Tesis

Hubungan antara Rasio Neutrofil Limfosit dengan Kejadian Penyakit Arteri Perifer Ekstremitas Bawah pada Penyandang Diabetes Melitus Tipe 2 = Relationship between Neutrophil Lymphocyte Ratio and Lower Extremity Peripheral Artery Disease in Patient with Type 2 Diabetes Mellitus.

Latar Belakang : Penyakit arteri perifer (PAP) ekstremitas bawah merupakan salah satu komplikasi makrovaskular DM tipe 2 yang memiliki angka morbiditas dan mortalitas yang tinggi. Proses inflamasi telah diketahui berperan dalam terjadinya PAP pada penyandang DM tipe 2. Rasio neutrofil limfosit atau neutrophil lymphocyte ratio (NLR) telah digunakan sebagai penanda inflamasi kronik. Sejauh penelusuran kepustakaan yang dilakukan, belum didapatkan studi yang meneliti hubungan antara NLR dengan kejadian PAP ekstremitas bawah pada penyandang DM tipe 2. Tujuan : Mengetahui hubungan antara NLR dengan kejadian PAP ekstremitas bawah pada penyandang DM tipe 2. Metodologi : Penelitian ini menggunakan desain potong lintang dengan subjek penyandang DM tipe 2 yang menjalani pemeriksaan ankle brachial index (ABI) di poliklinik divisi Metabolik Endokrin RSCM periode Oktober 2015 – September 2016. Didapatkan 249 subjek penelitian yang memenuhi kriteria inklusi dan eksklusi. Dilakukan pengambilan data sekunder dari rekam medis mengenai data ABI, NLR, data demografik serta faktor perancu. Subjek dinyatakan menderita PAP ekstremitas bawah jika memiliki nilai ABI ≤ 0,9 dengan pemeriksaan probe Doppler. Data NLR kemudian dikategorikan berdasarkan median nilai NLR dan dicari hubungan nilai NLR dengan kejadian PAP ekstremitas bawah. Uji chi square digunakan untuk analisis bivariat dan regresi logistik digunakan untuk analisis multivariat. Hasil : Penyakit arteri perifer ekstremitas bawah ditemukan pada 36 subjek (14,5%). Didapatkan nilai median NLR total sebesar 2,11. Nilai median NLR didapatkan lebih tinggi pada kelompok PAP daripada tanpa PAP (2,46 vs 2,04). Terdapat hubungan yang bermakna antara nilai NLR ≥ 2,11 dengan kejadian PAP ekstremitas bawah pada penyandang DM tipe 2 (PR 2,46, 95% IK 1,23 – 4,87; p=0,007). Dengan menggunakan uji regresi logistik, diketahui bahwa hipertensi merupakan variabel perancu. Simpulan : Terdapat hubungan antara rasio neutrofil limfosit dengan kejadian penyakit arteri perifer ekstremitas bawah pada penyandang DM tipe 2.
Kata kunci : rasio neutrofil limfosit, penyakit arteri perifer ekstremitas bawah, diabetes melitus tipe 2


Background : Lower extremity peripheral artery disease (PAD) is one of diabetic macrovascular complication which has high rate of morbidity and mortality. Chronic inflammation has been known to have a role in the pathogenesis of PAD in diabetic patient. Recently, neutrophil lymphocyte ratio (NLR) has been used as a marker of chronic inflammation. To the best of our knowledge, there are no prior studies about the relationship between NLR and PAD in type 2 diabetic patients. Aim : To determine the relationship between neutrophil lymphocyte ratio and lower extremity peripheral artery disease in type 2 diabetic patient. Methods : This was a cross sectional study on 249 patients with type 2 diabetes mellitus who underwent ankle brachial index (ABI) examination at Metabolic and Endocrinology Divison in Cipto Mangunkusumo Hospital between October 2015 – September 2016. The data were retrospectively collected from medical record. Lower extremity peripheral artery disease was defined as having ABI value ≤ 0,9 by probe Doppler. Neutrophil lymphocyte ratio were categorized based on the median value and the relationship with lower extremity PAD were determined. Chi square test was used for bivariate analysis and logistic regression was used for multivariate analysis against confounding variables. Result : Lower extremity peripheral artery disease was found in 36 subject (14,5%). Median of NLR was 2,11. The median value of NLR was found higher in subjects with lower extremity PAD than without PAD (2,46 vs 2,04). There was an association between NLR value ≥ 2,11 and lower extremity PAD in type 2 diabetic patient (p=0,007; PR 2,46 and 95% CI 1,23 – 4,87). By using logistic regression, it was known that hypertension was the confounding variable. Conclusion : There is a relationship between neutrophil lymphocyte ratio and lower extremity peripheral artery disease in type 2 diabetic patients.
Keywords: neutrophil lymphocyte ratio, lower extremity peripheral artery disease, type 2 diabetes mellitus.