?ngulo de fase da bioimped?ncia e o estado inflamat?rio na doen?a arterial coronariana

Autor: Ceolin, Jamile
Přispěvatelé: Bodanese, Luiz Carlos
Jazyk: portugalština
Rok vydání: 2022
Předmět:
Zdroj: Biblioteca Digital de Teses e Dissertações da PUC_RS
Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS)
instacron:PUC_RS
Popis: A doen?a arterial coronariana (DAC) ? um importante problema de sa?de p?blica por ser uma das principais causas de morbimortalidade. ? necess?rio, portanto, ferramentas que avaliem a sa?de celular de pacientes com DAC e que auxiliem no monitoramento dos processos inflamat?rios a fim de identificar precocemente indiv?duos com risco para eventos agudos e complica??es cardiovasculares futuras. Evid?ncias apontam o ?ngulo de fase (PhA) como um indicador de inflama??o em diversas situa??es de sa?de, no entanto, na doen?a coronariana n?o foi investigado. OBJETIVO: Investigar a associa??o do ?ngulo de fase com o estado inflamat?rio em pacientes com doen?a arterial coronariana cr?nica. M?TODOS: A tese ? composta por dois manuscritos: uma revis?o sistem?tica e um estudo original. Revis?o sistem?tica: Foram realizadas buscas nas bases de dados MEDLINE, EMBASE, Cochrane, Scielo, LILACS, CINAHL, Scopus e Web of Science. A sele??o foi realizada independentemente por dois revisores conforme os crit?rios de elegibilidade, assim como a an?lise do risco de vi?s e da qualidade dos estudos inclu?dos. Os resultados foram sintetizados e descritos na revis?o. Como n?o foram encontrados estudos em pacientes com DAC, exploramos artigos em pacientes com doen?as cardiometab?licas e indiv?duos sem doen?as cr?nicas. Estudo original: A amostra foi composta por pacientes com doen?a arterial coronariana cr?nica, atendidos no Ambulat?rio de Hipercolesterolemia do Servi?o de Cardiologia do Hospital S?o Lucas da PUCRS. O ?ngulo de fase foi avaliado atrav?s do equipamento Biospace, modelo Inbody S10, da Ottoboni. Os marcadores inflamat?rios avaliados foram: Prote?na c-reativa ultrassens?vel (PCR-us), interleucina-6 (IL-6), interleucina-10 (IL-10) e fator de necrose tumoral alfa (TNF-?). Foi inclu?do um grupo controle com indiv?duos sem DAC para an?lise comparativa. Na an?lise estat?stica, a correla??o do PhA e vari?veis preditoras foi verificado com os coeficientes de correla??o de Pearson e de Spearman. Para a identificar se os marcadores inflamat?rios influenciaram no ?ngulo de fase foi utilizada a regress?o linear. RESULTADOS: Revis?o sistem?tica: Foram identificados 755 artigos na pesquisa, e inclu?dos 11 artigos, totalizando 50.787 participantes. Os marcadores inflamat?rios investigados nos estudos foram: PCR, TNF-?, IL-6 e IL-33. Nos indiv?duos com doen?a cardiometab?lica, o ?ngulo de fase se associou negativamente com PCR, TNF-? e IL-6 em 71,4%, 50% e 100% dos estudos, respectivamente. Em indiv?duos sem doen?a cr?nica, foi observada uma associa??o negativa do PhA com PCR, TNF-? e IL-6 em 75%, 100% e 100% dos estudos, respectivamente. Estudo original: 82 indiv?duos participaram do estudo, sendo 60 do grupo DAC e 22 do grupo controle. A m?dia geral do ?ngulo de fase foi de 5,8?0,8?, n?o diferindo entre os grupos (p=0,933). Apenas a IL-6 foi significativamente superior entre os pacientes com DAC (p=0,002). O PhA n?o se correlacionou com nenhum dos marcadores inflamat?rios avaliados (p>0,05). CONCLUS?O: Os resultados da revis?o sistem?tica sugerem uma associa??o negativa do PhA com marcadores inflamat?rios PCR, IL-6 TNF-? em indiv?duo com doen?as cardiometab?licas e sem doen?a cr?nica. No entanto, no estudo original n?o foi encontrada associa??o do PhA com o estado inflamat?rio em pacientes com DAC cr?nica, necessitando mais estudos em pacientes sem tratamento pr?vio ou em fase inst?vel da doen?a. Coronary artery disease (CAD) is an important public health problem as it is one of the main causes of morbidity and mortality. It is therefore necessary to have tools that assess the cellular health of patients with CAD and that assist in the monitoring of inflammatory processes in order to early identify individuals at risk for acute events and future cardiovascular complications. Evidence points to the phase angle (PhA) as an indicator of inflammation in several health situations, however, in coronary disease it has not been investigated. OBJECTIVE: To investigate the association of phase angle with inflammatory status in patients with chronic coronary artery disease. METHODS: The thesis consists of two manuscripts: a systematic review and an original study. Systematic review: Searches were carried out in MEDLINE, EMBASE, Cochrane, Scielo, LILACS, CINAHL, Scopus and Web of Science databases. The selection was performed independently by two reviewers according to the eligibility criteria, as well as the analysis of the risk of bias and the quality of the included studies. The results were synthesized and described in the review. As no studies were found in patients with CAD, we explored articles in patients with cardiometabolic diseases and individuals without chronic diseases. Original study: The sample consisted of patients with chronic coronary artery disease, treated at the Hypercholesterolemia Outpatient Clinic of the Cardiology Service of Hospital S?o Lucas, PUCRS. The phase angle was evaluated using the Biospace equipment, model Inbody S10, from Ottoboni. The inflammatory markers evaluated were: Ultrasensitive c-reactive protein (hs-CRP), interleukin-6 (IL-6), interleukin-10 (IL-10) and tumor necrosis factor alpha (TNF-?). A control group with individuals without CAD was included for comparative analysis. In the statistical analysis, correlation of PhA and predictor variables was verified with Pearson's and Spearman's correlation coefficients. To identify whether the inflammatory markers influenced the phase angle, linear regression was used. RESULTS: Systematic review: 755 articles were identified in the research, and 11 articles were included, totaling 50,787 participants. The inflammatory markers investigated in the studies were: CRP, TNF-?, IL-6 and IL-33. In subjects with cardiometabolic disease, phase angle was negatively associated with CRP, TNF-? and IL-6 in 71.4%, 50% and 100% of the studies, respectively. In individuals without chronic disease, a negative association of PhA with CRP, TNF-? and IL-6 was observed in 75%, 100% and 100% of the studies, respectively. Original study: 82 individuals participated in the study, 60 from the CAD group and 22 from the control group. The general mean of the phase angle was 5.8?0.8?, not differing between the groups (p=0,933). Only IL-6 was significantly higher among CAD patients (p=0,002). PhA did not correlate with any of the inflammatory markers evaluated (p>0,05). CONCLUSION: The results of the systematic review suggest a negative association of PhA with inflammatory markers CRP, IL-6 TNF-? in individuals with cardiometabolic diseases and without chronic disease. However, in the original study, no association was found between PhA and inflammatory status in patients with chronic CAD, requiring further studies in patients with no previous treatment or in an unstable phase of the disease. Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES
Databáze: OpenAIRE
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