Rakhmawati, Yustian Devika (2020) Hubungan Antarakadar 25-Hydroxyvitamin Ddengan Rasio Neutrofil-Limfosit Dan Skor Psoriasis Area Severity Index (PASI) Pada Pasien Psoriasis Vulgaris. Magister thesis, Universitas Brawijaya.
Abstract
Psoriasis adalah penyakit kulit inflamasi kronis dengan keterlibatan genetik yang kuat dan khas pada kompleks perubahan pertumbuhan dan diferensiasi epidermal. Terdapat beberapa klasifikasi dari psoriasis yaitu psoriasis tipe plak, psoriasis guttate, psoriasis pustular dan psoriasis eritroderma. Psoriasis tipe plak adalah tipe yang paling sering terjadi dan lebih dikenal sebagai psoriasis vulgaris. Psoriasis melibatkan interaksi kompleks diantara berbagai sel pada sistem imun dan kulit, termasuk sel dendritik dermal, sel T, neutrofil dan keratinosit. Vitamin D 1α,25 (OH)2D3 tidak hanya berperan dalam skeletal saja, namun perannya dalam regulasi sistem imun juga telah banyak diteliti. Peran ini muncul setelah ditemukannya vitamin D receptor (VDR) pada sebagian besar sel imun, termasuk diantaranya adalah sel T CD4+ dan CD8+, sel B, neutrofil, dan antigen presenting cell (APCs) seperti makrofag dan sel dendritik. Selain itu ditemukan juga enzim CYP271B yaitu enzim yang bertanggung jawab pada sintesis 25-hydroxyvitamin D (25(OH)D) pada berbagai macam jaringan. Peran vitamin D pada psoriasis termasuk supresi dari aktivasi sel T, regulasi sekresi sitokin, dan menghambat maturasi, diferensiasi serta migrasi sel dendritik. Sebagai suatu penyakit inflamasi, psoriasis sering menunjukkan peningkatan pada sel darah putih khususnya neutrofil. Neutrofil merupakan komponen penting pada tahap awal psoriasis karena terlibat dalam rekrutmen dan aktivasi sel T serta proliferasi dan diferensiasi keratinosit. Neutrofil memproduksi beberapa sitokin inflamasi seperti IL- 1β dan TNF-α yang memprovokasi psoriasis. Limfosit T dikatakan memainkan peran penting pada produksi dan aktivasi sitokin-sitokin proinflamasi. Pengukuran rasio neutrofil – limfosit merupakan salah satu parameter sederhana dalam penentuan status inflamasi seseorang yang bersifat sistemik. Parameter ini mudah dihitung dari hasil hitung darah lengkap yang tersedia yaitu secara langsung membandingkan hitung jumlah neutrofil dengan limfosit. Skor PASI (Psoriasis Area and Severity Index) merupakan teknik pengukuran yang merupakan kombinasi dari tingkat keparahan dan luasnya keterlibatan kulit untuk psoriasis vulgaris. Skor PASI dapat digunakan untuk evaluasipsoriasis dengan berbagai modalitas terapi dan juga dikatakan lebih superior dibandingkan DLQI (Dermatology Life Quality Index). Penelitianinidilakukanuntukmelihathubunganantarakadar 25 hydroxyvitamin D denganrasioneutrofil-limfosit dan skor PASI pada pasien psoriasis vulgaris. Selainituuntukmelihatapakahrasioneutrofil-limfositdapatdijadikansebagai parameter tambahan yang bersifatobjektifuntukpenentuan