MARCELA DE ABREU SILVA COUTO

81,9 (56,'$'()('(5$/'(6­2&$5/26

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352*5$0$'(3Ï6*5$'8$d­2(0),6,27(5$3,$

CONCENTRAÇÕES SÉRICAS DIMINUÍDAS DE IGF-I E IGFBP-3, ATROFIA MUSCULAR E ALTERAÇÕES NO DESEMPENHO NEUROMUSCULAR

CONTRIBUEM PARA A FRAQUEZA MUSCULAR EM INDIVÍDUOS HEMIPARÉTICOS CRÔNICOS.

MARCELA DE ABREU SILVA COUTO

6­2&$5/26

81,9 (56,'$'()('(5$/'(6­2&$5/26

&(1752'(&,Ç1&,$6%,2/Ï*,&$6('$6$Ò'(

352*5$0$'(3Ï6*5$'8$d­2(0),6,27(5$3,$

CONCENTRAÇÕES SÉRICAS DIMINUÍDAS DE IGF-I E IGFBP-3, ATROFIA MUSCULAR E ALTERAÇÕES NO DESEMPENHO NEUROMUSCULAR

CONTRIBUEM PARA A FRAQUEZA MUSCULAR EM INDIVÍDUOS HEMIPARÉTICOS CRÔNICOS.

MARCELA DE ABREU SILVA COUTO

'LVVHUWDomR DSUHVHQWDGD DR 3URJUDPD GH 3yV *UDGXDomR HP )LVLRWHUDSLD GD 8QLYHUVLGDGH )HGHUDO GH 6mR&DUORVFRPRSDUWHGRVUHTXLVLWRVSDUDDREWHQomRGR WtWXORGH0HVWUHHP)LVLRWHUDSLD

Orientador: Prof. Dr. Thiago Luiz de Russo

Apoio Financeiro: %ROVLVWD GH 0HVWUDGR SHOR &RQVHOKR 1DFLRQDO GH 'HVHQYROYLPHQWR &LHQWtILFRH7HFQROyJLFR&13T

Ficha catalográfica elaborada pelo DePT da Biblioteca Comunitária da UFSCar

S586cs

Silva-Couto, Marcela de Abreu.

Concentrações séricas diminuídas de IGF-I e IGFBP-3, atrofia muscular e alterações no desempenho

neuromuscular contribuem para a fraqueza muscular em indivíduos hemiparéticos crônicos / Marcela de Abreu Silva Couto. -- São Carlos : UFSCar, 2013.

60 f.

Dissertação (Mestrado) -- Universidade Federal de São Carlos, 2013.

1. Fisioterapia. 2. Reabilitação neurológica. 3.

Hemiparesia. 4. Atrofia muscular. 5. Marcadores biológicos. 6. Eletromiografia. I. Título.

'HGLFR HVWH WUDEDOKR DRV TXHULGRV TXH VmR D LQVSLUDomR GD PLQKD YLGD H TXH VRPDP IRUoDV SDUD SURVVHJXLU R FDPLQKR PHX DPRU (SDSKUDV PHXV YDORURVRV SDLV PHXV PDUDYLOKRVRV LUPmRV H PHXV LPSUHVFLQGtYHLVDPLJRV

AGRADECIMENTOS

$JUDWLGmRpXPDSUiWLFDTXHHQDOWHFHRVHUKXPDQReDH[SUHVVmRRXRVHQWLPHQWR TXHWHPRSRGHUGHJHUDUFUHVFLPHQWRDWRGRVDRUHGRUHSULQFLSDOPHQWHDTXHPpJUDWR'HYH VHUSUDWLFDGDGLDULDPHQWHeDSULQFLSDOUHJUDGHHWLTXHWDSRUpPQDFRUUHULDGDYLGDPXLWDV YH]HVRXRWHPSRQmRQRVSHUPLWHRXQmRYHUEDOL]DPRVRXVLPSOHVPHQWHQRVHVTXHFHPRV 1RHQWDQWRWHQKRDULFDRSRUWXQLGDGHGHIRUPDOL]DUPHXVVLQFHURVDJUDGHFLPHQWRVjVSHVVRDV TXHFRQWULEXtUDPSDUDHVWDUHDOL]DomR

