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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">El lupus eritematoso sist&#233;mico &#40;LES&#41; es una enfermedad inflamatoria inmune que se caracteriza por la formaci&#243;n de autoanticuerpos y dep&#243;sitos de complejos inmunes&#46; La presencia de inflamaci&#243;n cr&#243;nica puede afectar a m&#250;ltiples &#243;rganos&#44; especialmente al coraz&#243;n<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">1</span></a>&#46; El da&#241;o en el sistema cardiovascular&#44; adem&#225;s de ser ocasionado primariamente por un proceso autoinmune&#47;inflamatorio&#44; tambi&#233;n se ha asociado de manera secundaria con la actividad y la severidad de la enfermedad&#44; as&#237; como con el tratamiento inmunosupresor&#44; principalmente el uso de esteroides<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">El involucro cardiaco es una de las mayores complicaciones del LES&#44; y puede afectar todas las estructuras del coraz&#243;n incluyendo el pericardio&#44; miocardio&#44; v&#225;lvulas y vasos coronarios con diferentes grados de severidad&#44; siendo la prevalencia reportada en estudios de autopsia del 40 al 70&#37;&#59; y detectada por afectaci&#243;n sintom&#225;tica solamente en el 5 a 10&#37; de los pacientes&#44; sugiriendo la naturaleza subcl&#237;nica del da&#241;o al miocardio<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">3</span></a>&#46; En la actualidad la supervivencia de los pacientes con lupus ha mejorado&#44; sin embargo&#44; la morbimortalidad cardiovascular contin&#250;a siendo alta&#44; oscilando entre el 17 y 76&#37; en diferentes estudios<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Existen factores inherentes al LES que se ha propuesto que promueven la enfermedad cardiovascular&#44; como son la presencia de anticuerpos antifosfol&#237;pidos&#44; la funci&#243;n renal disminuida&#44; la duraci&#243;n de la enfermedad&#44; el da&#241;o cr&#243;nico a &#243;rgano reflejado por el &#237;ndice de da&#241;o del <span class="elsevierStyleItalic">Systemic Lupus International Collaborating Clinics&#47;American College of Rheumatology</span> &#40;SLICC&#47;ACR&#41; <span class="elsevierStyleItalic">damage index</span>&#44; la duraci&#243;n y dosis de esteroides&#44; as&#237; como el uso de azatioprina<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">5</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Los pacientes con LES muestran 11 veces mayor riesgo de presentar alteraciones valvulares que la poblaci&#243;n sana<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">6</span></a>&#46; Las alteraciones valvulares m&#225;s frecuentes son las insuficiencias&#44; involucrando principalmente las v&#225;lvulas a&#243;rtica y mitral&#44; y se ha encontrado asociaci&#243;n con la presencia de anticuerpos antifosfol&#237;pidos o con el s&#237;ndrome antifosfol&#237;pido secundario&#46; En algunos estudios se ha reportado que los t&#237;tulos altos de anticuerpos antifosfol&#237;pidos se asocian fuertemente con anormalidades cardiacas en pacientes con lupus<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">7&#44;8</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">La aur&#237;cula izquierda juega un papel importante en mantener la funci&#243;n cardiaca&#44; ya que act&#250;a como reservorio&#44; conductor y bomba<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">9</span></a>&#46; En casos de disfunci&#243;n diast&#243;lica&#44; ocurren cambios en el llenado ventricular&#44; desencadenando cambios en las fases auriculares para mantener el volumen sist&#243;lico ventricular&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">El ecocardiograma es una herramienta sencilla y ampliamente disponible para el diagn&#243;stico de enfermedades cardiovasculares que aporta informaci&#243;n de la estructura&#44; funci&#243;n y par&#225;metros hemodin&#225;micos<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">10</span></a>&#46; Se ha reportado que la disfunci&#243;n diast&#243;lica ventricular izquierda &#40;DDVI&#41; es com&#250;n&#44; ocurre de manera temprana y persistente en los pacientes con LES&#44; pudiendo ser la &#250;nica manifestaci&#243;n de involucro cardiaco precediendo la disfunci&#243;n sist&#243;lica a gran escala<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">1</span></a>&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">El agrandamiento y disfunci&#243;n de la aur&#237;cula izquierda se ha considerado como un marcador subrogado de la duraci&#243;n y severidad de la disfunci&#243;n diast&#243;lica&#46; Y se ha identificado como potencial indicador de m&#250;ltiples eventos adversos cardiovasculares&#44; como mayor riesgo de infarto agudo al miocardio&#44; insuficiencia cardiaca&#44; fibrilaci&#243;n auricular y mortalidad<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">11</span></a>&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Recientemente se ha introducido la deformaci&#243;n mioc&#225;rdica de la aur&#237;cula izquierda como potencial marcador de funci&#243;n diast&#243;lica&#44; mediante el <span class="elsevierStyleItalic">strain</span> longitudinal global de la aur&#237;cula izquierda &#40;SLGAI&#41; por la t&#233;cnica <span class="elsevierStyleItalic">speckle tracking</span> por ecocardiograf&#237;a&#46; Tiene la gran ventaja de ser independiente del &#225;ngulo&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">La deformaci&#243;n mioc&#225;rdica de la aur&#237;cula izquierda es una propiedad mec&#225;nica inherente del coraz&#243;n&#44; la cual se puede calcular por medio del <span class="elsevierStyleItalic">software</span> del ecocardiograma&#59; esto nos permite valorar qu&#233; porcentaje de movimiento en la posici&#243;n espacial cambia la fibra mioc&#225;rdica en cada fase del ciclo auricular &#40;reservorio&#44; conducto y bomba&#41;&#59; mientras mayor es el porcentaje de deformaci&#243;n&#44; mejor es la funci&#243;n mioc&#225;rdica&#46; Tiene una gran implicaci&#243;n cl&#237;nica ya que se ha demostrado que comienza a alterarse antes que otros par&#225;metros de funci&#243;n cardiaca&#44; como el volumen de la aur&#237;cula izquierda&#44; la relaci&#243;n E&#47;e&#8217; y la fracci&#243;n de expulsi&#243;n del ventr&#237;culo izquierdo&#44; lo que nos permite detectar cambios subcl&#237;nicos en el miocardio&#46; Esta t&#233;cnica se correlaciona directamente con la funci&#243;n diast&#243;lica del ventr&#237;culo izquierdo&#44; la cual generalmente presenta disfunci&#243;n antes de la funci&#243;n sist&#243;lica<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">9&#44;11&#44;12</span></a>&#46; Existen estudios que han demostrado que el <span class="elsevierStyleItalic">strain</span> de la aur&#237;cula izquierda se ha asociado como predictor de cardiopat&#237;a isqu&#233;mica&#44; insuficiencia cardiaca&#44; fibrilaci&#243;n auricular y muerte cardiovascular<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">13-15</span></a>&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Recientemente se describi&#243; que el SLGAI est&#225; deprimido en pacientes con LES en comparaci&#243;n con controles<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">1</span></a>&#44; siendo nuestro estudio el segundo en la literatura que investigue estos par&#225;metros&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">El objetivo principal de este estudio es evaluar la funci&#243;n de la aur&#237;cula izquierda por <span class="elsevierStyleItalic">strain</span> a trav&#233;s de la t&#233;cnica ecocardiogr&#225;fica <span class="elsevierStyleItalic">speckle tracking</span> en pacientes con LES y s&#237;ndrome antifosfol&#237;pido asociado y compararlos con controles sanos&#59; adem&#225;s de determinar&#44; como objetivo secundario&#44; si existen factores de riesgo para una funci&#243;n de la aur&#237;cula izquierda deprimida en la medici&#243;n de <span class="elsevierStyleItalic">strain</span> en los pacientes con LES y s&#237;ndrome antifosfol&#237;pido sin s&#237;ntomas cardiovasculares&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">M&#233;todos</span><p id="par0060" class="elsevierStylePara elsevierViewall">Se reclutaron pacientes que acudieron al servicio de reumatolog&#237;a del Antiguo Hospital Civil de Guadalajara &#171;Fray Antonio Alcalde&#187; de marzo a agosto del 2018&#46; Todos los pacientes deb&#237;an ser mayores de 18 a&#241;os y cumplir criterios de clasificaci&#243;n de LES SLICC 2012<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">16</span></a> y&#44; adem&#225;s&#44; pod&#237;an tener diagn&#243;stico de s&#237;ndrome antifosfol&#237;pido secundario seg&#250;n los criterios de clasificaci&#243;n de S&#237;dney 2006<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">17</span></a> o presencia de anticuerpos antifosfol&#237;pidos&#46; Los pacientes fueron pareados con controles sanos por edad y g&#233;nero&#44; defini&#233;ndose como control sano aquellos pacientes sin ning&#250;n tipo de comorbilidad o enfermedad&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Se excluyeron pacientes con hipertensi&#243;n arterial de larga evoluci&#243;n con mal control&#44; antecedente de enfermedad valvular conocida&#44; fibrilaci&#243;n auricular o cualquier otra arritmia&#44; diabetes mellitus no controlada&#44; diagn&#243;stico previo de insuficiencia cardiaca&#44; cardiopat&#237;a isqu&#233;mica o pacientes que tuvieran enfermedades autoinmunes de sobreposici&#243;n&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Se recolectaron del expediente cl&#237;nico las caracter&#237;sticas cl&#237;nicas de los pacientes&#46; Se obtuvieron los datos de laboratorio como biometr&#237;a hem&#225;tica&#44; qu&#237;mica sangu&#237;nea&#44; pruebas de funci&#243;n hep&#225;tica&#44; examen general de orina&#44; prote&#237;nas en orina de 24<span class="elsevierStyleHsp" style=""></span>h&#44; perfil de l&#237;pidos&#44; adem&#225;s de anticuerpos antinucleares &#40;ANA&#41; &#40;inmunofluorescencia indirecta&#41;&#44; anticuerpos espec&#237;ficos &#40;anti-Smith y anti-DNA doble cadena&#41;&#44; anticuerpos antifosfol&#237;pidos &#40;ELISA&#41;&#44; anticoagulante l&#250;pico&#44; IgG e IgM anticardiolipinas y &#946;2 glicoprote&#237;na&#46; Se calcul&#243; la actividad de la enfermedad con el <span class="elsevierStyleItalic">Mexican Systemic Lupus Erythematosus Disease Activity Index</span> &#40;Mex-SLEDAI&#41;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">18</span></a> al momento de la visita&#44; que fue el d&#237;a de inclusi&#243;n al estudio&#44; y se calcul&#243; la escala SLICC&#47;ACR <span class="elsevierStyleItalic">damage index</span> &#40;SDI&#41;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">19</span></a> para determinar la presencia de da&#241;o cr&#243;nico por la enfermedad&#46; Se defini&#243; como actividad Mex-SLEDAI<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>9<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">18</span></a> y SDI<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>1&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Se document&#243; el tratamiento utilizado en cada paciente&#44; como terapia inmunosupresora&#44; uso de esteroides y antimal&#225;ricos&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Las im&#225;genes y c&#225;lculos ecocardiogr&#225;ficos fueron realizados en el laboratorio de ecocardiograf&#237;a del Hospital Civil de Guadalajara &#171;Fray Antonio Alcalde&#187; por 5 cardi&#243;logos&#44; con una variabilidad interobservador de 0&#44;85&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Los ecocardiogramas convencionales se realizaron en un ecocardiograma Siemens ACUSON SC2000 prime con un transductor 4v1c sectorial de 1&#44;25-4&#44;5<span class="elsevierStyleHsp" style=""></span>MHz&#46; Todos los pacientes fueron evaluados con un ecocardiograma bidimensional&#46; Se calcul&#243; la fracci&#243;n de expulsi&#243;n del ventr&#237;culo izquierdo mediante el m&#233;todo biplanar de Simpson en las vistas apicales 4 y 2 c&#225;maras&#46; El volumen indexado de la aur&#237;cula izquierda se determin&#243; al final de la s&#237;stole ventricular &#40;tama&#241;o m&#225;ximo de aur&#237;cula izquierda&#41; por m&#233;todo biplanar &#225;rea-longitud en la vista apical de 4 y 2 c&#225;maras&#44; indexando su resultado con la superficie corporal&#46; La relaci&#243;n E&#47;e&#8217; se obtuvo mediante la proporci&#243;n de la onda E del flujo transmitral y el promedio de las ondas e septal y lateral&#46; La fracci&#243;n de expulsi&#243;n de la aur&#237;cula izquierda se calcul&#243; mediante el <span class="elsevierStyleItalic">software</span> del c&#225;lculo del <span class="elsevierStyleItalic">strain</span>&#46; La valvulopat&#237;a se defini&#243; como la presencia de alg&#250;n grado de insuficiencia valvular vista con el doppler color en las v&#225;lvulas a&#243;rtica&#44; mitral&#44; pulmonar y tricusp&#237;dea&#46; La presencia de derrame peric&#225;rdico se busc&#243; en el eje apical 4 c&#225;maras&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Se determin&#243; la deformaci&#243;n de la aur&#237;cula izquierda &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41; mediante el <span class="elsevierStyleItalic">software</span> syngo&#174; Velocity Vector Imaging technology&#46; La vista ecocardiogr&#225;fica para el estudio fue la apical 4 c&#225;maras&#46; El endocardio de la aur&#237;cula izquierda se traz&#243; manualmente al final de la s&#237;stole&#44; y los bordes del endocardio fueron rastreados por el <span class="elsevierStyleItalic">software</span> a trav&#233;s del ciclo cardiaco&#46; El <span class="elsevierStyleItalic">software</span> tom&#243; el intervalo R-R del trazo del electrocardiograma para el c&#225;lculo de la deformaci&#243;n&#46; La deformaci&#243;n se evalu&#243; como <span class="elsevierStyleItalic">strain</span> longitudinal global y se calcularon 3 valores en la deformaci&#243;n auricular denominados&#58; <span class="elsevierStyleItalic">strain</span> longitudinal