Endothelial dysfunction in patients with pulmonary arterial hypertension and schistosomiasis / Avaliação do comprometimento da função do endotélio em pacientes com hipertensão arterial pulmonar idiopática e em esquistossomóticos

AUTOR(ES)
DATA DE PUBLICAÇÃO

2009

RESUMO

INTRODUCTION: There are several diseases that cause Pulmonary hypertension (PH), such as Idiopathic Pulmonary Arterial Hypertension and Schistosomiasis. The mechanisms that lead to PH are thought to be related to endothelial dysfunction. OBJECTIVES: To evaluate endothelial dysfunction, using plasma markers such as Endothelin-1(ET-1), E-Selectin, VEGF, PDGF-AB and -BB, in patients with idiopathic pulmonary arterial hypertension (IPAH) and schistosomiasis patients with or without PH; and to evaluate if schistosomiasis groups have endothelial dysfunction in the same degree. METHODOLOGY: Patients were divided in 4 different groups: Patients with IPAH (n=11), Patients with PH associated to Schistosomiasis (SchPH)(n=13), Patients with Schistosomiasis without PH (Sch)(n=13) and Controls(n=13). PAH patients were classified according to severity. All groups were submitted to echocardiography and right ventricule systolic pressure(RVSP) was measured. Abdominal ultrassonography was used to rule in or rule out schistosomiasis diagnosis. PH patients went through haemodynamics evaluation and all patients had laboratorial assessment (leucocytes and platelet count and BNP levels) Soluble adhesion molecules such as E-Selectin, VEGF, PDGF-AB, PDGF-BB e ET-1 were determined by ELISA. Leucocytes and platelet counts as well as BNP levels were also evaluated. Results: Subjects did not differ according to age and there was a higher proportion of female patients. Controls and Sch subjects had lower RVSP compared to PH groups (Sch: 23.4±4.6, controls: 29.5±8.5, IPAH: 79.8±26.4 and Sch+HP: 75.2±15.3 mmHg). Haemodynamics data did not differ in PH patients. In IPAH group, E-selectin was elevated (61.5±24,2x103pg/mL) compared to controls, Sch+HP and Sch (14.5±12.2; 23.9±15.3; 21.4±18 x103pg/mL, respectively, p=0,005). PDGF-BB was decreased in IPAH, Sch+HP, Sch (3.7±2.1; 5.2±3; 2.4±1.7x103pg/mL, respectively) compared to controls (8.9±4.8x 103 pg/mL, p<0.001). PDGF-AB was elevated in controls (25.6±8.6x103pg/mL) when compared to Sch (11.4±8.6 x103pg/mL)(p=0.006). There were no differences in ET-1 levels within groups. In relation to VEGF, IPAH group had higher levels compared to controls and Sch (96,6±68,2, 38,4±28, 37,±19,2 pg/mL, respectively) (p=0,002). Based on ROC curve, E-selectin cutoff value of 43.806 pg/mL showed a sensitivity of 91% and a specificity of 89% to distinguish IPAH patients from other groups and PDGF-BB had a good accuracy to differentiate controls with a sensitivity of 77% and a specificity of 83%. Furthermore, E-selectin had a strong correlation with BNP levels (r=0,74, p=0,006). The number of leucocytes and platelets were different within groups. IPAH patients had the highest, and Sch group had the lowest blood cells and platelets count. Conclusions: 1. IPAH patients had higher levels of serum E-selectin and VEGF and controls had higher levels of PDGF-BB and AB; 2. Schistosomiasis patients with or without PH had the same levels of endothelial dysfunction serum markers

ASSUNTO(S)

hipertensão pulmonar/complicações esquistossomose pulmonary hypertension/complications endothelium endotélio schistosomiasis

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