Utilidad del ultrasonido Doppler orbitario en

Anuncio
Anales de Radiología México 2011;4:233-246.
Dr. José Herminio Vargas García*
Dr. Ignacio Cano Muñoz*
Dr. Manuel Huerta Cerda**
Dr. Antonio Guardiola Fernández*
RESUMEN
Introducción.(OXOWUDVRQLGR
'RSSOHUFDURWtGHRTXHHYDO~DOD
UHJLyQH[WUDFUDQHDOGHODDUWHULD
FDUyWLGDLQWHUQDQRHVWXGLDODV
SRUFLRQHV SHWURVD FDYHUQRVD
\FHUHEUDOGHODPLVPDGLFKDV
SRUFLRQHVGHEHQVHUYDORUDGDV
SRU PHGLR GH HVWXGLRV HVSHFLDOL]DGRVGHPD\RUFRVWR\HQ
DOJXQRV FDVRV LQYDVLYRV FRPR
OD DQJLRJUDItD FHUHEUDO OD DQJLRWRPRJUDItD \ OD DQJLRUUHVRQDQFLDPDJQpWLFD(OXOWUDVRQLGR
'RSSOHU RUELWDULR GHWHFWD ORV
FDPELRVHQODIUHFXHQFLDUHÀHMDGDSRUODVDQJUHHQFLUFXODFLyQ
GHQWURGHXQYDVRSHUPLWLHQGR
ODHVWLPDFLyQFXDQWLWDWLYDGHVX
YHORFLGDGGHÀXMR\GLUHFFLyQOD
GHOPLVPR(ODQiOLVLVSXHGHVHU
UHDOL]DGRFRQHOPLVPRHTXLSR
\ SRU HO PLVPR SHUVRQDO TXH
UHDOL]D HO XOWUDVRQLGR 'RSSOHU
FDURWtGHR 3HUPLWH HYDOXDU GLYHUVDV DQRPDOtDV HQ ODV HVWUXFWXUDVGHOJORERRFXODUFRPR
ODV FDWDUDWDV OD GHJHQHUDFLyQ
YtWUHDHOKHPRYtWUHR\ODVDOWHUDFLRQHVYDVFXODUHVTXHDIHFWDQDO
JORERRFXODUFRPRHOVtQGURPH
LVTXpPLFR RFXODU \ ODV ItVWXODV
DUWHULRYHQRVDVRUELWDULDV
Objetivos.&RUURERUDUODDVRFLDFLyQHVWDEOHFLGDHQHVWXGLRV
SUHYLRV HQWUH ODV DOWHUDFLRQHV
ARTÍCULO DE REVISIÓN
Utilidad del ultrasonido Doppler orbitario
en pacientes con enfermedades
crónicas degenerativas. Presentación de
KDOOD]JRV\UHYLVLyQELEOLRJUi¿FD
GHOÀXMRGHORVYDVRVRUELWDULRV
\ FDURWtGHRV 'HPRVWUDU TXH
HO XVR DXQDGR GHO XOWUDVRQLGR
'RSSOHU RUELWDULR \ FDURWtGHR
SURYHHPHMRUHVGLDJQyVWLFRVHQ
SDFLHQWHVFRQIDFWRUHVGHULHVJR
SDUD HQIHUPHGDG REVWUXFWLYD
FDURWtGHD\HYHQWRFHUHEURYDVFXODUFRPSDUDGRFRQODSUiFWLFD
DFWXDOGHXVRH[FOXVLYRGHXOWUDVRQLGR'RSSOHUFDURWtGHR
Material y método.6HUHDOL]DURQXOWUDVRQLGRV'RSSOHURUELWDULR\FDURWtGHRDSDFLHQWHV
FRQIDFWRUHVGHULHVJRSDUDHQIHUPHGDGFDURWtGHDREVWUXFWLYD
\HYHQWRFHUHEURYDVFXODUHVWR
HV GLDEHWHV PHOOLWXV KLSHUWHQVLyQ GLVOLSLGHPLD \ REHVLGDG
UHIHULGRV SRU ORV VHUYLFLRV \
SRU &RQVXOWD ([WHUQD GH ORV
GHSDUWDPHQWRV GH 0HGLFLQD
,QWHUQD\2IWDOPRORJtDGHO+RVSLWDO0HWURSROLWDQR³'U%HUQDUGR
6HS~OYHGD´GHO6HFWRU6DOXGHQ
0RQWHUUH\1XHYR/HyQ
Resultados./RVSDFLHQWHVHYDOXDGRVSUHVHQWDURQHGDGHV GH D DxRV FRQ XQD
PHGLDGHDxRV(OJUXSR
GHDDxRVORLQWHJUDURQ
SDFLHQWHVHOJUXSRD
DxRV SDFLHQWHV \ HO JUXSR
GHDxRVHQDGHODQWH
SDFLHQWHV'HOJUXSRGHHVWXGLR
Q SDFLHQWHV IXHURQ
GHOVH[RIHPHQLQR\
SDFLHQWHV GH VH[R PDVFXOLQR
SDFLHQWHV SUHVHQWDURQ KLSHUWHQVLyQ DUWHULDO SDFLHQWHV GLDEHWHV
PHOOLWXV SDFLHQWHV
GLVOLSLGHPLD \ SUHVHQWy ³VREUHSHVR´ (Q SDFLHQWHVVHLGHQWL¿FDURQ
VtQWRPDVQHXUROyJLFRV\HQ
VtQWRPDVYLVXDOHV(Q
SDFLHQWHVVHLGHQWL¿Fy
DOWHUDFLyQGHOÀXMRGHODDUWHULD
RIWiOPLFD\HQDOWHUDFLyQGHOÀXMRGHODDUWHULDFHQWUDO
GHODUHWLQD
Discusión y conclusiones.
(QHVWHHVWXGLRVHGHPXHVWUDTXH
H[LVWHXQDDVRFLDFLyQHVWDGtVWLFDPHQWHVLJQL¿FDWLYDHQWUHGH
REVWUXFFLyQFDURWtGHDVXSHULRU\
DOWHUDFLyQ GHO ÀXMR GH OD DUWHULD
RIWiOPLFDHQWUHGLDEHWHVPHOOLWXV
\ODDOWHUDFLyQGHOÀXMRGHODDUWHULD
RIWiOPLFD\ODDUWHULDFHQWUDOGHOD
UHWLQDDVtFRPRFRQODSUHVHQFLD
GHFDWDUDWDVRKHPRYtWUHR)LQDOPHQWH WDPELpQ H[LVWH UHODFLyQ
HQWUHODKLSHUWHQVLyQDUWHULDO\ODV
FDWDUDWDV
Palabras clave: XOWUDVRQLGR
'RSSOHU'RSSOHUFDURWtGHRXOWUDVRQLGRRFXODUHQIHUPHGDGHV
GHJHQHUDWLYDV \ HQIHUPHGDG
YDVFXODUFHUHEUDO
Continúa en la pág. 234
'HSDUWDPHQWRGH5DGLRORJtDH,PDJHQGHO+RVSLWDO6DQ-RVp7HFGH0RQWHUUH\
+RVSLWDO0HWURSROLWDQRu%HUQDUGR6HS~OYHGDv661/$Y,JQDFLR0RURQHV3ULHWR
3WH&RO'RFWRUHV0RQWHUUH\1/
&RSLDVcopies'U-RVp+HUPLQLR9DUJDV*DUFtD(PDLOKHUPLQLRMYDUJDV#KRWPDLOFRP
'U,JQDFLR&DQR0XxR]LFDQRP#JPDLOFRP
Octubre-Diciembre 2011
233
Viene de la pág. 233
ABSTRACT
Introduction. &DURWLG 'RSSOHUXOWUDVRXQGZKLFKHYDOXDWHV
WKH H[WUDFUDQLDO UHJLRQ RI WKH
LQWHUQDOFDURWLGDUWHU\GRHVQRW
VWXG\ LWV SHWURXV FDYHUQRXV
DQG FHUHEUDO VHJPHQWV WKRVH
VHJPHQWV VKRXOG EH HYDOXDWHG
E\PHDQVRIPRUHFRVWO\DQGLQ
VRPH FDVHV LQYDVLYH VSHFLDOL]HG VWXGLHV VXFK DV FHUHEUDO
DQJLRJUDSK\DQJLRWRPRJUDSK\
DQG PDJQHWLF DQJLRUHVRQDQFH
2UELWDO 'RSSOHU XOWUDVRXQG GHWHFWV FKDQJHV LQ IUHTXHQF\ UHÀHFWHGE\WKHEORRGFLUFXODWLQJLQ
DEORRGYHVVHODOORZLQJTXDQWLWDWLYHHVWLPDWLRQRILWVUDWHDQG
GLUHFWLRQ RI ÀRZ 7KH DQDO\VLV
FDQEHSHUIRUPHGZLWKWKHVDPH
HTXLSPHQWDQGE\WKHVDPHSHUVRQQHO ZKR DGPLQLVWHU FDURWLG
'RSSOHUXOWUDVRXQG,WDOORZVXV
WRHYDOXDWHYDULRXVDQRPDOLHVLQ
