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Abstrak :
ABSTRAK
Penelitian ini bertujuan untuk mengetahui efek pemberian hidroksiklorokuin 400 mg selama 12 minggu terhadap kadar sVCAM-1 dan sE-Selectin sebagai petanda disfungsi endotel pada pasien artritis reumatoid. Penelitian ini juga melihat peran HOMA-IR, FFA dan ox-LDL terhadap perbaikan disfungsi endotel.Penelitian ini menggunakan dua disain yaitu uji klinis acak tersamar ganda dan kohort prospektif dilakukan pada pasien artritis reumatoid dengan terapi metotreksat di poliklinik Reumatologi RS Cipto Mangunkusumo, Jakarta, pada periode Februari 2016-Mei 2017. Pasien dengan terapi insulin, anti-hipertensi dan terapi lain yang mempengaruhi kadar sVCAM-1 dan sE-Selectin dieksklusi dari penelitian. Subjek yang eligibel dirandomisasi menjadi dua kelompok, kelompok yang mendapat hidroksiklorokuin HCQ 400 mg dan kelompok placebo, dan diikuti selama 12 minggu. Pemeriksaan sVCAM-1, sE-Selectin, HOMA-IR, FFA dan ox-LDL dilakukan pada awal penelitian dan pada minggu ke-12. Perbedaan persentase perubahan kadar sVCAM-1 dan sE-Selectin sebelum dan setelah perlakuan antara kedua kelompok dianalisis dengan uji-t dan uji Mann-Whitney. Persentase perubahan kadar sVCAM-1 dan sE-Selectin dikorelasikan dengan persentase perubahan HOMA-IR, FFA dan ox-LDL, dengan uji Spearman.Sebanyak 37 subjek diikutkan dalam penelitian, dan terdapat 3 subjek yang drop-out pada masing-masing kelompok, sehingga didapatkan 15 subjek pada kelompok HCQ dan 16 subjek pada kelompok placebo. Kadar sVCAM-1 serum minggu ke-12 pada kelompok HCQ menurun sebesar 17,1 median , sementara pada kelompok plasebo meningkat sebesar 9,7 , dan perbedaan tersebut bermakna secara statistik. Kadar E-Selectin pada kelompok terapi HCQ mengalami penurunan dalam persen yang lebih besar dibandingkan pada kelompok plasebo, tapi perbedaan tersebut tidak bermakna. Perubahan kadar sVCAM-1 dan sE-Selectin, juga dibuktikan tidak berkorelasi dengan perubahan HOMA-IR, FFA dan ox-LDL.Terapi hidroksiklorokuin pada pasien artritis reumatoid terbukti memperbaiki disfungsi endotel dengan menurunkan kadar sVCAM-1, namun tidak terbukti menurunkan sE-Selectin. Variable sVCAM-1 dan sE-Selectin tidak berkorelasi dengan HOMA-IR, FFA dan ox-LDL Kata kunci: artritis reumatoid, disfungsi endotel, hidroksiklorokuin, sE-Selectin, sVCAM-1.

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ABSTRACT
This study aims to evaluate the effect of hydroxychloroquine on sVCAM 1 and sE Selectin levels decreasing as endothelial dysfunction marker in rheumatoid arthritis patients. This study also assessed the correlation between changes in sVCAM 1 and sE Selectin levels with other variables of changes in HOMA IR, FFA and ox LDL.Two kinds of methods i.e. double blind randomized controlled trial and prospective cohort, were conducted, on patients with rheumatoid arthritis with methotrexate treatment at Rheumatology Outpatient Clinic of Cipto Mangunkusumo Hospital Faculty of Medicine Universitas Indonesia, Jakarta, during February 2016 July 2017. Patients with insulin, anti hypertension and other treatment which could affect sVCAM 1 and sE Selectin level, were excluded. Eligible subjects were randomly assigned into two groups. Eighteen subjects were administered hydroxychloroquine 400 mg daily and 19 patients were given placebo for 12 weeks. sVCAM 1, sE Selectin, HOMA IR, FFA dan ox LDL were examined in the beginning and in the end week 12. Differences of serum sVCAM 1 and sE Selectin level in percentage, before and after experiment, were evaluated, by T test or alternatively by Mann Whitney test. Differences of serum sVCAM 1 and sE Selectin level in percentage, were correlated with difference of serum HOMA IR, FFA and ox LDL level, by Spearman test.There were 37 subjects enrolled in the study, and there were 3 drop out subjects in each group, finally there were 15 subjects in the HCQ group and 16 in the placebo group. Serum sVCAM 1 level decreased 17.1 median in HCQ treatment group, while in placebo group, it increased 9,7 median compared with pre treatment value. The difference in percentage rate change of sVCAM between two group was significant. On the other hand, the change of E Selectin serum level in HCQ group was found a higher percentage of decrease compared with placebo group, but the difference was not significant. Changes in sVCAM 1 and sE Selectin levels were also proven no correlation with HOMA IR, FFA and ox LDL changes.Treatment of HCQ in patients with rheumatoid arthritis appears beneficial to improve endothelial dysfunction by lowering serum sVCAM 1, but not proven to decrease sE Selectin. The sVCAM 1 and sE Selectin variables were not correlated with HOMA IR, FFA and ox LDL Keywords endothelial dysfunction, hydroxychloroquine, rheumatoid arthritis, sE Selectin, sVCAM 1.

