HUBUNGAN KADAR INTERLEUKIN-10 (IL-10) DENGAN JUMLAH TROMBOSIT DAN PENINGKATAN HEMATOKRIT PADA INFEKSI DENGUE

SALMAWATI, Dr. dr. Umi S Intansari, M.Kes., Sp.PK(K).; Dr. dr. Teguh Triyono, M.Kes., Sp.PK(K).

2017 | Tesis-Spesialis | SP ILMU PATOLOGI KLINIK

Latar belakang: Infeksi dengue adalah penyakit virus yang ditularkan melalui perantara nyamuk. Morbiditas dan mortalitas yang tinggi dengan epidemi yang luas mengundang peneliti untuk terus mempelajarinya. Penyebab kematian tersering adalah syok karena kebocoran plasma dan perdarahan. Infeksi ringan dengue fever (DF) mempunyai risiko berkembang menjadi infeksi dengue berat (dengue haemorrhagic fever ( DHF)/ dengue shock syndrome (DSS)). Perjalanan penyakit infeksi virus dengue sulit diramalkan. Kebocoran plasma dan trombositopenia pada infeksi dengue berhubugan dengan peningkatan sitokin. Interleukin (IL)-10 merupakan salah satu sitokin yang berperan dalam perburukan klinis infeksi dengue. Tujuan: Penelitian ini bertujuan untuk mengetahui hubungan kadar IL-10 pada fase akut infeksi dengue dengan jumlah trombosit dan peningkatan hematokrit Metode: Penelitian ini merupakan penelitian observasional prospektif. Subjek penelitian adalah pasien suspek infeksi dengue berdasar kriteria WHO 2011. Pengambilan sampel secara konsekutif pada pasien yang dirawat di Instalasi Kesehatan Anak, Penyakit Dalam RSUP Dr. Sardjito Yogyakarta. Pemeriksaan darah lengkap diambil saat masuk rumah sakit kemudian dipantau nilai hematokrit dan jumlah trombosit. Delta hematokrit dihitung berdasar selisih hematokrit tertinggi pada fase akut dengan hematokrit terendah pada fase konvelesen dan data trombosit diambil dari jumlah terendah selama pasien dirawat. Pemeriksaan darah lengkap diukur dengan menggunakan alat Sysmex dan ADVIA. Interleukin10 diperiksa menggunakan metode Enzyme-Linked Immunosorbent Assay (ELISA). Data dianalisis scara statistik dengan menggunakan uji korelasi Spearman. Hasil: Selama periode waktu penelitian terdapat 70 subjek yang memenuhi kriteria inklusi, terdiri dari 35 pasien infeksi dengue ringan (DF) dan 35 pasien infeksi dengue berat (DHF dan DSS). Didapatkan median kadar IL-10 pada fase akut 45,1 (1,7- 456,4) pg/mL, rerata delta hematokrit (10+-6)%, median jumlah trombosit terendah 31 (7-139) x103/mcgL. Kesimpulan: Kadar IL-10 secara signifikan berkorelasi positif kuat dengan delta hematokrit (r= 0,776 ; p<0.0001) dan berkorelasi negatif kuat dengan jumlah trombosit rendah (r= - 0,787; p<0.0001)

Background: Dengue infection is a mosquito borne disease caused by viral. High morbidity and mortality with wide spread epidemy leads the disease to attracting scientists to continue to explore it. The most common cause of death is shock due to plasma leakage and bleeding. Dengue fever could become severe dengue infection (Dengue Haemorrhagic Fever ( DHF)/ Dengue syok syndrome (DSS)) progressively. Progressivity of dengue virus infection is difficult to be predicted. Plasma leakage and thrombositopenia in dengue infection is associated with increase of cytokine. Interleukin (IL)-10 may be suspected as one of the cytokines that play a role in severity of dengue fever. Objective: The aim of study was to determine correlation of IL-10 in acute phase dengue infection with increased hematocrit and trombocyte count in acute phase patiens. Methode: This is a prospective observasional study. The subject were patient with suspected dengue infection based on WHO criteria 2011. The Subject will be taken consecutively from Dr. Sardjito general hospital. Complete blood count examination was taken at the hospital and then monitored the hematocrit values and platelet counts. Delta hematocrit is calculated based on the highest hematocrit in acute phase difference with the lowest in konvalescent phase and the platelet count is the lowest amount during patient treated. Complete blood count were measured with Sysmex and Advia hematology analyzer. The level of Interleukin10 will determined using Enzyme-Linked Immunosorbent Assay (ELISA) method. The proportion and differences test will be performed between groups based on subject characteristics. The data were analized statistically using Spearman correlation. Result: During the study period there were 70 subjects included, consist of 35 non severe dengue (DF) and 35 severe dengue (DHF/DSS) subjects. This study found the median value of IL-10 in acute phase dengue was 45.1 (1.7- 456.4) pg/mL, The mean of delta hematocrit was (10+-6)%, and the median of the lowest thrombocyte count was 31 (7-139) x10 3 /mcgL. Conclusion: In acute phase dengue the IL-10 levels has a strong positive correlation with delta hematocrit (r= 0.776 ; p<0.0001) and a strong negative correlation with lowest thrombocyte count (r= - 0.787 ; p<0.0001)

Kata Kunci : infeksi dengue, interleukin 10, delta hematokrit, jumlah trombosit terendah, dengue infection, interleukin 10, delta hematocrit, lowest thrombocyte count