PENGARUH PEMBERIAN METFORMIN DAN TELMISARTAN TERHADAP KADAR ADIPONEKTIN PADA PASIEN SINDROMA METABOLIK DENGAN NON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD)

NELLY ANGGRAINY, Prof. dr. Siti Nurdjanah, M.Kes, SpPD, KGEH, dr. Hemi Sinorita, Sp.PD, KEMD

2015 | Tesis | SP Ilmu Penyakit Dalam

Latar belakang: Sindroma metabolik merupakan kumpulan yang terdiri dari obesitas sentral, resistensi insulin, dislipidemia, dan hipertensi yang berhubungan dengan komorbid lain, termasuk non-alcoholic fatty liver disease (NAFLD). Resistensi insulin pada sindroma metabolik menyebabkan terjadinya NAFLD melalui akumulasi lemak di hati. Tingginya kadar lemak akan menyebabkan tingginya kadar mediator inflamasi dan adiponektin merupakan molekul anti inflamasi utama yang diproduksi oleh adiposit. Salah satu strategi terapi NAFLD saat ini adalah untuk menghambat resistensi insulin, menghentikan kaskade inflamasi dan fibrosis. Tujuan: untuk mengetahui pengaruh pemberian metformin dan telmisartan terhadap kadar adiponektin pasien sindroma metabolik dengan NAFLD. Metode: Penelitian ini menggunakan desain before and after. Penelitian dilakukan di Poliklinik Penyakit Dalam Sub Bagian Endokrinologi RSUP dr Sardjito. Subyek penelitian adalah pasien sindroma metabolik sesuai kriteria IDF 2006 dengan NAFLD. Subyek diberikan terapi metformin dan telmisartan selama 12 minggu, dan dilakukan pemeriksaan kadar adiponektin sebelum dan sesudah terapi. Perbedaan rerata sebelum dan sesudah terapi diuji dengan paired t-test atau tes Wilcoxon dengan tingkat kemaknaan p<0,05 dan interval kepercayaan 95%. Hasil: Didapatkan 19 subjek dengan rerata usia 56,57 +- 4,65 tahun. Subjek laki-laki 11 orang (57,89%) dan perempuan 8 orang (42,10%), dengan rerata kadar adiponektin 3,87 +- 1,40 ng/ml. Kadar adiponektin menunjukkan peningkatan yang bermakna setelah terapi (3,87 +- 1,40 menjadi 36,62 +- 13,67, p<0,001). Kesimpulan: terdapat peningkatan bermakna kadar adiponektin setelah pemberian metformin dan telmisartan pada pasien sindroma metabolik dengan NAFLD

Background: Metabolic syndrome is a clustering of central obesity, insulin resistance, dyslipidemia, and hypertension and is associated with other comorbidities, including non-alcoholic fatty liver disease (NAFLD). Insulin resistance in metabolic syndrome lead to NAFLD by the accumulation of fat in the liver. High levels of fat will lead to high levels of inflammatory mediators and adiponectin is a major antiinflammatory molecule produced by adipocytes. One of current NAFLD therapeutic strategy is to inhibit insulin resistance, stop the cascade of inflammatory and fibrosis. Objective: To determine the effect of metformin and telmisartan on adiponectin levels in patients with metabolic syndrome and NAFLD. Methods: This study used a before and after design. The study was conducted at the Endocrinology Clinic of Dr. Sardjito Hospital. Subjects were patients with metabolic syndrome according to criteria of the IDF 2006 with NAFLD. Subjects given metformin and telmisartan treatment for 12 weeks, adiponectin levels were examined before and after treatment. The mean difference before and after treatment were tested by paired t-test or Wilcoxon test with significance level of p value <0.05 with 95% confidence interval. Results: Total samples were 19 subjects with mean age of 56.57 +- 4.65 years. Male subjects were 11 (57.89%) and female were 8 (42.10%), mean adiponectin levels of 3.87 +- 1.40 ng / ml. Adiponectin level increased significantly after treatment (3.87 +- 1.40 to 36.62 +- 13.67, p < 0.001). Conclusion: there was significant increase in adiponectin levels after treatment of metformin and telmisartan in patients with metabolic syndrome and NAFLD.

Kata Kunci : sindroma metabolik, non-alcoholic fatty liver disease (NAFLD), metformin, telmisartan, adiponektin, metabolic syndrome, non-alcoholic fatty liver disease (NAFLD), metformin, telmisartan, adiponectin