Abstrak :
Hidroksiklorokuin merupakan obat antimalaria yang digunakan dalam pengobatan lupus eritematosus sistemik, reumatoid artritis, dan malaria. Namun, hidroksiklorokuin memiliki efek samping seperti toksisitas okular, neurotoksisitas, gangguan gastrointestinal, hingga toksisitas berat seperti kardiotoksisitas. Oleh karena itu, diperlukan pemantauan terapi obat dalam penggunaan hidroksiklorokuin dosis tinggi atau jangka waktu yang panjang. Tujuan dari penelitian ini adalah untuk mendapatkan metode analisis dan preparasi sampel hidroksiklorokuin dalam VAMS menggunakan Kromatografi Cair Kinerja Tinggi – Photodiode Array yang optimum dan tervalidasi berdasarkan pedoman Food and Drug Administration 2018. Analisis kuantifikasi hidroksiklorokuin dilakukan dengan KCKT-PDA dengan kolom C18 (Waters, Sunfire™ 5μm; 250 x 4,6mm), volume injeksi 100 μL, dan suhu kolom 45 ºC. Fase gerak terdiri atas asetonitril-dietilamin 1% (65:35) (elusi isokratik) dengan laju alir 0,8 mL/menit dan total waktu analisis 12 menit. Preparasi sampel dalam VAMS dilakukan dengan metode ekstraksi cair-cair dengan pelarut amonia 1% dan n-heksan-etil asetat (50:50 v/v) dengan volume masing-masing 500 μL. Darah di dalam VAMS dikeringkan selama 2 jam, lalu ditambahkan baku dalam dan larutan ammonia 1%. Sampel dikocok dengan vortex selama 15 detik dan disonikasi selama 5 menit. Kemudian ditambahkan n-heksan-etil asetat (50:50) lalu dikocok kembali dengan vortex selama 15 detik dan disentrifugasi selama 5 menit pada kecepatan 10.000 rpm. Fase n-heksan-etil asetat diambil lalu dikeringkan dengan gas Nitrogen. Residu hasil pengeringan direkonstitusi dengan fase gerak sebanyak 150 μL dan dipindahkan ke vial autosampler untuk dianalisis dengan sistem KCKT-PDA. Metode ini telah memenuhi parameter validasi penuh menurut Food and Drug Administration 2018, dengan LLOQ 2 ng/mL dan rentang kurva kalibrasi 2-6500 ng/mL dengan koefisien korelasi 0,99927-0,99969. ......Hydroxychloroquine is an antimalarial drug that used for systemic lupus erythematosus, rheumatoid arthritis, and malaria treatment. However, hydroxychloroquine has several side effects such as ocular toxicity, neurotoxicity, gastrointestinal disorder, and also severe toxicity like cardiotoxicity. Therefore, therapeutic drug monitoring of high dose or long-term use of hydroxychloroquine is needed. This study aims to obtain an optimum and validated analysis and preparation method for hydroxychloroquine in VAMS using High Performance Liquid Chromatography – Photodiode Array Detector based on Food and Drug Administration guidelines (2018). Hydroxychloroquine quantification was performed using HPLC-PDA with Waters Sunfire™ C18 (5μm; 250 x 4,6mm) column with injection volume of 100 μL, and the temperature of column was controlled at 45 ºC. Mobile phase consist of acetonitrile-diethylamine 1% (65:35) (isocratic elution) and delivered at a flow rate of 0,8 mL/min through out the 12 minutes run. Sample in VAMS is extracted by liquid-liquid extraction with ammonia 1% and n-hexane-ethyl acetate (50:50 v/v), 500 μL each as a solvent. Blood in VAMS was dried for 2 hours, then added with internal standard solution and 1% ammonia solution. The samples were mixed on vortex for 15 seconds and sonicated for 5 minutes. n-hexane-ethyl acetate (50:50) was added to the samples, then mixed again on vortex for 15 second and centrifuged for 5 minuted at a speed of 10,000 rpm. n-hexane-ethyl acetate phase was separated and dried under Nitrogen gas flow. The residue from drying process as reconstituted with 150 μL mobile phase and transferred to autosampler vial for analysis. This method has successfully qualify the Food and Drug Administration (2018) parameters, with 2 ng/mL of LLOQ, range of calibration curve 2-6500 ng/mL, and coefficient of correlation 0,99927-0,99969.