EÏÏËÓÈÎË I·ÙÚÈÎË

TfiÌÔ˜ 75 • T‡¯Ô˜ 1
π·ÓÔ˘¿ÚÈÔ˜ – ª¿ÚÙÈÔ˜ 2009

¶ÂÚȯfiÌÂÓ·
EÓËÌÂÚˆÙÈο 5 ΔÔ ÔÍÂȉˆÙÈÎfi stress ÛÙË ¯ÚfiÓÈ· ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ·
¿ÚıÚ· Ã. ¡ÈÎÔÏ·˝‰Ô˘, °. ªÔ˘ÓÙÔ‡Ú˘

26 EÍÂÏ›ÍÂȘ ÛÙË ¯ÂÈÚÔ˘ÚÁÈ΋ ÙˆÓ ÂÈÓÂÊÚȉ›ˆÓ

∞. ∫·Ì·ÚÔ‡‰Ë˜, £. °ÂÚ·ÛÈÌ›‰Ë˜

38 “μÈÔ-ÔÈÎÔÏÔÁÈ΋” ·ÓÙÈÌÂÙÒÈÛË Ù˘ ¯ÚfiÓÈ·˜ Ë·ÙÈ΋˜ ‚Ï¿‚˘

Î·È ÂÁÎÂÊ·ÏÔ¿ıÂÈ·˜
S. Bengmark

47 º·Ú̷΢ÙÈ΋ ıÂÚ·›· Ù˘ ·¯˘Û·ÚΛ·˜

ª. ªÔ˘ÁÔ˘ÏÈ¿, ∏. ∂˘ı˘Ì›Ô˘

∂Ú¢ÓËÙÈΤ˜ 57 ∏ Â›‰Ú·ÛË Ù˘ Û˘Ó¯ԇ˜ ÂÓ‰ÔÊϤ‚È·˜ ¯ÔÚ‹ÁËÛ˘

ÂÚÁ·Û›Â˜ ÎÚ˘ÛÙ·ÏÏÈ΋˜ ÈÓÛÔ˘Ï›Ó˘ ÁÈ· ÙËÓ Â›Ù¢ÍË ÓÔÚÌÔÁÏ˘Î·ÈÌ›·˜
ÛÙË ıÓËÛÈÌfiÙËÙ· ÙˆÓ ÂÓ‹ÏÈÎˆÓ ·ÛıÂÓÒÓ Ù˘ ª∂£.
À¿Ú¯ÂÈ Â·Ú΋˜ ÙÂÎÌËÚ›ˆÛË;
∞. ª·ÛÙÚÔÎÒÛÙ·˜, ª. °ÎÚÈ˙ÈÒÙË, ¢. ¶··‰ËÌËÙÚ›Ô˘

65 ∂Ê·ÚÌÔÁ‹, ·ÍÈÔÏfiÁËÛË Î·È Û˘Û¯¤ÙÈÛË Ì ‰È¿ÊÔÚÔ˘˜ ·Ú¿ÁÔÓÙ˜

ÙÔ˘ ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘ ÔÈfiÙËÙ·˜ ˙ˆ‹˜ (HQLQ) ÛÙË ¯ÚfiÓÈ· Ë·Ù›Ùȉ· C
∂. ™ÈÓ¿ÎÔ˜, ∂. °ÈÁ‹, μ. ΔÛ¿·˜, £. §¿ÏÏ·, ∞. ª¤ÏÏÔ˘,
∞. ™Ô‡ÎÈ·, ª. ƒ·ÙÔÔ‡ÏÔ˘-°ÈÁ‹

74 ∏ Â›‰Ú·ÛË Ù˘ Ì·ÎÚÔ¯ÚfiÓÈ·˜ ¿ÛÎËÛ˘ ÛÙË ÏÂÈÙÔ˘ÚÁÈ΋

ÈηÓfiÙËÙ· Î·È ÙËÓ ÔÈfiÙËÙ· ˙ˆ‹˜ ·ÙfiÌˆÓ Ì ۯÈ˙ÔÊÚ¤ÓÂÈ·
¢. ª·ÌÂÏÂÙ˙‹, μ. £ÂÔ¯¿ÚË, ∂. ∫Ô˘ï‰‹, ¢. ∫·Ó‰‡Ï˘, Ã. ™›η,
∞. ∫·ÏÙÛ¿ÙÔ˘, °. ∫·Ú›Ó˘, ∞. ¢ÂÏËÁÈ¿ÓÓ˘

84 OÈ ‰È·¯ÚÔÓÈΤ˜ Ù¿ÛÂȘ Ù˘ ıÓËÛÈÌfiÙËÙ·˜ ÙÔ˘ ÂÏÏËÓÈÎÔ‡ ÏËı˘ÛÌÔ‡

·fi ÙÔ˘˜ ΢ÚÈfiÙÂÚÔ˘˜ Ù‡Ô˘˜ ηÚΛÓÔ˘ (1980-2005)
¡. ¶··‰¿Î˘, ¶. °ÂˆÚÁÈ·Ófi˜, ∂. °ÚËÁÔÚ¿ÎË, ¢. ÷ڷϷÌ›‰Ë˜,
O. ΔÛ·¯Ô˘Ú›‰Ô˘, °. ¶··‰¿Î˘, ∞. ª¤ÓÔ˜

∂ȉÈÎfi ¿ÚıÚÔ 91 ∂˘ı·Ó·Û›·

π. ª·ÓˆÏ‰¿Î˘
 Helliniki Iatriki
Volume 75 • No 1
January – March 2009

Contents
Brief reviews 5 Oxidative stress in chronic renal failure
Nikolaidou C, Boudouris G.

26 The evolving surgical treatment of adrenal gland diseases

Kambaroudis A, Gerasimidis T.

38 Bio-ecological control of chronic liver disease and encephalopathy

Bengmark S.

47 Pharmacotherapy for obesity

Bougoulia M, Efthimiou H.

Investigative 57 Evidence of continuous IV insulin administration for nomoglycemia,

papers in terms of mortality of adult critically ill patients
Mastrokostas A, Grizioti M, Papadimitiou D.

65 Translation, validation and application of the disease specific

for viral hepatitis quality of life questionnaire HQLQ
Sinakos E, Gigi E, Tsapas V, Lalla T, Bellou A, Soukja A,
Raptopoulou-Gigi M.

74 Effect of long-term exercise training on functional capacity

and quality of life in schizophrenics
Mamaletzi D, Theochari V, Kouidi E, Kandilis D, Sipka Ch,
Kaltsatou A, Kaprinis G, Deligianns A.

84 Temporal evaluation (1980-2005) of specific mortality rates of main

malignant tumors in the Greek population
Papadakis NG, Georgianos PI, Grigoraki E, Charalambidis D,
Tsachouridou O, Papadakis G, Benos A.

Special article 91 Euthanasia

Manoledakis J.
∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 2009, 75, 1: 5-25
ΔÔ ÔÍÂȉˆÙÈÎfi stress ÛÙË ¯ÚfiÓÈ· ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ·
Ã. ¡ÈÎÔÏ·˝‰Ô˘, °ÂÒÚÁÈÔ˜ ªÔ˘ÓÙÔ‡Ú˘
¢ã ¶·ıÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ ∞¶£, ¡ÔÛÔÎÔÌÂ›Ô πÔÎÚ¿ÙÂÈÔ, £ÂÛÛ·ÏÔÓ›ÎË
¶ÂÚ›ÏË„Ë. ΔÔ ÔÍÂȉˆÙÈÎfi stress Ô˘ ÚÔ·ÙÂÈ ·fi
·ÓÈÛÔÚÚÔ›· ÌÂٷ͇ Ù˘ ·Ú·ÁˆÁ‹˜ ÔÍÂȉˆÙÈÎÒÓ
Ô˘ÛÈÒÓ Î·È Ù˘ ÚÔÛٷ٢ÙÈ΋˜ ‰Ú¿Û˘ ÙˆÓ ·ÓÙÈÔ-
ÍÂȉˆÙÈÎÒÓ Û˘ÛÙËÌ¿ÙˆÓ Î·È ·ÔÙÂÏ› ÌÈ· ‰˘ÓËÙÈο
‚Ï·‚ÂÚ‹ ηٿÛÙ·ÛË ÁÈ· ÙÔÓ ÔÚÁ·ÓÈÛÌfi. ∂›Ó·È ϤÔÓ
·Ô‰ÂÎÙfi fiÙÈ Ë ¯ÚfiÓÈ· ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ· ¯·Ú·-
ÎÙËÚ›˙ÂÙ·È ·fi ÔÍÂȉˆÙÈÎfi stress, Ì¿ÏÈÛÙ· Ì ÚÔ˚-
Ô‡Û· Â›Ù·ÛË, ·Ú¿ÏÏËÏË Ì ÙËÓ ÂͤÏÈÍË Ù˘ ÓÂÊÚÈ-
΋˜ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·˜, Ì ÂÚ·ÈÙ¤Úˆ Âȉ›ӈÛË Î·Ù¿
ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙˆÓ ÎÏ·ÛÈÎÒÓ ÌÂıfi‰ˆÓ οı·ÚÛ˘. OÈ
΢ÚÈfiÙÂÚÔÈ ÏfiÁÔÈ Â›Ó·È Ë «‚ÈÔ·Û˘Ì‚·ÙfiÙËÙ·» ÙˆÓ
¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓˆÓ ˘ÏÈÎÒÓ, ÔÈ ·ÚÂÓ¤ÚÁÂȘ ÙˆÓ Â-
͈ÁÂÓÒ˜ ¯ÔÚËÁÔ‡ÌÂÓˆÓ Ô˘ÛÈÒÓ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ·
Ù˘ Û˘Ó‰ڛ·˜ οı·ÚÛ˘, ηıÒ˜ Î·È ÔÈ Ì·ÎÚÔ¯ÚfiÓȘ
∂π™∞°ø°∏
OÍÂȉˆÙÈÎfi stress, ÔÍÂȉˆÙÈΤ˜ Ô˘Û›Â˜ ηÈ
·ÓÙÈÔÍÂȉˆÙÈο Û˘ÛÙ‹Ì·Ù·
ø˜ ÔÍÂȉˆÙÈÎfi stress ¯·Ú·ÎÙËÚ›˙ÂÙ·È Ë ‰È·Ù·Ú·¯‹
Ù˘ ÈÛÔÚÚÔ›·˜ ÌÂٷ͇ Ù˘ ·Ú·ÁˆÁ‹˜ ÔÍÂȉˆÙÈ-
ÎÒÓ Ô˘ÛÈÒÓ Î·È Ù˘ ·ÓÙÈÚÚÔÈÛÙÈ΋˜ ‰Ú¿Û˘ ÙˆÓ
·ÓÙÈÔÍÂȉˆÙÈÎÒÓ Û˘ÛÙËÌ¿ÙˆÓ ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡
˘¤Ú ÙˆÓ ÚÒÙˆÓ, ÌÈ· ηٿÛÙ·ÛË Ô˘ ÌÔÚ› ‰˘-
ÓËÙÈο Ó· ÚÔηϤÛÂÈ ‚Ï¿‚Ë ÙˆÓ ÈÛÙÒÓ. ¶ÈÔ Û˘-
ÁÎÂÎÚÈ̤ӷ, ÌÔÚ› Ó· ÚÔ·ÙÂÈ ·fi «˘¤ÚÌÂ-
ÙÚË» Î·È «·ıÚfi·» ¿ıÚÔÈÛË ÔÍÂȉˆÙÈÎÒÓ Ô˘ÛÈÒÓ,
·ÓÂ¿ÚÎÂÈ· ÙˆÓ ·ÓÙÈÔÍÂȉˆÙÈÎÒÓ Û˘ÛÙËÌ¿ÙˆÓ, ‹
Î·È Ù· ‰‡Ô. ∏ ·Ú·ÁˆÁ‹ ÔÍÂȉˆÙÈÎÒÓ Ô˘ÛÈÒÓ ·-
ÔÙÂÏ› ÛËÌ·ÓÙÈÎfi ÛÙÔÈ¯Â›Ô Ù˘ ÊÏÂÁÌÔÓÒ‰Ô˘˜
‰È·‰Èηۛ·˜ Î·È ÙˆÓ ·Ì˘ÓÙÈÎÒÓ Ì˯·ÓÈÛÌÒÓ Î·Ù¿
‚·ÎÙËÚ›ˆÓ Î·È ¿ÏÏˆÓ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÒÓ, ‹ ·ÎfiÌ·
ηٿ ηÎÔ‹ıˆÓ ΢ÙÙ¿ÚˆÓ ÂÓÒ Û˘Ì‚¿ÏÏÂÈ ÛÙË ‰È·-
‰Èηۛ· Ù˘ ·Ó¿Ï·Û˘ ÙˆÓ ÈÛÙÒÓ ÌÂÙ¿ ·fi ‚Ï¿-
5
ÂÈÙÒÛÂȘ ÙˆÓ ›‰ÈˆÓ ÙˆÓ ÌÂıfi‰ˆÓ ˘ÔηٿÛÙ·Û˘
ÛÙȘ Ê˘ÛÈÔÏÔÁÈΤ˜ ‰Ô̤˜ ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡. ΔÔ ·˘ÍË̤-
ÓÔ ÔÍÂȉˆÙÈÎfi stress, ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙȘ ˘fiÏÔÈ˜
‰È·Ù·Ú·¯¤˜ Ô˘ ¯·Ú·ÎÙËÚ›˙Ô˘Ó ÙÔ˘˜ ¯ÚfiÓÈÔ˘˜ ÓÂ-
ÊÚÔ·ı›˜ ·ÛıÂÓ›˜, Ô‰ËÁ› Û ·˘ÍË̤ÓË ıÓËÙfiÙËÙ·
Î·È ıÓËÛÈÌfiÙËÙ· ·fi ηډȷÁÁÂȷο ΢ڛˆ˜ ·›ÙÈ·. ∏
ÚÔÛ¿ıÂÈ· ÁÈ· ÙË ‰È·Ù‹ÚËÛË Ù˘ ˘ÔÏÂÈÌÌ·ÙÈ΋˜
ÓÂÊÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ Î·È ÙËÓ ·Ó‡ÚÂÛË ÂÚÈÛÛfiÙÂÚÔ
«‚ÈÔÛ˘Ì‚·ÙÒÓ» ÌÂıfi‰ˆÓ Î·È ˘ÏÈÎÒÓ ˘ÔηٿÛÙ·Û‹˜
Ù˘, ·ÔÙÂÏÔ‡Ó Ù· ‚·ÛÈο ̤۷ ·ÓÙÈÌÂÙÒÈÛ˘ ÙÔ˘
ÔÍÂȉˆÙÈÎÔ‡ stress, Î·È ÂÔ̤ӈ˜ ÙÔ˘˜ ÚˆÙ·Ú¯È-
ÎÔ‡˜ ÙÔÌ›˜ ¤Ú¢ӷ˜.
EÏÏËÓ I·ÙÚ 2009, 75: 5 - 25.
‚Ë1. ∞fi ÙËÓ ¿ÏÏË, ÌÈ· ˘¤ÚÌÂÙÚË, «·ÚfiÛÊÔÚË»
‹ ‰˘ÛÚÔÛ·ÚÌÔÛÙÈ΋ ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ ÔÍÂȉˆÙÈ-
ÎÒÓ ‰È·‰ÈηÛÈÒÓ Î·È ˘ÂÚ·Ú·ÁˆÁ‹ ÔÍÂȉˆÙÈÎÒÓ
Ô˘ÛÈÒÓ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ¯ÚfiÓÈˆÓ ·ıÔÏÔÁÈÎÒÓ
ηٷÛÙ¿ÛˆÓ, fiˆ˜ Ë ¤ÎÙˆÛË Ù˘ ÓÂÊÚÈ΋˜ ÏÂÈ-
ÙÔ˘ÚÁ›·˜, ÌÔÚ› Ó· ÚÔηϤÛÂÈ Î˘ÙÙ·ÚÈ΋ ηÈ
ÈÛÙÈ΋ ‚Ï¿‚Ë2. ŒÙÛÈ, ÙÔ ÔÍÂȉˆÙÈÎfi stress Èı·ÓfiÓ
Ó· ÂÌϤÎÂÙ·È ÛÙËÓ ·ıÔÁ¤ÓÂÈ· οÔÈˆÓ ÂÈÏÔ-
ÎÒÓ Ù˘ ÓÂÊÚÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ (·ıËÚÔÛÎÏ‹ÚˆÛË,
·Ó·ÈÌ›·, η΋ ıÚ¤„Ë, ·Ì˘ÏÔ›‰ˆÛË), ÂȉÂÈÓÒÓÂ-
Ù·È ·Ú¿ÏÏËÏ· Ì ÙËÓ ÂÈ‚¿Ú˘ÓÛË Ù˘ ÓÂÊÚÈ΋˜
ÏÂÈÙÔ˘ÚÁ›·˜ Î·È Á›ÓÂÙ·È ÂÓÙÔÓfiÙÂÚÔ Ì ÙȘ ÌÂıfi-
‰Ô˘˜ ˘ÔηٿÛÙ·Û˘ —Ì ÂӉ¯fiÌÂÓË ÌÂÁ·Ï‡ÙÂ-
ÚË ·ÚÓËÙÈ΋ Â›‰Ú·ÛË Ù˘ ·ÈÌÔοı·ÚÛ˘ ¤Ó·ÓÙÈ
Ù˘ ÂÚÈÙÔÓ·˚΋˜3.
∫‡ÚÈÔ˜ ÙfiÔ˜ ·Ú·ÁˆÁ‹˜ ÔÍÂȉˆÙÈÎÒÓ Ô˘-
ÛÈÒÓ ÛÙÔÓ ÔÚÁ·ÓÈÛÌfi Â›Ó·È ÙÔ ÌÈÙÔ¯fiÓ‰ÚÈÔ —̤ۈ
Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ ·Ï‡ÛÔ˘— Ù· ÔÏ˘ÌÔÚÊÔ‡ÚË-
Ó· Ô˘‰ÂÙÂÚfiÊÈÏ· Î·È Ù· ÌÔÓÔ·ÙÙ·Ú·-Ì·ÎÚÔÊ¿-
6 Ã. ¡π∫O§∞´¢OÀ, °. ª¶OÀ¡ΔOÀƒ∏™

Á·. ™ÙÔ ÓÂÊÚfi ËÁ¤˜ ·ÔÙÂÏÔ‡Ó Ù· ÂÓÂÚÁÔÔÈË̤-
Ó· Ì·ÎÚÔÊ¿Á·, Ù· ÂÓ‰ÔıËÏȷο ·ÙÙ·Ú·, ÔÈ ÈÓÔ-
‚Ï¿ÛÙ˜ Î·È Ù· ‰È·ÌÂÛÔÛˆÏËÓ·Úȷο ·ÙÙ·Ú·4. OÈ
΢ÚÈfiÙÂÚ˜ ÔÍÂȉˆÙÈΤ˜ Ô˘Û›Â˜ Ô˘ ·Ú¿ÁÔÓÙ·È Â›-
Ó·È ÔÈ ‰Ú·ÛÙÈΤ˜ Ú›˙˜ Ô͢ÁfiÓÔ˘ (ROS) Î·È ¿ÏϘ
ÂχıÂÚ˜ Ú›˙˜. ΔÔ ˘ÂÚÔÍ›‰ÈÔ ÙÔ˘ ˘‰ÚÔÁfiÓÔ˘
(∏2O2), ÙÔ ˘ԯψÚÈ҉˜ Ô͇ (∏OCl), Ë Ú›˙· ÙÔ˘
˘ÂÚÔÍÂȉ›Ô˘ ÙÔ˘ Ô͢ÁfiÓÔ˘ (O2–), ÙÔ ˘‰ÚÔ͇ÏÈÔ
(O∏–) Î·È ÙÔ ÌÔÓÔÍ›‰ÈÔ ÙÔ˘ ·˙ÒÙÔ˘ (¡O–) ·ÔÙÂ-
ÏÔ‡Ó ÙȘ ÛËÌ·ÓÙÈÎfiÙÂÚ˜ ÔÍÂȉˆÙÈΤ˜ Ô˘Û›Â˜5. Δ·
·Ú·¿Óˆ ÌfiÚÈ· ·Ú¿ÁÔÓÙ·È Û˘Ó¯Ҙ ÛÙÔÓ ÔÚÁ·-
ÓÈÛÌfi Î·È ¤¯Ô˘Ó ‚Ú·¯‡ ¯ÚfiÓÔ ËÌ›ÛÂÈ·˜ ˙ˆ‹˜. ∂Ô-
̤ӈ˜, Ë ·Ï‹ ·Ó›¯ÓÂ˘Û‹ ÙÔ˘˜, ÂÎÙfi˜ ·fi ÙË ‰˘-
ÛÎÔÏ›· Ô˘ ÂÌÂÚȤ¯ÂÈ, ‰ÂÓ ·ÔÙÂÏ› Û·Ê‹ ¤Ó‰ÂÈ-
ÍË ÔÍÂȉˆÙÈÎÔ‡ stress6. OÈ Ô˘Û›Â˜ Ô˘ ÚÔ·ÙÔ˘Ó
·fi ÙËÓ ÔÍÂȉˆÙÈ΋ ÌÂÙ·ÙÚÔ‹ ÙˆÓ ÏÈȉ›ˆÓ, ÙˆÓ
ÚˆÙÂ˚ÓÒÓ, ÙˆÓ ˘‰·Ù·ÓıÚ¿ÎˆÓ Î·È ÙˆÓ ÓÔ˘ÎÏÂ˚-
ÎÒÓ ÔͤˆÓ ¤¯Ô˘Ó ¯ÚfiÓÔ˘˜ ËÌ›ÛÂÈ·˜ ˙ˆ‹˜ ˆÚÒÓ Ì¤-
¯ÚÈ Â‚‰ÔÌ¿‰ˆÓ Î·È ·ÔÙÂÏÔ‡Ó È‰·ÓÈÎÔ‡˜ ‰Â›ÎÙ˜
·Ó›¯Ó¢Û˘ ÙÔ˘ ÔÍÂȉˆÙÈÎÔ‡ stress. Δ· ‚ÈÔÌfiÚÈ·
Ô˘ ˘fiÎÂÈÓÙ·È Â˘ÎÔÏfiÙÂÚ· ÛÙË ‰Ú¿ÛË ÂχıÂÚˆÓ
ÚÈ˙ÒÓ Â›Ó·È Ù· ÏÈ›‰È·. ¶ÈÔ Û˘ÁÎÂÎÚÈ̤ӷ, ·Ï-
‰Â˛‰Â˜, fiˆ˜ Ë ·ÎÚÔϽÓË, Ë Ì·ÏÔÓ˘ÏÔ‰È·Ï‰Â˛‰Ë
(MDA), Ë 4 hydroxynonenal (∏¡∂) Î·È ÔÈ ÂÓÂÚÁ¤˜
Ô˘Û›Â˜ ÙÔ˘ ıÂÈÔ‚·Ú‚ÈÙÔ˘ÚÈÎÔ‡ ÔͤԘ (TBARS),
ÚÔ·ÙÔ˘Ó ·fi ·Ï˘ÛȉˆÙ¤˜ ·ÓÙȉڿÛÂȘ Ô˘
·ÎÔÏÔ˘ıÔ‡Ó ÙËÓ ˘ÂÚÔÍ›‰ˆÛË ÙˆÓ ÏÈȉ›ˆÓ. Δ·
F2-ÈÛÔÚÔÛÙ¿ÓÈ· ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙËÓ ÔÍ›‰ˆÛË
ÙÔ˘ ·Ú·¯È‰ÔÓÈÎÔ‡ ÔͤԘ, ÂÓÒ ¯Ú‹ÛÈÌÔ˘˜ ‰Â›ÎÙ˜ Ô-
ÍÂȉˆÙÈÎÔ‡ stress ÌÔÚ› Ó· ·ÔÙÂϤÛÔ˘Ó Ù· ÙÂÏÈ-
ο ÚÔ˚fiÓÙ· ÔÍ›‰ˆÛ˘ ÙˆÓ ÏÈȉ›ˆÓ (ALEs) ηÈ
Ù· ·ÓÙÈÛÒÌ·Ù· ηٿ ÙˆÓ ÔÍÂȉˆÌ¤ÓˆÓ ¯·ÌËÏ‹˜
˘ÎÓfiÙËÙ·˜ ÏÈÔÚˆÙÂ˚ÓÒÓ (anti-ox-LDLs). ∏ Ô-
Í›‰ˆÛË ÙˆÓ ÚˆÙÂ˚ÓÒÓ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ ÛÙË
‰ËÌÈÔ˘ÚÁ›· ÚˆÙÂ˚ÓÈÎÒÓ Î·Ú‚ÔÓ˘Ï›ˆÓ Î·È ÚÔ˚fi-
ÓÙˆÓ ·ÓıÂÎÙÈÎÒÓ ÛÙËÓ ÚˆÙÂfiÏ˘ÛË, fiˆ˜ Ù·
ÚˆÙÂ˚ÓÈο ÚÔ˚fiÓÙ· ÚÔίˆÚË̤Ó˘ ÔÍ›‰ˆÛ˘
(AOPPs), ηْ ·Ó·ÏÔÁ›· Ì ٷ ÙÂÏÈο ÚÔ˚fiÓÙ· ÚÔ-
ίˆÚË̤Ó˘ ÁÏ˘ÎÔÙÂÏÈ΋˜ ÔÍ›‰ˆÛ˘ (AGEs)2. Δ·
ÙÂÏÂ˘Ù·›· (AGEs) ·ÔÙÂÏÔ‡Ó ÌÈ· ηÙËÁÔÚ›· ·fi
Û‡ÓıÂÙ· ÚÔ˚fiÓÙ·. ∂›Ó·È ÛÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ· ÙÔ
·ÔÙ¤ÏÂÛÌ· ÁÏ˘ÎÔÍ›‰ˆÛ˘, ·ÏÏ¿ ÌÔÚ› Ó· ·ÔÙÂ-
ÏÔ‡Ó ÙÂÏÈο ÚÔ˚fiÓÙ· Ù˘ ÔÍ›‰ˆÛ˘ ÙˆÓ ÏÈȉ›ˆÓ.
OÈ Î·Ï‡ÙÂÚ· ¯ËÌÈο ¯·Ú·ÎÙËÚÈṲ̂Ó˜ ÂÓÒÛÂȘ
AGEs ÛÙÔÓ ¿ÓıÚˆÔ Â›Ó·È Ë ÂÓÙÔÛȉ›ÓË Î·È Ë
ηڂÔ͢Ï-ÌÂı˘Ï-Ï˘Û›ÓË (CML)7. Δ¤ÏÔ˜, Ë ÔÍ›‰ˆ-
ÛË ÙˆÓ ÓÔ˘ÎÏÂ˚ÎÒÓ ÔͤˆÓ, Ë ÔÔ›· ÌÔÚ› Ó· Û˘Ì-
‚¿ÏÏÂÈ ÛÙË ÌÂÙ·ÏÏ·ÍÈÔÁ¤ÓÂÛË Î·È ÔÁÎÔÁ¤ÓÂÛË,
Ô‰ËÁ› Û ÚÔ˚fiÓÙ· fiˆ˜ Ë 8-˘‰ÚÔ͢-2-‰ÂÔ͢ÁÔ˘-
·ÓÔÛ›ÓË (8-OHdG)8.
O ·ÓıÚÒÈÓÔ˜ ÔÚÁ·ÓÈÛÌfi˜ ·Ó¤Ù˘ÍÂ Û˘ÛÙ‹-
Ì·Ù· Ô˘ ·ÓÙ·ÁˆÓ›˙ÔÓÙ·È ÙË ‰Ú¿ÛË ÙˆÓ ÔÍÂȉˆÙÈ-
ÎÒÓ Ô˘ÛÈÒÓ, Û ÌÈ· ÚÔÛ¿ıÂÈ· Ó· ‰È·ÙËÚËı› Ë
··Ú·›ÙËÙË ÈÛÔÚÚÔ›· ÁÈ· ÙËÓ ÚÔÛÙ·Û›· ÙÔ˘ ·fi
ÙËÓ ÔÍÂȉˆÙÈ΋ ‚Ï¿‚Ë. Δ· ·ÓÙÈÔÍÂȉˆÙÈο ·˘Ù¿ Û˘-
ÛÙ‹Ì·Ù· ÌÔÚ› Ó· Â›Ó·È ÂÓ˙˘ÌÈο ‹ ÌË. ™Ù· ÚÒÙ·
·Ó‹ÎÔ˘Ó Ë ˘ÂÚÔÍÂȉÈ΋ ‰ÈÛÌÔ˘Ù¿ÛË (SOD), Ô˘
ÌÂÙ·ÙÚ¤ÂÈ ÙÔ O2– Û ∏2O2, ÙÔ ÔÔ›Ô ÛÙË Û˘Ó¤¯ÂÈ·
ÌÂÙ·ÙÚ¤ÂÙ·È Û ÓÂÚfi (∏2O) ·fi ÙËÓ Î·Ù·Ï¿ÛË.
∞ÎfiÌ·, Ë ÂÚȤ¯Ô˘Û· ÛÂÏ‹ÓÈÔ ˘ÂÚÔÍÂȉ¿ÛË Ù˘
ÁÏÔ˘Ù·ıÂÈfiÓ˘ (GSH-Px), Ô˘ ·ÓÙȉڿ Ì ÙȘ ÏÈÈ-
‰ÈΤ˜ ˘ÂÚÔÍÂȉ¿Û˜. ™Ù· ÌË ÂÓ˙˘ÌÈο ·ÓÙÈÔÍÂÈ-
‰ˆÙÈο Û˘ÛÙ‹Ì·Ù· ·Ó‹ÎÔ˘Ó Ë ÁÏÔ˘Ù·ıÂÈfiÓË
(GSH) Ë ÔÔ›· ·ÓÙȉڿ Ì ∏2O2, ÙÔ O∏– Î·È ÙȘ
¯ÏˆÚȈ̤Ó˜ ÔÍÂȉˆÙÈΤ˜ Ô˘Û›Â˜, Ë ÊÂÚÚÈÙ›ÓË, Ë
ÙÚ·ÓÛÊÂÚÚ›ÓË, Ë ÛÂÚÔ˘ÏÔÏ·ÛÌ›ÓË, ·ÎfiÌ· Î·È Ë
ÏÂ˘ÎˆÌ·Ù›ÓË. ∂͈ÁÂÓ›˜ Ô˘Û›Â˜, fiˆ˜ ÔÈ ‚Èٷ̛Ә
A, C Î·È E, Ô ¯·ÏÎfi˜ Î·È ÙÔ ÛÂÏ‹ÓÈÔ ·ÔÙÂÏÔ‡Ó
Â›Û˘ ÛËÌ·ÓÙÈΤ˜ ÌË ÂÓ˙˘ÌÈΤ˜ ·ÓÙÈÔÍÂȉˆÙÈΤ˜
Ô˘Û›Â˜1,9,10 (EÈÎ. 1). ™ËÌÂÈÒÓÂÙ·È fï˜, fiÙÈ Ë Ï¢-
Έ̷ٛÓË ÛÙÔ ÂÚÈ‚¿ÏÏÔÓ ÙÔ˘ ÓÂÊÚÔ‡ ÌÔÚ› Ó·
ÚÔηϤÛÂÈ ÙËÓ ·Ú·ÁˆÁ‹ ÊÏÂÁÌÔÓÔÁfiÓˆÓ Î˘ÙÙ·-

Ακολουθίες σημάτων/γονιδιακή έκφραση

Αντιοξειδωτικά ένζυμα ;

Πρωτεΐνες Αμινοξέα Σύστημα γλουταθειόνης

παραγωγή ROS Μικρή δραστικότητα,

Αντιοξειδωτικές ουσίες
αλλά υψηλή συγκέντωση Μεγάλη δραστικότητα,
αλλά όχι υψηλές
συγκεντρώσεις

∂ÈÎ. 1. ∏ ÔÍÂȉԷӷÁˆÁÈ΋ ÔÌÔÈfiÛÙ·ÛË: ÌÈ· ¢·›ÛıËÙË ÈÛÔÚÚÔ›· ÌÂٷ͇ ÙˆÓ ÔÍÂȉˆÙÈÎÒÓ Ô˘ÛÈÒÓ Î·È ÙˆÓ ·ÓÙÈÔÍÂÈ-
‰ˆÙÈÎÒÓ Û˘ÛÙËÌ¿ÙˆÓ ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡.
 ∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 75, 1 7

Oυραιμία
(καρβονυλικό stress,
άθροιση τοξινών)

Βλάβη πρωτεϊνών
(καρβονύλια, ΑΟPPs, AGEs)

Διέγερση SR
(ρόλος διακόπτη) Κυτταροκίνες
(TNF-α, IL-1β, IL-6)
και άλλοι μεσολαβητές
Ενεργοποίηση φλεγμονής
φλεγμονωδών και
αγγειακών κυττάρων

Ενεργές ρίζες
οξυγόνου και αζώτου
(ROS/RNS)

Αιμοκάθαρση
(ενεργοποίηση
λευκοκυττάρων)

∂ÈÎ. 2. O Ê·‡ÏÔ˜ ·ÎÏÔ˜ ÊÏÂÁÌÔÓ‹˜ Î·È ÔÍÂȉˆÙÈÎÔ‡ stress Ô˘ ‰ËÌÈÔ˘ÚÁÂ›Ù·È ·fi ÙËÓ ˘¤ÚÌÂÙÚË ‰È¤ÁÂÚÛË ÙˆÓ ÂÎ-
ηı·ÚÈÛÙÈÎÒÓ ˘Ô‰Ô¯¤ˆÓ (SR) ·fi ÙȘ ÔÍÂȉˆÌ¤Ó˜ ÚˆÙ½Ó˜ (ηڂÔÓ‡ÏÈ·/ AOPPs), ÏÈ›‰È· Î·È ˘‰·Ù¿ÓıڷΘ
(AGEs).

ÚÔÎÈÓÒÓ ÛÙ· ÂÁÁ‡˜ ÛˆÏËÓ·Úȷο ·ÙÙ·Ú·, ̤ۈ
Ù˘ ÂÓÂÚÁÔÔ›ËÛ˘ ÙÔ˘ ÁÔÓȉ›Ô˘ ÙÔ˘ ˘ÚËÓÈÎÔ‡
·Ú¿ÁÔÓÙ·-Îμ (NF-ÎB). O Ì˯·ÓÈÛÌfi˜ ·˘Ùfi˜ ·Ô-
ÙÂÏ› ÌÈ· ÂÏ΢ÛÙÈ΋ ıˆڛ· ÁÈ· ÙË ‚Ï¿‚Ë ÙÔ˘ ÓÂ-
ÊÚÔ‡ ·fi ÙËÓ ÚˆÙÂ˚ÓÔ˘Ú›·11.
∫·Ù¿ ÙËÓ ·Ú·ÁˆÁ‹ ÌÂÁ¿Ï˘ ÔÛfiÙËÙ·˜ ÔÍÂÈ-
‰ˆÙÈÎÒÓ Ô˘ÛÈÒÓ, Ù· ·ÓÙÈÔÍÂȉˆÙÈο Û˘ÛÙ‹Ì·Ù· fi¯È
ÌfiÓÔ ·ÓÂ·ÚÎÔ‡Ó, ·ÏÏ¿ ÌÔÚ› Ù· ›‰È· Ó· ÂÎÙÚ¤-
„Ô˘Ó ÙËÓ ÈÛÔÚÚÔ›· ÚÔ˜ ÙËÓ Î·Ù‡ı˘ÓÛË ÂÚ·ÈÙ¤-
Úˆ ÔÍÂȉˆÙÈÎÔ‡ stress. °È· ·Ú¿‰ÂÈÁÌ·, ¤ÓÙÔÓË
‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ SOD, ·ÏÏ¿ ·ÓÂ·Ú΋˜ ÛÙË Û˘-
Ó¤¯ÂÈ· ‰Ú¿ÛË Ù˘ ηٷϿÛ˘ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ ÛÂ
·‡ÍËÛË O∏– ˘fi ÙËÓ ·ÚÔ˘Û›· ÈfiÓÙˆÓ Ûȉ‹ÚÔ˘ ‹
¯·ÏÎÔ‡ (·ÓÙ›‰Ú·ÛË Fenton)4. ∞ӷʤÚÂÙ·È ·ÎfiÌ·
fiÙÈ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ¯ÚfiÓÈ· ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ·
Î·È Ô˘Ú·ÈÌ›· ˘fi ·ÈÌÔοı·ÚÛË, ·Ú·ÙËÚÂ›Ù·È Ì·˙È-
΋ Û˘ÁΤÓÙÚˆÛË ÂχıÂÚˆÓ Î·Ú‚ÔÓ˘Ï›ˆÓ – ÌÈ· η-
Ù¿ÛÙ·ÛË Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ˆ˜ «Î·Ú‚ÔÓ˘ÏÈÎfi
stress». Δ· ηڂÔÓ‡ÏÈ· ·˘Ù¿ ηı·›ÚÔÓÙ·È ·fi ÙÔÓ
ÔÚÁ·ÓÈÛÌfi ·fi ÌÈ· Ù¿ÍË ÚˆÙÂ˚ÓÈÎÒÓ ÌÂÌ‚Ú·ÓÒÓ,
ÙÔ˘˜ ÂÎηı·ÚÈÛÙÈÎÔ‡˜ ˘ԉԯ›˜ (SR-scavenger
receptors). ŸÙ·Ó ·Ú·ÙËÚÂ›Ù·È ¯ÚfiÓÈ· ÌÂÁ¿ÏË Û˘-
ÁΤÓÙÚˆÛË Î·Ú‚ÔÓ˘Ï›ˆÓ, AOPPs Î·È AGEs, ηıÒ˜
Î·È ˘ÂډȤÁÂÚÛË ÙˆÓ SR, ·˘ÙÔ› ÔÈ ÙÂÏÂ˘Ù·›ÔÈ ÌÔ-
ÚÔ‡Ó Ó· ÏÂÈÙÔ˘ÚÁ‹ÛÔ˘Ó ˆ˜ ¤Ó·˜ ‰È·ÎfiÙ˘ Ù˘
ÊÏÂÁÌÔÓÒ‰Ô˘˜ ‰È·‰Èηۛ·˜. ™Â Û˘Ó‰˘·ÛÌfi Ì ÙËÓ
Â›‰Ú·ÛË ÙÔ˘ ÔÍÂȉˆÙÈÎÔ‡ stress ÏfiÁˆ ·ÈÌÔοı·Ú-
Û˘, ‰ËÌÈÔ˘ÚÁÂ›Ù·È ¤Ó·˜ Ê·‡ÏÔ˜ ·ÎÏÔ˜ ÊÏÂÁÌÔÓ‹˜
Î·È ÔÍÂȉˆÙÈ΋˜ ηٿÛÙ·Û˘12 (∂ÈÎ. 2).
μÈÔÏÔÁÈΤ˜ ‰Ú¿ÛÂȘ ÙÔ˘ ÔÍÂȉˆÙÈÎÔ‡ stress
Ÿˆ˜ ·Ó·Ê¤ÚıËÎÂ, Ô Û¯ËÌ·ÙÈÛÌfi˜ ÙˆÓ ROS ·Ô-
ÙÂÏ› ̤ÚÔ˜ ÙÔ˘ ·Ì˘ÓÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÙÔ˘ ÔÚÁ·ÓÈ-
ÛÌÔ‡ ηٿ ‚·ÎÙËÚ›ˆÓ Î·È ¿ÏÏˆÓ ÌÈÎÚÔ‚›ˆÓ, ηÈ
Û˘Ó‰¤ÂÙ·È ¿ÌÂÛ· Ì ÙÔ˘˜ Ì˯·ÓÈÛÌÔ‡˜ Ù˘ ÊÏÂÁÌÔ-
Ó‹˜. ∞fi ÙËÓ ¿ÏÏË, ÔÈ ROS ÌÔÚ› Ó· ÂȉڿÛÔ˘Ó
Û ·ÙÙ·Ú· ÙÔ˘ ›‰ÈÔ˘ ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡, ΢ڛˆ˜ ÛÂ
ÂÚÈÔ¯¤˜ ÊÏÂÁÌÔÓ‹˜. ∫¿ÙÈ Ù¤ÙÔÈÔ ·Ú·ÙËÚÂ›Ù·È ÛÂ
ÔÈÎÈÏ›· ÓÂÊÚÈÎÒÓ ·ı‹ÛˆÓ, fiˆ˜ Ë ÛÂÈÚ·Ì·ÙÔ-
ÓÂÊÚ›Ùȉ·, Ë ÔÍ›· ‹ ¯ÚfiÓÈ· ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ·
Î·È Ë ‰È·ÌÂÛÔÛˆÏËÓ·Úȷ΋ ÓÂÊÚÔ¿ıÂÈ·13. ∞Ó·-
ʤÚÂÙ·È Â›Û˘ fiÙÈ ÌÔÚ› Ó· Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÙËÓ
8 Ã. ¡π∫O§∞´¢OÀ, °. ª¶OÀ¡ΔOÀƒ∏™
˘ÂÚÙÚÔÊ›· ÙˆÓ ÛˆÏËÓ·ÚÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ. OÈ ROS
ıˆÚÂ›Ù·È ·ÎfiÌ· fiÙÈ Û˘Ì‚¿ÏÏÔ˘Ó ÛÙËÓ ·ıÔÁ¤ÓÂÈ·
Ù˘ ÔÍ›·˜ ÛˆÏËÓ·Úȷ΋˜ Ó¤ÎÚˆÛ˘ ÈÛ¯·ÈÌÈ΋˜ ·È-
ÙÈÔÏÔÁ›·˜14. ŸÛÔÓ ·ÊÔÚ¿ ÛÙËÓ Â›‰Ú·ÛË ÙÔ˘ ÔÍÂÈ-
‰ˆÙÈÎÔ‡ stress ÛÙÔ Î·Ú‰È·ÁÁÂÈ·Îfi Û‡ÛÙËÌ·, ÙÔ ¡O
Ô˘ ‰Ú· ˆ˜ ·ÁÁÂÈԉȷÛÙ·ÏÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ·‰Ú·-
ÓÔÔÈÂ›Ù·È ·fi ÙÔ O2–, Î·È ÙÔ ÚÔ˚fiÓ Ù˘ ·ÓÙ›‰Ú·-
Û˘ O¡OO– (˘ÂÚÔ͢ÓÈÙÚ›ÙÈÔ) ¢ÓÔ› ÙÔ Û¯ËÌ·ÙÈ-
ÛÌfi ·ÎfiÌ· ÂÚÈÛÛfiÙÂÚˆÓ ROS fiˆ˜ ÙÔ O∏-. ™·Ó
·ÔÙ¤ÏÂÛÌ· ÚÔηÏÂ›Ù·È ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ÂÓ‰Ô-
ıËÏ›Ô˘ Î·È ÌÂÙ·‚ÔϤ˜ Ù˘ ΢ÙÙ·ÚÈ΋˜ ·Ó·‰È·ÌfiÚ-
ʈÛ˘. OÈ ·ıËÚÔÁfiÓ˜ ÏÈÔÚˆÙ½Ó˜ LDL ηÈ
Lp(a) (ÏÈÔÚˆÙ½ÓË ·) ÂÈÛ¤Ú¯ÔÓÙ·È Û’ ¤Ó· Ê·‡ÏÔ
·ÎÏÔ ÔÍ›‰ˆÛ˘ Î·È Á¤ÓÂÛ˘ ROS ˘ÂÓ‰ÔıËÏȷο.
∂Ô̤ӈ˜, ÙÔ ÔÍÂȉˆÙÈÎfi stress ·ÔÙÂÏ› ˘fi‚·ıÚÔ
Ù˘ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·˜, Ù˘ ·ıËÚÔÛÎÏ‹ÚˆÛ˘
Î·È Ù˘ ˘¤ÚÙ·Û˘4,15. Δ· ÙÂÏÂ˘Ù·›· ¤ÙË ÂÚÂ˘Ó¿Ù·È Ô
ÚfiÏÔ˜ ÙÔ˘ ÔÍÂȉˆÙÈÎÔ‡ stress ÛÙËÓ Î·ÚÎÈÓÔÁ¤ÓÂÛË,
ÙȘ Ó¢ÚÔÂÎÊ˘ÏÈÛÙÈΤ˜ ÓfiÛÔ˘˜ Î·È ÙË Á‹Ú·ÓÛË16.
O•∂π¢øΔπ∫O STRESS ∫∞π
ÃO¡π∞ ¡∂ºƒπ∫∏ ∞¡∂¶∞ƒ∫∂π∞
¶·Ú¿ÁÔÓÙ˜ Ô˘ ÂËÚ¿˙Ô˘Ó ÙËÓ ÂͤÏÈÍË
Ù˘ ÓÂÊÚÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜
∏ ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ· ·ÔÙÂÏ› ÌÈ· ÚÔ˚Ô‡Û·
ÓfiÛÔ. ∏ ηٿÏÏËÏË ‰È·ÈÙËÙÈ΋ ·ÁˆÁ‹ (ÂÚÈÔÚÈ-
ÛÌfi˜ ÚfiÛÏ˄˘ Ï¢ÎÒÌ·ÙÔ˜) Î·È Ë Ê·Ú̷΢ÙÈ΋
·ÁˆÁ‹ (·Ó·ÛÙÔÏ›˜ ÙÔ˘ ÌÂÙ·ÙÚÂÙÈÎÔ‡ ÂÓ˙‡ÌÔ˘ Ù˘
·ÁÁÂÈÔÙÂÓÛ›Ó˘, ·ÔÎÏÂÈÛÙ¤˜ ˘Ô‰Ô¯¤ˆÓ ·ÁÁÂÈÔ-
ÙÂÓÛ›Ó˘ II) ‰ÂÓ ¤¯Ô˘Ó ÂÈÙ‡¯ÂÈ ÂÓÙ˘ˆÛȷο ·Ô-
ÙÂϤÛÌ·Ù· ÛÙËÓ ÂÈ‚Ú¿‰˘ÓÛË Ù˘ ÓÂÊÚÈ΋˜ ÓfiÛÔ˘.
¶·Ú¿ÁÔÓÙ˜ Ô˘ ¤¯Ô˘Ó Û˘Û¯ÂÙÈÛÙ› Ì ÂͤÏÈÍË Ù˘
ÓÂÊÚÈ΋˜ ‚Ï¿‚˘ Â›Ó·È Ë ·ÚÙËÚȷ΋ ˘¤ÚÙ·ÛË, Ë
ÏÔ‡ÛÈ· ۠ϢÎÒÌ·Ù· ‰È·ÙÚÔÊ‹, Ë ÚˆÙÂ˚ÓÔ˘Ú›·,
Ù· ˘„ËÏ¿ Â›‰· ÏÈȉ›ˆÓ ÛÙÔÓ ÔÚfi, Î·È ÙÔ ÔÍÂÈ-
‰ˆÙÈÎfi stress13,17. O ‚·ıÌfi˜ Ù˘ ÚˆÙÂ˚ÓÔ˘Ú›·˜
¤¯ÂÈ Û˘Û¯ÂÙÈÛÙ› ıÂÙÈο Ì ÙÔ Ú˘ıÌfi ÚÔfi‰Ô˘ Ù˘
ÓÂÊÚÈ΋˜ ÓfiÛÔ˘11,18. ∏ ÂÛÙȷ΋ ÛÂÈÚ·Ì·ÙÈ΋
˘ÂډȋıËÛË Î·È ÚÔԉ¢ÙÈ΋ ÛÎÏ‹Ú˘ÓÛË ÙˆÓ ÛÂÈ-
Ú·Ì¿ÙˆÓ ÙˆÓ ˘fiÏÔÈˆÓ ·Ó¤·ÊˆÓ ÓÂÊÚÒÓˆÓ Ô‰Ë-
Á› ÛÙËÓ ÂÚ·ÈÙ¤Úˆ Âȉ›ӈÛË Ù˘ ÓfiÛÔ˘13.
O ÚfiÏÔ˜ ÙÔ˘ ÔÍÂȉˆÙÈÎÔ‡ stress
O ÚfiÏÔ˜ ÙÔ˘ ÔÍÂȉˆÙÈÎÔ‡ stress ÛÙË ÓÂÊÚÈ΋ ÓfiÛÔ
Â›Ó·È ϤÔÓ ·Ô‰ÂÎÙfi˜ Î·È ·ÔÙÂÏ› ¤Ó· ·fi Ù·
ÛËÌ·ÓÙÈÎfiÙÂÚ· ‰›· ¤Ú¢ӷ˜ Ù˘ ¡ÂÊÚÔÏÔÁ›·˜.
ΔÔ ÔÍÂȉˆÙÈÎfi stress ·›˙ÂÈ Ì›˙ÔÓ· ÚfiÏÔ Û ÛÂÈ-
Ú·Ì·ÙÈΤ˜ ·ı‹ÛÂȘ (ÌÂÌ‚Ú·Ó҉˘ ÛÂÈÚ·Ì·ÙÔÓÂ-
ÊÚ›Ùȉ·, IgA ÓÂÊÚÔ¿ıÂÈ·, ÓfiÛÔ˜ ÌÂÙã ÂÏ·¯›ÛÙˆÓ
·ÏÏÔÈÒÛˆÓ), ÛÙËÓ ÔÍ›· Ê·ÚÌ·ÎÔÁÂÓ‹ ÈÛ¯·ÈÌÈ΋
ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ·, ÛÙËÓ ·ÔÊÚ·ÎÙÈ΋ ÓÂÊÚÔ¿-
ıÂÈ· Î·È ÙËÓ ˘ÂÏÔÓÂÊÚ›Ùȉ·, ÛÙȘ ·ıÔÊ˘ÛÈÔÏÔÁÈ-
Τ˜ ÌÂÙ·‚ÔϤ˜ ÌÂÙ¿ ·fi ÌÂÙ·ÌfiÛ¯Â˘ÛË ÓÂÊÚÔ‡,
ηıÒ˜ Î·È ÛÙË ¯ÚfiÓÈ· ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ·10. OÈ
ROS ÌÔÚÔ‡Ó Ó· Û˘Ì‚¿ÏÏÔ˘Ó ÛÙËÓ ÚfiÔ‰Ô Ù˘
¯ÚfiÓÈ·˜ ÓÂÊÚÈ΋˜ ÓfiÛÔ˘ ̤ۈ ÚfiÎÏËÛ˘ ·ÈÌÔ‰˘-
Ó·ÌÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ, ÔÍÂÈÒÓ Î·È ¯ÚfiÓÈˆÓ ÊÏÂÁÌÔ-
Óˆ‰ÒÓ ·ÓÙȉڿÛˆÓ, ˘¤ÚÌÂÙÚˆÓ ‹ ·ıÔÏÔÁÈÎÒÓ
·˘ÍËÙÈÎÒÓ ‰Ú¿ÛˆÓ, Î·È ·˘ÍË̤Ó˘ ΢ÙÙ·ÚÈ΋˜
·fiÙˆÛ˘ (ÏfiÁˆ ·ÒÏÂÈ·˜ ÙÔ˘ ΢ÙÙ·ÚÈÎÔ‡ Ê·È-
ÓÔÙ‡Ô˘)3. ¶ÈÔ Û˘ÁÎÂÎÚÈ̤ӷ, ÔÈ ROS ¤¯Ô˘Ó ÏÂÈ-
fiÙÚÔÔ ‰Ú¿ÛË ÛÙÔ ÓÂÊÚfi. ™ÙË ÛÂÈÚ·Ì·ÙÈ΋ Û˘-
Û΢‹ ÌÔÚÔ‡Ó Û ÂÚ›ÙˆÛË ·ıÔÏÔÁÈÎÒÓ Î·Ù·-
ÛÙ¿ÛÂˆÓ fiˆ˜ Ë ÛÂÈÚ·Ì·ÙÔÓÂÊÚ›Ùȉ· ‹ Ë ÙÔÍÈ΋
‚Ï¿‚Ë Ó· ÚÔηϤÛÔ˘Ó Î˘ÙÙ·ÚÈÎfi Ô›‰ËÌ·, ÂÓ‰ÔıË-
Ïȷ΋ ‚Ï¿‚Ë, ·ÒÏÂÈ· Ù˘ ‚·ÛÈ΋˜ ÌÂÌ‚Ú¿Ó˘,
ıÚfiÌ‚ˆÛË, ‚Ï¿‚˜ ÙÔ˘ ÌÂÛ·ÁÁ›Ԣ (˘ÂÚÙÚÔÊ›·
Î·È ›ÓˆÛË), ηıÒ˜ Î·È ·˘ÍË̤ÓË ‰È·ÂÚ·ÙfiÙËÙ·
Ì ÚˆÙÂ˚ÓÔ˘Ú›·. ™Ù· ÓÂÊÚÈο ÛˆÏËÓ¿ÚÈ· ÌÔÚ›
Ó· Ô‰ËÁ‹ÛÔ˘Ó Û ΢ÙÙ·ÚÈÎfi Ô›‰ËÌ·, ·ÔÎfiÏÏËÛË
·fi ÙË ‚·ÛÈ΋ ÌÂÌ‚Ú¿ÓË Î·È Ï‡ÛË, ·˘ÍË̤ÓË ‰È·-
ÂÚ·ÙfiÙËÙ·, ÌÂÙ·‚ÔÏ‹ ÙÔ˘ ‰È·ÌÂÌ‚Ú·ÓÈÎÔ‡ ‰˘Ó·-
ÌÈÎÔ‡ Î·È Â›Ù·ÛË ÙÔ˘ ΢ÙÙ·ÚÈÎÔ‡ ÔÏÏ·Ï·ÛÈ·-
ÛÌÔ‡. Δ¤ÏÔ˜, ÛÙ· ·ÁÁ›· ÙÔ˘ ÓÂÊÚÔ‡ ÚÔÍÂÓÔ‡Ó Ô›-
‰ËÌ·, ıÚfiÌ‚ˆÛË Î·È ‚Ï¿‚Ë ÙˆÓ ÂÓ‰ÔıËÏÈ·ÎÒÓ
΢ÙÙ¿ÚˆÓ, Ì ·ÔÙ¤ÏÂÛÌ· ÙË ÌÂÙ·‚ÔÏ‹ Ù˘ ·ÁÁÂÈ·-
΋˜ ·ÓÙȉڷÛÙÈÎfiÙËÙ·˜, ÙËÓ ÚÔÛÎfiÏÏËÛË ÊÏÂÁÌÔ-
Óˆ‰ÒÓ Î˘ÙÙ¿ÚˆÓ Î·È ÙÔÓ ÔÏÏ·Ï·ÛÈ·ÛÌfi ÙˆÓ Ï›-
ˆÓ Ì˘˚ÎÒÓ Î˘ÙÙ¿ÚˆÓ4,10,19.
∏ ¯ÚfiÓÈ· ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ· ¯·Ú·ÎÙËÚ›˙Â-
Ù·È ·fi ÌÈ· ·ÓÈÛÔÚÚÔ›· ÌÂٷ͇ Ù˘ ·Ú·ÁˆÁ‹˜
ÔÍÂȉˆÙÈÎÒÓ Ô˘ÛÈÒÓ Î·È Ù˘ ·ÓÙÈÚÚÔÈÛÙÈ΋˜ ‰Ú¿-
Û˘ ÙˆÓ ·ÓÙÈÔÍÂȉˆÙÈÎÒÓ Û˘ÛÙËÌ¿ÙˆÓ. ™’ ·˘Ùfi
Û˘Ì‚¿ÏÏÔ˘Ó, ·fi ÙË ÌÈ· ÌÂÚÈ¿, Ù· ÂÏ·Ùو̤ӷ Â›-
‰· ‚ÈÙ·Ì›Ó˘ C (ÏfiÁˆ ‰È·ÈÙËÙÈÎÔ‡ ÂÚÈÔÚÈÛÌÔ‡
ÊÚÔ‡ÙˆÓ Î·È Ï·¯·ÓÈÎÒÓ ÁÈ· ÙÔ Êfi‚Ô ˘ÂÚηÏÈ·È-
Ì›·˜, ηıÒ˜ Î·È Ë ·ÒÏÂÈ¿ Ù˘ ηٿ ÙËÓ Î¿ı·ÚÛË),
Ù· ¯·ÌËÏ¿ ÂÓ‰Ô΢ÙÙ¿ÚÈ· Â›‰· ‚ÈÙ·Ì›Ó˘ ∂, Ë
ÂÏ·Ùو̤ÓË Û˘ÁΤÓÙÚˆÛË ÛÂÏËÓ›Ô˘, Î·È ÔÈ ‰È·Ù·-
Ú·¯¤˜ ÛÙÔ ·ÓÙÈÔÍÂȉˆÙÈÎfi Û‡ÛÙËÌ· Ù˘ GSH1,12,20.
∞fi ÙËÓ ¿ÏÏË, Ë ÚÔ-ÔÍÂȉˆÙÈ΋ ÈηÓfiÙËÙ· ›ӷÈ
·˘ÍË̤ÓË, ÏfiÁˆ ÙˆÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ÙˆÓ ·ÛıÂ-
ÓÒÓ Ô˘ ¿Û¯Ô˘Ó ·fi ÙË ÓfiÛÔ, fiˆ˜ Ë ÌÂÁ¿ÏË ËÏÈ-
Λ·, Ë Û˘¯Ó‹ Û˘Ó‡·ÚÍË Û·Î¯·ÚÒ‰Ô˘˜ ‰È·‚‹ÙË, Ë
Ô˘Ú·ÈÌ›· Î·È Ë ¯ÚfiÓÈ· ÊÏÂÁÌÔÓ‹. ∂›Ó·È ÛËÌ·ÓÙÈÎfi
fiÙÈ Ë ›‰È· Ë Ô˘Ú·ÈÌ›· Û˘ÌÌÂÙ¤¯ÂÈ ÛÙËÓ Âȉ›ӈÛË
Ù˘ ÓÂÊÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ Î·È ÙËÓ ÂͤÏÈÍË Ù˘ ÓÂ-
ÊÚÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜. ∏ Û‡ÛÙ·ÛË ÙÔ˘ Ô˘Ú·ÈÌÈÎÔ‡
Ï¿ÛÌ·ÙÔ˜ Â›Ó·È ÌÔÓ·‰È΋ ÛÙÔ fiÙÈ ÂÚȤ¯ÂÈ ÏËıÒ-
Ú· ÌÂÙ·‚ÔÏÈÙÒÓ Î·È ÙÔÍÈÓÒÓ, ÙÂÎÌËÚÈˆÌ¤ÓˆÓ Î·È
 ∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 75, 1
ÌË. ∏ Ô˘Ú·ÈÌ›· ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙ› Ì ·˘ÍË̤ÓË Û˘-
ÁΤÓÙÚˆÛË ÚÔÊÏÂÁÌÔÓˆ‰ÒÓ ÙÔÍÈÓÒÓ Î·È Â›Ù·ÛË
ÙÔ˘ ÔÍÂȉˆÙÈÎÔ‡ stress ÛÙËÓ ÔÍ›· ‹ ¯ÚfiÓÈ· ÓÂÊÚÈ-
΋ ÓfiÛÔ12,21. ∏ ıÂÚ·›· ˘ÔηٿÛÙ·Û˘ Ù˘ ÓÂ-
ÊÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜, ›Ù Ì ÂÚÈÙÔÓ·˚΋ οı·ÚÛË,
›Ù ΢ڛˆ˜ Ì ·ÈÌÔοı·ÚÛË ‰È·‰Ú·Ì·Ù›˙ÂÈ Â›Û˘
ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ·˘ÍË̤ÓË ÚÔ-ÔÍÂȉˆÙÈ΋
ηٿÛÙ·ÛË ÙˆÓ ·ÛıÂÓÒÓ1,12,15,22. ∫·È ÂÓÒ Ë ·Ú·-
¿Óˆ ·ÓÈÛÔÚÚÔ›· ·ÚÔ˘ÛÈ¿˙ÂÙ·È ‹‰Ë ·fi Ù· ·Ú-
¯Èο ÛÙ¿‰È· Ù˘ ¯ÚfiÓÈ·˜ ÓÂÊÚÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ —
Ì Â›Ù·ÛË Î·Ù¿ ÙËÓ ÂͤÏÈÍ‹ Ù˘— Á›ÓÂÙ·È ÂÚÈÛ-
ÛfiÙÂÚÔ ¤ÓÙÔÓË Î·È ÂÌÊ·Ó‹˜ ÛÙÔ˘˜ ·ÛıÂÓ›˜ ˘fi ·È-
ÌÔοı·ÚÛË. Δ· ÎÏÈÓÈο Û˘ÌÙÒÌ·Ù· Î·È ÔÈ ‚ÈÔ¯Ë-
ÌÈÎÔ› ‰Â›ÎÙ˜ ÙÔ˘ ÔÍÂȉˆÙÈÎÔ‡ stress Î·È Ù˘ ÊÏÂÁ-
ÌÔÓ‹˜ Û ·ÛıÂÓ›˜ Ì ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ· ÂËÚÂ-
¿˙ÔÓÙ·È ·fi ÙÔ ‚·ıÌfi Ù˘ ÓÂÊÚÈ΋˜ ‚Ï¿‚˘ ηÈ
·fi ÙÔ Â›‰Ô˜ Ù˘ ÂÊ·ÚÌÔ˙fiÌÂÓ˘ ıÂÚ·›·˜, ÌÂ
ÙËÓ ÂÍ‹˜ ‰È·‚¿ıÌÈÛË ·fi ÌÈÎÚfiÙÂÚÔ˘ ÚÔ˜ ÌÂÁ·-
χÙÂÚÔ˘ ‚·ıÌÔ‡: ÌÂÙ·ÌfiÛ¯Â˘ÛË ÓÂÊÚÔ‡ < Û˘ÓÙË-
ÚËÙÈ΋ Ê·Ú̷΢ÙÈ΋ ıÂÚ·›· < ÂÚÈÙÔÓ·˚΋
οı·ÚÛË < ·ÈÌÔοı·ÚÛË. ª¿ÏÈÛÙ·, Ë ÓÂÊÚÈ΋ ÌÂ-
Ù·ÌfiÛ¯Â˘ÛË ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ۯ‰fiÓ Ï‹ÚË
‰ÈfiÚıˆÛË ÙˆÓ ·Ú·¿Óˆ ‚ÈÔ¯ËÌÈÎÒÓ ‰ÂÈÎÙÒÓ12.
ΔÔ Û‡Ó‰ÚÔÌÔ ªπ∞
To 2000 ÚÔÙ¿ıËÎÂ ÁÈ· ÚÒÙË ÊÔÚ¿ Ë ·ÚÔ˘Û›·
ÂÓfi˜ Û˘Ó‰ÚfiÌÔ˘ Ô˘ Û˘Û¯¤ÙÈÛ ÙËÓ Î·Î‹ ıÚ¤„Ë, ÙË
ÊÏÂÁÌÔÓ‹ Î·È ÙËÓ ·ıËÚÔÛÎÏËÚˆÙÈ΋ ÓfiÛÔ Ô˘ ·-
Ú·ÙËÚÔ‡ÓÙ·È ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ÓÂÊÚÈ΋ ·ÓÂ¿Ú-
ÎÂÈ· ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘. ΔÔ Û‡Ó‰ÚÔÌÔ ·˘Ùfi ÔÓÔÌ¿-
ÛÙËÎÂ Malnutrition-Inflammation-Atherosclerosis
syndrome ‹ Û‡Ó‰ÚÔÌÔ ªπ∞23,24. ¶·Ú·ÙËÚÂ›Ù·È ÛÂ
ÌÂÁ¿ÏÔ ·ÚÈıÌfi ·ÛıÂÓÒÓ Ô˘ ˘fiÎÂÈÓÙ·È Û Â͈ÓÂ-
ÊÚÈ΋ οı·ÚÛË Î·È Û¯ÂÙ›˙ÂÙ·È Ì ˘„ËÏfi ÔÛÔÛÙfi
ıÓËÙfiÙËÙ·˜, ÙÔ ÔÔ›Ô Ì¿ÏÈÛÙ· Â›Ó·È ·ÚfiÌÔÈÔ ÌÂ
·˘Ùfi ÙˆÓ ·ÛıÂÓÒÓ Ì ÌÂÙ·ÛÙ·ÙÈ΋ ηÎÔ‹ıÂÈ·25.
∫·Î‹ ıÚ¤„Ë
∏ η΋ ıÚ¤„Ë ÚÔηÏÂ›Ù·È ·fi ·ÓÂ·Ú΋ Úfi-
ÛÏË„Ë ÏÂ˘ÎˆÌ¿ÙˆÓ Î·È ıÂÚÌ›‰ˆÓ, ÂÓÒ Ë Î·¯ÂÍ›·
·fi ‰È·Ù·Ú·¯‹ ÛÙËÓ ·ÔÚÚfiÊËÛË Î·È ¯Ú‹ÛË ÙˆÓ
ıÚÂÙÈÎÒÓ Û˘ÛÙ·ÙÈÎÒÓ, fiˆ˜ Â› ˘ÂÚηٷ‚ÔÏÈ-
ÛÌÔ‡ Î·È Û˘ÛÙËÌ·ÙÈ΋˜ ÊÏÂÁÌÔÓ‹˜. ∫·È Ù· ‰‡Ô ÁÂ-
ÁÔÓfiÙ· ·Ú·ÙËÚÔ‡ÓÙ·È Û ·ÈÌÔηı·ÈÚfiÌÂÓÔ˘˜
·ÛıÂÓ›˜, ·ÏÏ¿ Î·È Û ·ÛıÂÓ›˜ ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘
¯ÚfiÓÈ·˜ ÓÂÊÚÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ ÚÈÓ ·fi ÙËÓ ¤Ó·Ú-
ÍË Ù˘ ıÂÚ·›·˜ ˘ÔηٿÛÙ·Û˘. ¶ÈÔ Û˘ÁÎÂÎÚÈ-
̤ӷ, ÔÈ ·Èٛ˜ Ù˘ η΋˜ ıÚ¤„˘ Î·È ÊÏÂÁÌÔÓ‹˜
ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ· ÙÂÏÈÎÔ‡
ÛÙ·‰›Ô˘ ›ӷÈ: ·) ∏ ·ÒÏÂÈ· Ù˘ fiÚÂ͢, ΢ڛˆ˜
ÏfiÁˆ ηٷÎÚ¿ÙËÛ˘ Ô˘Ú·ÈÌÈÎÒÓ ÙÔÍÈÓÒÓ ‹/Î·È ·-
9
ÚÔ˘Û›·˜ ÌÂÙ·‚ÔÏÈ΋˜ ÔͤˆÛ˘, ‚) Ë ·ÒÏÂÈ· ·ÌÈ-
ÓÔͤˆÓ Ì οıÂ Û˘Ó‰ڛ· ·ÈÌÔοı·ÚÛ˘ ‹ Ì ÙËÓ
ÂÚÈÙÔÓ·˚΋ οı·ÚÛË (4-9 g Û ÓËÛÙÈÎÔ‡˜ ·ÛıÂ-
Ó›˜ ‹ 8-12 g ÌÂÙ¿ ·fi Á‡̷, Î·È 9 gr ÔÏÈÎÒÓ Ï¢-
ÎˆÌ¿ÙˆÓ Î·È 6 g ÏÂ˘ÎˆÌ·Ù›Ó˘ ÙËÓ Ë̤ڷ ·ÓÙ›-
ÛÙÔȯ·, ̤¯ÚÈ 20 g Û ÂÚ›ÙˆÛË ÂÚÈÙÔÓ›Ùȉ·˜)26,
27, Á) ÂÓ‰ÔÎÚÈÓÈΤ˜ Î·È ÌÂÙ·‚ÔÏÈΤ˜ ‰È·Ù·Ú·¯¤˜
fiˆ˜ Ë ·ÓÙ›ÛÙ·ÛË ÛÙËÓ ÈÓÛÔ˘Ï›ÓË, Ì ·ÔÙ¤ÏÂÛÌ·
ÙËÓ ÂÏ¿ÙÙˆÛË Ù˘ ÚˆÙÂ˚ÓÔÛ‡ÓıÂÛ˘ Î·È ÙËÓ ÚÔ·-
ÁˆÁ‹ ÙÔ˘ ηٷ‚ÔÏÈÛÌÔ‡ ÙˆÓ ÚˆÙÂ˚ÓÒÓ, ‰) Ë Èı·-
Ó‹ ‚ÈÔ·Û˘Ì‚·ÙfiÙËÙ· ÙˆÓ ÌÂÌ‚Ú·ÓÒÓ Ô˘ ¯ÚËÛÈÌÔ-
ÔÈÔ‡ÓÙ·È ÛÙȘ ıÂÚ·›˜ ˘ÔηٿÛÙ·Û˘, Î·È ÔÈ
ÂÈÙÒÛÂȘ ·fi ÙÔ ‰È¿Ï˘Ì· Ù˘ οı·ÚÛ˘ (ÌÈÎÚfi-
‚È·, ÙÔ͛Ә), Â) Ë ·ÚÔ˘Û›· ·ÚÂÌÈÙÔ˘ÛÒÓ ÏÔÈ-
̈‰ÒÓ Î·È ¿ÏÏˆÓ ÓfiÛˆÓ (·Ó·Ê¤ÚÔÓÙ·È ·Ú·Î¿-
Ùˆ), ÛÙ) È·ÙÚÔÁÂÓ›˜ ·Èٛ˜ (.¯. Ô‰ËÁ›Â˜ ÁÈ· ÂÏ·Ù-
و̤ÓË ÚfiÛÏË„Ë ÚˆÙÂ˚ÓÒÓ) Î·È ˙) Ë ‰˘ÓËÙÈ΋
Û˘Ì‚ÔÏ‹ „˘¯ÔÏÔÁÈÎÒÓ Î·È ÎÔÈÓˆÓÈÎÔ-ÔÈÎÔÓÔÌÈÎÒÓ
·Ú·ÁfiÓÙˆÓ (ηٷıÏÈÙÈ΋ ‰È·Ù·Ú·¯‹, ·Ó·ËÚ›·,
·Ó¤¯ÂÈ·)28. ∏ η΋ ıÚ¤„Ë Û¯ÂÙ›˙ÂÙ·È Ì ÌÂÁ·Ï‡ÙÂ-
ÚÔ ‚·ıÌfi ÊÏÂÁÌÔÓ‹˜ Î·È ÔÍÂȉˆÙÈÎÔ‡ stress, fiˆ˜
¤¯ÂÈ ·Ô‰Âȯı› ·fi ÌÂϤÙ˜ Û ·ÈÌÔηı·ÈÚfiÌÂ-
ÓÔ˘˜ ·ÛıÂÓ›˜ Ì ˘ÔÏÂ˘ÎˆÌ·ÙÈÓ·ÈÌ›·. ™˘Ì‚¿ÏÏÂÈ
fï˜ Î·È ÛÙËÓ ·˘ÍË̤ÓË ıÓËÛÈÌfiÙËÙ· ÙˆÓ ¯ÚfiÓȈÓ
ÓÂÊÚÔ·ıÒÓ ·ÛıÂÓÒÓ. Œ¯ÂÈ ·Ú·ÙËÚËı› ÈÛ¯˘Ú‹
Û˘Û¯¤ÙÈÛË ÌÂٷ͇ Ù˘ ‰È·ÙÚÔÊÈ΋˜ ηٿÛÙ·Û˘ ηÈ
Ù˘ ıÓËÙfiÙËÙ·˜ Î·È ıÓËÛÈÌfiÙËÙ·˜ ÙˆÓ ·ÛıÂÓÒÓ ÌÂ
ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ· ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘ ˘fi ·ÈÌÔο-
ı·ÚÛË. ¶ÈÔ Û˘ÁÎÂÎÚÈ̤ӷ ÔÈ ÙÈ̤˜ Ù˘ ÏÂ˘ÎˆÌ·Ù›-
Ó˘ ÔÚÔ‡ ·ÔÙÂÏÔ‡Ó ·ÓÂÍ¿ÚÙËÙÔ ÚÔÁÓˆÛÙÈÎfi ·-
Ú¿ÁÔÓÙ· ıÓËÛÈÌfiÙËÙ·˜ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ÂÓÙ¿Û-
ÛÔÓÙ·È Û ÚfiÁÚ·ÌÌ· ·ÈÌÔοı·ÚÛ˘, ·ÏÏ¿ ηÈ
ÛÙÔ˘˜ ¯ÚÔÓ›ˆ˜ ·ÈÌÔηı·ÈÚfiÌÂÓÔ˘˜ ·ÛıÂÓ›˜, fi-
ˆ˜ ·Ô‰ÂÈÎÓ‡ÂÙ·È Û ÌÔÓ٤Ϸ ÔÏÏ·ÏÒÓ ÌÂÙ·-
‚ÏËÙÒÓ ·fi ·Ó·‰ÚÔÌÈΤ˜ Î·È ÚÔÔÙÈΤ˜ ÌÂϤÙ˜.
OÈ ÂÚÈÛÛfiÙÂÚ˜ ·fi ·˘Ù¤˜ Û˘ÌʈÓÔ‡Ó ÛÙÔ fiÙÈ ÙÈ-
̤˜ ÏÂ˘ÎˆÌ·Ù›Ó˘ ÔÚÔ‡ οو ·fi 4,0 g/dL Û¯ÂÙ›-
˙ÔÓÙ·È Ì ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ı·Ó¿ÙÔ˘. ∏ ‰È·ÁÓˆ-
ÛÙÈ΋ ·Í›· ÙˆÓ ·Ú·¿Óˆ Â›Ó·È ÂÓÙÔÓfiÙÂÚË ÙÔ˘˜
ÚÒÙÔ˘˜ Ì‹Ó˜ ·Ú·ÎÔÏÔ‡ıËÛ˘ ÙˆÓ ·ÛıÂÓÒÓ,
·ÏÏ¿ ‰È·ÙËÚÂ›Ù·È Î·È ÁÈ· ÌÂÁ·Ï‡ÙÂÚÔ ¯ÚÔÓÈÎfi ‰È¿-
ÛÙËÌ·29-32. ∫·È fiˆ˜ ηٷ‰Â›¯ıËÎÂ, Ë ˘ÔÏÂ˘Îˆ-
Ì·ÙÈÓ·ÈÌ›·, Ë ÊÏÂÁÌÔÓ‹ ÔÍ›·˜ Ê¿Û˘, Î·È ÙÔ ÔÍÂÈ-
‰ˆÙÈÎfi stress ÌÔÚÔ‡Ó Ó· ·Û΋ÛÔ˘Ó Û˘ÓÂÚÁÈ΋
‰Ú¿ÛË ÛÙËÓ ·‡ÍËÛË Ù˘ ηډȷÁÁÂȷ΋˜ ıÓËÛÈÌfi-
ÙËÙ·˜ Î·È ıÓËÙfiÙËÙ·˜ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì Ù¯ÓËÙ‹
˘ÔηٿÛÙ·ÛË Ù˘ ÓÂÊÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜33.
ºÏÂÁÌÔÓ‹
∏ ÊÏÂÁÌÔÓ‹ ·ÔÙÂÏ› ÌÈ· Ê˘ÛÈÔÏÔÁÈ΋ ·¿ÓÙËÛË
ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ ¤Ó·ÓÙÈ ‚Ï·ÙÈÎÒÓ ·ÈÙ›ˆÓ (Â͈ÁÂ-
10 Ã. ¡π∫O§∞´¢OÀ, °. ª¶OÀ¡ΔOÀƒ∏™

ÓÒÓ Î·È ÂÓ‰ÔÁÂÓÒÓ), Î·È ¯·Ú·ÎÙËÚ›˙ÂÙ·È Î˘Ú›ˆ˜
·fi ÙËÓ ·ÓÙ›‰Ú·ÛË ÔÍ›·˜ Ê¿Û˘. ∞Ó Ë ÊÏÂÁÌÔÓ‹
Â›Ó·È ·Ú·ÙÂٷ̤ÓË Î·È Â›ÌÔÓË, ·Ú·ÙËÚÂ›Ù·È Ë
¯ÚfiÓÈ· ·ÓÙ›‰Ú·ÛË ÔÍ›·˜ Ê¿Û˘, Ë ÔÔ›· Ô‰ËÁ›
Û ·ÓÔÚÂÍ›·, ˘ÂÚηٷ‚ÔÏÈÛÌfi, ȉȷ›ÙÂÚ· ·˘ÍË̤-
ÓÔ ÚˆÙÂ˚ÓÈÎfi ηٷ‚ÔÏÈÛÌfi, ·ÒÏÂÈ· Ì˘˚΋˜ Ì¿-
˙·˜ Î·È ÏÈÒ‰Ô˘˜ ÈÛÙÔ‡, ÂÓ‰ÔıËÏȷ΋ ‚Ï¿‚Ë Î·È
·ıËÚÔÛÎÏ‹ÚˆÛË34. ∂ÓÂÚÁfi˜ ÊÏÂÁÌÔÓ҉˘ ·ÓÙ›-
‰Ú·ÛË ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÂÚ›Ô˘ ÛÙÔ 30-50% ÙˆÓ
·ÛıÂÓÒÓ Ì ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘ ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ·,
›Ù ·˘ÙÔ› ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È Ì ÂÚÈÙÔÓ·˚΋ ο-
ı·ÚÛË/·ÈÌÔοı·ÚÛË, ›Ù fi¯È. Δ· ·›ÙÈ· Ù˘ ·ÓÙ›-
‰Ú·Û˘ ·˘Ù‹˜ Â›Ó·È ÔÏÏ·Ï¿. ∫·Ù·Ú¯‹Ó, ÔÈ ·-
Ú·¿Óˆ ·ÛıÂÓ›˜ ÌÔÚ› Ó· ·ÚÔ˘ÛÈ¿˙Ô˘Ó Â›ÌÔ-
Ó˜ ÏÔÈÌÒÍÂȘ, ›Ù ÏfiÁˆ Ù˘ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘
·ÓÔÛÈ·ÎÔ‡ ÙÔ˘˜ Û˘ÛÙ‹Ì·ÙÔ˜ ›Ù ÏfiÁˆ ÂÈÌfiÏ˘Ó-
Û˘ ·fi Ù· ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓ· ˘ÏÈο ÙˆÓ ›‰ÈˆÓ ÙˆÓ
ÌÂıfi‰ˆÓ ˘ÔηٿÛÙ·Û˘. ∂ÈϤÔÓ, Ë ÂÏ·Ùو̤ÓË
ÓÂÊÚÈ΋ οı·ÚÛË ÚÔÊÏÂÁÌÔÓˆ‰ÒÓ Î˘ÙÙ·ÚÔÎÈ-
ÓÒÓ, Ë ¿ıÚÔÈÛË ÔÍÂȉˆÙÈÎÒÓ Ô˘ÛÈÒÓ Î·È ÚÔ˚fi-
ÓÙˆÓ ÂÓ‰ÔÁÂÓÔ‡˜ ÔÍ›‰ˆÛ˘, ηıÒ˜ Î·È ÔÈ Û˘Ó˘-
¿Ú¯Ô˘Û˜ ηٷÛÙ¿ÛÂȘ (.¯. Ë ¯ÚfiÓÈ· ηډȷ΋
·ÓÂ¿ÚÎÂÈ·), Û˘Ì‚¿ÏÏÔ˘Ó ÛÙË ‰È·Ù‹ÚËÛË ÌÈ·˜
ÂÓÂÚÁÔ‡ ÊÏÂÁÌÔÓÒ‰Ô˘˜ ηٿÛÙ·Û˘. Δ¤ÏÔ˜, Û˘Ó-
‰Ú¿ÌÔ˘Ó Î·È ·Ú¿ÁÔÓÙ˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ
›‰È· ÙË ıÂÚ·›· ˘ÔηٿÛÙ·Û˘22 (¶›Ó. 1).
¢Â›ÎÙ˜ ÊÏÂÁÌÔÓ‹˜ ÛÙË ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ·
ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘ ·ÔÙÂÏÔ‡Ó Ë CRP (‹ Ë hsCRP), Ù·
AGEs, Ë ÈÓÙÂÚÏ¢ΛÓË 6 (IL-6) Î·È Ô ·Ú¿ÁÔÓÙ·˜
Ó¤ÎÚˆÛ˘ fiÁΈÓ-· (TNF-·)20,22,35. ¶ÚfiÛÊ·Ù˜ ÌÂ-
ϤÙ˜ ·Ó·‰ÂÈÎÓ‡Ô˘Ó ÓÂfiÙÂÚÔ˘˜ ‰Â›ÎÙ˜, fiˆ˜ Ë IL-
836. H CRP, Ô˘ ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÛÙË Û˘Ó‹ıË ‰È·-
ÁÓˆÛÙÈ΋ Ú¿ÍË, ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ÙÂÏÈÎÔ‡ ÛÙ·‰›-
Ô˘ ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ· ¤¯ÂÈ ·Ó·‰Âȯı› ˆ˜ ÚÔ-
ÁÓˆÛÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ηډȷÁÁÂȷ΋˜ ıÓËÛÈÌfiÙË-
Ù·˜ ·ÏÏ¿ Î·È ıÓËÙfiÙËÙ·˜ ·fi fiϘ ÙȘ ·Èٛ˜20,37,38.
™ÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È Û ·ÈÌÔοı·ÚÛË
Ù· Â›‰· Ù˘ CRP ÌÔÚ› Ó· ·Ó¢ÚÂıÔ‡Ó ¤ÓÙÂ
¤ˆ˜ ‰¤Î· ÊÔÚ¤˜ ÈÔ ·˘ÍË̤ӷ Û ۇÁÎÚÈÛË Ì ÙÔ
ÁÂÓÈÎfi ÏËı˘ÛÌfi. Ÿˆ˜ fï˜ ‹‰Ë ·Ó·Ê¤ÚıËÎÂ, ÔÈ
Û˘ÁÎÂÎÚÈ̤ÓÔÈ ·ÛıÂÓ›˜, ·ÏÏ¿ ÂȉÈο ·˘ÙÔ› Ì ÓfiÛÔ
ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘, ¤¯Ô˘Ó Î·È ¿ÏϘ ·Èٛ˜ ·Ófi‰Ô˘ Ù˘
CRP ÂÎÙfi˜ ·fi ÙË ÊÏÂÁÌÔÓ‹ Ô˘ ÔÊ›ÏÂÙ·È ÛÙË Ófi-
ÛÔ Î·ı·˘Ù‹. ŸÛÔÓ ·ÊÔÚ¿ Ù· AGEs, ÌÔÚÔ‡Ó Ó·
ÍÂÎÈÓ‹ÛÔ˘Ó ÙË ÊÏÂÁÌÔÓÒ‰Ë ·¿ÓÙËÛË Î·È Ó· ÚÔ-
ηϤÛÔ˘Ó ‰È¤ÁÂÚÛË ÙˆÓ ÌÔÓÔ΢ÙÙ¿ÚˆÓ, Ì ÙÂÏÈÎfi
·ÔÙ¤ÏÂÛÌ· ÙËÓ ·Ú·ÁˆÁ‹ CRP39. ∏ IL-6 Û˘ÓÙÔÓ›-
˙ÂÈ ÙËÓ ·Ú·ÁˆÁ‹ ÚˆÙÂ˚ÓÒÓ ÔÍ›·˜ Ê¿Û˘, Î·È ıÂ-
ˆÚÂ›Ù·È ÚÔÁÓˆÛÙÈÎfi˜ ‰Â›ÎÙ˘ ÓÂÊÚÈ΋˜ ÓfiÛÔ˘. O
TNF-· Â›Û˘ ·ÚÂÌ‚·›ÓÂÈ ÛÙÔ Û˘ÓÙÔÓÈÛÌfi ·Ú·-
ÁˆÁ‹˜ ÚˆÙÂ˚ÓÒÓ ÔÍ›·˜ Ê¿Û˘ Î·È ıˆÚÂ›Ù·È ÛË-
Ì·ÓÙÈÎfi˜ ‰Â›ÎÙ˘ ÊÏÂÁÌÔÓÒ‰Ô˘˜ ÓfiÛÔ˘ ÛÙÔ˘˜ ·ÈÌÔ-
ηı·ÈÚfiÌÂÓÔ˘˜ ·ÛıÂÓ›˜34.
∞ıËÚÔÛÎÏËÚÔÛÏËÚˆÙÈ΋ ηډȷÁÁÂȷ΋ ÓfiÛÔ˜
∏ ·ıËÚÔÛÎÏËÚˆÙÈ΋ ηډȷÁÁÂȷ΋ ÓfiÛÔ˜ ·ÔÙÂ-
Ï› ÙË ‚·ÛÈ΋ ·ÈÙ›· ıÓËÛÈÌfiÙËÙ·˜ Î·È ıÓËÙfiÙËÙ·˜
ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ· ÙÂÏÈÎÔ‡
ÛÙ·‰›Ô˘20,40, ÛÙÔ˘˜ ÔÔ›Ô˘˜ Ì¿ÏÈÛÙ· Ô ÂÎÙÈÌÒÌÂÓÔ˜
ΛӉ˘ÓÔ˜ ηډȷÁÁÂÈ·ÎÒÓ Û˘Ì‚·Ì¿ÙˆÓ Â›Ó·È 3,5-
50(!) ÊÔÚ¤˜ ˘„ËÏfiÙÂÚÔ˜ Û ۯ¤ÛË Ì ÙÔ ÁÂÓÈÎfi
ÏËı˘ÛÌfi41,42. ∏ ·ıËÚÔÛÎÏ‹ÚˆÛË ÙˆÓ ·ÛıÂÓÒÓ
·˘ÙÒÓ ÔÊ›ÏÂÙ·È ÛÙÔ˘˜ ÎÏ·ÛÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Ô˘
ÂÓÔ¯ÔÔÈÔ‡ÓÙ·È ÛÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi, fiˆ˜ Ë ËÏÈ-
Λ·, Ô Û·Î¯·Ú҉˘ ‰È·‚‹Ù˘, Ë ·ÚÙËÚȷ΋ ˘¤ÚÙ·-
ÛË, Ë ‰˘ÛÏÈȉ·ÈÌ›·, Ë ·ÚÈÛÙÂÚ‹ ÎÔÈÏȷ΋ ˘ÂÚÙÚÔ-
Ê›·, Ë ÌÂȈ̤ÓË ÛˆÌ·ÙÈ΋ ¿ÛÎËÛË Î·È ÙÔ Î¿ÓÈ-
ÛÌ·. ¶·Ú¿ Ù·‡Ù· ÔÈ ·ÛıÂÓ›˜ ·˘ÙÔ› ·ÔÙÂÏÔ‡Ó ÌÈ·
ͯˆÚÈÛÙ‹ ÔÌ¿‰· Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ·˘ÍË-
̤ÓÔ fiÁÎÔ ·ÏÌÔ‡, ·Ó·ÈÌ›·, ·˘ÍË̤ӷ Â›‰·
Lp(a) Î·È ÔÌÔ΢ÛÙ½Ó˘, ¤ÓÙÔÓË ÊÏÂÁÌÔÓ‹ ηÈ
ÔÍÂȉˆÙÈÎfi stress. ∏ CRP, Ô˘ Û˘ÓÈÛÙ¿ ‚·ÛÈÎfi ‰Â›-
ÎÙË ÊÏÂÁÌÔÓ‹˜, ¤¯ÂÈ ·Ô‰Âȯı› fiÙÈ Û¯ÂÙ›˙ÂÙ·È Ì ÙÔÓ
ΛӉ˘ÓÔ ·ıËÚÔÛÎÏ‹ÚˆÛ˘ ÙfiÛÔ ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ
·ÁÁ›ˆÓ, fiÛÔ Î·È ÙˆÓ Î·ÚˆÙ›‰ˆÓ Û ·ÛıÂÓ›˜ Ì ÙÂ-
ÏÈÎÔ‡ ÛÙ·‰›Ô˘ ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ·24,43,44. ΔÔ ∫ÔÏ-
ϤÁÈÔ ¶·ıÔÏfiÁˆÓ ∞ÌÂÚÈ΋˜ (C∞P) ıˆÚ› ÙÈ̤˜
¿Óˆ ÙˆÓ 3 mg/l ˆ˜ ÂÈΛӉ˘Ó˜ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ·-

¶›Ó·Î·˜ 1. OÈ Î‡ÚȘ ·Èٛ˜ ÊÏÂÁÌÔÓ‹˜ Û ·ÛıÂÓ›˜ Ì ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ· ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘.

