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Peningkatan kadar Mean Platelet Volume-Lymphocyte Ratio (MPVLR) terhadap resiko diabetik nefropati pada pasien dengan diabetes melitus tipe II (DM-2) di RSUP Sanglah, Bali, Indonesia



Abstract

Background: Diabetic Nephropathy (DN) is Diabetes Mellitus’s microvascular complication with albuminuria and decrease glomerular filtration rate. DN pathogenesis is related with inflammatory process induced by chronic hyperglycaemia. Mean platelet volume (MPV)  and platelet-lymphocyte ratio (PLR) are potential for reviewing systemic inflammation. The combination of MPV and PLR index into MPVLR shows significant results in prognostic patients with diabetes mellitus and acute myocardial infarction and predicted DN. This study aims to determine the MPVLR index of DN risk in type II diabetes mellitus patients at Sanglah Hospital, Denpasar.

Method: Cross-sectional study of 50 DM-2 patients at Sanglah Hospital in 2016. The data is secondary data from the medical records of DM-2 patients according the inclusion and exclusion criteria with purposive sampling technique. Diabetic nephropathy is diagnose based on diagnostic criteria. Complete blood count (CBC) using the CELL-DYN Ruby System. MPVLR is an absolute comparison of the calculation of MPV and total lymphocytes. T-test and Mann-Whitney Test to assess differences mean of data. The MPVLR index for diabetic nephropathy was assessed by Receiver Operating Curve (ROC) and Area Under the Curve (AUC). p <0.05 is statistically significant.

Results: 50 data were grouped into nephropathy and without nephropathy groups. Men is dominant in both groups (p>0.05). The MPVLR ratio was statistically significantly higher in the nephropathy group (5.11 ± 2.20; P = 0.004). The MPVLR index cut point value was 3.835 with a sensitivity value of 73.7% and specificity of 71%.

Conclusion: MPVLR can use as independent predictor of diabetic nephropathy in diabetic patients.

 

Latar Belakang: Diabetik Nefropati (DN) merupakan komplikasi mikrovaskular Diabetes Melitus dengan albuminuria dan penurunan estimasi laju filtrasi glomerulus. Patogenesis DN berkaitan dengan proses inflamasi terinduksi hiperglikemia kronis. Indeks rerata volume trombosit (MPV) dan rasio trombosit-limfosit (PLR) potensial untuk meninjau inflamasi sistemik. Gabungan indeks MPV dan PLR menjadi MPVLR menunjukan hasil yang signifikan dalam diagnostik prognostik pada pasien diabetes melitus dan infarksi miokardial akut serta menjadi prediktor DN. Penelitian ini bertujuan untuk mengetahui indeks MPVLR terhadap risiko DN pada pasien diabetes melitus tipe II di RSUP Sanglah, Denpasar.

Metode: Studi potong lintang (cross-sectional) terhadap 50 pasien DM-2 di RSUP Sanglah tahun 2016. Data penelitian adalah data sekunder dari rekam medis pasien DM-2 yang memenuhi kriteria Inklusi dan Eksklusi dengan teknik purposive sampling. Diabetik nefropati ditegakkan berdasarkan kriteria diagnosis. Pemeriksaan darah lengkap (DL) menggunakan CELL-DYN Ruby System. Rasio MPV terhadap limfosit (MPVLR) adalah perbandingan absolut dari perhitungan MPV dan limfosit total. Uji-t dan Uji Mann-Whitney untuk menilai perbedaan antara rata-rata data dua kelompok. Indeks MPVLR terhadap diabetic nefropati dinilai dengan Receiver Operating Curve (ROC) dan Area Under the Curve (AUC). Nilai p<0,05 bermakna secara statistik.

Hasil: 50 data dikelompokkan menjadi kelompok dengan nefropati dan tanpa nefropati. Jenis kelami laki-laki dominan di kedua keompok tersebut (p>0,05). Rasio MPVLR secara statistik bermakna lebih tinggi pada kelompok dengan nefropati (5,11±2,20; P=0,004). Nilai titik potong indeks MPVLR sebesar 3,835 dengan nilai sensitifitas sebesar 73,7% dan spesifisitas 71%.

Simpulan: MPVLR dapat sebagai prediktor kuat dan independen diabetik nefropati pada pasien diabetes.

