Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2017-02-13T20:11:14Z No. of bitstreams: 1 JayraJulianaPaivaAlvesAbrantes_DISSERT.pdf: 1189237 bytes, checksum: f928fa1545c34b4209cea93ae78bb7f0 (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2017-02-16T00:23:25Z (GMT) No. of bitstreams: 1 JayraJulianaPaivaAlvesAbrantes_DISSERT.pdf: 1189237 bytes, checksum: f928fa1545c34b4209cea93ae78bb7f0 (MD5) / Made available in DSpace on 2017-02-16T00:23:25Z (GMT). No. of bitstreams: 1 JayraJulianaPaivaAlvesAbrantes_DISSERT.pdf: 1189237 bytes, checksum: f928fa1545c34b4209cea93ae78bb7f0 (MD5) Previous issue date: 2016-03-22 / A infec??o genital pelo v?rus do papiloma humano (HPV) ? uma das causas mais frequentes de doen?as sexualmente transmiss?veis, em ambos os sexos, com maior preval?ncia da infec??o entre mulheres jovens, com vida sexualmente ativa, constituindo-se em um grave problema de sa?de p?blica. A infec??o persistente por HPVs de alto risco, em conjunto com eventos adicionais desencadeados pela exposi??o a fatores f?sicos, qu?micos e ambientais, disfun??o do sitema imune podem favorecer o desenvolvimento de les?es pr?-malignas e malignas da c?rvice uterina. O objetivo deste estudo foi estimar a preval?ncia do HPV e avaliar o perfil da resposta imune em mulheres infectadas pelo HPV, por meio dos n?veis de express?o de citocinas, TLR9 e Myd88, e correlacion?-las com a presen?a ou n?o de les?es. Foram inclu?das no estudo, mulheres com idade entre 16 e 85 anos, m?dia de 36,2 anos, desvio padr?o de 11.26. Do total de 225 mulheres, 126 foram recrutadas entre as atendidas pelo programa de rastreio do c?ncer de colo do ?tero e 99 que foram encaminhadas ? Maternidade Janu?rio Cicco com suspeita de les?o da c?rvice uterina. As pacientes que concordaram participar do estudo passaram por entrevista para obten??o de dados s?cio-demogr?ficos, seguida de exame cl?nico e coletas de dois esp?cimes de raspado cervical, um para an?lise citol?gica e outra para analise molecular destinado a detec??o do HPV. Nas mulheres com suspeita de les?o foi realizada a colposcopia para detec??o de poss?veis altera??es, e coletados dois fragmentos de tecido por bi?psia, um para an?lise histopatol?gica, e outro para obten??o de ?cidos nucleicos, destinado ? detec??o do HPV por PCR convencional e a an?lise da express?o de citocinas, TLR9 e MyD88 por PCR em tempo real. A preval?ncia global do HPV foi de 39,5%, sendo 18,8% em pacientes sem les?es, e 61,1% em mulheres com les?es na c?rvice uterina. As mulheres com m?ltiplos parceiros apresentaram maiores riscos de infec??o pelo HPV, enquanto que as que tiveram duas ou mais gesta??es tiveram um fator protetor. Observou-se correla??o entre altera??es cervicais e a infec??o pelo HPV. Os n?veis de express?o de RNA-m das citocinas pr?-inflamat?rias INF-?, TNF-?, IL-17 e anti-inflamat?ria IL-10 de pacientes infectados pelo HPV, tiveram seus n?veis de express?o mais alto no grupo com les?o em compara??o ao sem les?o, em rela??o ao controle. ? poss?vel que, o aumento na express?o das citocinas, principalmente IL-10 e IL-17, esteja associado a um processo inflamat?rio de natureza cr?nica presente nas les?es e pode estar relacionadas ao favorecimento da persist?ncia viral e prov?vel progress?o para les?es malignas. / Genital human papillomavirus (HPV) infection is one of the most common causes of sexually transmitted diseases in both genders, with a higher infection prevalence among young women sexually active, consisting in a serious public health problem. The persistent high-risk HPV infection with epigenetic events triggered by exposure to physical, chemical, environmental, beyond the dysfunction of the immune system, can favor the development of premalignant and malignant lesions of the uterine cervix. The objective of this study was estimate the HPV prevalence and evaluate the profile of the immune response in women, with and without cervical lesions associated with it; through the expression levels of cytokines, TLR9 and Myd88 in the uterine mucosa, establishing a correlation with the presence or absence of lesions and HPV. The study included women aged between 16 and 85 years, with an average of 36,2 years and standard deviation of 11.26. A total of 225 women participated of this study, 126 were recruited among women attending the screening program for cervical cancer and the other 99 were sent to maternity Janu?rio Cicco with a suspected uterine cervix injury. Patients who agreed to participate, were submitted to an interview to obtain socio-demographic data, followed by clinical examination and collection of two cervical scrape specimens, one for cytological analysis and another for molecular analysis in order to detect HPV. Colposcopy was performed in women who had suspected injury to detect these possible changes. It was collected two fragments of tissue in each biopsy, one for histopathological analysis and other to obtain nucleic acid, destined to detection of HPV by conventional PCR and, analysis of receptors and cytokines expression involved in the immune response by real-time PCR. The overall HPV prevalence was 39.5%, 61,1% in patients with lesions and 18,8% % in patients without lesions. Women with multiple partners, and those who had two or more pregnancies had higher risk of HPV infection. There was a correlation between cervical changes and HPV infection. The RNA-m expression levels of The pro-inflammatory cytokines INF-?, TNF-?, IL-17 and the anti-inflammatory IL-10 showed higher expression levels in the positive HPV injury group compared to uninjured, compared to control. It is possible that the increased expression of cytokines, especially IL-10 and IL-17 is associated with a chronic inflammatory process present in the lesions and can be related to favor viral persistence and likely to progress to malignant lesions.