Perbedaan kadar carboxy terminal propeptide procollagen tipe I (PIP) serum pada pasien gagal jantung akibat hipertensi

AINI, Nurul, dr. Lucia Krisdinarti, SpPD-SpJP(K), FIHA

2010 | Tesis | S2 Ilmu Kedokteran Klinik

Hipertensi arteri mempengaruhi komposisi jaringan jantung yang mengakibatkan remodeling struktural miokard. Gangguan ketidakseimbangan sintesis dan degradasi kolagen tipe I menyebabkan fibrosis miokard berupa akumulasi sermemberi manfaat terhadap strategi terapi pasien gagal jantung akibat hipertensi.at kolagen tipe I di interstisial dan perivaskuler miokard. Akumulasi serat kolagen menurunkan tingkat relaksasi, hisap diastolik, kekakuan miokard, gangguan diastolik yang mempengaruhi kerja sistolik yang pada akhirnya mengakibatkan gagal jantung. Konsentrasi carboxy terminal propeptide procollagen tipe I (PIP) dalam darah perifer merupakan indeks sintesis kolagen tipe I pada HHD sehingga pengukuran PIP berguna memonitor derajat fibrosis miokard pada gagal jantung dan menentukan strategi terapi yang bertujuan tidak hanya menurunkan tekanan arteri dan massa ventrikel kiri tetapi juga memperbaiki bahkan mencegah remodeling miokard. Penelitian ini bertujuan menentukan perbedaan PIP pada pasien gagal jantung stage A, B, C akibat hipertensi. Desain penelitian ini adalah cross sectional pada pasien rawat jalan poli jantung RSUP Dr sardjito Yogyakarta dari Agustus 2009 sampai jumlah sampel terpenuhi. Untuk menganalisis perbedaan ketiga kelompok tahapan gagal jantung menggunakan 1-way ANOVA kemudian diikuti tes Student-Newman-Keuls setelah di tes normal dengan uji normalitas tes Shapiro-Wilks, jika tidak normal dilakukan tes nonparametrik dengan Kruskal-Wallis kemudian diikuti Mann-Whitney U test. Perbedaan dianggap bermakna bila p < 0.05 dengan interval kepercayaan 95%. Hasil penelitian menyajikan karakteristik subyek penelitian berdasarkan umur, jenis kelamin, IMT, tekanan darah diastolik dan sistolik, denyut jantung, derajat hipertensi, lama hipertensi, obat anti hipertensi, ejeksi fraksi. Ketebalan septum interventrikel, ketebalan dinding posterior akhir diastolik, diameter internal ventrikel kiri akhir diastolik, indeks massa ventrikel kiri dan hipertrofi ventrikel kiri. Lebih lanjut penelitian ini memberi manfaat terhadap strategi terapi pasien gagal jantung akibat hipertensi.

Arterial hypertension affects heart tissue composition which leads to structural remodeling of the myocardium. The imbalance between synthesis and degradation of type I collagen leading to myocardial fibrosis in a form of type I collagen fiber accumulation in the interstitial and perivascular myocardium. Collagen fiber accumulation reduces relaxation stage, diastolic suction, myocardial stiffness and diastolic disfunction which affects systolic disfunction leading to heart failure. Concentration of carboxy-terminal propeptide of procollagen type I (PIP) in peripheral blood is a synthesis index of type I collagen in HHD. Thus, the measurement of PIP is useful to monitor myocardial fibrosis stage in heart failure and to determine the therapeutic strategy that aims not only to reduce arterial pressure and left ventricular mass but also to prevent myocardial remodeling. This research aimed to determine difference PIP level in patients heart failure stage A, B, and C caused heart failure which is caused by hypertension. This research was a cross sectional research designed for cardiology policlinic’s outpatients at Dr Sardjito General Hospital Yogyakarta from August 2009 until the calculated sample number is fulfilled. One-way ANOVA was used to analyze the differences between the three groups of heart failure stages which was followed by Student-Newman-Keuls test after being tested for the normality using Shapiro-Wilks normality test, if the result didn’t show a normal value, a non-parametric test would be undergone using Kruskal-Wallis test followed by Mann-Whitney U test. The differences considered as significant if p < 0.05 with confidence interval of 95%. Research result showed the characteristics of research subjects based on age, sex, BMI, systolic and diastolic blood pressure, heart rate, hypertension stage, duration of hypertension, hypertension medications, ejection fraction, interventricular septum thickness, posterior wall thickness end diastolic, left ventricle internal diameter at end-diastolic, left ventricle mass index and left ventricular hypertrophy. Moreover, this research brought some advantages upon therapeutic strategy for patients with heart failure caused by hypertension.

Kata Kunci : Kolagen,Fibrosis,Hipertensi,Gagal jantung,Carboxy terminal propeptida,Heart failure