Associação entre anticorpo anticardiolipina e mutação C677T na metileno tetrahidrofolato redutase em mulheres com aborto espontâneo recorrente
um novo caminho na trombofilia?
Palavras-chave:
Metilenotetrahidrofolato redutase (NADPH2), Trombofilia, Trombose, Síndrome antifosfolipídica, Anticorpos anticardiolipinaResumo
CONTEXTO: O aborto espontâneo recorrente já foi associado a vários fatores etiológicos e à trombose materna. Fatores de trombofilia adquiridos e hereditários podem ser causas destes eventos. OBJETIVO: Avaliar a associação entre fatores de trombofilia e aborto espontâneo recorrente. TIPO DE ESTUDO: Caso-controle. LOCAL: Centro de Atenção Integral à Saúde da Mulher, Universidade Estadual de Campinas, São Paulo, Brasil. MÉTODOS: Foram retirados 40 ml de sangue de 88 mulheres com aborto espontâneo recorrente do Ambulatório de Aborto Recorrente e 88 mulheres férteis do Ambulatório de Planejamento Familiar, pareadas por idade e raça, para pesquisar fatores de trombofilia adquiridos e hereditários. O anticorpo anticardiolipina (ACA), anticoagulante lúpico (LA) e a deficiência das proteínas C, S e antitrombina III foram pesquisados por ELISA (enzyme-linkek immunosorbent assay), dRVVT (dilute Russel Viper Venom Time, dRVVT) e métodos coagulométrico e cromogênico. O ácido desoxirribonucléico (DNA) foi amplificado pela técnica de reação em cadeia da polimerase (PCR) para o estudo das mutações fator V de Leiden, G20210A no gene da protrombina e C677T no gene da enzima metilenotetrahidrofolato redutase (MTHFR). RESULTADOS: O ACA foi encontrado em 11 mulheres com RSA e em uma mulher fértil [OR 12.4 (IC 95% 1.5 a 98.5)]. A mutação C677T heterozigota foi encontrada em 59 mulheres com RSA e em 35 mulheres férteis [OR 3.1 (IC 95% 1.7 a 5.7)]. A presença concomitante do ACA e da mutação C677T heterozigota foi encontrada em oito mulheres com aborto espontâneo recorrente e em nenhuma mulher fértil (p < 0,01). DISCUSSÃO: O significado da associação entre a mutação heterozigota C677T no gene da MTHFR e o anticorpo anticardiolipina não está claro. Pode-se supor que um fator hereditário que, isolado, não pre- disporia fortemente um indivíduo à trombose poderia, em associação com um fator adquirido, deflagrar o processo e intensificar a expressão da trombose. CONCLUSÕES: O ACA e a mutação C677T heterozigota no gene da MTHFR apresentaram associação estatística com RSA. A concomitância destas duas alterações é um novo achado no estudo de fatores trombogênicos em aborto espontâneo recorrente.
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