Mutaqin, Fadilah (2020) Pengaruh Pemberian Nigella Sativa Terhadap Kadar Ige Dan Il-6 Plasma Serta Skor Asthma Control Test Pada Anak Dengan Asma Ringan Dan Sedang. Magister thesis, Universitas Brawijaya.
Abstract
Asma adalah penyakit saluran respiratori dengan dasar inflamasi kronis yang mengakibatkan obstruksi dan hiperreaktivitas saluran respiratori dengan derajat bervariasi. Manifestasi klinis asma dapat berupa batuk, wheezing, sesak napas, dada tertekan yang timbul secara kronis dan atau berulang, reversible, cenderung memberat pada malam atau dini hari, dan biasanya timbul jika ada pencetus. Episode akut penyempitan bronkus disebabkan oleh edema, infiltrasi oleh sel inflamasi, hipersekresi mukus, kontraksi otot polos dan deskuamasi epitel. IgE mempunyai peran sentral dalam patofisiologi asma. Interaksi alergen pada limfosit B dengan limfosit T spesifik alergen akan menyebabkan limfosit B memproduksi IgE spesifik alergen. Pajanan ulang oleh alergen yang sama akan meningkatkan produksi IgE spesifik yang akan berikatan dengan sel-sel yang mempunyai reseptor IgE seperti sel mast, basofil, eosinofil, makrofag dan platelet sehingga dapat menginduksi sinyal sel dan merangsang degranulasi sel mastosit, sehingga mediator inflamasi akan dilepaskan. Interleukin-6 (IL-6) merupakan sitokin pro-inflamasi yang diproduksi banyak sel (makrofag teraktivasi, sel endotel). IL-6 telah terbukti mempromosikan diferensiasi Th17 dan menekan diferensiasi Th1. IL-6 juga dapat memodulasi intensitas respon imun dengan menghambat perkembangan T regulator (Treg). Dari paparan diatas, IL-6 diduga dapat menjadi faktor kunci dalam menentukan keseimbangan sel T CD4 + menjadi sel Treg atau sel inflamasi Th17. Nigella sativa (jinten hitam) merupakan salah satu tanaman yang bermanfaat untuk pengobatan asma. Salah satu kandungannya yaitu asam linoleat, memiliki efek anti alergi dengan cara menurunkan sitokin pro-inflamasi, produksi histamin dan pembentukan IgE. Thymoquinone yang terkandung dalam jinten hitam memiliki efek antiinflamasi, dengan menurunkan sitokin Th2 yaitu IL-4, IL-5 dan IL-13, eosinofilia di paru, lipooksigenase serta siklooksigenase, serum IgE, menghambat influks Ca2+ sehingga dapat mencegah degranulasi sel mast. Secara klinis, keberhasilan kontrol gejala asma dapat dinilai dengan sistem skoring. Salah satu sistem skoring asma anak yang telah tervalidasi adalah ACT. ACT mempunyai akurasi yang lebih baik untuk penilaian kontrol asma. Penelitian ini akan membandingkan pengaruh pemberian Nigella sativa terhadap kadar IL-6 dan IgE plasma serta perbaikan skor Asthma Control Test pada anak dengan asma ringan dan sedang (mendapat terapi standar asma tanpa mendapat imunoterapi). Penelitian ini akan membahas hubungan antara kadar IL-6 dan IgE plasma terhadap skor Asthma Control Test pada anak dengan asma ringan dan sedang. Penelitian ini merupakan penelitian eksperimental, Clinical Trial, Pre-Post Control Study. Subjek dibagi menjadi 4 kelompok, dengan perlakuan pada kelompok A (asma ringan, mendapat terapi standart short acting beta agonis, kortikosteroid inhalasi dosis rendah dan Nigella Sativa) dan kelompok B (asma sedang, mendapat terapi standart long acting beta agonis, kortikosteroid inhalasi dosis rendah dan Nigella Sativa), kelompok kontrol pada kelompok C (asma ringan, hanya mendapat terapi standart short acting beta agonis, kortikosteroid inhalasi vi dosis rendah) dan kelompok D (asma sedang, hanya mendapat terapi standart long acting beta agonis, kortikosteroid inhalasi dosis rendah) tidak diberikan Nigella sativa. Sebelumnya pasien silakukan pemeriksaan kadar IgE, IL-6 dan skor ACT. Selanjutnya pasien diberikan perlakuan selama 8 minggu, lalu dinilai kembali kadar IgE, IL-6 dan skor ACT setelah perlakuan. Data dianalisis secara statistik menggunakan Statiistical Product and Service Solution versi 18 (SPSS 18). Pada penelitian ini kelompok berjenis kelamin laki-laki dan perempuan dalam jumlah yang hampir sama. Sedangkan karakteristik responden berdasarkan umur diperoleh informasi bahwa usia rerata 7 tahun pada asma ringan dan 9 tahun pada asma sedang. Didapatkan kadar IgE pada kelompok asma sedang lebih tinggi dibandingkan dengan asma ringan. Didapatkan penurunan rerata kadar IgE lebih tinggi pada perlakuan dibandingkan dengan control meskipun nilainya tidak berbeda bermakna. Didapatkan kadar IL-6 pada kelompok asma sedang lebih tinggi dibandingkan dengan asma ringan. Didapatkan penurunan rerata kadar IL-6 lebih tinggi pada perlakuan dibandingkan dengan kontrol meskipun nilainya tidak berbeda bermakna.Terdapat perubahan bermakna skor ACT antara sebelum dan setelah perlakuan pada semua kelompok perlakuan. Didapatkan korelasi negatif kuat antara kadar IgE plasma dengan skor ACT pada asma ringan. Hal ini menunjukkan bahwa semakin tinggi kadar IgE plasma maka akan semakin rendah skor ACT. Sedangkan pada IL-6 tidak didapatkan korelasi dengan skor ACT yang menunjukkan bahwa tidak ada hubungan antara IL-6 dengan skor ACT. Dari penelitian ini dapat disimpulkan bahwa pemberian N. sativa dapat menurunkan kadar IL-6 dan IgE plasma serta perbaikan skor Asthma Control Test pada anak dengan asma ringan dan sedang. Tidak terdapat hubungan antara penurunan IgE dan IL-6 plasma dengan peningkatan skor Asthma Control Test setelah pemberian N. sativa pada anak asma ringan dan sedang
English Abstract
