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e 4&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">3</span></a> Um estudo realizado com 1&#46;776 pacientes com HS observou que dislipidemia&#44; obesidade&#44; s&#237;ndrome metab&#243;lica &#40;SM&#41;&#44; hipertens&#227;o&#44; diabetes <span class="elsevierStyleItalic">mellitus</span> &#40;DM&#41;&#44; doen&#231;a da tireoide&#44; s&#237;ndrome do ov&#225;rio polic&#237;stico &#40;SOP&#41; e dist&#250;rbios psiqui&#225;tricos ocorreram em taxas aumentadas em pacientes com HS&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">4</span></a> Al&#233;m disso&#44; Egeberg et al&#46; relataram que a HS estava associada a um risco significativamente aumentado de infarto do mioc&#225;rdio&#44; acidente vascular cerebral isqu&#234;mico e morte associada a doen&#231;a cardiovascular &#40;DCV&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">5</span></a> Consequentemente&#44; a HS come&#231;a a ser reconhecida como uma condi&#231;&#227;o inflamat&#243;ria sist&#234;mica&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">A resist&#234;ncia &#224; insulina &#40;RI&#41; &#233; um forte preditor de DM tipo 2 e tamb&#233;m desempenha um papel importante no risco de SM e dislipidemia&#46; Sabe&#8208;se que o risco de aterosclerose&#44; DCV e eventos cardiovasculares adversos maiores &#233; mais significativo em pacientes com DM&#44; SM e dislipidemia&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">7</span></a> Os tecidos adiposo e muscular secretam citocinas e outros pept&#237;deos&#44; denominados adipocinas e miocinas&#44; que regulam o metabolismo humano por meio da comunica&#231;&#227;o tecidual&#44; essencial para manter a homeostase metab&#243;lica&#46; Akdo&#287;an et al&#46; encontraram n&#237;veis mais altos de visfatina &#40;uma adipocina&#41; em pacientes com HS do que em controles saud&#225;veis pareados por idade e sexo&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">8</span></a> A irisina &#233; uma nova miocina&#44; processada a partir do produto do gene da fibronectina de tipo III&#44; prote&#237;na com conte&#250;do de dom&#237;nio 5 &#40;FNDC5&#41; antes de ser liberada na circula&#231;&#227;o e regulada pelo coativador gama 1&#8208;alfa do receptor ativado por proliferador de peroxissoma &#40;PGC&#8208;1&#945;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">9</span></a> Essa miocina &#233; secretada principalmente pelo m&#250;sculo esquel&#233;tico e a poss&#237;vel rela&#231;&#227;o entre obesidade e dist&#250;rbios metab&#243;licos associados&#44; incluindo sensibilidade &#224; insulina&#44; foi investigada na literatura&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">10</span></a> Alguns autores presumiram que a irisina poderia ser um indicador de gordura corporal&#44; visto que estava elevada em indiv&#237;duos obesos e com SM em muitos estudos&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">11</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Este estudo teve como objetivo avaliar os n&#237;veis s&#233;ricos de irisina&#44; perfis lip&#237;dicos&#44; frequ&#234;ncia de RI e SM em pacientes com HS e compar&#225;&#8208;los com controles saud&#225;veis&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todos</span><p id="par0025" class="elsevierStylePara elsevierViewall">O estudo incluiu 37 pacientes &#40;M&#47;F&#58; 9&#47;28&#41; e 37 controles saud&#225;veis pareados por sexo&#44; idade e &#237;ndice de massa corporal &#40;IMC&#59; M&#47;F&#58; 11&#47;26&#41; que atenderam aos crit&#233;rios de inclus&#227;o&#58; idade &#8805; 18 anos&#44; hist&#243;rico negativo de c&#226;ncer e diagn&#243;stico de HS confirmado por dermatologistas&#44; de acordo com a defini&#231;&#227;o de Dessau&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">2</span></a> Os crit&#233;rios de exclus&#227;o foram gravidez&#59; lacta&#231;&#227;o&#59; infec&#231;&#227;o ativa ou cr&#244;nica&#59; presen&#231;a de outra doen&#231;a dermatol&#243;gica ou doen&#231;a metab&#243;lica pr&#233;via &#40;dist&#250;rbios da tireoide&#44; DM&#44; MS&#44; SOP e s&#237;ndrome de Cushing&#44; entre outras&#41; ou doen&#231;as autoimunes ou do tecido conjuntivo&#59; hist&#243;ria documentada de eventos cardiovasculares adversos maiores&#44; doen&#231;a renal ou hep&#225;tica