WKHVWUXFWXUHVRIWKHH\HVRFNHW
VXFKDVFDWDUDFWVYLWUHRXVGHJHQHUDWLRQ KHPRYLWUHRXV DQG
YDVFXODU GLVRUGHUV WKDW DIIHFW
WKH H\H VRFNHW VXFK DV RFXODU
LVFKHPLF V\QGURPH DQG RUELWDO
DUWHULRYHQRXV¿VWXODV
Purpose. &RUURERUDWH WKH
DVVRFLDWLRQHVWDEOLVKHGLQSULRU
VWXGLHV EHWZHHQ DOWHUDWLRQV RI
ÀRZ LQ WKH RUELWDO DQG FDURWLG
EORRGYHVVHOV6KRZWKDWDGGHG
XVHRIRUELWDODQGFDURWLG'RSSOHU XOWUDVRXQG SURYLGHV EHWWHU
GLDJQRVHV LQ SDWLHQWV ZLWK ULVN
IDFWRUV IRU REVWUXFWLYH FDURWLG
GLVHDVH DQG VWURNH FRPSDUHG
ZLWKWKHSUHVHQWSUDFWLFHRIH[FOXVLYH XVH RI FDURWLG 'RSSOHU
XOWUDVRXQG
Material and method.2UELWDO
DQGFDURWLG'RSSOHUXOWUDVRXQGV
ZHUH WDNHQ RI SDWLHQWV ZLWK
ULVN IDFWRUV IRU REVWUXFWLYH FDURWLG GLVHDVH DQG VWURNH LH
GLDEHWHV PHOOLWXV K\SHUWHQVLRQG\VOLSLGHPLDDQGREHVLW\
UHIHUUHGE\VSHFLDOL]HGVHUYLFHV
DQGE\RXWSDWLHQWVHUYLFHLQWKH
GHSDUWPHQWVRILQWHUQDOPHGLFLQH
DQG RSKWKDOPRORJ\ DW +RVSLWDO
0HWURSROLWDQR 'U %HUQDUGR
6HSXOYHGDDSXEOLFKHDOWKFDUH
LQVWLWXWLRQ LQ 0RQWHUUH\ 1XHYR
/HRQ0H[LFR
Results. 7KH SDWLHQWV
HYDOXDWHG ZHUH DJHG WR
\HDUV ZLWK D PHDQ DJH RI
\HDUV*URXSWR
\HDUV KDG SDWLHQWV JURXS
WR \HDUV SDWLHQWV
DQG JURXS \HDUV DQG
Introducción
(O XOWUDVRQLGR 'RSSOHU FDURWtGHR HV HO HVWXGLR GH
LPDJHQPiVXWLOL]DGRSDUDHOGLDJQyVWLFRGHODHQIHUPHGDGREVWUXFWLYDFDURWtGHD\SDUDHOULHVJRGHXQHYHQWR
FHUHEURYDVFXODU(Q(VWDGRV8QLGRVKDVWDGHORV
SDFLHQWHVDORVTXHVHOHVUHDOL]DHQGDUWHUHFWRPtDFDURWtGHDWXYLHURQDOXOWUDVRQLGR'RSSOHUFDURWtGHRFRPR
~QLFRHVWXGLRGHLPDJHQDQWHVGHGHFLGLUODUHDOL]DFLyQ
GHODLQWHUYHQFLyQ
/RVIDFWRUHVGHULHVJRSDUDODHQIHUPHGDGREVWUXFWLYD FDURWtGHD TXH SUHGRPLQDQ FDGD YH] PiV VRQ
DUWHULRHVFOHURVLVKLSHUWHQVLyQDUWHULDOGLDEHWHVPHOOLWXVGLVOLSLGHPLDVREHVLGDG\HGDGDYDQ]DGD
(O XOWUDVRQLGR 'RSSOHU FDURWtGHR HYDO~D OD UHJLyQ
H[WUDFUDQHDOGHODDUWHULDFDUyWLGDLQWHUQDSHURGHMDVLQ
HVWXGLDU ODV SRUFLRQHV SHWURVD FDYHUQRVD \ FHUHEUDO
2 3 4 Octubre-Diciembre 2011
RYHUSDWLHQWV2IWKHVWXG\
JURXSQ SDWLHQWVZHUH
IHPDOH DQG ZHUH
PDOH )RUW\ SDWLHQWV
SUHVHQWHG KLJK EORRG
SUHVVXUH SDWLHQWV GLDEHWHV
PHOOLWXV SDWLHQWV
G\VOLSLGHPLDDQG
ZHUH RYHUZHLJKW ,Q SDWLHQWV
QHXURORJLFDO V\PSWRPV
ZHUHLGHQWL¿HGDQGLQ
YLVXDOV\PSWRPV,QSDWLHQWV
DOWHUDWLRQRIÀRZLQWKH
RSKWKDOPLFDUWHU\ZDVLGHQWL¿HG
DQGLQDOWHUDWLRQRI
ÀRZLQWKHFHQWUDOUHWLQDODUWHU\
Discussion and conclusions. 7KLV VWXG\ VKRZV WKDW
WKHUHLVDVWDWLVWLFDOO\VLJQL¿FDQW
DVVRFLDWLRQEHWZHHQXSSHU
FDURWLG REVWUXFWLRQ DQG DOWHUDWLRQRIÀRZLQWKHRSKWKDOPLFDUWHU\EHWZHHQGLDEHWHVPHOOLWXV
DQG RI ÀRZ LQ WKH RSKWKDOPLF
DUWHU\ DQG WKH FHQWUDO UHWLQDO
DUWHU\$QGZLWKWKHSUHVHQFHRI
FDWDUDFWV RU KHPRYLWUHRXV )LQDOO\WKHUHLVDOVRDUHODWLRQVKLS
EHWZHHQ KLJK EORRG SUHVVXUH
DQGFDWDUDFWV
Key words:'RSSOHUXOWUDVRXQG
FDURWLG'RSSOHURFXODUXOWUDVRXQG
GHJHQHUDWLYH GLVHDVHV DQG FHUHEURYDVFXODUGLVHDVH
GHODPLVPDTXHGHEHQVHUYDORUDGDVSRUPHGLRGH
HVWXGLRVHVSHFLDOL]DGRVFRPRODDQJLRJUDItDFHUHEUDO
OD DQJLRWRPRJUDItD \ OD DQJLRUUHVRQDQFLD PDJQpWLFD
GH PD\RU FRVWR \ HQ DOJXQRV FDVRV LQYDVLYRV \ FRQ
FRQWUDLQGLFDFLRQHVDEVROXWDVSDUDDOJXQRVSDFLHQWHV
WDOHVHOFDVRGHSDFLHQWHVFRQPDUFDSDVRVUHDFFLRQHV
DOpUJLFDV D PHGLR GH FRQWUDVWH R LQVX¿FLHQFLD UHQDO
$GHPiVGLFKRVHVWXGLRVSRUVXDOWRFRVWR\ODQHFHVLGDGGHHTXLSR\SHUVRQDOHVSHFLDOL]DGRQRSXHGHQ
VHUDSOLFDGRVDJUDQGHVJUXSRVGHSREODFLyQDPDQHUD
GHHVFUXWLQLR
(O XOWUDVRQLGR 'RSSOHU RUELWDULR HV XQ HVWXGLR QR
LQYDVLYRTXHGHWHFWDORVFDPELRVHQODIUHFXHQFLDGH
ODRQGDVRQRUDUHÀHMDGDSRUODVDQJUHHQFLUFXODFLyQ
GHQWURGHOYDVRHVWXGLDGRSHUPLWLHQGRXQDHVWLPDFLyQ
FXDQWLWDWLYDGHVXYHORFLGDGGHÀXMR\VXGLUHFFLyQ
SXHGHUHDOL]DUVHSRUHOPLVPRHTXLSR\SHUVRQDOTXH
UHDOL]D HO XOWUDVRQLGR 'RSSOHU FDURWtGHR \ SHUPLWH
HYDOXDUYDULDVDIHFFLRQHVGHODVHVWUXFWXUDVGHOJORER
RFXODUGHVGHVXDVSHFWRQRUPDOLPiJHQHVD\E
KDVWDDOWHUDFLRQHVFRPRFDWDUDWDVLPDJHQGHJHQHUDFLyQ YtWUHD LPDJHQ KHPRYtWUHR LPDJHQ GHVSUHQGLPLHQWRGHOFXHUSRYtWUHRLPDJHQ\GHVSUHQGLPLHQWRGHUHWLQDLPiJHQHVD\ESRUPHGLR
GHLPiJHQHVHQPRGR%7DPELpQVLUYHSDUDDQDOL]DU
DOWHUDFLRQHV YDVFXODUHV TXH DIHFWDQ DO JORER RFXODU
FRPRHOVtQGURPHLVTXpPLFRRFXODULPiJHQHVD\E
\ItVWXODVDUWHULRYHQRVDVRUELWDULDVLPiJHQHVD\E
GHWHUPLQDQGRODSUHVHQFLD\GLUHFFLyQGHOÀXMRRVX
DXVHQFLDHQODPRGDOLGDG'RSSOHUFRORUSDUDHYDOXDU
OD IRUPD GHO HVSHFWUR OD YHORFLGDG VLVWyOLFD Pi[LPD
ODYHORFLGDGGLDVWyOLFD\HOtQGLFHGHUHVLVWHQFLDGHOD
DUWHULDFHQWUDOGHODUHWLQDGHODYHQDFHQWUDOGHODUHWLQDLPDJHQ\GHODDUWHULDRIWiOPLFDLPDJHQ