de la aur&#237;cula de reservorio &#40;SLAr&#41;&#44; de conducto &#40;SLAc&#41; y de bomba &#40;SLAb&#41;&#46; La SLAr correspondi&#243; al valor desde el pico m&#225;s alto de la fase de reservorio&#44; la SLAb al pico m&#225;s alto de la fase de bomba y la SLAc a la diferencia entre SLAr y SLAb&#46; Adem&#225;s&#44; se report&#243; el valor de la tasa de la deformaci&#243;n&#44; definido como <span class="elsevierStyleItalic">strain rate</span>&#46; El SLGAI menor del 35&#37; fue utilizado para definir una deformaci&#243;n de la aur&#237;cula deprimida reflejando alteraci&#243;n en la contracci&#243;n auricular y rigidez<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">20</span></a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Las variables num&#233;ricas se presentaron como medias y desviaci&#243;n est&#225;ndar o medianas y rangos intercuartiles&#44; seg&#250;n su distribuci&#243;n por la prueba de Kolmogorov-Smirnov&#46; Las variables categ&#243;ricas se expresaron como n&#250;meros absolutos y proporciones&#46; Se utiliz&#243; t de Student o U de Mann-Whitney para comparaci&#243;n de las variables continuas&#46; Para comparar las variables categ&#243;ricas se utiliz&#243; la &#967;<span class="elsevierStyleSup">2</span>&#46; Para comparar m&#250;ltiples variables cuantitativas con distribuci&#243;n normal se utiliz&#243; ANOVA y para no param&#233;tricas se utiliz&#243; Kruskal-Wallis&#46; Se realiz&#243; an&#225;lisis univariado y multivariado mediante regresi&#243;n log&#237;stica&#46; Las variables que fueron significativas en el an&#225;lisis univariado se analizaron en el multivariado para identificar las predictoras de un <span class="elsevierStyleItalic">strain</span> de aur&#237;cula izquierda anormal&#59; se tom&#243; como variable dependiente el <span class="elsevierStyleItalic">strain</span> de la aur&#237;cula izquierda&#44; y las independientes fueron&#58; g&#233;nero&#44; edad&#44; &#237;ndice de masa corporal&#44; tiempo de evoluci&#243;n&#44; presencia de anticuerpos antifosfol&#237;pidos&#44; diabetes mellitus&#44; hipertensi&#243;n arterial&#44; dislipidemia&#44; nefritis l&#250;pica&#44; uso de esteroides&#44; antimal&#225;ricos&#44; azatioprina&#44; metotrexato&#44; ciclofosfamida&#44; micofenolato de mofetilo&#44; rituximab&#44; actividad de la enfermedad y el &#237;ndice de da&#241;o&#46; Se utiliz&#243; el paquete estad&#237;stico Medcalc versi&#243;n 18&#46;9 para la evaluaci&#243;n de los datos&#46; Se consider&#243; como estad&#237;sticamente significativo una p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Resultados</span><p id="par0100" class="elsevierStylePara elsevierViewall">Durante el periodo de estudio se incluyeron 50 pacientes con LES y 50 controles sanos&#46; El g&#233;nero femenino fue el m&#225;s preponderante en ambos grupos &#40;90&#37; y 86&#37;&#44; respectivamente&#41;&#46; La media de edad de los pacientes con LES fue de 34 a&#241;os &#40;DE<span class="elsevierStyleHsp" style=""></span>&#177;12 a&#241;os&#41;&#46; No hubo diferencias en el &#237;ndice de masa corporal entre los pacientes con LES y controles sanos&#46; La comorbilidad m&#225;s frecuente fue la hipertensi&#243;n arterial&#44; con el 44&#37;&#46; La media de tiempo de evoluci&#243;n de la enfermedad fue de 6 a&#241;os &#40;DE<span class="elsevierStyleHsp" style=""></span>&#177;5 a&#241;os&#41;&#46; El 22&#37; de los pacientes ten&#237;an s&#237;ndrome antifosfol&#237;pido secundario y el 16&#37; de los pacientes presentaron anticuerpos antifosfol&#237;pidos circulantes sin tener criterios para s&#237;ndrome antifosfol&#237;pido&#44; siendo el 16&#37; de los pacientes triple positivo&#46; El 72&#37; de los pacientes ten&#237;an t&#237;tulos positivos de ANA 1&#58;640&#44; siendo el patr&#243;n moteado fino el m&#225;s com&#250;n&#46; El 46&#37; de los pacientes con LES estaban activos al presentar un Mex-SLEDAI mayor de 9&#46; Los dominios afectados m&#225;s frecuentemente fueron el hematol&#243;gico &#40;82&#37;&#41;&#44; mucocut&#225;neo &#40;76&#37;&#41;&#44; musculoesquel&#233;tico &#40;68&#37;&#41;&#46; El 40&#37; de los pacientes incluidos presentaron nefritis l&#250;pica&#44; siendo la clase IV la m&#225;s frecuente en un 14&#37;&#46; En cuanto al tratamiento&#44; el 44&#37; tomaba esteroides&#44; el 98&#37; antimal&#225;ricos&#44; el 28&#37; azatioprina&#44; el 12&#37; metotrexato&#44; el 38&#37; &#225;cido micofen&#243;lico&#44; el 34&#37; ciclofosfamida&#44; y el 8&#37; rituximab&#46; Se encontraron diferencias significativas en hemoglobina&#44; leucocitos&#44; neutr&#243;filos&#44; linfocitos&#44; alb&#250;mina&#44; glucosa&#44; &#225;cido &#250;rico y las lipoprote&#237;nas de alta densidad &#40;HDL&#41; entre los pacientes con LES y los controles &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">Dentro de las variables ecocardiogr&#225;ficas estudiadas&#44; se encontr&#243; que la funci&#243;n sist&#243;lica del ventr&#237;culo izquierdo en ambos grupos fue similar&#44; as&#237; como tambi&#233;n la funci&#243;n sist&#243;lica de la aur&#237;cula izquierda &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46; Se document&#243; mayor proporci&#243;n de derrame peric&#225;rdico en pacientes con LES &#40;20&#37; vs&#46; 0&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;003&#41;&#46; No existi&#243; diferencia en la presencia de alg&#250;n grado de valvulopat&#237;a entre ambos grupos&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">Dentro de los par&#225;metros de la funci&#243;n diast&#243;lica&#44; los pacientes con LES presentaron mayores presiones de llenado del ventr&#237;culo izquierdo&#44; expresados mediante la E&#47;e&#8217; &#40;7&#44;5 vs&#46; 6&#44;3&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;0003&#41; y el volumen indexado de la aur&#237;cula izquierda &#40;24<span class="elsevierStyleHsp" style=""></span>ml&#47;m<span class="elsevierStyleSup">2</span> vs&#46; 21<span class="elsevierStyleHsp" style=""></span>ml&#47;m<span class="elsevierStyleSup">2</span>&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;0007&#41;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">El SLGAI fue menor en los pacientes con LES en comparaci&#243;n con los controles &#40;41&#44;6&#37; vs&#46; 50&#44;5&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46; Tambi&#233;n fue menor las 3 fases del ciclo de la aur&#237;cula izquierda&#59; SLAr &#40;41&#44;6&#37; vs&#46; 50&#44;5&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41;&#44; SLAc &#40;26&#44;7&#37; vs&#46; 31&#44;4&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;008&#41; y SLAb &#40;14&#44;4&#37; y 17&#44;5&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;007&#41;&#46; No se encontr&#243; diferencia en el <span class="elsevierStyleItalic">strain rate</span> en pacientes con LES y controles sanos &#40;2&#44;5<span class="elsevierStyleHsp" style=""></span>s<span class="elsevierStyleSup">&#8722;1</span> vs&#46; 2&#44;7<span class="elsevierStyleHsp" style=""></span>s<span class="elsevierStyleSup">&#8722;1</span>&#41;&#46; Los resultados encontrados en SLGAI expresan una menor funci&#243;n diast&#243;lica en pacientes con LES&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">Se compararon los par&#225;metros ecocardiogr&#225;ficos entre controles sanos y LES activo y controles sanos y LES inactivo&#59; se encontr&#243; diferencia significativa en el SLGAI &#40;controles sanos 50&#44;5&#37; vs&#46; inactivo 43&#37; vs&#46; activos 36&#44;3&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>&#41;&#59; en el <span class="elsevierStyleItalic">strain</span> de las 3 fases de la aur&#237;cula izquierda&#59; y en el volumen indexado de la aur&#237;cula izquierda y E&#47;e&#8217;&#46; No se encontr&#243; diferencia en <span class="elsevierStyleItalic">strain rate</span> &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">Se contrastaron las variables cl&#237;nicas de los pacientes con LES que presentaron un SLGAI anormal vs&#46; normal &#40;punto de corte 35&#37;&#41;&#59; en este se encontraron 35 pacientes con SLGAI normal y 15 anormal &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#59; solo se encontraron diferencias significativas respecto a que los pacientes con SLGAI anormal presentaban mayor puntuaci&#243;n de la escala Mex-SLEDAI&#44; y por ende mayor porcentaje de pacientes activos&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0130" class="elsevierStylePara elsevierViewall">Se realiz&#243; an&#225;lisis univariado y multivariado &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a>&#41; para determinar si las variables influyen independientemente en el SLGAI&#46; Se document&#243; que en el an&#225;lisis univariado fueron significativos la presencia de anticuerpos antifosfol&#237;pidos circulantes&#44; la presencia de nefritis l&#250;pica&#44; el uso de esteroides y la actividad de la enfermedad&#46; Sin embargo&#44; en el an&#225;lisis multivariado no hubo diferencia significativa en ninguna de estas&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discusi&#243;n</span><p id="par0135" class="elsevierStylePara elsevierViewall">El objetivo de este estudio fue evaluar la funci&#243;n de la aur&#237;cula izquierda por medio de ecocardiograf&#237;a bidimensional&#44; <span class="elsevierStyleItalic">speckle tracking</span>&#44; un m&#233;todo no invasivo en pacientes con LES sin s&#237;ntomas cardiacos&#46; Los principales hallazgos encontrados en este estudio fueron que la deformaci&#243;n de la aur&#237;cula izquierda estaba alterada y disminuida en pacientes con LES comparados con personas sanas de la misma edad y sexo&#59; y presentando mayor disfunci&#243;n diast&#243;lica&#46; Adem&#225;s&#44; se encontr&#243; que&#44; en los pacientes con LES&#44; la deformaci&#243;n de la aur&#237;cula era menor cuando presentaban mayor actividad de la enfermedad&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">En este estudio se encontr&#243; que los pacientes con LES ten&#237;an un <span class="elsevierStyleItalic">strain</span> longitudinal global deprimido en comparaci&#243;n con controles sanos&#44; y tambi&#233;n presentaban disminuci&#243;n del <span class="elsevierStyleItalic">strain</span> de las 3 fases del ciclo de la aur&#237;cula&#44; lo que puede traducirse como una din&#225;mica alterada en la contracci&#243;n de las fibras mioc&#225;rdicas de la aur&#237;cula secundaria a la disfunci&#243;n diast&#243;lica ventricular y a la rigidez de las fibras mioc&#225;rdicas de la aur&#237;cula por el estado cr&#243;nico inflamatorio y el dep&#243;sito de inmunocomplejos<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">21</span></a>&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Nuestros resultados son parecidos a los de un estudio en el que se utiliz&#243; la t&#233;cnica de <span class="elsevierStyleItalic">speckle tracking</span> en aur&#237;cula izquierda en pacientes con LES y se compar&#243; con controles sanos&#44; se incluyeron 60 pacientes en cada grupo&#46; La media de edad de los pacientes con LES fue de 35&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;1&#44; la media de SLEDAI 2&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;0 y la media de SDI 2&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;2&#46; Se encontr&#243; que los pacientes con LES presentaban menor <span class="elsevierStyleItalic">strain</span> global en comparaci&#243;n con controles sanos &#40;26&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#44;5&#37; vs&#46; 32&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#44;8&#37;&#44; ambos p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; En este estudio no se encontr&#243; diferencias en las dimensiones de la aur&#237;cula izquierda y en la E&#47;e&#8217; &#40;33&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;3<span class="elsevierStyleHsp" style=""></span>mm vs&#46; 30&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;9<span class="elsevierStyleHsp" style=""></span>mm&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;23&#59; 8&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;5 vs&#46; 7&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;7&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;06&#41;&#59; sin embargo&#44; el volumen indexado de la aur&#237;cula izquierda fue mayor en los pacientes con LES &#40;24<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;0 vs&#46; 25&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;1&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Adem&#225;s&#44; se encontr&#243; en el an&#225;lisis multivariado que el SDI se asoci&#243; de manera independiente e inversamente con el <span class="elsevierStyleItalic">strain</span> global&#44; lo que refleja el da&#241;o acumulativo en la funci&#243;n cardiaca<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">1</span></a>&#59; sin embargo&#44; en nuestro estudio esto no fue similar&#44; ya que en el an&#225;lisis multivariado no fue significativo&#59; esto se pudo deber a que nuestros pacientes ten&#237;an un menor SDI y tiempo de evoluci&#243;n de la enfermedad&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Nosotros encontramos que otro de los par&#225;metros cl&#225;sicos de funci&#243;n diast&#243;lica del ventr&#237;culo izquierdo&#44; como lo son la E&#47;e&#8217; y el volumen indexado de la aur&#237;cula izquierda&#44; fue mayor en pacientes con LES&#44; a diferencia de controles&#59; incluso en aquellos activos tambi&#233;n fueron superiores ambos valores&#44; lo que correlaciona con una mayor disfunci&#243;n diast&#243;lica&#46; Este hecho ya hab&#237;a sido descrito anteriormente por Gu&#351;etu et al&#46; en un estudio que realizaron con 75 pacientes con LES&#44; donde lo compararon con 73 controles sanos<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">22</span></a>&#46; Esto tambi&#233;n lo documentaron Barutcu et al&#46;&#44; quienes estudiaron 50 pacientes con LES comparados con 30 controles y reportaron mayores valores de E&#47;e&#8217; y volumen indexado de la aur&#237;cula