Eƒ∂À¡∏Δπ∫∏ ª∂§∂Δ∏

ŒÏÂÁ¯Ô˜ ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ ÎÔÈÏÈÔο΢ ηÈ

ı˘ÚÂÔÂȉ›Ùȉ·˜ Hashimoto Û ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜
Ì ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË Ù‡Ô˘ I
A. °·ÏÏ‹-ΔÛÈÓÔÔ‡ÏÔ˘1, E.¶. ∫ÔÙ·Ó›‰Ô˘1, M.°. °Ú·ÌÌ·ÙÈÎÔÔ‡ÏÔ˘1,
A. ¶·˘Ï›ÙÔ˘-ΔÛÈfiÓÙÛË2, M. ºˆÙÔ˘Ï¿ÎË1
1 ¢ã ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ∞.¶.£., ¡ÔÛÔÎÔÌÂ›Ô ¶··ÁˆÚÁ›Ô˘, £ÂÛÛ·ÏÔÓ›ÎË
2 ∂ÚÁ·ÛÙ‹ÚÈÔ ∞ÓÔÛÔÏÔÁ›·˜ Î·È πÛÙÔÛ˘Ì‚·ÙfiÙËÙ·˜, ¡ÔÛÔÎÔÌÂ›Ô ¶··ÁˆÚÁ›Ô˘, £ÂÛÛ·ÏÔÓ›ÎË

Galli-Tsinopoulou A, Kotanidou E, Grammatikopoulou M, Pavlitou-Tsiontsi A, Fotoulaki M.

Screening for celiac disease related and thyroid disease related autoantibodies in children and adolescents with
type I diabetes mellitus.
4th Pediatric Clinic, Aristotle University of Thessaloniki,
Immunology, Histocompatibility lab, “Papageorgiou” Hospital, Thessaloniki, Greece. Paediatr N Gr 2009, 21: 235-241.

¶ÂÚ›ÏË„Ë. ™ÎÔfi˜: ¢ÈÂÚ‡ÓËÛË ÙÔ˘ Ù›ÙÏÔ˘ ÙˆÓ ·ÓÙÈı˘ÚÂ-
ÔÂȉÈÎÒÓ ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ Î·È ÙˆÓ ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ Ô˘
·ÓȯÓ‡ÔÓÙ·È ÛÙËÓ ÎÔÈÏÈÔοÎË, Û ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ ÌÂ
™·Î¯·ÚÒ‰Ë ¢È·‚‹ÙË Ù‡Ô˘ 1 (™¢1). ∞ÛıÂÓ›˜/ª¤ıÔ‰ÔÈ:
™Ù· Ï·›ÛÈ· ÙÔ˘ ÂÙ‹ÛÈÔ˘ ÂϤÁ¯Ô˘ ÙÔ˘˜, 150 ·È‰È¿ Î·È ¤ÊË-
‚ÔÈ Ì ™¢1 Û˘ÌÌÂÙ›¯·Ó ÛÙËÓ ÌÂϤÙË Î·Ù¿ ÙËÓ ÙÚÈÂÙ›· 2007-
2009. ™Â fiÏÔ˘˜ ‰ÈÂÍ‹¯ıË ÁÏ˘Î·ÈÌÈÎfi˜ ¤ÏÂÁ¯Ô˜, ¤ÏÂÁ¯Ô˜
Ù˘ ı˘ÚÂÔÂȉÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ (ΔSH, fT3,fT4), ¤ÏÂÁ¯Ô˜ ·ÓÙÈ-
ı˘ÚÂÔÂȉÈÎÒÓ ·˘Ùo·ÓÙÈÛˆÌ¿ÙˆÓ (anti-TPO, anti-Tg) ηÈ
¤ÏÂÁ¯Ô˜ ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ Ô˘ ·ÓȯÓ‡ÔÓÙ·È ÛÙËÓ ÎÔÈÏÈÔ-
οÎË (∂ª∞, ∞GA-IgA, AGA-IgG, TTG). ∞ÔÙÂϤÛÌ·Ù·: £Â-
ÙÈο ·˘ÙÔ·ÓÙÈÛÒÌ·Ù· Ô˘ ·ÓȯÓ‡ÔÓÙ·È ÛÙËÓ ÎÔÈÏÈÔοÎË
ÂÌÊ¿ÓÈÛ·Ó 14/148 (9.5%) ·ÛıÂÓ›˜ Ì ™¢1, ÂÓÒ Ù· ·ÓÙÈ-
ı˘ÚÂÔÂȉÈο ·˘ÙÔ·ÓÙÈÛÒÌ·Ù· ·ÓȯÓ‡ıËÎ·Ó ÛÙÔ 20.3%
ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜. ™ÙÔ 2.7% ÙˆÓ Û˘ÌÌÂÙ¯fiÓÙˆÓ ‚Ú¤ıËηÓ
Ù·˘Ùfi¯ÚÔÓ· ıÂÙÈο ·ÓÙÈı˘ÚÂÔÂȉÈο ·˘ÙÔ·ÓÙÈÛÒÌ·Ù· ηÈ
·˘ÙÔ·ÓÙÈÛÒÌ·Ù· ÁÈ· ÙËÓ ÎÔÈÏÈÔοÎË. ™Ù· ÎÔÚ›ÙÛÈ·, ÙÔ Ô-
ÛÔÛÙfi ıÂÙÈÎÒÓ ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚÔ, ÙfiÛÔ
ÙˆÓ ·ÓÙÈı˘ÚÂÔÂȉÈÎÒÓ fiÛÔ Î·È Ù˘ ÎÔÈÏÈÔο΢, ÂÓÒ ÛÙ·
·ÁfiÚÈ· Ù· ·˘ÙÔ·ÓÙÈÛÒÌ·Ù· Ô˘ ·ÓȯÓ‡ÔÓÙ·È ÛÙËÓ ÎÔÈÏÈÔ-
οÎË ·ÓȯÓ‡ÙËÎ·Ó ÚˆÈÌfiÙÂÚ· Û˘ÁÎÚÈÙÈο Ì ٷ ÎÔÚ›ÙÛÈ·.
Δ· anti-TPO ·˘ÙÔ·ÓÙÈÛÒÌ·Ù· ‚Ú¤ıËÎ·Ó ıÂÙÈο, ηٿ ÏÂÈ-
Ô„ËÊ›· ÛÙËÓ ÂÊË‚È΋ ËÏÈΛ· Î·È ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ ¤ÊË-
‚ÔÈ/¤Ê˂˜ ÂÌÊ¿ÓÈ˙·Ó ‹‰Ë ˘Ôı˘ÚÂÔÂȉÈÛÌfi. ™˘ÌÂÚ¿-
ÛÌ·Ù·: Δ· ·ÔÙÂϤÛÌ·Ù· ‰Â›¯ÓÔ˘Ó ·˘ÍË̤ӷ ÔÛÔÛÙ¿ ıÂ-
ÙÈÎÒÓ ·ÓÙÈı˘ÚÂÔÂȉÈÎÒÓ ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ Î·È ·˘ÙÔ·ÓÙÈ-
Abstract. Aim: To assess the prevalence of positive thyroid
and celiac disease antibodies in children and adolescents
with Diabetes Mellitus type 1 (DM1). Methods: A total of
150 children and adolescents with DM1 were recruited
during their annual screening control the years 2007-
2009. The screening included glycemic control, thyroid
function (ΔSH, fT3,fT4), thyroid autoantibodies (anti-TPO,
anti-Tg) and antibodies for celiac disease (CD) (∂ª∞, ∞GA-
IgA, AGA-IgG, TTG) and IgA sufficiency. Ig-A deficient
patients (2/150) were excluded. Results: Antibodies for
CD were detected in 14/148 (9.5%) patients with DM1,
whereas thyroid autoantibodies were found in 20.3% of
the participants. The prevalence of positive antibodies for
CD and thyroid was 2.7%. Girls demonstrated the highest
prevalence in both autoantibodies categories whereas in
boys CD positive antibodies were apparent in younger
ages than in girls, throughout the course of diabetes. Po-
sitive anti-TPO antibodies were predominant in ado-le-
scents, the majority of which demonstrated hypothyro-
idism as well. Conclusions: The results demonstrate high
rates of positive autoantibodies patients, regadless of the
duration of diabetes. In clinical practice, the results indi-
cate the need for screening for autoimmune disease even
from diabetes’ onset, as this would speed up the possible
diagnosis of a second autoimmune disease.
236 ¶·È‰È·ÙÚÈ΋ B√ƒ∂I√À ∂§§∞¢√™, 21, 3
ÛˆÌ¿ÙˆÓ Ô˘ ·ÓȯÓ‡ÔÓÙ·È ÛÙËÓ ÎÔÈÏÈÔοÎË Û ·È‰È¿ ÌÂ
™¢1 ·ÓÂÍ¿ÚÙËÙ· ·fi ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‰È·‚‹ÙË. ΔÔ ÁÂÁÔÓfi˜
·˘Ùfi οÓÂÈ ÂÈÙ·ÎÙÈ΋ ÙËÓ ·Ó¿ÁÎË ÁÈ· ‰ÈÂÚ‡ÓËÛË ÙˆÓ ·˘-
ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ÓfiÛÔ˘, ¤ÙÛÈ ÒÛÙ ӷ
˘¿ÚÍÂÈ ¤ÁηÈÚË ‰È¿ÁÓˆÛË Èı·Ó‹˜ ÂÌÊ¿ÓÈÛ˘ ‰Â‡ÙÂÚ˘
ÓfiÛÔ˘ ·˘ÙÔ¿ÓÔÛÔ˘ ¯·Ú·ÎÙ‹Ú·.
