PENGARUH PEMBERIAN METFORMIN DAN VALSARTAN TERHADAP KADAR ADIPONEKTIN PADA PASIEN SINDROMA METABOLIK

AGUS SUKAMTO, dr. R. Bowo Pramono, SpPD, KEMD.; dr. Hemi Sinorita, SpPD, KEMD

2015 | Tesis-Spesialis | SP Ilmu Penyakit Dalam

Latar belakang: Sindroma metabolik adalah prediktor utama morbiditas dan mortalitas kardiovaskuler dan diabetes melitus tipe 2. Sindroma ini ditandai dengan obesitas sentral, hipertensi, resistensi insulin dan dislipidemia aterogenik. Adiponektin adalah hormon yang disekresi oleh jaringan adiposa dan memiliki kemampuan anti diabetes, anti inflamasi dan anti aterogenik. Kadar adiponektin yang rendah ditemukan pada kondisi resistensi insulin. Rekomendasi terapi untuk komponen resistensi insulin adalah pemberian metformin dan obat generasi yang lebih baru dari golongan thiazolidindion. Metformin selain memiliki kemampuan untuk komponen resistensi insulin juga mampu meningkatkan adiponektin. Valsartan sebagai agonis angiotensin II receptor blocker dapat mengaktivasi PPARgama yang memberikan efek peningkatan kadar adiponektin. Pemberian kombinasi kedua obat ini diharapkan mampu memberikan efek sinergis kenaikan kadar adiponektin. Tujuan: untuk mengetahui pengaruh pemberian metformin dan valsartan terhadap kadar adiponektin pada pasien sindroma metabolik. Metode: menggunakan one group pretest-posttest design. Penelitian dilakukan di klinik Penyakit Dalam sub bagian Endokrinologi RSUP Dr. Sardjito Yogyakarta. Subyek penelitian adalah pasien sindroma metabolik sesuai kriteria IDF 2006. Subyek diberikan terapi metformin dan valsartan selama 12 minggu. Kadar adiponektin 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: Didapatkan 23 subyek penelitian. Analisis data dilakukan terhadap 22 subyek. Rerata kadar adiponektin mengalami peningkatan bermakna dari 3,63 mcg/ml (1,34-6.04) sebelum terapi menjadi 31,17 mcg/ml (17,18-101,73) setelah terapi 12 minggu (p=<0,001, IK 95%). Kesimpulan: Pemberian metformin dan valsartan selama 12 minggu dapat meningkatkan kadar adiponektin secara bermakna pada pasien sindroma metabolik.

Background: The metabolic syndrome is a major predictor of morbidity and mortality of cardiovascular and diabetes mellitus type 2. This syndrome is characterized by central obesity, hypertension, insulin resistance and atherogenic dyslipidemia. Adiponectin is a hormone secreted by adipose tissue and have antidiabetic, anti-inflammatory and anti-atherogenic. Low levels of adiponectin are found in conditions of insulin resistance. Recommended therapy for insulin resistance is a component of metformin and a newer generation of drugs from the class of thiazolidindion. Metformin in addition to having the ability to components of insulin resistance can also increase adiponectin. Valsartan as agonists Angiotensin II receptor blockers can activate PPAR-gama which gives the effects of an increase in adiponectin levels. Combination of both drugs are expected to provide a synergistic effects of the increase in adiponectin levels. Objective: The aim of this study was to examine the effects of metformin and valsartan on levels of adiponectin in patients with metabolic syndrome. Methods: This study used a one group pretest-posttest design. The study was observed at the clinic of internal medicine in subdivision of endocrinology and metabolic diabetes Dr. Sardjito general hospital. The subjects is patients with metabolic syndrome, it is adjusted to criteria of IDF 2006. The subjects were given metformin and valsartan for 12 weeks. Adiponectin levels were measured at baseline and at the end of the study. Mean difference before and after treatment were tested by paired t-test or Wilcoxon test. Level of significance when p <0.05 with a confidence interval of 95%. Results: There were 23 study subjects. Analysis was conducted on 22 subjects. Mean adiponectin levels increased significantly from 3.63 mcg / ml (1,34-6.04) before therapy to 31.17 mcg / ml (17.18 to 101.73) after 12 weeks of therapy (p = <0.001, CI 95% ). Conclusions: Metformin and valsartan administration for 12 week significantly increased adiponectin levels in patients with metabolic syndrome.

Kata Kunci : metabolic syndrome, adiponectin, metformin, valsartan