izquierda&#59; algo relevante fue que en ese estudio se report&#243; adem&#225;s que los pacientes con LES y anticuerpos anticardiolipinas positivos tuvieron m&#225;s valores de disfunci&#243;n diast&#243;lica<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">23</span></a>&#46; Li et al&#46;&#44; en un estudio entre 102 pacientes con lupus y 32 controles&#44; utilizaron ecocardiograf&#237;a 3D para valorar el volumen y funci&#243;n de la aur&#237;cula izquierda&#44; y encontraron que los pacientes con LES ten&#237;an mayor volumen y una funci&#243;n de la aur&#237;cula izquierda m&#225;s deteriorada&#44; siendo mayor en aquellos pacientes con SDI elevado y mayor actividad de la enfermedad<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">24</span></a>&#44; similar a nuestros resultados&#44; en donde se document&#243; que los pacientes con mayor actividad ten&#237;an una funci&#243;n de la aur&#237;cula izquierda m&#225;s deteriorada&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Nosotros documentamos que los pacientes con nefritis l&#250;pica pudieran tener asociaci&#243;n con mayor depresi&#243;n del <span class="elsevierStyleItalic">strain</span>&#59; esto pudiera explicarse ya que la mayor&#237;a de los pacientes clasificados como activos ten&#237;an mayor presencia de nefritis l&#250;pica&#46; Se ha descrito<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">25</span></a> que los pacientes con enfermedad renal cr&#243;nica tienen un SLGAI deprimido en comparaci&#243;n con controles sanos&#44; secundario a la activaci&#243;n de la v&#237;a renina-angiotensina-aldosterona causando fibrosis mioc&#225;rdica&#44; por lo que esto pudiera explicar que la nefritis l&#250;pica se haya relacionado con mayor depresi&#243;n del <span class="elsevierStyleItalic">strain</span> de aur&#237;cula izquierda en nuestro estudio&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">En nuestro estudio se encontr&#243; que la presencia de anticuerpos antifosfol&#237;pidos circulantes se pudiera relacionar en el an&#225;lisis univariado con presentar un <span class="elsevierStyleItalic">strain</span> deprimido&#44; lo que indica una mayor disfunci&#243;n diast&#243;lica&#46; Estos hallazgos coinciden con los descritos por Tufano et al&#46; en un estudio con 69 pacientes con s&#237;ndrome antifosfol&#237;pido y 69 controles sanos&#44; en el que demostraron que la presencia de disfunci&#243;n diast&#243;lica se correlacionaba con t&#237;tulos m&#225;s altos de anticoagulante l&#250;pico y con tener mayor edad&#46; Adem&#225;s&#44; se encontr&#243; que los pacientes con s&#237;ndrome antifosfol&#237;pido secundario presentaban mayor volumen de la aur&#237;cula izquierda<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">26</span></a>&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Nosotros evidenciamos que el uso de esteroides se pudiera asociar en el an&#225;lisis univariado a presentar SLGAI deprimido&#46; Hattori et al&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">27</span></a> hab&#237;an descrito en un estudio con modelos murinos el efecto de los esteroides a nivel cardiaco&#44; encontrando que produc&#237;an hipertensi&#243;n&#44; fibrosis ventricular e induc&#237;an disfunci&#243;n diast&#243;lica del ventr&#237;culo izquierdo&#44; por aumento del estr&#233;s oxidativo&#44; deficiencia de &#243;xido n&#237;trico&#44; actuando a trav&#233;s de los receptores mineralocorticoides &#40;RM&#41; y glucocorticoides &#40;RG&#41; ampliamente distribuidos en el sistema cardiovascular&#46; Adem&#225;s&#44; se observ&#243; la presencia de atrofia de las fibras cardiacas independientemente de la activaci&#243;n de los receptores&#46; Se encontr&#243; que estos efectos disminu&#237;an cuando se les administr&#243; espironolactona&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">El deterioro de la funci&#243;n de la aur&#237;cula izquierda en pacientes con LES pudiera deberse a la presencia de inflamaci&#243;n sist&#233;mica cr&#243;nica subcl&#237;nica&#44; aun con niveles bajos de actividad seg&#250;n los &#237;ndices existentes&#44; secundaria a la presencia de citosinas proinflamatorias circulantes&#46; En un estudio con pacientes con artritis reumatoide<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">28</span></a> y en otro estudio con pacientes con espondilitis anquilosante y artritis psori&#225;sica<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">29</span></a> se observ&#243; que administrar anti-TNF mejor&#243; la funci&#243;n de la aur&#237;cula izquierda&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Existe poca literatura acerca del uso de <span class="elsevierStyleItalic">strain</span> de aur&#237;cula izquierda en pacientes con LES y su aplicaci&#243;n en la detecci&#243;n de las alteraciones de la funci&#243;n de la aur&#237;cula izquierda&#46; Se encontr&#243; un solo estudio donde se compar&#243; la funci&#243;n de la aur&#237;cula izquierda por <span class="elsevierStyleItalic">strain</span> en pacientes con LES y controles&#44; por lo que este estudio es de utilidad para describir el posible valor de esta nueva t&#233;cnica de <span class="elsevierStyleItalic">strain</span> de aur&#237;cula izquierda en pacientes con LES para identificar cambios subcl&#237;nicos o incipientes de disfunci&#243;n diast&#243;lica y su detecci&#243;n de manera temprana para implementar acciones que disminuyan la progresi&#243;n a falla cardiaca con funci&#243;n sist&#243;lica preservada en un futuro&#46; Sin embargo&#44; se requieren m&#225;s estudios con seguimiento a largo plazo y a gran escala para validar la utilidad de esta t&#233;cnica en el seguimiento de pacientes con LES&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Las limitaciones de este estudio son principalmente el tama&#241;o modesto de la muestra y que no se cont&#243; con un seguimiento a largo plazo de los pacientes con ecocardiograma con t&#233;cnica <span class="elsevierStyleItalic">strain</span> de aur&#237;cula izquierda de control posterior a las modificaciones del tratamiento y al cambio en la actividad&#46; Resulta atractivo dar seguimiento a los pacientes durante su evoluci&#243;n con esta t&#233;cnica y evaluar los cambios en los par&#225;metros y el desenlace en el paciente&#46; Adem&#225;s&#44; la t&#233;cnica <span class="elsevierStyleItalic">strain</span> depende de la calidad de imagen y del operador&#44; y no se encuentra ampliamente en todos los centros&#44; aunque es una t&#233;cnica que est&#225; adquiriendo importancia para la evaluaci&#243;n cardiaca de los pacientes&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclusi&#243;n</span><p id="par0185" class="elsevierStylePara elsevierViewall">El LES es una entidad multiorg&#225;nica&#44; que afecta tambi&#233;n el coraz&#243;n&#46; En el estudio se encontr&#243; que la deformaci&#243;n de la aur&#237;cula izquierda y todas las fases del ciclo est&#225;n alteradas&#44; indicando afectaci&#243;n subcl&#237;nica del coraz&#243;n&#44; en pacientes asintom&#225;ticos&#44; dentro de la evoluci&#243;n y actividad de la enfermedad&#59; por lo que se recomienda la evaluaci&#243;n cardiaca peri&#243;dica aun en pacientes asintom&#225;ticos&#44; para emplear modificaciones al tratamiento de manera temprana y poder ofrecer un manejo integral a los pacientes&#44; previniendo el remodelamiento de la aur&#237;cula y evitando el desarrollo de arritmias y falla cardiaca con fracci&#243;n de expulsi&#243;n conservada</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflicto de intereses</span><p id="par0190" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Antecedentes</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">En los pacientes con lupus eritematoso sist&#233;mico &#40;LES&#41; la disfunci&#243;n diast&#243;lica del ventr&#237;culo izquierdo &#40;DDVI&#41; puede ser la &#250;nica manifestaci&#243;n de involucro cardiaco anticipando una disfunci&#243;n sist&#243;lica&#46; Se ha visto que la deformaci&#243;n mioc&#225;rdica de la aur&#237;cula izquierda &#40;AI&#41;&#44; mediante el <span class="elsevierStyleItalic">strain</span> longitudinal global de la AI &#40;SLGAI&#41;&#44; puede llegar a ser de utilidad en valorar la funci&#243;n diast&#243;lica&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Evaluar la funci&#243;n de la AI mediante la deformaci&#243;n mioc&#225;rdica en pacientes con LES&#46; Comparar el <span class="elsevierStyleItalic">strain</span> de la AI en pacientes con LES activos&#44; inactivos y controles&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 50 pacientes con LES y se compararon con controles sanos pareados por edad y sexo&#46; Se midi&#243; por ecocardiograma transtor&#225;cico la deformaci&#243;n mioc&#225;rdica mediante el SLGAI&#44; el <span class="elsevierStyleItalic">strain</span> de las 3 fases del ciclo de la AI y la tasa de <span class="elsevierStyleItalic">strain</span>&#46; La diferencia entre los grupos se analiz&#243; de forma univariante&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">El SLGAI en pacientes con LES fue menor que en los controles sanos &#40;41&#44;6&#37; vs&#46; 50&#44;5&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#41;&#44; as&#237; como tambi&#233;n fue menor en las 3 fases del ciclo de la AI&#46; No hubo diferencias en la tasa de <span class="elsevierStyleItalic">strain</span> en ambos grupos &#40;LES 2&#44;5<span class="elsevierStyleHsp" style=""></span>s<span class="elsevierStyleSup">&#8722;1</span> vs&#46; controles sanos 2&#44;75<span class="elsevierStyleHsp" style=""></span>s<span class="elsevierStyleSup">&#8722;1</span>&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;1&#41;&#46; Tambi&#233;n se encontr&#243; que el SLGAI fue menor en pacientes activos en comparaci&#243;n con controles e inactivos&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusiones</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Los pacientes con LES tienen menor deformaci&#243;n mioc&#225;rdica de la AI&#44; lo que se expresa como una menor funci&#243;n diast&#243;lica correlacionando con da&#241;o mioc&#225;rdico subcl&#237;nico precoz&#46;</p></span>"
        "secciones" => array:5 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Antecedentes"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Objetivo"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "M&#233;todos"
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          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Resultados"
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          4 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Conclusiones"
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      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Background</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">In patients with systemic lupus erythematosus &#40;SLE&#41;&#44; left ventricle diastolic dysfunction &#40;LVDD&#41; may be the only manifestation of cardiac involvement in anticipation of systolic dysfunction&#46; It has been seen that myocardial deformation of the left atrium &#40;LA&#41;&#44; through the LA global longitudinal strain &#40;LAGLS&#41;&#44; may be useful in assessing diastolic function&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objective</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">To evaluate LA function through myocardial deformation in patients with LES&#44; and compare the LA strain in patients with active&#44; inactive and controls&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Methods</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Fifty patients with SLE were included and compared with 50 healthy controls paired by age and gender&#46; Myocardial deformation was measured by transthoracic echocardiogram&#44; to investigate the LAGLS&#44; the strain of the three phases of the LA cycle and the strain rate&#46; The differences between groups were compared in univariate analysis&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">LAGLS in SLE patients was less than in the controls &#40;41&#46;6&#37; vs&#46; 50&#46;5&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;02&#41;&#44; and in the 3 phases of the LA cycle&#46; There were no differences in the LA strain rate in both groups &#40;SLE 2&#46;5<span class="elsevierStyleHsp" style=""></span>s<span class="elsevierStyleSup">&#8722;1</span> vs&#46; controls 2&#46;75<span class="elsevierStyleHsp" style=""></span>s<span class="elsevierStyleSup">&#8722;1</span>&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;1&#41;&#46; It was also found that the LAGLS was lesser in active patients than controls and inactive&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusions</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">SLE patients have lower myocardial deformation of the LA&#44; which is expressed as a lower diastolic function correlating with early subclinical myocardial damage&#46;</p></span>"
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            "identificador" => "abst0030"
            "titulo" => "Background"
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            "identificador" => "abst0040"
            "titulo" => "Methods"
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            "identificador" => "abst0045"
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          "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">A&#41; Imagen en vista apical 4 c&#225;maras donde se determinan los bordes de la aur&#237;cula izquierda para el c&#225;lculo del <span class="elsevierStyleItalic">strain</span>&#46; B&#41; Representaci&#243;n gr&#225;fica del <span class="elsevierStyleItalic">strain</span> de la aur&#237;cula izquierda en todo el ciclo auricular&#46; La SLAr correspondi&#243; al valor desde el pico m&#225;s alto de la fase de reservorio&#44; la SLAb al pico m&#225;s alto de la fase de bomba y la SLAc a la diferencia entre SLAr y SLAb&#46; C&#41; Representaci&#243;n del reporte de <span class="elsevierStyleItalic">strain</span> de aur&#237;cula izquierda del <span class="elsevierStyleItalic">software</span> VVI&#46;</p> <p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">SLAr&#58; <span class="elsevierStyleItalic">strain</span> logitudinal aur&#237;cula reservorio&#59; SLAb&#58; <span class="elsevierStyleItalic">strain</span> longitudinal aur&#237;cula bomba&#59; SLAc&#58; <span class="elsevierStyleItalic">strain</span> logitudinal aur&#237;cula conducto&#46;</p>"