cr&#244;nica e uso atual de agentes anti&#8208;hiperlipid&#234;micos&#44; tratamentos antidiab&#233;ticos ou outros agentes que podem afetar o metabolismo de carboidratos &#40;p&#46;ex&#46;&#44; corticosteroides&#44; retinoides&#41;&#46; Nenhum dos participantes estava sob qualquer restri&#231;&#227;o alimentar ou tratamento sist&#234;mico para HS por pelo menos seis meses antes da inclus&#227;o no estudo&#46; Foram exclu&#237;dos aqueles que praticavam esportes profissionais&#46; Todos os participantes assinaram um termo de consentimento livre e esclarecido antes de sua inclus&#227;o no estudo&#44; que foi aprovado pelo Comit&#234; de &#201;tica&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Dados demogr&#225;ficos&#44; incluindo idade&#44; sexo&#44; tabagismo&#44; consumo di&#225;rio de &#225;lcool&#44; dura&#231;&#227;o da doen&#231;a e gravidade da doen&#231;a foram registrados&#46; A gravidade da doen&#231;a foi avaliada no momento do exame cl&#237;nico com estadiamento de Hurley&#46; Circunfer&#234;ncia da cintura &#40;CC&#59; cm&#41;&#44; altura &#40;m&#41;&#44; peso &#40;kg&#41;&#44; press&#227;o arterial sist&#243;lica &#40;PA&#41;&#44; PA diast&#243;lica e IMC &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41; foram registrados para todos os pacientes e controles&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Amostras de sangue de sangue venoso perif&#233;rico foram coletadas ap&#243;s um jejum noturno em todos os participantes e colesterol total s&#233;rico &#40;TC&#41;&#44; colesterol de lipoprote&#237;na de alta densidade &#40;HDL&#8208;c&#41;&#44; colesterol de lipoprote&#237;na de baixa densidade &#40;LDL&#8208;c&#41;&#44; triglic&#233;rides&#44; glicose&#44; insulina&#44; n&#237;veis de prote&#237;na C&#8208;reativa &#40;PCR&#41;&#44; velocidade de hemossedimenta&#231;&#227;o &#40;VHS&#41; e par&#226;metros hematol&#243;gicos foram avaliados&#46; Para a an&#225;lise da irisina&#44; as amostras de sangue foram centrifugadas por 15<span class="elsevierStyleHsp" style=""></span>min a 1&#46;000<span class="elsevierStyleHsp" style=""></span>g e o soro foi armazenado a &#8722;80<span class="elsevierStyleHsp" style=""></span>&#176;C&#46; Os n&#237;veis s&#233;ricos de irisina foram medidos por ensaio de imunoabsor&#231;&#227;o enzim&#225;tica &#40;ELISA&#41; fornecido pelo ElabScience Kit &#40;Wuhan&#44; China&#44; Catolog n&#176; E&#8208;EL&#8208;H2254&#41; com intervalo de ensaio&#58; 0&#44;16&#8211;10 ng&#47;mL e sensibilidade de 0&#44;10 ng&#47;mL&#46; As amostras foram avaliadas com dilui&#231;&#227;o 1&#47;10&#44; com coeficiente de varia&#231;&#227;o intraensaio de 4&#44;8&#37; e coeficiente de varia&#231;&#227;o interensaio de 5&#44;6&#37;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">A SM foi diagnosticada pela presen&#231;a de tr&#234;s ou mais crit&#233;rios de acordo com o Painel de Tratamento de Adultos III do National Cholesterol Education Program &#40;ATP&#8208;III&#41;&#58; CC &#62; 102<span class="elsevierStyleHsp" style=""></span>cm nos homens ou &#62; 88<span class="elsevierStyleHsp" style=""></span>cm nas mulheres&#59; hipertrigliceridemia &#8805; 150<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#59; HDL&#8208;c &#60; 40<span class="elsevierStyleHsp" style=""></span>mg&#47;dL em homens e &#60; 50<span class="elsevierStyleHsp" style=""></span>mg&#47;dL em mulheres&#59; PA &#8805; 130&#47;85<span class="elsevierStyleHsp" style=""></span>mmHg ou uso atual de medicamento para hipertens&#227;o&#59; glicose plasm&#225;tica em jejum &#8805; 110<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#46; O modelo de avalia&#231;&#227;o da homeostase da resist&#234;ncia &#224; insulina &#40;HOMA&#8208;IR&#41; foi calculado pela f&#243;rmula&#58; n&#237;vel de insulina em jejum &#40;&#956;IU&#47;mL&#41; &#215; n&#237;vel de glicose em jejum &#40;mg&#47;dL&#41;&#47;405&#46; IR foi definida como HOMA&#8208;IR &#62; 2&#44;5&#46;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">12&#44;13</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Os dados foram analisados com IBM SPSS 15&#46;0 para Windows v&#46;21&#46;0&#46; &#40;IBM Corp&#46;&#44; Armonk&#44; NY&#41;&#46; As estat&#237;sticas descritivas foram apresentadas como n&#250;meros e porcentagens para vari&#225;veis categ&#243;ricas e m&#233;dias e desvios&#8208;padr&#227;o