Hubungan antara kadar Zinc Serum dengan angka limfosit total pada penderita sirosis hati

SIDIQ, Nurman, dr. Siti Nurdjanah, M.Kes.,SpPD-KGEH

2006 | Tesis | PPDS I Ilmu Penyakit Dalam

Latar belakang. Pada penderita sirosis hati kerap terjadi infeksi karena penurunan status imun. Defisiensi nutrisional merupakan penyebab terbanyak penurunan status imun, diantaranya adalah defisiensi Zinc. Zinc merupakan trace element yang berperan dalam sistem imun non-spesifik maupun spesifik. Pada sistem imun spesifik, defisiensi Zinc menyebabkan penurunan proliferasi dan fungsi limfosit sentral maupun perifer. Hasil penelitian ini diharapkan dapat menjadi dasar penelitian dan pengobatan sirosis hati. Tujuan penelitian. Untuk mengetahui hubungan antara kadar Zinc serum dengan angka limfosit total pada penderita sirosis hati. Metode/cara penelitian. Penelitian dilakukan secara potong lintang antara bulan Agustus 2004 sampai bulan September 2005 pada penderita sirosis hati yang kontrol di Poliklinik Gastroenterohepatologi dan penderita yang dirawat inap di Instalasi Rawat Inap RS Dr. Sardjito. Subyek penelitian dikelompokkan berdasar kriteria Child-Pugh, dan diperiksa kadar Zinc serum dan dengan metode atomic absorbance spectrophotometry, dan hitung darah lengkap dengan automatic hematology analyzer. Hasil. Didapatkan 82 subyek yang terdiri atas 59 (72,0%) laki-laki dan 23 (28,0%) wanita. Rerata umur adalah 58,49 ± 12,69 tahun, terbanyak pada dekade ke lima. Berdasar kriteria Child Pugh A, B dan C didapatkan masing masing 35 (42,7%), 37 (45,1%) dan 10 (12,28%) penderita. Rerata kadar Zinc serum didapatkan 11,4960 ± 2,1221 μmol/L, dan defisiensi Zinc didapatkan pada 46 (56,1%) penderita. Rerata kadar Zinc dan proporsi penderita dengan defisiensi Zinc tidak berbeda berdasar kriteria Child-Pugh. Rerata angka limfosit total didapatkan 1,5182 ± 0,8085 103 sel/mmk, limfopenia didapatkan pada 51 (62,2%) penderita. Tidak didapatkan hubungan yang bermakna antara kadar Zinc serum dengan angka limfosit total pada penelitian ini. Angka limfosit total berhubungan bermakna dengan kadar hemodlobin, angka lekosit, dan angka trombosit. Diduga penurunan angka limfosit total lebih berkaitan dengan hipersplenisme. Simpulan. Pada penderita sirosis hati didapatkan kadar Zinc serum dan angka limfosit total yang rendah, namun kadar Zinc serum tidak berhubungan dengan angka limfosit total.

Background. Patients with liver cirrhosis is susceptible for infection due to deterioration of the immune system. Nutritional deficiency, especially Zinc deficiency, that is often found in patients with liver cirrhosis causes deterioration in both specific and non-specific immune system. In specific immune system, Zinc deficiency decreases central and peripheral lymphocyte function and proliferation. Objectives. This study was aimed to determinate serum Zinc concentration and its correlation with total lymphocyte count in liver cirrhotic patients. Method. This cross-sectional study was conducted in Dr. Sardjito Hospital. Subjects were patients diagnosed liver cirrhosis and regularly visited to Gastroenterohepatology ambulatory clinic or patients hospitalized in Internal Medicine ward. Subjects were grouped into three classes of Child-Pugh, and were examined for serum Zinc concentration and complete blood count count. Results. There were all 92 subjects consisted of 59 (72,0%) men and 23 (28,0%) women. Mean of age was 58,49 ± 12,69, majority was within fifth decade. Subjects grouped into Child-Pugh class A, B, and C were 35 (42,7%), 37 (45,1%) and 10 (12,28%) patients respectively. Mean of serum Zinc concentration level was 11,4960 ± 2,1221 μmol/L, and Zinc deficiency found in 46 (56,1%) patients. The Serum Zinc level was not correlated with Child-Pugh criteria. Mean total lymphocyte count was 1,5182 ± 0,8085 103 cells/mmk, and lymphopenia found in 51 (62,2%) patients. There was no statistically significant correlation of serum Zinc concentration with total lymphocyte count in liver cirrhotic patients. Total lymphocyte count was correlated significantly to hemoglobin level, leukocyte count, and thrombocyte count. It suggested that total lymphocyte count was resulted from hypersplenism. Conclusion. The serum Zinc concentration level and total lymphocyte count decreased in liver cirrhotic patients, but there was no statistically significant correlation.

Kata Kunci : Zinc, sistem imun spesifik, sirosis hati, specific immune system, liver cirrhosis