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resist&#234;ncia a insulina&#44; dislipidemia&#44; obesidade&#44; hipertens&#227;o e aumento da prote&#237;na C reativa s&#233;rica de alta sensibilidade &#40;PCR&#8208;as&#41; s&#227;o fatores de risco para aterosclerose e doen&#231;as vasculares&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">2</span></a> As informa&#231;&#245;es sobre a rela&#231;&#227;o entre LP e rigidez arterial s&#227;o limitadas&#59; a rigidez foi medida com o exame ecocardiogr&#225;fico em apenas um estudo&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">O objetivo deste estudo foi avaliar a rigidez arterial com o m&#233;todo padr&#227;o&#8208;ouro&#44; hemodin&#226;mica cardiovascular e marcadores inflamat&#243;rios associados em pacientes com LP&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Desenho do estudo</span><p id="par0030" class="elsevierStylePara elsevierViewall">Este estudo foi feito para avaliar a rigidez arterial&#44; marcadores inflamat&#243;rios associados e hemodin&#226;mica card&#237;aca em pacientes com LP&#46; Os pacientes e controles foram pareados por idade e sexo&#46; Foram cadastrados todos os pacientes com LP atendidos neste Departamento de Dermatologia nos &#250;ltimos 18 meses&#46; Os crit&#233;rios de inclus&#227;o foram idade superior a 18 anos e diagn&#243;stico cl&#237;nico e histopatol&#243;gico de LP&#46; Foram exclu&#237;dos pacientes com hipertens&#227;o refrat&#225;ria&#44; doen&#231;a arterial perif&#233;rica&#44; DC&#44; insufici&#234;ncia renal ou obesidade m&#243;rbida e em uso de medicamentos como prednisolona e agentes hipolipemiantes &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; Durante o per&#237;odo do estudo&#44; 68 pacientes foram diagnosticados com LP e 55 foram inclu&#237;dos no grupo de pacientes&#46; Desses&#44; 19 pacientes tinham doen&#231;a cut&#226;nea&#44; 24 doen&#231;a mucocut&#226;nea e 12 apresentavam apenas les&#245;es em mucosas&#46; O grupo controle foi composto por 42 indiv&#237;duos&#46; Esses n&#227;o tinham DCV conhecida&#44; nem qualquer doen&#231;a inflamat&#243;ria&#46; A popula&#231;&#227;o fonte foi a mesma para os pacientes e controles&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Coleta de dados</span><p id="par0035" class="elsevierStylePara elsevierViewall">O termo de consentimento livre e esclarecido foi assinado por pacientes e controles&#46; Os dados demogr&#225;ficos&#44; cl&#237;nicos e laboratoriais foram registrados em formul&#225;rios de estudo por um dermatologista&#46; A press&#227;o arterial foi medida ap&#243;s o participante estar sentado por pelo menos 5 minutos&#46; A rigidez arterial e o exame ecocardiogr&#225;fico foram avaliados por um &#250;nico cardiologista experiente para avaliar o perfil cardiovascular em cada caso&#46; As amostras de sangue foram coletadas ap&#243;s um jejum noturno de 12<span class="elsevierStyleHsp" style=""></span>h&#46; Os n&#237;veis de colesterol total&#44; triglicer&#237;deos e glicose foram determinados por m&#233;todos enzim&#225;ticos&#46; A velocidade de hemossedimenta&#231;&#227;o &#40;VHS&#41; foi determinada com o m&#233;todo cl&#225;ssico de Westergren&#46; Os n&#237;veis de homociste&#237;na foram avaliados por imunonefelometria&#46; A lipoprote&#237;na de alta densidade &#40;HDL&#8208;C&#41; e a lipoprote&#237;na de baixa densidade &#40;LDL&#8208;C&#41; foram medidas com m&#233;todos de surfactante seletivo&#46; Os n&#237;veis de PCR&#8208;as foram avaliados com imunonefelometria &#40;Dade Behring&#44; BN II&#44; Marburg&#44; Alemanha&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Exame ecocardiogr&#225;fico</span><p id="par0040" class="elsevierStylePara elsevierViewall">A ecocardiografia foi feita em repouso com um dispositivo ecocardiogr&#225;fico &#40;Vivid 7&#44; GE Medical Systems&#44; Milwaukee&#44; Wis&#46;&#44; Estados Unidos&#41;&#46; As dimens&#245;es do &#225;trio esquerdo &#40;AE&#41; e ventr&#237;culo esquerdo &#40;VE&#41;&#44; fra&#231;&#227;o de eje&#231;&#227;o do VE &#40;FE&#41;&#44; padr&#227;o de fluxo mitral e imagens de Doppler tecidual foram obtidas de acordo com as recomenda&#231;&#245;es atuais da Sociedade Americana de Ecocardiografia&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">10</span></a> A FE foi avaliada com o m&#233;todo biplano modificado &#40;regra de Simpson modificada&#41;&#46; O volume amostral do Doppler pulsado foi avaliado entre as pontas dos folhetos da v&#225;lvula mitral para obter velocidades m&#225;ximas de enchimento&#46; As velocidades de fluxo transmitral precoce &#40;E&#41; e tardia &#40;A&#41; foram expressas em metros por segundo e o tempo de desacelera&#231;&#227;o &#40;TD&#41;&#44; em milissegundos&#46; Tamb&#233;m foi determinada a raz&#227;o entre as velocidades de pico precoce e tardia &#40;E&#47;A&#41;&#46; As velocidades sist&#243;licas de pico &#40;S&#8217;&#41; e diast&#243;lica precoce e tardia &#40;e&#8217; e a&#8217;&#41; foram medidas com Doppler tecidual da parede livre do VE a partir do corte apical de quatro c&#226;maras&#46; Os valores de todos os par&#226;metros foram calculados em tr&#234;s ciclos card&#237;acos separados&#46; E&#47;A e E&#47;e&#8217; foram calculados para avaliar a disfun&#231;&#227;o diast&#243;lica do VE &#40;DD&#41;&#46; O &#237;ndice de desempenho mioc&#225;rdico &#40;&#237;ndice IDM&#47;Tei&#41;&#44; inclusive intervalos de tempo sist&#243;lico e diast&#243;lico&#44; tamb&#233;m foi calculado para avaliar a disfun&#231;&#227;o card&#237;aca global&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">11</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Mensura&#231;&#227;o da rigidez arterial</span><p id="par0045" class="elsevierStylePara elsevierViewall">As propriedades da parede arterial&#44; VOP de reflex&#227;o de onda&#44; press&#227;o de dilata&#231;&#227;o &#40;PD&#41; e IDA foram avaliadas com tonometria de aplana&#231;&#227;o &#40;SphygmoCor&#44; AtCor Medical&#44; Sydney&#44; Austr&#225;lia&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">12</span></a> Foram calculados registros consecutivos de ondas de pulso da art&#233;ria car&#243;tida e femoral e o deslocamento do tempo de aparecimento de ondas no primeiro e no segundo locais&#46; A dist&#226;ncia entre os pulsos das art&#233;rias car&#243;tida e femoral foi medida na superf&#237;cie do corpo para determinar a VOP a&#243;rtica em metros por segundo&#46; A PA foi definida como press&#227;o arterial sist&#243;lica m&#225;xima menos a press&#227;o no ponto de inflex&#227;o&#46; IDA foi definido como PA dividido pela press&#227;o de pulso&#46; Valores mais altos de IDA indicam aumento da reflex&#227;o da onda da periferia ou retorno precoce da onda refletida como resultado do aumento da VOP&#46; O IDA depende das propriedades el&#225;sticas das art&#233;rias&#46; Como o IDA &#233; influenciado pela frequ&#234;ncia card&#237;aca&#44; foi usado um &#237;ndice normalizado para uma frequ&#234;ncia card&#237;aca de 75 bpm &#40;IDA&#64;75&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">13</span></a> Todas as medidas foram tiradas pelo mesmo indiv&#237;duo&#46; As medidas m&#233;dias para dez ciclos card&#237;acos foram calculadas&#46; As medidas foram repetidas em caso de valores extremos&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Aprova&#231;&#227;o pelo Comit&#234; de &#201;tica</span><p id="par0050" class="elsevierStylePara elsevierViewall">Este estudo foi aprovado pelo comit&#234; de &#233;tica da Universidade T&#233;cnica Karadeniz &#40;2016&#47;173&#41; com n&#250;mero de protocolo 5554&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">An&#225;lise estat&#237;stica</span><p id="par0055" class="elsevierStylePara elsevierViewall">Os dados foram analisados no <span class="elsevierStyleItalic">software</span> SPSS 23&#46;0&#46; Os resultados foram expressos em n&#250;mero &#40;n&#41; e porcentagem &#40;&#37;&#41; para dados descritivos&#46; O teste qui&#8208;quadrado foi usado para compara&#231;&#227;o das vari&#225;veis categ&#243;ricas&#46; A distribui&#231;&#227;o normal foi avaliada pelo teste de Kolmogorov&#8208;Smirnov&#46; O teste <span class="elsevierStyleItalic">t</span> de Student foi usado para comparar vari&#225;veis constantes distribu&#237;das normalmente e o teste U de Mann&#8208;Whitney para comparar vari&#225;veis distribu&#237;das n&#227;o normalmente&#46; A an&#225;lise de correla&#231;&#227;o foi feita com o teste de correla&#231;&#227;o de Spearman&#46; A an&#225;lise de regress&#227;o linear foi usada para comparar o impacto da idade&#44; dura&#231;&#227;o da doen&#231;a&#44; n&#237;veis de PCR e da forma erosiva do PL na rigidez arterial&#46; Valores&#8208;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05 foram considerados