Skip to main content Skip to main navigation menu Skip to site footer

Ekspresi fibulin-5 yang rendah pada ligamentum sakrouterina sebagai faktor risiko terjadinya prolaps uterus derajat iii-iv

Abstract

Introduction: Risk factors for uterine prolapse are multifactorial which associated with weak pelvic floor support muscles, the sacrouterine ligament. The sacrouterine ligament is composed of elastin and collagen where one of the elastin forming proteins is fibulin-5. If there is a disruption in fibulin-5 expression it will cause uterine prolapse. The aim of this study was to prove low fibulin-5 expression in the sacrouterine ligament as a risk factor for degree III-IV uterine prolapse.

Method: This study was an observational design with case control, located at Sanglah Hospital and Pathobiology Laboratory of the Faculty of Veterinary Medicine between April 1 and October 31, 2018. There were 22 subjects in the case and control groups respectively. Samples were taken from the sacrouterine ligament of III-IV uterine prolapse patients who underwent hysterectomy and non-prolapse who performed total hysterectomy with indications of benign abnormalities such as uterine myomas, or bleeding disorders that met the inclusion and exclusion criterias. Samples originating from the sacrouterina ligament were then taken to the Pathobiology Laboratory to make immunohistochemical preparations so they could assess the fibulin-5 expression. Fibulin-5 expression is divided into low and high. Data analysis using Chi-square test, with a value of p <0.005 considered significant.

Result: Based on fibulin-5 expression between the two groups, low fibulin-5 expression in the sacrouterine ligament was a risk factor for grade III - IV uterine prolapse of 4.91 times (OR = 4.91; 95% CI = 1.33- 18, 21; p = 0.014).

Conclusion: Based on the results of the study it can be concluded that low fibulin-5 expression in the sacrouterine ligament is a risk factor for degree III-IV uterine prolapse.



Pendahuluan: Prolaps uterus adalah turunnya uterus ke dalam liang vagina atau keluar liang vagina sebagai akibat gagalnya ligmentum penyokong dasar panggul. Faktor risiko terjadinya prolaps uterus bersifat multifaktorial yang berhubungan dengan lemahnya otot penyangga dasar panggul yaitu ligamentum sakrouterina.  Ligamentum sakrouterina tersusun oleh elastin dan kolagen dimana salah satu protein pembentuk elastin adalah fibulin-5. Apabila terjadi gangguan dalam ekspresi fibulin-5 akan menyebabkan terjadinya prolaps uterus. Tujuan penelitian ini adalah untuk membuktikan ekspresi fibulin-5 yang rendah pada ligamentum sakrouterina sebagai faktor risiko terjadinya prolaps uterus derajat III-IV.

Metode: Penelitian ini merupakan rancangan observasional dengan kasus kontrol, bertempat di RSUP Sanglah dan  Laboratorium Patobiologi Fakultas Kedokteran Hewan (FKH) Unud antara 1 april 2018 - 31 oktober 2018. Terdapat  masing-masing 22 subyek pada kelompok kasus dan kontrol. Sampel diambil dari ligamentum sakrouterina pasien prolaps uterus derajat III-IV yang menjalani histerektomi dan non-prolaps uterus yang dilakukan histerektomi total dengan indikasi kelainan jinak seperti mioma uteri, atau gangguan perdarahan yang memenuhi kriteria inklusi dan eksklusi. Sampel yang berasal dari ligamentum sakrouterina kemudian dibawa ke Laboratorium Patobiologi FKH Unud untuk dibuat preparat imunohistokimia sehingga dapat menilai expresi fibulin-5 sampel. Expresi fibulin-5 dibedakan menjadi rendah dan tinggi. Analisis data menggunakan uji Chi-square,  dengan nilai p<0,005 dianggap bermakna. 

Hasil: Berdasarkan ekspresi fibulin-5 antara kedua kelompok,  ekspresi fibulin-5 yang rendah pada ligamentum sakrouterina merupakan faktor risiko terjadinya prolaps uterus derajat III - IV sebesar 4,91 kali (OR =4,91; IK 95% =1,33-18,21; p =0,014).

Kesimpulan: Kesimpulan penelitian ini adalah ekspresi ekspresi fibulin-5 yang rendah pada ligamentum sakrouterina menjadi faktor risiko terjadinya prolaps uterus derajat III-IV.