Keywords: Diabetes Melitus tipe II Diabetik Nefropati MPVLR

References

  1. American Diabetes Association Diagnosis and classification of diabetes mellitus. Diabetes Care. 2014;37:S81–S90. doi: 10.2337/dc14-S081.
  2. Forbes JM, Cooper ME. Mechanisms of diabetic complications. Physiol Rev. 2013;93:137–188. doi: 10.1152/physrev.00045.2011.
  3. Toth-Manikowski S, Atta MG. Diabetic kidney disease: pathophysiology and therapeutic targets. J Diabetes Res. 2015;2015:697010. doi: 10.1155/2015/697010.
  4. Magee C, Grieve DJ, Watson CJ, Brazil DP. Diabetic Nephropathy: a Tangled Web to Unweave. Cardiovasc Drugs Ther. 2017;31(5-6):579–592. doi:10.1007/s10557-017-6755-9
  5. Oguntibeju OO. Type 2 diabetes mellitus, oxidative stress and inflammation: examining the links. Int J Physiol Pathophysiol Pharmacol. 2019;11(3):45–63. Published 2019 Jun 15.
  6. Liu J, Liu X, Li Y, Quan J, Wei S, An S et al. The association of neutrophil to lymphocyte ratio, mean platelet volume, and platelet distribution width with diabetic retinopathy and nephropathy: a meta-analysis. Bioscience Reports. 2018;38(3):BSR20180172.
  7. Qin BD, Ma N, Tang QQ, Wei TT, Yang M, Fu HT, Hu ZD, Liang Y, Yang ZX, Zhong RQ. Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) were useful markers in assessment of inflammatory response and disease activity in SLE patients. Mod Rheumatol. 2016;26(3):372–376.
  8. Şenel E, Acar B, Demir E. Mean platelet volume: a reliable marker of inflammation in recurrent apthous stomatitis and Behçet disease? Indian Dermatol Online J. 2017;8(6):468–470.
  9. Kamath S, Blann AD, Lip GY. Platelet activation: assessment and quantification. Eur Heart J. 2001;22(17):1561–1571.
  10. Chu SG, Becker RC, Berger PB, Bhatt DL, Eikelboom JW, Konkle B, Mohler ER, Reilly MP, Berger JS. Mean platelet volume as a predictor of cardiovascular risk: a systematic review and meta-analysis. J Thromb Haemost. 2010;8(1):148–156.
  11. Bozlu G, Karpuz D, Hallioglu O, Unal S, Kuyucu N. Relationship between mean platelet volume-to-lymphocyte ratio and coronary artery abnormalities in Kawasaki disease. Cardiol Young. 2018;28(6):832–836.
  12. Gunduz S, Mutlu H, Tural D, Yıldız Ö, Uysal M, Coskun HS, Bozcuk H. Platelet to lymphocyte ratio as a new prognostic for patients with metastatic renal cell cancer. Asia Pac J Clin Oncol. 2015;11(4):288–292.
  13. Luo WJ, Zhang WF. The relationship of blood cell-associated inflammatory indices and diabetic retinopathy: a Meta-analysis and systematic review. Int J Ophthalmol. 2019;12(2):312–323. Published 2019 Feb 18. doi:10.18240/ijo.2019.02.20
  14. Akbas EM, Demirtas L, Ozcicek A, et al. Association of epicardial adipose tissue, neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio with diabetic nephropathy. Int J Clin Exp Med. 2014;7(7):1794–1801. Published 2014 Jul 15.
  15. Hudzik B, Szkodziński J, Lekston A, Gierlotka M, Poloński L, Gąsior M. Mean platelet volume-to-lymphocyte ratio: a novel marker of poor short- and long-term prognosis in patients with diabetes mellitus and acute myocardial infarction. Journal of Diabetes and its Complications. 2016;30(6):1097-1102.
  16. Zahid Kocak M, Aktas G, Erkus E, T Duman T, M Atak B, Savli H. Mean Platelet Volume to Lymphocyte Ratio as a Novel Marker for Diabetic Nephropathy. Journal of the College of Physicians and Surgeons Pakistan. 2018;28(11):844-847.
  17. Shoelson SE, Lee J, Goldfine AB. Inflammation and insulin resistance [published correction appears in J Clin Invest. 2006 Aug;116(8):2308]. J Clin Invest. 2006;116(7):1793–1801. doi:10.1172/JCI29069
  18. Stringhini S, Batty GD, Bovet P, et al. Association of lifecourse socioeconomic status with chronic inflammation and type 2 diabetes risk: the Whitehall II prospective cohort study. PLoS Med. 2013;10(7):e1001479. doi:10.1371/journal.pmed.1001479
  19. Le Tulzo Y, Pangault C, Gacouin A, Guilloux V, Tribut O, Amiot L, et al. Early circulating lymphocyte apoptosis in human septic shock is associated with poor outcome. Shock. 2002; 18:487-94.
  20. Prabawa IPY, Bhargah A, Liwang F, Tandio DA, Tandio AL, Lestari AAW, et al. Pretreatment Neutrophil-to-Lymphocyte ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR) as a Predictive Value of Hematological Markers in Cervical Cancer. Asian Pac J Cancer Prev. 2019;20(3):863–868.
  21. Oylumlu M, Yildiz A, Oylumlu M, Yüksel M, Polat N, Bilik MZ, et al. Platelet-to-lymphocyte ratio is a predictor of in-hospital mortality patients with acute coronary syndrome. Anatol J Cardiol. 2015; 15:277-83.
  22. Kurtul A, Acikgoz SK. Usefulness of mean platelet volume-tolymphocyte ratio for predicting angiographic no-reflow and short-term prognosis after primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction. Am J Cardiol. 2017; 120:534-41.

How to Cite

Aryani, B. R., Prabawa, I. M. Y., & Saraswati, M. R. (2020). Peningkatan kadar Mean Platelet Volume-Lymphocyte Ratio (MPVLR) terhadap resiko diabetik nefropati pada pasien dengan diabetes melitus tipe II (DM-2) di RSUP Sanglah, Bali, Indonesia. Intisari Sains Medis, 11(1), 328–332. https://doi.org/10.15562/ism.v11i1.632
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Budi Ratna Aryani
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I Made Yoga Prabawa
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Made Ratna Saraswati
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