Augusta Y. L. Arifin
Divisi Endokrinologi dan Metabolik, Departemen Ilmu Penyakit Dalam Fakultas Kedokteran Rumah Sakit Dr. Hasan Sadikin Bandung

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Kadar Hypoxia Inducible Factor-1α pada Penderita Diabetes Melitus Tipe 2 Disertai Mikroalbuminuria dan Retinopati Hoo, Yumilia; Permana, Hikmat; Soetedjo, Nanny Natalia M; Arifin, Augusta Y. L.
Majalah Kedokteran Bandung Vol 46, No 2 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Diabetes melitus tipe 2 (DMT2) sampai saat ini masih menjadi masalah kesehatan karena bersifat progresif dan menimbulkan komplikasi. Menurut data epidemiologi dari International Diabetes Federation (IDF) tahun 2011, dinyatakan bahwa retinopati diabetik sering kali mendahului mikroalbuminuria. Komplikasi tersebut diawali oleh disfungsi endotel yang akan meningkatkan sekresi sitokin yang menginduksi angiogenesis dan limpangiogenesis. Pada keadaan hipoksia akibat perubahan mikrovaskular, hypoxia inducible factor-1 alpha (HIF-1α) disekresikan dan akan merangsang produksi vascular endothelial growth factor (VEGF) yang menginduksi angiogenesis. Penelitian ini bertujuan untuk mengetahui hubungan kadar HIF-1α plasma penderita DMT2 dengan mikroalbuminuria dan retinopati diabetik. Penelitian menggunakan rancangan studi potong lintang terhadap 158 penderita DMT2 yang berobat di poliklinik endokrinologi Rumah Sakit Dr. Hasan Sadikin Bandung periode Juli─Desember 2012. Data dianalisis menggunakan uji-t, Mann Whitney, dan multivariate analysis of variance (MANOVA). Subjek penelitian terdiri atas 82 orang pria (51,9%) dan 76 orang wanita (48,1%). Delapan puluh orang (50,6%) normoalbuminuria dan 78 orang (49,4%) mikroalbuminuria. Pada penelitian ini didapatkan 38 orang dengan retinopati diabetik (24,1%). Median kadar HIF-1α kelompok mikroalbuminuria adalah 0,103 (0,041–0,735) ng/mL dan pada normoalbuminuria 0,144 (0,041–0,481) ng/mL (p=0,257). Median kadar HIF-1α kelompok retinopati positif 0,041 (0,041–0,33) ng/mL, sedangkan kelompok tanpa retinopati 0,167 (0,041–0,735) ng/mL dengan p<0,01. Simpulan, kadar HIF-1α plasma yang rendah atau normal bergantung pada derajat retinopati diabetik. Kadar HIF-1α plasma yang tinggi pada penderita tanpa retinopati diabetik, menunjukkan akan terjadi retinopati diabetik di masa mendatang. [MKB. 2014;46(2):100–5]Kata kunci: Hypoxia inducible factor-1α, mikroalbuminuria, retinopati diabetikHypoxia Inducible Factor-1α in Type 2 Diabetes Mellitus with Microalbuminuria and RetinopathyType 2 diabetes mellitus (T2DM) is still considered a major problem in healthcare, mainly for its progressivity and complications. According to the epidemiological data from the International Diabetes Federation (IDF) in 2011, it is stated that microalbuminuria often precedes the onset of diabetic retinopathy. Complications are preceded by endothelial dysfunction that will increase the secretion of cytokines inducing angiogenesis and limpangiogenesis. In hypoxic conditions induced by microvascular changes, hypoxia inducible factor-1 alpha (HIF-1α) is secreted, stimulating the production of vascular endothelial growth factor (VEGF) which induce angiogenesis. The aim of this study was to know the correlation between plasma HIF-1α concentration with microalbuminuria pattern and diabetic retinopathy in T2DM patients. This cross-sectional study was conducted on 158 T2DM patients in Endocrinology Outpatient Departement of Dr. Hasan Sadikin Hospital during July to December 2012. Data were analyzed using t-test, Mann Whitney, and multivariate analysis of variance (MANOVA) methods. Eighty two males (51.9%) and 76 females (48.1%) participated in the study, making up 158 subjects. Eighty patients (50.6%) had normoalbuminuria and 78 patients (49.4%) had microalbuminuria. Thirty eight patients were found with diabetic retinopathy (24.1%). The median of HIF-1α plasma concentrations was 0.103 (0.041–0.735) ng/mL in the microalbuminuria group and 0.144 (0.041–0.481) ng/mL (p=0.257).in the normoalbuminuria group. The median of HIF-1α plasma concentration in the group with diabetic retinopathy was 0.041 (0.041–0.33) ng/mL, while in the group without diabetic retinopathy the median was 0.167 (0.041–0.735) ng/mL (p<0.01). In conclusion, low or normal HIF-1α plasma levels in patients without diabetic retinopathy predict the grading of diabetic retinopathy, while high levels of plasma HIF-1α suggests the likehood of retinopathy event in the future. [MKB. 2014;46(2):100–5]Key words: Diabetic retinopathy, hypoxia inducible factor-1α, microalbuminuria DOI: 10.15395/mkb.v46n2.281
Hypercoagulable State dan Diabetes Melitus Tipe 2: Korelasi antara Fibrinogen dan HbA1c Aprijadi, Hery; Sumantri, Rachmat; Heri, Trinugroho; Irani, Pandji; Oehadian, Amaylia; Arifin, Augusta Y. L.