A
Imagen 2.8OWUDVRQLGRRUELWDULRSDFLHQWHFRQFDWDUDWDVHFRV
GHEDMRQLYHOHQHOFULVWDOLQR
B
Imagen 3. 8OWUDVRQLGR RUELWDULR FRUWH D[LDO GHJHQHUDFLyQ
GHFXHUSRYtWUHRHFRVGHEDMRQLYHOQRPyYLOHVHQHOFXHUSR
YtWUHRVRORYLVLEOHVFRQJDQDQFLDVDOWDV
Imágenes 1a y 1b.8OWUDVRQLGRRUELWDULRJORERRFXODU\QHUYLR
ySWLFRQRUPDO
'DGRTXHODDUWHULDRIWiOPLFDHVXQDGHODVSULPHUDV
UDPDVGHODDUWHULDFDUyWLGDLQWHUQD\XQDGHVXVUDPDV
SULQFLSDOHVDQWHVGHOSROtJRQRGH:LOOLVODVDOWHUDFLRQHV
HQVXÀXMRVRQVHFXQGDULDVDXQIHQyPHQRGHURERYDVFXODUFDXVDGRSRUODREVWUXFFLyQGHODDUWHULDFDUyWLGD
LQWHUQD SUR[LPDO DO RULJHQ GH OD DUWHULD RIWiOPLFD
3RUORWDQWRGLFKDVDOWHUDFLRQHVGHÀXMRVRQDOWDPHQWH
HVSHFt¿FDVSDUDODHQIHUPHGDGREVWUXFWLYDFDURWtGHD
LQFOXVRHQUHJLRQHVRFXOWDVSDUDHOXOWUDVRQLGR'RSSOHU
Octubre-Diciembre 2011
235
A
B
&
D
Imágenes 4a, 4b, 4c, 4d.6HFXHQFLDGHLPiJHQHVGHXOWUDVRQLGRRUELWDULRSDFLHQWHFRQKHPRYtWUHRHFRVGHEDMRQLYHO
DJUXSDGRVTXHFDPELDQGHSRVLFLyQFRQORVPRYLPLHQWRVRFXODUHVGHOSDFLHQWH\VHGHSRVLWDQHQODSRUFLyQGHPiVGHFOLYH
GHOJORERRFXODU
Imagen 5. 8OWUDVRQLGR RUELWDULR SDFLHQWH FRQ GHVSUHQGLPLHQWRGHOFXHUSRYtWUHR6HLGHQWL¿FDHFRGHPHPEUDQDHQ
ODSRUFLyQSRVWHULRUGHOFXHUSRYtWUHR
A
FDURWtGHR3RUHOORHOXOWUDVRQLGR'RSSOHURUELWDULR
SXHGHVHUYLUSDUDFRPSOHPHQWDUDOXOWUDVRQLGR'RSSOHU
FDURWtGHR LQGLFDQGR TXp SDFLHQWHV VH EHQH¿FLDUtDQ
GHHVWXGLRVHVSHFLDOL]DGRVHQODLQWHQFLyQGHUHDOL]DU
GLDJQyVWLFRV\WUDWDPLHQWRVPiVRSRUWXQRVFRQXQFODUR
HIHFWRVREUHODPRUELOLGDG\VREUHODPRUWDOLGDGGHORV
HYHQWRVFHUHEURYDVFXODUHVLVTXpPLFRV
$ HVFDOD PXQGLDO ORV HYHQWRV FHUHEURYDVFXODUHV
VRQODVHJXQGDFDXVDGHPXHUWH\ODSULPHUDFDXVDGH
LQYDOLGH](Q(VWDGRV8QLGRVVRQODWHUFHUDFDXVDGH
PXHUWHFRQDSUR[LPDGDPHQWHFDVRV\KDVWD
PXHUWHVSRUDxR
(OHYHQWRFHUHEUDOYDVFXODU(&9³(VXQVtQGURPH
FOtQLFRFDUDFWHUL]DGRSRUHOUiSLGRGHVDUUROORGHVtQWRPDV\RVLJQRVFRUUHVSRQGLHQWHVXVXDOPHQWHDDIHFFLyQ
QHXUROyJLFDIRFDO\DYHFHVJOREDOTXHSHUVLVWHQSRU
PiV GH KRUDV R FRQGXFHQ D OD PXHUWH VLQ RWUD
FDXVDDSDUHQWHGHXQRULJHQYDVFXODU´206(O(9&
HVXQVtQGURPHFDXVDGRSRUXQDLQWHUUXSFLyQGHOÀXMR
VDQJXtQHRDDOJXQDSDUWHGHOFHUHEUR\DVHDGHELGR
DRFOXVLyQGHXQYDVR(&9LVTXpPLFRRDURWXUDGH
XQYDVRVDQJXtQHR(&9KHPRUUiJLFRFDXVDQGRGDxR
B
Imagen 6. (a)8OWUDVRQLGR'RSSOHURUELWDULRSDFLHQWHFRQGHVSUHQGLPLHQWRGHUHWLQDHFRGHPHPEUDQDGHDOWRQLYHOFRQ
YDVFXODULGDGDOHVWXGLR'RSSOHU(b)3DFLHQWHFRQFDWDUDWDGHVSUHQGLPLHQWRVGHFULVWDOLQR\UHWLQD
2 3 6 Octubre-Diciembre 2011
B
A
Imagen 7.&RPSDUDFLyQGHOHVSHFWURGHDPEDVDUWHULDVFHQWUDOHVGHODUHWLQDHQXQSDFLHQWHFRQVtQGURPHLVTXpPLFRRFXODU
(a)\RWURFRQFHJXHUDL]TXLHUGD(b)
A
B
Imágenes 8a, 8b.)tVWXODDUWHULRYHQRVDRUELWDULD,PiJHQHVREWHQLGDVGHOOLEUR7KH2UELW&DS&RORU'RSSOHU,PDJLQJRI
WKH(\HDQG2UELWGH:ROIJDQJ(/LHE
FHOXODU\SpUGLGDUHSHQWLQD\IRFDOL]DGDGHODVIXQFLRQHV
FHUHEUDOHV
/D LVTXHPLD FHUHEUDO HV HO HVWDGR FDUDFWHUL]DGR
SRUODGLVPLQXFLyQGHOPHWDEROLVPRHQHUJpWLFRDFRQVHFXHQFLDGHODGLVPLQXFLyQGHODSRUWHVDQJXtQHRHQ
IRUPDWRWDORSDUFLDO$SDUHFHFXDQGRHODSRUWHVDQJXtQHRFHUHEUDOGLVPLQX\HDPHQRVGHPOPLQJ
GHWHMLGRFHUHEUDO\SXHGHPDQLIHVWDUVHVyORSRUGDxR
QHXUROyJLFRIRFDORHYROXFLRQDUDLQIDUWRFHUHEUDOTXH
LPSOLFD OD HYLGHQFLD PRUIROyJLFD GH GDxR HVWUXFWXUDO
QHXURQDOLUUHYHUVLEOH
(O(&9LVTXpPLFRUHSUHVHQWDGHORVHYHQWRV
FHUHEURYDVFXODUHV\DXQTXHVXPRUWDOLGDGHVPHQRU
TXHODGHORV(&9KHPRUUiJLFRVSHUPDQHFHFRPROD
SULPHUDFDXVDGHLQYDOLGH]/DFDXVDSULQFLSDOGHORV
HYHQWRVYDVFXODUHVFHUHEUDOHV\GHODDIHFFLyQDODFDUyWLGDHVODDWHURJpQHVLVTXHWLHQGHDIRUPDUVHHQODV
UHJLRQHVGRQGHVHSLHUGHHOÀXMRODPLQDUFDXVDQGRXQ
ÀXMROHQWR\RVFLODQWH/DVFRQGLFLRQHVKHPRGLQiPLFDV
GHODELIXUFDFLyQFDURWtGHDKXPDQDRFDVLRQDQTXHHVWD
UHJLyQVHDHODVLHQWRPiVFRP~QGHDWHURJpQHVLVDQLYHOFDURWtGHR\SRUORWDQWRHVODVHFFLyQYDORUDGDFRQ
PD\RUpQIDVLVHQORVHVWXGLRVGHXOWUDVRQLGR'RSSOHU
FDURWtGHRLPDJHQ
,QWUDFUDQHDOPHQWHODVUHJLRQHVPiVDIHFWDGDVVRQ
³HOVLIyQFDURWtGHR´GRQGHODDUWHULDFDUyWLGDLQWHUQD
UHDOL]DFXUYDVGH\JUDGRV\HQHOVLVWHPD
YHUWHEUDOODXQLyQYHUWHEUREDVLODUGRQGHDPEDVDUWHULDVYHUWHEUDOHVVHXQHQSDUDIRUPDUHOWURQFRGHOD
DUWHULDEDVLODU
Octubre-Diciembre 2011
237
Imagen 9.(VSHFWURQRUPDOGHODDUWHULDFHQWUDOGHODUHWLQD
ÀXMR DQWHUyJUDGR HQFLPD GHO HMH ; FRQ HVSHFWUR GH EDMD
UHVLVWHQFLD\YHQDFHQWUDOGHODUHWLQDÀXMRUHWUyJUDGRSRU
GHEDMRGHOHMH;
Imagen 11.8OWUDVRQLGRFDURWtGHRELIXUFDFLyQFDURWtGHDFRQ
SODFDDWHURPDWRVD
A
B
Imagen 10.,PDJHQHVSHFWUDOQRUPDOGHODDUWHULDRIWiOPLFD
