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como &#225;cidos graxos de cadeia longa insaturados e saturados&#44; bem como eicosanoides e outros lip&#237;deos que protegem os organismos contra seu ac&#250;mulo prejudicial&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">7</span></a> A FABP4 &#233; secretada por adip&#243;citos e macr&#243;fagos e est&#225; intimamente associada &#224; obesidade e &#224; s&#237;ndrome metab&#243;lica &#40;SM&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">8</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">A SM &#233; uma condi&#231;&#227;o na qual a resist&#234;ncia &#224; insulina &#233; desenvolvida e&#44; eventualmente&#44; leva a problemas cardiovasculares&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">9</span></a> Cerca de 25&#37; da popula&#231;&#227;o em todo o mundo &#233; afetada pela SM&#44; com uma subpopula&#231;&#227;o substancial ligada a muitas doen&#231;as inflamat&#243;rias da pele&#44;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">10</span></a> incluindo vitiligo&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">11</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Zhang et al&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">12</span></a> descobriram a exist&#234;ncia de altos n&#237;veis de FABP4 sist&#234;mica e local em pacientes com osteoartrite&#46; No campo da dermatologia&#44; Baran et al&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">13</span></a> relataram que os n&#237;veis s&#233;ricos de FABP4 estavam significantemente aumentados em pacientes com psor&#237;ase&#46; Como o vitiligo &#233; considerado uma doen&#231;a inflamat&#243;ria&#44; a proposta deste estudo &#233; que&#44; no vitiligo&#44; a FABP4 pode atuar na interface das vias inflamat&#243;rias e metab&#243;licas&#46; Portanto&#44; o objetivo deste estudo foi avaliar o n&#237;vel s&#233;rico de FABP4 em pacientes com vitiligo e sua rela&#231;&#227;o com SM&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Pacientes e m&#233;todos</span><p id="par0035" class="elsevierStylePara elsevierViewall">Este &#233; um estudo caso&#8208;controle realizado em 90 indiv&#237;duos&#46; Eles inclu&#237;am 45 pacientes com diferentes tipos cl&#237;nicos de VNS e 45 indiv&#237;duos saud&#225;veis pareados por idade e g&#234;nero &#40;grupo controle&#41;&#44; selecionados do Ambulat&#243;rio de Dermatologia&#46; O diagn&#243;stico de vitiligo foi feito com base na hist&#243;ria do paciente e nas caracter&#237;sticas cl&#237;nicas t&#237;picas &#40;m&#225;culas e manchas discretas&#44; bem circunscritas&#44; despigmentadas&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">O estudo foi aprovado pelo Comit&#234; de Direitos Humanos em Pesquisa da Universidade&#46; Um termo de consentimento livre e informado por escrito foi obtido de cada participante ou de seus respons&#225;veis &#40;se &#60; 18 anos&#41; antes do in&#237;cio deste estudo&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Casos de VNS de ambos os sexos foram inclu&#237;dos&#46; Todo paciente inclu&#237;do precisou interromper qualquer tipo de tratamento sist&#234;mico &#40;seis semanas&#41; ou t&#243;pico &#40;duas semanas&#41; para vitiligo&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Indiv&#237;duos com doen&#231;as cut&#226;neas imunoinflamat&#243;rias &#40;por exemplo&#44; psor&#237;ase&#44; dermatite at&#243;pica&#41; e&#47;ou sist&#234;micas &#40;por exemplo&#44; da tireoide e do tecido conjuntivo&#41; e aqueles que tinham recebido corticosteroides sist&#234;micos e&#47;ou outros imunossupressores no &#250;ltimo m&#234;s foram exclu&#237;dos deste estudo&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Os pacientes estudados foram submetidos &#224; anamnese&#46; O &#237;ndice de massa corporal &#40;IMC&#41; foi calculado dividindo&#8208;se a massa corporal &#40;quilogramas&#41; pelo quadrado da altura corporal &#40;metros&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">14</span></a> A medida da press&#227;o arterial &#40;PA&#41; foi feita utilizando&#8208;se um esfigmoman&#244;metro de merc&#250;rio padr&#227;o ap&#243;s os indiv&#237;duos terem descansado por pelo menos 10 minutos com o bra&#231;o na altura do cora&#231;&#227;o&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Exame dermatol&#243;gico foi realizado para garantir o diagn&#243;stico de vitiligo NS&#44; determinar sua localiza&#231;&#227;o e identificar seu tipo &#40;acrofacial&#44; da mucosa&#44; generalizado&#44; universal ou misto&#41;&#46; A gravidade e a atividade da doen&#231;a foram avaliadas utilizando o &#237;ndice de pontua&#231;&#227;o da &#225;rea de vitiligo &#40;VASI&#44; do ingl&#234;s <span class="elsevierStyleItalic">Vitiligo Area Scoring Index</span>&#41; e a atividade da doen&#231;a do vitiligo &#40;VIDA&#44; do ingl&#234;s <span class="elsevierStyleItalic">Vitiligo Disease Activity</span>&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Para calcular o escore VASI&#44; o corpo foi dividido em cinco regi&#245;es&#58; m&#227;os&#44; extremidades superiores &#40;excluindo as m&#227;os&#41;&#44; tronco&#44; extremidades inferiores &#40;excluindo os p&#233;s&#41; e p&#233;s&#46; As axilas foram inclu&#237;das nas extremidades superiores&#44; enquanto as n&#225;degas e as regi&#245;es inguinais foram inclu&#237;das nas extremidades inferiores&#46; Uma unidade&#8208;m&#227;o &#40;a palma da m&#227;o mais a superf&#237;cie volar de todos os dedos&#41; foi usada como guia para estimar a porcentagem de acometimento de vitiligo &#40;1&#37;&#41; em cada regi&#227;o corporal&#46; A despigmenta&#231;&#227;o dentro de cada &#225;rea foi estimada em rela&#231;&#227;o &#224;s seguintes porcentagens&#58; 0 &#40;pele pigmentada normal&#41;&#44; 10&#37; &#40;pontos de despigmenta&#231;&#227;o&#41;&#44; 25&#37; &#40;&#225;rea pigmentada excede a &#225;rea despigmentada&#41;&#44; 50&#37; &#40;&#225;reas despigmentadas e pigmentadas s&#227;o iguais&#41;&#44; 75&#37; &#40;&#225;rea despigmentada excede a &#225;rea pigmentada&#41;&#44; 90&#37; &#40;pontos de pigmento&#41; e 100&#37; &#40;sem pigmento&#41;&#46; O VASI foi calculado utilizando&#8208;se esta f&#243;rmula&#58; VASI &#61; &#931; &#40;todas as partes do corpo&#41; &#40;unidades&#8208;m&#227;o&#41; &#215; &#40;despigmenta&#231;&#227;o&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">15</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">O escore VIDA baseou&#8208;se na opini&#227;o do pr&#243;prio paciente sobre a atividade da doen&#231;a ao longo do tempo&#46; O vitiligo ativo inclui a extens&#227;o de les&#245;es cut&#226;neas existentes ou o aparecimento de novas&#46; O escore foi classificado de &#43;4 &#40;ativo nas &#250;ltimas seis semanas&#41;&#44; &#43;3 &#40;ativo nos &#250;ltimos tr&#234;s meses&#41;&#44; &#43;2 &#40;ativo nos &#250;ltimos seis meses&#41;&#44; &#43;1 &#40;ativo no &#250;ltimo ano&#41;&#44; 0 &#40;est&#225;vel por pelo menos um ano&#41; a &#8722;1 &#40;est&#225;vel por pelo menos um ano e repigmenta&#231;&#227;o espont&#226;nea&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">16</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Ap&#243;s jejum noturno&#44; a pele sobre uma veia foi esterilizada com &#225;lcool 70&#37; e&#44; em seguida&#44; 5<span class="elsevierStyleHsp" style=""></span>mL de sangue venoso foram coletados de todos os indiv&#237;duos&#59; 3<span class="elsevierStyleHsp" style=""></span>mL de sangue venoso foram transferidos para um tubo simples&#44; deixados em repouso por meia hora e&#44; em seguida&#44; centrifugados por 10<span class="elsevierStyleHsp" style=""></span>min a 4&#46;000<span class="elsevierStyleHsp" style=""></span>rpm&#46; O soro foi obtido para a determina&#231;&#227;o do perfil lip&#237;dico e o n&#237;vel de FABP4&#44; enquanto 2<span class="elsevierStyleHsp" style=""></span>mL de sangue foram transferidos para tubos contendo fluoreto de s&#243;dio&#44; centrifugados por 10<span class="elsevierStyleHsp" style=""></span>min a 4&#46;000<span class="elsevierStyleHsp" style=""></span>rpm&#46; O plasma foi obtido para a determina&#231;&#227;o da glicose em jejum&#46; Outra amostra de sangue foi obtida para determinar a glicose 2 horas p&#243;s&#8208;prandial&#46; As amostras foram mantidas congeladas a &#8722;20<span class="elsevierStyleHsp" style=""></span>&#176;C at&#233; a an&#225;lise&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">O perfil lip&#237;dico incluindo triglicer&#237;deos &#40;TG&#41;&#44; n&#237;vel de colesterol e lipoprote&#237;nas como lipoprote&#237;nas de alta densidade &#40;HDL&#41; e lipoprote&#237;nas de baixa densidade &#40;LDL&#41;&#44; al&#233;m de glicemia de jejum e 2 horas p&#243;s&#8208;prandial no sangue foram medidos por um analisador qu&#237;mico autom&#225;tico &#40;sistema AU480 de Beckman Coulter&#44; EUA&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">O diagn&#243;stico de SM foi feito de acordo com a avalia&#231;&#227;o de TG&#44; LDL&#44; glicemia de jejum