Correlação entre a cistatina C sérica e marcadores de aterosclerose subclínica em pacientes hipertensos / Correlation between serum cystatin C and markers of subclinical atherosclerosis in hypertensive patients

FUNDAMENTO: A cistatina C sérica (s-CC), um marcador endógeno da função renal, tem sido proposta também como um marcador de risco cardiovascular. No entanto, ainda não está estabelecido se se trata de um marcador direto de aterosclerose, independentemente da função renal. OBJETIVO: O objetivo deste estudo foi correlacionar a s-CC com dois marcadores substitutos de aterosclerose subclínica. MÉTODOS: Trata-se de um estudo transversal envolvendo 103 pacientes hipertensos ambulatoriais, de meia idade (57,49 ± 11,7 anos), sendo 60 do sexo feminino (58,25%) e a maioria com função renal preservada. A s-CC foi correlacionada com a espessura mediointimal carotídea (EMIc) e a dilatação mediada por fluxo de artéria braquial (DMF), ambas avaliadas por ultrassonografia, bem como com o clearance de creatinina medido e fatores de risco cardiovascular estabelecidos. RESULTADOS: A s-CC não se correlacionou significativamente nem com a EMIc (r = -0,024, p = 0,84) nem com a DMF (r = -0,050 e p = 0,687), e não foi observada também associação significativa com fatores de risco convencionais nem marcadores inflamatórios. Na análise univariada, a s-CC se correlacionou com o clearance de creatinina medido (r = - 0,498, p < 0,001), idade (r = 0,408, p < 0,001), microalbuminúria (r = 0,291, p = 0,014), ácido úrico (r = 0,391, p < 0,001), relação E/e' (r = 0,242, p = 0,049) e escore de Framingham (r = 0,359, p = 0,001). No entanto, após análise de regressão múltipla, apenas a associação com o clearance de creatinina medido permaneceu significativa (r = -0,491, p <0,001). CONCLUSÃO: Em pacientes hipertensos ambulatoriais de meia idade, a s-CC se correlacionou com o clearance de creatinina medido,como esperado, mas não foi observada associação com marcadores de aterosclerose nem com fatores de risco cardiovascular estabelecidos.

BACKGROUND: Serum cystatin C (s-CC), an endogenous marker of kidney function, has also been proposed as a cardiovascular risk marker. However, it is unknown whether it is a direct marker of atherosclerosis, independently of kidney function. OBJECTIVE: The aim of this study was to correlate s-CC with two surrogate markers of subclinical atherosclerosis. METHODS: This is a cross-sectional study involving 103 middle-aged (57.49 ± 11.7 years) hypertensive outpatients, being 60 female (58.25%), most with preserved kidney function. S-CC was correlated with carotid intima media thickness (IMT) and flow-mediated dilation of brachial artery (FMD), both assessed by ultrasound, as well as with measured creatinine clearance and established cardiovascular risk factors. RESULTS: S-CC was neither significantly correlated with IMT (r = -0.024; p = 0.84) nor with FMD (r = -0.050 and p = 0.687) and no significant association was observed with conventional risk factors and inflammatory markers. In univariate analysis, s-CC was correlated with measured creatinine clearance (r = -0,498; p < 0,001), age (r = 0,408; p < 0,001), microalbuminuria (r = 0,291; p = 0,014), uric acid (r = 0,391; p < 0,001), ratio E/e' (r = 0,242; p = 0,049) and Framingham score (r = 0,359; p = 0,001). However, after multiple regression analysis, only the association with measured creatinine clearance remained significant (r = -0,491; p < 0,001). CONCLUSION: In middle-aged hypertensive outpatients, s-CC correlated with measured creatinine clearance, as expected, but no association was observed with markers of atherosclerosis neither with established cardiovascular risk factors.

Correlation between serum cystatin C and markers of subclinical atherosclerosis in hypertensive patients.

