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Master's Dissertation
DOI
https://doi.org/10.11606/D.5.2019.tde-10122019-112229
Document
Author
Full name
Rafael Giovane Missé
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2019
Supervisor
Committee
Shinjo, Samuel Katsuyuki (President)
Gualano, Bruno
Reis Neto, Edgard Torres dos
Souza, Fernando Henrique Carlos de
Title in Portuguese
Efeitos do treinamento físico na função endotelial e nas propriedades estruturais de grandes artérias de pacientes com miopatias autoimunes sistêmicas
Keywords in Portuguese
Dermatomiosite
Função endotelial
Miosite
Polimiosite
Rigidez arterial
Síndrome antissintetase
Treinamento físico
Abstract in Portuguese
Introdução. Dermatomiosite (DM), polimiosite (PM) e síndrome antissintetase (SAS) abrangem um grupo de doenças raras denominadas de miopatias autoimunes sistêmicas (MAS). Evidências recentes têm mostrado a presença de disfunção endotelial e aumento da rigidez arterial em diversas doenças autoimunes sistêmicas. Entretanto, há apenas um estudo que avaliou esses parâmetros em pacientes com MAS. Além disso, não há estudos avaliando o comportamento desses parâmetros vasculares nesses pacientes submetidos a um programa de treinamento físico. Objetivos. Avaliar a função endotelial e as propriedades estruturais de grandes artérias de pacientes com MAS. Secundariamente, avaliar o impacto do treinamento físico combinado sobre esses parâmetros vasculares. Métodos. O estudo constituiu de duas fases (transversal e longitudinal), no qual foram incluídos 23 pacientes consecutivos do sexo feminino com MAS (14 com DM, 7 com SAS e 2 com PM), no período de 2017 a 2018. Na análise transversal, as pacientes foram pareadas por idade e etnia com 12 indivíduos saudáveis (grupo controle) do sexo feminino. No estudo longitudinal, as pacientes foram submetidas a um programa de treinamento físico combinado entre força e aeróbio (2 vezes por semana em um período de 12 semanas). Os parâmetros do status da doença foram embasados nos escores do International Myositis Assessment & Clinical Studies Group (IMACS). A avaliação da função endotelial foi realizada através da vasodilatação mediada pelo fluxo (VMF) dependente do endotélio vascular, enquanto que as propriedades estruturais foram avaliadas por meio da velocidade de onda de pulso (VOP) e de mecanotransdutores no trajeto carótideo-femoral. Resultados. Na análise transversal, foram avaliadas 21 das 23 pacientes (14 com DM e 7 com SAS) e comparadas ao grupo controle. A média de idade das pacientes com DM e SAS, e grupo controle foram, respectivamente, 45,4±8,6, 44,0±6,1 e 43,9±7,2 anos (P > 0,999), com etnia predominantemente branca. Os valores de VMF (P=0,372) e VOP (P=0,253) foram comparáveis entre todas as pacientes e o grupo controle. Em uma análise adicional, foram observados valores semelhantes de VMF entre as pacientes com DM vs. SAS [8,3% (4,5%-10,9%) vs. 6,0% (-1,8%-8,2%); P=0.585]. Da mesma forma, os valores médios de VOP foram similares entre DM vs. SAS (7,4±0,8 m/s vs. 7,4±0,9 m/s; P=1,000). Na análise longitudinal, 5 pacientes (3 com DM e 2 com PM) foram avaliadas. Após a intervenção, houve a redução percentual da VMF em 4 pacientes (-44.0%, -50,4%, -80,0%, - 44,4%), e aumento da VOP (+15,0%, +3,3%, +1,1%, +15,4%). Conclusões. Pacientes com MAS apresentaram função endotelial e propriedades funcionais vasculares semelhantes ao grupo de indivíduos saudáveis. Após serem submetidas a um programa de treinamento físico combinado, observou-se uma redução porcentual da VMF e aumento da VOP. Estudos adicionais são necessários para corroborar com os dados do presente estudo
Title in English
Effects of exercise training on endothelial function and functional properties of large arteries in patients with systemic autoimmune myopathies
Keywords in English
Antisynthetase syndrome
Arterial stiffness
Dermatomyositis
Endothelial function
Myositis
Physical training
Polymyositis
Abstract in English
Background. Dermatomyositis (DM), polymyositis (PM) and antisynthetase syndrome (ASS) are a group of rare diseases defined as systemic autoimmune myopathies (SAMs). Recent data have shown the presence of endothelial dysfunction and increased arterial stiffness in several systemic autoimmune diseases. However, there is only one study that evaluated these parameters in patients with SAMs. In addition, there are no studies evaluating the behavior of these vascular parameters in these patients undergoing an exercise training program. Purpose. To evaluate the endothelial function and structural properties of large arteries of patients with SAMs. Secondarily, to evaluate the impact of combined physical training on these vascular parameters. Methods. The study consisted of two phases (transversal and longitudinal), in which 23 consecutive female patients with SAMs were included (14 patients with DM, 7 patients with ASS and 2 patients with PM), from 2017 to 2018. In the transversal analysis, the patients were matched by age and ethnicity with 12 healthy female individuals (control group). In the longitudinal study, patients underwent a combined physical and aerobic training program (twice a week for a period of 12-weeks). The disease status parameters were based on the International Myositis Assessment & Clinical Studies Group (IMACS) scores. Endothelial function assessment was performed through vascular endotheliumdependent flow-mediated vasodilation (FMD), while structural properties were measured by pulse wave velocity (PWV) and by mechano-transducers in the carotid-femoral pathway. Results. In the transversal analysis, 21 out of 23 patients (14 patients with DM and 7 patients with ASS) were evaluated and compared with the control group. The mean age of patients with DM and ASS and the control group were, respectively, 45.4±8.6, 44.0±6.1 and 43.9±7.2 years (P > 0.999), with predominance of the white ethnicity. FMD (P=0.372) and PWV (P=0.253) values were comparable among all patients and the control group. In an additional analysis, similar FMD values were observed between patients' group with DM vs. ASS [8.3% (4.5%-10.9%) vs. 6.0% (-1.8%-8.2%); P=0.585]. Likewise, the mean PWV values were similar between groups with DM vs. ASS (7.4±0.8 m/s vs. 7.4±0.9 m/s, P=1,000). Five patients (three patients with DM and two patients with PM) were evaluated in the longitudinal analysis. After the intervention, FMD percentage reduction was observed (- 44.0%, -50.4%, -80.0%, -44.4%), and increasing of the PWV (+15.0%, +3.3%, +1.1%, +15.4%) in four patients. Conclusions. Patients with SAMs presented endothelial function and vascular functional properties similar to healthy individuals. With a combined physical training program, the percentage of the FMD reduced, whereas the percentage of the PWV increased. Additional studies are needed to corroborate the data from the present study
 
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Publishing Date
2019-12-10
 
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