, Ô˘ ÚÔ¿ÁÔ˘ÓÙË Û˘Ó¯È˙fiÌÂÓË Î·Ù·ÛÙÚÔÊ‹ ÙˆÓ Ì˘ÈÎÒÓ Î˘ÙÙ¿ÚˆÓ.
∆· ·›ÙÈ· Ù˘ Ú·‚‰ÔÌ˘fiÏ˘Û˘ ‰È·ÎÚ›ÓÔÓÙ·È ·‰Ú¿ÛÂ Û˘ÁÁÂÓ‹ Î·È Â›ÎÙËÙ· (¶›Ó·Î·˜ 2) (1-3). ∞fi Ù·
75ƒ·‚‰ÔÌ˘fiÏ˘ÛË ÌÂÙ¿ ·fi influenza ∞
¶·È‰È·ÙÚÈ΋ 2008;71:74-78
¶›Ó·Î·˜ 1. ∂ÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· ·ÛıÂÓÔ‡˜
24ˆÚÔ ÓfiÛÔ˘ 1Ô 2Ô 3Ô 5Ô 8Ô
§Â˘Î¿ ·ÈÌÔÛÊ·›ÚÈ·/ÌL 1.800 1.800 2.700 4.050 5.550¶ÔÏ˘ÌÔÚÊÔ‡ÚËÓ· 37% 18% 34% 47% 37%
(666) (288) (618) (1.900) (2.035)CPK (U/L) 4.767 2.247 1.085 275 100SGOT (U/L) 203 187 98 70 40SGPT (U/L) 61 70 74 65 35LDH (U/L) 942 333 323 290ª˘ÔÛÊ·ÈÚ›ÓË Ô‡ÚˆÓ 154 60 7,8(Ìg/L)
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·75
Û˘ÁÁÂÓ‹ ·›ÙÈ· Ù· ÛËÌ·ÓÙÈÎfiÙÂÚ· Â›Ó·È Ù· ÌÂÙ·‚ÔÏÈ-
ο ÓÔÛ‹Ì·Ù· Î·È Ë Î·ÎÔ‹ı˘ ˘ÂÚıÂÚÌ›·. ∞fi Ù·
›ÎÙËÙ·, ÙË ÛÔ˘‰·ÈfiÙÂÚË ı¤ÛË ÛÙËÓ ·È‰È΋ ËÏÈ-
Λ· η٤¯Ô˘Ó ÔÈ ÏÔÈÌÒÍÂȘ Î·È ·ÎÔÏÔ˘ıÔ‡Ó Î·Ù·-
ÛÙ¿ÛÂȘ ·˘ÍË̤Ó˘ Ì˘˚΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Î·È Ì˘˚-
΋˜ ηٷÛÙÚÔÊ‹˜, Ù· ÂÁη‡Ì·Ù·, ÌÂÙ·‚ÔÏÈΤ˜ ηÈ
ËÏÂÎÙÚÔÏ˘ÙÈΤ˜ ‰È·Ù·Ú·¯¤˜, Ë ¯Ú‹ÛË ÙÔÍÈÎÒÓ Ô˘-
ÛÈÒÓ Î·È Ê·ÚÌ¿ÎˆÓ Î·È ÔÈ ÊÏÂÁÌÔÓÒ‰ÂȘ Ì˘Ô¿ıÂÈ-
˜. ∞Ó·ÊÔÚÈο Ì ÙÔ˘˜ ÏÔÈÌÒ‰ÂȘ ·Ú¿ÁÔÓÙ˜, ¤Ó·
Ï‹ıÔ˜ ÈÔÁÂÓÒÓ, ÌÈÎÚÔ‚È·ÎÒÓ Î·È Ì˘ÎËÙÈ·ÛÈÎÒÓ
·Ú·ÁfiÓÙˆÓ ÌÔÚÔ‡Ó Ó· ÏÂÈÙÔ˘ÚÁ‹ÛÔ˘Ó ˆ˜ ·ÈÙÈÔ-
ÏÔÁÈÎfi ˘fiÛÙڈ̷, Ì ÙȘ ÈÔÁÂÓ›˜ ÏÔÈÌÒÍÂȘ Ó·
·ÔÙÂÏÔ‡Ó ÙÔ Û˘¯ÓfiÙÂÚÔ ·›ÙÈÔ (¶›Ó·Î·˜ 2)
(1,2,4,5,8). ™ÙË ÌÂÁ·Ï‡ÙÂÚË ·Ó·‰ÚÔÌÈ΋ ÌÂϤÙË Ô˘
¤¯ÂÈ ‰ËÌÔÛÈ¢Ù› ̤¯ÚÈ Û‹ÌÂÚ·, ‰È·ÈÛÙÒıËΠfiÙÈ
˘¿Ú¯ÂÈ ‰ÈÎfiÚ˘ÊË Î·Ù·ÓÔÌ‹ ÙˆÓ ·ÈÙ›ˆÓ Ú·‚‰ÔÌ˘fi-
Ï˘Û˘ ÛÙËÓ ·È‰È΋ ËÏÈΛ· (3). ∂ȉÈÎfiÙÂÚ·, ÔÈ ÈÔ›
·ÔÙÂÏÔ‡Ó ÙÔ ÚˆÙ·Ú¯ÈÎfi ·›ÙÈÔ ÛÙȘ ËÏÈ˘ 0-9
¯ÚÔÓÒÓ, ÂÓÒ Û ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿ Ù· ÙÚ·‡Ì·Ù· ηÈ
Ë ̄ Ú‹ÛË ÙÔÍÈÎÒÓ Ô˘ÛÈÒÓ Â›Ó·È Ù· Û˘ÓËı¤ÛÙÂÚ· ·›ÙÈ·.
∆· ‰Â‰Ô̤ӷ Ô˘ ˘¿Ú¯Ô˘Ó Û¯ÂÙÈο Ì ÙË Û˘-
¯ÓfiÙËÙ· ÂΉ‹ÏˆÛ˘ Ú·‚‰ÔÌ˘fiÏ˘Û˘ ÛÙËÓ ÔÚ›·
Ïԛ̈͢ ·fi ÙÔÓ Èfi Ù˘ Áڛ˘ ÛÙ· ·È‰È¿ Â›Ó·È Â-
ÚÈÔÚÈṲ̂ӷ. ∞ӷʤÚÂÙ·È fiÙÈ ÙÔ 42% ÙˆÓ ÈÔÁÂÓÒÓ ·È-
Ù›ˆÓ Ú·‚‰ÔÌ˘fiÏ˘Û˘ Û ÂÓ‹ÏÈΘ ÔÊ›ÏÂÙ·È ÛÙÔÓ Èfi
Ù˘ Áڛ˘, ÂÓÒ Ë Û˘ÌÌÂÙÔ¯‹ ÙÔ˘ ÛÙËÓ ·È‰È΋ ËÏÈ-
Λ· ·ÔÙÂÏ› ÙÔÓ ·ÈÙÈÔÏÔÁÈÎfi ·Ú¿ÁÔÓÙ· ÌfiÓÔ ÛÙÔ
8% (2,3). ™Â ÂÚÁ·Û›· ÙˆÓ Agyeman Î·È Û˘Ó., Ô˘
·ÊÔÚÔ‡Û 311 ·È‰È¿ ÌÂ Ì˘ÔÛ›Ùȉ· ·fi ÙÔÓ Èfi Ù˘
Áڛ˘, ‰È·ÈÛÙÒıËΠfiÙÈ ÌfiÏȘ ÙÔ 3% ÂΉ‹ÏˆÛÂ
Ú·‚‰ÔÌ˘fiÏ˘ÛË (6). º·›ÓÂÙ·È, ÏÔÈfiÓ, fiÙÈ ÛÙ· ·È‰È¿
Ë ÂÌÊ¿ÓÈÛË Ú·‚‰ÔÌ˘fiÏ˘Û˘ ÛÙ· Ï·›ÛÈ· ÁÚÈÒ‰Ô˘˜
Û˘Ó‰ÚÔÌ‹˜ Â›Ó·È Û·ÓÈfiÙÂÚË Û˘ÁÎÚÈÙÈο Ì ÙÔ˘˜
ÂÓ‹ÏÈΘ, ÂÓÒ ÛÙËÓ ÎÏÈÓÈ΋ ÔÚ›· Ù˘ ÓfiÛÔ˘ Û˘Ì-
‚¿ÏÏÂÈ Î·È Ë Ê‡ÛË ÙˆÓ Î˘ÎÏÔÊÔÚÔ‡ÓÙˆÓ ÛÙÂϯÒÓ
ÙÔ˘ ÈÔ‡ ηٿ ÙË ‰È¿ÚÎÂÈ· ÌÈ·˜ ÂȉËÌ›·˜. √ Ù‡Ô˜ ∞
ÙÔ˘ ÈÔ‡ ÚÔηÏ› Û˘¯ÓfiÙÂÚ· Ú·‚‰ÔÌ˘fiÏ˘ÛË, ÂÓÒ Ô
Ù‡Ô˜ µ Ì˘ÔÛ›Ùȉ· (6,7).
∏ Ú·‚‰ÔÌ˘fiÏ˘ÛË ÂÌÊ·Ó›˙ÂÙ·È Û˘Ó‹ıˆ˜ Û ·È-
‰È¿ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ Î·È ÌÔÚ› Ó· ÂΉËψı› ÌÂ
ÙËÓ ¤Ó·ÚÍË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Ù˘ Áڛ˘, ÛÙËÓ Ô-
Ú›· Ù˘ ‹ ·ÎfiÌË Î·È ÌÂÙ¿ ÙËÓ ·Ô‰ÚÔÌ‹ Ù˘ (8).
™ÙËÓ ÂÚ›ÙˆÛË Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È, Ô ·ÛıÂÓ‹˜ Ófi-
ÛËÛ ÛÙË Ì¤ÛË ÙÔ˘ ¯ÂÈÌÒÓ·, ÂÔ¯‹ Ô˘ ‹‰Ë ›¯Â ·Ú-
¯›ÛÂÈ Ë ÂȉËÌÈ΋ ¤Í·ÚÛË Ù˘ ÓfiÛÔ˘ Î·È ·ÚÔ˘Û›·ÛÂ
Ì˘·ÏÁ›Â˜ ÙËÓ ÙÚ›ÙË Ë̤ڷ ÂÌÊ¿ÓÈÛ˘ Ù˘ ÁÚÈÒ‰Ô˘˜
Û˘Ó‰ÚÔÌ‹˜. ¶ÚÔÛ‚¿ÏÏÔÓÙ·È Ôχ Û˘¯Ó¿ ÔÈ Á·ÛÙÚÔ-
ÎÓ‹ÌÈÔÈ Ì‡Â˜ (70%) Î·È ·ÎÔÏÔ˘ıÔ‡Ó ÔÈ Ì‡Â˜ Ù˘
ˆÌÈ΋˜ ˙ÒÓ˘ Î·È ÙˆÓ ¿Óˆ ¿ÎÚˆÓ (20%) Î·È ÔÈ
ÔÛÊ˘˚ÎÔ› (5%) (6).
∂ÎÙfi˜ ·fi ÙÔÓ Èfi Ù˘ Áڛ˘ Ô˘ ·ÔÙÂÏ› ÙÔ Û˘-
¯ÓfiÙÂÚÔ ·›ÙÈÔ ÌÂÙ·ÏÔÈÌÒ‰Ô˘˜ Ú·‚‰ÔÌ˘fiÏ˘Û˘ ÛÙ·
·È‰È¿, ˘¿Ú¯ÂÈ ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· ÛÔÚ·‰È΋ ηٷ-
ÁÚ·Ê‹ ÂÚÈÛÙ·ÙÈÎÒÓ Ú·‚‰ÔÌ˘fiÏ˘Û˘ Î·È ·fi ¿ÏÏ·
ÏÔÈÌÒ‰Ë ·›ÙÈ· (¶›Ó·Î·˜ 2). ™˘¯ÓfiÙÂÚ· ·Ó·Ê¤ÚÔÓÙ·È
Ô Èfi˜ Ù˘ ·Ú·Áڛ˘, Ô Coxsackie B, Ô VZV, Ô HIV,
o EBV, Ô Èfi˜ ROTA Î·È ÙÔ Ì˘ÎfiÏ·ÛÌ·.
∞ÓÂÍ¿ÚÙËÙ· ·fi ÙÔ ·›ÙÈÔ Ô˘ ÙËÓ ÚÔοÏÂÛÂ, Ë
Ú·‚‰ÔÌ˘fiÏ˘ÛË ÌÔÚ› Ó· ÂΉËψı› ÎÏÈÓÈο ›ÙÂ
Ì ÙËÓ “ÎÏ·ÛÈ΋ ÙÚÈ¿‰·” Û˘ÌÙˆÌ¿ÙˆÓ (Ì˘·ÏÁ›Â˜,
Ì˘˚΋ ·‰˘Ó·Ì›·, ίڈṲ̂ӷ Ô‡Ú·), Ô˘ fï˜ Ë
Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ‹˜ Ù˘ Â›Ó·È Ôχ ÌÈÎÚ‹ (ÌfiÏȘ
0,5%), ›Ù Ì ¿Ù˘Ë Î·È ·Ì‚Ï˯ڋ Û˘Ìو̷ÙÔ-
ÏÔÁ›·. ∂ȉÈÎfiÙÂÚ·, Ë ÓfiÛÔ˜ ÌÔÚ› Ó· ÚÔ‚¿ÏÏÂÈ
ÙfiÛÔ Ì ÙÔÈο Û˘ÌÙÒÌ·Ù· Î·È ÛËÌ›·, fiˆ˜ Ì˘-
˚Τ˜ Û˘Û¿ÛÂȘ, ÌÂȈ̤ӷ ‹ ηٷÚÁË̤ӷ ÙÂÓfiÓÙÈ·
·ÓÙ·Ó·ÎÏ·ÛÙÈο, fiÛÔ Î·È ÌÂ Û˘ÛÙËÌ·ÙÈο, fiˆ˜
˘ÚÂÙfi, ηÎÔ˘¯›·, Ó·˘Ù›·, Â̤ÙÔ˘˜. √È ÌÂϤÙ˜
ÂȂ‚·ÈÒÓÔ˘Ó fiÙÈ Ì˘·ÏÁ›Â˜ ÂÌÊ·Ó›˙ÂÈ ÂÚ›Ô˘ ÙÔ
45% ÙˆÓ ·ÛıÂÓÒÓ, Ì˘˚΋ ·‰˘Ó·Ì›· ÙÔ 38%, ÂÓÒ
˘¤Ú¯ÚÔ· Ô‡Ú· ‰È·ÈÛÙÒÓÔÓÙ·È ÌfiÏȘ ÛÙÔ 3,6%
(3). ∂Ô̤ӈ˜, ··ÈÙÂ›Ù·È ˘„ËÏÔ‡ ‚·ıÌÔ‡ ˘Ô„›·
ÁÈ· Ó· ÙÂı› Ë ‰È¿ÁÓˆÛË.