$QWHURJUDGRTXHVHDFHUFDDOWUDQVGXFWRUFRQSLFRVLVWyOLFR
FDUDFWHUtVWLFRGHYDVRGHDOWDUHVLVWHQFLD
/D DUWHULD FDUyWLGD LQWHUQD LQFOX\HQGR VX SRUFLyQ
LQWUDFUDQHDOSUR[LPDODORULJHQGHODDUWHULDRIWiOPLFD
SXHGH VHU HYDOXDGD GH PDQHUD LQGLUHFWD DQDOL]DQGR
ODDUWHULDRIWiOPLFDLSVLODWHUDOREVHUYDEOHSRUPHGLRGH
XOWUDVRQLGR'RSSOHURUELWDULR\DVHDODWHUDODOQHUYLR
ySWLFRHQHOYpUWLFHRUELWDULRPHGLDO\OLJHUDPHQWHVXSHULRUDOPLVPRDPPRSRUGHWUiVGHOJORER
RFXODULPiJHQHVD\ESUHVHQWDYHORFLGDGHVGH
SLFRVLVWyOLFRQRUPDOHVGHDFPVFODVL¿FiQGRVH
VXVÀXMRVFRPRDXPHQWRGHÀXMRÀXMRGLVPLQXLGRÀXMR
DXVHQWHRÀXMRLQYHUWLGR
/DLQYHUVLyQGHOÀXMRGHODDUWHULDRIWiOPLFDLPiJHQHVDEF\GHVXQLQGLFDGRUFRQPiVGH
GH HVSHFL¿FLGDG SDUD OD REVWUXFFLyQ FDURWtGHD
2 3 8 Octubre-Diciembre 2011
Imagen 12.8OWUDVRQLGRRUELWDULRDUWHULDRIWiOPLFDYDORUDGD
HQHOYpUWLFHGHODyUELWD(a)(OÀXMRVHDFHUFDDOWUDQVGXFWRU
HQWUH\PPSRUGHWUiVGHOJORERRFXODUÀXMRDQWHUyJUDGR
\HVSHFWURQRUPDO(b)
FUtWLFD R WRWDO LPiJHQHV D E F \ G /D
GLVPLQXFLyQ GHO ÀXMR VXJLHUH XQD OHVLyQ REVWUXFWLYD
VLJQL¿FDWLYD SUR[LPDO DO RULJHQ GH OD DUWHULD RIWiOPLca\ODDXVHQFLDGHÀXMRLQGLFDXQDREVWUXFFLyQ
FRPSOHWDGHODDUWHULDRIWiOPLFDRGHODDUWHULDFDUyWLGD
LQWHUQD )LQDOPHQWH HO DXPHQWR GH ÀXMR VXJLHUH XQD
OHVLyQREVWUXFWLYDVLJQL¿FDWLYDDG\DFHQWHDORULJHQGH
ODDUWHULDRIWiOPLFD
/DVDUWHULD\YHQDFHQWUDOHVGHODUHWLQDVHSXHGHQ
HYDOXDUSRUXOWUDVRQLGR'RSSOHURUELWDULRHQVXWUD\HFWRGHQWURGHOQHUYLRySWLFRXViQGRORFRPRPDUFDGRU
DQDWyPLFRLPDJHQ(OYDORUQRUPDOGHOÀXMRGHOD
DUWHULDFHQWUDOGHODUHWLQDYDUtDGHDFPV\HOGHOD
YHQDFHQWUDOGHODUHWLQDHVGHDFPVpVWDVLUULJDQ\
GUHQDQODPiFXOD\ODSRUFLyQFHQWUDOGHODUHWLQDSRUOR
TXHODGLVPLQXFLyQXREVWUXFFLyQGHVXÀXMRLPiJHQHV
D\ERFDVLRQDQVtQWRPDVYLVXDOHVVLJQL¿FDWLYRV
LQFOXVR FHJXHUD (VWXGLRV SUHYLRV KDQ HVWDEOHFLGR
TXH ODV DOWHUDFLRQHV KHPRGLQiPLFDV GHWHFWDEOHV SRU
XOWUDVRQLGR'RSSOHURUELWDULRSUHFHGHQDORVVtQWRPDV10
Tipo de estudioSURVSHFWLYR\GHVFULSWLYR
Hipótesis H[LVWH XQD DVRFLDFLyQ HQWUH ORV KDOOD]JRVSRUHOXOWUDVRQLGR'RSSOHURUELWDULR\HOJUDGRGH
HQIHUPHGDG REVWUXFWLYD FDURWtGHD YDORUDGD PHGLDQWH
XOWUDVRQLGR'RSSOHUFDURWtGHR'LFKDDVRFLDFLyQSXHGH
VHU~WLOHQODHYDOXDFLyQGHORVSDFLHQWHVFRQIDFWRUHV
GHULHVJRSDUDHQIHUPHGDGREVWUXFWLYDFDURWtGHD\SDUD
HYHQWRVFHUHEURYDVFXODUHV
B
A
Imagen 15. 8OWUDVRQLGR 'RSSOHU RUELWDULR DUWHULD \ YHQDV
FHQWUDOHVGHODUHWLQD
Objetivo DSOLFDU OD DVRFLDFLyQ HVWDEOHFLGD SRU HVWXGLRV SUHYLRV HQWUH ODV DOWHUDFLRQHV GHO ÀXMR GH ORV
YDVRVRUELWDULRV\ODHQIHUPHGDGREVWUXFWLYDFDURWtGHD
D JUXSRV GH SREODFLyQ FRQ IDFWRUHV GH ULHVJR SDUD
HQIHUPHGDGREVWUXFWLYDFDURWtGHD\(&9'HVFULELUORV
KDOOD]JRV\GHWHUPLQDUVLH[LVWHXQiUHDGHRSRUWXQLGDG
HQODTXHHOXVRDXQDGRGHORVXOWUDVRQLGRV'RSSOHU
RUELWDULR\FDURWtGHRSURYHDQXQDPHMRUDGLDJQyVWLFD
SDUDSDFLHQWHVFRQIDFWRUHVGHULHVJRSDUDHQIHUPHGDG
REVWUXFWLYD FDURWtGHD \ (&9 HQ FRPSDUDFLyQ FRQ HO
&
D
Imagen 13.,QYHUVLyQGHÀXMR(a) y (c)ODVDUWHULDVRIWiOPLFDVHQ'RSSOHUFRORUPXHVWUDQHVSHFWURD]XOVHDOHMDGHOWUDQVGXFWRU6HREVHUYDHOYDORUGHÀXMRSRUGHEDMRGHOHMH;(b) y (d)GHELGRDODLQYHUVLyQGHÀXMR
A
B
&
D
Imagen 14.2EVWUXFFLyQFDURWtGHDFUtWLFD(a)'RSSOHUFDURWtGHRELIXUFDFLyQFDURWtGHDDUWHULDFDUyWLGDH[WHUQDQRUPDO(b)
SUR\HFFLyQVDJLWDOREVWUXFFLyQGHODDUWHULDFDUyWLGDLQWHUQD(c) y (d)'RSSOHUFDURWtGHRSUR\HFFLyQVDJLWDO\D[LDOFRPSDUDQGRFDUyWLGDVLQWHUQD\H[WHUQDREVWUXFFLyQGHODDUWHULDFDUyWLGDLQWHUQD
Octubre-Diciembre 2011
239
B
A
Imagen 16. (a)8OWUDVRQLGR'RSSOHURUELWDULRREVWUXFFLyQGHODDUWHULDFHQWUDOGHODUHWLQD(b)(VSHFWURGHODREVWUXFFLyQGH
ODDUWHULDFHQWUDOGHODUHWLQD
XVRH[FOXVLYRGHXOWUDVRQLGR'RSSOHUFDURWtGHRFRPR
VXFHGHHQODDFWXDOLGDG
-XVWL¿FDFLyQDHVFDODPXQGLDOORVHYHQWRVFHUHEURYDVFXODUHVVRQODVHJXQGDFDXVDGHPXHUWH\ODSULPHUD
FDXVDGHLQYDOLGH](Q(VWDGRV8QLGRVVRQODWHUFHUD
FDXVDGHPXHUWHFRQDSUR[LPDGDPHQWHFDVRV
\ PXHUWHV FDGD DxR ([LVWH XQD DVRFLDFLyQ
GLUHFWDHQWUHHOJUDGRGHOHVLyQDWHURPDWRVDREVWUXFWLYD
GHODVDUWHULDVFDUyWLGDV\HOULHVJRGHVXIULUXQHYHQWR
FHUHEURYDVFXODU9DULRVHVWXGLRVKDQGHWHUPLQDGRTXH
H[LVWHXQDDVRFLDFLyQVLJQL¿FDWLYDHQWUHODDOWHUDFLyQGHO
ÀXMRGHORVYDVRVRUELWDULRV\HOJUDGRGHREVWUXFFLyQ
FDURWtGHD+DVWDHOPRPHQWRQLQJ~QHVWXGLRKDLQWHQWDGR GHPRVWUDU GLFKD DVRFLDFLyQ HQ JUDQGHV JUXSRV
GHSREODFLyQFRQIDFWRUHVGHULHVJRSDUDHQIHUPHGDG
REVWUXFWLYDFDURWtGHD\SDUD(&9TXHGHGHPRVWUDUVH
LPSOLFDUtDTXHSXHGHXWLOL]DUVHSDUDPHMRUDUORVSURWRFRORVGHGLDJQyVWLFRDFWXDOHV
3DUD SRGHU UHDOL]DU GLFKR HVWXGLR VH UHTXLHUH XQD