ΔÂÏÈÎÔ‡ ÛÙ·‰›Ô˘ ∞ÈÌÔοı·ÚÛË ¶ÂÚÈÙÔÓ·˚΋ οı·ÚÛË

ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ· (ÂÈϤÔÓ ·›ÙÈ·) (ÂÈϤÔÓ ·›ÙÈ·)
∂Ï·Ùو̤ÓË ÓÂÊÚÈ΋ οı·ÚÛË Î˘ÙÔÎÈÓÒÓ ºÏÂÁÌÔÓ‹ Ù˘ ·ÚÙËÚÈÔÊÏ‚È΋˜ ¶ÂÚÈÙÔÓ›Ùȉ·
·Ó·ÛÙfïÛ˘
ÕıÚÔÈÛË AGEs μÈÔ·Û˘Ì‚·ÙfiÙËÙ· Ù˘ ÌÂÌ‚Ú¿Ó˘ μÈÔ·Û˘Ì‚·ÙfiÙËÙ· ÙÔ˘
·ÈÌÔοı·ÚÛ˘ ‰È·Ï‡Ì·ÙÔ˜ οı·ÚÛ˘
ÃÚfiÓÈ· ηډȷ΋ ·ÓÂ¿ÚÎÂÈ·
∞ıËÚÔÛÎÏ‹ÚˆÛË ŒÎıÂÛË Û ÂÓ‰ÔÙÔ͛Ә Î·È ·Ú·ÁˆÁ‹ ΢ÙÙ·ÚÔÎÈÓÒÓ
ºÏÂÁÌÔÓÒ‰ÂȘ ÓfiÛÔÈ ÏfiÁˆ ÌÔÏ˘Ṳ̂ÓÔ˘ ‰È·Ï˘ÙÈÎÔ‡ ̤ÛÔ˘
ÕÁÓˆÛÙ˘ ·ÈÙ›·˜ ÂÌ̤ÓÔ˘Û˜ ÏÔÈÌÒÍÂȘ
 ∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 75, 1
ıËÚÔÛÎÏËÚˆÙÈ΋˜ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘38. ΔÔ ·-
Ú·¿Óˆ fiÚÈÔ ¤¯ÂÈ ÂÚÈÔÚÈṲ̂ÓË ÂÊ·ÚÌÔÁ‹ ÛÙËÓ Î·-
ÙËÁÔÚ›· ÙˆÓ ·ÈÌÔηı·ÈÚfiÌÂÓˆÓ ·ÛıÂÓÒÓ ÂÍ·ÈÙ›·˜
ÙˆÓ —Ô‡Ùˆ˜ ‹ ¿Ïψ˜— ˘„ËÏÒÓ ÂÈ¤‰ˆÓ CRP Ô˘
·ÚÔ˘ÛÈ¿˙Ô˘Ó. ªÈ· ÚfiÛÊ·ÙË ÌÂϤÙË ÚÔÙ›ÓÂÈ ˆ˜
ÚÔÁÓˆÛÙÈÎfi ‰Â›ÎÙË Î·Ú‰È·ÁÁÂȷ΋˜ ÓfiÛÔ˘ Û ·ÈÌÔ-
ηı·ÈÚfiÌÂÓÔ˘˜ ·ÛıÂÓ›˜ Ù· Â›‰· CRP ¿Óˆ ÙˆÓ
10 mg/l. ΔÔÓ›˙ÂÙ·È fï˜ fiÙÈ Ë Û˘ÁΤÓÙÚˆÛË Ù˘ CRP
ÙÔ˘ ÔÚÔ‡ ‰ÂÓ ·ÔÙÂÏ› ηÏfi ÚÔÁÓˆÛÙÈÎfi ·Ú¿ÁÔ-
ÓÙ· ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘, Èı·ÓfiÙÂÚ· ÏfiÁˆ Ù˘
ıÂÙÈ΋˜ Û˘Û¯¤ÙÈÛ˘ ÌÂٷ͇ CRP Î·È ËÏÈΛ·˜, ·ÊÔ‡
ÔÈ ·ÛıÂÓ›˜ Ì ¯ÚfiÓÈ· ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ· Â›Ó·È Û˘-
Ó‹ıˆ˜ ÚÔίˆÚË̤Ó˘ ËÏÈΛ·˜. ™ËÌÂÈÒÓÂÙ·È ·Îfi-
Ì· fiÙÈ ‰ÂÓ Â›Ó·È ‰fiÎÈÌË Ë ¯ÚËÛÈÌÔÔ›ËÛË Ù˘ CRP
ˆ˜ Ì·ÎÚÔÚfiıÂÛÌÔ˘ ‰Â›ÎÙË ÊÏÂÁÌÔÓ‹˜ Î·È ÂϤÁ¯Ô˘
ÙÔ˘ ηډȷÁÁÂÈ·ÎÔ‡ ÎÈÓ‰‡ÓÔ˘ ÛÙÔ˘˜ ·ÈÌÔηı·ÈÚfi-
ÌÂÓÔ˘˜ ·ÛıÂÓ›˜, ÌÈ· ÂӉȷʤÚÔ˘Û· ¿Ô„Ë Ô˘
¯ÚÂÈ¿˙ÂÙ·È ÂÚ·ÈÙ¤Úˆ ÂÈÚ·Ì·ÙÈ΋ ÂȂ‚·›ˆÛË.
™ÙËÓ ›‰È· ÌÂϤÙË ·Ô‰ÂÈÎÓ‡ÂÙ·È fiÙÈ ÙÔ ¯ÚfiÓÈÔ ÔÍÂÈ-
‰ˆÙÈÎfi stress, ÂÎÊÚ·˙fiÌÂÓÔ Ì ÙÔÓ Ù›ÙÏÔ ÙˆÓ anti-ox-
LDL Û ·ÓÙ›ıÂÛË Ì ÙË ¯ÚfiÓÈ· ÊÏÂÁÌÔÓ‹, ·ÔÙÂÏ›
ÙÔÓ Î‡ÚÈÔ ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ηډȷÁÁÂȷ΋˜
ıÓËÛÈÌfiÙËÙ·˜ ÛÙÔÓ ÏËı˘ÛÌfi ÙˆÓ ËÏÈÎȈ̤ӈÓ
·ÛıÂÓÒÓ ˘fi ·ÈÌÔοı·ÚÛË ÌÂÙ¿ ·fi ·Ú·ÎÔÏÔ‡ıË-
ÛË ÙÂÛÛ¿ÚˆÓ ÂÙÒÓ20. ∫·È fiˆ˜ ¤¯ÂÈ ‹‰Ë ·Ó·Ï˘ı›, ÙÔ
ÔÍÂȉˆÙÈÎfi stress ·ÛΛ ÚÔ-·ıËÚÔÁÂÓÂÙÈ΋ ‰Ú¿ÛË,
̤ۈ Ù˘ ·ÏÏËÏÂ›‰Ú·Û˘ Ì ÙÔ ¡O (‰È·Ù·Ú·¯‹ ·Á-
ÁÂÈԉȷÛÙ·ÏÙÈ΋˜ ÈηÓfiÙËÙ·˜), Î·È Ù˘ ÔÍ›‰ˆÛ˘
ÙˆÓ LDL Î·È Lp(a) (‚Ï¿‚Ë ·ÁÁÂÈ·ÎÔ‡ ÙÔȯÒÌ·ÙÔ˜
Î·È ˘ÚÔ‰fiÙËÛË ‰È·‰Èηۛ·˜ ·ıËÚÔÛÎÏ‹ÚˆÛ˘).
∞Í›˙ÂÈ Ó· ÛËÌÂȈı› fiÙÈ Ë ¯ÚfiÓÈ· ÓÂÊÚÈ΋ ·ÓÂ¿Ú-
ÎÂÈ· ÌÔÚ› Ó· ÚÔηϤÛÂÈ ‰È·Ù·Ú·¯‹ Ù˘ ÂÓ‰ÔıË-
Ïȷ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ Î·È Ù˘ ·ÁÁÂÈԉȷÛÙ·ÏÙÈ΋˜ Èη-
ÓfiÙËÙ·˜ Î·È Ì ¿ÏÏÔ˘˜ Ì˯·ÓÈÛÌÔ‡˜ ¤Ú·Ó ÙÔ˘ ÔÍÂÈ-
‰ˆÙÈÎÔ‡ stress, Î·È ¤¯ÂÈ ·Ô‰Âȯı› Ë ‡·ÚÍË ·ÚÓË-
ÙÈ΋˜ Û˘Û¯¤ÙÈÛ˘ ÌÂٷ͇ Ù˘ ·ÁÁÂÈԉȷÛÙ·ÏÙÈ΋˜
ÈηÓfiÙËÙ·˜ Ô˘ ÂÍ·ÚÙ¿Ù·È ·fi ÙÔ ÂÓ‰Ôı‹ÏÈÔ Î·È ÙˆÓ
ÂÈ¤‰ˆÓ ÎÚ·ÙÈÓ›Ó˘ ÔÚÔ‡45-47.
∞ÈÌÔοı·ÚÛË
∏ ·ÈÌÔοı·ÚÛË ·ÓÙÈÚÔÛˆ‡ÂÈ ÂÓ Á¤ÓÂÈ ÌÈ· η-
Ù¿ÛÙ·ÛË stress. ∞ÔÙÂÏ› ÌÈ· ̤ıÔ‰Ô ÛˆÙ‹ÚÈ· ÁÈ·
ÙË ˙ˆ‹ ÙÔ˘ ·ÛıÂÓÔ‡˜, ·ÏÏ¿ Ù·˘Ùfi¯ÚÔÓ· Ô‰ËÁ› ÛÂ
ÂÓÂÚÁÔÔ›ËÛË ÂÓ‰ÔÁÂÓÒÓ ÊÏÂÁÌÔÓˆ‰ÒÓ ‰È·‰Èη-
ÛÈÒÓ Î·È ·˘ÍË̤ÓÔ ÔÍÂȉˆÙÈÎfi stress, ÏfiÁˆ Ù˘ ÙÚÔ-
ÔÔ›ËÛ˘ Ù˘ Ê˘ÛÈÔÏÔÁÈ΋˜ ΢ÎÏÔÊÔÚ›·˜ ÙÔ˘ ·›-
Ì·ÙÔ˜ Î·È Ù˘ ‰Èfi‰Ô˘ ÙÔ˘ ·fi ¤Ó·Ó ËıÌfi Â͈ÁÂÓÒÓ
Ê›ÏÙÚˆÓ Î·È Û˘ÛÙËÌ¿ÙˆÓ48. ∂ÈϤÔÓ, ·ÔÌ·ÎÚ‡ÓÂÈ
ÙÔ Ô˘ÚÈÎfi Ô͇, ¤Ó·Ó ÂÓ‰ÔÁÂÓ‹ ÌÂÙ·‚ÔÏ›ÙË Ì ÛËÌ·-
ÓÙÈΤ˜ ·ÓÙÈÔÍÂȉˆÙÈΤ˜ ȉÈfiÙËÙ˜49, ÂÓÒ ÌÔÚ› Ó·
11
ÂËÚ¿ÛÂÈ Ù· Â›‰· ¿ÏÏˆÓ ÂÓ‰ÔÁÂÓÒÓ ·ÓÙÈÔÍÂÈ-
‰ˆÙÈÎÒÓ Û˘ÛÙËÌ¿ÙˆÓ, fiˆ˜ ÔÈ ÚˆÙ½Ó˜ ÙÔ˘ Ï¿-
ÛÌ·ÙÔ˜ Î·È ÔÈ ‚Èٷ̛Ә (C, E). OÈ ·ÈÌÔηı·ÈÚfiÌÂ-
ÓÔÈ ·ÛıÂÓ›˜ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ¤Ó· Û˘Ó‰˘·ÛÌfi
Ì·˙È΋˜ ·Ú·ÁˆÁ‹˜ ROS Û οıÂ Û˘Ó‰ڛ·, ηÈ
¯ÚfiÓÈ·˜ ·ÓÂ¿ÚÎÂÈ·˜ ÙˆÓ Î‡ÚÈˆÓ ·ÓÙÈÔÍÂȉˆÙÈÎÒÓ
Û˘ÛÙËÌ¿ÙˆÓ. ™˘ÁÎÂÓÙÚˆÙÈο, ÙÔ ÔÍÂȉˆÙÈÎfi stress
ÏfiÁˆ ·ÈÌÔοı·ÚÛ˘ ÛÙËÚ›˙ÂÙ·È Û ÙÚ›· ·ÚÈ· ÛÙÔÈ-
¯Â›·: 1) ÙË ÌÂÌ‚Ú¿ÓË ‰È¿Ï˘Û˘ (‚ÈÔ·Û˘Ì‚·ÙfiÙË-
Ù·), 2) ÙË ÌÈÎÚԂȷ΋ ÌfiÏ˘ÓÛË ÙÔ˘ ̤ÛÔ˘ ‰È¿Ï˘-
Û˘, Î·È 3) ÙËÓ Èı·Ó‹ ÚÔ-ÔÍÂȉˆÙÈ΋ ‰Ú¿ÛË ÂÓfi˜
·ÚÈıÌÔ‡ ÌÂÙ·‚ÔÏÈÙÒÓ Ô˘ ‚Ú›ÛÎÔÓÙ·È Û ˘„ËÏ‹
Û˘ÁΤÓÙÚˆÛË ÛÙÔ Ï¿ÛÌ· ÙˆÓ ·ÛıÂÓÒÓ50.
O ‚·ıÌfi˜ ÔÍÂȉˆÙÈÎÔ‡ stress ÙˆÓ ·ÈÌÔηı·È-
ÚfiÌÂÓˆÓ ·ÛıÂÓÒÓ ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙ› ıÂÙÈο Ì ÙË
ÊÏÂÁÌÔÓÒ‰Ë Î·Ù¿ÛÙ·ÛË ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ Î·È ÙË
‰È¿ÚÎÂÈ· Ù˘ Û˘Ó‰ڛ·˜ οı·ÚÛ˘. Ÿˆ˜ ÙÔÓ›ÛÙË-
Π·Ú·¿Óˆ, Ë CRP Ô˘ Û˘ÓÈÛÙ¿ ‚·ÛÈÎfi ‰Â›ÎÙË
ÊÏÂÁÌÔÓ‹˜, ÌÔÚ› Ó· Â›Ó·È ¤ÓÙ ¤ˆ˜ ‰¤Î· ÊÔÚ¤˜
ÈÔ ·˘ÍË̤ÓË Û ·ÈÌÔηı·ÈÚfiÌÂÓÔ˘˜ ·ÛıÂÓ›˜ ÛÂ
Û¯¤ÛË Ì ÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi. Œ¯ÂÈ ‰È·ÈÛÙˆı›
fiÙÈ Ù· Â›‰· CRP Ï¿ÛÌ·ÙÔ˜ Û˘Û¯ÂÙ›˙ÔÓÙ·È ıÂ-
ÙÈο Ì ÙÈ̤˜ ÔÍÂȉˆÙÈÎÒÓ Ô˘ÛÈÒÓ fiˆ˜ ÔÈ
TBARS15. ∞fi ÙËÓ ¿ÏÏË, ¤¯ÂÈ ·Ú·ÙËÚËı› ÌÈ·
·ÓÙ›ÛÙÚÔÊË Û¯¤ÛË ÌÂٷ͇ Ù˘ ‰È¿ÚÎÂÈ·˜ Ù˘ ·ÈÌÔ-
οı·ÚÛ˘ Î·È Ù˘ Û˘ÁΤÓÙÚˆÛ˘ ÏÈÔ‰È·Ï˘ÙÒÓ
·ÓÙÈÔÍÂȉˆÙÈÎÒÓ Ô˘ÛÈÒÓ, fiˆ˜ Ë ·-ÙÔÎÔÊÂÚfiÏË
Î·È Ë Ô˘ÌÈÎÔ˘˚ÓfiÏË Î·È ·ԉ›¯ıËΠfiÙÈ Î¿ÙÈ Ù¤-
ÙÔÈÔ ÔÊ›ÏÂÙ·È ÛÙËÓ ·˘ÍË̤ÓË Î·Ù·Ó¿ÏˆÛ‹ ÙÔ˘˜
ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ Û˘Ó‰ڛ·˜ ·ÈÌÔοı·ÚÛ˘.
∞ӷʤÚıËΠ·ÎfiÌ· fiÙÈ Ë ÂÏ¿ÙÙˆÛË ÙˆÓ ÂÈ¤‰ˆÓ
Ù˘ ‚ÈÙ·Ì›Ó˘ C ÙÔ˘ Ï¿ÛÌ·ÙÔ˜ ÔÊ›ÏÔÓÙ·Ó Èı·-
Ófiٷٷ ÛÙËÓ ·ÚÔ˘Û›· ÌÈ·˜ ‰˘ÛÏÂÈÙÔ˘ÚÁÈ΋˜ ÌÔÚ-
Ê‹˜ Ù˘ ÛÙÔ˘˜ ·ÈÌÔηı·ÈÚfiÌÂÓÔ˘˜ ·ÛıÂÓ›˜15.
Œ¯ÂÈ ·Ô‰Âȯı› Â›Û˘ fiÙÈ Ë ‰È¿ÚÎÂÈ· Ù˘ ·ÈÌÔ-
οı·ÚÛ˘ ·ÚÔ˘ÛÈ¿˙ÂÈ ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË Ì ٷ
Â›‰· Ù˘ MDA Î·È ÙÔ˘ ‰Â›ÎÙË Â·ÓÂÓÂÚÁÔÔ›-
ËÛ˘ Ù˘ ‰-·ÌÈÓÔÏ‚ԢÏÂÓÈ΋˜ ‰Â¸‰ÚÔÁÂÓ¿Û˘
(ALA-D) (Ù˘ ÔÔ›·˜ Ë ‰Ú·ÛÙÈÎfiÙËÙ· Â›Ó·È ÂÏ·Ù-
و̤ÓË ÛÙÔ˘˜ ·ÈÌÔηı·ÈÚfiÌÂÓÔ˘˜ ·ÛıÂÓ›˜), Ô˘
·ÔÙÂÏÔ‡Ó ÛËÌ·ÓÙÈÎÔ‡˜ ‰Â›ÎÙ˜ ÂÎÙ›ÌËÛ˘ ÙÔ˘
¯ÚfiÓÈÔ˘ ÔÍÂȉˆÙÈÎÔ‡ stress51.
ŸÛÔÓ ·ÊÔÚ¿ ÙÔ Ì¤ÁÂıÔ˜ ÙˆÓ ˘fi οı·ÚÛË
ÌÔÚ›ˆÓ ·˘Ùfi Â›Ó·È Ô˘ÛÈ҉˜ ÛÙË ‰˘Ó·ÙfiÙËÙ· ·Ô-
Ì¿ÎÚ˘ÓÛ‹˜ ÙÔ˘˜ ̤ۈ Ù˘ ÌÂÌ‚Ú¿Ó˘ ·ÈÌÔοı·Ú-
Û˘. OÈ Û˘Ó‹ıÂȘ Ù¯ÓÈΤ˜ ·ÔÌ·ÎÚ‡ÓÔ˘Ó ·ÔÙÂÏÂ-
ÛÌ·ÙÈο, ·ÏÏ¿ ۯ‰fiÓ ·ÔÎÏÂÈÛÙÈο, ÌÈÎÚÔ‡ ηÈ
̤ÛÔ˘ ÌÔÚÈ·ÎÔ‡ ‚¿ÚÔ˘˜ ÌfiÚÈ· («Ô˘Ú·ÈÌÈΤ˜ ÙÔÍ›-
Ó˜») Î·È ÌfiÓÔ ÌÈÎÚfi ÔÛÔÛÙfi ÌÂÁ·Ï‡ÙÂÚˆÓ, fiˆ˜ Ë
‚2-ÌÈÎÚÔÛÊ·ÈÚ›ÓË. ∂›Ó·È ÛËÌ·ÓÙÈÎfi fiÙÈ ÔÈ ÌÂÙ·ÙÚÔ-
¤˜ Ô˘ ÂÈʤÚÔ˘Ó ÔÈ ÔÍÂȉˆÙÈΤ˜ ‰È·‰Èηۛ˜ ÛÙȘ
12 Ã. ¡π∫O§∞´¢OÀ, °. ª¶OÀ¡ΔOÀƒ∏™
Ô˘Û›Â˜ ˘fi οı·ÚÛË, ÙȘ ηıÈÛÙÔ‡Ó ÏÈÁfiÙÂÚÔ ‰È·Ï˘-
Ù¤˜ Î·È ÂÔ̤ӈ˜ ‰˘ÛÎÔÏfiÙÂÚ· ‰È·‚·Ù¤˜ ·fi ÙÔ˘˜
fiÚÔ˘˜ Ù˘ ÌÂÌ‚Ú¿Ó˘ ·ÈÌÔοı·ÚÛ˘. ∞˘Ùfi ÙÔ ÂÈ-
Ù˘Á¯¿ÓÔ˘Ó Ì ÌÂÙ·‚ÔÏ‹ ›Ù ÙÔ˘ ÌÔÚÈ·ÎÔ‡ ÙÔ˘˜ ‚¿-
ÚÔ˘˜ ›Ù ÙÔ˘ ËÏÂÎÙÚÈÎÔ‡ ÙÔ˘˜ ÊÔÚÙ›Ô˘. ¢ÂÓ ÌÔ-
ÚÔ‡Ó Ó· ‰È·ÂÚ¿ÛÔ˘Ó ÙË ÌÂÌ‚Ú¿ÓË ÌÈÎÚ¿ ÌfiÚÈ· ÌÂ
ÊÏÂÁÌÔÓÔÁfiÓ˜ (proinflammatory) ȉÈfiÙËÙ˜, ηıÒ˜
ÂÓÒÓÔÓÙ·È Û ÌÂÁ·Ï‡ÙÂÚ· ÌfiÚÈ· ÛÙÔ Ô˘Ú·ÈÌÈÎfi Â-
ÚÈ‚¿ÏÏÔÓ ÙˆÓ ¯ÚÔÓ›ˆÓ ÓÂÊÚÔ·ıÒÓ ·ÛıÂÓÒÓ12.
ŒÓ· ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÙˆÓ ·ÛıÂÓÒÓ Ì ¯ÚfiÓÈ·
ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ· Ô˘ ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È Ì ·È-
ÌÔοı·ÚÛË Â›Ó·È Ë ·Ó¿ÁÎË ÁÈ· Â͈ÁÂÓ‹ ¯ÔÚ‹ÁËÛË
Ô˘ÛÈÒÓ, ÔÈ Ôԛ˜ ‚Ú›ÛÎÔÓÙ·È Û ¤ÏÏÂÈ„Ë ÏfiÁˆ Ù˘
›‰È·˜ Ù˘ ÓfiÛÔ˘ Î·È ÙÔ˘ ¤ÓÙÔÓÔ˘ ÔÍÂȉˆÙÈÎÔ‡
stress, ·ÏÏ¿ Î·È ÏfiÁˆ Ù˘ ·ÒÏÂÈ¿˜ ÙÔ˘˜ ηٿ ÙË
‰È¿ÚÎÂÈ· Ù˘ οı·ÚÛ˘. ªÈ· Ù¤ÙÔÈ· Ô˘Û›· Â›Ó·È Ô
Û›‰ËÚÔ˜. ∏ ÂÓ‰ÔÊϤ‚È· ¯ÔÚ‹ÁËÛË Ûȉ‹ÚÔ˘ ›ӷÈ
··Ú·›ÙËÙË ÛÙÔ˘˜ ·ÈÌÔηı·ÈÚfiÌÂÓÔ˘˜ ·ÛıÂÓ›˜
ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ·Ó·ÈÌ›·˜, Î·È È‰È·›ÙÂÚ·
Û ÂΛÓÔ˘˜ Ô˘ Ï·Ì‚¿ÓÔ˘Ó Î·È ÂÚ˘ıÚÔÔÈËÙ›ÓË.
¶·ÚÔÏ’ ·˘Ù¿, Ë Û˘ÁÎÂÎÚÈ̤ÓË ıÂÚ·›· ÌÔÚ› Ó·
Â›Ó·È ÙÔÍÈ΋ Î·È ¤¯ÂÈ ·Ú·ÙËÚËı› fiÙÈ ‰ÈÂÁ›ÚÂÈ
ÙËÓ ·Ú·ÁˆÁ‹ ROS, ÂÓÒ Ù·˘Ùfi¯ÚÔÓ· ηٷӷÏÒÓÂÈ
·ÓÙÈÔÍÂȉˆÙÈΤ˜ Ô˘Û›Â˜, Û˘Ì‚¿ÏÏÔÓÙ·˜ ÛÙËÓ ·‡ÍË-
ÛË ÙÔ˘ ÔÍÂȉˆÙÈÎÔ‡ stress. ™Â Ôχ ˘„ËϤ˜ ‰fiÛÂȘ
ÌÔÚ› Ó· ÚÔηÏ› ÔÍ›‰ˆÛË ÙˆÓ ÏÈȉ›ˆÓ ηÈ
΢ÙÙ·ÚÈÎfi ı¿Ó·ÙÔ52. O Û›‰ËÚÔ˜ ÚÔηÏ› ÌÈ· ·Ï˘-
ÛȉˆÙ‹ ·ÓÙ›‰Ú·ÛË ·Ú·ÁˆÁ‹˜ ROS ̤ۈ Ù˘ ‰Ë-
ÌÈÔ˘ÚÁ›·˜ O∏– ·fi ÙÔ ∏2O2 (·ÓÙ›‰Ú·ÛË Fenton)4,
‹ ̤ۈ Ù˘ ‰È¤ÁÂÚÛ˘ Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ ·Ï‡ÛÔ˘
ÙˆÓ ÌÈÙÔ¯ÔÓ‰Ú›ˆÓ ÙˆÓ Ô˘‰ÂÙÂÚÔʛψÓ53. ¶ÂÈÚ·Ì·-
ÙÈο ÌÔÓ٤Ϸ Û ÔÓÙÈÎÔ‡˜ Ì ÂÍÂÏÈÛÛfiÌÂÓË ÓÂÊÚÈ-
΋ ÓfiÛÔ Î·Ù¤‰ÂÈÍ·Ó fiÙÈ Ù· ÂÈÚ·Ì·Ùfi˙ˆ· Ô˘
ÂÏ¿Ì‚·Ó·Ó ÌÈÎÚfiÙÂÚ· ÔÛ¿ Ûȉ‹ÚÔ˘ Ì ÙË ‰È·ÙÚÔ-
Ê‹ ·ÚÔ˘Û›·˙·Ó ÏÈÁfiÙÂÚË ÚˆÙÂ˚ÓÔ˘Ú›· Î·È ÌÈ-
ÎÚfiÙÂÚÔ˘ ‚·ıÌÔ‡ ÛÂÈÚ·Ì·ÙÈ΋ ÛÎÏ‹Ú˘ÓÛË54. ∂È-
ϤÔÓ, Ô ÂÚÈÔÚÈÛÌfi˜ ÙÔ˘ Ûȉ‹ÚÔ˘ ·fi ÙË ‰›·ÈÙ·
ÚÔÛٿ٢ ·fi ‰È·ÌÂÛÔÛˆÏËÓ·Úȷ΋ ›ÓˆÛË55.
¡ÂfiÙÂÚ· ‰Â‰Ô̤ӷ ·Ó·‰ÂÈÎÓ‡Ô˘Ó ÙÔ Û›‰ËÚÔ ˆ˜
ÚÔ-ÔÍÂȉˆÙÈ΋ Ô˘Û›·, Ì ‰˘Ó·ÙfiÙËÙ· ÔÍ›‰ˆÛ˘
ÙˆÓ ÏÈȉ›ˆÓ. ™˘ÁÎÂÎÚÈ̤ӷ, ·Ó¢ڤıËÎ·Ó ·˘ÍË-
̤ÓÔÈ Ù›ÙÏÔÈ anti-ox-LDLs ÛÙÔ˘˜ ·ÛıÂÓ›˜ ˘fi ÂÓ-
‰ÔÊϤ‚È· ÛȉËÚÔıÂÚ·›·, Î·È Ì¿ÏÈÛÙ· Ë ıÂÚ·-
›· ·˘Ù‹, fiˆ˜ Î·È Ù· anti-ox-LDLs ·ÔÙÂÏÔ‡Û·Ó
ÚÔÁÓˆÛÙÈÎÔ‡˜ ‰Â›ÎÙ˜ ıÓËÛÈÌfiÙËÙ·˜20. ªÂ ÂÓ‰Ô-
ÊϤ‚È· ¯ÔÚ‹ÁËÛË Ûȉ‹ÚÔ˘ ·˘Í‹ıËÎ·Ó Ù· Â›‰·
MDA (‰Â›ÎÙË ÔÍÂȉˆÙÈÎÔ‡ stress) ÙˆÓ ·ÈÌÔηı·È-
ÚfiÌÂÓˆÓ ·ÛıÂÓÒÓ Î·Ù¿ 21%. ∂›Ó·È ÛËÌ·ÓÙÈÎfi fiÙÈ
Ë ¯ÔÚ‹ÁËÛË ·fi ÙÔ ÛÙfiÌ· ‚ÈÙ·Ì›Ó˘ ∂ (400 IU) ηÈ
ÛÂÏËÓ›Ô˘ (600 Ìg) ¤ÍÈ ÒÚ˜ ÚÈÓ ÙË Û˘Ó‰ڛ· ·ÈÌÔ-
οı·ÚÛ˘ ·Ó¤ÛÙÂÈÏ ÙËÓ ÚÔ-ÔÍÂȉˆÙÈ΋ ‰Ú¿ÛË
ÙÔ˘ Ûȉ‹ÚÔ˘, Î·È ‰È·Ù‹ÚËÛ ÙÔ˘˜ ‰Â›ÎÙ˜ ÔÍÂȉˆÙÈ-
ÎÔ‡ stress ÛÙ· ›‰È· Â›‰· Ì ·˘Ù¿ ÚÈÓ ÙË Û˘ÓÂ-
‰Ú›·56. ∏ Èı·Ó‹ ÙÔÍÈ΋ ‰Ú¿ÛË ÙÔ˘ Ûȉ‹ÚÔ˘ ·Ô-
‰ÂÈÎÓ‡ÂÙ·È Î·È ·fi ÌÈ· ÌÂϤÙË Û ÌÂÁ¿ÏÔ ·ÚÈıÌfi
·ÈÌÔηı·ÈÚfiÌÂÓˆÓ ·ÛıÂÓÒÓ, ÛÙËÓ ÔÔ›· ÂΛÓÔÈ
Ô˘ ÂÏ¿Ì‚·Ó·Ó Û›‰ËÚÔ ÂÓ‰ÔÊϤ‚È· Û ÔÛfiÙËÙ·
ÌÂÁ·Ï‡ÙÂÚË ·fi 5g/¤ÙÔ˜ ¤ı·ÈÓ·Ó Û˘¯ÓfiÙÂÚ· ·fi
ÊÏÂÁÌÔÓÒ‰Ë Î·È Î·Ú‰È·ÁÁÂȷ΋ ÓfiÛÔ57. O Ú˘ıÌfi˜
¯ÔÚ‹ÁËÛ˘, ÙÔ˘ Ûȉ‹ÚÔ˘ Â›Ó·È Î·Ù·Ï˘ÙÈ΋˜ ÛËÌ·-
Û›·˜, ·ÊÔ‡ Ì ٷ Û˘ÓËıÈṲ̂ӷ ‰Â‰Ô̤ӷ Ù·¯Â›·˜
¯ÔÚ‹ÁËÛ˘ ̤۷ Û ÌÈÛ‹ ÒÚ· Ô‰ËÁԇ̷ÛÙ ÛÂ
˘ÂÚÎÔÚÂÛÌfi Ù˘ ÙÚ·ÓÛÊÂÚÚ›Ó˘. ΔÔ ˘fiÏÔÈÔ
ÔÛfi Ù˘ Ô˘Û›·˜ Û˘Ó‰¤ÂÙ·È ·ÛıÂÓÒ˜ Ì ¿ÏϘ Úˆ-
Ù½Ó˜-ÌÂÙ·ÊÔÚ›˜ Î·È ÌÔÚ› ‡ÎÔÏ· Ó· ‰ÈÂÁ›ÚÂÈ
ÙËÓ ·Ú·ÁˆÁ‹ ROS58,59. ∞ÂÓ·ÓÙ›·˜, ·ԉ›¯ıËÎÂ
fiÙÈ Ë ‚Ú·‰Â›· ÂÓ‰ÔÊϤ‚È· ¯ÔÚ‹ÁËÛË ÙÔ˘ Ûȉ‹ÚÔ˘
(Ì›· ÒÚ·) ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ Û˘Ó‰ڛ·˜ ·ÈÌÔ-
οı·ÚÛ˘ ‰ÂÓ ·˘Í¿ÓÂÈ ÙÔ˘˜ ‰Â›ÎÙ˜ ÊÏÂÁÌÔÓ‹˜ ηÈ
ÔÍÂȉˆÙÈÎÔ‡ stress, fiˆ˜ Ë ox-LDL, Ë hs-CRP, Ë
IL-6, Ô TNF-·, Î·È Ù· Â›‰· Ù˘ πª∞ (Ischemia-
ªodified ∞lbumin)35.
∏ ¯ÔÚ‹ÁËÛË ·Ó·Û˘Ó‰˘·Ṳ̂Ó˘ ·ÓıÚÒÂÈ·˜
ÂÚ˘ıÚÔÔÈËÙ›Ó˘ (rHuEpo) Â›Ó·È ··Ú·›ÙËÙË ÛÙËÓ
ÏÂÈÔ„ËÊ›· ÙˆÓ ·ÛıÂÓÒÓ Ì ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ·
ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘, ÂÍ·ÈÙ›·˜ Ù˘ Û˘ÓıÂÙÈ΋˜ ·‰˘Ó·Ì›·˜
ÙˆÓ ÓÂÊÚÒÓ. O ¢ÂÚÁÂÙÈÎfi˜ ÚfiÏÔ˜ Ù˘ ¤ÁÎÂÈÙ·È ÛÙË
‚ÂÏÙ›ˆÛË Ù˘ ·Ó·ÈÌ›·˜ Î·È ÛÙËÓ ¿ÓÔ‰Ô ÙˆÓ ÙÈÌÒÓ Ù˘
·ÈÌÔÛÊ·ÈÚ›Ó˘, Ë ÔÔ›· ·ԉ›¯ıËΠfiÙÈ ÚÔηÏ›
ÂÏ¿ÙÙˆÛË ÙÔ˘ ÔÍÂȉˆÙÈÎÔ‡ stress. ™˘ÁÎÂÎÚÈ̤ӷ, η-
Ù·ÁÚ¿ÊËΠÌÈ· ·ÓÙ›ÛÙÚÔÊË Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÙˆÓ
Û˘ÁÎÂÓÙÚÒÛÂˆÓ HNE Î·È MDA Ì ÙȘ ÙÈ̤˜ Ù˘ ·È-
ÌÔÛÊ·ÈÚ›Ó˘ (ÙfiÛÔ ÙˆÓ ˘ÁÈÒÓ ·ÙfiÌˆÓ fiÛÔ Î·È ÙˆÓ
·ÛıÂÓÒÓ Ì ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘ ÓÂÊÚÈ΋ ·ÓÂ¿Ú-
ÎÂÈ·)60. Œ¯ÂÈ ·Ú·ÙËÚËı› fï˜ fiÙÈ Ë ¯ÔÚ‹ÁËÛË
ÂÚ˘ıÚÔÔÈËÙ›Ó˘ Ô‰‹ÁËÛ Û ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋
ÂÏ¿ÙÙˆÛË Ù˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Ù˘ CuZn-SOD
(Erythrocyte copper zinc dependent superoxide
dismutase) ÙˆÓ ÂÚ˘ıÚÔ΢ÙÙ¿ÚˆÓ, Ë ÔÔ›· ·Ó‹ÎÂÈ
ÛÙ· ‚·ÛÈο ·ÓÙÈÔÍÂȉˆÙÈο ÙÔ˘˜ Û˘ÛÙ‹Ì·Ù·15,61.
¶ÂÚÈÙÔÓ·˚΋ οı·ÚÛË
∏ ÂÚÈÙÔÓ·˚΋ οı·ÚÛË ·ÔÙÂÏ› ̤ıÔ‰Ô ·ÓÙÈÌÂ-
ÙÒÈÛ˘ Ù˘ ¯ÚfiÓÈ·˜ ÓÂÊÚÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ Ô˘
¯·Ú·ÎÙËÚ›˙ÂÙ·È ÂÚÈÛÛfiÙÂÚÔ «Ê˘ÛÈÔÏÔÁÈ΋» ηÈ
«ÏÈÁfiÙÂÚÔ ÂÂÌ‚·ÙÈ΋» Û ۯ¤ÛË Ì ÙËÓ ·ÈÌÔο-
ı·ÚÛË. ∫È ·˘Ùfi ÁÈ·Ù› Ë ‰È·‰Èηۛ· οı·ÚÛ˘ ÙˆÓ
ÌÂÙ·‚ÔÏÈÎÒÓ ÚÔ˚fiÓÙˆÓ Î·È ÙÔÍÈÓÒÓ Ú·ÁÌ·ÙÔ-
ÔÈÂ›Ù·È ÛÙËÓ ÂÚÈÙÔÓ·˚΋ ÎÔÈÏfiÙËÙ· ÙÔ˘ ·ÛıÂÓÔ‡˜
̤ۈ ÙˆÓ ·ÁÁ›ˆÓ Ù˘ ÂÚÈÙÔÓ·˚΋˜ ÌÂÌ‚Ú¿Ó˘, ÌÂ
·ÔÙ¤ÏÂÛÌ· Ó· ÌËÓ ·Ú·ÙËÚÂ›Ù·È Ë ÊÏÂÁÌÔÓ‹ ηÈ
 ∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 75, 1
ÙÔ stress ÏfiÁˆ Ù˘ Â͈ۈ̷ÙÈ΋˜ ΢ÎÏÔÊÔÚ›·˜.
∂ÈϤÔÓ, ÔÈ ·ÛıÂÓ›˜ ˘fi ÂÚÈÙÔÓ·˚΋ οı·ÚÛË
·ÚÔ˘ÛÈ¿˙Ô˘Ó ÌÈÎÚfiÙÂÚË ÚÔ-ÛÂÈÚ·Ì·ÙÈ΋ ·ÚÙË-
Úȷ΋ ›ÂÛË Î·È ÌÈÎÚfiÙÂÚ· ÔÛ¿ ÚfiÛÏ˄˘ Úˆ-
ÙÂ˚ÓÒÓ. ¶·ÚÔÏ’ ·˘Ù¿, fiˆ˜ ·Ó·Ê¤ÚıËΠ·Ú·¿-
Óˆ, Ë Ì¤ıÔ‰Ô˜ ·˘Ù‹ ÂÈ‚·Ú‡ÓÂÙ·È Â›Û˘ ·Ó Î·È ÛÂ
ÌÈÎÚfiÙÂÚË ¤ÓÙ·ÛË Û ۯ¤ÛË Ì ÙËÓ ·ÈÌÔοı·ÚÛË–
Ì ÔÍÂȉˆÙÈÎfi stress Î·È ÙȘ Û˘Ó·ÎfiÏÔ˘ı˜ ÂÈÏÔ-
Τ˜ ÙÔ˘12. ŒÙÛÈ, Û ·ÛıÂÓ›˜ ˘fi ÂÚÈÙÔÓ·˚΋ ο-
ı·ÚÛË ¤¯Ô˘Ó ·Ú·ÙËÚËı› ·˘ÍË̤ӷ Â›‰·
ROS62, MDA, AGEs63, TBARS64, ηıÒ˜ Î·È ÂÏ·Ù-
و̤ÓË ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ GSH-Px Î·È ¯·ÌËÏ¿
Â›‰· ÛÂÏËÓ›Ô˘ Ï¿ÛÌ·ÙÔ˜64.
∞˘Ùfi Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÈ ÙËÓ ÂÚÈÙÔÓ·˚΋ ο-
ı·ÚÛË Â›Ó·È Ë È‰È·ÈÙÂÚfiÙËÙ· ÙÔ˘ ˘ÁÚÔ‡-‰È·Ï‡Ì·ÙÔ˜
οı·ÚÛ˘, ÙÔ ÔÔ›Ô Â›Ó·È Û˘Ó‹ıˆ˜ ÏÔ‡ÛÈÔ ÛÂ
ÁÏ˘Îfi˙Ë. ∏ Ì·ÎÚÔ¯ÚfiÓÈ· ¤ÎıÂÛË ÙÔ˘ ÂÚÈÙÔÓ·›Ô˘
ÛÙÔ ‰È¿Ï˘Ì· οı·ÚÛ˘, ·ÏÏ¿ Î·È Ë ›‰È· Ë ‰È·‰Èη-
Û›· ıÂÚÌÈ΋˜ ·ÔÛÙ›ڈÛ˘ ÙÔ˘ ‰È·Ï‡Ì·ÙÔ˜, Û˘Ì-
‚¿ÏÏÂÈ ÛÙËÓ ¿ıÚÔÈÛË AGEs Î·È GDPs (ÚÔ˚fiÓÙ·
·Ô‰fiÌËÛ˘ Ù˘ ÁÏ˘Îfi˙˘) Î·È ÙÂÏÈο ÛÙË Û¯ÂÙÈ΋
‚ÈÔ·Û˘Ì‚·ÙfiÙËÙ· ÙÔ˘ ̤ÛÔ˘ οı·ÚÛ˘65,66. ∂È-
ϤÔÓ, ÙÔ ÔÍÂȉˆÙÈÎfi Î·È Î·Ú‚ÔÓ˘ÏÈÎfi stress Ô˘
Û˘Ó‰¤ÂÙ·È Ì ÙË ¯ÚfiÓÈ· ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ· ηÈ
ÙËÓ Ô˘Ú·ÈÌ›· ÂÈÙ›ÓÂÈ ÙË Û˘ÁΤÓÙÚˆÛË ÙˆÓ ·Ú·-
¿Óˆ Ô˘ÛÈÒÓ66,67. ¶Ú¤ÂÈ Ó· ÛËÌÂȈı› fiÙÈ Ë ‚ÈÔ·-
Û˘Ì‚·ÙfiÙËÙ· ÔÊ›ÏÂÙ·È ·ÎfiÌ· ÛÙËÓ ˘„ËÏ‹ Û˘ÁΤ-
ÓÙÚˆÛË Á·Ï·ÎÙÈÎÒÓ, ÛÙÔ fiÍÈÓÔ pH Î·È Û ·˘ÍË̤-
ÓË ÔÛ̈ÙÈ΋ ›ÂÛË68. ΔÔ ÙÂÏÈÎfi ·ÔÙ¤ÏÂÛÌ· Ù˘
¿ıÚÔÈÛ˘ ÙˆÓ AGEs Î·È GDPs Â›Ó·È Ë ‰ËÌÈÔ˘ÚÁ›·
ÌÔÚÊÔÏÔÁÈÎÒÓ Î·È ÏÂÈÙÔ˘ÚÁÈÎÒÓ ÌÂÙ·‚ÔÏÒÓ Ù˘
ÂÚÈÙÔÓ·˚΋˜ ÌÂÌ‚Ú¿Ó˘ Î·È Ë Î˘ÙÙ·ÚÔÙÔÍÈ΋ ‰Ú¿-
ÛË ÛÙ· ·ÙÙ·Ú· ÙÔ˘ ÂÚÈÙÔÓ·›Ô˘65,69. ∏ ¿ıÚÔÈÛË
ÙˆÓ AGEs Î·È GDPs ·Ú·ÙËÚ‹ıËΠ΢ڛˆ˜ ÛÙÔ
ÌÂÛÔı‹ÏÈÔ, ÛÙÔ ÛÙÚÒÌ· ˘fi ÙÔ ÌÂÛÔı‹ÏÈÔ Î·È ÛÙÔ
·ÁÁÂÈ·Îfi ÙÔ›¯ˆÌ· ÙˆÓ ·ÛıÂÓÒÓ65. OÈ ÌÔÚÊÔÏÔÁÈ-
Τ˜ ÌÂÙ·‚ÔϤ˜ Ô˘ ÂÈʤÚÔ˘Ó ÔÈ Û˘ÁÎÂÎÚÈ̤Ó˜
Ô˘Û›Â˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó: ·) ∫·Ù·ÛÙÚÔÊ‹ («·ÔÁ‡-
ÌÓˆÛË») ÙÔ˘ ÌÂÛÔıËÏ›Ô˘, ‚) ‰È¿ÌÂÛË ›ÓˆÛË, ÌÂ Û˘-
ÓÂ·ÁfiÌÂÓË ÛÎÏ‹Ú˘ÓÛË ÙÔ˘ ÂÚÈÙÔÓ·›Ô˘, Á) ÔÈΛ-
Ϙ ·ÁÁÂȷΤ˜ ·ÏÏÔÈÒÛÂȘ, Ì ÈÔ ¯·Ú·ÎÙËÚÈÛÙÈ΋
ÙÔ ‰ÈÏ·ÛÈ·ÛÌfi ÙÔ˘ ¿¯Ô˘˜ Ù˘ ‚·ÛÈ΋˜ ÌÂÌ‚Ú¿Ó˘
ÙˆÓ ÂÚÈÙÔÓ·˚ÎÒÓ ÙÚȯÔÂȉÒÓ ·ÚfiÌÔÈÔ Ì ÂΛÓÔÓ
Ù˘ ‰È·‚ËÙÈ΋˜ ÌÈÎÚÔ·ÁÁÂÈÔ¿ıÂÈ·˜70,71, ‰) ÛÔ‚·-
ÚÔ‡ ‚·ıÌÔ‡ ›ÓˆÛË Î·È ˘·ÏÈÓÔÔ›ËÛË ÙÔ˘ ·ÁÁÂÈ·ÎÔ‡
ÙÔȯÒÌ·ÙÔ˜, ΢ڛˆ˜ ÙˆÓ ÌÂÙ·ÙÚȯÔÂȉÈÎÒÓ ÊÏ‚È-
‰›ˆÓ, Â) ·‡ÍËÛË ÙˆÓ ÈÓÒÓ ÎÔÏÏ·ÁfiÓÔ˘ ÙÔ˘ ̤ÛÔ˘ ¯È-
ÙÒÓ· ÙˆÓ ·ÁÁ›ˆÓ Î·È ·ÚÔ˘Û›· ÂÎÊ˘ÏÈÛÌ¤ÓˆÓ Ï›-
ˆÓ Ì˘˚ÎÒÓ Î˘ÙÙ¿ÚˆÓ Ì ÂÏ¿¯ÈÛÙË ÔÛfiÙËÙ· ΢ÙÙ·-
ÚÔÏ¿ÛÌ·ÙÔ˜ Î·È ˘ÎÓˆÙÈÎÔ‡˜ ˘Ú‹Ó˜65.
∏ ›ÓˆÛË ÙÔ˘ ÂÚÈÙÔÓ·›Ô˘ Î·È Ë ÛÎÏ‹Ú˘ÓÛË
13
ÙˆÓ ·ÁÁ›ˆÓ ÙÔ˘ ·ÔÙÂÏ› ¤Ó· ·ÎfiÌ· ¯·Ú·ÎÙËÚÈ-
ÛÙÈÎfi Ù˘ ÂÚÈÙÔÓ·˚΋˜ οı·ÚÛ˘. ™Â ÂÈÚ·Ì·Ùfi-
˙ˆ· ˘fi ÂÚÈÙÔÓ·˚΋ οı·ÚÛË ¤¯ÂÈ ·Ú·ÙËÚËı›
·˘ÍË̤ÓË ¤ÎÊÚ·ÛË ÙÔ˘ ÌÂÙ·ÙÚÂÙÈÎÔ‡ ·˘ÍËÙÈÎÔ‡
·Ú¿ÁÔÓÙ· ÙÔ˘ ÂÚÈÙÔÓ·›Ô˘ (TGF-1), ÙÔ˘ ÎÔÏÏ·-
ÁfiÓÔ˘ Ù‡Ô˘ π Î·È ÙÔ˘ ·ÁÁÂÈ·ÎÔ‡ ÂÓ‰ÔıËÏÈ·ÎÔ‡
·˘ÍËÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· (VEGF)62. Œ¯ÂÈ ÚÔÙ·ı›
fiÙÈ Ù· AGEs ÚÔηÏÔ‡Ó ·˘ÍË̤ÓË ¯ËÌÂÈÔÙ·Í›·
ÙˆÓ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ Î·È ·ÂÏ¢ı¤ÚˆÛË ÌÂÛÔÏ·‚Ë-
ÙÒÓ, fiˆ˜ Ô TNF-·, Ë IL-1 Î·È Ô PDGF (·ÈÌÔÂ-
Ù·ÏÈ·Îfi˜ ·˘ÍËÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜). OÈ Û˘ÁÎÂÎÚÈ̤-
ÓÔÈ ÌÂÛÔÏ·‚ËÙ¤˜ ‰ÈÂÁ›ÚÔ˘Ó Ù· Ï›· Ì˘˚ο ·ÙÙ·Ú·
ÚÔ˜ Û‡ÓıÂÛË ÂÍˆÎ˘ÙÙ¿ÚÈ·˜ ‚·ÛÈ΋˜ Ô˘Û›·˜, ÌÂ
·ÔÙ¤ÏÂÛÌ· ÛËÌ·ÓÙÈÎÔ‡ ‚·ıÌÔ‡ ›ÓˆÛË ÙÔ˘ ·ÁÁÂÈ-
·ÎÔ‡ ÙÔȯÒÌ·ÙÔ˜72,73. ∞ÎfiÌ·, Ù· AGEs ÌÔÚÔ‡Ó
Ó· ·ÓÂÓÂÚÁÔÔÈ‹ÛÔ˘Ó ÙÔ ¡O, ÙÔ ÔÔ›Ô ÂÎÙfi˜ ·fi
ÙËÓ ·ÁÁÂÈԉȷÛÙ·ÏÙÈ΋ ‰Ú¿ÛË ÙÔ˘ ÂÓÂÚÁ› Î·È Î·-
Ù¿ ÙÔ˘ ÔÏÏ·Ï·ÛÈ·ÛÌÔ‡ ÙˆÓ ÂÓ‰ÔıËÏÈ·ÎÒÓ Î˘Ù-
Ù¿ÚˆÓ74. ™ÙËÓ ·ıÔÁ¤ÓÂÈ· Ù˘ ›ÓˆÛ˘ Û˘Ì‚¿ÏÏÂÈ
Î·È Ë ·Ó·ÊÂÚfiÌÂÓË «·ÔÁ‡ÌÓˆÛË» ÙÔ˘ ÌÂÛÔıËÏ›-
Ô˘, Ô˘ ¤¯ÂÈ ·Ú·ÙËÚËı› Û ÛËÌ·ÓÙÈÎfi ·ÚÈıÌfi
·ÛıÂÓÒÓ, fiÙ·Ó ·˘Ù‹ ·ÎÔÏÔ˘ıÂ›Ù·È ·fi ·ÔÙ˘¯›·
Â·Ó·ÂÈıËÏÈÔÔ›ËÛ˘75,76. ∂›Ó·È ¯·Ú·ÎÙËÚÈÛÙÈÎfi
fiÙÈ ÔÈ ·ÏÏÔÈÒÛÂȘ ÙˆÓ ·ÛıÂÓÒÓ ˘fi ÂÚÈÙÔÓ·˚΋
οı·ÚÛË ·Ú·ÙËÚÔ‡ÓÙ·È ÌfiÓÔ ÛÙÔ ÂÚÈÙfiÓ·ÈÔ Î·È
Û ηӤӷ ¿ÏÏÔ ÈÛÙÈÎfi ÛÙfi¯Ô66.
ªÈ· ÛÔ‚·Ú‹ ÂÈÏÔ΋ Ù˘ Ì·ÎÚÔ¯ÚfiÓÈ·˜ Û˘-
Ó¯ԇ˜ ÂÚÈÙÔÓ·˚΋˜ οı·ÚÛ˘, Ë ÔÔ›· Û¯ÂÙ›˙Â-
Ù·È ÌÂ ÙËÓ ›ÓˆÛË ÙÔ˘ ÂÚÈÙÔÓ·›Ô˘, ÙË ÛÎÏ‹Ú˘ÓÛË
ÙˆÓ ·ÁÁ›ˆÓ ÙÔ˘ Î·È ÙËÓ ˘ÂÚ-‰È·‚·ÙfiÙËÙ· ·ÔÙÂ-
Ï› Ë ·ÓÂ¿ÚÎÂÈ· Ù˘ ˘ÂÚ-‰È‹ıËÛ˘. Œ¯ÂÈ ·Ú·-
ÙËÚËı› ·˘ÍË̤ÓË ¿ıÚÔÈÛË AGEs ÛÙÔÓ ÈÓÒ‰Ë ÈÛÙfi
ÙÔ˘ ÂÚÈÙÔÓ·›Ô˘ Î·È ÛÙÔ ·ÁÁÂÈ·Îfi ÙÔ›¯ˆÌ· ÙˆÓ
·ÛıÂÓÒÓ Ì ÂÏ·Ùو̤ÓÔ˘ ‚·ıÌÔ‡ ˘ÂÚ-‰È‹ıËÛË.
ª¿ÏÈÛÙ·, Ë ¤ÎÙ·ÛË Ù˘ ¿ıÚÔÈÛ˘ ·˘Ù‹˜ ·ÚÔ˘Û›·-
˙ ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË Ì ÙËÓ ÚfiÔ‰Ô Ù˘ ‰È¿ÌÂÛ˘
ÂÚÈÙÔÓ·˚΋˜ ›ÓˆÛ˘. ∂ÈϤÔÓ, Ô ÏfiÁÔ˜ Ù˘ ËÌÂ-
Ú‹ÛÈ·˜ ˘ÂÚ-‰È‹ıËÛ˘ ÚÔ˜ ÙÔ ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜
(‰Â›ÎÙ˘ ÈηÓfiÙËÙ·˜ Ù˘ ÂÚÈÙÔÓ·˚΋˜ ÌÂÌ‚Ú¿Ó˘
ÁÈ· ˘ÂÚ-‰È‹ıËÛË) ·ÚÔ˘Û›·˙ ·ÓÙ›ÛÙÚÔÊË Û˘Û¯¤-
ÙÈÛË Ì ÙË ‰È¿ÌÂÛË ›ÓˆÛË, ÙËÓ ÌÈÎÚÔ-·ÁÁÂȷ΋
ÛÎÏ‹Ú˘ÓÛË Î·È ÙËÓ ¿ıÚÔÈÛË ÙˆÓ AGEs66. ªÈ· Úfi-
ÛÊ·ÙË ÌÂϤÙË Û¯ÂÙÈο Ì ÙËÓ ›ÓˆÛË Ù˘ Ô˘Ú·ÈÌ›·˜
Î·È Ù˘ ÂÚÈÙÔÓ·˚΋˜ οı·ÚÛ˘, ·Ó·‰ÂÈÎÓ‡ÂÈ ÙÔ
ÚfiÏÔ ÙÔ˘ ˘Ô‰Ô¯¤· ÂÈÊ·Ó›·˜ ÙˆÓ AGEs (RA-
GE) ÛÙËÓ fiÏË ‰È·‰Èηۛ·. ∏ ·ÏÏËÏÂ›‰Ú·ÛË ÙˆÓ
AGEs Ì ÙÔ˘˜ RAGEs Ô‰ËÁ› Û ÂÓÂÚÁÔÔ›ËÛË
ÙˆÓ Î˘ÙÙ¿ÚˆÓ Î·È ·Ú·ÁˆÁ‹ ÙÔ˘ ÈÛÙÈÎÔ‡ ·˘ÍËÙÈ-
ÎÔ‡ ·Ú¿ÁÔÓÙ·-‚ (TGF-‚), ÙÔ˘ ÔÔ›Ô˘ Ô ÚfiÏÔ˜ ›-
Ó·È ÎÚ›ÛÈÌÔ˜ ÛÙË ‰È·‰Èηۛ· ÌÂÙ·ÙÚÔ‹˜ ÙÔ˘ ÂÈ-
ıËÏÈ·ÎÔ‡ ÈÛÙÔ‡ ÙÔ˘ ÂÚÈÙÔÓ·›Ô˘ Û ÌÂÛÂÁ¯˘Ì·ÙÈÎfi
14 Ã. ¡π∫O§∞´¢OÀ, °. ª¶OÀ¡ΔOÀƒ∏™
Ì ¯·Ú·ÎÙËÚÈÛÙÈο Ì˘Ô˚ÓÔ‚Ï·ÛÙÒÓ77,78. ∞ԉ›-
¯ıËΠfiÙÈ Ë Ô˘Ú·ÈÌ›· Ô‰‹ÁËÛ Û ¿ıÚÔÈÛË ÙˆÓ
AGEs, ·‡ÍËÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ RAGEs Î·È Ù˘
·Ú·ÁˆÁ‹˜ TGF-‚ Î·È ·Ó¿Ù˘ÍË ‰È¿ÌÂÛ˘ ›ÓˆÛ˘
Î·È ÛÎÏ‹Ú˘ÓÛ˘ ÙˆÓ ·ÁÁ›ˆÓ Ù˘ ÂÚÈÙÔÓ·˚΋˜
ÌÂÌ‚Ú¿Ó˘67.
∂›Ó·È Ôχ ÛËÌ·ÓÙÈÎfi fiÙÈ Ë ‰È·Ù‹ÚËÛË Ù˘
˘ÔÏÂÈÌÌ·ÙÈ΋˜ ÓÂÊÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ Â›Ó·È ¤Ó·˜
·fi ÙÔ˘˜ ÈÔ ÛËÌ·ÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Ô˘ ηıÔ-
Ú›˙Ô˘Ó ÙËÓ Â¿ÚÎÂÈ· Ù˘ ÂÚÈÙÔÓ·˚΋˜ οı·ÚÛ˘,
Î·È ÂËÚ¿˙Ô˘Ó Ô˘ÛÈ·ÛÙÈο ÙËÓ ÔÈfiÙËÙ· ˙ˆ‹˜, ÙË
ıÚ¤„Ë, ·ÏÏ¿ Î·È ÙË ıÓËÙfiÙËÙ· ÙˆÓ ·ÛıÂÓÒÓ63.
Œ¯ÂÈ ·Ô‰Âȯı› fiÙÈ Ë ÂÈ‚›ˆÛË ÙˆÓ ·ÛıÂÓÒÓ Û¯Â-
Ù›˙ÂÙ·È ÛÙ·ÙÈÛÙÈο ÂÚÈÛÛfiÙÂÚÔ Ì ÙËÓ ˘ÔÏÂÈÌÌ·-
ÙÈ΋ ÓÂÊÚÈ΋ ÏÂÈÙÔ˘ÚÁ›·, ·Ú¿ Ì ÙËÓ Â¿ÚÎÂÈ·
Ù˘ ÂÚÈÙÔÓ·˚΋˜ οı·ÚÛ˘79 Î·È fiÙÈ ÁÈ· οı 0,5
ml/min ÌÂÁ·Ï‡ÙÂÚË GFR (Ú˘ıÌfi˜ ÛÂÈÚ·Ì·ÙÈ΋˜
‰È‹ıËÛ˘) ·ÓÙÈÛÙÔȯ› ÌÈÎÚfiÙÂÚÔ˜ ΛӉ˘ÓÔ˜ ı·Ó¿-
ÙÔ˘ ηٿ 9%80. ª¿ÏÈÛÙ·, ÔÈ ·ÓÔ˘ÚÈÎÔ› ·ÛıÂÓ›˜
·ÚÔ˘ÛÈ¿˙Ô˘Ó ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚË ıÓËÙfiÙËÙ·
·fi ηډȷÁÁÂȷο ‹ ÌË ·›ÙÈ·, Û ۯ¤ÛË Ì ·˘ÙÔ‡˜
Ô˘ ‰È·ÙËÚÔ‡Ó ˘ÔÏÂÈÌÌ·ÙÈ΋ ÓÂÊÚÈ΋ ÏÂÈÙÔ˘Ú-
Á›·81. μ‚·›ˆ˜, Ë ·ÒÏÂÈ· Ù˘ ÓÂÊÚÈ΋˜ ÏÂÈÙÔ˘Ú-
Á›·˜ ÂÏ·ÙÙÒÓÂÈ ‰Ú·Ì·ÙÈο ÙËÓ Â¿ÚÎÂÈ· Ù˘ ÌÂıfi-
‰Ô˘. ∂›Ó·È ÛËÌ·ÓÙÈÎfi fiÙÈ ÔÈ ·ÛıÂÓ›˜ Ô˘ ·ÓÙÈÌÂ-
Ùˆ›˙ÔÓÙ·È Ì ÂÚÈÙÔÓ·˚΋ οı·ÚÛË ·ÚÔ˘ÛÈ¿-
˙Ô˘Ó ÈÔ ·ÚÁ‹ ·ÒÏÂÈ· Ù˘ ˘ÔÏÂÈÌÌ·ÙÈ΋˜ ÓÂÊÚÈ-
΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ Û ۯ¤ÛË Ì ÙÔ˘˜ ·ÈÌÔηı·ÈÚfiÌÂ-
ÓÔ˘˜ ·ÛıÂÓ›˜63. ™ÙË ÌÂϤÙË ÙˆÓ Moist LM ηÈ
Û˘Ó.82 ‰Â›¯ıËΠfiÙÈ ÔÈ ·ÛıÂÓ›˜ ˘fi ÂÚÈÙÔÓ·˚΋
οı·ÚÛË Â›¯·Ó ηٿ 65% ÌÈÎÚfiÙÂÚÔ Î›Ó‰˘ÓÔ ·Ò-
ÏÂÈ·˜ Ù˘ ˘ÔÏÂÈÌÌ·ÙÈ΋˜ ÓÂÊÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÛÂ
Û¯¤ÛË Ì ÙÔ˘˜ ·ÈÌÔηı·ÈÚfiÌÂÓÔ˘˜ ·ÛıÂÓ›˜. ∫·-
Ù·ÁÚ¿ÊËÎ·Ó ·ÎfiÌ· ÔÈ ÛËÌ·ÓÙÈÎfiÙÂÚÔÈ ÚÔÁÓˆÛÙÈ-
ÎÔ› ·Ú¿ÁÔÓÙ˜ ÁÈ· ÙËÓ ·ÒÏÂÈ· Ù˘ ÓÂÊÚÈ΋˜ ÏÂÈ-
ÙÔ˘ÚÁ›·˜, ÔÈ ÔÔ›ÔÈ Â›Ó·È: ·) ∏ ‰È¿ÚÎÂÈ· ÙÔ˘ ¯Úfi-
ÓÔ˘ ˘fi οı·ÚÛË, ‚) Ë ¯·ÌËÏ‹ ·Ú¯È΋ ÙÈÌ‹ GFR
ηٿ ÙËÓ ¤Ó·ÚÍË Ù˘ ÂÚÈÙÔÓ·˚΋˜ οı·ÚÛ˘, Á) ÙÔ
ı‹Ï˘ ʇÏÔ Û ·ÓÙ›ıÂÛË Ì ·Ï·ÈfiÙÂÚ˜ ÌÂϤÙ˜, ‰)
Ë ÌË-Ï¢΋ Ê˘Ï‹, Â) Ë ·ÚÔ˘Û›· ۷ί·ÚÒ‰Ô˘˜
‰È·‚‹ÙË, Î·È ÛÙ) ÙÔ ÈÛÙÔÚÈÎfi Û˘ÌÊÔÚËÙÈ΋˜ ηÚ-
‰È·Î‹˜ ·ÓÂ¿ÚÎÂÈ·˜. ∞fi ÙËÓ ¿ÏÏË, Ë ˘„ËÏ‹ ÙÈÌ‹
·Û‚ÂÛÙ›Ô˘ Ï¿ÛÌ·ÙÔ˜ Î·È Ë ¯Ú‹ÛË ·Ó·ÛÙÔϤˆÓ
ÙÔ˘ ÌÂÙ·ÙÚÂÙÈÎÔ‡ ÂÓ˙‡ÌÔ˘ Ù˘ ·ÁÁÂÈÔÙÂÓÛ›Ó˘ ‹
·ÔÎÏÂÈÛÙÒÓ ‰È·‡ÏˆÓ ·Û‚ÂÛÙ›Ô˘ Û¯ÂÙ›˙ÔÓÙ·È ÌÂ
ηχÙÂÚË ‰È·Ù‹ÚËÛË Ù˘ ˘ÔÏÂÈÌÌ·ÙÈ΋˜ ÓÂÊÚÈ΋˜
ÏÂÈÙÔ˘ÚÁ›·˜. Δ¤ÏÔ˜, ÛËÌÂÈÒÓÂÙ·È fiÙÈ ÛÙÔ˘˜ ·ÛıÂ-
Ó›˜ ˘fi ÂÚÈÙÔÓ·˚΋ οı·ÚÛË Ô Û¯ÂÙÈÎfi˜ ΛӉ˘-
ÓÔ˜ ıÓËÙfiÙËÙ·˜ Â›Ó·È ÌÈÎÚfiÙÂÚÔ˜ ÛÙ· ÚÒÙ· ¤ÙË
ıÂÚ·›·˜ Û ۇÁÎÚÈÛË Ì ÙÔ˘˜ ·ÈÌÔηı·ÈÚfiÌÂ-
ÓÔ˘˜ ·ÛıÂÓ›˜, ÂÓÒ ·˘Í¿ÓÂÈ Ì ÙËÓ ¿ÚÔ‰Ô ÙˆÓ
ÂÙÒÓ ıÂÚ·›·˜, Î·È ÂÔ̤ӈ˜ ·ÒÏÂÈ·˜ Ù˘ ÓÂ-
ÊÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜.
£∂ƒ∞¶∂ÀΔπ∫∂™ ¶∞ƒ∂ªμ∞™∂π™
¶ÚfiÏË„Ë
∞·Ú·›ÙËÙË ÚÔ¸fiıÂÛË ÁÈ· ÙËÓ ÚfiÏË„Ë ÂÚ·È-
Ù¤Úˆ Âȉ›ӈÛ˘ Ù˘ ÓÂÊÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜, ÌÂÙ¿ ÙË
‰È¿ÁÓˆÛË ¯ÚfiÓÈ·˜ ÓÂÊÚÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜, ·ÔÙÂÏ›
Ë Ù·ÎÙÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ‰ÂÈÎÙÒÓ ÔÍÂȉˆÙÈÎÔ‡
Î·È Î·Ú‚ÔÓ˘ÏÈÎÔ‡ stress. ∏ ‰È·Ù‹ÚËÛË Ù˘ ÓÂÊÚÈ΋˜
ÏÂÈÙÔ˘ÚÁ›·˜ Û ÛÙ·ıÂÚfi Â›Â‰Ô ÁÈ· fiÛÔ ÙÔ ‰˘Ó·ÙfiÓ
ÌÂÁ·Ï‡ÙÂÚÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· Î·È Ë ·ÓÙÈÌÂÙÒÈÛË
ÙˆÓ ÊÏÂÁÌÔÓÒÓ Î·È Ù˘ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘ ·ÓÔÛÈ·-
ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Ô˘ ·Ú·ÙËÚÔ‡ÓÙ·È ÛÙÔ˘˜ ·ÛıÂÓ›˜
Ì ¯ÚfiÓÈ· ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ·, ·ÔÙÂÏ› ÙÔ Ô˘-
ÛÈ·ÛÙÈÎfiÙÂÚÔ ÚÔÏËÙÈÎfi ̤ÙÚÔ.
∂ÈϤÔÓ, Èı·Ó‹ ÚÔÏËÙÈ΋ ‰Ú¿ÛË Î·Ù¿ ÙÔ˘
ÔÍÂȉˆÙÈÎÔ‡ stress ·ÛΛ Ë ‰ÈfiÚıˆÛË Ù˘ ·Ó·ÈÌ›·˜
ÙˆÓ ·ÛıÂÓÒÓ Ì ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ· ÙÂÏÈÎÔ‡ ÛÙ·-
‰›Ô˘. Δ· ÂÚ˘ıÚ¿ ·ÈÌÔÛÊ·›ÚÈ· ÂÚȤ¯Ô˘Ó ˘„ËÏ¿
Â›‰· ·ÓÙÈ-ÔÍÂȉˆÙÈÎÒÓ Ô˘ÛÈÒÓ, ΢ڛˆ˜ GSH1.
∂Ô̤ӈ˜, ÌÈ· ·‡ÍËÛË Ù˘ Ì¿˙·˜ ÙˆÓ ÂÚ˘ıÚÔ΢Ù-
Ù¿ÚˆÓ ÌÔÚ› Ó· ·˘Í‹ÛÂÈ ÙËÓ ·ÓÙÈ-ÔÍÂȉˆÙÈ΋ Èη-
ÓfiÙËÙ· ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡. ∂›Û˘, ÔÈ ·Ó·ÈÌÈÎÔ›
·ÛıÂÓ›˜ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ÌÈ· ÛÂÈÚ¿ ‰È·Ù·Ú·-
¯ÒÓ Ô˘ Û˘Ì‚¿ÏÏÔ˘Ó ÛÙË ‰ËÌÈÔ˘ÚÁ›· Î·È ‰È·Ù‹ÚË-
ÛË ÙÔ˘ ÔÍÂȉˆÙÈÎÔ‡ stress, fiˆ˜: ·) ∞‡ÍËÛË ÙˆÓ
ηÙ¯ÔÏ·ÌÈÓÒÓ, ÏfiÁˆ Ù˘ ˘ÔÍ·ÈÌ›·˜ Î·È ÙÔ˘ ·ÓÙÈ-
‰Ú·ÛÙÈÎÔ‡ ˘ÂÚ·ÂÚÈÛÌÔ‡, ‚) ‰È¤ÁÂÚÛË ÙˆÓ Ô˘‰ÂÙÂ-
ÚÔʛψÓ, Á) ·ÔÛ‡ÓıÂÛË ÙˆÓ Ô˘ÚÈÓÒÓ Ì¤Ûˆ Ù˘
Í·ÓıÈÓÔ-ÔÍÂȉ¿Û˘ ÙˆÓ ˘ÔÍÈÎÒÓ ÈÛÙÒÓ, Î·È ‰) ÌÂ-
ÚÈ΋ ·ÔÛ‡Ó‰ÂÛË Ù˘ ÔÍÂȉˆÙÈ΋˜ ʈÛÊÔÚ˘Ï›ˆ-
Û˘60. ∏ ‰ÈfiÚıˆÛË Ù˘ ·Ó·ÈÌ›·˜, Î·È Î·Ù¿ Û˘Ó¤-
ÂÈ· Ë ‚ÂÏÙ›ˆÛË ÙˆÓ ·Ú·¿Óˆ ‰È·Ù·Ú·¯ÒÓ, Ô‰Ë-
Á› Û ÚÔʇϷÍË ‹ ÂÚÈÔÚÈÛÌfi ÙÔ˘ ÔÍÂȉˆÙÈÎÔ‡
stress ÙˆÓ ÈÛÙÒÓ.
£ÂÚ·›·
∞ÈÌÔοı·ÚÛË
∏ ·ÈÌÔοı·ÚÛË Ì¤Ûˆ ·ÏÏËÏÂȉڿÛÂˆÓ ÙÔ˘ ·›Ì·-
ÙÔ˜ Î·È Ù˘ «‚ÈԷۇ̂·Ù˘» ÌÂÌ‚Ú¿Ó˘ ÚÔηÏ›
·ÓÒÌ·ÏË ÂÓÂÚÁÔÔ›ËÛË Û˘ÌÏËÚÒÌ·ÙÔ˜, ‰È·Ù·Ú·-
¯‹ ÙˆÓ ·ÏÏËÏÂȉڿÛÂˆÓ Ï¢ÎÔ΢ÙÙ¿ÚˆÓ – ÂÓ‰Ô-
ıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ, ·ÂÏ¢ı¤ÚˆÛË Î˘ÙÙ·ÚÔÎÈÓÒÓ
Î·È ÂÓÂÚÁÒÓ ÚÈ˙ÒÓ Ô͢ÁfiÓÔ˘ ‹ ¡O Î·È ÙÂÏÈο Úfi-
ÎÏËÛË ·ÁÁÂÈ·ÎÔ‡ ÔÍÂȉˆÙÈÎÔ‡ stress. ∏ ÚÔ·-
ÙÔ˘Û· Â·Ó·Ï·Ì‚·ÓfiÌÂÓË ÂÓ‰ÔıËÏȷ΋ ‚Ï¿‚Ë
·ÔÙÂÏ› ÌÈ· ÚÔÊ·Ó‹ ·ÈÙ›· ÁÈ· ÙËÓ ÂÈÙ·¯˘ÓfiÌÂ-
ÓË ·ıËڈ̿وÛË Û ·ÈÌÔηı·ÈÚfiÌÂÓÔ˘˜ ·ÛıÂ-
 ∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 75, 1
Ó›˜. ΔÔ US Renal Data System ¤‰ˆÛ ÂÈÛÙÈΤ˜
··ÓÙ‹ÛÂȘ fiÙÈ Ë ‚ÈÔ·Û˘Ì‚·ÙfiÙËÙ· Ù˘ ÌÂÌ‚Ú¿Ó˘
Ù˘ οı·ÚÛ˘ ·›˙ÂÈ ÚˆÙ‡ÔÓÙ· ÚfiÏÔ ÛÙÔ Ùˆ¯fi
·ÔÙ¤ÏÂÛÌ· Û ¯ÚfiÓÈ· ·ÈÌÔηı·ÈÚfiÌÂÓÔ˘˜, Ì ٷ
ÔÛÔÛÙ¿ ıÓËÙfiÙËÙ·˜ ÌÂÁ·Ï‡ÙÂÚ· Û ÌÂÌ‚Ú¿Ó˜
ÛÂÏÏÔ˘Ïfi˙˘ ¤Ó·ÓÙÈ ÂÎÂ›ÓˆÓ ÙÚÔÔÔÈË̤Ó˘ ÛÂÏ-
ÏÔ˘Ïfi˙˘ ‹ Û˘ÓıÂÙÈÎÒÓ, ˘Ô‰ÂÈÎÓ‡ÔÓÙ·˜ fiÙÈ Î¿-
ÔȘ ÌÂÌ‚Ú¿Ó˜ Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ «‚ÈÔÛ˘Ì‚·-
Ù¤˜». ªÂÌ‚Ú¿Ó˜ ÎÔ˘ÚÔÊ¿Ó˘ Î·È ÛÂÏÏÔ˘Ïfi˙˘
ÌÔÚÔ‡Ó Ó· Â¿ÁÔ˘Ó Û ÌÂÁ·Ï‡ÙÂÚÔ ‚·ıÌfi ‚ÈÔ·-
ۇ̂·Ù˜ ·ÔÎÚ›ÛÂȘ83. ∂›Ó·È ÛËÌ·ÓÙÈ΋ ÂÔ̤ӈ˜
Ë ‚ÂÏÙ›ˆÛË Ù˘ «ÔÈfiÙËÙ·˜» Ù˘ ‰È·‰Èηۛ·˜ ο-
ı·ÚÛ˘. ∞˘Ùfi ÂÈÙ˘Á¯¿ÓÂÙ·È Ì ηχÙÂÚË ‚ÈÔÛ˘Ì-
‚·ÙfiÙËÙ· Ù˘ ÌÂÌ‚Ú¿Ó˘ Î·È ÔÈfiÙËÙ· ÙÔ˘ ̤ÛÔ˘
‰È¿Ï˘Û˘. ™˘ÁÎÂÎÚÈ̤ӷ, ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÌÈÎÙ¤˜
̤ıÔ‰ÔÈ ‰È¿¯˘Û˘-ÌÂÙ·ÁˆÁ‹˜, Ù¯ÓÈΤ˜ ·ÔÚÚfiÊË-
Û˘, Î·È Ê›ÏÙÚ· ˘ÂÚÙ·¯Â›·˜ ÚÔ‹˜-ÚˆÙÂ˚ÓÈ΋˜
‰È·Ê˘Á‹˜ (PLD). ∞Ó¿ÌÂÛ· ÛÙȘ Ù·¯Â›·˜ ÚÔ‹˜ Û˘Ó-
ıÂÙÈΤ˜ ÌÂÌ‚Ú¿Ó˜, Ë PPMA (polymethylmetha-
crylate) ¤¯ÂÈ ¯ÚËÛÈÌÔÔÈËı› ÛÙËÓ ·Ú·ÁˆÁ‹ PLD
˘„ËÏ‹˜ ÔÈfiÙËÙ·˜, ·ÍÈÔÔÈÒÓÙ·˜ ¤Ó· Û˘Ó‰˘·ÛÌfi
¿ÌÂÛ˘ ·ÔÌ¿ÎÚ˘ÓÛ˘ Î·È ·ÔÚÚfiÊËÛ˘ ÌÂÁ¿ÏˆÓ
ÌÔÚ›ˆÓ84-86. ªÂ Ì˯·ÓÈÛÌÔ‡˜ ·ÔÚÚfiÊËÛ˘ Ë
PPMA, ·ÏÏ¿ Î·È ¿ÏÏ· ·ÚÓËÙÈο ËÏÂÎÙÚÈο ÊÔÚÙÈ-
Ṳ̂ӷ ˘ÏÈο Û·Ó ÙÔ polyacrylonitrite (ÌÂÌ‚Ú¿Ó˜
∞¡69), ·˘Í¿ÓÔ˘Ó ÙÔ Ú˘ıÌfi ·ÔÌ¿ÎÚ˘ÓÛ˘ ÌÂÁ¿-
ÏˆÓ Ô˘ÛÈÒÓ, ΢ÙÙ·ÚÔÎÈÓÒÓ Î·È Ì¤ÛÔ˘ ÌÔÚÈ·ÎÔ‡
‚¿ÚÔ˘˜ ÌÔÚ›ˆÓ (‚2-ÌÈÎÚÔÛÊ·ÈÚ›ÓË)87. OÈ ÌÂÌ‚Ú¿-
Ó˜ PPMA ÌÔÚÔ‡Ó Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó ÛÙ· Â-
ÚÈÛÛfiÙÂÚ· ΤÓÙÚ· ·ÈÌÔοı·ÚÛ˘, ¯ˆÚ›˜ ÙȘ ·ÚÂ-
Ó¤ÚÁÂȘ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ Î·Î‹ ıÚ¤„Ë Î·È
ÙËÓ ˘ÔÏÂ˘ÎˆÌ·ÙÈÓ·ÈÌ›·, ‹ Ì ÙÔÓ Î›Ó‰˘ÓÔ ÙÔ˘
backfiltration. ŒÙÛÈ ÌÂÙ¿ ÂÍ¿ÌËÓË ·ÈÌÔοı·ÚÛË
ÌÂ PLD ÌÂ ¯Ú‹ÛË PPMA, ·Ú·ÙËÚ‹ıËÎÂ ÂÏ¿ÙÙˆÛË
‰ÂÈÎÙÒÓ ÔÍÂȉˆÙÈÎÔ‡ stress, fiˆ˜ Ë ÂÓÙÔÛȉ›ÓË,
Ù· ∞Oƒƒ, Î·È Ù· ÚˆÙÂ˚ÓÈο ηڂÔÓ‡ÏÈ·. Δ· PLD
ηٿÊÂÚ·Ó Â›Û˘ Ó· ·ÔÌ·ÎÚ‡ÓÔ˘Ó ¤Ó· ÌÂÁ¿ÏÔ
ÔÛÔÛÙfi ÚˆÙÂ˚ÓÒÓ Ô˘ ÂÚÈ›¯·Ó ÔÍÂȉˆÙÈο
ÛÙÔȯ›· fiˆ˜ Ë 4-∏¡∂ Î·È Ë 3-ÓÈÙÚÔÙ˘ÚÔÛ›ÓË.
∂Ï¿ÙÙˆÛË Î·Ù·ÁÚ¿ÊËÎÂ Î·È ÁÈ· ÊÏÂÁÌÔÓÒ‰ÂȘ
‰Â›ÎÙ˜, fiˆ˜ Ë CRP Î·È Ë IL-6. ∞ÓÙÈı¤Ùˆ˜, Ù· Ù·-
¯Â›·˜ ÚÔ‹˜-ÌË ÚˆÙÂ˚ÓÈ΋˜ ‰È·Ê˘Á‹˜ Ê›ÏÙÚ·
(¡PLD) ‰ÂÓ ·ÚÔ˘Û›·Û·Ó ηÌÈ¿ ÌÂÙ·‚ÔÏ‹ ÛÙȘ
·Ú·¿Óˆ ·Ú·Ì¤ÙÚÔ˘˜12. ªÂϤÙË Û ¯ÚfiÓÈÔ˘˜
ÓÂÊÚÔ·ı›˜ ÚÔÛ‰ÈfiÚÈÛ ÙËÓ Ù·¯‡ÙËÙ· ·ÏÌÈÎÔ‡
·̷ÙÔ˜ [pulse wave velocity (PWV)] ÚÈÓ, ηٿ ÙË
‰È¿ÚÎÂÈ· Î·È ÌÂÙ¿ ÙË Û˘Ó‰ڛ· ·ÈÌÔοı·ÚÛ˘. ∏
·Ú¿ÌÂÙÚÔ˜ ·˘Ù‹ ·ÔÙÂÏ› ÌË ÂÂÌ‚·ÙÈ΋ ̤ıÔ‰Ô
̤ÙÚËÛ˘ Ù˘ ·ÁÁÂȷ΋˜ ·Î·Ì„›·˜ Î·È ¤Ó·Ó ·ÓÂ-
Í¿ÚÙËÙÔ ÚÔÁÓˆÛÙÈÎfi ·Ú¿ÁÔÓÙ· Û˘ÓÔÏÈ΋˜ ıÓË-
ÙfiÙËÙ·˜. OÈ ÔÏ˘ÛÔ˘ÏÊÔÓÈΤ˜ ·ÏÏ¿ fi¯È ÔÈ ÔÏ˘·ÌÈ-
15
‰ÈΤ˜ ÌÂÌ‚Ú¿Ó˜ ÙÚÔÔÔ›ËÛ·Ó ÙËÓ PWV ÏfiÁˆ ÌÂ-
Á·Ï‡ÙÂÚ˘ Û¯ÂÙÈ΋˜ ‚ÈÔ·Û˘Ì‚·ÙfiÙËÙ·˜, ˘Ô‰ÂÈ-
ÎÓ‡ÔÓÙ·˜ ÂÈ̤ÚÔ˘˜ ‰È·ÊÔÚ¤˜ Î·È ÌÂٷ͇ ÙˆÓ Û˘Ó-
ıÂÙÈÎÒÓ ÌÂÌ‚Ú·ÓÒÓ. OÈ ÌÂÌ‚Ú¿Ó˜ ÔÏ˘·Ìȉ›ˆÓ
‰Â›¯ıËΠfiÙÈ ·˘Í¿ÓÔ˘Ó ÙȘ ‰ÈÌÂı˘Ï·ÚÁÈÓ›Ó˜ Ô˘
·ÔÙÂÏÔ‡Ó ÂÓ‰ÔÁÂÓ›˜ ·Ó·ÛÙÔÏ›˜ Ù˘ ¡O Û˘ÓıÂ-
Ù¿Û˘88. ªÈ· ·ÎfiÌË ‰È·ÊÔÚ¿ ÌÂٷ͇ ·ÚfiÌÔȈÓ
Û˘ÓıÂÙÈÎÒÓ ÌÂÌ‚Ú·ÓÒÓ Û ۯ¤ÛË Ì ÙÔ ‚·ıÌfi ‚ÈÔ-
·Û˘Ì‚·ÙfiÙËÙ·˜ ÌÔÚ› Ó· ÔÊ›ÏÂÙ·È Û ‰È·ÊÔÚ¤˜
ÛÙËÓ ·Ó·ÏÔÁ›· ˘‰ÚfiÊÈψÓ/ ˘‰ÚfiÊÔ‚ˆÓ ‰ÔÌÈÎÒÓ
ÔÌ¿‰ˆÓ Ì ÙÚÔÔÔÈË̤ÓË Î¿ı ÊÔÚ¿ ÂÓÂÚÁÔÔ›-
ËÛË ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ‹Í˘89. ∞ÛıÂÓ›˜ Ì ÚÔ¸-
¿Ú¯Ô˘Û· ·ÁÁÂȷ΋ ÓfiÛÔ ÂËÚ¿˙ÔÓÙ·È ÏÈÁfiÙÂÚÔ
·fi ÙȘ ·ÓÙȉڿÛÂȘ ÛÙ· Ï·›ÛÈ· ‚ÈÔ·Û˘Ì‚·ÙfiÙË-
Ù·˜ ÂÓÒ Î·È ÚÔ˚fiÓÙÔ˜ ÙÔ˘ ¯ÚfiÓÔ˘ ·ÈÌÔοı·ÚÛ˘
ÔÈ ·ÓÙȉڿÛÂȘ ÂÚÈÔÚ›˙ÔÓÙ·È. ∏ Â·Ó·Ï·Ì‚·Ófi-
ÌÂÓË, ÚÔηÏÔ‡ÌÂÓË ·fi ÙË ‰È·‰Èηۛ· Ù˘ ο-
ı·ÚÛ˘ ÂÓ‰ÔıËÏȷ΋ ‚Ï¿‚Ë Â›Ó·È ÚÔÙÂÈÓfiÌÂÓÔ˜
Ì˯·ÓÈÛÌfi˜ Ì·ÎÚfi¯ÚÔÓ˘ ·ÁÁÂȷ΋˜ ‚Ï¿‚˘, ·ÏÏ¿
Ë ·ÚÔ‰È΋ ÂÓÂÚÁÔÔ›ËÛË ÙÔ˘ ÂÓ‰ÔıËÏ›Ô˘, Ô˘
ÚÔηÏ› ÌÈ· ÂÚ›Ô‰Ô ·˘ÍË̤Ó˘ ·ÚÙËÚȷ΋˜
·Î·Ì„›·˜ (Èı·ÓfiÓ Ì¤Ûˆ ÂÏ·Ùو̤Ó˘ ‰È·ıÂÛÈÌfi-
ÙËÙ·˜ ¡O), ÌÔÚ› Ó· Â›Ó·È ÂÈÊ·ÈÓfiÌÂÓÔ ¯ˆÚ›˜
ÛËÌ·ÓÙÈ΋ Û˘ÓÂÈÛÊÔÚ¿ ÛÙË Ì·ÎÚfi¯ÚÔÓË ·ÎÔÏÔ˘-
ı›· ·ÁÁÂȷ΋˜ ‚Ï¿‚˘90.
ªÂÁ¿ÏÔ ÂӉȷʤÚÔÓ ÚÔÛÂÏ·ÂÈ ÌÈ· Ó¤· ÙÂ-
¯ÓÈ΋ ·ÈÌÔοı·ÚÛ˘, Ë HFR (haemodiafiltration
with online regeneration of ultrafiltrate) Ë ÔÔ›·
¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ¤Ó· ‰ÈÏfi ı¿Ï·ÌÔ Ê›ÏÙÚÔ˘ ·È-
ÌÔοı·ÚÛ˘, Î·È Û˘Ó‰˘¿˙ÂÈ ÙȘ ÌÂıfi‰Ô˘˜ Ù˘ ‰È¿-
¯˘Û˘, Ù˘ ÌÂÙ·ÁˆÁ‹˜ Î·È Ù˘ ·ÔÚÚfiÊËÛ˘. ™˘-
ÁÎÂÎÚÈ̤ӷ, ÙÔ ‰ÈËıË̤ÓÔ ·›Ì· ˘Ê›ÛÙ·Ù·È ÂÂÍÂÚ-
Á·Û›· Û ¤Ó· ‰È·Ì¤ÚÈÛÌ· ·fi Û‡ÌÏÔÎÔ ¿Óıڷη-
ÚËÙ›Ó˘ Î·È ÙÔ ÙÂÏÈÎfi ‰È‹ıËÌ· Â·ÓÂÁ¯¤ÂÙ·È ÛÙËÓ
΢ÎÏÔÊÔÚ›· ÚÈÓ ÙÔ ÙÌ‹Ì· ‰È¿¯˘Û˘ ÙÔ˘ Ê›ÏÙÚÔ˘.
ŒÓ· ÂÈϤÔÓ ¯·Ú·ÎÙËÚÈÛÙÈÎfi Ù˘ ÌÂıfi‰Ô˘ ·Ô-
ÙÂÏ› Ë ·ÔÚÚfiÊËÛË Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ÊÏÂÁÌÔÓÔÁfi-
ÓˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ ·fi ÙË ÚËÙ›ÓË91. ªÂ ÙËÓ Ù¯ÓÈ΋
HFR ·Ú·ÙËÚ‹ıËΠıÂÙÈ΋ Â›‰Ú·ÛË Û ‰Â›ÎÙ˜
ÊÏÂÁÌÔÓ‹˜ ÙˆÓ ·ÈÌÔηı·ÈÚfiÌÂÓˆÓ ·ÛıÂÓÒÓ
(CRP, IL-6, TNF-·)92. ¶Èı·ÓÒ˜ ̤ۈ ·˘Ù‹˜ Ù˘
‰Ú¿Û˘ Ù˘, ·ÏÏ¿ Î·È Ù˘ ÚÔÛÙ·Û›·˜ ¤Ó·ÓÙÈ Ù˘
·ÒÏÂÈ·˜ ˘‰·ÙÔ‰È·Ï˘ÙÒÓ ·ÓÙÈÔÍÂȉˆÙÈÎÒÓ Ô˘-
ÛÈÒÓ, fiˆ˜ Ë ‚ÈÙ·Ì›ÓË C, Ë HFR ·ÚÔ˘ÛÈ¿˙ÂÈ ıÂ-
ÙÈ΋ Â›‰Ú·ÛË Î·È Û ·Ú·Ì¤ÙÚÔ˘˜ ÔÍÂȉˆÙÈÎÔ‡
stress. ªÂÈÒÓÂÈ ÙËÓ ·Ú·ÁˆÁ‹ mRNA Î·È ÙËÓ
ÚˆÙÂ˚ÓÈ΋ ¤ÎÊÚ·ÛË ‰ÂÈÎÙÒÓ ÔÍÂȉˆÙÈÎÔ‡ stress
(p22phox Î·È ƒ∞π-1 ÙˆÓ ÌÔÓÔ΢ÙÙ¿ÚˆÓ) Î·È ÂÏ·ÙÙÒ-
ÓÂÈ Ì ÛÙ·ÙÈÛÙÈ΋ ÛËÌ·ÓÙÈÎfiÙËÙ· Ù· Â›‰·
oxLDL ÙÔ˘ Ï¿ÛÌ·ÙÔ˜ —·ÛÎÒÓÙ·˜ Èı·Ó‹ ¢ÂÚ-
ÁÂÙÈ΋ Â›‰Ú·ÛË Î·È ÛÙËÓ Î·Ú‰È·ÁÁÂȷ΋ ÓfiÛÔ ÙˆÓ
16 Ã. ¡π∫O§∞´¢OÀ, °. ª¶OÀ¡ΔOÀƒ∏™

Υψηλή
Βιοσυμβατότητα ποιότητα
- τοξικότητα μέσου
της ουραιμίας διάλυσης
Υψηλή
βιοσυμβατότητα, Ρυθμός
φαρμακευτική κάθαρσης
θεραπεία Ειδικές
∆ιαταραχή
μεταβολισμού μέθοδοι
και κάθαρσης (απορρόφηση-
PPMA-HFR)

Συσσώρευση
ΠΡOΛΗΨΗ ΑΠOΜΑΚΡΥΝΣΗ
τοξικών ουσιών

∂ÈÎ. 3. ∏ Û˘ÛÛÒÚ¢ÛË ÙÔÍÈÎÒÓ-ÔÍÂȉˆÙÈÎÒÓ Ô˘ÛÈÒÓ Î·Ù¿ ÙËÓ ·ÈÌÔοı·ÚÛË, Î·È ÔÈ Èı·ÓÔ› ÙÚfiÔÈ ÚfiÏ˄˘ ηÈ
·ÔÌ¿ÎÚ˘ÓÛ‹˜ ÙÔ˘˜.

¯ÚÔÓ›ˆ˜ ÓÂÊÚÔ·ıÒÓ ·ÛıÂÓÒÓ—91. ™ÙËÓ ÂÈÎfiÓ· 3
·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Û˘ÓÔÙÈο ÔÈ ÙÚfiÔÈ ÚfiÏ˄˘
Ù˘ Û˘ÛÛÒÚ¢Û˘ ÙˆÓ ÙÔÍÈÎÒÓ Ô˘ÛÈÒÓ Î·Ù¿ ÙË ‰È·-
‰Èηۛ· Ù˘ ·ÈÌÔοı·ÚÛ˘, ηıÒ˜ Î·È ÔÈ ÙÚfiÔÈ
·ÔÌ¿ÎÚ˘ÓÛ‹˜ ÙÔ˘˜.
™ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÊÏÂÁÌÔÓ‹˜ Î·È ÙÔ˘
Û˘Ó‰ÚfiÌÔ˘ ªπ∞ ÙˆÓ ¯ÚÔÓ›ˆÓ ÓÂÊÚÔ·ıÒÓ ·ÛıÂ-
ÓÒÓ Ô˘ÛÈ·ÛÙÈÎfi˜ ·Ó·‰ÂÈÎÓ‡ÂÙ·È Î·È Ô ÚfiÏÔ˜ Ù˘
Ê·Ú̷΢ÙÈ΋˜ ıÂÚ·›·˜. ŒÙÛÈ, Û ÂÚ›ÙˆÛË
ÂÌ̤ÓÔ˘Û·˜ ÊÏÂÁÌÔÓÒ‰Ô˘˜ ÂÍÂÚÁ·Û›·˜, ‰fiÎÈÌË
ıˆÚÂ›Ù·È Ë ¯ÔÚ‹ÁËÛË ·ÓÙÈÌÈÎÚÔ‚È·ÎÒÓ22. ∏ ·ÛÈ-
Ú›ÓË (·ÎÂÙ˘ÏÔÛ·Ï˘ÎÈÏÈÎfi Ô͇) ÌÔÚ› Ó· ·ÔÙÂÏ›
ÌÈ· ·ÎfiÌ· ıÂÚ·¢ÙÈ΋ ÂÈÏÔÁ‹, ·ÊÔ‡ ‚Ú¤ıËÎÂ
fiÙÈ ÂÏ·ÙÙÒÓÂÈ Ù· Â›‰· Ù˘ CRP Î·È Ù˘ IL-6 ÛÂ
·ÛıÂÓ›˜ Ì ÈÛ¯·ÈÌÈ΋ ÓfiÛÔ ÙÔ˘ Ì˘Ôηډ›Ô˘, ηÈ
ÌÂÈÒÓÂÈ ·Ó·ÏÔÁÈο ÙÔÓ Î›Ó‰˘ÓÔ ÂÌÊÚ¿ÁÌ·ÙÔ˜93, 94.
Δ· ÙÂÏÂ˘Ù·›· ¤ÙË ÌÂÁ¿ÏÔ ÂӉȷʤÚÔÓ ·ÔÎÙÔ‡Ó ÔÈ
·Ó·ÛÙÔÏ›˜ ÙÔ˘ ÌÂÙ·ÙÚÂÙÈÎÔ‡ ÂÓ˙‡ÌÔ˘ Ù˘ ·ÁÁÂÈ-
ÔÙÂÓÛ›Ó˘ (∞ª∂∞) Î·È ÔÈ ·ÔÎÏÂÈÛÙ¤˜ ÙˆÓ ˘Ô‰Ô-
¯¤ˆÓ-1 Ù˘ ·ÁÁÂÈÔÙÂÓÛ›Ó˘-2 (∞Δ1). ∏ ¯Ú‹ÛË ÙˆÓ
∞ª∂∞ Û ·ÛıÂÓ›˜ Ì ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘ ÓÂÊÚÈ΋
·ÓÂ¿ÚÎÂÈ· ·ԉ›¯ıËΠfiÙÈ Û˘Û¯ÂÙ›˙ÂÙ·È Ì ¯·-
ÌËÏfiÙÂÚ· Â›‰· TNF-· Î·È CRP95, ηı˘ÛÙÂÚÒ-
ÓÙ·˜ ¤ÙÛÈ ÙËÓ ÚfiÔ‰Ô Ù˘ ¯ÚfiÓÈ·˜ ÓÂÊÚÈ΋˜ ·ÓÂ-
¿ÚÎÂÈ·˜ Î·È ‚ÂÏÙÈÒÓÔÓÙ·˜ ÙËÓ ÚfiÁÓˆÛ‹ Ù˘96.
∞fi ÙËÓ ¿ÏÏË, ¤¯ÂÈ Î·Ù·ÁÚ·Ê› ÌÂÁ·Ï‡ÙÂÚË Û˘-
ÁΤÓÙÚˆÛË ‰ÂÈÎÙÒÓ ÔÍÂȉˆÙÈÎÔ‡ stress ÛÙ· Ô‡Ú·
ÙˆÓ ·ÛıÂÓÒÓ Ì ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ· ÙÂÏÈÎÔ‡ ÛÙ·-
‰›Ô˘, Û ۯ¤ÛË Ì ·˘Ù‹Ó ÙÔ˘ ·›Ì·ÙÔ˜. ∏ ÏÂ˘ÎˆÌ·-
Ù›ÓË ·ÔÙÂÏ› ÙÔÓ Î‡ÚÈÔ ÛÙfi¯Ô Ù˘ ÔÍÂȉˆÙÈ΋˜
‚Ï¿‚˘. ¶·Ú·ÙËÚ‹ıËΠfiÙÈ Ë ÔÍÂȉˆÙÈ΋ ‰Ú¿ÛË
ÛÙË ÏÂ˘ÎˆÌ·Ù›ÓË ÌÔÚ› Ó· ÂÏ·ÙÙˆı› Ì ÙË ¯Ú‹ÛË
∞Δ1, Î·È Ì¿ÏÈÛÙ· ·ÓÂÍ¿ÚÙËÙ· ·fi ÙËÓ ÂÏ¿ÙÙˆÛË
Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ ‹ Ù˘ ÚˆÙÂ˚ÓÔ˘Ú›·˜11.
∞ӷʤÚÂÙ·È Â›Û˘, fiÙÈ Ë ‚Ú·¯˘¯ÚfiÓÈ· ¯ÔÚ‹ÁËÛË
‚·ÏÛ·ÚÙ¿Ó˘ (∞Δ1) ‹ ·ÌÏÔ‰È›Ó˘ (·ÔÎÏÂÈÛÙ‹˜
‰È·‡ÏˆÓ ·Û‚ÂÛÙ›Ô˘ Ù˘ Ù¿Í˘ ÙˆÓ ‰È˘‰ÚÔ˘ÚȉÈ-
ÓÒÓ) ÂÏ·ÙÙÒÓÂÈ ÛËÌ·ÓÙÈο Ù· Â›‰· ÙˆÓ ‰ÂÈÎÙÒÓ
ÙÔ˘ ÔÍÂȉˆÙÈÎÔ‡ stress 97. ™ËÌ·ÓÙÈÎfi˜ ·Ú·Ì¤ÓÂÈ Ô
ÚfiÏÔ˜ ÙˆÓ ÛÙ·ÙÈÓÒÓ ÛÙÔÓ ÂÚÈÔÚÈÛÌfi Ù˘ ÊÏÂÁÌÔ-
Ó‹˜ Î·È ÙÔ˘ ÔÍÂȉˆÙÈÎÔ‡ stress ÙˆÓ ¯ÚÔÓ›ˆÓ ÓÂÊÚÔ-
·ıÒÓ ·ÛıÂÓÒÓ. ∞˘Ùfi ÙÔ Î·ÙÔÚıÒÓÔ˘Ó Ì¤Ûˆ η-
Ù·ÛÙÔÏ‹˜ Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ÔÍÂȉˆÙÈÎÒÓ Ô‰ÒÓ, Û˘-
ÌÂÚÈÏ·Ì‚·ÓÔ̤Ó˘ Ù˘ ·Ú·ÁˆÁ‹˜ Ô˘ÛÈÒÓ Ô˘
ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙË MPO (Ì˘ÂÏÔ¸ÂÚÔÍÂȉ¿ÛË:
¤Ó˙˘ÌÔ ÙˆÓ ·Ì˘ÓÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ, Ô˘ Ô‰ËÁ› ÛÙÔ
Û¯ËÌ·ÙÈÛÌfi ˘ԯψÚÈÒ‰Ô˘˜ ÔͤԘ) Î·È ÙÔ ¡O.
¶·Ú·ÙËÚ‹ıËΠfiÙÈ Ë Ì·ÎÚÔ¯ÚfiÓÈ· ıÂÚ·›· ÌÂ
ÛÙ·Ù›Ó˜ Û¯ÂÙ›˙ÂÙ·È Ì ÛËÌ·ÓÙÈο ÌÈÎÚfiÙÂÚË ‰Ú·-
ÛÙËÚÈfiÙËÙ· Ù˘ ªƒO98.
ªÂÁ¿ÏÔ Ì¤ÚÔ˜ Ù˘ ¤Ú¢ӷ˜ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒ-
ÈÛË ÙÔ˘ ÔÍÂȉˆÙÈÎÔ‡ stress ÙˆÓ ·ÛıÂÓÒÓ Ì ÓÂ-
ÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ· ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘ η٤¯Ô˘Ó ÔÈ
·ÓÙÈÔÍÂȉˆÙÈΤ˜ Ô˘Û›Â˜, fiˆ˜ Ë ‚Èٷ̛Ә ∂ Î·È C
Î·È ÙÔ ÛÂÏ‹ÓÈÔ. ∏ ‚ÈÙ·Ì›ÓË ∂ Û˘ÓÈÛÙ¿ ÌÈ· ‚·ÛÈ΋
ÏÈÔ‰È·Ï˘Ù‹ ‚ÈÙ·Ì›ÓË, ··Ú·›ÙËÙË ÁÈ· ÙË ÏÂÈÙÔ˘Ú-
Á›· ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ Î·È ÙËÓ ÚÔÛÙ·Û›· ·fi ÔÍÂÈ-
‰ˆÙÈΤ˜ ‰Ú¿ÛÂȘ. ∂ÓÂÚÁ› Û Â›Â‰Ô ÏÈȉÈÎÒÓ
ÌÂÌ‚Ú·ÓÒÓ, ÛÂ ·ÓÙ›ıÂÛË ÌÂ ÙË GSH Ô˘ ‰Ú· ÛÙÔ
΢ÙÙ·ÚfiÏ·ÛÌ·. ∏ ÚÔÛÙ·Û›· ÙˆÓ ÏÈȉÈÎÒÓ ÌÂÌ-
‚Ú·ÓÒÓ ·fi ÙË ‚ÈÙ·Ì›ÓË ∂ ÌÔÚ› Ó· ÂÌÔ‰›ÛÂÈ
ÙËÓ Â›ÛÔ‰Ô ÔÍÂȉˆÙÈÎÒÓ Ô˘ÛÈÒÓ ÛÙÔ Î˘ÙÙ·ÚfiÏ·-
ÛÌ·, Î·È ¤ÙÛÈ Ó· ηٷÛÙ‹ÛÂÈ ÌË ·Ó·Áη›· ÙËÓ
ÂÓÂÚÁÔÔ›ËÛË ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ Ù˘ GSH56, 99. ¶·-
ÚfiÏÔ Ô˘ Ù· Â›‰· Ù˘ ‚ÈÙ·Ì›Ó˘ ∂ ‰ÂÓ ÂËÚ¿-
˙ÔÓÙ·È ·fi ÙË ‰È·‰Èηۛ· Ù˘ ·ÈÌÔοı·ÚÛ˘, Ë ¯Ô-
Ú‹ÁËÛ‹ Ù˘ ·fi ÙÔ ÛÙfiÌ· Û ˘„ËÏ‹ ‰fiÛË (1600
IU) ¤ÍÈ ÒÚ˜ ÚÈÓ ÙË Û˘Ó‰ڛ· ·ÈÌÔοı·ÚÛ˘
 ∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 75, 1
·ԉ›¯ıËΠfiÙÈ ÚÔÛٷهÂÈ ·fi ÙÔ ÔÍÂȉˆÙÈÎfi
stress100. Œ¯ÂÈ ·Ó¢ÚÂı› ÌÈ· ·ÓÙ›ÛÙÚÔÊË Û˘Û¯¤ÙÈ-
ÛË ÌÂٷ͇ Ù˘ ‚ÈÙ·Ì›Ó˘ ∂ Î·È ÙˆÓ ÂÈ¤‰ˆÓ anti-
ox-LDLs, Ô‰ËÁÒÓÙ·˜ ÛÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ Ë Û˘-
ÁÎÂÎÚÈ̤ÓË ‚ÈÙ·Ì›ÓË ·ÔÙÂÏ› ÛËÌ·ÓÙÈÎfi ·Ó·ÛÙÔ-
Ϥ· Ù˘ ÔÍ›‰ˆÛ˘ Ù˘ LDL. Ÿˆ˜ ·Ó·Ï‡ÂÙ·È, ÔÈ
Ù›ÙÏÔÈ ÙˆÓ anti-ox-LDLs ·ÔÙÂÏÔ‡Ó ·ÓÂÍ¿ÚÙËÙÔ
ÚÔÁÓˆÛÙÈÎfi ·Ú¿ÁÔÓÙ· ıÓËÙfiÙËÙ·˜ Î·È ÂÈ‚›ˆ-
Û˘ Û ·ÈÌÔηı·ÈÚfiÌÂÓÔ˘˜ ·ÛıÂÓ›˜20. ™Â ÌÂϤÙË
fiÔ˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó Ê›ÏÙÚ· ·ÈÌÔοı·ÚÛ˘ ÌÂ
ÛÂÏÔ˘Ïfi˙Ë ÂÈÎ·Ï˘Ì̤ÓË Ì ‚ÈÙ·Ì›ÓË ∂ ÁÈ· ‰‡Ô
Û˘Ó¯‹ ¤ÙË, ·Ú·ÙËÚ‹ıËΠÛËÌ·ÓÙÈ΋ ÂÏ¿ÙÙˆÛË
Ù˘ ÔÍ›‰ˆÛ˘ Ù˘ LDL Î·È Î·ı˘ÛÙÂÚË̤ÓË ÂͤÏÈ-
ÍË Ù˘ ·Û‚ÂÛÙÔÔ›ËÛ˘ Ù˘ ·ÔÚÙ‹˜101. ™ÙË ÌÂϤÙË
SPACE, Ë ¯ÔÚ‹ÁËÛË 800 IU ‚ÈÙ·Ì›Ó˘ ∂ ÙËÓ Ë̤-
Ú· Û ·ÈÌÔηı·ÈÚfiÌÂÓÔ˘˜ ·ÛıÂÓ›˜ Ì ÚÔ¸¿Ú-
¯Ô˘Û· ηډȷÁÁÂȷ΋ ÓfiÛÔ Â›¯Â Û·Ó ·ÔÙ¤ÏÂÛÌ·
ÙË ÛËÌ·ÓÙÈ΋ Ì›ˆÛË ÙˆÓ Î·Ù·ÏËÎÙÈÎÒÓ ÛËÌ›ˆÓ
Ù˘ ÓfiÛÔ˘, fiˆ˜ ÙÔ ¤ÌÊÚ·ÁÌ· Ì˘Ôηډ›Ô˘, ¯ˆÚ›˜
fï˜ Ô˘ÛÈ·ÛÙÈ΋ ÌÂÙ·‚ÔÏ‹ ÛÙË Û˘ÓÔÏÈ΋ ıÓËÙfiÙË-
Ù· Î·È ıÓËÛÈÌfiÙËÙ· ·fi ·˘Ù‹Ó102. ∏ ¯Ú‹ÛË ÌÂÌ-
‚Ú·ÓÒÓ Î¿ı·ÚÛ˘ ÎÔ˘ÚÔÊ¿Ó˘ (·ÏÏ¿ fi¯È Û˘ÓıÂ-
ÙÈÎÒÓ ÔÏ˘ÛÔ˘ÏÊÔÓÈÎÒÓ) Û¯ÂÙ›ÛÙËΠ̠ÂÏ¿ÙÙˆÛË
ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ ‚ÈÙ·Ì›Ó˘ ∂ ÙÔ˘ ÔÚÔ‡ ÌÂÙ¿ ÙËÓ
οıÂ Û˘Ó‰ڛ·, ˘Ô‰ÂÈÎÓ‡ÔÓÙ·˜ ˘„ËÏfiÙÂÚÔ˘ ‚·ı-
ÌÔ‡ ÔÍÂȉˆÙÈÎfi stress. ¶·Ú¿ Ù·‡Ù· ·˘Ù¤˜ ÔÈ ‰È·-
ÊÔÚ¤˜ ‰ÂÓ Â›Ó·È ÍÂοı·ÚÔ ·Ó Û¯ÂÙ›˙ÔÓÙ·È Ì ÛË-
Ì·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ˆ˜ ÚÔ˜ ÙÔ ÁÂÓÈÎfiÙÂÚÔ ·ÔÙ¤-
ÏÂÛÌ· Ù˘ ·ÈÌÔοı·ÚÛ˘ ηı’ ·˘Ù‹˜ ÛÙËÓ ÂÓ‰ÔıË-
Ïȷ΋ ÏÂÈÙÔ˘ÚÁ›·. ∂ÓÒ Ë Î¿ı·ÚÛË per se ÌÂ Û˘Ó-
ıÂÙÈ΋ ÔÏ˘ÛÔ˘ÏÊÔÓÈ΋ ÌÂÌ‚Ú¿ÓË ‰ÂÓ ·ÛΛ Ô͇
·ÔÙ¤ÏÂÛÌ· ÛÙËÓ ÂÍ·ÚÙÒÌÂÓË ·fi ÙË ÚÔ‹ ·ÁÁÂÈÔ-
‰È·ÛÙÔÏ‹ (FMV), Ë ¯Ú‹ÛË ÛÂÏÔ˘ÏÔ˙È΋˜ – ÎÔ˘-
ÚÔÊ·ÓÈ΋˜ ÌÂÌ‚Ú¿Ó˘ Û¯ÂÙ›˙ÂÙ·È Ì ÌÈÎÚ‹ ·ÏÏ¿
ÛËÌ·ÓÙÈ΋ ‰È·Ù·Ú·¯‹ Ù˘ ÂÓ‰ÔıËÏȷ΋˜ ÏÂÈÙÔ˘Ú-
Á›·˜. ΔÔ Ì·ÎÚfi¯ÚÔÓÔ ·ÔÙ¤ÏÂÛÌ· Ù˘ ¯Ú‹Û˘ ÓÂ-
ÒÙÂÚˆÓ ÌÂÌ‚Ú·ÓÒÓ ÛÙËÓ Î·Ú‰È·ÁÁÂȷ΋ ÓÔÛËÚfi-
ÙËÙ· Î·È ıÓËÙfiÙËÙ· ı· ·ÍÈÔÏÔÁËı› Û ̷ÎÚfi¯ÚÔ-
Ó˜ ÚÔÔÙÈΤ˜ ÌÂϤÙ˜ Ì ÌÂÁ¿ÏÔ ·ÚÈıÌfi ·ÛıÂ-
ÓÒÓ103. Δ· Â›‰· ÙˆÓ ÊÏÂÁÌÔÓˆ‰ÒÓ Î˘ÙÙ·ÚÔÎÈ-
ÓÒÓ, fiˆ˜ Î·È ÙˆÓ ·ÓÙ·ÁˆÓÈÛÙÒÓ ÙÔ˘˜ ·ÏÏ¿ ηÈ
ÙˆÓ ÌÔÚ›ˆÓ ÚÔÛÎfiÏÏËÛ˘ Â›Ó·È ·˘ÍË̤ӷ Û ·È-
ÌÔηı·ÈÚfiÌÂÓÔ˘˜ ·ÛıÂÓ›˜. Δ· Â›‰· ÚÈÓ ·fi
οıÂ Û˘Ó‰ڛ· ‰Â ‰È¤ÊÂÚ·Ó ÌÂٷ͇ ·ÛıÂÓÒÓ ÌÂ
ÎÔ˘ÚÔÊ·ÓÈΤ˜ ‹ ÔÏ˘ÛÔ˘ÏÊÔÓÈΤ˜ ÌÂÌ‚Ú¿Ó˜
·ÏÏ¿ Ë ¯Ú‹ÛË ÙˆÓ ÚÒÙˆÓ Ô‰‹ÁËÛ Û ÛËÌ·ÓÙÈο
ÌÂÁ·Ï‡ÙÂÚË ‰È¤ÁÂÚÛË Δ¡F-a ηٿ ÙË ‰È¿ÚÎÂÈ·
ÙˆÓ Û˘Ó‰ÚÈÒÓ ˘Ô‰ÂÈÎÓ‡ÔÓÙ·˜ ÌÂÁ·Ï‡ÙÂÚÔ ‚·ı-
Ìfi ‚ÈÔ·Û˘Ì‚·ÙfiÙËÙ·˜104, 105. ΔÚÔÔÔÈË̤Ó˜ ÌÂÌ-
‚Ú¿Ó˜ ÌÔÚÔ‡Ó Ó· Ô‰ËÁ‹ÛÔ˘Ó Û ÂÏ¿ÙÙˆÛË ÙˆÓ
ÂÈ¤‰ˆÓ ¡O Ï¿ÛÌ·ÙÔ˜. À’ ·˘Ù‹ ÙËÓ ¤ÓÓÔÈ· Ë
17
ÙÚÔÔÔÈË̤ÓË Ì ‚ÈÙ·Ì›ÓË ∂ ÛÂÏÔ˘ÏÔ˙È΋ ÌÂÌ-
‚Ú¿ÓË ÔÌÔÈ¿˙ÂÈ Û ۯ¤ÛË Ì ÙË ‚ÈÔÛ˘Ì‚·ÙfiÙËÙ·
ÂÚÈÛÛfiÙÂÚÔ ÚÔ˜ ÙȘ ÓÂfiÙÂÚ˜ —ÏÈÁfiÙÂÚÔ ÂÓÂÚ-
ÁÔÔȤ˜ ÙÔ˘ Û˘ÌÏËÚÒÌ·ÙÔ˜— Û˘ÓıÂÙÈΤ˜ ÌÂÌ-
‚Ú¿Ó˜ ÔÏ˘·Ìȉ›Ô˘. ΔÚÔÔÔÈË̤ÓË Ì ‚ÈÙ·Ì›ÓË
∂ ÛÂÏÏÔ˘ÏÔ˙È΋ ÌÂÌ‚Ú¿ÓË ¤¯ÂÈ È‰ÈfiÙËÙ˜ ÂÎηı·-
ÚÈÛÙ‹ ∂ƒO Û˘ÌÂÚÈÏ·Ì‚·ÓÔ̤ÓÔ˘ ÙÔ˘ ¡O, ÌÂ Û˘-
Ó¤ÂÈ· ÙËÓ ÂÏ¿ÙÙˆÛË ÙÔ˘ Â·ÁfiÌÂÓÔ˘ ·fi ÙËÓ ·È-
ÌÔοı·ÚÛË ÔÍÂȉˆÙÈÎÔ‡ stress, Ì ÙÂÏÈÎfi ·ÔÙ¤-
ÏÂÛÌ· ÙË ‚ÂÏÙ›ˆÛË Ù˘ ‚ÈÔÛ˘Ì‚·ÙfiÙËÙ·˜ Ù˘ ÌÂÌ-
‚Ú¿Ó˘. ∂Ï¿ÙÙˆÛ Â›Û˘ ÙËÓ ÔÍ›· ·Ú·ÁˆÁ‹ πL-
6 ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ·ÈÌÔοı·ÚÛ˘ ·ÏÏ¿ Î·È ÙË
Á¤ÓÂÛË C5b-9, ۯ‰fiÓ ÔÏÔÛ¯ÂÚÒ˜ ·¤ÎÏÂÈÛ ÙËÓ
¤ÎÊÚ·ÛË Ù˘ ‰ÈÂÁ¤ÚÛÈÌ˘ ¡O- Û˘ÓıÂÙ¿Û˘ (i
NOS) Î·È ÙËÓ ÂÓÂÚÁÔÔ›ËÛË Ù˘ JNK in vitro ηÈ
in vivo. ∏ ʈÛÊÔÚ˘Ï›ˆÛË Ù˘ JNK ÌÔÚ› Ó· ·ÓÙÈ-
ÚÔÛˆ‡ÂÈ ¤Ó· ÎÂÓÙÚÈÎfi ΢ÙÙ·ÚÈÎfi ÁÂÁÔÓfi˜ ÛÙËÓ
ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ ÂÚÈÊÂÚÈÎÒÓ ÌÔÓÔ‡ÚËÓˆÓ
΢ÙÙ¿ÚˆÓ ÙÔ˘ ·›Ì·ÙÔ˜ ηٿ ÙË ‰È¿ÚÎÂÈ· ·ÈÌÔο-
ı·ÚÛ˘ Ì ‚ÈԷۇ̂·Ù˜ ÌÂÌ‚Ú¿Ó˜106. ¶·ÚfiÌÔÈ·
·ÔÙÂϤÛÌ·Ù· ¤‰ÂÈÍ ÌÂϤÙË Ô˘ ÚÔÛ‰ÈfiÚÈ˙ ٷ
Â›‰· Ù˘ 8-O∏- ‰ÂÔ͢ÁÔ˘·ÓÔÛ›Ó˘, ‰Â›ÎÙË
ÔÍÂȉˆÙÈ΋˜ ‰Ú¿Û˘ ÛÙÔ DNA Ï¢ÎÔ΢ÙÙ¿ÚˆÓ107.
™˘ÓÂÒ˜, Ë ¯Ú‹ÛË Ù¤ÙÔÈˆÓ «ÙÚ›Ù˘ ÁÂÓÈ¿˜» ÌÂÌ-
‚Ú·ÓÒÓ ‰È¿Ï˘Û˘ ÂÏ·ÙÙÒÓÂÈ ÙÔ ÔÍÂȉˆÙÈÎfi stress
Î·È Î·Ù¿ Û˘Ó¤ÂÈ· ·ÛΛ ¢ÂÚÁÂÙÈΤ˜ ‰Ú¿ÛÂȘ ÛÙË
‰È·‰Èηۛ· Ù˘ ·ıËÚÔÛÎÏ‹Ú˘ÓÛ˘, ÙËÓ ÂÍ·ÚÙÒÌÂ-
ÓË ·fi ÙËÓ Î¿ı·ÚÛË ·Ì˘ÏÔ›‰ˆÛË, ÙË ‰È·‰Èηۛ·
ηÚÎÈÓÔÁ¤ÓÂÛ˘ ‹ ÙË ‚ÂÏÙ›ˆÛË Ù˘ ¿ÓÔÛ˘ ÏÂÈ-
ÙÔ˘ÚÁ›·˜ ¤Ó·ÓÙÈ ÏÔÈÌÔÁfiÓˆÓ ·Ú·ÁfiÓÙˆÓ ·ÛıÂ-
ÓÒÓ Û ¯ÚfiÓÈ· ·ÈÌÔοı·ÚÛË.
ΔÔ ÛÂÏ‹ÓÈÔ Â›Ó·È ¤Ó·˜ Û˘Ì·Ú¿ÁÔÓÙ·˜ Ù˘
GSH Î·È ‰Ú· ΢ڛˆ˜ Ì ÙË ÌÔÚÊ‹ ÙˆÓ Û˘ÌÏfiΈÓ
ÙÔ˘ Ì ÚˆÙ½Ó˜. Œ¯Ô˘Ó ·Ó·ÁÓˆÚÈÛÙ› ÙÔ˘Ï¿¯È-
ÛÙÔÓ 30 ‰È·ÊÔÚÂÙÈΤ˜ ÛÂÏËÓÈÔÚˆÙ½Ó˜, ·fi ÙȘ
Ôԛ˜ Ë GSH, Ë ÛÂÏËÓÈÔÚˆÙ½ÓË ƒ Î·È Ë Ú‰Ԣ-
ÎÙ¿ÛË Ù˘ ıÂÈÔÚ‰Ԣ͛Ó˘ ·ÔÙÂÏÔ‡Ó ‚·ÛÈο Û˘-
ÛÙ·ÙÈο ÙÔ˘ ·ÓÙÈÔÍÂȉˆÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÙÔ˘ ÔÚ-
Á·ÓÈÛÌÔ‡108. ∏ ·ÓÂ¿ÚÎÂÈ· ÛÂÏËÓ›Ô˘, Ô˘ ·Ú·ÙË-
ÚÂ›Ù·È Û ·ÛıÂÓ›˜ ˘fi ·ÈÌÔοı·ÚÛË, ÚÔηÏ›
ÂÏ¿ÙÙˆÛË Ù˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Ù˘ GSH, Ô‰ËÁÒ-
ÓÙ·˜ Û ·˘ÍË̤ÓÔ ÔÍÂȉˆÙÈÎfi stress. Δ· ‰Â‰Ô̤ӷ
Û¯ÂÙÈο Ì ÙËÓ ÚÔÛÙ·Û›· ÙˆÓ ·ÈÌÔηı·ÈÚfiÌÂÓˆÓ
·ÛıÂÓÒÓ Ì ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ· ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘
·fi ÙË ¯ÔÚ‹ÁËÛË ÛÂÏËÓ›Ô˘ Â›Ó·È ·ÓÙÈÎÚÔ˘fiÌÂÓ·.
¶ÂÈÚ·Ì·ÙÈο ÌÔÓ٤Ϸ Û ÔÓÙ›ÎÈ· ¤‰ÂÈÍ·Ó fiÙÈ Ë
¤ÏÏÂÈ„Ë ÛÂÏËÓ›Ô˘ ÚÔηÏ› ÚˆÙÂ˚ÓÔ˘Ú›· ηÈ
ÛÂÈÚ·Ì·ÙÈ΋ ÛÎÏ‹Ú˘ÓÛË109. ™Â ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘
ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ·, ‰ÂÓ ·Ú·ÙËÚ‹ıËΠ·‡ÍËÛË
Ù˘ ·ÓÙÈÔÍÂȉˆÙÈ΋˜ ÈηÓfiÙËÙ·˜ ÙÔ˘ Ï¿ÛÌ·ÙÔ˜ ÌÂ-
Ù¿ ·fi ¯ÔÚ‹ÁËÛË ÛÂÏËÓ›Ô˘, ΢ڛˆ˜ ÁÈ·Ù› Ë ·ÓÂ-
18 Ã. ¡π∫O§∞´¢OÀ, °. ª¶OÀ¡ΔOÀƒ∏™
¿ÚÎÂÈ· ÙÔ˘ ÓÂÊÚÔ‡ Ô˘ ıˆÚÂ›Ù·È fiÚÁ·ÓÔ —·-
ÚÈ· ËÁ‹ GSH— ‰ÂÓ ÂÈÙÚ¤ÂÈ ÙËÓ Ï‹ÚË ¤ÎÙ˘ÍË
ÙÔ˘ ·ÓÙÈÔÍÂȉˆÙÈÎÔ‡ ·˘ÙÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜110. ™ËÌÂÈ-
ÒÓÂÙ·È fiÙÈ Ë ıÂÚ·›· ˘ÔηٿÛÙ·Û˘ Ì ÛÂÏ‹ÓÈÔ
‚Ú¤ıËΠfiÙÈ ·˘Í¿ÓÂÈ Î˘Ú›ˆ˜ ÙË ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘
GSH ÙˆÓ ÂÚ˘ıÚÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ, Î·È fi¯È ÙÔ˘ Ï¿-
ÛÌ·ÙÔ˜111.
ªÈ· ¿ÏÏË, Èı·ÓÒ˜ ¯Ú‹ÛÈÌË ·ÓÙÈÔÍÂȉˆÙÈ΋
Ô˘Û›· Â›Ó·È Ë ‚ÈÙ·Ì›ÓË C, fiÙ·Ó ¯ÔÚËÁÂ›Ù·È ÂÓ‰Ô-
ÊϤ‚È· Û ˘„ËϤ˜ ‰fiÛÂȘ. ¶·Ú·ÙËÚ‹ıËΠfiÙÈ Ë ÂÓ-
‰ÔÊϤ‚È· ¯ÔÚ‹ÁËÛ‹ Ù˘ Û ·ÛıÂÓ›˜ Ì ÓÂÊÚÈ΋
·ÓÂ¿ÚÎÂÈ· ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘ Ô˘ ¤·Û¯·Ó ·fi
ηډȷÁÁÂȷ΋ ÓfiÛÔ, ‚ÂÏÙ›ˆÛ ÙËÓ ÚÔηÏÔ‡ÌÂÓË
·fi ÙËÓ ·ÎÂÙ˘ÏÔ¯ÔÏ›ÓË (Ach) ·ÁÁÂÈԉȷÛÙÔÏ‹, ο-
ÙÈ Ô˘ ‰Â Û˘Ó¤‚Ë ÛÙÔ˘˜ ÓÂÊÚÔ·ı›˜ ¯ˆÚ›˜ ηÚ-
‰È·ÁÁÂȷ΋ ÓfiÛÔ. ΔÔ ÁÂÁÔÓfi˜ ·˘Ùfi ·Ô‰fiıËÎÂ
ÛÙËÓ ·˘ÍË̤ÓË ·Ú·ÁˆÁ‹ ROS ÛÙËÓ ÚÒÙË ÔÌ¿-
‰·, Î·È ÛÙËÓ ·Ó·ÛÙÔÏ‹ ÙÔ˘˜ ·fi ÙË ‚ÈÙ·Ì›ÓË C1.
Δ· ·ÔÙÂϤÛÌ·Ù· ÙˆÓ ÂÚ¢ÓÒÓ ‰ÂÓ Â›Ó·È Î·-
ıÔÚÈÛÙÈο ÁÈ· ÙË ¯ÚËÛÈÌfiÙËÙ· Ù˘ Ì·ÎÚÔÚfiıÂ-
ÛÌ˘ ÚÔÏËÙÈ΋˜ ¯ÔÚ‹ÁËÛ˘ ·ÓÙÈÔÍÂȉˆÙÈÎÒÓ Ô˘-
ÛÈÒÓ Û ·ÛıÂÓ›˜ Ì ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘ ÓÂÊÚÈ΋ ·ÓÂ-
¿ÚÎÂÈ·. ¶·Ú¿ Ù·‡Ù·, Ê·›ÓÂÙ·È fiÙÈ ·ÛÎÂ›Ù·È Î¿-
ÔÈÔ˘ ‚·ıÌÔ‡ ÚÔÛٷ٢ÙÈ΋ ‰Ú¿ÛË (Û Â›‰Ô
ÔÍÂȉˆÙÈÎÔ‡ stress Î·È Èı·Ófiٷٷ Û˘Ó·ÎfiÏÔ˘ıˆÓ
ηډȷÁÁÂÈ·ÎÒÓ ‰Ú¿ÛˆÓ).
O ÚfiÏÔ˜ Ù˘ ‰È·ÙÚÔÊ‹˜ ·Ú·Ì¤ÓÂÈ ·ÌÊÈÏÂÁfi-
ÌÂÓÔ˜. ∞fi ÙË Ì›·, Ë Î·Î‹ ıÚ¤„Ë ·ÔÙÂÏ› ÛËÌ·-
ÓÙÈÎfi ÎÚ›ÎÔ ÛÙÔ Û‡Ó‰ÚÔÌÔ ªπ∞, Î·È ·Ú·ÙËÚ‹ıË-
ΠfiÙÈ Ë ¯ÔÚ‹ÁËÛË 45 Kcal/Kg μ.™./24h Î·È 1,5 g/
Kg μ.™./24h ÏÂ˘ÎˆÌ¿ÙˆÓ Û˘Ì‚¿ÏÏÂÈ ÛÙËÓ ÚfiÛÏË-
„Ë ‚¿ÚÔ˘˜ Î·È ÙË ‚ÂÏÙ›ˆÛË Ù˘ ÏÂ˘ÎˆÌ·Ù›Ó˘
ÔÚÔ‡, Î·È ¿ÏÏˆÓ ·Ú·Ì¤ÙÚˆÓ Ô˘ ÂÎÙÈÌÔ‡Ó ÙË ıÚ¤-
„Ë ÙˆÓ ‰˘ÛıÚÂÙÈÎÒÓ ·ÛıÂÓÒÓ112. ∞ÎfiÌ·, ·ÚÎÂ-
Ù¤˜ ÌÂϤÙ˜ ·Ó·‰ÂÈÎÓ‡Ô˘Ó ÙË ¯ÚËÛÈÌfiÙËÙ· Ù˘ ¯Ô-
Ú‹ÁËÛ˘ ‰È·Ï˘Ì¿ÙˆÓ ·ÚÂÓÙÂÚÈ΋˜ ‰È·ÙÚÔÊ‹˜ η-
Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ Û˘Ó‰ڛ·˜ οı·ÚÛ˘113. ∞fi
ÙËÓ ¿ÏÏË, Û ÂÈÚ·Ì·ÙÈο ÌÔÓ٤Ϸ Ì ÌÂÚÈ΋ ÓÂ-
ÊÚÂÎÙÔÌ‹, Ë ˘ÂÚ‚ÔÏÈ΋ ¯ÔÚ‹ÁËÛË ÚˆÙÂ˚ÓÒÓ
Ô‰ËÁ› Û ·‡ÍËÛË Ù˘ ηٷӿψÛ˘ ÙÔ˘ Ô͢ÁfiÓÔ˘
ÛÙÔ˘˜ ÂÓ·ÔÌ›ӷÓÙ˜ ÓÂÊÚÒÓ˜ Î·È ·˘ÍË̤ÓË ·-
Ú·ÁˆÁ‹ ROS114. ∂›Û˘, fiˆ˜ ‹‰Ë ·Ó·Ê¤ÚıËÎÂ, Ë
ÏÂ˘ÎˆÌ·Ù›ÓË ÛÙÔ ÂÚÈ‚¿ÏÏÔÓ ÙÔ˘ ÓÂÊÚÔ‡ ÌÔÚ›
Ó· ÚÔηϤÛÂÈ ÙËÓ ·Ú·ÁˆÁ‹ ÊÏÂÁÌÔÓÔÁfiÓˆÓ
΢ÙÙ·ÚÔÎÈÓÒÓ ÛÙ· ÂÁÁ‡˜ ÛˆÏËÓ·Úȷο ·ÙÙ·Ú·
Î·È Â·ÎfiÏÔ˘ıË ‚Ï¿‚Ë ÙÔ˘ ÓÂÊÚÔ‡.
Δ¤ÏÔ˜, ¤¯ÂÈ ÚÔÙ·ı› Ë ¯ÔÚ‹ÁËÛË ‚ÈÔÏÔÁÈÎÒÓ
·Ú·ÁfiÓÙˆÓ, fiˆ˜ ·ÓÙÈ-TNF-· ·ÓÙÈۈ̿وÓ, ‰È·-
Ï˘ÙÒÓ ˘Ô‰Ô¯¤ˆÓ TNF-· Î·È ·ÓÙ·ÁˆÓÈÛÙÒÓ ÙˆÓ
˘Ô‰Ô¯¤ˆÓ Ù˘ IL-1, ‹ ·ÎfiÌ· Î·È ı·ÏȉÔÌ›‰Ë˜ —
ÂÓfi˜ ÂÎÏÂÎÙÈÎÔ‡ ·Ó·ÛÙÔϤ· ·Ú·ÁˆÁ‹˜ TNF-·22.
¶›Ó·Î·˜ 2. £ÂÚ·¢ÙÈΤ˜ ÛÙÚ·ÙËÁÈΤ˜ ηٿ Ù˘ ÊÏÂÁÌÔÓ‹˜
Î·È ÙÔ˘ ÔÍÂȉˆÙÈÎÔ‡ stress Û ¯ÚÔÓ›ˆ˜ ·ÈÌÔηı·ÈÚfiÌÂÓÔ˘˜
·ÛıÂÓ›˜.
™˘Ó‹ıÂȘ ıÂÚ·¢ÙÈΤ˜ ̤ıÔ‰ÔÈ
μÂÏÙ›ˆÛË ÔÈfiÙËÙ·˜ ·ÈÌÔοı·ÚÛ˘
• μÈÔÛ˘Ì‚·Ù¤˜-ÙÚÔÔÔÈË̤Ó˜ ÌÂÌ‚Ú¿Ó˜
• À„ËÏ‹ ÔÈfiÙËÙ· ‰È·Ï˘ÙÈÎÔ‡ ̤ÛÔ˘
º·Ú̷΢ÙÈ΋ ·ÁˆÁ‹
• ∞ÓÙÈ‚ÈÔÙÈο
• ∞ÛÈÚ›ÓË
• ∞ª∂∞ Î·È ∞Δ1
• ™Ù·Ù›Ó˜
¢˘ÓËÙÈΤ˜ ıÂÚ·¢ÙÈΤ˜ ÂÈÏÔÁ¤˜
μÈٷ̛Ә ∂, C
™ÂÏ‹ÓÈÔ
μÈÔÏÔÁÈÎÔ› ·Ú¿ÁÔÓÙ˜
(.¯. ÌÔÓÔÎψÓÈο ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ Î˘ÙÙ·ÚÔÎÈÓÒÓ)
ı·ÏȉÔÌ›‰Ë
™ÙÔÓ ›Ó·Î· Ô˘ ·ÎÔÏÔ˘ı› Ê·›ÓÔÓÙ·È Û˘ÓÔÙÈο
ÔÈ ıÂÚ·¢ÙÈΤ˜ ÂÈÏÔÁ¤˜ ÛÙÔ˘˜ ·ÛıÂÓ›˜ ˘fi ·È-
ÌÔοı·ÚÛË (¶›Ó. 2).
¶ÂÚÈÙÔÓ·˚΋ οı·ÚÛË
∫·ıÒ˜ Â›Ó·È Î·Ù·Ï˘ÙÈÎfi˜ Ô ÚfiÏÔ˜ ÙˆÓ AGEs ÛÙËÓ
·ıÔÁ¤ÓÂÈ· ÙˆÓ ÌÔÚÊÔÏÔÁÈÎÒÓ Î·È ÏÂÈÙÔ˘ÚÁÈÎÒÓ
·ÏÏÔÈÒÛÂˆÓ Î·Ù¿ ÙË ¯ÚfiÓÈ· ‰È·‰Èηۛ· ÂÚÈÙÔÓ·˚-
΋˜ οı·ÚÛ˘, ÛËÌ·ÓÙÈÎfi ̤ÚÔ˜ Ù˘ ¤Ú¢ӷ˜ ¤¯ÂÈ
ÛÙÚ·Ê› ÚÔ˜ ÙËÓ ÂÏ¿ÙÙˆÛË ‹ Î·È ·ÔÙÚÔ‹ Û¯Ë-
Ì·ÙÈÛÌÔ‡ ·˘ÙÒÓ ÙˆÓ ÌÔÚ›ˆÓ. ∏ ·ÌÈÓÔÁÔ˘·Óȉ›ÓË
·ÔÙÂÏ› Ô˘Û›· Ô˘ ·ÔÌ·ÎÚ‡ÓÂÈ Ù· GDPs (ÚÔ˚-
fiÓÙ· ·Ô‰fiÌËÛ˘ Ù˘ ÁÏ˘Îfi˙˘) Î·È ÚÔÏ·Ì‚¿ÓÂÈ
ÙÔ Û¯ËÌ·ÙÈÛÌfi ÙˆÓ AGEs65. ∞ÎfiÌ·, ¤¯ÂÈ ·Ú·ÙË-
ÚËı› fiÙÈ ·ÓÂÓÂÚÁÔÔÈ› ÙË Û˘ÓıÂÙ¿ÛË ÙÔ˘ ¡O,
ÚÔηÏÒÓÙ·˜ ¤ÙÛÈ Ì›ˆÛË ÙÔ˘ ·ÁÁÂÈ·ÎÔ‡ ÔÏÏ·-
Ï·ÛÈ·ÛÌÔ‡115, Î·È ÂÏ·ÙÙÒÓÂÈ ÙȘ ‰È·‚ËÙÈΤ˜ ÂÈ-
ÏÔΤ˜116. ™ÙË ÌÂϤÙË ÙˆÓ Zareie M Î·È Û˘Ó.65 ÛÂ
ÂÈÚ·Ì·ÙÈÎfi ÌÔÓÙ¤ÏÔ ·ÚÔ˘Ú·›ˆÓ, ‰Â›¯ıËΠfiÙÈ Ë
ÚÔÛı‹ÎË ·ÌÈÓÔÁÔ˘·Óȉ›Ó˘ ÛÙÔ Û˘Ì‚·ÙÈÎfi —Â-
ÚȤ¯ÔÓ ÁÏ˘Îfi˙Ë— ‰È¿Ï˘Ì· ÂÚÈÙÔÓ·˚΋˜ οı·Ú-
Û˘, ·ÔÌ·ÎÚ‡ÓÂÈ ·ÔÙÂÏÂÛÌ·ÙÈο Ù· GDPs ηÈ
·ÔÙÚ¤ÂÈ ÙËÓ ¿ıÚÔÈÛË ÙˆÓ AGEs. ∂›Û˘, Û˘Û¯Â-
Ù›˙ÂÙ·È ÌÂ ÂÏ¿ÙÙˆÛË ÙÔ˘ ÔÏÏ·Ï·ÛÈ·ÛÌÔ‡ ÙˆÓ ÂÓ-
‰ÔıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ, Ù˘ ÓÂÔ·ÁÁÂÈÔÁ¤ÓÂÛ˘ ηÈ
Ù˘ ›ÓˆÛ˘ ÙÔ˘ ÂÚÈÙÔÓ·›Ô˘ Ô˘ ÚÔηÏÂ›Ù·È ·fi
ÙËÓ Â›‰Ú·ÛË ÙÔ˘ ‰È·Ï‡Ì·ÙÔ˜ οı·ÚÛ˘. Δ¤ÏÔ˜, Ë
‰È·Ê‡Ï·ÍË Ù˘ ÌÔÚÊÔÏÔÁ›·˜ ÙÔ˘ ÂÚÈÙÔÓ·›Ô˘ ÌÂ
ÙËÓ ÚÔÛı‹ÎË ·ÌÈÓÔÁÔ˘·Óȉ›Ó˘ ÛÙÔ ‰È¿Ï˘Ì· ο-
ı·ÚÛ˘ ‹Ù·Ó ÂÓÙÔÓfiÙÂÚË ·fi ·˘Ù‹Ó ¿ÏÏˆÓ ‚ÈÔÛ˘Ì-
‚·ÙÒÓ ‰È·Ï˘Ì¿ÙˆÓ, fiˆ˜ ÙÔ Physioneal65. ÃÚÂÈ¿-
˙ÂÙ·È Ó· ÛËÌÂȈı› fiÙÈ Ë ¯ÔÚ‹ÁËÛË ·ÌÈÓÔÁÔ˘·Óȉ›-
 ∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 75, 1
Ó˘ ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜ ÌÔÚ› Ó· Â›Ó·È ÙÔÍÈ΋, η-
ıÒ˜ ‰ÂÛ̇ÂÈ ÙËÓ ˘ÚȉÔÍ›ÓË (‚ÈÙ·Ì›ÓË μ6), ÂÓÒ Ë
¯ÔÚ‹ÁËÛ‹ Ù˘ ˆ˜ Û‡ÌÏÔÎÔ Ì ‚ÈÙ·Ì›ÓË μ6 ÚÔ-
Ï·Ì‚¿ÓÂÈ ÙȘ fiÔȘ ÂÈÏÔΤ˜117. ™ÙÔ˘˜ ·ÛıÂÓ›˜
Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È Û ÂÚÈÙÔÓ·˚΋ οı·ÚÛË Ë ·ÌÈ-
ÓÔÁÔ˘·Óȉ›ÓË —ÌfiÓË Ù˘ ‹ Û·Ó Û‡ÌÏÔÎÔ— ÌÔ-
Ú› Ó· ÚÔÛÙÂı› ÛÙÔ ‰È¿Ï˘Ì· οı·ÚÛ˘ Î·È ¤ÙÛÈ
Ó· ¯ÔÚËÁËı› ÙÔÈο Î·È Û Ôχ ÌÈÎÚfiÙÂÚ˜ Û˘-
ÁÎÂÓÙÚÒÛÂȘ ·fi ·˘Ù¤˜ Ô˘ Ô‰ËÁÔ‡Ó Û ÙÔÍÈÎfiÙË-
Ù·. O ·ÓÙ·ÁˆÓÈÛÌfi˜ Ù˘ ‰Ú¿Û˘ ÙˆÓ AGEs ÌÔÚ›
Ó· ÂÈÙ¢¯ı› Î·È Ì ÙÔÓ ·ÔÎÏÂÈÛÌfi ÙˆÓ ˘Ô‰Ô-
¯¤ˆÓ ÙÔ˘˜ (RAGE). ™Â ÂÈÚ·Ì·ÙÈÎfi ÌÔÓÙ¤ÏÔ ÂÈ-
Ú·Ì·Ùfi˙ˆˆÓ ·ԉ›¯ıËΠfiÙÈ Ë ÂÓ‰ÔÂÚÈÙÔÓ·˚΋
¯ÔÚ‹ÁËÛË ·ÓÙÈ-RAGE ·ÓÙÈÛÒÌ·ÙÔ˜ ÚÔÏ·Ì‚¿ÓÂÈ
ÙËÓ ·Ú·ÁˆÁ‹ TGF-‚ Î·È ÙËÓ ÂÈıËÏȷ΋ —ÚÔ˜
ÌÂÛÂÁ¯˘Ì·ÙÈ΋— ÌÂÙ·ÙÚÔ‹ ÙˆÓ ÌÂÛÔıËÏÈ·ÎÒÓ
΢ÙÙ¿ÚˆÓ ÙÔ˘ ÂÚÈÙÔÓ·›Ô˘ Î·È ÙË Û˘ÓÂ·ÎfiÏÔ˘ıË
›ÓˆÛ‹ ÙÔ˘67.
Ÿˆ˜ Î·È ÛÙËÓ ·ÈÌÔοı·ÚÛË, Ë ‚ÂÏÙ›ˆÛË Ù˘
«ÔÈfiÙËÙ·˜» Ù˘ ‰È·‰Èηۛ·˜ ÂÚÈÙÔÓ·˚΋˜ οı·Ú-
Û˘ Î·È Ë Î·Ï‡ÙÂÚË ‚ÈÔÛ˘Ì‚·ÙfiÙËÙ· ‚·›ÓÔ˘Ó ·-
Ú¿ÏÏËÏ· Ì ÙËÓ ÔÈfiÙËÙ· ÙˆÓ ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓˆÓ
‰È·Ï˘Ì¿ÙˆÓ. Δ· ‰È·Ï‡Ì·Ù· Ô˘ ÂÚȤ¯Ô˘Ó ˘„ËÏ‹
Û˘ÁΤÓÙÚˆÛË ÁÏ˘Îfi˙˘ Î·È GDPs, fiˆ˜ ·Ó·Ï‡ıË-
Π·Ú·¿Óˆ, ÂÏ·ÙÙÒÓÔ˘Ó ÙÔÓ Î˘ÙÙ·ÚÈÎfi ÔÏÏ·-
Ï·ÛÈ·ÛÌfi, ·˘Í¿ÓÔ˘Ó ÙËÓ ·fiÙˆÛË ÙˆÓ ÌÂÛÔıË-
ÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ Î·È Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÙËÓ ·ıÔÁ¤-
ÓÂÈ· Ù˘ ›ÓˆÛ˘ ÙÔ˘ ÂÚÈÙÔÓ·›Ô˘118, 119. Œ¯Ô˘Ó ‰Ë-
ÌÈÔ˘ÚÁËı› Ó¤· ‰È·Ï‡Ì·Ù· Ô˘ ÂÚȤ¯Ô˘Ó ÌÈÎÚfiÙÂ-
ÚË Û˘ÁΤÓÙÚˆÛË ÁÏ˘Îfi˙˘, Û ÌÈ· ÚÔÛ¿ıÂÈ·
ÚÔÛÙ·Û›·˜ ·fi ÙȘ ·ÚÂÓ¤ÚÁÂȘ ÙˆÓ ·Ï·ÈÔÙ¤-
ÚˆÓ Î·È Â›Ù¢Í˘ ˘„ËÏ‹˜ ‚ÈÔÛ˘Ì‚·ÙfiÙËÙ·˜. Δ¤-
ÙÔÈÔ Â›Ó·È ÙÔ Physioneal, ÙÔ ÔÔ›Ô ÂÚȤ¯ÂÈ ‰ÈÙÙ·Ó-
ıÚ·ÎÈο Î·È Á·Ï·ÎÙÈÎfi Ô͇, ‰È·ÙËÚÒÓÙ·˜ ¤Ó· Ô˘-
‰¤ÙÂÚÔ pH ̤۷ Û ‰È¿Ï˘Ì· ÁÏ˘Îfi˙˘, Ì ÌÈÎÚfiÙÂ-
ÚË Û˘ÁΤÓÙÚˆÛË GDPs. Œ¯ÂÈ ·Ú·ÙËÚËı› fiÙÈ, ÛÂ
Û‡ÁÎÚÈÛË Ì ٷ ·Ï·ÈfiÙÂÚ· ‰È·Ï‡Ì·Ù·, ‰È·ÙËÚ›
ηχÙÂÚ· ÙË ÏÂÈÙÔ˘ÚÁÈ΋ Î·È ÌÔÚÊÔÏÔÁÈ΋ ηٿ-
ÛÙ·ÛË ÙÔ˘ ÂÚÈÙÔÓ·›Ô˘, ·ÚÔ˘ÛÈ¿˙ÂÈ ÌÈÎÚfiÙÂÚË
·ÒÏÂÈ· Ù˘ ˘ÂÚ-‰È‹ıËÛ˘ Î·È Ô‰ËÁ› Û ÌÈÎÚfi-
ÙÂÚÔ Û¯ËÌ·ÙÈÛÌfi AGEs120,121. ∂ÈϤÔÓ, Ù· ‰È·Ï‡-
Ì·Ù· ‰ÈÙÙ·ÓıÚ·ÎÈÎÒÓ / Á·Ï·ÎÙÈÎÔ‡ ÔͤԘ ÂÈ-
‰ÚÔ‡Ó Â˘ÓÔ˚ο ÛÙË ‰È·ÙÚÔÊÈ΋ ηٿÛÙ·ÛË ÙˆÓ
·ÛıÂÓÒÓ, ̤ۈ Ù˘ ·‡ÍËÛ˘ Ù˘ fiÚÂ͢ Î·È Ù˘
ÂÏ¿ÙÙˆÛ˘ Ù˘ ÊÏÂÁÌÔÓÒ‰Ô˘˜ ηٿÛÙ·Û‹˜122. ŒÓ·
·ÎfiÌ· ‰È¿Ï˘Ì· Ì Ԣ‰¤ÙÂÚÔ pH Ô˘ Ê·›ÓÂÙ·È Ó·
ÏÂÔÓÂÎÙ› Û ۯ¤ÛË Ì ٷ Û˘Ì‚·ÙÈο Â›Ó·È ÙÔ
Balance. ™¯ËÌ·Ù›˙ÂÙ·È Û ¤Ó· Û‡ÛÙËÌ· ‰ÈÏÒÓ ı·-
Ͽ̈Ó, ÛÙÔ ÔÔ›Ô Ë ˘„ËÏ‹ Û˘ÁΤÓÙÚˆÛË ÁÏ˘Îfi˙˘
Û ÙÈ̤˜ pH 2,8-3,2 ‰È·¯ˆÚ›˙ÂÙ·È ·fi ¤Ó· ·ÏηÏÈ-
Îfi ‰È¿Ï˘Ì·, ÌÂ Û˘Ó¤ÂÈ· ÙË ÛËÌ·ÓÙÈ΋ ÂÏ¿ÙÙˆÛË
19
Ù˘ ·Ú·ÁˆÁ‹˜ GDPs. ™ÙË Û˘Ó¤¯ÂÈ·, ·Ì¤Ûˆ˜ ÚÈÓ
·fi ÙË ¯Ú‹ÛË, Ù· ‰È·Ï‡Ì·Ù· Î·È ·fi ÙÔ˘˜ ‰‡Ô ı·-
Ï¿ÌÔ˘˜ ·Ó·ÌÈÁÓ‡ÔÓÙ·È Î·È ÚÔ·ÙÂÈ ¤Ó· ‰È¿Ï˘Ì·
Ì Ԣ‰¤ÙÂÚÔ pH Î·È ÂÏ·Ùو̤ÓË Û˘ÁΤÓÙÚˆÛË
GDPs. ∞Ó¢ڤıË fiÙÈ Ë ÂÚÈÙÔÓ·˚΋ οı·ÚÛË Ì ÙÔ
Balance Ô‰‹ÁËÛ Û ÌÂÁ·Ï‡ÙÂÚÔ ÔÏÏ·Ï·ÛÈ·ÛÌfi
·ÓıÚÒÈÓˆÓ ÂÚÈÙÔÓ·˚ÎÒÓ ÌÂÛÔıËÏÈ·ÎÒÓ Î˘ÙÙ¿-
ÚˆÓ (ÚÔÛٷهÔÓÙ·˜ ¤ÙÛÈ ·fi ÙËÓ «·ÔÁ‡ÌÓˆÛË»
ÙÔ˘ ÌÂÛÔıËÏ›Ô˘) Î·È Û ηχÙÂÚË ‰È·Ù‹ÚËÛË Ù˘
‚ȈÛÈÌfiÙËÙ¿˜ ÙÔ˘˜, Û ۇÁÎÚÈÛË Ì ٷ ÎÔÈÓ¿ ‰È·-
χ̷ٷ68. ªÈ· ·fi ÙȘ ÔÏÏ¿ ˘ÔÛ¯fiÌÂÓ˜ Ù¯ÓÈ-
Τ˜ Â›Ó·È Ë Û˘Ó¯ԇ˜ ÚÔ‹˜ ÂÚÈÙÔÓ·˚΋ οı·ÚÛË
(CFPD), Ë ÔÔ›· ‰ËÌÈÔ˘ÚÁ‹ıËΠ—ÛÙËÓ ·Ú¯È΋
Ù˘ ÌÔÚÊ‹— ÚÈÓ ·ÚÎÂÙ¿ ¤ÙË, ·ÏÏ¿ ‰ÂÓ Ù¤ıËÎÂ
·ÎfiÌ· Û ÂÊ·ÚÌÔÁ‹. ªÂ ÙË Ì¤ıÔ‰Ô ·˘Ù‹, Ô˘ Û˘Ó-
‰˘¿˙ÂÈ ÙËÓ ÂÚÈÙÔÓ·˚΋ οı·ÚÛË Ì ÙËÓ Ù¯ÓÈ΋
Ù˘ ·ÈÌÔοı·ÚÛ˘, Á›ÓÂÙ·È ÌÈ· ÚÔÛ¿ıÂÈ· ·‡ÍË-
Û˘ Ù˘ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ Î·È Ù˘ ·fi‰ÔÛ˘
Ù˘ ÂÚÈÙÔÓ·˚΋˜ οı·ÚÛ˘. ∏ ˘ÂډȋıËÛË ÛÙËÓ
CFPD ÌÔÚ› Ó· ÂÈÙ¢¯ı› Ì ‰È¿Ï˘Ì· ¯·ÌËÏ‹˜
Û˘ÁΤÓÙÚˆÛ˘ Û ÁÏ˘Îfi˙Ë (Î·È ÂÔ̤ӈ˜ ¯·ÌËÏ‹˜
ÔÛ̈ÙÈ΋˜ ›ÂÛ˘), ·ÊÔ‡ Ë ›ÂÛË ‰È‹ıËÛ˘ ‰È·ÙË-
ÚÂ›Ù·È ·fi ÙË ÌÂÁ·Ï‡ÙÂÚË ÚÔ‹ ‰È·Ï‡Ì·ÙÔ˜. ŒÙÛÈ,
ÚÔηÏÔ‡ÓÙ·È ÏÈÁfiÙÂÚ˜ ÌÂÙ·‚ÔÏÈΤ˜ ÂÈÏÔΤ˜
Î·È ‚ÂÏÙÈÒÓÂÙ·È Ë ‚ÈÔÛ˘Ì‚·ÙfiÙËÙ·. 줂·È·, ¯ÚÂÈ¿-
˙ÔÓÙ·È ÂÚÈÛÛfiÙÂÚ˜ ÏËÚÔÊÔڛ˜ Û¯ÂÙÈο Ì ÙË
Ì·ÎÚÔ¯ÚfiÓÈ· ·ÓÔ¯‹ Î·È Ù˘ ÂÈÏÔΤ˜ Ù˘ ÌÂıfi-
‰Ô˘ ÚÈÓ ·˘Ù‹ ¯ÚËÛÈÌÔÔÈËı› ¢ڤˆ˜27.
ŸÛÔÓ ·ÊÔÚ¿ ÙËÓ ˘fiÏÔÈË Ê·Ú̷΢ÙÈ΋
·ÁˆÁ‹, Ë ÂÓ‰ÔÊϤ‚È· ¯ÔÚ‹ÁËÛË Ûȉ‹ÚÔ˘ ‰ÂÓ Â›Ó·È
··Ú·›ÙËÙË ÛÙËÓ ÏÂÈÔ„ËÊ›· ÙˆÓ ·ÛıÂÓÒÓ Î·È
·ԉ›¯ıËΠfiÙÈ —Û ·ÓÙ›ıÂÛË Ì ÙËÓ ·ÈÌÔοı·Ú-
ÛË— ‰ÂÓ ÂËÚ¿˙ÂÈ ÛËÌ·ÓÙÈο ÙËÓ ÔÍÂȉˆÙÈ΋ η-
Ù¿ÛÙ·ÛË ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ Î·È ‰ÂÓ ·˘Í¿ÓÂÈ ÙÔ˘˜ ‰Â›-
ÎÙ˜ ÊÏÂÁÌÔÓ‹˜123,124. ∂›Û˘, Ê·›ÓÂÙ·È fiÙÈ Ô Ú˘ı-
Ìfi˜ ¯ÔÚ‹ÁËÛ‹˜ ÙÔ˘ (Ù·¯Â›· - ‚Ú·‰Â›· ÂÓ‰ÔÊϤ‚È·
¯ÔÚ‹ÁËÛË) ‰ÂÓ ¤¯ÂÈ Î¿ÔÈ· ‰È·ÊÔÚÂÙÈ΋ Â›‰Ú·ÛË
ÛÙȘ ·Ú·¿Óˆ ·Ú·Ì¤ÙÚÔ˘˜ Î·È ÂÔ̤ӈ˜ ÌÔ-
Ú› Ó· ¯ÔÚËÁËı› ¿ÊÔ‚· Ù·¯¤ˆ˜ —Û ·ÓÙ›ıÂÛË ÌÂ
ÙËÓ ·ÈÌÔοı·ÚÛË116. ™ËÌ·ÓÙÈÎfi Â›Ó·È ÙÔ fiÊÂÏÔ˜
·fi ÙË ¯ÔÚ‹ÁËÛË ÛÙ·ÙÈÓÒÓ ÛÙÔ˘˜ ·ÛıÂÓ›˜ ˘fi Â-
ÚÈÙÔÓ·˚΋ οı·ÚÛË, ηıÒ˜ ·Ú·ÙËÚ‹ıËΠfiÙÈ
Ô‰ËÁÔ‡Ó Û Ì›ˆÛË ÙˆÓ ‰ÂÈÎÙÒÓ ÔÍÂȉˆÙÈÎÔ‡
stress, fiˆ˜ Ë CRP125. ∂ÈϤÔÓ, Ë ¯ÔÚ‹ÁËÛË ÛÙ·-
ÙÈÓÒÓ Û ·ÛıÂÓ›˜ Û ̷ÎÚÔ¯ÚfiÓÈ· ıÂÚ·›· ÌÂ
ÂÚÈÙÔÓ·˚΋ οı·ÚÛË, ·Ú·ÙËÚ‹ıËΠfiÙÈ Û˘Ì‚¿Ï-
ÏÂÈ ÛÙË Ì›ˆÛË Ù˘ ηډȷÁÁÂȷ΋˜ Î·È Û˘ÓÔÏÈ΋˜
ıÓËÙfiÙËÙ·˜126. ªÂÏÂÙ¿Ù·È Â›Û˘ Ô ÚfiÏÔ˜ ÙˆÓ
∞ª∂∞ Î·È ÙˆÓ ∞Δ1. Ÿˆ˜ ·Ó·Ê¤ÚıËΠ·Ú·¿-
Óˆ, Ë ¯Ú‹ÛË ·Ó·ÛÙÔϤˆÓ ÙÔ˘ ÌÂÙ·ÙÚÂÙÈÎÔ‡ ÂÓ˙‡-
ÌÔ˘ Ù˘ ·ÁÁÂÈÔÙÂÓÛ›Ó˘ ‹ ·ÔÎÏÂÈÛÙÒÓ ‰È·‡ÏˆÓ
20 Ã. ¡π∫O§∞´¢OÀ, °. ª¶OÀ¡ΔOÀƒ∏™
·Û‚ÂÛÙ›Ô˘ Û¯ÂÙ›˙ÂÙ·È Ì ηχÙÂÚË ‰È·Ù‹ÚËÛË Ù˘
˘ÔÏÂÈÌÌ·ÙÈ΋˜ ÓÂÊÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜82. ¶Èı·Ófi
fiÊÂÏÔ˜ ÌÔÚ› Ó· ÚÔ·„ÂÈ ·fi ÙËÓ ·Ú·Ù‹ÚËÛË
fiÙÈ Ë ¯ÔÚ‹ÁËÛË ÙÂÏÌÈÛ·ÚÙ¿Ó˘, ÂÓfi˜ ÂÎÏÂÎÙÈÎÔ‡
ÚÔÛ‰¤ÙË ÙˆÓ PPRÁ ˘Ô‰Ô¯¤ˆÓ, ÌÔÚ› Ó· Ô‰ËÁ‹-
ÛÂÈ Û Ì›ˆÛË Ù˘ ÈÓÛÔ˘Ï›Ó˘ Ï¿ÛÌ·ÙÔ˜ ÓËÛÙ›·˜
Î·È ·‡ÍËÛË Ù˘ ¢·ÈÛıËÛ›·˜ ÛÙËÓ ÈÓÛÔ˘Ï›ÓË ÛÂ
·ÛıÂÓ›˜ Ô˘ ‚Ú›ÛÎÔÓÙ·Ó Û ÂÚÈÙÔÓ·˚΋ οı·Ú-
ÛË. Δ· ·ÔÙÂϤÛÌ·Ù· ·˘Ù¿ ‹Ù·Ó ·ÓÂÍ¿ÚÙËÙ· ·fi
ÙȘ ÌÂÙ·‚ÔϤ˜ Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘127. ∏ ¯ÔÚ‹-
ÁËÛË ÂÓfi˜ ∞Δ1 (ÈÚ‚ÂÛ·ÚÙ¿Ó˘), ÂÓfi˜ ·ÓÙ·ÁˆÓÈÛÙ‹
Ù˘ ·Ï‰ÔÛÙÂÚfiÓ˘ (ÛÂÈÚÔÓÔÏ·ÎÙfiÓË) ‹ Î·È Ô Û˘Ó-
‰˘·ÛÌfi˜ ÙÔ˘˜ ·ԉ›¯ıËΠ۠ÂÈÚ·Ì·ÙÈÎfi ÌÔÓÙ¤-
ÏÔ fiÙÈ ÌÂÈÒÓÂÈ ÙÔ Ì¤ÁÂıÔ˜ Ù˘ ›ÓˆÛ˘ ÙÔ˘ ÂÚÈÙÔ-
Ó·›Ô˘ ÌÂÙ¿ ·fi ÂÂÈÛfi‰ÈÔ ÂÚÈÙÔÓ›Ùȉ·˜128. ∂Ô-
̤ӈ˜, Ù· Ê¿Ú̷η Ô˘ ·ÚÂÌ‚·›ÓÔ˘Ó ÛÙÔ Û‡ÛÙË-
Ì· ÚÂÓ›Ó˘-·ÁÁÂÈÔÙÂÓÛ›Ó˘-·Ï‰ÔÛÙÂÚfiÓ˘ ·ÛÎÔ‡Ó
ÚÔÛٷ٢ÙÈ΋ ‰Ú¿ÛË fi¯È ÌfiÓÔ ÛÙË ‰È·Ù‹ÚËÛË Ù˘
˘ÔÏÂÈÌÌ·ÙÈ΋˜ ÓÂÊÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜, ·ÏÏ¿ ηÈ
ÛÙȘ ‰Ô̤˜ Ù˘ ÂÚÈÙÔÓ·˚΋˜ ÌÂÌ‚Ú¿Ó˘. Δ¤ÏÔ˜, Û˘-
˙ËÙÂ›Ù·È Ë ¯ÔÚ‹ÁËÛË 5-ÌÂı˘ÏÙÂÙÚ·¸‰ÚÔ-Ê˘ÏÈÎÔ‡
(5-MTHF) ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜, Ë ÔÔ›· ÚÔηÏ› —
ÌfiÓË Ù˘ ‹ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ‚ÈÙ·Ì›ÓË μ— ÙËÓ ÙÒ-
ÛË ÙˆÓ Û˘ÁÎÂÓÙÚÒÛÂˆÓ Ù˘ ÔÌÔ΢ÛÙ½Ó˘ Ï¿ÛÌ·-
ÙÔ˜ ÙˆÓ ·ÛıÂÓÒÓ Ì ¯ÚfiÓÈ· ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ·.
ø˜ ÁÓˆÛÙfiÓ, Ë ÔÌÔ΢ÛÙ½ÓË ·ÔÙÂÏ› ·ÓÂÍ¿ÚÙËÙÔ
·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘. ¶·-
Ú·ÙËÚ‹ıËΠfiÙÈ Ë ¯ÔÚ‹ÁËÛË 5-MTHF ÌÔÚ› Ó·
ÂÏ·ÙÙÒÛÂÈ ÙËÓ ¿¯˘ÓÛË ÙÔ˘ ̤ÛÔ˘ ¯ÈÙÒÓ· ÙˆÓ Î·-
ÚˆÙ›‰ˆÓ ·ÛıÂÓÒÓ Ì ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘ ÓÂÊÚÈ΋
·ÓÂ¿ÚÎÂÈ·129 Î·È Ó· ‚ÂÏÙÈÒÛÂÈ ÙËÓ ÂÓ‰ÔıËÏȷ΋
ÏÂÈÙÔ˘ÚÁ›· ·ÛıÂÓÒÓ ˘fi ÂÚÈÙÔÓ·˚΋ οı·ÚÛË (Ë
ÔÔ›· Ì¿ÏÈÛÙ· Ê¿ÓËΠӷ Â›Ó·È ·ÓÂÍ¿ÚÙËÙË ·fi
ÙËÓ ÙÒÛË ÙˆÓ ÂÈ¤‰ˆÓ ÔÌÔ΢ÛÙ½Ó˘ Ï¿ÛÌ·-
ÙÔ˜)130. ¶·ÚÔÏ’ ·˘Ù¿, Ë ÔÌ·ÏÔÔ›ËÛË ÙˆÓ ÙÈÌÒÓ Ù˘
ÔÌÔ΢ÛÙ½Ó˘ Ï¿ÛÌ·ÙÔ˜ ‰Â Ê¿ÓËΠӷ Âȉڿ ıÂ-
ÙÈο ÛÙË Ì›ˆÛË Ù˘ ıÓËÛÈÌfiÙËÙ·˜ ÙˆÓ ¯ÚÔÓ›ˆ˜ ÓÂ-
ÊÚÔ·ıÒÓ ·ÛıÂÓÒÓ129,131,132.
™Àª¶∂ƒ∞™ª∞
™ÙËÓ ·ÚÔ‡Û· ·Ó·ÛÎfiËÛË Î·Ù·‰ÂÈÎÓ‡ÂÙ·È Â·Ú-
ÎÒ˜ Ë ·ÌÊ›‰ÚÔÌË Û¯¤ÛË ÙÔ˘ ÔÍÂȉˆÙÈÎÔ‡ stress ÌÂ
ÙË ¯ÚfiÓÈ· ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ·. O ‚·ıÌfi˜ ÙÔ˘ Ô-
ÍÂȉˆÙÈÎÔ‡ stress ·Ú·ÎÔÏÔ˘ı› ·Ó·ÏÔÁÈο ÙËÓ
ÔÚ›· Ù˘ ÓÂÊÚÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ ÚÔ˜ ÙÂÏÈÎÔ‡
ÛÙ·‰›Ô˘, ÂËÚ¿˙ÔÓÙ·˜ Û οÔÈÔ ‚·ıÌfi ÙËÓ Â-
Ú·ÈÙ¤Úˆ Âȉ›ӈۋ Ù˘. ∏ ÂÊ·ÚÌÔÁ‹ ÙˆÓ ÎÏ·ÛÈ-
ÎÒÓ ÌÂıfi‰ˆÓ ˘ÔηٿÛÙ·Û˘ Ù˘ ÓÂÊÚÈ΋˜ ÏÂÈ-
ÙÔ˘ÚÁ›·˜ Û˘ÓÙÂÏ›, ·ÓÙ›ıÂÙ· Ì fi,ÙÈ Î·Ó›˜ ›Ûˆ˜ ı·
·Ó·ÌÂÓfiÙ·Ó, Û Â›Ù·ÛË ÙÔ˘ ÔÍÂȉˆÙÈÎÔ‡ stress,
ÁÂÁÔÓfi˜ Ô˘ ¤¯ÂÈ Â·ÚÎÒ˜ ·ÈÙÈÔÏÔÁËı› ‚È‚ÏÈÔ-
ÁÚ·ÊÈο. ∏ ¯ÔÚ‹ÁËÛË ·ÓÙÈÔÍÂȉˆÙÈÎÒÓ Ô˘ÛÈÒÓ
‹/Î·È ÓÂfiÙÂÚˆÓ («ÙÚÔÔÔÈËÙÈÎÒÓ») ·Ú·ÁfiÓÙˆÓ
Ì ‰˘ÓËÙÈο ¢ÂÚÁÂÙÈ΋ Â›‰Ú·ÛË ÛÙÔ ÔÍÂȉˆÙÈÎfi
stress, ηıÒ˜ Î·È Ë ‚ÂÏÙ›ˆÛË ·˘ÙÒÓ Î·ı·˘ÙÒÓ ÙˆÓ
ÌÂıfi‰ˆÓ οı·ÚÛ˘ ÚÔ˜ ·˘Ù‹Ó ÙËÓ Î·Ù‡ı˘ÓÛË
·ÔÙÂÏÔ‡Ó ÛËÌ·ÓÙÈ΋ ÂͤÏÈÍË. ∞Ô̤ÓÂÈ Ë Ï‹Ú˘
ÙÂÎÌËÚ›ˆÛË Ù˘ Û˘Û¯¤ÙÈÛ˘ Ì ÙÔÓ Î·Ú‰È·ÁÁÂÈ·Îfi
ΛӉ˘ÓÔ Î·È Ë ·Ó¿‰ÂÈÍË Ù˘ ¯ÚËÛÈÌfiÙËÙ·˜ ÙˆÓ ·-
Ú·¿Óˆ ‚ÂÏÙÈˆÌ¤ÓˆÓ ÌÂıfi‰ˆÓ ¤Ó·ÓÙÈ ÙˆÓ ÎÏ·ÛÈ-
ÎÒÓ, ̤۷ ·fi ηϿ ۯ‰ȷṲ̂Ó˜ ÌÂϤÙ˜.
ABSTRACT
Nikolaidou C, Boudouris G. Oxidative stress in
chronic renal failure. Hell Iatr 2009, 75: 5-25.
Oxidative stress defines a potentially harmful
condition that results from an imbalance between
the formation of oxidative compounds and the
protective effect of anti-oxidative defence mecha-
nisms. Strong evidence indicates that uraemia and
end-stage renal disease are associated with oxi-
dative stress, which progresses along with the dete-
rioration of the kidney function and deteriorates
with the use of classical methods of dialysis. Oxida-
tive stress can be attributed to the bio-incompatibi-
lity of dialysis membranes and fluids, the inflamma-
tory and/or toxic effects of administered therapeutic
substances, and the long-term complications of the
treatment itself. Patients with end-stage renal di-
sease and enhanced oxidative stress have high mor-
bidity and mortality rates, primarily due to cardio-
vascular disease. Preserving residual renal function
and introducing newer, more bio-compatible dialy-
sis materials and techniques, can increase the effi-
cacy and adequacy of haemodialysis and peritoneal
dialysis, by attenuating oxidative stress.
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ÌÔ˘ Conn ‹ ÙÔ˘ ·ÌÊÔÙÂÚfiÏ¢ÚÔ˘ ÎÏËÚÔÓÔÌÈÎÔ‡
Ê·ÈÔ¯ÚˆÌÔ΢ÙÙÒÌ·ÙÔ˜, ÂÁηٷÏ›ÔÓÙ·˜ ˘ÁÈ‹ ÂÈ-
ÓÂÊÚȉÈÎfi ÈÛÙfi, Ì ÛÎÔfi ÙËÓ ·ÔÊ˘Á‹ Ù˘ ÂÊ’ fiÚÔ˘
˙ˆ‹˜ ıÂÚ·›·˜ ˘ÔηٿÛÙ·Û˘. ∏ ÚÔÌÔÙÈο ˘Ô-
‚ÔËıÔ‡ÌÂÓË Ï··ÚÔÛÎÔÈ΋ ÂÈÓÂÊÚȉÂÎÙÔÌ‹ ›ӷÈ
ϤÔÓ Ù¯ÓÈο ÂÊÈÎÙ‹ ηÈ, ›Ûˆ˜, ·ÔÙÂϤÛÂÈ ÙË ÌÂÏ-
ÏÔÓÙÈ΋ ¯ÂÈÚÔ˘ÚÁÈ΋ ̤ıÔ‰Ô.
EÏÏËÓ I·ÙÚ 2009, 75: 26 - 37.
¿Óˆ ÂÈÓÂÊÚȉÈ΋ ·ÚÙËÚ›· Ô˘ Â›Ó·È ÎÏ¿‰Ô˜ Ù˘
οو ÊÚÂÓÈ΋˜ ·ÚÙËÚ›·˜, ·fi ÙË Ì¤ÛË ÂÈÓÂÊÚÈ-
‰È΋ ·ÚÙËÚ›· Ô˘ Â›Ó·È ÎÏ¿‰Ô˜ Ù˘ ÎÔÈÏȷ΋˜
·ÔÚÙ‹˜ Î·È ·fi ÙËÓ Î¿Ùˆ ÂÈÓÂÊÚȉÈ΋ ·ÚÙËÚ›·
Ô˘ ÚÔ¤Ú¯ÂÙ·È ·fi ÙË ÓÂÊÚÈ΋ ·ÚÙËÚ›·. ∏ ÊÏÂ-
‚È΋ ΢ÎÏÔÊÔÚ›· Á›ÓÂÙ·È Î‡ÚÈ· ·fi ÙËÓ ÂÈÓÂ-
ÊÚȉÈ΋ ÊϤ‚· Ô˘ ‰ÂÍÈ¿ Â›Ó·È ÌÈÎÚ‹ Û ̋ÎÔ˜
Î·È Â΂¿ÏÏÂÈ ÛÙËÓ Î¿Ùˆ ÎÔ›ÏË ÊϤ‚·, ÂÓÒ ·ÚÈ-
ÛÙÂÚ¿ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË Û ̋ÎÔ˜ Î·È ÏÂÙfiÙÂÚË
Î·È Â΂¿ÏÏÂÈ ÛÙËÓ ·ÚÈÛÙÂÚ‹ ÓÂÊÚÈ΋ ÊϤ‚·, ηÈ
ÂÈÎÔ˘ÚÈο ·fi ÔÏÏÔ‡˜ ÌÈÎÚfiÙÂÚÔ˘˜ ÊÏ‚ÈÎÔ‡˜
ÎÏ¿‰Ô˘˜.
OÈ ¯ÂÈÚÔ˘ÚÁÈΤ˜ ·ı‹ÛÂȘ ÙˆÓ ÂÈÓÂÊÚȉ›ˆÓ
ÂÌÊ·Ó›˙ÔÓÙ·È Ì ÙË ÌÔÚÊ‹ ˘ÂÚÏ·Û›·˜ ‹ ‰ÈfiÁΈ-
Û˘ Ù˘ ÊÏÔÈÒ‰Ô˘˜ ‹ Ù˘ Ì˘ÂÏÒ‰Ô˘˜ ÌÔ›Ú·˜, Ô˘
ÌÔÚÔ‡Ó Ó· ·˘Í‹ÛÔ˘Ó ÙÔ Ì¤ÁÂıfi˜ ÙÔ˘˜ ̤¯ÚÈ ÙÔ
ÂηÙÔÓÙ·Ï¿ÛÈÔ. ∂ΉËÏÒÓÔÓÙ·È Û˘Ó‹ıˆ˜ Ì ÙË
 ∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 75, 1
ÌÔÚÊ‹ ˘ÂÚÂÎÎÚÈÙÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘, Ô˘ ›ӷÈ:
·) O ÚˆÙÔ·ı‹˜ ˘ÂڷωÔÛÙÂÚÔÓÈÛÌfi˜ ‹
Û‡Ó‰ÚÔÌÔ Conn Ô˘ ÚÔηÏÂ›Ù·È ·fi ˘ÂÚ¤ÎÎÚÈ-
ÛË ·Ï‰ÔÛÙÂÚfiÓ˘ ·fi Ù· ·ÙÙ·Ú· Ù˘ ÛÂÈÚ·Ì·ÙÈ-
΋˜ ˙ÒÓ˘. ∞·ÓÙ¿ Û˘¯ÓfiÙÂÚ· Û Á˘Ó·›Î˜ (∞/°:
1/2) Î·È ÛÙÔ 80% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÔÊ›ÏÂÙ·È ÛÂ
·‰¤ÓˆÌ·, ÂÓÒ ÙÔ ˘fiÏÔÈÔ 20% ÚÔηÏÂ›Ù·È ·fi
·ÌÊÔÙÂÚfiÏ¢ÚË ˘ÂÚÏ·Û›· ÙÔ˘ ÊÏÔÈÔ‡ ÙˆÓ ÂÈ-
ÓÂÊÚȉ›ˆÓ. ¶Ôχ Û¿ÓÈ· Â›Ó·È Î·ÎfiËı˜. ∂ÌÊ·Ó›-
˙ÂÙ·È Ì ˘¤ÚÙ·ÛË, Ì˘˚΋ ·‰˘Ó·Ì›·, ÎÂÊ·Ï·ÏÁ›·,
ÔÏ˘‰È„›·, ÔÏ˘Ô˘Ú›·, ˘ÔηÏÈ·ÈÌ›·, ÌÂÙ·‚ÔÏÈ΋
·ÏοψÛË Î·È ¯·ÌËÏ¿ Â›‰· ÚÂÓ›Ó˘ ÛÙÔ Ï¿-
ÛÌ·.
‚) ΔÔ Û‡Ó‰ÚÔÌÔ Cushing Ô˘ ÚÔηÏÂ›Ù·È ·-
fi ˘ÂÚ¤ÎÎÚÈÛË ÎÔÚÙÈ˙fiÏ˘. ∂ÌÊ·Ó›˙ÂÙ·È Ì ˘¤Ú-
Ù·ÛË, ·¯˘Û·ÚΛ· ÎÔÚÌÔ‡, ÏËıˆÚÈÎfi Î·È ·ÓÛÂ-
ÏËÓÔÂȉ¤˜ ÚÔÛˆ›Ô, ÔÚÊ˘Ú¤˜ Ú·‚‰ÒÛÂȘ ÛÙËÓ
ÎÔÈÏ›·, ÛÙÔ˘˜ Ì·ÛÙÔ‡˜ Î·È ÛÙÔ˘˜ ÌËÚÔ‡˜, ˘ÂÚÙÚ›-
¯ˆÛË, ·ÎÌ‹, ÛÂÍÔ˘·ÏÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·, ˘ÂÚÁÏ˘-
ηÈÌ›· Î·È ÔÛÙÂÔfiÚˆÛË. ªÔÚ› Ó· Ù·ÍÈÓÔÌËı›
Û ¤ÓÙ هÔ˘˜:
– ΔÔÓ ÎÂÓÙÚÈÎfi Ù‡Ô Ì ·ÌÊÔÙÂÚfiÏ¢ÚË ‰È¿-
¯˘ÙË ˘ÂÚÏ·Û›· Ù˘ ÊÏÔÈÒ‰Ô˘˜ ÌÔ›Ú·˜ Î·È ˘ÂÚ-
·Ú·ÁˆÁ‹ ÎÔÚÙÈ˙fiÏ˘ Û˘ÓÂ›· ÛÙ·ıÂÚ¿ ·˘ÍË̤-
Ó˘ ·Ú·ÁˆÁ‹˜ ACTH ·fi ÙËÓ ˘fiÊ˘ÛË.
– ΔÔ ·Ú·ÓÂÔÏ·ÛÌ·ÙÈÎfi Û‡Ó‰ÚÔÌÔ Cushing
Ô˘ ¤¯ÂÈ ÙËÓ ›‰È· ·ÈÙÈÔ·ıÔÏÔÁ›·, Ì ÙË ‰È·ÊÔÚ¿
fiÙÈ Ë ACTH ·Ú¿ÁÂÙ·È ·fi ACTH-·Ú·ÁˆÁÔ‡˜
fiÁÎÔ˘˜ Î·È fi¯È ·fi ÙËÓ ˘fiÊ˘ÛË.
– ΔË ÌÂÁ·ÏÔÔ˙Ò‰Ë ˘ÂÚÏ·Û›· Ù˘ ÊÏÔÈÒ-
‰Ô˘˜ ÌÔ›Ú·˜ ÌË ÂÍ·ÚÙÒÌÂÓ˘ ·fi ÙËÓ ACTH. ÷-
Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÙËÓ ·ÚÔ˘Û›· ÌÂÁ¿ÏˆÓ fi˙ˆÓ ÛÙË
ÊÏÔÈÒ‰Ë ÌÔ›Ú· Î·È Û˘Ó·ÎfiÏÔ˘ıË ·ÌÊÔÙÂÚfiÏ¢-
ÚË ˘ÂÚÏ·Û›· Ù˘ ÊÏÔÈÒ‰Ô˘˜ ÌÔ›Ú·˜.
– ΔÔÓ ÂÚÈÊÂÚÈÎfi Ù‡Ô Ô˘ ÚÔηÏÂ›Ù·È ·fi
ηÏÔ‹ıË ‹ ηÎÔ‹ıË fi˙Ô ÙÔ˘ ÊÏÔÈÔ‡. ∞ÔÙÂÏ› Â-
Ú›Ô˘ ÙÔ 20-30% ÙˆÓ ÂÚÈÙÒÛÂˆÓ Û˘Ó‰ÚfiÌÔ˘ Cu-
shing. ™Â ÎÔÚ›ÙÛÈ· Ù˘ ÂÊ˂›·˜ ÙÔ Û‡Ó‰ÚÔÌÔ Cu-
shing Â›Ó·È ¿ÓÙ· Û˘Ó¤ÂÈ· Ù˘ ·ÚÔ˘Û›·˜ fiÁÎÔ˘
·˘ÙÔ‡ ÙÔ˘ Ù‡Ô˘.
– ΔÔÓ È·ÙÚÔÁÂÓ‹ Ù‡Ô Ô˘ ·Ú·ÙËÚÂ›Ù·È ÛÂ
·ÛıÂÓ›˜ Ì ̷ÎÚÔ¯ÚfiÓÈ· Ï‹„Ë ÌÂÁ¿ÏˆÓ ‰fiÛˆÓ
ÎÔÚÙÈ˙fiÏ˘.
Á) ΔÔ ·Ó‰ÚÔÁÂÓÓËÙÈÎfi Û‡Ó‰ÚÔÌÔ Ô˘ ۯ‰fiÓ
¿ÓÙ· ÚÔηÏÂ›Ù·È ·fi fiÁÎÔ Ù˘ ‰ÈÎÙ˘ˆÙ‹˜ ˙ÒÓ˘
Ô˘ ˘ÂÚÂÎÎÚ›ÓÂÈ ·Ó‰ÚÔÁfiÓ· ‹ ÔÈÛÙÚÔÁfiÓ· Î·È ÌÂ-
ÚÈΤ˜ ÊÔÚ¤˜ ÎÔÚÙÈ˙fiÏË. ΔÔ 50% ÙˆÓ ÂÚÈÙÒÛˆÓ
··ÓÙ¿ Û ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜, ÂÓÒ ÛÙËÓ ÌÂÙÂÊË‚È-
΋ ËÏÈΛ· ·ÊÔÚ¿ ηٿ ·ÚÈÔ ÏfiÁÔ ÙȘ Á˘Ó·›Î˜. ™ÙË
Á˘Ó·›Î· ˘ÂÚ·Ú·ÁˆÁ‹ ·Ó‰ÚÔÁfiÓˆÓ Ô‰ËÁ› Û ·Ú-
27
ÚÂÓÔÔ›ËÛË Ô˘ ÂΉËÏÒÓÂÙ·È Ì ˘ÂÚÙÚ›¯ˆÛË,
·ÙÚÔÊ›· ÙˆÓ Ì·ÛÙÒÓ, ÔÏÈÁÔÌËÓfiÚÚÔÈ· Î·È ·‡ÍËÛË
ÙÔ˘ ÌÂÁ¤ıÔ˘˜ Ù˘ ÎÏÂÈÙÔÚ›‰·˜, ÂÓÒ ˘ÂÚ·Ú·ÁˆÁ‹
ÔÈÛÙÚÔÁfiÓˆÓ Ô‰ËÁ› Û ÚÒÈÌË ‹‚Ë. ™ÙÔÓ ¿Ó‰Ú·
˘ÂÚ·Ú·ÁˆÁ‹ ·Ó‰ÚÔÁfiÓˆÓ Ô‰ËÁ› Û ÚÒÈÌË ‹‚Ë,
ÂÓÒ ˘ÂÚ·Ú·ÁˆÁ‹ ÔÈÛÙÚÔÁfiÓˆÓ ÚÔηÏ› ıËÏÂÔ-
Ô›ËÛË Ô˘ ÂΉËÏÒÓÂÙ·È Ì Á˘Ó·ÈÎÔÌ·ÛÙ›·, ·ÙÚÔ-
Ê›· fiÚ¯ÂˆÓ Î·È ÂÏ·Ùو̤ÓË libido.
‰) ΔÔ Ê·ÈÔ¯ÚˆÌÔ·Ùو̷ Ô˘ Â›Ó·È Ë ÛËÌ·ÓÙÈ-
ÎfiÙÂÚË ÓfiÛÔ˜ ÙÔ˘ Ì˘ÂÏÔ‡ Î·È ÔÊ›ÏÂÙ·È Û ˘ÂÚ¤Î-
ÎÚÈÛË ·‰ÚÂÓ·Ï›Ó˘ ‹ ÓÔÚ·‰ÚÂÓ·Ï›Ó˘. ™ÙÔ 80-90%
ÙˆÓ ÂÚÈÙÒÛÂˆÓ ··ÓÙ¿ ˆ˜ ÌÔÓ‹Ú˘ fi˙Ô˜ Î·È ıÂ-
ˆÚÂ›Ù·È Â›ÎÙËÙË ÓfiÛÔ˜. ™ÙÔ 10% ··ÓÙ¿ ÂÎÙfi˜ ÙˆÓ
ÂÈÓÂÊÚȉ›ˆÓ Î·È ÛÙÔ 10% Â›Ó·È ·ÌÊÔÙÂÚfiÏ¢ÚÔ
(ÌÂÚÈΤ˜ ÊÔÚ¤˜ ˆ˜ ̤ÚÔ˜ ÔÈÎÔÁÂÓÔ‡˜ ÔÏÏ·Ï‹˜
ÂÓ‰ÔÎÚÈÓÔ‡˜ ÓÂÔÏ·Û›·˜ MEN2A Î·È MEN2B).
πÛÙÔÏÔÁÈο Â˘Ú‹Ì·Ù· ηÎÔ‹ıÂÈ·˜ ··ÓÙÔ‡Ó ÛÙÔ
10% ÙˆÓ ÂÚÈÙÒÛˆÓ. ¶·ıÔÁÂÓÂÙÈÎfi ÛËÌÂ›Ô Ù˘
ÓfiÛÔ˘ Â›Ó·È Ë ·ÚÔ͢ÛÌÈ΋ ˘¤ÚÙ·ÛË.1-4
™Â 32 ·ÛıÂÓ›˜ Ì ¯ÂÈÚÔ˘ÚÁÈ΋ ÓfiÛÔ ÙˆÓ ÂÈ-
ÓÂÊÚȉ›ˆÓ Ô˘ ·ÓÙÈÌÂÙˆ›Û·Ì ٷ ÙÂÏÂ˘Ù·›· ¤ÓÙÂ
¯ÚfiÓÈ· ÔÈ 18 (56%) ÚÔÛ‹Ïı·Ó Ì ÂÈÓÂÊÚȉÈ΋ ˘-
¤ÚÙ·ÛË Î·È ÔÈ 3 (9,4%) Ì Ï‹ÚË ÂÈÎfiÓ· Û˘Ó‰Úfi-
ÌÔ˘ Cushing (˘¤ÚÙ·ÛË, ·¯˘Û·ÚΛ·, Ì˘˚΋ ·‰˘-
Ó·Ì›·).
ŸÌˆ˜ ÌÔÚ› Ó· ÂΉËψıÔ‡Ó Î·È Ì fiÓÔ, Ô
ÔÔ›Ô˜ ÌÔÚ› Ó· Â›Ó·È ·Ì‚χ˜, ÂÌ̤ӈÓ, ηÈ
ÔÊ›ÏÂÙ·È Û˘Ó‹ıˆ˜ Û ηÚΛÓÔ ÙÔ˘ ÂÈÓÂÊÚȉ›Ô˘
Ô˘ Ȥ˙ÂÈ ÁÂÈÙÔÓÈο fiÚÁ·Ó· ‹ ‰ÈËı› Ó¢ÚÈο
ÛÙÔȯ›·, ‹ ¤ÓÙÔÓÔ˜ Î·È Ô͇˜ Û˘ÓÂ›· ·ÈÌÔÚÚ·-
Á›·˜ ÂÓÙfi˜ ÙÔ˘ fi˙Ô˘ ‹ ڋ͈˜ ÙÔ˘ fi˙Ô˘. ∂›Û˘,
‰˘Ó·ÙfiÓ Ó· ÚÔηÏÔ‡Ó ¿Ù˘· ÛËÌ›·, fiˆ˜ „Ë-
Ï·ÊËÙ‹ Ì¿˙·, ‹ Ù¤ÏÔ˜ Ó· ·Ó¢ÚÂıÔ‡Ó Ù˘¯·›· ÛÂ
·ÂÈÎÔÓÈÛÙÈΤ˜ ÂÍÂÙ¿ÛÂȘ (˘ÂÚ˯ÔÁÚ¿ÊËÌ·,
·ÍÔÓÈ΋ ‹ Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›·) Ô˘ Á›ÓÔÓÙ·È
ÁÈ· ¿ÏÏÔ˘˜ ÏfiÁÔ˘˜1-4. ªÂ ¿Ù˘Ë Û˘Ìو̷ÙÔÏÔ-
Á›· ‹ „ËÏ·ÊËÙ‹ ‰ÈfiÁΈÛË ÚÔÛ‹Ïı·Ó 9 (28,2%)
·ÛıÂÓ›˜ Ì·˜.
ªÂ ÙËÓ Â˘Ú›· ¯Ú‹ÛË Ù˘ ·ÍÔÓÈ΋˜ Î·È Ù˘
Ì·ÁÓËÙÈ΋˜ ÙÔÌÔÁÚ·Ê›·˜ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·
¤¯ÂÈ ·˘ÍËı› ÛËÌ·ÓÙÈο Ô ·ÚÈıÌfi˜ Ù˘¯·›ˆ˜ ·Ó¢-
ÚÈÛÎÔÌ¤ÓˆÓ fiÁÎˆÓ ÙˆÓ ÂÈÓÂÊÚȉ›ˆÓ (ÈÓÛÈÓÙÂ-
ÓÙ·ÏÒÌ·Ù·), Ô˘ ÛÙÔ 60% Â›Ó·È ·ÓÂÓÂÚÁ¿ ·‰Â-
ÓÒÌ·Ù·, ÛÙÔ 7,2% ˘ÔÎÏÈÓÈο Ê·ÈÔ¯ÚˆÌÔ΢ÙÙÒ-
Ì·Ù·, ÛÙÔ 6,6% ˘ÔÎÏÈÓÈÎfi Û‡Ó‰ÚÔÌÔ Cushing,
ÛÙÔ 2,4% ·Ï‰ÔÛÙÂÚÔÓÒÌ·Ù·, ÛÙÔ 3,1% ηÎÔ‹ıË
ÓÂÔÏ¿ÛÌ·Ù·, ÛÙÔ 8,1% ·ÛÙÂȘ ‹ Á·ÁÁÏÈÔÓ¢ÚÒ-
Ì·Ù· Î·È ÛÙÔ 3,6% Ì˘ÂÏÔÏÈÒÌ·Ù·. ΔÔ Ì˘ÂÏÔÏ›-
ˆÌ· ÔÊ›ÏÂÙ·È Ì¿ÏÏÔÓ Û ÌÂÙ·Ï·Û›· ÛÙÔȯ›-
ˆÓ ÙÔ˘ ÊÏÔÈÔ‡ Î·È ÙÔ˘ Ì˘ÂÏÔ‡, Â›Ó·È Î·ÏfiËı˜,
28 ∞. ∫∞ª¶∞ƒOÀ¢∏™, £. °∂ƒ∞™πªπ¢∏™

