DAFTAR PUSTAKA. 3. Rhee SY, Kim YS. Peripheral Arterial Disease in Patients with Type 2 Diabetes Mellitus. 2015;

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Lampiran 1. Informed Consent (Persetujuan Pasien)

JUDUL PENELITIAN : Hubungan antara Dislipidemia dengan Derajat Keparahan Penyakit Arteri Perifer (PAP) pada Pasien Diabetes Melitus Tipe 2 Terkontrol Sedang. INSTANSI PELAKSANA : Bagian Ilmu Penyakit Dalam FK Undip -

Mahasiswa Program Studi Strata-1 Kedokteran Umum Fakultas Kedokteran Universitas Diponegoro

PERSETUJUAN SETELAH PENJELASAN

(

INFORMED CONSENT)

Yth Bapak/Ibu ………..

Nama saya Eka Aryani, saya mahasiswa Program Studi S1 Ilmu Pendidikan Dokter Fakultas Kedokteran UNDIP. Saya melakukan penelitian dengan judul “Hubungan antara Dislipidemia dengan Derajat Keparahan Penyakit Arteri Perifer (PAP) pada Pasien Diabetes Melitus Tipe 2 Terkontrol Sedang”. Tujuan dari penelitian ini adalah untuk mengetahui hubungan antara dislipidemia dengan derajat keparahan penyakit arteri perifer (PAP) pada pasien DM tipe 2 terkontrol sedang. Dislipidemia adalah kelainan metabolisme lipid (lemak darah) dimana terjadi peningkatan maupun penurunan komponen lipid seperti kolesterol total, kolesterol LDL (Low Density Lipoprotein), TG (trigliserida), serta menurunnya kolesterol HDL (High Density Lipoprotein) dalam darah. Penyakit arteri perifer adalah gangguan suplai darah ke ekstremitas atas atau bawah (tungkai atau lengan) karena obstruksi atau sumbatan sehingga timbul gejala seperti rasa nyeri pada ekstremitas tersebut(klaudikasio intermiten). Bapak/Ibu

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terpilih sebagai peserta penelitian ini. Apabila Bapak/Ibu setuju untuk menjadi peserta penelitian maka ada beberapa hal yang akan Bapak/Ibu alami, yaitu:

- Pengambilan informasi nama, umur, jenis kelamin, status merokok, status hipertensi dan keluhan yang dirasakan melalui wawancara

- Diukur tekanan darah pada kedua kaki dan kedua lengan pada saat istirahat - Dan bila diperlukan, akan diukur tekanan darah pada kaki setelah berolah

raga naik-turun bangku selama 4-5 menit atau berjalan selama 6 menit atau dorsofleksi plantarfleksi selama 6 menit.

Keuntungan bagi Bapak/Ibu yang bersangkutan ikut dalam penelitian ini adalah mendapat fasilitas pendeteksian Penyakit Arteri Perifer (PAP) serta mengetahui derajat PAP yang diderita apabila terdeteksi. Dengan dilakukanya pendeteksian ini, kita dapat mengetahui apakah terdapat sumbatan pembuluh darah pada lengan atau kaki Bapak/Ibu. Bapak/Ibu juga akan diberi pemahaman mengenai PAP. Saya menjamin bahwa penelitian ini tidak akan menimbulkan efek yang merugikan pada Bapak/Ibu. Dalam penelitian ini tidak ada intervensi dalam bentuk apapun terhadap Bapak/ Ibu. Setiap data pemeriksaan dan penelitian dijamin kerahasiaannya dengan tidak mencantumkan identitas subyek. Sebagai peserta penelitian keikutsertaan ini bersifat sukarela dan tidak dikenakan biaya penelitian.

Penanggung jawab penelitian:

EkaAryani

085642702444

Sudah mendengar dan memahami penjelasan penelitian, dengan ini saya menyatakan

SETUJU / TIDAK SETUJU

untuk ikut sebagai subyek/sampel penelitian ini.

