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Amudi, Tulus
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Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Nursing Public Health

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Hubungan antara hs-CRP, Adiponektin, Fetuin A terhadap Resistensi Insulin pada Pria Dewasa Muda dengan Obesitas Sentral Amudi, Tulus; Pandelaki, Karel; Palar, Stella
e-CliniC Vol 9, No 1 (2021): e-CliniC
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.9.1.2021.32476

Abstract

Abstract: Obesity has quite a lot of risk factors for the incidence of metabolic diseases such as insulin resistance, diabetes mellitus, dyslipidemia, and metabolic syndrome. The accumulation of adipocytes causes the formation of chronic inflammatory mediators, and disrupts adipokine derived from adipocytes. These inflammatory mediators cause hepatocytes to secrete several types of proteins such as C-reactive protein and fetuin A into the blood circulation that are thought to cause insulin resistance in obesity cases. This study was aimed to determine the relationship among levels of hs-CRP, adiponectin, and fetuin A, and insulin resistance in adult male subjects with central obesity. This was an observational study with a cross sectional design. Subjects were young adult males with central obesity at Prof. Dr. R. D. Kandou Hospital, Manado. The results showed that 30 subjects had a mean hs-CRP level of 0.18 mg/dL (±0.16) which was higher than normal value. There was a positive and significant correlation between hs-CRP and HOMA-IR (r=0.380, p<0.023). There was a negative and insignificant correlation between adiponectin and Homa IR (r =-0.278, p=0.136), and there was no significant correlation between fetuin A and HOMA IR (r -0.048, p=0.801). In conclusion, among young adult males with central obesity there was an increase in hs-CRP level above normal value and there was a significant relationship between increased hs-CRP and insulin resistanceKeywords: fetuin-A, high sensitive C-reactive protein, adiponectin, HOMA-IR, central obesity Abstrak: Obesitas memiliki faktor risiko yang cukup banyak terhadap kejadian penyakit metabolik seperti resistensi insulin, diabetes melitus, dislipidemia, dan sindrom metabolik. Akumulasi adiposit menyebabkan terbentuknya mediator inflamasi kronik sehingga sintesis adipokin oleh adiposit terganggu. Mediator inflamasi tersebut juga menyebabkan hepatosit menyekresi beberapa jenis protein seperti C-reaktif protein dan fetuin A ke dalam sirkulasi darah yang diduga meyebabkan resistensi insulin pada kasus obesitas. Penelitian ini bertujuan untuk mengetahui hubungan antara kadar hs-CRP, adiponektin, dan fetuin A dengan resistensi insulin pada subjek pria dewasa dengan obesitas sentral. Jenis penelitian ialah observasional dengan desain potong lintang. Subyek penelitian ialah pria dewasa muda dengan obesitas sentral di RSUP Prof. Dr. R. D. Kandou Manado. Hasil penelitian mendapatkan 30 subyek dengan rerata kadar hs-CRP 0,18 mg/dl (±0,16) lebih tinggi dari nilai normal. Terdapat hubungan korelasi positif dan bermakna antara hs-CRP dan HOMA-IR (r=0,380, p<0,023); hubungan korelasi negatif dan tidak bermakna antara adiponektin dan Homa IR (r=-0,278, p=0,136); tidak didapatkan hubungan bermakna antara Fetuin A dengan HOMA IR (r=-0.048 dan p=0,801). Simpulan penelitian ini ialah pada pria dewasa muda dengan obesitas sentral terdapat peningkatan kadar hs-CRP melebihi nilai normal dan terdapat hubungan bermakna antara peningkatan hs-CRP dengan resistensi insulin.Kata kunci: fetuin-A, high sensitive C-reactive protein, adiponectin, HOMA-IR, obesitas sentral
Gagal Ginjal Kronik Hemodialisis dengan Kadar Eritropoietin dan Hemoglobin Normal: Laporan Kasus Amudi, Tulus; Palar, Stella
Medical Scope Journal Vol 2, No 2 (2021): Medical Scope Journal
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/msj.2.2.2021.32547

Abstract

Abstract: Generally, chronic kidney disease (CKD) is associated with anemia due to decrease of erythropoietin that plays an important role in erythropoiesis. We reported a patient, 61-year-old male, suffered from chronic hemodialysis kidney disease with coinfection of viral hepatitis C, albeit, had normal hemoglobin and erythropoietin levels. The patient was diagnosed as CKD in March 2014 with laboratory results, as follows: hemoglobin (Hb) 9.9 g/dl; ureum 223 mg/dl; creatinine 7.5 mg/dl, and was confirmed with ultrasonography. The patient underwent hemodialysis and was treated with erythropoiesis stimulating agent (ESA) for the first time in April 2014. The last ESA was given in June 2015 and the laboratory results were serum iron 61 µg/dl, total iron binding capacity (TIBC) 173 µg/dl, ferritin 1431 ng/ml, and the qualitative anti HCV test was reactive. Afterwards, the patient was not treated with ESA anymore since his Hb level was normal without ESA or blood transfusion. Moreover, the erythropoietin (EPO) level was tested in December 2018 resulted within normal level. Until now, the patient is still undergoing hemodialysis without ESA or transfusion. This is a rare condition, and there is still no certain pathophysiology to explain. It is assumed that the mechanism is related to hepatitis C infection that stimulates the hepatocyte regeneration, therefore, the cells produce endogen erythropoietin resulting in increased Hb level.Keywords: chronic kidney disease (CKD), erythropoietin and hemoglobin level Abstrak: Umumnya penyakit ginjal kronik (PGK) disertai dengan anemia akibat penurunan eritropoietin yang berperan penting dalam proses eritropoiesis. Kami melaporkan kasus seorang laki-laki 61 tahun dengan PGK hemodialisis disertai ko-infeksi hepatitis C namun dengan kadar hemoglobin dan eritropoietin normal. Pasien dinyatakan PGK sejak Maret 2014 dengan kadar hemoglobin (Hb) 9,9 g/dL; ureum 223 mg/dl; kreatinin 7,5 mg/dl, dan didukung oleh hasil ultrasonografi. Pasien diberikan hemodialisis dan terapi ESA pertama kali pada bulan April 2014. Terapi ESA terakhir diberikan pada bulan Juni 2015 dengan hasil serum iron 61 µg/dl, total iron binding capacity (TIBC) 173 µg/dl, feritin 1431 ng/ml, dan anti HCV kualitatif reaktif, Setelah itu pasien tidak mendapat terapi ESA lagi karena pada pemeriksaan laboratorium ditemukan kadar hemoglobin normal tanpa terapi ESA atau transfusi darah. Pemeriksaan kadar eritropoietin (EPO) pada bulan Desember 2018 mendapatkan hasil 16 mIU/ml (nilai normal 2,6-18,5 mIU/ml). Hingga saat ini pasien masih rutin menjalani hemodialisis dan tidak pernah mendapat terapi ESA atau transfusi darah. Keadaan tersebut jarang ditemukan, dan tidak ada patofisologi yang pasti untuk menjelaskan penyebab keadaan tersebut. Mekanisme keadaan ini dikaitkan dengan infeksi hepatitis C yang merangsang regenerasi hepatosit, sehingga sel-sel tersebut menghasilkan hormon ertiropoietin endogen, dengan hasil akhir ialah peningkatan hemoglobin.Kata kunci: penyakit ginjal kronik (PGK), kadar eritropoietin dan hemoglobin
Co-Authors Karel Pandelaki Stella Palar