¶›Ó·Î·˜ 1. ∫ÚÈÙ‹ÚÈ· ηÎÔ‹ıÂÈ·˜ ÂÈÓÂÊÚȉÈÎÔ‡ fi˙Ô˘

Hough Weiss Van Slooten

πÛÙÔÏÔÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο
ÔÏ˘ÌÔÚÊÈÛÌfi˜ + + +
ÓÂÎÚÒÛÂȘ + + +
ÌÈÙÒÛÂȘ + + +
‰È·Ù·Ú·¯‹ ·Ú¯ÈÙÂÎÙÔÓÈ΋˜ + + +
‰È‹ıËÛË: ο„·˜ + + +
·ÁÁ›ˆÓ + + +
·‡ÍËÛË ·ÚÈıÌÔ‡ ÈÓˆ‰ÒÓ Ù·ÈÓÈÒÓ +
‰È‹ıËÛË ÎÔÏÔÂȉÒÓ +
‰È·˘Á‹ ·ÙÙ·Ú· (<25%) +
·ÓÒÌ·Ï· ˘Ú‹ÓÈ· +
∞‰Ú¿ ¯·Ú·ÎÙËÚÈÛÙÈο
‚¿ÚÔ˜ fiÁÎÔ˘ (>100 gr) +
∫ÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο
17-ÎÂÙÔÛÙÂÚÔÂȉ‹ Ô‡ÚˆÓ +
(>10 mg/gr ÎÚ·ÙÈÓ›Ó˘/24h)
∞¿ÓÙËÛË (–/+) ÛÙËÓ ACTH +
AÒÏÂÈ· ‚¿ÚÔ˘˜ (>10 ÎÈÏÒÓ/3ÌËÓ.) +

¯ˆÚ›˜ Û˘ÌÙÒÌ·Ù·. ∞ÔÙÂÏÂ›Ù·È ·fi ÏÈÒ‰Ë Î·È

·ÈÌÔÔÈËÙÈο ·ÙÙ·Ú·. ŸÙ·Ó ·˘ÍËı› Û ̤ÁÂıÔ˜
ÚÔηÏ› Û˘ÌÙÒÌ·Ù· ·fi ›ÂÛË ·Ú·ÎÂÈ̤ӈÓ
ÔÚÁ¿ÓˆÓ Î·È ÛÙȘ ÂÚÈÙÒÛÂȘ ·˘Ù¤˜ Ù›ıÂÙ·È ı¤-
Ì· ¯ÂÈÚÔ˘ÚÁÈ΋˜ ÂÍ·›ÚÂÛ˘, ›Ù ÏfiÁˆ Ù˘ Û˘-
Ìو̷ÙÔÏÔÁ›·˜, ›Ù ÏfiÁˆ ·‰˘Ó·Ì›·˜ ÙÂÎÌËÚ›ˆ-
Û˘ Ù˘ ηÏÔ‹ıÂÈ·˜1-5. ™Â 2 (6,3%) ·ÛıÂÓ›˜ Ì·˜
Ë ÂÈÓÂÊÚȉÈ΋ ‚Ï¿‚Ë ‰È·ÁÓÒÛıËÎÂ Ù˘¯·›· ÛÙ·
Ï·›ÛÈ· ·ÂÈÎÔÓÈÛÙÈÎÔ‡ ÂϤÁ¯Ô˘ ¿ÏÏˆÓ Û˘ÛÙËÌ¿-
ÙˆÓ6-7.
OÈ ÂӉ›ÍÂȘ ηÎÔ‹ıÂÈ·˜ ÂÓfi˜ ÂÈÓÂÊÚȉÈ-
ÎÔ‡ fi˙Ô˘ ÚÔ·ÙÔ˘Ó ·fi Û˘Ó‰˘·ÛÌfi ÎÏÈÓÈÎÒÓ
Î·È ·Ú·ÎÏÈÓÈÎÒÓ ÎÚÈÙËÚ›ˆÓ fiˆ˜ Ë ·ÒÏÂÈ·
‚¿ÚÔ˘˜, Ë ¤ÎÎÚÈÛË 17-ÎÂÙÔÛÙÂÚÔÂȉÒÓ Î·È Ë ·¿-
ÓÙËÛË ÛÙËÓ ACTH, ·‰ÚÒÓ ·ıÔÏÔÁÔ·Ó·ÙÔÌÈÎÒÓ
∂ÈÎ. 1. ªÂÁ¿ÏÔ˘ ÌÂÁ¤ıÔ˘˜ fiÁÎÔ˜ ÙÔ˘ ‰ÂÍÈÔ‡ ÂÈÓÂÊÚȉ›Ô˘.
‰Â‰ÔÌ¤ÓˆÓ fiˆ˜ ÙÔ Ì¤ÁÂıÔ˜ Î·È ÙÔ ‚¿ÚÔ˜ ÙÔ˘
fiÁÎÔ˘ Î·È ÌÈÎÚÔÛÎÔÈÎÒÓ ÈÛÙÔÏÔÁÈÎÒÓ Â˘ÚËÌ¿-
ÙˆÓ Ô˘ Â›Ó·È ÔÈ ÌÂÁ¿Ï˜ ÈÓÒ‰ÂȘ ‰ÔΛ‰Â˜, Ë ‰È·- ∞fi ÙÔ˘˜ 32 ·ÛıÂÓ›˜ Ì·˜ ›¯·Ó:
Ù·Ú·¯‹ Ù˘ ·Ú¯ÈÙÂÎÙÔÓÈ΋˜ ÙÔ˘ fiÁÎÔ˘ Û ÔÛÔ- – ηÏÔ‹ıË ÓfiÛÔ ÔÈ 27 (84,37 %) Î·È Û˘ÁÎÂÎÚÈ-
ÛÙfi ÌÂÁ·Ï‡ÙÂÚÔ ÙÔ˘ 33%, Ë ‰È‹ıËÛË ÙˆÓ ·ÁÁ›ˆÓ ̤ӷ Ê·ÈÔ¯ÚˆÌÔ·Ùو̷ ÔÈ 15 (55,6%), Û‡Ó‰ÚÔÌÔ
Î·È Ù˘ ο„·˜ ÙÔ˘ fi˙Ô˘, Ë ·ÚÔ˘Û›· ÎÂÓÙÚÈÎÒÓ Cushing ÔÈ 2 (7,4%), ÚˆÙÔ·ı‹ ˘ÂڷωÔÛÙÂÚÔ-
ÓÂÎÚÒÛˆÓ, ÌÈÙÒÛÂˆÓ (ÂÚÈÛÛfiÙÂÚ˜ ÙˆÓ 5 ÌÈÙÒ- ÓÈÛÌfi ÔÈ 2 (7,4%), Ì˘ÂÏÔÏ›ˆÌ· 1(3,7%) Î·È ÌË
ÛÂˆÓ ·Ó¿ 50 ÔÙÈο ‰›·) Î·È ·Ù˘ÈÒÓ ÙˆÓ ˘- ÏÂÈÙÔ˘ÚÁÈÎfi ·‰¤ÓˆÌ· ‹ ˘ÂÚÏ·Û›· ÔÈ 7 (26%) ηÈ
Ú‹ÓˆÓ Î·È ·ÚÔ˘Û›· ˆÛÈÓÔÊÈÏÈÎÒÓ Î˘ÙÙ¿ÚˆÓ – ηÎÔ‹ıË ÓfiÛÔ ÔÈ 5 (15,63%) ÂÎ ÙˆÓ ÔÔ›ˆÓ
Û ÔÛÔÛÙfi ÌÂÁ·Ï‡ÙÂÚÔ ÙÔ˘ 75% (¶›Ó. 1). ™ÙËÓ Ê·ÈÔ¯ÚˆÌÔ·Ùو̷ 1 (20%), Û‡Ó‰ÚÔÌÔ Cushing 1
·ÍÔÓÈ΋ (∂ÈÎ. 1) ‹ Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· Ì ÙËÓ (20%), ÔÚÌÔÓÈο ·ÓÂÓÂÚÁ‹ fiÁÎÔ 2 (40%) Î·È ÌÂ-
Δ2 Û˘¯ÓfiÙËÙ·, ÂӉ›ÍÂȘ ηÎÔ‹ıÂÈ·˜ Â›Ó·È ÙÔ ÌÂ- Ù·ÛÙ·ÙÈÎfi ÓÂfiÏ·ÛÌ· ÚÔÂÚ¯fiÌÂÓÔ Î·Ù¿ Û˘Ó¤¯ÂÈ·
Á¿ÏÔ Ì¤ÁÂıÔ˜ ÙÔ˘ fi˙Ô˘, Ë ‡·ÚÍË ÎÂÓÙÚÈÎÒÓ ÓÂ- ÈÛÙÔ‡ ·fi ‚ÏÂÓÓÒ‰Ë Î˘ÛÙÈÎfi fiÁÎÔ Ù˘ Ô˘Ú¿˜ ÙÔ˘
ÎÚÒÛˆÓ, Ë ·Û·Ê‹˜ ·ÂÈÎfiÓÈÛË Ù˘ ο„·˜ Î·È Ë ·ÁÎÚ¤·ÙÔ˜ 1 (20%). Δ· ÈÛÙÔÏÔÁÈο ÛÙÔȯ›· ÙÔ˘˜
·ÚÔ˘Û›· ‰È‹ıËÛ˘ ÙˆÓ ¤ÚÈÍ ÈÛÙÒÓ Î·È ÙˆÓ ·Á- ·Ú·Ù›ıÂÓÙ·È ÛÙÔ˘˜ ›Ó·Î˜ 2 Î·È 3.
Á›ˆÓ8-11. ∂Ӊ›ÍÂȘ ÂÙÂÚfiÏ¢Ú˘ ÂÈÓÂÊÚȉÂÎÙÔÌ‹˜
 ∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 75, 1 29

¶›Ó·Î·˜ 2. πÛÙÔÏÔÁÈο ÛÙÔȯ›· ÙˆÓ Î·ÏÔ‹ıˆÓ ‰ÈÔÁÎÒÛˆÓ

·/· ‚¿ÚÔ˜ ÁÚ. ‰È·ÛÙ¿ÛÂȘ ÂÎ. ÈÛÙÔÏÔÁÈÎfi˜ Ù‡Ô˜

1 8×7×4 Ê·ÈÔ¯ÚˆÌÔ·Ùو̷
2 37 6×4×2,5 Ê·ÈÔ¯ÚˆÌÔ·Ùو̷
3 193 10×7,5×5 Ê·ÈÔ¯ÚˆÌÔ·Ùو̷
4 55 4,5×3,7×1,5 Ê·ÈÔ¯ÚˆÌÔ·Ùو̷
5 20 7×2,3×0,6 Ê·ÈÔ¯ÚˆÌÔ·Ùو̷
6 200 7×6×1,5 Ê·ÈÔ¯ÚˆÌÔ·Ùو̷
7 35 7×4,8 Ê·ÈÔ¯ÚˆÌÔ·Ùو̷
8 195 10×4,5 Ê·ÈÔ¯ÚˆÌÔ·Ùو̷
9 94 13x5x4 Ê·ÈÔ¯ÚˆÌÔ·Ùو̷
10 14 4,7x2X4,5 Ê·ÈÔ¯ÚˆÌÔ·Ùو̷
11 115 9,8x5,5x5 Ê·ÈÔ¯ÚˆÌÔ·Ùو̷
12 94 13x5x4 Ê·ÈÔ¯ÚˆÌÔ·Ùو̷
13 61 7x5x3,8 Ê·ÈÔ¯ÚˆÌÔ·Ùو̷
14 6×4 ·Ú·Á·ÁÁÏ›ˆÌ·
25 4×3,8 ·Ú·Á·ÁÁÏ›ˆÌ·
4 2,8×2 Ê·ÈÔ¯ÚˆÌÔ·Ùو̷
15 ¢∂ 12,2 Ê·ÈÔ¯ÚˆÌÔ·Ùو̷
∞ƒ 9 Ê·ÈÔ¯ÚˆÌÔ·Ùو̷
16 24 7×4×2,2 ‰È¿¯˘ÙË Î·È Ô˙҉˘ ˘ÂÚÏ·Û›· ÙÔ˘ ÊÏÔÈÔ‡
™‡Ó‰ÚÔÌÔ Cushing
17 26,6 9,7×2,7×1,1 ·‰¤ÓˆÌ· ÙÔ˘ ÊÏÔÈÔ‡, ™‡Ó‰ÚÔÌÔ Cushing
18 15 4×3×2,5 ·Ï‰ÔÛÙÂÚfiӈ̷
19 35 6X4 ·Ï‰ÔÛÙÂÚfiӈ̷
20 55 8,5×8×3 Ì˘ÂÏÔÏ›ˆÌ·
21 34 6X3,5 ·‰¤ÓˆÌ· ÙÔ˘ ÊÏÔÈÔ‡
22 70 8×5×3 ·‰¤ÓˆÌ· ÙÔ˘ ÊÏÔÈÔ‡
23 42 6×4×3 ·‰¤ÓˆÌ· ÙÔ˘ ÊÏÔÈÔ‡
24 3,5×2,1×1,3 ·‰¤ÓˆÌ· ÙÔ˘ ÊÏÔÈÔ‡
25 5 4×3×1 ·‰¤ÓˆÌ· ÙÔ˘ ÊÏÔÈÔ‡
26 71 7,5x5x3,8 ·‰¤ÓˆÌ· ÙÔ˘ ÊÏÔÈÔ‡
27 27 9,7×2,7×1 ·‰¤ÓˆÌ· ÙÔ˘ ÊÏÔÈÔ‡

¶›Ó·Î·˜ 3. πÛÙÔÏÔÁÈο ÛÙÔȯ›· ηÎÔ‹ıÂÈ·˜

·/· ¢È·ÛÙ¿ÛÂȘ μ¿ÚÔ˜ ¡ÂÎÚÒÛÂȘ ∞Ù˘›Â˜ ¶˘ÚËÓÔÎÈÓËۛ˜ ¢È‹ıËÛË

fiÁÎÔ˘: cm fiÁÎÔ˘: g ο„·˜ ·ÁÁ›ˆÓ ¤ÚÈÍ ÈÛÙÔ‡
1 10×7×4 170 + + + + + +
1,7×1×1 7 + + + + + +
2 12×12×5 + +
3 17×10×3 300 + + + + +
4 6×6,5×5 120 + + + + +
5 12,5×2×1 + + +

