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predominantemente c&#233;lulas T e c&#233;lulas dendr&#237;ticas&#46; A inflama&#231;&#227;o &#233; geralmente atribu&#237;da &#224; ativa&#231;&#227;o de neutr&#243;filos e mon&#243;citos circulantes mediados por citocinas pr&#243;&#8208;inflamat&#243;rias&#46; As altera&#231;&#245;es patol&#243;gicas na pele acabam causando a forma&#231;&#227;o local de placas psori&#225;sicas e contribuem ainda mais para o desenvolvimento de inflama&#231;&#227;o sist&#234;mica persistente&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">1&#44;6&#8211;10</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">A inflama&#231;&#227;o sist&#234;mica pode ser avaliada com v&#225;rios marcadores bioqu&#237;micos e hematol&#243;gicos&#46; No entanto&#44; ainda n&#227;o existem biomarcadores sens&#237;veis&#44; espec&#237;ficos e clinicamente &#250;teis que indiquem atividade da doen&#231;a na psor&#237;ase&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">8&#44;11</span></a> Os biomarcadores s&#227;o importantes na pr&#225;tica cl&#237;nica&#44; possibilitam uma avalia&#231;&#227;o objetiva e quantitativa do diagn&#243;stico&#44; processos da doen&#231;a e resposta ao tratamento&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">7</span></a> Atualmente&#44; a escala mais usada na determina&#231;&#227;o da gravidade da psor&#237;ase &#233; o escore do &#205;ndice da Gravidade da Psor&#237;ase por &#193;rea &#40;PASI&#41;&#44; que se baseia em uma avalia&#231;&#227;o visual das les&#245;es cut&#226;neas e combina a gravidade &#40;eritema&#44; endurecimento e descama&#231;&#227;o&#41; e porcentagem de &#225;rea afetada&#46; Entretanto&#44; esse m&#233;todo &#233; limitado por sua natureza subjetiva e sua utilidade na psor&#237;ase sem placa &#233; restrita&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">5&#44;8&#44;9&#44;12</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Entre os reagentes de fase aguda&#44; a prote&#237;na C reativa &#40;PCR&#41; e a velocidade de hemossedimenta&#231;&#227;o &#40;VHS&#41; s&#227;o dois &#237;ndices inflamat&#243;rios bem reconhecidos e podem ser usados para avaliar o &#244;nus da inflama&#231;&#227;o psori&#225;sica e da atividade da doen&#231;a em pacientes com psor&#237;ase&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">1&#44;3&#44;10&#44;12</span></a> Al&#233;m disso&#44; a eleva&#231;&#227;o da PCR &#233; considerada um fator de risco independente para doen&#231;as cardiovasculares&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">12</span></a> A amiloide A s&#233;rica &#40;AA&#41;&#44; outro importante reagente da fase aguda&#44; tamb&#233;m &#233; indicada como uma apolipoprote&#237;na relevante no metabolismo do colesterol e tem sido associada a aterog&#234;nese e doen&#231;as cardiovasculares&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">4&#44;13</span></a> A procalcitonina &#40;PCT&#41;&#44; o pept&#237;deo precursor do horm&#244;nio calcitonina&#44; &#233; liberada em resposta &#224; inflama&#231;&#227;o e tem recebido bastante aten&#231;&#227;o&#44; especialmente como um poss&#237;vel biomarcador de infec&#231;&#227;o bacteriana&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">14&#8211;16</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">A investiga&#231;&#227;o de outros marcadores inflamat&#243;rios&#44; como citocinas&#44; mol&#233;culas de ades&#227;o e quimiocinas por ensaios citom&#233;tricos de fluxo&#44; n&#227;o est&#225; dispon&#237;vel na maioria dos hospitais gerais e centros de sa&#250;de&#44; devido aos altos custos e procedimentos demorados e trabalhosos&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">5&#44;8&#44;16</span></a> Nos &#250;ltimos anos&#44; par&#226;metros hematol&#243;gicos&#44; como a raz&#227;o neutr&#243;filos&#47;linf&#243;citos &#40;RNL&#41;&#44; a raz&#227;o linf&#243;citos&#47;mon&#243;citos &#40;RLM&#41; e a raz&#227;o mon&#243;citos&#47;lipoprote&#237;na de alta densidade &#40;RMH&#41; t&#234;m sido investigados como indicadores de inflama&#231;&#227;o em diferentes doen&#231;as sist&#234;micas&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">5&#44;8&#44;17&#8211;20</span></a> Esses s&#227;o par&#226;metros rapidamente dispon&#237;veis e de baixo custo que podem ser obtidos por hemograma completo de rotina &#40;HCR&#41; e an&#225;lise bioqu&#237;mica&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">O presente estudo teve como objetivo investigar o &#244;nus inflamat&#243;rio sist&#234;mico na psor&#237;ase usando diferentes marcadores bioqu&#237;micos e hematol&#243;gicos e avaliar a correla&#231;&#227;o entre esses marcadores e a gravidade da doen&#231;a&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todos</span><p id="par0030" class="elsevierStylePara elsevierViewall">Este estudo transversal foi feito no Departamento de Dermatologia em colabora&#231;&#227;o com o Departamento de Microbiologia M&#233;dica&#44; Hospital de Pesquisa e Pr&#225;tica da Universidade Suleyman Demirel&#44; entre mar&#231;o de 2019 e setembro de 2019&#46; O estudo foi aprovado pelo Comit&#234; de &#201;tica da Universidade Suleyman Demirel&#44; Faculdade de Medicina &#40;documento n&#176; 72867572&#46;050&#46;01&#46;04&#47;39475&#41;&#46; O protocolo de pesquisa foi conduzido de acordo com a Declara&#231;&#227;o de Helsinque e o termo de consentimento livre e esclarecido foi assinado por todos os participantes antes do in&#237;cio do estudo&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">O estudo incluiu pacientes diagnosticados cl&#237;nica e histopatologicamente com psor&#237;ase vulgar&#46; Pacientes com outras doen&#231;as dermatol&#243;gicas inflamat&#243;rias&#44; doen&#231;a cardiovascular grave&#44; doen&#231;as hep&#225;ticas ou renais cr&#244;nicas&#44; doen&#231;as autoimunes&#44; neoplasias&#44; doen&#231;as end&#243;crinas ou hematol&#243;gicas e aqueles com qualquer hist&#243;rico de uso de medica&#231;&#227;o sist&#234;mica ou t&#243;pica nos &#250;ltimos tr&#234;s meses foram exclu&#237;dos&#46; O grupo controle consistiu em volunt&#225;rios saud&#225;veis&#44; pareados por sexo e idade&#44; sem hist&#243;rico de doen&#231;a sist&#234;mica&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Os exames dermatol&#243;gicos e a pontua&#231;&#227;o do PASI foram feitos pelo mesmo dermatologista&#46; Idade&#44; sexo&#44; hist&#243;rico familiar&#44; idade de in&#237;cio&#44; dura&#231;&#227;o da doen&#231;a e escores PASI de cada paciente foram registrados&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Amostras de sangue venoso foram coletadas de cada paciente e centrifugadas antes de ser examinadas&#46; Os n&#237;veis s&#233;ricos de AA foram medidos pelo m&#233;todo nefelom&#233;trico &#40;analisador BN II&#44; Siemens Healthcare Diagnostics &#8211; Erlangen&#44; Alemanha&#41;&#46; Os n&#237;veis s&#233;ricos de PCT e pept&#237;deo citrulinado antic&#237;clico &#40;anti&#8208;CCP&#41; foram analisados usando um m&#233;todo de imunoensaio automatizado por quimioluminesc&#234;ncia &#40;analisador Roche Cobas e601&#59; Roche Diagnostics &#8211; Mannheim&#44; Alemanha&#41;&#46; An&#225;lise bioqu&#237;mica &#40;PCR de alta sensibilidade &#91;hsPCR&#93;&#44; glicemia em jejum&#44; alanina aminotransaminase &#91;ALT&#93;&#44; aspartato aminotransferase &#91;AST&#93;&#44; nitrog&#234;nio ureico no sangue &#91;BUN&#93;&#44; creatinina&#44; triglicer&#237;deo em jejum &#91;TG&#93;&#44; colesterol total &#91;TC&#93;&#44; colesterol de lipoprote&#237;na de baixa densidade &#91;LDL&#8208;C&#93; e colesterol de lipoprote&#237;na de alta densidade &#91;HDL&#8208;C&#93;&#41; foi feita com um analisador qu&#237;mico AU 5800 &#40;Beckman Coulter &#8211; Brea&#44; Calif&#243;rnia&#44; Estados Unidos&#41;&#46; O hemograma completo &#40;contagem de leuc&#243;citos&#44; contagem de neutr&#243;filos&#44; contagem de linf&#243;citos&#44; contagem de mon&#243;citos&#44; hemoglobina &#91;Hb&#93;&#44; amplitude de distribui&#231;&#227;o de gl&#243;bulos vermelhos &#91;RDW&#93;&#44; contagem de plaquetas &#91;PLT&#93;&#44; volume m&#233;dio de plaquetas &#91;MPV&#93; e amplitude de distribui&#231;&#227;o de plaquetas &#91;PDW&#93;&#41; e a medi&#231;&#227;o da velocidade de hemossedimenta&#231;&#227;o &#40;VHS&#41; foram feitos com um analisador de hematologia UniCel DxH 800 &#40;Beckman Coulter &#8211; Brea&#44; Calif&#243;rnia&#44; Estados Unidos&#41; e um analisador de teste 1 &#40;Alifax &#8211; Padova&#44; It&#225;lia&#41;&#44; respectivamente&#46; Para o hemograma completo e VHS&#44; foram coletadas amostras de sangue venoso de cada paciente em tubos de sangue contendo &#225;cido etilenodiaminotetrac&#233;tico ou citrato&#46; Todos os ensaios foram feitos de acordo com as instru&#231;&#245;es do fabricante&#46; Com base na an&#225;lise bioqu&#237;mica e nos dados de hemograma&#44; foram calculados os valores de RNL&#44; RLM e RMH&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">A an&#225;lise estat&#237;stica foi feita com SPSS v&#46; 20 &#40;SPSS Inc&#46; &#8211; Chicago&#44; Illinois&#44; Estados Unidos&#41;&#46; A normalidade dos dados foi analisada com o teste de Kolmogorov&#8208;Smirnov&#46; Para comparar as diferen&#231;as nas vari&#225;veis cont&#237;nuas entre os grupos&#44; o teste <span class="elsevierStyleItalic">t</span> de Student ou o teste U de Mann&#8208;Whitney foram usados&#46; O teste do qui&#8208;quadrado foi usado para vari&#225;veis categ&#243;ricas&#46; Os resultados foram expressos em frequ&#234;ncias e porcentagens&#44; ou m&#233;dia<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>desvio padr&#227;o&#46; Uma curva de caracter&#237;stica de opera&#231;&#227;o do receptor &#40;ROC&#41; foi tra&#231;ada para a RMH e a &#225;rea sob a curva &#40;AUC&#41; com intervalo de confian&#231;a de 95&#37; &#40;IC&#41; foi calculada&#46; Um valor de corte foi determinado para predizer psor&#237;ase e a sensibilidade&#44; especificidade&#44; valor preditivo positivo &#40;VPP&#41; e valor preditivo negativo &#40;VPN&#41; foram calculados&#46; As correla&#231;&#245;es entre vari&#225;veis foram avaliadas pela an&#225;lise de correla&#231;&#227;o de Spearman&#46; Um valor&#8208;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05 foi considerado estatisticamente significativo&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="par0055" class="elsevierStylePara elsevierViewall">O estudo incluiu 60 pacientes com psor&#237;ase e 50 controles saud&#225;veis&#46; A <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a> apresenta a compara&#231;&#227;o das caracter&#237;sticas demogr&#225;ficas &#40;idade&#44; sexo&#41; e os achados laboratoriais nos grupos de pacientes e controle&#46; Observou&#8208;se hist&#243;rico familiar de psor&#237;ase em 31&#44;7&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>19&#41; dos pacientes&#46; As idades m&#233;dias de in&#237;cio e dura&#231;&#227;o da doen&#231;a em pacientes com psor&#237;ase foram 29&#44;65<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#44;85 anos &#40;intervalo&#58; 8&#8211;63&#41; e 9&#44;14<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;81 anos &#40;intervalo&#58; 1 a 31&#41;&#44; respectivamente&#46; A pontua&#231;&#227;o m&#233;dia no PASI foi de 10&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#44;56 &#40;intervalo&#58; 0&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>46&#44;8&#41; no grupo de pacientes&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">Foram observadas diferen&#231;as significativas nos n&#237;veis de hsPCR&#44; AA&#44; VHS&#44; WBC&#44; neutr&#243;filos&#44; RNL&#44; RMH&#44; AST e HDL&#8208;C entre os grupos paciente e controle &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; Comparados com o grupo controle&#44; os pacientes com psor&#237;ase apresentaram n&#237;veis significativamente mais altos de hsPCR&#44; AA&#44; VHS&#44; WBC&#44; neutr&#243;filos&#44; RNL&#44; RMH e AST e n&#237;veis significativamente mais baixos de HDL&#8208;C &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">N&#227;o foi observada diferen&#231;a significativa nos n&#237;veis de PCT&#44; linf&#243;citos&#44; mon&#243;citos&#44; Hb&#44; RDW&#44; PLT&#44; MPV&#44; PDW&#44; RLM&#44; anti&#8208;CCP&#44; glicose&#44; ALT&#44; BUN&#44; creatinina&#44; TG&#44; TC e LDL&#8208;C entre os dois grupos&#46; Observou&#8208;se anti&#8208;CCP elevado acima do n&#237;vel de corte &#40;&#8805; 17 U&#47;mL&#41; em tr&#234;s dos 60 pacientes com psor&#237;ase&#44; enquanto todos os indiv&#237;duos do grupo controle apresentaram n&#237;veis normais de anti&#8208;CCP&#46; Entre os tr&#234;s pacientes&#44; apenas um deles atendeu os crit&#233;rios CASPAR para o diagn&#243;stico de artrite