Atividade endotelial em pacientes HCV positivo em hemodialise
Arquivos
Data
2009
Autores
Alves, Claudia Maria Pereira 
Orientadores
Gabriel Júnior, Alexandre
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: a doença renal crônica é uma síndrome complexa; vários fatores contribuem para que pacientes em hemodiálise apresentem um estado inflamatório crônico e disfunção endotelial pronunciada, levando a alta prevalência de doença cardiovascular aterosclerótica prematura. A infecção pelo vírus da Hepatite C, comum
nestes pacientes, poderia ser um fator de piora para este estado inflamatório. Dosagem de marcadores de lesão endotelial como ICAM-1 e VEGF, pode ser uma arma para identificar pacientes com risco elevado que necessitam de medidas efetivas que possam diminuir a mortalidade. Objetivos: comparar atividade endotelial entre pacientes renais crônicos portadores e não portadores de Hepatite C submetidos à hemodiálise. Métodos: selecionamos 18 pacientes em diálise com hepatite C e
viremia positiva – grupo HCV(+), e outros 10 pacientes em diálise sem hepatite –
grupo HCV(-). Os grupos foram avaliados num único momento com relação a:
adequação da diálise (Kt/V); atividade endotelial – ICAM-1 e VEGF; atividade
necroinflamatória e função hepática – albumina, ALT e TAP; pesquisa de
crioglobulinemia; dosagem de C3, C4 e fator reumatóide; avaliação nutricional:
antropométrica, laboratorial e subjetiva – IMC, %adequação PCT, %adequação GC,
CMB e %adequação CMB; albumina, transferrina e linfócitos totais. Resultados: sexo
masculino 68%, idade entre 20-69 (45,39 + 14,11) anos. Tempo em hemodiálise
variou de 6 meses a 22 (7,45 + 6,35) anos, significativamente maior no grupo HCV(+),
p=0,0149. Todos os pacientes atingiram o valor esperado de Kt/V (1,32 + 0,17). O
ICAM-1 estava elevado (402 + 182,1) em 60,71% pacientes; mais alto no grupo C
positivo (435,1 + 188,6 vs 342 + 161,8), porém não significante, p=0,2024. Não houve
correlação entre nível de ICAM-1 com tempo em diálise ou ALT, em nenhum dos
grupos (r = 0). Os níveis de VEGF foram normais (295,4 + 237,9) em 92,85% dos
pacientes. Todos tinham função hepática normal (TAP 92,34 + 7,67) e não foi
encontrada lesão significativa no fígado (ALT 35,23 + 24,42). Em nenhum dos
pacientes foram encontradas crioglobulinas. Apenas a fração C3 do complemento
estava baixa (79,38 + 19,23) em 75% dos pacientes, sem diferença entre os grupos,
p=0,9293. O fator reumatóide foi normal (29,73 + 15,11) em 71,42%, também sem
diferença entre os grupos, p=0,1248. A avaliação nutricional antropométrica revelou
desnutrição leve a moderada, com reserva muscular diminuída (%CMB 85,20 + 10,28)
em todos, e gordura corporal elevada (%GC 22,30 + 3,19) em 55,56%. A média dos
valores dos parâmetros laboratoriais analisados, albumina (4,12 + 0,51), transferrina
(210,6 + 104,4) e contagem de linfócitos (1398 + 562,5) encontravam-se normais nos
dois grupos. Subjetivamente 92,85% classificado como desnutrição leve; 7,14%
moderada e nenhum eutrófico. Conclusões: observamos que renais crônicos em
hemodiálise possuem elevado grau de lesão endotelial, porém a presença de hepatite
C não foi um fator agravante deste quadro. ICAM-1 é um bom marcador nesta
população, já VEGF não se mostrou útil para a avaliação endotelial nestes pacientes.
É possível que estes resultados advenham da amostra limitada, necessárias análises
com um número maior de pacientes para estabelecer se existe maior atividade
endotelial em pacientes com insuficiência renal em hemodiálise com hepatite C.
