KARYA TULIS AKHIR

PENGARUH EKSTRAK BUAH MENGKUDU (Morinda citrifolia)

TERHADAP DIAMETER SEL LANGERHANS TIKUS PUTIH (Rattus

novergicus strain wistar) YANG DI INDUKSI STREPTOZOTOCIN

DISUSUN OLEH :

ANINA NI’MATUL JANNAH

201510330311088

UNIVERSITAS MUHAMMADIYAH MALANG

FAKULTAS KEDOKTERAN

2019

xii

DAFTAR ISI

LEMBAR PENGESAHAN .................................................................................. iii

PERNYATAAN ORISINALITAS ....................................................................... iv

LEMBAR PENGUJIAN ....................................................................................... v

KATA PENGANTAR ........................................................................................... vi

UCAPAN TERIMAKASIH.................................................................................. vii

ABSTRAK ............................................................................................................ x

ABSTRACT ........................................................................................................... xi

DAFTAR ISI .......................................................................................................... xii

DAFTAR TABEL ................................................................................................. xvi

DAFTAR GAMBAR ............................................................................................. xvii

DAFTAR SINGKATAN ....................................................................................... xviii

BAB 1 ...................................................................................................................... 1

PENDAHULUAN .................................................................................................. 1

1.1 Latar Belakang .......................................................................................... 1

1.2 Rumusan Masalah ..................................................................................... 4

1.3 Tujuan Penelitian ...................................................................................... 4

1.3.1 Tujuan Umum .................................................................................. 4

1.3.2 Tujuan Khusus ................................................................................. 4

1.4 Manfaat Penelitian .................................................................................... 4

1.4.1 Manfaat Ilmu Pengetahuan .............................................................. 4

1.4.2 Manfaat Klinis ................................................................................. 5

1.4.3 Manfaat bagi Masyarakat ................................................................ 5

BAB 2 ....................................................................................................................... 6

TINJAUAN PUSTAKA ........................................................................................ 6

2.1 Mengkudu .................................................................................................. 6

2.1.1 Taksonomi ....................................................................................... 6

2.1.2 Definisi ............................................................................................. 7

2.1.3 Morfologi ......................................................................................... 7

2.1.4 Kandungan Buah Mengkudu (Morinda citrifolia) ........................... 8

2.2 Hiperglikemia ............................................................................................ 12

2.2.1 Definisi ............................................................................................. 12

2.2.2 Etiologi .............................................................................................. 12

xiii

2.2.3 Mekanisme stress oksidatif pada hiperglikemia ............................... 13

2.3 Diabetes Melitus ........................................................................................ 14

2.3.1 Definisi .............................................................................................. 14

2.3.2 Klasifikasi Diabetes Melitus ............................................................. 14

2.3.3 Pathogenesis Diabetes Melitus ......................................................... 16

2.3.4 Diagnosis Diabetes Melitus .............................................................. 17

2.3.5 Komplikasi Diabetes Melitus ............................................................ 20

2.4 Pankreas dan Hormon Insulin ................................................................. 21

2.4.1 Organ Pankreas ................................................................................. 21

2.4.2 Hormon Insulin ................................................................................. 23

2.4.3 Mekanisme Produksi Insulin ............................................................ 24

2.5 Streptozotocin (STZ) ................................................................................ 25

2.5.1 Definisi ............................................................................................... 25

2.5.2 Mekanisme STZ Dalam Memicu Diabetes ........................................ 25

2.5.3 Perbedaan Dengan Alloksan .............................................................. 26

BAB 3 ..................................................................................................................... 30

KERANGKA KONSEPTUAL DAN HIPOTESIS PENELITIAN .................. 30

3.1 Kerangka Konseptual Penelitian ................................................................ 30

3.2 Hipotesis ..................................................................................................... 32

BAB 4 ..................................................................................................................... 33