§¤ÍÂȘ-ÎÏÂȉȿ: anti-TPO, anti-Tg, AGA, EMA, TTG.
∂ÈÛ·ÁˆÁ‹
∂›Ó·È ÁÓˆÛÙfi fiÙÈ ÔÏÏ¿ ·˘ÙÔ¿ÓÔÛ· ÓÔÛ‹Ì·Ù· Û¯ÂÙ›-
˙ÔÓÙ·È ÌÂٷ͇ ÙÔ˘˜ Î·È fiÙÈ ¿ÙÔÌ· Ì ¤Ó· ·˘ÙÔ¿ÓÔÛÔ
ÓfiÛËÌ· ¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚÔ Î›Ó‰˘ÓÔ Ó· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó
Î·È ‰Â‡ÙÂÚÔ ÓfiÛËÌ· ·˘ÙÔ¿ÓÔÛ˘ ·ÈÙÈÔ·ıÔÁ¤ÓÂÈ·˜1,2.
√ ۷ί·Ú҉˘ ‰È·‚‹Ù˘ Ù‡Ô˘ 1 (™¢1) ·ÔÙÂÏ› ÙÔ
Û˘¯ÓfiÙÂÚÔ ·˘ÙÔ¿ÓÔÛÔ ÓfiÛËÌ· ÛÙ· ·È‰È¿, ÂÓÒ ¤¯ÂÈ
‚ÚÂı› fiÙÈ Û˘¯Ó¿ Û˘Ó˘¿Ú¯ÂÈ Î·È Ì ¿ÏÏ· ·˘ÙÔ¿ÓÔÛ·
ÓÔÛ‹Ì·Ù· fiˆ˜ Ë ÎÔÈÏÈÔοÎË Î·È Ë ı˘ÚÂÔÂȉ›Ùȉ·
Hashimoto3-5. ™ÙËÓ ÚfiÛÊ·ÙË ‚È‚ÏÈÔÁÚ·Ê›· ·Ó·Ê¤-
ÚÂÙ·È fiÙÈ ·È‰È¿ Ì ™¢1 ÂÌÊ·Ó›˙Ô˘Ó ı˘ÚÂÔÂȉÈο ·˘-
ÙÔ·ÓÙÈÛÒÌ·Ù· ÛÂ ÔÛÔÛÙfi 7-40%6-9, ÂÓÒ Ë ÂÌÊ¿ÓÈÛË
ÎÔÈÏÈÔο΢ ÛÙÔÓ ›‰ÈÔ ÏËı˘ÛÌfi Î˘Ì·›ÓÂÙ·È ·fi 0.97
ÂÒ˜ 16.4%10. ªÂٷ͇ ÙˆÓ ‰‡Ô ÓÔÛËÌ¿ÙˆÓ Ê·›ÓÂÙ·È
Ó· ˘¿Ú¯ÂÈ ÁÂÓÂÙÈ΋ Û˘ÁÁ¤ÓÂÈ·11, Ë ÔÔ›· ÂÎÊÚ¿˙ÂÙ·È
ÙfiÛÔ Ì ٷ ·ÓÙÈÁfiÓ· ÙÔ˘ Ì›˙ÔÓÔ˜ Û˘ÛÙ‹Ì·ÙÔ˜ ÈÛÙÔ-
Û˘Ì‚·ÙfiÙËÙ·˜ fiˆ˜ Ù· HLA-DQB1 Î·È DQμ2 ÁÈ· ÙËÓ
ÎÔÈÏÈÔοÎË12 Î·È Ù· HLA-DQB1 Î·È HLA-DRB1 ÁÈ· ÙÔÓ
‰È·‚‹ÙË Ù‡Ô˘ 113, fiÛÔ Î·È Ì ÁÔÓȉȷΤ˜ ÂÚÈÔ¯¤˜
ÂÎÙfi˜ ÙÔ˘ Ì›˙ÔÓÔ˜ Û˘ÛÙ‹Ì·ÙÔ˜ ÈÛÙÔÛ˘Ì‚·ÙfiÙËÙ·˜
(RGS1, ILI8RAP, TAGAP, CCR5 Î·È PTPN2) Ô˘ Û˘Ó-
‰¤Ô˘Ó Ù· ‰‡Ô ·˘ÙÔ¿ÓÔÛ· ÓÔÛ‹Ì·Ù· ÌÂٷ͇ ÙÔ˘˜11.
™‡Ìʈӷ Ì ÙÔÓ Larsson Î·È ÙÔ˘˜ Û˘ÓÂÚÁ¿Ù˜ ÙÔ˘14,
ÔÈ ·ÏfiÙ˘ÔÈ HLA-DQA1*0501-DQB1*0201 Î·È HLA-
DQA1*0301-DQB1*0302 Â›Ó·È ÎÔÈÓÔ› ÛÙËÓ ÎÔÈÏÈÔο-
ÎË Î·È ÛÙÔÓ ™¢1, ÁÂÁÔÓfi˜ Ô˘ Û˘ÓËÁÔÚ› Û ̛· ıˆ-
Ú›· Û˘Û¯¤ÙÈÛ˘ ÙˆÓ ‰‡Ô ÓÔÛËÌ¿ÙˆÓ.
™‡Ìʈӷ Ì ÚfiÛÊ·Ù˜ Ô‰ËÁ›Â˜ ÙÔ˘ ISPAD 2006-
2007 (International Society for Pediatric and Adole-
scent Diabetes) ÛÙ· ·È‰È¿ Ì ™¢1 Ú¤ÂÈ Ó· Á›ÓÂÙ·È
¤ÏÂÁ¯Ô˜ Ù˘ ı˘ÚÂÔÂȉÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ ·ÏÏ¿ Î·È ¤ÏÂÁ-
¯Ô˜ ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ Ô˘ ·ÓȯÓ‡ÔÓÙ·È ÛÙËÓ ÎÔÈÏÈÔ-
οÎË Î¿ı ‰Â‡ÙÂÚÔ ¤ÙÔ˜ ·fi ÙË ÛÙÈÁÌ‹ Ù˘ ‰È¿ÁÓˆÛ˘
ÙÔ˘ ‰È·‚‹ÙË Î·È Ó· Â·Ó·Ï·Ì‚¿ÓÂÙ·È ÂÊ’fiÚÔ˘ ˙ˆ‹˜15.
∂›Û˘ Û‡Ìʈӷ Ì ÙÔÓ Holmes Î·È ÙÔ˘˜ Û˘ÓÂÚÁ¿Ù˜
ÙÔ˘16, Ë ·Ó¿ÁÎË ÁÈ· ÙË ‰ÈÂÚ‡ÓËÛË Ù˘ ÂÌÊ¿ÓÈÛ˘ ÎÔÈ-
ÏÈÔο΢ Û ·ÛıÂÓ›˜ Ì ™¢1 Â›Ó·È ÂÈÙ·ÎÙÈ΋, ·ÊÔ‡
ÔÈ ·ÛıÂÓ›˜ Â›Ó·È Û˘Ó‹ıˆ˜ ·Û˘Ìو̷ÙÈÎÔ›17-19, ÂÓÒ
Ë ‰È¿ÁÓˆÛË Û˘¯Ó¿ ·Ú·‚ϤÂÙ·È ·ÎfiÌË Î·È Û fiÛÔ˘˜
ÂÌÊ·Ó›˙Ô˘Ó Û˘Ìو̷ÙÔÏÔÁ›·.
Key words: anti-TPO, anti-Tg, AGA, EMA, TTG.
™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‹Ù·Ó Ë Î·Ù·ÁÚ·-
Ê‹ Î·È ·ÍÈÔÏfiÁËÛË ÙÔ˘ Ù›ÙÏÔ˘ Î·È Ù˘ ÔÚ›·˜ ÙˆÓ ·ÓÙÈ-
ı˘ÚÂÔÂȉÈÎÒÓ ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ Î·È ÙˆÓ ·˘ÙÔ·ÓÙÈÛˆ-
Ì¿ÙˆÓ Ô˘ ·ÓȯÓ‡ÔÓÙ·È ÛÙËÓ ÎÔÈÏÈÔοÎË, Û ·È‰È¿
Ì ™¢1, ÛÙË μfiÚÂÈÔ ∂ÏÏ¿‰·.