significativos&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Resultados</span><p id="par0060" class="elsevierStylePara elsevierViewall">O estudo incluiu 55 pacientes &#40;31 mulheres&#44; 24 homens&#44; m&#233;dia de 47&#44;84<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#44;55 anos&#41; e 42 indiv&#237;duos controle &#40;21 mulheres&#44; 21 homens e m&#233;dia de 45&#44;57<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;91 anos&#41;&#46; O comprometimento ocorreu no tronco em 28 pacientes &#40;51&#37;&#41;&#44; nas extremidades em 40 &#40;73&#37;&#41;&#44; na mucosa oral em 37 &#40;67&#37;&#41;&#44; na mucosa genital em oito &#40;15&#37;&#41; e nas unhas em tr&#234;s &#40;6&#37;&#41;&#46; Les&#245;es reticulares brancas estavam presentes em 25 &#40;68&#37;&#41; dos pacientes com comprometimento da mucosa oral e foram observadas eros&#245;es em 12 &#40;32&#37;&#41;&#46; A dura&#231;&#227;o m&#233;dia da doen&#231;a foi de 4&#44;09<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;46 anos&#46; A dura&#231;&#227;o m&#233;dia da doen&#231;a foi significativamente maior nos pacientes com LP erosivo oral &#40;8&#44;16<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;19 anos&#41; do que nos demais pacientes &#40;2&#44;96<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;86 anos&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; A <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a> apresenta os dados cl&#237;nicos e laboratoriais da popula&#231;&#227;o estudada&#46; O &#237;ndice de massa corporal foi significativamente maior nos pacientes do que nos controles &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#41;&#46; N&#227;o foram observadas diferen&#231;as estatisticamente significativas nas demais caracter&#237;sticas nem comorbidades cardiovasculares entre os grupos paciente e controle&#46; Marcadores inflamat&#243;rios&#44; como PCR e VHS&#44; foram significativamente maiores em pacientes com LP &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;049 e p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;044&#44; respectivamente&#41;&#44; enquanto nenhuma diferen&#231;a foi determinada em outros par&#226;metros laboratoriais&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">A <a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a> apresenta as medidas ecocardiogr&#225;ficas transtor&#225;cicas e os achados de rigidez arterial na popula&#231;&#227;o estudada&#46; A velocidade do IDM e E&#44; bem como a rela&#231;&#227;o E&#47;A&#44; todos marcadores de disfun&#231;&#227;o diast&#243;lica&#44; diferiram significativamente entre os pacientes com LP e os controles &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#44; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001 e p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;005&#44; respectivamente&#41;&#46; N&#227;o foi observada diferen&#231;a estatisticamente significativa nas medidas de rigidez arterial entre os grupos paciente e controle&#44; embora a rigidez tenha sido significativamente maior nos pacientes com LP oral erosivo &#40;10&#44;32<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;26&#41; em compara&#231;&#227;o com o grupo controle &#40;9&#44;09<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;40&#41; e com os demais pacientes com LP &#40;9&#44;12<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;75&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;009 e p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;023&#44; respectivamente&#59; <a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46; Os n&#237;veis m&#233;dios de VHS foram 21&#44;50<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#44;40<span class="elsevierStyleHsp" style=""></span>mm&#47;s nos pacientes com LP erosivo e 12&#44;21<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#44;37<span class="elsevierStyleHsp" style=""></span>mm&#47;s nos outros pacientes&#59; os n&#237;veis de PCR foram significativamente maiores no grupo LP erosivo &#40;0&#44;78<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;89<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#41; em compara&#231;&#227;o com os demais pacientes com LP &#40;0&#44;29<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;33<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;01 e p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#44; respectivamente&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">A correla&#231;&#227;o entre a dura&#231;&#227;o da doen&#231;a e a rigidez arterial e os par&#226;metros ecocardiogr&#225;ficos e laboratoriais s&#227;o apresentados na <a class="elsevierStyleCrossRef" href="#tbl0020">tabela 4</a>&#46; Observou&#8208;se uma correla&#231;&#227;o positiva entre a dura&#231;&#227;o da doen&#231;a e os marcadores de rigidez arterial&#46; Os efeitos dependentes do LP erosivo&#44; dura&#231;&#227;o da doen&#231;a&#44; idade do paciente e n&#237;veis de PCR na rigidez arterial foram avaliados por meio de an&#225;lise de regress&#227;o e observou&#8208;se que o aumento da dura&#231;&#227;o da doen&#231;a e os n&#237;veis de PCR constituem riscos para o desenvolvimento de rigidez &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">tabela 5</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discuss&#227;o</span><p id="par0075" class="elsevierStylePara elsevierViewall">No presente estudo&#44; a rigidez arterial foi significativamente maior no tipo erosivo de LP&#44; que evolui com eros&#245;es resistentes na boca e&#47;ou mucosa genital&#46; Tamb&#233;m foi observada uma correla&#231;&#227;o positiva entre a dura&#231;&#227;o da doen&#231;a e a rigidez arterial&#46; Os n&#237;veis de PCR e VHS foram significativamente mais altos nos pacientes com LP do que no grupo controle&#59; eles tamb&#233;m foram significativamente mais altos nos pacientes com LP erosivo do que nos pacientes sem LP erosivo&#46; Com base nesses achados&#44; os autores concluem que os n&#237;veis de rigidez arterial aumentam na forma oral erosiva do LP e que uma dura&#231;&#227;o prolongada da doen&#231;a aumenta a rigidez arterial&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">LP &#233; uma doen&#231;a que progride com inflama&#231;&#227;o cr&#244;nica&#44; semelhante &#224; psor&#237;ase vulgar&#44; na qual se observa uma resposta imune mediada por c&#233;lulas T acompanhada de disfun&#231;&#227;o endotelial&#46; Enquanto os linf&#243;citos T auxiliares predominam no infiltrado d&#233;rmico nas les&#245;es precoces&#44; a infiltra&#231;&#227;o de c&#233;lulas T citot&#243;xicas CD8<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&#233; observada nas les&#245;es tardias&#46; As c&#233;lulas T ativadas induzem citocinas e c&#233;lulas inflamat&#243;rias&#44; como o fator de necrose tumoral&#8208;&#945; &#40;TNF&#8208;&#945;&#41;&#44; interleucina&#8208;2 &#40;IL&#8208;2&#41; e interferon&#8208;&#947; &#40;IFN&#8208;&#947;&#41;&#44; levam a danos aos queratin&#243;citos<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">3</span></a>&#46; Al&#233;m disso&#44; citocinas elevadas&#44; como IL&#8208;2&#44; IL&#8208;6 e TNF&#8208;&#945;&#44; produzem metaloproteinases que reduzem o conte&#250;do da &#237;ntima a&#243;rtica e&#44; portanto&#44; podem promover aumento da rigidez arterial&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">14</span></a> Um aumento das esp&#233;cies reativas de oxig&#234;nio e de per&#243;xidos lip&#237;dicos tamb&#233;m foi apontado na patog&#234;nese do LP&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">15</span></a> Aumentos de 50&#37; nas taxas de DCV&#44; como infarto do mioc&#225;rdio e acidente vascular cerebral&#44; foram observados em indiv&#237;duos com v&#225;rias doen&#231;as inflamat&#243;rias cr&#244;nicas&#44; como psor&#237;ase&#44; artrite reumatoide e doen&#231;a inflamat&#243;ria intestinal&#44; quando comparados com a popula&#231;&#227;o em geral&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">16</span></a> Da mesma forma&#44; v&#225;rios estudos examinaram a rela&#231;&#227;o entre LP e comorbidades cardiovasculares e metab&#243;licas&#59; foram relatadas preval&#234;ncias aumentadas de s&#237;ndrome metab&#243;lica&#44; dislipidemia e hipertens&#227;o&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">2&#44;4&#44;6</span></a> Em um estudo anterior&#44; os presentes autores observaram uma preval&#234;ncia aumentada de s&#237;ndrome metab&#243;lica no LP&#44; particularmente na forma oral&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">17</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">A disfun&#231;&#227;o diast&#243;lica pode ser o primeiro sinal de DCV e doen&#231;as metab&#243;licas&#46; O tempo de relaxamento isovolum&#233;trico &#40;TRIV&#41;&#44; a raz&#227;o de velocidades de enchimento ventricular