USULAN PENELITIAN

DISLIPIDEMIA SEBAGAI FAKTOR RISIKO

PREEKLAMPSIA

SAWITRI ELLENA JUNIARTI

NIM: 1671031006

PROGRAM STUDI PENDIDIKAN DOKTER SPESIALIS

OBSTETRIK DAN GINEKOLOGI
FK UNUD / RSUP SANGLAH
DENPASAR
2019

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 Lembar Persetujuan Pembimbing

USULAN PENELITIAN INI TELAH DISETUJUI

PADA TANGGAL………………..

Pembimbing I, Pembimbing II,

Prof.Dr.dr. Ketut Suwiyoga, SpOG(K) Dr.dr. Ketut Surya Negara, SpOG(K)

NIP. 19530715 198003 1 009 NIP. 19670903 199703 1 001

Koordinator Program Studi

Pendidikan Dokter Spesialis Obstetri dan Ginekologi

FK UNUD / RSUP Sanglah Denpasar

Dr.dr. I Wayan Megadhana, SpOG(K)

NIP. 19600125 198710 1 002

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 DAFTAR ISI

LEMBAR PENGESAHAN .................................................................................. ii

DAFTAR ISI ......................................................................................................... iii
DAFTAR TABEL................................................................................................. vi
DAFTAR GAMBAR ........................................................................................... vii
DAFTAR LAMPIRAN ...................................................................................... viii
DAFTAR SINGKATAN ...................................................................................... ix

BAB I PENDAHULUAN ......................................................................................1

1.1 Latar Belakang ..........................................................................................1
1.2 Rumusan Masalah .....................................................................................3
1.3 Tujuan Penelitian ......................................................................................4
1.3.1 Tujuan umum ..................................................................................4
1.3.2 Tujuan khusus .................................................................................4
1.4 Manfaat penelitian ....................................................................................4
BAB II TINJAUAN PUSTAKA ...........................................................................5
2.1 Preeklampsia ............................................................................................6
2.2 Epidemiologi Preeklampsia ......................................................................6
2.3 Faktor Risiko Preeklampsia ......................................................................6
2.4 Patogenesis Preeklampsia .........................................................................8
2.4.1 Tahap pertama preeklampsia ..........................................................8
2.4.2 Tahap kedua preeklampsia ...........................................................11
2.5 Faktor yang Mempengaruhi Progresi Tahap 1 dan Tahap 2 Patogenesis
Preeklampsia .......................................................................................14
2.6 Interaksi Maternal dan Fetal pada Preeklampsia ....................................16
2.7 Peran Stres Retikulum Endoplasma dalam Patogenesis Preeklampsia
Awal ....................................................................................................19
2.8 Prediksi Preeklampsia .............................................................................24
2.9 Dislipidemia dan Hubungannya dengan Preeklampsia ..........................26
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 2.10 Lipoprotein ...........................................................................................29
2.11 Tranpor Lemak .....................................................................................36
2.11.1 Jalur eksogen .................................................................................38
2.11.2 Jalur endogen ................................................................................39
2.11.3 Jalur reverse cholesterol transport ...............................................41
2.12 Apolipoprotein ......................................................................................44
2.13 Enzim dan Protein Transpor yang Berperan dalam Metabolisme
Lipoprotein ..........................................................................................48
2.14 Reseptor Lipoprotein dan Transporter Lipid ........................................50
BAB III KERANGKA BERPIKIR, KONSEP DAN HIPOTESIS
PENELITIAN .......................................................................................................53
3.1 Kerangka Berpikir ..................................................................................54
3.2 Kerangka Penelitian ................................................................................54
3.3 Hipotesis Penelitian ................................................................................54
BAB IV METODE PENELITIAN ....................................................................55
4.1 Rancangan Penelitian..............................................................................55
4.2 Tempat dan Waktu Penelitian .................................................................56
4.3 Populasi Penelitian..................................................................................56
4.4 Sampel Penelitian ...................................................................................56
4.4.1 Kriteria subyek penelitian ...............................................................56
4.4.2 Penentuan besar sampel ..................................................................57
4.5 Variabel Penelitian..................................................................................58
4.6 Definisi Operasional Variabel ................................................................58
4.7 Prosedur Pengambilan Sampel ...............................................................60
4.8 Alur Penelitian ........................................................................................61
4.9 Analisis Data ...........................................................................................63
DAFTAR PUSTAKA ...........................................................................................64
LAMPIRAN ..........................................................................................................67

