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indefinida&#46; AA &#233; considerada doen&#231;a autoimune &#8211; o sistema imunol&#243;gico em sua totalidade &#233; influenciado por muitos fatores gen&#233;ticos e m&#250;ltiplos fatores ambientais&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">4</span></a> A AA est&#225; associada a risco aumentado de comorbidades metab&#243;licas&#44; sugerindo que as adipocinas podem desempenhar papel na patog&#234;nese da AA&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">O tecido adiposo n&#227;o &#233; um tecido inerte e produz adipocinas ativamente&#46; Essas adipocinas&#44; al&#233;m da regula&#231;&#227;o do gasto energ&#233;tico e da sensibilidade &#224; insulina&#44; desempenham papel importante como reguladores de muitos processos fisiol&#243;gicos e patol&#243;gicos&#44; incluindo inflama&#231;&#227;o e imunidade&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">A adiponectina &#233; uma adipocina circulante que aumenta a sensibilidade &#224; insulina&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">7</span></a> &#201; uma prote&#237;na com 224 amino&#225;cidos&#46; A estrutura da adiponectina &#233; composta por tr&#237;meros de cadeia &#250;nica&#59; um dom&#237;nio N&#8208;terminal vari&#225;vel&#44; um dom&#237;nio globular C&#8208;terminal e um dom&#237;nio de col&#225;geno&#46; Esse tr&#237;mero &#233; envolvido por uma estrutura em forma de sino&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">8</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">A adiponectina exerce muitas a&#231;&#245;es pleiotr&#243;picas&#59; promove a sensibilidade &#224; insulina&#44; promove a apoptose em c&#233;lulas carcinog&#234;nicas e tem efeitos antioxidantes e anti&#8208;inflamat&#243;rios&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">9</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Foi encontrado n&#237;vel diminu&#237;do de adiponectina no sangue na psor&#237;ase&#44;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">10&#44;11</span></a> acne vulgar<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">12&#8211;14</span></a> e dermatite at&#243;pica&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">15</span></a> No entanto&#44; apenas dois estudos recentes investigaram o n&#237;vel s&#233;rico de adiponectina em pacientes com AA&#46; Al&#233;m disso&#44; os dois estudos apresentaram resultados controversos&#46;<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">16&#44;17</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">O <span class="elsevierStyleItalic">ADIPOQ</span> est&#225; localizado no bra&#231;o longo do cromossomo 3&#44; <span class="elsevierStyleItalic">locus</span> 3q27&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">18</span></a> Esse gene tem 17<span class="elsevierStyleHsp" style=""></span>kb de comprimento e consiste em tr&#234;s &#233;xons e dois &#237;ntrons&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">19</span></a> Os SNPs do <span class="elsevierStyleItalic">ADIPOQ</span> est&#227;o associados ao risco aumentado de muitas doen&#231;as&#44; incluindo aterosclerose&#44;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">20</span></a> artrite reumatoide &#40;AR&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">21</span></a> acne vulgar<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">19</span></a> e dermatite at&#243;pica&#44;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">22</span></a> mas n&#227;o foram avaliados em AA at&#233; o momento&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">O objetivo deste estudo foi elucidar o poss&#237;vel papel da adiponectina na AA por meio da avalia&#231;&#227;o do polimorfismo do gene <span class="elsevierStyleItalic">ADIPOQ</span> &#40;rs2241766&#41; em rela&#231;&#227;o a seu n&#237;vel s&#233;rico em amostra de pacientes eg&#237;pcios portadores de AA&#44; bem como correlacionar os resultados avaliados com aspectos cl&#237;nicos da AA&#44; incluindo o local&#44; curso e gravidade da doen&#231;a nesses pacientes&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todos</span><p id="par0045" class="elsevierStylePara elsevierViewall">O atual estudo caso&#8208;controle foi conduzido em um n&#250;mero total de 150 indiv&#237;duos&#46; Foram inclu&#237;dos 75 pacientes com AA &#40;36 homens e 39 mulheres&#41; e 75 volunt&#225;rios aparentemente saud&#225;veis pareados por idade e sexo &#40;43 homens e 32 mulheres&#41; como grupo de controle&#46; Eles foram avaliados no Ambulat&#243;rio de Dermatologia do Menoufia University Hospital durante o per&#237;odo de mar&#231;o de 2022 a fevereiro de 2023&#46; A parte laboratorial do estudo foi realizada no Departamento de Bioqu&#237;mica M&#233;dica e Biologia Molecular da Faculdade de Medicina&#44; Menoufia University&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Design administrativo e &#233;tico</span><p id="par0050" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0055" class="elsevierStylePara elsevierViewall">O consentimento por escrito foi obtido de todos os participantes ap&#243;s serem informados sobre o objetivo e o processo do estudo&#44; bem como os objetivos aplic&#225;veis&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0060" class="elsevierStylePara elsevierViewall">O estudo foi aprovado pelo Comit&#234; de &#201;tica local em pesquisa envolvendo seres humanos da Faculdade de Medicina de Menoufia&#46; O n&#250;mero de aprova&#231;&#227;o &#233;tica &#233; 3&#47;2022 DERMA 19&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0065" class="elsevierStylePara elsevierViewall">Os procedimentos do estudo foram isentos de quaisquer efeitos nocivos para os participantes&#44; bem como o servi&#231;o prestado&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8226;</span><p id="par0070" class="elsevierStylePara elsevierViewall">O investigador principal manteve os dados individuais como informa&#231;&#245;es privadas de maneira segura&#46; N&#227;o houve nenhuma taxa extra a ser paga pelos participantes&#44; e o investigador cobriu todos os custos nesse sentido&#46;</p></li></ul></p><p id="par0075" class="elsevierStylePara elsevierViewall">Os crit&#233;rios de inclus&#227;o foram&#58; pacientes com grau vari&#225;vel de gravidade de AA&#44; de ambos os sexos e com idade igual ou superior a 18 anos&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Qualquer indiv&#237;duo que apresentasse uma ou mais das seguintes caracter&#237;sticas foi exclu&#237;do do estudo&#58; a&#41; pacientes com hist&#243;rico de uso de qualquer tratamento que pudesse impactar o estado metab&#243;lico nos tr&#234;s meses anteriores ao exame &#40;p&#46; ex&#46;&#44; terapia hormonal e tratamento sist&#234;mico&#44; como terapia oral com prednisolona&#41;&#59; b&#41; pacientes com outras doen&#231;as autoimunes &#40;p&#46; ex&#46;&#44; tireoidite de Hashimoto e vitiligo&#41;&#59; e c&#41; mulheres gr&#225;vidas e lactantes&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">M&#233;todos</span><p id="par0085" class="elsevierStylePara elsevierViewall">Cada um dos casos selecionados foi submetido a anamnese e exame geral completo&#46; O &#237;ndice de massa corporal &#40;IMC&#41; foi calculado &#91;IMC<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>peso &#40;kg&#41;&#47;altura &#40;m&#41;<span class="elsevierStyleSup">2</span>&#93;&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">23</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">O diagn&#243;stico de AA foi feito clinicamente por dois dermatologistas especializados&#46; A distribui&#231;&#227;o das les&#245;es de AA foi avaliada quanto a sua localiza&#231;&#227;o &#40;couro cabeludo&#44; barba&#44; sobrancelha e&#47;ou qualquer &#225;rea pilosa do corpo&#41;&#46; As variantes cl&#237;nicas de AA &#40;irregular&#44; total&#44; universal&#44; ofi&#225;sica&#44; ofi&#225;sica inversa&#41; foram registradas&#46; A avalia&#231;&#227;o cl&#237;nica da gravidade e extens&#227;o da doen&#231;a foi feita com base no escore SALT&#44;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">24</span></a> no qual o couro cabeludo &#233; dividido em quatro regi&#245;es&#58; direita &#40;18&#37;&#41;&#44; esquerda &#40;18&#37;&#41;&#44; posterior &#40;24&#37;&#41; e superior &#40;40&#37;&#41;&#46; Para cada regi&#227;o&#44; foi estimada a porcentagem da &#225;rea de cabelos afetada e depois transformada em uma nota de S0 a S5&#46; O escore SALT foi calculado multiplicando&#8208;se a porcentagem da perda de cabelo em cada um dos quatro quadrantes do couro cabeludo pela &#225;rea da superf&#237;cie do quadrante&#46; Ent&#227;o&#44; os quatro valores foram somados para obter&#8208;se o escore total&#46; O escore SALT variou de 0&#37; a 100&#37;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Ap&#243;s jejum de 12 horas&#44; foram coletados 6<span class="elsevierStyleHsp" style=""></span>mL de sangue venoso de cada participante&#44; sob completa assepsia&#46; Cada amostra foi dividida em duas partes&#58; uma parte &#40;3<span class="elsevierStyleHsp" style=""></span>mL&#41; para extra&#231;&#227;o de DNA&#44; que foi mantida em tubo de EDTA&#44; e a outra parte &#40;3<span class="elsevierStyleHsp" style=""></span>mL&#41; colocada em um tubo simples&#44; deixada coagular por 30 minutos em temperatura ambiente&#44; depois submetida a centrifuga&#231;&#227;o por 10 minutos a 4&#46;000<span class="elsevierStyleHsp" style=""></span>rpm&#59; o soro obtido foi armazenado a &#8722;80<span class="elsevierStyleHsp" style=""></span>&#176;C&#46; at&#233; o momento da an&#225;lise da glicemia de jejum &#40;GJ&#41;&#44; perfil lip&#237;dico e adiponectina s&#233;rica&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">A glicemia foi determinada por teste colorim&#233;trico enzim&#225;tico&#46; A glicose &#233; oxidada pela glicose oxidase em &#225;cido glucur&#244;nico e per&#243;xido de hidrog&#234;nio&#46; Em seguida&#44; o per&#243;xido de hidrog&#234;nio formado &#233; detectado por um aceptor de oxig&#234;nio cromog&#234;nico&#44; fenol aminofenazona na presen&#231;a de peroxidase&#44; produzindo quinonimina&#44; que &#233; um composto colorido cuja intensidade da cor &#233; diretamente proporcional &#224; quantidade de glicose na amostra&#46; A absorb&#226;ncia da amostra e do teste padr&#227;o foi medida por espectrofotometria e a concentra&#231;&#227;o de glicose na amostra foi determinada&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">25</span></a><elsevierMultimedia ident="eq0005"></elsevierMultimedia><elsevierMultimedia ident="eq0010"></elsevierMultimedia></p><p id="par0260" class="elsevierStylePara elsevierViewall">A estimativa quantitativa de colesterol total &#40;CT&#41;&#44; lipoprote&#237;na de alta densidade &#40;HDL&#41; e triglicer&#237;deos &#40;TG&#41; foi feita utilizando m&#233;todo enzim&#225;tico colorim&#233;trico&#44; utilizando <span class="elsevierStyleItalic">kits</span> colorim&#233;tricos enzim&#225;ticos padr&#227;o &#40;<span class="elsevierStyleItalic">kit</span> de diagn&#243;stico Spinreact&#44; Espanha&#41; e a lipoprote&#237;na de baixa densidade foi medida pela equa&#231;&#227;o modificada de Friedewald et al&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">26</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">A detec&#231;&#227;o do n&#237;vel s&#233;rico de adiponectina foi feita por ensaio imunoenzim&#225;tico &#40;ELISA&#41;&#46; O <span class="elsevierStyleItalic">kit</span> &#40;fabricado na China&#44; Sun Red Company&#41; usa um teste Sandwich ELISA com duplo anticorpo&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">A avalia&#231;&#227;o das variantes gen&#233;ticas do gene <span class="elsevierStyleItalic">ADIPOQ</span> &#40;rs2241766&#41; foi realizada por PCR em tempo real&#46; A extra&#231;&#227;o de DNA do sangue total foi realizada com o <span class="elsevierStyleItalic">kit</span> Quick&#8208;genomic DNA<span class="elsevierStyleSup">TM</span> MiniPrep&#44; Zymo Research&#46; A genotipagem do gene <span class="elsevierStyleItalic">ADIPOQ</span> &#40;rs2241766&#41; foi completada por ensaio de discrimina&#231;&#227;o al&#233;lica utilizando sondas TaqMan &#40;Applied Biosystems&#44; EUA&#41;&#46; Uma mistura geral de 25<span class="elsevierStyleHsp" style=""></span>&#956;L foi utilizada aplicando 5<span class="elsevierStyleHsp" style=""></span>&#956;L de amostra de DNA a uma mistura de 12&#44;5<span class="elsevierStyleHsp" style=""></span>&#956;L de master mix de genotipagem&#44; 1&#44;25<span class="elsevierStyleHsp" style=""></span>&#956;L de ensaio SNP e 6&#44;25<span class="elsevierStyleHsp" style=""></span>&#956;L de &#225;gua livre de nuclease&#46; As sondas TaqMan foram marcadas com corantes fluorescentes VIC e FAM&#46; A sequ&#234;ncia da sonda para <span class="elsevierStyleItalic">ADIPOQ</span> &#40;rs2241766&#41; foi TTCTACTGCTATTAGCTCTGCCCGG &#91;T&#47;G&#93; CATGACCAGGAAACCACGACTCAAG&#59; a ciclagem foi realizada com&#58; 95<span class="elsevierStyleHsp" style=""></span>&#176;C inicialmente por 10 minutos como etapa de desnatura&#231;&#227;o prim&#225;ria seguida por 45 ciclos de 15 segundos a 95<span class="elsevierStyleHsp" style=""></span>&#176;C e 60 segundos a 60<span class="elsevierStyleHsp" style=""></span>&#176;C &#40;ciclagem&#41;&#44; e uma etapa de extens&#227;o final por 60 segundos a 60<span class="elsevierStyleHsp" style=""></span>&#176;C&#46; O sistema de detec&#231;&#227;o de sequ&#234;ncia implementa a fluoresc&#234;ncia emitida durante a leitura da placa e os valores de fluoresc&#234;ncia &#40;Rn&#41; foram plotados dependendo dos sinais de cada po&#231;o&#46; Cada po&#231;o da placa de rea&#231;&#227;o de 96 po&#231;os &#233; um ponto individual no gr&#225;fico&#46; A detec&#231;&#227;o de fluoresc&#234;ncia e a an&#225;lise de dados foram realizadas pelo instrumento 7500 Real&#8208;Time PCR &#40;Applied Biosystems&#41; vers&#227;o 2&#46;0&#46;1&#46;</p><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">An&#225;lise estat&#237;stica</span><p id="par0120" class="elsevierStylePara elsevierViewall">Os dados foram coletados&#44; tabulados e analisados estatisticamente usando um computador pessoal com o <span class="elsevierStyleItalic">software</span> SPSS&#44; vers&#227;o 22 &#40;SPSS&#44; Inc&#44; Chicago&#44; Illinois&#44; EUA&#41;&#46; Foram aplicadas as seguintes estat&#237;sticas&#58; a&#41; estat&#237;stica descritiva&#58; na qual os dados quantitativos foram apresentados na forma de m&#233;dia&#44; desvio padr&#227;o &#40;DP&#41;&#44; varia&#231;&#227;o e os dados qualitativos foram apresentados na forma de n&#250;meros e porcentagens&#59; b&#41; estat&#237;stica anal&#237;tica&#58; utilizada para descobrir a poss&#237;vel associa&#231;&#227;o entre os fatores estudados e a doen&#231;a alvo&#46; Os testes de signific&#226;ncia utilizados inclu&#237;ram&#58; teste Qui&#8208;quadrado &#40;&#967;<span class="elsevierStyleSup">2</span>&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">27</span></a> teste <span class="elsevierStyleItalic">t</span> de Student &#40;t&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">28</span></a> teste de Mann&#8208;Whitney &#40;U&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">29</span></a> teste de Kruskal&#8208;Wallis<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">30</span></a>&#59; o valor de p foi considerado significante se &#8804; 0&#44;05&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Resultados</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Dados pessoais e cl&#237;nicos dos