∞ÛıÂÓ›˜ Î·È ª¤ıÔ‰ÔÈ
™Ù· Ï·›ÛÈ· ÙÔ˘ ÂÙ‹ÛÈÔ˘ ÂϤÁ¯Ô˘ ÙÔ˘˜ ÌÂÏÂÙ‹ıËηÓ
150 ·È‰È¿ Î·È ¤ÊË‚ÔÈ Ì ™¢1, Ù· ÔÔ›· ·Ú·ÎÔÏÔ˘-
ıÔ‡ÓÙ·È ÛÙÔ ¶·È‰Ô‰È·‚ËÙÔÏÔÁÈÎfi π·ÙÚÂ›Ô Ù˘ ¢ã ¶·È-
‰È·ÙÚÈ΋˜ ∫ÏÈÓÈ΋˜ ÙÔ˘ ∞ÚÈÛÙÔÙÂÏ›Ԣ ¶·ÓÂÈÛÙËÌ›Ô˘
£ÂÛÛ·ÏÔӛ΢. ∏ ÌÂϤÙË ¤Ï·‚ ¯ÒÚ· ·fi ÙÔÓ π·ÓÔ˘-
¿ÚÈÔ ÙÔ˘ 2007 ¤ˆ˜ ÙÔÓ ™Â٤̂ÚÈÔ ÙÔ˘ 2009. ¢‡Ô ·fi
ÙÔ˘˜ 150 ·ÛıÂÓ›˜ ‚Ú¤ıËÎ·Ó Ó· ¤¯Ô˘Ó ·ÓÂ¿ÚÎÂÈ· Ù˘
·ÓÔÛÔÛÊ·ÈÚ›Ó˘ ∞ Î·È ÁÈ· ÙÔ ÏfiÁÔ ·˘Ùfi ·ÔÎÏ›ÛıË-
Î·Ó ·fi ÙË ÌÂϤÙË. ŒÙÛÈ, ÙÔ ÙÂÏÈÎfi ‰Â›ÁÌ· ·ÔÙÂÏÔ‡-
ÓÙ·Ó ·fi 83 ·ÁfiÚÈ· Î·È 65 ÎÔÚ›ÙÛÈ·, ËÏÈΛ·˜ 11.7±
3.9 ÂÙÒÓ. ™ÙËÓ ÏÂÈÔ„ËÊ›· ÙˆÓ Û˘ÌÌÂÙ¯fiÓÙˆÓ Ë ‰È¿-
ÁÓˆÛË ÙÔ˘ ™¢1 Ù¤ıËΠ̠ÂÌÊ¿ÓÈÛË ‰È·‚ËÙÈ΋˜ ÎÂÙÔ-
ͤˆÛ˘ Î·È Ë ‰È¿ÚÎÂÈ· ÙÔ˘ ™¢1 ‹Ù·Ó 4.0±3.3 ¤ÙË (¶›Ó.
1). √È ÁÔÓ›˜ Î·È ÎˉÂÌfiÓ˜ ÙˆÓ Û˘ÌÌÂÙ¯fiÓÙˆÓ Û˘-
Ó·›ÓÂÛ·Ó ÁÈ· ÙË Û˘ÌÌÂÙÔ¯‹ ÙÔ˘˜ ÛÙËÓ ¤Ú¢ӷ. √ ÁÏ˘-
ηÈÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ ·ÍÈÔÏÔÁ‹ıËΠ̠ÙË Ì¤ÙÚËÛË Ù˘ ÁÏ˘-
ÎÔ˙˘ÏȈ̤Ó˘ ·ÈÌÔÛÊ·ÈÚ›Ó˘ (HbA1c) (Siemens DCA
2000 Analyser).
¶›Ó·Î·˜ 1. °ÂÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο ‰Â›ÁÌ·ÙÔ˜
∞ÁfiÚÈ· ∫ÔÚ›ÙÛÈ· ™‡ÓÔÏÔ
(n=83) (n=65) (n=148)
∏ÏÈΛ· (¤ÙË) 11.6±4.0 11.83±3.7 11.7±3.9
¢È¿ÚÎÂÈ· ™¢1 (¤ÙË) 3.9±3.5 4.16±3.1 4.0±3.3
∏ÏÈΛ· ÂÌÊ¿ÓÈÛ˘
™¢1 (¤ÙË) 7.7±3.9 7.76±3.9 7.7±3.9
∞˘ÙÔ·ÓÙÈÛÒÌ·Ù· Ô˘ ·ÓȯÓ‡ÔÓÙ·È ÛÙËÓ ÎÔÈÏÈÔοÎË
√ ¤ÏÂÁ¯Ô˜ Ù˘ ÎÔÈÏÈÔο΢ ¤ÁÈÓ Ì ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi
ÛÙÔÓ ÔÚfi ÙˆÓ ÂȉÈÎÒÓ ‰ÂÈÎÙÒÓ fiˆ˜: Ù· ·ÓÙÈÛÒÌ·Ù·
¤Ó·ÓÙÈ Ù˘ ÈÛÙÈ΋˜ ÙÚ·ÓÛÁÏÔ˘Ù·ÌÈÓ¿Û˘ (anti-tissue
transglutaminase : ΔΔG) Î·È Ù· ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ ÙÔ˘
 ¶·È‰È·ÙÚÈ΋ B√ƒ∂I√À ∂§§∞¢√™, 21, 3
ÂÓ‰ÔÌ˘›Ô˘ (endomysium antibodies: EMA)20. ΔÈ̤˜
ÌÂÁ·Ï‡ÙÂÚ˜ ·fi 20U21 ÔÚ›ÛıËÎ·Ó ˆ˜ ıÂÙÈΤ˜ ÁÈ· Ù·
·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ Ù˘ ÈÛÙÈ΋˜ ÙÚ·ÓÛÁÏÔ˘Ù·ÌÈÓ¿Û˘.
∂ÈϤÔÓ, ÌÂÙÚ‹ıËÎ·Ó Ù· ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ Ù˘ ÁÏÈ·-
‰›Ó˘ (Antigliadin antibodies: AGA IgA, AGAIgG), ÙÈ-
̤˜ ¿Óˆ ÙˆÓ 20U ÔÚ›ÛıËÎ·Ó ˆ˜ ıÂÙÈΤ˜. √ ÚÔÛ‰ÈÔ-
ÚÈÛÌfi˜ ÙˆÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ Ù˘ ÈÛÙÈ΋˜ ÙÚ·Ó-
ÛÁÏÔ˘Ù·ÌÈÓ¿Û˘ Î·È ¤Ó·ÓÙÈ Ù˘ ÁÏÈ·‰›Ó˘ ÛÙÔÓ ÔÚfi ¤ÁÈ-
Ó Ì ÙË ·ÓÔÛÔÂÓ˙˘ÌÈ΋ ̤ıÔ‰Ô ELISA (Enzyme-Linked
Immunosorbent Assay) ÌÂ ÙË ¯Ú‹ÛË AESKULISA kit
(Aesku.lab. Diagnostifcs, Wendelsheim, Germany).
Δ· ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ ÙÔ˘ ÂÓ‰ÔÌ˘›Ô˘ ÚÔÛ‰ÈÔÚ›ÛÙË-
Î·Ó Ì ÙËÓ Ì¤ıÔ‰Ô ÙÔ˘ ¤ÌÌÂÛÔ˘ ·ÓÔÛÔÊıÔÚÈÛÌÔ‡.
ŒÏÂÁ¯Ô˜ ı˘ÚÂÔÂȉÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ – ¶ÚÔÛ‰ÈÔÚÈÛÌfi˜
·ÓÙÈı˘ÚÂÔÂȉÈÎÒÓ ·˘ÙÔ·ÓÙÈۈ̿وÓ
∏ ı˘ÚÂÔÂȉÈ΋ ÏÂÈÙÔ˘ÚÁ›· ÂϤÁ¯ıËΠ̠ÙË Ì¤-
ÙÚËÛË ÛÙÔÓ ÔÚfi ÙˆÓ ı˘ÚÂÔÂȉÈÎÒÓ ÔÚÌÔÓÒÓ (fT3, fT4)
ηıÒ˜ Î·È Ù˘ ı˘ÚÂÔÙÚfiÔ˘ ÔÚÌfiÓ˘ (TSH). Δ· ·ÓÙÈ-
ı˘ÚÂÔÂȉÈο ·˘ÙÔ·ÓÙÈÛÒÌ·Ù· anti-TPO (thyroid pero-
xidase: anti-TPO) Î·È anti-TG (thyroglobulin: antiTg)
ÚÔÛ‰ÈÔÚ›ÛÙËÎ·Ó Ì ·ÓÔÛÔ‚ÈÔÏÔÁÈÎfi ÚˆÙfiÎÔÏÏÔ
¯ËÌÂÈÔʈٷ‡ÁÂÈ·˜ (Immulite® 2000, Diagnostic Pro-
ducts Corporation, Los Angeles, CA, USA). ™˘ÁÎÂÓ-
ÙÚÒÛÂȘ anti-TPO ·ÓÙÈÛˆÌ¿ÙˆÓ ¿Óˆ ·fi 35 IU/ml
Î·È anti-TG ·ÓÙÈÛˆÌ¿ÙˆÓ ¿Óˆ ·fi 40 IU/ml ıˆڋ-
ıËÎ·Ó ıÂÙÈΤ˜22.
∏ ‰È¿ÁÓˆÛË Ù˘ ı˘ÚÂÔÂȉ›Ùȉ·˜ Hashimoto ‚·Û›-
ÛıËΠÛÙ· ·Ú·Î¿Ùˆ ÎÚÈÙ‹ÚÈ·: ‡·ÚÍË ‚ÚÔÁ¯Ô΋Ï˘,
˘ÔÎÏÈÓÈÎÔ‡ ‹ ÎÏÈÓÈÎÔ‡ ˘Ôı˘ÚÂÔÂȉÈÛÌÔ‡ (TSH >5
ÌIU/mL), ··ÓÙËÙÈÎfiÙËÙ· ÛÙË ıÂÚ·›· Ì L-ı˘ÚÔÍ›ÓË
Î·È ˘„ËÏ¿ Â›‰· ·ÓÙÈı˘ÚÂÔÂȉÈÎÒÓ ·˘ÙÔ·ÓÙÈۈ̿-
ÙˆÓ (anti-TPO >35 IU/mL ηÈ/‹ anti-TG >40 IU/ mL)23.
