Avaliação da espessura da veia femoral como ferramenta diagnóstica na doença de Behçet: resultados de uma área não endêmica
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Data
2023-11-28
Autores
Neaime, Sarah Abati Curi [UNIFESP]
Orientadores
Souza, Alexandre Wagner Silva de [UNIFESP]
Tipo
Dissertação de mestrado
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ISSN da Revista
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Introdução: A doença de Behçet (DB) é uma vasculite sistêmica de vasos variáveis que se caracteriza por úlceras orais e genitais recorrentes, lesões cutâneas tais como o eritema nodoso. Pode levar ainda ao acometimento ocular, vascular e do sistema nervoso central. Não apresenta diferença de prevalência entre os sexos, no entanto, os homens tendem a ter manifestações mais graves. O envolvimento vascular acomete até 40% dos pacientes, no entanto, até hoje não temos um teste confiável para predizer risco de trombose. O diagnóstico também é um desafio na prática clínica, principalmente em países de baixa prevalência. O teste da patergia apresenta baixa sensibilidade e até hoje não temos um biomarcador disponível. A espessura da veia femoral (VF) foi avaliada em 2 estudos na Turquia que demonstraram espessamento em pacientes com DB, podendo ser um marcador diagnóstico com uma boa sensibilidade e especificidade.
Objetivo: Reproduzir os exames realizados na Turquia na população do Brasil tanto de controles como de pacientes para avaliar a espessura da VF como instrumento de avaliação para investigação de paciente com suspeita de DB.
Pacientes e métodos: Um estudo transversal foi realizado com pacientes com DB e controles saudáveis em que foram medidas as espessuras das VF bilateral e o diâmetro das veias safena parva e safena magna. Além disso, foram avaliados evidência de trombose ou refluxo nas veias analisadas. Os dados demográficos foram coletados de ambos os grupos e nos pacientes foram avaliados ainda quais sintomas eles apresentaram no início e no momento do estudo, terapia realizada, teste da patergia e HLA*B51.
Resultados: O estudo não observou diferença estatisticamente significante de idade (43,9 ± 12,9 anos vs. 46,4 ± 12,6 anos; p = 0,166) e frequência de sexo feminino (64% vs. 69%; p = 0,454) entre pacientes com DB e controles. A espessura da VF direita (0,6 mm (0,500-0,700) vs. 0,525mm (0,450-0,637); p = 0,012) e VF esquerda (0,550mm (0,450-0,650) vs. 0,500mm (0,450-0,550); p = 0,004) apresentou diferença entre os grupos, no entanto, o diâmetro das veias safenas magna (VSM) e parva (VSP) de ambos os lados, não demonstrou diferença (VSM direita 4,000mm (3,275-5,025) vs. 4,100mm (3,400-5,450); p = 0,591), (VSM esquerda 3,750mm (3,150-4,650) vs. 4,050mm (3,400-5,000); p = 0,266), (VSP direita 2,750mm (2,150- 3,437) vs. 2,575mm (2,212-3,075); p = 0,306), (VSP esquerda 2,600mm (2,275- 3,550) vs. 2,656mm (2,112- 3,537); p = 0,259), entre pacientes com DB e controles, respectivamente. Não foi vista correlação entre a espessura da VF direita e VF esquerda e exames coletados, índices de atividade de doença, terapia usada, apenas em relação a número de eventos vasculares prévios. Para o ponto de corte da VF direita e VF esquerda pelo índice de Youden (0,575mm) na curva Receiver Operating Characteristic (ROC), [área sob a curva (AUC): 0,692; intervalo de confiança de 95% (IC 95%): 0,524- 0,680 para VF direita e AUC: 0,615; IC 95% 0,537-0,693 para VF esquerda). Encontramos ainda para o lado direito e lado esquerdo, respectivamente, sensibilidade (52% vs. 43%), especificidade (64% vs. 77%), valor preditivo positivo (VPP) (59% vs. 65,1%), valor preditivo negativo (VPN) (57,1% vs. 57,4%).
