Anticorpos antifosfolípides e antiproteínas de choque térmico na doença obstrutiva severa de artérias carótidas

• Ano de defesa: 2006
• Autor(a) principal: Lopes, Mateus Recuero
• Orientador(a): Silva, Jefferson Luis Braga da
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Pontifícia Universidade Católica do Rio Grande do Sul; Porto Alegre
• Palavras-chave em Português: MEDICINA; ARTÉRIAS CARÓTIDAS; ANTICORPOS ANTIFOSFOLÍPIDES; PROTEÍNAS DO CHOQUE TÉRMICO; IMUNOLOGIA; ATEROSCLEROSE
• Link de acesso: http://hdl.handle.net/10923/4386

Theoretical basis – Severe obstructive carotid artery disease is related to atherosclerosis (ATC). Mechanisms of inflammation and self-immunity may have influence on the occurrence of ATC. This includes antiphospholipid antibodies (AAP), antiphospholipid syndrome markers (APS) and antibodies against heat shock proteins (anti-Hsp). A beta 2-glycoprotein I (beta2-gpI) and the 60 and 65 kilodaltons (kDa) Hsp are molecules present in atherosclerotic plaques. This is the first report including research on IgA anticardiolipin (aCL), IgG/IgM/IgA anti-beta2- glycoprotein I and anti-HSP in severe obstructive carotid artery disease cases. Objective – To determine the association, if any, between the presence of AAP/anti-Hsp and the occurrence of severe obstructive carotid artery disease. Patients and Methods – In our control case study the cases consisted of patients with either symptomatic or asymptomatic severe obstructive carotid artery disease. The presence of the disease was determined by anamnesis, physical examination, MR angiography (MRA) and carotid endarterectomy. The control group consisted of patients admitted to orthopedic wards. Both groups were assessed for risk factors: age, sex, race, hypertension, smoking, diabetes mellitus (DM) and hypercholesterolemy. IgG/IgM/IgA aCL, IgG/IgM/IgA anti-beta2-gpI, IgG anti-Hsp 60 kDa recombinant human and IgG anti-Hsp 65 kDa of Mycobacterium bovis antibodies were detected by enzymatic test. In order to assess the degree of association between antibodies with severe obstructive carotid artery disease, (odds ratios, OR) were calculated with their respective confidence intervals (IC 95%).Logistic regression was used to adjust the confusion factors. Results – 57 case patients and 93 control patients were studied and the average age was 66 + 8. 7 years for case patients and 47. 5 + 18. 8 years for control patients (P<0. 001). There was a predominance of black race individuals in the control group. Most case patients were male individuals (61. 4%), but there were less male individuals (49. 5%) among control patients. The presence of hypertension (OR=21. 0; IC 95% 8. 0 to 57. 1; P<0. 001) and hypercholesterolemy (OR=25. 5; IC 95% 9. 5 to 70. 9; P<0,001) determined the strongest associations between the risk factors already known and severe obstructive carotid artery disease. IgA antibeta2-gpI antibodies were detected in 33. 3% of the case patients and in 9. 7% of the control patients (OR adjusted 4. 7; IC 95% 1. 0 to 23. 7; P=0. 06). The frequency of other non-tested antibodies was not significantly different in cases and controls. Conclusion – No association was found between the presence of aCL, IgG/IgM antibeta2-gpI, anti-Hsp and the occurrence of severe obstructive carotid artery disease. The presence of IgA antibeta2-gpI antibodies was found to be an independent risk factor for severe obstructive carotid artery disease (OR adjusted 4. 7), although with borderline significance (P=0,06). The association of IgA antibeta2-gpI with severe obstructive carotid artery disease may be one of the links between auto-immunity and carotid.