Revista Brasileira de Reumatologia (Dec 2010)
Interação entre qualidade do meio ambiente, estresse e a variação do gene APOE na determinação da suscetibilidade à fibromialgia Association between environmental quality, stress and APOE gene variation in fibromyalgia susceptibility determination
Abstract
INTRODUÇÃO: A fibromialgia se trata de uma desordem multifatorial, cuja etiologia reside na interação entre a susceptibilidade genética e o ambiente. No entanto, poucos trabalhos procuram detectar quais seriam os fatores considerados de risco. OBJETIVO: Investigar a influência genética e sua interação com qualidade ambiental e com estresse como possíveis fatores de risco para o desenvolvimento da fibromialgia. PACIENTES E MÉTODOS: Neste estudo transversal, foram investigados dois grupos de mulheres, sendo 47 com diagnóstico clínico de fibromialgia, e 41 mulheres do grupo controle, todas da comunidade de Novo Hamburgo, RS. O polimorfismo do gene da apolipoproteína E (APOE) foi analisado, a partir do DNA extraído do sangue total de ambas as amostras. Os fatores ambientais foram avaliados através do inventário de sintomas para adultos de Lipp (ISSL), para a averiguação do estresse comportamental, e da aplicação do domínio V do WHOQOL-100. RESULTADOS: Dentre as pacientes, foram encontradas mais mulheres com níveis altos de estresse, quando comparado à amostra controle (P INTRODUCTION: Fibromyalgia is a multifactorial disease, of which etiology is based on interaction between genetic susceptibility and environment. However, few studies attempted to identify the risk factors. OBJECTIVE: To investigate the genetic influence and its interaction with environmental quality and stress, as possible risk factors for fibromyalgia development. PATIENTS AND METHODS: This cross-sectional study investigated two groups of women, of which 47 had a clinical diagnosis of fibromyalgia, and 41 women comprising thre control group, all from the town of Novo Hamburgo, RS. The apolipoprotein E (APOE) gene polymorphism was analyzed in DNA extracted from total blood, in both samples. Environmental factors were studied through Lipp's Inventory of Stress Symptoms for Adults and by applying the WHOQOL-100 domain V. RESULTS: Among the patients, more women had high stress levels when compared to the control sample (P < 0.001); moreover, the average scores of the WHOQOL-100 domain V, which analyze environment quality, were lower in this group (P < 0.001). APOE genotypic and allelic frequencies were similar between the two groups. Multivariate analysis showed that low WHOQOL-100 scores increase the chance of disease development by 57.7 times (P < 0.001), and that high stress levels were related with the disease (OR = 197.2; P < 0.001). This approach pointed out an interaction between stress and presence of E*2 allele (P = 0.028). Fibromyalgia was much more frequent in patients with high stress levels that were E*2 non-carriers (estimated OR = 265.1), when compared to patients with the same stress level, but E*2 carriers (estimated OR = 1.06). CONCLUSION: E*2 allele presence could have a protective action regarding the association between fibromyalgia and stress
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