Conclusões: A espessura da VFD e VFE apresentou nesse estudo, uma baixa sensibilidade, especificidade, VPP e VPN. Não foram encontradas correlação entre os exames laboratoriais avaliados, índice de atividade de doença, terapia em uso e a espessura da veia. Foi encontrado correlação apenas com o número de eventos vasculares prévios, sendo que aqueles pacientes que já tinham apresentado outros eventos, principalmente trombose venosa profunda, tinham a veia mais espessada em relação a pacientes sem acometimento vascular prévio e controles. Outros estudos devem ser realizados para melhor avaliação do ultrassom como possível método diagnóstico na DB.
Introduction: Behçet's disease (BD) is a systemic vasculitis of variable vessels that is characterized by recurrent oral and genital ulcers and skin lesions such as erythema nodosum. It can also lead to ocular, vascular and central nervous system involvement. There is no difference in prevalence between the sexes. However, men tend to have more serious manifestations. Vascular involvement affects up to 40% of patients, however, to date we do not have a reliable test to predict the risk of thrombosis. Diagnosis is also a challenge in clinical practice, especially in low prevalence countries. The pathergy test has low sensitivity and to date we do not have a biomarker available. Femoral vein (FV) thickness was evaluated in 2 studies in Turkey that demonstrated thickening in patients with BD was higher compared to healthy controls and could be a diagnostic marker with good sensitivity and specificity. Objective: Reproduce the tests carried out in Turkey in the Brazilian population of both controls and patients to evaluate the thickness of the FV as an evaluation tool for patients with suspected BD. Patients and methods: A cross-sectional study was carried out with patients with BD and healthy controls in which the thickness of the bilateral FV and the diameter of the small saphenous and great saphenous veins were measured. In addition, evidence of thrombosis or reflux in the analyzed veins was assessed. Demographic data was collected from both groups. Patients were also assessed in which symptoms they presented at the beginning and at the time of the study, therapy performed, pathergy test and HLA*B51. Results: The study did not observe a statistically significant difference in age (43.9 ± 12.9 years vs. 46.4 ± 12.6 years; p = 0.166) and frequency of female gender (64% vs. 69%; p = 0.454) between patients with BD and controls. The thickness of the right FV (0.600 mm (0.500-0.700) vs. 0.525mm (0.450-0.637); p = 0.012) and left FV (0.550mm (0.450-0.650) vs. 0.500mm (0.450-0.550); p = 0.004) showed a difference between the groups. However, the diameter of the great (GSV) and small (SSV) saphenous veins on both sides showed no difference (right GSV 4.000mm (3.275-5.025) vs. 4.100mm (3.400-5.450); p = 0.591); (left GSV 3.750 mm (3.150-4.650) vs. 4.050 mm (3.400-5.000); p = 0.266); (right SSV 2.750 mm (2.150- 3.437) vs. 2.575 mm (2.212-3.075); p = 0.306); (left SSV 2.600 mm (2.275- 3.550) vs. 2.656 mm (2.112- 3.537); p = 0.259), between patients with BD and controls, respectively. No correlation was seen between the thickness of the right FV and left FV and laboratory tests, disease activity indices, therapy used, only in relation to the number of previous vascular events. For the cutoff point of right FV and left FV by the Youden index (0.575mm) in the Receiver Operating Characteristic (ROC) curve, [area under the curve (AUC): 0.692; 95% confidence interval (95% CI): 0.524-0.680 for the right FV and AUC: 0.615; 95% CI: 0.537-0.693 for the left FV). We also found for the right side and left side, respectively, sensitivity (52.0% vs. 43.0%), specificity (64.0% vs. 77.0%), positive predictive value (PPV) (59.0% vs. 65.1%), negative predictive value (NPV) (57.1% vs. 57.4%). Conclusions: The thickness of the right FV and left FV in this study presented low sensitivity, specificity, PPV and NPV. No correlation was found between the laboratory tests evaluated, disease activity index, therapy in use and vein thickness. A correlation was found only with the number of previous vascular events, with those patients who had already presented other events, mainly deep venous thrombosis, having thickened veins compared to patients without previous vascular involvement and controls. Other studies should be carried out to better evaluate vascular ultrasound as a possible diagnostic method for BD.
