KOMBINASI TERBAIK ANTARA TRIAMCINOLONE ACETONIDE DAN 5-FLUOROURACIL SEBAGAI OBAT ANTIKELOID KAJIAN in vitro PADA SEL FIBROBLAS KELOID

ANDREAS ARIAWAN, dr. Ishandono D, SpB,SpBPRE.; dr.Yohanes Widodo Wirohadidjojo, SpKK (K)

2018 | Tesis-Spesialis | ILMU BEDAH

Latar Belakang: Individu berkulit gelap cenderung mengalami keloid. Keluhan yang sering dirasakan yaitu gatal, nyeri saat bergerak, menyebabkan kontraktur, dan tampak buruk secara estetika. Keloid terbentuk karena proliferasi fibroblas berlebihan dan adanya peningkatan sintesis kolagen. Terapi dari keloid adalah dengan menghambat inflamasi, proliferasi fibroblas, maupun sintesis kolagen. Triamcinolone acetonide (TAC) sering digunakan sebagai obat antikeloid. Kombinasi TAC dan 5-Fluorouracil (5-FU) dilaporkan lebih efektif dibanding TAC tunggal. Penelitian ini menggunakan beberapa kombinasi TAC dan 5-FU untuk menekan proliferasi fibroblas dan sintesis kolagen. Tujuan: Mengetahui perbandingan TAC dan 5-FU terbaik untuk menekan proliferasi fibroblas keloid. Mengetahui perbandingan TAC dan 5-FU terbaik untuk menekan sintesis kolagen. Metode: Penelitian in vitro dengan rancangan eksperimental menggunakan fibroblas keloid dari jaringan keloid pasien yang telah menandatangani informed consent. Proliferasi fibroblas diukur menggunakan uji MTT, sedangkan sintesis kolagen diukur menggunakan uji Sirius Red. Hasil dan pembahasan: Indeks proliferasi fibroblas kombinasi TAC dan 5-FU terendah adalah 53,19% lebih baik daripada TAC tunggal yaitu 73,15% (p<0,05). Indeks sintesis kolagen kombinasi TAC dan 5-FU terendah adalah 57,98% lebih baik daripada TAC tunggal yaitu 71,03% (p<0,05). Hasil indeks proliferasi fibroblas dan sintesis kolagen dari 5-FU lebih baik dari kombinasi TAC dan 5-FU yaitu 34,73% dan 45,48%. 5-FU tunggal memiliki efek samping nyeri, eritema lokal, hiperpigmentasi, kulit lecet, dan rekurensi tinggi. Kesimpulan: Perbandingan terbaik untuk menekan proliferasi fibroblas dan sintesis kolagen adalah 17,38 mc g/mL TAC dan 0,5 mg/mL 5-FU. Kombinasi tersebut lebih efektif menekan proliferasi fibroblas yang merupakan target terapi keloid daripada kombinasi yang lain.

Background: Individuals with dark skin tend to have keloids. They often complaining of itching, pain on moving, contractures, and aesthetically not good. Keloids are formed by excessive fibroblasts proliferation and an increase in collagen synthesis. Therapy for keloids is to inhibit inflammation process, proliferation of fibroblasts, as well as collagen synthesis. Triamcinolone acetonide (TAC) is often used as an antikeloidal drug. The combination of TAC and 5- Fluorouracil (5-FU) was reported to be more effective than a single TAC. This study used several combinations of TAC and 5-FU to suppress fibroblasts proliferation and collagen synthesis. Objective: To determine the best combination of TAC and 5-FU to suppress the proliferation of keloid fibroblasts. To determine the best combination of TAC and 5-FU to suppress collagen synthesis. Methods: In vitro study with experimental design using keloid fibroblasts taken from patients keloid who had signed informed consent. Proliferation of fibroblasts was measured using the MTT test, whereas collagen synthesis was measured using the Sirius Red test. Results and discussion: The lowest fibroblast proliferation index from the combination of TAC and 5-FU was 53.19% better than single dose of TAC which was 73.15% (p <0.05). The lowest collagen synthesis index from the combination of TAC and 5-FU was 57.98% better than single dose of TAC which was 71.03% (p <0.05). Results of fibroblast proliferation index and collagen synthesis index of 5-FU were better than TAC and 5-FU combination of 34.73% and 45.48%. Single dose 5-FU has side effects of pain, local erythema, hyperpigmentation, sloughing, and high recurrence. Conclusions: The best combination dose to suppress proliferation of fibroblasts and collagen synthesis were 17.38 mcg/mL TAC and 0.5 mg/mL 5-FU. This combination is more effective in suppressing the proliferation of fibroblasts which are the target of the keloid therapy than any other combination

Kata Kunci : keloid, fibroblas, Triamcinolone acetonide, 5-FU, proliferasi fibroblas, sintesis kolagen, keloid, fibroblast, Triamcinolone acetonide, 5-FU, fibroblast proliferation, collagen synthesis