EDVH DPSOLD GH SDFLHQWHV HQ ORV FXDOHV UHDOL]DU ORV
HVWXGLRVGHXOWUDVRQLGR'RSSOHUFDURWtGHR\RUELWDULR
GDUOHV VHJXLPLHQWR GXUDQWH YDULRV DxRV R FRPSDUDU
ORVHVWXGLRVFRQXQHVWiQGDUFRPRODDQJLRWRPRJUDItD
R OD DQJLRJUDItD FHUHEUDO HOOR LPSOLFD XQD LQYHUVLyQ
FXDQWLRVDGHUHFXUVRVSHUVRQDO\WLHPSRSRUORTXHHV
UHFRPHQGDEOHUHDOL]DUSULPHURXQHVWXGLRH[SORUDWRULR
GHVFULSWLYRDSHTXHxDHVFDOD
'H¿QLFLyQGHYDULDEOHV
(GDGHGDGGHOSDFLHQWHHQDxRVGHVGHVXIHFKD
GHQDFLPLHQWRKDVWDHOPRPHQWRGHOHVWXGLR
‡ 6H[RJpQHURGHOSDFLHQWH
‡ +LSHUWHQVLyQ GLDJQyVWLFR SUHYLR GH KLSHUWHQVLyQ
DUWHULDOGHOSDFLHQWHSRUDOJ~QRUJDQLVPRGHVDOXG
‡ 'LDEHWHVPHOOLWXVGLDJQyVWLFRSUHYLRGHGLDEHWHV
PHOOLWXVSRUDOJ~QRUJDQLVPRGHVDOXG
‡
2 4 0 Octubre-Diciembre 2011
‡
‡
‡
'LVOLSLGHPLD GLDJQyVWLFR SUHYLR GH DOWHUDFLyQ HQ
ODV FRQFHQWUDFLRQHV VpULFDV GH FROHVWHURO \R WULJOLFpULGRVUHDOL]DGRSRUDOJ~QRUJDQLVPRGHVDOXG
ËQGLFH GH PDVD FRUSRUDO ,0& VH FDOFXOD SDUD
FDGDSDFLHQWHHQIXQFLyQGHVXSHVR\VXHVWDWXUD
2EHVLGDGVHFODVL¿FDDFDGDSDFLHQWHSRUVXtQGLFH
GH PDVD FRUSRUDO HQ JUDGRV VHJ~Q HO VLVWHPD
GHO,QVWLWXWR1DFLRQDOGH6DOXGGH(VWDGRV8QLGRV
SHVRQRUPDO ,0&GHD
VREUHSHVR ,0&GHD
REHVLGDG ,0&GHD
REHVLGDGPyUELGD ,0&VXSHULRUD
6tQWRPDVQHXUROyJLFRVFHIDOHDPDUHRVSDUHVLDV
SDUHVWHVLDVLFWXVSDUiOLVLVWUDQVLWRULDDWDTXHLVTXpPLFRWUDQVLWRULRDQWHFHGHQWHGH(9&LVTXpPLFRFULVLV
FRQYXOVLYDV\QHXURSDWtDGLDEpWLFD
6tQWRPDVYLVXDOHVFXDOTXLHUVtQWRPDGHVFULWRSRU
HO SDFLHQWH TXH DIHFWH VX FDSDFLGDG YLVXDO DFWXDO R
SUHYLDFRQRVLQWUDWDPLHQWRDH[FHSFLyQGHOSWHULJLyQ
RORVSUREOHPDVUHIUDFWLYRV
$UWHULRHVFOHURVLVSUHVHQFLDGHSODFDVGHDWHURPD
EODQGDVRFDOFL¿FDGDVHQHOLQWHULRUGHORVYDVRVFDURWtGHRVGHWHUPLQDGDVSRUXOWUDVRQLGR'RSSOHUFDURWtGHR
FRQRVLQDOWHUDFLyQKHPRGLQiPLFD
*UDGR GH REVWUXFFLyQ FDURWtGHD VH LGHQWL¿FDQ ORV
JUDGRVGHUHGXFFLyQGHODOX]DUWHULDOSRUFDXVDVLQWUtQVHFDVRH[WUtQVHFDVPHGLDQWHXOWUDVRQLGR'RSSOHU
FDURWtGHR\VHFODVL¿FDQVHJ~QHO³&RQVHQVRGHUDGLyORJRVHQFRQIHUHQFLDHQXOWUDVRQLGRSDUDHOGLDJQyVWLFR
GHHVWHQRVLVDUWHULDOFDURWtGHD´
$OWHUDFLyQKHPRGLQiPLFDHQWUH\GHUHGXFFLyQGHODOX]DUWHULDO
2EVWUXFFLyQVLJQL¿FDWLYDHQWUH\GHUHGXFFLyQGHODOX]DUWHULDO
2EVWUXFFLyQFUtWLFDUHGXFFLyQGHODOX]DUWHULDOPD\RU
D
)OXMR GH OD DUWHULD RIWiOPLFD HO ÀXMR QRUPDO GH OD
DUWHULDRIWiOPLFDGHEHVHUDQWHUyJUDGRFRQHVSHFWUR
FDUDFWHUtVWLFRGHDOWDUHVLVWHQFLD\SLFRVLVWyOLFRHQWUH
\FPVYDORUHVREWHQLGRVGHORVWUDEDMRVGH*XWKRII
HWDO(/RVSDFLHQWHVVHFODVL¿FDQHQJUXSRV
ÀXMRQRUPDO
DXPHQWRGHODYHORFLGDGGHÀXMR
GLVPLQXFLyQGHODYHORFLGDGGHÀXMR
LQYHUVLyQGHOÀXMRÀXMRUHWURJUDGRTXHVHDOHMD
GHOWUDQVGXFWRUFRQHVSHFWURDUWHULDOFDUDFWHUtVWLFR
DXVHQFLDGHÀXMR
)OXMRGHODDUWHULDFHQWUDOGHODUHWLQDHOÀXMRQRUPDO
GHODDUWHULDFHQWUDOGHODUHWLQDVHREWLHQHDOPLVPR
WLHPSRTXHHOGHODYHQDFHQWUDOGHODUHWLQDSDUDOHOD\
DG\DFHQWHDHOOD(OÀXMRGHEHVHUDQWHUyJUDGRFRQDVSHFWRGHEDMDUHVLVWHQFLDFRQSLFRVLVWyOLFRUHGRQGHDGR
\ÀXMRFRQWLQXRHQGLiVWROHSRUGHEDMRGHOHMHFHURVH
REVHUYDHOHVSHFWURGHODYHQDFHQWUDOGHODUHWLQD(O
SLFRVLVWyOLFRWLHQHYDORUHVHQWUH\FPVYDORUHV
REWHQLGRVGHORVWUDEDMRVGH*XWKRIIHWDO(
/RVSDFLHQWHVVHFODVL¿FDQHQJUXSRV
ÀXMRQRUPDO
DXPHQWRGHODYHORFLGDGGHÀXMR
GLVPLQXFLyQGHODYHORFLGDGGHÀXMR
DXVHQFLDGHÀXMR
$IHFFLRQHV RFXODUHV IUHFXHQWHV HQ SDFLHQWHV FRQ
HQIHUPHGDGHVFUyQLFRGHJHQHUDWLYDV
&DWDUDWDSUHVHQFLDGHHFRVGHEDMRQLYHOHQHOLQWHULRUGHOFULVWDOLQRKDVWDODKLSHUHFRJHQLFLGDGFRPSOHWD
GHOPLVPR
'HJHQHUDFLyQYtWUHDHFRVGHEDMRQLYHOHQHOFXHUSR
YtWUHRTXHQRFDPELDQGHSRVLFLyQHQHOJORERRFXODUD
ORVPRYLPLHQWRVGHOSDFLHQWH
+HPRYtWUHR HFRV GH EDMR QLYHO DJUXSDGRV TXH
FDPELDQGHSRVLFLyQFRQORVPRYLPLHQWRVGHOSDFLHQWH
\ WLHQGHQ D FRORFDUVH HQ OD SRUFLyQ PiV GHFOLYH GHO
JORERRFXODU
'HVSUHQGLPLHQWRGHFULVWDOLQROtQHDHFRJpQLFDGHOJDGDHQFDVRVDJXGRVTXHSXHGHDXPHQWDUVXJURVRU
FRQODFURQLFLGDGYLVLEOH~QLFDPHQWHFRQJDQDQFLDVDOWDVGHOXOWUDVRQLGRVLQYDVFXODULGDGDOHVWXGLR'RSSOHU
'HVSUHQGLPLHQWRGHUHWLQDOtQHDGHDOWDHFRJHQLFLGDGYLVLEOHFRQJDQDQFLDVDOWDVREDMDVGHOXOWUDVRQLGR
SUHVHQWDYDVFXODULGDGDOHVWXGLR'RSSOHU
Material y métodos
6HXWLOL]yXQHTXLSRGHXOWUDVRQLGRPDUFD*HQHUDO
(OHFWULF PRGHOR /RJLF FRQ WUDQVGXFWRU OLQHDO GH
0+]&LQWDPpWULFD\EiVFXODGHSLVR
6H UHDOL]DURQ HVWXGLRV GH XOWUDVRQLGR 'RSSOHU
RUELWDULR YDORUDQGR DQDWRPtD GHO JORER RFXODU \ GH
OD UHJLyQ UHWURRFXODU OD DUWHULD RIWiOPLFD ODV DUWHULD
\ YHQD FHQWUDOHV GH OD UHWLQD SDUD GHWHUPLQDU SHUPHDELOLGDGYHORFLGDG\GLUHFFLyQGHOÀXMRtQGLFHGH