Asthma is a chronic inflammatory of respiratory tract that results in obstruction and hyperreactivity of the respiratory tract with varying degrees. Clinical manifestations of asthma is coughing, wheezing, shortness of breath, chest depression that arises chronically and / or repeatedly, reversibly, worsening at night or early morning, and usually arise if there is a trigger. Acute episodes of bronchial narrowing are caused by edema, infiltration by inflammatory cells, mucus hypersecretion, smooth muscle contraction and epithelial desquamation. IgE has a central role in the pathophysiology of asthma. The interaction of allergens on B lymphocytes with allergen-specific T lymphocytes will cause B lymphocytes to produce allergen-specific IgE. Repeated exposure by the same allergen will increase the production of specific IgE that will bind to cells that have IgE receptors such as mast cells, basophils, eosinophils, macrophages and platelets so that it can induce cell signals and stimulate mastocyte cell degranulation, so that inflammatory mediators will be released. Interleukin-6 (IL-6) is a pro-inflammatory cytokine that is produced in many cells (activated macrophages, endothelial cells). IL-6 has been shown to promote Th17 differentiation and suppress Th1 differentiation. IL-6 can also modulate the intensity of the immune response by inhibiting the development of T regulators (Tregs). From the above explanation, IL-6 is thought to be a key factor in determining the balance of CD4 + T cells into Treg cells or Th17 inflammatory cells. Nigella sativa (black cumin) is one of the beneficial plants for the treatment of asthma. One of the ingredients is linoleic acid, has anti-allergic effect by decreasing pro-inflammatory cytokines, histamine production and IgE formation. Thymoquinone contained in black cumin has anti-inflammatory effects, by decreasing the Th2 cytokines IL-4, IL-5 and IL-13, eosinophilia in the lung, lipooksigenase and cyclooxygenase, serum IgE, inhibiting Ca2 + influx that can prevent mast cell degranulation. Clinically, the success of asthma symptom control can be assessed by a scoring system. One of the validated children's asthma scoring systems is ACT. ACT has better accuracy for assessing asthma control. This study compared the effects of Nigella sativa on plasma IgE, IL-6 levels and ACT score in children with mild and moderate asthma with standard therapy (only standard asthma therapy without immunotherapy). This study will discuss the combined ability of standard therapy added with Nigella sativa in asthma in influencing levels of IgE and IL-6 in the blood and ACT score of the patient. This study is an experimental study, Clinical Trial, Pre-Post Control Study. Subjects were divided into 4 groups, with treatment in group A (mild asthma, standard short acting beta agonist therapy, low dose inhaled corticosteroids and Nigella sativa) and group B (moderate asthma, received standard long acting beta agonist therapy, low-dose inhaled corticosteroids and Nigella Sativa), the control group in the C group (mild asthma, only standard short acting beta agonist therapy, low dose inhaled corticosteroids) and group D (moderate asthma, received only standard long acting beta agonist therapy, low dose inhaled corticosteroids) given viii Nigella sativa. Previously patients performed plasma IgE, IL-6 examination and ACT score. Furthermore, patients were given treatment for 8 weeks, then reassessed plasma IgE, IL-6 and ACT score after treatment. Data were analyzed statistically using SPSS version 16. In this study groups of men and women in almost equal numbers. While the characteristics of respondents based on age obtained information that the average age of 7-9 years. Obtained IgE levels in the moderate asthma group compared with mild asthma. The mean decrease in total IgE levels in all groups was obtained even though the value was not significantly different. Obtained significant differences in IL-6 levels in mild and moderate asthma between groups both before and after treatment. After comparing between before and after treatment in each group, no significant difference was found. There was a significant change in ACT scores between before and after treatment in all treatment groups. A strong negative correlation was obtained between plasma IgE levels and ACT scores in mild asthma. This shows that the higher the plasma IgE level, the lower the ACT score. Whereas in IL-6 there was no correlation with ACT scores which showed that there was no relationship between IL-6 and ACT scores. From this study it can be concluded that administration of N. sativa can reduce plasma IL-6 and IgE levels and improve Asthma Control Test scores in children with mild and moderate asthma. There was no relationship between decreased IgE and IL-6 plasma with an increase in Asthma Control Test scores after administration of N. sativa in mild and moderate asthma children.
Other obstract
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| Item Type: | Thesis (Magister) |
|---|---|
| Identification Number: | TES/616.238/MUT/p/2020/042001966 |
| Uncontrolled Keywords: | ASTHMA, ASTHMA--TREATMENT |
| Subjects: | 600 Technology (Applied sciences) > 616 Diseases > 616.2 Diseases of respiratory system > 616.23 Diseases of trachea and bronchi > 616.238 Asthma |
| Divisions: | S2/S3 > Magister Ilmu Biomedis, Fakultas Kedokteran |
| Depositing User: | Endang Susworini |
| Date Deposited: | 04 Mar 2020 07:22 |
| Last Modified: | 13 Jan 2023 04:23 |
| URI: | http://repository.ub.ac.id/id/eprint/179889 |
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