psori&#225;sica&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Os pacientes com psor&#237;ase foram divididos em dois grupos de acordo com o escore PASI&#46; A gravidade da doen&#231;a com base no escore PASI foi classificada em leve &#40;PASI &#60;<span class="elsevierStyleHsp" style=""></span>10&#41; e moderada&#8208;grave &#40;PASI&#160;&#8805;&#160;10&#41;&#46; Trinta e sete pacientes apresentavam psor&#237;ase leve&#44; enquanto 23 apresentavam psor&#237;ase moderada a grave&#46; A compara&#231;&#227;o dos achados laboratoriais em pacientes com psor&#237;ase que apresentavam PASI &#60;<span class="elsevierStyleHsp" style=""></span>10 e PASI &#8805; 10 &#233; mostrada na <a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#46; Comparados com pacientes com PASI &#60;<span class="elsevierStyleHsp" style=""></span>10&#44; pacientes com PASI &#8805; 10 apresentaram n&#237;veis significativamente mais altos de hsPCR&#44; RMH e mon&#243;citos e n&#237;veis significativamente menores de RLM e HDL&#8208;C &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">A <a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a> apresenta as correla&#231;&#245;es entre os par&#226;metros laboratoriais relacionados &#224; inflama&#231;&#227;o e os escores PASI em pacientes com psor&#237;ase&#46; Foi observada uma correla&#231;&#227;o positiva entre o escore PASI e hsPCR &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;255&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;049&#41;&#44; AA &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;257&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;047&#41; e RMH &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;323&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;012&#41; e uma correla&#231;&#227;o negativa entre esse escore e RLM &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>0&#44;313&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;015&#41;&#46; N&#227;o foi observada correla&#231;&#227;o entre o escore PASI e outros par&#226;metros laboratoriais relacionados &#224; inflama&#231;&#227;o &#40;PCT&#44; VHS&#44; RNL&#44; anti&#8208;CCP&#44; leuc&#243;citos&#44; neutr&#243;filos&#44; linf&#243;citos&#44; mon&#243;citos&#44; RDW&#44; PLT&#44; MPV e PDW&#59; p<span class="elsevierStyleHsp" style=""></span>&#62; 0&#44;05&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">O valor de corte ideal da RMH para a predi&#231;&#227;o da psor&#237;ase foi determinado pela an&#225;lise da curva ROC &#40;AUC<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;631&#44; IC 95&#37;&#58;&#160;0&#44;526&#8211;0&#44;735&#41;&#46; O valor de corte &#8805; 9&#44;52 apresentou sensibilidade diagn&#243;stica de 71&#44;7&#37; &#40;IC 95&#37;&#58;&#160;59&#44;2&#8211;81&#44;5&#41;&#44; especificidade diagn&#243;stica de 54&#37; &#40;IC 95&#37;&#58;&#160;40&#44;4&#8211;67&#41;&#44; VPP de 65&#44;2&#37; &#40;IC 95&#37;&#58;&#160;53&#44;1&#8211;75&#44;5&#41; e VPN de 61&#44;4&#37; &#40;IC 95&#37;&#58;&#160;46&#44;6&#8211;74&#44;3&#41; na previs&#227;o da psor&#237;ase &#40;dados n&#227;o apresentados&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Discuss&#227;o</span><p id="par0085" class="elsevierStylePara elsevierViewall">At&#233; o momento&#44; houve in&#250;meras investiga&#231;&#245;es sobre biomarcadores na psor&#237;ase&#59; no entanto&#44; ainda n&#227;o existem biomarcadores clinicamente relevantes e espec&#237;ficos para a psor&#237;ase&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">1&#44;11</span></a> A pontua&#231;&#227;o PASI e um exame cl&#237;nico cuidadoso ainda s&#227;o a base da avalia&#231;&#227;o da gravidade da doen&#231;a&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">12</span></a> No entanto&#44; alguns marcadores inflamat&#243;rios&#44; como PCR e VHS&#44; ainda est&#227;o sendo usados na pr&#225;tica di&#225;ria com o escore PASI e s&#227;o &#250;teis em algum grau no diagn&#243;stico e acompanhamento cl&#237;nico&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">1&#44;3&#44;12</span></a> No entanto&#44; ainda s&#227;o necess&#225;rios m&#233;todos mais espec&#237;ficos&#44; baratos&#44; pr&#225;ticos e confi&#225;veis para a determina&#231;&#227;o da atividade da psor&#237;ase&#46; Neste estudo&#44; al&#233;m de marcadores inflamat&#243;rios s&#233;ricos bem conhecidos&#44; como hsPCR&#44; AA e PCT&#44; os autores tamb&#233;m tiveram como objetivo investigar novos marcadores inflamat&#243;rios que podem ser facilmente obtidos em hemograma e an&#225;lises bioqu&#237;micas de rotina&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">A PCR&#44; o marcador de inflama&#231;&#227;o s&#233;rica mais comumente usado&#44; pode ser medida rotineiramente por testes de alta sensibilidade&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">6&#44;12</span></a> A hsPCR pode indicar n&#237;veis ainda mais baixos de PCR&#44; que est&#227;o significativamente relacionados a certas doen&#231;as inflamat&#243;rias e cardiovasculares&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">4</span></a> Muitos estudos relataram a utilidade cl&#237;nica da hsPCR na psor&#237;ase&#46; No presente estudo&#44; os n&#237;veis de hsPCR foram significativamente mais altos nos pacientes do que nos controles e estavam positivamente correlacionados com o escore PASI e VHS &#40;tabela&#160;3&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">4&#44;6&#44;9&#44;10&#44;12&#44;21</span></a> Os dados atuais respaldam os relat&#243;rios anteriores&#44; indicam que o n&#237;vel s&#233;rico de PCR pode ser usado como um marcador apropriado para avaliar a gravidade da doen&#231;a na psor&#237;ase&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Ao contr&#225;rio da PCR ou VHS&#44; pouco se sabe sobre a utilidade cl&#237;nica da AA na psor&#237;ase&#46; Al&#233;m disso&#44; em compara&#231;&#227;o com a PCR&#44; os custos mais altos limitam o amplo uso da AA&#44; especialmente em pa&#237;ses em desenvolvimento&#46; Alguns relatos indicaram a associa&#231;&#227;o entre AA e psor&#237;ase&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">4&#44;13&#44;22&#44;23</span></a> Morizane et al&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">13</span></a> sugeriram que&#44; na psor&#237;ase&#44; a inflama&#231;&#227;o da pele melhora a express&#227;o da AA e que a eleva&#231;&#227;o dos n&#237;veis s&#233;ricos da AA pode levar ao desenvolvimento de complica&#231;&#245;es sist&#234;micas&#44; como a aterosclerose&#46; Dogan et al&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">22</span></a> relataram que a AA &#233; um marcador mais espec&#237;fico do que a PCR para avaliar a inflama&#231;&#227;o sist&#234;mica em pacientes com psor&#237;ase&#46; No presente estudo&#44; os n&#237;veis de AA foram significativamente mais altos nos pacientes do que nos controles e foram observadas correla&#231;&#245;es positivas entre a AA&#44; hsPCR e escore PASI &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46; AA e hsPCR s&#227;o os indicadores mais sens&#237;veis &#224; inflama&#231;&#227;o&#46; O uso paralelo desses dois par&#226;metros pode aumentar a sensibilidade e a precis&#227;o na avalia&#231;&#227;o da atividade e gravidade da psor&#237;ase&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Muitos estudos cl&#237;nicos indicaram que a medi&#231;&#227;o da PCT &#233; &#250;til para o diagn&#243;stico e monitoramento de infec&#231;&#245;es bacterianas graves&#44; sepse e disfun&#231;&#227;o de m&#250;ltiplos &#243;rg&#227;os&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">14&#8211;16</span></a> N&#227;o surpreendentemente&#44; o presente estudo encontrou valores normais de PCT em pacientes com psor&#237;ase&#46; Em contraste&#44; Ibrahimbas et al&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">14</span></a> relataram n&#237;veis significativamente aumentados de PCT s&#233;rico em pacientes com psor&#237;ase cr&#244;nica em placas com exacerba&#231;&#245;es&#46; Esses autores levantaram a hip&#243;tese de que um est&#237;mulo antig&#234;nico bacteriano poderia levar a essa eleva&#231;&#227;o&#46; Similarmente aos resultados do presente estudo&#44; Nagai et al&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">15</span></a> n&#227;o encontraram eleva&#231;&#227;o significativa dos n&#237;veis de PCT em pacientes com psor&#237;ase vulgar&#44; artrite psori&#225;sica e psor&#237;ase pustular generalizada&#46; Esses autores sugeriram que uma infec&#231;&#227;o microbiana &#233; improv&#225;vel na patog&#234;nese da psor&#237;ase&#46; Grandes estudos prospectivos com casos cuidadosamente selecionados com diferentes formas de psor&#237;ase s&#227;o necess&#225;rios para esclarecer o papel da PCT na psor&#237;ase&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">A citrulina&#231;&#227;o &#233; modifica&#231;&#227;o p&#243;s&#8208;traducional de prote&#237;nas que ocorre no contexto de inflama&#231;&#227;o&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">24</span></a> Os anticorpos anti&#8208;CCP s&#227;o direcionados contra pept&#237;deos citrulinados e s&#227;o comumente usados como um marcador diagn&#243;stico para artrite reumatoide&#46;<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">24&#44;25</span></a> No entanto&#44; relatos recentes sugeriram que os anticorpos anti&#8208;CCP tamb&#233;m s&#227;o observados na artrite psori&#225;sica&#44; artrite idiop&#225;tica juvenil&#44; gota e espondilite anquilosante&#46;<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">25&#44;26</span></a> Al&#233;m disso&#44; foi demonstrado que existem ep&#237;topos citrulinados nas placas ateroscler&#243;ticas que s&#227;o alvo de anticorpos anti&#8208;CCP e que a eleva&#231;&#227;o do anti&#8208;CCP est&#225; correlacionada a um risco cardiovascular progressivamente aumentado&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">24</span></a> &#192; luz dessas observa&#231;&#245;es&#44; o presente estudo teve como objetivo analisar os n&#237;veis de anti&#8208;CCP em termos de avalia&#231;&#227;o do &#244;nus inflamat&#243;rio na psor&#237;ase&#46; N&#237;veis mais altos de anti&#8208;CCP foram observados em pacientes psori&#225;sicos quando comparados com o grupo controle&#46; N&#237;veis elevados de anti&#8208;CCP tamb&#233;m foram observados em pacientes com psor&#237;ase moderada&#8208;grave quando comparados aos pacientes com psor&#237;ase leve&#46; Embora sem atingir signific&#226;ncia estat&#237;stica&#44; pode&#8208;se especular que esses resultados refletem parcialmente a diferen&#231;a no &#244;nus inflamat&#243;rio entre os grupos&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Os gl&#243;bulos brancos imunocompetentes&#44; inclusive neutr&#243;filos&#44; linf&#243;citos e mon&#243;citos&#44; desempenham um papel cr&#237;tico na resposta inflamat&#243;ria sist&#234;mica&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">16</span></a> Os neutr&#243;filos est&#227;o entre as primeiras c&#233;lulas a migrar para locais de inflama&#231;&#227;o e tamb&#233;m s&#227;o bastante ativos no recrutamento de outras c&#233;lulas imunes para as les&#245;es&#44; como macr&#243;fagos derivados de mon&#243;citos&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">9</span></a> A rea&#231;&#227;o inflamat&#243;ria sist&#234;mica geralmente causa neutrofilia e linfocitopenia relativa&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">16</span></a> A RNL&#44; um &#237;ndice combinado que usa contagens de neutr&#243;filos e linf&#243;citos&#44; pode indicar com mais precis&#227;o as flutua&#231;&#245;es entre neutr&#243;filos e linf&#243;citos na inflama&#231;&#227;o sist&#234;mica<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">8&#44;16</span></a> Nos &#250;ltimos anos&#44; foi demonstrado que a RNL &#233; um marcador de inflama&#231;&#227;o sist&#234;mica em v&#225;rias doen&#231;as&#44; como aterosclerose&#44; infarto do mioc&#225;rdio&#44; diabetes <span class="elsevierStyleItalic">mellitus</span>&#44; colite ulcerativa&#44; neoplasias e psor&#237;ase&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">3&#44;5&#44;8&#44;17&#44;18&#44;21&#44;27&#44;28</span></a> A RLM&#44; que tamb&#233;m reflete o &#244;nus de inflama&#231;&#227;o sist&#234;mica&#44; tem sido amplamente investigada como um marcador progn&#243;stico &#250;til em v&#225;rios tipos de c&#226;ncer&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">19</span></a> A literatura n&#227;o apresenta dados sobre a rela&#231;&#227;o entre psor&#237;ase e RLM&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">No presente estudo&#44; foi observada uma contagem de leuc&#243;citos significativamente maior em pacientes com psor&#237;ase&#44; devido ao aumento na contagem de neutr&#243;filos e