e press&#227;o arterial como segue&#58; TG &#8805; 150<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; n&#237;vel de HDL&#8208;C &#60; 40<span class="elsevierStyleHsp" style=""></span>mg&#47;dL em homens ou &#60; 50<span class="elsevierStyleHsp" style=""></span>mg&#47;dL em mulheres&#44; press&#227;o arterial &#8805; 130&#47;85<span class="elsevierStyleHsp" style=""></span>mmHg e hiperglicemia de jejum &#40;n&#237;vel de glicose &#62; 100<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">17</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">O n&#237;vel de FABP4 s&#233;rico foi analisado utilizando o kit Enzyme&#8208;Linked Immunosorbent Assay &#40;ELISA&#41; &#40;Quantikine&#174; ELISA&#44; R&#38;D Systems&#44; Inc&#46;&#44; EUA e Canad&#225;&#41;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Dados cl&#237;nicos dos indiv&#237;duos estudados</span><p id="par0095" class="elsevierStylePara elsevierViewall">Dos 45 pacientes inclu&#237;dos no estudo&#44; 20 &#40;44&#44;4&#37;&#41; eram do sexo feminino e 25 &#40;55&#44;6&#37;&#41; do masculino&#46; A idade variou de 11 a 65 anos&#46; O IMC variou de 19 a 37<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#46; PA sist&#243;lica e diast&#243;lica variaram de 100 a 150 e de 60 a 90<span class="elsevierStyleHsp" style=""></span>mmHg&#44; respectivamente&#46; Os pacientes e o grupo controle foram pareados quanto a idade&#44; sexo&#44; PA sist&#243;lica e diast&#243;lica &#40;p &#62; 0&#44;05 para todos&#41;&#46; Entretanto&#44; o IMC foi significantemente maior nos pacientes do que nos controles &#40;p &#60; 0&#44;001&#59; <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Os dados cl&#237;nicos dos pacientes com vitiligo neste estudo est&#227;o apresentados na <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Perfil lip&#237;dico e n&#237;veis de glicemia nos grupos estudados</span><p id="par0105" class="elsevierStylePara elsevierViewall">Havia n&#237;veis significantemente elevados de colesterol &#40;207&#44;16 &#177; 64&#44;51 <span class="elsevierStyleItalic">vs</span>&#46; 171&#44;36 &#177; 38&#44;05&#41; e TG &#40;143&#44;84 &#177; 55&#44;80 <span class="elsevierStyleItalic">vs</span>&#46; 117&#44;44 &#177; 27&#44;44&#41;&#44; bem como glicemia de jejum &#40;89&#44;44 &#177; 15&#44;93 <span class="elsevierStyleItalic">vs</span>&#46; 80&#44;11 &#177; 8&#44;36&#41; e 2 horas p&#243;s&#8208;prandial no sangue &#40;122&#44;89 &#177; 27&#44;10 <span class="elsevierStyleItalic">vs</span>&#46; 106&#44;00 &#177; 11&#44;56&#41; dos pacientes com vitiligo do que nos controles &#40;p &#60; 0&#44;001&#44; p &#61; 0&#44;005&#44; p &#61; 0&#44;001 e p &#60; 0&#44;001&#44; respectivamente&#59; <a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">S&#237;ndrome metab&#243;lica em pacientes com vitiligo e o grupo controle</span><p id="par0110" class="elsevierStylePara elsevierViewall">A SM foi significantemente mais prevalente nos pacientes do estudo com vitiligo &#40;13&#59; 28&#44;9&#37;&#41; do que no grupo controle &#40;0&#37;&#59; p &#60; 0&#44;001 &#8211; <a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">N&#237;veis s&#233;ricos de FABP4 em pacientes com vitiligo e nos controles</span><p id="par0115" class="elsevierStylePara elsevierViewall">Os n&#237;veis s&#233;ricos de FABP4 foram mais elevados nos pacientes com vitiligo &#40;46&#44;78 &#177; 14&#44;54 ng&#47;mL&#41; em compara&#231;&#227;o aos controles &#40;27&#44;67 &#177; 7&#44;65 ng&#47;mL&#59; p &#60; 0&#44;001 &#8208; <a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Papel da FABP4 no diagn&#243;stico precoce de vitiligo</span><p id="par0120" class="elsevierStylePara elsevierViewall">A curva ROC &#40;<span class="elsevierStyleItalic">receiver operating characteristic</span>&#41; mostrou que o n&#237;vel de FABP4 foi um bom teste diagn&#243;stico significativo para a detec&#231;&#227;o precoce de vitiligo com melhor ponto de corte de 33&#44;0 ng&#47;mL&#44; sensibilidade de 82&#37;&#44; especificidade de 76&#37; e &#225;rea sob a curva de 0&#44;863 &#40;p &#60; 0&#44;001&#59; <a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>A&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Papel do n&#237;vel de FABP 4 no diagn&#243;stico de sindrome metab&#243;lica em paciente com vitiligo&#58;</span><p id="par0125" class="elsevierStylePara elsevierViewall">A curva ROC mostrou que FABP4 foi um teste diagn&#243;stico ruim para detectar s&#237;ndrome metab&#243;lica em pacientes com vitiligo&#44; com &#225;rea sob a curva de 0&#44;590 &#40;p &#61; 0&#44;34&#59; <a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>B&#41;&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Rela&#231;&#227;o entre os n&#237;veis de FABP4 e os par&#226;metros estudados em pacientes com vitiligo</span><p id="par0130" class="elsevierStylePara elsevierViewall">Em pacientes com vitiligo&#44; os n&#237;veis s&#233;ricos elevados de FABP4 foram significantemente associados &#224; presen&#231;a de SM &#40;p &#61; 0&#44;037&#41;&#46; No entanto&#44; a FABP4 n&#227;o foi diferente de acordo com a gravidade do vitiligo&#44; pois o n&#237;vel s&#233;rico de FABP4 n&#227;o foi significantemente correlacionado com o escore VASI &#40;r &#61; &#8722;0&#44;21&#59; p &#61; 0&#44;162&#59; <a class="elsevierStyleCrossRef" href="#tbl0020">tabela 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">Houve correla&#231;&#245;es positivas significativas dos n&#237;veis s&#233;ricos de FABP4 com os n&#237;veis de TG&#44; colesterol e LDL &#40;r &#61; 0&#44;39&#44; p &#61; 0&#44;047&#59; r &#61; 0&#44;83&#44; p &#61; 0&#44;001&#59; r &#61; 0&#44;66&#44; p &#61; 0&#44;001&#44; respectivamente&#41; e uma correla&#231;&#227;o negativa significativa em rela&#231;&#227;o ao n&#237;vel de HDL &#40;r &#61; &#8722;0&#44;39&#44; p &#61; 0&#44;009&#59; <a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discuss&#227;o</span><p id="par0140" class="elsevierStylePara elsevierViewall">No presente estudo investigamos&#44; pela primeira vez&#44; o poss&#237;vel papel da FABP4 no desenvolvimento do vitiligo por meio da avalia&#231;&#227;o de seu n&#237;vel s&#233;rico em pacientes com VNS <span class="elsevierStyleItalic">versus</span> controles&#46; Relatamos um aumento significativo nos n&#237;veis circulantes de FABP4 em pacientes com vitiligo em rela&#231;&#227;o aos seus pares&#44; e essas altas concentra&#231;&#245;es foram significantemente associadas &#224; SM nos casos estudados&#44; confirmando que a patog&#234;nese do vitiligo tem um fundo imunometab&#243;lico&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">18</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">Tanacan e Atkan<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">19</span></a> revelaram que o risco de desenvolver SM &#233; aumentado em pacientes com VNS&#46; A patog&#234;nese do vitiligo n&#227;o &#233; bem conhecida&#44; mas a autoimunidade associada ao estresse oxidativo representam dois mecanismos importantes respons&#225;veis pelo vitiligo e sua etiopatog&#234;nese&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">20</span></a> O estresse oxidativo &#233; uma das principais raz&#245;es para o desenvolvimento de SM e pode estar relacionado com a patog&#234;nese de algumas doen&#231;as&#44; como psor&#237;ase e vitiligo&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">11</span></a> Al&#233;m disso&#44; um n&#237;vel elevado de homociste&#237;na&#44; que &#233; um inibidor da tirosinase&#44; pode tamb&#233;m ser um fator que contribui para o desenvolvimento de SM em pacientes com vitiligo&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">21</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">A SM aumenta o risco de desenvolver diabetes <span class="elsevierStyleItalic">mellitus</span> tipo 2 e doen&#231;as cardiovasculares em cerca de cinco e duas vezes&#44; respectivamente&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">22</span></a> Portanto&#44; &#233; essencial prevenir essas complica&#231;&#245;es graves associadas &#224; SM&#44; mudando o estilo de vida dos pacientes&#46; Al&#233;m disso&#44; o manejo ideal da SM pode melhorar o curso cl&#237;nico do vitiligo&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">A fun&#231;&#227;o da FABP4 foi associada &#224; sensibilidade &#224; insulina&#44; metabolismo lip&#237;dico e inflama&#231;&#227;o&#44;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">23</span></a> bem como &#224; produ&#231;&#227;o de glicose&#44; que contribui para a patog&#234;nese de doen&#231;as imunometab&#243;licas&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">24</span></a> Em concord&#226;ncia com esses dados&#44; relatamos um estado significativo de hiperglicemia e dislipidemia em casos de vitiligo&#44; que foi significantemente associado a n&#237;veis s&#233;ricos elevados de FABP4 &#40;correla&#231;&#245;es positivas significativas com os n&#237;veis de TG&#44; colesterol e LDL&#44; e uma correla&#231;&#227;o negativa significativa