Impacto da cirurgia bariátrica na uricemia e nos indicadores de risco cardiovascular em mulheres com síndrome metabólica
| Ano de defesa: | 2014 |
|---|---|
| Autor(a) principal: | |
| Orientador(a): | |
| Banca de defesa: | |
| Tipo de documento: | Dissertação |
| Tipo de acesso: | Acesso aberto |
| Idioma: | por |
| Instituição de defesa: |
Universidade Federal do Maranhão
|
| Programa de Pós-Graduação: |
PROGRAMA DE PÓS-GRADUAÇÃO EM SAÚDE DO ADULTO E DA CRIANÇA/CCBS
|
| Departamento: |
DEPARTAMENTO DE MEDICINA I/CCBS
|
| País: |
Brasil
|
| Palavras-chave em Português: | |
| Palavras-chave em Inglês: | |
| Área do conhecimento CNPq: | |
| Link de acesso: | http://tedebc.ufma.br:8080/jspui/handle/tede/1419 |
Resumo: | Introduction: The association between hyperuricemia and cardiovascular risk factors, especially the metabolic syndrome and his components, has been widely documented. Despite of don’t be a treatment directed to hyperuricemia, has been verified that, the bariatric surgery allowed to reach improvements on the acid uric metabolism. Methodology: It was accomplished an retrospective, observational, coorte and analytic study, through secondary data , women’s with diagnosed metabolic syndrome according to the criterions of the National Cholesterol Education Program Adult Treatment Panel – III (NCEP-ATP III), 2001, underwent to Roux-en-Y gastric bypass mixed technique, in the period of january of 2012 to january of 2014. Of 391 medical records only 84 attempted to the selected sample criterions. It was collected the plasmatic acid uric values, the syndrome metabolic components and otters cardiovascular risk factors. Results: It was noticed a high prevalence of young adult woman’s (27 to 34 years), 38,1% (32) , mean age to 33,5±10,1 years, with the mean Body Mass Index (BMI) levels to 39,3±4,3 Kg/m², degree II of obesity occurred with more often in 47,6% (40). The mean of triglycerides (TG) (202,1±92,8 mg/dL), diabetes glucose plasma (135,3±42,6 mg/dL), diastolic e systolic blood pressure, low density lipoprotein (LDL-c) (126,3± 30,5 mg/dL), very low density lipoprotein (VLDL-c) (41,2±19,2 mg/dL) all this data demonstrated an increase when the uric acid levels was ≥ 6 mg/dL, however there was a significant difference only to the variables triglycerides (p=0,0435) , of the hypertensives patients diastolic blood pressure (p=0,0413), and VLDL-c (p=0,0357). The only variable that was positively and significantly correlated (p =0,0026) with the uric acid was the systolic blood pressure, however demonstrated a weak correlation (r=0,3249). And those who presented uric acid level < 6mg/dL and 3, 4 e 5 aggregation of the metabolic syndrome components, the frequency was 100% (43), 77, 8% (21) and 35, 7% (5), respectively, demonstrating reduction of the frequency according with the inclusion of one more syndrome metabolic criteria. And on the cutoff ≥ 6mg/dL, that define hyperuricemia, occurred the opposite, and on the aggregation 4 and 5 the frequency was 22, 2% (6) and 66, 3% (9), and none of the participant with hyperuricemia on the aggregation 3. Conclusion: Surgery for Gastric Bypass Roux-Y was able to reduce the levels of uric acid and cardiometabolic control, including the metabolic syndrome. |
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NAVARRO, Francisco484.822.209-82033.016.143-10http://lattes.cnpq.br/7125132972922015Câmara , Thalita de Albuquerque Véras2017-05-17T18:34:39Z2014-11-26CÂMARA, Thalita de Albuquerque Véras. Impacto da cirurgia bariátrica na uricemia e nos indicadores de risco cardiovascular em mulheres com síndrome metabólica. 2014. 84 f. Dissertação (Programa de Pós-Graduação em Saúde do Adulto e da Criança) - Universidade Federal do Maranhão, São Luís, 2014.http://tedebc.ufma.br:8080/jspui/handle/tede/1419Introduction: The association between hyperuricemia and cardiovascular risk factors, especially the metabolic syndrome and his components, has been widely documented. Despite of don’t be a treatment directed to hyperuricemia, has been verified that, the bariatric surgery allowed to reach improvements on the acid uric metabolism. Methodology: It was accomplished an retrospective, observational, coorte and analytic study, through secondary data , women’s with diagnosed metabolic syndrome according to the criterions