∂ÚÁ·ÛÙËÚȷο, Ë Ú·‚‰ÔÌ˘fiÏ˘ÛË ÔÚ›˙ÂÙ·È ˆ˜ ·‡-
ÍËÛË Ù˘ ÙÈÌ‹˜ Ù˘ CPK (ÎÚ·ÙÈÓÔʈÛÊÔÎÈÓ¿ÛË)
¿Óˆ ·fi ÙÔ 5Ï¿ÛÈÔ Ù˘ Ê˘ÛÈÔÏÔÁÈ΋˜ ÁÈ· ÙËÓ ËÏÈ-
Λ· ÙÔ˘ ·ÛıÂÓÔ‡˜ ÙÈÌ‹˜, ÂÓÒ ÙÔ ÎÏ¿ÛÌ· CPK-MB
Ú¤ÂÈ Ó· Â›Ó·È <5% Ù˘ ÔÏÈ΋˜ ÙÈÌ‹˜. ∞˘ÍË̤Ó˜,
76 O. ºÈÏ›Ô˘ Î·È Û˘Ó.
Paediatriki 2008;71:74-78
¶›Ó·Î·˜ 2. ∞›ÙÈ· Ú·‚‰ÔÌ˘fiÏ˘Û˘
™˘ÁÁÂÓ‹ªÂÙ·‚ÔÏÈο ÓÔÛ‹Ì·Ù·: ·. ∞Ó¿ÚÎÂȘ ÁÏ˘ÎÔÏ˘ÙÈÎÒÓ ÂÓ˙‡ÌˆÓ‚. ¢È·Ù·Ú·¯¤˜ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÏÈȉ›ˆÓª˘˚Τ˜ ‰˘ÛÙÚÔʛ˜ÕÏÏ· (ηÎÔ‹ı˘ ̆ ÂÚıÂÚÌ›·)
∂›ÎÙËÙ·1. §ÔÈÌÒÍÂȘ
πÔ›: Influenza A-B, Parainfluenza 1-2-3, HIV, Coxsackie,ECHO, EBV, CMV, VZV, HSVµ·ÎÙËÚ›‰È·: Staphylococcus, Streptococcus, E.coli, Shigella,Salmonella spp, Mycoplasma, Legionella, Brucellaª‡ÎËÙ˜: Candida, Aspergillus
2. ∞˘ÍË̤ÓË Ì˘˚΋ ‰Ú·ÛÙËÚÈfiÙËÙ· (¿ıÏËÛË, statusepilepticus, Î.¿.)
3. ∞˘ÍË̤ÓË Ì˘˚΋ ηٷÛÙÚÔÊ‹ (ÂÁη‡Ì·Ù·, crushsyndrome)
4. ªÂÙ·‚ÔÏÈΤ˜ Î·È ËÏÂÎÙÚÔÏ˘ÙÈΤ˜ ‰È·Ù·Ú·¯¤˜5. ™·Î¯·Ú҉˘ ‰È·‚‹Ù˘, ÌË ÎÂÙˆÙÈÎfi ̆ ÂÚˆÛ̈ÙÈÎfi ÎÒÌ·,
Ì˘ÍÔ›‰ËÌ·, ̆ ÔÓ·ÙÚÈ·ÈÌ›·, ̆ ÔηÏÈ·ÈÌ›·,˘ÔʈÛÊ·Ù·ÈÌ›·
6. º¿Ú̷η, ÙÔÍÈΤ˜ Î·È Ó·ÚΈÙÈΤ˜ Ô˘Û›Â˜ (·ÓÙÈÈÛÙ·ÌÈÓÈο,·Ó·ÈÛıËÙÈο, ·ÏÎÔfiÏ, ‰‹ÁÌ·Ù· ÊȉÈÒÓ, ËÚˆ›ÓË,·ÌÊÂٷ̛Ә)
7. πÛ¯·ÈÌ›· Ì˘˚ÎÒÓ Î˘ÙÙ¿ÚˆÓ (ıÚÔÌ‚ÒÛÂȘ,‰Ú·ÓÔ΢ÙÙ·ÚÈ΋ ÎÚ›ÛË)
8. ºÏÂÁÌÔÓÒ‰ÂȘ Ì˘Ô¿ıÂȘ (ÔÏ˘ÔÌ˘ÔÛ›Ùȉ·,‰ÂÚÌ·ÙÔÌ˘ÔÛ›Ùȉ·)
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·76
·ÏÏ¿ ηÙÒÙÂÚ˜ ·fi ÙÔ ÚÔ·Ó·ÊÂÚı¤Ó fiÚÈÔ, ÙÈ̤˜,
Ì ›‰È· ‹ ·ÚfiÌÔÈ· ÎÏÈÓÈ΋ ÂÈÎfiÓ·, Û˘ÓÈÛÙÔ‡Ó Ì˘Ô-
Û›Ùȉ· (3,14). ∏ CPK ·ÔÙÂÏ› ¤Ó· ÁÚ‹ÁÔÚÔ Î·È
·ÍÈfiÈÛÙÔ ‰Â›ÎÙË ÙfiÛÔ ÁÈ· ÙË ‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘
(¢·ÈÛıËÛ›· 100%), fiÛÔ Î·È ÁÈ· ÙËÓ ·Ú·ÎÔÏÔ‡ıË-
ÛË Ù˘ ÔÚ›·˜ Ù˘. ™˘Ó‹ıˆ˜, ÊÙ¿ÓÂÈ ÙË Ì¤ÁÈÛÙË ÙÈ-
Ì‹ Ù˘ ÛÙÔ ÚÒÙÔ 24ˆÚÔ ·fi ÙËÓ ¤Ó·ÚÍË ÙˆÓ Û˘-
ÌÙˆÌ¿ÙˆÓ Î·È ÌÂÈÒÓÂÙ·È Î·ıËÌÂÚÈÓ¿ ηٿ 40%
ÂÚ›Ô˘. ¢È·Ù‹ÚËÛË ‹ ·‡ÍËÛË ÙˆÓ ÂȤ‰ˆÓ Ù˘
ÛÙÔÓ ÔÚfi ‰ËÏÒÓÂÈ Û˘Ó¯È˙fiÌÂÓË Ì˘˚΋ ηٷÛÙÚÔÊ‹
‹ Û‡Ó‰ÚÔÌÔ ‰È·ÌÂÚÈÛÌ·ÙÔÔ›ËÛ˘ (ÌÂÈÒÓÂÙ·È Ë ›Â-
ÛË ¿Ú‰Â˘Û˘ ÙˆÓ Ì˘ÈÎÒÓ ÈÓÒÓ, Ì ·ÔÙ¤ÏÂÛÌ· ˘Ô-
Í·ÈÌ›· Î·È ÈÛÙÈ΋ Ó¤ÎÚˆÛË). ∆· Û˘ÓÔ‰¿ Û˘ÌÙÒÌ·Ù·
Ô˘ ‰È·ÈÛÙÒÓÔÓÙ·È ·ÊÔÚÔ‡Ó: Ì˘ÔÛÊ·ÈÚÈÓÔ˘Ú›· ηÈ
Ì˘ÔÛÊ·ÈÚÈÓ·ÈÌ›·, ·‡ÍËÛË Ù˘ ·Ï‰ÔÏ¿Û˘, Ù˘ LDH
Î·È ÙˆÓ ÙÚ·ÓÛ·ÌÈÓ·ÛÒÓ, ˘ÂÚÔ˘Úȯ·ÈÌ›·, ˘ÂÚηÏÈ-
·ÈÌ›· Î·È ·‡ÍËÛË Ù˘ Ô˘Ú›·˜ Î·È Ù˘ ÎÚ·ÙÈÓ›Ó˘.
∞ÎfiÌË, ÌÔÚ› Ó· ÚÔÎÏËıÔ‡Ó ˘·Û‚ÂÛÙÈ·ÈÌ›· ηÈ
˘ÂÚʈÛÊ·Ù·ÈÌ›·, ÔÈ Ôԛ˜ ‰ÂÓ ¯Ú‹˙Ô˘Ó ‰ÈfiÚıˆ-
Û˘, ·Ú¿ ÌfiÓÔ Â› Û˘Ìو̿وÓ. ™ÙË ÁÂÓÈ΋ Ô‡-
ÚˆÓ ·ÓȯÓ‡ÂÙ·È ·ÈÌÔÛÊ·ÈÚ›ÓË ¯ˆÚ›˜ ÂÚ˘ıÚ¿ ·ÈÌÔ-
ÛÊ·›ÚÈ·, ÂÓÒ ÔÏϤ˜ ÊÔÚ¤˜ ÛÙÔ ›˙ËÌ· ÙˆÓ Ô‡ÚˆÓ
ÂÚȤ¯ÔÓÙ·È ÔÈ ¯·Ú·ÎÙËÚÈÛÙÈÎÔ› ηʤ Ï·ÛÒ‰ÂȘ
·ÏÈÓ‰ÚÔÈ (muddy brown casts).
∏ ÔÚ›· Ù˘ ÌÂÙ·ÏÔÈÌÒ‰Ô˘˜ Ú·‚‰ÔÌ˘fiÏ˘Û˘
Â›Ó·È Û˘Ó‹ıˆ˜ ηÏÔ‹ı˘, Â¿Ó ·ÓÙÈÌÂÙˆÈÛÙ› ¤ÁηÈ-
Ú· Î·È ÂÈıÂÙÈο, Î·È Ë ·ÔηٿÛÙ·ÛË ÛÙÔ Ê˘ÛÈÔÏÔ-
ÁÈÎfi ÌÔÚ› Ó· Á›ÓÂÈ ÂÓÙfi˜ ÔÏ›ÁˆÓ ËÌÂÚÒÓ, fiˆ˜ Û˘-
Ó¤‚Ë ÛÙÔÓ ·ÛıÂÓ‹ Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È, ·ÏÏ¿ ÌÔÚ›
Ó· ÎÚ·Ù‹ÛÂÈ Î·È ¤ˆ˜ 6 ‚‰ÔÌ¿‰Â˜ (8).
™ÙȘ ÂÈÏÔΤ˜ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È Ë ÔÍ›· ÓÂÊÚÈ΋
·Ó¿ÚÎÂÈ·, Ô˘ Â›Ó·È Ë ÛÔ‚·ÚfiÙÂÚË Î·È ÈÔ ÂÈΛÓ-
‰˘ÓË, Ë ˘ÔÔÁηÈÌ›·, Ë ÌÂÙ·‚ÔÏÈ΋ ÔͤˆÛË, ÔÈ ËÏÂ-
ÎÙÚÔηډÈÔÁÚ·ÊÈΤ˜ ·ÏÏÔÈÒÛÂȘ, Ë ‰È¿¯˘ÙË ÂÓ‰·Á-
ÁÂȷ΋ ‹ÍË Î·È ÙÔ Û‡Ó‰ÚÔÌÔ ‰È·ÌÂÚÈÛÌ·ÙÔÔ›ËÛ˘.
∏ Ú·‚‰ÔÌ˘fiÏ˘ÛË Ô˘ ÔÊ›ÏÂÙ·È ÛÙÔÓ Èfi Ù˘ ÁÚ›-
˘ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÂÈϷΛ ·fi ÔÍ›· ÓÂÊÚÈ΋
·Ó¿ÚÎÂÈ·, Û ÔÛÔÛÙfi Ô˘ Î˘Ì·›ÓÂÙ·È ÛÙȘ ‰È¿-
ÊÔÚ˜ ÌÂϤÙ˜ ·fi 2,2% ¤ˆ˜ 80% (6). ŸÌˆ˜, Ë ÂÈ-
ÏÔ΋ ·˘Ù‹ ۯ‰fiÓ ÔÙ¤ ‰ÂÓ ÌÂÙ·›ÙÂÈ Û ¯ÚÔÓÈfi-
ÙËÙ· (11,12). ∏ ‰È·Ù·Ú·¯‹ Ù˘ ÓÂÊÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜
Û˘Ì‚·›ÓÂÈ Î˘Ú›ˆ˜ Û ·ÛıÂÓ›˜ Ô˘ ÛÙËÓ ÔÚ›· Ù˘
Ïԛ̈͢ ÂΉËÏÒÓÔ˘Ó Û‹„Ë ‹ Û‡Ó‰ÚÔÌÔ ¤ÎÙˆÛ˘
ÔÏÏ·ÏÒÓ ÔÚÁ¿ÓˆÓ, ÂÓÒ ‰ÂÓ Ê·›ÓÂÙ·È Ó· ˘¿Ú¯ÂÈ
·Â˘ı›·˜ ÚÔÛ‚ÔÏ‹ ÙÔ˘ ÓÂÊÚÈÎÔ‡ ΢ÙÙ¿ÚÔ˘ ·fi
ÙÔÓ Èfi (11).
