Research Article

Analisis rasio monosit terhadap High Density Lipoprotein (HDL) pada pasien Diabetes Melitus Tipe 2 (DM-2) dengan dan tanpa nefropati diabetik

Yunita Rapa , Yuyun Widaningsih, Ani Kartini, Liong Boy Kurniawan

Yunita Rapa
Program Pendidikan Dokter Spesialis Patologi Klinik Fakultas Kedokteran, Universitas Hasanuddin, RSUP Dr. Wahidin Sudirohusodo, Makassar, Indonesia. Email: yunitta0906rapa@gmail.com

Yuyun Widaningsih
Departemen Ilmu Patologi Klinik, Fakultas Kedokteran, Universitas Hasanuddin, RSPTN Universitas Hasanuddin, Makassar, Indonesia

Ani Kartini
Departemen Ilmu Patologi Klinik, Fakultas Kedokteran, Universitas Hasanuddin, RSUD Labuang Baji, Makassar

Liong Boy Kurniawan
Departemen Ilmu Patologi Klinik, Fakultas Kedokteran, Universitas Hasanuddin, RSPTN Universitas Hasanuddin, Makassar, Indonesia
Online First: December 01, 2020 | Cite this Article
Rapa, Y., Widaningsih, Y., Kartini, A., Kurniawan, L. 2020. Analisis rasio monosit terhadap High Density Lipoprotein (HDL) pada pasien Diabetes Melitus Tipe 2 (DM-2) dengan dan tanpa nefropati diabetik. Intisari Sains Medis 11(3): 1341-1346. DOI:10.15562/ism.v11i3.765


Background: Diabetic nephropathy is one of the microvascular complications of type 2 diabetes mellitus (DM-2)—pathophysiology of diabetic nephropathy resulting from the interaction between hemodynamic and metabolic factors. High-Density Lipoprotein (HDL) functions as anti-atherosclerosis, protects the endothelium, and anti-inflammatory, whereas monocytes are associated with atherosclerosis and vascular inflammation. The HDL monocyte ratio is used as a marker of endothelial dysfunction and inflammation. This study aimed to determine the value of the HDL monocyte ratio in DM-2 patients with diabetic nephropathy and without diabetic nephropathy.

Methods: This study was conducted at Dr. Wahidin Sudirohusodo, Makassar, by taking the medical record data of DM-2 patients treated in January 2018-June 2019. There were 86 DM-2 patients with diabetic nephropathy and 56 DM-2 patients without diabetic nephropathy who participated in this study. The statistical tests used were Chi-Square, Independent T test, and Mann Whitney test on SPSS version 17 for Windows.

Results: The HDL monocyte ratio value was higher in type 2 diabetes mellitus with diabetic nephropathy than type 2 diabetes mellitus without diabetic nephropathy (35±56 vs. 23±24; p = 0.023). There was no significant difference in HDL cholesterol levels in the DM-2 patients' group with diabetic nephropathy and without diabetic nephropathy (p> 0.05), and so did the number of monocytes (p = 0.065). Based on the Youden index, a cutoff ratio of monocyte/HDL of 15.5 was chosen, which gave a sensitivity of 69% and a specificity of 55%.

Conclusion: HDL monocyte ratio was significantly higher in type 2 DM patients with diabetic nephropathy than type 2 diabetes mellitus without diabetic nephropathy. The HDL monocyte ratio can be used as a marker of endothelial dysfunction and inflammation in diabetic nephropathy.

 

Latar Belakang: Nefropati diabetik merupakan salah satu komplikasi mikrovaskuler diabetes melitus tipe 2 (DM Tipe 2). Patofisiologi nefropati diabetik sebagai akibat interaksi antara faktor hemodinamik dan metabolik. High Density Lipoprotein (HDL) berfungsi sebagai anti-aterosklerosis, melindungi endotel dan anti-inflamasi; sedangkan monosit berhubungan dengan aterosklerosis dan inflamasi vaskuler. Rasio monosit HDL digunakan sebagai penanda disfungsi endotel dan inflamasi. Tujuan penelitian ini adalah untuk engetahui nilai rasio monosit HDL pada pasien DM tipe 2 dengan nefropati diabetik dan tanpa nefropati diabetik.

Metode: Penelitian ini dilaksanakan di RSUP Dr. Wahidin Sudirohusodo, Makassar dengan mengambil data rekam medis pasien DM tipe 2 yang dirawat pada bulan Januari 2018-Juni 2019. Terdapat 86 pasien DM tipe 2 dengan nefropati diabetik dan 56 pasien DM tipe 2 tanpa nefropati diabetik ikut serta dalam penelitian ini. Uji statistik yang digunakan adalah Chi Square, Independent T test dan uji Mann Whitney pada SPSS versi 17 untuk Windows.

Hasil: Nilai rasio monosit HDL lebih tinggi pada DM tipe 2 dengan nefropati diabetik dibandingkan DM tipe 2 tanpa nefropati diabetik (35±56 vs 23±24, p=0,023). Tidak terdapat perbedaan bermakna kadar kolesterol HDL pada kelompok DM tipe 2 dengan nefropati diabetik dan tanpa nefropati diabetik (p>0,05) dan begitu juga pada jumlah monosit (p=0,065). Berdasarkan indeks Youden, dipilih cutoff rasio monosit/HDL sebesar 15,5 yang memberikan sensitivitas 69% dan spesifisitas 55%.

Kesimpulan: Rasio monosit HDL lebih tinggi secara bermakna pada pasien DM tipe 2 dengan nefropati diabetik dibandingkan DM tipe 2 tanpa nefropati diabetik. Rasio monosit HDL dapat digunakan sebagai penanda disfungsi endotel dan inflamasi pada nefropati diabetik.

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