Tegal, ……….2016 Saksi

Nama Terang : Nama Terang :

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Lampiran 2

DAFTAR TILIK PENELUSURAN REKAM MEDIK No Keterangan Nama Jenis Kelamin Umur Alamat No HP Kontrol teratur/tidak Status merokok ya/ tidak DM

Status glikemik (HbA1c): Kadar gula darah terakhir GDS:

GDP:

Lamanya DM: Obat yang diminum: Dislipidemia ya/ tidak TC:

LDL: HDL: TG:

Lamanya dislipidemia: Obat yang diminum: Hipertensi

Tekanan darah terakhir: Obat yang diminum:

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Lampiran 3

LEMBAR PENGUMPULAN DATA

ANKLE-BRACHIAL INDEX (ABI)

Tanggal Pemeriksaan:

Nama Pasien: Umur:

Catatan:

Apakah ada aktivitas berat yang baru saja dilakukan/ konsumsi kafein/ alkohol terakhir

Jenis Kelamin:

ABI saat istirahat

Kanan Pengukuran Rata-rata

Kiri Pengukuran Rata-rata I II I II Brachialis Brachialis Tibialis Posterior Tibialis Posterior Dorsalis Pedis Dorsalis Pedis

ABI kanan = rata − rata tertinggi tekanan sistolik kaki kanan DP atau TP rata − rata tertinggi tekanan sistolik lengan kanan atau kiri

ABI kiri = rata − rata tertinggi tekanan sistolik kaki kiri DP atau TP rata − rata tertinggi tekanan sistolik lengan (kanan atau kiri)

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ABI setelah exercise

(Diakukan apabila nilai ABI saat istirahat normal namun terdapat gejala klaudikasio)

Lamanya exercise =

Nilai tekanan sistolik kaki setelah exercise = Nilai ABI setelah exercise =

Kelengkapan Data

Status Merokok : Lamanya DM :

Lamanya Dislipidemia

Minum obat hipertensi teratur atau tidak : Minum obat diabetes teratur atau tidak : Minum obat dislipidemia teratur atau tidak :

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Lampiran 6. Biodata Mahasiswa

Identitas

Nama Lengkap : Eka Aryani Jenis Kelamin : Perempuan

Program Studi : Pendidikan Dokter

NIM : 22010112110093

Tempat, tanggal lahir : Tegal, 14 Februari 1995 E-mail : eka.aryani1402@gmail.com Nomor telepon/HP : 085642702444

Riwayat Pendidikan Formal

SD SMP SMA S1 Nama Institusi SDN Margadana 3 Kota Tegal SMPN 18 Kota Tegal SMAN 1 Kota Tegal Pendidikan Dokter Fakultas Kedokteran UNDIP Tahun masuk-lulus 2000-2006 2006-2009 2009-2012 2012

Organisasi yang Pernah Diikuti:

Lembaga Tahun

Divisi Pengembangan Mahasiswa Kelompok Studi Mahasiswa FK UNDIP

2013-2014

Bidang Riset HIMA KU UNDIP 2012-2014 Kelompok Ilmiah Remaja SMAN 1

Kota Tegal

2010-2012

Pengalaman Mengikuti Lomba Karya Ilmiah

Potensi Teng-teng Natto sebagai Alternatif Terapi Aterosklerosis, LKTI-GT Mini Scientific Fair 2014, Peserta Terbaik.

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Lampiran 7. Hasil SPSS

Frequencies Frequency Table

Status Dislipidemia

Frequency Percent Valid Percent Cumulative

Percent Valid ya 21 70,0 70,0 70,0 tidak 9 30,0 30,0 100,0 Total 30 100,0 100,0 Jenis kelamin

Percent Valid Laki-laki 17 56,7 56,7 56,7 Perempuan 13 43,3 43,3 100,0 Total 30 100,0 100,0 Usia N Valid 30 Missing 0 Mean 59,17 Median 58,50 Std. Deviation 7,250 Minimum 46 Maximum 71 Usia

Percent Valid 46 2 6,7 6,7 6,7 50 2 6,7 6,7 13,3 51 1 3,3 3,3 16,7 52 1 3,3 3,3 20,0 53 2 6,7 6,7 26,7 54 2 6,7 6,7 33,3 55 2 6,7 6,7 40,0 57 1 3,3 3,3 43,3 58 2 6,7 6,7 50,0 59 1 3,3 3,3 53,3 62 1 3,3 3,3 56,7

