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Antônio Lúcio Teixeira Júniorhttp://lattes.cnpq.br/2302805234722051Érica Leandro Marciano VieiraBruno Cópia FabregasAline Silva de MirandaVandack Alencar Nobre JuniorPaulo Pereira Christohttp://lattes.cnpq.br/3248833650336903Vinicius Sousa Pietra Pedroso2021-01-06T00:55:59Z2021-01-06T00:55:59Z2016-11-29http://hdl.handle.net/1843/34635Introdução: o acidente vascular encefálico (AVE) é um grande problema de saúde pública em todo o mundo e determina altas taxas de morbidade e mortalidade. Sequelas neuropsiquiátricas são muito frequentes após um evento cerebrovascular, destacando-se a depressão. Transtornos mentais associados ao AVE impactam negativamente na recuperação, na qualidade de vida e na sobrevida dos pacientes afetados e existem poucos elementos que possam auxiliar no diagnóstico clínico, tais como biomarcadores. Objetivo: investigar a prevalência de comorbidades psiquiátricas associadas ao AVE isquêmico agudo e procurar biomarcadores periféricos associados ao desenvolvimento de depressão pós-AVE (DPAVE). Métodos: foram incluídos sessenta pacientes com AVE isquêmico agudo, admitidos na Unidade de AVE do Hospital Municipal Odilon Behrens, em Belo Horizonte, Minas Gerais. Os pacientes foram avaliados por meio de entrevista clínica estruturada (Mini International Neuroppsychiatric Interview) e da aplicação do Mini-Exame do Estado Mental (MEEM), da Escala Hospitalar de Ansiedade e Depressão (HADS), da Escala de Choro e Riso Patológico, da Medida de Independência Funcional (MIF), da National Institutes of Health Stroke Scale e da Escala Modificada de Rankin (mRS). Níveis plasmáticos de IL-2, IL-4, IL-6, IL-10, IL-17A, IFNγ, TNF, sTNFR1, sTNFR2, TWEAK, STREM-1, E-Selectina, VCAM, BDNF, GDNF, NGF, Leptina e Adiponectina foram avaliados por meio de ELISA e CBA. Os pacientes foram comparados com 15 indivíduos controles saudáveis e 15 indivíduos com depressão maior, sem comorbidades cerebrovasculares. Resultados: Observou-se prevalência de algum transtorno mental em 55% dos pacientes afetados por AVE isquêmico agudo, com predomínio de depressão (26,7%) e transtornos de ansiedade (23,3%), além de abuso ou dependência de álcool (11,7%). Os pacientes com DPAVE apresentaram maior incapacidade à admissão aferida pela mRS e pior funcionalidade avaliada pela MIF, além de pior desempenho cognitivo no MEEM. A presença de diabetes aumentou o risco de desenvolvimento de DPAVE em 3 vezes. A HADS apresentou bom desempenho no rastreamento de casos de depressão, sendo encontrado o valor de corte de 6 para a subescala de depressão, atingindo sensibilidade de 100% e especificidade de 99,17%. Na avaliação de biomarcadores, observamos que os indivíduos com DPAVE tenderam a apresentar níveis reduzidos de STREM-1 e GDNF e essas proteínas se correlacionaram inversamente com a intensidade de sintomas depressivos aferidos pela HADS. Conclusões: o presente estudo fortalece a visão de que o AVE se relaciona ao desenvolvimento de transtornos mentais e sugere que as interrelações entre diabetes, estados inflamatórios crônicos e insulto cerebrovascular agudo podem desencadear a manifestação de sintomas depressivos.Introduction: stroke is a major public health problem worldwide and leads to high rates of morbidity and mortality. Neuropsychiatric sequelae are very commom after a cerebrovascular event, with emphasis on depression. Mental disorders