Introduction: the chronic renal disease is a complex syndrome; several factors contribute to a chronic inflammatory state and pronounced endothelial dysfunction in patients on hemodialysis, leading to high prevalence of atherosclerotic premature cardiovascular disease. The infection caused by hepatitis C virus, common in such patients, could be a worsening factor for this inflammatory state. Endothelial lesion markers dosage as ICAM-1 and VEGF, could be a tool to identify patients at high risk who need effective measures in order to reduce the mortality rate. Objectives: to compare endothelial activity between chronic renal patients with and without hepatitis C submitted to hemodialysis. Methods: 28 patients undergoing dialysis were divided in two groups: HCV(+) group – 18 patients: anti-HCV(+) and PCR(+); and HCV(-) group – 10 patients: anti-HCV(-). The groups were evaluated concerning to: dialysis efficiency (Kt/V); endothelial activity: ICAM-1 and VEGF; necroinflammatory activity and hepatic function: albumin, ALT and TAP; cryoglobulinemia research; C3, C4 and rheumatoid factor level; nutrition assessment: anthropometric (IMC, %PCT, %GC, CMB and %CMB), laboratory (albumin, transferrin and total lymphocytes) and subjective. Results: men were 68%, women 32%. Aged between 20-69 (45,39 + 14,11) years. Time on hemodialysis varied from 6 months to 22 years (7,45 + 6,35years), significantly higher in group HCV(+), p=0,0149. The entire patients reached expected value of Kt/V (1,32 + 0,17). ICAM-1 levels were high (402 + 182,1) in 60,71%; highest levels in HCV(+) group (435,1 + 188,6 vs 342 + 161,8) however, it was not statiscally significant – p=0,2024. There was no correlation between the ICAM-1 levels and the hemodialysis time or ALT levels in any group (r = 0). The levels of VEGF (295,4 + 237,9) were normal in 92,85%; only HCV(+) patients had high levels. No group presented any correlation between the VEGF levels and the dialysis time or ALT levels. All patients had normal hepatic function (TAP 92,34 + 7,67) and no significant liver lesion was found (ALT 35,23 + 24,42). None of the patients had cryoglobulins. Just C3 fraction of complement was low (79,38 + 19,23), in 75% of the patients, without difference between the groups – p=0,9293. The rheumatoid factor was standard (29,73 + 15,11) in 71,42%; without difference between the groups as well (p=0,1248). Anthropometric nutritional assessment showed light to moderate malnutrition, with reduced muscular reservation (%CMB 85,20 + 10,28) in all of them; and high corporal fat (%GC 22,30 + 3,19) in 55,56%. Laboratory parameters values analyzed: albumin (4,12 + 0,51), transferrin (210,6 + 104,4) and lymphocytes count (1398 + 562,5) were normal in both groups. Subjectively 92,85% was classified as light malnutrition; 7,14% moderate and no eutrophic. Conclusion: Patients undergoing hemodialysis show high endothelial lesion, nevertheless, the presence of HCV did not show an aggravating factor of such state. ICAM-1 is a good marker in this population. VEGF was not useful as endothelial marker in such patients. This result may have happened due to the small number of patients. It would be necessary analysis with a larger sample for more definitive conclusions.
Introduction: the chronic renal disease is a complex syndrome; several factors contribute to a chronic inflammatory state and pronounced endothelial dysfunction in patients on hemodialysis, leading to high prevalence of atherosclerotic premature cardiovascular disease. The infection caused by hepatitis C virus, common in such patients, could be a worsening factor for this inflammatory state. Endothelial lesion markers dosage as ICAM-1 and VEGF, could be a tool to identify patients at high risk who need effective measures in order to reduce the mortality rate. Objectives: to compare endothelial activity between chronic renal patients with and without hepatitis C submitted to hemodialysis. Methods: 28 patients undergoing dialysis were divided in two groups: HCV(+) group – 18 patients: anti-HCV(+) and PCR(+); and HCV(-) group – 10 patients: anti-HCV(-). The groups were evaluated concerning to: dialysis efficiency (Kt/V); endothelial activity: ICAM-1 and VEGF; necroinflammatory activity and hepatic function: albumin, ALT and TAP; cryoglobulinemia research; C3, C4 and rheumatoid factor level; nutrition assessment: anthropometric (IMC, %PCT, %GC, CMB and %CMB), laboratory (albumin, transferrin and total lymphocytes) and subjective. Results: men were 68%, women 32%. Aged between 20-69 (45,39 + 14,11) years. Time on hemodialysis varied from 6 months to 22 years (7,45 + 6,35years), significantly higher in group HCV(+), p=0,0149. The entire patients reached expected value of Kt/V (1,32 + 0,17). ICAM-1 levels were high (402 + 182,1) in 60,71%; highest levels in HCV(+) group (435,1 + 188,6 vs 342 + 161,8) however, it was not statiscally significant – p=0,2024. There was no correlation between the ICAM-1 levels and the hemodialysis time or ALT levels in any group (r = 0). The levels of VEGF (295,4 + 237,9) were normal in 92,85%; only HCV(+) patients had high levels. No group presented any correlation between the VEGF levels and the dialysis time or ALT levels. All patients had normal hepatic function (TAP 92,34 + 7,67) and no significant liver lesion was found (ALT 35,23 + 24,42). None of the patients had cryoglobulins. Just C3 fraction of complement was low (79,38 + 19,23), in 75% of the patients, without difference between the groups – p=0,9293. The rheumatoid factor was standard (29,73 + 15,11) in 71,42%; without difference between the groups as well (p=0,1248). Anthropometric nutritional assessment showed light to moderate malnutrition, with reduced muscular reservation (%CMB 85,20 + 10,28) in all of them; and high corporal fat (%GC 22,30 + 3,19) in 55,56%. Laboratory parameters values analyzed: albumin (4,12 + 0,51), transferrin (210,6 + 104,4) and lymphocytes count (1398 + 562,5) were normal in both groups. Subjectively 92,85% was classified as light malnutrition; 7,14% moderate and no eutrophic. Conclusion: Patients undergoing hemodialysis show high endothelial lesion, nevertheless, the presence of HCV did not show an aggravating factor of such state. ICAM-1 is a good marker in this population. VEGF was not useful as endothelial marker in such patients. This result may have happened due to the small number of patients. It would be necessary analysis with a larger sample for more definitive conclusions.
Descrição
Citação
ALVES, Claudia Maria Pereira. Atividade endotelial em pacientes HCV positivo em hemodialise. 2009. 96 f.Dissertação (Mestrado em Ciências) - Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, 2009