Estudo da prevalência do polimorfismo do gene da fibulina-5 em mulheres brasileiras com prolapso de órgãos pélvicos
Data
2021-08-26
Autores
Teixeira, Juliana Barbosa 
Orientadores
Castro, Rodrigo de Aquino
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: Sabe-se que o prolapso de órgãos pélvicos é uma condição
multifatorial. Contribuem para sua gênese fatores obstétricos, clínicos e
demográficos. A fibulina-5 é uma molécula de grande importância na homeostase
das fibras elásticas e se encontra reduzida no assoalho pélvico das pacientes com
grandes prolapsos. Objetivos: Avaliação da prevalência do polimorfismo
rs2018736 do gene da fibulina-5 e sua associação com o prolapso de órgãos
pélvicos em pacientes brasileiras, bem como avaliar outros fatores de risco para
prolapso encontrados nessa população. Metodologia: Estudo observacional,
transversal, do tipo caso-controle. O estudo incluiu 608 mulheres na pós menopausa que foram submetidas à avaliação clínica e análise do DNA do sangue
periférico. As participantes foram distribuídas em dois grupos: 1) Grupo Caso: 342
com diagnóstico de prolapso genital estadios III ou IV; e 2) Grupo Controle: 266
mulheres sem prolapso genital ou com prolaso genital mínimo (estadios 0 e I). A
associação entre a presença do polimorfismo e prolapso de órgão pélvico
acentuado foi estimada em odds ratio (OR) usando modelos de regressão logística
binária. Resultado: o polimorfismo rs2018736 está presente em 77% das pacientes
estudadas, e sua presença, em heterozigose aumenta 2,16 vezes o risco de
prolapso (IC: 1,16-4,01), enquanto em homozigose eleva 2,97 vezes (IC: 1,52-5,8)
Também podemos destacar como fator de risco de POP: idade (OR:1,08 IC:1,05-
1,112), antecedentes familiares de POP (OR:1,24 IC: 1,53-4,89), partos normais
(OR: 5,32 IC: 2,58-11,01) partos a fórceps (OR:3,34 IC: 1,72-6,47), peso fetal (OR:
1,001 IC: 1,0004-1,0012), HAS (OR:1,76 IC: 1,05-2,94) e DM (OR:2,1 IC: 1,53-
4,89). O parto cesáreo aparece como fator e proteção contra POP tendo a paciente
0,47 vezes a chance de apresentar prolapso se comparada a paciente que não teve
cesárea (IC: 0,27-0,83). Conclusões: o polimorfismo da fibulina 5 (rs2018736) é
fator de risco para prolapso genital. Dentre as variáveis demográficos e clínicas
aparecem como fator de risco para o desenvolvimento do POP: idade, antecedente
familiar, parto normal, parto fórceps, peso fetal, hipertensão arterial sistêmica e
diabetes mellitus. O parto cesáreo se mostrou fator protetor para doença.
Introduction: Pelvic organ prolapse is known to be a multifactorial condition. Obstetric, clinical and demographic factors contribute to its genesis. Fibulin-5 is a molecule of great importance in the homeostasis of elastic fibers and is reduced in the pelvic floor of patients with large prolapses. Objective: Evaluation of the prevalence of the fibulin-5 gene rs2018736 polymrphism and its association with pelvic organ prolapse in Brazilian patients, as well as assessing other risk factors for prolapse found in this. Metodology: Observational, cross-sectional, case-control study. The study included 608 postmenopausal women who underwent complete clinical evaluation and blood DNA analysis. The participants were divided into two groups, according prolapse level 1) case group: 342 with genital prolapse(stage III or IV); and 2) control group: 266 women with no or even minimal genital prolapse (stages 0 and I). The association between the polymorphism and pronounced pelvic organ prolapse was estimated in odds ratios (OR) and respective 95% confidence intervals (95% CI), using binary logistic regression models. Results:The rs2018736 polymorphism is present in 77% of the studied patients, and its presence in heterozygosis increases 2.16 times the risk of prolapse (CI: 1.16-4.01), while in homozygosity it increases 2.97 times (CI: 1.52-5.8) We can also highlight as a POP risk factor: age (OR: 1.08 CI: 1.05-1.112), family history of POP (OR: 1.24 CI: 1.53- 4.89), normal deliveries (OR: 5.32 CI: 2.58-11.01), forceps deliveries (OR: 3.34 CI: 1.72-6.47), fetal weight (OR: 1.001 CI : 1,0004-1,0012), SAH (OR: 1.76 CI: 1.05-2.94) and DM (OR: 2.1 CI: 1.53-4.89). Cesarean delivery appears as a factor of protection against POP, with the patient 0.47 times the chance of presenting prolapse compared to a patient who did not have a cesarean section (CI: 0.27-0.83). Conclusions: the rs2018736 polymorphism is a risk factor for genital prolapse. Also appear as risck factor for POP : age, family history, normal delivery, forceps delivery, fetal weight, systemic arterial hypertension and diabetes mellitus. Cesarean delivery appears, with statistical significance, as a protective factor against POP
Introduction: Pelvic organ prolapse is known to be a multifactorial condition. Obstetric, clinical and demographic factors contribute to its genesis. Fibulin-5 is a molecule of great importance in the homeostasis of elastic fibers and is reduced in the pelvic floor of patients with large prolapses. Objective: Evaluation of the prevalence of the fibulin-5 gene rs2018736 polymrphism and its association with pelvic organ prolapse in Brazilian patients, as well as assessing other risk factors for prolapse found in this. Metodology: Observational, cross-sectional, case-control study. The study included 608 postmenopausal women who underwent complete clinical evaluation and blood DNA analysis. The participants were divided into two groups, according prolapse level 1) case group: 342 with genital prolapse(stage III or IV); and 2) control group: 266 women with no or even minimal genital prolapse (stages 0 and I). The association between the polymorphism and pronounced pelvic organ prolapse was estimated in odds ratios (OR) and respective 95% confidence intervals (95% CI), using binary logistic regression models. Results:The rs2018736 polymorphism is present in 77% of the studied patients, and its presence in heterozygosis increases 2.16 times the risk of prolapse (CI: 1.16-4.01), while in homozygosity it increases 2.97 times (CI: 1.52-5.8) We can also highlight as a POP risk factor: age (OR: 1.08 CI: 1.05-1.112), family history of POP (OR: 1.24 CI: 1.53- 4.89), normal deliveries (OR: 5.32 CI: 2.58-11.01), forceps deliveries (OR: 3.34 CI: 1.72-6.47), fetal weight (OR: 1.001 CI : 1,0004-1,0012), SAH (OR: 1.76 CI: 1.05-2.94) and DM (OR: 2.1 CI: 1.53-4.89). Cesarean delivery appears as a factor of protection against POP, with the patient 0.47 times the chance of presenting prolapse compared to a patient who did not have a cesarean section (CI: 0.27-0.83). Conclusions: the rs2018736 polymorphism is a risk factor for genital prolapse. Also appear as risck factor for POP : age, family history, normal delivery, forceps delivery, fetal weight, systemic arterial hypertension and diabetes mellitus. Cesarean delivery appears, with statistical significance, as a protective factor against POP
Descrição
Citação
TEIXEIRA, J.B. Estudo da prevalência do polimorfismo do gene da fibulina-5 em mulheres brasileiras com prolapso de órgãos pélvicos. São Paulo, 2021. 60 f. Dissertação (Mestrado em Ginecologia) - Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP). São Paulo, 2021.