Contribuição do teste de lavagem de nitrogênio e da volumetria de vias aéreas em pacientes com esclerose sistêmica

• Autor(a) principal: Silva, Bruno Rangel Antunes da
• Data de Publicação: 2019
• Tipo de documento: Tese
• Idioma: por
• Título da fonte: Biblioteca Digital de Teses e Dissertações da UERJ
• Texto Completo: http://www.bdtd.uerj.br/handle/1/8523
• topic: Systemic sclerosis; Airways; Pulmonary function tests; Computed tomography; Esclerose sistêmica; Vias aéreas; Testes de função pulmonar; Tomografia computadorizada; Escleroderma Sistêmico; Testes funcionais dos pulmões; Vias aéreas (Medicina) Imagem; Diagnóstico por imagem; CNPQ::CIENCIAS DA SAUDE::MEDICINA::CLINICA MEDICA::PNEUMOLOGIA

Systemic sclerosis (SS) is a chronic disease of heterogeneous characteristics that can affect the skin and other organs. Its pathophisiology involves: fibroblast dysfunction with consequent fibrosis, vasculopathy leading to tissue hipoxya, and impaired immune response with B and T lymphocite dysfunction and autoantibody production. The clinical manifestations are diverse, with the respiratory system among the most affected, being interstitial ling disease, the main cause of morbidity and mortality in the disease. Almost all studies focus on the analysis of the pulmonary parenchyma and little is known about the involvement of the airways in SS. The main objetctive of this study was to identify possible morphological and functional alterations in the lower airways through CT and NWT in SS patients. The specific objectives were: to correlate the NWT findings with other pulmonary function parameters; determine the involvement of the lower airways; compare the airway volume values of SS patients with a control group; and to describe the tracheal changes observed in airways volumetry, correlating with clinical data and pulmonary funcition test (PFT). Two cross-sectional studies were performed with SS patients. This patients performed CT and the following PFT: spirometry, whole body pletismography, carbon monoxide diffusion capacity (DLco), respiratory muscle strength and NWT. CT images were imported and analyzed using the MatLab platform for later squeletonization and lower airways volumetry. The first study involved 52 patients with SS, who performed PFT and a subjective analysis of their chest CT. Patients were allocated into two groups according to the value of their forced vital capacity (FVC) higher or lower than 70% of predicted value. There was a statistically significant difference in mean FVC, forced expiratory volume in 1 second (FEV1), FEV1/FVC, DLco, total lung capacity (TLC), residual volume (RV), RV/TLC ratio, phase III slope and closing volume(CV)/ vital capacity (VC) ratio. An association with statistical significance was found between phase III slope and the following variables: FVC, FEV1, FEV1/FVC, CMDC, TLC, RV, RV/TLC. The CV/VC ratio correlated with FVC, FEV1, FEV1/FVC, TLC, RV/TLC and specific airway conductance (SGaw). The second study involved 28 SS patients and a control group of 27 individuals. The aim of this study was to identify morphological alterations in the trachea of SS patients through the application of airway volumetry technique in CT images. The SS group had higher values of area, eccentricity, greater and smaller diameters and sinuosity. The area and equivalent diameter had a negative correlation with the ratio of forced expiratory flow / forced inpiratory flow in 50% of FVC (FEF50%/FIF50%). The sinosity of the trachea correlated negatively with peak expiratory flow (PEF) (r = -0,51, p = 0,008). As conclusion, patients with ES present functional and morphological airways alterations, which are expressed both in imaging tests and in PFT, with important relationships between structure and function in these individuals. Thus, it is essential to incorporate the evaluation of the airways in the monitoring of these patients.