• Tidak ada hasil yang ditemukan

BAB V. SIMPULAN DAN SARAN

B. Saran

Implikasi klinis hasil penelitian ini yaitu kadar CRP dapat digunakan untuk memprediksi kadar apo B pada pasien DM tipe 2 dengan hipertensi. Perlu dilakukan penelitian lanjutan dengan lebih memperhatikan jenis obat-obatan yang dikonsumsi terutama obat anti inflamasi sebelum dilakukan penelitian, dan kondisi-kondisi yang dapat mempengaruhi hasil pemeriksaan apo B seperti malnutrisi, anemia kronik dan CKD sehingga hasil penelitian ini dapat diterapkan secara umum.

DAFTAR PUSTAKA

American Diabetes Association. 2012. Standards of Medical Care in Diabetes-2012.Diabetes Care. 35 (1): 3-6

American Diabetes Association. 2014. Standards of Medical Care in Diabetes-2014.Diabetes Care. 37 (1): S14-80

Arif M. 2001. Kapita Selekta Kedokteran: Nefrologi dan Hipertensi. Jakarta: Media Aesculapius FKUI. pp: 519-520

Arora S. 2012. Molecular basis of insulin resistance and its relation to metabolic syndrome.Intech; Chapter 1, pp: 1-24

Ballantyne C.M., Assmann G., Bagshaw D., Balasbranyam A., Barter P., Bays H., Blumenthal R.S., et al., 2009. Clinical lipidology a companion to braunwald’sheart disease. Philadelphia.Saunders.pp: 3-4, 212-5

Bautista L.E., Lopez J.P., Vera L.M. 2003. Is c-reactive protein an independen risk factor for essential hypertension?J Hypertens. Vol. 19: 857-861

Bhagwat R., Gupte A., Yadav K.S. 2012. Diagnostic utility of hs-CRP in coronary heart disease.Int J Molecular Biology. 3 (1): 36-9

Chan D.C. dan Watts G.F. 2006. Apolipoproteins as markers and managers of coronary risk.QJ Med99. Pp:277–287

Corwin E.J. 2009. Buku Saku Patofisiologi Penyakit Diabetes Melitus. EGC. Jakarta. p: 15

Cleveland C.L. 2012. High sensitivity c-reactive protein.Lab Med. pp: 1-2

Dahlan S. 2009. Besar sampel Dan Cara Pengambilan Sampel Dalam Penelitian Kedokteran Dan Kesehatan2nded. Salemba Medika. Jakarta. pp: 79-105

Dawri S., Padwal M.K., Melinkeri R. 2014. Evaluation of high sensitivity c-reactive protein and serum lipid profile in prehypertension and essential hypertension.NJIRM.Vol. 5 (1): 1-5

Dinh Q.N., Drummond G.R., Sobey C.G., Chrissobolis S. 2014. Roles of inflammation, oxidative stress, and vascular dysfunction in hypertension. BMJ. pp: 1-7

Duez H. dan Lewis G.F. 2008. Fat metabolism in insulin resistance and type 2 diabetes. In: Feinglos M.N., Bethel M.A. Type 2 diabetes mellitus an evidence-based approach to practical management. Humana Press. United State. pp: 49-74

Faraj M. dan Salem N. 2012. C-reactive protein.Blood Cell. pp: 1-12

Feinglos M.N. dan Bethel M.A. 2008. Contemporary endocrinology: type 2 diabetes mellitus: An evidence-based approach to practical management. Humana Press, Totowa.NJ.pp: 265-74

Godsland I.F. 2009. Insulin resistance and hyperinsulinaemia in the development and progression of cancer.Clin Sci(Lond). 118 (5): 315–332

Holt R.I.G., Cockram C.S., Flyvbjerg A., Goldstein B.J. 2010. Textbook of Diabetes4thed. Wiley-Blackwell. United Kingdom. pp: 25-6, 57, 644

Idemudia J., Ugwuja E., Afonja O., Idogun E., Ugwu N. 2008. C-reactive protein and cardiovascular risk indices in hypertensive Nigerians.J cardio Res. Vol 6 (2)

Jung U.J. dan Choi M.S. 2014. Obesity and its metabolic complications: The role of adipokines and the relationship between obesity, inflammation, insulin resistance, dyslipidemia and nonalcoholic fatty liver disease.Int J Mol Sci. (15): 6184-6223

Kaplan L.A. dan Pesce A.J. 2010.Clinical Chemistry. Mosby. Elsevier. p: 731

Kemenkes RI. 2013.Riset Kesehatan Dasar. Badan Penelitian dan Pengembangan Kesehatan Kementrian Kesehatan RI

