Tandiono, dr. Meliantha and dr. Iriana Maharani,, Sp.T.H.T.B.K.L. Subsp.Rino.(K), FICS and Prof. Dr. dr. Yuyun Yueniwati,, M. Kes, Sp. Rad (K) (2022) Hubungan Tipe Inflamasi Mukosa terhadap Global Osteitis Scoring Scale (GOSS) pada Rinosinusitis Kronis. Magister thesis, Universitas Brawijaya.
Abstract
Latar belakang: Rinosinusitis kronis (RSK) adalah inflamasi mukosa kavum nasi dan sinus paranasalis selama >12 minggu. RSK primer dibagi menjadi tipe 2 dan non-tipe 2 (tipe 1 dan 3) berdasarkan tipe inflamasi mukosanya. Inflamasi mukosa dapat menginduksi remodeling tulang menjadi osteitis. Tipe 2 dianggap memiliki dampak remodeling tulang yang lebih berat dibandingkan non-tipe 2. Sebanyak 36-53% pasien RSK mengalami osteitis, di mana menyebabkan RSK sulit disembuhkan. Belum ada penjelasan mengenai kaitan secara langsung antara tipe inflamasi mukosa dengan osteitis pada RSK. Tujuan: Menganalisis hubungan tipe inflamasi mukosa terhadap GOSS dan menganalisis GOSS yang memiliki risiko terhadap tipe inflamasi mukosa tertentu pada RSK. Metode: Penelitian observasional analitik cross-sectional melibatkan pasien RSK primer. Tipe inflamasi mukosa ditentukan dengan mengukur kadar protein biomarker IFNg (tipe 1), ECP dan CLC (tipe 2), IL-17A (tipe 3), pada mukosa prosesus unsinatus menggunakan metode ELISA. Osteitis dinding sinus paranasalis dievaluasi dengan CT scan dan dihitung berdasarkan GOSS. Hasil: Sebanyak 33 pasien RSK primer dan 8 kontrol. ECP (pg/ml) berkorelasi positif dengan GOSS total (r=0.473, p=0.003). logCLC, IFN-g, dan IL-17A berkorelasi negatif dan tidak signifikan dengan GOSS total. GOSS total dan masing-masing sinus paranasalis pada kelompok inflamasi mukosa tipe 2 lebih tinggi dibandingkan non-tipe 2 (p<0.05). GOSS-etmoidalis posterior (GOSS-EP) merupakan indikator diagnostik paling dominan terhadap inflamasi mukosa tipe 2 (p=0.003, PR=1.833). Cut-off GOSS-EP (AUC=0.823) >2.5 memiliki sensitivitas 85% dan spesifisitas 65% (p=0.005, PR=4.583), sedangkan cut-off >3.5 memiliki sensitivitas 69% dan spesifisitas 85% (p=0.002, PR=3.938) dalam mendiagnosis inflamasi mukosa tipe 2. Osteitis derajat sedang-berat berisiko lebih besar mengalami inflamasi mukosa tipe 2 dibandingkan non-tipe 2 pada RSK (p<0.001, PR=4.500). Kesimpulan: ECP merupakan marker osteitis pada RSK. Semakin tinggi nilai dan semakin parah derajat osteitis berdasarkan GOSS, risiko mengalami inflamasi mukosa tipe 2 semakin besar. GOSS-EP >2.5 dan >3.5 bermanfaat dalam skrining dan diagnosis inflamasi mukosa RSK tipe 2 secara klinis.
English Abstract
Background: Chronic rhinosinusitis (CRS) is inflammation of the mucosa of the nasal cavity and paranasal sinuses for >12 weeks. Primary CRS is divided into type 2 and non-type 2 (types 1 and 3) based on the type of mucosal inflammation. Mucosal inflammation can induce bone remodeling leading to osteitis. Type 2 is considered to have a more severe impact on bone remodeling than non-type 2. As many as 36-53% of CRS patients have osteitis, which makes CRS difficult to cure. There has been no explanation of a direct association between the type of mucosal inflammation and osteitis in CRS. Objectives: To analyze the relationship between types of mucosal inflammation and GOSS and to analyze which GOSS have a risk for certain types of mucosal inflammation in CRS. Methods: A cross-sectional analytic observational study involving primary CRS patients. The type of mucosal inflammation was determined by measuring the levels of the biomarker protein IFN-g (type 1), ECP and CLC (type 2), IL-17A (type 3), in the mucosa of the uncinate process using the ELISA method. Paranasal sinus wall osteitis was evaluated by CT scan and calculated based on GOSS. Results: A total of 33 primary CRS patients and 8 controls. ECP (pg/ml) was positively correlated with total GOSS (r=0.473, p=0.003). logCLC, IFN-g, and IL-17A were negatively and insignificantly correlated with total GOSS. Total GOSS and individual paranasal sinuses in the type 2 mucosal inflammation group were higher than in the non-type 2 group (p<0.05). GOSS-ethmoidalis posterior (GOSS-EP) was the most dominant diagnostic indicator of type 2 mucosal inflammation (p=0.003, PR=1.833). The GOSS-EP cut-off (AUC=0.823) >2.5 had a sensitivity of 85% and specificity 65% (p=0.005, PR=4.583), while the cut-off >3.5 had a sensitivity of 69% and a specificity of 85% (p=0.002, PR=3.938) in diagnosing type 2 mucosal inflammation. Moderate-severe osteitis had a greater risk of developing type 2 mucosal inflammation than non-type 2 in CRS (p<0.001, PR=4,500). Conclusion: ECP is a marker of osteitis in CRS. The higher the score and the more severe the grade of osteitis according to GOSS, the greater the risk of developing type 2 mucosal inflammation. GOSS-EP >2.5 and >3.5 are useful in the screening and clinical diagnosis of mucosal inflammation of type 2 CRS.
Other obstract
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| Item Type: | Thesis (Magister) |
|---|---|
| Identification Number: | 0422060166 |
| Uncontrolled Keywords: | Rinosinusitis kronis, tipe inflamasi mukosa, osteitis, IFN-g, CLC, ECP, IL-17A, Global Osteitis Scoring Scale |
| Subjects: | 600 Technology (Applied sciences) > 617 Surgery, regional medicine, dentistry, ophthalmology, otology, audiology > 617.5 Regional medicine > 617.51 Head |
| Divisions: | Profesi Kedokteran > Spesialis THT Kepala dan Leher, Fakultas Kedokteran |
| Depositing User: | Endang Susworini |
| Date Deposited: | 08 May 2023 06:14 |
| Last Modified: | 08 May 2023 06:14 |
| URI: | http://repository.ub.ac.id/id/eprint/198916 |
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