Hubungan Derajat Neuropati Perifer Diabetik dengan Ankle Brachial Index, Toe Brachial Index, dan Transcutaneous Partial Oxygen Pressure pada Pasien Diabetes Melitus Tipe 2

Taufik Rizkian Asir, Dono Antono, Em Yunir, Hamzah Shatri

Abstract

Pendahuluan. Neuropati perifer diabetik (NPD) di kaki terjadi akibat komplikasi diabetes pada mikrovaskular yang akhirnya mengakibatkan kerusakan pada persarafan di kaki. Maka perlu diwaspadai proses aterosklerosis di tempat lain, baik pada pembuluh arteri makro maupun mikrovaskular di kaki. Penelitian ini dilakukan untuk dapat menilai hubungan derajat neuropati perifer diabetik yang dinilai dengan Toronto clinical scoring system (TCSS) dengan proses ateroskerosis di pembuluh darah kaki, baik yang makrovaskular dengan ankle brachial index (ABI) dan toe brachial index (TBI) maupun mikrovaskular dengan transcutaneus partial oxygen pressure (TcPO2) pada pasien diabetes melitus (DM) tipe 2.

Metode. Penelitian potong lintang dilakukan pada pasien DM tipe 2 dengan NPD dengan nilai TCSS >5 di Poliklinik Pelayanan Jantung Terpadu, Poliklinik Endokrin dan Metabolik, dan Poliklinik Ilmu Penyakit Dalam Umum RSCM. Data diperoleh dari wawancara, rekam medik, pemeriksaan ABI, TBI dan TcPO2. Analisis bivariat terhadap masing-masing variabel dengan menggunakan uji spearman.

Hasil. Sebanyak 36 subjek yang memenuhi kriteria pemilihan diikutkan dalam penelitian, rerata usia 62 tahun (SB 9,2) dengan 20 (55,6%) diantaranya perempuan dan median lama diabetes 12 tahun. Berdasarkan analisis bivariat dengan uji spearman penelitian ini mendapatkan korelasi negatif yang bermakna secara statistik  dengan koefisien korelasi sedang antara derajat neuropati perifer diabetik yang dinilai dengan TCSS dengan ABI (r = -0,475, p = 0,003) dan TBI (r = -0,421, p = 0,010). Pada pemeriksaan TcPO2 juga didapatkan korelasi negatif yang bermakna secara statistik dengan koefisien korelasi sedang (r = -0,399, p = 0,016).

Simpulan. Terdapat korelasi negatif yang bermakna secara statistik antara derajat neuropati perifer diabetik dengan ABI, TBI, dan TcPO2.

 

Kata kunci:  ABI, neuropati perifer diabetik, TBI, TcPO2

The Association between Degree of  Diabetic Peripheral Neuropathy with Ankle Brachial Index, Toe Brachial Index, and Transcutaneus Partial Oxygen Pressure in Patients with Type 2 Diabetes Mellitus

Introduction. Diabetic peripheral neuropathy (DPN) in the lower extremity caused by complications of diabetes in the microvascular which can damage nerve in the lower extremity. Then, it is necessary to be aware of the process of aterosclerosis elsewhere, both in the macro and microvascular arteries in the lower extremity. This study was conducted to assess the association of the degree of diabetic peripheral neuropathy assessed by Toronto clinical scoring system (TCSS) with the process of atherosclerosis in the blood vessels of the lower extremity, both macrovascular with ankle brachial index (ABI) and toe brachial index (TBI), as well as microvascular with transcutaneus partial oxygen pressure (TcPO2) in patients with type 2 diabetes mellitus.

Methods. Cross-sectional study was carried out in patients with type 2 DM with DPN with TCSS values> 5 in the Integrated Cardiac Polyclinic, Endocrine and Metabolic Polyclinic, and Internal Medicine Polyclinics at Cipto Mangunkusumo Hospital. Data were obtained from interviews, medical records, as well as ABI, TBI and, TcPO2 examinations. Bivariate analysis of each variable was performed using Spearman test.

Results. Total of 36 subjects who met the selection criteria were included in the study, the average age was 62 years (SD 9.2) with 20 (55.6%) of whom were women and the median duration of diabetes was 12 years. Based on bivariate analysis with the Spearman test, there was a statistically significant negative correlation with moderate correlation coefficient between the degree of diabetic peripheral neuropathy assessed by TCSS with ABI (r = -0.475, p = 0.003) and TBI (r = -0.421, p = 0.010). The TcPO2 examination also found a statistically significant negative correlation with moderate correlation coefficient (r = -0.399, p = 0.016).

Conclusion. There is a statistically significant negative correlation between the degree of diabetic peripheral neuropaty with ABI, TBI, and TcPO2 examinations.

Keywords

ABI, diabetic peripheral neuropathy, TBI, TcPO2

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