mon&#243;citos&#46; Como em estudos anteriores&#44; a RNL foi significativamente maior em pacientes com psor&#237;ase em compara&#231;&#227;o com os controles&#46; No entanto&#44; a literatura apresenta resultados discrepantes quanto &#224; correla&#231;&#227;o entre os valores de RNL e o escore PASI&#46; Kim et al&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">3&#44;5&#44;8&#44;17&#44;18&#44;21&#44;27&#44;28</span></a> demonstraram uma correla&#231;&#227;o positiva entre a RNL e o escore PASI&#46; Por outro lado&#44; os resultados atuais foram consistentes com os resultados de dois estudos feitos na Turquia&#44; que n&#227;o observaram correla&#231;&#227;o entre a RNL e o escore PASI&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">8&#44;28</span></a> Essas discrep&#226;ncias podem ocorrer devido &#224;s diferen&#231;as no tamanho da amostra&#44; na popula&#231;&#227;o do estudo ou nos valores m&#233;dios do PASI&#46; Curiosamente&#44; n&#227;o foi observada uma diferen&#231;a significativa entre os grupos paciente e controle em termos de valores de RLM&#44; mas valores significativamente diferentes de RLM foram observados entre pacientes com psor&#237;ase leve e pacientes com psor&#237;ase moderada&#8208;grave&#46; Al&#233;m disso&#44; foram observadas correla&#231;&#245;es negativas significativas entre a RLM&#44; RNL e escore PASI &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46; Com base nesses resultados&#44; pode&#8208;se concluir que a RNL &#233; mais &#250;til na demonstra&#231;&#227;o de inflama&#231;&#227;o em pacientes com psor&#237;ase e que a RLM pode ser mais &#250;til na avalia&#231;&#227;o da atividade da doen&#231;a&#46; No entanto&#44; os pacientes psori&#225;sicos com valores de RNL elevados ou RLM baixos devem ser cuidadosamente monitorados&#44; mesmo que seus escores PASI sejam baixos&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">As plaquetas desempenham um papel crucial na manuten&#231;&#227;o da homeostase&#44; mas tamb&#233;m s&#227;o consideradas mediadores importantes das rea&#231;&#245;es inflamat&#243;rias agudas e cr&#244;nicas&#46; Eles podem ajudar outras c&#233;lulas inflamat&#243;rias a migrar para os locais das les&#245;es&#44; liberar grandes quantidades de citocinas inflamat&#243;rias e criar um ambiente inflamat&#243;rio&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">2&#44;11&#44;28</span></a> MPV e PDW s&#227;o conhecidos como &#237;ndices de ativa&#231;&#227;o PLT&#44; refletem a taxa de produ&#231;&#227;o e estimula&#231;&#227;o de PLT&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">2&#44;11&#44;29</span></a> A literatura apresenta resultados contradit&#243;rios quanto &#224; rela&#231;&#227;o entre marcadores de ativa&#231;&#227;o plaquet&#225;ria e psor&#237;ase&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">2&#44;27&#44;29&#44;30</span></a> Em um estudo feito na Coreia&#44; foram encontrados valores significativamente mais altos de MPV e PDW em pacientes com psor&#237;ase do que em controles e uma correla&#231;&#227;o positiva foi observada entre MPV e o escore PASI&#46; Em contrapartida&#44; Saleh et al&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">11&#44;31</span></a> n&#227;o observaram diferen&#231;a significativa nos n&#237;veis de MPV entre pacientes com psor&#237;ase e controles&#46; Do mesmo modo&#44; o presente estudo encontrou n&#237;veis mais altos de plaquetas&#44; MPV e PDW em pacientes com psor&#237;ase em compara&#231;&#227;o ao grupo controle&#44; mas a diferen&#231;a entre os dois grupos n&#227;o foi significativa&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Mon&#243;citos e macr&#243;fagos desempenham um papel fundamental no processo de inflama&#231;&#227;o durante o desenvolvimento e progress&#227;o da aterosclerose&#46; No est&#225;gio inicial do processo&#44; os mon&#243;citos circulantes migram para o espa&#231;o subendotelial da parede arterial&#44; transformam&#8208;se em macr&#243;fagos e internalizam LDLs oxidados e outros lip&#237;dios&#46; Em seguida&#44; essas c&#233;lulas se diferenciam nas c&#233;lulas espumosas para liberar citocinas pr&#243;&#8208;inflamat&#243;rias no local da inflama&#231;&#227;o que ativam linf&#243;citos T&#44; plaquetas e outros mon&#243;citos&#46;<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">20&#44;32</span></a> No entanto&#44; o HDL&#8208;C inibe as atividades de mon&#243;citos&#44; impede a transforma&#231;&#227;o de mon&#243;citos em macr&#243;fagos e elimina o colesterol dessas c&#233;lulas&#44; o que restringe a resposta inflamat&#243;ria&#46;<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">20&#44;32&#8211;34</span></a> Portanto&#44; &#233; razo&#225;vel combinar esses dois par&#226;metros em um &#250;nico &#237;ndice &#40;RMH&#41; como marcador inflamat&#243;rio&#46; Foi relatado que o aumento do n&#237;vel de RMH estava associado &#224; inflama&#231;&#227;o sist&#234;mica e que a RMH poderia ser usada como marcador preditivo de doen&#231;a cardiovascular futura&#46;<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">20&#44;32&#8211;35</span></a> Tanto quanto &#233; do conhecimento dos autores&#44; a RMH ainda n&#227;o foi avaliada em pacientes com psor&#237;ase&#46; O presente estudo apontou que os n&#237;veis de RMH no grupo de pacientes eram mais altos do que nos controles saud&#225;veis e que os valores da RMH estavam positivamente correlacionados com o escore PASI&#46; Por ser um par&#226;metro pr&#225;tico&#44; econ&#244;mico e reprodut&#237;vel da an&#225;lise do hemograma e bioqu&#237;mica&#44; a RMH pode ser usada na pr&#225;tica cl&#237;nica para a avalia&#231;&#227;o da gravidade da psor&#237;ase&#46; A avalia&#231;&#227;o dos n&#237;veis de RMH juntamente com outros marcadores que predizem risco cardiovascular&#44; como hsPCR e AA&#44; pode fornecer uma nova base para a identifica&#231;&#227;o de pacientes psori&#225;sicos com maior risco de doen&#231;a cardiovascular&#46; No entanto&#44; mais estudos prospectivos com amostras maiores s&#227;o necess&#225;rios para validar o uso cl&#237;nico da RMH em pacientes com psor&#237;ase&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">O presente estudo apresenta algumas limita&#231;&#245;es que devem ser consideradas na interpreta&#231;&#227;o de seus resultados&#46; Este foi um estudo de centro &#250;nico com n&#250;mero relativamente limitado de pacientes e controles&#46; Al&#233;m disso&#44; os marcadores inflamat&#243;rios foram mensurados apenas na admiss&#227;o e n&#227;o foi poss&#237;vel avaliar as altera&#231;&#245;es nos n&#237;veis dos marcadores e escore PASI ap&#243;s o tratamento durante o per&#237;odo de acompanhamento&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conclus&#245;es</span><p id="par0135" class="elsevierStylePara elsevierViewall">Os dados demonstram que n&#237;veis elevados de hsPCR&#44; AA&#44; VHS&#44; RNL e RMH podem refletir o &#244;nus inflamat&#243;rio sist&#234;mico em pacientes com psor&#237;ase&#46; Al&#233;m disso&#44; hsPCR&#44; AA&#44; RMH e RLM est&#227;o intimamente relacionados ao escore PASI&#59; esses marcadores podem ser usados na pr&#225;tica di&#225;ria para avaliar a gravidade da psor&#237;ase&#46; No entanto&#44; estudos adicionais s&#227;o necess&#225;rios para respaldar esses achados&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Suporte financeiro</span><p id="par0185" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Contribui&#231;&#227;o dos autores</span><p id="par0140" class="elsevierStylePara elsevierViewall">Mumtaz Cem Sirin&#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&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Selma Korkmaz&#58; An&#225;lise estat&#237;stica&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; revis&#227;o cr&#237;tica da literatura&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Ijlal Erturan&#58; An&#225;lise estat&#237;stica&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; revis&#227;o cr&#237;tica da literatura&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Basak Filiz&#58; Obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; revis&#227;o cr&#237;tica da literatura&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Buket Cicioglu Aridogan&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#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="par0165" class="elsevierStylePara elsevierViewall">Emel Sesli Cetin&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#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="par0170" class="elsevierStylePara elsevierViewall">Mehmet Yildirim&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; concep&#231;&#227;o e planejamento do estudo&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conflitos de interesse</span><p id="par0180" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Fundamentos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A psor&#237;ase &#233; doen&#231;a inflamat&#243;ria sist&#234;mica cr&#244;nica frequentemente associada a comorbidades graves&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Investigar o &#244;nus inflamat&#243;rio sist&#234;mico na psor&#237;ase e avaliar a correla&#231;&#227;o entre marcadores inflamat&#243;rios tradicionais e novos e a gravidade da doen&#231;a&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Estudo transversal feito em 60 pacientes com psor&#237;ase vulgar e 50 volunt&#225;rios saud&#225;veis&#46; Dados demogr&#225;ficos&#44; &#205;ndice de Gravidade da Psor&#237;ase por &#193;rea e resultados laboratoriais foram analisados e comparados&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Comparados com o grupo controle&#44; os pacientes psori&#225;sicos apresentaram valores significativamente maiores de prote&#237;na C reativa altamente sens&#237;vel&#44; amiloide A s&#233;rica&#44; velocidade de hemossedimenta&#231;&#227;o&#44; leuc&#243;citos&#44; neutr&#243;filos&#44; raz&#227;o neutr&#243;filos&#47;linf&#243;citos&#44; raz&#227;o entre mon&#243;citos e lipoprote&#237;na de alta densidade &#40;HDL&#41; e n&#237;veis de aspartato aminotransferase&#46; Al&#233;m disso&#44; foram observados n&#237;veis significativamente mais baixos de HDL &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; N&#227;o foi observada diferen&#231;a significativa na procalcitonina&#44; linf&#243;citos&#44; mon&#243;citos&#44; hemoglobina&#44; amplitude de distribui&#231;&#227;o de gl&#243;bulos vermelhos&#44; plaquetas&#44; volume m&#233;dio de plaquetas&#44; amplitude de distribui&#231;&#227;o de plaquetas&#44; raz&#227;o linf&#243;citos&#47;mon&#243;citos&#44; pept&#237;deo citrulinado antic&#237;clico&#44; glicose&#44; alanina aminotransaminase&#44; nitrog&#234;nio ureico no sangue&#44; creatinina&#44; triglicer&#237;deos&#44; colesterol total e colesterol LDL entre os dois grupos &#40;p<span class="elsevierStyleHsp" style=""></span>&#62; 0&#44;05&#41;&#46; A pontua&#231;&#227;o no &#205;ndice de Gravidade da Psor&#237;ase por &#193;rea foi correlacionada positivamente com a prote&#237;na C reativa de alta sensibilidade&#44; amiloide A s&#233;rica e raz&#227;o mon&#243;citos&#47;colesterol HDL&#44; e negativamente correlacionada com a raz&#227;o linf&#243;citos&#47;mon&#243;citos &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#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">Estudo de centro &#250;nico com n&#250;mero relativamente limitado de pacientes e controles&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclus&#245;es</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Os dados mostram que prote&#237;na C reativa de alta sensibilidade&#44; amiloide A s&#233;rica&#44; velocidade de hemossedimenta&#231;&#227;o&#44; raz&#227;o neutr&#243;filos&#47;linf&#243;citos e raz&#227;o mon&#243;citos&#47;colesterol HDL podem ser usados como marcadores de inflama&#231;&#227;o sist&#234;mica em pacientes com psor&#237;ase&#46; Al&#233;m disso&#44; prote&#237;na C reativa de alta sensibilidade&#44; amiloide A s&#233;rica&#44; raz&#227;o mon&#243;citos&#47;colesterol HDL e raz&#227;o linf&#243;citos&#47;mon&#243;citos est&#227;o intimamente relacionadas ao escore do &#205;ndice de Gravidade da Psor&#237;ase por &#193;rea e podem ser considerados indicadores objetivos na determina&#231;&#227;o da gravidade da doen&#231;a&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Como citar este artigo&#58; Sirin MC&#44; Korkmaz S&#44; Erturan I&#44; Filiz B&#44; Aridogan BC&#44; Cetin ES&#44; et al&#46; Evaluation of monocyte to HDL cholesterol ratio and other inflammatory markers in patients with psoriasis&#46; An Bras Dermatol&#46; 2020&#59;95&#58;575&#8211;82&#46;</p>"