3ULPHLUDPHQWHDJUDGHoRDRPHXDPLJRGHWRGDVDVKRUDVDTXHOHTXHFRQKHFHPHXV VHQWLPHQWRVHPHXVSHQVDPHQWRVTXHVRQGDRPHXFRUDomRHPHVXVWHQWDFRPVXDGHVWUDILHO $TXHOHTXHPXGRXDPLQKDKLVWyULDHTXHGiVHQWLGRjYLGDHDTXHPSRVVRFKDPDUGH3$, 7XGRRFRUUHSRU(OHHWXGRpSDUD(OH$(OHWRGDD+RQUD

$JUDGHoR D PLQKD IDPtOLD TXH PHVPR WmR GLVWDQWH QXQFD GHL[RX GH VHU PHX SRUWR VHJXUR0HXVTXHULGRVSDLVVHLTXHDEGLFDUDPGHVHXVSURMHWRVHTXHVHHVIRUoDUDP PXLWR SDUDSURSRUFLRQDUDUHDOL]DomRGRVRQKRTXHPXGRXUDGLFDOPHQWHQRVVDVYLGDV2EULJDGDSRU UHSUHVHQWDUHPWRGDDIRUoDTXHSUHFLVRSDUDVHJXLUHPIUHQWHSRUWHUHPPHLQVWUXtGRGLDQWHGD 3DODYUD GH 'HXV H SRU WHUHP PH HQVLQDGR VREUH R TXH p HWHUQR (VWH p R PHX EHP PDLV SUHFLRVR 0DUORQ 0DUFXV /LOLDQ %LD YRFr V VmR PDLV TXH LUPmRV -XQWRV VHPSUH $PR PXLWRYRFr V

(SDSKUDVHVSRVRDPLJRQDPRUDGRHTXDVHXP)LVLRWHUDSHXWD7HPVLGRPHXPDLRU SDUFHLURGHVGHRSULPHLURDQRGDIDFXOGDGH9 RFr ID]SDUWHGHWRGDVDVDOHJULDVGDPLQKDYLGD H PH LQFHQWLYD H FRQIRUWD QRV PRPHQWRV GLItFHLV 2EULJDGD SRU VHPSUH OXWDU SDUD TXH DV FRLVDVDFRQWHoDPGDPHOKRUIRUPD&RQWLQXDUHPRVDFRQVWUXLURVVRQKRVODGRDODGR

FRPSDUWLOKDUFRPH[FHOr QFLDDJUDQGHYLVmRGHXPMRYHPHWDOHQWRVRSHVTXLVDGRUGHFDUiWHU DGPLUiYHO7HQKRRPpULWRGHVHUVXDSULPHLUDDOXQD

¬ PLQKDDPLJDHVXSHUFRRULHQWDGRUD&KULVWLDQH2EULJDGDSRUWHUVLGRLQFDQViYHO SRU WHU PH HQVLQDGR SRU WHU PH SURSRUFLRQDGR DV IHUUDPHQWDV QHFHVViULDV SDUD PH VHQWLU FDSD]GLDQWHGHXPLPHQVRGHVDILR2EULJDGDSRLVFRPFDULQKRVLQJHOH]DHPDHVWULDYRFr PH IRUMRXFRPVXDH[SHULr QFLDHVDEHGRULD$GPLURWH

¬ TXHULGD7DQLDTXHPHDEULXDVSRUWDVGHXPDQRYDUHDOLGDGHTXDQGRPHUHFHEHXQR ODERUDWyULR 6HP PH HVTXHFHU GD TXHULGD (VSHUDQ]D TXH GH XPD IRUPD PXLWR HVSHFLDO PH DMXGRXHPXLWRPHLQFHQWLYRX9 RFr VVmRJUDQGHVUHIHUHQFLDVDVHVHJXLUHWHQKRRSULYLOpJLR GHWr ODVFRPRSHUVRQDJHQVGDPLQKDKLVWyULD

1mRWHQKRSDODYUDVSDUDDJUDGHFHUj3URIHVVRUD$QD%HDWUL]TXHFRPWRGDDSDFLr QFLD H DWHQomR GR PXQGR HODERURX D URWLQD SDUD R SURFHVVDPHQWR GRV GDGRV H FRP DPL]DGH RIHUHFHXWRGRRVXSRUWHTXHSUHFLVHL