·ÔÙÂÏÔ‡Ó ÎÓ˘Ù·È Û ·ÛıÂÓ›˜ Ì ۇӉÚÔÌÔ Cushing Ô˘ Ô-

– Δ· Û‡Ó‰ÚÔÌ· ˘ÂÚÏÂÈÙÔ˘ÚÁ›·˜ Ù˘ ÊÏÔÈÒ-
‰Ô˘˜ ‹ Ù˘ Ì˘ÂÏÒ‰Ô˘˜ ÌÔ›Ú·˜ Ô˘ ÔÊ›ÏÔÓÙ·È ÛÂ
fi˙Ô ‹ ˘ÂÚÙÚÔÊ›· ηÈ
– OÈ ÂÈÓÂÊÚȉÈÎÔ› fi˙ÔÈ ‰È·Ì¤ÙÚÔ˘ ÌÂÁ·Ï‡ÙÂ-
Ú˘ ÙˆÓ 3 cm ¯ˆÚ›˜ ÔÚÌÔÓÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· ÏfiÁˆ
·‡ÍËÛ˘ Ù˘ Èı·ÓfiÙËÙ·˜ Ó· ˘ÔÎÚ‡ÙÔ˘Ó Î·ÎÔ‹-
ıÂÈ·3. ∏ ·ÌÊÔÙÂÚfiÏ¢ÚË ÂÈÓÂÊÚȉÂÎÙÔÌ‹ ÂӉ›-
Ê›ÏÂÙ·È Û ÓfiÛÔ Cushing, Û ¤ÎÙÔË ·Ú·ÁˆÁ‹
ACTH ‹ Û ‰È¿¯˘ÙË ˘ÂÚÏ·Û›· Î·È Û ·ÌÊÔÙÂÚfi-
Ï¢ÚÔ Ê·ÈÔ¯ÚˆÌÔ·Ùو̷3.
To 1926 Ô Cesar Roux ÛÙË ∂Ï‚ÂÙ›· Î·È Ô Char-
les Mayo ÛÙȘ ∏¶∞ ÂÎÙ¤ÏÂÛ·Ó ÙȘ ÚÒÙ˜ ÂÈÙ˘¯Â›˜
ÂÂÌ‚¿ÛÂȘ ÁÈ· ·ı‹ÛÂȘ ÙˆÓ ÂÈÓÂÊÚȉ›ˆÓ (ÂÙÂÚfi-
Ï¢ÚË ÂÈÓÂÊÚȉÂÎÙÔÌ‹ ÁÈ· Ê·ÈÔ¯ÚˆÌÔ·Ù-
30 ∞. ∫∞ª¶∞ƒOÀ¢∏™, £. °∂ƒ∞™πªπ¢∏™
و̷)12. ŒÎÙÔÙ ‰È¿ÊÔÚ˜ ÙÚÔÔÔÈ‹ÛÂȘ ¤ÁÈÓ·Ó
ÛÙËÓ ·Ú·‰ÔÛȷ΋ ÂÈÓÂÊÚȉÂÎÙÔÌ‹, ÔÏϤ˜ ·fi
ÙȘ Ôԛ˜ ÂÚÈÂÏ¿Ì‚·Ó·Ó ·ÏÏ·Á¤˜ ÛÙËÓ ÙÔÌ‹ ηÈ
ÙËÓ ÚÔÛ¤Ï·ÛË ÒÛÙ ӷ ÌÂÁÈÛÙÔÔÈËı› Ë ¤ÎıÂÛË
ÙˆÓ fiÁÎˆÓ Î·È Ó· ÌÂȈı› Ë ÓÔÛËÚfiÙËÙ·. O Joseph
Petelin ÙÔ1992 ÚÒÙÔ˜ ÂÚȤÁÚ·„ ÙËÓ ÂÏ¿¯ÈÛÙ·
ÂÂÌ‚·ÙÈ΋ ¯ÂÈÚÔ˘ÚÁÈ΋ ÙˆÓ ÂÈÓÂÊÚȉ›ˆÓ, Ô
Gagner ÙËÓ ›‰È· ¯ÚÔÓÈ¿ ·Ó·ÎÔ›ÓˆÛ ÙËÓ Ï¿ÁÈ·
‰È·ÎÔÈÏȷ΋ Ï··ÚÔÛÎÔÈ΋ ÂÈÓÂÊÚȉÂÎÙÔÌ‹13
Î·È ÙÔ 1993 Ô Brunt ÙËÓ Â͈ÂÚÈÙÔÓ·˚΋ ÂÓ‰ÔÛÎÔ-
È΋ ÂÈÓÂÊÚȉÂÎÙÔÌ‹14. OÈ JanatcheÎ et al.15 ÙÔ
1998 ‹Ù·Ó ÔÈ ÚÒÙÔÈ Ô˘ ·Ó¤ÊÂÚ·Ó fiÙÈ Â›Ó·È ÂÊÈ-
ÎÙ‹ Ë ÌÂÚÈ΋ Ï··ÚÔÛÎÔÈ΋ ÂÈÓÂÊÚȉÂÎÙÔÌ‹ ÌÂ
‰È·Ù‹ÚËÛË ÙÔ˘ ˘ÁÈÔ‡˜ ÈÛÙÔ‡ Û ·ÌÊÔÙÂÚfiÏ¢ÚÔ˘˜
fiÁÎÔ˘˜ ÂÈÓÂÊÚȉ›ˆÓ Û 3 ·ÛıÂÓ›˜ Î·È ÙÔ 2000 ÔÈ
Gill Î·È Û˘Ó.16 ·Ó¤ÊÂÚ·Ó Ù· ÚÒÙ· ÂÚÈÛÙ·ÙÈο Ù˘
ÚÔÌÔÙÈ΋˜ ÂÈÓÂÊÚȉÂÎÙÔÌ‹˜.
OÈ ·ÛıÂÓ›˜ Ô˘ ÚfiÎÂÈÙ·È Ó· ˘Ô‚ÏËıÔ‡Ó ÛÂ
ÂÈÓÂÊÚȉÂÎÙÔÌ‹ ¯ÚÂÈ¿˙ÔÓÙ·È È‰È·›ÙÂÚË ÚÔÂÁ¯ÂÈ-
ÚËÙÈ΋ ÚÔÂÙÔÈÌ·Û›· Î·È ÂÓÙ·ÙÈ΋ ‰ÈÂÁ¯ÂÈÚËÙÈ΋
Î·È ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË. ŒÙÛÈ, ÁÈ· ÙÔ
Ê·ÈÔ¯ÚˆÌÔ·Ùو̷ ÂÈ‚¿ÏÏÂÙ·È Ë ÏÂÙÔÌÂÚ‹˜
ÚÔÂÁ¯ÂÈÚËÙÈ΋ ηډÈÔÏÔÁÈ΋ ÂÎÙ›ÌËÛË, Ë Â·Ú-
΋˜ ·ÓÙȸÂÚÙ·ÛÈ΋ ·ÁˆÁ‹ Ì ÂÎÏÂÎÙÈÎÔ‡˜ ·1-
·ÓÙ·ÁˆÓÈÛÙ¤˜ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ·Ó·ÛÙÔÏ›˜ ÙˆÓ ‚
˘Ô‰Ô¯¤ˆÓ (ÂÌ›˜ Û˘Ó‹ıˆ˜ ¯ÔÚËÁԇ̠Doxazocin
Î·È atenolol) Ô˘ ·Ú¯›˙ÂÈ 10-15 Ë̤Ú˜ ÚÈÓ ÙËÓ ÂÁ-
¯Â›ÚËÛË ÚÔÎÂÈ̤ÓÔ˘ Ó· ·ÔÊ¢¯ıÔ‡Ó Ù· ·ÔÙÂ-
ϤÛÌ·Ù· Ù˘ ‰Ú¿Û˘ ÙˆÓ Î·Ù¯ÔÏ·ÌÈÓÒÓ Ô˘ ·Â-
Ï¢ıÂÚÒÓÔÓÙ·È Û ÌÂÁ¿Ï˜ ÔÛfiÙËÙ˜ ΢ڛˆ˜ ÛÙË
‰ÈÂÁ¯ÂÈÚËÙÈ΋ Ê¿ÛË ·fi ÙÔ˘˜ ¯ÂÈÚÔ˘ÚÁÈÎÔ‡˜ ¯ÂÈÚÈ-
ÛÌÔ‡˜. ∂›Û˘, Ì ÙË ¯ÔÚ‹ÁËÛË ÙˆÓ Î·Ù¿ÏÏËψÓ
ÔÛÔÙ‹ÙˆÓ ¿ÌÂÛ· ÚÔÂÁ¯ÂÈÚËÙÈο ÎÚ˘ÛÙ·ÏÏÔÂÈ-
‰ÒÓ (1-2lt) Î·È ÎÔÏÏÔÂȉÒÓ ‰È·Ï˘Ì¿ÙˆÓ (Ï¿ÛÌ·,
·›Ì·) ÚÔÏ·Ì‚¿ÓÂÙ·È Î·È ·ÓÙÈÌÂÙˆ›˙ÂÙ·È Ë Â-
ÚÈÂÁ¯ÂÈÚËÙÈ΋ ˘ÔÔÁηÈÌ›·.
™ÙËÓ ÂÚ›ÙˆÛË ÙÔ˘ ·Ï‰ÔÛÙÂÚÔÓÒÌ·ÙÔ˜ ¯ÔÚË-
ÁÔ‡ÓÙ·È ÛÈÚÔÓÔÏ·ÎÙfiÓË Î·È ‰È·Ï‡Ì·Ù· Î·Ï›Ô˘ ÁÈ·
ÙË ‰ÈfiÚıˆÛË Ù˘ ˘ÔηÏÈ·ÈÌ›·˜, ÂÓÒ ÛÙÔ Û‡Ó‰ÚÔÌÔ
Cushing ··ÈÙÂ›Ù·È È‰È·›ÙÂÚË ÚÔÛÔ¯‹ ÛÙË Ú‡ıÌÈÛË
ÙˆÓ ÂÈ¤‰ˆÓ ÁÏ˘Îfi˙˘ ÙÔ˘ ·›Ì·ÙÔ˜1,7,17-19. OÈ ‰ÈÂÁ-
¯ÂÈÚËÙÈΤ˜ ·ÚÚ˘ı̛˜ Û˘Ó‹ıˆ˜ ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È ÌÂ
ÙË ¯ÔÚ‹ÁËÛË ÏȉÔη˝Ó˘ Î·È ÚÔ·ÓÔÏfiÏ˘ Î·È ÔÈ
˘ÂÚÙ·ÛÈΤ˜ ÎÚ›ÛÂȘ Ì ÓÈÙÚÔÚˆÛÛÈÎfi Ó¿ÙÚÈÔ.
¢ÈÂÁ¯ÂÈÚËÙÈο Î·È ¿ÌÂÛ· ÌÂÙÂÁ¯ÂÈÚËÙÈο ··ÈÙ›-
Ù·È ÂÓÙ·ÙÈ΋ ·ÈÌÔ‰˘Ó·ÌÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË (ÎÂ-
ÓÙÚÈ΋ ÊÏ‚È΋ ›ÂÛË, ·ÚÙËÚȷ΋ ›ÂÛË, ËÏÂÎÙÚÔ-
ηډÈÔÁÚ¿ÊËÌ·, ˆÚÈ·›· ‰ÈÔ‡ÚËÛË, ÎÔÚÂÛÌfi˜ Ô͢-
ÁfiÓÔ˘) ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂÏ·¯ÈÛÙÔÔÈËıÔ‡Ó ÔÈ ·ÓÂÈ-
ı‡ÌËÙ˜ ·ÓÙȉڿÛÂȘ. ™ÙËÓ ÂÚ›ÙˆÛË Ù˘ ·ÌÊÔÙÂ-
∂ÈÎ. 2. ∂ÈÓÂÊÚȉÈ΋ ÊÏ‚· Û ‰ÂÍÈ¿ ÂÈÓÂÊÚȉÂÎÙÔÌ‹.
ÚfiÏ¢Ú˘ ·Ê·›ÚÂÛ˘ ÙˆÓ ÂÈÓÂÊÚȉ›ˆÓ ¯ÔÚËÁ›-
Ù·È ÂÓ‰ÔÊϤ‚È· ˘‰ÚÔÎÔÚÙÈ˙fiÓË ÙËÓ Ë̤ڷ Ù˘ Â¤Ì-
‚·Û˘ Î·È ÙȘ 3 ÌÂÙÂÁ¯ÂÈÚËÙÈΤ˜ Ë̤Ú˜ (100 mg IV
‰ÈÂÁ¯ÂÈÚËÙÈο, 150 mg IV ÙËÓ Ë̤ڷ Ù˘ ÂÁ¯Â›ÚËÛ˘,
150 mg IV/24 ÒÚ˜ ÙȘ 3 ÚÒÙ˜ Ë̤Ú˜) Ô˘ ÛÙË Û˘-
Ó¤¯ÂÈ· ·ÓÙÈηı›ÛÙ·Ù·È Ì ÙËÓ ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜ ¯Ô-
Ú‹ÁËÛË (20 + 10 mg)7,18,20.
∏ ¯ÂÈÚÔ˘ÚÁÈ΋ ÚÔÛ¤ÁÁÈÛË ÂÍ·ÚÙ¿Ù·È ·fi ÙÔ
̤ÁÂıÔ˜ Ù˘ ‚Ï¿‚˘, ÙÔÓ Ù‡Ô Ù˘ ÓfiÛÔ˘, ÙË ÁÂÓÈ΋
ηٿÛÙ·ÛË ÙÔ˘ ·ÛıÂÓÔ‡˜, ÙËÓ ·ÁÁ›ˆÛË ÙÔ˘ ÂÈÓÂ-
ÊÚȉ›Ô˘ Î·È ÙËÓ ÂÌÂÈÚ›· Î·È ÙËÓ ÚÔÙ›ÌËÛË ÙÔ˘
¯ÂÈÚÔ˘ÚÁÔ‡.
∏ ·ÓÔÈÎÙ‹ ‰È·ÂÚÈÙÔÓ·˚΋ ÚÔÛ¤Ï·ÛË Á›ÓÂ-
Ù·È Â›Ù Ì ÂÙÂÚfiÏ¢ÚË ‹ ·ÌÊÔÙÂÚfiÏ¢ÚË ˘Ô-
χÚÈ· ÙÔÌ‹ ·Ó¿ÏÔÁ· Ì ÙËÓ ÂÓÙfiÈÛË Ù˘ ‚Ï¿-
‚˘, ›Ù Ì ̤ÛË ˘ÂÚ˘ÔÌÊ¿ÏÈÔ ÙÔÌ‹, ÚÔÛ¤ÁÁÈ-
ÛË ·Ï‹, Ì ÌÈÎÚ‹ ·ÈÌÔÚÚ·Á›· ·ÏÏ¿ ˘„ËÏ‹ Û˘¯Ófi-
ÙËÙ· ÌÂÙÂÁ¯ÂÈÚËÙÈ΋˜ ΋Ï˘. ∞Ó·Áη›· Â›Ó·È Ë Î·-
Ù¿Û·ÛË Ù˘ Û‡ÛÙÔȯ˘ ÎÔÏÈ΋˜ ηÌ‹˜, ÂÓÒ È‰È·›-
ÙÂÚË ÚÔÛÔ¯‹ ··ÈÙÂ›Ù·È ‰ÂÍÈ¿ ÛÙËÓ ·Ú·Û΢‹
Ù˘ ÂÈÓÂÊÚȉÈ΋˜ ÊϤ‚·˜ ÛÙËÓ Â΂ÔÏ‹ Ù˘ ÛÙËÓ
οو ÎÔ›ÏË ÊϤ‚· ÏfiÁˆ ÙÔ˘ Ôχ ÌÈÎÚÔ‡ Ì‹ÎÔ˘˜
Ù˘ (∂ÈÎ. 2) Î·È ·ÚÈÛÙÂÚ¿ ÛÙËÓ Ô˘Ú¿ ÙÔ˘ ·ÁÎÚ¤·-
ÙÔ˜. ∂Ӊ›ÎÓ˘ÓÙ·È Û ÌÂÁ¿ÏÔ˘˜ fiÁÎÔ˘˜, Û ·ÌÊÔÙÂ-
ÚfiÏ¢ÚË ÓfiÛÔ ‹ Û ηٷÛÙ¿ÛÂȘ Ô˘ ··ÈÙ›ٷÈ
Û˘Ó·Ê·›ÚÂÛË ÙÌËÌ¿ÙˆÓ ·Ú·Î›ÌÂÓˆÓ ÔÚÁ¿ÓˆÓ.
™Â ÌÂÁ¿ÏÔ˘˜ fiÁÎÔ˘˜ ÙÔ˘ ‰ÂÍÈÔ‡ ÂÈÓÂÊÚȉ›Ô˘ ·Ú-
ÎÂÙÔ› ¯ÚËÛÈÌÔÔÈÔ‡Ó ıˆÚ·ÎÔÎÔÈÏȷ΋ ÙÔÌ‹ Ô˘
ÙÔ˘˜ ·Ú¤¯ÂÈ Î·Ï‡ÙÂÚÔ ¯ÂÈÚÔ˘ÚÁÈÎfi ‰›Ô. ∏ Â͈-
ÂÚÈÙÔÓ·˚΋ ÚÔÛ¤Ï·ÛË Á›ÓÂÙ·È Ì Ô›ÛıÈ·
ÔÛÊ˘˚΋ ÙÔÌ‹, Ì ÙÔÓ ·ÛıÂÓ‹ Û ÚËÓ‹ ı¤ÛË Î·È
·Ê·›ÚÂÛË Ù˘ 10˘ ÏÂ˘Ú¿˜ Î·È ·Ú¤¯ÂÈ ¿ÌÂÛË
ÚÔÛ¤ÁÁÈÛË Ù˘ ÂÈÓÂÊÚȉÈ΋˜ ‚Ï¿‚˘ ·ÏÏ¿ ‰ÂÓ
¤¯ÂÈ ‰˘Ó·ÙfiÙËÙ· Â¤ÎÙ·Û˘ Â¿Ó ··ÈÙËı›, fiˆ˜
 ∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 75, 1
∂ÈÎ. 3. ¶Ï¿ÁÈ· ı¤ÛË ÓÂÊÚÂÎÙÔÌ‹˜ Û ·ÛıÂÓ‹ Ì ʷÈÔ-
¯ÚˆÌÔ·Ùو̷ ‰ÂÍÈÔ‡ ÂÈÓÂÊÚȉ›Ô˘.
Â› ·ÚÔ˘Û›·˜ ‰ÈÂÁ¯ÂÈÚËÙÈ΋˜ ÂÈÏÔ΋˜ ‹ Ì Ï¿-
ÁÈ· ÔÛÊ˘ÔÎÔÈÏȷ΋ ÛÙÔ ‡„Ô˜ Ù˘ 11˘ ‹ 12˘ Ï¢-
Ú¿˜ ÙÌ‹Ì· ÙˆÓ ÔÔ›ˆÓ Î·È ·Ê·ÈÚÂ›Ù·È (∂ÈÎ. 3 ηÈ
4) Î·È Ë ÔÔ›· ÂӉ›ÎÓ˘Ù·È ÁÈ· ÂÙÂÚfiÏ¢Ú˜ ‚Ï¿-
‚˜ Ì ÏÂÔÓÂÎÙ‹Ì·Ù· ÙËÓ Â‡ÎÔÏË ÚÔÛ¤Ï·ÛË ÙÔ˘
ÂÈÓÂÊÚȉ›Ô˘ Û ·ÛıÂÓ›˜ Ì ÂÂÌ‚¿ÛÂȘ ÛÙËÓ Â-
ÚÈÙÔÓ·˚΋ ÎÔÈÏfiÙËÙ·, ÙËÓ Ù·¯‡ÙÂÚË ÎÈÓËÙÔÔ›ËÛË
Î·È Û›ÙÈÛË ÙÔ˘ ·ÛıÂÓÔ‡˜, ÙËÓ ·ÔÊ˘Á‹ ÂÓ‰ÔÂÚÈÙÔ-
Ó·˚ÎÒÓ ÏÔÈÌÒ͈Ó, ÙËÓ ÂÏ¿ÙÙˆÛË Ù˘ Èı·ÓfiÙËÙ·˜
οΈÛ˘ ÂÓ‰ÔÂÚÈÙÔÓ·˚ÎÔ‡ ÔÚÁ¿ÓÔ˘, ÙË Ì›ˆÛË
ÙÔ˘ ÌÂÙÂÁ¯ÂÈÚËÙÈÎÔ‡ fiÓÔ˘ Î·È ÙÔ˘ ¯ÚfiÓÔ˘ ÓÔÛË-
Ï›·˜ 19,21-24.
™ÙÔ˘˜ 32 ·ÛıÂÓ›˜ Ì·˜ ¤ÁÈÓ·Ó 37 ÂÈÓÂÊÚȉÂ-
ÎÙÔ̤˜, 29 ÂÙÂÚfiÏ¢Ú˜ Î·È 3 ·ÌÊÔÙÂÚfiÏ¢Ú˜.
™ÙÔ˘˜ 27 (84,4%) Ë ÚÔÛ¤Ï·ÛË Ù˘ ÂÈÓÂÊÚȉÈ΋˜
‚Ï¿‚˘ ‹Ù·Ó ·ÓÔÈÎÙ‹ Î·È Û˘ÁÎÂÎÚÈ̤ӷ Ì Ï¿ÁÈ·
ÔÛÊ˘ÔÎÔÈÏȷ΋ ÙÔÌ‹ ÛÙÔ˘˜ 18 (66,7%) Î·È Ì ‰È·-
ÎÔÈÏȷ΋ ÙÔÌ‹ ÛÙÔ˘˜ 9(33.3%) ÂÎ ÙˆÓ ÔÔ›ˆÓ Û 6
ÂÙÂÚfiÏ¢ÚË Î·È Û 3 ·ÌÊÔÙÂÚfiÏ¢ÚË ˘Ôχ-
ÚÈ·.
∏ §··ÚÔÛÎÔÈ΋ - ∂Ó‰ÔÛÎÔÈ΋ ÚÔÛ¤ÁÁÈ-
ÛË ÌÔÚ› Ó· ¯ÚËÛÈÌÔÔÈËı› ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈ-
ÛË ÙÔ˘ ÚˆÙÔ·ıÔ‡˜ ˘ÂڷωÔÛÙÂÚÔÓÈÛÌÔ‡ (™‡Ó-
‰ÚÔÌÔ Conn) Ô˘ ÔÊ›ÏÂÙ·È Û ÏÂÈÙÔ˘ÚÁÈÎfi ·‰¤-
ӈ̷, ÙÔ˘ Ê·ÈÔ¯ÚˆÌÔ΢ÙÙÒÌ·ÙÔ˜, ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘
Cushing Î·È ÙˆÓ ÏÂÈÙÔ˘ÚÁÈο ÌË ÂÓÂÚÁÒÓ fiÁΈÓ
(·‰¤ÓˆÌ·, Ì˘ÂÏÔÏ›ˆÌ·, ·ÛÙË, incidentaloma)
ÌÂÁ¤ıÔ˘˜ ̤¯ÚÈ Î·È 12 ¤ˆ˜ 15 cm. ∞Ó Î·È ˘¿Ú¯ÂÈ
·ÎfiÌË ‰È¯ÔÁӈ̛· ÚÔÙ›ÓÂÙ·È Ë ¯Ú‹ÛË Ù˘ Î·È ÁÈ·
ÙËÓ ·Ê·›ÚÂÛË ÚˆÙÔ·ıÒÓ ‹ ÌÂÙ·ÛÙ·ÙÈÎÒÓ ÂÈÓÂ-
ÊÚȉÈÎÒÓ ÓÂÔÏ·ÛÌ¿ÙˆÓ20,25-34.
∏ Ï··ÚÔÛÎÔÈ΋ ÂÈÓÂÊÚȉÂÎÙÔÌ‹ ÌÔÚ›
Ó· Á›ÓÂÈ Ì ÙÔÓ ·ÛıÂÓ‹ Û ‡ÙÈ· ‹ Ï¿ÁÈ· ı¤ÛË. ∏
ÚÔÛ¤ÁÁÈÛË Û ‡ÙÈ· ı¤ÛË ÚÔÛʤÚÂÈ ÙÔ ÏÂÔÓ¤-
31
∂ÈÎ. 4. ¢ÂÍÈ¿ Ï¿ÁÈ· ÔÛÊ˘ÔÎÔÈÏȷ΋ ÙÔÌ‹ ÌÂ Û˘Ó·Ê·›-
ÚÂÛË Ù˘ 11˘ ÏÂ˘Ú¿˜.
ÎÙËÌ· Ù˘ Ï‹ÚÔ˘˜ ÂÈÎfiÓ·˜ Ù˘ ÂÚÈÙÔÓ·˚΋˜ ÎÔÈ-
ÏfiÙËÙ·˜ Î·È Ù˘ ‰˘Ó·ÙfiÙËÙ·˜ ÂÎÙ¤ÏÂÛ˘ ·ÌÊÔÙÂ-
ÚfiÏ¢Ú˘ ÂÈÓÂÊÚȉÂÎÙÔÌ‹˜ ¯ˆÚ›˜ Â·Ó·ÙÔÔ-
ı¤ÙËÛË ÙÔ˘ ·ÛıÂÓÔ‡˜. ∞·ÈÙ› ÂÈÚfiÛıÂÙ· ÛË-
Ì›· ÚÔÛ¤ÁÁÈÛ˘ Î·È ÂÚÈÛÛfiÙÂÚÔ ‰ÈÂÁ¯ÂÈÚËÙÈÎfi
¯ÚfiÓÔ. ∏ Ï¿ÁÈ· ı¤ÛË Â›Ó·È Ë Â˘Ú¤ˆ˜ ¯ÚËÛÈÌÔ-
ÔÈÔ‡ÌÂÓË ı¤ÛË ÁÈ·Ù› ·Ú¤¯ÂÈ ÙÔ Ì¤ÁÈÛÙÔ ¯ÂÈ-
ÚÔ˘ÚÁÈÎfi ‰›Ô Ì ÙË ‚Ô‹ıÂÈ· Ù˘ ·Ó¿Û·Û˘ ÙˆÓ
·Ú·ÎÂÈÌ¤ÓˆÓ ÔÚÁ¿ÓˆÓ. ∏ ¯ÚËÛÈÌÔÔ›ËÛ‹ Ù˘ ÛÂ
·ÌÊÔÙÂÚfiÏ¢ÚË ÂÈÓÂÊÚȉÂÎÙÔÌ‹ ··ÈÙ› Â·-
Ó·ÙÔÔı¤ÙËÛË ÙÔ˘ ·ÚÚÒÛÙÔ˘ ÛÙÔ ¯ÂÈÚÔ˘ÚÁÈÎfi
ÙÚ·¤˙È20,32.
∞·Ú·›ÙËÙ· ÛÙÔȯ›· Â›Ó·È Ë ÙÔÔı¤ÙËÛË ·Ú-
ÙËÚȷ΋˜ ÁÚ·ÌÌ‹˜, ÚÈÓÔÁ·ÛÙÚÈÎÔ‡ ηıÂÙ‹Ú·, η-
ıÂÙ‹Ú· Ô˘ÚÔ‰fi¯Ô˘ ·ÛÙˆ˜, ÂÓÒ ÎÂÓÙÚÈÎfi˜ ÊÏ‚È-
Îfi˜ ηıÂÙ‹Ú·˜ Â›Ó·È ··Ú·›ÙËÙÔ˜ ÌfiÓÔ ÛÙÔ˘˜
·ÛıÂÓ›˜ Ô˘ ÚԂϤÂÙ·È Ì·˙È΋ ÌÂٷΛÓËÛË
˘ÁÚÒÓ, fiˆ˜ Â› ·Ú·‰Â›ÁÌ·ÙÈ Û ʷÈÔ¯ÚˆÌÔ·Ù-
و̷. ¶ÂÚÈÂÁ¯ÂÈÚËÙÈ΋ ¯ËÌÂÈÔÚÔʇϷÍË ‰ÂÓ
··ÈÙÂ›Ù·È ÏËÓ ÙˆÓ ·ÛıÂÓÒÓ Ì ۇӉÚÔÌÔ Cu-
shing Ô˘ Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ ÂÈÚÚÂ›˜ Û Â-
ÚÈÂÁ¯ÂÈÚËÙÈΤ˜ ÏÔÈÌÒÍÂȘ. O ·ÛıÂÓ‹˜ ÙÔÔıÂÙ›-
Ù·È Û Ï¿ÁÈ· decubitus ı¤ÛË (Û ÁˆÓ›· 80Ô), ÙÔ
¯ÂÈÚÔ˘ÚÁÈÎfi ÙÚ·¤˙È Î·Ù·Û¿Ù·È ÛÙ· ‰‡Ô ¿ÎÚ·
Ô‡Ùˆ˜ ÒÛÙ ӷ ·ÓÔ›ÍÂÈ ÙÔ ‰›Ô ÌÂٷ͇ ÙˆÓ Î·Ùˆ-
Ù¤ÚˆÓ Ï¢ÚÒÓ Î·È Ù˘ Ï·ÁÔÓ›Ô˘ ¯ÒÚ·˜ Î·È Ô ¯ÂÈ-
ÚÔ˘ÚÁfi˜ Î·È ÔÈ ‚ÔËıÔ› ‚Ú›ÛÎÔÓÙ·È ÛÙËÓ ›‰È· Ï¢-
Ú¿ ‚ϤÔÓÙ·˜ ÙÔ ÚfiÛˆÔ ÙÔ˘ ·ÚÚÒÛÙÔ˘. ΔÔ
Ó¢ÌÔÂÚÈÙfiÓ·ÈÔ Î˘Ì·›ÓÂÙ·È ÌÂٷ͇ 12-14
mmHg Î·È ÂÈÙ˘Á¯¿ÓÂÙ·È Ì ÙËÓ ÂÈÛ·ÁˆÁ‹ ÛÙËÓ
ÂÚÈÙÔÓ·˚΋ ÎÔÈÏfiÙËÙ· CO2 ›Ù Ì ÙË ¯Ú‹ÛË ‚Â-
ÏfiÓ·˜ Veress ‹ Ì ÙË Ì¤ıÔ‰Ô Hasson. ÃÚËÛÈÌÔ-
ÔÈÔ‡ÓÙ·È Ù¤ÛÛÂÚȘ ÂÈÛ·ÁˆÁ›˜ - ˘ԉԯ›˜ ÂÚÁ·-
Ï›ˆÓ (trocars), Ô ¤Ó·˜ 10-12 mm ÁÈ· ÙËÓ ÂÈÛ·Áˆ-
32 ∞. ∫∞ª¶∞ƒOÀ¢∏™, £. °∂ƒ∞™πªπ¢∏™
5 mm port
12-12 mm port
Optional
∂ÈÎ. 5. £¤ÛË ÙÔ˘ ·ÛıÂÓÔ‡˜ Î·È Ù· ÛËÌ›· ÙÔÔı¤ÙËÛ˘
ÙˆÓ trocars Û ‰ÂÍÈ¿ Ï··ÚÔÛÎÔÈ΋ ÂÈÓÂÊÚȉÂÎÙÔÌ‹.
Á‹ Ï··ÚÔÛÎÔ›Ô˘ 0Ô ‹ 30Ô Î·È ÔÈ ¿ÏÏÔÈ ÙÚÂȘ 12
mm. O ˘Ô‰Ô¯¤·˜ ÙÔ˘ Ï··ÚÔÛÎÔ›Ô˘ ÙÔÔıÂÙ›-
Ù·È ·ÎÚÈ‚Ò˜ ˘ÔÌÊ¿ÏÈ·, ‰‡Ô ¿ÏÏÔÈ ÙÔÔıÂÙÔ‡ÓÙ·È
ηٿ Ì‹ÎÔ˜ Ù˘ ̤Û˘ Ì·Û¯·ÏÈ·›·˜ ÁÚ·ÌÌ‹˜, Ô
¤Ó·˜ 2 cm οوıÂÓ ÙÔ˘ Ï¢ÚÈÎÔ‡ ÙfiÍÔ˘ Î·È Ô ‰Â‡-
ÙÂÚÔ˜ 8-12 cm οوıÂÓ ÙÔ˘ ÚÔËÁÔ‡ÌÂÓÔ˘ Î·È ¯ÚË-
ÛÈÌÔÔÈÔ‡ÓÙ·È ÁÈ· ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙˆÓ ¯ÂÈÚÔ˘ÚÁÈÎÒÓ
ÂÚÁ·Ï›ˆÓ Î·È Ô Ù¤Ù·ÚÙÔ˜ ÙÔÔıÂÙÂ›Ù·È Î¿Ùˆ ·fi
ÙËÓ ÍÈÊÔÂȉ‹ ·fiÊ˘ÛË Â› Ù˘ ̤Û˘ ÁÚ·ÌÌ‹˜ ÁÈ·
ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ·Ó·Û·ÛÙ‹ (retractor) ÙˆÓ ÂÓ‰Ô-
ÎÔÈÏÈ·ÎÒÓ ÔÚÁ¿ÓˆÓ (∂ÈÎ. 5 Î·È 6). O ‰Â‡ÙÂÚÔ˜ ηÈ
ÙÚ›ÙÔ˜ ÂÈÛ·ÁˆÁ¤·˜ ÙˆÓ 12 mm ÌÔÚ› Ó· ·ÓÙÈηٷ-
ÛÙ·ıÔ‡Ó Ì ÂÈÛ·ÁˆÁ›˜ 5 mm ·Ó¿ÏÔÁ· Ì ٷ ¯ÂÈ-
ÚÔ˘ÚÁÈο ÂÚÁ·Ï›· Ô˘ ı· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó. ™ÙË
‰ÂÍÈ¿ Ï··ÚÔÛÎÔÈ΋ ÂÈÓÂÊÚȉÂÎÙÔÌ‹ Ô ·Ó·Û·-
ÛÙ‹˜ ÙÔ˘ ‹·ÙÔ˜ ÙÔÔıÂÙÂ›Ù·È ·fi ÙÔÓ ˘ÔÍÈÊÔÂȉÈ-
Îfi ÂÈÛ·ÁˆÁ¤·. ¢È·Ù¤ÌÓÂÙ·È Ô ÙÚ›ÁˆÓÔ˜ Û‡Ó‰ÂÛÌÔ˜
Î·È ÙÔ ‹·Ú ·Ó·Û¿Ù·È ÎÂÊ·ÏÈο. ΔÔ Ô›ÛıÈÔ Â-
ÚÈÙfiÓ·ÈÔ ‰È·Ù¤ÌÓÂÙ·È ÂÁοÚÛÈ· „ËÏ¿ οو ·fi ÙÔ
¯Â›ÏÔ˜ ÙÔ˘ ‹·ÙÔ˜ ÍÂÎÈÓÒÓÙ·˜ ·fi ÙËÓ ÁÚ·ÌÌ‹ ÙÔ˘
Toldt ÛÙ· Ï¿ÁÈ· Î·È Êı¿ÓÔÓÙ·˜ ̤¯ÚÈ ÙËÓ Î¿Ùˆ
ÎÔ›ÏË ÊϤ‚· ÎÂÓÙÚÈο. ΔÔ ‰ˆ‰Âη‰¿ÎÙ˘ÏÔ ·ˆı›-
Ù·È ÚÔÛÂÎÙÈο ÎÂÓÙÚÈο ÁÈ· ·ÔÊ˘Á‹ ÙÚ·˘Ì·ÙÈ-
ÛÌÔ‡ ÙÔ˘ ̤¯ÚȘ fiÙÔ˘ ·Ó·ÁÓˆÚÈÛı› Ë ·Ú˘Ê‹ ÙÔ˘
‰ÂÍÈÔ‡ ÓÂÊÚÔ‡. ∞ÎÔÏÔ˘ı› Ë ·Ó·ÁÓÒÚÈÛË Ù˘ ‰Â-
ÍÈ¿˜ ÂÈÓÂÊÚȉÈ΋˜ ÊϤ‚·˜. ∏ ‰È·ÙÔÌ‹ ÙˆÓ Ë·ÙÔ-
‰È·ÊÚ·ÁÌ·ÙÈÎÒÓ Û˘Ó‰¤ÛÌˆÓ Â›Ó·È È‰È·›ÙÂÚ· ˘Ô-
∂ÈÎ. 6. £¤ÛË ÙˆÓ trocars Û ·ÚÈÛÙÂÚ‹ Ï··ÚÔÛÎÔÈ΋
ÂÈÓÂÊÚȉÂÎÙÔÌ‹.
‚ÔËıËÙÈ΋ Û ¢ÌÂÁ¤ıÂȘ fiÁÎÔ˘˜, fiÙ·Ó ı¤ÏÔ˘Ì ӷ
ÎÈÓËÙÔÔÈ‹ÛÔ˘Ì ÙÔ ‹·Ú Û ¢Ú›· ¤ÎÙ·ÛË ÎÂÓÙÚÈ-
ο ÚÔÎÂÈ̤ÓÔ˘ Ó· ·Ôηχ„Ô˘Ì ÙËÓ Î¿Ùˆ ÎÔ›ÏË
ÊϤ‚· ̤¯ÚÈ ÙËÓ Â΂ÔÏ‹ ÙˆÓ Ë·ÙÈÎÒÓ ÊÏ‚ÒÓ.
ªÂÙ¿ ÙËÓ ·ÔϛӈÛË Î·È ‰È·ÙÔÌ‹ Ù˘ ÂÈÓÂÊÚȉÈ-
΋˜ ÊϤ‚·˜ ·ÎÔÏÔ˘ı› Ë ‰È·ÙÔÌ‹ ÙˆÓ ÌÈÎÚfiÙÂÚˆÓ
(οو Î·È ¿Óˆ) ÂÈÓÂÊÚȉÈÎÒÓ ÊÏ‚ÒÓ Î·È Ë Ï‹-
Ú˘ ÎÈÓËÙÔÔ›ËÛË ÙÔ˘ fiÁÎÔ˘ Ô˘ ÂÓ Û˘Ó¯›· ·Ê·È-
ÚÂ›Ù·È Ì ÙË ¯Ú‹ÛË Û¿ÎÔ˘. ™ÙËÓ ·ÚÈÛÙÂÚ‹ Ï··ÚÔ-
ÛÎÔÈ΋ ÂÈÓÂÊÚȉÂÎÙÔÌ‹ Ô ·Ó·Û·ÛÙ‹˜ ÙÔ˘ ÛÏË-
Ófi˜ ÙÔÔıÂÙÂ›Ù·È ·fi ÙÔÓ ˘ÔÍÈÊÔÂȉÈÎfi ÂÈÛ·Áˆ-
Á¤·. ∏ ÁÚ·ÌÌ‹ ÙÔ˘ Toldt ‰È·Ù¤ÌÓÂÙ·È ·fi ÙÔ ‡„Ô˜
Ù˘ ÛÏËÓÈ΋˜ ηÌ‹˜ ̤¯ÚÈ ÙÔ ÛÈÁÌÔÂȉ¤˜. O ÊÚÂ-
ÓÔÎÔÏÈÎfi˜ Û‡Ó‰ÂÛÌÔ˜ ‰È·Ù¤ÌÓÂÙ·È Î·È ÎÈÓËÙÔÔÈ›-
Ù·È ÎÂÓÙÚÈο Ë ·ÚÈÛÙÂÚ¿ ÎÔÏÈ΋ ηÌ‹. ∂¿Ó ÎÚ›ÓÂ-
Ù·È ··Ú·›ÙËÙÔ ·ÂÏ¢ıÂÚÒÓÂÙ·È Ô ÛÏ‹Ó·˜ ·fi
ÙȘ Û˘Ó‰¤ÛÂȘ ÙÔ˘ Ì ÙÔ Ï¿ÁÈÔ ÎÔÈÏÈ·Îfi ÙÔ›¯ˆÌ·
Î·È ÙÔ ‰È¿ÊÚ·ÁÌ·. π‰È·›ÙÂÚË ÚÔÛÔ¯‹ ··ÈÙ›ٷÈ
ÛÙËÓ ·ÔÊ˘Á‹ οΈÛ˘ Ù˘ Ô˘Ú¿˜ ÙÔ˘ ·ÁÎÚ¤·ÙÔ˜.
ªÂÙ¿ ÙËÓ ÎÈÓËÙÔÔ›ËÛË Ù˘ ·ÚÈÛÙÂÚ¿˜ ÎÔÏÈ΋˜ η-
Ì‹˜ Î·È ÙÔ˘ ÛÏ‹Ó· ·Ó·ÁÓˆÚ›˙ÂÙ·È Ë Î‡ÚÈ· ÂÈÓÂ-
ÊÚȉÈ΋ ÊϤ‚· (·ÚÈÛÙÂÚ¿ Ë Î¿Ùˆ ÂÈÓÂÊÚȉÈ΋
ÊϤ‚·) ÎÔÓÙ¿ ÛÙËÓ Â΂ÔÏ‹ Ù˘ ÛÙË ÓÂÊÚÈ΋ ÊϤ‚·,
fiÔ˘ ·ÔÏÈÓÒÓÂÙ·È Î·È ‰È·Ù¤ÌÓÂÙ·È. ∂› ·‰˘Ó·-
Ì›·˜ ·Ó·ÁÓˆÚ›ÛÂÒ˜ Ù˘, fiˆ˜ ÌÔÚ› Ó· Û˘Ì‚Â› ÛÂ
·¯‡Û·Úη ¿ÙÔÌ·, ÛËÌ·ÓÙÈ΋ Â›Ó·È Ë ·Ó·ÁÓÒÚÈÛË
Ù˘ ÛÂÚÌ·ÙÈ΋˜ ÊϤ‚·˜ Î·È Ë ·Ú·ÎÔÏÔ‡ıËÛË Ù˘
ÔÚ›·˜ Ù˘ ̤¯ÚÈ ÙËÓ Â΂ÔÏ‹ Ù˘ ÛÙË ÓÂÊÚÈ΋ ÊϤ-
‚·. ™ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÙˆÓ ÂÚÈÙÒÛÂˆÓ Ë ÂÈÓÂ-
ÊÚȉÈ΋ ÊϤ‚· ‚Ú›ÛÎÂÙ·È ·¤Ó·ÓÙÈ ·fi ÙËÓ Â΂ÔÏ‹
Ù˘ ÛÂÚÌ·ÙÈ΋˜ ÊϤ‚·˜ ÛÙË ÓÂÊÚÈ΋ ÊϤ‚·. ∞ÎÔ-
 ∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 75, 1
ÏÔ‡ıˆ˜ ·Ó·ÁÓˆÚ›˙ÔÓÙ·È Î·È ‰È·Ù¤ÌÓÔÓÙ·È Ë Ì¤ÛË
Î·È Ë ¿Óˆ ÂÈÓÂÊÚȉÈΤ˜ ÊϤ‚˜ Î·È Ë ÎÈÓËÙÔÔ›Ë-
ÛË ÙÂÏÂÈÒÓÂÈ Ì ÙË ‰È·ÙÔÌ‹ ÙˆÓ Ï¿ÁÈˆÓ Î·È Ì¤ÛˆÓ
Û˘Ó‰¤Û̈Ó20,32.
∞fiÏ˘Ù˜ ·ÓÙÂӉ›ÍÂȘ Ù˘ ÂÓ‰ÔÛÎÔÈ΋˜
ÚÔÛ¤ÁÁÈÛ˘ Â›Ó·È ÔÈ ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ËÎÙÈÎÔ‡ ÌË-
¯·ÓÈÛÌÔ‡, Ë ÂÓÂÚÁfi˜ ÔÈÛıÔÂÚÈÙÔÓ·˚΋ ÊÏÂÁÌÔ-
Ó‹, ÙÔ ·Ó‡ڢÛÌ· Ù˘ ÎÔÈÏȷ΋˜ ·ÔÚÙ‹˜ Î·È Ë ·-
ÚÔ˘Û›· ÂÓ‰ÔÎÔÈÏȷ΋˜ Ïԛ̈͢, ÂÓÒ Û¯ÂÙÈΤ˜
·ÓÙÂӉ›ÍÂȘ Ë Î·Ú‰È·Î‹ ‹ ·Ó·Ó¢ÛÙÈ΋ ·ÓÂ¿Ú-
ÎÂÈ·, Ë ˘Ï·›· ˘¤ÚÙ·ÛË Ì Â›Ù·ÛË ÙÔ˘ ÔÈÛıÔ-
ÂÚÈÙÔÓ·˚ÎÔ‡ ϤÁÌ·ÙÔ˜ ÙÔ˘ Retzius, Ë ÓÔÛÔÁfiÓÔ˜
·¯˘Û·ÚΛ·, Ë ÂÎÛÂÛËÌ·Ṳ̂ÓË ·ÛÎÈÙÈ΋ Û˘ÏÏÔÁ‹,
ÔÈ ÚÔËÁÔ‡ÌÂÓ˜ ¯ÂÈÚÔ˘ÚÁÈΤ˜ ÂÂÌ‚¿ÛÂȘ ÂÓ‰Ô- ‹
ÔÈÛıÔÂÚÈÙÔÓ·˚ο Î·È ÔÈ ÊÏÂÁÌÔÓÒ‰ÂȘ ηٷÛÙ¿-
ÛÂȘ ÙÔ˘ ÓÂÊÚÔ‡20,32.
∏ ‰È· ¯ÂÈÚfi˜ ˘Ô‚ÔËıÔ‡ÌÂÓË Ï··ÚÔÛÎÔÈ΋
ÂÈÓÂÊÚȉÂÎÙÔÌ‹ (hand-assisted laparoscopic adre-
nalectomy) ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÁÈ· ÙËÓ ·Ê·›ÚÂÛË ‰‡-
ÛÎÔÏˆÓ Î·È Ôχ ÌÂÁ¿ÏˆÓ fiÁÎˆÓ ÙˆÓ ÂÈÓÂÊÚÈ-
‰›ˆÓ Î·È Á›ÓÂÙ·È Ì¤Ûˆ ÙÔÌ‹˜ 7-8 cm. ΔÔ ÂχıÂÚÔ
¯¤ÚÈ ÙÔ˘ ¯ÂÈÚÔ˘ÚÁÔ‡ ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÁÈ· ÙËÓ ·Ó¿-
Û·ÛË ·Ú·ÎÂÈÌ¤ÓˆÓ ÔÚÁ¿ÓˆÓ, ÁÈ· ÙËÓ Ù˘ÊÏ‹ „Ë-
Ï¿ÊËÛË Î·È ·ÔÎfiÏÏËÛË Î·È ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô ÊÏ‚È-
΋˜ ·ÈÌÔÚÚ·Á›·˜35.
∏ ÂÓ‰ÔÛÎÔÈ΋ ÔÈÛıÔÂÚÈÙÔÓ·˚΋ ÚÔÛ¤Á-
ÁÈÛË ÂӉ›ÎÓ˘Ù·È ÌfiÓÔ Û ·ÛıÂÓ›˜ Ì ηÏÔ‹ıÂȘ
ÂÈÓÂÊÚȉÈÎÔ‡˜ fiÁÎÔ˘˜ ‰È·Ì¤ÙÚÔ˘ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ
6 cm. ∏ ÚÔËÁÔ‡ÌÂÓË ÂÁ¯Â›ÚËÛË ÛÙÔÓ ÂÚÈÓÂÊÚÈ-
Îfi ¯ÒÚÔ ·ÔÙÂÏ› ·ÓÙ¤Ó‰ÂÈÍË ·˘Ù‹˜ Ù˘ ÚÔÛ¤ÁÁÈ-
Û˘. °›ÓÂÙ·È Ì ÙÔÌ‹ 2 cm Ô˘ ‰È·¯ˆÚ›˙ÂÈ ÙÔ˘˜
̇˜ ÛÙË Ì¤ÛË Ì·Û¯·ÏÈ·›· ÁÚ·ÌÌ‹, ·ÎÚÈ‚Ò˜ Ô˘-
Ú·›· Ù˘ ¿ÎÚ˘ Ù˘ ÂÓ‰¤Î·Ù˘ ÏÂ˘Ú¿˜, ÁÈ· ÙËÓ Â›-
ÛÔ‰Ô ÛÙÔÓ ÔÈÛıÔÂÚÈÙÔÓ·˚Îfi ¯ÒÚÔ ·ÂÚÔı·Ï¿-
ÌÔ˘ Î·È ÂÌʇÛËÛË ·¤Ú· ÁÈ· ÙË ‰ËÌÈÔ˘ÚÁ›· ÛÙÔÓ
ÔÈÛıÔÂÚÈÙÔÓ·˚Îfi ¯ÒÚÔ Î·Ù¿ÏÏËÏÔ˘ ¯ÂÈÚÔ˘ÚÁÈ-
ÎÔ‡ ‰›Ô˘. OÈ ÂÈÛ·ÁˆÁ›˜ ÂÚÁ·Ï›ˆÓ (trocars)
ÙÔÔıÂÙÔ‡ÓÙ·È ÎÔÓÙ¿ ÛÙÔ ˘Ô¯fiÓ‰ÚÈÔ ÚÔÎÂÈ̤-
ÓÔ˘ Ó· ‰È¢ÎÔχÓÔÓÙ·È ÔÈ ÎÈÓ‹ÛÂȘ ÙˆÓ ÂÚÁ·Ï›ˆÓ.
¶ÏÂÔÓÂÎÙ‹Ì·Ù· ·˘Ù‹˜ Ù˘ ÚÔÛ¤ÁÁÈÛ˘ Â›Ó·È Ë
·ÔÊ˘Á‹ Ù˘ ÂÚÈÙÔÓ·˚΋˜ ÎÔÈÏfiÙËÙ·˜, Ë ‰˘Ó·Ùfi-
ÙËÙ· ÂÓ‰ÔÛÎÔÈ΋˜ ÚÔÛ¤Ï·Û˘ Û ·ÛıÂÓ›˜ Ô˘
¤¯Ô˘Ó ÚÔËÁÔ‡ÌÂÓË ÂÁ¯Â›ÚËÛË ÎÔÈÏ›·˜ ‹ ÌÂÁ¿ÏÔ
‹·Ú, ÙÔ ÔÔ›Ô Î¿ÓÂÈ ÙË ÌÂÙ·ÙfiÈÛ‹ ÙÔ˘ ‰‡ÛÎÔÏË
Û ·ÛıÂÓ›˜ Ì ‰ÂÍÈÔ‡˜ ÂÈÓÂÊÚȉÈÎÔ‡˜ fiÁÎÔ˘˜
Î·È Ë ÂÚÈÔÚÈṲ̂ÓË ·Ó¿ÁÎË ÁÈ· ÌÂÙ·ÙfiÈÛË ÙÔ˘
ÛÏ‹Ó·, ÙÔ˘ ‹·ÙÔ˜ ‹ ÙÔ˘ ·ÁÎÚ¤·ÙÔ˜, ÂÓÒ Ô‰ËÁ›
Û ÏÈÁfiÙÂÚ˜ ‰È·Ù·Ú·¯¤˜ ·fi ÙÔ ¤ÓÙÂÚÔ Î·È Û ÏÈ-
ÁfiÙÂÚÔ ÎÔÈÏÈ·Îfi fiÓÔ14,32,36-38.
¶·Ú¿ Ù·‡Ù· ÚÔÙÈÌ¿Ù·È Ë ‰È·ÂÚÈÙÔÓ·˚΋
33
ÚÔÛ¤Ï·ÛË ÁÈ·Ù›:
– Â›Ó·È ÁÓˆÛÙ‹ Ë ·Ó·ÙÔÌ›· ÙÔ˘ ¯ÒÚÔ˘ Î·È ·-
Ú¤¯ÂÙ·È ÏËıÒÚ· ÂÓ‰ÔÂÚÈÙÔÓ·˚ÎÒÓ ÛËÌ›ˆÓ ÁÈ·
ÚÔÛ·Ó·ÙÔÏÈÛÌfi ÙÔ˘ ¯ÂÈÚÔ˘ÚÁÔ‡.
– Â›Ó·È ‰˘Ó·Ù‹ Ë ÂÈÛÎfiËÛË ÙÔ˘ ÌÂÁ·Ï‡ÙÂÚÔ˘
̤ÚÔ˘˜ Ù˘ ÂÚÈÙÔÓ·˚΋˜ ÎÔÈÏfiÙËÙ·˜
– ·Ú¤¯ÂÈ Â˘Ú‡ ¯ÂÈÚÔ˘ÚÁÈÎfi ‰›Ô Î·È Î·Ï‡-
ÙÂÚË ÔÚ·ÙfiÙËÙ· ÁÈ· ·Ê·›ÚÂÛË ÌÂÁ·Ï‡ÙÂÚˆÓ fiÁΈÓ
ηÈ
– ˘¿Ú¯ÂÈ ÌÂÁ·Ï‡ÙÂÚË ÂÌÂÈÚ›·.
∞fi ÙÔ˘˜ ·ÛıÂÓ›˜ Ì·˜ 5 (15,6%) ·ÓÙÈÌÂÙˆ›-
ÛıËÎ·Ó Ï··ÚÔÛÎÔÈο Ì›· Ì ۇӉÚÔÌÔ Cushing
·ÚÈÛÙÂÚÔ‡ ÂÈÓÂÊÚȉ›Ô˘, ‰‡Ô Ì ·Ï‰ÔÛÙÂÚfiӈ̷,
Ì›· Ì ۇӉÚÔÌÔ Cushing ‰ÂÍÈÔ‡ ÂÈÓÂÊÚȉ›Ô˘ ηÈ
Ì›· Ì ÌË ÏÂÈÙÔ˘ÚÁÈÎfi ·‰¤ÓˆÌ· ‰ÂÍÈÔ‡ ÂÈÓÂÊÚȉ›-
Ô˘. ŸÏ˜ ¤ÁÈÓ·Ó Ì ‰È·ÂÚÈÙÔÓ·˚΋ ÚÔÛ¤Ï·ÛË
Ì ÙË ¯Ú‹ÛË 4 ÂÈÛ·ÁˆÁ¤ˆÓ (trocars), fiÔ˘ ÙÔ ÚÒ-
ÙÔ ÙÔÔıÂÙÔ‡ÓÙ·Ó Ì ·ÓÔÈÎÙ‹ ̤ıÔ‰Ô (Hasson) ηÈ
Ì Ó¢ÌÔÂÚÈÙfiÓ·ÈÔ 12 mmHg.
OÈ ÂÈÏÔΤ˜ Ù˘ ·ÓÔÈÎÙ‹˜ ÚÔÛ¤ÁÁÈÛ˘ ΢-
Ì·›ÓÔÓÙ·È ·fi 0,5 ¤ˆ˜ 2,5% ÌÂ Û˘¯ÓfiÙÂÚË ÙËÓ ·È-
ÌÔÚÚ·Á›· (οΈÛË Î¿Ùˆ ÎÔ›Ï˘ ÊϤ‚·˜ ‰ÂÍÈ¿ ‹
¿ÏÏˆÓ ·ÁÁ›ˆÓ) Î·È ‰Â‡ÙÂÚË ÙËÓ Î¿ÎˆÛË ·Ú·-
ÎÂÈÌ¤ÓˆÓ Û˘Ì·ÁÒÓ ÔÚÁ¿ÓˆÓ fiˆ˜ ÙÔ˘ ‹·ÙÔ˜,
ÙÔ˘ ÛÏËÓfi˜, ÙÔ˘ ·ÁÎÚ¤·ÙÔ˜ ‹ ÙÔ˘ ÓÂÊÚÔ‡. ¶ÈÔ
Û¿ÓȘ Â›Ó·È ÔÈ Î·ÎÒÛÂȘ ÎÔ›ÏÔ˘ ÛÏ¿Á¯ÓÔ˘ ‹
ÙÔ˘ ˘Â˙ˆÎfiÙ· Î·È Ë Ïԛ̈ÍË ÙÔ˘ ÙÚ·‡Ì·ÙÔ˜22-24.
∏ ·ÈÌÔ‰˘Ó·ÌÈ΋ ·ÛÙ¿ıÂÈ· ·ÔÙÂÏ› ȉȷ›ÙÂÚË
ÂÈÏÔ΋ Ù˘ ·ÓÙÈÌÂÙÒÈÛ˘ ÙÔ˘ Ê·ÈÔ¯ÚˆÌÔ΢Ù-
ÙÒÌ·ÙÔ˜ Î·È Â›Ó·È ·ÔÙ¤ÏÂÛÌ· Ù˘ ‰Ú¿Û˘ ÙˆÓ
ηÙ¯ÔÏ·ÌÈÓÒÓ Ô˘ ·ÂÏ¢ıÂÚÒÓÔÓÙ·È Û ÌÂÁ¿-
Ϙ ÔÛfiÙËÙ˜ ΢ڛˆ˜ ÛÙË ‰ÈÂÁ¯ÂÈÚËÙÈ΋ Ê¿ÛË
·fi ÙÔ˘˜ ¯ÂÈÚÔ˘ÚÁÈÎÔ‡˜ ¯ÂÈÚÈÛÌÔ‡˜. ∏ Û˘¯ÓfiÙËÙ¿
Ù˘, ÔÔÈÔ˘‰‹ÔÙ ‚·ıÌÔ‡ ‚·Ú‡ÙËÙ·˜, Î˘Ì·›ÓÂÙ·È
·fi 30 ¤ˆ˜ 50%18,32. ◊È· ‰ÈÂÁ¯ÂÈÚËÙÈ΋ ·ÈÌÔ‰˘-
Ó·ÌÈ΋ ‰È·Ù·Ú·¯‹, ‰ËÏ·‰‹ ‰È·ÊfiÚÔ˘ ‚·ıÌÔ‡
˘¤ÚÙ·ÛË, ·ÚÚ˘ıÌ›· Î·È Ù·¯˘Î·Ú‰›· ·ÚÔ˘Û›·-
Û·Ó fiÏÔÈ ÔÈ ·ÛıÂÓ›˜ Ì·˜ Ì ʷÈÔ¯ÚˆÌÔ·Ùو̷.
™ÙËÓ ¿ÌÂÛË ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ ÂÚ›Ô‰Ô 5 (15,62 %)
·ÛıÂÓ›˜ ·ÚÔ˘Û›·Û·Ó ÂÈÏÔΤ˜, 3 ·ÈÌÔÚÚ·Á›·,
¤Ó·˜ ÈÛ¯·ÈÌÈ΋ Ó¤ÎÚˆÛË Ù˘ ·ÚÈÛÙÂÚ¿˜ ÎÔÏÈ΋˜
ηÌ‹˜ Î·È Ì›· ·ÁÎÚ·ÙÈÎfi Û˘Ú›ÁÁÈÔ. ∂·Ó·¯ÂÈ-
ÚÔ˘ÚÁ‹ıËÎ·Ó ÔÈ 3 Ì ·ÈÌÔÚÚ·Á›· Ô˘ ÚÔ¤Ú¯Ô-
ÓÙ·Ó ·fi ÌÈÎÚ¿ ·ÁÁÂȷο ÛÙÂϤ¯Ë fiÈÛıÂÓ Ù˘
οو ÎÔ›Ï˘ ÊÏ‚fi˜ ‹ ÙˆÓ ˘ÏÒÓ ÙÔ˘ ÛÏËÓfi˜ ηÈ
·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó ÂÈÙ˘¯Ò˜ Î·È Ô ¤Ó·˜ Ì ÈÛ¯·È-
ÌÈ΋ Ó¤ÎÚˆÛË Ù˘ ·ÚÈÛÙÂÚ¿˜ ÎÔÏÈ΋˜ ηÌ‹˜ Ô˘
ÔÊ›ÏÔÓÙ·Ó ÛÙËÓ ÂÎÙÂٷ̤ÓË ÂÎÙÔÌ‹ ÏfiÁˆ ˘ÔÙÚÔ-
‹˜ ηÚΛÓÔ˘ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ÂÈÓÂÊÚȉ›Ô˘. ΔÔ ·-
ÁÎÚ·ÙÈÎfi Û˘Ú›ÁÁÈÔ ‹Ù·Ó Û˘Ó¤ÂÈ· ‰ÈÂÁ¯ÂÈÚËÙÈ΋˜
34 ∞. ∫∞ª¶∞ƒOÀ¢∏™, £. °∂ƒ∞™πªπ¢∏™
οΈÛ˘ Ù˘ Ô˘Ú¿˜ ÙÔ˘ ·ÁÎÚ¤·ÙÔ˜ Î·È ·ÓÙÈÌÂÙˆ-
›ÛÙËÎÂ Û˘ÓÙËÚËÙÈο.
∏ Ï··ÚÔÛÎÔÈ΋ - ÂÓ‰ÔÛÎÔÈ΋ ÚÔÛ¤ÁÁÈÛË
Û˘Óԉ‡ÂÙ·È ·fi ÙȘ ›‰È˜ ÂÈÏÔΤ˜ fiˆ˜ Î·È Ë
·ÓÔÈÎÙ‹ ÚÔÛ¤ÁÁÈÛË Î·È Û ÔÛÔÛÙfi 2 ¤ˆ˜ 15%
Î·È Ì ÙËÓ ›‰È· Û˘¯ÓfiÙËÙ· (·ÈÌÔÚÚ·Á›·, οΈÛË
·Ú·ÎÂÈÌ¤ÓˆÓ Û˘Ì·ÁÒÓ ÔÚÁ¿ÓˆÓ, οΈÛË ÎÔ›-
ÏÔ˘ ÛÏ¿Á¯ÓÔ˘ ‹ ˘Â˙ˆÎfiÙ·, Ïԛ̈ÍË ÙÚ·‡Ì·ÙÔ˜
Î·È ·ÈÌÔ‰˘Ó·ÌÈΤ˜ ‰È·Ù·Ú·¯¤˜ ÛÙÔ Ê·ÈÔ¯ÚˆÌÔ-
·Ùو̷). ∏ ·Ó¿ÁÎË ÌÂÙ·ÙÚÔ‹˜ ÂÍ·ÚÙ¿Ù·È ·fi
ÙËÓ ÂÌÂÈÚ›· Ù˘ ¯ÂÈÚÔ˘ÚÁÈ΋˜ ÔÌ¿‰Ô˜ Î·È ·fi Ù·
ÎÚÈÙ‹ÚÈ· ÂÈÏÔÁ‹˜ ÙˆÓ ·ÛıÂÓÒÓ Î·È Î˘Ì·›ÓÂÙ·È
·fi 0 ¤ˆ˜ 14%20,25-38.
¢ÈÂÁ¯ÂÈÚËÙÈο Û 2 ·ÛıÂÓ›˜ Ì·˜ Ì Ϸ·ÚÔ-
ÛÎÔÈ΋ ÚÔÛ¤ÁÁÈÛË ··ÈÙ‹ıËΠÌÂÙ·ÙÚÔ‹ Ù˘
ÌÂıfi‰Ô˘ Û ·ÓÔÈÎÙ‹ ÏfiÁˆ ‰˘Û¯¤ÚÂÈ·˜ ·Ú·Û΢‹˜
ÙÔ˘ fiÁÎÔ˘ Î·È ·ÈÌÔÚÚ·Á›·˜.
™Â ÌÈ· ÔÏ˘ÎÂÓÙÚÈ΋ ·Ó·ÛÎfiËÛË 2565 Ï·-
·ÚÔÛÎÔÈÎÒÓ ÂÈÓÂÊÚȉÂÎÙÔÌÒÓ 33 Ô ¯ÂÈÚÔ˘Ú-
ÁÈÎfi˜ ¯ÚfiÓÔ˜ Î˘Ì¿ÓıËΠ·fi 65 ¤ˆ˜ 240 min (137
min) Ë ·ÒÏÂÈ· ·›Ì·ÙÔ˜ ·fi 20 ¤ˆ˜ 106 ml (81
ml), Ë ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ ÓÔÛËÏ›· ·fi 1 ¤ˆ˜ 5,8
Ë̤Ú˜ (3.3 Ë̤Ú˜), ÔÈ ÂÈÏÔΤ˜ ·fi 2,9 ¤ˆ˜
15,5% (9%) Ë ıÓËÙfiÙËÙ· ·fi 0 ¤ˆ˜ 1,2% (0,2%)
Î·È Ë ·Ó¿ÁÎË ÌÂÙ·ÙÚÔ‹˜ Û ·ÓÔÈÎÙ‹ ·fi 0 ¤ˆ˜
13% (2%). ∏ ·ÈÌÔÚÚ·Á›· ‹Ù·Ó Ë Û˘¯ÓfiÙÂÚË ÂÈ-
ÏÔ΋ (40% ÙˆÓ ÂÈÏÔÎÒÓ), ·Ó Î·È ÌÂÙ¿ÁÁÈÛË
··ÈÙ‹ıËΠÌfiÓÔ ÛÙÔ 5%. OÈ Î˘ÚÈfiÙÂÚ˜ ·Èٛ˜
Ù˘ ‹Ù·Ó Ë Î¿ÎˆÛË Ù˘ οو ÎÔ›Ï˘ ÊϤ‚·˜ ‹ Ù˘
·ÚÈÛÙÂÚ‹˜ ÓÂÊÚÈ΋˜ ÊϤ‚·˜ Î·È ·ÎÔÏÔ˘ıÔ‡Û·Ó
Ì·ÎÚ¿Ó Î·ÎÒÛÂȘ ¿ÏÏˆÓ ·ÁÁ›ˆÓ. ∏ οΈÛË ÂÓ-
‰Ô- ‹ ÔÈÛıÔÂÚÈÙÔÓ·˚ÎÒÓ ÔÚÁ¿ÓˆÓ ·ÔÙÂÏÔ‡ÛÂ
ÙË ‰Â‡ÙÂÚË ÛÂ Û˘¯ÓfiÙËÙ· ÂÈÏÔ΋ (5% ÙˆÓ ÂÈ-
ÏÔÎÒÓ) Î·È ·ÊÔÚÔ‡Û ÙÔ ‹·Ú, ÙÔÓ ÛÏ‹Ó·, ÙÔ
¿ÁÎÚ·˜, ÙÔ ÎfiÏÔ, Ù· ÏÂÌÊ·ÁÁ›· ‹ ÙÔ ‰È¿ÊÚ·Á-
Ì·. ™Ô‚·Ú‹ ˘ÂÚÙ·ÛÈ΋ ÎÚ›ÛË ·Ú·ÙËÚ‹ıËΠÛÙÔ
1%. ∏ ·ÈÌÔÚÚ·Á›· Î·È Ë ‰È·‡ËÛË ‹ ÙÔ ·È̿و̷
ÙÔ˘ ÙÚ·‡Ì·ÙÔ˜, Ù· ıÚÔÌ‚ÔÂÌ‚ÔÏÈο ÂÂÈÛfi‰È·, ÔÈ
Á·ÛÙÚÂÓÙÂÚÈΤ˜ ‰È·Ù·Ú·¯¤˜, Ë Ó¢ÌÔÓÈ΋ Ïԛ̈-
ÍË, Ë Ïԛ̈ÍË Ù˘ Ô˘ÚÔÊfiÚÔ˘ Ô‰Ô‡ Î·È Ù· ηÚ-
‰È·ÁÁÂȷο ÚÔ‚Ï‹Ì·Ù· ·ÔÙÂÏÔ‡Û·Ó Û¿ÓÈ·
·ÓÂÈı‡ÌËÙ· Û˘Ì‚¿Ì·Ù·
OÈ ‰‡Ô Û˘¯ÓfiÙÂÚ˜ ·Èٛ˜ ÌÂÙ·ÙÚÔ‹˜ Ù˘ ÛÂ
¶›Ó·Î·˜ 4. ™˘ÁÎÚÈÙÈο ÛÙÔȯ›· ·ÓÔÈÎÙ‹˜ vs. Ï··ÚÔÛÎÔÈ΋˜ ÂÈÓÂÊÚȉÂÎÙÔÌ‹˜
÷ڷÎÙËÚÈÛÙÈο ∞ÓÔÈÎÙ‹ ÂÈÓÂÊÚȉÂÎÙÔÌ‹
ÃÂÈÚÔ˘ÚÁÈÎfi˜ ¯ÚfiÓÔ˜ 149 min
∞ÒÏÂÈ· ·›Ì·ÙÔ˜ 355 ml
ªÂÙÂÁ¯ÂÈÚËÙÈ΋ ÓÔÛËÏ›· 6,55 Ë̤Ú˜
∂ÈÏÔΤ˜ 24%
·ÓÔÈÎÙ‹ ÂÈÓÂÊÚȉÂÎÙÔÌ‹ ‹Ù·Ó Ë ÌË ÂÏÂÁ¯fiÌÂÓË
·ÈÌÔÚÚ·Á›· ·fi ÌÂÁ¿Ï· ·ÁÁ›· Î·È Ë Î·ÎÔ‹ıÂÈ·
Ì ÙÔÈΤ˜ ‹ ·ÁÁÂȷΤ˜ ‰ÈËı‹ÛÂȘ. ™·ÓÈfiÙÂÚ˜
·Èٛ˜ ·ÂÙ¤ÏÂÛ·Ó ÔÈ Û˘ÌʇÛÂȘ, Ë ·¯˘Û·ÚΛ·, Ë
οΈÛË ÔÚÁ¿ÓˆÓ, Ë ‰È·ÊÚ·ÁÌ·ÙÔ΋ÏË, ÙÔ ÌÂÁ¿ÏÔ
‹·Ú Î·È ÔÈ Ôχ ÌÂÁ¿ÏÔÈ Î·ÏÔ‹ıÂȘ fiÁÎÔÈ, ÂÓÒ
·Èٛ˜ ı·Ó¿ÙÔ˘ ‹Ù·Ó Ë Ì·˙È΋ ·ÈÌÔÚÚ·Á›·, Ë ÓÂ-
ÎÚˆÙÈ΋ ·ÁÎÚ·ٛÙȉ·, Ë Ó¢ÌÔÓÈ΋ ÂÌ‚ÔÏ‹, Ë
ÛËÙÈ΋ ηٿÛÙ·ÛË Î·È Ë Î·Ú‰ÈÔÓ¢ÌÔÓÈ΋ ·ÓÂ-
¿ÚÎÂÈ·.
O McKinlay Î·È Û˘Ó.39 Û ÌÂϤÙË ÙÔ˘˜ Û˘ÁÎÚ›-
ÓÔ˘Ó ÙËÓ ·ÓÔÈÎÙ‹ Ì ÙË Ï··ÚÔÛÎÔÈ΋ ÚÔÛ¤ÁÁÈÛË
Î·È ‚Ú›ÛÎÔ˘Ó fiˆ˜ Î·È ÔÏÏÔ› ¿ÏÏÔÈ Û˘ÁÁÚ·Ê›˜ fiÙÈ
Ë Ï··ÚÔÛÎÔÈ΋ ÂÈÓÂÊÚȉÂÎÙÔÌ‹ Â›Ó·È ÂÊ¿ÌÈÏÏË
Ù˘ ·ÓÔÈÎÙ‹˜ Î·È ·fiÏ˘Ù· ·ÛÊ·Ï‹˜ (¶›Ó. 4).
™˘˙ËÙ‹ÛÈÌÔ˜ Â›Ó·È Ë ÌÂÚÈ΋ ÂÈÓÂÊÚȉÂÎÙÔÌ‹
΢ڛˆ˜ ÛÙËÓ ÂÚ›ÙˆÛË ÙˆÓ ÔÈÎÔÁÂÓÒÓ Ê·ÈÔ¯Úˆ-
ÌÔ΢ÙÙˆÌ¿ÙˆÓ Î·È ÙˆÓ ·Ï‰ÔÛÙÂÚÔӈ̿وÓ.
∞ÚÎÂÙÔ› ·ÛıÂÓ›˜ ¤¯Ô˘Ó ÎÏËÚÔÓÔÌÈο Ê·ÈÔ¯Úˆ-
ÌÔ΢ÙÙÒÌ·Ù· Ô˘ Û˘Ó‰¤ÔÓÙ·È Ì ÙËÓ ª∂¡ 2,
VHL Î·È NF-1, Ì ·˘ÍË̤ÓË Èı·ÓfiÙËÙ· Û‡Á¯ÚÔ-
Ó˘ ‹ ÌÂÙ¿¯ÚÔÓ˘ ÔÏÏ·Ï‹˜ ‹ ·ÌÊÔÙÂÚfiÏ¢Ú˘
ÂÓÙfiÈÛ˘. ™ÙÔ MEN-2 Î·È ÙÔ VHL Ë Û˘¯ÓfiÙËÙ·
·ÌÊÔÙÂÚfiÏ¢Ú˘ ÓfiÛÔ˘ Â›Ó·È 50% Î·È 40-60%
·ÓÙ›ÛÙÔȯ·. ∂›Û˘ ÔÈ Brunt et al. ·Ó·Ê¤ÚÔ˘Ó
33% ÂÌÊ¿ÓÈÛË Ê·ÈÔ¯ÚˆÌÔ΢ÙÙˆÌ¿ÙˆÓ ÛÙËÓ ·ÓÙ›-
ıÂÙË ÏÂ˘Ú¿ ÛÙËÓ 5ÂÙ›·. ∏ ·ÌÊÔÙÂÚfiÏ¢ÚË ÂÈ-
ÓÂÊÚȉÂÎÙÔÌ‹ ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÂÊ’ fiÚÔ˘
˙ˆ‹˜ ˘ÔηٿÛÙ·ÛË Ì ÛÙÂÚÔÂȉÈΤ˜ ÔÚÌfiÓ˜ ηÈ
ÙÔÓ Î›Ó‰˘ÓÔ ·‰ÈÛÔÓÈ΋˜ ÎÚ›Û˘. ŒÙÛÈ, Ë ÌÂÚÈ΋ ‹
˘ÊÔÏÈ΋ ÂÈÓÂÊÚȉÂÎÙÔÌ‹ Ì ·Ê·›ÚÂÛË ÌfiÓÔ ÙÔ˘
ÙÌ‹Ì·ÙÔ˜ ÙÔ˘ ·‰¤Ó· Ô˘ ÂÚȤ¯ÂÈ ÙÔÓ fiÁÎÔ, ¤¯ÂÈ
ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·ÔÊ˘Á‹ Ù˘ ÂÊ’ fiÚÔ˘ ˙ˆ‹˜
˘ÔηٿÛÙ·Û˘ Ì ÔÚÌfiÓ˜, ÙËÓ ÂÏ¿ÙÙˆÛË ÙÔ˘
ÎÈÓ‰‡ÓÔ˘ ÌÈ·˜ ı·Ó·ÙËÊfiÚ·˜ ·‰ÈÛÔÓÈ΋˜ ÎÚ›Û˘
Î·È ÙË ‚ÂÏÙ›ˆÛË ¤ÙÛÈ Ù˘ ÔÈfiÙËÙ·˜ ˙ˆ‹˜ ÙˆÓ
·ÛıÂÓÒÓ. ∏ ÌÂÚÈ΋ ÂÈÓÂÊÚȉÂÎÙÔÌ‹ Â›Ó·È ÂÊÈÎÙ‹
Î·È Ï··ÚÔÛÎÔÈο Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·. ªÂÁ¿-
ÏË ‚Ô‹ıÂÈ· ÛÙËÓ Ù¯ÓÈ΋ ·˘Ù‹ ÚÔÛʤÚÂÈ ÙÔ ÂÓ-
‰ÔÛÎÔÈÎfi ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÁÈ· ÙËÓ ÂÓÙfiÈÛË
ÙÔ˘ fiÁÎÔ˘ Î·È ÙˆÓ ÔÚ›ˆÓ ÙÔ˘ ΢ڛˆ˜ Û ÌÈÎÚ¿ ·Ï-
‰ÔÛÙÂÚÔÓÒÌ·Ù· (1-2 cm), ÙÔ „·Ï›‰È ÙˆÓ ˘ÂÚ‹-
¯ˆÓ, Ë ‰ÈÔÏÈ΋ ‰È·ıÂÚÌ›·, ÔÈ ·ÁÎÙ‹Ú˜ ·ÈÌfiÛÙ·-
§··ÚÔÛÎÔÈ΋ ÂÈÓÂÊÚȉÂÎÙÔÌ‹
195 min
153 ml
2,57 Ë̤Ú˜
7%
 ∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 75, 1
Û˘ (endoclips) Î·È Ë ÎfiÏÏ· ÈÓÈ΋˜ ÁÈ· ÙËÓ ·Ó·›-
Ì·ÎÙË ‰È·ÙÔÌ‹ Î·È ·Ú·Û΢‹ ÙÔ˘ Ôχ ·ÁÁÂÈÔ-
‚ÚÈıÔ‡˜ ÂÈÓÂÊÚȉÈÎÔ‡ ÈÛÙÔ‡. ∏ ·ÈÌfiÛÙ·ÛË Ú¤-
ÂÈ Ó· Â›Ó·È È‰È·›ÙÂÚ· ηϋ ÁÈ·Ù› ÙÔ Ó¢-
ÌÔÂÚÈÙfiÓ·ÈÔ ·Ó·ÛÙ¤ÏÏÂÈ ÙËÓ ·ÈÌÔÚÚ·Á›· Ì ·Ô-
Ù¤ÏÂÛÌ· ÙËÓ ·˘ÍË̤ÓË Èı·ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ‹˜ Ù˘
¿ÌÂÛ· ÌÂÙÂÁ¯ÂÈÚËÙÈο. ÀÔ¯ÚˆÙÈο Ú¤ÂÈ Ó·
‰È·ÙËÚËı› Ë ·ÈÌ¿ÙˆÛË ÙÔ˘ ÂÓ·ÔÌ›ӷÓÙÔ˜ ˘-
ÁÈÔ‡˜ ÈÛÙÔ‡, ¿Ú· Â›Ó·È ··Ú·›ÙËÙË Ë ·ÎÂÚ·ÈfiÙËÙ·
Ù˘ ÂÈÓÂÊÚȉÈ΋˜ ·ÚÙËÚ›·˜ Î·È Ù˘ ÊϤ‚·˜ ÂÎÙfi˜
Î·È ·Ó Ô fiÁÎÔ˜ ÂÓÙÔ›˙ÂÙ·È ÏËÛ›ÔÓ ÙˆÓ ÎÂÓÙÚÈ-
ÎÒÓ ·ÁÁ›ˆÓ Î·È Ô ˘ÁÈ‹˜ ÈÛÙfi˜ ÚÔ˜ Ù· ¤Íˆ ‹ ÎÂ-
Ê·ÏÈο Ù˘ ‚Ï¿‚˘3,17,32,33,40. ™Â Ì›· ·ÛıÂÓ‹ Ì·˜
Ì ·Ï‰ÔÛÙÂÚfiӈ̷ Ì Ϸ·ÚÔÛÎÔÈ΋ ÚÔÛ¤ÁÁÈ-
ÛË ¤ÁÈÓ ÌÂÚÈ΋ ÂÈÓÂÊÚȉÂÎÙÔÌ‹ Ì ‰È·Ù‹ÚËÛË
ÙÔ˘ ÎÂÊ·ÏÈÎÔ‡ ÙÌ‹Ì·ÙÔ˜ ÙÔ˘ ·‰¤Ó·.
°ÂÓÈο, Ë Ï··ÚÔÛÎÔÈ΋ ÚÔÛ¤ÁÁÈÛË Û˘-
ÁÎÚÈÓfiÌÂÓË Ì ÙËÓ ·ÓÔÈÎÙ‹ ¤¯ÂÈ ÌÈÎÚfiÙÂÚÔ ¯ÂÈ-
ÚÔ˘ÚÁÈÎfi ÙÚ·‡Ì·, ÌÂȈ̤ÓË ·ÒÏÂÈ· ·›Ì·ÙÔ˜, ÌÂÈ-
ˆÌ¤ÓË ÓÔÛËÚfiÙËÙ·, ÏÈÁfiÙÂÚË ¯ÔÚ‹ÁËÛË ·Ó·ÏÁË-
Û›·˜, ÌÈÎÚfiÙÂÚÔ ¯ÚfiÓÔ ÓÔÛËÏ›·˜ Î·È Î·Ï‡ÙÂÚÔ ·È-
ÛıËÙÈÎfi ·ÔÙ¤ÏÂÛÌ·, ÂÓÒ Û˘Óԉ‡ÂÙ·È ·fi ÌÂÁ·-
χÙÂÚË ‰È¿ÚÎÂÈ· ÂÁ¯Â›ÚËÛ˘ Î·È Û¯ÂÙÈο ÌÂÁ·Ï‡-
ÙÂÚÔ ¯ÂÈÚÔ˘ÚÁÈÎfi ÎfiÛÙÔ˜, ·Ó Î·È ÙÔ Û˘ÓÔÏÈÎfi Îfi-
ÛÙÔ˜ Â›Ó·È Î·Ù¿ ÙÈ ÌÈÎÚfiÙÂÚÔ, ¤¯ÂÈ Û¯ÂÙÈ΋ ·ÓÙ¤Ó-
‰ÂÈÍË ÛÙȘ ηÎÔ‹ıÂȘ Î·È ··ÈÙ› ÌÂÁ·Ï‡ÙÂÚË Î·-
Ì‡ÏË ÂÎÌ¿ıËÛ˘.
ΔÔ 2000 Ô Gill Î·È ÔÈ Û˘Ó.16 ‰ËÌÔÛÈÂ‡Ô˘Ó ÙËÓ
ÚÔÌÔÙÈο ˘Ô‚ÔËıÔ‡ÌÂÓË Ï··ÚÔÛÎÔÈ΋ ÂÈÓÂ-
ÊÚȉÂÎÙÔÌ‹ Û ˙Ò· (Zeus vs. Da Vinci) Î·È ÙÔ 2001
ÙËÓ ÚÔÌÔÙÈο ˘Ô‚ÔËıÔ‡ÌÂÓË Ï··ÚÔÛÎÔÈ΋ Â-
ÈÓÂÊÚȉÂÎÙÔÌ‹ Û ¿ÓıÚˆÔ, ÂÓÒ ÙÔ 2002 ÔÈ Desai
Î·È Û˘Ó.41 Ú·ÁÌ·ÙÔÔ›ËÛ·Ó 2 ÂÈÙ˘¯Â›˜ ÚÔÌÔÙÈ-
ο ˘Ô‚ÔËıÔ‡ÌÂÓ˜ ÂÈÓÂÊÚȉÂÎÙÔ̤˜ Û ¤Ó· ·-
ÛıÂÓ‹ Ì ÏÂÈÔÌ˘ÔÛ¿ÚΈ̷ Î·È Û ¤Ó· Ì ʷÈÔ¯Úˆ-
ÌÔ·Ùو̷. Δ¤ÏÔ˜, ÙÔ 2004 Ô Marescaux Î·È ÔÈ
Û˘Ó.42 ÂÈÙ˘Á¯¿ÓÔ˘Ó Ó· ÂÎÙÂϤÛÔ˘Ó ÙËÏ - ÂÈÓÂ-
ÊÚȉÂÎÙÔÌ‹.
™˘ÌÂÚ·ÛÌ·ÙÈο, Ë ·ÓÔÈÎÙ‹ ÚÔÛ¤ÁÁÈÛË
¤¯ÂÈ ¿ÓÙ· ÙË ı¤ÛË Ù˘ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ
·ı‹ÛÂˆÓ ÙˆÓ ÂÈÓÂÊÚȉ›ˆÓ. º·›ÓÂÙ·È fï˜ fiÙÈ
ηٿ ÙÔÓ ·ÚfiÓÙ· ¯ÚfiÓÔ Ë Ï··ÚÔÛÎÔÈ΋ ÂÈ-
ÓÂÊÚȉÂÎÙÔÌ‹ ·ÔÙÂÏ› ÙË ¯ÂÈÚÔ˘ÚÁÈ΋ Ù¯ÓÈ΋
ÂÎÏÔÁ‹˜. ∏ ÚÔÌÔÙÈο ˘Ô‚ÔËıÔ‡ÌÂÓË Ï··ÚÔ-
ÛÎÔÈ΋ ÂÈÓÂÊÚȉÂÎÙÔÌ‹ ¯ÚÂÈ¿˙ÂÙ·È Ôχ ‰Úfi-
ÌÔ ·ÎfiÌË ÚÔÎÂÈ̤ÓÔ˘ Ó· ·ԉ›ÍÂÈ ÙË ¯ÚËÛÈÌfi-
ÙËÙ¿ Ù˘ Î·È Ù· ÂӉ¯fiÌÂÓ· ÏÂÔÓÂÎÙ‹Ì·Ù¿ Ù˘
Î·È ›Ûˆ˜ Ó· Â›Ó·È Ë ¯ÂÈÚÔ˘ÚÁÈ΋ ÚÔÛ¤ÁÁÈÛË ÙÔ˘
̤ÏÏÔÓÙÔ˜.
35
SUMMARY
Kambaroudis ∞, Gerasimidis T. The evolving sur-
gical treatment of adrenal gland diseases. ∏ell
Iatr 2009, 75: 26-37.
Benign or malignant tumours within the
adrenal glands and adrenal gland hyperplasia can
cause several hypersecretion syndromes, depen-
ding on the region affected. These include over-
secretion of aldosterone (Conn’s syndrome), cor-
tisol (Cushing syndrome) or androgens (androge-
nital syndrome) and of adrenaline or noradrenaline
(pheochromocytoma). Moreover, some patients are
without symptoms (incidentaloma) or with no ty-
pical symptoms (non-functional lesions). It is
difficult to distinguish between benign and malig-
nant adrenocortical tumours pre-op. A number of
imaging criteria can be applied, including size (be-
nign tumours are generally smaller than malignant
tumours), grade of homogeneousity (benign tu-
mours tend to be homogeneous in cross-section,
compared with heterogeneous malignant tumours)
and the presence of distant metastases. Open
adrenalectomy remains a safe and effective surgical
technique, especially for complicated and recurrent
adrenal tumours. Laparoscopic adrenalectomy has
become the preferred method for removal of benign
functioning and non-functioning tumours of the
adrenal gland that are <12 cm. The role of lapa-
roscopic adrenalectomy in the management of ma-
lignant adrenal tumours is controversial and most a-
drenocortical cancers are treated by open adrena-
lectomy. Laparoscopic adrenalectomy can be per-
formed by both the anterior or lateral trans-abdo-
minal approach, as well as the lateral or posterior
retro-peritoneal approach, with each method being
suitable for specific indications. Laparoscopic a-
drenalectomy is a safe and minimally invasive sur-
gical technique and is associated with shorter ho-
spital stay, reduced pain, minimal complication rate
and improved cosmetic result. Open or laparo-
scopic partial adrenalectomy can be used in patients
with primary hyperaldosteronism or hereditary
pheochromocytoma and aims to balance tumor re-
moval with preservation of adrenocortical function.
Robotic-assisted laparoscopic adrenalectomy is
technically feasible and with increasing experience
and evolving technology it is likely to expand in
scope and application.
36 ∞. ∫∞ª¶∞ƒOÀ¢∏™, £. °∂ƒ∞™πªπ¢∏™
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∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 2009, 75, 1: 38 - 46
“BÈÔ-ÔÈÎÔÏÔÁÈ΋” ·ÓÙÈÌÂÙÒÈÛË Ù˘ ¯ÚfiÓÈ·˜
Ë·ÙÈ΋˜ ‚Ï¿‚˘ Î·È ÂÁÎÂÊ·ÏÔ¿ıÂÈ·˜
Stig Bengmark
MD, PhD, FRACS (hon), FRCPS (hon), Member Academia Europeae,
Emeritus Professor Lund University, Lund, Sweden,
Honorary Visiting Professor to University College London (UCL), London University,
Affiliation to Departments of Hepatology and Surgery
¶ÂÚ›ÏË„Ë. Δ· ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù· Â›Ó·È Û˘Ó‰Â‰Â̤ӷ
Ì ÂΉËÏÒÛÂȘ ¯ÚfiÓÈ·˜ ÊÏÂÁÌÔÓÒ‰Ô˘˜ ·ÓÙ›‰Ú·Û˘,
Ë ÔÔ›· ·˘Í¿ÓÂÈ ÙȘ Èı·ÓfiÙËÙ˜ ÂÌÊ¿ÓÈÛ˘, ÙfiÛÔ
Î·È ÂÓfi˜ ¿ÏÏÔ˘ ¯ÚfiÓÈÔ˘ ÓÔÛ‹Ì·ÙÔ˜, fiÛÔ Î·È ÛÔ‚·-
ÚÒÓ ÂÈÏÔÎÒÓ, fiˆ˜ ÏÔÈÌÒÍÂȘ, ÔÛÙÂÔfiÚˆÛË
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Œ¯Ô˘Ó ‹‰Ë ÂÚ¿ÛÂÈ 50 ¯ÚfiÓÈ· ·fi ÙfiÙ Ô˘ —ÌÂ
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™Ô˘Ë‰›·, ÙÔÓ Rolf Olsson— ¿Ú¯ÈÛ ¤Ó· ÂÚ¢ÓËÙÈ-
Îfi ÚfiÁÚ·ÌÌ· ÁÈ· ÙÔ˘˜ ÙÚfiÔ˘˜ Ì›ˆÛ˘ ‹/ηÈ
ÚfiÏ˄˘ Ù˘ ÔÍ›·˜ ·ÏÏ¿ Î·È Ù˘ ¯ÚfiÓÈ·˜ ‚Ï¿‚˘
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΢ڛˆ˜ Û Â›Ì˘Â˜, ‰È¿ÊÔÚ· ÌÔÓ٤Ϸ Ë·ÙÈ΋˜
‚Ï¿‚˘ fiˆ˜ ÌÂÙ¿ Ë·ÙÂÎÙÔÌ‹, ÏfiÁˆ ·fiÊڷ͢
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ÚˆÛ˘ Û¯ÂÙÈ˙fiÌÂÓ˘ Ì ÙË ‰È·ÙÚÔÊ‹, ·ÏÏ¿ Â›Û˘
Î·È Û ·ÓıÚÒÔ˘˜ ÌÂÙ¿ Ë·ÙÂÎÙÔÌ‹1-11.
∂ΛÓË ÙËÓ ÂÔ¯‹ ÔÈ ÁÓÒÛÂȘ Ì·˜ ÁÈ· ÙÔ ·ÓÔ-
ÛÈ·Îfi Û‡ÛÙËÌ· ‹Ù·Ó Ôχ ÂÚÈÔÚÈṲ̂Ó˜, fiˆ˜ ηÈ
Ë ¤ÓÓÔÈ· Ù˘ ·fiÙˆÛ˘, ·ÏÏ¿ ·fi ¤ÓÛÙÈÎÙÔ, ›Ûˆ˜,
·ÈÛı·ÓfiÌ·ÛÙ·Ó fiÙÈ Î¿ÔȘ ‚Ï¿‚˜ ÌÔÚÔ‡Ó Ó·
ÌÂȈıÔ‡Ó ‹ Î·È Ó· È·ıÔ‡Ó Ì ÙËÓ Î·Ù¿ÏÏËÏË «ÚÔ-
ÛÙ·Û›·». ¶·Ú·ÙËÚÔ‡Û·Ì .¯. fiÙÈ ÛÙ· ı‹Ï· ÂÈ-
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Ù·È Ë ÂÌÂÈÚ›· Ô˘ ·ÔÎÙ‹ıËÎÂ ·fi ÙËÓ ÂÊ·ÚÌÔÁ‹
ÙÔ˘˜ Î·È È‰È·›ÙÂÚ· ·fi ÙË ¯Ú‹ÛË ÙÔ˘ Synbiotic 2000
– ÂÓfi˜ Û΢¿ÛÌ·ÙÔ˜ Ì 4 ›‰Ë Á·Ï·ÎÙÔ‚·Î›ÏˆÓ Î·È 4
›‰Ë Ú‚ÈÔÙÈÎÒÓ ÈÓÒÓ – Ô˘ Ê·›ÓÂÙ·È fiÙÈ ÌÂÈÒÓÂÈ
ÛËÌ·ÓÙÈο ÙË Û˘¯ÓfiÙËÙ· Ù˘ ÂÁÎÂÊ·ÏÔ¿ıÂÈ·˜, ·Ï-
Ï¿ ΢ڛˆ˜ ‚ÂÏÙÈÒÓÂÈ ÙÔ ÎÏÈÓÈÎfi ÛÙ¿‰ÈÔ Ù˘ ÓfiÛÔ˘ ÛÂ
ÔÛÔÛÙfi ¿Óˆ ÙÔ˘ 50% ÙˆÓ ·ÛıÂÓÒÓ.
EÏÏËÓ I·ÙÚ 2009, 75: 38 - 46.
Ú·Ì·Ùfi˙ˆ· ÂΉËÏÒÓÔÓÙ·Ó ÛÔ‚·ÚfiÙÂÚ˜ ÙÔÍÈΤ˜
‚Ï¿‚˜ Û ۯ¤ÛË Ì ٷ ¿ÚÚÂÓ· Î·È ·˘Ùfi Ì·˜ Ô‰‹-
ÁËÛ ӷ ‰ÔÎÈÌ¿ÛÔ˘Ì ÙËÓ ÙÂÛÙÔÛÙÂÚfiÓË ÁÈ· ÙË Ì›-
ˆÛË Ù˘ Ë·ÙÈ΋˜ ‚Ï¿‚˘ ·fi ÙÔÍÈÎÔ‡˜ ·Ú¿ÁÔ-
ÓÙ˜, ÌÂÙ¿ ·fi ¯ÂÈÚÔ˘ÚÁÈÎfi ÙÚ·‡Ì·, fiˆ˜ Î·È ÛÙËÓ
ΛÚÚˆÛË ÏfiÁˆ ‰È·ÙÚÔÊ‹˜2,5,8,10,12. ∏ Û¯¤ÛË ÌÂٷ͇
‚ÈÙ·Ì›Ó˘ μ12 Î·È Û‡ÓıÂÛ˘ ÓÔ˘ÎÏÂ˚ÓÈÎÒÓ ÔͤˆÓ
Ì·˜ ÒıËÛ ÛÙË ¯Ú‹ÛË Ù˘ ‚ÈÙ·Ì›Ó˘ ·˘Ù‹˜ ˆ˜ Û˘-
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mer disease] ‹ ·ÚÎÂÙ¤˜ ‚‰ÔÌ¿‰Â˜ [ηٿıÏÈ„Ë]
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• æ˘¯ÔÏÔÁÈÎfi Î·È Ê˘ÛÈÎfi ÛÙÚ˜. OÈ ‰Â›ÎÙ˜
ÊÏÂÁÌÔÓ‹˜ Ê·›ÓÂÙ·È fiÙÈ ·˘Í¿ÓÔ˘Ó ÛËÌ·ÓÙÈο ÌÂÙ¿
›Ù „˘¯ÔÏÔÁÈ΋ ›ÙÂ Ê˘ÛÈ΋ ηٷfiÓËÛË Î·È Ì¿-
ÏÈÛÙ· Ù· Â›‰· ·ÓÙ›‰Ú·Û˘ Â›Ó·È ÁÂÓÈο ˘„ËÏfi-
ÙÂÚ· Û ·ÛıÂÓ›˜ Ô˘ ¿Û¯Ô˘Ó ‹‰Ë ·fi ¯ÚfiÓȘ
ÓfiÛÔ˘˜, fiˆ˜ ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ. À¿Ú¯ÂÈ Â›Û˘
ÌÈ· ÈÛ¯˘Ú‹ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÙˆÓ ‰ÂÈÎÙÒÓ ÙÔ˘
ÛÙÚ˜, Ù˘ ·‡ÍËÛ˘ Ù˘ CRP Î·È IL-6 Î·È Ù˘ ·˘-
39
ÍË̤Ó˘ ·fiÎÚÈÛ˘ Ù˘ ÓÔÚÂÈÓÂÊÚ›Ó˘ Û οıÂ
Ó¢ÚÈÎfi ÛÙÚ˜21.
• ∫¿ÓÈÛÌ· Î·È ˘ÂÚ‚ÔÏÈ΋ ¯Ú‹ÛË ·ÏÎÔfiÏ. OÈ
ÚÒËÓ Î·ÓÈÛÙ¤˜ Û ۇÁÎÚÈÛË Ì ·˘ÙÔ‡˜ Ô˘ ÔÙ¤
‰ÂÓ Î¿ÓÈÛ·Ó ¤¯Ô˘Ó ÛËÌ·ÓÙÈο ·˘ÍË̤ӷ Â›‰·
CRP Î·È ·˘ÙÔ› Ô˘ ηÓ›˙Ô˘Ó ÛËÌ·ÓÙÈο ·˘ÍË̤-
ÓÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÊÏÂÁÌÔÓ‹˜, Â˘Ú‹Ì·Ù· Ô˘ ˘Ô-
ÛÙËÚ›˙Ô˘Ó ÙË Û¯¤ÛË Î·Ó›ÛÌ·ÙÔ˜ Î·È ÊÏÂÁÌÔÓ‹˜.
ŸÌÔÈ· ‰È·ÈÛÙÒıËΠ̛ˆÛË Ù˘ ¤ÎÊÚ·Û˘ Ù˘
HLA-DR, ·‡ÍËÛË Ù˘ ‰Ú·ÛÙÈÎfiÙËÙ·˜ ÙÔ˘ CD123
Î·È ·˘ÍË̤ÓË ¤ÎÎÚÈÛË IL-1‚, IL-6, IL-12 Î·È TNF-
· ·fi Ù· ‰ÂÓ‰ÚÈÙÈο ·ÙÙ·Ú· ÛÙÔ˘˜ ¯ÚfiÓÈÔ˘˜ ·Ï-
ÎÔÔÏÈÎÔ‡˜, ·ÎfiÌË ÎÈ ·Ó ‰ÂÓ ˘¿Ú¯ÂÈ ÂÌÊ·Ó‹˜ Ë·-
ÙÈ΋ ÓfiÛÔ˜22.
• ∞˘ÍË̤ÓË ÚfiÛÏË„Ë ÙÚÔÊÒÓ Ô˘ ÂÚȤ¯Ô˘Ó
ÊÏÂÁÌÔÓÒ‰ÂȘ ·Ú¿ÁÔÓÙ˜. ∏ ÚfiÛÏË„Ë ÙÚÔÊ‹˜ ÌÂ
˘„ËÏ¿ Â›‰· ÁÏ˘ÎÔ˙˘ÏÈˆÌ¤ÓˆÓ ‹ ÏÈÔ-ÔÍÂȉˆ-
Ì¤ÓˆÓ ÚˆÙÂ˚ÓÒÓ [∞GE’s Î·È ALE’s] Î·È ÂÙÈ-
‰›ˆÓ Û¯ÂÙ›˙ÂÙ·È Ì ˘„ËÏ¿ Â›‰· Û˘ÛÙËÌ·ÙÈ΋˜
ÊÏÂÁÌÔÓ‹˜, ¯ÚfiÓȘ ÓfiÛÔ˘˜ Î·È ÚÒÈÌË Á‹Ú·ÓÛË.
Δ¤ÙÔÈ· ÌfiÚÈ· Êı¿ÓÔ˘Ó ÛÙÔÓ ÔÚÁ·ÓÈÛÌfi Ì ÙÔ Î¿-
ÓÈÛÌ· Î·È Û ·ÎfiÌË ÌÂÁ·Ï‡ÙÂÚÔ ‚·ıÌfi Ì ÙËÓ
ÚfiÛÏË„Ë ÙÚÔÊÒÓ ÏÔ‡ÛÈˆÓ Û ÌfiÚÈ· ÊÏÂÁÌÔÓ‹˜.
∏ ı¤ÚÌ·ÓÛË, Ë ·ÎÙÈÓÔ‚fiÏËÛË Î·È Ô ÈÔÓÈÛÌfi˜ ÙˆÓ
ÙÚÔÊÒÓ Â›Ó·È ÁÓˆÛÙÔ› Û˘ÓÙÂÏÂÛÙ¤˜ ¤ÎÏ˘Û˘ ÌÔ-
Ú›ˆÓ ÊÏÂÁÌÔÓ‹˜, Ë ·Ú·ÁˆÁ‹ ÙˆÓ ÔÔ›ˆÓ ·˘Í¿ÓÂ-
Ù·È ı·̷ÙÈο fiÙ·Ó Ë ıÂÚÌÔÎÚ·Û›· ·Ú·Û΢‹˜
ÙˆÓ ÙÚÔÊÒÓ ÍÂÂÚ¿ÛÂÈ ÙÔ˘˜ 80Ô C ‹ fiÙ·Ó ·˘Ù¿ Û˘-
ÓÙËÚÔ‡ÓÙ·È ÁÈ· Ì·ÎÚ¿ ¯ÚÔÓÈ΋ ÂÚ›Ô‰Ô Û ıÂÚÌÔ-
Îڷۛ˜ ‰ˆÌ·Ù›Ô˘16. ÷ڷÎÙËÚÈÛÙÈÎfi ·Ú¿‰ÂÈÁÌ·
Ë ÛÎfiÓË Á¿Ï·ÎÙÔ˜, ¤Ó· ÎÔÈÓfi Û˘ÛÙ·ÙÈÎfi ÔÏÏÒÓ
ÙÚÔÊÒÓ fiˆ˜ ·ÁˆÙ¿, ÁÏ˘Î¿ ·ÏÏ¿ Î·È ‰È·Ï‡Ì·Ù·
ÎÏÈÓÈ΋˜ ‰È·ÙÚÔÊ‹˜ Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ Î·È
ÙˆÓ ·È‰ÈÎÒÓ ÙÚÔÊÒÓ23. OÈ ˘ԉԯ›˜ [RAGE]
ÙˆÓ ÙÂÏÈÎÒÓ ÚÔ˚fiÓÙˆÓ ÁÏ˘ÎÔ˙˘Ï›ˆÛ˘ [advanced
glycation end-products – AGEs] Â›Ó·È ¤Ó· ̤ÏÔ˜
Ù˘ ˘ÂÚ-ÔÈÎÔÁ¤ÓÂÈ·˜ ÙˆÓ ·ÓÔÛÔÛÊ·ÈÚÈÓÒÓ Ù˘
΢ÙÙ·ÚÈ΋˜ ÂÈÊ¿ÓÂÈ·˜ Î·È ÏÂÈÙÔ˘ÚÁÔ‡Ó ˆ˜ Ô ÎÂ-
ÓÙÚÈÎfi˜ ‰È·ÎfiÙ˘ ÁÈ· ÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÙÔ˘ NF-
ÎB, Ô ÔÔ›Ô˜ ÛÙË Û˘Ó¤¯ÂÈ· ÂÓÂÚÁÔÔÈ› ÂÚÈÛÛfiÙÂ-
Ú· ·fi 400 ¤Ó˙˘Ì·, ηٷÛÙ¤ÏÏÂÈ ÂÓ‰ÔÁÂÓ›˜ ·˘ÙÔ-
Ú˘ıÌÈÛÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜ Î·È ÌÂÙ·ÙÚ¤ÂÈ ÙË ¯ÚfiÓÈ·
΢ÙÙ·ÚÈ΋ ‰Ú·ÛÙËÚÈÔÔ›ËÛË, Û ·Ú·ÙÂٷ̤ÓË
΢ÙÙ·ÚÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Î·È ÓfiÛÔ, Û˘ÌÂÚÈÏ·Ì-
‚·ÓÔÌ¤ÓˆÓ ÙˆÓ ·ÏÏÂÚÁÈÒÓ, Ù˘ ÓfiÛÔ˘ Alzheimer,
Ù˘ ΛÚÚˆÛ˘ ÙÔ˘ ‹·ÙÔ˜ Î·È Ù˘ ÓfiÛÔ˘ Parkinson.
ÕÏÏ· ÌfiÚÈ· Ô˘ ÚÔ¤Ú¯ÔÓÙ·È ·fi Ù· ÙÚfiÊÈÌ· ηÈ
ÚÔηÏÔ‡Ó ÊÏÂÁÌÔÓ‹ Â›Ó·È Ë ÁÏÔ˘Ù¤ÓË [ÛÙÔ ÛÈÙ¿ÚÈ,
ÙË Û›Î·ÏË Î·È ÙÔ ÎÚÈı¿ÚÈ] Î·È ·ÛÊ·ÏÒ˜ ÔÈ ÔÚÌfiÓ˜
fiˆ˜ Ù· ÔÈÛÙÚÔÁfiÓ· Î·È Î˘Ú›ˆ˜ Ë 17‚ ÔÈÛÙÚ·‰ÈfiÏË
Î·È Ë IGF-1 [΢ڛˆ˜ ·fi ÙÔ ·ÁÂÏ·‰ÈÓfi Á¿Ï·], ÁÓˆ-
40 S. BENGMARK
ÛÙ¤˜ ÁÈ· ÙȘ ÊÏÂÁÌÔÓÒ‰ÂȘ Î·È Î·ÚÎÈÓÔÁfiÓ˜ ȉÈfi-
ÙËÙ¤˜ ÙÔ˘˜24-28. OÈ ÔÚÌfiÓ˜ ·˘Ù¤˜ ÂηÙÔÓÙ·Ï·ÛÈ¿-
˙ÔÓÙ·È Î·Ù¿ ÙËÓ Î‡ËÛË Î·È ÙÔ ÛËÌÂÚÈÓfi ‚ÈÔÌ˯·-
ÓÔÔÈË̤ÓÔ Á¿Ï· ÚÔ¤Ú¯ÂÙ·È Î·Ù¿ 80% ÂÚ›Ô˘
·fi ÂÁ·Ԣ˜ ·ÁÂÏ¿‰Â˜. μϤÔÓÙ·˜ ÙÔ ·fi ·˘Ù‹Ó
ÙËÓ ÚÔÔÙÈ΋, Â›Ó·È ÂÍ·ÈÚÂÙÈο ÂӉȷʤÚÔÓ ÙÔ ÁÂ-
ÁÔÓfi˜ fiÙÈ ÔÈ ÂÚÈÛÛfiÙÂÚ˜ ¯ÚfiÓȘ ÓfiÛÔÈ ¤¯Ô˘Ó ·˘-
ÍËı› ÛÙËÓ π·ˆÓ›· ηٿ Ù· ÙÂÏÂ˘Ù·›· 50 ¯ÚfiÓÈ·:
.¯. Ô Î·ÚΛÓÔ˜ ÙÔ˘ ÚÔÛÙ¿ÙË ·˘Í‹ıËΠηٿ 25
ÊÔÚ¤˜, ·Ó·ÏÔÁÈο Ì ÙËÓ ·‡ÍËÛË Ù˘ ηٷӿψÛ˘
ÙÔ˘ ÎÚ¤·ÙÔ˜ ηٿ 9 ÊÔÚ¤˜ Î·È ÙˆÓ Á·Ï·ÎÙÔÎÔÌÈ-
ÎÒÓ Î·Ù¿ 20 ÊÔÚ¤˜. ∂Í¿ÏÏÔ˘, Ë ˘„ËÏ‹ ηٷӿψ-
ÛË Á·Ï·ÎÙÔÎÔÌÈÎÒÓ Û¯ÂÙ›˙ÂÙ·È Î·È Ì ÙȘ Ó¢ÚÔÂÎ-
Ê˘ÏÈÛÙÈΤ˜ ·ı‹ÛÂȘ, Î·È ÂȉÈο Ì ÙË ÓfiÛÔ ÙÔ˘
Parkinson29.
• ÷ÌËÏ‹ ÚfiÛÏË„Ë ÙÚÔÊÒÓ Ì ·ÓÙÈÊÏÂÁÌÔ-
ÓÒ‰Ë ‰Ú¿ÛË. Δ· Ê˘Ù¿ ÁÂÓÈÎÒ˜ Î·È È‰È·›ÙÂÚ· Ù· Ï·-
¯·ÓÈο, fiˆ˜ Î·È Î¿ÔÈÔÈ Á·Ï·ÎÙÔ‚¿ÎÈÏÏÔÈ ÔÏÔ¤-
Ó· Î·È ÂÚÈÛÛfiÙÂÚÔ ·Ó·ÁÓˆÚ›˙ÔÓÙ·È ÁÈ· ÙËÓ ÈÛ¯˘-
Ú‹ ·ÓÙÈÊÏÂÁÌÔÓÒ‰Ë ‰Ú¿ÛË ÙÔ˘˜, Ë ÔÔ›· ı· ·Ó·-
Ï˘ı› ηو٤ڈ.
¶∂¶Δπ∫O™ ™ø§∏¡∞™ – √ μ∏ª∞Δ√¢√Δ∏™ Δ√À
∞ÀΔ√¡√ª√À ∞¡√™π∞∫√À ™À™Δ∏ª∞Δ√™
°È· ¿Ú· ÔÏÏ¿ ¯ÚfiÓÈ· ıˆÚÔ‡ÓÙ·Ó fiÙÈ ÙÔ ·ÓÔ-
ÛÈ·Îfi Û‡ÛÙËÌ· ›¯Â ÙËÓ ¤‰Ú· ÙÔ˘ ÛÙÔ Ì˘ÂÏfi ÙˆÓ
ÔÛÙÒÓ, ÙÔ ÛÏ‹Ó· Î·È ÙÔ˘˜ ÏÂÌÊ·‰¤Ó˜, Ù· ÙÂÏ¢-
Ù·›· fï˜ 20 ¯ÚfiÓÈ· ¤ÁÈÓ ÛÙ·‰È·Î¿ ·Ô‰ÂÎÙfi fiÙÈ
Ë Î‡ÚÈ· ı¤ÛË Â›Ó·È ÙÔ ¤ÓÙÂÚÔ, Û ÔÛÔÛÙfi 70% ˆ˜
80%30. ∏ Û‡ÛÙ·ÛË Ù˘ ÂÓÙÂÚÈ΋˜ Ì·˜ ¯ÏˆÚ›‰·˜ ηÈ
Ë ÙÚÔÊ‹ Ô˘ ηٷӷÏÒÓÔ˘Ì ¤¯Ô˘Ó ¤Î‰ËÏÔ ·ÔÙ¤-
ÏÂÛÌ· ÛÙË ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ· ÙÔ˘ ·ÓÔÛÈ·ÎÔ‡ Ì·˜ Û˘-
ÛÙ‹Ì·ÙÔ˜, ÛÙË Á‹Ú·ÓÛË Î·È ÛÙËÓ ·Ó¿Ù˘ÍË ÓfiÛÔ˘,
·ÊÔ‡ Ë ·ÏÏËÏÔÂ›‰Ú·ÛË Ù˘ ÂÓÙÂÚÈ΋˜ ¯ÏˆÚ›‰·˜
Î·È ÙˆÓ ·ÓÔÛÔ-΢ÙÙ¿ÚˆÓ ÛÙÔ ÙÔ›¯ˆÌ· ÙÔ˘ ÂÓÙ¤ÚÔ˘
Â›Ó·È ˘„›ÛÙ˘ ÛËÌ·Û›·˜ ÁÈ· ÙËÓ ·ÓÔÛȷ΋ ·fiÎÚÈ-
ÛË. Àfi ȉ·ÓÈΤ˜ Û˘Óı‹Î˜ ÙÔ ¤ÓÙÂÚÔ ¤¯ÂÈ Ì¤¯ÚÈ 2
kg ‚·ÎÙ‹ÚÈ· Ô˘ ·Ó‹ÎÔ˘Ó Û ÂÚ›Ô˘ 2 ÂηÙÔÌ̇-
ÚÈ· Á¤ÓË, Û ۇÁÎÚÈÛË Ì ٷ ÂÚ›Ô˘ 25.000 Á¤ÓË
ÛÙ· ¢ηÚȈÙÈο ·ÙÙ·Ú· ÙÔ˘ ÛÒÌ·ÙÔ˜. ŸÌˆ˜, ο-
ÔÈ· ‚·ÎÙ‹ÚÈ· Ê·›ÓÂÙ·È fiÙÈ ‰ÂÓ ÌÔÚÔ‡Ó Ó· ÂÈ-
‚ÈÒÛÔ˘Ó Ì ÙÔ ¢˘ÙÈÎfi ÙÚfiÔ ˙ˆ‹˜ Î·È ·˘Ùfi ÚÔ·-
ÙÂÈ ·fi ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ô Û‡Á¯ÚÔÓÔ˜ ¿ÓıÚˆÔ˜
¤¯ÂÈ ÛËÌ·ÓÙÈο ÂÏ·Ùو̤ÓË ÔÈÎÈÏ›· Î·È ·ÚÈıÌfi
‚·ÎÙËÚ›ˆÓ ÛÙÔÓ ÂÙÈÎfi ÙÔ˘ ۈϋӷ31,32. ™ËÌ·ÓÙÈ-
ο ÌÂȈ̤ÓË ¯ÏˆÚ›‰· ·Ú·ÙËÚÂ›Ù·È Â›Û˘ ÛÙÔ˘˜
ËÏÈÎȈ̤ÓÔ˘˜ Î·È Û¯ÂÙ›˙ÂÙ·È Ì ÙË ÌÂȈ̤ÓË ·ÎÂ-
Ú·ÈfiÙËÙ· ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ÂÈıËÏ›Ô˘ Î·È ÙËÓ Â›Û˘
ÌÂȈ̤ÓË ·Ú·ÁˆÁ‹ ÛÙÔȯ›ˆÓ ÙÔ˘ ÂÓÙÂÚÈÎÔ‡
‚ÏÂÓÓÔÁfiÓÈÔ˘ ÊÚ·ÁÌÔ‡, fiˆ˜ Ù˘ ‰È·Ï˘Ù‹˜ IgA
[sIgA], ‚ÏÂÓÓÈÓÒÓ, ÓÙÂÊÂÓÛÈÓÒÓ ·ÏÏ¿ Î·È ÂÎÎÚ›ÛÂ-
ˆÓ, fiˆ˜ ÙÔ˘ Á·ÛÙÚÈÎÔ‡ ÔͤԘ. O ΢ÙÙ·ÚÔÌÂÁ·ÏÔ˚-
fi˜ ‹ ¿ÏϘ ÏÔÈÌÒÍÂȘ ·fi ÈÔ‡˜ Â›Ó·È Û˘¯Ó¤˜ Û ¿ÙÔ-
Ì· ·˘Ù‹˜ Ù˘ ËÏÈΛ·˜ Î·È Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ÂÚ·È-
Ù¤Úˆ ηٷÛÙÔÏ‹ Ù˘ ·ÓÔÛȷ΋˜ ‰Ú¿Û˘ Î·È È‰È·›-
ÙÂÚ· ·˘Ù‹˜ Ô˘ ¤¯ÂÈ Û¯¤ÛË Ì ٷ Δ-ÏÂÌÊÔ·ÙÙ·Ú·.
∏ ‰È·Ù·Ú·Á̤ÓË ÂÓÙÂÚÈ΋ ¯ÏˆÚ›‰· ·ÔÙÂÏ›
ÌÈ· ÛÔ˘‰·›· ÂÛÙ›· ‰È·ÚÎÔ‡˜ ·ÓÙÈÁÔÓÈ΋˜ ‰È¤ÁÂÚ-
Û˘ Î·È Û˘Ì‚¿ÏÏÂÈ ÛËÌ·ÓÙÈο ÛÙËÓ ·Ó¿Ù˘ÍË ¯ÚÔ-
Ó›ˆÓ ÓfiÛˆÓ Î·È ÛÙË ‚·ıÌÈ·›· ·ÓÔÛÔ·Ú¿Ï˘ÛË33,34.
∏ ηχÙÂÚË ·ÓÙÈÌÂÙÒÈÛË ÌÈ·˜ Ù¤ÙÔÈ·˜ ÂͤÏÈ͢,
ÂÎÙfi˜ ·fi ÙËÓ ·ÔÊ˘Á‹ ÙÔ˘ ÛÙÚ˜ Î·È ÙËÓ Î·Ù¿Ï-
ÏËÏË ‰È·ÙÚÔÊ‹, Ê·›ÓÂÙ·È fiÙÈ Â›Ó·È:
• Ë Û˘Ó¯‹˜ Ê˘ÛÈ΋ ¿ÛÎËÛË35
• Ë ÂÏ¿ÙÙˆÛË ÙÔ˘ ·ÓÙÈÁÔÓÈÎÔ‡ ÊÔÚÙ›Ô˘ ·fi Ù·
·ıÔÁfiÓ·, fiˆ˜ Ô Èfi˜ Ù˘ ÁÚ›˘ Î·È Ô Î˘ÙÙ·ÚÔ-
ÌÂÁ·ÏÔ˚fi˜ Ì ηٿÏÏËÏÔ˘˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡˜, fiÔ˘
˘¿Ú¯ÂÈ ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ÂÌ‚fiÏÈÔ36
• Ë ÂÏ¿ÙÙˆÛË ÙÔ˘ ·ÓÙÈÁÔÓÈÎÔ‡ ÊÔÚÙ›Ô˘ ÌÂ Û˘-
ÌÏËÚÒÌ·Ù· ‰È·ÙÚÔÊ‹˜ Ô˘ ÂÚȤ¯Ô˘Ó ÚÔ‚ÈÔÙÈ-
ο, ÚÔ‚ÈÔÙÈο Î·È Û˘Ó‰˘·ÛÌfi ÙÔ˘˜ [Û˘Ì‚ÈÔÙÈο].
Δ¤ÙÔȘ «ıÂÚ·›˜» ¤¯Ô˘Ó ·ԉ›ÍÂÈ ÙËÓ ÈηÓfiÙË-
Ù· ÙÔ˘˜ Ó· ˘ÔÛÙÚ¤ÊÔ˘Ó ÙȘ ·ÓÙȉڿÛÂȘ ˘ÂÚ¢·È-
ÛıËÛ›·˜, fiˆ˜ ÙË ‰˘Û·ÓÂÍ›· ÛÙȘ ÙÚÔʤ˜ Î·È ÙÔ
·ÙÔÈÎfi ¤Î˙ÂÌ· Î·È Ó· ·˘Í¿ÓÔ˘Ó ÙË Ê·ÁÔ΢ÙÙ¿-
ÚˆÛË37-39.
Oπ ∂∫¢∏§ø™∂π™ Δø¡ Ã√¡πø¡ ¡√™ø¡
∞ÚÎÂÙ¤˜ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ÓfiÛÔ˘ Â›Ó·È ÎÔÈÓ¤˜
Û ÂÚÈÛÛfiÙÂÚ˜ ·fi ÌÈ· ¯ÚfiÓȘ ÂÓ‰ËÌÈΤ˜ Ófi-
ÛÔ˘˜ Î·È Ì¿ÏÈÛÙ· ·˘ÙÒÓ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙÔ ¢˘-
ÙÈÎfi ÙÚfiÔ ˙ˆ‹˜, ÙËÓ ÚfiÛÏË„Ë ÙÚÔÊ‹˜ Î·È ÙË
‰È·Ú΋ ·‡ÍËÛË Ù˘ Û˘ÛÙËÌ·ÙÈ΋˜ ÊÏÂÁÌÔÓÒ‰Ô˘˜
·ÓÙ›‰Ú·Û˘. Δ¤ÙÔȘ ÂΉËÏÒÛÂȘ Â›Ó·È Ë ·Ú·‰fi-
ÓÙˆÛË, Ë ÔÛÙÂÔfiÚˆÛË Î·È Ë ÂÁÎÂÊ·ÏÔ¿ıÂÈ·, Ë
ÔÔ›· ÁÈ· Ì·ÎÚfi ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· Û¯ÂÙ›˙ÔÓÙ·Ó
ÌfiÓÔ Ì ÙË ¯ÚfiÓÈ· Ë·ÙÈ΋ ÓfiÛÔ, ·ÏÏ¿ Û‹ÌÂÚ· ıÂ-
ˆÚÂ›Ù·È ϤÔÓ fiÙÈ ¤¯ÂÈ Û¯¤ÛË Î·È Ì ¯ÚfiÓȘ ‚Ï¿-
‚˜ ÙÔ˘ ÓÂÊÚÔ‡, ÙÔ˘ Ó‡ÌÔÓ· [·ÔÊÚ·ÎÙÈ΋
Ó¢ÌÔÓÔ¿ıÂÈ· COPD] ÙÔ˘ ı˘ÚÂÔÂȉԇ˜, Ì ÙÔ
۷ί·ÚÒ‰Ë ‰È·‚‹ÙË, ÙË ÓÔÛÔÁfiÓÔ ·¯˘Û·ÚΛ· ηÈ
¿ÏϘ ¯ÚfiÓȘ ηٷÛÙ¿ÛÂȘ.
ŸÏ˜ ·˘Ù¤˜ ÔÈ ÂΉËÏÒÛÂȘ ÔÏÔ¤Ó· Î·È ÂÚÈÛ-
ÛfiÙÂÚÔ ·Ó·ÁÓˆÚ›˙ÔÓÙ·È ˆ˜ ·Ú¿ÁÔÓÙ˜ ÂÈÎÈÓ‰˘-
ÓfiÙËÙ·˜ ÁÈ· ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ Î·È ‰È·‚‹ÙË ·ÏÏ¿ ηÈ
ÁÈ· ¿ÏϘ ¯ÚfiÓȘ ·ı‹ÛÂȘ. °È· ÔÏÏ¿ ¯ÚfiÓÈ·
˘‹Ú¯Â ÚÔ‚ÏËÌ·ÙÈÛÌfi˜ ÁÈ· ÙÔ ˘„ËÏfi ÔÛÔÛÙfi
ÔÛÙÂÔfiÚˆÛ˘ ÛÙȘ ‰˘ÙÈΤ˜ ÎÔÈӈӛ˜ ·Ú¿ ÙËÓ
ÚfiÛÏË„Ë È¯ÓÔÛÙÔȯ›ˆÓ Û Ôχ ˘„ËÏfiÙÂÚ˜ ‰fi-
ÛÂȘ Û ۯ¤ÛË Ì ÙȘ ¯·ÌËÏÔ‡ ‚ÈÔÙÈÎÔ‡ ÂÈ¤‰Ô˘
¯ÒÚ˜, fiÔ˘, ·Ú·‰fi͈˜, ˘¿Ú¯ÂÈ ÌÈÎÚfiÙÂÚÔ Ô-
 ∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 75, 1
ÛÔÛÙfi ÓfiÛÔ˘. ªÈ· ÚfiÛÊ·ÙË ∞ÌÂÚÈηÓÈ΋ ÌÂϤÙË
·Ó·Ê¤ÚÂÈ ÛËÌ·ÓÙÈ΋ Ì›ˆÛË Ù˘ ÔÛÙÈ΋˜ ˘ÎÓfiÙË-
Ù·˜ Û ËÏÈÎȈ̤Ó˜ Á˘Ó·›Î˜ Ô˘ ηٷӷÏÒÓÔ˘Ó
>3 ÎÔ˘ÙÈ¿ Îfiη-ÎfiÏ· [ÏÔ‡ÛÈ· Û AGE’s ηÈ
ALE’s] ÙËÓ Â‚‰ÔÌ¿‰· Û ۇÁÎÚÈÛË Ì ÔÌ¿‰· ÂϤÁ-
¯Ô˘ Ô˘ ηٷӿψÓ fiÌÔÈ· ÔÛfiÙËÙ· ¿ÏÏˆÓ ·Ó-
ıÚ·ÎÔ‡¯ˆÓ ÔÙÒÓ40. ∂›Û˘, Û ·ÛıÂÓ›˜ Ì ¯Úfi-
ÓÈ· ·ÔÊÚ·ÎÙÈ΋ Ó¢ÌÔÓÔ¿ıÂÈ·, ·Ú·ÙËÚ‹ıËÎÂ
fiÙÈ ·˘ÙÔ› Ô˘ ηٷӷÏÒÓÔ˘Ó Û˘ÓÙËÚË̤ÓÔ ÎÚ¤·˜,
[Ì¤ÈÎÔÓ, ÏÔ˘Î¿ÓÈη, ˙·ÌfiÓ ÎÏ.] —Â›Û˘ ÏÔ‡-
ÛÈ· Û AGE’s Î·È ALE’s— ¿Óˆ ·fi 14 ÊÔÚ¤˜ ÙÔ
Ì‹Ó· ¤¯Ô˘Ó ÛËÌ·ÓÙÈο ÌÂȈ̤ÓË ·Ó·Ó¢ÛÙÈ΋
ÏÂÈÙÔ˘ÚÁ›· [FEV1], Û ۯ¤ÛË Ì ·˘ÙÔ‡˜ Ô˘ ÙÚÒÓÂ
Ù¤ÙÔȘ ÙÚÔʤ˜ 3-4 ÊÔÚ¤˜ ÙÔ Ì‹Ó·41. ∂›Ó·È ‰Â ȉȷ›-
ÙÂÚ· ÂӉȷʤÚÔÓ Î·È ÙÔ ·ÓÙ›ÛÙÚÔÊÔ, fiÙÈ ‰ËÏ·‰‹ Ë
ÚfiÛÏË„Ë ÔÏfiÎÏËÚˆÓ ÊÚÔ‡ÙˆÓ Î·È ÂȉÈÎfiÙÂÚ· Ë
ÚfiÛÏË„Ë Î·Ù¯ÈÓÒÓ [Ô˘ ˘¿Ú¯Ô˘Ó Û ÌÂÁ¿Ï˜
ÔÛfiÙËÙ˜ ÛÙÔ ÙÛ¿È Î·È Ù· Ì‹Ï·] Û˘Û¯ÂÙ›˙ÂÙ·È ÌÂ
·‡ÍËÛË ÙÔ˘ ÂÎÓÂfiÌÂÓÔ˘ fiÁÎÔ˘ [FEV1] Î·È Û˘ÓÔ-
‰Â‡ÂÙ·È ·fi ÛËÌ·ÓÙÈ΋ Ì›ˆÛË ÙˆÓ Û˘Ìو̿وÓ
Ù˘ ·ÔÊÚ·ÎÙÈ΋˜ Ó¢ÌÔÓÔ¿ıÂÈ·˜: ¯ÚfiÓÈÔ˜ ‚‹-
¯·˜, ÂÎÎÚ›ÛÂȘ, ‰‡ÛÓÔÈ·42. ∞˘Ù¤˜ ÔÈ ·Ú·ÙËÚ‹-
ÛÂȘ ÌÔÚ› Ó· Ù·ÈÚÈ¿˙Ô˘Ó Â›Û˘ Î·È Û ÂΉËÏÒ-
ÛÂȘ ¿ÏÏˆÓ ¯ÚfiÓÈˆÓ ÓfiÛˆÓ, Û˘ÌÂÚÈÏ·Ì‚·ÓÔ̤-
ÓˆÓ Î·È ÙˆÓ ‰È·ÊfiÚˆÓ ÂÁÎÂÊ·ÏÔ·ıÂÈÒÓ.
ªÈ· ÚfiÛÊ·ÙË ÌÂϤÙË43 ·Ó·Ê¤ÚÂÈ fiÙÈ ·Ú·-
ÙËÚ‹ıËΠÛËÌ·ÓÙÈ΋ ÂÏ¿ÙÙˆÛË ÙÔ˘ ÔÍÂȉˆÙÈÎÔ‡
ÛÙÚ˜, Ù˘ ÊÏÂÁÌÔÓ‹˜ ·ÏÏ¿ Î·È Ù˘ ÓÔËÙÈ΋˜ ηı˘-
ÛÙ¤ÚËÛ˘ Û ‰È·‚ËÙÈÎÔ‡˜ Â›Ì˘Â˜ Ô˘ ¤Ï·‚·Ó ÌÂ
ÙËÓ ÙÚÔÊ‹ ÙÔ˘˜ 60 mg/kg ‚¿ÚÔ˘˜ ÛÒÌ·ÙÔ˜ ÎÔ˘Ú-
ÎÔ˘Ì›Ó˘ – Û˘ÛÙ·ÙÈÎÔ‡ ÙÔ˘ ÙÔ˘Ṳ́ÚÈÎ, ÁÓˆÛÙÔ‡ ÁÈ·
ÙȘ ·ÓÙÈÊÏÂÁÌÔÓÒ‰ÂȘ ȉÈfiÙËÙ¤˜ ÙÔ˘15,17.
™À™™øƒ∂À™∏ √À™πø¡ ¶√À ∂¶πº∂ƒ√À¡
¢À™§∂πΔ√Àƒ°π∞
∞˘ÍË̤ӷ Â›‰· ÙÂÏÈÎÒÓ ÚÔ˚fiÓÙˆÓ ÁÏ˘ÎÔ˙˘-
Ï›ˆÛ˘ Î·È ÏÈÔÍ›‰ˆÛ˘ [AGE/ALE] ÂÚÈÁÚ¿ÊÔ-
ÓÙ·È Û ۯ‰fiÓ fiϘ ÙȘ ¯ÚfiÓȘ ÓfiÛÔ˘˜, ·fi ÙȘ ·Ï-
ÏÂÚÁ›Â˜ Î·È ÙË ÓfiÛÔ Alzheimer ˆ˜ ÙȘ ÔÏ˘Î˘ÛÙÈ-
Τ˜ ˆÔı‹Î˜ Î·È ÙȘ ‰È¿ÊÔÚ˜ ÓfiÛÔ˘˜ ÙÔ˘ Ô˘ÚÔ-
ÁÂÓÓËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ∏ ηٷӿψÛË Á·Ï·ÎÙÔ-
ÎÔÌÈÎÒÓ ÚÔ˚fiÓÙˆÓ Û˘˙ËÙÈ¤Ù·È Î·È Û˘¯ÂÙ›˙ÂÙ·È Â›
Ì·ÎÚfiÓ Ì ÙËÓ ·Ó¿Ù˘ÍË ·ÏÏÂÚÁ›·˜, ÛÙÂÊ·ÓÈ·›·˜
ÓfiÛÔ˘, ‰È·‚‹ÙË, ÓfiÛÔ˘ Parkinson Î·È ‰È·ÊfiÚˆÓ
ηÚÎ›ÓˆÓ fiˆ˜ Ì·ÛÙÔ‡, ÚÔÛÙ¿ÙË, ˆÔıËÎÒÓ Î·È
Ì‹ÙÚ·˜16. ™ËÌ·ÓÙÈ΋ ·‡ÍËÛË ÙˆÓ ÂÈ¤‰ˆÓ AGE/
ALE ·Ó·Ê¤ÚÂÙ·È Â›Û˘ Û ÓfiÛÔ˘˜ Ì ¿ÁÓˆÛÙË ‹
·‰È¢ÎÚ›ÓÈÛÙË ·ÈÙÈÔÏÔÁ›·, fiˆ˜ Ë Ú‹ÍË ÙÔ˘ ∞¯›Ï-
ÏÂÈÔ˘ Ù¤ÓÔÓÙ·44 Î·È Ë ÈÓÔÌ˘·ÏÁ›· [fibromyalgia]45.
ªÂÁ¿ÏË ‚·Ú‡ÙËÙ· ÁÈ· ÙÔ˘˜ Û˘Û¯ÂÙÈÛÌÔ‡˜ ·˘ÙÔ‡˜
41
¤¯Ô˘Ó Î·È ÔÈ ·Ú·ÙËÚ‹ÛÂȘ ˘„ËÏ‹˜ Û˘ÁΤÓÙÚˆÛ˘
AGE/ALE Û ¯ÚfiÓȘ ·ı‹ÛÂȘ, fiˆ˜ Ë ÌË ·ÏÎÔÔ-
ÏÈ΋ ÛÙ·ÙÔ-Ë·Ù›Ùȉ· [NASH]46 Î·È Ë Ë·ÙÈ΋
ΛÚÚˆÛË47. Δ· Â›‰· ÙˆÓ AGE/ALE ÛÙÔÓ ÔÚfi
·˘Í¿ÓÔ˘Ó ·Ó·ÏÔÁÈο Ì ÙÔ ÎÏÈÓÈÎfi ÛÙ¿‰ÈÔ [ηٿ
Child] Ù˘ ΛÚÚˆÛ˘47 Î·È ‰ÂÓ Â·Ó¤Ú¯ÔÓÙ·È ÛÙÔ
Ê˘ÛÈÔÏÔÁÈÎfi ÌÂÙ¿ Ë·ÙÈ΋ ÌÂÙ·ÌfiÛ¯Â˘ÛË48, ÁÂÁÔ-
Ófi˜ Ô˘ ÌÔÚ› Ó· ÂÍËÁ‹ÛÂÈ ÙËÓ ·Ú·Ì¤ÓÔ˘Û·
˘„ËÏ‹ Û˘¯ÓfiÙËÙ· ÎÈÓ‰‡ÓÔ˘ ·Ó¿Ù˘Í˘ ¿ÏÏˆÓ ¯ÚÔ-
Ó›ˆÓ ÓfiÛˆÓ, ·ÎfiÌË Î·È ÌÂÙ¿ ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË.
Œ¯ÂÈ ·Ô‰Âȯı› fiÙÈ ÔÈ ¯ÔÚÙÔÊ¿ÁÔÈ, Û ÌÂÁ¿-
ÏË ·ÓÙ›ıÂÛË Ì ÙÔ˘˜ ÎÚ·ÙÔÊ¿ÁÔ˘˜ Î·È ÙÔ˘˜ ¯ÔÚ-
ÙÔÊ¿ÁÔ˘˜ Ô˘ ηٷӷÏÒÓÔ˘Ó Î·È Á·Ï·ÎÙÔÎÔÌÈο
¤¯Ô˘Ó ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚ· Â›‰· AGEs/
ALEs49. ∞˘Ùfi ÌÂÙ·ÊÚ¿˙ÂÙ·È Û ÛËÌ·ÓÙÈο ÔʤÏË
ÁÈ· ÙËÓ ˘Á›· ÙÔ˘˜: ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ¯·ÌËÏfi-
ÙÂÚ· Â›‰· ÌÔÚ›ˆÓ ÊÏÂÁÌÔÓ‹˜ fiˆ˜ ΢ÙÙ·ÚÔΛ-
Ó˜ Î·È ÚˆÙ½Ó˜ ÔÍ›·˜ Ê¿Ûˆ˜, ¯·ÌËÏfiÙÂÚË Û˘-
ÛÙÔÏÈ΋ Î·È ‰È·ÛÙÔÏÈ΋ ›ÂÛË, ¯·ÌËÏfiÙÂÚË ÔÏÈ΋
¯ÔÏËÛÙÂÚfiÏË, Î·È LDL, ¯·ÌËÏfiÙÂÚÔ Û¿Î¯·ÚÔ ÓË-
ÛÙ›·˜ Î·È ÙÚÈÁÏ˘ÎÂÚ›‰È·, Î·È ·ÛÊ·ÏÒ˜ ÌÈÎÚfiÙÂÚË
Û˘¯ÓfiÙËÙ· ¯ÚÔÓ›ˆÓ ÓfiÛˆÓ, ÂȉÈο ۷ί·ÚÒ‰Ë ‰È·-
‚‹ÙË Î·È ÙˆÓ ÂÈÏÔÎÒÓ ÙÔ˘. ∞ÓÙ›ıÂÙ·, ÔÈ Á·Ï·-
ÎÙÔ-¯ÔÚÙÔÊ¿ÁÔÈ ¤¯Ô˘Ó ÂÏ·ÊÚÒ˜ ˘„ËÏfiÙÂÚ· Â›Â-
‰· AGEs/ALEs ÛÙÔÓ ÔÚÁ·ÓÈÛÌfi ÙÔ˘˜ Û ۯ¤ÛË ÌÂ
ÙÔ˘˜ ÎÚ·ÙÔÊ¿ÁÔ˘˜ Î·È ·˘Ùfi ÌÔÚ› Ó· Û¯ÂÙ›˙ÂÙ·È
Ì ÙË ÌÂÁ·Ï‡ÙÂÚË ÚfiÛÏË„Ë ÊÚÔ˘ÎÙfi˙˘ ·ÏÏ¿ ηÈ
Á·Ï·ÎÙÔÎÔÌÈÎÒÓ ÚÔ˚fiÓÙˆÓ Î·È Î˘Ú›ˆ˜ Ù˘ÚÈÔ‡.
Oπ ¢ƒA™∂π™ Δø¡ ¶ƒ√μπ√Δπ∫ø¡ ∫∞π
Δø¡ ™Àªμπ√Δπ∫ø¡
ªfiÓÔ Ï›Á· ÚÔ‚ÈÔÙÈο ÛÙÂϤ¯Ë ¤¯Ô˘Ó ̤¯ÚÈ ÛÙÈÁ-
Ì‹˜ ·Ô‰Âȯı› fiÙÈ ¤¯Ô˘Ó ÙËÓ ÈηÓfiÙËÙ· Ó· ÌÂÈÒ-
ÓÔ˘Ó ÙËÓ ·Ú·ÁˆÁ‹ ÌÔÚ›ˆÓ ÊÏÂÁÌÔÓ‹˜ fiˆ˜ Ù·
AGEs, ALEs, Ù· ÁÏÔ˘ÙÂÓÔÂȉ‹ Î·È ÙȘ ÂÙÂÚÔ΢ÎÏÈ-
Τ˜ ·Ì›Ó˜ ÙˆÓ ÙÚÔÊÒÓ. ∞ÎfiÌË ÂÚÈÛÛfiÙÂÚÔ, ÌfiÓÔ
ÂÏ¿¯ÈÛÙ· ·fi ÙȘ ·ÚÎÂÙ¤˜ ÂηÙÔÓÙ¿‰Â˜ ÙˆÓ ÚÔ-
‚ÈÔÙÈÎÒÓ ÛÙÂϯÒÓ Ô˘ ÂϤÁ¯ıËÎ·Ó ¤¯Ô˘Ó ÙËÓ Èη-
ÓfiÙËÙ· fiÙ·Ó ¯ÔÚËÁËıÔ‡Ó Ó· ηٷÛÙ›ÏÔ˘Ó ÙËÓ ‹‰Ë
˘¿Ú¯Ô˘Û· ÊÏÂÁÌÔÓ‹. Ÿˆ˜ Â›Ó·È Ê·ÓÂÚfi, ÂÍ·È-
ÚÂÙÈο ÂÈı˘ÌËÙ¿ Â›Ó·È Ù· ÛÙÂϤ¯Ë ÂΛӷ Ô˘
ÌÔÚÔ‡Ó Ó· ‚ÂÏÙÈÒÛÔ˘Ó ÙËÓ ·ÓÔÛȷ΋ ·fiÎÚÈÛË,
ÙË Ê·ÁÔ΢ÙÙ¿ÚˆÛË Î·È ÙËÓ ·Ó·ÏÔÁ›· ÙˆÓ Th1 ηÈ
NK ΢ÙÙ¿ÚˆÓ50.
OÈ ÁÂÓÂÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÌÂٷ͇ ‰È·ÊÔÚÂÙÈÎÒÓ
ÛÙÂϯÒÓ Á·Ï·ÎÙÔ‚·Î›ÏˆÓ Â›Ó·È ÌÂÁ¿Ï˜, ÙfiÛÔ
Ô˘ οÔÈÔÈ Ï¤Ó fiÙÈ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚ˜ ·fi ÙË
‰È·ÊÔÚ¿ ÌÂٷ͇ „·ÚÈÔ‡ Î·È ·ÓıÚÒÔ˘. ∏ ÂÈÏÔÁ‹
ÚÔ‚ÈÔÙÈÎÔ‡ ÁÈ· ÎÏÈÓÈ΋ ¯Ú‹ÛË Â›Ó·È ÎÚÈÙÈ΋˜ ÛË-
Ì·Û›·˜, ÂȉÈο ÁÈ· ÛÙÂϤ¯Ë Ì ÙÔ ›‰ÈÔ fiÓÔÌ· Ô˘
42 S. BENGMARK
¤¯Ô˘Ó Û˘¯Ó¿ ‰È·ÊÔÚÂÙÈο ‹ Î·È ·ÓÙ›ıÂÙ· ·ÔÙÂϤ-
ÛÌ·Ù·. ªÈ· ÚfiÛÊ·ÙË ÌÂϤÙË ·Ó·Ê¤ÚÂÈ fiÙÈ ·Ô-
ÌÔÓÒıËÎ·Ó 46 ÛÙÂϤ¯Ë Lactococcus lactis ·fi Â-
Ú›Ô˘ 2600 Á·Ï·ÎÙÔ‚·Î›ÏÔ˘˜ Î·È Û˘ÁÎÚ›ıËΠË
ÈηÓfiÙËÙ· ÙÔ˘˜ Ó· ÚÔ¿ÁÔ˘Ó ÙËÓ ·Ú·ÁˆÁ‹ ΢ÙÙ·-
ÚÔÎÈÓÒÓ51. ¢È·ÈÛÙÒıËΠfiÙÈ ˘‹Ú¯·Ó ÛËÌ·ÓÙÈΤ˜
‰È·ÊÔÚ¤˜ Ô˘ ˘ÔÁÚ·ÌÌ›˙Ô˘Ó ÙËÓ ·Ó¿ÁÎË ÁÈ· Û¯Ô-
Ï·ÛÙÈ΋ ÂÈÏÔÁ‹ fiÙ·Ó ÚfiÎÂÈÙ·È ÁÈ· ÎÏÈÓÈΤ˜
ÂÊ·ÚÌÔÁ¤˜.
∫¿ÔÈ· ÛÙÂϤ¯Ë ¤¯Ô˘Ó ·ԉ‰ÂÈÁ̤ӷ ÈÛ¯˘Ú‹
ÎÏÈÓÈ΋ ‰Ú¿ÛË: Ô Lactobacillus paracasei subsp. pa-
racasei, Ô Lactobacillus plantarum, Î·È Ô Pediococ-
cus pentosaceus. ∂ȉÈο, Ô Lactobacillus paracasei
¤¯ÂÈ ·Ô‰Âȯı› fiÙÈ ÚÔ¿ÁÂÈ ÙËÓ Î˘ÙÙ·ÚÈ΋ ·ÓÔÛ›·,
‰ÈÂÁ›ÚÂÈ ÙËÓ ·Ú·ÁˆÁ‹ ηٷÛÙ·ÏÙÈÎÒÓ Î˘ÙÙ·ÚÔÎÈ-
ÓÒÓ, ÌÂÈÒÓÂÈ ÙË ‰Ú¿ÛË ÙˆÓ Th2 Î·È CD4 Δ-ÏÂÌÊÔ-
΢ÙÙ¿ÚˆÓ, ηٷÛÙ¤ÏÏÂÈ ÙÔÓ ÔÏÏ·Ï·ÛÈ·ÛÌfi ÙˆÓ
ÛÏËÓÈÎÒÓ Î˘ÙÙ¿ÚˆÓ Î·È ÌÂÈÒÓÂÈ ÙËÓ ÂȉÈ΋ ¤Ó·ÓÙÈ
ÙˆÓ ·ÓÙÈÁfiÓˆÓ IgE Î·È IgG1 ·ÓÔÛ›·52-55. O Lacto-
bacillus paracasei —ÌÂÙ¿ ·fi ÌÂϤÙË ÂÚÈÛÛÔÙ¤ÚˆÓ
·fi 100 ÛÙÂϯÒÓ ÙÔ˘— Ê¿ÓËΠÂ›Û˘ fiÙÈ Â›Ó·È
¤Ó·˜ ÈÛ¯˘Úfi˜ ÂÎÊÚ·ÛÙ‹˜ ÙˆÓ Th1 ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ
Î·È Î·Ù·ÛÙÔϤ·˜ ÙˆÓ Th2 ΢ÙÙ·ÚÔÎÈÓÒÓ56. ™Â ÌÈ·
ÚfiÛÊ·ÙË ÌÂϤÙË Û Â›Ì˘Â˜ Û˘ÁÎÚ›ıËÎÂ Ë ÈηÓfi-
ÙËÙ· 4 ‰È·ÊÔÚÂÙÈÎÒÓ ÛÙÂϯÒÓ: Lactobacillus para-
casei, Lactobacillus johnsonii, Bifidobacterium lon-
gum, Bifidobacterium lactis Ó· ÂϤÁÍÔ˘Ó ÙË Ïԛ̈ÍË
·fi Trichinella spiralis Î·È ‚Ú¤ıËΠÌfiÓÔ Ô Lacto-
bacillus paracasei Î·È Î·Ó¤Ó·˜ ¿ÏÏÔ˜ Á·Ï·ÎÙÔ‚¿ÎÈ-
ÏÔ˜ ‰ÂÓ ÌÔÚÔ‡Û ӷ ÌÂÈÒÛÂÈ ÙËÓ ·¿ÓÙËÛË ÙˆÓ
Th2 ÛÙË Ïԛ̈ÍË Î·È Ù· Â›‰· ÙˆÓ TGF-‚, COX-
2 Î·È PGE-2, Ô˘ Ô‰ËÁÔ‡Ó Û ÚfiÎÏËÛË Ì˘ÈÎÔ‡
Û·ÛÌÔ‡57. ™Â ÌÈ· ·ÎfiÌË ÈÔ ÚfiÛÊ·ÙË ÌÂϤÙË Û˘Á-
ÎÚ›ıËÎ·Ó Ù· ÛÙÂϤ¯Ë Bifidobacterium lactis NCC362,
Lactobacillus johnsonii NCC533, Î·È Lactobacillus
paracasei NCC2461 ˆ˜ ÚÔ˜ ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙË-
Ù¿ ÙÔ˘˜ ÛÙËÓ ‰È·Ù‹ÚËÛË Ù˘ ·ÎÂÚ·ÈfiÙËÙ·˜ ÙÔ˘ ‚ÏÂÓ-
ÓÔÁfiÓÈÔ˘ ÂÓÙÂÚÈÎÔ‡ ÊÚ·ÁÌÔ‡ Û ηٷÛÙ¿ÛÂȘ
ÛÙÚ˜ Î·È ÙËÓ Â˘·ÈÛıËÛ›· ÙÔ˘˜ ηٿ ÙË ‰È¿Ù·ÛË ÙÔ˘
·¯¤Ô˜ ÂÓÙ¤ÚÔ˘. ∫·È ÛÙËÓ ÂÚ›ÙˆÛË ·˘Ù‹ Â›Û˘
ÌfiÓÔÓ Ô Lactobacillus paracasei ¤‰ÂÈÍ fiÙÈ ÌÔÚ›
Ì ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ Ó· ÌÂÈÒÛÂÈ ÙÔ ÎÔÈÏÈ·Îfi ¿Ï-
ÁÔ˜ Î·È ÙËÓ ˘ÂÚ¢·ÈÛıËÛ›· Î·È Ó· ·ÔηٷÛÙ‹ÛÂÈ
ÛÙÔ Ê˘ÛÈÔÏÔÁÈÎfi ÙËÓ ÂÓÙÂÚÈ΋ ‰È·ÂÚ·ÙfiÙËÙ·58.
¶·ÚfiÌÔÈ· ÂÍ·ÈÚÂÙÈο ·ÔÙÂϤÛÌ·Ù· fï˜ ¤‰ÂÈÍÂ
Î·È Ô Lactobacillus planetarium: ÌÂÏÂÙ‹ıËÎ·Ó 50
ÛÙÂϤ¯Ë Á·Ï·ÎÙÔ‚·Î›ÏˆÓ ·Ó ÌÔÚÔ‡Ó Ó· ÂϤÁÍÔ˘Ó
23 ‰È·ÊÔÚÂÙÈο ÛÙÂϤ¯Ë Clostridium difficile. ªfiÓÔ
Ô Lactobacillus paracasei Î·È Ô Lactobacillus planta-
rum ÌfiÚÂÛ·Ó Ó· ÌÂÈÒÛÔ˘Ó ‰Ú·ÛÙÈο Ù· ÛÙÂϤ¯Ë
ÙÔ˘ Clostridium difficile, ÂÓÒ ÂÚÈÛÛfiÙÂÚ· ·fi Ù·
ÌÈÛ¿ ÛÙÂϤ¯Ë Á·Ï·ÎÙÔ‚·Î›ÏˆÓ ·ԉ›¯ıËÎ·Ó ÔÏÈ-
ο ·ÓÂÓÂÚÁ¿ ‹ Ï›ÁÔ ÂÓÂÚÁ¿59.
∫¿ÔÈÔÈ Á·Ï·ÎÙÔ‚¿ÎÈÏÔÈ Ê¿ÓËΠfiÙÈ ·˘Í¿-
ÓÔ˘Ó ÙȘ ÈηÓfiÙËÙ¤˜ ÙÔ˘˜ Ì ÙË Û‡Á¯ÚÔÓË ¯ÔÚ‹ÁËÛË
Ú‚ÈÔÙÈÎÒÓ ÈÓÒÓ [probiotics + prebiotics = syn-
biotics] ·ÏÏ¿ ÁÂÓÈο ·ÚÔ˘Û›·˙·Ó ÌÂÁ¿Ï˜ ‰È·ÊÔ-
Ú¤˜ ÛÙËÓ ÈηÓfiÙËÙ¿ ÙÔ˘˜ Ó· ¯ÚËÛÈÌÔÔÈÔ‡Ó ËÌÈ˙˘-
ÌÔ‡ÌÂÓ˜ ›Ó˜, fiˆ˜ ÙȘ ÔÏÈÁÔÊÚÔ˘ÎÙ¿Ó˜. ∞fi Ù·
712 ‰È·ÊÔÚÂÙÈο ÛÙÂϤ¯Ë Ï·ÎÙÔ‚·Î›ÏˆÓ Ô˘ ÌÂÏÂ-
Ù‹ıËηÓ, ÌfiÓÔ Ù· Lactobacillus plantarum, Lacto-
bacillus paracasei subsp. paracasei, Lactobacillus
brevis Î·È Pediococcus pentosaceus ÌfiÚÂÛ·Ó Ó·
‰È·Û¿ÛÔ˘Ó ÙËÓ ÈÓÔ˘Ï›ÓË Î·È ÙË ÊϽÓË60.
ªÂÙ¿ ·fi ÙË ÌÂϤÙË 550 ‰È·ÊÔÚÂÙÈÎÒÓ ÛÙÂÏÂ-
¯ÒÓ Á·Ï·ÎÙÔ‚·Î›ÏˆÓ ˆ˜ ÚÔ˜ ÙËÓ ·ÓÙÈÊÏÂÁÌÔÓÒ-
‰Ë ‰Ú¿ÛË ÙÔ˘˜, ·Ó·Ù‡¯ıËΠ¤Ó· Û˘Ì‚ÈÔÙÈÎfi Û·-
·ÛÌ· Ô˘ ÂÚÈ›¯Â Lactobacillus plantarum, Lacto-
bacillus paracasei subsp. paracasei, Lactococcus ra-
finolactis Î·È Pediococcus pentosaceus. ™’ ·˘Ù‹ ÙË
Û‡ÓıÂÛË ‚·Î›ÏˆÓ ÚÔÛÙ¤ıËÎ·Ó Î·È 4 ‰È·ÊÔÚÂÙÈ-
Τ˜ Ê˘ÙÈΤ˜ ›Ó˜ ÁÓˆÛÙ‹˜ ÈÛ¯˘Ú‹˜ ‰Ú¿Û˘: Ë ‚-ÁÏ˘-
οÓË, Ë ÈÓÔ˘Ï›ÓË, Ë ËÎÙ›ÓË Î·È ÙÔ ·ÓıÂÎÙÈÎfi ¿Ì˘-
ÏÔ Î·È ÛÙËÓ fiÏË Û‡ÓıÂÛË ‰fiıËΠÙÔ fiÓÔÌ· Syn-
biotic 2000. ∏ Û‡ÓıÂÛË ·˘Ù‹ ¤¯ÂÈ ‰ÔÎÈÌ·Ûı› ÂÈ-
Ù˘¯Ò˜ Û ÔÏϤ˜ ÔÍ›˜ ηٷÛÙ¿ÛÂȘ.
∏ ¢ƒ∞™∏ Δø¡ ¶ƒ√μπ√Δπ∫ø¡ ™Δ∏ §∂πΔ√Àƒ°π∞
Δ√À ∏¶∞Δ√™ ∫∞π Δ√À ∂°∫∂º∞§√À
OÏÔ¤Ó· Î·È ÂÚÈÛÛfiÙÂÚ˜ ÌÂϤÙ˜ ˘ÔÛÙËÚ›˙Ô˘Ó
fiÙÈ Ù· ÚÔ‚ÈÔÙÈο ÌfiÓ· ÙÔ˘˜ ‹ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ٷ
Ê˘ÙÈο ·ÓÙÈÔÍÂȉˆÙÈο Î·È ÙȘ Ê˘ÙÈΤ˜ ›Ó˜ ¤¯Ô˘Ó
ÈÛ¯˘Ú‹ Ó¢ÚÔÂÓ‰ÔÎÚÈÓÈ΋ Ú˘ıÌÈÛÙÈ΋ ‰Ú¿ÛË Î·È
·ÓÙÈÚÚÔÔ‡Ó Ù· ηο ·ÔÙÂϤÛÌ·Ù· ÙÔ˘ Ê˘ÛÈÎÔ‡
Î·È „˘¯ÔÏÔÁÈÎÔ‡ ÛÙÚ˜61, 62.
À¿Ú¯Ô˘Ó 2 ÌÂϤÙ˜ fiÔ˘ ÙÔ Û˘Ì‚ÈÔÙÈÎfi
Û··ÛÌ· Ô˘ ·Ó·Ê¤ÚıËΠÚÔËÁÔ˘Ì¤Óˆ˜ ¯ÔÚË-
Á‹ıËΠ۠·ÛıÂÓ›˜ Ì Ë·ÙÈ΋ ΛÚÚˆÛË Î·È ÂÁÎÂ-
Ê·ÏÔ¿ıÂÈ·.
™ÙËÓ ÚÒÙË ÌÂϤÙË Ô˘ ¤ÁÈÓ ÛÙËÓ ∫›Ó·63, 55
·ÛıÂÓ›˜ Ì ΛÚÚˆÛË Î·È ÂÁÎÂÊ·ÏÔ¿ıÂÈ· Ù˘¯·ÈÔ-
ÔÈ‹ıËÎ·Ó Ó· Ï·Ì‚¿ÓÔ˘Ó Â› 30 Ë̤Ú˜ Synbiotic
2000 [n=20], ÌfiÓÔ ÙȘ Ê˘ÙÈΤ˜ ›Ó˜ ÙÔ˘ Û΢¿ÛÌ·-
ÙÔ˜ [n=20], ‹ placebo [n=15]. OÈ ÎÈÚÚˆÙÈÎÔ› ÌÂ
ÂÁÎÂÊ·ÏÔ¿ıÂÈ· ‚Ú¤ıËΠfiÙÈ Â›¯·Ó ÛËÌ·ÓÙÈΤ˜
‰È·Ù·Ú·¯¤˜ ÛÙËÓ ÂÓÙÂÚÈ΋ ¯ÏˆÚ›‰· Ì ˘ÂÚ·Ó¿-
Ù˘ÍË ÙÔ˘ ‰˘ÓËÙÈο ·ıÔÁfiÓÔ˘ E. coli Î·È Staphy-
lococcal species ÛÙ· ÎfiÚ·Ó·. ∏ ıÂÚ·›· ÙÔ˘˜ ÌÂ
Û˘Ì‚ÈÔÙÈο ·‡ÍËÛ ÛËÌ·ÓÙÈο ÙÔ ÔÛÔÛÙfi ÙˆÓ Á·-
Ï·ÎÙÔ‚·Î›ÏˆÓ Ô˘ ‰ÂÓ ·Ú¿ÁÔ˘Ó Ô˘Ú¿ÛË ÂȘ ‚¿-
ÚÔ˜ ÙˆÓ ¿ÏÏˆÓ ‚·ÎÙËÚ›ˆÓ ÛÙ· ÎfiÚ·Ó·. ∞˘Ù‹ Ë
 ∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 75, 1
ÙÚÔÔÔ›ËÛË Ù˘ ÂÓÙÂÚÈ΋˜ ¯ÏˆÚ›‰·˜ Û˘¯ÂÙ›ÛıËÎÂ
ÎÏÈÓÈο Ì ÛËÌ·ÓÙÈ΋ Ì›ˆÛË ÙˆÓ ÂÈ¤‰ˆÓ ·Ì̈-
Ó›·˜ ÛÙÔ ·›Ì· Î·È ·Ó¤ÛÙÚ„ ÙËÓ ÂÁÎÂÊ·ÏÔ¿ıÂÈ·
ÛÙÔ 50% ÙˆÓ ·ÛıÂÓÒÓ. ∂›Û˘ Ô‰‹ÁËÛ Û ÛËÌ·-
ÓÙÈ΋ Ì›ˆÛË Ù˘ ÂÓ‰ÔÙÔÍÈÓ·ÈÌ›·˜ Î·È ‚ÂÏÙ›ˆÛ ÙËÓ
ηٿ Child-Pugh ηٿٷÍË ÙˆÓ ·ÛıÂÓÒÓ Û¯Â‰fiÓ
ÛÙÔ 50% ÙˆÓ ÂÚÈÙÒÛˆÓ. ∏ ıÂÚ·›· Ì ÌfiÓÔ
ÙȘ Ê˘ÙÈΤ˜ ›Ó˜ ÙÔ˘ Û΢¿ÛÌ·ÙÔ˜ – Ú‚ÈÔÙÈο [2Ë
ÔÌ¿‰·] ›¯Â Â›Û˘ ÔʤÏË Û ۯ¤ÛË Ì ÙËÓ ÔÌ¿‰·
placebo. Δ· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘ ·˘Ù‹˜ ¤ÁÈ-
Ó·Ó ‰ÂÎÙ¿ Ì ÂÓıÔ˘ÛÈ·ÛÌfi ·fi ÙÔ˘˜ Ë·ÙÔÏfiÁÔ˘˜
·Ó¿ ÙÔÓ ÎfiÛÌÔ ˆ˜ ÛËÌ·ÓÙÈ΋˜ ÎÏÈÓÈ΋˜ ÛËÌ·Û›·˜
Î·È Û¯ÔÏÈ¿ÛıËÎ·Ó ˆ˜ ¤Ó· ÌÂÁ¿ÏÔ ‚‹Ì· ÛÙËÓ ÂÚÌË-
Ó›· Ù˘ Û¯¤Û˘ ÂÓÙ¤ÚÔ˘-‹·ÙÔ˜64.
™ÙË ‰Â‡ÙÂÚË ÌÂϤÙË Ô˘ ¤ÁÈÓ ÛÙËÓ ∞˘ÛÙÚ·-
Ï›·65 30 ÎÈÚÚˆÙÈÎÔ› ¤Ï·‚·Ó Synbiotic 2000 ‹ pla-
cebo ÁÈ· ÌfiÏȘ 7 Ë̤Ú˜. ∞ÍÈÔÏÔÁ‹ıËÎ·Ó ÚÈÓ Î·È
ÌÂÙ¿ ÙË ıÂÚ·›· ÔÈ ˙ˆÓÙ·Ó¤˜ ·ÔÈ˘ Lactoba-
cillus ÛÙ· ÎfiÚ·Ó·, ÙÔ ÛÙ¿‰ÈÔ Ù˘ ΛÚÚˆÛ˘ ηٿ
Child-Pugh, Ë Î·Ù·ÎÚ¿ÙËÛË ÙÔ˘ Ú¿ÛÈÓÔ˘ Ù˘ ÈÓ-
‰Ô΢·Ó›Ó˘ ÛÙÔ Ï¿ÛÌ·, ÙÔ mRNA ÙÔ˘ TNF-· ηÈ
IL-6 Û ÔÏÈÎfi ·›Ì·, Ô TNF-· ÛÙÔÓ ÔÚfi, Ô ‰È·Ï˘Ùfi˜
˘Ô‰Ô¯¤·˜ I Î·È II ÙÔ˘ TNF [sTNFR-I, sTNFR-II]
Î·È Ù· Â›‰· IL-6 Î·È ÂÓ‰ÔÙÔ͛Ӣ ÛÙÔ Ï¿ÛÌ·.
∏ ıÂÚ·›· Ì Synbiotic 2000 ¤‰ÂÈÍ fiÙÈ ·˘Í¿ÓÂÈ
ÛËÌ·ÓÙÈο ÙȘ ·ÔÈ˘ Á·Ï·ÎÙÔ‚·Î›ÏˆÓ ÛÙ· Îfi-
Ú·Ó· Î·È ‚ÂÏÙÈÒÓÂÈ ÙËÓ Î¿ı·ÚÛË ÙÔ˘ Ú¿ÛÈÓÔ˘
Ù˘ ÈÓ‰Ô΢·Ó›Ó˘ Î·È ÙËÓ ÎÏÈÓÈ΋ ηٿÛÙ·ÛË Î·Ù¿
Child-Pugh. ∂›Û˘ ·˘Í¿ÓÂÈ ÛËÌ·ÓÙÈο ÙÔ mRNA
ÙÔ˘ TNF-· Î·È IL-6 ÛÙÔ ÔÏÈÎfi ·›Ì·, ·Ú¿ÏÏËÏ· ÌÂ
Ù· Â›‰· ÛÙÔÓ ÔÚfi ÙˆÓ sTNFR-I Î·È –II, fiˆ˜
Î·È ÙˆÓ TNF-· Î·È IL-6. ∏ ‚ÂÏÙ›ˆÛË Ù˘ οı·ÚÛ˘
Ù˘ ÈÓ‰Ô΢·Ó›Ó˘ ÛÙËÓ ÔÌ¿‰· ÙˆÓ Û˘Ì‚ÈÔÙÈÎÒÓ
Û¯ÂÙ›˙ÂÙ·È ÛËÌ·ÓÙÈο Ì ÌÂÙ·‚ÔϤ˜ Ù˘ IL-6 ÙfiÛÔ
Û Â›Â‰Ô mRNA fiÛÔ Î·È ÚˆÙ½Ó˘, ·ÏÏ¿ ›ӷÈ
¿Û¯ÂÙË ·fi Ù· Â›‰· ÂÓ‰ÔÙÔ͛Ӣ ÛÙÔ Ï¿ÛÌ·.
∞ÓÙ›ıÂÙ·, ÛÙËÓ ÔÌ¿‰· placebo ‰ÂÓ ·Ú·ÙËÚ‹ıËÎÂ
η̛· ÌÂÙ·‚ÔÏ‹. ™˘ÌÂÚ·›ÓÂÙ·È ÏÔÈfiÓ fiÙÈ ·ÎfiÌË
Î·È Ë ‚Ú·¯‡¯ÚÔÓË ıÂÚ·›· ÌÂ Û˘Ì‚ÈÔÙÈο ÙÚÔÔ-
ÔÈ› ÛËÌ·ÓÙÈο ÙËÓ ÂÓÙÂÚÈ΋ ¯ÏˆÚ›‰· Î·È ‚ÂÏÙÈÒ-
ÓÂÈ ÙË ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ· ÙÔ˘ ‹·ÙÔ˜ Û ·ÛıÂÓ›˜ ÌÂ
ΛÚÚˆÛË65.
™˘Á¯ÚfiÓˆ˜, ¤ÁÈÓ·Ó Î·È ¿ÏϘ 4 ÌÂϤÙ˜. ∂›ÎÔ-
ÛÈ ‰‡Ô ·ÛıÂÓ›˜ Ì ÌË ·ÏÎÔÔÏÈ΋˜ ·ÈÙÈÔÏÔÁ›·˜ ÏÈ-
҉˜ ‹·Ú [NAFLD], 20 Ì ·ÏÎÔÔÏÈ΋ ΛÚÚˆÛË
[AC] Î·È 36 ÔÚÔıÂÙÈÎÔ› ÛÙËÓ Ë·Ù›Ùȉ· C [HCV+],
¤Ï·‚·Ó ÁÈ· 3 Ì‹Ó˜ 45Ã1010 ‚·ÎÙ‹ÚÈ· ÙÔ˘ Û΢¿-
ÛÌ·ÙÔ˜ VSL#3, ÙÔ ÔÔ›Ô ÂÚȤ¯ÂÈ Streptococcus
thermophilus, Bifidobacterium breve, Bifidobacte-
rium longum, Bifidobacterium infantis, Lactobacillus
acidophilus, Lactobacillus plantarum, Lactobacillus
43
casei Î·È Lactobacillus bulgaricus66. ™ÙÔ Ù¤ÏÔ˜ Ù˘
ÌÂϤÙ˘ ·Ú·ÙËÚ‹ıËΠ‚ÂÏÙ›ˆÛË ÛÙÔ˘˜ ‰Â›ÎÙ˜
ÙÔ˘ Ï¿ÛÌ·ÙÔ˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙË ÏÈȉȷ΋
˘ÂÚÔÍ›‰ˆÛË – malondialdehyde [MDA] Î·È 4-
hydroxynonenal [4-HNE] – ÛÙȘ ÔÌ¿‰Â˜ NAFLD
Î·È AC ·ÏÏ¿ fi¯È Î·È ÛÙËÓ HCV+. ∞ÓÙ›ıÂÙ·, Ù·
Â›‰· ÙˆÓ ÊÏÂÁÌÔÓˆ‰ÒÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ [TNF-·,
IL-6 Î·È IL-10] ‚ÂÏÙÈÒıËÎ·Ó ÌfiÓÔ ÛÙÔ˘˜ ·ÛıÂÓ›˜
Ì ·ÏÎÔÔÏÈ΋ ΛÚÚˆÛË, ÂÓÒ Ù· Ë·ÙÈο ¤Ó˙˘Ì·
‚ÂÏÙÈÒıËÎ·Ó Û fiϘ ÙȘ ÔÌ¿‰Â˜, ‰ÂÓ ˘¿Ú¯Ô˘Ó
fï˜ ÏËÚÔÊÔڛ˜ Û¯ÂÙÈο Ì ÙË ‰Ú¿ÛË ÙÔ˘ ÛÙËÓ
ÂÁÎÂÊ·ÏÔ¿ıÂÈ· ‹ ÙȘ ÏÔÈÌÒÍÂȘ.
™ËÌ·ÓÙÈ΋ ‚ÂÏÙ›ˆÛË ÛÙÔÓ ·ÔÈÎÈÛÌfi ÙÔ˘ ÂÓÙ¤-
ÚÔ˘ [p<0,001] Î·È Ù¿ÛË ÁÈ· ÌÈÎÚfiÙÂÚÔ˘ ‚·ıÌÔ‡
ÂÓ‰ÔÙÔÍÈÓ·ÈÌ›· [p=0,07] Î·È ÎÏÈÓÈ΋ ‚ÂÏÙ›ˆÛË Î·-
Ù¿ Child-Pugh [p=0,06] ·Ó·Ê¤ÚıËΠ۠39 ·ÛıÂ-
Ó›˜ Ì ΛÚÚˆÛË Ô˘ ¤Ï·‚·Ó ›Ù E.coli Nissle ‹
placebo ÁÈ· 42 Ë̤Ú˜. ŸÌˆ˜ Â›Û˘ ‰ÂÓ ˘¿Ú¯ÂÈ
η̛· ÏËÚÔÊÔÚ›· ÁÈ· Ù· ·ÔÙÂϤÛÌ·Ù· Â› Ù˘
ÂÁÎÂÊ·ÏÔ¿ıÂÈ·˜67.
ŒÓ· ¿ÏÏÔ Û··ÛÌ· Ì Bifidobacterium lon-
gum + 2,5 g ÊÚÔ˘ÎÙÔ-ÔÏÈÁÔ۷ί·Ú›Ù˜ [FOS] ‹
placebo ¯ÔÚËÁ‹ıËΠÁÈ· 90 Ë̤Ú˜ Û 60 ÎÈÚÚˆÙÈ-
ÎÔ‡˜. ¶·Ú·ÙËÚ‹ıËΠÛËÌ·ÓÙÈ΋ Ì›ˆÛË [p=0,003]
Ù˘ ·Ì̈ӛ·˜ ÛÙÔ ·›Ì·, Î·È ‚ÂÏÙ›ˆÛË ÛÙË ‚·ıÌÔ-
ÏÔÁ›· ÛÙ· ‰È·ÊfiÚ· Ó¢ÚÔ„˘¯È·ÙÚÈο ÙÂÛÙ [Trail
Making Test-A & B, symbol digit modalities, test
block design p=,000] Î·È ÛÙÔ Mini Mental State E-
xamination [MMSE] ÛÙ· ÔÔ›· ˘Ô‚Ï‹ıËÎ·Ó ÔÈ
·ÛıÂÓ›˜68.
¶ÚfiÛÊ·Ù·69 ÂÌÊ·Ó›ÛıËÎÂ Î·È ÌÈ· ÌÈÎÚ‹ ÌÂϤ-
ÙË Ì 12 ·ÛıÂÓ›˜ Ì ΛÚÚˆÛË ·ÏÎÔÔÏÈ΋˜ ·ÈÙÈÔÏÔ-
Á›·˜. ∞˘ÙÔ› ¤Ï·‚·Ó 3 ÊÔÚ¤˜ ÙËÓ Ë̤ڷ Â› 4 ‚‰Ô-
Ì¿‰Â˜ —ˆ˜ Û˘Ìϋڈ̷ ‰È·ÙÚÔÊ‹˜— 65 mL ÂÓfi˜
ÚÔ‚ÈÔÙÈÎÔ‡ ÚÔÊ‹Ì·ÙÔ˜ Ô˘ ÂÚÈ›¯Â Lb casei Shi-
rota. ™ÙÔ Ù¤ÏÔ˜ ÙÔ˘ ¯ÚfiÓÔ˘ ÌÂϤÙ˘ Ê¿ÓËΠfiÙÈ Ë Ê·-
ÁÔ΢ÙÙ·ÚÈ΋ ÈηÓfiÙËÙ· ÙˆÓ Ô˘‰ÂÙÂÚfiÊÈÏˆÓ Â-
·Ó‹Ïı ÛÙ· Ê˘ÛÈÔÏÔÁÈο Ù˘ fiÚÈ·, ÂÓÒ ·Ú¯Èο
‹Ù·Ó ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚË, Û ۯ¤ÛË Ì ÙÔ˘˜ ˘ÁÈ-
›˜ [73% versus 98%, p<0,05]. ∂›Û˘, ÔÌ·ÏÔÔÈ‹-
ıËÎÂ Ë ¤ÎÊÚ·ÛË ÙÔ˘ ·Ú¿ÁÔÓÙ· TLR4, ·ÏÏ¿ fi¯È ηÈ
ÙˆÓ TLR2 Î·È 9, ÔÈ ÔÔ›ÔÈ ·ÚÔ˘Û›·˙·Ó ˘ÂÚ¤Î-
ÊÚ·ÛË ÛÙËÓ ·Ú¯‹ Ù˘ ÌÂϤÙ˘. ∞ÓÙ›ıÂÙ·, Ô ‰È·Ï˘Ùfi˜
˘Ô‰Ô¯¤·˜ 1 Î·È 2 ÙÔ˘ TNF [sTNFR-1 Î·È -2] Î·È Ë
IL-10 ÛÙÔ Ï¿ÛÌ·, Ô˘ ‹Ù·Ó ·Ú¯Èο ÛËÌ·ÓÙÈο ·˘-
ÍË̤ÓÔÈ ‰Â ÌÂÙ·‚Ï‹ıËÎ·Ó ·fi ÙË ıÂÚ·›·. º˘ÛÈ-
ο, fiˆ˜ ‹Ù·Ó ·Ó·ÌÂÓfiÌÂÓÔ ‰ÂÓ ˘‹ÚÍ η̛· ÌÂ-
Ù·‚ÔÏ‹ ÛÙËÓ ÔÌ¿‰· ÙˆÓ ˘ÁÈÒÓ Ì·ÚÙ‡ÚˆÓ.
44 S. BENGMARK
∂¶I§√°√™
∏ Á‹Ú·ÓÛË Î·È Ù· ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù· Û¯ÂÙ›˙ÔÓÙ·È ÌÂ
·˘ÍË̤ÓË ·Ô‰ÈÔÚÁ¿ÓˆÛË ÙˆÓ ÏÂÈÙÔ˘ÚÁÈÒÓ ÙÔ˘
Ó¢ÚÔ-ÂÓ‰ÔÎÚÈÓÈÎÔ‡ ¿ÍÔÓ·, Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·‡-
ÍËÛË ÙˆÓ ÂΉËÏÒÛÂˆÓ ÊÏÂÁÌÔÓÒ‰Ô˘˜ ·ÓÙ›‰Ú·-
Û˘13,14,17.
∞˘Ùfi Âȉڿ ÛÙËÓ ÂÓÙÂÚÈ΋ ¯ÏˆÚ›‰·, Ì ·ÔÙ¤-
ÏÂÛÌ· ÙË Ì›ˆÛ‹ Ù˘, ÙfiÛÔ ÛÙËÓ ÔÈÎÈÏÔÌÔÚÊ›· Ù˘
fiÛÔ Î·È ÛÙÔÓ ·ÚÈıÌfi Ù˘. ∏ ÂÁÎÂÊ·ÏÔ¿ıÂÈ· ·Ó·-
ÁÓˆÚ›˙ÂÙ·È ÔÏÔ¤Ó· Î·È ÂÚÈÛÛfiÙÂÚÔ ˆ˜ ¤Ó· ‚·ÛÈÎfi
ÁÓÒÚÈÛÌ· Û ÔÏÏ¿ ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù· ¤Ú·Ó Ù˘
ΛÚÚˆÛ˘ Î·È Ê·›ÓÂÙ·È fiÙÈ ¤¯ÂÈ ¿ÌÂÛË ÈÛ¯˘Ú‹ Û˘-
Û¯¤ÙÈÛË Ì ‰È·ÊÔÚÂÙÈ΋˜ ·ÈÙÈÔÏÔÁ›·˜, ·ÏÏ¿ ÔˆÛ-
‰‹ÔÙ ÂÈ̤ÓÔ˘Û·˜ ÂΉ‹ÏˆÛ˘ Û˘ÛÙËÌ·ÙÈ΋˜
ÊÏÂÁÌÔÓÒ‰Ô˘˜ ·ÓÙ›‰Ú·Û˘. ∏ Û˘Ó¯‹˜ ¯ÔÚ‹ÁËÛË
ÚÔ‚ÈÔÙÈÎÒÓ Î·È Û˘Ì‚ÈÔÙÈÎÒÓ, ·ÏÏ¿ Â›Û˘ Ê˘ÙÈÎÒÓ
ÈÓÒÓ Î·È ·ÓÙÈÔÍÂȉˆÙÈÎÒÓ, ·Ú¤¯ÂÈ ÌÈ· ÔÏÏ¿ ˘Ô-
Û¯fiÌÂÓË ÂÓ·ÏÏ·ÎÙÈ΋ χÛË ÛÙËÓ ÚÔÛ¿ıÂÈ· ηٷ-
ÛÙÔÏ‹˜ Ù˘ ÊÏÂÁÌÔÓ‹˜, ÛÙË Ì›ˆÛË Ù˘ ·Ó¿Ù˘Í˘
¿ÏÏˆÓ ¯ÚfiÓÈˆÓ ÓÔÛËÌ¿ÙˆÓ ‹ ÂÈÏÔÎÒÓ ÙÔ˘˜ ηÈ
ÛÙË ‚ÂÏÙ›ˆÛË Ù˘ ÔÈfiÙËÙ·˜ ˙ˆ‹˜ ÙˆÓ ·ÛıÂÓÒÓ ·˘-
ÙÒÓ. Œ¯ÂÈ ÌÂÁ¿ÏË ÛËÌ·Û›· ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ë Ì›ˆÛË
Ù˘ ÊÏÂÁÌÔÓ‹˜ ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË Synbiotic 2000,
fiˆ˜ Ê¿ÓËΠ·fi ÙË Ì›ˆÛË ÙˆÓ ‰ÂÈÎÙÒÓ ÊÏÂÁÌÔ-
Ó‹˜70, ı· ÌÔÚÔ‡Û ӷ ÂϤÁÍÂÈ ÙÔ Úfi‚ÏËÌ· ÙˆÓ ÌÂ-
ÙÂÁ¯ÂÈÚËÙÈÎÒÓ ÏÔÈÌÒ͈Ó, fiˆ˜ ·˘ÙÒÓ ÌÂÙ¿ ·fi
ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜71. ∞˘Ùfi ·ÔÙÂÏ› ÌÈ· ÌÂÁ¿ÏË
ÂÏ›‰· ÁÈ· ÙÔ Ì¤ÏÏÔÓ.
E˘¯·ÚÈÛٛ˜
∂Èı˘ÌÒ Ó· ¢¯·ÚÈÛÙ‹Ûˆ ÙË ¯ÂÈÚÔ˘ÚÁfi Î. ∫·ÙÂÚ›-
Ó· ∫ÔÙ˙¿Ì·ÛË ÁÈ· ÙË ‚Ô‹ıÂÈ¿ Ù˘ ÛÙË ÌÂÙ¿ÊÚ·ÛË
Î·È ‰È·Û΢‹ ÙÔ˘ ¿ÚıÚÔ˘ ·˘ÙÔ‡.
ABSTRACT
μengmark S. Bio-ecological control of chronic li-
ver disease and encephalopathy. Hell Iatr 2009, 75:
38-46.
Chronic diseases are accompanied by an in-
creased level of systemic inflammation, which in-
creases the risk of development of other chronic
diseases, but also the risk of development of serious
complications such as infection, osteoporosis and
encephalopathy. These complications are common
in liver cirrhosis, but are also often seen in diabetes
and in chronic lung and chronic renal disease. Pro-
biotics have in recent years been increasingly used
in liver cirrhosis, with the aim to suppress inflam-
mation and reduce the risk of the above complica-
tions. This review summarizes and discusses the ex-
perience from such studies. Administration, for one
month, of a combination of four lactic acid bacteria
and four prebiotic fibres (Synbiotic 2000) signifi-
cantly reduces the incidence of encephalopathy,
and, most remarkably, also improves the stage of
liver cirrhosis in more than 50% of treated patients.
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∞ÏÏËÏÔÁÚ·Ê›·:
Stig Bengmark
185 Barrier Point Road, Pontoon Docks
London, E16 2SE, United Kingdom
Tel. & fax +44 20 7511 6842
s.bengmark@ucl.ac.uk
Corresponding Author:
Stig Bengmark
185 Barrier Point Road, Pontoon Docks
London, E16 2SE, United Kingdom
Tel. & fax +44 20 7511 6842
s.bengmark@ucl.ac.uk
∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 2009, 75, 1: 47- 56
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ÔÛÔÛÙfi ˘¤Ú‚·ÚˆÓ Î·È ·¯‡Û·ÚÎˆÓ ·ÙfïÓ
ÛÙÔ˘˜ ÂÓ‹ÏÈΘ Ì ηٷÓÔÌ‹ ·Ó¿ÏÔÁ· Ì ÙÔ Ê‡ÏÔ,
ηıÒ˜ Â›Û˘ ÛÙ· ·È‰È¿ Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜2.
∏ ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· ÙˆÓ ˘¤Ú‚·ÚˆÓ ηÈ
·¯‡Û·ÚÎˆÓ ·ÙfiÌˆÓ ·Ô‰›‰ÂÙ·È ·Ê’ ÂÓfi˜ ÛÙËÓ ˘-
ÂÚηٷӿψÛË ÙÚÔÊÒÓ ÏÔ˘Û›ˆÓ Û ˘‰·Ù¿ÓıÚ·-
Θ Î·È Ï›Ë ·Ê’ ¤ÙÂÚÔ˘ ÛÙÔ Û‡Á¯ÚÔÓÔ ÙÚfiÔ ˙ˆ‹˜,
Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ·Ô˘Û›· ΛÓËÛ˘ ηÈ
Û˘ÌÌÂÙÔ¯‹˜ ÛÙȘ ·ıÏËÙÈΤ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜3.
∂›Ó·È ÁÓˆÛÙfi fiÙÈ Ë ‚·ÛÈ΋ ıÂÚ·›· Ù˘ ·-
¯˘Û·ÚΛ·˜ ÂÚÈÏ·Ì‚¿ÓÂÈ: 1) ÙËÓ ÔÏÈÁÔıÂÚÌȉÈ΋
‰›·ÈÙ· 2) ÙËÓ ·˘ÍË̤ÓË ÛˆÌ·ÙÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ·
3) ÙËÓ ÙÚÔÔÔ›ËÛË Ù˘ Û˘ÌÂÚÈÊÔÚ¿˜ ÙÔ˘ ·ÙfiÌÔ˘
fiÙ·Ó ˘¿Ú¯ÂÈ Úfi‚ÏËÌ·4 (EÈÎ. 1).
∞Ó ÔÈ ·Ú·¿Óˆ ıÂÚ·¢ÙÈΤ˜ ̤ıÔ‰ÔÈ ·Ô-
Ù‡¯Ô˘Ó ÙfiÙ ÚÔÛÙ›ıÂÙ·È Ë Ê·Ú̷΢ÙÈ΋ ıÂÚ·-
›· ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ˘¤Ú‚·ÚˆÓ ·Ùfi-
ÌˆÓ ÌÂ Û˘Ó˘¿Ú¯Ô˘Û˜ ·ı‹ÛÂȘ fiˆ˜ ˘¤ÚÙ·ÛË,
‰˘ÛÏÈȉ·ÈÌ›·, ۷ί·Ú҉˘ ‰È·‚‹Ù˘, ηډȷο
Ûı¤Ó ‚¿ÚÔ˜ ÌÂÙ¿ ÙËÓ ‰È·ÎÔ‹ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘. ∏
·fiÊ·ÛË Ù˘ ¤Ó·Ú͢ Ê·Ú̷΢ÙÈ΋˜ ıÂÚ·›·˜ ÁÈ·
ÙËÓ ·¯˘Û·ÚΛ· Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÌÂÙ¿ ·fi ÚÔÛÂ-
ÎÙÈ΋ ÂÎÙ›ÌËÛË ÙˆÓ ÏÂÔÓÂÎÙËÌ¿ÙˆÓ Î·È ÙˆÓ ·ÚÂ-
ÓÂÚÁÂÈÒÓ Ù˘.
EÏÏËÓ I·ÙÚ 2009, 75: 47 - 56.
ÓÔÛ‹Ì·Ù·.
∏ ¯ÚËÛÈÌÔÔ›ËÛË ÂÓfi˜ Ê·ÚÌ¿ÎÔ˘ ÛÙË ıÂÚ·-
¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ·¯˘Û·ÚΛ·˜ ··ÈÙ› ‰˘Ô
ÚÔ¸Ôı¤ÛÂȘ 1) Ó· Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈÎfi 2) Ó· ›-
Ó·È ·ÛʷϤ˜5.
∏ ·Ó¿ÁÎË ¯ÚËÛÈÌÔÔ›ËÛ˘ Ù˘ Ê·Ú̷΢ÙÈ-
΋˜ ıÂÚ·›·˜ ÚÔ¤Ú¯ÂÙ·È ·fi Ù· ·ÔÙÂϤÛÌ·Ù·
‰˘Ô ·Ú·ÙËÚ‹ÛˆÓ: 1) ÔÈ ·ÛıÂÓ›˜ ÌÂÙ¿ ·fi ̤-
ÙÚÈ· ·ÒÏÂÈ· ‚¿ÚÔ˘˜ ÂÌÊ·Ó›˙Ô˘Ó “plateaux” ÛÙ·-
ÛÈÌfiÙËÙ·˜ ÛÙËÓ ÂÚ·ÈÙ¤Úˆ ·ÒÏÂÈ· ‚¿ÚÔ˘˜. ™ÙË
ÛÙ·ÛÈÌfiÙËÙ· ·˘Ù‹ Û˘Ì‚¿ÏÔ˘Ó ·ÓÙÈÚÚÔÈÛÙÈÎÔ› ÌË-
¯·ÓÈÛÌÔ› Ô˘ Û˘ÓÔÙÈο ›ӷÈ: Ë Ì›ˆÛË Ù˘ ÙÚȈ-
‰Ôı˘ÚÔÓ›Ó˘ 3 (Δ3), Ù˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÙÔ˘ Û˘-
Ì·ıËÙÈÎÔ‡, ÙÔ˘ ‚·ÛÈÎÔ‡ ÌÂÙ·‚ÔÏÈÛÌÔ‡ Î·È Ù˘
ÏÂÙ›Ó˘ Ô˘ ·˘Í¿ÓÂÈ ÙËÓ Â˘·ÈÛıËÛ›· ÙˆÓ ÈÛÙÒÓ
ÛÙËÓ ÈÓÛÔ˘Ï›ÓË Î·È ÙËÓ ÏÈÔÁ¤ÓÂÛË, ηıÒ˜ Î·È Ë
·‡ÍËÛË Ù˘ ÁÎÚÂÏ›Ó˘ Ô˘ ÚÔηÏ› ·‡ÍËÛË Ù˘
fiÚÂ͢6. ŸÏÔÈ ÔÈ ·Ú·¿Óˆ ·ÓÙÈÚÚÔÈÛÙÈÎÔ› ÌË-
¯·ÓÈÛÌÔ› ‰È¢ÎÔχÓÔ˘Ó ÙËÓ Â·Ó¿ÎÙËÛË ÙÔ˘ ·Ô-
ÏÂÛı¤ÓÙÔ˜ ‚¿ÚÔ˘˜.
2) OÈ ÂÚÈÛÛfiÙÂÚÔÈ ·ÛıÂÓ›˜ Â·Ó·ÎÙÔ‡Ó ÙÔ
·ÔÏÂÛı¤Ó ‚¿ÚÔ˜ Ì ÙËÓ ‰È·ÎÔ‹ Ù˘ ıÂÚ·›·˜.
∏ ¤Ó·ÚÍË Ù˘ Ê·Ú̷΢ÙÈ΋˜ ıÂÚ·›·˜ ÚÔ-
¸Ôı¤ÙÂÈ ÙËÓ ÂÎÙ›ÌËÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ Î·È ÙÔ˘ Ôʤ-
ÏÔ˘˜ ·fi ÙË ¯Ú‹ÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘.
48 ª. ª¶OÀ°OÀ§π∞, ∏. ∂À£ÀªπOÀ
∂ÈÎ. 1. EÓÂÚÁÂÈ·Îfi ÈÛÔ˙‡ÁÈÔ.
OÈ ÂӉ›ÍÂȘ Ù˘ Ê·Ú̷΢ÙÈ΋˜ ıÂÚ·›·˜
·ÊÔÚ¿ ˘¤Ú‚·Ú· ¿ÙÔÌ· μªπ 25-29,9 kg/m2 Ì ÎÂ-
ÓÙÚÈ΋ ηٷÓÔÌ‹ ÙÔ˘ Ï›Ô˘˜ Î·È ÂÚ›ÌÂÙÚÔ Ì¤Û˘
ÁÈ· ÙÔ˘˜ ¿ÓÙÚ˜>102 cm Î·È ÁÈ· ÙȘ Á˘Ó·›Î˜ >88
cm, ˘¤Ú‚·Ú· ¿ÙÔÌ· Ì μªπ 27-29,9 kg/m2 ÌÂ Û˘-
Ó˘¿Ú¯Ô˘Û˜ ·ı‹ÛÂȘ fiˆ˜ ™¢2, ‰˘ÛÏÈȉ·ÈÌ›·,
˘¤ÚÙ·ÛË Î·È Î·Ú‰È·Î¿ ÓÔÛ‹Ì·Ù·5,7.
¶·¯‡Û·Úη ¿ÙÔÌ· Ì μªπ >30 kg/m2 Ì ۇÓ-
‰ÚÔÌÔ ˘ÓÈ΋˜ ¿ÓÔÈ·˜ Î·È ·ÛıÂÓ›˜ ·¯‡Û·ÚÎÔÈ
˘Ô„‹ÊÈÔÈ Ó· ˘Ô‚ÏËıÔ‡Ó Û ‚·ÚÈ·ÙÚÈΤ˜ ÂÂÌ-
‚¿ÛÂȘ - ¶ÚÔ¸fiıÂÛË ¤Ó·Ú͢ Ù˘ Ê·Ú̷΢ÙÈ΋˜
ıÂÚ·›·˜ Â›Ó·È Ë ÛÙÂÓ‹ Û˘ÓÂÚÁ·Û›· ÁÈ·ÙÚÔ‡ ηÈ
·ÛıÂÓ‹ ÁÈ· ÙÔÓ Î·ıÔÚÈÛÌfi Ù˘ ÂÊÈÎÙ‹˜ ·ÒÏÂÈ·˜
‚¿ÚÔ˘˜ Î·È fi¯È Ù˘ ȉ·ÓÈ΋˜.
∏ ÂÈÙ˘¯›· Ù˘ Ê·Ú̷΢ÙÈ΋˜ ıÂÚ·›·˜ ¯·-
Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÙÔÓ ‚·ıÌfi Ù˘ ·ÒÏÂÈ·˜ ‚¿ÚÔ˘˜
Î·È ÙËÓ ‚ÂÏÙ›ˆÛË ÙˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘.
O ‚·ıÌfi˜ Ù˘ ·ÒÏÂÈ·˜ ‚¿ÚÔ˘˜ ÁÈ· Ó· ›ӷÈ
ÈηÓÔÔÈËÙÈÎfi˜ Ú¤ÂÈ Ó· ÏËÚÔ› Ù· ÎÚÈÙ‹ÚÈ·8:
1Ô Ì‹Ó· ·ÒÏÂÈ· ‚¿ÚÔ˘˜ 2 kg
ΔÔÓ 3Ô-6Ô Ì‹Ó· 5% ÙÔ˘ ·Ú¯ÈÎÔ‡ ‚¿ÚÔ˘˜
‹ 5-10% ıˆÚÂ›Ù·È Î·Ï‹ ·¿ÓÙËÛË
‹ 10-15% » Ôχ ηϋ ·¿ÓÙËÛË
‹ 15% ¿ÚÈÛÙË ·¿ÓÙËÛË
∏ ‚ÂÏÙ›ˆÛË ÙˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓˆÓ ·ÊÔÚ¿
ÙËÓ ÂÏ¿ÙÙˆÛË Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘, ÙˆÓ ÏÈȉ›ˆÓ,
Ù˘ ·ÓÙ›ÛÙ·Û˘ ÛÙËÓ ÈÓÛÔ˘Ï›ÓË Î·È Ù˘ ˘ÂÚÁÏ˘-
ηÈÌÈ·˜5.
ÃÚ‹ÛÈ̘ ÂÈÛËÌ¿ÓÛÂȘ Ô˘ Ú¤ÂÈ Ó· ¤¯ÂÈ ˘fi-
„Ë ÙÔ˘ Ô ıÂÚ¿ˆÓ ÁÈ·ÙÚfi˜ ›ӷÈ:
1ÔÓ ∏ ıÂÚ·›· ‰ÂÓ ıÂÚ·‡ÂÈ ÙËÓ ·¯˘Û·Ú-
Λ·
2ÔÓ ∏ ÂÓË̤ڈÛË ÙÔ˘ ·ÛıÂÓ‹ fiÙÈ Ë ·ÒÏÂÈ·
‚¿ÚÔ˘˜ ‰ÂÓ Û˘Ó¯›˙ÂÙ·È fiÙ·Ó ÂÈÙ¢¯ı› ÙÔ Ì¤ÁÈ-
ÛÙÔ ıÂÚ·¢ÙÈÎfi ·ÔÙ¤ÏÂÛÌ·
3ÔÓ ∏ Â›Ù¢ÍË Ù˘ ‰È·Ù‹ÚËÛ˘ Ù˘ ·ÒÏÂÈ·˜
‚¿ÚÔ˘˜ Â›Ó·È ‰‡ÛÎÔÏË ˘fiıÂÛË
1. ™˘Ì·ıËÙÈÎÔÌÈÌËÙÈο
™ÈÌÔ˘ÙÚ·Ì›ÓË
2. º¿Ú̷η Ô˘ ÂËÚ¿˙Ô˘Ó ÙËÓ ·ÔÚÚfiÊËÛË ÙÔ˘ Ï›-
Ô˘˜
OÚÏÈÛÙ¿ÙË
3. ∂Ó‰ÔηÓÓ·‚ÈÓÔÂȉ¤˜ Û‡ÛÙËÌ·
ƒÔÌfiÓ·Ì·ÓÙ
4. ™·Î¯. ¢È·‚‹ÙË
ªÂÙÊÔÚÌ›ÓË
ªÚ·ÌÏÈÓÙ›‰Ë
∂ÍÂÓ·Ù›ÓË
5. ∞ÓÙÈηٷıÏÈÙÈο
ºÏÔ˘ÔÍÂÙ›ÓË
ªÔ˘ÚÔÈfiÓË
6. ∞ÓÙÈÂÈÏËÙÈο
ΔÔÈÚ·Ì¿ÙË
7. ™˘ÌÏËÚÒÌ·Ù· ‰›·ÈÙ·˜
8. ¶ÂÈÚ·Ì·ÙÈο Ê¿Ú̷η
¶ÂÙ›‰È·
§ÂÙ›ÓË
¶ÂÙ›‰ÈÔ ÀÀ
O͢ÓÙÔÌÔÓÙÔ˘Ï›ÓË
∞ÁˆÓÈÛÙ‹˜ ÙÔ˘ ˘Ô‰Ô¯¤· Ù˘ ÌÂÏ·ÓÔÎÔÚÙ›Ó˘-4
∂ÈÎ. 2. º¿Ú̷η ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ·¯˘Û·ÚΛ·˜.
4ÔÓ ∏ ‰È·ÎÔ‹ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Û˘Ó‰˘¿˙ÂÙ·È
ÔÏϤ˜ ÊÔÚ¤˜ Ì Â·Ó¿ÎÙËÛË ÙÔ˘ ·ÔÏÂÛı¤ÓÙÔ˜
‚¿ÚÔ˘˜9.
Δ· Ê¿Ú̷η Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÁÈ· ÙËÓ
·ÓÙÈÌÂÙÒÈÛË Ù˘ ·¯˘Û·ÚΛ·˜ ÂÚÈÁÚ¿ÊÔÓÙ·È
ÛÙËÓ ÂÈÎfiÓ· 2, ÂÓÒ ·˘Ù¿ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È
ÛÙËÓ Î·ıËÌÂÚÈÓ‹ Ú·ÎÙÈ΋ Î·È Î˘ÎÏÔÊÔÚÔ‡Ó ÛÙËÓ
¯ÒÚ· Ì·˜ ›ӷÈ:
∏ ÛÈÌÔ˘ÙÚ·Ì›ÓË, Ë ÔÚÏÈÛÙ¿ÙË Î·È ÙÔ ÚÈÌfiÓ·-
Ì·ÓÙ.
∏ ÌÂÙÊÔÚÌ›ÓË ·Ó Î·È ‰ÂÓ ·Ó‹ÎÂÈ ÛÙËÓ ·ÌÈÁ‹
ηÙËÁÔÚ›· ÙˆÓ Ê·ÚÌ¿ÎˆÓ Ô˘ ÚÔηÏÔ‡Ó ÂÏ¿ÙÙˆ-
ÛË ÙÔ˘ ‚¿ÚÔ˘˜ ÙÔ˘ ÛÒÌ·ÙÔ˜ ηٿ 5% ÙÔ˘ ·Ú¯ÈÎÔ‡
‚¿ÚÔ˘˜ ÛÙÔ ÚÒÙÔ ÂÍ¿ÌËÓÔ Û˘ÌÂÚÈÏ·Ì‚¿ÓÂÙ·È
ÛÙËÓ Î·ÙËÁÔÚ›· ·˘Ù‹, ÁÈ· ÔÌ¿‰· ·ÙfiÌˆÓ Ô˘ ¿-
Û¯Ô˘Ó ·fi ·¯˘Û·ÚΛ·, ·ÓÙ›ÛÙ·ÛË ÛÙËÓ ÈÓÛÔ˘Ï›ÓË
Î·È Úԉȷ‚ËÙÈ΋ ηٿÛÙ·ÛË - ‰È·Ù·Ú·Á̤ÓË ÁÏ˘-
Îfi˙Ë ÓËÛÙ›·˜ (IFG), ‰È·Ù·Ú·Á̤ÓË ·ÓÔ¯‹ ÛÙË
ÁÏ˘Îfi˙Ë (IGT).
– ∞fi ÙȘ ˘fiÏÔÈ˜ ηÙËÁÔڛ˜ Ê·Ú̿ΈÓ
·Ú¿ ÙȘ ÔÏϤ˜ ÌÂϤÙ˜ ·Ú·ÙËÚ‹ÛˆÓ, ÚÔ˜ ÙÔ
·ÚfiÓ, ‰ÂÓ ¤¯Ô˘Ó ÂÍ·¯ı› ·ÔÙÂϤÛÌ·Ù· Ô˘ Ù·
ηıÈÂÚÒÓÔ˘Ó ÛÙËÓ Î·ıËÌÂÚÈÓ‹ ÙÔ˘˜ ¯Ú‹ÛË
– ™ÙË Û˘Ó¤¯ÂÈ· ·Ú·Ù›ıÂÓÙ·È Û˘ÓÔÙÈο Ù·
·ÔÙÂϤÛÌ·Ù· Ù˘¯·ÈÔÔÈË̤ӈÓ-ÂÏÂÁ¯fiÌÂÓˆÓ Ô-
Ï˘ÎÂÓÙÚÈÎÒÓ ÌÂÏÂÙÒÓ ÁÈ· Ù· ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓ· 3
 ∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 75, 1
Ê¿Ú̷η
1) ÛÈÌÔ˘ÙÚ·Ì›ÓË
2) ÔÚÏÈÛÙ¿ÙË
3) ÚÈÌfiÓ·Ì·ÓÙ
– °È· οı ʿÚÌ·ÎÔ ÂÚÈÁÚ¿ÊÔÓÙ·È ÂÚÁ·Û›Â˜
Ô˘ ·ÊÔÚÔ‡Ó ÛÙË ‰Ú¿ÛË ÙÔ˘˜ ÛÙËÓ ·ÒÏÂÈ· ÙÔ˘
‚¿ÚÔ˘˜ ÙÔ˘ ÛÒÌ·ÙÔ˜ (ÙÔ˘Ï¿¯ÈÛÙÔÓ ÛÙÔ 5% ÙÔ˘ ·Ú-
¯ÈÎÔ‡ ‚¿ÚÔ˘˜), ÛÙËÓ Ì·ÎÚÔ¯ÚfiÓÈ· ‰È·Ù‹ÚËÛË Ù˘
·ÒÏÂÈ·˜ ‚¿ÚÔ˘˜ Î·È Ù· ÔʤÏË ·fi ÙËÓ ¯ÔÚ‹ÁËÛË
ÙÔ˘˜ Û ·ÛıÂÓ›˜ Ì ™¢2 Ô˘ ‚Ú›ÛÎÔÓÙ·È Û ıÂÚ·-
›· Ì ÈÓÛÔ˘Ï›ÓË ‹ ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜ ¯ÔÚËÁÔ‡ÌÂ-
Ó· ·ÓÙȉȷ‚ËÙÈο ‰ÈÛΛ·
™πª¶OÀΔƒ∞ªπ¡∏
ø˜ Ì˯·ÓÈÛÌfi˜ ‰Ú¿Û˘ Ù˘ ÛÈÌÔ˘ÙÚ·Ì›Ó˘ ·Ó·-
ʤÚÂÙ·È Ë ·Ó·ÛÙÔÏ‹ Ù˘ Â·Ó·ÚfiÛÏ˄˘ (reupta-
ke) Ù˘ ÓÔÚ·‰ÚÂÓ·Ï›Ó˘ Î·È ÛÂÚÔÙÔÓ›Ó˘ ηٿ
ÚÒÙÔ ÏfiÁÔ Î·È ÓÙÔ·Ì›Ó˘ Û ÂÏ¿ÛÛÔÓ· ‚·ıÌfi
·fi Ù· ÂÁÎÂÊ·ÏÈο ·ÙÙ·Ú·, Ô˘ Ô‰ËÁ› Û ·‡ÍËÛË
ÙÔ˘ ·ÈÛı‹Ì·ÙÔ˜ ÎÔÚÂÛÌÔ‡. ™ÙÔ ÛÏ·¯ÓÈÎfi Ï›Ô˜(
brown tissue) ÚÔ¿ÁÂÈ ÙËÓ ıÂÚÌÔÁ¤ÓÂÛË Î·È ÌÂÈÒÓÂÈ
ÙÔ Ê·ÈÓfiÌÂÓÔ Ù˘ ÂÏ¿ÙÙˆÛ˘ Ú˘ıÌÔ‡ ÙÔ˘ ‚·ÛÈÎÔ‡
ÌÂÙ·‚ÔÏÈÛÌÔ‡, Ô˘ ·Ú·ÙËÚÂ›Ù·È Î·Ù¿ ÙËÓ ·ÒÏÂÈ·
‚¿ÚÔ˘˜. OÈ Û˘¯ÓfiÙÂÚ˜ ·ÚÂÓ¤ÚÁÂȘ Ù˘ ÛÈÌÔ˘-
ÙÚ·Ì›Ó˘ Â›Ó·È ÍËÚÔÛÙÔÌ›·, ·¸Ó›·, ·ÓÔÚÂÍ›· ηÈ
‰˘ÛÎÔÈÏÈfiÙËÙ·. ™˘¯Ó¤˜ Â›Û˘ ıˆÚÔ‡ÓÙ·È Ë Ù·¯˘-
ηډ›· Î·È ÙÔ ·›ÛıËÌ· ·ÏÌÒÓ. ™ÙȘ ·ÓÙÂӉ›ÍÂȘ
ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÌÂٷ͇ ÙˆÓ ¿ÏψÓ,
Ë ÂÁηÙÂÛÙË̤ÓË ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ˜, Ë Î·Ú‰È·Î‹
·ÓÂ¿ÚÎÂÈ·, Ë ÂÚÈÊÂÚÈ΋ ·ÔÊÚ·ÎÙÈ΋ ·ÚÙËÚÈÔ-
¿ıÂÈ·, ηډȷΤ˜ ·ÚÚ˘ı̛˜, ÙÈ̤˜ ·ÚÙËÚȷ΋˜
›ÂÛ˘ >145/90 Î·È ·ı‹ÛÂȘ ÙˆÓ ÂÁÎÂÊ·ÏÈÎÒÓ ·Á-
Á›ˆÓ, Û ¿ÙÔÌ· Ô˘ Ï·Ì‚¿ÓÔ˘Ó ÂÚ˘ıÚÔÌ˘Î›ÓË ‹
ÎÂÙÔÎÔÓ·˙fiÏË (Ë ÛÈÌÔ˘ÙÚ·Ì›ÓË ÌÂÙ·‚ÔÏ›˙ÂÙ·È ·fi
ÙÔ Î˘Ùfi¯ÚˆÌ· P450 (ÈÛÔ¤Ó˙˘ÌÔ CYP3A4). ¢ÂÓ Ê·›-
ÓÂÙ·È ¿ÓÙˆ˜ Ó· ‰ËÌÈÔ˘ÚÁ› ‚·Ï‚ȉÔ¿ıÂȘ ‹
Ó¢ÌÔÓÈ΋ ˘¤ÚÙ·ÛË. ∂›Ó·È Û˘ÓÂÒ˜ ··Ú·›ÙËÙÔ
ÚÈÓ ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘, Ó· ¤¯ÂÈ ÚÔËÁË-
ı› ηډÈÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜.
E›Ó·È ÚÔÊ·Ó¤˜ fï˜ fiÙÈ, Ô ·ÚÈıÌfi˜ Î·È Ë ÛÔ-
‚·ÚfiÙËÙ· ÙˆÓ Û˘Ì‚·Ì¿ÙˆÓ ÂÈÙ¿ÛÛÂÈ ÙË ¯ÚËÛÈÌÔ-
Ô›ËÛ‹ ÙÔ˘ Ì ȉȷ›ÙÂÚË ÚÔÛÔ¯‹ Î·È ·ÊÔ‡ ÏË-
ÊıÔ‡Ó fiÏ· Ù· ·Ó·Áη›· ̤ÙÚ· ÁÈ· ÙËÓ ·Ú·ÎÔÏÔ‡-
ıËÛË ÙˆÓ ·ÛıÂÓÒÓ14. ŸÛÔÓ ·ÊÔÚ¿ ÛÙË ÛÈÌÔ˘ÙÚ·-
Ì›ÓË ¤¯Ô˘Ó ‰ËÌÔÛÈ¢ı› ÌÈ· ÔÏ˘ÎÂÓÙÚÈ΋ ÌÂϤÙË
ÁÈ· ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Û ‰È¿-
ÊÔÚ˜ ‰fiÛÂȘ10, ‰˘Ô ÌÂϤÙ˜ Ì·ÎÚ¿˜ Û¯ÂÙÈ΋˜
‰È¿ÚÎÂÈ·˜(1 ¯ÚfiÓÔ)11,12, ÙÚÂȘ Ô˘ ·ÊÔÚÔ‡Û·Ó ÛÙË
‰È·Ù‹ÚËÛË ÙÔ˘ ‚¿ÚÔ˘˜ ÌÂÙ¿ ÙËÓ ‰È·ÎÔ‹ ÙÔ˘ Ê·Ú-
Ì¿ÎÔ˘13-15, ‰˘Ô ÌÂϤÙ˜ Ô˘ ·ÊÔÚÔ‡Û·Ó ‰È·‚ËÙÈ-
ÎÔ‡˜ ·ÛıÂÓ›˜ Ù‡Ô˘ 216,17, ‰˘Ô ÌÂϤÙ˜ Ì ˘ÂÚÙ·-
49
ÛÈÎÔ‡˜ ·ÛıÂÓ›˜18,19, ‰˘Ô Ì ÂÊ‹‚Ô˘˜20,21, Î·È ‰˘Ô
ÌÂÙ·-·Ó·Ï‡ÛÂȘ22,23. Δ· ·ÔÙÂϤÛÌ·Ù· ·fi ·˘Ù¤˜
ÙȘ ÌÂϤÙ˜ ÂÚÈÁÚ¿ÊÔÓÙ·È:
™ÙËÓ ÔÏ˘ÎÂÓÙÚÈ΋ Ô˘ ›¯Â ÛÙfi¯Ô ÙËÓ ·ÔÙÂ-
ÏÂÛÌ·ÙÈÎfiÙËÙ· ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Û ‰È¿ÊÔÚ˜ ‰fiÛÂȘ,
Û˘ÌÌÂÙ›¯·Ó 1047 ·ÛıÂÓ›˜ Î·È Â›¯Â ‰È¿ÚÎÂÈ· 6 Ì‹-
Ó˜10. ∞fi Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ Ê·›ÓÂÙ·È fiÙÈ Ù·
·ÔÙÂϤÛÌ·Ù· ÛÙËÓ ·ÒÏÂÈ· ÙÔ˘ ‚¿ÚÔ˘˜ ÂÍ·ÚÙÒ-
ÓÙ·È ·fi ÙËÓ ‰fiÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Î·È fiÙÈ Ë Î·Ï‡ÙÂ-
ÚË ‰ÔÛÔÏÔÁ›· ÁÈ· ÙËÓ ÎÏÈÓÈ΋ Ú¿ÍË Â›Ó·È 5-15 mg.
™Â ÌÂϤÙË Ô˘ ‰È‹ÚÎËÛ 1 ¯ÚfiÓÔ ÌÂÙ¿ ÙËÓ
·ÒÏÂÈ· ‚¿ÚÔ˘˜, Ù· ·¯‡Û·Úη ¿ÙÔÌ· Ô˘ ÂÏ¿Ì-
‚·Ó·Ó ÛÈÌÔ˘ÙÚ·Ì›ÓË ÛÂ Û˘Ó‰˘·ÛÌfi Ì ¯·ÌËÏÒÓ
ıÂÚÌ›‰ˆÓ ‰›·ÈÙ·, ¤¯·Û·Ó ÌÂÙ¿ ÙÔ ·Ú¯ÈÎfi ‚¿ÚÔ˜
ηٿ ̤ÛÔÓ fiÚÔ 5,2 kg Û ۯ¤ÛË Ì ·˘ÙÔ‡˜ Ô˘
ÂÏ¿Ì‚·Ó·Ó ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ Ô˘ ¤¯·Û·Ó ÌfiÓÔ
0,5 kg13. OÈ ·ÛıÂÓ›˜ Ô˘ ¤Ï·‚·Ó ÛÈÌÔ˘ÙÚ·Ì›ÓË Ë
·ÒÏÂÈ· ÙÔ˘ ‚¿ÚÔ˘˜ Û˘Ó‰˘¿ÛıËΠ̠ٷ ¢ÓÔ˚ο
·ÔÙÂϤÛÌ·Ù· ÛÙËÓ Ì›ˆÛË ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ
Î·È Ù˘ LDL ¯ÔÏËÛÙÂÚfiÏ˘10. OÈ ·¯‡Û·ÚÎÔÈ ‰È·-
‚ËÙÈÎÔ› ·ÛıÂÓ›˜ Â›Û˘ ¢ÓÔ‹ıËÎ·Ó ·fi ÙËÓ ¯Ô-
Ú‹ÁËÛË Ù˘ ÛÈÌÔ˘ÙÚ·Ì›Ó˘16,17. ªÂÙ¿ ¯ÔÚ‹ÁËÛË
Ù˘ ÁÈ· 6 Ì‹Ó˜ ÔÈ ‰È·‚ËÙÈÎÔ› ·¯‡Û·ÚÎÔÈ ·ÊÂÓfi˜
¤¯·Û·Ó ‚¿ÚÔ˜ ·ÊÂÙ¤ÚÔ˘ ‚ÂÏÙ›ˆÛ·Ó ÙȘ ÙÈ̤˜ Ù˘
ÁÏ˘Îfi˙˘, Ù˘ ÁÏ˘ÎÔ˙˘ÏȈ̤Ó˘ ·ÈÌÔÛÊ·ÈÚ›Ó˘
(HbA1C), ÂÓÒ ‰ÂÓ ÛËÌÂÈÒıËΠη̛· ·ÏÏ·Á‹ ÛÙËÓ
·ÚÙËÚȷ΋ ›ÂÛË17. ™ÙÔ˘˜ ·¯‡Û·ÚÎÔ˘˜ ÂÊ‹‚Ô˘˜ Ë
ÛÈÌÔ˘ÙÚ·Ì›ÓË Û˘Ó¤‚·Ï Â›Û˘ ÛÙËÓ ·ÒÏÂÈ· ‚¿-
ÚÔ˘˜20,21. ªÂÙ¿ ·fi ¯ÔÚ‹ÁËÛË Ù˘ ÁÈ· 6 Ì‹Ó˜ ÔÈ
¤ÊË‚ÔÈ Ô˘ ¤Ï·‚·Ó ÛÈÌÔ˘ÙÚ·Ì›ÓË ¤¯·Û·Ó 10,3 ±
6,6 kg Û ·ÓÙ›ıÂÛË Ì ·˘ÙÔ‡˜ Ô˘ ¤Ï·‚·Ó ÂÈÎÔÓÈÎfi
Ê¿ÚÌ·ÎÔ Ô˘ ¤¯·Û·Ó 2,4 ± 2,5 kg20. O Berkowitz
Î·È Û˘Ó.21, ‚ڋΠٷ ›‰È· ·ÔÙÂϤÛÌ·Ù· ÌfiÓÔ Ô˘
Û ÌÂÚÈÎÔ‡˜ ÂÊ‹‚Ô˘˜ ÌÂÈÒıËÎÂ Ë ‰fiÛË ÙÔ˘ Ê·ÚÌ¿-
ÎÔ˘ ‹ Î·È ‰È·ÎfiËΠÏfiÁˆ ·‡ÍËÛË Ù˘ ·ÚÙËÚȷ΋˜
›ÂÛ˘, ÙÔ˘ ηډȷÎÔ‡ Ú˘ıÌÔ‡ ‹ ¿ÏÏˆÓ Û˘Ìو̿-
ÙˆÓ. OÈ ˘ÂÚÙ·ÛÈÎÔ› ·ÛıÂÓ›˜ Ô˘ ¤Ï·‚·Ó ÛÈÌÔ˘-
ÙÚ·Ì›ÓË ÛËÌ›ˆÛ·Ó ·‡ÍËÛË Î˘Ú›ˆ˜ Ù˘ ‰È·ÛÙÔÏÈ-
΋˜ ›ÂÛ˘ Î·È ÙÔ˘ ηډȷÎÔ‡ Ú˘ıÌÔ˘18,19. º·›ÓÂ-
Ù·È fiÙÈ Î·Ó¤Ó· ·ÓÙÈ˘ÂÚÙ·ÛÈÎfi Ê¿ÚÌ·ÎÔ ·ÎfiÌË
Î·È Ë ¯ÔÚ‹ÁËÛË ÙˆÓ ‚-·ÔÎÏÂÈÛÙÒÓ ‰ÂÓ ÚÔÏ·Ì-
‚¿ÓÂÈ ÙËÓ ·‡ÍËÛË ÙÔ˘ ηډȷÎÔ‡ Ú˘ıÌÔ‡.
Oƒ§π™Δ∞Δ∏
∏ ÔÚÏÈÛÙ¿ÙË Â›Ó·È Û˘ÓıÂÙÈÎfi ·Ú¿ÁˆÁÔ Ù˘ ÏÈÔ-
ÛÙ·Ù›Ó˘. ∏ ÏÈÔÛÙ·Ù›ÓË Â›Ó·È ÌÈ· Ê˘ÛÈ΋ Ô˘Û›·
Ô˘ ·Ó‹ÎÂÈ ÛÙËÓ Î·ÙËÁÔÚ›· ÙˆÓ ‰ÂÛÌ¢ÙÒÓ Ï›Ô˘˜
Ô˘ ·Ó·ÛÙ¤ÏÏÔ˘Ó ÙË ‰Ú¿ÛË Ù˘ ÏÈ¿Û˘. ∏ ÏÈ¿ÛË
Â›Ó·È ¤Ó· ¤Ó˙˘ÌÔ ÙÔ ÔÔ›Ô ·Ú¿ÁÂÙ·È ·fi ÙÔ ¿-
ÁÎÚ·˜ Î·È ÙÔ ÔÔ›Ô Û˘Ì‚¿ÏÏÂÈ ÛÙËÓ ¤„Ë ÙˆÓ ÏÈ-
50 ª. ª¶OÀ°OÀ§π∞, ∏. ∂À£ÀªπOÀ
ÒÓ. ∏ Ô˘Û›· ÔÚÏÈÛÙ¿ÙË, ÙÔ ‰Ú·ÛÙÈÎfi Û˘ÛÙ·ÙÈÎfi
ÙÔ˘ Ê·ÚÌ¿ÎÔ˘, ·Ó·ÛÙ¤ÏÏÂÈ ÂÈÏÂÎÙÈο ÙË ‰Ú¿ÛË
Ù˘ ÏÈ¿Û˘. ∞ÛΛ ηı·Ú¿ ÙÔÈ΋ ‰Ú¿ÛË ÛÙÔ Î·-
ÙÒÙÂÚÔ ÂÙÈÎfi ¯ˆÚ›˜ ·ÔÚÚfiÊËÛ‹ ÙÔ˘ ÛÙË Û˘ÛÙË-
Ì·ÙÈ΋ ΢ÎÏÔÊÔÚ›·. ŸÙ·Ó Ï·Ì‚¿ÓÂÙ·È Ì·˙› Ì ÙÚÔ-
ʤ˜ Ô˘ ÂÚȤ¯Ô˘Ó Ï›Ô˜, ÂÌÔ‰›˙ÂÈ ÂÈÏÂÎÙÈο ÙËÓ
·ÔÚÚfiÊËÛ‹ ÙÔ˘, Ì Â·ÎfiÏÔ˘ıÔ ÙËÓ ·Ô‚ÔÏ‹ ÌÂ
Ù· ÎfiÚ·Ó· ÙÔ˘ 30% ÙÔ˘ ÚÔÛÏ·Ì‚·ÓÔ̤ÓÔ˘ Ï›-
Ô˘˜ Ì ÙËÓ ÙÚÔÊ‹ ÌÂ Û˘Ó¤ÂÈ· Ó· ÌËÓ ·ÔÚÚÔÊÔ‡-
ÓÙ·È ÔÈ ıÂÚÌ›‰Â˜ Ô˘ ÂÚȤ¯ÂÈ. £ÂˆÚÂ›Ù·È ·Î›Ó‰˘ÓÔ
ÁÈ· ÙÔÓ ÏfiÁÔ fiÙÈ ·ÔÚÚÔÊ¿Ù·È <1%. OÈ ·Ó·ÊÂÚfi-
ÌÂÓ˜ ·ÚÂÓ¤ÚÁÂȘ Â›Ó·È Ô ÌÂÙˆÚÈÛÌfi˜, ÔÈ ‰È·Ú-
ÚÔ˚Τ˜ ÏÈ·Ú¤˜ ÎÂÓÒÛÂȘ Û ÔÛÔÛÙfi 15-30%, ηÈ
Ë Ì›ˆÛË ÙˆÓ Â›‰ˆÓ ÙˆÓ ‚ÈÙ. ∞, ∂ Î·È D24.
™Â ÌÂÁ¿ÏË Ù˘¯·ÈÔÔÈË̤ÓË ÔÏ˘ÎÂÓÙÚÈ΋ ÌÂϤ-
ÙË Ô˘ ‰È‹ÚÎËÛ 4 ¯ÚfiÓÈ· Ì 743 ·¯˘Û¿ÚÎÔ˘˜
·ÛıÂÓ›˜ ÂÎÙÈÌ‹ıËÎÂ Ë ·ÒÏÂÈ· ‚¿ÚÔ˘˜ ÙfiÛÔ Ì ÙËÓ
ıÂÚ·›· Ì ÔÚÏÈÛÙ¿ÙË fiÛÔ Î·È Ì ÙËÓ ‰È·ÎÔ‹ ÙÔ˘
Ê·ÚÌ¿ÎÔ˘ ηıÒ˜ Î·È Ë Â›‰Ú·ÛË Ù˘ ÛÙËÓ ·ÚÙËÚÈ·-
΋ ›ÂÛË Î·È ÛÙÔ ÏÈȉ·ÈÌÈÎfi ÚÔÊ›Ï24. Δ· ·ÔÙÂϤ-
ÛÌ·Ù· Ù˘ ÌÂϤÙ˘ ÂÚÈÁÚ¿ÊÔÓÙ·È ÛÙÔÓ ›Ó·Î· 2.
™Â ¿ÏÏË ÌÂϤÙË ÂÎÙÈÌ‹ıËÎÂ Ë ‰È·Ù‹ÚËÛË Ù˘
·ÒÏÂÈ·˜ ‚¿ÚÔ˘˜, Ë ÚfiÏË„Ë Ù˘ Â·Ó¿ÎÙËÛË ÙÔ˘
™μ (ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜) ÁÈ· ÙË ‚ÂÏÙ›ˆÛË ÙÔ˘ ηÚ-
‰È·ÁÁÂÈ·ÎÒÓ ·Ú·ÁfiÓÙˆÓ. Δ· ·ÔÙÂϤÛÌ·Ù· Ù˘
¤‰ÂÈÍ·Ó ÛËÌ·ÓÙÈ΋ ‚ÂÏÙ›ˆÛË Ù˘ ÔÏÈ΋˜ Î·È LDL
¯ÔÏËÛÙÂÚ›Ó˘25. ™Â Ù˘¯·ÈÔÔÈË̤ÓË ‰ÈÏ‹ ÌÂϤÙË
‰È¿ÚÎÂÈ·˜ 4 ÂÙÒÓ ÌÂÏÂÙ‹ıËÎ·Ó 3304 ˘¤Ú‚·Ú· ¿ÙÔ-
Ì·, ÙÔ 21% ·˘ÙÒÓ ·ÚÔ˘Û›·˙·Ó ‰È·Ù·Ú·¯‹ Ù˘ ·ÓÔ-
¯‹˜ ÛÙË ÁÏ˘Îfi˙Ë. ∏ ·ÒÏÂÈ· ÙÔ˘ ‚¿ÚÔ˘˜ ÛÙÔÓ 1 ¯Úfi-
ÓÔ ÌÂϤÙ˘ ‹Ù·Ó Û 11% ÛÙËÓ ÔÌ¿‰· Ù˘ ÔÚÏÈÛÙ¿Ù˘
ÂÓÒ ÛÙËÓ ÔÌ¿‰· ÙÔ˘ ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘ 6%. ªÂ-
Ù¿ 3 ¯ÚfiÓÈ· ÛËÌÂÈÒıËΠÌÈÎÚ‹ Â·Ó¿ÎÙËÛË ÙÔ˘ ‚¿-
ÚÔ˘˜ ¤ÙÛÈ ÒÛÙ ÙÔÓ 4Ô ¯ÚfiÓÔ Ë ·ÒÏÂÈ· ÛÙËÓ ÔÌ¿‰·
Ù˘ ÔÚÏÈÛÙ¿Ù˘ ·Ó‹Ú¯ÂÙÔ Û 6,9% ÂÓÒ ÛÙÔ ÂÈÎÔÓÈÎfi
Ê¿ÚÌ·ÎÔ 4,1%. ∂›Û˘, ÛËÌÂÈÒıËΠ̛ˆÛË Ù˘ ÂÌ-
Ê¿ÓÈÛ˘ ÙÔ˘ ™¢ ÛÙ· ¿ÙÔÌ· Ì ‰È·Ù·Ú·Á̤ÓË ·ÓÔ¯‹
ÛÙËÓ ÁÏ˘Îfi˙Ë Î·Ù¿ 37%26. ™Â ‰È·‚ËÙÈÎÔ‡˜ ·ÛıÂÓ›˜
Ë ÔÚÏÈÛÙ¿ÙË Ì›ˆÛ ÛËÌ·ÓÙÈο ÙÔ ÛˆÌ·ÙÈÎfi ‚¿ÚÔ˜
ηıÒ˜ Î·È ÙËÓ HBA1C , ÌÂÙ¿ ¯ÔÚ‹ÁËÛË Ù˘ ÁÈ· 1
¯ÚfiÓÔ27,28. ÕÏϘ ¢ÓÔ˚Τ˜ ‰Ú¿ÛÂȘ Ù˘ ÔÚÏÈÛÙ¿Ù˘:
Â›Ó·È Ë ‚ÂÏÙ›ˆÛË ÙÔ˘ ÏÈȉ·ÈÌÈÎÔ‡ ÚÔÊ›Ï ÁÂÁÔÓfi˜
Ô˘ ‰ÂÓ ÂÍËÁÂ›Ù·È ÌfiÓÔ ·fi ÙËÓ ·ÒÏÂÈ· ‚¿ÚÔ˘˜
·ÏÏ¿ ÛÙËÓ ÂÏ¿ÙÙˆÛË Ù˘ ÌÂÙ·ÁÂ˘Ì·ÙÈ΋˜ ÏÈ·ÈÌ›·˜
Ì ÙËÓ ¯ÔÚ‹ÁËÛË ÔÚÏÈÛÙ¿Ù˘29-31.
ƒπªO¡∞ª¶∞¡Δ
∂ȉÈÎfi˜ ·Ó·ÛÙÔϤ·˜ ÙÔ˘ ˘Ô‰Ô¯¤· 1 ÙˆÓ Î·ÓÓ·‚È-
ÓÔÂȉÒÓ (˘ԉԯ›˜ CB1) ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Î·È ÙˆÓ
ÂÚÈÊÂÚÈÎÒÓ ÔÚÁ¿ÓˆÓ Ô˘ ˘ÂÈÛ¤Ú¯ÔÓÙ·È ÛÙÔ ÌÂÙ·-
‚ÔÏÈÛÌfi Ù˘ ÁÏ˘Îfi˙˘ Î·È ÙˆÓ ÏÈȉ›ˆÓ (‹ ÙÔ˘ Ï›-
Ô˘˜), Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ ÙÔ˘ ÏÈÒ‰Ô˘˜ ÈÛÙÔ‡,
ÙÔ˘ ‹·ÙÔ˜, Ù˘ Á·ÛÙÚÂÓÙÂÚÈ΋˜ Ô‰Ô‡ Î·È ÙˆÓ Ì˘ÒÓ.
∞ÔÎÏ›ÔÓÙ·˜ ÙÔ˘˜ ˘ԉԯ›˜ CB1, ÙÔ ÚÈÌfiÓ·Ì·ÓÙ
·Ó·ÛÙ¤ÏÏÂÈ ÙËÓ ˘ÂÚÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ÂÓ‰ÔηÓÓ·‚ÈÓÔ-
Âȉԇ˜ Û˘ÛÙ‹Ì·ÙÔ˜ (EC Û˘ÛÙ‹Ì·ÙÔ˜). TÔ Û‡ÛÙËÌ·
EC Â›Ó·È ¤Ó· Ê˘ÛÈÔÏÔÁÈÎfi Û‡ÛÙËÌ· Ô˘ ·Ó·Î·Ï‡-
ÊıËΠÚfiÛÊ·Ù· Î·È ··ÚÙ›˙ÂÙ·È ·fi ˘ԉԯ›˜,
fiˆ˜ ÔÈ CB1, ıˆÚÂ›Ù·È fiÙÈ ‰È·‰Ú·Ì·Ù›˙ÂÈ ÛËÌ·ÓÙÈ-
Îfi ÚfiÏÔ ÙfiÛÔ ÛÙË Ú‡ıÌÈÛË ÙÔ˘ ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜
Î·È ÙÔ˘ ÂÓÂÚÁÂÈ·ÎÔ‡ ÈÛÔ˙˘Á›Ô˘, fiÛÔ Î·È ÛÙÔ ÌÂÙ·-
‚ÔÏÈÛÌfi Ù˘ ÁÏ˘Îfi˙˘ Î·È ÙˆÓ ÏÈȉ›ˆÓ.
∞Ó·ÛÙ¤ÏÏÔÓÙ·˜ ÏÔÈfiÓ ÙÔ˘˜ CB1, ÙÔ ÚÈÌfiÓ·-
Ì·ÓÙ, ÌÂÈÒÓÂÈ ÙËÓ ÚfiÛÏË„Ë Ù˘ ÙÚÔÊ‹˜ Î·È ‰ÈÂ-
Á›ÚÂÈ ¿ÌÂÛ· ÙËÓ ¤ÎÊÚ·ÛË Ù˘ ·‰ÈÔÓÂÎÙ›Ó˘ ÛÙÔÓ
Ï¢Îfi ÏÈÒ‰Ë ÈÛÙfi15.
ΔÔ ÚÈÌfiÓ·Ì·ÓÙ ÌÂÏÂÙ‹ıËΠηٷگ¿˜ Û·Ó
Ô˘Û›· ÁÈ· ÙËÓ ‰È·ÎÔ‹ ÙÔ˘ ηÓ›ÛÌ·ÙÔ˜ Î·È ÁÈ·
ÙËÓ ·¯˘Û·ÚΛ· Û 3 ÌÂϤÙ˜ ‰È¿ÚÎÂÈ·˜ 1 ¤ÙÔ˘˜32-
34 Î·È Û 1 ‰È¿ÚÎÂÈ·˜ 2 ÂÙˆÓ35. ∂ÓÒ ÙÔ ÚÈÌfiÓ·Ì·-
ÓÙ Ê·›ÓÂÙ·È Ó· Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈÎfi ÛÙËÓ ·Ò-
ÏÂÈ· ÙÔ˘ ‚¿ÚÔ˘˜, Ú¤ÂÈ Ó· ›̷ÛÙ ÚÔÛÂÎÙÈÎÔ›
ÛÙËÓ ¯ÔÚ‹ÁËÛË ÙÔ˘, Ï·Ì‚¿ÓÔÓÙ·˜ ˘’ fi„ÈÓ ÙȘ ·-
ÓÙÂӉ›ÍÂȘ Î·È ÙȘ Ù˘¯fiÓ ·ÚÂÓ¤ÚÁÂȘ36. O Van
Gaal Î·È Û˘Ó.32 ÛÙËÓ ÌÂϤÙË RIO-Europe Ë ÔÔ›·
‰È‹ÚÎËÛ 1 ¤ÙÔ˜, Û 1507 ·¯‡Û·ÚÎÔ˘˜ ·ÛıÂÓ›˜
Ì BMI >30 kg/m2 (‹ >27 kg/m2 Ì ‰˘ÛÏÈȉ·ÈÌ›·,
˘¤ÚÙ·ÛË) ¯ÔÚËÁ‹Û·Ó ÚÈÌfiÓ·Ì·ÓÙ Û ‰fiÛÂȘ 5 ‹
20 mg/Ë̤ڷ) ‹ ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ ÛÂ Û˘Ó‰˘·ÛÌfi
Ì ˘ÔıÂÚÌȉÈ΋ ‰›·ÈÙ·. Δ· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂ-
ϤÙ˘ ‹Ù·Ó: Ë Ì¤ÛË ·ÒÏÂÈ· ‚¿ÚÔ˘˜ Û 1 ¤ÙÔ˜ ‹Ù·Ó
-3,4 kg ± 5,7, -6,6 kg ± 7,2, Î·È -1,8 kg ± 6,4 Ì ÚÈ-
ÌfiÓ·Ì·ÓÙ 5 mg, 20 mg, Î·È ÔÌ¿‰· ÂÈÎÔÓÈÎÔ‡ Ê·Ú-
Ì¿ÎÔ˘ ·ÓÙ›ÛÙÔȯ·. ΔÔ ÚÈÌfiÓ·Ì·ÓÙ Û ‰fiÛË 20 mg
‚ÂÏÙ›ˆÛ ÛËÌ·ÓÙÈο ÙËÓ ÂÚ›ÌÂÙÚÔ Ì¤Û˘, ÙËÓ
HDL, Ù· ÙÚÈÁÏ˘ÎÂÚ›‰È·, ÙËÓ ·ÓÙ›ÛÙ·ÛË ÛÙËÓ ÈÓÛÔ˘-
Ï›ÓË Û ۯ¤ÛË Ì ·˘ÙÔ‡˜ Ô˘ ÂÏ¿Ì‚·Ó·Ó ÂÈÎÔÓÈÎfi
Ê¿ÚÌ·ÎÔ. ™ÙËÓ ÌÂϤÙË RIO-Diabetes ÌÂÏÂÙ‹ıËηÓ
1047 ·¯‡Û·ÚÎÔÈ ·ÛıÂÓ›˜ Ì ™¢ Ù‡Ô˘ 2, ÔÈ ÔÔ›-
ÔÈ ÂÏ¿Ì‚·Ó·Ó ˆ˜ ıÂÚ·›· ÈÓÛÔ˘Ï›ÓË ‹ ·ÓÙȉȷ‚Ë-
ÙÈο ‰ÈÛΛ·. ªÂ ÙËÓ ¯ÔÚ‹ÁËÛË ÙÔ˘ ÚÈÌfiÓ·Ì·ÓÙ
‰È·ÈÛÙÒıËΠÂ›Û˘ ÂÎÙfi˜ Ù˘ ·ÒÏÂÈ·˜ ÙÔ˘ ‚¿-
ÚÔ˘˜, ‚ÂÏÙ›ˆÛË ÙˆÓ ÏÈȉ›ˆÓ, Ù˘ HBA1C Î·È Ù˘
ÂÚÈ̤ÙÚÔ˘ Ù˘ ̤Û˘34.
OÈ ·ÚÂÓ¤ÚÁÂȘ ·fi ÙËÓ ¯Ú‹ÛË ÙÔ˘ Ê·ÚÌ¿-
ÎÔ˘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ‰È·Ù·Ú·¯¤˜ ÛÙÔÓ „˘¯ÈÛÌfi,
Ó·˘Ù›·, Â̤ÙÔ˘˜, ‰È¿ÚÚÔÈ·, ›ÏÈÁÁÔ, ¿Á¯Ô˜.
¶·ÚfiÌÔÈ· ·ÔÙÂϤÛÌ·Ù·, ‰ËÏ·‰‹ ·ÒÏÂÈ·
‚¿ÚÔ˘˜ Î·È ‚ÂÏÙ›ˆÛË ÏÈȉ·ÈÌÈÎÔ‡ ÚÔÊ›Ï, ·Ó·Ê¤-
ÚÔÓÙ·È Î·È ÛÙËÓ ÌÂϤÙË ÙˆÓ Pi-Sunyer Î·È Û˘Ó.35
ÛÙËÓ ÌÂϤÙË RIO-North America Ô˘ Û˘ÌÌÂÙ›¯·Ó
3045 ·¯‡Û·ÚÎÔÈ ‹ ˘¤Ú‚·ÚÔÈ ·ÛıÂÓ›˜. OÈ „˘-
 ∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 75, 1
¯È·ÙÚÈΤ˜ ‰È·Ù·Ú·¯¤˜ Â›Ó·È ÈÔ ÂÌÊ·Ó›˜ ÛÙËÓ ‰fi-
ÛË ÙˆÓ 20 mg. ∏ ÌÂϤÙË ÙÂÚÌ·Ù›ÛıËΠÏfiÁˆ ÙˆÓ
‰È·Ù·Ú·¯ÒÓ ·˘ÙÒÓ ÛÙÔ 50% ÙˆÓ Û˘ÌÌÂÙ¯fiÓÙˆÓ
ÛÙÔ Ù¤ÏÔ˜ ÙÔ˘ 1Ô˘ ¤ÙÔ˘˜.
ΔÔ ÚÈÌfiÓ·Ì·ÓÙ Î˘ÎÏÔÊÔÚÔ‡Û ÛÙËÓ ¯ÒÚ·
Ì·˜ ̤¯ÚÈ ÚfiÙÈÓÔ˜ ·ÏÏ¿ ·ÔÛ‡ÚıËΠÚfiÛÊ·Ù·.
™ÙËÓ ∞ÌÂÚÈ΋ ‰ÂÓ ¤¯ÂÈ ÂÁÎÚÈı› ·fi ÙÔ FDA.
ª∂Δº√ƒªI¡∏
∂ÓÂÚÁÔÔÈ› ÙËÓ AMP-ÚˆÙÂ˚ÓÈ΋ ÎÈÓ¿ÛË, ÂÏ·Ù-
ÙÒÓÔÓÙ·˜ ÙËÓ Ë·ÙÈ΋ ·Ú·ÁˆÁ‹ Ù˘ ÁÏ˘Îfi˙˘
(HPG). º·›ÓÂÙ·È fiÙÈ ·Ó·ÛÙ¤ÏÏÂÈ ÙËÓ ÏÈÔÁ¤ÓÂÛË
ÛÙÔ ÏÈ҉˜ ·ÙÙ·ÚÔ Î·È ·˘Í¿ÓÂÈ ÙËÓ Â˘·ÈÛıËÛ›·
Ù˘ ÈÓÛÔ˘Ï›Ó˘ ÛÙÔ˘˜ ÂÚÈÊÂÚÈÎÔ‡˜ ÈÛÙÔ‡˜.
¶Èı·ÓÔÏÔÁÂ›Ù·È fiÙÈ ÂÏ·ÙÙÒÓÂÈ ÙËÓ fiÚÂÍË ·˘-
Í¿ÓÔÓÙ·˜ ÙÔ GLP-1 (Glucagon like peptide-1)16.
™Â ÌÈ· ÌÂϤÙË Ì ·¯‡Û·ÚÎÔ˘˜ ·ÛıÂÓ›˜ ηÈ
ÌÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ, ·˘ÙÔ› Ô˘ ¤Ï·‚·Ó ÌÂÙÊÔÚÌ›-
ÓË ¤¯·Û·Ó ‚¿ÚÔ˜ 1-2 kg Û ۯ¤ÛË Ì ·˘ÙÔ‡˜ Ô˘
¤Ï·‚·Ó ÂÈÎÔÓÈÎfi Ê·ÚÌ·ÎÔ37. ™ÙËÓ ÌÂϤÙË DPP (Di-
abetes Prevention Program), Û ·ÛıÂÓ›˜ Ì ‰È·Ù·-
Ú·Á̤ÓË ·ÓÔ¯‹ ÛÙË ÁÏ˘Îfi˙Ë ÌÂÙ¿ ·fi ÂÚ›Ô˘ 2,8
¯ÚfiÓÈ· ·Ú·ÎÔÏÔ‡ıËÛ˘, ·˘ÙÔ› Ô˘ ¤Ï·‚·Ó ÌÂÙ-
ÊÔÚÌ›ÓË ¤¯·Û·Ó 2,5% ÙÔ˘ ‚¿ÚÔ˘˜ ÙÔ˘˜ (p <0,001
Û ۯ¤ÛË Ì ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ)38. ∞Ó Î·È Ë ÌÂÙ-
ÊÔÚÌ›ÓË ‰ÂÓ ÚÔηÏ› ÛËÌ·ÓÙÈ΋ ·ÒÏÂÈ· ‚¿ÚÔ˘˜
Â›Ó·È Î·Ù¿ÏÏËÏÔ ÁÈ· ·ÛıÂÓ›˜ ˘¤Ú‚·ÚÔ˘˜ Ô˘ ÂÌ-
Ê·Ó›˙Ô˘Ó Î›Ó‰˘ÓÔ ·Ó¿Ù˘Í˘ ™¢.
∂¶π™∏ªA¡™∂π™ ™Δ∏ £∂ƒ∞¶∂π∞
Δ∏™ ¶∞ÃÀ™∞ƒ∫π∞™
∞fi Ù· ·Ú·¿Óˆ ·Ó·ÊÂÚfiÌÂÓ· ÛÙËÓ ‚È‚ÏÈÔÁÚ·-
Ê›· ·Í›˙ÂÈ Ó· ÙÔÓÈÛıÔ‡Ó ÔÚÈṲ̂ӷ ‰Â‰Ô̤ӷ.
1. ∫·Ù¿ ÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘ Ê·Ú̷΢ÙÈ΋˜
·ÁˆÁ‹˜ Û ·¯‡Û·ÚÎÔ˘˜ ·ÛıÂÓ›˜ Ú¤ÂÈ Ó· ‰È·-
ÈÛÙÒÓÂÙ·È ¤ÁηÈÚ· Ë ·ÔÙ˘¯›· Ù˘ Ê·Ú̷΢ÙÈ-
΋˜ ıÂÚ·›·˜.
2. ∏ ‰È¿ÚÎÂÈ· ÙˆÓ ÌÂÏÂÙÒÓ ÙˆÓ Ê·ÚÌ¿ÎˆÓ Â›-
Ó·È ÌÈÎÚ‹: ÁÈ· ÙËÓ ÛÈÌÔ˘ÙÚ·Ì›ÓË Â›Ó·È 2 ¯ÚfiÓÈ·,
ÁÈ· ÙËÓ ÔÚÏÈÛÙ¿ÙË 4 ¯ÚfiÓÈ· Î·È ÁÈ· ÙÔ ÚÈÌfiÓ·Ì·-
ÓÙ 2 ¯ÚfiÓÈ·.
3. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ıÂÚ·›·˜ Û˘ÓÙ‹ÚË-
Û˘ Û ÔÏÏÔ‡˜ ·ÛıÂÓ›˜ ‰È·ÈÛÙÒÓÂÙ·È ÌÂÚÈ΋
Â·Ó¿ÎÙËÛË ÙÔ˘ ·ÔÏÂÛı¤ÓÙÔ˜ ‚¿ÚÔ˘˜.
4. ∞Í›˙ÂÈ Ó· ÙÔÓÈÛıÔ‡Ó Ù· ˘„ËÏ¿ ÔÛÔÛÙ¿ ‰È·-
ÎÔ‹˜ Ù˘ ıÂÚ·›·˜ ÙˆÓ ·ÛıÂÓÒÓ Ô˘ Î˘Ì·›ÓÔ-
ÓÙ·È ·fi 27-44%.
5. π‰È·›ÙÂÚË ÚÔÛÔ¯‹ Ú¤ÂÈ Ó· ‰›ÓÂÙ·È ÛÙȘ
·ÓÙÂӉ›ÍÂȘ ¯ÔÚ‹ÁËÛ˘ ÙˆÓ Ê·ÚÌ¿ÎˆÓ fiˆ˜ ÛÙËÓ
Ó‡ڈÛË, ÛÙËÓ ·ÏÏ·Á‹ ÙÔ˘ ı˘ÌÈÎÔ‡ ÁÈ· ÙÔ ÚÈÌfiÓ·-
51
Ì·ÓÙ, ÛÙËÓ ˘¤ÚÙ·ÛË ÛÙË Î·Ú‰È·ÁÁÂȷ΋ ÓfiÛÔ
ÁÈ· ÙËÓ ÛÈÌÔ˘ÙÚ·Ì›ÓË Î·È ÓÔÛ‹Ì·Ù· ÙÔ˘ ÂÙÈÎÔ‡
Î·È ‰È·Ù·Ú·¯¤˜ Ù˘ ‚ÈÙ. D ÁÈ· ÙËÓ ÔÚÏÈÛÙ¿ÙË.
6. ¡· ÂÎÙÈÌ¿Ù·È Ë ·Ú¿Ï¢ÚË Â˘ÓÔ˚΋ Â›-
‰Ú·ÛË ÙˆÓ ¯ÔÚËÁÔ˘Ì¤ÓˆÓ Ê·ÚÌ¿ÎˆÓ ÛÂ Û˘Ó˘¿Ú-
¯Ô˘Û˜ ·ı‹ÛÂȘ, ÂÏ¿ÙÙˆÛË ÙˆÓ ÏÈȉ·ÈÌÈÎÒÓ ·-
ڷ̤ÙÚˆÓ , ·ÓÙ›ÛÙ·ÛË ÛÙËÓ ÈÓÛÔ˘Ï›ÓË, ÂÏ¿ÙÙˆÛË
Ù˘ ÁÏ˘Îfi˙˘ Î·È Ù˘ ÂÚÈ̤ÙÚÔ˘ Ù˘ ̤Û˘, ·‡ÍË-
ÛË Ù˘ ·‰ÈÔÓÂÎÙ›Ó˘.
7. ∂›Ó·È ¯Ú‹ÛÈÌË Ë Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ ÁÈ· ÙËÓ
·ÓÙÈÌÂÙÒÈÛË Ù˘ ·¯˘Û·ÚΛ·˜ ·ÏÏ¿ Ú¤ÂÈ Ó· ÁÓˆ-
Ú›˙Ô˘Ì ÙȘ ‰˘Ó·ÙfiÙËÙ˜ Î·È ÙÔ˘˜ ÂÚÈÔÚÈÛÌÔ‡˜ Ù˘.
ªÂ ‚¿ÛË Ù· ·Ú·¿Óˆ, ·¯‡Û·Úη ¿ÙÔÌ· ÌÂ
μªπ >30 kg/m2 Ì ·˘ÍË̤ÓË ÂÚ›ÌÂÙÚÔ Ì¤Û˘, ˘¤Ú-
Ù·ÛË, ‰˘ÛÏÈȉ·ÈÌ›·, ÌÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ Î·È Î·Ú-
‰È·Î¤˜ ·ı‹ÛÂȘ, ÂÎÙfi˜ Ù˘ ‰›·ÈÙ·˜ Ù˘ ¿ÛÎËÛ˘ ηÈ
Ù˘ ÙÚÔÔÔ›ËÛ˘ Ù˘ Û˘ÌÂÚÈÊÔÚ¿˜ fiÙ·Ó ˘¿Ú¯ÂÈ
Úfi‚ÏËÌ· Û˘ÛÙ‹ÓÂÙ·È Ê·Ú̷΢ÙÈ΋ ıÂÚ·›·.
™Â ·¯‡Û·Úη ¿ÙÔÌ· ¯ˆÚ›˜ Û˘Ó˘¿Ú¯Ô˘Û˜
·ı‹ÛÂȘ Û˘ÛÙ‹ÓÂÙ·È ÙÔ ÚÈÌfiÓ·Ì·ÓÙ, Ë ÔÚÏÈÛÙ¿ÙË
Î·È Ë ÛÈÌÔ˘ÙÚ·Ì›ÓË, ™Â ·¯‡Û·Úη ¿ÙÔÌ· Ì ·˘-
ÍË̤ÓË ∞¶, ‰˘ÛÏÈȉ·ÈÌ›· ηډȷÁÁÂȷ΋ ÓfiÛÔ ÙÔ
ÚÈÌfiÓ·Ì·ÓÙ Î·È Ë ÔÚÏÈÛÙ¿ÙË.
™Â ·ÛıÂÓ›˜ Ì ™¢2 Û˘ÛÙ‹ÓÂÙ·È ¤Ó·ÚÍË Ù˘
ıÂÚ·›·˜ Ì ÌÂÙÊÔÚÌ›ÓË fiÔ˘ ÂÈÙ˘Á¯¿ÓÂÙ·È ÁÏ˘-
ηÈÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ Î·È Ì¤ÙÚÈ· ·ÒÏÂÈ· ‚¿ÚÔ˘˜ ·Ï-
Ï¿ ÙÔ ÚÈÌfiÓ·Ì·ÓÙ Â›Ó·È È‰Â҉˜ ÁÈ· ·ÛıÂÓ›˜ ·˘-
Ù‹˜ Ù˘ ηÙËÁÔÚ›·˜. ∂› ·ÓÙÂӉ›ÍÂˆÓ ÛÙË ¯ÔÚ‹ÁË-
ÛË ÙÔ˘ Û˘ÛÙ‹ÓÂÙ·È Ë ÔÚÏÈÛÙ¿ÙË ÁÈ· ÂÚ·ÈÙ¤Úˆ ·-
ÒÏÂÈ· ‚¿ÚÔ˘˜ ‹ ÛÈÌÔ˘ÙÚ·Ì›ÓË ·Ó Ô ·ÛıÂÓ‹˜ ‰ÂÓ
¤¯ÂÈ ˘¤ÚÙ·ÛË.
∞¶√Δ∂§E™ª∞Δ∞ ª∂Δ∞-∞¡∞§Y™∂ø¡
Δ· ·ÔÙÂϤÛÌ·Ù· Ù˘ Ê·Ú̷΢ÙÈ΋˜ ıÂÚ·›·˜
Û ·¯‡Û·ÚÎÔ˘˜ ÂÓ‹ÏÈΘ - ·fi ÙËÓ ÌÂÙ¿-·Ó¿Ï˘ÛË
4 ÌÂÏÂÙÒÓ Ù˘ ÛÈÌÔ˘ÙÚ·Ì›Ó˘39-42, 4 Ù˘ ÔÚÏÈÛÙ¿-
Ù˘39-42, 1 Ù˘ ÌÂÙÊÔÚÌ›Ó˘38 - DPP (Diabetic Pre-
vention Program) - 1 Ù˘ XENDOS-ÔÚÏÈÛÙ¿ÙË26
Î·È 3 ÔÏ˘ÎÂÓÙÚÈΤ˜ ÌÂϤÙ˜ ÙÔ˘ ÚÈÌfiÓ·Ì·ÓÙ32,
33,35 ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÔÓ ›Ó·Î· 1, 2. OÈ ÂÚÈÛÛfiÙÂ-
Ú˜ ÌÂϤÙ˜ Â›Ó·È ÌÈÎÚ‹˜ ‰È¿ÚÎÂÈ·˜ Î·È ÌfiÓÔ Ë
DPP (metformin) Î·È Ë Xendos (ÔÚÏÈÛÙ¿ÙË) ‰È‹Ú-
ÎÂÛ·Ó 4 ¯ÚfiÓÈ·. ¶ÔÈÎÈÏ›· ¢ÓÔ˚ÎÒÓ ·ÔÙÂÏÂÛÌ¿-
ÙˆÓ ÂÌÊ·Ó›˙ÔÓÙ·È ·fi ÙËÓ ¯ÔÚ‹ÁËÛË ÙˆÓ Ê·ÚÌ¿-
ÎˆÓ ÛÙËÓ ·ÚÙËÚȷ΋ ›ÂÛË, ÛÙËÓ ÁÏ˘Îfi˙Ë, ÛÙËÓ ÈÓ-
ÛÔ˘Ï›ÓË ÓËÛÙ›·˜ Î·È ÛÙȘ ÏÈȉ·ÈÌÈΤ˜ ·Ú·Ì¤-
ÙÚÔ˘˜ ÙˆÓ ·ÛıÂÓÒÓ39-42 (¶›Ó. 1, 2).
∏ ·ÒÏÂÈ· ÙÔ˘ ‚¿ÚÔ˘˜ Î˘Ì·›ÓÂÙ·È ·fi -2,5%
¤ˆ˜ -6,5 %.
°È· ÙËÓ ÂÎÙ›ÌËÛË ÙˆÓ ÌÂÏÂÙÒÓ ·˘ÙÒÓ Ú¤ÂÈ Ó·
ÏËÊıÔ‡Ó ˘’ Ô„ÈÓ Î·È Ù· ˘„ËÏ¿ ÔÛÔÛÙ¿ ÙˆÓ ·ÛıÂ-
52 ª. ª¶OÀ°OÀ§π∞, ∏. ∂À£ÀªπOÀ