associated with stroke negatively impact the recovery, quality of life and survival of affected patients. Unfortunately, there are still few tools that could aid in clinical diagnosis, such as biomarkers. Objective: to investigate the prevalence of psychiatric comorbidities associated with acute ischemic stroke and to look for peripheral biomarkers associated with de development of post-stroke depression (PSD). Methods: we evaluated sixty patients with acute ischemic, who were admitted to the stroke unit at the Hospital Municipal Odilon Behrens, in Belo Horizonte, Minas Gerais. Patients were assessed by the use of a structured clinical interview (Mini International Neuroppsychiatric Interview) and the application of the Mini-Mental State Examination (MMSE), the Hospital Anxiety and Depression Scale (HADS), the Pathological Laugh and Crying Scale, the Functional Independence Measure (MIF), the National Institutes of Health Stroke Scale, and the Rankin Modified Scale (mRS). Plasma levels of IL-2, IL-6, IL-10, IL-17A, IFNγ, TNF, sTNFR1, sTNFR2, TWEAK, STREM-1, E-Selectin, VCAM, BDNF, GDNF, NGF, Leptin and Adiponectin were evaluated by ELISA and CBA. Patients were compared with 15 healthy control subjects and 15 individuals with major depression, without cerebrovascular comorbidities. Results: We found a prevalence of some mental disorder in 55% of the patients affected by acute ischemic stroke, with predominance of depression (26.7%) and anxiety disorders (23.3%), as well as alcohol abuse or dependence (11.7% ). Patients with PSD had greater disability at admission, as measured by the mRS, worse functionality assessed by MIF, and worse cognitive performance on the MMSE. The presence of diabetes increased by 3-fold the risk of developing PSD. HADS performed well in tracking cases of depression. We found the cutoff value of 6 for the depression subscale, which reached sensitivity of 100% and specificity of 99.17%. Regarding biomarkers, we observed that individuals with PSD presented reduced levels of STREM-1 and GDNF and that these proteins correlated inversely with the intensity of depressive symptoms, as measured by the HADS. Conclusions: this study strengthens the view that the stroke is related to the development of mental disorders and suggests that the interrelationships between diabetes, chronic inflammation and acute cerebrovascular insult can trigger the manifestation of depressive symptoms.porUniversidade Federal de Minas GeraisPrograma de Pós-Graduação em NeurociênciasUFMGBrasilICB - INSTITUTO DE CIÊNCIAS BIOLOGICAShttp://creativecommons.org/licenses/by-nc-nd/3.0/pt/info:eu-repo/semantics/openAccessNeurociênciasAcidente vascular cerebralDepressãoFatores de crescimento neuralBiomarcadoresAcidente vascular encefálicoDepressãoFatores neurotróficosBiomarcadoresMecanismos inflamatóriosAvaliação de biomarcadores periféricos na depressão pós-acidente vascular encefálico isquêmico agudoinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/doctoralThesisreponame:Repositório Institucional da UFMGinstname:Universidade Federal de Minas Gerais (UFMG)instacron:UFMGORIGINALVinicius Sousa Pietra Pedroso - Tese de Doutorado.pdfVinicius Sousa Pietra Pedroso - Tese de