∏ ·ÓÔÛÔÛÊ·ÈÚ›ÓË ∞ (IgA) ÚÔÛ‰ÈÔÚ›ÛÙËΠ̠ÓÂ-
ÊÂÏÔÌÂÙÚ›·. √ ÚÔÛ‰ÈÔÚÈÛÌfi˜ ¤ÁÈÓ ÁÈ· ÙËÓ ·ÔÊ˘Á‹
„¢‰ÒÓ ·ÚÓËÙÈÎÒÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ, fiˆ˜ Û˘Ì‚·›ÓÂÈ
Û ¤ÏÏÂÈ„‹ Ù˘.
™Ù·ÙÈÛÙÈ΋ ∞Ó¿Ï˘ÛË
∏ ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ¤ÁÈÓ Ì ÙÔ ÛÙ·ÙÈÛÙÈÎfi ·Î¤ÙÔ
SPSS, ¤Î‰ÔÛË 14.0. √È Û˘Ó¯›˜ ÌÂÙ·‚ÏËÙ¤˜ ÂϤÁ¯ıË-
Î·Ó ÁÈ· ÔÌ·Ï‹ ηٷÓÔÌ‹ Î·È ‚Ú¤ıËÎ·Ó fiϘ Ó· ÙËÓ
·ÎÔÏÔ˘ıÔ‡Ó. ªÂٷ͇ ηÙËÁÔÚÈÒÓ ¯ÚËÛÈÌÔÔÈ‹ıËηÓ
ÔÈ ¤ÏÂÁ¯ÔÈ ¯2 Î·È Mann-Whitney. °È· ÙË Û‡ÁÎÚÈÛË ÙˆÓ
Û˘Ó¯ÒÓ ÌÂÙ·‚ÏËÙÒÓ ¯ÚËÛÈÌÔÔÈ‹ıËΠt- test ·ÓÂ-
Í·ÚÙ‹ÙˆÓ ÌÂÙ·‚ÏËÙÒÓ. H ÁÏ˘ÎÔ˙˘ÏȈ̤ÓË ·ÈÌÔÛÊ·È-
Ú›ÓË ‰ÈÔÚıÒıËΠÁÈ· ÙËÓ ËÏÈΛ· ÙˆÓ Û˘ÌÌÂÙ¯fiÓÙˆÓ
Î·È ÔÈ ‰ÈÔÚıˆÌ¤Ó˜ ÙÈ̤˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÁÈ· ÙË ÛÙ·-
ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË. Δ· Â›‰· ÛËÌ·ÓÙÈÎfiÙËÙ·˜ ÔÚ›ÛÙË-
Î·Ó ÛÙÔ 5% (p≤0.05).
237
∞ÔÙÂϤÛÌ·Ù·
ŒÏÂÁ¯Ô˜ ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ Ô˘ ·ÓȯÓ‡ÔÓÙ·È
ÛÙËÓ ÎÔÈÏÈÔοÎË
¢Âη٤ÛÛÂÚȘ ÛÙÔ˘˜ 148 ·ÛıÂÓ›˜ Ì ™¢1 (9.5%) ÂÌ-
Ê¿ÓÈÛ·Ó ıÂÙÈο ·˘ÙÔ·ÓÙÈÛÒÌ·Ù· (EMA ηÈ/‹ TTG). ∞Ó¿-
ÌÂÛ· ÛÙ· ‰‡Ô ʇϷ, Ù· ÎÔÚ›ÙÛÈ· ÂÌÊ¿ÓÈÛ·Ó ÛÙ·ÙÈÛÙÈ-
ο ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ıÂÙÈÎÒÓ ·˘ÙÔ·ÓÙÈۈ̿وÓ
Û ۇÁÎÚÈÛË Ì ٷ ·ÁfiÚÈ· (15.4% Î·È 4.8%, ·ÓÙ›-
ÛÙÔȯ·, p≤0.001). ∞fi ÙÔ˘˜ ıÂÙÈÎÔ‡˜ ·ÛıÂÓ›˜, ÙÔ
14.3% ÂÌÊ¿ÓÈÛ ıÂÙÈο ·ÓÙÈÁÏÈ·‰ÈÓÈο ·ÓÙÈÛÒÌ·Ù·
(AGA IgA). ∫·Ì›· ‰È·ÊÔÚ¿ ‰ÂÓ ·Ú·ÙËÚ‹ıËΠÛÙË
‰È¿ÚÎÂÈ· ÙÔ˘ ‰È·‚‹ÙË Î·È ÛÙËÓ ËÏÈΛ· ÂÌÊ¿ÓÈÛ˘ Ù˘
ÓfiÛÔ˘ ÌÂٷ͇ Û˘ÌÌÂÙ¯fiÓÙˆÓ Ì ıÂÙÈο Î·È ·ÚÓËÙÈο
·˘ÙÔ·ÓÙÈÛÒÌ·Ù· Ô˘ ·ÓȯÓ‡ÔÓÙ·È ÛÙËÓ ÎÔÈÏÈÔοÎË.
ªÂٷ͇ ÙˆÓ Ê‡ÏˆÓ, Ù· ·ÁfiÚÈ· Ì ıÂÙÈο ·˘ÙÔ·ÓÙÈÛÒ-
Ì·Ù· Ô˘ ·ÓȯÓ‡ÔÓÙ·È ÛÙËÓ ÎÔÈÏÈÔοÎË ·ÚÔ˘Û›·Û·Ó
ÌÈÎÚfiÙÂÚË ‰È¿ÚÎÂÈ· ™¢1 Û˘ÁÎÚÈÙÈο Ì ٷ ÎÔÚ›ÙÛÈ·
(p≤0.030 0.4±0.6 Î·È 3.9±2.8 ¤ÙË ·ÓÙ›ÛÙÔȯ·). ™Â 4
·ÛıÂÓ›˜ Ì ıÂÙÈο ·˘ÙÔ·ÓÙÈÛÒÌ·Ù· Û˘ÛÙ‹ıËΠηÈ
Ú·ÁÌ·ÙÔÔÈ‹ıËΠ‚ÈÔ„›· ÏÂÙÔ‡ ÂÓÙ¤ÚÔ˘. ∏ ‰È¿-
ÁÓˆÛË Ù˘ ÎÔÈÏÈÔο΢ ÂȂ‚·ÈÒıËΠÈÛÙÔÏÔÁÈο Ìfi-
ÓÔ Û 2 ·fi ·˘ÙÔ‡˜. ™ÙÔ˘˜ ˘fiÏÔÈÔ˘˜ ·ÛıÂÓ›˜ (10/
14), Ô Ù›ÙÏÔ˜ ÙˆÓ ·ÓÙÈÛˆÌ¿ÙˆÓ Ù˘ ÎÔÈÏÈÔο΢ ·-
ÚÔ˘Û›·Û ÛËÌ·ÓÙÈΤ˜ ·˘ÍÔÌÂÈÒÛÂȘ Û Â·Ó·ÏËÙÈΤ˜
ÌÂÙÚ‹ÛÂȘ ÛÙËÓ ‰È¿ÚÎÂÈ· ÙÔ˘ ¯ÚfiÓÔ˘. ∏ ÔÚ›· ÙˆÓ ÙÈ-
ÌÒÓ fiÏˆÓ ÙˆÓ ·ÛıÂÓÒÓ Ì ıÂÙÈο ·˘ÙÔ·ÓÙÈÛÒÌ·Ù·
Ô˘ ·ÓȯÓ‡ÔÓÙ·È ÛÙËÓ ÎÔÈÏÈÔοÎË ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÂÎÙÂ-
ÓÒ˜ ÛÙÔÓ ›Ó·Î· 2.
ŒÏÂÁ¯Ô˜ ·ÓÙÈı˘ÚÂÔÂȉÈÎÒÓ ·˘ÙÔ·ÓÙÈۈ̿وÓ
£ÂÙÈο ·ÓÙÈı˘ÚÂÔÂȉÈο ·˘ÙÔ·ÓÙÈÛÒÌ·Ù· ·ÓȯÓ‡ÙËηÓ
ÛÙÔ 27.7% ÙˆÓ ÎÔÚÈÙÛÈÒÓ Î·È ÛÙÔ 14.5% ÙˆÓ ·ÁÔ-
ÚÈÒÓ (p≤0.001) Î·È ÛÙÔ 20.3% ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ Û˘Ì-
ÌÂÙ¯fiÓÙˆÓ. ¢ÂÓ ·Ú·ÙËÚ‹ıËΠηÌÈ¿ ‰È·ÊÔÚ¿ ·Ó·-
ÊÔÚÈο Ì ÙË ‰È¿ÚÎÂÈ· ‹ ÙËÓ ËÏÈΛ· ÂÌÊ¿ÓÈÛ˘ ÙÔ˘ ™¢1
ÌÂٷ͇ ·ÛıÂÓÒÓ Ì ıÂÙÈο Î·È ·ÚÓËÙÈο ·ÓÙÈı˘ÚÂÔÂÈ-
‰Èο ·˘ÙÔ·ÓÙÈÛÒÌ·Ù·. ∏ ÙÈÌ‹ Ù˘ HbA1c ‹Ù·Ó ˘„ËÏfi-
ÙÂÚË ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ıÂÙÈο ·ÓÙÈı˘ÚÂÔÂȉÈο ·˘ÙÔ-
·ÓÙÈÛÒÌ·Ù· (p≤0.032). ∏ ÔÌ¿‰· Ì ıÂÙÈο ·˘ÙÔ·ÓÙÈ-
ÛÒÌ·Ù· ÂÌÊ¿ÓÈÛ ÌÂÁ·Ï‡ÙÂÚË ËÏÈΛ· Û˘ÁÎÚÈÙÈο ÌÂ
ÙËÓ ÔÌ¿‰· ÙˆÓ ·ÚÓËÙÈÎÒÓ ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ (p≤0.038,
13.0±3.7 Î·È 11.4±3.8 ¤ÙË, ·ÓÙ›ÛÙÔȯ·).
