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1.
Int Urol Nephrol ; 45(3): 777-83, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23001640

RESUMO

AIM: The aim of this study is to assess whether the haemostatic markers D-dimer, factor VIII (FVIII) and von Willebrand factor (VWF) are predictive of non-dipping status in treated hypertensive patients; so, as easy available laboratory data can predict non-dipping pattern and help with the selection of the patients whom circadian blood pressure should be re-examined. PATIENTS AND METHODS: Forty treated hypertensive patients with essential hypertension were included in the study. Twenty-four-hour ambulatory blood pressure monitoring was performed in all patients. Daytime and nocturnal average systolic, diastolic and mean blood pressures were calculated. Patients were characterised as "non-dippers" on the basis of a less than 10 % decline in nocturnal blood pressure (BP); either systolic or diastolic or mean (MAP). D-dimer as marker of fibrinolytic function, FVIII activity and VWF antigen as marker of endothelial dysfunction were measured on plasma. The predictive efficiency was analysed by receiver operating characteristic (ROC) curves. Youden index was used for the estimation of the cut-off points and the associated values for sensitivity and 1-specificity. RESULTS: Plasma levels of D-dimer, FVIII and VWF were significantly higher in non-dippers as compared with dippers, irrespective of the classification used (BP index); all P < 0.05. The ROC curves indicated a good diagnostic efficiency for D-dimer (AUC(ROC) = 0.697, 0.715 and 0.774), FVIII (AUC(ROC) = 0.714, 0.692 and 0.755) and VWF (AUC(ROC) = 0.706, 0.740 and 0.708) in distinguishing non-dipping pattern (systolic, diastolic or mean) in the study population; all P < 0.05. Among the three haemostatic markers, D-dimer presents the most satisfactory sensitivity/1-specificity for the differentiation of non-dippers, with a cut-off point >168 ng/ml (sensitivity/1-specificity for systolic BP non-dippers of 0.789/0.381, for diastolic BP non-dippers 0.923/0.444 and for MAP non-dippers 0.875/0.375). CONCLUSION: In conclusion, D-dimer has a good predictive value for non-dipping pattern and the decision for the 24-h ambulatory blood pressure re-monitoring among dippers could rely on its values.


Assuntos
Pressão Sanguínea/fisiologia , Ritmo Circadiano/fisiologia , Fator VIII/metabolismo , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Hipertensão/sangue , Fator de von Willebrand/metabolismo , Idoso , Biomarcadores/sangue , Monitorização Ambulatorial da Pressão Arterial , Progressão da Doença , Feminino , Seguimentos , Humanos , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Curva ROC
2.
Int Urol Nephrol ; 44(2): 523-33, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21387085

RESUMO

BACKGROUND: Non-dipper hypertensive patients are at increased risk for cardiovascular disease. Coagulation and fibrinolysis activation factors are considered as risk factors for cardiovascular disease. The aim of this study was to examine the relationship between the haemostatic and platelet activation markers and the non-dipping pattern in treated hypertensive patients. PATIENTS AND METHODS: Seventy-one treated hypertensive patients (53 with essential and 18 with secondary hypertension, due to chronic kidney disease-stage 4), aged 33 to 81 years (30 men), were classified as dippers and non-dippers, according to the presence or absence, respectively, of a decline of nocturnal average systolic blood pressure (BP) by more than 10% of the diurnal BP (non-dipping pattern) on 24-hour ambulatory BP monitoring. Plasma levels of factors VIII and IX, fibrinogen, prothrombin fragment 1 + 2, thrombin-antithrombin complex, protein C, plasmin-alpha-2 antiplasmin complex, D-dimer and platelet factor 4 were measured in all patients. RESULTS: Thirty-seven patients were classified as dippers and 34 as non-dippers. The percentages of patients with essential and with secondary hypertension were similar in the dippers and in the non-dippers groups (both P = 0.754). Multivariate analysis of variance showed statistically significant differences in all measured variables between dippers and non-dippers (P = 0.043). Plasma levels of factors VIII and IX, fibrinogen, prothrombin fragment 1 + 2, protein C, plasmin-alpha-2-antiplasmin complex, and D-dimers were significantly higher in non-dippers when compared to dippers (P < 0.05 for all). In contrast, there were no significant differences in plasma levels of thrombin-antithrombin complex (P = 0.955) and platelet factor 4 (P = 0.431) between the two groups. CONCLUSION: This study provides evidence that non-dipper treated hypertensive patients exhibit alterations in haemostasis, which may affect their cardiovascular risk.


Assuntos
Fatores de Coagulação Sanguínea/metabolismo , Plaquetas/metabolismo , Plaquetas/patologia , Hemostasia/fisiologia , Hipertensão/sangue , Ativação Plaquetária , Adulto , Idoso , Idoso de 80 Anos ou mais , Anti-Hipertensivos/uso terapêutico , Biomarcadores/sangue , Pressão Sanguínea , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Nefelometria e Turbidimetria , Contagem de Plaquetas
3.
Lab Hematol ; 13(2): 63-8, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17573284

RESUMO

The role of RET-Y (the mean value of the forward-scattered light histogram within the reticulocyte population), soluble transferrin receptor (sTfR), and the ratio of soluble transferrin receptor to log10 ferritin (sTfR-F index) in discriminating hemoglobinopathies remains unclear. For that purpose, a cohort of 141 patients with microcytic, hypochromic anemia, along with 58 healthy individuals, were evaluated in the present study. Patients were divided into 4 groups: A (beta-thalassemia trait, n=62), B (iron-deficiency anemia [IDA], n=41), C (alpha-thalassemia trait, n=10) and D (hemoglobin O-Arab trait, n=28). Whole blood count, RET-Y, ferritin, sTfR, and sTfR-F index were performed for each individual. Diagnostic efficiency was analyzed by receiver operating characteristic (ROC) curves. Youden index was used for the estimation of the cutoff points and the associated values for sensitivity and 1-specificity. Statistically significant differences were observed for RET-Y, sTfR-F, and sTfR-F index between patients and healthy individuals, except for sTfR-F index of group C; between groups A, D, and B for RET-Y; between groups C, D, and B for sTfR; and between groups A, C, D, and B for sTfR-F index. ROC curves were constructed considering IDA as a positive case and indicated a very good diagnostic ability for sTfR-F index (area under the ROC curve [AUCROC]=0.938, cutoff point >2.19) in differentiating IDA from hemoglobinopathies in the study population. When the beta-thalassemia trait was considered as a positive case, ROC curves demonstrated a very good diagnostic efficiency for RET-Y (AUCROC=0.894, cutoff point <1411.8 AU). In populations where hemoglobinopathies are frequent, the full blood count, including the new parameter RET-Y, and sTfR-F index provide an extra, simple, and accurate tool for diagnosis and genetic consulting.


Assuntos
Anemia Hipocrômica/sangue , Hemoglobinopatias/sangue , Receptores da Transferrina/sangue , Contagem de Reticulócitos , Adolescente , Adulto , Anemia Ferropriva/sangue , Estudos de Coortes , Índices de Eritrócitos , Feminino , Ferritinas/sangue , Hemoglobinas/análise , Hemoglobinas Anormais/análise , Humanos , Luz , Masculino , Pessoa de Meia-Idade , Nefelometria e Turbidimetria , Curva ROC , Espalhamento de Radiação , Sensibilidade e Especificidade , Talassemia/sangue
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