Tese (doutorado)—Universidade de Brasília, Faculdade de Ciências da Saúde, 2008. / Submitted by Kathryn Cardim Araujo (kathryn.cardim@gmail.com) on 2009-10-15T16:09:56Z
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Previous issue date: 2008 / Introdução: A doença de Kawasaki (DK) é uma vasculite sistêmica de etiologia ainda desconhecida cuja principal complicação é a arterite coronariana. Casos de perda auditiva neurossensorial também são descritos como complicação desta afecção. Objetivos: Avaliar em pacientes com DK (a) a prevalência da perda auditiva neurossensorial (transitória ou definitiva), e determinar a estrutura funcional responsável pelo acometimento; (b) relacionar estes achados com a prevalência das complicações cardíacas, com o uso da gamaglobulina na fase aguda e subaguda, e com os resultados dos exames laboratoriais. Método: Estudo prospectivo (coorte clínica) de 40 pacientes com idade entre dois meses e 11 anos com DK entre 2005 e 2007. Os pacientes foram avaliados por imitanciometria e por Potenciais Evocados Auditivos (BERA-Brainstem Evikaded Responses Audiometry) realizado dentro dos primeiros 30 dias de doença, e seis meses depois do início da febre. Teste de emissões otoacústicas foi realizado nos pacientes que ainda permaneciam com deficiência auditiva. Todos os pacientes foram tratados com gamaglobulina EV e acompanhados com ecocardiogramas com doppler, hemogramas completos e provas de atividades inflamatórias. Resultados: Dos 40 pacientes, 22 (55%) apresentaram deficiência auditiva nos 30 primeiros dias e 12 pacientes (30%) continuaram com perda auditiva seis meses depois. Dos 12 pacientes com perda auditiva após os seis meses, alteração coclear foi observada em um e comprometimento do nervo acústico em 11 pacientes. Dez pacientes (25%) apresentaram aneurisma de coronária. A trombocitose (plaquetas >500.000) esteve presente em 10 (83,3%) dos pacientes que apresentaram perda auditiva mantida (na fase aguda e após seis meses). A anemia (Hb <10mg/dl) esteve presente em oito (66%) destes pacientes. VHS elevado (acima de 50mm) por mais de 30 dias foi encontrado em 100% dos pacientes com perda auditiva mantida seis meses depois. Conclusão: Dentro dos 30 dias e após seis meses de evolução a perda auditiva neurossensorial foi mais prevalente do que as complicações coronarianas. Em 11 pacientes (90,1%) o acometimento foi no nervo acústico. Pelo resultado do teste exato de quiquadrado houve associação entre (a) uso de gamaglobulina após a fase aguda e perda auditiva neurosenssorial (p= 0,0097), (b) trombocitose e perda auditiva (p= 0,039); (c) anemia e perda auditiva (p<0,046); (d) atividade inflamatória prolongada e perda auditiva mantida seis meses depois do início da febre (p<0,001). _________________________________________________________________________________________ ABSTRACT / Introduction: Kawasaki Disease (KD) is an acute systemic vasculitis of unknown etiology whose main complication is the coronary arteritis. Cases of sensorineural hearing loss have also been described as complication of this disorder. Objective: To evaluate in patients with KD: (a) prevalence of sensorineural hearing loss (temporary or permanent), and to determine the structure responsible for the disorder (b) to relate these findings with the prevalence of cardiac complications, with the use of gammaglobulin in the acute and subacute phases, and the results of laboratory tests. Method: Prospective study (clinical cohort) of 40 patients with KD between 2005 and 2007. Each patient was evaluated by imitanciometry and BERA (Brainstem Evikaded Responses Audiometry) conducted within the first 30 days of the disease and six months after. Otoacoustic emissions test was conducted in patients who still remained with hearing disability. All patients were treated with gammaglobulin EV and accompanied with echocardiograms with Doppler, full blood counts and inflammatory activity tests. Results: From the 40 patients, 22 (55%) had hearing disability in the first 30 days and 12 patients (30%) continued with hearing loss after six months. From the 12 patients with hearing loss after six months, cochlear change was observed in one and commitment of the acoustic nerve in 11 patients. Ten patients (25%) had coronary aneurysm. Thrombocytosis (platelets> 500,000) was present in 10 (83.3%) patients who had hearing loss (in the acute phase and after six months). Anemia (Hb <10mg/dl) was present in eight (66%) of these patients. High VHS (over 50mm) for longer than 30 days was found in 100% of patients with maintained hearing loss. Conclusion: Within the 30 days and after six months of evolution, the sensorineural hearing loss was more prevalent than coronary complications. The bilateral hearing involvement was prevalent. In 11 patients (90.1%), the involvement was in the acoustic nerve. The exact chi-square test revealed association between (a) the use of gammaglobulin after acute phase and neurossensorial hearing loss (p=0,0097), (b) thrombocytosis and maintained hearing loss (p=0.039), (c) anemia and maintained hearing loss (p<0.046), (d) prolonged inflammatory activity and maintained hearing loss (p<0.001).
| Identifer | oai:union.ndltd.org:IBICT/oai:repositorio.unb.br:10482/3458 |
| Date | January 2008 |
| Creators | Magalhães, Cristina Medeiros Ribeiro de |
| Contributors | Pratesi, Riccardo |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | Portuguese |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/doctoralThesis |
| Source | reponame:Repositório Institucional da UnB, instname:Universidade de Brasília, instacron:UNB |
| Rights | info:eu-repo/semantics/openAccess |
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