Rasio Platelet Limfosit (PLR) sebagai Penanda Risiko Gangguan Fungsi Kognitif pada Pasien Diabetes Melitus Tipe 2
Article History
Submited : April 4, 2024
Published : June 5, 2024
Penelitian ini bertujuan untuk mengetahui hubungan ratio platelet limfosit (PLR) dengan fungsi kognitif pada pasien DMT2. Penelitian ini menggunakan rancangan penelitian observasional analitik dengan desain cross-sectional. Populasi penelitian adalah penderita DMT2 yang datang ke Poli Rawat Jalan RSWS dan RS Jejaring Pendidikan yang telah didiagnosis DMT2 oleh dokter spesialis penyakit dalam sesuai kriteria PERKENI 2015. Adapun besar sampel penelitian ditetapkan sebanyak 41 pasien. Variabel yang digunakan dalam penelitian ini adalah: Variabel Independen (Rasio platelet limfosit), Variabel Dependen (Gangguan kognitif), Variabel Antara (Proses inflamasi kronik), Variabel Perancu (Usia, jenis kelamin, Pendidikan, lama onset DMT2, komorbiditas), Variabel Kontrol (Stroke, Alzheimer, dementia lewy’s body, epilepsy). Analisis data yaitu analisis bivariat menggunakan uji Pearson atau Rank Spearman untuk menilai koefisien R, dan analisis multivariate menggunakan analisis regresi linier berganda. Data diolah melalui program SPSS. Hasil penelitian yaitu korelasi negatif antara nilai PLR dengan fungsi kognitif pada pasien DMT2. Semakin tinggi nilai PLR maka akan fungsi kognitif semakin rendah. Kemudian, Pada tingkat domain fungsi kognitif terdapat korelasi negatif antara nilai PLR dengan domain fungsi eksekutif, visuospasial, dan memori pada pasien DMT2. Adapun nilai cut-off pada nilai PLR untuk mendiagnosis gangguan kognitif adalah 186,1 dengan sensitivity: 57.58% dan specificity: 87,50%. Kesimpulan yaitu PLR dapat menjadi penanda risiko terjadinya gangguan fungsi kognitif pada pasien DMT2. Peningkatan nilai PLR dapat dikaitkan dengan penurunan fungsi kognitif pada pasien DMT2, terutama pada domain fungsi eksekutif, visuospasial, dan memori.
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2. Adamowicz, D. H., Shilling, P. D., Palmer, B. W., Nguyen, T. T., Wang, E., Liu, C., Tu, X., Jeste, D. V., Irwin, M. R., & Lee, E. E. (2022). Associations between inflammatory marker profiles and neurocognitive functioning in people with schizophrenia and non-psychiatric comparison subjects. Journal of Psychiatric Research, 149, 106–113. https://doi.org/10.1016/j.jpsychires.2022.02.029
3. Alexandrakis, M. G., Passam, F. H., Moschandrea, I. A., Christophoridou, A. V., Pappa, C. A., Coulocheri, S. A., & Kyriakou, D. S. (2003). Levels of serum cytokines and acute phase proteins in patients with essential and cancer-related thrombocytosis. American Journal of Clinical Oncology, 26(2), 135–140. https://doi.org/10.1097/00000421-200304000-00007
4. Balta, S., & Ozturk, C. (2015). The platelet-lymphocyte ratio: A simple, inexpensive and rapid prognostic marker for cardiovascular events. Platelets, 26(7), 680–681. https://doi.org/10.3109/09537104.2014.979340
5. Biessels, G. J., Strachan, M. W. J., Visseren, F. L. J., Kappelle, L. J., & Whitmer, R. A. (2014). Dementia and cognitive decline in type 2 diabetes and prediabetic stages: Towards targeted interventions. The Lancet. Diabetes & Endocrinology, 2(3), 246–255. https://doi.org/10.1016/S2213-8587(13)70088-3
6. Culley, D. J., Snayd, M., Baxter, M. G., Xie, Z., Lee, I. H., Rudolph, J., Inouye, S. K., Marcantonio, E. R., & Crosby, G. (2014). Systemic Inflammation Impairs Attention and Cognitive Flexibility but Not Associative Learning in Aged Rats: Possible Implications for Delirium. Frontiers in Aging Neuroscience, 6(107), 1–7. https://doi.org/10.3389/fnagi.2014.00107
7. Dietrich-Muszalska, A., & Wachowicz, B. (2017). Platelet haemostatic function in psychiatric disorders: Effects of antidepressants and antipsychotic drugs. The World Journal of Biological Psychiatry: The Official Journal of the World Federation of Societies of Biological Psychiatry, 18(8), 564–574. https://doi.org/10.3109/15622975.2016.1155748