£ÂÙÈο ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ Ù˘ ı˘ÚÂÔ¸ÂÚÔÍÂȉ¿-
Û˘ (anti-TPO) ÂÌÊ¿ÓÈÛ·Ó 17.6% ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜. ∞fi
·˘ÙÔ‡˜, Ù· ÎÔÚ›ÙÛÈ· ηÙ›¯·Ó ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi
(57.7%) ¤Ó·ÓÙÈ ÙˆÓ ·ÁÔÚÈÒÓ Ô˘ Î¿Ï˘Ù·Ó ÙÔ 42.3%
(p≤0.001). ∏ ̤ÛË ËÏÈΛ· ÙˆÓ Û˘ÌÌÂÙ¯fiÓÙˆÓ Ì ıÂ-
ÙÈο anti-TPO ‹Ù·Ó 12.9±4.0 ¤ÙË. ∞˘ÍË̤ӷ Â›‰·
TSH ·Ú·ÙËÚ‹ıËÎ·Ó ÛÙÔ 73.1% ÙˆÓ ·ÛıÂÓÒÓ Ì ıÂ-
238 ¶·È‰È·ÙÚÈ΋ B√ƒ∂I√À ∂§§∞¢√™, 21, 3

¶›Ó·Î·˜ 2. ∞ÛıÂÓ›˜ Ì ıÂÙÈο ·ÓÙÈÛÒÌ·Ù· ÎÔÈÏÈÔο΢

1 2 3 4 5 6 7 8 9 10 11 12 13 14

∂ª∞ + + – – – – – – – – – – – –
(+/-) + – + – – – – – – – – –
+ – – – – – – – – – –
∞GA-IgG 53.5 89.2 6.7 2.0 21.1 14.1 3.6 9.7 3.6 4.8 5.8 4.9 13.8 3.8
(U) 108.2 63.2 46.4 28.3 12.7 11.8 11.8 3.1 10.8 10.1 14.2 3.1
85.9 81.1 20.5 16.5 13.1 15.4 12.7 5.7 7.8 15.6 6.3
AGA-IgA 75.4 85.5 8.3 3.3 4.5 7.8 4.7 3.3 3.4 5.2 5.0 4.1 12.6 5.1
(U) 87.4 16.8 5.0 4.7 5.5 3.4 2 3.4 14.5 3.4 5.2 6.9
80.1 25.3 5.1 9.5 6.7 6.4 5.2 4.1 5.7 9.2 11.5
TTG 111.3 88.3 7.2 3.7 24.8 64.8 29.1 24.7 30.9 27.1 22.9 8.2 13.3 18.9
(U) 119.5 18.4 11.4 42.6 53.6 21.5 8.2 15.2 67.3 45.9 21.4 29.0
122.0 51.0 8.2 27.8 42.2 26.9 38.7 79.8 24.6 20.2

ÙÈο Î·È ÌfiÏȘ ÛÙÔ 3.3% ÙˆÓ ·ÛıÂÓÒÓ Ì ·ÚÓËÙÈο ¶›Ó·Î·˜ 3. ™¯¤ÛË ÌÂٷ͇ ·ÓÙÈÛˆÌ¿ÙˆÓ ÎÔÈÏÈÔο΢ Î·È ı˘ÚÂ-
anti-TPO ·ÓÙÈÛÒÌ·Ù· (p≤0.001). ∫ÏÈÓÈÎfi˜ ˘Ôı˘ÚÂÔ- ÔÂȉԇ˜, n (%)
ÂȉÈÛÌfi˜ (TSH>10 mlU/L) ‚Ú¤ıËΠÛÙÔ 15.4% Î·È ˘Ô- £ÂÙÈο ∞ÚÓËÙÈο ™‡ÓÔÏÔ
ÎÏÈÓÈÎfi˜ ˘Ôı˘ÚÂÔÂȉÈÛÌfi˜ (TSH>5 mlU/L) ÛÙÔ 11.5% ·ÓÙÈı˘ÚÂÔÂȉÈο ·ÓÙÈı˘ÚÂÔÂȉÈο
ÙˆÓ ·ÛıÂÓÒÓ Ì ıÂÙÈο anti-TPO ·ÓÙÈÛÒÌ·Ù·, ÂÓÒ ·ÓÙÈÛÒÌ·Ù· ·ÓÙÈÛÒÌ·Ù·
˘ÂÚı˘ÚÂÔÂȉÈÛÌfi˜ ·ÓȯÓ‡ÙËΠ̛۠· ¤ÊË‚Ë ·ÛıÂ-
£ÂÙÈο 4 (2.7%) 10 (6.8%) 14 (9.5%)
Ó‹. ŸÙ·Ó ÙÔ ‰Â›ÁÌ· ¯ˆÚ›ÛÙËΠ۠·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ ·ÓÙÈÛÒÌ·Ù·
(>10 ÂÙÒÓ), Ë Û˘¯ÓfiÙËÙ· ÙˆÓ ıÂÙÈÎÒÓ anti-TPO ·ÓÙÈ- ÎÔÈÏÈÔο΢
ÛˆÌ¿ÙˆÓ ‹Ù·Ó ÛËÌ·ÓÙÈο ·˘ÍË̤ÓË ÛÙÔ˘˜ ¤ÊË‚Ô˘˜ ∞ÚÓËÙÈο 26 (17.6%) 108 (73.0%) 134 (90.5%)
(21.2% ¤Ó·ÓÙÈ 9.1% ÛÙ· ·È‰È¿). ™Â fiÙÈ ·ÊÔÚ¿ ÛÙË ·ÓÙÈÛÒÌ·Ù·
‰È¿ÚÎÂÈ· Ù˘ ÓfiÛÔ˘, Ë ÏÂÈÔÓfiÙËÙ· ÙˆÓ anti-TPO ıÂ- ÎÔÈÏÈÔο΢
ÙÈÎÒÓ ·ÛıÂÓÒÓ Â›¯Â ™¢1 ÁÈ· ‰È¿ÛÙËÌ· ÌÈÎÚfiÙÂÚÔ ÙˆÓ 5
™‡ÓÔÏÔ 30 (20.3%) 118 (79.7%) 148 (100%)
ÂÙÒÓ (65.2%), ÂÓÒ ÛÙÔ ˘fiÏÔÈÔ 34.8% Ô ™¢1 ›¯Â
‰È·ÁÓˆÛı› ̤۷ Û ‰È¿ÛÙËÌ· 5-10 ÂÙÒÓ. ∫·Ó¤Ó·˜ ·ÛıÂ-
Ó‹˜ ‰Â ‚Ú¤ıËΠ̠ıÂÙÈο anti-TPO ·ÓÙÈÛÒÌ·Ù· Î·È ‰È¿Ú- ¯Ó‡ÔÓÙ·È ÛÙËÓ ÎÔÈÏÈÔοÎË Û ÔÛÔÛÙfi 9.5% Î·È ıÂ-
ÎÂÈ· ‰È·‚‹ÙË ÌÂÁ·Ï‡ÙÂÚË ÙˆÓ 10 ÂÙÒÓ. ∫·Ì›· ‰È·ÊÔÚ¿ ÙÈο ·ÓÙÈı˘ÚÂÔÂȉÈο ·˘ÙÔ·ÓÙÈÛÒÌ·Ù· Û ÔÛÔÛÙfi
‰ÂÓ ·Ú·ÙËÚ‹ıËΠ۠fiÙÈ ·ÊÔÚ¿ ÛÙË ‰È¿ÚÎÂÈ· Ù˘ Ófi- 20.3%. T· ÎÔÚ›ÙÛÈ· ÂÌÊ¿ÓÈÛ·Ó Û˘¯ÓfiÙÂÚ· ıÂÙÈο ·˘-
ÛÔ˘ ÙÔ˘ ‰È·‚‹ÙË ·Ó¿ÌÂÛ· ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜, fiÙ·Ó ÙÔ ‰Â›Á- ÙÔ·ÓÙÈÛÒÌ·Ù· Û˘ÁÎÚÈÙÈο Ì ٷ ·ÁfiÚÈ· Î·È ÁÈ· ÙȘ ‰‡Ô
Ì· ¯ˆÚ›ÛÙËΠ۠·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ (>10 ÂÙÒÓ). ηÙËÁÔڛ˜ ·˘ÙÔ·ÓÙÈۈ̿وÓ. ™ËÌ·ÓÙÈÎfi ‡ÚËÌ· Ù˘
¤Ú¢ӷ˜ ·ÔÙÂÏ› ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ë ·ÚÔ˘Û›· ıÂÙÈÎÒÓ
™˘Ó‡·ÚÍË fiÏˆÓ ÙˆÓ ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ Ô˘ ·ÓȯÓ‡ÔÓÙ·È ÛÙËÓ ÎÔÈÏÈÔοÎË
™ÙÔ Û‡ÓÔÏÔ ÙˆÓ ·ÛıÂÓÒÓ, ÔÈ 14 (9.5%) ›¯·Ó ıÂÙÈο ÛÙ· ·ÁfiÚÈ· ÂÌÊ·Ó›ÛÙËΠӈڛÙÂÚ· ÛÙËÓ ÔÚ›· Ù˘ Ófi-
·˘ÙÔ·ÓÙÈÛÒÌ·Ù· Ô˘ ·ÓȯÓ‡ÔÓÙ·È ÛÙËÓ ÎÔÈÏÈÔοÎË ÛÔ˘ ÙÔ˘ ‰È·‚‹ÙË, ·’ fiÙÈ ÛÙ· ÎÔÚ›ÙÛÈ·. ∏ ÏÂÈÔ„ËÊ›·
Î·È ÔÈ 30 (20.3%) ıÂÙÈο ·ÓÙÈı˘ÚÂÔÂȉÈο ·˘ÙÔ·ÓÙÈ- ÙˆÓ ·ÛıÂÓÒÓ Ì ıÂÙÈο ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ Ù˘ ı˘ÚÂÔ-
ÛÒÌ·Ù·. Δ¤ÛÛÂÚȘ ·ÛıÂÓ›˜ (2.7%) ·ÓȯÓ‡ÙËÎ·Ó ıÂ- ¸ÂÚÔÍÂȉ¿Û˘ ‹Ù·Ó ¤ÊË‚ÔÈ, ÂÓÒ ÌÂÁ¿ÏÔ ÔÛÔÛÙfi ·˘-
ÙÈÎÔ› Î·È ÁÈ· ÙȘ ‰‡Ô ÔÌ¿‰Â˜ ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ (¶›Ó. 3). ÙÒÓ ÂÌÊ¿ÓÈÛ ·˘ÍË̤ӷ Â›‰· TSH, ˘Ô‰ËÏÒÓÔ-
™ËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ·Ú·ÙËÚ‹ıËΠÌÂٷ͇ ÙˆÓ ÔÌ¿- ÓÙ·˜ ˘Ôı˘ÚÂÔÂȉÈÛÌfi. ™Â ÔÛÔÛÙfi 2.7%, Ù· ıÂÙÈο
‰ˆÓ Ì ıÂÙÈο Î·È ·ÚÓËÙÈο ·˘ÙÔ·ÓÙÈÛÒÌ·Ù· ÎÔÈÏÈÔ- ·˘ÙÔ·ÓÙÈÛÒÌ·Ù· ÎÔÈÏÈÔο΢ Û˘Ó˘‹Ú¯·Ó Ì ıÂÙÈο
ο΢ Î·È ı˘ÚÂÔÂȉԇ˜, Û‡Ìʈӷ Ì ÙÔ Mann ·ÓÙÈı˘ÚÂÔÂȉÈο ·˘ÙÔ·ÓÙÈÛÒÌ·Ù·.