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64 3 10,0 10,0 66,7 65 2 6,7 6,7 73,3 66 2 6,7 6,7 80,0 67 3 10,0 10,0 90,0 68 2 6,7 6,7 96,7 71 1 3,3 3,3 100,0 Total 30 100,0 100,0 Status merokok

Percent Valid Ya 6 20,0 20,0 20,0 pasif 5 16,7 16,7 36,7 mantan 3 10,0 10,0 46,7 tidak 16 53,3 53,3 100,0 Total 30 100,0 100,0 Hipertensi

Percent

Valid

Ya 13 43,3 43,3 43,3

Tidak 17 56,7 56,7 100,0

Total 30 100,0 100,0

Penyakit atherosclerosis lain

Percent Valid Ya 7 23,3 23,3 23,3 Tidak 23 76,7 76,7 100,0 Total 30 100,0 100,0 Crosstabs

Case Processing Summary

Cases

Valid Missing Total

N Percent N Percent N Percent

Status Dislipidemia * Status PAP

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Status Dislipidemia * Status PAP Crosstabulation

Status PAP Total

Ya Tidak

Status Dislipidemia ya

Count 12 9 21

Expected Count 8,4 12,6 21,0

% within Status PAP 100,0% 50,0% 70,0%

% of Total 40,0% 30,0% 70,0%

tidak

Count 0 9 9

% of Total 0,0% 30,0% 30,0%

Total

Count 12 18 30

% of Total 40,0% 60,0% 100,0%

Chi-Square Tests

Value df Asymp. Sig.

(2-sided) Exact Sig. (2-sided) Exact Sig. (1-sided) Pearson Chi-Square 8,571a 1 ,003 Continuity Correctionb 6,356 1 ,012 Likelihood Ratio 11,699 1 ,001

Fisher's Exact Test ,004 ,003

Linear-by-Linear Association 8,286 1 ,004

N of Valid Cases 30

a. 1 cells (25,0%) have expected count less than 5. The minimum expected count is 3,60. b. Computed only for a 2x2 table

Risk Estimate

Value 95% Confidence Interval

Lower Upper

For cohort Status PAP = Tidak

,429 ,262 ,702

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T-Test

Group Statistics

Status PAP N Mean Std. Deviation Std. Error Mean

Kolesterol total Ya 12 212,00 45,798 13,221

Tidak 9 164,33 34,077 11,359

Independent Samples Test

Levene's Test for Equality of

Variances

t-test for Equality of Means

F Sig. t df Sig. (2-tailed) Mean Differenc e Std. Error Differenc e 95% Confidence Interval of the Difference Lower Upper Kolester ol total Equal variances assumed 1,62 2 ,218 2,61 9 19 ,017 47,667 18,199 9,577 85,757 Equal variances not assumed 2,73 5 18,999 ,013 47,667 17,430 11,184 84,149 T-Test Group Statistics

LDL Ya 12 136,83 31,007 8,951

Tidak 9 104,44 30,566 10,189

Levene's Test for Equality of Variances

F Sig. t df Sig. (2-tailed) Mean Differenc e Std. Error Differenc e 95% Confidence Interval of the Difference Lower Upper LDL Equal variances assumed ,042 ,840 2,383 19 ,028 32,389 13,591 3,942 60,836 Equal variances not assumed 2,388 17,52 3 ,028 32,389 13,562 3,841 60,937

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T-Test

HDL Ya 12 25,58 9,549 2,756

Tidak 9 33,67 5,074 1,691

NPar Tests

Mann-Whitney Test

Ranks

Status PAP N Mean Rank Sum of Ranks

Trigliserida Ya 12 13,42 161,00 Tidak 9 7,78 70,00 Total 21 Test Statisticsa Trigliserida Mann-Whitney U 25,000 Wilcoxon W 70,000 Z -2,061

Asymp. Sig. (2-tailed) ,039

Exact Sig. [2*(1-tailed Sig.)] ,041b

a. Grouping Variable: Status PAP b. Not corrected for ties.

