Oetji, Theresa Sugiarti and Dr. dr. Hani Susianti,, Sp.PK.(K.) and dr. Catur Suci S., M.Biomed.,, Sp.PK.(K.) (2022) Nilai Diagnostik Procollagen I N-Terminal Propeptide dan Tartrate-Resistant Acid Phosphatase 5b pada Pasien Osteopenia. Magister thesis, Universitas Brawijaya.
Abstract
Latar Belakang. Osteopenia merupakan kondisi kepadatan tulang tidak normal namun belum dapat dikatakan sebagai osteoporosis. Kondisi osteopenia ini sebaiknya bisa dideteksi secara dini pada kelompok risiko tinggi sehingga pasien tidak jatuh pada kondisi osteoporosis. Pada pasien osteopenia, metabolisme tulang terganggu yang mengarah pada pengeroposan tulang, diikuti dengan perubahaan mikroarsitektur tulang. Penanda pergantian tulang seperti Procollagen I N-Terminal Propeptide (PINP) sebagai penanda pembentukan tulang dari osteoblas dan TartRate-resistant Acid Phosphatase 5b (TRACP-5b) sebagai penanda resorpsi tulang dari osteoklas dapat memberikan informasi yang berharga untuk deteksi dini osteopenia. Tujuan. Menentukan perbedaan kadar PINP dan TRACP-5b pada pasien menopause dengan bone mineral density (BMD) normal dan pasien menopause dengan osteopenia. Mengetahui nilai diagnostik PINP dan TRACP-5b untuk menentukan diagnosis osteopenia, juga korelasi antara PINP dengan TRACP-5b pada pasien osteopenia. Metode. Penelitian observasional analitik cross-sectional ini dilakukan pada wanita menopause yang berobat ke Poliklinik Reumatologi RSUD Dr. Saiful Anwar Malang sejak September 2019 sampai Agustus 2020. Subjek penelitian diperiksa BMD dan dibagi menjadi pasien dengan osteopenia dan pasien dengan BMD normal, kemudian dilakukan pemeriksaan PINP dan TRACP-5b. Analisis statistik berupa uji beda dengan independent t-test atau uji Mann-Whitney U, uji diagnostik PINP dan TRACP-5b pada diagnosis osteopenia menggunakan kurva ROC sedangkan uji korelasi PINP dan TRACP-5b menggunakan uji korelasi Spearman. Hasil. Kadar PINP dan TRACP-5b kelompok pasien osteopenia lebih tinggi secara signifikan dibandingkan kadar PINP dan TRACP-5b kelompok pasien BMD normal (p<0,001). Sensitivitas dan spesifisitas PINP pada cut-off > 56,89 ng/mL adalah 92,3% dan 90% (AUC=0,944) dengan nilai ramal positif 94,74% dan nilai ramal negatif 85,71%, sedangkan sensitivitas dan spesifisitas TRACP-5b pada cut-off > 1,43 U/L sebesar 92,3% dan 90% (AUC=0,976) dengan nilai ramal positif 94,74% dan nilai ramal negatif 85,71%. Terdapat korelasi yang signifikan antara PINP dan TRACP-5b (r=0,571) dengan arah hubungan yang positif dengan kekuatan korelasi cukup. Kesimpulan. PINP dan TRACP-5b dapat dipertimbangkan sebagai modalitas untuk deteksi dini osteopenia. Penelitian longitudinal untuk mengikuti perjalanan klinis pasien dapat dilakukan untuk melihat peran PINP dan TRACP-5b terhadap prognosis dan terapi pasien osteopenia.
English Abstract
Background. Osteopenia is an abnormal bone density condition but not yet be considered as osteoporosis. This osteopenia condition should be detected early in high-risk group in order to prevent those patients fall into osteoporosis. In osteopenia patients, bone metabolism is disturbed leading to bone loss, followed by changes in bone microarchitecture. Bone turnover markers (BTM) such as Procollagen I N-Terminal Propeptide (PINP) as a bone formation marker of osteoblasts and TartRate-resistant Acid Phosphatase 5b (TRACP-5b) as a bone resorption marker of osteoclasts can provide valuable information for early detection of osteopenia. Purpose. To determine the differences in PINP and TRACP-5b levels between menopausal patients with normal bone mineral density (BMD) and menopausal patients with osteopenia. To assign the diagnostic value of PINP and TRACP-5b to determine the diagnosis of osteopenia, also the correlation between PINP and TRACP-5b in osteopenia patients. Methods. A cross-sectional analytical observational study was conducted among menopausal women who visited Rheumatology Clinic in Dr. Saiful Anwar Malang Hospital from September 2019 to August 2020. BMD examination was performed and subjects were divided into osteopenia patients and normal BMD patients, they were examined for PINP and TRACP-5b afterwards. Statistical analysis was performed using independent t-test or Mann-Whitney U test to differentiate two groups, ROC curve for PINP and TRACP-5b diagnostic test and Spearman correlation test for PINP and TRACP-5b correlation. Results. The PINP and TRACP-5b levels of the osteopenia group were significantly higher than those of the normal BMD group (p<0.001). The sensitivity and specificity values of PINP were 92.3% and 90% respectively (AUC=0.944) at a cut-off of > 56.89 ng/mL with positive predictive value of 94.74% and negative predictive value of 85.71%, whereas the sensitivity and specificity values of TRACP-5b were 92,3% and 90% respectively at a cut-off of > 1.43 U/L (AUC=0.976) with positive predictive value of 94.74% and negative predictive value of 85.71%. Also, there is a significant correlation between PINP and TRACP-5b (r=0.571) with a positive relationship and sufficient correlation strength. Conclusion. PINP and TRACP-5b can be considered as modalities for early detection of osteopenia. Longitudinal studies to follow the patient's clinical course can be carried out to see the role of PINP and TRACP-5b on the prognosis and therapy of osteopenia patients.
Other obstract
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| Item Type: | Thesis (Magister) |
|---|---|
| Identification Number: | 0422060184 |
| Uncontrolled Keywords: | Osteopenia, PINP, TRACP-5b |
| Subjects: | 600 Technology (Applied sciences) > 616 Diseases > 616.07 Pathology |
| Divisions: | Profesi Kedokteran > Spesialis Patologi Klinik, Fakultas Kedokteran |
| Depositing User: | Endang Susworini |
| Date Deposited: | 10 May 2023 01:24 |
| Last Modified: | 10 May 2023 01:24 |
| URI: | http://repository.ub.ac.id/id/eprint/199164 |
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