Ensefalopati Hepatik pada Sirosis Hati: Faktor Presipitasi dan Luaran Perawatan di RSUD dr. Saiful Anwar Malang
DOI:
https://doi.org/10.21776/ub.jkb.2015.028.04.15Abstract
Peran Th17 dalam patogenesis asma dan imunoterapi menjadi konsep dan paradigma terbaru. Imunoterapi merupakan salah satu manajemen di dalam asma dan memerlukan waktu yang lama sehingga sering mengakibatkan kegagalan terapi. Terapi adjuvant antara lain probiotik dan Nigella sativa diduga dapat meningkatkan efektifitas imunoterapi. Penelitian dilakukan untuk mengevaluasi efek pemberian imunoterapi, probiotik dan/atau Nigella sativa terhadap jumlah sel Th17, neutrofil dan skoring asma pada anak asma selama imunoterapi fase rumatan. Penelitian dilakukan pada 31 anak yang dikelompokkan secara acak yaitu imunoterapi plus plasebo atau imunoterapi plus Nigella sativa atau imunoterapi plus probiotik atau imunoterapi plus Nigella sativa plus probiotik selama 56 minggu. Pengukuran jumlah sel Th17 dan neutrofil dilakukan menggunakan flowcytometry setelah perlakuan. Asthma Control Test dilakukan untuk mengevaluasi gejala klinis. Data dianalisis menggunakan uji komparasi Anova One Way dan uji korelasi Pearson. Hasil menunjukkan tidak didapatkan perbedaan yang bermakna jumlah sel Th17 dan neutrophil antara kelompok perlakuan (p-value 0,199 dan 0,326). Asthma control test secara bermakna didapatkan perbedaan antara perlakuan imunoterapi plus probiotik dibandingkan imunoterapi saja. Skoring asma pada kelompok perlakuan imunoterapi plus probiotik adalah yang tertinggi (22,6). Jumlah sel Th17, neutrofil dan ACT menunjukkan hubungan yang lemah dan tidak bermakna secara statistik (r=-0,2) (p= 0,156). Jumlah sel Th17 dan neutrofil tidak didapatkan perbedaan yang bermakna. Skoring asma pada kelompok imunoterapi plus probiotik adalah yang tertinggi. Dapat disimpulkan tidak terdapat hubungan antara Th17, neutrofil dan skoring asma. Kata Kunci: Imunoterapi, neutrofil, Nigella sativa, probiotik, sel Th17, skoring asmaDownloads
References
Bacon BR. Cirrhosis and Its Complications. In: Longo D and Fauci AS (Eds). Harrisson's Gastroenterology-Hepatology. New York: McGraw Hill Medical; 2012: pp. 419-343.
Lawrence S and Friedman. Liver, Biliary Tract, and Pancreas Disorders. In: Papadakis MA, McPhee SJ, and Rabow MW (Eds). Current Medical Diagnosis & Treatment 49th edition. New York: McGraw Hill Lange; 2010: pp. 622-623.
Gracia G. Cirrhosis and Its Sequele. In: Goldman L and Schaffer AI (Eds). Goldman's Cecil Medicine 24th edition. New York: Elsevier Sauders; 2012: pp. 999-1007.
Munoz SJ. Hepatic Encephalopathy. Medical Clinics of North America. 2008; 92(4): 795-812.
Vilstrup H, Amodio P, Bajaj J, et al. Hepatic Encephalopathy in Chronic Liver Disease: 2014 Practice Guideline by AASL and EASL. Alexandria, Virginia: American Association for the Study of Liver Disease; 2014.
Nadeem M, Yousaf MA, Zakaria M, Hussain T, and Ali N. The Value of Clinical Signs in Diagnosis of Cirrhosis. Pakistan Journal of Medical Sciences. 2005; 21(2): 121-124.
