Estudo comparativo da frequencia de fatores trombogenicos entre mulheres com aborto espontaneo recorrente e mulheres ferteis

Orientadores : Ricardo Barini, Joyce Maria Annichino-BizzacchiTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias MedicasDoutorad

Subfertility phenotype, chromosome polymorphism and conception failures

PURPOSE: to evaluate the prevalence of cytogenetic alterations and chromosomic polymorphism in couples with a subfertility phenotype in a Brazilian population. METHODS: karyotype analysis through G and C banding of 1,236 individuals who presented the subfertility phenotype, from two different centers (public and private) were included in the study. These patients were classified in two sub-groups: one with two or more gestational consecutive losses or not and the o with, at least, one gestacional loss or absence of conception. Karyotype results were evaluated in different groups and frequencies were calculated. Statistical analyses were carried out through Fisher's exact test and Odds Ratio analysis. RESULTS: approximately 25% of the cases presented abnormal karyotype results, including numerical and structural alterations and also polymorphic variants. In both centers, the prevalence of polymorphic variants was 8.9 and 3.8%, respectively. CONCLUSIONS: there was no significant difference between the prevalence of polymorphic variants and other abnormalities in individuals with or without previous history of reproductive loss. The results of the present study reinforce the need of adequate disclosure of complete cytogenetic information in the karyotype results, with specific attention in relation to the polymorphic variants.OBJETIVO: avaliar a prevalência de alterações citogenéticas e polimorfismos cromossômicos em casais com fenótipo de subfertilidade em uma população brasileira. MÉTODOS: foram avaliados 1.236 cariótipos de casais com fenótipo de subfertilidade de dois diferentes centros (público e privado). Esses pacientes foram classificados em dois subgrupos: um com duas ou mais perdas gestacionais, consecutivas ou não, e outro com, ao menos, uma perda gestacional ou ausência de concepção. Os cariótipos foram obtidos com bandamento convencional G e C. As anomalias citogenéticas foram agrupadas e as frequências calculadas segundo a classificação dos pacientes. Quando aplicável, os testes estatísticos de Fisher e análise de Odds Ratio foram empregados. RESULTADOS: aproximadamente 25% de todos os casos apresentaram cariótipo anormal, incluindo alterações numéricas e estruturais e também variantes polimórficas. Nos dois diferentes centros, a prevalência de variantes polimórficas diferiu, sendo de 8,9 e 3,8%, respectivamente. CONCLUSÃO: não houve diferença significativa entre a predominância de variantes polimórficas e outras alterações nos indivíduos com ou sem história de perda reprodutiva. Os resultados do presente estudo reforçam a necessidade da adequada divulgação da informação citogenética completa nos resultados de cariótipo, com atenção específica em relação às variantes polimórficas.24625

Association Of Anticardiolipin Antibody And C677t In Methylenetetrahydrofolate Reductase Mutation In Women With Recurrent Spontaneous Abortions: A New Path To Thrombophilia?

Recurrent spontaneous abortion (RSA) has been associated with venous thrombosis in the mother. Acquired and inherited thrombophilia factors are possible causes. To evaluate the association between thrombogenic factors and recurrent spontaneous abortion. Case-control study. Centro de Atenção Integral à Saúde da Mulher, Universidade Estadual de Campinas. 40 ml of blood was collected from 88 women attending an RSA clinic and 88 fertile women attending a family planning clinic, to evaluate the presence of acquired and inherited thrombophilia factors. Anticardiolipin antibodies (ACA), lupus anticoagulant and deficiencies of proteins C and S and antithrombin III were evaluated by enzyme-linked immunosorbent assay (ELISA), dilute Russell Viper Venom time (dRVVT), coagulometric and chromogenic methods. DNA was amplified by the polymerase chain reaction (PCR) to study factor V Leiden and G20210A mutations in the prothrombin gene and C677T mutation in the methylenetetrahydrofolate reductase (MTHFR) gene. Data were analyzed using odds ratios and a regression model for age adjustment. Fishers exact test was used to evaluate statistical relationships between associated factors and RSA. ACA was detected in 11 women with RSA and one fertile woman. Heterozygous C677T was detected in 59 women with RSA and 35 fertile women. Concomitant presence of ACA and C677T was found in eight women with RSA and no fertile women (p < 0.01). The meaning of the association between C677T mutation in the MTHFR gene and ACA is still not clear. It is possible that an inherited factor that alone would not strongly predispose a woman to thrombosis could, when associated with an acquired factor, start the process and increase the likelihood of thrombosis expression. ACA and C677T in the MTHFR gene are statistically associated with RSA. The association of these two conditions is a new finding in thrombogenic factors and RSA.12315-2

