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Novas perspetivas sobre o impacto do ácido úrico como fator prognóstico na hipertensão arterial pulmonar
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Introdução: A hipertensão pulmonar arterial (HAP) é uma doença rara, crónica e progressiva, caraterizada pelo aumento da pressão pulmonar pré-capilar e diagnosticada por cateterismo cardíaco direito. Diversos fatores têm sido associados ao prognóstico HAP, entre os quais valores elevados de ácido úrico (AU).
Objetivos: Analisar a relação entre o prognóstico e a uricémia em doentes com HAP; avaliar o papel do AU na patogénese da doença; e rever os mecanismos fisiopatológicos subjacentes.
Material e métodos: Neste estudo retrospetivo, foram selecionados 32 doentes com HAP da base de dados da consulta de Hipertensão Pulmonar do CHLN, EPE. Avaliou-se a uricémia de acordo com a classe funcional, distância percorrida no T6MM, a mortalidade e concentração sérica de endotelina-1.
Resultados: A uricémia correlacionou-se positivamente com a classe funcional (r=0,52; p=0,002) e negativamente com a distância percorrida no T6MM (r=–0,52; p=0,02). A uricémia era mais elevada no grupo de doentes que faleceram (7,4±2,7 mg/dL vs. 5,4±1,7 mg/dL; p <0,04). Encontrou-se uma relação entre os valores séricos de AU e de endotelina-1 (r=0,5; p=0,03).
Discussão: Há uma relação entre os níveis séricos de AU e o prognóstico da HAP. Várias explicações são apontadas para justificar esta associação, nomeadamente a hipóxia tecidular e a diminuição da excreção renal de AU. Mais recentemente, acredita-se que o próprio AU possa contribuir para o agravamento da HAP por participar em processos de disfunção endotelial e remodeling vascular.
Conclusão: Permanece desconhecido se o AU representa apenas um fator de prognóstico ou se participa também na fisiopatologia da HAP. São necessários mais estudos para avaliar o impacto da redução da uricémia no prognóstico da HAP.
Introduction: Pulmonary arterial hypertension (PHA) is a rare, chronic and progressive condition, characterized by pulmonary precapillary hypertension and diagnosed by right heart catheterization. Several factors, such as high uric acid levels (UA), have been implicated in the prognosis. Objectives: Assess the relationship between serum UA levels and the prognosis in PHA patients; understand UA role in the disease’s pathogenesis; and review the underlying pathophysiological mechanisms. Material and methods: In this retrospective analysis, 32 PHA patients were selected from the CHLN, EPE Pulmonary Hypertension database. Serum UA levels were assessed, according to functional class, distance walked in the 6MWT, mortality and serum endothelin-1 values. Results: Serum UA levels correlated positively with the functional class (r=0,52; p=0,002) and negatively with the distance walked in the 6MWT (r=–0,52; p=0,02). Serum UA was higher in the group of patients who deceased (7,4±2,7 mg/dL vs. 5,4±1,7 mg/dL; p <0,04). We also found a relationship between UA and endothelin-1 levels (r=0,5; p=0,03). Discussion: We reported a relationship between serum UA levels and PHA prognosis, which is according to previous studies. Several mechanisms are thought to contribute to this association, namely tissue hypoxia and a decrease of UA renal elimination. More recently, it has been proposed that UA itself may contribute to PAH progression by participating in processes of endothelial dysfunction and vascular remodeling. Conclusion: Whether UA is just a predictor of gravity or takes part in PAH pathophysiology remains unknown. More studies are needed to evaluate the impact of the reduction of the UA levels in PAH prognosis.
Introduction: Pulmonary arterial hypertension (PHA) is a rare, chronic and progressive condition, characterized by pulmonary precapillary hypertension and diagnosed by right heart catheterization. Several factors, such as high uric acid levels (UA), have been implicated in the prognosis. Objectives: Assess the relationship between serum UA levels and the prognosis in PHA patients; understand UA role in the disease’s pathogenesis; and review the underlying pathophysiological mechanisms. Material and methods: In this retrospective analysis, 32 PHA patients were selected from the CHLN, EPE Pulmonary Hypertension database. Serum UA levels were assessed, according to functional class, distance walked in the 6MWT, mortality and serum endothelin-1 values. Results: Serum UA levels correlated positively with the functional class (r=0,52; p=0,002) and negatively with the distance walked in the 6MWT (r=–0,52; p=0,02). Serum UA was higher in the group of patients who deceased (7,4±2,7 mg/dL vs. 5,4±1,7 mg/dL; p <0,04). We also found a relationship between UA and endothelin-1 levels (r=0,5; p=0,03). Discussion: We reported a relationship between serum UA levels and PHA prognosis, which is according to previous studies. Several mechanisms are thought to contribute to this association, namely tissue hypoxia and a decrease of UA renal elimination. More recently, it has been proposed that UA itself may contribute to PAH progression by participating in processes of endothelial dysfunction and vascular remodeling. Conclusion: Whether UA is just a predictor of gravity or takes part in PAH pathophysiology remains unknown. More studies are needed to evaluate the impact of the reduction of the UA levels in PAH prognosis.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2018
Palavras-chave
Hipertensão arterial pulmonar Uuricémia Ácido úrico Disfunção endotelial Cardiologia