Avaliação das complicações orais, sua influência no transplante de células tronco hematopoéticas e a importância da melatonina como biomarcador de prognóstico
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Data
2017-03-02
Autores
Ruiz, Andréa Engracia [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
O transplante de células tronco hematopoéticas (TCTH) constitui uma importante opção terapêutica para pacientes com doenças onco-hematológicas, autoimunes e alguns tumores sólidos; caracteriza-se pela infusão intravenosa de células progenitoras hematopoéticas com o objetivo de restabelecer a função medular e imunológica. No entanto, esse procedimento requer imunossupressão o que favorece o desenvolvimento de complicações, principalmente infecciosas, as quais frequentemente se manifestam ou se originam na cavidade bucal podendo ser causadora de infecções sistêmicas. O estado de saúde bucal do paciente submetido ao TCTH tem sido considerado como um fator que interfere diretamente no grau de morbimortalidade. A mucosite representa o principal fator de risco para as infecções sistêmicas e está entre as complicações de maior relevância. Uma vez que existe uma relação direta entre inflamação crônica e muitas doenças emergentes, tem se destacado o estudo da melatonina (MEL), um hormônio fabricado pela glândula pineal, que pode ser capaz de proteger não somente a cavidade bucal, mas todo o organismo dos radicais livres produzidos por processos inflamatórios e infecciosos. O objetivo deste estudo foi avaliar a prevalência e os fatores de risco desencadeadores das infecções odontogênicas, lesões da mucosa oral, estabelecendo um índice de complicações orais (ICO-TCTH) e sua relação com a concentração de melatonina extraída da saliva dos pacientes, doenças de base e tipo de transplante; considerando a aplicabilidade desse hormônio como um biomarcador prognóstico nos pacientes submetidos ao TCTH. Os resultados obtidos permitiram concluir que o acompanhamento odontológico destes pacientes condiciona maior índice de sucesso ao TCTH, o uso da laserterapia principalmente quando associamos um possível biomarcador prognóstico. As manifestações orais ao precederem o aparecimento de uma doença de base, são passíveis de serem consideradas úteis no desenvolvimento de um diagnóstico diferencial e precoce em especial na Doença de Crohn que pode anteceder até sete anos a manifestação intestinal da doença. A melatonina nos dá a possibilidade de referenciá-la neste cenário como um biomarcador prognóstico, já que os pacientes que possuem um baixo risco para complicações orais obtiveram uma maior expressividade deste hormônio.
Hematopoietic stem cell transplantation (HSCT) is an important therapeutic option for patients with onco-hematological, autoimmune and some solid tumors; It is characterized by the intravenous infusion of hematopoietic progenitor cells with the objective of restoring the medullary and immunological function. However, this procedure requires an effect of complications, mainly infectious, how often they manifest or originate in the oral cavity and can be the cause of systemic infections. The state of oral health of patients submitted to HSCT has been considered as a factor that directly interferes with the degree of morbidity and mortality. Mucositis represents the main risk factor for systemic infections and is among the most relevant complications. Since there is a direct relationship between chronic inflammation and many emerging diseases, a melatonin (MEL) is a hormone made by the pineal gland, which may be able to protect not only an oral cavity, but the entire body of free radicals produced by processes Inflammatory and infectious.The objective of this study is to evaluate the prevalence and risk factors of odontogenic infections, lesions of the oral mucosa, to meet the oral complications index (ICO-HSCT) and to relate it to the concentration of melatonin extracted from the patient's saliva , Underlying diseases and type of transplant presenting an oral cavity treatment plan that may interfere with no transplant success; One might advocate this hormone as a prognostic biomarker for patients who received the HSCT. The results obtained allowed us to conclude that dental patient’s condition greater success rate in HSCT, the use of laser therapy when we associate a possible prognostic biomarker. As oral manifestations preceding the onset of a basic disease, they may be considered useful in the development of a differential and early diagnosis especially in Crohn's Disease that can precede up to seven years an intestinal manifestation of the disease. The melatonin gives us the possibility of reference in a scenario as a prognostic biomarker, since the patients who are at low risk for oral complications have greater expressiveness of this hormone.
Hematopoietic stem cell transplantation (HSCT) is an important therapeutic option for patients with onco-hematological, autoimmune and some solid tumors; It is characterized by the intravenous infusion of hematopoietic progenitor cells with the objective of restoring the medullary and immunological function. However, this procedure requires an effect of complications, mainly infectious, how often they manifest or originate in the oral cavity and can be the cause of systemic infections. The state of oral health of patients submitted to HSCT has been considered as a factor that directly interferes with the degree of morbidity and mortality. Mucositis represents the main risk factor for systemic infections and is among the most relevant complications. Since there is a direct relationship between chronic inflammation and many emerging diseases, a melatonin (MEL) is a hormone made by the pineal gland, which may be able to protect not only an oral cavity, but the entire body of free radicals produced by processes Inflammatory and infectious.The objective of this study is to evaluate the prevalence and risk factors of odontogenic infections, lesions of the oral mucosa, to meet the oral complications index (ICO-HSCT) and to relate it to the concentration of melatonin extracted from the patient's saliva , Underlying diseases and type of transplant presenting an oral cavity treatment plan that may interfere with no transplant success; One might advocate this hormone as a prognostic biomarker for patients who received the HSCT. The results obtained allowed us to conclude that dental patient’s condition greater success rate in HSCT, the use of laser therapy when we associate a possible prognostic biomarker. As oral manifestations preceding the onset of a basic disease, they may be considered useful in the development of a differential and early diagnosis especially in Crohn's Disease that can precede up to seven years an intestinal manifestation of the disease. The melatonin gives us the possibility of reference in a scenario as a prognostic biomarker, since the patients who are at low risk for oral complications have greater expressiveness of this hormone.
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Palavras-chave
Terapia celular, Infecções odontogênicas, Imunossupressão, Melatonina, Cell therapy, Odontogenic infections, Melatonin, Immunosuppression