Chatauret N and Butterworth RF. Effects of Liver Failure on Inter-Organ Trafficking of Ammonia: Implications for the Treatment of Hepatic Encephalopathy. Journal of Gastroenterology and Hepatology. 2004; 19(7): S219–S223.
Ahl B, Weissenborn K, van den Hoff J, et al. Regional Differences in Cerebral Blood Flow and Cerebral Ammonia Metabolism in Patients with Cirrhosis. Hepatology. 2004; 40(1): 73–79.
Lesmana LA, Nusi IA, Gani RA, Hasan I, dan Sanitoyoso A. Panduan Praktik Klinik Ensefalopati Hepatik di Indonesia. Jakarta: Perhimpunan Peneliti Hati Indonesia; 2014: hal. 1-18.
Nusi IA. Penatalaksanaan Masa Kini Ensefalopati Heaptik. Pendidikan Kedokteran Berkelanjutan XIV Laboratorium-SMF Penyakit Dalam FK Unair RSUD Dr Soetomo. Surabaya, 1999; hal. 45-59.
Marchesini G, Bianchi G, Amodio P, et al. Factors Associated with Poor Health Related Quality of Life of Patients with Cirrhosis. Gastroenterology 2001; 120(1): 170-178.
Ahmed H, Rehman M, Saeedi MI, and Shah D. Factors Precipitating Hepatic Encephalopathy In Cirrhosis Liver. Journal of Postgraduate Medical Institue. 2001; 15(1): 91-97.
Maqsood S, Saleem A, Iqbal A, and Butt JA. Precipitating Factors of Hepatic Encephalopathy: Experience at Pakistan Institute of Medical Sciences Islamabad. Journal of Ayub Medical College Abbottabad. 2006; 18(4): 57-62.
Bustamante J, Rimola A, Ventura PJ, et al. Prognostic Significance of Hepatic Encephalopathy in Patients with Cirrhosis. Journal of Hepatology. 1999; 30(5); 890-895.
Zakaria M, Hussain SR, Rehman M, Butt A, and Rana GF. Hepatic Encephalopathy; Precipitating Factors in Patients with Cirrhosis. Professional Medical Journal. 2008; 15(3): 375-379.
Masood N, Rahopoto Q, Gouri A, and Munir A. Precipitating Factors of Hepatic Encephalopathy in with Cirrhocis of Liver. Medical Channel. 2010; 16(3): 376-379.
Ashoor MA, Wahab EA, Elshafey MM, and Afifi AF. Precipitating Factors and Hospital Outcome of Hepatic Encephalopathy In Cirrhotic Patients at Tertiary Centre in Egypt. Journal of American Science. 2012; 8(9): 344-352.
Strauss E and da Costa MF. The Importance of Bacterial Infection as Precipitating Factor of Chronic Hepatic Encephalopathy. Hepato-Gastroenterology. 1998; 45(21): 900-904.
Hayat AS, Shaikh N, and Memon F. Identification of Precipitating Factors in Hepatic Encephalopathy Patients at Liaquat University Hospital Jamshoro. World Applied Sciences Journal. 2010; 8(6): 661-666.
Pratomo B. Ensefalopati Hepatik, Current Management of Cirrhosis Complication. Pertemuan Ilmiah Tahunan XI. Update in Internal Medicine. Oktober 2011; hal. 105- 116.
Charlton M. Branched-Chain Amino Acid Enriched Suplements as Therapy of Liver Disease. Journal of Nutrition. 2006; 136(1): 295S-298S.
Tariq M, Iqbal S, Khan N, and Basri R. Precipitating Factors of Hepatic Encephalopathy. Rawal Medical Journal. 2009; 34(1): 95-97.
Mumtaz K, Ahmed U, Abid S, Baig N, Hamid S, and Jafri, W. Precipitating Factors and the Outcome of Hepatic Encephalopathy in Liver Cirrhosis. Journal of the College of Physicians and Surgeons-Pakistan. 2010; 20(8): 514-518.
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