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Abstrak :
ABSTRAK
Tesis ini membahas perbandingan hasil dari pemeriksaan klasik aPL, dan aPS sehingga dokter, sebagai penyedia layanan kesehatan, dapat mengetahui pemeriksaan yang lebih baik dari pemeriksaan sebelumnya, yang berguna untuk menetapkan diagnosis maupun strategi penanganan selanjutnya..Penelitian ini dilakukan dengan desain potong lintang deskriptif. Semua pasien hamil normal tidak memiliki satupun pemeriksaan klasik (LA, aCL dan anti-β2GPI) dan aPS yang positif. Dari penelitian ini, didapatkan pada pasien yang dicurigai APS tetapi memiliki hasil negatif terhadap aCL, anti- β2GPI , dan LA, ternyata sebanyak 5 (18,5%) pasien memiliki hasil positif pada pemeriksaan aPS.

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ABSTRACT
This thesis discusses the comparison of the results of classical aPL and APS so the doctor, as health care providers, can know better inspection of previous examinations, which are useful to establish the diagnosis and treatment strategies. This study was a descriptive cross-sectional. All pregnant patients normally do not have any classic examination (LA, aCL and anti-β2GPI) and aPS were positive. It was found in patients with suspected APS, but has a negative result against aCL, anti- β2GPI, and LA, it turns out as many as 5 (18.5%) patients had positive results on the examination of the APS.

