Korelasi Antara Kortisol Saliva Dan TNF-α Saliva Pasien Eritema Nodosum Leprosum

Nugroho, Alfonsus Rendy Laksditalia and dr. Aunur Rofiq, Sp.KK (K) and dr. Herwinda Brahmanti, Msc., Sp.KK (2019) Korelasi Antara Kortisol Saliva Dan TNF-α Saliva Pasien Eritema Nodosum Leprosum. Magister thesis, Universitas Brawijaya.

Abstract

Eritema nodosum leprosum merupakan suatu komplikasi penyakit kusta yang dimediasi imun, suatu sindroma kompleks imun yang terdiri atas IgG, IgM, Komplemen (C3) dan antigen Mycobacterium leprae. Merupakan suatu bentuk reaksi hipersensitivitas tipe 3 (Menurut Klasifikasi Coombs dan Gell). Sedangkan berdasarkan Ridley Jopling dari penyakit kusta diklasifikasikan sebagai reaksi kusta tipe 2. Penggunaan istilah ENL dikarenakan mayoritas lesi klinis yang umumnya ditemukan adalah tipe eritema nodosum. Penegakan diagnosis ditegakkan dengan didapatkannya kriteria mayor atau paling tidak kriteria minor dari Naafs, 2003 dan Lockwood, 2017. Menurut Global Leprosy Strategy 2016 - 2020 dari WHO, satu diantara tiga pilar inti yang disebutkan adalah koordinasi dan pembagian kerjasama dalam menghentikan kusta dan komplikasinya. Berkaitan dengan hal tersebut, komplikasi kusta, yaitu reaksi ENL masih menjadi permasalahan yang patut ditanggulangi terutama karena dapat pula menyebabkan kecacatan, seringkali membuat pasien merasa penyakitnya menjadi lebih parah, sehingga mempengaruhi kepatuhan berobat. Indonesia menempati penyumbang angka penderita kusta terbesar kedua di dunia. Jawa Timur, tempat dimana peneliti melakukan penelitian, merupakan wilayah endemis dengan NCDR masih tinggi yaitu 8,58% pada tahun 2017. Kortisol eksogen selama ini diberikan untuk mengatasi reaksi ENL, sehingga mulai dihipotesiskan keterlibatan kortisol dalam suatu reaksi ENL. Studi terpublikasi mendapatkan kadar kortisol menurun dan ada pula yang normal pada ENL .Diduga, cortisone-cortisol shuttle, paparan kronis sitokin, derajat inflamasi sitokin dan reseptor kortisol mempengaruhi peran kortisol dalam ENL. TNF-α terbukti diproduksi oleh makrofag dan neutrofil dalam reaksi ENL dalam beberapa penelitian, dan diketahui diantara sitokin lainnya, memegang peranan penting dalam patogenesis ENL. Penelitian in vitro sebelumnya menyatakan TNF-α diketahui memiliki kemampuan menurunkan kortisol dengan menghambat kemampuan stimulasi ACTH pada sel adrenal. Sepengetahuan penulis, belum ada penelitian sebelumnya yang meneliti hubungan antara kadar kortisol saliva dan TNF-α saliva pada pasien ENL. Hubungan antara kortisol dan TNF-α membuat studi mengenai dua variabel ini menarik diketahui dalam mengungkap pemahaman ENL yang patogenesisnya secara rinci belum jelas. Penelitian ini bertujuan untuk mengetahui hubungan antara kadar kortisol saliva dan kadar TNF-α saliva pada pasien ENL. Penelitian dilakukan di di Poliklinik dan Rawat Inap Kulit dan Kelamin RSUD dr. Saiful Anwar Malang dan RS Kusta (Daha Husada) Kediri dengan menggunakan desain penelitian potong lintang. Subyek penelitian dipilih secara consecutive sampling dan didapatkan total 30 subyek yang memenuhi kriteria inklusi dan eksklusi dan telah disetujui komisi etik kedua rumah sakit , sesuai Deklarasi Helsinski. Dari 30 subyek penelitian didapatkan kadar kortisol terendah 0.020 μg/dL dan kadar kortisol tertinggi 0.476 μg/dL dengan rerata kadar kortisol saliva 0.21 ± 0.120 μg/dL. Dari 30 subyek penelitian didapatkan kadar TNF-α saliva terendah 18.670 ng/L dan kadar TNF-α tertinggi 302.713 ng/L dengan rerata kadar TNF-α 171.060 ± 86.550 ng/L. Uji Normalitas Kolmogorov-smirnov menghasilkan asumsi normalitas terpenuhi. Berdasarkan uji korelasi Spearman didapatkan korelasi negatif (r = - 0.441) signifikan secara statistik (P = 0.015) antara kadar kortisol saliva dan kadar TNF-α saliva dengan keeratan kuat. Korelasi bersifat negatif, yaitu semakin tinggi kadar TNF-α saliva, semakin rendah kadar kortisol saliva. Sebaliknya, semakin rendah kadar TNF-α saliva, semakin tinggi kadar kortisol saliva.

