Ekspresi tenascin-C yang tinggi pada ligamentum sakrouterina sebagai faktor risiko terjadinya prolaps uterus derajat III-IV di RSUP Sanglah Denpasar, Bali-Indonesia - I Wayan Megadhana; Riza Firman Satria; Ketut Suwiyoga; I Gusti Putu Mayun Mayura; Putu Doster Mahayasa; I Nyoman Bayu Mahendra (Intisari Sains Medis, 2020)
Introduction: Uterine prolapse is the descent of the uterus into the vagina or out of the vagina as a result of the failure of the ligament as a pelvic support. Uterine prolapse has multifactorial risk factors, but in every case of uterine prolapse, weakness is found in the pelvic floor supporting tissues, including the sacrouterine ligament. Childbirth is direct trauma that cause damage and weakness of levaor ani muscle, which leads to stretch of sacrouterine ligament that plays important role in maintaining uterus in its normal position. The main structure of the sacrouterine ligament consists of cells and extracellular matrix such as collagen, elastin, glycoproteins (fibronectin, tenascin, link protein, fibromodulin and dan osteopontin) and proteoglycans (agrecan, versican, biglican, dan perlecan). Tenascin is a major oligomeric glycoprotein found in the extracellular matrix. Tenascin has an important role not only during development but also when there are pathological conditions in adulthood such as tissue injury and tumorigenesis. Based on the current research, there are four tenascin groups, that are: tenascin-C, tenascin-R, tenascin-X, tenascin-Y and tenascin-W. If there is an expression of tenascin-C disturbance  in the sacrouterine ligament, it will cause uterine prolapse. The purpose of this study was to prove the high expression of tenascin-C in the sacrouterine ligament as a risk factor for stage III-IV uterine prolapse.Method: This research is an observational study with case control design. Forty four cases was included in this study. Twenty-two cases of III-IV degree uterine prolapse as study group and another 22 non-prolapse cases as a control group. This research was carried out in Sanglah General Hospital and Patobiology Laboratory of the Faculty of Veterinary Medicine UNUD. Samples were taken from the sacrouterine ligament of grade III-IV uterine prolapse patients and uterine non-prolapse patients, that had been performed total hysterectomy.Result: The results showed that high tenascin-C expression was a risk factor for stage III - IV uterine prolapse by 5.9 times (OR = 5.9; IK 95% = 1.59-22.32; p = 0.006).Conclusion: It can be concluded  that high expression of tenascin-C in the sacrouterine ligament is a risk factor of III-IV degree uterine prolapse.  Latar Belakang: Prolaps uterus adalah turunnya uterus ke dalam liang vagina atau keluar liang vagina sebagai akibat gagalnya ligmentum penyokong dasar panggul. Prolaps uterus memiliki faktor risiko yang bersifat multifaktorial, namun pada setiap  kasus prolaps uterus, selalu ditemukan kelemahan pada jaringan penyangga dasar panggul, termasuk ligamentum sakrouterina. Trauma langsung pada jalan lahir yang mengakibatkan kerusakan dan kelemahan otot levaor ani sehingga mengakibatkan ligamentum sakrouterina meregang untuk mempertahankan uterus dalam posisi normal. Struktur utama ligamen sakrouterina terdiri dari sel dan matriks ekstraseluler seperti kolagen, elastin, glikoprotein (fibronectin, tenascin, link protein, fibromodulin ) dan proteoglikan (agrecan, versican, biglican, dan perlecan). Tenascin merupakan suatu glikoprotein oligomerik utama yang terdapat pada matriks ekstraseluler. Tenascin memiliki peranan penting tidak hanya pada masa perkembangan tetapi juga saat terjadi kondisi patologis pada usia dewasa  seperti cedera jaringan dan tumorigenesis. Berdasarkan penelitian saat ini,  dikenal empat kelompok tenascin yaitu : tenascin-C, tenascin-R, tenascin-X, tenascin-Y dan tenascin-W. Apabila terjadi gangguan dalam ekspresi tenascin-C pada ligamentum sakrouterina akan menyebabkan terjadinya prolaps uterus. Tujuan penelitian ini adalah untuk membuktikan ekspresi tenascin-C yang tinggi pada ligamentum sakrouterina sebagai faktor risiko terjadinya prolaps uterus derajat III-IV.Metode: Penelitian ini merupakan rancangan observasional dengan kasus kontrol. Terdapat  22 kasus prolaps uterus derajat III-IV sebagai kelompok kasus dan 22 kasus non prolaps sebagai kelompok kontrol. Penelitian ini dikerjakan di RSUP Sanglah dan Laboratorium Patobiologi FKH UNUD. Sampel diambil dari ligamentum sakrouterina pasien prolaps uterus derajat III-IV dan  non-prolaps uterus yang telah dilakukan histerektomi total.Hasil: Hasil penelitian didapatkan bahwa ekspresi tenacin-C yang tinggi merupakan faktor risiko terjadinya prolaps uterus derajat III - IV sebesar 5,9 kali (OR =5,9; IK 95% =1,59-22,32; p =0,006).Simpulan: Sehingga dapat disimpulkan bahwa ekspresi tenascin-C yang tinggi pada ligamentum sakrouterina sebagai faktor risiko terjadinya prolaps uterus derajat III-IV.