Uso de imunomodulador tópico e papel do polimorfismo de defensinas DEFA1 e DEFB1 no tratamento de lesões intraepiteliais de vulva

• Ano de defesa: 2013
• Autor(a) principal: Rama, Ana Luisa de Figueiredo e Silva [UNIFESP]
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• dARK ID: ark:/48912/001300002mn8h
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: papillomavirus infections; vulvar neoplasms; in situ carcinoma; aminoquinolones; therapeutic use; infecções por papillomavirus; neoplasias vulvares; carcinoma in situ; aminoquinolonas/uso terapêutico; defensinas
• Link de acesso: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=944098; https://repositorio.unifesp.br/handle/11600/47509

Purposes: Evaluate the efficacy of topical use of imiquimod 5% in the treatment of vulvar lesions type condyloma acuminated and VIN I, in comparison to expectant management. Analyze the levels of residual or recurrent lesions after the treatments mentioned above. Evaluate the efficacy of topical use of imiquimod 5% in the treatment of vulvar lesions type VIN II and VIN III, compared to the CO2 laser vaporization. Similarly, to analyze the levels of residual or recurrent lesions after treatments with topical imiquimod 5% CO2 laser vaporization. Relate the participation of polymorphisms of defensins HD1 and hBD-1 with the severity of vulvar lesions HPV-induced and the treatment responses of these lesions. Methods: Were selected 80 women with vulvar HPV-induced lesions, subdivided as histologic grade, and 51 with vulvar lesions type condyloma acuminata and VIN I in Group 1 and 29 patients with vulvar lesions type VIN II and VIN III in Group 2. In the first group the patients were subjected to a treatment with topical imiquimod 5% or expectant management, and the second group undergoing to a treatment with topical imiquimod 5% or CO2 laser vaporization. All patients answered a anamnestic questionnaire and underwent collection vulvar smears, colposcopy of the vulva and biopsy of the lesions found. The vulvar smears were submitted to the detection tests and genotyping of HPV and evaluation of polymorphisms of defensins HD1 and hBD-1. Patients were followed during treatment and after its completion followed for evaluation of residual and recurrent lesions. Results: There were statistically significant difference between the clinical response of patients in group 1 subjected to the use of topical imiquimod 5% when compared to expectant management. Residual or recurrent lesions in Group 1 were more frequent in patients who underwent to expectant management (p=0,01). In Group 2, our findings were similar in patients undergoing to a treatment with topical 5% imiquimod or CO2 laser vaporization. Our results for the presence of residual or recurrent lesions in Group 2 were similar among treatments performed, but the patients treated with topical imiquimod 5% showed recurrent lesions less severe when compared to patients who underwent to laser vaporization of CO2.There was no involvement of polymorphism of defensins HD1 and hBD-1 in severity of vulvar HPV-induced lesions. Likewise, there was no participation of polymorphism HD1 and hBD-1 in the best clinical responses. Conclusions: From these results we concluded that topical imiquimod 5% showed good results in the treatment of vulvar HPV-induced lesions, however in the vulvar lesions type VIN II / III its efficacy was similar to the CO2 laser vaporization. In Group 1, the cases referred to the use of topical imiquimod 5% had less residual or recurrent lesions, now in Group 2 it was not checked. The polymorphism of defensins HD1 and hBD-1 was not related to the severity of vulvar HPV-induced lesions, was also not associated with better clinical responses.