HUBUNGAN KADAR RESISTIN DENGAN SKOR SYNTAX PADA PASIEN ANGINA PEKTORIS STABIL

ZULFAHMI, Dr. Nahar Taufiq, Sp.JP(K)

2014 | Tesis | SP KARDIOLOGI DAN KEDOKTERAN VASKULAR

Latar belakang: Resistin adalah salah satu sitokin inflamasi yang diproduksi oleh monosit/makrofag pada manusia. Resistin diketahui terlibat dalam patogenesis aterosklerosis, dan kadar resistin diasosiasikan dengan penyakit jantung koroner serta risiko kematian kardiovaskular. Beberapa penelitian telah menunjukkan hasil bahwa ada hubungan kadar resistin dengan keparahan lesi koroner, tetapi hasinya tidak konsisten dan sepengetahuan penulis belum ada penelitian yang menghubungkan kadar resistin dengan keparahan lesi pembuluh darah koroner berdasar skor Syntax. Skor Syntax adalah suatu metode penilaian keparahan lesi koroner menggunakan perangkat lunak komputer yang digunakan secara luas dibidang intervensi untuk memprediksi penatalaksanaan berdasarkan kompleksitas anatomi koroner. Penelitian ini bertujuan mengetahui hubungan kadar resistin dengan skor Syntax sebagai metode untuk menilai keparahan lesi koroner pada pasien angina pektoris stabil. Metode: Penelitian potong lintang dilakukan dengan 44 subyek angina pektoris stabil yang memenuhi kriteria inklusi dan eksklusi. Pengambilan darah kadar resistin dilakukan sebelum dilakukan tindakan angiografi koroner. Skor Syntax dinilai oleh dua orang observer dan dilakukan uji kesesuaian (uji kappa). Uji korelasi Pearson atau Spearman dilakukan untuk menganalisis korelasi antara kadar resistin dengan skor Syntax. Uji analisis multivarian dilakukan untuk menilai faktor perancu. Hasil: Rata-rata usia pasien 59.18±8,54 tahun, laki-laki 35 orang (79,5%), wanita 9 orang (20,5%). Yang menderita diabetes 11 (25%), hipertensi 31 (70,5%), dislipidemia 25 orang (56,8%), riwayat keluarga dengan PJK 5 orang (11,4%). Nilai median HDL 45mg/dL (nilai maksimun –minimun 24-141), trigliseride 141mg/dL (56-337), Gula darah sewaktu 110mg/dL (77-293), nilai resistin 387ng/L (295.17-738.89). Penilaian skor Syntax didapatkan nilai kappa 0,611. Uji korelasi antara kadar resistin dengan skor Syntax didapatkan nilai r=0,476 dengan nilai p=0,001. Simpulan: Didapatkan korelasi positif kadar resistin dengan skor Syntax pada pasien angina pektoris stabil.

Background: Resistin is one of the inflammation cytokine that is mainly produced by monocyte/macrofage in human. Resistin has been seen to play a potensial role in pathogenesis of atherosclerosis. Serum resistin levels are associated with coronary artery diasease and the risk of cardiovascular death. Several studies has shown correlation between resistin level and severity of lesion in the coronary arteries, but the results are inconsistent and there is no current study that shows correlation between resistin level with severity of lesion using Syntax score. Syntax score is widely used method in intervension using computer software, to assess severity of coronary artery lesions and predict management strategy by the complexity of coronary artery anatomy. This study examined the correlation between serum resistin level and Syntax score that represent the severity of CAD by angiography. Method: A cross sectional study of 44 stable angina pectoris patients. Subjects were recruited according to inclusion and exclusion criteria. Blood sample for the serum resistin level was drawn before coronary angiography. The severity of CAD was calculated with the Syntax score system. Syntax score measurement was done by two experienced interventionist and then Kappa test was performed. Pearson or Spearman΄ correlattion test were done to analyze the correlation between resistin level and Syntax score, while multivariant analysis was performed to analyze confounding factors. Result: Patients mean age was 59.18±8,54 years old, consisted of 35 males (79.5%), 9 females (20.5%). There were 11 patients (25%) with diabetes, 31 patients (70.5%) with hypertension, 25 (56.7%) patients with dyslipidemia and 5 patients (11.4%) with family history of coronary heart disease. Median value for HDL level 45 mg/dL (24-141), trigliseride (56-337), random blood glucose level 110 mg/dL (77-293), resistin value 387 ng/L (295.17-738.89). Syntax score measurement was done by two experienced interventionist and then kappa test was 0,611. Significant positive correlation was found between serum resistin level and Syntax score (r=0,476, p=0,000). Conclusion: Significant positive correlation was found between serum resistin level and Syntax score.

Kata Kunci : Resistin, angina pektoris stabil, skor Syntax