Introduction: Behçet's disease (BD) is a systemic vasculitis of variable vessels that is characterized by recurrent oral and genital ulcers and skin lesions such as erythema nodosum. It can also lead to ocular, vascular and central nervous system involvement. There is no difference in prevalence between the sexes. However, men tend to have more serious manifestations. Vascular involvement affects up to 40% of patients, however, to date we do not have a reliable test to predict the risk of thrombosis. Diagnosis is also a challenge in clinical practice, especially in low prevalence countries. The pathergy test has low sensitivity and to date we do not have a biomarker available. Femoral vein (FV) thickness was evaluated in 2 studies in Turkey that demonstrated thickening in patients with BD was higher compared to healthy controls and could be a diagnostic marker with good sensitivity and specificity. Objective: Reproduce the tests carried out in Turkey in the Brazilian population of both controls and patients to evaluate the thickness of the FV as an evaluation tool for patients with suspected BD. Patients and methods: A cross-sectional study was carried out with patients with BD and healthy controls in which the thickness of the bilateral FV and the diameter of the small saphenous and great saphenous veins were measured. In addition, evidence of thrombosis or reflux in the analyzed veins was assessed. Demographic data was collected from both groups. Patients were also assessed in which symptoms they presented at the beginning and at the time of the study, therapy performed, pathergy test and HLA*B51. Results: The study did not observe a statistically significant difference in age (43.9 ± 12.9 years vs. 46.4 ± 12.6 years; p = 0.166) and frequency of female gender (64% vs. 69%; p = 0.454) between patients with BD and controls. The thickness of the right FV (0.600 mm (0.500-0.700) vs. 0.525mm (0.450-0.637); p = 0.012) and left FV (0.550mm (0.450-0.650) vs. 0.500mm (0.450-0.550); p = 0.004) showed a difference between the groups. However, the diameter of the great (GSV) and small (SSV) saphenous veins on both sides showed no difference (right GSV 4.000mm (3.275-5.025) vs. 4.100mm (3.400-5.450); p = 0.591); (left GSV 3.750 mm (3.150-4.650) vs. 4.050 mm (3.400-5.000); p = 0.266); (right SSV 2.750 mm (2.150- 3.437) vs. 2.575 mm (2.212-3.075); p = 0.306); (left SSV 2.600 mm (2.275- 3.550) vs. 2.656 mm (2.112- 3.537); p = 0.259), between patients with BD and controls, respectively. No correlation was seen between the thickness of the right FV and left FV and laboratory tests, disease activity indices, therapy used, only in relation to the number of previous vascular events. For the cutoff point of right FV and left FV by the Youden index (0.575mm) in the Receiver Operating Characteristic (ROC) curve, [area under the curve (AUC): 0.692; 95% confidence interval (95% CI): 0.524-0.680 for the right FV and AUC: 0.615; 95% CI: 0.537-0.693 for the left FV). We also found for the right side and left side, respectively, sensitivity (52.0% vs. 43.0%), specificity (64.0% vs. 77.0%), positive predictive value (PPV) (59.0% vs. 65.1%), negative predictive value (NPV) (57.1% vs. 57.4%). Conclusions: The thickness of the right FV and left FV in this study presented low sensitivity, specificity, PPV and NPV. No correlation was found between the laboratory tests evaluated, disease activity index, therapy in use and vein thickness. A correlation was found only with the number of previous vascular events, with those patients who had already presented other events, mainly deep venous thrombosis, having thickened veins compared to patients without previous vascular involvement and controls. Other studies should be carried out to better evaluate vascular ultrasound as a possible diagnostic method for BD.
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Citação
NEAIME, Sarah Abati Curi. Avaliação da espessura da veia femoral como ferramenta diagnóstica na doença de Behçet: resultados de uma área não endêmica. 2023. 91 f. Dissertação (Mestrado em Reumatologia) - Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, 2023.