Título :	Efeito da inflamação sistêmica na qualidade do sêmen de pacientes renais crônicos submetidos à hemodiálise : análise dos níveis de ferritina e transferrina seminal
Autor :	Silva, Gilmar Pereira
Orientador(es)::	Carneiro, Fabiana Pirani
Assunto::	Doença renal crônica Disfunção gonadal Sêmen - qualidade Infertilidade Inflamação sistêmica Hemodiálise - pacientes
Fecha de publicación :	17-ago-2018
Data de defesa::	27-feb-2018
Citación :	SILVA, Gilmar Pereira. Efeito da inflamação sistêmica na qualidade do sêmen de pacientes renais crônicos submetidos à hemodiálise: análise dos níveis de ferritina e transferrina seminal. 2018. [94] f., il. Tese (Doutorado em Ciências da Saúde)—Universidade de Brasília, Brasília, 2018.
Abstract:	Introduction: gonadal dysfunction occurs in the course of many acute or chronic diseases as a result of the action of endogenous or exogenous toxins, acute or chronic inflammatory and oxidative processes. The gonadal dysfunction promotes changes in sex hormone levels and seminal quality, manifested clinically by changes in fertility (sub / infertility). Even if we did not find studies that evaluate the percentage of patients with chronic hemodialytic kidney disease in males with changes in seminal quality, it is admitted that the percentage of such as important seminal quality changes manifested by oligospermia, teratospermia and azoospermia is not negligible. Previous studies have attributed these changes in this group of patients, predominantly to uremic and oxidative factors commonly associated with them. Considering that about 40-60% of chronic renal patients undergoing hemodialysis present a chronic systemic inflammatory process, it was decided to verify if systemic inflammation interferes in the levels of seminal ferritin (Fts) and seminal transferrin (Tfs) and whether these are associated with seminal parameters and fertility index (IF), considering the possible antioxidative property attributed to these proteins. Methodology: a cross-sectional study carried out in the Hemodialysis Sector of the University Hospital of the University of Brasília between July 2016 and December 2016 in men aged between 18 and 60 years, without acute or chronic hepatopathy and eugonadic. They were excluded those with a diagnosis of hemochromatosis or diseases of iron metabolism. Sample composed of 60 cases of patients on chronic hemodialysis subdivided into three subgroups according ultrasensitive c-reactive protein (CRP) serum level: group 1 (“with inflammation”, n = 30, CRP> 5 ng / ml), group 2(without inflammation, n = 30, PCR ≤ 5ng / ml), group 3 (group 1 + group 2) and group 4 (healthy controls, n = 30, PCR ≤ 1ng / ml). Blood samples and sperm harvested to indicate biochemical and hematological parameters (urea, creatinine, albumin and globulin fractions and complete blood count), hormonal parameters (follicle stimulating hormone(FSH), luteinizing hormone(LH), total testosterone(TT), prolactin(PRL), SF and ST, serum CRP and SP(spermogram - manual method), calculation of fertility index(FI) and preparation of seminal fluid by centrifugation. Results: hematological and biochemical parameters (hemoglobin, urea, creatinine and albumin); SP; hormonal parameters (FSH, LH, TT and PRL); FI and ST were significantly lower in the group 3 compared to the group 4. There were no significant differences for age, globulin and SF variables (P <0.05). The inflammatory factor analyzed alone does not seem to interfere in the subgroups cases (groups 1 and 2), but there were significant differences (P <0.05) found between groups 3 and 4 for the variables (biochemical, seminal and hormonal parameter, FI and ST. SF did not correlate (p> 0.05) with FI, SP, FSH, TT and ST, independently of the inflammatory status. ST was positively correlated (p≤0.001), independently of inflammatory status, with FI and seminal parameters, except the sperm morphology of the without inflammation group (r = 0.272, p = 0.146) and hormones. CRP correlated with SF and sperm motility in the without inflammation group. Conclusions: since chronic systemic inflammation is prevalent in chronic renal patients, the present study is important because it is the first to verify the possible effect of the inflammatory factor defined by serum CRP levels on seminal quality, whereas that previous studies have attributed these changes predominantly to the uremic and oxidative factors commonly associated with these patients. The results obtained here suggest that systemic inflammation does not appear to significantly interfere with seminal ferritin / transferrin levels. But seminal transferrin seems useful in the initial evaluation of these patients with suspected infertility by alteration in seminal quality because it is associated with all seminal parameters and fertility index.
metadata.dc.description.unidade:	Faculdade de Ciências da Saúde (FS)
Descripción :	Tese (doutorado)—Universidade de Brasília, Faculdade de Ciências da Saúde, Programa de Pós-Graduação em Ciências da Saúde, 2018.
metadata.dc.description.ppg:	Programa de Pós-Graduação em Ciências da Saúde
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