¶›Ó·Î·˜ 1. ∂›‰Ú·ÛË ÙˆÓ Ê·ÚÌ¿ÎˆÓ ÛÙËÓ ∞¶, ÁÏ˘Îfi˙Ë Î·È ÈÓÛÔ˘Ï›ÓË

£ÂÚ·›· ∞¶ (¢∞¶/™∞¶ mmHg) °Ï˘Îfi˙Ë) (mg/dl) πÓÛÔ˘Ï›ÓË (Ìu/ml)

OÚÏÈÛÙ¿ÙË -1,8/-1,2 -1,8 -1,8
™ÈÌÔ˘ÙÚ·Ì›ÓË +0,8/1,2 O˘‰¤Ó O˘‰¤Ó
ƒÈÌfiÓ·Ì·ÓÙ O˘‰¤Ó -0,7 -2,2
ªÂÙÊÔÚÌ›ÓË ¶ÔÈΛÏÂÈ -6,2 -3,6

¶›Ó·Î·˜ 2. E›‰Ú·ÛË ÙˆÓ Ê·ÚÌ¿ÎˆÓ ÛÙÔ ÏÈȉ·ÈÌÈÎfi ÚÔÊ›Ï

£ÂÚ·›· ÃÔÏËÛÙ. (mg/dl) LDL (mg/dl) HDL (mg/dl) ÙÚÈÁÏ˘ÎÂÚ›‰È· (mg/dl)

OÚÏÈÛÙ¿ÙË -12,7 -10,4 -0,8 -2,2
™ÈÌÔ˘ÙÚ·Ì›ÓË Ô˘‰¤Ó Ô˘‰¤Ó ¶ÔÈΛÏÂÈ ÔÈΛÏÂÈ
ƒÈÌfiÓ·Ì·ÓÙ Ô˘‰¤Ó Ô˘‰¤Ó +1,5 -13,7
ªÂÙÊÔÚÌ›ÓË ÔÈΛÏÂÈ -0,44 ÔÈΛÏÂÈ Ô˘‰¤Ó

ÓÒÓ Ô˘ ‰È¤ÎÔ„·Ó ÙËÓ ıÂÚ·›· ÏfiÁˆ ·ÚÂÓÂÚÁÂÈ-
ÒÓ ∂›Û˘ Ë ·fiÛ˘ÚÛË ÙˆÓ ·ÛıÂÓÒÓ ·fi ÙËÓ ıÂÚ·-
›· ÏfiÁˆ ·ÚÂÓÂÚÁÂÈÒÓ ÂÌÊ·Ó›˙ÂÈ ·ÚfiÌÔÈ· Ô-
ÛÔÛÙ¿ Ì ÙÔ˘˜ ÂÓ‹ÏÈΘ ‰ËÏ·‰‹ 24% ¤ˆ˜ 43%.
™˘ÓÔÙÈο: Ë ·ÒÏÂÈ· ÙÔ˘ ‚¿ÚÔ˘˜ Û 1 ¯ÚfiÓÔ
Î·È Ë ‰È·ÎÔ‹ Ù˘ Û˘ÌÌÂÙÔ¯‹˜ ÙˆÓ ·ÛıÂÓÒÓ ÛÙËÓ ÌÂ-
ϤÙË ÏfiÁˆ ·ÚÂÓÂÚÁÂÈÒÓ ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÔÓ ›Ó·Î·
3. ∞fi Ù· ·ÔÙÂϤÛÌ·Ù· ÙˆÓ ÌÂÏÂÙÒÓ Ù˘ Xendos
Î·È Ù˘ DPP Û ·¯‡Û·ÚÎÔ˘˜ ÂÓ‹ÏÈΘ Ì IGT ‰È·-
ÈÛÙÒıËΠÂÏ¿ÙÙˆÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ Ù˘ ÂÌÊ¿ÓÈÛ˘
ÙÔ˘ ™¢2 ηٿ 32% Î·È 31% ·ÓÙ›ÛÙÔȯ·26,38.
¶∞ÃÀ™∞ƒ∫I∞ ¶∞π¢Iø¡- ∂º∏μø¡
™ÙËÓ ‚È‚ÏÈÔÁÚ·Ê›· ·Ó·Ê¤ÚÂÙ·È Ù· ÙÂÏÂ˘Ù·›· 4
¯ÚfiÓÈ· Ë ¯ÔÚ‹ÁËÛË Ê·Ú̷΢ÙÈ΋˜ ıÂÚ·›·˜ ÛÂ
·¯‡Û·Úη ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ Ô˘ ÂÌÊ¿ÓÈ˙·Ó
·˘ÍË̤ÓË ·ÓÙ›ÛÙ·ÛË ÛÙËÓ ÈÓÛÔ˘Ï›ÓË.
∏ ·ÈÙ›· Ù˘ ¯ÔÚ‹ÁËÛ˘ Ù˘ Ê·Ú̷΢ÙÈ΋˜ ıÂ-
Ú·›·˜ ÛÙËÓ ·È‰È΋ ·¯˘Û·ÚΛ· ‹Ù·Ó Ù· ·ÓËÛ˘-
¯ËÙÈο ·ÔÙÂϤÛÌ·Ù· ‰‡Ô ÌÂÏÂÙÒÓ. OÈ Weiss ηÈ
Û˘Ó.43 ‰È·›ÛÙˆÛ·Ó fiÙÈ ÙÔ 1/3 ÙˆÓ ·È‰ÈÒÓ Ô˘ ÂÌ-
Ê¿ÓÈ˙·Ó ‰˘Û·ÓÔ¯‹ ÛÙËÓ ÁÏ˘Îfi˙Ë ÂΉ‹ÏˆÛ·Ó ™¢2
ηٿ ÙËÓ ‰È¿ÚÎÂÈ· ÙˆÓ 21 ÌËÓÒÓ Ù˘ ·Ú·ÎÔÏÔ‡-
ıËÛ˘ ÙÔ˘˜. OÈ Pavkov Î·È Û˘Ó.44 ‚Ú‹Î·Ó fiÙÈ Ô È ÓÂ-
·ÚÔ› ·ÛıÂÓ›˜ Ì ™¢2 ·ÚÔ˘Û›·Û·Ó Ù·¯Â›· ÂͤÏÈ-
ÍË Ù˘ ÓÂÊÚÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘ Ô˘
Û¯ÂÙÈ˙fiÙ·Ó Ì ÙËÓ ‰È¿ÚÎÂÈ· ÙÔ˘ ™¢2 Î·È fi¯È ÙËÓ ‰˘-
Û·ÓÔ¯‹ Ù˘ ÁÏ˘Îfi˙˘.
OÈ ÌÂϤÙ˜ ÙˆÓ Ê·ÚÌ¿ÎˆÓ Ô˘ ¯ÔÚËÁ‹ıËηÓ
ÛÙËÓ ·È‰È΋ ·¯˘Û·ÚΛ· Â›Ó·È 8. ∂›Ó·È ÚÔÔÙÈ-
Τ˜ ÂÏÂÁ¯fiÌÂÓ˜ Î·È ·ÊÔÚÔ‡Ó: OÚÏÈÛÙ¿ÙË (1)45, ÛÈ-
ÌÔ˘ÙÚ·Ì›ÓË (4)46-48, ÌÂÙÊÔÚÌ›ÓË (3)49-51 Î·È Î·Ì›·
ÌÂ ÙÔ ÚÈÌfiÓ·Ì·ÓÙ.
Δ· ·ÔÙÂϤÛÌ·Ù· ·fi ÙËÓ ¯ÔÚ‹ÁËÛË Ù˘ Ê·Ú-
̷΢ÙÈ΋˜ ıÂÚ·›·˜ Û ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ ›-
Ó·È ·Ó¿ÏÔÁ· ÙˆÓ ÂÓËÏ›ÎˆÓ Î·È ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÔÓ
›Ó·Î· 4.

¶›Ó·Î·˜ 3. E›‰Ú·ÛË ÙˆÓ Ê·ÚÌ¿ÎˆÓ ÛÙËÓ ·ÒÏÂÈ· ‚¿ÚÔ˘˜ Î·È ·fiÛ˘ÚÛË ·fi ·ÚÂÓ¤ÚÁÂȘ

º¿Ú̷η ∞ÒÏÂÈ· ‚¿ÚÔ˘˜ Û 1 ¯ÚfiÓÔ(kg) ∞fiÛ˘ÚÛË ·ÛıÂÓÒÓ

OÚÏÈÛÙ¿ÙË 2,5-2,9 33-35%
™ÈÌÔ˘ÙÚ·Ì›ÓË 4,5-7,7 24-43%
ƒÈÌfiÓ·Ì·ÓÙ 5.6 40%
ªÂÙÊÔÚÌ›ÓË 2.6 6-7%

¶›Ó·Î·˜ 4. E›‰Ú·ÛË ÙˆÓ Ê·ÚÌ¿ÎˆÓ ÛÙÔ ‚¿ÚÔ˜, μªπ, ÁÏ˘Îfi˙Ë Î·È ÏÈ›‰È· ÛÙÔ˘˜ ÂÊ‹‚Ô˘˜

OÚÏÈÛÙ¿ÙË (¡=357) ™ÈÌÔ˘ÙÚ·Ì›ÓË (¡=464) ªÂÙÊÔÚÌ›ÓË (¡=54)

μ¿ÚÔ˜ -2,5 -7,7 -3,1
μªπ -0,86 -2,8 -3,1
°Ï˘Îfi˙Ë O˘‰¤Ó O˘‰¤Ó -3,9
§È›‰È· O˘‰¤Ó 0-25 -8,2
 ∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 75, 1
∞§§∞ º∞ƒª∞∫∞ ¶√À ∂¡¢∂Ã√ª∂¡ø™
¶ƒ√∫∞§√À¡ ∞¶ø§∂π∞ μ∞ƒ√À™
¶∂ƒπ°ƒ∞º√¡Δ∞π ™À¡√¶Δπ∫∞
∞ÓÙÈηٷıÏÈÙÈο
ºÏÔ˘ÔÍÂÙ›ÓË-ÛÂÙÚ·Ï›ÓË ‰˘Ô ÂÎÏÂÎÙÈÎÔ› ·Ó·ÛÙÔ-
Ï›˜ Ù˘ Â·Ó·ÚfiÛÏ˄˘ Ù˘ ÛÂÚÔÙÔÓ›Ó˘ (SSRI)
¤¯Ô˘Ó ¤Ó‰ÂÈÍË ÁÈ· ÙËÓ ıÂÚ·›· Ù˘ ηٿıÏȄ˘ ηÈ
‰‡Ó·ÓÙ·È Ó· ‰È¢ÎÔχÓÔ˘Ó ÙËÓ ·ÒÏÂÈ· ‚¿ÚÔ˘˜.
™Â ÌÈ· ÌÂÙ¿-·Ó¿Ï˘ÛË, ÌÂϤÙ˜ Ì ÊÏÔ˘ÔÍÂÙ›ÓË
Û·Ó Ê¿ÚÌ·ÎÔ Î·Ù¿ Ù˘ ·¯˘Û·ÚΛ·˜ Û ‰fiÛË 60
mg/ËÌ. (3 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚË ‰fiÛË ·fi ÙËÓ Û˘ÓËıÈ-
Ṳ̂ÓË ÁÈ· ÙËÓ Î·Ù¿ıÏÈ„Ë) ÚÔοÏÂÛ ·ÒÏÂÈ· ‚¿-
ÚÔ˘˜ Ù˘ Ù¿Í˘ ·fi 14,5 kg ̤¯ÚÈ Î·È ·‡ÍËÛË 0.40
kg42. ™Â ÌÂϤÙË Ô˘ Û˘ÌÌÂÙ›¯·Ó Û˘ÓÔÏÈο 1441 ¿ÙÔ-
Ì· Ô˘ ¤Ï·‚·Ó ÊÏÔ˘ÔÍÂÙ›ÓË (60 mg/ËÌ.), ÛËÌÂÈÒıË-
Π·ÒÏÂÈ· ‚¿ÚÔ˘˜ Û 6 Ì‹Ó˜ Î·È 1 ¯ÚfiÓÔ 4,8 ηÈ
2,4 kg ·ÓÙ›ÛÙÔȯ· Û ۇÁÎÚÈÛË Ì ÙËÓ ÔÌ¿‰· ÂÈÎÔÓÈ-
ÎÔ‡ Ê·ÚÌ¿ÎÔ˘ Ô˘ Ë ·ÒÏÂÈ· ‹Ù·Ó 2,2 Î·È 1,8 kg. ∏
Â·Ó¿ÎÙËÛË ÙÔ˘ 50% ÙÔ˘ ·ÔÏÂÛı¤ÓÙÔ˜ ‚¿ÚÔ˘˜ ÛÙÔ
2Ô ÂÍ¿ÌËÓÔ Ù˘ ¯ÔÚ‹ÁËÛ˘ Ù˘ ÊÏÔ˘ÔÍÂÙ›Ó˘, ηıÈ-
ÛÙ¿ ÙÔ Ê¿ÚÌ·ÎÔ ÌË ÂȉÈÎfi ÁÈ· ÙËÓ ·¯˘Û·ÚΛ·52.
∂ÓÙÔ‡ÙÔȘ Û ¿ÙÔÌ· ·¯‡Û·Úη Ì ηٿıÏÈ„Ë,
SSRIs ı· Ú¤ÂÈ Ó· ÚÔÙÈÌÔ‡ÓÙ·È ¤Ó·ÓÙÈ ¿ÏψÓ
·ÓÙÈηٷıÏÈÙÈÎÒÓ Ù· ÔÔ›· ·˘Í¿ÓÔ˘Ó ÙÔ ‚¿ÚÔ˜.
ªÔ˘ÚÔÈfiÓË: Ê¿ÚÌ·ÎÔ Ì ¤ÁÎÚÈÛË ÁÈ· ÙËÓ
ηٿıÏÈ„Ë Î·È ÙËÓ ‰È·ÎÔ‹ ÙÔ˘ ηÓ›ÛÌ·ÙÔ˜. ÃÔ-
ÚËÁÂ›Ù·È ÁÈ· ÙËÓ ·ÔÊ˘Á‹ ·‡ÍËÛ˘ ‚¿ÚÔ˘˜ Ì ÙË
‰È·ÎÔ‹ ÙÔ˘ ηÓÈÛÌ·ÙÔ˜53. ¶Èı·ÓÒ˜, Ó· ‰Ú· ̤-
Ûˆ Ù˘ Ú‡ıÌÈÛ˘ Ù˘ ‰Ú¿Û˘ Ù˘ ÂÈÓÂÊÚ›Ó˘53.
¶¿ÓÙˆ˜ Â› ÙÔ˘ ·ÚfiÓÙÔ˜ ‰ÂÓ Û˘ÛÙ‹ÓÂÙ·È Û·Ó
Ê¿ÚÌ·ÎÔ ÁÈ· ÙËÓ ·¯˘Û·ÚΛ·.
∞ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η
ΔÔÈÚ·Ì¿ÙË: Â›Ó·È Ê¿ÚÌ·ÎÔ Î·Ù¿ Ù˘ ÂÈÏË-
„›·˜ Î·È ¯ÔÚËÁÂ›Ù·È ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ËÌÈ-
ÎÚ·Ó›·˜. ∫·Ù¿ ÙËÓ ¯ÔÚ‹ÁËÛË Ù˘ Û ·ÛıÂÓ›˜ ÛË-
ÌÂÈÒıËΠ·ÒÏÂÈ· ۈ̷ÙÈÎÔ‡ ‚·ÚÔ˘˜54-56. Œ¯ÂÈ
ÛËÌ·ÓÙÈΤ˜ ·ÚÂÓ¤ÚÁÂȘ fiˆ˜ ·Ú·ÈÛı‹ÛÂȘ,
˘ÓËÏ›·, ·‰˘Ó·Ì›· Û˘ÁΤÓÙÚˆÛ˘. Œ¯ÂÈ ÛËÌÂȈ-
ı› ÌÂÙ·‚ÔÏÈ΋ ÔͤˆÛË Î·È ‰ÂÓ Û˘ÛÙ‹ÓÂÙ·È ÁÈ· ÙËÓ
ıÂÚ·›· Ù˘ ·¯˘Û·ÚΛ·˜.
º¿Ú̷η ·ÓÙȉȷ‚ËÙÈο
¶Ú·ÌÏÈÓÙ›‰Ë: ·Ì˘Ï›ÓË Â›Ó·È ÂÙȉÈ΋ ÔÚÌfi-
ÓË Ô˘ ÂÎÎÚ›ÓÂÙ·È ·fi Ù· ‚-·ÙÙ·Ú· ÙÔ˘ ·ÁÎÚ¤·-
ÙÔ˜ Ì·˙› Ì ÙËÓ ÈÓÛÔ˘Ï›ÓË ÌÂÙ¿ ·fi Ï‹„Ë ÙÚÔÊ‹˜.
∏ ·ÏÌÈÙȉ›ÓË Â›Ó·È Û˘ÓıÂÙÈÎfi ·Ú¿ÁˆÁÔ Ù˘ ·Ì˘-
Ï›Ó˘ Ô˘ ÂÈ‚Ú·‰‡ÓÂÈ ÙËÓ Î¤ÓˆÛË ÙÔ˘ ÛÙÔÌ¿¯Ô˘,
ÌÂÈÒÓÂÈ ÙËÓ ÌÂÙ·ÁÂ˘Ì·ÙÈ΋ ·‡ÍËÛË Ù˘ ÁÏ˘Îfi˙˘
53
Î·È ‚ÂÏÙÈÒÓÂÈ ÙȘ ÙÈ̤˜ Ù˘ ∏μ∞1C Û ·ÛıÂÓ›˜ ÌÂ
™¢ Ù‡Ô˘ 1 Î·È 2. ∞ÓÙ›ıÂÙ· Ì ÙËÓ ÈÓÛÔ˘Ï›ÓË Û¯Â-
Ù›˙ÂÙ·È Ì ‹È· ·ÒÏÂÈ· ‚·ÚÔ˘˜57,58.
∂ÍÂÓ·Ù›‰Ë: Â›Ó·È ÈÓÎÚÂÙ›ÓË (glucagon-like po-
lypeptide-1 [GLP-1]), Á·ÛÙÚÂÓÙÂÚÈ΋ ÔÚÌfiÓË Ë
ÔÔ›· ‰ÈÂÁ›ÚÂÈ ÙËÓ ¤ÎÎÚÈÛË Ù˘ ÈÓÛÔ˘Ï›Ó˘ ̤ۈ
Ù˘ ÁÏ˘Îfi˙˘. ÙÔ GLP-1 Â›Û˘ ·Ó·ÛÙ¤ÏÏÂÈ ÙËÓ ¤Î-
ÎÚÈÛË ÙÔ˘ ÁÏԢηÁfiÓÔ˘ Î·È ÙËÓ Î¤ÓˆÛË ÙÔ˘ ÛÙÔ-
Ì¿¯Ô˘. ∏ ÂÍ·ÓÂÙ›‰Ë Â›Ó·È ¤Ó·˜ ÂÙȉÈÎfi˜ ·ÁˆÓÈ-
ÛÙ‹˜ ÙÔ˘ ˘Ô‰Ô¯¤· ÙÔ˘ ÁÏԢηÁÔÓfiÌÔÚÊÔ˘ ÂÙÈ-
‰›Ô˘-1 (GLP-1), ·ÓıÂÎÙÈÎfi˜ ÛÙË ‰Ú¿ÛË ÙÔ˘ ÂÓ˙‡-
ÌÔ˘ ‰ÈÂÙȉ˘Ï-ÂÙȉ¿ÛË-4 (DPP4). ÃÔÚËÁ›ٷÈ
Û ·ÛıÂÓ›˜ Ì ™¢2. ™Â ÎÏÈÓÈΤ˜ ‰ÔÎÈ̤˜ Ê·›ÓÂÙ·È
fiÙÈ ÚÔηÏ› ‹È· ·ÒÏÂÈ· ‚¿ÚÔ˘˜.
¶ÂÈÚ·Ì·ÙÈο Ê¿Ú̷η
§ÂÙ›ÓË: ¶ÂÙ›‰ÈÔ Ô˘ ÂÎÎÚ›ÓÂÙ·È Î˘Ú›ˆ˜ ÛÙÔ
ÏÈÒ‰Ë ÈÛÙfi. ∞Ô˘Û›· Ù˘ ÏÂÙ›Ó˘ Ê·›ÓÂÙ·È fiÙÈ
ÚÔηÏ› ÂÎÛÂÛËÌ·Ṳ̂ÓË ·¯˘Û·ÚΛ· Û ÔÓÙ›-
ÎÈ· (ob/ob) Î·È Û ·ÓıÚÒÔ˘˜59. ™Â ÔÓÙ›ÎÈ· ηÈ
Û¿ÓÈ· Û ·ÓıÚÒÔ˘˜ Ì ¤ÏÏÂÈ„Ë ÏÂÙ›Ó˘ Ë ¯ÔÚ‹-
ÁËÛË Ù˘ ÚÔηÏ› ·ÒÏÂÈ· ‚¿ÚÔ˘˜60. ∞ÓÙ›ıÂÙ·,
Û db/db ÔÓÙ›ÎÈ· Ù· ÔÔ›· ¤¯Ô˘Ó ÁÂÓÂÙÈÎfi ÌÂÈÔÓ¤-
ÎÙËÌ· ÛÙÔÓ ˘Ô‰Ô¯¤· Ù˘ ÏÂÙ›Ó˘ Î·È Â›Ó·È ·¯‡-
Û·Úη ‰ÂÓ ··ÓÙÔ‡Ó ÛÙËÓ ¯ÔÚ‹ÁËÛË Ù˘.
¶ÂÙ›‰ÈÔ YY: ∂ÓÙÂÚÈ΋ ÔÚÌfiÓË Ô˘ ηٷ-
ÛÙ¤ÏÏÂÈ ÙËÓ fiÚÂÍË Î·È ÙËÓ ÚfiÛÏË„Ë ÙÚÔÊ‹˜. ¶È-
ı·ÓÒ˜, ÌÂÏÏÔÓÙÈο Ó· ¯ÚËÛÈÌÔÔÈËı› Û·Ó Ê¿ÚÌ·-
ÎÔ Î·Ù¿ Ù˘ ·¯˘Û·ÚΛ·˜61.
O͢ÓÙÔÌÔÓÙÔ˘Ï›ÓË: ¶ÂÙ›‰ÈÔ Ô˘ ·Ú¿ÁÂÙ·È
·fi Ù· L-·ÙÙ·Ú· ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ ۈϋӷ. Â-
ÓÂÚÁ› ÛÙÔÓ ˘Ôı¿Ï·ÌÔ, ÌÈ· ÂÚÈÔ¯‹ ÙÔ˘ ÂÁÎÂÊ¿-
ÏÔ˘ Ô˘ Â›Ó·È ÛËÌ·ÓÙÈ΋ ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô ÙÔ˘ ÂÓÂÚ-
ÁÂÈ·ÎÔ‡ ÈÛÔ˙˘Á›Ô˘. ∏ Ô͢ÓÙÔÌÔÓÙÔ˘Ï›ÓË Î·È ¿ÏÏ·
΢ÎÏÔÊÔÚÔ‡ÓÙ· Û‹Ì·Ù· Â›Ó·È Èηӿ Ó· ‰È·Û¯›ÛÔ˘Ó
ÙÔÓ ·ÈÌ·ÙÔÂÁÎÂÊ·ÏÈÎfi ÊÚ·ÁÌfi, ̤ۈ ÌÈ·˜ ÂÍÂȉÈ-
ÎÂ˘Ì¤Ó˘ ÂÚÈÔ¯‹˜ ‰›Ï· ÛÙÔÓ ˘Ôı¿Ï·ÌÔ. O ˘Ô-
ı¿Ï·ÌÔ˜ ÌÔÚ› ÙfiÙ ӷ Ï¿‚ÂÈ Î·È Ó· ÂÂÍÂÚÁ·-
ÛÙ› ·˘Ù¿ Ù· Û‹Ì·Ù·. OÈ Ó¢Úԉȷ‚È‚·ÛÙ¤˜ Ô˘
·ÂÏ¢ıÂÚÒÓÔÓÙ·È, ÔÈ ÔÔ›ÔÈ ÛÙ¤ÏÓÔ˘Ó ÌËӇ̷ٷ
·fi ÙÔÓ ˘Ôı¿Ï·ÌÔ Û ÔÏϤ˜ ‰È·ÊÔÚÂÙÈΤ˜ Â-
ÚÈÔ¯¤˜ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘, Ô‰ËÁÔ‡Ó Û ·ÏÏ·Á‹ Ù˘ Û˘-
ÌÂÚÈÊÔÚ¿˜. ∫·Ù¿ Û˘Ó¤ÂÈ·, ÌÈ· ·‡ÍËÛË ÛÙ· ΢-
ÎÏÔÊÔÚÔ‡ÓÙ· Â›‰· Ù˘ Ô͢ÓÙÔÌÔÓÙÔ˘Ï›Ó˘ Ô‰Ë-
Á› Û ¤Ó· Û˘Ó·›ÛıËÌ· ÏËÚfiÙËÙ·˜ Î·È ÂÈÙÚ¤ÂÈ
ÌÈ· ·‡ÍËÛË ÙˆÓ ÂÈ¤‰ˆÓ ‰Ú·ÛÙËÚÈfiÙËÙ·˜. ∞˘Ùfi
ÌÔÚ› Ó· Â›Ó·È ¤Ó·˜ ÏÔÁÈÎfi˜ Û˘Ó‰˘·ÛÌfi˜ ·ÔÙÂ-
ÏÂÛÌ¿ÙˆÓ, ‰Â‰Ô̤ÓÔ˘ fiÙÈ ı· Â¤ÙÚÂ ÌÈ· ÂÚ›Ô‰Ô
¤ÓÙÔÓ˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜, fiÙ·Ó ˘¿Ú¯Ô˘Ó ·ÚÎÂÙ¿
ÙÚfiÊÈÌ· ÁÈ· Ó· ·Ú¤¯Ô˘Ó ÙËÓ ÂÓ¤ÚÁÂÈ· (∂ÈÎ. 3).
54 ª. ª¶OÀ°OÀ§π∞, ∏. ∂À£ÀªπOÀ
∂ÈÎ. 3. O͢ÓÙÔÌÔÓÙÔ˘Ï›ÓË Î·È ÎÔÚÂÛÌfi˜.
ŸÙ·Ó ¯ÔÚËÁ‹ıËΠ۠˘ÁÈ›˜ ÂıÂÏÔÓÙ¤˜ ·¯‡-
Û·ÚÎÔ˘˜ 3 ÊÔÚ¤˜ ÙËÓ Ë̤ڷ 30 ÏÂÙ¿ ÚÔ ÙÔ˘ Á‡-
Ì·ÙÔ˜ Ë ÔÌ¿‰· ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ¤¯·Û 2,3 ± 0,4 kg,
Û ۯ¤ÛË Ì ·˘ÙÔ‡˜ Ù˘ ÔÌ¿‰·˜ ÙÔ˘ ÂÈÎÔÓÈÎÔ‡ Ê·Ú-
Ì¿ÎÔ˘ 0,5 ± 0,5 kg.
∞ÁˆÓÈÛÙ‹˜ ÙÔ˘ ˘Ô‰Ô¯¤· 4 Ù˘ ÌÂÏ·ÓÔÎÔÚÙ›-
Ó˘: ∏ ˘Ôı·Ï·ÌÈ΋ ÌÂÏ·ÓÔÎÔÚÙ›ÓË Ê·›ÓÂÙ·È Ó·
‰È·‰Ú·Ì·Ù›˙ÂÈ ÛÔ˘‰·›Ô ÚfiÏÔ ÛÙËÓ Ú‡ıÌÈÛË ÙÔ˘ Ûˆ-
Ì·ÙÈÎÔ‡ ‚·ÚÔ˘˜63. ¶·ÚfiÏ· Ù·‡Ù· Û ÌÂϤÙË 23
˘¤Ú‚·ÚˆÓ ·Ó‰ÚÒÓ fiÙ·Ó ¯ÔÚËÁ‹ıËΠÁÈ· 12 Ì‹Ó˜
‰ÂÓ ÛËÌ›ˆÛ·Ó ·ÏÏ·Á‹ ÛÙÔ ÛˆÌ·ÙÈÎfi ÙÔ˘˜ ‚¿ÚÔ˜64.
™˘ÌÂÚ·ÛÌ·ÙÈο Ë Ê·Ú̷΢ÙÈ΋ ·Ú¤Ì‚·-
ÛË ¤¯ÂÈ ˆ˜ ÛÙfi¯Ô ÙËÓ ÚfiÏË„Ë ‹ ÙËÓ ·Ó·ÛÙÚÔÊ‹
Ù˘ ÂÌÊ¿ÓÈÛ˘ ÙˆÓ ÌÂÙ·‚ÔÏÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ Î·È
ÙˆÓ ÂÈÏÔÎÒÓ Ù˘ ·¯˘Û·ÚΛ·˜.
Δ· Ê¿Ú̷η ¯ÔÚËÁÔ‡ÓÙ·È ¿ÓÙÔÙ ÛÂ Û˘Ó‰˘·-
ÛÌfi Ì ÙËÓ ‰›·ÈÙ·, ¿ÛÎËÛË, ÙËÓ ÙÚÔÔÔ›ËÛË Ù˘ Û˘-
ÌÂÚÈÊÔÚ¿˜ Î·È ‰ÚÔ˘Ó Û˘ÓÂÚÁÈο Î·È ·ıÚÔÈÛÙÈο.
∏ ¯ÔÚ‹ÁËÛË ÙˆÓ Ê·ÚÌ¿ÎˆÓ ÛÙÔ˘˜ ·¯‡Û·Ú-
ÎÔ˘˜ ·ÛıÂÓ›˜ ÚÔ¸Ôı¤ÙÂÈ ÙËÓ ÂÍ·ÛÊ¿ÏÈÛË Ù˘
ηϋ˜ ·ÓÔ¯‹˜ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Î·È ÙËÓ ¤ÏÏÂÈ„Ë ÙˆÓ
·ÚÂÓÂÚÁÂÈÒÓ ÙÔ˘˜.
ABSTRACT
Bougoulia M, Efthimiou H. Pharmacotherapy for
obesity. Hell Iatr 2009, 75: 47-56.
Drug therapy for overweight or obese patients
may be helpful when used in combination with diet,
exercise and behavioural modification. The role of
drug therapy has been questioned, however, be-
cause of concerns regarding efficacy, safety, and the
observation that most patients regain their weight
when their weight-loss drugs are stopped. The de-
cision to initiate drug therapy in overweight subjects
should be made only after a careful evaluation of the
risks and benefits.
μπμ§π√°ƒ∞ºπ∞
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∞ÏÏËÏÔÁÚ·Ê›·:
M. ªÔ˘ÁÔ˘ÏÈ¿
¶fiÓÙÔ˘ 62 – ∫·Ï·Ì·ÚÈ¿
551 31 £ÂÛÛ·ÏÔÓ›ÎË
Corresponding Author:
M. Bougoulia
Pontou 62 – Kalamaria
551 31 Thessaloniki
Greece
∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 2009, 75, 1: 57- 64
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Û‡ÛÙ·ÛË ÙÂÎÌËÚ›ˆÛ˘ ÂÈ¤‰Ô˘ ∞ (Grade A recom-
mendation) ÁÈ· ÙËÓ Â›Ù¢ÍË ÓÔÚÌÔÁÏ˘Î·ÈÌ›·˜ Ì ÙËÓ
πV ¯ÔÚ‹ÁËÛË ÈÓÛÔ˘Ï›Ó˘ ÛÙÔ˘˜ ‚·Ú¤ˆ˜ ¿Û¯ÔÓÙ˜.
EÏÏËÓ I·ÙÚ 2009, 75: 57 - 64.
·fi ¿Ô„Ë ÂÈÏÔÎÒÓ4. ™Â ·ÛıÂÓ›˜ Ô˘ ˘Ô‚Ï‹-
ıËÎ·Ó Û ηډÈÔ¯ÂÈÚÔ˘ÚÁÈ΋ Â¤Ì‚·ÛË, Ë ˘ÂÚ-
ÁÏ˘Î·ÈÌ›· Ê¿ÓËΠfiÙÈ Û¯ÂÙ›˙ÂÙ·È Ì ÛËÌ·ÓÙÈ΋ ·‡-
ÍËÛË ıÓËÛÈÌfiÙËÙ·˜ Î·È ÌÂÁ·Ï‡ÙÂÚÔ ¯ÚfiÓÔ ·ԉȷ-
ۈϋӈÛ˘5,6. ∏ ˘ÂÚÁÏ˘Î·ÈÌ›· ‰ÈÂÁ¯ÂÈÚËÙÈο
·ԉ›¯ÙËΠ·ÓÂÍ¿ÚÙËÙÔ˜ ·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘
ÌÂÙ¿ Ù¤ÙÔÈÔ˘ ›‰Ô˘˜ ÂÂÌ‚¿ÛÂȘ7. ∂ÈϤÔÓ, Û ·-
ÛıÂÓ›˜ Ì Ô͇ ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘ ηÈ
ηډȷ΋ ·ÓÂ¿ÚÎÂÈ·, Ë ˘ÂÚÁÏ˘Î·ÈÌ›· Ê·›ÓÂÙ·È
fiÙÈ Û¯ÂÙ›˙ÂÙ·È Ì ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ı·Ó¿ÙÔ˘8. Δ·
58 A. MA™ΔƒO∫ø™Δ∞™ ∫∞π ™À¡.
·˘ÍË̤ӷ Â›‰· ۷ί¿ÚÔ˘ ·›Ì·ÙÔ˜ (™∞) ÛÂ
ÙÚ·˘Ì·Ù›Â˜ ‹Ù·Ó Â›Û˘ ÚÔÁÓˆÛÙÈÎfi˜ ‰Â›ÎÙ˘ ·˘-
ÍË̤Ó˘ ıÓËÛÈÌfiÙËÙ·˜ Î·È ·Ú·ÙÂٷ̤Ó˘ ÓÔÛË-
Ï›·˜ ÛÙË ª.∂.£, ÂÓÒ Û¯ÂÙ›˙ÔÓÙ·È Â›Û˘ Ì ·˘ÍË-
̤Ó˜ ÏÔÈÌÒÍÂȘ Î·È ÌÂÁ·Ï‡ÙÂÚË ·Ó¿ÁÎË Û Ì˯·-
ÓÈÎfi ·ÂÚÈÛÌfi9-13. ∂ÎÙfi˜ ·fi ÙËÓ ÚÔÁÓˆÛÙÈ΋ ·Í›·
Ù˘ ˘ÂÚÁÏ˘Î·ÈÌ›·˜ ÛÙËÓ ÂÈ‚›ˆÛË ÙˆÓ ·ÛıÂÓÒÓ
Ì ÛÔ‚·Ú¤˜ ÎÚ·ÓÈÔÂÁÎÂÊ·ÏÈΤ˜ ηÎÒÛÂȘ, ·Ó¢-
Ú¤ıËÎÂ Î·È ÛËÌ·ÓÙÈ΋ Û¯¤ÛË ÌÂٷ͇ ÙˆÓ ˘„ËÏÒÓ
ÙÈÌÒÓ ™∞ Î·È Ù˘ Âȉ›ӈÛ˘ Ù˘ Ó¢ÚÔÏÔÁÈ΋˜
ÂÈÎfiÓ·˜, Ù˘ ÂÓ‰ÔÎÚ¿ÓÈ·˜ ˘¤ÚÙ·Û˘ Î·È Ù˘ ·‡ÍË-
Û˘ ÙÔ˘ ¯ÚfiÓÔ˘ ÓÔÛËÏ›·˜14,15. OÌÔ›ˆ˜, Ë ˘ÂÚÁÏ˘-
ηÈÌ›· ‹Ù·Ó ÚÔÁÓˆÛÙÈÎfi˜ ‰Â›ÎÙ˘ ·˘ÍË̤Ó˘ ıÓË-
ÛÈÌfiÙËÙ·˜ Î·È ÂÏ·Ùو̤Ó˘ ÏÂÈÙÔ˘ÚÁÈ΋˜ ·Ôη-
Ù¿ÛÙ·Û˘ Û ·ÛıÂÓ›˜ ÌÂÙ¿ ·fi ·ÁÁÂÈ·Îfi ÂÁÎÂÊ·-
ÏÈÎfi ÂÂÈÛfi‰ÈÔ16. ∂ÈϤÔÓ, fiÛÔÓ ·ÊÔÚ¿ ÛÙÔ˘˜
·È‰È·ÙÚÈÎÔ‡˜ ·ÛıÂÓ›˜ Ù˘ ª∂£, ¤¯ÂÈ ·Ô‰ÂȯÙ›
fiÙÈ Ë ˘ÂÚÁÏ˘Î·ÈÌ›· Û¯ÂÙ›˙ÂÙ·È Ì ¯ÂÈÚfiÙÂÚË ¤Î‚·-
ÛË17. ™˘ÁÎÂÎÚÈ̤ӷ ÁÈ· ·È‰È¿ Ì ÂÁη‡Ì·Ù·, Ë
ıÓËÛÈÌfiÙËÙ· Î·È Ë ‚·ÎÙËÚÈ·ÈÌ›· ‹Ù·Ó ˘„ËÏfiÙÂÚË
ÛÙÔ˘˜ ˘ÂÚÁÏ˘Î·ÈÌÈÎÔ‡˜18. ª¿ÏÈÛÙ·, ·Ó·‰ÚÔÌÈ΋
·Ó¿Ï˘ÛË ÂÓfi˜ ÂÙÂÚÔÁÂÓÔ‡˜ ·È‰È·ÙÚÈÎÔ‡ ÏËı˘-
ÛÌÔ‡ ÛÙËÓ ÂÓÙ·ÙÈ΋, ·ÔÎ¿Ï˘„ fiÙÈ ·ÎfiÌ· Î·È Ì¤-
ÙÚÈÔ˘ ‚·ıÌÔ‡ ˘ÂÚÁÏ˘Î·ÈÌ›· Û¯ÂÙÈ˙fiÙ·Ó Ì ÛËÌ·-
ÓÙÈο ·˘ÍË̤ÓË ıÓËÛÈÌfiÙËÙ·19. ∂ÎÙfi˜ ·˘ÙÔ‡, ·Îfi-
Ì· Î·È Ë ‰È·Î‡Ì·ÓÛË ÙˆÓ ÙÈÌÒÓ ™∞ ηٿ ÙË ‰È¿Ú-
ÎÂÈ· ÓÔÛËÏ›·˜ ÛÙË ª∂£, Ê¿ÓËΠfiÙÈ Û¯ÂÙ›˙ÂÙ·È
ÌÂ ÙË ıÓËÛÈÌfiÙËÙ·20.
Àfi ÙÔÓ fiÁÎÔ Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜ Ô˘ ˘Ô‰ÂÈ-
ÎÓ‡ÂÈ ÙËÓ ˘ÂÚÁÏ˘Î·ÈÌ›· ˆ˜ ¤Ó· ÛËÌ·ÓÙÈÎfi ·ÚÓË-
ÙÈÎfi ÚÔÁÓˆÛÙÈÎfi ‰Â›ÎÙË, Ê¿ÓËΠ·Ó·Áη›· Ë ‰È·-
¯Â›ÚÈÛ‹ Ù˘ Ì ÙË ¯ÔÚ‹ÁËÛË ÈÓÛÔ˘Ï›Ó˘ ÛÙÔ˘˜ ‚·-
Ú¤ˆ˜ ¿Û¯ÔÓÙ˜. μ·ÛÈÎfi fï˜ ÂÚÒÙËÌ· ·Ú¤ÌÂÓÂ
ÙÔ ·Ô‰ÂÎÙfi Â›Â‰Ô ÙÈÌÒÓ ™∞. ª¤¯ÚÈ ÚfiÛÊ·Ù·,
‹Ù·Ó ÎÔÈÓ‹ Ú·ÎÙÈ΋ Ë ·ÓÔ¯‹ ÂÈ¤‰ˆÓ ™∞ ̤¯ÚÈ
220 mg/dl ÁÈ· ÙÔ˘˜ ‚·Ú¤ˆ˜ ¿Û¯ÔÓÙ˜ ·ÛıÂÓ›˜
Ô˘ ÛÈÙ›˙ÔÓÙ·È Î·È ÌfiÓÔ fiÙ·Ó Ë ˘ÂÚÁÏ˘Î·ÈÌ›· ÍÂ-
ÂÚÓÔ‡Û ·˘Ù¤˜ ÙȘ ÙÈ̤˜ ÁÈÓfiÙ·Ó ¯ÔÚ‹ÁËÛË ÈÓÛÔ˘-
Ï›Ó˘. Δ· ÎÏ·ÛÈο ÂȯÂÈÚ‹Ì·Ù· ÁÈ· ÙËÓ ·ÓÔ¯‹ Ù˘
˘ÂÚÁÏ˘Î·ÈÌ›·˜ ‹Ù·Ó fiÙÈ Ë Ì¤ÙÚÈ· ˘ÂÚÁÏ˘Î·ÈÌ›·
Â›Ó·È Â˘ÂÚÁÂÙÈ΋ ÁÈ· fiÚÁ·Ó· Ô˘ ÂÍ·ÚÙÒÓÙ·È
ÂÓÂÚÁÂȷο ·fi ÙËÓ ÚfiÛÏË„Ë ÁÏ˘Îfi˙˘ (ÂÁΤʷ-
ÏÔ˜, ̇˜, ·ÙÙ·Ú· ÙÔ˘ ·ÈÌÔÔÈËÙÈÎÔ‡, ·ÓÔÛÔÔÈË-
ÙÈÎfi) Î·È Ô Êfi‚Ô˜ ÁÈ· Ù˘¯fiÓ ˘ÔÁÏ˘Î·ÈÌ›· ηٿ ÙË
¯ÔÚ‹ÁËÛË ÈÓÛÔ˘Ï›Ó˘3.
∏ ÚÒÙË ÈÛ¯˘Ú‹ ¤Ó‰ÂÈÍË ÂÓ·ÓÙ›ÔÓ ·˘Ù‹˜ Ù˘
ÂÔ›ıËÛ˘ ‹Úı Ì ÌÈ· ÌÂÁ¿ÏË ÚÔÔÙÈ΋, Ù˘¯·È-
ÔÔÈË̤ÓË, ÂÏÂÁ¯fiÌÂÓË ÌÂϤÙË ÁÈ· ÙË Û˘Ó¯‹ IV
¯ÔÚ‹ÁËÛË ÈÓÛÔ˘Ï›Ó˘ Û ¤Ó· ÏËı˘ÛÌfi ª∂£ ÂÓË-
ϛΈÓ. ∞˘Ù‹ Ë ¤Ú¢ӷ ÂÎÙfi˜ ·fi ÙËÓ ·ÈÙÈÔÏÔÁÈ΋
Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ˘ÂÚÁÏ˘Î·ÈÌ›·˜ Î·È ‰˘ÛÌÂÓÔ‡˜
¶›Ó·Î·˜ 1. ¶Èı·ÓÔ› Ì˯·ÓÈÛÌÔ› ‰Ú¿Û˘ Ù˘ ÈÓÛÔ˘ÏÈÓÔıÂÚ·-
›·˜ Î·È ÙÔ˘ ÂϤÁ¯Ô˘ Ù˘ ˘ÂÚÁÏ˘Î·ÈÌ›·˜ ÛÙÔ˘˜ ·ÛıÂÓ›˜
Ù˘ ª∂£28-30
• μÂÏÙ›ˆÛË Ù˘ ·ÓÔÛÔÔÈËÙÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ Î·È ÂÏ·Ùو̤-
ÓË Â˘¿ıÂÈ· Û ÏÔÈÌÒÍÂȘ
• ¶ÂÚÈÔÚÈṲ̂ÓË Û˘ÛÙËÌ·ÙÈ΋ ÊÏÂÁÌÔÓ҉˘ ·ÓÙ›‰Ú·ÛË
• μÂÏÙȈ̤ÓË ÂÓ‰ÔıËÏȷ΋ ÏÂÈÙÔ˘ÚÁ›·, ̤ۈ Ù˘ ‰È¤ÁÂÚÛ˘
·Ú·ÁˆÁ‹˜ ¡O Î·È Ù˘ ÚÔ·ÁˆÁ‹˜ Ù˘ ·ÁÁÂÈÔÎÈÓËÙÈ΋˜
ÏÂÈÙÔ˘ÚÁ›·˜
• μÂÏÙ›ˆÛË Ù˘ ηٿÛÙ·Û˘ ÙÔ˘ ËÎÙÈÎÔ‡ Ì˯·ÓÈÛÌÔ‡ ÌÂ
ÙËÓ ÂÓ›Û¯˘ÛË Ù˘ ÈÓˆ‰ÔÁÔÓfiÏ˘Û˘ Î·È Ù˘ ·ÈÌÔÂÙ·ÏÈ·-
΋˜ ÏÂÈÙÔ˘ÚÁ›·˜
• ∂Ï¿ÙÙˆÛË ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ Î·È ·‡ÍËÛË ÙˆÓ HDL
• ∞Ó·‚ÔÏÈ΋ ‰Ú¿ÛË ÈÓÛÔ˘Ï›Ó˘
• μÂÏÙȈ̤ÓË Î·Ú‰È·Î‹ ÏÂÈÙÔ˘ÚÁ›· Î·È Û˘ÛÙ·ÏÙÈÎfiÙËÙ·
• ªÂ›ˆÛË ÂÏ¢ı¤ÚˆÓ ÚÈ˙ÒÓ Ô͢ÁfiÓÔ˘ Î·È ÂÏ¿ÙÙˆÛË ÔÍÂȉˆ-
ÙÈÎÔ‡ stress
ÚfiÁÓˆÛ˘, ·¤‰ÂÈÍ ÙËÓ Â˘ÂÚÁÂÙÈ΋ Â›‰Ú·ÛË Ù˘
ÂÊ·ÚÌÔÁ‹˜ ÙÔ˘ ÛÙÂÓÔ‡ ÂϤÁ¯Ô˘ ÙÔ˘ ™∞ ÛÙË ıÓËÛÈ-
ÌfiÙËÙ· Î·È ÓÔÛËÚfiÙËÙ·21. ª¤¯ÚÈ ÙfiÙÂ, ÔÈ ÌfiÓ˜
¤Ú¢Ó˜ Ô˘ ›¯·Ó Á›ÓÂÈ Û¯ÂÙÈο Ì ÙË Ì›ˆÛË Ù˘
ıÓËÛÈÌfiÙËÙ·˜ Ì ÙË ¯ÔÚ‹ÁËÛË ÈÓÛÔ˘Ï›Ó˘, ·ÊÔÚÔ‡-
Û·Ó Û˘ÁÎÂÎÚÈ̤ÓÔ˘˜ ÏËı˘ÛÌÔ‡˜ (·ÛıÂÓ›˜ ÌÂ
O∂ª22, ∞∂∂ Î·È ‰È·‚ËÙÈÎÔ‡˜23 Î·È ¯ÔÚ‹ÁËÛË ‰È·-
χ̷ÙÔ˜ ÈÓÛÔ˘Ï›Ó˘, Î·Ï›Ô˘, ÁÏ˘Îfi˙˘-GIK)24,25.
∞Ó Î·È Ù· ·ÔÙÂϤÛÌ·Ù· ‹Ù·Ó ÂÓı·ÚÚ˘ÓÙÈο, ˆ-
ÛÙfiÛÔ ‰ÂÓ ÌÔÚÔ‡Û·Ó ÚÔÊ·ÓÒ˜ Ó· ÁÂÓÈ΢ÙÔ‡Ó
Û fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ Ù˘ ª∂£3. ΔÔ ÛÎÂÙÈÎfi
Ù˘ ·ÓÙÈÌÂÙÒÈÛ˘ fiÏˆÓ ÙˆÓ ·ÛıÂÓÒÓ ·ÓÂÍ·ÚÙ‹-
Ùˆ˜ ÈÛÙÔÚÈÎÔ‡ ™¢ Î·È ·ı‹Ûˆ˜ Ì ¯ÔÚ‹ÁËÛË IV
ÈÓÛÔ˘Ï›Ó˘ ÁÈ· ÙËÓ Â›Ù¢ÍË Î·È ‰È·Ù‹ÚËÛË Ê˘ÛÈÔ-
ÏÔÁÈÎÒÓ ÙÈÌÒÓ ™∞ ηı’ fiÏË ÙË ‰È¿ÚÎÂÈ· ÓÔÛËÏ›·˜,
Ì ۷ʋ ·ÔÙÂϤÛÌ·Ù· ÛÙË ıÓËÛÈÌfiÙËÙ· Î·È ÙȘ
ÂÈÏÔΤ˜ ¿ÓÔÈÍ Ӥ˜ ÚÔÔÙÈΤ˜ ÛÙË ÌÂÙ·‚ÔÏÈ΋
‰È·¯Â›ÚÈÛË ÙˆÓ ‚·Ú¤ˆ˜ ·Û¯fiÓÙˆÓ. ŒÎÙÔÙÂ, Ë ‰ÈÂ-
ıÓ‹˜ ‚È‚ÏÈÔÁÚ·Ê›· ·Û¯ÔÏÂ›Ù·È Û˘ÛÙËÌ·ÙÈο Ì ÙË
‰ÈÂÚ‡ÓËÛË ·˘Ù‹˜ Ù˘ Û¯¤Û˘ Î·È Ì ÙËÓ ÂÍ·ÎÚ›-
‚ˆÛË Ù˘ ÂÊ·ÚÌÔÁ‹˜ ÙÔ˘˜ Û ¢Ú›· Îϛ̷η26. ∞Ó
Î·È ·ÎfiÌ· ‰ÂÓ ¤¯ÂÈ Á›ÓÂÈ ÍÂοı·ÚÔ ·Ó Ë ‰È·¯Â›ÚÈ-
ÛË Ù˘ ˘ÂÚÁÏ˘Î·ÈÌ›·˜ ‹ Ë ¯ÔÚ‹ÁËÛË ÈÓÛÔ˘Ï›Ó˘
per se ¢ı‡ÓÂÙ·È ÁÈ· Ù· fiÔÈ· ıÂÙÈο ·ÔÙÂϤÛÌ·-
Ù·27, ˆÛÙfiÛÔ ¤¯Ô˘Ó ÚÔÙ·ı› ‰È¿ÊÔÚÔÈ Èı·ÓÔ› ÌË-
¯·ÓÈÛÌÔ› (¶›Ó. 1).
∏ π∞Δƒπ∫∏ μ∞™π™ª∂¡∏ ™∂ ∂¡¢∂π•∂π™ (πμ∂)
∏ ‚·ÛÈ΋ ·Ú¯‹ Ù˘ πμ∂ Â›Ó·È fiÙÈ Ë ÂÈÛÙËÌÔÓÈ΋,
ÌÂıÔ‰È΋ Î·È ¯ˆÚ›˜ ÚÔηٿÏË„Ë Û˘ÏÏÔÁ‹ Î·È ÂÎÙ›-
ÌËÛË Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜, ÌÔÚ› Ó· ÚÔÛʤÚÂÈ ÙÂÎ-
ÌËÚ›ˆÛË Î·È ÛÙ‹ÚÈÍË ÛÙË Ï‹„Ë ÎÏÈÓÈÎÒÓ ·ÔÊ¿ÛÂ-
ˆÓ. μ·ÛÈο ÂÚÁ·Ï›· Ù˘ Â›Ó·È Ë Û˘ÛÙËÌ·ÙÈ΋ ·Ó·-
ÛÎfiËÛË Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜ Î·È Ë ÌÂÙ·-·Ó¿Ï˘ÛË.
 ∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 75, 1
¢π∞ΔÀ¶ø™∏ Δ√À ∂ƒ∂À¡∏Δπ∫√À ∂ƒøΔ∏ª∞Δ√™
ΔÔ ÈÔ ÛËÌ·ÓÙÈÎfi ‚‹Ì· Û ÔÔÈ·‰‹ÔÙÂ Û˘ÛÙËÌ·-
ÙÈ΋ ·Ó·ÛÎfiËÛË Â›Ó·È Ë ÍÂοı·ÚË ‰È·Ù‡ˆÛË
ÂÓfi˜ ÎÏÈÓÈο ÛËÌ·ÓÙÈÎÔ‡ ÂÚˆÙ‹Ì·ÙÔ˜. °È· ÙË Û˘-
ÛÙËÌ·ÙÈ΋ ‰È·ÌfiÚʈÛË ÙÔ˘ ÂÚ¢ÓËÙÈÎÔ‡ ÂÚˆÙ‹Ì·-
ÙÔ˜ ¯ÚËÛÈÌÔÔÈ‹ıËΠÙÔ ÚfiÙ˘Ô PICO (Popula-
tion, Intervention, Comparator, Outcome)31. ŒÙÛÈ,
ÙÔ ÂÚ¢ÓËÙÈÎfi ÂÚÒÙËÌ· Ù˘ Û˘ÁÎÂÎÚÈ̤Ó˘ ÂÚÁ·-
Û›·˜ Â›Ó·È ÙÔ ÂÍ‹˜: ¶ÔÈ· Â›Ó·È Ë Â›‰Ú·ÛË Ù˘ Û˘ÓÂ-
¯Ô‡˜ IV ¯ÔÚ‹ÁËÛ˘ ÎÚ˘ÛÙ·ÏÏÈ΋˜ ÈÓÛÔ˘Ï›Ó˘ ÁÈ·
ÙËÓ Â›Ù¢ÍË ÓÔÚÌÔÁÏ˘Î·ÈÌ›·˜ ÛÙË ıÓËÛÈÌfiÙËÙ·
ÙˆÓ ÂÓËÏ›ÎˆÓ ·ÛıÂÓÒÓ Ù˘ ª∂£.
ª∂£√¢√§√°ÿ∞
∏ Û˘ÛÙËÌ·ÙÈ΋ ·Ó·˙‹ÙËÛË Ù˘ ¤Á΢Ú˘ Î·È Û¯ÂÙÈ΋˜ ‚È‚ÏÈÔ-
ÁÚ·Ê›·˜ ¤ÁÈÓ Ì ÙË ‚Ô‹ıÂÈ· ËÏÂÎÙÚÔÓÈÎÒÓ ‚¿ÛÂˆÓ ‰Â‰Ô̤-
ÓˆÓ, Ô˘ ÂÈÙÚ¤Ô˘Ó ÚfiÛ‚·ÛË Û Ï‹Ú˜ ΛÌÂÓÔ ÙˆÓ ¿Ú-
ıÚˆÓ. ∫˘Ú›ˆ˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë ‚¿ÛË MEDLINE, ̤ۈ
ÙÔ˘ NCBI (www.pubmed.com) Ô˘ ¤¯ÂÈ Ï‹ÚË ‰ˆÚÂ¿Ó Úfi-
Û‚·ÛË Ì¤Ûˆ ÙÔ˘ ∞.¶.£. ∂ÈϤÔÓ, ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë ‚¿ÛË
Cohrane (www3.interscience.wiley.com) ÁÈ· ÙÔ ·Ú¯Â›Ô ÎÏÈÓÈ-
ÎÒÓ ‰ÔÎÈÌÒÓ Ô˘ ÂÚÈÏ·Ì‚¿ÓÂÈ. ¶ÂÚÈÏ‹ÊıËΠÌfiÓÔ Ë ‚È-
‚ÏÈÔÁÚ·Ê›· ÛÙËÓ ·ÁÁÏÈ΋ ÁÏÒÛÛ·-·Ó Î·È ·˘Ùfi Ì¿ÏÏÔÓ ‰ÂÓ
ÂËÚ¤·Û ÛËÌ·ÓÙÈο ÙËÓ ·Ó·˙‹ÙËÛË ÁÈ·Ù› ˘‹Ú¯·Ó ÂÏ¿¯ÈÛÙ·
¿ÚıÚ· ÛÙË Á·ÏÏÈ΋, ÁÂÚÌ·ÓÈ΋, ÓÔÚ‚ËÁÈ΋ Î·È ÈÛ·ÓÈ΋
ÁÏÒÛÛ·. ™˘ÌÂÚÈÏ‹ÊıËÎ·Ó ÌfiÓÔ ¤Ú¢Ó˜ Ô˘ ‰ËÌÔÛ›Â˘Û·Ó
Ù· ÙÂÏÈο ÙÔ˘˜ ·ÔÙÂϤÛÌ·Ù·. ¢ÂÓ Ù¤ıËΠ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·
·Ó·˙‹ÙËÛ˘, ÁÈ·Ù› ÙÔ ı¤Ì· Â›Ó·È ÚfiÛÊ·ÙÔ Î·È Ë ÚÒÙË ‚È-
‚ÏÈÔÁÚ·ÊÈ΋ ·Ú·ÔÌ‹ Ô˘ Ô˘ÛÈ·ÛÙÈο ÔÚÈÔıÂÙ› ÙËÓ
··Ú¯‹ Ù˘ Û¯ÂÙÈ΋˜ ¤Ú¢ӷ˜ Â›Ó·È ÙÔ 2001. ∞ÔÎÏ›ÛÙËηÓ
ÌÂϤÙ˜ ÔÈ Ôԛ˜ ·Ó·Ê¤ÚÔÓÙ·Ó ÌfiÓÔ Û ‰ÈÂÁ¯ÂÈÚËÙÈ΋ ¯ÔÚ‹-
ÁËÛË ÈÓÛÔ˘Ï›Ó˘ ‹ Û ¯ÔÚ‹ÁËÛË ‰È·Ï‡Ì·ÙÔ˜ GIK. ∞ÔÎÏ›-
ÛÙËÎ·Ó ÌÂϤÙ˜ Ô˘ ·ÊÔÚÔ‡Û·Ó ÌfiÓÔ ‰È·‚ËÙÈÎÔ‡˜ ÏËı˘-
ÛÌÔ‡˜ Î·È Ù¤ÏÔ˜ ¤Ú¢Ó˜ Û ·È‰È·ÙÚÈÎÔ‡˜ ·ÛıÂÓ›˜. Δ· ÎÚÈ-
Ù‹ÚÈ· ÂÈÏÔÁ‹˜-·ÔÎÏÂÈÛÌÔ‡, Ê·›ÓÔÓÙ·È ÛÙÔÓ ›Ó·Î· 2.
OÈ fiÚÔÈ ÎÏÂȉȿ Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ‹Ù·Ó: tight
glycemic control, strict glycemic control, hyperglycemia,
normoglycemia, intensive insulin therapy, intensive care
unit, critical care, mortality, morbidity.
ÃÚËÛÈÌÔÔÈÒÓÙ·˜ Ù· ÂÚÁ·Ï›· Û‡ÓıÂÙ˘ ·Ó·˙‹ÙËÛ˘
Î·È ÈÛÙÔÚÈÎÔ‡ Ô˘ ·Ú¤¯Ô˘Ó ÔÈ ·ÓÙ›ÛÙÔȯ˜ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜
‚¿ÛÂȘ, Û˘ÏϤ¯ıËÎÂ Ô fiÁÎÔ˜ Ù˘ Û¯ÂÙÈ΋˜ ‚È‚ÏÈÔÁÚ·Ê›·˜. ∏
¶›Ó·Î·˜ 2. ∫ÚÈÙ‹ÚÈ· ÂÈÏÔÁ‹˜ ¤ÓÙ·Í˘ - ·ÔÎÏÂÈÛÌÔ‡ ÂÚ¢-
ÓÒÓ
∫ÚÈÙ‹ÚÈ· ¤ÓÙ·Í˘
• ∂Ó‹ÏÈΘ ·ÛıÂÓ›˜ ª∂£
• ™Ù¿Á‰ËÓ IV ¯ÔÚ‹ÁËÛË ÈÓÛÔ˘Ï›Ó˘
• ∞ÁÁÏÈ΋ ÁÏÒÛÛ·
• ŒÎ‚·ÛË: £ÓËÛÈÌfiÙËÙ· ηٿ ÙË ‰È¿ÚÎÂÈ· ÓÔÛËÏ›·˜ ÛÙË
ª∂£
∫ÚÈÙ‹ÚÈ· ·ÔÎÏÂÈÛÌÔ‡
• ¶·È‰È·ÙÚÈÎÔ› ·ÛıÂÓ›˜
• GIK, SC
• ªfiÓÔ ‰ÈÂÁ¯ÂÈÚËÙÈ΋ ¯ÔÚ‹ÁËÛË
• ªfiÓÔ ‰È·‚ËÙÈÎÔ› ÏËı˘ÛÌÔ›
59
·Ô‰ÂÏÙ›ˆÛË Ô˘ ·ÎÔÏÔ‡ıËÛ ¤ÁÈÓ Ì ÎÚÈÙ‹ÚÈÔ ÙË Û¯ÂÙÈÎfi-
ÙËÙ· Ì ÙÔ ÂÚ¢ÓËÙÈÎfi ÂÚÒÙËÌ· Î·È ÙÔ ÛÎÔfi ÂÓ Á¤ÓÂÈ Ù˘ ÂÚ-
Á·Û›·˜, Ï·Ì‚¿ÓÔÓÙ·˜ ‚¤‚·È· ˘fi„ÈÓ Ù· ÎÚÈÙ‹ÚÈ· ¤ÓÙ·Í˘-
·ÔÎÏÂÈÛÌÔ‡. ∫‡ÚÈ· ‚¤‚·È· ‚·Ú‡ÙËÙ· ‰fiıËΠÛÙȘ ÚˆÙÔ-
ÁÂÓ›˜ Ù˘¯·ÈÔÔÈË̤Ó˜ ÌÂϤÙ˜ Î·È ÌÂÙ··Ó·Ï‡ÛÂȘ Î·È ¤ÂÈ-
Ù· ÛÙ· ¿ÏÏ· ›‰Ë ÂÚ¢ÓÒÓ. ∂ÈϤÔÓ ÂÎÙÈÌ‹ıËÎÂ Ô ‰Â›ÎÙ˘
ÂÌ‚¤ÏÂÈ·˜ ‰ËÌÔÛ›Â˘Û˘ (Impact Factor).
∞fi ÙËÓ ÎÚÈÙÈ΋ ÂÎÙ›ÌËÛË Ù˘ Û˘Ïϯı›۷˜ ‚È‚ÏÈÔÁÚ·-
Ê›·˜, ÙÔ ÂӉȷʤÚÔÓ ÂÈÎÂÓÙÚÒıËΠ۠1 ÌÂÙ·-·Ó¿Ï˘ÛË, 4
ÚÔÔÙÈΤ˜ ÂÏÂÁ¯fiÌÂÓ˜ Ù˘¯·ÈÔÔÈË̤Ó˜ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜,
2 ÚÔÔÙÈΤ˜ ÂÏÂÁ¯fiÌÂÓ˜ ÌË Ù˘¯·ÈÔÔÈË̤Ó˜ ÌÂϤÙ˜, 1
ÚÔÔÙÈ΋ ÌÂϤÙË ÎÔfiÚÙ˘ Î·È 1 pooled analysis ˆ˜ ÚˆÙÔ-
ÁÂÓ›˜ ËÁ¤˜ ‰Â‰Ô̤ӈÓ. ∂ÈϤÔÓ, ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÂÈ-
ÏÂÁ̤Ó˜ ·Ó·ÛÎÔ‹ÛÂȘ (Û˘ÛÙËÌ·ÙÈΤ˜ Î·È ÌË), ηÙ¢ı˘ÓÙ‹-
ÚȘ Ô‰ËÁ›Â˜, ·fi„ÂȘ ÂȉÈÎÒÓ Î·È ·ÚÂÌÊÂÚ›˜ ÎÏÈÓÈΤ˜ ÌÂ-
ϤÙ˜ Ì ÌÈÎÚfiÙÂÚÔ ‚·ıÌfi ÙÂÎÌËÚ›ˆÛ˘. ™˘ÓÔÙÈο Ê·›ÓÔ-
ÓÙ·È Ù· ÙÂÏÈο ·ÔÙÂϤÛÌ·Ù· ·Ó·˙‹ÙËÛ˘ ÛÙÔÓ ›Ó·Î· 3.
∞¶√Δ∂§∂™ª∞Δ∞
∏ ÚÒÙË ¤Ú¢ӷ ÙˆÓ Van Den Berghe Î·È Û˘Ó
(ÁÓˆÛÙ‹ ˆ˜ ¤Ú¢ӷ ÙÔ˘ Leuven) ·ÊÔÚÔ‡Û ¤Ó· ÌÂ-
Á¿ÏÔ ÏËı˘ÛÌfi ·ÛıÂÓÒÓ ª∂£ (¡=1548), ÛÙËÓ
ÏÂÈÔÓfiÙËÙ¿ ÙÔ˘˜ ÌÂÙÂÁ¯ÂÈÚËÙÈÎÔ› ·ÛıÂÓ›˜, ÌÂÙ¿
·fi ÙÚ·‡Ì· ‹ ¯ÂÈÚÔ˘ÚÁÈΤ˜ ÂÈÏÔΤ˜ (΢ڛˆ˜ ÙÔ˘
ηډÈÔ¯ÂÈÚÔ˘ÚÁÈÎÔ‡ ÙÔ̤·). ™ÙÔ˘˜ ·ÛıÂÓ›˜ Ù˘
ÔÌ¿‰·˜ Û˘ÓÙËÚËÙÈ΋˜ ÚÔÛ¤ÁÁÈÛ˘, ¯ÔÚËÁ‹ıËÎÂ
IV ÈÓÛÔ˘Ï›ÓË ÌfiÓÔ fiÙ·Ó ÔÈ ÙÈ̤˜ ™∞ ÍÂÂÚÓÔ‡Û·Ó
ÙÔ 215 mg/dl, Ì ÛÎÔfi ÙË ‰È·Ù‹ÚËÛË ÙˆÓ ÙÈÌÒÓ
·fi 180-200 mg/dl. ™ÙËÓ ÔÌ¿‰· ÂÓÙ·ÙÈ΋˜ ¯ÔÚ‹ÁË-
Û˘, ¯ÔÚËÁ‹ıËÎÂ Û˘Ó¯Ҙ IV ÈÓÛÔ˘Ï›ÓË ÁÈ· ‰È·Ù‹-
ÚËÛË Ù˘ ÓÔÚÌÔÁÏ˘Î·ÈÌ›·˜ (80-110 mg/dl). ∞˘Ùfi˜ Ô
ÛÙÂÓfi˜ ¤ÏÂÁ¯Ô˜ ÙˆÓ ÙÈÌÒÓ ÙÔ˘ ™∞, ÂÏ¿ÙÙˆÛ ÙË
ıÓËÛÈÌfiÙËÙ· ̤۷ ÛÙË ª∂£ ·fi 8% Û 4,6%
(Absolute Risk Reduction-ARR:3,4% p<0.04) ηÈ
ÙËÓ ÂÓ‰ÔÓÔÛÔÎÔÌÂȷ΋ ıÓËÛÈÌfiÙËÙ· ·fi 10,9% ÛÂ
7,2% (ARR:3,7% p=0,01). ΔÔ fiÊÂÏÔ˜ ·˘Í·ÓfiÙ·Ó
Ì ÙË ‰È¿ÚÎÂÈ· Ù˘ ¯ÔÚ‹ÁËÛ˘ ÈÓÛÔ˘Ï›Ó˘, Ì ȉȷ›-
ÙÂÚ· ÚÔÊ·Ó¤˜ ·ÔÙ¤ÏÂÛÌ· ÛÙÔ˘˜ ·ÛıÂÓ›˜ ÌÂ
‰È¿ÚÎÂÈ· ·Ú·ÌÔÓ‹˜ ÛÙË ª∂£ >5 Ë̤Ú˜ (ARR;
9,5% p=0,01). ∂ÎÙfi˜ ·fi ÙË ıÓËÛÈÌfiÙËÙ·, Ô˘ ›-
Ó·È ‚¤‚·È· ÙÔ Î‡ÚÈÔ ·ÔÙ¤ÏÂÛÌ· Ô˘ ÂӉȷʤÚÂÈ
ÙËÓ ·Ó·ÛÎfiËÛ‹ Ì·˜, Ôχ ÂӉȷʤÚÔÓ Â›¯·Ó Ù·
·ÔÙÂϤÛÌ·Ù· Ù˘ ÂÓÙ·ÙÈ΋˜ ¯ÔÚ‹ÁËÛ˘ ÈÓÛÔ˘Ï›-
Ó˘ Û ‰È¿ÊÔÚ˜ ÂÈÏÔΤ˜. ŒÙÛÈ, Ê¿ÓËΠfiÙÈ ÌÂÈ-
ÒıËÎ·Ó ÛËÌ·ÓÙÈο ÔÈ ·ÈÌ·ÙÔÁÂÓ›˜ ÏÔÈÌÒÍÂȘ, Ë
ÔÍ›· ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ· Î·È Ë ·Ó¿ÁÎË ÁÈ· ıÂ-
Ú·›· ÓÂÊÚÈ΋˜ ˘ÔηٿÛÙ·Û˘, Ë ÔÏ˘Ó¢ÚÔ¿-
ıÂÈ· Î·È Ë ·Ó·ÈÌ›·32. ∂ÈϤÔÓ, ÂÏ·ÙÙÒıËΠË
‰È¿ÚÎÂÈ· ·Ú·ÌÔÓ‹˜ Û Ì˯·ÓÈÎfi ·ÂÚÈÛÌfi Î·È Ë
Û˘ÓÔÏÈ΋ ‰È¿ÚÎÂÈ· ·Ú·ÌÔÓ‹˜ ÛÙÔ ¡ÔÛÔÎÔÌ›Ô21.
¶·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ô Û¯Â‰È·ÛÌfi˜ Ù˘ ¤Ú¢ӷ˜ ‹-
Ù·Ó ¿ÚÈÛÙÔ˜, ÔÈ Î‡ÚȘ ÂÓÛÙ¿ÛÂȘ Û˘ÓÔ„›˙ÔÓÙ·È ÛÙÔ
ÁÂÁÔÓfi˜ fiÙÈ ÚfiÎÂÈÙ·È ÁÈ· ÌÔÓÔÎÂÓÙÚÈ΋ ¤Ú¢ӷ,
 60

¶›Ó·Î·˜ 3. ™˘ÓÔÙÈο ·ÔÙÂϤÛÌ·Ù· ·Ó·˙‹ÙËÛ˘

™˘ÁÁÚ·Ê›˜ ŒÙÔ˜ ∂›‰Ô˜ ÌÂϤÙ˘ ª∂£ ¡ ŸÚÈ· ™.∞ ™˘ÌÂÚ¿ÛÌ·Ù· ¶ÂÚÈÔ‰ÈÎfi/π.F

Van Den Berghe 2001 ¶ÚÔÔÙÈ΋ Ù˘¯·ÈÔÔÈË̤ÓË ÃÂÈÚÔ˘ÚÁÈ΋ 1548 80-110 mg/dl ªÂ›ˆÛË ıÓËÛÈÌfiÙËÙ·˜ NEJM/ 51.296
et al21 ÂÏÂÁ¯fiÌÂÓË
Van Den Berghe et al34 2006 ¶ÚÔÔÙÈ΋ Ù˘¯·ÈÔÔÈË̤ÓË ¶·ıÔÏÔÁÈ΋ 1200 80-110 mg/dl ªÂ›ˆÛË ıÓËÛÈÌfiÙËÙ·˜ NEJM/ 51.296
ÂÏÂÁ¯fiÌÂÓË
Van Den Berghe et al35 2006 ™˘ÁÎÂÓÙÚˆÙÈ΋ ·Ó¿Ï˘ÛË ÃÂÈÚÔ˘ÚÁÈ΋-·ıÔÏÔÁÈ΋ 2748 80-110 mg/dl ªÂ›ˆÛË ıÓËÛÈÌfiÙËÙ·˜ Diabetes/ 7.955
Krinsley JS36 2004 ™˘ÁÎÚÈÙÈ΋ ÌË Ù˘¯·ÈÔÔÈ- ÃÂÈÚÔ˘ÚÁÈ΋ - 600 110-140 ªÂ›ˆÛË Mayo Clin Proc/ 4.022
Ë̤ÓË ÎÏÈÓÈ΋ ÌÂϤÙË ·ıÔÏÔÁÈ΋ mg/dl ıÓËÛÈÌfiÙËÙ·˜
Collier BD et al37 2005 ¶ÚÔÔÙÈ΋ ÂÏÂÁ¯fiÌÂÓË ÌË ¶ÔÏ˘ÙÚ·˘Ì·ÙÈÒÓ 818 >110 mg/dl NS Journal of Parenteral &
Ù˘¯·ÈÔÔÈË̤ÓË Enteral Nutrition / 1.898
Pittas A.G et al38 2006 ªÂÙ¿-·Ó¿Ï˘ÛË ÃÂÈÚÔ˘ÚÁÈ΋ - 6 ¤Ú¢Ó˜ – ªÂ›ˆÛË ıÓËÛÈÌfiÙËÙ·˜ Journal of Parenteral &
·ıÔÏÔÁÈ΋ Enteral Nutrition/ 1.898
Farah R39 2007 ¶ÚÔÔÙÈ΋ Ù˘¯·ÈÔÔÈË̤ÓË ∞Ó·Ó¢ÛÙÈ΋˜ 89 110-140 mg/dl NS IMAJ/ 0.510
ÂÏÂÁ¯fiÌÂÓË ∞ÓÂ¿ÚÎÂÈ·˜ 140-200 mg/dl
A. MA™ΔƒO∫ø™Δ∞™ ∫∞π ™À¡.

