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    RSUPN Dr. Cipto Mangunkusumo

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Vol 33 No 2 Maret 2016


PERBEDAAN KADAR GLIAL FIBRILLARY ACIDIC PROTEIN (GFAP) SERUM STROKE ISKEMIK DAN HEMORAGIK FASE AKUT BERDASARKAN AWITAN DAN TINGKAT KEPARAHAN STROKE
Alfirdian Irwan,* Syarif Indra,* Yuliarni Syafrita*

DIFFERENCE OF SERUM GLIAL FIBRILLARY ACIDIC PROTEIN  (GFAP) BETWEEN ISCHEMIC AND HAEMORRHAGIC STROKE PATIENTS BASED ON ONSET AND STROKE SEVERITY

ABSTRACT 

Introduction: Some studies have found that glial fibrillary acidic protein (GFAP) has a high diagnostic value in dis- tinguishing ischemic (IS) and hemorrhagic stroke (ICH), however no studies directly compare the differences in the levels of serum GFAP on the onset and severity of both types of stroke.

Aims: To study the serum GFAP levels differences between IS and ICH in the acute phase and its relation to the onset and stroke severity.

Methods: A cross-sectional study in Dr. M. Djamil Hospital, Padang, between December 2014-April 2015. A total of

28 patients with IS and 30 patients ICH was included in this study. Serum GFAP levels examined using enzyme-linked im- munosorbent assay (ELISA). Mean differences of serum GFAP levels between the two groups were analyzed using one-way ANOVA. The onset of stroke was divided into ≤ 6 hours and 6-12 hours. NIHSS scores were divided into NIHSS score ≤14 and >14. Significance differences in the levels of GFAP between subgroups were analyzed post hoc analysis.

Results: Mean levels of serum GFAP in ICH group was significantly higher than IS group (p=0.006), and was high- est in ICH group onset ≤ 6 hours. Significant differences between IS and ICH within 6 hours of onset (p=0.04). Based on NIHSS score, the highest serum GFAP levels in ICH with NIHSS score >14. Significant difference was found between IS with NIHSS >14 compared with ICH with NIHSS >14 (p=0.01) and IS with NIHSS score >14 compared with ICH with NIHSS score ≤14 (p=0.03).

Discussion: There were serum GFAP levels differences between ischemic stroke and intracerebral hemorrhage in the acute phase. The mean levels of serum GFAP were highest at 6 hours of the stroke onset. The mean levels of serum GFAP in intracerebral hemorrhage with a lower severity level remains higher than ischemic stroke with greater severity.

Keywords: Acute stroke, glial fibrillary acidic protein

ABSTRAK

Pendahuluan: Beberapa penelitian mendapatkan bahwa terdapat perbedaan kadar glial fibrillary acidic protein (GFAP) yang signifikan antara stroke iskemik dan hemoragik pada fase akut stroke, namun belum ada penelitian yang membandingkan secara langsung perbedaan kadar GFAP berdasarkan awitan dan tingkat keparahan kedua jenis stroke tersebut.

Tujuan: Melihat perbedaan kadar GFAP serum antara stroke iskemik dan hemoragik pada fase akut dan hubungannya dengan awitan serta tingkat keparahan stroke.

Metode: Penelitian ini dilakukan secara potong lintang terhadap pasien stroke akut di RSUP Dr. M. Djamil, Padang,pada bulan Desember 2014-April 2015. Kadar GFAP serum diperiksa dalam 12 jam awitan menggunakan teknik ELISA, dibagi menjadi ≤6 jam dan 6-12 jam. Derajat keparahan stroke berdasarkan National Institute of Health Stroke Scale (NIHSS) dibagi menjadi derajat ringan (NIHSS ≤14) dan berat (NIHSS >14). Perbedaan rerata kadar GFAP serum antara kedua kelompok dianalisis menggunakan uji one way ANOVA. Kemaknaan perbedaan kadar GFAP berdasarkan subkelompok dianalisis dengan uji post hoc.

Hasil: Didapatkan 28 subjek stroke iskemik dan 30 stroke hemoragik. Rerata kadar GFAP serum pada kelompok stroke hemoragik lebih tinggi dibanding kelompok stroke iskemik secara bermakna (p=0,006), terutama pada onset ≤6 jam (p=0,04). Kadar GFAP serum tertinggi ditemukan pada kelompok stroke hemoragik derajat berat. Kadar GFAP serum pada stroke hemoragik derajat ringan tetap lebih tinggi dibanding stroke iskemik derajat berat secara bermakna (p=0,03).

Diskusi: Terdapat perbedaan kadar GFAP serum antara stroke iskemik dan stroke hemoragik pada fase akut. Rerata kadar GFAP serum paling tinggi pada stroke hemoragik awitan 6 jam. Rerata kadar GFAP serum pada stroke hemoragik dengan tingkat keparahan lebih rendah tetap lebih tinggi dibanding stroke iskemik dengan tingkat keparahan lebih besar.

Kata kunci: Glial fibrillary acidic protein, hemoragik, iskemik, stroke akut
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*Bagian/SMF Neurologi FK Universitas Andalas/RSUP Dr. M. Djamil, Padang.

Korespondensi: dr.alfirdian@yahoo.com


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Vol 33 No 2 Maret 2016


  Terakreditasi DIKTI Nomor: 12/M/Kp/II/15

 

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