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          "es" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Strain</span> longitudinal global de la aur&#237;cula izquierda en pacientes con lupus eritematoso sist&#233;mico y controles sanos&#46;</p>"
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        "etiqueta" => "Figura 3"
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          "es" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Strain</span> longitudinal global de la aur&#237;cula izquierda en controles sanos y pacientes con lupus eritematoso sist&#233;mico activo e inactivo&#46;</p>"
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          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">ANA&#58; anticuerpos antinucleares&#59; DM2&#58; diabetes mellitus 2&#59; EVC&#58; enfermedad vascular cerebral&#59; HAS&#58; hipertensi&#243;n arterial&#59; HDL&#58; lipoprote&#237;na de alta densidad&#59; IMC&#58; &#237;ndice de masa corporal&#59; LDL&#58; lipoprote&#237;na de baja densidad&#59; Mex-SLEDAI&#58; <span class="elsevierStyleItalic">Mexican</span><span class="elsevierStyleItalic">Systemic Lupus Erythematosus Disease Activity Index</span>&#59; SAF&#58; s&#237;ndrome antifosfol&#237;pido&#59; SDI&#58; SLICC&#47;ACR <span class="elsevierStyleItalic">damage index</span>&#59; TVP&#58; trombosis venosa profunda&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Par&#225;metro&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;24&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">TVP</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;01&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">EVC</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Tiempo evoluci&#243;n &#40;a&#241;os&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;&#177;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">SAF secundario</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Presencia de anticuerpos antifosfol&#237;pidos</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Anticuerpo asociado</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Anticoagulante l&#250;pico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IgG anticardiolipinas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IgM anticardiolipinas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>B2 Glicoprote&#237;na I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Triple positivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">ANA</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Anti-DNA ds&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Anti-Ro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Anti-Sm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Anti-La&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Patr&#243;n ANA</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Citoplasm&#225;tico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Homog&#233;neo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Moteado fino&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Moteado grueso&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Mex-SLEDAI</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Actividad &#40;&#37; activos&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">SDI</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;7 &#40;&#177;1&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Dominios</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">General</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">44&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Mucocut&#225;neo</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Neurol&#243;gico</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Musculoesquel&#233;tico</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Cardiaco</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Serositis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Vasculitis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Oft&#225;lmico</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Abdominal</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Hematol&#243;gico</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">82&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Renal</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Clase de biopsia</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Clase I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Clase II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Clase III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Clase IV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Clase V&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Clase V<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>IV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Tratamiento</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Esteroide&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Antimal&#225;ricos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">98&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Azatioprina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Metotrexato&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#193;cido micofen&#243;lico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ciclofosfamida&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Rituximab&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Laboratorios</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hemoglobina &#40;g&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#44;8 &#40;&#177;2&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#44;5 &#40;&#177;1&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Leucocitos &#40;mm<span class="elsevierStyleSup">3</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;318 &#40;&#177;2073&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;566 &#40;&#177;1&#46;786&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Neutr&#243;filos &#40;mm<span class="elsevierStyleSup">3</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;842 &#40;&#177;3&#46;200&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;641 &#40;&#177;1&#46;357&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Linfocitos &#40;mm<span class="elsevierStyleSup">3</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;358 &#40;&#177;1&#46;056&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;976 &#40;&#177;706&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Tiempo evoluci&#243;n &#40;a&#241;os&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Presencia de anticuerpos antifosfol&#237;pidos</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Triple positividad anticuerpos antifosfol&#237;pidos</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Actividad &#40;&#37; activos&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Tratamiento</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Esteroide&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Antimal&#225;ricos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">27&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Presencia de anticuerpos antifosfol&#237;pidos circulantes&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#44;3 &#40;1&#44;1-26&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4 &#40;0&#44;6-24&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">DM2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;2 &#40;0&#44;1-14&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">HAS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dislipidemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;9 &#40;0&#44;7-20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nefritis l&#250;pica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5 &#40;1&#44;3-18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#44;1 &#40;0&#44;3-14&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Esteroides&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&#44;8 &#40;1&#44;1-13&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#44;6 &#40;0&#44;5-13&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Antimal&#225;ricos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;4 &#40;0&#44;1-34&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Azatioprina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;9 &#40;0&#44;2-3&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Metotrexato&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;1 &#40;0&#44;01-1&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ciclofosfamida&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#44;5 &#40;0&#44;7-8&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MMF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;1 &#40;0&#44;3-3&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rituximab&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;0&#44;5-17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Actividad&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&#44;3 &#40;1&#44;4-20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;5 &#40;0&#44;2-13&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SDI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;5 &#40;0&#44;7-8&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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              "imagenFichero" => array:1 [
                0 => "xTab2656535.png"
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        "descripcion" => array:1 [
          "es" => "<p id="spar0125" class="elsevierStyleSimplePara elsevierViewall">An&#225;lisis univariado y multivariado de los factores asociados a SLGAI<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>35&#37;</p>"
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      ]
    ]
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                    0 => array:2 [
                      "titulo" => "Evaluation of left atrial function by speckle tracking echocardiography in patients with systemic lupus erythematosus"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Dai"
                            1 => "K&#46;L&#46; Li"
                            2 => "D&#46;J&#46; Qian"
                            3 => "J&#46; Lu"
                            4 => "Y&#46;H&#46; Zou"
                            5 => "Y&#46;X&#46; Cao"
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                      "doi" => "10.1177/0961203315619029"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26657736"
                            "web" => "Medline"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Primary cardiac disease in systemic lupus erythematosus patients&#58; Protective and risk factors -- data from a multi-ethnic Latin American cohort"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;A&#46; Garc&#237;a"
                            1 => "G&#46;S&#46; Alarc&#243;n"
                            2 => "G&#46; Boggio"
                            3 => "L&#46; Hachuel"
                            4 => "A&#46;I&#46; Marcos"
                            5 => "J&#46;C&#46; Marcos"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/rheumatology/keu011"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rheumatology &#40;Oxford&#41;&#46;"
                        "fecha" => "2014"
                        "volumen" => "53"
                        "paginaInicial" => "1431"
                        "paginaFinal" => "1438"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24633413"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "SLICC&#47;ACR damage index independently associated with left ventricular diastolic dysfunction in patients with systemic lupus erythematosus"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "Q&#46; Shang"
                            1 => "G&#46;W&#46;K&#46; Yip"
                            2 => "L&#46;S&#46; Tam"
                            3 => "Q&#46; Zhang"
                            4 => "J&#46;E&#46; Sanderson"
                            5 => "Y&#46;Y&#46; Lam"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1177/0961203312446628"
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                        "fecha" => "2012"
                        "volumen" => "21"
                        "paginaInicial" => "1057"
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                          0 => array:2 [
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk factors for cardiovascular mortality in patients with systemic lupus erythematosus&#44; a prospective cohort study"
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                          "etal" => true
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                            0 => "J&#46;T&#46; Gustafsson"
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                            2 => "I&#46; Gunnarsson"
                            3 => "K&#46; Elvin"
                            4 => "I&#46;E&#46; Lundberg"
                            5 => "L&#46;-O&#46; Hansson"
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                    0 => array:2 [
                      "doi" => "10.1186/ar3759"
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                        "tituloSerie" => "Arthritis Res Ther&#46;"
                        "fecha" => "2012"
                        "volumen" => "14"
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Original
Deformación miocárdica de la aurícula izquierda en pacientes con lupus eritematoso sistémico
Left Atrial Strain in Patients With Systemic Lupus Erythematosus
Silvia Esmeralda Pérez-Topetea, Tomás Miranda-Aquinob,
Autor para correspondencia
tomas_miranda_a@hotmail.com

Autor para correspondencia.