indiv&#237;duos investigados</span><p id="par0125" class="elsevierStylePara elsevierViewall">Os pacientes com AA eram 36 &#40;48&#37;&#41; homens e 39 &#40;52&#37;&#41; mulheres&#44; com propor&#231;&#227;o homem&#58;mulher de 1&#58;1&#44;08&#46; A idade variou de 22 a 53 anos&#44; com 32&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;14 anos como valor m&#233;dio<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DP&#46; Os indiv&#237;duos controle eram 43 &#40;57&#44;3&#37;&#41; homens e 32 &#40;42&#44;7&#37;&#41; mulheres&#44; com propor&#231;&#227;o homem&#58;mulher de 1&#44;34&#58;1&#46; A idade variou de 18 a 54 anos&#44; com 32&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#44;11 anos como valor m&#233;dio<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DP&#46; Houve diferen&#231;as n&#227;o estatisticamente significantes entre casos e controles em rela&#231;&#227;o a idade &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;956&#41; e sexo &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;252&#41;&#46; A <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a> mostra os dados cl&#237;nicos de pacientes com AA &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>75&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">IMC&#44; press&#227;o arterial e exames laboratoriais dos indiv&#237;duos estudados</span><p id="par0130" class="elsevierStylePara elsevierViewall">Houve diferen&#231;as n&#227;o significantes entre os pacientes com AA e controles em rela&#231;&#227;o ao IMC &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;131&#41;&#44; press&#227;o arterial sist&#243;lica &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;665&#41;&#44; press&#227;o arterial diast&#243;lica &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;304&#41;&#44; glicemia de jejum &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;171&#41;&#44; triglic&#233;rides &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;097&#41; e lipoprote&#237;na de baixa densidade &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;347&#41;&#46; Houve eleva&#231;&#227;o significante do colesterol total &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;019&#41; e diminui&#231;&#227;o significante da lipoprote&#237;na de alta densidade &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#59; <a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">N&#237;vel s&#233;rico de adiponectina e polimorfismo &#40;rs2241766&#41; do gene <span class="elsevierStyleItalic">ADIPOQ</span> dos indiv&#237;duos estudados</span><p id="par0135" class="elsevierStylePara elsevierViewall">O n&#237;vel s&#233;rico de adiponectina foi significantemente menor nos pacientes com AA do que nos controles &#40;9&#44;45<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;12 <span class="elsevierStyleItalic">vs</span>&#46; 13&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#44;62 ng&#47;mL&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#59; <a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall">O estudo do polimorfismo do gene <span class="elsevierStyleItalic">ADIPOQ</span> &#40;rs2241766&#41; mostrou que houve diferen&#231;a significante entre pacientes com AA e controles&#46; O gen&#243;tipo <span class="elsevierStyleItalic">TG</span> estava presente em 31 &#40;41&#44;3&#37;&#41; pacientes com AA <span class="elsevierStyleItalic">versus</span> nove &#40;12&#44;0&#37;&#41; controles&#46; A presen&#231;a do gen&#243;tipo <span class="elsevierStyleItalic">TG</span> aumentou significantemente o risco de AA em cerca de cinco vezes &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#44;17&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Al&#233;m disso&#44; o alelo G aumenta significantemente o risco de AA em cerca de quatro vezes &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#44;82&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#59; <a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">N&#237;vel s&#233;rico de adiponectina em rela&#231;&#227;o aos dados estudados de pacientes com AA</span><p id="par0145" class="elsevierStylePara elsevierViewall">Houve rela&#231;&#245;es n&#227;o significantes entre o n&#237;vel s&#233;rico de adiponectina e os dados investigados de pacientes com AA&#44; exceto para o tipo de alopecia &#40;significantemente menor na alopecia total &#91;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;016&#93;&#41; e o escore SALT &#91;correla&#231;&#227;o negativa significante &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#44;435&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#59; <a class="elsevierStyleCrossRef" href="#tbl0020">tabela 4</a>&#41;&#46; O n&#237;vel s&#233;rico de adiponectina foi significantemente menor em pacientes com AA com gen&#243;tipo <span class="elsevierStyleItalic">TG</span> do que nos casos com gen&#243;tipo <span class="elsevierStyleItalic">TT</span> &#40;5&#44;33<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;02 <span class="elsevierStyleItalic">vs</span>&#46; 12&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;34&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#59; <a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1A</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Rela&#231;&#227;o entre gen&#243;tipos do polimorfismo &#40;rs2241766&#41; do gene <span class="elsevierStyleItalic">ADIPOQ</span> e dados estudados de pacientes com AA</span><p id="par0150" class="elsevierStylePara elsevierViewall">Houve rela&#231;&#245;es n&#227;o significantes entre os gen&#243;tipos do polimorfismo &#40;rs2241766&#41; do gene <span class="elsevierStyleItalic">ADIPOQ</span> e os dados cl&#237;nicos dos pacientes com AA estudados&#44; exceto o escore SALT&#44; que foi significantemente maior nos portadores do gen&#243;tipo <span class="elsevierStyleItalic">TG</span> do que nos portadores de <span class="elsevierStyleItalic">TT</span> &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#59; <a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1B</a>&#41;&#46;</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discuss&#227;o</span><p id="par0155" class="elsevierStylePara elsevierViewall">No presente estudo&#44; o SNP do gene <span class="elsevierStyleItalic">ADIPOQ</span> &#40;rs2241766&#41; foi fortemente relacionado &#224;s concentra&#231;&#245;es s&#233;ricas de adiponectina em pacientes com AA e associado &#224; gravidade da doen&#231;a&#46; O presente estudo acrescenta dados a literatura crescente que sugere que o SNP &#40;rs2241766&#41; do gene <span class="elsevierStyleItalic">ADIPOQ</span> poderia modular o risco de AA e contribuir para o desenvolvimento de AA em popula&#231;&#245;es eg&#237;pcias que n&#227;o haviam sido identificadas anteriormente&#44; e confirma que a diminui&#231;&#227;o dos n&#237;veis circulantes de adiponectina pode ter papel ativo na etiopatogenia da AA&#46; Estudos confirmat&#243;rios como o atual s&#227;o necess&#225;rios para garantir que as associa&#231;&#245;es observadas sejam verdadeiras e n&#227;o esp&#250;rias&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">O metabolismo e o sistema imunol&#243;gico est&#227;o conectados por meio de uma rede de numerosos mediadores sol&#250;veis conhecidos como adipocinas&#46; Essas adipocinas podem ser boas e ruins&#46; As adipocinas ruins s&#227;o pr&#243;&#8208;inflamat&#243;rias e produzem resist&#234;ncia &#224; insulina&#44; disfun&#231;&#227;o vascular e rea&#231;&#245;es inflamat&#243;rias locais que induzem inflama&#231;&#227;o cut&#226;nea&#46; Por outro lado&#44; as adipocinas boas t&#234;m propriedades opostas&#46;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">31</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">Aqui&#44; os autores consideraram a adiponectina uma boa adipocina&#44; j&#225; que foi encontrada diminui&#231;&#227;o significante em seu n&#237;vel circulante nos pacientes com AA em rela&#231;&#227;o aos controles&#44; e essa baixa concentra&#231;&#227;o foi observada mais frequentemente em casos mais graves e na alopecia total&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Confirmando essas observa&#231;&#245;es&#44; Stochmal et al&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">17</span></a> demonstraram diminui&#231;&#227;o significante no n&#237;vel s&#233;rico de adiponectina em pacientes com AA em rela&#231;&#227;o a seus pares&#46; Eles tamb&#233;m relataram que o n&#237;vel s&#233;rico de adiponectina foi negativamente correlacionado com o escore SALT e tinha concentra&#231;&#227;o mais baixa em pacientes com alopecia universal&#46; N&#237;veis diminu&#237;dos de adiponectina s&#233;rica tamb&#233;m foram descritos em pacientes com s&#237;ndrome de Sj&#246;gren&#44; artrite psori&#225;sica e esclerose m&#250;ltipla&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">32</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">A adiponectina&#44; uma prote&#237;na s&#233;rica&#44; &#233; produzida principalmente pelos adip&#243;citos&#46; Por&#233;m&#44; outras c&#233;lulas como os fibroblastos&#44; c&#233;lulas endoteliais&#44; macr&#243;fagos e leuc&#243;citos tamb&#233;m podem sintetizar a adiponectina&#46;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">33</span></a> A adiponectina tem efeito anti&#8208;inflamat&#243;rio&#44; reduz a linfopoiese das c&#233;lulas B e a capacidade de resposta das c&#233;lulas T&#44; bem como a s&#237;ntese de TNF&#8208;&#945;&#46; Tamb&#233;m estimula a produ&#231;&#227;o de IL&#8208;10&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">32</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">A patog&#234;nese da AA n&#227;o &#233; completamente entendida&#46; Parece que a ativa&#231;&#227;o do sistema imunol&#243;gico &#233; considerada um dos principais processos biol&#243;gicos ligados &#224; patog&#234;nese da AA&#46;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">34</span></a> Na AA&#44; foram confirmados n&#237;veis incomuns de muitas citocinas pr&#243;&#8208;inflamat&#243;rias&#44; como IL&#8208;6 e TNF&#8208;&#945;&#44; e anti&#8208;inflamat&#243;rias&#44; como IL&#8208;10&#46;<a class="elsevierStyleCrossRefs" href="#bib0385"><span class="elsevierStyleSup">35&#44;36</span></a> Parece que o desequil&#237;brio na produ&#231;&#227;o de citocinas&#44; com um excesso relativo de citocinas pr&#243;&#8208;inflamat&#243;rias <span class="elsevierStyleItalic">versus</span> baixas citocinas anti&#8208;inflamat&#243;rias&#44; poderia ter papel ativo no desenvolvimento de AA&#46;<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">37</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">O TNF&#8208;&#945; &#233; um inibidor normal <span class="elsevierStyleItalic">in vitro</span> do crescimento do fol&#237;culo piloso&#46; O TNF&#8208;&#945;&#44; juntamente com IL&#8208;1&#945; e &#946;&#44; induz a vacuoliza&#231;&#227;o das c&#233;lulas da matriz dentro do bulbo do fol&#237;culo piloso e a diminui&#231;&#227;o do tamanho da matriz&#46; Tamb&#233;m desorganiza os melan&#243;citos foliculares e induz a diferencia&#231;&#227;o anormal na bainha radicular interna e nas c&#233;lulas pr&#233;&#8208;corticais&#46;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">38</span></a> Foi relatado que os n&#237;veis s&#233;ricos<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">39</span></a> e teciduais<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">38</span></a> de TNF&#8208;&#945; em pacientes com AA foram significantemente maiores que nos controles&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Assim&#44; foi levantada a hip&#243;tese de que na AA&#44; a adiponectina poderia atuar como mol&#233;cula anti&#8208;inflamat&#243;ria&#44; e os baixos n&#237;veis s&#233;ricos de adiponectina demonstrados em pacientes com AA no presente estudo podem ser traduzidos em uma atividade anti&#8208;inflamat&#243;ria reprimida&#46; N&#237;veis prejudicados de adiponectina podem influenciar v&#225;rios processos no ambiente do fol&#237;culo piloso&#44; levando a uma resposta autoimune local&#44; resultando em perda exacerbada de cabelos&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Entretanto&#44; Serarslan et al&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">16</span></a> n&#227;o mostraram diferen&#231;as significantes na concentra&#231;&#227;o de adiponectina em pacientes com AA em compara&#231;&#227;o com controles saud&#225;veis&#46; Al&#233;m disso&#44; os autores demonstraram n&#237;veis s&#233;ricos mais elevados de adiponectina em pacientes com queda de cabelo no couro cabeludo em compara&#231;&#227;o com aqueles com AA isolada em barba e sobrancelha&#46; Esses autores afirmaram que o resultado foi uma descoberta inesperada&#46; Eles acrescentaram que&#44; assim como na AR&#44; onde os n&#237;veis s&#233;ricos e sinoviais de adiponectina estavam aumentados&#44; sugere&#8208;se que a adiponectina aumente a produ&#231;&#227;o de mediadores inflamat&#243;rios&#46;<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">40</span></a> Esses resultados controversos precisam de mais estudos semelhantes em grande escala para serem verificados&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">No presente trabalho&#44; analisamos&#44; pela primeira vez&#44; o SNP &#40;rs2241766&#41; do gene <span class="elsevierStyleItalic">ADIPOQ</span> em pacientes com AA e correlacionamos os gen&#243;tipos com a gravidade&#44; local&#44; progress&#227;o e dura&#231;&#227;o da AA&#44; bem como com o n&#237;vel s&#233;rico de adiponectina&#46; Os resultados mostraram que o gen&#243;tipo <span class="elsevierStyleItalic">TG</span> estava significantemente presente em pacientes com AA&#44; aumentando seu risco em cerca de cinco vezes&#44; enquanto o alelo <span class="elsevierStyleItalic">G</span> aumenta significantemente o risco em cerca de quatro vezes&#46; Al&#233;m disso&#44; os portadores do gen&#243;tipo <span class="elsevierStyleItalic">TG</span> do polimorfismo &#40;rs2241766&#41; do gene <span class="elsevierStyleItalic">ADIPOQ</span> demonstraram n&#237;veis s&#233;ricos de adiponectina significantemente baixos e forma grave de AA&#46; Portanto&#44; sugere&#8208;se que o polimorfismo &#40;rs2241766&#41; do gene <span class="elsevierStyleItalic">ADIPOQ</span> contribui n&#227;o apenas para o desenvolvimento da AA&#44; mas tamb&#233;m para sua gravidade&#46; Isso &#233; mediado pela desregula&#231;&#227;o da transcri&#231;&#227;o da adiponectina&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">Apoiando esses resultados&#44; Saleh et al&#46;<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">41</span></a> revelaram que os alelos mutantes do polimorfismo &#40;rs2241766&#41; do gene <span class="elsevierStyleItalic">ADIPOQ</span> estavam ligados &#224; diminui&#231;&#227;o dos n&#237;veis circulat&#243;rios de adiponectina em casos de infarto do mioc&#225;rdio&#46; Al&#233;m disso&#44; Al&#8208;Shaheri et al&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">22</span></a> descobriram que os SNPs rs2241766 e rs3774261 do gene <span class="elsevierStyleItalic">ADIPOQ</span> aumentam o risco de dermatite at&#243;pica&#46; Anteriormente&#44; Wassel et al&#46;<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">42</span></a> relataram que os SNPs da adiponectina rs17300539&#44; rs182052&#44; rs822393&#44; rs9882205 e rs3774261 estavam fortemente associados &#224;s concentra&#231;&#245;es s&#233;ricas de adiponectina em indiv&#237;duos brancos&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">As limita&#231;&#245;es do estudo foram&#58; a&#41; o