Kadar c-reactive protein darah selama pengobatan dengan obat anti tuberkulosis kombinasi dosis tetap tahap intensif dan hubungannya dengan konversi kuman pada pasien tuberkulosis paru dewasa bta positif di Yogyakarta

SETIYAWATI, Fitri Indah, Dr. Erna Kristin, M.Si., Apt

2010 | Tesis | S2 Ilmu Kedokteran Dasar dan Biomedis

Latar Belakang: Tuberkulosis (TB) masih menjadi penyakit infeksi saluran napas tersering di dunia dan Indonesia. Strategi DOTS yang selama ini digunakan cukup efektif dalam mengatasi masalah tuberkulosis di beberapa daerah. Meskipun demikian, angka prevalensi tuberkulosis di Indonesia masih cukup tinggi. Proses pengobatan TB yang cukup lama sering menyebabkan pasien putus berobat atau menjalankan pengobatan secara tidak teratur. Kedua hal itu dapat menyebabkan resistensi. Efektivitas dan respon pengobatan dievaluasi dengan metode pemeriksaan konversi kuman. Akan tetapi metode standar tersebut memiliki keterbatasan yakni hanya dapat dilakukan beberapa bulan setelah pengobatan sehingga tidak dapat dengan segera mengetahui respon pengobatan. Untuk itu maka diperlukan suatu metode pemeriksaan yang lebih cepat. Salah satu protein fase akut seperti C-reactive protein (CRP) memungkinkan digunakan untuk mengevaluasi respon pengobatan karena protein ini sangat sensitif terhadap perubahan patologis dalam tubuh. Tujuan: Mengetahui kadar CRP selama pengobatan OAT fase intensif dan hubungannya dengan konversi sputum pada penderita TB paru dewasa BTA + yang mendapat OAT-KDT. Metode: Sebanyak 42 subyek dengan TB paru dewasa BTA positif dievaluasi sebanyak 2 kali, yakni sebelum dan sesudah pengobatan OAT tahap intensif. Kadar CRP diukur dengan teknik imunometri, sedangkan konversi sputum ditetapkan dengan pengecatan Ziehl Nielson. Analisis statistik dengan menggunakan program SPSS dan EpiInfo. Kata kunci : tuberkulosis, OAT-KDT, CRP, konversi kuman Hasil: Median kadar CRP sesudah pengobatan lebih rendah secara bermakna dibandingkan dengan sebelum pengobatan (6,50 (5,00-19,00) mg/L (median)(25-75 persentil) versus 35,00 (16,00-63,00) mg/L (median)(25-75 persentil., p<0,05). Subyek pada kelompok gagal konversi memiliki median kadar CRP yang lebih tinggi dibandingkan subyek pada kelompok berhasil konversi, yakni 27,00 (17,00-27,00) mg/L versus 6,00 (5,00-12,00) mg/L. Sensitivitas CRP cukup tinggi (86%). Resiko gagal konversi pada subyek dengan kadar CRP abnormal adalah 9,75 kali lebih besar dari pada subyek dengan kadar CRP normal (RR= 9,75; 95% CI= 1,29-73,75). Konversi kuman dan kadar CRP terbukti memiliki korelasi, namun lemah. Spesifitas CRP cukup rendah (71%). Kesimpulan: Pengobatan dengan OAT-KDT tahap intensif menurunkan kadar CRP. Penurunan kadar CRP kelompok yang gagal konversi lebih tinggi dibandingkan yang berhasil konversi. Konversi kuman dan kadar CRP memiliki korelasi yang lemah.

Background: Tuberculosis still became respiratorius tract infection problems both in the world and Indonesia. The DOTS strategy became effective manner to counter this disease in several regions in Indonesia, but the prevalence rates still high. The long periode of TB treatment could cause default treatment. This default could caused drug resistency. Recently, treatment effectivity and response were evaluated with sputum conversion examination. This kind of examination had weakness, because the examination done only after several months after treatment, so treatment respon could not known immediately. Based on those, this was urgent to discover other faster method. One kind of acute reactan protein, CRP, may could use to evaluate treatment response because this protein very sensitive with pathologic changes in our body. Objectives: To evaluate serum level concentration of CRP during intensive phase tuberculosis treatment with fixed dose combination drugs and its relation with sputum conversion among adult tuberculosis patients. Method: Fourty two patients with positive sputum smear pulmonary tuberculosis were evaluated at two time points: pretreatment (day 0) and posttreatment (day 56) of intensive phase tuberculosis treatment. Level of CRP were determined using immunodiffusion method in the serum peripheral blood sample. Sputum smear conversion were determined using Ziehl Nielson staining. The SPSS Program and EpiInfo were used to analyzed the data. Results: The median serum level concentration of CRP after treatment were significantly lower than before treatment (6,50 (5,00-19,00) mg/L (median)(25-75 persentil) versus 35,00 (16,00-63,00) mg/L (median)(25-75 persentil., p<0,05). Patients with no conversion had median serum concentration significantly higher than patients with conversion (27,00 (17,00-27,00) mg/L versus 6,00 (5,00-12,00) mg/L. The sensitivity of CRP was high (86%). The relative risk for no conversion in patients with abnormal CRP concentration was 9,75x higher than patients with normal CRP level (RR= 9,75; 95% CI= 1,29-73,75). There was weak correlation between sputum conversion and CRP level. The specivity of CRP was low (71%). Conclusions: Tuberculosis treatment with fixed dose combination drugs during intensive phase could reduced serum level concentration of CRP. Serum level concentration of CRP among patients with conversion was significantly lower than patients with no conversion. There was weak correlation between sputum conversion and CRP level.

Kata Kunci : tuberkulosis, OAT-KDT, CRP, konversi kuman, tuberculosis, fixed-doses combination, sputum conversion, CRP level