∏ ıÂڷ›· Ù˘ Ú·‚‰ÔÌ˘fiÏ˘Û˘, ·ÓÂÍ¿ÚÙËÙ·
·fi ÙËÓ ·ÈÙÈÔÏÔÁ›· Ù˘, ÛÙËÚ›˙ÂÙ·È ÛÙËÓ ÂÈıÂÙÈ΋
ÂÓ˘‰¿ÙˆÛË ˘fi Û˘Ó¯‹ ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ˙ˆÙÈ-
ÎÒÓ ÛËÌ›ˆÓ Î·È ÛÙËÓ ·˘ÍË̤ÓË ‰ÈÔ‡ÚËÛË, Ì ÛÙfi¯Ô
ÙË ‰È·Ù‹ÚËÛË ÈηÓÔÔÈËÙÈ΋˜ ÓÂÊÚÈ΋˜ ÏÂÈÙÔ˘Ú-
Á›·˜. ÃÔÚËÁÔ‡ÓÙ·È ÈÛfiÙÔÓ· ‰È·Ï‡Ì·Ù· ¯ÏˆÚÈÔ‡¯Ô˘
Ó·ÙÚ›Ô˘ Û ÔÛfiÙËÙ· ‰ÈÏ¿ÛÈ· ‹/Î·È ÙÚÈÏ¿ÛÈ· ÙˆÓ
ËÌÂÚ‹ÛÈˆÓ ·Ó·ÁÎÒÓ ÙÔ˘ ·ÛıÂÓÔ‡˜, ÒÛÙ ӷ ÂÈÙ¢-
¯ı› ÈηÓÔÔÈËÙÈ΋ ¤ÎÙ˘ÍË ÙÔ˘ ÂÍˆÎ˘ÙÙ¿ÚÈÔ˘ ¯Ò-
ÚÔ˘. ∞·Ú·›ÙËÙË Â›Ó·È, ›Û˘, Ë Ù·ÎÙÈ΋ (·Ó¿ 2
ÒÚ˜) ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ËÏÂÎÙÚÔÏ˘ÙÒÓ, ÙÔ˘ pH
Î·È ÙˆÓ ‰ÈÙÙ·ÓıÚ·ÎÈÎÒÓ ÙÔ˘ ·›Ì·ÙÔ˜, ηıÒ˜ Î·È ÙÔ˘
pH ÙˆÓ Ô‡ÚˆÓ, fiˆ˜ Î·È Ë ÙÔÔı¤ÙËÛË Ô˘ÚÔηıÂ-
Ù‹Ú·, Ì ÛÙfi¯Ô ÙËÓ Î·Ù·ÁÚ·Ê‹ Ù˘ ˆÚÈ·›·˜ ‰ÈÔ‡ÚË-
Û˘. ™Â Û˘Ó˘¿Ú¯Ô˘Û· ÌÂÙ·‚ÔÏÈ΋ ÔͤˆÛË, ¯ÔÚË-
ÁÔ‡ÓÙ·È Ì ÚÔÛÔ¯‹ i.v. ‰ÈÙÙ·ÓıÚ·ÎÈο, ÂÓÒ ÚÔÙ›-
ÓÂÙ·È Î·È ·ÏηÏÔÔ›ËÛË ÙˆÓ Ô‡ÚˆÓ (ÛÙfi¯Ô˜ pH Ô‡-
ÚˆÓ >6,5), ÂÓÒ Â› ÔÏÈÁÔ˘Ú›·˜, ¯ÔÚËÁÂ›Ù·È ÊÔ˘ÚÔÛÂ-
Ì›‰Ë. ™Â ÂÚ›ÙˆÛË ÂÌÊ¿ÓÈÛ˘ ÔÍ›·˜ ÓÂÊÚÈ΋˜
·Ó¿ÚÎÂÈ·˜ Ô˘ ‰ÂÓ ·ÓÙ·ÔÎÚ›ÓÂÙ·È ÛÙ· ‰ÈÔ˘ÚËÙÈ-
ο, ›ÌÔÓ˘ ˘ÂÚηÏÈ·ÈÌ›·˜ ‹/Î·È ÌÂÙ·‚ÔÏÈ΋˜
ÔͤˆÛ˘, Ó¢ÌÔÓÈÎÔ‡ Ôȉ‹Ì·ÙÔ˜ ‹ Û˘ÌÊÔÚËÙÈ΋˜
ηډȷ΋˜ ·Ó¿ÚÎÂÈ·˜, Ô ·ÛıÂÓ‹˜ ˘Ô‚¿ÏÏÂÙ·È ÛÂ
ıÂڷ›· ÓÂÊÚÈ΋˜ ˘ÔηٿÛÙ·Û˘ Ì ‰È¿ÊÔÚ˜
ÌÂıfi‰Ô˘˜ Â͈ÓÂÊÚÈ΋˜ οı·ÚÛ˘, ·Ó¿ÏÔÁ· Ì ÙËÓ
ËÏÈΛ· Î·È ÙËÓ ÎÏÈÓÈ΋ ÙÔ˘ ÂÈÎfiÓ· (ÂÚÈÙÔÓ·˚΋ ο-
ı·ÚÛË, Û˘Ó¯‹ ·ÈÌԉȋıËÛË, ·ÈÌÔοı·ÚÛË) (9,13).
™˘ÌÂÚ·ÛÌ·ÙÈο, Ë Ú·‚‰ÔÌ˘fiÏ˘ÛË Â›Ó·È ÌÈ·
Û¯ÂÙÈο Û¿ÓÈ· ÂÈÏÔ΋ Ù˘ Ïԛ̈͢ ·fi ÙÔÓ Èfi
Ù˘ Áڛ˘, Ë ÔÔ›· fï˜ ··ÈÙ› ˘„ËÏÔ‡ ‚·ıÌÔ‡
˘Ô„›· ÏfiÁˆ Ù˘ ¿Ù˘Ë˜ ÎÏÈÓÈ΋˜ ÚÔ‚ÔÏ‹˜. ∏ Ófi-
ÛÔ˜ ¤¯ÂÈ Û˘Ó‹ıˆ˜ ηÏÔ‹ıË ÔÚ›· ÛÙ· ·È‰È¿, ·ÏÏ¿
ÌÔÚ› Ó· ÚÔηϤÛÂÈ ÛÔ‚·Ú¤˜ Î·È Û οÔȘ ÂÚÈ-
ÙÒÛÂȘ ı·Ó·ÙËÊfiÚ˜ ÂÈÏÔΤ˜, fiˆ˜ ÔÍ›· ÓÂ-
ÊÚÈ΋ ·Ó¿ÚÎÂÈ· Î·È ‰È¿¯˘ÙË ÂÓ‰·ÁÁÂȷ΋ ‹ÍË.
µÈ‚ÏÈÔÁÚ·Ê›·
1. Poels PJ, Gabreëls FJ. Rhabdomyolysis: a review of the lit-
erature. Clin Neurol Neurosurg 1993;95:175-192.
2. Singh U, Scheld WM. Infectious etiologies of rhabdomyol-
ysis: three case reports and review. Clin Infect Dis
1996;22:642-649.
3. Mannix R, Tan ML, Wright R, Baskin M. Acute pediatric
rhabdomyolysis: causes and rates of renal failure. Pedi-
atrics 2006;118:2119-2125.
4. Watemberg N, Leshner RL, Armstrong BA, Lerman-Sagie
T. Acute pediatric rhabdomyolysis. J Child Neurol
2000;15:222-227.
5. Hue V, Martinot A, Fourier C, Cremer R, Leteurtre S, Le-
clerc F. Acute rhabdomyolysis in the child. Arch Pediatr
1998;5:887-895.
6. Agyeman P, Duppenthaler A, Heininger U, Aebi C. In-
fluenza-associated myositis in children. Infection
2004;32:199-203.
7. Hu JJ, Kao CL, Lee PI, Chen CM, Lee CY, Lu CY, Huang
LM. Clinical features of influenza A and B in children and
association with myositis. J Microbiol Immunol Infect
2004;37:95-98.
8. Mackay MT, Kornberg AJ, Shield LK, Dennett X. Benign
acute childhood myositis: laboratory and clinical features.
Neurology 1999;53:2127-2131.
9. Berger RP, Wadowksy RM. Rhabdomyolysis associated
with infection by Mycoplasma pneumoniae: a case report.
Pediatrics 2000;105:433-436.
77ƒ·‚‰ÔÌ˘fiÏ˘ÛË ÌÂÙ¿ ·fi influenza ∞
¶·È‰È·ÙÚÈ΋ 2008;71:74-78
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·77
10. Watanabe T. Rhabdomyolysis and acute renal failure inchildren. Pediatr Nephrol 2001;16:1072-1075.
11. Watanabe T, Yoshikawa H, Abe Y, Yamazaki S, Uehara Y,Abe T. Renal involvement in children with influenza Avirus infection. Pediatr Nephrol 2003;18:541-544.
12. ∞be M, Higuchi T, Okada K, Kaizu K, Matsumoto K. Clin-ical study of influenza-associated rhabdomyolysis withacute renal failure. Clin Nephrol 2006;66:166-170.
13. Wakabayashi Y, Nakano T, Kikuno T, Ohwada T, Kikawa-da R. Massive rhabdomyolysis associated with influenza Ainfection. Internal Med 1994;33:450-453.
14. Muscal E, de Guzman MM, Wilson R, Shah BR. Rhab-domyolysis. eMedicine [Internet]. 2007 Apr: Webpage:http://www.emedicine.com/ped/topic2003.htm.
78 O. ºÈÏ›Ô˘ Î·È Û˘Ó.
Paediatriki 2008;71:74-78
Dariusz Tulik, 15 ÂÙÒÓ, ¶Ôψӛ·¶·È‰› Ì ÌÂÚÈ΋ fiÚ·ÛË
“∆· Ù˘ÊÏ¿ ·È‰È¿
˙ˆÁÚ·Ê›˙Ô˘Ó”, ÕÓÓ· §·Ô˘Ù¿ÚË-°ÎÚÈÙ˙¿Ï·, ∞ı‹Ó· 2006
Dariusz Tulik, 15 years old, PolandPartially blind child
“Blind children paint”, Anna Laoutari-Gritzala,Athens 2006
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·78
∂ÈÎfiÓ· 2. ª·ÁÓËÙÈ΋ ÊÏ‚ÔÁÚ·Ê›·: ÂÏ·Ùو̤ÓË ¤ˆ˜ ·Ô‡-Û· ÚÔ‹ ÛÙÔ ÌÂÁ·Ï‡ÙÂÚÔ Ì‹ÎÔ˜ ÙÔ˘ ‰ÂÍÈÔ‡ ÂÁηÚÛ›Ô˘ ÎfiÏ-Ô˘ (‚¤ÏË).
79∫§π¡π∫√ ∫√Àπ∑
¶·È‰È·ÙÚÈ΋ 2008;71:79,86
1 ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋2 ªÔÓ¿‰· ∂ÓÙ·ÙÈ΋˜
£Âڷ›·˜ ¶·›‰ˆÓ3 ∂ÚÁ·ÛÙ‹ÚÈÔ π·ÙÚÈ΋˜
∞ÂÈÎfiÓÈÛ˘,¶·ÓÂÈÛÙËÌÈ·Îfi °ÂÓÈÎfi¡ÔÛÔÎÔÌÂ›Ô ∏Ú·ÎÏ›Ԣ
AÏÏËÏÔÁÚ·Ê›·:
∂. °·Ï·Ó¿Î˘[email protected]¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋, ¶·ÓÂÈÛÙËÌÈ·Îfi °ÂÓÈÎfi¡ÔÛÔÎÔÌÂ›Ô ∏Ú·ÎÏ›Ԣ
∞. ™·‚‚›‰Ô˘1, °. ªÚÈ·ÛÔ‡Ï˘2, ª. ƒ·˚Û¿ÎË3, Õ. ª. ™·Ó¿ÎË2, ¡. º˘ÙÚÔÏ¿ÎË2, ∂. °·Ï·Ó¿Î˘1, ª. ∫·ÏÌ·ÓÙ‹1
∞ÁfiÚÈ 7 ÂÙÒÓ ‰È·ÎÔÌ›ÛıËΠÛÙË ªÔÓ¿‰·∂ÓÙ·ÙÈ΋˜ £Âڷ›·˜ Ì ˘ÚÂÙfi, ÎÂÊ·Ï·ÏÁ›·Î·È Â̤ÙÔ˘˜ ·fi 12ÒÚÔ˘. ∫·Ù¿ ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ-΋ ÂͤٷÛË ÂÈÛfi‰Ô˘, ÙÔ ·È‰› ‹Ù·Ó ÏËı·ÚÁÈÎfi,Ì Îϛ̷η °Ï·ÛÎ҂˘ 9/15 Î·È Ì ·˘¯ÂÓÈ΋ ‰˘-Ûη̄›·. √ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ÂÈÛfi‰Ô˘¤‰ÂÈÍ ÏÂ˘Î¿ ·ÈÌÔÛÊ·›ÚÈ· 23.000/Ìl Ì 92% Ô-Ï˘ÌÔÚÊÔ‡ÚËÓ·, ·ÈÌÔÛÊ·ÈÚ›ÓË 13,3 gr/dl, ·ÈÌÔ-ÂÙ¿ÏÈ· 154.000/Ìl, C ·ÓÙȉÚÒÛ· ÚˆÙÂ˚ÓË 18mg/dl, ¯ˆÚ›˜ ËÏÂÎÙÚÔÏ˘ÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ ηȯˆÚ›˜ ‰È·Ù·Ú·¯¤˜ ·fi ÙË ÓÂÊÚÈ΋ Î·È Ë·ÙÈ΋ÏÂÈÙÔ˘ÚÁ›·. ∏ ÔÛÊ˘ÔÓˆÙÈ·›· ·Ú·Î¤ÓÙËÛË ¤‰ÂÈ-Í 900 ·ÙÙ·Ú·/Ìl (51% Ô˘‰ÂÙÂÚfiÊÈÏ· Î·È 15%ÏÂÌÊÔ·ÙÙ·Ú· Î·È Ù· ˘fiÏÔÈ· ‹Ù·Ó ÌÔÓÔ‡ÚË-Ó· ‹ ÌË ·Ó·ÁÓˆÚ›ÛÈÌ·), ÚˆÙ½ÓË 128 mg/dl ηÈÁÏ˘Îfi˙Ë 67 mg/dl. √ ·ÛıÂÓ‹˜ ‰È·ÛˆÏËÓÒıËÎÂ
Î·È Ù¤ıËΠ۠ÂÌÂÈÚÈ΋ ·ÁˆÁ‹ Ì ÎÂÊÙÚÈ·ÍfiÓË,‚·ÓÎÔÌ˘Î›ÓË, ·Î˘ÎÏÔ‚›ÚË Î·È ‰ÂÍ·ÌÂı·˙fiÓË.ŒÁÈÓ ̷ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· Ì ·ÎÔÏÔ˘ı›Â˜ ‰È¿-¯˘Û˘ (∂ÈÎfiÓ˜ 1∞, 1µ, 1°) Î·È Ì ‚¿ÛË Ù· ¢ڋ-Ì·Ù¿ Ù˘ ·ÎÔÏÔ‡ıËÛÂ Î·È Ì·ÁÓËÙÈ΋ ÊÏ‚ÔÁÚ·-Ê›· (∂ÈÎfiÓ· 2).
¶Èı·Ó¤˜ ‰È·ÁÓÒÛÂȘ:
1. ∂ÚËÙÈ΋ ÂÁÎÂÊ·Ï›Ùȉ·2. ∞ÁÁÂÈ›Ùȉ· ·fi Û˘ÛÙËÌ·ÙÈÎfi ÂÚ˘ıËÌ·ÙÒ‰Ë
χÎÔ3. µ·ÎÙËÚȷ΋ ÌËÓÈÁÁ›Ùȉ· Ì ıÚfiÌ‚ˆÛË
ÂÁηÚÛ›Ô˘ ÎfiÏÔ˘4. ªËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋ ÓfiÛÔ˜ Ì ‰È¿¯˘ÙË ÂÓ-
‰Ô·ÁÁÂȷ΋ ‹ÍË5. ∂ÁÎÂÊ·Ï›Ùȉ· ·fi ÚÈΤÙÛÈ·
∂ÈÎfiÓ· 1. ∞. ∞ÎÔÏÔ˘ı›· ‰È¿¯˘Û˘: ÔÏϷϤ˜ ÌÈÎÚ¤˜ Â-ÚÈÔ¯¤˜ Ì ÂÚÈÔÚÈṲ̂ÓË ‰È¿¯˘ÛË (‚¤ÏË) ÛÙËÓ ˘ÔÊÏÔÈÒ‰ËÏ¢΋ Ô˘Û›· ÙˆÓ ‚ÚÂÁÌ·ÙÈÎÒÓ ÏÔ‚ÒÓ. µ. ∞ÎÔÏÔ˘ı›· ADC¯¿ÚÙÔ˘ ÛÙÔ ›‰ÈÔ Â›Â‰Ô: ÔÈ ‚Ï¿‚˜ ·Ô‰›‰Ô˘Ó ¯·ÌËÏ‹˜¤ÓÙ·Û˘ Û‹Ì· (‚¤ÏË), ‡ÚËÌ· ÂÓ‰ÂÈÎÙÈÎfi ÈÛ¯·ÈÌÈÎÒÓ ·ÏÏÔÈ-ÒÛÂˆÓ Û ÔÍ›· Ê¿ÛË. °. ™ÙË Û˘Ì‚·ÙÈ΋ ·ÎÔÏÔ˘ı›· ∆2 ÚÔ-Û·Ó·ÙÔÏÈÛÌÔ‡, ÔÈ ‚Ï¿‚˜ Â›Ó·È ÌfiÏȘ ˘ÔÛËÌ·ÈÓfiÌÂÓ˜.