Doutorado.pdfapplication/pdf4467147https://repositorio.ufmg.br/bitstream/1843/34635/1/Vinicius%20Sousa%20Pietra%20Pedroso%20-%20Tese%20de%20Doutorado.pdf7cf2e90c593e88d39f72d524cec7451cMD51CC-LICENSElicense_rdflicense_rdfapplication/rdf+xml; charset=utf-8811https://repositorio.ufmg.br/bitstream/1843/34635/2/license_rdfcfd6801dba008cb6adbd9838b81582abMD52LICENSElicense.txtlicense.txttext/plain; charset=utf-82119https://repositorio.ufmg.br/bitstream/1843/34635/3/license.txt34badce4be7e31e3adb4575ae96af679MD531843/346352021-01-05 21:55:59.295oai:repositorio.ufmg.br:1843/34635TElDRU7Dh0EgREUgRElTVFJJQlVJw4fDg08gTsODTy1FWENMVVNJVkEgRE8gUkVQT1NJVMOTUklPIElOU1RJVFVDSU9OQUwgREEgVUZNRwoKQ29tIGEgYXByZXNlbnRhw6fDo28gZGVzdGEgbGljZW7Dp2EsIHZvY8OqIChvIGF1dG9yIChlcykgb3UgbyB0aXR1bGFyIGRvcyBkaXJlaXRvcyBkZSBhdXRvcikgY29uY2VkZSBhbyBSZXBvc2l0w7NyaW8gSW5zdGl0dWNpb25hbCBkYSBVRk1HIChSSS1VRk1HKSBvIGRpcmVpdG8gbsOjbyBleGNsdXNpdm8gZSBpcnJldm9nw6F2ZWwgZGUgcmVwcm9kdXppciBlL291IGRpc3RyaWJ1aXIgYSBzdWEgcHVibGljYcOnw6NvIChpbmNsdWluZG8gbyByZXN1bW8pIHBvciB0b2RvIG8gbXVuZG8gbm8gZm9ybWF0byBpbXByZXNzbyBlIGVsZXRyw7RuaWNvIGUgZW0gcXVhbHF1ZXIgbWVpbywgaW5jbHVpbmRvIG9zIGZvcm1hdG9zIMOhdWRpbyBvdSB2w61kZW8uCgpWb2PDqiBkZWNsYXJhIHF1ZSBjb25oZWNlIGEgcG9sw610aWNhIGRlIGNvcHlyaWdodCBkYSBlZGl0b3JhIGRvIHNldSBkb2N1bWVudG8gZSBxdWUgY29uaGVjZSBlIGFjZWl0YSBhcyBEaXJldHJpemVzIGRvIFJJLVVGTUcuCgpWb2PDqiBjb25jb3JkYSBxdWUgbyBSZXBvc2l0w7NyaW8gSW5zdGl0dWNpb25hbCBkYSBVRk1HIHBvZGUsIHNlbSBhbHRlcmFyIG8gY29udGXDumRvLCB0cmFuc3BvciBhIHN1YSBwdWJsaWNhw6fDo28gcGFyYSBxdWFscXVlciBtZWlvIG91IGZvcm1hdG8gcGFyYSBmaW5zIGRlIHByZXNlcnZhw6fDo28uCgpWb2PDqiB0YW1iw6ltIGNvbmNvcmRhIHF1ZSBvIFJlcG9zaXTDs3JpbyBJbnN0aXR1Y2lvbmFsIGRhIFVGTUcgcG9kZSBtYW50ZXIgbWFpcyBkZSB1bWEgY8OzcGlhIGRlIHN1YSBwdWJsaWNhw6fDo28gcGFyYSBmaW5zIGRlIHNlZ3VyYW7Dp2EsIGJhY2stdXAgZSBwcmVzZXJ2YcOnw6NvLgoKVm9jw6ogZGVjbGFyYSBxdWUgYSBzdWEgcHVibGljYcOnw6NvIMOpIG9yaWdpbmFsIGUgcXVlIHZvY8OqIHRlbSBvIHBvZGVyIGRlIGNvbmNlZGVyIG9zIGRpcmVpdG9zIGNvbnRpZG9zIG5lc3RhIGxpY2Vuw6dhLiBWb2PDqiB0YW1iw6ltIGRlY2xhcmEgcXVlIG8gZGVww7NzaXRvIGRlIHN1YSBwdWJsaWNhw6fDo28gbsOjbywgcXVlIHNlamEgZGUgc2V1IGNvbmhlY2ltZW50bywgaW5mcmluZ2UgZGlyZWl0b3MgYXV0b3JhaXMgZGUgbmluZ3XDqW0uCgpDYXNvIGEgc3VhIHB1YmxpY2HDp8OjbyBjb250ZW5oYSBtYXRlcmlhbCBxdWUgdm9jw6ogbsOjbyBwb3NzdWkgYSB0aXR1bGFyaWRhZGUgZG9zIGRpcmVpdG9zIGF1dG9yYWlzLCB2b2PDqiBkZWNsYXJhIHF1ZSBvYnRldmUgYSBwZXJtaXNzw6NvIGlycmVzdHJpdGEgZG8gZGV0ZW50b3IgZG9zIGRpcmVpdG9zIGF1dG9yYWlzIHBhcmEgY29uY2VkZXIgYW8gUmVwb3NpdMOzcmlvIEluc3RpdHVjaW9uYWwgZGEgVUZNRyBvcyBkaXJlaXRvcyBhcHJlc2VudGFkb3MgbmVzdGEgbGljZW7Dp2EsIGUgcXVlIGVzc2UgbWF0ZXJpYWwgZGUgcHJvcHJpZWRhZGUgZGUgdGVyY2Vpcm9zIGVzdMOhIGNsYXJhbWVudGUgaWRlbnRpZmljYWRvIGUgcmVjb25oZWNpZG8gbm8gdGV4dG8gb3Ugbm8gY29udGXDumRvIGRhIHB1YmxpY2HDp8OjbyBvcmEgZGVwb3NpdGFkYS4KCkNBU08gQSBQVUJMSUNBw4fDg08gT1JBIERFUE9TSVRBREEgVEVOSEEgU0lETyBSRVNVTFRBRE8gREUgVU0gUEFUUk9Dw41OSU8gT1UgQVBPSU8gREUgVU1BIEFHw4pOQ0lBIERFIEZPTUVOVE8gT1UgT1VUUk8gT1JHQU5JU01PLCBWT0PDiiBERUNMQVJBIFFVRSBSRVNQRUlUT1UgVE9ET1MgRSBRVUFJU1FVRVIgRElSRUlUT1MgREUgUkVWSVPDg08gQ09NTyBUQU1Cw4lNIEFTIERFTUFJUyBPQlJJR0HDh8OVRVMgRVhJR0lEQVMgUE9SIENPTlRSQVRPIE9VIEFDT1JETy4KCk8gUmVwb3NpdMOzcmlvIEluc3RpdHVjaW9uYWwgZGEgVUZNRyBzZSBjb21wcm9tZXRlIGEgaWRlbnRpZmljYXIgY2xhcmFtZW50ZSBvIHNldSBub21lKHMpIG91IG8ocykgbm9tZXMocykgZG8ocykgZGV0ZW50b3IoZXMpIGRvcyBkaXJlaXRvcyBhdXRvcmFpcyBkYSBwdWJsaWNhw6fDo28sIGUgbsOjbyBmYXLDoSBxdWFscXVlciBhbHRlcmHDp8OjbywgYWzDqW0gZGFxdWVsYXMgY29uY2VkaWRhcyBwb3IgZXN0YSBsaWNlbsOnYS4KCg==Repositório InstitucionalPUBhttps://repositorio.ufmg.br/oaiopendoar:2021-01-06T00:55:59Repositório Institucional da UFMG - Universidade Federal de Minas Gerais (UFMG)false
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