Tesis

Hubungan HIF-1α, Leukosit, dan CRP pada Luka Kaki Diabetes yang menjalani Debridemen dan Amputasi = Relationship of HIF-1α, Leukocytes, and CRP in Diabetic Foot Ulcers undergoing Debridement and Amputation.

Latar Belakang: Luka kaki diabetes merupakan salah satu komplikasi diabetes melitus dengan tingkat disabilitas, morbiditas, dan mortalitas yang tinggi. Sebanyak 15% pasien dengan luka kaki diabetes harus menjalani amputasi pada ekstremitas bawah. Selain risiko amputasi yang tinggi, kaki diabetes juga menimbulkan beban ekonomi bagi pasien yaitu sekitar 20% dari biaya pengobatan DM dihabiskan untuk perawatan luka kaki diabetes. Tujuan: Penelitian ini bertujuan untuk menganalisis hubungan HIF-1α, Leukosit, dan CRP pada Luka Kaki Diabetes yang menjalani Debridemen dan Amputasi, sehingga dapat dijadikan dasar dalam melakukan tata laksana yang tepat untuk pasien Luka kaki diabetes. Metode: Desain penelitian potong lintang (cross sectional). Subjek penelitian penderita luka kaki diabetes yang berobat ke RSUPN dr. Cipto Mangunkusumo, diambil data dasar (jenis kelamin dan usia), pemeriksaan klinis, pemeriksaan laboratorium (darah perifer lengkap, hitung jenis leukosit, glukosa darah, dan CRP). Selanjutnya biopsi jaringan luka kaki diabetes saat operasi debridement dan amputasi untuk pemeriksaan ekspresi HIF-1α secara biomolekular dengan pemeriksaan ELISA. Hasil: Subyek penelitian 30 pasien Luka kaki diabetes, amputasi 15 pasien dan debridemen 15 pasien. Usia rerata kelompok amputasi 51 tahun, dan kelompok debridement 54 tahun. Jenis kelamin laki-laki 50% dan perempuan 50%. Karakteristik laboratorium, GDS kelompok amputasi rerata 211 dan kelompok debridement 186. Laboratorium penanda inflamasi CRP dan Leukosit dua kelompok tidak didapatkan perbedaan bermakna (p > 0.05). Ekspresi HIF-1α pada pemeriksaan Elisa didapatkan perbedaan bermakna antara kelompok amputasi dan debridement (p=0.007). Korelasi antara HIF-1α, Leukosit, dan CRP tidak signifikan. Nilai korelasi signifikan pada hubungan CRP dengan Leukosit, p < 0,001. Kesimpulan: Didapatkan perbedaan signifikan ekspresi HIF-1α pada luka kaki diabetes yang dilakukan debridemen dan amputasi. Akan tetapi tidak ada korelasi yang signikan antara HIF-1α, leukosit, dan CRP pada luka kaki diabetes yang dilakukan debridemen dan amputasi. Dan didapatkan korelasi yang signifikan antara nilai leukosit dan CRP pada pasien luka kaki diabetes yang dilakukan amputasi dan debridement.
Kata Kunci: CRP, HIF-1α, Leukosit, Luka kaki diabetes.


Background: Diabetic foot ulcers are one of the complications of diabetes mellitus with high rates of disability, morbidity, and mortality. As much as 15% of patients with diabetic foot ulcers have to undergo lower extremity amputation. In addition to the high risk of amputation, diabetic foot also poses an economic burden for patients, because 20% of DM treatment costs is spent on treating diabetic foot wounds. Objective: This study aims to analyze the relationship between HIF-1α, leukocyte count, and CRP in diabetic foot patients who had undergone debridement and amputation, to examine their value as biomarkers for appropriate management in diabetic foot ulcers patients. Methods: The research design was cross-sectional. The subjects of the study were patients with diabetic foot ulcers who were treated at Cipto Mangunkusumo General Hospital, the basic data were taken (gender and age), clinical examination, laboratory examination (complete peripheral blood, leukocyte count, blood glucose, and CRP). Furthermore, diabetic foot ulcers tissue biopsy during debridement and amputation surgery for biomolecular examination of HIF-1α expression by ELISA examination. Results: The study subjects were 30 patients with diabetic foot ulcers, 15 patients for amputation and 15 patients for debridement. The mean age of the amputation group was 51 years, and the debridement group was 54 years. Gender is 50% male and 50% female. Laboratory characteristics, the mean GDS of the amputation group was 211 and the debridement group was 186. The laboratory inflammatory markers of CRP and Leukocytes did not show a significant difference (p > 0.05). HIF-1α expression on Elisa's examination showed a significant difference between the amputation and debridement groups (p=0.007). The correlation between HIF-1α, Leukocytes, and CRP was not significant. The correlation value was significant on the relationship between CRP and Leukocytes, p < 0.001. Conclusion: There was significant difference in the expressions of HIF-1α in diabetic foot ulcers patients treated with debridement compared to those who are tretated with amputation. However, there was no significant correlation between HIF-1α, leukocytes, and CRP in debridement compared to amputation patients. There was a significant correlation between the value of leukocyte count and CRP in diabetic foot ulcers patients who underwent amputation compared to debridement.
Keyword: CRP, Diabetic foot ulcers, HIF-1α, , Leukocytes.