HUBUNGAN PSORIASIS VULGARIS DAN TUMOR NECROSIS FACTOR-α DENGAN SINDROMMETABOLIK

Yuni Lidya, Prof. Dr.dr. Hardyanto Soebono, SpKK(K),

2013 | Tesis | S2 Ked.Klinik/MS-PPDS

Psoriasis vulgaris adalah penyakit inflamasi kronik yang diperantarai sel T dan sitokin-sitokin proinflamasi. Sitokin-sitokin proinflamasi terutama TNF-α dan IL-6 menyebabkan efek sistemik berupa resistensi insulin. Resistensi insulin merupakan patogenesis dasar terjadinya sindrom metabolik. Sindrom metabolik merupakan kelompok faktor-faktor risiko kardiometabolik yaitu obesitas abdominal, dislipidemia, hipertensi dan peningkatan glukosa puasa. Tujuan penelitian ini adalah mengetahui hubungan antara psoriasis vulgaris dengan sindrom metabolik. Desain penelitian ini adalah potong lintang, melibatkan 40 pasien psoriasis vulgaris dan 40 pasien orang sehat non-psoriasis di RSUP Dr. Sardjito, Yogyakarta. Tiap subyek diukur lingkar pinggang, tekanan darah, kolesterol HDL, trigliserida, glukosa puasa dan kadar TNF-α. Hasil penelitian menunjukkan prevalensi sindrom metabolik adalah 35 % pada penderita psoriasis, lebih tinggi dibanding pada non-psoriasis (15%) (RP 2,33; 95%CI 1,032-9,022; p=0,039). Rerata PASI pada psoriasis dengan sindrom metabolik adalah 19,7% dibanding rerata PASI pada psoriasis tanpa sindrom metabolik 8,07(p=0,01). Kadar TNF-α serum penderita psoriasis adalag 6,2 pg/dl dan pada non-psoriasis adalah 5,4 pg/dl (p=0,04). Kadar TNF-α serum berhubungan dengan skor PASI (r=0,511; p=0,001). Tidak terdapat perbedaan bermakna antara kadar TNF-α serum psoriasis dengan sindrom metabolik dibandingkan kadar TNF-α serum psoriasis tanpa sindrom metabolik (7,02 pg/dl vs 5,9 pg/dl; p>0,05). Kesimpulan: Ada hubungan psoriasis vulgaris dengan sindrom metabolik pada orang Indonesia. Prevalensi sindrom metabolikpada psoriasis vulgaris lebih tinggi secara bermakna dibanding non-psoriasis.Terdapat hubungankadar TNF-α dengan keparahan psoriasis (PASI). Tidak terdapat perbedaan bermakna kadar TNF-α antara psoriasis vulgaris dengan dan tanpa sindrom metabolik.

Psoriasis vulgaris is chronic inflammatoryskin disease which mediated by T cell and proinflammatory cytokines. Proinflammatory cytokines especially TNF-α and IL-6 exert systemic effects on insulin resistance. Insulin resistance is basic pathophysiology of metabolic syndrome. Metabolic syndrome is the risk of individual cardiometabolic diseasewhich include abdominal obesity, dyslipidemia, hypertension and elevated blood glucose. The objective of this study was to investigate the association between psoriasis vulgaris and metabolic syndrome. A cross-sectional study was done among 40 psoriasis vulgaris patients and 40 non psoriatic healthy subjects visiting outpatient Department of Dermatology and Venereology clinic Dr. Sardjito hospital, Yogyakarta. Blood pressure, fasting bood glucose, HDL cholesterol, waist circumference, triglycerides and TNF-α were examined. Metabolic syndrome was found in 35% psoriatic patients compared to 15 % in non-psoriatic patients(RR 2,33; 95%CI 1,032-9,022; p= 0,039). Average PASI score was calculated 19,7 in psoriatic patients with metabolic syndrome compared to 8,07 in psoriatic patients without metabolic syndrome (p=0,01). Mean TNF-α serum level was found 6,2 pg/dl in psoriatic patients compared to 5,4 pg/dl in non-psoriasis(p=0,04). Level of TNF-α serum had correlation with PASI score (r=0,511; p=0,001). There was no significant difference level of TNF-α serum between psoriatic patient with and without metabolic syndrome (7,02 pg/dl vs 5,9 pg/dl; p>0,05). Conclusions: Psoriasis vulgaris is associated with metabolic syndrome in Indonesia. Prevalence of metabolic syndrome is higher in psoriasis vulgaris compared to non-psoriatic individuals. Serum level of TNF-α is correlated with degree of psoriasis severity (PASI). No difference of mean serum level of TNF-α in psoriatic patient with and without metabolic syndrome was found.

Kata Kunci : Psoriasis vulgaris, sindrom metabolik, TNF-α, obesitas, dislipidemia