precoce e tardia e o tempo de desacelera&#231;&#227;o precoce do fluxo foram usados para avaliar a fun&#231;&#227;o diast&#243;lica na ecocardiografia&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">18</span></a> A disfun&#231;&#227;o diast&#243;lica do VE &#233; uma condi&#231;&#227;o clinicamente significativa&#46; A disfun&#231;&#227;o diast&#243;lica pode&#44; por si s&#243;&#44; dar origem a sintomas e achados de insufici&#234;ncia card&#237;aca&#44; mesmo que as fun&#231;&#245;es sist&#243;licas sejam normais&#46; As fun&#231;&#245;es diast&#243;licas do cora&#231;&#227;o dependem de fatores inter&#8208;relacionados complexos&#46; As principais causas de disfun&#231;&#227;o diast&#243;lica s&#227;o idade avan&#231;ada&#44; hipertens&#227;o e cardiopatia isqu&#234;mica&#44; embora v&#225;rias doen&#231;as que progridem com inflama&#231;&#227;o sist&#234;mica tamb&#233;m possam afetar as fun&#231;&#245;es diast&#243;licas do VE&#46; Estudos anteriores determinaram o comprometimento das fun&#231;&#245;es card&#237;acas em doen&#231;as relacionadas &#224; inflama&#231;&#227;o difusa&#44; como AR e psor&#237;ase&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">19&#44;20</span></a> Da mesma forma&#44; um estudo das fun&#231;&#245;es sist&#243;lica e diast&#243;lica do VE em pacientes com LP determinou diferen&#231;as significativas nos pacientes em compara&#231;&#227;o com um grupo controle&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">14</span></a> No presente estudo&#44; a disfun&#231;&#227;o diast&#243;lica foi similarmente maior no grupo de pacientes&#46; Embora a rela&#231;&#227;o E&#47;A tenha sido menor do que no grupo controle&#44; ainda estava dentro da faixa normal nos dois grupos&#46; Isso indica que o comprometimento existente &#233; muito baixo&#46; Ao serem semelhantes ao do grupo controle&#44; as medidas de disfun&#231;&#227;o diast&#243;lica&#44; como TD&#44; dimens&#227;o do AE e E&#47;e&#44; respaldam essa teoria&#46; Achados semelhantes foram observados quando pacientes com LP erosivo&#44; com maior inflama&#231;&#227;o e dura&#231;&#227;o da doen&#231;a&#44; foram analisados separadamente&#44; ao contr&#225;rio do observado por Koseoglu et al&#46; Considerando esses achados&#44; o LP parece ter um efeito leve na disfun&#231;&#227;o diast&#243;lica do ventr&#237;culo esquerdo&#46; O IDM foi avaliado no presente estudo&#44; pois reflete a fun&#231;&#227;o global do cora&#231;&#227;o no n&#237;vel subcl&#237;nico&#46; Similarmente a estudos anteriores&#44; o IDM foi significativamente maior nos pacientes com LP<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">14</span></a>&#46; Um efeito semelhante foi determinado no grupo de pacientes com LP erosivo&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">A avalia&#231;&#227;o da rigidez arterial e das caracter&#237;sticas el&#225;sticas da aorta por meio de reflex&#245;es de ondas tem sido amplamente usada na avalia&#231;&#227;o cl&#237;nica de pacientes com doen&#231;as inflamat&#243;rias&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">21</span></a> A rigidez arterial &#233; uma condi&#231;&#227;o sist&#234;mica que causa um impacto nas fun&#231;&#245;es card&#237;acas&#59; reflex&#245;es de ondas maiores tamb&#233;m contribuem para o risco de DCV&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">16&#44;21&#8211;23</span></a> A VOP carotidofemoral &#233; um indicador de rigidez a&#243;rtica do tipo el&#225;stico&#44; enquanto o IDA &#233; um marcador de reflex&#227;o da onda&#46; A VOP carotidofemoral e o IDA s&#227;o os m&#233;todos padr&#227;o&#8208;ouro&#46; O aumento da rigidez arterial afeta adversamente as fun&#231;&#245;es sist&#243;lica e diast&#243;lica do mioc&#225;rdio e a estrutura card&#237;aca&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">24</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">A inflama&#231;&#227;o sist&#234;mica cr&#244;nica pode levar &#224; aterosclerose&#44; que progredir&#225; enquanto a inflama&#231;&#227;o persistir&#46; Acredita&#8208;se que a inflama&#231;&#227;o e a disfun&#231;&#227;o endotelial existentes no LP sejam capazes de aumentar a rigidez arterial&#44; resultem em danos na parede arterial&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">14&#44;25</span></a> Um estudo anterior indicou aumento da rigidez arterial e dos valores do IDM em pacientes com LP em compara&#231;&#227;o ao grupo controle&#46; Nesse estudo&#44; Koseoglu et al&#46; avaliaram a rigidez arterial por ecocardiografia&#46; A rigidez a&#243;rtica significativamente alta foi determinada independentemente do tipo de doen&#231;a em compara&#231;&#227;o com o grupo controle&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">14</span></a> Em contraste com o estudo daqueles autores&#44; no presente estudo n&#227;o foi observada diferen&#231;a significativa na rigidez arterial entre os grupos de pacientes e controle&#44; mas uma rigidez significativamente maior foi observada em pacientes com LP oral erosivo&#46; Similarmente a outros estudos&#44; foi observada uma correla&#231;&#227;o positiva entre a dura&#231;&#227;o da doen&#231;a e a rigidez arterial&#44; avaliada por meio da VOP&#46; A avalia&#231;&#227;o da rigidez por VOP e IDA &#233; o padr&#227;o&#8208;ouro&#44; mais sens&#237;veis do que a ecocardiografia&#46; Em contraste com outros estudos&#44; todos os par&#226;metros de rigidez arterial foram semelhantes nos grupos de pacientes e controle no presente estudo&#44; mas uma rigidez arterial significativamente maior foi observada em pacientes com LP erosivo&#46; Com base nesses achados&#44; pode&#8208;se concluir que a rigidez arterial no LP &#233; mais comumente observada em pacientes com maior dura&#231;&#227;o da doen&#231;a e maior inflama&#231;&#227;o&#46; Apesar da aus&#234;ncia de comprometimento acentuado das fun&#231;&#245;es card&#237;acas no grupo de pacientes&#44; a eleva&#231;&#227;o acentuada da rigidez arterial sugere que a inflama&#231;&#227;o &#233; mais danosa no n&#237;vel das c&#233;lulas vasculares do que no n&#237;vel do mioc&#225;rdio&#46; Mais estudos no n&#237;vel celular s&#227;o necess&#225;rios para elucidar esse ponto&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Sabe&#8208;se que a homociste&#237;na produz efeitos pr&#243;&#8208;aterog&#234;nicos e pode desempenhar um papel no dano endotelial&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">18</span></a> A PCR &#233; depositada na &#237;ntima arterial nas les&#245;es ateroscler&#243;ticas precoces&#44; induz um fen&#243;tipo inflamat&#243;rio e aterog&#234;nico nas c&#233;lulas endoteliais e estimula a migra&#231;&#227;o e prolifera&#231;&#227;o de c&#233;lulas musculares lisas vasculares&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">26</span></a> Saleh et al&#46; relataram homociste&#237;na&#44; fibrinog&#234;nio e PCR&#8208;as significativamente mais altos em pacientes com LP do que nos controles&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">2</span></a> Entretanto&#44; no presente estudo os n&#237;veis de homociste&#237;na foram semelhantes&#44; mas os valores de PCR e VHS foram maiores no grupo de pacientes e&#44; principalmente&#44; nos pacientes com LP erosivo&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">O n&#250;mero relativamente baixo de pacientes no presente estudo deve ser considerado uma limita&#231;&#227;o&#46; S&#227;o necess&#225;rios mais estudos com um n&#250;mero maior para respaldar as presentes conclus&#245;es&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclus&#227;o</span><p id="par0110" class="elsevierStylePara elsevierViewall">Foi observada correla&#231;&#227;o significativa entre rigidez arterial e dura&#231;&#227;o da doen&#231;a em pacientes com LP&#44; particularmente naqueles com LP erosivo&#44; uma forma resistente&#46; Com base nos presentes achados&#44; o risco de doen&#231;a cardiovascular &#233; maior em indiv&#237;duos com uma dura&#231;&#227;o mais longa da doen&#231;a e com uma forma resistente e esses pacientes devem ser submetidos a um monitoramento mais constante&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Suporte financeiro</span><p id="par0115" class="elsevierStylePara elsevierViewall">Unidade de Pesquisa Cient&#237;fica da Universidade T&#233;cnica Karadeniz&#44; sob o projeto n&#250;mero 5554&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Contribui&#231;&#227;o dos autores</span><p id="par0120" class="elsevierStylePara elsevierViewall">Leyla Baykal Selcuk&#58; An&#225;lise estat&#237;stica&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; concep&#231;&#227;o e planejamento do estudo&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; revis&#227;o cr&#237;tica da literatura&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Mursel