HUBUNGAN NEURON SPECIFIC ENOLASE (NSE) SERUM DENGAN DEFISIT NEUROLOGIS STROKE INFARK

dr. Noor Kamariah, dr. Setyawati, Sp.PK(K).

2011 | Tesis | S2 Ked.Klinik/MS-PPDS

Stroke infark merupakan penyebab kematian dan kecacatan di dunia. Penanganan stroke ditentukan oleh diagnosis dan prognosis yang akan terjadi dan penilaiannya berdasarkan pemeriksaan klinis dan pemeriksaan penunjang. Analisis terhadap serum biomarker untuk monitoring kerusakan jaringan sistem syaraf pusat di level subklinik sangat dibutuhkan. Monitoring tersebut antara lain terhadap adanya protein maupun enzim spesifik yang berasal dari sel astroglia maupun neuron dalam darah tepi. Salah satu biomarker yang diusulkan adalah Neuron Spesific Enolase (NSE) yang diyakini mempunyai hubungan positif dengan derajat keparahan stroke infark. Tujuan penelitian ini adalah untuk menguji hubungan kadar NSE serum dengan defisit neurologis stroke infark. Penelitian ini merupakan cross sectional study yang berbasis hospitale based yang membahas hubungan kadar NSE serum dengan defisit neurologis pada stroke infark. Penilaian defisit neurologis pada penelitian ini menggunakan Skala Stroke Gadjah Mada (SSGM). Populasi target penelitian adalah semua penderita stroke infark akut ≥ 24 jam setelah onset yang dirawat di RSUP Dr Sardjito Yogyakarta. Populasi terjangkau, adalah pasien stroke infark yang dirawat di Unit Stroke RSUP Dr Sardjito Yogyakarta. Sampel penelitian ini adalah penderita baru yang dirawat di Unit Stroke RSUP Dr Sardjito Yogyakarta, yang mendapatkan diagnosis stroke infark akut berdasarkan Head CT scan secara berurutan antara bulan September – Desember 2010. Pemeriksaan kadar NSE serum menggunakan metode sandwich ElectroCheluminescence ImmunoAssay (ECLIA) dengan alat Cobas e 411. Data karakteristik subyek penelitian ditampilkan secara deskriptif. untuk melihat adanya hubungan antara kadar NSE serum dengan skor SSGM dan volume infark pada seluruh subjek penelitian digunakan analisis Pearson correlation jika data berdistribusi normal atau Spearman correlation untuk data yang terdistribusi tidak normal. Kenormalan distribusi data dilakukan dengan Uji Kolmogorov Smirnov, nilai p<0,05. Perhitungan statistik menggunakan batas kemaknaan p<0,05 dengan interval kepercayaan 95%. Hasil penelitian ini diharapkan terdapat hubungan signifikan antara kadar NSE serum dengan defisit neurologis stroke infark.

Ischemic stroke is a leading cause of death and disability in the world. The management of stroke is determined by the diagnosis and prognosis that will happen and the assessments is based on clinical examination and work up studies. Analysis of serum biomarker to monitor the central nervous system tissue damage in subclinical level is urgently needed. Among those monitors detects the specific proteins or enzymes derived from astroglia and neuronal cells in the peripheral blood. One of the proposed biomarker is a Neuron specific Enolase (NSE) which is believed to have a positive correlation with the severity of ischemic stroke. The objective of this study is to test the relationship between serum NSE levels with neurologic deficits in ischemic stroke. This is a hospital-based cross sectional study, which assess the relationship between serum NSE levels with neurological deficits in ischemic stroke. The assessment of neurological deficits in this study is done by Skala Stroke Gadjah Mada (SSGM, Gadjah Mada University Stroke Scale). the target population is all patients with acute ischemic stroke ≥ 24 hours after onset who were treated at Dr Sardjito Hospital, Yogyakarta. The reachable population is ischemic stroke patients treated in the Stroke Unit of Dr Sardjito hospital, Yogyakarta. The study sample is new consecutive patients who were treated at the Stroke Unit of Dr Sardjito hospital Yogyakarta, diagnosed with acute ischemic stroke based on Head CT scan between the September and December 2010. serum NSE will be measured with a sandwich ElectroCheluminescence immunoassay (ECLIA) method with a Cobas e 411 instrument. The data characteristics will be presented as the result of descriptive analysis. To find any correlation between serum NSE levels and SSGM score as well as infarct volume in all subjects, we will use Pearson correlation analysis if data has a normal distribution or the alternative Spearman correlation for skewed data. Normality of data distribution will be assessed by Kolmogorov Smirnov test, with p value <0.05. Statistical analysis will be conducted with significance cut off of p<0.05 and 95% confidence interval. The results of this study are expected to show a significant correlation between serum NSE levels with neurologic deficits of ischemis stroke.

Kata Kunci : Stroke infark akut, NSE serum, defisit neurologis