A B °
∏ ·¿ÓÙËÛË ·ÎÔÏÔ˘ı› ÛÙË ÛÂÏ›‰· 86
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·79
∂ÏÏËÓÈ΋ ·È‰È·ÙÚÈ΋ ¤Ú¢ӷ Û ‰ÈÂıÓ‹ ÂÚÈÔ‰Èο, 2007
∂. °·Ï·Ó¿Î˘
∆Ô 2007, ηٷ¯ˆÚ‹ıËÎ·Ó 483 ÂÚÁ·Û›Â˜ ·fi ÙËÓ ∂ÏÏ¿‰· ÁÈ· ÙÔ ·È‰› Û 284 ‰ÈÂıÓ‹ ÂÚÈÔ‰Èο (·Ó·˙‹-ÙËÛË ÛÙË ‚¿ÛË ISI, 31 ¢ÂÎÂÌ‚Ú›Ô˘ 2007, ϤÍÂȘ-ÎÏÂȉȿ: “child*” ÁÈ· ÙÔ ·ÓÙÈΛÌÂÓÔ Î·È “Greece” ÁÈ· ÙÔΤÓÙÚÔ ÚÔ¤Ï¢Û˘). ∏ ‰ËÌÔÛÈÂ˘Ì¤ÓË ¤Ú¢ӷ Î¿Ï˘Ù fiÏ· Ù· ‰›·, ·fi ÙÔ ÂÚÁ·ÛÙËÚÈ·Îfi ˆ˜ ÙÔ ÎÏÈÓÈ-Îfi Î·È ÙÔ ÎÔÈÓˆÓÈÎfi, Î·È fiϘ ÙȘ ËÏÈ˘, ·fi ÙÔ ÓÂÔÁÓfi Î·È ÙÔ ‚Ú¤ÊÔ˜ ˆ˜ ÙÔ ·È‰› Î·È ÙÔÓ ¤ÊË‚Ô. ∞ÎÔ-ÏÔ˘ıÔ‡Ó, Ôχ ÂÈÁÚ·ÌÌ·ÙÈο, ·ÔÙÂϤÛÌ·Ù· ¢ڇÙÂÚÔ˘ ÂӉȷʤÚÔÓÙÔ˜ Ï›ÁˆÓ ·fi ·˘Ù¤˜ ÙȘ ÂÚÁ·Û›Â˜.
Greek paediatric research in international journals, 2007
E. Galanakis
In 2007, 483 studies from Greece focusing on child health were recorded in 284 international journals(search in the ISI; December 31, 2007; terms “child*” for topic and “Greece” for address). The reportedstudies extended from laboratory to clinical and social fields and from the neonatal age through infancyand childhood to adolescence. A handful of the results of these studies that are of general interest arepresented here in brief.
¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋¶·ÓÂÈÛÙ‹ÌÈÔ ∫Ú‹Ù˘
AÏÏËÏÔÁÚ·Ê›·:
∂ÌÌ·ÓÔ˘‹Ï °·Ï·Ó¿Î˘[email protected]¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘
Department of Paediatrics,University of Crete
Correspondence:
Emmanouil [email protected] of Paediatrics,University of Crete
80 ™À¡∆√ª∞ ¶∞π¢π∞∆ƒπ∫∞ ¡∂∞
Paediatriki 2008;71:80-82
√È ÂÚÁ·˙fiÌÂÓ˜ ÌËÙ¤Ú˜ ıËÏ¿˙Ô˘Ó Â-
ÚÈÛÛfiÙÂÚÔ. ∞fi 3.734 ÌËÙ¤Ú˜ Ô˘ Á¤ÓÓËÛ·Ó
ÙÔ 2000 Î·È ·ÓÙ·ÔÎÚ›ıËÎ·Ó (77%) Û ÂÚˆÙË-
Ì·ÙÔÏfiÁÈÔ 8-12 Ì‹Ó˜ ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi: ÛÙÔ˘˜
ÚÒÙÔ˘˜ 3 Î·È 6 Ì‹Ó˜ ı‹Ï·˙·Ó 52% Î·È 24%
(·ÔÎÏÂÈÛÙÈÎfi˜ ıËÏ·ÛÌfi˜ 37% Î·È 17%, ·ÓÙ›-
ÛÙÔȯ·). ¶ÂÚÈÛÛfiÙÂÚÔ ı‹Ï·Û·Ó ÔÈ ÂÚÁ·˙fiÌÂ-
Ó˜ ÌËÙ¤Ú˜, fiˆ˜ Î·È fiÛ˜ ›¯·Ó Í·Ó·ıËÏ¿-
ÛÂÈ (Bakoula C, et al. Acta Pediatr 2007;96:
510-515).
∏ ¯ÔÚ‹ÁËÛË ÁÏ˘ÎÔÎÔÚÙÈÎÔÂȉÒÓ ÛÙËÓ
¤ÁÎ˘Ô ÂËÚ¿˙ÂÈ ÙËÓ ÂÌ‚Ú˘È΋ ÔÛÙÂÔÁ¤ÓÂÛË
(¯·ÌËÏ¿ ›‰· ÚÔÂÙȉ›Ô˘ ÙÔ˘ ÚÔÎÔÏ-
Ï·ÁfiÓÔ˘ Ù‡Ô˘ π ÛÙÔ ÓÂÔÁÓfi), ˆÛÙfiÛÔ, ·˘Ù‹ Ë
›وÛË ¤¯ÂÈ ÚÔÛˆÚÈÓfi Î·È ·Ó·ÛÙÚ¤„ÈÌÔ ¯·-
Ú·ÎÙ‹Ú· ‹‰Ë ÛÙȘ ÚÒÙ˜ Ë̤Ú˜ ˙ˆ‹˜
(Korakaki E, et al. J Bone Miner Metab
2007;25:172-178).
¶·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÂÁÎÂÊ·ÏÈ΋˜ ·Ú¿-
Ï˘Û˘. 15ÂÙ‹˜ (1989-2003) ÌÂϤÙË fiÏˆÓ ÙˆÓ
ÓÂÔÁÓÒÓ Ì ÓÔÛËÏ›· ÛÙË ª∂¡¡ πˆ·ÓÓ›ÓˆÓ
Î·È ÌÂÙ¤ÂÈÙ· ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË Î·Ù¤ÏËÍÂ
fiÙÈ ÔÈ Î‡ÚÈÔÈ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ‹Û·Ó, ÁÈ·
ÌÂÓ Ù· ÓÂÔÁÓ¿ <34 ‚‰ÔÌ¿‰ˆÓ ËÏÈΛ·˜ ·ËÛ˘
Ë ÂÚÈÎÔÈÏȷ΋ Ï¢ÎÔ̷ϷΛ·, Ë ·Ú·ÙÂٷ̤-
ÓË Ú‹ÍË ÙˆÓ ÂÌ‚Ú˘ÈÎÒÓ ˘Ì¤ÓˆÓ Î·È Ë ·Ú·ÌÔ-
Ó‹ ·ÓÔÈÎÙÔ‡ ·ÚÙËÚÈ·ÎÔ‡ fiÚÔ˘, ÁÈ· ‰Â Ù· ÓÂÔ-
ÁÓ¿ >34 ‚‰ÔÌ¿‰ˆÓ ÙÔ ÌÈÎÚfi ‚¿ÚÔ˜ ÁÈ· ÙËÓ
ËÏÈΛ· ·ËÛ˘, Ë ÌÂÙ·ÊÔÚ¿ ÙÔ˘ ÓÂÔÁÓÔ‡ Î·È Ë
ÛË„·ÈÌ›·-ÌËÓÈÁÁ›Ùȉ· (Drougia A, et al. Early
Hum Dev 2007;83:541-547).
∞ÓÙÔ¯‹ Ô˘ÚÔ·ıÔÁfiÓˆÓ ÛÙ· ·ÓÙÈ‚ÈÔÙÈο
ÚÒÙ˘ ÁÚ·ÌÌ‹˜. ªÂϤÙË ÂÓÙ·ÂÙ›·˜ (2000-
2004) ÙˆÓ Ô˘ÚÔ·ıÔÁfiÓˆÓ Û 262 ·È‰È¿ ÌÂ
ÚÒÙÔ ÂÂÈÛfi‰ÈÔ Ô˘ÚÔÏԛ̈͢ ÛÙËÓ ∫Ú‹ÙË
¤‰ÂÈÍ ·ÓÙÔ¯‹ Û ·ÌÈÎÈÏÏ›ÓË, ÙÚÈÌÂıÔÚ›ÌË-
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·80
81PAEDIATRIC NEWS IN BRIEF
¶·È‰È·ÙÚÈ΋ 2008;71:80-82
ÛÔ˘ÏÊ·ÌÂıÔÍ·˙fiÏË Î·È ÎÂÊ·ÎÏfiÚË Û 61%, 28%,
Î·È 27%, ·ÓÙ›ÛÙÔȯ· (Anatoliotaki M, et al. Scand J
Infect Dis 2007;39:671-675).
ªËÓÈÁÁ›Ùȉ·: Ì·ÎÚÔ¯ÚfiÓȘ Ù¿ÛÂȘ. ∞Ó·ÛÎfiËÛË
2.477 ÎÚÔ˘ÛÌ¿ÙˆÓ ‚·ÎÙËÚȷ΋˜ ÌËÓÈÁÁ›Ùȉ·˜ (32 ¤ÙË,
1974-2005) ÛÙÔ “∞Á›· ™ÔÊ›·”: Ô ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˜
‹Ù·Ó ÛÙ·ıÂÚ¿ ÙÔ ÚÒÙÔ ·›ÙÈÔ ÁÈ· fiϘ ÙȘ ËÏÈ˘, ÌÂ
10ÂÙ‹ ΢ÎÏÈÎfiÙËÙ·. √ ·ÈÌfiÊÈÏÔ˜ ‹Ù·Ó ·Ú¯Èο ‰Â‡ÙÂ-
ÚÔ ·›ÙÈÔ, ·ÏÏ¿ Ë Â›ÙˆÛ‹ ÙÔ˘ ˘ÔÂÍ·Ï·ÛÈ¿ÛÙËÎÂ
ÌÂÙ¿ ÙÔ ÂÌ‚fiÏÈÔ. √ Ó¢ÌÔÓÈfiÎÔÎÎÔ˜ ›¯Â ÌÈ· ÛÙ·ıÂ-
Ú‹ ·ÚÔ˘Û›·. ∏ ÁÂÓÈ΋ ıÓËÙfiÙËÙ· ‹Ù·Ó 3,8%
(Theodoridou MN, et al. BMC Infect Dis 2007;7:101).
™¯‹Ì· ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÁÈ· ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ.
∞fi 348 ·È‰›·ÙÚÔ˘˜ ·fi fiÏË ÙË ¯ÒÚ·, 72% ÚÔÙÈ-
ÌÔ‡Ó Û¯‹Ì· ÌÈ·˜ ÌfiÓÔ ‰fiÛ˘ ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈÎÔ‡
ÂÌ‚ÔÏ›Ô˘ C ÌÂÙ¿ ÙËÓ ËÏÈΛ· ÙˆÓ 12 ÌËÓÒÓ. ∏ Î¿Ï˘-
„Ë Ì ÌÈ· ÙÔ˘Ï¿¯ÈÛÙÔÓ ‰fiÛË Â›Ó·È Û¯Â‰fiÓ 100% ÁÈ·
Ù· ·È‰È¿ ¤ˆ˜ 2 ÂÙÒÓ Î·È 51% ÁÈ· ÙÔ Û‡ÓÔÏÔ ≤15
ÂÙÒÓ. ∏ ΢ÎÏÔÊÔÚ›· (2001) ÙÔ˘ Û˘ÓÂ˙¢Á̤ÓÔ˘ ÂÌ-
‚ÔÏ›Ô˘ Û˘Óԉ‡ıËΠ·fi ‰Ú·Ì·ÙÈ΋ Ì›ˆÛË Ù˘
›وÛ˘ Ù˘ ÔÚÔÔÌ¿‰·˜ C (Kafetzis DA, et al. Clin
Microbiol Infect 2007;13:550-552).
∞ÓÙÔ¯‹ ÙÔ˘ Ó¢ÌÔÓÈÔÎfiÎÎÔ˘. ¶·ÓÂÏÏ‹ÓÈ· ÌÂ-
ϤÙË 780 ÛÙÂϯÒÓ S. pneumoniae ·fi ÙÔ ÚÈÓÔÊ¿-
Ú˘ÁÁ· ·È‰ÈÒÓ ·fi ‚ÚÂÊÔÓËÈ·ÎÔ‡˜ ÛÙ·ıÌÔ‡˜ ÛÙÔ
‰È¿ÛÙËÌ· 2004-6 ¤‰ÂÈÍ ÌË-¢·ÈÛıËÛ›· Û ÂÓÈÎÈÏ-
Ï›ÓË, ÎÂÊÔ˘ÚÔÍ›ÌË, ÎÂÊÙÚÈ·ÍfiÓË, ÂÚ˘ıÚÔÌ˘Î›ÓË, ÙÂ-
Ùڷ΢ÎÏ›ÓË Î·È ÙÚÈÌÂıÔÚ›ÌË-ÛÔ˘ÏÊ·ÌÂıÔÍ·˙fiÏË
ÛÙÔ 35%, 25%, 1%, 34%, 26% Î·È 44%. ∆Ô 7‰‡Ó·ÌÔ
Û˘ÓÂ˙¢Á̤ÓÔ Ó¢ÌÔÓÈÔÎÔÎÎÈÎfi ÂÌ‚fiÏÈÔ ı· Âο-
Ï˘Ù ÙÔ 72% ÙˆÓ ÛÙÂϯÒÓ (Poulakou G, et al. Int J
Antimicrob Agents 2007;30:87-92).
º˘Ì·Ù›ˆÛË: ·ÓÙÔ¯‹ ÛÙ· ·ÓÙÈÊ˘Ì·ÙÈο. ∞fi 77
ÛÙÂϤ¯Ë M. tuberculosis ·fi ÈÛ¿ÚÈıÌ· ·È‰È¿ (42%
ËÏÈΛ·˜ <2 ÂÙÒÓ, 87% ∂ÏÏËÓfiÔ˘Ï·), 1994-2004,
21% ‹Û·Ó ·ÓıÂÎÙÈο Û 1 ÙÔ˘Ï¿¯ÈÛÙÔÓ ·ÓÙÈÊ˘Ì·ÙÈ-
Îfi Î·È 4% ÔÏ˘·ÓıÂÎÙÈο (ÙÔ˘Ï¿¯ÈÛÙÔÓ Û ÈÛÔÓÈ·˙›-
‰Ë Î·È ÚÈÊ·ÌÈΛÓË). ∏ ·ÓÙÔ¯‹ ÛÙË ÛÙÚÂÙÔÌ˘Î›ÓË
‹Ù·Ó ÈÔ Û˘¯Ó‹ ÛÙ· ·È‰È¿ ·Ú¿ ÛÙÔ˘˜ ÂÓ‹ÏÈΘ
(p<0,001). ∆· ÛÙÂϤ¯Ë ·ÔÌÔÓÒıËÎ·Ó Î·Ù¿ 87%
·fi Á·ÛÙÚÈÎfi ˘ÁÚfi (Kanavaki S, et al. Int J Tuberc
Lung Dis 2007;11:424-428).