F Sig. t df Sig. (2-tailed) Mean Differenc e Std. Error Differenc e 95% Confidence Interval of the Difference Lower Upper HDL Equal variances assumed 4,985 ,038 -2,298 19 ,033 -8,083 3,517 -15,445 -,721 Equal variances not assumed -2,499 17,44 3 ,023 -8,083 3,234 -14,893 -1,273

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Crosstabs

Cases

Valid Missing Total

jumlah dislipidemia * Status PAP 21 100,0% 0 0,0% 21 100,0%

jumlah dislipidemia * Status PAP Crosstabulation

Status PAP Total

Ya Tidak

jumlah dislipidemia

1 komponen

Count 0 6 6

% of Total 0,0% 28,6% 28,6%

2 komponen

Count 9 3 12

% of Total 42,9% 14,3% 57,1%

3 komponen

Count 2 0 2

Expected Count 1,1 ,9 2,0

% of Total 9,5% 0,0% 9,5%

4 komponen

Count 1 0 1

Expected Count ,6 ,4 1,0

% of Total 4,8% 0,0% 4,8%

Total

Count 12 9 21

% of Total 57,1% 42,9% 100,0%

(2-sided)

Pearson Chi-Square 11,813a 3 ,008

Likelihood Ratio 15,186 3 ,002

N of Valid Cases 21

a. 6 cells (75,0%) have expected count less than 5. The minimum expected count is ,43.

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Frequencies

jenis komponen

Percent Valid HDL 4 19,0 19,0 19,0 TG 2 9,5 9,5 28,6 TC HDL 1 4,8 4,8 33,3 HDL TG 10 47,6 47,6 81,0 LDL HDL 1 4,8 4,8 85,7 TC LDL HDL 2 9,5 9,5 95,2 TC LDL HDL TG 1 4,8 4,8 100,0 Total 21 100,0 100,0 NPar Tests Descriptive Statistics N Mean Std. Deviation

Minimum Maximum Percentiles

25th 50th (Median) 75th jenis komponen 21 3,57 1,720 1 7 2,00 4,00 4,00 Status PAP 21 1,43 ,507 1 2 1,00 1,00 2,00

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Mann-Whitney Test

Ranks

Status PAP N Mean Rank Sum of Ranks

jenis komponen Ya 12 14,38 172,50 Tidak 9 6,50 58,50 Total 21 Test Statisticsa jenis komponen Mann-Whitney U 13,500 Wilcoxon W 58,500 Z -3,059

Asymp. Sig. (2-tailed) ,002

Exact Sig. [2*(1-tailed Sig.)] ,002b

a. Grouping Variable: Status PAP b. Not corrected for ties.

Crosstabs

Cases

Valid Missing Total

Jenis kelamin * Status PAP 30 100,0% 0 0,0% 30 100,0%

Jenis kelamin * Status PAP Crosstabulation

Status PAP Total

Ya Tidak

Jenis kelamin

Laki-laki

Count 6 11 17

% of Total 20,0% 36,7% 56,7%

Perempuan

Count 6 7 13

% of Total 20,0% 23,3% 43,3%

Total

Count 12 18 30

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(2-sided) Exact Sig. (2-sided) Exact Sig. (1-sided) Pearson Chi-Square ,362a 1 ,547 Continuity Correctionb ,051 1 ,821 Likelihood Ratio ,361 1 ,548

Linear-by-Linear Association ,350 1 ,554

N of Valid Cases 30

Risk Estimate

Lower Upper

Odds Ratio for Jenis kelamin (Laki-laki / Perempuan)

,636 ,145 2,784

For cohort Status PAP = Ya ,765 ,320 1,828

1,202 ,651 2,220

N of Valid Cases 30

T-Test

Usia Ya 12 61,08 6,302 1,819

Tidak 18 57,89 7,722 1,820

F Sig. t df Sig. (2-tailed) Mean Differenc e Std. Error Differenc e 95% Confidence Interval of the Difference Lower Upper Usia Equal variances assumed 1,788 ,192 1,191 28 ,244 3,194 2,683 -2,300 8,689 Equal variances not assumed 1,241 26,72 0 ,225 3,194 2,574 -2,089 8,477

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Crosstabs

Cases

Valid Missing Total

Status merokok * Status PAP

30 100,0% 0 0,0% 30 100,0%

Status merokok * Status PAP Crosstabulation

Status PAP Total

Ya Tidak

Status merokok Ya

Count 4 2 6

% of Total 13,3% 6,7% 20,0%

pasif

Count 3 2 5

% of Total 10,0% 6,7% 16,7%

mantan

Count 1 2 3

% of Total 3,3% 6,7% 10,0%

tidak

Count 4 12 16

% of Total 13,3% 40,0% 53,3%

Total

Count 12 18 30

% of Total 40,0% 60,0% 100,0%

(2-sided)

(27)

a. 6 cells (75,0%) have expected count less than 5. The minimum expected count is 1,20.