pequeno tamanho da amostra&#59; b&#41; estudo ser estruturalmente um estudo de caso&#8208;controle&#59; e c&#41; ter sido avaliada apenas uma &#250;nica adipocina em vez de m&#250;ltiplas&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conclus&#227;o</span><p id="par0215" class="elsevierStylePara elsevierViewall">Parece que o polimorfismo &#40;rs2241766&#41; do gene <span class="elsevierStyleItalic">ADIPOQ</span> &#40;gen&#243;tipo <span class="elsevierStyleItalic">TG</span> e alelo <span class="elsevierStyleItalic">G</span>&#41; pode modular o risco de AA e contribuir para o desenvolvimento de AA em popula&#231;&#245;es eg&#237;pcias&#46; A diminui&#231;&#227;o dos n&#237;veis circulantes de adiponectina pode ter papel din&#226;mico na etiopatogenia da AA&#44; que poderia ser mediada por seus efeitos anti&#8208;inflamat&#243;rios&#46; A concentra&#231;&#227;o s&#233;rica de adiponectina pode ser considerada um marcador de gravidade da queda de cabelos na AA&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Suporte financeiro</span><p id="par0220" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Contribui&#231;&#227;o dos autores</span><p id="par0225" class="elsevierStylePara elsevierViewall">Azza Gaber Antar Farag&#58; Revis&#227;o cr&#237;tica da literatura&#59; concep&#231;&#227;o e planejamento do estudo&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Eman Abd&#8208;Elfatah Badr labeeb&#58; An&#225;lise e interpreta&#231;&#227;o dos dados&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">Banan Mohamed Gamal Abd&#8208;Elaty&#58; Obten&#231;&#227;o dos dados</p><p id="par0240" class="elsevierStylePara elsevierViewall">Nada Farag Elnaidany&#58; An&#225;lise estat&#237;stica&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">Mai Medhat Mohamed Ghanem&#58; An&#225;lise e interpreta&#231;&#227;o dos dados&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflito de interesses</span><p id="par0250" 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 alopecia areata &#40;AA&#41; &#233; uma forma autoimune adquirida de queda de cabelos n&#227;o cicatricial&#46; A adiponectina e seu polimorfismo gen&#233;tico foram relacionados a muitas doen&#231;as autoimunes&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Avaliar o n&#237;vel s&#233;rico de adiponectina e o polimorfismo de nucleot&#237;dio &#250;nico &#40;SNP&#41; rs2241766 do gene da adiponectina &#40;<span class="elsevierStyleItalic">ADIPOQ</span>&#41; em pacientes com AA e correlacionar os resultados com a gravidade da doen&#231;a nesses pacientes&#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 incluiu 75 pacientes com AA e 75 indiv&#237;duos saud&#225;veis pareados por idade e sexo &#40;controles&#41;&#46; Foi realizada avalia&#231;&#227;o do escore Severity of Alopecia Tool &#40;SALT&#41; para determinar a gravidade da AA&#46; Os n&#237;veis s&#233;ricos de adiponectina foram avaliados por ELISA e SNP do gene <span class="elsevierStyleItalic">ADIPOQ</span> &#40;rs2241766&#41; por PCR&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Os n&#237;veis s&#233;ricos de adiponectina resultaram significantemente menor nos pacientes com AA do que nos controles &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; O gen&#243;tipo <span class="elsevierStyleItalic">TG</span> do gene <span class="elsevierStyleItalic">ADIPOQ</span> &#40;rs2241766&#41; e o alelo <span class="elsevierStyleItalic">G</span> predominaram nos pacientes com AA&#44; aumentando seu risco em cinco e quatro vezes &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#44;17&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#59; OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#44;82&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; respectivamente&#46; Os n&#237;veis s&#233;ricos de adiponectina correlaconaram&#8208;se negativamente com o escore SALT &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>0&#44;435&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; e associado &#224; alopecia total &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;016&#41;&#46; O gen&#243;tipo <span class="elsevierStyleItalic">TG</span> do gene <span class="elsevierStyleItalic">ADIPOQ</span> &#40;rs2241766&#41; foi significantemente associado aos menores n&#237;veis s&#233;ricos de adiponectina e maior escore SALT &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Limita&#231;&#245;es do estudo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">O pequeno tamanho da amostra&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclus&#245;es</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">O polimorfismo &#40;rs2241766&#41; do gene <span class="elsevierStyleItalic">ADIPOQ</span> &#40;gen&#243;tipo <span class="elsevierStyleItalic">TG</span> e alelo <span class="elsevierStyleItalic">G</span>&#41; pode modular o risco de AA e contribuir para o desenvolvimento de AA em popula&#231;&#245;es eg&#237;pcias&#46; A diminui&#231;&#227;o dos n&#237;veis circulantes de adiponectina pode ter papel din&#226;mico na etiopatogenia da AA&#46; A concentra&#231;&#227;o s&#233;rica de adiponectina pode ser considerada marcador de gravidade da queda de cabelos na AA&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Como citar este artigo&#58; Farag AGA&#44; Badr EA&#44; Abd&#8208;Elaty BMG&#44; Elnaidany NF&#44; Ghanem MMM&#46; Adiponectin serum level and <span class="elsevierStyleItalic">ADIPOQ</span> polymorphism in alopecia areata Egyptian patients&#46; An Bras Dermatol&#46; 2024&#59;99&#58;181&#8211;8&#46;</p>"
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      1 => array:2 [
        "etiqueta" => "&#9734;&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Trabalho realizado no Departamento de Dermatologia&#44; Andrologia e ISTs&#44; e Departamento de Bioqu&#237;mica M&#233;dica e Biologia Molecular&#44; Faculdade de Medicina&#44; Menoufia University&#44; Menoufia&#44; Egito&#46;</p>"
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        "etiqueta" => "Figura 1"
        "tipo" => "MULTIMEDIAFIGURA"
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        "descripcion" => array:1 [
          "pt" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Gen&#243;tipos do polimorfismo <span class="elsevierStyleItalic">&#40;rs2241766&#41;</span> do gene <span class="elsevierStyleItalic">ADIPOQ</span> em rela&#231;&#227;o a&#58; n&#237;vel s&#233;rico de adiponectina entre os pacientes com AA estudados &#40;A&#41;&#59; escore SALT dos pacientes com AA estudados &#40;B&#41;&#46;</p>"
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        "etiqueta" => "Tabela 1"
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          "leyenda" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">N<span class="elsevierStyleSup">o</span>&#44; n&#250;mero&#59; &#37;&#44; porcentagem&#59; DP&#44; desvio padr&#227;o&#59; AA&#44; alopecia areata&#59; SALT&#44; Severity of Alopecia Areata Tool&#46;</p>"
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                  \t\t\t\t">48&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>M&#233;dia<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DP&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">32&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;14</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">95&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">44&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Dura&#231;&#227;o&#47;meses</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>M&#233;dia<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#44;80</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mediana&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#44;0</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Varia&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;00&#8211;36&#44;0</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Hist&#243;ria familiar</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Positiva&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Negativa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">88&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Tipo de alopecia</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Em placas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">94&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ofi&#225;sica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Associa&#231;&#245;es</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ansiedade&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Depress&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Atopia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>N<span class="elsevierStyleSup">o</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Altera&#231;&#245;es ungueais</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Linha de Beau&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Onicofagia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sulcos nas unhas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Leuconiquia pontuada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Traquion&#237;quia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>N<span class="elsevierStyleSup">o</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\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="elsevierStyleHsp" style=""></span>M&#233;dia<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DP&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mediana&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Glicemia de jejum &#40;mg&#47;dL&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Mediana&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">M&#233;dia<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DP &#40;ng&#47;mL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Sexo</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Masculino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;07<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">U</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;373&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Feminino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;81<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;891&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">In&#237;cio</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Repentino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;55<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">U&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;605&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Gradual&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;11<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;518&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Curso da doen&#231;a</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Progressivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#44;93<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">U</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;287&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estacion&#225;rio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Hist&#243;ria familiar</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Positiva&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">U&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;546&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Negativa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;32<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;603&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Tipo de alopecia</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;016&#42;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ofi&#225;sica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">K&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Em placas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;69<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#44;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;10<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Associa&#231;&#245;es</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ansiedade&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">9&#44;90<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;68&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Depress&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6&#44;48<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;98&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">K&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;088&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Atopia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;40<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6&#44;55&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Altera&#231;&#245;es ungueais</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Linha de Beau&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Onicofagia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;85<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#44;28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">K&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;229&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sulcos nas unhas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&#44;62&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Leuconiquia pontuada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;70<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Traquion&#237;quia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">8&#44;25<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Idade&#47;anos</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">r</span>0&#44;183&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">p&#8208;valor</span>0&#44;115&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Dura&#231;&#227;o da doen&#231;a&#47;meses</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;025&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;833&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">IMC &#40;kg&#47;m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;110&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;348&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">PAS &#40;mmHg&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8722;0&#44;080&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;497&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">PAD &#40;mmHg&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;122&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;340&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Glicemia de jejum &#40;mg&#47;dL&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;171&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;143&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Triglicer&#237;deos &#40;mg&#47;dL&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8722;0&#44;085&nbsp;\t\t\t\t\t\t\n
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Journal Information
Vol. 99. Issue 2.
Pages 181-188 (1 March 2024)
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3047
Vol. 99. Issue 2.
Pages 181-188 (1 March 2024)
Artigo original
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Nível sérico de adiponectina e polimorfismo do gene ADIPOQ em pacientes egípcios com alopecia areata
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Azza Gaber Antar Faraga, Eman Abd‐Elfatah Badrb, Banan Mohamed Gamal Abd‐Elatyc, Nada Farag Elnaidanyd, Mai Medhat Mohamed Ghanema,
Corresponding author
mai_medhat251@yahoo.com

