Avaliação do comprometimento da função do endotélio em pacientes com hipertensão arterial pulmonar idiopática e em esquistossomóticos / Endothelial dysfunction in patients with pulmonary arterial hypertension and schistosomiasis

RESUMO

INTRODUÇÃO: Existem várias doenças que evoluem com hipertensão pulmonar (HP), entre elas a Hipertensão Arterial Pulmonar Idiopática (HAPI) e a Esquistossomose. Acredita-se que um dos principais fatores desencadeantes da HP esteja relacionado com a disfunção endotelial. OBJETIVOS: 1. Avaliar a disfunção endotelial de pacientes com HAPI e esquistossomóticos com e sem HAP usando os marcadores plasmáticos Endotelina-1, Selectina E, VEGF, PDGFAB e PDGF-BB; 2.Avaliar se pacientes com HAP associada à esquistossomose possuem o mesmo grau de disfunção endotelial que pacientes com esquistossomose sem HAP. METODOLOGIA: Foram formados 4 grupos distintos Controle (n=13), HAPI (n=11), pacientes com esquistossomose e HP (ESQ+HP) (n=13) e pacientes com esquistossomose sem HP (ESQ)(n=13). Os pacientes foram submetidos a avaliação clínica (caracterizados quanto a gravidade), funcional (realizaram ecocardiograma com medida de pressão sistólica de ventrículo direito, ultrassonografia abdominal quando indicada e exames para excluir outras doenças) e laboratorial (entre eles, contagem de leucócitos, plaquetas e dosagem de BNP). A avaliação hemodinâmica foi realizada nos pacientes com HP. Para a análise da disfunção endotelial, foram coletados 40 mL de sangue de todos os indivíduos para a dosagem de Endotelina-1, Selectina E, VEGF, PDGF-AB e PDGF-BB. RESULTADOS: Observou-se que os grupos não se diferiram quanto a idade, houve um predomínio do sexo feminino e os grupos controle e ESQ apresentaram valores de PSVD menores do que os grupos com HP (controles 23,4±4,6, ESQ 29,5±8,5, HAPI 79,8±26,4 e ESQ+HP 75,2±15,3 mmHg). As medidas hemodinâmicas foram semelhantes em ambos os grupos com HAP. Quanto aos marcadores da função endotelial, o grupo controle apresentou valores séricos de PDGF-BB mais aumentados (8,9±4,8x 103 pg/mL, p<0,001) que os grupos HAPI, ESQ+HP, ESQ (3,7±2,1; 5,2±3 ; 2,4±1,7 x 103 pg/mL, respectivamente). O grupo HAPI apresentou valores mais elevados...

ABSTRACT

INTRODUCTION: There are several diseases that cause Pulmonary hypertension (PH), such as Idiopathic Pulmonary Arterial Hypertension and Schistosomiasis. The mechanisms that lead to PH are thought to be related to endothelial dysfunction. OBJECTIVES: To evaluate endothelial dysfunction, using plasma markers such as Endothelin-1(ET-1), E-Selectin, VEGF, PDGF-AB and -BB, in patients with idiopathic pulmonary arterial hypertension (IPAH) and schistosomiasis patients with or without PH; and to evaluate if schistosomiasis groups have endothelial dysfunction in the same degree. METHODOLOGY: Patients were divided in 4 different groups Patients with IPAH (n=11), Patients with PH associated to Schistosomiasis (SchPH)(n=13), Patients with Schistosomiasis without PH (Sch)(n=13) and Controls(n=13). PAH patients were classified according to severity. All groups were submitted to echocardiography and right ventricule systolic pressure(RVSP) was measured. Abdominal ultrassonography was used to rule in or rule out schistosomiasis diagnosis. PH patients went through haemodynamics evaluation and all patients had laboratorial assessment (leucocytes and platelet count and BNP levels) Soluble adhesion molecules such as E-Selectin, VEGF, PDGF-AB, PDGF-BB e ET-1 were determined by ELISA. Leucocytes and platelet counts as well as BNP levels were also evaluated. Results: Subjects did not differ according to age and there was a higher proportion of female patients. Controls and Sch subjects had lower RVSP compared to PH groups (Sch 23.4±4.6, controls 29.5±8.5, IPAH 79.8±26.4 and Sch+HP 75.2±15.3 mmHg). Haemodynamics data did not differ in PH patients. In IPAH group, E-selectin was elevated (61.5±24,2x103pg/mL) compared to controls, Sch+HP and Sch (14.5±12.2; 23.9±15.3; 21.4±18 x103pg/mL, respectively, p=0,005). PDGF-BB was decreased in IPAH, Sch+HP, Sch (3.7±2.1; 5.2±3; 2.4±1.7x103pg/mL, respectively) compared to controls (8.9±4.8x 103 pg/mL, p<0.001). PDGF-AB was elevated...