com o n&#237;vel de HDL&#41;&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Portanto&#44; sugerimos que a FABP4 pode ter um papel ativo durante o processo da doen&#231;a vitiligo&#44; que pode ser mediado por dislipidemia e hiperglicemia associadas&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Como o vitiligo &#233; considerado uma doen&#231;a inflamat&#243;ria&#44; a FABP4 pode atuar na interface das vias inflamat&#243;rias e metab&#243;licas&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">25</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">Ela induz respostas inflamat&#243;rias por meio da ativa&#231;&#227;o das vias I&#954;B Quinase&#8208;Fator Nuclear&#8208;kabba B &#40;IKK&#8208;NF&#8208;&#954;B&#41; e c&#8208;jun N&#8208;terminal Quinase&#8208;Ativador Prote&#237;na&#8208;1 &#40;JNK&#8208;AP&#8208;1&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">26</span></a> bem como pelo fator de necrose tumoral alfa &#40;TNF&#8208;&#945;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">27</span></a> O efeito do TNF&#8208;&#945; na cultura de melan&#243;citos de pele humana desempenha pap&#233;is importantes no vitiligo por meio da ativa&#231;&#227;o do NF&#8208;&#954;B&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">28</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">A ativa&#231;&#227;o aberrante de c&#233;lulas imunes inatas na pele de pacientes com vitiligo inclui c&#233;lulas dendr&#237;ticas inflamat&#243;rias que migram da pele para os linfonodos de drenagem&#44; apresentando ant&#237;genos de melan&#243;citos para c&#233;lulas T e os ativam&#46; Essas c&#233;lulas tamb&#233;m secretam citocinas que recrutam e estimulam c&#233;lulas T autorreativas e&#44; em seguida&#44; matam os melan&#243;citos diretamente&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">29</span></a> Foi demonstrado que a FABP4 em c&#233;lulas dendr&#237;ticas regula o <span class="elsevierStyleItalic">priming</span> das c&#233;lulas T&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">30</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">As c&#233;lulas T autorreativas de mem&#243;ria residentes nos tecidos inibem a produ&#231;&#227;o de melanina e afetam a regenera&#231;&#227;o dos melan&#243;citos ao bloquear as c&#233;lulas T reguladoras localmente&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">31</span></a> Resultados recentes confirmam a presen&#231;a de c&#233;lulas CD8 &#43; autorreativas com fen&#243;tipo CD103<span class="elsevierStyleSup">&#43;</span>CD69<span class="elsevierStyleSup">&#43;</span>CD49a<span class="elsevierStyleSup">&#43;</span>&#160;T<span class="elsevierStyleInf">RM</span> na pele de pacientes com vitiligo&#46; As c&#233;lulas CD8&#43; autorreativas de mem&#243;ria residentes nos tecidos exibem superexpress&#227;o em estudos da FABP4 <span class="elsevierStyleItalic">in vitro</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">32</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">Com rela&#231;&#227;o ao papel das c&#233;lulas endoteliais no vitiligo&#44; as c&#233;lulas endoteliais d&#233;rmicas microvasculares humanas secretam grandes quantidades de clusterina&#46; A clusterina&#44; por meio de um <span class="elsevierStyleItalic">crosstalk</span> &#40;intera&#231;&#227;o&#41; par&#225;crino entre as c&#233;lulas endoteliais e os melan&#243;citos&#44; pode inibir a melanog&#234;nese&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">33</span></a> A FABP4 tem um papel potencial no crescimento das c&#233;lulas endoteliais&#44; promovendo a prolifera&#231;&#227;o&#44; migra&#231;&#227;o&#44; sobreviv&#234;ncia e morfog&#234;nese das c&#233;lulas&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">34</span></a></p><p id="par0190" class="elsevierStylePara elsevierViewall">Com base nos dados mencionados&#44; postulamos que o papel da FABP4 na patog&#234;nese do vitiligo pode ser mediado n&#227;o apenas atrav&#233;s de sua fun&#231;&#227;o metab&#243;lica &#40;hiperglicemia e dislipidemia demonstradas&#41;&#44; mas tamb&#233;m atrav&#233;s de seus mecanismos imunomediados&#44; incluindo citocinas inflamat&#243;rias upreguladas&#44;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">27</span></a> c&#233;lulas T autorreativas de mem&#243;ria residentes nos tecidos com superexpress&#227;o<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">32</span></a> e c&#233;lulas endoteliais estimuladas&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">34</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">A FABP4 atua como um importante mediador no <span class="elsevierStyleItalic">crosstalk</span> entre adip&#243;citos e macr&#243;fagos no tecido adiposo&#46; Camundongos <span class="elsevierStyleItalic">knockout</span> para FABP4 foram protegidos do desenvolvimento de obesidade&#44; resist&#234;ncia &#224; insulina e toler&#226;ncia diminu&#237;da &#224; glicose&#44; e seus adip&#243;citos mostraram redu&#231;&#227;o da lip&#243;lise&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">35</span></a> Em conson&#226;ncia com esses achados&#44; o presente estudo observou uma associa&#231;&#227;o significativa entre os n&#237;veis elevados de FABP4 e a presen&#231;a de SM nos pacientes com vitiligo&#46; Al&#233;m disso&#44; Terra et al&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">36</span></a> encontraram uma rela&#231;&#227;o entre os n&#237;veis circulantes de FABP4 e a presen&#231;a de obesidade e SM&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Embora o presente estudo tenha demonstrado que a FABP4 n&#227;o foi capaz de prever o desenvolvimento de SM nos pacientes com vitiligo estudados &#40;o que pode ser atribu&#237;do ao pequeno tamanho da amostra nesta pesquisa&#41;&#44; &#233; demonstrado que o n&#237;vel de FABP4 foi um bom teste diagn&#243;stico para a detec&#231;&#227;o precoce de vitiligo que poderia ajudar no diagn&#243;stico de vitiligo em casos amb&#237;guos&#46; Estudos em larga escala s&#227;o necess&#225;rios para confirmar esse resultado&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conclus&#245;es</span><p id="par0205" class="elsevierStylePara elsevierViewall">A FABP4 pode desempenhar um papel ativo no desenvolvimento do vitiligo&#44; e sua utiliza&#231;&#227;o como alvo pode ser &#250;til na avalia&#231;&#227;o cl&#237;nica para o tratamento do vitiligo&#46; O papel da FABP4 no processo da doen&#231;a vitiligo pode ser mediado por dislipidemia e hiperglicemia associadas&#46; A FABP4 pode ser um marcador de vitiligo&#44; ajudando no diagn&#243;stico precoce&#44; mas n&#227;o parece ser &#250;til para determinar a gravidade e atividade da doen&#231;a ou SM associada&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Limita&#231;&#245;es do estudo</span><p id="par0210" class="elsevierStylePara elsevierViewall">O pequeno n&#250;mero de indiv&#237;duos estudados foi a principal limita&#231;&#227;o do presente estudo&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Suporte financeiro</span><p id="par0215" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Contribui&#231;&#227;o dos autores</span><p id="par0220" class="elsevierStylePara elsevierViewall">Azza Gaber Antar Farag&#58; Revis&#227;o cr&#237;tica da literatura&#59; concep&#231;&#227;o e planejamento do estudo&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Eman Abdelfatah Bader&#58; Obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Asmaa El&#8208;Shafey Soliman El&#8208;Shafey&#58; Obten&#231;&#227;o dos dados&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">Mustafa Elsayed Elshaib&#58; An&#225;lise estat&#237;stica&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflito de interesses</span><p id="par0240" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Fundamentos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">O vitiligo &#233; uma doen&#231;a mucocut&#226;nea adquirida e progressiva&#44; resultante da perda de melan&#243;citos epid&#233;rmicos ativos&#46; A s&#237;ndrome metab&#243;lica &#40;SM&#41; afeta cerca de 25&#37; da popula&#231;&#227;o mundial e est&#225; ligada a doen&#231;as inflamat&#243;rias da pele&#44; incluindo o vitiligo&#46; A prote&#237;na de liga&#231;&#227;o a &#225;cidos graxos tipo 4 &#40;FABP4&#41; &#233; uma chaperona lip&#237;dica intracelular e est&#225; intimamente associada &#224; SM&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Avaliar o n&#237;vel s&#233;rico de FABP4 em pacientes com vitiligo e sua rela&#231;&#227;o com a SM nos casos investigados&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">O presente estudo tipo caso&#8208;controle foi conduzido em 45 pacientes com vitiligo n&#227;o segmentar e 45 controles pareados&#46; O perfil lip&#237;dico&#44; a glicose no sangue e os n&#237;veis s&#233;ricos de FABP4 foram medidos nesses indiv&#237;duos&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Houve eleva&#231;&#245;es significativas nos n&#237;veis de FABP4 &#40;p &#60; 0&#44;001&#41;&#44; colesterol &#40;p &#60; 0&#44;001&#41;&#44; triglic&#233;rides &#40;p &#61; 0&#44;005&#41; e glicose &#40;em jejum &#91;p &#61; 0&#44;001&#93; e 2 horas p&#243;s&#8208;prandial &#91;p &#60; 0&#44;001&#93;&#41; em pacientes comparados aos controles&#46; A SM foi significantemente mais prevalente em pacientes com vitiligo &#40;p &#60; 0&#44;001&#41; e associada a n&#237;veis s&#233;ricos elevados de FABP4 &#40;p &#61; 0&#44;037&#41;&#46; Em pacientes com vitiligo&#44; houve correla&#231;&#245;es positivas significativas entre os n&#237;veis s&#233;ricos de FABP4 e triglicer&#237;deos &#40;p &#61; 0&#44;047&#41;&#44; colesterol &#40;p &#61; 0&#44;001&#41; e LDL &#40;p &#61; 0&#44;001&#41; e correla&#231;&#227;o negativa em rela&#231;&#227;o aos n&#237;veis de HDL &#40;p &#61; 0&#44;009&#41;&#46; O n&#237;vel de FABP4 mostrou ser um bom teste diagn&#243;stico para a detec&#231;&#227;o precoce de vitiligo &#40;p &#60; 0&#44;001&#41;&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Limita&#231;&#245;es do estudo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Pequeno n&#250;mero de indiv&#237;duos estudados&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclus&#245;es</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A FABP4 pode desempenhar um papel ativo no processo da doen&#231;a vitiligo&#44; que pode ser mediado por dislipidemia e hiperglicemia associadas&#46; A FABP4 pode ser um marcador de vitiligo ajudando no diagn&#243;stico precoce&#44; mas n&#227;o parece ser &#250;til para determinar a gravidade e atividade do vitiligo&#44; ou SM associada&#46;</p></span>"
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Controles&#40;n &#61; 45&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Teste de signific&#226;ncia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&#8208;valor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Sexo</span></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
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Masculino&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">25 &#40;55&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">27 &#40;60&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#967;<span class="elsevierStyleSup">2</span> &#61; 0&#44;18&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;670&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"><span class="elsevierStyleHsp" style=""></span>Feminino&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">20 &#40;44&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">18 &#40;40&#44;0&#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"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Idade &#40;anos&#41;</span></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
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>M&#233;dia &#177; DP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">35&#44;51 &#177; 15&#44;98&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">32&#44;89 &#177; 13&#44;56&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"><span class="elsevierStyleItalic">U</span> &#61; 0&#44;84&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;404&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mediana&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">30&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Varia&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">11&#8208;65&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">14&#8208;65&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">IMC &#40;kg&#47;m</span><a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleItalic">&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>M&#233;dia &#177; DP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">29&#44;53 &#177; 5&#44;02&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">23&#44;89 &#177; 2&#44;40&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">t</span> &#61;6&#44;80&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">&#60; 0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mediana&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">29&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">24&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Varia&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">19&#8208;37&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">20&#8211;28&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"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">PAS &#40;mmHg&#41;</span></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
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>M&#233;dia &#177; DP&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">119&#44;78 &#177; 15&#44;15&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">117&#44;56 &#177; 14&#44;79&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">t</span> &#61; 0&#44;70&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;483&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mediana&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">120&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"><span class="elsevierStyleHsp" style=""></span>Varia&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">100&#8208;150&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">100&#8211;150&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">PAD &#40;mmHg&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>M&#233;dia &#177; DP&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">75&#44;33 &#177; 8&#44;69&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Idade de in&#237;cio da doen&#231;a &#40;anos&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>M&#233;dia &#177; DP&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Dura&#231;&#227;o da doen&#231;a &#40;anos&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>M&#233;dia &#177; DP&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Escore VASI</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>M&#233;dia &#177; DP&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7 &#40;15&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10 &#40;22&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11 &#40;24&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>M&#233;dia &#177; DP&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">26&#44;42 &#177; 25&#44;44&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">18&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Varia&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Leucotr&#237;quia</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Positiva&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;6&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Negativa&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">42 &#40;93&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Varia&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
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                    0 => array:2 [
                      "titulo" => "Focus on Clinical Aspects Immunopathogenesis&#44; and Therapy"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "K&#46; Boniface"
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                        "tituloSerie" => "Clin Rev Allergy Immunol&#46;"
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                      "titulo" => "The genetic architecture of vitiligo"
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                    0 => array:2 [
                      "doi" => "10.1111/pcmr.12848"
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                0 => array:2 [
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                      "titulo" => "The changes of gene expression profiling between segmental vitiligo&#44; generalized vitiligo and healthy individual"
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                          "etal" => true
                          "autores" => array:6 [
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                        "volumen" => "84"
                        "paginaInicial" => "40"
                        "paginaFinal" => "49"
                        "link" => array:1 [
                          0 => array:2 [
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                  "contribucion" => array:1 [
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                      "titulo" => "Autoimmunity in Segmental Vitiligo"
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                    0 => array:2 [
                      "doi" => "10.4061/2011/642612"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22121495"
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                      "doi" => "10.1007/s00592-016-0867-8"
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Artigo Original
Níveis circulantes de proteínas de ligação a ácidos graxos tipo 4 no vitiligo não segmentar
Azza Gaber Antar Faraga,
Autor para correspondência
azzagaber92@yahoo.com

Autor para correspondência.