Anticardiolipin antibody in recurrent spontaneous aborting and fertile women

OBJECTIVE: To determine the association between the presence of anticardiolipin antibody and a history of recurrent spontaneous abortion. STUDY DESIGN: clinical controlled study LOCATION: Department of Gynecology and Obstetrics - University of Campinas (UNICAMP) SUBJECTS: 52 individuals with recurrent spontaneous abortion were included in Group 1 and 104 individuals with at least one live born child in Group 2. Elapsed time from last delivery to blood sampling varied from six months to two years. METHOD: Between November 1993 and November 1994, patients' blood samples were screened for anticardiolipin antibody by ELISA, as described by Triplett, Barna and Unger (1993). ANALYSIS: Chi-square and Fisher's Exact tests were used for statistical analysis. Student's t test was used to compare the means. RESULTS: There was no statistical difference in the presence of the anticardiolipin antibody between Group I (zero and 2.9%) and Group 2 (7.7 and 5.8%). CONCLUSION: There was no association between the presence of anticardiolipin antibody and recurrent spontaneous abortion.OBJETIVO: Determinar a associação entre a presença do anticorpo anticardiolipina e o antecedente de aborto espontâneo recorrente. TIPO DE ESTUDO: Estudo clínico-controlado. LOCAL: Departamento de Tocoginecologia da Faculdade de Ciências Médicas da UNICAMP. PARTICIPANTES: No grupo 1 foram incluídas 52 pacientes que apresentavam antecedente de aborto espontâneo recorrente e, no grupo 2, 104 pacientes com antecedente de pelo menos uma gestação bem sucedida. O prazo máximo entre o último parto e a data da coleta de sangue foi de dois anos; o mínimo foi de seis meses. INTERVENÇÃO: Entre novembro de 1993 e novembro de 1994 as pacientes foram submetidas à pesquisa sérica do anticorpo anticardiolipina por ELISA, segundo técnica descrita por TRIPLETT, BARNA, UNGER (1993). MENSURAÇÃO: Os resultados foram analisados através dos testes Qui-Quadrado, Exato de Fisher e t de Student. RESULTADOS: Não foi encontrada diferença estatisticamente significativa na freqüência do anticorpo anticardiolipina entre os grupos I e II para IgM (zero e 2,9%) e IgG (7,7 e 5,8%). CONCLUSÕES: Não foi encontrada associação entre a presença do anticorpo anticardiolipina e o antecedente de aborto recorrente.1760176

Estudo comparativo da frequencia do anticorpo anticardiolipina entre mulheres com aborto recorrente e mulheres ferteis

Orientador: Ricardo BariniDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências MédicasResumo: A literatura indica que algumas mulheres com antecedente de aborto espontâneo recorrente (AER) são portadoras do anticorpo anticardiolipina (ACL). Sugere-se que este anticorpo esteja envolvido na etiologia do AER. Realizou-se, no Departamento de Tocoginecologia do Hospital de Clínicas da Universidade Estadual de Campinas, um estudo clínico-controlado, envolvendo 52 mulheres com antecedente de AER e 104 mulheres que tinham pelo menos um filho vivo, para determinar a associação entre a presença do ACL e o antecedente de AER. O método utilizado para identificar o ACL sérico foi o "Enzyme-Linked Immunosorbent Assay" (ELlSA), determinando-se o tipo de imunoglobina presente: IgM ou IgG. Os resultados obtidos foram analisados através dos testes Qui-Quadrado, Teste Exato de Fisher e Teste t de Student para comparação de médias. Não foi encontrada diferença estatisticamente significativa entre a freqüência de ACL nas mulheres que tinham aborto recorrente e nas mulheres férteis, tanto para IgG quanto para IgMAbstract: Current medical literature indicates that a group of women with recurrent spontaneous abortion (RSA) are carriers of the anticardiolipin antibody (ACA). It has been sugested that this antibody is related to the etiology of RSA. A clinicalcontrolled study was performed including 52 women with RSA and 104 women with at least one live bom child, to determine the association between the positivity for ACA and RSA. Enzyme-Linked Immunosorbent Assay was used to identify the presence of ACA and the immunoglobulin subtype: IgM or IgG. Statistical analysis was performed using' Chi-square, Fisher's Exact Test and "t" Student test to compare the mean differences between the two groups. No statistical differences were detected on the frequency of ACA betweem women with RSA and women with fertife past history, both for IgM and IgGMestradoTocoginecologiaMestre em Tocoginecologi