Sari, RatnaMustka (2012) Hubungan Peningkatan Jumlah Makrofag dan Kadar Tumor Nekrosis Faktor Alfa (TNFα) Cairan Ketuban dengan Sepsis Neonatorum Awitan Dini pada Bayi dengan Risiko Infeksi. Magister thesis, Universitas Brawijaya.
Abstract
Sepsis neonatorum sampai saat ini masih merupakan masalah di bidang neonatologi dan merupakan penyebab utama kematian dalam periode neonatus. Diagnosa sepsis neonatorum masih sulit ditegakan karena klinis sepsis neonatorum bervariasi, khususnya pada sepsis awitan dini. Penelitian ini bertujuan untuk membuktikan adanya hubungan peningkatan jumlah makrofag dan kadar Tumor Nekrosis Faktor Alfa (TNF- a ) cairan ketuban dengan terjadinya sepsis neonatorum awitan dini pada bayi dengan risiko infeksi. Penelitian menggunakan rancangan studi kohort di bagian Perinatologi Rumah Sakit Saiful Anwar serta Laboratorium Biomedik FK Universitas Brawijaya Malang pada juli 2010 - September 2010. Sampel diambil secara consecutivesampling . Sampel yang digunakan adalah cairan ketuban bayi aterm dengan dan tanpa risiko infeksi dan bayi prematur, yang dilahirkan di RSU Dr. Saiful Anwar Malang. Analisa statistik yang digunakan adalah uji Oneway Anova, uji T tidak berpasangan, dan uji korelasi Spearman serta odds ratio, sensitivitas, spesifisitas, nilai prediksi positif dan negatif. Didapatkan 81 sampel yaitu 30 bayi prematur, 25 bayi aterm dengan risiko infeksi dan 26 bayi aterm tanpa risiko infeksi. Perbandingan rata-rata jumlah makrofag antara bayi prematur dengan risiko infeksi, aterm risiko infeksi dan bayi aterm tanpa risiko infeksi masing-masing adalah 26.20, 11.96, dan 4.69 (p=0.000). Perbandingan jumlah makrofag antara bayi yang sepsis (Mean+SD = 18.50+7.905) dan non sepsis (Mean+SD = 13.00+9.800) (p=0.012). Makrofag berhubungan dengan sepsis neonatorum awitan dini (r=0.296, p=0.007). Pada penelitian ini nilai AUC yang diperoleh dari metode ROC sebesar 68.0% untuk makrofag. Ditetapkan nilai ambang 13.5 untuk makrofag. Dengan sensitifitas sebesar 64.15% dan spesifisitas sebesar 60.71%. Sedangkan rasio kemungkinan (LR) sebesar 1.63. Besarnya nilai duga positif (PPV) 75.56% dan nilai duga negatif (NPV) 47.22%. Perbandingan kadar TNF- a antara bayi prematur risiko infeksi, aterm risiko infeksi dan aterm tanpa risiko infeksi masing-masing adalah 54.31, 37.01, dan 21.96 (p=0.000). Kadar TNF- a pada bayi yang sepsis (Mean + SD = 43.94320 + 8.796338) dan non sepsis (Mean + SD = 35.76135 + 16.395372) (p=0.005). Kadar TNF- a berhubungan dengan sepsis neonatorum awitan dini (r=0.296, p=0.007). Nilai AUC kadar TNF- a yang diperoleh dari metode ROC pada penelitian ini adalah 81.5%. Didapatkan nilai ambang 38.95. Dengan sensitifitas dan spesifisitas 64.15% dan 64.29%. Sedangkan rasio kemungkinan (LR) sebesar 1.796. Nilai duga positif (PPV) dan nilai duga negatif (NPV) masing-masing 77.27% dan 48.65%. Dapat disimpulkan bahwa terdapat hubungan antara peningkatan jumlah makrofag dan kadar tumor nekrosis faktor alfa (TNF- a ) cairan ketuban dengan terjadinya sepsis neonatorum awitan dini pada bayi dengan risiko infeksi.
English Abstract
Neonatal sepsis is still one of most important causes of morbidity and mortality in this age group. Early detection of neonatal sepsis is difficult for various reasons, firstly, early warning signs and symptoms are often protean and non-specific. In this study, we aimed to investigate value of macrophage and TNF- a ) in establishing early diagnosis of early-onset neonatal sepsis. This prospective cohort study was conducted in Departments of Perinatology Saiful Anwar General Hospital and Laboratorium of Biochemistry Brawijaya Medical University, Malang between July 2010 and September 2010. consecutive samples were collected from amniotic fluid aterm and preterm neonates with and without risk of infection. Statistical analysis were performed using Oneway Anova, unpaired T test and Spearman correlation test. sensitivity, specificity, PPV, NPV and AUC of tests for optimal cut-off values selected were identified using ROC analysis. In which total of 81 neonates, 30 were premature neonates, 25 were aterm with risk of infection and 26 were aterm without risk of infection. Mean amniotic fluid of macrophage and TNF- a ) between 3 groups were 26.20, 11.96, 4.69 (p=0.000) and 54.31, 37.01, 21.96 (p=0.000), respectively. Comparation of macrophage and TNF-α between sepsis neonates versus non sepsis neonates were (Mean+SD = 18.50+7.905) vs (Mean+SD = 13.00+9.800) (p=0.012) and (Mean + SD = 43.94320 + 8.796338) vs (Mean + SD = 35.76135 + 16.395372) (p=0.005), respectively. Macrophage and TNF- a ) had correlation with early onset sepsis (r=0.296, p=0.007) of each. area under receiver operating characteristic (ROC) curve (AUC) for macrophage and TNF- a ) were 68.0% and 81.5%, respectively. For cut-off value of macrophage ≥13.5%, test was found to have a sensitivity of 64.15%, specificity of 60.71%, positive predictive value of 75.56% and negative predictive value of 47.22% for early onset neonatal sepsis. For cut-off value of TNF- a ) ≥38.95 pg/ml, sensitivity, specificity, positive predictive value, and negative predictive value were found to be 64.15%, 64.29%, 77.27%, and 48.65%, respectively. In conclusion, in this prospective study, macrophage and TNF- a ) had significant correlation with early onset neonatal sepsis. It was also determined that se markers are valuable in determining diagnosis of early-onset neonatal sepsis.
| Item Type: | Thesis (Magister) |
|---|---|
| Identification Number: | TES/616.079 95/SAR/h/041201993 |
| Subjects: | 600 Technology (Applied sciences) > 616 Diseases |
| Depositing User: | Endro Setyobudi |
| Date Deposited: | 08 Aug 2012 11:49 |
| Last Modified: | 08 Aug 2012 11:49 |
| URI: | http://repository.ub.ac.id/id/eprint/158266 |
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