Autor para correspondência.
a Departamento de Dermatologia, Andrologia e ISTs, Faculty of Medicine, Menoufia University, Shebin El‐Kom, Menoufia, Egito
b Departamento de Bioquímica Médica e Biologia Molecular, Faculty of Medicine, Menoufia University, Shebin El‐Kom, Menoufia, Egito
c Departamento de Dermatologia, Sers El‐Lian General Hospital, Ministry of Health, Sers El‐Lian, Menoufia, Egito
d Departamento de Farmácia Clínica, Faculty of Pharmacy, Modern Sciences and Arts University, 6th October, Egito
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Abstract
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Figures (1)
Tables (4)
Tabela 1. Dados demográficos e clínicos dos pacientes com AA (n=75)
Tabela 2. Comparação entre pacientes com AA e controles em relação ao IMC, pressão arterial e exames laboratoriais (n=150)
Tabela 3. Comparação entre pacientes com AA e controles em relação ao nível sérico de adiponectina e ao SNP rs1077398 do gene da adiponectina (n=150)
Tabela 4. Relação entre nível sérico de adiponectina e dados estudados de pacientes com AA (n=75)
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Resumo
Fundamentos

A alopecia areata (AA) é uma forma autoimune adquirida de queda de cabelos não cicatricial. A adiponectina e seu polimorfismo genético foram relacionados a muitas doenças autoimunes.

