Marcadores inflamatórios e perfil metabólico da massa óssea de adultos com anemia falciforme

Abstract

Sickle cell anaemia (SCA) is a multisystemic disease that involves a chronic inflammatory process and several complications, such as osteometabolic alterations The role of inflammation in bone involvement in SCA is still poorly studied in the literature. This study aimed to assess the relation between inflammatory markers and osteometabolic alterations with SCA. A cross- sectional, analytical and controlled study was carried out with 55 adults with SCA (Hb-SS group), in stable clinical condition, with mean age of 26.5 (±5.2) years, 60 healthy controls (Hb- AA group), with mean age of 28 (±4.9) years and 46 controls with sickle cell trait (Hb-AS group), with mean age of 33.1 (±6.9) years. Participants underwent questionnaires about sociodemographic and clinical data, level of physical activity, 24h dietary recall to estimate daily calcium intake, anthropometric and laboratory assessment, with measurements of hematimetric indices, markers of hemolysis, bone metabolism and inflammatory LDH, IL-1β, IL-6, IL-8, IL-10, TNF-α and sTREM-1. Hb-SS and Hb-AA groups also underwent bone densitometry. Hb-SS group had higher levels of LDH, IL-1β, IL-6, IL-10 and TNF-α than the other two groups, as well as higher levels of alkaline phosphatase and CTX, bone remodeling markers, in addition to higher frequency (50%) of vitamin D insufficiency/deficiency and lower BMD in the lumbar spine (BMDLS) than Hb-AA group. Positive correlation of hemoglobin and hematocrit and negative of phosphorus with BMDLS was seen in Hb-SS group. Correlation between inflammatory markers and BMDLS was not noted. In the multiple linear regression analysis, it was found that hematocrit and reticulocytes showed direct relation with BMDLS and, in the model by groups of variables, a positive relation of hematocrit and negative phosphorus with BMDLS. The findings do not corroborate the hypothesis that inflammation is a determining factor for BMD and reinforce the idea that the reduction in BMD in this population is due to the hemolytic anemia that occurs in SCA.