Chi-Square Bivariate Analysis Insulin Resistance HOMA-

56 To assess the role of insulin resistance HOMA-IR, IGF-1 as a risk factor for prostate hyperplasia performed logistic regression analysis to find the value OR. Cut-off point based on the study and the literature used to divide the numeric variables into dichotomous variables. Normal IGF-1 levels to the normal population, and for over 40 years was 150 ngmL Bravermen et al., 2013. Normal IGF-1 the lowest value of 150 ngmL and IGF-1 high 150 ngmL. To cut-off point value of HOMA-IR, insulin resistance in healthy populations without diabetes was 2.7 Komshian et al., 2000. So the value of HOMA-IR in this study were divided into insulin resistance  2,7 and without insulin resistance low - value 2 . On the other hand for a marker of inflammation, the value of CRP and IL-6 is considered the upper limit of normal in the population at risk for developing insulin resistance are respectively 1.32 mg L and 12.56 pg mL Deepa et al., 2006. But in this study IL-6 values of all samples either in cases or controls are within the normal range 0.15 to 5.46 pg mL, so that the cut-off point used is from the median of the results of this study are 0.875 pg mL. The result of bivariate analysis with chi-square test are presented in Table 5.2 while the results of logistic regression that describes the role of HOMA-IR and IGF-1 are high risk factors for prostate hyperplasia in Ob-Ab is presented in Table 5.3. Table 5.2 Bivariate Analysis Chi square HOMA-IR, IGF-1, hsCRP, IL-6 Prostate Hyperplasia Case Abdomina l obesity patient with prostate hyperplasia n=40 Control Abdominal obesity patient without prostate hyperplasia n=40 OR P CI HOMA- Insulin 14 77,8 4 22,2 1,94 0,005 1,30- 57 IR Resistance 2,7 2,89 Non- insulin Resistance 2,7 24 40 36 60 IGF-1 ngmL 150 23 74,2 8 25,8 2,139 0,001 1,38- 3,30 150 17 34,7 32 65,3 hsCRP mgL 1,32 17 47,2 19 52,8 0,903 0,653 0,57- 1,4 1,32 23 52,3 2147,7 IL-6 pgmL 0,875 21 52,5 19 47,5 1,105 0,655 0,71- 1,71 0,875 19 47,5 21 52,5 From the test results obtained bivariate chi-square significant association between insulin resistance HOMA-IR and IGF-1 in prostate hyperplasia. When viewed one by one in bivariate, HOMA-IR and IGF-1 respectively increase the risk of prostate hyperplasia. HOMA-IR increased the risk of prostate hyperplasia with OR = 1.94 CI 1.30 to 2.89 and statistically significant with p = 0.005. IGF-1 increases the risk of prostate hyperplasia with OR = 2.14 CI 1.38 to 3.3 , p = 0.001. From the results of this analysis also found that the inflammatory variables such as IL-6 and hsCRP was not significantly associated with prostate hyperplasia. hsCRP with OR = 0.9 ; p = 0.653, while IL-6 value OR = 1.1105 , with p = 0.655. However, there is a tendency of IL-6 enhances prostate hyperplasia, although not statistically significant. 5.3 Multivariate Logistic Regression Analysis HOMA-IR and IGF-1 toward Prostate Hyperplasia in Ob-Ab. In multivariate analysis, logistic regression with backward method, when the role of HOMA-IR, IGF-1 calculated simultaneously, HOMA-IR Insulin Resistance and IGF-1 still significantly raise risk for prostate hyperplasia. 58 Tabel 5.3 Multivariate Analysis with Logistic Regression about correlation between HOMA-IR, IGF-1 with Prostate Hyperplasia Abdominal obesity patient with prostate hyperplasia Regression coefficient B OR ExpB p CI 95 HOMA-IR Insulin Resistance 1,43 4,18 0,03 1,15- 15,00 IGF-1 ngmL 1,59 4,93 0,002 1,76- 13,78 constant -0,89 Insulin Resistance HOMA-IR and IGF have significant influence towards the incidence of prostate hyperplasia in patient with abdominal obesity table 5.3 with OR and p-value OR=4,18; p=0,03; IK 1,15-15,00 and OR=4,93; IK 1,76-13,78; p=0,002. If we analyze more thoroughly the role of insulin resistance HOMA- IR in predicting and elevating the risk of prostate hyperplasia in Ab-Ob we gained y=-0,89+1,43HOMA-IR+1,59IGF-1. The probability of prostate hyperplasia was p=11+e -y ,where are natural number with value 2,7. HOMA-IR value is 1 if the concentration 2,7. IGF-1 worth is 1 if the concentration is 150ngmL. All variable value was 0 in y equation if the value less than cut off point. If the result of IGF-1150ngmL and HOMA- IR2,7 than the probability of prostate hyperplasia was 89. 59

5.4 Path Analysis Relationship of HOMA-IR, IGF-1, and

Prostate Hyperplasia To see the causal effect relationship of HOMA-IR, IGF-1 to prostate hyperplasia we use path analysis. In this analysis external variable was HOMA-IR, IGF-1, IL-6 and hsCRP. And the internal variable was prostate hyperplasia. Based on the literature review and analysis results like the above, then we made models and output analysis and present it in Figure 5.1. Figure 5.1 Structural model pathway analysis result 60 In structural phase model we obtained direct effect to BPHLUTS: HOMA-IR toward BPHLUTS was 0,31 31, IGF- 1 toward BPHLUTS was 0,03 3, IL-6 toward BPHLUTS was 0,10 10 and hsCRP toward BPHLUTS was 0,05 5. On the other hand direct effect of HOMA-IR toward other variable: effect HOMA-IR toward IGF-1, IL-6, hsCRP consecutively was 3,79 379, 0,005 0,5 and 0,015 1,5. From this structural model it appears that HOMA-IR has the most powerfull effect toward IGF-1, while the most powerful variable that influence BPHLUTS was HOMA-IR. Relationships between constructs was presented in Table 5.4 once analyzed with AMOS. The magnitude of each independent variable toward dependent variable represented by critical ratio CR. CR Value is obtained from estimate valued divided by standard error SE. The higher the value of CR hence the effect is more significant.