PERBEDAAN GAMBARAN ELEKTRODIAGNOSTIK NERVE CONDUCTION STUDY ANTARA NEUROPATHY ASSOCIATED PREDIABETES DAN NEUROPATI DIABETIKA

Indera, Prof.Dr.dr. Samekto Wibowo, P.Far.K.,Sp.FK(K),Sp.S(K)

2014 | Tesis | S2 Ilmu Penyakit Saraf

Prediabetes adalah tahap awal transisi diabetes melitus (DM) dan memainkan peranan penting dalam kejadian neuropati. Onset kerusakan saraf dapat mulai terjadi pada fase inisial abnormalitas metabolik selama periode intoleransi glukosa. Penelitian ini bertujuan untuk membedakan abnormalitas nerve conduction study (NCS) antara neuropathy associated prediabetes (NAP) dan neuropati diabetika (ND). Penelitian ini menggunakan rancangan studi cross sectional. Subjek penelitian adalah populasi normal dan populasi intoleransi glukosa yang dikelompokkan menjadi prediabetes dan DM menurut kriteria ADA 2012. Pemeriksaan NCS dilakukan terhadap populasi normal dan intoleransi glukosa (prediabetes dan DM) untuk mendapatkan gambaran neuropati subklinis. Subjek penelitian akhir terdiri atas 40 subjek normal, 50 subjek NAP dan 50 subjek ND (n=50) yang dilakukan analisis terhadap gambaran NCS saraf motorik medianus, saraf sensoris medianus, saraf motorik tibialis dan saraf sensoris suralis. Subjek NAP menunjukkan abnormalitas saraf sensoris medianus (latensi distal (p=0,044) dan amplitudo distal (p=0,027)) dan saraf sensoris suralis (latensi distal (p=0,038) dan amplitudo distal (p<0,001)). Subjek ND menunjukkan abnormalitas semua parameter NCS baik saraf motorik ataupun sensoris (p<0,001). Perbandingan antara subjek NAP dan ND menunjukkan perbedaan statistik yang bermakna pada semua parameter NCS (p<0,05). Hasil analisis multivariat menunjukkan bahwa saraf sensoris suralis berperan secara bermakna terhadap gangguan neuropati intoleransi glukosa (p<0,001). Abnormalitas saraf sensoris terjadi predominan lebih awal pada status hiperglikemia. Kerusakan akson didapatkan lebih berat dibandingkan kerusakan mielin pada neuropati intoleransi glukosa. Gangguan abnormalitas sensoris pada status hiperglikemia terjadi lebih berat pada ekstremitas bawah.

Prediabetes is a transitional stage to DM and plays an important role in the early development of neuropathy. Currently, it is considered that the onset of the neural injury can occur in the initial phase of this metabolic abnormality, during the period of glucose intolerance. The aim of this study was to differentiate the NCS abnormalities in neuropathy associated prediabetes (NAP) and diabetic neuropathy (DN). The design of study was cross sectional. Normoglycemia and glucose intolerance population grouped into prediabetes and DM based on ADA criteria (2012) were recruited in this study. Electrodiagnostic NCS was performed to discover subclinical neuropathy in glucose intolerance population. Parameter medianus MCS, medianus SCS, tibialis MCS and suralis SCS were analysed in 40 normal group, 50 NAP group and 50 DN group. Abnormalities of medianus SCS (distal latency (p=0,044) and distal amplitude (p=0,027)) and suralis SCS (distal latency (p=0,038) and distal amplitude (p<0,001)) were showed in NAP group. Abnormalities of all SCS as well as MCS parameters were showed in DN group (p<0,001). Comparison of NAP and DN group showed statistically significant in all NCS parameters (p<0,05). Multivariate analyses showed SCS suralis reflects earliest alteration in glucose intolerance neuropathy (p<0,001). Sensory abnormality predominant occurs in earliest stage of hyperglycemic state. Axonal degeneration was found more severe instead of demyelination in glucose intolerance neuropathy. In addition, sensory abnormality identified potentially severity in lower extremities.

Kata Kunci : nerve conduction study, neuropathy associated prediabetes, neuropati diabetika