ABSTRAKPreeklamsia merupakan salah satu penyebab kematian utama ibu dan perinatal di
dunia. Inflamasi disertai tingginya indeks apoptosis di syncytiotrophoblast dan
ekspresi Cyclophilin A diduga berperan pada preeklamsia. Faktor tersebut
diasumsikan menyebabkan jejas jantung/pembuluh darah yang meningkatkan
risiko morbiditas dan mortalitas ibu dan perinatal. Tujuan penelitan ini adalah
menganalisis peran inflamasi, indeks apoptosis dan Cyclophilin A terhadap jejas
jantung/pembuluh darah pada preeklamsia awitan dini, lanjut dan kehamilan
normal.
Sebanyak 47 wanita hamil yang terpilih dilakukan pemeriksaan hematologi,
ekokardiografi dan ultrasonografi Doppler. Plasenta diperiksa secara histopatologis
untuk mengukur ekspresi NF-KB dan PARP-1, indeks apoptosis berdasarkan
pemeriksan TUNEL, ekspresi Cyclophilin A dan pemeriksaan ultrastruktur
mikroskopik pada syncytiotrophoblast. Analisis Anova digunakan untuk
mengidentifikasi perbedaan antara ketiga kelompok, sedangkan regresi linier
digunakan untuk mengetahui korelasi faktor yang diduga terhadap jejas
jantung/pembuluh darah menggunakan SPSS 20.
Usia ibu, indeks massa tubuh (IMT), hitung trombosit, NF- KB dan indeks
apoptosis lebih tinggi disertai Cyclophilin A lebih rendah pada preeklamsia awitan
dini dibandingkan preeklamsia awitan lanjut dan kehamilan normal. Hitung
leukosit lebih tinggi pada preeklamsia awitan lanjut dibandingkan awitan dini dan
normal. Total peripheral resistance (TPR) paling tinggi pada kelompok awitan dini
dibandingkan awitan lanjut dan kehamilan normal, sedangkan cardiac index (CI)
tidak berbeda bermakna pada ketiga kelompok. Resistensi indeks (RI) lebih tinggi
pada preeklamsia awitan dini dibandingkan awitan lanjut dan kehamilan normal.
Berdasarkan analisis regresi linier multivariat, membuktikan indeks apoptosis dan
Cyclophilin A memiliki hubungan dengan jejas jantung/pembuluh darah. Hal
tersebut menunjukkan inflamasi, indeks apoptosis, Cyclophilin A disertai
pemeriksan ekokardiografi dan ultrasonografi Doppler merupakan metode yang
cepat, tepat dan noninvasif faktor risiko terhadap jejas jantung/pembuluh darah
pada preeklamsia. Penelitian yang dianjurkan di masa datang adalah menilai
geometri jantung dengan ekokardiografi dan volumetri plasenta dengan
ultrasonografi.
ABSTRACTPreeclampsia is one of the leading cause of maternal and perinatal death in the
world. Inflammation accompanied by a high apototic index of syncytiotrophoblast
and Cyclophilin A were speculated to play a role in preeclampsia. Those response
were assumed to cause cardiovascular injury which lead to the risk of maternal and
perinatal morbidity and mortality in preeclampsia. The objective of the study was
to investigate the role of inflammation, apoptotic index and Cyclophilin A in
cardiovascular injury in early and late onset preeclampsia compared to normal
pregnancy.
A total of 47 pregnant women were selected, consisting almost the same size of
each group (30%) and assessed for maternal hematology, echocardiography and
Doppler ultrasound. Placentae were assessed histopathologically by measuring
nuclear factor kappa-light-chain-enhancer of activated B cells (NF- KB) and Poly
(ADP-ribose) polymerase 1 (PARP-1) expression for inflammation marker,
terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay for
apoptotic index and Cyclophilin A. Confirmation by transmission electron
microscopy (TEM) was done. Anova analysis was used to identify the differences
between the three groups while linier regression was employed to assess the
correlation between factors on cardiovascular injury using SPSS 20.
Maternal age, body mass index (BMI), platelet count, NF- KB and apoptotic index,
resistance index (RI) were higher supported by low Cyclophilin A in early onset
preeclampsia (EOP) than in late onset preeclampsia (LOP) and normal pregnancy.
Leukocyte count was higher in late onset preeeclampsia than in early and normal
pregnancy. Total peripheral resistance (TPR) was highest in the EOP compared to
LOP and normal pregnancy, while the cardiac index (CI) was not significantly
different in all groups. Based on multivariate linear regression analysis, the
apoptotic index and Cyclophilin A correlated to cardiovascular injury. Assesing
inflammation, apoptotic index, Cyclophilin A, echocardiography examination and
Doppler ultrasound examination might indicated timely and non-invasive detection
as an alarm entry point for cardiovascular injury in both early and late onset
preeclampsia. Cardiac geometry by echocardiography and placental volumetry by
Doppler ultrasound should be performed in future research