Associações entre as variações de adipocinas, citocinas inflamatórias e composição corporal em pacientes com doença pulmonar obstrutiva crônica no período de um ano
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2018-02-22
Autores
Mesquita, Carolina Bonfanti
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Universidade Estadual Paulista (Unesp)
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Introdução: Estudos recentes mostram que o tecido adiposo também contribui para a inflamação sistêmica em pacientes com DPOC. Entretanto, não há dados na literatura que avaliem a variação das adipocinas e suas associações com marcadores inflamatórios, exacerbações e mortalidade em um ano nos pacientes com DPOC. Objetivo: Avaliar as variações das adipocinas, citocinas inflamatórias e composição corporal em pacientes com DPOC no período de um ano. Pacientes e Métodos: Foram avaliados 57 pacientes com DPOC leve a muito grave, destes 6 pacientes morreram, 6 não foram contatados após a avaliação e 5 não quiseram participar da segunda fase estudo, logo realizamos análise de dois momentos dos 40 pacientes que completaram um ano de acompanhamento. No momento basal e após 1 ano foram realizados espirometria pré e pós-broncodilatador, gasometria arterial, exames laboratoriais, oximetria de pulso, dosagem plasmática sérica de interleucina (IL)-6, fator de necrose tumoral alfa (TNF-α), adiponectina e leptina e avaliação sérica laboratorial. Também foi realizado avaliação da composição do corpo, força muscular do quadríceps (FMQ) (MicroFet 2), sensação de dispneia, por meio do Índice de Dispneia Basal (BDI), Escala de Borg e Medical Research Council Modificado (mMRC), avaliação do estado geral de saúde, por meio do questionário de Qualidade de Vida na Doença Respiratória do Hospital Saint George (SGRQ) e Escala Hospitalar de Ansiedade e Depressão (HAD), calculado índice de BODE e Teste de caminhada de 6 minutos. Resultados: Na análise da variação dos 40 pacientes nos dois momentos observamos associação da variação da leptina com a variação de IMC (R:0,43; p=0,006), variação de FMQ E (R:0,42; p=0,008), variação do índice BODE (R:0,39; p=0,024) e variação da IL-6 (R:-0,33; p=0,003). Na análise de regressão linear múltipla apenas observamos associação negativa da variação da IMMC com a variação da adiponectina (coef: -0,35; p=0,03). Não observamos associação das adipocinas na frequência de exacerbação ou mortalidade em um ano. Conclusão: O presente estudo mostrou que a leptina está associada positivamente com a IMC, força muscular periférica e índice BODE e associada negativamente com a IL-6. Novos estudos sobre a variação das adipocinas e suas associações com as variações dos marcadores inflamatórios e do estado nutricional devem ser realizados para melhor esclarecimento.
Introduction: Recent studies show that adipose tissue also contributes to systemic inflammation in chronic obstructive pulmonary disease (COPD). However, there are no data in the literature evaluating the evolution of level of adipokines and their associations with systemic inflammation, exacerbations and mortality in COPD patients. Objective: Evaluate the variations of adipokines and their association with systemic inflammation and and body composition in patients with COPD during one year. Patients and Methods: Fifty-seven patients with mild to very severe COPD were evaluated. During the follow up, six patients died, six lost the follow up and five refused to participate in the second assessment. At baseline and after one year we performed post-bronchodilator spirometry, arterial blood gas analysis, laboratory tests, pulse oximetry, serum plasma levels of interleukin (IL)-6, tumor necrosis factor alpha (TNF-α), adiponectin and leptin. We also assessed body composition, peripheral muscle strength (quadriceps), Basal Dyspnea Index (BDI), Borg Scale, and Modified Medical Research Council (mMRC), general health status was evaluated by Saint George Respiratory Questionnaire (SGRQ), Hospital Anxiety and Depression Scale (HAD), BODE index and 6-minute walk test. Results: From the total of 40 patients, we analyzed the variation during one year and we observed a positive association between leptin and BMI (R:0.43; p=0.006), QMS L (R:0.42; p=0.008) and BODE index (R:0.39; p=0.024) and a negative association between IL-6 (R:-0.33; p=0.003). Multiple linear regression showed a negative association between the variation of IMMC and variation of adiponectin levels (coef:-0.35, p=0.03). We did not find association between the frequency of exacerbation and mortality with adipokines. Conclusion: The present study showed that leptin is positively associated with BMI, peripheral muscle strength and BODE index and negatively associated with the IL-6. Further studies on the variation of adipokines and their associations with variations in inflammatory markers and nutritional status should be performed for better clarification.
Introduction: Recent studies show that adipose tissue also contributes to systemic inflammation in chronic obstructive pulmonary disease (COPD). However, there are no data in the literature evaluating the evolution of level of adipokines and their associations with systemic inflammation, exacerbations and mortality in COPD patients. Objective: Evaluate the variations of adipokines and their association with systemic inflammation and and body composition in patients with COPD during one year. Patients and Methods: Fifty-seven patients with mild to very severe COPD were evaluated. During the follow up, six patients died, six lost the follow up and five refused to participate in the second assessment. At baseline and after one year we performed post-bronchodilator spirometry, arterial blood gas analysis, laboratory tests, pulse oximetry, serum plasma levels of interleukin (IL)-6, tumor necrosis factor alpha (TNF-α), adiponectin and leptin. We also assessed body composition, peripheral muscle strength (quadriceps), Basal Dyspnea Index (BDI), Borg Scale, and Modified Medical Research Council (mMRC), general health status was evaluated by Saint George Respiratory Questionnaire (SGRQ), Hospital Anxiety and Depression Scale (HAD), BODE index and 6-minute walk test. Results: From the total of 40 patients, we analyzed the variation during one year and we observed a positive association between leptin and BMI (R:0.43; p=0.006), QMS L (R:0.42; p=0.008) and BODE index (R:0.39; p=0.024) and a negative association between IL-6 (R:-0.33; p=0.003). Multiple linear regression showed a negative association between the variation of IMMC and variation of adiponectin levels (coef:-0.35, p=0.03). We did not find association between the frequency of exacerbation and mortality with adipokines. Conclusion: The present study showed that leptin is positively associated with BMI, peripheral muscle strength and BODE index and negatively associated with the IL-6. Further studies on the variation of adipokines and their associations with variations in inflammatory markers and nutritional status should be performed for better clarification.
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Palavras-chave
DPOC, Citocinas Inflamatórias, Leptina, Adiponectina, Mortalidade, Exacerbação, COPD, Inflammatory cytokines, Leptin, Adiponectin, Mortality, Exacerbation