status inflamasi pada pasien psoriasis vulgaris. Desainpenelitianmenggunakananalitikobservasionalpotonglintangdenganmetodeconsecu tive sampling. Subjekpenelitianadalahpasien yang terdiagnosa psoriasis vulgaris baiksecaraklinis dan ditunjangdenganpemeriksaanhistopatologidi Instalasi Rawat Jalan Dermatologi dan Venereologi RSUD Dr.Saiful Anwar Malang (RSSA) dan memenuhikriteriainklusi dan eksklusisertatanpamempertimbangkanriwayatpengobatan. Jumlah total subjekadalah 23 orang namunhanya 20 subjek yang memenuhikriteriainklusi dan eksklusipenelitian. Subjekpenelitiandilakukanpemeriksaandarah di pagiharidengansebelumnyaberpuasadahuluselama 10 jam. Pemeriksaandarahmeliputidarahlengkap, hitungjenisseldarahputih, guladarahpuasa, fungsihepar, fungsiginjal, dan kadar 25 hydroxyvitamin D. Kemudianpasien juga dilakukanpenghitunganskor PASI pada hari yang sama. x Hasil uji bedaparametrikdenganindependent T Testmenunjukkanperbedaan yang bermakna (p<0,05) antara onset dan reratakadar 25 hydroxyvitamin D dimanamakin lama onset penyakit, makareratakadar 25 hydroxyvitamin D semakinrendah. Hasil uji beda lain menggunakan uji bedaMann Whitneyantarajeniskelamin dan skor PASI juga menunjukkanperbedaan yang bermakna (p<0,05). Dimana pada kelompoklakilakididapatkanskor PASI yang lebihtinggisecarabermaknadibandingkankelompokperempuan. Hasil uji korelasiRank Spearmanmenunjukkanhubunganantarakadar 25 hydroxyvitamin D dan rasioneutrofillimfosit( N/L) dengankecenderungan linier negatifdimanamakinrendahkadar 25 hydroxyvitamin D makamakintinggirasio N/L namuntidakbernilaisignifikan (p>0,05). Hasil uji korelasiRank Spearmanmenunjukkanhubunganantarakadar 25 hydroxyvitamin D dan skor PASI dengankecenderungan linier negatifdimanamakinrendahkadar 25 hydroxivitamin D makamakintinggiskor PASI namuntidakbernilaisignifikan (p>0,05). Hasil uji korelasiRank Spearmanmenunjukkanhubunganantararasio (N/L) dan skor PASI dengankecenderungan linier positifdimanamakintinggirasio N/L makaskor PASI juga semakintinggi dan bernilaisignifikan (p<0,05). Kesimpulan daripenelitianiniadalahhubunganantarakadar 25 hydroxyvitamin D denganrasio N/L dan skor PASI tidakbernilaisignifikanmeskipundidapatkanadanyakecenderungan linier negatif. Beberapahal yang dapatmempengaruhihaliniadalahdimungkinkandarisubjekpenelitian yang sudahmendapatkanterapibaiktopikal, sistemikmaupunkombinasi yang dapatberpengaruhterhadaprasio N/L dan skor PASI nya. Hal lain yang dapatdisimpulkanadalahrasio N/L dapatdipertimbangkansebagai parameter tambahan yang bersifatobjektifuntukevaluasipasien psoriasis vulgaris karenadidapatkanadanyahubunganlinier positifyang signifikanantararasio N/L dan skor PASI. Pemberiansuplemen vitamin D mungkin juga dapatdipertimbangkan pada pasien psoriasis vulgaris mengingat pada onset penyakit yang makin lama, makakadar 25 hydroxyvitamin D akansemakinrendah.