English Abstract

Erythema nodosum leprosum is complication of leprosy that being mediated by immune, an immune complex syndrome that consist of IgG, IgM, complement (C3) and Mycobacterium leprae antigen. It was known as hypersensitivity reaction type 3 (Coombs and Gell Classification), meanwhile it was classified as type 2 of leprosy reaction according to Ridley and Jopling.The term of erythema nodosum leprosum was being used because majority of lesion being found was erythema nodosum. One major criteria and at least three minor criteria of Naafs, 2003 and Lockwood, 2017 are diagnosis finding for ENL. According to Global Leprosy Strategy 2016-2020 from WHO, one of the main pillars being mention was coordination and strengthening cooperation to stop leprosy and its complication. In accordance to it, leprosy complication, ENL, still become problem that need to be solved mainly because it may lead to disability, make patient feels the illness get worse, and lead to bad compliance of therapy. Indonesia is still the second highest rank of leprosy incidence in the world. East Java, location where the research were being done, is an endemic area with high NCDR 8,58% on 2017. Exogenous cortisol recently being used to overcome ENL, therefore being hypothesized of cortisol involvement in erythema nodosum leprosum. Some research report lower cortisol level while other report normal cortisol level in ENL. Several studies suspect cortisone-cortisol shuttle, chronic cytokine exposure, cytokine inflammatory degree and cortisol receptor were involved within the role of cortisol in ENL. It was known that TNF- α was produced by macrophage and neutrophiles during ENL in several studies. It was known among other cytokines, TNF-α holds important role in ENL pathogenesis. Previous in vitro research found that TNF-α has ability in lowering cortisol level by inhibit stimulation ability of ACTH on adrenal cell. Within author’s knowledge, there have not been any research before that studying corelation between cortisol saliva and TNF-α saliva of patients with ENL. Relationship between cortisol and TNF-α were the centre of interest in this study in order to reveal ENL which its pathogenesis was not fully elucidated. This study aimed to determine the correlation between cortisol saliva and TNF-α saliva of patients with ENL. The reasearch was held in dr. Saiful Anwar Regional General Hospital Malang and Leprosy General Hospital (Daha Husada) Kediri Outpatient and Inpatient department using a cross-sectional design. The subjects were selected by consecutive sampling method and involved 30 subjects who fulfilling the inclusion and exclusion criteria and had been approved by the research ethics committee of both hospital, according to the Helsinski Declaration. Based on 30 subjects, the lowest cortisol level was 0.020 μg/dL and the highest cortisol level was 0.476 μg/dL with average level of cortisol saliva was 0.21 ± 0.120 μg/dL. Based on 30 subjects, the lowest TNF-α saliva level was 18.670 ng/L and the highest TNF-α saliva level was 302.713 ng/L with average level of TNFα was 171.060 ± 86.550 ng/L. Normal data distribution was obtained by Kolmogorovsmirnov test. Spearman corelation test showed statistically significant (P = 0.015) with negative correlation between cortisol saliva and TNF-α saliva and both have strong correlation (r = - 0.441). The correlation is negative which means the higher TNF-α saliva level, the less cortisol level ; in reverse, the less TNF-α saliva level, the higher cortisol level.

Item Type: Thesis (Magister)
Identification Number: TES/616.998/NUG/k/2019/041903822
Uncontrolled Keywords: kortisol saliva, TNF-α saliva, eritema nodosum leprosum, kusta,cortisol saliva, TNF-α saliva, erythema nodosum leprosum, leprosy
Subjects: 600 Technology (Applied sciences) > 616 Diseases > 616.9 Other disease > 616.99 Tumors and miscellaneous communicable diseases > 616.998 Hansen's disease (Leprosy)
Divisions: Profesi Kedokteran > Spesialis Dermatologi dan Venereologi, Fakultas Kedokteran
Depositing User: soegeng sugeng
Date Deposited: 15 Aug 2022 02:51
Last Modified: 15 Aug 2022 02:51
URI: http://repository.ub.ac.id/id/eprint/193213
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