Whitney U test (p≤0.001). ¢Â‰Ô̤Ó˘ Ù˘ Û¯¤Û˘ ÙfiÛÔ ÙÔ˘ ™¢1, fiÛÔ Î·È Ù˘
ÎÔÈÏÈÔο΢, Ì ٷ ·ÓÙÈÁfiÓ· ÙÔ˘ Ì›˙ÔÓÔ˜ Û˘ÛÙ‹Ì·ÙÔ˜
™˘˙‹ÙËÛË ÈÛÙÔÛ˘Ì‚·ÙfiÙËÙ·˜ (HLA DRμ1, DQμ1) ÎÚ›ÓÂÙ·È ÛËÌ·-
™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ‚Ú¤ıËΠfiÙÈ Ì¤Û· Û ‰È¿ÛÙËÌ· ÓÙÈ΋ Ë ·ÔÙ‡ˆÛË ÙˆÓ ÔÛÔÛÙÒÓ Â›ÙˆÛ˘ Î·È Û˘-
Ì›·˜ ÙÚÈÂÙ›·˜, Ù· ·È‰È¿ Î·È ¤ÊË‚ÔÈ Ì ™¢1 ÂÌÊ·Ó›˙Ô˘Ó Û¯¤ÙÈÛ˘ ÙˆÓ ‰‡Ô ÓÔÛËÌ¿ÙˆÓ Û ‰È¿ÊÔÚÔ˘˜ ÏËı˘-
ÙÔ˘Ï¿¯ÈÛÙÔÓ Ì›· ÊÔÚ¿ ıÂÙÈο ·˘ÙÔ·ÓÙÈÛÒÌ·Ù· Ô˘ ·ÓÈ- ÛÌÔ‡˜.
 ¶·È‰È·ÙÚÈ΋ B√ƒ∂I√À ∂§§∞¢√™, 21, 3
¶ÚfiÛÊ·Ù˜ ¤Ú¢Ó˜24-26 ¤‰ÂÈÍ·Ó fiÙÈ ·È‰È·ÙÚÈÎÔ›
·ÛıÂÓ›˜ Ì ™¢1 Ì ÎÂÓÙÚÔ- Î·È ‚ÔÚÂÈÔÂ˘Úˆ·˚΋ η-
Ù·ÁˆÁ‹, ÂÌÊ·Ó›˙Ô˘Ó ıÂÙÈο ·˘ÙÔ·ÓÙÈÛÒÌ·Ù· Ô˘ ·ÓÈ-
¯Ó‡ÔÓÙ·È ÛÙËÓ ÎÔÈÏÈÔοÎË Û ÔÛÔÛÙfi 10-11%. ™ÙÔÓ
∂ÏÏ·‰ÈÎfi ¯ÒÚÔ27 ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ÔÛÔÛÙfi ıÂÙÈÎÒÓ ¤Ó·-
ÓÙÈ Ù˘ ÙÚ·ÓÛÁÏÔ˘Ù·ÌÈÓ¿Û˘ ·ÓÙÈÛˆÌ¿ÙˆÓ Û ·È‰È¿
Ì ™¢1 ¤¯ÂÈ ·ÔÙ˘ˆı› ÛÙÔ 7.6%. ∏ ÎÔÈÏÈÔοÎË Ô‰Ë-
Á› Û ‰˘Û·ÔÚÚfiÊËÛË ıÚÂÙÈÎÒÓ Û˘ÛÙ·ÙÈÎÒÓ Ô˘
·Ï˘ÛȉˆÙ¿ ÂËÚ¿˙Ô˘Ó ÙË Ú‡ıÌÈÛË ÙÔ˘ ‰È·‚‹ÙË, ÂÓÒ
Ë ÛȈËÏ‹ ÎÔÈÏÈÔοÎË ÌÔÚ› Ó· ÚÔηϤÛÂÈ ·Ó·È-
Ì›·, ·ÓÂ·Ú΋ ·Ó¿Ù˘ÍË Î·È Î·ı˘ÛÙ¤ÚËÛË ‹‚˘28,29.
∂ÈϤÔÓ, Û‡Ìʈӷ Ì ÙËÓ ˘fiıÂÛË ÙÔ˘ Smyth11, Ù·
‰ËÌËÙÚȷο Î·È Ë ÁÏÔ˘Ù¤ÓË Â›Ó·È Èı·Ófi Ó· ·ÔÙÂÏÔ‡Ó
¤Ó·Ó ÂÚÈ‚·ÏÏÔÓÙÈÎfi ·Ú¿ÁÔÓÙ· Ô˘ Ô‰ËÁ› Û ·Ï-
Ï·Á‹ Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘ ·ÓÔÛÈ·ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÙÔ˘
ÂÓÙ¤ÚÔ˘ Î·È Ù˘ Û¯¤Û˘ ÙÔ˘ Ì ÙÔ ·ÓÔÛÈ·Îfi Û‡ÛÙËÌ·
ÙÔ˘ ·ÁÎÚ¤·ÙÔ˜, Û ·ÛıÂÓ›˜ Ì ™¢1. °È· ÙÔ˘˜ ·Ú·-
¿Óˆ ÏfiÁÔ˘˜, Ô ¤ÏÂÁ¯Ô˜ ÁÈ· ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ Ù˘ ÈÛÙÈ-
΋˜ ÙÚ·ÓÛÁÏÔ˘Ù·ÌÈÓ¿Û˘, ¤Ó·ÓÙÈ ÙÔ˘ ÂÓ‰ÔÌ˘›Ô˘ ηÈ
¤Ó·ÓÙÈ Ù˘ ÁÏÈ·‰›Ó˘ Û ·È‰È·ÙÚÈÎÔ‡˜ ·ÛıÂÓ›˜ Ì ™¢1
ÎÚ›ÓÂÙ·È ÛËÌ·ÓÙÈÎfi˜ Î·È ÔÊ›ÏÂÈ Ó· Ï·Ì‚¿ÓÂÈ ¯ÒÚ· ο-
ı ‰ÈÂÙ›·.
