PERBEDAAN KADAR ENDOTELIN-1 PADA PENDERITA DIABETES MELLITUS TIPE 2 WANITA DENGAN RETINOPATI ATAU NEFROPATI DIBANDINGKAN TANPA RETINOPATI DAN NEFROPATI

SITI MUZAYYANAH, dr. Luthfan Budi Purnomo, SpPD-KEMD

2012 | Tesis | S2 Ilmu Penyakit Dalam

Latar belakang. Komplikasi kronik diabetes mellitus (DM) terdiri dari mikroangiopati dan makroangiopati. Mikroangiopati meliputi retinopati, nefropati dan neuropati, sedangkan makroangiopati meliputi penyakit jantung koroner, stroke dan penyakit arteri perifer. Pada diabetes mellitus (DM) tipe 2 ketika diagnosis ditegakkan, sekitar 25% sudah menderita retinopati diabetik non proliferatif. Dalam waktu 1-3 tahun retinopati non proliferatif berkembang menjadi retinopati diabetik proliferatif yang dapat mengakibatkan ablasio retina, glaukoma dan kebutaan. Nefropati diabetik terjadi pada 20 - 40 % penderita diabetes mellitus. Nefropati diabetik merupakan penyebab utama End Stage Renal Disease (ESRD) dan merupakan risiko tinggi terjadinya Cardiovascular Disease (CVD). Disfungsi endotel mendasari semua kejadian ini. Marker endotelial yaitu endotelin-1 dinilai pada penderita DM tipe 2 dengan retinopati atau nefropati dan tanpa retinopati dan nefropati. Tujuan. Mengetahui perbedaan kadar endotelin-1 pada wanita penderita DM tipe-2 dengan retinopati atau nefropati dan tanpa retinopati dan nefropati. Metode. Penelitian dilakukan secara potong lintang pada subyek DM tipe-2 dengan retinopati atau nefropati dibandingkan tanpa retinopati dan nefropati di poliklinik Endrokrinologi RSUP Dr. Sardjito, Yogyakarta. Pemeriksaan kadar plasma endotelin-1 melalui pengambilan darah vena dan diukur dengan ELISA sandwich. Perbedaan antara kedua kelompok dianalisa dengan uji t tidak berpasangan dan uji Mann-Whitney. Dianggap bermakna secara statistik bila p<0,05. Retinopati diabetik ditegakkan melalui pemeriksaan fundoskopi. Nefropati diabetik ditegakkan dengan pemeriksaan Albumin Creatinin Ratio (ACR) dengan hasil ≥ 30ug/mg. Hasil. Terdapat 52 subyek wanita DM tipe-2 yang terdiri dari 26 (50%) subyek dengan retinopati atau nefropati dan 26 (50%) subyek tanpa retinopati dan nefropati. Median usia adalah 54 (44-59) tahun. Rerata kadar endotelin-1 didapatkan lebih tinggi pada wanita DM tipe-2 dengan retinopati atau nefropati (19,47 ± 9,94 ng/ml) dibanding tanpa retinopati dan nefropati (17,64 ± 11,63 ng/ml), meskipun perbedaan tersebut tidak bermakna secara statistik (p=0,944). Simpulan. Kadar endotelin-1 lebih tinggi pada wanita DM tipe-2 dengan retinopati atau nefropati dibanding tanpa retinopati dan nefropati namun perbedaan tersebut tidak bermakna secara statistik.

Background. Chronic complications of diabetes mellitus (DM) include microangiopathy and macroangiopathy. Microangiopathy include retinopathy, nephropathy and neuropathy, while macroangiopathy include coronary heart disease, stroke and peripheral arterial disease. In type 2 diabetes mellitus (DM) when the diagnosis is established, approximately 25% had suffered nonproliferative diabetic retinopathy. Within 1-3 years of non proliferative retinopathy progress to proliferative diabetic retinopathy can eventually lead to retinal detachment, glaucoma and blindness. Diabetic nephropathy occurs in 20- 40% of patients with diabetes mellitus. Diabetic nephropathy is the leading cause of End Stage Renal Disease (ESRD) and is a high risk of Cardiovascular Disease (CVD). Endothelial dysfunction underlies all of this. Markers of endothelial endothelin-1 is assessed in patients with type 2 diabetes with retinopathy or nephropathy and without retinopathy and nephropathy. Aim. To evaluate the difference levels of endothelin-1 in type 2 diabetes mellitus women with retinopathy or nephropathy and without retinopathy and nephropathy. Methods. Cross sectional design was conducted on subjects from outpatients type 2 diabetes mellitus women with retinopathy or nephropathy compared without retinopathy and nephropathy at endocrinology clinic, Dr. Sardjito General Hospital, Yogyakarta. ELISA sandwich’s methods was used to measure plasma levels of endothelin-1 from veins blood. Differences between groups were compared by student’s unpaired t-test and Mann-Whitney test ( significant when p<0.05). Diabetic retinopathy is enforced through inspection fundoskopi. Diabetic nephropathy is made by albumin creatinine ratio (ACR) ≥ 30ug/mg. Results. There are 52 female subjects with type 2 DM is composed of 26 (50%) subjects with retinopathy or nephropathy and 26 (50%) subjects without retinopathy and nephropathy. Median age was 54 (44-59) years. The mean levels of endothelin-1 obtained was higher in women with type-2 diabetes mellitus with retinopathy or nephropathy (19,47 ± 9,94 ng / ml) compared with no retinopathy and nephropathy (17,64 ± 11,63 ng / ml), although the difference was not statistically significant (p = 0,944). Conclusion. Endothelin-1 levels were higher in women with type-2 diabetes mellitus with retinopathy or nephropathy than without retinopathy and nephropathy, but the difference was not statistically significant.

Kata Kunci : endotelin-1, retinopati diabetik, nefropati diabetik, diabetes mellitus tipe 2