Vitiligo: aspectos clínico-epidemiológicos, imunológicos e interação com qualidade de vida e sono
Data
2024-01-18
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Objetivos: Com etiopatogenia complexa, o vitiligo pode gerar impacto psicológico negativo e diversas repercussões orgânicas no indivíduo. Este estudo teve como objetivo investigar a relação clínico-epidemiológica e laboratorial entre vitiligo, qualidade de vida (QoL – Quality of Life) e sono. Foram enfatizados aspectos hormonais, metabólicos, inflamatórios e imunológicos, que podem estar correlacionados ao mecanismo autoimune da doença e à qualidade de sono. Métodos: Neste estudo transversal, foram incluídos 30 pacientes com vitiligo e 26 voluntários controles. Foram aplicados protocolo de pesquisa com dados clínico-epidemiológicos gerais e questionários de QoL [Short Form Survey-36 (SF-36) e Índice de Qualidade de Vida em Dermatologia (DLQI)] e de sono [Índice de Qualidade de Sono de Pittsburgh (PSQI) e Índice de Gravidade de Insônia (IGI)]. Foram realizadas dosagens séricas do hormônio tireoestimulante (TSH); componentes do metabolismo do cálcio, incluindo 1,25-dihidroxicalciferol [1,25(OH)2D] e 25-hidroxivitamina D [25(OH)D], cálcio e paratormônio (PTH); marcadores autoimunes [autoanticorpos tireoidianos antitireoperoxidase (anti-TPO) e antitireoglobulina (anti-TGB), e fator antinuclear (FAN)]; e substratos imunológicos/inflamatórios: citocinas interferon-gama (IFN-γ), interleucina (IL)-4, IL-6, IL-10, IL-17A, IL-12 p40 e fator de necrose tumoral alfa (TNF-α). Resultados: No grupo vitiligo, a média de idade foi 47,7 anos, com prevalência do sexo feminino (66,7%) e fototipo III/IV (60%). Lesões mucosas (70%), acrais (60%) e subtipo focal (53,3%) predominaram. Sinais de atividade do vitiligo foram identificados em 63,3% da amostra. Os domínios do SF-36 “limitação física”, “limitação emocional”, “aspectos sociais” e “dor física” foram piores no grupo vitiligo. A média do DLQI (escore=5,57) indicou impacto leve a moderado na QoL. O escore médio do PSQI foi maior no grupo vitiligo (média=9,96), no qual predominaram “maus dormidores” (escore>5). A média do anti-TPO esteve aumentada no grupo vitiligo. Citocinas séricas não obtiveram significância estatística entre grupos. Pacientes tratados previamente com fototerapia apresentaram média maior de 25(OH)D, porém sem significância estatística comparada ao grupo controle. Entretanto, as médias descritivas de 25(OH)D corresponderam a valores insuficientes desta vitamina (<30 ng/mL). Não houve diferença estatística da influência de dados clínico-epidemiológicos do vitiligo nos níveis de 25(OH)D. Atividade do vitiligo foi estatisticamente associada a níveis maiores de TSH, 25(OH)D, e IL-6, ao FAN reagente, redução dos níveis de IL-4 e menores escores do PSQI. A análise da fototerapia na interação entre citocinas e sono mostrou significância das IL-4, IL-6 e IL-10. Não houve significância estatística entre citocinas e PSQI; em relação ao IGI, houve correlação da insônia com aumento de IL-17A no grupo vitiligo. Conclusões: O sono de má qualidade predominou no grupo vitiligo. Alguns resultados foram inversos ao esperado, como a influência de escores menores do PSQI e aumento de 25(OH)D na atividade da doença. A atividade do vitiligo foi associada ao FAN reagente e aumento do TSH e IL-6, e à diminuição de IL-4. Houve relação positiva da fototerapia prévia com citocinas de influência circadiana, e da insônia com aumento da IL-17A no vitiligo. Diversas vias associadas ao vitiligo, incluindo hormonal, metabólica, autoimune e imunológica (citocinas), e como elas interagem entre si e com o ritmo circadiano, sugerem a complexidade da interação entre vitiligo e sono.