Risk Estimate

Value Odds Ratio for Status

merokok (Ya / pasif)

a

a. Risk Estimate statistics cannot be computed. They are only computed for a 2*2 table without empty cells.

Crosstabs

Cases

Valid Missing Total

Hipertensi * Status PAP 30 100,0% 0 0,0% 30 100,0%

Hipertensi * Status PAP Crosstabulation

Status PAP Total

Ya Tidak

Hipertensi Ya

Count 9 4 13

% of Total 30,0% 13,3% 43,3%

Tidak

Count 3 14 17

% of Total 10,0% 46,7% 56,7%

Total

Count 12 18 30

(28)

N of Valid Cases 30

Risk Estimate

Lower Upper

Odds Ratio for Hipertensi (Ya / Tidak)

10,500 1,889 58,359

For cohort Status PAP = Ya 3,923 1,320 11,656

,374 ,161 ,869

N of Valid Cases 30

Crosstabs

Cases

Valid Missing Total

Penyakit atherosclerosis lain * Status PAP

30 100,0% 0 0,0% 30 100,0%

Penyakit atherosclerosis lain * Status PAP Crosstabulation

Status PAP Total

Ya Tidak

Penyakit atherosclerosis lain Ya

Count 4 3 7

% of Total 13,3% 10,0% 23,3%

Tidak Count 8 15 23

(29)

% of Total 26,7% 50,0% 76,7%

Total

Count 12 18 30

% of Total 40,0% 60,0% 100,0%

(2-sided) Exact Sig. (2-sided) Exact Sig. (1-sided) Pearson Chi-Square 1,118a 1 ,290 Continuity Correctionb ,380 1 ,537 Likelihood Ratio 1,100 1 ,294

N of Valid Cases 30

Risk Estimate

Lower Upper

Odds Ratio for Penyakit atherosclerosis lain (Ya / Tidak)

2,500 ,445 14,037

For cohort Status PAP = Ya 1,643 ,701 3,849

,657 ,266 1,626

N of Valid Cases 30

Crosstabs

Minum obat * Status PAP Crosstabulation

Status PAP Total

Ya Tidak

Minum obat Teratur

Count 6 16 22

% of Total 20,0% 53,3% 73,3%

(30)

% of Total 20,0% 6,7% 26,7%

Total

Count 12 18 30

% of Total 40,0% 60,0% 100,0%

N of Valid Cases 30

Risk Estimate

Lower Upper

Odds Ratio for Minum obat (Teratur / Tidak teratur)

,125 ,020 ,799

For cohort Status PAP = Ya ,364 ,165 ,802

2,909 ,853 9,925

N of Valid Cases 30

Crosstabs

Cases

Valid Missing Total

Obat dislipidemia * Status PAP

(31)

Obat dislipidemia * Status PAP Crosstabulation

Status PAP Total

Ya Tidak

Obat dislipidemia ya

Count 5 3 8

% of Total 16,7% 10,0% 26,7%

tidak

Count 7 8 15

% of Total 23,3% 26,7% 50,0%

tidak minum obat

Count 0 7 7

% of Total 0,0% 23,3% 23,3%

Total

Count 12 18 30

% of Total 40,0% 60,0% 100,0%

(2-sided)

N of Valid Cases 30

Risk Estimate

Value Odds Ratio for Obat

dislipidemia (ya / tidak)

a

(32)

Crosstabs

Cases

Valid Missing Total

obat hipertensi * Status PAP 30 100,0% 0 0,0% 30 100,0%

obat hipertensi * Status PAP Crosstabulation

Status PAP Total

Ya Tidak

obat hipertensi

teratur

Count 5 2 7

% of Total 16,7% 6,7% 23,3%

tidak teratur

Count 4 2 6

% of Total 13,3% 6,7% 20,0%

tidak minum obat

Count 3 14 17

% of Total 10,0% 46,7% 56,7%

Total

Count 12 18 30

% of Total 40,0% 60,0% 100,0%

(2-sided)