Objetivo

Avaliar o nível sérico de adiponectina e o polimorfismo de nucleotídio único (SNP) rs2241766 do gene da adiponectina (ADIPOQ) em pacientes com AA e correlacionar os resultados com a gravidade da doença nesses pacientes.

Métodos

Este estudo incluiu 75 pacientes com AA e 75 indivíduos saudáveis pareados por idade e sexo (controles). Foi realizada avaliação do escore Severity of Alopecia Tool (SALT) para determinar a gravidade da AA. Os níveis séricos de adiponectina foram avaliados por ELISA e SNP do gene ADIPOQ (rs2241766) por PCR.

Resultados

Os níveis séricos de adiponectina resultaram significantemente menor nos pacientes com AA do que nos controles (p=0,001). O genótipo TG do gene ADIPOQ (rs2241766) e o alelo G predominaram nos pacientes com AA, aumentando seu risco em cinco e quatro vezes (OR=5,17, p=0,001; OR=3,82, p=0,001), respectivamente. Os níveis séricos de adiponectina correlaconaram‐se negativamente com o escore SALT (r=0,435, p=0,001) e associado à alopecia total (p=0,016). O genótipo TG do gene ADIPOQ (rs2241766) foi significantemente associado aos menores níveis séricos de adiponectina e maior escore SALT (p=0,001).

Limitações do estudo

O pequeno tamanho da amostra.

Conclusões

O polimorfismo (rs2241766) do gene ADIPOQ (genótipo TG e alelo G) pode modular o risco de AA e contribuir para o desenvolvimento de AA em populações egípcias. A diminuição dos níveis circulantes de adiponectina pode ter papel dinâmico na etiopatogenia da AA. A concentração sérica de adiponectina pode ser considerada marcador de gravidade da queda de cabelos na AA.

