Hubungan Rasio Kadar Serum Ige Spesifik Hdm / Ige Total Dengan Skor Act Sebagai Biomarker Respons Efektivitas Imunoterapi Pada Asma Alergi Anak

Afrida, Bela Siska and Dr.dr. Wisnu Barlianto and Dr.dr.Ery Olivianto and dr.Desy Wulandari (2022) Hubungan Rasio Kadar Serum Ige Spesifik Hdm / Ige Total Dengan Skor Act Sebagai Biomarker Respons Efektivitas Imunoterapi Pada Asma Alergi Anak. Magister thesis, Universitas Brawijaya.

Abstract

Asma adalah penyakit inflamasi kronik yang berhubungan dengan obstruksi dan hiperreaktivitas saluran pernapasan. Asma alergi adalah asma yang disebabkan oleh reaksi alergi yang diperantarai oleh IgE atau disebut juga allergy-induced asthma. Asma merupakan salah satu penyakit tidak menular atau non communicable disease (NCD) yang masih menjadi masalah kesehatan global dengan angka morbiditas dan mortalitas yang cukup tinggi. Saat ini tatalaksana asma masih menjadi tantangan besar. Imunoterapi adalah satu- satunya pengobatan yang berbasis etiologi pada asma. Meskipun imunoterapi terbukti efektif secara klinis, hingga saat ini belum ada biomarker standar yang ditetapkan untuk evaluasi respons terhadap imunoterapi. Penelitian ini bertujuan untuk mengetahui hubungan kadar rasio serum IgE Spesifik HDM/IgE Total dengan skor ACT sebagai biomarker respons efektivitas imunoterapi pada pasien asma alergi anak. Penelitian ini adalah penelitian kohort retrospektif pada 26 pasien asma alergi yang menjalani imunoterapi subkutan spesifik HDM fase build-up di Poliklinik Alergi Imunologi Anak RSSA Malang selama 14 minggu periode Januari - Desember 2019. Subjek adalah pasien yang terdiagnosis asma alergi berdasarkan hasil tes skin prick test (SPT), IgE spesifik HDM, dan bersedia menjalani imunoterapi subkutan dengan rentang usia 5-18 tahun. Kadar IgE spesifik dan IgE total serum diukur dengan metode Immuno Chemiluminescence and Enzyme-linked Iimmunosorbent Assays (ELISA) sebelum dan 14 minggu setelah imunoterapi. Peningkatan kontrol asma dinilai dengan skor Asthma Control Test (ACT). Uji analisis komparatif dilakukan dengan uji Wilcoxon Signed Ranked Test. Uji Korelasi antara rasio IgE Spesifik HDM/IgE Total dengan skor ACT dilakukan dengan uji korelasi Spearman. Uji analisis signifikan jika p  0,05. Analisis dilakukan dengan software SPSS statistic 26 for windows. Usia rata-rata subjek adalah 7,05 ± 1,81 tahun dan tidak terdapat hubungan antara usia dengan IgE Total (IU/ml), IgE Spesifik HDM (kuA/L), Rasio dan ACT (Asma). Jumlah laki-laki dan perempuan pada penelitian ini hampir seimbang dan juga tidak ditemukan hubungan yang signifikan dengan parameter IgE Total (IU/ml), IgE Spesifik HDM (kuA/L), Rasio dan ACT (Asma). Berdasarkan