EÏÏËÓÈÎË I·ÙÚÈÎË

TfiÌÔ˜ 70 • T‡¯Ô˜ 4
OÎÙÒ‚ÚÈÔ˜ – ¢ÂΤ̂ÚÈÔ˜ 2004

¶ÂÚȯfiÌÂÓ·
∂ÓËÌÂÚˆÙÈο 237 ™·ÚÎÔ›‰ˆÛË
¿ÚıÚ· §. ™È¯ÏÂÙ›‰Ë˜, ¢. ÃψÚfi˜

247 ¶ÔÏ˘Ê·Ú̷΢ÙÈ΋ ·ÓÙÔ¯‹ ÛÙËÓ ÔÍ›· Ï¢¯·ÈÌ›· ÙˆÓ ·È‰ÈÒÓ

ª. ∫Ô‡ÚÙË, º. ∞ı·Ó·ÛÈ¿‰Ô˘-¶ÈÂÚÔÔ‡ÏÔ˘

256 ¢È·Ù·Ú·¯¤˜ ˘Á›·˜ Û ·ıÏËÙ¤˜ ÎÔχ̂ËÛ˘

¡. ∫Ô˘ÙÏÈ¿ÓÔ˜

∂Ú¢ÓËÙÈΤ˜ 264 ¶ÔÚ›· Ù˘ C ·ÓÙȉÚÒÛ·˜ ÚˆÙ½Ó˘ Û ·ÛıÂÓ›˜ Ì ıÚÔÌ‚ÔÏ˘ı¤Ó

ÂÚÁ·Û›Â˜ Ô͇ ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘ Î·È Û˘Û¯¤ÙÈÛ‹ Ù˘ Ì ÙËÓ
ÂÓ‰ÔÓÔÛÔÎÔÌÂȷ΋ Î·È ÙËÓ ·ÒÙÂÚË ÚfiÁÓˆÛË
∞. ∑ȿη˜, ™. °·‚ÚÈËÏ›‰Ë˜, °. °È·ÓÓfiÁÏÔ˘, ∂. ™Ô‡ÏÈÔ˘, ∫. °ÎÂÌÈÙ˙‹˜,
£. ™ÙÂÊ·Ó›‰Ë˜, ª. ∞Ú‚·ÓÈÙ›‰Ô˘-µ·ÁȈӿ, π. ¶ÈÓ‰fiÓÈ·,
°. ¶·Ú¯·Ú›‰Ë˜, °. §Ô˘Ú›‰·˜

272 TH-1 Î·È ∆∏-2 ΢ÙÙ·ÚÔΛÓ˜ ÛÙË ¯ÚfiÓÈ· Ë·Ù›Ùȉ· µ Î·È C

∂. §¿ÏÏ·, ª. ƒ·ÙÔÔ‡ÏÔ˘-°ÈÁ‹, ∂. OÚÊ·ÓÔ‡, ∂. ™ÈÓ¿ÎÔ˜, ∂. µÚÂÙÙÔ‡

279 OÈ ÌÂÙ·‚ÔϤ˜ ÙÔ˘ ÈÛÔÚÔÛÙ·Ó›Ô˘ 8-ISO-PGF2· ÛÙ· ÌÂÛÔ΢ÙÙ¿ÚÈ·

˘ÁÚ¿ ÙˆÓ Ì˘ÒÓ ·ÈÌÔηı·ÈÚfiÌÂÓˆÓ ·ÛıÂÓÒÓ
π. ∫·Ú·ÌÔ‡˙˘, ¢. °Ú¤Î·˜, ª. ∫·Ú·ÌÔ‡˙˘, Sv. Valiveva-Staikova
D. Kovachev, ∞. ∆ÚÈ¿ÓÙÔ˜, ™Ù. ∏ÏÈ¿‰Ë˜, °. ¶··ÁˆÚÁ›Ô˘, ¢. ¢ËÌËÙÚÈ¿‰Ô˘

∂ӉȷʤÚÔ˘Û˜ 286 ÃÂÈÚÔ˘ÚÁÈ΋ ıÂÚ·›· ÌÂÙÂÌÊÚ·ÁÌ·ÙÈÎÔ‡ „¢‰Ô·Ó¢ڇÛÌ·ÙÔ˜

ÂÚÈÙÒÛÂȘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ Ì ÌÈÎÚÔ‡ ‚·ıÌÔ‡ ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ
∫. ƒ¿ÌÌÔ˜, Ã. ∫·Ú‚Ô‡Ó˘

ÕÚıÚÔ Û‡ÓÙ·Í˘ 289 C-·ÓÙȉÚÒÛ· ÚˆÙ½ÓË (CRP) Î·È Î·Ú‰È·ÁÁÂȷ΋ ÓfiÛÔ˜

¡¤Â˜ ·fi„ÂȘ ÁÈ· ÌÈ· ÎÏ·ÛÈ΋ ÚˆÙ½ÓË
Ã. §·Ê¿Ú·˜
 Helliniki Iatriki
Volume 70 • No 4
October – December 2004

Contents
Brief reviews 237 Sarcoidosis
Sichletidis L, Chloros D.

247 Multidrug resistance of childhood acute leukemia

Kourti M, Athanasiadou-Piperopoulou F.

256 Health disorders in swimmers

Koultianos N.

Investigative 264 Time course of C-reactive protein (CRP) levels in patients with acute
papers myocardial infarction receiving thrombolysis and their relationship
to inhospital and to further follow up period prognosis
Ziakas A, Gabriilidis S, Giannoglou G, Souliou E, Gemitzis K,
Stefanidis Th, Arvanitidou-Vagiona M, Pindonia I, Parcharidis G, Louridas G.

272 Th1 and Th2 cytokine production in patients with chronic

hepatitis B and C
Lalla E, Raptopoulou-Gigi M, Orfanou E, Sinakos E, Brettou E.

279 The changes of muscle inerstitial F2-isoprostane 8-iso-PGF2a in

hemodialyzed patients
Karamouzis I, Grekas D, Karamouzis M, Valiveva-Staikova Sv,
Kovachev D, Triantos A, Eliadis St, Papageorgiou G, Dimitriadou A.

Cases report 286 Surgical treatment of a left ventricular pseudoaneurysm in a patient

with minimal coronary artery disease
Rammos K, Karvounis Ch.

Editorial 289 C-reactive protein and cardiovascular disease. New opinions

for a classic protein
Lafaras Ch.
∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 2004, 70, 4: 237 - 246
™·ÚÎÔ›‰ˆÛË
§¿˙·ÚÔ˜ ™È¯ÏÂÙ›‰Ë˜, ¢È·Ì·ÓÙ‹˜ ÃψÚfi˜
¶Ó¢ÌÔÓÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ ∞¶£, ∂ÚÁ·ÛÙ‹ÚÈÔ ŒÚ¢ӷ˜ ¶·ı‹ÛÂˆÓ ·fi ÙÔ ¶ÂÚÈ‚¿ÏÏÔÓ,
NoÛÔÎÔÌÂ›Ô «°. ¶··ÓÈÎÔÏ¿Ô˘», ∂ÍÔ¯‹ £ÂÛÛ·ÏÔӛ΢
¶ÂÚ›ÏË„Ë. ∏ Û·ÚÎÔ›‰ˆÛË Â›Ó·È ¯ÚfiÓÈ· ÔÏ˘Û˘-
ÛÙËÌ·ÙÈ΋ ÊÏÂÁÌÔÓ҉˘ ÓfiÛÔ˜ ¿ÁÓˆÛÙ˘ ·ÈÙÈÔÏÔ-
Á›·˜, Ô˘ Û˘¯Ófiٷٷ ÚÔÛ‚¿ÏÏÂÈ ÙÔ˘˜ Ó‡ÌÔÓ˜.
∆Ô ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÈÛÙÔÏÔÁÈÎfi Ù˘ ÁÓÒÚÈÛÌ· Â›Ó·È Ô
Û¯ËÌ·ÙÈÛÌfi˜ ÌË ÓÂÎÚˆÙÈÎÒÓ ÂÈıËÏÈÔÂȉÒÓ ÎÔÎÎȈ-
Ì¿ÙˆÓ ÛÙ· ÚÔÛ‚·ÏÏfiÌÂÓ· fiÚÁ·Ó·. ∂ÌÊ·Ó›˙ÂÙ·È
΢ڛˆ˜ Û ӤԢ˜ ÂÓ‹ÏÈΘ Î·È Ë Â›ÙˆÛ‹ Ù˘ ÔÈ-
ΛÏÏÂÈ ·fi ¯ÒÚ· Û ¯ÒÚ·. ¶Èı·ÓÔÏÔÁÂ›Ù·È Ë ‡·Ú-
ÍË ÂÓfi˜, ¿ÁÓˆÛÙÔ˘ ·ÎfiÌË, ÂÚÈ‚·ÏÏÔÓÙÈÎÔ‡ ·Ú¿-
ÁÔÓÙ·, ›Ûˆ˜ ÏÔÈÌÒ‰Ô˘˜, ˆ˜ ·ÈÙ›Ô˘ Ù˘ ÓfiÛÔ˘, ·fi
ÙËÓ ¿ÏÏË fï˜ ÏÂ˘Ú¿ ˘¿Ú¯Ô˘Ó ÂӉ›ÍÂȘ, fiÙÈ Ë
ÓfiÛÔ˜ ·Ó·Ù‡ÛÛÂÙ·È Û ÔÚÈṲ̂ӷ ÁÂÓÂÙÈÎÒ˜ ÚÔ-
‰È·ÙÂıÂÈ̤ӷ ¿ÙÔÌ·. ∆· Û˘ÌÙÒÌ·Ù· Î·È ÛËÌ›·
ÔÈΛÏÏÔ˘Ó ·Ó¿ÏÔÁ· Ì ٷ ÚÔÛ‚·ÏÏfiÌÂÓ· fiÚÁ·Ó·.
™ËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙË ‰È¿ÁÓˆÛË Ù˘ Û·ÚÎÔ›‰ˆÛ˘
Oƒπ™ªO™
∏ Û·ÚÎÔ›‰ˆÛË Â›Ó·È ÎÔÎÎȈ̷Ù҉˘ ÔÏ˘Û˘ÛÙË-
Ì·ÙÈ΋ ÓfiÛÔ˜ ¿ÁÓˆÛÙ˘ ·ÈÙÈÔÏÔÁ›·˜. ¶ÚÔÛ‚¿ÏÏÂÈ
΢ڛˆ˜ ÙÔ˘˜ Ó‡ÌÔÓ˜, ·fi ÙÔ˘˜ ÔÔ›Ô˘˜ Û˘Ó‹-
ıˆ˜ ÚÔ¤Ú¯ÂÙ·È Ë ‰È¿ÁÓˆÛË.
∂¶π¢∏ªπO§O°π∞
∏ Û·ÚÎÔ›‰ˆÛË ÚÔÛ‚¿ÏÏÂÈ Î˘Ú›ˆ˜ Ó¤Ô˘˜ ÂÓ‹ÏÈ-
Θ οو ÙˆÓ 40 ÂÙÒÓ. ™Â ÔÚÈṲ̂Ó˜ ÂÚÈÔ¯¤˜ ÙÔ˘
Ï·Ó‹ÙË (™Î·Ó‰ÈÓ·‚ÈΤ˜ ¯ÒÚ˜ Î·È π·ˆÓ›·) ·-
Ú·ÙËÚÂ›Ù·È ·‡ÍËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ Ù˘ ÓfiÛÔ˘ ÛÂ
Á˘Ó·›Î˜ ¿Óˆ ÙˆÓ 50 ÂÙÒÓ1. ™ÙË ÌÔÓ·‰È΋ ÌÂϤÙË
Û ÁÂÓÈÎfi ÏËı˘ÛÌfi, ÛÙȘ ∏¶∞, Ë Û˘¯ÓfiÙËÙ· Ù˘
ÓfiÛÔ˘ ‹Ù·Ó 5,9 ·Ó¿ 100.000 ¿ÙÔÌ· ÙÔ ¯ÚfiÓÔ ÁÈ·
ÙÔ˘˜ ¿Ó‰Ú˜ Î·È 6,3 ·Ó¿ 100.000 ¿ÙÔÌ· ÙÔ ¯ÚfiÓÔ
ÁÈ· ÙȘ Á˘Ó·›Î˜2. ∏ ÌÂÁ·Ï‡ÙÂÚË Â›ÙˆÛË ÛÙÔÓ
ÎfiÛÌÔ ·Ú·ÙËÚÂ›Ù·È ÛÙÔ˘˜ ™Ô˘Ë‰Ô‡˜, ÙÔ˘˜ ¢·-
237
·›˙ÂÈ Ë ·Ó¿Ï˘ÛË ÙÔ˘ ˘ÁÚÔ‡ Ù˘ ‚ÚÔÁ¯Ô΢„ÂÏÈ΋˜
¤ÎÏ˘Û˘ (BAL) ÛÙÔ ÔÔ›Ô ·Ú·ÙËÚÂ›Ù·È ¯·Ú·ÎÙË-
ÚÈÛÙÈο ÌÂÁ¿ÏË ·‡ÍËÛË ÂÓÂÚÁÔÔÈËÌ¤ÓˆÓ CD4 T-
ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ, Ë HRCT Ó¢ÌfiÓˆÓ, ÙÔ ÛÈÓıËÚÔ-
ÁÚ¿ÊËÌ· Ì Á¿ÏÏÈÔ–67 Î·È Ë Ì¤ÙÚËÛË ÙÔ˘ ·ÁÁÂÈÔÌÂ-
Ù·ÙÚÂÙÈÎÔ‡ ÂÓ˙‡ÌÔ˘ ÙÔ˘ ÔÚÔ‡ (ACE). ∏ Û›ÁÔ˘ÚË
‰È¿ÁÓˆÛË Á›ÓÂÙ·È ÌfiÓÔ Ì ‚ÈÔ„›· ·fi ÙÔ Î·Ù¿ÏÏË-
Ï· ÂÈÏÂÁfiÌÂÓÔ ÛËÌ›Ô. ∏ ÓfiÛÔ˜ ·ÎÔÏÔ˘ı› Û˘Ó‹-
ıˆ˜ ηÏÔ‹ıË ÔÚ›· Î·È Û˘¯Ó¿ ·˘ÙÔ˚¿Ù·È. ∂¿Ó
··ÈÙËı› ¯ÔÚ‹ÁËÛË ıÂÚ·›·˜, ·˘Ù‹ Û˘Ó›ÛٷٷÈ
ÛÙË ¯ÔÚ‹ÁËÛË ÎÔÚÙÈÎÔÛÙÂÚÔÂȉÒÓ ‹/Î·È Î˘ÙÙ·ÚÔÙÔ-
ÍÈÎÒÓ Ê·Ú̿ΈÓ. ∆ÂÏÂ˘Ù·›ˆ˜ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È,
Ì ÂÓı·ÚÚ˘ÓÙÈο ·ÔÙÂϤÛÌ·Ù·, Ê¿Ú̷η Ô˘ ·-
Ó·ÛÙ¤ÏÏÔ˘Ó ÙÔÓ TNF-a.
EÏÏËÓ I·ÙÚ 2004, 70: 237 - 246.
ÓÔ‡˜ Î·È ÙÔ˘˜ Ì·‡ÚÔ˘˜ ÙˆÓ ∏¶∞3, ÛÙÔ˘˜ ÔÔ›Ô˘˜
Ë ÓfiÛÔ˜ Ê·›ÓÂÙ·È fiÙÈ Â›Ó·È ÈÔ ÛÔ‚·Ú‹. ∏ Â͈ıˆ-
Ú·ÎÈ΋ ÂÓÙfiÈÛË Â›Ó·È ÈÔ Û˘¯Ó‹ Û ÔÚÈṲ̂ÓÔ˘˜
ÏËı˘ÛÌÔ‡˜ (.¯. Ë ¯ÚfiÓÈ· Ú·ÁÔÂȉ›Ùȉ· ÛÙÔ˘˜
Ì·‡ÚÔ˘˜ ÙˆÓ ∏¶∞, Ô ‰ÂÚÌ·ÙÈÎfi˜ χÎÔ˜ ÛÙÔ˘˜
¶ÔÚÙÔÚÈηÓÔ‡˜ Î·È ÙÔ Ô˙҉˜ ÂÚ‡ıËÌ· ÛÙÔ˘˜ ∂˘-
Úˆ·›Ô˘˜). ∏ Û·ÚÎÔ›‰ˆÛË Î·Ú‰È¿˜ Î·È ÔÊı·Ï-
ÌÒÓ Â›Ó·È ÈÔ Û˘¯Ó‹ ÛÙËÓ π·ˆÓ›·4, fiÔ˘ Ë ÚÔ-
Û‚ÔÏ‹ ÙÔ˘ Ì˘Ôηډ›Ô˘ ·ÔÙÂÏ› ÙËÓ ÈÔ Û˘¯Ó‹ ·È-
Ù›· ı·Ó¿ÙÔ˘ ·fi Û·ÚÎÔ›‰ˆÛË. OÔ˘‰‹ÔÙ ·Ï-
ÏÔ‡ ÛÙÔÓ ÎfiÛÌÔ Ë ÈÔ Û˘¯Ó‹ ·ÈÙ›· ı·Ó¿ÙÔ˘ Â›Ó·È Ë
·Ó·Ó¢ÛÙÈ΋ ·ÓÂ¿ÚÎÂÈ·.
ÕÏÏÔÈ ·Ú¿ÁÔÓÙ˜ Ô˘ ¤¯Ô˘Ó Û˘Ó‰Âı› Ì ÙËÓ
ÂȉËÌÈÔÏÔÁ›· Ù˘ ÓfiÛÔ˘ ›ӷÈ:
1. °ÂˆÁÚ·ÊÈÎfi˜ ÙfiÔ˜: ∏ Û˘¯ÓfiÙËÙ· Ù˘ Ófi-
ÛÔ˘ ·˘Í¿ÓÂÙ·È ·fi ÙÔÓ ÈÛËÌÂÚÈÓfi ÚÔ˜ ÙÔ˘˜ fi-
ÏÔ˘˜. 2. OÈÎÔÁÂÓÂÈ·Îfi ÂÚÈ‚¿ÏÏÔÓ: Œ¯Ô˘Ó ÂÚÈ-
ÁÚ·Ê› ÂÚÈÙÒÛÂȘ Û·ÚÎÔ›‰ˆÛ˘ ÛÙËÓ ›‰È· ÔÈ-
238 §. ™πç∂∆π¢∏™, ¢. çøƒO™
ÎÔÁ¤ÓÂÈ·. 3. ∂›ÎÙËÙÔÈ ·Ú¿ÁÔÓÙ˜: ∏ ÓfiÛÔ˜ ·-
ÚÔ˘ÛÈ¿˙ÂÙ·È Û˘¯ÓfiÙÂÚ· Û ÌË Î·ÓÈÛÙ¤˜. 4. °ÂÓÂ-
ÙÈÎÔ› ·Ú¿ÁÔÓÙ˜: OÚÈṲ̂ÓÔÈ ÁÂÓÂÙÈÎÔ› ·Ú¿ÁÔ-
ÓÙ˜ ÌÔÚ› Ó· ·›˙Ô˘Ó ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ÎÏÈ-
ÓÈ΋ ÂÌÊ¿ÓÈÛË, ÙËÓ ÂͤÏÈÍË Î·È ÙËÓ ÚfiÁÓˆÛË Ù˘
ÓfiÛÔ˘. 5. ¶ÂÚÈ‚·ÏÏÔÓÙÈÎÔ› ·Ú¿ÁÔÓÙ˜: ¢È¿ÊÔÚÔÈ
ÂÚÈ‚·ÏÏÔÓÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ¤¯Ô˘Ó ÂÓÔ¯ÔÔÈËı›
ηٿ ηÈÚÔ‡˜ ˆ˜ Èı·Ó‹ ·ÈÙ›· Û·ÚÎÔ›‰ˆÛ˘. ∞fi
ÙÔ˘˜ ÏÔÈÌÒ‰ÂȘ ·Ú¿ÁÔÓÙ˜ ÙÔ Ì˘ÎÔ‚·ÎÙËÚ›‰ÈÔ Ù˘
Ê˘Ì·Ù›ˆÛ˘ ·ÔÙÂÏÔ‡Û ÁÈ· ÌÂÁ¿ÏÔ ¯ÚÔÓÈÎfi ‰È¿-
ÛÙËÌ· ÙÔ ÛËÌ·ÓÙÈÎfiÙÂÚÔ ‡ÔÙÔ ·ÈÙÈÔÏÔÁÈÎfi ·-
Ú¿ÁÔÓÙ·, ‰Â‰Ô̤ÓÔ˘ fiÙÈ Î·È ÛÙ· ‰‡Ô ÓÔÛ‹Ì·Ù· ·-
Ú·ÙËÚÔ‡ÓÙ·È ÎÔÎÎÈÒÌ·Ù· Ì ÌfiÓË ‰È·ÊÔÚ¿ ÙËÓ Ù˘-
ÚÔÂȉ‹ Ó¤ÎÚˆÛË ÛÙË Ê˘Ì·Ù›ˆÛË. ∏ ıˆڛ· ·˘Ù‹
‰ÂÓ ·ԉ›¯ÙËÎÂ, Ù· ÙÂÏÂ˘Ù·›· fï˜ ¯ÚfiÓÈ· ·Ó·-
˙ˆ˘ÚÒıËΠÙÔ ÂӉȷʤÚÔÓ ÁÈ· ÙËÓ Èı·ÓfiÙËÙ·
Û˘Û¯¤ÙÈÛ˘, ‰Â‰Ô̤ÓÔ˘ fiÙÈ Û ۷ÚÎÔÂȉÈΤ˜ ‚Ï¿-
‚˜ ·ÔÌÔÓÒıËΠ̠ƒCR ÙÔ DNA ÔÍ¿ÓÙÔ¯ˆÓ
Ì˘ÎÔ‚·ÎÙËÚȉ›ˆÓ5. ∂ÓÔ¯ÔÔÈ‹ıËÎÂ Î·È Ô Èfi˜ ∂p-
stein-Barr, ‰Â‰Ô̤ÓÔ˘ fiÙÈ ·Ú·ÙËÚ‹ıËΠ·‡ÍËÛË
ÙˆÓ ÂȉÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ÛÙÔÓ ÔÚfi ·ÙfiÌˆÓ ÌÂ
Û·ÚÎÔ›‰ˆÛË. ∆Ô ‚ËÚ‡ÏÏÈÔ, ÙÔ ·ÚÁ›ÏÈÔ Î·È ÙÔ ˙ÈÚ-
ÎfiÓÈÔ ÌÔÚ› Ó· ÚÔηϤÛÔ˘Ó ‰ËÌÈÔ˘ÚÁ›· ÎÔÎÎȈ-
Ì¿ÙˆÓ fiÌÔÈˆÓ Ì ÂΛӷ Ù˘ Û·ÚÎÔ›‰ˆÛ˘. ∞fi
ÚfiÛÊ·Ù˜ ÌÂϤÙ˜ ÛÙȘ ∏¶∞6 ‰ÂÓ ·ԉ›¯ÙËÎÂ
Û¯¤ÛË Û·ÚÎÔ›‰ˆÛ˘ Ì ÂÚÈ‚·ÏÏÔÓÙÈÎÔ‡˜ ·Ú¿-
ÁÔÓÙ˜. 6. ªÂÙ·ÌfiÛ¯Â˘ÛË ÔÚÁ¿ÓˆÓ Î·È Û·ÚÎÔ›-
‰ˆÛË: Œ¯ÂÈ ‚ÚÂı› fiÙÈ Û Ó‡ÌÔÓ˜ Ô˘ ¤¯Ô˘Ó ÌÂ-
Ù·ÌÔÛ¯Â˘Ù› Û ·ÛıÂÓ›˜ Ì ۷ÚÎÔ›‰ˆÛË ÙÂÏÈÎÔ‡
ÛÙ·‰›Ô˘ ÌÔÚ› Ó· ·Ó·Ù˘¯ÙÔ‡Ó ÎÔÎÎÈÒÌ·Ù·.
ÀÔÙÚÔ‹ Û·ÚÎÔ›‰ˆÛ˘ ¤¯ÂÈ ·Ú·ÙËÚËı› Â›-
Û˘ ÌÂÙ¿ ·fi ÌÂÙ·ÌfiÛ¯Â˘ÛË ¿ÏÏˆÓ ÔÚÁ¿ÓˆÓ.
∞ÓÙÈÛÙÚfiʈ˜, ¤¯Ô˘Ó ·Ó·ÊÂÚı› ÂÚÈÙÒÛÂȘ ÂÌ-
Ê¿ÓÈÛ˘ Ù˘ ÓfiÛÔ˘ Û ¿ÙÔÌ· Ù· ÔÔ›· ‰¤¯ÙËηÓ
ÌÔۯ‡̷ٷ ·fi ¿Û¯ÔÓÙ˜ ·fi Û·ÚÎÔ›‰ˆÛË. 7.
™·ÚÎÔ›‰ˆÛË Î·È ·ÓÔÛÔıÂÚ·›·: ∂ÌÊ¿ÓÈÛË ‹
˘ÔÙÚÔ‹ Ù˘ Û·ÚÎÔ›‰ˆÛ˘ ·Ú·ÙËÚ‹ıËΠÌÂÙ¿
·fi ¯ÔÚ‹ÁËÛË IFN-· Î·È IFN-‚. ™ÙÔÓ ·ıÔÊ˘ÛÈÔ-
ÏÔÁÈÎfi Ì˯·ÓÈÛÌfi ÂÌϤÎÔÓÙ·È Ù· Th ÏÂÌÊÔ·ÙÙ·-
Ú·7. ∏ ¯ÔÚ‹ÁËÛË IL–2 Û ·ÛıÂÓ›˜ Ì ∞πDS ÂÓÔ-
¯ÔÔÈ‹ıËΠÁÈ· ÙËÓ ÚfiÎÏËÛË Û·ÚÎÔ›‰ˆÛ˘.
∞¡O™O§O°π∞
∏ ‰ËÌÈÔ˘ÚÁ›· Û·ÚÎÔÂȉÈÎÒÓ ÎÔÎÎÈˆÌ¿ÙˆÓ Ê·›ÓÂ-
Ù·È fiÙÈ ÚÔηÏÂ›Ù·È ·fi ·‰È¢ÎÚ›ÓÈÛÙÔ ·ÓÙÈÁÔÓÈÎfi
ÂÚ¤ıÈÛÌ·, ÙÔ ÔÔ›Ô ÂÓÂÚÁÔÔÈ› Ù· ΢„ÂÏȉÈο Ì·-
ÎÚÔÊ¿Á· Ô˘ ·ÂÏ¢ıÂÚÒÓÔ˘Ó Î˘ÙÙ·ÚÔΛÓ˜ (IL-
1), ‰ÈÂÁ›ÚÔ˘Ó Ù· CD4 ∆-ÏÂÌÊÔ·ÙÙ·Ú· Ô˘ Ì ÙË
ÛÂÈÚ¿ ÙÔ˘˜ ·ÂÏ¢ıÂÚÒÓÔ˘Ó IL–2. ∏ ÙÂÏÂ˘Ù·›·
‰Ú· ˆ˜ ÙÔÈÎfi˜ ·˘ÍËÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÁÈ· Ù· ∆-
ÏÂÌÊÔ·ÙÙ·Ú·, Ù· ÔÔ›· ‰ÈÂÈÛ‰‡Ô˘Ó ÛÙÔ Ó¢ÌÔÓÈ-
Îfi ·Ú¤Á¯˘Ì· Î·È ¿ÏÏÔ˘˜ ÈÛÙÔ‡˜ Ì ÙÂÏÈÎfi ·ÔÙ¤-
ÏÂÛÌ· ÙËÓ ·Ó¿Ù˘ÍË Û·ÚÎÔÂȉÈÎÔ‡ ÎÔÎÎÈÒÌ·ÙÔ˜8.
∆· ·ÓÔÛÔÏÔÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο Ù˘ Û·ÚÎÔ-
›‰ˆÛ˘ ›ӷÈ:
1. ∫·Ù·ÛÙÔÏ‹ Ù˘ ÂÈ‚Ú·‰˘ÓfiÌÂÓÔ˘ Ù‡Ô˘ ˘Â-
Ú¢·ÈÛıËÛ›·˜. ∆· ∆-·ÙÙ·Ú· ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ·›-
Ì·ÙÔ˜ ·ÛıÂÓÒÓ Ì ÂÓÂÚÁfi Û·ÚÎÔ›‰ˆÛË ˘ÛÙÂÚÔ‡Ó
ÛËÌ·ÓÙÈο Û ··ÓÙËÙÈ΋ ÈηÓfiÙËÙ·9. ∏ ·ÓÂÓÂÚÁ›·
·˘Ù‹ ı· ÌÔÚÔ‡Û ӷ ÂÍËÁ‹ÛÂÈ ÙËÓ Î·Ù·ÛÙÔÏ‹ Ù˘
ÂÈ‚Ú·‰˘ÓfiÌÂÓ˘ ˘ÂÚ¢·ÈÛıËÛ›·˜ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜
Û ‰È¿ÊÔÚ· ·ÓÙÈÁfiÓ· (·ÚÓËÙÈ΋ Mantoux).
2. ™˘ÛÛÒÚ¢ÛË ∆-ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Î·È Ì·ÎÚÔ-
Ê¿ÁˆÓ ÛÙȘ ‚Ï¿‚˜.
3. ÀÂÚÁ·ÌÌ·ÛÊ·ÈÚÈÓ·ÈÌ›·. OÊ›ÏÂÙ·È ÛÙËÓ
ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ µ-ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ·fi Ù· ÂÓÂÚ-
ÁÔÔÈË̤ӷ Th ÏÂÌÊÔ·ÙÙ·Ú·.
4. ∞ÂÏ¢ı¤ÚˆÛË Î˘ÙÙ·ÚÔÎÈÓÒÓ ·fi Ù· Ì·-
ÎÚÔÊ¿Á·.
5. ∞Ó‡ÚÂÛË CD4 ÛÙ· ÎÔÎÎÈÒÌ·Ù·.
6. ∞‡ÍËÛË ÙÔ˘ ÏfiÁÔ˘ CD4/CD8 Û 5-15/1 ÛÙÔ
‚ÚÔÁ¯Ô΢„ÂÏȉÈÎfi ¤ÎÏ˘Ì·. ™ÙÔ 18% ÙˆÓ ·ÛıÂ-
ÓÒÓ Ì ۷ÚÎÔ›‰ˆÛË Ô ÏfiÁÔ˜ CD4/CD8 ‚Ú¤ıËÎÂ
οو ·fi 2. ∂ÓÒ ÛÙȘ Â͈ÁÂÓ›˜ ΢„ÂÏȉ›Ùȉ˜ fi-
Ô˘ ¯·Ú·ÎÙËÚÈÛÙÈο Ô ÏfiÁÔ˜ CD4/CD8 Â›Ó·È ¯·-
ÌËÏfi˜, ‚Ú¤ıËΠfiÙÈ ÛÙÔ 12% ÙˆÓ ÂÚÈÙÒÛÂˆÓ Â›-
Ó·È ¿Óˆ ·fi 3,510.
¶∞£O§O°π∫∏ ∞¡∞∆Oªπ∫∏
∆Ô ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÈÛÙÔÏÔÁÈÎfi ‡ÚËÌ· Ù˘ Û·ÚÎÔ-
›‰ˆÛ˘ Â›Ó·È ÙÔ ÌË ÓÂÎÚˆÙÈÎfi ÂÈıËÏÈÔÂȉ¤˜ ÎÔÎ-
ΛˆÌ·, Ô˘ ·ÔÙÂÏÂ›Ù·È ·fi ηϿ ‰È·ÊÔÚÔÔÈË̤-
Ó· ÌÔÓÔ‡ÚËÓ· Ê·ÁÔ·ÙÙ·Ú· (ÂÈıËÏÈÔÂȉ‹ ·Ù-
Ù·Ú· Î·È ÁÈÁ·ÓÙÔ·ÙÙ·Ú· Ù‡Ô˘ Langhans) ηÈ
ÏÂÌÊÔ·ÙÙ·Ú·. ∆· ÁÈÁ·ÓÙÔ·ÙÙ·Ú· ÌÔÚ› Ó· Â-
ÚȤ¯Ô˘Ó ·ÛÙÂÚÔÂȉ‹ ۈ̿ÙÈ· Î·È ÛˆÌ¿ÙÈ· Schau-
mann. ™ÙÔ Î¤ÓÙÚÔ ÙÔ˘ ÎÔÎÎÈÒÌ·ÙÔ˜ ˘¿Ú¯Ô˘Ó ΢-
Ú›ˆ˜ CD4 ÏÂÌÊÔ·ÙÙ·Ú·, ÂÓÒ ÛÙËÓ ÂÚÈʤÚÂÈ·
CD811. ∆Ô Û·ÚÎÔÂȉÈÎfi ÎÔÎΛˆÌ· ÌÔÚ› Ó· ·Ó·-
Ù‡ÍÂÈ Ô˘ÏÔÔ›ËÛË ·fi ÙËÓ ÂÚÈʤÚÂÈ· ÚÔ˜ ÙÔ
ΤÓÙÚÔ. ªÔÚ› Â›Û˘ Ó· ÂÌÊ·ÓÈÛÙ› ˘·ÏÔÂȉ‹˜
Ó¤ÎÚˆÛË. ™ÙÔ˘˜ Ó‡ÌÔÓ˜ Ù· ÎÔÎÎÈÒÌ·Ù· ÂÓÙÔ›-
˙ÔÓÙ·È ÛÙÔ ‰È¿ÌÂÛÔ ÈÛÙfi.
∫§π¡π∫∏ ∂π∫O¡∞
¶¡∂Àª√¡π∫∏™ ™∞ƒ∫√∂π¢ø™∏™
1. ªË ÂȉÈο Û˘ÌÙÒÌ·Ù·: ∆Ô ¤Ó· ÙÚ›ÙÔ ÙˆÓ ·ÛıÂ-
ÓÒÓ Ì ۷ÚÎÔ›‰ˆÛË ÂÌÊ·Ó›˙ÂÈ ÁÂÓÈο Û˘ÌÙÒÌ·-
Ù· fiˆ˜: ·. ¶˘ÚÂÙfi, Ô ÔÔ›Ô˜ Û˘Ó‹ıˆ˜ Â›Ó·È ¯·ÌË-
Ïfi˜, ·ÏÏ¿ ÌÔÚ› Ó· ÊÙ¿ÛÂÈ Ì¤¯ÚÈ 40Ô C. ∏ Û·ÚÎÔ-
›‰ˆÛË ·ÔÙÂÏ› Û˘¯Ó‹ ·ÈÙ›· ˘ÚÂÙÔ‡ ¿ÁÓˆÛÙ˘
 ∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 70, 4 239

·ÈÙÈÔÏÔÁ›·˜12, ‚. ∫·ÎÔ˘¯›·, Á. ∫·Ù·‚ÔÏ‹, ‰. ∞Ò-

ÏÂÈ· ‚¿ÚÔ˘˜. ™˘Ó‹ıˆ˜ 2 Ì 6 kg 3-4 Ì‹Ó˜ ÚÈÓ ·fi
ÙËÓ ÂÌÊ¿ÓÈÛË Ù˘ ÓfiÛÔ˘.
2. ™˘ÌÙÒÌ·Ù· ·fi ÙÔ ·Ó·Ó¢ÛÙÈÎfi: OÈ
Ó‡ÌÔÓ˜ ÚÔÛ‚¿ÏÏÔÓÙ·È ÛÙÔ 90% ÙˆÓ ·ÛıÂÓÒÓ
Ì ۷ÚÎÔ›‰ˆÛË. ∆· ·ÚÈ· Û˘ÌÙÒÌ·Ù· ·fi ÙÔ
·Ó·Ó¢ÛÙÈÎfi Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È ¤ˆ˜ Î·È ÛÙÔ 50%
ÙˆÓ ·ÛıÂÓÒÓ Ì ۷ÚÎÔ›‰ˆÛË Â›Ó·È: ·. •ËÚfi˜ ‚‹-
¯·˜, ‚. ¢‡ÛÓÔÈ·, Á. £ˆÚ·ÎÈÎfi ¿ÏÁÔ˜ Î·È ‰. ∞ÈÌfi-
Ù˘ÛË (Û¿ÓÈ·).
∏ ÎÏÈÓÈ΋ ÂÈÎfiÓ· Ù˘ Ó¢ÌÔÓÈ΋˜ Û·ÚÎÔ›-
‰ˆÛ˘ ÂÚÈÏ·Ì‚¿ÓÂÈ: ·. ™˘ÌÙÒÌ·Ù· ·fi ÙÔ ·Ó·-
Ó¢ÛÙÈÎfi ÛÙÔ 30-50% ÙˆÓ ÂÚÈÙÒÛˆÓ, ‚. °ÂÓÈο
Û˘ÌÙÒÌ·Ù· ÛÙÔ 30% ÙˆÓ ÂÚÈÙÒÛÂˆÓ Î·È Á. ¶·- ∂ÈÎ. 2. ∞ÌÊÔÙÂÚfiÏ¢ÚË ‰ÈfiÁΈÛË ˘Ï·›ˆÓ ÏÂÌÊ·‰¤-
ıÔÏÔÁÈ΋ ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη ¯ˆÚ›˜ Û˘ÌÙÒÌ·- ÓˆÓ, ‰È¿Û·ÚÙ˜ ·ÓÈÛÔÌÂÁ¤ıÂȘ Ô˙ȉȷΤ˜ ÛÎÈ¿ÛÂȘ
Ù· ÛÙÔ 20% ÙˆÓ ÂÚÈÙÒÛˆÓ. (ÛÙ¿‰ÈÔ ππ). ÕÚÚˆÛÙÔ˜ ÂÙÒÓ 23 Ì ∫veim ıÂÙÈ΋ Î·È ‚ÈÔ-
„›· ‰ÂÚÌ·ÙÈ΋ ıÂÙÈ΋.
∞∫∆π¡O§O°π∫∏ ∂π∫O¡∞
∞ÎÙÈÓÔÏÔÁÈο ‰È·ÎÚ›ÓÔ˘Ì 5 ÛÙ¿‰È· Ù˘ ÓfiÛÔ˘:
™Ù¿‰ÈÔ 0: º˘ÛÈÔÏÔÁÈ΋ ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη
(10%)
™Ù¿‰ÈÔ I: ¶˘Ï·›· ÏÂÌÊ·‰ÂÓ›Ùȉ· (50%), (∂ÈÎ. 1).
™Ù¿‰ÈÔ II: ¶˘Ï·›· ÏÂÌÊ·‰ÂÓ›Ùȉ· Î·È ·ÚÂÁ-
¯˘Ì·ÙÈΤ˜ ‚Ï¿‚˜ (20-30%), (∂ÈÎ. 2).
™Ù¿‰ÈÔ III: ¶·ÚÂÁ¯˘Ì·ÙÈΤ˜ ‚Ï¿‚˜ (10-
15%), (∂ÈÎ. 3).
™Ù¿‰ÈÔ IV: ¶Ó¢ÌÔÓÈ΋ ›ÓˆÛË ÌË ·Ó·ÛÙÚ¤„È-
ÌË, (∂ÈÎ. 4).
∞Û˘Ó‹ıÂȘ ‚Ï¿‚˜ ·ÔÙÂÏÔ‡Ó Ë ˘Â˙ˆÎÔÙÈ΋
Û˘ÏÏÔÁ‹ (∂ÈÎ. 5), Ô Ó¢ÌÔıÒڷη˜, ÔÈ Â·Û‚ÂÛÙÈ-
ˆÌ¤ÓÔÈ ÏÂÌÊ·‰¤Ó˜ (∂ÈÎ. 6) Î·È Ë Ù‹ÍË (Û‹Ï·ÈÔ) ∂ÈÎ. 3. ¢È¿¯˘Ù˜ ·ÓÔÌÔÈÔÁÂÓ›˜ ÛÎÈ¿ÛÂȘ (ÛÙ¿‰ÈÔ πππ).
(∂ÈÎ. 7)13. ÕÚÚˆÛÙÔ˜, ÂÙÒÓ 31, Ì ∫veim ıÂÙÈ΋ Î·È ‚ÈÔ„›· ‰¤ÚÌ·-
™˘ÓËı¤ÛÙÂÚ· Â˘Ú‹Ì·Ù· ÛÙË HRCT ıÒڷη ÙÔ˜ ıÂÙÈ΋.
›ӷÈ: ·. ¢È¿¯˘Ù˜ ÌÈÎÚÔÔ˙Ò‰ÂȘ ÛÎÈ¿ÛÂȘ (∂ÈÎ. 8),
‚. ¶¿¯˘ÓÛË ÌÂÛÔÏÔ‚›ˆÓ ‰È·ÊÚ·ÁÌ¿ÙˆÓ (∂ÈÎ. 9), Á.

