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Master's Dissertation
DOI
https://doi.org/10.11606/D.17.2020.tde-05102020-130551
Document
Author
Full name
Larissa Brito Bastos
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
Ribeirão Preto, 2020
Supervisor
Committee
Quintana, Silvana Maria (President)
Cardoso, Viviane Cunha
Linhares, Iara Moreno
Title in Portuguese
Infecção do trato genital inferior por Chlamydia trachomatis em gestantes de um estudo aninhado a coorte BRISA
Keywords in Portuguese
Chlamydia trachomatis
Infecção
Mediadores imunológicos
Parto pré-termo
Resposta imune
Abstract in Portuguese
O Parto Pré-Termo (PPT) está relacionado a um elevado grau de morbidade materna e neonatal. Embora sua etiologia seja multifatorial, as infecções bacterianas têm sido responsabilizadas por até 50% dos casos, constituindo um importante fator de risco. Dentre as potenciais bactérias que podem estar associadas ao PPT, destacamos a Chlamydia trachomatis (CT). Por isso, este trabalho visou avaliar a associação entre infecção por Chlamydia trachomatis e PPT espontâneo (PPTe) nas gestantes da coorte pré-natal do Projeto BRISA. Para isso, foram analisadas parte das gestantes entre 20 e 25 semanas e 6 dias provenientes da coorte pré-natal de 2010-2011 do Projeto BRISA. Neste recorte, incluímos todas as gestantes de PPTe e os casos de parto a termo (Controle) foram selecionados randomicamente. Para o diagnóstico de CT, foi realizado Reação em Cadeia da Polimerase (PCR) com amostras de conteúdo cervicovaginal. Os mediadores inflamatórios TGF-α, IFN-γ, IL-10, IL-13, IL-1α, IL-1β, IL-2, IL-4, IL-6, IL-8, TNF-α, TNF-β foram dosados por Ensaio Multiplex®, as MMP-2 e -9 foram quantificadas por Ensaio Imunoenzimático (ELISA) a partir de amostras de plasma. As gestantes incluídas também para coleta de dados sociodemográficos, comportamentais e histórico clínico. Todas as participantes assinaram o TCLE concordando em participar do estudo e as amostras foram coletadas no momento da inclusão. Os dados obtidos foram analisados pelo software SAS - versão 9.4 e os resultados com p<0,05 foram considerados estatisticamente significativos. Ao todo, foram analisadas 561 gestantes, sendo 121 de PPTe e 440 de parto a termo. Dentre os principais achados, destacamos a ausência de associação entre a infecção por CT e desfecho de PPTe (OR 1,127; IC 95% 0,497 - 2,558) e a relação entre histórico de PPT prévio e desencadeamento de um PPTe (aOR 17,442; IC 95% 8,773 - 34,677). Ainda, foi observado maior frequência de diagnóstico positivo para CT entre as gestantes com idade igual ou inferior a 19 anos (p=0,0032; OR 4,046; IC 95% 1,734 - 9,436). Os níveis de TGF-α, IFN-γ, IL-10, IL-13, IL-1α, IL-1β, IL-2, IL-4, IL-6, IL-8, TNF-α, TNF-β não diferiram entre as gestantes, no entanto, o nível de MMP-2 esteve aumentado no grupo Controle (p=0,0184), já no caso da MMP-9, seus níveis estavam significativamente aumentados no grupo de PPTe (p<0,0001). Desta forma, a infecção por Chlamydia trachomatis não esteve associada ao desfecho de PPTe na parcela da coorte BRISA analisada, no entanto, a associação da bactéria com gestantes jovens sugere maior cautela no manejo clínico dessas pacientes. A avaliação do perfil imunológico de gestantes deve ser mais profundamente investigada para que se possa chegar a uma conclusão concreta sobre a relação de algum mediador e o desfecho gestacional.
Title in English
Chlamydia trachomatis lower genital tract infection in pregnant women from a study nested in the BRISA cohort
Keywords in English
Chlamydia trachomatis
Infection
Preterm birth
Abstract in English
Preterm Birth (PTB) is associated with a high degree of maternal and neonatal morbidity. Although its etiology is multifactorial, bacterial infections have been responsible for up to 50% of cases, constituting an important risk factor. Among the potential bacteria that may be associated with PTB, we highlight Chlamydia trachomatis (CT). So, we aimed to evaluate the association between Chlamydia trachomatis infection and spontaneous PTB (sPTB) in pregnant women of a prenatal cohort named BRISA Project. This study analyzed part of the pregnant women with 20-25 gestational weeks and 6 days all from BRISA prenatal cohort of 2010-2011. All pregnant women with sPTB were included and the cases of term delivery were randomly selected for the Control group. Polymerase Chain Reaction (PCR) was performed for CT's diagnosis in cervicovaginal fluid samples. The immune mediators TGF-α, IFN-γ, IL-10, IL-13, IL-1α, IL-1β, IL-2, IL-4, IL-6, IL-8, TNF-α, and TNF-β were measured using Multiplex Assay, MMP-2 and -9 were quantified by Immunoenzymatic Assay (ELISA) in plasma samples. All pregnants included were also interviewed for sociodemographic, behavioral and clinical history data collection. They also had signed the Consent Form at the time of inclusion and before samples collection. Our results were analyzed using SAS software - version 9.4, results with p<0.05 were considered statistically significant. 561 pregnant were evaluated, 121 of them had sPTB and 440 had term delivery (Control). Among our main findings, we highlight the absence of association between CT infection and sPTB (OR 1.127; 95% CI 0.497 - 2.558) and the association between previous PTB in triggering a sPTB (aOR 17.42; 95% CI 8.773 - 34.677). Besides, we observed a higher frequency of CT infection among younger pregnant (19 years old or less) (p=0.0032; OR 4.046; 95% CI 1.734 - 9.436). Levels of TGF-α, IFN-γ, IL-10, IL-13, IL-1α, IL-1β, IL-2, IL-4, IL-6, IL-8, TNF-α and TNF-β did not differ between the groups, however, MMP-2 level was increased in Control group (p=0.0184), whereas MMP-9 was significantly increased in sPTB group (p<0.0001). Therefore, Chlamydia trachomatis infection was not associated with sPTB in this part of BRISA cohort that we had analyzed. However, its correlation with younger pregnant suggests that these patients require more caution in clinical management. The immunological profile of pregnant should be further investigated to achieve concrete knowledge about the relationship of any immune mediator and pregnancy outcome.
 
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Publishing Date
2020-10-19
 
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