, Jorge Eduardo Hernández-del Ríoc, Sergio Cerpa-Cruza, Sergio Ramón Gutiérrez-Ureñaa, Gloria Martínez-Bonillaa, Verónica González-Díaza
a Reumatología, Hospital Civil de Guadalajara «Fray Antonio Alcalde», Jalisco, México
b Cardiología, Hospital Civil de Guadalajara «Fray Antonio Alcalde», Jalisco, México
c Cardiología y ecocardiografía, Hospital Civil de Guadalajara «Fray Antonio Alcalde», Jalisco, México
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">El lupus eritematoso sist&#233;mico &#40;LES&#41; es una enfermedad inflamatoria inmune que se caracteriza por la formaci&#243;n de autoanticuerpos y dep&#243;sitos de complejos inmunes&#46; La presencia de inflamaci&#243;n cr&#243;nica puede afectar a m&#250;ltiples &#243;rganos&#44; especialmente al coraz&#243;n<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">1</span></a>&#46; El da&#241;o en el sistema cardiovascular&#44; adem&#225;s de ser ocasionado primariamente por un proceso autoinmune&#47;inflamatorio&#44; tambi&#233;n se ha asociado de manera secundaria con la actividad y la severidad de la enfermedad&#44; as&#237; como con el tratamiento inmunosupresor&#44; principalmente el uso de esteroides<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">El involucro cardiaco es una de las mayores complicaciones del LES&#44; y puede afectar todas las estructuras del coraz&#243;n incluyendo el pericardio&#44; miocardio&#44; v&#225;lvulas y vasos coronarios con diferentes grados de severidad&#44; siendo la prevalencia reportada en estudios de autopsia del 40 al 70&#37;&#59; y detectada por afectaci&#243;n sintom&#225;tica solamente en el 5 a 10&#37; de los pacientes&#44; sugiriendo la naturaleza subcl&#237;nica del da&#241;o al miocardio<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">3</span></a>&#46; En la actualidad la supervivencia de los pacientes con lupus ha mejorado&#44; sin embargo&#44; la morbimortalidad cardiovascular contin&#250;a siendo alta&#44; oscilando entre el 17 y 76&#37; en diferentes estudios<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Existen factores inherentes al LES que se ha propuesto que promueven la enfermedad cardiovascular&#44; como son la presencia de anticuerpos antifosfol&#237;pidos&#44; la funci&#243;n renal disminuida&#44; la duraci&#243;n de la enfermedad&#44; el da&#241;o cr&#243;nico a &#243;rgano reflejado por el &#237;ndice de da&#241;o del <span class="elsevierStyleItalic">Systemic Lupus International Collaborating Clinics&#47;American College of Rheumatology</span> &#40;SLICC&#47;ACR&#41; <span class="elsevierStyleItalic">damage index</span>&#44; la duraci&#243;n y dosis de esteroides&#44; as&#237; como el uso de azatioprina<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">5</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Los pacientes con LES muestran 11 veces mayor riesgo de presentar alteraciones valvulares que la poblaci&#243;n sana<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">6</span></a>&#46; Las alteraciones valvulares m&#225;s frecuentes son las insuficiencias&#44; involucrando principalmente las v&#225;lvulas a&#243;rtica y mitral&#44; y se ha encontrado asociaci&#243;n con la presencia de anticuerpos antifosfol&#237;pidos o con el s&#237;ndrome antifosfol&#237;pido secundario&#46; En algunos estudios se ha reportado que los t&#237;tulos altos de anticuerpos antifosfol&#237;pidos se asocian fuertemente con anormalidades cardiacas en pacientes con lupus<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">7&#44;8</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">La aur&#237;cula izquierda juega un papel importante en mantener la funci&#243;n cardiaca&#44; ya que act&#250;a como reservorio&#44; conductor y bomba<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">9</span></a>&#46; En casos de disfunci&#243;n diast&#243;lica&#44; ocurren cambios en el llenado ventricular&#44; desencadenando cambios en las fases auriculares para mantener el volumen sist&#243;lico ventricular&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">El ecocardiograma es una herramienta sencilla y ampliamente disponible para el diagn&#243;stico de enfermedades cardiovasculares que aporta informaci&#243;n de la estructura&#44; funci&#243;n y par&#225;metros hemodin&#225;micos<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">10</span></a>&#46; Se ha reportado que la disfunci&#243;n diast&#243;lica ventricular izquierda &#40;DDVI&#41; es com&#250;n&#44; ocurre de manera temprana y persistente en los pacientes con LES&#44; pudiendo ser la &#250;nica manifestaci&#243;n de involucro cardiaco precediendo la disfunci&#243;n sist&#243;lica a gran escala<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">1</span></a>&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">El agrandamiento y disfunci&#243;n de la aur&#237;cula izquierda se ha considerado como un marcador subrogado de la duraci&#243;n y severidad de la disfunci&#243;n diast&#243;lica&#46; Y se ha identificado como potencial indicador de m&#250;ltiples eventos adversos cardiovasculares&#44; como mayor riesgo de infarto agudo al miocardio&#44; insuficiencia cardiaca&#44; fibrilaci&#243;n auricular y mortalidad<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">11</span></a>&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Recientemente se ha introducido la deformaci&#243;n mioc&#225;rdica de la aur&#237;cula izquierda como potencial marcador de funci&#243;n diast&#243;lica&#44; mediante el <span class="elsevierStyleItalic">strain</span> longitudinal global de la aur&#237;cula izquierda &#40;SLGAI&#41; por la t&#233;cnica <span class="elsevierStyleItalic">speckle tracking</span> por ecocardiograf&#237;a&#46; Tiene la gran ventaja de ser independiente del &#225;ngulo&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">La deformaci&#243;n mioc&#225;rdica de la aur&#237;cula izquierda es una propiedad mec&#225;nica inherente del coraz&#243;n&#44; la cual se puede calcular por medio del <span class="elsevierStyleItalic">software</span> del ecocardiograma&#59; esto nos permite valorar qu&#233; porcentaje de movimiento en la posici&#243;n espacial cambia la fibra mioc&#225;rdica en cada fase del ciclo auricular &#40;reservorio&#44; conducto y bomba&#41;&#59; mientras mayor es el porcentaje de deformaci&#243;n&#44; mejor es la funci&#243;n mioc&#225;rdica&#46; Tiene una gran implicaci&#243;n cl&#237;nica ya que se ha demostrado que comienza a alterarse antes que otros par&#225;metros de funci&#243;n cardiaca&#44; como el volumen de la aur&#237;cula izquierda&#44; la relaci&#243;n E&#47;e&#8217; y la fracci&#243;n de expulsi&#243;n del ventr&#237;culo izquierdo&#44; lo que nos permite detectar cambios subcl&#237;nicos en el miocardio&#46; Esta t&#233;cnica se correlaciona directamente con la funci&#243;n diast&#243;lica del ventr&#237;culo izquierdo&#44; la cual generalmente presenta disfunci&#243;n antes de la funci&#243;n sist&#243;lica<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">9&#44;11&#44;12</span></a>&#46; Existen estudios que han demostrado que el <span class="elsevierStyleItalic">strain</span> de la aur&#237;cula izquierda se ha asociado como predictor de cardiopat&#237;a isqu&#233;mica&#44; insuficiencia cardiaca&#44; fibrilaci&#243;n auricular y muerte cardiovascular<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">13-15</span></a>&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Recientemente se describi&#243; que el SLGAI est&#225; deprimido en pacientes con LES en comparaci&#243;n con controles<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">1</span></a>&#44; siendo nuestro estudio el segundo en la literatura que investigue estos par&#225;metros&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">El objetivo principal de este estudio es evaluar la funci&#243;n de la aur&#237;cula izquierda por <span class="elsevierStyleItalic">strain</span> a trav&#233;s de la t&#233;cnica ecocardiogr&#225;fica <span class="elsevierStyleItalic">speckle tracking</span> en pacientes con LES y s&#237;ndrome antifosfol&#237;pido asociado y compararlos con controles sanos&#59; adem&#225;s de determinar&#44; como objetivo secundario&#44; si existen factores de riesgo para una funci&#243;n de la aur&#237;cula izquierda deprimida en la medici&#243;n de <span class="elsevierStyleItalic">strain</span> en los pacientes con LES y s&#237;ndrome antifosfol&#237;pido sin s&#237;ntomas cardiovasculares&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">M&#233;todos</span><p id="par0060" class="elsevierStylePara elsevierViewall">Se reclutaron pacientes que acudieron al servicio de reumatolog&#237;a del Antiguo Hospital Civil de Guadalajara &#171;Fray Antonio Alcalde&#187; de marzo a agosto del 2018&#46; Todos los pacientes deb&#237;an ser mayores de 18 a&#241;os y cumplir criterios de clasificaci&#243;n de LES SLICC 2012<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">16</span></a> y&#44; adem&#225;s&#44; pod&#237;an tener diagn&#243;stico de s&#237;ndrome antifosfol&#237;pido secundario seg&#250;n los criterios de clasificaci&#243;n de S&#237;dney 2006<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">17</span></a> o presencia de anticuerpos antifosfol&#237;pidos&#46; Los pacientes fueron pareados con controles sanos por edad y g&#233;nero&#44; defini&#233;ndose como control sano aquellos pacientes sin ning&#250;n tipo de comorbilidad o enfermedad&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Se excluyeron pacientes con hipertensi&#243;n arterial de larga evoluci&#243;n con mal control&#44; antecedente de enfermedad valvular conocida&#44; fibrilaci&#243;n auricular o cualquier otra arritmia&#44; diabetes mellitus no controlada&#44; diagn&#243;stico previo de insuficiencia cardiaca&#44; cardiopat&#237;a isqu&#233;mica o pacientes que tuvieran enfermedades autoinmunes de sobreposici&#243;n&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Se recolectaron del expediente cl&#237;nico las caracter&#237;sticas cl&#237;nicas de los pacientes&#46; Se obtuvieron los datos de laboratorio como biometr&#237;a hem&#225;tica&#44; qu&#237;mica sangu&#237;nea&#44; pruebas de funci&#243;n hep&#225;tica&#44; examen general de orina&#44; prote&#237;nas en orina de 24<span class="elsevierStyleHsp" style=""></span>h&#44; perfil de l&#237;pidos&#44; adem&#225;s de anticuerpos antinucleares &#40;ANA&#41; &#40;inmunofluorescencia indirecta&#41;&#44; anticuerpos espec&#237;ficos &#40;anti-Smith y anti-DNA doble cadena&#41;&#44; anticuerpos antifosfol&#237;pidos &#40;ELISA&#41;&#44; anticoagulante l&#250;pico&#44; IgG e IgM anticardiolipinas y &#946;2 glicoprote&#237;na&#46; Se calcul&#243; la actividad de la enfermedad con el <span class="elsevierStyleItalic">Mexican Systemic Lupus Erythematosus Disease Activity Index</span> &#40;Mex-SLEDAI&#41;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">18</span></a> al momento de la visita&#44; que fue el d&#237;a de inclusi&#243;n al estudio&#44; y se calcul&#243; la escala SLICC&#47;ACR <span class="elsevierStyleItalic">damage index</span> &#40;SDI&#41;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">19</span></a> para determinar la presencia de da&#241;o cr&#243;nico por la enfermedad&#46; Se defini&#243; como actividad Mex-SLEDAI<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>9<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">18</span></a> y SDI<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>1&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Se document&#243; el tratamiento utilizado en cada paciente&#44; como terapia inmunosupresora&#44; uso de esteroides y antimal&#225;ricos&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Las im&#225;genes y c&#225;lculos ecocardiogr&#225;ficos fueron realizados en el laboratorio de ecocardiograf&#237;a del Hospital Civil de Guadalajara &#171;Fray Antonio Alcalde&#187; por 5 cardi&#243;logos&#44; con una variabilidad interobservador de 0&#44;85&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Los ecocardiogramas convencionales se realizaron en un ecocardiograma Siemens ACUSON SC2000 prime con un transductor 4v1c sectorial de 1&#44;25-4&#44;5<span class="elsevierStyleHsp" style=""></span>MHz&#46; Todos los pacientes fueron evaluados con un ecocardiograma bidimensional&#46; Se calcul&#243; la fracci&#243;n de expulsi&#243;n del ventr&#237;culo izquierdo mediante el m&#233;todo biplanar de Simpson en las vistas apicales 4 y 2 c&#225;maras&#46; El volumen indexado de la aur&#237;cula izquierda se determin&#243; al final de la s&#237;stole ventricular &#40;tama&#241;o m&#225;ximo de aur&#237;cula izquierda&#41; por m&#233;todo biplanar &#225;rea-longitud en la vista apical de 4 y 2 c&#225;maras&#44; indexando su resultado con la superficie corporal&#46; La relaci&#243;n E&#47;e&#8217; se obtuvo mediante la proporci&#243;n de la onda E del flujo transmitral y el promedio de las ondas e septal y lateral&#46; La fracci&#243;n de expulsi&#243;n de la aur&#237;cula izquierda se