Wilanti, Nesa Wike (2019) Hubungan Indeks Bakteri Dengan Kadar Serum Zink Pasien Morbus Hansen Tipe Multibasiler. Magister thesis, Universitas Brawijaya.
Abstract
Morbus Hansen (MH), penyakit infeksi bakteri kronis oleh Mycobacterium leprae yang menyerang terutama pada kulit dan saraf tepi, dengan spektrum klinis berdasarkan respon imunitas seluler host. Menurut WHO, Indonesia adalah negara dengan jumlah kasus MH terbesar nomor tiga di dunia pada akhir tahun 2016, dan Jawa Timur termasuk wilayah endemis. Respon imun seluler host yang rendah berkaitan dengan MH Tipe Multibasiler (MB) dan merupakan sumber utama infeksi karena jumlah bakteri tinggi, dan yang dinilai melalui pengukuran Indeks Bakteri (IB) dalam sediaan apusan sayatan kulit dengan nilai 0 sampai 6+ menurut Ridley dan Joplin. Pemeriksaan IB juga merupakan suatu bagian yang mendasar dalam menegakkan diagnosis Morbus Hansen Zink merupakan trace element penting yang menjadi komponen struktural atau katalitik utama dari ratusan enzim untuk kelangsungan hidup dari organisme, baik pada host maupun patogen, hingga terjadi persaingan antara host dan patogen untuk mengontrol ketersediaannya. Host dengan Nramp1 (Natural-Resistance-Associated Macrophage Protein 1) menahan serapan zink oleh patogen, sementara patogen menggunakan homolog Nramp (Mramp) dan P-type ATPases untuk serapan maupun untuk menetralisir efek racun dari zink di makrofag. Kadar serum zink yang lebih rendah pada MH tipe MB karena mekanisme redistribusi zink dari darah ke berbagai jaringan terkait pelepasan leucocyte endogenous mediator (LEM/IL1) sebab proses fagositosis terus menerus M. leprae oleh makrofag jaringan serta pemanfaatan zink oleh milyaran M. leprae dari sel host untuk pertahanan hidup patogen. Selain itu, defisiensi zink menyebabkan terganggunya sistem imunitas seluler yang penting untuk eliminasi bakteri. Penelitian ini bertujuan untuk untuk mengetahui hubungan antara indeks bakteri dengan kadar serum zink pada pasien MH tipe MB. Penelitian dilakukan di Instalasi Rawat Jalan (IRJA) RSUD Dr. Saiful Anwar Malang dan RS Kusta Kediri dengan menggunakan desain penelitian potong lintang. Subyek penelitian dipilih secara consecutive sampling, dan memenuhi kriteria inklusi dan eksklusi serta telah disetujui komisi etik penelitian RSUD dr. Saiful Anwar Malang dan RS Kusta Kediri sesuai Desklarasi Helsinski. Total terdapat 31 subyek mulai periode bulan Februari hingga Maret 2019 yang telah menandatangani informed consent, dan dilakukan anamnesis, pemeriksaan fisik, pemeriksaan apusan sayatan kulit dan pemeriksaan laboratorium darah termasuk kadar serum zink. Pemeriksaan laboratorium darah dilakukan di laboratorium sentral RSUD Dr. Saiful Anwar dan RS Kusta Kediri, sementara pemeriksaan kadar serum zink dilakukan di laboratorium Prodia menggunakan alat Inductively Coupled Plasma-Mass Spectrometer (ICP-MS). Data dianalisis menggunakan program Statistical Package for Social Sciences (SPSS) versi 24. Dari 31 subyek penelitian didapatkan nilai median indeks bakteri sebesar 3.5±2, dengan indeks bakteri terendah 1+ dan indeks bakteri tertinggi 6+. Rerata kadar serum zink adalah 61.81±13.28 μg/dL dengan kadar terendah 37.00 μg/dL dan tertinggi 94.00 μg/dL. Berdasarkan uji korelasi Spearman didapatkan nilai korelasi -0.557 (55.7%) dan nilai p = 0.001. Diisimpulkan terdapat korelasi signifikan antara indeks bakteri dan kadar serum zink dengan nilai keeratan kuat. Korelasi bersifat negatif, yaitu semakin tinggi indeks bakteri maka semakin rendah kadar serum zink.
