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Abstrak :
Background. Systemic lupus erythematosus (SLE) has diverse clinical manifestations, including renal and non-renal. Renal manifestation is related to significant morbidity and mortality. SLE is also characterized by serological aberrations, including levels of complement C3, C4 and anti-dsDNA, but the association of them with clinical manifestations including renal and non-renal is unclear. This study investigated the associations of C3, C4 and anti-dsDNA levels with renal and non-renal manifestations in SLE patients. Method. A cross-sectional study was conducted in the Polyclinic of Rheumatology, Dr. Saiful Anwar Hospital Malang. A number of 43 subjects fulfilled the 1997 American College of Rheumatology criteria participated in this study, that consisted of 11 patients with renal manifestation and 32 patients with non-renal manifestations. Serum C3 and C4 levels were measured using immunoturbidimetry, and serum anti-dsDNA levels were measured using enzyme-linked immunosorbent assays (ELISA). The independent T-test was used to compare C3 levels and the Mann-Whitney U test was used to compare C4 and anti-dsDNA levels between groups. Result. SLE with renal manifestation had significant lower levels of serum C3 compare to non-renal manifestations (mean ± SD: 71.27 ± 32.65 mg/dL and 94.47 ± 26.29 mg/dL respectively, p=0.022). SLE with renal manifestation also had significantly lower levels of serum C4 compare to non-renal manifestations (mean ± SD: 14.55 ± 8.20 mg/dL and 25.50 ± 11.05 mg/dL respectively, p=0.002). Conversely, SLE with renal manifestation had significantly higher levels of serum anti-dsDNA compare to non-renal manifestations (mean ± SD: 249.27 ± 240.34 IU/mL and 109.91 ± 166.11 IU/mL respectively, p=0.014). Conclusion. SLE patients with renal manifestation have significantly lower levels of serum C3 and C4 and a higher level of serum anti-dsDNA than SLE patients with non-renal manifestations.

Abstrak :
Latar Belakang: Anti dsDNA merupakan salah satu faktor risiko aterosklerosis yang berasal dari LES dan belum ada penelitian yang melihat hubungan antara kadar anti dsDNA dengan ketebalan tunika intima-media arteri karotis. Penelitian ini bertujuan untuk melihat korelasi antara anti dsDNA dengan ketebalan tunik intima-media arteri karotis. Metode: Penelitian ini adalah penelitian potong lintang, melibatkan 84 pasien LES dengan kriteria inklusi adalah pasie LES yang memenuhi kriteria diagnosis sesuai dengan ACR 1997 atau SLICC 2012, dan kriteria eksklusi adalah bila terdapat variasi anatomi pembuluh darah yang tidak dapat dilakukan pengukuran. Anti dsDNA diperiksa dengan menggunakan ELISA dan USG Doppler dilakukan pada pasien untuk mengukur ketebalan maksimal tunika intima media arteri karotis (max-IMT). Analisa statistik dilakukan dengan uji parametrik Pearson dan bila tidak memenuhi syarat dilakukan uji non parametrik Spearman. Hasil: Delapan empat responden (82 perempuan dan 2 laki-laki) dilakukan analisa. Rerata usia pasien 35,5±8,9 tahun dengan 64,3% berusia di bawah 40 tahun, median anti dsDNA 38,9 IU/L(0,9 ? 750 IU/L) dan Median max-IMT adalah 581 μm (385-1800 μm). Terdapat 43 (51,2 %) pasien dengan ketebalan pada tunika intima-media arteri karotis, 36 (42,9%) pasien dengan ketebalan saja, 6 (7,1%) pasien dengan ketebalan pada tunika intimamedia dan plak dan 1 (1,2%) pasien dengan plak di near wall bulbus kiri tanpa disertai dengan ketebalan pada tunika intima-media. Plak terutama ditemukan pada bulbus karotis kanan dan kiri. Berdasarkan uji korelasi speraman's tidak terdapat korelasi antara ati dsDNA dengan ketebalan maksimal tunika intima media arteri karotis. (r = 0,073, p= 0,520). Kesimpulan: Tidak terdapat korelasi antara anti dsDNA dengan ketebalan tunika intima-media arteri karotis pada pasien LES. ...... Background: Anti dsDNA is considered as one of SLE-related risk factors for atherosclerosis. The evaluation of Carotid intimal-media thickness has recently became one of the surrogate markers for atherosclerosis. Until now, there hasn't been any study relate the level of anti dsDNA antibody with Carotid intimal-media thickness. This study is conducted to determine the correlation between anti dsDNA and Carotid intima-Media Thickness. Methods: This is a cross sectional study, 84 SLE patients were included. Patients diagnosed as SLE according to ACR 1997 or SLICC 2012 criteria were included in the study, while SLE patients with anatomical variation which difficult to measured were excluded from this study. Doppler ultrasound was carried out for patients and max-IMT was measured. Anti dsDNA was measured with ELISA. Study results: Eighty four subjects (82 female, 2 male) were included. Mean age was 35,5 ±8,9 years old, 64,3 % between 18-39 years old, median anti dsDNA level 38,9 IU/L (0,9 - 750 IU), and median max-IMT value was 581 μm. There were 43 (51,2 %) patients Carotid intima-media thickness, 36 (42,9%) patients with increased IMT only, 6 (7,1%) patients with increase IMT and Plaque, and 1 (1,2%) patient with plaque in near wall left bulbus without increased IMT. Based on spearman's correlation test there are no correlation between anti dsDNA and max-IMT (r=-0,073, p= 0,520). Conclusion: There are no correlation between anti dsDNA level and Carotid intimal-media thickness this study.