º˘Ì·Ù›ˆÛË: ‚Ú·¯‡ÙÂÚ· Û¯‹Ì·Ù·. ∂Ó‰ÂηÂÙ‹˜
ÌÂϤÙË (1995-2005) Û 926 ·È‰È¿ Ì ϷÓı¿ÓÔ˘Û·
Ê˘Ì·Ù›ˆÛË Û˘Ó¤ÎÚÈÓ ÙË ¯ÔÚ‹ÁËÛË ÈÛÔÓÈ·˙›‰Ë˜ ›
9 Ì‹Ó˜ Ì ÙÔ Û˘Ó‰˘·ÛÌfi ÈÛÔÓÈ·˙›‰Ë˜ Î·È ÚÈÊ·ÌÈ-
ΛÓ˘ › 3 ‹ 4 Ì‹Ó˜. ∏ Û˘ÌÌfiÚʈÛË ‹Ù·Ó ηχÙÂ-
ÚË ÛÙ· ‚Ú·¯¤· Û¯‹Ì·Ù·. ™ÙËÓ 3ÂÙ‹ ÙÔ˘Ï¿¯ÈÛÙÔÓ ·-
Ú·ÎÔÏÔ‡ıËÛË, ηӤӷ ·È‰› ‰ÂÓ ·Ó¤Ù˘Í ÎÏÈÓÈ΋
ÓfiÛÔ Î·È Ó¤· ·ÎÙÈÓÔÏÔÁÈο Â˘Ú‹Ì·Ù· ÂÓ‰ÂÈÎÙÈο
ÂÓÂÚÁÔ‡ ÓfiÛÔ˘ ‹Ù·Ó Û·ÓÈfiÙÂÚ· ÛÙ· ·È‰È¿ Ì ٷ
‚Ú·¯¤· Û¯‹Ì·Ù· (Spyridis NP, et al. Clin Infect Dis
2007;45:715-722).
°·ÛÙÚÂÓÙÂÚ›Ùȉ· Î·È Èfi˜ ÚfiÙ·. ªÂϤÙË ·fi Ù·
ÓÔÛÔÎÔÌ›· 4 fiÏÂˆÓ Î·È 50 ·È‰È¿ÙÚÔ˘˜ Û fiÏË ÙË
¯ÒÚ·, π·ÓÔ˘¿ÚÈÔ˜-∞Ú›ÏÈÔ˜ 2006: ·fi 706 ·È‰È¿ ÌÂ
ÔÍ›· Á·ÛÙÚÂÓÙÂÚ›Ùȉ·, 29% ›¯·Ó Ïԛ̈ÍË ·fi Èfi
ÚfiÙ·, ÎÈ ·fi ·˘Ù¿ Ù· 72% ›¯·Ó ËÏÈΛ· 6 ÌËÓÒÓ-3
ÂÙÒÓ. √ Èfi˜ ÚfiÙ· Û˘Ó‰˘¿ÛıËΠ̠‚·Ú‡ÙÂÚË ÎÏÈÓÈ΋
ÂÈÎfiÓ· (p<0,01), ÂÚÈÛÛfiÙÂÚ˜ ÂÈÛ·ÁˆÁ¤˜ (p<0,01)
Î·È Ì·ÎÚ‡ÙÂÚÔ ̄ ÚfiÓÔ ÓÔÛËÏ›·˜ (p<0,05) ·fi Ù· ¿Ï-
Ï· ·›ÙÈ· (Kavaliotis I, et al. Eur J Pediatr 2007;Epub
ahead of print).
∏ ‚ÚԢΤÏψÛË ÂÈ̤ÓÂÈ. ∞Ó·‰ÚÔÌÈ΋ 14ÂÙ‹˜
ÌÂϤÙË ·fi ÙË §·ÎˆÓ›· Ì 144 ÎÚÔ‡ÛÌ·Ù· ‚ÚԢΤÏ-
ψÛ˘ (·È‰È¿ Î·È ÂÓ‹ÏÈΘ): ÔÈ Î·ÏÏȤÚÁÂȘ ·›Ì·-
ÙÔ˜ ‹Û·Ó ıÂÙÈΤ˜ ÛÙÔ 82% Î·È Ë ·ÓÙ·fiÎÚÈÛË ÛÙË
ıÂڷ›· (ÛÙÚÂÙÔÌ˘Î›ÓË Î·È ‰Ô͢΢ÎÏ›ÓË) 97%.
√È 4 ˘ÔÙÚÔ¤˜ ·ÊÔÚÔ‡Û·Ó ·ÛıÂÓ›˜ Ô˘ ‰ÂÓ Â›¯·Ó
Û˘ÌÌÔÚʈı› ÛÙËÓ ·ÁˆÁ‹ (Andriopoulos P, et al. Int
J Infect Dis 2007;11:52-57).
°ÂÓÂÙÈ΋ ÙˆÓ Û˘ÁÁÂÓÒÓ ·ÓˆÌ·ÏÈÒÓ ÙÔ˘ Ô˘ÚÔ-
ÔÈËÙÈÎÔ‡. ªÂϤÙË ·fi Ù· πˆ¿ÓÓÈÓ· Ì 275 ·È‰È¿
ÌÂ Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜ Ô˘ÚÔÔÈËÙÈÎÔ‡ ‰ÂÓ ÂÈ‚Â-
‚·›ˆÛÂ Û˘Û¯¤ÙÈÛË ÙÔ˘ ÔÏ˘ÌÔÚÊÈÛÌÔ‡ ∞-1332G
ÛÙÔ ÁÔÓ›‰ÈÔ ÙÔ˘ ˘Ô‰Ô¯¤· Ù‡Ô˘ 2 Ù˘ ·ÁÁÂÈÔÙÂÓÛ›-
Ó˘ ππ ÌÂ Û˘ÁÁÂÓ›˜ Ô˘ÚÔ¿ıÂȘ (Siomou E, et al.
Pediatr Res 2007;62:83-87).
∂›Â‰· ¯·ÏÎÔ‡ Î·È „¢‰·ÚÁ‡ÚÔ˘ Û ˘ÁÈ‹ ·È-
‰È¿. ™Â ÌÈ· ÚÒÙË ÁÈ· ÙËÓ ∂ÏÏ¿‰· ÌÂϤÙË, ÚÔÛ‰ÈÔ-
Ú›ÛıËÎ·Ó ¯·ÏÎfi˜ Î·È „¢‰¿ÚÁ˘ÚÔ˜ ÛÙÔÓ ÔÚfi 105
˘ÁÈÒÓ ·È‰ÈÒÓ ÛÙË £Ú¿ÎË Î·È ‰È·ÈÛÙÒıËÎ·Ó Û˘-
Û¯ÂÙ›ÛÂȘ Ì ËÏÈΛ·, ‡„Ô˜, ‰Â›ÎÙË Ì¿˙·˜ ÛÒÌ·ÙÔ˜
Î·È ‰È·ÈÙËÙÈΤ˜ Û˘Ó‹ıÂȘ (Arvanitidou V, et al. Biol
Trace Elem Res 2007;115:1-12).
¶·¯˘Û·ÚΛ· Î·È ‰È·Ù·Ú·¯¤˜ ‡ÓÔ˘. ªÂϤÙË
·fi ÙË §¿ÚÈÛ· Û ·È‰È¿ Ì ÚÔ¯·ÏËÙfi η٤ÏËÍ fiÙÈ
Ë ·¯˘Û·ÚΛ· ‰ÂÓ ·ÔÙÂÏ› ÚÔÁÓˆÛÙÈÎfi ‰Â›ÎÙË Ù˘
‚·Ú‡ÙËÙ·˜ ÙˆÓ ·ÔÊÚ·ÎÙÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ Ù˘ ·Ó·-
ÓÔ‹˜ ηٿ ÙÔÓ ‡ÓÔ ÛÙ· ÌÈÎÚ¿ ·È‰È¿, ·Ó Î·È ÂÓ‰Â-
¯Ô̤ӈ˜ Ó· ¤¯ÂÈ ÈÔ ÛËÌ·ÓÙÈ΋ Û˘Ì‚ÔÏ‹ ÛÙȘ ‰È·Ù·-
Ú·¯¤˜ Û ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿ (Kaditis AG, et al. Sleep
Breath 2007; [Epub ahead of print]).
¶·¯˘Û·ÚΛ· ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ. ™Â ‰Â›ÁÌ·
6.448 Ì·ıËÙÒÓ ËÏÈΛ·˜ 6-17 ÂÙÒÓ, ·fi fiÏË ÙËÓ
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·81
∂ÏÏ¿‰· (1990-1991), 17% ÙˆÓ ·ÁÔÚÈÒÓ Î·È 18%ÙˆÓ ÎÔÚÈÙÛÈÒÓ ‹Û·Ó ˘¤Ú‚·Ú·, Î·È 3,8% ÙˆÓ·ÁÔÚÈÒÓ Î·È 3,3% ÙˆÓ ÎÔÚÈÙÛÈÒÓ ‹Û·Ó ·¯‡-Û·Úη. ∆· ÔÛÔÛÙ¿ ·˘Ù¿ ‹Ù·Ó ·Ó¿ÏÔÁ· ¿ÏψÓ∂˘Úˆ·˚ÎÒÓ ¯ˆÚÒÓ (Georgiadis G, et al. Eur JClin Nutr 2007;61:1072-1074).
∂Ê˂›· Î·È ¿Á¯Ô˜. ™‡Ìʈӷ Ì fiÛ· ·¿-ÓÙËÛ·Ó 3.373 ŒÏÏËÓ˜ ¤ÊË‚ÔÈ ËÏÈΛ·˜ 18 ÂÙÒÓÎ·È 7.039 ºÈÓÏ·Ó‰Ô› ¤ÊË‚ÔÈ ËÏÈΛ·˜ 15-16ÂÙÒÓ, ÔÈ ¤ÊË‚ÔÈ ÛÙËÓ ∂ÏÏ¿‰· ›¯·Ó ÈÔ Û˘¯Ó¿¿Á¯Ô˜ Î·È Î·Ù¿ıÏÈ„Ë (Kapi A, et al. ActaPaediatr 2007;96:1174-1179).
∂Ê˂›· Î·È ·ÏÎÔfiÏ. ™Â ÌÂϤÙË 1.185 ÂÊ‹-‚ˆÓ ·fi 15 Û¯ÔÏ›· Ù˘ £ÂÛÛ·ÏÔӛ΢, 57%ÙˆÓ ·ÁÔÚÈÒÓ Î·È 48% ÙˆÓ ÎÔÚÈÙÛÈÒÓ ·Ó¤ÊÂÚ·ÓηٷӿψÛË ·ÏÎÔfiÏ, Ì ¤Ó·ÚÍË ÛÙ· 13 ÂÚ›-Ô˘ ¤ÙË. ¶ÂÚÈÛÛfiÙÂÚÔ ¤ÈÓ·Ó ÔÈ ¤ÊË‚ÔÈ Ì ÁÔ-Ó›˜ ¯·ÌËÏÔ‡ ÌÔÚʈÙÈÎÔ‡ ÂȤ‰Ô˘, ¤ÏÏÂÈ„Ëۈ̷ÙÈ΋˜ ¿ÛÎËÛ˘ Î·È Û˘¯Ó‹ ¯Ú‹ÛË Î·Ê¤ ηÈηÓÔ‡. ∏ ¯Ú‹ÛË ·ÏÎÔfiÏ Ê·›ÓÂÙ·È Ó· ÌÂÈÒÓÂ-Ù·È, ̂ ÛÙfiÛÔ, ·Ú·Ì¤ÓÂÈ ·Ó¿ÌÂÛ· ÛÙȘ ̆ „ËÏfiÙÂ-Ú˜ Â˘Úˆ·˚Τ˜ (Arvanitidou M, et al. Am JDrug Alcohol Abuse 2007;33:411-417).
∂Ê˂›· Î·È Î¿ÓÈÛÌ·. ∞fi ·ÓÂÏÏ‹ÓÈԉ›ÁÌ· ÂÊ‹‚ˆÓ ËÏÈΛ·˜ 13-15 ÂÙÒÓ, 32% ›¯·Ó‰ÔÎÈÌ¿ÛÂÈ ÙÛÈÁ¿ÚÔ Î·È 16% οÓÈ˙·Ó ηٿ ÙÔÓ¯ÚfiÓÔ Ù˘ ÌÂϤÙ˘. ŒÓ·˜ ÛÙÔ˘˜ 4 Ì ·Ó·ÌÓËÛÙÈ-Îfi ηӛÛÌ·ÙÔ˜ ¿Ú¯ÈÛ ÚÈÓ ·fi Ù· 10 ¤ÙË. 90%ÙˆÓ ÂÊ‹‚ˆÓ ›¯·Ó ¤ÎıÂÛË Û ηÓfi ÛÙÔ Û›ÙÈÎ·È 95% ·Ó¤ÊÂÚ·Ó fiÙÈ ÌÔÚÔ‡Û·Ó Ó· ·ÁÔÚ¿-ÛÔ˘Ó fiÛ· ÙÛÈÁ¿Ú· ‹ıÂÏ·Ó Ì ‰Èο ÙÔ˘˜ ¯Ú‹Ì·Ù·(Kyrlesi A, et al. BMC Public Health 2007;7:3).
¶·ıËÙÈÎfi οÓÈÛÌ· ÓË›ˆÓ. ∞fi 2.809 ÁÔ-Ó›˜ Ì ·È‰› Û ‚ÚÂÊÔÓËÈ·Îfi ÛÙ·ıÌfi ÛÙË ¢˘-ÙÈ΋ ∫Ú‹ÙË (2004-2005), 52% ÙˆÓ ·Ù¤ÚˆÓ ηÈ36% ÙˆÓ ÌËÙ¤ÚˆÓ Î¿ÓÈ˙·Ó, ÛÙÔ 63% ÙˆÓ ÔÈÎÔ-ÁÂÓÂÈÒÓ Î¿ÓÈ˙ ÙÔ˘Ï¿¯ÈÛÙÔÓ Ô ¤Ó·˜ Î·È ÛÙÔ26% οÓÈ˙·Ó Î·È ÔÈ ‰˘Ô ÁÔÓ›˜ (Vardavas CI, etal. BMC Public Health 2007;7:112).
