ABSTRAK
Preeklamsia merupakan salah satu penyebab kematian utama ibu dan perinatal didunia. Inflamasi disertai tingginya indeks apoptosis di syncytiotrophoblast danekspresi Cyclophilin A diduga berperan pada preeklamsia. Faktor tersebutdiasumsikan menyebabkan jejas jantung/pembuluh darah yang meningkatkanrisiko morbiditas dan mortalitas ibu dan perinatal. Tujuan penelitan ini adalahmenganalisis peran inflamasi, indeks apoptosis dan Cyclophilin A terhadap jejasjantung/pembuluh darah pada preeklamsia awitan dini, lanjut dan kehamilannormal.Sebanyak 47 wanita hamil yang terpilih dilakukan pemeriksaan hematologi,ekokardiografi dan ultrasonografi Doppler. Plasenta diperiksa secara histopatologisuntuk mengukur ekspresi NF-KB dan PARP-1, indeks apoptosis berdasarkanpemeriksan TUNEL, ekspresi Cyclophilin A dan pemeriksaan ultrastrukturmikroskopik pada syncytiotrophoblast. Analisis Anova digunakan untukmengidentifikasi perbedaan antara ketiga kelompok, sedangkan regresi linierdigunakan untuk mengetahui korelasi faktor yang diduga terhadap jejasjantung/pembuluh darah menggunakan SPSS 20.Usia ibu, indeks massa tubuh (IMT), hitung trombosit, NF- KB dan indeksapoptosis lebih tinggi disertai Cyclophilin A lebih rendah pada preeklamsia awitandini dibandingkan preeklamsia awitan lanjut dan kehamilan normal. Hitungleukosit lebih tinggi pada preeklamsia awitan lanjut dibandingkan awitan dini dannormal. Total peripheral resistance (TPR) paling tinggi pada kelompok awitan dinidibandingkan awitan lanjut dan kehamilan normal, sedangkan cardiac index (CI)tidak berbeda bermakna pada ketiga kelompok. Resistensi indeks (RI) lebih tinggipada preeklamsia awitan dini dibandingkan awitan lanjut dan kehamilan normal.Berdasarkan analisis regresi linier multivariat, membuktikan indeks apoptosis danCyclophilin A memiliki hubungan dengan jejas jantung/pembuluh darah. Haltersebut menunjukkan inflamasi, indeks apoptosis, Cyclophilin A disertaipemeriksan ekokardiografi dan ultrasonografi Doppler merupakan metode yangcepat, tepat dan noninvasif faktor risiko terhadap jejas jantung/pembuluh darahpada preeklamsia. Penelitian yang dianjurkan di masa datang adalah menilaigeometri jantung dengan ekokardiografi dan volumetri plasenta denganultrasonografi.ABSTRACT
Preeclampsia is one of the leading cause of maternal and perinatal death in theworld. Inflammation accompanied by a high apototic index of syncytiotrophoblastand Cyclophilin A were speculated to play a role in preeclampsia. Those responsewere assumed to cause cardiovascular injury which lead to the risk of maternal andperinatal morbidity and mortality in preeclampsia. The objective of the study wasto investigate the role of inflammation, apoptotic index and Cyclophilin A incardiovascular injury in early and late onset preeclampsia compared to normalpregnancy.A total of 47 pregnant women were selected, consisting almost the same size ofeach group (30%) and assessed for maternal hematology, echocardiography andDoppler ultrasound. Placentae were assessed histopathologically by measuringnuclear 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 forapoptotic index and Cyclophilin A. Confirmation by transmission electronmicroscopy (TEM) was done. Anova analysis was used to identify the differencesbetween the three groups while linier regression was employed to assess thecorrelation 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 onsetpreeclampsia (EOP) than in late onset preeclampsia (LOP) and normal pregnancy.Leukocyte count was higher in late onset preeeclampsia than in early and normalpregnancy. Total peripheral resistance (TPR) was highest in the EOP compared toLOP and normal pregnancy, while the cardiac index (CI) was not significantlydifferent in all groups. Based on multivariate linear regression analysis, theapoptotic index and Cyclophilin A correlated to cardiovascular injury. Assesinginflammation, apoptotic index, Cyclophilin A, echocardiography examination andDoppler ultrasound examination might indicated timely and non-invasive detectionas an alarm entry point for cardiovascular injury in both early and late onsetpreeclampsia. Cardiac geometry by echocardiography and placental volumetry byDoppler ultrasound should be performed in future research |
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