of the National Cholesterol Education Program Adult Treatment Panel – III (NCEP-ATP III), 2001, underwent to Roux-en-Y gastric bypass mixed technique, in the period of january of 2012 to january of 2014. Of 391 medical records only 84 attempted to the selected sample criterions. It was collected the plasmatic acid uric values, the syndrome metabolic components and otters cardiovascular risk factors. Results: It was noticed a high prevalence of young adult woman’s (27 to 34 years), 38,1% (32) , mean age to 33,5±10,1 years, with the mean Body Mass Index (BMI) levels to 39,3±4,3 Kg/m², degree II of obesity occurred with more often in 47,6% (40). The mean of triglycerides (TG) (202,1±92,8 mg/dL), diabetes glucose plasma (135,3±42,6 mg/dL), diastolic e systolic blood pressure, low density lipoprotein (LDL-c) (126,3± 30,5 mg/dL), very low density lipoprotein (VLDL-c) (41,2±19,2 mg/dL) all this data demonstrated an increase when the uric acid levels was ≥ 6 mg/dL, however there was a significant difference only to the variables triglycerides (p=0,0435) , of the hypertensives patients diastolic blood pressure (p=0,0413), and VLDL-c (p=0,0357). The only variable that was positively and significantly correlated (p =0,0026) with the uric acid was the systolic blood pressure, however demonstrated a weak correlation (r=0,3249). And those who presented uric acid level < 6mg/dL and 3, 4 e 5 aggregation of the metabolic syndrome components, the frequency was 100% (43), 77, 8% (21) and 35, 7% (5), respectively, demonstrating reduction of the frequency according with the inclusion of one more syndrome metabolic criteria. And on the cutoff ≥ 6mg/dL, that define hyperuricemia, occurred the opposite, and on the aggregation 4 and 5 the frequency was 22, 2% (6) and 66, 3% (9), and none of the participant with hyperuricemia on the aggregation 3. Conclusion: Surgery for Gastric Bypass Roux-Y was able to reduce the levels of uric acid and cardiometabolic control, including the metabolic syndrome.ntrodução: A associação entre os níveis de ácido úrico e fatores de risco cardiovascular, especialmente, na síndrome metabólica e com seus componentes tem sido amplamente documentada. Apesar de não ser um tratamento dirigido à hiperuricemia, tem sido verificado que a cirurgia bariátrica permite alcançar uma melhoria no metabolismo do ácido úrico. Objetivo: Verificar o impacto da cirurgia bariátrica na uricemia e nos indicadores de risco cardiovascular, e associação, em mulheres com síndrome metabólica. Metodologia: Foi realizado um estudo retrospectivo, observacional do tipo coorte e analítico com coleta de dados secundários de mulheres com Síndrome Metabólica, diagnosticadas de acordo com os critérios do Programa Nacional de Educação sobre Colesterol, ligado ao III Painel de Tratamento do Adulto (NCEP-ATP III), 2001, submetidas à cirurgia bariátrica pela técnica mista do bypass gástrico em Y de Roux, no período de janeiro de 2012 a janeiro de 2014. De 391 prontuários, apenas 84 atenderam aos critérios de seleção da amostra. Foram coletados valores de ácido úrico plasmático, componentes da síndrome metabólica e outros fatores de risco cardiovascular. Resultados: Notou-se elevada prevalência de mulheres adultas jovens (faixa de 27 a 34 anos), 38,1% (32), média de idade de 33,5±10,1 anos, Índice de Massa Corporal (IMC) com média de 39,3±4,3kg/m² e grau II de obesidade foi o mais frequente, 47,6% (40). Demonstrou-se que as médias de triglicerídeos (202,1±92,8 mg/dL), glicemia das diabéticas (135,3±42,6 mg/dL), pressão arterial sistólica e diastólica, lipoproteína de baixa densidade (LDL-c) (126,3±30,5 mg/dL), e lipoproteínas de muito baixa densidade (VLDL-c) (41,2±19,2 mg/dL) foram mais elevadas quando os níveis de ácido úrico estavam ≥ 6mg/dL, no entanto, houve diferença significativa apenas para as variáveis triglicerídeos (p=0,0435), pressão arterial diastólica das hipertensas (p=0,0413) e VLDL-c (p=0,0357). E, aquelas que apresentaram níveis de ácido úrico < 6mg/dL e aglomerado 3, 4 e 5 de componentes da SM, a frequência foi de 100% (43), 77,8% (21) e 35,7% (5), respectivamente, mostrando redução da frequência de acordo com a inclusão de mais um critério da síndrome metabólica. No ponto de corte ≥ 6 mg/dl, que determina a hiperuricemia, ocorreu o inverso, no aglomerado 