ÕÛıÌ·: Ì·ÎÚÔ¯ÚfiÓȘ Ù¿ÛÂȘ. √ ÂÈÔÏ·-ÛÌfi˜ ÙÔ˘ ¿ÛıÌ·ÙÔ˜/‚ÚÔÁ¯fiÛ·ÛÌÔ˘ Û 11.221
·È‰È¿ ËÏÈΛ·˜ 8-10 ÂÙÒÓ ÛÙËÓ ¶¿ÙÚ· ÌÂÏÂÙ‹-ıËΠ̠ÛÙ·ıÂÚ‹ ÌÂıÔ‰ÔÏÔÁ›· ÛÙË ‰È·‰ÚÔÌ‹ÌÈ·˜ 25ÂÙ›·˜ (1978, 1991, 1998 Î·È 2003) ηȂڤıËΠ1,5%, 4,6%, 6% Î·È 6,9%, ·ÓÙ›ÛÙÔȯ·,Ì ÛÙ·ıÂÚ‹ ‰ËÏ·‰‹ ·‡ÍËÛË, ·Ó Î·È Ì ٿÛËÂȤ‰ˆÛ˘ ÛÙ· ÙÂÏÂ˘Ù·›· ¤ÙË (Anthra-copoulos MB, et al. Arch Dis Child 2007; 92:209-212).
¢ˆÚ¿ ÔÚÁ¿ÓˆÓ ·fi ·È‰È¿. ∞Ó·ÛÎfiËÛËÙˆÓ ‚ÈˆÌ¿ÙˆÓ 22 ÁÔÓ¤ˆÓ 14 ·È‰ÈÒÓ Ì ÂÁÎÂ-Ê·ÏÈÎfi ı¿Ó·ÙÔ Û 2 ·È‰È·ÙÚÈΤ˜ ª∂£ ÛÙËÓ∞ı‹Ó· Î·È Ù˘ ·fiÊ·Û‹˜ ÙÔ˘˜ Ó· ‰ˆÚËıÔ‡ÓfiÚÁ·Ó· Î·È ÈÛÙÔ› ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜ (Bellali T, etal. Soc Sci Med 2007;64:439-450).
ŒÎıÂÛË ÛÙÔÓ ‹ÏÈÔ Î·È ÏÂÌÊÒÌ·Ù·. ªÂÏÂ-Ù‹ıËÎ·Ó ÔÈ Û˘Ó‹ıÂȘ ¤ÎıÂÛ˘ ÛÙÔÓ ‹ÏÈÔ 71·È‰ÈÒÓ Ì ϤÌʈ̷ Hodgin, 87 Ì ϤÌʈ̷ÌË Hodgin Î·È 164 ·È‰ÈÒÓ ÔÌ¿‰·˜ ÂϤÁ¯Ô˘. ∏·˘ÍË̤ÓË ¤ÎıÂÛË ÛÙÔÓ ‹ÏÈÔ ‚Ú¤ıËΠӷ Û¯ÂÙ›-˙ÂÙ·È Ì ÂÏ¿ÙÙˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ϤÌʈ̷ÌË Hodgin (Petridou ET, et al. Cancer CausesControl 2007;18:1031-1037).
ªÂÛÔÁÂȷ΋ ‰›·ÈÙ·. ªÂϤÙË 690 ·È‰ÈÒÓÎ·È ÂÊ‹‚ˆÓ ËÏÈΛ·˜ 7-18 ÂÙÒÓ ÛÙËÓ ·ÁÚÔÙÈ΋∫Ú‹ÙË ¤‰ÂÈÍ fiÙÈ Ë ‰È·ÙÚÔÊ‹ Ì ÛٷʇÏÈ·,ÔÚÙÔοÏÈ·, Ì‹Ï· Î·È ÓÙÔÌ¿Ù˜ ÚÔÛٷهÂÈ·fi ‚ÚÔÁ¯fiÛ·ÛÌÔ Î·È ÚÈÓ›Ùȉ· Î·È Ë ÌÂÁ¿ÏËηٷӿψÛË ÍËÚÒÓ Î·ÚÒÓ ·fi ‚ÚÔÁ¯fiÛ·-ÛÌÔ. ∏ ·ÏÏÂÚÁÈ΋ ÚÈÓ›Ùȉ· ‹Ù·Ó ÈÔ Û˘¯Ó‹ ÌÂÙËÓ Î·Ù·Ó¿ÏˆÛË Ì·ÚÁ·Ú›Ó˘ (fiˆ˜ Î·È Ô ‚ÚÔÁ-¯fiÛ·ÛÌÔ˜) Î·È ÈÔ Û¿ÓÈ· Ì ÙË ÌÂÛÔÁÂȷ΋‰›·ÈÙ· (Chatzi L, et al. Thorax 2007;62:677-683).
¢ÔÛÔÏÔÁ›· ÎÏ·ÚÈıÚÔÌ˘Î›Ó˘. ∞fi 343 ·È-‰È¿ Ì Ïԛ̈ÍË ·Ó·Ó¢ÛÙÈÎÔ‡ Î·È ·ÁˆÁ‹ ·fi29 ·È‰È¿ÙÚÔ˘˜ Ù˘ ∞ı‹Ó·˜, 78% ‹Ú·Ó ËÌÂ-Ú‹ÛÈ· ‰fiÛË ÌÂÁ·Ï‡ÙÂÚË Ù˘ Û˘ÓÈÛÙÒÌÂÓ˘ (15mg/kg) Î·È 26% ËÌÂÚ‹ÛÈ· ‰fiÛË ≥30 mg/kg. ∫·-΋ ·ÓÔ¯‹ ·Ó·Ê¤ÚıËΠÛÙÔ 4% Î·È ·ÚÂÓ¤ÚÁÂÈ-˜ (΢ڛˆ˜ Á·ÛÙÚÂÓÙÂÚÈΤ˜) ÛÙÔ 18%. ∏ ·˘ÍË-̤ÓË ‰fiÛË ‰ÂÓ Û˘Û¯ÂÙ›ÛıËΠ̠ÙËÓ ·ÓÔ¯‹ ‹ÙȘ ·ÚÂÓ¤ÚÁÂȘ (Kafetzis DA, et al. Eur J ClinMicrobiol Infect Dis 2007;26:99-103).
82 ™À¡∆√ª∞ ¶∞π¢π∞∆ƒπ∫∞ ¡∂∞
Paediatriki 2008;71:80-82
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·82
83¡∂∞ ∞¶√ ∆√ ¢π∞¢π∫∆À√
¶·È‰È·ÙÚÈ΋ 2008;71:83-85
πÛÙÔÛÂÏ›‰Â˜ ÁÈ· ÙËÓ ∞ÏÏÂÚÁÈÔÏÔÁ›·
ÃÚ˘Û¿ÓıË ™Î¢¿ÎË
πÛÙÔÛÂÏ›‰· Ù˘ ∂˘Úˆ·˚΋˜
∞η‰ËÌ›·˜ ∞ÏÏÂÚÁÈÔÏÔÁ›·˜ ηÈ
∫ÏÈÓÈ΋˜ ∞ÓÔÛÔÏÔÁ›·˜ -
http://www.eaaci.net
H ÈÛÙÔÛÂÏ›‰· www.eaaci.net·ÔÙÂÏ› ÙÔÓ Â›ÛËÌÔ ‰È·‰ÈÎÙ˘·ÎfiÙfiÔ Ù˘ ∂˘Úˆ·˚΋˜ ∞η‰ËÌ›·˜∞ÏÏÂÚÁÈÔÏÔÁ›·˜ Î·È ∫ÏÈÓÈ΋˜ ∞ÓÔ-ÛÔÏÔÁ›·˜, Ë ÔÔ›· ȉڇıËΠÙÔ1956 ÛÙË ºÏˆÚÂÓÙ›· Î·È ·ÚÈıÌ›̤¯ÚÈ Û‹ÌÂÚ· 40 ∂˘Úˆ·˚Τ˜ ∂ıÓÈ-Τ˜ ∂ÓÒÛÂȘ (National Societies)Î·È ÂÚÈÛÛfiÙÂÚ· ·fi 5.500 ̤ÏË,ÚÔÂÚ¯fiÌÂÓ· ·fi ÙËÓ ·Î·‰ËÌ·˚Î‹Î·È ÂÚ¢ÓËÙÈ΋ È·ÙÚÈ΋ ÎÔÈÓfiÙËÙ·.™Ùfi¯Ô˜ Ù˘ ∞η‰ËÌ›·˜ Â›Ó·È Ë ÚÔ-
ÒıËÛË Ù˘ ‚·ÛÈ΋˜ Î·È ÎÏÈÓÈ΋˜ ¤Ú¢ӷ˜ ÛÙÔ Â‰›Ô Ù˘ ·ÏÏÂÚÁÈÔÏÔÁ›·˜ Î·È ÎÏÈÓÈ΋˜ ·ÓÔÛÔÏÔÁ›·˜,Ë Û˘ÏÏÔÁ‹, ηٷÁÚ·Ê‹, ·ÍÈÔÏfiÁËÛË Î·È ‰È¿‰ÔÛË Ù˘ ÂÈÛÙËÌÔÓÈ΋˜ ÏËÚÔÊfiÚËÛ˘, Ë ÏÂÈÙÔ˘ÚÁ›·ˆ˜ ΤÓÙÚÔ˘ ·Ó·ÊÔÚ¿˜ ÁÈ· ÂÈÛÙËÌÔÓÈο fiÚÁ·Ó· Î·È ÔÏÈÙÈΤ˜ ‰Ô̤˜ ÁÈ· ÙË Ï‹„Ë ·ÔÊ¿ÛÂˆÓ Û·ÓÂ˘Úˆ·˚Îfi ›‰Ô, Ë ÂÓı¿ÚÚ˘ÓÛË Î·È ÚÔÛÊÔÚ¿ Û˘Ó¯È˙fiÌÂÓ˘ È·ÙÚÈ΋˜ Âη›‰Â˘Û˘ Î·È ËÚÔÛÊÔÚ¿ ˘ËÚÂÛÈÒÓ ÂÓË̤ڈÛ˘ Û ·ÛıÂÓ›˜ Ì ·ÏÏÂÚÁ›Â˜ Î·È ¿ÛıÌ·. ™ÙȘ ‰Ú¿ÛÂȘ Ù˘ ∞η‰Ë-Ì›·˜ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È Û˘ÓÂÚÁ·Û›Â˜ Ì ·ÓÙ›ÛÙÔȯ˜ ·ÁÎfiÛÌȘ ÔÚÁ·ÓÒÛÂȘ, Û˘ÌÌÂÙÔ¯‹ Û ÂÚ¢ÓË-ÙÈο ÚÔÁÚ¿ÌÌ·Ù· Î·È ‰ÈÂıÓ›˜ Û˘Ó·ÓÙ‹ÛÂȘ, Ì ·ÔÎÔڇʈ̷ ÙÔ ÂÙ‹ÛÈÔ ‰ÈÂıÓ¤˜ Û˘Ó¤‰ÚÈÔ ·ÏÏÂÚ-ÁÈÔÏÔÁ›·˜ Î·È ÎÏÈÓÈ΋˜ ·ÓÔÛÔÏÔÁ›·˜.
™ÙËÓ Î·ÙËÁÔÚ›· ¡¤· ˘¿Ú¯ÂÈ ÏËÚÔÊfiÚËÛË ÂÈÛÙËÌÔÓÈÎÔ‡ Î·È ÂȉËÛÂÔÁÚ·ÊÈÎÔ‡ ÂÚȯÔ̤-ÓÔ˘ Û¯ÂÙÈο Ì ÙȘ ·ÏÏÂÚÁ›Â˜ Î·È ÙÔ ¿ÛıÌ·. ∂ÈϤÔÓ, ÛÙËÓ ˘ÔηÙËÁÔÚ›· ¶ÚÔÊ›Ï, Á›ÓÂÙ·È ·ÚÔ˘-Û›·ÛË ÂÈÏÂÁÌ¤ÓˆÓ ÚÔÛˆÈÎÔÙ‹ÙˆÓ Ì¤Û· ·fi ÙËÓ ∞η‰ËÌ›·, Ì ¤ÓÙÔÓË ‰Ú¿ÛË Î·È ÂÈÛÙËÌÔÓÈÎfiÚÔÊ›Ï. ∆¤ÏÔ˜, ÛÙËÓ ÂÓfiÙËÙ· ·˘Ù‹ Á›ÓÂÙ·È ·Ó·ÊÔÚ¿ Î·È Û Ӥ˜ ÂΉfiÛÂȘ Î·È ‚È‚Ï›· ·fi ÙÔ ¯ÒÚÔÙ˘ ·ÏÏÂÚÁÈÔÏÔÁ›·˜.
™ÙËÓ Î·ÙËÁÔÚ›· ¢Ú·ÛÙËÚÈfiÙËÙ˜, ÂÎÙfi˜ ·fi ÙËÓ Ù·ÎÙÈ΋ ÂÙ‹ÛÈ· Û˘Ó¿ÓÙËÛË Ù˘ ∞η‰ËÌ›·˜,˘¿Ú¯Ô˘Ó ÏËÚÔÊÔڛ˜ ÁÈ· Ù· ıÂÚÈÓ¿ Î·È ¯ÂÈÌÂÚÈÓ¿ Û¯ÔÏ›· Ì ÂÎ·È‰Â˘ÙÈÎfi ¯·Ú·ÎÙ‹Ú·, ÂÈÛÙË-ÌÔÓÈΤ˜ Û˘Ó·ÓÙ‹ÛÂȘ, ·ÏÏ¿ Î·È ÁÂÓÈÎfiÙÂÚË ÏËÚÔÊfiÚËÛË ÁÈ· ·ÚÂÌÊÂÚÔ‡˜ ¯·Ú·ÎÙ‹Ú· ÁÂÁÔÓfiÙ·Û ·ÁÎfiÛÌÈÔ Â›Â‰Ô.
∆· ÂÈ̤ÚÔ˘˜ ÂÚ¢ÓËÙÈο Î·È ÂÈÛÙËÌÔÓÈο ‰›· ÛÙÔ ¯ÒÚÔ Ù˘ ·ÏÏÂÚÁÈÔÏÔÁ›·˜ Î·È ÎÏÈÓÈ΋˜·ÓÔÛÔÏÔÁ›·˜ ÂÚÈÁÚ¿ÊÔÓÙ·È ·Ó·Ï˘ÙÈο ÛÙËÓ Î·ÙËÁÔÚ›· ∂ÓfiÙËÙ˜/√Ì¿‰Â˜ ∂ӉȷʤÚÔÓÙÔ˜, ÂÓÒ ÁÈ· Ù·Ó·ڿ ̤ÏË Ù˘ ∞η‰ËÌ›·˜ (¤ˆ˜ 35 ÂÙÒÓ) ˘¿Ú¯ÂÈ Í¯ˆÚÈÛÙ‹ ηÙËÁÔÚ›· Ì ÏËÚÔÊÔڛ˜ Î·È Ó¤·Ô˘ ·Â˘ı‡ÓÔÓÙ·È ÛÙÔ˘˜ Ó¤Ô˘˜ ÂÈÛÙ‹ÌÔÓ˜ ÙÔ˘ ¯ÒÚÔ˘. ¶·Ú¿ÏÏËÏ·, ˘¿Ú¯ÂÈ Î·È Ë ÂȉÈ΋ ÂÓfiÙË-Ù· °È· Ù· ª¤ÏË ªfiÓÔ, ÛÙËÓ ÔÔ›· ÂÈÙÚ¤ÂÙ·È Ë ÚfiÛ‚·ÛË ‚¿ÛÂÈ Îˆ‰ÈÎÔ‡ ηıÒ˜ ÚÔÛʤÚÂÈ ÂÍ·-ÙÔÌÈÎÂ˘Ì¤ÓË ÏËÚÔÊfiÚËÛË.