∂ÈÎ. 4. ∂ÎÙÂٷ̤ÓË Ó¢ÌÔÓÈ΋ ›ÓˆÛË. ¶·Ú·ÙËÚÔ‡ÓÙ·È

Â·Û‚ÂÛÙȈ̤ÓÔÈ ·‰¤Ó˜ ·ÚÈÛÙÂÚ¿ (ÛÙ¿‰ÈÔ πV). ÕÚÚˆ-
∂ÈÎ. 1. ∞ÌÊÔÙÂÚfiÏ¢ÚË ‰ÈfiÁΈÛË ˘Ï·›ˆÓ Î·È ·Ú·ÙÚ·- ÛÙË, ÂÙÒÓ 70, Ì ∫veim ıÂÙÈ΋ Î·È ‚ÈÔ„›· ÏÂÌÊ·‰¤Ó· ıÂ-
¯ÂÈ·ÎÒÓ ÏÂÌÊ·‰¤ÓˆÓ (ÛÙ¿‰ÈÔ π). ÕÚÚˆÛÙË ÂÙÒÓ 21. ÙÈ΋.
240 §. ™πç∂∆π¢∏™, ¢. çøƒO™
∂ÈÎ. 5. ¢È¿Û·ÚÙ˜ ‰ÈÎÙ˘ÔÔ˙Ò‰ÂȘ ÛÎÈ¿ÛÂȘ. ¢È·ÎÚ›ÓÂ-
Ù·È Û˘ÏÏÔÁ‹ ˘ÁÚÔ‡ ‰ÂÍÈ¿ (ÛÙ¿‰ÈÔ πππ). ÕÚÚˆÛÙÔ˜, ÂÙÒÓ
25, Ì ıÂÙÈ΋ ∫veim Î·È ‚ÈÔ„›Â˜ ‰¤ÚÌ·ÙÔ˜ Î·È ˘Â˙ˆÎfi-
Ù· ıÂÙÈΤ˜.
∂ÈÎ. 6. ∂·Û‚ÂÛÙÈÒÛÂȘ ‰›ÎËÓ ÎÂχÊÔ˘˜ ·˘ÁÔ‡ (egg
shell). ÕÚÚˆÛÙË, ÂÙÒÓ 56, Ì ∫veim ıÂÙÈ΋ Î·È ‚ÈÔ„›·
ÏÂÌÊ·‰¤Ó· ıÂÙÈ΋.
∂ÈÎ. 7. ¢È¿Û·ÚÙ˜ ÌÂÁ·ÏÔÔ˙Ò‰ÂȘ ÛÎÈ¿ÛÂȘ Ì ÂÈÎfiÓ·
Ù‹Í˘ (ÛÙ¿‰ÈÔ πππ). ÕÚÚˆÛÙÔ˜, ÂÙÒÓ 55, Ì ∫veim ıÂÙÈ΋
Î·È ‚ÈÔ„›· Ó‡ÌÔÓ· ıÂÙÈ΋.
∂ÈÎ. 9. HRCT ·Ú·ÙËÚÔ‡ÓÙ·È: ·) ∂˘ı¤· ‚¤ÏË: µÚÔÁ¯Â-
Îٷۛ˜ Î·È ‚) ∫˘ÚÙ¿ ‚¤ÏË: ¶¿¯˘ÓÛË ÌÂÛÔÏÔ‚›ˆÓ ‰È·-
ÊÚ·ÁÌ¿ÙˆÓ.
∂ÈÎ. 8. ∏RCT ·Ú·ÙËÚÔ‡ÓÙ·: ·) µ¤ÏË: Ô˙›‰È· ηٿ Ì‹-
ÎÔ˜ ÙˆÓ ‚ÚfiÁ¯ˆÓ Î·È ‚) ∫ÂʷϤ˜ ‚ÂÏÒÓ: Ô˙›‰È· ηٿ Ì‹-
ÎÔ˜ ·ÁÁ›ˆÓ.
∂ÈÎfiÓ· ıÔÏ‹˜ ˘¿ÏÔ˘ (ground-glass) (∂ÈÎ. 10), ‰.
¢È·Ù·Ú·¯‹ Ù˘ ·Ú¯ÈÙÂÎÙÔÓÈ΋˜ ‰ÔÌ‹˜ (∂ÈÎ. 11) ηÈ
Â. K‡ÛÙÂȘ Î·È ‚ÚÔÁ¯ÂÎٷۛ˜.
¢π∞°¡ø™∆π∫Oπ Ã∂πƒπ™ªOπ
OÈ ‰È·ÁÓˆÛÙÈÎÔ› ¯ÂÈÚÈÛÌÔ› ÛÙË Û·ÚÎÔ›‰ˆÛË ÂÚÈ-
Ï·Ì‚¿ÓÔ˘Ó: 1. πÛÙÔÚÈÎfi-Ê˘ÛÈ΋ ÂͤٷÛË, 2. ∞ÎÙÈ-
ÓÔÁÚ·Ê›·-HRCT Ó¢ÌfiÓˆÓ, 3. ∞ÓÙ›‰Ú·ÛË Kve-
im, Ë ÔÔ›· Â›Ó·È ‰ÂÚÌÔ·ÓÙ›‰Ú·ÛË ÛÙËÓ ÔÔ›· Á›-
ÓÂÙ·È ¤Á¯˘ÛË ÂÓ‰Ô‰ÂÚÌÈο, ÛÙËÓ ÚfiÛıÈ· ÂÈÊ¿-
ÓÂÈ· ÙÔ˘ ·ÓÙÈ‚Ú·¯›Ô˘, Î·È Û ÔÛfiÙËÙ· 0,1-0,2 ml,
·ÓıÚÒÈÓÔ˘ Û·ÚÎÔÂȉÈÎÔ‡ ÈÛÙÔ‡, Ô ÔÔ›Ô˜ Ï·Ì‚¿-
ÓÂÙ·È ·fi ¤Ó· ÙÚ·¯ËÏÈÎfi ÏÂÌÊ·‰¤Ó· ·ÛıÂÓÔ‡˜ ÌÂ
Û·ÚÎÔ›‰ˆÛË. ªÂÙ¿ 20 Ë̤Ú˜ Ï·Ì‚¿ÓÂÙ·È ‚ÈÔ„›·
 ∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 70, 4
∂ÈÎ. 10. HRCT ·Ú·ÙËÚÔ‡ÓÙ·È: ·) ∂ÈÎfiÓ· ıÔÏ‹˜ ˘¿ÏÔ˘
Î·È ‚) ∞ÌÊÔÙÂÚfiÏ¢ÚË ÏÂÌÊ·‰ÂÓ›Ùȉ·.
Î·È Â› ıÂÙÈÎÔ‡ ·ÔÙÂϤÛÌ·ÙÔ˜ ·ÔηχÙÂÙ·È
Û·ÚÎÔÂȉÈÎfi˜ ÈÛÙfi˜. ∏ ·ÓÙ›‰Ú·ÛË ‰ÂÓ ÂÊ·ÚÌfi˙Â-
Ù·È ϤÔÓ, 4. ∞ÁÁÂÈÔÌÂÙ·ÙÚÂÙÈÎfi ¤Ó˙˘ÌÔ ÙÔ˘ ÔÚÔ‡
(SACE). ∆Ô 25% ÂÚ›Ô˘ ÙˆÓ ·ÛıÂÓÒÓ ÌÂ ÂÓÂÚÁfi
Û·ÚÎÔ›‰ˆÛË ‰ÂÓ ¤¯Ô˘Ó ·˘ÍË̤ÓÔ ÙÔ ¤Ó˙˘ÌÔ ·˘Ùfi
ÛÙÔÓ ÔÚfi, ˘¿Ú¯Ô˘Ó ‰Â Î·È ¿ÏÏ· ÓÔÛ‹Ì·Ù·, fiˆ˜ Ë
ϤÚ·, Ë Ïԛ̈ÍË ·fi ¿Ù˘· Ì˘ÎÔ‚·ÎÙËÚ›‰È·, Ë
Ó¢ÌÔÓ›· ÂÍ ˘ÂÚ¢·ÈÛıËÛ›·˜, Ë ·Ì˘ÏÔ›‰ˆÛË, Ë
ȉÈÔ·ı‹˜ Ó¢ÌÔÓÈ΋ ›ÓˆÛË, Ô ˘ÂÚı˘ÚÂÔÂȉÈ-
ÛÌfi˜, Ë Ë·Ù›Ùȉ·, Ë ·ÏÎÔÔÏÈ΋ ΛÚÚˆÛË Î.¿. ÛÙ·
ÔÔ›· ÌÔÚ› Ó· ·ÚÔ˘ÛÈ¿˙ÂÙ·È ·‡ÍËÛË ÙÔ˘
SACE14,15, 5. ™ÈÓıËÚÔÁÚ¿ÊËÌ· ÌÂ Á¿ÏÏÈÔ-67. ∆Ô
Á¿ÏÏÈÔ-67 ¤¯ÂÈ ÙËÓ Ù¿ÛË Ó· ‰ÂÛ̇ÂÙ·È ·fi Ù· Ì·-
ÎÚÔÊ¿Á· Î·È Ù· ÎÔÎÎÈÔ·ÙÙ·Ú·16. ÃÔÚËÁÂ›Ù·È ÂÓ-
‰ÔÊϤ‚È· Î·È ÙÔ ÛÈÓıËÚÔÁÚ¿ÊËÌ· Á›ÓÂÙ·È ÌÂÙ¿
·fi ÙÚÂȘ Ë̤Ú˜, ÔfiÙÂ Î·È ·ÔηχÙÂÙ·È ‰È¿¯˘-
ÙË ·‡ÍËÛË Ù˘ Û˘ÁΤÓÙÚˆÛ‹˜ ÙÔ˘ ÛÙ· Û·ÚÎÔÂȉÈο
ÎÔÎÎÈÒÌ·Ù·. Ÿˆ˜ Î·È ÙÔ SACE, Ô ‚·ıÌfi˜ Ù˘
ÚfiÛÏ˄˘ ÙÔ˘ Á·ÏÏ›Ô˘-67 ÂËÚ¿˙ÂÙ·È ·ÚÓËÙÈο
·fi ÙË ¯ÔÚ‹ÁËÛË ÎÔÚÙÈÎÔÛÙÂÚÔÂȉÒÓ. ∆Ô ÛÈÓıË-
ÚÔÁÚ¿ÊËÌ· ÌÔÚ› Ó· Â›Ó·È ıÂÙÈÎfi Î·È Û ÂÚÈ-
ÙÒÛÂȘ ÌÈÙˆÙÈÎÒÓ Î·È ÊÏÂÁÌÔÓˆ‰ÒÓ ÂÍÂÚÁ·ÛÈÒÓ
ÙÔ˘ Ó‡ÌÔÓ·, 6. µÚÔÁ¯Ô΢„ÂÏȉÈ΋ ¤ÎÏ˘ÛË. ÷-
Ú·ÎÙËÚÈÛÙÈÎfi ‡ÚËÌ· Ë Û¯¤ÛË CD4/CD8 5-15/1, 7.
µÈÔ„›·. ∏ ̤ıÔ‰Ô˜ Ô˘ ÂÊ·ÚÌfi˙ÂÙ·È ÛÙȘ ÂÚÈÛ-
ÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ Â›Ó·È Ë ‰È·‚ÚÔÁ¯È΋ ‚ÈÔ„›·
Ó‡ÌÔÓ·. µÈÔ„›· ÌÔÚ› Ó· Á›ÓÂÈ Î·È ·fi ÙȘ ÔÚ·-
Ù¤˜ ·ÏÏÔÈÒÛÂȘ ÙÔ˘ ‚ÚÔÁ¯ÈÎÔ‡ ‚ÏÂÓÓÔÁfiÓÔ˘. °È·
¤Ó·Ó ¤ÌÂÈÚÔ ‚ÚÔÁ¯ÔÛÎfiÔ Ë Ì·ÎÚÔÛÎÔÈ΋ ÂÈÎfi-
Ó· ÙˆÓ ‚ÚfiÁ¯ˆÓ Â›Ó·È Ì¿ÏÏÔÓ ·ıÔÁÓˆÌÈ΋. ŸÙ·Ó
ÔÈ ·Ú·¿Óˆ Â›Ó·È ·ÚÓËÙÈΤ˜ Î·È ˘¿Ú¯Ô˘Ó ‚Ï¿-
‚˜ ÛÙÔ Ó¢ÌÔÓÈÎfi ·Ú¤Á¯˘Ì·, Ú¤ÂÈ Ó· Á›ÓÂÙ·È
·ÓÔÈÎÙ‹ ‚ÈÔ„›· Ó‡ÌÔÓ·. ∏ ‡·ÚÍË ÏÂÌÊ·‰¤ÓˆÓ
ÛÙÔ ÌÂÛÔıˆÚ¿ÎÈÔ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û ÌÂÛÔıˆ-
Ú·ÎÔÛÎfiËÛË Î·È ‚ÈÔ„›· ÏÂÌÊ·‰¤ÓˆÓ. ÕÏϘ ı¤-
241
∂ÈÎ. 11. HRCT ·Ú·ÙËÚÔ‡ÓÙ·È: ·) µÚÔÁ¯ÂÎٷۛ˜ ηÈ
‚) ¢È·Ù·Ú·¯‹ Ù˘ ·Ú¯ÈÙÂÎÙÔÓÈ΋˜.
ÛÂȘ ‚ÈÔ„›·˜ Â›Ó·È ÙÔ ‰¤ÚÌ·, ÔÈ ÂÚÈÊÂÚÈÎÔ› ÏÂÌ-
Ê·‰¤Ó˜, ÙÔ ‹·Ú, Ë ÚÔÛηÏËÓÈ΋ ¯ÒÚ· (΢ڛˆ˜
‰ÂÍÈ¿), ÔÈ Ì‡Â˜ Ù˘ Á·ÛÙÚÔÎÓËÌ›·˜ Î·È Ù· ¯Â›ÏË. ∆Ô
Ô˙҉˜ ÂÚ‡ıËÌ· ‰›ÓÂÈ ÙËÓ ÂÈÎfiÓ· ÌË ÂȉÈ΋˜ ·Á-
ÁÂÈ›Ùȉ·˜ ¯ˆÚ›˜ ÙËÓ ‡·ÚÍË ÎÔÎÎȈ̿وÓ, ÔfiÙ Ë
‚ÈÔ„›· ‰ÂÓ ¤¯ÂÈ Î·Ó¤Ó· ÓfiËÌ·. øÛÙfiÛÔ ÙÔ Ô˙҉˜
ÂÚ‡ıËÌ· Ú¤ÂÈ, Ì ÙȘ ÛËÌÂÚÈÓ¤˜ ÁÓÒÛÂȘ, Ó· Ô‰Ë-
Á‹ÛÂÈ ÛÙËÓ ·Ó·˙‹ÙËÛË Ù˘ ÓfiÛÔ˘, 8. ¢È·Ù·Ú·¯¤˜
Ù˘ ·Ó·Ó¢ÛÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›·˜. ¶·Ú·ÙËÚÔ‡ÓÙ·È
ÛÙÔ 20% ÙˆÓ ·ÛıÂÓÒÓ ÛÙ·‰›Ô˘ π Û ۇÁÎÚÈÛË Ì ÙÔ
40-70% ÙˆÓ ·ÛıÂÓÒÓ ÛÙ·‰›ˆÓ ππ, πππ ‹ IV. OÈ Û˘-
ÓËı¤ÛÙÂÚ˜ ‰È·Ù·Ú·¯¤˜ Â›Ó·È Ë Ì›ˆÛË Ù˘ ‰È¿¯˘-
Û˘ Î·È Ù˘ ˙ˆÙÈ΋˜ ¯ˆÚËÙÈÎfiÙËÙ·˜17. ¶·Ú·ÙËÚÔ‡-
ÓÙ·È ÌÈÎÙ¤˜ ‰È·Ù·Ú·¯¤˜, ÂÚÈÔÚÈÛÙÈÎÔ‡ Î·È ·Ô-
ÊÚ·ÎÙÈÎÔ‡ Ù‡Ô˘18 (¶›Ó. 1), 9. ∞¤ÚÈ· ·ÚÙËÚÈ·ÎÔ‡
·›Ì·ÙÔ˜. ÀÔ͢ÁÔÓ·ÈÌ›· Î·È ¯ÚfiÓÈ· ˘ÔηÓ›·,
10. ∞ÈÌ·ÙÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜. ∞ÈÌÔÏ˘ÙÈ΋ ·Ó·ÈÌ›·,
11. OÊı·ÏÌÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜. ƒ·ÁÔÂȉ›Ùȉ·, 12.
∏∫°. ∞ÚÚ˘ı̛˜, ‰È·Ù·Ú·¯¤˜ Ù˘ ·ÁˆÁÈÌfiÙËÙ·˜,
Â˘Ú‹Ì·Ù· ηډȷ΋˜ ·ÓÂ¿ÚÎÂÈ·˜.
¶›Ó·Î·˜ 1. ¢È·Ù·Ú·¯¤˜ Ó¢ÌÔÓÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜
™Ù¿‰ÈÔ I ™Ù¿‰È· II-III-IV
% ·ÛıÂÓÒÓ ÌÂ
·ıÔÏÔÁÈΤ˜ ‰ÔÎÈ̷ۛ˜
DLCO 55 92
FVC 20 65
TLC 10-15 60
FEF 25-75% 40 50
¢ƒ∞™∆∏ƒπO∆∏∆∞ ∆∏™ ¡O™OÀ
O ηıÔÚÈÛÌfi˜ Ù˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Ù˘ ÓfiÛÔ˘ Á›ÓÂ-
Ù·È Ì ‚¿ÛË ÎÏÈÓÈÎÔ‡˜ ‰Â›ÎÙ˜ Ô˘ ·ÊÔÚÔ‡Ó ÛÙÔÓ
ÙÚfiÔ ÂÌÊ¿ÓÈÛ˘ Ù˘ ÓfiÛÔ˘ Î·È ÙËÓ Âȉ›ӈÛË ‹
242 §. ™πç∂∆π¢∏™, ¢. çøƒO™
·Ú·ÌÔÓ‹ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙË
Û·ÚÎÔ›‰ˆÛË. OÈ ÎÏÈÓÈÎÔ› ‰Â›ÎÙ˜ Â›Ó·È Ù· ÁÂÓÈο
Û˘ÌÙÒÌ·Ù· (˘ÚÂÙfi˜, ·ÚıÚ·ÏÁ›Â˜), Ù· Û˘ÌÙÒÌ·-
Ù· ·fi ÙÔ ·Ó·Ó¢ÛÙÈÎfi Î·È ÎÏÈÓÈο ÛËÌ›·, fiˆ˜
ÙÔ Ô˙҉˜ ÂÚ‡ıËÌ·, Ë ÈÚȉÔ΢ÎÏ›Ùȉ·, Ë ‰ÈfiÁΈÛË
·ÚˆÙ›‰ˆÓ, ‰·ÎÚ˘ÈÎÒÓ ·‰¤ÓˆÓ Î·È ÏÂÌÊ·‰¤ÓˆÓ.
OÈ ÂÚÁ·ÛÙËÚÈ·ÎÔ› ‰Â›ÎÙ˜ ·ÊÔÚÔ‡Ó ÂÍÂÙ¿ÛÂȘ ‚ÈÔ-
¯ËÌÈΤ˜, ·ÎÙÈÓÔÏÔÁÈΤ˜ Î·È Ú·‰ÈÔ˚ÛÔÙÔÈΤ˜. OÈ
΢ÚÈfiÙÂÚÔÈ ‰Â›ÎÙ˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Ù˘ ÓfiÛÔ˘ ›-
Ó·È: 1. SACE, 2. ∞Û‚¤ÛÙÈÔ Ô‡ÚˆÓ ·›Ì·ÙÔ˜, 3. ™È-
ÚÔ̤ÙÚËÛË-¢È¿¯˘ÛË, 4. BAL CD4/CD8, 5. ∏∫°, 6.
µÈÔ¯ËÌÈΤ˜ ÂÍÂÙ¿ÛÂȘ ‹·ÙÔ˜, 7. ∞/· ‹ HRTC
Ó¢ÌfiÓˆÓ, 8. ™ÈÓıËÚÔÁÚ¿ÊËÌ· Ì Á¿ÏÏÈÔ-67, 9.
ºÏÔ˘ÔÚÔ·ÁÁÂÈÔÁÚ·Ê›· ÔÊı·ÏÌÒÓ Î·È 10. ªRI ‹
CT ÂÁÎÂÊ¿ÏÔ˘.
∂•ø£øƒ∞∫π∫∂™ ∂∫¢∏§ø™∂π™
™∞ƒ∫√∂π¢ø™∏™
∆Ô ÔÛÔÛÙfi Ù˘ Â͈Ó¢ÌÔÓÈ΋˜ Û·ÚÎÔ›‰ˆÛ˘
˘ÔÏÔÁ›˙ÂÙ·È ÛÙÔ 17% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ÂÚÈÙÒ-
ÛˆÓ, Ë ‰Â ‰È¿ÁÓˆÛË Â›Ó·È ‰‡ÛÎÔÏË ÏfiÁˆ Ù˘ Ô-
χÌÔÚÊ˘ ÎÏÈÓÈ΋˜ Û˘Ìو̷ÙÔÏÔÁ›·˜. OÈ ÂΉË-
ÏÒÛÂȘ ·fi Ù· ‰È¿ÊÔÚ· Û˘ÛÙ‹Ì·Ù· ¤¯Ô˘Ó ˆ˜ ÂÍ‹˜:
– OÊı·ÏÌÔ›: ∏ Û˘¯ÓfiÙËÙ· ÚÔÛ‚ÔÏ‹˜ ÏËÛÈ¿-
˙ÂÈ ÙÔ 25% Î·È Â›Ó·È ÈÔ Û˘¯Ó‹ Û Á˘Ó·›Î˜ ·Ó·-
·Ú·ÁˆÁÈ΋˜ ËÏÈΛ·˜. ∏ Ú·ÁÔÂȉ›Ùȉ· Â›Ó·È Ë Û˘-
¯ÓfiÙÂÚË ÂΉ‹ÏˆÛË. ∏ ÚfiÛıÈ· Ú·ÁÔÂȉ›Ùȉ· ‰È·-
ÎÚ›ÓÂÙ·È Û ÔÍ›· Î·È ¯ÚfiÓÈ· ÈÚȉÔ΢ÎÏ›Ùȉ·. ∏ Ô-
Í›· ÈÚȉÔ΢ÎÏ›Ùȉ· Â›Ó·È ·ÈÊÓ›‰È·, Ì ıÔÚ˘‚Ò‰Ë
¤Ó·ÚÍË Ì fiÓÔ, ʈÙÔÊÔ‚›·, ı¿Ì‚Ô˜ Î·È ÂÚ˘ıÚfi-
ÙËÙ· ÔÊı·ÏÌÒÓ. ªÔÚ› Ó· ˘Ô¯ˆÚ‹ÛÂÈ ·˘ÙfiÌ·Ù·
¯ˆÚ›˜ Ó· ·Ê‹ÛÂÈ ÌfiÓÈ̘ ‚Ï¿‚˜. ∏ ¯ÚfiÓÈ·
ÈÚȉÔ΢ÎÏ›Ùȉ· ¤¯ÂÈ ‡Ô˘ÏË ¤Ó·ÚÍË, Ì ̷ÎÚ¿ Ô-
Ú›· Î·È Ë ›ÓˆÛË Ô˘ Û˘Ó‹ıˆ˜ ·ÎÔÏÔ˘ı› Ô‰ËÁ› ÛÂ
ÁÏ·‡ÎˆÌ· Î·È Î·Ù·ÚÚ¿ÎÙË. ∏ Ô›ÛıÈ· Ú·ÁÔÂȉ›ÙÈ-
‰· ‰È·ÁÈÁÓÒÛÎÂÙ·È ‰‡ÛÎÔÏ· Î·È ÂÊfiÛÔÓ ‰ÂÓ ·ÓÙÈÌÂ-
ÙˆÈÛÙ› ¤ÁηÈÚ·, ηٷϋÁÂÈ Û هÊψÛË. ™˘¯Ó‹ Ô-
Êı·ÏÌÔÏÔÁÈ΋ ÂΉ‹ÏˆÛË Â›Ó·È Î·È Ë ÂÈÂÊ˘Î›Ùȉ·.
– °·ÛÙÚÂÓÙÂÚÈÎfi Û‡ÛÙËÌ·: ∏ Û˘¯ÓfiÙËÙ· ÚÔ-
Û‚ÔÏ‹˜ ÙÔ˘ ‹·ÙÔ˜ Â›Ó·È 25% Î·È Ù· Û·ÚÎÔÂȉÈο
ÎÔÎÎÈÒÌ·Ù· ‰ÂÓ ‰ËÌÈÔ˘ÚÁÔ‡Ó Û˘Ó‹ıˆ˜ Û˘ÌÙÒÌ·-
Ù·. ∏ ·ÏηÏÈ΋ ʈÛÊ·Ù¿ÛË Î·È Ë ·Û·ÚÙÈ΋ ÙÚ·Ó-
Û·ÌÈÓ¿ÛË (SGPT) ÌÔÚ› Ó· Â›Ó·È ·˘ÍË̤Ó˜. ™˘-
Ó‹ı˘ Â›Ó·È Î·È Ë ÛÏËÓÔÌÂÁ·Ï›·.
– ¡Â˘ÚÈÎfi Û‡ÛÙËÌ·: ¶ÚÔÛ‚ÔÏ‹ ‰È·ÈÛÙÒÓÂ-
Ù·È Û ÔÛÔÛÙfi 10% ÙˆÓ ·ÛıÂÓÒÓ Ì ۷ÚÎÔ›‰ˆ-
ÛË. ∏ ÈÔ Û˘¯Ó‹ ÂΉ‹ÏˆÛË Â›Ó·È Ë ¿ÚÂÛË ÙÔ˘
ÚÔÛˆÈÎÔ‡ Ó‡ÚÔ˘, ÂÙÂÚfiÏ¢ÚË ‹ ·ÌÊÔÙÂÚfi-
Ï¢ÚË. ÕÏϘ ÂΉËÏÒÛÂȘ Â›Ó·È Ë ÌËÓÈÁÁ›Ùȉ·, Ë
ÌËÓÈÁÁÔÂÁÎÂÊ·Ï›Ùȉ·, ÔÈ ÂÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ ηÈ
ÔÈ ÂÚÈÊÂÚÈΤ˜ Ó¢ÚÔ¿ıÂȘ.
– ∫·Ú‰È·ÁÁÂÈ·Îfi Û‡ÛÙËÌ·: ¢È·ÈÛÙÒıËÎÂ,
ÓÂÎÚÔÙÔÌÈο, ÚÔÛ‚ÔÏ‹ 5 ¤ˆ˜ 30%. ∂ΉËÏÒÓÂÙ·È
Ì ·ÚÔ͢ÛÌÈΤ˜ ÎÔÈÏȷΤ˜ Î·È ˘ÂÚÎÔÈÏȷΤ˜ ·Ú-
Ú˘ı̛˜, Ï‹ÚË ÎÔÏÔÎÔÈÏÈ·Îfi ·ÔÎÏÂÈÛÌfi, ·Ô-
ÎÏÂÈÛÌÔ‡˜ ‰ÂÌ·Ù›Ô˘, ·ÓÂ¿ÚÎÂÈ· Ù˘ ·ÚÈÛÙÂÚ‹˜
ÎÔÈÏ›·˜, ‚·Ï‚ȉÈΤ˜ ‰˘ÛÏÂÈÙÔ˘ÚÁ›Â˜ (Û˘¯ÓfiÙÂÚ·
·ÓÂ¿ÚÎÂÈ· Ù˘ ÌÈÙÚÔÂȉԇ˜), ÛÙËı·Á¯ÈÎfi fiÓÔ
ÏfiÁˆ Ù˘ Û˘ÌÌÂÙÔ¯‹˜ ÙˆÓ ÌÈÎÚÒÓ ·ÁÁ›ˆÓ, Ì˘Ô-
ηډÈÔ¿ıÂÈ·, ·Ó‡ڢÛÌ· ÎÔÈÏ›·˜ Î·È ·ÈÊÓ›‰ÈÔ
ı¿Ó·ÙÔ19. ∆Ô ÛÈÓıËÚÔÁÚ¿ÊËÌ· ÌÂ ı¿ÏÏÈÔ ·ÔÙÂ-
Ï› ¯Ú‹ÛÈÌË Ì¤ıÔ‰Ô ÁÈ· ÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË
Ù˘ Û·ÚÎÔ›‰ˆÛ˘ ÙÔ˘ Ì˘Ôηډ›Ô˘ ·fi ÙË ‰Â˘ÙÂ-
ÚÔ·ı‹ ÚÔÛ‚ÔÏ‹ Ù˘ ηډȿ˜.
– O˘ÚÔÔÈËÙÈÎfi Û‡ÛÙËÌ·: ∏ Û˘¯ÓfiÙËÙ· ÚÔ-
Û‚ÔÏ‹˜, Ô˘ ‰È·ÈÛÙÒÓÂÙ·È ÓÂÎÚÔÙÔÌÈο, ·Ó¤Ú¯ÂÙ·È
ÛÙÔ 10-20%. ∏ Û·ÚÎÔ›‰ˆÛË ÚÔηÏ› ÓÂÊÚÈ΋ Ófi-
ÛÔ Ì ‰‡Ô Ì˯·ÓÈÛÌÔ‡˜ ·fiÏ˘Ù· ‰È¢ÎÚÈÓÈṲ̂ÓÔ˘˜:
·. ªÂ ·¢ı›·˜ Û˘ÌÌÂÙÔ¯‹ ÙˆÓ ÓÂÊÚÒÓ Ë ÔÔ›·
ÚÔηÏ› ÎÔÎÎȈ̷ÙÒ‰Ë ‰È¿ÌÂÛË ÓÂÊÚ›Ùȉ· Î·È ‚.
ª¤Ûˆ ÙˆÓ ÂÈÙÒÛÂˆÓ Ù˘ ‰È·Ù·Ú·¯‹˜ ÌÂÙ·‚ÔÏÈ-
ÛÌÔ‡ ÙÔ˘ ·Û‚ÂÛÙ›Ô˘ Ë ÔÔ›· Ô‰ËÁ› Û ÓÂÊÚ·Û‚¤-
ÛÙˆÛË, Ô˘ÚÔÏÈı›·ÛË ‹ ˘ÂÚ·Û‚ÂÛÙÈ·ÈÌÈ΋ ÓÂÊÚÈ΋
·ÓÂ¿ÚÎÂÈ·20. ∏ ‰È·Ù·Ú·¯‹ ÛÙÔ ÌÂÙ·‚ÔÏÈÛÌfi ÙÔ˘
·Û‚ÂÛÙ›Ô˘ ÛÙË Û·ÚÎÔ›‰ˆÛË ÔÊ›ÏÂÙ·È Û ·‡ÍËÛË
ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ ‚ÈÙ·Ì›Ó˘ D Ô˘ ·Ú¿ÁÂÙ·È ·fi
Ù· Ì·ÎÚÔÊ¿Á· ÛÙ· Û·ÚÎÔÂȉÈο ÎÔÎÎÈÒÌ·Ù·. ∞˘Ùfi
ÙÔ ÁÂÁÔÓfi˜ Ô‰ËÁ› ÛÙËÓ ·‡ÍËÛË Ù˘ ·ÔÚÚfiÊËÛ˘
ÙÔ˘ ·Û‚ÂÛÙ›Ô˘ ·fi ÙÔ ÏÂÙfi ¤ÓÙÂÚÔ, Ì ·ÔÙ¤ÏÂ-
ÛÌ· ˘ÂÚ·Û‚ÂÛÙÈ·ÈÌ›· Î·È ·Û‚ÂÛÙÈÔ˘Ú›·.
– ∞ÈÌÔÔÈËÙÈÎfi Û‡ÛÙËÌ·: ¶·Ú·ÙËÚÂ›Ù·È ˘-
ÂÚÛÏËÓÈÛÌfi˜ Ì Â·ÎfiÏÔ˘ıÔ ıÚÔÌ‚ÔÂÓ›·, ·È-
ÌÔÏ˘ÙÈ΋ ·Ó·ÈÌ›· ÌÂ Û˘¯ÓfiÙËÙ· 30%, Ï¢ÎÔÂÓ›·
Î·È ÏÂÌÊÔÂÓ›· ÌÂ Û˘¯ÓfiÙËÙ· 30%, ˆÛÈÓÔÊÈÏ›·
ÌÂ Û˘¯ÓfiÙËÙ· 30% Î·È ‰ÈfiÁΈÛË ÙˆÓ ÏÂÌÊ·‰¤ÓˆÓ.
– ª˘ÔÛÎÂÏÂÙÈÎfi Û‡ÛÙËÌ·: ¶ÚÔÛ‚¿ÏÏÂÙ·È ÛÂ
Û˘¯ÓfiÙËÙ· 40%. ∏ ÚÔÛ‚ÔÏ‹ ÙˆÓ ÔÛÙÒÓ Û˘¯ÓfiÙÂ-
Ú· ·ÊÔÚ¿ ÛÙȘ ÙÂÏÈΤ˜ Ê¿Ï·ÁÁ˜ ÙˆÓ ‰·ÎهψÓ
ÙˆÓ ¯ÂÚÈÒÓ Î·È ÙˆÓ Ô‰ÈÒÓ. ∞ÎÙÈÓÔÏÔÁÈο ‰È·È-
ÛÙÒÓÔÓÙ·È Î˘ÛÙÈΤ˜ ·ÏÏÔÈÒÛÂȘ ÙˆÓ Ê·Ï¿ÁÁˆÓ.
O›‰ËÌ· ÙÔ˘ Ì·Ï·ÎÔ‡ ÈÛÙÔ‡ Ô˘ ÂÓÙÔ›˙ÂÙ·È ¿Óˆ-
ıÂÓ ÙˆÓ Î‡ÛÙÂˆÓ ÙˆÓ ÔÛÙÒÓ Â›Ó·È Û˘¯Ófi ‡ÚËÌ·
Î·È ÌÔÚ› ÔÏϤ˜ ÊÔÚ¤˜ Ó· ÚÔËÁÂ›Ù·È Ù˘ ·ÎÙÈ-
ÓÔÏÔÁÈ΋˜ ·ÂÈÎfiÓÈÛ˘. ∏ ÚÔÛ‚ÔÏ‹ ÙˆÓ ·ÚıÚÒ-
ÛÂˆÓ ÂÌÊ·Ó›˙ÂÙ·È Ì ÙÚÂȘ ÌÔÚʤ˜: ·. ªÂÙ·Ó·-
ÛÙ¢ÙÈ΋ ÔÏ˘·ÚıÚ›Ùȉ· Û¯ÂÙÈ˙fiÌÂÓË Ì Ô˙҉˜
ÂÚ‡ıËÌ·, ‚. ªÂÌÔӈ̤ӷ ‹ ˘ÔÙÚÔÈ¿˙ÔÓÙ· ÂÂÈ-
Ûfi‰È· ÔÏ˘·ÚıÚ›Ùȉ·˜ ‹ ÌÔÓÔ·ÚıÚ›Ùȉ·˜ Î·È Á. ∂-
È̤ÓÔ˘Û· ·ÚıÚ›Ùȉ·21. ∏ ·Ó¿Ù˘ÍË Û·ÚÎÔÂȉÈ-
ÎÒÓ ÎÔÎÎÈˆÌ¿ÙˆÓ ÌÔÚ› Ó· ·Ú·ÙËÚËı› Û Ô-
ÔÈÔÓ‰‹ÔÙÂ Ì˘ ÙÔ˘ ·ÓıÚÒÈÓÔ˘ ÛÒÌ·ÙÔ˜, ÌÂ Û˘-
 ∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 70, 4
¯ÓfiÙÂÚ˜ ÂÓÙÔ›ÛÂȘ ÙÔ˘˜ Ì˘˜ Ù˘ ˆÌÈ΋˜ ˙ÒÓ˘ ηÈ
Ù˘ Á·ÛÙÚÔÎÓËÌ›·˜.
– ¢¤ÚÌ·: ™˘¯ÓfiÙËÙ· ÚÔÛ‚ÔÏ‹˜ 25%. ∆Ô Ô˙Ò-
‰Â˜ ÂÚ‡ıËÌ· Â›Ó·È Ë Û˘¯ÓfiÙÂÚË ‰ÂÚÌ·ÙÈ΋ ÂΉ‹-
ψÛË, Û˘Óԉ¢fiÌÂÓË Ì¿ÏÈÛÙ· Û˘¯Ó¿ ·fi ˘ÚÂÙfi
Î·È ·ÚıÚ·ÏÁ›Â˜ Î·È ÚÔ‰Èο˙ÂÈ Ì¿ÏÏÔÓ Â˘ÓÔ˚΋
ÔÚ›· Ù˘ ÓfiÛÔ˘, ÌÔÏÔÓfiÙÈ ÌÔÚ› Ó· ˘ÔÙÚÔÈ¿-
˙ÂÈ ÁÈ· ÔÏÏ¿ ¯ÚfiÓÈ·22. ∏ ÙÚÈ¿‰· «Ô˙҉˜ ÂÚ‡ıË-
Ì·, ·ÌÊÔÙÂÚfiÏ¢ÚË ˘Ï·›· ÏÂÌÊ·‰ÂÓ›Ùȉ· ηÈ
ÔÍ›· ÈÚȉÔ΢ÎÏ›Ùȉ·», ·ÔÙÂÏ› ÙÔ Û‡Ó‰ÚÔÌÔ Lö-
fgren, ÙÔ ÔÔ›Ô ¤¯ÂÈ Î·Ï‹ ÚfiÁÓˆÛË. ªÔÚ› Ó·
·Ú·ÙËÚËıÔ‡Ó ÎËÏȉԂϷÙȉ҉˜ ÂÍ¿ÓıËÌ· ηÈ
˘Ô‰fiÚÈ· Ô˙›‰È·. Œ¯Ô˘Ó ·Ó·ÊÂÚı› Î·È ÂÚÈÙÒ-
ÛÂȘ ¯ÂÈÌÂÙÏÔÂȉԇ˜ χÎÔ˘. ∞ÔÙÂÏ› ÙË ÛÔ‚·ÚfiÙÂ-
ÚË ‰ÂÚÌ·ÙÈ΋ ÌÔÚÊ‹. ∂ÓÙÔ›˙ÂÙ·È ÛÙË Ì‡ÙË Î·È ÙȘ
·ÚÂȤ˜ Î·È ÌÔÚ› Ó· ÂÎÙ›ÓÂÙ·È ÛÙ· ·˘ÙÈ¿ Î·È Ù·
¯Â›ÏË.
– ∞ÓÒÙÂÚÔÈ ·ÂÚ·ÁˆÁÔ›: ™˘¯ÓfiÙËÙ· ÚÔÛ‚ÔÏ‹˜
1-2%. ∞ӷʤÚıËÎ·Ó Û¿ÓȘ ÂÚÈÙÒÛÂȘ ·Û˘-
Ìو̷ÙÈ΋˜ Û·ÚÎÔ›‰ˆÛ˘ Ù˘ ̇Ù˘, ÙÔ˘ Ê¿Ú˘Á-
Á· Î·È ÙÔ˘ Ï¿Ú˘ÁÁ· Ì ‚Ú¿Á¯Ô˜ ʈӋ˜ Î·È ÚÈÓÈ΋
Û˘ÌÊfiÚËÛË.
– ∂Ó‰ÔÎÚÈÓ›˜ ·‰¤Ó˜: ™¿ÓÈ· ÚÔÛ‚¿ÏÏÔÓÙ·È
Ë ˘fiÊ˘ÛË Î·È Ô ˘Ôı¿Ï·ÌÔ˜ Ì ·ÔÙ¤ÏÂÛÌ· ‰Â˘-
ÙÂÚÔ·ı‹ ¿ÔÈÔ ‰È·‚‹ÙË19.
– ™ÈÂÏÔÁfiÓÔÈ, ·ÚˆÙȉÈÎÔ› Î·È ‰·ÎÚ˘ÈÎÔ› ·‰¤-
Ó˜: ∏ ÚÔÛ‚ÔÏ‹ ÙˆÓ ÛÈÂÏÔÁfiÓˆÓ ·‰¤ÓˆÓ ›ӷÈ
Û˘¯Ó‹. ∏ ‚ÈÔ„›· ¯Â›ÏÔ˘˜ ‰›‰ÂÈ ıÂÙÈο ·ÔÙÂϤÛÌ·-
Ù· Û ÔÛÔÛÙfi 60%23. ∏ Û˘¯ÓfiÙËÙ· ÚÔÛ‚ÔÏ‹˜ ÙˆÓ
·ÚˆÙ›‰ˆÓ Â›Ó·È 6%23. ∏ Û˘ÌÌÂÙÔ¯‹ ÙˆÓ ‰·ÎÚ˘È-
ÎÒÓ ·‰¤ÓˆÓ Â›Ó·È Û˘¯Ó‹ Î·È ÚÔηÏ› ÌÂȈ̤ÓË ¤Î-
ÎÚÈÛË ‰·ÎÚ‡ˆÓ Ô˘ Ô‰ËÁ› Û ÊÏÂÁÌÔÓ‹ Î·È ÂÎʇ-
ÏÈÛË ÙÔ˘ ÎÂÚ·ÙÔÂȉ‹ ¯ÈÙÒÓ· Î·È ÙÔ˘ ÂÈÂÊ˘ÎfiÙ·.
£∂ƒ∞¶∂π∞
°È· ÙËÓ ÂÚ›ÙˆÛË Û·ÚÎÔ›‰ˆÛ˘ Ú¤ÂÈ Ó· ··-
ÓÙËıÔ‡Ó Ù· ÂÚˆÙ‹Ì·Ù·:
– À¿Ú¯ÂÈ ÈÛÙÔÏÔÁÈ΋ ÂȂ‚·›ˆÛË;
– Œ¯ÂÈ Á›ÓÂÈ ÂÎÙ›ÌËÛË Ù˘ ¤ÎÙ·Û˘ Î·È Ù˘ ÛÔ-
‚·ÚfiÙËÙ·˜ Ù˘ ÚÔÛ‚ÔÏ‹˜ ‰È¿ÊÔÚˆÓ ÔÚÁ¿ÓˆÓ;
– Œ¯ÂÈ ÂÎÙÈÌËı› Ë ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ÓfiÛÔ˘;
– ÃÚÂÈ¿˙ÂÙ·È ıÂÚ·›· Ô ·ÛıÂÓ‹˜;
¶Ú¤ÂÈ Â›Û˘ Ó· ÏËÊı› ˘fi„Ë, fiÙÈ Ë Û·ÚÎÔ-
›‰ˆÛË Â›Ó·È Î·ÏÔ‹ı˘ ÓfiÛÔ˜ Ë ÔÔ›· ·˘ÙÔ˚¿Ù·È
Ù· ÚÒÙ· ÙÚ›· ¯ÚfiÓÈ· ÛÙÔ 60-70%, ·ÚÔ˘ÛÈ¿˙ÂÈ
ÛÙ·ÛÈÌfiÙËÙ· ‹ Âȉ›ӈÛË ÛÙÔ 20-30% Î·È ¤¯ÂÈ
ıÓËÙfiÙËÙ· 0,5-5%24.
∞fi ÙË ‰ÂηÂÙ›· ÙÔ˘ 1950 ÛÙË ıÂÚ·¢ÙÈ΋
·ÓÙÈÌÂÙÒÈÛË Ù˘ Û·ÚÎÔ›‰ˆÛ˘ ÂÊ·ÚÌfiÛÙËΠË
ÎÔÚÙÈÎÔıÂÚ·›·. ∆Ô ÂӉȷʤÚÔÓ ÛÙË ıÂÚ·›·
¤¯ÂÈ ÌÂÙ·ÙÔÈÛÙ› ÛÙËÓ ·¿ÓÙËÛË ÙˆÓ ·Ú·Î¿Ùˆ
243
ÛÔ˘‰·›ˆÓ ÂÚˆÙËÌ¿ÙˆÓ:
– ¶ÔÈÔÈ ·ÛıÂÓ›˜ ı· Ï¿‚Ô˘Ó ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹;
– ™Â ÔÈ· ‰fiÛË;
– °È· fiÛÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·;
– ∂› ·ÔÙ˘¯›·˜ Ù˘ ÎÔÚÙÈÎÔıÂÚ·›·˜ ÔȘ
ÂÓ·ÏÏ·ÎÙÈΤ˜ χÛÂȘ ˘¿Ú¯Ô˘Ó;
∫ÔÚÙÈÎÔıÂÚ·›·: ∏ ‰Ú¿ÛË ÙˆÓ ÎÔÚÙÈÎÔÛÙÂÚÔ-
ÂȉÒÓ Â›Ó·È ·Ó·ÛÙÔÏ‹ ÙÔ˘ Û¯ËÌ·ÙÈÛÌÔ‡ ÎÔÎÎȈ̿-
ÙˆÓ. ∆· ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹ ‚ÂÏÙÈÒÓÔ˘Ó:
·. ∆· Û˘ÌÙÒÌ·Ù· ·fi ÙÔ ·Ó·Ó¢ÛÙÈÎfi Û‡-
ÛÙËÌ·
‚. ∆· ·ÎÙÈÓÔÏÔÁÈο Â˘Ú‹Ì·Ù·
Á. ∆ËÓ ·Ó·Ó¢ÛÙÈ΋ ÏÂÈÙÔ˘ÚÁ›·25,26.
°ÂÓÈο Ë ·fiÊ·ÛË ÁÈ· ¯ÔÚ‹ÁËÛË ÎÔÚÙÈÎÔÛÙÂ-
ÚÔÂȉÒÓ ÛÙËÚ›˙ÂÙ·È: ™ÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ·, ÛÙ· ·ÎÙÈ-
ÓÔÏÔÁÈο Â˘Ú‹Ì·Ù· ·fi ÙÔ ıÒڷη, ÛÙ· Â˘Ú‹Ì·Ù·
·fi ÙȘ ÏÂÈÙÔ˘ÚÁÈΤ˜ ‰ÔÎÈ̷ۛ˜ ·Ó·Ó¢ÛÙÈÎÔ‡,
ÛÙ· Â˘Ú‹Ì·Ù· ·fi ÙÔ µ∞L Î·È ÛÙËÓ ÙÈÌ‹ ÙÔ˘ SA-
CE. ∞fiÏ˘ÙË ¤Ó‰ÂÈÍË ÎÔÚÙÈÎÔıÂÚ·›·˜ Â›Ó·È Ë
ÂÈÓ¤ÌËÛË ˙ˆÙÈÎÒÓ ÔÚÁ¿ÓˆÓ (ηډȿ, ÔÊı·ÏÌÔ›,
∫¡™), Ë ˘ÂÚ·Û‚ÂÛÙÈ·ÈÌ›· Î·È Ë ·Û‚ÂÛÙÈÔ˘Ú›·. ∏
ÂÓ‰ÂÈÎÓ˘fiÌÂÓË ıÂÚ·¢ÙÈ΋ ·ÁˆÁ‹ ÛÙȘ ÂÚÈÙÒ-
ÛÂȘ Ó¢ÌÔÓÈ΋˜ Û·ÚÎÔ›‰ˆÛ˘ ›ӷÈ:
• ™Ù¿‰ÈÔ π: ¢Â ¯ÔÚËÁÂ›Ù·È ıÂÚ·›·. ¶·Ú·ÎÔ-
ÏÔ‡ıËÛË ÙÔ˘ ·ÛıÂÓ‹27.
• ™Ù¿‰ÈÔ ππ Î·È πππ: ™Â ·Û˘Ìو̷ÙÈÎÔ‡˜ ·-
Ú·ÎÔÏÔ‡ıËÛË ÁÈ· 3-6 Ì‹Ó˜ Î·È Â¿Ó ÂȉÂÈÓÒÓÔ-
ÓÙ·È, fiˆ˜ ÎÚ›ÓÂÙ·È ·fi Ù· Û˘ÌÙÒÌ·Ù·, ÙËÓ ·ÎÙÈ-
ÓÔÁÚ·Ê›· ıÒڷη Î·È ÙËÓ ·Ó·Ó¢ÛÙÈ΋ ÏÂÈÙÔ˘Ú-
Á›·, ¯ÔÚËÁÂ›Ù·È ıÂÚ·›·.
• ™Ù¿‰ÈÔ ππ Î·È πππ: ™Â Û˘Ìو̷ÙÈÎÔ‡˜ ·ÛıÂ-
Ó›˜ Ì ‰È·Ù·Ú·¯‹ ·Ó·Ó¢ÛÙÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ ¯Ô-
ÚËÁÂ›Ù·È ıÂÚ·›·.
• ™Ù¿‰ÈÔ πV: ÃÔÚËÁÔ‡ÓÙ·È ‰ÔÎÈÌ·ÛÙÈο ÎÔÚÙÈ-
ÎÔÛÙÂÚÔÂȉ‹ ÁÈ· 3 Ì‹Ó˜ Î·È ·Ó¿ÏÔÁ· Ì ÙÔ ·ÔÙ¤-
ÏÂÛÌ· ÎÚ›ÓÂÙ·È Â¿Ó ı· Û˘Ó¯ÈÛÙ› ‹ fi¯È Ë ¯ÔÚ‹ÁË-
Û‹ ÙÔ˘˜.
∏ ‰ÔÛÔÏÔÁ›· ÎÔÚÙÈÎÔÛÙÂÚÔÂȉÒÓ Â›Ó·È 20-40
mg Ú‰ÓÈ˙ÔÏfiÓ˘ ËÌÂÚËÛ›ˆ˜. ™ÙÔ˘˜ ÙÚÂȘ ÚÒ-
ÙÔ˘˜ Ì‹Ó˜ Ï‹Ú˘ ‰fiÛË, ÛÙË Û˘Ó¤¯ÂÈ· ÛÙ·‰È·Î‹
Ì›ˆÛË. ¢fiÛË Û˘ÓÙ‹ÚËÛ˘ 5-10 mg ËÌÂÚËÛ›ˆ˜ ‹ ÛÂ
Û¯‹Ì· ̤ڷ ·Ú¿ ̤ڷ, ÙÔ˘Ï¿¯ÈÛÙÔÓ ÁÈ· 12 Ì‹Ó˜.
™Â ÂÚ›ÙˆÛË ˘ÔÙÚÔ‹˜ ÂÊ·ÚÌfi˙ÂÙ·È Ì·ÎÚÔ¯Úfi-
ÓÈ· Û˘Ó¯‹˜ ıÂÚ·›· Ì ÌÈÎÚfiÙÂÚ˜ ‰fiÛÂȘ_ ‰È·-
ÈÛÙÒıËΠfiÙÈ ˘ÂÚ¤¯ÂÈ ¤Ó·ÓÙÈ Ù˘ ‰È·ÎÂÎÔÌ̤Ó˘
ıÂÚ·›·˜.
∂Ó·ÏÏ·ÎÙÈ΋ ıÂÚ·›·: ∏ ÂÓ·ÏÏ·ÎÙÈ΋ ıÂÚ·-
›· ÛÙË Û·ÚÎÔ›‰ˆÛË ÂÊ·ÚÌfi˙ÂÙ·È Û ÂȉÈΤ˜ Â-
ÚÈÙÒÛÂȘ ·ÛıÂÓÒÓ28. ¢ËÏ·‰‹ ÂÚÈÙÒÛÂȘ ¯ÚÔÓ›-
˙Ô˘Û·˜ ‹ ˘ÔÙÚÔÈ¿˙Ô˘Û·˜ ÓfiÛÔ˘. ∂›Û˘ ¯ÚËÛÈ-
ÌÔÔÈÂ›Ù·È Û ÂÚÈÙÒÛÂȘ ·ÓÙÔ¯‹˜ Ù˘ ÓfiÛÔ˘ ÛÙËÓ
244 §. ™πç∂∆π¢∏™, ¢. çøƒO™
¶›Ó·Î·˜ 2. ∂Ó·ÏÏ·ÎÙÈ΋ ıÂÚ·›·
º¿Ú̷η ¢ÔÛÔÏÔÁ›·
∞. ∞ÓıÂÏÔÓÔÛȷο µÏ¿‚Ë ·ÌÊÈ‚ÏËÛÙÚÔÂȉԇ˜,
À‰ÚÔ͢¯ÏˆÚÔΛÓË (Plaquenil) 200-400 mg/ËÌ
µ. ∫˘ÙÙ·ÚÔÙÔÍÈο
ªÂıÔÙÚÂÍ¿ÙË 10-25 mg/‚‰
∞ı·ıÂÈÔÚ›ÓË (Imuran) 50-200 mg/ËÌ
∫˘ÎÏÔʈÛÊ·Ì›‰Ë (Endoxan) 50-150 mg/ËÌ
ÃψÚÔÌ‚Ô˘Î›ÏË (Leukeran) 2-10 mg/ËÌ
°. ∞Ó·ÛÙÔÏ›˜ ÙÔ˘ ∆¡F-·
¶ÂÓÙÔÍ˘Ê˘Ï›ÓË (∆arontal) 400 mg x 3 ËÌ
Infliximab (Remicade) 3 mg/kg
£·ÏȉÔÌ›‰Ë 100 mg/ËÌ
ÎÔÚÙÈÎÔıÂÚ·›· ‹ Û ÂÚÈÙÒÛÂȘ ‰˘Û·ÓÂÍ›·˜
Î·È ÛÔ‚·ÚÒÓ ÂÈÏÔÎÒÓ. ∆· ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓ·
Ê¿Ú̷η ¯ÔÚËÁÔ‡ÓÙ·È ÌfiÓ· ÙÔ˘˜ ‹ ÛÂ Û˘Ó‰˘·ÛÌfi
Ì ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹ Û ÌÈÎÚfiÙÂÚ˜ ‰fiÛÂȘ.
∞) ∫˘ÙÙ·ÚÔÙÔÍÈÎÔ› ·Ú¿ÁÔÓÙ˜: ∆Ô ÂÚÈÛÛfiÙÂ-
ÚÔ ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓÔ Ê¿ÚÌ·ÎÔ Â›Ó·È Ë ÌÂıÔÙÚÂÍ¿-
ÙË29. ∏ ·˙·ıÂÈÔÚ›ÓË ¯ÚËÛÈÌÔÔÈÂ›Ù·È Û ÂÚÈÙÒ-
ÛÂȘ ¯ÚÔÓÈfiÙËÙ·˜ Ù˘ ÓfiÛÔ˘. ™Â ÂÚ›ÙˆÛË ÂÈÌÔÓ‹˜
‹ Ù·¯Â›·˜ Âȉ›ӈÛ˘ ‹ ÂÈÓ¤ÌËÛ˘ ÙÔ˘ ∫ÂÓÙÚÈÎÔ‡
¡Â˘ÚÈÎÔ‡ ™˘ÛÙ‹Ì·ÙÔ˜ ¯ÚËÛÈÌÔÔÈÂ›Ù·È Ë Î˘ÎÏÔʈ-
ÛÊ·Ì›‰Ë. ™Â ÂÚ›ÙˆÛË Î·Ú‰È·Î‹˜ ·ÓÂ¿ÚÎÂÈ·˜
Û˘ÓÈÛÙ¿Ù·È Â›Û˘ Î·È Ë ¯Ú‹ÛË ¯ÏˆÚ·Ì‚ԢΛÏ˘.
µ) ∞ÓÔÛÔ‰ÈÂÁÂÚÙÈο Ê¿Ú̷η: º¿Ú̷η Ù·
ÔÔ›· ÙÚÔÔÔÈÔ‡Ó ÙËÓ ·ÓÔÛÔÔÈËÙÈ΋ ÏÂÈÙÔ˘ÚÁ›·
‹ ·Ó·ÛÙ¤ÏÏÔ˘Ó ÙË ‰Ú¿ÛË Î˘ÙÙ·ÚÔÎÈÓÒÓ ¤¯Ô˘Ó ¯ÚË-
ÛÈÌÔÔÈËı› ÛÙË ıÂÚ·›· Ù˘ Û·ÚÎÔ›‰ˆÛ˘28. ∆·
·ÓıÂÏÔÓÔÛȷο Ê¿Ú̷η (˘‰ÚÔ͢¯ÏˆÚÔΛÓË) ¤-
¯Ô˘Ó ¯ÚËÛÈÌÔÔÈËı› ÁÈ· ·ÓÙÈÌÂÙÒÈÛË ‰ÂÚÌ·ÙÈ΋˜
Û·ÚÎÔ›‰ˆÛ˘ ‹ ÂÚÈÙÒÛÂˆÓ ˘ÂÚ·Û‚ÂÛÙÈ·È-
Ì›·˜-·Û‚ÂÛÙÈÔ˘Ú›·˜30.
∞fi ‚È‚ÏÈÔÁÚ·ÊÈο ‰Â‰Ô̤ӷ Â›Ó·È ÁÓˆÛÙfi
fiÙÈ Ô ·Ú¿ÁÔÓÙ·˜ Ó¤ÎÚˆÛ˘ ÙˆÓ fiÁÎˆÓ (Tumor
necrosis factor-TNF) ·Ú¿ÁÂÙ·È Û ÌÂÁ·Ï‡ÙÂÚ·
ÔÛ¿ ·fi Ù· ΢„ÂÏȉÈο Ì·ÎÚÔÊ¿Á· Û ·ÛıÂÓ›˜
Ì ۷ÚÎÔ›‰ˆÛË Î·È fiÙÈ Ë ¯Ú‹ÛË ÎÔÚÙÈÎÔÛÙÂÚÔÂÈ-
‰ÒÓ Î·È ÌÂıÔÙÚÂÍ¿Ù˘ ÂÏ·ÙÙÒÓÂÈ ÙËÓ ·Ú·ÁˆÁ‹
·˘Ù‹28. ∞˘Ù‹ Ë ·Ú·Ù‹ÚËÛË Ô‰‹ÁËÛ ÛÙË ¯Ú‹ÛË
Ê·ÚÌ¿ÎˆÓ Ù· ÔÔ›· ·Ó·ÛÙ¤ÏÏÔ˘Ó ÙËÓ ·Ú·ÁˆÁ‹
ÙÔ˘ ∆¡F, ÛÙË ıÂÚ·›· Ù˘ Û·ÚÎÔ›‰ˆÛ˘. ŒÓ·
·fi Ù· ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓ· Ê¿Ú̷η Â›Ó·È Ë Â-
ÓÙÔÍ˘Ê˘Ï›ÓË, Ë ÔÔ›· ¯ÚËÛÈÌÔÔÈÂ›Ù·È Û ÂÚÈ-
ÙÒÛÂȘ ÔÍ›·˜ Ó¢ÌÔÓÈ΋˜ ÌÔÚÊ‹˜, ·Ó·Ê¤ÚÔ-
ÓÙ·È fï˜ ˘„ËÏ¿ ÔÛÔÛÙ¿ ˘ÔÙÚÔ‹˜ Ù˘ ÓfiÛÔ˘,
ÂÓÒ Ë ¯ÚfiÓÈ· ¯Ú‹ÛË Ù˘ ‰ÂÓ ¤¯ÂÈ ÌÂÏÂÙËı›31. ÕÏ-
ÏÔ Ê¿ÚÌ·ÎÔ Ì ·ÚfiÌÔÈ· ‰Ú¿ÛË ÂÓ·ÓÙ›ÔÓ ÙÔ˘
¶·ÚÂÓ¤ÚÁÂȘ
∫·ÎÔ˘¯›·
¶Ó¢ÌÔÓ›Ùȉ·,
Ì˘ÂÏÔÙÔÍÈÎfi,
Ë·ÙÔÙÔÍÈÎfi
ª˘ÂÏÔÙÔÍÈÎfi
∞ÈÌÔÚÚ·ÁÈ΋ ΢ÛÙ›Ùȉ·,
Ì˘ÂÏÔÙÔÍÈÎfi
ª˘ÂÏÔÙÔÍÈÎfi
∆¡F, ·ÏÏ¿ Î·È Ù˘ ÈÓÙÂÚÏ¢ΛÓ˘-12 Â›Ó·È Ë ı·ÏÈ-
‰ÔÌ›‰Ë, Ô˘ Ê·›ÓÂÙ·È Ó· ¤¯ÂÈ Î·Ï‹ ‰Ú¿ÛË Û Â-
ÚÈÙÒÛÂȘ ¯ÚfiÓÈ·˜ ‰ÂÚÌ·ÙÈ΋˜ ÌÔÚÊ‹˜ Ù˘ ÓfiÛÔ˘.
Œ¯ÂÈ Â›Û˘ ¯ÚËÛÈÌÔÔÈËı› Ë Ô˘Û›· Infliximab
(·Ó·ÛÙÔϤ·˜ ÙÔ˘ TNF) Ì ÂÓı·ÚÚ˘ÓÙÈο ·ÔÙÂ-
ϤÛÌ·Ù· ΢ڛˆ˜ Û ÂÚÈÙÒÛÂȘ ÂÈ̤ÓÔ˘Û·˜ Ófi-
ÛÔ˘32.
™ÙÔÓ ›Ó·Î· 2 ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ù· ÂÓ·ÏÏ·ÎÙÈ-
ο Ê¿Ú̷η, Ë ‰ÔÛÔÏÔÁ›· ÙÔ˘˜ Î·È ÔÈ ·ÚÂÓ¤ÚÁÂÈ-
¤˜ ÙÔ˘˜.
°) ÕÏϘ ıÂÚ·¢ÙÈΤ˜ ̤ıÔ‰ÔÈ: ™Â ÂÚÈÙÒ-
ÛÂȘ Û·ÚÎÔ›‰ˆÛ˘ ∫¡™ Ì ÌÔÓ‹ÚÂȘ ÔÁÎfiÌÔÚʘ
‚Ï¿‚˜ Á›ÓÂÙ·È ·ÎÙÈÓÔıÂÚ·›·. ™Â Ôχ Ï›Á· Â-
ÚÈÛÙ·ÙÈο Ó¢ÌÔÓÈ΋˜ Û·ÚÎÔ›‰ˆÛ˘ ¤¯ÂÈ ÂȯÂÈ-
ÚËı› Ë ÌÂÙ·ÌfiÛ¯Â˘ÛË ÙˆÓ ÚÔۂ‚ÏËÌ¤ÓˆÓ ÔÚ-
Á¿ÓˆÓ (‹·Ú, ηډȿ, Ó‡ÌÔÓ˜, ÓÂÊÚÔ›)29.
∞¡∞¶∞¡∆∏∆∞ ∂ƒø∆∏ª∞∆∞
ªÔÏÔÓfiÙÈ Â›Ó·È ÁÓˆÛÙ‹ ·fi ÔÏÏ¿ ¯ÚfiÓÈ· Ë ÓfiÛÔ˜,
ÂÓÙÔ‡ÙÔȘ ˘¿Ú¯Ô˘Ó ·Ó·¿ÓÙËÙ· ÂÚˆÙ‹Ì·Ù·, Ù·
ÔÔ›· ›ӷÈ:
• ¶ˆ˜ ·Ó·ÁÓˆÚ›˙ÔÓÙ·È ·ÛıÂÓ›˜ Ì ۷ÚÎÔ›‰ˆ-
ÛË Ô˘ ÎÈÓ‰˘ÓÂ‡Ô˘Ó Ó· ·Ó·Ù‡ÍÔ˘Ó Ó¢ÌÔÓÈ-
΋ ›ÓˆÛË;
• ¶ÔÈÔ› ·Ú¿ÁÔÓÙ˜ ÂËÚ¿˙Ô˘Ó ÙËÓ ÂͤÏÈÍË Ù˘
ÓfiÛÔ˘ Î·È ˆ˜ ÌÔÚ› Ó· ÙÚÔÔÔÈËıÔ‡Ó;
• ¶ÔÈÔ› ÔÈ ‰Â›ÎÙ˜ ·Ú·ÎÔÏÔ‡ıËÛ˘ Ù˘ ‰Ú·ÛÙË-
ÚÈfiÙËÙ·˜ Ù˘ ÓfiÛÔ˘;
• ¶ÔÈÔ› Â›Ó·È ÔÈ ÁÂÓÂÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ Ô˘ ÚÔ-
‰È·ı¤ÙÔ˘Ó ÁÈ· Û·ÚÎÔ›‰ˆÛË;
• ¶ÔÈfi ‹ ÔÈ· Â›Ó·È Ù· ·ÓÙÈÁfiÓ· Ô˘ ÂÌϤÎÔÓÙ·È
ÛÙË Û·ÚÎÔ›‰ˆÛË;
• ¶ÔÈ¿ Â›Ó·È Ë Î·Ù¿ÏÏËÏË ıÂÚ·›· ÁÈ· ÙÔ˘˜
·ÛıÂÓ›˜ Ì ÛÔ‚·Ú‹ ÓfiÛÔ;
 ∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 70, 4
ABSTRACT
Sichletidis L, Chloros D. Sarcoidosis. Hell Iatr 2004,
70: 237 - 246.
Sarcoidosis is a chronic multisystem inflamma-
tory disease of unknown etiology that very often
affects the lungs. The histologic hallmark is the for-
mation of non-caseating epithelioid granuloma. It
affects usually young adults and its incidence varies
from country to country. It is speculated that an un-
known yet and perhaps infectious environmental e-
tiologic factor exists. On the other hand there is e-
vidence that the disease develops in certain ge-
netically predisposed individuals. The symptoms
and signs may vary, depending on the affected or-
gans. In the diagnosis of sarcoidosis the analysis of
bronchoalveolar lavage (BAL) fluid, in which cha-
racteristically large increase of the number of acti-
vated CD4+ T-lymphocytes is observed, plays a vi-
tal role, as well as the HRCT of the lungs, the scin-
tigraphy with gallium-67 and the measurement of
serum angiotensin-converting enzyme (ACE) level.
The diagnosis is reached safely only through biopsy
from an appropriate organ, usually the lung. Sarcoi-
dosis often follows a benign course and is self-limi-
ted. If treatment is required, it consists of cortico-
steroids or even cytotoxic agents. Recently, drugs
that block the action of tumor necrosis factor (TNF–
a) were used with encouraging results.
µπµ§πO°ƒ∞ºπ∞
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3. James DJ. Sarcoidosis and other granulomatous disor-
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festing as fever of unknown origin. Mayo Clin Proc
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13. ™È¯ÏÂÙ›‰Ë˜ §, ∆˙Ë̿η˜ Ã, ∆Û¤ÚÔ˜ ¶, µ·Ì‚·ÎÔÔ‡ÏÔ˘
µ, ƒ›ÁÁÔ˜ ¢. ∞ÎÙÈÓÔÌÔÚÊÔÏÔÁÈο Â˘Ú‹Ì·Ù· Ó¢ÌÔÓÈ-
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§. ™È¯ÏÂÙ›‰Ë˜
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Med 2002, 8: 464-9. ∫. ¡Ù‹Ï 3
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hibits TNF-alpha production from human alveolar Greece
∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 2004, 70, 4: 247 - 255
¶ÔÏ˘Ê·Ú̷΢ÙÈ΋ ·ÓÙÔ¯‹ ÛÙËÓ ÔÍ›·
Ï¢¯·ÈÌ›· ÙˆÓ ·È‰ÈÒÓ
ª·Ú›· ∫Ô‡ÚÙË, º·Ó‹ ∞ı·Ó·ÛÈ¿‰Ô˘-¶ÈÂÚÔÔ‡ÏÔ˘
µ′ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ∞¶£, ¡ÔÛÔÎÔÌÂ›Ô ∞Ã∂¶∞, £ÂÛÛ·ÏÔÓ›ÎË
¶ÂÚ›ÏË„Ë. ∏ ¯Ú‹ÛË Û‡Á¯ÚÔÓˆÓ ¯ËÌÂÈÔıÂÚ·¢ÙÈ-
ÎÒÓ ÚˆÙÔÎfiÏÏˆÓ ÛÙËÓ ÔÍ›· Ï¢¯·ÈÌ›· ÙˆÓ ·È-
‰ÈÒÓ Â›¯Â Û·Ó ·ÔÙ¤ÏÂÛÌ· ÙËÓ Â›Ù¢ÍË Ï‹ÚÔ˘˜
‡ÊÂÛ˘ ÛÙËÓ ÏÂÈÔ„ËÊ›· ÙˆÓ ·ÛıÂÓÒÓ. ¶·ÚfiÏ·
·˘Ù¿ ¤Ó·˜ ÛËÌ·ÓÙÈÎfi˜ ·ÚÈıÌfi˜ ·˘ÙÒÓ ı· ÂÌÊ·Ó›ÛÂÈ
˘ÔÙÚÔ‹ Ù˘ ÓfiÛÔ˘ ÌÂÙ¿ ÙËÓ ·Ú¯È΋ ÂÈÛ·ÁˆÁ‹
ÛÙËÓ ‡ÊÂÛË. ∞˘Ùfi Û ¤Ó· ÌÂÁ¿ÏÔ ÔÛÔÛÙfi ·Ô‰›-
‰ÂÙ·È ÛÙËÓ ÂÌÊ¿ÓÈÛË ÂÓ‰ÔÁÂÓÔ‡˜ ‹ Â›ÎÙËÙ˘ ·ÓÙÔ-
¯‹˜ ÙˆÓ Î·ÎÔ‹ıˆÓ ΢ÙÙ¿ÚˆÓ ÛÙÔ˘˜ ¯ËÌÂÈÔıÂÚ·-
¢ÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Ô˘ ·ÔηÏÂ›Ù·È ÔÏ˘-
Ê·Ú̷΢ÙÈ΋ ·ÓÙÔ¯‹. OÈ ˘‡ı˘ÓÔÈ Ì˯·ÓÈÛÌÔ›
Ù˘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙËÓ ˘ÂÚ¤ÎÊÚ·ÛË ÙˆÓ ·‰ÂÓÔ-
ÙÚÈʈÛʈÚÈÎÒÓ ‰ÂÛÌ¢ÙÈÎÒÓ ÚˆÙÂ˚ÓÒÓ (P-ÁÏ˘-
ÎÔÚˆÙ½ÓË, ÚˆÙ½ÓË ÔÏÏ·Ï‹˜ ·ÓÙÔ¯‹˜, Úˆ-
Ù½ÓË ·ÓÙÔ¯‹˜ ÛÙÔÓ Î·ÚΛÓÔ ÙÔ˘ Ì·ÛÙÔ‡) ÔÈ Ôԛ˜
‰ÚÔ˘Ó ÂÏ·ÙÙÒÓÔÓÙ·˜ ÙËÓ ÂÓ‰Ô΢ÙÙ¿ÚÈ· Û˘ÁΤÓ-
∏ ÔÍ›· Ï¢¯·ÈÌ›· (O§) ÙˆÓ ·È‰ÈÒÓ ·ÔÙÂÏ› ÙÔ
25-30% fiÏˆÓ ÙˆÓ ÓÂÔÏ·ÛÈÒÓ Ù˘ ·È‰È΋˜ ËÏÈ-
Λ·˜, ÌÂ Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ 3-4 ÂÚÈÙÒÛÂȘ
ÂÙËÛ›ˆ˜ ·Ó¿ 100.000 ·È‰ÈÎÔ‡ ÏËı˘ÛÌÔ‡ ËÏÈ-
Λ·˜ οو ÙˆÓ 15 ÂÙÒÓ1. ¶ÂÚ›Ô˘ ÙÔ 83% ÙˆÓ Â-
ÚÈÙÒÛÂˆÓ Â›Ó·È ÔÍ›· ÏÂÌÊÔ‚Ï·ÛÙÈ΋ Ï¢¯·ÈÌ›·
(O§§), Î·È ÙÔ 17% ÔÍ›· ÌË ÏÂÌÊÔ‚Ï·ÛÙÈ΋
(Oª§)2.
∂›Ó·È ÓfiÛËÌ· Ì ¢ڇ Î·È ÂÙÂÚÔÁÂÓ¤˜ Ê¿ÛÌ·
ÙfiÛÔ ˆ˜ ÚÔ˜ ÙÔÓ ·ÈÌ·ÙÔÏÔÁÈÎfi Î·È ÎÏÈÓÈÎfi Ê·ÈÓfi-
Ù˘Ô, fiÛÔ Î·È ˆ˜ ÚÔ˜ ÙÔ˘˜ ˘ÔΛÌÂÓÔ˘˜ ‚ÈÔÏÔÁÈ-
ÎÔ‡˜ Ì˯·ÓÈÛÌÔ‡˜ Ù˘ ·ıÔÁ¤ÓÂÈ¿˜ ÙÔ˘. O ·ÎÚÈ-
‚‹˜ ·ıÔÁÂÓÂÙÈÎfi˜ Ì˯·ÓÈÛÌfi˜ Ù˘ O§ ‰ÂÓ ¤¯ÂÈ
Ï‹Úˆ˜ ‰È¢ÎÚÈÓÈÛÙ›, ·ÏÏ¿ Â›Ó·È Ôχ Èı·Ófi Ó·
ÔÊ›ÏÂÙ·È Û ÁÂÓÂÙÈ΋ ‚Ï¿‚Ë ÙÔ˘ ÔÏ˘‰‡Ó·ÌÔ˘ ·È-
247
ÙÚˆÛË ÙˆÓ Ê·Ú̿ΈÓ, ÙËÓ ÙÚÔÔÔ›ËÛË ÛÙË ‰Ú·-
ÛÙËÚÈfiÙËÙ· ÙˆÓ ÂÓ˙‡ÌˆÓ ÙÔ˘ ˘Ú‹Ó· fiˆ˜ ÔÈ ÙÔ-
Ô˚ÛÔÌÂÚ¿Û˜ ππ Î·È Ë ·‡ÍËÛË ÛÙË ‰Ú·ÛÙËÚÈfiÙËÙ·
ÂÓ˙‡ÌˆÓ ÂÓ‰Ô΢ÙÙ¿ÚÈ·˜ ·ÔÙÔ͛ӈÛ˘ fiˆ˜ ÔÈ
ÁÏÔ˘Ù·ıÂÈoÓÔ-S-ÙÚ·ÓÛÊÂÚ¿Û˜ Î·È ÌÂÙ·‚ÔϤ˜ ÛÙËÓ
·fiÙˆÛË. OÈ ÚÔÛ¿ıÂȘ ÁÈ· ÙËÓ ·Ó·ÛÙÚÔÊ‹
Ù˘ ÔÏ˘Ê·Ú̷΢ÙÈ΋˜ ·ÓÙÔ¯‹˜ ¤¯Ô˘Ó ΢ڛˆ˜ Â-
ÈÎÂÓÙÚˆı› ÛÙËÓ ƒ-ÁÏ˘ÎÔÚˆÙ½ÓË. ∏ ÎÏÈÓÈ΋ fi-
̈˜ ¯ÚËÛÈÌfiÙËÙ· ÙˆÓ ·Ó·ÛÙÔϤˆÓ Ù˘ ÂÚÈÔÚ›-
ÛÙËΠ·fi ÙËÓ Âȉ›ӈÛË Ù˘ ÎÏÈÓÈ΋˜ ÙÔÍÈÎfiÙË-
Ù·˜ ÙˆÓ ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓˆÓ ¯ËÌÂÈÔıÂÚ·¢ÙÈÎÒÓ
·Ú·ÁfiÓÙˆÓ. ∏ ·ÓÙÈÛÙÚÔÊ‹ ÙÔ˘ Ê·ÈÓfiÙ˘Ô˘ Ù˘
ÔÏ˘Ê·Ú̷΢ÙÈ΋˜ ·ÓÙÔ¯‹˜ ··ÈÙ› ÂÎÙfi˜ ·fi
ÙËÓ ·Ó¿Ù˘ÍË ÙˆÓ ÂȉÈÎÒÓ ÙÚÔÔÔÈËÙÒÓ Ù˘ ηÈ
ÙËÓ ÏËÚ¤ÛÙÂÚË Î·Ù·ÓfiËÛË Ù˘ Ï¢¯·ÈÌÈÔÁ¤ÓÂÛ˘.
EÏÏËÓ I·ÙÚ 2004, 70: 247 - 255.
ÌÔÔÈËÙÈÎÔ‡ ÚÔÁÔÓÈÎÔ‡ ΢ÙÙ¿ÚÔ˘ Ô˘ Ô‰ËÁ› ÛÂ
ÎψÓÈ΋ ÂÍ¿ψÛË Î·È ·Ó·ÛÙÔÏ‹ Ù˘ ‰È·ÊÔÚÔÔ›-
ËÛ‹˜ ÙÔ˘ Û οÔÈÔ ÛÙ¿‰ÈÔ ˆÚ›Ì·ÓÛ˘.
∏ ÂÓÙ·ÂÙ‹˜ ÂχıÂÚË ÓfiÛÔ˘ ÂÈ‚›ˆÛË ·È-
‰ÈÒÓ Ì O§§, Ì ÙË ¯Ú‹ÛË Û‡Á¯ÚÔÓˆÓ ÔÏ˘¯ËÌÂÈ-
ÔıÂÚ·¢ÙÈÎÒÓ ÚˆÙÔÎfiÏψÓ, Î˘Ì·›ÓÂÙ·È ·fi 63-
83%3, ÂÓÒ ÙÔ ÔÛÔÛÙfi ›·Û˘ Ù˘ Oª§ Î˘Ì·›ÓÂÙ·È
·fi 35-50%4-5. ¶·Ú¿ ÙË ÌÂÁ¿ÏË ÚfiÔ‰Ô Ô˘ ¤¯ÂÈ
ÛËÌÂȈı› ÛÙË ıÂÚ·›· ÙˆÓ ·È‰ÈÒÓ Ì Ï¢¯·È-
Ì›·, ¤Ó· ÛËÌ·ÓÙÈÎfi ÔÛÔÛÙfi ·˘ÙÒÓ ˘ÔÙÚÔÈ¿˙ÂÈ
ÌÂÙ¿ ·fi ÙËÓ ·Ú¯È΋ ÂÈÛ·ÁˆÁ‹ Û ‡ÊÂÛË. ∞˘Ùfi
·Ô‰›‰ÂÙ·È Î˘Ú›ˆ˜ ÛÙËÓ ÂÌÊ¿ÓÈÛË ·ÓÙÔ¯‹˜ ÙˆÓ
ηÎÔ‹ıˆÓ ΢ÙÙ¿ÚˆÓ ÛÙÔ˘˜ ¯ËÌÂÈÔıÂÚ·¢ÙÈÎÔ‡˜
·Ú¿ÁÔÓÙ˜, Ô˘ ·ÔηÏÂ›Ù·È ÔÏ˘Ê·Ú̷΢ÙÈ΋
·ÓÙÔ¯‹ (multidrug resistance, MDR).
248 ª. ∫OÀƒ∆∏, º. ∞£∞¡∞™π∞¢OÀ-¶π¶∂ƒO¶OÀ§OÀ

ª∏Ã∞¡π™ª√π ¶√§Àº∞ƒª∞∫∂À∆π∫∏™
∞¡∆√Ã∏™ BCRP

NH2 COOH
∏ ÔÏ˘Ê·Ú̷΢ÙÈ΋ ·ÓÙÔ¯‹ Â›Ó·È ¤Ó· ÔÏ˘·Ú·-
ÁÔÓÙÈÎfi Ê·ÈÓfiÌÂÓÔ Î·È ÔÈ Î˘ÚÈfiÙÂÚÔÈ Ì˯·ÓÈÛÌÔ›
MDR-1
ÂÌÊ¿ÓÈÛ‹˜ Ù˘ ·ÓÙÈÚÔÛˆÂ‡Ô˘Ó Û˘ÛÙ‹Ì·Ù· ΢ÙÙ·- MRP4-5
ÚÈ΋˜ ÚÔÛÙ·Û›·˜. ∞˘ÙÔ› Û˘ÓÔ„›˙ÔÓÙ·È ÛÙÔÓ ›Ó·Î·
1 Î·È ÂÚÈÁÚ¿ÊÔÓÙ·È ·Ó·Ï˘ÙÈο ·Ú·Î¿Ùˆ. NH2

¶›Ó·Î·˜ 1. ∫˘ÚÈfiÙÂÚÔÈ Ì˯·ÓÈÛÌÔ› ÔÏ˘Ê·Ú̷΢ÙÈ΋˜ MRP1-2-3-6

·ÓÙÔ¯‹˜
L0
1. ÀÂÚ¤ÎÊÚ·ÛË ÙˆÓ ∞∆ƒ-‰ÂÛÌ¢ÙÈÎÒÓ ÚˆÙÂ˚ÓÒÓ [P-ÁÏ˘ÎÔ-
∂ÈÎ. 1. ™¯ËÌ·ÙÈ΋ ·ÂÈÎfiÓÈÛË Ù˘ ‰ÔÌ‹˜ ÙˆÓ ABC-Úˆ-
ÚˆÙ½ÓË (P-glycoprotein, P-gp), ÚˆÙ½ÓË ÔÏÏ·Ï‹˜
·ÓÙÔ¯‹˜ (Multiple-Resistance Protein, MRP), ÚˆÙ½ÓË ·- ÙÂ˚ÓÒÓ Ô˘ ÂÓ¤¯ÔÓÙ·È ÛÙÔÓ Ì˯·ÓÈÛÌfi Ù˘ ÔÏ˘Ê·ÚÌ·-
ÓÙÔ¯‹˜ ÙÔ˘ ηÚΛÓÔ˘ ÙÔ˘ Ì·ÛÙÔ‡ (Breast Cancer-Resi- ΢ÙÈ΋˜ ·ÓÙÔ¯‹˜.
stance Protein, BCRP), Ô˘ ‰ÚÔ˘Ó ˆ˜ ·ÓÙϛ˜ ·Ô‚ÔÏ‹˜
Ê·Ú̿ΈÓ. Ê·Ú̿ΈÓ, fiˆ˜ ÔÈ ·Óıڷ΢ÎϛӘ (‰ÔÍÔÚÔ˘‚ÈΛ-
2. ∂Ï·Ùو̤ÓË ÂÓ‰Ô΢ÙÙ¿ÚÈ· Û˘ÁΤÓÙÚˆÛË Ê·ÚÌ¿ÎÔ˘ Ô˘ Ô- ÓË, ‰·Ô˘ÓÔÚÔ˘‚ÈΛÓË), Ô Ù·Í¿Ó˜, Ù· ·ÏηÏÔÂȉ‹
Ê›ÏÂÙ·È Û ¿ÏÏÔ˘˜ Ì˯·ÓÈÛÌÔ‡˜ ÂÎÙfi˜ ÙˆÓ ∞∆ƒ-‰ÂÛÌ¢ÙÈ- Ù˘ vinca (‚ÈÓÎÚÈÛÙ›ÓË), Î·È ÔÈ ÂÈÔ‰ÔÊ˘ÏÏÔÙÔÍ›-
ÎÒÓ ÚˆÙÂ˚ÓÒÓ, fiˆ˜ Ë ˘ÂÚ¤ÎÊÚ·ÛË Ù˘ Ó¢ÌÔÓÈ΋˜
·ÓıÂÎÙÈ΋˜ ÚˆÙ½Ó˘ (Lung-Resistance protein, LRP).
Ó˜ (ÂÙÔÔÛ›‰Ë), ÚÔηÏÒÓÙ·˜ ‰È·ÛÙ·˘ÚÔ‡ÌÂÓË
3. ∆ÚÔÔÔ›ËÛË Ù˘ ‰Ú·ÛÙÈÎfiÙËÙ·˜ ÙÔ˘ ˘ÚËÓÈÎÔ‡ ÂÓ˙‡ÌÔ˘ ·ÓÙÔ¯‹ Û ·˘Ù¿ (∂ÈÎ. 2). ∆Ô ÁÔÓ›‰ÈÔ Ô˘ Έ‰ÈÎÔ-
ÙÔÔ˚ÛÔÌÂÚ¿ÛË ππ. ÔÈ› ÙËÓ P-gp ¯·ÚÙÔÁÚ·Ê‹ıËΠÛÙÔ 7q21.1 ¯Úˆ-
4. ÀÂÚ¤ÎÊÚ·ÛË ÙˆÓ ÂÓ˙‡ÌˆÓ ÂÓ‰Ô΢ÙÙ¿ÚÈ·˜ ·ÔÙÔ͛ӈÛ˘ Ìfiۈ̷ Î·È Ù·˘ÙÔÔÈ‹ıËΠˆ˜ MDR19-10.
fiˆ˜ ÔÈ ÁÏÔ˘Ù·ıÂÈÔÓÔ-S-ÙÚ·ÓÛÊÂÚ¿Û˜. ∏ ¤ÎÊÚ·ÛË ÙÔ˘ MDR1 Û ÂÓ‹ÏÈΘ ·ÛıÂÓ›˜
5. ÀÂÚ¤ÎÊÚ·ÛË ÙˆÓ Ú˘ıÌÈÛÙÈÎÒÓ ÁÔÓȉ›ˆÓ Ù˘ ·fiÙˆÛ˘
Ì Oª§ Û¯ÂÙ›˙ÂÙ·È Ì ·ÓıÂÎÙÈ΋ ÓfiÛÔ, ‰˘ÛÌÂÓ‹
(bcl-2, bcl-xL).
ÚfiÁÓˆÛË Î·È ÂÌÊ¿ÓÈÛË ˘ÔÙÚÔ‹˜11-13. ∞ÓÙ›ıÂÙ·,
ÛÙËÓ O§§ ÙˆÓ ·È‰ÈÒÓ Ù· ·ÔÙÂϤÛÌ·Ù· ›ӷÈ
·ÓÙÈÎÚÔ˘fiÌÂÓ·. ™‡Ìʈӷ Ì ÔÚÈṲ̂Ó˜ ÌÂϤÙ˜ Ë
1. A‰ÂÓÔÙÚÈʈÛʈÚÈΤ˜ ‰ÂÛÌ¢ÙÈΤ˜ Úˆ-
¤ÎÊÚ·ÛË ÙÔ˘ MDR1 ‹Ù·Ó ˘„ËÏfiÙÂÚË Î·Ù¿ ÙË Ê¿-
Ù½Ó˜ (∞∆ƒ-binding cassette proteins,
∞µC-proteins)
·) P-ÁÏ˘ÎÔÚˆÙ½ÓË (P-gp)
∏ ÚÒÙË ·Ó·ÊÔÚ¿ ÛÙË Ê·Ú̷΢ÙÈ΋ ·ÓÙÔ¯‹ ¤ÁÈ-
Ó ÙÔ 1950 ۠Ϣ¯·ÈÌÈο ·ÙÙ·Ú· Â›Ì˘ˆÓ Ù· Aνθρακυλίνες
Aλκαλοειδή vinca
ÔÔ›· ÂÌÊ¿ÓÈÛ·Ó ·ÓÙÔ¯‹ ÛÙÔ 4-·ÌÈÓÔ-¡10-ÌÂı˘Ï- Eπιποδοφυλλοτοξίνες κ.ά.
ÙÂÚÔÁÏÔ˘Ù·ÌÈÎfi Ô͇ ÛÙ· Ï·›ÛÈ· ÂÚ¢ÓËÙÈ΋˜ ÂÚ-
Á·Û›·˜6. ∆Ô 1973, ÔÈ Dano Î·È Û˘ÓÂÚÁ¿Ù˜ ·Ó·Î¿-
Ï˘„·Ó ÙËÓ ·ÔÌ¿ÎÚ˘ÓÛË Ù˘ ‰·Ô˘ÓÔÌ˘Î›Ó˘ ·fi
·ÓıÂÎÙÈο ·ÙÙ·Ú· Ô˘ ÂÌÊ¿ÓÈ˙·Ó ·ÓÙÔ¯‹ Î·È ÛÂ
¿ÏÏÔ˘˜ ¯ËÌÂÈÔıÂÚ·¢ÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜, fiˆ˜
Ù· ·ÏηÏÔÂȉ‹ Ù˘ vinca Î·È ¿ÏϘ ·Óıڷ΢ÎϛӘ7.
ŸÏÔÈ ÔÈ ÂÚ¢ÓËÙ¤˜ Ô˘ ·Ó··Ú‹Á·Á·Ó ÂÈÚ·Ì·ÙÈο
·˘Ùfi ÙÔ Ê·ÈÓfiÙ˘Ô ÔÏ˘Ê·Ú̷΢ÙÈ΋˜ ·ÓÙÔ¯‹˜
‚Ú‹Î·Ó ÙËÓ ˘ÂÚ¤ÎÊÚ·ÛË Ù˘ 170-kDa ΢ÙÙ·ÚÈ΋˜
ÌÂÌ‚Ú·ÓÈ΋˜ ÚˆÙ½Ó˘ Ô˘ ÔÓoÌ¿ÛÙËΠP-ÁÏ˘ÎÔ-
ÚˆÙ½ÓË (P-glycoprotein, P-gp)8. H P-gp Â›Ó·È ÌÈ·
ÁÏ˘ÎÔÚˆÙ½ÓË Ô˘ ÂÓÙÔ›˙ÂÙ·È ÛÙËÓ Î˘ÙÙ·ÚÔÏ·-
ÛÌ·ÙÈ΋ ÌÂÌ‚Ú¿ÓË Î·È ¤¯ÂÈ 2 ÙÌ‹Ì·Ù· Ì 6 ‰È·ÌÂÌ-
‚Ú·ÓÈΤ˜ ÂÚÈÔ¯¤˜ ÙÔ Î·ı¤Ó· (EÈÎ. 1)9. ∂›Ó·È ̤ÏÔ˜
Ù˘ ¢ڇÙÂÚ˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ÙˆÓ ABC- ÚˆÙÂ˚ÓÒÓ.
§ÂÈÙÔ˘ÚÁ› ˆ˜ ·ÓÙÏ›· ÂÓÂÚÁËÙÈ΋˜ ·Ô‚ÔÏ‹˜ ·fi ÙÔ ∂ÈÎ. 2. ™¯ËÌ·ÙÈ΋ ·ÂÈÎfiÓÈÛË ÙÔ˘ Ì˯·ÓÈÛÌÔ‡ ‰Ú¿Û˘
·ÙÙ·ÚÔ ÙÔÍÈÎÒÓ ÌÂÙ·‚ÔÏÈÙÒÓ Î˘ÙÙ·ÚÔÙÔÍÈÎÒÓ Ù˘ P-gp.
 ∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 70, 4 249