 

 

 

 

References

  1. Bagian Obstetri dan Ginekologi FK UNUD / RSUP Sanglah Denpasar. 2009. Laporan Tahunan Obgin FK UNUD / RSUP Sanglah Denpasar tahun 2009.
  2. Shrestha AD. 2012. Prevalence of uterine prolapse amongst gynecology OPD patients in tribhuvan university teaching hospital in nepal and its socio- cultural determinants.
  3. Junizaf, Santoso, B.I. 2013. Buku Ajar Uroginekologi Indonesia. Himpunan Uroginekologi Indonesia Bagian Obstetri dan Ginekologi FKUI. 2011.
  4. Jelovsek, J.E., Maher, C., Baber, M.D. 2007. Pelvic Organ Prolapse. Lancet. 369 : 27-38
  5. DeLancey JOL.2007. The hidden epidemic of pelvic floor dysfunction : Achievable goals for improved prevention and treatment. Am J Obstet Gynecol 2005. Vol 192 : 5
  6. Dietz, H.P. 2008. The aetiology of prolapse. International Urogynecology Journal. 19(10):1323-1329.
  7. Schneider, R., Jensen, S.A., Whiteman, P., James, S.O., McCullagh, Redfield, C., Handford, P.A. 2010. Biophysical Characterisation of Fibulin-5 Proteins Associated with Disease. J. Mol. Biol. 401 : 605–617
  8. Miao, W., Rolf, A.B. 2013. FBLN5 (fibulun 5). Gene section review in Atlas of Genetics and Cytogenetics in Oncology and Hematology. 17 (12): 811-15.
  9. Tinelli, Malvasi, Rahimi, Negro, Vergara, Martignagi, Pellegrino, Cavallotti. 2010. Age-related pelvic floor modifications and prolapse risk factors in postmenopausal women. Dalam Menopause. 17(1):204-212, January 2010. 10.1097/gme.0b013e3181b0c2ae, PMID: 19629013.
  10. Yilmaz, Nafiye., Ozaksit Gulnur., Terzi, Yunus Kasim., Budak Burcu., Aksaka. Orhan.2014. HOXA11 and MMP2 Gene Expression in Uterosacral Ligaments o Women with Pelvic Organ Prolapse. Dalam J Turk Ger Gynecol Assoc;15. P104-8.
  11. Midwood, K.S., Schwarzbauer, J.E. 2002. Elastic Fibers: Building Bridges Between Cells and Their Matrix. Current Biology; Vol. 12: R279–R281
  12. Zhao BH and Zhou JH. Decreased expression of elastin, fibulin-5 and lysyl oxidase-like 1 in the uterosacral ligaments of postmenopausal women with pelvic organ prolapse. Journal of Obstetrics and Gynaecology Research 2012; 38(6): 925–931
  13. Jung, H.J., Jeon, M.J., Yim, G.W., Kim,S.K., Choi, J.R., Bai, S.W. 2009. Changes in expression of fibulin-5 and lysyl oxidase-like 1 associated with pelvic organ prolapsed. European Journal of Obstetrics & Gynecology and Reproductive Biology, 145: 117–122
  14. Kathleen Chin, Cecilia Wieslander, Haolin Shi, Sunil Balgobin, T. Ignacio Montoya, Hiromi Yanagisawa, R. Ann Word. 2016. Pelvic Organ Support in Animals with Partial Loss of Fibulin-5 in the Vaginal Wall. Diego Fraidenraich, Rutgers University -New Jersey Medical School, UNITED STATES

How to Cite

Mahardhika, I. N. G. D., Suwiyoga, K., Putra, I. G. M., Negara, K. S., Mahendra, I. N. B., Darmayasa, M., Megadhana, I. W., & Suwardewa, T. G. A. (2020). Ekspresi fibulin-5 yang rendah pada ligamentum sakrouterina sebagai faktor risiko terjadinya prolaps uterus derajat iii-iv. Medicina, 51(2). https://doi.org/10.15562/medicina.v51i2.881

HTML
96

Total
64

Share

Search Panel

I Nyoman Gde Dwipa Mahardhika
Google Scholar
Pubmed
Medicina Journal


Ketut Suwiyoga
Google Scholar
Pubmed
Medicina Journal


I Gede Mega Putra
Google Scholar
Pubmed
Medicina Journal


Ketut Surya Negara
Google Scholar
Pubmed
Medicina Journal


I Nyoman Bayu Mahendra
Google Scholar
Pubmed
Medicina Journal


Made Darmayasa
Google Scholar
Pubmed
Medicina Journal


I Wayan Megadhana
Google Scholar
Pubmed
Medicina Journal


Tjokorda Gde Agung Suwardewa
Google Scholar
Pubmed
Medicina Journal