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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</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">PLT &#40;x 10<span class="elsevierStyleSup">3</span>&#47;&#956;L&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">249&#44;81<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>59&#44;42&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">248&#44;16<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>53&#44;11&nbsp;\t\t\t\t\t\t\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;879&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">MPV &#40;fL&#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">8&#44;71<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;83&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">8&#44;63<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;78&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;643&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">PDW &#40;&#37;&#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">16&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;43&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">16&#44;77<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;42&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;754&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">RNL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;42<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;7&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;009&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">RLM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;14&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;223&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">RMA&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;21<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;11&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;010&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">Anti&#8208;CCP &#40;U&#47;mL&#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">8&#44;58<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;94&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">7&#44;11<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;03&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;248&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">Glicose &#40;mg&#47;dL&#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">105&#44;06<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>45&#44;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">93&#44;63<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#44;38&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;095&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">ALT &#40;UI&#47;L&#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">24&#44;85<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&#44;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">20&#44;92<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#44;75&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;209&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">AST &#40;UI&#47;L&#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">26&#44;52<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#44;97&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#44;75<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#44;27&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">0&#44;038&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">BUN &#40;mg&#47;dL&#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">13&#44;11<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;55&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#44;32<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
                  \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;204&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">Creatinina&#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;91<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;15&nbsp;\t\t\t\t\t\t\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;95<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#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;105&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 &#40;mg&#47;dL&#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">129&#44;98<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>62&#44;24&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">122&#44;97<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>57&#44;73&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;545&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 &#40;mg&#47;dL&#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">186&#44;33<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>29&#44;07&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">192&#44;35<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>33&#44;09&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;160&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&#8208;C &#40;mg&#47;dL&#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">111&#44;95<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>26&#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">113&#44;89<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>29&#44;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;715&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&#8208;C &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">48&#44;37<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#44;39&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">53&#44;21<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#44;52&nbsp;\t\t\t\t\t\t\n
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          "pt" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Compara&#231;&#227;o de caracter&#237;sticas demogr&#225;ficas e achados laboratoriais nos grupos de pacientes e controle</p>"
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          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Os valores foram expressos como m&#233;dia<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DP&#46;</p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">hsPCR&#44; prote&#237;na C reativa de alta sensibilidade&#59; AA&#44; amiloide A s&#233;rica&#59; PCT&#44; procalcitonina&#59; VHS&#44; velocidade de hemossedimenta&#231;&#227;o&#59; WBC&#44; contagem de linf&#243;citos&#59; Hb&#44; hemoglobina&#59; RDW&#44; amplitude de distribui&#231;&#227;o de gl&#243;bulos vermelhos&#59; PLT&#44; contagem de plaquetas&#59; MPV&#44; volume m&#233;dio de plaquetas&#59; PDW&#44; amplitude de distribui&#231;&#227;o de plaquetas&#59; RNL&#44; raz&#227;o neutr&#243;filos&#47;linf&#243;citos&#59; RLM&#44; raz&#227;o linf&#243;citos&#47;mon&#243;citos&#59; RMA&#44; raz&#227;o mon&#243;citos&#47;lipoprote&#237;na de alta densidade&#59; anti&#8208;CCP&#44; pept&#237;deo citrulinado antic&#237;clico&#59; ALT&#44; aminotransaminase&#59; AST&#44; aspartato aminotransferase&#59; BUN&#44; nitrog&#234;nio ureico no sangue&#59; LDL&#8208;C&#44; lipoprote&#237;nas de baixa densidade&#59; HDL&#8208;C&#44; lipoprote&#237;nas de alta densidade&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">PASI &#8805; 10 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>23&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">valor&#8208;p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">hsPCR &#40;mg&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#44;66<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#44;07&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18&#44;03&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">38&#44;66<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>73&#44;42&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</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">PCT &#40;ng&#47;mL&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;0247<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;012&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">0&#44;0271<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;012&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
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">VHS &#40;mm&#47;h&#41;&nbsp;\t\t\t\t\t\t\n
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                  \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">0&#44;473&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">Leuc&#243;citos &#40;x 103&#47;&#956;L&#41;&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</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Neutr&#243;filos &#40;x 10<span class="elsevierStyleSup">3</span>&#47;&#956;L&#41;&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">4&#44;35<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;33&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">5&#44;43<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;081&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">Linf&#243;citos &#40;x 10<span class="elsevierStyleSup">3</span>&#47;&#956;L&#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
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                  \t\t\t\t">2&#44;12<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;63&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;12<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;67&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;996&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">Mon&#243;citos &#40;x 10<span class="elsevierStyleSup">3</span>&#47;&#956;L&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;52<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;15&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;63<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;21&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">0&#44;019&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">Hb &#40;g&#47;dL&#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;33<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;52&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;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;08&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;945&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">RDW &#40;&#37;&#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
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                  \t\t\t\t">14&#44;04<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#44;21<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;59&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;664&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">PLT &#40;x 10<span class="elsevierStyleSup">3</span>&#47;&#956;L&#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">250&#44;27<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>55&#44;43&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">249&#44;08<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>66&#44;64&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;941&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">MPV &#40;fL&#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 ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">RLM&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 ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  """
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        "descripcion" => array:1 [
          "pt" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Compara&#231;&#227;o dos achados laboratoriais em pacientes com psor&#237;ase apresentando PASI &#60;<span class="elsevierStyleHsp" style=""></span>10 e PASI &#8805; 10</p>"
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        "etiqueta" => "Tabela 3"
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8211;&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">&#8211;&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">RMA&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">Anti&#8208;CCP&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">WBC&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Neutr&#243;filos&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\ttop\n
                  \t\t\t\t">Linf&#243;citos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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          "pt" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Correla&#231;&#227;o entre os par&#226;metros laboratoriais relacionados &#224; inflama&#231;&#227;o e o escore PASI em pacientes com psor&#237;ase &#40;valor r &#91;valor p&#93;&#41;</p>"
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Investigação
Avaliação da razão monócitos/colesterol HDL e outros marcadores inflamatórios em pacientes com psoríase
Mumtaz Cem Sirina,
Autor para correspondência
drmcemsirin@yahoo.com

Autor para correspondência.
