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Indra
Hubungan hormon anti-mullerian serum dan resistensi insulin terhadap fenotip sindrom polikistik ovarium = The relationship between polycystic ovary syndrome phenotype and insulin resistance with serum anti-mullerian hormone amh level
Abstrak :
ABSTRAK
Latar Belakang: Sindroma ovarium polikistik (SOPK) merupakan kelainan kompleks endokrin terbanyak pada usia reproduksi. Ketidakseimbangan hormon merupakan salah satu temuan SOPK yang terkait dengan patofisiologinya. Adanya perbedaan kejadian resistensi insulin mungkin terkait dengan perbedaan karakteristik hormon pada pasien SOPK pada berbagai fenotipe, salah satunya Hormon Anti-Mullerian (HAM). Metode: Desain penelitian potong lintang (cross sectional), pengambilan subjek dimulai dari identifikasi kelompok dengan SOPK menggunakan titik potong HAM >4,45 ng/dl, lalu akan dikelompokkan menjadi empat kelompok sesuai dengan fenotipnya berdasarkan kriteria Rotterdam 2003, di klinik Yasmin dan Makmal Endokrinologi di bagian Obstetri dan Ginekologi RSUPN Dr.Cipto Mangunkusumo selama tahun 2011 ?2014. Resistensi insulin dinilai menggunakan homeostatic model assessment for insulin resistance (HOMA IR). Hasil: Didapatkan 125 subjek SOPK dengan kadar HAM cenderung lebih tinggi pada fenotipe 1 dan lebih rendah pada fenotipe 4 (p<0,05). Selain itu, ditemukan perbedaan kadar LH dan rasio LH/FSH pada keempat fenotipe (p<0,05). Nilai HOMA IR juga lebih tinggi pada fenotipe 1 (p<0,05). Berdasarkan analisis regresi linear, didapatkan indeks massa tubuh dan HAM berkorelasi positif dengan nilai HOMA IR (r=0,19 p=0,015 dan r=0,53 p<0,001, berturut-turut). Kesimpulan: Terdapat korelasi positif kadar HAM terhadap nilai HOMA IR. Pada keempat fenotipe SOPK didapatkan kadar HAM dan HOMA IR lebih tinggi pada fenotipe 1 dan semakin rendah pada fenotipe 4. ABSTRACT Background: Polycystic ovary syndrome (PCOS) is an endocrine disorder that is the most complex in the reproductive age. Hormonal imbalance remains a part of its pathophysiology. Insulin resistance might be linked with difference in hormonal parameter across four phenotypes of PCOS, especillay in AMH level. Method: The study design was cross-sectional (cross-sectional). Subject retrieval starts from the identification of the group with PCOS (with cutt-off AMH serum >4.45 ng/dl), and will be grouped into four groups according to their phenotype based on the criteria of Rotterdam in 2003, in the clinic Yasmin and Endocrinology Laboratory at the Obstetrics and Gynecology RSUPN Dr.Cipto Mangunkusomo during 2011 -2014. Insulin resistance was counted using homeostatic model assessment for insulin resistance (HOMA IR). Result: A total of 125 PCOS patients were recruited with AMH serum significantly higher among phenotype 1 and lower among phenotype 4 (p<0.05). Besides, Lh serum and LH/FSH ratio were also different across four phenotypes (p<0.05). The value of HOMA IR tend to be higher among phenotype 1 (p<0.05). Using multivariable linear regression analysis, body mass index and AMH serum were positively correlated with HOMA IR (r=0.19 p=0.015 and r=0.53 p<0.001, respectively). Conclusion: There was a positive correlation between AMH serum and HOMA IR value. The four PCOS phenotypes had significantly different value of HAM serum and HOMA IR with phenotype 1 possed higher value among the others. ;Background: Polycystic ovary syndrome (PCOS) is an endocrine disorder that is the most complex in the reproductive age. Hormonal imbalance remains a part of its pathophysiology. Insulin resistance might be linked with difference in hormonal parameter across four phenotypes of PCOS, especillay in AMH level. Method: The study design was cross-sectional (cross-sectional). Subject retrieval starts from the identification of the group with PCOS (with cutt-off AMH serum >4.45 ng/dl), and will be grouped into four groups according to their phenotype based on the criteria of Rotterdam in 2003, in the clinic Yasmin and Endocrinology Laboratory at the Obstetrics and Gynecology RSUPN Dr.Cipto Mangunkusomo during 2011 -2014. Insulin resistance was counted using homeostatic model assessment for insulin resistance (HOMA IR). Result: A total of 125 PCOS patients were recruited with AMH serum significantly higher among phenotype 1 and lower among phenotype 4 (p<0.05). Besides, Lh serum and LH/FSH ratio were also different across four phenotypes (p<0.05). The value of HOMA IR tend to be higher among phenotype 1 (p<0.05). Using multivariable linear regression analysis, body mass index and AMH serum were positively correlated with HOMA IR (r=0.19 p=0.015 and r=0.53 p<0.001, respectively). Conclusion: There was a positive correlation between AMH serum and HOMA IR value. The four PCOS phenotypes had significantly different value of HAM serum and HOMA IR with phenotype 1 possed higher value among the others. ;Background: Polycystic ovary syndrome (PCOS) is an endocrine disorder that is the most complex in the reproductive age. Hormonal imbalance remains a part of its pathophysiology. Insulin resistance might be linked with difference in hormonal parameter across four phenotypes of PCOS, especillay in AMH level. Method: The study design was cross-sectional (cross-sectional). Subject retrieval starts from the identification of the group with PCOS (with cutt-off AMH serum >4.45 ng/dl), and will be grouped into four groups according to their phenotype based on the criteria of Rotterdam in 2003, in the clinic Yasmin and Endocrinology Laboratory at the Obstetrics and Gynecology RSUPN Dr.Cipto Mangunkusomo during 2011 -2014. Insulin resistance was counted using homeostatic model assessment for insulin resistance (HOMA IR). Result: A total of 125 PCOS patients were recruited with AMH serum significantly higher among phenotype 1 and lower among phenotype 4 (p<0.05). Besides, Lh serum and LH/FSH ratio were also different across four phenotypes (p<0.05). The value of HOMA IR tend to be higher among phenotype 1 (p<0.05). Using multivariable linear regression analysis, body mass index and AMH serum were positively correlated with HOMA IR (r=0.19 p=0.015 and r=0.53 p<0.001, respectively). Conclusion: There was a positive correlation between AMH serum and HOMA IR value. The four PCOS phenotypes had significantly different value of HAM serum and HOMA IR with phenotype 1 possed higher value among the others.
