ELASTASE-1 FESES PADA PENDERITA DIABETES MELITUS TIPE-2

Abstract

Background. Functionally, pancreas has two task as exocrine and endocrine glands Both linked very closely anatomically and physiologically. Reduced exocrine pancreatic function has been observed in a high percentage of patients with type-1 diabetes mellitus in the past. Most investigators performed direct stimulation test (secretin- CCK test) in smaller group of patients. Until recently only few data for type-2 diabetes available and they are contradictory. The fecal concentration of elastase-1 is an easy indirect test and the result correlating well with direct test methods. We used this test to investigate the exocrine pancreas function in type-2 diabetes. Patients and methods. Hundred subjects with type-2 diabetes (49 male, 51 female, mean age 57,6 years) from outpatients clinic at general hospital in Semarang were investigated. They were asked about their clinical symptoms and medical history using a questionnaire. The patients were divided into good, moderate and poorly controlled diabetics based on fasting and postprandial blood glucose every month for three consecutive months. Fecal elastase-1 (FE-1), was analyzed by ELISA (Schebo-Tech Wettenberg, Germany). Results. FE-1 was normal (> 200.µg/ g) in 54 % and reduced was found 46 % in our type-2 diabetes. It was reduced (FE-1 = 100 — 200 mg/ g) in 25 % and markedly reduce (FE-1 < 100 mg/ g) in 21 %. Based on blood glucose : 27 subject were good controlled, 29 subject were moderate, and 44 subject were poorly controlled. 41 subjects were complaining about abdominal discomfort. The differences observed in FE-1 was statistically different in patients with and without abdominal discomfort (FE-1 = 207,38 mg/ g vs. 690 mg/ g, p = 0,000). In patients with and without decreased bodyweight FE-1 was statistically different (FE-1 = 174,46 mg/ g vs. 678,69 mg/ g, p = 0,000). There were significant correlation between FE-1 and blood glucose regulation (r = -0,549, p = 0,000), FE-1 and abdominal discomfort (r = 0,483, p = 0,000), FE-1 and decreased bodyweight (r = 0,526, p = 0,000). FE-1 didn't correlate with BMI, diabetes duration and age. Conclusion. In our type-2 diabetic show that exocrine pancreatic function is also impaired in a high percentage (46%). The present findings show a significant relationship between FE-1 and blood glucose regulation, abdominal discomfort and decreased bodyweight. Pancreatic exocrine insufficiency is significantly associated with poorly controlled diabetes. Latar belakang. Pankreas terdiri kelenjar eksokrin dan endokrin yang berhubungan sangat dekat baik secara anatomis maupun fisiologis. Adanya penurunan fungsi eksokrin pankreas telah sejak lama ditemukan dalam persentase tinggi pada penderita DM tipe-1. Penelitian terdahulu kebanyakan menggunakan metode tes stimulasi langsung (tes sekretin-CCK) pada sejumlah kecil pasien. Sedangkan data tentang penurunan fungsi eksokrin pankreas pada DM tipe-2 masih sangat sedikit dan saling bertolak belakang. Konsentrasi elastase-1 feses adalah pemeriksaan tidak langsung yang mudah dilakukan dan hasilnya hampir sebanding dengan metode tes langsung. Kami menggunakan tes ini untuk mengetahui fungsi eksokrin pankreas pada penderita DM tipe-2. Pasien dan metode. Dilakukan penelitian terhadap 100 orang penderita DM tipe-2 (49 laki-laki, 51 wanita, rerata umur 57,56 th) pasien rawat jalan pada Rumah Sakit Umum di Semarang Dengan menggunakan kuesioner dicatat tentang keluhan, gejala klinis dan riwayat penyakit. Berdasarkan gula darah puasa dan 2 jam postprandial tiap bulan selama 3 bulan berturut-turut, dibagi menjadi 3 kelompok regulasi : baik, sedang dan buruk. Elastase-1 feses diperiksa dengan ELISA (Schebo-Tech Wettenberg, Germany). Hasil. Elastase-1 feses normal (> 200 ttg/ g) sebanyak 54 % dan menurun sebanyak 46 % pada penderita DM tipe-2. Insufisiensi ringan (FE-1 = 100 — 200 lig/ g) pada 25 % dan insufisiensi berat (FE-1 < 100 lig/ g) pada 21 %. Pembagian berdasarkan regulasi gula darah didapatkan : 27 orang regulasi baik, 29 orang regulasi sedang dan 44 orang regulasi buruk. Keluhan abdominal discomfort dialami 41 orang. Perbedaan rerata elastase-1 feses antara orang yang mengalami abdominal discomfort dan tidak secara statistik sangat bermakna (FE-1 = 207,38 lig/ g vs. 690 jig/ g, p = 0,000). Pada pasien yang mengeluh adanya penurunan berat badan, rerata elastase-1 feses juga sangat bermakna secara statistik (FE-1 = 174,46 j.tg/ g vs. 678,69 lig/ g, p = 0,000). Hubungan korelasi antara elastase-1 feses dengan regulasi gula darah sangat bermakna (r = -0,549, p = 0,000), demikian juga elastase-1 dengan abdominal discomfort (r = 0,483, p = 0,000) serta elastase-1 feses dengan penurunan berat badan (r = 0,526, p = 0,000). Elastase-1 feses tidak mempunyai korelasi dengan IMT, lama diabetes dan umur. Kesimpulan. Penelitian yang kami lakukan pada penderita DM tipe-2 menunjukkan adanya penurunan fungsi eksokrin pankreas dalam persentase tinggi (46 %). Pada penelitian ini menunjukkan adanya hubungan bermakna antara elastase-1 feses dengan regulasi gula darah, abdominal discomfort dan penurunan berat badan. Insufisiensi eksokrin pankreas memiliki hubungan bermakna dengan kontrol gula darah yang buruk.