, Selma Korkmazb, Ijlal Erturanb, Basak Filizb, Buket Cicioglu Aridogana, Emel Sesli Cetina, Mehmet Yildirimb
a Departamento de Microbiologia Médica, Faculdade de Medicina, Suleyman Demirel University, Isparta, Turquia
b Departamento de Dermatologia, Faculdade de Medicina, Suleyman Demirel University, Isparta, Turquia
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Introdu&#231;&#227;o</span><p id="par0005" class="elsevierStylePara elsevierViewall">A psor&#237;ase &#233; doen&#231;a dermatol&#243;gica inflamat&#243;ria cr&#244;nica&#44; mediada por imunidade e que afeta entre 1&#37; e 3&#37; da popula&#231;&#227;o geral&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">1&#8211;3</span></a> A doen&#231;a afeta principalmente a pele&#59; no entanto&#44; a psor&#237;ase &#233; doen&#231;a sist&#234;mica frequentemente associada a comorbidades graves&#44; como doen&#231;as cardiovasculares&#44; s&#237;ndrome metab&#243;lica&#44; artrite&#44; intoler&#226;ncia &#224; glicose e obesidade&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">3&#8211;5</span></a> Acredita&#8208;se que o processo da doen&#231;a na pele seja caracterizado histopatologicamente por diferencia&#231;&#227;o prejudicada e hiperprolifera&#231;&#227;o de queratin&#243;citos epid&#233;rmicos e infiltra&#231;&#227;o de c&#233;lulas imunes&#44; predominantemente c&#233;lulas T e c&#233;lulas dendr&#237;ticas&#46; A inflama&#231;&#227;o &#233; geralmente atribu&#237;da &#224; ativa&#231;&#227;o de neutr&#243;filos e mon&#243;citos circulantes mediados por citocinas pr&#243;&#8208;inflamat&#243;rias&#46; As altera&#231;&#245;es patol&#243;gicas na pele acabam causando a forma&#231;&#227;o local de placas psori&#225;sicas e contribuem ainda mais para o desenvolvimento de inflama&#231;&#227;o sist&#234;mica persistente&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">1&#44;6&#8211;10</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">A inflama&#231;&#227;o sist&#234;mica pode ser avaliada com v&#225;rios marcadores bioqu&#237;micos e hematol&#243;gicos&#46; No entanto&#44; ainda n&#227;o existem biomarcadores sens&#237;veis&#44; espec&#237;ficos e clinicamente &#250;teis que indiquem atividade da doen&#231;a na psor&#237;ase&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">8&#44;11</span></a> Os biomarcadores s&#227;o importantes na pr&#225;tica cl&#237;nica&#44; possibilitam uma avalia&#231;&#227;o objetiva e quantitativa do diagn&#243;stico&#44; processos da doen&#231;a e resposta ao tratamento&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">7</span></a> Atualmente&#44; a escala mais usada na determina&#231;&#227;o da gravidade da psor&#237;ase &#233; o escore do &#205;ndice da Gravidade da Psor&#237;ase por &#193;rea &#40;PASI&#41;&#44; que se baseia em uma avalia&#231;&#227;o visual das les&#245;es cut&#226;neas e combina a gravidade &#40;eritema&#44; endurecimento e descama&#231;&#227;o&#41; e porcentagem de &#225;rea afetada&#46; Entretanto&#44; esse m&#233;todo &#233; limitado por sua natureza subjetiva e sua utilidade na psor&#237;ase sem placa &#233; restrita&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">5&#44;8&#44;9&#44;12</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Entre os reagentes de fase aguda&#44; a prote&#237;na C reativa &#40;PCR&#41; e a velocidade de hemossedimenta&#231;&#227;o &#40;VHS&#41; s&#227;o dois &#237;ndices inflamat&#243;rios bem reconhecidos e podem ser usados para avaliar o &#244;nus da inflama&#231;&#227;o psori&#225;sica e da atividade da doen&#231;a em pacientes com psor&#237;ase&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">1&#44;3&#44;10&#44;12</span></a> Al&#233;m disso&#44; a eleva&#231;&#227;o da PCR &#233; considerada um fator de risco independente para doen&#231;as cardiovasculares&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">12</span></a> A amiloide A s&#233;rica &#40;AA&#41;&#44; outro importante reagente da fase aguda&#44; tamb&#233;m &#233; indicada como uma apolipoprote&#237;na relevante no metabolismo do colesterol e tem sido associada a aterog&#234;nese e doen&#231;as cardiovasculares&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">4&#44;13</span></a> A procalcitonina &#40;PCT&#41;&#44; o pept&#237;deo precursor do horm&#244;nio calcitonina&#44; &#233; liberada em resposta &#224; inflama&#231;&#227;o e tem recebido bastante aten&#231;&#227;o&#44; especialmente como um poss&#237;vel biomarcador de infec&#231;&#227;o bacteriana&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">14&#8211;16</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">A investiga&#231;&#227;o de outros marcadores inflamat&#243;rios&#44; como citocinas&#44; mol&#233;culas de ades&#227;o e quimiocinas por ensaios citom&#233;tricos de fluxo&#44; n&#227;o est&#225; dispon&#237;vel na maioria dos hospitais gerais e centros de sa&#250;de&#44; devido aos altos custos e procedimentos demorados e trabalhosos&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">5&#44;8&#44;16</span></a> Nos &#250;ltimos anos&#44; par&#226;metros hematol&#243;gicos&#44; como a raz&#227;o neutr&#243;filos&#47;linf&#243;citos &#40;RNL&#41;&#44; a raz&#227;o linf&#243;citos&#47;mon&#243;citos &#40;RLM&#41; e a raz&#227;o mon&#243;citos&#47;lipoprote&#237;na de alta densidade &#40;RMH&#41; t&#234;m sido investigados como indicadores de inflama&#231;&#227;o em diferentes doen&#231;as sist&#234;micas&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">5&#44;8&#44;17&#8211;20</span></a> Esses s&#227;o par&#226;metros rapidamente dispon&#237;veis e de baixo custo que podem ser obtidos por hemograma completo de rotina &#40;HCR&#41; e an&#225;lise bioqu&#237;mica&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">O presente estudo teve como objetivo investigar o &#244;nus inflamat&#243;rio sist&#234;mico na psor&#237;ase usando diferentes marcadores bioqu&#237;micos e hematol&#243;gicos e avaliar a correla&#231;&#227;o entre esses marcadores e a gravidade da doen&#231;a&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todos</span><p id="par0030" class="elsevierStylePara elsevierViewall">Este estudo transversal foi feito no Departamento de Dermatologia em colabora&#231;&#227;o com o Departamento de Microbiologia M&#233;dica&#44; Hospital de Pesquisa e Pr&#225;tica da Universidade Suleyman Demirel&#44; entre mar&#231;o de 2019 e setembro de 2019&#46; O estudo foi aprovado pelo Comit&#234; de &#201;tica da Universidade Suleyman Demirel&#44; Faculdade de Medicina &#40;documento n&#176; 72867572&#46;050&#46;01&#46;04&#47;39475&#41;&#46; O protocolo de pesquisa foi conduzido de acordo com a Declara&#231;&#227;o de Helsinque e o termo de consentimento livre e esclarecido foi assinado por todos os participantes antes do in&#237;cio do estudo&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">O estudo incluiu pacientes diagnosticados cl&#237;nica e histopatologicamente com psor&#237;ase vulgar&#46; Pacientes com outras doen&#231;as dermatol&#243;gicas inflamat&#243;rias&#44; doen&#231;a cardiovascular grave&#44; doen&#231;as hep&#225;ticas ou renais cr&#244;nicas&#44; doen&#231;as autoimunes&#44; neoplasias&#44; doen&#231;as end&#243;crinas ou hematol&#243;gicas e aqueles com qualquer hist&#243;rico de uso de medica&#231;&#227;o sist&#234;mica ou t&#243;pica nos &#250;ltimos tr&#234;s meses foram exclu&#237;dos&#46; O grupo controle consistiu em volunt&#225;rios saud&#225;veis&#44; pareados por sexo e idade&#44; sem hist&#243;rico de doen&#231;a sist&#234;mica&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Os exames dermatol&#243;gicos e a pontua&#231;&#227;o do PASI foram feitos pelo mesmo dermatologista&#46; Idade&#44; sexo&#44; hist&#243;rico familiar&#44; idade de in&#237;cio&#44; dura&#231;&#227;o da doen&#231;a e escores PASI de cada paciente foram registrados&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Amostras de sangue venoso foram coletadas de cada paciente e centrifugadas antes de ser examinadas&#46; Os n&#237;veis s&#233;ricos de AA foram medidos pelo m&#233;todo nefelom&#233;trico &#40;analisador BN II&#44; Siemens Healthcare Diagnostics &#8211; Erlangen&#44; Alemanha&#41;&#46; Os n&#237;veis s&#233;ricos de PCT e pept&#237;deo citrulinado antic&#237;clico &#40;anti&#8208;CCP&#41; foram analisados usando um m&#233;todo de imunoensaio automatizado por quimioluminesc&#234;ncia &#40;analisador Roche Cobas e601&#59; Roche Diagnostics &#8211; Mannheim&#44; Alemanha&#41;&#46; An&#225;lise bioqu&#237;mica &#40;PCR de alta sensibilidade &#91;hsPCR&#93;&#44; glicemia em jejum&#44; alanina aminotransaminase &#91;ALT&#93;&#44; aspartato aminotransferase &#91;AST&#93;&#44; nitrog&#234;nio ureico no sangue &#91;BUN&#93;&#44; creatinina&#44; triglicer&#237;deo em jejum &#91;TG&#93;&#44; colesterol total &#91;TC&#93;&#44; colesterol de lipoprote&#237;na de baixa densidade &#91;LDL&#8208;C&#93; e colesterol de lipoprote&#237;na de alta densidade &#91;HDL&#8208;C&#93;&#41; foi feita com um analisador qu&#237;mico AU 5800 &#40;Beckman Coulter &#8211; Brea&#44; Calif&#243;rnia&#44; Estados Unidos&#41;&#46; O hemograma completo &#40;contagem de leuc&#243;citos&#44; contagem de neutr&#243;filos&#44; contagem de linf&#243;citos&#44; contagem de mon&#243;citos&#44; hemoglobina &#91;Hb&#93;&#44; amplitude de distribui&#231;&#227;o de gl&#243;bulos vermelhos &#91;RDW&#93;&#44; contagem de plaquetas &#91;PLT&#93;&#44; volume m&#233;dio de plaquetas &#91;MPV&#93; e amplitude de distribui&#231;&#227;o de plaquetas &#91;PDW&#93;&#41; e a medi&#231;&#227;o da velocidade de hemossedimenta&#231;&#227;o &#40;VHS&#41; foram feitos com um analisador de hematologia UniCel DxH 800 &#40;Beckman Coulter &#8211; Brea&#44; Calif&#243;rnia&#44; Estados Unidos&#41; e um analisador de teste 1 &#40;Alifax &#8211; Padova&#44; It&#225;lia&#41;&#44; respectivamente&#46; Para o hemograma completo e VHS&#44; foram coletadas amostras de sangue venoso de cada paciente em tubos de sangue contendo &#225;cido etilenodiaminotetrac&#233;tico ou citrato&#46; Todos os ensaios foram feitos de acordo com as instru&#231;&#245;es do fabricante&#46; Com base na an&#225;lise bioqu&#237;mica e nos dados de hemograma&#44; foram calculados os valores de RNL&#44; RLM e RMH&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">A an&#225;lise estat&#237;stica foi feita com SPSS v&#46; 20 &#40;SPSS Inc&#46; &#8211; Chicago&#44; Illinois&#44; Estados Unidos&#41;&#46; A normalidade dos dados foi analisada com o teste de Kolmogorov&#8208;Smirnov&#46; Para comparar as diferen&#231;as nas vari&#225;veis cont&#237;nuas entre os grupos&#44; o teste <span class="elsevierStyleItalic">t</span> de Student ou o teste U de Mann&#8208;Whitney foram usados&#46; O teste do qui&#8208;quadrado foi usado para vari&#225;veis categ&#243;ricas&#46; Os resultados foram expressos em frequ&#234;ncias e porcentagens&#44; ou m&#233;dia<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>desvio padr&#227;o&#46; Uma curva de caracter&#237;stica de opera&#231;&#227;o do receptor &#40;ROC&#41; foi tra&#231;ada para a RMH e a &#225;rea sob a curva &#40;AUC&#41; com intervalo de confian&#231;a de 95&#37; &#40;IC&#41; foi calculada&#46; Um valor de corte foi determinado para predizer psor&#237;ase e a sensibilidade&#44; especificidade&#44; valor preditivo positivo &#40;VPP&#41; e valor preditivo negativo &#40;VPN&#41; foram calculados&#46; As correla&#231;&#245;es entre vari&#225;veis foram avaliadas pela an&#225;lise de correla&#231;&#227;o de Spearman&#46; Um valor&#8208;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05 foi considerado estatisticamente significativo&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="par0055" class="elsevierStylePara elsevierViewall">O estudo incluiu 60 pacientes com psor&#237;ase e 50 controles saud&#225;veis&#46; A <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a> apresenta a compara&#231;&#227;o das caracter&#237;sticas demogr&#225;ficas &#40;idade&#44; sexo&#41; e os achados laboratoriais nos grupos de pacientes e controle&#46; Observou&#8208;se hist&#243;rico familiar de psor&#237;ase em 31&#44;7&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>19&#41; dos pacientes&#46; As idades m&#233;dias de in&#237;cio e dura&#231;&#227;o da doen&#231;a em pacientes com psor&#237;ase foram 29&#44;65<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#44;85 anos &#40;intervalo&#58; 8&#8211;63&#41; e 9&#44;14<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;81 anos &#40;intervalo&#58; 1 a 31&#41;&#44; respectivamente&#46; A pontua&#231;&#227;o m&#233;dia no PASI foi de 10&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#44;56 &#40;intervalo&#58; 0&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>46&#44;8&#41; no grupo de pacientes&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">Foram observadas diferen&#231;as significativas nos n&#237;veis de hsPCR&#44; AA&#44; VHS&#44; WBC&#44; neutr&#243;filos&#44; RNL&#44; RMH&#44; AST e HDL&#8208;C entre os grupos paciente e controle &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; Comparados com o grupo controle&#44; os pacientes com psor&#237;ase apresentaram n&#237;veis significativamente mais altos de hsPCR&#44; AA&#44; VHS&#44; WBC&#44; neutr&#243;filos&#44; RNL&#44; RMH e AST e n&#237;veis significativamente mais baixos de HDL&#8208;C &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">N&#227;o foi observada diferen&#231;a significativa nos n&#237;veis de PCT&#44; linf&#243;citos&#44; mon&#243;citos&#44; Hb&#44; RDW&#44; PLT&#44; MPV&#44; PDW&#44; RLM&#44; anti&#8208;CCP&#44; glicose&#44; ALT&#44; BUN&#44; creatinina&#44; TG&#44; TC e LDL&#8208;C entre os dois grupos&#46; Observou&#8208;se anti&#8208;CCP elevado acima do n&#237;vel de corte &#40;&#8805; 17 U&#47;mL&#41; em tr&#234;s dos 60 pacientes com psor&#237;ase&#44; enquanto todos os