Sahin&#58; Concep&#231;&#227;o e planejamento do estudo&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Deniz Aksu Ar&#305;ca&#58; Concep&#231;&#227;o e planejamento do estudo&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">As&#305;m Orem&#58; Concep&#231;&#227;o e planejamento do estudo&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Zeynep Karaca Ural&#58; An&#225;lise estat&#237;stica&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Sava&#351; Yayl&#305;&#58; Concep&#231;&#227;o e planejamento do estudo&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflitos de interesse</span><p id="par0150" 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">O l&#237;quen plano &#233; uma doen&#231;a mucocut&#226;nea inflamat&#243;ria cr&#244;nica&#46; Estudos recentes sugeriram que ela est&#225; associada a um maior risco de comorbidades cardiovasculares&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Avaliar e comparar a rigidez arterial e a hemodin&#226;mica cardiovascular em pacientes com l&#237;quen plano e um grupo controle saud&#225;vel&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Foram inclu&#237;dos 55 pacientes com l&#237;quen plano e 42 controles saud&#225;veis&#46; Todos os pacientes foram submetidos a um exame ecocardiogr&#225;fico&#59; a rigidez arterial foi mensurada por tonometria de aplana&#231;&#227;o&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Nenhuma diferen&#231;a estatisticamente significante foi observada entre os grupos paciente e controle em termos de rigidez arterial&#44; mas ela foi significativamente maior nos pacientes com l&#237;quen plano erosivo em compara&#231;&#227;o com o grupo controle e outros pacientes &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;006 e p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;023&#44; respectivamente&#41;&#46; Observou&#8208;se uma correla&#231;&#227;o positiva moderada entre a dura&#231;&#227;o da doen&#231;a e a rigidez arterial&#46; O comprometimento das fun&#231;&#245;es sist&#243;lica e diast&#243;lica tamb&#233;m foi observado em pacientes com l&#237;quen plano em compara&#231;&#227;o ao grupo controle &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001 e p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;005&#44; respectivamente&#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">N&#250;mero relativamente baixo de pacientes&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclus&#227;o</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A correla&#231;&#227;o positiva observada entre a dura&#231;&#227;o da doen&#231;a e a rigidez arterial em pacientes com l&#237;quen plano sugere que esses pacientes devam ser monitorados quanto ao risco cardiovascular na presen&#231;a de doen&#231;a resistente e de longo prazo&#44; principalmente no caso de l&#237;quen plano erosivo&#46;</p></span>"
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                  \t\t\t\t">Sexo &#40;n&#41;</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;676&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><span class="elsevierStyleItalic">Masculino</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">24&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">21&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><span class="elsevierStyleItalic">Feminino</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">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">21&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">&#205;ndice de massa corporal &#40;kg&#47;m<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">2</span></a>&#41;&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">29&#44;76<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;97&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">27&#44;65<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;87&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;026&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">Hipertens&#227;o&#44; n&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">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">1&#44;000&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">Diabetes melito&#44; n&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">0&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;504&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">&#193;lcool&#44; n&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&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;000&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">Glicemia plasm&#225;tica em jejum&#44; mg&#47;dL&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">95&#44;15<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&#44;85&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">96&#44;31<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#44;21&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;069&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">Colesterol total&#44; mg&#47;dL&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">212&#44;54<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>63&#44;29&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">201&#44;53<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>54&#44;88&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;469&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">Triglic&#233;rides&#44; mg&#47;dL&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">148&#44;57<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>106&#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">145&#44;31<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>68&#44;45&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;746&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">HDL&#44; mg&#47;dL&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">54&#44;26<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#44;47&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">49&#44;31<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#44;62&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;123&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">LDL&#44; mg&#47;dL&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">135&#44;93<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>47&#44;07&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">133&#44;14<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>37&#44;81&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;740&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">PCR&#44; mg&#47;dL&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;40<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;54&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;28<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;44&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;049&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">VHS&#44; &#40;mm&#47;s&#41;&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">14&#44;28<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#44;97&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;12<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#44;76&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;044&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">Homociste&#237;na&#44; mg&#47;dL&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;22<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#44;59<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;88&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;469&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">Hemoglobina&#44; g&#47;L&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;95<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;30&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;85<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;16&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;717&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">Leuc&#243;cito&#44; uL&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">7532&#44;31<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1681&#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">9&#44;61<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;99&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;260&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">LA &#40;mm&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">33&#44;98<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;86&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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Comprometimento das funções miocárdicas e rigidez arterial em pacientes com líquen plano
Leyla Baykal Selcuka,
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dr.leylabaykal@gmail.com

Autor para correspondência.