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 DAFTAR TABEL

Halaman
Tabel 2.1 Rentang nilai normal profil lipid pada ibu hamil ..................................27
Tabel 2.1 Karakteristik dan Persentase Konten Berbagai Lipoporotein Relatif
Terhadap Berat Total .............................................................................29
Tabel 2.2 Klasifikasi HDL .....................................................................................33
Tabel 2.3 Klasifikasi Apolipoprotein ....................................................................47
Tabel 4.1 Perhitungan odds ratio ...........................................................................63

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 DAFTAR GAMBAR

Halaman
Gambar 2.1 Proses Plasentasi pada Kehamilan Normal, IUGR, dan
Preeklampsia Onset Dini ................................................................11
Gambar 2.2 Dua Tahap Patogenesis Preeklampsia ............................................16
Gambar 2.3 Interaksi Maternal dan Fetal pada Preeklampsia ............................19
Gambar 2.4 Jalur Persinyalan yang Diaktivasi oleh Protein Tak Terlipat pada
Stress Retikulum Endoplasma ........................................................21
Gambar 2.5 Patofisiologi Preeklampsia dari Stress Retikulum Endoplasma dan
Stres Oksidatif ................................................................................23
Gambar 2.6 Patogenesis Preeklampsia ...............................................................28
Gambar 2.7 Struktur Lipoprotein .......................................................................29
Gambar 2.8 Mekanisme Metabolisme HDL ......................................................34
Gambar 2.9 Struktur Lipoprotein (a) ..................................................................34
Gambar 2.10 Berbagai Jenis Lipoprotein..............................................................36
Gambar 2.11 Jalur Eksogen dan Endogen Kolesterol dan Trigliserid dalam
Sirkulasi ..........................................................................................37
Gambar 2.12 Jalur Lipoprotein Eksogen ..............................................................39
Gambar 2.13 Jalur Lipoprotein Endogen .............................................................41
Gamvar 2.14 Mekanisme Efluks Kolesterol ........................................................44
Gambar 2.15 Jalur Reseptor LDL ........................................................................51
Gambar 2.16 Jaur SREBP ....................................................................................52
Gambar 3.1 Kerangka konsep ............................................................................54
Gambar 4.1 Bagan Rancangan Penelitian ..........................................................55
Gambar 4.2 Alur Penelitian ................................................................................61

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 DAFTAR LAMPIRAN

Halaman
Lampiran1 Penjelasan penelitian ......................................................................67
Lampiran 2 Surat pernyataan persetujuan ikut serta dalam penelitian ..............71
Lampiran 3 Lembar pengunduran diri ...............................................................72
Lampiran 3 Formulir penelitian .........................................................................73
Lampiran 4 Rancangan anggaran biaya penelitian ............................................75

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 DAFTAR SINGKATAN

CRP : C-Reactive Protein

eIF2α : eukaryotic initiation factor 2 subunit α

GRP 78 : Glucose regulated protein 78

HDL-C : High-Density Lipoprotein Cholesterol

HELLP : Hemolysis, elevated liver function enzymes and low platelets

HLA-C : Human leukocyte antigen C

HMG-CoA : Hydroxy-3 methylglutaryl coenzyme A

LCAT : Lecithin–cholesterol acyltransferase

IDL : Intermediate-density lipoprotein

IMT : Indeks massa tubuh

Ire 1 : Inositol-requiring 1

IRD : Instalasi Rawat Darurat

IUGR : Intrauterine growth restriction

KIRs : Killer immunoglobulin receptor

LPL : Lipoprotein lipase

LDL-C : Low-Density Lipoprotein Cholesterol

PAI-1 : Plasminogen activator inhibitor 1

PERK : PKR-like endoplasmic reticulum kinase

sFlt-1 : soluble fms-like tyrosine kinase

uNK : Uterine natural killer

UPR : Unfolded protein response

VEGF : Vascular endothelial growth factor

VLDL : Very-low-density lipoprotein

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