English Abstract
Psoriasis is a chronic inflammatory skin disease with strong genetic involvement and typically in growth change and epidermal differentiation complex. There was some classification in psoriasis namely, plaque type psoriasis, guttate psoriasis, pustular psoriasis, and erythroderma psoriasis. Plaque type psoriasis is the most common type and commonly known as psoriasis vulgaris. Psoriasis involve complex interaction between various cell in immune system and skin, including dermal dendritic cell, T cell, neutrophil, and keratinocyte. Vitamin D 1α,25 (OH)2D3 not only have a role in skeletal system, but plays a role in immune system regulation have been researched. This role after the discovery of vitamin D receptor (VDR) in most of the immune cells, including CD4+ T cell and CD8+ B cell, neutrophil, and antigen presenting cell (APCs) like macrophage and dendritic cells. Furthermore, they found CYP271B enzyme that responsible in 25-hydroxyvitamin D (25(OH)D) synthesis in various tissue. The role of vitamin D in psoriasis including suppression the T cell activation, cytokine secretion regulation, and inhibit maturation, differentiation, and migration of dendritic cells. As an inflammatory disease, psoriasis often shows an increase in leukocyte particularly neutrophils. Neutrophil is an integral component in the early phase of psoriasis because its involved in recruitment and activation of T cells and proliferation and differentiation of keratinocyte. Neutrophils produce various inflammatory cytokine like IL-1β dan TNF-α that induce psoriasis. T lymphocyte have an important role in the production and activation of the proinflammatory cytokines. Neutrophil-lymphocyte ratio measurement is one of the simple parameter in the determination of inflammatory status systemically. This parameter is easy to calculate from available complete blood count results that is directly compare neutrophils and lymphocyte diff count. PASI (Psoriasis Area and Severity Index) score is a measurement technique which is combination from severity level and skin area involved for psoriasis vulgaris. PASI score can be used to evaluate psoriasis with various therapy modalities and said to be superior than DLQI (Dermatology Life Quality Index). This research was conducted to analyze association between 25 hydroxyvitamin D level with neutrophil-lymphocyte ratio and PASI score in psoriasis vulgaris patient. Furthermore, to analyze whether neutrophil-lymphocyte ratio can be used as additional parameter for determination of inflammatory status from the psoriasis vulgaris patient objectively. Research design using analytic observational cross sectional with consecutive sampling method. Research subject is the patients in outpatient clinic in Dr. Saiful Anwar General Hospital Malang (RSSA) and meet the inclusion and exclusion criteria and without considering treatment history. The total subjects were 23 people but only 20 people meet the inclusion and exclusion criteria of the research. Research subjects undergone blood tests in the morning with fasting for 10 hours before the blood test. The blood tests including complete blood count, leukocyte count, fasting blood glucose, liver function test, kidney function test, and 25 hydroxyvitamin D level. Subsequently, the patient also undergone PASI score measurement in the same day. Comparative study results with independent T test showed a significant difference (p<0,05) between onset and mean of the 25 hydroxyvitamin D level where the longer xii onset of the disease, then the mean of the 25 hydroxyvitamin D level became lower. The other comparative study results with Mann Whitney comparative study between gender and PASI score also showed a significant difference (p<0,05). Whereas in male groups has higher PASI score significantly compared with female groups. Rank Spearman correlation study results showed a correlation between 25 hydroxyvitamin D level and neutrophil-lymphocyte ratio (N/L) with negative linear tendency whereas the lower the 25 hydroxyvitamin D level then the higher N/L ratio, but not significant (p>0,05). Rank Spearman correlation study results showed a correlation between 25 hydroxyvitamin D level and PASI score with negative linear tendency whereas the lower the 25 hydroxyvitamin D level then the higher PASI score, but not significant (p>0,05). Rank Spearman correlation study results showed a correlation between neutrophil-lymphocyte ratio (N/L) and PASI score with positive linear tendency whereas the higher the N/L ratio then the higher PASI score and have significant value (p<0,05). Conclusion from this research is relationship between 25 hydroxyvitamin D level with N/L ratio and PASI score was not significant although there was a negative linear tendency. Several factor that can affect this association may be from the research subjects that received either topical, systemic, or combination therapy that can affect the N/L ratio and PASI score. Other factor that can be concluded is N/L ratio can be considered as additional parameter to evaluate psoriasis vulgaris patient objectively because there was a positive linear significant association between N/L ratio and PASI score. Vitamin D supplementation also can be considered in patient with psoriasis vulgaris, because the longer the onset of the disease, then the 25 hydroxyvitamin D level will be lower.
Other obstract
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| Item Type: | Thesis (Magister) |
|---|---|
| Identification Number: | TES/616.526/RAK/h/2020/042002027 |
| Uncontrolled Keywords: | PSORIASIS, NATROPHILS, LYMPHOCYTES |
| Subjects: | 600 Technology (Applied sciences) > 616 Diseases > 616.5 Diseases of integument / Skin--Diseases > 616.52 Viral and bacterial skin diseases; psoriasis > 616.526 Psoriasis |
| Divisions: | Profesi Kedokteran > Spesialis Dermatologi dan Venereologi, Fakultas Kedokteran |
| Depositing User: | Endang Susworini |
| Date Deposited: | 05 Mar 2020 06:39 |
| Last Modified: | 13 Jan 2023 03:44 |
| URI: | http://repository.ub.ac.id/id/eprint/179955 |
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