, Mursel Sahina, Deniz Aksu Arıcaa, Asım Oremb, Zeynep Karaca Urala, Savaş Yaylıa
a Departamento de Dermatologia, Faculdade de Medicina, Universidade Técnica Karadeniz, Trabzon, Turquia
b Departamento de Bioquímica, Faculdade de Medicina, Universidade Técnica Karadeniz, Trabzon, Turquia
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enquanto as que acometem a mucosa oral e as unhas tendem a ser mais persistentes&#46; Em particular&#44; o LP oral erosivo e ulcerativo pode durar a vida toda&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">3</span></a> Estudos recentes sugerem que o LP est&#225; associado a uma maior preval&#234;ncia de doen&#231;as cardiovasculares &#40;DCV&#41; devido &#224; inflama&#231;&#227;o sist&#234;mica cr&#244;nica&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">2&#44;4&#44;5</span></a> Estudos tamb&#233;m mostraram que pacientes com LP apresentam maior preval&#234;ncia de s&#237;ndrome metab&#243;lica&#44; dislipidemia&#44; hiperglicemia e hipertens&#227;o&#46; Al&#233;m disso&#44; a inflama&#231;&#227;o cr&#244;nica causa disfun&#231;&#227;o endotelial&#44; o est&#225;gio inicial da aterog&#234;nese&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">2&#44;4&#44;6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">A rigidez arterial consiste em inflama&#231;&#227;o cr&#244;nica e altera&#231;&#227;o da fun&#231;&#227;o endotelial&#44; com les&#227;o de elementos estruturais da parede arterial inclusive m&#250;sculo&#59; ela &#233; um fator de risco conhecido para DCV&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">7</span></a> Hipertens&#227;o&#44; hiperlipidemia&#44; idade avan&#231;ada&#44; diabetes melito&#44; insufici&#234;ncia card&#237;aca cr&#244;nica&#44; obesidade central&#44; tabagismo&#44; doen&#231;a renal&#44; doen&#231;a coronariana &#40;DC&#41; e acidente vascular cerebral est&#227;o associados &#224; rigidez&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">8</span></a> Dos diferentes m&#233;todos usados para medir a rigidez arterial&#44; a velocidade da onda de pulso carotidofemoral &#40;VOP&#41; e o &#237;ndice de dilata&#231;&#227;o da aorta &#40;IDA&#41;&#44; ambos n&#227;o invasivos&#44; s&#227;o as t&#233;cnicas padr&#227;o de medi&#231;&#227;o<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">8&#44;9</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Hiper&#8208;homocisteinemia&#44; resist&#234;ncia a insulina&#44; dislipidemia&#44; obesidade&#44; hipertens&#227;o e aumento da prote&#237;na C reativa s&#233;rica de alta sensibilidade &#40;PCR&#8208;as&#41; s&#227;o fatores de risco para aterosclerose e doen&#231;as vasculares&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">2</span></a> As informa&#231;&#245;es sobre a rela&#231;&#227;o entre LP e rigidez arterial s&#227;o limitadas&#59; a rigidez foi medida com o exame ecocardiogr&#225;fico em apenas um estudo&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">O objetivo deste estudo foi avaliar a rigidez arterial com o m&#233;todo padr&#227;o&#8208;ouro&#44; hemodin&#226;mica cardiovascular e marcadores inflamat&#243;rios associados em pacientes com LP&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Desenho do estudo</span><p id="par0030" class="elsevierStylePara elsevierViewall">Este estudo foi feito para avaliar a rigidez arterial&#44; marcadores inflamat&#243;rios associados e hemodin&#226;mica card&#237;aca em pacientes com LP&#46; Os pacientes e controles foram pareados por idade e sexo&#46; Foram cadastrados todos os pacientes com LP atendidos neste Departamento de Dermatologia nos &#250;ltimos 18 meses&#46; Os crit&#233;rios de inclus&#227;o foram idade superior a 18 anos e diagn&#243;stico cl&#237;nico e histopatol&#243;gico de LP&#46; Foram exclu&#237;dos pacientes com hipertens&#227;o refrat&#225;ria&#44; doen&#231;a arterial perif&#233;rica&#44; DC&#44; insufici&#234;ncia renal ou obesidade m&#243;rbida e em uso de medicamentos como prednisolona e agentes hipolipemiantes &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; Durante o per&#237;odo do estudo&#44; 68 pacientes foram diagnosticados com LP e 55 foram inclu&#237;dos no grupo de pacientes&#46; Desses&#44; 19 pacientes tinham doen&#231;a cut&#226;nea&#44; 24 doen&#231;a mucocut&#226;nea e 12 apresentavam apenas les&#245;es em mucosas&#46; O grupo controle foi composto por 42 indiv&#237;duos&#46; Esses n&#227;o tinham DCV conhecida&#44; nem qualquer doen&#231;a inflamat&#243;ria&#46; A popula&#231;&#227;o fonte foi a mesma para os pacientes e controles&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Coleta de dados</span><p id="par0035" class="elsevierStylePara elsevierViewall">O termo de consentimento livre e esclarecido foi assinado por pacientes e controles&#46; Os dados demogr&#225;ficos&#44; cl&#237;nicos e laboratoriais foram registrados em formul&#225;rios de estudo por um dermatologista&#46; A press&#227;o arterial foi medida ap&#243;s o participante estar sentado por pelo menos 5 minutos&#46; A rigidez arterial e o exame ecocardiogr&#225;fico foram avaliados por um &#250;nico cardiologista experiente para avaliar o perfil cardiovascular em cada caso&#46; As amostras de sangue foram coletadas ap&#243;s um jejum noturno de 12<span class="elsevierStyleHsp" style=""></span>h&#46; Os n&#237;veis de colesterol total&#44; triglicer&#237;deos e glicose foram determinados por m&#233;todos enzim&#225;ticos&#46; A velocidade de hemossedimenta&#231;&#227;o &#40;VHS&#41; foi determinada com o m&#233;todo cl&#225;ssico de Westergren&#46; Os n&#237;veis de homociste&#237;na foram avaliados por imunonefelometria&#46; A lipoprote&#237;na de alta densidade &#40;HDL&#8208;C&#41; e a lipoprote&#237;na de baixa densidade &#40;LDL&#8208;C&#41; foram medidas com m&#233;todos de surfactante seletivo&#46; Os n&#237;veis de PCR&#8208;as foram avaliados com imunonefelometria &#40;Dade Behring&#44; BN II&#44; Marburg&#44; Alemanha&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Exame ecocardiogr&#225;fico</span><p id="par0040" class="elsevierStylePara elsevierViewall">A ecocardiografia foi feita em repouso com um dispositivo ecocardiogr&#225;fico &#40;Vivid 7&#44; GE Medical Systems&#44; Milwaukee&#44; Wis&#46;&#44; Estados Unidos&#41;&#46; As dimens&#245;es do &#225;trio esquerdo &#40;AE&#41; e ventr&#237;culo esquerdo &#40;VE&#41;&#44; fra&#231;&#227;o de eje&#231;&#227;o do VE &#40;FE&#41;&#44; padr&#227;o de fluxo mitral e imagens de Doppler tecidual foram obtidas de acordo com as recomenda&#231;&#245;es atuais da Sociedade Americana de Ecocardiografia&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">10</span></a> A FE foi avaliada com o m&#233;todo biplano modificado &#40;regra de Simpson modificada&#41;&#46; O volume amostral do Doppler pulsado foi avaliado entre as pontas dos folhetos da v&#225;lvula mitral para obter velocidades m&#225;ximas de enchimento&#46; As velocidades de fluxo transmitral precoce &#40;E&#41; e tardia &#40;A&#41; foram expressas em metros por segundo e o tempo de desacelera&#231;&#227;o &#40;TD&#41;&#44; em milissegundos&#46; Tamb&#233;m foi determinada a raz&#227;o entre as velocidades de pico precoce e tardia &#40;E&#47;A&#41;&#46; As velocidades sist&#243;licas de pico &#40;S&#8217;&#41; e diast&#243;lica precoce e tardia &#40;e&#8217; e a&#8217;&#41; foram medidas com Doppler tecidual da parede livre do VE a partir do corte apical de quatro c&#226;maras&#46; Os valores de todos os par&#226;metros foram calculados em tr&#234;s ciclos card&#237;acos separados&#46; E&#47;A e E&#47;e&#8217; foram calculados para avaliar a disfun&#231;&#227;o diast&#243;lica do VE &#40;DD&#41;&#46; O &#237;ndice de desempenho mioc&#225;rdico &#40;&#237;ndice IDM&#47;Tei&#41;&#44; inclusive intervalos de tempo sist&#243;lico e diast&#243;lico&#44; tamb&#233;m foi calculado para avaliar a disfun&#231;&#227;o card&#237;aca global&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">11</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Mensura&#231;&#227;o da rigidez arterial</span><p id="par0045" class="elsevierStylePara elsevierViewall">As propriedades da parede arterial&#44; VOP de reflex&#227;o de onda&#44; press&#227;o de dilata&#231;&#227;o &#40;PD&#41; e IDA foram avaliadas com tonometria de aplana&#231;&#227;o &#40;SphygmoCor&#44; AtCor Medical&#44; Sydney&#44; Austr&#225;lia&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">12</span></a> Foram calculados registros consecutivos de ondas de pulso da art&#233;ria car&#243;tida e femoral e o deslocamento do tempo de aparecimento de ondas no primeiro e no segundo locais&#46; A dist&#226;ncia entre os pulsos das art&#233;rias car&#243;tida e femoral foi medida na superf&#237;cie do corpo para determinar a VOP a&#243;rtica em metros por segundo&#46; A PA foi definida como press&#227;o arterial sist&#243;lica m&#225;xima menos a press&#227;o no ponto de inflex&#227;o&#46; IDA foi definido como PA dividido pela press&#227;o de pulso&#46; Valores mais altos de IDA indicam aumento da reflex&#227;o da onda da periferia ou retorno precoce da onda refletida como resultado do aumento da VOP&#46; O IDA depende das propriedades el&#225;sticas das art&#233;rias&#46; Como o IDA &#233; influenciado pela frequ&#234;ncia card&#237;aca&#44; foi usado um &#237;ndice normalizado para uma frequ&#234;ncia card&#237;aca de 75 bpm &#40;IDA&#64;75&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">13</span></a> Todas as medidas foram tiradas pelo mesmo indiv&#237;duo&#46; As medidas m&#233;dias para dez ciclos card&#237;acos foram calculadas&#46; As medidas foram repetidas em caso de valores extremos&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Aprova&#231;&#227;o pelo Comit&#234; de &#201;tica</span><p id="par0050" class="elsevierStylePara elsevierViewall">Este estudo foi aprovado pelo comit&#234; de &#233;tica da Universidade T&#233;cnica Karadeniz &#40;2016&#47;173&#41; com n&#250;mero de protocolo 5554&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">An&#225;lise estat&#237;stica</span><p id="par0055" class="elsevierStylePara elsevierViewall">Os dados foram analisados no <span class="elsevierStyleItalic">software</span> SPSS 23&#46;0&#46; Os resultados foram expressos em n&#250;mero &#40;n&#41; e porcentagem &#40;&#37;&#41; para dados descritivos&#46; O teste qui&#8208;quadrado foi usado para compara&#231;&#227;o das vari&#225;veis categ&#243;ricas&#46; A distribui&#231;&#227;o normal foi avaliada pelo teste de Kolmogorov&#8208;Smirnov&#46; O teste <span class="elsevierStyleItalic">t</span> de Student foi usado