Abstrak :
Trombositopenia merupakan manifestasi hematologis pada pasien lupus eritematosus sistemik (LES) yang berhubungan dengan prognosis buruk. Kadar C3, C4, dan anti-dsDNA berhubungan dengan aktivitas penyakit pada pasien LES. Peningkatan aktivitas penyakit berhubungan dengan penurunan kadar trombosit pada pasien LES melalui aktivasi komplemen dan interaksi autoantibodi dengan trombosit. Tujuan dari penelitian ini adalah mengetahui korelasi kadar serum C3, C4, dan anti-dsDNA terhadap hitung trombosit pada pasien LES dengan trombositopenia. Penelitian ini merupakan penelitian analitik observasional dengan menggunakan desain studi potong lintang. Penelitian ini merekrut subjek LES dengan hitung trombosit <150.000/µL. Kadar C3, C4, dan anti-dsDNA serta hitung trombosit diukur pada awal kunjungan pasien. Didapatkan 41 subjek LES dengan trombositopenia. Hitung trombosit memiliki korelasi yang bermakna terhadap kadar C3 (p=0.004; r=0.445) dan anti-dsDNA (p=0.001; r=-0.481). Namun, tidak ditemukan korelasi yang signifikan antara hitung trombosit dengan kadar C4 (p=0.052; r=0.306). Terdapat korelasi yang bermakna antara hitung trombosit dengan aktivitas penyakit dan kadar C3 serta anti-dsDNA pada subjek LES dengan trombositopenia. Namun, tidak terdapat korelasi yang bermakna antara hitung trombosit dengan kadar C4. ......Thrombocytopenia is a hematological manifestation in systemic lupus erythematosus (SLE) patients that is associated with a poor prognosis. C3, C4, and anti-dsDNA levels have been associated with disease activity in SLE patients. Increased disease activity is associated with decreased platelet levels in SLE patients through complement activation and autoantibody interactions with platelets. The aim of this study was to determine the correlation of serum levels of C3, C4, and anti-dsDNA with platelet counts in SLE patients with thrombocytopenia. This research is an observational analytical study using a cross-sectional study design. This study recruited subjects of SLE patients with platelet counts <150,000/µL. C3, C4, and anti-dsDNA levels and platelet counts were measured at the initial patient visit. This study recruit 41 samples of SLE patients with thrombocytopenia. Platelet count had a significant correlation with C3 levels (p=0.004; r=0.445) and anti-dsDNA (p=0.001; r=-0.481). However, no significant correlation was found between platelet count and C4 levels (p=0.052; r=0.306). There is  a significant correlation between platelet count and disease activity and C3 and anti-dsDNA levels in SLE patients with thrombocytopenia. However, there was no significant correlation between platelet count and C4 levels.

