ABSTRAK
Latar Belakang: Sindrom Ovarium Polikistik (SOPK) merupakan penyebab 40%infertilitas pada wanita usia reproduksi. Resistensi insulin sebagai salah satupatofisiolofi yang mendasari SOPK, berkaitan erat dengan jaringan adiposaviseral dan ditemukan pada 30-50% pasien SOPK dengan indeks masa tubuhnormal serta lingkar pinggang kurang dari 80 cm. Retinol Binding Protein-4(RBP-4) yang disekresi oleh jaringan adiposa viseral diketahui sebagai salah satuadipokin yang menyebabkan resistensi insulin. Pengukuran IMT dan lingkarpinggang tidak dapat mewakili akumulasi jaringan adiposa viseral pada SOPKdengan IMT normal serta lingkar pinggang kurang dari 80 cm. Dengandiketahuinya titik potong optimal kadar serum RBP-4 sebagai penanda jaringanadiposa viseral, diharapkan dapat memprediksi risiko kejadian resistensi insulinyang bermanfaat dalam menentukan penatalaksanaan kasus SOPK dengan IMTnormal terkait strategi pengurangan akumulasi jaringan adiposa viseral. Tujuan: Diketahuinya titik potong optimal kadar serum RBP-4 sebagai penandajaringan adiposa viseral untuk memprediksi risiko kejadian resistensi insulin padapenderita SOPK dengan IMT normal. Metode: Studi observasional dengan desain potong lintang selama periode Juli2014 hingga Maret 2015 di Poliklinik Yasmin, RSCM, Jakarta. Hasil: Sejumlah 40 subjek SOPK dengan IMT normal yang memenuhi kriteriainklusi didapatkan 16 subjek (40%) yang mengalami resistensi insulin dan 24subjek (60%) nir resistensi insulin. Sejumlah 23 subjek (57.5%) memiliki lingkarpinggang kurang dari 80 cm, dimana 6 subjek (26%) diantaranya mengalami resistensi insulin. Kadar serum RBP-4 pada kelompok resistensi insulin bermakna lebih tinggi dibandingkan nir resistensi insulin (p 0.008). Dengan analisis ROCdidapatkan AUC kadar serum RBP-4 78.8% (IK 95% -8445.59 ? -1447.98)dengan nilai p 0.002. Titik potong optimal kadar serum RBP-4 adalah 24133ng/mL dengan sensitivitas sebesar 75% dan spesifisitas sebesar 75%. Dengananalisis regresi logistik biner didapatkan pemeriksaan serum RBP-4 menambahnilai diagnostik dari parameter demografis dan klinis AUC 85.7% menjadi 91.1%. Kesimpulan: Kadar serum RBP-4 sebagai penanda jaringan adiposa viseral dapat digunakan untuk memprediksi risiko kejadian resistensi insulin pada penderita SOPK dengan IMT normal. ABSTRACT Background: Polycystic ovarian syndrome (PCOS) contributes to fourty percent of infertility?s issues on reproductive women. Insulin resistance as one ofimportant pathophysiology in PCOS, correlates with visceral adipose tissue and isfound on 30-50% PCOS patients with normal body mass index and waistcircumference less than 80 cm. Retinol Binding Protein-4 (RBP-4), which issecreted by visceral adipose tissue, known as one of adipokines that cause insulinresistance. The measurement of body mass index and waist circumference couldnot represent visceral adiposity on PCOS with normal body mass index and waistcircumference less than 80 cm. Determination of serum RBP-4 cut off level asvisceral adipose tissue marker hopefully could predict the risk of insulinresistance on polycystic ovarian syndrome with normal body mass index,therefore it will be useful on its management related to reduction of visceraladiposity.Objective: To obtain serum RBP-4 cut off level as visceral adipose tissue markerto predict the risk of insulin resistance on PCOS with normal body mass index. Method: This was an observational study with cross sectional design conducted atYasmin Clinic, RSCM, Jakarta during a period of July 2014 until March 2015.Result: Fourty PCOS patients with normal body mass index were participated onthis study. There were 16 subjects (40%) who were insulin resistance and 24subjects (60%) who were not insulin resistance. There were 23 subjects (57.5%)who had waist circumference less than 80 cm, where 6 of them (26%) wereinsulim resistance. Serum RBP-4 level was significantly higher on insulin resistance group (p 0.008). After ROC analysis was performed, AUC of serum RBP-4 was 78.8% (CI 95% -8445.59 ? -1447.98, p 0.002). The cut off level ofserum RBP-4 was 24133 ng/mL with sensitivity 75% and specificity 75%. Afterlogistic regression analysis was performed, it was found that serum RBP-4 increase diagnostic value of demographic and clinical parameter with AUC 85.7% to 91.1%. ;Background: Polycystic ovarian syndrome (PCOS) contributes to fourty percent of infertility?s issues on reproductive women. Insulin resistance as one ofimportant pathophysiology in PCOS, correlates with visceral adipose tissue and isfound on 30-50% PCOS patients with normal body mass index and waistcircumference less than 80 cm. Retinol Binding Protein-4 (RBP-4), which issecreted by visceral adipose tissue, known as one of adipokines that cause insulinresistance. The measurement of body mass index and waist circumference couldnot represent visceral adiposity on PCOS with normal body mass index and waistcircumference less than 80 cm. Determination of serum RBP-4 cut off level asvisceral adipose tissue marker hopefully could predict the risk of insulinresistance on polycystic ovarian syndrome with normal body mass index,therefore it will be useful on its management related to reduction of visceraladiposity.Objective: To obtain serum RBP-4 cut off level as visceral adipose tissue markerto predict the risk of insulin resistance on PCOS with normal body mass index. Method: This was an observational study with cross sectional design conducted atYasmin Clinic, RSCM, Jakarta during a period of July 2014 until March 2015.Result: Fourty PCOS patients with normal body mass index were participated onthis study. There were 16 subjects (40%) who were insulin resistance and 24subjects (60%) who were not insulin resistance. There were 23 subjects (57.5%)who had waist circumference less than 80 cm, where 6 of them (26%) wereinsulim resistance. Serum RBP-4 level was significantly higher on insulin resistance group (p 0.008). After ROC analysis was performed, AUC of serum RBP-4 was 78.8% (CI 95% -8445.59 ? -1447.98, p 0.002). The cut off level ofserum RBP-4 was 24133 ng/mL with sensitivity 75% and specificity 75%. Afterlogistic regression analysis was performed, it was found that serum RBP-4 increase diagnostic value of demographic and clinical parameter with AUC 85.7% to 91.1%. |
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