4 e 5 a frequência foi de 22,2% (6) e 64,3% (9), e nenhuma participante com hiperuricemia no aglomerado 3. Conclusão: A cirurgia do bypass gástrico em Y de Roux foi capaz de reduzir os níveis de ácido úrico e controle cardiometabolico, incluindo a Síndrome Metabólica.Submitted by Rosivalda Pereira (mrs.pereira@ufma.br) on 2017-05-17T18:34:39Z No. of bitstreams: 1 ThalitaCamara.pdf: 1228117 bytes, checksum: ef9a2fea64bd1f59d9de3091281a24f4 (MD5)Made available in DSpace on 2017-05-17T18:34:39Z (GMT). No. of bitstreams: 1 ThalitaCamara.pdf: 1228117 bytes, checksum: ef9a2fea64bd1f59d9de3091281a24f4 (MD5) Previous issue date: 2014-11-26application/pdfporUniversidade Federal do MaranhãoPROGRAMA DE PÓS-GRADUAÇÃO EM SAÚDE DO ADULTO E DA CRIANÇA/CCBSUFMABrasilDEPARTAMENTO DE MEDICINA I/CCBSÁcido ÚricoDoença CardiovascularCirurgia bariátricaSíndrome MetabólicaAcid UricCardiovascular diseaseBariatric surgeryMetabolic SyndromeCirurgia GastroenterologiaImpacto da cirurgia bariátrica na uricemia e nos indicadores de risco cardiovascular em mulheres com síndrome metabólicaIMPACT BARIATRIC SURGERY IN THE URICEMIA AND IN THE CARDIOVASCULAR RISK INDICATORS IN WOMEN WITH METABOLIC SYNDROMEinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesisinfo:eu-repo/semantics/openAccessreponame:Biblioteca Digital de Teses e Dissertações da UFMAinstname:Universidade Federal do Maranhão (UFMA)instacron:UFMAORIGINALThalitaCamara.pdfThalitaCamara.pdfapplication/pdf1228117http://tedebc.ufma.br:8080/bitstream/tede/1419/2/ThalitaCamara.pdfef9a2fea64bd1f59d9de3091281a24f4MD52LICENSElicense.txtlicense.txttext/plain; charset=utf-82255http://tedebc.ufma.br:8080/bitstream/tede/1419/1/license.txt97eeade1fce43278e63fe063657f8083MD51tede/14192018-01-31 18:00:56.331oai:tede2: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Biblioteca Digital de Teses e Dissertaçõeshttps://tedebc.ufma.br/jspui/PUBhttp://tedebc.ufma.br:8080/oai/requestrepositorio@ufma.br||repositorio@ufma.bropendoar:21312018-01-31T21:00:56Biblioteca Digital de Teses e Dissertações da UFMA - Universidade Federal do Maranhão (UFMA)false |
| dc.title.por.fl_str_mv |
Impacto da cirurgia bariátrica na uricemia e nos indicadores de risco cardiovascular em mulheres com síndrome metabólica |
| dc.title.alternative.por.fl_str_mv |
IMPACT BARIATRIC SURGERY IN THE URICEMIA AND IN THE CARDIOVASCULAR RISK INDICATORS IN WOMEN WITH METABOLIC SYNDROME |
| title |
Impacto da cirurgia bariátrica na uricemia e nos indicadores de risco cardiovascular em mulheres com síndrome metabólica |
| spellingShingle |
Impacto da cirurgia bariátrica na uricemia e nos indicadores de risco cardiovascular em mulheres com síndrome metabólica Câmara , Thalita de Albuquerque Véras Ácido Úrico Doença Cardiovascular Cirurgia bariátrica Síndrome Metabólica Acid Uric Cardiovascular disease Bariatric surgery Metabolic Syndrome Cirurgia Gastroenterologia |
| title_short |
Impacto da cirurgia bariátrica na uricemia e nos indicadores de risco cardiovascular em mulheres com síndrome metabólica |
| title_full |
Impacto da cirurgia bariátrica na uricemia e nos indicadores de risco cardiovascular em mulheres com síndrome metabólica |
| title_fullStr |
Impacto da cirurgia bariátrica na uricemia e nos indicadores de risco cardiovascular em mulheres com síndrome metabólica |
| title_full_unstemmed |
Impacto da cirurgia bariátrica na uricemia e nos indicadores de risco cardiovascular em mulheres com síndrome metabólica |
| title_sort |
Impacto da cirurgia bariátrica na uricemia e nos indicadores de risco cardiovascular em mulheres com síndrome metabólica |
| author |
Câmara , Thalita de Albuquerque Véras |
| author_facet |
Câmara , Thalita de Albuquerque Véras |
| author_role |
author |
| dc.contributor.advisor2ID.por.fl_str_mv |
484.822.209-82 |
| dc.contributor.advisor1.fl_str_mv |
NAVARRO, Francisco |
| dc.contributor.authorID.fl_str_mv |
033.016.143-10 |
| dc.contributor.authorLattes.fl_str_mv |
http://lattes.cnpq.br/7125132972922015 |
| dc.contributor.author.fl_str_mv |
Câmara , Thalita de Albuquerque Véras |
| contributor_str_mv |
NAVARRO, Francisco |
| dc.subject.por.fl_str_mv |
Ácido Úrico Doença Cardiovascular Cirurgia bariátrica Síndrome Metabólica |
| topic |
Ácido Úrico Doença Cardiovascular Cirurgia bariátrica Síndrome Metabólica Acid Uric Cardiovascular disease Bariatric surgery Metabolic Syndrome Cirurgia Gastroenterologia |
