Tesis

Hubungan antara Vitiligo dengan Kejadian Sindrom Metabolik: Studi Kasus Kontrol di Rumah Sakit Pendidikan di Jakarta = Relationship Between Vitiligo and the Occurrence of Metabolic Syndrome: A Case–Control Study at a Teaching Hospital in Jakarta.

Pendahuluan: Vitiligo merupakan kelainan depigmentasi dengan patogenesis multifaktorial. Dua mekanisme yang paling sering diajukan, yaitu stres oksidatif dan proses autoimun, dapat memicu peradangan sistemik tingkat rendah yang mengganggu homeostasis glukosa dan lipid serta fungsi endotel, sehingga berkaitan dengan komponen sindrom metabolik (obesitas sentral, hipertensi, hiperglikemia, hipertrigliseridemia, dan high density lipoprotein [HDL]). Berbagai studi menunjukkan kecenderungan peningkatan risiko sindrom metabolik pada pasien vitiligo, meskipun hasilnya belum konsisten. Bukti pada populasi Indonesia masih terbatas. Oleh karena itu, diperlukan penelitian untuk menilai hubungan vitiligo dengan kejadian sindrom metabolik beserta komponennya pada populasi Indonesia. Penelitian ini dapat menjadi dasar pertimbangan skrining sindrom metabolik pada pasien vitiligo di Indonesia. Tujuan Penelitian: Menganalisis hubungan antara vitiligo dan sindrom metabolik serta komponenkomponennya. Metodologi Penelitian: Studi observasional analitik dengan desain kasus–kontrol melibatkan pasien vitiligo dan kontrol sehat (masing-masing 35 subjek). Anamnesis, pemeriksaan fisik, dan dilakukan pemeriksaan darah untuk menilai komponen sindrom metabolik berdasarkan kriteria National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) modifikasi populasi Asia, meliputi obesitas sentral (lingkar pinggang), tekanan darah, glukosa darah puasa, trigliserida, dan kolesterol HDL. Data kategorik dianalisis dengan uji chi-kuadrat, dan uji Fisher bila syarat chi-kuadrat tidak terpenuhi. Hasil Penelitian: Prevalensi sindrom metabolik lebih tinggi pada pasien vitiligo (37,1%) dibanding kelompok kontrol (8,6%) (p= 0,009), dengan odds ratio 6,30 (IK 95%: 1,61 –24,75). Dua komponen sindrom metabolik berbeda bermakna, yaitu hipertensi (54,3% pada vitiligo dan 25,7% pada kontrol; p= 0,015; OR 3,43; IK 95%: 1,25–9,40) dan glukosa darah puasa ≥100 mg/dL (25,7% pada vitiligo dan 5,7% pada kontrol; p= 0,022; OR 5,71; IK 95%: 1,13–28,75). Trigliserida tinggi dan HDL rendah lebih sering pada vitiligo, tetapi tidak bermakna (masing-masing p= 0,382 dan p= 0,356). Kesimpulan: Terdapat hubungan antara vitiligo dengan glukosa darah tinggi dan hipertensi. Terdapat hubungan antara vitiligo dengan kejadian sindrom metabolik.
Kata kunci: Dislipidemia; hiperglikemia; hipertensi; sindrom metabolik; vitiligo


Background: Vitiligo is a depigmenting disorder with a multifactorial pathogenesis. Two leading mechanisms, oxidative stress and autoimmunity, may trigger low-grade systemic inflammation that disrupts glucose and lipid homeostasis and endothelial function, thereby linking vitiligo to components of metabolic syndrome (central obesity, hypertension, hyperglycemia, hypertriglyceridemia, and low high-density lipoprotein [HDL] cholesterol). Several studies suggest an increased risk of metabolic syndrome among patients with vitiligo, although findings remain inconsistent. Evidence in the Indonesian population is limited. Therefore, research is needed to assess the association between vitiligo and the occurrence of metabolic syndrome and its components in the Indonesian population. This study may serve as a basis for considering metabolic syndrome screening among patients with vitiligo in Indonesia. Research Objective: To analyze the association between vitiligo and metabolic syndrome and its components. Methods: An analytical observational case-control study involving patients with vitiligo and healthy controls (35 subjects in each group). Medical history taking, physical examination, and blood tests were performed to assess components of metabolic syndrome according to the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) criteria modified for Asian populations, including central obesity (waist circumference), blood pressure, fasting plasma glucose, triglycerides, and HDL cholesterol. Categorical data were analyzed using the chi-square test, and Fisher’s exact test was applied when the assumptions of the chi-square test were not met. Results: The prevalence of metabolic syndrome was higher in patients with vitiligo (37.1%) than in the control group (8.6%) (p= 0.009), with an odds ratio of 6.30 (95% CI: 1.61 –24.75). Two components differed significantly, namely hypertension (54.3% in vitiligo and 25.7% in controls; p= 0.015; OR 3.43; 95% CI: 1.25–9.40) and fasting plasma glucose ≥100 mg/dL (25.7% in vitiligo and 5.7% in controls; p= 0.022; OR 5.71; 95% CI: 1.13–28.75). Elevated triglycerides and low HDL were more frequent in vitiligo but were not statistically significant (p= 0.382 and p= 0.356, respectively). Conclusion: There was an association between vitiligo and elevated blood glucose and hypertension. Vitiligo was also associated with the occurrence of metabolic syndrome.
Keyword: dyslipidemia; hyperglycemia; hypertension; metabolic syndrome; vitiligo disease.