8. Dove, A., Shang, Y., Grande, G., Laukka, E. J., Fratiglioni, L., Xu, W., & Marseglia, A. (2020). Type 2 diabetes and cardiovascular disease increase the risk of cognitive impairment and accelerate the progression to dementia in Swedish older adults. Alzheimer’s & Dementia, 16(S10), e041025. https://doi.org/10.1002/alz.041025
9. Du, L., Hu, X., Zhang, B., Miao, X., Wang, J., Shen, J., Ding, K., Zeng, T., Sun, F., Yang, H., & Lin, H. (2021). The relationship of platelet-to-lymphocyte ratio with cognitive decline in T2DM. Diabetology & Metabolic Syndrome, 13(1), 151. https://doi.org/10.1186/s13098-021-00772-y
10. Elias, P. K., Elias, M. F., D’Agostino, R. B., Cupples, L. A., Wilson, P. W., Silbershatz, H., & Wolf, P. A. (1997). NIDDM and blood pressure as risk factors for poor cognitive performance. The Framingham Study. Diabetes Care, 20(9), 1388–1395. https://doi.org/10.2337/diacare.20.9.1388
11. Espelt, A., Borrell, C., Roskam, A. J., Rodríguez-Sanz, M., Stirbu, I., Dalmau-Bueno, A., Regidor, E., Bopp, M., Martikainen, P., Leinsalu, M., Artnik, B., Rychtarikova, J., Kalediene, R., Dzurova, D., Mackenbach, J., & Kunst, A. E. (2008). Socioeconomic inequalities in diabetes mellitus across Europe at the beginning of the 21st century. Diabetologia, 51(11), 1971–1979. https://doi.org/10.1007/s00125-008-1146-1
12. Galicia-Garcia, U., Benito-Vicente, A., Jebari, S., Larrea-Sebal, A., Siddiqi, H., Uribe, K. B., Ostolaza, H., & Martín, C. (2020). Pathophysiology of Type 2 Diabetes Mellitus. International Journal of Molecular Sciences, 21(17), Article 17. https://doi.org/10.3390/ijms21176275
13. Gottesman, R. F., Rawlings, A. M., Sharrett, A. R., Albert, M., Alonso, A., Bandeen-Roche, K., Coker, L. H., Coresh, J., Couper, D. J., Griswold, M. E., Heiss, G., Knopman, D. S., Patel, M. D., Penman, A. D., Power, M. C., Selnes, O. A., Schneider, A. L. C., Wagenknecht, L. E., Windham, B. G., … Mosley, T. H. (2014). Impact of Differential Attrition on the Association of Education With Cognitive Change Over 20 Years of Follow-up: The ARIC Neurocognitive Study. American Journal of Epidemiology, 179(8), 956–966. https://doi.org/10.1093/aje/kwu020
14. He, Q., He, Q., Qin, X., Li, S., Li, T., Xie, L., Deng, Y., He, Y., Chen, Y., & Wei, Z. (2016). The Relationship between Inflammatory Marker Levels and Hepatitis C Virus Severity. Gastroenterology Research and Practice, 2016, 2978479. https://doi.org/10.1155/2016/2978479
15. Indrahadi, D., Wardana, A., & Pierewan, A. C. (2021). The prevalence of diabetes mellitus and relationship with socioeconomic status in the Indonesian population. Jurnal Gizi Klinik Indonesia, 17(3), 103–112. https://doi.org/10.22146/ijcn.55003
16. International Diabetes Federation. (2021). IDF Diabetes Atlas 2021 | IDF Diabetes Atlas. https://diabetesatlas.org/atlas/tenth-edition/
17. Kaban, D. Y. (2020). Pengaruh Latihan Pasrah Diri Terhadap Platelet to Lymphocyte Ratio pada Pasien Diabetes Mellitus Tipe 2 Tanpa Depresi [Universitas Gadjah Mada]. https://etd.repository.ugm.ac.id/penelitian/detail/185775
18. Kálcza Jánosi, K., & Lukács, A. (2023). Independent and interactive effect of type 2 diabetes and hypertension on memory functions in middle aged adults. BMC Endocrine Disorders, 23(1), 59. https://doi.org/10.1186/s12902-023-01308-3
19. Kelly, A., Calamia, M., Koval, A., Terrera, G. M., Piccinin, A. M., Clouston, S., Hassing, L. B., Bennett, D. A., Johansson, B., & Hofer, S. M. (2016). Independent and interactive impacts of hypertension and diabetes mellitus on verbal memory: A coordinated analysis of longitudinal data from England, Sweden, and the United States. Psychology and Aging, 31(3), 262–273. https://doi.org/10.1037/pag0000078