Treggiari M40 2008 ¶ÏËı˘ÛÌfi˜ ¶ÔÏ˘ÙÚ·˘Ì·ÙÈÒÓ 10456 3 ÔÌ¿‰Â˜ ∞‡ÍËÛË ıÓËÛÈÌfiÙËÙ·˜ Critical care /3.116
·ÛıÂÓÒÓ 120-180 mg/dl
80-130 mg/dl
80-110 mg/d
Brunkhorst F et al) 2008 ¶ÚÔÔÙÈ΋ Ù˘¯·ÈÔÔÈË̤ÓË ∞ÛıÂÓ›˜ Ì ۋ„Ë 537 80-110 mg/dl NS -ÚfiˆÚÔ˜ NEJM/ 51.296
(VISEP)41 ÂÏÂÁ¯fiÌÂÓË-ÔÏ˘ÎÂÓÙÚÈ΋ ÙÂÚÌ·ÙÈÛÌfi˜

IF: IMPACT FACTOR (‰Â›ÎÙ˘ ÂÌ‚¤ÏÂÈ·˜)

NS: NOT SIGNIFICANT (ÌË ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈÎfi)
 ∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 75, 1
‰ÂÓ ‹Ù·Ó Ù˘ÊÏ‹ ·fi ÙËÓ ÏÂ˘Ú¿ ÙÔ˘ ÂÚ¢ÓËÙ‹ ηÈ
fiÙÈ ÔÈ ·ÛıÂÓ›˜ Ô˘ Û˘ÌÌÂÙ›¯·Ó ‹Ù·Ó ΢ڛˆ˜ ¯ÂÈ-
ÚÔ˘ÚÁÈÎÔ› Î·È ÂÔ̤ӈ˜ Ù· Û˘ÌÂÚ¿ÛÌ·Ù¿ Ù˘ ‰ÂÓ
ı· ÌÔÚÔ‡Û·Ó Ó· ÁÂÓÈ΢ÙÔ‡Ó Û ¿ÏϘ ηÙËÁÔ-
ڛ˜ ·ÛıÂÓÒÓ ª∂£33.
∞ÎÔÏÔ˘ıÒÓÙ·˜ ÙÔ ·ÎÚÈ‚Ò˜ ›‰ÈÔ ÚˆÙfiÎÔÏÏÔ
ÌÂϤÙ˘, Ë ›‰È· ÔÌ¿‰· ÂÚ¢ÓËÙÒÓ ÙÔ 2006 ÌÂϤÙËÛÂ
ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ·Ú¤Ì‚·Û˘ Û ¤Ó·
ÏËı˘ÛÌfi ·ÛıÂÓÒÓ ·ıÔÏÔÁÈ΋˜ ª∂£, Ì ÂÚ›-
Ô˘ ›‰ÈÔ ·ÚÈıÌfi ‰Â›ÁÌ·ÙÔ˜ (¡=1200). ∏ Û˘ÓÔÏÈ΋
ıÓËÛÈÌfiÙËÙ· ÛÙË ª∂£ ÌÂÈÒıËΠ·ÏÏ¿ fi¯È ÛËÌ·-
ÓÙÈο (ARR:2,6%, p=0,31). ∏ ¤ÏÏÂÈ„Ë ÛÙ·ÙÈÛÙÈ΋˜
ÛËÌ·ÓÙÈÎfiÙËÙ·˜, Èı·ÓfiÓ ÔÊ›ÏÂÙ·È ÛÙÔ ÁÂÁÔÓfi˜
fiÙÈ Ë ¤Ú¢ӷ ‰ÂÓ Â›¯Â ÙËÓ ÈηӋ ÛÙ·ÙÈÛÙÈ΋ ÈÛ¯‡ ÁÈ
·˘Ùfi ÙÔ Â›‰Ô. ™ÙÔ˘˜ ·ÛıÂÓ›˜ Ì ‰È¿ÚÎÂÈ· ÓÔ-
ÛËÏ›·˜>3 Ë̤Ú˜, fï˜, Ë ¯ÔÚ‹ÁËÛË ÈÓÛÔ˘Ï›Ó˘
ÂÏ¿ÙÙˆÛ ÙË ıÓËÛÈÌfiÙËÙ· ÛÙË ª∂£ ÛËÌ·ÓÙÈο
(ARR: 6,8%, p=0,05). ∏ Û˘ÓÔÏÈ΋ ÂÓ‰ÔÓÔÛÔÎÔ-
ÌÂȷ΋ ıÓËÛÈÌfiÙËÙ· ÙˆÓ ·ÛıÂÓÒÓ Ù˘ ¤Ú¢ӷ˜ Â-
Ï·ÙÙÒıËΠ(ARR:9.5% p=0,009). ¶·ÚfiÌÔÈ· ·Ô-
ÙÂϤÛÌ·Ù· Ì ÙËÓ ÚÒÙË ¤Ú¢ӷ ›¯Â Î·È ÛÙÔÓ ÙÔ-
̤· ÙˆÓ ÂÈÏÔÎÒÓ34.
™Â ÌÈ· ÚÔÛ¿ıÂÈ· ·‡ÍËÛ˘ Ù˘ ÛÙ·ÙÈÛÙÈ΋˜
ÈÛ¯‡Ô˜ Î·È Ù˘ ÁÂÓ›Î¢Û˘ ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ÛÂ
ÌÈÎÙfi ÏËı˘ÛÌfi ª∂£ (¯ÂÈÚÔ˘ÚÁÈÎfi-·ıÔÏÔÁÈÎfi),
Ë ÔÌ¿‰· Ô˘ ‰ÈÂÍ‹Á·Á ÙȘ ‰˘Ô ·Ú·¿Óˆ ÌÂϤÙ˜,
¤Î·Ó ÌÈ· pooled analysis ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ÙˆÓ
‰‡Ô ÂÚ¢ÓÒÓ, ÁÂÁÔÓfi˜ Ô˘ ‰È¢ÎÔχÓÂÙ·È ·fi ÙÔÓ
·ÎÚÈ‚Ò˜ ›‰ÈÔ Û¯Â‰È·ÛÌfi ÙÔ˘˜. ªÂ ‰Â›ÁÌ· 2748 ·-
ÛıÂÓÒÓ Ë ıÓËÛÈÌfiÙËÙ· ‹Ù·Ó ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂ-
ÚË ÛÙËÓ ÔÌ¿‰· ÂÓÙ·ÙÈ΋˜ ¯ÔÚ‹ÁËÛ˘ ÈÓÛÔ˘Ï›Ó˘
ÁÈ· ÙÔ intention to treat group (OR:0,76 95%CI:
0,60-0,96 p=0,02). π‰È·›ÙÂÚ· ÁÈ· ÙËÓ ˘ÔηÙËÁÔÚ›·
·ÛıÂÓÒÓ Ì ‰È¿ÚÎÂÈ· ÓÔÛËÏ›·˜ ÛÙËÓ ÂÓÙ·ÙÈ΋ >3
Ë̤Ú˜, ÙÔ fiÊÂÏÔ˜ ‹Ù·Ó ·ÎfiÌ· ÌÂÁ·Ï‡ÙÂÚÔ
(OR:0,67 95%CI:0,51-0,87 p=0,003)35.
To 2004 ÌÈ· Û˘ÁÎÚÈÙÈ΋ ÌË Ù˘¯·ÈÔÔÈË̤ÓË
¤Ú¢ӷ ·fi ÙȘ ∏¶∞ Âȯ›ÚËÛ ӷ ·Ó··Ú¿ÁÂÈ
ÙËÓ ¤Ú¢ӷ ÙÔ˘ Leuven, Û ¤Ó· ÌÈÎÙfi (¯ÂÈÚÔ˘ÚÁÈ-
Îfi-·ıÔÏÔÁÈÎfi) ÏËı˘ÛÌfi 1600 ·ÛıÂÓÒÓ ª∂£.
∞˘Ù‹ Ë ¤Ú¢ӷ, Û˘Ó¤ÎÚÈÓ ÙËÓ ÂÈ‚›ˆÛË ÌÈ·˜ ÔÌ¿-
‰·˜ 800 ‰È·‰Ô¯ÈÎÒÓ ·ÛıÂÓÒÓ ÌÂÙ¿ ÙËÓ ÂÓÂÚÁÔÔ›-
ËÛË ÂÓfi˜ ÚˆÙÔÎfiÏÏÔ˘ IV ¯ÔÚ‹ÁËÛ˘ ÈÓÛÔ˘Ï›Ó˘
ÁÈ· ÙË ‰È·Ù‹ÚËÛË ÙÈÌÒÓ <140 mg/dl, Ì ÌÈ· ÈÛ¿ÚÈı-
ÌË ÔÌ¿‰· ·ÛıÂÓÒÓ Ù˘ ›‰È·˜ ª∂£, ·ÎÚÈ‚Ò˜ ÚÈÓ
ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ÚˆÙÔÎfiÏÏÔ˘. OÈ ‰‡Ô ÔÌ¿‰Â˜
‹Ù·Ó ›‰È˜ ÛÙ· ‚·ÛÈο ÙÔ˘˜ ‰ËÌÔÁÚ·ÊÈο ¯·Ú·-
ÎÙËÚÈÛÙÈο Î·È ÛÙËÓ ÎÏÈÓÈ΋ ÙÔ˘˜ ‚·Ú‡ÙËÙ·. ªÂÙ¿
ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ÚˆÙÔÎfiÏÏÔ˘, Ë ÂÓ‰ÔÓÔÛÔÎÔ-
ÌÂȷ΋ ıÓËÛÈÌfiÙËÙ· ·˘ÙÒÓ ÙˆÓ ·ÛıÂÓÒÓ ÂÏ·ÙÙÒ-
ıËΠηٿ 29,3% (∞RR: 6,1% p=0,02), ηıÒ˜ ·-
61
Ú¿ÏÏËÏ· ÂÏ·ÙÙÒıËÎÂ Ë ‰È¿ÚÎÂÈ· ·Ú·ÌÔÓ‹˜, Ë
ÔÍ›· ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ· Î·È Ë ·Ó¿ÁÎË ¯ÔÚ‹ÁË-
Û˘ ÌÔÓ¿‰ˆÓ ·›Ì·ÙÔ˜36.
ªÈ· ÚÔÔÙÈ΋ ¤Ú¢ӷ ÙÔ 2005 ÙˆÓ Collier
Î·È Û˘Ó. Û ·ÛıÂÓ›˜ ÌÈ·˜ ª∂£ ÔÏ˘ÙÚ·˘Ì·ÙÈÒÓ
(¡=818), ¯ÚËÛÈÌÔÔ›ËÛ ˆ˜ ÔÌ¿‰· ÂϤÁ¯Ô˘ ·ÛıÂ-
Ó›˜ Ô˘ ÓÔÛËχÙËÎ·Ó ¤Ó· ¤ÙÔ˜ ÚÈÓ ÙËÓ ¤Ó·ÚÍË
ÙÔ˘ ÚˆÙÔÎfiÏÏÔ˘ ÂÓÙ·ÙÈ΋˜ ¯ÔÚ‹ÁËÛ˘ ÈÓÛÔ˘Ï›-
Ó˘, Ô˘ Ù· ÂÚÈÛÙ·ÙÈο ˘ÂÚÁÏ˘Î·ÈÌ›·˜ ÙÔ˘˜ Ú˘ı-
Ì›˙ÔÓÙ·Ó Î·Ù¿ ÂÚ›ÙˆÛË ÌÂÙ¿ ·fi È·ÙÚÈ΋ Ô‰Ë-
Á›·. ∏ ̤ÛË ÙÈÌ‹ ™∞ ÁÈ· ·˘Ù‹ ÙËÓ ÔÌ¿‰· ‹Ù·Ó
130,6±14,3 mg/dl, ÂÓÒ ÛÙËÓ ÔÌ¿‰· Ô˘ ÂÊ·ÚÌfi-
ÛÙËΠÙÔ ÚˆÙfiÎÔÏÏÔ ‹Ù·Ó 109,3 ±4 mg/dl. ¢ÂÓ
‚Ú¤ıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙË ıÓËÛÈ-
ÌfiÙËÙ· ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ·ÛıÂÓÒÓ (12,3%
vs 13,1%, p=0,722). ∞ÍÈÔÛËÌ›ˆÙÔ Â›Ó·È ÙÔ Â‡ÚË-
Ì· fiÙÈ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ÙÔ ™∞ ‹Ù·Ó >150 mg/dl
ÁÈ· ÂÚÈÛÛfiÙÂÚ˜ ·fi Ì›· Ë̤Ú˜, ˘‹Ú¯Â ‰ÈÏ·-
ÛÈ·ÛÌfi˜ Ù˘ ıÓËÛÈÌfiÙËÙ·˜ Û ۯ¤ÛË Ì ·˘ÙÔ‡˜ Ô˘
›¯·Ó ™∞ <150 mg/dl, ÁÂÁÔÓfi˜ Ô˘ ¤Ú¯ÂÙ·È ÛÂ
Ï‹ÚË Ù·‡ÙÈÛË ÌÂ ÙË ‚È‚ÏÈÔÁÚ·Ê›·37.
∏ ÌfiÓË Û¯ÂÙÈ΋ ÌÂÙ··Ó¿Ï˘ÛË Ô˘ ÚԤ΢„Â
·fi ÙËÓ ·Ó·˙‹ÙËÛË Â›Ó·È ÙˆÓ Pittas Î·È Û˘Ó. ÙÔ
2006. ™ËÌÂȈ٤ÔÓ, fiÙÈ ÂÂȉ‹ ÙÔ ı¤Ì· Â›Ó·È Û¯ÂÙÈ-
ο ÚfiÛÊ·ÙÔ, ‰ÂÓ ˘¿Ú¯Ô˘Ó ÔÏϤ˜ ÂÏÂÁ¯fiÌÂÓ˜
Ù˘¯·ÈÔÔÈË̤Ó˜ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ Î·È ÂÔ̤ӈ˜
Î·È ÌÂÙ··Ó·Ï‡ÛÂȘ. ∏ ÌÂÙ··Ó¿Ï˘ÛË ·˘Ù‹, Û˘ÌÂ-
ÚȤϷ‚ 38 ÌÂϤÙ˜. ∏ ÏÂÈÔÓfiÙËÙ· ·˘ÙÒÓ ·ÊÔ-
ÚÔ‡Û ÙËÓ ¯ÔÚ‹ÁËÛË ‰È·Ï‡Ì·ÙÔ˜ GIK ‹ ˘Ô‰fiÚÈ·
¯ÔÚ‹ÁËÛË ÈÓÛÔ˘Ï›Ó˘. ªfiÓÔ ¤ÍÈ ¤Ú¢Ó˜ ¯ÚËÛÈÌÔ-
ÔÈÔ‡Û·Ó ÚˆÙfiÎÔÏÏ· IV ¯ÔÚ‹ÁËÛ˘ ÈÓÛÔ˘Ï›Ó˘
ÁÈ· ÙË ‰È·¯Â›ÚÈÛË Ù˘ ˘ÂÚÁÏ˘Î·ÈÌ›·˜ Û ·ÛıÂÓ›˜
ª∂£. ™Â ·˘Ù¤˜ ÙȘ ¤Ú¢Ó˜, ‰È·ÈÛÙÒıËΠ̛ˆÛË
Ù˘ ıÓËÛÈÌfiÙËÙ·˜ ÙˆÓ ·ÛıÂÓÒÓ ÙÔ˘ ÛÙÂÓÔ‡ ÂϤÁ-
¯Ô˘ ™∞ ηٿ 27% (RR:0,73 95%CI:0,57-0,94)38.
ªÈ· ÌÈÎÚfiÙÂÚË ÂÏÂÁ¯fiÌÂÓË Ù˘¯·ÈÔÔÈË̤ÓË
ÎÏÈÓÈ΋ ¤Ú¢ӷ ·fi ÙÔ πÛÚ·‹Ï ÙÔ 2007 Ì 89 ·ÛıÂ-
Ó›˜ ÌÂϤÙËÛ ÙË ıÓËÛÈÌfiÙËÙ· ÌÂٷ͇ ‰‡Ô ÔÌ¿‰ˆÓ
·ÛıÂÓÒÓ ÛÙȘ Ôԛ˜ ÂÊ¿ÚÌÔÛ ÙÔ ›‰ÈÔ ÚˆÙfiÎÔÏ-
ÏÔ ¯ÔÚ‹ÁËÛ˘ ÈÓÛÔ˘Ï›Ó˘, Ì ‰È·ÊÔÚÂÙÈο fï˜
fiÚÈ· ™∞. ™ÙËÓ ÚÒÙË ÔÌ¿‰·, Ù· ÂÈı˘ÌËÙ¿ fiÚÈ·
‹Ù·Ó 110-140 mg/dl ÂÓÒ ÛÙË ‰Â‡ÙÂÚË 140-200 mg/
dl. ∞Ó Î·È ‰Â ‚Ú¤ıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·-
ÊÔÚ¿ ÛÙË ıÓËÛÈÌfiÙËÙ· ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ,
·Ú·ÙËÚ‹ıËÎ·Ó ˆÛÙfiÛÔ ÏÈÁfiÙÂÚ· ηډȷÁÁÂȷο
Û˘Ì‚¿Ì·Ù·, ·ÁÁÂȷο ÂÁÎÂÊ·ÏÈο ÂÂÈÛfi‰È· ηÈ
ıÚÔÌ‚ÒÛÂȘ ÛÙËÓ ÚÒÙË ÔÌ¿‰·39.
¶ÚfiÛÊ·Ù·, ÔÈ Treggiari Î·È Û˘Ó. ‰ËÌÔÛ›Â˘Û·Ó
ÌÈ· ¤Ú¢ӷ ÎÔÔfiÚÙ˘ Ì 10456 ·ÛıÂÓ›˜ ª∂£ Ô-
Ï˘ÙÚ·˘Ì·ÙÈÒÓ. ∏ ÎÔfiÚÙË ¯ˆÚ›ÛÙËΠ۠ÙÚÂȘ ¯ÚÔ-
ÓÈΤ˜ ÂÚÈfi‰Ô˘˜, Ô˘ ·ÓÙÈÛÙÔÈ¯Ô‡Û·Ó ÛÙȘ ·ÏÏ·Á¤˜
62 A. MA™ΔƒO∫ø™Δ∞™ ∫∞π ™À¡.
ÙˆÓ ÚˆÙÔÎfiÏÏˆÓ Î· ÙˆÓ ÔÚ›ˆÓ ™∞. ™ÙËÓ ÚÒÙË
ÂÚ›Ô‰Ô ¯ÔÚËÁÔ‡ÓÙ·Ó IV Î·È SC ÈÓÛÔ˘Ï›ÓË Ì ÁÂ-
ÓÈÎfi ÛÙfi¯Ô ™∞ 120-180 mg/dl, ÛÙË ‰Â‡ÙÂÚË Î·È
ÛÙËÓ ÙÚ›ÙË ÂÚ›Ô‰Ô ÌfiÓÔ IV ÌÂ fiÚÈ· 80-130 mg/dl
Î·È 80-110 mg/dl ·ÓÙ›ÛÙÔȯ·. ¢ÂÓ ‰È·ÈÛÙÒıËÎÂ
ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÌÂٷ͇ Ù˘ ÚÒÙ˘
Î·È ÙÚ›Ù˘ ÂÚÈfi‰Ô˘ fiÛÔÓ ·ÊÔÚ¿ ÙË ıÓËÛÈÌfiÙËÙ·
ÙˆÓ ·ÛıÂÓÒÓ ÛÙË ª∂£. ªÂÙ¿ ·fi ÔÏ˘·Ú·ÁÔ-
ÓÙÈ΋ ·Ó¿Ï˘ÛË ÌÂٷ͇ Ù˘ ÙÚ›Ù˘ Î·È ÚÒÙ˘ Â-
ÚÈfi‰Ô˘, Ì ‰ÈfiÚıˆÛË (adjustment) ÁÈ· ‰È¿ÊÔÚÔ˘˜
Û˘Á¯˘ÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜, ·Ú·ÙËÚ‹ıËΠ·˘ÍË̤-
ÓË ıÓËÛÈÌfiÙËÙ· ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ù˘ ª∂£ Ì ÛÙÂÓfi
¤ÏÂÁ¯Ô ™∞ (80-110 mg/dl.) Û ۯ¤ÛË Ì ÙÔ˘˜ ·ÛıÂ-
Ó›˜ Ô˘ ‰ÂÓ ÂÊ¿ÚÌÔ˙·Ó ÚˆÙfiÎÔÏÏ· ÓÔÚÌÔÁÏ˘-
ηÈÌ›·˜ (OR: 1,26 95%CI:1,04-1,53 p=0,019)40.
Δ¤ÏÔ˜, Ë ÌfiÓË ÔÏ˘ÎÂÓÙÚÈ΋ Ù˘¯·ÈÔÔÈË̤ÓË
ÌÂϤÙË, ÁÓˆÛÙ‹ ˆ˜ VISEP (Volume Substitution
and Insulin Therapy in Severe Sepsis) ‰ËÌÔÛȇÙË-
Πto 2008 Î·È ·ÊÔÚÔ‡Û ·ÛıÂÓ›˜ Ì ۋ„Ë. ΔÔ
¤Ó· ÛΤÏÔ˜ Ù˘ Û˘Ó¤ÎÚÈÓ ÙË ıÓËÛÈÌfiÙËÙ· ÌÂٷ͇
ÌÈ·˜ ÔÌ¿‰·˜ ÂÓÙ·ÙÈ΋˜ ¯ÔÚ‹ÁËÛ˘ ÈÓÛÔ˘Ï›Ó˘ ηÈ
ÌÈ·˜ Û˘Ì‚·ÙÈ΋˜ Û‡Ìʈӷ Ì ÙÔ ÚˆÙfiÎÔÏÏÔ Ù˘
¤Ú¢ӷ˜ Ù˘ Van Den Berghe. ∏ ¤Ú¢ӷ ‰È·ÎfiË-
ΠÚfiˆÚ·, ÏfiÁˆ ·˘ÍË̤Ó˘ Û˘¯ÓfiÙËÙ·˜ ÂÚÈÛÙ·-
ÙÈÎÒÓ ˘ÔÁÏ˘Î·ÈÌ›·˜, ¤¯ÔÓÙ·˜ Û˘ÏϤÍÂÈ ·ÔÙÂϤ-
ÛÌ·Ù· ·fi 537 ·ÛıÂÓ›˜. ∞fi ·˘Ù¿ Ù· ·ÔÙÂϤ-
ÛÌ·Ù· ÚԤ΢„ fiÙÈ ‰ÂÓ ˘‹Ú¯Â ÛÙ·ÙÈÛÙÈο ÛËÌ·-
ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙË ıÓËÛÈÌfiÙËÙ· ÌÂٷ͇ ÙˆÓ ‰‡Ô
ÔÌ¿‰ˆÓ(24,7% vs 26%, p=0,74)41.
™Àª¶∂ƒ∞™ª∞Δ∞
™‡Ìʈӷ Ì ٷ ·Ú·¿Óˆ, Ê·›ÓÂÙ·È Ë ·Ó·ÁηÈfi-
ÙËÙ· Ù˘ ‰È·¯Â›ÚÈÛ˘ Ù˘ ˘ÂÚÁÏ˘Î·ÈÌ›·˜ ÛÙÔ˘˜ ‚·-
Ú¤ˆ˜ ¿Û¯ÔÓÙ˜ ·ÛıÂÓ›˜ Ù˘ ª∂£ ·ÓÂÍ·Úًو˜
ÈÛÙÔÚÈÎÔ‡ ‰È·‚‹ÙË, Ì ÙË Û˘Ó¯‹ IV ¯ÔÚ‹ÁËÛË ÈÓ-
ÛÔ˘Ï›Ó˘. O ˘Ú‹Ó·˜ ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜ ‚Ú›ÛÎÂÙ·È
ÛÙ· ÂÈı˘ÌËÙ¿ fiÚÈ· ÙÈÌÒÓ ™∞. ∏ Û˘ÛÙËÌ·ÙÈ΋ ·-
Ó·˙‹ÙËÛ‹ Ì·˜ ÁÈ· ÙËÓ ÙÂÎÌËÚ›ˆÛË, ¤‰ˆÛ 9 ¤Ú¢-
Ó˜. ∞fi ·˘Ù¤˜, ÔÈ 6 ¤‰ˆÛ·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο
·ÔÙÂϤÛÌ·Ù· Ù˘ ¢ÂÚÁËÙÈ΋˜ ‰Ú¿Û˘ Ù˘ ÓÔÚÌÔ-
ÁÏ˘Î·ÈÌ›·˜ ÛÙË ıÓËÛÈÌfiÙËÙ·. OÈ 5 ¤‰ÂÈÍ·Ó ÛËÌ·-
ÓÙÈ΋ Ì›ˆÛË Ù˘ ıÓËÛÈÌfiÙËÙ·˜ ÙˆÓ ·ÛıÂÓÒÓ ÛÙË
ª∂£ ÌÂÙ¿ ÙËÓ ÂÊ·ÚÌÔÁ‹ ÚˆÙÔÎfiÏÏˆÓ ÓÔÚÌÔÁÏ˘-
ηÈÌ›·˜ Î·È Ë Ì›· ·‡ÍËÛË. §·Ì‚¿ÓÔÓÙ·˜ ˘fi„ÈÓ Ù·
‚·ÛÈο ÂÚÁ·Ï›· Ù˘ πμ∂, ‰ËÏ·‰‹ ÙÔ Û¯Â‰È·ÛÌfi
Ù˘ ¤Ú¢ӷ˜, ÙÔ ‰Â›ÁÌ· Î·È ÙÔÓ ‰Â›ÎÙË ÂÌ‚¤ÏÂÈ·˜
‰ËÌÔÛ›Â˘Û˘, Ê·›ÓÂÙ·È fiÙÈ Î·Ù·Ï‹ÁÔ˘Ì Û ۇÛÙ·-
ÛË ÙÂÎÌËÚ›ˆÛ˘ ÂÈ¤‰Ô˘ ∞ (Grade A recommen-
dation) ÁÈ· ÙËÓ Â›Ù¢ÍË ÓÔÚÌÔÁÏ˘Î·ÈÌ›·˜ Ì ÙËÓ
πV ¯ÔÚ‹ÁËÛË ÈÓÛÔ˘Ï›Ó˘ ÛÙÔ˘˜ ‚·Ú¤ˆ˜ ¿Û¯ÔÓÙ˜
(¶›Ó. 3).
OÈ Û‡Á¯ÚÔÓ˜ ηÙ¢ı˘ÓÙ‹ÚȘ ÁÚ·Ì̤˜ ÔÏ-
ÏÒÓ ¤ÁÎÚÈÙˆÓ ÂÙ·ÈÚÂÈÒÓ, ı¤ÙÔ˘Ó ÙË ÓÔÚÌÔÁÏ˘Î·È-
Ì›· ˆ˜ ‚·ÛÈ΋ ·Ú¿ÌÂÙÚÔ Ù˘ ηıËÌÂÚÈÓ‹˜ ÎÏÈÓÈ-
΋˜ Ú¿Í˘ ÛÙË ª∂£ (standard of care)42. Δ¤ÙÔÈ-
˜ ÂÙ·ÈÚ›˜ Â›Ó·È Ë ∞ÌÂÚÈοÓÈÎË ∂Ù·ÈÚ›· ¢È·‚‹-
ÙË (www.diabetes.org), Ë ∞ÌÂÚÈοÓÈÎË ∂Ù·ÈÚ›·
£ÒÚ·ÎÔ˜ (www.thoracic.org), Ë Joint Commission
on Accreditation of Healthcare (www.jcaho.org)
Î·È ÙÔ Institute for Healthcare Improvement (www.
ihi.org)28,29,43.
∏ ÙÂÎÌËÚ›ˆÛË ÛÙËÓ π·ÙÚÈ΋ Ú¿ÍË Â›Ó·È ·-
Ó·ÌÊÈÛ‚‹ÙËÙ· ÌÈ· ‰˘Ó·ÌÈ΋ ‰È·‰Èηۛ· ÛÙÂÓ¿
Û˘Ó‰Â‰Â̤ÓË Ì ÙȘ ÂÍÂÏ›ÍÂȘ ÛÙËÓ ¤Ú¢ӷ. ™’ ·˘Ù¿
Ù· Ï·›ÛÈ·, ·Ó·Ì¤ÓÔÓÙ·È Ì ȉȷ›ÙÂÚÔ ÂӉȷʤÚÔÓ
Ù· ·ÔÙÂϤÛÌ·Ù· ÌÈ·˜ ÚÔÔÙÈ΋˜ Ù˘¯·ÈÔÔÈË̤Ó˘
ÔÏ˘ÎÂÓÙÚÈ΋˜ ÌÂϤÙ˘ ÁÓˆÛÙ‹˜ ˆ˜ NICE-SUGAR
(Normoglycemia in Intensive Care Evaluation and
Survival Using Glucose Algorithm Regulation). ∞˘-
Ù‹ Ë ¤Ú¢ӷ, ¤¯ÂÈ ÛÎÔfi Ó· ÂÚÈÏ¿‚ÂÈ ÙÔ˘Ï¿¯ÈÛÙÔÓ
4500 ¯ÂÈÚÔ˘ÚÁÈÎÔ‡˜ Î·È ·ıÔÏÔÁÈÎÔ‡˜ ·ÛıÂÓ›˜ ·-
fi ‰È¿ÊÔÚ˜ ª∂£ Ù˘ ∞˘ÛÙÚ·Ï›·˜, Ù˘ ¡¤·˜ ∑Ë-
Ï·Ó‰›·˜ Î·È ÙÔ˘ ∫·Ó·‰¿, ÂÊ·ÚÌfi˙ÔÓÙ·˜ ÙÔ ÚˆÙfi-
ÎÔÏÏÔ Ù˘ ¤Ú¢ӷ˜ ÙÔ˘ Leuven. Δ· ·ÔÙÂϤÛÌ·Ù·
ÌÈ·˜ ¤Ú¢ӷ˜ Ù¤ÙÔÈ·˜ ÈÛ¯‡Ô˜ ı· ÂÓÈÛ¯‡ÛÔ˘Ó ‹ ı·
·ÌÊÈÛ‚ËÙ‹ÛÔ˘Ó ÙËÓ ·ÚÔ‡Û· ÙÂÎÌËÚ›ˆÛË. ¶Ú¤ÂÈ
‚¤‚·È· Ó· ÛËÌÂȈı› fiÙÈ ·ÓÙ›ÛÙÔÈ¯Ë ÔÏ˘ÎÂÓÙÚÈ΋
ÚÔÛ¿ıÂÈ· ÛÙËÓ ∂˘ÚÒË, ÁÓˆÛÙ‹ ˆ˜ GLUCon-
trol, ÂÁηٷÏ›ÊıËΠÚÔÙÔ‡ ÔÏÔÎÏËÚˆı›, ÏfiÁˆ
ÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ ˘ÔÁÏ˘Î·ÈÌ›·˜ Ô˘ ·Ú·ÙËÚ‹ıË-
Î·Ó ÛÙËÓ ÔÌ¿‰· ÂÓÙ·ÙÈ΋˜ ¯ÔÚ‹ÁËÛ˘, ¯ˆÚ›˜ Ó· ‰Ë-
ÌÔÛȇÛÂÈ ·ÔÙÂϤÛÌ·Ù·2,44.
¶¤Ú·Ó Ù˘ ÙÂÎÌËÚ›ˆÛ˘, ÙÔ ÎÏÂȉ› Ê·›ÓÂÙ·È Ó·
‚Ú›ÛÎÂÙ·È ÛÙËÓ ÂÊ·ÚÌÔÛÈÌfiÙËÙ· Ù¤ÙÔÈˆÓ ÚˆÙÔ-
ÎfiÏÏˆÓ ÛÙËÓ ÎÏÈÓÈ΋ Ú¿ÍË, ηıÒ˜ ÚÔ¸Ôı¤ÙÔ˘Ó
Â·ÚΤ˜ monitoring ÁÈ· ÙËÓ ·ÔÊ˘Á‹ ÂÚÈÛÙ·ÙÈ-
ÎÒÓ ˘ÔÁÏ˘Î·ÈÌ›·˜. ŸÙ·Ó οÙÈ Ù¤ÙÔÈÔ ÂÍ·ÛÊ·ÏÈ-
ÛÙ› Ì ÈηӋ ÛÙÂϤ¯ˆÛË Î·È ÂÎ·›‰Â˘ÛË, Â›Ó·È È‰È-
·›ÙÂÚ· ·ÛÊ·Ï‹ Î·È ·ÔÙÂÏÂÛÌ·ÙÈο45-47.
ABSTRACT
Mastrokostas A, Grizioti M, Papadimitriou D. ∂vi-
dence of continuous IV insulin administration for
nomoglycemia, in terms of mortality of adult cri-
tically ill patients. Hell Iatr 2009, 75: 57-64.
Critical care patient management recently em-
braCritical care patient management has recently
embraced management of hyperglycemia as a stan-
dard of care. The aim of this study was to investi-
gate, by means of evidence based medicine, the ef-
fect of continuous IV insulin administration for nor-
 ∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 75, 1
moglycemia, on mortality in adult, critically ill pa-
tients. A systematic review of recent medical pu-
blications, using Medline and Cohrane databases
was performed. Impact factor was also considered.
Systematic search provided 9 original researches; 1
meta-analysis, 4 prospective randomized controlled
trials, 2 prospective non-randomized controlled
trials, 1 cohort study and 1 pooled analysis. Six stu-
dies found a statistically significant effect of normo-
glycemia on mortality in critically ill patients. Of
these, 5 demonstrated significant mortality redu-
ction and only one a significant increase of mor-
tality. Considering the main evidence based medi-
cine (EBM) principles, such as research design,
sample and impact factor, it appears that IV insulin
administration for achieving normoglycemia is
beneficial in terms of mortality, with a possible gra-
de A recommendation, in critically ill patients.
μπμ§πO°ƒ∞ºπ∞
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47. ª·ÛÙÚÔÎÒÛÙ·˜ ∞, °ÎÚÈ˙ÈÒÙË ª, μ·ÛÈÏ›Ԣ μ. ∂Ê·ÚÌÔ-
Á‹ ÂÓfi˜ ·ÛÊ·ÏÔ‡˜ Î·È ·ÔÙÂÏÂÛÌ·ÙÈÎÔ‡ ÚˆÙÔÎfiÏ-
ÏÔ˘ ¯ÔÚ‹ÁËÛ˘ ÈÓÛÔ˘Ï›Ó˘ Û ÌÈÎÙ‹ ªÔÓ¿‰· ∂ÓÙ·ÙÈ-
΋˜ £ÂÚ·›·˜. ¡ÔÛËÏ¢ÙÈ΋ 2008, 47: 232-239.
∞ÏÏËÏÔÁÚ·Ê›·:
M. °ÎÚÈ˙ÈÒÙË
μ·ÛÈÏÈο
570 06 £ÂÛÛ·ÏÔÓ›ÎË
Corresponding Author:
M. Grizioti
Vasilika
570 06 Thessaloniki
Greece
∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 2009, 75, 1: 65 - 73
EÊ·ÚÌÔÁ‹, ·ÍÈÔÏfiÁËÛË Î·È Û˘Û¯¤ÙÈÛË Ì ‰È¿ÊÔÚÔ˘˜
·Ú¿ÁÔÓÙ˜ ÙÔ˘ ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘ ÔÈfiÙËÙ·˜ ˙ˆ‹˜
(HQLQ) ÛÙË ¯ÚfiÓÈ· Ë·Ù›Ùȉ· C
∂. ™ÈÓ¿ÎÔ˜, ∂. °ÈÁ‹, μ. ΔÛ¿·˜, £. §¿ÏÏ·, ∞. ª¤ÏÏÔ˘,
∞. ™Ô‡ÎÈ·, ª. ƒ·ÙÔÔ‡ÏÔ˘-°ÈÁ‹
μ′ ¶·ıÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ ∞¶£, πÔÎÚ¿ÙÂÈÔ ¡ÔÛÔÎÔÌ›Ô, £ÂÛÛ·ÏÔÓ›ÎË
¶ÂÚ›ÏË„Ë. ∏ Ïԛ̈ÍË Ì ÙÔÓ Èfi Ù˘ Ë·Ù›Ùȉ·˜ C
(HCV) Â›Ó·È ϤÔÓ ÁÓˆÛÙfi fiÙÈ ÌÔÚ› Ó· ÚÔηϤÛÂÈ
ÌÈ· ÛÂÈÚ¿ Ó¢ÚÔ„˘¯È·ÙÚÈÎÒÓ Û˘Ìو̿وÓ, ·Ú¿
ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ıˆÚÂ›Ù·È ·Û˘Ìو̷ÙÈ΋ ÓfiÛÔ˜ ÛÙ·
·Ú¯Èο ÛÙ¿‰È·. ™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ›ӷÈ
Ë Û‡ÁÎÚÈÛË ÙÔ˘ ÂÈ¤‰Ô˘ Ù˘ ÔÈfiÙËÙ·˜ ˙ˆ‹˜ ÙˆÓ
∂ÏÏ‹ÓˆÓ ·ÛıÂÓÒÓ Ì ¯ÚfiÓÈ· Ë·Ù›Ùȉ· C Ì ·˘Ùfi
˘ÁÈÒÓ Ì·ÚÙ‡ÚˆÓ Ì ÙË ¯Ú‹ÛË ÂÓfi˜ ÂȉÈÎÔ‡ ÂÚˆÙËÌ·-
ÙÔÏÔÁ›Ô˘ Î·È Ë Û˘Û¯¤ÙÈÛË Ù˘ ÔÈfiÙËÙ·˜ ˙ˆ‹˜ Ì ‰Ë-
ÌÔÁÚ·ÊÈÎÔ‡˜ Î·È ÂÚÁ·ÛÙËÚÈ·ÎÔ‡˜ ·Ú¿ÁÔÓÙ˜. ™ÙË
ÌÂϤÙË Û˘ÌÂÚÈÏ‹ÊıËÎ·Ó 99 ·ÛıÂÓ›˜ Ì ¯ÚfiÓÈ·
Ë·Ù›Ùȉ· C Î·È 91 ˘ÁÈ›˜ Ì¿ÚÙ˘Ú˜. OÈ ·ÛıÂÓ›˜ Û˘-
ÌÏ‹ÚˆÛ·Ó ÙÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ÔÈfiÙËÙ·˜ ˙ˆ‹˜
HQLQ Û ÂÏÏËÓÈ΋ ÌÂÙ¿ÊÚ·ÛË. ∏ ·ÍÈÔÏfiÁËÛË Ù˘
·ÍÈÔÈÛÙ›·˜ ÙÔ˘ ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘ HQLQ Ú·ÁÌ·-
ÙÔÔÈ‹ıËΠ̠ÙË Û‡ÁÎÚÈÛË ÙˆÓ ÙÂÛÛ¿ÚˆÓ ‰ÂÈÎÙÒÓ
ÙÔ˘ ÂȉÈÎÔ‡ ·˘ÙÔ‡ ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘ Ì ÙȘ 8 ÁÓˆ-
ÛÙ¤˜ Îϛ̷Θ ÙÔ˘ ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘ SF-36, Ô˘ ·Ô-
ÙÂÏ› ÙÌ‹Ì· ÙÔ˘ HQLQ. OÈ ÙÈ̤˜ ÔÈfiÙËÙ·˜ ˙ˆ‹˜
ÙˆÓ ·ÛıÂÓÒÓ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó ¯·ÌËÏfiÙÂÚ˜ ·fi ÙȘ
·ÓÙ›ÛÙÔȯ˜ ÙˆÓ ˘ÁÈÒÓ Û fiϘ ÙȘ Îϛ̷Θ Ô˘ Û˘-
∂π™∞°ø°∏
∏ HCV Ïԛ̈ÍË Â›Ó·È ‰˘Ó·Ùfi Ó· ‰È·‰Ú¿ÌÂÈ ·Û˘-
Ìو̷ÙÈο ÛÙ· ·Ú¯Èο ÛÙ¿‰È·. ∂ÓÙÔ‡ÙÔȘ, ¤¯ÂÈ
‰È·ÈÛÙˆı› Û¯ÂÙÈο ÚfiÛÊ·Ù· fiÙÈ ÔÈ ·ÛıÂÓ›˜ ÌÂ
¯ÚfiÓÈ· Ë·Ù›Ùȉ· C ÂÌÊ·Ó›˙Ô˘Ó ¯·ÌËÏfiÙÂÚÔ Â›-
Â‰Ô ÔÈfiÙËÙ·˜ ˙ˆ‹˜ Û˘ÁÎÚÈÙÈο Ì ˘ÁÈ›˜ Ì¿ÚÙ˘-
Ú˜, fiˆ˜ Â›Û˘ Î·È fiÙÈ Ë ·ÓÙ·fiÎÚÈÛË ÛÙË ıÂÚ·-
›· Û¯ÂÙ›˙ÂÙ·È Ì ‚ÂÏÙ›ˆÛË Ù˘ ÔÈfiÙËÙ·˜ ˙ˆ‹˜1,2.
ÁÎÚ›ıËηÓ. ∫·ÙfiÈÓ Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ Û˘Û¯¤ÙÈÛË
ÙˆÓ ÙÈÌÒÓ ÙˆÓ ·ÛıÂÓÒÓ ÛÙȘ ‰Ò‰Âη Îϛ̷Θ ÙÔ˘
ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘ HQLQ Ì ‰È¿ÊÔÚÔ˘˜ ·Ú¿ÁÔÓÙ˜.
¢È·ÈÛÙÒıËΠ·ÚÓËÙÈ΋ Û˘Û¯¤ÙÈÛË ÌÂÙÚ›Ô˘ ‚·ıÌÔ‡
Ù˘ Îϛ̷η˜ ÁÂÓÈ΋˜ ˘Á›·˜ (general health, GH) ÌÂ
ÙÔ ÈÛÙÔÚÈÎfi ¯Ú‹Û˘ Ó·ÚΈÙÈÎÒÓ Ô˘ÛÈÒÓ Î·È ıÂÙÈ΋
Û˘Û¯¤ÙÈÛË Ù˘ Îϛ̷η˜ „˘¯È΋˜ ˘Á›·˜ (mental
health, MH) Ì ÙËÓ ËÏÈΛ·. ™ÙËÓ ÔÏÏ·Ï‹ ÁÚ·ÌÌÈ΋
·Ï›Ó‰ÚÔÌË ·Ó¿Ï˘ÛË ‰È·ÈÛÙÒıËΠfiÙÈ ÙÔ ÈÛÙÔÚÈÎfi
¯Ú‹Û˘ Ó·ÚΈÙÈÎÒÓ Ô˘ÛÈÒÓ, Ë ËÏÈΛ· Î·È Ô ‚·ıÌfi˜
Ù˘ ›ÓˆÛ˘ ÛÙË ‚ÈÔ„›· ‹·ÙÔ˜ ÂËÚ¿˙ÂÈ ·ÚÓËÙÈο
ÙËÓ ÔÈfiÙËÙ· ˙ˆ‹˜ ÙˆÓ ·ÛıÂÓÒÓ. ™˘ÌÂÚ·ÛÌ·ÙÈο
ÙÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ HQLQ ¤¯ÂÈ ÙËÓ ··ÈÙÔ‡ÌÂÓË
·ÍÈÔÈÛÙ›· ÁÈ· ÙË ÌÂϤÙË Ù˘ ÔÈfiÙËÙ·˜ ˙ˆ‹˜ ÙˆÓ
∂ÏÏ‹ÓˆÓ ·ÛıÂÓÒÓ Ì ¯ÚfiÓÈ· ÈÔÁÂÓ‹ Ë·Ù›Ùȉ·. ™‡Ì-
ʈӷ Ì ٷ Â˘Ú‹Ì·Ù· Ù˘ ÌÂϤÙ˘ ÙÔ ÈÛÙÔÚÈÎfi ¯Ú‹-
Û˘ Ó·ÚΈÙÈÎÒÓ Ô˘ÛÈÒÓ Î·È Ë ËÏÈΛ· ·ÔÙÂÏÔ‡Ó ·ÓÂ-
Í¿ÚÙËÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ Ô˘ ÂȉÚÔ‡Ó ÛÙËÓ ÔÈfiÙË-
Ù· ˙ˆ‹˜ ÙˆÓ ·ÛıÂÓÒÓ Ì ¯ÚfiÓÈ· Ë·Ù›Ùȉ· C.
EÏÏËÓ I·ÙÚ 2009, 75: 65 - 73.
∂ÈϤÔÓ, Ë ÂÁÎÂÎÚÈ̤ÓË ıÂÚ·›· ÁÈ· ÙË ¯ÚfiÓÈ·
Ë·Ù›Ùȉ· C ÌÂ Û˘Ó‰˘·ÛÌfi ÂÁ΢ÏȈ̤Ó˘ ÈÓÙÂÚ-
ÊÂÚfiÓ˘ Ì ÚÈÌ·‚ÈÚ›ÓË ÚÔηÏ› ÔÈÎÈÏ›· ·ÓÂÈ-
ı‡ÌËÙˆÓ ÂÓÂÚÁÂÈÒÓ Î·È Û˘¯Ó¿ ÂËÚ¿˙ÂÈ ÙËÓ „˘-
¯È΋ ÛÊ·›Ú· ‰ËÌÈÔ˘ÚÁÒÓÙ·˜ ÌÂÙ·‚ÔϤ˜ ÛÙË ‰È¿ıÂ-
ÛË, Ì›ˆÛË Ù˘ ÈηÓfiÙËÙ·˜ Û˘ÁΤÓÙÚˆÛ˘ Î·È ÙÔ˘
libido, ηٿıÏÈ„Ë, ̤¯ÚÈ Î·È ·˘ÙÔηٷÛÙÚÔÊÈΤ˜
Ù¿ÛÂȘ3,4.
66 E. ™π¡∞∫O™ ∫∞π ™À¡.
∏ ¢ڇÙËÙ· Î·È Ë ÔÏ˘ÏÔÎfiÙËÙ· Ù˘ ¤ÓÓÔÈ·˜
«ÔÈfiÙËÙ· ˙ˆ‹˜» Î·È Ë ÂÈÛÙËÌÔÓÈ΋ ·Ó·ÁηÈfiÙË-
Ù· ·ÓÙÈÎÂÈÌÂÓÈ΋˜ ηٷÁÚ·Ê‹˜ Ô‰‹ÁËÛ·Ó ÙÔ˘˜
ÂÚ¢ÓËÙ¤˜ ÛÙËÓ ·Ó¿Ù˘ÍË ÌÂıfi‰ˆÓ ÔÛÔÙÈ΋˜ ̤-
ÙÚËÛ˘ Ù˘ ÔÈfiÙËÙ·˜ ˙ˆ‹˜ Î·È ÙˆÓ ÌÂÙ·‚ÔÏÒÓ Ù˘.
Δ· ÂÚÁ·Ï›· ·˘Ù¿ ÂÍÂÏ›¯ıËÎ·Ó Ì ÙËÓ ¿ÚÔ‰Ô ÙˆÓ
ÂÙÒÓ ·fi Îϛ̷Θ ÁÂÓÈ΋˜ ·ÍÈÔÏfiÁËÛ˘ Ù˘ ÔÈfi-
ÙËÙ·˜ ˙ˆ‹˜ Û ÂÍÂȉÈÎÂ˘Ì¤Ó· ÂÚˆÙËÌ·ÙÔÏfiÁÈ· ·˘-
ÙÔ·ÍÈÔÏfiÁËÛ˘.
Δ· Ë·ÙÈο ÓÔÛ‹Ì·Ù· ÂËÚ¿˙Ô˘Ó ÔχÏ¢-
Ú· ÙËÓ ÔÈfiÙËÙ· ˙ˆ‹˜ Ô˘ Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ˘Á›·
(Health-Related Quality of Life, HRQoL), fiˆ˜ Ô-
Ú›˙ÂÙ·È ÔÚıfiÙÂÚ· Ë ÔÈfiÙËÙ· ˙ˆ‹˜ ÛÙËÓ ÎÏÈÓÈ΋ È·-
ÙÚÈ΋. ∏ ÁÂÓÈ΋ Ù¿ÛË, fiˆ˜ ÚÔ·ÙÂÈ ·fi ÙË ‚È-
‚ÏÈÔÁÚ·Ê›·, Â›Ó·È fiÙÈ Ù· ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù· ÙÔ˘ ‹-
·ÙÔ˜ ÂȉÚÔ‡Ó ·ÚÓËÙÈο ÛÙËÓ ÔÈfiÙËÙ· ˙ˆ‹˜ ÙˆÓ
·ÛıÂÓÒÓ5. Δ· Û˘¯ÓfiÙÂÚ· ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓ· ÂÚˆ-
ÙËÌ·ÙÔÏfiÁÈ· ÁÈ· Ù· ÓÔÛ‹Ì·Ù· ·˘Ù¿ Â›Ó·È ÙÔ Hepa-
titis Quality of Life Questionnaire (HQLQ), ÙÔ
Chronic Liver Disease Questionnaire (CLDQ) ηÈ
ÙÔ Liver Disease Quality of Life Questionnaire
(LDOL). ∞fi ·˘Ù¿ ÙÔ ÚÒÙÔ Â›Ó·È ÂȉÈÎfi ÂÚˆÙË-
Ì·ÙÔÏfiÁÈÔ ÁÈ· ÙËÓ ÈÔÁÂÓ‹ Ë·Ù›Ùȉ·, ÂÓÒ Ù· ¿ÏÏ·
‰‡Ô ·ÔÙÂÏÔ‡Ó ÁÂÓÈο ÂÚˆÙËÌ·ÙÔÏfiÁÈ· ÁÈ· Ë·ÙÈ-
ο ÓÔÛ‹Ì·Ù·. ™ÙËÓ ∂ÏÏ¿‰· ‰ÂÓ ˘‹Ú¯Â ̤¯ÚÈ ÙÒÚ·
ÈÛÙÔÔÈË̤ÓË ÌÂÙ¿ÊÚ·ÛË ÂȉÈÎÔ‡ ÂÚˆÙËÌ·ÙÔÏÔ-
Á›Ô˘ ÁÈ· ÙË ¯ÚfiÓÈ· ÈÔÁÂÓ‹ Ë·Ù›Ùȉ·, ÁÂÁÔÓfi˜ Ô˘
‰ËÌÈÔ˘ÚÁÔ‡Û ÛËÌ·ÓÙÈÎfi ÎÂÓfi ÛÙËÓ ·ÍÈÔÏfiÁËÛË
Ù˘ ÔÈfiÙËÙ·˜ ˙ˆ‹˜ ÙˆÓ ·ÛıÂÓÒÓ.
™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ÌÂÙ·ÊÚ¿ÛıËΠ̠ÂȉÈ-
Îfi ÙÚfiÔ ÙÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ HQLQ ·fi Ù·
∞ÁÁÏÈο ÛÙ· ∂ÏÏËÓÈο, ·ÍÈÔÏÔÁ‹ıËÎÂ Ë ·ÍÈÔÈ-
ÛÙ›· Î·È Ú·ÁÌ·ÙÔÔÈ‹ıËΠ̠‚¿ÛË Ù· ÛÙÔȯ›·
ÙÔ˘ ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘ 1) Û‡ÁÎÚÈÛË Ù˘ ÔÈfiÙËÙ·˜
˙ˆ‹˜ ÙˆÓ ·ÛıÂÓÒÓ Ì ¯ÚfiÓÈ· Ë·Ù›Ùȉ· C Ì ˘ÁÈ›˜
Ì¿ÚÙ˘Ú˜ Î·È 2) Û˘Û¯¤ÙÈÛË Ù˘ ÔÈfiÙËÙ·˜ ˙ˆ‹˜ ÌÂ
‰ËÌÔÁÚ·ÊÈÎÔ‡˜ (ËÏÈΛ·, ʇÏÔ), ÂÚÁ·ÛÙËÚÈ·ÎÔ‡˜
(ALT, HCV-RNA, ÁÔÓfiÙ˘Ô ÙÔ˘ ÈÔ‡) Î·È ¿ÏÏÔ˘˜
·Ú¿ÁÔÓÙ˜ fiˆ˜ ÙÔ ÈÛÙÔÏÔÁÈÎfi ÛÙ¿‰ÈÔ, ÙÔÓ ÙÚfi-
Ô˜ ·fiÎÙËÛ˘ Ù˘ Ïԛ̈͢ Î·È ÙÔ ‰Â›ÎÙË Ì¿˙·˜
ÛÒÌ·ÙÔ˜ (Body Mass Index, BMI).
∞™£∂¡∂π™ ∫∞π ª∂£O¢Oπ
™ÙË ÌÂϤÙË Û˘ÌÂÚÈÏ‹ÊıËÎ·Ó 99 ·ÛıÂÓ›˜ Ì ¯ÚfiÓÈ· Ë·Ù›-
Ùȉ· C Î·È 91 ˘ÁÈ›˜ Ì¿ÚÙ˘Ú˜. ŸÏÔÈ ÔÈ ·ÛıÂÓ›˜ ÂÍÂÙ¿ÛıË-
Î·Ó ÛÙ· Ï·›ÛÈ· ÙÔ˘ Â͈ÙÂÚÈÎÔ‡ È·ÙÚ›Ԣ ÙÔ˘ ∏·ÙÔÏÔÁÈÎÔ‡
ΔÌ‹Ì·ÙÔ˜ Ù˘ μ’ ¶·ıÔÏÔÁÈ΋˜ ∫ÏÈÓÈ΋˜ ÙÔ˘ ∞.¶.£. ÛÙÔ
πÔÎÚ¿ÙÂÈÔ NÔÛÔÎÔÌÂ›Ô Î·È Û˘ÌÏ‹ÚˆÛ·Ó ÔÈÎÂÈÔıÂÏÒ˜
Î·È ÌÂÙ¿ ·fi ÂÓË̤ڈÛË ÙÔ˘˜ ÁÈ· ÙÔ ÛÎÔfi Ù˘ ÌÂϤÙ˘, ÙÔ
ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ÔÈfiÙËÙ·˜ ˙ˆ‹˜ HQLQ.
ŸÏÔÈ ÔÈ ·ÛıÂÓ›˜ ›¯·Ó antiHCV (+)/HBsAg (-) ηÈ
HCV-RNA (+) Î·È ‰ÂÓ Â›¯·Ó Ï¿‚ÂÈ ·ÓÙÈÈ΋ ıÂÚ·›· ÛÙÔ
·ÚÂÏıfiÓ, ÂÓÒ fiÏÔÈ ÔÈ ˘ÁÈ›˜ Ì¿ÚÙ˘Ú˜ ‹Ù·Ó antiHCV(-)
/HBsAg (-). °È· ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙÔ˘ HCV-RNA ¯ÚËÛÈÌÔ-
ÔÈ‹ıËÎÂ Ë Ì¤ıÔ‰Ô˜ PCR (Combas Amplicor HCV ηÈ
Amplicor HCV Monitor – ROCHE Diagnostics). ∫·Ó¤Ó·˜
·fi ÙÔ˘˜ ·ÛıÂÓ›˜ ‰ÂÓ ¤·Û¯Â ·fi ¿ÏÏÔ ¯ÚfiÓÈÔ ÓfiÛËÌ·, Ô˘
ÂӉ¯Ô̤ӈ˜ ı· ÂËÚ¤·˙ ÙËÓ ÔÈfiÙËÙ· ˙ˆ‹˜ ÙÔ˘ Î·È Î·Ó¤-
Ó·˜ ‰ÂÓ Â›¯Â ΛÚÚˆÛË ÙÔ˘ ‹·ÙÔ˜.
∏ ÂÎÙ›ÌËÛË ÙˆÓ ·ÛıÂÓÒÓ ÂÚÈÂÏ¿Ì‚·Ó ÏÂÙÔÌÂÚ‹ Ï‹-
„Ë ÙÔ˘ ÈÛÙÔÚÈÎÔ‡ Ì ȉȷ›ÙÂÚË ¤ÌÊ·ÛË ÛÙÔÓ ÙÚfiÔ ·fiÎÙËÛ˘
Ù˘ Ïԛ̈͢ Î·È ÛÙÔ Èı·Ófi ÈÛÙÔÚÈÎfi ¯Ú‹Û˘ Ó·ÚΈÙÈÎÒÓ Ô˘-
ÛÈÒÓ ÛÙÔ ·ÚÂÏıfiÓ. O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ·ÔÙÂÏÔ‡ÓÙ·Ó
·fi Ï‹ÚÂȘ ·ÈÌ·ÙÔÏÔÁÈΤ˜ Î·È ‚ÈÔ¯ËÌÈΤ˜ ÂÍÂÙ¿ÛÂȘ, ηıÒ˜
Î·È ·fi ¤ÏÂÁ¯Ô ÙÔ˘ ËÎÙÈÎÔ‡ ÙÔ˘˜ Ì˯·ÓÈÛÌÔ‡. ∂›Û˘, ÔÈ
·ÛıÂÓ›˜ ÂϤÁ¯ÔÓÙ·Ó ÁÈ· ÙËÓ ·ÚÔ˘Û›· ÛÙÔÓ ÔÚfi ÙÔ˘ ÂÈÊ·-
ÓÂÈ·ÎÔ‡ ·ÓÙÈÁfiÓÔ˘ Ù˘ Ë·Ù›Ùȉ·˜ μ Î·È ÙˆÓ ·ÓÙÈۈ̿وÓ
¤Ó·ÓÙÈ ÙÔ˘ ÈÔ‡ Ù˘ Â›ÎÙËÙ˘ ·ÓÔÛÔÏÔÁÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜
(HIV). Δ¤ÏÔ˜, ÔÈ ·ÛıÂÓ›˜ ˘Ô‚¿ÏÏÔÓÙ·Ó Û ˘ÂÚ˯ÔÁÚ¿ÊË-
Ì· ¿Óˆ ÎÔÈÏ›·˜. ™Â fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ ¤ÁÈÓ ÚÔÛ‰ÈÔÚÈÛÌfi˜
ÙÔ˘ ÁÔÓfiÙ˘Ô˘ ÙÔ˘ HCV (INNOLIPA, Bayer Diagnostics),
ÂÓÒ 61/99 ·ÛıÂÓ›˜ ˘Ô‚Ï‹ıËηÓ, Ì ÙË Û‡ÌʈÓË ÁÓÒÌË ÙÔ˘˜,
Û ‚ÈÔ„›· ‹·ÙÔ˜. °È· ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi Ù˘ ÓÂÎÚÔÊÏÂÁÌÔÓÒ-
‰Ô˘˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Î·È ÙÔ˘ ÛÙ·‰›Ô˘ Ù˘ ›ÓˆÛ˘ ¯ÚËÛÈÌÔÔÈ-
‹ıËΠÙÔ ÙÚÔÔÔÈË̤ÓÔ Û‡ÛÙËÌ· ·ÍÈÔÏfiÁËÛ˘ ηٿ Knodell.
ΔÔ Û‡ÛÙËÌ· ·˘Ùfi ÂÎÙÈÌ¿ ÙËÓ ›ÓˆÛË Û ÌÈ· ·ÚÈıÌËÙÈ΋ Îϛ̷-
η ·fi 0 ¤ˆ˜ 4, Ì ÙÔ ÛÙ¿‰ÈÔ 0 Ó· ·ÓÙÈÚÔÛˆ‡ÂÈ ÙËÓ ·Ô˘-
Û›· ›ÓˆÛ˘ Î·È ÙÔ ÛÙ¿‰ÈÔ 4 ÙËÓ Î›ÚÚˆÛË6.
°È· ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙÔ˘ ‰Â›ÎÙË Ì¿˙·˜ ÛÒÌ·ÙÔ˜ ¯ÚË-
ÛÈÌÔÔÈ‹ıËÎÂ Ô Ù‡Ô˜:
BMI = μ¿ÚÔ˜ ÛÒÌ·ÙÔ˜ (kg) / ⁄„Ô˜2 (m)
ø˜ ÚÒËÓ ¯Ú‹ÛÙ˜ ÂÓ‰ÔÊÏ‚›ˆÓ Ó·ÚΈÙÈÎÒÓ Ô˘ÛÈÒÓ
(Intravenous Drug Users, IVDU) ¯·Ú·ÎÙËÚ›ÛıËÎ·Ó ÔÈ ·-
ÛıÂÓ›˜ Ô˘ ·Ó¤ÊÂÚ·Ó ¯Ú‹ÛË Ô˘ÛÈÒÓ ÛÙÔ ·ÚÂÏıfiÓ Î·È Ô˘
›¯·Ó ·Ô¯‹ ·fi ÙË ¯Ú‹ÛË ÁÈ· ÙÔ˘Ï¿¯ÈÛÙÔÓ 3 Ì‹Ó˜.
∏ Û˘ÌÏ‹ÚˆÛË ÙÔ˘ ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘ ÁÈÓfiÙ·Ó ·ÚÔ˘-
Û›· ÂÓfi˜ ·fi ÙÔ˘˜ ıÂÚ¿ÔÓÙ˜ È·ÙÚÔ‡˜, ¯ˆÚ›˜ fï˜ ÔÔÈ·-
‰‹ÔÙ ·Ú¤Ì‚·ÛË ÛÙȘ ··ÓÙ‹ÛÂȘ ÙˆÓ ·ÛıÂÓÒÓ.
∂ÚˆÙËÌ·ÙÔÏfiÁÈÔ HQLQ
ΔÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ HQLQ Â›Ó·È ¤Ó· ÂȉÈÎfi ÂÚˆÙËÌ·ÙÔÏfi-
ÁÈÔ Û¯Â‰È·Ṳ̂ÓÔ ÁÈ· ·ÛıÂÓ›˜ Ì ÈÔÁÂÓ‹ Ë·Ù›Ùȉ·. ¢ËÌÈ-
Ô˘ÚÁ‹ıËΠ̠ÛÎÔfi Ó· ·˘Í‹ÛÂÈ ÙËÓ Â˘·ÈÛıËÛ›· ÙˆÓ ÁÂÓÈ-
ÎÒÓ ÂÚˆÙËÌ·ÙÔÏÔÁ›ˆÓ ÁÈ· ÙËÓ ·Ó›¯Ó¢ÛË ÙˆÓ ÂȉڿÛˆÓ
ÛÙËÓ ÔÈfiÙËÙ· ˙ˆ‹˜, Ô˘ Û¯ÂÙ›˙ÔÓÙ·È ·ÔÎÏÂÈÛÙÈο Ì ÙȘ
¯ÚfiÓȘ ÈÔÁÂÓ›˜ Ë·Ù›Ùȉ˜. ∞ÔÙÂÏÂ›Ù·È ·fi ‰ÂηÂÙ¿
ÂÚˆÙ‹ÛÂȘ Î·È ¯ˆÚ›˙ÂÙ·È Û ‰‡Ô ‚·ÛÈο ̤ÚË, ÙÔ ÎÏ·ÛÈÎfi ÁÂ-
ÓÈÎfi ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ SF-36 Ì 8 Îϛ̷Θ ·ÍÈÔÏfiÁËÛ˘ ηÈ
¤Ó· ÂÈϤÔÓ ϤÁÌ· ¤ÍÈ ÂÚˆÙ‹ÛˆÓ, Ô˘ ·ÍÈÔÏÔÁÂ›Ù·È ¯ˆ-
ÚÈÛÙ¿ Ì 4 ÂÈϤÔÓ Îϛ̷Θ ·ÍÈÔÏfiÁËÛ˘. OÈ ÂÚˆÙ‹ÛÂȘ
·˘Ù¤˜ ÂϤÁ¯Ô˘Ó Ù˘¯¤˜ Ù˘ ÁÂÓÈ΋˜ ˘Á›·˜, Ô˘ ‰ÂÓ ÂϤÁ¯Ô-
ÓÙ·È Ì ÙÔ SF-36, ηıÒ˜ Î·È Èı·Ó¤˜ ¿ÌÂÛ˜ ÂÈÙÒÛÂȘ Ù˘
Ë·Ù›Ùȉ·˜ ÛÙÔ˘˜ ·ÛıÂÓ›˜.
°È· ÙË ‰ÈÂÍ·ÁˆÁ‹ Ù˘ ÌÂϤÙ˘ ÂÍ·ÛÊ·Ï›ÛÙËÎÂ Ë ¿‰ÂÈ·
¯Ú‹Û˘ (license) Ù˘ ·Ó·ıˆÚË̤Ó˘ ¤Î‰ÔÛ˘ ÙÔ˘ ÂÚˆÙËÌ·-
ÙÔÏÔÁ›Ô˘ SF-36 (SF-36-v2TM Health Survey) ÛÙ· ÂÏÏËÓÈο
·fi ÙËÓ ÂÙ·ÈÚ›· QualityMetric Inc., Lincoln U.S.A., Ô˘ η-
Ù¤¯ÂÈ Ù· ÓÂ˘Ì·ÙÈο ‰ÈηÈÒÌ·Ù· (copyright).
∏ ·ÍÈÔÏfiÁËÛË ÙÔ˘ ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘ ¤ÁÈÓ Û 12 Îϛ̷-
Θ Ì ÂÏ¿¯ÈÛÙË ‚·ıÌÔÏÔÁ›· ÙÔ 0 Î·È Ì¤ÁÈÛÙË ÙÔ 100. OÈ ÔÎÙÒ
ÚÒÙ˜ Â›Ó·È ÔÈ ÁÓˆÛÙ¤˜ Îϛ̷Θ ·ÍÈÔÏfiÁËÛ˘ ÙÔ˘ ÂÚˆÙË-
 ∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 75, 1
Ì·ÙÔÏÔÁ›Ô˘ SF-36 ˆ˜ ÂÍ‹˜:
™ˆÌ·ÙÈ΋ ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ· (Physical Functioning, PF)
™ˆÌ·ÙÈÎfi˜ ÚfiÏÔ˜ (Ê˘ÛÈ΋ ηٿÛÙ·ÛË) (Role Physical, RP)
™ˆÌ·ÙÈÎfi˜ fiÓÔ˜ (Bodily Pain, BP)
°ÂÓÈ΋ ˘Á›· (General Health, GH)
∑ˆÙÈÎfiÙËÙ· (Vitality, VT)
∫ÔÈÓˆÓÈ΋ ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ· (Social Functioning, SF)
™˘Ó·ÈÛıËÌ·ÙÈÎfi˜ ÚfiÏÔ˜ (Role Emotional, RE)
æ˘¯È΋ ˘Á›· (Mental Health, MH).
OÈ ˘fiÏÔÈ˜ Ù¤ÛÛÂÚȘ Â›Ó·È ÔÈ Îϛ̷Θ, Ô˘ ·ÍÈÔÏÔÁÔ‡Ó
ÙËÓ ÂȉÈ΋ Â›‰Ú·ÛË Ù˘ Ë·Ù›Ùȉ·˜ ÛÙËÓ ÔÈfiÙËÙ· ˙ˆ‹˜ ÙˆÓ
·ÛıÂÓÒÓ Î·È Â›Ó·È ÔÈ ÂÍ‹˜:
ÕÁ¯Ô˜ ÁÈ· ÙËÓ ˘Á›· (Health Distress, HD)
∂˘ÂÍ›· (Positive Well-Being, PWB)
¶ÂÚÈÔÚÈÛÌÔ› ÏfiÁˆ Ù˘ Ë·Ù›Ùȉ·˜ (Hepatitis Limitations,
HLIM)
ÕÁ¯Ô˜ ÁÈ· ÙËÓ ˘Á›· Û¯ÂÙÈÎfi Ì ÙËÓ Ë·Ù›Ùȉ· (Hepatitis
Health Distress, HHD).
™Ù·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË
°È· Ù· ÙÔÓ ¤ÏÂÁ¯Ô Ù˘ ·ÍÈÔÈÛÙ›·˜ ÙˆÓ ÙÂÛÛ¿ÚˆÓ ‰ÂÈÎÙÒÓ
(HD, PWB, HLIM, HHD) ÙÔ˘ ÂȉÈÎÔ‡ ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘
HQLQ Û fi,ÙÈ ·ÊÔÚ¿ ÛÙËÓ ·ÔÙ‡ˆÛË Ù˘ ÔÈfiÙËÙ·˜ ˙ˆ‹˜
ÙˆÓ ·ÛıÂÓÒÓ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ Ù˘ ÌÂϤÙ˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÛÂ
Û˘Ó‰˘·ÛÌÔ‡˜ Î·È Û˘ÓÔÏÈο ÔÈ ‰È·‰Èηۛ˜ ÂͤٷÛ˘-Â·ÓÂͤ-
Ù·Û˘ (test-retest), ·ÍÈÔÈÛÙ›·˜ ÙˆÓ ‰‡Ô ËÌ›ÎÏ·ÛÙˆÓ (split-half
reliability) Î·È Ô Û˘ÓÙÂÏÂÛÙ‹˜ ¿ÏÊ· (coefficient alpha).
∏ Û‡ÁÎÚÈÛË ÙˆÓ Ì¤ÛˆÓ fiÚˆÓ ÙˆÓ ÙÈÌÒÓ ÔÈfiÙËÙ·˜ ˙ˆ-
‹˜ ÛÙȘ ÔÎÙÒ ˘ÔÎϛ̷Θ ÙÔ˘ ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘ SF-36 ÌÂÙ·-
͇ ÙˆÓ ·ÛıÂÓÒÓ Î·È ÙˆÓ ˘ÁÈÒÓ Ì·ÚÙ‡ÚˆÓ ¤ÁÈÓ Ì ÙË ÛÙ·ÙÈ-
ÛÙÈ΋ ̤ıÔ‰Ô Student t test. ∂›Â‰Ô ÛÙ·ÙÈÛÙÈ΋˜ ÛËÌ·ÓÙÈ-
ÎfiÙËÙ·˜ ıˆڋıËΠÙÔ 95% (‰ËÏ·‰‹ ıˆڋıËÎ·Ó ÛÙ·ÙÈÛÙÈ-
ÎÒ˜ ÛËÌ·ÓÙÈο ÂΛӷ Ù· Â˘Ú‹Ì·Ù· ÁÈ· Ù· ÔÔ›· ÙÔ p<0,05).
™ÙË Û˘Ó¤¯ÂÈ· ‰ÈÂÚ¢ӋıËÎÂ Ë ‡·ÚÍË Èı·ÓÒÓ Î·Ù¿
˙‡ÁË Û˘Û¯ÂÙ›ÛÂˆÓ ÙˆÓ ÙÈÌÒÓ ÙˆÓ ·ÛıÂÓÒÓ ÛÙȘ ‰Ò‰Âη ÎÏ›-
̷Θ ÙÔ˘ ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘ HQLQ Ì ÙÔ˘˜ ·Ú·Î¿Ùˆ ·Ú¿-
ÁÔÓÙ˜: ∏ÏÈΛ·, ʇÏÔ, Â›‰· ALT Î·È RNA, ÁÔÓfiÙ˘Ô˜ ÙÔ˘
ÈÔ‡, ÛÙ¿‰ÈÔ ›ÓˆÛ˘, ÙÈÌ‹ BMI, Î·È ÈÛÙÔÚÈÎfi ¯Ú‹Û˘ Ó·ÚΈÙÈ-
ÎÒÓ Ô˘ÛÈÒÓ. ÃÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÔÈ ‰ÔÎÈ̷ۛ˜ ÙÔ˘ Pearson
Î·È Spearman, ·ÔÎÏ›ÔÓÙ·˜ ÙȘ „¢‰ÔÈı·ÓfiÙËÙ˜ Ì ÙË Ì¤-
ıÔ‰Ô ÙˆÓ Larzelere Î·È Mulaik (·ÔÎÏ›ÛıËÎÂ Ë ÚÔÛ¤ÁÁÈÛË
ηٿ Bonferroni ÏfiÁˆ ¤ÏÏÂȄ˘ ¢·ÈÛıËÛ›·˜). ¶Ú·ÁÌ·ÙÔÔÈ-
‹ıËΠÔÏÏ·Ï‹ ÁÚ·ÌÌÈ΋ ·Ï›Ó‰ÚÔÌË ·Ó¿Ï˘ÛË, ÁÈ· Ó· ‰ÈÂ-
Ú¢ÓËı› Ë Â›‰Ú·Û‹ ÙÔ˘˜ ÛÙÔ˘˜ ‰Â›ÎÙ˜ ‚·ıÌÔÏfiÁËÛ˘. ™ÙÔ
ÛÙ·ÙÈÛÙÈÎfi ÌÔÓÙ¤ÏÔ Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËΠÂÈÛ‹¯ıËÛ·Ó Î·Ù¿
‚‹Ì·Ù· Î·È Ù·˘Ùfi¯ÚÔÓ· ÔÈ ·Ú·¿Óˆ ·Ú¿ÁÔÓÙ˜ ÛÂ Û˘Ó‰˘·-
ÛÌÔ‡˜ Ì ‚¿ÛË ÎÏÈÓÈο Î·È ÛÙ·ÙÈÛÙÈο ÎÚÈÙ‹ÚÈ·.
∞¶OΔ∂§∂™ª∞Δ∞
1. ªÂÙ¿ÊÚ·ÛË ÙÔ˘ HQLQ
OÈ ¤ÍÈ ÂÚˆÙ‹ÛÂȘ ÙÔ˘ ‰Â‡ÙÂÚÔ˘ ÙÌ‹Ì·ÙÔ˜ ÙÔ˘ ÂÚˆ-
ÙËÌ·ÙÔÏÔÁ›Ô˘ HQLQ ÌÂÙ·ÊÚ¿ÛıËÎ·Ó ÛÙ· ÂÏÏËÓÈ-
ο Ì ÂȉÈ΋ ‰È·‰Èηۛ·, Ô˘ ˘ԉ›¯ıËΠ·fi ÙËÓ
›‰È· ÂÙ·ÈÚ›·, Ô˘ Â›Ó·È Î¿ÙÔ¯Ô˜ ÙˆÓ ÓÂ˘Ì·ÙÈÎÒÓ
‰ÈÎ·ÈˆÌ¿ÙˆÓ Î·È ÙÔ˘ HQLQ, Î·È Ë ÔÔ›· ›ӷÈ
Û‡ÌʈÓË Î·È Ì ÙËÓ ÚÔÙÂÈÓfiÌÂÓË ‰ÈÂıÓÒ˜ ‰È·‰È-
ηۛ· ÌÂÙ¿ÊÚ·Û˘ ÂÚˆÙËÌ·ÙÔÏÔÁ›ˆÓ7.
67
ŒÙÛÈ, ·Ú¯Èο ¤ÁÈÓ ÌÂÙ¿ÊÚ·ÛË ÙˆÓ ¤ÍÈ ·˘ÙÒÓ
ÂÚˆÙ‹ÛÂˆÓ ÛÙ· ÂÏÏËÓÈο ·fi ‰‡Ô ŒÏÏËÓ˜ ÌÂÙ·-
ÊÚ·ÛÙ¤˜, Ô˘ ›¯·Ó ¿ÓÂÛË ÛÙË ¯ÚËÛÈÌÔÔ›ËÛË Ù˘
·ÁÁÏÈ΋˜ ÁÏÒÛÛ·˜. OÈ ‰‡Ô ÌÂÙ·ÊÚ¿ÛÂȘ Ô˘ ÚÔ¤-
΢„·Ó Û˘ÁÎÚ›ıËÎ·Ó ÌÂٷ͇ ÙÔ˘˜ Î·È ¤ÁÈÓ ¤Ó·˜
Û˘Ì‚È‚·ÛÌfi˜ ÌÂٷ͇ ÙˆÓ Ù˘¯fiÓ ‰È·ÊÔÚÒÓ ÙÔ˘˜.
™ÙË Û˘Ó¤¯ÂÈ· ¤Ó·˜ ÕÁÁÏÔ˜ ÌÂÙ·ÊÚ·ÛÙ‹˜, Ô˘ ‰Â
ÁÓÒÚÈ˙ ÙÔ ·Ú¯ÈÎfi ΛÌÂÓÔ ÙˆÓ ¤ÍÈ ÂÚˆÙ‹ÛÂˆÓ ÛÙ·
·ÁÁÏÈο, ÌÂÙ¤ÊÚ·Û «·Ó¿Ô‰·» ÙÔ Î›ÌÂÓÔ Ô˘
ÚԤ΢„ ·fi ÙËÓ ÚÔËÁÔ‡ÌÂÓË ‰È·‰Èηۛ· ·fi
Ù· ÂÏÏËÓÈο ÛÙ· ·ÁÁÏÈο. ŒÓ· ÙÚ›ÙÔ ¿ÙÔÌÔ Û˘Ó¤-
ÎÚÈÓ ηÙfiÈÓ Î¿ı ÂÚÒÙËÌ· ·˘Ù‹˜ Ù˘, ÚÔÂÚ¯fi-
ÌÂÓ˘ ·fi ÙËÓ ·Ú¯È΋, ·ÓÙ›ÛÙÚÔÊ˘ ÌÂÙ¿ÊÚ·Û˘
Ì ÙÔ ÚˆÙfiÙ˘Ô Î·È ÂÙԛ̷Û ÌÈ· ÁÚ·Ù‹ ·Ó·ÊÔ-
Ú¿ fiÏˆÓ ÙˆÓ ‰È·ÊÔÚÒÓ ÙÔ˘˜. ∏ fiÏË ‰È·‰Èηۛ· ›-
¯Â ÙÔ ÛÎÔfi Ë ·Ú¯È΋ Î·È Ë ·ÓÙ›ÛÙÚÔÊË ÌÂÙ¿ÊÚ·-
ÛË Ó· ·ÓÙ·ÔÎÚ›ÓÔÓÙ·È Ì ·ÎÚ›‚ÂÈ· ÛÙÔ ÂÚȯfi-
ÌÂÓÔ Î·È ÛÙÔ ÓfiËÌ· ÙÔ˘ ÚˆÙÔÙ‡Ô˘. ªÂÙ¿ ÙÔ Ù¤-
ÏÔ˜ Ù˘ ÌÂÙ¿ÊÚ·Û˘ Î·È ÚÈÓ ÙËÓ ¤Ó·ÚÍË Ù˘ Û˘-
ÌÏ‹ÚˆÛ˘ ·fi ÙÔ˘˜ ·ÛıÂÓ›˜, ÌÂÛÔÏ¿‚ËÛ ¤Ó·
ÛÙ¿‰ÈÔ ‰ÔÎÈÌ‹˜ ÙÔ˘ Û ÙÚÂȘ ÂıÂÏÔÓÙ¤˜ ·ÛıÂÓ›˜
ÁÈ· Ó· ÂÏÂÁ¯ı› ηٿ fiÛÔ Â›Ó·È Î·Ù·ÓÔËÙfi ·fi
·˘ÙÔ‡˜ Î·È Â›Û˘ Ó· ηıÔÚÈÛı› Ô ··ÈÙÔ‡ÌÂÓÔ˜
¯ÚfiÓÔ˜ ÁÈ· ÙË Û˘ÌÏ‹ÚˆÛ‹ ÙÔ˘.
™ÙÔ Ù¤ÏÔ˜ ÙÔ˘ ¿ÚıÚÔ˘ ·Ú·Ù›ıÂÓÙ·È ÔÈ ÌÂÙ·-
ÊÚ·Ṳ̂Ó˜ ÂÚˆÙ‹ÛÂȘ ÙÔ˘ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ HQLQ
ÛÙËÓ ÙÂÏÈ΋ ÙÔ˘˜ ÌÔÚÊ‹ ¤ÙÛÈ, fiˆ˜ ¯ÚËÛÈÌÔÔÈ‹-
ıËÎ·Ó ÛÙË ÌÂϤÙË.
2. ∞ÍÈÔÏfiÁËÛË ÙÔ˘ HQLQ
∏ ·ÍÈÔÏfiÁËÛË ÙÔ˘ ÌÂÙ·ÊÚ·Ṳ̂ÓÔ˘ ÂÚˆÙËÌ·ÙÔÏÔ-
Á›Ô˘ ¤ÁÈÓ ̤ۈ ÙÔ˘ ÂϤÁ¯Ô˘ Ù˘ ·ÍÈÔÈÛÙ›·˜ ÙˆÓ
ÙÂÛÛ¿ÚˆÓ ÂÈϤÔÓ ÙÔ˘ SF-36 ‰ÂÈÎÙÒÓ (HD, PWB,
HLIM, HHD) ÙÔ˘ HQLQ ÛÂ fi,ÙÈ ·ÊÔÚ¿ ÛÙËÓ ·Ô-
Ù‡ˆÛË Ù˘ ÔÈfiÙËÙ·˜ ˙ˆ‹˜ ÙˆÓ ·ÛıÂÓÒÓ ÙÔ˘ ‰Â›Á-
Ì·Ùfi˜ Ù˘ ÌÂϤÙ˘. °È· ÙÔ ÛÎÔfi ·˘Ùfi, Û˘ÁÎÚ›ıË-
Î·Ó ÔÈ Ù¤ÛÛÂÚȘ ·Ú·¿Óˆ ‰Â›ÎÙ˜ Ì ÙȘ 8 ÁÓˆ-
ÛÙ¤˜ Îϛ̷Θ ÙÔ˘ ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘ SF-36, ÙÔ
ÔÔ›Ô Â›Ó·È ‹‰Ë ÈÛÙÔÔÈË̤ÓÔ ÛÙË ¯ÒÚ· Ì·˜8.
ÃÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÛÂ Û˘Ó‰˘·ÛÌÔ‡˜ Î·È Û˘ÓÔÏÈο
ÔÈ ‰È·‰Èηۛ˜ ÂͤٷÛ˘-Â·ÓÂͤٷÛ˘ (test-re-
test), ·ÍÈÔÈÛÙ›·˜ ÙˆÓ ‰‡Ô ËÌ›ÎÏ·ÛÙˆÓ (split-half
reliability) Î·È Ô Û˘ÓÙÂÏÂÛÙ‹˜ ¿ÏÊ· (coefficient al-
pha). Δ· ·ÔÙÂϤÛÌ·Ù· Ì·˜ (r=0,842, Spearman-
Brown coefficient=0,914 – Gutmann coefficient=
0,914, Cronbach’s alpha=0,917) ·Ó·‰ÂÈÎÓ‡Ô˘Ó ˘-
„ËÏ‹ ·ÍÈÔÈÛÙ›· ÙˆÓ ÙÂÛÛ¿ÚˆÓ ‰ÂÈÎÙÒÓ Ô˘ ¯ÚË-
ÛÈÌÔÔÈ‹ıËÎ·Ó Î·È ·Ô‰ÂÈÎÓ‡Ô˘Ó ÛÙ·ÙÈÛÙÈο ÙË
Û˘ÓÔÏÈ΋ ·ÍÈÔÈÛÙ›· ÙÔ˘ ÌÂÙ·ÊÚ·Ṳ̂ÓÔ˘ ÂÚˆÙË-
Ì·ÙÔÏÔÁ›Ô˘ HQLQ.
68 E. ™π¡∞∫O™ ∫∞π ™À¡.

3. ™‡ÁÎÚÈÛË ÙˆÓ ÙÈÌÒÓ Ù˘ ÔÈfiÙËÙ·˜ ˙ˆ- ¶›Ó·Î·˜ 2. ΔÈ̤˜ ÙˆÓ ÎÏÈÌ¿ÎˆÓ ÙÔ˘ ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘ SF-36
‹˜ ÌÂٷ͇ ÙˆÓ ·ÛıÂÓÒÓ Ì ¯ÚfiÓÈ· Ë·Ù›ÙÈ- ˘ÁÈÒÓ Î·È ·ÛıÂÓÒÓ

‰· C Î·È ÙˆÓ ˘ÁÈÒÓ ∫ϛ̷Θ N ª.O. S.D. p-value

Δ· ‰ËÌÔÁÚ·ÊÈο ¯·Ú·ÎÙËÚÈÛÙÈο Î·È ÔÈ ÂÚÁ·ÛÙË- PF ÀÁÈ›˜ 91 88,40 12,92
ÚȷΤ˜ ·Ú¿ÌÂÙÚÔÈ ÙˆÓ ·ÛıÂÓÒÓ Û˘ÓÔ„›˙ÔÓÙ·È ∞ÛıÂÓ›˜ 99 88,03 18,760 NS
ÛÙÔÓ ›Ó·Î· 1. RP ÀÁÈ›˜ 91 85,43 23,88
∞Ûı`ÂÓ›˜ 99 76,01 33,10 0,025
OÈ ˘ÁÈ›˜ ÂÌÊ¿ÓÈ˙·Ó ·Ó¿ÏÔÁ· ‰ËÌÔÁÚ·ÊÈο
BP ÀÁÈ›˜ 91 75,10 22,24
¯·Ú·ÎÙËÚÈÛÙÈο Ì ̤ÛÔ fiÚÔ ËÏÈΛ·˜ 37,1±9,4 ¤ÙË ∞ÛıÂÓ›˜ 99 73,17 25,31 NS
Î·È ·Ó·ÏÔÁ›· ʇÏÔ˘ (∞/£) 63/28. GH ÀÁÈ›˜ 91 64,92 19,27
·) OÈ ˘ÁÈ›˜ ‰ÂÓ Û˘ÌÏ‹ÚˆÛ·Ó ÙȘ ÂÚˆÙ‹ÛÂȘ ∞ÛıÂÓ›˜ 99 56,18 22,18 0,004
Ô˘ ·¢ı‡ÓÔÓÙ·Ó Û ¿ÙÔÌ· Ì ¯ÚfiÓÈ· Ë·Ù›Ùȉ· VT ÀÁÈ›˜ 91 61,15 14,72
∞ÛıÂÓ›˜ 99 59,54 22,58 NS
C Î·È Î·Ù¿ Û˘Ó¤ÂÈ· ÁÈ· ÙË Û‡ÁÎÚÈÛË ·˘Ù‹ ‰ÂÓ
SF ÀÁÈ›˜ 91 74,72 19,09
¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÔÈ ÂȉÈΤ˜ Îϛ̷Θ ÙÔ˘ ÂÚˆÙË- ∞ÛıÂÓ›˜ 99 67,36 26,08 0,027
Ì·ÙÔÏÔÁ›Ô˘ HQLQ. OÈ ÙÈ̤˜ ÙˆÓ ·ÛıÂÓÒÓ ‹Ù·Ó RE ÀÁÈ›˜ 91 84,61 26,90
¯·ÌËÏfiÙÂÚ˜ ·fi ÙȘ ·ÓÙ›ÛÙÔȯ˜ ÙˆÓ ˘ÁÈÒÓ Û ∞ÛıÂÓ›˜ 99 66,66 36,57 0,001
fiϘ ÙȘ Îϛ̷Θ ÙÔ˘ SF-36 (¶›Ó. 2). ™Ù·ÙÈÛÙÈο MH ÀÁÈ›˜ 91 59,56 14,46
ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ·Ú·ÙËÚ‹ıËÎ·Ó ÛÙȘ Îϛ̷- ∞ÛıÂÓ›˜ 99 55,87 22,28 NS
Θ ÙÔ˘ ۈ̷ÙÈÎÔ‡ ÚfiÏÔ˘ (p=0,025), Ù˘ ÁÂÓÈ΋˜
˘Á›·˜ (p= 0,004), Ù˘ ÎÔÈÓˆÓÈ΋˜ ÏÂÈÙÔ˘ÚÁÈÎfiÙË- Â‰Ô «ÁÂÓÈ΋˜ ˘Á›·˜» ·fi ÙÔ˘˜ ÌË ¯Ú‹ÛÙ˜, ÂÓÒ
Ù·˜ (p=0,027), Î·È ÙÔ˘ Û˘Ó·ÈÛıËÌ·ÙÈÎÔ‡ ÚfiÏÔ˘ fiÛÔ ·‡Í·ÓÂ Ë ËÏÈΛ· ÙˆÓ ·ÛıÂÓÒÓ ‚ÂÏÙȈÓfiÙ·Ó Ë
(p=0,001). «„˘¯È΋ ˘Á›·» ÙÔ˘˜.
‚) ™ÙË Û˘Ó¤¯ÂÈ·, Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ Û˘Û¯¤ÙÈ- Á) Δ¤ÏÔ˜ ‰ÈÂÓÂÚÁ‹ıËΠÔÏÏ·Ï‹ ÁÚ·ÌÌÈ΋
ÛË Î·Ù¿ ˙‡ÁË ÙˆÓ ÙÈÌÒÓ ÙˆÓ ·ÛıÂÓÒÓ ÛÙȘ ‰Ò‰Â- ·Ï›Ó‰ÚÔÌË ·Ó¿Ï˘ÛË, ÁÈ· Ó· ‰ÈÂÚ¢ÓËı› Ë Â›-
η Îϛ̷Θ ÙÔ˘ ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘ HQLQ Ì ÙÔ˘˜ ‰Ú·ÛË ÙˆÓ ÎÏÈÓÈÎÒÓ Î·È ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ·Ú·Ì¤-
·Ú·Î¿Ùˆ ·Ú¿ÁÔÓÙ˜: ËÏÈΛ·, ʇÏÔ, Â›‰· ÙÚˆÓ ÛÙÔ˘˜ ‰Â›ÎÙ˜ Ù˘ ‚·ıÌÔÏfiÁËÛ‹˜ Ì·˜. ™ÙÔ
ALT (·fiÏ˘ÙË ÙÈÌ‹ Î·È Î·Ù¿ ÔÌ¿‰Â˜ ÌÂ Ê˘ÛÈÔÏÔ- ÛÙ·ÙÈÛÙÈÎfi ÌÔÓÙ¤ÏÔ ÛËÌ·ÓÙÈ΋ Â›‰Ú·ÛË ¤¯Ô˘Ó Ù·
ÁÈΤ˜ Î·È ÌË Ê˘ÛÈÔÏÔÁÈΤ˜ ÙÚ·ÓÛ·ÌÈÓ¿Û˜), Â›Â- ÂÍ‹˜:
‰· RNA, ÁÔÓfiÙ˘Ô˜ ÙÔ˘ ÈÔ‡, ÛÙ¿‰ÈÔ ›ÓˆÛ˘, ÙÈÌ‹ 1. ΔÔ ÈÛÙÔÚÈÎfi ¯Ú‹Û˘ Ó·ÚΈÙÈÎÒÓ Ô˘ÛÈÒÓ
BMI, Î·È ÈÛÙÔÚÈÎfi ¯Ú‹Û˘ Ó·ÚΈÙÈÎÒÓ Ô˘ÛÈÒÓ. ÛÙËÓ ˘ÔÎϛ̷η ÙÔ˘ ۈ̷ÙÈÎÔ‡ fiÓÔ˘ (BP)
¢È·ÈÛÙÒıËΠ·ÚÓËÙÈ΋ Û˘Û¯¤ÙÈÛË ÌÂÙÚ›Ô˘ ‚·ı- (p=0,003, R=0,351) Î·È ÛÙËÓ ˘ÔÎϛ̷η Ù˘ ÁÂÓÈ-
ÌÔ‡ Ù˘ Îϛ̷η˜ ÁÂÓÈ΋˜ ˘Á›·˜ Ì ÙÔ ÈÛÙÔÚÈÎfi ΋˜ ˘Á›·˜ (GH) (p=0,002, R=0,462).
¯Ú‹Û˘ Ó·ÚΈÙÈÎÒÓ Ô˘ÛÈÒÓ (r = -0,339, p=0,001) 2. ∏ ËÏÈΛ· ÛÙËÓ ˘ÔÎϛ̷η Ù˘ ˙ˆÙÈÎfiÙËÙ·˜
Î·È ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË Ù˘ Îϛ̷η˜ „˘¯È΋˜ ˘Á›·˜ (VT) (p=0,036, R=0,26) Î·È ÛÙËÓ ˘ÔÎϛ̷η Ù˘
Ì ÙËÓ ËÏÈΛ· (r=0,337, p=0,001). ™‡Ìʈӷ Ì ·˘- „˘¯È΋˜ ˘Á›·˜ (ªH) (p=0,004, R=0,351).
Ù¤˜ ÙȘ ·Ú·ÙËÚ‹ÛÂȘ ÔÈ ÚÒËÓ ¯Ú‹ÛÙ˜ Ó·ÚΈÙÈ- 3. O ‚·ıÌfi˜ Ù˘ ›ÓˆÛ˘ ÛÙË ‚ÈÔ„›· ‹·ÙÔ˜
ÎÒÓ Ô˘ÛÈÒÓ (IVDU) ÂÌÊ¿ÓÈ˙·Ó ¯·ÌËÏfiÙÂÚÔ Â›- ÛÙËÓ ˘ÔÎϛ̷η ÙÔ˘ ¿Á¯Ô˘˜ ÁÈ· ÙËÓ ˘Á›· (HD)
(p=0,03, R=0,324).
¶›Ó·Î·˜ 1. ¢ËÌÔÁÚ·ÊÈο – ÂÚÁ·ÛÙËÚȷο ¯·Ú·ÎÙËÚÈÛÙÈο
·ÛıÂÓÒÓ
™À∑∏Δ∏™∏
¡ 99
∏ ÂÎÙ›ÌËÛË Ù˘ ÔÈfiÙËÙ·˜ ˙ˆ‹˜ Ô˘ Û¯ÂÙ›˙ÂÙ·È ÌÂ
∏ÏÈΛ· (¤ÙË) 35,9±11,5 ÙËÓ ˘Á›· (HRQoL) ÙˆÓ ·ÛıÂÓÒÓ Ì ¯ÚfiÓÈ· Ë·-
º‡ÏÔ (¿ÚÚÂÓ / ı‹Ï˘) 64 / 35 Ù›Ùȉ· C ¤¯ÂÈ Î·Ù·ÛÙ› Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, ÙÔ˘Ï¿-
ALT (IU/ML) 102,1±96,6
HCV-RNA (IU/ML) 2.346.064±8.013.688
¯ÈÛÙÔÓ ÛÙÔ Â›Â‰Ô ÙˆÓ ÎÏÈÓÈÎÒÓ ÌÂÏÂÙÒÓ, ··Ú·›-
°ÔÓfiÙ˘Ô˜ (1 / ÌË-1) 37 / 62 ÙËÙÔ ÛÙÔÈ¯Â›Ô Ù˘ Û˘ÓÔÏÈ΋˜ ÂÎÙ›ÌËÛ˘ ÙˆÓ ·ÛıÂ-
™Ù¿‰ÈÔ ›ÓˆÛ˘ (<2 / ≥2) 38/61 (63,3%) / 23/61 (37,7%) ÓÒÓ, fiˆ˜ ¿ÏψÛÙÂ Û˘Ì‚·›ÓÂÈ ÁÂÓÈÎfiÙÂÚ· ÛÙËÓ È·-
¢Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ 24,6±3,7 ÙÚÈ΋ Û‹ÌÂÚ·. ΔÔ ÁÂÓÈÎfi Û˘Ì¤Ú·ÛÌ· ·fi ÙËÓ
ÃÚ‹ÛÙ˜ ÂÓ‰ÔÊÏ‚›ˆÓ ·Ó·ÛÎfiËÛË Ù˘ Û¯ÂÙÈ΋˜ ‚È‚ÏÈÔÁÚ·Ê›·˜ Â›Ó·È fiÙÈ
Ô˘ÛÈÒÓ 63/99 (63,6%)
Ë ¯ÚfiÓÈ· Ë·Ù›Ùȉ· C, fiˆ˜ Î·È ÔÈ ˘fiÏÔÈ˜ Ë·-
OÈ ÙÈ̤˜ ·ÓÙÈÛÙÔÈ¯Ô‡Ó Û ̤ÛË ÙÈÌ‹ ± ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË ÙÔ¿ıÂȘ, ÂȉÚÔ‡Ó ·ÚÓËÙÈο ÛÙÔ Â›Â‰Ô Ù˘
(Standard Deviation) ÔÈfiÙËÙ·˜ ˙ˆ‹˜ ÙˆÓ ·ÛıÂÓÒÓ5. Δ· ÙÂÏÂ˘Ù·›· ¯Úfi-
 ∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 75, 1
ÓÈ· Ì¿ÏÈÛÙ· Û˘ÏϤÁÔÓÙ·È Û˘Ó¯Ҙ Ó¤· ÂÈÛÙËÌÔÓÈ-
ο ‰Â‰Ô̤ӷ ÁÈ· ¿ÌÂÛË ÂÌÏÔ΋ ÙÔ˘ HCV ÛÙËÓ
ÂÁÎÂÊ·ÏÈ΋ ÏÂÈÙÔ˘ÚÁ›·, Ô˘ ¤¯ÂÈ Û·Ó Û˘Ó¤ÂÈ· ¤Î-
ÙˆÛË ÙˆÓ ÓÔËÙÈÎÒÓ ÏÂÈÙÔ˘ÚÁÈÒÓ ÙˆÓ ·ÛıÂÓÒÓ9-13.
™ÙËÓ ∂ÏÏ¿‰·, Ë ÚÒÙË ÔÏÔÎÏËڈ̤ÓË ÌÂϤÙË
ÁÈ· ÙËÓ Î·Ù·ÁÚ·Ê‹ Ù˘ ÔÈfiÙËÙ·˜ ˙ˆ‹˜ ÙˆÓ ·ÛıÂ-
ÓÒÓ Ì ¯ÚfiÓÈ· Ë·Ù›Ùȉ· C Ì ÙË ¯ÚËÛÈÌÔÔ›ËÛË ÙÔ˘
ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘ SF-36 ¤‰ÂÈÍ fiÙÈ ·˘Ù‹ Â›Ó·È ¯·ÌË-
ÏfiÙÂÚÔ˘ ÂÈ¤‰Ô˘ Û˘ÁÎÚÈÙÈο Ì ·˘Ù‹ ÙÔ˘ ˘ÁÈÔ‡˜
ÏËı˘ÛÌÔ‡, Û‡Ìʈӷ Î·È Ì ٷ ·ÔÙÂϤÛÌ·Ù· Ù˘
‰ÈÂıÓÔ‡˜ ‚È‚ÏÈÔÁÚ·Ê›·˜14. ª¤¯ÚÈ ÙÒÚ· ˘‹ÚÍ ̛·
ÌfiÓÔ Úfi‰ÚÔÌË ÌÂϤÙË Ì ÙË ¯Ú‹ÛË ÂȉÈÎÔ‡ ÂÚˆÙË-
Ì·ÙÔÏÔÁ›Ô˘ ÁÈ· ÈÔÁÂÓ›˜ Ë·Ù›Ùȉ˜, ÙÔ˘ HQLQ, ÛÂ
ÌÈÎÚfi ·ÚÈıÌfi ·ÛıÂÓÒÓ Î·È ¯ˆÚ›˜ ·ÍÈÔÏfiÁËÛË Ù˘
ÌÂÙ¿ÊÚ·Û˘ ÙÔ˘ ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘15.
Δ· ·Ú·¿Óˆ ‰Â‰Ô̤ӷ Î·È Ë ·Ô˘Û›· ·Ó¿-
ÏÔÁˆÓ ÌÂÏÂÙÒÓ ÛÙÔÓ ÂÏÏËÓÈÎfi ÏËı˘ÛÌfi ·ÔÙ¤ÏÂ-
Û·Ó ÙÔ Î›ÓËÙÚÔ ÁÈ· ÙË ‰ÈÂÍ·ÁˆÁ‹ Ù˘ ·ÚÔ‡Û·˜ ÌÂ-
ϤÙ˘. ™ÎÔfi˜ Ù˘ ‹Ù·Ó Ë ÌÂÙ¿ÊÚ·ÛË ÛÙ· ÂÏÏËÓÈο
Ì ÂȉÈ΋ ‰È·‰Èηۛ· ÙÔ˘ HQLQ Ë ·ÍÈÔÏfiÁËÛ‹ ÙÔ˘
Î·È ÛÙË Û˘Ó¤¯ÂÈ· Ë Û‡ÁÎÚÈÛË ÙÔ˘ ÂÈ¤‰Ô˘ Ù˘ ÔÈ-
fiÙËÙ·˜ ˙ˆ‹˜ ÙˆÓ ·ÛıÂÓÒÓ Ì ¯ÚfiÓÈ· Ë·Ù›Ùȉ· C
ÚÈÓ Ï¿‚Ô˘Ó ıÂÚ·›· Ì ·˘Ùfi ˘ÁÈÒÓ Ì·ÚÙ‡ÚˆÓ
Î·È Ë Û˘Û¯¤ÙÈÛË Ì ‰ËÌÔÁÚ·ÊÈÎÔ‡˜, ÂÚÁ·ÛÙËÚÈ·-
ÎÔ‡˜ Î·È ¿ÏÏÔ˘˜ ·Ú¿ÁÔÓÙ˜.
∏ ‰È·‰Èηۛ· Ù˘ ÌÂÙ¿ÊÚ·Û˘ Ô˘ ·ÎÔÏÔ˘ı‹-
ıËΠÛÙË ÌÂϤÙË Ì·˜ ‹Ù·Ó ·˘Ù‹ Ô˘ ‰ÈÂıÓÒ˜ ·ÎÔ-
ÏÔ˘ıÂ›Ù·È ÁÈ· ÙË ÌÂÙ¿ÊÚ·ÛË ÂÚˆÙËÌ·ÙÔÏÔÁ›ˆÓ
ÔÈfiÙËÙ·˜ ˙ˆ‹˜. O ¤ÏÂÁ¯Ô˜ Ù˘ ·ÍÈÔÈÛÙ›·˜ ÙÔ˘ ÌÂ-
Ù·ÊÚ·Ṳ̂ÓÔ˘ ÎÂÈ̤ÓÔ˘ Ú·ÁÌ·ÙÔÔÈ‹ıËΠ̠ۇ-
ÁÎÚÈÛË ÙˆÓ ÙÂÛÛ¿ÚˆÓ ‰ÂÈÎÙÒÓ (HD, PWB, HLIM,
HHD) ÙÔ˘ HQLQ Ì ÙȘ 8 ÁÓˆÛÙ¤˜ Îϛ̷Θ ÙÔ˘
ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘ SF-36. Δ· ·ÔÙÂϤÛÌ·Ù· ·˘Ù‹˜
Ù˘ Û‡ÁÎÚÈÛ˘ η٤‰ÂÈÍ·Ó ÙË ÛÙ·ÙÈÛÙÈο ˘„ËÏ‹
·ÍÈÔÈÛÙ›· ÙˆÓ ÙÂÛÛ¿ÚˆÓ ‰ÂÈÎÙÒÓ Ô˘ ¯ÚËÛÈÌÔ-
ÔÈ‹ıËÎ·Ó Î·È Î·Ù¿ Û˘Ó¤ÂÈ· ÙË Û˘ÓÔÏÈ΋ ·ÍÈÔÈ-
ÛÙ›· Ù˘ ÂÏÏËÓÈ΋˜ ¤Î‰ÔÛ˘ ÙÔ˘ HQLQ.
Δ· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘ Ì·˜ ˆ˜ ÚÔ˜ ÙË
Û‡ÁÎÚÈÛË Ù˘ ÔÈfiÙËÙ·˜ ˙ˆ‹˜ ·ÛıÂÓÒÓ Î·È ˘ÁÈÒÓ
Â›Ó·È Û‡Ìʈӷ Ì ÙÔ Û‡ÓÔÏÔ Û¯Â‰fiÓ Ù˘ ‚È‚ÏÈÔ-
ÁÚ·Ê›·˜16-31. ∂ȉÈÎfiÙÂÚ·, ÔÈ ·ÛıÂÓ›˜ Ù˘ ÌÂϤÙ˘
Ì·˜ ÂÌÊ¿ÓÈÛ·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜
ÛÙȘ Îϛ̷Θ ÙÔ˘ ۈ̷ÙÈÎÔ‡ ÚfiÏÔ˘ (p=0,025), Ù˘
ÁÂÓÈ΋˜ ˘Á›·˜ (p=0,004), Ù˘ ÎÔÈÓˆÓÈ΋˜ ÏÂÈÙÔ˘Ú-
ÁÈÎfiÙËÙ·˜ (p=0,027), Î·È ÙÔ˘ Û˘Ó·ÈÛıËÌ·ÙÈÎÔ‡ Úfi-
ÏÔ˘ (p=0,001). ™Â ÌÈ· ÚfiÛÊ·ÙË ·Ó·ÛÎfiËÛË 15
ÂÚÁ·ÛÈÒÓ, Ë ÔÔ›· ›¯Â ˆ˜ ÛÎÔfi ÙË Û˘ÁÎÂÓÙÚˆÙÈ-
΋ ·ÚÔ˘Û›·ÛË ÙˆÓ Û¯ÂÙÈÎÒÓ ‰ËÌÔÛȇۈÓ, ·Ó·-
ʤÚÂÙ·È fiÙÈ ÔÈ ÌÂÁ·Ï‡ÙÂÚ˜ ÌÂÈÒÛÂȘ ÛÙÔ˘˜ ·ÛıÂ-
Ó›˜ Û ۯ¤ÛË Ì ÙÔ˘˜ ˘ÁÈ›˜ ·Ú·ÙËÚÔ‡ÓÙ·È ÛÙÔ˘˜
ÙÔÌ›˜ ÙÔ˘ ۈ̷ÙÈÎÔ‡ ÚfiÏÔ˘, Ù˘ ÁÂÓÈ΋˜ ˘Á›·˜
69
Î·È ÙÔ˘ Û˘Ó·ÈÛıËÌ·ÙÈÎÔ‡ ÚfiÏÔ˘, fiˆ˜ ·ÎÚÈ‚Ò˜
Î·È ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì·˜17.
∏ Â›‰Ú·ÛË Ù˘ HCV Ïԛ̈͢ ÛÙËÓ ÔÈfiÙËÙ·
˙ˆ‹˜ ¤¯ÂÈ ·Ô‰Âȯı› fiÙÈ Â›Ó·È ·ÓÂÍ¿ÚÙËÙË ·fi ÙË
‚·Ú‡ÙËÙ· Ù˘ Ë·ÙÈ΋˜ ‚Ï¿‚˘32. ŒÙÛÈ Û¯ÂÙÈΤ˜
ÌÂϤÙ˜ ‰ÂÓ ¤‰ÂÈÍ·Ó Û˘Û¯¤ÙÈÛË ÙÔ˘ ÂÈ¤‰Ô˘ ÔÈfi-
ÙËÙ·˜ ˙ˆ‹˜ ÙˆÓ ·ÛıÂÓÒÓ Ì ÙÔ Â›Â‰Ô Ù˘ ALT
Î·È ÙÔ˘ HCV-RNA, ÙÔ ÁÔÓfiÙ˘Ô ÙÔ˘ ÈÔ‡ ‹ ÙËÓ
ÈÛÙÔÏÔÁÈ΋ ÂÈÎfiÓ·, ÂÎÙfi˜ ·fi ÙÔ˘˜ ·ÛıÂÓ›˜ ÌÂ
ÂÁηÙÂÛÙË̤ÓË Î›ÚÚˆÛË, ÔÈ ÔÔ›ÔÈ ÂÌÊ·Ó›˙Ô˘Ó Û·-
ÊÒ˜ ÌÂÁ·Ï‡ÙÂÚË ÂÏ¿ÙÙˆÛË Ù˘ ÔÈfiÙËÙ·˜ ˙ˆ‹˜
ÙÔ˘˜1,16,24,33. 줂·È·, ÛÙË ÏÂÙÔÌÂÚ¤ÛÙÂÚË ›Ûˆ˜ ÌÂ-
ϤÙË ·˘ÙÔ‡ ÙÔ˘ ›‰Ô˘˜ ηٷÁÚ¿ÊÔÓÙ·È Ù¤ÙÔȘ Û˘-
Û¯ÂÙ›ÛÂȘ Ì ·ÚÎÂÙÔ‡˜ ·Ú¿ÁÔÓÙ˜ (΢ڛˆ˜ Ì ÙÔ
ʇÏÔ Î·È ÙÔ μªπ, ·ÏÏ¿ ·ÛıÂÓ¤ÛÙÂÚ· Î·È Ì ÙËÓ
ALT, ÙÔ HCV-RNA Î·È ÙËÓ ÈÛÙÔÏÔÁÈ΋ ÂÈÎfiÓ·), ÔÈ
Ôԛ˜ fï˜ Á›ÓÔÓÙ·È ÏÈÁfiÙÂÚÔ ÛËÌ·ÓÙÈΤ˜, fiÙ·Ó
Û˘ÌÂÚÈÏËÊı› ÛÙË ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ÙÔ ÈÛÙÔÚÈ-
Îfi ηٿıÏȄ˘ ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ÂӉ¯Ô̤ӈ˜
ÚÔ¸‹Ú¯Â23.
∞ÓÙ›ıÂÙ· Ì ÙȘ ·Ú·¿Óˆ ÌÂϤÙ˜ ÛÙËÓ ·-
ÚÔ‡Û· ÌÂϤÙË ·Ú·ÙËÚ‹ıËΠfiÙÈ Ô ‚·ıÌfi˜ Ù˘
Ë·ÙÈ΋˜ ›ÓˆÛ˘ ÂËÚ¿˙ÂÈ ÙÔ ¿Á¯Ô˜ ÙˆÓ ·ÛıÂÓÒÓ
ÁÈ· ÙËÓ ˘Á›· ÙÔ˘˜, Ô˘ Â›Ó·È ÌÈ· Îϛ̷η ÙÔ˘ ÂȉÈ-
ÎÔ‡ ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘. ΔÔ Â‡ÚËÌ· ·˘Ùfi ÂÈ‚¿ÏÏÂÈ
ÙËÓ ÂÚ·ÈÙ¤Úˆ ·Ó¿Ï˘Û‹ ÙÔ˘ Û ÌÂϤÙ˜, Ô˘ ÂÓ‰Â-
¯Ô̤ӈ˜ ı· Û˘ÌÂÚÈÏ¿‚Ô˘Ó Î·È ÎÈÚÚˆÙÈÎÔ‡˜
·ÛıÂÓ›˜, ÌÔÏÔÓfiÙÈ Ë Î·Ù·ÓÔÌ‹ ÙÔ˘ ÛÙ·‰›Ô˘ ›Óˆ-
Û˘ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ (38% ÌÂ
ÛÙ¿‰ÈÔ ≥2, ·ÏÏ¿ ÌfiÓÔ 3 ·ÛıÂÓ›˜ Ì ÛÙ¿‰ÈÔ 3) Â-
ÚÈÔÚ›˙ÂÈ ÙË ÛËÌ·Û›· ÙÔ˘. OÈ ‰‡Ô ·Ú¿ÁÔÓÙ˜, Ô˘
ηı·Ú¿ ÂËÚ¿˙Ô˘Ó ÙËÓ ÔÈfiÙËÙ· ˙ˆ‹˜ ÙˆÓ ·ÛıÂ-
ÓÒÓ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘, Â›Ó·È ÙÔ ÈÛÙÔÚÈÎfi ¯Ú‹-
Û˘ Ó·ÚΈÙÈÎÒÓ Ô˘ÛÈÒÓ Î·È Ë ËÏÈΛ·. ¶·ÚÔÌÔ›ˆ˜
·Ó·Ê¤ÚÂÙ·È Û ¿ÏϘ ÌÂϤÙ˜ fiÙÈ ÔÈ ·ÛıÂÓ›˜ ÌÂ
ÈÛÙÔÚÈÎfi ¯Ú‹Û˘ Ó·ÚΈÙÈÎÒÓ Ô˘ÛÈÒÓ ¤¯Ô˘Ó ¯·ÌË-
Ïfi Â›Â‰Ô ÔÈfiÙËÙ·˜ ˙ˆ‹˜18. ΔÔ Â‡ÚËÌ· ·˘Ùfi ¿-
ÓÙˆ˜ ‰ÂÓ Â›Ó·È ÛÙ·ıÂÚfi Û fiϘ ÙȘ ÌÂϤÙ˜, ÂÓ‰Â-
¯Ô̤ӈ˜ ÏfiÁˆ Ù˘ ‰È·ÎÔ‹˜ Ù˘ ¯Ú‹Û˘ ÂΠ̤ÚÔ˘˜
ÙˆÓ ·ÛıÂÓÒÓ ·ÚÎÂÙfi ‰È¿ÛÙËÌ· ÚÈÓ ·fi ÙË ‰ÈÂÍ·-
ÁˆÁ‹ ÙˆÓ ÌÂÏÂÙÒÓ19. ∞ÓÙ›ıÂÙ·, ÛÙËÓ ·ÚÔ‡Û· ÌÂ-
ϤÙË ÔÈ ÚÒËÓ ¯Ú‹ÛÙ˜ Ó·ÚΈÙÈÎÒÓ Ô˘ÛÈÒÓ ÂÌÊ¿-
ÓÈÛ·Ó ¯·ÌËÏfiÙÂÚÔ Â›Â‰Ô ÁÂÓÈ΋˜ ˘Á›·˜ Î·È ÛË-
Ì·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÛÙËÓ ·ÓÙ›ÏË„Ë ÙÔ˘ ۈ̷ÙÈÎÔ‡
fiÓÔ˘. Δ· Â˘Ú‹Ì·Ù· ·˘Ù¿ ·ÔÎÙÔ‡Ó È‰È·›ÙÂÚË
·Í›· ÏfiÁˆ ÙÔ˘ ˘„ËÏÔ‡ ÔÛÔÛÙÔ‡ ¯ÚËÛÙÒÓ Ó·ÚΈ-
ÙÈÎÒÓ Ô˘ÛÈÒÓ (64%), Ô˘ Û˘ÌÂÚÈÏ‹ÊıËÎ·Ó ÛÙË
ÌÂϤÙË, Î·È ÙÔ˘ ÌÈÎÚÔ‡ ¯ÚfiÓÔ˘ ‰È·ÎÔ‹˜ Ù˘ ¯Ú‹-
Û˘ Ô˘ÛÈÒÓ ÙˆÓ ·ÛıÂÓÒÓ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘
(ÛÙÔ˘˜ ÂÚÈÛÛfiÙÂÚÔ˘˜ ÂÚ›Ô˘ 10 Ì‹Ó˜). ∂Ӊȷ-
ʤÚÔÓÙ· Â›Ó·È Î·È Ù· Â˘Ú‹Ì·Ù· Û¯ÂÙÈο Ì ÙËÓ Â›-
70 E. ™π¡∞∫O™ ∫∞π ™À¡.

‰Ú·ÛË Ù˘ ËÏÈΛ·˜, ηıÒ˜ ‰ÂÓ ˘¿Ú¯Ô˘Ó ·Ó¿ÏÔÁ˜ ¶∞ƒ∞ƒΔ∏ª∞

·Ó·ÊÔÚ¤˜ ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›·. ∏ ËÏÈΛ· ÙˆÓ
·ÛıÂÓÒÓ ı· Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÂÙ·È ˘fi„Ë ÚÈÓ ÙËÓ ∂ÚˆÙËÌ·ÙÔÏfiÁÈÔ HQLQ Ô˘ ¯ÚËÛÈÌÔÔÈ‹-
¤Ó·ÚÍË Ù˘ ·ÓÙÈÈ΋˜ ·ÁˆÁ‹˜ fi¯È ÌfiÓÔ ÏfiÁˆ Èı·- ıËΠÛÙË ÌÂϤÙË
ÓÒÓ Û˘ÓÔ‰ÒÓ ÓfiÛˆÓ, ·ÏÏ¿ Î·È ÁÈ·Ù› ¤¯ÂÈ ·ÓÂÍ¿Ú-
12. ™Â Û‡ÁÎÚÈÛË Ì ÙÔ Û˘ÓËıÈṲ̂ÓÔ Â›Â‰Ô ÎÔÈÓˆÓÈ΋˜
ÙËÙË Â›‰Ú·ÛË Û ÙÔÌ›˜ Ù˘ ۈ̷ÙÈ΋˜ Î·È „˘¯È-
Û·˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜, ¤¯ÂÈ Ë ÎÔÈÓˆÓÈ΋ Û·˜ ‰Ú·ÛÙËÚÈfi-
΋˜ ˘Á›·˜ ÙˆÓ ·ÛıÂÓÒÓ.
ÙËÙ· ηٿ ÙȘ ÙÂÏÂ˘Ù·›Â˜ 4 ‚‰ÔÌ¿‰Â˜ ÌÂȈı›, ¤ÌÂÈÓÂ
Ÿˆ˜ ‹‰Ë ·Ó·Ê¤ÚıËÎÂ, Ë ¯ÚËÛÈÌÔÔ›ËÛË Â-
Ë ›‰È·, ‹ ·˘Í‹ıËÎÂ, ÂÍ·ÈÙ›·˜ οÔÈ·˜ ÌÂÙ·‚ÔÏ‹˜ ÛÙË
Ófi˜ ÂȉÈÎÔ‡ ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘ ÁÈ· ÈÔÁÂÓ›˜ Ë·Ù›ÙÈ-
Ê˘ÛÈ΋ ‹ Û˘Ó·ÈÛıËÌ·ÙÈ΋ Û·˜ ηٿÛÙ·ÛË;
‰Â˜ ·ÔÙ¤ÏÂÛ ÌÈ· ÚˆÙÔÙ˘›· Ù˘ ·ÚÔ‡Û·˜ ÌÂϤ-
Ù˘. ∏ ¯ÚËÛÈÌÔÔ›ËÛË ÂÓfi˜ Ù¤ÙÔÈÔ˘ ÂÚˆÙËÌ·ÙÔÏÔÁ›- (΢ÎÏÒÛÙ ¤Ó·)
Ô˘ ‰ÂÓ ·Ó·ÌÂÓfiÙ·Ó Ó· ·ÏÏ¿ÍÂÈ ÙËÓ Ô˘Û›· ÙˆÓ ·Ô- ¶Ôχ ÏÈÁfiÙÂÚÔ ÎÔÈÓˆÓÈο 1
ÙÂÏÂÛÌ¿ÙˆÓ, ·ÏÏ¿ Ó· ·ÓȯÓ‡ÛÂÈ Ù˘¯¤˜ Ù˘ ÔÈfiÙË- ÂÓÂÚÁfi˜ ·fi ÚÈÓ
Ù·˜ ˙ˆ‹˜ ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ‰ÂÓ ·ÓȯÓ‡ÔÓÙ·È Ì ٷ ∫¿ˆ˜ ÏÈÁfiÙÂÚÔ ÎÔÈÓˆÓÈο 2
ÂÓÂÚÁfi˜ ·fi ÚÈÓ
ÁÂÓÈο ÂÚˆÙËÌ·ÙÔÏfiÁÈ·, fiˆ˜ ‰È·ÈÛÙÒıËÎÂ Î·È ÛÂ
¶ÂÚ›Ô˘ ÙÔ ›‰ÈÔ ÎÔÈÓˆÓÈο 3
¿ÏϘ ÌÂϤÙ˜ 2,16,23. ∞Í›˙ÂÈ Ó· ÙÔÓÈÛı› Â›Û˘ fiÙÈ ÔÈ
ÂÓÂÚÁfi˜ Ì ÚÈÓ
·ÛıÂÓ›˜, Ô˘ Û˘ÌÂÚÈÏ‹ÊıËÎ·Ó ‰ÂÓ ÂÈϤ¯ıËηÓ
∫¿ˆ˜ ÂÚÈÛÛfiÙÂÚÔ ÎÔÈÓˆÓÈο 4
‚¿ÛÂÈ ÂȉÈÎÒÓ ÎÚÈÙËÚ›ˆÓ, ÂÎÙfi˜ ·fi Ù· ÎÚÈÙ‹ÚÈ· ÂÈ-
ÂÓÂÚÁfi˜ ·fi ÚÈÓ
Ûfi‰Ô˘ Î·È ·ÔÎÏÂÈÛÌÔ‡ ·fi ÙË ÌÂϤÙË, Ô˘ ÂÚÈ-
¶Ôχ ÂÚÈÛÛfiÙÂÚÔ ÎÔÈÓˆÓÈο 5
ÁÚ¿ÊËÎ·Ó ÓˆÚ›ÙÂÚ·. ŒÙÛÈ Ë ÌÂϤÙË ·ÓÙ·Ó·ÎÏ¿ ÙËÓ
ÂÓÂÚÁfi˜ ·fi ÚÈÓ
ηıËÌÂÚÈÓ‹ ÎÏÈÓÈ΋ Ú·ÎÙÈ΋, Ì ·ÔÙ¤ÏÂÛÌ· Ù·
Â˘Ú‹Ì·Ù¿ Ù˘ Ó· ·ÔÎÙÔ‡Ó ‰˘Ó·ÙfiÙËÙ· ÂÊ·ÚÌÔÁ‹˜ 13. ™Â Û‡ÁÎÚÈÛË ÌÂ Û˘ÓÔÌËÏ›ÎÔ˘˜ Û·˜, ‹Ù·Ó ÔÈ ÎÔÈÓˆÓÈΤ˜
Û ¿ÏϘ ÔÌ¿‰Â˜ ·ÛıÂÓÒÓ. Û·˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜ ÂÚÈÔÚÈṲ̂Ó˜ ÂÍ·ÈÙ›·˜ Ù˘ Ê˘ÛÈ-
™˘ÌÂÚ·ÛÌ·ÙÈο, ı· ÌÔÚÔ‡Û ӷ ˘ÔÛÙËÚÈ- ΋˜ Û·˜ ηٿÛÙ·Û˘ ‹ ÙˆÓ Û˘Ó·ÈÛıËÌ·ÙÈÎÒÓ Û·˜
¯ı› fiÙÈ Ë ¯ÚËÛÈÌÔÔ›ËÛË Ù˘ ÛÙ·ıÌÈṲ̂Ó˘ ÌÂÙ¿- ÚÔ‚ÏËÌ¿ÙˆÓ Î·Ù¿ ÙȘ ÙÂÏÂ˘Ù·›Â˜ 4 ‚‰ÔÌ¿‰Â˜;
ÊÚ·Û˘ ÛÙ· ÂÏÏËÓÈο ÙÔ˘ ÂȉÈÎÔ‡ ÂÚˆÙËÌ·ÙÔÏÔÁ›-
(΢ÎÏÒÛÙ ¤Ó·)
Ô˘ HQLQ ÌÔÚ› Ó· Û˘ÓÂÈÛʤÚÂÈ ÛËÌ·ÓÙÈο ÛÙË
¶Ôχ ÂÚÈÛÛfiÙÂÚÔ ÂÚÈÔÚÈ- 1
ÌÂϤÙË Ù˘ ÔÈfiÙËÙ·˜ ˙ˆ‹˜ ÙˆÓ ·ÛıÂÓÒÓ Ì ¯ÚfiÓÈ·
Ṳ̂Ó˜ ·fi ¿ÏÏÔ˘˜
ÈÔÁÂÓ‹ Ë·Ù›Ùȉ· ÛÙË ¯ÒÚ· Ì·˜, ÒÛÙ ӷ ‚ÂÏÙȈı›
∫¿ˆ˜ ÂÚÈÛÛfiÙÂÚÔ ÂÚÈÔÚÈ- 2
Ë ÔÏÈÛÙÈ΋ ÚÔÛ¤ÁÁÈÛË ·˘ÙÒÓ ÙˆÓ ·ÛıÂÓÒÓ. ™‡Ì-
Ṳ̂Ó˜ ·fi ¿ÏÏÔ˘˜
ʈӷ Ì ٷ Â˘Ú‹Ì·Ù· Ù˘ ÌÂϤÙ˘ Ì·˜ ÔÈ ıÂÚ¿Ô-
¶ÂÚ›Ô˘ ›‰È˜ ·fi ¿ÏÏÔ˘˜ 3
ÓÙ˜ È·ÙÚÔ› ı· Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÔ˘Ó ÂȉÈ΋ ̤ÚÈ- ∫¿ˆ˜ ÏÈÁfiÙÂÚÔ ÂÚÈÔÚÈṲ̂Ó˜ 4
ÌÓ· ÁÈ· ÙÔ˘˜ ¯Ú‹ÛÙ˜ Ó·ÚΈÙÈÎÒÓ Ô˘ÛÈÒÓ Î·È ÙÔ˘˜ ·fi ¿ÏÏÔ˘˜
ËÏÈÎȈ̤ÓÔ˘˜ ·ÛıÂÓ›˜, ηıÒ˜ ‰È·ÈÛÙÒıËΠfiÙÈ Ë ¶Ôχ ÏÈÁfiÙÂÚÔ ÂÚÈÔÚÈṲ̂Ó˜ 5
ÔÈfiÙËÙ· ˙ˆ‹˜ ·˘ÙÒÓ ÙˆÓ ÔÌ¿‰ˆÓ ·ÛıÂÓÒÓ ÂËÚÂ- ·fi ¿ÏÏÔ˘˜
¿˙ÂÙ·È ·ÓÂÍ¿ÚÙËÙ· ·fi ÙË ¯ÚfiÓÈ· Ë·Ù›Ùȉ· C.