Δ· ·ÔÙÂϤÛÌ·Ù¿ Ì·˜ ¤‰ÂÈÍ·Ó fiÙÈ ÛÙ· ·ÁfiÚÈ· ÌÂ
™¢1, Ë ‡·ÚÍË ıÂÙÈÎÒÓ ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ Ô˘ ·ÓÈ-
¯Ó‡ÔÓÙ·È ÛÙËÓ ÎÔÈÏÈÔοÎË ÂÌÊ·Ó›˙ÂÙ·È ÓˆÚ›ÙÂÚ· ÛÙËÓ
ÔÚ›· Ù˘ ÓfiÛÔ˘ Û˘ÁÎÚÈÙÈο Ì ٷ ÎÔÚ›ÙÛÈ·. ¶·Úfi-
ÌÔÈ· Û‡ÁÎÚÈÛË ‰ÂÓ ¤¯ÂÈ Î·Ù·ÁÚ·Ê› Û ¿ÏϘ ÌÂϤÙ˜,
fï˜ Û‡Ìʈӷ Ì ÙË Salardi29, Ù· ıÂÙÈο ·˘ÙÔ·ÓÙÈ-
ÛÒÌ·Ù· Ô˘ ·ÓȯÓ‡ÔÓÙ·È ÛÙËÓ ÎÔÈÏÈÔοÎË Ù›ÓÔ˘Ó Ó·
ÂÌÊ·Ó›˙ÔÓÙ·È Ì¤Û· ÛÙÔ˘˜ ÚÒÙÔ˘˜ 18 Ì‹Ó˜ ·fi ÙËÓ
¤Ó·ÚÍË ÙÔ˘ ‰È·‚‹ÙË Î·È Û‡Ìʈӷ Ì ÙÔÓ Larsson Ô
ΛӉ˘ÓÔ˜ ÁÈ· ¤Ó· ·È‰› Ì ™¢1 Ó· ·Ó·Ù‡ÍÂÈ ÎÔÈÏÈÔο-
ÎË Â›Ó·È ˘„ËÏfiÙÂÚÔ˜ Ù· 2 ÚÒÙ· ¤ÙË ·fi ÙËÓ ‰È¿ÁÓˆ-
ÛË ÙÔ˘ ‰È·‚‹ÙË ÂÓÒ ÛÙË Û˘Ó¤¯ÂÈ· ÌÂÈÒÓÂÙ·È Î·Ù·Îfi-
Ú˘Ê·14. ∞˘Ùfi ÛÙËÚ›˙ÂÈ ÙËÓ ˘fiıÂÛË fiÙÈ ‹ οÔÈÔ˜ ÌË-
¯·ÓÈÛÌfi˜ Ô˘ ÚÔηÏ› ÙËÓ ÂÌÊ¿ÓÈÛË ÙÔ˘ ‰È·‚‹ÙË
ÚÔηÏ› Î·È ÙËÓ ÂÌÊ¿ÓÈÛË ÎÔÈÏÈÔο΢, ‹ οÔÈÔÈ ·-
Ú¿ÁÔÓÙ˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ÚÒÈÌË ıÂÚ·›· ÙÔ˘
‰È·‚‹ÙË ÂÓÂÚÁÔÔÈÔ‡Ó ÙËÓ ·ÓÔÛȷ΋ ·¿ÓÙËÛË ÛÙË
ÁÏÈ·‰›ÓË, ‹ Ù¤ÏÔ˜, Ë ·ÓÔÛȷ΋ ·˘Ù‹ ·¿ÓÙËÛË ÔÊ›-
ÏÂÙ·È ÛÙÔ ›‰ÈÔ ÂÚ¤ıÈÛÌ· Ô˘ Ô‰ËÁ› ÛÙÔ ‰È·‚‹ÙË30. ¶¿-
ÓÙˆ˜, Ë ‡·ÚÍË ıÂÙÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ Ô˘ ·ÓȯÓ‡Ô-
ÓÙ·È ÛÙËÓ ÎÔÈÏÈÔοÎË Ê·›ÓÂÙ·È Ó· ·ÔÙÂÏ› ÁÓÒÚÈÛÌ·
ÙˆÓ ·ÙfiÌˆÓ Ì ¤Ó·ÚÍË ™¢1 Û Ó·ڋ ËÏÈΛ·25,31.
∂›Û˘, ·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ù· ‰‡Ô ÓÔÛ‹Ì·Ù· ÂÌ-
Ê·Ó›˙ÔÓÙ·È Ó· ¤¯Ô˘Ó ÎÔÈÓ¿ ÚԉȷıÂÛÈο ·ÏÏ‹ÏÈ· ÛÙÔ
ÁÔÓ›‰ÈÔ DQB1 ÙÔ˘ Ì›˙ÔÓÔ˜ Û˘ÛÙ‹Ì·ÙÔ˜ ÈÛÙÔÛ˘Ì‚·-
ÙfiÙËÙ·˜, Û‡Ìʈӷ Ì ÙÔÓ Deborah et al ÌÂÏÂÙÒÓÙ·˜
ÙÔÓ ÁÔÓfiÙ˘Ô ÙÔ˘ HLA-DQB1 ÌÔÚԇ̠ӷ ‚ÚÔ‡ÌÂ
‰È·ÊÔÚ¤˜ Ô˘ ÛËÌ·ÙÔ‰ÔÙÔ‡Ó ÙËÓ Î¿ı ÓfiÛÔ. ŒÙÛÈ, È-
239
ı·Ó‹ ÎÚ›ÓÂÙ·È ϤÔÓ Î·È Ë ÂÚÌËÓ›· ÙÔ˘ ÎÔÈÓÔ‡ ÁÂÓÂ-
ÙÈÎÔ‡ ˘Ô‚¿ıÚÔ˘ ÙˆÓ ‰‡Ô ÓÔÛËÌ¿ÙˆÓ, ÙÔ ÔÔ›Ô ÛÙË
Û˘Ó¤¯ÂÈ· ˘Ê›ÛÙ·Ù·È ÂÈÁÂÓÂÙÈΤ˜ ÙÚÔÔÔÈ‹ÛÂȘ ÙfiÛÔ
ÛÙÔ Â›Â‰Ô ÙÔ˘ Ì›˙ÔÓÔ˜ Û˘ÛÙ‹Ì·ÙÔ˜ ÈÛÙÔÛ˘Ì‚·Ùfi-
ÙËÙ·˜ fiÛÔ Î·È Û ¿ÏϘ ÌË-HLA ÁÔÓȉȷΤ˜ ÂÚÈÔ¯¤˜.
√ Û˘Ó‰˘·ÛÌfi˜ ÙˆÓ ÙÚÔÔÔÈ‹ÛÂˆÓ ·˘ÙÒÓ Ì ÙËÓ Â›-
‰Ú·ÛË ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ Â›Ó·È Ô˘ ı· ηıÔÚ›ÛÔ˘Ó
ÙËÓ ÎÏÈÓÈ΋ ‹ ˘ÔÎÏÈÓÈ΋ ¤ÎÊÚ·ÛË Ù˘ Ì›·˜ ‹ Ù˘ ¿Ï-
Ï˘ ÓfiÛÔ˘11.
™ËÌ·ÓÙÈÎfi ‡ÚËÌ· ·ÔÙÂÏ› ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ·Ú¿
Ù· ˘„ËÏ¿ ÔÛÔÛÙ¿ ÂȉÈÎfiÙËÙ·˜ ÙÔ˘ Ù›ÙÏÔ˘ ÙˆÓ ΔΔG ηÈ
EMA ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ (94% Î·È 97% ·ÓÙ›ÛÙÔȯ·) ÛÙË
‰È¿ÁÓˆÛË Ù˘ ÎÔÈÏÈÔο΢ Û ˘ÁÈ‹ ÏËı˘ÛÌfi32, ›ӷÈ
ÁÓˆÛÙfi Ò˜ fiÙ·Ó Û˘Ó˘¿Ú¯ÂÈ ™¢1 ˘¿Ú¯ÂÈ ÛËÌ·ÓÙÈ-
Îfi ÔÛÔÛÙfi „¢‰ÒÓ ıÂÙÈÎÒ˜ ·ÔÙÂÏÂÛÌ¿ÙˆÓ16. ™‡Ì-
ʈӷ Ì ÙËÓ ∫·Ú·‚·Ó¿ÎË27, ÙÔ 62.0% ÙˆÓ ·ÛıÂÓÒÓ
Ì ıÂÙÈο TTG ·ÓÙÈÛÒÌ·Ù· ÂȂ‚·›ˆÛ ÙËÓ ‰È¿ÁÓˆÛË
Ù˘ ÎÔÈÏÈÔο΢ ÈÛÙÔÏÔÁÈο, ÂÓÒ Û‡Ìʈӷ Ì ÙÔÓ
Crone17 ÌfiÏȘ 8 ·fi ÙÔ˘˜ 16 ∂ª∞ ıÂÙÈÎÔ‡˜ ·ÛıÂÓ›˜
ÂÌÊ¿ÓÈÛ·Ó Û˘Ì‚·Ù‹ Ì ÙË ÓfiÛÔ ‚ÈÔ„›· ÏÂÙÔ‡ ÂÓÙ¤-
ÚÔ˘. ™ÙË ‰È΋ Ì·˜ ÌÂϤÙË ‰‡Ô ·fi ÙÔ˘˜ Ù¤ÛÛÂÚȘ ·ÛıÂ-
Ó›˜ Ô˘ ˘Ô‚Ï‹ıËÎ·Ó Û ‚ÈÔ„›· ÂȂ‚·›ˆÛ·Ó ÙË Ófi-
ÛÔ, ÂÓÒ ÂȉÈÎfiÙÂÚ· ÛÙÔ ‰Â›ÁÌ· Ì·˜, ÔÈ Ù›ÙÏÔÈ ÙˆÓ ·ÓÙÈ-
ÛˆÌ¿ÙˆÓ ÂÌÊ¿ÓÈÛ·Ó ·˘ÍÔÌÂÈÒÛÂȘ Û ‰È·‰Ô¯ÈΤ˜ ÌÂ-
ÙÚ‹ÛÂȘ, ·Ú¿ ÙËÓ Û˘Ó¯‹ ¤ÎıÂÛË ÙˆÓ ·ÛıÂÓÒÓ ÛÙË
ÁÏÔ˘Ù¤ÓË ÁÂÁÔÓfi˜ Ô˘ ÂȂ‚·ÈÒÓÂÙ·È ‚È‚ÏÈÔÁÚ·ÊÈ-
ο21. ∏ ÔÌ¿‰· Ù˘ Simell33 ·Ú·Ù‹ÚËÛ ÙÔ ›‰ÈÔ Ê·È-
ÓfiÌÂÓÔ Û ÁÂÓÂÙÈο ÚԉȷıÂÙË̤ÓÔ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË
ÎÔÈÏÈÔο΢ ·È‰È·ÙÚÈÎfi ÏËı˘ÛÌfi ¯ˆÚ›˜ ™¢1, ÌÂ
fiÏÔ˘˜ ÙÔ˘˜ Ù›ÙÏÔ˘˜ ÙˆÓ ·ÓÙÈÛˆÌ¿ÙˆÓ Ô˘ ·ÓȯÓ‡Ô-
ÓÙ·È ÛÙËÓ ÎÔÈÏÈÔοÎË (AGA-IgA, AGA-IgG, EMA, TTG)
Ó· ÌÂÈÒÓÔÓÙ·È ÛÙ·‰È·Î¿ ÛÙËÓ ÔÚ›· ÙÔ˘ ¯ÚfiÓÔ˘, ‰›-
¯ˆ˜ ‰È·ÈÙËÙÈ΋ ÚÔÛ·ÚÌÔÁ‹ ÙˆÓ ·ÛıÂÓÒÓ. ŸÏ· Ù· ·-
Ú·¿Óˆ ÂÍ·›ÚÔ˘Ó ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ë ‰È¿ÁÓˆÛË Ù˘ ÎÔÈ-
ÏÈÔο΢ ı· Ú¤ÂÈ Ó· Ù›ıÂÙ·È ·ÔÎÏÂÈÛÙÈο Û ÈÛÙÔ-
ÏÔÁÈ΋ ‚¿ÛË Î·È fi¯È Û ÔÚÔÏÔÁÈ΋ ‰È·›ÛÙˆÛË20,32,34.