calcul&#243; mediante el <span class="elsevierStyleItalic">software</span> del c&#225;lculo del <span class="elsevierStyleItalic">strain</span>&#46; La valvulopat&#237;a se defini&#243; como la presencia de alg&#250;n grado de insuficiencia valvular vista con el doppler color en las v&#225;lvulas a&#243;rtica&#44; mitral&#44; pulmonar y tricusp&#237;dea&#46; La presencia de derrame peric&#225;rdico se busc&#243; en el eje apical 4 c&#225;maras&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Se determin&#243; la deformaci&#243;n de la aur&#237;cula izquierda &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41; mediante el <span class="elsevierStyleItalic">software</span> syngo&#174; Velocity Vector Imaging technology&#46; La vista ecocardiogr&#225;fica para el estudio fue la apical 4 c&#225;maras&#46; El endocardio de la aur&#237;cula izquierda se traz&#243; manualmente al final de la s&#237;stole&#44; y los bordes del endocardio fueron rastreados por el <span class="elsevierStyleItalic">software</span> a trav&#233;s del ciclo cardiaco&#46; El <span class="elsevierStyleItalic">software</span> tom&#243; el intervalo R-R del trazo del electrocardiograma para el c&#225;lculo de la deformaci&#243;n&#46; La deformaci&#243;n se evalu&#243; como <span class="elsevierStyleItalic">strain</span> longitudinal global y se calcularon 3 valores en la deformaci&#243;n auricular denominados&#58; <span class="elsevierStyleItalic">strain</span> longitudinal de la aur&#237;cula de reservorio &#40;SLAr&#41;&#44; de conducto &#40;SLAc&#41; y de bomba &#40;SLAb&#41;&#46; La SLAr correspondi&#243; al valor desde el pico m&#225;s alto de la fase de reservorio&#44; la SLAb al pico m&#225;s alto de la fase de bomba y la SLAc a la diferencia entre SLAr y SLAb&#46; Adem&#225;s&#44; se report&#243; el valor de la tasa de la deformaci&#243;n&#44; definido como <span class="elsevierStyleItalic">strain rate</span>&#46; El SLGAI menor del 35&#37; fue utilizado para definir una deformaci&#243;n de la aur&#237;cula deprimida reflejando alteraci&#243;n en la contracci&#243;n auricular y rigidez<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">20</span></a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Las variables num&#233;ricas se presentaron como medias y desviaci&#243;n est&#225;ndar o medianas y rangos intercuartiles&#44; seg&#250;n su distribuci&#243;n por la prueba de Kolmogorov-Smirnov&#46; Las variables categ&#243;ricas se expresaron como n&#250;meros absolutos y proporciones&#46; Se utiliz&#243; t de Student o U de Mann-Whitney para comparaci&#243;n de las variables continuas&#46; Para comparar las variables categ&#243;ricas se utiliz&#243; la &#967;<span class="elsevierStyleSup">2</span>&#46; Para comparar m&#250;ltiples variables cuantitativas con distribuci&#243;n normal se utiliz&#243; ANOVA y para no param&#233;tricas se utiliz&#243; Kruskal-Wallis&#46; Se realiz&#243; an&#225;lisis univariado y multivariado mediante regresi&#243;n log&#237;stica&#46; Las variables que fueron significativas en el an&#225;lisis univariado se analizaron en el multivariado para identificar las predictoras de un <span class="elsevierStyleItalic">strain</span> de aur&#237;cula izquierda anormal&#59; se tom&#243; como variable dependiente el <span class="elsevierStyleItalic">strain</span> de la aur&#237;cula izquierda&#44; y las independientes fueron&#58; g&#233;nero&#44; edad&#44; &#237;ndice de masa corporal&#44; tiempo de evoluci&#243;n&#44; presencia de anticuerpos antifosfol&#237;pidos&#44; diabetes mellitus&#44; hipertensi&#243;n arterial&#44; dislipidemia&#44; nefritis l&#250;pica&#44; uso de esteroides&#44; antimal&#225;ricos&#44; azatioprina&#44; metotrexato&#44; ciclofosfamida&#44; micofenolato de mofetilo&#44; rituximab&#44; actividad de la enfermedad y el &#237;ndice de da&#241;o&#46; Se utiliz&#243; el paquete estad&#237;stico Medcalc versi&#243;n 18&#46;9 para la evaluaci&#243;n de los datos&#46; Se consider&#243; como estad&#237;sticamente significativo una p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Resultados</span><p id="par0100" class="elsevierStylePara elsevierViewall">Durante el periodo de estudio se incluyeron 50 pacientes con LES y 50 controles sanos&#46; El g&#233;nero femenino fue el m&#225;s preponderante en ambos grupos &#40;90&#37; y 86&#37;&#44; respectivamente&#41;&#46; La media de edad de los pacientes con LES fue de 34 a&#241;os &#40;DE<span class="elsevierStyleHsp" style=""></span>&#177;12 a&#241;os&#41;&#46; No hubo diferencias en el &#237;ndice de masa corporal entre los pacientes con LES y controles sanos&#46; La comorbilidad m&#225;s frecuente fue la hipertensi&#243;n arterial&#44; con el 44&#37;&#46; La media de tiempo de evoluci&#243;n de la enfermedad fue de 6 a&#241;os &#40;DE<span class="elsevierStyleHsp" style=""></span>&#177;5 a&#241;os&#41;&#46; El 22&#37; de los pacientes ten&#237;an s&#237;ndrome antifosfol&#237;pido secundario y el 16&#37; de los pacientes presentaron anticuerpos antifosfol&#237;pidos circulantes sin tener criterios para s&#237;ndrome antifosfol&#237;pido&#44; siendo el 16&#37; de los pacientes triple positivo&#46; El 72&#37; de los pacientes ten&#237;an t&#237;tulos positivos de ANA 1&#58;640&#44; siendo el patr&#243;n moteado fino el m&#225;s com&#250;n&#46; El 46&#37; de los pacientes con LES estaban activos al presentar un Mex-SLEDAI mayor de 9&#46; Los dominios afectados m&#225;s frecuentemente fueron el hematol&#243;gico &#40;82&#37;&#41;&#44; mucocut&#225;neo &#40;76&#37;&#41;&#44; musculoesquel&#233;tico &#40;68&#37;&#41;&#46; El 40&#37; de los pacientes incluidos presentaron nefritis l&#250;pica&#44; siendo la clase IV la m&#225;s frecuente en un 14&#37;&#46; En cuanto al tratamiento&#44; el 44&#37; tomaba esteroides&#44; el 98&#37; antimal&#225;ricos&#44; el 28&#37; azatioprina&#44; el 12&#37; metotrexato&#44; el 38&#37; &#225;cido micofen&#243;lico&#44; el 34&#37; ciclofosfamida&#44; y el 8&#37; rituximab&#46; Se encontraron diferencias significativas en hemoglobina&#44; leucocitos&#44; neutr&#243;filos&#44; linfocitos&#44; alb&#250;mina&#44; glucosa&#44; &#225;cido &#250;rico y las lipoprote&#237;nas de alta densidad &#40;HDL&#41; entre los pacientes con LES y los controles &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">Dentro de las variables ecocardiogr&#225;ficas estudiadas&#44; se encontr&#243; que la funci&#243;n sist&#243;lica del ventr&#237;culo izquierdo en ambos grupos fue similar&#44; as&#237; como tambi&#233;n la funci&#243;n sist&#243;lica de la aur&#237;cula izquierda &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46; Se document&#243; mayor proporci&#243;n de derrame peric&#225;rdico en pacientes con LES &#40;20&#37; vs&#46; 0&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;003&#41;&#46; No existi&#243; diferencia en la presencia de alg&#250;n grado de valvulopat&#237;a entre ambos grupos&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">Dentro de los par&#225;metros de la funci&#243;n diast&#243;lica&#44; los pacientes con LES presentaron mayores presiones de llenado del ventr&#237;culo izquierdo&#44; expresados mediante la E&#47;e&#8217; &#40;7&#44;5 vs&#46; 6&#44;3&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;0003&#41; y el volumen indexado de la aur&#237;cula izquierda &#40;24<span class="elsevierStyleHsp" style=""></span>ml&#47;m<span class="elsevierStyleSup">2</span> vs&#46; 21<span class="elsevierStyleHsp" style=""></span>ml&#47;m<span class="elsevierStyleSup">2</span>&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;0007&#41;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">El SLGAI fue menor en los pacientes con LES en comparaci&#243;n con los controles &#40;41&#44;6&#37; vs&#46; 50&#44;5&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46; Tambi&#233;n fue menor las 3 fases del ciclo de la aur&#237;cula izquierda&#59; SLAr &#40;41&#44;6&#37; vs&#46; 50&#44;5&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41;&#44; SLAc &#40;26&#44;7&#37; vs&#46; 31&#44;4&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;008&#41; y SLAb &#40;14&#44;4&#37; y 17&#44;5&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;007&#41;&#46; No se encontr&#243; diferencia en el <span class="elsevierStyleItalic">strain rate</span> en pacientes con LES y controles sanos &#40;2&#44;5<span class="elsevierStyleHsp" style=""></span>s<span class="elsevierStyleSup">&#8722;1</span> vs&#46; 2&#44;7<span class="elsevierStyleHsp" style=""></span>s<span class="elsevierStyleSup">&#8722;1</span>&#41;&#46; Los resultados encontrados en SLGAI expresan una menor funci&#243;n diast&#243;lica en pacientes con LES&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">Se compararon los par&#225;metros ecocardiogr&#225;ficos entre controles sanos y LES activo y controles sanos y LES inactivo&#59; se encontr&#243; diferencia significativa en el SLGAI &#40;controles sanos 50&#44;5&#37; vs&#46; inactivo 43&#37; vs&#46; activos 36&#44;3&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>&#41;&#59; en el <span class="elsevierStyleItalic">strain</span> de las 3 fases de la aur&#237;cula izquierda&#59; y en el volumen indexado de la aur&#237;cula izquierda y E&#47;e&#8217;&#46; No se encontr&#243; diferencia en <span class="elsevierStyleItalic">strain rate</span> &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">Se contrastaron las variables cl&#237;nicas de los pacientes con LES que presentaron un SLGAI anormal vs&#46; normal &#40;punto de corte 35&#37;&#41;&#59; en este se encontraron 35 pacientes con SLGAI normal y 15 anormal &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#59; solo se encontraron diferencias significativas respecto a que los pacientes con SLGAI anormal presentaban mayor puntuaci&#243;n de la escala Mex-SLEDAI&#44; y por ende mayor porcentaje de pacientes activos&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0130" class="elsevierStylePara elsevierViewall">Se realiz&#243; an&#225;lisis univariado y multivariado &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a>&#41; para determinar si las variables influyen independientemente en el SLGAI&#46; Se document&#243; que en el an&#225;lisis univariado fueron significativos la presencia de anticuerpos antifosfol&#237;pidos circulantes&#44; la presencia de nefritis l&#250;pica&#44; el uso de esteroides y la actividad de la enfermedad&#46; Sin embargo&#44; en el an&#225;lisis multivariado no hubo diferencia significativa en ninguna de estas&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discusi&#243;n</span><p id="par0135" class="elsevierStylePara elsevierViewall">El objetivo de este estudio fue evaluar la funci&#243;n de la aur&#237;cula izquierda por medio de ecocardiograf&#237;a bidimensional&#44; <span class="elsevierStyleItalic">speckle tracking</span>&#44; un m&#233;todo no invasivo en pacientes con LES sin s&#237;ntomas cardiacos&#46; Los principales hallazgos encontrados en este estudio fueron que la deformaci&#243;n de la aur&#237;cula izquierda estaba alterada y disminuida en pacientes con LES comparados con personas sanas de la misma edad y sexo&#59; y presentando mayor disfunci&#243;n diast&#243;lica&#46; Adem&#225;s&#44; se encontr&#243; que&#44; en los pacientes con LES&#44; la deformaci&#243;n de la aur&#237;cula era menor cuando presentaban mayor actividad de la enfermedad&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">En este estudio se encontr&#243; que los pacientes con LES ten&#237;an un <span class="elsevierStyleItalic">strain</span> longitudinal global deprimido en comparaci&#243;n con controles sanos&#44; y tambi&#233;n presentaban disminuci&#243;n del <span class="elsevierStyleItalic">strain</span> de las 3 fases del ciclo de la aur&#237;cula&#44; lo que puede traducirse como una din&#225;mica alterada en la contracci&#243;n de las fibras mioc&#225;rdicas de la aur&#237;cula secundaria a la disfunci&#243;n diast&#243;lica ventricular y a la rigidez de las fibras mioc&#225;rdicas de la aur&#237;cula por el estado cr&#243;nico inflamatorio y el dep&#243;sito de inmunocomplejos<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">21</span></a>&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Nuestros resultados son parecidos a los de un estudio en el que se utiliz&#243; la t&#233;cnica de <span class="elsevierStyleItalic">speckle tracking</span> en aur&#237;cula izquierda en pacientes con LES y se compar&#243; con controles sanos&#44; se incluyeron 60 pacientes en cada grupo&#46; La media de edad de los pacientes con LES fue de 35&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;1&#44; la media de SLEDAI 2&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;0 y la media de SDI 2&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;2&#46; Se encontr&#243; que los pacientes con LES presentaban menor <span class="elsevierStyleItalic">strain</span> global en comparaci&#243;n con controles sanos &#40;26&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#44;5&#37; vs&#46; 