ÛË Ù˘ ˘ÔÙÚÔ‹˜ Û ۯ¤ÛË Ì ÙËÓ ¤ÎÊÚ·ÛË Î·Ù¿ ¶›Ó·Î·˜ 2. ∞∆ƒ-‰ÂÛÌ¢ÙÈΤ˜ ÚˆÙ½Ó˜ Î·È ·ÓÙÔ¯‹ Û ΢Ù-
ÙË ‰È¿ÁÓˆÛË Î·È Û¯ÂÙÈ˙fiÙ·Ó Ì ÙÔÓ Î›Ó‰˘ÓÔ ˘Ô- Ù·ÚÔÛÙ·ÙÈο
ÙÚÔ‹˜, ‰˘ÛÌÂÓ¤ÛÙÂÚË ¤Î‚·ÛË Î·È ÌÈÎÚfiÙÂÚË ÂÈ- ¶ÚˆÙ½ÓË ∫˘ÙÙ·ÚÈο Ê¿Ú̷η
‚›ˆÛË10,14-19. À¿Ú¯Ô˘Ó fï˜ Î·È ¿ÏϘ ÌÂϤÙ˜
P-gp ¢·Ô˘ÓÔÚÔ˘‚ÈΛÓË
Ô˘ ‰ÂÓ ·Ô‰ÂÈÎÓ‡Ô˘Ó ·Ó¿ÏÔÁË Û˘Û¯¤ÙÈÛË20-22.
¢ÔÍÔÚÔ˘‚ÈΛÓË
∞˘Ù¿ Ù· ·ÓÙÈÎÚÔ˘fiÌÂÓ· ·ÔÙÂϤÛÌ·Ù· ÌÔÚ› Ó· π‰·ÚÔ˘‚ÈΛÓË
ÔÊ›ÏÔÓÙ·È ÛÙȘ ‰È·ÊÔÚÂÙÈΤ˜ Ù¯ÓÈΤ˜ Ô˘ ¯ÚËÛÈ- ∂ÈÚÔ˘‚ÈΛÓË
ÌÔÔÈÔ‡ÓÙ·È ÁÈ· ÙË ÌÂϤÙË Ù˘ ¤ÎÊÚ·Û˘ ÙÔ˘ ÁÔÓÈ- ªÈÙÔÍ·ÓÙÚfiÓË
‰›Ô˘ ‹ Ù˘ ÚˆÙ½Ó˘ Ô˘ Έ‰ÈÎÔÔÈ›. µÈÓÏ·ÛÙ›ÓË
µÈÓÎÚÈÛÙ›ÓË
∂ÙÔÔÛ›‰Ë
‚) ¶ÚˆÙ½ÓË ÔÏÏ·Ï‹˜ ·ÓÙÔ¯‹˜ (Multiple-Re-
∆ÔÔÙÂοÓË
sistance Protein, MRP)
MRP-1 ¢·Ô˘ÓÔÚÔ˘‚ÈΛÓË
∏ ÌË ¤ÎÊÚ·ÛË Ù˘ P-gp Û ΢ÙÙ·ÚÈΤ˜ ÛÂÈÚ¤˜ Ô˘ ¢ÔÍÔÚÔ˘‚ÈΛÓË
ÂÌÊ¿ÓÈ˙·Ó ÔÏ˘Ê·Ú̷΢ÙÈ΋ ·ÓÙÔ¯‹ Ô‰‹ÁËÛ·Ó ∂ÈÚÔ˘‚ÈΛÓË
ÛÙË ‰ÈÂÚ‡ÓËÛË Ù˘ ‡·Ú͢ Î·È ¿ÏÏˆÓ ‰È·ÌÂÌ- ªÈÙÔÍ·ÓÙÚfiÓË
‚Ú·ÓÈÎÒÓ ÚˆÙÂ˚ÓÒÓ Ô˘ ÏÂÈÙÔ˘ÚÁÔ‡Ó ˆ˜ ·ÓÙϛ˜ µÈÓÏ·ÛÙ›ÓË
µÈÓÎÚÈÛÙ›ÓË
·Ô‚ÔÏ‹˜ Ê·Ú̿ΈÓ. ∆Ô 1992 ÎψÓÔÔÈ‹ıËΠÙÔ ∂ÙÔÔÛ›‰Ë
ªRP1 ÁÔÓ›‰ÈÔ ·fi ÌÈ· ΢ÙÙ·ÚÈ΋ ÛÂÈÚ¿ ·ÓıÚÒÈ- ∆ÂÓÈÔÛ›‰Ë
ÓÔ˘ ÌÈÎÚÔ΢ÙÙ·ÚÈÎÔ‡ ηÚΛÓÔ˘ ÙÔ˘ Ó‡ÌÔÓ·23. MÂıÔÙÚÂÍ¿ÙË
¶ÚÔ˚fiÓ ÙÔ˘ ÁÔÓȉ›Ô˘ Â›Ó·È Ë ªRP1 Ì ÌÔÚÈ·Îfi ‚¿- MRP-2 ¢ÔÍÔÚÔ˘‚ÈΛÓË
ÚÔ˜ 190kDa Î·È ·ÔÙÂÏÂ›Ù·È ·fi ÙÚ›· ÙÌ‹Ì·Ù· Ì ∂ÈÚÔ˘‚ÈΛÓË
6 ‰È·ÌÂÌ‚Ú·ÓÈΤ˜ ÂÚÈÔ¯¤˜ ÙÔ Î·ı¤Ó· (∂ÈÎ. 1). O µÈÓÏ·ÛÙ›ÓË
Ê˘ÛÈÔÏÔÁÈÎfi˜ ÚfiÏÔ˜ ÙÔ˘ Â›Ó·È Ë ·ÔÙÔ͛ӈÛË ·fi µÈÓÎÚÈÛÙ›ÓË
Ù· ÂÓ‰Ô΢ÙÙ¿ÚÈ· ÔÍÂȉˆÙÈο. ¶ÂÚȤ¯ÂÈ ÏÈÁfiÙÂÚÔ ∂ÙÔÔÛ›‰Ë
ªÂıÔÙÚÂÍ¿ÙË
·fi 20% Ù·˘ÙfiÛËÌ· ·ÌÈÓÔͤ· Ì ÙËÓ P-gp ηÈ
™ÈÛÏ·Ù›ÓË
Ô‰ËÁ› Û ·ÓÙ›ÛÙ·ÛË ÛÙȘ ›‰È˜ ηÙËÁÔڛ˜ Ê·ÚÌ¿- πÚÈÓÔÙÂοÓË
ÎˆÓ (¶›Ó. 2).24 ∏ ‚·ÛÈ΋ ‰È·ÊÔÚ¿ ÌÂٷ͇ MRP1
MRP-3 ¢ÔÍÔÚÔ˘‚ÈΛÓË
Î·È P-gp Â›Ó·È fiÙÈ Ë ÚÒÙË ÌÂٷʤÚÂÈ Î·ÙÈÔÓÈο ∂ÙÔÔÛ›‰Ë
Î·È Ô˘‰¤ÙÂÚ· Û˘ÛÙ·ÙÈο, Ì ÙËÓ ÚÔ¸fiıÂÛË fï˜ ∆ÂÓÈÔÛ›‰Ë
Ù˘ ·ÚÔ˘Û›·˜ Ù˘ ÁÏÔ˘Ù·ıÂÈfiÓ˘, fiˆ˜ Ë ‚ÈÓÎÚÈ- µÈÓÎÚÈÛÙ›ÓË
ÛÙ›ÓË, Ë ‰·Ô˘ÓÔÚÔ‚ÈΛÓË, Ë ‰ÔÍÔÚÔ˘‚ÈΛÓË, Ë ÂÙÔ- ªÂıÔÙÚÂÍ¿ÙË
ÔÛ›‰Ë Î·È Ë ÎÔϯÈΛÓË25. ∏ ‚·ÛÈ΋ ‰È·ÊÔÚ¿ ÙÔ˘˜ ™ÈÛÏ·Ù›ÓË
Â›Ó·È fiÙÈ Ë ÌÂıÔÙÚÂÍ¿ÙË Â›Ó·È ˘fiÛÙڈ̷ Ù˘ MRP-4 ªÂıÔÙÚÂÍ¿ÙË
MRP1 fi¯È fï˜ Î·È Ù˘ P-gp. 6-ªÂÚηÙÔÔ˘Ú›ÓË
∏ ÔÈÎÔÁ¤ÓÂÈ· ÙˆÓ MRP ÁÔÓȉ›ˆÓ ÂÚÈÏ·Ì‚¿- £ÂÈÔÁÔ˘·Ó›ÓË
ÓÂÈ Ì¤¯ÚÈ Û‹ÌÂÚ· ÂÙ¿ ̤ÏË (ªRP1-7). Ÿˆ˜ Ê·›- MRP-5 6-ªÂÚηÙÔÔ˘Ú›ÓË
ÓÂÙ·È Î·È ÛÙÔÓ ›Ó·Î· 1, Ë MRP5 ÌÂٷʤÚÂÈ ÓÔ˘- £ÂÈÔÁÔ˘·Ó›ÓË
ÎÏÂÔÙȉÈο ·Ó¿ÏÔÁ· (fiˆ˜ 6-ÌÂÚηÙÔÔ˘Ú›ÓË BCRP ¢·Ô˘ÓÔÚÔ˘‚ÈΛÓË
Î·È ıÂÈÔÁÔ˘·Ó›ÓË) Î·È Î·Ù¿ Û˘Ó¤ÂÈ· Èı·ÓÒ˜ Ó· ¢ÔÍÔÚÔ˘‚ÈΛÓË
·›˙ÂÈ ÚfiÏÔ ÛÙËÓ Ê·Ú̷΢ÙÈ΋ ·ÓÙÔ¯‹ ÛÙËÓ ∂ÈÚÔ˘‚ÈΛÓË
ªÈÙÔÍ·ÓÙÚfiÓË
O§§26,27. ∞Ó·ÊÔÚÈο Ì ÙËÓ Oª§ ÙˆÓ ÂÓËϛΈÓ
∆ÔÔÙÂοÓË
ÂȂ‚·ÈÒıËÎÂ Ë ÂÌÊ¿ÓÈÛË ·ÓÙÔ¯‹˜ ÛÙÔ˘˜ ·ÛıÂ- πÚÈÓÔÙÂοÓË
Ó›˜ Ô˘ ¤ÊÂÚ·Ó ÙÔ ÁÔÓ›‰ÈÔ MRP1 Î·È ÚÔÙ›ÓÂÙ·È
·fi ÔÚÈṲ̂ÓÔ˘˜ ÂÚ¢ÓËÙ¤˜ Ó· ÂÊ·ÚÌfi˙ÂÙ·È ÚÔÏË-
ÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ (screening test) ÂÓÙÔÈÛÌÔ‡ ÙÔ˘ ÁÔ- ˙ÂÙ·È Ì ¯·ÌËÏfiÙÂÚ· ÔÛÔÛÙ¿ ÂχıÂÚ˘ ÓfiÛÔ˘
Óȉ›Ô˘ ÚÈÓ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜28. ™¯ÂÙÈο ÂÈ‚›ˆÛ˘ Î·È ‰˘ÛÌÂÓ¤ÛÙÂÚË ÚfiÁÓˆÛË32.
Ì ÙËÓ O§§ ÙˆÓ ·È‰ÈÒÓ, ÌÂϤÙ˜ ·Ó·Ê¤ÚÔ˘Ó ·˘-
Á) ¶ÚˆÙ½ÓË ·ÓÙÔ¯‹˜ ÙÔ˘ ηÚΛÓÔ˘ ÙÔ˘ Ì·-
ÍË̤ÓË ¤ÎÊÚ·ÛË ÙÔ˘ MRP1 Û ‚Ï·ÛÙÈο ·ÙÙ·Ú·
ÛÙÔ‡ (Breast Cancer Resistance Protein, BCRP)
·È‰ÈÒÓ Ì O§§ Î·È È‰È·›ÙÂÚ· Û ·È‰È¿ Ì ÚÔ-
µ O§§29-31. ∞Ó·ÊÔÚÈο Ì ÙËÓ Oª§ ÙˆÓ ·È‰ÈÒÓ ¶ÚfiÛÊ·Ù· ÂÚÈÁÚ¿ÊÙËΠ۠ÌÂϤÙ˜ Ô˘ ·ÊÔÚÔ‡-
Ë ·˘ÍË̤ÓË ¤ÎÊÚ·ÛË ÙˆÓ MRP2 Î·È MRP3 Û¯ÂÙ›- Û·Ó Î˘ÙÙ·ÚÈΤ˜ ÛÂÈÚ¤˜ Ê·Ú̷΢ÙÈ΋ ·ÓÙÔ¯‹ ÛÙË
250 ª. ∫OÀƒ∆∏, º. ∞£∞¡∞™π∞¢OÀ-¶π¶∂ƒO¶OÀ§OÀ
ÌÈÙÔÍ·ÓÙÚfiÓË, ‰·Ô˘ÓÔÚÔ‚ÈΛÓË ‹ ‰ÔÍÔÚÔ˘‚ÈΛÓË
Î·È ‰È¿ÊÔÚ· ·Ó¿ÏÔÁ· Ù˘ ηÌÙÔıÂοÓ˘
(camptothecin) ¯ˆÚ›˜ ˘ÂÚ¤ÎÊÚ·ÛË Ù˘ P-gp ‹ Ù˘
ªRP133. ∏ ÓÂÔ·Ó·Î·Ï˘Êı›۷ ÚˆÙ½ÓË ÔÓÔÌ¿-
ÛÙËΠ“µreast Cancer Related Protein” ‰ÈfiÙÈ ·Ô-
ÌÔÓÒıËΠ·fi ·ÓıÚÒÈÓ· ·ÙÙ·Ú· ηÚΛÓÔ˘ ÙÔ˘
Ì·ÛÙÔ‡. ¶ÂÚȤ¯ÂÈ 655 ·ÌÈÓÔͤ· Î·È ¤¯ÂÈ ÌÔÚÈ·Îfi
‚¿ÚÔ˜ 72,6 kDa. H ‰ÔÌ‹ Ù˘ ÂÚÈÏ·Ì‚¿ÓÂÈ 6 ‰È·-
ÌÂÌ‚Ú·ÓÈΤ˜ ÂÚÈÔ¯¤˜ Ô˘ ÂÌÊ·Ó›˙Ô˘Ó ÌÈ· ˘‰Úfi-
ÊÔ‚Ë Î·È ÌÈ· ˘‰ÚfiÊÈÏË ÏÂ˘Ú¿, Ë ÔÔ›· ÂÚȤ¯ÂÈ
ÙËÓ ATP-‰ÂÛÌ¢ÙÈ΋ ÂÚÈÔ¯‹34 (∂ÈÎ. 1). ∞Ó·ÊÔ-
ÚÈο Ì ÙËÓ Oª§ Û ÂÓ‹ÏÈΘ ·ÛıÂÓ›˜ ¤¯ÂÈ ‚ÚÂ-
ı› ˘„ËÏfiÙÂÚË ¤ÎÊÚ·ÛË ÙÔ˘ BCRP ÁÔÓȉ›Ô˘ ȉȷ›-
ÙÂÚ· Û ˘ÔÙÚÔ‹ Oª§ ‹ ·ÓıÂÎÙÈ΋ ÛÙË ıÂÚ·-
›· Oª§36,37. ¶·ÚfiÌÔÈ· Â›Ó·È Î·È Ù· ·ÔÙÂϤ-
ÛÌ·Ù· ·fi Ì›· ÌÂϤÙË Û Oª§ ÙˆÓ ·È‰ÈÒÓ, Ô˘
·Ó·Ê¤ÚÂÈ ˘„ËÏfiÙÂÚË ¤ÎÊÚ·ÛË ÙÔ˘ BCRP ÁÔÓȉ›Ô˘
ηٿ ÙËÓ ˘ÔÙÚÔ‹ Ù˘ ÓfiÛÔ˘38. ∆· ·ÔÙÂϤÛÌ·Ù·
fï˜ ·fi ÌÂϤÙ˜ Û Â›Â‰Ô ÚˆÙ½Ó˘ (Ì ÌÂıfi-
‰Ô˘˜ ΢ÙÙ·ÚÔÌÂÙÚ›·˜ ÚÔ‹˜) ¤Ú¯ÔÓÙ·È Û ·ÓÙ›ıÂÛË
Ì ٷ ·Ú·¿Óˆ39,40. ∏ ¤ÎÊÚ·ÛË ÙÔ˘ BCRP ÁÔÓÈ-
‰›Ô˘ Èı·ÓÒ˜ Ó· ·›˙ÂÈ ÚfiÏÔ ÛÙËÓ O§§ ÙˆÓ ·È-
‰ÈÒÓ, ηıÒ˜ ÔÈ ·ÛıÂÓ›˜ Ì O§§ Ï·Ì‚¿ÓÔ˘Ó ıÂ-
Ú·›· Ì ¯ËÌÂÈÔıÂÚ·¢ÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Ô˘
Â›Ó·È ˘ÔÛÙÚÒÌ·Ù· ÁÈ· ÙËÓ BCRP fiˆ˜ Ë ÌÂıÔ-
ÙÚÂÍ¿ÙË, Ë ‰·Ô˘ÓÔÚÔ˘‚ÈΛÓË, Ë ‰ÔÍÔÚÔ˘‚ÈΛÓË Î·È
Ë ÌÈÙÔÍ·ÓÙÚfiÓË. ™‡Ìʈӷ Ì ÚfiÛÊ·Ù· ‰ËÌÔÛÈ¢-
̤Ó˜ ÂÚÁ·Û›Â˜ ÙÔ BCRP ÁÔÓ›‰ÈÔ ÂÎÊÚ¿˙ÂÙ·È Î·È
Â›Ó·È ÏÂÈÙÔ˘ÚÁÈο ÈÔ ÂÓÂÚÁfi ÛÙËÓ µ-O§§ Û ۯ¤-
ÛË Ì ÙËÓ ∆-O§§4. ∞ÓÙ›ıÂÙ·, ‰Â ‚Ú¤ıËÎÂ Û˘Û¯¤ÙÈ-
ÛË ·Ó¿ÌÂÛ· ÛÙÔ Â›Â‰Ô ¤ÎÊÚ·Û˘ ÙÔ˘ BCRP ÁÔ-
Óȉ›Ô˘ Î·È ÚÔÁÓˆÛÙÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ fiˆ˜ Ô
·ÚÈıÌfi˜ ÙˆÓ Ï¢ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ Î·È Ë Ì˘ÂÏÈ΋
·ÓÙ·fiÎÚÈÛË ÛÙË ıÂÚ·›·. ™ÙËÓ O§§ Ù˘ ‚ÚÂÊÈ-
΋˜ ËÏÈΛ·˜, Ù· ‚Ï·ÛÙÈο ·ÙÙ·Ú· ÂÌÊ·Ó›˙Ô˘Ó ¯·-
ÌËÏfiÙÂÚ· Â›‰· ¤ÎÊÚ·Û˘ Û ۯ¤ÛË Ì ·˘Ù¿ ÌÂ-
Á·Ï‡ÙÂÚˆÓ ·È‰ÈÒÓ42,43.
2. ¶Ó¢ÌÔÓÈ΋ ∞ÓıÂÎÙÈ΋ ¶ÚˆÙ½ÓË (Lung
Resistance Protein, LRP)
ŒÓ·˜ ¿ÏÏÔ˜ Ì˯·ÓÈÛÌfi˜ Ê·Ú̷΢ÙÈ΋˜ ·ÓÙÔ¯‹˜
Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ˘ÂÚ¤ÎÊÚ·ÛË ÙÔ˘ LRP (lung-
resistance protein) ÁÔÓȉ›Ô˘ Ô˘ ¯·ÚÙÔÁÚ·Ê‹ıËÎÂ
ÛÙÔ 16p11.2 ¯ÚˆÌfiۈ̷. To ÁÔÓ›‰ÈÔ ·˘Ùfi Έ‰ÈÎÔ-
ÔÈ› ÙËÓ LRP Ì 110 kDa ÌÔÚÈ·Îfi ‚¿ÚÔ˜. ∞Ú¯Èο
ÂÚÈÁÚ¿ÊËΠ۠΢ÙÙ·ÚÈΤ˜ ÛÂÈÚ¤˜ ÌË ÌÈÎÚÔ΢ÙÙ·-
ÚÈÎÔ‡ ηÚΛÓÔ˘ ÙÔ˘ Ó‡ÌÔÓ·, ÛÙȘ Ôԛ˜ ‰ÂÓ ÂÎ-
ÊÚ·˙fiÙ·Ó Ë P-gp44. ∂ÈϤÔÓ, ‚Ú¤ıËΠfiÙÈ ÂÎÊÚ¿-
˙ÂÙ·È Î·È Û ¿ÏϘ ηÚÎÈÓÈΤ˜ ΢ÙÙ·ÚÈΤ˜ ÛÂÈÚ¤˜
Î·È Û¯ÂÙ›˙ÂÙ·È Ì ÂÓ‰ÔÁÂÓ‹ ·ÓÙ›ÛÙ·ÛË ÛÙË ‚ÈÓÎÚÈ-
ÛÙ›ÓË, ÙȘ ·Óıڷ΢ÎϛӘ fiˆ˜ ÙË ‰ÔÍÔÚÔ˘‚ÈΛÓË
Î·È Ê¿Ú̷η Ô˘ ÂÚȤ¯Ô˘Ó Ï·Ù›ÓË45. ∏ ÚÔÁÓˆ-
ÛÙÈ΋ ·Í›· Ù˘ ÁÔÓȉȷ΋˜ ¤ÎÊÚ·Û˘ Ù˘ LRP ·Îfi-
ÌË ‰ÈÂÚÂ˘Ó¿Ù·È Î˘Ú›ˆ˜ ÛÙËÓ OM§ Ì ·ÓÙÈÎÚÔ˘fi-
ÌÂÓ· ·ÔÙÂϤÛÌ·Ù· Ô˘ ÔÈΛÏÏÔ˘Ó ·Ó¿ÏÔÁ· ÌÂ
ÙȘ ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓ˜ Ù¯ÓÈΤ˜46. ∏ ·ÓÔÛÔ˚ÛÙÔ¯Ë-
ÌÈ΋ ‰ÈÂÚ‡ÓËÛË Û¯ÂÙ›˙ÂÙ·È Ì ˘„ËÏ‹ ÚÔÁÓˆÛÙÈ΋
·Í›· Ù˘ ¤ÎÊÚ·Û˘ ÙÔ˘ LRP ÁÔÓȉ›Ô˘ Î·È Ù˘ ‰˘-
ÛÌÂÓÔ‡˜ ÚfiÁÓˆÛ˘ ÛÙËÓ Oª§. ∞ÓÙ›ıÂÙ·, Û ÌÂ-
ϤÙ˜ Ì ÌÂıfi‰Ô˘˜ ΢ÙÙ·ÚÔÊÏÔ˘ÔÚÔÌÂÙÚ›·˜ ‰Â
‚Ú¤ıËΠ·Ó¿ÏÔÁË Û˘Û¯¤ÙÈÛË. ™ÙËÓ O§§ ÙˆÓ ·È-
‰ÈÒÓ ÔÈ ÂÚÈÛÛfiÙÂÚ˜ ÌÂϤÙ˜ ηٷ‰ÂÈÎÓ‡Ô˘Ó fiÙÈ Ë
¤ÎÊÚ·ÛË ÙÔ˘ ÁÔÓȉ›Ô˘ Ù˘ LRP ¤¯ÂÈ ÚÔÁÓˆÛÙÈ΋
·Í›·. Î·È Û¯ÂÙ›˙ÂÙ·È Ì ‰˘ÛÌÂÓ‹ ÚfiÁÓˆÛË47,48.
3. ∞ÓÙÔ¯‹ ÛÙËÓ ·fiÙˆÛË
ŒÓ·˜ ¿ÏÏÔ˜ Ì˯·ÓÈÛÌfi˜ ÔÏ˘Ê·Ú̷΢ÙÈ΋˜ ·-
ÓÙÔ¯‹˜ Â›Ó·È ÔÈ ÌÂÙ·‚ÔϤ˜ ÛÙËÓ ·fiÙˆÛË, ‰ËÏ·‰‹
ÙÔÓ ÚÔÁÚ·ÌÌ·ÙÈṲ̂ÓÔ Î˘ÙÙ·ÚÈÎfi ı¿Ó·ÙÔ, ‰È·Ì¤-
ÛÔ˘ ˘ÂÚ¤ÎÊÚ·Û˘ ‹ ÌÂÙ·ÏÏ¿ÍÂˆÓ ÙˆÓ p53 ‹ bcl-2
ÁÔÓȉ›Ô˘. H ˘ÂÚ¤ÎÊÚ·ÛË ·˘ÙÒÓ ·ÏÏ¿ Î·È ¿ÏψÓ
ÁÔÓȉ›ˆÓ ÙÔ˘ Ì˯·ÓÈÛÌÔ‡ ·fiÙˆÛ˘ fiˆ˜ ÙÔ˘
bcl-xL ¤¯Ô˘Ó Û˘Û¯ÂÙÈÛÙ› Ì ÙË Ê·Ú̷΢ÙÈ΋ ·ÓÙÔ-
¯‹ ۠Ϣ¯·ÈÌÈΤ˜ ΢ÙÙ·ÚÈΤ˜ ÛÂÈÚ¤˜.49-52 ªÂÚÈΤ˜
ÌÂϤÙ˜ Ô˘ ·ÊÔÚÔ‡Û·Ó ÙËÓ Oª§ ·Ó·Ê¤ÚÔ˘Ó ıÂ-
ÙÈ΋ Û˘Û¯¤ÙÈÛË Ù˘ ¤ÎÊÚ·Û˘ ÙÔ˘ bcl-2 Î·È Ù˘ ÌË
·ÓÙ·fiÎÚÈÛ˘ ÛÙË ıÂÚ·›·53. ∞ÓÙ›ıÂÙ·, ÛÙËÓ
O§§ ‰Â ‚Ú¤ıËΠ·ÓÙ›ÛÙÔÈ¯Ë Û˘Û¯¤ÙÈÛË54.
4. ∆ÔÔ˚ÛÔÌÂÚ¿ÛË ππ
OÈ ÙÔÔ˚ÛÔÌÂÚ¿Û˜ Â›Ó·È ¤Ó˙˘Ì· Ô˘ ‚Ú›ÛÎÔÓÙ·È
ÛÙÔÓ ˘Ú‹Ó· ÙˆÓ Î˘ÙÙ¿ÚˆÓ, ‰ÚÔ˘Ó ÛÙÔ ÌÂÙ·‚ÔÏÈ-
ÛÌfi ÙÔ˘ DNA Î·È Â›Ó·È ÛÙfi¯Ô˜ ÙˆÓ ·Óıڷ΢ÎÏÈ-
ÓÒÓ Î·È ÙˆÓ ÂÈÔ‰ÔÊ˘ÏÏÔÙÔÍÈÓÒÓ55. ∏ ÂÏ·Ùو̤-
ÓË ¤ÎÊÚ·ÛË ‹ ÌÂÙ·ÏÏ¿ÍÂȘ ÙˆÓ ÁÔÓȉ›ˆÓ ÙˆÓ ÈÛÔ-
ÌÔÚÊÒÓ ππ· Î·È Iπ‚ Ù˘ ÙÔÔ˚ÛÔÌÂÚ¿Û˘ ππ Û¯ÂÙ›-
˙ÔÓÙ·È Ì ÙÔ Ì˯·ÓÈÛÌfi Ù˘ ÔÏ˘Ê·Ú̷΢ÙÈ΋˜
·ÓÙÔ¯‹˜. ∆· ÁÔÓ›‰È· ·˘Ù¿ ¯·ÚÙÔÁÚ·Ê‹ıËÎ·Ó ÛÙ·
17p21-22 Î·È 3p24 ¯ÚˆÌÔÛÒÌ·Ù· ·ÓÙ›ÛÙÔȯ·56. ∞Ó
Î·È Û ΢ÙÙ·ÚÈΤ˜ ÛÂÈÚ¤˜ ¤¯ÂÈ ‚ÚÂı› ıÂÙÈ΋ Û˘-
Û¯¤ÙÈÛË Ù˘ Ê·Ú̷΢ÙÈ΋˜ ·ÓÙÔ¯‹˜ Î·È Ù˘ ¤Î-
ÊÚ·Û˘ Ù˘ ÙÔÔ˚ÛÔÌÂÚ¿Û˘ ππ·, Û ‰Â›ÁÌ·Ù· ·-
ÛıÂÓÒÓ Ì Oª§ Ë ÏÂÈÔ„ËÊ›· ÙˆÓ ÌÂÏÂÙÒÓ ‰ÂÓ
η٤‰ÂÈÍ ·ÓÙ›ÛÙÔȯ˜ Û˘Û¯ÂÙ›ÛÂȘ57.
5. °ÏÔ˘Ù·ıÂÈÔÓÔS-ÙÚ·ÓÛÊÂÚ¿Û˜ (GSTs)
OÈ GSTs ·ÔÙÂÏÔ‡Ó ¤Ó· ÛËÌ·ÓÙÈÎfi ÙÌ‹Ì· ÙÔ˘ ÌË-
¯·ÓÈÛÌÔ‡ Ù˘ ÂÓ‰Ô΢ÙÙ¿ÚÈ·˜ ·ÔÙÔ͛ӈÛ˘, ηٷ-
χÔÓÙ·˜ ÙË Û‡Ó‰ÂÛË Ù˘ ÁÏÔ˘Ù·ıÂÈfiÓ˘ ÌÂ Û˘ÛÙ·ÙÈ-
 ∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 70, 4
ο ‰È·ÊfiÚˆÓ Î˘ÙÙ·ÚÔÙÔÍÈÎÒÓ Ê·ÚÌ¿ÎˆÓ Î·È Ê˘-
ÛÈο ÙÔÍÈο ÚÔ˚fiÓÙ· (xenobiotics). To ÙÂÏÈÎfi
ÚÔ˚fiÓ Ù˘ Û‡Ó‰ÂÛ‹˜ ÙÔ˘˜ Â›Ó·È ÏÈÁfiÙÂÚÔ ÙÔÍÈÎfi,
ÂÚÈÛÛfiÙÂÚÔ ‰È·Ï˘Ùfi Î·È ·Ô‚¿ÏÏÂÙ·È ·¢ı›·˜
·fi Ù· ·ÙÙ·Ú· ‰È·Ì¤ÛÔ˘ ÚˆÙÂ˚ÓÈÎÒÓ ·ÓÙÏÈÒÓ ÌÂ
ηٷӿψÛË ÂÓ¤ÚÁÂÈ·˜ Û˘ÌÂÚÈÏ·Ì‚·ÓÔ̤ÓÔ˘ ηÈ
Ù˘ MRP58. ∞ÔÙÂÏÔ‡Ó ÌÈ· ÔÏ˘ÁÔÓȉȷ΋ ÔÌ¿‰·
ÂÓ˙‡ÌˆÓ Ô˘ ÚÔÛÊ¿Ùˆ˜ ¯ˆÚ›ÛÙËΠ۠٤ÛÛÂÚȘ
˘ÔÙ¿ÍÂȘ ÙȘ ·, Ì,  Î·È ı (GSTA, GSTM, GSTP,
GSTT, ·ÓÙ›ÛÙÔȯ·). ∞fi ÙȘ Ù¤ÛÛÂÚȘ ˘ÔÙ¿ÍÂȘ
ÙˆÓ GSTs, ÌfiÓÔ ÔÈ GS∆ª Î·È GSTP Ô˘ ¯·ÚÙÔ-
ÁÚ·Ê‹ıËÎ·Ó ÛÙ· ¯ÚˆÌÔÛÒÌ·Ù· 1 Î·È 22 ·ÓÙ›ÛÙÔÈ-
¯·, ¤¯Ô˘Ó ÌÂÏÂÙËı› Û ·ÈÌ·ÙÔÏÔÁÈΤ˜ ηÎÔ‹ıÂȘ.
™Â οÔȘ ÌÂϤÙ˜ ·Ó·Ê¤ÚÂÙ·È Û˘Û¯¤ÙÈÛË Ù˘
GSTM Ì ‰˘ÛÌÂÓ‹ ÚfiÁÓˆÛË ÛÙËÓ O§§ ÙˆÓ ·È-
‰ÈÒÓ59, ÂÓÒ Û οÔȘ ¿ÏϘ ·Ó·Ê¤ÚÂÙ·È ·ÓÙ›-
ÛÙÔÈ¯Ë Û˘Û¯¤ÙÈÛË Ù˘ GSTP Ì ٷ˘Ùfi¯ÚÔÓË fï˜
¤ÎÊÚ·ÛË Ù˘ Pgp60.
¢π∞°¡ø™∆π∫∂™ ª∂£√¢√π
∆∏™ ¶√§Àº∞ƒª∞∫∂À∆π∫∏™ ∞¡∆√Ã∏™
∏ ÏÂÈÔÓfiÙËÙ· ÙˆÓ ÁÓÒÛÂˆÓ fiÛÔÓ ·ÊÔÚ¿ ÛÙË ÌÂ-
ıÔ‰ÔÏÔÁ›· Ù˘ ÔÏ˘Ê·Ú̷΢ÙÈ΋˜ ·ÓÙÔ¯‹˜ ÚÔ-
¤Ú¯ÂÙ·È ·fi Ù¯ÓÈΤ˜ Ô˘ ÂÊ·ÚÌfi˙ÔÓÙ·È Û ΢ÙÙ·-
ÚÈΤ˜ ÛÂÈÚ¤˜. OÈ ÚˆÙ½Ó˜ fï˜ Ê·Ú̷΢ÙÈ΋˜
·ÓÙÔ¯‹˜ ÂÎÊÚ¿˙ÔÓÙ·È Û ÌÈÎÚfiÙÂÚÔ ÔÛÔÛÙfi ÛÙ·
ÎÏÈÓÈο ‰Â›ÁÌ·Ù· Û ۯ¤ÛË Ì ÙȘ ·ÓıÂÎÙÈΤ˜ ΢Ù-
Ù·ÚÈΤ˜ ÛÂÈÚ¤˜. ∫·Ù¿ Û˘Ó¤ÂÈ· ·ÎfiÌË Î·È ÌÈ· ÌÈ-
ÎÚ‹ ·‡ÍËÛË ÛÙËÓ ‰Ú·ÛÙËÚÈfiÙËÙ· ÙÔ˘ ÔÏ˘Ê·ÚÌ·-
΢ÙÈÎÔ‡ ·ÓıÂÎÙÈÎÔ‡ Ê·ÈÓfiÙ˘Ô˘ ÌÔÚ› Ó· ¤¯ÂÈ
ÎÏÈÓÈ΋ ÛËÌ·Û›·. ªÈ· Û˘Ì‚·ÙÈ΋ ̤ıÔ‰Ô˜ Âͤٷ-
Û˘ Ù˘ ÔÏ˘Ê·Ú̷΢ÙÈ΋˜ ·ÓÙÔ¯‹˜ ‚·Û›˙ÂÙ·È
ÛÙË ¯Ú‹ÛË ÌÂıfi‰ˆÓ ΢ÙÙ·ÚÈ΋˜ ÂÈ‚›ˆÛ˘ Ì ÙËÓ
·ÚÔ˘Û›· ‹ ·Ô˘Û›· ΢ÙÙ·ÚÔÙÔÍÈÎÒÓ Ê·Ú̿ΈÓ.
∆Ô ‚·ÛÈÎfi ÌÂÈÔÓ¤ÎÙËÌ· Â›Ó·È Ô ··ÈÙÔ‡ÌÂÓÔ˜ ¯Úfi-
ÓÔ˜ 3-4 ËÌÂÚÒÓ in vitro ΢ÙÙ·ÚÈ΋˜ ηÏÏȤÚÁÂÈ·˜,
ÁÂÁÔÓfi˜ Ô˘ ηıÈÛÙ¿ ‰‡ÛÎÔÏË ÙËÓ ÂÊ·ÚÌÔÁ‹ ÛÂ
‰Â›ÁÌ·Ù· ·ÛıÂÓÒÓ61.
∏ ̤ÙÚËÛË ÙÔ˘ ÂÈ¤‰Ô˘ ¤ÎÊÚ·Û˘ ÙÔ˘
mRNA ÙˆÓ ÁÔÓȉ›ˆÓ ÔÏ˘Ê·Ú̷΢ÙÈ΋˜ ·ÓÙÔ¯‹˜
Ì ÙËÓ Û Ú·ÁÌ·ÙÈÎfi ¯ÚfiÓÔ-·Ï˘ÛȉˆÙ‹ ·ÓÙ›‰Ú·ÛË
ÔÏ˘ÌÂÚ¿Û˘ (real-time PCR) ·ÓÙÈÚÔÛˆ‡ÂÈ
ÔÛÔÙÈ΋ ̤ıÔ‰Ô. Œ¯ÂÈ ˘„ËÏ‹ ¢·ÈÛıËÛ›· Î·È ÂÈ-
‰ÈÎfiÙËÙ·. ∂›Ó·È fï˜ ÌÈ· ÂÚÁ҉˘ ÌÂıÔ‰ÔÏÔÁ›·
Ô˘ Â›Ó·È ‰‡ÛÎÔÏÔ Ó· ÂÊ·ÚÌÔÛÙ› Û Â›Â‰Ô ÂÚ-
Á·ÛÙËÚȷ΋˜ ÚÔ˘Ù›Ó·˜62-64.
O ηıÔÚÈÛÌfi˜ Ù˘ ÚˆÙÂ˚ÓÈ΋˜ ¤ÎÊÚ·Û˘ Á›-
ÓÂÙ·È Î˘Ú›ˆ˜ Ì ÙËÓ Î˘ÙÙ·ÚÔÌÂÙÚ›· ÚÔ‹˜, ÂÓÒ Ë
·ÓÔÛÔ˚ÛÙÔ¯ËÌ›· ¯ÚËÛÈÌÔÔÈÂ›Ù·È Î˘Ú›ˆ˜ ÛÂ Û˘Ì-
·Á›˜ fiÁÎÔ˘˜. ∏ ·Ó·ÁÓÒÚÈÛË ÙˆÓ MDR ÚˆÙÂ˚-
251
ÓÒÓ Á›ÓÂÙ·È Ì ÙË ¯Ú‹ÛË ÌÔÓÔÎψÓÈÎÒÓ ·ÓÙÈۈ̿-
ÙˆÓ ¤Ó·ÓÙÈ Â͈ÙÂÚÈÎÒÓ Â›ÙÔˆÓ. ¢ÂÓ Â›Ó·È ÔÛÔ-
ÙÈ΋ ̤ıÔ‰Ô˜ Î·È ¤¯ÂÈ ¯·ÌËÏ‹ ¢·ÈÛıËÛ›· ‰ÈfiÙÈ ÂÌ-
Ê·Ó›˙ÂÈ ‰È·ÛÙ·˘ÚÔ‡ÌÂÓ˜ ·ÓÙȉڿÛÂȘ65,66. ∂È-
ϤÔÓ Û ·ÓÙ›ıÂÛË Ì ٷ ÌÔÓÔÎψÓÈο ·ÓÙÈÛÒÌ·Ù·
¤Ó·ÓÙÈ Ù˘ P-gp Ô˘ ·ÓÙȉÚÔ‡Ó Ì Â͈ÙÂÚÈÎÔ‡˜
·ÓÙÈÁÔÓÈÎÔ‡˜ ÂÈÙfiÔ˘˜, Ë LRP ‰Ú· ÛÙËÓ ˘ÚËÓÈ΋
΢ÙÙ·ÚÔÏ·ÛÌ·ÙÈ΋ ÂÚÈÔ¯‹ Î·È ‰ÂÓ ˘¿Ú¯Ô˘Ó
‰È·ı¤ÛÈÌ· ÌÔÓÔÎψÓÈο ·ÓÙÈÛÒÌ·Ù·61.
OÈ ÏÂÈÙÔ˘ÚÁÈΤ˜ ‰ÔÎÈ̷ۛ˜ Ù˘ ΢ÙÙ·ÚÔÊÏÔ˘-
ÔÚÔÌÂÙÚ›·˜ ÂÌÊ·Ó›˙Ô˘Ó ‚·ÛÈÎfi ÏÂÔÓ¤ÎÙËÌ· ¤Ó·-
ÓÙÈ ÙˆÓ ÌÂÙÚ‹ÛÂˆÓ ÙˆÓ ·ÓÙÈÁÔÓÈÎÒÓ Â›ÙÔˆÓ, ‰ÈfiÙÈ
ÌÂÙÚÔ‡Ó ÙËÓ ‰Ú·ÛÙËÚÈfiÙËÙ· ÌÂÙ·ÊÔÚ¿˜ ÙˆÓ MDR
ÚˆÙÂ˚ÓÒÓ. ∏ ¯Ú‹ÛË ÙÔ˘˜ ÂÚÈÔÚ›˙ÂÙ·È Î˘Ú›ˆ˜ ÛÂ
ÂÚ¢ÓËÙÈο ÂÚÁ·ÛÙ‹ÚÈ· Ì ÙËÓ Ù¯ÓÈ΋ Ú·‰ÈÔÛ‹Ì·Ó-
Û˘ Î·È Ì¤ÙÚËÛ˘ Ù˘ ‰Ú·ÛÙÈÎfiÙËÙ·˜ Ù˘ ATP¿Û˘
Ù˘ ΢ÙÙ·ÚÈ΋˜ ÌÂÌ‚Ú¿Ó˘. ∏ ¢ڤˆ˜ ¯ÚËÛÈÌÔÔÈ-
Ô‡ÌÂÓË Ù¯ÓÈ΋ ÁÈ· ÙËÓ ·Ó›¯Ó¢ÛË Ù˘ MDR ‰Ú·-
ÛÙËÚÈfiÙËÙ·˜ ‚·Û›˙ÂÙ·È ÛÙË ¯Ú‹ÛË Ù˘ ÊıÔÚ›˙Ô˘Û·˜
¯ÚˆÛÙÈ΋˜ rhodamine 123 Î·È calcein AM67,68. ∆·
·ÙÙ·Ú· Âˆ¿˙ÔÓÙ·È Ì ÙÔ˘˜ ÊıÔÚ›˙ÔÓÙ˜ ·ÓȯÓ¢-
Ù¤˜, ÔÈ ÔÔ›ÔÈ ÌÂٷʤÚÔÓÙ·È ·fi ÙȘ MDR Úˆ-
Ù½Ó˜ Î·È ÌÂÙÚ¿Ù·È Ë Î·Ù·ÓÔÌ‹ Ù˘ ¯ÚˆÛÙÈ΋˜ ÛÙÔ
ÂÓ‰Ô΢ÙÙ¿ÚÈÔ Î·È ÂÍˆÎ˘ÙÙ¿ÚÈÔ ‰È·Ì¤ÚÈÛÌ·. £Âˆ-
ÚÂ›Ù·È Ì¤ıÔ‰Ô˜ ÂÎÏÔÁ‹˜ ÛÙË Ï¢¯·ÈÌ›·.
∫§π¡π∫∂™ ª∂§∂∆∂™ °π∞ ∆∏¡ ∞¡∞™∆ƒ√º∏
∆∏™ ¶√§Àº∞ƒª∞∫∂À∆π∫∏™ ∞¡∆√Ã∏™
∏ ÏÂÈÔÓfiÙËÙ· ÙˆÓ ÎÏÈÓÈÎÒÓ ÌÂÏÂÙÒÓ Â›¯Â ˆ˜ ÛÙfi-
¯Ô Ó· ‰ÈÂÚ¢ӋÛÂÈ Â¿Ó Ë ¯Ú‹ÛË ·Ó·ÛÙÔϤˆÓ Ù˘ P-
gp ÌÔÚ› Ó· ‚ÂÏÙÈÒÛÂÈ ÙËÓ ÂÈ‚›ˆÛË Û ·ÛıÂÓ›˜
΢ڛˆ˜ ÂÓ‹ÏÈΘ Ì ˘„ËÏ‹ ¤ÎÊÚ·ÛË Ù˘ ÚˆÙ½Ó˘
·˘Ù‹˜. ™ÙȘ ·Ú¯ÈΤ˜ ÌÂϤÙ˜ Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıË-
Î·Ó Ê¿Ú̷η fiˆ˜ Ë ‚ÂÚ··Ì›ÏË ¤‰ÂÈÍ·Ó ÂÚÈÔ-
ÚÈṲ̂ÓË ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ηıÒ˜ Ë ÂÌÊ¿ÓÈÛË
·ÚÂÓÂÚÁÂÈÒÓ ‰ÂÓ Â¤ÙÚÂ·Ó ÈηÓÔÔÈËÙÈο Â›-
‰· ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ÛÙÔÓ ÔÚfi ÒÛÙ ӷ ·ÓÙÈÛÙÚ¤-
„Ô˘Ó ÙËÓ ¤ÎÊÚ·ÛË Ù˘ P-gp65. ∂ÈϤÔÓ, ÔÏÏÔ›
·fi ÙÔ˘˜ ·Ó·ÛÙÔÏ›˜ Ù˘ P-gp ÂËÚ¿˙Ô˘Ó ÙË Ê·Ú-
Ì·ÎÔÎÈÓËÙÈ΋ ·Ô‚ÔÏ‹˜ ÙˆÓ ·ÓÙÈηÚÎÈÓÈÎÒÓ Ê·Ú-
Ì¿ÎˆÓ ·fi ÙÔ˘˜ ÓÂÊÚÔ‡˜ ‹ ÙÔ ‹·Ú. °È· ÙÔ ÏfiÁÔ
·˘Ùfi ÛÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÎÏÈÓÈÎÒÓ ÌÂÏÂÙÒÓ, ıˆڋ-
ıËΠ··Ú·›ÙËÙÔ Ó· ÂÏ·ÙÙˆı› Ë ‰fiÛË ÙÔ˘ ¯ËÌÂÈÔ-
ıÂÚ·¢ÙÈÎÔ‡ ÁÈ· ÙËÓ Â›Ù¢ÍË ÈÛfiÙÈÌ˘ ÎÏÈÓÈ΋˜
ÙÔÍÈÎfiÙËÙ·˜. Ÿˆ˜ ÚÔ·ÙÂÈ ·fi ÙËÓ ·Ó·ÛÎfiË-
ÛË Ù˘ Û‡Á¯ÚÔÓ˘ ‚È‚ÏÈÔÁÚ·Ê›·˜, ÌfiÓÔ Ë quinine
Î·È Ë Î˘ÎÏÔÛÔÚ›ÓË, Û˘ÌÂÚÈÂÏ‹ÊıËÛ·Ó ÛÙË Ê¿ÛË
πππ ÎÏÈÓÈÎÒÓ ÌÂÏÂÙÒÓ Ì ·ÛıÂÓ›˜ ÂÓ‹ÏÈΘ ηÈ
·È‰È¿ Ì η΋˜ ÚfiÁÓˆÛ˘ Oª§69-74. ∏ ÚÔÛı‹-
ÎË Î˘Ú›ˆ˜ Ù˘ ΢ÎÏÔÛÔÚ›Ó˘ ÛÙ· ¯ËÌÂÈÔıÂÚ·¢-
252 ª. ∫OÀƒ∆∏, º. ∞£∞¡∞™π∞¢OÀ-¶π¶∂ƒO¶OÀ§OÀ
ÙÈο Û¯‹Ì·Ù· Ô‰‹ÁËÛ Û ·ÓÙÈÎÚÔ˘fiÌÂÓ· ·ÔÙÂϤ-
ÛÌ·Ù· Ô˘ ÚÔÊ·ÓÒ˜ ·ÓÙ·Ó·ÎÏÔ‡Ó ÙÔ ‰È·ÊÔÚÂÙÈ-
Îfi ۯ‰ȷÛÌfi, ÏËı˘ÛÌfi Î·È ÙË ‰È·ÊÔÚÂÙÈ΋ ‰ÔÛÔ-
ÏÔÁ›· ÙˆÓ Ê·ÚÌ¿ÎˆÓ Û οı ÌÂϤÙË.
ŒÓ·˜ ¿ÏÏÔ˜ ·Ú¿ÁÔÓÙ·˜ Ô˘ ·Ó·ÛÙ¤ÏÏÂÈ ÙË
‰Ú¿ÛË Ù˘ Pgp, Â›Ó·È ÙÔ PSC833, ¤Ó· ·Ú¿ÁˆÁÔ
Ù˘ ΢ÎÏÔÛÔÚ›Ó˘ D (Vaspodar, ∂ast ∏annover,
NJ), Ì ÂÓı·ÚÚ˘ÓÙÈο ·ÔÙÂϤÛÌ·Ù· Û ÎÏÈÓÈΤ˜
ÌÂϤÙ˜ Ê¿Û˘ π,ππ75-77. OÈ ·Ú¿ÁÔÓÙ˜ GG120918,
VX710 (BiricÔdar Vertex, Pharmaceutical, Cam-
bridge, MA) Â›Ó·È ·Ó·ÛÙÔÏ›˜ Ù˘ P-gp ·ÏÏ¿ ÙÚÔ-
ÔÔÈÔ‡Ó Î·È ÙËÓ ¤ÎÊÚ·ÛË ÙˆÓ BCRP Î·È MRP1
MRP2 Î·È ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Û ÎÏÈÓÈΤ˜ ÌÂϤÙ˜
Ê¿Û˘ ππ78-79.
∂ÎÙfi˜ ÙˆÓ ·Ú·ÁfiÓÙˆÓ Ô˘ ‰ÚÔ˘Ó Î˘Ú›ˆ˜
¤Ó·ÓÙÈ ÙˆÓ ∞∆ƒ-‰ÂÛÌ¢ÙÈÎÒÓ ÚˆÙÂ˚ÓÒÓ, ÌÈ· ¿ÏÏË
ÛÙÚ·ÙËÁÈ΋ ÁÈ· ÙËÓ ·Ó·ÛÙÔÏ‹ Ù˘ ÔÏ˘Ê·Ú̷΢-
ÙÈ΋˜ ·ÓÙÔ¯‹˜ ÂÚÈÏ·Ì‚¿ÓÂÈ ÙË ¯Ú‹ÛË bcl-2 ·ÓÙÈ-
ÓÔËÌ·ÙÈÎÒÓ (anti-sense) ÔÏÈÁÔÓÔ˘ÎÏÂÔÙȉ›ˆÓ. ∞˘-
Ù¿ ¢·ÈÛıËÙÔÔÈÔ‡Ó ÙȘ Ì˘ÂÏÔ‚Ï¿ÛÙ˜ ÛÙËÓ Î˘ÙÔÛ›-
ÓË-·Ú·‚ÈÓÔÛ›‰Ë Î·È ÚÔ¿ÁÔ˘Ó ÙËÓ ·fiÙˆÛË in
vitrÔ80. ÕÏÏÔ˜ ÛÙfi¯Ô˜ ÁÈ· ÙËÓ ıÂÚ·›· ÙˆÓ ·ÓÙÈ-
ÓÔËÌ·ÙÈÎÒÓ ÔÏÈÁÔÓÔ˘ÎÏÂÔÙȉ›ˆÓ Â›Ó·È Ë ·ÚÔ˘Û›·
Ù˘ ÌÂÙ¿ıÂÛ˘ BCR-ABL81.
ª∂§§√¡∆π∫∂™ ¶ƒ√√¶∆π∫∂™
H ·Ó¿Ù˘ÍË ÙÔ˘ Ê·ÈÓfiÙ˘Ô˘ Ù˘ ÔÏ˘Ê·Ú̷΢ÙÈ-
΋˜ ·ÓÙÔ¯‹˜ ÂÍ·ÚÙ¿Ù·È Î˘Ú›ˆ˜ ·fi ÁÂÓÂÙÈΤ˜ ÌÂ-
Ù·‚ÔϤ˜. ∏ ·Ó·ÁÓÒÚÈÛË ·˘ÙÒÓ Î·È Ë ÂÎÙ›ÌËÛË ÙÔ˘
ÚfiÏÔ˘ ÙÔ˘˜ ÛÙËÓ ·ÓÙÔ¯‹ Û ¯ËÌÂÈÔıÂÚ·¢ÙÈÎÔ‡˜
·Ú¿ÁÔÓÙ˜ Û˘ÁÎÂÓÙÚÒÓÂÈ ÌÂÁ¿ÏÔ ÎÏÈÓÈÎfi ÂӉȷ-
ʤÚÔÓ. OÈ ÌÂÏÏÔÓÙÈΤ˜ ÚÔÔÙÈΤ˜ ÛÙÔÓ ÙÔ̤· ·˘-
Ùfi ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙËÓ ·Ó¿Ù˘ÍË ·ÊÂÓfi˜ ÌÂÓ Ù¯ÓÈ-
ÎÒÓ ÁÂÓÂÙÈ΋˜ Î·È ÚˆÙÂÔÌÈ΋˜ ÁÈ· ÙËÓ ¤ÁηÈÚË
·Ó·ÁÓÒÚÈÛË Î·È ·Ú·ÎÔÏÔ‡ıËÛË Ù˘ ÔÏ˘Ê·ÚÌ·-
΢ÙÈ΋˜ ·ÓÙÔ¯‹˜, ·ÊÂÙ¤ÚÔ˘ ‰Â ÙËÓ ·Ó·ÁÓÒÚÈÛË
ÂÎÂ›ÓˆÓ ÙˆÓ Ê·ÚÌ¿ÎˆÓ Ô˘ ·ÔÙÂÏÂÛÌ·ÙÈο ·Ó·-
ÛÙ¤ÏÏÔ˘Ó ÙËÓ ¤ÎÊÚ·ÛË Î·È ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ MDR
ÚˆÙÂ˚ÓÒÓ. ¶·Ú¿ Ù· ÚÔÎÏÈÓÈο ÂÈÚ¿Ì·Ù· Ô˘
¤‰ÂÈÍ·Ó fiÙÈ ÔÚÈṲ̂ÓÔÈ ·ÓıÂÎÙÈÎÔ› Ê·ÈÓfiÙ˘ÔÈ ÌÔ-
ÚÔ‡Ó Ó· ÍÂÂÚ·ÛÙÔ‡Ó Ì ÙË ¯Ú‹ÛË ÂȉÈÎÒÓ ·Ú·-
ÁfiÓÙˆÓ, ÙÔ Î˘ÙÙ·ÚÈÎfi ÚÔÊ›Ï ·ÓıÂÎÙÈÎfiÙËÙ·˜ ·ÓÙÈ-
ÚÔÛˆ‡ÂÈ ÌÈ· ÔχÏÔÎË ·ÏÏËÏÂ›‰Ú·ÛË ÔÏ-
Ï·ÏÒÓ Î˘ÙÙ·ÚÈÎÒÓ ÌÂÙ·‚ÔÏÒÓ, fiˆ˜ ÔÈ ÌÂÙ·ÏÏ¿-
ÍÂȘ Ô˘ Ô‰ËÁÔ‡Ó Û ÔÏ˘Ê·Ú̷΢ÙÈ΋ ·ÓÙÔ¯‹
·ÏÏ¿ Èı·ÓÒ˜ Ó· ÚÔÛʤÚÔ˘Ó Î·È ¿ÏÏ· ¿ÁÓˆÛÙ·
ÏÂÔÓÂÎÙ‹Ì·Ù· Û ΢ÙÙ·ÚÈÎfi Â›‰Ô.
∏ Ù¯ÓÔÏÔÁ›· ÙˆÓ c-DNA ÌÈÎÚÔÛ˘ÛÙÔȯÈÒÓ
(microarrays) Â›Ó·È Ë È‰·ÓÈ΋ ̤ıÔ‰Ô˜ ÁÈ· ÙË ‰ÈÂ-
Ú‡ÓËÛË ÙÔ˘ Ê·ÈÓÔ̤ÓÔ˘ Ù˘ ÔÏ˘Ê·Ú̷΢ÙÈ΋˜
·ÓÙÔ¯‹˜ Ì ÙË Û‡ÁÎÚÈÛË Ù˘ ¤ÎÊÚ·Û˘ ÂηÙÔÓÙ¿-
‰ˆÓ ÁÔÓȉ›ˆÓ Ù·˘Ùfi¯ÚÔÓ· Û ¢·›ÛıËÙ· Î·È ·ÓıÂ-
ÎÙÈο ηÚÎÈÓÈο ·ÙÙ·Ú·. H ÛËÌ·Û›· Ù˘ ÙÚÔÔ-
Ô›ËÛ˘ οı ÁÔÓȉ›Ô˘ ı· ·ÔÙÂϤÛÂÈ ÙÔ ·ÓÙÈΛ-
ÌÂÓÔ ÙˆÓ ÌÂÏÏÔÓÙÈÎÒÓ ÂÚ¢ÓÒÓ. ∏ ·Ó¿Ù˘ÍË ÙˆÓ
ÂȉÈÎÒÓ ÙÚÔÔÔÈËÙÒÓ Ù˘ ÔÏ˘Ê·Ú̷΢ÙÈ΋˜
·ÓÙÔ¯‹˜ Î·È Ë ÂÓۈ̿وۋ ÙÔ˘˜ ÛÙËÓ ·ÓÙÈÏ¢¯·È-
ÌÈ΋ ıÂÚ·›·, ··ÈÙ› ÙËÓ ÏËÚ¤ÛÙÂÚË Î·Ù·ÓfiË-
ÛË Ù˘ Ï¢¯·ÈÌÈÔÁ¤ÓÂÛ˘.
∆ÂÏÈÎfi˜ ÛÙfi¯Ô˜ Â›Ó·È Ë ıÂÚ·›· Ó· ηÙ¢ı‡-
ÓÂÙ·È ÛÙÔ˘˜ ÁÂÓÂÙÈÎÔ‡˜ ˘ÔÙ‡Ô˘˜ Ù˘ Ï¢¯·ÈÌ›·˜,
Î·È Ë ‰È¿ÚÎÂÈ¿ Ù˘ Ó· ÚÔÛ·ÚÌfi˙ÂÙ·È ÛÙÔ ÁÂÓÂÙÈÎfi
ÚÔÊ›Ï ÙÔ˘ οı ·ÛıÂÓ‹ Ì ÙËÓ ·ÔÙ‡ˆÛË ÙÔ˘
ÁÔÓȉȷÎÔ‡ ¯¿ÚÙË Ù˘ ÓfiÛÔ˘ οı ·ÛıÂÓ‹.
ABSTRACT
∫Ôurti M, Athanasiadou-Piperopoulou F. ªulti-
drug resistance of childhood acute leukemia. Hell
Iatr 2004, 70: 247-255.
Modern treatment protocols for childhood leu-
kemia lead to complete remission in a high pro-
portion of patients. Nevertheless, a large number of
them show a relapse while on therapy. The progno-
sis for them is extremely poor and their vast majo-
rity fail to respond to subsequent chemotherapy.
Treatment failure in these patients is mainly attribu-
table to de novo or acquired resistance to a wide
variety of structurally and functionally unrelated
chemotherapeutic drugs which is called multidrug
resistance (MDR). The mechanisms responsible for
MDR include overexpression of the adenosine tri-
phosphate-binding cassette protein superfamily (P-
glycoprotein, multidrug resistance associated pro-
teins, breast cancer resistance protein), which act as
drug-efflux pumps, modifications of nuclear or de-
toxifying enzymes like topoisomerase II and glu-
tathion-S-transferases respectively and defects in
chemotherapy induced apoptosis. The efforts to o-
vercome drug resistance have been focused on
modulation of P-glycoprotein. The majority of
clinical studies were limited by pharmacokinetic in-
teractions exacerbating the clinical toxicities of che-
motherapy. Overcoming clinical resistance in leuke-
mia therapy may require not only targeted resistan-
ce modifiers, but also a more complete biologic and
clinical understanding of the leukemic process.
µπµ§π√°ƒ∞ºπ∞
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Ó·˜ ‹ ·ÎfiÌË Î·È Ì¤Û· ÛÙÔ ÓÂÚfi ÂÎÙÂÏÒÓÙ·˜ ÙÚÔ-
ÔÔÈË̤ÓÔ ·ÛÎËÛÈÔÏfiÁÈÔ. øÛÙfiÛÔ, Ô ÚÔÔÓËÙ‹˜
Î·È Ô È·ÙÚfi˜ ı· Ú¤ÂÈ Ó· Â›Ó·È ÂÓ‹ÌÂÚÔÈ ÁÈ· ÙËÓ
ÂÈ‚¿Ú˘ÓÛË Ù˘ ˘Á›·˜ ÙÔ˘ ¿Û¯ÔÓÙÔ˜ ÎÔÏ˘Ì‚ËÙ‹
·fi ÙË Û˘Ó¤¯ÈÛË Ù˘ ÚÔÔÓËÙÈ΋˜ ‰È·‰Èηۛ·˜,
ÒÛÙ ӷ ÚÔÏ¿‚Ô˘Ó ÛÔ‚·Ú¤˜ ÂÈÏÔΤ˜ Î·È Ó· η-
ıÔ‰ËÁ‹ÛÔ˘Ó Î·Ù¿ÏÏËÏ· ÙË ıÂÚ·¢ÙÈ΋ ·ÁˆÁ‹
Î·È ÙËÓ ·ÔηٿÛÙ·Û‹ ÙÔ˘7. O ÛÎÔfi˜ ·˘Ù‹˜ Ù˘
 ∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 70, 4
·Ó·ÛÎÔÈ΋˜ ÌÂϤÙ˘ Â›Ó·È Ó· ·ÚÔ˘ÛÈ¿ÛÂÈ ÙȘ ÈÔ
Û˘¯Ó¤˜ ‰È·Ù·Ú·¯¤˜ Ù˘ ˘Á›·˜ ÛÙËÓ ·ÁˆÓÈÛÙÈ΋ ÎÔ-
χ̂ËÛË Ô˘ ÌÔÚ› Ó· ·Ó·ÛÙ›ÏÔ˘Ó ÙË Û˘ÌÌÂÙÔ¯‹
ÙÔ˘ ÎÔÏ˘Ì‚ËÙ‹ ÛÙȘ ·ıÏËÙÈΤ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜ ηÈ
Ó· ·ÚÂÌÔ‰›ÛÔ˘Ó ÙË ÌÂÁÈÛÙÔÔ›ËÛË Ù˘ ·ıÏËÙÈ-
΋˜ ÙÔ˘ ·fi‰ÔÛ˘.
§OIMø•∂π™ ∆√À ∞¡∞¶¡∂À™∆π∫√À ™À™∆∏ª∞-
∆√™
OÈ ÏÔÈÌÒÍÂȘ ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹-
Ì·ÙÔ˜ ·ÔÙÂÏÔ‡Ó È‰È·›ÙÂÚ· Û˘¯Ó‹ ·ÈÙ›· ‰È·ÎÔ‹˜
Ù˘ ÚÔfiÓËÛ˘ ÛÙËÓ ·ÁˆÓÈÛÙÈ΋ ÎÔχ̂ËÛË, ¯ˆ-
Ú›˜ fï˜ Ó· ·Ú·ÙËÚÔ‡ÓÙ·È Û˘¯ÓfiÙÂÚ· ÛÙÔ˘˜ ÎÔ-
Ï˘Ì‚ËÙ¤˜ ·fi fiÙÈ ÛÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi8. øÛÙfiÛÔ,
·ÎfiÌ· Î·È ÌÈÎÚ‹˜ ‚·Ú‡ÙËÙ·˜ ÏÔÈÌÒÍÂȘ Â›Ó·È ‰˘-
Ó·ÙfiÓ Ó· ·Ô‚Ô‡Ó ÛÔ‚·Ú¤˜ ÙfiÛÔ ÁÈ· ÙËÓ ˘Á›· ÙÔ˘
ÎÔÏ˘Ì‚ËÙ‹ fiÛÔ Î·È ÁÈ· ÙËÓ ·ıÏËÙÈ΋ ÙÔ˘ ·fi‰ÔÛË,
ÏfiÁˆ Ù˘ ȉȷ›ÙÂÚ˘ ÛËÌ·Û›·˜ Ù˘ Ê˘ÛÈÔÏÔÁÈ΋˜
ÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÁÈ·
ÙËÓ ÂÎÙ¤ÏÂÛË Ù˘ ·Ó·ÓÔ‹˜ ̤۷ ÛÙÔ ÓÂÚfi ÛÙÔ
¿ıÏËÌ· Ù˘ ÎÔχ̂ËÛ˘. OÈ Û˘¯ÓfiÙÂÚ˜ ÏÔÈÌÒÍÂȘ
ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Â›Ó·È ÔÈ
ÚÈÓ›Ùȉ˜ Î·È ÔÈ ·Ú·ÚÈÓÔÎÔÏ›Ùȉ˜ ΢ڛˆ˜ ÈÔÁÂ-
ÓÔ‡˜ ·ÈÙÈÔÏÔÁ›·˜9. ∞ÚÎÂÙÔ› ÂÚ¢ÓËÙ¤˜ ¤¯Ô˘Ó ÌÂÏÂ-
Ù‹ÛÂÈ ÙË Û¯¤ÛË ÌÂٷ͇ ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ ÁÏÔ˘Ù·Ì›-
Ó˘ Ï¿ÛÌ·ÙÔ˜ Ì ÙËÓ ÂÌÊ¿ÓÈÛË ÏÔÈÌÒÍÂˆÓ ·fi ÙÔ
·Ó·Ó¢ÛÙÈÎfi10. øÛÙfiÛÔ, Ù· ÌÂȈ̤ӷ Â›‰· Ù˘
ÁÏÔ˘Ù·Ì›Ó˘ Ô˘ ·Ú·ÙËÚÔ‡ÓÙ·È Û ÎÔÏ˘Ì‚ËÙ¤˜ ÌÂ
¤ÓÙÔÓË ÚÔÔÓËÙÈ΋ ÂÈ‚¿Ú˘ÓÛË ‰Â Ê·›ÓÂÙ·È Ó·
Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì ÙË Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ÏÔÈÌÒ-
ÍÂˆÓ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜10. ÕÏϘ ÌÂ-
ϤÙ˜ ·Ó·Ê¤ÚÔ˘Ó fiÙÈ ÔÈ ¯·ÌËϤ˜ ÙÈ̤˜ Ù˘ ·ÓÔÛÔ-
ÛÊ·ÈÚ›Ó˘ IgA ÛȤÏÔ˘ ÛÙËÓ ·Ú¯‹ Ù˘ ÚÔÔÓËÙÈ΋˜
ÂÚÈfi‰Ô˘ ÌÔÚÔ‡Ó Ó· Úԉȷı¤ÛÔ˘Ó ıÂÙÈο ÛÙËÓ
ÂÌÊ¿ÓÈÛË ·Ó·Ó¢ÛÙÈÎÒÓ ÏÔÈÌÒÍÂˆÓ ÛÙÔ˘˜ ÎÔÏ˘Ì-
‚ËÙ¤˜11. ¡ÂfiÙÂÚ˜ ¤Ú¢Ó˜ ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ ÔÈ ¯·-
ÌËϤ˜ ÙÈ̤˜ ÁÏÔ˘Ù·Ì›Ó˘, ·ÓÔÛÔÛÊ·ÈÚÈÓÒÓ Î·È Î˘Ù-
Ù·ÚÔÎÈÓÒÓ Ï¿ÛÌ·ÙÔ˜ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ‰È·Ù·Ú·-
¯¤˜ Ù˘ ‰Ú¿Û˘ ÙˆÓ Ô˘‰ÂÙÂÚfiÊÈÏˆÓ Ï¢ÎÔ΢ÙÙ¿-
ÚˆÓ Î·È ÙˆÓ Î˘ÙÙ¿ÚˆÓ Ê˘ÛÈÎÒÓ ÊÔÓ¤ˆÓ ÌÂÈÒÓÔ˘Ó
ÙËÓ ·ÓÙ›ÛÙ·ÛË ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ Û ·Ϥ˜ ÏÔÈÌÒÍÂȘ
ηٿ ÙËÓ ÂÚ›Ô‰Ô ¤ÓÙÔÓ˘ ÚÔfiÓËÛ˘12. ∂ÈϤ-
ÔÓ, ÙÔ ¯ÏÒÚÈÔ Ù˘ ÈÛ›Ó·˜ ·ÔÙÂÏ› ¤Ó·Ó ÚfiÛıÂÙÔ
ÂÈ‚·Ú˘ÓÙÈÎfi ·Ú¿ÁÔÓÙ· ÁÈ· ÙÔ ·ÓÒÙÂÚÔ ·Ó·-
Ó¢ÛÙÈÎfi Û‡ÛÙËÌ· ÙˆÓ ÎÔÏ˘Ì‚ËÙÒÓ. ∏ ÚfiÏË„Ë
ÙˆÓ ·Ó·Ó¢ÛÙÈÎÒÓ ÏÔÈÌÒÍÂˆÓ Î·ı›ÛÙ·Ù·È ··-
Ú·›ÙËÙË ÙfiÛÔ ÁÈ· ÙËÓ ˘Á›· ÙˆÓ ·ıÏËÙÒÓ fiÛÔ fï˜
Î·È ÙˆÓ ÚÔÔÓËÙÒÓ ÙÔ˘˜. OÈ ‚·ÛÈÎfiÙÂÚ˜ ‰ÈÂ-
ıÓ›˜ ÚԉȷÁڷʤ˜ ˘ÁÈÂÈÓ‹˜ ÙÔ˘ ‡‰·ÙÔ˜ ÎÔÏ˘Ì‚Ë-
ÙËÚ›ˆÓ ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔÓ ›Ó·Î· 1. ∂ȉÈÎfiÙÂÚ·
257
¶›Ó·Î·˜ 1. ¶ÚԉȷÁڷʤ˜ ˘ÁÈÂÈÓ‹˜ ‡‰·ÙÔ˜ ÎÔÏ˘Ì‚ËÙËÚ›ˆÓ
(¢ÈÂıÓ›˜ Ô‰ËÁ›Â˜ ¶·ÁÎfiÛÌÈ·˜ ∫ÔÏ˘Ì‚ËÙÈ΋˜ OÌÔÛÔÓ‰›·˜-
FINA 2002-2005).
1. Ÿ„Ë: ¢È·˘Á‹˜
2. £ÂÚÌÔÎÚ·Û›·: 24 - 28Æ
3. ph: 7.2 – 7.6
4. ∂χıÂÚ· ÛÙÔȯ›· ¯ÏˆÚ›Ô˘: 0,3 – 0,6 mg/L
5. ™˘Ó‰Â‰Â̤ÓÔ ¯ÏÒÚÈÔ: 0,4 mg/L
6. ∫ÔÏÔ‚·ÎÙËÚ›‰È· (E.Coli): 0/dl
7. ∞ÔÈ˘ ÌÈÎÚÔ‚›ˆÓ: <100/dl (21ÆC ± 0.5ÆC)
̤ÙÚ· ÚfiÏ˄˘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi
΢ڛˆ˜ ÂÓ·ÓÙ›ÔÓ ÙÔ˘ ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘ Î·È ÙˆÓ
ÂԯȷÎÒÓ ÂȉËÌÈÒÓ ÙÔ˘ ÈÔ‡ Ù˘ ÁÚ›˘, ΢ڛˆ˜
ÁÈ· ÙÔ˘˜ ÎÔÏ˘Ì‚ËÙ¤˜ Ô˘ ‰È¿ÁÔ˘Ó ÔÌ·‰È΋ ˙ˆ‹
(‰È·‚›ˆÛË Û ÎÔÈÓ¿ ηٷχ̷ٷ - Û˘¯Ó¤˜ ÔÌ·‰ÈΤ˜
ÌÂÙ·ÎÈÓ‹ÛÂȘ). ∞ÚÎÂÙÔ› Û‡ÏÏÔÁÔÈ ÎÔχ̂ËÛ˘ ÛÙÔ
Â͈ÙÂÚÈÎfi ÂÚÈÔÚ›˙Ô˘Ó ÙÔ˘˜ ÎÔÏ˘Ì‚ËÙ¤˜ Ì ÂÏ·-
ÊÚ¤˜ ÏÔÈÌÒÍÂȘ ÛÂ Û˘ÁÎÂÎÚÈ̤ÓÔ˘˜ ·ıÏËÙÈÎÔ‡˜
¯ÒÚÔ˘˜ ÚÔ˜ ·ÔÊ˘Á‹ ÂÍ¿ψÛ˘ Ù˘ Ïԛ̈͢
̤۷ ÛÙËÓ ÔÌ¿‰·.
§√πªø•∂π™ ∂•ø ∫∞π ª∂™√À ø∆√™
∏ ÂÓÙÔÈṲ̂ÓË ‹ ‰È¿¯˘ÙË Â͈ÙÂÚÈ΋ ‹ ̤ÛË ˆÙ›ÙÈ-
‰· ·ÔÙÂÏÔ‡Ó Û˘¯Ó¿ ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù· ÛÙÔ˘˜
ÎÔÏ˘Ì‚ËÙ¤˜7. ªÂ ÙÔÓ fiÚÔ Â͈ÙÂÚÈ΋ ˆÙ›Ùȉ· ¯·Ú·-
ÎÙËÚ›˙ÂÙ·È ÙÔ Û‡ÓÔÏÔ ÙˆÓ ÊÏÂÁÌÔÓˆ‰ÒÓ Î·Ù·ÛÙ¿-
ÛÂˆÓ ÛÙÔ ‰¤ÚÌ· ÙÔ˘ Â͈ÙÂÚÈÎÔ‡ ˆÙfi˜, ÙfiÛÔ ÙÔ˘
ÙÂÚ˘Á›Ô˘ fiÛÔ Î·È ÙÔ˘ ¤Íˆ ·ÎÔ˘ÛÙÈÎÔ‡ fiÚÔ˘. ∏
˘ÁÚ·Û›· ·ÔÙÂÏ› ÙÔ Î˘ÚÈfiÙÂÚÔ ·›ÙÈÔ ÁÈ· ÙËÓ ÂÌ-
Ê¿ÓÈÛ‹ Ù˘ ÚÔηÏÒÓÙ·˜ ÌÂÙ·‚ÔÏ‹ ÛÙËÓ ÔÈfiÙËÙ·
ÙÔ˘ ÂÈıËÏ›Ô˘ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜. ¶ÚÔηÏÂ›Ù·È ·ÙÚÔÊ›·
ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ ÙˆÓ Î˘„ÂÏȉÔÔÈÒÓ Î·È ÛÌËÁÌ·ÙÔ-
ÁfiÓˆÓ ·‰¤ÓˆÓ, Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·ÒÏÂÈ· ÙÔ˘
ÚÔÛٷ٢ÙÈÎÔ‡ ÛÙÚÒÌ·ÙÔ˜ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜, Ô˘
Û¯ËÌ·Ù›˙Ô˘Ó ÔÈ ÂÎÎÚ›ÛÂȘ. ∏ ÌÂÙ·‚ÔÏ‹ ·˘Ù‹ ¢ÓÔ-
› ÙËÓ ·Ó¿Ù˘ÍË ÊÏÂÁÌÔÓÒÓ ·fi ÌÈÎÚfi‚È·, ÈÔ‡˜ ηÈ
̇ÎËÙ˜ ÛÙÔ˘˜ ÎÔÏ˘Ì‚ËÙ¤˜. ∏ ̤ÛË ˆÙ›Ùȉ· Î·È ÂÈ-
‰ÈÎfiÙÂÚ· Ë ÔÍ›· ̤ÛË ˘Ò‰Ë˜ ÌÔÚÊ‹ Ù˘, ·ÔÙÂ-
Ï› ÔÍ›· ÊÏÂÁÌÔÓÒ‰Ë ·ÓÙ›‰Ú·ÛË ÙÔ˘ ‚ÏÂÓÓÔÁfiÓÔ˘
ÙÔ˘ ̤ÛÔ˘ ˆÙfi˜ Û ÌÈÎÚԂȷ΋ ÂÈÌfiÏ˘ÓÛË. ¶·Ú·-
ÙËÚÂ›Ù·È Û˘¯ÓfiÙÂÚ· ÛÙÔ˘˜ ÎÔÏ˘Ì‚ËÙ¤˜ Ô˘ ¿-
Û¯Ô˘Ó ·fi ÏÔÈÌÒÍÂȘ ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈ-
ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ˆ˜ Â¤ÎÙ·ÛË Ù˘ ÊÏÂÁÌÔÓ‹˜ ÙˆÓ
ÚÈÓÈÎÒÓ ı·Ï¿ÌˆÓ Î·È ÙÔ˘ ÚÈÓÔÊ¿Ú˘ÁÁ·, ‰È· ̤ÛÔ˘
Ù˘ ¢ÛÙ·¯È·Ó‹˜ Û¿ÏÈÁÁ·˜ ηıÒ˜ Î·È ‰È·Ì¤ÛÔ˘
ÙÔ˘ ¤Íˆ ·ÎÔ˘ÛÙÈÎÔ‡ fiÚÔ˘ fiÙ·Ó ÚÔ¸¿Ú¯ÂÈ ‰È¿-
ÙÚËÛË ‰È·ÊfiÚÔ˘ ‚·ıÌÔ‡ ÙÔ˘ Ù˘Ì¿ÓÔ˘ Î·È Â›ÛÔ‰Ô˜
ÌÔÏ˘Ṳ̂ÓÔ˘ ‡‰·ÙÔ˜. ∏ ÚÔÏËÙÈ΋ ¯Ú‹ÛË Ì ÂÓ-
ÛÙ¿Ï·ÍË ÛÙÔÓ ¤Íˆ ·ÎÔ˘ÛÙÈÎfi fiÚÔ ÛÙ·ÁfiÓˆÓ Ô˘
·ÔÌ·ÎÚ‡ÓÔ˘Ó ÙËÓ ˘ÁÚ·Û›· ÌÂÙ¿ ÙËÓ ÚÔfiÓËÛË ‹
258 N. KOYT§π∞¡O™
Ë ÂÊ·ÚÌÔÁ‹ ÂȉÈÎÒÓ ÚÔÛٷ٢ÙÈÎÒÓ ˆÙÈÎÒÓ Î·-
Ï˘ÌÌ¿ÙˆÓ Û˘Ì‚¿ÏÏÂÈ ÛÙË Ì›ˆÛË Ù˘ Û˘¯ÓfiÙËÙ·˜
ÂÌÊ¿ÓÈÛ˘ ÏÔÈÌÒÍÂˆÓ ÙÔ˘ ˆÙfi˜ ÛÙËÓ ÎÔχ̂ËÛË13.
§√πªø•∂π™ ∆√À √Àƒ√¶√π√°∂¡¡∏∆π∫√À
™À™∆∏ª∞∆√™
OÈ Â˘Î·ÈÚȷΤ˜ ÏÔÈÌÒÍÂȘ ÙÔ˘ Ô˘ÚÔÔÈÔÁÂÓÓËÙÈ-
ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ηٷÁÚ¿ÊÔÓÙ·È Û˘¯Ó¿ ÛÙËÓ ÎÔ-
χ̂ËÛË, ȉȷ›ÙÂÚ· ÛÙËÓ ·ÓÔÈÎÙ‹ ı¿Ï·ÛÛ· Î·È ÂÌ-
Ê·Ó›˙ÔÓÙ·È Î˘Ú›ˆ˜ ÛÙȘ ÎÔÏ˘Ì‚‹ÙÚȘ14. ∆· ·Ó·ÙÔ-
ÌÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ Ô˘ÚÔÔÈËÙÈÎÔ‡ Î·È ÙÔ˘
ÁÂÓÓËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÛÙȘ Á˘Ó·›Î˜ (ÌÈÎÚfi Ì‹-
ÎÔ˜ Ô˘Ú‹ıÚ·˜, ÁÂÈÙÓ›·ÛË Ô˘Ú‹ıÚ·˜ – Ô˘ÚÔ‰fi¯Ô˘
·ÛÙˆ˜ Ì ٷ Â͈ÙÂÚÈο ÁÂÓÓËÙÈο fiÚÁ·Ó· ηÈ
ÙÔÓ ÎÔÏÂfi) Úԉȷı¤ÙÔ˘Ó ÛÙË Û˘¯Ó‹ ÂÌÊ¿ÓÈÛË ÏÔÈ-
ÌÒ͈Ó, fiˆ˜ ÌÈÎÚԂȷΤ˜ ‹ Ì˘ÎËÙÈ·ÛÈΤ˜ ÔÍ›˜
·È‰ÔÈÔÎÔÏ›Ùȉ˜, Ô˘ÚËıÚ›Ùȉ˜ Î·È Î˘ÛÙ›Ùȉ˜. OÈ
ÙÚȯÔÌÔÓ¿‰Â˜ ·ÔÙÂÏÔ‡Ó ÙÔ Û˘¯ÓfiÙÂÚÔ ·ıÔÁfiÓÔ
·›ÙÈÔ ÎÔÏ›Ùȉ·˜ ÛÙȘ ÎÔÏ˘Ì‚‹ÙÚȘ15. T· Û˘ÌÙÒ-
Ì·Ù· Û˘Ó‹ıˆ˜ Â›Ó·È Ë ÂÌÊ¿ÓÈÛË ÙÔÈο ÎÓËÛÌÔ‡
Î·È ¿ÏÁÔ˘˜, Û˘¯ÓÔÔ˘Ú›·˜, ‰˘ÛÔ˘Ú›·˜ Î·È ·‡ÍËÛ˘
Ù˘ ¤ÎÎÚÈÛ˘ ÎÔÏÈÎÒÓ ˘ÁÚÒÓ Ô˘ Â›Ó·È Û˘Ó‹ıˆ˜
‰‡ÛÔÛÌ· Î·È Ì ÌÂÙ·‚ÔÏ‹ ÛÙÔ Ê˘ÛÈÔÏÔÁÈÎfi ¯ÚÒÌ·.
∏ ÌË ÔÚı‹ ıÂÚ·¢ÙÈ΋ ÚÔÛ¤ÁÁÈÛË ÙˆÓ ÏÔÈÌÒ͈Ó
·˘ÙÒÓ Î·È Ë ÌË Ï‹„Ë ÙˆÓ ··Ú·›ÙËÙˆÓ Ì¤ÙÚˆÓ ·ÙÔ-
ÌÈ΋˜ ˘ÁÈÂÈÓ‹˜ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÔ˘Ó Û ¯ÚfiÓȘ ÏÔÈ-
ÌÒÍÂȘ Ì ÛÔ‚·Ú¤˜ ÂÓ›ÔÙ ÂÈÙÒÛÂȘ ÛÙË ÏÂÈÙÔ˘Ú-
Á›· ÙˆÓ ‰‡Ô Û˘ÛÙËÌ¿ÙˆÓ. ∞Í›˙ÂÈ Ó· ÛËÌÂȈı› fiÙÈ Ë
ÏÂÈÔ„ËÊ›· ÙˆÓ ÏÔÈÌÒÍÂˆÓ ÙÔ˘ Ô˘ÚÔÔÈÔÁÂÓÓËÙÈ-
ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÛÙȘ ÎÔÏ˘Ì‚‹ÙÚȘ ÔÊ›ÏÂÙ·È Û ÂÏ-
ÏÈ‹ ˘ÁÈÂÈÓ‹ ÙˆÓ ‚ÔËıËÙÈÎÒÓ ¯ÒÚˆÓ ÙÔ˘ ÎÔÏ˘Ì‚Ë-
ÙËÚ›Ô˘ Î·È ÏÈÁfiÙÂÚÔ Û ¿ÌÂÛË ÌÂÙ¿‰ÔÛË Ì¤Ûˆ ÙÔ˘
‡‰·ÙÔ˜14. ∂ÈϤÔÓ, Û˘¯Ó¿ ··ÈÙÂ›Ù·È Û˘Ó‰˘·Ṳ̂ÓË
ıÂÚ·›· ÏfiÁˆ Ù˘ ÁÂÈÙÓ›·Û˘ ÙˆÓ ‰‡Ô Û˘ÛÙËÌ¿ÙˆÓ
Î·È Ù˘ ¢ÎÔÏfiÙÂÚ˘ ÌÂÙ¿‰ÔÛ˘ Ù˘ Ïԛ̈͢. ∏
·Ú·ÙÂٷ̤ÓË ¯ÚËÛÈÌÔÔ›ËÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ ÁÈ·
ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÌÈ·˜ Ô˘ÚÔÏԛ̈͢ ÌÔÚ› Ó·
¢ÓÔ‹ÛÂÈ ÙËÓ ·Ó¿Ù˘ÍË Ì˘Î‹ÙˆÓ ÛÙ· ÁÂÓÓËÙÈο fiÚ-
Á·Ó· Î·È ÙËÓ ÂÌÊ¿ÓÈÛË ˘ÔÙÚÔÈ¿˙Ô˘ÛˆÓ Î·È ·Ó-
ıÂÎÙÈÎÒÓ ÛÙË ıÂÚ·›· ÏÔÈÌÒ͈Ó.
§√πªø•∂π™ ¢∂ƒª∞∆√™ – ªÀ∫∏∆π∞™∂π™
OÈ ‚·ÎÙËÚȷΤ˜ ‰ÂÚÌ·ÙÔ¿ıÂȘ ÙˆÓ ÎÔÏ˘Ì‚ËÙÒÓ
ÔÊ›ÏÔÓÙ·È Û˘Ó‹ıˆ˜ Û Ïԛ̈ÍË ·fi ÛÙ·Ê˘ÏfiÎÔÎ-
ÎÔ (staphylococcus aureus), Û˘ÓËı¤ÛÙÂÚ· ‡ÛÙÂÚ·
·fi οÔÈ· χÛË Ù˘ Û˘Ó¯›·˜ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜16. ∆Ô
ÌÔÏ˘ÛÌ·ÙÈÎfi ÎËÚ›Ô Î·È ÔÈ ‰È¿ÊÔÚÔÈ Ù‡ÔÈ ı˘Ï·Î›-
Ùȉ·˜ ·ÔÙÂÏÔ‡Ó ÙȘ Û˘¯ÓfiÙÂÚ˜ ‚·ÎÙËÚȷΤ˜ ÏÔÈ-
ÌÒÍÂȘ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ ÙˆÓ ÎÔÏ˘Ì‚ËÙÒÓ7. OÈ ‚·ÎÙË-
ÚÈÔÁÂÓ›˜ ÏÔÈÌÒÍÂȘ ı· Ú¤ÂÈ Ó· ‰È·ÊÔÚԉȷÁÈ-
ÁÓÒÛÎÔÓÙ·È ·fi ÙȘ ‰ÂÚÌ·ÙÔ¿ıÂȘ ÂÍ’ Â·Ê‹˜,
ÙȘ ·ÙÔÈΤ˜ Î·È ·ÏÏÂÚÁÈΤ˜ ‰ÂÚÌ·Ù›Ùȉ˜, ηıÒ˜
Î·È ·fi ÙȘ Ì˘ÎËÙÈ·ÛÈΤ˜ ‰ÂÚÌ·ÙÔ¿ıÂȘ. OÈ Ì˘-
ÎËÙÈ·ÛÈΤ˜ ‰ÂÚÌ·ÙÔ¿ıÂȘ ·ÔÙÂÏÔ‡Ó ÙȘ Û˘¯Ófi-
ÙÂÚ˜ ‰ÂÚÌ·ÙÔÏÔÁÈΤ˜ ‰È·Ù·Ú·¯¤˜ ÙˆÓ ÎÔÏ˘Ì‚Ë-
ÙÒÓ. ∏ ÈÔ ÁÓˆÛÙ‹ ¿ıËÛË Â›Ó·È Ô «Ô˘˜ ÙˆÓ ·ıÏË-
ÙÒÓ» (tinea pedis) Ô˘ ÔÊ›ÏÂÙ·È Û ÂȉÈÎÔ‡˜ ‰ÂÚ-
Ì·ÙfiÊ˘ÙÔ˘˜ ̇ÎËÙ˜. ∏ Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ Ù˘
‰ÂÚÌ·ÙÔÊ˘Ù›·Û˘ ÙÔ˘ Ô‰fi˜ ÛÙÔ˘˜ ÎÔÏ˘Ì‚ËÙ¤˜
·Ó¤Ú¯ÂÙ·È ·fi 15% ¤ˆ˜ 64% Î·È ÔÊ›ÏÂÙ·È Î˘Ú›ˆ˜
ÛÙÔ˘˜ ̇ÎËÙ˜ Ù˘ ηÙËÁÔÚ›·˜ Trichophyton
mentagrophytes17,18. ∏ Ì˘ÎËÙ›·ÛË ÛÙÔ˘˜ ÎÔÏ˘Ì‚Ë-
Ù¤˜ ÂΉËÏÒÓÂÙ·È Û˘Ó‹ıˆ˜ Ì ÙËÓ ÂÌÊ¿ÓÈÛË ÂÚ˘-
ıÚÒÓ ÛÎÏËÚÒÓ Î·È ·ÔÏÂÈÛÌ¤ÓˆÓ ÂÚÈÔ¯ÒÓ ÛÙÔ
