Hubungan Kadar Resistin Plasma dengan Resistensi Insulin pada Penderita Sirosis Hati

Abstract

In liver cirrhosis, impaired insulin sensitivity and subsequent alteration in glucose ,metabolism, such as high prevalence of insulin resitance and glucose intolerance are reported and resistin level positively correlated with fasting plasma insulin, HOMA-IR and negatively correlated with serum transaminase levels.Several study before reported that presence of high plasma resistin levels in patients with liver cirrhosis relative to the kontrol and these level increased in proportion with the severity of liver cirrhosis . Objective We want to determine the difference and correlate increased of plasma resistin levels and insulin resistance in patients of liver cirrhosis . Method The research had been done since March 2010 until July 2010 with cross sectional method. The amount of participant examined 30 patients with 20 patients liver cirrhosis and 10 patients normal which outpatient in clinic and hospitalized in Adam Malik hospital. Of all patients were performed anamnese, physical diagnostic, Ultrasonography, laboratory examination, plasma resistin levels, fasting plasma insulin and fasting plasma glucose levels. Plasma resistin concentrations and insulin resistance were analyzed by Spearman’s Results Plasma resistin concentrations were increased in patients with liver cirrhosis relative to its normal value (29,597 ± 18,708ng/ml vs 17,328 ± 14,616 ng/ml) and this level increased in proportion with the severity of liver cirrhosis (Child B : Child C = : 28,7590±20,635 ng/ml : 30,4350±17,650 ng/ml), The Homeostasis Model Assesment Insulin Resistance (HOMA-IR) were also significantly decrased in patients with liver cirrhosis in comparison to controls (38,02 ± 46,116 vs 13,64 ± 8,719 , p<0,05) and positive correlation between plasma resistin and BMI, albumin and fasting plasma glucose and fasting plasma insulin. Conclusion Plasma resistin concentrations were increased in patients with liver cirrhosis and this level increased resistin may contribute to insulin resistance in patients with advanced liver cirrhosis.

Latar Belakang Pada Sirosis Hati dilaporkan terjadi gangguan sensitifitas insulin diikuti dengan perubahan metabolisme glukosa seperti tingginya prevalensi resistensi insulin dan intoleransi glukosa, dan resistin plasma secara langsung berkorelasi dengan insulin plasma puasa, HOMA-IR dan berkorelasi secara negatif dengan kadar transaminase serum, namun studi sebelumnya menyebutkan bahwa kadar resistin plasma meningkat pada Sirosis hati dan peningkatan ini sejalan dengan semakin memberatnya tingkat kerusakan sirosis hati. Tujuan Untuk mengetahui perbedaan dan hubungan peningkatan kadar resistin plasma dengan resistensi insulin pada penderita sirosis hati. Metode Penelitian dilakukan mulai bulan Maret 2010 sampai dengan Juli 2010 dengan metode potong lintang. Jumlah peserta yang diperiksa adalah 30 orang, 20 orang penderita Sirosis hati, 10 orang normal yang berobat rawat jalan di poliklinik dan rawat inap Gastroentero Hepatologi RSHAM. Semua penderita dilakukan anamnesa, pemeriksaan fisik, USG, pemeriksaan laboratorium, resistin plasma, insulin puasa dan KGD puasa .Kadar resistin plasma dan resistensi insulin diuji dengan Spearman’s Hasil Kadar resistin plasma meningkat pada penderita sirosis dibanding dengan nilai normalnya (29,597 ± 18,708ng/ml vs 17,328 ± 14,616 ng/ml), dan resistin plasma meningkat sejalan dengan meningkatnya tingkat kerusakan hati (Child B : Child C = : 28,7590±20,635 ng/ml : 30,4350±17,650 ng/ml), The Homeostasis Model Assesment Insulin Resistance (HOMA-IR) meningkat pada penderita sirosis hati dibanding dengan nilai normalnya(38,02 ± 46,116 vs 13,64 ± 8,719 , p<0,05) serta didapatkan korelasi positif antara resistin dengan IMT, albumin, KGD puasa dan insulin plasma puasa. Kesimpulan Kadar resistin plasma meningkat pada penderita Sirosis hati dan peningkatan kadar resistin dapat menyebabkan resistensi insulin pada penderita sirosis hati yang lanjut.