Rasio Ekspresi Matriks Metallo Proteinase-2 (MMP-2) dan Tissue Inhibitor of MMP-2 (TIMP-2) dengan Ketebalan Kolagen Tipe-III Ligamentum Sakro Uterina pada Wanita Menopause dengan Prolaps Orga Pelvis

Abstract

Latar Belakang: Insidensi POP cukup tinggi pada wanita menopause. POP terjadi akibat lemahnya ligamentum sakrouterina. Kekuatan ligamentum dipertahankan oleh jaringan ikat yang mengandung kolagen. Berkurangnya kolagen tipe III diduga karena proses degradasi oleh Matrix Metalloproteinase-2 (MMP-2). TIMP-2 adalah protein yang menghambat aktifitas proteolitik MMP-2. Ketidakseimbangan rasio MMP-2/TIMP-2 akan menyebabkan degradasi kolagen tipe III. Tujuan: Penelitian ini bertujuan menilai perbandingan ekspresi enzim MMP-2 dan TIMP-2 terhadap ketebalan kolagen tipe III ligamentum sakrouterina wanita menopause dengan POP. Bahan dan Metode: Jenis penelitian ini adalah analitik dengan rancangan potong lintang. Penelitian dilakukan di Departemen Obgin FK USU RSUP. H. Adam Malik Medan, Laboratorium Patologi Anatomi RSUP. H. Adam Malik Medan dan Pusat Laboratorium Forensik POLRI Jakarta. Penelitian dimulai pada Desember 2017 sampai besar sampel terpenuhi. Sampel dibagi menjadi kelompok kasus (wanita menopause dengan POP) dan kelompok kontrol (wanita menopause non POP). Bahan yang diteliti adalah jaringan dalam bentuk blok parafin dengan pulasan HE, diperiksa secara imunohistokimia dengan menilai MMP-2, TIMP-2 dan kolagen tipe III. Penilaian menggunakan skor Allred. Hasil: Penelitian dilakukan pada 45 pasien POP dan 47 pasien normal yang sudah melalui uji- Kappa dengan nilai 94,3%. Didapatkan korelasi negatif antara rasio ekspresi MMP-2/TIMP-2 dengan ketebalan kolagen tipe III (r = -0,638, p<0,001). Kesimpulan: Semakin tinggi rasio MMP-2/TIMP-2 akan menyebabkan semakin tipis ketebalan kolagen tipe III.

Background: POP incidence is quite high in menopausal women. POP occurs due to weakness of the uterosacral ligament. The strength of the ligament is maintained by connective tissue which contains collagen. The decreasing type III collagen might be the result of the degradation process caused by Matrix Metalloproteinase-2 (MMP-2). TIMP-2 is a protein that inhibits the proteolytic activity of MMP-2. The imbalance of the MMP-2 / TIMP-2 ratio will cause the degradation of type III collagen. Objective: This study aimed to assess the comparison of the expression of MMP-2 and TIMP-2 enzymes to the thickness of uterosacral ligament's type III collagen in menopausal women with POP. Materials and Methods: This type of research is analytic with cross-sectional design. The study was conducted in the Obstetrics and Gynaecology Department of H. Adam Malik General Hospital Medical Faculty of Universitas Sumatera Utara, Medan and the Centre for Indonesian Forensic Laboratory, Jakarta. Research began in December 2017 until the minimum sample size is met. The study sample are divided into menopausal women with POP (case group) and menopausal women who did not experience POP (control group). The material studied is tissue in the form of paraffin blocks with HE coating, examined immunohistochemically by assessing MMP-2, TIMP-2 and type III collagen. Research uses Allred scores. Results: The study was conducted on 45 POP patients and 47 normal patients who had gone through the Kappa test with a value of 94.3%. There was a negative correlation between the ratio of MMP-2 / TIMP-2 expression with the thickness of type III collagen (r = -0,638, p <0.001). Conclusion: The higher the MMP-2 / TIMP-2 ratio will effected the thickness of type III collagen.