para vari&#225;veis num&#233;ricas&#44; quando apropriado&#46; Quando as suposi&#231;&#245;es param&#233;tricas foram atendidas&#44; o teste <span class="elsevierStyleItalic">t</span> de Student para amostras independentes foi usado para comparar vari&#225;veis num&#233;ricas entre pacientes e controles&#46; O teste U de Mann&#8208;Whitney foi usado para comparar vari&#225;veis num&#233;ricas quando as suposi&#231;&#245;es param&#233;tricas n&#227;o foram atendidas&#46; O teste do qui&#8208;quadrado foi usado para comparar as diferen&#231;as entre os grupos nas vari&#225;veis categ&#243;ricas&#46; O coeficiente de correla&#231;&#227;o de Spearman foi considerado para analisar a associa&#231;&#227;o entre as vari&#225;veis num&#233;ricas&#46; O n&#237;vel de signific&#226;ncia foi definido como p &#60; 0&#44;05&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="par0050" class="elsevierStylePara elsevierViewall">A <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a> apresenta os principais achados demogr&#225;ficos e cl&#237;nicos de 37 pacientes e 37 controles&#46; Os pacientes e o grupo controle&#44; pareados por IMC&#44; idade e sexo&#44; foram semelhantes em altura&#44; peso&#44; h&#225;bitos de fumar e consumo excessivo de &#225;lcool&#46; A dura&#231;&#227;o m&#233;dia da doen&#231;a foi de 85&#44;6 &#177; 88&#44;9 meses&#46; Embora o IMC tenha sido semelhante nos grupos &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;068&#41;&#44; o grupo HS apresentou CC significativamente maior do que os controles saud&#225;veis &#40;p &#60; 0&#44;001&#41;&#46; A RI foi observada em 45&#44;9&#37; dos pacientes e em 8&#44;1&#37; dos controles &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;003&#41;&#44; enquanto a SM foi observada em 32&#44;4&#37; dos pacientes e em 5&#44;4&#37; dos controles &#40;p &#60; 0&#44;001&#41;&#46; Oito pacientes com HS &#40;21&#44;6&#37;&#41; foram classificados como est&#225;gio I de Hurley&#44; 14 &#40;37&#44;8&#37;&#41; como est&#225;gio II e 15 &#40;40&#44;5&#37;&#41; como est&#225;gio III&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Os n&#237;veis de triglic&#233;rides&#44; glicose plasm&#225;tica e insulina foram significativamente maiores no grupo HS e n&#227;o foi observada diferen&#231;a estatisticamente significativa em termos de CT&#44; HDL&#8208;c e LDL&#8208;c entre pacientes e controles &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46; Os valores m&#233;dios de irisina foram 37&#44;4 &#177; 32&#44;6 nos pacientes e 26&#44;2 &#177; 24&#44;7 nos controles&#44; mas essa diferen&#231;a n&#227;o foi estatisticamente significativa &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;217&#41;&#46; PCR&#44; VHS&#44; leuc&#243;citos e neutr&#243;filos foram significativamente maiores em pacientes com HS&#46; A CC foi positivamente correlacionada com a irisina nos grupos paciente &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;495&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41; e controle &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;484&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41;&#46; O IMC teve correla&#231;&#227;o positiva com a irisina apenas no grupo controle &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;523&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41;&#46; O HDL&#8208;c foi negativamente correlacionado com irisina &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#44;495&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;005&#41;&#59; por sua vez&#44; o LDL&#8208;c foi positivamente correlacionado com a irisina &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;327&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;048&#41; no grupo controle&#46; Os resultados da an&#225;lise de correla&#231;&#227;o de Spearman n&#227;o mostraram correla&#231;&#227;o adicional entre a irisina e os outros par&#226;metros investigados&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">N&#227;o foram observadas diferen&#231;as significativas nos valores de irisina e HOMA&#8208;IR nas compara&#231;&#245;es de acordo com os est&#225;gios de Hurley em pacientes com HS &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Discuss&#227;o</span><p id="par0065" class="elsevierStylePara elsevierViewall">O presente estudo demonstrou que