Palavras‐chave:
Adiponectina
Alopecia em áreas
Genética
Full Text
Introdução

A alopecia areata (AA) representa um tipo de queda de cabelo, em que o sistema imunológico ataca erroneamente os folículos pilosos.1 A prevalência estimada de AA é de aproximadamente 1 em 1.000 pessoas, com risco ao longo da vida de cerca de 2%.2 Tanto adultos quanto crianças são afetados pela AA, com taxa semelhante em mulheres e homens.3

A etiologia exata da AA é indefinida. AA é considerada doença autoimune – o sistema imunológico em sua totalidade é influenciado por muitos fatores genéticos e múltiplos fatores ambientais.4 A AA está associada a risco aumentado de comorbidades metabólicas, sugerindo que as adipocinas podem desempenhar papel na patogênese da AA.5

O tecido adiposo não é um tecido inerte e produz adipocinas ativamente. Essas adipocinas, além da regulação do gasto energético e da sensibilidade à insulina, desempenham papel importante como reguladores de muitos processos fisiológicos e patológicos, incluindo inflamação e imunidade.6

A adiponectina é uma adipocina circulante que aumenta a sensibilidade à insulina.7 É uma proteína com 224 aminoácidos. A estrutura da adiponectina é composta por trímeros de cadeia única; um domínio N‐terminal variável, um domínio globular C‐terminal e um domínio de colágeno. Esse trímero é envolvido por uma estrutura em forma de sino.8

A adiponectina exerce muitas ações pleiotrópicas; promove a sensibilidade à insulina, promove a apoptose em células carcinogênicas e tem efeitos antioxidantes e anti‐inflamatórios.9

Foi encontrado nível diminuído de adiponectina no sangue na psoríase,10,11 acne vulgar12–14 e dermatite atópica.15 No entanto, apenas dois estudos recentes investigaram o nível sérico de adiponectina em pacientes com AA. Além disso, os dois estudos apresentaram resultados controversos.16,17

O ADIPOQ está localizado no braço longo do cromossomo 3, locus 3q27.18 Esse gene tem 17kb de comprimento e consiste em três éxons e dois íntrons.19 Os SNPs do ADIPOQ estão associados ao risco aumentado de muitas doenças, incluindo aterosclerose,20 artrite reumatoide (AR),21 acne vulgar19 e dermatite atópica,22 mas não foram avaliados em AA até o momento.

O objetivo deste estudo foi elucidar o possível papel da adiponectina na AA por meio da avaliação do polimorfismo do gene ADIPOQ (rs2241766) em relação a seu nível sérico em amostra de pacientes egípcios portadores de AA, bem como correlacionar os resultados avaliados com aspectos clínicos da AA, incluindo o local, curso e gravidade da doença nesses pacientes.

Métodos

O atual estudo caso‐controle foi conduzido em um número total de 150 indivíduos. Foram incluídos 75 pacientes com AA (36 homens e 39 mulheres) e 75 voluntários aparentemente saudáveis pareados por idade e sexo (43 homens e 32 mulheres) como grupo de controle. Eles foram avaliados no Ambulatório de Dermatologia do Menoufia University Hospital durante o período de março de 2022 a fevereiro de 2023. A parte laboratorial do estudo foi realizada no Departamento de Bioquímica Médica e Biologia Molecular da Faculdade de Medicina, Menoufia University.

Design administrativo e ético

  • O consentimento por escrito foi obtido de todos os participantes após serem informados sobre o objetivo e o processo do estudo, bem como os objetivos aplicáveis.

  • O estudo foi aprovado pelo Comitê de Ética local em pesquisa envolvendo seres humanos da Faculdade de Medicina de Menoufia. O número de aprovação ética é 3/2022 DERMA 19.

  • Os procedimentos do estudo foram isentos de quaisquer efeitos nocivos para os participantes, bem como o serviço prestado.

  • O investigador principal manteve os dados individuais como informações privadas de maneira segura. Não houve nenhuma taxa extra a ser paga pelos participantes, e o investigador cobriu todos os custos nesse sentido.

Os critérios de inclusão foram: pacientes com grau variável de gravidade de AA, de ambos os sexos e com idade igual ou superior a 18 anos.

Qualquer indivíduo que apresentasse uma ou mais das seguintes características foi excluído do estudo: a) pacientes com histórico de uso de qualquer tratamento que pudesse impactar o estado metabólico nos três meses anteriores ao exame (p. ex., terapia hormonal e tratamento sistêmico, como terapia oral com prednisolona); b) pacientes com outras doenças autoimunes (p. ex., tireoidite de Hashimoto e vitiligo); e c) mulheres grávidas e lactantes.

Métodos

Cada um dos casos selecionados foi submetido a anamnese e exame geral completo. O índice de massa corporal (IMC) foi calculado [IMC=peso (kg)/altura (m)2].23

O diagnóstico de AA foi feito clinicamente por dois dermatologistas especializados. A distribuição das lesões de AA foi avaliada quanto a sua localização (couro cabeludo, barba, sobrancelha e/ou qualquer área pilosa do corpo). As variantes clínicas de AA (irregular, total, universal, ofiásica, ofiásica inversa) foram registradas. A avaliação clínica da gravidade e extensão da doença foi feita com base no escore SALT,24 no qual o couro cabeludo é dividido em quatro regiões: direita (18%), esquerda (18%), posterior (24%) e superior (40%). Para cada região, foi estimada a porcentagem da área de cabelos afetada e depois transformada em uma nota de S0 a S5. O escore SALT foi calculado multiplicando‐se a porcentagem da perda de cabelo em cada um dos quatro quadrantes do couro cabeludo pela área da superfície do quadrante. Então, os quatro valores foram somados para obter‐se o escore total. O escore SALT variou de 0% a 100%.

Após jejum de 12 horas, foram coletados 6mL de sangue venoso de cada participante, sob completa assepsia. Cada amostra foi dividida em duas partes: uma parte (3mL) para extração de DNA, que foi mantida em tubo de EDTA, e a outra parte (3mL) colocada em um tubo simples, deixada coagular por 30 minutos em temperatura ambiente, depois submetida a centrifugação por 10 minutos a 4.000rpm; o soro obtido foi armazenado a −80°C. até o momento da análise da glicemia de jejum (GJ), perfil lipídico e adiponectina sérica.

A glicemia foi determinada por teste colorimétrico enzimático. A glicose é oxidada pela glicose oxidase em ácido glucurônico e peróxido de hidrogênio. Em seguida, o peróxido de hidrogênio formado é detectado por um aceptor de oxigênio cromogênico, fenol aminofenazona na presença de peroxidase, produzindo quinonimina, que é um composto colorido cuja intensidade da cor é diretamente proporcional à quantidade de glicose na amostra. A absorbância da amostra e do teste padrão foi medida por espectrofotometria e a concentração de glicose na amostra foi determinada.25

Glicose+O2+H2O ----‐ glicose oxidase-- → H2O2+Gluconato
2H2O2+fenol+4‐Ap ------‐ peroxidase --‐ → Quinonimina+4H2O

A estimativa quantitativa de colesterol total (CT), lipoproteína de alta densidade (HDL) e triglicerídeos (TG) foi feita utilizando método enzimático colorimétrico, utilizando kits colorimétricos enzimáticos padrão (kit de diagnóstico Spinreact, Espanha) e a lipoproteína de baixa densidade foi medida pela equação modificada de Friedewald et al.26

A detecção do nível sérico de adiponectina foi feita por ensaio imunoenzimático (ELISA). O kit (fabricado na China, Sun Red Company) usa um teste Sandwich ELISA com duplo anticorpo.

A avaliação das variantes genéticas do gene ADIPOQ (rs2241766) foi realizada por PCR em tempo real. A extração de DNA do sangue total foi realizada com o kit Quick‐genomic DNATM MiniPrep, Zymo Research. A genotipagem do gene ADIPOQ (rs2241766) foi completada por ensaio de discriminação alélica utilizando sondas TaqMan (Applied Biosystems, EUA). Uma mistura geral de 25μL foi utilizada aplicando 5μL de amostra de DNA a uma mistura de 12,5μL de master mix de genotipagem, 1,25μL de ensaio SNP e 6,25μL de água livre de nuclease. As sondas TaqMan foram marcadas com corantes fluorescentes VIC e FAM. A sequência da sonda para ADIPOQ (rs2241766) foi TTCTACTGCTATTAGCTCTGCCCGG [T/G] CATGACCAGGAAACCACGACTCAAG; a ciclagem foi realizada com: 95°C inicialmente por 10 minutos como etapa de desnaturação primária seguida por 45 ciclos de 15 segundos a 95°C e 60 segundos a 60°C (ciclagem), e uma etapa de extensão final por 60 segundos a 60°C. O sistema de detecção de sequência implementa a fluorescência emitida durante a leitura da placa e os valores de fluorescência (Rn) foram plotados dependendo dos sinais de cada poço. Cada poço da placa de reação de 96 poços é um ponto individual no gráfico. A detecção de fluorescência e a análise de dados foram realizadas pelo instrumento 7500 Real‐Time PCR (Applied Biosystems) versão 2.0.1.

Análise estatística

Os dados foram coletados, tabulados e analisados estatisticamente usando um computador pessoal com o software SPSS, versão 22 (SPSS, Inc, Chicago, Illinois, EUA). Foram aplicadas as seguintes estatísticas: a) estatística descritiva: na qual os dados quantitativos foram apresentados na forma de média, desvio padrão (DP), variação e os dados qualitativos foram apresentados na forma de números e porcentagens; b) estatística analítica: utilizada para descobrir a possível associação entre os fatores estudados e a doença alvo. Os testes de significância utilizados incluíram: teste Qui‐quadrado (χ2),27 teste t de Student (t),28 teste de Mann‐Whitney (U),29 teste de Kruskal‐Wallis30; o valor de p foi considerado significante se ≤ 0,05.