UHVLVWHQFLD \ DQiOLVLV HVSHFWUDO HQ FRQMXQWR FRQ HO
HVWXGLR GH XOWUDVRQLGR 'RSSOHU FDURWtGHR$ SDFLHQWHV LQWHUQDGRV HQ HO VHUYLFLR GH PHGLFLQD LQWHUQD D
SDFLHQWHV GH OD FRQVXOWD GH PHGLFLQD LQWHUQD SDUD
HQIHUPHGDGHV FURQLFRGHJHQHUDWLYDV GH OD FRQVXOWD
GHRIWDOPRORJtDSDUDSDFLHQWHVGLDEpWLFRVGHO+RVSLWDO
0HWURSROLWDQR³'U%HUQDUGR6HS~OYHGD´GHO6HFWRU6DOXGDVtFRPRDSDFLHQWHVH[WHUQRVFRQORVIDFWRUHVGH
ULHVJRPHQFLRQDGRVHQODLQWURGXFFLyQTXHDFHSWDURQ
SDUWLFLSDUHQHVWHHVWXGLR
6HUHDOL]DURQPHGLFLyQGHSHVRHVWDWXUD\FiOFXOR
GHOtQGLFHGHPDVDFRUSRUDO6HUHFDEDURQGDWRVSRU
LQWHUURJDWRULRDOSDFLHQWHRGHVXH[SHGLHQWHFOtQLFRFRQ
UHODFLyQDDQWHFHGHQWHVFOtQLFRVGHLPSRUWDQFLDFRPR
KLSHUWHQVLyQGLDEHWHVGLVOLSLGHPLDVVtQWRPDVQHXUROyJLFRV\RYLVXDOHVDVtFRPRWUDWDPLHQWRVUHDOL]DGRV
\HOJUDGRGHDSHJRDORVPLVPRV7RGRORDQWHULRUFRQ
ODLQWHQFLyQGHUHODFLRQDUORVKDOOD]JRVREVHUYDGRVSRU
XOWUDVRQLGR'RSSOHURUELWDULR\FDURWtGHRHQWUHVt\FRQ
HOFXDGURFOtQLFRGHOSDFLHQWHSDUDJHQHUDUXQDEDVH
GHGDWRVTXHSHUPLWLHUDODGLVFXVLyQGHWDOODGDGHORV
KDOOD]JRV
Criterios de inclusión
3REODFLyQIHPHQLQDRPDVFXOLQDGHDxRVGHHGDG
RPiVSURYHQLHQWHGHOVHUYLFLRGHPHGLFLQDLQWHUQDTXH
DFXGLHURQDODFRQVXOWDGHRIWDOPRORJtDSDUDSDFLHQWHVGLDEpWLFRV\SDFLHQWHVGHODFRQVXOWDGHPHGLFLQD
LQWHUQDSDUDHQIHUPHGDGHVFURQLFRGHJHQHUDWLYDVDVt
FRPRSDFLHQWHVH[WHUQRVTXHSUHVHQWDEDQDOJXQDGH
ODVVLJXLHQWHVHQIHUPHGDGHVKLSHUWHQVLyQDUWHULDOGLDEHWHVPHOOLWXVGLVOLSLGHPLDREHVLGDGRFRPELQDFLRQHV
GHODVPLVPDV\TXHDFHSWDURQIRUPDUSDUWHGHOHVWXGLR
Criterios de exclusión
(PEDUD]RRSXHUSHULRPHQRUDPHVHV
$OWHUDFLRQHVHQODVFRQFHQWUDFLRQHVGHODVKRUPRQDV
WLURLGHDV
$OWHUDFLRQHVHQODVFRQFHQWUDFLRQHVGHODVKRUPRQDV
VXSUDUUHQDOHV
9DVFXOLWLV
$QRPDOtDVFRQJpQLWDVRUELWDULDV
(QXFOHDFLyQRFXODU
Resultados
‡ SDFLHQWHVIXHURQGHVH[RIHPHQLQR\
GHVH[RPDVFXOLQR¿JXUDD
‡ SDFLHQWHVHYDOXDGRVFRQHGDGHVHQWUH\
DxRVPHGLDGHPHGLDQDGHPRGDGH
\GHVYLDFLyQWtSLFDGHGLYLGLGRVHQJUXSRV
Octubre-Diciembre 2011
241
*UXSRDDxRVSDFLHQWHV
*UXSRDDxRVSDFLHQWHV
*UXSRDxRVHQDGHODQWHSDFLHQWHV¿JXra 1b)
‡ SDFLHQWHVHQHGDGODERUDOSURGXFWLYD
‡
‡
‡
‡
Factores de riesgo
SDFLHQWHVFRQKLSHUWHQVLyQDUWHULDO
SDFLHQWHVFRQGLDEHWHVPHOOLWXV
SDFLHQWHVFRQGLVOLSLGHPLD
SDFLHQWHV FRQ VtQGURPH PHWDEyOLFR
KLSHUWHQVLyQ GLVOLSLGHPLD GLDEHWHV \ REHVLGDG
¿JXUDD
‡
‡
‡
‡
‡
/RV SDFLHQWHV PDQLIHVWDEDQ GLYHUVRV VtQWRPDV \
VLJQRV GH DFXHUGR FRQ ORV FULWHULRV GH ODV YDULDEOHV
HVWDEOHFLGDV
‡
‡
SDFLHQWHVFRQVtQWRPDVQHXUROyJLFRV
SDFLHQWHV FRQ VtQWRPDV YLVXDOHV ¿JXUDVD\E
‡ SDFLHQWHVFRQDOWHUDFLyQGHOÀXMRGHOD
DUWHULDRIWiOPLFD
‡ SDFLHQWHVFRQDOWHUDFLyQGHOÀXMRGHOD
DUWHULDFHQWUDOGHODUHWLQD¿JXUDVD\E
/DVDIHFFLRQHVGHOJORERRFXODUHQFRQWUDGDVIXHURQ
¿JXUD
‡
Masculino
41%
Femenino
59%
SDFLHQWHVFRQSHVRDGHFXDGR
SDFLHQWHVFRQVREUHSHVR
SDFLHQWHVFRQREHVLGDG
SDFLHQWHVFRQREHVLGDGPyUELGD
SDFLHQWHVFRQDOJ~QJUDGRGHREHVLGDG
¿JXUDE
80
70
60
50
40
30
20
10
0
&DWDUDWDVSDFLHQWHV
72.2
74.1
31.5
18.5
Hipertensión
Diabetes
Dislipidemia
Sindróme
metabólico
Factores de riesgo
Figura 1a.3RUFHQWDMHVGHSDFLHQWHVSRUJpQHUR
Figura 2a.3RUFHQWDMHVGHSDFLHQWHVSRUIDFWRUGHULHVJR
60
55.6
50
Algun grado de
obesidad
24.1
40
30
20
25.9
18.5
Obesidad
mórbida
9.3
24.1
Obesidad
10
37
Sobrepeso
0
20 a 40 años
40 a 60 años
60 años o más
29.6
Peso adecuado
Grupos de edad
0
Figura 1b.3RUFHQWDMHVGHSDFLHQWHVSRUJUXSRGHHGDG
2 4 2 Octubre-Diciembre 2011
10
20
30
40
Figura 2b.3RUFHQWDMHVGHSDFLHQWHVSRUJUDGRGHREHVLGDG
‡
‡
‡
‡
'HJHQHUDFLyQYtWUHDSDFLHQWHV
+HPRYtWUHRSDFLHQWHV
'HVSUHQGLPLHQWRGHOFXHUSRYtWUHRSDFLHQWHV
'HVSUHQGLPLHQWRGHUHWLQDSDFLHQWHV
0DQWHQtDQXQFRQWUROGH¿FLHQWHGHVXHQIHUPHGDG
FURQLFRGHJHQHUDWLYDGHORVSDFLHQWHVPLHQWUDV
TXHVtWHQtDQXQFRQWURODGHFXDGR
6HLGHQWL¿FDURQSDFLHQWHVFRQDOWHUDFLyQGHÀXMR
GH OD DUWHULD RIWiOPLFD GLDJQRVWLFDGD SRU XOWUDVRQLGR
'RSSOHU RUELWDULR VLQ DIHFFLyQ FDURWtGHD VLJQL¿FDWLYD
YDORUDGDSRUXOWUDVRQLGR'RSSOHUFDURWtGHR
EVC
isquémico
5.6
6HFRPSDUDURQFRQXQtQGLFHGHFRQ¿DQ]DGH
mediante prueba de r2FRQFRUUHFFLyQGH-DWHVODSUHVHQFLDGHREVWUXFFLyQGHODOX]FDURWtGHDLJXDORPD\RU
DFRQODVDOWHUDFLRQHVHQHOÀXMRGHODDUWHULDRIWiOPLFDHQFRQWUiQGRVHXQDDVRFLDFLyQHVWDGtVWLFDPHQWH
VLJQL¿FDWLYDFXDGUR,
6HFRPSDUDURQFRQXQtQGLFHGHFRQ¿DQ]DGH
mediante prueba de r2 FRQ FRUUHFFLyQ GH -DWHV OD
SUHVHQFLD GH IDFWRUHV GH ULHVJR FRQ OD SUHVHQFLD GH
DOWHUDFLRQHVGHOÀXMRGHYDVRVRUELWDULRV\DIHFFLRQHV
RFXODUHVFXDGUR,,HOUHFXDGURVRPEUHDGRLQGLFDXQD