os pacientes com HS apresentam RI e SM significativamente maiores quando comparados com o grupo controle pareado por idade&#44; sexo e IMC&#46; Al&#233;m disso&#44; os n&#237;veis de CC&#44; triglic&#233;rides&#44; glicose plasm&#225;tica em jejum e insulina foram estatisticamente maiores em pacientes com HS&#46; Em estudos anteriores&#44; os pacientes com HS apresentaram IMC mais elevados do que os controles saud&#225;veis de mesma idade e sexo&#46; No presente estudo&#44; os autores compararam o IMC entre os dois grupos para eliminar poss&#237;veis fatores de confus&#227;o para a homeostase metab&#243;lica&#46; &#201; importante observar que a CC ainda era significativamente maior no grupo de pacientes &#40;p &#60; 0&#44;001&#41;&#46; Anteriormente&#44; Miller et al&#46; encontraram resultados semelhantes na CC&#44; bem como aumento do IMC e raz&#227;o cintura&#8208;quadril em pacientes com HS quando comparados com controles&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">14</span></a> Esses autores tamb&#233;m observaram maior taxa metab&#243;lica basal prevista para os grupos HS quando comparados com controles saud&#225;veis e sugeriram que o aumento da taxa metab&#243;lica basal em pacientes com HS pode refletir um metabolismo disfuncional&#44; contribuir para o alto teor de gordura corporal&#46; Al&#233;m disso&#44; sabe&#8208;se que o risco cardiovascular &#233; maior em pacientes obesos&#44; principalmente naqueles com fen&#243;tipo adiposo abdominal&#47;visceral&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">15</span></a> Portanto&#44; os presentes achados podem indicar que os pacientes com HS apresentam maior risco de eventos cardiovasculares&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Em conson&#226;ncia com os presentes achados&#44; Vilanova et al&#46; inclu&#237;ram 76 pacientes com HS e 61 controles saud&#225;veis e relataram que a preval&#234;ncia de SM foi tr&#234;s vezes mais maior em pacientes com HS do que em indiv&#237;duos controles&#46; Em uma an&#225;lise multivariada&#44; ap&#243;s ajuste para idade&#44; sexo e IMC&#44; esses autores observaram que a HS &#233; um fator de risco significativo para RI&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">16</span></a> Nesse sentido&#44; Vita et al&#46; afirmaram que a desregula&#231;&#227;o da sinaliza&#231;&#227;o de mTORC1 &#233; a chave do aumento de RI em HS&#58; mTORC1 ativa a S6 quinase &#40;S6K&#41; e S6K causa fosforila&#231;&#227;o e degrada&#231;&#227;o do substrato do receptor de insulina 1&#47;2&#44; prejudica assim a sinaliza&#231;&#227;o da insulina&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">17</span></a> Outra poss&#237;vel explica&#231;&#227;o para a associa&#231;&#227;o entre HS e RI pode ser a presen&#231;a de inflama&#231;&#227;o cr&#244;nica por citocinas pr&#243;&#8208;inflamat&#243;rias&#44; como o TNF&#8208;&#945;&#46; Assim&#44; a superprodu&#231;&#227;o de TNF&#8208;&#945; pode prejudicar a sinaliza&#231;&#227;o da insulina por meio da inibi&#231;&#227;o da atividade da tirosina quinase do receptor de insulina&#44; suprime a secre&#231;&#227;o de adiponectina pelos adip&#243;citos&#46; A adiponectina &#233; conhecida como uma mol&#233;cula anti&#8208;inflamat&#243;ria que tamb&#233;m regula a sensibilidade &#224; insulina&#46; Malara et al&#46; observaram que os pacientes com HS apresentavam n&#237;veis reduzidos de adiponectina quando comparados com controles saud&#225;veis pareados por sexo e idade&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">18</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">No presente estudo&#44; SM &#40;definida de acordo com os crit&#233;rios do ATPIII&#41; foi observada com maior frequ&#234;ncia em pacientes com HS do que no grupo controle&#46; A HS foi associada com MS e obesidade em estudos anteriores&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">19</span></a> N&#227;o surpreendentemente&#44; o risco de morte associada a DCV foi maior em pacientes com HS em compara&#231;&#227;o com controles em estudos anteriores&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">20</span></a> Kohorst et al&#46; conclu&#237;ram que esse risco era maior do que o observado em pacientes com psor&#237;ase&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">6</span></a> Al&#233;m