¤ÏÌ· ‹ ÛÙȘ ÌÂÛÔ‰·ÎÙ‡ÏȘ ÂÚÈÔ¯¤˜ ÙÔ˘ ¿ÎÚÔ˘
fi‰·, Û˘Ó‹ıˆ˜ ÌÂٷ͇ ÙÚ›ÙÔ˘ Î·È ¤ÌÙÔ˘ ‰·ÎÙ‡-
ÏÔ˘. OÈ ‰ÂÚÌ·ÙfiÊ˘Ù˜ Ì˘ÎËÙËÛÈ¿ÛÂȘ Â›Ó·È ‰˘Ó·-
ÙfiÓ Ó· ÂÈÏ·ÎÔ‡Ó Ì ÔÓ˘¯Ô̇ΈÛË (tinea unguium)
Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÎÂÚ·ÙÈÓfiÏ˘ÛË, ‡ıÚ·˘-
ÛÙÔ˘˜, Â·¯˘Ì¤ÓÔ˘˜ Î·È ˘fi¯ÚˆÌÔ˘˜ fiÓ˘¯Â˜19.
OÈ ·Ú¿ÁÔÓÙ˜ Ô˘ ¢ÓÔÔ‡Ó ÙËÓ ·Ó¿Ù˘ÍË ÙˆÓ
‰ÂÚÌ·ÙfiÊ˘ÙˆÓ Ì˘Î‹ÙˆÓ ÛÙÔ˘˜ ÎÔÏ˘Ì‚ËÙ¤˜ Â›Ó·È Ô
ȉÚÒÙ·˜, Ë ÂÏÏÈ‹˜ ·ÙÔÌÈ΋ ˘ÁÈÂÈÓ‹ Î·È Î˘Ú›ˆ˜ Ë
˘ÁÚ·Û›·. ∞ÚÎÂÙ¤˜ ¤Ú¢Ó˜ ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ Ë ÌÂÈ-
ˆÌ¤ÓË Î·ı·ÚÈfiÙËÙ· ÙˆÓ ¯ÒÚˆÓ ¤Íˆ ·fi ÙÔ ÓÂÚfi
·ÔÙÂÏÔ‡Ó ÙÔ Î‡ÚÈÔ ÌÂÙ·‰ÔÙÈÎfi ·›ÙÈÔ ÙˆÓ Ì˘ÎËÙÈ¿-
ÛˆÓ14-18. ∏ ÚÔÏËÙÈ΋ ·ÔÌfiÓˆÛË ÙÔ˘ ¿Û¯Ô-
ÓÙÔ˜ ÎÔÏ˘Ì‚ËÙ‹ ·fi ÙÔ ÓÂÚfi Ù˘ ÈÛ›Ó·˜ Î·È Ë Î·-
Ù¿ÏÏËÏË ıÂÚ·¢ÙÈ΋ ·ÁˆÁ‹ Û˘Ì‚¿ÏÏÔ˘Ó ÛÙÔÓ Â-
ÚÈÔÚÈÛÌfi ÙÔ˘ ÂÈÔÏ·ÛÌÔ‡ Ù˘ ¿ıËÛ˘.
∞™∫∏™π√°∂¡∏™ µƒ√°Ã√™¶∞™ª√™
O ·ÛÎËÛÈÔÁÂÓ‹˜ ‚ÚÔÁ¯fiÛ·ÛÌÔ˜ Â›Ó·È Ôχ Û˘¯Ó‹
ÂÈÏÔ΋ ÛÙÔ˘˜ ÎÔÏ˘Ì‚ËÙ¤˜ Ô˘ ¿Û¯Ô˘Ó ·fi ¯Úfi-
ÓÈÔ ‚ÚÔÁ¯ÈÎfi ¿ÛıÌ·. øÛÙfiÛÔ, ÔÈ ·ÛıÌ·ÙÈÎÔ› Ô˘
ı¤ÏÔ˘Ó Ó· ·ıÏËıÔ‡Ó Û˘¯Ó¿ ÂÈϤÁÔ˘Ó ÙËÓ ÎÔχÌ-
‚ËÛË ÏfiÁˆ Ù˘ ÁÂÓÈ΋˜ ÂÔ›ıËÛ˘ fiÙÈ ÙÔ ÎÔÚÂ-
Ṳ̂ÓÔ Û ˘‰Ú·ÙÌÔ‡˜ ÂÚÈ‚¿ÏÏÔÓ Â›Ó·È ÈÔ ÊÈÏÈÎfi
ÁÈ· ÙË ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜,
¿Ô„Ë Ô˘ ÂÓÈÛ¯‡ÂÙ·È Î·È ·fi ÙȘ Û˘¯Ó¤˜ ÂÈÙ˘-
¯›Â˜ ÎÔÏ˘Ì‚ËÙÒÓ Ì ¿ÛıÌ· Û ÌÂÁ¿Ï˜ ·ıÏËÙÈΤ˜
‰ÈÔÚÁ·ÓÒÛÂȘ20. øÛÙfiÛÔ, ÚfiÛÊ·Ù˜ ¤Ú¢Ó˜ ¤-
¯Ô˘Ó ·ԉ›ÍÂÈ fiÙÈ ÙÔ ¯ÏÒÚÈÔ ÛÙȘ ÈÛ›Ó˜ ·ÔÙÂÏ›
‚·ÛÈÎfi ÂÚÂıÈÛÙÈÎfi ·›ÙÈÔ ¤ÎÏ˘Û˘ ·ÛıÌ·ÙÈÎÒÓ ÎÚ›-
ÛˆÓ20-21. OÈ Bernard Î·È Û˘Ó. η٤ÏËÍ·Ó ÛÙËÓ ¿-
Ô„Ë fiÙÈ Ë ¤ÎıÂÛË ˘ÁÈÒÓ ·È‰ÈÒÓ Û ¯ÏˆÚȈ̤Ó˜
ÈÛ›Ó˜ ·˘Í¿ÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛ˘ ¿ÛıÌ·ÙÔ˜,
ȉȷ›ÙÂÚ· ÛÙ· ÎÏÂÈÛÙ¿ ÎÔÏ˘Ì‚ËÙ‹ÚÈ·22. ∞ÓÙ›ıÂÙ·,
ÌÈ· ·˘ÛÙÚ·ÏÈ·Ó‹ ÌÂϤÙË ‰È·›ÛÙˆÛ fiÙÈ 1964 ·È-
‰È¿ Ì ¿ÛıÌ· Ô˘ ·Ú·ÎÔÏÔ‡ıËÛ·Ó ıÂÚ·¢ÙÈÎfi
ÚfiÁÚ·ÌÌ· ÎÔχ̂ËÛ˘, ·ÚÔ˘Û›·Û·Ó ‚ÂÏÙ›ˆÛË
 ∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 70, 4
Ù˘ ÔÈfiÙËÙ·˜ ˙ˆ‹˜ Î·È Ù˘ Ú‡ıÌÈÛ˘ ÙÔ˘˜ ¿ÛıÌ·ÙÔ˜
Ì ÙËÓ ÂÏ¿ÙÙˆÛË Ù˘ Ê·Ú̷΢ÙÈ΋˜ ÙÔ˘˜ ·ÁˆÁ‹˜,
Ù˘ Û˘¯ÓfiÙËÙ·˜ Î·È Ù˘ ÛÔ‚·ÚfiÙËÙ·˜ ÙˆÓ ·ÛıÌ·ÙÈ-
ÎÒÓ ÎÚ›ÛˆÓ23. ÀÔÛÙËÚ›˙ÂÙ·È, ÏÔÈfiÓ, fiÙÈ Ë ÎÔχÌ-
‚ËÛË Û ÎÏÂÈÛÙ¤˜ Î·È È‰È·›ÙÂÚ· Û ˘ÂگψÚȈ̤-
Ó˜ ÈÛ›Ó˜ ÌÔÚ› Ó· ·ÔÙÂÏ› ÂÎÏ˘ÙÈÎfi ·›ÙÈÔ ÂÌ-
Ê¿ÓÈÛ˘ ·ÛÎËÛÈÔÁÂÓÔ‡˜ ‚ÚÔÁ¯fiÛ·ÛÌÔ˘ Û ÎÔÏ˘Ì-
‚ËÙ¤˜ ˘„ËÏÔ‡ ÂÈ¤‰Ô˘, ΢ڛˆ˜ ÏfiÁˆ ÚfiÎÏËÛ˘
ˈÛÈÓÔÊÈÏÈÎÒÓ ÊÏÂÁÌÔÓÒÓ ÛÙÔ Ï·›ÛÈÔ Ù˘ ·ÛÎË-
ÛÈÔÁÂÓÔ‡˜ ‚ÚÔÁ¯È΋˜ ˘ÂÚ·ÓÙȉڷÛÙÈÎfiÙËÙ·˜24.
øÛÙfiÛÔ, Ë ÎÔχ̂ËÛË ÌÔÚ› Ó· ·Ԃ› ȉȷ›ÙÂÚ·
ˆÊ¤ÏÈÌË ÛÂ Û˘Ìو̷ÙÈÎÔ‡˜ ·ÛıÌ·ÙÈÎÔ‡˜ Ô‰ËÁÒ-
ÓÙ·˜ Û Ì›ˆÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ ÙˆÓ ÎÚ›ÛÂˆÓ Î·È ÛÂ
‚ÂÏÙ›ˆÛË Ù˘ ·ÂÚfi‚È¿˜ ÙÔ˘˜ ÈηÓfiÙËÙ·˜25.
Ã√¡π∞ ∫√¶ø™∏
ªÈ· ¿ÏÏË Î·ÙËÁÔÚ›· ‰È·Ù·Ú·¯ÒÓ Ù˘ ˘Á›·˜ ÛÙËÓ
·ÁˆÓÈÛÙÈ΋ ÎÔχ̂ËÛË Â›Ó·È ÔÈ ÂÈÙÒÛÂȘ ·fi ÙË
Ì·ÎÚfi¯ÚÔÓË Î·È ˘ÂÚ‚ÔÏÈ΋ ÚÔfiÓËÛË. ∏ ¯Úfi-
ÓÈ· ÎfiˆÛË Ô˘ ÂÌÊ·Ó›˙ÂÙ·È Ì ÙËÓ ·‡ÍËÛË Ù˘
¤ÓÙ·Û˘ Î·È ÙÔ˘ fiÁÎÔ˘ Ù˘ ÚÔfiÓËÛ˘ ÌÔÚ› Ó·
ÂËÚ¿ÛÂÈ ÙË ‰È¿ıÂÛË, ÙË Û˘ÌÂÚÈÊÔÚ¿ Î·È ÙËÓ
·fi‰ÔÛË ÙˆÓ ·ıÏËÙÒÓ ˘„ËÏÔ‡ ÂÈ¤‰Ô˘26. ∏ ÂÏ¿Ù-
ÙˆÛË Ù˘ ·ıÏËÙÈ΋˜ Â›‰ÔÛ˘, Ë ÂÌÊ¿ÓÈÛË ·ÓÂÍ‹-
ÁËÙ˘ ÎfiˆÛ˘ Î·È ÔÈ ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ‡ÓÔ˘ ηÈ
ÙÔ˘ ı˘ÌÈÎÔ‡ Â›Ó·È Ù· ¯·Ú·ÎÙËÚÈÛÙÈο Û˘ÌÙÒÌ·Ù·
ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ˘ÂÚÚÔfiÓËÛ˘. OÈ Mackinnon
Î·È Û˘Ó. ˘ÔÛÙ‹ÚÈÍ·Ó fiÙÈ ÔÈ Ó¢ÚÔÂÓ‰ÔÎÚÈÓÈΤ˜ ÌÂ-
Ù·‚ÔϤ˜ Ô˘ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ÌÂȈ̤ÓË ¤Î-
ÎÚÈÛË ÓÔÚÂÈÓÂÊÚ›Ó˘ ÚÔËÁÔ‡ÓÙ·È ‰‡Ô Ì ٤ÛÛÂ-
ÚȘ ‚‰ÔÌ¿‰Â˜ Ù˘ ÂÌÊ¿ÓÈÛ˘ ‰È·Ù·Ú·¯ÒÓ Ù˘
˘Á›·˜ ÏfiÁˆ ˘ÂÚÚÔfiÓËÛ˘10. ŒÓ·Ó ÚfiÛıÂÙÔ
ÚԉȷıÂÛÈÎfi ·Ú¿ÁÔÓÙ· ÂÌÊ¿ÓÈÛ˘ Û˘Ìو̿-
ÙˆÓ ˘ÂÚÚÔfiÓËÛ˘ ·ÔÙÂÏ› Ë Î·Î‹ ‰È·ÙÚÔÊ‹
ÙÔ˘ ÎÔÏ˘Ì‚ËÙ‹. OÈ Costill Î·È Û˘Ó. ‰È·›ÛÙˆÛ·Ó
ˆ˜ Ë ·ÓÂ·Ú΋˜ ÚfiÛÏË„Ë ˘‰·Ù·ÓıÚ¿ÎˆÓ ÌÔ-
Ú› Ó· Ô‰ËÁ‹ÛÂÈ Û ¯ÚfiÓÈ· Ì˘˚΋ ÎfiˆÛË27. ∏ ÏÔÈ-
Ì҉˘ ÌÔÓÔ˘Ú‹ÓˆÛË ÌÔÚ›, Â›Û˘, Ó· Ô‰ËÁ‹ÛÂÈ
ÛÙËÓ ÂÌÊ¿ÓÈÛË ¯ÚfiÓÈ·˜ ÎfiˆÛ˘ Î·È Ó· ·Ԃ›
ÂÍÔ˘ıÂÓˆÙÈ΋ ȉȷ›ÙÂÚ· ÁÈ· ÙÔÓ ÎÔÏ˘Ì‚ËÙ‹ Ô˘
˘Ô‚Ï‹ıËΠ۠·Ú·ÙÂٷ̤ÓË ÂÚ›Ô‰Ô ·Ó¿ÚÚˆ-
Û˘28. O ÚÔÔÓËÙ‹˜ ÔÊ›ÏÂÈ Ó· ·Ú·ÎÔÏÔ˘ı›
ÛÙÂÓ¿ ÙÔÓ ·ıÏËÙ‹ ÁÈ· Ù˘¯fiÓ Âȉ›ӈÛË Ù˘ ˘Á›·˜
ÙÔ˘ Î·È Ó· ÙÔÓ Ô‰ËÁ› ÚÔԉ¢ÙÈο Û ÂÓÙÔÓfiÙÂÚ˜
ÚÔÔÓËÙÈΤ˜ ÂÈ‚·Ú‡ÓÛÂȘ29. ∏ ÂÎ·›‰Â˘ÛË ÙˆÓ
ÚÔÔÓËÙÒÓ Î·È ÙˆÓ ·ıÏËÙÒÓ ÁÈ· ÙËÓ ·ÍÈÔÏfiÁËÛË
ÂӉ›ÍÂˆÓ Û˘Ó‰ÚfiÌÔ˘ ˘ÂÚηٷfiÓËÛ˘ ‹ ˘ÂÚ-
ÚÔfiÓËÛ˘ ηıÒ˜ Î·È ÁÈ· ÙȘ ·Ú¯¤˜ ·ÔÙÂÏÂÛÌ·-
ÙÈ΋˜ ·ÓÙÈÌÂÙÒÈÛ‹˜ ÙÔ˘˜ fiˆ˜ Ë Û¯ÔÏ·ÛÙÈ΋
ÂÊ·ÚÌÔÁ‹ ÚÔԉ¢ÙÈ΋˜ ·‡ÍËÛ˘ Ù˘ ÂÈ‚¿Ú˘ÓÛ˘
Î·È ÂÚÈfi‰ˆÓ ·ÔηٿÛÙ·Û˘, Û˘Ì‚¿ÏÏÂÈ ÛËÌ·ÓÙÈ-
259
ο ÙfiÛÔ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË fiÛÔ Î·È ÛÙËÓ ·ÔÊ˘Á‹
ÌÂÏÏÔÓÙÈ΋˜ Â·ÓÂÌÊ¿ÓÈÛ˘ ÙˆÓ Û˘Ìو̿وÓ30.
∞£§∏∆π∫∂™ ∫∞∫ø™∂π™
∏ ÚfiÎÏËÛË ÙˆÓ Ì˘ÔÛÎÂÏÂÙÈÎÒÓ ÙÚ·˘Ì·ÙÈÛÌÒÓ
·ÔÙÂÏ› ÛËÌ·ÓÙÈ΋ Î·È Û˘¯Ó‹ ‰È·Ù·Ú·¯‹ Ù˘ ˘Á›-
·˜ ÛÙËÓ ·ÁˆÓÈÛÙÈ΋ ÎÔχ̂ËÛË Ô˘ Ô‰ËÁ› ·Ú¿Ï-
ÏËÏ· Û ÛËÌ·ÓÙÈ΋ ·ÒÏÂÈ· fiÁÎÔ˘ ÚÔfiÓËÛ˘.
OÈ Chalmers Î·È Û˘Ó. ·Ó·Ê¤ÚÔ˘Ó Û˘¯ÓfiÙËÙ· ÂÌÊ¿-
ÓÈÛ˘ 1,2 ÙÚ·˘Ì·ÙÈÛÌÒÓ ·Ó¿ 1000 ÒÚ˜ ÚÔfiÓË-
Û˘ Û Ó·ÚÔ‡˜ ÎÔÏ˘Ì‚ËÙ¤˜31. OÈ ÈÔ Û˘¯ÓÔ› ÙÚ·˘-
Ì·ÙÈÛÌÔ› ÛÙËÓ ·ÁˆÓÈÛÙÈ΋ ÎÔχ̂ËÛË ·ÊÔÚÔ‡Ó
ηÎÒÛÂȘ ÛÙËÓ ˆÌÈ΋ ˙ÒÓË, ÛÙË ÛÔÓ‰˘ÏÈ΋ ÛÙ‹ÏË
Î·È ÛÙËÓ ¿ÚıÚˆÛË ÙÔ˘ ÁfiÓ·ÙÔ˜1,2. OÈ Pink ηÈ
Û˘Ó.32, ηıÒ˜ Î·È ÔÈ Wadsworth Î·È Û˘Ó.33 ÌÂϤÙË-
Û·Ó ·ÓÙ›ÛÙÔȯ· ÙÔ˘˜ ÙÚ·˘Ì·ÙÈÛÌÔ‡˜ ·ÌÂÚÈηÓÒÓ
Î·È ·˘ÛÙÚ·ÏÒÓ ÎÔÏ˘Ì‚ËÙÒÓ ·ÁˆÓÈÛÙÈÎÔ‡ ÂÈ¤-
‰Ô˘ Î·È ·ÚÔ˘Û›·Û·Ó ‰ÈÂÍÔ‰Èο ÙÔ˘˜ ·ıÔÁÂÓÂÙÈ-
ÎÔ‡˜ Ì˯·ÓÈÛÌÔ‡˜ ÙˆÓ Î·ÎÒÛÂˆÓ ÙÔ˘ ÒÌÔ˘ Î·È Ù˘
ˆÌÔÏ·ÙÈ·›·˜ ¿ÚıÚˆÛ˘ ÛÙËÓ ·ÁˆÓÈÛÙÈ΋ ÎÔχÌ-
‚ËÛË Ì ÙË ¯Ú‹ÛË ËÏÂÎÙÚÔÌ˘ÔÁÚ·Ê‹Ì·ÙÔ˜. OÈ Â-
Ú¢ÓËÙ¤˜ ÚfiÙÂÈÓ·Ó ÙË Û˘ÛÙËÌ·ÙÈ΋ ÂÊ·ÚÌÔÁ‹ ÙÔ˘
ËÏÂÎÙÚÔÌ˘ÔÁÚ·Ê‹Ì·ÙÔ˜ ˆ˜ ̤ıÔ‰Ô Úfi‚Ï„˘
ÙÚ·˘Ì·ÙÈÛÌÒÓ. ∞ÓÙ›ıÂÙ·, ‰ÂÓ ˘¿Ú¯Ô˘Ó Â·ÚΛ˜
ÏËÚÔÊÔڛ˜ ÁÈ· ÙȘ ηÎÒÛÂȘ Ù˘ ÔÛÊ˘˚΋˜ ÌÔ›-
Ú·˜ Ù˘ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘, ÔÈ Ôԛ˜ ·Ó¤Ú¯ÔÓÙ·È
ÛÙÔ 20% ÂÚ›Ô˘ ÙˆÓ ÙÚ·˘Ì·ÙÈÛÌÒÓ ÛÙËÓ ·ÁˆÓÈ-
ÛÙÈ΋ ÎÔχ̂ËÛË1,2. OÈ Î·ÎÒÛÂȘ Ù˘ ¿ÚıÚˆÛ˘
ÙÔ˘ ÁfiÓ·ÙÔ˜ ·ÔÙÂÏÔ‡Ó ÙÔ 10% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ
·ıÏËÙÈÎÒÓ Î·ÎÒÛÂˆÓ ÛÙËÓ ÎÔχ̂ËÛË Î·È ÔÊ›ÏÔ-
ÓÙ·È Â›Ù Û ÙÚ·˘Ì·ÙÈÛÌÔ‡˜ ηٿ ÙËÓ ÚÔfiÓËÛË
¤Íˆ ·fi ÙÔ ÓÂÚfi ›Ù Û ϿıË Ù¯ÓÈ΋˜ ΢ڛˆ˜ ÛÙËÓ
Ù¯ÓÈ΋ ÙÔ˘ ÚÔÛı›Ô˘1,2,5.
OÈ ÙÚ·˘Ì·ÙÈÛÌÔ› Ù˘ Ú¿¯Ë˜ ÛÙËÓ ÎÔχ̂ËÛË
ÔÊ›ÏÔÓÙ·È Û˘Ó‹ıˆ˜ ÛÙËÓ ˘ÂÚ‚ÔÏÈ΋ ÂÈ‚¿Ú˘ÓÛË
Ù˘ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘ ›Ù ÏfiÁˆ η΋˜ ı¤Û˘ ÙÔ˘
ÛÒÌ·ÙÔ˜ ηٿ ÙËÓ ÚÔfiÓËÛË ÎÔχ̂ËÛ˘ ÛÙȘ
‰È¿ÊÔÚ˜ ·ÁˆÓÈÛÙÈΤ˜ Ù¯ÓÈΤ˜, ›Ù ηٿ ÙËÓ ÚÔ-
fiÓËÛË Ì ·ÓÙÈÛÙ¿ÛÂȘ. OÈ Johnson Î·È Û˘Ó. ·Ó·-
ʤÚÔ˘Ó fiÙÈ ÔÈ Î·ÎÒÛÂȘ Ù˘ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘
ÛÙÔ˘˜ ÎÔÏ˘Ì‚ËÙ¤˜ ·Ó¤Ú¯ÔÓÙ·È Û ÔÛÔÛÙfi 23%2
ÂÙËÛ›ˆ˜, ÂÓÒ ·ÓÙ›ÛÙÔÈ¯Ë Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ·-
Ú·ÙËÚÔ‡Ó Î·È ÔÈ Bak Î·È Û˘Ó. Û ¢·ÓÔ‡˜ ÎÔÏ˘Ì‚Ë-
Ù¤˜ ˘„ËÏÔ‡ ÂÈ¤‰Ô˘1. ™Â Û˘ÁÎÚÈÙÈ΋ ÌÂϤÙË ÌÂÙ·-
͇ ÎÔÏ˘Ì‚ËÙÒÓ Î·È ·ıÏËÙÒÓ ÂÓfiÚÁ·Ó˘ Á˘ÌÓ·ÛÙÈ-
΋˜, ÙÔ 16% ÙˆÓ ÎÔÏ˘Ì‚ËÙÒÓ ·ÚÔ˘Û›·Û ηÎÒ-
ÛÂȘ ‰È·ÊfiÚÔ˘ ‚·ıÌÔ‡ ÛÙË ÛÔÓ‰˘ÏÈ΋ ÛÙ‹ÏË Û˘-
ÁÎÚÈÙÈο Ì ÙÔ 36% ÙˆÓ ·ıÏËÙÒÓ Ù˘ ÂÓfiÚÁ·Ó˘34.
¶ÚÔ¤ÊË‚ÔÈ ÎÔÏ˘Ì‚ËÙ¤˜ ÌÂ Û˘ÌÙÒÌ·Ù· fiˆ˜ ¿Ï-
ÁÔ˜ ÛÙË Ú¿¯Ë, ıˆÚ·ÎÈÎfi ¿ÏÁÔ˜ Î·È Î‡ÊˆÛË ‰È·Êfi-
ÚÔ˘ ‚·ıÌÔ‡, Â›Ó·È ‰˘Ó·Ùfi Ó· ¿Û¯Ô˘Ó ·fi ÙËÓ ¿-
260 N. KOYT§π∞¡O™
ıËÛË ÙÔ˘ Scheuermann Î·È ı· Ú¤ÂÈ Ó· ·Ú·ÎÔ-
ÏÔ˘ıÔ‡ÓÙ·È Ù·ÎÙÈο ÁÈ· ÙËÓ ÂͤÏÈÍË Ù˘ ¿ıËÛ˘
·˘Ù‹˜. ∂› ‚‚·›·˜ ‰È¿ÁÓˆÛ˘ Ù˘ ¿ıËÛ˘ ÙÔ˘
Scheuermann, ÔÈ Ù¯ÓÈΤ˜ Ù˘ ÂÙ·ÏÔ‡‰·˜ Î·È ÙÔ˘
ÚÔÛı›Ô˘ ı· Ú¤ÂÈ Ó· ·ÔʇÁÔÓÙ·È35. ÕÏϘ η-
ÎÒÛÂȘ Ù˘ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó
‰È¿ÚıÚÈ· ηٿÁÌ·Ù· ÎfiˆÛ˘, ·ÔÙ¤ÏÂÛÌ· ÙfiÛÔ
Ù˘ ÎÔχ̂ËÛ˘ fiÛÔ Î·È Ù˘ ÚÔfiÓËÛ˘ Ì ·ÓÙÈ-
ÛÙ¿ÛÂȘ ¤Íˆ ·fi ÙÔ ÓÂÚfi. ªÂ ÙËÓ ·‡ÍËÛË Ù˘ Û˘-
¯ÓfiÙËÙ·˜ ÂÊ·ÚÌÔÁ‹˜ Ù˘ ˘Ô‚Ú‡¯È·˜ Ù¯ÓÈ΋˜ ÙˆÓ
οو ¿ÎÚˆÓ fiˆ˜ ÛÙËÓ Ù¯ÓÈ΋ Ù˘ ÂÙ·ÏÔ‡‰·˜
ηٿ ÙËÓ ÂÎΛÓËÛË Î·È ÙȘ ÛÙÚÔʤ˜ Û fiϘ ÙȘ ·Áˆ-
ÓÈÛÙÈΤ˜ Ù¯ÓÈΤ˜, Ë ÂÈ‚¿Ú˘ÓÛË Ù˘ ˘ÂÚ¤ÎÙ·Û˘
¿Óˆ ÛÙË ÛÔÓ‰˘ÏÈ΋ ÛÙ‹ÏË ·˘Í¿ÓÂÈ Î·ıÒ˜ Î·È ÔÈ
Û˘Ó·ÎfiÏÔ˘ıÔÈ ÙÚ·˘Ì·ÙÈÛÌÔ› Ù˘. ∫ÔÏ˘Ì‚ËÙ¤˜ ÌÂ
ηÎÒÛÂȘ ÙˆÓ ÛÔÓ‰‡ÏˆÓ ı· Ú¤ÂÈ Ó· ·¤¯Ô˘Ó
·fi ÙËÓ ÚÔfiÓËÛË ÁÈ· ¤Ó· ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· Â-
Ú›Ô˘ 12 ‚‰ÔÌ¿‰ˆÓ Î·È Ó· ÂÈÛÙÚ¤ÊÔ˘Ó ÛÙ·‰È·-
ο ¤¯ÔÓÙ·˜ ÚˆÙ›ÛÙˆ˜ ·Ú·ÎÔÏÔ˘ı‹ÛÂÈ ÂÍ·ÙÔÌÈ-
ÎÂ˘Ì¤ÓÔ ÚfiÁÚ·ÌÌ· ÂÓ‰˘Ó¿ÌˆÛ˘ Î·È ÛÙ·ıÂÚÔ-
Ô›ËÛ˘ ÙˆÓ ÌÔÚ›ˆÓ Ù˘ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘36. ™˘-
Û¯¤ÙÈÛË ÌÂٷ͇ οΈÛ˘ ÙˆÓ ÌÂÛÔÛÔÓ‰˘Ï›ˆÓ ‰›-
ÛÎˆÓ Î·È Ù˘ ·ÁˆÓÈÛÙÈ΋˜ ÎÔχ̂ËÛ˘ ‰ÂÓ ¤¯ÂÈ
ÂȂ‚·Èˆı›37, ÂÓÒ ·ÓÙ›ıÂÙ· ˘¿Ú¯Ô˘Ó ·ÚÎÂÙ¤˜
·Ó·ÊÔÚ¤˜ ÁÈ· Û‡Ó‰ÂÛË ÙˆÓ ‰È·Ù·Ú·¯ÒÓ Ù˘ ÎÈÓËÙÈ-
ÎfiÙËÙ·˜ Ù˘ ˆÌÈ΋˜ ˙ÒÓ˘ Ì ÙËÓ ÚfiÎÏËÛË ÙÚ·˘-
Ì·ÙÈÛÌÒÓ ÛÙË ÛÔÓ‰˘ÏÈ΋ ÛÙ‹ÏË38.
∏ Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ÛÔ‚·ÚÒÓ ÙÚ·˘Ì·ÙÈ-
ÛÌÒÓ ÙÔ˘ ÒÌÔ˘ ÛÙËÓ ·ÁˆÓÈÛÙÈ΋ ÎÔχ̂ËÛË Î˘Ì·›-
ÓÂÙ·È ·fi 30% ̤۷ Û ÌÈ· ·ÁˆÓÈÛÙÈ΋ ÂÚ›Ô‰Ô
¤ˆ˜ Î·È 48% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ÎÔÏ˘Ì‚ËÙÒÓ ÛÙË
‰È¿ÚÎÂÈ· Ù˘ ·ıÏËÙÈ΋˜ ÙÔ˘˜ ÛÙ·‰ÈÔ‰ÚÔÌ›·˜1,2-5.
∆· ·ÚÈ· ·›ÙÈ· Ô˘ ¤¯Ô˘Ó ÂÓÔ¯ÔÔÈËı› ÁÈ· ÙȘ η-
ÎÒÛÂȘ ÙÔ˘ ÒÌÔ˘ Â›Ó·È Ë ÙÔÈ΋ Ì˘˚΋ ÎfiˆÛË Î·È
Ë ÈÛ¯·ÈÌ›·, ηıÒ˜ Î·È ÂÌ‚ÈÔÌ˯·ÓÈΤ˜ ‰È·Ù·Ú·¯¤˜
fiˆ˜ Ë ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Ù˘ ˆÌÔÏ·ÙÈ·›·˜ Î·È Ù˘
ÁÏËÓÔ‚Ú·¯ÈfiÓÈ·˜ ‰È¿ÚıÚˆÛ˘. OÈ Kennedy ηÈ
Û˘Ó. ·¤‰ˆÛ·Ó ÙÔ ÏÂÁfiÌÂÓÔ Û‡Ó‰ÚÔÌÔ «ÒÌÔ˜ ÙÔ˘
ÎÔÏ˘Ì‚ËÙ‹» Û ÚfiÛıÈÔ ˘ÂÍ¿ÚıÚËÌ· Ù˘ ÎÂÊ·-
Ï‹˜ ÙÔ˘ ‚Ú·¯ÈÔÓ›Ô˘ ·fi ÙËÓ ˆÌÔÁÏ‹ÓË3. OÈ Bak ηÈ
Û˘Ó. ·Ú·Ù‹ÚËÛ·Ó fiÙÈ Ë ÁÏËÓÔ‚Ú·¯ÈfiÓÈ· ·ÛÙ¿ıÂÈ·
Î·È Ë ÙÚÈ‚‹ Ù˘ ·ÎÚˆÌÈÔÎÔÚ·ÎÔÂȉԇ˜ ¿ÚıÚˆÛ˘
Û ÎÔÏ˘Ì‚ËÙ¤˜ ˘„ËÏÔ‡ ÂÈ¤‰Ô˘ ÂÌÊ¿ÓÈ˙·Ó fiÌÔÈ·
Û˘Ìو̷ÙÔÏÔÁ›·39. O McMaster ·Ó·Ê¤ÚÂÈ ÙËÓ ‡-
·ÚÍË ÔÏÏ·ÏÒÓ Î·ÎÒÛÂˆÓ ÛÙÔÓ Âȯ›ÏÈÔ ¯fiÓ-
‰ÚÔ Ù˘ ¿ÚıÚˆÛ˘ ÙÔ˘ ÒÌÔ˘ Û ÎÔÏ˘Ì‚ËÙ¤˜ ·ÁˆÓÈ-
ÛÙÈÎÔ‡ ÂÈ¤‰Ô˘, Èı·Ófiٷٷ ‰Â˘ÙÂÚÔ·ıÔ‡˜ ·È-
ÙÈÔÏÔÁ›·˜ ÏfiÁˆ ˘ÂÍ·ÚıÚ‹Ì·ÙÔ˜ ‹ ·ÛÙ¿ıÂÈ·˜ Ù˘
ÁÏËÓÔ‚Ú·¯ÈfiÓÈ·˜ ‰È¿ÚıÚˆÛ˘40. ¶·ÚfiÏÔ Ô˘ ‰ÂÓ
˘¿Ú¯Ô˘Ó ‚È‚ÏÈÔÁÚ·ÊÈο ‰Â‰Ô̤ӷ ·Ó·ÊÔÚÈο ÌÂ
ÙȘ ‚Ï¿‚˜ ÙÔ˘ Âȯ›ÏÈÔ˘ ¯fiÓ‰ÚÔ˘, ÔÏÏÔ› ÎÔÏ˘Ì-
‚ËÙ¤˜ ˘„ËÏÔ‡ ÂÈ¤‰Ô˘ ¤¯Ô˘Ó ÂÈÛÙÚ¤„ÂÈ Û ˘„Ë-
Ϥ˜ ·ÁˆÓÈÛÙÈΤ˜ ÂȉfiÛÂȘ ÌÂÙ¿ ·fi ¯ÂÈÚÔ˘ÚÁÈ΋
Â¤Ì‚·ÛË ÛÙÔÓ ÒÌÔ ÁÈ· ÙËÓ ·ÔηٿÛÙ·ÛË ÙÔ˘
Âȯ›ÏÈÔ˘ ¯fiÓ‰ÚÔ˘ Î·È ÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË ÚÔ-
ÁÚ¿ÌÌ·ÙÔ˜ ÛÙ·ıÂÚÔÔ›ËÛ˘ Î·È ÂÓ‰˘Ó¿ÌˆÛ˘ ÙˆÓ
Ì·Ï·ÎÒÓ ÌÔÚ›ˆÓ Ù˘ ˆÌÈ΋˜ ˙ÒÓ˘. ∆· ÚÔÁÚ¿Ì-
Ì·Ù· ·ÔηٿÛÙ·Û˘ ÙˆÓ ˆÌÈÎÒÓ Î·ÎÒÛÂˆÓ ‰Â
ı· Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÌfiÓÔ ·Û΋ÛÂȘ ÂÓ‰˘-
ӿ̈Û˘ ÙˆÓ ¤Íˆ ÛÙÚÔʤˆÓ Ì˘ÒÓ Ù˘ ¿ÚıÚˆÛ˘
fiˆ˜ ·ÎÔÏÔ˘ıÂ›Ù·È Û˘Ó‹ıˆ˜41, ·ÏÏ¿ ÙÔ˘ Û˘ÓfiÏÔ˘
ÙˆÓ Ì˘ÒÓ Ù˘ ˆÌÈ΋˜ ˙ÒÓ˘ Î·È ÙÔ˘ ¿Óˆ ¿ÎÚÔ˘33.
∏ ÚÔÛÂÎÙÈ΋ Î·È ÛÙ·‰È·Î‹ ·ÔηٿÛÙ·ÛË ÙˆÓ
ÙÚ·˘Ì·ÙÈÛÌÒÓ ÙÔ˘ ÒÌÔ˘ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Ì·-
ÎÚÔÚfiıÂÛÌ· Û ‚ÂÏÙ›ˆÛË Ù˘ ·ıÏËÙÈ΋˜ ·fi‰Ô-
Û˘ Ì ÙË Ì›ˆÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ ÂÌÊ¿ÓÈÛ˘ ηÎÒ-
ÛÂˆÓ ÛÙË Ú¿¯Ë Î·È ÛÙËÓ ÔÛÊ˘˚΋ ÌÔ›Ú· Ù˘ ÛÔÓ-
‰˘ÏÈ΋˜ ÛÙ‹Ï˘.
OÈ ÙÚ·˘Ì·ÙÈÛÌÔ› ÛÙÔ ¿Óˆ ËÌÈÌfiÚÈÔ ÙÔ˘ ÛÒÌ·-
ÙÔ˜ ηٷÁÚ¿ÊÔÓÙ·È Û˘ÁÎÚÈÙÈο Ì ÙÔ˘˜ ÙÚ·˘Ì·ÙÈ-
ÛÌÔ‡˜ ÙÔ˘ οو ËÌÈÌÔÚ›Ô˘ Û ·Ó·ÏÔÁ›· 3:136. ∂È-
ϤÔÓ, ÎÔÏ˘Ì‚‹ÙÚȘ ÎÔÏÂÁÈ·ÎÔ‡ ÂÈ¤‰Ô˘ ·Ó·-
ʤÚıËΠfiÙÈ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·Ó·ÏÔÁ›· ÂÌÊ¿ÓÈÛ˘
ÙÚ·˘Ì·ÙÈÛÌÔ‡ ÙˆÓ Î¿Ùˆ ¿ÎÚˆÓ 4:1 ηٿ ÙË ‰ÚÔÌÈ-
΋ ÚÔfiÓËÛË Û˘ÁÎÚÈÙÈο Ì ÙËÓ ÚÔfiÓËÛË Ì¤Û·
ÛÙÔ ÓÂÚfi42. ∂ȉËÌÈÔÏÔÁÈ΋ ÌÂϤÙË ÙÔ˘ 1980 ·Ó·-
ʤÚÂÈ fiÙÈ ÔÈ Û˘¯ÓfiÙÂÚ˜ ηÎÒÛÂȘ ÛÙËÓ Ù¯ÓÈ΋ ÙÔ˘
ÚÔÛı›Ô˘ Â›Ó·È Ë ÊÏÂÁÌÔÓ‹ Ù˘ ¤Ûˆ ÂÈÊ¿ÓÂÈ·˜
Ù˘ ÂÈÁÔÓ·Ù›‰·˜ ηıÒ˜ Î·È ÔÈ Î·ÎÒÛÂȘ ÙÔ˘ ¤Ûˆ
Ï·Á›Ô˘ Û˘Ó‰¤ÛÌÔ˘ ÙÔ˘ ÁfiÓ·ÙÔ˜ Î·È ˘ÔÛÙËÚ›¯ıË-
Π̠ÙË ¯Ú‹ÛË ÎÈÓËÌ·ÙÔÁÚ·ÊÈ΋˜ ·Ó¿Ï˘Û˘ Ë Û˘-
Û¯¤ÙÈÛË Ù˘ ÌÔÚÊÔÏÔÁ›·˜ ÙˆÓ ÙÚ·˘Ì·ÙÈÛÌÒÓ Ì ÙËÓ
Ù¯ÓÈ΋ ÙˆÓ Î¿Ùˆ ¿ÎÚˆÓ ÛÙËÓ Ù¯ÓÈ΋ ÙÔ˘ ÚÔÛı›-
Ô˘43. ™Â ÌÂÙ·ÁÂÓ¤ÛÙÂÚË ÌÂϤÙË, ÔÈ Keskinen ηÈ
Û˘Ó. ‰È¤ÁÓˆÛ·Ó Ì ÙË ¯Ú‹ÛË ·ÚıÚÔÛÎfiËÛ˘ ÔÚÔ-
ÁÔÓÔı˘Ï·Î›Ùȉ· ÙÔ˘ ÁfiÓ·ÙÔ˜ ÛÙÔ˘˜ 7 ·fi ÙÔ˘˜ 9
ÎÔÏ˘Ì‚ËÙ¤˜ ÚÔÛı›Ô˘ Ô˘ ÌÂÏÂÙ‹ıËηÓ, ¯ˆÚ›˜ ˆ-
ÛÙfiÛÔ Ó· ‰È·ÈÛÙÒÓÂÙ·È ÎÈÓËÌ·ÙÔÁÚ·ÊÈο fiÙÈ Ë
οΈÛË ·˘Ù‹ Û˘Ó‰¤ÂÙ·È Ì ÙËÓ Ù¯ÓÈ΋ ÙˆÓ Î¿Ùˆ
¿ÎÚˆÓ44. OÈ ÂÚ¢ÓËÙ¤˜ η٤ÏËÍ·Ó ÛÙÔ Û˘Ì¤Ú·-
ÛÌ· fiÙÈ ÙÔ ÏÂÁfiÌÂÓÔ «ÁfiÓ·ÙÔ ÙˆÓ ÎÔÏ˘Ì‚ËÙÒÓ ÚÔ-
Ûı›Ô˘» Â›Ó·È ÌÈ· ÌÔÚÊ‹ ¯ÚfiÓÈ·˜ ÔÚÔÁÔÓÔı˘Ï·Î›ÙÈ-
‰·˜ ˘¤Ú¯ÚËÛ˘. ÕÏÏË ÌÂϤÙË ÙÔ˘ 1985 ‰È·›ÛÙˆ-
Û Ì ÙËÓ Ù¯ÓÈ΋ Ù˘ ·ÚıÚÔÛÎfiËÛ˘ fiÙÈ ÙÔ 47%
ÙˆÓ ÎÔÏ˘Ì‚ËÙÒÓ ÚÔÛı›Ô˘ ·ÚÔ˘Û›·˙ ÊÏÂÁÌÔÓ‹
Ù˘ ¤Ûˆ ·ÚıÚÈ΋˜ Ù˘¯‹˜ ÙÔ˘ ÁfiÓ·ÙÔ˜41. ∏ ÚfiÏË-
„Ë ÙˆÓ Î·ÎÒÛÂˆÓ ÙÔ˘ ÁfiÓ·ÙÔ˜ ÛÙÔ ÚfiÛıÈÔ ÌÔ-
Ú› Ó· ÂÈÙ¢¯ı› ÂÎÙÂÏÒÓÙ·˜ ÏÈÁfiÙÂÚ˜ Â·Ó·Ï‹-
„ÂȘ ÙˆÓ Î¿Ùˆ ¿ÎÚˆÓ ÛÙËÓ ÚÔfiÓËÛË Î·È ÂÊ·Ú-
Ìfi˙ÔÓÙ·˜ ··ÁˆÁ‹ ÙˆÓ ÈÛ¯›ˆÓ ηٿ ÙËÓ ÂÎÙ¤ÏÂÛË
Ù˘ ΛÓËÛ˘ ÛÙȘ 37Ô Ì 42Ô 45. ∏ ıÂÚ·›· ÂÚÈÏ·Ì-
‚¿ÓÂÈ ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÊÏÂÁÌÔÓ‹˜ Ì ·ÁÔıÂ-
 ∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 70, 4
Ú·›· Î·È ·ÓÙÈÊÏÂÁÌÔÓÒ‰Ë Ê·Ú̷΢ÙÈ΋ ·Áˆ-
Á‹, ÙÔÓ ÂÚÈÔÚÈÛÌfi Ù˘ ·ÁˆÓÈÛÙÈ΋˜ ΛÓËÛ˘ ÙˆÓ
οو ¿ÎÚˆÓ Î·È ÙËÓ ÚÔԉ¢ÙÈ΋ Â·Ó¤ÓÙ·ÍË ÛÙËÓ
ÚÔÔÓËÙÈ΋ ‰È·‰Èηۛ·46. OÈ Î·ÎÒÛÂȘ Û ÌËÓ›-
ÛÎÔ˘˜, ¯fiÓ‰ÚÔ˘˜ Î·È Û˘Ó‰¤ÛÌÔ˘˜ Â›Ó·È Û˘Ó‹ıˆ˜
·ÔÙ¤ÏÂÛÌ· ÚÔfiÓËÛ˘ ¤Íˆ ·fi ÙËÓ ÈÛ›Ó· ÛÂ
·ıÏËÙÈΤ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜ fiˆ˜ ÙÚ¤ÍÈÌÔ, ‚¿ÚË Î·È
Û¯ÔÈÓ¿ÎÈ Ô˘ Û˘Óԉ‡ÔÓÙ·È ·fi ˘„ËÏ‹ ¤ÓÙ·ÛË
ÂÎÙ¤ÏÂÛ˘ Ù˘ ¿ÛÎËÛ˘.
™√µ∞ƒ∂™ ∂¶π¶§√∫∂™ ∆∏™ À°∂π∞™
OÈ ϤÔÓ ÛÔ‚·Ú¤˜ ‰È·Ù·Ú·¯¤˜ Ù˘ ˘Á›·˜ ÛÙËÓ
·ÁˆÓÈÛÙÈ΋ ÎÔχ̂ËÛË Â›Ó·È ÔÈ Î·ÎÒÛÂȘ Ù˘ ·˘-
¯ÂÓÈ΋˜ ÌÔ›Ú·˜ Ù˘ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘, Ô ÓÈÁÌfi˜
Î·È Ô ·ÈÊÓ›‰ÈÔ˜ ı¿Ó·ÙÔ˜. OÈ ÙÚ·˘Ì·ÙÈÛÌÔ› ÙÔ˘ ·˘-
¯¤Ó· Ô˘ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÔ˘Ó Û ÛÔ‚·Ú¤˜ Ó¢ÚÔ-
ÏÔÁÈΤ˜ ‰È·Ù·Ú·¯¤˜, Â›Ó·È Û˘Ó‹ıˆ˜ ·ÔÙ¤ÏÂÛÌ·
ηٿ‰˘Û˘ Û Ú˯‹ ÈÛ›Ó· ‹ ÚfiÛÎÚÔ˘Û˘ Ù˘ ÎÂ-
Ê·Ï‹˜ ÛÙÔÓ ÙÔ›¯Ô Ù˘ ÈÛ›Ó·˜, Û˘ÓËı¤ÛÙÂÚ· ÛÙËÓ
Ù¯ÓÈ΋ ÙÔ˘ ˘Ù›Ô˘. OÈ ÚԉȷÁڷʤ˜ ·ÛÊ·Ï›·˜
ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÂÏ¿¯ÈÛÙÔ ‚¿ıÔ˜ ÈÛ›Ó·˜ ‰‡Ô ̤-
ÙÚˆÓ ÁÈ· ÙȘ ·ÁˆÓÈÛÙÈΤ˜ ÂÎÎÈÓ‹ÛÂȘ, ÂÓÒ ÁÈ· ÙÔ
ÛÙ˘Ï ÙÔ˘ ˘Ù›Ô˘, ÙÔÔıÂÙÔ‡ÓÙ·È ÚÔÂȉÔÔÈËÙÈΤ˜
ÛËÌ·›Â˜ ¤ÓÙ ̤ÙÚ· ÚÈÓ ÙÔÓ ÙÔ›¯Ô Ù˘ ÈÛ›Ó·˜. OÈ
ÚÔÔÓËÙ¤˜ Ú¤ÂÈ ˘Ô¯ÚˆÙÈο Ó· Â›Ó·È ÂÎ·È-
‰Â˘Ì¤ÓÔÈ Û ÚÒÙ˜ ‚Ô‹ıÂȘ Î·È Î·Ú‰ÈÔÓ¢ÌÔÓÈ-
΋ ·Ó·˙ˆÔÁfiÓËÛË Î·È Ó· ·Ó·ÓÂÒÓÔ˘Ó Ù·ÎÙÈο ÙȘ
ÁÓÒÛÂȘ ÙÔ˘˜. ∂ÈϤÔÓ, Ë ÂÎÌ¿ıËÛË ÂÎÎÈÓ‹ÛˆÓ
Ì ¯·ÌËÏ‹ ÁˆÓ›· ÂÈÛfi‰Ô˘ Î·È ÁÚ‹ÁÔÚË ¿ÓÔ‰Ô ÛÙËÓ
ÂÈÊ¿ÓÂÈ· Ì ÙËÓ Î·Ù¿ÏÏËÏË ÙÔÔı¤ÙËÛË ÙˆÓ ¿Óˆ
¿ÎÚˆÓ, ÌÔÚ› Ó· Û˘Ì‚¿ÏÂÈ ÛÙËÓ ÚfiÏË„Ë ‰˘Û¿-
ÚÂÛÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ47.
O ÓÈÁÌfi˜ Â›Ó·È Û˘Ó‹ıˆ˜ ÙÔ ·ÔÙ¤ÏÂÛÌ· ˘Ô-
‚Ú‡¯È·˜ Î·È ·ÓÔ˚΋˜ ÎÔχ̂ËÛ˘. ∏ ·ÒÏÂÈ· ÙˆÓ
·ÈÛı‹ÛÂˆÓ Î·È Ô ÓÈÁÌfi˜ Â¤Ú¯ÔÓÙ·È fiÙ·Ó Ë PaO2
ÌÂÈÒÓÂÙ·È Ù·¯‡Ù·Ù· ÚÈÓ ·fi ÙËÓ ¿ÓÔ‰Ô Ù˘
PaCO2, Ë ÔÔ›· ·ÔÙÂÏ› ÙÔ ‚·ÛÈÎfi ÂÚ¤ıÈÛÌ· ÁÈ·
ÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÙÔ˘ ΤÓÙÚÔ˘ ·Ó·ÓÔ‹˜. øÛÙfiÛÔ,
ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· ·Ó·Ê¤ÚÔÓÙ·È ÓÈÁÌÔ› ÛÙËÓ ÎÔ-
χ̂ËÛË Ô˘ ‰ÂÓ ·Ô‰fiıËÎ·Ó ÛÙËÓ ˘ÔÍ›· ·ÏÏ¿
Û ηډÈÔÏÔÁÈΤ˜ ‰È·Ù·Ú·¯¤˜. OÈ ‰È·Ù·Ú·¯¤˜ ·˘-
Ù¤˜, fiˆ˜ Ë ˘ÂÚÙÚÔÊÈ΋ ·ÔÊÚ·ÎÙÈ΋ Ì˘ÔηډÈÔ-
¿ıÂÈ·, Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜ ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ ·Á-
Á›ˆÓ, ÙÔ Û‡Ó‰ÚÔÌÔ ·Ú·ÙÂٷ̤ÓÔ˘ QT Î·È ¿ÏϘ,
ÌÔÚ› Ó· Ô‰ËÁ‹ÛÔ˘Ó Î·È ÛÙËÓ ÂΉ‹ÏˆÛË ·ÈÊÓȉ›-
Ô˘ ηډȷÎÔ‡ ı·Ó¿ÙÔ˘48,49. O ΛӉ˘ÓÔ˜ ‡·Ú͢
·ıÔÏÔÁÈÎÔ‡ ˘ÔÛÙÚÒÌ·ÙÔ˜ ÛÙÔÓ ·ıÏËÙ‹ ÎÔχÌ-
‚ËÛ˘ ηıÈÛÙ¿ ·Ó·Áη›· ÙËÓ Ù·ÎÙÈ΋ ‰ÈÂÓ¤ÚÁÂÈ·
Ï‹ÚÔ˘˜ ÚÔÏËÙÈÎÔ‡ È·ÙÚÈÎÔ‡ ÂϤÁ¯Ô˘ ÁÈ· ÙËÓ È-
ÛÙÔÔ›ËÛË Ù˘ ˘Á›·˜ ÙÔ˘.
261
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OÈ ‰È·Ù·Ú·¯¤˜ Ù˘ ˘Á›·˜ ÙÔ˘ ÎÔÏ˘Ì‚ËÙ‹ ÌÔÚÔ‡Ó
Ó· ÂÚÈÔÚ›ÛÔ˘Ó ÛËÌ·ÓÙÈο ÙËÓ ·ıÏËÙÈ΋ ÙÔ˘ ·fi-
‰ÔÛË Î·È Ó· ·Ó·ÛÙ›ÏÔ˘Ó ÚÔÛˆÚÈÓ¿ ‹ Î·È ÌfiÓÈÌ·
ÙËÓ ÔÚ›· Ù˘ ·ıÏËÙÈ΋˜ ÙÔ˘ ÛÙ·‰ÈÔ‰ÚÔÌ›·˜. OÈ
ηÎÒÛÂȘ ÙÔ˘ ÒÌÔ˘ Î·È ÔÈ ÔÍ›˜ ÏÔÈÌÒÍÂȘ ÙÔ˘ ·-
ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ·ÔÙÂÏÔ‡Ó Ù·
Û˘¯ÓfiÙÂÚ· ·›ÙÈ· ‰È·ÎÔ‹˜ Ù˘ ÚÔfiÓËÛ˘ ÛÙËÓ
·ÁˆÓÈÛÙÈ΋ ÎÔχ̂ËÛË. øÛÙfiÛÔ, Ë Û˘¯ÓfiÙËÙ¿ ÙÔ˘˜
ÌÔÚ› Ó· ÂÚÈÔÚÈÛÙ› Ì ÙËÓ ÂÓË̤ڈÛË ÚÔ˜
ÙÔ˘˜ ·ıÏËÙ¤˜ Î·È ÙÔ˘˜ ÚÔÔÓËÙ¤˜ ÙˆÓ ÎÈÓ‰‡ÓˆÓ
ÂÌÊ¿ÓÈÛ‹˜ ÙÔ˘˜ Î·È ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙˆÓ Î·Ù¿ÏÏËψÓ
ÚÔÏËÙÈÎÒÓ Ì¤ÙÚˆÓ. ∏ Â·Ó¤ÓÙ·ÍË ÛÙËÓ ÚÔfi-
ÓËÛË ÌÂÙ¿ ·fi ¯ÚfiÓÈ· ·Ûı¤ÓÂÈ· ‹ ÙÚ·˘Ì·ÙÈÛÌfi
Ú¤ÂÈ Ó· Û˘Óԉ‡ÂÙ·È ·fi ÛÙ·‰È·Î‹ Î·È ÂÏÂÁ¯fi-
ÌÂÓË ·‡ÍËÛË Ù˘ ÂÈ‚¿Ú˘ÓÛ˘ ÒÛÙ ӷ ÂÚÈÔÚ›˙Â-
Ù·È Ë Èı·ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ˘ÔÙÚÔÒÓ. ∏ ÂÈÎÔÈ-
ÓˆÓ›· Î·È Ë Û˘ÓÂÓÓfiËÛË ÙÔ˘ ÚÔÔÓËÙ‹ Î·È ÙÔ˘ È·-
ÙÚÔ‡ Ì ÙÔÓ ÎÔÏ˘Ì‚ËÙ‹ Î·È ÙËÓ ÔÈÎÔÁ¤ÓÂÈ¿ ÙÔ˘ ÁÈ·
ÚÔԉ¢ÙÈ΋ ·ÔηٿÛÙ·ÛË, ·ÔÙÂÏ› ÙËÓ ·ÊÂÙË-
Ú›· ÙfiÛÔ ÁÈ· ÙË ‰È·Ê‡Ï·ÍË Ù˘ ˘Á›·˜ fiÛÔ Î·È ÁÈ·
ÙËÓ ·ÛÊ·Ï‹ ÂÈÛÙÚÔÊ‹ ÛÙÔÓ ·ıÏËÙÈÛÌfi Î·È ÙËÓ
Â›Ù¢ÍË ˘„ËÏÒÓ ·ÁˆÓÈÛÙÈÎÒÓ ÂȉfiÛˆÓ.
ABSTRACT
Koutlianos ¡. ∏ealth disorders in swimmers. Hell
Iatr 2004, 70: 256-263.
The purpose of this review is to present the
most frequent health disorders of swimmers which
may subsequently limit a swimmer’s ability to exer-
cise and compete. The acute or chronic infections of
the upper respiratory tract, the fungus- and bacteria-
induced dermatitis, urogenital infections and ex-ter-
nal otitis are the prevailing infectious diseases in
competitive swimming. When the common muscu-
loskeletal injuries to the shoulder, back and knee be-
come chronic, these overuse injuries significantly af-
fect performance, even though proper training and
therapeutic interventions are occurred. The health
disorders in swimming such as the numerous infecti-
ons and the sport injuries are frequently characteri-
zed by a long period of convalescence and they may
be present for long period after the eventual training
cessation. Furthermore, the injuries to the neck and
the risk of drowning are life-threatening in any case.
By identifying the risks for swimming injury and il-
lness and implementing appropriate prevention
strategies, the physician may substantially promote
swimmer’s health and physical performance.
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∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 2004, 70, 4: 264 - 271
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‰ÈÔÚÈÛÙ› Ë ÌÂÙ·‚ÔÏ‹ ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ CRP Û ·˘-
ÙÔ‡˜ ÙÔ˘˜ ·ÛıÂÓ›˜ Î·È Ó· Û˘Û¯ÂÙÈÛÙ› Ì ÙËÓ ÂÓ‰Ô-
ÓÔÛÔÎÔÌÂȷ΋ ÚfiÁÓˆÛË Î·È ÙËÓ ÚfiÁÓˆÛË Î·Ù¿ ÙË
‰È¿ÚÎÂÈ· 12ÌËÓ˘ ·Ú·ÎÔÏÔ‡ıËÛ˘. ™Â 30 ·ÛıÂÓ›˜
Ì Ô͇ ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘ Ô˘ ÚÔÛ‹Ïı·Ó
¤ˆ˜ Î·È 6 ÒÚ˜ ·fi ÙËÓ ¤Ó·ÚÍË ÙˆÓ Û˘Ìو̿وÓ
Î·È ˘Ô‚Ï‹ıËÎ·Ó Û ıÚÔÌ‚fiÏ˘ÛË ÚÔÛ‰ÈÔÚ›ÛÙËηÓ
Ù· Â›‰· Ù˘ CRP ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹ Î·È ÌÂÙ¿
6,12,24,48,72 ÒÚ˜, 7 Ë̤Ú˜ Î·È 6 Ì‹Ó˜. ∞fi ÙË ÌÂ-
ϤÙË ·ÔÎÏ›ÛÙËÎ·Ó ·ÛıÂÓ›˜ Ì ÓÔÛ‹Ì·Ù· Ô˘
ÚÔηÏÔ‡Ó ÌÂÙ·‚ÔÏ‹ ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ CRP. OÈ ·-
ÛıÂÓ›˜ ÂÍÂÙ¿ÛÙËÎ·Ó ÛÙÔ˘˜ 6 Î·È 12 Ì‹Ó˜ Î·È Ù·
·Ú·Î¿Ùˆ Û˘Ì‚¿Ì·Ù· ηٷÁÚ¿ÊËηÓ: ı¿Ó·ÙÔ˜,
Â·ÓÂÌÊ¿ÓÈÛË ÛÙËı¿Á¯Ë˜, Ô͇ ¤ÌÊÚ·ÁÌ·, ηډȷ΋
·ÓÂ¿ÚÎÂÈ·. ∆· Â›‰· Ù˘ CRP ·˘Í‹ıËÎ·Ó ÛËÌ·-
ÓÙÈο (p<0,01) Û ۯ¤ÛË Ì ٷ Â›‰· ηٿ ÙËÓ ÂÈ-
Û·ÁˆÁ‹ ÛÙȘ 12 ÒÚ˜ (0,73±0,43 ¤Ó·ÓÙÈ 0,23± 0,11
mg/dl), ·¤ÎÙËÛ·Ó ÙË Ì¤ÁÈÛÙË ÙÈÌ‹ ÛÙȘ 72 ÒÚ˜
(7,66±3,28 mg/dl), ·Ú¤ÌÂÈÓ·Ó ·˘ÍË̤ӷ ÛÙȘ 7
∂›Ó·È ϤÔÓ ÁÓˆÛÙfi fiÙÈ Ë ÊÏÂÁÌÔÓ‹ ·›˙ÂÈ ¤Ó· ÛË-
Ì·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ·Ó¿Ù˘ÍË Ù˘ ·ıËÚÔÛÎÏ‹Úˆ-
Û˘ Î·È Ù˘ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘. ºÏÂÁÌÔÓÒ‰Ë Î‡Ù-
Ù·Ú· Â›Ó·È ·ÚfiÓÙ· ηٿ ÙËÓ ·ıËÚÔÁ¤ÓÂÛË Î·È ÛÂ
264
Ë̤Ú˜ Î·È Â·Ó‹Ïı·Ó ÂÓÙfi˜ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ Ô-
Ú›ˆÓ ÛÙÔ˘˜ 6 Ì‹Ó˜ (0,49±0,29 mg/dl). ∫·Ù¿ ÙË
‰È¿ÚÎÂÈ· Ù˘ ÓÔÛËÏ›·˜ 24 ·ÛıÂÓ›˜ ‰ÂÓ ·ÚÔ˘Û›·-
Û·Ó ÂÈÏÔΤ˜ Î·È 6 ·ÚÔ˘Û›·Û·Ó Û˘Ì‚¿Ì·Ù· (2
ÌÂÙÂÌÊÚ·ÁÌ·ÙÈ΋ ÛÙËı¿Á¯Ë, 4 ηډȷ΋ ·ÓÂ¿Ú-
ÎÂÈ·). ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ 12ÌËÓ˘ ·Ú·ÎÔÏÔ‡ıË-
Û˘ 20 ·ÛıÂÓ›˜ ‰ÂÓ ·ÚÔ˘Û›·Û·Ó ÂÈÏÔΤ˜ Î·È 10
·ÚÔ˘Û›·Û·Ó Û˘Ì‚¿Ì·Ù· (1 ı¿Ó·ÙÔ˜, 5 ÛÙËı¿Á¯Ë,
1 Ô͇ ¤ÌÊÚ·ÁÌ·, 3 ηډȷ΋ ·ÓÂ¿ÚÎÂÈ·). ™¯ÂÙÈο
Ì ÙËÓ ÂÓ‰ÔÓÔÛÔÎÔÌÂȷ΋ ÚfiÁÓˆÛË Ù· Â›‰·
Ù˘ CRP ‹Ù·Ó ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚ· ÛÙÔ˘˜ ·ÛıÂ-
Ó›˜ Ì ÂÈÏÔΤ˜ ·fi ÙȘ 12 ÒÚ˜ ¤ˆ˜ Î·È ÙËÓ 7Ë
Ë̤ڷ. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ 12ÌËÓ˘ ·Ú·ÎÔÏÔ‡-
ıËÛ˘ Ù· Â›‰· Ù˘ CRP ‹Ù·Ó ˘„ËÏfiÙÂÚ· ÛÙÔ˘˜
·ÛıÂÓ›˜ Ì ÂÈÏÔΤ˜ ·ÏÏ¿ ‹Ù·Ó ÛËÌ·ÓÙÈο ˘„Ë-
ÏfiÙÂÚ· (p<0,05) ÌfiÓÔ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ÂÌÊ¿ÓÈ-
Û·Ó ÂÈÏÔΤ˜ ÙÔ ÚÒÙÔ 6ÌËÓÔ. ™˘ÌÂÚ·›ÓÂÙ·È fiÙÈ
Ù· Â›‰· Ù˘ CRP Û ·ÛıÂÓ›˜ Ì Ô͇ ¤ÌÊÚ·ÁÌ·
ÙÔ˘ Ì˘Ôηډ›Ô˘ Ô˘ Ï·Ì‚¿ÓÔ˘Ó ıÚÔÌ‚fiÏ˘ÛË Û˘-
Û¯ÂÙ›˙ÔÓÙ·È ÙfiÛÔ Ì ÙËÓ ÂÓ‰ÔÓÔÛÔÎÔÌÂȷ΋ Úfi-
ÁÓˆÛË fiÛÔ Î·È Ì ÙËÓ ÚfiÁÓˆÛË ÛÙÔ˘˜ 6 Ì‹Ó˜.
EÏÏËÓ I·ÙÚ 2004, 70: 264 - 271.
Ú·Á›Û˜ ·ıËÚÔÛÎÏËÚˆÙÈΤ˜ ϿΘ Ô˘ ÚÔο-
ÏÂÛ·Ó ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘1. ∞ÛıÂÓ›˜ ÌÂ
ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ ¤¯Ô˘Ó Û˘¯Ó¿ ·˘ÍË̤Ó˜ Û˘ÁÎÂÓ-
ÙÚÒÛÂȘ ·fi ‰Â›ÎÙ˜ ÊÏÂÁÌÔÓ‹˜ fiˆ˜ Ù˘ C-·ÓÙÈ-
 ∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 70, 4
‰ÚÒÛ·˜ ÚˆÙ½Ó˘ (CRP), Ù˘ ÈÓÙÂÚÏ¢ΛÓ˘ 6 ηÈ
ÙÔ˘ ÈÓˆ‰ÔÁfiÓÔ˘2,3. ∂›Ó·È Â›Û˘ ϤÔÓ ÁÓˆÛÙfi fiÙÈ
Ë ÙÈÌ‹ Ù˘ CRP ¤¯ÂÈ ÚÔÁÓˆÛÙÈ΋ ·Í›· ÙfiÛÔ Û ˘-
ÁÈ‹ ¿ÙÔÌ·4,5 fiÛÔ Î·È Û ·ÛıÂÓ›˜ Ì ·ÛÙ·ı‹ ÛÙË-
ı¿Á¯Ë ‹ non Q wave ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘6-8,
ηıÒ˜ ˘„ËϤ˜ ÙÈ̤˜ ·˘Ù‹˜ ·˘Í¿ÓÔ˘Ó ÙÔÓ Î›Ó‰˘ÓÔ
ÌÂÏÏÔÓÙÈÎÒÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ. ™Â ·-
ÛıÂÓ›˜ Ì Ô͇ ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘ (O∂ª)
Ô˘ ¤Ï·‚·Ó ıÚÔÌ‚ÔÏ˘ÙÈ΋ ·ÁˆÁ‹ Ë ÔÚ›· Ù˘
CRP ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙ› Ì ÙËÓ ÂÓ‰ÔÓÔÛÔÎÔÌÂȷ΋
ÚfiÁÓˆÛË, ÂÓÒ Ù· ·ÔÙÂϤÛÌ·Ù· Û¯ÂÙÈο Ì ÙËÓ
·ÒÙÂÚË ÚfiÁÓˆÛË Â›Ó·È ·ÓÙÈÊ·ÙÈο9-15.
™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ÂÚ¢ӋıËÎ·Ó ÔÈ ÌÂÙ·-
‚ÔϤ˜ ÙˆÓ ÙÈÌÒÓ Ù˘ CRP Û ·ÛıÂÓ›˜ Ì Ô͇ ¤Ì-
ÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘ Ô˘ ¤Ï·‚·Ó ıÚÔÌ‚ÔÏ˘ÙÈ-
΋ ·ÁˆÁ‹ Î·È Ë Ù˘¯fiÓ ‡·ÚÍË ÚÔÁÓˆÛÙÈ΋˜ ·Í›·˜
·˘ÙÒÓ. ŒÙÛÈ Î·Ù·ÁÚ¿ÊËÎ·Ó ÔÈ ÌÂÙ·‚ÔϤ˜ Ù˘ CRP
Û 30 ·ÛıÂÓ›˜ Ì O∂ª, Î·È ÔÈ ÌÂÙ·‚ÔϤ˜ ·˘Ù¤˜
Û˘Û¯ÂÙ›ÛÙËÎ·Ó ÚÔ˜ ÙËÓ ÔÚ›·-ÂͤÏÈÍË ÙˆÓ ·ÛıÂ-
ÓÒÓ, ÙfiÛÔ Î·Ù¿ ÙË ÓÔÛËÏ›· ÙÔ˘˜, fiÛÔ Î·È Û ¤Ó·
‰È¿ÛÙËÌ· ·Ú·ÎÔÏÔ‡ıËÛ˘ 12 ÌËÓÒÓ.
À§π∫O ∫∞π ª∂£O¢Oπ
MÂÏÂÙ‹ıËÎ·Ó 30 ·ÛıÂÓ›˜ Ô˘ ÓÔÛËχÙËÎ·Ó Û ÌÈ· ÂÚ›Ô-
‰Ô 18 ÌËÓÒÓ ÛÙË ÛÙÂÊ·ÓÈ·›· ÌÔÓ¿‰· Ù˘ ∞′ ∫·Ú‰ÈÔÏÔÁÈ΋˜
∫ÏÈÓÈ΋˜ ÙÔ˘ ∞¶£ ÏfiÁˆ ÔͤԘ ÂÌÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘Ôηډ›-
Ô˘ Î·È ¤Ï·‚·Ó ıÚÔÌ‚ÔÏ˘ÙÈ΋ ·ÁˆÁ‹.
∞ÛıÂÓ›˜ Î·È Â›‰Ô˜ ıÂÚ·›·˜
™˘ÁÎÂÎÚÈ̤ӷ ÔÈ 30 ·ÛıÂÓ›˜ ÚÔÛ‹Ïı·Ó Û Ë̤ڷ ÁÂÓÈ΋˜
ÂÊËÌÂÚ›·˜ Ì ÎÏÈÓÈ΋ ÂÈÎfiÓ· O.∂.ª. (ÂÌÊ¿ÓÈÛË Â›ÌÔÓÔ˘
ÚÔοډÈÔ˘ ‹ ÔÈÛıÔÛÙÂÚÓÈÎÔ‡ ¿ÏÁÔ˘˜ ‰È¿ÚÎÂÈ·˜ >30 ÏÂ-
ÙÒÓ ·ÏÏ¿ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ 6 ˆÚÒÓ), Î·È ·ÚÔ˘Û›· ÛÙÔ ËÏÂ-
ÎÙÚÔηډÈÔÁÚ¿ÊËÌ· (∏∫°) - Û ‰‡Ô Û˘Ó¯fiÌÂÓ˜ ∏∫°/Τ˜
··ÁˆÁ¤˜ - ·Ó¿Û·Û˘ ÙÔ˘ ST ≥1 mm ‹ ÓÂÔÂÌÊ·ÓÈÛı¤ÓÙÔ˜
·ÔÎÏÂÈÛÌÔ‡ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ÛΤÏÔ˘˜. ŸÏÔÈ ÔÈ ·ÛıÂÓ›˜ ¤Ï·-
‚·Ó ıÚÔÌ‚ÔÏ˘ÙÈ΋ ·ÁˆÁ‹ ›Ù Ì ÛÙÚÂÙÔÎÈÓ¿ÛË (Streptase,
Hoechst Marion Roussel, ™ÙÚ·Û‚Ô‡ÚÁÔ, °·ÏÏ›·) 1.5 Âη-
ÙÔÌ̇ÚÈ· ÌÔÓ¿‰Â˜ (IU) ÂÓ‰ÔÊÏ‚›ˆ˜ (iv.) Û ̛· ÒÚ·, ›ÙÂ
Ì ·ÏÙÂÏ¿ÛË (Actilyse, Boehringer Ingelheim, °ÂÚÌ·Ó›·) 10
mg bolus, ·ÎÔÏÔ˘ıÔ‡ÌÂÓÔ ·fi ¤Á¯˘ÛË 50 mg Û ̛· ÒÚ· ηÈ
40 mg ÙËÓ ÂfiÌÂÓË ÒÚ·. OÈ ·ÛıÂÓ›˜ Ô˘ ¤Ï·‚·Ó ·ÏÙÂÏ¿-
ÛË, ¤Ï·‚·Ó Â›Û˘ ÂÓ‰ÔÊÏ‚›ˆ˜ Ë·Ú›ÓË, 5000 bolus ·ÎÔ-
ÏÔ˘ıÔ‡ÌÂÓË ·fi ¤Á¯˘ÛË ÁÈ· 24-48 ÒÚ˜. ∞ÎfiÌË ÔÈ ·ÛıÂÓ›˜
¤Ï·‚·Ó ÙËÓ Î·ıÈÂڈ̤ÓË ıÂÚ·›· (·ÎÂÙ˘ÏÔÛ·ÏÈ΢ÏÈÎfi
Ô͇, ‚ ·ÔÎÏÂÈÛÙ¤˜, ÓÈÙÚÒ‰Ë, ·Ó·ÛÙÔÏ›˜ ÙÔ˘ ÌÂÙ·ÙÚÂÙÈÎÔ‡
ÂÓ˙‡ÌÔ˘ Ù˘ ·ÁÁÂÈÔÙÂÓÛ›Ó˘, ‰ÈÔ˘ÚËÙÈο Î·È ˘ÔÏÈȉ·ÈÌÈο
Ê¿Ú̷η) ·Ó¿ÏÔÁ· Ì ÙËÓ ÎÏÈÓÈ΋ ÙÔ˘˜ ÔÚ›· Î·È ÙȘ ‰ÈÂ-
ıÓ›˜ Ô‰ËÁ›Â˜.
∞fi ÙË ÌÂϤÙË ·ÔÎÏ›ÛÙËÎ·Ó ·ÛıÂÓ›˜ Ô˘ ‰ÂÓ ÏË-
ÚÔ‡Û·Ó Ù· ÎÚÈÙ‹ÚÈ· ÂÈÏÔÁ‹˜ ‹ ›¯·Ó Î·È ¿ÏϘ ·ı‹ÛÂȘ
.¯. ÚÂ˘Ì·ÙÔ¿ıÂȘ Ô˘ ÂËÚ¤·˙·Ó ‚·ÛÈο ÙË CRP Î·È Î·-
ıÈÛÙÔ‡Û·Ó ‰˘Û¯ÂÚ‹ ÙËÓ ·Ú·ÎÔÏÔ‡ıËÛ‹ Ù˘.
265
¶·Ú·ÎÔÏÔ‡ıËÛË ·ÛıÂÓÒÓ
∫·Ù’ ·Ú¯‹Ó fiÏÔÈ ÔÈ ·ÛıÂÓ›˜ Ô˘ ÂÚÈÏ‹ÊıËÎ·Ó ÛÙË ÌÂϤÙË
·˘Ù‹ ‰¤¯ÙËÎ·Ó Ó· Û˘ÌÌÂÙ¿Û¯Ô˘Ó ÌÂÙ¿ ÙË Û¯ÂÙÈ΋ ÙÔ˘˜ ÂÓË̤-
ÚˆÛË, Î·È ‹Ù·Ó Úfiı˘ÌÔÈ Ó· Û˘ÌÌÔÚʈıÔ‡Ó ÛÙȘ «··ÈÙ‹-
ÛÂȘ» ·˘Ù‹˜, ‰ËÏ·‰‹ ÙËÓ ˘Ô‚ÔÏ‹ ÙÔ˘˜ Û Ӥ˜ ÂÍÂÙ¿ÛÂȘ, ηÈ
ȉȷ›ÙÂÚ· ÙËÓ ÚÔÛ¤ÏÂ˘Û‹ ÙÔ˘˜ Û ·ÎÚȂ›˜ ¯ÚfiÓÔ˘˜ ÁÈ· Â-
·Ó¤ÏÂÁ¯Ô. ∏ ·Ú·ÎÔÏÔ‡ıËÛË ÂÚÈÂÏ¿Ì‚·Ó ‰‡Ô ÂÚÈfi‰Ô˘˜.
∆ËÓ ÚÒÙË, Ô˘ ·ÊÔÚÔ‡Û ÙËÓ ÂÓ‰ÔÓÔÛÔÎÔÌÂȷ΋ ÓÔÛËÏ›·
Î·È ÙË ‰Â‡ÙÂÚË, Ô˘ ·ÊÔÚÔ‡Û ÙË ÌÂÙ¤ÂÈÙ· Â͈ÓÔÛÔÎÔÌÂÈ·-
΋ ÔÚ›·, ‹Ù·Ó ‰È¿ÚÎÂÈ·˜ 12 ÌËÓÒÓ Î·È ÂÚÈÂÏ¿Ì‚·Ó Ï‹ÚË
ÎÏÈÓÈÎfi ¤ÏÂÁ¯Ô (ÎÏÈÓÈ΋ ÔÚ›· Ì ÂÌÊ¿ÓÈÛË ‹ ÌË Û˘Ìو̿-
ÙˆÓ ‹/Î·È ÂÈÏÔÎÒÓ) ÛÙÔ˘˜ 6 Î·È 12 Ì‹Ó˜. ∆fiÛÔ Î·Ù¿ ÙËÓ ÂÓ-
‰ÔÓÔÛÔÎÔÌÂȷ΋ ÓÔÛËÏ›·, fiÛÔ Î·È ÛÙÔ˘˜ 6 Î·È 12 Ì‹Ó˜ η-
Ù·ÁÚ¿ÊÔÓÙ·Ó Ë ÂͤÏÈÍË ÙˆÓ ·ÛıÂÓÒÓ Î·È Ë ÂÌÊ¿ÓÈÛË ÂÈÏÔ-
ÎÒÓ Î·È Û˘ÁÎÂÎÚÈ̤ӷ: ÛÙËı¿Á¯Ë˜ (ÛÙ·ıÂÚ‹˜ ‹ ·ÛÙ·ıÔ‡˜),
Ó¤Ô˘ ∂.ª., ηډȷ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ ‹ ı·Ó¿ÙÔ˘.
§‹„Ë ‰ÂÈÁÌ¿ÙˆÓ ·›Ì·ÙÔ˜ Î·È Ì¤ıÔ‰Ô˜ ̤-
ÙÚËÛ˘ Ù˘ CRP
OÈ Ï‹„ÂȘ ÙˆÓ ‰ÂÈÁÌ¿ÙˆÓ ·›Ì·ÙÔ˜ ÁÈ· ÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË
ÙˆÓ ÌÂÙ·‚ÔÏÒÓ Ù˘ CRP Á›ÓÔÓÙ·Ó Î·Ù¿ ÙËÓ Â›ÛÔ‰Ô ÙˆÓ ·ÛıÂ-
ÓÒÓ ÛÙËÓ ÎÏÈÓÈ΋ (=¯ÚfiÓÔ˜ 0), ÛÙË Û˘Ó¤¯ÂÈ· ÛÙȘ 6, 12, 24,48
Î·È 72 ÒÚ˜ Ù˘ ÓÔÛËÏ›·˜ Î·È ÙËÓ 7Ë Ë̤ڷ, Ë ÔÔ›· Û˘Ó‹ıˆ˜
Û˘Ó¤ÈÙ Ì ÙËÓ ¤ÍÔ‰Ô ÙÔ˘ ·ÛıÂÓÔ‡˜ ·fi ÙËÓ ÎÏÈÓÈ΋, Î·È Ù¤-
ÏÔ˜ ÛÙÔ˘˜ 6 Ì‹Ó˜, ηٿ ÙÔÓ Â·Ó¤ÏÂÁ¯Ô ÙˆÓ ·ÛıÂÓÒÓ.
∆· ‰Â›ÁÌ·Ù· ÙÔ˘ ·›Ì·ÙÔ˜ ÁÈ· ÙËÓ Ì¤ÙÚËÛË Ù˘ CRP
Ï·Ì‚¿ÓÔÓÙ·Ó Û Á˘¿ÏÈÓÔ ÛˆÏËÓ¿ÚÈ·, Ù· ÔÔ›· ˘Ô‚¿ÏÏÔ-
ÓÙ·Ó ÛÂ Ê˘ÁÔΤÓÙÚËÛË ÛÙȘ 20.000 ÛÙÚÔʤ˜ ÁÈ· 20′ Î·È ÌÂÙ¿
ÁÈÓfiÙ·Ó Ï‹„Ë ÙÔ˘ ˘ÂÚÎÂÈ̤ÓÔ˘ ÔÚÔ‡. ∆· ÛˆÏËÓ¿ÚÈ· Ì ÙÔÓ
ÔÚfi Ê˘Ï¿ÁÔÓÙ·Ó Û -70Ô C ˆ˜ ÙËÓ Ë̤ڷ ÙˆÓ ÌÂÙÚ‹ÛˆÓ, Ô˘
Á›ÓÔÓÙ·Ó ÌÂÙ¿ ÙË Û˘ÏÏÔÁ‹ ÔÏÏÒÓ ‰ÂÈÁÌ¿ÙˆÓ. O ÚÔÛ‰ÈÔÚÈ-
ÛÌfi˜ Ù˘ CRP Á›ÓÔÓÙ·Ó ÔÛÔÙÈο ÛÙÔÓ ÔÚfi ÙÔ˘ ·›Ì·ÙÔ˜ ÌÂ
ÙËÓ Ì¤ıÔ‰Ô Ù˘ ÎÈÓËÙÈ΋˜ ÓÂÊÂÏÔÌÂÙÚ›·˜ (rate nephelo-
metry), Ì ÓÂÊÂÏfiÌÂÙÚÔ ARRAY SYSTEM 360 Ù˘ ÂÙ·ÈÚ›-
·˜ BECKMMAN Î·È Û‡Ìʈӷ Ì ÙȘ Ô‰ËÁ›Â˜ Ù˘ ηٷÛ΢-
¿ÛÙÚÈ·˜ ÂÙ·ÈÚ›·˜.
™Ù·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË
OÈ ÙÈ̤˜ ÙˆÓ Û˘Ó¯ÒÓ ÌÂÙ·‚ÏËÙÒÓ ÂÎÊÚ¿ÛÙËÎ·Ó ˆ˜ ̤Û˜ ÙÈ-
̤˜ ± ÛÙ·ıÂÚ¤˜ ·ÔÎÏ›ÛÂȘ. °È· ÙË ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ¯ÚË-
ÛÈÌÔÔÈ‹ıËΠÙÔ ÚfiÁÚ·ÌÌ· SPPS 10 for Windows.OÈ Û˘-
ÁÎÚ›ÛÂȘ ÙˆÓ ÔÛÔÙÈÎÒÓ ÌÂÙ·‚ÔÏÒÓ Ù˘ CRP ·Ó¿ ˙‡ÁË ÛÙȘ
‰È¿ÊÔÚ˜ ¯ÚÔÓÈΤ˜ Ê¿ÛÂȘ ¤ÁÈÓ Ì ÙË ‰ÔÎÈÌ·Û›· paired t-
test. °È· ÙÔÓ ¤ÏÂÁ¯Ô ‡·Ú͢ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ‰È·ÊÔ-
ÚÒÓ ÌÂٷ͇ ÙˆÓ ˘ÔÔÌ¿‰ˆÓ ÛÙȘ ‰È¿ÊÔÚ˜ ¯ÚÔÓÈΤ˜ Ê¿ÛÂȘ
¯ÚËÛÈÌÔÔÈ‹ıËΠÙÔ student’s t-test. ™ÙËÓ ÔÏ˘·Ú·ÁÔÓÙÈ΋
·Ó¿Ï˘ÛË ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë ‰˘·‰È΋ ÏÔÁÈÛÙÈ΋ ·ÏÈÓ‰Úfi-
ÌËÛË (binary logistic regression). ø˜ Â›Â‰Ô ÛÙ·ÙÈÛÙÈ΋˜ ÛË-
Ì·ÓÙÈÎfiÙËÙ·˜ ıˆڋıËÎÂ Ë Èı·ÓfiÙËÙ· p<0,05.
∞¶O∆∂§∂™ª∞∆∞
∆· ÁÂÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ·ÛıÂÓÒÓ ·ÚÔ˘-
ÛÈ¿˙ÔÓÙ·È ÛÙÔÓ ›Ó·Î· 1.
∞Í›˙ÂÈ Ó· ·Ó·ÊÂÚı› fiÙÈ ÛÙË ÌÂϤÙË ·˘Ù‹ Ë
Ê˘ÛÈÔÏÔÁÈ΋ ÙÈÌ‹ Ù˘ CRP ˘ÔÏÔÁ›ÛÙËΠÌÂÙ¿ ·fi
Â·ÓÂÈÏËÌ̤Ó˜ ÌÂÙÚ‹ÛÂȘ Ù˘, Ô˘ ¤ÁÈÓ·Ó Û ÔÏ-
266 A. ZIAKA™ ∫∞π ™À¡.

