Kadar Hypoxia Inducible Factor-1α pada Penderita Diabetes Melitus Tipe 2 Disertai Mikroalbuminuria dan Retinopati

Abstract

Diabetes melitus tipe 2 (DMT2) sampai saat ini masih menjadi masalah kesehatan karena bersifat progresif dan menimbulkan komplikasi. Menurut data epidemiologi dari International Diabetes Federation (IDF) tahun 2011, dinyatakan bahwa retinopati diabetik sering kali mendahului mikroalbuminuria. Komplikasi tersebut diawali oleh disfungsi endotel yang akan meningkatkan sekresi sitokin yang menginduksi angiogenesis dan limpangiogenesis. Pada keadaan hipoksia akibat perubahan mikrovaskular, hypoxia inducible factor-1 alpha (HIF-1α) disekresikan dan akan merangsang produksi vascular endothelial growth factor (VEGF) yang menginduksi angiogenesis. Penelitian ini bertujuan untuk mengetahui hubungan kadar HIF-1α plasma penderita DMT2 dengan mikroalbuminuria dan retinopati diabetik. Penelitian menggunakan rancangan studi potong lintang terhadap 158 penderita DMT2 yang berobat di poliklinik endokrinologi Rumah Sakit Dr. Hasan Sadikin Bandung periode Juli─Desember 2012. Data dianalisis menggunakan uji-t, Mann Whitney, dan multivariate analysis of variance (MANOVA). Subjek penelitian terdiri atas 82 orang pria (51,9%) dan 76 orang wanita (48,1%). Delapan puluh orang (50,6%) normoalbuminuria dan 78 orang (49,4%) mikroalbuminuria. Pada penelitian ini didapatkan 38 orang dengan retinopati diabetik (24,1%). Median kadar HIF-1α kelompok mikroalbuminuria adalah 0,103 (0,041–0,735) ng/mL dan pada normoalbuminuria 0,144 (0,041–0,481) ng/mL (p=0,257). Median kadar HIF-1α kelompok retinopati positif 0,041 (0,041–0,33) ng/mL, sedangkan kelompok tanpa retinopati 0,167 (0,041–0,735) ng/mL dengan p<0,01. Simpulan, kadar HIF-1α plasma yang rendah atau normal bergantung pada derajat retinopati diabetik. Kadar HIF-1α plasma yang tinggi pada penderita tanpa retinopati diabetik, menunjukkan akan terjadi retinopati diabetik di masa mendatang. [MKB. 2014;46(2):100–5]

Kata kunci: Hypoxia inducible factor-1α, mikroalbuminuria, retinopati diabetik

Hypoxia Inducible Factor-1α in Type 2 Diabetes Mellitus with Microalbuminuria and Retinopathy

Type 2 diabetes mellitus (T2DM) is still considered a major problem in healthcare, mainly for its progressivity and complications. According to the epidemiological data from the International Diabetes Federation (IDF) in 2011, it is stated that microalbuminuria often precedes the onset of diabetic retinopathy. Complications are preceded by endothelial dysfunction that will increase the secretion of cytokines inducing angiogenesis and limpangiogenesis. In hypoxic conditions induced by microvascular changes, hypoxia inducible factor-1 alpha (HIF-1α) is secreted, stimulating the production of vascular endothelial growth factor (VEGF) which induce angiogenesis. The aim of this study was to know the correlation between plasma HIF-1α concentration with microalbuminuria pattern and diabetic retinopathy in T2DM patients. This cross-sectional study was conducted on 158 T2DM patients in Endocrinology Outpatient Departement of Dr. Hasan Sadikin Hospital during July to December 2012. Data were analyzed using t-test, Mann Whitney, and multivariate analysis of variance (MANOVA) methods. Eighty two males (51.9%) and 76 females (48.1%) participated in the study, making up 158 subjects. Eighty patients (50.6%) had normoalbuminuria and 78 patients (49.4%) had microalbuminuria. Thirty eight patients were found with diabetic retinopathy (24.1%). The median of HIF-1α plasma concentrations was 0.103 (0.041–0.735) ng/mL in the microalbuminuria group and 0.144 (0.041–0.481) ng/mL (p=0.257).in the normoalbuminuria group. The median of HIF-1α plasma concentration in the group with diabetic retinopathy was 0.041 (0.041–0.33) ng/mL, while in the group without diabetic retinopathy the median was 0.167 (0.041–0.735) ng/mL (p<0.01). In conclusion, low or normal HIF-1α plasma levels in patients without diabetic retinopathy predict the grading of diabetic retinopathy, while high levels of plasma HIF-1α suggests the likehood of retinopathy event in the future. [MKB. 2014;46(2):100–5]

Key words: Diabetic retinopathy, hypoxia inducible factor-1α, microalbuminuria

DOI: 10.15395/mkb.v46n2.281