PERBANDINGAN ABNORMALITAS KONDUKSI SARAF PADA SUBJEK DIABETES MELITUS DENGAN ULKUS DAN TANPA ULKUS

Fajar Maskuri, Prof. Dr. dr. Sri Sutarni, Sp.S(K)

2014 | Tesis | S2 Ked.Klinik/MS-PPDS

Ulkus kaki diabetik merupakan komplikasi tersering diabetes, yang terjadi pada 15% populasi diabetik, serta penyebab penderita diabetes menjalani rawat inap dan amputasi ekstremitas bawah. Faktor risiko ulkus kaki diabetik adalah multifaktor, neuropati perifer adalah faktor risiko yang paling berperan. Beratnya neuropati dapat diukur secara elektrodiagnostik. Penelitian ini bertujuan untuk membandingkan abnormalitas elektrodiagnostik (nilai konduksi saraf motorik [MCS, motor conduction studies] dan sensorik [SCS (sensory conduction sudies]) antara subjek DM dengan ulkus dan subjek DM tanpa ulkus, serta menilai variabel elektrodiagnostik yang paling berhubungan dengan kejadian ulkus diabetik. Penelitian menggunakan rancang penelitian potong lintang pada subjek DM yang menjalani pemeriksaan elektrodiagnostik. Subjek dilakukan pemeriksaan MCS dan SCS, kemudian dilakukan analisis statistik. Didapatkan 56 subjek yang terdiri dari 23 subjek dengan ulkus diabetik serta 33 subjek tanpa ulkus diabetik. Pada MCS, didapatkan perbedaan bermakna pada variabel KHS medianus (38,73±9,99 vs 47,15±8,77 m/s, p=0,001) dan tibialis (28,76±8,48 vs 34,00±7,33 m/s, p=0,030) antara subjek DM dengan ulkus dan DM tanpa ulkus. Nilai latensi distal, amplitudo distal, dan amplitudo proksimal tidak berbeda bermakna pada subjek DM dengan ulkus dibanding subjek DM tanpa ulkus. Nilai KHS <80% meningkatkan risiko ulkus diabetik (rasio prevalensi [IK 95%]) 3,28 (1,08–9,99). Penelitian menyimpulkan, perlambatan KHS pada subjek DM dengan ulkus diabetik lebih berat secara bermakna dibanding subjek DM tanpa ulkus diabetik, serta abnormalitas KHS adalah yang lebih berhubungan dengan kejadian ulkus diabetik.

Foot ulcer is by far the most frequently found complication of diabetes, occuring in 15% of the diabetic population, and is the most popular cause of hospital admission and lower extremity amputation of diabetic patients. The risk factors of diabetic ulcers is multifactorial, peripheral neuropathy being the most dominant factor. The severity of the neuropathy may be measured by means of electrodiagnostics. This study is aimed to compare the electrodiagnostic abnormalities (the values of motor nerves conduction studies [MCS] and sensory nerves conduction studies [SCS]) in diabetic subjects with and without ulcers, and assessing the electrodiagnostic variable most associated with the prevalence of diabetic ulcers. A cross sectional study was used on diabetic subjects that underwent an electrodiagnostic studies. Subjects went through a MCS and SCS and were then subjected to statistical analysed. Fifty-six subjects included in this study consisted of 23 subjects with diabetic ulcers and 33 subjects without diabetic ulcers. For MCS, there were significantly differences in median (38,73±9,99 vs 47,15±8,77 m/s, p=0,001) and tibial (28,76±8,48 vs 34,00±7,33 m/s, p=0,030) NCV between diabetic subjects with and without foot ulcers. Distal latency, distal amplitude and proximal amplitude values did not show any significant difference between the two groups. The value of NCV <80% increases the risk of diabetic ulcers (prevalence ratio [95% CI]) 3,28 (1,08–9,99). The study concludes, NCV slowing on diabetic subjects with ulcers is more severe than the diabetic subjects without ulcers, and the NCV abnormality is more closely associated with diabetic ulcers.

Kata Kunci : konduksi saraf – diabetes – ulkus kaki diabetik – neuropati – KHS Korespondensi : Fajar Maskuri, email: [e-mail]