ResultadosDados pessoais e clínicos dos indivíduos investigados

Os pacientes com AA eram 36 (48%) homens e 39 (52%) mulheres, com proporção homem:mulher de 1:1,08. A idade variou de 22 a 53 anos, com 32,4±7,14 anos como valor médio±DP. Os indivíduos controle eram 43 (57,3%) homens e 32 (42,7%) mulheres, com proporção homem:mulher de 1,34:1. A idade variou de 18 a 54 anos, com 32,7±9,11 anos como valor médio±DP. Houve diferenças não estatisticamente significantes entre casos e controles em relação a idade (p=0,956) e sexo (p=0,252). A tabela 1 mostra os dados clínicos de pacientes com AA (n=75).

Tabela 1.

Dados demográficos e clínicos dos pacientes com AA (n=75)

Variáveis estudadas 
Pacientes com AA     
(N=75)     
Sexo     
Masculino  36  48 
Feminino  39  52 
Idade/anos     
Média±DP  32,4±7,14
Mediana  31,0
Variação  22,0–53,0
Início     
Repentino  95  78,7 
Gradual  16  21,3 
Curso da doença     
Progressivo  44  58,7 
Estacionário  31  41,3 
Duração/meses     
Média±DP  11,3±6,80
Mediana  10,0
Variação  2,00–36,0
História familiar     
Positiva  12,0 
Negativa  66  88,0 
Tipo de alopecia     
Em placas  71  94,7 
Total  4,00 
Ofiásica  1,30 
Associações     
Ansiedade  53  70,7 
Depressão  8,00 
Atopia  1,30 
No  15  20,0 
Alterações ungueais     
Linha de Beau  4,00 
Onicofagia  5,30 
Sulcos nas unhas  4,00 
Leuconiquia pontuada  4,00 
Traquioníquia  2,70 
No  60  80,0 
Escore SALT     
Média±DP  17,2±31,9
Mediana  1,80
Variação  0,60–100,0

No, número; %, porcentagem; DP, desvio padrão; AA, alopecia areata; SALT, Severity of Alopecia Areata Tool.

IMC, pressão arterial e exames laboratoriais dos indivíduos estudados

Houve diferenças não significantes entre os pacientes com AA e controles em relação ao IMC (p=0,131), pressão arterial sistólica (p=0,665), pressão arterial diastólica (p=0,304), glicemia de jejum (p=0,171), triglicérides (p=0,097) e lipoproteína de baixa densidade (p=0,347). Houve elevação significante do colesterol total (p=0,019) e diminuição significante da lipoproteína de alta densidade (p=0,001; tabela 2).

Tabela 2.

Comparação entre pacientes com AA e controles em relação ao IMC, pressão arterial e exames laboratoriais (n=150)

Variáveis estudadas  Pacientes com AA (N=75)  Controles (N=75)  Teste de Mann Whitney  p‐valor 
IMC (kg/m2)         
Média±DP  24,7±3,96  22,3±2,04     
Mediana  24,0  22,0  1,51  0,131 
Variação  18,0–35,0  19,0–26,0     
Pressão arterial sistólica (mmHg)         
Média±DP  118,5±10,0  118,4±9,65     
Mediana  120,0  120,0  0,432  0,665 
Variação  90,0–135,0  90,0–135,0     
Pressão arterial diastólica (mmHg)         
Média±DP  80,9±5,85  79,8±5,60     
Mediana  80,0  80,0  1,02  0,304 
Variação  60,0–90,0  60,0–90,0     
Glicemia de jejum (mg/dL)         
Média±DP  88,3±8,22  91,6±11,7     
Mediana  89,0  90,0  1,36  0,171 
Variação  73,0–103,0  73,0–125,0     
Triglicerídeos (mg/dL)         
Média±DP  128,7±13,9  123,4±21,3     
Mediana  129,0  125,0  1,65  0,097 
Variação  100,0–152,0  89,0–170,0     
Colesterol Total (mg/dL)         
Média±DP  149,8±24,0  140,5±22,4     
Mediana  150,5  140,0  2,34  0,019* 
Variação  111,0–196,0  110,0–200,0     
HDL‐c (mg/dL)         
Média±DP  66,2±4,15  73,7±6,69     
Mediana  66,0  75,0  6,86  0,001* 
Variação  60,0–77,0  60,0–88,0     
LDL‐c (mg/dL)         
Média±DP  87,8±9,09  85,8±10,6     
Mediana  90,0  87,0  0,941  0,347 
Variação  69,0–102,0  47,0–104,0     

DP, desvio padrão; U, teste de Mann‐Whitney; IMC, índice de massa corporal; GJ, glicemia de jejum; TG, Triglicerídeo; HDL, lipoproteína de alta densidade; LDL, lipoproteína de baixa densidade; AA, alopecia areata.

Nível sérico de adiponectina e polimorfismo (rs2241766) do gene ADIPOQ dos indivíduos estudados

O nível sérico de adiponectina foi significantemente menor nos pacientes com AA do que nos controles (9,45±4,12 vs. 13,8±5,62 ng/mL; p=0,001; tabela 3).

Tabela 3.

Comparação entre pacientes com AA e controles em relação ao nível sérico de adiponectina e ao SNP rs1077398 do gene da adiponectina (n=150)

Variáveis estudadas  Pacientes com AA (N=75)  Controles (N=75)  Teste  p‐valor  OR (IC95%) 
Nível sérico de adiponectina (ng/mL)      Mann‐Whitney     
Média±DP  9,45±4,12  13,8±5,62  4,380,001a
Mediana  9,60  12,6 
Variação  2,80–15,3  6,8929,5 
SNP rs2241766 do gene da adiponectina  No  No  χ2     
TT  44  58,7  66  88,0      Referência 5,17 (2,24–11,9) 
TG  31  41,3  12,0  16,5  0,001   
Alelos  N=150  N=150  χ2     
T  119  79,3  141  94,0  13,9  0,001  Referência 3,82 (1,75–8,35) 
G  31  20.7  6,00       

AA, alopecia areata; N, número; %, porcentagem; χ2, teste de qui‐quadrado; OR, odds ratio; IC, intervalo de confiança.

a

Significante.

O estudo do polimorfismo do gene ADIPOQ (rs2241766) mostrou que houve diferença significante entre pacientes com AA e controles. O genótipo TG estava presente em 31 (41,3%) pacientes com AA versus nove (12,0%) controles. A presença do genótipo TG aumentou significantemente o risco de AA em cerca de cinco vezes (OR=5,17, p=0,001). Além disso, o alelo G aumenta significantemente o risco de AA em cerca de quatro vezes (OR=3,82, p=0,001; tabela 3).

Nível sérico de adiponectina em relação aos dados estudados de pacientes com AA

Houve relações não significantes entre o nível sérico de adiponectina e os dados investigados de pacientes com AA, exceto para o tipo de alopecia (significantemente menor na alopecia total [p=0,016]) e o escore SALT [correlação negativa significante (r=−0,435, p=0,001; tabela 4). O nível sérico de adiponectina foi significantemente menor em pacientes com AA com genótipo TG do que nos casos com genótipo TT (5,33±2,02 vs. 12,3±2,34; p=0,001; fig. 1A).

Tabela 4.

Relação entre nível sérico de adiponectina e dados estudados de pacientes com AA (n=75)

Variáveis estudadas  Adiponectina sérica  Teste estatístico  p‐valor 
  Média±DP (ng/mL)     
Sexo       
Masculino  9,07±3,82  U  0,373 
Feminino  9,81±4,39  0,891   
Início       
Repentino  9,55±4,12  0,605 
Gradual  9,11±4,22  0,518   
Curso da doença       
Progressivo  8,93±4,70  U  0,287 
Estacionário  10,2±3,02  1,06   
História familiar       
Positiva  10,4±3,75  0,546 
Negativa  9,32±4,17  0,603   
Tipo de alopecia      0,016* 
Ofiásica  11,4±0,00   
Em placas  9,69±4,01  8,31   
Total  3,10±0,26     
Associações       
Ansiedade  9,90±3,68     
Depressão  6,48±4,98  0,088 
Atopia  3,40±0,00  6,55   
Alterações ungueais       
Linha de Beau  13,8±0,92     
Onicofagia  9,85±6,28  0,229 
Sulcos nas unhas  11,2±2,82  5,62   
Leuconiquia pontuada  3,70±0,51     
Traquioníquia  8,25±4,45     
Idade/anos  r0,183    p‐valor0,115 
Duração da doença/meses  0,025    0,833 
IMC (kg/m2)  0,110    0,348 
PAS (mmHg)  −0,080    0,497 
PAD (mmHg)  0,122    0,340 
Glicemia de jejum (mg/dL)  0,171    0,143 
Triglicerídeos (mg/dL)  −0,085    0,471 
Colesterol Total (mg/dL)  0,143    0,220 
HDL‐c (mg/dL)  0,048    0,685 
LDL‐c (mg/dL)  −0,032    0,787 
Escore SALT  −0,435    0,001a 

DP, desvio padrão; K, teste de Kruskal‐Wallis; U, teste de Mann‐Whitney; *r, correlação de Spearman; IMC, índice de massa corporal; PAS, pressão arterial sistólica; PAD, pressão arterial diastólica; HDL, lipoproteína de alta densidade; LDL, lipoproteína de baixa densidade; SALT, Severity of Alopecia Areata Tool.

a

Significante.

