Doctoral Thesis
DOI
https://doi.org/10.11606/T.23.2019.tde-08072020-132813
Document
Author
Full name
Jefferson da Rocha Tenório
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2019
Supervisor
Committee
Ortega, Karem Lopez (President)
Fernandes, Karin Sá
Eduardo, Fernanda de Paula
Gallottini, Marina Helena Cury
Title in Portuguese
Avaliação dos níveis séricos e salivares de RANKL, OPG, IL-1?, IL-6 e TNF-? e sua relação com o índice da cortical mandibular em pacientes com cirrose hepática
Keywords in Portuguese
Cirrose Hepática
Inflamação
Ligante RANK
Osteoporose
Osteoprotegerina
Radiografia panorâmica
Abstract in Portuguese
Pacientes com cirrose hepática podem desenvolver osteoporose como complicação relacionada ao déficit funcional hepático. O objetivo desse estudo é o de avaliar a presença de proteínas relacionadas ao metabolismo ósseo (RANKL, OPG, IL-1?, IL-6 e TNF-?) na saliva e no sangue de pacientes cirróticos e compará-los com o índice da cortical mandibular (ICM), relacionado à densidade mineral óssea, em radiografias panorâmicas. Trinta e oito pacientes cirróticos foram submetidos à anamnese, exame físico e tiveram amostras de sangue e de saliva não estimulada coletadas. Desses, 22 apresentavam radiografias panorâmicas que foram avaliadas segundo o ICM. As proteínas foram avaliadas através da tecnologia LuminexTM xMAP. Foram considerados estatisticamente significativos valores de p <=0.05. A maioria dos pacientes era do sexo masculino (68,4%), com idade média de 50,61 anos, média de MELD de 18 pontos no momento da consulta e média de 21,34 meses na fila de espera para o transplante. A análise das radiografias panorâmicas permitiu constatar que a maior parte da amostra apresentava alguma modificação na cortical mandibular sugestiva de alterações osteoporóticas (72,7%). O perfil de expressão das proteínas foi bastante variável no sangue e na saliva. Correlação estatisticamente significativa foi observada entre a expressão salivar de RANKL e OPG em pacientes com ICM alterado. Não foi observada relação estatisticamente significante entre o perfil das proteínas e a etiologia da cirrose, tempo na fila de transplante hepático, idade e sexo dos pacientes. As proteínas RANKL, OPG, IL-1?, IL-6 e TNF-? se comportam de maneira diferente na saliva e no sangue. Valores elevados de RANKL e OPG em saliva estão relacionados com ICM sugestivo de osteoporose em pacientes cirróticos, e propõe-se que esse aumento ocorra devido ao microambiente inflamatório local.
Title in English
Evaluation of serum and salivary levels of RANKL, OPG, IL-1?, IL-6 and TNF-? and their association with mandibular cortical index in patients with liver cirrhosis
Keywords in English
Cirrhosis
Inflammation
Osteoporosis
Osteoprotegerin
Panoramic radiography
RANK Ligand
Abstract in English
Patients with liver cirrhosis may develop osteoporosis as a complication related to hepatic functional deficit. The aim of this study is to evaluate the presence of bone metabolism-related proteins (RANKL, OPG, IL-1?, IL-6 and TNF-?) in the saliva and blood of cirrhotic patients and to compare them with mandibular cortical index (MCI), related to bone mineral density, on panoramic radiographs. Thirty-eight cirrhotic patients underwent anamnesis, physical examination and had blood samples and unstimulated saliva collected. Of these, 22 had panoramic radiographs that were evaluated according to the MCI. Proteins were evaluated using LuminexTM xMAP technology. Values of p <=0.05 were considered statistically significant. Most patients were male (68.4%), with a mean age of 50.61 years, with an average MELD of 18 points at the time of consultation, and an average of 21.34 months in the waiting list of liver transplantation. The analysis of panoramic radiographs showed that most of the sample presented alterations in the mandibular cortex suggestive of osteoporotic alterations (72.7%). The protein expression profile was quite variable in blood and saliva. Statistically significant correlation was observed between salivary expression of RANKL and OPG in patients with altered CMI. There was no statistically significant relationship between protein profile and cirrhosis etiology, time of diagnosis of cirrhosis, age or gender. The RANKL, OPG, IL-1?, IL-6 and TNF-? proteins behave differently in saliva and blood. High RANKL and OPG values in saliva are related to MCI suggestive of osteoporosis in cirrhotic patients, and it is proposed that this increase occurs due to the local inflammatory microenvironment.
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Publishing Date
2020-09-13