Fakultas Kedokteran Universitas Indonesia, 2015
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UI - Tugas Akhir  Universitas Indonesia Library
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Veinardi Madjid
Analisa ketebalan endometrium morfologi endometrium dan jumlah folikel dominan pada wanita mendapat agen induksi ovulasi atau stimulasi ovarium dengan klomifen sitrat atau letrozole = Analysis of endometrial thickness endometrial morphology and dominant follicle count between clomiphene citrate and letrozole as an ovulation induction or ovarian stimulation
Abstrak :
Latar Belakang: Penggunaan klomifen sitrat sebagai obat induksi kehamilan masih memiliki angka keberhasilan kehamilan yang rendah. Letrozol merupakan agen penghambat aromatase yang dianggap memiliki efektivitas lebih baik dibanding klomifen sitrat, namun efektivitasnya masih dilaporkan bervariasi. Penelitian ini bertujuan untuk mengetahui perbedaan pemberian klomifen sitrat dan letrozol terhadap ketebalan endometrium, morfologi endometrium dan jumlah folikel dominan pada perempuan yang dilakukan induksi ovulasi atau stimulasi ovarium. Metode: Penelitian ini merupakan penelitian retrospektif dengan menggunakan medis pasien yang dilakukan induksi ovulasi atau stimulasi ovarium pada Januari 2011 - Mei 2015. Didapatkan 143 wanita siklus anovulasi yang terbagi dalam empat kelompok: klomifen sitrat 50 mg, klomifen sitrat 100 mg, letrozol 2,5 mg dan letrozol 5 mg. Agen pemicu ovulasi pada subjek dimulai pada hari ke-2 selama berlangsung selama lima hari. Data ketebalan endometrium, morfologi endometrium dan jumlah folikel dominan didapat pada status dari data pemeriksaan ultrosonografi transvaginal di hari ke-12 siklus haid. Hasil: Dari semua subjek, didapatkan 45 subjek (31,5%) mendapat klomifen sitrat 50 mg, 29 subjek (20,3%) dengan klomifen sitrat 100 mg, 23 subjek (16,1%) dengan letrozol 2,5 mg, dan 46 subjek (32,2%) dengan letrozol 5 mg. Subjek dengan letrozol memiliki endometrium yang lebih tebal dibandingkan dengan klomifen sitrat (p<0,05). Didapatkan pulan subjek dengan letrozol memiliki lebih banyak proporsi subjek dengan morfologi endometrium trilaminer. Tidak dijumpai perbedaan ketebalan endometrium pada subjek dengan perbedaan dosis pada masing-masing obat. Selain itu, tidak ditemukan perbedaan jumlah folikel dominan pada keempat kelompok. Kesimpulan: Penggunaan letrozol menghasilkan endometrium yang lebih tebal dan endometrium trilaminer dibandingkan klomifen sitrat. Tidak dijumpai perbedaan jumlah folikel dominan pada kedua kelompok. ......Background: The use of clomiphene citrate as an induction agent still has dissappointing results regarding its pregnancy rate. Letrozole is an aromatase inhibitor that is perceived to has better efficacy compared to clomiphene citrate, however, the reporting results were still varied. This study aimed to know the efficacy of clomiphene citrate and letrozol for ovulation induction in anovulation women. Method: This was a retrospective study using medical recors of women undergone ovulation induction from January 2011-May 2015. A number of 143 anovulation women were divided into clomiphene citrate 50 mg, clomiphene citrate 100 mg, letrozol 2,5 mg and letrozol 5mg. Every group of ovulation induction agent recieved the agent daily on 3rd until 7th day menstrual cycle. On 12th menstrual cycle the transvaginal ultrasound was performed to measure endometrial thickness and dominant follicle number. Results: From all subjects, 45 subjects (31,5%) were in 50 mg clomiphene citrate groups, 29 subjects (20,3%) in 100 mg clomiphene citrate group, 23 subjects (16,1%) in 2,5 mg letrozole group, and 46 subjects (32,2%) in 5 mg letrozole group. Subjects receiving letrozol had thicker endometrium compared to clomiphene citrate (p<0,05). Different doses did not associated with different endometrial thickness between subjects receiving either letrozole or clomiphene citrate. In addition, subjects receiving letrozole had higher proportion of having trilaminar endometrium morphology. We did not observe a difference in total number of dominant follicle between groups. Conclusion: The usage of letrozol resulted in thicker endometrium and proportion of subjects with trilaminar endometrium. Yet, there is no difference in number of dominant follicle between groups.
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2015
SP-Pdf
UI - Tugas Akhir  Universitas Indonesia Library