14. ¶fiÛ˜ ÊÔÚ¤˜ ηٿ ÙȘ ÙÂÏÂ˘Ù·›Â˜ 4 ‚‰ÔÌ¿‰Â˜ (΢ÎÏÒÛÙ ¤Ó·Ó ·ÚÈıÌfi Û οı ÛÂÈÚ¿)

™˘Ó¤¯ÂÈ· ΔȘ ÂÚÈÛÛfiÙÂÚ˜ ∞ÚÎÂÙ¤˜ ∫¿ÔȘ §›Á˜ ∫·ıfiÏÔ˘

ÊÔÚ¤˜ ÊÔÚ¤˜ ÊÔÚ¤˜ ÊÔÚ¤˜
∞. ¡ÈÒÛ·Ù ӷ ¯¿ÓÂÙ ÙÔ ı¿ÚÚÔ˜
Û·˜ ÏfiÁˆ ÙˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ Ù˘
˘Á›·˜ Û·˜; 1 2 3 4 5 6
μ. ¡ÈÒÛ·Ù ӷ Û·˜ ηٷ‚¿ÏÔ˘Ó
Ù· ÚÔ‚Ï‹Ì·Ù· Ù˘ ˘Á›·˜ Û·˜; 1 2 3 4 5 6
°. ◊Ù·Ó Ë ˘Á›· Û·˜ ÌÈ· ·ÓËÛ˘¯›·
ÛÙË ˙ˆ‹ Û·˜; 1 2 3 4 5 6
¢. ∞ÂÏÈÛًηÙ ·fi ÙËÓ ˘Á›· Û·˜; 1 2 3 4 5 6
 ∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 75, 1 71

15. ¶fiÛ˜ ÊÔÚ¤˜ ηٿ ÙȘ ÙÂÏÂ˘Ù·›Â˜ 4 ‚‰ÔÌ¿‰Â˜ (΢ÎÏÒÛÙ ¤Ó·Ó ·ÚÈıÌfi Û οı ÛÂÈÚ¿)

™˘Ó¤¯ÂÈ· ΔȘ ÂÚÈÛÛfiÙÂÚ˜ ∞ÚÎÂÙ¤˜ ∫¿ÔȘ §›Á˜ ∫·ıfiÏÔ˘

ÊÔÚ¤˜ ÊÔÚ¤˜ ÊÔÚ¤˜ ÊÔÚ¤˜
∞. °ÂÓÈο ·ÔÏ·‡Û·Ù ٷ Ú¿ÁÌ·Ù·
Ô˘ οӷÙÂ; 1 2 3 4 5 6
μ. ◊Ù·Ó Ë Î·ıËÌÂÚÈÓ‹ Û·˜ ˙ˆ‹
ÁÂÌ¿ÙË ·fi Ú¿ÁÌ·Ù· Ô˘
Û·˜ ÂӉȤÊÂÚ·Ó; 1 2 3 4 5 6
°. ¡ÈÒÛ·Ù ÎÂÊ¿ÙÔ˜, ͤÓÔÈ·ÛÙÔ˜; 1 2 3 4 5 6
¢. ◊Ù·Ó Ë ˙ˆ‹ ÌÈ· ˘¤ÚÔ¯Ë
ÂÌÂÈÚ›· ÁÈ· Û·˜; 1 2 3 4 5 6

™Ã∂Δπ∫∞ ª∂ Δ∏¡ ∏¶∞ΔπΔπ¢∞

16. ¶fiÛ˜ ÊÔÚ¤˜ ηٿ ÙȘ ÙÂÏÂ˘Ù·›Â˜ 4 ‚‰ÔÌ¿‰Â˜... Ë Ë·Ù›Ùȉ· ÂÚÈfiÚÈÛÂ;

(΢ÎÏÒÛÙ ¤Ó·Ó ·ÚÈıÌfi Û οı ÛÂÈÚ¿)

™˘Ó¤¯ÂÈ· ΔȘ ÂÚÈÛÛfiÙÂÚ˜ ∞ÚÎÂÙ¤˜ ∫¿ÔȘ §›Á˜ ∫·ıfiÏÔ˘

ÊÔÚ¤˜ ÊÔÚ¤˜ ÊÔÚ¤˜ ÊÔÚ¤˜
∞. ΔȘ ηıËÌÂÚÈÓ¤˜ Û·˜ Ê˘ÛÈΤ˜
‰Ú·ÛÙËÚÈfiÙËÙ˜, fiˆ˜ ÙÔ ÂÚ¿ÙËÌ· ‹
ÙÔ ·Ó¤‚·ÛÌ· ÛοϷ˜, ÙÔ ÎÔ˘‚¿ÏËÌ· ÙˆÓ
„ÒÓÈˆÓ ‹ ÙË Û˘ÌÌÂÙÔ¯‹ Û·˜ Û ÛÔÚ; 1 2 3 4 5 6
μ. ΔËÓ Î·ıËÌÂÚÈÓ‹ Û·˜ ÂÚÁ·Û›· ¤Íˆ
·fi ÙÔ Û›ÙÈ Î·È ÙË ‰Ô˘ÏÂÈ¿ ÛÙÔ Û›ÙÈ; 1 2 3 4 5 6
°. ΔȘ Û˘ÓËıÈṲ̂Ó˜ ÎÔÈÓˆÓÈΤ˜ Û·˜
‰Ú·ÛÙËÚÈfiÙËÙ˜ Ì ÙËÓ ÔÈÎÔÁ¤ÓÂÈ·,
ÙÔ˘˜ Ê›ÏÔ˘˜, ÙÔ˘˜ Á›ÙÔÓ˜ ‹
¿ÏϘ ÔÌ¿‰Â˜; 1 2 3 4 5 6

17. ¶fiÛ˜ ÊÔÚ¤˜ ηٿ ÙȘ ÙÂÏÂ˘Ù·›Â˜ 4 ‚‰ÔÌ¿‰Â˜

(΢ÎÏÒÛÙ ¤Ó·Ó ·ÚÈıÌfi Û οı ÛÂÈÚ¿)

™˘Ó¤¯ÂÈ· ΔȘ ÂÚÈÛÛfiÙÂÚ˜ ∞ÚÎÂÙ¤˜ ∫¿ÔȘ §›Á˜ ∫·ıfiÏÔ˘

ÊÔÚ¤˜ ÊÔÚ¤˜ ÊÔÚ¤˜ ÊÔÚ¤˜
∞. ÿ۷Ù ÙÔ ÎÔ˘Ú¿ÁÈÔ Û·˜ ÂÍ·ÈÙ›·˜
Ù˘ Ë·Ù›Ùȉ·˜; 1 2 3 4 5 6
μ. ¡ÈÒÛ·Ù ӷ Û·˜ ηٷ‚¿ÏÂÈ
Ë Ë·Ù›Ùȉ·; 1 2 3 4 5 6
°. ◊Ù·Ó Ë È‰¤· fiÙÈ ¿Û¯ÂÙÂ
·fi Ë·Ù›Ùȉ· ÌÈ· ·ÓËÛ˘¯›·
ÛÙË ˙ˆ‹ Û·˜ 1 2 3 4 5 6
¢. ¡ÈÒÛ·Ù ·ÂÏÈṲ̂ÓÔ˜
ÂÍ·ÈÙ›·˜ Ù˘ Ë·Ù›Ùȉ·˜; 1 2 3 4 5 6
72 E. ™π¡∞∫O™ ∫∞π ™À¡.
ABSTRACT
Sinakos E, Gigi E, Tsapas V, Lalla T, Bellou A, Sou-
kja A, Raptopoulou-Gigi M. Translation, validati-
on and application of the disease specific for viral
hepatitis quality of life questionnaire HQLQ. Hell
Iatr 2009, 75: 65-73.
Hepatitis C viral (HCV) infection can cause a
series of neuropsychiatric symptoms, prior to liver
cirrhosis. The aim of this study was to compare
health-related quality of life (HRQoL) in patients
with chronic HCV and in healthy controls, using a
disease-specific questionnaire, and to identify
possible interactions of demographic characteristics
and laboratory findings. Ninety-nine patients with
chronic HCV and 91 healthy controls were enrolled
in this study. All patients completed the HQLQ
questionnaire, which was translated into Greek. The
reliability of the translated HQLQ questionnaire was
examined, by comparing the four translated HQLQ
scales with the well-known 8 scales of the SF-36
questionnaire, which is a part of the HQLQ. Pati-
ents’ quality of life was found to be inferior to heal-
thy controls in all the SF-36 scales. Furthermore, we
found a significant negative correlation between a
history of drug abuse and patients’ scores in general
health (GH), and a positive correlation between age
and mental health (MH). Multiple linear regression
analysis showed that a history of drug abuse, age
and hepatic fibrosis have a negative impact on pa-
tient HRQoL. In conclusion, the translated HQLQ
questionnaire shows adequate reliability for the stu-
dy of quality of life in Greek patients with chronic
hepatitis C. A history of drug abuse and age, inde-
pendently affect quality of life in these patients.
μπμ§πO°ƒ∞ºπ∞
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∞ÏÏËÏÔÁÚ·Ê›·:
∂ÌÌ. ∫. ™ÈÓ¿ÎÔ˜
¶ÂÚ‰›Î· 11∞, ¶˘Ï·›·
555 35 £ÂÛÛ·ÏÔÓ›ÎË
Corresponding Author:
Emm. K. Sinakos
Perdika 11A, Pilea
555 35 Thessaloniki
Greece
∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 2009, 75, 1: 74- 83
∏ Â›‰Ú·ÛË Ù˘ Ì·ÎÚÔ¯ÚfiÓÈ·˜ ¿ÛÎËÛ˘ ÛÙË ÏÂÈÙÔ˘ÚÁÈ΋
ÈηÓfiÙËÙ· Î·È ÙËÓ ÔÈfiÙËÙ· ˙ˆ‹˜ ·ÙfïÓ
Ì ۯÈ˙ÔÊÚ¤ÓÂÈ·
¢. ª·ÌÂÏÂÙ˙‹1, μ. £ÂÔ¯¿ÚË1, ∂. ∫Ô˘˚‰‹1, ¢. ∫·Ó‰‡Ï˘2, Ã. ™›η1, ∞.
∫·ÏÙÛ¿ÙÔ˘1, °. ∫·Ú›Ó˘2, ∞. ¢ÂÏËÁÈ¿ÓÓ˘1
1 ∂ÚÁ·ÛÙ‹ÚÈÔ ∞ıÏËÙÈ·ÙÚÈ΋˜, ΔÌ‹Ì· ∂ÈÛÙ‹Ì˘ º˘ÛÈ΋˜ ∞ÁˆÁ‹˜ & ∞ıÏËÙÈÛÌÔ‡, A¶£
2 °′ æ˘¯È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ∞¶£, ¡ÔÛÔÎÔÌÂ›Ô ∞Ã∂¶∞, £ÂÛÛ·ÏÔÓ›ÎË
¶ÂÚ›ÏË„Ë. ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ë ·ÍÈÔÏfiÁËÛË
Ù˘ Â›‰Ú·Û˘ Ù˘ Ì·ÎÚÔ¯ÚfiÓÈ·˜ Á‡ÌÓ·Û˘ ÛÙË ÏÂÈ-
ÙÔ˘ÚÁÈ΋ ÈηÓfiÙËÙ· Î·È ÙËÓ ÔÈfiÙËÙ· ˙ˆ‹˜ ÙˆÓ
·ÛıÂÓÒÓ Ì ۯÈ˙ÔÊÚ¤ÓÂÈ·. ΔÚÈ¿ÓÙ· ·ÛıÂÓ›˜ ËÏÈΛ·˜
59,6±14,9 ÂÙÒÓ, ‰È·ÈÚ¤ıËÎ·Ó Ù˘¯·›· Û ‰‡Ô ÈÛ¿ÚÈı-
̘ ÔÌ¿‰Â˜, ÛÙËÓ ÔÌ¿‰· ∞, Ë ÔÔ›· Û˘ÌÌÂÙ›¯Â ÛÂ
¤Ó· 18-ÌËÓÔ ÚfiÁÚ·ÌÌ· Á‡ÌÓ·Û˘, Î·È ÛÙËÓ ÔÌ¿‰·
μ (ÂϤÁ¯Ô˘). ŸÏÔÈ ÔÈ ·ÛıÂÓ›˜ ˘Ô‚Ï‹ıËÎ·Ó Û ¤ÏÂÁ-
¯Ô Ù˘ ÏÂÈÙÔ˘ÚÁÈ΋˜ ÈηÓfiÙËÙ·˜ Ì ÙËÓ ÂÍ¿ÏÂÙË
‰ÔÎÈÌ·Û›· ‚·‰›ÛÌ·ÙÔ˜ (6MWT) Î·È Û˘ÌÏ‹ÚˆÛ·Ó
ÙÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ÂÎÙ›ÌËÛ˘ Ù˘ ÔÈfiÙËÙ·˜ ˙ˆ‹˜
ÁÈ· ÙËÓ Â˘¯·Ú›ÛÙËÛË Î·È ÙËÓ ÈηÓÔÔ›ËÛË (Q-LES-
Q), ÛÙËÓ ¤Ó·ÚÍË, ÛÙÔ Ì¤ÛÔ Î·È ÛÙË Ï‹ÍË Ù˘ 18-ÌË-
Ó˘ ÌÂϤÙ˘. ∫·Ù¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ÌÂϤÙ˘ ‰ÂÓ
˘‹ÚÍ·Ó ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿-
‰ˆÓ ÛÙ· ‰ËÌÔÁÚ·ÊÈο Î·È ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο.
™ÙÔ Ù¤ÏÔ˜ Ù˘ ÌÂϤÙ˘ ÌÂÈÒıËΠÙÔ ÛˆÌ·ÙÈÎfi ‚¿ÚÔ˜
ÙˆÓ ·ÛıÂÓÒÓ Ù˘ ÔÌ¿‰·˜ ∞ ηٿ 4,1% (p<0,05).
∞Ó·ÊÔÚÈο Ì ÙË ÏÂÈÙÔ˘ÚÁÈ΋ ÈηÓfiÙËÙ·, ÌÂÙ¿ ·fi
∂π™∞°ø°∏
∏ Û¯È˙ÔÊÚ¤ÓÂÈ· ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ¤ÓÙÔÓË ·Ï-
ÏÔ›ˆÛË Ù˘ Â͈ÙÂÚÈ΋˜ Î·È Ù˘ ÂÛˆÙÂÚÈ΋˜ Ú·Á-
Ì·ÙÈÎfiÙËÙ·˜, Ë ÔÔ›· ÂΉËÏÒÓÂÙ·È Ì ‰È·Ù·Ú·¯¤˜
ÛÙËÓ ÔÌÈÏ›·, ÛÙË ÛΤ„Ë, ÛÙËÓ ·ÓÙ›ÏË„Ë Î·È ÛÙËÓ
„˘¯ÔÎÈÓËÙÈÎfiÙËÙ·1. OÈ ·ÛıÂÓ›˜ Ì ۯÈ˙ÔÊÚ¤ÓÂÈ·
ÂÌÊ·Ó›˙Ô˘Ó ·˘ÍË̤ÓË ıÓËÛÈÌfiÙËÙ·2,3, Ë ÔÔ›·
·Ô‰›‰ÂÙ·È ÛÂ Û˘ÓÔ‰¿ ÓÔÛ‹Ì·Ù· fiˆ˜ Ë ·¯˘Û·Ú-
18 Ì‹Ó˜ Á‡ÌÓ·Û˘ ÛÙËÓ ÔÌ¿‰· ∞, ·Ú·ÙËÚ‹ıËÎÂ
ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË Ù˘ ·fiÛÙ·Û˘ Ô˘ ‰È·Ó‡ıËÎÂ
ηٿ ÙËÓ ÂÍ¿ÏÂÙË ‰ÔÎÈÌ·Û›· ‚·‰›ÛÌ·ÙÔ˜ ηٿ
44% (p<0,05). ŸÛÔÓ ·ÊÔÚ¿ ÛÙÔ˘˜ ÂÈ̤ÚÔ˘˜ ÙÔ-
Ì›˜ Ù˘ ÔÈfiÙËÙ·˜ ˙ˆ‹˜, ÔÈ ·ÛıÂÓ›˜ Ù˘ ÔÌ¿‰·˜ ∞
·ÚÔ˘Û›·Û·Ó ‚ÂÏÙ›ˆÛË Î·Ù¿ 20% (p< 0,05) ÛÙÔÓ
ÙÔ̤· Ù˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜, ηٿ 19% (p<0,05) ÛÙ·
Û˘Ó·ÈÛı‹Ì·Ù·, ηٿ 20% (p<0,05) ÛÙËÓ ÂÚÁ·Û›·,
ηٿ 51% (p<0,05) ÛÙËÓ ·Ó·„˘¯‹, ηٿ 23%
(p<0,05) ÛÙȘ ÎÔÈÓˆÓÈΤ˜ Û¯¤ÛÂȘ Î·È Î·Ù¿ 15%
(p<0,05) ÛÙȘ ÁÂÓÈΤ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜, ·fi ÙËÓ ·Ú-
¯È΋ ÛÙËÓ ÙÂÏÈ΋ ̤ÙÚËÛË. ∞fi Ù· ·ÔÙÂϤÛÌ·Ù·
Ù˘ ÌÂϤÙ˘ ‰È·ÈÛÙÒÓÂÙ·È fiÙÈ ÔÈ ·ÛıÂÓ›˜ Ì ۯÈ˙Ô-
ÊÚ¤ÓÂÈ· ÌÔÚÔ‡Ó Ó· Û˘ÌÌÂÙ¤¯Ô˘Ó Û ̷ÎÚÔ¯ÚfiÓÈ·
ÚÔÁÚ¿ÌÌ·Ù· Á‡ÌÓ·Û˘, Ù· ÔÔ›· Û˘Ì‚¿ÏÏÔ˘Ó
ÛÙËÓ ·‡ÍËÛË Ù˘ ÏÂÈÙÔ˘ÚÁÈ΋˜ ÈηÓfiÙËÙ·˜ Î·È ÛÙË
‚ÂÏÙ›ˆÛË Ù˘ ÔÈfiÙËÙ·˜ ˙ˆ‹˜ ÙÔ˘˜.
EÏÏËÓ I·ÙÚ 2009, 75: 74 - 83.
Λ·4, Ô Û·Î¯·Ú҉˘ ‰È·‚‹Ù˘5 Î·È ÔÈ ·Ó·Ó¢ÛÙÈ-
Τ˜ Î·È Î·Ú‰È·ÁÁÂȷΤ˜ ·ı‹ÛÂȘ6,7.
Δ· ¿ÙÔÌ· Ì ۯÈ˙ÔÊÚ¤ÓÂÈ· ˙Ô˘Ó Î·Ù¿ ̤ÛÔ
fiÚÔ ÂÓÓ¤· Ì ‰Ò‰Âη ¤ÙË ÏÈÁfiÙÂÚ· ·fi ÙÔÓ ˘fi-
ÏÔÈÔ ÏËı˘ÛÌfi, ÂÍ·ÈÙ›·˜ ·ÚÓËÙÈÎÒÓ ÂÚÈ‚·ÏÏÔ-
ÓÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ, fiˆ˜ Ë Î·Î‹ ‰È·ÙÚÔÊ‹, ÙÔ
˘ÂÚ‚ÔÏÈÎfi οÓÈÛÌ·, Ë ˘¤ÚÌÂÙÚË Î·Ù·Ó¿ÏˆÛË
·ÏÎÔfiÏ Î·È Ë ¤ÏÏÂÈ„Ë Ê˘ÛÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜8-
 ∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 75, 1
11.™ËÌ·ÓÙÈο ÚÔ‚Ï‹Ì·Ù· ÙˆÓ Û¯È˙ÔÊÚÂÓÒÓ ·Ô-
ÙÂÏÔ‡Ó Ë ÌÂȈ̤ÓË ÏÂÈÙÔ˘ÚÁÈ΋ ÈηÓfiÙËÙ· Î·È Ê˘-
ÛÈ΋ Â¿ÚÎÂÈ·, Ë ¤ÏÏÂÈ„Ë ÈÛÔÚÚÔ›·˜ Î·È ÚÔÛ·-
Ó·ÙÔÏÈÛÌÔ‡ ÛÙÔ ¯ÒÚÔ, ηıÒ˜ Î·È Ë ÌÂȈ̤ÓË Ó¢-
ÚÔÌ˘˚΋ Û˘Ó·ÚÌÔÁ‹, Û˘ÁÎÚÈÙÈο Ì ˘ÁÈ‹ ¿ÙÔÌ·
Î·È Ì ·ÛıÂÓ›˜ Ô˘ ¿Û¯Ô˘Ó ·fi ¿ÏÏ· „˘¯È·ÙÚÈ-
ο ÓÔÛ‹Ì·Ù·, ÌÂ Û˘Ó¤ÂÈ· ÙËÓ ·‰˘Ó·Ì›· ·˘ÙÔÂ-
͢ËÚ¤ÙËÛ˘ Î·È ÙËÓ ·ÓÈηÓfiÙËÙ· Ó· ·ÓÙ·ÂͤÏ-
ıÔ˘Ó ÛÙȘ ηıËÌÂÚÈÓ¤˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜12-14. ∏
ÔÈfiÙËÙ· ˙ˆ‹˜ ÙˆÓ ·ÙfiÌˆÓ Ì ¯ÚfiÓÈ· Û¯È˙ÔÊÚ¤-
ÓÂÈ· Â›Ó·È ÛËÌ·ÓÙÈο ÌÂȈ̤ÓË Û ۇÁÎÚÈÛË ÌÂ
ÙËÓ ÔÈfiÙËÙ· ˙ˆ‹˜ ÙÔ˘ ÁÂÓÈÎÔ‡ ÏËı˘ÛÌÔ‡ ηÈ
ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ¿Û¯Ô˘Ó ·fi ¯ÚfiÓȘ ·ı‹-
ÛÂȘ15-19. ∏ ·ÓÙÈÏ·Ì‚·ÓfiÌÂÓË ÔÈfiÙËÙ· ˙ˆ‹˜ ·ÊÔ-
Ú¿ ÙËÓ ˘ÔÎÂÈÌÂÓÈ΋ ·ÓÙ›ÏË„Ë Ù˘ Û˘ÓÔÏÈ΋˜ η-
Ù¿ÛÙ·Û˘ ÙÔ˘ ·ÙfiÌÔ˘ Î·È Ù˘ ¢ËÌÂÚ›·˜ ÙÔ˘20-22
Î·È ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ¯ÚfiÓÈ· Û¯È˙ÔÊÚ¤ÓÂÈ· Û˘Ó-
‰¤ÂÙ·È Ì ٷ ·ÚÓËÙÈο Û˘ÌÙÒÌ·Ù· Ù˘ ÓfiÛÔ˘23,
ÙȘ ·ÚÂÓ¤ÚÁÂȘ Ù˘ Ê·Ú̷΢ÙÈ΋˜ ·Áˆ-
Á‹˜16,18,24, ÙË Û˘ÓÔÏÈ΋ ‰È¿ÚÎÂÈ· Ù˘ ·Ûı¤ÓÂÈ·˜25,
ÙÔ ¯ÚfiÓÔ Ù˘ ‰È·ÌÔÓ‹˜ Û ȉڇ̷ٷ26, ÙËÓ ËÏÈΛ·
ÂÌÊ¿ÓÈÛ˘ Ù˘ ÓfiÛÔ˘ Î·È ÙÔ ÏÂÈÙÔ˘ÚÁÈÎfi Â›‰Ô
οı ·ÛıÂÓÔ‡˜16.
Δ· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, Ë „˘¯È·ÙÚÈ΋ ÂÚ›ı·Ï-
„Ë ÙˆÓ ·ÙfiÌˆÓ Ì ۯÈ˙ÔÊÚ¤ÓÂÈ· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ
¤ÓÙ·Í‹ ÙÔ˘˜ Û „˘¯È·ÙÚÈο ÚÔÁÚ¿ÌÌ·Ù· ·Ôη-
Ù¿ÛÙ·Û˘ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙË Ï‹„Ë ÂÍÂÏÈÁ̤ӈÓ
·ÓÙÈ„˘¯ˆÙÈÎÒÓ Ê·Ú̿ΈÓ, ÁÂÁÔÓfi˜ Ô˘ ‚ÂÏÙÈÒÓÂÈ
ÛËÌ·ÓÙÈο ÙËÓ ÔÈfiÙËÙ· ˙ˆ‹˜ ÙÔ˘˜. ∏ Û˘ÛÙËÌ·ÙÈ΋
Û˘ÌÌÂÙÔ¯‹ ÙˆÓ ·ÛıÂÓÒÓ Ì „˘¯È·ÙÚÈο ÓÔÛ‹Ì·Ù·
Û ÚÔÁÚ¿ÌÌ·Ù· ¿ÛÎËÛ˘ Û˘Ì‚¿ÏÏÂÈ ÛÙË ‚ÂÏÙ›ˆÛË
ÙfiÛÔ Ù˘ ۈ̷ÙÈ΋˜ fiÛÔ Î·È Ù˘ „˘¯È΋˜ ÙÔ˘˜ ˘Á›-
·˜27-30. ™˘ÁÎÂÎÚÈ̤ӷ, Ê·›ÓÂÙ·È fiÙÈ ÂÈʤÚÂÈ Ì›ˆ-
ÛË ÙÔ˘ ¿Á¯Ô˘˜, Ù˘ ηٿıÏȄ˘ Î·È Ù˘ ·ÚÓËÙÈ΋˜
‰È¿ıÂÛ˘, ηıÒ˜ Î·È ‚ÂÏÙ›ˆÛË Ù˘ ·˘ÙÔÂÎÙ›ÌËÛ‹˜
ÙÔ˘˜31,32. Δ· ıÂÙÈο ·˘Ù¿ ·ÔÙÂϤÛÌ·Ù· Ù˘ ¿ÛÎË-
Û˘ ·Ô‰›‰ÔÓÙ·È Î˘Ú›ˆ˜ ÛÙËÓ ¿ÌÂÛË ‰Ú¿ÛË Ù˘ ÛÙ·
Â›‰· ÙˆÓ Ó¢ÚÔÂÙȉ›ˆÓ, fiˆ˜ ÙˆÓ ÂÓ‰ÔÚÊÈ-
ÓÒÓ Î·È Ù˘ ÛÂÚÔÙÔÓ›Ó˘33. ∂ÈϤÔÓ, ¤¯ÂÈ ‚ÚÂı›
fiÙÈ Ë ÂÊ·ÚÌÔÁ‹ ÚÔÁÚ·ÌÌ¿ÙˆÓ, ·ÂÚfi‚È·˜ ΢ڛˆ˜
¿ÛÎËÛ˘, ‚ÂÏÙÈÒÓÂÈ ÙË Ê˘ÛÈ΋ ηٿÛÙ·ÛË34 ηÈ
ÂÈʤÚÂÈ Ì›ˆÛË ÙÔ˘ ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜ ÙˆÓ Û¯È˙Ô-
ÊÚÂÓÒÓ ·ÛıÂÓÒÓ35.
øÛÙfiÛÔ, ‰ÂÓ ¤¯ÂÈ ÂÍÂÙ·ÛÙ› ·Ó ÔÈ Û¯È˙ÔÊÚÂ-
Ó›˜ ÌÔÚÔ‡Ó Ó· Û˘ÌÌÂÙ¤¯Ô˘Ó Û ̷ÎÚÔ¯ÚfiÓÈ·
ÚÔÁÚ¿ÌÌ·Ù· ¿ÛÎËÛ˘ Î·È ÔÈ· Â›Ó·È Ë Â›‰Ú·Û‹
ÙÔ˘˜ ÛÙË ÏÂÈÙÔ˘ÚÁÈ΋ ÈηÓfiÙËÙ· Î·È ÙËÓ ÔÈfiÙËÙ·
˙ˆ‹˜ ÙÔ˘˜. ™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ Â›Ó·È Ó·
‰ÈÂÚ¢ÓËı› Ë ‰˘Ó·ÙfiÙËÙ· ÂÊ·ÚÌÔÁ‹˜ Ì·ÎÚÔ¯Úfi-
ÓÈÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ Á‡ÌÓ·Û˘ Û ˘ÔÏÂÈÌÌ·ÙÈÎÔ‡
75
Ù‡Ô˘ Û¯È˙ÔÊÚÂÓ›˜, ηıÒ˜ Î·È Ë Â›‰Ú·Û‹ ÙÔ˘ ÛÙË
ÏÂÈÙÔ˘ÚÁÈ΋ ÈηÓfiÙËÙ· Î·È ÛÙËÓ ·ÓÙÈÏ·Ì‚·ÓfiÌÂÓË
ÔÈfiÙËÙ· ˙ˆ‹˜ ÙˆÓ ·ÛıÂÓÒÓ ·˘ÙÒÓ.
À§π∫O ∫∞π ª∂£O¢Oπ
¢Â›ÁÌ·
™ÙË ÌÂϤÙË ‰¤¯ıËÎ·Ó Ó· Û˘ÌÌÂÙ¿Û¯Ô˘Ó 48 ·ÛıÂÓ›˜ ËÏÈΛ·˜
23 ˆ˜ 82 ÂÙÒÓ, Ô˘ ¤·Û¯·Ó ·fi ˘ÔÏÂÈÌÌ·ÙÈ΋ Û¯È˙ÔÊÚ¤-
ÓÂÈ· Î·È ‰È¤ÌÂÓ·Ó ÛÙÔ ÔÈÎÔÙÚÔÊÂ›Ô Ù˘ ∂æÀ∫∞ ÛÙÔ ¡. ƒ‡-
ÛÈÔ £ÂÛÛ·ÏÔӛ΢. ∫·Ù¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ÌÂϤÙ˘, fiÏÔÈ ˘Ô-
‚Ï‹ıËÎ·Ó Û ÎÏÈÓÈ΋ ÂͤٷÛË, ÂÎÙ›ÌËÛË Ù˘ ÓÔËÙÈ΋˜ ηٿ-
ÛÙ·Û˘ Û‡Ìʈӷ Ì ÙËÓ Îϛ̷η Mini Mental State Exami-
nation36,37 Î·È ËÏÂÎÙÚÔηډÈÔÁÚ¿ÊËÌ· ËÚÂÌ›·˜. ∞fi ÙÔ˘˜
·Ú·¿Óˆ ·ÛıÂÓ›˜ ·ÔÎÏ›ÛıËÎ·Ó 6, ηıÒ˜ ·ÚÔ˘Û›·˙·Ó
οÔÈ· ·fi Ù· ·Ú·Î¿Ùˆ ÎÚÈÙ‹ÚÈ· ·ÔÎÏÂÈÛÌÔ‡: Ôχ ¯·-
ÌËÏ‹ ÓÔËÙÈ΋ ηٿÛÙ·ÛË (ÛÎÔÚ ≤22), ·ÛÙ·ı‹ ÛÙËı¿Á¯Ë, ÛÔ-
‚·Ú‹ Ì˘ÔÛÎÂÏÂÙÈ΋ ¿ıËÛË, ·ÚÚ‡ıÌÈÛÙÔ Û·Î¯·ÚÒ‰Ë ‰È·‚‹-
ÙË, ÂÓÂÚÁfi Ïԛ̈ÍË, ÚfiÛÊ·ÙÔ ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘
Î·È ÌË ÂÏÂÁ¯fiÌÂÓË ·ÚÙËÚȷ΋ ˘¤ÚÙ·ÛË.
OÈ 42 ·ÛıÂÓ›˜, Ô˘ Û˘ÌÌÂÙ›¯·Ó ÛÙÔ ÚfiÁÚ·ÌÌ·
¿ÛÎËÛ˘, ¯ˆÚ›ÛÙËÎ·Ó Ù˘¯·›· ÌÂÙ¿ ·fi ÎÏ‹ÚˆÛË Û ‰‡Ô
ÈÛ¿ÚÈı̘ ÔÌ¿‰Â˜. ™ÙËÓ ÔÌ¿‰· ∞ (ÂÈÚ·Ì·ÙÈ΋ ÔÌ¿‰·)
ÂÓÙ¿¯ıËÎ·Ó 21 ·ÛıÂÓ›˜, Ô˘ ·ÎÔÏÔ‡ıËÛ·Ó ÚfiÁÚ·ÌÌ·
¿ÛÎËÛ˘ Û˘ÓÔÏÈ΋˜ ‰È¿ÚÎÂÈ·˜ 18 ÌËÓÒÓ, Î·È ÛÙËÓ ÔÌ¿‰· μ
ÂÓÙ¿¯ıËÎ·Ó ÔÈ ˘fiÏÔÈÔÈ 21 ·ÛıÂÓ›˜, Ô˘ Û˘Ó¤¯ÈÛ·Ó ÙȘ
ηıËÌÂÚÈÓ¤˜ ÙÔ˘˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜ Î·È ¯ÚËÛ›ÌÂ˘Û·Ó ˆ˜
ÔÌ¿‰· ÂϤÁ¯Ô˘. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÌÂϤÙ˘, 6 ·ÛıÂÓ›˜
·fi ÙËÓ ÔÌ¿‰· ∞, ‰È¤ÎÔ„·Ó ÙÔ ÚfiÁÚ·ÌÌ· ¿ÛÎËÛ˘. OÈ
Ù¤ÛÛÂÚȘ ·fi ·˘ÙÔ‡˜ ‰Â Û˘ÌÏ‹ÚˆÛ·Ó ÈηÓÔÔÈËÙÈÎfi ·ÚÈı-
Ìfi ·ÚÔ˘ÛÈÒÓ ÛÙË Á‡ÌÓ·ÛË Î·È ÔÈ ‰‡Ô ‰È¤ÎÔ„·Ó ÁÈ· È·ÙÚÈ-
ÎÔ‡˜ ÏfiÁÔ˘˜. ∞fi ÙËÓ ÔÌ¿‰· μ, Â›Û˘ 6 ·ÛıÂÓ›˜ ‰ÂÓ ÔÏÔ-
ÎÏ‹ÚˆÛ·Ó ÙȘ ÙÂÏÈΤ˜ ÌÂÙÚ‹ÛÂȘ, ÂÂȉ‹ 5 ·fi ·˘ÙÔ‡˜ ÌÂ-
ٷʤÚıËÎ·Ó Û ¿ÏϘ „˘¯È·ÙÚÈΤ˜ ‰Ô̤˜ Î·È 1 ‰ÂÓ ÚÔ-
Û‹Ïı ÛÙȘ ÙÂÏÈΤ˜ ÌÂÙÚ‹ÛÂȘ, ÏfiÁˆ ÛÔ‚·ÚÒÓ ÔÚıÔ‰ÈÎÒÓ
ÚÔ‚ÏËÌ¿ÙˆÓ. ΔÂÏÈο, 30 ·ÛıÂÓ›˜, 15 ·fi οı ÔÌ¿‰·,
ÔÏÔÎÏ‹ÚˆÛ·Ó ÙË ÌÂϤÙË. ∫·ı’ fiÏË ÙË ‰È¿ÚÎÂÈ· Ù˘ ¤Ú¢ӷ˜,
Ë Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ ‹Ù·Ó ÛÙ·ıÂÚ‹ Ì ¿Ù˘· ·ÓÙÈ„˘¯ˆ-
ÛÈο Ê¿Ú̷η (90% ÙˆÓ ·ÛıÂÓÒÓ Ï¿Ì‚·Ó·Ó ¿Ù˘· ·ÓÙÈ-
„˘¯ˆÛÈο Ê¿Ú̷η).
ªÂÙÚ‹ÛÂȘ
™ÙËÓ ¤Ó·ÚÍË, ÛÙÔ Ì¤ÛÔ (9 Ì‹Ó˜) Î·È ÛÙÔ Ù¤ÏÔ˜ Ù˘ ÌÂϤÙ˘
(18 Ì‹Ó˜), fiÏÔÈ ÔÈ ·ÛıÂÓ›˜ ˘Ô‚Ï‹ıËÎ·Ó Û ÂÍ¿ÏÂÙË ‰Ô-
ÎÈÌ·Û›· ‚·‰›ÛÌ·ÙÔ˜ (6-minutes walking test, 6MWT).
°È· ÙËÓ ÂÎÙ›ÌËÛË Ù˘ ÏÂÈÙÔ˘ÚÁÈ΋˜ ÈηÓfiÙËÙ·˜, ÙÔ
6MWT ·ÔÙÂÏ› ÌÈ· ¤Á΢ÚË Î·È ·ÍÈfiÈÛÙË ‰ÔÎÈÌ·Û›· ‰›-
Ô˘, Ë ÔÔ›· ‰Â›¯ÓÂÈ ÙËÓ ÈηÓfiÙËÙ· ÙÔ˘ ·ÙfiÌÔ˘ Ó· ·ÓÙÂÂͤÚ-
¯ÂÙ·È ÛÙȘ ηıËÌÂÚÈÓ¤˜ ÙÔ˘ ‰Ú·ÛÙËÚÈfiÙËÙ˜. ∂›Ó·È ȉȷ›ÙÂÚ·
ηٿÏÏËÏË ÁÈ· ·ÛıÂÓ›˜, Ô˘ ‰ÂÓ ÌÔÚÔ‡Ó Ó· ÂÎÙÂϤÛÔ˘Ó
‰ÔÎÈÌ·Û›· ÎfiˆÛ˘ Û ΢ÎÏÔÂÚÁfiÌÂÙÚÔ ‹ ‰·‰ÔÂÚÁfiÌÂ-
ÙÚÔ, ÁÈ·Ù› ·Ú¤¯ÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· ÛÙÔÓ ÂÍÂÙ·˙fiÌÂÓÔ Ó· ¯ÚË-
ÛÈÌÔÔÈ‹ÛÂÈ ÙÔ ‰ÈÎfi ÙÔ˘ Ú˘ıÌfi38. OÈ ·ÛıÂÓ›˜ ÎÏ‹ıËÎ·Ó Ó·
‚·‰›ÛÔ˘Ó, fiÛÔ ÙÔ ‰˘Ó·ÙfiÓ ÌÂÁ·Ï‡ÙÂÚË ·fiÛÙ·ÛË, ÎÈÓÔ‡ÌÂ-
ÓÔÈ ¿Óˆ Û ¤Ó· ‰È¿‰ÚÔÌÔ Ì‹ÎÔ˘˜ 15 ̤ÙÚˆÓ ÁÈ· 6 ÏÂÙ¿39.
ΔÔ ‚¿‰ÈÛÌ¿ ÙÔ˘˜ ¤ÚÂ ӷ Â›Ó·È Û˘Ó¯fiÌÂÓÔ Î·È fiÛÔ ÙÔ ‰˘-
Ó·Ùfi Ù·¯‡ÙÂÚÔ. OÈ Ô‰ËÁ›Â˜ Ô˘ ‰›ÓÔÓÙ·Ó ‹Ù·Ó ·Ϥ˜ Î·È Î·-
76 ¢. ª∞ª∂§∂Δ∑∏ ∫∞π ™À¡.
Ù·ÓÔËÙ¤˜ Î·È Á›ÓÔÓÙ·Ó Â‡ÎÔÏ· ·ÓÙÈÏËÙ¤˜ ·fi ÙÔ˘˜ ·ÛıÂ-
Ó›˜. ∏ Û˘Ó¯‹˜ ÂÓı¿ÚÚ˘ÓÛË ÙˆÓ ·ÛıÂÓÒÓ Î·È Ë ÚÔÊÔÚÈ΋
·Ó·ÙÚÔÊÔ‰fiÙËÛ‹ ÙÔ˘˜ ÎÚ›ıËΠ··Ú·›ÙËÙË. ™ËÌÂÈÒÓÂÙ·È fiÙÈ
fiÏÔÈ ÔÈ ·ÛıÂÓ›˜ ÔÏÔÎÏ‹ÚˆÛ·Ó ÙËÓ ÂÍ¿ÏÂÙË ‰ÔÎÈÌ·Û›· ‚·-
‰›ÛÌ·ÙÔ˜ ¯ˆÚ›˜ ȉȷ›ÙÂÚ· ÚÔ‚Ï‹Ì·Ù·.
¶·Ú¿ÏÏËÏ· ηٿ ÙËÓ ¤Ó·ÚÍË, ̤ÛË Î·È Ï‹ÍË Ù˘ ÌÂϤ-
Ù˘ ¤ÁÈÓÂ Ë ÂÎÙ›ÌËÛË ÙˆÓ ‰ÂÈÎÙÒÓ Ù˘ ÔÈfiÙËÙ·˜ ˙ˆ‹˜ ÙˆÓ
·ÛıÂÓÒÓ Ì ÙÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ÂÎÙ›ÌËÛ˘ ÔÈfiÙËÙ·˜ ˙ˆ‹˜
ÁÈ· ÙËÓ Â˘¯·Ú›ÛÙËÛË Î·È ÙËÓ ÈηÓÔÔ›ËÛË (Quality of Life
Enjoyment and Satisfaction Questionnaire: Q-LES-Q), ÙÔ
ÔÔ›Ô Û˘ÌÏ‹ÚˆÛ·Ó ÔÈ ›‰ÈÔÈ, ÌÂÙ¿ ·fi Ô‰ËÁ›Â˜ Î·È ··Ú·›-
ÙËÙ˜ ‰È¢ÎÚÈÓ‹ÛÂȘ. ÃÚËÛÈÌÔÔÈ‹ıËÎÂ Ë ÂÏÏËÓÈ΋ ¤Î‰ÔÛË
ÙÔ˘ Q-LES-Q (Jean Endicott, Department of Research As-
sessment and Training, Unit 123, 1051 Riverside Drive, New
York, NY 10032), Ô˘ Â›Ó·È ¤Ó· ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Ô˘ ·ÍÈÔ-
ÏÔÁ› ÙÔ ‚·ıÌfi ·fiÏ·˘Û˘ Î·È ÈηÓÔÔ›ËÛ˘ Ô˘ ‚ÈÒÓÔ˘Ó
Ù· ¿ÙÔÌ· Û ‰È¿ÊÔÚÔ˘˜ ÙÔÌ›˜ Ù˘ ηıËÌÂÚÈÓ‹˜ ÙÔ˘˜ ˙ˆ‹˜.
∞ÔÙÂÏÂ›Ù·È ·fi ÂÚˆÙ‹ÛÂȘ Ô˘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙÔ˘˜ ÙÔÌ›˜
ÙˆÓ ‰Ú·ÛÙËÚÈÔÙ‹ÙˆÓ ÂχıÂÚÔ˘ ¯ÚfiÓÔ˘, ÙˆÓ ·ÙÔÌÈÎÒÓ Û˘-
Ó·ÈÛıËÌ¿ÙˆÓ, Ù˘ ÂÚÁ·Û›·˜, Ù˘ ·Ó·„˘¯‹˜, ÙˆÓ ÎÔÈÓˆÓÈÎÒÓ
Û¯¤ÛÂˆÓ Î·È ÙˆÓ ÁÂÓÈÎÒÓ ‰Ú·ÛÙËÚÈÔًوÓ. ∫¿ı ÂÚÒÙËÛË
‚·ıÌÔÏÔÁÂ›Ù·È Û Îϛ̷η 0 ¤ˆ˜ 5 Î·È ‰Â›¯ÓÂÈ ÙÔ ‚·ıÌfi Èη-
ÓÔÔ›ËÛ˘ Ô˘ ‚›ˆÛÂ Ô ·ÛıÂÓ‹˜ ÙËÓ ÚÔËÁÔ‡ÌÂÓË Â‚‰ÔÌ¿-
‰·, ·ÛÎÒÓÙ·˜ ÙË ‰Ú·ÛÙËÚÈfiÙËÙ· Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È ÛÙËÓ
ÂÚÒÙËÛË40.
¶ÚfiÁÚ·ÌÌ· Á‡ÌÓ·Û˘
∏ ¿ÛÎËÛË Ù˘ ÔÌ¿‰·˜ ∞ Ú·ÁÌ·ÙÔÔÈÔ‡ÓÙ·Ó ÙÚÂȘ ÊÔÚ¤˜
ÙËÓ Â‚‰ÔÌ¿‰· ÛÙ· „˘¯Èο ΤÓÙÚ· Ô˘ ‰È¤ÌÂÓ·Ó ÔÈ ·ÛıÂÓ›˜,
Û ÂÛˆÙÂÚÈÎÔ‡˜ Î·È Â͈ÙÂÚÈÎÔ‡˜ ¯ÒÚÔ˘˜, ‰ÈfiÙÈ Ë ÌÂÙ·ÊÔÚ¿
ÙÔ˘˜ ‰ÂÓ ‹Ù·Ó ÂÊÈÎÙ‹ Û ÂȉÈο ΤÓÙÚ· Á‡ÌÓ·Û˘. OÈ ·ÛıÂ-
Ó›˜ ÁÈ· ÚÒÙË ÊÔÚ¿ Û˘ÌÌÂÙ›¯·Ó Û ٤ÙÔÈÔ˘ ›‰Ô˘˜ Úfi-
ÁÚ·ÌÌ·. ∏ ‰È¿ÚÎÂÈ· οıÂ Û˘Ó‰ڛ·˜ ‹Ù·Ó ÚÔԉ¢ÙÈο ·˘-
Í·ÓfiÌÂÓË, ·Ú¯›˙ÔÓÙ·˜ ·fi Ù· 30 ÏÂÙ¿ ÛÙÔ˘˜ ÚÒÙÔ˘˜ Ì‹Ó˜
Ù˘ Á‡ÌÓ·Û˘ Î·È ÊÙ¿ÓÔÓÙ·˜ ÛÙ· 60 ÏÂÙ¿ ̤¯ÚÈ ÙÔ Ù¤ÏÔ˜ Ù˘
ÌÂϤÙ˘. ™ÙËÓ ¤Ó·ÚÍË ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜, Ë ¤ÓÙ·ÛË ÙˆÓ
·Û΋ÛÂˆÓ Î˘Ì·ÈÓfiÙ·Ó ÛÙÔ 60% Ù˘ ̤ÁÈÛÙ˘ ÚÔ‚ÏÂfiÌÂÓ˘
ÁÈ· ÙËÓ ËÏÈΛ· ηډȷ΋˜ Û˘¯ÓfiÙËÙ·˜ Î·È Î·Ù¿ ÙË Ï‹ÍË Ù˘
ÌÂϤÙ˘ ¤ÊÙ·Û ÛÙÔ 75% ·˘Ù‹˜.
∏ Á‡ÌÓ·ÛË ÙˆÓ ·ÛıÂÓÒÓ Û οıÂ Û˘Ó‰ڛ· ÍÂÎÈÓÔ‡ÛÂ
Ì 10 ÏÂÙ¿ ÚÔı¤ÚÌ·ÓÛË Û ΢ÎÏÔÂÚÁfiÌÂÙÚÔ Ì ¯·ÌËÏ‹
¤ÓÙ·ÛË, Ô˘ ·ÔÛÎÔÔ‡Û ÛÙËÓ Î·Ï‡ÙÂÚË ÚÔÂÙÔÈÌ·Û›· ÙÔ˘
Ì˘ÔÛÎÂÏÂÙÈÎÔ‡ Î·È Î·Ú‰È·ÁÁÂÈ·ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ∞Ú¯Èο ÔÈ
·ÛıÂÓ›˜ Û˘ÌÌÂÙ›¯·Ó Û ·Ïfi ÚfiÁÚ·ÌÌ· ·ÂÚfi‚ÈÔ˘ Ù‡Ô˘,
¯·ÌËÏ‹˜ Î·È Ì¤ÙÚÈ·˜ ¤ÓÙ·Û˘ ·Û΋ÛˆÓ, ΢ڛˆ˜ ̤ۈ ÌÔ˘-
ÛÈÎÔÎÈÓËÙÈ΋˜ ·ÁˆÁ‹˜ ‰È¿ÚÎÂÈ·˜ 20 ÏÂÙÒÓ, ÂÎÙÂÏÔ‡Û·Ó
·Ïfi ‚¿‰ÈÛÌ·, ¿ÛÎËÛË Û ΢ÎÏÔÂÚÁfiÌÂÙÚÔ Î·È ·È¯Ó›‰È· ÌÂ
Ì¿Ï·. ŸÏ˜ ÔÈ ·Û΋ÛÂȘ ‹Ù·Ó ·Ϥ˜ Î·È Î·Ù·ÓÔËÙ¤˜ ÁÈ· Ó·
ÌÔÚÔ‡Ó Ó· Û˘ÌÌÂÙ¤¯Ô˘Ó fiÏÔÈ ÔÈ ·ÛıÂÓ›˜. À‹Ú¯·Ó ÂÓ·Ï-
Ï·Á¤˜ Î·È ÔÈÎÈÏ›· ÛÙȘ ·Û΋ÛÂȘ Î·È ¤ÙÛÈ ˘‹Ú¯Â ÂӉȷʤ-
ÚÔÓ ·fi ÙÔ˘˜ ·ÛıÂÓ›˜. ∞ÚÁfiÙÂÚ·, ÂÓÙ¿¯ıËÎ·Ó Î·È ·È¯Ó›-
‰È· Ì Ì¿Ï·, ·ıÏÔ·È‰È¤˜ Î·È ·Ú·‰ÔÛÈ·ÎÔ› ¯ÔÚÔ›. ™ÙËÓ
·Ú¯‹ Î·È ÛÙÔ Ù¤ÏÔ˜ ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ Á›ÓÔÓÙ·Ó ‰È·Ù·ÙÈΤ˜
·Û΋ÛÂȘ, ÔÈ Ôԛ˜ ÔÏÔÎÏËÚÒÓÔÓÙ·Ó Ì ÔÚıÔÛˆÌÈ΋ Á˘ÌÓ·-
ÛÙÈ΋ ÁÈ· ÙË ÛÙ·‰È·Î‹ Â·Ó·ÊÔÚ¿ fiÏˆÓ ÙˆÓ Û˘ÛÙËÌ¿ÙˆÓ ÛÂ
Û˘Óı‹Î˜ ËÚÂÌ›·˜,
™Ù·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË
¶ÚÔÛ‰ÈÔÚ›ÛÙËÎ·Ó ÔÈ Ì¤ÛÔÈ fiÚÔÈ Î·È ÔÈ Ù˘ÈΤ˜ ·ÔÎÏ›ÛÂȘ
ÙˆÓ ·Ú·Ì¤ÙÚˆÓ (̤ÛÔÈ fiÚÔÈ ± Ù˘È΋ ·fiÎÏÈÛË) Ì ÙȘ ÎÏ·-
ÛÈΤ˜ ÌÂıfi‰Ô˘˜ Ù˘ ÂÚÈÁÚ·ÊÈ΋˜ ÛÙ·ÙÈÛÙÈ΋˜. ∏ Û˘ÁÎÚÈÙÈ΋
·Ó¿Ï˘ÛË ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ Ú·ÁÌ·ÙÔÔÈ‹ıËΠ̠ÙËÓ ·Ó¿Ï˘ÛË
‰È·Î‡Ì·ÓÛ˘ ‰‡Ô ·Ú·ÁfiÓÙˆÓ Ì Â·Ó·Ï·Ì‚·ÓfiÌÂÓ˜ ÌÂ-
ÙÚ‹ÛÂȘ (two-way ANOVA). °È· ÙË ÛÙ·ÙÈÛÙÈ΋ ÂÂÍÂÚÁ·Û›·
ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ¯ÚËÛÈÌÔÔÈ‹ıËΠÙÔ ÛÙ·ÙÈÛÙÈÎfi ·Î¤ÙÔ
SPSS, version 12. ø˜ Â›Â‰Ô ÛÙ·ÙÈÛÙÈ΋˜ ÛËÌ·ÓÙÈÎfiÙËÙ·˜
ηıÔÚ›ÛÙËΠÙÔ p<0,05.
∞¶OΔ∂§∂™ª∞Δ∞
Δ· Ê˘ÛÈο Î·È ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ·Ùfi-
ÌˆÓ Ô˘ Û˘ÌÌÂÙ›¯·Ó ÛÙË ÌÂϤÙË ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È
ÛÙÔÓ ›Ó·Î· 1. OÈ ‰‡Ô ÔÌ¿‰Â˜ ‰Â ‰È¤ÊÂÚ·Ó ÌÂٷ͇
ÙÔ˘˜ ˆ˜ ÚÔ˜ ÙËÓ ËÏÈΛ·, ÙÔ ‚¿ÚÔ˜, ÙÔ ‡„Ô˜ Î·È Ù·
¯ÚfiÓÈ· ÓÔÛËÏ›·˜.
Δ· ¿ÙÔÌ· Ù˘ ÔÌ¿‰·˜ ∞ ·ÚÔ˘Û›·Û·Ó Ì›ˆÛË
ÙÔ˘ ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜ ηٿ 4,1% (p<0,05) ·Ó¿-
ÌÂÛ· ÛÙËÓ ·Ú¯È΋ Î·È ÙËÓ ÙÂÏÈ΋ ̤ÙÚËÛË. ™˘ÁÎÂ-
ÎÚÈ̤ӷ, ηٿ ÙË Ì¤ÛË Î·È ÙËÓ ÙÂÏÈ΋ ̤ÙÚËÛË Â›-
¯·Ó ۈ̷ÙÈÎfi ‚¿ÚÔ˜ 68,8±15,5 kg Î·È 67,7±14,2
kg, ·ÓÙ›ÛÙÔȯ·. ∞ÓÙ›ıÂÙ·, Ù· ¿ÙÔÌ· Ù˘ ÔÌ¿‰·˜ μ
ÂÌÊ¿ÓÈÛ·Ó ·‡ÍËÛË ÙÔ˘ ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜ ηٿ
4,9% (p<0,05) ·Ó¿ÌÂÛ· ÛÙËÓ ·Ú¯È΋ Î·È ÙËÓ ÙÂÏÈ-
΋ ̤ÙÚËÛË. ™˘ÁÎÂÎÚÈ̤ӷ, ηٿ ÙË Ì¤ÛË Î·È ÙËÓ
ÙÂÏÈ΋ ̤ÙÚËÛË Â›¯·Ó ۈ̷ÙÈÎfi ‚¿ÚÔ˜ 70,8±12,8
kg Î·È 72,4±11,6 kg, ·ÓÙ›ÛÙÔȯ·.
∞Ó·ÊÔÚÈο Ì ÙËÓ ÂÍ¿ÏÂÙË ‰ÔÎÈÌ·Û›· ‚·‰›-
ÛÌ·ÙÔ˜ (6MWT), ηٿ ÙËÓ ·Ú¯È΋ ̤ÙÚËÛË, ÔÈ
‰‡Ô ÔÌ¿‰Â˜ ‰ÂÓ ‰È¤ÊÂÚ·Ó ÌÂٷ͇ ÙÔ˘˜ ˆ˜ ÚÔ˜ ÙË
‰È·Ó˘fiÌÂÓË ·fiÛÙ·ÛË. ∞ÓÙ›ıÂÙ·, ηٿ ÙË Ì¤ÛË
Î·È ÙËÓ ÙÂÏÈ΋ ̤ÙÚËÛË ÙÔ˘ 6MWT, Ù· ¿ÙÔÌ· Ù˘
ÔÌ¿‰·˜ ∞ ›¯·Ó ηٿ 11% (p<0,05) Î·È Î·Ù¿
28% (p<0,05), ·ÓÙ›ÛÙÔȯ·, ÌÂÁ·Ï‡ÙÂÚ˜ ÙÈ̤˜
·fi ÙÔ˘˜ ·ÛıÂÓ›˜ Ù˘ ÔÌ¿‰·˜ μ. OÈ ·ÛıÂÓ›˜ Ù˘
ÔÌ¿‰·˜ ∞ ·‡ÍËÛ·Ó ÙËÓ ·fiÛÙ·ÛË Ô˘ ‰È‹Ó˘Û·Ó
·fi ÙËÓ ·Ú¯È΋ ÛÙË Ì¤ÛË Ì¤ÙÚËÛË Î·Ù¿ 14%
(p<0,05), ηٿ 27% (p<0,05) ·fi ÙË Ì¤ÛË ÛÙËÓ
¶›Ó·Î·˜ 1. º˘ÛÈο Î·È ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ Û¯È˙Ô-
ÊÚÂÓÒÓ ·ÛıÂÓÒÓ Î·Ù¿ ÙËÓ ¤Ó·ÚÍË ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ¿-
ÛÎËÛ˘
OÌ¿‰· ∞ OÌ¿‰· μ
∞ÛıÂÓ›˜ (n) 15 15
ÕÓ‰Ú˜/ °˘Ó·›Î˜ 12/3 11/4
∏ÏÈΛ· (¤ÙË) 59,5 ± 19,6 60,4 ± 8,6
⁄„Ô˜ (cm) 171 ± 20 173 ± 12
μ¿ÚÔ˜ (kg) 70,6 ± 17,6 69,0 ± 13,0
¡ÔÛËÏ›· (¤ÙË) 36,2 ± 19,1 31,5 ± 19,3
OÌ¿‰· ∞: ¶ÂÈÚ·Ì·ÙÈ΋ ÔÌ¿‰·. OÌ¿‰· μ: OÌ¿‰· ÂϤÁ¯Ô˘
 ∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 75, 1 77

Εξάλεπτη δοκιμασία βαδίσματος (6MWT)

*
500 * Oμάδα Α

450 * Oμάδα Β
Απόσταση (m)

400 *
350 *
300
250

200
150

100
Έναρξη Μέσο Λήξη
Μετρήσεις

∂ÈÎ. 1. ∞fiÛÙ·ÛË Ô˘ ‰È·Ó‡ıËΠηٿ ÙËÓ 6-ÏÂÙË ‰ÔÎÈÌ·Û›· ‚·‰›ÛÌ·ÙÔ˜ (6MWT) ÁÈ· ÙȘ ‰‡Ô ÔÌ¿‰Â˜ ÙˆÓ Û¯È˙Ô-
ÊÚÂÓÒÓ, ηٿ ÙËÓ ¤Ó·ÚÍË, ÙÔ Ì¤ÛÔ (9 Ì‹Ó˜) Î·È ÙË Ï‹ÍË ÙÔ˘ 18-ÌËÓÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ¿ÛÎËÛ˘.

ÙÂÏÈ΋ ̤ÙÚËÛË Î·È Î·Ù¿ 44% (p<0,05) ·fi ÙËÓ
·Ú¯È΋ ÛÙËÓ ÙÂÏÈ΋ ̤ÙÚËÛË. Δ· ¿ÙÔÌ· Ù˘ ÔÌ¿-
‰·˜ ÂϤÁ¯Ô˘ ‰ÂÓ ·ÚÔ˘Û›·Û·Ó Ô˘ÛÈ·ÛÙÈο η̛·
ÌÂÙ·‚ÔÏ‹ ÛÙËÓ ·fiÛÙ·ÛË, ηٿ ÙË ‰ÔÎÈÌ·Û›· ‚·-
‰›ÛÌ·ÙÔ˜ ÌÂٷ͇ Ù˘ ·Ú¯È΋˜ Î·È ÙÂÏÈ΋˜ ̤ÙÚË-
Û˘ (∂ÈÎ. 1).
∞fi ÙÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Q-LES-Q ÁÈ· ÙËÓ
·Ú¿ÌÂÙÚÔ «‰Ú·ÛÙËÚÈfiÙËÙ·» ÙˆÓ ·ÛıÂÓÒÓ, ‰ÂÓ
·Ú·ÙËÚ‹ıËÎ·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔ-
Ú¤˜ ÛÙȘ ·Ú¯ÈΤ˜ ÌÂÙÚ‹ÛÂȘ ·Ó¿ÌÂÛ· ÛÙȘ ‰˘Ô
ÔÌ¿‰Â˜, ÂÓÒ Î·Ù¿ ÙË Ì¤ÛË Ì¤ÙÚËÛË Ù· ¿ÙÔÌ· Ù˘
ÔÌ¿‰·˜ ∞ ÂÌÊ¿ÓÈÛ·Ó Î·Ù¿ 21% (p<0.05) ÌÂÁ·-
χÙÂÚ˜ ÙÈ̤˜ Û ۇÁÎÚÈÛË Ì ٷ ¿ÙÔÌ· Ù˘ ÔÌ¿-
‰·˜ μ Î·È Î·Ù¿ ÙËÓ ÙÂÏÈ΋ ̤ÙÚËÛË Î·Ù¿ 23%
(p<0,05). OÈ ·ÛıÂÓ›˜ Ù˘ ÔÌ¿‰·˜ ∞ ›¯·Ó ·‡ÍË-
ÛË Î·Ù¿ 11% (p< 0,05) ·fi ÙËÓ ·Ú¯È΋ ÛÙË Ì¤ÛË
̤ÙÚËÛË, ηٿ 8% (p<0,05) ·fi ÙË Ì¤ÛË ÛÙËÓ ÙÂ-
ÏÈ΋ ̤ÙÚËÛË Î·È Î·Ù¿ 20% (p<0,05) ·fi ÙËÓ
·Ú¯È΋ ÛÙËÓ ÙÂÏÈ΋ ̤ÙÚËÛË. Δ· ¿ÙÔÌ· Ù˘ ÔÌ¿-
‰·˜ μ ‰ÂÓ ·ÚÔ˘Û›·Û·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜
‰È·ÊÔÚ¤˜ ÛÙË «‰Ú·ÛÙËÚÈfiÙËÙ·» Î·È ÛÙȘ ÙÚÂȘ ÌÂ-
ÙÚ‹ÛÂȘ (¶›Ó. 2).
™ÙËÓ ·Ú¿ÌÂÙÚÔ «Û˘Ó·ÈÛı‹Ì·Ù·» ÙÔ˘ ÂÚˆÙË-
Ì·ÙÔÏÔÁ›Ô˘ Q-LES-Q, ‰ÂÓ ·ÚÔ˘ÛÈ¿ÛÙËÎ·Ó ÛÙ·ÙÈ-
ÛÙÈο ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÛÙȘ ·Ú¯ÈΤ˜ ÌÂÙÚ‹ÛÂȘ
ÙˆÓ Û˘Ó·ÈÛıËÌ¿ÙˆÓ ·Ó¿ÌÂÛ· ÛÙȘ ‰˘Ô ÔÌ¿‰Â˜. ∫·-
Ù¿ ÙË Ì¤ÛË Î·È ÙËÓ ÙÂÏÈ΋ ̤ÙÚËÛË Ù· ¿ÙÔÌ· Ù˘
ÔÌ¿‰·˜ ∞ ÂÌÊ¿ÓÈÛ·Ó Î·Ù¿ 8% (p<0,05) Î·È Î·Ù¿
10% (p<0,05) ·ÓÙ›ÛÙÔȯ· ÌÂÁ·Ï‡ÙÂÚ˜ ÙÈ̤˜ ·fi
ÙÔ˘˜ ·ÛıÂÓ›˜ Ù˘ ÔÌ¿‰·˜ μ. OÈ ·ÛıÂÓ›˜ Ù˘ ÔÌ¿-
‰·˜ ∞ ›¯·Ó ·‡ÍËÛË Î·Ù¿ 13% (p<0,05) ·fi ÙËÓ
·Ú¯È΋ ÛÙË Ì¤ÛË Ì¤ÙÚËÛË Î·È Î·Ù¿ 5% (p<0,05)
·fi ÙË Ì¤ÛË ÛÙËÓ ÙÂÏÈ΋ ̤ÙÚËÛË Î·È Î·Ù¿ 19%
(p<0,05) ·fi ÙËÓ ·Ú¯È΋ ÛÙËÓ ÙÂÏÈ΋ ̤ÙÚËÛË. Δ·
¿ÙÔÌ· Ù˘ ÔÌ¿‰·˜ μ ·ÚÔ˘Û›·Û·Ó ·‡ÍËÛË Î·Ù¿
5% (p<0,05) ·fi ÙËÓ ·Ú¯È΋ ÛÙË Ì¤ÛË Ì¤ÙÚËÛË,
ηٿ 2% (p<0,05) ·fi ÙË Ì¤ÛË ÛÙËÓ ÙÂÏÈ΋ ̤ÙÚË-
ÛË Î·È Î·Ù¿ 8% (p<0,05) ·fi ÙËÓ ·Ú¯È΋ ÛÙËÓ ÙÂ-
ÏÈ΋ ̤ÙÚËÛË (¶›Ó. 2).
™¯ÂÙÈο Ì ÙËÓ ·Ú¿ÌÂÙÚÔ «ÂÚÁ·Û›·», Ù· ¿ÙÔ-
Ì· Ù˘ ÔÌ¿‰·˜ ∞, ηٿ ÙËÓ ·Ú¯È΋ ̤ÙÚËÛË Â›¯·Ó
ÌÂÁ·Ï‡ÙÂÚ˜ ÙÈ̤˜ ηٿ 19% Û ۇÁÎÚÈÛË Ì ٷ
¿ÙÔÌ· Ù˘ ÔÌ¿‰·˜ μ (p<0,05), ηٿ ÙË Ì¤ÛË Ì¤-
ÙÚËÛË Î·Ù¿ 27% (p<0,05), ÂÓÒ Î·Ù¿ ÙËÓ ÙÂÏÈ΋ ̤-
ÙÚËÛË Î·Ù¿ 14% (p<0,05). OÈ ·ÛıÂÓ›˜ Ù˘ ÔÌ¿-
‰·˜ ∞ ·ÚÔ˘Û›·Û·Ó ·‡ÍËÛË Î·Ù¿ 7% (p<0,05)
·fi ÙËÓ ·Ú¯È΋ ÛÙË Ì¤ÛË Ì¤ÙÚËÛË, ηٿ 12% (p<
0,05) ·fi ÙË Ì¤ÛË ÛÙËÓ ÙÂÏÈ΋ ̤ÙÚËÛË Î·È Î·Ù¿
20% (p<0,05) ·fi ÙËÓ ·Ú¯È΋ ÛÙËÓ ÙÂÏÈ΋ ̤ÙÚË-
ÛË. Δ· ¿ÙÔÌ· Ù˘ ÔÌ¿‰·˜ μ ‰ÂÓ ·ÚÔ˘Û›·Û·Ó ÛÙ·-
ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ·fi ÙËÓ ·Ú¯È΋ ÛÙË
̤ÛË Ì¤ÙÚËÛË, ÂÓÒ ‰È·ÈÛÙÒıËΠ·‡ÍËÛË Î·Ù¿
31% ÂÚ›Ô˘ (p<0,05) ·fi ÙË Ì¤ÛË ÛÙËÓ ÙÂÏÈ΋
̤ÙÚËÛË Î·È Î·Ù¿ 26% (p<0,05) ·fi ÙËÓ ·Ú¯È΋
ÛÙËÓ ÙÂÏÈ΋ ̤ÙÚËÛË (¶›Ó. 2).
ø˜ ÚÔ˜ ÙËÓ ·Ú¿ÌÂÙÚÔ «·Ó·„˘¯‹» ÙÔ˘ ÂÚˆ-
ÙËÌ·ÙÔÏÔÁ›Ô˘ Q-LES-Q, ‰ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ÛÙ·-
ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÛÙȘ ·Ú¯ÈΤ˜ ÌÂÙÚ‹-
ÛÂȘ ·Ó¿ÌÂÛ· ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜. OÈ ·ÛıÂÓ›˜ Ù˘
ÔÌ¿‰·˜ ∞ ›¯·Ó ·‡ÍËÛË Î·Ù¿ 38% (p<0,05) ·fi
ÙËÓ ·Ú¯È΋ ÛÙË Ì¤ÛË Ì¤ÙÚËÛË, ηٿ 10% (p<0,05)
·fi ÙË Ì¤ÛË ÛÙËÓ ÙÂÏÈ΋ ̤ÙÚËÛË Î·È Î·Ù¿ 51%
78 ¢. ª∞ª∂§∂Δ∑∏ ∫∞π ™À¡.

(p<0,05) ·fi ÙËÓ ·Ú¯È΋ ÛÙËÓ ÙÂÏÈ΋ ̤ÙÚËÛË. Δ·

¶›Ó·Î·˜ 2. ∞ÔÙÂϤÛÌ·Ù· ÙÔ˘ ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘ Q-LES-Q ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ÙˆÓ Û¯È˙ÔÊÚÂÓÒÓ, ηٿ ÙËÓ ¤Ó·ÚÍË, ÙÔ Ì¤ÛÔ (9 Ì‹Ó˜) Î·È ÙË Ï‹ÍË ÙÔ˘ 18-ÌËÓÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ¿ÛÎËÛ˘.

34,9 ± 6,4
39,7 ± 6,1
17,7 ± 6,9
21,1 ± 2,8
28,5 ± 6,6
47,5 ± 8,8
OÌ¿‰· μ
¿ÙÔÌ· Ù˘ ÔÌ¿‰·˜ μ ÂÌÊ¿ÓÈÛ·Ó ·‡ÍËÛË Î·Ù¿ 7%
(p<0,05) ·fi ÙËÓ ·Ú¯È΋ ÛÙË Ì¤ÛË Ì¤ÙÚËÛË, ηٿ
26% (p<0,05) ·fi ÙË Ì¤ÛË ÛÙËÓ ÙÂÏÈ΋ ̤ÙÚËÛË
Î·È Î·Ù¿ 34% (p<0,05) ·fi ÙËÓ ·Ú¯È΋ ÛÙËÓ ÙÂÏÈ-
΋ ̤ÙÚËÛË. ∫·Ù¿ ÙË Ì¤ÛË Î·È ÙËÓ ÙÂÏÈ΋ ̤ÙÚËÛË,
§‹ÍË

Ù· ¿ÙÔÌ· Ù˘ ÔÌ¿‰·˜ ∞ ›¯·Ó ηٿ 19% (p<0,05)

Î·È Î·Ù¿ 7% (p<0,05) ·ÓÙ›ÛÙÔȯ· ÌÂÁ·Ï‡ÙÂÚ˜ ÙÈ-
44,3 ± 11,2
45,3 ± 7,1

20,7 ± 7,3
22,7 ± 5,4
30,1 ± 5,6
49,9 ± 6,0
OÌ¿‰· ∞

̤˜ Û ۇÁÎÚÈÛË Ì ÙËÓ ÔÌ¿‰· μ (¶›Ó. 2).

™¯ÂÙÈο Ì ÙËÓ ·Ú¿ÌÂÙÚÔ «ÎÔÈÓˆÓÈΤ˜ Û¯¤-
ÛÂȘ», ‰ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο
‰È·ÊÔÚ¤˜ ÛÙȘ ·Ú¯ÈΤ˜ ÌÂÙÚ‹ÛÂȘ ·Ó¿ÌÂÛ· ÛÙȘ
‰˘Ô ÔÌ¿‰Â˜. OÈ ·ÛıÂÓ›˜ Ù˘ ÔÌ¿‰·˜ ∞ ·ÚÔ˘Û›·-
Û·Ó ·‡ÍËÛË Î·Ù¿ 16% (p<0,05) ·fi ÙËÓ ·Ú¯È΋
ÛÙË Ì¤ÛË Ì¤ÙÚËÛË, ηٿ 6% (p<0,05) ·fi ÙË Ì¤ÛË
ÛÙËÓ ÙÂÏÈ΋ ̤ÙÚËÛË Î·È Î·Ù¿ 23% (p<0,05) ·fi
33,1 ± 4,0
38,9 ± 5,5
13,5 ± 4,6
16,9 ± 3,7
25,3 ± 6,6
40,4 ± 6,3
OÌ¿‰· μ

ÙËÓ ·Ú¯È΋ ÛÙËÓ ÙÂÏÈ΋ ̤ÙÚËÛË. Δ· ¿ÙÔÌ· Ù˘

ÔÌ¿‰·˜ μ ‰ÂÓ ·ÚÔ˘Û›·Û·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ-
Τ˜ ‰È·ÊÔÚ¤˜ ·fi ÙËÓ ·Ú¯È΋ ÛÙË Ì¤ÛË Ì¤ÙÚËÛË,
ÂÓÒ ‰È·ÈÛÙÒıËΠ·‡ÍËÛË Î·Ù¿ 13% (p<0,05)
ª¤ÛÔ

·fi ÙË Ì¤ÛË ÛÙËÓ ÙÂÏÈ΋ ̤ÙÚËÛË Î·È Î·Ù¿ 14%

(p<0,05) ·fi ÙËÓ ·Ú¯È΋ ÛÙËÓ ÙÂÏÈ΋ ̤ÙÚËÛË. ∫·-
42,1 ± 10,6

Ù¿ ÙË Ì¤ÛË Î·È ÙËÓ ÙÂÏÈ΋ ̤ÙÚËÛË Ù· ¿ÙÔÌ· Ù˘

41,8 ± 7,3

18,5 ± 7,1
20,7 ± 5,3
28,5 ± 4,8
46,1 ± 6,1
OÌ¿‰· ∞

ÔÌ¿‰·˜ ∞ ›¯·Ó ηٿ 11% (p<0,05) Î·È Î·Ù¿ 5%

(p<0,05) ·ÓÙ›ÛÙÔȯ· ÌÂÁ·Ï‡ÙÂÚ˜ ÙÈ̤˜ ·fi ÙËÓ
ÔÌ¿‰· μ (¶›Ó. 2).
ø˜ ÚÔ˜ ÙËÓ ·Ú¿ÌÂÙÚÔ ÙÔ˘ ÂÚˆÙËÌ·ÙÔÏÔÁ›-
Ô˘ Q-LES-Q «ÁÂÓÈΤ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜», Ù· ¿ÙÔÌ·
Ù˘ ÔÌ¿‰·˜ ∞ ηٿ ÙËÓ ·Ú¯È΋ ̤ÙÚËÛË Â›¯·Ó η-
Ù¿ 8% (p<0,05) ÌÂÁ·Ï‡ÙÂÚ˜ ÙÈ̤˜ Û ۇÁÎÚÈÛË
36,9 ± 4,9
36,9 ± 5,3
14,0 ± 4,6
15,7 ± 3,3
24,9 ± 6,2
40,2 ± 6,2
OÌ¿‰· μ

Ì ٷ ¿ÙÔÌ· Ù˘ ÔÌ¿‰·˜ μ, ηٿ ÙË Ì¤ÛË Ì¤ÙÚËÛË

ηٿ 12% (p<0,05) Î·È Î·Ù¿ ÙËÓ ÙÂÏÈ΋ ̤ÙÚËÛË
ηٿ 5% (p<0,05). OÈ ·ÛıÂÓ›˜ Ù˘ ÔÌ¿‰·˜ ∞ ·-
Q-LES-Q: ∂ÚˆÙËÌ·ÙÔÏfiÁÈÔ ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË Ù˘ ÔÈfiÙËÙ·˜ ˙ˆ‹˜

ÚÔ˘Û›·Û·Ó ·‡ÍËÛË Î·Ù¿ 6% (p<0,05) ·fi ÙËÓ

ŒÓ·ÚÍË

·Ú¯È΋ ÛÙË Ì¤ÛË Ì¤ÙÚËÛË, ηٿ 8% (p<0,05) ·fi

ÙË Ì¤ÛË ÛÙËÓ ÙÂÏÈ΋ ̤ÙÚËÛË Î·È Î·Ù¿ 15%
(p<0,05) ·fi ÙËÓ ·Ú¯È΋ ÛÙËÓ ÙÂÏÈ΋ ̤ÙÚËÛË. Δ·
37,3 ± 11,3

15,0 ± 4,0

¿ÙÔÌ· Ù˘ ÔÌ¿‰·˜ μ ‰ÂÓ ·ÚÔ˘Û›·Û·Ó ÛÙ·ÙÈÛÙÈο

37,5 ± 2,9

17,2 ± 6,3

24,5 ± 5,1
43,5 ± 6,5
OÌ¿‰· ∞

ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ·fi ÙËÓ ·Ú¯È΋ ÛÙË Ì¤ÛË

̤ÙÚËÛË, ÂÓÒ ‰È·ÈÛÙÒıËΠ·‡ÍËÛË Î·Ù¿ 18%
(p<0,05) ·fi ÙË Ì¤ÛË ÛÙËÓ ÙÂÏÈ΋ ̤ÙÚËÛË, fiˆ˜
Î·È ·fi ÙËÓ ·Ú¯È΋ ÛÙËÓ ÙÂÏÈ΋ ̤ÙÚËÛË (p<0,05)
OÌ¿‰· ∞: ¶ÂÈÚ·Ì·ÙÈ΋ ÔÌ¿‰·

(¶›Ó. 2).
OÌ¿‰· μ: OÌ¿‰· ÂϤÁ¯Ô˘
¢Â›ÎÙ˜ ÔÈfiÙËÙ·˜ ˙ˆ‹˜

°ÂÓÈΤ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜

™À∑∏Δ∏™∏
∫ÔÈÓˆÓÈΤ˜ Û¯¤ÛÂȘ

¶·Ú¿ ÙËÓ ÚfiÔ‰Ô ÛÙËÓ ·ÓÙÈ„˘¯ˆÙÈ΋ Ê·Ú̷΢-

¢Ú·ÛÙËÚÈfiÙËÙ·
™˘Ó·ÈÛı‹Ì·Ù·

ÙÈ΋ ·ÁˆÁ‹, ÔÈ „˘¯ÔÎÔÈÓˆÓÈÎÔ› ÂÚÈÔÚÈÛÌÔ› Ù˘

ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ·˜ Î·È Ë ÌÂȈ̤ÓË ÔÈfiÙËÙ· ˙ˆ‹˜
∞Ó·„˘¯‹
∂ÚÁ·Û›·

·Ú·Ì¤ÓÔ˘Ó ÛËÌ·ÓÙÈο ÂÌfi‰È· ÛÙË Û¯È˙ÔÊÚ¤-

ÓÂÈ·41. ∞fi ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË Ê¿ÓËΠfiÙÈ Â›Ó·È
 ∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 75, 1
ÂÊÈÎÙfi, ÔÈ ·ÛıÂÓ›˜ Ì ۯÈ˙ÔÊÚ¤ÓÂÈ· Ó· Û˘ÌÌÂÙ¤-
¯Ô˘Ó Û ̷ÎÚÔ¯ÚfiÓÈ· ÚÔÁÚ¿ÌÌ·Ù· ¿ÛÎËÛ˘.
∂›Û˘, ·Ú·ÙËÚ‹ıËΠfiÙÈ Ë Ì·ÎÚÔ¯ÚfiÓÈ· ¿ÛÎË-
ÛË Û˘Ì‚¿ÏÏÂÈ ÛËÌ·ÓÙÈο ÛÙË ‚ÂÏÙ›ˆÛË Ù˘ ÏÂÈ-
ÙÔ˘ÚÁÈ΋˜ ÙÔ˘˜ ÈηÓfiÙËÙ·˜ Î·È ÛÙËÓ ·‡ÍËÛË Ù˘
Û˘ÌÌÂÙÔ¯‹˜ ÙÔ˘˜ Û ηıËÌÂÚÈÓ¤˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜,
ÁÂÁÔÓfi˜ Ô˘ Û˘ÓÙÂÏ› ÛÙË ‚ÂÏÙ›ˆÛË Ù˘ ÔÈfiÙËÙ·˜
˙ˆ‹˜ ÙÔ˘˜.
™‡Ìʈӷ Ì ÚfiÛÊ·Ù˜ ÌÂϤÙ˜, ÔÈ ÂÚÈÛÛfi-
ÙÂÚÔÈ „˘¯È·ÙÚÈÎÔ› ·ÛıÂÓ›˜ ‰È·ÙÚ¤¯Ô˘Ó ·˘ÍË̤ÓÔ
ΛӉ˘ÓÔ ·¯˘Û·ÚΛ·˜, ΢ڛˆ˜ ÏfiÁˆ Ù˘ ¯Ú‹Û˘
ÙˆÓ ·ÓÙÈ„˘¯ˆÙÈÎÒÓ Ê·Ú̿ΈÓ42-44. ™ÙËÓ ·ÚÔ‡Û·
ÌÂϤÙË ‰È·ÈÛÙÒıËΠfiÙÈ Ë Û˘ÛÙËÌ·ÙÈ΋ Á‡ÌÓ·ÛË
ÙˆÓ ·ÛıÂÓÒÓ Â¤‰Ú·Û ıÂÙÈο ÛÙËÓ ·ÒÏÂÈ· ‚¿-
ÚÔ˘˜. ™Â fiÏË ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ Ì·ÎÚÔ¯ÚfiÓÈÔ˘ ÚÔ-
ÁÚ¿ÌÌ·ÙÔ˜ ¿ÛÎËÛ˘ ·Ú·ÙËÚ‹ıËΠÛÙ·‰È·Î‹
·ÒÏÂÈ· ‚¿ÚÔ˘˜. ∞ÓÙ›ıÂÙ·, ÔÈ ·ÛıÂÓ›˜ Ô˘ ‰ÂÓ
·Û΋ıËÎ·Ó ÂÌÊ¿ÓÈÛ·Ó ·‡ÍËÛË ÙÔ˘ ۈ̷ÙÈÎÔ‡ ‚¿-
ÚÔ˘˜ Ì ÙÔ ¤Ú·˜ ÙÔ˘ ¯ÚfiÓÔ˘. ¶·ÚfiÌÔÈ·, ÛÙË ÌÂ-
ϤÙË ÙˆÓ Centorrino Î·È Û˘Ó.45, ·Ú·ÙËÚ‹ıËΠ·-
ÒÏÂÈ· ‚¿ÚÔ˘˜ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ Û˘ÌÌÂÙ›¯·Ó
Û ÂÍ¿ÌËÓÔ ÚfiÁÚ·ÌÌ· ¿ÛÎËÛ˘ Î·È ·‡ÍËÛË ‚¿-
ÚÔ˘˜ Û ·ÛıÂÓ›˜ Ô˘ ‰ÂÓ ·ÛÎÔ‡ÓÙ·Ó. ™Â ¿ÏÏË
¤Ú¢ӷ, Ë ÂÊ·ÚÌÔÁ‹ Û˘ÛÙËÌ·ÙÈ΋˜ Á‡ÌÓ·Û˘ 12
‚‰ÔÌ¿‰ˆÓ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ηٿÏÏËÏÔ ÚfiÁÚ·Ì-
Ì· ‰È·ÙÚÔÊÈ΋˜ ·ÁˆÁ‹˜, Ô‰‹ÁËÛ Û ÛËÌ·ÓÙÈ΋
Ì›ˆÛË ÙÔ˘ ‚¿ÚÔ˘˜ ηٿ 2,7 kg35. ∏ Ì›ˆÛË ÙÔ˘
ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜ ÙˆÓ Û¯È˙ÔÊÚÂÓÒÓ ·ÛıÂÓÒÓ
·Ô‰›‰ÂÙ·È ÛÙËÓ ·‡ÍËÛË ÙˆÓ Î·Ù·Ó·ÏˆÌ¤ÓˆÓ ıÂÚ-
Ì›‰ˆÓ, ÏfiÁˆ Ù˘ Û˘ÌÌÂÙÔ¯‹˜ ÙÔ˘˜ ÛÂ Ê˘ÛÈΤ˜ ‰Ú·-
ÛÙËÚÈfiÙËÙ˜35. ∂›Û˘, ÛËÌ·ÓÙÈ΋ ·ÒÏÂÈ· ‚¿ÚÔ˘˜
Î·È ‚ÂÏÙ›ˆÛË Ù˘ Ê˘ÛÈ΋˜ ηٿÛÙ·Û˘ ÂÈÛËÌ¿Ó-
ıËΠ۠ۯÈ˙ÔÊÚÂÓ›˜ ·ÛıÂÓ›˜, Ô˘ Û˘ÌÌÂÙ›¯·Ó
Û ·ÂÚfi‚È· ÚÔÁÚ¿ÌÌ·Ù· ¿ÛÎËÛ˘46,47. ÕÏÏÔÈ
ÂÚ¢ÓËÙ¤˜ ‚Ú‹Î·Ó ÛËÌ·ÓÙÈ΋ Ì›ˆÛË ÙÔ˘ ۈ̷ÙÈ-
ÎÔ‡ Ï›Ô˘˜ Î·È ¿Ì‚Ï˘ÓÛË ÙˆÓ „˘¯È·ÙÚÈÎÒÓ Û˘-
ÌÙˆÌ¿ÙˆÓ ÙˆÓ Û¯È˙ÔÊÚÂÓÒÓ, ÌÂÙ¿ ·fi ¤Ó· Úfi-
ÁÚ·ÌÌ· Á‡ÌÓ·Û˘ Ì ÂÚ¿ÙËÌ· ‰È¿ÚÎÂÈ·˜ 16
‚‰ÔÌ¿‰ˆÓ48.
ŸÛÔÓ ·ÊÔÚ¿ ÛÙË ÏÂÈÙÔ˘ÚÁÈ΋ ÈηÓfiÙËÙ· ÙˆÓ
·ÛıÂÓÒÓ, Ë ÔÔ›· ÂÎÙÈÌ‹ıËΠ̤ۈ Ù˘ ‰ÔÎÈÌ·-
Û›·˜ ‚·‰›ÛÌ·ÙÔ˜ ÙˆÓ 6 ÏÂÙÒÓ, Ê¿ÓËΠfiÙÈ ‹Ù·Ó
¯·ÌËÏ‹ ÛÙËÓ ·Ú¯‹ Ù˘ ÌÂϤÙ˘. ™˘ÁÎÂÎÚÈ̤ӷ, Ë
·fiÛÙ·ÛË Ô˘ ‰È·Ó‡ıËΠηٿ ÙËÓ ·Ú·¿Óˆ ‰Ô-
ÎÈÌ·Û›· ‹Ù·Ó ÛËÌ·ÓÙÈο ÌÈÎÚfiÙÂÚË Û˘ÁÎÚÈÙÈο ÌÂ
·˘Ù‹ ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ¿Û¯Ô˘Ó ·fi ¿ÏϘ ¯Úfi-
ÓȘ ·ı‹ÛÂȘ34,49. ∏ ÂÏ·Ùو̤ÓË Ê˘ÛÈ΋ Â¿Ú-
ÎÂÈ· ÙˆÓ ·ÛıÂÓÒÓ Î·È Ë Â‡ÎÔÏË ÎfiˆÛË, ·Ô‰›-
‰ÔÓÙ·È Î·Ù¿ ·ÚÈÔ ÏfiÁÔ ÛÙË Ê‡ÛË Ù˘ ·Ûı¤ÓÂÈ¿˜
ÙÔ˘˜, ·ÏÏ¿ Î·È ÛÙËÓ ÎÔÈÓˆÓÈ΋ ·ÔÌfiÓˆÛË Ô˘
79
¯·Ú·ÎÙËÚ›˙ÂÈ ·˘ÙÔ‡˜ ÙÔ˘˜ ·ÛıÂÓ›˜, ÁÂÁÔÓfi˜ Ô˘
Âȉڿ ·ÚÓËÙÈο ÛÙÔÓ Î·ıËÌÂÚÈÓfi ÙÚfiÔ ˙ˆ‹˜
ÙÔ˘˜, Ô‰ËÁÒÓÙ·˜ ÙÔ˘˜ Û ÂÚÈÔÚÈṲ̂ÓË Ê˘ÛÈ΋
‰Ú·ÛÙËÚÈfiÙËÙ· Î·È Î·ıÈÛÙÈÎfi ÙÚfiÔ ˙ˆ‹˜49. øÛÙfi-
ÛÔ, ÛÙÔ Ù¤ÏÔ˜ Ù˘ ÌÂϤÙ˘ ‰È·ÈÛÙÒıËΠÛËÌ·ÓÙÈ-
΋ ‚ÂÏÙ›ˆÛË Ù˘ Ê˘ÛÈ΋˜ Â¿ÚÎÂÈ·˜ ÙˆÓ ·ÛıÂÓÒÓ
Ô˘ ·ÎÔÏÔ‡ıËÛ·Ó ÙÔ ÚfiÁÚ·ÌÌ· Á‡ÌÓ·Û˘, ÛÂ
·ÓÙ›ıÂÛË Ì ·˘ÙÔ‡˜ Ô˘ Û˘Ó¤¯ÈÛ·Ó Î·ıÈÛÙÈÎfi ÙÚfi-
Ô ‰È·‚›ˆÛ˘. ªÂ ·˘Ùfi ÙÔ ·ÔÙ¤ÏÂÛÌ· Û˘Ìʈ-
ÓÔ‡Ó ¿ÏϘ ÌÂϤÙ˜ Ô˘, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÙË ‰Ô-
ÎÈÌ·Û›· ‚·‰›ÛÌ·ÙÔ˜ ÙˆÓ 6 ÏÂÙÒÓ, ‚Ú‹Î·Ó fiÙÈ ÔÈ
Û¯È˙ÔÊÚÂÓ›˜ ‚ÂÏÙ›ˆÛ·Ó ÙË Ê˘ÛÈ΋ ÙÔ˘˜ Â¿ÚÎÂÈ·
ÌÂÙ¿ ·fi ÚfiÁÚ·ÌÌ· ·ÂÚfi‚È·˜ ¿ÛÎËÛ˘34,48. ∏
ÛËÌ·ÓÙÈ΋ ‚ÂÏÙ›ˆÛË Ô˘ ·Ú·ÙËÚ‹ıËΠÛÙËÓ ·fi-
ÛÙ·ÛË Ô˘ ‰È‹Ó˘Û·Ó ÔÈ ·ÛıÂÓ›˜ ηٿ ÙËÓ ·Ú·-
¿Óˆ ‰ÔÎÈÌ·Û›·, ·Ô‰›‰ÂÙ·È Û ÏÂÈÙÔ˘ÚÁÈΤ˜ ηÈ
ÌÔÚÊÔÏÔÁÈΤ˜ ÚÔÛ·ÚÌÔÁ¤˜ ÙˆÓ Ì˘ÒÓ ÌÂÙ¿ ·fi
Û˘ÛÙËÌ·ÙÈ΋ ¿ÛÎËÛË50-52.
ø˜ ÚÔ˜ ÙËÓ ·ÓÙÈÏ·Ì‚·ÓfiÌÂÓË ÔÈfiÙËÙ· ˙ˆ‹˜,
ÔÈ Û¯È˙ÔÊÚÂÓ›˜ Î·È ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ·Ó¤ÊÂÚ·Ó
ÌÂȈ̤Ó˜ ηıËÌÂÚÈÓ¤˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜ Î·È ÂÚÁ·-
Û›·, ηٿ ÙËÓ ¤Ó·ÚÍË Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘. ¶ÔÏ-
ÏÔ› Â›Ó·È ÔÈ ÏfiÁÔÈ Ô˘ ¢ı‡ÓÔÓÙ·È ÁÈ· Ù· ¯·ÌËÏ¿
Â›‰· ÙˆÓ ÂÈ̤ÚÔ˘˜ ·˘ÙÒÓ ·Ú·Ì¤ÙÚˆÓ. ¢È¿-
ÊÔÚÔÈ ÎÏÈÓÈÎÔ› ·Ú¿ÁÔÓÙ˜, fiˆ˜ Ë ÛÔ‚·Ú‹ „˘¯Ô-
·ıÔÏÔÁ›· ÙˆÓ ·ÛıÂÓÒÓ, Ë ‰È¿ÚÎÂÈ· Ù˘ ·Ûı¤ÓÂÈ-
·˜, Ù· ·ÓÙÈ„˘¯ˆÙÈο Ê¿Ú̷η Î·È Ë ÛÔ‚·ÚfiÙËÙ·
Ù˘ ·Ûı¤ÓÂÈ·˜, ÂËÚ¿˙Ô˘Ó ÛËÌ·ÓÙÈο ÙËÓ ÂÎÙÈÌÒ-
ÌÂÓË ÈηÓÔÔ›ËÛ‹ ÙÔ˘˜ Û fiÏÔ˘˜ ۯ‰fiÓ ÙÔ˘˜ ÙÔ-
Ì›˜ Ù˘ ˙ˆ‹˜ Î·È ÙËÓ ¿ÚÓËÛ‹ ÙÔ˘˜ ÁÈ· Û˘ÌÌÂÙÔ¯‹
ÛÂ Ê˘ÛÈΤ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜ Î·È ÂÎÙ¤ÏÂÛË ÔÔÈ·Û-
‰‹ÔÙ ÂÚÁ·Û›·˜25,53. øÛÙfiÛÔ, ¤Ó· ‰ÔÌË̤ÓÔ Î·È
˘ÔÛÙËÚÈÎÙÈÎfi ÂÚÈ‚¿ÏÏÔÓ, ÚÔÛ·ÚÌÔṲ̂ÓÔ ÛÙȘ
ÈηÓfiÙËÙ˜ Î·È ÙȘ ‚·ÛÈΤ˜ ·Ó¿ÁΘ ÙˆÓ ·ÛıÂÓÒÓ,
Û˘Ì‚¿ÏÏÂÈ ÛÙË Û˘ÌÌÂÙÔ¯‹ ÙÔ˘˜ ÛÙȘ ηıËÌÂÚÈÓ¤˜
‰Ú·ÛÙËÚÈfiÙËÙ˜ ÂÚÈÛÛfiÙÂÚÔ ·fi ÙÔ Â›Â‰Ô Ù˘
Û˘Ìو̷ÙÔÏÔÁ›·˜ ÙÔ˘˜54. ∂ÈϤÔÓ, ÔÈ Û¯È˙ÔÊÚÂ-
Ó›˜ Ô˘ ÂÚÁ¿˙ÔÓÙ·È ·ÚÔ˘ÛÈ¿˙Ô˘Ó Î·Ï‡ÙÂÚË ÔÈ-
fiÙËÙ· ˙ˆ‹˜ ÛÙÔÓ ÂÚÁ·ÛÈ·Îfi ÙÔ̤· Î·È ¤¯Ô˘Ó Â-
ÚÈÛÛfiÙÂÚ˜ ÎÔÈÓˆÓÈΤ˜ ·ÏÏËÏÂȉڿÛÂȘ Î·È ÎÔÈ-
ÓˆÓÈΤ˜ Â·Ê¤˜, Û ۯ¤ÛË Ì ÂΛÓÔ˘˜ Ô˘ ‰ÂÓ ÂÚ-
Á¿˙ÔÓÙ·È55.
∞ÍÈÔÛËÌ›ˆÙË ‹Ù·Ó Ë ·‡ÍËÛË Ô˘ ·Ú·ÙËÚ‹-
ıËΠÛÙÔ˘˜ ·ÛıÂÓ›˜ Ù˘ ÔÌ¿‰·˜ Á‡ÌÓ·Û˘ ÛÙÔ ‰Â›-
ÎÙË ÙˆÓ Î·ıËÌÂÚÈÓÒÓ ‰Ú·ÛÙËÚÈÔÙ‹ÙˆÓ ÌÂÙ¿ ÙË
Û˘ÌÌÂÙÔ¯‹ ÙÔ˘˜ ÛÙÔ ÚfiÁÚ·ÌÌ· ¿ÛÎËÛ˘, Û ۇ-
ÁÎÚÈÛË Ì ÙÔ˘˜ ÌË ·ÛÎÔ‡ÌÂÓÔ˘˜. ¶·ÚfiÌÔÈ·, Û ¿Ï-
Ϙ ¤Ú¢Ó˜ ‚Ú¤ıËΠfiÙÈ, Û ۯÈ˙ÔÊÚÂÓ›˜ ·ÛıÂ-
Ó›˜ Ô˘ ·ÛÎÔ‡ÓÙ·Ó ·˘Í‹ıËÎÂ Ë ÂÓ·Û¯fiÏËÛË ÌÂ
ηıËÌÂÚÈÓ¤˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜, ÁÂÁÔÓfi˜ ÙÔ ÔÔ›Ô
80 ¢. ª∞ª∂§∂Δ∑∏ ∫∞π ™À¡.
Â¤‰Ú·Û ¢ÓÔ˚ο ÛÙËÓ ÔÈfiÙËÙ· ˙ˆ‹˜ ÙÔ˘˜56,57.
∞˘Ù‹ Ë ‚ÂÏÙ›ˆÛË ·Ô‰›‰ÂÙ·È Î˘Ú›ˆ˜ ÛÙËÓ ·‡ÍËÛË
Ù˘ ÂÓÂÚÁËÙÈÎfiÙËÙ·˜, Ù˘ ÈηÓÔÔ›ËÛ˘ Î·È Ù˘ ¢-
¯·Ú›ÛÙËÛ˘, Ô˘ ·ÔÎÔÌ›˙Ô˘Ó ·fi ÙË Û˘ÌÌÂÙÔ¯‹
ÙÔ˘˜ ÛÙË Á‡ÌÓ·ÛË.
™ÙÔÓ ÙÔ̤· ÙˆÓ ÎÔÈÓˆÓÈÎÒÓ Û¯¤ÛˆÓ, ÔÈ ·-
ÛıÂÓ›˜ ÂÌÊ¿ÓÈÛ·Ó Ôχ ÌÂȈ̤ӷ Â›‰· ÛÙËÓ
·Ú¯‹ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘, ÂÓÒ ÛÙË Û˘Ó¤¯ÂÈ·,
˘‹ÚÍ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‚ÂÏÙ›ˆÛË ÛÙÔÓ ÙÔ-
̤· ÙˆÓ ÎÔÈÓˆÓÈÎÒÓ Û¯¤ÛÂˆÓ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘
Û˘ÌÌÂÙ›¯·Ó ÛÙÔ ÚfiÁÚ·ÌÌ· Á‡ÌÓ·Û˘. ¶·Úfi-
ÌÔÈ·, Û ¿ÏϘ ¤Ú¢Ó˜, ·ÛıÂÓ›˜ Ì ۯÈ˙ÔÊÚ¤-
ÓÂÈ· Ô˘ Û˘ÌÌÂÙ›¯·Ó Û ÚÔÁÚ¿ÌÌ·Ù· Á‡ÌÓ·Û˘,
·ÚÔ˘Û›·Û·Ó ¿ÌÂÛË Î·È Î·Ï‡ÙÂÚË Â·Ê‹ Ì ÙȘ
ÔÈÎÔÁ¤ÓÂȘ Î·È ÙÔ˘˜ Ê›ÏÔ˘˜ ÙÔ˘˜ Î·È ‹Ù·Ó ÎÔÈÓˆ-
ÓÈο ÈÔ ÂÓÂÚÁÔ› ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÌÂϤ-
Ù˘58,59.
™ÙÔÓ ÙÔ̤· ÙˆÓ Û˘Ó·ÈÛıËÌ¿ÙˆÓ Î·È Ù˘ ·Ó·-
„˘¯‹˜, ÔÈ ·ÛıÂÓ›˜ ·ÚÔ˘Û›·Û·Ó Ôχ ÌÂȈ̤Ó˜
ÙÈ̤˜ ÛÙËÓ ·Ú¯‹ Ù˘ ÌÂϤÙ˘. ™˘ÁÎÂÎÚÈ̤ӷ, ‰È·-
ÈÛÙÒıËΠfiÙÈ ‹Ù·Ó Û˘Ó·ÈÛıËÌ·ÙÈο ·ÔÎÔÌ̤-
ÓÔÈ ·fi ÙÔ˘˜ ¿ÏÏÔ˘˜, ·ÚÔ˘Û›·˙·Ó ¿ÚÓËÛË ÁÈ·
Û˘ÌÌÂÙÔ¯‹ Û ‰Ú·ÛÙËÚÈfiÙËÙ˜ ·Ó·„˘¯‹˜ Î·È ‰ÂÓ
›¯·Ó ¯fiÌÈ. ∂Ï¿¯ÈÛÙÔÈ ‹Ù·Ó ÔÈ ·ÛıÂÓ›˜ Ô˘ ÏÂÈ-
ÙÔ˘ÚÁÔ‡Û·Ó Û ÔÌ¿‰Â˜. ∞Ó¿ÏÔÁ· Â›Ó·È Ù· ·ÔÙÂ-
ϤÛÌ·Ù· Î·È ¿ÏÏˆÓ ÂÚ¢ÓÒÓ, fiÔ˘ ‰È·ÈÛÙÒÓÂ-
Ù·È fiÙÈ ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ Û¯È˙ÔÊÚÂÓ›˜ Â›Ó·È Û˘-
Ó·ÈÛıËÌ·ÙÈο ·ÔÌÔӈ̤ÓÔÈ, ‰ÂÓ Û˘˙ËÙÔ‡Ó Ù·
ÚÔ‚Ï‹Ì·Ù¿ ÙÔ˘˜ Î·È ‰ÂÓ ¤¯Ô˘Ó ÂӉȷʤÚÔÓÙ·60.
∞˘Ùfi ·Ô‰›‰ÂÙ·È Î˘Ú›ˆ˜ ÛÙ· Û˘ÌÙÒÌ·Ù· Ù˘
›‰È·˜ Ù˘ ¿ıËÛ˘, ·ÏÏ¿ Î·È ÛÙȘ ÂÈÙÒÛÂȘ ÙˆÓ
Ê·Ú̿ΈÓ, Ô˘ Ô‰ËÁÔ‡Ó ÙÔ˘˜ ·ÛıÂÓ›˜ Û ÌË Â˘-
¯¤ÚÂÈ· ÏfiÁÔ˘, ·ÔÌfiÓˆÛË Î·È ¤ÏÏÂÈ„Ë ÂӉȷÊÂ-
ÚfiÓÙˆÓ.
∏ Û˘ÌÌÂÙÔ¯‹ ÙˆÓ ·ÛıÂÓÒÓ ÛÙÔ Ì·ÎÚÔ¯ÚfiÓÈÔ
ÚfiÁÚ·ÌÌ· ¿ÛÎËÛ˘ Û˘ÓÂÙ¤ÏÂÛ ÛÙËÓ ·‡ÍËÛË ÙˆÓ
‰ÂÈÎÙÒÓ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ٷ Û˘Ó·ÈÛı‹Ì·Ù· ηÈ
ÙËÓ ·Ó·„˘¯‹. ªÂÙ¿ ÙË Á‡ÌÓ·ÛË, ÔÈ ·ÛıÂÓ›˜ Ù˘
·ÚÔ‡Û·˜ ÌÂϤÙ˘ ·ÚÔ˘Û›·Û·Ó ÙËÓ ÂÈÎfiÓ· ÈÔ
ÎÔÈÓˆÓÈÎÒÓ ·ÙfïÓ, Û˘Ó·ÈÛıËÌ·ÙÈο ÂÍ·ÚÙÒÌÂ-
ÓˆÓ ·fi ÙËÓ ÔÌ¿‰·, ÛÙÔÈ¯Â›Ô Ô˘ Ê¿ÓËΠηٿ ÙË
‰È¿ÚÎÂÈ· ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ·fi ÙËÓ ·Ó¿ÁÎË Ó·
ÂÓÂÚÁÔ‡Ó Û·Ó ÔÌ¿‰·, ȉȷ›ÙÂÚ· ̤۷ ·fi ÙȘ ·ıÏÔ-
·È‰È¤˜. ∂ÈϤÔÓ, Ù· ÂӉȷʤÚÔÓÙ¿ ÙÔ˘˜ ·˘Í‹ıË-
Î·Ó Î·È ÚfiÛıÂÛ·Ó ÛÙËÓ Î·ıËÌÂÚÈÓ‹ ÙÔ˘˜ ˙ˆ‹ ÙÔ
ÛÙÔÈ¯Â›Ô Ù˘ ¿ÛÎËÛ˘, ˆ˜ ̤ÛÔ „˘¯·ÁˆÁ›·˜ ηÈ
·Ó·„˘¯‹˜. ªÂϤÙ˜ Ô˘ ¤ÁÈÓ·Ó Û ¿ÏϘ ÔÌ¿‰Â˜
„˘¯È·ÙÚÈÎÒÓ ·ÛıÂÓÒÓ ‚Ú‹Î·Ó fiÙÈ Ë Á‡ÌÓ·ÛË ÛÂ
ÔÌ¿‰Â˜ ÂËÚ¿˙ÂÈ ¿ÌÂÛ· ÙÔÓ ÙÔ̤· ÙˆÓ Û˘Ó·ÈÛıË-
Ì¿ÙˆÓ Î·È Ù˘ „˘¯·ÁˆÁ›·˜47. ∂›Û˘, Û ۯÈ˙ÔÊÚÂ-
Ó›˜ ·ÛıÂÓ›˜, ‚Ú¤ıËΠfiÙÈ Ë ‰˘Ó·ÌÈ΋ Ù˘ ÔÌ¿‰·˜,
ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ Á‡ÌÓ·Û˘, ÂÓÈÛ¯‡ÂÈ ÙÔÓ ÂÓ-
ıÔ˘ÛÈ·ÛÌfi, ÙÔ ÂӉȷʤÚÔÓ ÁÈ· ¿ÛÎËÛË Î·È ÙË ‰È·-
ÛΤ‰·ÛË61.
°ÂÓÈο, ·fi Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ·ÚÔ‡Û·˜
ÌÂϤÙ˘ ‰È·ÈÛÙÒıËΠÌÈ· Û˘Ó¯‹˜ ‚ÂÏÙ›ˆÛË ÙˆÓ
ÂÈ̤ÚÔ˘˜ ·Ú·Ì¤ÙÚˆÓ Ù˘ ÔÈfiÙËÙ·˜ ˙ˆ‹˜, ·ÏÏ¿
Î·È Ù˘ ÏÂÈÙÔ˘ÚÁÈ΋˜ ÈηÓfiÙËÙ·˜ ÙˆÓ Û¯È˙ÔÊÚÂÓÒÓ
̤ۈ Ù˘ ¿ÛÎËÛ˘, ÁÂÁÔÓfi˜ Ô˘ ÂȂ‚·ÈÒÓÂÈ ÙËÓ
·Ó¿ÁÎË ¤ÓÙ·Í˘ ÚÔÁÚ·ÌÌ¿ÙˆÓ ¿ÛÎËÛ˘ ÛÙÔ Î·-
ıËÌÂÚÈÓfi ÙÔ˘˜ ÚfiÁÚ·ÌÌ·. OÈ Bobes ηÈ
Gonzalez62 Î·È ÔÈ Meltzer Î·È Û˘Ó.63 ˘ÔÛÙËÚ›˙Ô˘Ó
fiÙÈ Ë Î·Ï‡ÙÂÚË ÔÈfiÙËÙ· ˙ˆ‹˜ ÙˆÓ Û¯È˙ÔÊÚÂÓÒÓ
·ÛıÂÓÒÓ Î·È Ë ˘ÔÎÂÈÌÂÓÈ΋ ÙÔ˘˜ ¢ËÌÂÚ›· ÂÍ·Ú-
Ù¿Ù·È ÂÚÈÛÛfiÙÂÚÔ ·fi ÙȘ ‰Ú·ÛÙËÚÈfiÙËÙ˜ Ì ÙȘ
Ôԛ˜ ·Û¯ÔÏÔ‡ÓÙ·È, ÙȘ ηϤ˜ Û¯¤ÛÂȘ Î·È Â·Ê¤˜
Ì ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi Î·È ÎÔÈÓˆÓÈÎfi ÙÔ˘˜ ÂÚÈ‚¿Ï-
ÏÔÓ, ·Ú¿ ·fi ÙÔ Â›Â‰Ô ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÙÔ˘˜,
ÛÙÔȯ›· Ô˘ ÂÓÈÛ¯‡ÔÓÙ·È ıÂÙÈο Ì ÙË Û˘ÌÌÂÙÔ¯‹
ÙÔ˘˜ Û ÚÔÁÚ¿ÌÌ·Ù· Á‡ÌÓ·Û˘.
™Ùfi¯Ô˜ ÏÔÈfiÓ ÙˆÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ ¿ÛÎËÛ˘
·ÛıÂÓÒÓ Ì ۯÈ˙ÔÊÚ¤ÓÂÈ· Â›Ó·È Ë ÎÈÓËÙÔÔ›ËÛË
ÙÔ˘ ·ÛıÂÓ‹, Ë ‚ÂÏÙ›ˆÛË Ù˘ Ê˘ÛÈ΋˜ Î·È „˘¯È΋˜
ÙÔ˘ ηٿÛÙ·Û˘ Î·È Ë ÎÔÈÓˆÓÈÎÔÔ›ËÛ‹ ÙÔ˘. Δ·
ÚÔÁÚ¿ÌÌ·Ù· ¿ÛÎËÛ˘ ÌÔÚÔ‡Ó Ó· ÂÓÙ·¯ıÔ‡Ó ÌÂ
Û¯ÂÙÈ΋ ¢ÎÔÏ›· ÛÙËÓ Î·ıËÌÂÚÈÓfiÙËÙ· ÙˆÓ ·ÛıÂ-
ÓÒÓ Ì „˘¯È·ÙÚÈο ÓÔÛ‹Ì·Ù·, Ì ÙËÓ ÚÔ¸fiıÂÛË
fiÙÈ ‰ÂÓ ˘¿Ú¯Ô˘Ó ·ÓÙÂӉ›ÍÂȘ64. ™˘ÁÎÂÎÚÈ̤ӷ,
Û˘ÓÈÛÙ¿Ù·È ¿ÛÎËÛË Î˘Ú›ˆ˜ ·ÂÚfi‚È· Î·È ·Û΋ÛÂȘ
ÂÓ‰˘Ó¿ÌˆÛ˘, ̤ÙÚÈ·˜ ¤ÓÙ·Û˘, ‰È¿ÚÎÂÈ·˜ ÙÔ˘Ï¿-
¯ÈÛÙÔÓ ÙÚÈ¿ÓÙ· ÏÂÙÒÓ ÌÂ Û˘¯ÓfiÙËÙ· ÙÔ˘Ï¿¯ÈÛÙÔÓ 3
ÊÔÚ¤˜ ÙËÓ Â‚‰ÔÌ¿‰·42,64,65.
°ÂÓÈο, Ù· ¿ÙÔÌ· Ì ۯÈ˙ÔÊÚ¤ÓÂÈ· ·ÔÙÂÏÔ‡Ó
Ì›· ÛËÌ·ÓÙÈ΋ ÏËı˘ÛÌȷ΋ ÔÌ¿‰· Ì ·ÚÎÂÙ¿ Û˘-
ÓÔ‰¿ ÚÔ‚Ï‹Ì·Ù· ˘Á›·˜, Ô˘ ¯Ú‹˙ÂÈ fi¯È ÌfiÓÔ Ê·Ú-
̷΢ÙÈ΋˜ ÂÚ›ı·Ï„˘, ·ÏÏ¿ Î·È ÈÔ ‹ÈˆÓ ·ÚÂÌ-
‚¿ÛÂˆÓ Ì ÛÙfi¯Ô ÙË ıÂÙÈ΋ ·ÏÏ·Á‹ ÙÔ˘ ÙÚfiÔ˘ ˙ˆ-
‹˜. ∏ Ì·ÎÚÔ¯ÚfiÓÈ· Á‡ÌÓ·ÛË ÙˆÓ ·ÛıÂÓÒÓ Ì ¯Úfi-
ÓÈ· Û¯È˙ÔÊÚ¤ÓÂÈ· ·ÔÙÂÏ› ÌÈ· ·ÔÙÂÏÂÛÌ·ÙÈ΋,
ÚÔÛÈÙ‹, ·ÛÊ·Ï‹ Î·È Â˘¯¿ÚÈÛÙË ıÂÚ·¢ÙÈ΋ Û˘-
ÌÏËڈ̷ÙÈ΋ ·Ú¤Ì‚·ÛË ÁÈ· ÙË ‚ÂÏÙ›ˆÛË Ù˘ ÔÈ-
fiÙËÙ·˜ ˙ˆ‹˜ Î·È Ù˘ ÏÂÈÙÔ˘ÚÁÈ΋˜ ÈηÓfiÙËÙ¿˜ ÙÔ˘˜.
ABSTRACT
Mameletzi D, Theochari V, Kouidi E, K·ndilis D,
Sipka Ch, Kaltsatou ∞, Kaprinis G, Deligiannis ∞.
Effect of long-term exercise training on functional
capacity and quality of life in schizophrenics. Hell
Iatr 2009, 75: 74-83.
 ∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 75, 1
The aim of this study was to evaluate the ef-
fects of long-term exercise training on the function-
al capacity and quality of life in patients with schizo-
phrenia. Thirty patients (n=30), aged 59.6±14.9
years, were randomly assigned into two equal num-
bered groups. Group A participated in an 18-month
exercise training program, while group B served as
controls. At the onset, the middle and the end of the
study, all patients underwent estimation of their
functional capacity with the 6-minute walking test
(6MWT) and they filled-out a quality of life evalua-
tion questionnaire for pleasure and satisfaction (Q-
LES-Q). At baseline, there was no significant diffe-
rence between the two groups in all demographic
and clinical measurements. At the end of the study,
body weight in group A was reduced by 4.1% (p<
0.05). After 18 months of exercise training, group A
showed a significant increase by 44% (p< 0.05) in
the distance covered during the 6-MWT. Regarding
perceived quality of life, at the end of the study,
group A showed an improvement of 20% (p<0.05)
in the activity field, 19% (p<0.05) in emotions, 20%
(p< 0.05) in work, 51% (p<0.05) in recreation, 23%
(p< 0.05) in social relationships and 15% (p<0.05)
in general activities. These results indicate that sy-
stematic long-term exercise training is feasible and
effective in increasing the functional capacity of
schizophrenic patients and greatly contributes to
improvement of their quality of life.
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·Û˘Ìو̷ÙÈÎÔ‡ ÚÔÏËÙÈÎÔ‡ ÏËı˘ÛÌÈ·ÎÔ‡ Â-
ϤÁ¯Ô˘ Î·È ÙËÓ ÂÓË̤ڈÛË-¢·ÈÛıËÙÔÔ›ËÛË. ∏
·ÍÈÔÏfiÁËÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ÙÔ˘ ÚÔÁÚ¿ÌÌ·-
ÙÔ˜ ¤‰ÂÈÍ fiÙÈ Ô ÛÙfi¯Ô˜ ÙÔ˘ 15% ‰ÂÓ ÂÈÙ‡¯ıËÎÂ,
fï˜ ÛËÌÂÈÒıËΠÌÈ· Ì›ˆÛË ÙˆÓ ·Ó·ÌÂÓfiÌÂÓˆÓ
ı·Ó¿ÙˆÓ ·fi ηÚΛÓÔ Î·Ù¿ 92573, ÂÓÒ ÙˆÙÈ΋ Ù¿-
ÛË ÂÌÊ·Ó›˙Ô˘Ó ÔÈ ‰Â›ÎÙ˜ ıÓËÛÈÌfiÙËÙ·˜ ·fi ηÚ-
ΛÓÔ ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ Â˘Úˆ·˚Τ˜ ¯ÒÚ˜7.
¢Â‰Ô̤Ó˘ Ù˘ ¤ÏÏÂȄ˘ ÂÓfi˜ ÂÓÈ·›Ô˘ ‰ÈÎÙ‡Ô˘
ηٷÁÚ·Ê‹˜ ÙÔ˘ ηÚΛÓÔ˘ ÛÙËÓ ∂ÏÏ¿‰·, ÌÈ· Èη-
ÓÔÔÈËÙÈ΋ ÚÔÛ¤ÁÁÈÛË Ô˘ ÌÔÚ› Ó· ‰ÒÛÂÈ ıÂÌÈ-
Ù¿ Û˘ÁÎÚÈÙÈο ·ÔÙÂϤÛÌ·Ù· Â›Ó·È Ë ÂÎÙ›ÌËÛË Ù˘
ıÓËÛÈÌfiÙËÙ·˜ ·fi ÙÔ˘˜ ¤ÓÙÂ Û˘¯ÓfiÙÂÚ· ÂÌÊ·ÓÈ-
˙fiÌÂÓÔ˘˜ ηÚΛÓÔ˘˜ ÛÙË ¯ÒÚ· Ì·˜ ·fi ÙÔ 1980 ̤-
¯ÚÈ Û‹ÌÂÚ·. ∏ ·Ó¿Ï˘ÛË Ù˘ ‰È·¯ÚÔÓÈ΋˜ ÂͤÏÈ͢
Ù˘ ıÓËÛÈÌfiÙËÙ·˜ ÛÙËÓ ∂ÏÏ¿‰· Î·È Ë Û˘ÁÎÚÈÙÈ΋
ÌÂϤÙË, Ï·Ì‚¿ÓÔÓÙ·˜ ˘fi„Ë Ù· ·ÓÙ›ÛÙÔȯ· ‰ÈÂıÓ‹
‰Â‰Ô̤ӷ, ÌÔÚ› Ó· ‰ÒÛÂÈ ÌÈ· ·ÓÙÈÚÔÛˆ¢ÙÈ΋
ÂÈÎfiÓ· ÁÈ· ÙËÓ ÏËı˘ÛÌȷ΋ ¤ÎÊÚ·ÛË ÙÔ˘ ηÚΛ-
ÓÔ˘, Ô‰ËÁÒÓÙ·˜ ÛÂ Û˘ÌÂÚ¿ÛÌ·Ù· ȉȷ›ÙÂÚ· ¯Ú‹-
ÛÈÌ· ÁÈ· ÙÔ Û¯Â‰È·ÛÌfi ÙˆÓ ˘ËÚÂÛÈÒÓ ˘Á›·˜ ηÈ
ÙËÓ ÔÚÈÔı¤ÙËÛË ÚÔÙÂÚ·ÈÔÙ‹ÙˆÓ ÛÙÔÓ ÙÔ̤· Ù˘
ÚfiÏ˄˘.
À§π∫O ∫∞π ª∂£√¢√π
™ÙËÓ ·ÚÔ‡Û· ¤Ú¢ӷ ÂÍÂÙ¿˙ÔÓÙ·È ÔÈ ‰È·¯ÚÔÓÈΤ˜ Ù¿ÛÂȘ Ù˘
ıÓËÛÈÌfiÙËÙ·˜ ÙˆÓ Î·ÎÔ‹ıˆÓ ÓÂÔÏ·ÛÌ¿ÙˆÓ:
1. ∫·ÚΛÓÔ˜ ÙÔ˘ Ó‡ÌÔÓ· (ICD9: 101)
2. ∫·ÚΛÓÔ˜ ÙÔ˘ ÚÔÛÙ¿ÙË (ICD9: 124)
3. ∫·ÚΛÓÔ˜ ÙÔ˘ ÛÙÔÌ¿¯Ô˘ (ICD9: 091)
4. ∫·ÚΛÓÔ˜ ÙÔ˘ ·¯¤Ô˜ ÂÓÙ¤ÚÔ˘ - ÔÚıÔ‡ (ICD9: 093)
5. ∫·ÚΛÓÔ˜ ÙÔ˘ Á˘Ó·ÈΛԢ Ì·ÛÙÔ‡ (ICD9: 113).
ÀÔÏÔÁ›ÛıËÎ·Ó ÁÈ· οı ¯ÚÔÓÔÏÔÁÈÎfi ¤ÙÔ˜ ÔÈ ÂȉÈÎÔ›
Û˘ÓÙÂÏÂÛÙ¤˜ ıÓËÛÈÌfiÙËÙ·˜ ÁÈ· οı ÓfiÛËÌ· ÛÙ· ‰‡Ô ʇϷ
¯ˆÚÈÛÙ¿ Î·È ÌÂÏÂÙ‹ıËÎ·Ó ÙÚÂȘ ËÏÈÎȷΤ˜ ÔÌ¿‰Â˜ 25-54, 55-
85
74 Î·È ¿Óˆ ÙˆÓ 75 ÂÙÒÓ.
Δ· ‰Â‰Ô̤ӷ ÙfiÛÔ ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ı·Ó¿ÙˆÓ (·ÚÈıÌË-
Ù‹˜), fiÛÔ Î·È ÙÔ˘ ·ÓÙ›ÛÙÔÈ¯Ô˘ ̤ÛÔ˘ ÂÙ‹ÛÈÔ˘ ÏËı˘ÛÌÔ‡ ÁÈ·
ÙËÓ Î¿ı ËÏÈÎȷ΋ ÔÌ¿‰· Î·È Ê‡ÏÔ (·Ú·ÓÔÌ·ÛÙ‹˜), ÚÔ¤Ú-
¯ÔÓÙ·È ·fi Ù· ·Ú¯Â›· Ù˘ ∂ıÓÈ΋˜ ™Ù·ÙÈÛÙÈ΋˜ ÀËÚÂÛ›·˜
∂ÏÏ¿‰Ô˜ (∂™À∂) ÁÈ· fiÏ· Ù· ¤ÙË ·fi ÙÔ 1980-2005.
∞¶OΔ∂§∂™ª∞Δ∞
™ÙÔ˘˜ ¿Ó‰Ú˜ ËÏÈΛ·˜ 25-54 Ô Î·ÚΛÓÔ˜ ÙÔ˘ Ó‡-
ÌÔÓ· ·ÚÔ˘ÛÈ¿˙ÂÈ ÌÈ· ·˘ÍËÙÈ΋ Ù¿ÛË ÙÔ˘ Û˘ÓÙÂÏÂ-
ÛÙ‹ ıÓËÛÈÌfiÙËÙ·˜ ·fi ÙÔ 1980 ¤ˆ˜ Î·È ÙÔ 2000 Ë
ÔÔ›· ·Ó·ÎfiÙÂÙ·È Ù· ÙÂÏÂ˘Ù·›· ¤ÓÙ ¯ÚfiÓÈ· ¤ÙÛÈ
ÒÛÙ ÙÔ 2005 Ô ∂.™.£. Ó· Êı¿ÛÂÈ ÙÔ˘˜ 19 ı·Ó¿ÙÔ˘˜
·Ó¿ 100.000 ¿Ó‰Ú˜ ËÏÈΛ·˜ 25-54. Δ· ÓÂÔÏ¿ÛÌ·-
Ù· ÙÔ˘ ÚÔÛÙ¿ÙË, ÙÔ˘ ·¯¤Ô˜ ÂÓÙ¤ÚÔ˘ Î·È ÙÔ˘ ÛÙÔ-
Ì¿¯Ô˘ Â›Ó·È Û¯ÂÙÈο Û¿ÓÈ· ÛÙȘ ËÏÈ˘ οو ÙˆÓ
50 ÂÙÒÓ Î·È Ë ıÓËÛÈÌfiÙËÙ· Î˘Ì·›ÓÂÙ·È Û Â›‰·
¯·ÌËÏfiÙÂÚ· ·fi 5 ı·Ó¿ÙÔ˘˜ ·Ó¿ 100.000 Ì ÂÌÊ·-
Ó‹ ÙÒÛË Ù˘ ıÓËÛÈÌfiÙËÙ·˜ ÙÔ˘ ηÚΛÓÔ˘ ÙÔ˘ ÛÙÔ-
Ì¿¯Ô˘ (EÈÎ. 1).
™ÙȘ Á˘Ó·›Î˜ ËÏÈΛ·˜ 25-54 Ë ıÓËÛÈÌfiÙËÙ· ·fi
ηÚΛÓÔ ÙÔ˘ Ì·ÛÙÔ‡ ÂÌÊ·Ó›˙ÂÈ ·fi ÙÔ 1987 ¤ˆ˜ Û‹-
ÌÂÚ· ÌÈ· ÛËÌ·ÓÙÈ΋ ÙˆÙÈ΋ ÔÚ›· Î·È Ô ∂.™.£.
·ÚÔ˘ÛÈ¿˙ÂÈ ÌÈ· ÙÒÛË Î·Ù¿ 38,9%. Δ· ÓÂÔÏ¿-
ÛÌ·Ù· ÙÔ˘ Ó‡ÌÔÓ·, ÙÔ˘ ·¯¤Ô˜ ÂÓÙ¤ÚÔ˘ Î·È ÙÔ˘
ÛÙÔÌ¿¯Ô˘ ÂÌÊ·Ó›˙Ô˘Ó ıÓËÛÈÌfiÙËÙ· Ô˘ Î˘Ì·›ÓÂÙ·È,
fiˆ˜ Î·È ÛÙÔ˘˜ ¿Ó‰Ú˜ Ù˘ ›‰È·˜ ËÏÈÎȷ΋˜ ÔÌ¿‰·˜,
Û Ôχ ¯·ÌËÏ¿ Â›‰· οو ÙˆÓ ¤ÓÙ ı·Ó¿ÙˆÓ
·Ó¿ 100.000 Á˘Ó·›Î˜ ËÏÈΛ·˜ 25-54 (EÈÎ. 2).
™ÙÔ˘˜ ¿Ó‰Ú˜ ËÏÈΛ·˜ 55-74, Ë ıÓËÛÈÌfiÙËÙ·
·fi ηÚΛÓÔ ÙÔ˘ Ó‡ÌÔÓ· ·ÚÔ˘ÛÈ¿˙ÂÈ ‰È·¯ÚÔÓÈ-
ο ÙËÓ ÂÚ›Ô‰Ô 1980-2005 ÌÈ· ÛÙ·ıÂÚ‹ ÔÚ›· ÌÂ
ÌÈÎÚ¤˜ ‰È·Î˘Ì¿ÓÛÂȘ ÙÔ˘ ∂.™.£. Á‡Úˆ ·fi ÙÔ˘˜
250 ı·Ó¿ÙÔ˘˜ ·Ó¿ 100.000 ¿Ó‰Ú˜. ∏ ıÓËÛÈÌfiÙËÙ·
·fi ÙÔÓ Î·ÚΛÓÔ ÙÔ˘ ·¯¤Ô˜ ÂÓÙ¤ÚÔ˘ ·ÚÔ˘ÛÈ¿˙ÂÈ
ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË Î·Ù¿ 72,9% ηٿ ÙË ‰È¿ÚÎÂÈ·
Ù˘ 25ÂÙ›·˜, ÂÓÒ Ô Î·ÚΛÓÔ˜ ÙÔ˘ ÚÔÛÙ¿ÙË ÂÌÊ·Ó›-
˙ÂÈ ÌÈÎÚ¤˜ ‰È·Î˘Ì¿ÓÛÂȘ ÛÙȘ ÙÈ̤˜ ÙÔ˘ ∂.™.£. Á‡-
Úˆ ·fi ÙÔ˘˜ 30 ı·Ó¿ÙÔ˘˜ ·Ó¿ 100.000 ¿Ó‰Ú˜ ·˘-
Ù‹˜ Ù˘ ËÏÈÎȷ΋˜ ÔÌ¿‰·˜. O ηÚΛÓÔ˜ ÙÔ˘ ÛÙÔÌ¿-
¯Ô˘ ÂÌÊ·Ó›˙ÂÈ ÌÈ· ÛËÌ·ÓÙÈ΋ Î·È ÛÙ·ıÂÚ‹ ÙˆÙÈ΋
ÔÚ›· ÛÙÔ˘˜ ÂÙ‹ÛÈÔ˘˜ ∂.™.£. ΔÔ 1980 Ô ∂.™.£.
˘ÔÏÔÁ›ÛıËΠ۠54,7 ı·Ó¿ÙÔ˘˜ ·Ó¿ 100.000 ¿ÙÔ-
Ì· ÂÓÒ ÙÔ 2005 Û 31,7 ı·Ó¿ÙÔ˘˜, ÌÈ· ÙÒÛË Î·Ù¿
42% (EÈÎ. 3).
™ÙȘ Á˘Ó·›Î˜ ËÏÈΛ·˜ 55-74, Ë ıÓËÛÈÌfiÙËÙ·
·fi ηÚΛÓÔ ÙÔ˘ Ì·ÛÙÔ‡ ‰ÂÓ ÂÌÊ·Ó›˙ÂÈ ÙÒÛË ÛÂ
·ÓÙ›ıÂÛË Ì ÙËÓ ÚÔËÁÔ‡ÌÂÓË ËÏÈÎȷ΋ ÔÌ¿‰· ÙˆÓ
Á˘Ó·ÈÎÒÓ ËÏÈΛ·˜ 25-54. O ∂.™.£. ·fi ηÚΛÓÔ ÙÔ˘
Ì·ÛÙÔ‡ ÂÌÊ·Ó›˙ÂÈ ‰È·¯ÚÔÓÈο ÌÈÎÚ¤˜ ‰È·Î˘Ì¿Ó-
ÛÂȘ Á‡Úˆ ·fi ÙÔ˘˜ 60 ı·Ó¿ÙÔ˘˜ ·Ó¿ 100.000 ¿ÙÔ-
86 N. ¶∞¶∞¢∞∫∏™ ∫∞π ™À¡.

Κακοήθη νεοπλάσματα, Άνδρες (25-54)

30

25

20
Ε.Σ.Θ.

15

10 Πνεύμονας
Προστάτης
5 Παχύ έντερο
Στόμαχος
0
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
EÈÎ. 1. ¢È·¯ÚÔÓÈΤ˜ Ù¿ÛÂȘ Ù˘ ıÓËÛÈÌfiÙËÙ·˜ ·fi Ù· ηÎÔ‹ıË ÓÂÔÏ¿ÛÌ·Ù· ÙÔ˘ Ó‡ÌÔÓ·, ÙÔ˘ ÚÔÛÙ¿ÙË, ÙÔ˘ ÛÙÔ-
Ì¿¯Ô˘ Î·È ÙÔ˘ ·¯¤Ô˜ ÂÓÙ¤ÚÔ˘ ÛÙÔ˘˜ ¿Ó‰Ú˜ ËÏÈΛ·˜ 25-54.

Κακοήθη νεοπλάσματα, Γυναίκες (25-54)

25

20

15
Ε.Σ.Θ.

10

Πνεύμονας
5 Μαστός
Παχύ έντερο
0 Στόμαχος
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005

EÈÎ. 2. ¢È·¯ÚÔÓÈΤ˜ Ù¿ÛÂȘ Ù˘ ıÓËÛÈÌfiÙËÙ·˜ ·fi Ù· ηÎÔ‹ıË ÓÂÔÏ¿ÛÌ·Ù· ÙÔ˘ Ó‡ÌÔÓ·, ÙÔ˘ Ì·ÛÙÔ‡, ÙÔ˘ ÛÙÔÌ¿-
¯Ô˘ Î·È ÙÔ˘ ·¯¤Ô˜ ÂÓÙ¤ÚÔ˘ ÛÙȘ Á˘Ó·›Î˜ ËÏÈΛ·˜ 25-54.

Κακοήθη νεοπλάσματα, Άνδρες (55-74)

280
260
240
220
200
180
160
Ε.Σ.Θ.

140
120
100
80 Πνεύμονας
60
Προστάτης
40
20 Παχύ έντερο
0 Στόμαχος
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005

EÈÎ. 3. ¢È·¯ÚÔÓÈΤ˜ Ù¿ÛÂȘ Ù˘ ıÓËÛÈÌfiÙËÙ·˜ ·fi Ù· ηÎÔ‹ıË ÓÂÔÏ¿ÛÌ·Ù· ÙÔ˘ Ó‡ÌÔÓ·, ÙÔ˘ ÚÔÛÙ¿ÙË, ÙÔ˘ ÛÙÔ-
Ì¿¯Ô˘ Î·È ÙÔ˘ ·¯¤Ô˜ ÂÓÙ¤ÚÔ˘ ÛÙÔ˘˜ ¿Ó‰Ú˜ ËÏÈΛ·˜ 55-74.
 ∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 75, 1 87

Ì·. ∏ ıÓËÛÈÌfiÙËÙ· ·fi ηÚΛÓÔ ÙÔ˘ Ó‡ÌÔÓ· ·- ÓÙÂÏÂÛÙ‹ ıÓËÛÈÌfiÙËÙ·˜ ÁÈ· ÙÔÓ Î·ÚΛÓÔ ÙÔ˘ Ó‡-
ÚÔ˘ÛÈ¿˙ÂÈ Ù· ¤ÙË 1980-1988 ÌÈ· ·˘ÍËÙÈ΋ Ù¿ÛË ·fi ÌÔÓ·, ÙÔ˘ ÚÔÛÙ¿ÙË Î·È ÙÔ˘ ·¯¤Ô˜ ÂÓÙ¤ÚÔ˘. O
26/100.000 Û 32/100.000 ı·Ó¿ÙÔ˘˜ ÂÓÒ ÌÂÙ¤ÂÈÙ· ηÚΛÓÔ˜ ÙÔ˘ ÛÙÔÌ¿¯Ô˘ ÂÌÊ·Ó›˙ÂÈ Î·È Û ·˘Ù‹Ó ÙËÓ
Ô ∂.™.£. ·ÚÔ˘ÛÈ¿˙ÂÈ ÛÙ·ıÂÚ‹ ÔÚ›·, ¯ˆÚ›˜ Ù¿- ËÏÈÎȷ΋ ÔÌ¿‰· Û·Ê‹ ÙÒÛË ÛÙË ıÓËÛÈÌfiÙËÙ·. ∂È-
ÛÂȘ ο̄˘. ∏ ıÓËÛÈÌfiÙËÙ· ·fi ηÚΛÓÔ ÙÔ˘ ·- ‰ÈÎfiÙÂÚ· ηٿ ÙËÓ ¯ÚÔÓÈ΋ ÂÚ›Ô‰Ô 1980-2005 Ô
¯¤Ô˜ ÂÓÙ¤ÚÔ˘ ·ÚÔ˘ÛÈ¿˙ÂÈ ÌÈ· ÛÙ·ıÂÚ¿ ·ÓÔ‰È΋ ∂.™.£. ÁÈ· ÙÔÓ Î·ÚΛÓÔ ÙÔ˘ Ó‡ÌÔÓ· ·˘Í‹ıËÎÂ
ÔÚ›· ΢ڛˆ˜ ¤ˆ˜ ÙÔ 2000, ÂÓÒ Ù· ÙÂÏÂ˘Ù·›· ¯Úfi- ηٿ 38%, ÁÈ· ÙÔÓ Î·ÚΛÓÔ ÙÔ˘ ÚÔÛÙ¿ÙË Î·Ù¿ 78%
ÓÈ· ·Ú·ÙËÚ‹ıËΠÌÈ· ·Ó·ÎÔ‹ ·˘Ù‹ Ù˘ ·Ófi‰Ô˘. ·fi 187 ı·Ó¿ÙÔ˘˜ ·Ó¿ 100.000 ¿Ó‰Ú˜ ËÏÈΛ·˜ ¿Óˆ
O ηÚΛÓÔ˜ ÙÔ˘ ÛÙÔÌ¿¯Ô˘ Î·È ÛÙÔ Á˘Ó·ÈÎÂ›Ô ÏË- ÙˆÓ 75 ÂÙÒÓ ÙÔ 1980 Û 334 ı·Ó¿ÙÔ˘˜ ÙÔ 2005. ∞Ó¿-
ı˘ÛÌfi ·˘Ù‹˜ Ù˘ ËÏÈÎȷ΋˜ ÔÌ¿‰·˜ ÂÌÊ·Ó›˙ÂÈ Ùˆ- ÏÔÁË ·˘ÍËÙÈ΋ Ù¿ÛË ·ÎÔÏÔ‡ıËÛÂ Î·È Ô ∂.™.£. ÁÈ·
ÙÈ΋ ÔÚ›· ·Ó¿ÏÔÁË ·˘Ù‹˜ Ô˘ ·Ú·ÙËÚ‹ıËΠÙÔÓ Î·ÚΛÓÔ ÙÔ˘ ·¯¤Ô˜ ÂÓÙ¤ÚÔ˘ Ì ÔÛÔÛÙÈ·›· ·‡-
ÛÙÔÓ ·Ó‰ÚÈÎfi ÏËı˘ÛÌfi Ì ÙÒÛË ÙÔ˘ ∂.™.£. ÛÙËÓ ÍËÛË Î·Ù¿ 116%. O ηÚΛÓÔ˜ ÙÔ˘ ÛÙÔÌ¿¯Ô˘ ·-
25ÂÙ›· ηٿ 48,5% (EÈÎ. 4). ÚÔ˘ÛÈ¿˙ÂÈ ÂÌÊ·Ó‹ ÙÒÛË ÛÙÔ˘˜ ÂÙ‹ÛÈÔ˘˜ ‰Â›ÎÙ˜
™ÙÔ˘˜ ¿Ó‰Ú˜ ËÏÈΛ·˜ ¿Óˆ ÙˆÓ 75 ÂÙÒÓ ·Ú·- ıÓËÛÈÌfiÙËÙ·˜ Î·È Î·Ù¿ ÙËÓ ÂÚ›Ô‰Ô 1980-2005 ·-
ÙËÚÂ›Ù·È ÛËÌ·ÓÙÈ΋ ·˘ÍËÙÈ΋ Ù¿ÛË ÙÔ˘ ÂȉÈÎÔ‡ Û˘- ÚÔ˘ÛÈ¿˙ÂÈ ÔÛÔÛÙÈ·›· ÙÒÛË 32,3% (EÈÎ. 5).

Κακοήθη νεοπλάσματα, Γυναίκες (55-74)

120
110
100
90
80
70
Ε.Σ.Θ.

60
50
40
30
Πνεύμονας
20 Μαστός
10 Παχύ έντερο
0 Στόμαχος
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005

EÈÎ. 4. ¢È·¯ÚÔÓÈΤ˜ Ù¿ÛÂȘ Ù˘ ıÓËÛÈÌfiÙËÙ·˜ ·fi Ù· ηÎÔ‹ıË ÓÂÔÏ¿ÛÌ·Ù· ÙÔ˘ Ó‡ÌÔÓ·, ÙÔ˘ Ì·ÛÙÔ‡, ÙÔ˘ ÛÙÔÌ¿-
¯Ô˘ Î·È ÙÔ˘ ·¯¤Ô˜ ÂÓÙ¤ÚÔ˘ ÛÙȘ Á˘Ó·›Î˜ ËÏÈΛ·˜ 55-74.

Κακοήθη νεοπλάσματα, Άνδρες (75+)

600

500

400
Ε.Σ.Θ.

300

200
Πνεύμονας
100 Προστάτης
Παχύ έντερο
0 Στόμαχος
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005

EÈÎ. 5. ¢È·¯ÚÔÓÈΤ˜ Ù¿ÛÂȘ Ù˘ ıÓËÛÈÌfiÙËÙ·˜ ·fi Ù· ηÎÔ‹ıË ÓÂÔÏ¿ÛÌ·Ù· ÙÔ˘ Ó‡ÌÔÓ·, ÙÔ˘ ÚÔÛÙ¿ÙË, ÙÔ˘ ÛÙÔ-
Ì¿¯Ô˘ Î·È ÙÔ˘ ·¯¤Ô˜ ÂÓÙ¤ÚÔ˘ ÛÙÔ˘˜ ¿Ó‰Ú˜ ËÏÈΛ·˜ ¿Óˆ ÙˆÓ 75 ÂÙÒÓ.
88 N. ¶∞¶∞¢∞∫∏™ ∫∞π ™À¡.