para comparar vari&#225;veis constantes distribu&#237;das normalmente e o teste U de Mann&#8208;Whitney para comparar vari&#225;veis distribu&#237;das n&#227;o normalmente&#46; A an&#225;lise de correla&#231;&#227;o foi feita com o teste de correla&#231;&#227;o de Spearman&#46; A an&#225;lise de regress&#227;o linear foi usada para comparar o impacto da idade&#44; dura&#231;&#227;o da doen&#231;a&#44; n&#237;veis de PCR e da forma erosiva do PL na rigidez arterial&#46; Valores&#8208;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05 foram considerados significativos&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Resultados</span><p id="par0060" class="elsevierStylePara elsevierViewall">O estudo incluiu 55 pacientes &#40;31 mulheres&#44; 24 homens&#44; m&#233;dia de 47&#44;84<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#44;55 anos&#41; e 42 indiv&#237;duos controle &#40;21 mulheres&#44; 21 homens e m&#233;dia de 45&#44;57<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;91 anos&#41;&#46; O comprometimento ocorreu no tronco em 28 pacientes &#40;51&#37;&#41;&#44; nas extremidades em 40 &#40;73&#37;&#41;&#44; na mucosa oral em 37 &#40;67&#37;&#41;&#44; na mucosa genital em oito &#40;15&#37;&#41; e nas unhas em tr&#234;s &#40;6&#37;&#41;&#46; Les&#245;es reticulares brancas estavam presentes em 25 &#40;68&#37;&#41; dos pacientes com comprometimento da mucosa oral e foram observadas eros&#245;es em 12 &#40;32&#37;&#41;&#46; A dura&#231;&#227;o m&#233;dia da doen&#231;a foi de 4&#44;09<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;46 anos&#46; A dura&#231;&#227;o m&#233;dia da doen&#231;a foi significativamente maior nos pacientes com LP erosivo oral &#40;8&#44;16<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;19 anos&#41; do que nos demais pacientes &#40;2&#44;96<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;86 anos&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; A <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a> apresenta os dados cl&#237;nicos e laboratoriais da popula&#231;&#227;o estudada&#46; O &#237;ndice de massa corporal foi significativamente maior nos pacientes do que nos controles &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#41;&#46; N&#227;o foram observadas diferen&#231;as estatisticamente significativas nas demais caracter&#237;sticas nem comorbidades cardiovasculares entre os grupos paciente e controle&#46; Marcadores inflamat&#243;rios&#44; como PCR e VHS&#44; foram significativamente maiores em pacientes com LP &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;049 e p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;044&#44; respectivamente&#41;&#44; enquanto nenhuma diferen&#231;a foi determinada em outros par&#226;metros laboratoriais&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">A <a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a> apresenta as medidas ecocardiogr&#225;ficas transtor&#225;cicas e os achados de rigidez arterial na popula&#231;&#227;o estudada&#46; A velocidade do IDM e E&#44; bem como a rela&#231;&#227;o E&#47;A&#44; todos marcadores de disfun&#231;&#227;o diast&#243;lica&#44; diferiram significativamente entre os pacientes com LP e os controles &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#44; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001 e p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;005&#44; respectivamente&#41;&#46; N&#227;o foi observada diferen&#231;a estatisticamente significativa nas medidas de rigidez arterial entre os grupos paciente e controle&#44; embora a rigidez tenha sido significativamente maior nos pacientes com LP oral erosivo &#40;10&#44;32<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;26&#41; em compara&#231;&#227;o com o grupo controle &#40;9&#44;09<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;40&#41; e com os demais pacientes com LP &#40;9&#44;12<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;75&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;009 e p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;023&#44; respectivamente&#59; <a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46; Os n&#237;veis m&#233;dios de VHS foram 21&#44;50<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#44;40<span class="elsevierStyleHsp" style=""></span>mm&#47;s nos pacientes com LP erosivo e 12&#44;21<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#44;37<span class="elsevierStyleHsp" style=""></span>mm&#47;s nos outros pacientes&#59; os n&#237;veis de PCR foram significativamente maiores no grupo LP erosivo &#40;0&#44;78<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;89<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#41; em compara&#231;&#227;o com os demais pacientes com LP &#40;0&#44;29<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;33<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;01 e p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#44; respectivamente&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">A correla&#231;&#227;o entre a dura&#231;&#227;o da doen&#231;a e a rigidez arterial e os par&#226;metros ecocardiogr&#225;ficos e laboratoriais s&#227;o apresentados na <a class="elsevierStyleCrossRef" href="#tbl0020">tabela 4</a>&#46; Observou&#8208;se uma correla&#231;&#227;o positiva entre a dura&#231;&#227;o da doen&#231;a e os marcadores de rigidez arterial&#46; Os efeitos dependentes do LP erosivo&#44; dura&#231;&#227;o da doen&#231;a&#44; idade do paciente e n&#237;veis de PCR na rigidez arterial foram avaliados por meio de an&#225;lise de regress&#227;o e observou&#8208;se que o aumento da dura&#231;&#227;o da doen&#231;a e os n&#237;veis de PCR constituem riscos para o desenvolvimento de rigidez &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">tabela 5</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discuss&#227;o</span><p id="par0075" class="elsevierStylePara elsevierViewall">No presente estudo&#44; a rigidez arterial foi significativamente maior no tipo erosivo de LP&#44; que evolui com eros&#245;es resistentes na boca e&#47;ou mucosa genital&#46; Tamb&#233;m foi observada uma correla&#231;&#227;o positiva entre a dura&#231;&#227;o da doen&#231;a e a rigidez arterial&#46; Os n&#237;veis de PCR e VHS foram significativamente mais altos nos pacientes com LP do que no grupo controle&#59; eles tamb&#233;m foram significativamente mais altos nos pacientes com LP erosivo do que nos pacientes sem LP erosivo&#46; Com base nesses achados&#44; os autores concluem que os n&#237;veis de rigidez arterial aumentam na forma oral erosiva do LP e que uma dura&#231;&#227;o prolongada da doen&#231;a aumenta a rigidez arterial&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">LP &#233; uma doen&#231;a que progride com inflama&#231;&#227;o cr&#244;nica&#44; semelhante &#224; psor&#237;ase vulgar&#44; na qual se observa uma resposta imune mediada por c&#233;lulas T acompanhada de disfun&#231;&#227;o endotelial&#46; Enquanto os linf&#243;citos T auxiliares predominam no infiltrado d&#233;rmico nas les&#245;es precoces&#44; a infiltra&#231;&#227;o de c&#233;lulas T citot&#243;xicas CD8<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&#233; observada nas les&#245;es tardias&#46; As c&#233;lulas T ativadas induzem citocinas e c&#233;lulas inflamat&#243;rias&#44; como o fator de necrose tumoral&#8208;&#945; &#40;TNF&#8208;&#945;&#41;&#44; interleucina&#8208;2 &#40;IL&#8208;2&#41; e interferon&#8208;&#947; &#40;IFN&#8208;&#947;&#41;&#44; levam a danos aos queratin&#243;citos<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">3</span></a>&#46; Al&#233;m disso&#44; citocinas elevadas&#44; como IL&#8208;2&#44; IL&#8208;6 e TNF&#8208;&#945;&#44; produzem metaloproteinases que reduzem o conte&#250;do da &#237;ntima a&#243;rtica e&#44; portanto&#44; podem promover aumento da rigidez arterial&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">14</span></a> Um aumento das esp&#233;cies reativas de oxig&#234;nio e de per&#243;xidos lip&#237;dicos tamb&#233;m foi apontado na patog&#234;nese do LP&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">15</span></a> Aumentos de 50&#37; nas taxas de DCV&#44; como infarto do mioc&#225;rdio e acidente vascular cerebral&#44; foram observados em indiv&#237;duos com v&#225;rias doen&#231;as inflamat&#243;rias cr&#244;nicas&#44; como psor&#237;ase&#44; artrite reumatoide e doen&#231;a inflamat&#243;ria intestinal&#44; quando comparados com a popula&#231;&#227;o em geral&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">16</span></a> Da mesma forma&#44; v&#225;rios estudos examinaram a rela&#231;&#227;o entre LP e comorbidades cardiovasculares e metab&#243;licas&#59; foram relatadas preval&#234;ncias aumentadas de s&#237;ndrome metab&#243;lica&#44; dislipidemia e hipertens&#227;o&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">2&#44;4&#44;6</span></a> Em um estudo anterior&#44; os presentes autores observaram uma preval&#234;ncia aumentada de s&#237;ndrome metab&#243;lica no LP&#44; particularmente na forma oral&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">17</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">A disfun&#231;&#227;o diast&#243;lica pode ser o primeiro sinal de DCV e doen&#231;as metab&#243;licas&#46; O tempo de relaxamento isovolum&#233;trico &#40;TRIV&#41;&#44; a raz&#227;o de velocidades de enchimento ventricular precoce e tardia e o tempo de desacelera&#231;&#227;o precoce do fluxo foram usados para avaliar a fun&#231;&#227;o diast&#243;lica na ecocardiografia&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">18</span></a> A disfun&#231;&#227;o diast&#243;lica do VE &#233; uma condi&#231;&#227;o clinicamente significativa&#46; A disfun&#231;&#227;o diast&#243;lica pode&#44; por si s&#243;&#44; dar origem a sintomas e achados de insufici&#234;ncia card&#237;aca&#44; mesmo que as fun&#231;&#245;es sist&#243;licas sejam normais&#46; As fun&#231;&#245;es diast&#243;licas do cora&#231;&#227;o dependem de fatores inter&#8208;relacionados complexos&#46; As principais causas de disfun&#231;&#227;o diast&#243;lica s&#227;o idade avan&#231;ada&#44; hipertens&#227;o e cardiopatia isqu&#234;mica&#44; embora v&#225;rias doen&#231;as que progridem com inflama&#231;&#227;o sist&#234;mica tamb&#233;m possam afetar as fun&#231;&#245;es diast&#243;licas do VE&#46; Estudos anteriores determinaram o comprometimento das fun&#231;&#245;es card&#237;acas em doen&#231;as relacionadas &#224; inflama&#231;&#227;o difusa&#44; como AR e psor&#237;ase&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">19&#44;20</span></a> Da