disso&#44; Gonzalez&#8208;Lopez et al&#46; observaram que h&#225; um desenvolvimento prematuro e acelerado de aterosclerose em pacientes com HS&#44; sugeriram que a pr&#243;pria HS pode ser um fator de risco independente para DCV ateroscler&#243;tica precoce e eventos cardiovasculares adversos importantes relacionados&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">21</span></a> Foi relatado que a preval&#234;ncia de dislipidemia &#233; maior em pacientes com HS do que na popula&#231;&#227;o normal&#46; <a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">22</span></a> No presente estudo&#44; uma diferen&#231;a estatisticamente significativa foi observada apenas nos n&#237;veis de triglic&#233;rides plasm&#225;ticos&#44; e n&#227;o nos n&#237;veis de CT ou LDL&#8208;c em pacientes com HS&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">A irisina &#233; uma miocina que leva ao aumento do gasto de energia devido &#224; sua capacidade de estimular o &#8220;escurecimento&#8221; do tecido adiposo branco&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">23</span></a> Em nosso estudo&#44; os n&#237;veis plasm&#225;ticos de irisina foram mais elevados em pacientes com HS do que nos controles&#59; no entanto&#44; essa diferen&#231;a n&#227;o foi estatisticamente significativa &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;217&#41;&#46; Huh et al&#46; relataram que pacientes diab&#233;ticos tinham n&#237;veis mais elevados de irisina e afirmaram que a irisina era um preditor independente de DM&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">24</span></a> Em outro estudo&#44; mulheres com SOP que estavam com sobrepeso ou obesas tinham n&#237;veis elevados de irisina &#40;&#8764; 15&#37;&#8208;20&#37;&#41; quando comparadas com controles de peso normal&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">25</span></a> Da mesma maneira&#44; foi relatado que a perda de peso &#40;&#8722;6&#44;31 &#177; 0&#44;195&#37;&#41; leva a uma diminui&#231;&#227;o significativa na circula&#231;&#227;o da irisina &#40;15&#37;&#41; e que a recupera&#231;&#227;o do peso faz com que os n&#237;veis de irisina voltem aos valores basais&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">26</span></a> Crujerias et al&#46; afirmam que&#44; em indiv&#237;duos saud&#225;veis&#44; a maior parte da irisina &#233; produzida nas c&#233;lulas musculares&#44; mas&#44; na obesidade&#44; a quantidade de irisina secretada pelo tecido adiposo &#233; provavelmente maior&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">27</span></a> No presente estudo&#44; os grupos de pacientes e controle foram pareados por IMC&#46; Portanto&#44; essa diferen&#231;a nos n&#237;veis de irisina n&#227;o pode ser atribu&#237;da ao aumento do tecido adiposo&#46; Al&#233;m disso&#44; estudos mostraram que existe uma correla&#231;&#227;o positiva entre irisina e HOMA&#8208;IR&#46;<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">28&#44;29</span></a> Assim&#44; pacientes com HS podem ter n&#237;veis mais elevados de irisina devido aos valores mais elevados de HOMA&#8208;IR&#44; mas essa correla&#231;&#227;o foi estatisticamente insignificante &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;036&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;836&#41;&#46; Al&#233;m disso&#44; os n&#237;veis de irisina est&#227;o associados positivamente ao risco de SM em indiv&#237;duos caucasianos &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>9&#44;44&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">30</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">N&#237;veis aumentados de irisina foram associados a eventos cardiovasculares adversos maiores em pacientes com doen&#231;a coronariana estabelecida ap&#243;s interven&#231;&#227;o coron&#225;ria percut&#226;nea&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">31</span></a> Em um estudo recente&#44; Baran et al&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">32</span></a> descobriram que os n&#237;veis s&#233;ricos de irisina estavam insignificantemente aumentados em pacientes com psor&#237;ase quando comparados com controles saud&#225;veis &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;38&#41;&#46; Eles tamb&#233;m observaram uma rela&#231;&#227;o estat&#237;stica positiva entre a irisina e a lipocalina&#8208;2 &#40;LCN&#8208;2&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">33</span></a> A LCN&#8208;2 tem sido associada a IR&#44; DM e disfun&#231;&#227;o endotelial induzida por obesidade&#46; Baran et al&#46; tamb&#233;m relataram que a LCN&#8208;2 s&#233;rica estava significativamente superexpressada em pacientes com psor&#237;ase em compara&#231;&#227;o com indiv&#237;duos saud&#225;veis&#46; Curiosamente&#44; Wolk et al&#46; encontraram express&#227;o de LCN&#8208;2 fortemente elevada em les&#245;es de HS&#59; esses autores afirmaram que granul&#243;citos e queratin&#243;citos eram as fontes dessa express&#227;o&#46; Eles sugeriram que a LCN&#8208;2 pode servir como um biomarcador sangu&#237;neo para a avalia&#231;&#227;o objetiva da atividade inflamat&#243;ria em HS&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">34</span></a> Em uma pesquisa posterior&#44; esses autores relataram que a preval&#234;ncia de HS aumentou em pacientes com psor&#237;ase&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">35</span></a> Os resultados semelhantes de estudos com irisina e LCN&#8208;2 em pacientes com HS e psor&#237;ase podem indicar uma poss&#237;vel liga&#231;&#227;o patogen&#233;tica entre essas duas condi&#231;&#245;es&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">O ponto forte do presente estudo &#233; que ele foi o primeiro a avaliar a irisina em HS e suas rela&#231;&#245;es com RI e outros par&#226;metros metab&#243;licos&#46; No entanto&#44; existem algumas limita&#231;&#245;es&#46; Primeiramente&#44; uma pequena amostra foi avaliada&#46; Em segundo lugar&#44; embora indiv&#237;duos que praticam esportes profissionais n&#227;o tenham sido inclu&#237;dos &#40;visto que a irisina &#233; uma miocina&#41;&#44; a atividade f&#237;sica e o n&#237;vel de exerc&#237;cio dos pacientes e controles n&#227;o foram documentados&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conclus&#227;o</span><p id="par0095" class="elsevierStylePara elsevierViewall">Pacientes com HS apresentam n&#237;veis plasm&#225;ticos de glicose&#44; insulina&#44; triglicer&#237;deos e irisina s&#233;rica mais elevados em jejum do que os controles&#46; Uma frequ&#234;ncia aumentada de IR e SM foi observada em HS&#46; Os resultados do presente estudo apontam a necessidade de mais aten&#231;&#227;o para a associa&#231;&#227;o entre HS e homeostase metab&#243;lica desregulada&#59; os m&#233;dicos devem estar cientes das consequ&#234;ncias cl&#237;nicas e da carga geral de comorbidades em pacientes com HS&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Suporte financeiro</span><p id="par0100" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Contribui&#231;&#227;o dos autores</span><p id="par0105" class="elsevierStylePara elsevierViewall">Ezgi &#214;zkur&#58; An&#225;lise estat&#237;stica&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; concep&#231;&#227;o e planejamento do estudo&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; revis&#227;o cr&#237;tica da literatura&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Yasemin Erdem&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">&#304;lknur K&#305;van&#231; Altunay&#58; Revis&#227;o cr&#237;tica da literatura&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Damla Demir&#58; Obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Nurcihan &#199;al&#305;&#351;kan Dolu&#58; Obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Erdin&#231; Serin&#58; Revis&#227;o cr&#237;tica da literatura&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Asl&#305; Aksu &#199;erman&#58; Concep&#231;&#227;o e planejamento do estudo&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conflitos de interesse</span><p id="par0140" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Fundamentos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A hidradenite supurativa &#233; uma doen&#231;a inflamat&#243;ria cr&#244;nica da pele do acroinfund&#237;bulo folicular terminal&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Avaliar os n&#237;veis s&#233;ricos de irisina&#44; glicose plasm&#225;tica&#44; insulina e lip&#237;dios na hidradenite supurativa e elucidar poss&#237;veis associa&#231;&#245;es com a atividade da doen&#231;a e par&#226;metros inflamat&#243;rios ou metab&#243;licos&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Este