PENGARUH PEMBERIAN METFORMIN DAN TELMISARTAN TERHADAP PROFIL LIPID PADA PENDERITA SINDROMA METABOLIK DENGAN NON ALCOHOLIC FATTY LIVER DISEASE

TIWI CHARISMA, dr. Putut Bayupurnama, SpPD-KGEH; dr. Hemi Sinorita, SpPD-KEMD,

2015 | Tesis | SP Ilmu Penyakit Dalam

Latar belakang: Sindroma metabolik adalah sindroma yang ditandai kumpulan faktor risiko penyakit kardiovaskular pada seorang individu meliputi dislipidemia, peningkatan glukosa darah, hipertensi dan obesitas. Non Alcoholic Fatty Liver Disease (NAFLD) dianggap merupakan manifestasi hepatik sindroma metabolik dengan resistensi insulin sebagai inti mekanisme patogenesisnya. Hubungan antara resistensi insulin dengan terjadinya NAFLD menyebabkan pemakaian obat- obatan yang meningkatkan sensitivitas insulin berguna untuk pencegahan dan perbaikan NAFLD. Tujuan: untuk mengetahui pengaruh pemberian metformin dan telmisartan terhadap profil lipid penderita sindroma metabolik dengan NAFLD. Metode: menggunakan before after design. Penelitian dilakukan di klinik Penyakit Dalam sub bagian Endokrinologi RSUP Dr. Sardjito Yogyakarta. Subyek penelitian adalah penderita sindroma metabolik sesuai kriteria IDF 2006 dengan NAFLD. Subyek diberikan terapi metformin dan telmisartan selama 12 minggu. Profil lipid diperiksa sebelum dan sesudah terapi. Perbedaan rerata sebelum dan sesudah terapi diuji dengan paired t-test atau tes Wilcoxon. Tingkat kemaknaan bila p<0,05 dengan interval kepercayaan 95%. Hasil: Terkumpul 19 subyek penelitian. Analisis data dilakukan terhadap 13 subyek. Kolesterol LDL mengalami penurunan bermakna setelah terapi, p=0,024 (4,04 - 46,57), IK 95%. Kadar trigliserida mengalami penurunan tidak bermakna, sedangkan kolesterol HDL tidak meningkat. Kesimpulan: terdapat penurunan bermakna salah satu parameter profil lipid yaitu kolesterol LDL setelah pemberian metformin dan telmisartan pada penderita sindroma metabolik dengan NAFLD.

Background: Metabolic syndrome is characterized by constellation cardiovascular disease risk factors including dyslipidemia, elevated blood glucose, hypertension and obesity. Non Alcoholic Fatty Liver Disease (NAFLD) is considered as hepatic manifestation of metabolic syndrome with insulin resistance as the main pathogenetic mechanism. The relationship between insulin resistance and NAFLD causes drugs therapy that improve insulin sensitivity are useful for prevention and improvement of NAFLD. Objective: To determine the effect of metformin and telmisartan on lipid profile in patients with metabolic syndrome and NAFLD. Methods: This study used before after design. The study was conducted in the subdivision clinic of Endocrinology, Dr. Sardjito General Hospital Yogyakarta. Subjects were patients with metabolic syndrome according to IDF criteria 2006 and NAFLD. Subjects were given metformin and telmisartan therapy for 12 weeks. Lipid profile were examined before and after therapy. Mean difference before and after therapy were assessed by paired t-test or Wilcoxon test. P value < 0,05 was considered significant with 95% confidence interval. Results: Total sample were 19 subjects. Analysis was conducted on 13 subjects. LDL cholesterol decreased significantly after treatment, p=0,024 (4,04 - 46,57), CI 95%. Triglyceride levels decreased nonsignificant, whereas HDL cholesterol did not increase. Conclusion: there was significant decrease in lipid profile parameter which was LDL cholesterol after metformin and telmisartan therapy in patients with metabolic syndrome and NAFLD.

Kata Kunci : sindroma metabolik, non-alcoholic fatty liver disease (NAFLD), profil lipid, metformin, telmisartan ; metabolic syndrome, non-alcoholic fatty liver disease (NAFLD), lipid profile, metformin, telmisartan