| dc.subject.eng.fl_str_mv |
Acid Uric Cardiovascular disease Bariatric surgery Metabolic Syndrome |
| dc.subject.cnpq.fl_str_mv |
Cirurgia Gastroenterologia |
| description |
Introduction: The association between hyperuricemia and cardiovascular risk factors, especially the metabolic syndrome and his components, has been widely documented. Despite of don’t be a treatment directed to hyperuricemia, has been verified that, the bariatric surgery allowed to reach improvements on the acid uric metabolism. Methodology: It was accomplished an retrospective, observational, coorte and analytic study, through secondary data , women’s with diagnosed metabolic syndrome according to the criterions of the National Cholesterol Education Program Adult Treatment Panel – III (NCEP-ATP III), 2001, underwent to Roux-en-Y gastric bypass mixed technique, in the period of january of 2012 to january of 2014. Of 391 medical records only 84 attempted to the selected sample criterions. It was collected the plasmatic acid uric values, the syndrome metabolic components and otters cardiovascular risk factors. Results: It was noticed a high prevalence of young adult woman’s (27 to 34 years), 38,1% (32) , mean age to 33,5±10,1 years, with the mean Body Mass Index (BMI) levels to 39,3±4,3 Kg/m², degree II of obesity occurred with more often in 47,6% (40). The mean of triglycerides (TG) (202,1±92,8 mg/dL), diabetes glucose plasma (135,3±42,6 mg/dL), diastolic e systolic blood pressure, low density lipoprotein (LDL-c) (126,3± 30,5 mg/dL), very low density lipoprotein (VLDL-c) (41,2±19,2 mg/dL) all this data demonstrated an increase when the uric acid levels was ≥ 6 mg/dL, however there was a significant difference only to the variables triglycerides (p=0,0435) , of the hypertensives patients diastolic blood pressure (p=0,0413), and VLDL-c (p=0,0357). The only variable that was positively and significantly correlated (p =0,0026) with the uric acid was the systolic blood pressure, however demonstrated a weak correlation (r=0,3249). And those who presented uric acid level < 6mg/dL and 3, 4 e 5 aggregation of the metabolic syndrome components, the frequency was 100% (43), 77, 8% (21) and 35, 7% (5), respectively, demonstrating reduction of the frequency according with the inclusion of one more syndrome metabolic criteria. And on the cutoff ≥ 6mg/dL, that define hyperuricemia, occurred the opposite, and on the aggregation 4 and 5 the frequency was 22, 2% (6) and 66, 3% (9), and none of the participant with hyperuricemia on the aggregation 3. Conclusion: Surgery for Gastric Bypass Roux-Y was able to reduce the levels of uric acid and cardiometabolic control, including the metabolic syndrome. |
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2014 |
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2014-11-26 |
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2017-05-17T18:34:39Z |
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CÂMARA, Thalita de Albuquerque Véras. Impacto da cirurgia bariátrica na uricemia e nos indicadores de risco cardiovascular em mulheres com síndrome metabólica. 2014. 84 f. Dissertação (Programa de Pós-Graduação em Saúde do Adulto e da Criança) - Universidade Federal do Maranhão, São Luís, 2014. |
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http://tedebc.ufma.br:8080/jspui/handle/tede/1419 |
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CÂMARA, Thalita de Albuquerque Véras. Impacto da cirurgia bariátrica na uricemia e nos indicadores de risco cardiovascular em mulheres com síndrome metabólica. 2014. 84 f. Dissertação (Programa de Pós-Graduação em Saúde do Adulto e da Criança) - Universidade Federal do Maranhão, São Luís, 2014. |
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UFMA |
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Brasil |
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Universidade Federal do Maranhão |
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MD5 MD5 |
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Biblioteca Digital de Teses e Dissertações da UFMA - Universidade Federal do Maranhão (UFMA) |
| repository.mail.fl_str_mv |
repositorio@ufma.br||repositorio@ufma.br |
| _version_ |
1853507986748604416 |