status gizi pada subjek penelitian ini, terbanyak merupakan subyek penelitian dengan status gizi baik yaitu sebesar 92,30% dan tidak berhubungan signifikan dengan IgE Total (IU/ml), IgE Spesifik HDM (kuA/L), Rasio dan ACT (Asma). Klasifikasi derajat asma sebesar 73,07% merupakan subjek penelitian dengan asma derajat ringan dan sisanya merupakan asma derajat sedang namun tidak ditemukan hubungan dengan IgE Total (IU/ml), IgE Spesifik HDM (kuA/L), Rasio dan ACT (Asma). Riwayat atopi pada keluarga didapatkan pada seluruh subjek penelitian. Keberhasilan terapi berdasarkan skor ACT pada subyek penelitian sebesar 76,9% terkontrol sebagian dan sebesar 23,1% tidak terkontrol. Dari hasil tidak ditemukan hubungan yang signifikan dengan IgE Total vi (IU/ml), IgE Spesifik HDM (kuA/L), Rasio dan ACT (Asma). Dalam penelitian ini terdapat penurunan yang signifikan kadar serum sIgE HMD sebelum imunoterapi [9,88 ± 5,74 kuA/L] dibandingkan setelah imunoterapi selama 14 minggu [4,51 ± 3,98 kuA/L], p=0,000. Kadar serum tIgE menurun secara signifikan sebelum imunoterapi [207,6 ± 120,8IU/ml] dibandingkan setelah imunoterapi selama 14 minggu [109,83 ± 189,39 IU /ml], p=0,000. Rasio kadar serum sIgE HDM/tIgE terdapat penurunan yang signifikan sebelum imunoterapi [0,063 ± 0,05] dibandingkan setelah imunoterapi selama 14 minggu [0,041 ± 0,039], p=0,012 , Terdapat peningkatan skor ACT sebelum dan setelah imunoterapi (masing- masing 15,5 ± 1,79 dan 20,96 ± 2,049, p=0,000). Terdapat korelasi yang signifikan antara kadar serum sIgE HDM/tIgE dan skor ACT dengan arah hubungan negatif (p=0,034 dan r=-0,29). Pada penelitian ini juga dianalisa faktor lain yang mempengaruhi Kadar IgE Spesifik HDM, IgE Total, Rasio IgE Spesifik HDM/IgE Total dan Skor ACT. Jenis kelamin, usia, status gizi, multialergen pada hasil skin prick test dan penggunaan obat pengendali (controller) tidak berhubungan signifikan dengan Kadar IgE total, IgE Spesifik HDM, Rasio IgE Spesifik HDM/IgE Total dan Skor ACT. Berdasakan hasil tersebut, terdapat penurunan kadar sIgE HDM, tIgE , rasio sIgE HDM/tIgE dan peningkatan skor ACT setelah pemberian imunoterapi HDM selama 14 minggu. Terdapat hubungan yang lemah antara rasio kadar sIgE HDM/tIgE dengan skor ACT. Semakin rendah rasio kadar sIgE HDM/tIgE maka semakin tinggi skor ACT pada pasien asma alergi anak. Kadar rasio IgE Spesifik HDM/IgE Total dapat digunakan sebagai biomarker pendamping efektivitas imunoterapi pasien asma alergi anak. Jenis kelamin, usia, status gizi, multialergen pada hasil skin prick test dan penggunaan obat pengendali (controller) tidak berhubungan signifikan dengan Kadar IgE total, IgE Spesifik HDM, Rasio IgE Spesifik HDM/IgE Total dan Skor ACT.