32&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#44;8&#37;&#44; ambos p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; En este estudio no se encontr&#243; diferencias en las dimensiones de la aur&#237;cula izquierda y en la E&#47;e&#8217; &#40;33&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;3<span class="elsevierStyleHsp" style=""></span>mm vs&#46; 30&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;9<span class="elsevierStyleHsp" style=""></span>mm&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;23&#59; 8&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;5 vs&#46; 7&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;7&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;06&#41;&#59; sin embargo&#44; el volumen indexado de la aur&#237;cula izquierda fue mayor en los pacientes con LES &#40;24<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;0 vs&#46; 25&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;1&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Adem&#225;s&#44; se encontr&#243; en el an&#225;lisis multivariado que el SDI se asoci&#243; de manera independiente e inversamente con el <span class="elsevierStyleItalic">strain</span> global&#44; lo que refleja el da&#241;o acumulativo en la funci&#243;n cardiaca<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">1</span></a>&#59; sin embargo&#44; en nuestro estudio esto no fue similar&#44; ya que en el an&#225;lisis multivariado no fue significativo&#59; esto se pudo deber a que nuestros pacientes ten&#237;an un menor SDI y tiempo de evoluci&#243;n de la enfermedad&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Nosotros encontramos que otro de los par&#225;metros cl&#225;sicos de funci&#243;n diast&#243;lica del ventr&#237;culo izquierdo&#44; como lo son la E&#47;e&#8217; y el volumen indexado de la aur&#237;cula izquierda&#44; fue mayor en pacientes con LES&#44; a diferencia de controles&#59; incluso en aquellos activos tambi&#233;n fueron superiores ambos valores&#44; lo que correlaciona con una mayor disfunci&#243;n diast&#243;lica&#46; Este hecho ya hab&#237;a sido descrito anteriormente por Gu&#351;etu et al&#46; en un estudio que realizaron con 75 pacientes con LES&#44; donde lo compararon con 73 controles sanos<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">22</span></a>&#46; Esto tambi&#233;n lo documentaron Barutcu et al&#46;&#44; quienes estudiaron 50 pacientes con LES comparados con 30 controles y reportaron mayores valores de E&#47;e&#8217; y volumen indexado de la aur&#237;cula izquierda&#59; algo relevante fue que en ese estudio se report&#243; adem&#225;s que los pacientes con LES y anticuerpos anticardiolipinas positivos tuvieron m&#225;s valores de disfunci&#243;n diast&#243;lica<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">23</span></a>&#46; Li et al&#46;&#44; en un estudio entre 102 pacientes con lupus y 32 controles&#44; utilizaron ecocardiograf&#237;a 3D para valorar el volumen y funci&#243;n de la aur&#237;cula izquierda&#44; y encontraron que los pacientes con LES ten&#237;an mayor volumen y una funci&#243;n de la aur&#237;cula izquierda m&#225;s deteriorada&#44; siendo mayor en aquellos pacientes con SDI elevado y mayor actividad de la enfermedad<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">24</span></a>&#44; similar a nuestros resultados&#44; en donde se document&#243; que los pacientes con mayor actividad ten&#237;an una funci&#243;n de la aur&#237;cula izquierda m&#225;s deteriorada&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Nosotros documentamos que los pacientes con nefritis l&#250;pica pudieran tener asociaci&#243;n con mayor depresi&#243;n del <span class="elsevierStyleItalic">strain</span>&#59; esto pudiera explicarse ya que la mayor&#237;a de los pacientes clasificados como activos ten&#237;an mayor presencia de nefritis l&#250;pica&#46; Se ha descrito<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">25</span></a> que los pacientes con enfermedad renal cr&#243;nica tienen un SLGAI deprimido en comparaci&#243;n con controles sanos&#44; secundario a la activaci&#243;n de la v&#237;a renina-angiotensina-aldosterona causando fibrosis mioc&#225;rdica&#44; por lo que esto pudiera explicar que la nefritis l&#250;pica se haya relacionado con mayor depresi&#243;n del <span class="elsevierStyleItalic">strain</span> de aur&#237;cula izquierda en nuestro estudio&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">En nuestro estudio se encontr&#243; que la presencia de anticuerpos antifosfol&#237;pidos circulantes se pudiera relacionar en el an&#225;lisis univariado con presentar un <span class="elsevierStyleItalic">strain</span> deprimido&#44; lo que indica una mayor disfunci&#243;n diast&#243;lica&#46; Estos hallazgos coinciden con los descritos por Tufano et al&#46; en un estudio con 69 pacientes con s&#237;ndrome antifosfol&#237;pido y 69 controles sanos&#44; en el que demostraron que la presencia de disfunci&#243;n diast&#243;lica se correlacionaba con t&#237;tulos m&#225;s altos de anticoagulante l&#250;pico y con tener mayor edad&#46; Adem&#225;s&#44; se encontr&#243; que los pacientes con s&#237;ndrome antifosfol&#237;pido secundario presentaban mayor volumen de la aur&#237;cula izquierda<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">26</span></a>&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Nosotros evidenciamos que el uso de esteroides se pudiera asociar en el an&#225;lisis univariado a presentar SLGAI deprimido&#46; Hattori et al&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">27</span></a> hab&#237;an descrito en un estudio con modelos murinos el efecto de los esteroides a nivel cardiaco&#44; encontrando que produc&#237;an hipertensi&#243;n&#44; fibrosis ventricular e induc&#237;an disfunci&#243;n diast&#243;lica del ventr&#237;culo izquierdo&#44; por aumento del estr&#233;s oxidativo&#44; deficiencia de &#243;xido n&#237;trico&#44; actuando a trav&#233;s de los receptores mineralocorticoides &#40;RM&#41; y glucocorticoides &#40;RG&#41; ampliamente distribuidos en el sistema cardiovascular&#46; Adem&#225;s&#44; se observ&#243; la presencia de atrofia de las fibras cardiacas independientemente de la activaci&#243;n de los receptores&#46; Se encontr&#243; que estos efectos disminu&#237;an cuando se les administr&#243; espironolactona&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">El deterioro de la funci&#243;n de la aur&#237;cula izquierda en pacientes con LES pudiera deberse a la presencia de inflamaci&#243;n sist&#233;mica cr&#243;nica subcl&#237;nica&#44; aun con niveles bajos de actividad seg&#250;n los &#237;ndices existentes&#44; secundaria a la presencia de citosinas proinflamatorias circulantes&#46; En un estudio con pacientes con artritis reumatoide<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">28</span></a> y en otro estudio con pacientes con espondilitis anquilosante y artritis psori&#225;sica<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">29</span></a> se observ&#243; que administrar anti-TNF mejor&#243; la funci&#243;n de la aur&#237;cula izquierda&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Existe poca literatura acerca del uso de <span class="elsevierStyleItalic">strain</span> de aur&#237;cula izquierda en pacientes con LES y su aplicaci&#243;n en la detecci&#243;n de las alteraciones de la funci&#243;n de la aur&#237;cula izquierda&#46; Se encontr&#243; un solo estudio donde se compar&#243; la funci&#243;n de la aur&#237;cula izquierda por <span class="elsevierStyleItalic">strain</span> en pacientes con LES y controles&#44; por lo que este estudio es de utilidad para describir el posible valor de esta nueva t&#233;cnica de <span class="elsevierStyleItalic">strain</span> de aur&#237;cula izquierda en pacientes con LES para identificar cambios subcl&#237;nicos o incipientes de disfunci&#243;n diast&#243;lica y su detecci&#243;n de manera temprana para implementar acciones que disminuyan la progresi&#243;n a falla cardiaca con funci&#243;n sist&#243;lica preservada en un futuro&#46; Sin embargo&#44; se requieren m&#225;s estudios con seguimiento a largo plazo y a gran escala para validar la utilidad de esta t&#233;cnica en el seguimiento de pacientes con LES&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Las limitaciones de este estudio son principalmente el tama&#241;o modesto de la muestra y que no se cont&#243; con un seguimiento a largo plazo de los pacientes con ecocardiograma con t&#233;cnica <span class="elsevierStyleItalic">strain</span> de aur&#237;cula izquierda de control posterior a las modificaciones del tratamiento y al cambio en la actividad&#46; Resulta atractivo dar seguimiento a los pacientes durante su evoluci&#243;n con esta t&#233;cnica y evaluar los cambios en los par&#225;metros y el desenlace en el paciente&#46; Adem&#225;s&#44; la t&#233;cnica <span class="elsevierStyleItalic">strain</span> depende de la calidad de imagen y del operador&#44; y no se encuentra ampliamente en todos los centros&#44; aunque es una t&#233;cnica que est&#225; adquiriendo importancia para la evaluaci&#243;n cardiaca de los pacientes&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclusi&#243;n</span><p id="par0185" class="elsevierStylePara elsevierViewall">El LES es una entidad multiorg&#225;nica&#44; que afecta tambi&#233;n el coraz&#243;n&#46; En el estudio se encontr&#243; que la deformaci&#243;n de la aur&#237;cula izquierda y todas las fases del ciclo est&#225;n alteradas&#44; indicando afectaci&#243;n subcl&#237;nica del coraz&#243;n&#44; en pacientes asintom&#225;ticos&#44; dentro de la evoluci&#243;n y actividad de la enfermedad&#59; por lo que se recomienda la evaluaci&#243;n cardiaca peri&#243;dica aun en pacientes asintom&#225;ticos&#44; para emplear modificaciones al tratamiento de manera temprana y poder ofrecer un manejo integral a los pacientes&#44; previniendo el remodelamiento de la aur&#237;cula y evitando el desarrollo de arritmias y falla cardiaca con fracci&#243;n de expulsi&#243;n conservada</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflicto de intereses</span><p id="par0190" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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          "titulo" => "Abstract"
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    "fechaAceptado" => "2019-03-22"
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          "palabras" => array:4 [
            0 => "Lupus eritematoso sist&#233;mico"
            1 => "Disfunci&#243;n diast&#243;lica"
            2 => "<span class="elsevierStyleItalic">Strain</span> longitudinal global aur&#237;cula izquierda"
            3 => "Mex-SLEDAI"
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            0 => "Systemic lupus erythematosus"
            1 => "Diastolic dysfunction"
            2 => "Left atrial global longitudinal strain"
            3 => "Mex-SLEDAI"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Antecedentes</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">En los pacientes con lupus eritematoso sist&#233;mico &#40;LES&#41; la disfunci&#243;n diast&#243;lica del ventr&#237;culo izquierdo &#40;DDVI&#41; puede ser la &#250;nica manifestaci&#243;n de involucro cardiaco anticipando una disfunci&#243;n sist&#243;lica&#46; Se ha visto que la deformaci&#243;n mioc&#225;rdica de la aur&#237;cula izquierda &#40;AI&#41;&#44; mediante el <span class="elsevierStyleItalic">strain</span> longitudinal global de la AI &#40;SLGAI&#41;&#44; puede llegar a ser de utilidad en valorar la funci&#243;n diast&#243;lica&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Evaluar la funci&#243;n de la AI mediante la deformaci&#243;n mioc&#225;rdica en pacientes con LES&#46; Comparar el <span class="elsevierStyleItalic">strain</span> de la AI en pacientes con LES activos&#44; inactivos y controles&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 50 pacientes con LES y se compararon con controles sanos pareados por edad y sexo&#46; Se midi&#243; por ecocardiograma transtor&#225;cico la deformaci&#243;n mioc&#225;rdica mediante el SLGAI&#44; el <span class="elsevierStyleItalic">strain</span> de las 3 fases del ciclo de la AI y la tasa de <span class="elsevierStyleItalic">strain</span>&#46; La diferencia entre los grupos se analiz&#243; de forma univariante&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">El SLGAI en pacientes con LES fue menor que en los controles sanos &#40;41&#44;6&#37; vs&#46; 50&#44;5&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#41;&#44; as&#237; como tambi&#233;n fue menor en las 3 fases del ciclo de la AI&#46; No hubo diferencias en la tasa de <span class="elsevierStyleItalic">strain</span> en ambos grupos &#40;LES 2&#44;5<span class="elsevierStyleHsp" style=""></span>s<span class="elsevierStyleSup">&#8722;1</span> vs&#46; controles sanos 2&#44;75<span class="elsevierStyleHsp" style=""></span>s<span class="elsevierStyleSup">&#8722;1</span>&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;1&#41;&#46; Tambi&#233;n se encontr&#243; que el SLGAI fue menor en pacientes activos en comparaci&#243;n con controles e inactivos&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusiones</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Los pacientes con LES tienen menor deformaci&#243;n mioc&#225;rdica de la AI&#44; lo que se expresa como una menor funci&#243;n diast&#243;lica correlacionando con da&#241;o mioc&#225;rdico subcl&#237;nico precoz&#46;</p></span>"