Κακοήθη νεοπλάσματα, Γυναίκες (75+)

180
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140
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100
Ε.Σ.Θ.

80
60
Πνεύμονας
40
Μαστός
20 Παχύ έντερο
0 Στόμαχος
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EÈÎ. 6. ¢È·¯ÚÔÓÈΤ˜ Ù¿ÛÂȘ Ù˘ ıÓËÛÈÌfiÙËÙ·˜ ·fi Ù· ηÎÔ‹ıË ÓÂÔÏ¿ÛÌ·Ù· ÙÔ˘ Ó‡ÌÔÓ·, ÙÔ˘ Ì·ÛÙÔ‡, ÙÔ˘ ÛÙÔÌ¿-
¯Ô˘ Î·È ÙÔ˘ ·¯¤Ô˜ ÂÓÙ¤ÚÔ˘ ÛÙȘ Á˘Ó·›Î˜ ËÏÈΛ·˜ ¿Óˆ ÙˆÓ 75 ÂÙÒÓ.

™ÙȘ Á˘Ó·›Î˜ ËÏÈΛ·˜ ¿Óˆ ÙˆÓ 75 ÂÙÒÓ Ù· ÓÂ- ∂˘ÚÒË Î·Ù¿ 11% ÙËÓ ÂÚ›Ô‰Ô 2000-2015 ›ӷÈ
ÔÏ¿ÛÌ·Ù· ÙÔ˘ Ì·ÛÙÔ‡, ÙÔ˘ ·¯¤Ô˜ ÂÓÙ¤ÚÔ˘ Î·È Ú·ÏÈÛÙÈÎfi˜8.
ÙÔ˘ ÛÙÔÌ¿¯Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÌÈ· ·ÍÈÔÛËÌ›ˆÙË ·‡- ΔËÓ ÂÚ›Ô‰Ô 1985-2000 ·Ú·ÙËÚ‹ıËΠÌÈ·
ÍËÛË ÙˆÓ ∂.™.£. ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÚÈfi‰Ô˘ ÙˆÙÈ΋ ÔÚ›· Ù˘ ıÓËÛÈÌfiÙËÙ·˜ ·fi ηÚΛÓÔ ÙÔ˘
1980-2005. ∞ÓÙ›ıÂÙ· ÛÙ·ıÂÚ‹ Â›Ó·È Ë ÙˆÙÈ΋ Ô- Ó‡ÌÔÓ· ÛÙÔÓ ·Ó‰ÚÈÎfi ÏËı˘ÛÌfi Ù˘ ∂˘Úˆ·˚-
Ú›· Ù˘ ıÓËÛÈÌfiÙËÙ·˜ ·fi ηÚΛÓÔ ÙÔ˘ ÛÙÔÌ¿¯Ô˘ ΋˜ ŒÓˆÛ˘. O ·ÚÈıÌfi˜ ÙˆÓ ı·Ó¿ÙˆÓ ÙËÓ ·Ú·-
ÛÙÔ Á˘Ó·ÈÎÂ›Ô ÏËı˘ÛÌfi Î·È ·˘Ù‹˜ Ù˘ ËÏÈÎȷ΋˜ ¿Óˆ ÂÚ›Ô‰Ô ÌÂÈÒıËΠηٿ 15% Û ۯ¤ÛË ÌÂ
ÔÌ¿‰·˜. O ∂.™.£. ÁÈ· ÙÔÓ Î·ÚΛÓÔ ÙÔ˘ Ì·ÛÙÔ‡ ÛË- ÙÔ˘˜ ·Ó·ÌÂÓfiÌÂÓÔ˘˜, ÂÓÒ Ô Î›Ó‰˘ÓÔ˜ ı·Ó¿ÙÔ˘ ·fi
Ì›ˆÛ ·‡ÍËÛË Ù˘ Ù¿Í˘ ÙÔ˘ 142%, ÁÈ· ÙÔÓ Î·ÚΛ- ηÚΛÓÔ ÙÔ˘ Ó‡ÌÔÓ· ÛÙÔ˘˜ ¿Ó‰Ú˜ ÌÂÈÒıËÎÂ Û˘-
ÓÔ ÙÔ˘ ·¯¤Ô˜ ÂÓÙ¤ÚÔ˘ 94% Î·È ÙÔ˘ Ó‡ÌÔÓ· ÓÔÏÈο ηٿ 17%. ªÂÁ·Ï‡ÙÂÚË ÙÒÛË ·Ú·ÙËÚ‹-
47,9%, ÂÓÒ ·ÓÙ›ıÂÙ· Ë ÙÒÛË ÙÔ˘ ∂.™.£. ÁÈ· ÙÔÓ ıËΠÛÙËÓ ∞ÁÁÏ›· Î·È ÙËÓ ºÈÏ·Ó‰›·, ÂÓÒ ·‡ÍËÛË
ηÚΛÓÔ ÙÔ˘ ÛÙÔÌ¿¯Ô˘ ÊÙ¿ÓÂÈ ÙÔ 61% (EÈÎ. 6). ·Ú·ÙËÚ‹ıËΠ΢ڛˆ˜ ÛÙËÓ ¶ÔÚÙÔÁ·Ï›· Î·È ÙËÓ
πÛ·Ó›· Î·È ·ÎÔÏÔ˘ıÔ‡Ó Ë °·ÏÏ›· Î·È Ë ∂ÏÏ¿‰·.
™À∑∏Δ∏™∏ ∞ÓÙ›ıÂÙ· ÛÙȘ Á˘Ó·›Î˜ Ô Î·ÚΛÓÔ˜ ÙÔ˘ Ó‡ÌÔÓ·
∏ ıÓËÛÈÌfiÙËÙ· ·fi ηÎÔ‹ıË ÓÂÔÏ¿ÛÌ·Ù· ÛÙȘ ÂÌÊ·Ó›˙ÂÈ ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË ÛÙÔ˘˜ ‰Â›ÎÙ˜ ıÓËÛÈ-
¯ÒÚ˜ Ù˘ ∂˘Úˆ·˚΋˜ ŒÓˆÛ˘ (∂.∂.) ÙË ‰ÂηÂ- ÌfiÙËÙ·˜ Û fiϘ Ù˘ ¯ÒÚ˜ Ù˘ ∂.∂. Ì ÙËÓ ÌÂÁ·Ï‡-
Ù›· 1988-1997 ÛËÌ›ˆÛ ÌÈ· ÙÒÛË Ù˘ ٿ͈˜ ÙÔ˘ ÙÂÚË ·‡ÍËÛË ÛÙËÓ OÏÏ·Ó‰›·. O ΛӉ˘ÓÔ˜ ı·Ó¿ÙÔ˘
9% ÛÙÔ Û‡ÓÔÏÔ ÙÔ˘ ÏËı˘ÛÌÔ‡. ∏ ÙˆÙÈ΋ ·˘Ù‹ ·fi ηÚΛÓÔ ÙÔ˘ Ó‡ÌÔÓ· ÛÙÔÓ Á˘Ó·ÈÎÂ›Ô ÏËı˘-
Ù¿ÛË Û˘Ó¯›ÛıËÎÂ Î·È ÙËÓ ÂfiÌÂÓË ÂÓÙ·ÂÙ›·. ÛÌfi Ù˘ ∂.∂. ÙËÓ ÂÚ›Ô‰Ô 1985-2000 ·˘Í‹ıËΠη-
™ÙÔÓ ·Ó‰ÚÈÎfi ÏËı˘ÛÌfi Ë Û˘ÓÔÏÈ΋ ıÓËÛÈÌfiÙËÙ· Ù¿ 29%7,9.
·fi ηÎÔ‹ıË ÓÂÔÏ¿ÛÌ·Ù· ÌÂÙ¿ ·fi ¤Ó· ̤ÁÈÛÙÔ O ηÚΛÓÔ˜ ÙÔ˘ ÚÔÛÙ¿ÙË ÛÙËÓ ∂.∂. ÙˆÓ 15
ÙÔ 1987 Ì 191,1 ı·Ó¿ÙÔ˘˜ ·Ó¿ 100.000 ¿ÙÔÌ· ÌÂÈ- ·ÚÔ˘Û›·Û ÌÈ· ÌÈÎÚ‹ ·‡ÍËÛË Ù˘ ıÓËÛÈÌfiÙËÙ·˜.
ÒıËΠÛÙÔ˘˜ 177,8/100.000 ÙÔ 1997 (-7%) Î·È ΔÔ 2000 ÔÈ ı¿Ó·ÙÔÈ ·fi ηÚΛÓÔ ÙÔ˘ ÚÔÛÙ¿ÙË
ÛÙÔ˘˜ 166,5/100.000 ÙÔ 2002. ∞ÓÙ›ÛÙÔȯ· ÔÈ ÙÈ̤˜ ‹Ù·Ó 7,5% ÂÚÈÛÛfiÙÂÚÔÈ ·fi ÙÔ˘˜ ·Ó·ÌÂÓfiÌÂÓÔ˘˜
Ù˘ ıÓËÛÈÌfiÙËÙ·˜ ÁÈ· ÙÔÓ Á˘Ó·ÈÎÂ›Ô ÏËı˘ÛÌfi ‹- Î·È Ô Î›Ó‰˘ÓÔ˜ ı·Ó¿ÙÔ˘ ·fi ηÚΛÓÔ ÙÔ˘ ÚÔÛÙ¿-
Ù·Ó 107,9 ı¿Ó·ÙÔÈ/100.000 Á˘Ó·›Î˜ ÙÔ 1987 Î·È ÙË ·˘Í‹ıËΠÛÙËÓ ∂.∂. ηٿ 5% ÙËÓ ÂÚ›Ô‰Ô 1985-
·Ú·ÙËÚ‹ıËΠÙÒÛË ÙÔ˘ ∂.™.£. ÛÙÔ˘˜ 100,5/ 2000. ∞‡ÍËÛË ·Ú·ÙËÚ‹ıËΠÛÙȘ ÂÚÈÛÛfiÙÂÚ˜
100.000 ÙÔ 1997 Î·È ÛÙÔ˘˜ 95,2/100.000 ÙÔ 2002, ¯ÒÚ˜ Ù˘ ∂.∂. Ì ÂÍ·›ÚÂÛË ÙËÓ °·ÏÏ›·, ÙËÓ πÙ·Ï›·,
ÙÒÛË Î·Ù¿ 7% ÙË ‰ÂηÂÙ›· 1988-1997 Î·È 5% ÙËÓ ÙÔ §Ô˘ÍÂÌ‚Ô‡ÚÁÔ Î·È ÙËÓ °ÂÚÌ·Ó›· 7,10.
ÂÓÙ·ÂÙ›· 1997-2002. ∞˘Ù‹ Ë ÙˆÙÈ΋ Ù¿ÛË ÙˆÓ O ηÚΛÓÔ˜ ÙÔ˘ Ì·ÛÙÔ‡ ÛÙËÓ ∂.∂. ÙˆÓ 15 ·-
‰ÂÈÎÙÒÓ ıÓËÛÈÌfiÙËÙ·˜ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÛÙȘ ÚÔ˘Û›·Û ÌÈ· ÌÈÎÚ‹ ÙÒÛË Ù˘ ıÓËÛÈÌfiÙËÙ·˜. ΔÔ
¯ÒÚ˜ Ù˘ ∂.∂. Â›Ó·È Ôχ ÂÓı·ÚÚ˘ÓÙÈ΋ Î·È ¤ÙÛÈ 2000 ÔÈ ı¿Ó·ÙÔÈ ·fi ηÚΛÓÔ ÙÔ˘ Ì·ÛÙÔ‡ ‹Ù·Ó η-
˘ÔÏÔÁ›˙ÂÙ·È fiÙÈ Ô ÛÙfi¯Ô˜ Ù˘ ÂÚ·ÈÙ¤Úˆ Ì›ˆÛ˘ Ù¿ 3% ¯·ÌËÏfiÙÂÚÔÈ ·fi ÙÔ˘˜ ·Ó·ÌÂÓfiÌÂÓÔ˘˜ Î·È Ô
Ù˘ ıÓËÛÈÌfiÙËÙ·˜ ·fi ηÎÔ‹ıË ÓÂÔÏ¿ÛÌ·Ù· ÛÙËÓ Î›Ó‰˘ÓÔ˜ ı·Ó¿ÙÔ˘ ·fi ηÚΛÓÔ ÙÔ˘ Ì·ÛÙÔ‡ ÛÙÔ Á˘-
 ∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 75, 1
Ó·ÈÎÂ›Ô ÏËı˘ÛÌfi Ù˘ ∂.∂. ÌÂÈÒıËΠηٿ 5% ÙËÓ
ÂÚ›Ô‰Ô 1985-2000. ™ËÌ·ÓÙÈÎfiÙÂÚ˜ ÌÂÈÒÛÂȘ ·-
Ú·ÙËÚ‹ıËÎ·Ó ÛÙÔ §Ô˘ÍÂÌ‚Ô‡ÚÁÔ, ÛÙËÓ ∞ÁÁÏ›· ηÈ
ÙËÓ ™Ô˘Ë‰›·, ÂÓÒ ¿ÓÔ‰Ô˜ ·Ú·ÙËÚ‹ıËΠÛÙËÓ
πÛ·Ó›·, ÙËÓ ¶ÔÚÙÔÁ·Ï›· Î·È ÙËÓ ∂ÏÏ¿‰· 7,11.
O ÔÚıÔÎÔÏÈÎfi˜ ηÚΛÓÔ˜ ·ÚÔ˘ÛÈ¿˙ÂÈ ÌÈ· ÌÈ-
ÎÚ‹ ÙÒÛË Ù˘ ıÓËÛÈÌfiÙËÙ·˜ ÛÙÔÓ ·Ó‰ÚÈÎfi ÏËı˘-
ÛÌfi Ù˘ ∂.∂. ÙˆÓ 15. ΔÔ 2000 ÔÈ ı¿Ó·ÙÔÈ ·fi ÔÚ-
ıÔÎÔÏÈÎfi ηÚΛÓÔ ‹Ù·Ó ηٿ 5,2% ¯·ÌËÏfiÙÂÚÔÈ ÛÂ
Û¯¤ÛË Ì ÙÔ˘˜ ·Ó·ÌÂÓfiÌÂÓÔ˘˜, ÂÓÒ ˘¿Ú¯Ô˘Ó ÛË-
Ì·ÓÙÈΤ˜ ‰È·ÊÔÚÔÔÈ‹ÛÂȘ ÌÂٷ͇ ÙˆÓ ¯ˆÚÒÓ. ΔËÓ
ÂÚ›Ô‰Ô 1985 – 2000 ÛËÌ·ÓÙÈÎfiÙÂÚ˜ ·˘Í‹ÛÂȘ ÙÔ˘
ÎÈÓ‰‡ÓÔ˘ ı·Ó¿ÙÔ˘ ·fi ÔÚıÔÎÔÏÈÎfi ηÚΛÓÔ ·-
ÚÔ˘Û›·Û·Ó Ë πÛ·Ó›·, Ë ¶ÔÚÙÔÁ·Ï›· Î·È Ë ∂ÏÏ¿-
‰·. ™ÙÔÓ Á˘Ó·ÈÎÂ›Ô ÏËı˘ÛÌfi Ë ıÓËÛÈÌfiÙËÙ· ·fi
ÔÚıÔÎÔÏÈÎfi ηÚΛÓÔ ÛËÌ›ˆÛ ÌÂÁ·Ï‡ÙÂÚË ÙÒÛË.
OÈ ·ÓÙ›ÛÙÔȯÔÈ ı¿Ó·ÙÔÈ ÙÔ 2000 ‹Ù·Ó ÌÂȈ̤ÓÔÈ Î·-
Ù¿ 16,45% Û ۯ¤ÛË Ì ÙÔ˘˜ ·Ó·ÌÂÓfiÌÂÓÔ˘˜, ÂÓÒ Ô
ΛӉ˘ÓÔ˜ ı·Ó¿ÙÔ˘ ÁÈ· ÙȘ Á˘Ó·›Î˜ ÙËÓ ÂÚ›Ô‰Ô
1985-2000 ·ÚÔ˘Û›·Û ÛËÌ·ÓÙÈ΋ ÙÒÛË Û fiϘ
Ù˘ ∂˘Úˆ·˚Τ˜ ¯ÒÚ˜ Ì ÂÍ·›ÚÂÛË ÙËÓ ∂ÏÏ¿‰·,
ÙËÓ ¶ÔÚÙÔÁ·Ï›· Î·È ÙËÓ πÛ·Ó›·7.
O ηÚΛÓÔ˜ ÙÔ˘ ÛÙÔÌ¿¯Ô˘ ·ÚÔ˘ÛÈ¿˙ÂÈ ÌÈ·
ÛËÌ·ÓÙÈ΋ ÙÒÛË Ù˘ ıÓËÛÈÌfiÙËÙ·˜ ÙfiÛÔ ÛÙÔÓ ·Ó-
‰ÚÈÎfi fiÛÔ Î·È ÛÙÔÓ Á˘Ó·ÈÎÂ›Ô ÏËı˘ÛÌfi Û fiϘ
ÙȘ ¯ÒÚ˜ Ù˘ ∂.∂. ÙËÓ ÂÚ›Ô‰Ô 1985-2000. ™ÙÔ˘˜
¿Ó‰Ú˜ ÔÈ ı¿Ó·ÙÔÈ ·fi ηÚΛÓÔ ÙÔ˘ ÛÙÔÌ¿¯Ô˘ ÙÔ
2000 ‹Ù·Ó ηٿ 42% ¯·ÌËÏfiÙÂÚÔÈ ·fi ÙÔ˘˜ ·Ó·ÌÂ-
ÓfiÌÂÓÔ˘˜ Î·È ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ÔÛÔÛÙfi ÁÈ· ÙȘ Á˘Ó·›-
Θ ‹Ù·Ó 45%7.
™ÙËÓ ∂ÏÏ¿‰· Ù· ηÎÔ‹ıË ÓÂÔÏ¿ÛÌ·Ù· ·Ô-
ÙÂÏÔ‡Ó ¤Ó· ÛËÌ·ÓÙÈÎfi Úfi‚ÏËÌ· ‰ËÌfiÛÈ·˜ ˘Á›·˜.
∏ ·Ô˘Û›· ÂÓfi˜ ÔÏÔÎÏËڈ̤ÓÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ η-
Ù·ÁÚ·Ê‹˜ Ù˘ ÓÔÛËÚfiÙËÙ·˜ ÙÔ˘ ÂÏÏËÓÈÎÔ‡ ÏËı˘-
ÛÌÔ‡ ·fi ηÎÔ‹ıË ÓÂÔÏ¿ÛÌ·Ù· ‰˘Û¯ÂÚ·›ÓÂÈ ÙËÓ
ÂȉËÌÈÔÏÔÁÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ÓÔÛËÌ¿ÙˆÓ,
ÙËÓ ÂÎÙ›ÌËÛË Ù˘ ‚·Ú‡ÙËÙ¿˜ ÙÔ˘˜ ÛÙÔÓ ÏËı˘ÛÌfi
Î·È ÙËÓ ·ÍÈÔÏfiÁËÛË ÙˆÓ Ì¤ÙÚˆÓ ÚfiÏ˄˘ Î·È ÁÂ-
ÓÈÎfiÙÂÚ· Ù˘ ÔÏÈÙÈ΋˜ ˘Á›·˜ Ô˘ ·ÛÎÂ›Ù·È ÌÂ
ÛÙfi¯Ô ÙËÓ ÂÈÙ‹ÚËÛË Î·È ÙÔÓ ¤ÏÂÁ¯Ô ÙÔ˘ ηÚΛÓÔ˘
ÛÙËÓ ∂ÏÏ¿‰·.
∞fi ÙËÓ ÌÂϤÙË ‰È·¯ÚÔÓÈο ÙËÓ ÂÚ›Ô‰Ô 1980
– 2005 ÚÔ·ÙÂÈ fiÙÈ:
1. ∏ ıÓËÛÈÌfiÙËÙ· ·fi ηÚΛÓÔ ÙÔ˘ ÛÙÔÌ¿¯Ô˘
ÂÌÊ·Ó›˙ÂÈ ÌÈ· ÛËÌ·ÓÙÈ΋ ÙÒÛË Û fiϘ ÙȘ ËÏÈÎÈ·-
Τ˜ ÔÌ¿‰Â˜ Î·È ÛÙ· ‰‡Ô ʇϷ.
2. ∏ ıÓËÛÈÌfiÙËÙ· ·fi ηÚΛÓÔ ÙÔ˘ ·¯¤Ô˜
ÂÓÙ¤ÚÔ˘ ÂÌÊ·Ó›˙ÂÈ ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË Î·È ÛÙ· ‰‡Ô
ʇϷ ÛÙȘ ËÏÈÎȷΤ˜ ÔÌ¿‰Â˜ 55-74 Î·È ¿Óˆ ÙˆÓ 75
ÂÙÒÓ Î·È ·ÔÙÂÏ› ÛËÌ·ÓÙÈÎfi Úfi‚ÏËÌ· ‰ËÌfiÛÈ·˜
˘Á›·˜.
89
3. O ηÚΛÓÔ˜ ÙÔ˘ ÚÔÛÙ¿ÙË, ˆ˜ ÓfiÛÔ˜ ÙˆÓ
ÌÂÁ¿ÏˆÓ ËÏÈÎÈÒÓ, ÂÌÊ·Ó›˙ÂÈ ÌÂÁ·Ï‡ÙÂÚË ıÓËÛÈÌfi-
ÙËÙ· ÛÙËÓ ËÏÈÎȷ΋ ÔÌ¿‰· ¿Óˆ ÙˆÓ 75 ÂÙÒÓ ÂÓÒ
‰È·¯ÚÔÓÈο ÛËÌÂÈÒÓÂÙ·È ÌÈ· ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË
ÙÔ˘ ∂.™.£. Û ·˘Ù‹Ó ÙËÓ ËÏÈÎȷ΋ ÔÌ¿‰·.
4. O ηÚΛÓÔ˜ ÙÔ˘ Á˘Ó·ÈΛԢ Ì·ÛÙÔ‡ ÛÙËÓ
ËÏÈÎȷ΋ ÔÌ¿‰· 25-54 ·ÚÔ˘ÛÈ¿˙ÂÈ ÌÈ· ÛËÌ·ÓÙÈ΋
ÙÒÛË ÙÔ˘ ∂.™.£. ÌÂÙ¿ ÙÔ 1988, ÛÙËÓ ËÏÈÎȷ΋ ÔÌ¿-
‰· 55-74 Ë ıÓËÛÈÌfiÙËÙ· ÂÌÊ·Ó›˙ÂÈ ‰È·¯ÚÔÓÈο ‰È·-
Î˘Ì¿ÓÛÂȘ ¯ˆÚ›˜ ÂÌÊ·Ó‹ Ù¿ÛË Ì›ˆÛ˘, ÂÓÒ ÛÙȘ
ÌÂÁ¿Ï˜ Á˘Ó·›Î˜ ¿Óˆ ÙˆÓ 75 ÂÙÒÓ ·Ú·ÙËÚ›ٷÈ
ÌÈ· ·ÍÈfiÏÔÁË ·˘ÍËÙÈ΋ Ù¿ÛË ÙÔ˘ ∂.™.£.
5. ∏ ıÓËÛÈÌfiÙËÙ· ·fi ηÚΛÓÔ ÙÔ˘ Ó‡ÌÔÓ·
ÛÙÔÓ ·Ó‰ÚÈÎfi ÏËı˘ÛÌfi ·ÚÔ˘ÛÈ¿˙ÂÈ ÛÙ·ıÂÚ‹ Âͤ-
ÏÈÍË Ì ÌÈÎÚ¤˜ ‰È·Î˘Ì¿ÓÛÂȘ ¯ˆÚ›˜ Ù¿ÛÂȘ ο̄˘,
ÂÓÒ ÛÙȘ ËÏÈ˘ ¿Óˆ ÙˆÓ 75 ÂÙÒÓ ·Ú·ÙËÚÂ›Ù·È ÛË-
Ì·ÓÙÈ΋ ·‡ÍËÛË ÙÔ˘ ∂.™.£. ™ÙÔÓ Á˘Ó·ÈÎÂ›Ô ÏËı˘-
ÛÌfi Ë ıÓËÛÈÌfiÙËÙ· ·fi ηÚΛÓÔ ÙÔ˘ Ó‡ÌÔÓ· ·-
ÚÔ˘ÛÈ¿˙ÂÈ ÌÈÎÚ‹ ·˘ÍËÙÈ΋ Ù¿ÛË ÛÙȘ ËÏÈ˘ 55-74
Î·È ÛËÌ·ÓÙÈ΋ ·˘ÍËÙÈ΋ Ù¿ÛË ÛÙȘ ËÏÈ˘ ¿Óˆ ÙˆÓ
75 Î·È Ê·›ÓÂÙ·È Ë ıÓËÛÈÌfiÙËÙ· ÛÙÔÓ Á˘Ó·ÈÎÂ›Ô ÂÏ-
ÏËÓÈÎfi ÏËı˘ÛÌfi Ó· ·ÎÔÏÔ˘ı› ÙȘ ·ÓÙ›ÛÙÔȯ˜ Ù¿-
ÛÂȘ Ô˘ ·Ú·ÙËÚÔ‡ÓÙ·È ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ‰˘ÙÈ-
ÎÔÂ˘Úˆ·˚Τ˜ ¯ÒÚ˜.
∂›Ó·È ÂÌÊ·Ó‹˜ Ë ·Ó¿ÁÎË ÁÈ· ÙËÓ ¯¿Ú·ÍË ÌÈ·˜
Ó¤·˜ ÛÙÚ·ÙËÁÈ΋˜ ÚfiÏ˄˘ ÙÔ˘ ηÚΛÓÔ˘ ÛÙÔÓ ÂÏ-
ÏËÓÈÎfi ÏËı˘ÛÌfi. ∂›Ó·È ·Ó·Áη›· Ë ‰ËÌÈÔ˘ÚÁ›·
ÂÓfi˜ ‰ÈÎÙ‡Ô˘ ηٷÁÚ·Ê‹˜ Ù˘ ÓÔÛËÚfiÙËÙ·˜ ÙÔ˘ ÂÏ-
ÏËÓÈÎÔ‡ ÏËı˘ÛÌÔ‡ ·fi ηÎÔ‹ıË ÓÂÔÏ¿ÛÌ·Ù·.
™ÙÔ¯Â˘Ì¤Ó· ̤ÙÚ· ÚÔÁÚ¿ÌÌ·Ù· ÚfiÏ˄˘ ÌÂ
ÛÙfi¯Ô ÙËÓ ÂÓË̤ڈÛË Î·È ÙËÓ Â˘·ÈÛıËÙÔÔ›ËÛË
ÙÔ˘ ÏËı˘ÛÌÔ‡, ÔÏÔÎÏËڈ̤ÓÔ˜ Î·È fi¯È ·ÔÛ·-
ÛÌ·ÙÈÎfi˜ ÚÔÛ˘Ìو̷ÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ Î·È ¤ÌÊ·ÛË
ÛÙËÓ ÚˆÙÔÁÂÓ‹ ÚfiÏË„Ë Â›Ó·È Î¿ÔȘ ·fi ÙȘ
ÔÏÈÙÈΤ˜ Ô˘ ÂÊ·ÚÌfi˙ÔÓÙ·È Ì ÂÈÙ˘¯›· ÛÂ Â˘Úˆ-
·˚Îfi Î·È ‰ÈÂıÓ¤˜ Â›Â‰Ô Î·È Ô‰‹ÁËÛ·Ó Û ÛËÌ·-
ÓÙÈ΋ ÙÒÛË Ù˘ ıÓËÛÈÌfiÙËÙ·˜ ·fi ηÚΛÓÔ Ù· ÙÂ-
ÏÂ˘Ù·›· ¯ÚfiÓÈ·12. ∏ ÂÓ·ÚÌfiÓÈÛË Ù˘ ∂ÏÏ¿‰·˜ ÌÂ
·˘Ù¤˜ ÙȘ ÔÏÈÙÈΤ˜ Î·È Ë ¯ÚËÌ·ÙÔ‰fiÙËÛË Ù˘ Úfi-
Ï˄˘ ı· Û˘Ì‚¿ÏÔ˘Ó Ô˘ÛÈ·ÛÙÈο ÛÙËÓ ÂÈÙ‹ÚËÛË
Î·È ÙÔÓ ¤ÏÂÁ¯Ô ÙÔ˘ ηÚΛÓÔ˘ ÛÙËÓ ∂ÏÏ¿‰·.
ABSTRACT
Papadakis NG, Georgianos PI, Grigoraki E, Chara-
lambidis D, Tsachouridou O, Papadakis G, Benos A.
Δemporal evaluation (1980-2005) of specific mor-
tality rates of main malignat tumors in the Greek
population. ∏ell Iatr 2009, 75: 84-90.
Malignant tumors remain the second leading
cause of death, after cardiovascular diseases, in de-
90 N. ¶∞¶∞¢∞∫∏™ ∫∞π ™À¡.
veloped countries and are an important public health
problem. The aim of this study was the temporal
evaluation of specific mortality rates for five common
malignant tumors in the Greek population, in relation
to age and sex. Data from the Greek National Sta-
tistical Service regarding the recordings of deaths
caused by malignant tumors in Greece, during the
period 1980-2005, were analyzed. The specific
mortality rates according to etiology, age and sex
were estimated. The number of deaths caused by
lung cancer, breast cancer, prostate cancer, stomach
cancer and colon cancer in the age groups 25-54 yrs.,
55-74yrs., 75+ yrs, were estimated. Results revealed
that deaths from stomach cancer showed a de-
creasing trend over time, in all age groups and in both
sexes. Breast cancer mortality rates also demon-
strated a decreasing trend in the age group 25-54 yrs.
Death rates for the remaining types of cancer showed
an increase, especially in ages over 75 yrs. There is
clearly a need for widespread efficient cancer
prevention programs and early detection methods
that apply to the entire Greek population.
μπμ§πO°ƒ∞ºπ∞
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΋ È·ÙÚÈ΋ Î·È ‰ËÌfiÛÈ· ˘Á›·. ∞ı‹Ó·: ∑‹Ù· π·ÙÚÈΤ˜
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∞ÏÏËÏÔÁÚ·Ê›·:
¡. ¶··‰¿Î˘
μ. μ‡˙·ÓÙÔ˜ 24
546 36 £ÂÛÛ·ÏÔÓ›ÎË
Corresponding Author:
N. Papadakis
24, V. Vizandos, str.
546 36 Thessaloniki
Greece
∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 2009, 75, 1: 91- 96
∂˘ı·Ó·Û›·*
π. ª·ÓˆÏ‰¿Î˘
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Û Έ̷ÙÒ‰Ë Î·Ù¿ÛÙ·ÛË Û ÎÏÈÓÈ΋ ÙÔ˘ ªÈÏ¿ÓÔ˘
·fi ÙÔÓ π·ÓÔ˘¿ÚÈÔ ÙÔ˘ 1992, ÌÂÙ¿ ·fi ÙÚÔ¯·›Ô ·-
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Ù˘ ÏÂÁfiÌÂÓ˘ «Â˘ı·Ó·Û›·˜». ∏ ÔÈÎÔÁ¤ÓÂÈ¿ Ù˘ ›-
¯Â ˙ËÙ‹ÛÂÈ Ó· ÌÂÙ·ÊÂÚı› ·fi ÙËÓ Î·ıÔÏÈ΋ ÎÏÈÓÈ-
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¯ÙËΠӷ ‰È·Îfi„ÂÈ ÙË Ì˯·ÓÈ΋ ˘ÔÛÙ‹ÚÈÍË Ô˘
ÙËÓ ÎÚ·ÙÔ‡Û ÛÙË ˙ˆ‹. ¶ÚÔËÁÔ˘Ì¤Óˆ˜, ÙÔ ¡Ô¤Ì-
‚ÚÈÔ ÙÔ˘ 2008 Ì ·fiÊ·ÛË ÙÔ˘ ∞ÓÒÙ·ÙÔ˘ ¢Èη-
ÛÙËÚ›Ô˘ Ù˘ πÙ·Ï›·˜ ›¯Â ÂÈÙÚ·› ·˘Ù‹ Ë ·Ô-
Û‡Ó‰ÂÛË ·fi Ù· Ì˯·Ó‹Ì·Ù·, ·ÏÏ¿ ÙÔ ÀÔ˘ÚÁ›Ô
ÀÁ›·˜ ÚÔÂȉÔÔ›ËÛ ٷ ÎÚ·ÙÈο ÓÔÛËÏ¢ÙÈο
ȉڇ̷ٷ Ó· ÌË ÚÔ‚Ô‡Ó ÛÙË ‰È·ÎÔ‹. ∏ πÙ·ÏÈ΋
ÎÔÈÓˆÓ›· ‰È¯¿ÛÙËÎÂ. ¢È·‰Ëψ٤˜ Ô˘ ‰È·ÊˆÓÔ‡-
Û·Ó Ì ÙËÓ Â˘ı·Ó·Û›· ÚÔÛ·ıÔ‡Û·Ó Ó· ÂÌÔ‰›-
ÛÔ˘Ó ÙÔ ·ÛıÂÓÔÊfiÚÔ Ô˘ ı· ÌÂÙ¤ÊÂÚ ÙËÓ ∂ÏÔ˘¿-
Ó· ÛÙËÓ È‰ÈˆÙÈ΋ ÎÏÈÓÈ΋, ʈӿ˙ÔÓÙ·˜ “ÌË ÙË ÛÎÔ-
ÙÒÓÂÙ”, “Ë ∂ÏÔ˘¿Ó· ˙ÂÈ”. O Úˆı˘Ô˘ÚÁfi˜ Ù˘
πÙ·Ï›·˜ ·Ó·Ì›¯ıËΠ‰˘Ó·ÌÈο ÛÙËÓ ˘fiıÂÛË Ê¤-
ÚÔÓÙ·˜ ÓÔÌÔÛ¯¤‰ÈÔ ÙÔ˘ μÔ˘Ï‹ ÁÈ· ÙË Û·Ê‹ ηÈ
ÔÚÈÛÙÈ΋ ··ÁfiÚ¢ÛË Î¿ı ÌÔÚÊ‹˜ “¢ı·Ó·Û›·˜”
Î·È ‚¤‚·È·, ÙËÓ ·Î‡ÚˆÛË Ù˘ ·fiÊ·Û˘ ÙÔ˘ ∞ÓÒ-
ÙÂÚÔ˘ ¢ÈηÛÙËÚ›Ô˘ Ù˘ πÙ·Ï›·˜, Ô˘ Â¤ÙÚ„ ÙËÓ
·ÔÛ‡Ó‰ÂÛË ·fi Ù· Ì˯·Ó‹Ì·Ù· ˘ÔÛÙ‹ÚÈ͢ ÛÙË
Û˘ÁÎÂÎÚÈ̤ÓË ÂÚ›ÙˆÛË. ΔÂÏÈο ·Ó·ÎÔÈÓÒıËÎÂ
“Ê˘ÛÈÔÏÔÁÈÎfi˜” ı¿Ó·ÙÔ˜ Ù˘ Á˘Ó·›Î·˜ ÛÙËÓ È‰ÈˆÙÈ-
΋ ÎÏÈÓÈ΋ Î·È Ë “ı·ÙÚÈ΋ ·Ú¿ÛÙ·ÛË” ÙˆÓ Ì¤-
ÛˆÓ ÂÓË̤ڈÛ˘ ÙÂÏ›ˆÛÂ. flÛÔ˘ Ó· Í·Ó·ÓÔ›ÍÂÈ
Ë ·˘Ï·›· ÁÈ· οÈÔ· ·ÚfiÌÔÈ· ÂÚ›ÙˆÛË ÛÙÔ
̤ÏÏÔÓ Î·È Ó· ÍÂÛ¿ÛÂÈ Ë ÁÓˆÛÙ‹ ‰È·Ì¿¯Ë Ì ÙȘ
* OÌÈÏ›· ηٿ ÙËÓ ÂÓ·ÚÎÙ‹ÚÈ· ÙÂÏÂÙ‹ ÙÔ˘ 24Ô˘ μÔÚÂÈÔÂÏÏ·‰ÈÎÔ‡ π·ÙÚÈÎÔ‡ ™˘Ó‰ڛԢ, 26-28/3/2009 £ÂÛÛ·ÏÔÓ›ÎË.
·Ù¤ÚÌÔÓ˜ Û˘˙ËÙ‹ÛÂȘ Î·È Ù· ÚÔÊ·Ó‹ ·‰È¤ÍÔ‰·.
™ÙÔ ÚfiÛÊ·ÙÔ ·ÚÂÏıfiÓ Â›¯·Ì ۯÂÙÈΤ˜ Â-
ÚÈÙÒÛÂȘ Ô˘ ›‰·Ó ÙÔ Êˆ˜ Ù˘ ‰ËÌÔÛÈfiÙËÙ·˜,
fiˆ˜ ÙÔ 2003 ÙÔ˘ °¿ÏÏÔ˘ μÂÓÛ¿Ó πÌ¤Ú, ÙÔ˘ Ó·-
ÚÔ‡ ÙÂÙÚ·ÏËÁÈÎÔ‡ (¤ÂÈÙ· ·fi ÛÔ‚·Úfi ÙÚÔ¯·›Ô
·Ù‡¯ËÌ·) Ô˘ ›¯Â ÚԂ› ÛÙËÓ ÙÚ·ÁÈ΋ ¤ÎÎÏËÛË:
“™·˜ ˙ËÙÒ ÙÔ ‰Èη›ˆÌ· Ó· Âı¿Óˆ”. O ÁÈ·ÙÚfi˜ ÌÂ
ÙÔ ÂÈÙÂÏÂ›Ô ÙÔ˘ ÛÙ·Ì¿ÙËÛ·Ó ÙËÓ Ù¯ÓËÙ‹ ‰È·Ù‹ÚË-
ÛË ÛÙË ˙ˆ‹ ÙÔ˘ ÙÂÙÚ·ÏËÁÈÎÔ‡ Ô ÔÔ›Ô˜ ›¯Â ¤ÛÂÈ
ÚÔËÁÔ˘Ì¤Óˆ˜ Û ÎÒÌ· ¤ÂÈÙ· ·fi ÈÛ¯˘Ú‹ ‰fiÛË
‚·Ú‚ÈÙÔ˘ÚÈÎÒÓ, Ô˘ ÙÔ˘ ¤‰ˆÛÂ Ë ÌËÙ¤Ú· ÙÔ˘ ÁÈ·
Ó· ÙÔÓ ‚ÔËı‹ÛÂÈ Ó· Âı¿ÓÂÈ ÌÂÙ¿ ÙËÓ ÙÚ·ÁÈ΋ ¤Î-
ÎÏËÛ‹ ÙÔ˘.
OÈ ‰‡Ô ÂÚÈÙÒÛÂȘ, Ù˘ πÙ·Ï›‰·˜ ·ÊÂÓfi˜ ηÈ
ÙÔ˘ °¿ÏÏÔ˘ ·ÊÂÙ¤ÚÔ˘ ›ӷÈ, ‚¤‚·È·, Û¯ÂÙÈΤ˜ ·Ï-
Ï¿ ‰ÂÓ Â›Ó·È fiÌÔȘ. ∫·È ÔÈ ‰‡Ô ·Ó·Ê¤ÚÔÓÙ·È ÛÂ
Ôχ¯ÚÔÓ˜ Ô‰˘ÓËÚ¤˜ ηٷÛÙ¿ÛÂȘ: Έ̷Ù҉˘
ηٿÛÙ·ÛË Ë ÚÒÙË, ηٿÛÙ·ÛË ÙÂÙÚ·ÏËÁ›·˜
(·Ú·Ï˘Û›·, Ù‡ÊψÛË, ·Ï·Ï›·) ·ÏÏ¿ Ì ÎÒÌ· ÌÈ-
ÎÚ‹˜ ¯ÚÔÓÈ΋˜ ‰È¿ÚÎÂÈ·˜, Ë ‰Â‡ÙÂÚË ÂÚ›ÙˆÛË.
øÛÙfiÛÔ, ÛÙËÓ ÂÚ›ÙˆÛË Ù˘ πÙ·Ï›‰·˜ Ë ›‰È· ‰ÂÓ
˙‹ÙËÛ ӷ Âı¿ÓÂÈ Î·ıÒ˜ ‚ÚÈÛÎfiÙ·Ó Û Ôχ¯ÚÔ-
ÓÔ ÎÒÌ·, ÂÓÒ ÙÔ ˙ËÙÔ‡ÌÂÓÔ ‹Ù·Ó Ó· ÂÈÙÚ·› Ë
·ÔÛ‡Ó‰ÂÛË ÙÔ˘ Ì˯·Ó‹Ì·ÙÔ˜ Ô˘ ÙËÓ ÎÚ·ÙÔ‡ÛÂ
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Ù· ·fi 17 ¯ÚfiÓÈ· ·ÂÏÈṲ̂ÓÔ˘ ·ÁÒÓ· Ì ÙÔ ı¿-
Ó·ÙÔ. ¶ÚÔÊ·ÓÒ˜ ›¯·Ó ¯¿ÛÂÈ ÙȘ ÂÏ›‰Â˜ ÙÔ˘˜, ÂÓÒ
ÙÔ ÂÚÒÙËÌ· Ô˘ Ù›ıÂÙ·È ·ÓÙÈÎÂÈÌÂÓÈο (Î·È ÂÚ‹ÌËÓ
ÙÔ˘ ›‰ÈÔ˘ ÙÔ˘ ·ÛıÂÓÔ‡˜) ›ӷÈ: ∞Í›˙ÂÈ Ì›· Ù¤ÙÔÈ·
˙ˆ‹, ÙfiÛ· ¯ÚfiÓÈ· Û ÎÒÌ·, Ì Ì˯·ÓÈ΋ ·ÏÒ˜ ˘-
ÔÛÙ‹ÚÈÍË; ∂‰Ò, ‚¤‚·È·, ÚfiÎÂÈÙ·È ÁÈ· ˙‹ÙËÌ·
“¢ı·Ó·Û›·˜” Ì ÙËÓ Â˘Ú›· ¤ÓÓÔÈ· ÙÔ˘ fiÚÔ˘, η-
ıÒ˜ ‰ÂÓ Â›ÎÂÈÙÔ Ô ı¿Ó·ÙÔ˜. ∏ Έ̷Ù҉˘ ηٿ-
ÛÙ·ÛË Ù˘ πÙ·Ï›‰·˜ ı· ÌÔÚÔ‡Û ӷ ‰È·ÚΤÛÂÈ
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·ÎfiÌË Ì‹Ó˜ ‹ Î·È ¯ÚfiÓÈ·. ∏ ·fiÊ·ÛË Ó· ‰È·ÎÔ-
› Ë Ì˯·ÓÈ΋ ˘ÔÛÙ‹ÚÈÍË, Ô˘ ··ÈÙ› ÂÓ¤ÚÁÂÈ·
ÙˆÓ ÁÈ·ÙÚÒÓ, ÛËÌ·›ÓÂÈ ·fiÊ·ÛË ı·Ó¿ÙˆÛ˘ ÂÓfi˜
·ÓıÚÒÔ˘. ¢ÈηÈÔÏÔÁÂ›Ù·È Î¿ÙÈ Ù¤ÙÔÈÔ; ∫·È ÁÈ·Ù›
ÙÒÚ·, ‡ÛÙÂÚ· ·fi 17 ¯ÚfiÓÈ·. ∞Ó, ‚¤‚·È·, Ë ‰È·ÎÔ-
‹ Ù˘ Ì˯·ÓÈ΋˜ ˘ÔÛÙ‹ÚÈ͢ ÂÌÊ·ÓÈ˙fiÙ·Ó ÌÔÈ-
Ú·›ˆ˜ ·Ó·Áη›· ÁÈ· Ó· ‰È·ÙÂı› ÙÔ ÌÔÓ·‰ÈÎfi (·˜
Ô‡ÌÂ) Ì˯¿ÓËÌ· Û ¿ÏÏË ÂÚ›ÙˆÛË Ô˘ ÌfiÏȘ ›-
¯Â ÂÌÊ·ÓÈÛÙ›, ı· ˘‹Ú¯Â ı¤Ì· ηٿÛÙ·Û˘ ·Ó¿-
Á΢, ÙÔ ÔÔ›Ô ÌÔÚ› Ó· ·ÓÙÈÌÂÙˆÈÛÙ› ·fi ÙÔ ‰›-
ηÈÔ ·Ó Î·È Â›Ó·È ‰˘Û¯ÂÚ¤ÛÙÂÚÔ. ∂‰Ò fï˜ ‰ÂÓ
ÚfiÎÂÈÙ·È ÁÈ· οÙÈ Ù¤ÙÔÈÔ. ∏ ˘fiıÂÛ‹ Ì·˜ Û˘Ì‚·›-
ÓÂÈ ÛÙÔ ªÈÏ¿ÓÔ, ˘¿Ú¯Ô˘Ó ÔÏϤ˜ ÎÏÈÓÈΤ˜ Î·È ÓÔ-
ÛÔÎÔÌ›·, ‰ËÌfiÛÈ· Î·È È‰ÈˆÙÈο, ‰ÂÓ ‰ËÏÒÓÂÙ·È
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͢ Ù˘ ˙ˆ‹˜. ª‹ˆ˜ Ù· ¤ÍÔ‰· Â›Ó·È ‰˘Û‚¿ÛÙ·ÎÙ·
ÁÈ· ÙÔ˘˜ ÔÈΛԢ˜ ‹ ÙÔ ·ÛÊ·ÏÈÛÙÈÎfi Ù·ÌÂ›Ô Ô˘ η-
χÙÂÈ ÙË Ì˯·ÓÈ΋ ˘ÔÛÙ‹ÚÈÍË; ·ÏÏ¿ ·˘Ù‹ Ë ·‰˘-
Ó·Ì›· ı· ¤ÚÂ ӷ ›¯Â ÚÔ·„ÂÈ ·fi ÙËÓ ·Ú¯‹ ‹
¤ÛÙˆ, Û ¤Ó· ‡ÏÔÁÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ·fi ÙËÓ
¤Ó·ÚÍË Ù˘ Ì˯·ÓÈ΋˜ ˘ÔÛÙ‹ÚÈ͢ Î·È fi¯È ‡ÛÙÂÚ·
·fi ÙfiÛ· ¯ÚfiÓÈ·. ¶ÚÔÊ·ÓÒ˜, ÏÔÈfiÓ, ÛÙËÓ ÂÚ›-
ÙˆÛ‹ Ì·˜ ÈÛ¯‡ÂÈ Ë ÁÓˆÛÙ‹ ¤ÎÊÚ·ÛË: “¢ÂÓ ¿ÂÈ
¿ÏÏÔ”! ΔÔ „˘¯ÈÎfi ÎfiÛÙÔ˜, ÙÔ ÔÔ›Ô ÌÂÁÂı‡ÓÂÙ·È ÌÂ
ÙËÓ ¿ÚÔ‰Ô ÙÔ˘ ¯ÚfiÓÔ˘ ÁÈ· ÙÔ˘˜ ÔÈΛԢ˜, Ë ˙ˆ‹
Ô˘ ‰ÂÓ ÙË ˙ÂÈ Ë ¿ÚÚˆÛÙË ÛÙËÓ Î·Ù¿ÛÙ·ÛË Ô˘ ‚Ú›-
ÛÎÂÙ·È, Ë ¤ÏÏÂÈ„Ë ÚÔÔÙÈ΋˜, Ë ÔÔ›· Î·È ·˘Ù‹ Á›-
ÓÂÙ·È Û·Ê¤ÛÙÂÚË Ì ÙËÓ ¿ÚÔ‰Ô ÙÔ˘ ¯ÚfiÓÔ˘, η-
ıÒ˜ ·ÔÌ·ÎÚ˘ÓfiÌ·ÛÙ ̷˙› ÙÔ˘ ·fi ÙÔ ÂӉ¯fiÌÂ-
ÓÔ ÙÔ˘ È·ÙÚÈÎÔ‡ ıÚ·‡Ì·ÙÔ˜, fiÏ· ·˘Ù¿ Û˘ÓËÁÔÚÔ‡Ó
˘¤Ú Ù˘ ·Ô‰Ô¯‹˜ ÙÔ˘ ·ÈÙ‹Ì·ÙÔ˜ Ó· ‰Ôı› Ù¤ÏÔ˜
Û’ ·˘Ù‹ ÙËÓ Î·Ù¿ÛÙ·ÛË. ¶ÔÈÔ˜ ı· ÙÔ ·ÔÊ·Û›ÛÂÈ;
OÈ ÔÈΛÔÈ ÚÔÛ¤Ê˘Á·Ó ÛÙÔ ¢ÈηÛÙ‹ÚÈÔ ÎÈ ·˘Ùfi
¤‰ˆÛ ÙËÓ ¿‰ÂÈ· Û·Ó Ó· ÂÚfiÎÂÈÙÔ ÁÈ· ÓÔÌÈÎfi ˙‹-
ÙËÌ·. O ›‰ÈÔ˜ Ô Úˆı˘Ô˘ÚÁfi˜ ¤Û¢Û ӷ ¿ÚÂÈ
ı¤ÛË – ·ÓÙ›ıÂÙË Ì ÙÔ ‰ÈηÛÙ‹ÚÈÔ – Û·Ó Ó· ÂÚfi-
ÎÂÈÙÔ ÁÈ· ÔÏÈÙÈÎfi ˙‹ÙËÌ·.
¶ÚÈÓ ˘ÔÛÙËڛ͈ ÙË ‰È΋ ÌÔ˘ ¿Ô„Ë ÁÈ· ÙÔ
ı¤Ì· ·˘Ùfi, ·˜ Û˘ÁÎÚ·Ù‹ÛÔ˘Ì ÙÔ‡ÙÔ ·fi ÙËÓ ˘fi-
ıÂÛË: ™ÙȘ ÂÚÈÙÒÛÂȘ Ù˘ ·ÓÙÈÎÂÈÌÂÓÈ΋˜ ÎÚ›Û˘
ÁÈ· ÙËÓ Â˘ı·Ó·Û›·, fiˆ˜ Ë ÚÔΛÌÂÓË, ÙÔ ˙ËÙÔ‡-
ÌÂÓÔ Â›Ó·È ·Ó ‚ÚÈÛÎfiÌ·ÛÙ ÌÚÔÛÙ¿ Û ̛· ÂÚ›-
ÙˆÛË ˙ˆ‹˜ “Ô˘ ‰ÂÓ ·Í›˙ÂÈ Ó· ÙË ˙ÂÈ Î·Ó›˜”.
¶ÔÈÔ˜ fï˜ ı· ÙÔ ÎÚ›ÓÂÈ; OÈ ÔÈΛÔÈ Ô˘ ‚ÈÒÓÔ˘Ó
ÙËÓ ÙÚ·Áˆ‰›· Î·È ·ÔÊ·›ÓÔÓÙ·È ÁÈ· ÏÔÁ·ÚÈ·ÛÌfi
ÙÔ˘˜, ·ÏÏ¿ Î·È ÁÈ· ÏÔÁ·ÚÈ·ÛÌfi ÙÔ˘ Û˘ÁÁÂÓ‹ ÙÔ˘˜
ηٿ ÙËÓ ÂÈη˙fiÌÂÓË ÚÔÊ·ÓÒ˜ ı¤ÏËÛ‹ ÙÔ˘; ∏ ‰È-
ηÈÔÛ‡ÓË Ô˘ ÎÚ›ÓÂÈ Î·Ù¿ ÂÚ›ÙˆÛË, ÛÙ·ıÌ›˙Ô-
ÓÙ·˜ Ù· ¤ÓÓÔÌ· Û˘ÌʤÚÔÓÙ·; ∏ ÔÏÈÙ›· Ô˘ ÓÔÌÔ-
ıÂÙ›, ÂÎÊÚ·˙fiÌÂÓË Î·Ù’ ·Ó¿ÁÎË ÁÂÓÈο, ˘ÔΛ-
ÌÂÓË Û ȉÂÔÏÔÁÈΤ˜ Î·È ÔÏÈÙÈΤ˜ ÛÎÔÈÌfiÙËÙ˜;
£· Â·Ó¤Ïıˆ ÛÙ· ÂÚˆÙ‹Ì·Ù· ·˘Ù¿ ÁÈ· Ó· ‰È·Ù˘-
ÒÛˆ Î·È ÙË ı¤ÛË ÌÔ˘.
™ÙËÓ ÂÚ›ÙˆÛË ÙÔ˘ °¿ÏÏÔ˘, Ô ›‰ÈÔ˜ ›¯Â ˙Ë-
Ù‹ÛÂÈ Ó· Âı¿ÓÂÈ ÚÈÓ ¤ÛÂÈ Û ÎÒÌ· ·fi ÙËÓ
ÂÓ¤ÚÁÂÈ· Ù˘ ÌËÙ¤Ú·˜ ÙÔ˘ Ó· ÙÔ˘ ·Ú¿Û¯ÂÈ Â˘ı·-
Ó·Û›· ÁÈ· Ó· ÙÔÓ Ï˘ÙÚÒÛÂÈ ·fi ÙËÓ Î·Ù¿ÛÙ·ÛË ÙÂ-
ÙÚ·ÏËÁ›·˜. ΔÔ Â›¯Â ‰ËψÛÂÈ ÚËÙ¿: “™·˜ ˙ËÙÒ ÙÔ
‰Èη›ˆÌ· Ó· Âı¿Óˆ”. ∏ ÎÚ›ÛË Â‰Ò ÁÈ· ÙË ˙ˆ‹
“Ô˘ ‰ÂÓ ·Í›˙ÂÈ Ó· ÙË ˙ÂÈ Î·Ó›˜” Â›Ó·È ˘ÔÎÂÈÌÂ-
ÓÈ΋, ÙÔ˘ ›‰ÈÔ˘ ÙÔ˘ ·ÚÚÒÛÙÔ˘, Î·È fi¯È ·ÓÙÈÎÂÈÌÂÓÈ-
΋, Î·È Û˘Ó¿ÙÂÙ·È Ì ÙÔ ÏÂÁfiÌÂÓÔ (·fi ÓÔÌÈÎÔ‡˜
Î·È ÌË) “‰Èη›ˆÌ· ÛÙÔ ı¿Ó·ÙÔ”. ™˘ÓÂÒ˜ ÙÔ ‰Èη-
ÛÙ‹ÚÈÔ, Ô˘ ı· ÎÏËı› ÂӉ¯Ô̤ӈ˜ Ó· ·ÔÊ·Óı›
ÁÈ· ÙËÓ ÂÚ›ÙˆÛË ‰ÂÓ Â›¯Â Ó· ÎÚ›ÓÂÈ ·Ó Ë Û˘ÁÎÂ-
ÎÚÈ̤ÓË ˙ˆ‹ “¿ÍÈ˙ ‹ fi¯È”, ·ÏÏ¿ ·Ó ˘¿Ú¯ÂÈ ‰Èη›-
ˆÌ· ÛÙÔ ı¿Ó·ÙÔ ÁÈ’ ·˘ÙfiÓ Ô˘ ÙÔ ÂÈηÏÂ›Ù·È (ÎÚ›-
ÛË Ô˘ ÂËÚ¿˙ÂÙ·È, ‚¤‚·È·, ·fi ÙȘ Û˘Óı‹Î˜ Ô˘
‰ÈηÈÔÏÔÁÔ‡Ó ÙËÓ Â›ÎÏËÛË Ù¤ÙÔÈÔ˘ ‰ÈηÈÒÌ·ÙÔ˜),
fiˆ˜ Û˘Ì‚·›ÓÂÈ Û οı ÂÚ›ÙˆÛË ‰ÈηÛÙÈ΋˜
ÎÚ›Û˘ ÁÈ· ÙËÓ ·ÚÔ¯‹ ¤ÓÓÔÌ˘ ÚÔÛÙ·Û›·˜ ÙÔ˘
ÔÏ›ÙË, Ô ÔÔ›Ô˜ ÚÔÛʇÁÂÈ Û’ ·˘Ù‹Ó Û‡Ìʈӷ ÌÂ
ÙÔ ¿ÚıÚÔ 20 ·Ú¿ÁÚ·ÊÔ˜ 1 ÙÔ˘ ™˘ÓÙ¿ÁÌ·ÙÔ˜. °È·
Ó· ·ÔÊ·Óı› fï˜ Û οıÂ Û˘ÁÎÂÎÚÈ̤ÓË ÂÚ›-
ÙˆÛË ÙÔ ‰ÈηÛÙ‹ÚÈÔ, ı· Ú¤ÂÈ Ó· ˘¿Ú¯ÂÈ ÓfiÌÔ˜
Ô˘ Ó· ·Ó·ÁˆÚ›˙ÂÈ ÁÂÓÈο Î·È ·ÚfiÛˆ· “‰Èη›ˆ-
Ì· ÙÔ˘ ·ÙfiÌÔ˘ ÛÙÔ ı¿Ó·ÙÔ” ηıÔÚ›˙ÔÓÙ·˜ Î·È ÙȘ
ÚÔ¸Ôı¤ÛÂȘ Ô˘ ÌÔÚÔ‡Ó Ó· ÙÔ ıÂÌÂÏÈÒÛÔ˘Ó.
¶¿ÓÙ· ÁÂÓÈο Î·È ·ÚfiÛˆ·.
Δ¤ÙÔÈÔ˜ ÓfiÌÔ˜ Ô˘ Ó· ·Ó·ÁÓˆÚ›˙ÂÈ ÛÙÔ «‰È-
η›ˆÌ· ÛÙÔ ı¿Ó·ÙÔ” ‰ÂÓ ˘¿Ú¯ÂÈ. ¶ÚÒÙ·-ÚÒÙ·,
Ë ¤ÓÓÔÈ· ÙÔ˘ ‰ÈηÈÒÌ·ÙÔ˜ —Û‡Ìʈӷ Ì ¿ÁÈÔ
ÔÚÈÛÌfi Ù˘ ÓÔÌÈ΋˜ ÂÈÛÙ‹Ì˘— ·Ó·Ê¤ÚÂÙ·È ÛÙËÓ
ÈηÓÔÔ›ËÛË ‚ÈÔÙÈÎÔ‡ Û˘ÌʤÚÔÓÙÔ˜. “¢Èη›ˆÌ·
Â›Ó·È Ë ·Ú¯fiÌÂÓË ·fi ÙËÓ ¤ÓÓÔÌË Ù¿ÍË ÛÙÔ Úfi-
ÛˆÔ ÂÍÔ˘Û›· ÁÈ· Ú·ÁÌ¿ÙˆÛË ‚ÈÔÙÈÎÔ‡ Û˘ÌʤÚÔ-
ÓÙÔ˜”. ΔÔ ‰Èη›ˆÌ· ÓÔÂ›Ù·È Â‰Ò ˘fi ÙË ÓÔÌÈ΋ ¤Ó-
ÓÔÈ· ÙÔ˘ fiÚÔ˘ Î·È fi¯È ˆ˜ ËıÈÎfi, Ê˘ÛÈÎfi ‹ ÌÂÙ·Ê˘-
ÛÈÎfi ·›ÙËÌ·. ¶¤Ú· ·fi ÙÔ fiÙÈ ¤Ó· Ù¤ÙÔÈÔ ·›ÙËÌ·
¤¯ÂÈ ·Î·ıfiÚÈÛÙÔ Î·È fi¯È ÙÔ ›‰ÈÔ ·ÓÙÈÏËÙfi ·fi
fiÏÔ˘˜ ÂÚȯfiÌÂÓÔ, Î·È Û˘ÓÂÒ˜ ‰ÂÓ ÌÔÚ› Ó·
·ÔÙÂÏ› ÛÙ·ıÂÚfi ÛËÌÂ›Ô ·Ó·ÊÔÚ¿˜ (fiˆ˜ ÙÔ ‰È-
η›ˆÌ· Ô˘ ·Ó·ÁÓˆÚ›˙ÂÙ·È ÛÂ Û˘ÁÎÂÎÚÈ̤Ó˜ ‰È·-
Ù¿ÍÂȘ ÙÔ˘ ıÂÙÈÎÔ‡ ‰Èη›Ô˘), ÂÊfiÛÔÓ ·˘ÙÔ› Ô˘
˘ÔÛÙËÚ›˙Ô˘Ó ÙËÓ ‡·ÚÍ‹ ÙÔ˘ ˙ËÙÔ‡Ó ·fi ÙÔ ‰›-
ηÈÔ ÙËÓ ·Ó·ÁÓÒÚÈÛË Î·È ÈηÓÔÔ›ËÛ‹ ÙÔ˘, ı·
Ú¤ÂÈ Ó· ¯ÚËÛÈÌÔÔÈÔ‡Ó ÙÔÓ fiÚÔ “‰Èη›ˆÌ·” ˘fi
ÙË ÓÔÌÈ΋ ÙÔ˘ ·ÔÎÏÂÈÛÙÈο ¤ÓÓÔÈ·. Àfi ·˘Ù‹ ÙËÓ
¤ÓÓÔÈ·, ËÁ‹ ‰ÈηÈÒÌ·ÙÔ˜ ·ÔÙÂÏ› Ë ¤ÓÓÔÌË Ù¿-
ÍË. ŸÛÔÈ ÌÈÏÔ‡Ó ÁÈ· “‰Èη›ˆÌ· ÙÔ˘ ·ÙfiÌÔ˘ ÛÙÔ ı¿-
Ó·ÙÔ” Û˘Á¯¤Ô˘Ó ÚÔÊ·ÓÒ˜ ÙÔ ‰Èη›ˆÌ· ˘fi ÙË ÓÔ-
ÌÈ΋ ¤ÓÓÔÈ· ÙÔ˘ fiÚÔ˘ Ì ÙÔÓ fiÚÔ “‰Èη›ˆÌ·” ˆ˜
 ∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 75, 1
ËıÈÎfi, Ê˘ÛÈÎfi ‹ ÌÂÙ·Ê˘ÛÈÎfi ·›ÙËÌ·. ¢ÂÓ ÌÔÚ›
fï˜ Ó· ˙ËÙÔ‡Ó ·fi ÙËÓ ¤ÓÓÔÌË Ù¿ÍË ÙËÓ ÚÔÛÙ·-
Û›· “·ÈÙ‹Ì·ÙÔ˜” Ô˘ ‰ÂÓ ËÁ¿˙ÂÈ ·fi ·˘Ù‹Ó. ¢ÂÓ
ÌÔÚ› ‰ËÏ·‰‹ ¿ÏÏË Ó· Â›Ó·È Ë ËÁ‹ ·ÊÂÙËÚ›·˜
Î·È ¿ÏÏË Ë ËÁ‹ ÚÔÛÙ·Û›·˜ ÙÔ˘ ‰ÈηÈÒÌ·ÙÔ˜.
∫·Ù¿ ÙÔ ıÂÙÈÎfi ‰›Î·ÈÔ, ÏÔÈfiÓ, ÓÔÌÈ΋ ‰È¿Ù·-
ÍË Ô˘ Ó· ·Ó·ÁÓˆÚ›˙ÂÈ ÛÙÔ ¿ÙÔÌÔ “‰Èη›ˆÌ· ÛÙÔ
ı¿Ó·ÙÔ” ‰ÂÓ ˘¿Ú¯ÂÈ. ªÈ· Ù¤ÙÔÈ· ‰È¿Ù·ÍË ı· ‹Ù·Ó
·Ú¿ÏÔÁË, ·ÊÔ‡ ı· ¤Ú¯ÔÓÙ·Ó ÛÂ ·ÓÙ›ıÂÛË ÌÂ ÙÔ
ÂÓÓÔÈÔÏÔÁÈÎfi ÂÚȯfiÌÂÓÔ ÙÔ˘ ‰ÈηÈÒÌ·ÙÔ˜ fiˆ˜
¿ÁÈ· Á›ÓÂÙ·È ‰ÂÎÙfi ·fi ÙË ÓÔÌÈ΋ ÂÈÛÙ‹ÌË.
OÚÈṲ̂ÓÔÈ ÓÔÌÈÎÔ›, ÂÓÙÂÏÒ˜ ÂÛÊ·Ï̤ӷ ηٿ
ÙË ÁÓÒÌË ÌÔ˘, ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ ÙÔ ÏÂÁfiÌÂÓÔ (ηْ
·˘ÙÔ‡˜) “‰Èη›ˆÌ· ÛÙÔ ı¿Ó·ÙÔ” ÛÙËÚ›˙ÂÙ·È ÛÙÔ
¿ÚıÚÔ 5 ·Ú¿ÁÚ·ÊÔ˜ 1 ÙÔ˘ ™˘ÓÙ¿ÁÌ·ÙÔ˜, Ô˘ ÔÚ›-
˙ÂÈ fiÙÈ “ηı¤Ó·˜ ¤¯ÂÈ ‰Èη›ˆÌ· Ó· ·Ó·Ù‡ÛÛÂÈ Â-
χıÂÚ· ÙËÓ ÚÔÛˆÈÎfiÙËÙ¿ ÙÔ˘... ÂÊfiÛÔÓ ‰ÂÓ
ÚÔÛ‚¿ÏÏÂÈ Ù· ‰ÈηÈÒÌ·Ù· ÙˆÓ ¿ÏÏˆÓ Î·È ‰ÂÓ ·-
Ú·‚È¿˙ÂÈ ÙÔ ™‡ÓÙ·ÁÌ· ‹ Ù· ¯ÚËÛÙ¿ ‹ıË”. ∂›Û˘ Â-
ÈηÏÔ‡ÓÙ·È ÙÔ ¿ÚıÚÔ 2 ·Ú¿ÁÚ·ÊÔ˜ 1 ÙÔ˘ ™˘ÓÙ¿-
ÁÌ·ÙÔ˜ Ô˘ ÔÚ›˙ÂÈ fiÙÈ “Ô Û‚·ÛÌfi˜ Î·È Ë ÚÔÛÙ·-
Û›· Ù˘ ·Í›·˜ ÙÔ˘ ·ÓıÚÒÔ˘ ·ÔÙÂÏÔ‡Ó ÙËÓ Úˆ-
Ù·Ú¯È΋ ˘Ô¯Ú¤ˆÛË Ù˘ ¶ÔÏÈÙ›·˜”. ∏ ¶ÔÏÈÙ›·
ı· Ú¤ÂÈ ‰ËÏ·‰‹, Ó· ÌÂÚÈÌÓ¿ Î·È Ó· ÂÍ·ÛÊ·Ï›˙ÂÈ
¤Ó·Ó ·ÍÈÔÚÂ‹ ı¿Ó·ÙÔ ÁÈ· fiÏÔ˘˜.
OÈ ı¤ÛÂȘ ·˘Ù¤˜, ¤Ú· ·fi ÙËÓ ÂÛÊ·Ï̤ÓË ÂÓ-
ÓÔÈÔÏÔÁÈο ¯Ú‹ÛË ÙÔ˘ ÓÔÌÈÎÔ‡ fiÚÔ˘ “‰Èη›ˆÌ·”,
ÁÈ· ÙËÓ ÔÔ›· ÌfiÏȘ ¤ÁÈÓ ÏfiÁÔ˜, ·Ú·‚ϤÔ˘Ó ÙË
‚·ÛÈ΋ ‰È¿Ù·ÍË ÙÔ˘ ¿ÚıÚÔ˘ 5 ·Ú¿ÁÚ·ÊÔ˜ 2 ÙÔ˘
™˘ÓÙ¿ÁÌ·ÙÔ˜ ÁÈ· ÙËÓ ·fiÏ˘ÙË ÚÔÛÙ·Û›· Ù˘ ˙ˆ‹˜.
∏ ˙ˆ‹ ·ÔÙÂÏ› ÚÔ¸fiıÂÛË ÁÈ· ÙËÓ ‡·ÚÍË ÔÈÔ˘-
‰‹ÔÙÂ, ‰ËÏ·‰‹ fiÏˆÓ ÙˆÓ ·ÙÔÌÈÎÒÓ ‰ÈηȈ̿وÓ.
™˘ÓÂÒ˜, ηÓÂÓfi˜ ‰ÈηÈÒÌ·ÙÔ˜ Ë ¯Ú‹ÛË ‰ÂÓ ÌÔ-
Ú› Ó· Ô‰ËÁ› ÛÙËÓ Î·Ù¿Ï˘Û‹ Ù˘. ΔÔ ‰Èη›ˆÌ· Ù˘
ÂχıÂÚ˘ ·Ó¿Ù˘Í˘ Ù˘ ÚÔÛˆÈÎfiÙËÙ·˜ —¤-
Ú·Ó ÙÔ˘ fiÙÈ ·Ó·Ê¤ÚÂÙ·È Û ·Ó¿Ù˘ÍË Î·È fi¯È ÂÍ·-
Ê¿ÓÈÛË ÙÔ˘ ÚÔÛÒÔ˘— ÌÔÚ› Ó· Êı¿ÛÂÈ Ì¤¯ÚÈ
ÙËÓ ÂÏ¢ıÂÚ›· ·˘ÙԉȷÎÈÓ‰‡Ó¢Û˘ ÙÔ˘ ÊÔÚ¤· ÙÔ˘,
ÁÈ· ÙËÓ ÈηÓÔÔ›ËÛË ÂÓfi˜ ¿ÏÏÔ˘ ·Ó·Ù˘ÍÈ·ÎÔ‡
ÛÙfi¯Ô˘ ÙÔ˘, fi¯È fï˜ Î·È ˆ˜ ÙËÓ ·˘ÙÔηٷÛÙÚÔÊ‹
ÙÔ˘. ∞Ó ˘‹Ú¯Â, ηı’ ˘fiıÂÛË, “‰Èη›ˆÌ· ÛÙÔ ı¿-
Ó·ÙÔ”, ı· ¤ÚÂÂ Ë ·ÚÂÌfi‰ÈÛË Î¿ÔÈÔ˘ Ó· ·˘-
ÙÔÎÙÔÓ‹ÛÂÈ – Ô˘ ·ÔÙÂÏ› Û‹ÌÂÚ· ÛÙÔȯÂÈÒ‰Ë
˘Ô¯Ú¤ˆÛË fi¯È ÌfiÓÔ ÙˆÓ ÎÚ·ÙÈÎÒÓ ÔÚÁ¿ÓˆÓ, ·ÏÏ¿
οı ·Ú¢ÚÈÛÎfiÌÂÓÔ˘ ÛÙËÓ ·fiÂÈÚ· ·˘ÙÔÎÙÔ-
Ó›·˜ Û˘Ó-·ÓıÚÒÔ˘ Ó· ·ÔÙÂÏ› ¿‰ÈÎË Ú¿ÍË, ˆ˜
·Ú·ÎÒÏ˘ÛË ¿ÛÎËÛ˘ ‰ÈηÈÒÌ·ÙÔ˜ ÙÔ˘ ˘Ô„‹ÊÈ-
Ô˘ ·˘Ùfi¯ÂÈÚ·! ∫·Ó›˜, fï˜, ÛÔ‚·Úfi˜ ˘ÔÛÙËÚÈ-
ÎÙ‹˜ ÙÔ˘ ÏÂÁfiÌÂÓÔ˘ “‰ÈηÈÒÌ·ÙÔ˜ ÛÙÔ ı¿Ó·ÙÔ” ‰ÂÓ
ı· ÙÔÏÌÔ‡Û ӷ ˘ÔÛÙËÚ›ÍÂÈ Î¿ÙÈ Ù¤ÙÔÈÔ.
ŸÛÔ ÁÈ· ÙÔ ı¤Ì· ÙÔ˘ “·ÍÈÔÚÂÔ‡˜ ı·Ó¿ÙÔ˘”,
93
Ô˘ ·Ú·¤ÌÂÈ Î·È ·˘Ùfi ÛÙËÓ ÂÈΛӉ˘ÓË, fiˆ˜
ı· ‰Ô‡ÌÂ, ÎÚ›ÛË ÁÈ· ÙË “˙ˆ‹ Ô˘ ·Í›˙ÂÈ ‹ ‰ÂÓ ·Í›-
˙ÂÈ Ó· ˙ÂÈ Î·Ó›˜”, ¤Ú· ·fi ÙËÓ ·‰˘Ó·Ì›· ÚÔÛ-
‰ÈÔÚÈÛÌÔ‡ ÙÔ˘, ‰ÂÓ ¤¯ÂÈ Î·Ì›· Û¯¤ÛË Ì ÙÔ ¿ÚıÚÔ
2 ·Ú¿ÁÚ·ÊÔ˜ 1 ÙÔ˘ ™˘ÓÙ¿ÁÌ·ÙÔ˜ ÁÈ· ÙÔ Û‚·ÛÌfi
Ù˘ ·Í›·˜ ÙÔ˘ ·ÓıÚÒÔ˘. ∞˘Ùfi ·Ó·Ê¤ÚÂÙ·È ÛÙȘ
ÂÂÌ‚¿ÛÂȘ Ù˘ ÔÏÈÙ›·˜ ÛÙÔ ¯ÒÚÔ ÙˆÓ ‰ÈηȈ̿-
ÙˆÓ ÙÔ˘ ·ÓıÚÒÔ˘ ηٿ ÙËÓ ¿ÛÎËÛË Ù˘ ÂÍÔ˘Û›·˜
‹ (ηÈ) ÛÙȘ ÂÂÌ‚¿ÛÂȘ ÙˆÓ ¿ÏÏˆÓ Û˘ÌÔÏÈÙÒÓ Î·-
Ù¿ ÙËÓ ¿ÛÎËÛË ÙˆÓ ‰ÈÎÒÓ ÙÔ˘˜ ‰ÈηȈ̿وÓ, ηÈ
fi¯È, ‚¤‚·È· ÛÙȘ ÂÈÏÔÁ¤˜ ÙÔ˘ ›‰ÈÔ˘ ÙÔ˘ ·ÙfiÌÔ˘ ÁÈ·
ÙÔÓ ÙÚfiÔ Ù˘ ˙ˆ‹˜ ‹ ÙÔ˘ ı·Ó¿ÙÔ˘ ÙÔ˘.
∞ÏÏ¿ Ô‡ÙÂ Î·È ·Ú·›ÙËÛË ·fi ÙÔ ‰Èη›ˆÌ·
ÛÙË ˙ˆ‹ Ô˘ ηÙÔ¯˘ÚÒÓÂÈ ÙÔ ¿ÚıÚÔ 5 ·Ú¿Á. 2 ÙÔ˘
™˘ÓÙ¿ÁÌ·ÙÔ˜ Â›Ó·È ÓÔÌÈο ÂÈÙÚÂ‹. ¶·Ú·ÈÙ‹ÛÂȘ
·fi ·ÙÔÌÈο, ÔÏÈÙÈο Î·È ÎÔÈÓˆÓÈο ‰ÈηÈÒÌ·Ù·
›ӷÈ, ‚¤‚·È·, ‰˘Ó·Ù¤˜ ÁÈ· ÙÔÓ ÊÔÚ¤· ÙÔ˘˜, ·ÏÏ¿
ÌfiÓÔ ÂÊfiÛÔÓ ‰ÂÓ ı›ÁÔ˘Ó ıÂÌÂÏÈÒ‰ÂȘ ·Ú¯¤˜ ÙÔ˘ ‰È-
η›Ô˘, ηÙÔ¯˘ÚˆÌ¤Ó˜ ÛÙÔ ™‡ÓÙ·ÁÌ· ‹ ‰ÈηÈÒÌ·-
Ù· ¿ÏψÓ. ¢ÂÓ Â›Ó·È ÓÔÌÈο ÂÈÙÚÂ‹ Ë ·Ú·›ÙËÛË
·fi ÙÔ ‰Èη›ˆÌ· ÛÙË ˙ˆ‹, ·ÊÔ‡ ı›ÁÂÈ ÙËÓ ·fiÏ˘ÙË
·Í›· Ù˘ ˙ˆ‹˜ (ηÙÔ¯˘ÚˆÌ¤ÓË ÛÙÔ ¿ÚıÚÔ 5 ·Ú. 2
™˘ÓÙ.) ÛÙËÓ ÔÔ›· ıÂÌÂÏÈÒÓÂÙ·È Ë ›‰È· Ë ‡·ÚÍË
Ù˘ ÎÔÈÓˆÓ›·˜. Ÿˆ˜ ‰ÂÓ Â›Ó·È ÓÔÌÈο ÂÈÙÚÂÙ‹ Ë
ηıÔÏÈ΋ ·Ú·›ÙËÛË ·fi ÙÔ ‰Èη›ˆÌ· Ù˘ ÂÏ¢ıÂ-
Ú›·˜ Ì ÙËÓ ÔÈÎÂÈÔıÂÏ‹ ˘Ô‚ÔÏ‹ ÙÔ˘ ÊÔÚ¤· ÙÔ˘ ÛÂ
ηٿÛÙ·ÛË ‰Ô˘Ï›·˜, ηıÒ˜ ·˘Ù‹ ¤Ú¯ÂÙ·È Û Ï‹-
ÚË ·ÓÙ›ıÂÛË Ì ÙË ıÂÌÂÏÈÒ‰Ë ·Ú¯‹ Ù˘ ÚÔÛˆÈ-
΋˜ ÂÏ¢ıÂÚ›·˜ (¿ÚıÚÔ 5 ·Ú. 1 ™˘ÓÙ.) ÛÙËÓ ÔÔ›·
ÔÈÎÔ‰ÔÌÂ›Ù·È Ë ÂχıÂÚË ÔÏÈÙ›·. ∂›Û˘, ÌÔÚ›
Ì›· Á˘Ó·›Î· Ó· ·Ú·ÈÙËı› ·fi ÙÔ ‰Èη›ˆÌ· ÛÙËÓ
ÌËÙÚfiÙËÙ· ÌËÓ Î¿ÓÔÓÙ·˜ ·È‰È¿. ∞Ó fï˜ ÁÂÓÓ‹ÛÂÈ
·È‰›, ‰ÂÓ ÌÔÚ› Ó· ÙÔ ÂÁηٷÏ›„ÂÈ ·Ú·ÈÙÔ‡ÌÂ-
ÓË ·fi ÙÔ ‰Èη›ˆÌ· Ù˘ ÌËÙÚfiÙËÙ·˜, ·ÊÔ‡ ·˘Ù‹ Ë
·Ú·›ÙËÛË ÚÔÛ‚¿ÏÏÂÈ ÙÔ ‰Èη›ˆÌ· ÛÙË ˙ˆ‹ ÙÔ˘
ÓÂÔÁ¤ÓÓËÙÔ˘ ·È‰ÈÔ‡.
μϤÔ˘ÌÂ, ÏÔÈfiÓ, ·fi ÙËÓ ÚÔËÁÔ‡ÌÂÓË ·Ó¿-
Ï˘ÛË fiÙÈ “‰Èη›ˆÌ· ÛÙÔ ı¿Ó·ÙÔ” ·fi ÓÔÌÈ΋ ¿Ô-
„Ë ‰ÂÓ ˘¿Ú¯ÂÈ Ô‡Ù ÌÔÚ› Ó· ˘¿ÚÍÂÈ Ì ÓÔÌÔ-
ıÂÙÈ΋ Ú‡ıÌÈÛË.
OÈ ·ÓÙ›ıÂÙ˜ ı¤ÛÂȘ ÛÙËÚ›˙ÔÓÙ·È ÊÈÏÔÛÔÊÈο
Û ̛· ¿ÎÚˆ˜ ·ÙÔÌÔÎÂÓÙÚÈ΋ ÊÈÏÂÏ¢ıÂÚ›ÛÙÈÎË
·ÓÙ›ÏË„Ë, Ô˘ ÚÔ‚Ï‹ıËΠ¤ÓÙÔÓ· ÛÙË ‰‡ÛË ÌÂÙ¿
ÙÔ ‰È·ÊˆÙÈÛÌfi Î·È Ô‰‹ÁËÛ ÛÙËÓ ·Ú·‰Ô¯‹ ÙÔ˘
ÌÔÓÙ¤ÚÓÔ˘ ÂÁˆÎÂÓÙÚÈÛÌÔ‡. øÛÙfiÛÔ Î·È ÛÙË ÊÈÏÂ-
χıÂÚË ÎÔÈÓˆÓ›· Ë Û˘Ó‡·ÚÍË ÙˆÓ (ÔÏÏÒÓ) ·Ó-
ıÚÒˆÓ ‰ÂÓ ·ÔÙÂÏ› ·ÏÒ˜ ·Ú¿ÏÏËÏË ‡·ÚÍË
ÔÏÏÒÓ. O ¿ÓıÚˆÔ˜ ˆ˜ ÎÔÈÓˆÓÈÎfi “›ӷȔ ‰ÂÓ Â›-
Ó·È ÌfiÓÔ˜ ÙÔ˘ ·Ó¿ÌÂÛ· ÛÙÔ˘˜ ¿ÏÏÔ˘˜. ∂›Ó·È Û˘Ó-
‰Â‰Â̤ÓÔ˜ Ì ÙÔ˘˜ ¿ÏÏÔ˘˜, Â›Ó·È ˆ˜ – ÚÔ˜ – ·˘-
ÙÔ‡˜ Î·È Ì·˙› – Ì ·˘ÙÔ‡˜. ∂›Ó·È ¿ÓıÚˆÔ˜ – ÁÔÓ¤-
94 I. MANø§∂¢∞∫∏™
·˜, ·‰ÂÏÊfi˜, Û‡ÓÙÚÔÊÔ˜, ‰¿ÛηÏÔ˜, Û˘Ó-¿ÓıÚˆ-
Ô˜. ∞˘ÙÔ ÙÔ ÚfiÛˆÔ ·ÔÙÂÏ› ÙÔ ÊÔÚ¤· ÙÔ˘ ‰È-
ηÈÒÌ·ÙÔ˜ ÛÙË ˙ˆ‹, Ô˘ ·Ú¤¯ÂÙ·È Î·È Î·ÙÔ¯˘ÚÒ-
ÓÂÙ·È ·fi ÙËÓ ¤ÓÓÔÌË Ù¿ÍË. ™ÙÔ Ï·›ÛÈÔ, ÏÔÈfiÓ,
ÙˆÓ ·ÍÈÔÏÔÁ‹ÛÂÒÓ Ù˘ ·ÛÎÂ›Ù·È ÂÈÙÚÂÙ¿ ‹ fi¯È
Î·È ÙÔ Î¿ı ‰Èη›ˆÌ·. ¶·Ú·‰Ô¯‹ “‰ÈηÈÒÌ·ÙÔ˜
ÛÙÔ ı¿Ó·ÙÔ” ı· Û‹Ì·ÈÓ ˆ˜ Ë ¤ÓÓÔÌË Ù¿ÍË ·Ú¤-
¯ÂÈ Û οı ¿ÓıÚˆÔ ÙËÓ ÂÍÔ˘Û›· —ÂÓÂÚÁÒÓÙ·˜
ˆ˜ ·ÔÎÔÌ̤ÓÔ ·fi ÙËÓ ÎÔÈÓˆÓ›· Î·È ÌÔÓ·¯ÈÎfi
¿ÙÔÌÔ— Ó· ηٷχÛÂÈ Î·È fiÏÔ˘˜ ÙÔ˘˜ ÚÔÛˆÈ-
ÎÔ‡˜ ÙÔ˘ ‰ÂÛÌÔ‡˜, Ô˘ Û ·ÌÔÈ‚·›· ‰È·ÏÔ΋ Û˘-
ÁÎÚÔÙÔ‡Ó ·˘Ùfi Ô˘ ϤÁÂÙ·È ÎÔÈÓˆÓ›·. £· ÂÚ¯fiÙ·Ó
¤ÙÛÈ Ë ¤ÓÓÔÌË Ù¿ÍË ÛÂ ·ÓÙ›ıÂÛË ÌÂ ÙÔÓ ÚÔÔÚÈÛÌfi
Ù˘, Ô˘ Â›Ó·È Ë ÚÔÒıËÛË Ù˘ ˙ˆ‹˜ “ÂÓ ÎÔÈÓˆÓ›·
‰Èη›Ô˘”. ¶·Ú¿‰ÔÍÔ Û¯‹Ì· Î·È ·fi ÓÔÌÈ΋ ηÈ
·fi ÎÔÈÓˆÓÈÔÏÔÁÈ΋ ¿Ô„Ë.
∞˜ ¤ÚıÔ˘ÌÂ, ÙÒÚ·, ÛÙËÓ ÚÒÙË ÂÚ›ÙˆÛË Ù˘
πÙ·Ï›‰·˜, ÙËÓ ÂÚ›ÙˆÛË Ù˘ ¢ı·Ó·Û›·˜ ÁÈ· ÙËÓ
Î·Ù¿Ï˘ÛË ÌÈ·˜ ˙ˆ‹˜ “Ô˘ ‰ÂÓ ·Í›˙ÂÈ Ó· ˙ÂÈ Î·-
Ó›˜”. ∞fi ÊÈÏÔÛÔÊÈ΋˜ ¿Ԅ˘ ÌÔÚ›, ‚¤‚·È·,
Ó· ˘ÔÛÙËÚȯıÔ‡Ó ‰È¿ÊÔÚ˜ ı¤ÛÂȘ ·fi ÙË ıÚË-
Û΢ÙÈ΋, fiÙÈ Ë ˙ˆ‹ ˆ˜ ‰ËÌÈÔ‡ÚÁËÌ· £ÂÔ‡ ›ӷÈ
¿ÍÈ· Ó· ÙË ˙ÂÈ Î·Ó›˜ ˘fi ÔÔÈ·‰‹ÔÙ ÌÔÚÊ‹ Ù˘,
̤¯ÚÈ ÙËÓ Â˘ÁÔÓÈ΋, Ô˘ Û˘Ó·ÚÙ¿ ÙËÓ ·Í›· Ù˘ ˙ˆ-
‹˜ ηı·˘Ù‹Ó ·fi ÙËÓ ÔÈfiÙËÙ¿ Ù˘, ·ÚÓÔ‡ÌÂÓË ÛÂ
οÔȘ ·ÎÚ·›Â˜ ÂÚÈÙÒÛÂȘ ÙËÓ ›‰È· ÙËÓ ‡·ÚÍË
Ù˘ ˙ˆ‹˜ ·Ó ¤¯·Û ÙË ÛÙÔȯÂÈÒ‰Ë ÔÈfiÙËÙ¿ Ù˘. ¢ÂÓ
ÚfiÎÂÈÙ·È fï˜ ÁÈ’ ·˘Ù¤˜ ÙȘ ÊÈÏÔÛÔÊÈΤ˜ ·fi„ÂȘ
fiÙ·Ó Á›ÓÂÙ·È ÏfiÁÔ˜ ÁÈ· ¢ı·Ó·Û›· ˆ˜ Úfi‚ÏËÌ·
ÛÙ· ̤۷ ÂÓË̤ڈÛ˘. ¢ÈfiÙÈ Â›Ó·È ·˘ÙÔÓfiËÙÔ fiÙÈ
·Ó¿ÏÔÁ· Ì ÙȘ ÊÈÏÔÛÔÊÈΤ˜ ÙÔ˘ ÂÔÈı‹ÛÂȘ ı·
ÚԂ› ‹ ‰ÂÓ ı· ÚԂ› οÔÈÔ˜ Û ¢ı·Ó·Û›·
(ÁÈ· ÙÔÓ Â·˘Ùfi ÙÔ˘, ‹ Î·È ÁÈ· ¿ÏÏÔÓ Ô˘ ‰ÂÓ ÌÔÚ›
Ó· ÂÓÂÚÁ‹ÛÂÈ ÌfiÓÔ˜ ÙÔ˘) ·Ó ‚ÚÂı› ÛÙËÓ ÙÚ·ÁÈ΋
˘·ÚÍȷ΋ ηٿÛÙ·ÛË Ó· οÓÂÈ ÌÈ· Ù¤ÙÔÈ· ÂÈÏÔ-
Á‹. ∞ÏÏ¿ ÚfiÎÂÈÙ·È ÁÈ· ÙËÓ Â˘ı·Ó·Û›· ˆ˜ ÓÔÌÈ΋
ÂÈÏÔÁ‹.
∫·È ÛÙËÓ ÂÚ›ÙˆÛË Ù˘ πÙ·Ï›‰·˜ Î·È ÛÙËÓ Â-
Ú›ÙˆÛË ÙÔ˘ °¿ÏÏÔ˘ ı· ÌÔÚÔ‡Û ӷ ¤¯ÂÈ Á›ÓÂÈ ·˘-
Ùfi Ô˘ ÙÂÏÈο ¤ÁÈÓ ¯ˆÚ›˜ Ù˘Ì·ÓÔÎÚÔ˘Û›Â˜ Î·È ‰Ë-
ÌÔÛÈfiÙËÙ·. ΔÔ ›‰ÈÔ ÈÛ¯‡ÂÈ ÁÈ· fiϘ ÙȘ “ÂÚÈÙÒ-
ÛÂȘ ¢ı·Ó·Û›·˜” Ô˘ ÚÔ‚Ï‹ıËÎ·Ó ·fi Ù· ̤۷
ÂÓË̤ڈÛ˘ Î·È ÚÔοÏÂÛ·Ó ÙË Û¯ÂÙÈ΋ Û˘˙‹ÙËÛË
Î·È ·ÓÙȉÈΛ·. ¢ÈfiÙÈ Û fiϘ ÙȘ ÂÚÈÙÒÛÂȘ ˙ËÙ‹-
ıËÎÂ Ë ÓÔÌÈ΋ Î¿Ï˘„Ë Ù˘ ¢ı·Ó·Û›·˜. ∏ ¿‰ÂÈ·
ÙÔ˘ ‰ÈηÛÙËÚ›Ô˘ ‹ Ë ı¤ÛÈÛË ÓfiÌÔ˘ Ô˘ Ó· ÙËÓ ÂÈ-
ÙÚ¤ÂÈ.
Ÿˆ˜, fï˜, ÙÔ ‰›Î·ÈÔ ‰ÂÓ ÌÔÚ› Ó· ·Ó·-
ÁÓˆÚ›ÛÂÈ “‰Èη›ˆÌ· ÛÙÔ ı¿Ó·ÙÔ”, ·ÊÔ‡ οÙÈ Ù¤-
ÙÔÈÔ ı· ÂÚ¯fiÙ·Ó —fiˆ˜ ›·Ì— Û ·ÓÙ›ıÂÛË ÌÂ
ÙÔ ÂÓÓÔÈÔÏÔÁÈÎfi ÂÚȯfiÌÂÓÔ ÙÔ˘ ‰ÈηÈÒÌ·ÙÔ˜, ·Ï-
Ï¿ Î·È ÙÔÓ ÚÔÔÚÈÛÌfi ÙÔ˘ ‰Èη›Ô˘ Î·È ÙȘ Û˘ÓÙ·Á-
Ì·ÙÈΤ˜ ηÙÔ¯˘ÚˆÌ¤Ó˜ ıÂÌÂÏÈÒ‰ÂȘ ·Ú¯¤˜ ÙÔ˘
ÛÙË ‰ËÌÔÎÚ·ÙÈ΋ ÔÏÈÙ›· —fiˆ˜ Â›Ó·È Ë ·fiÏ˘ÙË
ÚÔÛÙ·Û›· Ù˘ ˙ˆ‹˜—, ¤ÙÛÈ Î·È ‰ÂÓ ÌÔÚ› ÙÔ ‰›-
ηÈÔ ·˘ıÂÓÙÈο Ó· ÚÔÛ‰ÈÔÚ›ÛÂÈ ÔÈ· ˙ˆ‹ ·Í›˙ÂÈ
Ó· Û˘Ó¯›˙ÂÙ·È Î·È ÔÈ¿ fi¯È. ΔÔ ‰›Î·ÈÔ ÚÔÛ‰ÈÔÚ›-
˙ÂÈ ÌfiÓÔ ÙËÓ ·Ú¯‹ Î·È ÙÔ Ù¤ÏÔ˜ Ù˘ ·ÓıÚÒÈÓ˘ ˙ˆ-
‹˜ ÔÚÈÔıÂÙÒÓÙ·˜ Î·È ‰È·ÎÚ›ÓÔÓÙ·˜ ÙÔÓ ÁÂÓÓË̤ÓÔ
¿ÓıÚˆÔ ·fi ÙÔ ¤Ì‚Ú˘Ô ·ÊÂÓfi˜ Î·È ‰›ÓÔÓÙ·˜ ÙÔÓ
ÔÚÈÛÌfi ÙÔ˘ ı·Ó¿ÙÔ˘ ·ÊÂÙ¤ÚÔ˘. Ÿ¯È Ôχ ‡ÎÔÏ·
Î·È ÛÙȘ ‰‡Ô ÂÚÈÙÒÛÂȘ.
™ÙËÓ ÚÒÙË ÂÚ›ÙˆÛË, Ì¿ÏÈÛÙ·, Ù˘ ·Ú¯‹˜
Ù˘ ˙ˆ‹˜ ÙÔ˘ ·ÓıÚÒÔ˘, ‰ÂÓ ˘¿Ú¯ÂÈ ÚËÙ‹ ‰È¿Ù·ÍË
ÙÔ˘ ıÂÙÈÎÔ‡ ‰Èη›Ô˘, ·ÏÏ¿ Ô ÓÔÌÔı¤Ù˘ ¿ÊËÛ ÙÔ
ı¤Ì· ÛÙËÓ ÂÈÛÙ‹ÌË Î·È ÙË ÓÔÌÔÏÔÁ›· ÙˆÓ ‰Èη-
ÛÙËÚ›ˆÓ.
ŒÙÛÈ Ù· ‰ÈηÛÙ‹ÚÈ· ‰¤¯ÔÓÙ·È fiÙÈ Ô ¿ÓıÚˆÔ˜
·Ú¯›˙ÂÈ Ó· ˘¿Ú¯ÂÈ ·fi ÙË ÛÙÈÁÌ‹ Ô˘ ÂͤگÂÙ·È
¤ÛÙˆ Î·È ¤Ó· ÙÌ‹Ì· ÙÔ˘ ·fi ÙÔ ÌËÙÚÈÎfi ¯ÒÌ·. ™ÙË
ÓÔÌÈ΋ ıˆڛ· ˘ÔÛÙËÚ›¯ıËÎ·Ó Î·È ÔÈ ·fi„ÂȘ fiÙÈ
Ô ¿ÓıÚˆÔ˜ ·Ú¯›˙ÂÈ Ó· ˘¿Ú¯ÂÈ fiÙ·Ó ÂÌÊ·Ó›˙ÂÙ·È
ÛÙÔÓ Â͈ÙÂÚÈÎfi ÎfiÛÌÔ ˆ˜ ÌÈ· ·˘ÙÔÙÂÏ‹˜ ÔÓÙfiÙËÙ·
Ì ٷ ‚·ÛÈο ÌÔÚÊÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ ·ÓıÚÒ-
ÈÓÔ˘ Á¤ÓÔ˘˜, ÂÓÒ ¿ÏÏË ·ÓÙ›ıÂÙË ¿Ô„Ë ÙÔÔıÂÙ›
ÙËÓ ·Ú¯‹ ·˘Ù‹ ÛÙËÓ ¤Ó·ÚÍË ÙÔ˘ ÙÔÎÂÙÔ‡.
™ÙËÓ ÂÚ›ÙˆÛË ÙÔ˘ ı·Ó¿ÙÔ˘, Ô ÓÔÌÔı¤Ù˘
Â¤ÏÂÍ ˆ˜ ÎÚÈÙ‹ÚÈÔ ÙË Ó¤ÎÚˆÛË ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘
(ÂÁÎÂÊ·ÏÈÎfi˜ ı¿Ó·ÙÔ˜) ÛÙÔ ÓfiÌÔ 2737/1990 ÁÈ· ÙȘ
ÌÂÙ·ÌÔۯ‡ÛÂȘ ·ÓıÚÒÈÓˆÓ ÈÛÙÒÓ Î·È ÔÚÁ¿ÓˆÓ,
ÂÓÒ ˆ˜ Ù· ̤۷ Ù˘ ‰ÂηÂÙ›·˜ ÙÔ˘ ’60 ÁÈÓfiÙ·Ó ‰Â-
ÎÙfi fiÙÈ Ô ¿ÓıÚˆÔ˜ ·‡ÂÈ Ó· ˘¿Ú¯ÂÈ fiÙ·Ó ÛÙ·Ì·-
Ù¿ ÔÚÈÛÙÈο Ë Î˘ÎÏÔÊÔÚ›· ÙÔ˘ ·›Ì·ÙÔ˜ Î·È Ë ·Ó·-
ÓÔ‹. ∞ÏÏ¿ Î·È Ô Ó¤Ô˜ ÔÚÈÛÌfi˜ ¤ÁÈÓ ‰ÂÎÙfi˜ ÛÙË
ÓÔÌÈ΋ ÂÈÛÙ‹ÌË Ì ÔÏϤ˜ ÂÈÊ˘Ï¿ÍÂȘ.
ø˜ Â‰Ò ÏÔÈfiÓ Ù· fiÚÈ· ÙÔ˘ ‰Èη›Ô˘. ªÂÙ’
ÂÌÔ‰›ˆÓ!
º·ÓÙ·ÛÙ›ÙÂ, ÙÒÚ·, Ó· ˙ËÙ‹ÛÔ˘Ì ·fi ÙÔ ‰›-
ηÈÔ Ó· ÚÔÛ‰ÈÔÚ›ÛÂÈ Ù· ¯·Ú·ÎÙËÚÈÛÙÈο Ù˘ ˙ˆ‹˜
Ô˘ “‰ÂÓ ·Í›˙ÂÈ Ó· ˘¿Ú¯ÂÈ”! ¡· ·ÍÈÔÏÔÁ‹ÛÂÈ, ‰Ë-
Ï·‰‹, ÁÂÓÈο ÂÚÈÙÒÛÂȘ fiˆ˜ Ë Ê˘ÛÈ΋ ηٿÛÙ·-
ÛË, Ë ¿ÓÓÔÈ·, ÔÈ fiÁÎÔÈ ÂÁÎÂÊ¿ÏÔ˘, Ë ÎˆÌ·Ù҉˘
ηٿÛÙ·ÛË, Ô˘ ÌÔÚ›, fï˜, Ó· ÔÊ›ÏÂÙ·È ÛÂ
‰È¿ÊÔÚÔ˘˜ ÏfiÁÔ˘˜, ·Ó·ÊÂÚfiÌÂÓÔ˘˜ Û ·fiÏ˘Ù·
‰È·ÎÚÈÙ¤˜ ÌÂٷ͇ ÙÔ˘˜ ÎÏÈÓÈΤ˜ ÔÓÙfiÙËÙ˜. ∫·È Ó·
·ÔÊ·Óı› Ì ÚËÙ‹ ‰È¿Ù·ÍË, ‹ ¤ÛÙˆ Ì ·Ú·ÔÌ‹
ÙÔ˘ ı¤Ì·ÙÔ˜ ÛÙË ÓÔÌÔÏÔÁ›· ÙˆÓ ‰ÈηÛÙËÚ›ˆÓ, fiÙÂ
ÌÔÚ› Î·È fiÙ fi¯È Ó· ‰È·ÎÔ› Ë ÔÚ›· Ù˘
“·Ó¿ÍÈ·˜ ˙ˆ‹˜” ÚÔ˜ ÙÔ ı¿Ó·ÙÔ...”. ∫·È Ë ÌÂÓ ÓÔ-
ÌÔÏÔÁ›· ı· ‰ËÌÈÔ˘ÚÁÔ‡Û ÛÙËÓ ÂÚ›ÙˆÛË ·˘Ù‹
·Ê¿ÓÙ·ÛÙË ·Ó·ÛÊ¿ÏÂÈ· ‰Èη›Ô˘, ·ÊÔ‡ Ù· ‰ÈηÛÙ‹-
ÚÈ· ÎÚ›ÓÔ˘Ó Î·Ù¿ ÂÚ›ÙˆÛË Î·È ‰ÂÓ ˘¿Ú¯ÂÈ ÛÙÔ
 ∂ÏÏËÓÈ΋ π·ÙÚÈ΋ 75, 1
ÂÏÏËÓÈÎfi ‰›Î·ÈÔ ÓÔÌÈο ‰ÂÛÌ¢ÙÈÎfi ÓÔÌÔÏÔÁÈ·Îfi
ÚÔËÁÔ‡ÌÂÓÔ. O ‰Â ÓÔÌÔı¤Ù˘, ·ÍÈÔÏÔÁÒÓÙ·˜ ÙË
˙ˆ‹ Î·È ÙÔ ı¿Ó·ÙÔ Ì ÁÂÓÈ΋ ‰È¿Ù·ÍË, ı· ¿ÓÔÈÁÂ
ÙËÓ fiÚÂÍË ÁÈ· Â¤ÎÙ·ÛË Ù˘ ÎÚ›Û˘ ÙÔ˘ “¢ ˙ÂÈÓ”
Î·È “¢ıÓ‹ÛÎÂÈÓ” Ô˘ ı· Ì·˜ Ô‰ËÁÔ‡Û Û ÔÏÈÙÈ-
Τ˜, fi¯È ¿ÁÓˆÛÙ˜, ‰˘ÛÙ˘¯Ò˜, ÛÙËÓ “ÔÏÈÙÈṲ̂ÓË”
∂˘ÚÒË Ï›ÁÔ ÚÈÓ ·fi Ù· ̤۷ ÙÔ˘ ÚÔËÁÔ‡ÌÂÓÔ˘
·ÈÒÓ·.
¶Ú¤ÂÈ, ÏÔÈfiÓ, Ó· ÛÙ·Ì·Ù‹ÛÂÈ ·˘Ù‹ Ë ÈÛÙÔÚ›·
Ì ÙËÓ Â›ÎÏËÛË ÙÔ˘ ‰Èη›Ô˘ ÁÈ· ÙË Ú‡ıÌÈÛË ÙÔ˘
ı¤Ì·ÙÔ˜ Ù˘ ¢ı·Ó·Û›·˜. ∫·È Ó· ·ÓÙÈÏËÊıÔ‡Ó ÙfiÛÔ
ÔÈ ÌË-ÓÔÌÈÎÔ› Ô˘ ÈÛÙÂ‡Ô˘Ó ÛÙËÓ ·ÓÙÔ‰˘Ó·Ì›·
ÙÔ˘ ‰Èη›Ô˘, fiÛÔ Î·È ÔÈ ÓÔÌÈÎÔ› Ô˘ ¤¯Ô˘Ó ÌÂÁ¿ÏË
ȉ¤· ÁÈ· ÙËÓ Â¿ÚÎÂÈ· ÙÔ˘ ‰Èη›Ô˘ Î·È Ù˘ ÓÔÌÈ΋˜
ÂÈÛÙ‹Ì˘, fiÙÈ ÙÔ ‰›Î·ÈÔ (ˆ˜ ¤ÏÏÔÁÔ Î·Ù·Û··-
ÛÌ· ÙÔ˘ ·ÓıÚÒÔ˘) ¤¯ÂÈ Û¯ÂÙÈ΋ ·Í›· Î·È ‰ÂÓ
ÌÔÚ› Ó· χÛÂÈ fiÏ· Ù· ÚÔ‚Ï‹Ì·Ù· Ù˘ ·ÓıÚÒÈ-
Ó˘ ‡·Ú͢. ∏ ¢ı·Ó·Û›· ·ÔÙÂÏ› ¤Ó· Ù¤ÙÔÈÔ ı¤-
Ì· ˘·ÚÍÈ·Îfi, ¤Ú·Ó ÙÔ˘ ÎÂÈ̤ÓÔ˘ ‰Èη›Ô˘. ∂›Ó·È
ÌÈ· ηٿÛÙ·ÛË fiÔ˘ Ô ÁÈ·ÙÚfi˜ Û ÌÈ· ‚·ıÈ¿ ·Ó-
ıÚÒÈÓË Û¯¤ÛË Ì ÙÔÓ ¿Û¯ÔÓÙ· ·ÛıÂÓ‹ ı· ·Ô-
Ê·Û›ÛÂÈ (‹ ı· ·ÔÊ·Û›ÛÔ˘Ó ·Ô ÎÔÈÓÔ‡), ÂÓÒÈÔÓ
·ÔÎÏÂÈÛÙÈο Ù˘ Û˘Ó›‰ËÛ‹˜ ÙÔ˘ ÙËÓ Â›Û¢ÛË
ÂÓfi˜ ·ÓÒ‰˘ÓÔ˘ ı·Ó¿ÙÔ˘. O ÁÈ·ÙÚfi˜ ˙ÂÈ ‰Ú·Ì·ÙÈο
ÙȘ “ÌÂٷȯÌȷΤ˜ ÛÙÈÁ̤˜ ÙÔ˘ ·ÛıÂÓ‹ ·Ó¿ÌÂÛ· ÛÙË
˙ˆ‹ Î·È ÛÙÔ ı¿Ó·ÙÔ”, fiˆ˜ ¯·Ú·ÎÙËÚÈÛÙÈο ÁÚ¿-
ÊÂÈ Û˘Ó¿‰ÂÏÊÔ˜ Ù˘ π·ÙÚÈ΋˜, Ô ¡ÈÎfiÏ·Ô˜ Δ¿ÛÎÔ˜.
“∂›Ó·È ‰È΋ ÙÔ˘ ¢ı‡ÓË, ˘fi ·˘ÛÙËÚ¤˜ È·ÙÚÈΤ˜
ÚÔ¸Ôı¤ÛÂȘ Ó· ‰È·Ê˘Ï¿ÍÂÈ ÙËÓ ·ÍÈÔÚ¤ÂÈ· ÙÔ˘
·ÛıÂÓ‹ ÙÔ˘ ÛÙËÓ ÔÚ›· ÙÔ˘ ÚÔ˜ ÙÔ ı¿Ó·ÙÔ”. ¢ÂÓ
ÌÔÚ› fï˜ Ó· ˙ËÙ‹ÛÂÈ ÙËÓ ¿‰ÂÈ· ÙÔ˘ ‰Èη›Ô˘ ÁÈ’
·˘Ùfi. ΔÔ ‰›Î·ÈÔ, fiˆ˜ ›‰·ÌÂ, ‰ÂÓ ÌÔÚ›, ·ÏÏ¿
Î·È ‰ÂÓ Ú¤ÂÈ Ó· ‰ÒÛÂÈ Ù¤ÙÔÈ· Î¿Ï˘„Ë. ™˘Ì‚·›ÓÂÈ
Â‰Ò fiˆ˜ Î·È Ì ÙËÓ ÂÚ›ÙˆÛË ÌÈ·˜ ¿ÏÏ˘ ÔÚÈ·-
΋˜ ˘·ÚÍȷ΋˜ ηٿÛÙ·Û˘ (ÎÔÈÓˆÓÈ΋˜ Î·È fi¯È
·ÙÔÌÈ΋˜): ÙËÓ Â·Ó¿ÛÙ·ÛË.
ΔËÓ Â·Ó¿ÛÙ·ÛË ÌÔÚ› Ó· ÙËÓ ·ÔÊ·Û›ÛÂÈ
¤Ó·˜ ηٷÈÂ˙fiÌÂÓÔ˜ Ï·fi˜, fiÙ·Ó ‰ÂÓ ·ÓÙ¤¯ÂÈ ¿ÏÏÔ
ÙËÓ Î·Ù·›ÂÛË ÌÈ·˜ Û˘ÁÎÂÎÚÈ̤Ó˘ ÂÍÔ˘Û›·˜, Ô˘
ÂÍ·ıÏÈÒÓÂÈ ÙË ˙ˆ‹ ÙÔ˘. ∞ÏÏ¿ ‰ÂÓ ˙ËÙ¿, ‚¤‚·È·, ÙËÓ
¿‰ÂÈ· ÙÔ˘ ÂÈÛ·ÁÁÂϤ· ÁÈ· Ó· οÓÂÈ ÙËÓ Â·Ó¿ÛÙ·-
ÛË. ∫·Ó¤Ó· ıÂÙÈÎfi ‰›Î·ÈÔ ÛÙÔÓ ÎfiÛÌÔ ‰ÂÓ ÚԂϤ-
ÂÈ fiÙ ÂÈÙÚ¤ÂÙ·È Ë Â·Ó¿ÛÙ·ÛË.
OÈ Î·Ù¿ ηÈÚÔ‡˜ Î·È ·fi ÔÚÈṲ̂ÓÔ˘˜ ÚÔÙÂÈ-
ÓfiÌÂÓ˜ “ÂÈÙÚÔ¤˜” (·fi ‰ÈηÛÙ¤˜, ÁÈ·ÙÚÔ‡˜ ηÈ
¿ÏÏÔ˘˜ ÏÂÈÙÔ˘ÚÁÔ‡˜), Ô˘ Ó· ·ÔÊ·›ÓÔÓÙ·È Û οıÂ
Û˘ÁÎÂÎÚÈ̤ÓË ÂÚ›ÙˆÛË ÁÈ· ÙËÓ Ù¤ÏÂÛË ‹ fi¯È ¢-
ı·Ó·Û›·˜ ‰ÂÓ ·ÔÙÂÏÔ‡Ó, ‚¤‚·È·, ÛÔ‚·Ú‹ ·ÓÙÈÌÂ-
ÙÒÈÛË ÙÔ˘ ı¤Ì·ÙÔ˜. ∞ÊÔ‡ ÙÔ ‰›Î·ÈÔ Î·È Ë Ù·ÎÙÈ΋
‰ÈηÈÔÛ‡ÓË ‰ÂÓ ÌÔÚÔ‡Ó, fiˆ˜ ·Ó·Ï˘ÙÈο ›·ÌÂ,
Ó· ‰ÒÛÔ˘Ó Ï‡ÛË ÛÙÔ Úfi‚ÏËÌ·, ηٿ Ì›˙ÔÓ· ÏfiÁÔ
95
‰ÂÓ ÌÔÚÔ‡Ó ÔÈ ÌÂÈÎÙ¤˜ ÂÈÙÚÔ¤˜. £· ÂÂÎÙ›ӷÌÂ,
·ÏÒ˜, ÙË ÁÚ·ÊÂÈÔÎÚ·Ù›· ·ÎfiÌË Î·È ÛÙË ‰È·‰Èη-
Û›· ÙÔ˘ ı·Ó¿ÙÔ˘, Ì ÂӉ¯fiÌÂÓË Û˘Ó¤ÂÈ·, ÎÔÓÙ¿
ÛÙ· ¿ÏÏ·, Î·È ÙËÓ ·‡ÍËÛË Ù˘ ‰È·ÊıÔÚ¿˜.
£· ÙÂÏÂÈÒÛˆ Ì ÙÔ ¿ÚıÚÔ 29 ÙÔ˘ ∫Ò‰Èη π·-
ÙÚÈ΋˜ ¢ÂÔÓÙÔÏÔÁ›·˜ (Ó. 3418/2005), Ô˘ ‰ÂÓ ·Ô-
ÙÂÏ›, ‚¤‚·È·, ‰È¿Ù·ÍË ÂÚ› ¢ı·Ó·Û›·˜, ·ÏÏ¿
·ÔÙ˘ÒÓÂÈ ·˘Ùfi Ô˘ Ú¿ÁÌ·ÙÈ Á›ÓÂÙ·È Î·È ·ÔÙÂ-
Ï› ÙË ÌfiÓË, ηٿ ÙË ÁÓÒÌË ÌÔ˘, ÛÔ‚·Ú‹ ·ÓÙÈÌÂÙÒ-
ÈÛË ÙÔ˘ ı¤Ì·ÙÔ˜:
“1. O È·ÙÚfi˜, Û ÂÚ›ÙˆÛË ·Ó›·Ù˘ ·Ûı¤ÓÂÈ-
·˜ Ô˘ ‚Ú›ÛÎÂÙ·È ÛÙÔ ÙÂÏÈÎfi Ù˘ ÛÙ¿‰ÈÔ, ·ÎfiÌË Î·È
·Ó ÂÍ·ÓÙÏËıÔ‡Ó fiÏ· Ù· È·ÙÚÈο ıÂÚ·¢ÙÈο ÂÚÈ-
ıÒÚÈ·, ÔÊ›ÏÂÈ Ó· ÊÚÔÓÙ›˙ÂÈ ÁÈ· ÙËÓ ·Ó·ÎÔ‡ÊÈÛË
ÙˆÓ „˘¯Ôۈ̷ÙÈÎÒÓ fiÓˆÓ ÙÔ˘ ·ÛıÂÓ‹. ΔÔ˘ ÚÔ-
ÛʤÚÂÈ ·ÚËÁÔÚËÙÈ΋ ·ÁˆÁ‹ Î·È Û˘ÓÂÚÁ¿˙ÂÙ·È ÌÂ
ÙÔ˘˜ ÔÈΛԢ˜ ÙÔ˘ ·ÛıÂÓ‹ ÚÔ˜ ·˘Ù‹Ó ÙËÓ Î·Ù‡-
ı˘ÓÛË. ™Â οı ÂÚ›ÙˆÛË, Û˘Ì·Ú›ÛÙ·Ù·È ÛÙÔÓ
·ÛıÂÓ‹ ̤¯ÚÈ ÙÔ Ù¤ÏÔ˜ Ù˘ ˙ˆ‹˜ ÙÔ˘ Î·È ÊÚÔÓÙ›˙ÂÈ
ÒÛÙ ӷ ‰È·ÙËÚ› ÙËÓ ·ÍÈÔÚ¤ÂÈ¿ ÙÔ˘ ̤¯ÚÈ ÙÔ ÛË-
ÌÂ›Ô ·˘Ùfi.
2. O È·ÙÚfi˜ Ï·Ì‚¿ÓÂÈ ˘fi„Ë ÙȘ ÂÈı˘Ì›Â˜ Ô˘
›¯Â ÂÎÊÚ¿ÛÂÈ Ô ·ÛıÂÓ‹˜ ·ÎfiÌË Î·È ·Ó, ηٿ ÙÔ
¯ÚfiÓÔ Ù˘ Â¤Ì‚·Û˘, Ô ·ÛıÂÓ‹˜ ‰ÂÓ Â›Ó·È Û ı¤ÛË
Ó· ÙȘ Â·Ó·Ï¿‚ÂÈ.
3. O È·ÙÚfi˜ ÔÊ›ÏÂÈ Ó· ÁÓˆÚ›˙ÂÈ fiÙÈ Ë ÂÈı˘Ì›·
ÂÓfi˜ ·ÛıÂÓ‹ Ó· Âı¿ÓÂÈ, fiÙ·Ó ‚Ú›ÛÎÂÙ·È ÛÙÔ ÙÂ-
ÏÂ˘Ù·›Ô ÛÙ¿‰ÈÔ, ‰ÂÓ Û˘ÓÈÛÙ¿ ÓÔÌÈ΋ ‰ÈηÈÏfiÁËÛË
ÁÈ· ÙË ‰ÈÂÓ¤ÚÁÂÈ· Ú¿ÍÂˆÓ ÔÈ Ôԛ˜ ÛÙÔ¯Â‡Ô˘Ó
ÛÙËÓ Â›Û΢ÛË ÙÔ˘ ı·Ó¿ÙÔ˘”.
™ÙËÓ ÙÂÏÂ˘Ù·›· ·˘Ù‹ ·Ú¿ÁÚ·ÊÔ Á›ÓÂÙ·È Û·-
ʤ˜ fiÙÈ ‰ÂÓ ·Ó·ÁÓˆÚ›˙ÂÙ·È “‰Èη›ˆÌ·” ÙÔ˘ ·ÚÚÒ-
ÛÙÔ˘ ÛÙÔ ı¿Ó·ÙÔ. ∏ ·Ó·ÎÔ‡ÊÈÛË ÙÔ˘ fiÓÔ˘, Ë ·-
ÚËÁÔÚËÙÈ΋ ·ÁˆÁ‹, Ë Û˘Ì·Ú¿ÛÙ·ÛË Ì¤¯ÚÈ ÙÔ Ù¤-
ÏÔ˜ Ù˘ ˙ˆ‹˜ Î·È Ë ÊÚÔÓÙ›‰· ÙÔ˘ ÁÈ·ÙÚÔ‡ ÁÈ· ÙË
‰È·Ù‹ÚËÛË Ù˘ ·ÍÈÔÚ¤ÂÈ·˜ ÙÔ˘ ·ÛıÂÓÔ‡˜ ·ÔÙÂ-
ÏÔ‡Ó Ù· ‚·ÛÈο ÛËÌ›· Ù˘ Ú‡ıÌÈÛ˘ ÙÔ˘ ∫Ò‰Èη
π·ÙÚÈ΋˜ ¢ÂÔÓÙÔÏÔÁ›·˜ ·Ó·ÊÔÚÈο Ì ÙȘ È·ÙÚÈΤ˜
·ÔÊ¿ÛÂȘ Î·È Ú¿ÍÂȘ ÛÙÔ Ù¤ÏÔ˜ Ù˘ ˙ˆ‹˜ ÙÔ˘ ·Ú-
ÚÒÛÙÔ˘. ∫·ıÒ˜ Â›Û˘ Î·È Ë ˘fiÌÓËÛË ÛÙËÓ ·-
Ú¿ÁÚ·ÊÔ 2 fiÙÈ Ô ÁÈ·ÙÚfi˜ “Ï·Ì‚¿ÓÂÈ ˘fi„Ë” ÙȘ
ÂÈı˘Ì›Â˜ Ô˘ ›¯Â ÂÎÊÚ¿ÛÂÈ Ô ·ÛıÂÓ‹˜ ·ÎfiÌË Î·È
·Ó ηٿ ÙÔ ¯ÚfiÓÔ Ù˘ Â¤Ì‚·Û˘ ‰ÂÓ Â›Ó·È Û ı¤ÛË
Ó· ÙȘ Â·Ó·Ï¿‚ÂÈ. ™ÙÔ ÛËÌÂ›Ô ·˘Ùfi ¯ÚÂÈ¿˙ÂÙ·È
ÚÔÛÔ¯‹. O ÓfiÌÔ˜ ·Ó·Ê¤ÚÂÈ “ÂÈı˘Ì›Â˜”, fiˆ˜
‚·ÛÈο Â›Ó·È ÔÈ ÂÈÏÔÁ¤˜ ÁÈ· ÔÈfiÙËÙ· ˙ˆ‹˜ Î·È ÙÔ
Ù¤ÏÔ˜ Ù˘ (Ë ÂÍ¿ÏÂÈ„Ë ‹ ÂÏ·¯ÈÛÙÔÔ›ËÛË ÙÔ˘ fi-
ÓÔ˘, Ë ÓÔÛËÏ›· ÛÙÔ Û›ÙÈ ÁÈ· ÙȘ ÙÂÏÂ˘Ù·›Â˜ ÛÙÈÁ-
̤˜ ÎÏ.) Î·È fi¯È, ‚¤‚·È· Ë ÂÈı˘Ì›· ı·Ó¿ÙÔ˘. ∞˘-
Ùfi ·ÔÎÏ›ÂÙ·È Ó· ¯ÚËÛÈÌÔÔÈËı› ˆ˜ ÓÔÌÈ΋ ‰È-
ηÈÔÏfiÁËÛË ÁÈ· ÙË ‰ÈÂÓ¤ÚÁÂÈ· Ú¿ÍÂˆÓ Ô˘ ÛÙÔ-
96 I. MANø§∂¢∞∫∏™
¯Â‡Ô˘Ó ÛÙËÓ Â›Û¢ÛË ÙÔ˘ ı·Ó¿ÙÔ˘, Û‡Ìʈӷ ÌÂ
ÙË ÚËÙ‹ ÂÈÙ·Á‹ Ù˘ ÙÂÏÂ˘Ù·›·˜ ·Ú·ÁÚ¿ÊÔ˘ ÙÔ˘
¿ÚıÚÔ˘, fiˆ˜ ›‰·Ì ·Ì¤Ûˆ˜ ÚÔËÁÔ˘Ì¤Óˆ˜. ∂›-
Û˘ Ú¤ÂÈ Ó· ÚÔÛ¯ı› Ë ‰È·Ù‡ˆÛË ÙÔ˘ ÓfiÌÔ˘
fiÙÈ Ô ÁÈ·ÙÚfi˜ “Ï·Ì‚¿ÓÂÈ ˘fi„Ë” ÙȘ ÂÈı˘Ì›Â˜ ÙÔ˘
·ÚÚÒÛÙÔ˘, ·ÓÙ› ÁÈ· ÙË ‰È·Ù‡ˆÛË “Û˘ÌÌÔÚÊÒÓÂ-
Ù·È” ‹ “ÂÎÏËÚÒÓÂÈ” ÂÈı˘Ì›Â˜. ∞˘Ù‹ Ë ÂÈÏÔÁ‹ ÙÔ˘
ÓÔÌÔı¤ÙË ‰ÂÓ Â›Ó·È Ù˘¯·›·. ΔÔÓ›˙ÂÈ Â‡ÛÙÔ¯· ÙËÓ ·˘-
ÙÔÓÔÌ›· ÙÔ˘ ˘„ËÏÔ‡ È·ÙÚÈÎÔ‡ ÏÂÈÙÔ˘ÚÁ‹Ì·ÙÔ˜ ηÈ
·Ê‹ÓÂÈ ÂÚÈıÒÚÈ· ÛÙÔ ÁÈ·ÙÚfi Ó· Û˘˙ËÙ‹ÛÂÈ ·˘Ù¤˜
ÙȘ ÂÈı˘Ì›Â˜ Ì ÙÔÓ ¿ÚÚˆÛÙÔ Î·È ÂӉ¯Ô̤ӈ˜ Ó·
ÙÔÓ ÌÂÙ·›ÛÂÈ. ¢ÈfiÙÈ ÔÏϤ˜ ÊÔÚ¤˜ ÔÈ ÂÈı˘Ì›Â˜ ÙÔ˘
·ÚÚÒÛÙÔ˘ ÔÊ›ÏÔÓÙ·È Û ÂÛÊ·Ï̤ÓË ÂÓË̤ڈۋ
ÙÔ˘, Û ÚÔηٷϋ„ÂȘ ‹ Û ·‰ÈηÈÔÏfiÁËÙ˜ ÊÔ‚›Â˜.
O ÁÈ·ÙÚfi˜ ı· Ú¤ÂÈ Ó· ˘ÔÛÙËÚ›ÍÂÈ ÙËÓ ÂÈÛÙËÌÔ-
ÓÈ΋ È·ÙÚÈ΋ ¿Ô„Ë, ·ÏÏ¿ Ì ηٷÓfiËÛË, ·ÓıÚˆÈ-
ÛÌfi Î·È ÚÔ·ÓÙÒ˜ ÌÂ Û˘ÌfiÓÔÈ· ÁÈ· ÙÔÓ ¿Û¯Ô-
ÓÙ·. ∂‰Ò ‚Ú›ÛÎÂÙ·È Ë Ô˘Û›· ÙÔ˘ ı¤Ì·ÙÔ˜.
™˘ÌÂÚ·ÛÌ·ÙÈο, Ë ÓÔÌÔıÂÛ›· Ì·˜ ·Ó·ÊÔÚÈ-
ο Ì ÙÔ Úfi‚ÏËÌ· Ù˘ È·ÙÚÈ΋˜ ·ÓÙÈÌÂÙÒÈÛ˘ ÙÔ˘
Ù¤ÏÔ˘˜ Ù˘ ˙ˆ‹˜ Â›Ó·È Â·Ú΋˜ Î·È ÂÍ·ÓÙÏ› ÙȘ ‰˘-
Ó·ÙfiÙËÙ˜ ÙÔ˘ ‰Èη›Ô˘. ™˘˙ËÙ‹ÛÂȘ, ‚¤‚·È·, ı· ÂÍ·-
ÎÔÏÔ˘ıÔ‡Ó Ó· Á›ÓÔÓÙ·È Û ÊÈÏÔÛÔÊÈÎfi Î·È ËıÈÎfi
Â›Â‰Ô ÁÈ· ÙÔ ˘·ÚÍÈ·Îfi Úfi‚ÏËÌ· ÙÔ˘ ı·Ó¿ÙÔ˘
Î·È Ù˘ ÔÈfiÙËÙ¿˜ ÙÔ˘. ∞˜ ÂÚÈÔÚÈÛÙԇ̠ے ·˘Ù¤˜
Î·È ·˜ ·Ê‹ÛÔ˘Ì ÙÔ ıÂÙÈÎfi ‰›Î·ÈÔ Ì ÙËÓ Ù˘ÈÎfiÙË-
Ù· Î·È ÙË Û¯ÂÙÈÎfiÙËÙ¿ ÙÔ˘ Ó· ·ÓÙÈÌÂÙˆ›˙ÂÈ ÂΛӷ
Ù· ı¤Ì·Ù· ÁÈ· Ù· ÔÔ›· ÌÔÚ› Ó· ‰›ÓÂÈ Ï‡ÛÂȘ.
Manoledakis J. Enthanasia. ∏ell Iatr 2009, 75: 91-96.