Abstrak :
Latar Belakang: Sindrom antifosfolipid (antiphospholipid syndrome = APS) merupakan penyakit autoimun dengan gejala trombosis vena atau arteri, kematian janin berulang, dan peningkatan kadar antibodi antifosfolipid yang persisten. Sindrom antifosfolipid merupakan faktor risiko didapat yang paling sering dihubungkan dengan trombosis. Sampai saat ini efek antibodi anti-?2GP1 pada sistem koagulasi, antikoagulan alamiah dan sistem fibrinolisis masih belum jelas. Tujuan: Menganalisis efek imunoglobulin (Ig)G dan IgM anti-beta-2 glikoprotein-1(?2GP1) terhadap ekspresi messenger RNA (mRNA) tissue factor (TF), mRNA trombomodulin (TM), dan mRNA plasminogen activator inhibitor-1(PAI-1) pada endotel. Metode: Studi eksperimental dengan memajankan antibodi anti-?2GP1 pada human umbilical vein endothelial cells (HUVEC). Penelitian dilakukan di Rumah Sakit Ciptomangunkusumo/ Fakultas Kedokteran Universitas Indonesia. Sampel adalah IgG anti-?2GP1 dan IgM anti-?2GP1 dipurifikasi dari 6 pasien sindrom antifosfolipid. Kontrol adalah IgG dan IgM yang dipurifikasi dari orang sehat. HUVEC dipajan dengan IgG anti-?2GP1, IgM anti-?2GP1, IgG orang sehat, IgM orang sehat selama 4 jam. Pengukuran ekspresi relatif mRNA TF, mRNA TM, dan mRNA PAI-1 dilakukan sebelum dan sesudah pemajanan dengan metode real time reverse transcription polymerase chain reaction. Hasil: Ekspresi relatif mRNA TF, mRNA TM, dan mRNA PAI-1 pada HUVEC yang dipajan dengan IgG anti-?2GP1 adalah (3,14 ± 0,93)-, (0,31 ± 0,13)-, (5,33 ± 2,75)-kali dibandingkan pada HUVEC yang dipajan dengan IgG orang sehat. Ekspresi relatif mRNA TF, mRNA TM, dan mRNA PAI-1 pada HUVEC yang dipajan IgM anti-?2GP1 adalah (4,33 ± 1,98)-, (0,33 ± 0,22)-, (5,47 ± 2.64)-kali dibandingkan pada HUVEC yang dipajan IgM orang sehat. Hasil analisis statistik, sebelum dan sesudah pemajanan HUVEC dengan IgG anti-?2GP1, memperlihatkan perbedaan bermakna ekspresi relatif mRNA TF (1,09 ± 0,76 berbanding 3,14 ± 0,93, p = 0,003), mRNA TM (0,91 ± 0,11 berbanding 0,31 ± 0,13, p = 0,001), dan mRNA PAI-1 (0,93 ± 0,13 berbanding 5,33 ± 2,75, p = 0,013). Hasil analisis statistik, sebelum dan sesudah pemajanan HUVEC dengan IgM anti-?2GP1 memperlihatkan perbedaan bermakna ekspresi relatif mRNA TF (1,03 ± 0,11 berbanding 4,33 ± 1,98, p = 0,008), mRNA TM (0,93 ± 0,08 berbanding 0,33 ± 0,22, p = 0,003), dan mRNA PAI-1 (1,02 ± 0,10 berbanding 5,47 ± 2,64, p = 0,01). Kesimpulan: Pada penelitian ini terbukti bahwa IgG anti-?2GP1 dan IgM anti- ?2GP1 mempunyai efek protrombotik pada sel endotel dengan meningkatkan mRNA TF dan mRNA PAI-1, serta menurunkan mRNA trombomodulin. Hasil penelitian ini menyimpulkan bahwa mekanisme trombosis pada APS dapat terjadi melalui peningkatan aktivasi koagulasi, penurunan aktivitas fibrinolisis dan penurunan aktivitas antikoagulan. ......Background: Antiphospholipid syndrome (APS) is an autoimmune disorder characterized by venous or arterial thrombosis, recurrent pregnancy morbidity and the presence of persistent antiphospholipid antibodies. The antiphospholipid syndrome is the most common acquired risk factor of thrombosis. Until now, the effect of anti-?2GP1 antibodies on coagulation system, natural anticoagulant and fibrinolytic`system has not been completely understood. Objectives: To analyse the effects of IgG and IgM anti-beta-2 glycoprotein-1 (anti-?2GP1) on the expression of tissue factor (TF), thrombomodulin (TM), and plasminogen activator inhibitor-1(PAI-1) of endothelial cells in the messenger RNA level. Methods: Experimental study in human umbilical vein endothelial cells (HUVEC) was done at Cipto Mangunkusumo Hospital/ Faculty of Medicine, Universitas Indonesia. Samples are purified immunoglobulin(Ig)G anti-?2GP1 and IgM anti-?2GP1 from six APS patients serum. For controls, purified IgG and IgM from normal human serum (IgG-NHS and IgM-NHS) were used. HUVEC were treated with purified IgG anti-?2GP1, IgM anti-?2GP1, IgG-NHS, IgM-NHS for four hours of incubation. We measured TF, TM, and PAI-1 of HUVEC in mRNA relative expression levels (before and after treatment) by real time reverse transcription polymerase chain reaction. Results: The mean value of TF, TM, and PAI-1 mRNA levels in HUVEC after treated with IgG anti-?2GP1 compared to Ig-NHS were (3.14 ± 0.93)-, (0.31 ± 0.13)-, (5.33 ± 2.75)-fold respectively. On the other hand, after treated with IgM anti-?2GP1 compared to IgM-NHS, mRNA levels of TF, TM, and PAI-1 were (4.33 ± 1.98)-, (0.33 ± 0.22)-, (5.47 ± 2.64)-fold respectively. Before and after treatment with IgG anti-?2GP1, this study showed significant differences of TF mRNA levels (1.09 ± 0.76 versus 3.14 ± 0.93, p = 0.003), TM mRNA levels (0.91 ± 0.11 versus 0.31 ± 0.13, p = 0.001), and PAI-1 mRNA levels (0.93 ± 0.13 versus 5.33 ± 2.75, p = 0.013). Before and after treatment with IgM anti-?2GP1, this study showed significant differences of TF mRNA levels (1.03 ± 0.11 versus 4.33 ± 1.98, p = 0.008), TM mRNA levels (0.93 ± 0.08 versus 0.33 ± 0.22, p = 0.003), and PAI-1 mRNA levels (1.02 ± 0.10 versus 5.47 ± 2.64, p = 0.01). Conclusion: This study has proven that IgG anti-?2GP1 and IgM anti-?2GP1 increase TF and PAI-1 mRNA levels in endothelial cells. However, IgG anti-?2GP1 and IgM anti-?2GP1 decrease TM mRNA levels in endothelial cells. It has shown that the mechanism of thrombosis in APS occurs through coagulation activation, reduction of fibrinolysis activity, and reduction of anticoagulant activity

Abstrak :
Hughes syndrome : the antiphospholipid syndrome : a guide for students provides an in-depth analysis into the main effects of hughes syndrome. In 1983, Dr Graham Hughes, and his team in London, described a syndrome and subsequently developed simple blood tests to diagnose the condition. This syndrome is characterised by thrombosis (both in limbs and internal organs), headaches, memory loss, strokes and, in pregnant women, placental clotting and recurrent miscarriage. The syndrome, now known worldwide as Hughes syndrome, or the antiphospholipid syndrome, is common, being responsible for example, for up to 1 in 5 cases of young stroke and more importantly, it is treatable.

Abstrak :
The International Congress on Antiphospholipid Antibodies is held every three years to discuss the recent advances and future directions in Antiphospholipid Syndrome (APS). This volume collects the scientific highlights and new findings about APS that were generated from the most recent 13th congress, held in Galveston, Texas in 2010. Chapters were written by an internationally-distinguished group of scientists from the point-of-view of multiple specialty areas. Each chapter was written in a uniform and systematic basis to present the latest evidence-based research, including the basic science of APS, task force reports from the congress on controversial aspects of APS, and future directions of APS research.