Objectives: With a complex etiopathogenesis, vitiligo can have a negative psychological impact and several organic repercussions in the individual. This study aimed to investigate the clinical-epidemiological and laboratory relationship between vitiligo, quality of life (QoL) and sleep. Hormonal, metabolic, inflammatory and immunological aspects were emphasized, which may be correlated with autoimmune mechanisms of the disease and the sleep quality. Methods: In this cross-sectional study, 30 patients with vitiligo and 26 control volunteers were included. A research protocol with general clinical-epidemiological data and QoL questionnaires [Short Form Survey-36 (SF-36) and Dermatology Quality of Life Index (DLQI)], and sleep questionnaires [Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI)] were applied. There have been performed serum measurement of thyroid-stimulating hormone (TSH); components of calcium metabolism, including vitamin D 1,25-dihydroxycalciferol [1,25(OH)2D] and 25-hydroxy vitamin D [25(OH)D], calcium, and parathyroid hormone (PTH); autoimmune markers [anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin (anti-TGB) thyroid autoantibodies, and antinuclear antibody (ANA)]; and immunological/inflammatory substrates: cytokines interferon-gamma (IFN-γ), interleukin (IL)-4, IL-6, IL-10, IL-17A, IL-12 p40 and tumor necrosis factor alpha (TNF-α). Results: In the vitiligo group, the mean age was 47.7 years-old, with prevalence of females (66.7%) and phototype III/IV (60%). Mucosal (70%), acral (60%) and focal subtype (53.3%) lesions predominated. Signs of vitiligo activity were identified in 63.3% of the sample. The SF-36 domains “physical limitation”, “emotional limitation”, “social aspects” and “physical pain” were worse in the vitiligo group. The DLQI mean (score=5.57) indicated mild to moderate impact in the QoL. The PSQI score average was increased in the vitiligo group (mean=9.96), in which “poor sleepers” (score>5) predominated. Anti-TPO mean was higher in vitiligo group. Serum cytokines were not statistically significant between groups. Patients who underwent previous phototherapy had a higher average of 25(OH)D levels, but without statistical significance compared to controls. However, the descriptive means of 25(OH)D corresponded to insufficient values of this vitamin (<30 ng/mL). There was no statistical difference in the influence of clinical and epidemiological data of vitiligo on 25(OH)D levels. Signs of disease activity were statistically influenced by higher levels of TSH, 25(OH)D, and IL-6, reagent ANA, reduced levels of IL-4, and lower PSQI scores. The analysis of the phototherapy on the interaction between cytokines and sleep showed significance for IL-4, IL-6 and IL-10. There was no statistical significance between cytokines and PSQI; regarding ISI, there was a correlation between insomnia and increasing IL-17A in the vitiligo group. Conclusions: Poor sleep quality predominated in the vitiligo group. Some results were the opposite of those expected, such as the influence of lower PSQI scores and increased 25(OH)D levels on disease activity. Vitiligo activity was associated with reagent ANA and the increase of TSH and IL-6, and IL-4 decrease. There was positive relationship between previous phototherapy and cytokines with circadian influence, and between insomnia and IL-17A increase in vitiligo. Several pathways associated with vitiligo, including hormonal, metabolic, autoimmune and immune (cytokines), and how they interact with each other and with the circadian cycle, suggest the complexity of the interaction between vitiligo and sleep.
Objectives: With a complex etiopathogenesis, vitiligo can have a negative psychological impact and several organic repercussions in the individual. This study aimed to investigate the clinical-epidemiological and laboratory relationship between vitiligo, quality of life (QoL) and sleep. Hormonal, metabolic, inflammatory and immunological aspects were emphasized, which may be correlated with autoimmune mechanisms of the disease and the sleep quality. Methods: In this cross-sectional study, 30 patients with vitiligo and 26 control volunteers were included. A research protocol with general clinical-epidemiological data and QoL questionnaires [Short Form Survey-36 (SF-36) and Dermatology Quality of Life Index (DLQI)], and sleep questionnaires [Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI)] were applied. There have been performed serum measurement of thyroid-stimulating hormone (TSH); components of calcium metabolism, including vitamin D 1,25-dihydroxycalciferol [1,25(OH)2D] and 25-hydroxy vitamin D [25(OH)D], calcium, and parathyroid hormone (PTH); autoimmune markers [anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin (anti-TGB) thyroid autoantibodies, and antinuclear antibody (ANA)]; and immunological/inflammatory substrates: cytokines interferon-gamma (IFN-γ), interleukin (IL)-4, IL-6, IL-10, IL-17A, IL-12 p40 and tumor necrosis factor alpha (TNF-α). Results: In the vitiligo group, the mean age was 47.7 years-old, with prevalence of females (66.7%) and phototype III/IV (60%). Mucosal (70%), acral (60%) and focal subtype (53.3%) lesions predominated. Signs of vitiligo activity were identified in 63.3% of the sample. The SF-36 domains “physical limitation”, “emotional limitation”, “social aspects” and “physical pain” were worse in the vitiligo group. The DLQI mean (score=5.57) indicated mild to moderate impact in the QoL. The PSQI score average was increased in the vitiligo group (mean=9.96), in which “poor sleepers” (score>5) predominated. Anti-TPO mean was higher in vitiligo group. Serum cytokines were not statistically significant between groups. Patients who underwent previous phototherapy had a higher average of 25(OH)D levels, but without statistical significance compared to controls. However, the descriptive means of 25(OH)D corresponded to insufficient values of this vitamin (<30 ng/mL). There was no statistical difference in the influence of clinical and epidemiological data of vitiligo on 25(OH)D levels. Signs of disease activity were statistically influenced by higher levels of TSH, 25(OH)D, and IL-6, reagent ANA, reduced levels of IL-4, and lower PSQI scores. The analysis of the phototherapy on the interaction between cytokines and sleep showed significance for IL-4, IL-6 and IL-10. There was no statistical significance between cytokines and PSQI; regarding ISI, there was a correlation between insomnia and increasing IL-17A in the vitiligo group. Conclusions: Poor sleep quality predominated in the vitiligo group. Some results were the opposite of those expected, such as the influence of lower PSQI scores and increased 25(OH)D levels on disease activity. Vitiligo activity was associated with reagent ANA and the increase of TSH and IL-6, and IL-4 decrease. There was positive relationship between previous phototherapy and cytokines with circadian influence, and between insomnia and IL-17A increase in vitiligo. Several pathways associated with vitiligo, including hormonal, metabolic, autoimmune and immune (cytokines), and how they interact with each other and with the circadian cycle, suggest the complexity of the interaction between vitiligo and sleep.