Pengaruh pemberian Metformin dan Valsartan terhadap kadar asam lemak bebas pada penderita sindroma metabolik dengan non-alcoholic fatty liver disease

DODDY SUDARMANTO, dr. Putut Bayupurnama, SpPD-KGEH; dr. Hemi Sinorita, SpPD-KEMD

2015 | Tesis-Spesialis | 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 sentral. Non Alcoholic Fatty Liver Disease (NAFLD) dianggap merupakan manifestasi hepatal dari sindroma metabolik dengan resistensi insulin sebagai kunci patogenesisnya. Asam lemak bebas mempunyai peranan penting terhadap terjadinya sindroma metabolik. Metformin menurunkan asam lemak bebas plasma dengan menurunkan efflux asam lemak bebas dan memperbaiki sensitivitas insulin perifer. Valasartan merupakan agonis PPAR-gamma dan obat ini diharapkan memperbaiki sensitivitas insulin. Tujuan : mengetahui efek pemberian metformin dan valsartan terhadap kadar asam lemak bebas pada penderita sindroma metabolik dengan NAFLD. Metode : penelitian ini menggunakan before-after design. Penelitian dilakukan di poliklinik Endokrinologi RSUP Dr. Sardjito Yogyakarta. Waktu penelitian dimulai bulan Mei 2012 sampai bulan Maret 2013. Subyek penelitian adalah pasien dengan sindroma metabolik sesuai kriteria IDF 2006 dengan NAFLD. Subyek diberikan terapi metformin dan valsartan selama 12 minggu. Asam lemak bebas plasma 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 15 subyek penelitian yang memenuhi kriteria inklusi dan eksklusi. Didapatkan penurunan kadar asam lemak bebas yang bermakna setelah pemberian metformin dan valsartan selama 12 minggu {p=0,01(107,897-697,231),Interval kepercayaan 95%}. Penurunan kadar asam lemak bebas ini sejalan dengan perbaikan parameter sindroma metabolik yang meliputi turunnya berat badan dan kadar gula darah puasa walaupun hasilnya tidak bermakna secara statistik. Kesimpulan : Terdapat penurunan kadar asam lemak bebas plasma secara bermakna sesudah pemberian metformin dan valsartan selama 12 minggu pada penderita sindroma metabolik dengan NAFLD

Background : Metabolic syndrome is characterized by constellation of individual cardiovascular disease risk factors including dyslipidemia, elevated blood glucose, hypertension, and central obesity. Non Alcoholic Fatty Liver Disease (NAFLD) is considered as hepatic manifestation of metabolic syndrome with insulin resistance's role in its pathogenesis. Free fatty acids play an important role for the occurrence of metabolic syndrome. Metformin lowers plasma free fatty acids by decreasing efflux of free fatty acids and improve peripheral insulin sensitivity. Valsartan is an agonist of PPAR gamma and the drug is expected to improve insulin sensitivity. Objective : This study aimed to determine the effects of metformin and valsartan therapy on reducing free fatty acid levels in patients with metabolic syndrome and NAFLD. Methods : The study used a before-after design. The study was conducted in the Endocrinology Clinic, Dr. Sardjito Hospital,Yogyakarta. The study began in May 2012 until March 2013. Subjects were patients with metabolic syndrome according to IDF 2006 and NAFLD. Subjects given metformin and valsartan therapy for 12 weeks. The difference of free fatty acid before and after treatment were statistically assessed by paired-t test or tes Wilcoxon. P value < 0,05 was considered significant with 95% confidence interval. Results: There are 15 subjects who met the inclusion and exclusion criteria in this study. Mean plasma free fatty acids levels decreases significantly after administration of metformin and valsartan for 12 weeks, {p=0,01(107,897-697,231), 95% confidence interval}. This finding was in line with the improvements on metabolic syndrome parameters including weight loss and fasting blood glucose levels even though the results were not statistically significant. Conclusion : There was significant decrease in levels of plasma free fatty acids after metformin and valsartan therapy for 12 weeks in patients with metabolic syndrome and NAFLD

Kata Kunci : sindroma metabolik, non alcoholic fatty liver disease (NAFLD), asam lemak bebas, metformin,valsartan, metabolic syndrome, non alcoholic fatty liver disease (NAFLD), free fatty acids level, metformin,valsartan