English Abstract

Asthma is a chronic inflammatory disease associated with airway obstruction and hyperreactivity. Allergic asthma is caused by an IgE-mediated allergic reaction, also known as allergy-induced asthma. Asthma is a non- communicable disease (NCD), has emerged as a major global public health problem with high rates of morbidity and mortality. Currently the management of asthma is still a big challenge. Immunotherapy is the only etiology-based treatment for asthma. Although immunotherapy has been shown to be clinically effective, to date no standard biomarker has been established for evaluation of response to immunotherapy. This study aims to determine the correlation between the ratio of HDM-Specific IgE /Total IgE with the ACT score as a biomarker of the response to the effectiveness of immunotherapy in pediatric allergic asthmatic patients. This study is a retrospective cohort of 26 allergic asthma patients who underwent HDM-specific subcutaneous immunotherapy in the build-up phase at the Pediatric Allergy Immunology Saiful Anwar Outpatient clinic Malang for 14 weeks from January to December 2019. The subjects were patients diagnosed with allergic asthma based on the results of the skin prick test (SPT), HDM-specific IgE, Total IgE and willing to undergo subcutaneous immunotherapy with an age range of 5-18 years. Serum specific IgE and total IgE levels were measured by the Immuno Chemiluminescence and Enzyme-linked Immunosorbent Assays (ELISA) method before and 14 weeks after immunotherapy. Improved asthma control was assessed by the Asthma Control Test (ACT) score. The comparative analysis test was carried out using the Wilcoxon Signed Ranked Test. The correlation test between the HDM/Total IgE Specific IgE ratio and the ACT score was carried out using the Spearman correlation test. The statistical significancy was considered significant if p≤0.05. Analysis was done with SPSS statistic 26 software for Windows. The mean age of the subjects was 7.05 ± 1.81 years and there was no relationship between age and Total IgE (IU/ml), HDM Specific IgE (kuA/L), Ratio and ACT (Asthma). The number of boys and girls in this study was almost equal and there was also no significant relationship with the parameters of Total IgE (IU/ml), HDM Specific IgE (kuA/L), Ratio and ACT (Asthma). Based on the nutritional status of the research subjects, most of them were research subjects with good nutritional status, which was 92.30% and had no significant relationship with Total IgE (IU/ml), HDM Specific IgE (kuA/L), Ratio and ACT (Asthma). Asthma severity of 73.07% were study subjects with mild asthma and the rest were moderate asthma but no association was found with Total IgE (IU/ml), HDM Specific IgE (kuA/L), Ratio and ACT (Asthma). Family history of atopy was found in all study subjects. The success of therapy based on the ACT score in the study subjects was 76.9% partially controlled and 23.1% uncontrolled. From the results, there was no significant relationship with Total IgE (IU/ml), HDM Specific IgE (kuA/L), Ratio and ACT (Asthma). In this study, there viii was a significant decrease in serum HMD sIgE levels before immunotherapy [9.88 ± 5.74 kuA/L] compared to 14 weeks after immunotherapy [4.51 ± 3.98 kuA/L], p=0.000. Serum tIgE levels decreased significantly before immunotherapy [207.6 ± 120.8IU/ml] compared to 14 weeks after immunotherapy [109.83 ± 189.39 IU/ml], p=0.000. The ratio of serum HDM sIgE/tIgE levels was significantly decreased before immunotherapy [0.063 ± 0.05] compared to 14 weeks after immunotherapy [0.041 ± 0.039], p=0.012 , There was an increase in ACT scores before and after immunotherapy (each 15, 5 ± 1.79 and 20.96 ± 2.049, p=0.000). There was a significant correlation between HDM/tIgE serum sIgE levels and ACT scores with a negative relationship (p=0.034 and r=-0.29). In this study also analyzed other factors that affect HDM Specific IgE Levels, Total IgE, HDM-Specific IgE Ratio/Total IgE and ACT Score. The Gender, age, nutritional status, multiallergens on skin prick test results and use of controller drugs were not significantly associated with total IgE levels, HDM-specific IgE, HDM-specific IgE/Total IgE ratios and ACT scores. Based on these results, there was a decrease in HDM sIgE levels, tIgE levels, HDM sIgE/tIgE ratio and an increase in ACT scores after 14 weeks of HDM immunotherapy. There was a weak relationship between the ratio of HDM sIgE/tIgE levels and ACT scores. The lower the HDM sIgE/tIgE ratio, the higher the ACT score in pediatric allergic asthmatic patients. The HDM Specific-IgE/ IgE Total ratio can be used as a complementary biomarker for the effectiveness of immunotherapy in pediatric allergic asthma patients. The Gender, age, nutritional status, multiallergens on skin prick test results and use of controller drugs were not significantly associated with total IgE levels, HDM-specific IgE, HDM-specific IgE/Total IgE ratio and ACT scores

Other obstract

Item Type:	Thesis (Magister)
Identification Number:	0422060086
Uncontrolled Keywords:	Rasio sIgE HDM/tIgE, skor ACT, Imunoterapi, Asma Alergi,-HDM sIgE/tIgE ratio, ACT score, Immunotherapy, Allergic Asthma
Subjects:	600 Technology (Applied sciences) > 618 Gynecology, obstetrics, pediatrics, geriatrics > 618.9 Pediatrics and geriatrics
Divisions:	Profesi Kedokteran > Spesialis Ilmu Kesehatan Anak, Fakultas Kedokteran
Depositing User:	Endang Susworini
Date Deposited:	20 Jan 2023 04:15
Last Modified:	20 Jan 2023 04:15
URI:	http://repository.ub.ac.id/id/eprint/196810

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