, Eman A.E. Badrb, Asmaa El‐Shafey Soliman El‐Shafeyc, Mustafa Elsayed Elshaibd
a Andrologia e ISTs, Faculdade de Medicina, Menoufia University, Shebin AlKom, Egito
b Departamento de Bioquímica Médica e Biologia Molecular, Faculdade de Medicina, Menoufia University, Shebin AlKom, Egito
c Ministério da Saúde, Shebin AlKom General Hospital, Shebin AlKom, Egito
d Faculdade de Medicina, Menoufia University, Shebin AlKom, Egito
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          "pt" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Curva ROC dos n&#237;veis de FABP4 para &#40;A&#41;&#44; diagn&#243;stico precoce de vitiligo &#91;melhor ponto de corte 33&#44;0 ng&#47;mL&#44; sensibilidade de 82&#37;&#44; especificidade de 76&#37; e &#225;rea sob a curva de 0&#44;863 &#40;p &#60; 0&#44;001&#41;&#93; e &#40;B&#41;&#44; detec&#231;&#227;o de SM em pacientes com vitiligo &#91;sensibilidade de 77&#37;&#44; especificidade de 28&#37; e &#225;rea sob a curva de 0&#44;590 &#40;p &#61; 0&#44;348&#41;&#93;&#46;</p>"
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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">O vitiligo &#233; uma doen&#231;a mucocut&#226;nea progressiva adquirida e idiop&#225;tica&#44; caracterizada por dano aos melan&#243;citos epid&#233;rmicos funcionantes&#46; Em quase metade dos pacientes&#44; o vitiligo se desenvolve antes dos 20 anos&#59; entretanto&#44; tamb&#233;m pode ser observado em qualquer idade&#44; com uma diferen&#231;a n&#227;o significativa entre os sexos&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">O vitiligo foi classificado como vitiligo segmentar &#40;VS&#41; e vitiligo n&#227;o segmentar &#40;VNS&#41;&#46; No VNS&#44; fatores gen&#233;ticos de risco aumentado para autoimunidade foram descobertos por meio de estudo de gen&#244;mica ampla&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">2</span></a> A regula&#231;&#227;o da resposta imune inata mais a diferencia&#231;&#227;o de c&#233;lulas B&#44; bem como sua ativa&#231;&#227;o&#44; foram demonstradas em VNS&#44;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">3</span></a> e foram relatadas como sendo mais proeminentes no VNS do que no VS&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">A Fatty Acid&#8208;Binding Protein 4 &#40;FABP 4&#41; &#233; um membro de uma fam&#237;lia de prote&#237;nas de 14&#8208;15 kDa conhecidas como chaperonas lip&#237;dicas intracelulares&#46; Elas regulam o tr&#225;fego de lip&#237;dios nas c&#233;lulas&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">5</span></a> A FABP4&#44; tamb&#233;m chamada de prote&#237;na 2 de adip&#243;citos&#44; &#233; formada por 132 amino&#225;cidos&#46; Ela representa cerca de 1&#37; de todas as prote&#237;nas sol&#250;veis no tecido adiposo&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">A FABP4 tem a capacidade de se ligar reversivelmente a ligantes hidrof&#243;bicos&#44; como &#225;cidos graxos de cadeia longa insaturados e saturados&#44; bem como eicosanoides e outros lip&#237;deos que protegem os organismos contra seu ac&#250;mulo prejudicial&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">7</span></a> A FABP4 &#233; secretada por adip&#243;citos e macr&#243;fagos e est&#225; intimamente associada &#224; obesidade e &#224; s&#237;ndrome metab&#243;lica &#40;SM&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">8</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">A SM &#233; uma condi&#231;&#227;o na qual a resist&#234;ncia &#224; insulina &#233; desenvolvida e&#44; eventualmente&#44; leva a problemas cardiovasculares&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">9</span></a> Cerca de 25&#37; da popula&#231;&#227;o em todo o mundo &#233; afetada pela SM&#44; com uma subpopula&#231;&#227;o substancial ligada a muitas doen&#231;as inflamat&#243;rias da pele&#44;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">10</span></a> incluindo vitiligo&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">11</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Zhang et al&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">12</span></a> descobriram a exist&#234;ncia de altos n&#237;veis de FABP4 sist&#234;mica e local em pacientes com osteoartrite&#46; No campo da dermatologia&#44; Baran et al&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">13</span></a> relataram que os n&#237;veis s&#233;ricos de FABP4 estavam significantemente aumentados em pacientes com psor&#237;ase&#46; Como o vitiligo &#233; considerado uma doen&#231;a inflamat&#243;ria&#44; a proposta deste estudo &#233; que&#44; no vitiligo&#44; a FABP4 pode atuar na interface das vias inflamat&#243;rias e metab&#243;licas&#46; Portanto&#44; o objetivo deste estudo foi avaliar o n&#237;vel s&#233;rico de FABP4 em pacientes com vitiligo e sua rela&#231;&#227;o com SM&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Pacientes e m&#233;todos</span><p id="par0035" class="elsevierStylePara elsevierViewall">Este &#233; um estudo caso&#8208;controle realizado em 90 indiv&#237;duos&#46; Eles inclu&#237;am 45 pacientes com diferentes tipos cl&#237;nicos de VNS e 45 indiv&#237;duos saud&#225;veis pareados por idade e g&#234;nero &#40;grupo controle&#41;&#44; selecionados do Ambulat&#243;rio de Dermatologia&#46; O diagn&#243;stico de vitiligo foi feito com base na hist&#243;ria do paciente e nas caracter&#237;sticas cl&#237;nicas t&#237;picas &#40;m&#225;culas e manchas discretas&#44; bem circunscritas&#44; despigmentadas&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">O estudo foi aprovado pelo Comit&#234; de Direitos Humanos em Pesquisa da Universidade&#46; Um termo de consentimento livre e informado por escrito foi obtido de cada participante ou de seus respons&#225;veis &#40;se &#60; 18 anos&#41; antes do in&#237;cio deste estudo&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Casos de VNS de ambos os sexos foram inclu&#237;dos&#46; Todo paciente inclu&#237;do precisou interromper qualquer tipo de tratamento sist&#234;mico &#40;seis semanas&#41; ou t&#243;pico &#40;duas semanas&#41; para vitiligo&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Indiv&#237;duos com doen&#231;as cut&#226;neas imunoinflamat&#243;rias &#40;por exemplo&#44; psor&#237;ase&#44; dermatite at&#243;pica&#41; e&#47;ou sist&#234;micas &#40;por exemplo&#44; da tireoide e do tecido conjuntivo&#41; e aqueles que tinham recebido corticosteroides sist&#234;micos e&#47;ou outros imunossupressores no &#250;ltimo m&#234;s foram exclu&#237;dos deste estudo&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Os pacientes estudados foram submetidos &#224; anamnese&#46; O &#237;ndice de massa corporal &#40;IMC&#41; foi calculado dividindo&#8208;se a massa corporal &#40;quilogramas&#41; pelo quadrado da altura corporal &#40;metros&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">14</span></a> A medida da press&#227;o arterial &#40;PA&#41; foi feita utilizando&#8208;se um esfigmoman&#244;metro de merc&#250;rio padr&#227;o ap&#243;s os indiv&#237;duos terem descansado por pelo menos 10 minutos com o bra&#231;o na altura do cora&#231;&#227;o&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Exame dermatol&#243;gico foi realizado para garantir o diagn&#243;stico de vitiligo NS&#44; determinar sua localiza&#231;&#227;o e identificar seu tipo &#40;acrofacial&#44; da mucosa&#44; generalizado&#44; universal ou misto&#41;&#46; A gravidade e a atividade da doen&#231;a foram avaliadas utilizando o &#237;ndice de pontua&#231;&#227;o da &#225;rea de vitiligo &#40;VASI&#44; do ingl&#234;s <span class="elsevierStyleItalic">Vitiligo Area Scoring Index</span>&#41; e a atividade da doen&#231;a do vitiligo &#40;VIDA&#44; do ingl&#234;s <span class="elsevierStyleItalic">Vitiligo Disease Activity</span>&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Para calcular o escore VASI&#44; o corpo foi dividido em cinco regi&#245;es&#58; m&#227;os&#44; extremidades superiores &#40;excluindo as m&#227;os&#41;&#44; tronco&#44; extremidades inferiores &#40;excluindo os p&#233;s&#41; e p&#233;s&#46; As axilas foram inclu&#237;das nas extremidades superiores&#44; enquanto as n&#225;degas e as regi&#245;es inguinais foram inclu&#237;das nas extremidades inferiores&#46; Uma unidade&#8208;m&#227;o &#40;a palma da m&#227;o mais a superf&#237;cie volar de todos os dedos&#41; foi usada como guia para estimar a porcentagem de acometimento de vitiligo &#40;1&#37;&#41; em cada regi&#227;o corporal&#46; A despigmenta&#231;&#227;o dentro de cada &#225;rea foi estimada em rela&#231;&#227;o &#224;s seguintes porcentagens&#58; 0 &#40;pele pigmentada normal&#41;&#44; 10&#37; &#40;pontos de despigmenta&#231;&#227;o&#41;&#44; 25&#37; &#40;&#225;rea pigmentada excede a &#225;rea despigmentada&#41;&#44; 50&#37; &#40;&#225;reas despigmentadas e pigmentadas s&#227;o iguais&#41;&#44; 