mesma forma&#44; um estudo das fun&#231;&#245;es sist&#243;lica e diast&#243;lica do VE em pacientes com LP determinou diferen&#231;as significativas nos pacientes em compara&#231;&#227;o com um grupo controle&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">14</span></a> No presente estudo&#44; a disfun&#231;&#227;o diast&#243;lica foi similarmente maior no grupo de pacientes&#46; Embora a rela&#231;&#227;o E&#47;A tenha sido menor do que no grupo controle&#44; ainda estava dentro da faixa normal nos dois grupos&#46; Isso indica que o comprometimento existente &#233; muito baixo&#46; Ao serem semelhantes ao do grupo controle&#44; as medidas de disfun&#231;&#227;o diast&#243;lica&#44; como TD&#44; dimens&#227;o do AE e E&#47;e&#44; respaldam essa teoria&#46; Achados semelhantes foram observados quando pacientes com LP erosivo&#44; com maior inflama&#231;&#227;o e dura&#231;&#227;o da doen&#231;a&#44; foram analisados separadamente&#44; ao contr&#225;rio do observado por Koseoglu et al&#46; Considerando esses achados&#44; o LP parece ter um efeito leve na disfun&#231;&#227;o diast&#243;lica do ventr&#237;culo esquerdo&#46; O IDM foi avaliado no presente estudo&#44; pois reflete a fun&#231;&#227;o global do cora&#231;&#227;o no n&#237;vel subcl&#237;nico&#46; Similarmente a estudos anteriores&#44; o IDM foi significativamente maior nos pacientes com LP<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">14</span></a>&#46; Um efeito semelhante foi determinado no grupo de pacientes com LP erosivo&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">A avalia&#231;&#227;o da rigidez arterial e das caracter&#237;sticas el&#225;sticas da aorta por meio de reflex&#245;es de ondas tem sido amplamente usada na avalia&#231;&#227;o cl&#237;nica de pacientes com doen&#231;as inflamat&#243;rias&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">21</span></a> A rigidez arterial &#233; uma condi&#231;&#227;o sist&#234;mica que causa um impacto nas fun&#231;&#245;es card&#237;acas&#59; reflex&#245;es de ondas maiores tamb&#233;m contribuem para o risco de DCV&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">16&#44;21&#8211;23</span></a> A VOP carotidofemoral &#233; um indicador de rigidez a&#243;rtica do tipo el&#225;stico&#44; enquanto o IDA &#233; um marcador de reflex&#227;o da onda&#46; A VOP carotidofemoral e o IDA s&#227;o os m&#233;todos padr&#227;o&#8208;ouro&#46; O aumento da rigidez arterial afeta adversamente as fun&#231;&#245;es sist&#243;lica e diast&#243;lica do mioc&#225;rdio e a estrutura card&#237;aca&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">24</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">A inflama&#231;&#227;o sist&#234;mica cr&#244;nica pode levar &#224; aterosclerose&#44; que progredir&#225; enquanto a inflama&#231;&#227;o persistir&#46; Acredita&#8208;se que a inflama&#231;&#227;o e a disfun&#231;&#227;o endotelial existentes no LP sejam capazes de aumentar a rigidez arterial&#44; resultem em danos na parede arterial&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">14&#44;25</span></a> Um estudo anterior indicou aumento da rigidez arterial e dos valores do IDM em pacientes com LP em compara&#231;&#227;o ao grupo controle&#46; Nesse estudo&#44; Koseoglu et al&#46; avaliaram a rigidez arterial por ecocardiografia&#46; A rigidez a&#243;rtica significativamente alta foi determinada independentemente do tipo de doen&#231;a em compara&#231;&#227;o com o grupo controle&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">14</span></a> Em contraste com o estudo daqueles autores&#44; no presente estudo n&#227;o foi observada diferen&#231;a significativa na rigidez arterial entre os grupos de pacientes e controle&#44; mas uma rigidez significativamente maior foi observada em pacientes com LP oral erosivo&#46; Similarmente a outros estudos&#44; foi observada uma correla&#231;&#227;o positiva entre a dura&#231;&#227;o da doen&#231;a e a rigidez arterial&#44; avaliada por meio da VOP&#46; A avalia&#231;&#227;o da rigidez por VOP e IDA &#233; o padr&#227;o&#8208;ouro&#44; mais sens&#237;veis do que a ecocardiografia&#46; Em contraste com outros estudos&#44; todos os par&#226;metros de rigidez arterial foram semelhantes nos grupos de pacientes e controle no presente estudo&#44; mas uma rigidez arterial significativamente maior foi observada em pacientes com LP erosivo&#46; Com base nesses achados&#44; pode&#8208;se concluir que a rigidez arterial no LP &#233; mais comumente observada em pacientes com maior dura&#231;&#227;o da doen&#231;a e maior inflama&#231;&#227;o&#46; Apesar da aus&#234;ncia de comprometimento acentuado das fun&#231;&#245;es card&#237;acas no grupo de pacientes&#44; a eleva&#231;&#227;o acentuada da rigidez arterial sugere que a inflama&#231;&#227;o &#233; mais danosa no n&#237;vel das c&#233;lulas vasculares do que no n&#237;vel do mioc&#225;rdio&#46; Mais estudos no n&#237;vel celular s&#227;o necess&#225;rios para elucidar esse ponto&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Sabe&#8208;se que a homociste&#237;na produz efeitos pr&#243;&#8208;aterog&#234;nicos e pode desempenhar um papel no dano endotelial&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">18</span></a> A PCR &#233; depositada na &#237;ntima arterial nas les&#245;es ateroscler&#243;ticas precoces&#44; induz um fen&#243;tipo inflamat&#243;rio e aterog&#234;nico nas c&#233;lulas endoteliais e estimula a migra&#231;&#227;o e prolifera&#231;&#227;o de c&#233;lulas musculares lisas vasculares&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">26</span></a> Saleh et al&#46; relataram homociste&#237;na&#44; fibrinog&#234;nio e PCR&#8208;as significativamente mais altos em pacientes com LP do que nos controles&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">2</span></a> Entretanto&#44; no presente estudo os n&#237;veis de homociste&#237;na foram semelhantes&#44; mas os valores de PCR e VHS foram maiores no grupo de pacientes e&#44; principalmente&#44; nos pacientes com LP erosivo&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">O n&#250;mero relativamente baixo de pacientes no presente estudo deve ser considerado uma limita&#231;&#227;o&#46; S&#227;o necess&#225;rios mais estudos com um n&#250;mero maior para respaldar as presentes conclus&#245;es&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclus&#227;o</span><p id="par0110" class="elsevierStylePara elsevierViewall">Foi observada correla&#231;&#227;o significativa entre rigidez arterial e dura&#231;&#227;o da doen&#231;a em pacientes com LP&#44; particularmente naqueles com LP erosivo&#44; uma forma resistente&#46; Com base nos presentes achados&#44; o risco de doen&#231;a cardiovascular &#233; maior em indiv&#237;duos com uma dura&#231;&#227;o mais longa da doen&#231;a e com uma forma resistente e esses pacientes devem ser submetidos a um monitoramento mais constante&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Suporte financeiro</span><p id="par0115" class="elsevierStylePara elsevierViewall">Unidade de Pesquisa Cient&#237;fica da Universidade T&#233;cnica Karadeniz&#44; sob o projeto n&#250;mero 5554&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Contribui&#231;&#227;o dos autores</span><p id="par0120" class="elsevierStylePara elsevierViewall">Leyla Baykal Selcuk&#58; An&#225;lise estat&#237;stica&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; concep&#231;&#227;o e planejamento do estudo&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; revis&#227;o cr&#237;tica da literatura&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Mursel Sahin&#58; Concep&#231;&#227;o e planejamento do estudo&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Deniz Aksu Ar&#305;ca&#58; Concep&#231;&#227;o e planejamento do estudo&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">As&#305;m Orem&#58; Concep&#231;&#227;o e planejamento do estudo&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Zeynep Karaca Ural&#58; An&#225;lise estat&#237;stica&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Sava&#351; Yayl&#305;&#58; Concep&#231;&#227;o e planejamento do estudo&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflitos de interesse</span><p id="par0150" 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">O l&#237;quen plano &#233; uma doen&#231;a mucocut&#226;nea inflamat&#243;ria cr&#244;nica&#46; Estudos recentes sugeriram que ela est&#225; associada a um maior risco de comorbidades cardiovasculares&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Avaliar e comparar a rigidez arterial e a hemodin&#226;mica cardiovascular em pacientes com l&#237;quen plano e um grupo controle saud&#225;vel&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Foram inclu&#237;dos 55 pacientes com l&#237;quen plano e 42 controles saud&#225;veis&#46; Todos os pacientes foram submetidos a um exame ecocardiogr&#225;fico&#59; a rigidez arterial foi mensurada por tonometria de aplana&#231;&#227;o&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Nenhuma diferen&#231;a estatisticamente significante foi observada entre os grupos paciente e controle em termos de rigidez arterial&#44; mas ela foi significativamente maior nos pacientes com l&#237;quen plano erosivo em compara&#231;&#227;o com o grupo controle e outros pacientes &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;006 e p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;023&#44; respectivamente&#41;&#46; Observou&#8208;se uma correla&#231;&#227;o positiva moderada entre a dura&#231;&#227;o da doen&#231;a e a rigidez arterial&#46; O comprometimento das fun&#231;&#245;es sist&#243;lica e diast&#243;lica tamb&#233;m foi observado em pacientes com l&#237;quen plano em compara&#231;&#227;o ao grupo controle &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001 e p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;005&#44; respectivamente&#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">N&#250;mero relativamente baixo de pacientes&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclus&#227;o</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A correla&#231;&#227;o positiva observada entre a dura&#231;&#227;o da doen&#231;a e a rigidez arterial em pacientes com l&#237;quen plano sugere que esses pacientes devam ser monitorados quanto ao risco cardiovascular na presen&#231;a de doen&#231;a resistente e de longo prazo&#44; principalmente no caso de l&#237;quen plano erosivo&#46;</p></span>"