¶›Ó·Î·˜ 1. °ÂÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ·ÛıÂÓÒÓ Ì Ô͇ ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘

°ÂÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο ·ÚÈıÌfi˜ %

∞ÚÈıÌfi˜ ·ÛıÂÓÒÓ 30
∏ÏÈΛ· (¤ÙË) /‡ÚÔ˜ ‰È·Î‡Ì·ÓÛ˘ 58,4±7,5 (41-75)
º‡ÏÔ: ÕÓ‰Ú˜ 26 87
°˘Ó·›Î˜ 4 13
¢Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ (µªπ, kg/m2) 26,2±2,2 23-33
¶·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ™¡
∫¿ÓÈÛÌ· 23 78
∞ÚÙËÚȷ΋ ˘¤ÚÙ·ÛË 9 30
™·Î¯·Ú҉˘ ‰È·‚‹Ù˘ 4 13
ÀÂÚÏÈȉ·ÈÌ›· 5 17
OÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ™¡ 5 17
∞ÙÔÌÈÎfi ÈÛÙÔÚÈÎfi ™ÙÂÊ·ÓÈ·È·˜ ¡ÔÛÔ˘
¶·Ï·Èfi ÂÌÊÚ·ÁÌ· Ì˘Ôηډ›Ô˘ 3 10
™Ù·ıÂÚ‹ ÛÙËı¿Á¯Ë 4 13
¶ÚÔËÁÔ‡ÌÂÓË PTCA 0 0
¶ÚÔËÁÔ‡ÌÂÓË CABG 0 0
∂ÓÙfiÈÛË ÂÌÊÚ¿ÁÌ·ÙÔ˜ Ì˘Ôηډ›Ô˘
¶ÚfiÛıÈÔ ÙÔ›¯ˆÌ· 13 43
∫¿Ùˆ ÙÔ›¯ˆÌ·/¶Ï¿ÁÈÔ 17 57
¢ÈÂÓ¤ÚÁÂÈ· ÛÙÂÊ·ÓÈÔÁÚ·Ê›·˜ 28 93
∞ÚÈıÌfi˜ ·ÁÁ›ˆÓ Ì ‚Ï¿‚Ë 1,8±0,7 1-3
∫Ï¿ÛÌ· Â͈ı‹Ûˆ˜ 51±9,9 30-65

Ï¿ ¿ÙÔÌ· Ê˘ÛÈÔÏÔÁÈο30, ·ÏÏ¿ Î·È Ù˘ ›‰È·˜ ËÏÈ- ηٿ ÙËÓ ÂÓ‰ÔÓÔÛÔÎÔÌÂȷ΋ ÓÔÛËÏ›· ÙˆÓ ·ÛıÂ-
Λ·˜ Ì ÙÔ˘˜ ·ÛıÂÓ›˜ Ì·˜. ∂ÙÛÈ Ë Ì¤ÛË Ê˘ÛÈÔÏÔÁÈ- ÓÒÓ, ·ÏÏ¿ Î·È ÛÙÔ˘˜ 6 Ì‹Ó˜ ·fi ÙËÓ ¤ÍÔ‰fi ÙÔ˘˜
΋ ÙÈÌ‹ Ù˘ CRP ·Ó¤Ú¯ÂÙ·È 0.80 mg/dL Î·È Ë ÔÔ›· ·fi ÙËÓ ÎÏÈÓÈ΋. ∞fi ÙËÓ ·Ó¿Ï˘ÛË ÙˆÓ ÛÙÔȯ›ˆÓ
Â›Ó·È ·˘Ù‹ Ô˘ ‰›ÓÂÙ·È ÁÈ· ÙËÓ ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓË ÙÔ˘ ›Ó·Î· 2 Ê·›ÓÂÙ·È fiÙÈ Ë ·Ú¯È΋ ÙÈÌ‹ Ù˘ CRP
̤ıÔ‰Ô Ì¤ÙÚËÛ‹˜ Ù˘. (0,23±0,11 mg/dL) Î˘Ì·›ÓÔÓÙ·Ó ÛÙ· Ê˘ÛÈÔÏÔÁÈο
1. °ÂÓÈ΋ ÂͤÏÈÍË Ù˘ CRP ÛÙÔ˘˜ ·ÛıÂÓ›˜. Â›‰· (Ê.Ù. <0,80 mg/dL), Î·È ÛÙË Û˘Ó¤¯ÂÈ· ·-
™ÙÔÓ ›Ó·Î· 2 Î·È ÛÙËÓ ÂÈÎfiÓ· 1 ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÚÔ˘Û›·Û ÚÔԉ¢ÙÈ΋ ·‡ÍËÛË Î·Ù¿ ÙËÓ ÔÚ›·
ÔÈ ÌÂÙ·‚ÔϤ˜ Ù˘ C-·ÓÙȉÚÒÛ·˜ ÚˆÙÂ˚Ó˘ (CRP) ÙÔ˘ O∂ª. ∂ȉÈÎfiÙÂÚ· ÛÙȘ 6 ÒÚ˜ Ë ·‡ÍËÛË Ù˘
CRP ‹Ù·Ó ÌÈÎÚ‹ Î·È ·Û‹Ì·ÓÙË p≤0,07). ™ÙË Û˘Ó¤-
¯ÂÈ·, ÛÙȘ 12 Î·È 24 ÒÚ˜ ÔÈ ·˘Í‹ÛÂȘ Ù˘ CRP ‹Ù·Ó
C αντιδρώσα πρωτεΐνη (CRP) ορού (mg/dl)

12

10
ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚ˜ (p12≤0,004 Î·È p24≤ 0,006
·ÓÙ›ÛÙÔȯ·), ÂÓÒ ÔÈ Ì¤ÁÈÛÙ˜ ·˘Í‹ÛÂȘ ÛÙȘ ÙÈ̤˜
8
·Ú·ÙËÚ‹ıËÎ·Ó ÛÙȘ 48 ÒÚ˜ (p≤0,002, Û ۯ¤ÛË
6
ÚÔ˜ ÙËÓ ÚÔËÁÔ‡ÌÂÓË ÙÈÌ‹) Î·È ÛÙȘ 72 ÒÚ˜
4 (p≤0,001, Û ۯ¤ÛË ÚÔ˜ ÙËÓ ·Ú¯È΋ ÙÈÌ‹). ¶¿ÓÙˆ˜
2 ÔÈ ÙÈ̤˜ Ù˘ CRP ÛÙȘ 48 Î·È 72 ÒÚ˜, Û˘ÁÎÚÈÓfiÌÂ-
0
Ó˜ ÌÂٷ͇ ÙÔ˘˜, ‰Â ‰È¤ÊÂÚ·Ó ÛËÌ·ÓÙÈο (p≤0,81).
0 ώρες 6 ώρες 12 ώρες 24 ώρες 48 ώρες 72 ώρες 7η ηµέρα 6 µήνες
∆¤ÏÔ˜ Ë ÙÈÌ‹ Ù˘ CRP ÙËÓ ¤‚‰ÔÌË Ë̤ڷ Ù˘ ÓfiÛÔ˘
Xρόνος µετά την έναρξη του OEM
‹Ù·Ó ÛËÌ·ÓÙÈο ÌÈÎÚfiÙÂÚË Ù˘ ÚÔËÁÔ‡ÌÂÓ˘ ÙˆÓ
∂ÈÎ. 1. °Ú·ÊÈ΋ ·ÂÈÎfiÓÈÛË ÙˆÓ ÌÂÙ·‚ÔÏÒÓ Ù˘ CRP ÙÔ˘ 72 ˆÚÒÓ (p≤0,003), ·ÏÏ¿ ÂÍ·ÎÔÏÔ˘ıÔ‡Û ӷ ›ӷÈ
ÔÚÔ‡ Û ·ÛıÂÓ›˜ Ì O∂ª. ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚË Ù˘ ·Ú¯È΋˜ ‹ ÙÈÌ‹˜ ¤Ó·Ú-

¶›Ó·Î·˜ 2. ªÂÙ·‚ÔϤ˜ Ù˘ CRP ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì Ô͇ ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘ (O∂ª), ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÓ‰ÔÓÔÛÔ-
ÎÔÌÂȷ΋˜ ÓÔÛËÏ›·˜ Î·È ÛÙÔ˘˜ ¤ÍÈ Ì‹Ó˜

§‹„Ë ‰Â›ÁÌ·ÙÔ˜ 0 ÒÚ˜ 6 ÒÚ˜ 12 ÒÚ˜ 24 ÒÚ˜ 48 ÒÚ˜ 72 ÒÚ˜ 7Ë Ë̤ڷ 6 Ì‹Ó˜
30 ·ÛıÂÓ›˜ 0,23±0,11 0,34±0,24 0,73±0,43 3,44±1,55 7,54±3,46 7,66±3,28 2,32±1,05 0,49±0,29
p≤0,07 p≤0,004 p≤0,006 p≤0,002 p≤0,81 p≤0,003 p≤0,005
 ∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 70, 4 267

͢ Ù˘ ÓfiÛÔ˘ (p≤0,002). ™ÙÔ˘˜ ¤ÍÈ Ì‹Ó˜ Ë ÙÈÌ‹ Ù˘ ÌÂÙ¿ ÙȘ 12ÒÚ˜ Î·È ˆ˜ ÙËÓ 7Ë Ë̤ڷ, ‹Ù·Ó ÛÙ·ÙÈ-
CRP (0,49±0,29) ‹Ù·Ó ·ÚfiÌÔÈ· Ù˘ ·ÓÙ›ÛÙÔȯ˘ ÛÙÈο ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚ˜ ·fi ÙȘ ·ÓÙ›ÛÙÔȯ˜
·Ú¯È΋˜, Î˘Ì·›ÓÔÓÙ·Ó ÛÙ· Ê˘ÛÈÔÏÔÁÈο Â›‰·, ÛÙËÓ ÔÌ¿‰· ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ‰ÂÓ ·ÚÔ˘Û›·Û·Ó
ÂÓÒ Û˘ÁÎÚÈÓfiÌÂÓ˜ ÌÂٷ͇ ÙÔ˘˜ ‰ÂÓ ‰È¤ÊÂÚ·Ó ÛË- ÂÈÏÔΤ˜ (‚1).
Ì·ÓÙÈο (p≤0,81). ∏ ËÏÈΛ· ÙˆÓ ·ÛıÂÓÒÓ (59,5±7,2 ¤ÙË ÔÌ¿‰· ‚1
2. ∂Ó‰ÔÓÔÛÔÎÔÌÂȷ΋ ÂͤÏÈÍË ·ÛıÂÓÒÓ Î·È ¤Ó·ÓÙÈ 54,8±7,9 ¤ÙË ÔÌ¿‰· ‚2), Ô ‰Â›ÎÙ˘ Ì¿˙·˜
ÌÂÙ·‚ÔϤ˜ Ù˘ CRP. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÓÔÛË- ÛÒÌ·ÙÔ˜ (25,8±1,5 kg/m2ÔÌ¿‰· ‚1 ¤Ó·ÓÙÈ 26,6±3,1
Ï›·˜ 24 ·ÛıÂÓ›˜ (ÔÌ¿‰· ‚1) ›¯·Ó ÔÌ·Ï‹ ÔÚ›·, kg/m2 ÔÌ¿‰· ‚2), Ô ·ÚÈıÌfi˜ ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ ·Á-
ÂÓÒ 6 (ÔÌ¿‰· ‚2) ·ÚÔ˘Û›·Û·Ó ÂÈÏÔΤ˜. ™˘ÁÎÂ- Á›ˆÓ Ì ‚Ï¿‚Ë (1,72±0,82 ÔÌ¿‰· ‚1 ¤Ó·ÓÙÈ 2,16±
ÎÚÈ̤ӷ 2 ·ÛıÂÓ›˜ ·ÚÔ˘Û›·Û·Ó ÌÂÙÂÌÊÚ·ÁÌ·ÙÈ- 0,98 ÔÌ¿‰· ‚2) Î·È Ë ÙÈÌ‹ Ù˘ ÙÚÔÔÓ›Ó˘ ∆ (8,67±
΋ ÛÙËı¿Á¯Ë (¤Ó·˜ Ì ÚfiÛıÈÔ O∂ª Î·È ¤Ó·˜ Ì 3,19 pg/ml ¤Ó·ÓÙÈ 9,33±3,36 pg/ml ·ÓÙ›ÛÙÔȯ·) ‰Â
O∂ª οو ÙÔȯÒÌ·ÙÔ˜) Î·È 4 ηډȷ΋ ·ÓÂ¿Ú- ‰È¤ÊÂÚ·Ó ÛËÌ·ÓÙÈο ÛÙÔ˘˜ ·ÛıÂÓ›˜ ¯ˆÚ›˜ ‹ Ì ÂÈ-
ÎÂÈ· (3 Ì ÚfiÛıÈÔ O∂ª Î·È ¤Ó·˜ Ì O∂ª οو ÏÔΤ˜ (p≥0,05), ÂÓÒ ·ÓÙ›ıÂÙ· ÙÔ ÎÏ¿ÛÌ· Â͈ı‹-
ÙÔȯÒÌ·ÙÔ˜). ŒÓ·˜ ·fi ÙÔ˘˜ ·ÛıÂÓ›˜ Ì ηډȷ- Ûˆ˜ ‹Ù·Ó ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚÔ ÛÙÔ˘˜ ·ÛıÂÓ›˜
΋ ·ÓÂ¿ÚÎÂÈ· ¤·Û¯Â ·fi ·Ï·Èfi O∂ª. ™ÙÔ˘˜ Ì ÂÈÏÔΤ˜ (44,1±10,6% ¤Ó·ÓÙÈ 53,8± 8,6%, p≤
12 ·fi ÙÔ˘˜ 30 ·ÛıÂÓ›˜ Ë ıÚÔÌ‚fiÏ˘ÛË ıˆڋıË- 0,05). ∂›Û˘ Ë ÂÈÙ˘¯›· ‹ fi¯È Ù˘ ıÚÔÌ‚fiÏ˘Û˘ Û¯Â-
Π·ÓÂÈÙ˘¯‹˜. ∫·È ÔÈ 6 ·ÛıÂÓ›˜ Ì ÂÈÏÔΤ˜ ›- Ù›˙ÔÓÙ·Ó Ì ÙËÓ ÂÓ‰ÔÓÔÛÔÎÔÌÂȷ΋ ÚfiÁÓˆÛË (p≤
¯·Ó ·ÓÂÈÙ˘¯‹ ıÚÔÌ‚fiÏ˘ÛË, ÂÓÒ ÔÈ ÙÈ̤˜ Ù˘ CRP 0,05), fi¯È fï˜ Î·È ÙÔ Â›‰Ô˜ Ù˘ ıÂÚ·›·˜ (Ê·ÚÌ·-
·fi ÙȘ 24 ¤ˆ˜ ÙȘ 72 ÒÚ˜ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·- ΢ÙÈ΋ ·ÁˆÁ‹, ·ÁÁÂÈÔÏ·ÛÙÈ΋, ·ÔÚÙÔÛÙÂÊ·ÓÈ·›·
ÓÙÈο ÌÂÁ·Ï‡ÙÂÚ˜ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ·ÓÂÈÙ˘¯‹ ·Ú¿Î·Ì„Ë, p≥0,05), ‹ ÔÈ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘
ıÚÔÌ‚fiÏ˘ÛË (p≥0,05). ∞fi ÙÔ˘˜ 30 ·ÛıÂÓ›˜ ÔÈ 14 ÁÈ· ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ (Û. ‰È·‚‹Ù˘, ˘¤ÚÙ·ÛË, ˘ÂÚ-
ÂÍ‹Ïı·Ó ÙÔ˘ ÓÔÛÔÎÔÌ›Ԣ Ì ʷÚ̷΢ÙÈ΋ ·Áˆ- ÏÈȉ·ÈÌ›·, οÓÈÛÌ·, ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ™¡).
Á‹, ÔÈ 9 ˘Ô‚Ï‹ıËÎ·Ó Û ·ÁÁÂÈÔÏ·ÛÙÈ΋ Î·È ÔÈ 7 ∆¤ÏÔ˜, ÛÙËÓ ÔÏ˘·Ú·ÁÔÓÙÈ΋ ·Ó¿Ï˘ÛË Ô˘ ¯ÚËÛÈ-
Û ·ÔÚÙÔÛÙÂÊ·ÓÈ·›· ·Ú¿Î·Ì„Ë. ÌÔÔÈ‹Û·Ì ηٿ ÙËÓ ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË Ë ÙÈÌ‹ Ù˘
™ÙËÓ ÂÈÎfiÓ· 2 ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÔÈ ÌÂÙ·‚ÔϤ˜ CRP ÛÙȘ 24 ÒÚ˜ ‹Ù·Ó Ô ÛËÌ·ÓÙÈÎfiÙÂÚÔ˜ ·Ô
Ù˘ CRP ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ÌÔÓ·‰ÈÎfi ÎÚÈÙ‹ÚÈÔ ÙËÓ fiÏÔ˘˜ ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·Ó Ì ÙËÓ ÂÓ-
ÂÓ‰ÔÓÔÛÔÎÔÌÂȷ΋ ÂͤÏÈÍ‹ ÙÔ˘˜, ‰ËÏ·‰‹ Â¿Ó ‹Ù·Ó ‰ÔÓÔÛÔÎÔÌÂȷ΋ ÚfiÁÓˆÛË Ì p<0,07, ·ÎÔÏÔ˘ıÔ‡-
ÔÌ·Ï‹ ‹ Ì ÂÈÏÔΤ˜. ∞fi Ù· ÛÙÔȯ›· ÙÔ˘ ›Ó·Î· ÌÂÓË ·fi ÙÔ ÎÏ¿ÛÌ· Â͈ı‹Ûˆ˜ Î·È ÙËÓ ÂÈÙ˘¯›· ‹
4 Â›Ó·È Ê·ÓÂÚfi fiÙÈ ÔÈ ·Ú¯ÈΤ˜ ÙÈ̤˜ Ù˘ CRP ÙfiÛÔ fi¯È Ù˘ ıÚÔÌ‚fiÏ˘Û˘, Ù· ÔÔ›· fï˜ ‰Â ‚Ú¤ıËηÓ
ÛÙËÓ ÔÌ¿‰· ‚1 (0,20+0,10 mg/dL), fiÛÔ Î·È ÛÙËÓ ‚2 ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο (p>0,10).
(0,27±0,13 mg/dL), Î˘Ì·›ÓÔÓÙ·Ó ÛÙ· Ê˘ÛÈÔÏÔÁÈο 3. ∂͈ÓÔÛÔÎÔÌÂȷ΋ ÂͤÏÈÍË ÙˆÓ ·ÛıÂÓÒÓ
Â›‰·, ÂÓÒ ‰Â ‰È¤ÊÂÚ·Ó ÛËÌ·ÓÙÈο ÌÂٷ͇ ÙÔ˘˜ ÛÙÔ˘˜ 6 Î·È 12 Ì‹Ó˜ Î·È ÌÂÙ·‚ÔϤ˜ Ù˘ CRP. ∫·-
(p≤0,85). OÈ ÙÈ̤˜ Ù˘ CRP ·˘Í‹ıËÎ·Ó ÚÔԉ¢ÙÈ- Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ 6 ÚÒÙˆÓ ÌËÓÒÓ Ù˘ ·Ú·ÎÔ-
ο ηٿ ÙËÓ ÔÚ›· Ù˘ ÓfiÛÔ˘, ÙfiÛÔ ÛÙËÓ ÔÌ¿‰· ‚1 ÏÔ‡ıËÛ˘ 22 ·ÛıÂÓ›˜ (ÔÌ¿‰· Á1) ›¯·Ó ÔÌ·Ï‹ Ô-
fiÛÔ Î·È ÛÙËÓ ÔÌ¿‰· ‚2. ™ÙËÓ ÔÌ¿‰· ÙˆÓ ·ÛıÂÓÒÓ Ú›·, Î·È 8 (ÔÌ¿‰· Á2) ÂÌÊ¿ÓÈÛ·Ó ÂÈÏÔΤ˜, ÂÓÒ
Ô˘ ·ÚÔ˘Û›·Û·Ó ÂÈÏÔΤ˜ (‚2) ÔÈ ÙÈ̤˜ Ù˘ CRP, ηٿ ÙË ‰È¿ÚÎÂÈ· Û˘ÓÔÏÈο ÙˆÓ 12 ÌËÓÒÓ Ù˘ ·-
Ú·ÎÔÏÔ‡ıËÛ˘ 20 ·ÛıÂÓ›˜ (ÔÌ¿‰· ‰1) ›¯·Ó ÔÌ·-
30
Ï‹ ÔÚ›·, ÂÓÒ 10 (ÔÌ¿‰· ‰2) ÂÌÊ¿ÓÈÛ·Ó ÂÈÏÔ-
C ·ÓÙȉÚÒÛ· ÚˆÙ½ÓË (CRP) ÔÚÔ‡ (mg/dl)

Τ˜. ∞fi ÙÔ˘˜ ·ÛıÂÓ›˜ Ì ÂÈÏÔΤ˜, ÔÈ 5 ·ÚÔ˘-

25
Û›·Û·Ó ÛÙËı¿Á¯Ë (2 Ì ÚfiÛıÈÔ O∂ª Î·È 3 ÌÂ
20 O∂ª οو ÙÔȯÒÌ·ÙÔ˜), ¤Ó·˜ Ó¤Ô O∂ª (·ÛıÂÓ‹˜
15
Ì O∂ª οو ÙÔȯÒÌ·ÙÔ˜), 3 ηډȷ΋ ·ÓÂ¿Ú-
ÎÂÈ· (2 Ì ÚfiÛıÈÔ O∂ª Î·È ¤Ó·˜ Ì O∂ª οو
10
ÙÔȯÒÌ·ÙÔ˜) Î·È ¤Ó·˜ ¤ı·Ó ·fi ·ÈÊÓ›‰ÈÔ Î·Ú-
5 ‰È·Îfi ı¿Ó·ÙÔ (·ÛıÂÓ‹˜ Ì ÚfiÛıÈÔ O∂ª). ŒÓ·˜
0 ·fi ÙÔ˘˜ ·ÛıÂÓ›˜ Ì ηډȷ΋ ·ÓÂ¿ÚÎÂÈ· ¤·-
0 ÒÚẪ 6 ÒÚẪ 12 ÒÚẪ 24 ÒÚẪ 2Ë Ë̤ڷ 3Ë Ë̤ڷ 7Ë Ë̤ڷ
ۯ ·fi ·Ï·Èfi O∂ª.
XÚfiÓỖ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË ÙÔ˘ OEM
™ÙËÓ ÂÈÎfiÓ· 3 ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÔÈ ÌÂÙ·‚ÔϤ˜
∂ÈÎ. 2. °Ú·ÊÈ΋ ·ÂÈÎfiÓÈÛË ÙˆÓ ÌÂÙ·‚ÔÏÒÓ Ù˘ CRP ÙÔ˘ Ù˘ CRP ÛÙȘ ÔÌ¿‰Â˜ Á1 Î·È Á2 . ∞fi Ù· ÛÙÔȯ›·
ÔÚÔ‡ ÛÙÔ O∂ª ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜ ‚1 (=¯ˆÚ›˜ ÂÈÏÔΤ˜, ·˘Ù¿ Ê·›ÓÂÙ·È fiÙÈ ÔÈ ÙÈ̤˜ Ù˘ CRP Î·È ÛÙȘ ‰‡Ô
⋅ ⎯⎯ ⋅) Î·È ‚2 (=Ì ÂÈÏÔΤ˜, ⋅ - ⋅ - ⋅). ÔÌ¿‰Â˜ ·ÛıÂÓÒÓ (Á1 Î·È Á2) ·ÚÔ˘Û›·Û·Ó ηٿ ÙËÓ
268 A. ZIAKA™ ∫∞π ™À¡.

18 16

C ·ÓÙȉÚÒÛ· ÚˆÙ½ÓË (CRP) ÔÚÔ‡ (mg/dl)

C ·ÓÙȉÚÒÛ· ÚˆÙ½ÓË (CRP) ÔÚÔ‡ (mg/dl)
16 14

14 12
12 10
10 8
8
6
6
4
4
2
2
0
0 0 ÒÚẪ 6 ÒÚẪ 12 ÒÚẪ 24 ÒÚẪ 2Ë Ë̤ڷ 3Ë Ë̤ڷ 7Ë Ë̤ڷ
0 ÒÚẪ 6 ÒÚẪ 12 ÒÚẪ 24 ÒÚẪ 48 ÒÚẪ 72 ÒÚẪ 7Ë Ë̤ڷ
XÚfiÓỖ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË ÙÔ˘ OEM
XÚfiÓỖ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË ÙÔ˘ OEM

∂ÈÎ. 4. °Ú·ÊÈ΋ ·ÂÈÎfiÓÈÛË ÙˆÓ ÌÂÙ·‚ÔÏÒÓ Ù˘ CRP ÙÔ˘

∂ÈÎ. 3. °Ú·ÊÈ΋ ·ÂÈÎfiÓÈÛË ÙˆÓ ÌÂÙ·‚ÔÏÒÓ Ù˘ CRP ÙÔ˘
ÔÚÔ‡ ÛÙÔ O∂ª Î·È ÛÙȘ ÔÌ¿‰Â˜ ‰1 (=¯ˆÚ›˜ ÂÈÏÔΤ˜, ⋅
ÔÚÔ‡ ÛÙÔ O∂ª Î·È ÛÙȘ ÔÌ¿‰Â˜ Á1 (=¯ˆÚ›˜ ÂÈÏÔΤ˜, ⋅
⎯⎯ ⋅) Î·È ‰2 (=Ì ÂÈÏÔΤ˜, ⋅ - ⋅ - ⋅).
⎯⎯ ⋅) Î·È Á2 (=Ì ÂÈÏÔΤ˜, ⋅ - ⋅ - ⋅).