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        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Background</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">In patients with systemic lupus erythematosus &#40;SLE&#41;&#44; left ventricle diastolic dysfunction &#40;LVDD&#41; may be the only manifestation of cardiac involvement in anticipation of systolic dysfunction&#46; It has been seen that myocardial deformation of the left atrium &#40;LA&#41;&#44; through the LA global longitudinal strain &#40;LAGLS&#41;&#44; may be useful in assessing diastolic function&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objective</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">To evaluate LA function through myocardial deformation in patients with LES&#44; and compare the LA strain in patients with active&#44; inactive and controls&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Methods</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Fifty patients with SLE were included and compared with 50 healthy controls paired by age and gender&#46; Myocardial deformation was measured by transthoracic echocardiogram&#44; to investigate the LAGLS&#44; the strain of the three phases of the LA cycle and the strain rate&#46; The differences between groups were compared in univariate analysis&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">LAGLS in SLE patients was less than in the controls &#40;41&#46;6&#37; vs&#46; 50&#46;5&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;02&#41;&#44; and in the 3 phases of the LA cycle&#46; There were no differences in the LA strain rate in both groups &#40;SLE 2&#46;5<span class="elsevierStyleHsp" style=""></span>s<span class="elsevierStyleSup">&#8722;1</span> vs&#46; controls 2&#46;75<span class="elsevierStyleHsp" style=""></span>s<span class="elsevierStyleSup">&#8722;1</span>&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;1&#41;&#46; It was also found that the LAGLS was lesser in active patients than controls and inactive&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusions</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">SLE patients have lower myocardial deformation of the LA&#44; which is expressed as a lower diastolic function correlating with early subclinical myocardial damage&#46;</p></span>"
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          "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">A&#41; Imagen en vista apical 4 c&#225;maras donde se determinan los bordes de la aur&#237;cula izquierda para el c&#225;lculo del <span class="elsevierStyleItalic">strain</span>&#46; B&#41; Representaci&#243;n gr&#225;fica del <span class="elsevierStyleItalic">strain</span> de la aur&#237;cula izquierda en todo el ciclo auricular&#46; La SLAr correspondi&#243; al valor desde el pico m&#225;s alto de la fase de reservorio&#44; la SLAb al pico m&#225;s alto de la fase de bomba y la SLAc a la diferencia entre SLAr y SLAb&#46; C&#41; Representaci&#243;n del reporte de <span class="elsevierStyleItalic">strain</span> de aur&#237;cula izquierda del <span class="elsevierStyleItalic">software</span> VVI&#46;</p> <p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">SLAr&#58; <span class="elsevierStyleItalic">strain</span> logitudinal aur&#237;cula reservorio&#59; SLAb&#58; <span class="elsevierStyleItalic">strain</span> longitudinal aur&#237;cula bomba&#59; SLAc&#58; <span class="elsevierStyleItalic">strain</span> logitudinal aur&#237;cula conducto&#46;</p>"
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IgG anticardiolipinas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IgM anticardiolipinas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>B2 Glicoprote&#237;na I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Triple positivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">ANA</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Anti-DNA ds&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Anti-Ro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Anti-Sm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Anti-La&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Patr&#243;n ANA</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Citoplasm&#225;tico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Homog&#233;neo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Moteado fino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Moteado grueso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Mex-SLEDAI</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#44;7 &#40;&#177;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Actividad &#40;&#37; activos&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">SDI</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;7 &#40;&#177;1&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Dominios</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">General</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Mucocut&#225;neo</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Neurol&#243;gico</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Musculoesquel&#233;tico</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Cardiaco</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Serositis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Vasculitis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Oft&#225;lmico</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Abdominal</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Hematol&#243;gico</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">82&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Renal</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Clase de biopsia</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Clase I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Clase II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Clase III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Clase IV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Clase V&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Clase V<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>IV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Tratamiento</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Esteroide&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Antimal&#225;ricos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">98&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Azatioprina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">28&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Metotrexato&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#193;cido micofen&#243;lico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ciclofosfamida&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Rituximab&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Laboratorios</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hemoglobina &#40;g&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#44;8 &#40;&#177;2&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#44;5 &#40;&#177;1&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Leucocitos &#40;mm<span class="elsevierStyleSup">3</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;318 &#40;&#177;2073&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;566 &#40;&#177;1&#46;786&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Neutr&#243;filos &#40;mm<span class="elsevierStyleSup">3</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;842 &#40;&#177;3&#46;200&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;641 &#40;&#177;1&#46;357&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Linfocitos &#40;mm<span class="elsevierStyleSup">3</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;358 &#40;&#177;1&#46;056&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;976 &#40;&#177;706&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Plaquetas &#40;mm<span class="elsevierStyleSup">3</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">222 &#40;&#177;91&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">220 &#40;&#177;62&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Globulina &#40;g&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;3 &#40;&#177;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;4 &#40;&#177;0&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Alb&#250;mina &#40;g&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;3 &#40;&#177;0&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;8 &#40;&#177;0&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Creatinina &#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;8 &#40;&#177;0&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;7 &#40;&#177;0&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Urea &#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&#44;4 &#40;&#177;32&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#44;3 &#40;&#177;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Glucosa &#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">99 &#40;&#177;42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">82 &#40;&#177;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#193;cido &#250;rico &#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Par&#225;metro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">An&#225;lisis univariado OR &#40;IC 95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">An&#225;lisis multivariado OR &#40;IC 95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">G&#233;nero &#40;hombres&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;6 &#40;0&#44;2-10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Edad&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;5 &#40;0&#44;4-5&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IMC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;6 &#40;0&#44;2-2&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Evoluci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;7 &#40;0&#44;2-2&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Presencia de anticuerpos antifosfol&#237;pidos circulantes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;3 &#40;1&#44;1-26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;0&#44;6-24&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">DM2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;2 &#40;0&#44;1-14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HAS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;5 &#40;0&#44;7-8&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dislipidemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;9 &#40;0&#44;7-20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nefritis l&#250;pica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;1&#44;3-18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;1 &#40;0&#44;3-14&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esteroides&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;8 &#40;1&#44;1-13&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;6 &#40;0&#44;5-13&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Antimal&#225;ricos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;4 &#40;0&#44;1-34&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Azatioprina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;9 &#40;0&#44;2-3&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Metotrexato&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;1 &#40;0&#44;01-1&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Ciclofosfamida&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;5 &#40;0&#44;7-8&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">MMF&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1&#44;1 &#40;0&#44;3-3&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Rituximab&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3 &#40;0&#44;5-17&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Actividad&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#44;3 &#40;1&#44;4-20&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">SDI&nbsp;\t\t\t\t\t\t\n
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          "es" => "<p id="spar0125" class="elsevierStyleSimplePara elsevierViewall">An&#225;lisis univariado y multivariado de los factores asociados a SLGAI<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>35&#37;</p>"
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Información del artículo
ISSN: 1699258X
Idioma original: Español
DOI:10.1016/j.reuma.2019.03.006
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