Marcadores inflamatórios e sua relação com a capacidade de exercício em pacientes com Síndrome de Eisenmenger
Data
2018
Autores
Santos, Ana Carolina Cardoso dos 
Orientadores
Guizilini, Solange
Tipo
Trabalho de conclusão de curso
Título da Revista
ISSN da Revista
Título de Volume
Resumo
A Síndrome de Eisenmenger (SE) é caracterizada como a manifestação mais severa
da hipertensão arterial pulmonar (HAP) em pacientes com cardiopatia congênita.
Com os avanços no tratamento cirúrgico e na área de cardiologia pediátrica, a
prevalência de SE tem diminuído. O desenvolvimento da SE depende da magnitude
e local da alteração estrutural cardíaca, e as mais comuns são: comunicação
interventricular, comunicação interatrial e persistência do canal arterial. Indivíduos
que desenvolvem SE apresentam uma importante alteração da capacidade de
exercício. Outras alterações envolvendo mecanismos como a inflamação, por
exemplo, podem estar associados ao processo de remodelamento da circulação
cardiopulmonar, os quais estão relacionados à expressão de mediadores vasoativos
e contribuem para o desenvolvimento da SE. O aumento do nível de marcadores
inflamatórios pode estar relacionado com distância percorrida no teste de caminhada
de 6 minutos (TC6min), ou seja, pode ter relação com a capacidade de exercício
desses indivíduos.Objetivos: avaliar a relação dos níveis de citocinas inflamatórias
com a capacidade de exercício de indivíduos com SE. Método: Trinta pacientes com
diagnóstico de SE foram avaliados quanto à capacidade de exercício, utilizando o
TC6min, e quanto ao nível sérico de marcadores inflamatórios, quantificadas pelo
método ELISA (enzyme-linked immune-sorbent assay). Resultados: A distância
média percorrida pelos indivíduos foi de 340 ±71 metros (59,2 ± 16,2 % do previsto).
Foi identificada na análise de interleucina 10 (IL-10), uma média de 13 ± 8 pg/µL,
enquanto interleucina 1ȕ (IL-1ȕ) foi de 6 ± 2 pg/µL e fator de necrose tumoral α
(tumor necrosis factor - TNF-α) 23 ± 11 pg/µL. Quanto à correlação com a
capacidade de exercício e IL-1ȕ, observa-se uma associação positiva fraca (r = 0,34;
p = 0,078), e em relação à IL-10 houve também uma correlação positiva, porém
desprezível (r = 0,23; p = 0,246), e ambas sem relevância estatística. Já a
correlação entre TNF-α e a distância percorrida foi negativa moderada com
relevância estatística (r = -0,54; p = 0,0041). Conclusão: Foi possível identificar uma
correlação negativa entre uma das citocinas, TNF-α e a capacidade de exercício. O
mesmo não foi identificado confrontando a distância percorrida e as citocinas IL-1ȕ e
IL-10. Tal resultado determina uma relação do perfil inflamatório com a capacidade
de exercício ainda inconclusiva, necessitando de mais estudos para esclarecer essa
associação
Eisenmenger syndrome (ES) is characterized as the most severe manifestation of pulmonary arterial hypertension (PAH) in patients with congenital heart disease (CC). Advances in surgical treatment and pediatric cardiology decreased the prevalence of ES. The development of SE depends on the magnitude and location of the cardiac defect, and the most common are ventricular septal defect, atrial septal defect, and patent ductus arteriosus. Individuals who develop ES present an important change in exercise capacity. Other changes involving mechanisms such as inflammation, for example, may be associated with the remodeling process of the cardiopulmonary circulation, which are related to the expression of vasoactive mediators and contribute to the development of ES. Increased levels of inflammatory markers may be related to the distance measured on the 6-minute walk test (6MWT), thus, it may be related to the exercise capacity of these individuals. Objectives: Evaluate the relationship between cytokine levels and the exercise capacity of the individual with SE. Materials and Methods: Thirty patients were submitted to 6MWT, and serum levels of inflammatory markers were quantified by ELISA (enzyme-linked immunesorbent assay). Results: The average 6-minute walking distance was 340 ± 71 meters. This represents an average of 59.2 ± 16.2% of the predicted for each individual. The IL-10 assay was 13 ± 8 pg / μL, whereas IL-1ȕ was 6 ± 2 pg / μL, and TNF-α was 23 ± 11 pg / μL. There was a weak positive correlation between exercise capacity and IL-1ȕ (r = 0.34, p = 0.078). An insignificant positive correlation was observed with IL-10 (r = 0, 23, p = 0.246), and both correlations didn't presented statistical relevance. The correlation between TNF-α and the 6-minute walking distance was moderate negative, with statistical significance (r = -0.54, p = 0.0041). Conclusion: A negative correlation between one of the cytokines, TNF-α, and exercise capacity was identified. Though, it was not observed the same correlation with IL-1ȕ and IL-10 cytokines. The association between the inflammatory profile and the exercise capacity is still inconclusive, thus, further studies are necessary in order to clarify this correlation
Eisenmenger syndrome (ES) is characterized as the most severe manifestation of pulmonary arterial hypertension (PAH) in patients with congenital heart disease (CC). Advances in surgical treatment and pediatric cardiology decreased the prevalence of ES. The development of SE depends on the magnitude and location of the cardiac defect, and the most common are ventricular septal defect, atrial septal defect, and patent ductus arteriosus. Individuals who develop ES present an important change in exercise capacity. Other changes involving mechanisms such as inflammation, for example, may be associated with the remodeling process of the cardiopulmonary circulation, which are related to the expression of vasoactive mediators and contribute to the development of ES. Increased levels of inflammatory markers may be related to the distance measured on the 6-minute walk test (6MWT), thus, it may be related to the exercise capacity of these individuals. Objectives: Evaluate the relationship between cytokine levels and the exercise capacity of the individual with SE. Materials and Methods: Thirty patients were submitted to 6MWT, and serum levels of inflammatory markers were quantified by ELISA (enzyme-linked immunesorbent assay). Results: The average 6-minute walking distance was 340 ± 71 meters. This represents an average of 59.2 ± 16.2% of the predicted for each individual. The IL-10 assay was 13 ± 8 pg / μL, whereas IL-1ȕ was 6 ± 2 pg / μL, and TNF-α was 23 ± 11 pg / μL. There was a weak positive correlation between exercise capacity and IL-1ȕ (r = 0.34, p = 0.078). An insignificant positive correlation was observed with IL-10 (r = 0, 23, p = 0.246), and both correlations didn't presented statistical relevance. The correlation between TNF-α and the 6-minute walking distance was moderate negative, with statistical significance (r = -0.54, p = 0.0041). Conclusion: A negative correlation between one of the cytokines, TNF-α, and exercise capacity was identified. Though, it was not observed the same correlation with IL-1ȕ and IL-10 cytokines. The association between the inflammatory profile and the exercise capacity is still inconclusive, thus, further studies are necessary in order to clarify this correlation
Descrição
Citação
SANTOS, Ana Carolina Cardoso dos. Marcadores inflamatórios e sua relação com a capacidade de exercício em pacientes com Síndrome de Eisenmenger. 2018. 33 f. Trabalho de conclusão de curso de graduação (Fisioterapia) - Instituto de Saúde e Sociedade (ISS), Universidade Federal de São Paulo (UNIFESP), Santos, 2018.