PERBEDAAN H-REFLEKS PADA PASIEN DIABETES MELITUS DENGAN ULKUS KAKI DIABETIK DAN TANPA ULKUS KAKI DIABETIK

YULIAWATI, dr. Ahmad Asmedi, M.Kes. SpS(K).

2015 | Tesis | SP ILMU PENYAKIT SYARAF

Peningkatan prevalensi diabetes menyebabkan peningkatan prevalensi komplikasi jangka panjang terkait diabetes. Salah satu komplikasi tersebut adalah ulkus kaki diabetik. Ulkus kaki diabetik dapat dicegah dengan identifikasi dan penanganan faktor resiko. Salah satu faktor resiko utama ulkus kaki diabetik adalah neuropati. H-refleks merupakan pemeriksaan elektrodiagnostik yang dapat digunakan untuk identifikasi dan diagnosis neuropati diabetika. Namun penelitian H-refleks pada ulkus kaki diabetik masih sedikit. Penelitian ini menggunakan rancangan cross sectional. Subjek penelitian terdiri 35 pasien DM dengan ulkus kaki diabetik dan 35 pasien DM tanpa ulkus kaki diabetik. Pemeriksaan H-refleks Soleus dilakukan terhadap kedua kelompok sehingga didapatkan parameter H-refleks Soleus berupa latensi H, amplitudo H, latensi M dan amplitudo H. Perbandingan parameter H-refleks menunjukkan perbedaan bermakna secara statistik baik berupa latensi H, amplitudo H, latensi M dan amplitudo M antara pasien DM dengan ulkus kaki diabetik dan pasien DM tanpa ulkus kaki diabetik. Latensi H pasien DM dengan ulkus kaki diabetik latensi H berkisar 122% dari nilai normal dan pasien DM tanpa ulkus kaki diabetik berkisar 108% dari nilai normal. Amplitudo H pasien DM dengan ulkus kaki diabetik berkisar 28,3% dari nilai normal dan pasien DM tanpa ulkus kaki diabetik berkisar 12,1%. Latensi M pasien DM dengan ulkus kaki diabetik berkisar 113% dan pasien DM tanpa ulkus kaki berkisar 97%. Kesimpulan penelitian ini adalah latensi H dan latensi M pasien DM dengan ulkus kaki diabetik lebih memanjang dibandingkan pasien DM tanpa ulkus. Amplitudo H dan amplitudo M pasien DM dengan ulkus kaki diabetik lebih rendah dibandingkan kelompok DM tanpa ulkus

The prevalence of diabetes mellitus (DM) is increasing dramatically worldwide. As the prevalence of diabetes increases, the prevalence of long-term diabetes-related complications is also likely to increase. One of the long-term complications of diabetes mellitus in the lower extremities is a diabetic foot ulcer. Diabetic foot ulcers can be prevented with the identification and management of risk factors. One of the main risk factors underlying the development of diabetic foot ulcers is neuropathy. H-reflex is electrodiagnostic studies that can be used for the identification and diagnosis of diabetic neuropathy. But, H-reflex study in patients with diabetic foot ulcers is still limited and there has been no study comparing examination of the H-reflex in diabetic patients with diabetic foot ulcers and diabetic patients without diabetic foot ulcers. This study used cross sectional design. The population of the subject comprised of 35 diabetic patients with diabetic foot ulcers and 35 diabetic patients without diabetic foot ulcers. H-reflex examination were done in both of group to obtain the H-reflex parameters such as H latency, H amplitude, M latency and M amplitude. Comparison of the H-reflex parameters showed statistically significant differences in all parameters of the H-reflex including H latency, H amplitude, M latency and M amplitude between diabetic patients with and without diabetic foot ulcers. The H Latency in diabetic patients with diabetic foot ulcers is 122% of the normal value and 108% of normal value in diabetic patients without diabetic foot ulcers. The H amplitude in diabetic patients with diabetic foot ulcers was 28.3% of the normal value and 12,1 % of the normal value in diabetic patients without diabetic foot ulcers. M Latency in diabetic patients with diabetic foot ulcers is 113% of the normal value and 97% of the normal value in diabetic patients without foot. The conclusion of this study are the H and M latency in patients with diabetic foot ulcers were more prolonged than DM patients without ulcers. The H and M amplitude were more decreased in diabetic patients with diabetic foot ulcers than without ulcer.

Kata Kunci : H-refleks, Neuropati diabetika, ulkus kaki diabetik