¬ JDOHUDGDYHOKDJXDUGDGRVWHPSRVGHEDQFDGDHDSRLRWpFQLFR6DEULQD-RmR5LWD *DEULHOD IORUHSULPHLUDGDPD'DYLQKD&DUROLQD&RORPELDQD3DXOD 0DUL&ULVWLQDHD GLJQtVVLPD7HUHVD

¬ VJDURWDVVXSHUSRGHURVDV*DEL/XL]DDPDVFRWLQKD'ULH&DURODTXHPGHVWDFR SHORWUDEDOKRQRPHVPRSURMHWR*DURWDGHILEUDSDUFHLUDRPEURDPLJRREULJDGDSRUVHPSUH HVWDUSRUSHUWR$PLJDREULJDGDSRUWXGR)RLPXLWRERPWUDEDOKDUDRVHXODGR$RV,&V $UDFL&DURO]LQKDH&HOVR6HPPHHVTXHFHUGRDSRLRGD0DtUDHGD7HUHVDGXUDQWHDVFROHWDV pFODUR)RUPDPRVXPD³EHOD´HTXLSH9 RFr VVmRGHPDLV

$RV LQHVTXHFtYHLV YROXQWiULRV SHORV RV TXDLV GHYR UHVSHLWR H DPL]DGH 6HP YRFr V QDGDVHULDSRVVtYHO

WH5DIDHODDV*LV)DELQKRH3DXOD-RLFH$GULDQLQKDHWRGDVDVYL]LQKDVGDQHXURSHGLDWUD VHPSUH VROtFLWRV 6RX JUDWD DR DPLJR =p SHOD GHGLFDomR H SRU WHU QRV GDGR VXSRUWH QR ODERUDWyULR/D)DU

$JUDGHoRD5RVDQDDPLJDGRFROpJLROiGH7Ur V5LRV5-JUDQGHUHHQFRQWUR6HUHL VHPSUHJUDWDSHODDFROKLGDKRVSHGDJHPRPEURDPLJRDSRLRDWHQomR$PRWHDPLJD

$RVSURIHVVRUHV6WHOOD5RVDQD+HORtVD7DWLDQDH$QLHOOHTXHGLUHWDHLQGLUHWDPHQWH FRQWULEXtUDPSDUDRWUDEDOKR'HLJXDOIRUPDDRVIXQFLRQiULRVDPLJRVSURIHVVRUHVGD86(H WRGDDJDOHUDGD3yV*UDGXDomRGD)LVLRWHUDSLDSDUFHLURVGDVGLVFLSOLQDVHVHFUHWiULRV8P DJUDGHFLPHQWRHVSHFLDODRVDOXQRVGDJUDGXDomR

$RV SDUFHLURV GR &,', 'U /XL] DR TXHULGR 0DUFLQKR H UHFHSFLRQLVWDV TXH PXLWR FRQWULEXtUDPSDUDDDQiOLVHGD501

$RVTXHULGRV6WHIDQDV1RHPL6DOLVD6tQWLTXH'pERUD/XFDV*DEULHO0DULHOLVD6U -RmRHPLQKDVRJUDTXHULGD%HUQDGHWH9 RFr VVHPSUHSXGHFRQWDUFRPRDSRLRGHVWDIDPtOLD DEHQoRDGD9 RFr VWDPEpPID]HPSDUWHGHVWDKLVWyULD

$WRGDDFRPXQLGDGHGDLJUHMD0HWRGLVWDHP6mR&DUORVQDTXDOUHFHERDSRLRHPH VLQWRHPFDVD0DUFLD-HIHUVRQ*DEL1DQD5DSKD5RGULJR/DULVVDV³/RVKHUPDQRV´-RVp eULF 5RVDOLD -pVVLFD *DEULHO :LO 3U H 6RQLQKD 9 RFr V HVWmR JXDUGDGRV QR FRUDomR SUD VHPSUH