Martin S.S., Qasim A.N., Mehta N.N., Wolfe M., Terembula K., Schwartz S., Iqbal N. 2009. Apolipoprotein B but not LDL cholesterol is associated with coronary artery calcification in type 2 diabetic whites. DIABETES. (58): 1887-91

McGarry. 2001. Dysregulation of fatty acid metabolism in the etiology of type 2 diabetes.Diabetes. (51): 7-18

Narasimhaswamy K.N., Ravi G.N., Neema K.N. 2014.A study of dyslipidemia in type 2 diabetes mellitus.IJHIMR.1 (1): 12-4

Oliveira M.I.A., Souza E.M., Pedrosa F.O., Rea R.R., Alves A.S.C., Picheth G., Rego F.G.M. 2013. RAGE receptor and its soluble isoforms in diabetes mellitus complications.J Bras Patol Med Lab. (49): 97-108

Olofsson S.O., Wiklund O., Boren J. 2007. Apolipoprotein A-1 and B: Biosynthesis, role in the development of atherosclerosis and targets for intervention against cardiovascular disease. Vas Health Risk Manag. (3): 491-2

Onat A., Can G., Hergenc G., Yazici M., Karabulut A., Albayrak S. 2007. Serum apolipoprotein B predicts dyslipidemia, metabolic syndrome and, in women, hypertension and diabetes, independent of markers of central obesity and inflammation.Int J Obest. pp: 1119-25

Oparil S., Zaman M.A., Calhoun D.A. 2003. Pathogenesis of hypertension. Ann Intern Med.(139): 761-776

Osman R., L’Allier P.L., Elgharib N., Tardif J.C. 2006. Critical appraisa of C reactive protein throughout the spectrum of cardiovascular disease. Vasc Health and Risk Manag. 2 (3): 221-237

Perhimpunan Dokter Spesialis Patologi Klinik Indonesia Cabang Jakarta. 2004. Tabel Konversi dan Nilai Rujukan Kimia In SI Units Tabel Konversi Sistem Satuan SI-Konvensional dan Nilai Rujukan Dewasa-Anak Parameter Laboratorium Klinik. Jakarta. p: 45

Perkeni. 2011. Konsensus Pengendalian dan Pencegahan Diabetes Melitus Tipe2 di Indonesia. pp: 1-8

Power A.C. 2010. Diabetes Mellitus. In: Jameson J.L. Harrison’s Endocrinology, 2ndEd. The McGraw-Hill. United State. pp: 267-313

Senghor A. dan William E. 2013. Non-HDL-c and AIP compared to hs-CRP in hypertriglyceridemic diabetics– A better cardiovascular risk marker? Asian J Pharm Clin Res.Vol. 6 (4): 128-130

Sesso H.D., Buring J.E., Rifai N., Blake G.J., Gaziano J.M., Ridker P.M. 2010. C-reactive protein and the risk of developing hypertension.J cardio Res. Vol. 12 (2)

Shradha B. dan Sisodia S.S. 2010. Diabetes, dyslipidemia, antioxidant and status of oxidative stress.IJRAP.Vol 1 (1): 33-42

Sniderman A.D., Islam S., Yusuf S., McQueen M.J. 2013. Is the superiority of apoB over non-HDL-C as a marker of cardiovascular risk in the INTERHEART study due to confounding by related variables? J Clin Lipidol.7 (6): 626-31

Tudor M.N., Mitrea A., Popa S., Zaharie S., Mota M., Mota E. 2014. Apolipoproteins: Good markers for cardiovacular risk in patients with chronic kidney disease and dyslipidemia. Rom J Diabetes Nutr Metab Dis. 21 (3): 185-191

Van den Oever I.A., Raterman H.G., Nurmohamed M.T., Simsek S. 2010. Endothelial dysfunction, inflammation, and apoptosis in diabetes mellitus. Hindawi Publishing Corporation. Med Inflam.pp: 2-8

Waheed P., Naveed A.K., Farooq F. 2009. Levels of inflammatory markers and their correlation with dyslipidemia in diabetics.J Coll Physicians Surg Pak. Vol. 19 (4): 207-210

Walldius G. dan Jungner I. 2004. Apolipoprotein B and apolipoprotein A-I: risk indicators of coronary heart disease and targets for lipid-modifying therapy. J Intern Med. 255 (2): 188–205

Walldius G. dan Jungner I. 2006. The apoB/ apoA-I ratio: a strong, new risk factor for cardiovascular disease and a target for lipid-lowering therapy– a review of the evidence.J Intern Med. (259): 493–519

Wiyono W., Wiadnyana I.G.P., Nendrodueito D., Yamin G., Trisnawati E., Yusnayati L. 2004. Pedoman Praktek Laboratorium Yang Benar (Good Laboratory Practice) 3th Ed. Depkes RI. Dirjen Yanmed, Dirjen Labkes. Jakarta. pp: 32-120 commit to user

Lampiran 1

Biodata

a. Nama : Laily Shofiyah, dr b. Tempat/Tanggal lahir : Boyolali/25 Maret 1977 c. Profesi/Jabatan : Dokter/PNS Kemenkes RI

d. Alamat kantor : KKP Kelas I Tanjung Priok, Jalan Raya Pelabuhan No. 11 Tanjung Priok, Jakarta Utara

e. Alamat rumah : Jl.Swasembada Timur 7 No.7 Tanjung Priok, Jakarta Utara.

