Avaliação da função endotelial através da dilatação fluxo mediada da artéria braquial em adolescentes no pós-parto

Abstract

Aims : To evaluate the endothelial function by flow mediated dilation in adolescents and to observe if there is difference among those with a history of normotensive pregnancy or with pré-eclampsia ( PE ) . Methodology : A total of 99 adolescents after delivery ( this interval ranged from 2 to 11 months post partum ). It was evaluated the flow mediated dilation of brachial artery ( FMD), after resting from 5 to 10 minutes in a supine position, it was checked the blood pressure in the right arm and achieved the light measure of the brachial vessel to ultrasound. This measure was considered the baseline one. So, it was performed the compression of the arm with the sphygmomanometer about 3 to 5 minutes with a pressure that exceeded in 30 mmHg the systolic pressure. After the release of the compression, it was checked the diameter of the lumen after 30, 60, 90, 120, and 180 seconds in diastole in the same place of the basal verification . For FMD calculation, it was considered the biggest expansion in percentage. It was used a high-frequency transducer (6 to 9 MHz). The ultrasonographer did not know the result of the pregnancy at the moment of the exam. It was found retrospectively, the result of the pregnancy concerning to the absence or development of PE (mild or severe). PE was considered the appearing of arterial blood pressure greater or equal to 140 x 90 mmHg after 20 weeks of pregnancy associated with proteinuria (a cross in two checks or two crosses in only one in an isolated sample or 300 mg/day in 24-hour evaluation). The normal distribution of data was evaluated by Shapiro - Walk and Levene tests. The groups were compared through the test of Kruskal – Wallis, R- student and Mann – Whitney. It was considered p < 0, 05 as significant. Results: The age ranged from 13 to 18 years (mean 16,2 ± 1,3 ). 76 pregnancies were considered normotensive, 23 pre–eclampsia (11 mild and 12 severe PE). It was found the presence of FMD > 10 % in 75 patients and ≤ 10% in just 24. Eight patients (8, 1%) presented FMD < 5%. First the population was divided in three groups: normotensive, mild and severe PE. There was no statistical difference between the groups in relation to age (16,3 x 15,9 x 16,1, p = 0,615), time between delivery and evaluation (6,8 x 6,2 x 6,7, p= 0, 497). IMC (22,8 x 26,1 x 24,3 Kg/m², p = 0,090), diastolic blood pressure (70,3 x 73,6 x 73,4 mmHg, p = 0,181), or FMD (16,8 x 16,5 x 11,4%, p= 0,085). The systolic blood pressure was statistically different between the groups (108,8 x 117,2 x 110,8 mmHg, p = 0,005), systolic blood pressure in mild PE was higher than in normotensive (p = 0,003). There was no difference between mild and severe PE (p = 0,126) and between severe PE and normotensive (p = 0,686). When it was compared only two groups PE x normotensive, the Body Mass Index (BMI) was statistically different (p = 0,031). In the history of PE, the Body Mass Index (BMI) was higher (25,3 x 22,8 Kg /m²). Conclusion :There is no difference in the presence of endothelial disfunction observed by the flow mediated dilation of the brachial artery in adolescents with a history of normotensive pregnancy or PE. Patients with history of PE presented systolic blood pressure and BMI higher than women with prior gestational normotensive.