ABSTRAK
Latar Belakang. Perempuan dengan preeklampsia memiliki resiko tinggiterhadap penyakit kardiovaskuler 5-15 tahun pasca kehamilan. Disfungsi endoteldiperkirakan menjadi patogenesis manifestasi klinik preeklampsia danpenghubung antara preeklampsia dan kejadian kardivaskular setelah kehamilan.Nilai flow mediated vasodilation (FMD) dari arteri brakhialis pada sebagiansubset preeklampsia tetap rendah 3-10 tahun pasca-melahirkan. Proteinuria padapreeklampsia secara etiologi juga berhubungan dengan disfungsi endotelglomerulus. Namun, tidak seperti pada populasi hipertensi dan diabetes mellitus, sampai saat ini belum diketahui bagaimana korelasi antara nilai proteinuriadengan nilai FMD pada populasi preeklampsia.Tujuan : Untuk mengetahui hubungan/korelasi antara proteinuria terhadap nilaiFMD pada preeklampsia sebelum dan sesudah melahirkan Metode. Studi prospektif dilakukan di tiga rumah sakit. Subyek preeklampsiayang akan diterminasi dan sesuai kriteria inklusi dan eksklusi diperiksa nilai FMDdan rasio protein-kreatinin urinnya (RPKU) sebelum melahirkan, 48-72 jamsetelah melahirkan dan pasca-nifas. Data kemudian diolah dengan analisis bivariatdan multivariat untuk mengetahui korelasi antara rasio protein-kreatinin urindengan nilai FMD dan perubahannya sebelum dan setelah melahirkan.Hasil Penelitian. Sebanyak 30 perempuan preeklampsia diikutsertakan dalampenelitian ini. Rerata nilai FMD sebelum melahirkan, 48-72 jam pasca-melahirkandan follow up pasca-nifas adalah 5.46 ± 0.27 ,, 6.10 ± 0.35 dan 8.14 ± 2.48 ( p<0.001). Ditemukan 40 % subyek masih dengan FMD < 7 saat pemeriksaanpasca-nifas (40-60 hari). Uji korelasi bivariat menunjukkan korelasi dengan arahnegatif yang kuat antara proteinuria (RPKU) pasca-nifas dengan nilai FMD pascanifas(r= -0.73, p <0.001) , dan nilai RPKU sebelum melahirkan berhubungandengan rendahnya FMD pasca-nifas dan perubahan (delta) FMD sebelum-sesudahmelahirkan. Tidak diperoleh korelasi bermakna antara proteinuria dan nilai FMDsebelum melahirkan. Analisis multivariat dengan regresi linier membuktikankorelasi yang independen antara proteinuria dan nilai FMD pasca-nifas dan deltaFMD. Kesimpulan. Studi ini menegaskan korelasi yang kuat yang arahnya negatifantara nilai proteinuria pasca-melahirkan dengan nilai flow mediated dilationpasca melahirkan pada subyek preeklampsi dan semakin tinggi nilai proteinuriasebelum melahirkan berhubungan dengan rendahnya perubahan FMD sebelumdan sesudah melahirkan.
ABSTRACT
Background. Endothelial dysfunction was associated with both of thepredisposition of preeclampsia and the later development of vascular disease.Flow mediated dilation (FMD) was reduced in preeclamptic women and persistafter delivery in several cases. Proteinuria in preeclampsia was also amanifestation of endothelial dysfunction in kidney, but there was no data untillnow showing the correlation of FMD and the level of proteinuria in preeclampticwomanObjectives. To asses the correlation between urine protein-creatinine ratio andflow mediated dilation (FMD) before and after delivery in preeclamptic women.Methods. Women with a diagnosis of preeclampsia and planned for terminationwere enrolled for the study. History of hypertension before 20 weeks of gestation,diabetes mellitus, chronic kidney disease became exclusion criterias. The FMDwas studied through the use of high resolution vascular ultrasound examination ofbrachial artery for 3 times; before delivery, 48-72 hours after delivery and 40-60days after delivery. Urine protein-creatinine ratio (UPCR) was measured twice;prior to delivery and 40-60 days after delivery. Correlation between them wasthen evaluated.Results. Thirty patients were enrolled in this study. The mean ages was 29.5±6,4years old. FMD was improved after delivery, 5.46 ± 0.27 % (before delivery) &8.14 ± 2.48 % ( p <0.001) 40-60 days after delivery. Bivariates analysis showedthat after delivery, there was an inverse correlation between UPCR with FMD (r=0,735p<0,0001).UPCRpriortodeliveryalsohasinversecorrelationwithFMDafterdelivery (r= -0.55.p=0.002) and with the change of FMD before and afterdelivery (r= -0.45 with p =0.01). Multivariate analysis showed that correlationbetween UPCR after delivery with FMD after delivery was independent. Conclusion. This study demonstrated there was a moderate-strong correlationbetween urinary protein prior and after delivery with flow mediated vasodilatationof brachial artery after delivery.;Background. Endothelial dysfunction was associated with both of thepredisposition of preeclampsia and the later development of vascular disease.Flow mediated dilation (FMD) was reduced in preeclamptic women and persistafter delivery in several cases. Proteinuria in preeclampsia was also amanifestation of endothelial dysfunction in kidney, but there was no data untillnow showing the correlation of FMD and the level of proteinuria in preeclampticwomanObjectives. To asses the correlation between urine protein-creatinine ratio andflow mediated dilation (FMD) before and after delivery in preeclamptic women.Methods. Women with a diagnosis of preeclampsia and planned for terminationwere enrolled for the study. History of hypertension before 20 weeks of gestation,diabetes mellitus, chronic kidney disease became exclusion criterias. The FMDwas studied through the use of high resolution vascular ultrasound examination ofbrachial artery for 3 times; before delivery, 48-72 hours after delivery and 40-60days after delivery. Urine protein-creatinine ratio (UPCR) was measured twice;prior to delivery and 40-60 days after delivery. Correlation between them wasthen evaluated.Results. Thirty patients were enrolled in this study. The mean ages was 29.5±6,4years old. FMD was improved after delivery, 5.46 ± 0.27 % (before delivery) &8.14 ± 2.48 % ( p <0.001) 40-60 days after delivery. Bivariates analysis showedthat after delivery, there was an inverse correlation between UPCR with FMD (r=0,735p<0,0001).UPCRpriortodeliveryalsohasinversecorrelationwithFMDafterdelivery (r= -0.55.p=0.002) and with the change of FMD before and afterdelivery (r= -0.45 with p =0.01). Multivariate analysis showed that correlationbetween UPCR after delivery with FMD after delivery was independent. Conclusion. This study demonstrated there was a moderate-strong correlationbetween urinary protein prior and after delivery with flow mediated vasodilatationof brachial artery after delivery. |
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