METODOLOGI PENELITIAN .......................................................................... 33

4.1 Jenis Penelitian ........................................................................................... 33

4.2 Lokasi Penelitian ........................................................................................ 33

4.3 Sampel dan Replikasi ................................................................................. 33

4.3.1 Sampel .............................................................................................. 33

4.3.2 Replikasi ........................................................................................... 33

4.3.3 Estimasi Besar Sampel ...................................................................... 33

4.3.4 Karakteristik Sampel Penelitian ........................................................ 35

4.4 Variabel Penelitian ..................................................................................... 35

4.4.1 Variabel Bebas .................................................................................. 35

4.4.2 Variabel Tergantung ......................................................................... 35

4.4.3 Variabel Kontrol ............................................................................... 36

4.5 Definisi Operasional .................................................................................... 36

4.6 Alat dan Bahan Penelitian ........................................................................... 37

4.5.1 Alat ..................................................................................................... 37

4.5.2 Bahan ................................................................................................. 38

4.7 Alur Penelitian ............................................................................................. 39

4.8 Prosedur Penelitian ..................................................................................... 40

4.8.1 Adaptasi Hewan Percobaan .............................................................. 40

xiv

4.8.2 Pengelompokan Tikus ....................................................................... 40

4.8.3 Penentuan Dosis ................................................................................ 40

4.8.4 Pembuatan Larutan Streptozotocin ................................................... 41

4.8.5 Pembuatan Larutan Ekstrak Mengkudu ............................................ 41

4.8.6 Percobaan .......................................................................................... 42

4.9 Analisis Data ............................................................................................... 46

4.9.1 Uji Normalitas .................................................................................... 46

4.9.2 Uji Homogenitas ................................................................................ 47

4.9.3 Uji ANOVA dan Post Hoc Bonferroni .............................................. 47

4.9.4 Uji Regresi Linier ............................................................................... 47

BAB 5 .................................................................................................................... 48

HASIL PENELITIAN DAN ANALISIS DATA ................................................ 48

5.1 Hasil Penelitian ........................................................................................... 48

5.2 Analisis Data ............................................................................................... 50

5.2.1 Uji One Way ANOVA ....................................................................... 50

5.2.2 Uji Post Hoc Bonferroni..................................................................... 50

5.2.3 Uji Regresi Linier ............................................................................... 51

BAB 6 ..................................................................................................................... 54

PEMBAHASAN .................................................................................................... 54

BAB 7 ..................................................................................................................... 60

KESIMPULAN DAN SARAN ............................................................................. 60

7.1 Kesimpulan ................................................................................................. 60

7.2 Saran ............................................................................................................ 60

DAFTAR PUSTAKA ............................................................................................ 61

LAMPIRAN ........................................................................................................... 70

I. Analisis Data ............................................................................................... 70

II. Dokumentasi Kegiatan ................................................................................ 72

III. Uji Taksonomi Buah Mengkudu ................................................................. 75

IV. Surat Etik Penelitian .................................................................................... 76

V. Surat Keterangan Lolos Komisi Ilmiah ....................................................... 77

VI. Surat Pembacaan Hasil Patologi Anatomi .................................................. 78

VII. Surat Keterangan Telah Melakukan Penelitian ..................................... 79

VIII. Kartu Konsultasi Tugas Akhir .............................................................. 80

IX. Hasil Deteksi Plagiasi ........................................................................... 82

61

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xvi

DAFTAR TABEL

Halaman

2.1.4 Hasil Skrining Fitokimia Ekstrak Buah Mengkudu ................................... 9

2.1.4 Tingkat antioksidan dalam ekstrak buah sirsak .........................................10

2.1.4 Daftar Penelitian Efek Kandungan Buah Mengkudu Terhadap Diabetes

Mellitus ...................................................................................................... 10