∏ ÂÌÊ¿ÓÈÛË ıÂÙÈÎÒÓ ·ÓÙÈı˘ÚÂÔÂȉÈÎÒÓ ·˘ÙÔ·ÓÙÈ-
ÛˆÌ¿ÙˆÓ ÛÙ· ·È‰È¿ Ì ™¢1 Î˘Ì·›ÓÂÙ·È ÌÂٷ͇ 15-
25.2%25,35. ∏ ÏÂÈÔ„ËÊ›· ÙˆÓ Û˘ÌÌÂÙ¯fiÓÙˆÓ Ì ıÂ-
ÙÈο ·ÓÙÈı˘ÚÂÔÂȉÈο ·˘ÙÔ·ÓÙÈÛÒÌ·Ù· (73.1%) ÂÌÊ¿-
ÓÈ˙ ٷ˘Ùfi¯ÚÔÓ· Î·È ˘„ËÏ¿ Â›‰· TSH, ‡ÚËÌ· ÛÂ
Û˘Ìʈӛ· Ì ÚÔËÁÔ‡ÌÂÓË ¤Ú¢ӷ35. ∏ ÂÌÊ¿ÓÈÛË ıÂ-
ÙÈÎÒÓ ·ÓÙÈı˘ÚÂÔÂȉÈÎÒÓ ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ ·˘Í¿ÓÂÈ ÌÂ
ÙËÓ ËÏÈΛ·, Ì ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi Ó· ÂÌÊ·Ó›˙ÂÙ·È
ÛÙÔ˘˜ ÂÓ‹ÏÈΘ Û˘ÁÎÚÈÙÈο Ì ÙÔ˘˜ ¤ÊË‚Ô˘˜ Î·È ÛÙÔ˘˜
¤ÊË‚Ô˘˜ Û˘ÁÎÚÈÙÈο Ì ٷ ·È‰È¿7,26,36. T· ·ÔÙÂϤ-
ÛÌ·Ù¿ Ì·˜ ¤‰ÂÈÍ·Ó Â›Û˘ fiÙÈ fiÙ·Ó Ë ÁÏ˘ÎÔ˙˘ÏȈ̤ÓË
·ÈÌÔÛÊ·ÈÚ›ÓË ‰ÈÔÚıˆı› ÁÈ· ÙËÓ ËÏÈΛ· ÙˆÓ ·ÛıÂÓÒÓ
Ì ™¢1, Ù· ıÂÙÈο ·ÓÙÈı˘ÚÂÔÂȉÈο ·˘ÙÔ·ÓÙÈÛÒÌ·Ù· Û˘Ì-
‚·‰›˙Ô˘Ó Ì ˘„ËÏfiÙÂÚ˜ ÙÈ̤˜ HbA1c. ΔÔ ·Ó Ë ÂÌÊ¿ÓÈ-
240 ¶·È‰È·ÙÚÈ΋ B√ƒ∂I√À ∂§§∞¢√™, 21, 3
ÛË ıÂÙÈÎÒÓ ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ ÂËÚ¿˙ÂÈ ÙË Ú‡ıÌÈÛË
ÙÔ˘ ‰È·‚‹ÙË ‹ Ë Ì¤ÙÚÈ· Ú‡ıÌÈÛË ÚÔηÏ› ÙËÓ ÂÌÊ¿-
ÓÈÛË ıÂÙÈÎÒÓ ·˘·ÓÙÈÛˆÌ¿ÙˆÓ ‰Â ‰È¢ÎÚÈÓ›˙ÂÙ·È ·fi Ù·
·ÔÙÂϤÛÌ·Ù¿ Ì·˜ Î·È ¯Ú‹˙ÂÈ ÂÚ·ÈÙ¤Úˆ ¤Ú¢ӷ˜.
∏ ·ÚÔ‡Û· ¤Ú¢ӷ ¤‰ÂÈÍ fiÙÈ Ë Û˘Ó‡·ÚÍË ™¢1
ÌÂ Û˘ÓÔ‰¿ ·˘ÙÔ¿ÓÔÛ· ÓÔÛ‹Ì·Ù· Â›Ó·È Û˘¯ÓfiÙÂÚË ÛÙ·
ÎÔÚ›ÙÛÈ· Û˘ÁÎÚÈÙÈο Ì ٷ ·ÁfiÚÈ·, ÁÂÁÔÓfi˜ Ô˘ ¤¯ÂÈ
ÂȂ‚·Èˆı› Î·È ·fi ¿ÏÏÔ˘˜ ÂÚ¢ÓËÙ¤˜7,25,26,36 .
™ÙÔ˘˜ ÂÚÈÔÚÈÛÌÔ‡˜ Ù˘ ·ÚÔ‡Û·˜ ¤Ú¢ӷ˜ ÂÚÈ-
Ï·Ì‚¿ÓÔÓÙ·È ÙÔ Û¯ÂÙÈο ÌÈÎÚfi ̤ÁÂıÔ˜ ‰Â›ÁÌ·ÙÔ˜ Û˘-
ÁÎÚÈÙÈο Ì ¤Ú¢Ó˜ ÂÎÙfi˜ ÙÔ˘ ∂ÏÏ·‰ÈÎÔ‡ ¯ÒÚÔ˘. ∏
Û˘ÏÏÔÁ‹ ÙˆÓ ·ÛıÂÓÒÓ ·fi Ì›· ÌfiÓÔ ÎÏÈÓÈ΋, ·ÔÙÂ-
Ï› ÏÂÔÓ¤ÎÙËÌ·, ‰ÈfiÙÈ Â¤ÙÚ„ ÙË Û‡ÁÎÚÈÛË ÙˆÓ ·-
ڷ̤ÙÚˆÓ, ·ÊÔ‡ ÔÈ ÂÍÂÙ¿ÛÂȘ ¤Ï·‚·Ó ¯ÒÚ· ÛÙÔ ›‰ÈÔ
ÂÚÁ·ÛÙ‹ÚÈÔ. ªÂÏÏÔÓÙÈΤ˜ ¤Ú¢Ó˜ ÌÔÚ› Ó· ‰È¢ÎÚÈ-
Ó›ÛÔ˘Ó ÙË Û¯¤ÛË ÙÔ˘ ÁÏ˘Î·ÈÌÈÎÔ‡ ÂϤÁ¯Ô˘ Ì ÙËÓ ÂÌ-
Ê¿ÓÈÛË ıÂÙÈÎÒÓ ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ Î·È Ó· ‰ÈÂÚ¢Ӌ-
ÛÔ˘Ó ÙÔ ÔÛÔÛÙfi ‰È·ÁÓˆÛı¤ÓÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ ÎÔÈ-
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μÈ‚ÏÈÔÁÚ·Ê›·
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mellitus (T1DM). Horm Res 2009, 71: 201-6.
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children with type 1 diabetes: two views of the con-
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Δ∫ 564 03, £ÂÛÛ·ÏÔÓ›ÎË
B, et al. Prevalence of celiac disease in children with type ΔËÏ./Fax: +302310 991537
1 diabetes mellitus increased in the mid-1990s: an 18- e-mail: gallitsin@gmail.com
year longitudinal study based on anti-endomysial antibo-
dies. J Pediatr Gastoent Nutr 2008, 46: 612-4. Correspondence authÔr:
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31. Cerutti F, Bruno G, Chiarelli F, Lorini R, Meschi F, Sacchetti Aristotle University of Thessaloniki
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betes Care 2004, 27: 1294-8. Ring Road Nea Efkarpia
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transglutaminase enzyme-linked immunosorbent assay
Tel./Fax: +302310 991537
as a screening test for celiac disease in pediatric patients.
Pediatrics 2001, 107: E8. e-mail: gallitsin@gmail.com