ÂÓ‰ÔÓÔÛÔÎÔÌÂȷ΋ ÙÔ˘˜ ÓÔÛËÏ›· ÙËÓ ›‰È· ÚÔÔ- ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚ˜ ·fi ÙȘ ·ÓÙ›ÛÙÔȯ˜ ÙÈ̤˜ ÛÙËÓ
‰Â˘ÙÈ΋ ÂͤÏÈÍË, fiˆ˜ Î·È ÙÔ Û‡ÓÔÏÔ ÙˆÓ ıÚÔÌ‚Ô- ÔÌ¿‰· ÙˆÓ ·ÛıÂÓÒÓ ¯ˆÚ›˜ ÂÈÏÔΤ˜ (‰1) ·fi ÙȘ
Ï˘ı¤ÓÙˆÓ ·ÛıÂÓÒÓ. °ÂÓÈο ÔÈ ÙÈ̤˜ Ù˘ CRP ÛÙËÓ 12ÒÚ˜ ¤ˆ˜ ÙËÓ 7Ë Ë̤ڷ, ·ÏÏ¿ ‰Â ‰È¤ÊÂÚ·Ó ÔÙ¤
ÔÌ¿‰· ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ·ÚÔ˘Û›·Û·Ó ÂÈÏÔΤ˜ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο (p≥0,05). ∏ ËÏÈΛ· ÙˆÓ
(Á2) ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚ˜ ·fi ÙȘ ·ÓÙ›ÛÙÔȯ˜ ÙÈ̤˜ ·ÛıÂÓÒÓ (56,8±6,3 ¤ÙË ÔÌ¿‰· ‚1 ¤Ó·ÓÙÈ 61,4±9,0
ÛÙËÓ ÔÌ¿‰· ÙˆÓ ·ÛıÂÓÒÓ ¯ˆÚ›˜ ÂÈÏÔΤ˜ (Á1) ¤ÙË ÔÌ¿‰· ‚2), Ô ‰Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ (25,8±1,5
·fi ÙȘ 12ÒÚ˜ ¤ˆ˜ ÙËÓ 7Ë Ë̤ڷ, ‰Â ‰È¤ÊÂÚ·Ó fi- kg/m2 ÔÌ¿‰· ‚1 ¤Ó·ÓÙÈ 26,6±3,1 kg/m2 ÔÌ¿‰· ‚2), Ô
̈˜ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο Ì ÌÔÓ·‰È΋ ÂÍ·›ÚÂÛË ·ÚÈıÌfi˜ ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ ·ÁÁ›ˆÓ Ì ‚Ï¿‚Ë
ÙËÓ ÙÈÌ‹ Ù˘ CRP ÛÙȘ 24 ÒÚ˜ (p≤0,01). ∏ ËÏÈΛ· (1,80±0,86 ÔÌ¿‰· ‚1 ¤Ó·ÓÙÈ 1,88±0,92 ÔÌ¿‰· ‚2),
ÙˆÓ ·ÛıÂÓÒÓ (57,5±6,4 ¤ÙË ÔÌ¿‰· Á1 ¤Ó·ÓÙÈ 60,7± Ë ÙÈÌ‹ Ù˘ ÙÚÔÔÓ›Ó˘ ∆ (8,31±3,51 pg/ml ¤Ó·ÓÙÈ
10,2 ¤ÙË ÔÌ¿‰· Á2), Ô ‰Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ 9,56±3,29 pg/ml ·ÓÙ›ÛÙÔȯ·) ·ÏÏ¿ Î·È ÙÔ ÎÏ¿ÛÌ·
(25,9±1,5 kg/m2 ÔÌ¿‰· Á1 ¤Ó·ÓÙÈ 26,7±3,5 kg/m2 Â͈ı‹Ûˆ˜ (53,6±8,9% ¤Ó·ÓÙÈ 47,7±10,9%, p≥
ÔÌ¿‰· Á2), Ô ·ÚÈıÌfi˜ ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ ·ÁÁ›ˆÓ Ì 0,05) ‰Â ‰È¤ÊÂÚ·Ó ÛËÌ·ÓÙÈο ÛÙÔ˘˜ ·ÛıÂÓ›˜ ¯ˆ-
‚Ï¿‚Ë (1,76± 0,83 ÔÌ¿‰· Á1 ¤Ó·ÓÙÈ 2,00±1,00 ÔÌ¿- Ú›˜ ‹ Ì ÂÈÏÔΤ˜. ∂›Û˘, Ë ÂÈÙ˘¯›· ‹ fi¯È Ù˘
‰· Á2) Î·È Ë ÙÈÌ‹ Ù˘ ÙÚÔÔÓ›Ó˘ ∆ (7,35±2,27 ıÚÔÌ‚fiÏ˘Û˘, ÙÔ Â›‰Ô˜ Ù˘ ıÂÚ·›·˜, Î·È ÔÈ ·-
pg/ml ¤Ó·ÓÙÈ 8,96±2,81 pg/ml ·ÓÙ›ÛÙÔȯ·) ‰Â ‰È¤- Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ ‰Â Û¯ÂÙ›-
ÊÂÚ·Ó ÛËÌ·ÓÙÈο ÛÙÔ˘˜ ·ÛıÂÓ›˜ ¯ˆÚ›˜ ‹ Ì ÂÈ- ˙ÔÓÙ·Ó Ì ÙËÓ ÚfiÁÓˆÛË Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘
ÏÔΤ˜ (p≥0,05), ÂÓÒ ·ÓÙ›ıÂÙ· ÙÔ ÎÏ¿ÛÌ· Â͈ı‹- 12ÌËÓ˘ ·Ú·ÎÔÏÔ‡ıËÛ˘ (p≥0,05).
Ûˆ˜ ‹Ù·Ó ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚÔ ÛÙÔ˘˜ ·ÛıÂÓ›˜
Ì ÂÈÏÔΤ˜ (44,2±9,3% ¤Ó·ÓÙÈ 54,4±8,8%, ™À∑∏∆∏™∏
p≤0,05). ∂›Û˘, Ë ÂÈÙ˘¯›· ‹ fi¯È Ù˘ ıÚÔÌ‚fiÏ˘Û˘, ∞. °ÂÓÈΤ˜ ÌÂÙ·‚ÔϤ˜ Ù˘ CRP
ÙÔ Â›‰Ô˜ Ù˘ ıÂÚ·›·˜ (Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹, ·Á-
™ÙË ÌÂϤÙË Ì·˜ ‰È·ÈÛÙÒıËΠfiÙÈ Ë CRP Û ·ÛıÂ-
ÁÂÈÔÏ·ÛÙÈ΋, ·ÔÚÙÔÛÙÂÊ·ÓÈ·›· ·Ú¿Î·Ì„Ë) ηÈ
Ó›˜ Ô˘ ˘¤ÛÙËÛ·Ó O∂ª Î·È ¤Ï·‚·Ó ıÚÔÌ‚ÔÏ˘ÙÈ-
ÔÈ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ ‰ÂÓ
΋ ·ÁˆÁ‹ ·ÚÔ˘Û›·Û ÚÔԉ¢ÙÈ΋ ·‡ÍËÛË, Ë Ô-
Û¯ÂÙ›˙ÔÓÙ·Ó Ì ÙËÓ ÚfiÁÓˆÛË ÛÙÔ˘˜ 6 Ì‹Ó˜ (p≥ Ô›· ¿Ú¯ÈÛ ¤ÍÈ ÒÚ˜ ÂÚ›Ô˘ ·fi ÙËÓ ¤Ó·ÚÍË ÙÔ˘
0,05). ∆¤ÏÔ˜, ÛÙËÓ ÔÏ˘·Ú·ÁÔÓÙÈ΋ ·Ó¿Ï˘ÛË Ô˘ O∂ª Î·È ÌÂÁÈÛÙÔÔÈ‹ıËΠÛÙȘ 48 Ì 72 ÒÚ˜ Ù˘
¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë ÙÈÌ‹ Ù˘ CRP ÛÙȘ 24 ÒÚ˜ ‰ÂÓ ÓfiÛÔ˘, ÂÓÒ ÛÙË Û˘Ó¤¯ÂÈ· ·Ú·ÙËÚ‹ıËΠÂÏ¿ÙÙˆÛË
›¯Â ϤÔÓ ÚÔÁÓˆÛÙÈ΋ ·Í›· (p>0,10). ·˘Ù‹˜ ÙËÓ ¤‚‰ÔÌË Ì¤Ú· Ù˘ ÓfiÛÔ˘. ∏ ·‡ÍËÛË Ù˘
™ÙËÓ ÂÈÎfiÓ· 4 ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÔÈ ÌÂÙ·‚ÔϤ˜ CRP ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì·˜ ÂÍËÁÂ›Ù·È ·fi ÙÔ ÁÂÁÔÓfi˜
Ù˘ CRP ÛÙȘ ÔÌ¿‰Â˜ ‰1 Î·È ‰2. °ÂÓÈο Î·È ÛÙȘ ‰‡Ô fiÙÈ Û οı ·ÓÙ›‰Ú·ÛË ÔÍ›·˜ Ê¿Û˘ (∞Oº) ÌÂÙ·-
·˘Ù¤˜ ÔÌ¿‰Â˜ ·ÛıÂÓÒÓ (‰1 Î·È ‰2), ÔÈ ÙÈ̤˜ Ù˘ ͇ ÙˆÓ ÚˆÙÂ˚ÓÒÓ ÔÍ›·˜ Ê¿Û˘ Ô˘ ·˘Í¿ÓÔ˘Ó Â›-
CRP ÙfiÛÔ Î·Ù¿ ÙËÓ ÂÓ‰ÔÓÔÛÔÎÔÌÂȷ΋ ÓÔÛËÏ›· Ó·È Î·È Ë CRP16. ∆Ô O.∂.ª., ‰È¿ ̤ÛÔ˘ Ó¤ÎÚˆÛ˘
fiÛÔ Î·È ÛÙÔ˘˜ 6 Ì‹Ó˜ ·ÚÔ˘Û›·Û·Ó ÛÙ·ıÂÚ¿ ÙËÓ ÈÛÙÔ‡ Ô˘ ÚÔηÏ›, ÂÓÂÚÁÔÔÈ› ÌÈ· ∞Oº ηÈ
›‰È· ÂÚ›Ô˘ ÔÚ›·, fiˆ˜ Î·È ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ ÚÔηÏ› ·‡ÍËÛË Ù˘ ÚˆÙÂ˚Ó˘ ·˘Ù‹˜17. ¶·Ï·Èfi-
ıÚÔÌ‚ÔÏ˘ı¤ÓÙˆÓ ·ÛıÂÓÒÓ. ∫·È Â‰Ò ÔÈ ÙÈ̤˜ Ù˘ ÙÂÚ˜ ÌÂϤÙ˜18-21 Û ·ÛıÂÓ›˜ Ì O∂ª Ô˘ ‰ÂÓ Â›-
CRP ÛÙËÓ ÔÌ¿‰· ÙˆÓ ·ÛıÂÓÒÓ Ì ÂÈÏÔΤ˜ (‰2) ¯·Ó ˘Ô‚ÏËı› Û ıÚÔÌ‚fiÏ˘ÛË ¤‰ÂÈÍ·Ó fiÙÈ Ë CRP
 ∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 70, 4
ÙÔ˘ ÔÚÔ‡ ·˘Í¿ÓÂÈ ÛÙË ÓfiÛÔ ·˘Ù‹, ÂÓÒ Ë ÔÚ›· Ù˘
ÌÂÙ·‚ÔÏ‹˜ Ù˘ ‹Ù·Ó ·ÚfiÌÔÈ· Ì ·˘Ù‹ Ô˘ ‰È·È-
ÛÙÒıËÎÂ Î·È ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ù˘ ÌÂϤÙ˘ Ì·˜.
ŸÌˆ˜ Î·È ÈÔ ÚfiÛÊ·Ù˜ ÌÂϤÙ˜ Ô˘ ·Û¯ÔÏ‹ıË-
Î·Ó Ì ÙË ÌÂÙ·‚ÔÏ‹ Ù˘ C-·ÓÙȉÚÒÛ·˜ ÚˆÙÂ˚Ó˘
(CRP) Û ·ÛıÂÓ›˜ Ô˘ ˘¤ÛÙËÛ·Ó O∂ª Î·È ¤Ï·-
‚·Ó ıÚÔÌ‚ÔÏ˘ÙÈ΋ ·ÁˆÁ‹ ¤‰ÂÈÍ·Ó ·‡ÍËÛË Ù˘ Ô˘-
Û›·˜ ·˘Ù‹˜9,13,15,22,23 Ì ÂÌÊ¿ÓÈÛË Ù˘ ̤ÁÈÛÙ˘ ÙÈ-
Ì‹˜ Ù˘ ÙËÓ 3Ë Ë̤ڷ ÓÔÛËÏ›·˜, ‡ÚËÌ· Ô˘ Û˘Ì-
ʈÓ› Ì ٷ ·ÔÙÂϤÛÌ·Ù· Ì·˜.
µ. ªÂÙ·‚ÔϤ˜ Ù˘ CRP Î·È ÂÓ‰ÔÓÔÛÔÎÔÌÂÈ-
·Î‹ ÚfiÁÓˆÛË
ŸÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÂÓ‰ÔÓÔÛÔÎÔÌÂȷ΋ ÔÚ›· ÙˆÓ
·ÛıÂÓÒÓ ÛÙË ÌÂϤÙË Ì·˜ ·Ú·ÙËÚ‹Û·Ì fiÙÈ ÛÙÔ˘˜
·ÛıÂÓ›˜ Ô˘ ·ÚÔ˘Û›·Û·Ó ÂÈÏÔΤ˜ ηٿ ÙË
‰È¿ÚÎÂÈ· Ù˘ ÓÔÛËÏ›·˜ ÙÔ˘˜, ÔÈ ÙÈ̤˜ Ù˘ CRP ÙÔ˘
ÔÚÔ‡ ÌÂÙ¿ ÙȘ 12 ÒÚ˜ Î·È ˆ˜ ÙËÓ ¤‚‰ÔÌË Ì¤Ú· ÙÔ˘
O∂ª, ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚ˜
ÙˆÓ ·ÓÙ›ÛÙÔȯˆÓ ÙÈÌÒÓ ·˘Ù‹˜ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘
›¯·Ó ÔÌ·Ï‹ ÂÓ‰ÔÓÔÛÔÎÔÌÂȷ΋ ÔÚ›·. ∆· ¢ڋ-
Ì·Ù¿ Ì·˜ Û˘ÌʈÓÔ‡Ó Ì 6 ¿ÏϘ ÌÂϤÙ˜ Ô˘ ·Û¯Ô-
Ï‹ıËÎ·Ó Ì ÙË CRP Î·È ÙË Û˘Û¯¤ÙÈÛË Ù˘ Ì ÙËÓ ÂÓ-
‰ÔÓÔÛÔÎÔÌÂȷ΋ ÔÚ›· ·ÛıÂÓÒÓ Ì O∂ª Ô˘
˘Ô‚¿ÏÏÔÓÙ·È Û ıÚÔÌ‚fiÏ˘ÛË9,11-15. ™ÙȘ ÌÂϤÙ˜
·˘Ù¤˜ ˘‹Ú¯Â ÛËÌ·ÓÙÈ΋ Û˘Û¯¤ÙÈÛË Ù˘ CRP Ì ÙËÓ
ÂÌÊ¿ÓÈÛË Î·Ú‰È·Î‹˜ ·ÓÂ¿ÚÎÂÈ·˜ ηÈ/‹ ηډȷ-
ÎÔ‡ ı·Ó¿ÙÔ˘, ÂÓÒ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì·˜ Û˘¯ÓfiÙÂÚË
ÂÈÏÔ΋ ‹Ù·Ó Ë Î·Ú‰È·Î‹ ·ÓÂ¿ÚÎÂÈ· Î·È ÌÂÙ¿ Ë
ÂÌÊ¿ÓÈÛË ÛÙËı¿Á¯Ë˜. ∞ÎfiÌË ÛÙË ÌÂϤÙË Ì·˜ ÙÔ
ÎÏ¿ÛÌ· Â͈ı‹Ûˆ˜ Î·È Ë ÂÈÙ˘¯›· ‹ fi¯È Ù˘ ıÚÔÌ-
‚fiÏ˘Û˘ Û¯ÂÙ›˙ÔÓÙ·Ó Ì ÙËÓ ÂÓ‰ÔÓÔÛÔÎÔÌÂȷ΋
ÚfiÁÓˆÛË, fi¯È fï˜ Ë ËÏÈΛ· ÙˆÓ ·ÛıÂÓÒÓ, Ô ·ÚÈı-
Ìfi˜ ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ ·ÁÁ›ˆÓ Ì ‚Ï¿‚Ë, Ë ÙÈÌ‹ Ù˘
ÙÚÔÔÓ›Ó˘ ∆, ÙÔ Â›‰Ô˜ Ù˘ ıÂÚ·›·˜ (Ê·Ú̷΢-
ÙÈ΋ ·ÁˆÁ‹, ·ÁÁÂÈÔÏ·ÛÙÈ΋, ·ÔÚÙÔÛÙÂÊ·ÓÈ·›·
·Ú¿Î·Ì„Ë) Î·È ÔÈ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÛÙÂ-
Ê·ÓÈ·›· ÓfiÛÔ.
∂›Ó·È ÂӉȷʤÚÔÓ fiÙÈ ÛÙË ‚È‚ÏÈÔÁÚ·Ê›·9,22,
fiˆ˜ Î·È ÛÙË ÌÂϤÙË Ì·˜ ‰ÂÓ ¤¯ÂÈ ‰È·ÈÛÙˆı› Û˘-
Û¯¤ÙÈÛË ÙˆÓ ÔÛÔÙÈÎÒÓ ÌÂÙ·‚ÔÏÒÓ Ù˘ CRP ÚÔ˜
ÙÔ Ì¤ÁÂıÔ˜ ÙÔ˘ O∂ª, οÙÈ Ô˘ ÂӉ¯Ô̤ӈ˜ ı·
ÂÚÌ‹Ó¢Â, ˆ˜ ¤Ó· ‚·ıÌfi, ÙËÓ ÂΉ‹ÏˆÛË Ù˘ ÂÈ-
ÏÔ΋˜ ηډȷ΋ ·ÓÂ¿ÚÎÂÈ· ‹ Î·È ÌÂÚÈÎÒ˜ ÙÔ˘
ηډȷÎÔ‡ ı·Ó¿ÙÔ˘ (ÂȉÈο ·˘ÙÔ‡ Ô˘ Û˘Ó‰¤ÂÙ·È
Ì ¤Ó· ȉȷ›ÙÂÚ· ÂÎÙÂٷ̤ÓÔ O∂ª), fi¯È fï˜ ηÈ
ÙËÓ ÂΉ‹ÏˆÛË Ù˘ ¿ÏÏ˘ ÂÈÏÔ΋˜ ‰ËÏ·‰‹ Ù˘
ÛÙËı¿Á¯Ë˜, Ù˘ ÔÔ›·˜ Ë ÂÌÊ¿ÓÈÛË ÚÔÊ·ÓÒ˜ Û˘Ó-
‰¤ÂÙ·È Ì ÙÔ ‚·ıÌfi ‰È¿ÓÔÈ͢ ‹ ÌË (Ì ÙË ıÚÔÌ‚fi-
Ï˘ÛË) ÙÔ˘ ˘‡ı˘ÓÔ˘ ÁÈ· ÙÔ O∂ª ÛÙÂÊ·ÓÈ·›Ô˘ ·Á-
269
Á›Ԣ. ™Â ‰‡Ô ÌÂϤÙ˜22,24 ·fi ÙËÓ ›‰È· ÂÚ¢ÓËÙÈ΋
ÔÌ¿‰· ‰È·ÈÛÙÒıËΠfiÙÈ Ë ·‡ÍËÛË Ù˘ CRP ÙÔ˘
ÔÚÔ‡ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË Û ·ÛıÂÓ›˜ ÛÙÔ˘˜ ÔÔ›Ô˘˜
Ë ıÚÔÌ‚fiÏ˘ÛË ‰ÂÓ Â›Ó·È ÂÈÙ˘¯‹˜ Û˘ÁÎÚÈÙÈο ÌÂ
·˘ÙÔ‡˜ Ì ÂÈÙ˘¯‹ ıÚÔÌ‚fiÏ˘ÛË, ‡ÚËÌ· Ô˘ Û˘Ì-
ʈÓ› Ì ٷ ‰Èο Ì·˜ ·ÔÙÂϤÛÌ·Ù· Î·È Ù· ÂÚÌË-
Ó‡ÂÈ ÂÓ Ì¤ÚÂÈ, ηıÒ˜ Ë ÌË ‰È¿ÓÔÈÍË Ù˘ ˘‡ı˘Ó˘
ÁÈ· ÙÔ ¤ÌÊÚ·ÁÌ· ·ÚÙËÚ›·˜ Ì ÙË ıÚÔÌ‚fiÏ˘ÛË Ô‰Ë-
Á› Û ÌÂÁ·Ï‡ÙÂÚÔ ·ÚÈıÌfi ÂÈÏÔÎÒÓ. ∂›Ó·È ÂӉȷ-
ʤÚÔÓ fï˜ fiÙÈ ÛÙËÓ ÔÏ˘·Ú·ÁÔÓÙÈ΋ ·Ó¿Ï˘ÛË
Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËΠηٿ ÙË ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË
Ë ÙÈÌ‹ Ù˘ CRP (24 ÒÚ˜) ‹Ù·Ó Ô ÛËÌ·ÓÙÈÎfiÙÂÚÔ˜
·Ú¿ÁÔÓÙ·˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·Ó Ì ÙËÓ ÂÓ‰ÔÓÔÛÔÎÔ-
ÌÂȷ΋ ÚfiÁÓˆÛË Û˘ÁÎÚÈÙÈο Ì ÙÔ ÎÏ¿ÛÌ· Â͈ı‹-
Ûˆ˜ Î·È ÙËÓ ÂÈÙ˘¯›· ‹ fi¯È Ù˘ ıÚÔÌ‚fiÏ˘Û˘. ∆Ô
ÁÂÁÔÓfi˜ ·˘Ùfi ÛËÌ·›ÓÂÈ fiÙÈ Ë ‰È¿ÓÔÈÍË ‹ ÌË Ù˘ ˘‡-
ı˘Ó˘ ÁÈ· ÙÔ ¤ÌÊÚ·ÁÌ· ·ÚÙËÚ›·˜ ‰ÂÓ Â›Ó·È Ô ÌfiÓÔ˜
Ì˯·ÓÈÛÌfi˜ Ì ÙÔÓ ÔÔ›Ô Ë CRP Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ
ÂÓ‰ÔÓÔÛÔÎÔÌÂȷ΋ ÚfiÁÓˆÛË. ∂›Û˘, Ï·Ì‚¿ÓÔ-
ÓÙ·˜ ˘fi„Ë fiÙÈ Ô ·ÚÈıÌfi˜ ÙˆÓ ·ÛıÂÓÒÓ (‰Â›ÁÌ·)
‰ÂÓ Â›Ó·È ÌÂÁ¿ÏÔ, ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ë Ë CRP Û˘Ì‚¿Ï-
ÏÂÈ ÛÙËÓ ·ÎÚ›‚ÂÈ· Ù˘ ÚfiÁÓˆÛ˘ Ì p<0,07 ›ӷÈ
ÛÔ‚·Ú‹ ¤Ó‰ÂÈÍË fiÙÈ ·˘Ù‹ ·ÔÙÂÏ› ¤Ó·Ó ·fi ÙÔ˘˜
ÛËÌ·ÓÙÈÎfiÙÂÚÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÚfiÁÓˆÛ˘ Î·È ·Ó·-
‰ÂÈÎÓ‡ÂÈ ÙËÓ Í¯ˆÚÈÛÙ‹ ÛËÌ·Û›· ÙÔ˘ ÚÔÛ‰ÈÔÚÈ-
ÛÌÔ‡ ·˘Ù‹˜ ÛÙÔ Ô͇ ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘.
°. ªÂÙ·‚ÔϤ˜ Ù˘ CRP Î·È Â͈ÓÔÛÔÎÔÌÂÈ·-
΋ ÚfiÁÓˆÛË
™ÙË ÌÂϤÙË Ì·˜ Ë ·Ú·ÎÔÏÔ‡ıËÛË Ù˘ ÔÚ›-
·˜-ÂͤÏÈ͢ ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ˘Ô‚Ï‹ıËÎ·Ó ÛÂ
ıÚÔÌ‚fiÏ˘ÛË ÂÂÎÙ¿ıËÎÂ Î·È ÌÂÙ¿ ÙËÓ ¤ÍÔ‰fi ÙÔ˘˜
·fi ÙËÓ ÎÏÈÓÈ΋ Î·È Û ¯ÚÔÓÈÎfi ÔÚ›˙ÔÓÙ· 6 Î·È 12
ÌËÓÒÓ. ™ÙËÓ ÔÌ¿‰· ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ·ÚÔ˘Û›·ÛÂ
ÂÈÏÔΤ˜ Î·È Û˘ÓÂÒ˜ ›¯Â ¯ÂÈÚfiÙÂÚË ÚfiÁÓˆÛË,
oÈ ÙÈ̤˜ Ù˘ CRP ·fi ÙȘ 12 ÒÚ˜ ¤ˆ˜ ÙËÓ 7Ë Ë̤-
Ú· ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚ˜ Û ۯ¤ÛË Ì ÙÔ˘˜ ·ÛıÂÓ›˜ ÌÂ
ηϋ ÚfiÁÓˆÛË, ·ÏÏ¿ ÔÈ ‰È·ÊÔÚ¤˜ ÙÔ˘˜ ‰ÂÓ ¤Êı·-
Û·Ó Û ÛÙ·ÙÈÛÙÈÎÒ˜ ÛËÌ·ÓÙÈο Â›‰·. ªÔÓ·‰È΋
ÂÍ·›ÚÂÛË ·ÔÙ¤ÏÂÛÂ Ë ÙÈÌ‹ Ù˘ CRP ÛÙȘ 24 ÒÚ˜
ÙÔ˘ O∂ª, Ë ÔÔ›· ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο
˘„ËÏfiÙÂÚË Û ۯ¤ÛË Ì ÙÔ˘˜ ·ÛıÂÓ›˜ ¯ˆÚ›˜ ÂÈ-
ÏÔΤ˜, ÌfiÓÔ fï˜ fiÙ·Ó Ë ÚfiÁÓˆÛË ·Ó·Ê¤ÚÔÓÙ·Ó
ÛÙÔ˘˜ 6 ÚÒÙÔ˘˜ Ì‹Ó˜ ÌÂÙ¿ ÙÔ O∂ª. ∞ÎfiÌË ·fi
ÙÔ˘˜ ¿ÏÏÔ˘˜ ·Ú¿ÁÔÓÙ˜ (ÂÈÙ˘¯›· ‹ fi¯È Ù˘ ıÚÔÌ-
‚fiÏ˘Û˘, ËÏÈΛ· ÙˆÓ ·ÛıÂÓÒÓ, ·ÚÈıÌfi˜ ÙˆÓ ÛÙÂÊ·-
ÓÈ·›ˆÓ ·ÁÁ›ˆÓ Ì ‚Ï¿‚Ë, ÙÈÌ‹ Ù˘ ÙÚÔÔÓ›Ó˘ ∆,
·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ) ÌfiÓÔÓ
ÙÔ ÎÏ¿ÛÌ· Â͈ı‹Ûˆ˜ Û¯ÂÙ›˙ÔÓÙ·Ó Ì ÙËÓ ÂÌÊ¿ÓÈ-
ÛË ÂÈÏÔÎÒÓ, Î·È Â‰Ò fï˜ ÌfiÓÔÓ fiÙ·Ó Ë Úfi-
270 A. ZIAKA™ ∫∞π ™À¡.
ÁÓˆÛË ·Ó·Ê¤ÚÔÓÙ·Ó ÛÙÔ˘˜ 6 ÚÒÙÔ˘˜ Ì‹Ó˜ ÌÂÙ¿
ÙÔ O∂ª.
∆· Â˘Ú‹Ì·Ù¿ Ù˘ ÌÂϤÙ˘ Ì·˜ Û¯ÂÙÈο Ì ÙË
CRP ¢ڛÛÎÔÓÙ·È Û ıÂÙÈ΋ ·ÓÙÈÛÙÔȯ›· Ì ·˘Ù¿
Ù˘ ÌÂϤÙ˘ ÙˆÓ Pietila Î·È Û˘Ó.10 Ë ÔÔ›· Û˘ÁÎÚÈ-
ÙÈο Ì ÙË ‰È΋ Ì·˜ ÌÂϤÙË ÂÚȤϷ‚ ۷ÊÒ˜ ÌÂ-
Á·Ï‡ÙÂÚÔ ·ÚÈıÌfi ·ÛıÂÓÒÓ, ›¯Â Ì·ÎÚfiÙÂÚË ·Ú·-
ÎÔÏÔ‡ıËÛË (ˆ˜ 2 ¤ÙË), Ô ‰Â ۯ‰ȷÛÌfi˜ Ù˘ ÂÚȤ-
Ï·‚ ۇÁÎÚÈÛË-Û˘Û¯¤ÙÈÛË ÙˆÓ ÌÂÁ·Ï‡ÙÂÚˆÓ ÌÂÙ·-
‚ÔÏÒÓ Ù˘ CRP (Ô˘ ÛËÌÂȈ٤ÔÓ ·Ú·ÙËÚ‹ıËÎÂ
ÌÂٷ͇ 2˘ Î·È 4˘ Ë̤ڷ˜ ÙÔ˘ O∂ª) ÛÙȘ ‰‡Ô ˘Ô-
ÔÌ¿‰Â˜ (Ì η΋ ‹ ηϋ ÚfiÁÓˆÛË) ÚÔ˜ ÙËÓ ÔÏÈ-
΋ ıÓËÙfiÙËÙ·. ™ÙË ÌÂϤÙË ·˘Ù‹, fiˆ˜ Î·È ÛÙË ‰È΋
Ì·˜, ‰È·ÈÛÙÒıËΠfiÙÈ Ë ·Ú·¿Óˆ ÙÈÌ‹ Ù˘ CRP
ÙÔ˘ ÔÚÔ‡ ‹Ù·Ó ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚË ÛÙËÓ ÔÌ¿‰·
ÙˆÓ ·ÛıÂÓÒÓ Ì η΋ ÚfiÁÓˆÛË, ·˘Ùfi fï˜ ›Û¯˘Â
ÌfiÓÔ Î·Ù¿ ÙËÓ ÚÒÙË ÂÚ›Ô‰Ô ·Ú·ÎÔÏÔ‡ıËÛ˘
ÙˆÓ ·ÛıÂÓÒÓ, ‰ËÏ·‰‹ ˆ˜ ÙÔ˘˜ ¤ÍÈ Ì‹Ó˜, fiÔ˘ Û˘-
Ó¤‚ËÛ·Ó Î·È ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ ı¿Ó·ÙÔÈ. °ÂÓÈο fï˜
Ù· Â˘Ú‹Ì·Ù· Û¯ÂÙÈο Ì ÙË CRP Î·È ÙËÓ ·ÒÙÂÚË
ÚfiÁÓˆÛË Û ·ÛıÂÓ›˜ Ì O∂ª Â›Ó·È ·ÓÙÈÊ·ÙÈο,
ηıÒ˜ 3 ÈÔ ÚfiÛÊ·Ù˜ ÌÂϤÙ˜11-13 Ì ‰È¿ÚÎÂÈ· ·-
Ú·ÎÔÏÔ‡ıËÛ˘ ·fi 1 ¤ˆ˜ 3 ¤ÙË ‰È·›ÛÙˆÛ·Ó Û˘Û¯¤-
ÙÈÛË Ù˘ CRP Ì ÙËÓ ÚfiÁÓˆÛË ÙˆÓ ·ÛıÂÓÒÓ ÌÂ
O∂ª ÌÂÙ¿ ÙËÓ ¤ÍÔ‰Ô ·fi ÙÔ ÓÔÛÔÎÔÌ›Ô, Î·È ÈÔ
Û˘ÁÎÂÎÚÈ̤ӷ Ì ÙËÓ ÂÌÊ¿ÓÈÛË ·ÈÊÓ›‰ÈÔ˘ ηډȷ-
ÎÔ‡ ı·Ó¿ÙÔ˘ ‹ ı·Ó¿ÙÔ˘ ·fi ηډȷ΋ ·ÓÂ¿ÚÎÂÈ·.
∞ÓÙ›ıÂÙ· ÌÈ· ¿ÏÏË ÌÂϤÙË14 ‰Â ‰È·›ÛÙˆÛ ·ÓÂÍ¿Ú-
ÙËÙË ÚÔÁÓˆÛÙÈ΋ ·Í›· ÁÈ· ÙË CRP, fiÙ·Ó ÛÙË ÛÙ·ÙÈ-
ÛÙÈ΋ ·Ó¿Ï˘ÛË ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó Î·È ÔÈ ÏÔÈÔ› η-
ıÈÂڈ̤ÓÔÈ ÚÔÁÓˆÛÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ÌÂÙ¿ ·fi
¤Ó· Ô͇ ¤ÌÊÚ·ÁÌ· Ì˘Ôηډ›Ô˘ ‰ËÏ·‰‹ Ë ËÏÈΛ·, Ë
·ÚÔ˘Û›· ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË Î·È Ë ÏÂÈÙÔ˘ÚÁÈÎfiÙË-
Ù· Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜. ∫·È ÛÙË ‰È΋ Ì·˜ ÌÂϤÙË,
fiÙ·Ó ÛÙË ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ
ÔÏ˘·Ú·ÁÔÓÙÈ΋ ·Ó¿Ï˘ÛË Ë ÙÈÌ‹ Ù˘ CRP ÛÙȘ 24
ÒÚ˜ ‰ÂÓ Â›¯Â ϤÔÓ ÚÔÁÓˆÛÙÈ΋ ·Í›· ÁÈ· ÙËÓ
Â͈ÓÔÛÔÎÔÌÂȷ΋ ÔÚ›·.
∆ÂÏÈο ˆ˜ Û˘Ì¤Ú·ÛÌ· ı· ÌÔÚÔ‡Û ӷ ˘Ô-
ÛÙËÚȯı› fiÙÈ Ë ÔÚ›· Ù˘ CRP ÙÔ˘ ÔÚÔ‡ Â›Ó·È ‰˘-
Ó·ÙfiÓ Ó· ·ÔÙÂϤÛÂÈ ¤Ó·Ó ÚÔÁÓˆÛÙÈÎfi ‰Â›ÎÙË Ù˘
ÂͤÏÈ͢ ÙˆÓ ·ÛıÂÓÒÓ Ì O∂ª Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È
Û ıÚÔÌ‚fiÏ˘ÛË, ΢ڛˆ˜ fï˜ ηٿ ÙËÓ ÔÍ›· Ê¿ÛË
·˘ÙÔ‡ (‰ËÏ·‰‹ Ù˘ ÂÓ‰ÔÓÔÛÔÎÔÌÂȷ΋˜ ÓÔÛËÏ›-
·˜), Î·È ÏÈÁfiÙÂÚÔ ·ÚÁfiÙÂÚ· ÌÂÙ¿ ÙËÓ ¤ÍÔ‰Ô ÙˆÓ
·ÛıÂÓÒÓ ·fi ÙËÓ ÎÏÈÓÈ΋.
ABSTRACT
Ziakas A, Gavriilidis S, Giannoglou G, Souliou E,
Gemitzis K, Stefanidis Th, Arvanitidou-Vagiona M,
Pindona I, Parcharidis G, Louridas G. Time course
of C-reactive protein (CRP) levels in patients with
acute myocardial infarction receiving thrombolysis
and their relationship to inhospital and to further
follow up period prognosis. Hell Iatr 2004, 70: 264-
271.
C reactive protein (CRP) levels alter during ho-
spitalization in patients with acute myocardial infar-
ction (AMI) receiving thrombolysis. Aim of our study
was to investigate the time course of CRP levels in
such patients and their relationship to in-hospital
and to a 12-month follow up period pro gnosis. In 30
patients presenting with AMI within 6 hours of
symptom onset and treated with thrombolysis, CRP
levels were measured on admission and after 6, 12,
24, 48, 72 hours, 7 days and 6 months. Patients
suffering from another disease that can alter CRP
levels were excluded. Patients had clinical follow up
at 6 and 12 months, and the follo-wing cardiac
events were recorded: cardiac death, recurrent
angina, recurrent AMI, heart failure. CRP levels
increased significantly comparing to admission levels
(p<0.01) at 12 hours (0.73± 0.43 versus 0.23±0.11
mg/dl ), reached peak value at 72 hours (7.66±3.28
mg/dl), remained elevated at 7 days, and were back
to admission levels at 6 months (0.49±0.29 mg/dl).
During the in-hospital phase 24 patients had an
uneventful course, and 6 patients had complications
(2 postinfarct angina, 4 heart failure).During the 12-
month follow up period 20 patients had an une-
ventful course, and 10 patients had complications (1
cardiac death, 5 recurrent angina, 1 recurrent AMI, 3
heart failure). Regarding the in-hospital prognosis
CRP levels were significantly higher in patients with
complications from 12 hours until the 7th day.
During the 12 month follow up CRP levels were
higher in patients with complications but achieved
statistical significance (p< 0.05) only in the
subgroup of patients who had complications within
the first 6 months following AMI. It is cocluded that
in patients with AMI receiving thrombolysis CRP
levels are related both to in-hospital and to 6-month
follow up prognosis.
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∞ÏÏËÏÔÁÚ·Ê›·:
A. ∑ȿη˜
A′ ∫·Ú‰ÈÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ ∞¶£
¡ÔÛÔÎÔÌÂ›Ô ∞Ã∂¶∞
™. ∫˘ÚȷΛ‰Ë 1
546 36, £ÂÛÛ·ÏÔÓ›ÎË
Corresponding author:
A. Ziakas
A′ Department of Cardiology
Aristotle University,
AHEPA Hospital
S. Kyriakidi 1
546 36, Thessaloniki
Greece
∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 2004, 70, 4: 272 - 278
∆H-1 Î·È ∆H-2 ΢ÙÙ·ÚÔΛÓ˜
ÛÙË ¯ÚfiÓÈ· Ë·Ù›Ùȉ· µ Î·È C
∂. §¿ÏÏ·1, M. ƒ·ÙÔÔ‡ÏÔ˘-°ÈÁ‹1, E. √ÚÊ·ÓÔ‡1,
∂. ™ÈÓ¿ÎÔ˜1, E. µÚÂÙÙÔ‡2
1 ¢′ ¶·ıÔÏÔÁÈ΋ ∫ÏÈÓÈ΋, A¶£, ¡ÔÛÔÎÔÌÂ›Ô «πÔÎÚ¿ÙÂÈÔ», £ÂÛÛ·ÏÔÓ›ÎË
2 ∂ÚÁ·ÛÙ‹ÚÈÔ ¶·ıÔÏÔÁÈ΋˜ ∞Ó·ÙÔÌÈ΋˜ ∞¶£, £ÂÛÛ·ÏÔÓ›ÎË
¶ÂÚ›ÏË„Ë. ∏ ·ÚÔ‡Û· ÌÂϤÙË Û¯Â‰È¿ÛÙËΠÌÂ
ÛÎÔfi Ó· ‰ÈÂÚ¢ÓËıÔ‡Ó ÔÈ ∆∏1 Î·È ∆∏2 ΢ÙÙ·ÚÔΛ-
Ó˜ ÛÙÔÓ ÔÚfi Î·È ÛÙÔÓ Ë·ÙÈÎfi ÈÛÙfi ·ÛıÂÓÒÓ ÌÂ
¯ÚfiÓÈ· Ë·Ù›Ùȉ· µ (Ã∏µ) Î·È ¯ÚfiÓÈ· Ë·Ù›Ùȉ· C
(Ã∏C). ∆· Â›‰· ÙˆÓ ∆∏1 (IL-2, IFN-Á) Î·È ∆∏2
(IL-4, IL-10) ΢ÙÙ·ÚÔÎÈÓÒÓ ÌÂÙÚ‹ıËÎ·Ó ÛÙÔÓ ÔÚfi 51
Û˘ÓÔÏÈο ·ÛıÂÓÒÓ Ì ¯ÚfiÓÈ· Ë·Ù›Ùȉ· µ Î·È C ηÈ
20 Ì·ÚÙ‡ÚˆÓ. ™Â 21 ·ÛıÂÓ›˜ Î·È Û 2 ˘ÁÈ›˜ Ì¿ÚÙ˘-
Ú˜ ¤ÁÈÓ ·Ó›¯Ó¢ÛË ÙÔ˘ mRNA ÙˆÓ ›‰ÈˆÓ ΢ÙÙ·ÚÔÎÈ-
ÓÒÓ ÛÙÔÓ Ë·ÙÈÎfi ÈÛÙfi. ¢È·ÈÛÙÒıËΠÛËÌ·ÓÙÈ΋
·‡ÍËÛË ÙˆÓ ∆∏2 (IL-4, IL-10) Î·È fi¯È ÙˆÓ ∆∏1 (IL-2,
IFN-Á) ΢ÙÙ·ÚÔÎÈÓÒÓ ÛÙÔÓ ÔÚfi ÙˆÓ ·ÛıÂÓÒÓ Û ۇ-
ÁÎÚÈÛË Ì ÙÔ˘˜ Ì¿ÚÙ˘Ú˜ (̤ÛÔ˜ fiÚÔ˜ ÙÈÌÒÓ Û pg/l
Ù˘ IL-4: Ì¿ÚÙ˘Ú˜ 0, ·ÛıÂÓ›˜ Ì Ã∏µ 0,327±0,560,
·ÛıÂÓ›˜ Ì XHC 0,538±0,665, ̤ÛÔ˜ fiÚÔ˜ ÙÈÌÒÓ ÛÂ
pg/l Ù˘ IL-10: Ì¿ÚÙ˘Ú˜ 1,139±0,282, ·ÛıÂÓ›˜ ÌÂ
OÈ ÈÔÁÂÓ›˜ Ë·Ù›Ùȉ˜ µ Î·È C ·ÔÙÂÏÔ‡Ó ÛËÌ·-
ÓÙÈΤ˜ ·Èٛ˜ ÓÔÛËÚfiÙËÙ·˜ Î·È ıÓËÙfiÙËÙ·˜ ·ÁÎÔ-
ÛÌ›ˆ˜. ÷ڷÎÙËÚÈÛÙÈÎfi ÙÔ˘˜ ÁÓÒÚÈÛÌ· Î·È Û˘Á-
¯ÚfiÓˆ˜ Ì›˙ÔÓ Úfi‚ÏËÌ· ·ÔÙÂÏ› Ë ÌÂÙ¿ÙˆÛË
Ù˘ ÓfiÛÔ˘ Û ¯ÚÔÓÈfiÙËÙ· Î·È Ë ÂÌ̤ÓÔ˘Û· Ïԛ̈-
ÍË, Ô˘ ·Ú·ÙËÚÂ›Ù·È ÛÙÔ 80% ÙˆÓ ·ÛıÂÓÒÓ ÌÂ
Ë·Ù›Ùȉ· C Î·È ÛÙÔ 10% ÙˆÓ ·ÛıÂÓÒÓ Ì Ë·Ù›ÙÈ-
‰· µ. ∂ÈÚfiÛıÂÙ· ÔÈ ·ÛıÂÓ›˜ Ì ¯ÚfiÓÈ· ÓfiÛÔ
·ÓÙÈÌÂÙˆ›˙Ô˘Ó ÛËÌ·ÓÙÈÎfi ΛӉ˘ÓÔ ·Ó¿Ù˘Í˘
ΛÚÚˆÛ˘ ÙÔ˘ ‹·ÙÔ˜ ‹/Î·È Ë·ÙÔ΢ÙÙ·ÚÈÎÔ‡ ηÚ-
ÎÈÓÒÌ·ÙÔ˜1,2. OÈ ·ıÔÁÂÓÂÙÈÎÔ› Ì˯·ÓÈÛÌÔ› Ô˘
ÂÓ¤¯ÔÓÙ·È ÛÙË ÌÂÙ¿ÙˆÛË Ù˘ ÓfiÛÔ˘ Û ¯ÚÔÓÈfiÙË-
Ù· Î·È ÛÙËÓ ÚfiÎÏËÛË Ù˘ Ë·ÙÈ΋˜ ‚Ï¿‚˘ ‰ÂÓ Â›-
Ó·È Ï‹Úˆ˜ ‰È¢ÎÚÈÓÈṲ̂ÓÔÈ.
272
Ã∏µ 1,704±0,574, ·ÛıÂÓ›˜ Ì XHC 1,816±0,619,
̤ÛÔ˜ fiÚÔ˜ ÙÈÌÒÓ Û pg/l Ù˘ IL-2: Ì¿ÚÙ˘Ú˜ 1,940±
3,965, ·ÛıÂÓ›˜ Ì Ã∏µ 0,3440±12,655, ·ÛıÂÓ›˜ ÌÂ
XHC 0,791±1,948, ̤ÛÔ˜ fiÚÔ˜ ÙÈÌÒÓ Û pg/l Ù˘ IFN-
Á: Ì¿ÚÙ˘Ú˜ 0,455±2,034, ·ÛıÂÓ›˜ Ì Ã∏µ 1,793±
4,788, ·ÛıÂÓ›˜ Ì XHC 0). ∂Ó‰ÔË·ÙÈ΋ ¤ÎÊÚ·ÛË
ÙÔ˘ mRNA ÙˆÓ ∆∏1 ΢ÙÙ·ÚÔÎÈÓÒÓ ‰È·ÈÛÙÒıËΠÛÂ
8 ·ÛıÂÓ›˜, ÂÓÒ mRNA ÙˆÓ ∆∏2 ΢ÙÙ·ÚÔÎÈÓÒÓ ‰ÂÓ
·ÓȯÓ‡ıËΠ۠ηӤӷ ‰Â›ÁÌ·. ™ÙË ¯ÚfiÓÈ· ÈÔÁÂÓ‹
Ë·Ù›Ùȉ· µ Î·È C ˘ÂÚ¤¯ÂÈ Ë ·Ú·ÁˆÁ‹ ∆∏2 (IL-4,
IL-10) ΢ÙÙ·ÚÔÎÈÓÒÓ ÛÙËÓ ÂÚÈʤÚÂÈ· Î·È ∆∏1 (IL-2,
IFN-Á) ΢ÙÙ·ÚÔÎÈÓÒÓ ÛÙÔÓ Ë·ÙÈÎfi ÈÛÙfi. ¶Èı·ÓfiÓ ÙÔ
ÚÔÊ›Ï ·˘Ùfi ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ Ó· ÂÌϤÎÂÙ·È ÛÙËÓ
·ÓÔÛÔ·ıÔÁ¤ÓÂÈ· Î·È ÙË Ê˘ÛÈ΋ ÈÛÙÔÚ›· Ù˘ ÓfiÛÔ˘
EÏÏËÓ I·ÙÚ 2004, 70: 272 - 278.
OÈ Î˘ÙÙ·ÚÔΛÓ˜ ·ÔÙÂÏÔ‡Ó ÛËÌ·ÓÙÈÎfiÙ·ÙÔ˘˜
ÌÂÛÔÏ·‚ËÙ¤˜ ÙˆÓ ÂÍ·ÚÙÒÌÂÓˆÓ ·fi Ù· ∆ ÏÂÌÊÔ-
·ÙÙ·Ú· ·ÓÔÛÈ·ÎÒÓ ··ÓÙ‹ÛÂˆÓ ¤Ó·ÓÙÈ ÚˆÙÂ˚ÓÈ-
ÎÒÓ ·ÓÙÈÁfiÓˆÓ. ∫·Ù¿ Û˘Ó¤ÂÈ· ÙÔ Â›‰Ô˜ ÙˆÓ Î˘ÙÙ·-
ÚÔÎÈÓÒÓ Ô˘ ·Ú¿ÁÔÓÙ·È Î·Ù¿ ÙËÓ ÂͤÏÈÍË ÌÈ·˜
·ÓÔÛȷ΋˜ ·¿ÓÙËÛ˘, ηıÔÚ›˙ÂÈ ÙfiÛÔ ÙË Ê‡ÛË fiÛÔ
Î·È ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ·¿ÓÙËÛ˘ ·˘Ù‹˜.
∆· CD4+ ∆ ÏÂÌÊÔ·ÙÙ·Ú· ‰È·ÎÚ›ÓÔÓÙ·È ÛÂ
‰‡Ô ˘ÔÏËı˘ÛÌÔ‡˜ Ì ‚¿ÛË ÙȘ ÂÎÎÚÈÓfiÌÂÓ˜ ·fi
·˘Ù¿ ΢ÙÙ·ÚÔΛÓ˜. OÈ ‰˘Ô ·˘ÙÔ› ˘ÔÏËı˘ÛÌÔ›
ÙˆÓ ∆ ‚ÔËıËÙÈÎÒÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ (T Helper cells)
ÔÓÔÌ¿ÛÙËÎ·Ó ∆∏1 Î·È ∆∏2.
∆· ∆∏1 ·ÙÙ·Ú· ·Ú¿ÁÔ˘Ó IL-2, IFN-Á, IL-
12 Î·È ∆NF-‚, ÂÓÒ Ù· ∆∏2 ·ÙÙ·Ú· ·Ú¿ÁÔ˘Ó IL-
 ∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 70, 4
4, IL-5, IL-6, IL-10 Î·È IL-13.
∆· ∆∏1 ·ÙÙ·Ú· ‹ ÔÈ ∆∏1-Ù‡Ô˘ ΢ÙÙ·ÚÔΛ-
Ó˜ ÚÔ¿ÁÔ˘Ó ÙËÓ Î˘ÙÙ·ÚÈ΋ ·ÓÔÛ›·, ÙË Ê·ÁÔ΢Ù-
Ù¿ÚˆÛË, ÙËÓ ·ÚÔ˘Û›·ÛË ÙÔ˘ ·ÓÙÈÁfiÓÔ˘ Î·È ÙËÓ ÂÈ-
‰È΋ ΢ÙÙ·ÚÔÙÔÍÈ΋ ·ÓÙ›‰Ú·ÛË, ÂÓÒ ÔÈ ∆∏2-Ù‡Ô˘
΢ÙÙ·ÚÔΛÓ˜ Ú˘ıÌ›˙Ô˘Ó ÙËÓ ·Ú·ÁˆÁ‹ ÙˆÓ ·ÓÙÈ-
ۈ̿وÓ, ·›˙Ô˘Ó ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙȘ ·ÏÏÂÚÁÈ-
Τ˜ ··ÓÙ‹ÛÂȘ Î·È Î·Ù·ÛÙ¤ÏÏÔ˘Ó ÙËÓ Î˘ÙÙ·ÚÈ΋
·ÓÔÛ›·, Ë ÔÔ›· Â›Ó·È ÛËÌ·ÓÙÈ΋ ÁÈ· ÙËÓ ¿Ì˘Ó· ÙÔ˘
ÔÚÁ·ÓÈÛÌÔ‡ ¤Ó·ÓÙÈ ÙˆÓ ÏÔÈÌÒÍÂˆÓ ·fi ÈÔ‡˜3-10.
E›Ó·È Èı·Ófi, fiÙÈ ÛÙË ¯ÚfiÓÈ· ÈÔÁÂÓ‹ Ë·Ù›Ùȉ·
µ Î·È C ÌÈ· ‰È·Ù·Ú·¯‹ Ù˘ ÈÛÔÚÚÔ›·˜ ÛÙËÓ ·Ú·-
ÁˆÁ‹ ÙˆÓ ∆∏1 Î·È ∆∏2 ΢ÙÙ·ÚÔÎÈÓÒÓ Ó· ÂÌϤÎÂ-
Ù·È ·ÊÂÓfi˜ ÛÙËÓ ·ÓÔÛÔ·ıÔÁ¤ÓÂÈ· Î·È ÙË Ê˘ÛÈ΋
ÈÛÙÔÚ›· Ù˘ ÓfiÛÔ˘ Î·È ·ÊÂÙ¤ÚÔ˘ ÛÙËÓ ÚfiÎÏËÛË
Ù˘ Ë·ÙÈ΋˜ ‚Ï¿‚˘11-28.
∏ ·ÚÔ‡Û· ÌÂϤÙË Û¯Â‰È¿ÛÙËΠ̠ÛÎÔfi Ó·
ÂÍÂÙ·ÛÙ› ·˘Ù‹ ·ÎÚÈ‚Ò˜ Ë ˘fiıÂÛË, Î·È ÁÈ· ÙÔ Ïfi-
ÁÔ ·˘Ùfi ‰ÈÂÚ¢ӋıËÎ·Ó Ù· Â›‰· ÙˆÓ ∆∏1 ηÈ
∆∏2 ΢ÙÙ·ÚÔÎÈÓÒÓ ÛÙÔÓ ÔÚfi Î·È ·ÓȯÓ‡ıËΠÙÔ
mRNA ·˘ÙÒÓ ÛÙÔÓ Ë·ÙÈÎfi ÈÛÙfi ·ÛıÂÓÒÓ ÌÂ ¯Úfi-
ÓÈ· ÈÔÁÂÓ‹ Ë·Ù›Ùȉ· µ Î·È C.
∞™£∂¡∂π™ ∫∞π ª∂£O¢Oπ
™ÙË ÌÂϤÙË Û˘ÌÂÚÈÏ‹ÊıËÛ·Ó Û˘ÓÔÏÈο 51 ·ÛıÂÓ›˜ Î·È 20
˘ÁÈ›˜ Ì¿ÚÙ˘Ú˜. ∞fi ÙÔ˘˜ ·ÛıÂÓ›˜ ÔÈ 32 ›¯·Ó ¯ÚfiÓÈ· Ë·-
Ù›Ùȉ· µ (28 ¿Ó‰Ú˜-4 Á˘Ó·›Î˜, ̤ÛË ËÏÈΛ· 34,75 ¤ÙË) Î·È ÔÈ
19 ¯ÚfiÓÈ· Ë·Ù›Ùȉ· C (12 ¿Ó‰Ú˜-7 Á˘Ó·›Î˜, ̤ÛË ËÏÈΛ·
32,20 ¤ÙË). ∏ ÔÌ¿‰· ÙˆÓ ˘ÁÈÒÓ Ì·ÚÙ‡ÚˆÓ ·ÔÙÂÏÔ‡ÓÙ·Ó ·fi
12 ¿Ó‰Ú˜ Î·È 8 Á˘Ó·›Î˜ (̤ÛË ËÏÈΛ· 33,35 ¤ÙË).
ŸÏÔÈ ÔÈ ·ÛıÂÓ›˜ ÂÌÊ¿ÓÈ˙·Ó ·‡ÍËÛË ÙˆÓ ÙÚ·ÓÛ·-
ÌÈÓ·ÛÒÓ >Ã1,5 ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÙÈÌÒÓ Î·È Â›¯·Ó ÈÛÙÔÏÔÁÈ-
ο ‰È·ÈÛو̤ÓË ¯ÚfiÓÈ· Ë·Ù›Ùȉ·. OÈ ·ÛıÂÓ›˜ ÂÈϤ¯ıË-
Î·Ó ¤ÙÛÈ ÒÛÙÂ Ô ‚·ıÌfi˜ ÂÓÂÚÁfiÙËÙ·˜ Ù˘ ÓfiÛÔ˘ Î·È ÙÔ ÛÙ¿-
‰ÈÔ Ù˘ ›ÓˆÛ˘ Ó· Â›Ó·È ·ÚfiÌÔÈ· Û fiÏÔ˘˜ (Ishak score,
∏∞π 8-9, ›ÓˆÛË 2-3)30.
OÈ ·ÛıÂÓ›˜ Ì ¯ÚfiÓÈ· Ë·Ù›Ùȉ· µ ‹Ù·Ó HBsAg(+),
HBeAg(–)/anti-HBe(+), HBVDNA (+) Î·È anti-HCV/
HIV(–).
OÈ ·ÛıÂÓ›˜ Ì ¯ÚfiÓÈ· Ë·Ù›Ùȉ· C ‹Ù·Ó anti-HCV(+),
HCVRNA(+) Î·È HBV/HIV(–).
OÈ ˘ÁÈ›˜ Ì¿ÚÙ˘Ú˜ ‹Ù·Ó HBsAg(–), anti-HCV(–).
∫·Ó¤Ó·˜ ·fi ÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ Û˘ÌÂÚÈÏ‹ÊıËÛ·Ó ÛÙË
ÌÂϤÙË ‰ÂÓ Â›¯Â Ï¿‚ÂÈ ÚÔËÁÔ˘Ì¤Óˆ˜ ηÓÂÓfi˜ ›‰Ô˘˜ ıÂÚ·-
¢ÙÈ΋ ·ÁˆÁ‹ ÁÈ· ÙË ¯ÚfiÓÈ· Ë·Ù›Ùȉ·.
™ÙÔ Û‡ÓÔÏÔ ÙˆÓ ·ÛıÂÓÒÓ Î·È ÙˆÓ Ì·ÚÙ‡ÚˆÓ ÌÂÙÚ‹ıË-
Î·Ó ÛÙÔÓ ÔÚfi Ù· Â›‰· ÙˆÓ ∆∏1 ΢ÙÙ·ÚÔÎÈÓÒÓ IFN-Á ηÈ
IL-2 Î·È ÙˆÓ ∆∏2 ΢ÙÙ·ÚÔÎÈÓÒÓ IL-4 Î·È IL-10.
OÈ ÌÂÙÚ‹ÛÂȘ ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ ÛÙÔÓ ÔÚfi ¤ÁÈÓ·Ó Ì ÙËÓ
ÂÌÔÚÈο ‰È·ı¤ÛÈÌË ·ÓÔÛÔÂÓ˙˘ÌÈ΋ ̤ıÔ‰Ô Human πn-
terleukin ELISA Ù˘ ÂÙ·ÈÚ›·˜ ENDOGEN, Û‡Ìʈӷ Ì ÙȘ
Ô‰ËÁ›Â˜ ÙÔ˘ ηٷÛ΢·ÛÙ‹.
™Â Û˘ÓÔÏÈο 21 ·ÛıÂÓ›˜, 6 Ì ¯ÚfiÓÈ· Ë·Ù›Ùȉ· µ ηÈ
15 Ì ¯ÚfiÓÈ· Ë·Ù›Ùȉ· C Î·È Û 2 ˘ÁÈ›˜ Ì¿ÚÙ˘Ú˜ ¤ÁÈÓ ÔÈ-
ÔÙÈ΋ ·Ó›¯Ó¢ÛË ÙÔ˘ mRNA ÙˆÓ ∆∏1 ΢ÙÙ·ÚÔÎÈÓÒÓ IFN-Á
273
Î·È IL-2 Î·È ÙˆÓ ∆∏2 ΢ÙÙ·ÚÔÎÈÓÒÓ IL-4 Î·È IL-10 ÛÙÔÓ
Ë·ÙÈÎfi ÈÛÙfi.
∏ Ï‹„Ë ÙÔ˘ ÙÂÌ·¯›Ô˘ ÙÔ˘ Ë·ÙÈÎÔ‡ ÈÛÙÔ‡ ·fi ÙÔ˘˜
·ÛıÂÓ›˜ ¤ÁÈÓ ÌÂÙ¿ ·fi ‚ÈÔ„›· ‹·ÙÔ˜ Ì ÛÂÙ ‚ÈÔ„›·˜ ηٿ
Menghini (Hepafix, B. Braun Melsungen, Germany). ∏ Ï‹„Ë
ÙÔ˘ ÙÂÌ·¯›Ô˘ ÙÔ˘ Ë·ÙÈÎÔ‡ ÈÛÙÔ‡ ·fi ÙÔ˘˜ Ì¿ÚÙ˘Ú˜ ¤ÁÈÓÂ
‰ÈÂÁ¯ÂÈÚËÙÈο, ηٿ ÙË ‰È¿ÚÎÂÈ· ÌÂÚÈ΋˜ Ë·ÙÂÎÙÔÌ‹˜ ÏfiÁˆ
ÙÚ·˘Ì·ÙÈ΋˜ ڋ͢ ‹·ÙÔ˜. ∆Ô Ì‹ÎÔ˜ ÙÔ˘ ÈÛÙÔÙÂÌ·¯›Ô˘ ‹Ù·Ó
Û fiϘ ÙȘ ÂÚÈÙÒÛÂȘ ÙÔ ›‰ÈÔ: ÂÚ›Ô˘ 25 mm. ∆· ÈÛÙÔÙÂ-
Ì¿¯È· ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË Ï‹„Ë ÙÔ˘˜ „‡¯ıËÎ·Ó Û ˘ÁÚfi ¿˙ˆÙÔ
Î·È ‰È·ÙËÚ‹ıËÎ·Ó ÛÙÔ˘˜ –70Ô C.
°È· ÙËÓ ·Ó›¯Ó¢ÛË ÙÔ˘ mRNA ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ ÛÙÔÓ
Ë·ÙÈÎfi ÈÛÙfi ¯ÚËÛÈÌÔÔÈ‹ıËΠ̤ıÔ‰Ô˜, Ë ÔÔ›· ÂÚÈÁÚ¿-
ÊÙËΠ·fi ÙÔ˘˜ Dumoulin et.al. (1997), Ì ÌÈÎÚ¤˜ ·Ú·ÏÏ·-
Á¤˜25.
∏ ̤ıÔ‰Ô˜ ¤¯ÂÈ ˆ˜ ‚¿ÛË ÙËÓ ·Ó¿ÛÙÚÔÊË ·Ï˘ÛȉˆÙ‹
·ÓÙ›‰Ú·ÛË ÔÏ˘ÌÂÚ¿Û˘ (RT-PCR) Î·È ·ÔÙÂÏÂ›Ù·È ·fi
Ù¤ÛÛÂÚ· ÛÙ¿‰È·:
1. ∂ί‡ÏÈÛË (extraction) ÙÔ˘ mRNA ·fi ÙÔÓ Ë·ÙÈÎfi
ÈÛÙfi, ÌÂ ÙË ¯Ú‹ÛË Trizol (GIBCO)
2. ∞Ó¿ÛÙÚÔÊË ÌÂÙ·ÁÚ·Ê‹ ÛÂ Û˘ÌÏËڈ̷ÙÈÎfi DNA
(complementary DNA, cDNA), Ì ÙË ¯Ú‹ÛË Ù˘¯·›ˆÓ ÂÎÎÈÓË-
ÙÒÓ (ramdom primers) Î·È ÙÔ˘ ÂÓ˙‡ÌÔ˘ ·Ó¿ÛÙÚÔÊË ÌÂÙ·-
ÁÚ·Ê¿ÛË (reverse transcriptase ) (Superscript II RT,
GIBCO)
3. PCR Ì ÙË ¯Ú‹ÛË ÂȉÈÎÒÓ ÁÈ· ÙËÓ Î¿ı ΢ÙÙ·ÚÔΛÓË
ÂÎÎÈÓËÙÒÓ (specific primers). ¶ÈÔ ·Ó·Ï˘ÙÈο Ù· ÛˆÏËÓ¿ÚÈ·
ÙÔÔıÂÙÔ‡ÓÙ·È Û ıÂÚÌÔ΢ÎÏÔÔÈËÙ‹ (thermal cycler) ÛÂ
ÚfiÁÚ·ÌÌ· 35 ·ÎψÓ: ·ԉȿٷÍË (denaturation) ÛÙÔ˘˜
95Ô C Â› 5 min, ˘‚ÚȉÈÛÌfi˜ ÙˆÓ ÂÎÎÈÓËÙÒÓ Ì ÙȘ Û˘ÌÏËÚˆ-
Ì·ÙÈΤ˜ ÙÔ˘˜ ·ÏÏËÏÔ˘¯›Â˜ (annealing) ÛÙÔ˘˜ 60Ô C Â› 2 min,
Â¤ÎÙ·ÛË ÙˆÓ Û˘ÌÏËڈ̷ÙÈÎÒÓ ·Ï˘Û›‰ˆÓ (extension)
ÛÙÔ˘˜ 72Ô C Â› 2 min.
4. ∏ÏÂÎÙÚÔÊfiÚËÛË Û gel ·Á·Úfi˙˘. ∏ ʈÙÔÁÚ¿ÊËÛË
Î·È ·Ó¿ÁÓˆÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ Á›ÓÂÙ·È ÛÂ Û˘Û΢‹ ÂÎ-
ÔÌ‹˜ ˘ÂÚÈÒ‰Ô˘˜ ʈÙÂÈÓ‹˜ ·ÎÙÈÓÔ‚ÔÏ›·˜ UV (Vilber Lur-
mat)
OÈ Ì¤ıÔ‰ÔÈ Ù˘ ÌÂϤÙ˘ Â›Ó·È ÛÂ Û˘Ìʈӛ· Ì ÙȘ ·Ú¯¤˜
‰È·Î‹Ú˘Í˘ ÙÔ˘ ∂ÏÛ›ÓÎÈ (1975).
™Ù·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË: ∏ ÛÙ·ÙÈÛÙÈ΋ ÂÂÍÂÚÁ·Û›· ÙˆÓ
·ÔÙÂÏÂÛÌ¿ÙˆÓ ¤ÁÈÓ Ì ÙË ‚Ô‹ıÂÈ· ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ SPSS
ÁÈ· Ù· Windows. ÃÚËÛÈÌÔÔÈ‹ıËηÓ, ·Ó¿ÏÔÁ· Ì ÙËÓ ÂÚ›-
ÙˆÛË, ÙÔ Mann-Whitney non-parametric rank-sum test ηÈ
ÙÔ Wilcoxon test.
∞¶O∆∂§∂™ª∞∆∞
∞. √Úfi˜
IL-4
∆· Â›‰· Ù˘ IL-4 ÙfiÛÔ ÛÙÔ˘˜ ·ÛıÂÓ›˜ ÌÂ
¯ÚfiÓÈ· Ë·Ù›Ùȉ· µ, fiÛÔ Î·È ÛÙÔ˘˜ ·ÛıÂÓ›˜ ÌÂ
¯ÚfiÓÈ· Ë·Ù›Ùȉ· C ‹Ù·Ó ÛËÌ·ÓÙÈο ·˘ÍË̤ӷ ÛÂ
Û‡ÁÎÚÈÛË Ì ·˘Ù¿ ÙˆÓ ˘ÁÈÒÓ Ì·ÚÙ‡ÚˆÓ (p<0,0001
Î·È p<0,002 ·ÓÙ›ÛÙÔȯ·). ∞ÓÙ›ıÂÙ· ‰Â ‰È·ÈÛÙÒıË-
ΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙȘ ÙÈ̤˜ ÙˆÓ
ÂÈ¤‰ˆÓ Ù˘ IL-4 ÙÔ˘ ÔÚÔ‡ ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿-
‰ˆÓ ÙˆÓ ·ÛıÂÓÒÓ (p=0,3995) (∂ÈÎ. 1).
∏ ÌÈÎÚfiÙÂÚË (minimum) Î·È Ë ÌÂÁ·Ï‡ÙÂÚË ÙÈ-
274 E. §∞§§∞ ∫∞π ™À¡.

p = 0,3995 p = 0,6468

p = 0,002 p = 0,0001
3,0 3,0
p = 0,0001 p = 0,0001
2,5 18 2,5
14

2,0
* 28 2,5 18

15

1,5
* 23 2,0
Pg/ml

11

Pg/ml
1,5
1,0
1,0
0,5
0,5

0,0 0,0
27

-,5 -,5
N= 20 32 19 N= 20 32 19

Ì¿ÚÙ˘ÚẪ ·ÛıÂÓ›̃ Ì XHB ·ÛıÂÓ›̃ Ì XHC Ì¿ÚÙ˘ÚẪ ·ÛıÂÓ›̃ Ì XHB ·ÛıÂÓ›̃ Ì XHC

∂ÈÎ. 1*. ª¤ÙÚËÛË Ù˘ IL-4 ÛÙÔÓ ÔÚfi ÙˆÓ Ì·ÚÙ‡ÚˆÓ, ÙˆÓ
·ÛıÂÓÒÓ Ì ¯ÚfiÓÈ· Ë·Ù›Ùȉ· µ (Ã∏µ) Î·È ÙˆÓ ·ÛıÂÓÒÓ
Ì ¯ÚfiÓÈ· Ë·Ù›Ùȉ· C (Ã∏C). OÈ ÙÈ̤˜ ÙˆÓ ·ÛıÂÓÒÓ Î·È
ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ÂÌÊ·Ó›˙Ô˘Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ·‡-
ÍËÛË Û ۯ¤ÛË Ì ·˘Ù¤˜ ÙˆÓ ˘ÁÈÒÓ Ì·ÚÙ‡ÚˆÓ, fiˆ˜ Ê·›-
ÓÂÙ·È ·fi ÙȘ ÙÈ̤˜ ÙˆÓ p. ∏ ‰È·ÊÔÚ¿ ÙˆÓ ÙÈÌÒÓ Ù˘ IL-
4 ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ÙˆÓ ·ÛıÂÓÒÓ ‰ÂÓ Â›Ó·È ÛÙ·ÙÈ-
ÛÙÈο ÛËÌ·ÓÙÈ΋.
* ∆Ô ÁÎÚ›˙Ô ÙÂÙÚ¿Ï¢ÚÔ ·ÓÙÈÚÔÛˆ‡ÂÈ ÙË ‰È·ÛÔ-
Ú¿ ÙˆÓ ÙÈÌÒÓ ·Ó¿ÌÂÛ· ÛÙËÓ 25Ë Î·È ÙËÓ 75Ë ÂηÙÔÛÙÈ·›· ı¤-
ÛË, Ë ¤ÎÙ·Û‹ ÙÔ˘ ‰ËÏ·‰‹ ·ÓÙÈÚÔÛˆ‡ÂÈ ÙÔ Ì¤ÛÔ 50% ÙˆÓ
ÙÈÌÒÓ (interquartile range –IQR). ∏ ¤ÓÙÔÓË ÔÚÈ˙fiÓÙÈ· ÁÚ·Ì-
Ì‹ ·ÓÙÈÚÔÛˆ‡ÂÈ ÙÔ Ì¤ÛÔ fiÚÔ ÙˆÓ ÙÈÌÒÓ, ÂÓÒ ÂÎÙfi˜ ÙÔ˘
ÙÂÙÚ·χÚÔ˘ ·ÂÈÎÔÓ›˙ÔÓÙ·È ÔÈ ·ÔÎÏ›ÓÔ˘Û˜ ÙÈ̤˜
(outside values).
∂ÈÎ. 2.* ª¤ÙÚËÛË Ù˘ IL-10 ÛÙÔÓ ÔÚfi ÙˆÓ Ì·ÚÙ‡ÚˆÓ, ÙˆÓ
·ÛıÂÓÒÓ Ì ¯ÚfiÓÈ· Ë·Ù›Ùȉ· µ (XHB) Î·È ÙˆÓ ·ÛıÂÓÒÓ
Ì ¯ÚfiÓÈ· Ë·Ù›Ùȉ· C (XHC). OÈ ÙÈ̤˜ ÙˆÓ ·ÛıÂÓÒÓ Î·È
ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ÂÌÊ·Ó›˙Ô˘Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ·‡-
ÍËÛË Û ۯ¤ÛË Ì ·˘Ù¤˜ ÙˆÓ ˘ÁÈÒÓ Ì·ÚÙ‡ÚˆÓ, fiˆ˜ Ê·›-
ÓÂÙ·È ·fi ÙȘ ÙÈ̤˜ ÙˆÓ p. ∏ ‰È·ÊÔÚ¿ ÙˆÓ ÙÈÌÒÓ Ù˘ IL-
10 ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ÙˆÓ ·ÛıÂÓÒÓ ‰ÂÓ Â›Ó·È ÛÙ·-
ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋.
* ∆Ô ÁÎÚ›˙Ô ÙÂÙÚ¿Ï¢ÚÔ ·ÓÙÈÚÔÛˆ‡ÂÈ ÙË ‰È·ÛÔ-
Ú¿ ÙˆÓ ÙÈÌÒÓ ·Ó¿ÌÂÛ· ÛÙËÓ 25Ë Î·È ÙËÓ 75Ë ÂηÙÔÛÙÈ·›· ı¤-
ÛË, Ë ¤ÎÙ·Û‹ ÙÔ˘ ‰ËÏ·‰‹ ·ÓÙÈÚÔÛˆ‡ÂÈ ÙÔ Ì¤ÛÔ 50% ÙˆÓ
ÙÈÌÒÓ (interquartile range –IQR). ∏ ¤ÓÙÔÓË ÔÚÈ˙fiÓÙÈ· ÁÚ·Ì-
Ì‹ ·ÓÙÈÚÔÛˆ‡ÂÈ ÙÔ Ì¤ÛÔ fiÚÔ ÙˆÓ ÙÈÌÒÓ, ÂÓÒ ÂÎÙfi˜ ÙÔ˘
ÙÂÙÚ·χÚÔ˘ ·ÂÈÎÔÓ›˙ÔÓÙ·È ÔÈ ·ÔÎÏ›ÓÔ˘Û˜ ÙÈ̤˜
(outside values).

Ì‹ (maximum) Ù˘ IL-4 Û pg/ml, Ô Ì¤ÛÔ˜ fiÚÔ˜ ÙˆÓ ·ÛıÂÓÒÓ (p=0,6468) (∂ÈÎ. 2).
(mean) Î·È Ë ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË (std deviation) ∏ ÌÈÎÚfiÙÂÚË (minimum) Î·È Ë ÌÂÁ·Ï‡ÙÂÚË ÙÈ-
ÙˆÓ ÙÈÌÒÓ ÛÙÔ˘˜ Ì¿ÚÙ˘Ú˜ Î·È ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ̋ (maximum) Ù˘ IL-10 Û pg/ml, Ô Ì¤ÛÔ˜ fiÚÔ˜
¯ÚfiÓÈ· Ë·Ù›Ùȉ· µ Î·È C (Ã∏µ Î·È Ã∏C ·ÓÙ›- (mean) Î·È Ë ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË (std deviation)
ÛÙÔȯ·) ¤¯Ô˘Ó ˆ˜ ÂÍ‹˜: ÙˆÓ ÙÈÌÒÓ ÛÙÔ˘˜ Ì¿ÚÙ˘Ú˜ Î·È ÛÙÔ˘˜ ·ÛıÂÓ›˜ ÌÂ
¯ÚfiÓÈ· Ë·Ù›Ùȉ· µ Î·È C (Ã∏µ Î·È Ã∏C ·ÓÙ›-
n minimum maximum mean Std ÛÙÔȯ·) ¤¯Ô˘Ó ˆ˜ ÂÍ‹˜:
deviation
IL-4 Ì¿ÚÙ˘Ú˜ 20 0 0 0 0 n minimum maximum mean Std
IL-4 Ã∏µ 32 0 2,27 0,327 0,560 deviation
IL-4 Ã∏C 19 0 2,52 0,538 0,665 IL-10 Ì¿ÚÙ˘Ú˜ 20 0,640 1,870 1,139 0,282
IL-10 Ã∏µ 32 0,390 3,030 1,704 0,574
IL-10 IL-10 ̸C 19 1,050 3,330 1,816 0,619
∆· Â›‰· Ù˘ IL-10 ÙfiÛÔ ÛÙÔ˘˜ ·ÛıÂÓ›˜ ÌÂ
¯ÚfiÓÈ· Ë·Ù›Ùȉ· µ fiÛÔ Î·È ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì IL-2, IFN-Á
¯ÚfiÓÈ· Ë·Ù›Ùȉ· C ‹Ù·Ó Â›Û˘ ÛËÌ·ÓÙÈο ·˘ÍË- ¢ÂÓ ·Ú·ÙËÚ‹ıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ·‡-
̤ӷ Û ۇÁÎÚÈÛË Ì ·˘Ù¿ ÙˆÓ ˘ÁÈÒÓ Ì·ÚÙ‡ÚˆÓ ÍËÛË ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ IL-2 Î·È Ù˘ IFN-Á ÛÙÔ˘˜
(p<0,0001 Î·È ÛÙȘ ‰˘Ô ÂÚÈÙÒÛÂȘ). ∞ÓÙ›ıÂÙ· ‰Â ·ÛıÂÓ›˜ Ì ¯ÚfiÓÈ· Ë·Ù›Ùȉ· µ Î·È C Û ۯ¤ÛË ÌÂ
‰È·ÈÛÙÒıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙȘ ÙÔ˘˜ ˘ÁÈ›˜ Ì¿ÚÙ˘Ú˜ (∂ÈÎ. 3, 4).
ÙÈ̤˜ Ù˘ IL-10 ÙÔ˘ ÔÚÔ‡ ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ∏ ÌÈÎÚfiÙÂÚË (minimum) Î·È Ë ÌÂÁ·Ï‡ÙÂÚË ÙÈ-
 ∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 70, 4 275

