Hubungan antara kadar serum matrix metalloproteinase-9 dengan kadar serum troponin-1 pada sindrom koroner akut

RUCHANIHADI, dr. Budi Yuli Setianto, SpPD(K)-KKV, SpJP(K), FIHA

2010 | Tesis |

Latar Belakang. Patofisiologi SKA adalah adanya ruptur atau erosi dari plak aterosklerosis, khususnya pada bagian “shoulder of plaque” yang diikuti trombosis di dalam plak dan kemudian menyebabkan trombosis pembuluh darah baik total atau sebagian. MMP-9 merupakan enzim perusak matrik ekstraseluler, yang berperan dalam melisiskan pembungkus plak aterosklerosis, dan menyebabkan ruptur plak sehingga terjadi SKA. Troponin-I merupakan penanda kerusakan otot jantung karena nekrosis yang spesifik. Tujuan. Tujuan penelitian ini adalah untuk mengetahui hubungan antara kadar serum MMP-9 dengan kadar serum Troponin-I pada pasien SKA. Metode. Desain penelitian adalah cross sectional study (studi potong lintang). Pengambilan sampel dilakukan secara berurutan (consecutive sampling) dari pasien SKA yang dirawat di bagian ICCU RSUP Dr Sardjito Yogyakarta, sejak Juni 2008 sampai Agustus 2010. Digunakan kuisioner untuk mengumpulkan data dasar sampel. Pengukuran MMP-9 dan Troponin dilakukan 1 kali sebelum dilakukan trombolisis dari darah vena. Data disajikan dalam bentuk analisis diskriptif tentang karakteristik subjek penelitian berupa rata-rata dan simpangan baku kadar MMP-9 dan Troponin I. Hubungan antara MMP-9 dan Troponin I dianalisa menggunakan uji korelasi Spearman. Angka kemaknaan adalah p< 0.05. Hasil. Terdapat 139 subjek, yang terdiri dari 63 pasien STEMI, 27 pasien NSTEMI, dan 49 pasien UAP. Rata-rata dan simpangan baku kadar Troponin-I pada seluruh sampel SKA adalah 9.49 ± 10.47 ng/dL, dan rata-rata dan simpangan baku kadar MMP-9 pada seluruh sampel SKA adalah 1296.06 ± 729.97 ng/dL. Terdapat hubungan yang bermakna antara kadar MMP-9 dan Troponin-I pada pasien SKA (r = 0.34, p=0,000) Kesimpulan. Terdapat hubungan yang bermakna antara MMP-9 dan Troponin-I pada pasien SKA di bagian ICCU RSUP Dr Sardjito Yogyakarta.

Background.The pathophysiology of acute coronary syndromes (ACS) is now accepted as the rupture or erosion of an atherosclerotic plaque, initial occurs at the shoulder of the plaque and is followed by intra-plaque thrombosis, then spread to the vascular lumen and cause total or partial vascular occlusion. MMP-9 is an extracellular matrix degrading enzyme, plays a crucial role in the breakdown of the fibrous cap of plaque and subsequent rupture in the pathogenesis of ACS. Cardiac troponins are currently the most sensitive and specific biochemical markers of myocyte necrosis. Objective. to known the correlation between serum level of MMP-9 and serum level of Troponin-I in patient with ACS. Method. Study design was cross sectional. Data were collected by consecutive sampling from patient in ICCU board of RSUP Dr Sardjito Yogyakarta, in June 2008 – Agust 2010. A questionnaire was used to collect information from patient. After admission, peripheral venous blood was drawn once time and measuring consentration of serum level of MMP-9 and Troponin I before defenitif thrombolysis. Data are expressed as means±standart deviation (SD). Correlation between serum level of MMP- 9 and serum level of Troponin-I were assessed using Spearman’s rank correlations test. A value of p<0.05 was considered statistically significant. Results. There were 139 patient with ACS and comprising 63 patient with STEMI, 27 patient with NSTEMI, and 49 patient with UAP. Means±SD of Troponin I from all of sampel was 9.49±10.47 ng/dL. Means±SD of MMP-9 from all of sampel was 1296.06±729.97 ng/dL. There were significant correlations between MMP-9 and Troponin-I in patient with ACS (r = 0.34, p=0,000). Conclusion. There were significant correlations between MMP-9 and Troponin-I in ACS patient in ICCU RSUP Dr Sardjito Yogyakarta

Kata Kunci : SKA,MMP,9,Troponin,1