π‰È·›ÙÂÚÔ ÂӉȷʤÚÔÓ ·ÚÔ˘ÛÈ¿˙ÂÈ Ë ÂÓfiÙËÙ· ¶ËÁ¤˜, Ô˘ ÚÔÛʤÚÂÈ ÂÚÁ·Ï›· ËÏÂÎÙÚÔÓÈ΋˜ ÂÎ-·›‰Â˘Û˘ (e-learning) Ì ‰È·‰Ú·ÛÙÈ΋ Û˘ÌÌÂÙÔ¯‹ ÙÔ˘ ¯Ú‹ÛÙË (webcasts), ·‰ËÌÔÛ›Â˘Ù˜ ÂÈÛÙË-ÌÔÓÈΤ˜ ¤Ú¢Ó˜ Î·È case-studies, ÏÔ‡ÛÈÔ ÊˆÙÔÁÚ·ÊÈÎfi ˘ÏÈÎfi Î·È ÏËÚÔÊfiÚËÛË ÁÈ· ı¤ÛÂȘ ¤Ú¢-Ó·˜ Î·È ÂÚÁ·Û›·˜. ∆¤ÏÔ˜, Ë ÈÛÙÔÛÂÏ›‰· ÙÔ˘ www.eaaci.net ÚÔÛʤÚÂÈ ÚfiÛ‚·ÛË ÛÙȘ ›ÛË̘ ÂÎ-‰fiÛÂȘ Ù˘ ∞η‰ËÌ›·˜ (Allergy, Pediatric Allergy and Immunology, Newsletter) ηıÒ˜ Î·È ËÏÂÎÙÚÔ-ÓÈΤ˜ Û˘Ó‰¤ÛÂȘ Ì ·ÁÎfiÛÌȘ ÂÈÛÙËÌÔÓÈΤ˜ Î·È È·ÙÚÈΤ˜ ÔÚÁ·ÓÒÛÂȘ.
µ’ ¶·È‰È·ÙÚÈ΋¶·ÓÂÈÛÙËÌȷ΋ ∫ÏÈÓÈ΋,¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ ∞ıËÓÒÓ«¶. & ∞. ∫˘ÚÈ·ÎÔ‡»
AÏÏËÏÔÁÚ·Ê›·:
ÃÚ˘Û¿ÓıË ™Î¢¿ÎË[email protected]
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·83
84
Paediatriki 2008;71:83-85
¡∂∞ ∞¶√ ∆√ ¢π∞¢π∫∆À√
πÛÙÔÛÂÏ›‰· ÙÔ˘ ¶·ÁÎfiÛÌÈÔ˘
√ÚÁ·ÓÈÛÌÔ‡ ∞ÏÏÂÚÁ›·˜ -
http://www.worldallergy.
org/index.php
∏ ·Ó·Óˆ̤ÓË ÈÛÙÔÛÂÏ›‰·www.worldallergy.org ·ÔÙÂÏ› ÙÔÓ›ÛËÌÔ ‰È·‰ÈÎÙ˘·Îfi ÙfiÔ ÙÔ˘¶·ÁÎfiÛÌÈÔ˘ √ÚÁ·ÓÈÛÌÔ‡ ∞ÏÏÂÚ-Á›·˜ (WAO), Ô ÔÔ›Ô˜ ·ÓÙÈÚÔÛˆ-‡ÂÈ ¤Ó· ‰ÈÂıÓ¤˜ ‰›ÎÙ˘Ô ·fi 74ÂıÓÈΤ˜ Î·È ÂÚÈÊÂÚÂȷΤ˜ ÂÙ·ÈÚ›-˜ ·ÏÏÂÚÁÈÔÏÔÁ›·˜ Î·È ÎÏÈÓÈ΋˜·ÓÔÛÔÏÔÁ›·˜ ·fi fiÏÔ ÙÔÓ ÎfiÛÌÔ.™Ùfi¯Ô˜ ÙÔ˘ WAO Â›Ó·È Ó· ·ÔÙÂ-ϤÛÂÈ ¤Ó· ·ÁÎfiÛÌÈÔ Î¤ÓÙÚÔ ÂÈ-ÛÙËÌÔÓÈ΋˜ ÏËÚÔÊfiÚËÛ˘ ÁÈ· ÙËÓÎÏÈÓÈ΋ Ú·ÎÙÈ΋, ÙËÓ ¤Ú¢ӷ, ÙËÓ
Âη›‰Â˘ÛË Î·È ÙË ‰È· ‚›Ô˘ ηٿÚÙÈÛË, ̤۷ ·fi ‰ÈÔÚÁ·ÓÒÛÂȘ, ÂÈÛÙËÌÔÓÈο Û˘ÌfiÛÈ·, ÂηÈ-‰Â˘ÙÈο ÚÔÁÚ¿ÌÌ·Ù· Î·È ÂÎ·È‰Â˘ÙÈÎfi ˘ÏÈÎfi, Ì ¤ÌÊ·ÛË ÛÙȘ ·Ó·Ù˘ÛÛfiÌÂÓ˜ ΢ڛˆ˜ ¯ÒÚ˜. √¶·ÁÎfiÛÌÈÔ˜ √ÚÁ·ÓÈÛÌfi˜ ∞ÏÏÂÚÁ›·˜ ȉڇıËΠÙÔ 1951 Û˘ÓÂÓÒÓÔÓÙ·˜ ÙËÓ ÂÚ¢ÓËÙÈ΋, ·Î·‰ËÌ·˚Î‹Î·È È·ÙÚÈ΋ ÎÔÈÓfiÙËÙ· ·fi ÙÔ ¯ÒÚÔ Ù˘ ·ÏÏÂÚÁÈÔÏÔÁ›·˜, ÂÓÒ Û˘ÓÂÚÁ¿˙ÂÙ·È Â›Û˘ ÛÙÂÓ¿ Î·È Ì ÙÔÓ¶·ÁÎfiÛÌÈÔ √ÚÁ·ÓÈÛÌfi ÀÁ›·˜ (WHO).
H ÈÛÙÔÛÂÏ›‰· ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡, Ì ÚfiÛÊ·ÙÔ, ·Ó·Óˆ̤ÓÔ ÚÔÊ›Ï, ¤¯ÂÈ ÌÔÓÙ¤ÚÓÔ Û¯Â‰È·ÛÌfi ηȇÎÔÏË ÏÔ‹ÁËÛË. ∏ ηÙËÁÔÚ›· ∂η›‰Â˘ÛË ÛÙËÓ ∞ÏÏÂÚÁ›· ÂÚÈÏ·Ì‚¿ÓÂÈ ÏËÚÔÊÔڛ˜ ÁÈ· Ù· ÂÎ-·È‰Â˘ÙÈο ÚÔÁÚ¿ÌÌ·Ù· ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡, ÛÂÌÈÓ¿ÚÈ· Î·È ˘ÔÙÚÔʛ˜. ∏ ηÙËÁÔÚ›· ŒÚ¢ӷ ÛÙËÓ∞ÏÏÂÚÁ›· ÂÚÈÏ·Ì‚¿ÓÂÈ ÏËÚÔÊÔڛ˜ ÁÈ· ÂÚ¢ÓËÙÈο ÚÔÁÚ¿ÌÌ·Ù·, ÂÈÛÙËÌÔÓÈΤ˜ Û˘Ó·ÓÙ‹ÛÂȘ,Ì·ı‹Ì·Ù· Î·È ÈÛÙÔÔÈËÙÈο ÁÓÒÛ˘ Á‡Úˆ ·fi ÙËÓ ·ÏÏÂÚÁ›· Î·È ÙËÓ ÎÏÈÓÈ΋ ·ÓÔÛÔÏÔÁ›·.
π‰È·›ÙÂÚÔ ÂӉȷʤÚÔÓ ·ÚÔ˘ÛÈ¿˙ÂÈ Ë ÂÓfiÙËÙ· ∫ÚÈÙÈΤ˜, fiÔ˘ ·Ó·Ê¤ÚÂÙ·È Û ÎÚÈÙÈΤ˜ ‚È‚Ï›ˆÓ,ÂÚÈÔ‰ÈÎÒÓ Î·È ¿ÏÏˆÓ ÂÈÛÙËÌÔÓÈÎÒÓ ÂΉfiÛÂˆÓ Ì ·ÓÙÈΛÌÂÓÔ ÙËÓ ·ÏÏÂÚÁ›·. ∏ ÈÛÙÔÛÂÏ›‰· ÏÂÈ-ÙÔ˘ÚÁ›, ›Û˘, ˆ˜ ̤ÛÔ ÂÈÎÔÈÓˆÓ›·˜ Ì ٷ ̤ÏË ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ ̤۷ ·fi Ì›· ͯˆÚÈÛÙ‹ η-ÙËÁÔÚ›· (°È· Ù· ª¤ÏË ªfiÓÔ), Ë ÔÔ›· ‰›ÓÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· ˘Ô‚ÔÏ‹˜ ÂÚˆÙËÌ¿ÙˆÓ Û ÂȉÈÎÔ‡˜·fi ÙÔ ¯ÒÚÔ Ù˘ ·ÏÏÂÚÁÈÔÏÔÁ›·˜. ∆¤ÏÔ˜, Ë ÈÛÙÔÛÂÏ›‰· ÚÔÛʤÚÂÈ ÏËÚÔÊfiÚËÛË ÁÈ· Ù· ÂÂÚ¯fi-ÌÂÓ· Û˘Ó¤‰ÚÈ· ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡, ηıÒ˜ Î·È ËÏÂÎÙÚÔÓÈΤ˜ Û˘Ó‰¤ÛÂȘ Ì ·ÚÂÌÊÂÚ›˜ ÔÚÁ·ÓÈÛÌÔ‡˜Î·È ÂÓÒÛÂȘ.
πÛÙÔÛÂÏ›‰· Ù˘ ∂˘Úˆ·˚΋˜ √ÌÔÛÔÓ‰›·˜ ÁÈ· ÙȘ ∂ÓÒÛÂȘ ∞ÛıÂÓÒÓ Ì ∞ÏÏÂÚÁ›· Î·È ¶·-
ı‹ÛÂȘ ÙÔ˘ ∞Ó·Ó¢ÛÙÈÎÔ‡ (EFA) - http://www.efanet.org/
∏ ÈÛÙÔÛÂÏ›‰· www.efanet.org ·ÔÙÂÏ› ÙÔÓ Â›ÛËÌÔ ‰È·‰ÈÎÙ˘·Îfi ÙfiÔ Ù˘ ∂˘Úˆ·˚΋˜ √ÌÔ-ÛÔÓ‰›·˜ ÁÈ· ÙȘ ∂ÓÒÛÂȘ ∞ÛıÂÓÒÓ Ì ∞ÏÏÂÚÁ›· Î·È ¶·ı‹ÛÂȘ ÙÔ˘ ∞Ó·Ó¢ÛÙÈÎÔ‡, EFA, Ë ÔÔ›·È‰Ú‡ıËΠÙÔ 1991 ÛÙË ™Ô˘Ë‰›·. ™Ùfi¯Ô˜ ‹Ù·Ó Ó· Û˘ÓÂÓÒÛÂÈ fiϘ ÙȘ ÂÓÒÛÂȘ ·ÛıÂÓÒÓ Ì ·ÏÏÂÚÁ›Â˜Î·È ¿ÛıÌ· ÛÙËÓ ∂˘ÚÒË ÁÈ· Ó· ÈηÓÔÔÈ‹ÛÂÈ ÙȘ ·Ó¿ÁΘ ÙÔ˘˜ Î·È Ó· ÚÔ·Û›ÛÂÈ Ù· ‰ÈηÈÒÌ·Ù¿ÙÔ˘˜, ·ÔÛÎÔÒÓÙ·˜ ÛÙË ‚ÂÏÙ›ˆÛË Ù˘ ˘Á›·˜ ÙÔ˘˜ Î·È ÂÓ Á¤ÓÂÈ Ù˘ ÔÈfiÙËÙ·˜ Ù˘ ˙ˆ‹˜ ÙÔ˘˜. ™ÙÔÏ·›ÛÈÔ ·˘Ùfi, ÚÔÛʤÚÂÈ ˘ËÚÂۛ˜ ÂȉËÛÂÔÁÚ·ÊÈ΋˜ ÂÓË̤ڈÛ˘ Î·È ÂÌÂÚÈÛٷو̤Ó˘ ÂÈÛÙË-ÌÔÓÈ΋˜ ÏËÚÔÊfiÚËÛ˘, ηıÒ˜ Î·È Û˘Ó·Ê¤˜ ÂÎ·È‰Â˘ÙÈÎfi ˘ÏÈÎfi. ª¤¯ÚÈ Û‹ÌÂÚ·, ÙÔ ‰›ÎÙ˘Ô Ù˘EFA ÂÚÈÏ·Ì‚¿ÓÂÈ 14 ÂıÓÈΤ˜ ÂÓÒÛÂȘ Ì ۇÓÔÏÔ ÌÂÏÒÓ ¿Óˆ ÙˆÓ 400.000 Û fiÏË ÙËÓ ∂˘ÚÒË.
∏ ηÙËÁÔÚ›· ¢Ú·ÛÙËÚÈfiÙËÙ˜ ÂÚÈÏ·Ì‚¿ÓÂÈ ÏËÚÔÊÔڛ˜ ÁÈ· ÙȘ Ù·ÎÙÈΤ˜ Î·È ¤ÎÙ·ÎÙ˜ ÂΉfiÛÂȘÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡, ÁÂÁÔÓfiÙ· Î·È ÂΉËÏÒÛÂȘ, ‰Ú¿ÛÂȘ Î·È ÚˆÙÔ‚Ô˘Ï›Â˜ Ù˘ ∂∂ Î·È ÂÎ·È‰Â˘ÙÈο ηÈÂÚ¢ÓËÙÈο ÚÔÁÚ¿ÌÌ·Ù· ÛÂ Û˘ÓÂÚÁ·Û›· Ì ·ÚÂÌÊÂÚ›˜ Â˘Úˆ·˚ÎÔ‡˜ ÊÔÚ›˜. ∂ÈϤÔÓ, ˘¿Ú¯ÂÈÂÎÙÂٷ̤ÓË ·Ó·ÊÔÚ¿ Û ¤ÁÁÚ·Ê· ÔÏÈÙÈ΋˜, fiˆ˜ Â˘Úˆ·˚Τ˜ Û˘Óı‹Î˜ Î·È Û˘ÛÙ¿ÛÂȘ, ı¤Ì·Ù·
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·84
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¶·È‰È·ÙÚÈ΋ 2008;71:83-85
ηٷӷψÙÈÎÔ‡ ÂӉȷʤÚÔÓÙÔ˜ Î·È˘ÁÂÈÔÓÔÌÈ΋˜ ÂÚ›ı·Ï„˘, ÂÚÈ-‚·ÏÏÔÓÙÔÏÔÁÈο ı¤Ì·Ù·, Û˘Ó‰Âfi-ÌÂÓ· Ì ÙȘ ·ÏÏÂÚÁ›Â˜ Î·È ÙȘ ·ı‹-ÛÂȘ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡, ˙ËÙ‹Ì·Ù·‰È·ÙÚÔÊ‹˜ Î·È Û‹Ì·ÓÛ˘ ÙˆÓ ÙÚÔ-ÊÒÓ, ηıÒ˜ Î·È ˙ËÙ‹Ì·Ù· È·ÙÚÔ-Ê·Ú̷΢ÙÈ΋˜ ÂÚ›ı·Ï„˘.
