Electronic Theses and Dissertation

Latar Belakang: Endometriosis adalah kondisi ginekologi kronis yang memengaruhi 10% wanita usia reproduksi, ditandai dengan adanya jaringan endometrium di luar kavum uteri. Penyakit ini sering didiagnosis terlambat karena gejala yang tidak spesifik dan kurangnya biomarker yang dapat diandalkan. Kadar serum CA125, prolaktin, dan kortisol merupakan biomarker yang diduga berperan dalam patogenesis endometriosis melalui jalur inflamasi, neuroendokrin, dan stress-response yang saling terkait. Namun, penelitian mengenai hubungan simultan ketiga biomarker ini dengan stadium penyakit dan intensitas nyeri masih terbatas, terutama pada populasi Indonesia. Memahami profil biomarker terintegrasi sangat penting untuk meningkatkan akurasi diagnostik dan strategi pengobatan yang lebih efektif.
Tujuan: Mengetahui hubungan antara kadar serum CA125, prolaktin, dan kortisol dengan stadium endometriosis dan derajat nyeri pada pasien dengan diagnosis endometriosis.
Metode: Penelitian observasional cross-sectional dilakukan di RSUD Dr. Zainoel Abidin, Banda Aceh, melibatkan 30 pasien dengan endometriosis yang telah dikonfirmasi. Kadar serum CA125, prolaktin, dan kortisol diukur menggunakan ECLIA. Stadium endometriosis ditentukan berdasarkan klasifikasi American Society for Reproductive Medicine (ASRM), dan derajat nyeri dinilai menggunakan Numeric Rating Scale (NRS). Analisis statistik dilakukan menggunakan uji korelasi Spearman.
Hasil: Rerata usia subjek adalah 37,23 ± 7,44 tahun dengan distribusi stadium II (20,0%), stadium III (16,7%), dan stadium IV (63,3%). Rerata skor nyeri adalah 5,60 ± 1,48 pada NRS. Semua biomarker menunjukkan elevasi melebihi nilai normal: CA125 (72,65 ± 55,39 U/mL), prolaktin (1456,77 ± 1799,79 ng/mL), dan kortisol (341,92 ± 189,02 μg/dL). Terdapat hubungan positif yang signifikan antara kadar CA125 dengan stadium endometriosis (r=0,580, p=0,001). Namun, tidak ditemukan hubungan yang signifikan antara prolaktin (r=-0,069, p=0,718) dan kortisol (r=-0,039, p=0,837) dengan stadium endometriosis. Tidak ada biomarker yang berkorelasi signifikan dengan derajat nyeri: CA125 (r=0,191, p=0,312), prolaktin (r=-0,068, p=0,720), dan kortisol (r=-0,356, p=0,054).
Kesimpulan: Kadar serum CA125 menunjukkan korelasi signifikan dengan stadium endometriosis (r=0,580, p=0,001) dan dapat digunakan sebagai biomarker untuk evaluasi progresivitas penyakit. Meskipun kadar serum prolaktin dan kortisol tidak berkorelasi dengan parameter klinis, elevasi ekstrem keduanya mengindikasikan disregulasi neuroendokrin pada pasien endometriosis. Hasil penelitian ini mendukung penggunaan kadar serum CA125 sebagai biomarker untuk menilai keparahan endometriosis dan menunjukkan pentingnya evaluasi komprehensif yang mempertimbangkan faktor biologis, psikologis, dan sosial dalam penanganan nyeri pada pasien endometriosis.
Kata Kunci: Endometriosis, CA125, prolaktin, kortisol, biomarker, penilaian nyeri

Background: Endometriosis is a chronic gynecological condition affecting 10% of women of reproductive age, characterized by the presence of endometrial tissue outside the uterine cavity. This disease is often diagnosed late due to nonspecific symptoms and the lack of reliable biomarkers. Serum CA125, prolactin, and cortisol levels are biomarkers suspected to play interconnected roles in endometriosis pathogenesis through inflammatory, neuroendocrine, and stress-response pathways. However, research examining the simultaneous association of these three biomarkers with disease stage and pain intensity remains limited, particularly in Indonesian populations. Understanding integrated biomarker profiles is crucial for improving diagnostic accuracy and developing more effective treatment strategies. Objective: To investigate the relationship between serum CA125, prolactin, and cortisol levels with endometriosis staging and pain severity in patients with endometriosis. Methods: This cross-sectional observational study was conducted at RSUD Dr. Zainoel Abidin, Banda Aceh, involving 30 patients with confirmed endometriosis. Serum levels of CA125, prolactin, and cortisol were measured using ELISA/ECLIA. Endometriosis staging was determined according to the American Society for Reproductive Medicine (ASRM) classification, and pain severity was assessed using the Numeric Rating Scale (NRS). Statistical analysis was performed using Spearman correlation tests. Results: Mean patient age was 37.23 ± 7.44 years with stage distribution of II (20.0%), III (16.7%), and IV (63.3%). Mean pain score was 5.60 ± 1.48 on NRS. All biomarkers showed elevation above normal values: CA125 (72.65 ± 55.39 U/mL), prolactin (1456.77 ± 1799.79 ng/mL), and cortisol (341.92 ± 189.02 μg/dL). A significant positive correlation was found between CA125 levels and endometriosis staging (r=0.580, p=0.001). However, no significant relationships were found between prolactin (r=-0.069, p=0.718) and cortisol (r=-0.039, p=0.837) levels with endometriosis staging. No biomarkers showed significant correlations with pain severity: CA125 (r=0.191, p=0.312), prolactin (r=-0.068, p=0.720), and cortisol (r=-0.356, p=0.054). Conclusion: Serum CA125 levels demonstrate significant correlation with endometriosis staging and can be utilized as a biomarker for disease progression evaluation. Although serum prolactin and cortisol levels do not correlate with clinical parameters, their extreme elevation indicates neuroendocrine dysregulation in endometriosis patients. These findings support the use of serum CA125 level as a biomarker for assessing endometriosis severity and highlight the importance of comprehensive evaluation considering biological, psychological, and social factors in pain management for endometriosis patients. Keywords: Endometriosis, CA125, prolactin, cortisol, biomarkers, pain assessment