20. Kemenkes RI. (2019). Hasil Riset Kesehatan Dasar Tahun 2018. Kementrian Kesehatan RI.
21. Khan, M. A. B., Hashim, M. J., King, J. K., Govender, R. D., Mustafa, H., & Al Kaabi, J. (2019). Epidemiology of Type 2 Diabetes – Global Burden of Disease and Forecasted Trends: Journal of Epidemiology and Global Health, 10(1), 107–111. https://doi.org/10.2991/jegh.k.191028.001
22. Kim, Y. J., Jeon, J. Y., Han, S. J., Kim, H. J., Lee, K. W., & Kim, D. J. (2015). Effect of socio-economic status on the prevalence of diabetes. Yonsei Medical Journal, 56(3), 641–647. https://doi.org/10.3349/ymj.2015.56.3.641
23. Kumarasamy, C., Sabarimurugan, S., Madurantakam, R. M., Lakhotiya, K., Samiappan, S., Baxi, S., Nachimuthu, R., Gothandam, K. M., & Jayaraj, R. (2019). Prognostic significance of blood inflammatory biomarkers NLR, PLR, and LMR in cancer—A protocol for systematic review and meta-analysis. Medicine, 98(24), e14834. https://doi.org/10.1097/MD.0000000000014834
24. Malik, A., Ahmed, M., Mansoor, S., Ambreen, S., Usman, B., & Shehryar, M. (2022). Cognitive Impairment in Type 2 Diabetes Mellitus. Cureus, 14(2), e22193. https://doi.org/10.7759/cureus.22193
25. Mok, V., & Kim, J. S. (2015). Prevention and Management of Cerebral Small Vessel Disease. Journal of Stroke, 17(2), 111–122. https://doi.org/10.5853/jos.2015.17.2.111
26. Okaniawan, P. E. P., & Agustini, N. N. M. (2021). Penurunan Fungsi Kognitif Akibat Diabetes Melitus. Ganesha Medicina, 1(1), Article 1. https://doi.org/10.23887/gm.v1i1.31708
27. Rosenberg, G. A. (2017). Extracellular matrix inflammation in vascular cognitive impairment and dementia. Clinical Science (London, England: 1979), 131(6), 425–437. https://doi.org/10.1042/CS20160604
28. Salim, I. O. (2018). Hubungan Kadar Glukosa Darah sewaktu dan Gangguan Fungsi Kognitif pada Pasien Diabetes Melitus Tipe 2 di Puskesmas Purnama Pontianak. Jurnal Cerebellum, 2(1), 385–401.
29. Sonoda, N., Morimoto, A., Ugi, S., Morino, K., Sekine, O., Nemoto, K., Maegawa, H., & Miyamatsu, N. (2016). Smoking status is associated with mild cognitive impairment assessed with the mini-mental state examination in Japanese diabetic patients. Diabetology International, 7(4), 361–367. https://doi.org/10.1007/s13340-016-0256-0
30. Sun, H., Saeedi, P., Karuranga, S., Pinkepank, M., Ogurtsova, K., Duncan, B. B., Stein, C., Basit, A., Chan, J. C. N., Mbanya, J. C., Pavkov, M. E., Ramachandaran, A., Wild, S. H., James, S., Herman, W. H., Zhang, P., Bommer, C., Kuo, S., Boyko, E. J., & Magliano, D. J. (2022). IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Research and Clinical Practice, 183, 109119. https://doi.org/10.1016/j.diabres.2021.109119
31. Yerrapragada, D. B., Rao, C. R., Karunakaran, K., & Lee, H. S. E. (2019). Cognitive Dysfunction Among Adults With Type 2 Diabetes Mellitus in Karnataka, India. Ochsner Journal, 19(3), 227–234. https://doi.org/10.31486/toj.18.0160
32. Zhao, X., Han, Q., Lv, Y., Sun, L., Gang, X., & Wang, G. (2017). Biomarkers for cognitive decline in patients with diabetes mellitus: Evidence from clinical studies. Oncotarget, 9(7), 7710–7726. https://doi.org/10.18632/oncotarget.23284
33. Zheng, Y., Ley, S. H., & Hu, F. B. (2018). Global aetiology and epidemiology of type 2 diabetes mellitus and its complications. Nature Reviews. Endocrinology, 14(2), 88–98. https://doi.org/10.1038/nrendo.2017.151
Wulaa, N., Muis, A., Maricar, N., Masadah, R., Sompa, A., & Umar, H. (2024). Rasio Platelet Limfosit (PLR) sebagai Penanda Risiko Gangguan Fungsi Kognitif pada Pasien Diabetes Melitus Tipe 2. Ghidza: Jurnal Gizi Dan Kesehatan, 8(1), 48-59. https://doi.org/10.22487/ghidza.v8i1.1213
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