Figura 1.

Genótipos do polimorfismo (rs2241766) do gene ADIPOQ em relação a: nível sérico de adiponectina entre os pacientes com AA estudados (A); escore SALT dos pacientes com AA estudados (B).

(0.21MB).
Relação entre genótipos do polimorfismo (rs2241766) do gene ADIPOQ e dados estudados de pacientes com AA

Houve relações não significantes entre os genótipos do polimorfismo (rs2241766) do gene ADIPOQ e os dados clínicos dos pacientes com AA estudados, exceto o escore SALT, que foi significantemente maior nos portadores do genótipo TG do que nos portadores de TT (p=0,001; fig. 1B).

Discussão

No presente estudo, o SNP do gene ADIPOQ (rs2241766) foi fortemente relacionado às concentrações séricas de adiponectina em pacientes com AA e associado à gravidade da doença. O presente estudo acrescenta dados a literatura crescente que sugere que o SNP (rs2241766) do gene ADIPOQ poderia modular o risco de AA e contribuir para o desenvolvimento de AA em populações egípcias que não haviam sido identificadas anteriormente, e confirma que a diminuição dos níveis circulantes de adiponectina pode ter papel ativo na etiopatogenia da AA. Estudos confirmatórios como o atual são necessários para garantir que as associações observadas sejam verdadeiras e não espúrias.

O metabolismo e o sistema imunológico estão conectados por meio de uma rede de numerosos mediadores solúveis conhecidos como adipocinas. Essas adipocinas podem ser boas e ruins. As adipocinas ruins são pró‐inflamatórias e produzem resistência à insulina, disfunção vascular e reações inflamatórias locais que induzem inflamação cutânea. Por outro lado, as adipocinas boas têm propriedades opostas.31

Aqui, os autores consideraram a adiponectina uma boa adipocina, já que foi encontrada diminuição significante em seu nível circulante nos pacientes com AA em relação aos controles, e essa baixa concentração foi observada mais frequentemente em casos mais graves e na alopecia total.

Confirmando essas observações, Stochmal et al.17 demonstraram diminuição significante no nível sérico de adiponectina em pacientes com AA em relação a seus pares. Eles também relataram que o nível sérico de adiponectina foi negativamente correlacionado com o escore SALT e tinha concentração mais baixa em pacientes com alopecia universal. Níveis diminuídos de adiponectina sérica também foram descritos em pacientes com síndrome de Sjögren, artrite psoriásica e esclerose múltipla.32

A adiponectina, uma proteína sérica, é produzida principalmente pelos adipócitos. Porém, outras células como os fibroblastos, células endoteliais, macrófagos e leucócitos também podem sintetizar a adiponectina.33 A adiponectina tem efeito anti‐inflamatório, reduz a linfopoiese das células B e a capacidade de resposta das células T, bem como a síntese de TNF‐α. Também estimula a produção de IL‐10.32

A patogênese da AA não é completamente entendida. Parece que a ativação do sistema imunológico é considerada um dos principais processos biológicos ligados à patogênese da AA.34 Na AA, foram confirmados níveis incomuns de muitas citocinas pró‐inflamatórias, como IL‐6 e TNF‐α, e anti‐inflamatórias, como IL‐10.35,36 Parece que o desequilíbrio na produção de citocinas, com um excesso relativo de citocinas pró‐inflamatórias versus baixas citocinas anti‐inflamatórias, poderia ter papel ativo no desenvolvimento de AA.37

O TNF‐α é um inibidor normal in vitro do crescimento do folículo piloso. O TNF‐α, juntamente com IL‐1α e β, induz a vacuolização das células da matriz dentro do bulbo do folículo piloso e a diminuição do tamanho da matriz. Também desorganiza os melanócitos foliculares e induz a diferenciação anormal na bainha radicular interna e nas células pré‐corticais.38 Foi relatado que os níveis séricos39 e teciduais38 de TNF‐α em pacientes com AA foram significantemente maiores que nos controles.

Assim, foi levantada a hipótese de que na AA, a adiponectina poderia atuar como molécula anti‐inflamatória, e os baixos níveis séricos de adiponectina demonstrados em pacientes com AA no presente estudo podem ser traduzidos em uma atividade anti‐inflamatória reprimida. Níveis prejudicados de adiponectina podem influenciar vários processos no ambiente do folículo piloso, levando a uma resposta autoimune local, resultando em perda exacerbada de cabelos.

Entretanto, Serarslan et al.16 não mostraram diferenças significantes na concentração de adiponectina em pacientes com AA em comparação com controles saudáveis. Além disso, os autores demonstraram níveis séricos mais elevados de adiponectina em pacientes com queda de cabelo no couro cabeludo em comparação com aqueles com AA isolada em barba e sobrancelha. Esses autores afirmaram que o resultado foi uma descoberta inesperada. Eles acrescentaram que, assim como na AR, onde os níveis séricos e sinoviais de adiponectina estavam aumentados, sugere‐se que a adiponectina aumente a produção de mediadores inflamatórios.40 Esses resultados controversos precisam de mais estudos semelhantes em grande escala para serem verificados.

No presente trabalho, analisamos, pela primeira vez, o SNP (rs2241766) do gene ADIPOQ em pacientes com AA e correlacionamos os genótipos com a gravidade, local, progressão e duração da AA, bem como com o nível sérico de adiponectina. Os resultados mostraram que o genótipo TG estava significantemente presente em pacientes com AA, aumentando seu risco em cerca de cinco vezes, enquanto o alelo G aumenta significantemente o risco em cerca de quatro vezes. Além disso, os portadores do genótipo TG do polimorfismo (rs2241766) do gene ADIPOQ demonstraram níveis séricos de adiponectina significantemente baixos e forma grave de AA. Portanto, sugere‐se que o polimorfismo (rs2241766) do gene ADIPOQ contribui não apenas para o desenvolvimento da AA, mas também para sua gravidade. Isso é mediado pela desregulação da transcrição da adiponectina.

Apoiando esses resultados, Saleh et al.41 revelaram que os alelos mutantes do polimorfismo (rs2241766) do gene ADIPOQ estavam ligados à diminuição dos níveis circulatórios de adiponectina em casos de infarto do miocárdio. Além disso, Al‐Shaheri et al.22 descobriram que os SNPs rs2241766 e rs3774261 do gene ADIPOQ aumentam o risco de dermatite atópica. Anteriormente, Wassel et al.42 relataram que os SNPs da adiponectina rs17300539, rs182052, rs822393, rs9882205 e rs3774261 estavam fortemente associados às concentrações séricas de adiponectina em indivíduos brancos.

As limitações do estudo foram: a) o pequeno tamanho da amostra; b) estudo ser estruturalmente um estudo de caso‐controle; e c) ter sido avaliada apenas uma única adipocina em vez de múltiplas.

Conclusão

Parece que o polimorfismo (rs2241766) do gene ADIPOQ (genótipo TG e alelo G) pode modular o risco de AA e contribuir para o desenvolvimento de AA em populações egípcias. A diminuição dos níveis circulantes de adiponectina pode ter papel dinâmico na etiopatogenia da AA, que poderia ser mediada por seus efeitos anti‐inflamatórios. A concentração sérica de adiponectina pode ser considerada um marcador de gravidade da queda de cabelos na AA.

Suporte financeiro

Nenhum.

Contribuição dos autores

Azza Gaber Antar Farag: Revisão crítica da literatura; concepção e planejamento do estudo.

Eman Abd‐Elfatah Badr labeeb: Análise e interpretação dos dados.

Banan Mohamed Gamal Abd‐Elaty: Obtenção dos dados

Nada Farag Elnaidany: Análise estatística.

Mai Medhat Mohamed Ghanem: Análise e interpretação dos dados.

Conflito de interesses

Nenhum.

Agradecimento

Agradecemos às equipes técnicas e administrativas do Departamento de Dermatologia e Bioquímica da Faculdade de Medicina, Menoufia University, que gentilmente ajudaram ao longo deste trabalho.

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Como citar este artigo: Farag AGA, Badr EA, Abd‐Elaty BMG, Elnaidany NF, Ghanem MMM. Adiponectin serum level and ADIPOQ polymorphism in alopecia areata Egyptian patients. An Bras Dermatol. 2024;99:181–8.

Trabalho realizado no Departamento de Dermatologia, Andrologia e ISTs, e Departamento de Bioquímica Médica e Biologia Molecular, Faculdade de Medicina, Menoufia University, Menoufia, Egito.

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