Pandeyan RT 03/6, Ngemplak, Boyolali. f. Email : lailyshofiyah@rocketmail.com

g. Riwayat Pendidikan Perguruan Tinggi:

No Institusi Bidang Ilmu Tahun Lulus Gelar

1 FK UNS Kedokteran Umum 2002 Dokter

2 FK UNS Kedokteran Umum 2000 Sarjana Kedokteran

Surakarta, April 2015

Laily Shofiyah, dr

Lampiran 2

Formulir Persetujuan Mengikuti Penelitian Dan Tindakan Medis

Yang bertanda tangan di bawah ini:

Nama : ... Umur : ... tahun, Jenis Kelamin : L/P

Alamat : ... Telp : ... Pekerjaan : ... menerangkan bahwa setelah mendapatkan penjelasan yang lengkap mengenai latar belakang dan tujuan penelitian, menyatakan bersedia mengikuti penelitian dan tidak keberatan untuk dilakukan pemeriksaan dan dimintai data-data yang diperlukan untuk penelitian ini.

Surakarta, ... Peneliti Laily Shofiyah, dr Peserta/Wali peserta ... Saksi ... commit to user

Lampiran 3

Formulir Isian Penelitian

Nama : ... Umur : ... Alamat : ... Tanggal pemeriksaan : ..., Jam : ... WIB Riwayat penyakit terdahulu:

Diabetes melitus ... ya/tidak Lama menderita ... tahun Obat yang diminum ... Merokok ...ya/tidak Lama merokok ... tahun Jumlah perhari ... batang Penyakit hati ...ya/tidak Riwayat stroke ... ya/tidak Riwayat minum obat saat ini... Pemeriksaan fisik saat datang:

TB/BB: ...(m)/ ...(kg), IMT ... Pemeriksaan laboratorium saat datang:

HbA1c(metode HPLC): ... (%) GDP: ... (mg/dl) G2JPPP: ... (mg/dl) Kolesterol total ... (mg/dl) Trigliserida: ... (mg/dl) LDL: ... (mg/dl) HDL-c: ... (mg/dl) SGPT: ... (mg/dl) CRP: ………. (mg/dl) Apo B: ... (mg/dl) commit to user

Case Processing Summary

Cases

Valid Missing Total

N Percent N Percent N Percent

GDP 44 100.0% 0 .0% 44 100.0% G2JPP 44 100.0% 0 .0% 44 100.0% HbA1C 44 100.0% 0 .0% 44 100.0% KolestTotal 44 100.0% 0 .0% 44 100.0% Trigliserida 44 100.0% 0 .0% 44 100.0% LDL 44 100.0% 0 .0% 44 100.0% HDL 44 100.0% 0 .0% 44 100.0% Sistole 44 100.0% 0 .0% 44 100.0% Diastole 44 100.0% 0 .0% 44 100.0% CRP 44 100.0% 0 .0% 44 100.0% apoB 44 100.0% 0 .0% 44 100.0% commit to user

Lampiran 5. Tabel uji presisi sehari

Tabel 6. Uji presisi sehari CRP Tabel 7. Uji presisi sehari apo B No Kadar (g/L) Mean SD KV (%) No Kadar (mg/dL) Mean SD KV (%) 1. 0,4 0,3 0,1 3,3 1. 86 85,6 1,07 1,26 2. 0,3 2. 84 3. 0,5 3. 87 4. 0,3 4. 85 5. 0,1 5. 85 6. 0,1 6. 85 7. 0,3 7. 85 8. 0,1 8. 87 9. 0,2 9. 87 10. 0,2 10. 85

Lampiran 5. Tabel uji presisi hari ke hari

Tabel 8. Uji presisi hari ke hari CRP Tabel 9. Uji presisi hari kehari apo B No Kadar (g/L) Mean SD KV (%) No Kadar (mg/dL) Mean SD KV (%) 1. 4,16 4,31 0,15 3,62 1. 106 108,5 2,42 2,23 2. 4,2 2. 107 3. 4,11 3. 106 4. 4,21 4. 111 5. 4,41 5. 110 6. 4,2 6. 110 7. 4,4 7. 105 8. 4,3 8. 112 9. 4,57 9. 110 10. 4,5 10. 108 commit to user

Dokumen terkait