p = 0,5524 20
p = 0,3834
* 226
70
*
60
* 31 10 *3 * 14
50 * 6

* 19
* 29

Pg/ml
40
* 23
Pg/ml

30 0

20

* 53
10
* 84
***715
29
*115 -10
0 **7 N= 20 32 19

Ì¿ÚÙ˘ÚẪ ·ÛıÂÓ›̃ Ì XHB ·ÛıÂÓ›̃ Ì XHC

-10
N= 20 32 19
∂ÈÎ. 4.* ª¤ÙÚËÛË Ù˘ IFN-Á ÛÙÔÓ ÔÚfi ÙˆÓ Ì·ÚÙ‡ÚˆÓ, ÙˆÓ
Ì¿ÚÙ˘ÚẪ ·ÛıÂÓ›̃ Ì XHB ·ÛıÂÓ›̃ Ì XHC ·ÛıÂÓÒÓ Ì ¯ÚfiÓÈ· Ë·Ù›Ùȉ· µ (Ã∏µ) Î·È ÙˆÓ ·ÛıÂÓÒÓ
Ì ¯ÚfiÓÈ· Ë·Ù›Ùȉ· C (Ã∏C). ∏ ‰È·ÊÔÚ¿ ÙˆÓ ÙÈÌÒÓ Ù˘
∂ÈÎ. 3.* ª¤ÙÚËÛË Ù˘ IL-2 ÛÙÔÓ ÔÚfi ÙˆÓ Ì·ÚÙ‡ÚˆÓ, ÙˆÓ
IFN-Á ÌÂٷ͇ ÙˆÓ Ì·ÚÙ‡ÚˆÓ Î·È ÙˆÓ ·ÛıÂÓÒÓ ‰ÂÓ Â›Ó·È
·ÛıÂÓÒÓ Ì ¯ÚfiÓÈ· Ë·Ù›Ùȉ· µ (Ã∏µ) Î·È ÙˆÓ ·ÛıÂÓÒÓ
ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋, fiˆ˜ Ê·›ÓÂÙ·È ·fi ÙȘ ÙÈ̤˜ ÙˆÓ p.
Ì ¯ÚfiÓÈ· Ë·Ù›Ùȉ· C (Ã∏C). ∏ ‰È·ÊÔÚ¿ ÙˆÓ ÙÈÌÒÓ Ù˘
* ∏ ¤ÓÙÔÓË ÔÚÈ˙fiÓÙÈ· ÁÚ·ÌÌ‹ ·ÓÙÈÚÔÛˆ‡ÂÈ ÙÔ Ì¤-
IL-2 ÌÂٷ͇ ÙˆÓ Ì·ÚÙ‡ÚˆÓ Î·È ÙˆÓ ·ÛıÂÓÒÓ ‰ÂÓ Â›Ó·È
ÛÔ fiÚÔ ÙˆÓ ÙÈÌÒÓ, ÂÓÒ ¿Óˆ ·fi ·˘Ù‹Ó ·ÂÈÎÔÓ›˙ÔÓÙ·È ÔÈ
ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋, fiˆ˜ Ê·›ÓÂÙ·È ·fi ÙȘ ÙÈ̤˜ ÙˆÓ p.
·ÔÎÏ›ÓÔ˘Û˜ ÙÈ̤˜ (outside values).
* ∆Ô ÁÎÚ›˙Ô ÙÂÙÚ¿Ï¢ÚÔ ·ÓÙÈÚÔÛˆ‡ÂÈ ÙË ‰È·ÛÔ-
Ú¿ ÙˆÓ ÙÈÌÒÓ ·Ó¿ÌÂÛ· ÛÙËÓ 25Ë Î·È ÙËÓ 75Ë ÂηÙÔÛÙÈ·›· ı¤-
ÛË, Ë ¤ÎÙ·Û‹ ÙÔ˘ ‰ËÏ·‰‹ ·ÓÙÈÚÔÛˆ‡ÂÈ ÙÔ Ì¤ÛÔ 50% ÙˆÓ IL-4, IL-10).
ÙÈÌÒÓ (interquartile range –IQR). ∏ ¤ÓÙÔÓË ÔÚÈ˙fiÓÙÈ· ÁÚ·Ì- ∂Ó‰ÔË·ÙÈ΋ ¤ÎÊÚ·ÛË ÙÔ˘ mRNA Ù˘ ∆∏1
Ì‹ ·ÓÙÈÚÔÛˆ‡ÂÈ ÙÔ Ì¤ÛÔ fiÚÔ ÙˆÓ ÙÈÌÒÓ, ÂÓÒ ÂÎÙfi˜ ÙÔ˘ ΢ÙÙ·ÚÔΛÓ˘ IL-2 ·ÓȯÓ‡ıËΠ۠6 Û˘ÓÔÏÈο
ÙÂÙÚ·χÚÔ˘ ·ÂÈÎÔÓ›˙ÔÓÙ·È ÔÈ ·ÔÎÏ›ÓÔ˘Û˜ ÙÈ̤˜ ·ÛıÂÓ›˜ (1 Ì ¯ÚfiÓÈ· Ë·Ù›Ùȉ· µ Î·È 5 Ì ¯ÚfiÓÈ·
(outside values). Ë·Ù›Ùȉ· C).
∂Ó‰ÔË·ÙÈ΋ ¤ÎÊÚ·ÛË ÙÔ˘ mRNA Ù˘ ∆∏1
Ì‹ (maximum) Ù˘ IL-2 Î·È Ù˘ IFN-Á Û pg/ml, Ô Î˘ÙÙ·ÚÔΛÓ˘ IFN-Á ·ÓȯÓ‡ıËΠ۠2 Û˘ÓÔÏÈο
̤ÛÔ˜ fiÚÔ˜ (mean) Î·È Ë ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË (std ·ÛıÂÓ›˜ (1 Ì ¯ÚfiÓÈ· Ë·Ù›Ùȉ· µ Î·È 1 Ì ¯ÚfiÓÈ·
deviation) ÙˆÓ ÙÈÌÒÓ ÛÙÔ˘˜ Ì¿ÚÙ˘Ú˜ Î·È ÛÙÔ˘˜ Ë·Ù›Ùȉ· C).
·ÛıÂÓ›˜ Ì ¯ÚfiÓÈ· Ë·Ù›Ùȉ· µ Î·È C (Ã∏µ Î·È ™Â ηӤӷ ·fi Ù· ‰Â›ÁÌ·Ù· ÙÔ˘ Ë·ÙÈÎÔ‡
Ã∏C ·ÓÙ›ÛÙÔȯ·) ¤¯Ô˘Ó ˆ˜ ÂÍ‹˜: ÈÛÙÔ‡ ÙˆÓ 21 Û˘ÓÔÏÈο ·ÛıÂÓÒÓ ‰ÂÓ ·ÓȯÓ‡ıËÎÂ
mRNA ÙˆÓ ∆∏2 ΢ÙÙ·ÚÔÎÈÓÒÓ IL-4 Î·È IL-10.
n minimum maximum mean Std
deviation
™À∑∏∆∏™∏
IL-2 Ì¿ÚÙ˘Ú˜ 20 0 15,070 1,940 3,965
IL-2 Ã∏µ 32 0 57,820 3,440 12,655 ¶·Ú¿ ÙȘ ÙÂÚ¿ÛÙȘ ÚÔfi‰Ô˘˜ Ô˘ ¤¯Ô˘Ó Û˘ÓÙÂÏÂ-
IL-2 Ã∏C 19 0 6,020 0,791 1,948 ÛÙ› Û fiÙÈ ·ÊÔÚ¿ ÙȘ ÁÓÒÛÂȘ Ì·˜ ÁÈ· ÙËÓ ÂȉË-
ÌÈÔÏÔÁ›· Î·È ÙË ÌÔÚȷ΋ ‚ÈÔÏÔÁ›· ÙˆÓ ÈÒÓ µ Î·È C
Ù˘ Ë·Ù›Ùȉ·˜, ÔÈ ·ÎÚȂ›˜ ·ıÔÁÂÓÂÙÈÎÔ› Ì˯·ÓÈ-
n minimum maximum mean Std ÛÌÔ› Ù˘ ÌÂÙ¿ÙˆÛ˘ ÙˆÓ ‰‡Ô ÈÔÁÂÓÒÓ Ë·ÙÈÙ›‰ˆÓ
deviation
Û ¯ÚÔÓÈfiÙËÙ·, fiÛÔ Î·È ÔÈ Ì˯·ÓÈÛÌÔ› ÚfiÎÏËÛ˘
IL-Á Ì¿ÚÙ˘Ú˜ 20 0 9,100 0,455 2,034 Ù˘ Ë·ÙÔ΢ÙÙ·ÚÈ΋˜ ‚Ï¿‚˘ ‰ÂÓ ¤¯Ô˘Ó ·ÎfiÌË
IL-Á Ã∏µ 32 0 18,220 1,793 4,788 Ï‹Úˆ˜ ‰È¢ÎÚÈÓÈÛÙ›.
IL-Á Ã∏C 19 0 0 0 0
OÈ ÈÔ› Ù˘ Ë·Ù›Ùȉ·˜ µ Î·È C, ÛÙȘ ÂÚÈÛÛfiÙÂ-
Ú˜ ÂÚÈÙÒÛÂȘ, ‰ÂÓ Â›Ó·È ¿ÌÂÛ· Ë·ÙÔ΢ÙÙ·ÚÔ-
µ. ∏·ÙÈÎfi˜ ÈÛÙfi˜ ÙÔÍÈÎÔ›, ∏ ·ÓÔÛȷ΋ ·¿ÓÙËÛË ÙÔ˘ ÍÂÓÈÛÙ‹ Û Â›-
™Â ηӤӷ ·fi Ù· ‰Â›ÁÌ·Ù· ÙÔ˘ Ë·ÙÈÎÔ‡ ÈÛÙÔ‡ Â‰Ô ¯˘ÌÈ΋˜ Î·È Î˘ÙÙ·ÚÈ΋˜ ·ÓÔÛ›·˜ ÂÌϤÎÂÙ·È
ÙˆÓ 2 ˘ÁÈÒÓ Ì·ÚÙ‡ÚˆÓ ‰ÂÓ ·ÓȯÓ‡ıËΠmRNA ÛÙËÓ ÂÍÔ˘‰ÂÙ¤ÚˆÛË ÙÔ˘ ÈÔ‡ Î·È Û˘Á¯ÚfiÓˆ˜ Ë Î˘Ù-
ÙˆÓ Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ (IL-2, IFN-Á, Ù·ÚÈ΋ ·ÓÔÛ›· Û˘ÌÌÂÙ¤¯ÂÈ ÛÙË ÊÏÂÁÌÔÓÒ‰Ë ·ÓÙ›-
276 E. §∞§§∞ ∫∞π ™À¡.
‰Ú·ÛË Î·È ÛÙËÓ ÚfiÎÏËÛË Ù˘ Ë·ÙÈ΋˜ ‚Ï¿‚˘.
∆· ÙÂÏÂ˘Ù·›· ¤ÙË ˘¿Ú¯ÂÈ ·ÚÎÂÙfi ÂÚ¢ÓËÙÈÎfi
ÂӉȷʤÚÔÓ Û¯ÂÙÈο Ì ÙÔ ÚfiÏÔ Ô˘ ‰È·‰Ú·Ì·Ù›˙ÂÈ
ÙÔ ÚÔÊ›Ï ÙˆÓ ·Ú·ÁfiÌÂÓˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ ÛÙËÓ
·ÓÔÛÔ·ıÔÁ¤ÓÂÈ· ÙˆÓ ÈÔÁÂÓÒÓ Ë·ÙÈÙ›‰ˆÓ B ηÈ
C11-28. ∆· Â˘Ú‹Ì·Ù¿ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ Ô‰Ë-
ÁÔ‡Ó ÛÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ Î·Ù¿ ÙË ‰È·‰ÚÔÌ‹ Ù˘
¯ÚfiÓÈ·˜ ÈÔÁÂÓÔ‡˜ Ë·Ù›Ùȉ·˜ µ Î·È C ÛÙÔ ÂÚÈÊÂ-
ÚÈÎfi ·›Ì· ÂÈÎÚ·Ù› Ë ·Ú·ÁˆÁ‹ ÙˆÓ ∆∏2-Ù‡Ô˘
΢ÙÙ·ÚÔÎÈÓÒÓ, ÂÓÒ ÛÙÔÓ Ë·ÙÈÎfi ÈÛÙfi Ë ·Ú·ÁˆÁ‹
ÙˆÓ ∆∏1-Ù‡Ô˘ ΢ÙÙ·ÚÔÎÈÓÒÓ.
OÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ó·ÊÔÚ¤˜ Û¯ÂÙÈο Ì ÙȘ
΢ÙÙ·ÚÔΛÓ˜ ÛÙË ¯ÚfiÓÈ· Ë·Ù›Ùȉ· µ Â›Ó·È ÂÚÈÔ-
ÚÈṲ̂Ó˜, ª¤ÙÚËÛË ÛÙÔÓ ÔÚfi ·ÛıÂÓÒÓ Ì ¯ÚfiÓÈ·
Ë·Ù›Ùȉ· µ ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ IL-
10, IL-2 Î·È TNF-· ·Ó·Ê¤ÚÂÙ·È ·fi ÙÔ˘˜ Bozkaya
Î·È Û˘Ó.21 Û ÚfiÛÊ·Ù· ‰ËÌÔÛÈÂ˘Ì¤ÓË ÌÂϤÙË. OÈ
Û˘ÁÁÚ·Ê›˜ Û˘ÌÂÚ·›ÓÔ˘Ó fiÙÈ ˘¿Ú¯ÂÈ ·˘ÍË̤ÓË
·Ú·ÁˆÁ‹ Î·È ÙˆÓ ÙÚÈÒÓ ·˘ÙÒÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ ÛÙÔÓ
ÔÚfi ÙˆÓ ·ÛıÂÓÒÓ Î·È Ì¿ÏÈÛÙ· Ù· Â›‰¿ ÙÔ˘˜ ·-
ÚÔ˘ÛÈ¿˙Ô˘Ó ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË Ì ÙËÓ ·ÚÔ˘Û›· ÙÔ˘
HBeAg, ÙÔ HBVDNA Î·È ÙËÓ ÈÛÙÔÏÔÁÈ΋ ‚·Ú‡ÙË-
Ù· Ù˘ ÓfiÛÔ˘. ∏ ̤ıÔ‰Ô˜ Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ
ÛÙË ÌÂϤÙË Â›Ó·È fiÌÔÈ· Ì ·˘Ù‹ Ù˘ ·ÚÔ‡Û·˜ ÌÂ-
ϤÙ˘, ÂÓÙÔ‡ÙÔȘ Ù· Â˘Ú‹Ì·Ù· Û˘Ì‚·‰›˙Ô˘Ó Ì ٷ
‰Èο Ì·˜ ÌfiÓÔ Û fiÙÈ ·ÊÔÚ¿ ÙËÓ ·‡ÍËÛË Ù˘ ·Ú·-
ÁˆÁ‹˜ Ù˘ IL-10 ÛÙÔÓ ÔÚfi. ¶Ú¤ÂÈ ˆÛÙfiÛÔ Ó· ÛË-
ÌÂȈı› fiÙÈ Ë ÌÂϤÙË ·˘Ù‹ ·ÊÔÚÔ‡Û ·ÛıÂÓ›˜ ÌÂ
HµeAg(+) Ë·Ù›Ùȉ· µ, ÂÓÒ ·ÓÙ›ıÂÙ· ÛÙËÓ ·-
ÚÔ‡Û· ÌÂϤÙË fiÏÔÈ ÔÈ ·ÛıÂÓ›˜ ›¯·Ó Ïԛ̈ÍË ÌÂ
ÙÔÓ ÌÂÙ·ÏÏ·Á̤ÓÔ Èfi, ‹Ù·Ó ‰ËÏ·‰‹ HBeAg (–) /
anti HBe (+) Î·È Â›¯·Ó ÂÈÏÂÁ› ÒÛÙ ӷ ¤¯Ô˘Ó Â-
Ú›Ô˘ Ù˘ ›‰È·˜ ‚·Ú‡ÙËÙ·˜ ¯ÚfiÓÈ· ÓfiÛÔ. ∫·Ù¿ Û˘-
Ó¤ÂÈ· Ù· ‰È·ÊÔÚÂÙÈο Â˘Ú‹Ì·Ù· fiÛÔÓ ·ÊÔÚ¿ Ù·
Â›‰· Ù˘ IL-2 Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÔÊ›ÏÔÓÙ·È ÛÂ
·˘ÙÔ‡˜ ·ÎÚÈ‚Ò˜ ÙÔ˘˜ ÏfiÁÔ˘˜ Î·È ÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ
Â›Ó·È Èı·ÓfiÓ Ë ·ÓÔÛȷ΋ ·¿ÓÙËÛË Ô˘ ÂÁ›ÚÂÙ·È
¤Ó·ÓÙÈ ÙÔ˘ ÌÂÙ·ÏÏ·Á̤ÓÔ˘ ÈÔ‡ Ó· ‰È·Ê¤ÚÂÈ ·fi ·˘-
Ù‹Ó ¤Ó·ÓÙÈ ÙÔ˘ ·Ú¯ÈÎÔ‡ HµeAg(+) ÈÔ‡.
ŸÛÔÓ ·ÊÔÚ¿ ÙËÓ ·Ó›¯Ó¢ÛË ÙÔ˘ mRNA ÙˆÓ
΢ÙÙ·ÚÔÎÈÓÒÓ ÛÙÔ ‹·Ú, Ë ‰ÈÂıÓ‹˜ ‚È‚ÏÈÔÁÚ·Ê›·
Â›Ó·È ÂÍ·ÈÚÂÙÈο Ùˆ¯‹ Î·È ·Ó¢ڤıËΠÌfiÓÔ ÌÈ·
·Ó¿ÏÔÁË ÌÂϤÙË. OÈ Fukuda Î·È Û˘Ó.29 ‰È·›ÛÙˆ-
Û·Ó ·‡ÍËÛË ÙÔ˘ mRNA ÙˆÓ Ù‡Ô˘ ∆∏1 ΢ÙÙ·ÚÔ-
ÎÈÓÒÓ IL-2 Î·È IFN – Á ÛÙÔÓ Ë·ÙÈÎfi ÈÛÙfi ηٿ ÙȘ
·ÚÔ͇ÓÛÂȘ Ù˘ ¯ÚfiÓÈ·˜ HBV Ïԛ̈͢ Î·È ÂÏ¿Ù-
ÙˆÛ‹ ÙÔ˘˜, Ì ˘ÂÚ›Û¯˘ÛË Ù˘ IL-4 (∆∏2), ηٿ
ÙËÓ ·Ô‰ÚÔÌ‹ ÙˆÓ ·ÚÔ͇ÓÛÂˆÓ ·˘ÙÒÓ. ∫·Ù¿ Û˘-
Ó¤ÂÈ· Ù· Â˘Ú‹Ì·Ù¿ ÙÔ˘˜ Û˘ÌʈÓÔ‡Ó Ì ٷ ¢ڋ-
Ì·Ù· Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘, Ù˘ ÔÔ›·˜ fiÏÔÈ ÔÈ
·ÛıÂÓ›˜ ›¯·Ó ÂÓÂÚÁfi ÓfiÛÔ.
™Â fiÙÈ ·ÊÔÚ¿ ÙËÓ Ë·Ù›Ùȉ· C, Û¯ÂÙÈο ÌÂÁ·-
χÙÂÚÔ˜ ·ÚÈıÌfi˜ ÌÂÏÂÙÒÓ ¤¯ÂÈ ‰ËÌÔÛÈ¢Ù› Ù· ÙÂ-
ÏÂ˘Ù·›· ¯ÚfiÓÈ· Á‡Úˆ ·fi ÙÔ ÚfiÏÔ ÙˆÓ Î˘ÙÙ·ÚÔÎÈ-
ÓÒÓ. ∆Ô ·˘ÍË̤ÓÔ ·˘Ùfi ÂÚ¢ÓËÙÈÎfi ÂӉȷʤÚÔÓ
›Ûˆ˜ ÂÚÌËÓ‡ÂÙ·È ·fi ÙËÓ È‰È·›ÙÂÚË ÛËÌ·ÓÙÈÎfiÙË-
Ù· Ù˘ HCV Ïԛ̈͢, Ô˘ ·ÔÚÚ¤ÂÈ ·fi ÙÔ ÂÍ·È-
ÚÂÙÈο ÌÂÁ¿ÏÔ ÔÛÔÛÙfi ÌÂÙ¿ÙˆÛ‹˜ Ù˘ Û ¯ÚÔ-
ÓÈfiÙËÙ·, ·fi ÙËÓ ¤ÏÏÂÈ„Ë ÚÔÛٷ٢ÙÈÎÔ‡ ÂÌ‚ÔÏ›-
Ô˘ ηıÒ˜ Î·È ·fi ÙÔÓ Û˘Ó¯Ҙ ·˘Í·ÓfiÌÂÓÔ ÂÈÔ-
Ï·ÛÌfi Ù˘ ÓfiÛÔ˘ ·ÁÎfiÛÌÈ·, Û ·ÓÙ›ıÂÛË Ì fiÙÈ
Û˘Ì‚·›ÓÂÈ Ì ÙËÓ Ë·Ù›Ùȉ· µ.
OÈ Reiser Î·È Û˘Ó.18 ‰È·›ÛÙˆÛ·Ó ˘ÂÚÔ¯‹ Ù˘
∆∏2 ·¿ÓÙËÛ˘ ÛÙË ¯ÚfiÓÈ· Ë·Ù›Ùȉ· C, ηıÒ˜
·Ó›¯ÓÂ˘Û·Ó ÛÙÔÓ ÔÚfi ÙˆÓ ·ÛıÂÓÒÓ ·˘ÍË̤ӷ Â›-
‰· ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ IL-4 Î·È IL-10. øÛÙfiÛÔ
ÛÙËÓ ÂÚ›ÙˆÛË ·˘Ù‹ Ù· Â˘Ú‹Ì·Ù· ‰ÂÓ Û˘Û¯ÂÙ›˙Ô-
ÓÙ·Ó Ì ÎÏÈÓÈο, ÈÔÏÔÁÈο ‹ ÈÛÙÔÏÔÁÈο Â˘Ú‹Ì·Ù·.
OÈ Fan Î·È Û˘Ó.23 Â›Û˘ ‰È·›ÛÙˆÛ·Ó ÛËÌ·-
ÓÙÈ΋ ·‡ÍËÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ∆∏2 ΢ÙÙ·ÚÔÎÈ-
ÓÒÓ IL-4 Î·È IL-10 Î·È Ôχ ÌÈÎÚfiÙÂÚË ·‡ÍËÛË Ù˘
IL-2, fi¯È fï˜ Î·È Ù˘ IFN-Á ÛÙÔÓ ÔÚfi ÙˆÓ ·ÛıÂÓÒÓ.
OÈ Û˘ÁÁÚ·Ê›˜ Û˘ÌÂÚ·›ÓÔ˘Ó fiÙÈ ÌÈ· ¤ÓÙÔÓË ∆∏2-
Ù‡Ô˘ ·¿ÓÙËÛË Â›Ó·È ·ÚÔ‡Û· ηٿ ÙËÓ ¯ÚfiÓÈ·
HCV Ïԛ̈ÍË, Ë ÔÔ›· Èı·ÓfiÓ Â˘ı‡ÓÂÙ·È Î·È ÁÈ·
ÙËÓ ÌÂÙ¿ÙˆÛË Ù˘ Ïԛ̈͢ Û ¯ÚÔÓÈfiÙËÙ·.
™Â Â›Â‰Ô Ë·ÙÈÎÔ‡ ÈÛÙÔ‡, ÔÈ Napoli ηÈ
20
Û˘Ó. ‰È·›ÛÙˆÛ·Ó ÂÓ‰ÔË·ÙÈ΋ ·‡ÍËÛË Ù˘ ¤Î-
ÊÚ·Û˘ ÙÔ˘ mRNA Ù˘ IFN-Á Î·È IL-2, Ë ÔÔ›·
Û¯ÂÙ›˙ÔÓÙ·Ó Ì ÙËÓ ‚·Ú‡ÙËÙ· Ù˘ ›ÓˆÛ˘ Î·È Ù˘
˘Ï·›·˜ ÊÏÂÁÌÔÓ‹˜ ÙÔ˘ ‹·ÙÔ˜ Û ·ÛıÂÓ›˜ ÌÂ
¯ÚfiÓÈ· Ë·Ù›Ùȉ· C.
∫·Ù¿ ·Ó¿ÏÔÁÔ ÙÚfiÔ ÔÈ Dumoulin Î·È Û˘Ó.25
·Ó›¯ÓÂ˘Û·Ó Û Ë·ÙÈÎfi ÈÛÙfi ·ÛıÂÓÒÓ Ì ¯ÚfiÓÈ· Ë-
·Ù›Ùȉ· C ·˘ÍË̤ÓË ¤ÎÊÚ·ÛË ÙÔ˘ mRNA Ù˘ ∆∏1
΢ÙÙ·ÚÔΛÓ˘ IFN-Á, fi¯È fï˜ Î·È ÙˆÓ ∆∏2 ΢ÙÙ·-
ÚÔÎÈÓÒÓ IL-4 Î·È IL-10. ∆· Â˘Ú‹Ì·Ù· ‰ÂÓ ÂÌÊ¿ÓÈ-
˙·Ó Û˘Û¯¤ÙÈÛË Ì ÙÔ ‚ÈÔ¯ËÌÈÎfi Î·È ÈÔÏÔÁÈÎfi ÚÔÊ›Ï
ÙˆÓ ·ÛıÂÓÒÓ, Ô‡ÙÂ Î·È Ì ÙËÓ ÈÛÙÔÏÔÁÈ΋ ‚·Ú‡ÙËÙ·
Ù˘ ÓfiÛÔ˘. OÈ Û˘ÁÁÚ·Ê›˜ Èı·ÓÔÏÔÁÔ‡Ó fiÙÈ ˘¿Ú-
¯ÂÈ ÂÏ·Ùو̤ÓË Â˘·ÈÛıËÛ›· ÙÔ˘ ÈÔ‡ ÛÙË ‰Ú¿ÛË Ù˘
IFN-Á Ì Â·ÎfiÏÔ˘ıÔ ÙË ÌË ÂÎÚ›˙ˆÛ‹ ÙÔ˘.
∆· Â˘Ú‹Ì·Ù· ÙˆÓ ÂÚÈÛÛfiÙÂÚˆÓ ÌÂÏÂÙÒÓ Ù˘
‰ÈÂıÓÔ‡˜ ‚È‚ÏÈÔÁÚ·Ê›·˜ Ê·›ÓÂÙ·È ˆ˜ Â›Ó·È ·Úfi-
ÌÔÈ· Ì ٷ Â˘Ú‹Ì·Ù· Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘, Ù·
ÔÔ›· Û˘ÓÔ„›˙ÔÓÙ·È ˆ˜ ÂÍ‹˜:
·) ∏ ·Ó›¯Ó¢ÛË ÙÔ˘ mRNA ÙˆÓ ∆∏1 ΢ÙÙ·-
ÚÔÎÈÓÒÓ IL-2 Î·È IFN-Á ÛÙÔÓ Ë·ÙÈÎfi ÈÛÙfi ˘Ô‰Ë-
ÏÒÓÂÈ fiÙÈ ÔÈ Î˘ÙÙ·ÚÔΛÓ˜ ·˘Ù¤˜ ·Ú¿ÁÔÓÙ·È ·fi
ÂÓÂÚÁÔÔÈË̤ÓÔ˘˜ ÂÓ‰ÔË·ÙÈÎÔ‡˜ ∆ ÏÂÌÊÔ΢ÙÙ·-
ÚÈÎÔ‡˜ ÎÏÒÓÔ˘˜, Èı·ÓfiÓ Ì ÛÎÔfi ÙËÓ Î·Ù·ÛÙÔÏ‹
ÙÔ˘ ÈÈÎÔ‡ ÔÏÏ·Ï·ÛÈ·ÛÌÔ‡ Î·È ÙËÓ ÂÍ¿ÏÂÈ„Ë Ù˘
 ∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 70, 4
Ïԛ̈͢. øÛÙfiÛÔ Ê·›ÓÂÙ·È fiÙÈ Ë ∆∏1 Ù‡Ô˘ ·¿-
ÓÙËÛË ÛÙÔ ‹·Ú ‰ÂÓ Â›Ó·È ÈηӋ Ó· ÂÎÚÈ˙ÒÛÂÈ ÙÔÓ
Èfi, ÂÓÒ ÂÈϤÔÓ Èı·ÓfiÓ Â˘ı‡ÓÂÙ·È Î·È ÁÈ· ÙËÓ
ÚfiÎÏËÛË Ù˘ Ë·ÙÔ΢ÙÙ·ÚÈ΋˜ ‚Ï¿‚˘.
‚) ∆· ÛËÌ·ÓÙÈο ·˘ÍË̤ӷ Â›‰· ÙˆÓ ∆∏2
΢ÙÙ·ÚÔÎÈÓÒÓ IL-4 Î·È IL-10 ÛÙÔÓ ÔÚfi ÙˆÓ ·ÛıÂ-
ÓÒÓ ˘Ô‰ËÏÒÓÔ˘Ó fiÙÈ ÔÈ Î˘ÙÙ·ÚÔΛÓ˜ ·˘Ù¤˜ ·Ú¿-
ÁÔÓÙ·È ·fi ÂÚÈÊÂÚÈÎÔ‡˜ ∆ ÏÂÌÊÔ΢ÙÙ·ÚÈÎÔ‡˜
ÎÏÒÓÔ˘˜, Èı·ÓfiÓ Ì ÛÎÔfi Ó· ÂÚÈÔÚ›ÛÔ˘Ó ÙËÓ
∆∏1 ·¿ÓÙËÛË ÛÙÔ ‹·Ú ÒÛÙ ӷ ·ÔÊ¢¯ıÔ‡Ó
Û˘ÛÙËÌ·ÙÈΤ˜ ·ÓÙȉڿÛÂȘ. ∂ÈÚfiÛıÂÙ· ·˘Ù‹ Ë
∆∏2 Ù‡Ô˘ ÛÙÚÔÊ‹ Ù˘ ·ÓÔÛȷ΋˜ ·¿ÓÙËÛ˘ ›Ûˆ˜
Û˘Ì‚¿ÏÏÂÈ ÛÙËÓ ·‰˘Ó·Ì›· ÙÔ˘ ÍÂÓÈÛÙ‹ Ó· ÂÍ·Ï›-
„ÂÈ ÙÔÓ Èfi, Ì ·ÔÙ¤ÏÂÛÌ· ÙË ÌÂÙ¿ÙˆÛË Ù˘ ÓfiÛÔ˘
ÛÂ ¯ÚÔÓÈfiÙËÙ·.
Á) ∆Ô ÁÂÁÔÓfi˜ fiÙÈ ‰Â ‰È·ÈÛÙÒıËΠÛËÌ·ÓÙÈ΋
‰È·ÊÔÚ¿ ÛÙ· Â›‰· ÙˆÓ ·Ú·ÁfiÌÂÓˆÓ Î˘ÙÙ·ÚÔ-
ÎÈÓÒÓ ÙÔ˘ ÔÚÔ‡ ÌÂٷ͇ ÙˆÓ ·ÛıÂÓÒÓ Ì ¯ÚfiÓÈ·
Ë·Ù›Ùȉ· µ Î·È ÙˆÓ ·ÛıÂÓÒÓ Ì ¯ÚfiÓÈ· Ë·Ù›Ùȉ·
C Ô‰ËÁ› ÛÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ Èı·ÓfiÓ Ù· ‰‡Ô ÓÔ-
Û‹Ì·Ù· ¤¯Ô˘Ó ÎÔÈÓfi ·ıÔÁÂÓÂÙÈÎfi Ì˯·ÓÈÛÌfi.
∂˘¯·ÚÈÛٛ˜
£· ı¤Ï·Ì ӷ ¢¯·ÚÈÛÙ‹ÛÔ˘Ì ÙË Ê·Ú̷΢ÙÈ΋
ÂÙ·ÈÚ›· BioAnalytica ÁÈ· ÙËÓ Â˘ÁÂÓÈ΋ ÚÔÛÊÔÚ¿
ÙˆÓ ÂȉÈÎÒÓ ÁÈ· ÙËÓ Î¿ı ΢ÙÙ·ÚÔΛÓË ÂÎÎÈÓËÙÒÓ
(specific primers, GENSET, France).
ABSTRACT
Lalla E, Raptopoulou-Gigi, Orfanou E, Sinakos E,
Brettou E. ∆h1 and Th2 cytokine production in
patients with chronic hepatitis B and C. Hell Iatr
2004, 70: 272-278.
The cytokine pattern secreted by T cells is be-
lieved to play an important pathogenetic role in
chronic viral hepatitis. The aim of this study was to
determine serum and intrahepatic Th1 and Th2 cy-
tokine production in patients with chronic hepatitis
B and C. Serum levels of Th1 (IL-2, IFN- Á) and Th2
(IL-4, IL-10) cytokines were measured in patients
with chronic hepatitis B (n=32) and C (n=19), and
controls (n=20). Intrahepatic mRNA expression of
the same cytokines was determined in 6 patients
with chronic hepatitis B, 15 with chronic hepatitis C
and in 2 controls. Serum levels of IL-4 and IL-10 we-
re significantly increased in both chronic hepatitis B
and C patients compared to controls, whereas levels
of IL-2 and IFN- Á ranged within normal limits (me-
an serum levels (pg/ml) of IL-4: controls 0, chronic
277
hepatitis B patients 0.327+0.560, chronic hepatitis
C patients 0.538 +0.665, mean serum levels (pg/
ml) of IL-10: controls 1.139+0.282, chronic hepa-
titis B patients 1.704+0.574, chronic hepatitis C pa-
tients 1.816+0.619, mean serum levels (pg/ml) of
IL-2: controls 1.940+3.965, chronic hepatitis B pa-
tients 0.3440+12.655, chronic hepatitis C patients
0.791+1.948, mean serum levels (pg/ml) of IFN-Á:
controls 0.455+2.034, chronic hepatitis B patients
1.793+4.788, chronic hepatitis C patients 0), Intra-
hepatic mRNA expression of IL-2 and IFN-Á was de-
tected in 6 and 2 patients respectively. mRNA ex-
pression of IL-4 and IL-10 was not detected in any
of the liver samples. This study showed that in chro-
nic hepatitis B and C a Th1 (IL-2, IFN-Á) cytokine
pattern predominates in the liver, while levels of
Th2 (IL-4, IL-10) cytokines are increased in the peri-
phery. This imbalance may contribute to liver dama-
ge and play a role in viral persistence.
µπµ§πO°ƒ∞ºπ∞
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696-9.
∞ÏÏËÏÔÁÚ·Ê›·:
ª. ƒ·ÙÔÔ‡ÏÔ˘-°ÈÁ‹
µ′ ¶·ıÔÏÔÁÈ΋ ∫ÏÈÓÈ΋
¡ÔÛÔÎÔÌÂ›Ô πÔÎÚ¿ÙÂÈÔ
∫ˆÓÛÙ·ÓÙÈÓÔ˘fiψ˜ 49
£ÂÛÛ·ÏÔÓ›ÎË
Corresponding author:
M. Raptopoulou-Gigi
B′ Medical Department
“Hippocration” Hospital
49, Konstantinoupoleos Str.
Thessaloniki
Greece
∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 2004, 70, 4: 279 - 285
OÈ ÌÂÙ·‚ÔϤ˜ ÙÔ˘ ÈÛÔÚÔÛÙ·Ó›Ô˘ 8-iso-PGF2· ÛÙ·
ÌÂÛÔ΢ÙÙ¿ÚÈ· ˘ÁÚ¿ ÙˆÓ Ì˘ÒÓ ·ÈÌÔηı·ÚfiÌÂÓˆÓ ·ÛıÂÓÒÓ
π. ∫·Ú·ÌÔ‡˙˘1, ¢. °Ú¤Î·˜2, ª. ∫·Ú·ÌÔ‡˙˘1, Sv. Valiveva-Staikova3,
D. Kovachev3, ∞. ∆ÚÈ¿ÓÙÔ˜1, ™Ù. ∏ÏÈ¿‰Ë˜1, °. ¶··ÁˆÚÁ›Ô˘1,
¢. ¢ËÌËÙÚÈ¿‰Ô˘1
1 ∂ÚÁ·ÛÙ‹ÚÈÔ µÈÔÏÔÁÈ΋˜ ÃËÌ›·˜, π·ÙÚÈ΋ ™¯ÔÏ‹ ∞¶£ £ÂÛÛ·ÏÔӛ΢
2 ∞′ ¶·ıÔÏÔÁÈ΋ ∫ÏÈÓÈ΋, π·ÙÚÈ΋ ™¯ÔÏ‹ ∞¶£, ¡ÔÛÔÎÔÌÂ›Ô ∞Ã∂¶∞ £ÂÛÛ·ÏÔӛ΢
3 Clinic of Nephrology, Medical University of Varna, Boulgaria
¶ÂÚ›ÏË„Ë. ∆o 8-iso-PGF2· Â›Ó·È ¤Ó· ·fi Ù· Ûo˘-
‰·ÈfiÙÂÚ· F2-ÈÛoÚoÛÙ¿ÓÈ·, Ùo oo›o ·Ú¿ÁÂÙ·È
ÛÙ· ·ÙÙ·Ú· ÙˆÓ ÈÛÙÒÓ Ùo˘ ·ÓıÚÒÈÓo˘ oÚÁ·ÓÈ-
ÛÌo‡ Ì ÙË ÌË ÂÓ˙˘ÌÈ΋ ‰Ú¿ÛË ÙˆÓ ÂÏ¢ı¤ÚˆÓ ÚÈ-
˙ÒÓ ¿Óˆ ÛÙo ·Ú·¯È‰oÓÈÎfi o͇ ÙˆÓ ÊˆÛÊoÏÈÈ-
‰›ˆÓ, ÙˆÓ Î˘ÙÙ·ÚÈÎÒÓ ÌÂÌ‚Ú·ÓÒÓ Î·È ÙˆÓ ÏÈo-
ÚˆÙÂ˚ÓÒÓ Ùo˘ Ï¿ÛÌ·Ùo˜, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙËÓ ÂÓ-
˙˘ÌÈ΋ ‰Ú¿ÛË Ù˘ ΢ÎÏoo͢ÁoÓ¿Û˘ (COX). ∏ ̤-
ÙÚËÛË ÙˆÓ ÂÈ¤‰ˆÓ Ùo˘ 8-iso-PGF2· ÛÙo Ï¿ÛÌ·
ıˆÚÂ›Ù·È o Èo ·ÍÈfiÈÛÙo˜ ‚Èo¯ËÌÈÎfi˜ ‰Â›ÎÙ˘ Ù˘
ÏÈȉÈ΋˜ ˘ÂÚoÍ›‰ˆÛ˘ Î·È Ùo˘ oÍÂȉˆÙÈÎo‡
stress ·ÛıÂÓÒÓ Ì ¤Ó· Ï‹ıo˜ ·ıoÏoÁÈÎÒÓ Î·Ù·-
ÛÙ¿ÛÂˆÓ (ηډȷÁÁÂȷΤ˜ ·ı‹ÛÂȘ, ˘¤ÚÙ·ÛË,
۷ί·Ú҉˘ ‰È·‚‹Ù˘, Ó¢ÌoÓÈΤ˜ ·ı‹ÛÂȘ, ·˘-
Ùo¿ÓoÛ· ÚÂ˘Ì·ÙÈο ÓoÛ‹Ì·Ù·, ÓfiÛo˜ Ùo˘ Alzhei-
mer, ηÎo‹ıË ÓoÛ‹Ì·Ù·, Û·ÚÎo›‰ˆÛË, Ú·‚‰ÔÌ˘fi-
Ï˘ÛË, ÛÏ·¯ÓÈ΋ ·¯˘Û·ÚΛ·, Ë·ÙoÓÂÊÚÈÎfi Û‡Ó-
‰ÚoÌo Î.¿.) ÌÂٷ͇ ÙˆÓ oo›ˆÓ Û˘ÁηٷϤÁÂÙ·È Î·È
Ë ¯ÚfiÓÈ· ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ·. øÛÙfiÛo ‰ÂÓ ˘-
¿Ú¯o˘Ó ·Ó·ÊoÚ¤˜ ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈoÁÚ·Ê›· Û¯ÂÙÈ-
ο Ì ÙȘ ÌÂÙ·‚oϤ˜ Ùo˘ 8-iso-PGF2· ÛÙ· ÌÂÛo΢Ù-
Ù¿ÚÈ· ˘ÁÚ¿ ÙˆÓ Ì˘ÒÓ (Ì.˘.), ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘
·ÈÌoοı·ÚÛ˘. O ÛÎÔfi˜ Ù˘ ÌÂϤÙ˘ ·˘Ù‹˜ ‹Ù·Ó:
·) ¡· Û˘ÏϯıÔ‡Ó Ù· ÌÂÛÔ΢ÙÙ¿ÚÈ· ˘ÁÚ¿ ÙˆÓ Ì˘ÒÓ
·ÈÌÔηı·ÚfiÌÂÓˆÓ ·ÛıÂÓÒÓ Ì ÙË Ì¤ıÔ‰Ô Ù˘ ÌÈ-
ÎÚԉȷ›‰˘Û˘ in vivo. ‚) ¡· ÌÂÙÚËıÔ‡Ó Ù· Â‰·
ÙÔ˘ 8-iso-PGF2· ÛÙ· Ì.˘. ÙˆÓ Ì˘ÒÓ ·ÈÌÔηı·ÚfiÌÂ-
ÓˆÓ ·ÛıÂÓÒÓ Î·È Ó· ÂÎÙÈÌËıÔ‡Ó ÔÈ ÌÂÙ·‚ÔϤ˜ ÙÔ˘˜
ÚÈÓ, ηٿ ÙË ‰È¿ÚÎÂÈ· Î·È ÌÂÙ¿ ÙËÓ ·ÈÌÔοı·ÚÛË.
∆Ô ˘ÏÈÎfi Ì·˜ ÙÔ ·ÔÙ¤ÏÂÛ·Ó ÙÚÂȘ ·ÈÌÔηı·ÚfiÌÂ-
ÓÔÈ ·ÛıÂÓ›˜ ËÏÈΛ·˜ 45-52 ¯ÚfiÓˆÓ, Û ηϋ ÁÂÓÈ΋
279
ηٿÛÙ·ÛË, Ô˘ ˘Ô‚¿ÏÏÔÓÙ·Ó Û ·ÈÌÔοı·ÚÛË
(ÛÙË ¡ÂÊÚÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ - ∆Ì‹Ì· ∞ÈÌÔοı·ÚÛ˘
Ù˘ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ Ù˘ µ¿Ú-
Ó·˜ µÔ˘ÏÁ·Ú›·˜). ™Â οı ¤Ó·Ó ·fi ÙÔ˘˜ ·ÛıÂÓ›˜
ÙÔÔıÂÙ‹ıËÎ·Ó Ì ÙË ‚Ô‹ıÂÈ· ÂȉÈÎÔ‡ ηıÂÙ‹Ú·
‰˘Ô ËÌȉȷÂÚ·Ù¤˜ ÌÂÌ‚Ú¿Ó˜ (Cª∞ Medical, Sto-
ckholm, Sweden) ÛÙÔÓ ¤Íˆ Ï·Ù‡ ÌËÚÈ·›Ô Ì˘. ªÂÙ¿
ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙˆÓ ÌÂÌ‚Ú·ÓÒÓ ¤ÁÈÓ ¤Á¯˘ÛË ÈÛfiÙÔ-
ÓÔ˘ ‰È·Ï‡Ì·ÙÔ˜ Ringer’s acetate Ì ÙË ‚Ô‹ıÂÈ· ÌÈ-
ÎÚÔ·ÓÙÏ›·˜ Î·È Ì ٷ¯‡ÙËÙ· ÚÔ‹˜ 0,30 Ìl/min. To
‰È·›‰˘Ì· Û˘ÏϤ¯ıËÎÂ: ·) Û ‰È¿ÛÙËÌ· 0 min-60
min ÚÈÓ ÙËÓ ·ÈÌÔοı·ÚÛË, ‚) Û ‰È¿ÛÙËÌ· 0 min-
60 min, Á) 60 min-120 min, ‰) 120 min-180 min, Â)
180 min-240 min ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ·ÈÌÔοı·Ú-
Û˘ Î·È ˙) Û ‰È¿ÛÙËÌ· 0 min-60 min ÌÂÙ¿ ÙËÓ ·ÈÌÔ-
οı·ÚÛË. ∞fi ÙȘ ÌÂÙÚ‹ÛÂȘ Ì·˜ ‰È·ÈÛÙÒıËΠfiÙÈ
Ù· Â›‰· ÙÔ˘ 8-iso-PGF2· ÛÙ· Ì.˘. ÙÔ˘ ¤Íˆ Ï·Ù‡
ÌËÚÈ·›Ô˘ Ì˘fi˜ ·˘Í‹ıËÎ·Ó ÛËÌ·ÓÙÈο ÙËÓ ÚÒÙË
ÒÚ· ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ·ÈÌÔοı·ÚÛ˘, ‰È·ÙËÚ‹-
ıËÎ·Ó ·˘ÍË̤ӷ ÛÙË ‰Â‡ÙÂÚË, ÙÚ›ÙË Î·È Ù¤Ù·ÚÙË Ò-
Ú·, ηıÒ˜ Î·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÚÒÙ˘ ÒÚ·˜
ÌÂÙ¿ ÙËÓ ·ÈÌÔοı·ÚÛË. ™˘ÌÂÚ·›ÓÂÙ·È fiÙÈ: ·) ηٿ
ÙË ‰È¿ÚÎÂÈ· Ù˘ ·ÈÌÔοı·ÚÛ˘ ÔÈ ·ÛıÂÓ›˜ ˘Ê›ÛÙ·-
ÓÙ·È ÏÈȉÈ΋ ˘ÂÚÔÍ›‰ˆÛË Î·È ¤ÓÙÔÓÔ ÔÍÂȉˆÙÈÎfi
stress, ÙÔ ÔÔ›Ô ·Ú·Ì¤ÓÂÈ Î·È Ì›· ÒÚ· ÌÂÙ¿ ÙÔ Ù¤-
ÏÔ˜ Ù˘. ‚) ∏ ̤ıÔ‰Ô˜ Ù˘ ÌÈÎÚԉȷ›‰˘Û˘ in vivo
ÌÔÚ› Ó· ÂÊ·ÚÌÔÛÙ› Ì ·ÛÊ¿ÏÂÈ· Î·È ÛÙÔ˘˜ ·È-
ÌÔηı·ÚfiÌÂÓÔ˘˜ ·ÛıÂÓ›˜ ÁÈ· ÙËÓ ¿ÌÂÛË ÂÎÙ›ÌËÛË
Ù˘ ÏÈȉÈ΋˜ ˘ÂÚÔÍ›‰ˆÛ˘ Î·È ÙÔ˘ ÔÍÂȉˆÙÈÎÔ‡
stress ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÙÔ˘ Ì˘˚ÎÔ‡ ÙÔ˘˜ ÈÛÙÔ‡.
EÏÏËÓ I·ÙÚ 2004, 70: 279 - 285.
280 I. KAƒAMOY∑∏™ ∫∞π ™À¡.
∆Ô 8-iso-PGF2· (8-iso-ÚÔÛÙ·ÁÏ·Ó‰›ÓË F2·)
Â›Ó·È ÙÔ ÛÔ˘‰·ÈfiÙÂÚÔ ·fi Ù· F2-ÈÛÔÚÔÛÙ¿ÓÈ·
(64 ÈÛÔÌÂÚ‹), ÙÔ ÔÔ›Ô ·Ó‹ÎÂÈ ÛÙËÓ Ù¿ÍË πππ ·˘-
ÙÒÓ1. ∏ ‚ÈÔÛ‡ÓıÂÛ‹ ÙÔ˘ Á›ÓÂÙ·È Ì ÙË ‰Ú¿ÛË ÙˆÓ
ÂÏ¢ı¤ÚˆÓ ÚÈ˙ÒÓ ¿Óˆ ÛÙÔ ·Ú·¯È‰ÔÓÈÎfi Ô͇ (·.
Ô.), ÙˆÓ ÊˆÛÊÔÏÈȉ›ˆÓ, ÙˆÓ Î˘ÙÙ·ÚÈÎÒÓ ÌÂÌ‚Ú·-
ÓÒÓ, ÙˆÓ ÈÛÙÒÓ Î·È ÔÚÁ¿ÓˆÓ ÙÔ˘ ·ÓıÚÒÈÓÔ˘ ÔÚ-
Á·ÓÈÛÌÔ‡ Î·È ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ ÙÔ˘ Ï¿ÛÌ·ÙÔ˜.
∏ ÌË ÂÓ˙˘ÌÈ΋ ·˘Ù‹ Û‡ÓıÂÛË ÙÔ˘ 8-iso-PGF2· ıˆ-
ÚÂ›Ù·È ·ÓÂÍ¿ÚÙËÙË ÙÔ˘ ηٷ‚ÔÏÈÛÌÔ‡ ÙÔ˘ ·.Ô. ‰È·
̤ÛÔ˘ Ù˘ ‰Ú¿Û˘ Ù˘ ΢ÎÏÔÔ͢ÁÔÓ¿Û˘ (COX-I,
COX-II)2-4. ¶ÚfiÛÊ·Ù˜ fï˜ ¤Ú¢Ó˜ ˘ÔÛÙËÚ›-
˙Ô˘Ó fiÙÈ ÙÔ 8-iso-PGF2· ·Ú¿ÁÂÙ·È Û Ôχ ÌÈÎÚ¤˜
ÔÛfiÙËÙ˜ Î·È Î·Ù¿ ÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ ·ÈÌÔÂ-
Ù·Ï›ˆÓ Ì ÙË ‰Ú¿ÛË Ù˘ COX-I, Ù·˘Ùfi¯ÚÔÓ· Ì ÙË
‚ÈÔÛ‡ÓıÂÛË ÙÔ˘ ıÚÔÌ‚ÔÍ·Ó›Ô˘ (∆Ã∞2), ηıÒ˜
Â›Û˘ Î·È ·fi Ù· ÌÔÓÔ·ÙÙ·Ú· ÙÔ˘ ·ÓıÚÒÈÓÔ˘
ÔÚÁ·ÓÈÛÌÔ‡, ›Ù Ì ÂÓ˙˘ÌÈ΋, ›Ù Ì ÌË ÂÓ˙˘ÌÈ΋
‰Ú¿ÛË5. ¶¤Ú·Ó ·˘ÙÒÓ, Ë ‚ÈÔÛ‡ÓıÂÛË ÙÔ˘ 8-iso-
PGF2· ÂËÚ¿˙ÂÙ·È Î·È ·fi ÔÚÈṲ̂ÓÔ˘˜ ÂÚÈ‚·Ï-
ÏÔÓÙÈÎÔ‡˜ Î·È ‰È·ÈÙËÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ (οÓÈ-
ÛÌ·, ·˘ÍË̤ÓÔ fi˙ÔÓ, ˘ÂÚÈÒ‰Ë ·ÎÙÈÓÔ‚ÔÏ›· (UV),
ÂÏ·ÈfiÏ·‰Ô, ‚ÈÙ·Ì›ÓË C, E, Ì·‡ÚÔ ÙÛ¿È Î.¿.6-13. ∆Ô
‚ÈÔÌfiÚÈÔ ·˘Ùfi ÛÙÔ Ï¿ÛÌ· ÙÔ˘ ·ÓıÚÒÈÓÔ˘ ÔÚÁ·-
ÓÈÛÌÔ‡ ΢ÎÏÔÊÔÚ› Û ‰˘Ô ÌÔÚʤ˜, ÙÔ ÂχıÂÚÔ
Î·È ÙÔ ÂÛÙÂÚÔÔÈË̤ÓÔ ÛÙ· ʈÛÊÔÏÈ›‰È· ÙˆÓ
LDL. ∏ ·Ó·ÏÔÁ›· ÙˆÓ ‰‡Ô ÌÔÚÊÒÓ (ÂχıÂÚÔ /
ÂÛÙÂÚÔÔÈË̤ÓÔ) Â›Ó·È ÂÚ›Ô˘ 1:214-16.
∏ ËÌÈÂÚ›Ô‰Ô˜ ˙ˆ‹˜ ÙÔ˘ 8-iso-PGF2· Â›Ó·È 16
min Î·È Î·Ù¿ ÙÔÓ Î·Ù·‚ÔÏÈÛÌfi ÙÔ˘ Û¯ËÌ·Ù›˙ÔÓÙ·È
ÙÔ˘Ï¿¯ÈÛÙÔÓ ‰‡Ô ·ÚÈ· ·Ú¿ÁˆÁ¿ ÙÔ˘ ÙÔ 2,3 dinor-
8-iso-PGF2· Î·È ÙÔ 2,3 dinor, 5.6-‰È˛‰ÚÔ-8-iso-
PGF2·. ¶¤Ú·Ó ·˘ÙÒÓ ÚfiÛÊ·Ù˜ ¤Ú¢Ó˜ ¤¯Ô˘Ó
‰Â›ÍÂÈ fiÙÈ Ì ÂÈÌÂÚÈÛÌfi ÙÔ˘ 8-iso-PGF2· Û¯ËÌ·Ù›-
˙ÂÙ·È Î·È Ë ÚÔÛÙ·ÁÏ·Ó‰›ÓË ∂2 (PGE2) ·ÓÂÍ¿ÚÙËÙ·
·fi ÙË ‚ÈÔÛ‡ÓıÂÛ‹ Ù˘ Ì ÙË ‰Ú¿ÛË Ù˘ COX17.
∆Ô 8-iso-PGF2· ¤¯ÂÈ ¤ÓÙÔÓ˜ ‚ÈÔÏÔÁÈΤ˜ ‰Ú¿-
ÛÂȘ, ÔÈ ÛÔ˘‰·ÈfiÙÂÚ˜ ·fi ÙȘ Ôԛ˜ Â›Ó·È ÔÈ ÂÍ‹˜:
·) ∞ÛΛ ¤ÓÙÔÓË ·ÁÁÂÈÔÛ˘ÛÙ·ÏÙÈ΋ ‰Ú¿ÛË
(΢ڛˆ˜ ÛÙȘ ÓÂÊÚÈΤ˜ Î·È Ó¢ÌÔÓÈΤ˜ ·ÚÙËڛ˜)
‚) ¶ÚÔηÏ› ÚÔÛÎfiÏÏËÛË Î·È Û˘ÛÛÒÚ¢ÛË
ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ Û˘ÓÂÚÁÈο Ì ÙÔ ıÚÔÌ‚ÔÍ¿ÓÈÔ.
OÈ ‰Ú¿ÛÂȘ ÙÔ˘ 8-iso-PGF2· Ú˘ıÌ›˙ÔÓÙ·È ‰È· ̤ÛÔ˘
ÙˆÓ ˘Ô‰Ô¯¤ˆÓ ÙÔ˘ ıÚÔÌ‚ÔÍ·Ó›Ô˘ / ÂÓ‰Ô¸ÂÚÔÍÂÈ-
‰›Ô˘ ∏2 ÚÔÛÙ·ÁÏ·Ó‰ÈÓÒÓ (∆Ã∞2/PGH2)16,18-21.
∏ ̤ÙÚËÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙÔ˘ 8-iso-PGF2· ÛÙÔ
Ï¿ÛÌ· ıˆÚÂ›Ù·È Ô ϤÔÓ ·ÍÈfiÈÛÙÔ˜ ‚ÈÔ¯ËÌÈÎfi˜
‰Â›ÎÙ˘ Û ·ıÔÏÔÁÈΤ˜ ηٷÛÙ¿ÛÂȘ Ô˘ Û˘ÓÔ-
‰Â‡ÔÓÙ·È ·fi ¤ÓÙÔÓË ÏÈȉÈ΋ ˘ÂÚÔÍ›‰ˆÛË Î·È
·˘ÍË̤ÓÔ ÔÍÂȉˆÙÈÎfi stress, ÂÍ ·ÈÙ›·˜ Ù˘ ·˘ÍË̤-
Ó˘ ·Ú·ÁˆÁ‹˜ ÂÏ¢ı¤ÚˆÓ ÚÈ˙ÒÓ (΢ڛˆ˜ Ô͢Áfi-
ÓÔ˘ Î·È ·˙ÒÙÔ˘)22. OÈ ÛÔ˘‰·ÈfiÙÂÚ˜ ·fi ÙȘ ·-
ıÔÏÔÁÈΤ˜ ηٷÛÙ¿ÛÂȘ Ô˘ Û˘Óԉ‡ÔÓÙ·È ·fi ·˘-
ÍË̤ӷ Â›‰· ÙÔ˘ 8-iso-PGF2· ÛÙ· ‚ÈÔÏÔÁÈο
˘ÁÚ¿ ÙˆÓ ·ÛıÂÓÒÓ Â›Ó·È ÔÈ ÂÍ‹˜:
·) ÔÈ Î·Ú‰ÈÔÏÔÁÈΤ˜ ·ı‹ÛÂȘ (ηډȷ΋ ·ÓÂ-
¿ÚÎÂÈ·, ·ÛÙ·ı‹˜ ÛÙËı¿Á¯Ë Î.¿.)23-25,
‚) Ô Û·Î¯·Ú҉˘ ‰È·‚‹Ù˘ Ù‡Ô˘ 2 Î·È ÏÈÁfi-
ÙÂÚÔ Ô Ù‡Ô˘ 126-27,
Á) ÔÈ Ó¢ÌÔÓÈΤ˜ ·ı‹ÛÂȘ (¿ÛıÌ·, ΢ÛÙÈ΋
›ÓˆÛË, Ó¢ÌÔÓÈ΋ ˘¤ÚÙ·ÛË Î.¿.)28-30,
‰) ‰È¿ÊÔÚ˜ ÊÏÂÁÌÔÓÒ‰ÂȘ ηٷÛÙ¿ÛÂȘ (·˘ÙÔ-
¿ÓÔÛ· ÓÔÛ‹Ì·Ù·, ÚÂ˘Ì·ÙÔÂȉ‹˜ ·ÚıÚ›Ùȉ·, Î.¿.)31-33,
Â) ‰È¿ÊÔÚ· Ó¢ÚÔÂÎÊ˘ÏÈÛÙÈο ÓÔÛ‹Ì·Ù· (Ófi-
ÛÔ˜ ÙÔ˘ Alzheimer, ·ı‹ÛÂȘ ÙÔ˘ ÓˆÙÈ·›Ô˘ ۈϋӷ
Î.¿.)34-35,
ÛÙ) ‰È¿ÊÔÚ· ηÎÔ‹ıË ÓÔÛ‹Ì·Ù·36,
˙) Ë ¯ÚfiÓÈ· ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ·37-40,
™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó:
·) Ó· Û˘ÏϯıÔ‡Ó Ì ·ÛÊ¿ÏÂÈ· Ù· ÌÂÛÔ΢ÙÙ¿-
ÚÈ· ˘ÁÚ¿ ÙˆÓ Ì˘ÒÓ Ì ÙË Ó¤· ̤ıÔ‰Ô Ù˘ ÌÈÎÚÔ-
‰È·›‰˘Û˘ in vivo,
‚) Ó· ÌÂÙÚËıÔ‡Ó Ù· Â›‰· ÙÔ˘ F2-ÈÛÔÚÔ-
ÛÙ·Ó›Ô˘ 8-iso-PGF2· ÛÙ· Ì.˘. ÙˆÓ Ì˘ÒÓ ·ÈÌÔηı·-
ÚfiÌÂÓˆÓ ·ÛıÂÓÒÓ Î·È Ó· ÂÎÙÈÌËıÔ‡Ó ÔÈ ÌÂÙ·‚ÔϤ˜
ÙÔ˘˜ ÚÈÓ, ηٿ ÙË ‰È¿ÚÎÂÈ· Î·È ÌÂÙ¿ ·fi ÙËÓ ·È-
ÌÔοı·ÚÛË.
À§π∫√ ∫∞π ª∂£√¢√π
∆Ô ˘ÏÈÎfi Ì·˜ ÙÔ ·ÔÙ¤ÏÂÛ·Ó ÙÚÂȘ ¯ÚfiÓÈ· ·ÈÌÔηı·ÚfiÌÂÓÔÈ
·ÛıÂÓ›˜ Ù˘ ªÔÓ¿‰·˜ ∆¯ÓËÙÔ‡ ¡ÂÊÚÔ‡ Ù˘ ¡ÂÊÚÔÏÔÁÈ΋˜
∫ÏÈÓÈ΋˜ Ù˘ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ µ¿ÚÓ·˜ Ù˘
µÔ˘ÏÁ·Ú›·˜ (ÛÙ· Ï·›ÛÈ· ÂÈÛÙËÌÔÓÈ΋˜ Ì·˜ Û˘ÓÂÚÁ·Û›·˜).
OÈ ÙÚÂȘ ·ÛıÂÓ›˜ ‹Ù·Ó ËÏÈΛ·˜ 45, 51 Î·È 52 ÂÙÒÓ. ∫ÏÈÓÈο
‹Ù·Ó Û Ôχ ηϋ ηٿÛÙ·ÛË Î·È ‰ÂÓ ¤·ÈÚÓ·Ó Ê¿Ú̷η
Ô˘ ı· ÌÔÚÔ‡Û·Ó Ó· ÂËÚ¿ÛÔ˘Ó ÙȘ ÌÂÙÚ‹ÛÂȘ Ì·˜ (·Ó·-
ÁˆÁÈΤ˜ Ô˘Û›Â˜, ·Ó·ÛÙÔÏ›˜ Ù˘ COX Î.¿.). O Û˘ÓÔÏÈÎfi˜ ¯Úfi-
ÓÔ˜ ·ÈÌÔοı·ÚÛ˘ ‹Ù·Ó 15, 30 Î·È 20 Ì‹Ó˜ ·ÓÙ›ÛÙÔȯ· ÌÂ
Ê›ÏÙÚ· fresenius polysulfione. ™Â οı ¤Ó·Ó ·fi ÙÔ˘˜ ·Ú·-
¿Óˆ ·ÛıÂÓ›˜ ÂÏ‹ÊıËÛ·Ó ÌÂÛÔ΢ÙÙ¿ÚÈ· ˘ÁÚ¿ ÙˆÓ Ì˘ÒÓ ÌÂ
ÙË Ì¤ıÔ‰Ô Ù˘ ÌÈÎÚԉȷ›‰˘Û˘ in vivo. °È· ÙÔ ÛÎÔfi ·˘Ùfi,
ÙÔÔıÂÙ‹ıËÎ·Ó ·fi ‰˘Ô ËÌȉȷÂÚ·Ù¤˜ ÌÂÌ‚Ú¿Ó˜, Ì ÙË
‚Ô‹ıÂÈ· ÂȉÈÎÒÓ Î·ıÂÙ‹ÚˆÓ (CMA 60 microdialysis catheter
CMA Medical Stockholm, Sweden), ÛÙÔÓ ¤Íˆ Ï·Ù‡ ÌËÚÈ·›Ô
Ì˘ ÙÔ˘ ‰ÂÍÈÔ‡ Ô‰ÈÔ‡. ∏ ÂÈÛ·ÁˆÁ‹ ÙˆÓ Î·ıÂÙ‹ÚˆÓ ÛÙÔ˘˜ Ì˘˜
¤ÁÈÓ 30 min ÚÈÓ ÙËÓ ¤Ó·ÚÍË Ù˘ Û˘ÏÏÔÁ‹˜ ÙÔ˘ ‰È·ȉ‡Ì·ÙÔ˜
Î·È Û˘ÓÔÏÈο 90 min (30 min+60 min) ÚÈÓ ·fi ÙËÓ ¤Ó·ÚÍË
Ù˘ ·ÈÌÔοı·ÚÛ˘, ÌÂÙ¿ ·fi ÙÔÈ΋ ·Ó·ÈÛıËÛ›· Î·È ÙÔÈ΋
·ÓÙÈÛË„›·. ªÂ ÙÔÓ ÙÚfiÔ ·˘Ùfi ·Ôʇ¯ıËÎ·Ó Ù· Èı·Ó¿
ÚÔ‚Ï‹Ì·Ù· ·ÈÌÔÚÚ·Á›·˜ ÂÍ·ÈÙ›·˜ Ù˘ ¯ÔÚ‹ÁËÛ˘ Ë·Ú›Ó˘
ÛÙÔ˘˜ ·ÛıÂÓ›˜ ηٿ ÙËÓ ·ÈÌÔοı·ÚÛË.
∏ Û˘ÏÏÔÁ‹ ÙˆÓ ‰ÂÈÁÌ¿ÙˆÓ ¤ÁÈÓ ηٿ ÙÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙË-
Ì· ·) 0 min - 60 min ÚÈÓ ÙËÓ ·ÈÌÔοı·ÚÛË (á∞0) ‚) ηٿ ÙÔ
¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· 0 min - 60 min (á∞1), Á) 60 min - 120 min
(á∞2), ‰) 120 min - 180 min (á∞3), Â) 180 min - 240 min
 ∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 70, 4 281

(á∞4) ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ·ÈÌÔοı·ÚÛ˘ Î·È ˙) ηٿ ÙÔ ¯ÚÔ-
ÓÈÎfi ‰È¿ÛÙËÌ· 0 min -60 min (á∞5) ÌÂÙ¿ ÙËÓ ·ÈÌÔοı·ÚÛË.
™Â οı ¤Ó· ·fi ÙÔ˘ ·ÛıÂÓ›˜ ÂÏ‹ÊıËÛ·Ó ‰ÈÏ¿ ‰Â›ÁÌ·-
Ù· Û οı ¯ÚÔÓÈ΋ ÛÙÈÁÌ‹.
ªÈÎÚԉȷ›‰˘ÛË in vivo
™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, ÁÈ· ÙË Û˘ÏÏÔÁ‹ ÙˆÓ ÌÂÛÔ΢ÙÙ·Ú›ˆÓ
˘ÁÚÒÓ ÙÔ˘ ¤Íˆ Ï·Ù‡ ÌËÚÈ·›Ô˘ Ì˘fi˜ Î·È ÛÙË Û˘Ó¤¯ÂÈ· ÙÔ˘
ÚÔÛ‰ÈÔÚÈÛÌÔ‡ ÙˆÓ ÂÈ¤‰ˆÓ ÙÔ˘ 8-iso-PGF2· Û ·˘Ù¿, Â-
Ê·ÚÌfiÛıËÎÂ Ë Ù¯ÓÈ΋ Ù˘ ÌÈÎÚԉȷ›‰˘Û˘ in vivo fiˆ˜ ·˘-
Ù‹ ÂÚÈÁÚ¿ÊÂÙ·È Û ÚÔËÁÔ‡ÌÂÓË ÂÚÁ·Û›· Ì·˜41. ∂Ó Û˘ÓÙÔ-
Ì›·, Ë ÌÈÎÚԉȷ›‰˘ÛË in vivo ‚·Û›˙ÂÙ·È ÛÙË ‰È·›‰˘ÛË Ô˘-
ÛÈÒÓ ÌÈÎÚÔ‡ ÌÔÚÈ·ÎÔ‡ ‚¿ÚÔ˘˜ <20 Kda (fiˆ˜ Â›Ó·È ÛÙËÓ Â-
Ú›ÙˆÛ‹ Ì·˜ ÙÔ 8-iso-PGF2·) ‰È· ̤ÛÔ˘ ËÌȉȷÂÚ·Ù‹˜ ÌÂÌ-
‚Ú¿Ó˘, Ô˘ ÙÔÔıÂÙÂ›Ù·È ÛÙÔÓ ˘fi ¤Ú¢ӷ ÈÛÙfi ‹ fiÚÁ·ÓÔ. ∏
̤ÙÚËÛË ÙÔ˘ ÔÛÔÛÙÔ‡ Ù˘ ‰È·ȉԇÌÂÓ˘ Ô˘Û›·˜ (·fi‰ÔÛË
‰È·›‰˘Û˘) Á›ÓÂÙ·È ÂÈÚ·Ì·ÙÈο, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÂÈÛË-
Ì·Ṳ̂ӷ ÌfiÚÈ· (.¯. Ì ∏3) Ù˘ ÂÍÂÙ·˙fiÌÂÓ˘ Ô˘Û›·˜, οو
·fi ÙȘ ›‰È˜ Û˘Óı‹Î˜ ‹ ηٷÛÙ¿ÛÂȘ Ô˘ ÈÛ¯‡Ô˘Ó ÁÈ· ÙÔÓ
˘fi ÌÂϤÙË ÈÛÙfi42. ∏ ‰È·‰Èηۛ· Ù˘ ‰È·›‰˘Û˘ Á›ÓÂÙ·È Ì ÙË
¯ÚËÛÈÌÔÔ›ËÛË ÂȉÈ΋˜ ÌÈÎÚÔ·ÓÙÏ›·˜, Ì ÙËÓ ÔÔ›· ÂÈÛ¿ÁÂ-
Ù·È Ô Î·Ù¿ÏÏËÏÔ˜ ‰È·Ï‡Ù˘ (Û˘Ó‹ıˆ˜ ÈÛfiÙÔÓÔ ‰È¿Ï˘Ì· Rin-
ger’s acetate, Ì Ôχ ÌÈÎÚ‹ Ù·¯‡ÙËÙ· ÚÔ‹˜ (0,1-5,0 Ìl/1′)
ÛÙËÓ ËÌȉȷÂÚ·Ù‹ ÌÂÌ‚Ú¿ÓË Ô˘ ¤¯ÂÈ ÙÔÔıÂÙËı› ÚÔË-
ÁÔ˘Ì¤Óˆ˜ ÛÙÔÓ ˘fi ÌÂϤÙË ÈÛÙfi, Ì ÙË ‚Ô‹ıÂÈ· ÂȉÈÎÔ‡ η-
8-iso-PGF2a pg/ml
‚ÏËÙfiÙËÙ·˜ CV ‹Ù·Ó 5% Ì ·ÓÙȉڷÛÙ‹ÚÈ· Ù˘ ›‰È·˜ Û˘Û΢-
·Û›·˜ Î·È 7,3% Ì ‰È·ÊÔÚÂÙÈ΋˜. ∂›Û˘ Ë ÂȉÈÎfiÙËÙ· Ù˘
ÌÂıfi‰Ô˘ ‹Ù·Ó Ôχ ηϋ41.
™∆∞∆π™∆π∫∏ ∞¡∞§À™∏
∏ ÛÙ·ÙÈÛÙÈ΋ ·ÍÈÔÏfiÁËÛË ¤ÁÈÓ Ì ÙÔ ÛÙ·ÙÈÛÙÈÎfi ÚfiÁÚ·ÌÌ·
NCSS 2000 Ì ÙË ‰ÔÎÈÌ·Û›· ANOVA Î·È Û˘ÁÎÂÎÚÈ̤ӷ ÌÂ
ÙÔ Ï‹Úˆ˜ Ù˘¯·ÈÔÔÈË̤ÓÔ Û¯¤‰ÈÔ ÔÌ¿‰ˆÓ (randomized
complete block design), ÛÙÔ ÔÔ›Ô ÔÈ ÔÌ¿‰Â˜ ‹Ù·Ó ÔÈ ·ÛıÂ-
Ó›˜ Î·È ÔÈ ·ÚÂÌ‚¿ÛÂȘ ÔÈ Â·ÓÂÈÏËÌ̤Ó˜ ÌÂÙÚ‹ÛÂȘ ÙÔ˘ 8-
iso-PGF2·. °È· ÙËÓ ·Ó¿‰ÂÈÍË Ù˘ ‰È·ÊÔÚ¿˜ ÙˆÓ Ì¤ÛˆÓ ÙÈÌÒÓ
ÙÔ˘ 8-iso-PGF2· ÌÂٷ͇ ÙˆÓ ·ÛıÂÓÒÓ Ù˘ ÌÂϤÙ˘ ¤ÁÈÓÂ Ë ‰Ô-
ÎÈÌ·Û›· Tukey-Kramer Û Â›Â‰Ô 0,05 Î·È 0,01.
∞¶√∆∂§∂™ª∞∆∞
∆· ·ÔÙÂϤÛÌ·Ù¿ Ì·˜ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÙÔÓ ›Ó·-
η 1 Î·È ÛÙÔ ‰È¿ÁÚ·ÌÌ· Ù˘ ÂÈÎfiÓ·˜ 1 Î·È ÂÎÊÚ¿-
1300
1125

ıÂÙ‹Ú·. ∏ Û˘ÏÏÔÁ‹ ÙˆÓ ‰ÂÈÁÌ¿ÙˆÓ (‰È·›‰˘Ì·) Á›ÓÂÙ·È ÌÂÙ¿

·fi ÔÚÈṲ̂ÓÔ ¯ÚfiÓÔ, Û ÂȉÈο ÌÈÎÚÔÛˆÏËÓ¿ÚÈ·. ™ÙË Û˘Ó¤-
¯ÂÈ· ÛÙÔ ‰È·›‰˘Ì· Á›ÓÂÙ·È ·Ó›¯Ó¢ÛË, Ù·˘ÙÔÔ›ËÛË Î·È Ô- 950
ÛÔÙÈÎfi˜ ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙÔ˘ ˙ËÙÔ‡ÌÂÓÔ˘ ‚ÈÔÌÔÚ›Ô˘, Ï·Ì‚¿-
ÓÔÓÙ·˜ ˘fi„Ë ÙËÓ ·fi‰ÔÛË Ù˘ ‰È·›‰˘Û˘ Ù˘ ÌÂÏÂÙÔ‡ÌÂ-
Ó˘ Ô˘Û›·˜42. 775

ª¤ıÔ‰ÔÈ ÚÔÛ‰ÈÔÚÈÛÌÔ‡ ÙÔ˘ 8-iso-PGF2·

O ÔÛÔÙÈÎfi˜ ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ ÂÈ¤‰ˆÓ ÙÔ˘ ÂχıÂÚÔ˘ 8- 600
XNA0 XNA1 XNA2 XNA3 XNA4 XNA5
iso-PGF2· ÛÙ· Ì.˘. ÙˆÓ Ì˘ÒÓ ¤ÁÈÓ Ì ·ÓÔÛÔÂÓ˙˘ÌÈ΋ ̤ıÔ‰Ô
ÌÂ Ù˘ÔÔÈË̤ӷ ·ÓÙȉڷÛÙ‹ÚÈ· (kit) Ù˘ ÂÙ·ÈÚ›·˜ Cayman ∂ÈÎ. 1. °Ú·ÊÈ΋ ·Ú¿ÛÙ·ÛË ÙˆÓ Ì¤ÛˆÓ ÙÈÌÒÓ ÙˆÓ ÂÈ¤-
Chemical Company No 516351 (www.Cayman Chem. com). ‰ˆÓ ÙÔ˘ 8-iso-PGF2· ÛÙ· Ì.˘. ÙˆÓ Ì˘ÒÓ ÙˆÓ ·ÛıÂÓÒÓ ÌÂ
∏ ¢·ÈÛıËÛ›· Ù˘ ÌÂıfi‰Ô˘ ‹Ù·Ó 5 pg/ml Î·È Ë Â·Ó·- ÙȘ ·ÓÙ›ÛÙÔȯ˜ ÛÙ·ıÂÚ¤˜ ·ÔÎÏ›ÛÂȘ ·˘ÙÒÓ ÛÙÔ˘˜ ¤ÍÈ ¯Úfi-
ÏË„ÈÌfiÙËÙ· Ôχ ηϋ. ™˘ÁÎÂÎÚÈ̤ӷ Ô Û˘ÓÙÂÏÂÛÙ‹˜ ÌÂÙ·- ÓÔ˘˜ ·ÈÌÔÏË„›·˜.

¶›Ó·Î·˜ 1. ª¤Û˜ ÙÈ̤˜ ÙˆÓ ÂÈ¤‰ˆÓ ÙÔ˘ 8-iso-PGF2· ÛÙ· Ì.˘. ÙˆÓ Ì˘ÒÓ ÙˆÓ ·ÛıÂÓÒÓ Ù˘ ÌÂϤÙ˘ Ì ÙȘ ·ÓÙ›ÛÙÔȯ˜ ÛÙ·-
ıÂÚ¤˜ ·ÔÎÏ›ÛÂȘ ·˘ÙÒÓ Î·È ÙË ÛÙ·ÙÈÛÙÈ΋ ÙÔ˘˜ ·ÍÈÔÏfiÁËÛË ÛÙÔ˘˜ ¤ÍÈ ¯ÚfiÓÔ˘˜ ·ÈÌÔÏË„›·˜

