PERBEDAAN KADAR CARBOXY TERMINAL PROPEPTIDE PROCOLLAGEN TIPE I (PIP) SERUM PADA PASIEN GAGAL JANTUNG AKIBAT HIPERTENSI

Nurul Aini, dr. Lucia Kris Dinarti, SpPD-SpJP (K), FIHA,

2012 | Tesis | S2 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 serat 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. Konsentrasi PIP serum diukur dengan Enzyme Immunoassay. 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 setelah di tes normal dengan uji normalitas Kolmogorov smirnove, 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%. Penelitian dilakukan pada 64 pasien gagal jantung akibat hipertensi yang terdiri dari 22 stage A, 19 stage B dan 23 stage C. Kadar rerata PIP kelompok gagal jantung stage B 819,78 ± 91,03 ng/ml lebih tinggi dibanding stage A 808,47 ± 80,8 ng/ml dan rerata PIP stage C 852 ± 55.51 ng/ml lebih tinggi dibanding stage B, Kadar rerata PIP tidak berbeda bermakna secara statistik (p=0,317). Kesimpulan: Tidak terdapat perbedaan bermakna kadar PIP serum pada kelompok gagal jantung stage A, B dan C.

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. The serum consentration of PIP was measured by enzyme immunoassay. 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 after being tested for the normality using Kolmogorov-smirnove 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%. The research was performed in 64 patients heart failure caused by hypertension consisted of 22 stage A, 19 stage B and 23 stage C. PIP mean levels of the group stage B 819.78 ± 91,03 ng/ml was higher compared stage A 808.47 ± 80.8 ng/ml and PIP mean levels stage C 852 ± 55.51 ng/ml was higher compared stage B. The PIP mean levels didn’t differ statistically significant (p=0.317). Conclution: There were no significant differences in serum level of PIP on the stage heart failure A, B and C.

Kata Kunci : Kolagen, fibrosis, hipertensi, gagal Jantung, carboxy terminal propeptide