Tesis

Aktivasi Koagulasi dan Produk Akhir Glikasi pada Cairan Vitreus Pasien Retinopati Diabetik tipe Proliferatif = Activation of coagulation and advanced glycation end products in vitreous humour proliferative diabetic retinopathy patients.

Latar belakang: Retinopati diabetik merupakan komplikasi mikrovaskular DM. Akumulasi AGEs menyebabkan disfungsi endotel, aktivasi koagulasi, dan peningkatan VEGF. D-dimer merupakan petanda aktivasi koagulasi dan fibrinolisis. Tujuan: Penelitian ini bertujuan untuk mengetahui kadar AGEs dan D-dimer cairan vitreus, serta mencari korelasi antara D-dimer dengan HbA1c dan AGEs pada pasien retinopati diabetik tipe proliferatif. Pasien dan metode: Penelitian dilakukan pada 47 sampel cairan vitreus penyandang retinopati diabetik tipe proliferatif dengan desain analitik korelasi pada bulan Juni 2017. Kadar HbA1c darah merupakan data sekunder dari penelitian Victor et al. Kadar D-dimer vitreus ditentukan dengan VIDAS D-Dimer Exclusion II Assay dari Bio Mérieux, dan kadar AGEs vitreus ditentukan dengan OxiSelect Advanced Glycation End Products ELISA Kit Cell dari Biolabs di Departemen Patologi Klinik FKUI-RSCM. Hasil: Kadar D-dimer vitreus disajikan dalam rentang 44–37394 ng/mL dengan median 5.446 ng/mL. Kadar AGEs vitreus disajikan dalam rentang 3-48 μg/mL dengan median 11 μg/mL. Rerata kadar HbA1c darah 8,47±0,28%. Terdapat korelasi positif yang bermakna dengan kekuatan sedang antara kadar HbA1c darah dengan AGEs vitreus (r=0,524; p=0,0001), korelasi positif bermakna dengan kekuatan lemah antara HbA1c darah dengan D-dimer vitreus (r=0,324; p=0,019), dan korelasi positif bermakna dengan kekuatan lemah antara kadar D-dimer dengan AGEs vitreus (r=0,292; p=0,046). Kesimpulan: Pada penelitian ini, pasien retinopati diabetik tipe proliferatif memiliki kadar D-dimer vitreus dengan median 5.446 ng/mL (44–37394 ng/mL), kadar AGEs vitreus dengan median 11 μg/mL (3-48 μg/mL). Terdapat korelasi positif bermakna dengan kekuatan sedang antara kadar HbA1c dengan D-dimer vitreus dan korelasi positif bermakna dengan kekuatan lemah antara kadar HbA1c dengan AGEs vitreus, dan antara D-dimer dan AGEs vitreus.
Kata kunci: D-dimer vitreus, AGEs vitreus, Retinopati Diabetik Tipe Proliferatif


Background: Diabetic retinopathy is a microvascular complication of diabetic mellitus. Accumulation of AGEs (advanced glycation end products) results in endothelial dysfunction, coagulation activation, and increased VEGF. D-dimers are a sign of coagulation and fibrinolysis activation. Objective: The aim of this study was to determine the levels of AGEs and D-dimer of vitreous fluid as well as find a correlation between D-dimers and AGEs vitreous with HbA1c in proliferative diabetic retinopathy patients. Patients and methods: The study was conducted on 47 vitreous fluid samples from proliferative diabetic retinopathy patients with analytic correlative design in June 2017. HbA1c level was a secondary data from the study of Victor et al. The D- dimer vitreous levels were determined by VIDAS D-Dimer Exclusion II Assay of Bio Mérieux, and AGEs vitreous levels were determined by OxiSelect Advanced Glycation End Products ELISA Kit Cell from Biolabs. The study took place in Clinical Pathology Departement, Faculty of Medicine University of Indonesia – DR Cipto Mangunkusumo National General Hospital Results: D-dimer vitreous levels ranged from 44-37394 with median 5,446 ng/mL. AGEs vitreous levels ranged from 3-48μg/mL with median of 11μg/mL. HbA1c level mean was 8.47±0.28%. There was a significant positive correlation with moderate strength between HbA1c and AGEs vitreous (r=0.524; p=0,0001), a weak strength positive correlation between HbA1c and D-dimer vitreous (r=0.324; p=0,019), and a weak strength positive correlation between D-dimer and AGEs vitreous (r=0.292; p=0,046). Conclusion: From this study, D-dimer vitreous median level was 5,446 ng/mL (ranged from 44 to 37394 ng/mL). AGEs vitreous median level was 11 μg/mL (ranged from 3 to 48 μg/mL). There was a significant positive correlation with moderate strength between HbA1c and D-dimer vitreous levels and a significant weak strength positive correlation between HbA1c and AGEs vitreous levels, and between D-dimers and AGEs vitreous.
Key words: D-dimer vitreous, AGEs vitreous, proliferative diabetic retinopathy