estudo tipo caso&#8208;controle incluiu 37 pacientes &#40;M&#47;F&#58; 9&#47;28&#41; e 37 controles saud&#225;veis pareados por sexo&#44; idade e &#237;ndice de massa corporal &#40;M&#47;F&#58; 11&#47;26&#41;&#46; Dados demogr&#225;ficos&#44; estadiamento de Hurley&#44; glicose em jejum&#44; insulina&#44; colesterol total&#44; colesterol de lipoprote&#237;na de alta densidade&#44; colesterol de lipoprote&#237;na de baixa densidade&#44; triglicer&#237;deos&#44; n&#237;veis de prote&#237;na C&#8208;reativa&#44; taxa de sedimenta&#231;&#227;o de eritr&#243;citos&#44; par&#226;metros hematol&#243;gicos e irisina s&#233;rica foram avaliados&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">O grupo com hidradenite supurativa apresentou circunfer&#234;ncia da cintura significativamente maior do que os controles &#40;p &#60; 0&#44;001&#41;&#46; A resist&#234;ncia &#224; insulina&#44; definida como valores acima de 2&#44;5 no modelo de avalia&#231;&#227;o da homeostase da resist&#234;ncia &#224; insulina&#44; foi observada em 45&#44;9&#37; dos pacientes e em 8&#44;1&#37; dos controles &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;003&#41;&#44; enquanto a s&#237;ndrome metab&#243;lica foi observada em 32&#44;4&#37; dos pacientes e em 5&#44;4&#37; dos controles &#40;p &#60; 0&#44;001&#41;&#46; Al&#233;m disso&#44; os n&#237;veis plasm&#225;ticos de triglic&#233;rides&#44; glicose e insulina foram significativamente maiores nos pacientes com hidradenite supurativa &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;013&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001 e p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;004&#44; respectivamente&#41;&#46; O n&#237;vel m&#233;dio de irisina foi insignificantemente maior no grupo com hidradenite supurativa &#40;37&#44;4 &#177; 32&#44;6&#41; do que nos controles &#40;26&#44;2 &#177; 24&#44;7&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;217&#41;&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Limita&#231;&#227;o do estudo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A pr&#225;tica e os n&#237;veis de atividade f&#237;sica dos participantes n&#227;o foram documentados&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclus&#227;o</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Este estudo indica que os pacientes com hidradenite supurativa t&#234;m n&#237;veis s&#233;ricos de irisina&#44; glicose plasm&#225;tica em jejum&#44; insulina e triglic&#233;rides mais elevados do que os controles saud&#225;veis&#46; Assim&#44; os autores sugerem que pacientes com hidradenite supurativa devam ser avaliados e monitorados quanto &#224; resist&#234;ncia &#224; insulina e s&#237;ndrome metab&#243;lica&#46;</p></span>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">M&#233;dia &#177; DP&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Dura&#231;&#227;o da doen&#231;a &#40;meses&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Consumo excessivo de &#225;lcool&#44; n&#160;&#40;&#37;&#41; &#40;&#62;2 doses por dia&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Press&#227;o arterial sist&#243;lica &#40;mmHg&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Press&#227;o arterial diast&#243;lica &#40;mmHg&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Circunfer&#234;ncia da cintura &#40;cm&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">S&#237;ndrome metab&#243;lica&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Resist&#234;ncia &#224; insulina&#44; n &#40;&#37;&#41;</span><span class="elsevierStyleItalic">&#40;HOMA&#8208;IR &#62; 2&#44;5&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t">Glicemia plasm&#225;tica em jejum &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Insulina plasm&#225;tica em jejum &#40;&#956;IU&#47;mL&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">HOMA&#8208;IR&nbsp;\t\t\t\t\t\t\n
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          "pt" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Compara&#231;&#227;o dos valores m&#233;dios do modelo de avalia&#231;&#227;o da homeostase da resist&#234;ncia &#224; insulina e n&#237;vel de irisina em pacientes com hidradenite supurativa em rela&#231;&#227;o ao estadiamento de Hurley</p>"
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