UJI DIAGNOSTIK ACANTHOSIS NIGRICANS UNTUK RESISTENSI INSULIN PADA REMAJA OBES DI YOGYAKARTA

RAHMAH LATIFAH, Prof. dr. Madarina Julia, Ph.D, Sp.A(K); dr. Endy Paryanto P, MPH, Sp.A(K)

2020 | Tesis | MAGISTER ILMU KEDOKTERAN KLINIS

Latar belakang: Acanthosis nigricans (AN) banyak dihubungkan dengan kondisi obesitas, gangguan endokrin, keganasan, diabetes melitus (DM), dan gangguan metabolik lain, dan paling banyak dihubungkan dengan kondisi hiperinsulinemia. Hiperinsulinemia (yang kemudian akan berkembang menjadi resistensi insulin) merupakan etiologi terjadinya diabetes melitus tipe 2 dan penyakit metabolik lain. Performa AN sebagai alat uji diagnostik resistensi insulin pada remaja obes belum banyak diteliti. Tujuan: Untuk mengetahui performa diagnostik AN dalam menilai resistensi insulin pada remaja obes usia 15-18 tahun di Yogyakarta. Metode: Kami melakukan uji potong lintang (cross sectional study) dengan merekrut siswa Sekolah Menengah Atas (SMA) usia 15-18 tahun dari 10 SMA di Yogyakarta. Masing-masing subjek dinilai apakah didapatkan AN pada leher. Resistensi insulin dinilai dengan homeostatic model assessment insulin resistance (HOMA-IR). Hasil: Kami merekrut 177 subjek penelitian yang terdiri dari 100 (56,5%) laki-laki. Rata-rata skor standar deviasi indeks massa tubuh (SSD IMT) adalah 2,6 (SD 0,54). Didapatkan 157 (97,2%) subjek memiliki AN dan 161 (90,9%) subjek mengalami resistensi insulin (HOMA-IR ≥3,16). Derajat keparahan AN memiliki kekuatan korelasi positif yang lemah (r=0,307; p<0,001) terhadap kadar HOMA-IR. Sensitivitas, spesifisitas, nilai ramal positif, dan nilai ramal negatif AN untuk mendeteksi resistensi insulin pada remaja obes adalah sebesar 71,4%, 56,2%, 50,0%, dan 76,3%. Kesimpulan: Acanthosis nigricans merupakan penanda resistensi insulin yang cukup baik pada remaja obes, namun belum memiliki kekuatan yang baik sebagai alat diagnostik resistensi insulin.

Background: Acanthosis nigricans (AN) is a skin disorder associated with obesity, endocrine disorders, malignancy, diabetes mellitus (DM), and other metabolic disorders, mostly associated with hyperinsulinemia. Hyperinsulinemia, which will later develop into insulin resistance, is an etiology for type 2 diabetes mellitus and other metabolic diseases. Acanthosis nigricans performance as a diagnostic test for insulin resistance in obese adolescents has not been much studied. Objective: To assess diagnostic performance of AN in assessing insulin resistance in obese adolescents aged 15-18 years in Yogyakarta. Methods: We conducted a cross-sectional study by recruiting high school students aged 15-18 from ten schools in Yogyakarta, Indonesia. Each subject was assessed whether AN was found in the neck. Insulin resistance was assessed by homeostatic insulin resistance assessment model (HOMA-IR). Results: We recruited 177 subjects consisting of 100 (56.5%) boys. The mean of BMI-for-age z-score was 2.6 (SD 0.54). In all, 157 (97.2%) subjects had AN and 161 (90.9%) subjects had insulin resistance (HOMA-IR ≥3.16). The severity of AN had a weak positive correlation (r=0.307; p <0.001) to the HOMA-IR levels. Sensitivity, specificity, positive predictive value, and negative predictive value of AN for detecting insulin resistance in obese adolescents were 71.4%, 56.2%, 50.0%, and 76.3%, respectively. Conclusion: Acanthosis nigricans is a good surrogate marker for insulin resistance in obese adolescents, but does not have good strength as a diagnostic tool for insulin resistance.

Kata Kunci : Acanthosis nigricans, resistensi insulin, hiperinsulinemia, HOMA-IR, remaja obes