75&#37; &#40;&#225;rea despigmentada excede a &#225;rea pigmentada&#41;&#44; 90&#37; &#40;pontos de pigmento&#41; e 100&#37; &#40;sem pigmento&#41;&#46; O VASI foi calculado utilizando&#8208;se esta f&#243;rmula&#58; VASI &#61; &#931; &#40;todas as partes do corpo&#41; &#40;unidades&#8208;m&#227;o&#41; &#215; &#40;despigmenta&#231;&#227;o&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">15</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">O escore VIDA baseou&#8208;se na opini&#227;o do pr&#243;prio paciente sobre a atividade da doen&#231;a ao longo do tempo&#46; O vitiligo ativo inclui a extens&#227;o de les&#245;es cut&#226;neas existentes ou o aparecimento de novas&#46; O escore foi classificado de &#43;4 &#40;ativo nas &#250;ltimas seis semanas&#41;&#44; &#43;3 &#40;ativo nos &#250;ltimos tr&#234;s meses&#41;&#44; &#43;2 &#40;ativo nos &#250;ltimos seis meses&#41;&#44; &#43;1 &#40;ativo no &#250;ltimo ano&#41;&#44; 0 &#40;est&#225;vel por pelo menos um ano&#41; a &#8722;1 &#40;est&#225;vel por pelo menos um ano e repigmenta&#231;&#227;o espont&#226;nea&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">16</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Ap&#243;s jejum noturno&#44; a pele sobre uma veia foi esterilizada com &#225;lcool 70&#37; e&#44; em seguida&#44; 5<span class="elsevierStyleHsp" style=""></span>mL de sangue venoso foram coletados de todos os indiv&#237;duos&#59; 3<span class="elsevierStyleHsp" style=""></span>mL de sangue venoso foram transferidos para um tubo simples&#44; deixados em repouso por meia hora e&#44; em seguida&#44; centrifugados por 10<span class="elsevierStyleHsp" style=""></span>min a 4&#46;000<span class="elsevierStyleHsp" style=""></span>rpm&#46; O soro foi obtido para a determina&#231;&#227;o do perfil lip&#237;dico e o n&#237;vel de FABP4&#44; enquanto 2<span class="elsevierStyleHsp" style=""></span>mL de sangue foram transferidos para tubos contendo fluoreto de s&#243;dio&#44; centrifugados por 10<span class="elsevierStyleHsp" style=""></span>min a 4&#46;000<span class="elsevierStyleHsp" style=""></span>rpm&#46; O plasma foi obtido para a determina&#231;&#227;o da glicose em jejum&#46; Outra amostra de sangue foi obtida para determinar a glicose 2 horas p&#243;s&#8208;prandial&#46; As amostras foram mantidas congeladas a &#8722;20<span class="elsevierStyleHsp" style=""></span>&#176;C at&#233; a an&#225;lise&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">O perfil lip&#237;dico incluindo triglicer&#237;deos &#40;TG&#41;&#44; n&#237;vel de colesterol e lipoprote&#237;nas como lipoprote&#237;nas de alta densidade &#40;HDL&#41; e lipoprote&#237;nas de baixa densidade &#40;LDL&#41;&#44; al&#233;m de glicemia de jejum e 2 horas p&#243;s&#8208;prandial no sangue foram medidos por um analisador qu&#237;mico autom&#225;tico &#40;sistema AU480 de Beckman Coulter&#44; EUA&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">O diagn&#243;stico de SM foi feito de acordo com a avalia&#231;&#227;o de TG&#44; LDL&#44; glicemia de jejum e press&#227;o arterial como segue&#58; TG &#8805; 150<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; n&#237;vel de HDL&#8208;C &#60; 40<span class="elsevierStyleHsp" style=""></span>mg&#47;dL em homens ou &#60; 50<span class="elsevierStyleHsp" style=""></span>mg&#47;dL em mulheres&#44; press&#227;o arterial &#8805; 130&#47;85<span class="elsevierStyleHsp" style=""></span>mmHg e hiperglicemia de jejum &#40;n&#237;vel de glicose &#62; 100<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">17</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">O n&#237;vel de FABP4 s&#233;rico foi analisado utilizando o kit Enzyme&#8208;Linked Immunosorbent Assay &#40;ELISA&#41; &#40;Quantikine&#174; ELISA&#44; R&#38;D Systems&#44; Inc&#46;&#44; EUA e Canad&#225;&#41;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Dados cl&#237;nicos dos indiv&#237;duos estudados</span><p id="par0095" class="elsevierStylePara elsevierViewall">Dos 45 pacientes inclu&#237;dos no estudo&#44; 20 &#40;44&#44;4&#37;&#41; eram do sexo feminino e 25 &#40;55&#44;6&#37;&#41; do masculino&#46; A idade variou de 11 a 65 anos&#46; O IMC variou de 19 a 37<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#46; PA sist&#243;lica e diast&#243;lica variaram de 100 a 150 e de 60 a 90<span class="elsevierStyleHsp" style=""></span>mmHg&#44; respectivamente&#46; Os pacientes e o grupo controle foram pareados quanto a idade&#44; sexo&#44; PA sist&#243;lica e diast&#243;lica &#40;p &#62; 0&#44;05 para todos&#41;&#46; Entretanto&#44; o IMC foi significantemente maior nos pacientes do que nos controles &#40;p &#60; 0&#44;001&#59; <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Os dados cl&#237;nicos dos pacientes com vitiligo neste estudo est&#227;o apresentados na <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Perfil lip&#237;dico e n&#237;veis de glicemia nos grupos estudados</span><p id="par0105" class="elsevierStylePara elsevierViewall">Havia n&#237;veis significantemente elevados de colesterol &#40;207&#44;16 &#177; 64&#44;51 <span class="elsevierStyleItalic">vs</span>&#46; 171&#44;36 &#177; 38&#44;05&#41; e TG &#40;143&#44;84 &#177; 55&#44;80 <span class="elsevierStyleItalic">vs</span>&#46; 117&#44;44 &#177; 27&#44;44&#41;&#44; bem como glicemia de jejum &#40;89&#44;44 &#177; 15&#44;93 <span class="elsevierStyleItalic">vs</span>&#46; 80&#44;11 &#177; 8&#44;36&#41; e 2 horas p&#243;s&#8208;prandial no sangue &#40;122&#44;89 &#177; 27&#44;10 <span class="elsevierStyleItalic">vs</span>&#46; 106&#44;00 &#177; 11&#44;56&#41; dos pacientes com vitiligo do que nos controles &#40;p &#60; 0&#44;001&#44; p &#61; 0&#44;005&#44; p &#61; 0&#44;001 e p &#60; 0&#44;001&#44; respectivamente&#59; <a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">S&#237;ndrome metab&#243;lica em pacientes com vitiligo e o grupo controle</span><p id="par0110" class="elsevierStylePara elsevierViewall">A SM foi significantemente mais prevalente nos pacientes do estudo com vitiligo &#40;13&#59; 28&#44;9&#37;&#41; do que no grupo controle &#40;0&#37;&#59; p &#60; 0&#44;001 &#8211; <a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">N&#237;veis s&#233;ricos de FABP4 em pacientes com vitiligo e nos controles</span><p id="par0115" class="elsevierStylePara elsevierViewall">Os n&#237;veis s&#233;ricos de FABP4 foram mais elevados nos pacientes com vitiligo &#40;46&#44;78 &#177; 14&#44;54 ng&#47;mL&#41; em compara&#231;&#227;o aos controles &#40;27&#44;67 &#177; 7&#44;65 ng&#47;mL&#59; p &#60; 0&#44;001 &#8208; <a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Papel da FABP4 no diagn&#243;stico precoce de vitiligo</span><p id="par0120" class="elsevierStylePara elsevierViewall">A curva ROC &#40;<span class="elsevierStyleItalic">receiver operating characteristic</span>&#41; mostrou que o n&#237;vel de FABP4 foi um bom teste diagn&#243;stico significativo para a detec&#231;&#227;o precoce de vitiligo com melhor ponto de corte de 33&#44;0 ng&#47;mL&#44; sensibilidade de 82&#37;&#44; especificidade de 76&#37; e &#225;rea sob a curva de 0&#44;863 &#40;p &#60; 0&#44;001&#59; <a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>A&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Papel do n&#237;vel de FABP 4 no diagn&#243;stico de sindrome metab&#243;lica em paciente com vitiligo&#58;</span><p id="par0125" class="elsevierStylePara elsevierViewall">A curva ROC mostrou que FABP4 foi um teste diagn&#243;stico ruim para detectar s&#237;ndrome metab&#243;lica em pacientes com vitiligo&#44; com &#225;rea sob a curva de 0&#44;590 &#40;p &#61; 0&#44;34&#59; <a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>B&#41;&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Rela&#231;&#227;o entre os n&#237;veis de FABP4 e os par&#226;metros estudados em pacientes com vitiligo</span><p id="par0130" class="elsevierStylePara elsevierViewall">Em pacientes com vitiligo&#44; os n&#237;veis s&#233;ricos elevados de FABP4 foram significantemente associados &#224; presen&#231;a de SM &#40;p &#61; 0&#44;037&#41;&#46; No entanto&#44; a FABP4 n&#227;o foi diferente de acordo com a gravidade do vitiligo&#44; pois o n&#237;vel s&#233;rico de FABP4 n&#227;o foi significantemente correlacionado com o escore VASI &#40;r &#61; &#8722;0&#44;21&#59; p &#61; 0&#44;162&#59; <a class="elsevierStyleCrossRef" href="#tbl0020">tabela 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">Houve correla&#231;&#245;es positivas significativas dos n&#237;veis s&#233;ricos de FABP4 com os n&#237;veis de TG&#44; colesterol e LDL &#40;r &#61; 0&#44;39&#44; p &#61; 0&#44;047&#59; r &#61; 0&#44;83&#44; p &#61; 0&#44;001&#59; r &#61; 0&#44;66&#44; p &#61; 0&#44;001&#44; respectivamente&#41; e uma correla&#231;&#227;o negativa significativa em rela&#231;&#227;o ao n&#237;vel de HDL &#40;r &#61; &#8722;0&#44;39&#44; p &#61; 0&#44;009&#59; <a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discuss&#227;o</span><p id="par0140" class="elsevierStylePara elsevierViewall">No presente estudo investigamos&#44; pela primeira vez&#44; o poss&#237;vel papel da FABP4 no desenvolvimento do vitiligo por meio da avalia&#231;&#227;o de seu n&#237;vel s&#233;rico em pacientes com VNS <span class="elsevierStyleItalic">versus</span> controles&#46; Relatamos um aumento significativo nos n&#237;veis circulantes de FABP4 em pacientes com vitiligo em rela&#231;&#227;o aos seus pares&#44; e essas altas concentra&#231;&#245;es foram significantemente associadas &#224; SM nos casos estudados&#44; confirmando que a patog&#234;nese do vitiligo tem um fundo imunometab&#243;lico&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">18</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">Tanacan e Atkan<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">19</span></a> revelaram que o risco de desenvolver SM &#233; aumentado em pacientes com VNS&#46; A patog&#234;nese do vitiligo n&#227;o &#233; bem conhecida&#44; mas a autoimunidade associada ao estresse oxidativo representam dois mecanismos importantes respons&#225;veis pelo vitiligo e sua etiopatog&#234;nese&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">20</span></a> O estresse oxidativo &#233; uma das principais raz&#245;es para o desenvolvimento de SM e pode estar relacionado com a patog&#234;nese de algumas doen&#231;as&#44; como psor&#237;ase e vitiligo&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">11</span></a> Al&#233;m disso&#44; um n&#237;vel elevado de homociste&#237;na&#44; que &#233; um inibidor da tirosinase&#44; pode tamb&#233;m ser um fator que contribui para o desenvolvimento de SM em pacientes com vitiligo&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">21</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">A SM aumenta o risco de desenvolver diabetes <span class="elsevierStyleItalic">mellitus</span> tipo 2 e doen&#231;as cardiovasculares em cerca de cinco e duas vezes&#44; respectivamente&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">22</span></a> Portanto&#44; &#233; essencial prevenir essas complica&#231;&#245;es graves associadas &#224; SM&#44; mudando o estilo de vida dos pacientes&#46; Al&#233;m disso&#44; o manejo ideal da SM pode melhorar o curso cl&#237;nico do vitiligo&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">A fun&#231;&#227;o da FABP4 foi associada &#224; sensibilidade &#224; insulina&#44; metabolismo lip&#237;dico e inflama&#231;&#227;o&#44;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">23</span></a> bem como &#224; produ&#231;&#227;o de glicose&#44; que contribui para a patog&#234;nese de doen&#231;as imunometab&#243;licas&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">24</span></a> Em concord&#226;ncia com esses dados&#44; relatamos um estado significativo de hiperglicemia e dislipidemia em casos de vitiligo&#44; que foi significantemente associado a n&#237;veis s&#233;ricos elevados de FABP4 &#40;correla&#231;&#245;es positivas significativas com os n&#237;veis de TG&#44; colesterol e LDL&#44; e uma correla&#231;&#227;o negativa significativa com o n&#237;vel de HDL&#41;&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Portanto&#44; sugerimos que a FABP4 pode ter um papel ativo durante o processo da doen&#231;a vitiligo&#44; que pode ser mediado por dislipidemia e hiperglicemia associadas&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Como o vitiligo &#233; considerado uma doen&#231;a inflamat&#243;ria&#44; a FABP4 pode atuar na interface das vias inflamat&#243;rias e metab&#243;licas&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">25</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">Ela induz respostas inflamat&#243;rias por meio da ativa&#231;&#227;o das vias I&#954;B Quinase&#8208;Fator Nuclear&#8208;kabba B &#40;IKK&#8208;NF&#8208;&#954;B&#41; e c&#8208;jun N&#8208;terminal Quinase&#8208;Ativador Prote&#237;na&#8208;1 &#40;JNK&#8208;AP&#8208;1&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">26</span></a> bem como pelo fator de necrose tumoral alfa &#40;TNF&#8208;&#945;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">27</span></a> O efeito do TNF&#8208;&#945; na cultura de melan&#243;citos de pele humana desempenha pap&#233;is importantes no vitiligo por meio da ativa&#231;&#227;o do NF&#8208;&#954;B&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">28</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">A ativa&#231;&#227;o aberrante de c&#233;lulas imunes inatas na pele de pacientes com vitiligo inclui c&#233;lulas dendr&#237;ticas inflamat&#243;rias que migram da pele para os linfonodos de drenagem&#44; apresentando ant&#237;genos de melan&#243;citos para c&#233;lulas T e os ativam&#46; Essas c&#233;lulas tamb&#233;m secretam citocinas que recrutam e estimulam c&#233;lulas T autorreativas e&#44; em seguida&#44; matam os melan&#243;citos diretamente&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">29</span></a> Foi demonstrado que a FABP4 em c&#233;lulas dendr&#237;ticas regula o <span class="elsevierStyleItalic">priming</span> das c&#233;lulas T&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">30</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">As c&#233;lulas T autorreativas de mem&#243;ria residentes nos tecidos inibem a produ&#231;&#227;o de melanina e afetam a regenera&#231;&#227;o dos melan&#243;citos ao bloquear as c&#233;lulas T reguladoras localmente&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">31</span></a> Resultados recentes confirmam a presen&#231;a de c&#233;lulas CD8 &#43; autorreativas com fen&#243;tipo CD103<span class="elsevierStyleSup">&#43;</span>CD69<span class="elsevierStyleSup">&#43;</span>CD49a<span class="elsevierStyleSup">&#43;</span>&#160;T<span class="elsevierStyleInf">RM</span> na pele de pacientes com vitiligo&#46; As c&#233;lulas CD8&#43; autorreativas de mem&#243;ria residentes nos tecidos exibem superexpress&#227;o em estudos da FABP4 <span class="elsevierStyleItalic">in vitro</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">32</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">Com rela&#231;&#227;o ao papel das c&#233;lulas endoteliais no vitiligo&#44; as c&#233;lulas endoteliais d&#233;rmicas microvasculares humanas secretam grandes quantidades de clusterina&#46; A clusterina&#44; por meio de um <span class="elsevierStyleItalic">crosstalk</span> &#40;intera&#231;&#227;o&#41; par&#225;crino entre as c&#233;lulas endoteliais e os melan&#243;citos&#44; pode inibir a melanog&#234;nese&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">33</span></a> A FABP4 tem um papel potencial no crescimento das c&#233;lulas endoteliais&#44; promovendo a prolifera&#231;&#227;o&#44; migra&#231;&#227;o&#44; sobreviv&#234;ncia e morfog&#234;nese das c&#233;lulas&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">34</span></a></p><p id="par0190" class="elsevierStylePara elsevierViewall">Com base nos dados mencionados&#44; postulamos que o papel da FABP4 na patog&#234;nese do vitiligo pode ser mediado n&#227;o apenas atrav&#233;s de sua fun&#231;&#227;o metab&#243;lica &#40;hiperglicemia e dislipidemia demonstradas&#41;&#44; mas tamb&#233;m atrav&#233;s de seus mecanismos imunomediados&#44; incluindo citocinas inflamat&#243;rias upreguladas&#44;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">27</span></a> c&#233;lulas T autorreativas de mem&#243;ria residentes nos tecidos com superexpress&#227;o<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">32</span></a> e c&#233;lulas endoteliais estimuladas&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">34</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">A FABP4 atua como um importante mediador no <span class="elsevierStyleItalic">crosstalk</span> entre adip&#243;citos e macr&#243;fagos no tecido adiposo&#46; Camundongos <span class="elsevierStyleItalic">knockout</span> para FABP4 foram protegidos do desenvolvimento de obesidade&#44; resist&#234;ncia &#224; insulina e toler&#226;ncia diminu&#237;da &#224; glicose&#44; e seus adip&#243;citos mostraram redu&#231;&#227;o da lip&#243;lise&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">35</span></a> Em conson&#226;ncia com esses achados&#44; o presente estudo observou uma associa&#231;&#227;o significativa entre os n&#237;veis elevados de FABP4 e a presen&#231;a de SM nos pacientes com vitiligo&#46; Al&#233;m disso&#44; Terra et al&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">36</span></a> encontraram uma rela&#231;&#227;o entre os n&#237;veis circulantes de FABP4 e a presen&#231;a de obesidade e SM&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Embora o presente estudo tenha demonstrado que a FABP4 n&#227;o foi capaz de prever o desenvolvimento de SM