indiv&#237;duos do grupo controle apresentaram n&#237;veis normais de anti&#8208;CCP&#46; Entre os tr&#234;s pacientes&#44; apenas um deles atendeu os crit&#233;rios CASPAR para o diagn&#243;stico de artrite psori&#225;sica&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Os pacientes com psor&#237;ase foram divididos em dois grupos de acordo com o escore PASI&#46; A gravidade da doen&#231;a com base no escore PASI foi classificada em leve &#40;PASI &#60;<span class="elsevierStyleHsp" style=""></span>10&#41; e moderada&#8208;grave &#40;PASI&#160;&#8805;&#160;10&#41;&#46; Trinta e sete pacientes apresentavam psor&#237;ase leve&#44; enquanto 23 apresentavam psor&#237;ase moderada a grave&#46; A compara&#231;&#227;o dos achados laboratoriais em pacientes com psor&#237;ase que apresentavam PASI &#60;<span class="elsevierStyleHsp" style=""></span>10 e PASI &#8805; 10 &#233; mostrada na <a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#46; Comparados com pacientes com PASI &#60;<span class="elsevierStyleHsp" style=""></span>10&#44; pacientes com PASI &#8805; 10 apresentaram n&#237;veis significativamente mais altos de hsPCR&#44; RMH e mon&#243;citos e n&#237;veis significativamente menores de RLM e HDL&#8208;C &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">A <a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a> apresenta as correla&#231;&#245;es entre os par&#226;metros laboratoriais relacionados &#224; inflama&#231;&#227;o e os escores PASI em pacientes com psor&#237;ase&#46; Foi observada uma correla&#231;&#227;o positiva entre o escore PASI e hsPCR &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;255&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;049&#41;&#44; AA &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;257&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;047&#41; e RMH &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;323&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;012&#41; e uma correla&#231;&#227;o negativa entre esse escore e RLM &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>0&#44;313&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;015&#41;&#46; N&#227;o foi observada correla&#231;&#227;o entre o escore PASI e outros par&#226;metros laboratoriais relacionados &#224; inflama&#231;&#227;o &#40;PCT&#44; VHS&#44; RNL&#44; anti&#8208;CCP&#44; leuc&#243;citos&#44; neutr&#243;filos&#44; linf&#243;citos&#44; mon&#243;citos&#44; RDW&#44; PLT&#44; MPV e PDW&#59; p<span class="elsevierStyleHsp" style=""></span>&#62; 0&#44;05&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">O valor de corte ideal da RMH para a predi&#231;&#227;o da psor&#237;ase foi determinado pela an&#225;lise da curva ROC &#40;AUC<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;631&#44; IC 95&#37;&#58;&#160;0&#44;526&#8211;0&#44;735&#41;&#46; O valor de corte &#8805; 9&#44;52 apresentou sensibilidade diagn&#243;stica de 71&#44;7&#37; &#40;IC 95&#37;&#58;&#160;59&#44;2&#8211;81&#44;5&#41;&#44; especificidade diagn&#243;stica de 54&#37; &#40;IC 95&#37;&#58;&#160;40&#44;4&#8211;67&#41;&#44; VPP de 65&#44;2&#37; &#40;IC 95&#37;&#58;&#160;53&#44;1&#8211;75&#44;5&#41; e VPN de 61&#44;4&#37; &#40;IC 95&#37;&#58;&#160;46&#44;6&#8211;74&#44;3&#41; na previs&#227;o da psor&#237;ase &#40;dados n&#227;o apresentados&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Discuss&#227;o</span><p id="par0085" class="elsevierStylePara elsevierViewall">At&#233; o momento&#44; houve in&#250;meras investiga&#231;&#245;es sobre biomarcadores na psor&#237;ase&#59; no entanto&#44; ainda n&#227;o existem biomarcadores clinicamente relevantes e espec&#237;ficos para a psor&#237;ase&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">1&#44;11</span></a> A pontua&#231;&#227;o PASI e um exame cl&#237;nico cuidadoso ainda s&#227;o a base da avalia&#231;&#227;o da gravidade da doen&#231;a&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">12</span></a> No entanto&#44; alguns marcadores inflamat&#243;rios&#44; como PCR e VHS&#44; ainda est&#227;o sendo usados na pr&#225;tica di&#225;ria com o escore PASI e s&#227;o &#250;teis em algum grau no diagn&#243;stico e acompanhamento cl&#237;nico&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">1&#44;3&#44;12</span></a> No entanto&#44; ainda s&#227;o necess&#225;rios m&#233;todos mais espec&#237;ficos&#44; baratos&#44; pr&#225;ticos e confi&#225;veis para a determina&#231;&#227;o da atividade da psor&#237;ase&#46; Neste estudo&#44; al&#233;m de marcadores inflamat&#243;rios s&#233;ricos bem conhecidos&#44; como hsPCR&#44; AA e PCT&#44; os autores tamb&#233;m tiveram como objetivo investigar novos marcadores inflamat&#243;rios que podem ser facilmente obtidos em hemograma e an&#225;lises bioqu&#237;micas de rotina&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">A PCR&#44; o marcador de inflama&#231;&#227;o s&#233;rica mais comumente usado&#44; pode ser medida rotineiramente por testes de alta sensibilidade&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">6&#44;12</span></a> A hsPCR pode indicar n&#237;veis ainda mais baixos de PCR&#44; que est&#227;o significativamente relacionados a certas doen&#231;as inflamat&#243;rias e cardiovasculares&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">4</span></a> Muitos estudos relataram a utilidade cl&#237;nica da hsPCR na psor&#237;ase&#46; No presente estudo&#44; os n&#237;veis de hsPCR foram significativamente mais altos nos pacientes do que nos controles e estavam positivamente correlacionados com o escore PASI e VHS &#40;tabela&#160;3&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">4&#44;6&#44;9&#44;10&#44;12&#44;21</span></a> Os dados atuais respaldam os relat&#243;rios anteriores&#44; indicam que o n&#237;vel s&#233;rico de PCR pode ser usado como um marcador apropriado para avaliar a gravidade da doen&#231;a na psor&#237;ase&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Ao contr&#225;rio da PCR ou VHS&#44; pouco se sabe sobre a utilidade cl&#237;nica da AA na psor&#237;ase&#46; Al&#233;m disso&#44; em compara&#231;&#227;o com a PCR&#44; os custos mais altos limitam o amplo uso da AA&#44; especialmente em pa&#237;ses em desenvolvimento&#46; Alguns relatos indicaram a associa&#231;&#227;o entre AA e psor&#237;ase&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">4&#44;13&#44;22&#44;23</span></a> Morizane et al&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">13</span></a> sugeriram que&#44; na psor&#237;ase&#44; a inflama&#231;&#227;o da pele melhora a express&#227;o da AA e que a eleva&#231;&#227;o dos n&#237;veis s&#233;ricos da AA pode levar ao desenvolvimento de complica&#231;&#245;es sist&#234;micas&#44; como a aterosclerose&#46; Dogan et al&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">22</span></a> relataram que a AA &#233; um marcador mais espec&#237;fico do que a PCR para avaliar a inflama&#231;&#227;o sist&#234;mica em pacientes com psor&#237;ase&#46; No presente estudo&#44; os n&#237;veis de AA foram significativamente mais altos nos pacientes do que nos controles e foram observadas correla&#231;&#245;es positivas entre a AA&#44; hsPCR e escore PASI &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46; AA e hsPCR s&#227;o os indicadores mais sens&#237;veis &#224; inflama&#231;&#227;o&#46; O uso paralelo desses dois par&#226;metros pode aumentar a sensibilidade e a precis&#227;o na avalia&#231;&#227;o da atividade e gravidade da psor&#237;ase&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Muitos estudos cl&#237;nicos indicaram que a medi&#231;&#227;o da PCT &#233; &#250;til para o diagn&#243;stico e monitoramento de infec&#231;&#245;es bacterianas graves&#44; sepse e disfun&#231;&#227;o de m&#250;ltiplos &#243;rg&#227;os&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">14&#8211;16</span></a> N&#227;o surpreendentemente&#44; o presente estudo encontrou valores normais de PCT em pacientes com psor&#237;ase&#46; Em contraste&#44; Ibrahimbas et al&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">14</span></a> relataram n&#237;veis significativamente aumentados de PCT s&#233;rico em pacientes com psor&#237;ase cr&#244;nica em placas com exacerba&#231;&#245;es&#46; Esses autores levantaram a hip&#243;tese de que um est&#237;mulo antig&#234;nico bacteriano poderia levar a essa eleva&#231;&#227;o&#46; Similarmente aos resultados do presente estudo&#44; Nagai et al&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">15</span></a> n&#227;o encontraram eleva&#231;&#227;o significativa dos n&#237;veis de PCT em pacientes com psor&#237;ase vulgar&#44; artrite psori&#225;sica e psor&#237;ase pustular generalizada&#46; Esses autores sugeriram que uma infec&#231;&#227;o microbiana &#233; improv&#225;vel na patog&#234;nese da psor&#237;ase&#46; Grandes estudos prospectivos com casos cuidadosamente selecionados com diferentes formas de psor&#237;ase s&#227;o necess&#225;rios para esclarecer o papel da PCT na psor&#237;ase&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">A citrulina&#231;&#227;o &#233; modifica&#231;&#227;o p&#243;s&#8208;traducional de prote&#237;nas que ocorre no contexto de inflama&#231;&#227;o&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">24</span></a> Os anticorpos anti&#8208;CCP s&#227;o direcionados contra pept&#237;deos citrulinados e s&#227;o comumente usados como um marcador diagn&#243;stico para artrite reumatoide&#46;<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">24&#44;25</span></a> No entanto&#44; relatos recentes sugeriram que os anticorpos anti&#8208;CCP tamb&#233;m s&#227;o observados na artrite psori&#225;sica&#44; artrite idiop&#225;tica juvenil&#44; gota e espondilite anquilosante&#46;<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">25&#44;26</span></a> Al&#233;m disso&#44; foi demonstrado que existem ep&#237;topos citrulinados nas placas ateroscler&#243;ticas que s&#227;o alvo de anticorpos anti&#8208;CCP e que a eleva&#231;&#227;o do anti&#8208;CCP est&#225; correlacionada a um risco cardiovascular progressivamente aumentado&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">24</span></a> &#192; luz dessas observa&#231;&#245;es&#44; o presente estudo teve como objetivo analisar os n&#237;veis de anti&#8208;CCP em termos de avalia&#231;&#227;o do &#244;nus inflamat&#243;rio na psor&#237;ase&#46; N&#237;veis mais altos de anti&#8208;CCP foram observados em pacientes psori&#225;sicos quando comparados com o grupo controle&#46; N&#237;veis elevados de anti&#8208;CCP tamb&#233;m foram observados em pacientes com psor&#237;ase moderada&#8208;grave quando comparados aos pacientes com psor&#237;ase leve&#46; Embora sem atingir signific&#226;ncia estat&#237;stica&#44; pode&#8208;se especular que esses resultados refletem parcialmente a diferen&#231;a no &#244;nus inflamat&#243;rio entre os grupos&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Os gl&#243;bulos brancos imunocompetentes&#44; inclusive neutr&#243;filos&#44; linf&#243;citos e mon&#243;citos&#44; desempenham um papel cr&#237;tico na resposta inflamat&#243;ria sist&#234;mica&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">16</span></a> Os neutr&#243;filos est&#227;o entre as primeiras c&#233;lulas a migrar para locais de inflama&#231;&#227;o e tamb&#233;m s&#227;o bastante ativos no recrutamento de outras c&#233;lulas imunes para as les&#245;es&#44; como macr&#243;fagos derivados de mon&#243;citos&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">9</span></a> A rea&#231;&#227;o inflamat&#243;ria sist&#234;mica geralmente causa neutrofilia e linfocitopenia relativa&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">16</span></a> A RNL&#44; um &#237;ndice combinado que usa contagens de neutr&#243;filos e linf&#243;citos&#44; pode indicar com mais precis&#227;o as flutua&#231;&#245;es entre neutr&#243;filos e linf&#243;citos na inflama&#231;&#227;o sist&#234;mica<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">8&#44;16</span></a> Nos &#250;ltimos anos&#44; foi demonstrado que a RNL &#233; um marcador de inflama&#231;&#227;o sist&#234;mica em v&#225;rias doen&#231;as&#44; como aterosclerose&#44; infarto do mioc&#225;rdio&#44; diabetes <span class="elsevierStyleItalic">mellitus</span>&#44; colite ulcerativa&#44; neoplasias e psor&#237;ase&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">3&#44;5&#44;8&#44;17&#44;18&#44;21&#44;27&#44;28</span></a> A RLM&#44; que tamb&#233;m reflete o &#244;nus de inflama&#231;&#227;o sist&#234;mica&#44; tem sido amplamente investigada como um marcador progn&#243;stico &#250;til em v&#225;rios tipos de c&#226;ncer&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">19</span></a> A literatura n&#227;o apresenta dados sobre a rela&#231;&#227;o entre psor&#237;ase e RLM&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">No presente estudo&#44; foi observada uma contagem de leuc&#243;citos significativamente maior em pacientes com psor&#237;ase&#44; devido ao aumento na contagem de neutr&#243;filos e mon&#243;citos&#46; Como em estudos anteriores&#44; a RNL foi significativamente maior em pacientes com psor&#237;ase em compara&#231;&#227;o com os controles&#46; No entanto&#44; a literatura apresenta resultados discrepantes quanto &#224; correla&#231;&#227;o entre os valores de RNL e o escore PASI&#46; Kim et al&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">3&#44;5&#44;8&#44;17&#44;18&#44;21&#44;27&#44;28</span></a> demonstraram uma correla&#231;&#227;o positiva entre a RNL e o escore PASI&#46; Por outro lado&#44; os resultados atuais foram consistentes com os resultados de dois estudos feitos na Turquia&#44; que n&#227;o observaram correla&#231;&#227;o entre a RNL e o escore PASI&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">8&#44;28</span></a> Essas discrep&#226;ncias podem ocorrer devido &#224;s diferen&#231;as no tamanho da amostra&#44; na