$JUDGHoRWDPEpPD&$3(6HD)$3(63TXHYLDELOL]DUDPPHXVHVWXGRVRSURMHWRH RVWUDEDOKRVTXHDQWHFHGHUDPDHVWH

LISTA DE ABREVIATURAS

$67È UHDGHVHFomRWUDQVYHUVD $9 &$FLGHQWH9 DVFXODU&HUHEUDO %)±%tFHSVIHPRUDO

&,09 ±&RQWUDomRLVRPpWULFDYROXQWiULDPi[LPD ((%±(VFDODGHHTXLOtEULRGH%HUJ

,*)%33URWHtQDVOLJDQWHVGRIDWRUGHFUHVFLPHQWRVHPHOKDQWHjLQVXOLQD ,*),)DWRUGHFUHVFLPHQWRVHPHOKDQWHjLQVXOLQD,

--RXOHV

PV±0HWURVSRUVHJXQGRV 1P±1HZWRQ[PHWUR 37±3LFRGHWRUTXH 5)±5HWRIHPRUDO V±6HJXQGRV

66±6HPLPHPEUDQRVRHVHPLWHQGLQRVR 67±6HPLWHQGLQRVR

7PV±7HVODPHWURSRUVHJXQGR 78*±Time up and go

LISTA DE TABELAS

Tabela 1.Descrição funcional e demográfica dos grupos. 30

Tabela 2.Desempenho muscular isocinético.0&PHPEURFRQWUROH013PHPEUR QmR SDUpWLFR 03 PHPEUR SDUpWLFR 3& 3HVR FRUSRUDO GLIHUHQoD HP UHODomR DR *UXSR &RQWUROH S ‚ GLIHUHQoD HP UHODomR DR PHPEUR QmR SDUpWLFR S 1P1HZWRQ[PHWUR--RXOHV.

LISTA DE FIGURAS

Figure 1. )OX[RJUDPD GR HVWXGR *+ JUXSR KHPLSDUpWLFR *& JUXSR FRQWUROH )$&

Functional Ambulation Category'32& GRHQoDSXOPRQDUREVWUXWLYDFU{QLFD

28

Figura 2Volume dos músculos extensores e flexores do joelho 0& PHPEUR FRQWUROH 013PHPEURQmRSDUpWLFR03PHPEURSDUpWLFR$)LJXUDUHSUHVHQWDWLYDGD510GR JUXSRFRQWUROH*&%)LJXUDUHSUHVHQWDWLYDGD510GRJUXSRKHPLSDUpWLFR*+& 9 ROXPH GRV P~VFXORV 4XDGUtFHSV UHWR IHPRUDO 5) YDVWR PHGLDO 9 0 YDVWR LQWHUPpGLR 9 , YDVWR ODWHUDO 9 / ' 9 ROXPH GRV P~VFXORV LVTXLRWLELDLV VHPLWHQGLQRVRHVHPLPHPEUDQRVR66HEtFHSVIHPRUDO%)SFRPSDUDGRDR *&1RWHDDWURILDVHOHWLYDGRVP~VFXORV9 09 ,%)H66QRVPHPEURVSDUpWLFRV%DUUD FP

31

Figura 3Concentração sérica de IGF-I e IGFBP-3.*&JUXSRFRQWUROH*+JUXSR KHPLSDUpWLFR S FRPSDUDGR D *& 2EVHUYH TXH R *+ DSUHVHQWRX PHQRUHV FRQFHQWUDo}HVVpULFDVGH,*),H,*)%3HPFRPSDUDomRDR*&

32

Figura 4. Ativação muscular durante as contrações dinâmicas concêntricas dos extensores e flexores do joelho.5065RRW0HDQ6TXDUH&,9 0&RQWUDomR,VRPpWULFD9 ROXQWiULD0i[LPD

0& PHPEUR FRQWUROH 013 PHPEUR QmR SDUpWLFR 03 PHPEUR SDUpWLFR 5) UHWR IHPRUDO

9 0 YDVWR PHGLDO 9 / YDVWR ODWHUDO %) EtFHSV IHPRUDO 67 VHPLWHQGLQRVR S

&RPSDUDo}HV DSUHVHQWDGDV SHORV FROFKHWHV 1RWH R DXPHQWR GD DWLYLGDGH GR 5) H GR 67 QR

PHPEURSDUpWLFR

36

Figura 5. Ativação muscular durante as contrações dinâmicas excêntricas dos flexores e extensores de joelho. 506 5RRW 0HDQ 6TXDUH &,9 0 &RQWUDomR ,VRPpWULFD 9 ROXQWiULD 0i[LPD0& PHPEUR FRQWUROH013 PHPEUR QmR SDUpWLFR 03 PHPEUR SDUpWLFR 5) UHWR IHPRUDO9 0YDVWRPHGLDO9 /YDVWRODWHUDO%)EtFHSVIHPRUDO67VHPLWHQGLQRVRS

