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Ekspresi matriks metaloproteinase-2 (MMP-2) yang tinggi pada ligamentum sakrouterina sebagai faktor risiko terjadinya prolaps uterus derajat III-IV

Abstract

Background: Uterine prolapse is the descent of the uterus into the vaginal canal or beyond vaginal introitus as a result of the failure of the pelvic floor supporting ligament. Uterine prolapse has multifactorial risk factors, but in every case of uterine prolapse, pelvic floor supporting tissue weakness, including the sacrouterine ligament, is always found. The strength of the sacrouterine ligament is determined by fibroblasts and extracellular matrix. The strength of the extracellular matrix itself is influenced by regulators such as TGF-β, TSP-1 and matrix metalloproteases (MMPs). Various MMPs play a role in the degradation of extracellular matrix where MMP-2 is one of them. The purpose of this study was to prove that the high expression of MMP-2 on sacrouterine ligament as a risk factor for stage III-IV uterine prolapse.

Method: This research is an observational study with case control method. There were 22 cases of stage III-IV uterine prolapse as a case group and 22 non-prolapse cases as a control group. This research was conducted at Sanglah General Hospital and the Pathobiology Laboratory of the Faculty of Veterinary Medicine, Udayana University. Samples were taken from the sacrouterine ligament of stage III-IV uterine prolapsed patients and non-prolapse uterus who had undergone total hysterectomy. Matrix Metaloproteinase-2 expression was assessed by immunohistochemical staining methods.

Result: High expression of MMP-2 on sacrouterine ligament was a risk factor for stage III-IV uterine prolapse as much as 6.5 times (OR =6,5; CI 95% =1,64-25,76; p =0,005).

Conclusion: The conclusion of this study was high expression of MMP-2 on sacrouterine ligament was a risk factor for stage 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. Prolaps uterus memiliki faktor risiko yang bersifat multifaktorial, namun pada setiap  kasus prolaps uterus, selalu ditemukan kelemahan pada jaringan penyangga dasar panggul, termasuk ligamentum sakrouterina. Kekuatan  ligamentum  sakrouterina ditentukan oleh fibroblast dan  matriks ekstraselular. Kekuatan matriks ekstraselular sendiri dipengaruhi oleh regulator-regulator seperti TGF-β, TSP-1 dan matriks metaloprotease (MMPs).  Beragam  MMP yang berperan dalam degradasi matriks ekstraselular dimana MMP-2 salah satu diantaranya. Tujuan penelitian ini adalah  untuk membuktikan ekspresi MMP-2 yang tinggi pada ligamentum sakrouterina sebagai faktor risiko terjadinya prolaps uterus derajat III-IV.

Metode: Penelitian ini merupakan penelitian observasional dengan metode kasus kontrol. Terdapat 22 kasus prolaps uterus derajat III-IV sebagai kelompok kasus dan 22 kasus non prolaps sebagai kelompok kontrol. Penelitian ini dikerjakan di Rumah Sakit Umum Pusat Sanglah dan Laboratorium Patobiologi Fakultas Kedokteran Hewan Universitas Udayana. Sampel diambil dari ligamentum sakrouterina pasien prolaps uterus derajat III-IV dan non-prolaps uterus yang telah dilakukan histerektomi total. Ekspresi matriks metaloproteinase-2 dinilai dengan metode pengecatan immunohistokimia.

Hasil: Ekspresi MMP-2 yang tinggi pada ligamentum sakrouterina merupakan faktor risiko terjadinya prolaps uterus derajat III - IV sebesar 6.5 kali (OR =6,5; IK 95% =1,64-25,76; p =0,005).

Kesimpulan: Kesimpulan penelitian ini adalah ekspresi MMP-2 yang tinggi pada ligamentum sakrouterina sebagai faktor risiko terjadinya prolaps uterus derajat III-IV.

References

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How to Cite

Pratiwi, K. Y. M., Putra, I. G. M., Suwiyoga, K., Darmayasa, M., Mahendra, I. N. B., Surya, I. G. N. H. W., Suwardewa, T. G. A., & Megadhana, I. W. (2020). Ekspresi matriks metaloproteinase-2 (MMP-2) yang tinggi pada ligamentum sakrouterina sebagai faktor risiko terjadinya prolaps uterus derajat III-IV. Medicina, 51(3). https://doi.org/10.15562/medicina.v51i3.884

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