Tesis

Perbandingan Kurva Referensi Pertumbuhan Nasional dengan Kurva Centers for Disease Control dalam Mendiagnosis Perawakan Pendek dan Kadar Insulin-Like Growth Factor 1 (IGF-1), IGF Binding Protein 3 (IGFBP-3) pada Anak Usia Sekolah = Comparison of National Synthetic Growth Charts and Centers for Disease Control Growth Charts in Diagnosing Short Stature and Insulin-Like Growth Factor 1 (IGF-1) and IGF Binding Protein 3 (IGFBP-3) levels in School-aged Children.

Latar belakang: Kurva pertumbuhan terdiri atas kurva standar dan referensi pertumbuhan. Kurva standar pertumbuhan cenderung memberikan underdiagnosis perawakan pendek di negara maju dibandingkan kurva referensi, tetapi memberikan overdiagnosis perawakan pendek di negara berkembang. Kurva referensi pertumbuhan Indonesia terbaru adalah kurva referensi pertumbuhan nasional (KRPN). Pemeriksaan penunjang untuk mengevaluasi perawakan pendek meliputi bone age, tiroid, insulin-like growth factor 1 (IGF-1) dan IGF binding protein 3 (IGFBP-3). Nilai IGF-1 dan IGFBP- 3 yang rendah menunjukkan perawakan pendek patologis. Tujuan: Mengetahui perbandingan KRPN dengan kurva CDC dalam mendiagnosis perawakan pendek pada anak usia sekolah dan sebaran data IGF-1 dan IGFBP-3 pada populasi perawakan pendek. Metode: Studi ini merupakan studi potong lintang menggunakan metode clustered random sampling pada siswa SDN Petojo Utara 05 dan SDN Cideng 04. Seluruh sampel dilakukan pengukuran tinggi badan dan berat badan, lalu data di-plot pada kurva CDC dan KRPN. Anak dengan perawakan pendek dilakukan evaluasi IGF-1 dan IGFBP-3. Data pada kedua kurva dilakukan analisis kesesuaian dengan koefisien Kappa. Hasil: Prevalens perawakan pendek anak usia sekolah di Jakarta berdasarkan KRPN adalah 0,8% dan berdasarkan kurva CDC sebesar 13,9%. Penegakkan perawakan pendek pada KRPN dan CDC memberikan hasil kesesuaian sangat lemah. Evaluasi nilai IGF-1 didapatkan rendah pada 11 dari 35 anak dan IGFBP-3 rendah pada 2 dari 35 anak pada kelompok pendek menurut CDC, sementara nilai IGF-1 rendah ditemukan sebanyak 2 dari 3 anak dan IGFBP-3 rendah sebanyak 1 dari 3 anak pada kelompok pendek KRPN. Dua anak dengan nilai IGF-1 dan IGFBP-3 terdeteksi di kurva CDC, tetapi hanya satu anak yang terdeteksi di KRPN. Simpulan: Kurva CDC memberikan hasil perawakan pendek lebih banyak dibandingkan KRPN, kurva CDC dapat mendeteksi dua perawakan pendek dengan hasil IGF-1 dan IGFBP-3 rendah, sementara KRPN hanya mendeteksi satu perawakan pendek dengan hasil kedua hormon rendah. Kurva pertumbuhan referensi Indonesia perlu dilakukan peninjauan dan pembuatan ulang sesuai secular trend.
Kata kunci: kurva pertumbuhan referensi, kurva Centers for Disease Control, IGF-1, IGFBP-3, perawakan pendek


Background: Growth chart is divided into a standard and reference growth chart. The standard growth chart tends to underdiagnose short stature in developed countries compared to the reference curve, but overdiagnoses short stature in developing countries. The latest Indonesian growth reference chart is the national synthetic growth chart (KRPN). Evaluation in short stature includes bone age, thyroid, insulin-like growth factor 1 (IGF-1) and IGF binding protein 3 (IGFBP-3). Low IGF-1 and IGFBP-3 values indicate pathological short stature. Objective: To compare KRPN with CDC chart in diagnosing short stature in school-age children and the distribution of IGF-1 and IGFBP-3 data in children with short stature. Method: This is a cross-sectional study using clustered random sampling on students of SDN Petojo Utara 05 and SDN Cideng 04. All samples were measured for height and weight. Data were then plotted on the CDC and KRPN charts. Children with short stature were evaluated for IGF-1 and IGFBP-3. Data on both charts were analyzed for goodnessof-fit using the Kappa coefficient. Results: The prevalence of short stature in school-age children in Jakarta based on KRPN is 0.8% and based on the CDC chart is 13.9%. The short stature diagnosis in KRPN and CDC gave very weak agreenment. Laboratory evaluation showed low IGF-1 in 11 of 35 children and low IGFBP-3 in 2 of 35 children in CDC short stature group, while low IGF- 1 was found in 2 of 3 children and low IGFBP-3 in 1 of 3 children in the KRPN short stature group. Conclusion: The CDC growth detected more children with short stature than the KRPN, CDC chart could detect two short statures with low IGF-1 and IGFBP-3 results, while KRPN could only detect one short stature with low both hormone levels. The Indonesian reference growth chart needs to be reviewed and reproduced according to the current secular trend.
Keywords: Indonesian national synthetic growth charts, Centers for Disease Control growth charts, IGF-1, IGFBP-3, short stature