2.3.4 Diagnosis Diabetes Mellitus ...................................................................... 19

2.3.4 Kategori Status Glukosa ............................................................................. 20

2.5.3. Perbandingan sifat kimia Alloxan dan Streptozotocin............................ 27

5.1 Rata – rata diameter sel Langerhans............................................................. 46

5.2 Hasil Analisis One-Way ANOVA................................................................ 48

5.3 Hasil Analisis Post Hoc Bonferroni.............................................................. 49

5.4 Hasil Analisis Regresi Linier........................................................................ 49

xvii

DAFTAR GAMBAR

Halaman

2.1.1 Tumbuhan Mengkudu .................................................................................. 6

2.1.4 Fitokimia Morinda citrifolia .........................................................................9

2.4.1 Bentuk Anatomi Pankreas. ......................................................................... 21

2.4.1 Bentuk Histologi Pankreas Normal ............................................................ 22

2.4.1 Diameter Langerhans Tikus ....................................................................... 23

2.4.2 Struktur Hormon Insulin ............................................................................ 23

2.5.3. Representasi skematis efek toksik dari analog glukosa aloksan dan

Streptozotocin dalam sel beta.....................................................................28

5.1 Gambar Diameter Sel Langerhans................................................................ 47

5.2 Grafik Antara Diameter Sel Langerhans dengan Pemberian Dosis Ekstrak...51

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DAFTAR SINGKATAN

ADA : American Diabetes Association

ADP : Adenosin Diphosphate

AGEs : Advanced Glycation EndProducts

ATP : Adenosin Triphosphate

cAMP : Cyclic Adenosine Monophosphate

DM : Diabetes Mellitus

DMG : Diabetes Melitus Gestasional

DNA : Deoxyribonucleic Acid

eNOS : Endothelial Nitric Oxide Synthase

GAD : Glutamic Acid Decarboxylase

GDP : Gula Darah Puasa

GDS : Gula Darah Sewaktu

GH : Growth Hormone

GHRH : Growth Hormone Releasing Hormone

GIP : Glucose Dependent Insulinotropic Polypeptide

GLP : Glucagon Like Peptide

GLUT : Glucose Transporter

HDL : High-density lipoprotein

HE : Hematoxycilin Eosin

IDDM : Insulin Dependent Diabetes Mellitus

IDF : International Diabetes Federation

IGF : Insulin-Like Growth Factor

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IP : Intraperitoneal

ISPAD : International Society for Pediatrics and Adolescent

Diabetes

KGD : Kadar Gula Darah

MDA : Malondialdehyde

NAD+ : Nicotinamide Adenine Dinucleotide

NFκB : Nuclear Factor Kappa B

NIDDM : Non Insulin Dependent Diabetes Mellitus

NO : Nitric Oxide

RAGE : ReceptorAdvanced Glycation EndProducts

RISKESDAS : Riset Kesehatan Dasar

ROS : Reactive Oxygen Species

SOD : Superoxide Dismutase

STZ : Streptozotocin

TNF-α : Tumor Necrosis Factor - Α

TTGO : Test Toleransi Glukosa Oral

VEGF : Vascular Endothelial Growth Factor

WHO : World Health Organization

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KATA PENGANTAR

Assalamu’alaikum Warahmatullah Wabarakatuh

Puji syukur kehadirat Allah Subhanahu wata’ala Yang Maha Pengasih lagi

Maha Penyayang dan atas karunia-Nya, penulisan tugas akhir ini dapat selesai

dengan baik. Shalawat serta salam selalu tercurahkan kepada Rasulullah

Muhammad shalallahu alaihi wasallam, keluarganya dan para sahabatnya yang

telah berjasa membawa syiar dakwah Islam ke seluruh dunia.

Penelitian tugas akhir ini berjudul “Pengaruh Ekstrak Buah Mengkudu

(Morinda citrifolia) Terhadap Diameter Sel Langerhans Tikus Putih (Rattus

novergicus strain wistar) Yang Di Induksi Streptozotocin”. Tugas akhir ini

diajukan untuk memenuhi persyaratan Pendidikan Sarjana Fakultas Kedokteran

Universitas Muhammadiyah Malang.

Penulis menyadari tugas akhir ini masih jauh dari kata sempurna, oleh

karena itu, penulis sangat mengharapkan saran dan masukan yang membangun.

Semoga karya tulis ini dapat menambah wawasan keilmuan dan bermanfaat bagi

semua pihak.

Wassalamu’alaikum Warahmatullah Wabarakatuh

Malang, 14 Mei 2019

Penulis

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