Jannati, Devi Albaiti and Dr. dr. Ery Olivianto, Sp. A (K) and Dr. dr. Agustin Iskandar, M. Kes, Sp. PK, Subsp.P.I (K) Dr. dr. (2024) . Peran Pemberian Vitamin D Dan Zink Terhadap Kadar Granulocyte Macrophage Colony-Stimulating Factor (GM-CSF) dan Hitung Monosit Pada Pasien Tuberkulosis Anak. Sarjana thesis, Universitas Brawijaya.
Abstract
Penelitian ini merupakan penelitian obervasional analitik dengan 33 subjek penelitian. Sebanyak 11 subjek merupakan kelompok kontrol, 11 subjek kelompok Zink dan 11 subjek kelompok Vitamin D. Subjek merupakan pasien rawat jalan maupun rawat inap RS dr. Saiful Anwar Malang. Kriteria inklusi penelitian ini adalah pasien anak usia < 18 tahun yang terdiagnosis TB sesuai Juknis TB 2023, belum pernah mendapatkan terapi OAT sebelumnya, dan orangtua menyetujui dengan penandatanganan informed consent. Penelitian dilakukan selama 2 bulan fase intensif. Data dianalisis menggunakan Uji normalitas dengan Saphiro Wilk untuk melihat distribusi data dan Uji varians dengan Levene’s test. Jika data terdistribusi normal dan homogen maka dilakukan Uji One Way Anova untuk membandingkan jumlah hitung monosit dan GM-CSF pada kelompok A, B, dan C dan Paired T-Test untuk membandingkan jumlah hitung monosit dan GM-CSF sebelum dan sesudah pemberian Zink dan Vitamin D. Namun jika data tidak terdistribusi normal dan tidak homogen maka dilakukan uji alternatif dengan Kruskall Wallis dan Wilcoxon. Data dianalisis menggunakan program SPSS 25. Hasil penelitian menunjukkan kadar GM-CSF ketiga kelompok diatas nilai normal . Median kadar GM-CSF kelompok kontrol 86.5 pg/ml, kelompok Zink 69.5 pg/ml, dan kelompok Vitamin D 101.4 pg/ml. Dengan hasil uji perbandingan Krusskal Wallis antara ketiga kelompok tidak bermakna secara statistik (p 0.375). Median monosit pada kelompok kontrol 715/l, median monosit kelompok Zink 1023/l dan median monosit kelompok Vitamin D 750/l. Dengan hasil uji perbandingan Krusskal Wallis antara ketiga kelompok tidak bermakna secara statistik (p 0.773). Kemudian subjek diberikan perlakuan pemberian suplementasi Zink 15 mg/hari dan Vitamin D 1000 iu/hari selama fase intensif (2 bulan) lalu didapatkan penurunan pada kadar GM-CSF ketiga kelompok dan penurunan hitung monosit ketiga kelompok. Adapun hasil uji perbandingan selisih GM-CSF kelompok kontrol -19.3 pg/dl, kelompok Zink -12.4 pg/ml, dan kelompok Vitamin D -41.4 pg/ml walaupun secara statistik tidak bermakna (p 0.328). Selisih hitung monosit kelompok kontrol -95/l, kelompok Zink -295/l, dan kelompok Vitamin D -102 /l walaupun secara statistik tidak bermakna (p 0.402). Hasil uji Wilcoxon menunjukkan perbedaan yang signifikan kadar GM-CSF sebelum dan sesudah perlakuan pada kelompok Vitamin D (p 0.016). Selain itu didapatkan pula perbedaan yang signifikan pada hitung monosit sebelum dan sesudah perlakuan pada kelompok Vitamin D (p 0.05). Penelitian ini juga menilai luaran klinis berupa berat badan, gambaran foto toraks, dan konversi sputum. Hasil penelitian menunjukkan pada ketiga kelompok mengalami peningkatan berat badan terutama pada kelompok Zink dengan selisih 1.4 kg dan bermakna secara statistik (p 0.007), selisih berat badan pada kelompok Vitamin D 3.9 kg dan bermakna secara statistik (p 0.000). Didapatkan perbedaan signifikan konversi sputum pada kelompok Zink , dari 5 subjek BTA positif setelah 2 bulanvi suplementasi hanya 1 subjek dengan evaluasi BTA masih positif dan secara statistik bermakna (p 0.046). Perbedaan signifikan konversi sputum juga berbeda signifikan pada kelompok Vitamin D . Dari 4 subjek BTA positif setelah 2 bulan suplementasi Vitamin D seluruhnya konversi menjadi negatif (p 0.046). Kesimpulan penelitian ini adalah pemberian suplementasi Zink dan Vitamin D memperbaiki parameter laboratoris dan meningkatkan luaran klinis pada tuberkulosis anak. Suplementasi Zink dan Vitamin D dapat direkomendasikan sebagai terapi tambahan pada TB anak.
