Peranan hiperfibrinogenemia sebagai faktor prognosis perburukan pada stroke iskemik akut

YULIASARI, Intan, Prof. dr. Samekto Wibowo, P.Far.K, Sp.FK(K), Sp.S(K)

2010 | Tesis |

Proses inflamasi berperan penting dalam patogenesis stroke iskemik. Respon inflamasi sebelum dan selama fase akut stroke iskemik dapat mempengaruhi tingkat keparahan stroke. Salah satu protein fase akut yaitu fibrinogen diduga berperan terhadap perburukan stroke iskemik akut. Penelitian ini bertujuan untuk mengetahui apakah hiperfibrinogenemia mempunyai kontribusi terhadap perburukan pada stroke iskemik akut. Penelitian ini merupakan penelitian kasus kontrol dengan populasi pada pasien stroke iskemik akut yang rawat inap di bangsal dan unit stroke RSUP Dr. Sardjito, Yogyakarta. Penelitian dilakukan sejak April – Juli 2010. Analisis univariat menggunakan uji Chi-Square dan analisis multivariat menggunakan uji regresi logistik. Hasil dianggap bermakna secara statistik apabila nilaiP<0,05. Enam puluh delapan subjek penelitian berpartisipasi dalam penelitian ini (34 pasien dalam setiap kelompok). Hiperfibrinogenemia pada pasien stroke iskemik akut bermakna memperburuk defisit neurologis menjadi 3,3 kali dibanding pasien stroke iskemik akut dengan kadar fibrinogen yang normal. (OR =3,30;95%CI:CI 1,16 – 9,39; P=0,026). Analisis multivariat didapatkan hiperfibrinogenemia dan riwayat penyakit jantung bermakna sebagai faktor prognosis perburukan pada stroke iskemik akut (OR= 5,52; 95%CI 1,33 – 22,93;P=0,019), (OR =3,30;95%CI 1,16 – 9,39;P=0,026). Hiperfibrinogenemia merupakan faktor prognosis perburukan pada stroke iskemik akut. Didapatkan hubungan yang signifikan antara hiperfibrinogenemia dengan perburukan defisit neurologis.

Inflammation process has an important role in pathogenesis ischemic stroke. Inflammation response before and after acute ischemic stroke can affect degree of stroke severity. One of acute phase protein is fibrinogen which is suspected has contribution in worsening acute ischemic stroke. This research aims to explore whether hyperfibrinogenemia has contribution in deteriorating ischemic acute stroke. This research is case control type research applied to population of ischemic stroke patients. The samples consisted of patients who admitted to stroke center Sardjito Hospital. The research were conducted since April until July 2010. Univariate analysis was performed using Chi-Square test and multivariate analysis was completed by logistic regression . Results are deemed meaningful statistically if P < 0.05. Sixty eight objects participated in this research (thirty four patients in each group). Hyperfibrinogenemia in acute ischemic stroke contributes in deteriorating neurological deficit by 3.3 compared to other ischemic stroke patients with normal fibrinogen level (OR =3,30;95%CI:CI 1,16 – 9,39; P=0,026). Multivariate analysis has shown hyperfibrinogenemia and cardiovascular disturbance to be meaningful as prognostic factor of neurological deficit on acute ischemic stroke patients (OR= 5,52; 95%CI 1,33 – 22,93;P=0,019), (OR =3,30;95%CI 1,16 – 9,39;P=0,026). Hyperfibrinogenemia is a prognostic factor in deterioration of acute ischemic stroke. There is significant correlation between hyperfibrinogenemia and neurological deficit.

Kata Kunci : Fibrinogen,Stroke iskemik akut,Perburukan,Prognosis