Kadar Lipoprotein (A) pada Penderita Stroke Iskemik Fase Akut dan pada Non Stroke

Abstract

Background : Abnormalities of lipoprotein (a) are being recognized and investigated as independent risk factors in ischemic stroke. Lp (a) is correlated to atherosclerosis and thrombosis, processes that underlay the mechanism of ischemic stroke, although the definite pathogenesis mechanism has not been known yet. Several previous studies provide contradictory findings regarding Lp (a) as a risk factor for ischemic stroke. In Indonesia, data on Lp(a) plasma level in ischemic stroke patients are limited. Methods : This study was carried out at Department of Neurology, School of Medicine, University of Sumatera Utara, Medan, from March to August 2002. Data of age, sex and race are presented descriptively. The difference of Lp (a) plasma level between stroke patients and non stroke subjects were analysed by using t-paired and t-independent tests. Correlations were analyzed by using Exact Fisher's test and Pearson's correlation test. Level of significances was set at p 0.05. Result : There were 27 ischemic stroke patients and 24 non stroke subjects met the inclusion and exclucion criterias. Lp(a) level in stroke patients (mean 35.6 mg/dl, SD 31.3 mg/dl, range 3.3 – 129.7 mg/dl) were significantly higher (p = 0.009) than in non stroke subjects (mean 16.5 mg/dl, SD 15.6 mg/dl, range 0,8-60.4 mg/dl). There was no significant difference of Lp (a) level between both sexes, either in stroke patients (p = 0.666) or non stroke subjects (p = 0.214). Regarding age groups of below and over 50 years old, neither statiscally significant difference was found between Lp (a) level in stroke patients (p = 0.669), nor in non stroke subjects (p = 0.853). there was no correlation was found between Lp (a) plasma level and the other lipid fractions level in ischemic stroke patients (p > 0.05, R-square < 20%).Conclusion : There was no statistically significant difference between Lp (a) plasma level in stroke patients and in non stroke subjects, regardless age group and sex. Lp (a) plasma level in stroke patients were significantly different from non stroke subjects. No correlation was found between Lp (a) plasma level and the other lipid fractions levels in ischemic stroke patients.

Latar Belakang : Salah satu faktor resiko stroke iskemik yang masih terus diteliti adalah lipoprotein (a) ( Lp (a)) Lp (a) berhubungan dengan kejadian aterosklerosis dan trombosis yang mendasari terjadinya stroke iskemik, walaupun mekanisme patogenesisnya belum diketahu secara pasti.Beberapa panelitian terdahulu mengenai kadar Lp (e) pada penderita stroke iskemik memberikan hasil yang saling bertentangan. Di Indonesia penelitian mengenai kadar Lp (a) pada penderita stroke iskemik masih sangat terbatas. Metodologi: Penelitian ini merupakan penelitian prospektit cross-sectional. Penelitian dilakukan di Bagian Ilmu Penyakit Sarat FK-USU/RSUP HAM Madan dari Maret sampai Agustus 2002. Gambaran kelompok umur, jenis kelamin, dan suku bangsa pada masing-masing kelompok stroke iskemik dan kelompok non stroke dipaparkan secara deskriptif. Perbedaan nilai rerata kadar Lp (a) pada kedua kelompok disnalisa secara dengan menggunakan uji t berpasangan. Perbedsen nilsi rerata kadar Lp (e) berdasarkan kelompok umur dianalisa dengan uji t independen, dan berdasarkan jenis kelamin dangan uji Exact Fisher. Uji korelasi Pearson digunakan untuk mengetahui ada tidaknya korelasi antars kadar Lp (a) dengan kadar fraksi lipid yang lain. Nilai kemaknaan p < 0,05. Hasil : Diteliti 27 penderita stroke iskemik dan 24 individu non stroke yang memenuhi syarat. Kadar Lp (a) pada penderita stroke iskemik akut (nilai rata-rata 35,6mg/dl, simpang baku 31,3 mg/dl dan nilai rentang 3,3-129,7 mg/dl) lebih tinggi secara bermakna (p = 0.009) daripada kadar Lp (a) pada individu non stroke (nilai rerata 16,5 mg/dl, simpang baku 15,6 mg/dl dan nilai rentang 0,8 - 60,4 mg/dl).Tidak terdapat perbedaan yang bermakna antara kadar Lp (a) laki-Iaki dengan kadar Lp (a) perempuan baik pada kelompok stroke iskemik (p = 0,666) maupun pada kelompok nonstroke (p = 0,214). Perbedaan kadar Lp (a) pada kelompok umur < 50 tahun dan ? 50 tahun tidak bermakna, baik pada kelompok stroke iskemik (p =0,669) maupun pada kelompok non stroke (p=0,853). Tidak terdapat korelasi yang bermakna antara kadar Lp (a) dengan kadar fraksi lipidyang lain (p = > 0,05, R-square < 20%). Kesimpulan: Tidak terdapat perbedaan yang bermakna antara kadar Lp (a) pada kelompok stroke iskemik dan kelompok non stroke berdasarkan kelompok umur dan jenis kelamin. Terdapat perbedaan yang bermakna antara kadar Lp (a) penderita stroke iskemik dengan individu non stroke. Tidak terdapat korelasi yang bermakna antara kadar Lp (a) dengan kadar treksi lipid lainnya.