Peran Prediktor Placental Growth Factor, Soluble Endoglin, Soluble-FMS-Like Tyrosine Kinase 1 dan Takidiastolik Arteri Uterina untuk Memprediksi Kejadian Preeklampsia Awitan Dini

Abstract

Tujuan: Preeklampsia merupakan masalah global yang mempengaruhi 2 - 8% dari kehamilan, dan diperkirakan 8,3 juta wanita hamil mengalami Preeklampsia setiap tahun.Pada preeklampsia akan ditemukan peningkatan kadar SFlt-1 dan sEng dan penurunan kadar PlGF. Keadaan ini akan menyebabkan gangguan vaskulogenesis dan angiogenesis pada sirkulasi fetomaternal yang pada akhirnya akan menimbulkan sindrom preeklampsia seperti proteinuria, hipertensi dan disfungsi endotel. Metode: Penelitian menggunakan rancangan penelitian observasional dengan desain nested case control. Penelitian dilakukan di Rumah Sakit Bunda Thamrin, Rumah Sakit Mitra Medika Tanjung Mulia, Rumah Sakit Sundari dan praktek pribadi, mulai bulan Maret - November 2018 dengan sampel sebanyak 64 subjek penelitian. Hasil: Hasil penelitian ini menunjukkan bahwa dijumpai nilai bermakna dengan p<0,05 yaitu nilai pulsatil indeks arteri uterina dengan cut-off point 1,228, Area Under Curve (AUC) sebesar 78,2% (95% IK 59,3% - 97%), sensitivitas 80%, spesifisitas 64,6%, kadar PlGF dengan cut-off point 441 pg/ml, Area Under Curve (AUC) sebesar 82,5% (95% IK 61,5% - 100%), sensitivitas 80%, spesifisitas 87,7%, kadar sFlt-1 dengan cut-off point 10087,5 pg/ml, Area Under Curve (AUC) sebesar 81,2% (95% IK 63,6% - 98,9%), sensitivitas 80%, spesifisitas 67,7% sedangkan sEng dengan nilai p value >0,05 yang berarti tidak bermakna signifikan. Kesimpulan: Dari penelitian ini tidak ditemukan adanya perbedaan bermakna dari sEng, sedangkan ditemukan beda pada nilai pulsatil indeks arteri uterina, kadar PlGF, dan kadar sFlt-1 terhadap kejadian preeklampsia awitan dini. Dari analisis multivariat, pemeriksaan kadar PlGF saja sudah cukup sebagai prediktor preeklampsia awitan dini.

Objective: Preeclampsia is a global problem that affects 2 - 8% of pregnancies, and an estimated 8.3 million pregnant women experience preeclampsia every year. In preeclampsia there will be an increase in SFlt-1 and in and decrease in PlGF levels. This condition will cause disorders of vasculogenesis and angiogenesis in fetomaternal circulation which will eventually lead to preeclampsia syndrome such as proteinuria, hypertension and endothelial dysfunction. Methods: Thestudy used an observational study design with nested case control. The study was conducted at Bunda Thamrin Hospital, Tanjung Mulia Medika Hospital, Sundari Hospital and private practice, from March to November 2018 with a sample of 64 research subjects. Results: The results of this study indicate that there were significant values with p <0.05, namely the pulsatile value of the uterine artery index with a 1.228 cut-off point, Area Under Curve (AUC) of 78.2% (95% CI 59.3% - 97%), sensitivity 80%, specificity 64.6%, PlGF level with 441 pg / ml cut-off point, Area Under Curve (AUC) of 82.5% (95% CI 61.5% - 100%), sensitivity 80% , specificity 87.7%, sFlt-1 level with a cut-off point of 10087.5 pg / ml, Area Under Curve (AUC) of 81.2% (95% CI 63.6% - 98.9%), sensitivity 80%, specificity 67.7% while sEng with p value> 0.05 which means it is not significant. Conclusion: From this study no significant differences were found in sEng, whereas differences were found in the pulsatile value of the uterine artery index, PlGF levels, and sFlt-1 levels in the incidence of early onset preeclampsia. From multivariate analysis, examination of PlGF levels alone is sufficient as a predictor of early onset preeclampsia.