English Abstract
Tuberculosis is a chronic disease caused by the bacteria Mycobacterium Tuberculosis (Mtb) which is transmitted through droplets. Nowadays , Indonesia ranks 2nd in terms of the highest TB incidence in the world. The death rate due to TB in Indonesia is quite high. Children with TB have been shown to suffer from micronutrient deficiencies such as Zinc and Vitamin D. Meanwhile, Zinc and Vitamin D have a large role in immunopathogenesis against Mtb through natural and adaptive pathways. Zinc is able to increase the production of pro-inflammatory cytokines such as GM-CSF and increase monocyte counts. Vitamin D triggers macrophages to increase phagosome maturation and stimulates the production of antimicrobial cathelicidin which activates transcription of autophagy-related genes. This research is an analytic observational study with 33 subjects. A total of 11 subjects were in the control group, 11 subjects in the Zinc group and 11 subjects in the Vitamin D group. Subjects were outpatients and inpatients at Dr. Saiful Anwar Malang Hospital. The inclusion criteria for this study were pediatric patients aged < 18 years who were diagnosed with TB according to the 2023 TB Guidelines, who had never received OAT before, and whose parents agreed by signing an informed consent. The research was conducted during an intensive phase of 2 months. Data were analyzed using the normality test with Shapiro Wilk to see the distribution and the variance test with Levene's test. If the data is normally distributed and homogeneous then a One Way Anova Test is carried out to compare the number of monocyte counts and GM-CSF in groups A, B and C and a Paired T-Test to compare the number of monocyte counts and GM-CSF before and after supplementation of Zink and Vitamin D. However, if the data is not normally distributed and is not homogeneous then an alternative test is carried out with Krusskall Wallis and Wilcoxon. Data were analyzed using the SPSS 25 program. The results showed that the GM-CSF levels in the three groups were increased from baseline. The median GM-CSF level in the control group was 86.5 pg/ml, the Zinc group 69.5 pg/ml, and the Vitamin D group 101.4 pg/ml. The results of the Krusskal Wallis comparison test between the three groups were not statistically significant (p 0.375). Median monocytes in the control group were 715/l, median monocytes in the Zinc group were 1023/l and median monocytes in the Vitamin D group were 750/l. The results of the Krusskal Wallis comparison test between the three groups were not statistically significant (p 0.773). Then the subjects were given treatment with Zinc supplementation 15 mg/day and Vitamin D 1000 iu/day during the intensive phase (2 months) and there was a decrease median of GM-CSF in all three groups and a decrease median in monocyte counts in all three groups. The results of the comparison test for the difference in GM-CSF for the control group were -19.3 pg/dl, the Zinc group -12.4 pg/ml, and the Vitamin D group -41.4 pg/ml, although it was not statistically significant (p 0.328). The difference in monocyte count in the control group -95/l, Zinc group -295/l, and Vitamin D group -102 /l although not statistically significant (p 0.402). The Wilcoxon test showed a significant difference in GM-CSF levels before and after supplementation in the Vitamin D group (p 0.016). But, there was no significant difference in monocyte counts before and after treatment in the Vitamin D group (p 0.05). This study also assessed clinical outcomes in the form of body weight, chest radiographs, and sputum conversion. The results showed that the three groups experienced an increase in body weight, especially in the Zinc group with a difference of 1.4 kg and was statisticallyviii significant (p 0.007), the difference in body weight in the Vitamin D group was 3.9 kg and was statistically significant (p 0.000). There was a significant difference in sputum conversion in the Zink group, of the 5 BTA positive subjects after 2 months of supplementation, only 1 subject with BTA evaluation was still positive and this was statistically significant (p 0.046). The significant difference in sputum conversion was also significantly different in the Vitamin D group. Of the 4 BTA positive subjects after 2 months of Vitamin D supplementation, all of them converted to negative (p 0.046). The conclusion of this study is that Zinc and Vitamin D supplementation improves laboratory parameters and improves clinical outcomes in childhood tuberculosis. Zinc and Vitamin D supplementation can be recommended as additional therapy for pediatric TB.
| Item Type: | Thesis (Sarjana) |
|---|---|
| Identification Number: | 0424060033 |
| Divisions: | Profesi Kedokteran > Spesialis Ilmu Kesehatan Anak, Fakultas Kedokteran |
| Depositing User: | Unnamed user with username nova |
| Date Deposited: | 19 Aug 2024 06:22 |
| Last Modified: | 19 Aug 2024 06:22 |
| URI: | http://repository.ub.ac.id/id/eprint/223401 |
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