Deteksi Disfungsi Endotel pada Gangguan Depresi Mayor dengan Pengukuran Endothelial-Dependent Flow-Mediated Vasodilatation

Abstract

Gangguan depresi mayor ialah salah satu gangguan jiwa yang mengganggu fungsi kehidupan dan sebagai salah satu penyebab terbesar disabilitas di seluruh dunia termasuk masalah kesehatan masyarakat, baik dalam segi sosial, ekonomi, maupun klinis. Depresi memicu disfungsi endotel yang merupakan proses awal gangguan kardiovaskular dan menjadi faktor risiko independen penyakit jantung koroner. Deteksi disfungsi endotel pada pasien gangguan depresi mayor diharapkan dapat menunjang penatalaksanaan yang komprehensif dan menurunkan risiko gangguan kardiovaskular. Tujuan penelitian mengetahui disfungsi endotel pada gangguan depresi mayor dengan mengukur endothelial-dependent flow-mediated vasodilatation (FMD). Penelitian ini adalah bagian dari penelitian gangguan depresi mayor periode Maret 2015–Maret 2016. Gangguan depresi mayor ditentukan menggunakan Structured Clinical Interview for DSM-IV Axis I Disorder (SCID-I) dan Hamilton Depression Rating Scale-17 item (HDRS-17). Usia dan jenis kelamin subjek disesuaikan, kriteria inklusi penelitian adalah pasien memenuhi kriteria gangguan depresi mayor SCID-I, skor HDRS-17 ≥19, tekanan darah, indeks massa tubuh, profil lipid dan kadar gula darah dalam batas normal, serta tidak sedang menderita atau mempunyai riwayat penyakit kardiovaskular. Pada penelitian ini dilakukan pemeriksaan terhadap 15 pasien dari RS Dustira dan RS Salamun yang memenuhi kriteria inklusi dan 15 partisipan sehat. Deteksi disfungsi endotel noninvasif digunakan alat ultrasonografi resolusi tinggi pada arteri brakialis (FMD) yang menggambarkan fungsi vasodilatasi yang endotel-dependen. Pemeriksaan FMD dilakukan di Instalasi Pelayanan Jantung RSUP Dr. Hasan Sadikin Bandung menggunakan alat ekokardiografi merek General Electric tipe Vivid 7 dan dinilai berdasar atas skoring yang berlaku. Nilai FMD pasien gangguan depresi mayor abnormal pada 11 dari 15 pasien. Nilai abnormal pada skoring FMD menunjukkan gangguan respons vasodilatasi pada pasien gangguan depresi mayor yang menggambarkan disfungsi endotel. Simpulan, FMD dapat digunakan sebagai alternatif pemeriksaan fungsi endotel yang noninvasif untuk deteksi dini proses awal gangguan fungsi pembuluh darah.

ENDOTHELIAL DYSFUNCTION DETECTION IN MAJOR DEPRESSIVE DISORDER USING ENDOTHELIAL-DEPENDENT FLOW-MEDIATED VASODILATATION ASSESSMENT

Major depressive disorder is a mental disorder that reduce people’s functioned, is the leading cause of disability worldwide and a significant contributor to the global burden of disease. The global burden of depression poses a substantial public health challenge at the social, economic and clinical level. Depressive symptoms may influence the development and progression of cardiovascular diseases by fostering endothelial dysfunction. Depressive symptoms of sufficient severity can serve as independent risk factors for ischemic heart disease. Early detection of endothelial dysfunction will decrease the risk of cardiovascular disorders in major depressive disorder cases. The aim of this study was to detect endothelial dysfunction in major depressive disorder’s patient using endothelial-dependent flow-mediated vasodilatation (FMD). This study was part of a study held from March 2015 to March 2016. Assessment of major depressive disorder was measured using Structured Clinical Interview for DSM-IV Axis I Disorder (SCID-I) and 17 item Hamilton Depression Rating Scale. After controlling for age, sex, mean arterial pressure, body mass index, lipid profile, blood glucose and cardiovascular diseases, 15 patients from RS Dustira and RS Salamun, and 15 healthy participants were assessed. The patients were met the major depressive disorder criteria using SCID-I, had 17 item HDRS score ≥19, and had no diagnosis of other psychiatric disorder. Participants were measured noninvasively by brachial artery endothelial-dependent flow-mediated vasodilatation (FMD) to examine the impact of mood states on endothelial function. FMD was carried out using echocardiography (General Electric, Vivid 7) at Instalasi Pelayanan Jantung RSUP Dr. Hasan Sadikin Bandung. The FMD score in major depressive disorder patients were abnormal in 11 out of 15. Abnormal score in the majority of patients represent impairment of the endothelial-dependent vasodilation and sign of an endothelial dysfunction. In conclusion, FMD could be used as a noninvasive endothelial dysfunction assessment, an early detection of vascular diseases in major depressive disorder.