Hubungan kadar matriks metaloproteinase-3 (MMP-3) cairan sendi dengan kadar high sensitive c-reative protein (hs-CRP) serum pada osteoartritis lutut
HARYANI, Isti, dr. Nyoman Kertia, SpPD-KR
2008 | Tesis | S2 Ilmu Penyakit DalamLatar belakang. Matriks metaloproteinase-3 (MMP-3) merupakan salah satu enzim proteolitik yang mampu mendegradasi semua komponen matriks ekstraseluler, dan diyakini berperan sebagai mediator utama destruksi kartilago pada osteoartritis (OA). Kerusakan kartilago menyebabkan inflamasi sinovial yang menyebabkan kerusakan kartilago lebih lanjut. High sensitive C-reactive protein (hs-CRP) merupakan marker sensitif inflamasi sistemik derajat rendah yang mencerminkan proses dan intensitas inflamasi. Diperkirakan kadar MMP-3 cairan sendi berhubungan dengan kadar hs-CRP serum pada osteoartritis. Tujuan penelitian. Untuk mengetahui hubungan antara kadar matriks metaloproteinase-3 (MMP-3) cairan sendi dengan kadar high sensitive C-reactive protein (hs-CRP) serum pada osteoartritis lutut. Metode dan cara penelitian. Penelitian ini merupakan studi potong lintang (cross-sectional study) terhadap pasien osteoartritis lutut yang periksa di Poliklinik Rematologi RSUP Dr. Sardjito Yogyakarta pada bulan September – Desember 2006. Kadar MMP-3 cairan sendi diperiksa dengan metode ELISA, sedangkan kadar hs-CRP serum diperiksa dengan immunoturbidimetric assay. Hubungan antara MMP-3 cairan sendi dengan hs-CRP serum dianalisis dengan Fisher’s Exact test, dinyatakan bermakna bila p<0,05. Perbedaan rerata kadar MMP-3 cairan sendi pada kelompok hs-CRP tinggi dan rendah dianalisis dengan Mann Whitney U-test. Hasil. Terdapat 21 subyek penelitian, yang terdiri dari 15 perempuan dan 6 laki-laki. Rerata kadar MMP-3 cairan sendi sebesar 403,78±219,72 ng/ml dan rerata kadar hs-CRP serum adalah 6,49±10,26 mg/L. Subyek dengan kadar MMP-3 cairan sendi ≥250 ng/ml berjumlah 15 orang, sebanyak 7 orang diantaranya mempunyai kadar hs-CRP tinggi (≥3 mg/L) dan 8 orang mempunyai kadar hs-CRP rendah (<3 mg/L). Hasil uji Fisher’s Exact menunjukkan tidak terdapat hubungan yang bermakna antara kadar MMP-3 cairan sendi dengan kadar hs-CRP serum (p=0,336). Rerata kadar MMP-3 cairan sendi pada kelompok hs-CRP tinggi menunjukkan hasil lebih tinggi daripada kelompok hs-CRP rendah, namun tidak berbeda bermakna secara statistik (474,69±174,84 ng/ml dan 360,14±239,20 ng/ml; p=0,246). Simpulan. Tidak terdapat hubungan yang bermakna antara kadar MMP-3 cairan sendi dengan kadar hs-CRP serum pada osteoartritis lutut.
Background. Matrix metalloproteinase-3 (MMP-3) is one of the proteolytic enzymes that can degrade extracellular matrix components, and thought to be major mediators of cartilage destruction. Cartilage destruction may cause synovial inflammation that leads to further cartilage destruction. High sensitive C-reactive protein (hs-CRP) is sensitive marker of low grade systemic inflammation that reflects the presence and intensity of inflammation. It is assumed that synovial fluid MMP-3 levels have association with serum hs-CRP levels in osteoarthritis. Objective. The purpose of the study was to assess the association between synovial fluid MMP-3 levels and serum hs-CRP levels in knee osteoarthritis. Methods. The design of this study was a cross-sectional study. The subjects were knee osteoarthritis patients who visited the rheumatology outpatient clinic of Dr. Sardjito Hospital Yogyakarta on September – December 2006. The synovial fluid MMP-3 level was measured by ELISA, while the serum hs-CRP level was measured by immunoturbidimetric assay. The association between synovial fluid MMP-3 levels and serum hs-CRP levels was analyzed by Fisher’s Exact test with level of significance (p) < 0.05. The difference of mean synovial fluid MMP-3 levels in each hs-CRP group (≥3 mg/L or <3 mg/L) was analyzed by Mann Whitney U-test. Results. There were 21 subjects, 15 females and 6 males. The mean of synovial fluid MMP-3 levels was 403.78±219.72 ng/ml, and the mean of serum hs-CRP levels was 6.49±10.26 mg/L. There were 15 subjects with high synovial fluid MMP-3 levels (≥250 ng/ml), 7 of them had high serum hs-CRP levels (≥3 mg/L) and the others (8 subjects) had low serum hs-CRP levels (<3 mg/L). Fisher’s Exact test showed no significant association between synovial fluid MMP-3 levels and serum hs-CRP levels (p=0.336). The mean of synovial fluid MMP-3 levels was higher in group with hs-CRP levels ≥3 mg/L (high hs-CRP) than group with hs-CRP levels <3 mg/L (low hs-CRP), but there was no statistically significant difference (474.69±174.84 ng/ml and 360.14±239.20 ng/ml; p=0.246). Conclusion. There was no significant association between synovial fluid MMP-3 levels and serum hs-CRP levels in knee osteoarthritis.
Kata Kunci : Osteoartritis,Matriks metaloproteinase,3,hs,CRP, osteoarthritis, matrix metalloproteinase-3, hs-CRP