BACKGROUND: Serum cystatin C (s-CC), an endogenous marker of kidney function, has also been proposed as a cardiovascular risk marker. However, it is unknown whether it is a direct marker of atherosclerosis, independently of kidney function. OBJECTIVE: The aim of this study was to correlate s-CC with two surrogate markers of subclinical atherosclerosis. METHODS: This is a cross-sectional study involving 103 middle-aged (57.49 ± 11.7 years) hypertensive outpatients, being 60 female (58.25%), most with preserved kidney function. S-CC was correlated with carotid intima media thickness (IMT) and flow-mediated dilation of brachial artery (FMD), both assessed by ultrasound, as well as with measured creatinine clearance and established cardiovascular risk factors. RESULTS: S-CC was neither significantly correlated with IMT (r = -0.024; p = 0.84) nor with FMD (r = -0.050 and p = 0.687) and no significant association was observed with conventional risk factors and inflammatory markers. In univariate analysis, s-CC was correlated with measured creatinine clearance (r = -0,498; p < 0,001), age (r = 0,408; p < 0,001), microalbuminuria (r = 0,291; p = 0,014), uric acid (r = 0,391; p < 0,001), ratio E/e' (r = 0,242; p = 0,049) and Framingham score (r = 0,359; p = 0,001). However, after multiple regression analysis, only the association with measured creatinine clearance remained significant (r = -0,491; p < 0,001). CONCLUSION: In middle-aged hypertensive outpatients, s-CC correlated with measured creatinine clearance, as expected, but no association was observed with markers of atherosclerosis neither with established cardiovascular risk factors.

[Evaluation of the hydro-alcoholic Schinus terebinthifolius Raddi (Aroeira) extract in the healing process of the alba linea in rats]. / Avaliação do efeito do extrato hidroalcoólico de Schinus terebinthifolius Raddi (Aroeira) no processo de cicatrização da linea alba de ratos.

PURPOSE: To evaluate the healing process in the abdominal wall of rats after the intra-peritoneal injection of the hydro-alcoholic Schinus terebinthifolius Raddi extract. METHODS: Forty Wistar rats were used, distributed in two groups of 20 animals, divided into two subgroups, according to the death day, three or seven, after the intra-peritoneal injection of the extract. The experimental group was injected with only one dose of the hydro-alcoholic Aroeira extract (100mg per animal kilogram); the control group was injected with only one dose of isotonic saline solution at 0.9%. After the animal death, an inventory of the peritoneal cavity was carried out in a careful search for any adhesion, followed by the resection of the anterior abdominal wall encompassing the operating incision in order to examine it for evidence of infection. The adhesions were classified according to the Nair criteria. The tensiometric assessment was performed by means of the measurement of the maximum charge and maximum deformity tolerated, measured in a universal Tiratest type testing machine and, finally, the histological evaluation was performed by means of the hematoxylin-eosine staining in following parameters: severe inflammation, chronic inflammation, ischemic necrosis, gigantocellular reaction of the foreign body type, fibroblastic proliferation, fibrosis, re-epithelization and co-optation of the suture borders. RESULTS: The macroscopic evaluation didn't have any evidence of significant adherence between the alba linea and the intra-abdominal viscera in the study groups. The tensiometry showed significant effect for the Maximum Charge and Maximum Deformity (p=0.006 and p=0.000, respectively) between the 7-day control and experimental groups. The histological 3-day and 7-day control and experimental intergroup evaluation did not show significant alteration for the parameters vascular neoformation, necrosis, fibrosis, re-epithelization and co-aptation. A significant difference was perceived for fibroblastic proliferation (p=0.014) in the 3-day intergroup evaluation and for chronic inflammation (p=0.023) and gigantocellular reaction of the foreign body type (p=0.008) in the 7-day intergroup evaluation. The control intragroup analysis, had a significant difference for chronic inflammation in the 3-day group and, finally, in the experimental intragroup analysis, a significant difference was observed for acute inflammation and fibroblastic proliferation (p=0.001 and p=0.020) in the 3-day regarding the 7-day group. CONCLUSION: The intraperitoneal injection of the Schinus terebinthifolius Raddi hydro-alcoholic extract in median laparotomies in rats has not determined any significant alteration in the macroscopic analysis, but it induced an increase of maximum charge of rupture and maximum deformity of the alba linea in the tensiometric analysis. In the histological point of view, the Aroeira group had a positive healing effect on the 3-day.