&RPSDUDo}HVDSUHVHQWDGDVSHORVFROFKHWHV2EVHUYHRDXPHQWRGDDWLYLGDGHGR5)GR013HGR 67GR03GXUDQWHDH[WHQVmRGRMRHOKR'XUDQWHDIOH[mRQmRKRXYHGLIHUHQoDVVLJQLILFDWLYDV HQWUHRVJUXSRV

SUMÁRIO RESUMO

ABSTRACT

APRESENTAÇÃO 1

CONTEXTUALIZAÇÃO 2

REVISÃO DA LITERATURA 4

OBJETIVOS 10

2EMHWLYRVJHUDLV 10

2EMHWLYRVHVSHFtILFRV 13

MANUSCRITO 11

Introdução 13

Métodos 17

$VSHFWRVpWLFRVGHVHQKRH[SHULPHQWDOHVXMHLWRV 17

&ULWpULRVGHLQFOXVmRHH[FOXVmR 17

$YDOLDomRGRQtYHOGHDWLYLGDGHItVLFDHGDIXQFLRQDOLGDGH 18

5HVVRQkQFLD0DJQpWLFD1XFOHDU 21

4XDQWLILFDomRGH%LRPDUFDGRUHV 22

&ROHWDHSUHSDURGDDPRVWUDGHVDQJXH 22

0HQVXUDomRGDFRQFHQWUDomRVpULFDGH,*),H,*)%3SRU(/,6$ 23

$YDOLDomRLVRFLQpWLFDV 23

$TXLVLomRGDDWLYLGDGHPXVFXODUSRUHOHWURPLRJUDILD(0* 24

$QiOLVH(VWDWtVWLFD 25

Resultados 27

&DUDFWHUL]DomRGRV6XMHLWRV 27

1tYHLVGHDWLYLGDGHPRELOLGDGHIXQFLRQDOLGDGHTXDOLGDGHGHYLGD 29 9 ROXPHGRVP~VFXORVH[WHQVRUHVHIOH[RUHVGRMRHOKR 30

&RQFHQWUDo}HVVpULFDVGH,*),H,*)%3 32

7RUTXHHDWLYDomRPXVFXODU 33

DISCUSSÃO 39

CONCLUSÃO 45

AGRADECIMENTO 46

ATIVIDADE NO PERÍODO 47

REFERÊNCIAS BIBLIOGRÁFICAS 50

RESUMO

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ABSTRACT

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Análise Estatística

RESULTADOS

Caracterização dos Sujeitos

Níveis de atividade, mobilidade, funcionalidade e qualidade de vida

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Tabela 1 – Descrição demográfica e funcional dos grupos.

Variáveis

Grupo Controle (n=14)

Grupo Hemiparético

(n=14) 9DORU3

Idade (anos) “ “

Altura (m) “ “

Peso Corporal (Kg) “ “

Índice de Massa Corporal “ “

Escala de Equilíbrio de Berg “ “

TUG Test (s) “ ±

Teste de caminhada 10 m (m/s) “ “

Alcance Funcional “ “

Volume dos músculos flexores e extensores do joelho

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Figura 2Volume dos músculos extensores e flexores do joelho.0&PHPEURFRQWUROH013PHPEUR

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Concentrações séricas de IGF-I e IGFBP-3

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Torque e Ativação muscular

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Tabela 2 –Desempenho Muscular Isocinético

CONCÊNTRICA

MC “ “ “ “ “ “

MNP “ “ “ “ “ “

MP “‚ “‚ “‚ “‚ “‚ “‚

EXCÊNTRICA

Extensão Flexão

Pico de Torque

(Nm/PC) Trabalho(J/PC) (Watts/PC)Potência Pico de Torque (Nm/PC) Trabalho(J/PC) (Watts/PC)Potência

MC “ “ “ “ “ “

MNP “ “ “ “ “ “

MP “‚ “‚ “‚ “‚ “‚ “‚

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Figura 4

Figura 4. Ativação muscular durante as contrações dinâmicas concêntricas dos extensores e

Figura 5

Figura 5. Ativação muscular durante as contrações dinâmicas excêntricas dos flexores e

Correlações entre as concentrações séricas de IGF-I e IGFBP-3 e variáveis do desempenho neuromuscular e funcionalidade

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DISCUSSÃO

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