Avaliação da capacidade funcional e metabolismo muscular em indivíduos com doença arterial periférica com e sem diabetes

• Ano de defesa: 2018
• Autor(a) principal: Patricia Paulino Geisel
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de Minas Gerais; UFMG
• Palavras-chave em Português: Espectroscopia de luz próxima ao infravermelho; Doença arterial periférica; Diabetes; Claudicação intermitente; Doença arterial periféria; Claudicação intermintente; Capacidade Funcional
• Link de acesso: http://hdl.handle.net/1843/EEFF-BB5GZL

The Peripheral Arterial Disease (PAD) is characterized by the chronic obstruction of the inferior limbs distal arterial bed, having atherosclerosis as its main cause. Its prevalence is estimated as being around 3 to 10% in general population, rinsing up to 15 to 20% in elderly people. Among the risk factors, diabetes is highlighted, for it predisposes PAD and increases its mortality. The main manifestation of PAD is Intermittent Claudication (IC). The IC interferes in walking capacity, leads to worsening of functional capacity, limits daily life activities, and makes quality of life worse. Factors such gravity of vascular obstruction caused by the atherosclerotic plate are connected with the appearance of IC, but recent studies highlight the importance of local factors of vascular flow and muscular metabolism, which can interfere in IC and in functional performance. This mechanism isnt clearly defined in PAD yet, especially in associated conditions like diabetes. The Near-infrared spectroscopy (NIRS) technique has been used to assess tissue peripheral oxygenation, and can be promising in comprehending local tissue mechanisms associated with walking capacity in individuals with PAD. This way, this masters dissertation has two complementary objectives, which are to identify the muscular metabolism and vascular function variables using NIRS and the possible associations with functional capacity in individuals with PAD, and to verify the difference between individuals with PAD with and without diabetes in relation to functional capacity and the behavior of peripheral tissue oxygenation through the use of NIRS. There were recruited adults with PAD referred to the Outpatient Service of Support for People with Peripheral Arterial Disease of the Hospital das Clínicas from the Universidade Federal de Minas Gerais. They were assessed in relation to the functional capacity through the total distance walked in the treadmill test with constant velocity and inclination (3.2Km/h and 10%), and in relation to the function and muscular metabolism variables through the use of NIRS in rest and during the treadmill test. The Spearman correlation coefficient was made to assess the presence of association between variables, and the multiple linear regression analysis considering the test total distance as a dependent variable. For the assessment between groups, it was made the independent T Test or the Mann Whitney-U, when indicated. The significance level of 5% was adopted for all analysis. There were collected 40 volunteers for the initial project, one being excluded in this group because the NIRS data were lost. Of the remaining 39, 28 were men, being 14 (35.9%) diabetics and 25 (64.1%) non diabetics. The mean age was 64.23 ± 10.63 years, the body mass index (BMI) was 27.03 ± 4.64, the right ankle-brachial index was 0.61 ± 0.17 and the left ankle-brachial index was 0.62 ± 0.17. Of the total sample, 89.7% presented high blood pressure, 30.8% were active smokers, 53.8% ex-smokers, and 15.4% never smoked. The variables derived from the NIRS de-oxygenation rate in the treadmill, relative re-oxygenation rate, and time of re-oxygenation in occlusion explained 83% of the variability in functional capacity (p < 0.001) in the first model, and the walking economy in relation to heart rate (m/FC), de-oxygenation rate in the treadmill, and time of re-oxygenation in occlusion explained 60% of the variability (p < 0.001) in the second model. In the comparison between the groups PAD with and without diabetes, the time of re-oxygenation in occlusion presented a significant difference (p= 0.049). These findings reinforce the hypothesis that peripheral factors related to vascular function and muscular metabolism can impact walking capacity in PAD, and that the micro vascular dysfunction is more present in diabetic individuals with PAD.