popula&#231;&#227;o do estudo ou nos valores m&#233;dios do PASI&#46; Curiosamente&#44; n&#227;o foi observada uma diferen&#231;a significativa entre os grupos paciente e controle em termos de valores de RLM&#44; mas valores significativamente diferentes de RLM foram observados entre pacientes com psor&#237;ase leve e pacientes com psor&#237;ase moderada&#8208;grave&#46; Al&#233;m disso&#44; foram observadas correla&#231;&#245;es negativas significativas entre a RLM&#44; RNL e escore PASI &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46; Com base nesses resultados&#44; pode&#8208;se concluir que a RNL &#233; mais &#250;til na demonstra&#231;&#227;o de inflama&#231;&#227;o em pacientes com psor&#237;ase e que a RLM pode ser mais &#250;til na avalia&#231;&#227;o da atividade da doen&#231;a&#46; No entanto&#44; os pacientes psori&#225;sicos com valores de RNL elevados ou RLM baixos devem ser cuidadosamente monitorados&#44; mesmo que seus escores PASI sejam baixos&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">As plaquetas desempenham um papel crucial na manuten&#231;&#227;o da homeostase&#44; mas tamb&#233;m s&#227;o consideradas mediadores importantes das rea&#231;&#245;es inflamat&#243;rias agudas e cr&#244;nicas&#46; Eles podem ajudar outras c&#233;lulas inflamat&#243;rias a migrar para os locais das les&#245;es&#44; liberar grandes quantidades de citocinas inflamat&#243;rias e criar um ambiente inflamat&#243;rio&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">2&#44;11&#44;28</span></a> MPV e PDW s&#227;o conhecidos como &#237;ndices de ativa&#231;&#227;o PLT&#44; refletem a taxa de produ&#231;&#227;o e estimula&#231;&#227;o de PLT&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">2&#44;11&#44;29</span></a> A literatura apresenta resultados contradit&#243;rios quanto &#224; rela&#231;&#227;o entre marcadores de ativa&#231;&#227;o plaquet&#225;ria e psor&#237;ase&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">2&#44;27&#44;29&#44;30</span></a> Em um estudo feito na Coreia&#44; foram encontrados valores significativamente mais altos de MPV e PDW em pacientes com psor&#237;ase do que em controles e uma correla&#231;&#227;o positiva foi observada entre MPV e o escore PASI&#46; Em contrapartida&#44; Saleh et al&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">11&#44;31</span></a> n&#227;o observaram diferen&#231;a significativa nos n&#237;veis de MPV entre pacientes com psor&#237;ase e controles&#46; Do mesmo modo&#44; o presente estudo encontrou n&#237;veis mais altos de plaquetas&#44; MPV e PDW em pacientes com psor&#237;ase em compara&#231;&#227;o ao grupo controle&#44; mas a diferen&#231;a entre os dois grupos n&#227;o foi significativa&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Mon&#243;citos e macr&#243;fagos desempenham um papel fundamental no processo de inflama&#231;&#227;o durante o desenvolvimento e progress&#227;o da aterosclerose&#46; No est&#225;gio inicial do processo&#44; os mon&#243;citos circulantes migram para o espa&#231;o subendotelial da parede arterial&#44; transformam&#8208;se em macr&#243;fagos e internalizam LDLs oxidados e outros lip&#237;dios&#46; Em seguida&#44; essas c&#233;lulas se diferenciam nas c&#233;lulas espumosas para liberar citocinas pr&#243;&#8208;inflamat&#243;rias no local da inflama&#231;&#227;o que ativam linf&#243;citos T&#44; plaquetas e outros mon&#243;citos&#46;<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">20&#44;32</span></a> No entanto&#44; o HDL&#8208;C inibe as atividades de mon&#243;citos&#44; impede a transforma&#231;&#227;o de mon&#243;citos em macr&#243;fagos e elimina o colesterol dessas c&#233;lulas&#44; o que restringe a resposta inflamat&#243;ria&#46;<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">20&#44;32&#8211;34</span></a> Portanto&#44; &#233; razo&#225;vel combinar esses dois par&#226;metros em um &#250;nico &#237;ndice &#40;RMH&#41; como marcador inflamat&#243;rio&#46; Foi relatado que o aumento do n&#237;vel de RMH estava associado &#224; inflama&#231;&#227;o sist&#234;mica e que a RMH poderia ser usada como marcador preditivo de doen&#231;a cardiovascular futura&#46;<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">20&#44;32&#8211;35</span></a> Tanto quanto &#233; do conhecimento dos autores&#44; a RMH ainda n&#227;o foi avaliada em pacientes com psor&#237;ase&#46; O presente estudo apontou que os n&#237;veis de RMH no grupo de pacientes eram mais altos do que nos controles saud&#225;veis e que os valores da RMH estavam positivamente correlacionados com o escore PASI&#46; Por ser um par&#226;metro pr&#225;tico&#44; econ&#244;mico e reprodut&#237;vel da an&#225;lise do hemograma e bioqu&#237;mica&#44; a RMH pode ser usada na pr&#225;tica cl&#237;nica para a avalia&#231;&#227;o da gravidade da psor&#237;ase&#46; A avalia&#231;&#227;o dos n&#237;veis de RMH juntamente com outros marcadores que predizem risco cardiovascular&#44; como hsPCR e AA&#44; pode fornecer uma nova base para a identifica&#231;&#227;o de pacientes psori&#225;sicos com maior risco de doen&#231;a cardiovascular&#46; No entanto&#44; mais estudos prospectivos com amostras maiores s&#227;o necess&#225;rios para validar o uso cl&#237;nico da RMH em pacientes com psor&#237;ase&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">O presente estudo apresenta algumas limita&#231;&#245;es que devem ser consideradas na interpreta&#231;&#227;o de seus resultados&#46; Este foi um estudo de centro &#250;nico com n&#250;mero relativamente limitado de pacientes e controles&#46; Al&#233;m disso&#44; os marcadores inflamat&#243;rios foram mensurados apenas na admiss&#227;o e n&#227;o foi poss&#237;vel avaliar as altera&#231;&#245;es nos n&#237;veis dos marcadores e escore PASI ap&#243;s o tratamento durante o per&#237;odo de acompanhamento&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conclus&#245;es</span><p id="par0135" class="elsevierStylePara elsevierViewall">Os dados demonstram que n&#237;veis elevados de hsPCR&#44; AA&#44; VHS&#44; RNL e RMH podem refletir o &#244;nus inflamat&#243;rio sist&#234;mico em pacientes com psor&#237;ase&#46; Al&#233;m disso&#44; hsPCR&#44; AA&#44; RMH e RLM est&#227;o intimamente relacionados ao escore PASI&#59; esses marcadores podem ser usados na pr&#225;tica di&#225;ria para avaliar a gravidade da psor&#237;ase&#46; No entanto&#44; estudos adicionais s&#227;o necess&#225;rios para respaldar esses achados&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Suporte financeiro</span><p id="par0185" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Contribui&#231;&#227;o dos autores</span><p id="par0140" class="elsevierStylePara elsevierViewall">Mumtaz Cem Sirin&#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&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Selma Korkmaz&#58; An&#225;lise estat&#237;stica&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; revis&#227;o cr&#237;tica da literatura&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Ijlal Erturan&#58; An&#225;lise estat&#237;stica&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; revis&#227;o cr&#237;tica da literatura&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Basak Filiz&#58; Obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; revis&#227;o cr&#237;tica da literatura&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Buket Cicioglu Aridogan&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#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="par0165" class="elsevierStylePara elsevierViewall">Emel Sesli Cetin&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#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="par0170" class="elsevierStylePara elsevierViewall">Mehmet Yildirim&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; concep&#231;&#227;o e planejamento do estudo&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conflitos de interesse</span><p id="par0180" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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            2 => "Inflama&#231;&#227;o"
            3 => "Mon&#243;citos"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Fundamentos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A psor&#237;ase &#233; doen&#231;a inflamat&#243;ria sist&#234;mica cr&#244;nica frequentemente associada a comorbidades graves&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Investigar o &#244;nus inflamat&#243;rio sist&#234;mico na psor&#237;ase e avaliar a correla&#231;&#227;o entre marcadores inflamat&#243;rios tradicionais e novos e a gravidade da doen&#231;a&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Estudo transversal feito em 60 pacientes com psor&#237;ase vulgar e 50 volunt&#225;rios saud&#225;veis&#46; Dados demogr&#225;ficos&#44; &#205;ndice de Gravidade da Psor&#237;ase por &#193;rea e resultados laboratoriais foram analisados e comparados&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Comparados com o grupo controle&#44; os pacientes psori&#225;sicos apresentaram valores significativamente maiores de prote&#237;na C reativa altamente sens&#237;vel&#44; amiloide A s&#233;rica&#44; velocidade de hemossedimenta&#231;&#227;o&#44; leuc&#243;citos&#44; neutr&#243;filos&#44; raz&#227;o neutr&#243;filos&#47;linf&#243;citos&#44; raz&#227;o entre mon&#243;citos e lipoprote&#237;na de alta densidade &#40;HDL&#41; e n&#237;veis de aspartato aminotransferase&#46; Al&#233;m disso&#44; foram observados n&#237;veis significativamente mais baixos de HDL &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; N&#227;o foi observada diferen&#231;a significativa na procalcitonina&#44; linf&#243;citos&#44; mon&#243;citos&#44; hemoglobina&#44; amplitude de distribui&#231;&#227;o de gl&#243;bulos vermelhos&#44; plaquetas&#44; volume m&#233;dio de plaquetas&#44; amplitude de distribui&#231;&#227;o de plaquetas&#44; raz&#227;o linf&#243;citos&#47;mon&#243;citos&#44; pept&#237;deo citrulinado antic&#237;clico&#44; glicose&#44; alanina aminotransaminase&#44; nitrog&#234;nio ureico no sangue&#44; creatinina&#44; triglicer&#237;deos&#44; colesterol total e colesterol LDL entre os dois grupos &#40;p<span class="elsevierStyleHsp" style=""></span>&#62; 0&#44;05&#41;&#46; A pontua&#231;&#227;o no &#205;ndice de Gravidade da Psor&#237;ase por &#193;rea foi correlacionada positivamente com a prote&#237;na C reativa de alta sensibilidade&#44; amiloide A s&#233;rica e raz&#227;o mon&#243;citos&#47;colesterol HDL&#44; e negativamente correlacionada com a raz&#227;o linf&#243;citos&#47;mon&#243;citos &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#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">Estudo de centro &#250;nico com n&#250;mero relativamente limitado de pacientes e controles&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclus&#245;es</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Os dados mostram que prote&#237;na C reativa de alta sensibilidade&#44; amiloide A s&#233;rica&#44; velocidade de hemossedimenta&#231;&#227;o&#44; raz&#227;o neutr&#243;filos&#47;linf&#243;citos e raz&#227;o mon&#243;citos&#47;colesterol HDL podem ser usados como marcadores de inflama&#231;&#227;o sist&#234;mica em pacientes com psor&#237;ase&#46; Al&#233;m disso&#44; prote&#237;na C reativa de alta sensibilidade&#44; amiloide A s&#233;rica&#44; raz&#227;o mon&#243;citos&#47;colesterol HDL e raz&#227;o linf&#243;citos&#47;mon&#243;citos est&#227;o intimamente relacionadas ao escore do &#205;ndice de Gravidade da Psor&#237;ase por &#193;rea e podem ser considerados indicadores objetivos na determina&#231;&#227;o da gravidade da doen&#231;a&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Como citar este artigo&#58; Sirin MC&#44; Korkmaz S&#44; Erturan I&#44; Filiz B&#44; Aridogan BC&#44; Cetin ES&#44; et al&#46; Evaluation of monocyte to HDL cholesterol ratio and other inflammatory markers in patients with psoriasis&#46; An Bras Dermatol&#46; 2020&#59;95&#58;575&#8211;82&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Trabalho realizado no Hospital de Pesquisa e Pr&#225;tica&#44; Suleyman Demirel University&#44; Cunur&#44; Isparta&#44; Turquia&#46;</p>"
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          "leyenda" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Os valores s&#227;o expressos em n &#40;&#37;&#41; ou m&#233;dia<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DP&#46;</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">hsPCR&#44; prote&#237;na C reativa de alta sensibilidade&#59; AA&#44; amiloide A s&#233;rica&#59; PCT&#44; procalcitonina&#59; VHS&#44; velocidade de hemossedimenta&#231;&#227;o&#59; WBC&#44; contagem de linf&#243;citos&#59; Hb&#44; hemoglobina&#59; RDW&#44; amplitude de distribui&#231;&#227;o de gl&#243;bulos vermelhos&#59; PLT&#44; contagem de plaquetas&#59; MPV&#44; volume m&#233;dio de plaquetas&#59; PDW&#44; amplitude de distribui&#231;&#227;o de plaquetas&#59; RNL&#44; raz&#227;o neutr&#243;filos&#47;linf&#243;citos&#59; RLM&#44; raz&#227;o linf&#243;citos&#47;mon&#243;citos&#59; RMA&#44; raz&#227;o mon&#243;citos&#47;lipoprote&#237;na de alta densidade&#59; anti&#8208;CCP&#44; pept&#237;deo citrulinado antic&#237;clico&#59; ALT&#44; aminotransaminase&#59; AST&#44; aspartato aminotransferase&#59; BUN&#44; nitrog&#234;nio ureico no sangue&#59; LDL&#8208;C&#44; lipoprote&#237;nas de baixa densidade&#59; HDL&#8208;C&#44; lipoprote&#237;nas de alta densidade&#46;</p>"
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                  \t\t\t\t">hsPCR &#40;mg&#47;L&#41;&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\ttop\n
                  \t\t\t\t">6&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#44;15&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;025&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">AA &#40;mg&#47;L&#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