∏ ηÙËÁÔÚ›· ¡¤· ·fi ÙËÓ EFAÂÚÈÏ·Ì‚¿ÓÂÈ Âȉ‹ÛÂȘ ·fi ÙÔÓ ∆‡-Ô Û¯ÂÙÈο Ì ÙȘ ·ÏÏÂÚÁ›Â˜ Î·È ÙÔ¿ÛıÌ·, ÙËÓ ËÏÂÎÙÚÔÓÈ΋ ¤Î‰ÔÛËÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡, ηıÒ˜ Î·È Âȉ‹-ÛÂȘ ·fi ÙÔ ‰È·‰›ÎÙ˘Ô.
∂ÎÙfi˜ ·fi ÙȘ ͯˆÚÈÛÙ¤˜ η-ÙËÁÔڛ˜ ÂÓË̤ڈÛ˘ ∞ÏÏÂÚÁ›· ηÈÕÛıÌ·, Ô˘ ÂÚȤ¯Ô˘Ó ÏËÚÔÊÔ-ڛ˜ Û¯ÂÙÈο Ì ÙË Ê‡ÛË, ÙËÓ ÔÚÔ-
ÏÔÁ›·, ÙË ÏÂÈÙÔ˘ÚÁ›· Î·È ÙËÓ ÂͤÏÈÍË ÙˆÓ ·ı‹ÛÂˆÓ ·˘ÙÒÓ, Ë ÈÛÙÔÛÂÏ›‰· ÂÚÈÏ·Ì‚¿ÓÂÈ Î·È ÂȉÈ-΋ ηÙËÁÔÚ›· ÁÈ· ÙË ÃÚfiÓÈ· ∞ÔÊÚ·ÎÙÈ΋ ¶Ó¢ÌÔÓÔ¿ıÂÈ·. ™ÙËÓ ÂÓ ÏfiÁˆ ηÙËÁÔÚ›·, ÚÔÛʤÚÂÙ·ÈÏËÚÔÊfiÚËÛË Û¯ÂÙÈο Ì ÙËÓ ·Ó·ÁÓÒÚÈÛË Ù˘ Û˘ÁÎÂÎÚÈ̤Ó˘ ¿ıËÛ˘, Ù· ̤ÙÚ· ÚfiÏ˄˘, ÙËÓ·ÓÙÈÌÂÙÒÈÛË Î·È ÙË ‚ÂÏÙ›ˆÛË Ù˘ ÔÈfiÙËÙ·˜ ˙ˆ‹˜ ÙÔ˘ ¿Û¯ÔÓÙÔ˜.
∆¤ÏÔ˜, ÛÙËÓ Î·ÙËÁÔÚ›· ÃÚ‹ÛÈ̘ ™˘Ó‰¤ÛÂȘ, Ë ÈÛÙÔÛÂÏ›‰· ÚÔÛʤÚÂÈ ÏËıÒÚ· ËÁÒÓ Î·È Û˘Ó-‰¤ÛÌˆÓ Ì ·ÓÙ›ÛÙÔÈ¯Ô˘˜ ÊÔÚ›˜ Î·È ÔÚÁ·ÓÒÛÂȘ ·fi ÙÔ ¯ÒÚÔ Ù˘ ˘Á›·˜ Î·È Ù˘ ¤Ú¢ӷ˜.
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·85
86 ∫§π¡π∫√ ∫√Àπ∑
Paediatriki 2008;71:79,86
∫ÏÈÓÈÎfi QUIZ
∞¶∞¡∆∏™∏
∏ ‰È¿ÁÓˆÛË ‹Ù·Ó ‚·ÎÙËÚȷ΋ ÌËÓÈÁÁ›Ùȉ·
Ì ıÚfiÌ‚ˆÛË ÂÁηÚÛ›Ô˘ ÎfiÏÔ˘. ∏ PCR ÙÔ˘
ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô˘ ˘ÁÚÔ‡ ‹Ù·Ó ıÂÙÈ΋ ÁÈ· ÙÔÓ
ÔÚfiÙ˘Ô 6 ÙÔ˘ S. pneumoniae. ∏ ÂÈÎfiÓ· ıÚfiÌ‚ˆ-
Û˘ ÙÔ˘ ‰ÂÍÈÔ‡ ÂÁοÚÛÈÔ˘ ÎfiÏÔ˘ Î·È ÔÈ ÔÏÏ·-
Ϥ˜ ÌÈÎÚ¤˜ ‚Ï¿‚˜ ÛÙË Ï¢΋ Ô˘Û›· ÙˆÓ ‚ÚÂÁ-
Ì·ÙÈÎÒÓ ÏÔ‚ÒÓ ı· ÌÔÚÔ‡Û·Ó Ó· ·Ô‰ÔıÔ‡Ó ÛÂ
ÌÈÎÚ¤˜ ÂÚÈÔ¯¤˜ ÈÛ¯·ÈÌ›·˜, ·fiÚÚÔÈ· Ù˘ ıÚfiÌ-
‚ˆÛ˘ ÙˆÓ ÊÏ‚ˆ‰ÒÓ ÎfiÏˆÓ ‹/Î·È ·fiÚÚÔÈ·
·ÁÁÂÈ›Ùȉ·˜ ÛÙ· Ï·›ÛÈ· ÂÁÎÂÊ·Ï›Ùȉ·˜. ∆Ô ·È‰›
Ù¤ıËΠ۠˘Ô‰fiÚÈ· ¯ÔÚ‹ÁËÛË ÂÓÔÍ··Ú›Ó˘
Î·È ·Ú¤ÌÂÈÓ ‰È·ÛˆÏËӈ̤ÓÔ ÁÈ· 6 24ˆÚ·. ∆Ë
2Ë Â‚‰ÔÌ¿‰· Ù˘ ÓfiÛÔ˘, ¤ÁÈÓ ̷ÁÓËÙÈ΋ ÙÔÌÔ-
ÁÚ·Ê›· Ô˘ ¤‰ÂÈÍ ‚ÂÏÙ›ˆÛË ÙˆÓ ·ÂÈÎÔÓÈÛÙÈ-
ÎÒÓ Â˘ÚËÌ¿ÙˆÓ ıÚfiÌ‚ˆÛ˘. √È ‚Ï¿‚˜ Ù˘ Ï¢-
΋˜ Ô˘Û›·˜ ¤ÁÈÓ·Ó ÂÌÊ·Ó¤ÛÙÂÚ˜ ÛÙȘ Û˘Ì‚·ÙÈ-
Τ˜ ·ÎÔÏÔ˘ı›Â˜, ‰ÂÓ ÂÌÊ¿ÓÈ˙·Ó ÂÚÈÔÚÈÛÌfi Ù˘
‰È¿¯˘Û˘ ÛÙÔ ÛÙ¿‰ÈÔ ·˘Ùfi Î·È ÂÌÏÔ˘Ù›˙ÔÓÙ·Ó
Ì ÛÎÈ·ÁÚ·ÊÈ΋ Ô˘Û›·, Â˘Ú‹Ì·Ù· ÂÓ‰ÂÈÎÙÈο
ÈÛ¯·ÈÌÈÎÒÓ ·ÏÏÔÈÒÛÂˆÓ Û ˘ÔÍ›· Ê¿ÛË ·ÈÌ¿-
ÙˆÛ˘. ™ÙËÓ Â·ÓÂͤٷÛË ÌÂÙ¿ ·fi 1 Ì‹Ó·, Ë
Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ·Ó¤‰ÂÈÍ ˘ÊÔÏÈ΋ χÛË
Ù˘ ıÚfiÌ‚ˆÛ˘ ÙÔ˘ ÂÁηÚÛ›Ô˘ ÊÏÂ‚Ò‰Ô˘˜ ÎfiÏ-
Ô˘ Î·È ˘ÔÏÂÈÌÌ·ÙÈΤ˜ ÌÈÎÚÔ·ÏÏÔÈÒÛÂȘ ÁÏÔ›-
ˆÛ˘ Ï¢΋˜ Ô˘Û›·˜. √ ¤ÏÂÁ¯Ô˜ ËÎÙÈÎfiÙËÙ·˜
‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜ (ÔÌÔ΢ÛÙ½ÓË, ·Ú¿ÁÔÓÙ·˜
Leyden, ÚˆÙ½ÓË S, ÚˆÙ½ÓË C, ·ÓÙÈıÚÔÌ‚›ÓË
πππ, ·ÓÙÈʈÛÊÔÏÈȉÈο ·ÓÙÈÛÒÌ·Ù·).
√ Ó¢ÌÔÓÈfiÎÔÎÎÔ˜ Â›Ó·È ÎÔÈÓfi ·›ÙÈÔ ‚·ÎÙË-
Úȷ΋˜ ÌËÓÈÁÁ›Ùȉ·˜, ‰Â‡ÙÂÚÔ ÛÂ Û˘¯ÓfiÙËÙ·, ÌÂ-
Ù¿ ÙÔ ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ, Û ·È‰ÈÎÔ‡˜ ÏËı˘-
ÛÌÔ‡˜ Ô˘ ¤¯Ô˘Ó ÂÌ‚ÔÏÈ·Ûı› ÁÈ· ·ÈÌfiÊÈÏÔ Ù˘
Áڛ˘ Ù‡Ô˘ b (1). H ıÓËÙfiÙËÙ· Ù˘ Ó¢ÌÔ-
ÓÈÔÎÔÎÎÈ΋˜ ÌËÓÈÁÁ›Ùȉ·˜ ‰ÂÓ Â›Ó·È ·ÌÂÏËÙ¤·
Î·È ÔÈ Ì·ÎÚÔ¯ÚfiÓȘ ÂÈÏÔΤ˜ Â›Ó·È ·ÚÎÂÙ¿ Û˘-
¯Ó¤˜. ∏ ÚfiÛÊ·ÙË ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ ¤¯ÂÈ
ÔˆÛ‰‹ÔÙÂ Û˘Ì‚¿ÏÏÂÈ ÛÙË Ì¿¯Ë ηٿ Ù˘ Ófi-
ÛÔ˘, ·fi ÙËÓ ¿ÏÏË fï˜ Ë ·Ó¿‰˘ÛË ÛÙÂϯÒÓ·ÓıÂÎÙÈÎÒÓ ÛÙȘ ÎÂÊ·ÏÔÛÔÚ›Ó˜ Áã ÁÂÓ¿˜ ¤¯ÂÈÂÈ‚¿ÏÏÂÈ ÙËÓ ÚÔÛı‹ÎË Ù˘ ‚·ÓÎÔÌ˘Î›Ó˘ ÛÙÔÂÌÂÈÚÈÎfi ·ÓÙÈ‚ÈÔÙÈÎfi Û¯‹Ì· Ù˘ ÎÂÊ·ÏÔÛÔÚ›-Ó˘ Áã ÁÂÓ¿˜ (2,3). ∏ ‰ÂÍ·ÌÂı·˙fiÓË ÚÔÛÙ›ıÂ-Ù·È Û˘¯Ó¿ ÛÙË ıÂڷ›·, ·Ó Î·È Ë ·ÔÙÂÏÂÛÌ·ÙÈ-ÎfiÙËÙ¿ Ù˘ Â›Ó·È Û˘˙ËÙ‹ÛÈÌË.
∏ ıÚfiÌ‚ˆÛË ÊÏ‚ˆ‰ÒÓ ÎfiÏˆÓ ÌÂÙ¿ ·fiÓ¢ÌÔÓÈÔÎÔÎÎÈ΋ ÌËÓÈÁÁ›Ùȉ· ¤¯ÂÈ ·Ó·ÊÂÚı›Û ÂÍ·ÈÚÂÙÈο Û¿ÓȘ ÂÚÈÙÒÛÂȘ (4,5). ¶ÚÔ-‰È·ıÂÛÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÁÈ· ıÚfiÌ‚ˆÛË ÊÏ‚ˆ-‰ÒÓ ÎfiÏˆÓ ·ÔÙÂÏ› Ë ·Ê˘‰¿ÙˆÛË, Ë ÔÔ›· È-ı·ÓfiÓ, ÏfiÁˆ ÚÔËÁËı¤ÓÙˆÓ Â̤وÓ, Ó· Û˘ÓÙ¤ÏÂ-Û ÛÙË ‰ËÌÈÔ˘ÚÁ›· ıÚfiÌ‚ˆÛ˘ ÛÙÔÓ ·ÛıÂÓ‹ Ì·˜.
µÈ‚ÏÈÔÁÚ·Ê›·
1. Theodoridou MN, Vasilopoulou VA, Atsali EE, Pan-galis AM, Mostrou GJ, Syriopoulou VP, et al. Menin-gitis registry of hospitalized cases in children: epi-demiological patterns of acute bacterial meningitisthroughout a 32-year period. BMC Infect Dis2007;7:101.
2. Poulakou G, Katsarolis I, Matthaiopoulou I, TsiodrasS, Kanavaki S, et al; Hellenic Study Group for the Sus-ceptibility of Streptococcus pneumoniae. Nationwidesurveillance of Streptococcus pneumoniae in Greece:patterns of resistance and serotype epidemiology. Int JAntimicrob Agents 2007;30:87-92.
3. Levidiotou S, Vrioni G, Tzanakaki G, Pappa C, Ge-souli H, Gartzonika C, et al. Serotype distribution ofStreptococcus pneumoniae in north-western Greeceand implications for a vaccination programme. FEMSImmunol Med Microbiol 2006;48:179-182.
4. Jorens PG, Parizel PM, Wojciechowski M, Laridon A,De Weerdt A, Mertens G, et al. Streptococcus pneu-moniae meningoencephalitis with unusual and wide-spread white matter lesions. Eur J Paediatr Neurol2007 [Epub ahead of print].
5. Chatterjee T, Gowardman JR, Goh TD. Pneumococ-cal meningitis masquerading as subarachnoid haem-orrhage. Med J Aust 2003;178:505-507.
Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·86
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Pediatri Jan-Feb 08 15-02-08 11:00 ™ÂÏ›‰·87
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