8-iso-PGF2· pg/ml
á∞0 á∞1 á∞2 á∞3 á∞4 á∞5
670,5 1067,5 1109,8 1153,3 1125,7 1068,0
±81,0 ±126,3 ±130,8 ±136,3 ±133,4 ±126,4
1. p<0,01 p<0,01 p<0,01 p<0,01 p<0,01
2. p<0,05 p<0,01 p<0,01 N.S.
3. p<0,05 N.S. p<0,05
4. N.S. p<0,05
5. p<0,05
™‡ÁÎÚÈÛË ÙˆÓ Ì¤ÛˆÓ ÙÈÌÒÓ ÙÔ˘ 8-iso-PGF2· ÌÂٷ͇ Ù˘ ÔÌ¿‰·˜:
1. á∞0 Î·È ÙˆÓ ÔÌ¿‰ˆÓ á∞1, á∞2, á∞3, á∞4 Î·È Ã¡∞5, 2. á∞1 Î·È ÙˆÓ ÔÌ¿‰ˆÓ á∞2, á∞3, á∞4 Î·È Ã¡∞5
3. á∞2 Î·È ÙˆÓ ÔÌ¿‰ˆÓ á∞3, á∞4 Î·È Ã¡∞5, 4. á∞3 Î·È ÙˆÓ ÔÌ¿‰ˆÓ á∞4 Î·È Ã¡∞5
5. á∞4 Î·È Ù˘ ÔÌ¿‰·˜ á∞5
282 I. KAƒAMOY∑∏™ ∫∞π ™À¡.
–
˙ÔÓÙ·È Ì ÙË Ì¤ÛË ÙÈÌ‹ (x) Ù˘ Û˘ÁΤÓÙÚˆÛ˘ ÙÔ˘ 8-
iso-PGF2· ÛÙ· Ì.˘. Ì ÙȘ ·ÓÙ›ÛÙÔȯ˜ ÛÙ·ıÂÚ¤˜ ·-
ÔÎÏ›ÛÂȘ ·˘ÙÒÓ (s.d.).
∏ ·fi‰ÔÛË Ù˘ ‰È·›‰˘Û˘ ÙÔ˘ 8-iso-PGF2·
‰È¿ ̤ÛÔ˘ ÙˆÓ ËÌȉȷÂÚ·ÙÒÓ ÌÂÌ‚Ú·ÓÒÓ ıˆڋ-
ıËΠfiÙÈ ‹Ù·Ó ۯ‰fiÓ ÛÙÔ 100% Û fiϘ ÙȘ ËÌȉȷ-
ÂÚ·Ù¤˜ ÌÂÌ‚Ú¿Ó˜, ÛÙȘ Û˘Óı‹Î˜ ÙÔ˘ ÂÈÚ¿Ì·-
ÙÔ˜, Ì ÙËÓ Ôχ ¯·ÌËÏ‹ Ù·¯‡ÙËÙ· ‰ÈÔ¯¤Ù¢Û˘ (0,3
Ìl/1 min) Ì ÙË ÌÈÎÚÔ·ÓÙÏ›· ÙÔ˘ ‰È·Ï‡ÙÔ˘ (Ringer’s
acetate) ÛÙÔ˘˜ Ì˘˜42.
™À∑∏∆∏™∏
∫·Ù’ ·Ú¯‹Ó ı· Ú¤ÂÈ Ó· ·Ó·ÊÂÚı› fiÙÈ Ë ÂÊ·ÚÌÔ-
Á‹ Ù˘ ÌÈÎÚԉȷ›‰˘Û˘ in vivo ÛÙÔ˘˜ ·ÈÌÔηı·Úfi-
ÌÂÓÔ˘˜ ·ÛıÂÓ›˜, ‹Ù·Ó ·fiÏ˘Ù· ·ÛÊ·Ï‹˜ Î·È ‰ÂÓ
ÚԤ΢„·Ó ÚÔ‚Ï‹Ì·Ù· ·ÈÌÔÚÚ·Á›·˜ ·Ú¿ ÙË ¯Ô-
Ú‹ÁËÛË Ë·Ú›Ó˘ ηٿ ÙË ‰È·‰Èηۛ· Ù˘ ·ÈÌÔο-
ı·ÚÛ˘. ∞˘Ùfi Èı·ÓÒ˜ ÔÊÂÈÏfiÙ·Ó ÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ
ÔÈ Î·ıÂÙ‹Ú˜ Ì ÙȘ ËÌȉȷÂÚ·Ù¤˜ ÌÂÌ‚Ú¿Ó˜ ÙÔ-
ÔıÂÙ‹ıËÎ·Ó ÛÙÔ˘˜ Ì˘˜ ÙˆÓ ·ÛıÂÓÒÓ ·ÚÎÂÙfi ¯Úfi-
ÓÔ (90′) ÚÈÓ ÙË ¯ÔÚ‹ÁËÛË Ë·Ú›Ó˘ Î·È ÙËÓ ¤Ó·Ú-
ÍË Ù˘ ·ÈÌÔοı·ÚÛ˘, ÔfiÙÂ Ù˘¯fiÓ ÌÈÎÚÔηÎÒÛÂȘ
ÙˆÓ Ì˘ÒÓ ·fi ÙȘ ‚ÂÏfiÓ˜ ÙÔ˘ ηıÂÙ‹Ú·, ÂÔ˘ÏÒ-
ıËÎ·Ó Î·È ‰ÂÓ ˘‹Ú¯Â ηӤӷ Úfi‚ÏËÌ· ·ÈÌÔÚÚ·-
Á›·˜ Ì ÙËÓ ¤Ó·ÚÍË Ù˘ ·ÈÌÔοı·ÚÛ˘. ∞Ó¿ÏÔÁË
·ÛÊ·Ï‹ ÂÊ·ÚÌÔÁ‹ Ù˘ ÌÈÎÚԉȷ›‰˘Û˘ in vivo ÛÂ
·ÈÌÔηı·ÚfiÌÂÓÔ˘˜ ·ÛıÂÓ›˜ ·Ó¤ÊÂÚ·Ó Î·È ÔÈ Al-
quist M. Î·È Û˘Ó. 1999 Ì ÙË ‰È·ÊÔÚ¿ fiÙÈ ÔÈ ·Ú·-
¿Óˆ ÂÚ¢ÓËÙ¤˜ ̤ÙÚËÛ·Ó Ô˘Ú›· ÛÙÔ Ì.˘. ÙˆÓ Ì˘ÒÓ
Î·È fi¯È ÙÔ F2-ÈÛÔÚÔÛÙ¿ÓÈÔ43. ¢È¢ÎÚÈÓ›˙ÂÙ·È fiÙÈ ÙÔ
‰È·›‰˘Ì· Ô˘ Û˘ÏϤÁÂÙ·È Ì ÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘ in
vivo ÌÈÎÚԉȷ›‰˘Û˘ ÛÙÂÚÂ›Ù·È ÂÓ˙‡ÌˆÓ, ‰ÈfiÙÈ Ù·
¤Ó˙˘Ì· ˆ˜ ÌÂÁ·ÏÔÌÔÚȷΤ˜ ÂÓÒÛÂȘ ‰ÂÓ ÂÚÓÔ‡Ó
ÙȘ ËÌȉȷÂÚ·Ù¤˜ ÌÂÌ‚Ú¿Ó˜. ∞ÔÙ¤ÏÂÛÌ· ·˘ÙÔ‡
›ӷÈ, Ù· ‰È¿ÊÔÚ· ‚ÈÔÌfiÚÈ·, Ô˘ Û˘ÏϤÁÔÓÙ·È Ì ÙÔ
‰È·›‰˘Ì· ‰ÂÓ Î·Ù·‚ÔÏ›˙ÔÓÙ·È, ·Ú·Ì¤ÓÔ˘Ó ¿ıÈ-
ÎÙ· Î·È Ë Ì¤ÙÚËÛË ÙˆÓ ÂÈ¤‰ˆÓ ·˘ÙÒÓ ÛÙ· ÌÂÛÔ-
΢ÙÙ¿ÚÈ· ˘ÁÚ¿ (‰È·›‰˘Ì·), ÚÈÓ ‰È·¯˘ıÔ‡Ó ÛÙÔÓ
ÌÂÁ¿ÏÔ fiÁÎÔ ÙÔ˘ ·›Ì·ÙÔ˜, ‰›‰Ô˘Ó ÙËÓ Ú·ÁÌ·ÙÈ΋
ÂÈÎfiÓ· Ù˘ ·Ú·ÁˆÁ‹˜ ·˘ÙÒÓ ·fi Ù· ·ÙÙ·Ú· ÙˆÓ
ÈÛÙÒÓ42.
ŸÛÔÓ ·ÊÔÚ¿ Ù· Â›‰· ÙÔ˘ ÂχıÂÚÔ˘ 8-iso-
PGF2· ÛÙ· Ì.˘. ÙˆÓ Ì˘ÒÓ ÙˆÓ ·ÈÌÔηı·ÚfiÌÂÓˆÓ
·ÛıÂÓÒÓ ‰È·ÈÛÙÒıËΠfiÙÈ ·˘Í¿ÓÔÓÙ·Ó ÛÙ·‰È·Î¿
Ì ÙËÓ ÚfiÔ‰Ô Ù˘ ·ÈÌÔοı·ÚÛ˘ Î·È Û¯Â‰fiÓ ÛÙ·-
ıÂÚÔÔÈ‹ıËÎ·Ó Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ 3˘ Î·È 4˘
ÒÚ·˜, ÂÓÒ ÂÏ·ÙÙÒıËÎ·Ó Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ 1˘
ÒÚ·˜ ÌÂÙ¿ ÙËÓ ·ÈÌÔοı·ÚÛË Û ۯ¤ÛË Ì ·˘Ù¿ Ù˘
3˘ Î·È 4˘ ÒÚ·˜. ¶·Ú¤ÌÂÈÓ·Ó fï˜ ˘„ËÏfiÙÂÚ· ·-
fi Ù· Â›‰· ÙÔ˘ 8-iso-PGF2· ηٿ ÙË ‰È¿ÚÎÂÈ·
Ù˘ 1˘ ÒÚ·˜ ÚÈÓ ÙËÓ ·ÈÌÔοı·ÚÛË. ™˘ÁÎÂÎÚÈ̤-
Ó·, Ù· Â›‰· ÙÔ˘ 8-iso-PGF2· ÛÙ· Ì.˘. ÙˆÓ Ì˘ÒÓ
ÙˆÓ ·ÈÌÔηı·ÚfiÌÂÓˆÓ ·ÛıÂÓÒÓ ·) ∫·Ù¿ ÙË ‰È¿Ú-
ÎÂÈ· Ù˘ 1˘ ÒÚ·˜ ÚÈÓ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ·ÈÌÔ-
οı·ÚÛ˘ ‹Ù·Ó 670,5±81,0 pg/ml, ‚) ∫·Ù¿ ÙË
‰È¿ÚÎÂÈ· Ù˘ 1˘ ÒÚ·˜ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ·ÈÌÔο-
ı·ÚÛ˘ ·˘Í‹ıËÎ·Ó ÛËÌ·ÓÙÈο (1067,5±126,3
pg/ml, p<0,01), Á) ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ 2˘ ÒÚ·˜
·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ·ÈÌÔοı·ÚÛ˘ ·˘Í‹ıËηÓ
·ÎfiÌË ÂÚÈÛÛfiÙÂÚÔ (1109,8±130,8 pg/ml) Ì ÛÙ·-
ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ·fi Ù· Â›‰¿ ÙÔ˘
ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ 1˘ ÒÚ·˜ (p<0,052), ‰) ∫·Ù¿
ÙË ‰È¿ÚÎÂÈ· Ù˘ 3˘ ÒÚ·˜ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ·ÈÌÔ-
οı·ÚÛ˘ ‹Ú·Ó ÙË Ì¤ÁÈÛÙË ÙÈÌ‹ (1153,3±136,6
pg/ml), Ì ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ·fi Ù·
Â›‰¿ ÙÔ˘ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ 2˘ ÒÚ·˜
(p<0,05), Â) ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ 4˘ ÒÚ·˜ ·fi
ÙËÓ ¤Ó·ÚÍË Ù˘ ·ÈÌÔοı·ÚÛ˘ ‹Ù·Ó ۯ‰fiÓ ›‰È· ÌÂ
Ù· Â›‰¿ ÙÔ˘˜ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ 3˘ ÒÚ·˜, ÌÂ
ÌË ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ (N.S.) ‰È·ÊÔÚ¿ ÌÂٷ͇
ÙÔ˘˜. ˙) ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ 1˘ ÒÚ·˜ ÌÂÙ¿ ÙËÓ ·È-
ÌÔοı·ÚÛË ‹Ù·Ó ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚ·
(1068,0±126,4 pg/ml) ·fi Ù· Â›‰¿ ÙÔ˘ ηٿ ÙË
‰È¿ÚÎÂÈ· Ù˘ 4˘ ÒÚ·˜ (p<0,05), ·ÏÏ¿ ÛËÌ·ÓÙÈο
˘„ËÏfiÙÂÚ· ·fi Ù· Â›‰¿ ÙÔ˘ ÚÈÓ ÙËÓ ¤Ó·ÚÍË
Ù˘ ·ÈÌÔοı·ÚÛ˘ (p<0,01).
∆· Â›‰· ÙÔ˘ ÂχıÂÚÔ˘ 8-iso-PGF2· ÛÙÔ˘˜
¯ÚfiÓÈ· ·ÈÌÔηı·ÚfiÌÂÓÔ˘˜ ·ÛıÂÓ›˜ ÚÈÓ ·fi ÙËÓ
·ÈÌÔοı·ÚÛË ‹Ù·Ó ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚ· ·fi Ù·
Â›‰· ÙÔ˘ ÂχıÂÚÔ˘ 8-iso-PGF2· ÛÙ· ÌÂÛÔ΢Ù-
Ù¿ÚÈ· ˘ÁÚ¿ ÙˆÓ Ì˘ÒÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ·ÙfiÌˆÓ Ô˘
›¯·Ì ‚ÚÂÈ Û ÚÔËÁÔ‡ÌÂÓË ÌÂϤÙË Ì·˜41 (112,5±
30,2 pg/ml, p<0,001). ¢˘ÛÙ˘¯Ò˜ ‰ÂÓ ˘¿Ú¯Ô˘Ó ‚È-
‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ó·ÊÔÚ¤˜ ÁÈ· Û‡ÁÎÚÈÛË Û¯ÂÙÈο ÌÂ
Ù· Â›‰· ÙÔ˘ ÌÂÏÂÙÔ‡ÌÂÓÔ˘ ‚ÈÔÌÔÚ›Ô˘ ÛÙ· ÌÂÛÔ-
΢ÙÙ¿ÚÈ· ˘ÁÚ¿ ·ÈÌÔηı·ÚfiÌÂÓˆÓ ·ÛıÂÓÒÓ Î·Ù¿
ÙËÓ ‰È¿ÚÎÂÈ· Ù˘ ·ÈÌÔοı·ÚÛ˘ ·˘ÙÒÓ. ∏ ·‡ÍËÛË
ÙÔ˘ 8-iso-PGF2· ÛÙ· Ì.˘. ÙˆÓ ¯ÚfiÓÈ· ·ÈÌÔηı·Úfi-
ÌÂÓˆÓ ·ÛıÂÓÒÓ Èı·ÓfiÓ ÔÊ›ÏÂÙ·È ÛÙËÓ ·˘ÍË̤ÓË
ÏÈȉÈ΋ ˘ÂÚÔÍ›‰ˆÛË Î·È ÛÙÔ ·˘ÍË̤ÓÔ ÔÍÂȉˆ-
ÙÈÎfi stress Ô˘ ¤¯Ô˘Ó ÔÈ ·ÛıÂÓ›˜ Ì ¯ÚfiÓÈ· ÓÂÊÚÈ-
΋ ·ÓÂ¿ÚÎÂÈ· (á∞) Î·È È‰È·›ÙÂÚ· ÔÈ ÓÂÊÚÔ·-
ı›˜ ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘ Ô˘ οÓÔ˘Ó ·ÈÌÔοı·ÚÛË. ∏
·˘ÍË̤ÓË ÏÈȉÈ΋ ˘ÂÚÔÍ›‰ˆÛË Î·È ÙÔ ·˘ÍË̤ÓÔ
ÔÍÂȉˆÙÈÎfi stress ÙˆÓ ¯ÚfiÓÈ· ·ÈÌÔηı·ÚfiÌÂÓˆÓ
·ÛıÂÓÒÓ Ú¤ÂÈ Ó· ÔÊ›ÏÂÙ·È ÛÙËÓ ·˘ÍË̤ÓË ·-
Ú·ÁˆÁ‹ ÂÏ¢ı¤ÚˆÓ ÚÈ˙ÒÓ (΢ڛˆ˜ Ô͢ÁfiÓÔ˘ ηÈ
·˙ÒÙÔ˘) Î·È ÛÙÔ˘˜ ÌÂȈ̤ÓÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÂÍÔ˘-
‰ÂÙ¤ÚˆÛ‹˜ ÙÔ˘˜ ÛÙÔ˘˜ ·Ú·¿Óˆ ·ÛıÂÓ›˜44.
¶ÈÔ Û˘ÁÎÂÎÚÈ̤ӷ, ÙÔ ·˘ÍË̤ÓÔ ÔÍÂȉˆÙÈÎfi
stress (Ô˘ Û˘Óԉ‡ÂÙ·È ·fi ·˘ÍË̤ÓË ·Ú·ÁˆÁ‹
 ∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 70, 4
ÙˆÓ ‰Ú·ÛÙÈÎÒÓ ÌÔÚÊÒÓ Ô͢ÁfiÓÔ˘ Î·È ·˙ÒÙÔ˘) ηÈ
Ë ·˘ÍË̤ÓË ÏÈȉÈ΋ ˘ÂÚÔÍ›‰ˆÛË ÙˆÓ ·ÈÌÔηı·-
ÚfiÌÂÓˆÓ ·ÛıÂÓÒÓ Ú¤ÂÈ Ó· ÔÊ›ÏÂÙ·È:
1. ™ÙÔ Ô˘Ú·ÈÌÈÎfi ÂÚÈ‚¿ÏÏÔÓ, ÙÔ ÔÔ›Ô ÚÔ-
ηÏ› ·˘ÍË̤ÓË ·Ú·ÁˆÁ‹ ÙˆÓ ‰Ú·ÛÙÈÎÒÓ ÌÔÚ-
ÊÒÓ Ô͢ÁfiÓÔ˘ (ROS) Î·È ·˙ÒÙÔ˘ ·fi Ù· ÔÏ˘-
ÌÔÚÊÔ‡ÚËÓ·44,45.
2. ™ÙËÓ ·ÒÏÂÈ· ÙˆÓ ˘‰·ÙÔ‰È·Ï˘ÙÒÓ ·ÓÙÈÔÍÂÈ-
‰ˆÙÈÎÒÓ-·Ó·ÁˆÁÈÎÒÓ Ô˘ÛÈÒÓ ÌÔÚÈ·ÎÔ‡ ‚¿ÚÔ˘˜
(‚ÈÙ·Ì›Ó˘ C, ÛÂÏËÓ›Ô˘ Î.¿.) ηٿ ÙËÓ ·ÈÌÔοı·Ú-
ÛË46,47 Î·È ÛÙË ‚ÈÔÛ˘Ì‚·ÙfiÙËÙ· ÙˆÓ ÌÂÌ‚Ú·ÓÒÓ
ÙˆÓ Ê›ÏÙÚˆÓ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Î·Ù¿ ÙË ‰È¿Ú-
ÎÂÈ· Ù˘ ·ÈÌÔοı·ÚÛ˘. ÀÔÛÙËÚ›˙ÂÙ·È Ì¿ÏÈÛÙ·
fiÙÈ Ì ÙËÓ Â·Ê‹ ÙÔ˘ ·›Ì·ÙÔ˜ Ì ÙȘ ÁÚ·Ì̤˜ Û‡Ó-
‰ÂÛ˘ ·fi Ï·ÛÙÈÎfi ˘ÏÈÎfi (ͤÓÔ ÛÒÌ·), ÂÓÂÚÁÔ-
ÔÈÔ‡ÓÙ·È Ù· ÔÏ˘ÌÔÚÊÔ‡ÚËÓ· Î·È ·Ú¿ÁÔ˘Ó ·˘-
ÍË̤ӷ ÔÛ¿ ÙˆÓ ROS. ∂›Û˘ ηٿ ÙȘ ÂÈÌÔχÓ-
ÛÂȘ ÙÔ˘ ‰È·Ï‡Ì·ÙÔ˜ Ù˘ ·ÈÌÔοı·ÚÛ˘ ·fi ÂÓ‰Ô-
ÙÔ͛Ә Î·È ˘ÚÂÙÔÁfiÓ˜ Ô˘Û›Â˜ ÂÓÂÚÁÔÔÈÔ‡ÓÙ·È
Ù· ÌÔÓÔ·ÙÙ·Ú· Ì·ÎÚÔÊ¿Á· Î·È ·Ú¿ÁÔ˘Ó ÌÂÁ·-
χÙÂÚ· ÔÛ¿ ÙˆÓ ROS48-50. ∆· ·Ú·¿Óˆ ÂÓÈÛ¯‡Ô-
ÓÙ·È Î·È ·fi ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË
‚Ú¤ıËΠfiÙÈ Ù· Â›‰· ÙÔ˘ 8-iso-PGF2· ÛÙ· Ì.˘.
ÙˆÓ ·ÈÌÔηı·ÚfiÌÂÓˆÓ ·ÛıÂÓÒÓ, ·˘Í¿ÓÔÓÙ·Ó ÛÙ·-
‰È·Î¿ Ì ÙËÓ ÚfiÔ‰Ô Ù˘ ·ÈÌÔοı·ÚÛ˘, ÂÓÒ ÂÏ·Ù-
ÙÒÓÔÓÙ·Ó ÌÂÙ¿ ·fi ·˘Ù‹Ó.
3. ™ÙË ¯ÔÚ‹ÁËÛË ÔÚÈÛÌ¤ÓˆÓ Ê·Ú̷΢ÙÈÎÒÓ
Û΢·ÛÌ¿ÙˆÓ fiˆ˜ ÙÔ˘ Ûȉ‹ÚÔ˘ Î·È Ù˘ ÂÚ˘ıÚÔ-
ÔÈËÙ›Ó˘ ÛÙÔ˘˜ ·ÈÌÔηı·ÚfiÌÂÓÔ˘˜ ·ÛıÂÓ›˜, ÔÈ
Ôԛ˜ Èı·ÓfiÓ ·˘Í¿ÓÔ˘Ó ÙÔ ÔÍÂȉˆÙÈÎfi stress ÙˆÓ
·ÛıÂÓÒÓ ·˘ÙÒÓ.51
4. ¶¤Ú·Ó ·˘ÙÒÓ ˘¿Ú¯Ô˘Ó Î·È ÂÚÈ‚·ÏÏÔÓÙÈ-
ÎÔ› ηıÒ˜ Î·È ‰È·ÙÚÔÊÈÎÔ› ·Ú¿ÁÔÓÙ˜, ÔÈ ÔÔ›ÔÈ
ÂËÚ¿˙Ô˘Ó ÛËÌ·ÓÙÈο, ·ÏÏ¿ Û ‰È·ÊÔÚÂÙÈÎfi ‚·ı-
Ìfi οı ¤Ó· ·fi ÙÔ˘˜ ·ÛıÂÓ›˜ ·˘ÙÔ‡˜, ·Ó¿ÏÔÁ·
Ì ÙÔ ÂÚÈ‚¿ÏÏÔÓ Ô˘ ˙Ô˘Ó Î·È ÙȘ ‰È·ÈÙËÙÈΤ˜ ÙÔ˘˜
Û˘Ó‹ıÂȘ.6-11
™Àª¶∂ƒ∞™ª∞∆∞
∞fi Ù· Â˘Ú‹Ì·Ù· Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ÚԤ΢-
„·Ó fiÙÈ ·) ∏ Ù¯ÓÈ΋ Ù˘ in vivo ÌÈÎÚԉȷ›‰˘Û˘
ÛÙÔ˘˜ ·ÈÌÔηı·ÚfiÌÂÓÔ˘˜ ·ÛıÂÓ›˜ Â›Ó·È ·ÛÊ·Ï‹˜,
Î·È ÌÔÚ› Ó· ÂÊ·ÚÌÔÛÙ› ·Î›Ó‰˘Ó· ÁÈ· ÙË Û˘ÏÏÔ-
Á‹ ÌÂÛÔ΢ÙÙ·Ú›ˆÓ ˘ÁÚÒÓ ÙˆÓ Ì˘ÒÓ ÙÔ˘˜ Î·È ÙËÓ
ÂÎÙ›ÌËÛË Ù˘ ÏÈȉÈ΋˜ ˘ÂÚÔÍ›‰ˆÛ˘ Î·È ÙÔ˘
ÔÍÂȉˆÙÈÎÔ‡ stress ÙˆÓ ·ÛıÂÓÒÓ ·˘ÙÒÓ Î·Ù¢ı›·Ó
ÛÙ· ÌÂÛÔ΢ÙÙ¿ÚÈ· ˘ÁÚ¿ ÙˆÓ Ì˘ÒÓ ÙÔ˘˜ ÚÈÓ Ù·
ÚÔ˚fiÓÙ· ÙÔ˘ ÔÍÂȉˆÙÈÎÔ‡ stress ‰È·¯˘ıÔ‡Ó ÛÙÔ ·›-
Ì· Î·È Î·Ù·‚ÔÏÈÛÙÔ‡Ó. ‚) ∏ ÏÈȉÈ΋ ˘ÂÚÔÍ›‰ˆ-
ÛË (ÂÎÊÚ·˙fiÌÂÓË Ì ٷ Â›‰· ÙÔ˘ 8-iso-PGF2·
ÛÙ· ÌÂÛÔ΢ÙÙ¿ÚÈ· ˘ÁÚ¿ ÙˆÓ Ì˘ÒÓ) ÙˆÓ ·ÈÌÔηı·-
283
ÚfiÌÂÓˆÓ ·ÛıÂÓÒÓ ÚÈÓ ÙËÓ ¤Ó·ÚÍË Ù˘ ·ÈÌÔο-
ı·ÚÛ˘ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË ·fi ·˘Ù‹ ÙˆÓ Ê˘ÛÈÔÏÔÁÈ-
ÎÒÓ ·ÙfiÌˆÓ Î·È ·˘Í¿ÓÂÙ·È ÛÙ·‰È·Î¿ Ì ÙËÓ ÚfiÔ-
‰Ô Ù˘ ·ÈÌÔοı·ÚÛ˘, ÂÓÒ ÂÏ·ÙÙÒÓÂÙ·È ÌÂÙ¿ ÙÔ Ù¤-
ÏÔ˜ ·˘Ù‹˜.
ABSTRACT
Karamouzis π, Grekas D, Karamouzis M, Valiveva-
Staikova Sv, Kovachev D, Triantos A, Eliadis St, Pa-
pageorgiou G, Dimitriadou A. The changes of mu-
scle interstitial F2-isoprostane 8-iso-PGF2· in he-
modialyzed patients. ∏ell Iatr 2004, 70: 279-285.
The 8-iso-prostaglandin F2· (8-iso-PGF2·) is a
characteristic F2-isoprostane which is produced in
humans via free radical-catalyzed lipid peroxidation
mechanism of arachidonic acid and it is indepen-
dent from the cycloxygenase synthase pathway. The
measurement of plasma levels of 8-iso-PGF2· has
been proposed to be the most reliable biochemical
index of lipid peroxidation and oxidative stress sta-
tus in patients with a great number of pathological
conditions including the heamodialysed patients.
However, there are no references in the literature a-
bout local muscle interstitial 8-iso-PGF2· produ-
ction and movement during hemodialysis. In this
study, two microdialysis probes were inserted with
CMA-60 microdialysis catheters into the vastus la-
teralis of the quadriceps femorus muscle group of
the right leg of three stable male patients with end
stage renal failure, undergoing hemodialysis. The
dialysate fluids were collected i) during 60 min be-
fore hemodialysis, ii) during 0 min-60 min, 60 min-
120 min, 120 min-180 min and 180 min-240 min
during hemodialysis and iii) during 0 min-60 minaf-
ter hemodialysis. The results have shown that the
muscle interstitial fluid (i.f.) levels of 8-iso-PGF2· a)
one hour before hemodialysis were higher than in
normal people b) The i.f. levels of 8-iso-PGF2·
during hemodialysis were higher than before he-
modialysis c) The i.f. levels of 8-iso-PGF2· one hour
after hemodialysis continued to be higher than be-
fore. The measurements show that during hemodia-
lysis there is an increase of lipid peroxidation and
increased oxidative stress.
µπµ§πO°ƒ∞ºI∞
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∞ÏÏËÏÔÁÚ·Ê›·:
π. ∫·Ú·ÌÔ‡˙˘
π. ∑ËÚÁ¿ÓÔ˘ 14
551 34 £ÂÛÛ·ÏÔÓ›ÎË
Corresponding author:
I. Karamouzis
14, I. Zirganou Str.
551 34 Thessaloniki
Greece
∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 2004, 70, 4: 286 - 288
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ÛÓÔÈ· Î·È ÛÙË Ê˘ÛÈ΋ ÂͤٷÛË ‚Ú¤ıËÎÂ Û˘ÛÙÔÏÈÎfi ʇÛËÌ·
ÂÓÙÔÈṲ̂ÓÔ ÛÙÔ ·ÚÈÛÙÂÚfi ¯Â›ÏÔ˜ ÙÔ˘ ÛÙ¤ÚÓÔ˘. ∏ Doppler
˯ÔηډÈÔÁÚ·Ê›· ·ÔÎ¿Ï˘„ ÂÈÎÔÈÓˆÓ›· ÌÂٷ͇ ÎÔÚ˘Ê‹˜
Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ Î·È ÌÈ·˜ Â͈ηډȷ΋˜ ÎÔÈÏfiÙËÙ·˜ ÌÂ
ÛÙfiÌÈÔ 1,2 cm (EÈÎ. 1). §·Ì‚¿ÓÔÓÙ·˜ ˘’ fi„Ë ÙÔ ÈÛÙÔÚÈÎfi ÙÔ˘
ÚÔËÁËı¤ÓÙÔ˜ ÂÌÊÚ¿ÁÌ·ÙÔ˜, Ù¤ıËÎÂ Ë Èı·Ó‹ ‰È¿ÁÓˆÛË
„¢‰Ô·Ó¢ڇÛÌ·ÙÔ˜. ™ÙË Û˘Ó¤¯ÂÈ· ˘Ô‚Ï‹ıËΠ۠ÛÙÂÊ·-
ÓÈÔÁÚ·Ê›· Î·È ÎÔÈÏÈÔÁÚ·Ê›· Ô˘ ¤‰ÂÈÍ·Ó 80% ÛÙ¤ÓˆÛË ÛÙËÓ
·fiÏËÍË Ù˘ ÂÚÈÛÒÌÂÓ˘ Î·È Ô›ÛıÈ·˜ ηÙÈÔ‡Û·˜ ÛÙÂÊ·-
ÓÈ·›·˜ ·ÚÙËÚ›·˜, ÂÓÒ ÙÔ ÎÏ¿ÛÌ· ÂÍÒıËÛ˘ ˘ÔÏÔÁ›ÛÙËÎÂ
ÛÙÔ 50%. ™ÙË ÂÈÎfiÓ· 2 ·ÂÈÎÔÓ›˙ÂÙ·È Ë ÂÈÎÔÈÓˆÓ›· ηٿ ÙË
‰ÈÂÍ·ÁˆÁ‹ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏÈÔÁÚ·Ê›·˜.
Àfi ÁÂÓÈ΋ ÂÓ‰ÔÙÚ·¯Âȷ΋ ·Ó·ÈÛıËÛ›·, ÌËÚÈ·ÈÔ-ÌËÚÈ-
·›· ·Ú¿Î·Ì„Ë Î·È Ì¤ÛË ÛÙÂÚÓÔÙÔÌ‹, ÂÈÛ‹¯ıË ÛÙËÓ Â͈ۈ-
Ì·ÙÈ΋ ΢ÎÏÔÊÔÚ›· (̤ÙÚÈ· ˘ÔıÂÚÌ›·), ·ÔÎÏ›ÛÙËΠË
·ÔÚÙ‹ Î·È ¯ÔÚËÁ‹ıËΠ„˘¯Ú‹ ÎÚ˘ÛÙ·ÏÏÈ΋ ηډÈÔÏËÁ›· St.
Thomas I. ªÂ ·ÔÛ˘Ì›ÂÛË Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ (LV) ηÈ
ÔÍ›· ‰È¿ÙÌËÛË ÙˆÓ Û˘ÌʇÛÂˆÓ ¤ÁÈÓ ÂÎÙÔÌ‹ ÙÔ˘ „¢‰Ô·-
Ó¢ڇÛÌ·ÙÔ˜, ‰È·ÛÙ¿ÛÂˆÓ 4,5 × 2,5 cm ·fi ÙËÓ ÎÔÚ˘Ê‹ Ù˘
·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ Î·È ÛÙÂÚÚ¿ Û˘ÌÂÊ˘Ì¤ÓÔ˘ ÛÙÔÓ ·ÚÈÛÙÂÚfi
ıÒڷη Î·È ÙÔ ‰È¿ÊÚ·ÁÌ·, ·ÔʇÁÔÓÙ·˜ Ù˘¯fiÓ ÙÚ·˘Ì·ÙÈ-
∂ÈÎ. 1. ™ÙËÓ Doppler ˯ÔηډÈÔÁÚ·Ê›· ·ÔηχÙÂÙ·È
Ë ÂχıÂÚË ÂÈÎÔÈÓˆÓ›· ÌÂٷ͇ ÎÔÚ˘Ê‹˜ Ù˘ ·ÚÈÛÙÂÚ‹˜
ÎÔÈÏ›·˜ Î·È ÌÈ·˜ Â͈ηډȷ΋˜ ÎÔÈÏfiÙËÙ·˜.
∂ÈÎ. 2. ¢ÂÍÈ¿ ÚfiÛıÈ· ÏÔÍ‹ ÚÔ‚ÔÏ‹ (·ÚÈÛÙÂÚ‹ ÎÔÈÏÈÔ-
ÁÚ·Ê›·) ÛÙËÓ ÔÔ›· ·ÂÈÎÔÓ›˙ÂÙ·È ÙÔ „¢‰Ô·Ó‡ڢÛÌ·
Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜.
287
∂ÈÎ. 3. 2D – ˯ÔηډÈÔÁÚ·Ê›· ÂÙ¿ ¤ÙË ÌÂÙ¿ ÙËÓ ÂÈÙ˘-
¯‹ ¯ÂÈÚÔ˘ÚÁÈ΋ ‰ÈfiÚıˆÛË.
ÛÌfi ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ÊÚÂÓÈÎÔ‡ Ó‡ÚÔ˘. ∆Ô ·Ó‡ڢÛÌ· ÂÚÈ›-
¯Â ıÚfiÌ‚Ô˘˜ ÂÓÒ Ë ·ıÔÏÔÁÔ·Ó·ÙÔÌÈ΋ ÂͤٷÛË ‰ÂÓ ¤‰ÂÈÍÂ
‡·ÚÍË Ì˘ÔηډȷÎÔ‡ ÈÛÙÔ‡ ‹ ÛÙÂÊ·ÓÈ·›ˆÓ. ∆Ô ¤ÏÏÂÈÌÌ·
Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ ÌÂÙ¿ ÙËÓ ÂÎÙÔÌ‹ ·ÔηٷÛÙ¿ıËÎÂ
ÚˆÙÔÁÂÓÒ˜ Û ‰‡Ô ÛÙÚÒÌ·Ù· Ì ψڛ‰Â˜ Teflon. ¢ÂÓ ¤ÁÈÓÂ
·ÔÚÙÔÛÙÂÊ·ÓÈ·›· ·Ú¿Î·Ì„Ë ÏfiÁˆ Ù˘ ÂÚÈÊÂÚÈ΋˜ ÂÓÙfiÈ-
Û˘ Ù˘ ÓfiÛÔ˘. O ·ÛıÂÓ‹˜ ›¯Â ·ÓÂ›ÏÂÎÙË ÔÚ›· Î·È ·-
ڷ̤ÓÂÈ ‰Ú·ÛÙ‹ÚÈÔ˜ 7 ¤ÙË ·ÚÁfiÙÂÚ·. ∏ ˯ÔηډÈÔÁÚ·Ê›·
ÛÙËÓ ·ÒÙÂÚË ·Ú·ÎÔÏÔ‡ıËÛË ¤‰ÂÈÍ ÈηÓÔÔÈËÙÈ΋ ¯ÂÈ-
ÚÔ˘ÚÁÈ΋ ‰ÈfiÚıˆÛË (∂ÈÎ. 3).
™À∑∏∆∏™∏
OÈ ÓÂÎÚÔÙÔÌÈΤ˜ ÌÂϤÙ˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ Ë Âχ-
ıÂÚË Ú‹ÍË ÂÈϤÎÂÈ Û¯Â‰fiÓ ÙÔ 4% ÙˆÓ ÂÌÊÚ·Á-
Ì¿ÙˆÓ ÙÔ˘ Ì˘Ôηډ›Ô˘ Î·È ·ÔÙÂÏ› ÙÔ 12-21%
ÙˆÓ ı·Ó¿ÙˆÓ ÌÂÙ¿ ·fi ·˘Ùfi3. ¶·ÚfiÏÔ Ô˘ Ë Ú‹ÍË
Â›Ó·È Û˘Ó‹ıˆ˜ ı·Ó·ÙËÊfiÚ·, ÔÚÈṲ̂ÓÔÈ ·ÛıÂÓ›˜
ÂÈ‚ÈÒÓÔ˘Ó Î·È ·ÚÁfiÙÂÚ· ÂÌÊ·Ó›˙Ô˘Ó ·Ó‡ڢÛÌ·.
∆Ô „¢‰Ô·Ó‡ڢÛÌ· ·˘Ùfi, ·ÓÙ›ıÂÙ· ·fi ÙÔ ·ÏË-
ı¤˜ ·Ó‡ڢÛÌ·, ¤¯ÂÈ ÙËÓ Ù¿ÛË Ú‹Í˘ Î·È ÂÔ̤ӈ˜
Ì ÙË ‰È¿ÁÓˆÛ‹ ÙÔ˘ Ú¤ÂÈ Ó· ·ÓÙÈÌÂÙˆ›˙ÂÙ·È
¿ÌÂÛ·. ∆Ô „¢‰Ô·Ó‡ڢÛÌ· ¤¯ÂÈ Û˘Ó‹ıˆ˜ ÛÙÂÓfi
·˘¯¤Ó· Î·È ÙÔ›¯ˆÌ· ·fi ÈÓÒ‰Ë ÛÙÔȯ›·, Ê˘ÏÏÔÂÈ-
‰Â›˜ ıÚfiÌ‚Ô˘˜ Î·È ·Ô˘Û›· Ì˘ÔηډȷÎÔ‡ ÈÛÙÔ‡.
™¿ÓÈ· ¤Ó· „¢‰Ô·Ó‡ڢÛÌ· ÌÔÚ› Ó· ‰ËÌÈÔ˘Ú-
ÁËı› ÌÂÙ¿ ·fi Ú‹ÍË ·ÏËıÔ‡˜ ·Ó¢ڇÛÌ·ÙÔ˜. ∏
Û˘ÌÊÔÚËÙÈ΋ ηډȷ΋ ·ÓÂ¿ÚÎÂÈ· ÌÂ Û˘ÓÔ‰fi
ÛÙËı¿Á¯Ë Â›Ó·È ÔÈ Û˘¯ÓfiÙÂÚ˜ ÎÏÈÓÈΤ˜ ÂΉËÏÒ-
ÛÂȘ, Ì ÈÔ Û¿ÓÈ· ÙËÓ ÂÌÊ¿ÓÈÛË Û˘ÁÎÔ‹˜, ıÚÔÌ-
‚ÔÂÌ‚ÔÏÈÎÒÓ ÂÈÏÔÎÒÓ Î·È ÎÔÈÏÈ·ÎÒÓ ·ÚÚ˘ı-
ÌÈÒÓ2. ∏ Û˘ÓËı¤ÛÙÂÚË ÂÓÙfiÈÛ‹ ÙÔ˘˜ Â›Ó·È ÛÙÔ
ÚfiÛıÈÔ ‹ ÙÔ Ï¿ÁÈÔ ÙÔ›¯ˆÌ·, ÛÙË ÌÂÛfiÙËÙ· Ù˘
ÎÔÈÏ›·˜ Î·È Î·Ù¿ Ì‹ÎÔ˜ Ù˘ ÎÔÚ˘Ê‹˜ Î·È Ù˘ ‚¿Û˘
·˘Ù‹˜. OÈ ·ÛıÂÓ›˜ Ì ٤ÙÔÈÔ „¢‰Ô·Ó‡ڢÛÌ·
¤¯Ô˘Ó Û˘Ó‹ıˆ˜ ÔÏ˘·ÁÁÂȷ΋ ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ ÌÂ
·fiÊÚ·ÍË ÙÔ˘Ï¿¯ÈÛÙÔÓ Ì›·˜ ÌÂÁ¿Ï˘ ÛÙÂÊ·ÓÈ·›·˜
·ÚÙËÚ›·˜. ™¿ÓÈ·, fiˆ˜ ÛÙËÓ ÂÚ›ÙˆÛ‹ Ì·˜, Ô
288 ∫.™. ƒ∞ªªO™, Ã.π. ∫∞ƒµOÀ¡∏™
·ÛıÂÓ‹˜ ·ÚÔ˘ÛÈ¿˙ÂÙ·È Ì „¢‰Ô·Ó‡ڢÛÌ· Ù˘
·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ ¯ˆÚ›˜ ·fiÊÚ·ÍË Î‡ÚÈˆÓ ÛÙÂÊ·-
ÓÈ·›ˆÓ ·ÚÙËÚÈÒÓ4.
∏ ‰È¿ÁÓˆÛË ‚·Û›˙ÂÙ·È ÛÙËÓ 2D-˯ÔηډÈÔ-
ÁÚ·Ê›·, ÙËÓ ˘ÚËÓÈ΋ ·ÁÁÂÈÔÁÚ·Ê›·, ÙËÓ ÎÔÈÏÈÔ-
ÁÚ·Ê›· Ì ÛÎÈ·ÛÙÈÎfi Î·È ÙË Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›·
(NMR). À‹ÚÍ·Ó ‰ËÌÔÛȇÛÂȘ ÂÈÙ˘¯Ô‡˜ ‰ÈfiÚ-
ıˆÛ˘ ÛÙË ‰ÂηÂÙ›· ÙÔ˘ ’705,6 Î·È Û˘Ó¯›˙ÔÓÙ·È Ì¤-
¯ÚÈ Û‹ÌÂÚ· ·Ú¿ ÙË Û·ÓÈfiÙËÙ· Ù˘ ÂÈÏÔ΋˜ ·˘-
Ù‹˜7,8. OÈ Û˘Ó‹ıÂȘ ÙÚfiÔÈ ¯ÂÈÚÔ˘ÚÁÈ΋˜ ıÂÚ·›·˜
Â›Ó·È Ë ÂÌÊÚ·ÁÌ·ÙÂÎÙÔÌ‹ Î·È Ë ·ÓÙÈηٿÛÙ·ÛË ÌÂ
ÚÔÛıÂÙÈÎfi ÂÌ‚¿ÏˆÌ· ‹ ·Ï‹ Û˘ÚÚ·Ê‹ ÂÓÈÛ¯˘Ì¤-
ÓË Ì ψڛ‰Â˜ Teflon Î·È ¤Á¯˘ÛË ‚ÈÔÏÔÁÈ΋˜ ÎfiÏ-
Ï·˜ ÛÙËÓ ÂÈηډȷ΋ ÂÈÊ¿ÓÂÈ·2.
OÈ ÏfiÁÔÈ ·ÚÔ˘Û›·Û˘ Ù˘ ÂÚ›ÙˆÛ˘ ·˘Ù‹˜
Â›Ó·È ·ÊÂÓfi˜ Ë ·ÛÊ·Ï‹˜ ÚÔÛ¤Ï·ÛË (ÌËÚÈ·ÈÔ-ÌË-
ÚÈ·›· ·Ú¿Î·Ì„Ë Î·È ÛÙË Û˘Ó¤¯ÂÈ· ̤ÛË ÛÙÂÚÓÔ-
ÙÔÌ‹) ·ÔʇÁÔÓÙ·˜ ÙÔÓ Î›Ó‰˘ÓÔ ÂÈÛfi‰Ô˘ Û ¢ÌÂ-
Á¤ıË „¢‰Ô·Ó¢ڇÛÌ·Ù· Ì ÂÂÎÙ¿ÛÂȘ fi¯È ¿ÓÙÔ-
Ù ‰È¢ÎÚÈÓÈṲ̂Ó˜ ·fi ÙÔ ˘ÂÚ˯ÔηډÈÔÁÚ¿ÊË-
Ì· Î·È ÙËÓ ÎÔÈÏÈÔÁÚ·Ê›·, Î·È ·ÊÂÙ¤ÚÔ˘ Ë ÂÈ‚Â-
‚·›ˆÛË Ù˘ Û¯¤Û˘ Ù˘ ÌÂÙÂÌÊÚ·ÁÌ·ÙÈ΋˜ ·˘Ù‹˜
ÂÈÏÔ΋˜ Ì ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ ÂÏ¿¯ÈÛÙ˘ ¯ÂÈÚÔ˘Ú-
ÁÈ΋˜ ÛËÌ·Û›·˜.
SUMMARY
Rammos K, Karvounis Ch. Surgical treatment of a
left ventricular pseudoaneurysm in a patient with
minimal coronary artery disease. Hell Iatr 2004,
70: 286-288.
A 57-years-old male with a history of myocar-
dial infarction, 8 months prior to his admission, was
referred to our institution for surgical treatment of a
left ventricular (LV) (posterior-apical) pseudoane-
urysm. With obesity and family history of coronary
artery disease being the predisposing factors, he
presented with rest angina, shortness of breath, and
a systolic murmur localized at the left sternal bor-
der. Doppler echo and coronary angiography re-
vealed a well functioning LV with a false aneurysm
in the posterior apical region. In addition there was
an 80% stenosis of the most distal portion of the cir-
cumflex and the posterior descending branch of the
right coronary artery. Under general endotracheal
anesthesia, median sternotomy, femoro-femoral by-
pass, and crystalloid cardioplegia, a 4,5 × 2,5 cm fal-
se aneurysm originating from the apex and well ad-
herent and protruding from the left chest and dia-
phragm, was excised and the defect was closed pri-
marily with Teflon felts. There was no need for
CABG. The patient had an uneventful recovery,
being asymptomatic and in good general condition
in a 7 year’s follow up. The case is presented for the
safety of the approach (femoral-femoral bypass) and
the presence of a moderate size pseudoaneurysm in
contrast with minimal coronary artery disease.
µπµ§πO°ƒ∞ºπ∞
1. Mackenzie JW, Lemole GM. Pseudoaneurysm of the left
ventricle. Tex Heart Inst J 1994, 21: 296-301.
2. Sutherland FWH, Guell FJ, Pathi VL, Naik SK. Postin-
farction ventricular free wall rupture: strategies for
diagnosis and treatment. Ann Thorac Surg 1996 ; 61 :
1281-5.
3. Reddy SG, Roberts WC. Frequency of the left ventricular
free wall or ventricular septum among necropsy cases
of fatal myocardial infarction since the introduction of
coronary care units. Am J Cardiol 1989, 63: 906-11.
4. Tesler UF, Leccese A. Pseudoaneurysm of the free wall of
the left ventricle without obstruction of major coro-
nary arteries. Tex Heart Inst J 1996, 23: 58-61.
5. Fitzgibbon GM, Hooper GD, Heggtveit HA. Successful
surgical treatment of postinfarction external cardiac
rupture. J Thorac Cardiovasc Surg 1974, 63: 622-6.
6. Montegut FJ Jr. Left ventricular rupture secondary to
myocardial infarction: report of survival with surgical
repair. Ann Thorac Surg 1972, 14: 75-8.
7. Ruvolo G, Greco E, Speziale G, Di Natale M, Marino B.
Surgical repair of pseudo-aneurysm arising from a true
chronic aneurysm of the left ventricular lateral wall.
Eur J Cardio-Thorac Surg 1994, 8: 449-50.
8. Ivert T, Almdahl SM, Lunde P, Lindblow D. Post-infar-
ction left ventricular pseudoaneurysm - echocardio-
graphic diagnosis and surgical repair. Cardiovasc Surg
1994, 2: 463-6.
AÏÏËÏÔÁÚ·Ê›·:
∫. ™Ù. ƒ¿ÌÌÔ˜
∫·ÚfiÏÔ˘ ¡ÙËÏ 29
546 23 £ÂÛÛ·ÏÔÓ›ÎË
Corresponding author:
∫.St. Rammos
29, C. Diehl Str.
546 23 Thessaloniki
Greece
∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 2004, 70, 4: 289 - 291
C-·ÓÙȉÚÒÛ· ÚˆÙ½ÓË (CRP) Î·È Î·Ú‰È·ÁÁÂȷ΋ ÓfiÛÔ˜.
¡¤Â˜ ·fi„ÂȘ ÁÈ· ÌÈ· ÎÏ·ÛÈ΋ ÚˆÙ½ÓË
ÃÚ‹ÛÙÔ˜ §·Ê¿Ú·˜
∫·Ú‰ÈÔÏÔÁÈ΋ ªÔÓ¿‰·, ∞¡£ «£Â·Á¤ÓÂÈÔ», £ÂÛÛ·ÏÔÓ›ÎË
∏ ÂӉȷʤÚo˘Û· ÂÚ¢ÓËÙÈ΋ ÂÚÁ·Û›· ÙˆÓ ∑ȿη
Î·È Û˘Ó.1 o˘ ‰ËÌoÛȇÂÙ·È ÛÙo ·ÚfiÓ Ù‡¯o˜ ·-
oÙ¤ÏÂÛ Ùo ¤Ó·˘ÛÌ· ÁÈ· ÙË Û˘ÁÁÚ·Ê‹ ·˘Ùo‡ Ùo˘
¿ÚıÚo˘.
∂›Ó·È ÁÓˆÛÙfi fiÙÈ Ë ÊÏÂÁÌoÓ‹ Ùo˘ ÂÓ‰oıËÏ›o˘
Î·È Ù˘ ˘ÂÓ‰oıËÏȷ΋˜ ÛÙÈ‚¿‰·˜ Ùo˘ ·ÚÙËÚÈ·Îo‡
ÙoȯÒÌ·Ùo˜ ‰È·‰Ú·Ì·Ù›˙ÂÈ ÛËÌ·ÓÙÈÎfi ÚfiÏo ÙfiÛo
ÛÙËÓ ¤Ó·ÚÍË, fiÛo Î·È ÛÙËÓ ÂͤÏÈÍË Ù˘ ÛÙÂÊ·ÓÈ·›-
·˜ ÓfiÛo˘. ∏ Ì˘oηډȷ΋ Ó¤ÎÚˆÛË o˘ ·ÎoÏo˘-
ı› Ùo o͇ ¤ÌÊÚ·ÁÌ· Ùo˘ Ì˘oηډ›o˘ (O∂ª) ÚÔ-
ηÏ› ÙËÓ ·Ú·ÁˆÁ‹ ÂÏ¢ı¤ÚˆÓ ÚÈ˙ÒÓ Î·È ˘ÚÔ-
‰ÔÙ› ÙÔÓ «Î·Ù·ÚÚ¿ÎÙË» Ù˘ ÊÏÂÁÌÔÓ‹˜. ∏ C-·ÓÙÈ-
‰ÚÒÛ· ÚˆÙ½ÓË (CRP) ıˆÚÂ›Ù·È Ô Î‡ÚÈÔ˜ ÂÎÚfi-
ÛˆÔ˜ ÙˆÓ ÚˆÙÂ˚ÓÒÓ Ù˘ ÔÍ›·˜ Ê¿Û˘ Î·È Û˘ÓÙ›-
ıÂÙ·È ÛÙÔ ‹·Ú Ì ÙË ‰Ú¿ÛË Î˘ÙÙ·ÚÔÎÈÓÒÓ, ȉȷ›ÙÂ-
Ú· Ù˘ ÈÓÙÂÚÏ¢ΛÓ˘-6, Ô˘ ·ÂÏ¢ıÂÚÒÓÔÓÙ·È
·fi ÙÔ ÊÏÂÁÌ·›ÓÔÓÙ· ÈÛÙfi. OÈ Ê˘ÛÈÔÏÔÁÈΤ˜ Ù˘ ÙÈ-
̤˜ Î˘Ì·›ÓÔÓÙ·È ·fi 0-1,0 mg/dl. ™Â ·ÛıÂÓ›˜ ÌÂ
ÔÍ›· ÊÏÂÁÌÔÓ‹ Ë Û˘ÁΤÓÙÚˆÛ‹ Ù˘ ÌÔÚ› Ó· ·˘-
ÍËı› ̤¯ÚÈ Î·È 1000 ÊÔÚ¤˜, Û ·ÓÙ›ıÂÛË Ì ÙȘ ¿Ï-
Ϙ ÚˆÙ½Ó˜ Ù˘ ÔÍ›·˜ Ê¿Û˘, fiˆ˜ ÈÓˆ‰ÔÁfiÓÔ,
·ÙÔÛÊ·ÈÚ›ÓË, ÛÂÚÔ˘ÏÔÏ·ÛÌ›ÓË Î·È Û˘Ìϋڈ̷
C3 Î·È C4 Ô˘ ·˘Í¿ÓÔÓÙ·È ÌfiÓÔ 2-3 ÊÔÚ¤˜ Û ۯ¤ÛË
Ì ÙȘ ·ÓÙ›ÛÙÔȯ˜ ÛÂ Û˘Óı‹Î˜ ËÚÂÌ›·˜. À„ËϤ˜
Û˘ÁÎÂÓÙÚÒÛÂȘ Ù˘ CRP ¤¯Ô˘Ó ·Ú·ÙËÚËı› ÛÂ
·ÛıÂÓ›˜ Ì ÏÔÈÌÒÍÂȘ, ηÎÔ‹ıË ÓÔÛ‹Ì·Ù·, ·ÚıÚ›-
Ùȉ·, ÙÚ·‡Ì·, ¯ÂÈÚÔ˘ÚÁÈΤ˜ ÂÂÌ‚¿ÛÂȘ, ¿Á¯Ô˜ ηÈ
Ôͤ· ÈÛ¯·ÈÌÈο Û‡Ó‰ÚÔÌ·.
∞ӷηχÊıËΠÙÔ 1930 ·fi ÙÔ˘˜ Tillet ηÈ
Francis, ÔÈ ÔÔ›ÔÈ ·Ú·Ù‹ÚËÛ·Ó fiÙÈ Ë ÚÔÛı‹ÎË
ÔÚÔ‡ ·ÛıÂÓÒÓ Ì Ó¢ÌÔÓ›· ÚÔηÏÔ‡Û ›˙ËÌ·
Ù˘ C-ÔÏ˘Û·Î¯·Ú›‰Ë˜ ÙÔ˘ Ó¢ÌÔÓÈÔÎfiÎÎÔ˘2. ∂›-
Ó·È Û‹ÌÂÚ· ÁÓˆÛÙfi fiÙÈ Ë CRP ·Ó·ÁÓˆÚ›˙ÂÈ ÂȉÈο
ÙËÓ ÊˆÛÊÔ¯ÔÏ›ÓË, Ô˘ ·ÔÙÂÏ› ÙÔ ˘‰ÚfiÊÈÏÔ ÙÌ‹-
289
Ì· Ù˘ ʈÛÊ·Ùȉ˘ÏÔ¯ÔÏ›Ó˘ ÛÙȘ ΢ÙÙ·ÚÈΤ˜ ÌÂÌ-
‚Ú¿Ó˜. ∏ Û‡Ó‰ÂÛ‹ Ù˘ ÛÙÔ ÙÔ›¯ˆÌ· ÙˆÓ Î˘ÙÙ¿ÚˆÓ
ÂÓÂÚÁÔÔÈ› ÙÔ Û˘Ìϋڈ̷ ̤ۈ Ù˘ ÎÏ·ÛÈ΋˜
Ô‰Ô‡, ‰ÈÂÁ›ÚÂÈ Ù· Ì·ÎÚÔÊ¿Á· Î·È ¿ÏÏ· ·ÙÙ·Ú·
ÁÈ· Ê·ÁÔ΢ÙÙ¿ÚˆÛË3 Î·È Û˘ÌÌÂÙ¤¯ÂÈ ÛÙË ‰È·‰Èη-
Û›· Û˘ÁÎfiÏÏËÛ˘ ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ4, ÂΉËÏÒÓÔ-
ÓÙ·˜ ¤ÙÛÈ ÙË ‚ÈÔÏÔÁÈ΋ Ù˘ ‰Ú¿ÛË.
∞Ó Î·È Ë CRP ¤¯ÂÈ ¯ÚËÛÈÌÔÔÈËı› Â˘Ú‡Ù·Ù·
ÛÙËÓ ÎÏÈÓÈ΋ Ú¿ÍË, ÙfiÛÔ ÁÈ· ÙË ‰È¿ÁÓˆÛË Î·È ÙËÓ
ÂͤÏÈÍË Ù˘ ÂÓÂÚÁÔ‡ Ê¿Û˘ ‰È·ÊfiÚˆÓ ÓfiÛˆÓ, fiÛÔ
Î·È ÁÈ· ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ÂÊ·ÚÌÔ˙fiÌÂ-
Ó˘ ıÂÚ·›·˜, ÙÂÏÂ˘Ù·›· ¤¯ÂÈ ·Ó·˙ˆ˘Úˆı› ÙÔ
ÂӉȷʤÚÔÓ ÏfiÁˆ Ù˘ ¯ÚËÛÈÌfiÙËÙ¿˜ Ù˘ ÛÙȘ ηÚ-
‰È·ÁÁÂȷΤ˜ ·ı‹ÛÂȘ. ∞˘Ùfi ÔÊ›ÏÂÙ·È ÛÙËÓ Î·Ï‡-
ÙÂÚË Î·Ù·ÓfiËÛË ÙÔ˘ ÚfiÏÔ˘ Ù˘ ÊÏÂÁÌÔÓ‹˜ ÛÙËÓ
·ıÔÊ˘ÛÈÔÏÔÁ›· Ù˘ ·ıËÚÔÛÎÏ‹ÚˆÛ˘ Î·È ÙˆÓ Ô-
ͤˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ Û˘Ó‰ÚfïÓ. ∫ÏÈÓÈΤ˜ ÌÂϤÙ˜
¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ Ë CRP ÌÔÚ› Ó· ¯ÚËÛÈÌÔÔÈËı›
ˆ˜ ‰Â›ÎÙ˘ ÁÈ· ÙË ‰È·ÛÙڈ̿وÛË ÎÈÓ‰‡ÓÔ˘ ÙfiÛÔ
Û ˘ÁÈ›˜5,6, fiÛÔ Î·È Û ·ÛıÂÓ›˜ Ì ·ÛÙ·ı‹ ÛÙË-
ı¿Á¯Ë Î·È O∂ª7.
O ÚfiÏÔ˜ Ù˘ CRP Û ·ÛıÂÓ›˜ Ì O∂ª ¤¯ÂÈ
ÌÂÏÂÙËı› ·fi ·ÚÎÂÙÔ‡˜ ÂÚ¢ÓËÙ¤˜. ¢È·ÈÛÙÒıËÎÂ
fiÙÈ Ë CRP ·˘Í¿ÓÂÙ·È ÂÚ›Ô˘ 12 ÒÚ˜ ·fi ÙËÓ
¤Ó·ÚÍË Ù˘ ÓfiÛÔ˘, Êı¿ÓÂÈ ÛÙË Ì¤ÁÈÛÙË ÙÈÌ‹ Ù˘
ÛÙȘ 50 ÒÚ˜ Î·È ÛÙË Û˘Ó¤¯ÂÈ· ˘Ô¯ˆÚ› ÚÔԉ¢-
ÙÈο ̤¯ÚÈ ÙËÓ ¤‚‰ÔÌË Ë̤ڷ. ∆Ô ÂÚÒÙËÌ· ‹Ù·Ó
Â¿Ó Ë Û˘ÁΤÓÙÚˆÛ‹ Ù˘ ·ÔÙÂÏ› ¢·›ÛıËÙÔ Î·È
·ÍÈfiÈÛÙÔ ‰Â›ÎÙË ÂÎÙ›ÌËÛ˘ Ù˘ ¤ÎÙ·Û˘ Ù˘ ÂÌ-
ÊÚ·ÁÌ·ÙÈ΋˜ ˙ÒÓ˘ Î·È Â¿Ó ÔÈ ˘„ËÏfiÙÂÚ˜ ÙÈ̤˜
Ù˘ ·ÓÙÈηÙÔÙÚ›˙Ô˘Ó ÙË ÛÔ‚·ÚfiÙËÙ· ÙÔ˘ ÂÌÊÚ¿Á-
Ì·ÙÔ˜ Î·È Û˘ÓÂÒ˜ ÙË ¯ÂÈÚfiÙÂÚË ÚfiÁÓˆÛË. OÈ ÌÂ-
ϤÙ˜ ¤‰ÂÈÍ·Ó fiÙÈ ÔÈ ÙÈ̤˜ Ù˘ CRP ‹Ù·Ó ¯·ÌËÏfiÙÂ-
Ú˜ ÛÙ· non-Q ÂÌÊÚ¿ÁÌ·Ù· Û˘ÁÎÚÈÙÈο Ì ٷ Q-
290 X. §∞º∞ƒ∞™
∂ª, ηıÒ˜ Î·È ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ÂÈÙ˘¯‹ ıÚÔÌ-
‚fiÏ˘ÛË Î·È Â·Ó·ÈÌ¿ÙˆÛË Û ۇÁÎÚÈÛË Ì ÂΛ-
ÓÔ˘˜ Ì ·ÓÂÈÙ˘¯‹ ıÚÔÌ‚fiÏ˘ÛË, ›Ù ÙÔ˘˜ ·ÛıÂÓ›˜
¯ˆÚ›˜ ıÚÔÌ‚ÔÏ˘ÙÈ΋ ıÂÚ·›·8. ∂ÊfiÛÔÓ fiÏ· Ù·
∂ª Û˘Ó‰¤ÔÓÙ·È Ì ·ÂÏ¢ı¤ÚˆÛË Ù˘ CRP, ˘„Ë-
ÏfiÙÂÚ˜ ÙÈ̤˜ “Ô˘‰Ô‡” ı· Ú¤ÂÈ Ó· ¯ÚËÛÈÌÔÔÈË-
ıÔ‡Ó ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË Ù˘ ÛÔ‚·ÚfiÙËÙ·˜ ÙÔ˘ ÂÌ-
ÊÚ¿ÁÌ·ÙÔ˜ Î·È Ù˘ ÚfiÎÏËÛ˘ ηډȷÁÁÂÈ·ÎÒÓ
Û˘Ì‚·Ì¿ÙˆÓ.
ªÈ· ·fi ÙȘ ÈÔ ·ÍÈfiÏÔÁ˜ ÌÂϤÙ˜ Ô˘ Û˘-
Û¯¤ÙÈÛ·Ó ÙȘ ÌÂÙ·‚ÔϤ˜ Ù˘ CRP Ì ÙËÓ ÚfiÁÓˆÛË
ÙˆÓ ·ÛıÂÓÒÓ Ì Ô͇ ¤ÌÊÚ·ÁÌ· Ì˘Ôηډ›Ô˘ ›ӷÈ
ÙˆÓ Pietila Î·È Û˘Ó.9. ªÂÏÂÙ‹ıËÎ·Ó 188 ·ÛıÂÓ›˜
Ô˘ ˘Ô‚Ï‹ıËÎ·Ó Û ıÚÔÌ‚ÔÏ˘ÙÈ΋ ıÂÚ·›· ÌÂ
ÛÙÚÂÙÔÎÈÓ¿ÛË (124 ¿ÙÔÌ·) ‹ t-PA (64 ¿ÙÔÌ·) ηÈ
ÌÂÙÚ‹ıËÎÂ Ë CRP Â› 7 Ë̤Ú˜ ÌÂÙ¿ ÙËÓ ÂΉ‹ÏˆÛË
Ù˘ ÓfiÛÔ˘. ™˘Û¯ÂÙ›ÛÙËÎ·Ó ÔÈ ÌÂÙ·‚ÔϤ˜ Ù˘ ÙfiÛÔ
Ì ÙËÓ ÔÏÈ΋ ıÓËÛÈÌfiÙËÙ· fiÛÔ Î·È Ù· ÂÈ̤ÚÔ˘˜
ηډȷο ·›ÙÈ· ı·Ó¿ÙÔ˘ (Ó¤Ô ∂ª, Û˘ÌÊÔÚËÙÈ΋
ηډȷ΋ ·ÓÂ¿ÚÎÂÈ· Î·È ·ÈÊÓ›‰ÈÔ˜ ηډȷÎfi˜ ı¿-
Ó·ÙÔ˜), Û˘ÓÔÏÈο ÛÙ· 2 ¤ÙË ·Ú·ÎÔÏÔ‡ıËÛ˘ ηÈ
ÛÙȘ ÂÍ‹˜ ÛÙ·ıÂÚ¤˜ ¯ÚÔÓÈΤ˜ ÂÚÈfi‰Ô˘˜: 3 Ì‹Ó˜, 3-
6, 6-12 Î·È 12-24 Ì‹Ó˜. ™˘Ó¤‚ËÛ·Ó 28 ı¿Ó·ÙÔÈ, ·fi
ÙÔ˘˜ ÔÔ›Ô˘˜ ÔÈ 17 ÙÔ˘˜ ÚÒÙÔ˘˜ 6 Ì‹Ó˜ (14+3
·ÓÙ›ÛÙÔȯ·) Î·È 11 (6+5 ·ÓÙ›ÛÙÔȯ·) ÛÙËÓ ÂfiÌÂÓË
ÂÚ›Ô‰Ô. ¢È·ÈÛÙÒıËΠfiÙÈ Ë Ì¤ÁÈÛÙË ÙÈÌ‹ Ù˘ CRP,
Ô˘ ÌÂÙÚ‹ıËΠÌÂٷ͇ Ù˘ 2˘ Î·È 4˘ ̤ڷ˜ ·fi ÙËÓ
ÂΉ‹ÏˆÛË ÙÔ˘ ÂÌÊÚ¿ÁÌ·ÙÔ˜, ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ·Â-
‚›ˆÛ·Ó, ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚË Ù˘ ·ÓÙ›ÛÙÔȯ˘ ÂΛӈÓ
Ô˘ Â¤˙ËÛ·Ó, ·ÏÏ¿ ÌfiÓÔ ÛÙÔ˘˜ ÚÒÙÔ˘˜ 3-6 Ì‹Ó˜
Ù˘ ·Ú·ÎÔÏÔ‡ıËÛ˘ (166 mg/dl ¤Ó·ÓÙÈ 136 mg/dl,
·ÓÙ›ÛÙÔȯ·). ∂ÈϤÔÓ, ÔÈ ÙÈ̤˜ Ù˘ CRP ÛÙÔ˘˜ ·-
ÛıÂÓ›˜ Ô˘ η٤ÏËÍ·Ó ·fi Û˘ÌÊÔÚËÙÈ΋ ηډȷ΋
·ÓÂ¿ÚÎÂÈ· ‹Ù·Ó ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚ˜ ·fi ÙȘ
·ÓÙ›ÛÙÔȯ˜ ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ÂÌÊ¿ÓÈÛ·Ó ·ÈÊÓ›‰ÈÔ
ηډȷÎfi ı¿Ó·ÙÔ (226 mg/dl ¤Ó·ÓÙÈ 167 mg/dl). ∆Ô
ÙÂÏÈÎfi Û˘Ì¤Ú·ÛÌ· ÙˆÓ ÂÚ¢ÓËÙÒÓ ‹Ù·Ó fiÙÈ Ë ·˘-
ÍË̤ÓË CRP ÌÔÚ› Ó· ¯ÚËÛÈÌÔÔÈËı› ˆ˜ ÚÔÁÓˆ-
ÛÙÈÎfi˜ ‰Â›ÎÙ˘ ÁÈ· ÙËÓ ÂͤÏÈÍË ÙˆÓ ·ÛıÂÓÒÓ ÌÂ
O∂ª Ô˘ ˘Ô‚Ï‹ıËÎ·Ó Û ıÚÔÌ‚ÔÏ˘ÙÈ΋ ıÂÚ·-
›·, ·ÏÏ¿ ÌfiÓÔ ÁÈ· ÙÔ˘˜ ÚÒÙÔ˘˜ 6 Ì‹Ó˜ ·fi ÙËÓ
ÂΉ‹ÏˆÛË Ù˘ ÓfiÛÔ˘.
OÈ Anzai Î·È Û˘Ó.10 ÌÂÏÂÙÒÓÙ·˜ 220 ·ÛıÂÓ›˜
Ì ÚˆÙÔÂÌÊ·ÓÈÛı¤Ó Ô͇ ‰È·ÙÔȯˆÌ·ÙÈÎfi ¤ÌÊÚ·Á-
Ì· Ì˘Ôηډ›Ô˘ ·Ú·Ù‹ÚËÛ·Ó ÛËÌ·ÓÙÈ΋ Û˘Û¯¤ÙÈ-
ÛË ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ CRP Ì ÙËÓ ÚfiÎÏËÛË Ú‹Í˘
ÙÔ˘ Ì˘Ôηډ›Ô˘ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÓÔÛËÏ›·˜,
·Ó¢ڇÛÌ·ÙÔ˜ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜, ‹ ηډȷÎÔ‡
ı·Ó¿ÙÔ˘, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÙÈÌ‹ “cut off” ÁÈ· ÙË
CRP Ù· 20 mg/dl (Odds ratio significance: 4,72,
2,11 Î·È 3,44 ·ÓÙ›ÛÙÔȯ·).
OÈ Tommasi Î·È Û˘Ó.11 ·Ú·ÎÔÏÔ‡ıËÛ·Ó 64
·ÛıÂÓ›˜ Ì ·ÓÂ›ÏÂÎÙÔ O∂ª ÁÈ· 13±4 Ì‹Ó˜, ÔÈ
ÔÔ›ÔÈ ÔÚ›ÛÙËÎ·Ó ˆ˜ ÔÈ ·ÛıÂÓ›˜ ¯ˆÚ›˜ ˘ÔÏÂÈfi-
ÌÂÓË ÈÛ¯·ÈÌ›· ÛÙË ‰ÔÎÈÌ·Û›· ÎfiˆÛ˘, ÚÈÓ ÙËÓ
¤ÍÔ‰Ô ·fi ÙÔ ÓÔÛÔÎÔÌÂ›Ô Î·È ÌÂ Ê˘ÛÈÔÏÔÁÈ΋ Û˘-
ÛÙÔÏÈ΋ ÏÂÈÙÔ˘ÚÁ›· Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ (ÎÏ¿ÛÌ·
ÂÍÒıËÛ˘ >50%). ¢È·ÈÛÙÒıËΠfiÙÈ ÔÈ ·ÛıÂÓ›˜
Ô˘ ÂÌÊ¿ÓÈÛ·Ó ÂÈÏÔΤ˜ (ı¿Ó·ÙÔ˜, Â·ÓÂÌÊ¿ÓÈ-
ÛË ÛÙËı¿Á¯Ë˜ ‹ Ó¤Ô ∂ª) ›¯·Ó ÛËÌ·ÓÙÈο ˘„ËÏfi-
ÙÂÚ˜ ÙÈ̤˜ CRP (3,61±2,83 mg/dl ¤Ó·ÓÙÈ 1,48±
2,07 mg/dl ·ÓÙ›ÛÙÔȯ·). ™˘Ì¤Ú·Ó·Ó ÏÔÈfiÓ fiÙÈ Ë
CRP ÌÔÚ› Ó· ¯ÚËÛÈÌÔÔÈËı› ˆ˜ ÚÔÁÓˆÛÙÈÎfi˜
‰Â›ÎÙ˘ ÌÂÏÏÔÓÙÈ΋˜ ÂÌÊ¿ÓÈÛ˘ ηډȷÁÁÂÈ·ÎÒÓ
Û˘Ì‚·Ì¿ÙˆÓ Î·È ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ·ÓÂ›ÏÂÎÙÔ
¤ÌÊÚ·ÁÌ· Ì˘Ôηډ›Ô˘.
∆· Â˘Ú‹Ì·Ù· ÙˆÓ ∑ȿη Î·È Û˘Ó. Û˘ÌʈÓÔ‡Ó
Ì ·˘Ù¿ ÙˆÓ ·Ó·ÊÂÚı¤ÓÙˆÓ ÂÚ¢ÓËÙÒÓ. OÈ Ì¤ÁÈ-
ÛÙ˜ ÙÈ̤˜ Ù˘ CRP ÌÂÙÚ‹ıËÎ·Ó ÛÙȘ 48-72 ÒÚ˜
·fi ÙËÓ ÂΉ‹ÏˆÛË ÙÔ˘ ÂÌÊÚ¿ÁÌ·ÙÔ˜, Ì ÚÔԉ¢-
ÙÈ΋ Ì›ˆÛË ÙËÓ ¤‚‰ÔÌË Ë̤ڷ Î·È Â·Ó·ÊÔÚ¿
ÛÙȘ ÙÈ̤˜ ηٿ ÙËÓ ÚÔÛ¤ÏÂ˘Û‹ ÙÔ˘˜ ÛÙÔ˘˜ 6 Ì‹Ó˜.
∏ ÂÓ‰ÔÓÔÛÔÎÔÌÂȷ΋ ÂͤÏÈÍË ‹Ù·Ó ÔÌ·Ï‹ ÛÙÔ˘˜ 24
·ÛıÂÓ›˜ Î·È 6 ·ÚÔ˘Û›·Û·Ó ηډȷÁÁÂȷΤ˜ ÂÈ-
ÏÔΤ˜ (2 ÌÂÙÂÌÊÚ·ÁÌ·ÙÈ΋ ÛÙËı¿Á¯Ë Î·È 4 ηÚ-
‰È·Î‹ ·ÓÂ¿ÚÎÂÈ·), ÔÈ ÔÔ›ÔÈ Â›¯·Ó ·ÓÂÈÙ˘¯‹
ıÚÔÌ‚fiÏ˘ÛË. OÈ ÌÂÙ·‚ÔϤ˜ Ù˘ CRP ÌÂÙ¿ 12 ÒÚ˜
Î·È ÙËÓ 7Ë Ë̤ڷ ‹Ù·Ó ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚ˜ ·fi
ÙȘ ·ÓÙ›ÛÙÔȯ˜ ÙˆÓ ·ÛıÂÓÒÓ ¯ˆÚ›˜ ÂÈÏÔΤ˜.
∞ÍÈÔÛËÌ›ˆÙÔ Â›Ó·È fiÙÈ ÔÏ˘·Ú·ÁÔÓÙÈ΋ ·Ó¿Ï˘ÛË
¤‰ÂÈÍ fiÙÈ Ë ÙÈÌ‹ Ù˘ CRP ÛÙȘ 24 ÒÚ˜ ‹Ù·Ó Ô ÛË-
Ì·ÓÙÈÎfiÙÂÚÔ˜ ·Ú¿ÁÔÓÙ·˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·Ó Ì ÙËÓ
ÂÓ‰ÔÓÔÛÔÎÔÌÂȷ΋ ÚfiÁÓˆÛË ·ÎÔÏÔ˘ıÔ‡ÌÂÓË ·fi
ÙÔ ÎÏ¿ÛÌ· ÂÍÒıËÛ˘ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ Î·È ÙËÓ
ÂÈÙ˘¯›· ‹ fi¯È Ù˘ ıÚÔÌ‚fiÏ˘Û˘. ™˘ÓÂÒ˜ Ô Ì˯·-
ÓÈÛÌfi˜ Ì ÙÔÓ ÔÔ›Ô Ë CRP Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ÂÓ‰Ô-
ÓÔÛÔÎÔÌÂȷ΋ ÚfiÁÓˆÛË Â›Ó·È ÔÏ˘·Ú·ÁÔÓÙÈÎfi˜.
∏ Û‡ÓıÂÛ‹ Ù˘ ÔÊ›ÏÂÙ·È fi¯È ÌfiÓÔ ÛÙË Ì˘Ôηډȷ-
΋ Ó¤ÎÚˆÛË, ·ÏÏ¿ Î·È ÛÙ· ÂÓÂÚÁÔÔÈË̤ӷ Ì·ÎÚÔ-
Ê¿Á· ·fi ÙË Û˘Ó¯È˙fiÌÂÓË ÙÔÈ΋ ÊÏÂÁÌÔÓ‹ ÛÙ·
ÛËÌ›· ڋ͢ Ù˘ ˘‡ı˘Ó˘ ·ıËڈ̷ÙÒ‰Ô˘˜ Ï¿-
η˜. OÈ ÌÂÙ·‚ÔϤ˜ Ù˘ CRP ÛÙËÓ ÔÍ›· Ê¿ÛË ÙÔ˘
∂ª Û¯ÂÙ›˙ÔÓÙ·È Â›Û˘ Ì ÙË ÌÔÚÊÔÏÔÁ›· Ù˘ ˘‡-
ı˘Ó˘ ·ÁÁÂȷ΋˜ ‚Ï¿‚˘ ÛÙ· ÛÙÂÊ·ÓÈ·›· ·Á-
Á›·12,13. OÈ ·ÛıÂÓ›˜ Ô˘ ·ÚÔ˘Û›·Û·Ó ÂÈÏÔΤ˜
ÛÙËÓ ÂÍ¿ÌËÓË ·Ú·ÎÔÏÔ‡ıËÛË ÂÌÊ¿ÓÈÛ·Ó ÙÈ̤˜ Ù˘
CRP ÛÙȘ 24 ÒÚ˜ ·fi ÙËÓ ÂΉ‹ÏˆÛË ÙÔ˘ ÂÌÊÚ¿Á-
Ì·ÙÔ˜ ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚ˜ ·fi ÙȘ ·ÓÙ›ÛÙÔȯ˜
ÙˆÓ ·ÛıÂÓÒÓ Ì ÔÌ·Ï‹ ÔÚ›· (p≤0,01).
™ÙË ‰ˆ‰ÂοÌËÓË ·Ú·ÎÔÏÔ‡ıËÛË, ·Ó Î·È ÔÈ
ÙÈ̤˜ Ù˘ CRP ÛÙËÓ ÔÌ¿‰· ÙˆÓ ·ÛıÂÓÒÓ Ì ÂÈ-
ÏÔΤ˜ ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚ˜ ·fi ÙȘ ·ÓÙ›ÛÙÔȯ˜ ·˘-
 ∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 70, 4
ÙÒÓ Ì ÔÌ·Ï‹ ÔÚ›·, ‰Â ‰È·Ê¤ÚÔ˘Ó ÛÙ·ÙÈÛÙÈο ÛË-
Ì·ÓÙÈο. ∞Í›˙ÂÈ Ó· ·Ó·ÊÂÚı› Â›Û˘ fiÙÈ Ë ÂÈÙ˘-
¯›· ‹ fi¯È Ù˘ ıÚÔÌ‚fiÏ˘Û˘, ÔÈ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡-
ÓÔ˘ ÁÈ· ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ Î·È ÙÔ Â›‰Ô˜ Ù˘ ÂÊ·ÚÌÔ-
˙fiÌÂÓ˘ ıÂÚ·›·˜ (Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹, ·ÁÁÂÈÔ-
Ï·ÛÙÈ΋, ·ÔÚÙÔÛÙÂÊ·ÓÈ·›· ·Ú¿Î·Ì„Ë) ‰Â ‚Ú¤-
ıËΠӷ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ÚfiÁÓˆÛË ÙˆÓ ·ÛıÂ-
ÓÒÓ ÙfiÛÔ ÛÙÔ˘˜ 6, fiÛÔ Î·È ÛÙÔ˘˜ 12 Ì‹Ó˜.
∞fi ÙËÓ ·Ó·ÛÎfiËÛË Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜ Ê·›-
ÓÂÙ·È fiÙÈ Ë CRP ·ÔÙÂÏ› ¢·›ÛıËÙÔ Î·È ·ÍÈfiÈÛÙÔ
ÚÔÁÓˆÛÙÈÎfi ‰Â›ÎÙË Û ·ÛıÂÓ›˜ Ì O∂ª Ô˘
˘Ô‚Ï‹ıËÎ·Ó Û ıÚÔÌ‚ÔÏ˘ÙÈ΋ ıÂÚ·›·, ΢ڛˆ˜
Ù˘ ÂÓ‰ÔÓÔÛÔÎÔÌÂȷ΋˜ ÔÚ›·˜ Î·È ÏÈÁfiÙÂÚÔ Ù˘
Â͈ÓÔÛÔÎÔÌÂȷ΋˜ ÂͤÏÈ͢. ∏ Û˘ÌÌÂÙÔ¯‹ Ù˘
CRP ÛÙË ‰È·‰Èηۛ· Ù˘ ·ıËڈ̿وÛ˘ Î·È ÛÙËÓ
·ıÔÊ˘ÛÈÔÏÔÁ›· ÙˆÓ ÔͤˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ Û˘Ó‰Úfi-
ÌˆÓ ¤¯ÂÈ ÚÔÛ‰ÒÛÂÈ Ó¤Ô˘˜ ÚfiÏÔ˘˜ Û ¤Ó·Ó ·Ú·-
‰ÔÛÈ·Îfi ‰Â›ÎÙË, ·ÊÔ‡ Ë CRP Â›Ó·È ÌÈ· ÚˆÙ½ÓË
ÁÓˆÛÙ‹ ·fi Ôχ ·Ï·È¿14. ¶·Ú¿ÏÏËÏ· ¿ÓÔÈÍ Ӥ-
Ô˘˜ ÔÚ›˙ÔÓÙ˜ ÛÙË ıÂÚ·¢ÙÈ΋ ÚÔÛ¤ÁÁÈÛË ·˘ÙÒÓ
ÙˆÓ ·ÛıÂÓÒÓ. ¶ÚfiÛÊ·Ù˜ ÌÂϤÙ˜ ¤‰ÂÈÍ·Ó Û˘Û¯¤-
ÙÈÛË ÌÂٷ͇ Ù˘ ÂÓÂÚÁÔÔ›ËÛ˘ ÙÔ˘ Ì˯·ÓÈÛÌÔ‡
Ù˘ ‹Í˘ Î·È ÙˆÓ ‰È·Ù·Ú·¯ÒÓ Ù˘ ÊÏÂÁÌÔÓÒ‰Ô˘˜
‰È·‰Èηۛ·˜ Û ·ÛıÂÓ›˜ Ì O∂ª, fiÔ˘ ·Ú·ÙË-
Ú‹ıËΠfiÙÈ Ô ·Ú¿ÁÔÓÙ·˜ ‹Í˘ FXa Û˘ÌÌÂÙ¤¯ÂÈ
ÛÙË ÊÏÂÁÌÔÓ‹ Ì ÙËÓ ·ÂÏ¢ı¤ÚˆÛË Ù˘ IL-815.
¶Èı·ÓfiÓ, ÛÙÔ Ì¤ÏÏÔÓ Ë ¯ÚËÛÈÌÔÔ›ËÛË ·Ó·-
ÛÙÔϤˆÓ ÙˆÓ ÊÏÂÁÌÔÓˆ‰ÒÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ Î·È Î·-
Ù¿ Û˘Ó¤ÂÈ· Ë ÂÏ¿ÙÙˆÛË Ù˘ CRP, ¤Ú· ·fi ÙËÓ
ÎÏ·ÛÈ΋ Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ Ó· Û˘Ì‚¿ÏÂÈ ÛÙË
‚ÂÏÙ›ˆÛË Ù˘ ÚfiÁÓˆÛ˘ ÙˆÓ ·ÛıÂÓÒÓ Ì Ôͤ·
ÈÛ¯·ÈÌÈο Û‡Ó‰ÚÔÌ·16.
µπµ§πO°ƒ∞ºπ∞
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Ï˘ı¤Ó Ô͇ ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘ Î·È Û˘Û¯¤ÙÈÛË
Ù˘ Ì ÙËÓ ÂÓ‰ÔÓÔÛÔÎÔÌÂȷ΋ Î·È ÙËÓ ·ÒÙÂÚË Úfi-
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∞ÏÏËÏÔÁÚ·Ê›·:
Ã. §·Ê¿Ú·˜
∫·ÚfiÏÔ˘ ¡ÙËÏ 12
546 23 £ÂÛÛ·ÏÔÓ›ÎË
Corresponding author:
C. Lafaras
12, C. Diehl Str.
546 23 Thessaloniki
Greece