English Abstract
Morbus Hansen (MH), a chronic bacterial infectious disease caused by Mycobacterium leprae which attacks mainly on the skin and peripheral nerves, with a clinical spectrum based on the host's cellular immune response. According to WHO, Indonesia is the country with the third largest number of Morbus Hansen cases in the world at the end of 2016, and the East Java is an endemic region. The host's low cellular immune response is associated with Multibacillary (MB) type and is the main source of infection due to high bacterial counts which is assessed by measuring Bacterial Index (BI) in slit skin smear preparations with values 0 to 6+ according to Ridley and Joplin. The BI examination is also a fundamental part of establishing the diagnosis of Morbus Hansen. Zinc is an important trace element that is the main structural or catalytic component of hundreds of enzymes for the survival of both hosts and pathogens, so they make competition to control zinc availability. Hosts with Nramp1 (Natural-Resistance-Associated Macrophage Protein 1) resist zinc absorption by pathogens, while pathogens use Nramp homologs (Mramp) and P-type ATPases for absorption and to neutralize the effects of toxins from zinc in macrophages. Lower serum zinc levels in MB type MH because of the mechanism of redistribution of zinc from blood to various tissues related to the release of endogenous mediator leucocyte (LEM / IL1) due to the continuous phagocytic process of M. leprae by tissue macrophages and zinc utilization by billions of M. leprae from host cells for pathogenic survival. In addition, zinc deficiency causes disruption of the cellular immune system which is important for bacterial elimination. This study aimed for determining the correlation between bacterial index and zinc serum levels in MB-type MH patients. The study was held in Dr. Saiful Anwar Regional General Hospital Malang and Leprosy General Hospital Kediri Outpatient Clinic using a cross-sectional design. The research subjects were selected by consecutive sampling, and fulfilled the inclusion and exclusion criteria and were approved by the research ethics commission of the Dr. Saiful Anwar Regional General Hospital Malang and Leprosy General Hospital Kediri according to the Helsinki Declaration. There were 31 total subjects starting from the period of February to March 2019 who had signed an informed consent and carried out anamnesis, physical examination, slit skin smear examination and blood laboratory examination including serum zinc levels.Blood laboratory tests are carried out in the central laboratory of Dr. Saiful Anwar Regional General Hospital Malang and Leprosy General Hospital Kediri, while examining serum zinc levels was carried out in Prodia laboratory using the Inductively Coupled Plasma-Mass Spectrometer (ICP-MS) device. The available data were then analyzed statistically, using version 24 of the Statistical Package for Social Sciences (SPSS) program. Based on the 31 subjects, the lowest bacterial index 1+ and the highest bacterial index 6+ with the median 3.5±2. The mean serum zinc level was 61.81 ± 13.28 μg / dL with the lowest level 37.00 μg / dL and the highest was 94.00 μg / dL. Based on the Spearman correlation test, the correlation value -0.557 (55.7%) and p = 0.001 were obtained. It was concluded that there was a significant correlation between the bacterial index and zinc serum levels with strong closeness values. The correlation is negative, that is the higher bacterial index, the lower zinc serum levels.
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| Item Type: | Thesis (Magister) |
|---|---|
| Identification Number: | TES/614.546/WIL/h/2019/041903354 |
| Uncontrolled Keywords: | indeks bakteri, serum zink, morbus hansen,-bacterial index, zinc serum, morbus hansen |
| Subjects: | 600 Technology (Applied sciences) > 614 Forensic medicine; incidence of injuries, wounds, disease; public preventive medicine > 614.5 Incidence of and public measure to prevent specific disease and kinds of diseases > 614.546 Hansen's desease (Leprosy) |
| Divisions: | Profesi Kedokteran > Spesialis Dermatologi dan Venereologi, Fakultas Kedokteran |
| Depositing User: | Endang Susworini |
| Date Deposited: | 15 Jun 2022 03:46 |
| Last Modified: | 15 Jun 2022 03:46 |
| URI: | http://repository.ub.ac.id/id/eprint/191173 |
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