nos pacientes com vitiligo estudados &#40;o que pode ser atribu&#237;do ao pequeno tamanho da amostra nesta pesquisa&#41;&#44; &#233; demonstrado que o n&#237;vel de FABP4 foi um bom teste diagn&#243;stico para a detec&#231;&#227;o precoce de vitiligo que poderia ajudar no diagn&#243;stico de vitiligo em casos amb&#237;guos&#46; Estudos em larga escala s&#227;o necess&#225;rios para confirmar esse resultado&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conclus&#245;es</span><p id="par0205" class="elsevierStylePara elsevierViewall">A FABP4 pode desempenhar um papel ativo no desenvolvimento do vitiligo&#44; e sua utiliza&#231;&#227;o como alvo pode ser &#250;til na avalia&#231;&#227;o cl&#237;nica para o tratamento do vitiligo&#46; O papel da FABP4 no processo da doen&#231;a vitiligo pode ser mediado por dislipidemia e hiperglicemia associadas&#46; A FABP4 pode ser um marcador de vitiligo&#44; ajudando no diagn&#243;stico precoce&#44; mas n&#227;o parece ser &#250;til para determinar a gravidade e atividade da doen&#231;a ou SM associada&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Limita&#231;&#245;es do estudo</span><p id="par0210" class="elsevierStylePara elsevierViewall">O pequeno n&#250;mero de indiv&#237;duos estudados foi a principal limita&#231;&#227;o do presente estudo&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Suporte financeiro</span><p id="par0215" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Contribui&#231;&#227;o dos autores</span><p id="par0220" class="elsevierStylePara elsevierViewall">Azza Gaber Antar Farag&#58; Revis&#227;o cr&#237;tica da literatura&#59; concep&#231;&#227;o e planejamento do estudo&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Eman Abdelfatah Bader&#58; Obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Asmaa El&#8208;Shafey Soliman El&#8208;Shafey&#58; Obten&#231;&#227;o dos dados&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">Mustafa Elsayed Elshaib&#58; An&#225;lise estat&#237;stica&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflito de interesses</span><p id="par0240" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Fundamentos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">O vitiligo &#233; uma doen&#231;a mucocut&#226;nea adquirida e progressiva&#44; resultante da perda de melan&#243;citos epid&#233;rmicos ativos&#46; A s&#237;ndrome metab&#243;lica &#40;SM&#41; afeta cerca de 25&#37; da popula&#231;&#227;o mundial e est&#225; ligada a doen&#231;as inflamat&#243;rias da pele&#44; incluindo o vitiligo&#46; A prote&#237;na de liga&#231;&#227;o a &#225;cidos graxos tipo 4 &#40;FABP4&#41; &#233; uma chaperona lip&#237;dica intracelular e est&#225; intimamente associada &#224; SM&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Avaliar o n&#237;vel s&#233;rico de FABP4 em pacientes com vitiligo e sua rela&#231;&#227;o com a SM nos casos investigados&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">O presente estudo tipo caso&#8208;controle foi conduzido em 45 pacientes com vitiligo n&#227;o segmentar e 45 controles pareados&#46; O perfil lip&#237;dico&#44; a glicose no sangue e os n&#237;veis s&#233;ricos de FABP4 foram medidos nesses indiv&#237;duos&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Houve eleva&#231;&#245;es significativas nos n&#237;veis de FABP4 &#40;p &#60; 0&#44;001&#41;&#44; colesterol &#40;p &#60; 0&#44;001&#41;&#44; triglic&#233;rides &#40;p &#61; 0&#44;005&#41; e glicose &#40;em jejum &#91;p &#61; 0&#44;001&#93; e 2 horas p&#243;s&#8208;prandial &#91;p &#60; 0&#44;001&#93;&#41; em pacientes comparados aos controles&#46; A SM foi significantemente mais prevalente em pacientes com vitiligo &#40;p &#60; 0&#44;001&#41; e associada a n&#237;veis s&#233;ricos elevados de FABP4 &#40;p &#61; 0&#44;037&#41;&#46; Em pacientes com vitiligo&#44; houve correla&#231;&#245;es positivas significativas entre os n&#237;veis s&#233;ricos de FABP4 e triglicer&#237;deos &#40;p &#61; 0&#44;047&#41;&#44; colesterol &#40;p &#61; 0&#44;001&#41; e LDL &#40;p &#61; 0&#44;001&#41; e correla&#231;&#227;o negativa em rela&#231;&#227;o aos n&#237;veis de HDL &#40;p &#61; 0&#44;009&#41;&#46; O n&#237;vel de FABP4 mostrou ser um bom teste diagn&#243;stico para a detec&#231;&#227;o precoce de vitiligo &#40;p &#60; 0&#44;001&#41;&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Limita&#231;&#245;es do estudo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Pequeno n&#250;mero de indiv&#237;duos estudados&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclus&#245;es</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A FABP4 pode desempenhar um papel ativo no processo da doen&#231;a vitiligo&#44; que pode ser mediado por dislipidemia e hiperglicemia associadas&#46; A FABP4 pode ser um marcador de vitiligo ajudando no diagn&#243;stico precoce&#44; mas n&#227;o parece ser &#250;til para determinar a gravidade e atividade do vitiligo&#44; ou SM associada&#46;</p></span>"
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                  \t\t\t\t">&#60; 0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&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
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mediana&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Varia&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">19&#8208;37&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">20&#8211;28&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">PAS &#40;mmHg&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>M&#233;dia &#177; DP&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">119&#44;78 &#177; 15&#44;15&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">117&#44;56 &#177; 14&#44;79&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">t</span> &#61; 0&#44;70&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;483&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mediana&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">120&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Varia&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">100&#8208;150&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">100&#8211;150&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">PAD &#40;mmHg&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>M&#233;dia &#177; DP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">75&#44;33 &#177; 8&#44;69&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">77&#44;11 &#177; 8&#44;43&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">t</span> &#61; 0&#44;99&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mediana&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">70&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Varia&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">60&#8208;90&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">60&#8211;90&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Idade de in&#237;cio da doen&#231;a &#40;anos&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>M&#233;dia &#177; DP&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mediana&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">29&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Varia&#231;&#227;o&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">7&#8208;63&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"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Dura&#231;&#227;o da doen&#231;a &#40;anos&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>M&#233;dia &#177; DP&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">4&#44;69 &#177; 4&#44;89&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"><span class="elsevierStyleHsp" style=""></span>Mediana&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">4&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">11 &#40;24&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mediana&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&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\ttable-entry\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#8208;90&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\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Negativa&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Positiva&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"><span class="elsevierStyleHsp" style=""></span>Negativa&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Hist&#243;ria familiar</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Positiva&nbsp;\t\t\t\t\t\t\n
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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">10 &#40;22&#44;2&#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  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>M&#233;dia &#177; DP&nbsp;\t\t\t\t\t\t\n
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