DVRFLDFLyQHVWDGtVWLFDPHQWHVLJQL¿FDWLYD
6H GHPXHVWUD TXH H[LVWH XQD DVRFLDFLyQ HVWDGtVWLFDPHQWH VLJQL¿FDWLYD HQWUH OD REVWUXFFLyQ FDURWtGHD
VXSHULRU D \ OD DOWHUDFLyQ GHO ÀXMR GH OD DUWHULD
RIWiOPLFD4XHH[LVWHXQDDVRFLDFLyQHVWDGtVWLFDPHQWH
VLJQL¿FDWLYDHQWUHODGLDEHWHVPHOOLWXV\ODVDOWHUDFLRQHV
Ataque isquémico
transitorio
1.9
Crisis convulsivas
1.9
Neuropatía diabética
1.9
Disminuido
3.8
Parálisis facial
1.9
Invertido
3.8
0
83.4
Normal
9.4
Aumentado
2
4
0
6
Figura 3a.3RUFHQWDMHVGHSDFLHQWHVVHJ~QVtQWRPDVQHXUROyJLFRV
10
20
30
40
50
60
70
80
90
Figura 4a. 3RUFHQWDMHV GH SDFLHQWHV SRU ÀXMR GH DUWHULD
RIWiOPLFD
77.8
Normal
25.9
Síntomas
visuales
13.1
Aumentado
1.9
Disminuido
74.1
Asintomáticos
7.5
Ausente
0
20
40
60
80
Figura 3b.3RUFHQWDMHVGHSDFLHQWHVVHJ~QVtQWRPDVRIWiOPLFRV
0
20
40
60
80
100
Figura 4b. 3RUFHQWDMHV GH SDFLHQWHV SRU ÀXMR GH DUWHULD
FHQWUDOGHODUHWLQD
Octubre-Diciembre 2011
243
Catarata
GHOÀXMRGHODVDUWHULDVRIWiOPLFD\FHQWUDOGHODUHWLQD
6H GHPXHVWUD TXH H[LVWH XQD DVRFLDFLyQ HVWDGtVWLFDPHQWH VLJQL¿FDWLYD HQWUH OD GLDEHWHV PHOOLWXV \ OD
SUHVHQFLDGHFDWDUDWDVRGHKHPRYtWUHR
(QHVWHHVWXGLRH[LVWLyXQDDVRFLDFLyQHVWDGtVWLFDPHQWH VLJQL¿FDWLYD HQWUH OD KLSHUWHQVLyQ DUWHULDO \ OD
SUHVHQFLDGHFDWDUDWDV
24.1
Degeneración
vítrea
16.7
Hemovítreo
12.9
Desprendimiento
vítreo
Desprendimiento
de retina
9.2
9.2
0
5
10
15
20
25
30
Figura 5.3RUFHQWDMHVGHSDFLHQWHVVHJ~QDIHFFLyQRFXODU
Cuadro I.*UDGRGHFRQ¿DELOLGDG
r2,&
2EVWUXFFLyQFDURWtGHD
$UWHULDRIWiOPLFDÀXMR
$UWHULDFHQWUDOGHODUHWLQDÀXMR
r2
p
r2
p
Discusión
/RVHVWXGLRVSUHYLRVGHPXHVWUDQODDVRFLDFLyQHQWUH
ODREVWUXFFLyQFDURWtGHDVXSHULRUD\ODVDOWHUDFLRQHVGHOÀXMRRUELWDULRSHURQRPHQFLRQDQODYDORUDFLyQ
GHDIHFFLRQHVGHODVHVWUXFWXUDVLQWHUQDVGHOJORERRFXODU3DUDXQHVWXGLRSURVSHFWLYR\GHVFULSWLYRFRPRHO
QXHVWURHVWDLQIRUPDFLyQHVLPSRUWDQWHSXHVFDGDXQD
GHODVDIHFFLRQHVHYDOXDGDVFDWDUDWDGHJHQHUDFLyQ
YtWUHDKHPRYtWUHRGHVSUHQGLPLHQWRGHOFXHUSRYtWUHR
\GHVSUHQGLPLHQWRGHODUHWLQDHVFDXVDSRWHQFLDOGH
GLVFDSDFLGDGVXGLDJQyVWLFR\WUDWDPLHQWRRSRUWXQRV
VRQXQEHQH¿FLRDGLFLRQDOSDUDHOSDFLHQWH
/RVHVWXGLRVUHDOL]DGRVSRU<DPDPRWR&HMDV+X
/LHE7DWHPLVKL\3HWWHUQHOGHPXHVWUDQODDVRFLDFLyQ
HQWUHODHQIHUPHGDGREVWUXFWLYDFDURWtGHDGHPiVGH
\ OD DOWHUDFLyQ GHO ÀXMR GH YDVRV RUELWDULRV HQ
SDFLHQWHV FRQ JUDGRV LPSRUWDQWHV GH HQIHUPHGDG
Cuadro II.)DFWRUHVGHULHVJRHQIHUPHGDGHVRFXODUHV\VXFRQ¿DELOLGDGHQHOGLDJQyVWLFR
r2,&
$UWHULRHVFOHURVLV
2EVWUXFFLyQFDURWtGHD
$UWHULDRIWiOPLFDÀXMR
$UWHULDFHQWUDOGHODUHWLQDÀXMR
&DWDUDWDV
'HJHQHUDFLyQYtWUHD
'HVSUHQGLPLHQWRYtWUHR
+HPRYtWUHR
Antecedentes
+7$
'0
'LVOLSLGHPLD
Obesidad
r2
p
r
2
p
r2
p
r2
p
r2
p
r2
p
r2
p
r2
p
r
p
2
'HVSUHQGLPLHQWRGHUHWLQD
,& LQWHUYDORGHFRQ¿DQ]D+7$ KLSHUWHQVLyQDUWHULDO'0 GLDEHWHVPHOOLWXV
2 4 4 Octubre-Diciembre 2011
REVWUXFWLYDFDURWtGHD1RH[LVWHQHVWXGLRVSUHYLRVTXH
GHPXHVWUHQGLFKDDVRFLDFLyQHQJUXSRVGHSREODFLyQ
FRQ IDFWRUHV GH ULHVJR SDUD HQIHUPHGDG REVWUXFWLYD
FDURWtGHD 'HPRVWUDU GLFKD DVRFLDFLyQ HQ XQ JUXSR
DPSOLRGHSDFLHQWHVVLJQL¿FDTXHVHSXHGHVXJHULUHO
XVRGHOXOWUDVRQLGR'RSSOHURUELWDULRSDUDPHMRUDUODV
JXtDV\SURWRFRORVGHGLDJQyVWLFRDFWXDOHV
(QHVWHHVWXGLRVHLGHQWL¿FDURQSDFLHQWHV
FRQDOWHUDFLRQHVHQHOÀXMRGHORVYDVRVRUELWDULRVTXH
QRSUHVHQWDURQGDWRVVLJQL¿FDWLYRVHQHOHVWXGLR'RSSOHUFDURWtGHR(VWRVHSXHGHH[SOLFDUGHODVLJXLHQWH
PDQHUDDQDWyPLFDPHQWHHOXOWUDVRQLGRFDURWtGHRQR
YDORUDODSRUFLyQ FHUYLFDOGLVWDOGHODDUWHULDFDUyWLGD
LQWHUQDQLODSRUFLyQLQWUDFUDQHDOGHODPLVPDHOVLIyQ
FDURWtGHR/DOLWHUDWXUDVHxDODTXHGLFKDUHJLyQHVHOVHJXQGROXJDUHQFXDQWRDIUHFXHQFLDGRQGHVHIRUPDQ
SODFDVGHDWHURPDFDURWtGHR/DVOHVLRQHVREVWUXFWLYDV
SUR[LPDOHVDORULJHQGHODDUWHULDRIWiOPLFDRFDVLRQDUtD
DOWHUDFLRQHVHQHOÀXMRGHODDUWHULDRIWiOPLFDSHURHVWDV
OHVLRQHV QR VH PRVWUDUtDQ HQ HO XOWUDVRQLGR 'RSSOHU
FDURWtGHR
(O HVWXGLR GH <DPDPRWR H[SRQH TXH DQWH XQD
REVWUXFFLyQ FDURWtGHD FUtWLFD HO FXHUSR FRPSHQVD OD
IDOWD GH ÀXMR VDQJXtQHR D WUDYpV GH XQ FRUWRFLUFXLWR
FRQHOVLVWHPDFDURWtGHRFRQWUDODWHUDO \FRQHOVLVWHPD YHUWHEUREDVLODU SRU PHGLR GHO SROtJRQR GH :LOOLV
(Q ORV FDVRV GRQGH HO SROtJRQR GH :LOOLV SUHVHQWD
YDULDQWHV DQDWyPLFDV QRUPDOHV FRPR OD KLSRSODVLD
GHDUWHULDVFRPXQLFDQWHV\QRDOFDQ]DDFRPSHQVDU
FRPSOHWDPHQWH GLFKD REVWUXFFLyQ RFXUUHQ FDPELRV
KHPRGLQiPLFRVHQODDUWHULDRIWiOPLFDDFRQVHFXHQFLD