N of Valid Cases 30

(33)

Risk Estimate

Value Odds Ratio for obat

hipertensi (teratur / tidak teratur)

a

Logistic Regression

Unweighted Casesa N Percent

Selected Cases Included in Analysis 30 100,0 Missing Cases 0 ,0 Total 30 100,0 Unselected Cases 0 ,0 Total 30 100,0

a. If weight is in effect, see classification table for the total number of cases.

Dependent Variable Encoding

Original Value Internal Value

Ya 0

Tidak 1

Categorical Variables Codings

Frequency Parameter coding

(1)

Minum obat Teratur 22 1,000

Tidak teratur 8 ,000

Hipertensi Ya 13 1,000

Tidak 17 ,000

Block 0: Beginning Block

Classification Tablea,b

Observed Predicted

Status PAP Percentage

Correct Ya Tidak Step 0 Status PAP Ya 0 12 ,0 Tidak 0 18 100,0 Overall Percentage 60,0

(34)

b. The cut value is ,500

Variables in the Equation

B S.E. Wald df Sig. Exp(B)

Step 0 Constant ,405 ,373 1,184 1 ,277 1,500

Variables not in the Equation

Score df Sig.

Step 0 Variables

Hipertensi(1) 8,167 1 ,004

obat_dm(1) 5,568 1 ,018

Overall Statistics 10,027 2 ,007

Block 1: Method = Backward Stepwise (Likelihood Ratio)

Omnibus Tests of Model Coefficients

Chi-square df Sig. Step 1 Step 10,792 2 ,005 Block 10,792 2 ,005 Model 10,792 2 ,005 Step 2a Step -2,303 1 ,129 Block 8,488 1 ,004 Model 8,488 1 ,004

a. A negative Chi-squares value indicates that the Chi-squares value has decreased from the previous step.

Model Summary

Step -2 Log likelihood Cox & Snell R

Square

Nagelkerke R Square

1 29,589a ,302 ,408

2 31,892a ,246 ,333

a. Estimation terminated at iteration number 4 because parameter estimates changed by less than ,001.

Hosmer and Lemeshow Test

Step Chi-square df Sig.

1 ,070 2 ,966

(35)

Contingency Table for Hosmer and Lemeshow Test

Status PAP = Ya Status PAP = Tidak Total

Observed Expected Observed Expected

Step 1 1 5 5,124 1 ,876 6 2 4 3,876 3 3,124 7 3 1 ,876 1 1,124 2 4 2 2,124 13 12,876 15 Step 2 1 9 9,000 4 4,000 13 2 3 3,000 14 14,000 17 Classification Tablea Observed Predicted

Status PAP Percentage

Correct Ya Tidak Step 1 Status PAP Ya 9 3 75,0 Tidak 4 14 77,8 Overall Percentage 76,7 Step 2 Status PAP Ya 9 3 75,0 Tidak 4 14 77,8 Overall Percentage 76,7

a. The cut value is ,500

Variables in the Equation

B S.E. Wald df Sig. Exp(B) 95% C.I.for EXP(B)

Lower Upper Step 1a Hipertensi(1) -2,017 ,919 4,820 1 ,028 ,133 ,022 ,805 obat_dm(1) 1,552 1,048 2,190 1 ,139 4,719 ,604 36,836 Constant ,250 1,055 ,056 1 ,813 1,284 Step 2a Hipertensi(1) -2,351 ,875 7,219 1 ,007 ,095 ,017 ,529 Constant 1,540 ,636 5,863 1 ,015 4,667

(36)

Model if Term Removed

Variable Model Log

Likelihood Change in -2 Log Likelihood df Sig. of the Change Step 1 Hipertensi -17,390 5,190 1 ,023 obat_dm -15,946 2,303 1 ,129 Step 2 Hipertensi -20,190 8,488 1 ,004

Variables not in the Equation

Score df Sig.

Step 2a Variables obat_dm(1) 2,360 1 ,124

Overall Statistics 2,360 1 ,124