Hubungan antara Kendali Glikemik pada Pasien Diabetes Melitus Tipe 2 dengan Aktivitas Sel Natural Killer

Dian Ristanti, Gatot Soegiarto, Hermina Novida

Abstract

Pendahuluan. Sebagian besar penelitian terdahulu mendapatkan penurunan fungsi sel imunitas alami pada pasien diabetes melitus tipe 2 (DMT2) seperti sel neutrofil dan monosit-makrofag. Fungsi sel natural killer (NK) dan hubungannya dengan tingkat kendali glikemik belum banyak diteliti. Penelitian ini bertujuan mengevaluasi aktivitas sel NK pada pasien DMT2 dan hubungannya dengan tingkat kendali glikemik.

Metode. Pasien DMT2 yang berobat di instalasi rawat jalan RSUD Dr. Soetomo Surabaya pada bulan Juli-Agustus 2018 dan memenuhi kriteria inklusi-eksklusi dilibatkan dalam penelitian ini. Kadar HbA1c diperiksa sesuai prosedur standar. Aktivitas sel NK diukur menggunakan flowcytometer dan dihitung berdasarkan persentase sel NK yang teraktivasi dari total jumlah sel NK. Selanjutnya, dilakukan uji korelasi untuk kedua variabel.

Hasil. Dari 38 subjek penelitian yang diikutsertakan secara konsekutif didapatkan 15 laki-laki dan 23 perempuan, dengan rerata usia 52 tahun (simpang baku [SB] 6 tahun). Subjek penelitian rutin menggunakan terapi OAD (36,8%), insulin (44,7%), atau terapi kombinasi OAD-Insulin (18,4%). Median kadar HbA1c adalah 7,8% (rentang: 5,5-13%). Median aktivitas sel NK adalah sebesar 7,08% (rentang: 21,55-2,95%). Dengan uji Spearman tidak didapatkan hubungan bermakna antara kadar HbA1c dengan aktivitas sel NK (r=0,292 dengan nilai p=0,075).

Simpulan. Tingkat kendali glikemik pada pasien DMT2 tidak terbukti memengaruhi aktivitas sel NK. Perlu dilakukan eksplorasi lebih lanjut apakah pada pasien DMT2 terdapat perubahan sel NK yang berkontribusi pada penurunan fungsi imunitas alami.

Kata Kunci:  Aktivitas sel natural killer, Diabetes melitus tipe 2, Disfungsi imunitas alami, HbA1c

 

Correlation between Glycemic Control in Type 2 Diabetes Mellitus Patients with Natural Killer Cell Activity

Introduction. Most of the previous studies showed decreased polymorphonuclear cells and monocytes/macrophages in type 2 diabetes mellitus (T2DM). Natural killer (NK) cell functions were rarely studied in T2DM. This study aimed to evaluate NK cell activity and determine its correlation with glycemic control in T2DM patients.

Methods. Type 2 diabetes mellitus (T2DM) patients who regularly visit the diabetes outpatient clinic of Dr. Soetomo General Hospital during July – August 2018 and fulfill the inclusion-exclusion criteria were recruited to the study. The HbA1c level was measured according to the standard procedure. The NK cell activity was measured using flow cytometry and expressed as the percentage of activated NK cells from total NK cell numbers. Correlation between the two variables was determined.

Results. There were 38 subjects eligible for this study, consisted of 15 males and 23 females, with mean of age 52 (standard deviation [SD] 6) years. The subjects routinely received OAD (36.8%), insulin (44.7%), or OAD-Insulin combination therapy (18.4%). Median HbA1c was 7.8% (range: 5.5 – 13%). Median NK cell activity was 7.08% (range: 2.95 – 21.55%). Using a Spearman test, there was no significant correlation between HbA1c levels and NK cell activity (r=0.292; p=0.075).            

Conclusions. The glycemic control in T2DM did not significantly influence NK cell activity. Further exploration and research should be done to determine whether there were changes in NK cells that contribute to innate immune dysfunction in T2DM patients.

Keywords

HbA1c, Innate immune dysfunction, Natural killer cell activity, Type 2 Diabetes Mellitus

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