KORELASI KADAR LEPTIN DENGAN GLUKOSA DARAH: Kajian pada Ibu Hamil 24 - 28 Minggu dengan dan tanpa Diabetes Melitus Gestasional

HIMAWAN SARTONO, dr. Windarwati,M.Sc,Sp.PK(K);Dr.dr.Andaru Dahesihdewi,M.Kes,Sp.PK(K)

2021 | Tesis-Spesialis | PATOLOGI KLINIK

INTISARI Latar belakang: Federasi Diabetes Internasional (IDF) memperkirakan bahwa 21,3 juta atau 16,2 % kelahiran hidup berasal dari wanita dengan hiperglikemia dan 86,4 % nya karena diabetes melitus gestasional (DMG). Pada kehamilan dengan obesitas berkaitan erat dengan peningkatan ekspresi dan resistensi leptin yang dapat berkontribusi dalam patogenesis DMG. Tujuan penelitian ini adalah untuk mengetahui korelasi antara leptin dengan glukosa pada ibu hamil dengan dan tanpa DMG. Metode penelitian: Penelitian ini merupakan studi observasional potong lintang. Kriteria DMG ditetapkan berdasar International Association of Diabetes and Pregnancy Study Groups (IAPDSG). Subjek penelitian adalah ibu hamil 24-28 minggu yang melakukan pemeriksaan di 8 Puskesmas wilayah kerja propinsi Daerah Istimewa Yogyakarta. Pemeriksaan glukosa darah dan lipid berdasarkan metode enzimatik kolorimetri. Pemeriksaan leptin berdasarkan sandwich ELISA. Analisis statistik menggunakan korelasi Spearman untuk menilai korelasi antara leptin dengan glukosa (menggunakan SPSS versi 18,0) dan p <0,05 dianggap bermakna secara statistik. Hasil penelitian: Subjek penelitian sebanyak 70 ibu hamil, 25 DMG, dan 45 tanpa DMG. Median usia ibu DMG (33 (24 - 42) tahun lebih tua secara bermakna dibandingkan tanpa DMG 28 (17-41) tahun (p< 0,001). Pada kelompok usia 30-35 tahun proporsi ibu DMG 56 % lebih besar secara bermakna daripada tanpa DMG 24,4% (p<0,005). Rerata Indeks Massa Tubuh (IMT) ibu DMG 28,18 ± 5,75 kg/m2 lebih tinggi secara bermakna dibandingkan ibu tanpa DMG 25,06±4,06 kg/m2 (p< 0,006). Pada penelitian ini tidak terdapat perbedaan yang bermakna antara ibu DMG dengan tanpa DMG pada tinggi badan, tekanan darah, proporsi jumlah kehamilan, proporsi abortus, proporsi riwayat keluarga DM, proporsi pendidikan, proporsi pekerjaan ibu, kadar kolesterol, dan HDL. Rerata kadar trigliserid pada ibu DMG 266 ± 83,12 mg/dl lebih tinggi secara bermakna daripada ibu tanpa DMG 213,84±63,8 mg/dl (p=0,005). Rerata kadar Low Density Lipoprotein (LDL) pada ibu DMG 127,28 ± 49,25 mg/dl lebih rendah secara bermakna daripada ibu tanpa DMG 152,6±42,04 mg/dl (p=0,026).Tidak terdapat korelasi yang bermakna antara kadar leptin terhadap glukosa darah pada populasi DMG (r= -0,02 p= 0,924), tanpa DMG (r= -0,9 p=0,529), maupun populasi gabungan keduanya (r = -0,19 p= 0,116). Simpulan: Pada penelitian ini tidak terdapat korelasi yang bermakna antara kadar leptin dengan glukosa darah pada populasi DMG, tanpa DMG, maupun gabungan keduanya. Kata kunci: Diabetes Melitus Gestasional, Leptin, Kehamilan, Glukosa, Obesitas

ABSTRACT Background: The International Diabetes Federation (IDF) estimates that 21.3 million or 16.2% of live births are from women with hyperglycemia and 86.4% due to gestational diabetes mellitus (GDM). In pregnancy, obesity is closely related to the increased expression and resistance of leptin which can contribute to the pathogenesis of GDM. The aim of this study was to investigate the correlation between leptin and glucose in pregnant women with GDM and non GDM. Research method: This study is a cross-sectional observational study. DMG criteria are established based on the International Association of Diabetes and Pregnancy Study Groups (IAPDSG). The research subjects were pregnant women 24-28 weeks who carried out examinations at 8 Puskesmas in the working area of the Special Region of Yogyakarta. Examination of blood glucose and lipids based on colorimetric enzymatic methods. Leptin examination based on sandwich ELISA. Statistical analysis used Spearman's correlation to assess the correlation between leptin and glucose (using SPSS version 18.0) and p <0.05 was considered statistically significant. Results: The research subjects were 70 pregnant women, 25 GDM, and 45 without GDM. The median age of GDM mothers (33 (24 - 42) years was significantly older than without GDM 28 (17-41) years (p <0.001) .In the 30-35 year age group the proportion of GDM mothers was 56% significantly greater than without GDM 24.4% (p <0.005). The mean body mass index (BMI) of GDM mothers 28.18 ± 5.75 kg / m2 was significantly higher than mothers without GDM 25.06 ± 4.06 kg / m2 (p <0.006) In this study, there was no significant difference between GDM mothers with no GDM in height, blood pressure, proportion of pregnancy numbers, proportion of abortions, proportion of family history of DM, proportion of education, proportion of maternal occupation, cholesterol levels, and HDL. The mean of triglyceride levels in GDM mothers was 266 ± 83.12 mg / dl significantly higher than mothers without GDM 213.84 ± 63.8 mg / dl (p = 0.005) .The mean levels of Low Density Lipoprotein (LDL) in GDMmothers were 127 , 28 ± 49.25 mg / dl was significantly lower than mothers without GDM152.6 ± 42.04 mg / dl (p = 0.026). In this study, there was no significant correlation between leptin levels and blood glucose o blood glucose in the GDM population (r = -0.02 p = 0.924), without GDM (r = -0.9 p = 0.529), or the combined population of both (r = -0.19 p = 0.116). Conclusion: In this study, there was no significant correlation between leptin levels and blood glucose in the GDM population, without GDM, or a combination of both.

Kata Kunci : Diabetes Melitus Gestasional, Leptin, Kehamilan, Glukosa, Obesitas/Gestational Diabetes Mellitus, Leptin, Pregnancy, Glucose, Obesity