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;029&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">PCT &#40;ng&#47;mL&#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
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                  \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">VHS &#40;mm&#47;h&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \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;citos &#40;x 10<span class="elsevierStyleSup">3</span>&#47;&#956;L&#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
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                  \t\t\t\t  " align="left" valign="\n
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                  \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">Neutr&#243;filos &#40;x 10<span class="elsevierStyleSup">3</span>&#47;&#956;L&#41;&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
                  \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">Linf&#243;citos &#40;x 10<span class="elsevierStyleSup">3</span>&#47;&#956;L&#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">Mon&#243;citos &#40;x 10<span class="elsevierStyleSup">3</span>&#47;&#956;L&#41;&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</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">Hb &#40;g&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">RDW &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">0&#44;879&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">MPV &#40;fL&#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
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                  \t\t\t\t">0&#44;643&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">PDW &#40;&#37;&#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
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                  \t\t\t\t">16&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;43&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;754&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">RNL&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</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">RLM&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  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \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">RMA&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;21<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;11&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;010&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">Anti&#8208;CCP &#40;U&#47;mL&#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">8&#44;58<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;94&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">7&#44;11<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;03&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;248&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">Glicose &#40;mg&#47;dL&#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">105&#44;06<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>45&#44;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">93&#44;63<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#44;38&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;095&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">ALT &#40;UI&#47;L&#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">24&#44;85<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&#44;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">20&#44;92<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#44;75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;209&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">AST &#40;UI&#47;L&#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">26&#44;52<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#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">21&#44;75<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#44;27&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;038&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">BUN &#40;mg&#47;dL&#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">13&#44;11<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;55&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;32<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
                  \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;204&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">Creatinina&#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;91<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;95<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#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;105&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 &#40;mg&#47;dL&#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">129&#44;98<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>62&#44;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">122&#44;97<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>57&#44;73&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;545&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 &#40;mg&#47;dL&#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">186&#44;33<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>29&#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">192&#44;35<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>33&#44;09&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;160&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&#8208;C &#40;mg&#47;dL&#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">111&#44;95<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>26&#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">113&#44;89<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>29&#44;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;715&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&#8208;C &#40;mg&#47;dL&#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
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                  \t\t\t\t">48&#44;37<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#44;39&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">53&#44;21<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#44;52&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">0&#44;020&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">hsPCR &#40;mg&#47;L&#41;&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">3&#44;66<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#44;07&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18&#44;03&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;038&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">AA &#40;mg&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#44;27<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>43&#44;15&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">38&#44;66<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>73&#44;42&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;280&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">PCT &#40;ng&#47;mL&#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">0&#44;0247<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;012&nbsp;\t\t\t\t\t\t\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;0271<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;012&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;474&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 &#40;mm&#47;h&#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
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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">26&#44;65<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&#44;13&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;473&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;citos &#40;x 103&#47;&#956;L&#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">7&#44;22<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;75&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
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;080&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">Neutr&#243;filos &#40;x 10<span class="elsevierStyleSup">3</span>&#47;&#956;L&#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">4&#44;35<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;43<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;32&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;081&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">Linf&#243;citos &#40;x 10<span class="elsevierStyleSup">3</span>&#47;&#956;L&#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">2&#44;12<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;12<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;67&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;996&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">Mon&#243;citos &#40;x 10<span class="elsevierStyleSup">3</span>&#47;&#956;L&#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">0&#44;52<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;63<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#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;019&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">Hb &#40;g&#47;dL&#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;33<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;52&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;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;08&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">0&#44;945&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">RDW &#40;&#37;&#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;04<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;4&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</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;664&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">PLT &#40;x 10<span class="elsevierStyleSup">3</span>&#47;&#956;L&#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">250&#44;27<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>55&#44;43&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">249&#44;08<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>66&#44;64&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;941&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">MPV &#40;fL&#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">8&#44;71<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;93&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#44;69<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;66&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;917&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">PDW &#40;&#37;&#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">16&#44;79<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#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">16&#44;81<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;36&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;874&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">RNL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;17<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;77&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">2&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;22&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;118&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">RLM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;38<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;54&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">3&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;67&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">0&#44;007&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">RMA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#44;71<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#44;63<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#44;54&nbsp;\t\t\t\t\t\t\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;003&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">Anti&#8208;CCP &#40;U&#47;mL&#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
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">hsPCR&#44; prote&#237;na C reativa de alta sensibilidade&#59; AA&#44; amiloide A s&#233;rica&#59; PCT&#44; procalcitonina&#59; VHS&#44; velocidade de hemossedimenta&#231;&#227;o&#59; WBC&#44; contagem de linf&#243;citos&#59; Hb&#44; hemoglobina&#59; RDW&#44; amplitude de distribui&#231;&#227;o de gl&#243;bulos vermelhos&#59; PLT&#44; contagem de plaquetas&#59; MPV&#44; volume m&#233;dio de plaquetas&#59; PDW&#44; amplitude de distribui&#231;&#227;o de plaquetas&#59; RNL&#44; raz&#227;o neutr&#243;filos&#47;linf&#243;citos&#59; RLM&#44; raz&#227;o linf&#243;citos&#47;mon&#243;citos&#59; RMA&#44; raz&#227;o mon&#243;citos&#47;lipoprote&#237;na de alta densidade&#46;</p>"
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">WBC&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Neutr&#243;filos&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\ttop\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\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
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\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">Mon&#243;citos&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">0&#44;233 &#40;0&#44;073&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;013 &#40;0&#44;919&#41;&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</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">RDW&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;120 &#40;0&#44;360&#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">PLT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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