GHXQVHJXQGRFRUWRFLUFXLWRHQWUHODVFLUFXODFLRQHVFDURWtGHDVLSVLODWHUDOHVLQWHUQD\H[WHUQDSRUPHGLRGHODV
DUWHULDVVXSUDWURFOHDU\VXSUDRUELWDULDTXHFRPXQLFDQ
ODVDUWHULDVSHULRUELWDULDVGHODFDUD\ODDUWHULDRIWiOPLFD
'HHQWUHGLFKRVFDPELRVKHPRGLQiPLFRVODinversión
GHÀXMRGHODDUWHULDRIWiOPLFDWLHQHXQDHVSHFL¿FLGDG
GHSDUDREVWUXFFLyQFDURWtGHDLSVLODWHUDOFUtWLFD
(Q QXHVWUR HVWXGLR VH LGHQWL¿FDURQ FLQFR SDFLHQWHV FRQ REVWUXFFLyQ FDURWtGHD FUtWLFD SRU XOWUDVRQLGR
'RSSOHU FDURWtGHR GH ORV FXDOHV SUHVHQWDURQ DOWHUDFLRQHVGHÀXMRGHODDUWHULDRIWiOPLFD\SDFLHQWHV
IHPHQLQDV SUHVHQWDURQ HO IHQyPHQR GH inversión de
ÀXMRDOHVWXGLRGHXOWUDVRQLGR'RSSOHURUELWDULR8QDGH
ODVSDFLHQWHVQRSUHVHQWDEDVtQWRPDVYLVXDOHVSHURVt
QHXUROyJLFRVHQUHODFLyQFRQSDUiOLVLVIDFLDOWUDQVLWRULD
HQRFDVLRQHV/DVSDFLHQWHVFRQLQYHUVLyQGHÀXMR
VHHYDOXDURQSRUWRPRJUDItDFRQWUDVWDGDGHYDVRVGHO
FXHOOR\XQDSUHVHQWyREVWUXFFLyQFRPSOHWDGHODDUWHULD
FDUyWLGDLQWHUQDSRUHQIHUPHGDGDWHURPDWRVDPLHQWUDV
TXHODRWUDSUHVHQWyREVWUXFFLyQH[WUtQVHFDGHODDUWHULD
FDUyWLGDLQWHUQDRFDVLRQDGDSRUXQDDSy¿VLVWUDQVYHUVD
SURPLQHQWHTXHFRPSULPtDODDUWHULDFDUyWLGDLQWHUQD
HQ KLSHUH[WHQVLyQ GHO FXHOOR \ OD GHVFRPSULPtD D OD
ÀH[LyQGHOPLVPR(VWRFRQFXHUGDFRQORVWUDEDMRVGH
<DPDPRWR&RVWD\/LHETXHGH¿QHQODVDOWHUDFLRQHVGHOÀXMRRUELWDULRFRPRVHFXQGDULDVDXQIHQyPHQR
GHURERYDVFXODU
(OHVWXGLRGH&HMDV10GHWHUPLQyTXHGLFKRVFDPELRV
VRQGHWHFWDEOHVSRUXOWUDVRQLGR'RSSOHURUELWDULRDQWHV
GHTXHVHLQVWDXUHQVtQWRPDVYLVXDOHV\VHHYROXFLRQH
DXQVtQGURPHGHLVTXHPLDRFXODURDXQHYHQWRFHUHEURYDVFXODU
Conclusiones
([LVWHXQDDVRFLDFLyQHVWDGtVWLFDPHQWHVLJQL¿FDWLYD
HQWUHODVDOWHUDFLRQHVGHÀXMRGHORVYDVRVRUELWDULRV
HYDOXDGRVSRUXOWUDVRQLGR'RSSOHURUELWDULR\HOJUDGR
GH REVWUXFFLyQ FDURWtGHD YDORUDGD SRU XOWUDVRQLGR
'RSSOHU FDURWtGHR DO DSOLFDU HVWRV HVWXGLRV D
JUXSRV GH SREODFLyQ FRQ IDFWRUHV GH ULHVJR SDUD
HQIHUPHGDG REVWUXFWLYD FDURWtGHD \ (9& (VWXGLRV
SRVWHULRUHVSRGUtDQGHPRVWUDUTXHHOXVRGHDPERV
HVWXGLRV UHSUHVHQWD XQD PHMRUD HQ OD VHQVLELOLGDG
GLDJQyVWLFD IUHQWH DO XVR DLVODGR GHO XOWUDVRQLGR
'RSSOHUFDURWtGHR
Octubre-Diciembre 2011
245
Referencias
7DKPDVHESRXU+5%XFNOH\$5&RRSHUEHUJ3,)L[&+6RQRJUDSKLF([DPLQDWLRQRIWKH&DURWLG$UWHULHV5DGLRJUDSKLF
*UDQW(*%HQVRQ&%$OH[DQGURY$9HW
DO6RFLHW\RI5DGLRORJLVWLQ8OWUDVRXQG
&RQVHQVXV&RQIHUHQFH&DURWLG$UWHU\
6WHQRVLV *UD\VFDOH DQG 'RSSOHU 86
'LDJQRVLV 5DGLRORJ\ %DUULQDJDUUHPHQWHULD$%ULWR)&&DUORV (QIHUPHGDG 9DVFXODU &HUHEUDO
(GLWRULDO 0DQXDO 0RGHUQR SS &HMDV & %HQDYLGH] 6 6DQJXLQHWWL
00 HW DO (FRJUDItD \ 'RSSOHU 2FXODU
\2UELWDULR(GLFLRQHV-RXUQDOSS
/LHE:(&RKHQ600HUWRQ'$HWDO
&RORU 'RSSOHU LPDJLQJ RI WKH H\H DQG
RUELW WHFKQLTXH DQG QRUPDO DQDWRP\
$UFK2SKWDOPRO
*XWKRII 5) %HUJHU 5: :LQNOHU 3
HW DO 'RSSOHU XOWUDVRQRJUDSK\ RI WKH
RSKWKDOPLF DQG FHQWUDO UHWLQDO YHVVHOV
$UFK2SKWDOPRO
(ULNVRQ6-+HQGUL[/(0DVVDUR%0HW
DO &ROORU 'RSSOHU )ORZ ,PDJLQJ RI WKH
2 4 6 Octubre-Diciembre 2011
1RUPDODQG$EQRUPDO2UELW5DGLRORJ\
%HOGHQ&-$EELWW3/%HDGOHV.$HWDO
&RORU'RSSOHU86RIWKH2UELW5DGLRJUDSKLF
:RQJ $' &RRSHUEHUJ 3/ 5RVV
:+$UDNL '1 'LIIHUHQWLDWLRQ RI 'HWDFKHG 5HWLQD DQG 9LWUHRXV 0HPEUDQH
ZLWK &RORU )ORZ 'RSSOHU 5DGLRORJ\
&HMDV&%HQDYLGH]66DQJXLQHWWL00
HWDO&RORU'RSSOHULPDJLQJRIWKHRUELW
LQFDURWLGRFFOXVLYHGLVHDVH5HY$UJHQ
UDGLRO
<DPDPRWR 7 0RUL . <DVXKDUD 7 HW
DO2SKWKDOPLF$UWHU\ %ORRG )ORZ LQ 3DWLHQWVZLWK,QWHUQDO&DURWLG$UWHU\2FFOXVLRQ%U-2SKWKDOPRO
&RVWD 93 .X]QLHF 6 0ROQDU /- HW
DO &ROODWHUDO EORRG VXSSO\ WKURXJK WKH
RSKWKDOPLFDUWHU\$VWHDOSKHQRPHQRQ
DQDO\]HG E\ FRORU 'RSSOHU ,PDJLQJ
2SKWKDOPRO
/LHE :( )ODKDUW\ 30 6HUJRWW 5&
HW DO &RORU 'RSSOHU LPDJLQJ SURYLGHV
DFFXUDWH DVVHVVPHQW RI RUELWDO EORRG
ÀRZLQRFFOXVLYHFDURWLGDUWHU\GLVHDVH
2SKWDOPRORJ\
+X++6KHQJ:\<HQ0</DL677HQJ
00 &RORU 'RSSOHU LPDJLQJ RI RUELWDO
DUWHULHVIRUGHWHFWLRQRIFDURWLGRFFOXVLYH
GLVHDVH6WURNH
7DWHPLFKL7.&KDPRUUR$3HWW\*:
HWDO+HPRG\QDPLFUROHRIRSKWKDOPLF
DUWHU\FROODWHUDOLQLQWHUQDOFDURWLGDUWHU\
RFFOXVLRQ 1HXURORJ\ :LOOLDPVRQ 7+ %D[WHU *0 'XWWRQ
*1 &RORU 'RSSOHU YHORFLPHWU\ RI WKH
RSWLF QHUYH KHDG LQ DUWHULDO RFFOXVLRQ
2SKWKDOPRORJ\
+R$&/LHE:()ODKHUW\30HWDO&RORU
'RSSOHULPDJLQJRIWKHRFXODULVFKHPLF
V\QGURPH2SKWKDOPRO
3HWWHUQHO 32 .HEHU '8 9LGHFQLN 9,
&DURWLGDUWHULHVLQFHQWUDOUHWLQDOYHVVHO
RFFOXVLRQDVDVVHVVHGE\'RSSOHUXOWUDVRXQG %U - 2SKWKDOPRO 0DZQ/$+HGJHV75,,,5DQG:HWDO
2UELWDO&RORU'RSSOHU,PDJLQJLQ&DURWLG
2FFOXVLYH 'LVHDVH$UFK 2SKWKDOPRO
Descargar