Abstrak :
Latar Belakang. Depresi sering ditemukan pada pasien lupus eritematosus sistemik (LES) dan berhubungan dengan aktivitas penyakit LES. Kurangnya perhatian klinisi terhadap penapisan hingga tatalaksana depresi pada LES sangat berperan. Hospital Anxiety and Depression Scal (HADS) merupakan salah satu skala pengukuran depresi berbentuk kuesioner yang sering dan mudah digunakan serta memiliki banyak terjemahan yang tervalidasi sedangkan Mexican- Systemic Lupus Erythematosus Disease Activity Index (Mex-SLEDAI) merupakan sistem skoring untuk menilai aktivitas penyakit LES dengan biaya minimal namun mempunyai reliabilitas dan validitas yang baik. Rasio neutrofil-limfosit (RNL) merupakan penanda inflamasi sistemik sedangan anti-dsDNA merupakan autoantibodi spesifik pada LES yang kadarnya meningkat seiring dengan aktivitas penyakit. Saat ini di Indonesia, belum ada penelitian yang mengkorelasikan antara skor HADS-D dengan RNL, kadar anti-dsDNA dan skor Mex-SLEDAI pada LES. Tujuan. Mengetahui korelasi antara skor HADS-D dengan RNL, kadar anti-dsDNA dan skor Mex-SLEDAI pada pasien LES. Metode. Studi ini menggunakan desain potong lintang, dilakukan analisis data primer pasien LES usia 18-60 tahun. Dilakukan wawancara dan pemeriksaan fisik serta pengisian kuesioner HADS diikuti dengan pengambilan sampel darah untuk menilai kadar anti-dsDNA dan melengkapi perhitungan skor Mex-SLEDAI. Korelasi antara skor HADS-D dengan RNL, kadar anti-dsDNA, dan skor Mex-SLEDAI didapat dengan uji korelasi Spearman menggunakan SPSS. Hasil. Dilakukan analisis pada 121 subjek. Seluruh sampel adalah perempuan dengan median usia 31 (24-39) tahun. Median skor HADS-D sebesar 6 (4-7), median RNL sebesar 2,64 (1,945-3,91), median anti-dsDNA sebesar 133,5 (29,8-388,5), dan median skor Mex-SLEDAI sebesar 5 (3-10). Terdapat korelasi positif sangat lemah antara skor HADS-D dengan RNL (r 0,18 dan p 0,048). Terdapat korelasi positif lemah antara skor HADS-D dengan Mex-SLEDAI (r 0,244 dan p 0,007). Tidak terdapat korelasi antara skor HADS-D dengan anti-dsDNA. Kesimpulan. Terdapat korelasi positif antara skor HADS-D dengan RNL dan skor Mex-SLEDAI tetapi tidak ada korelasi antara skor HADS-D dengan kadar anti-dsDNA pada pasien dengan LES. ......Background. Depression is common in systemic lupus erythematosus (SLE) and can increase SLE disease activity. Lack of clinical attention to screening until the management of depression play an important role. Hospital Anxiety Depression Scale (HADS) is a depression measurement scales that is often and easy to use while Mexican-Systemic Lupus Erythematosus Disease Activity Index (Mex-SLEDAI) is a scoring system to asses disease activity at lower cost but has good reliability and validity. Neutrophil-lymphocyte ratio (NLR) is a systemic inflammation marker whereas anti-dsDNA is a specific antibody for SLE. In  Indonesia, there are no studies that correlate HADS-D score with NLR, anti-dsDNA level, and Mex-SLEDAI score in SLE patients. Objective. To determine the correlation between HADS-D score with NLR, anti-dsDNA level, and Mex-SLEDAI score in SLE patients. Methods. This study used a cross-sectional design that analysed the primary data of SLE patients aged 18-60 years. Interviews and physical examinations were carried out as well as filling out the HADS questionnaire followed by blood sampling to assess anti-dsDNA levels and calculate Mex-SLEDAI score. The correlation between HADS-D score with NLR, anti-dsDNA level, and Mex-SLEDAI score were obtained by using the Spearman correlation test using SPSS. Results. This study analysed on 121 subjects with a median age of 31 (24-39) years. The median HADS-D score was 6 (4-7), median NLR was 2.64 (1.945-3.91), median anti-dsDNA level was 133.5 (29.8-388.5), and median Mex- SLEDAI score was 5 (3-10). There is a very weak positive correlation between HADS-D and NLR (r 0.18 and p 0.048) and weak positive correlation between HADS-D and Mex-SLEDAI (r 0.244 and p 0.007). There is no correlation between HADS-D and anti-dsDNA. Conclusion. There are positive correlation between HADS-D score with NLR and Mex-SLEDAI score but there is no correlation between HADS-D score with anti-dsDNA level in SLE patients.