Majalah Kedokteran Bandung Vol 46, No 1 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Hiperkoagulabilitas merupakan penyebab kelainan vaskular pada diabetes melitus tipe 2 (DM tipe 2). Fibrinogen merupakan petanda hiperkoagulabilitas akibat inflamasi sistemik. Kadar HbA1c dipakai untuk menilai kadar gula darah jangka panjang dan berhubungan dengan petanda inflamasi. Terdapat perbedaan hasil penelitian terdahulu tentang bagaimana hubungan antara kadar fibrinogen dan HbA1c. Ada yang menyatakan hubungan bermakna dan ada pula yang tidak. Tujuan penelitian ini untuk melihat adakah korelasi antara fibrinogen dan HbA1c. Penelitian ini merupakan penelitian potong lintang pada penderita rawat jalan DM tipe 2 di RS Dr. Hasan Sadikin Bandung selama Januari−Juli 2010. Kriteria inklusi penderita DM tipe 2 yang baru didiagnosis, normotensi, kadar hemoglobin normal, serta tes fungsi hati dan ginjal normal. Dilakukan pemeriksaan kadar fibrinogen, trigliserida, dan HbA1c. Kriteria eksklusi yaitu mendapat obat antiagregasi trombosit, obat antidiabetik oral, atau menderita penyakit autoimun. Analisis statistik berupa Spearman dan regresi digunakan pada penelitian ini. Terdapat 63 subjek yang diikutkan dalam penelitian. Semua subjek memiliki kadar HbA1c lebih dari 6,5% (rata-rata 8,21±2,5%). Terdapat 33 penderita (53%) dengan kadar fibrinogen di atas harga normal (rata-rata 416,75±102,7 mg/dL). Tidak terdapat korelasi yang bermakna antara kadar fibrinogen dan HbA1c. Simpulan, tidak terdapat korelasi antara kadar fibrinogen dan HbA1c. Meskipun demikian subjek dengan diabetes melitus cenderung mempunyai kadar fibrinogen yang tinggi. [MKB. 2014;46(1):48–51]Kata kunci: Diabetes melitus tipe 2, fibrinogen, HbA1c, hypercoagulable state Hypercoagulable State and Type 2 Diabetes Mellitus: the Correlation between Fibrinogen and HbA1cHypercoagulability has been suggested as a result of type 2 diabetic mellitus vascular disease. Fibrinogen is a marker of hypercoagulability due to systemic inflammation. HbA1c level is used to measure long-term blood glucose level. There was inconsistent findings about the correlation between fibrinogen level and HbA1c. Previous study found a significant correlation between fibrinogen levels and HbA1c, while other study showed different results for this finding. The aim of this study was to determine the correlation between fibrinogen and HbA1c. A cross-sectional study was performed in outpatients type 2 diabetes mellitus (DM) in Dr. Hasan Sadikin General Hospital Bandung during January−July 2010. Patients with newly diagnosed type 2 DM, normotension, normal hemoglobin level, normal liver function test and normal kidney function test were included in this study. Fibrinogen, trigliseride, and HbA1c levels were examined. The exclusion criteria were patients taking antiplatelet drugs or oral antidiabetic and had autoimmune diseases. Spearman and regression analysis were used in this study. Sixty three subjects were included in this study. All subjects had HbA1c level more than 6.5% (mean 8.21±2.5%). Thirty three patients (53%) had fibrinogen level of more than the normal limit (mean 416.75±102.7 mg/dL). The mean of trigliseride level was 235.32±131.3 mg/dL. No significant correlation between fibrinogen and HbA1c. In conclusion, there is no correlation between the fibrinogen levels and HbA1c. However, subjects with diabetes mellitus tend to have high fibrinogen levels. [MKB. 2014;46(1):48–51]Key words: Fibrinogen, HbA1c, hypercoagulable state, type 2 diabetes mellitus DOI:  10.15395/mkb.v46n1.227