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Pacientes &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>55&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Controle &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>42&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&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">Idade &#40;anos&#41;&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">47&#44;84<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#44;5&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">45&#44;57<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;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">0&#44;325&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sexo &#40;n&#41;</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;676&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><span class="elsevierStyleItalic">Masculino</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">24&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">21&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><span class="elsevierStyleItalic">Feminino</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">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">21&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">&#205;ndice de massa corporal &#40;kg&#47;m<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">2</span></a>&#41;&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">29&#44;76<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;97&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">27&#44;65<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;87&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;026&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">Hipertens&#227;o&#44; n&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">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">1&#44;000&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">Diabetes melito&#44; n&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">0&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;504&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">&#193;lcool&#44; n&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&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;000&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">Glicemia plasm&#225;tica em jejum&#44; mg&#47;dL&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">95&#44;15<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&#44;85&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">96&#44;31<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#44;21&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;069&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">Colesterol total&#44; mg&#47;dL&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">212&#44;54<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>63&#44;29&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">201&#44;53<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>54&#44;88&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;469&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">Triglic&#233;rides&#44; mg&#47;dL&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">148&#44;57<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>106&#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">145&#44;31<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>68&#44;45&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;746&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">HDL&#44; mg&#47;dL&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">54&#44;26<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#44;47&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">49&#44;31<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#44;62&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;123&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">LDL&#44; mg&#47;dL&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">135&#44;93<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>47&#44;07&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">133&#44;14<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>37&#44;81&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;740&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">PCR&#44; mg&#47;dL&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;40<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;54&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;28<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;44&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;049&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">VHS&#44; &#40;mm&#47;s&#41;&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">14&#44;28<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#44;97&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;12<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#44;76&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;044&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">Homociste&#237;na&#44; mg&#47;dL&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">12&#44;22<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#44;59<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;88&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 ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Hemoglobina&#44; g&#47;L&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">13&#44;95<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;30&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">13&#44;85<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;16&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 ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">PA sist&#243;lica&#44; mm&#47;hg&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">120&#44;65<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&#44;37&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">121&#44;19<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#44;29&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">PA diast&#243;lica&#44; mm&#47;hg&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">77&#44;41<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#44;76&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">77&#44;86<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;47&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-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">62&#44;75<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;81&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">62&#44;81<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;82&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
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                  \t\t\t\t">10&#44;40<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;97&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10&#44;09<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;10&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\ttable-entry\n
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                  \t\t\t\t">9&#44;89<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;96&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">9&#44;61<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;99&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;260&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">LA &#40;mm&#41;&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">33&#44;98<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;86&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">34&#44;21<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;99&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;769&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">E &#40;m&#47;s&#41;&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  " align="left" valign="\n
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                  \t\t\t\t">0&#44;017&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">PA diast&#243;lica&nbsp;\t\t\t\t\t\t\n
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                          "etal" => false
                          "autores" => array:2 [
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Homocysteine and other cardiovascular risk factors in patients with lichen planus"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
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                    0 => array:2 [
                      "doi" => "10.1111/jdv.12329"
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                        "tituloSerie" => "J Eur Acad Dermatol Venereol&#46;"
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                        "volumen" => "28"
                        "paginaInicial" => "1507"
                        "paginaFinal" => "1513"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24330130"
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                            0 => "T&#46; Shiora"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lipid levels in patients with lichen planus&#58; a case&#8208;control study"
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                          "etal" => true
                          "autores" => array:6 [
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                        0 => array:2 [
                          "etal" => false
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                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2133.2009.09235.x"
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                        "tituloSerie" => "Br J Dermatol&#46;"
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                    0 => array:2 [
                      "doi" => "10.1016/j.amjmed.2010.12.025"
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                        "tituloSerie" => "Am J Med&#46;"
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                        "volumen" => "124"
                        "paginaInicial" => "543"
                        "paginaFinal" => "548"
                        "link" => array:1 [
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                      "titulo" => "Circulating levels of erythropoietin and its relation to arterial stiffness in patients with hypertension"
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                          "autores" => array:3 [
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Informação do artigo
ISSN: 26662752
Idioma original: Português
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