HUBUNGAN DOSIS KUMULATIF METIL PREDNISOLON ORAL DAN KEPADATAN MASSA TULANG PENDERITA LUPUS ERITEMATOSUS SISTEMIK MENGGUNAKAN N-MID OSTEOKALSIN SEBAGAI VARIABEL MEDIATOR

YULYANI WERDININGSIH, Prof.Dr.dr.Nyoman Kertia, SpPD-KR, Dr.dr.Deddy Nur Wachid A, SpPD-KR

2021 | Tesis-Subspesialis | SUBSPESIALIS ILMU PENYAKIT DALAM

Latar belakang : Glukokortikoid merupakan merupakan terapi utama LES dan penyebab tersering osteoporosis sekunder melalui pengaruh langsung dan tidak langsung terhadap tulang. Penelitian tentang pengaruh dosis kumulatif Glukokortikoid oral terhadap osteoblas dan kejadian osteoporosis masih jarang. N Mid osteokalsin merupakan penanda dari aktifitas osteoblas. Tujuan penelitian : membuktikan kadar N-Mid osteokalsin serum sebagai variabel mediator dalam hubungan antara dosis kumulatif metil prednisolon(MP) oral dengan kepadatan massa tulang penderita (BMD) pada penderita LES. Metode : Penelitian menggunakan desain potong lintang dilakukan di Poliklinik Reumatologi RSUD dr.Moewardi Surakarta periode Agustus-September 2019. Subyek penelitian adalah wanita SLE berumur 18-50 tahun belum menopause, dalam terapi MP oral minimal 6 bulan dan tidak mempunyai penyebab osteoporosis sekunder lain. Data dosis kumulatif MP oral dari buku obat, kemudian dilakukan pemeriksaan darah dan BMD. Data diolah dengan SPSS, analisis dengan regresi linier dan tes sobel. Hasil : Subyek penelitian berjumlah 34 orang, dimana 5 orang (14,71%) osteoporosis. Terdapat korelasi negatif r=-0,404 antara dosis kumulatif MP oral dengan kadar N Mid Osteokalsin, korelasi positif r=0,400 antara kadar N Mid Osteokalsin dengan BMD serta korelasi negatif r=-0,369 antara dosis kumulatif MP oral dengan BMD. Hasil persamaan regresi linier adalah sbb : Kadar Osteokalsin = 13,843 - 0,497 dosis kumulatif MP, Gambaran BMD = 0,826 + 0,010 Kadar Osteokalsin, Gambaran BMD = 1,007 - 0,011 Dosis kumulatif MP. Namun Tes Sobel mendapatkan Z hitung kurang dari Z tabel. Kesimpulan : Kadar N Mid Osteokalsin tidak memediasi pengaruh dosis kumulatif MP oral terhadap Gambaran BMD. Hal itu berarti bahwa pengaruh dosis kumulatif MP terhadap Gambaran BMD bersifat langsung

Background : Glucocorticoids is the main therapy for SLE and the most reason leading to secondary osteoporosis both directy and indirectly. Studies related to the relations of cumulative dosage of oral glucocorticoids and the occurence of osteoporosis are still limited. N-mid osteocalcin is a maker of the activated osteoblasts. Aim : to prove N-mild osteocalcin serum level as a mediating variable in the relations among cumulative dosage oral methylprednisolone (MP) and bone Mineral Density (BMD) in SLE patients Method : The study was using cross sectional design, held in Rheumatology Policlinic in dr. Moewardi Hospital Surakarta from August to September 2019. The subjects were female SLE patients from 18-50 years old, had not have menopause, in oral MP therapy for the minimum of 6 months and did not have any other cause of secondary osteoporosis. Data were collected from the drug records, blood examination and BMD. The data were processed using SPSS, analized using linier regression and sobel test. Results : The subjects were 34 patients, in which 5 patients (14,7%) were found osteoporosis. There is negative correlation r = -0,404 between cumulative dosage of oral MP and N-Mid Osteocalcin level; positive correlation r=0,400 between N-Mid Osteocalcin and BMD; negative correlation r= -0,369 between cumulative dosage of oral MP and BMD. The results of liner regressions are: Osteocalcin level = 13,843 - 0,497 cumulative dosage, BMD = 0,826 + 0,010 osteocalcin level, BMD= 1,007 - 0,011 cumulative dose of MP. But from the Sobel test result, the counted Z is less than Z table. Conclusion : N-Mid Osteocalcin level is not mediating the effects of cumulative dosage of oral MP to the BMD result. That implies the relation of cumulative dosage of MP and BMD result is directy

Kata Kunci : Cumulative dosage of MP, N Mid Osteocalsin, BMD.