KORELASI ANTARA KADAR FERITIN SERUM DAN FUNGSI KOGNITIF PADA ANAK DENGAN THALASSEMIA MAYOR

HASTUTI INDRA RETNANI, Prof. dr. Djauhar Ismail, MPH, Ph.D, Sp.A.(K)

2013 | Tesis | S2 Ked.Klinik/MS-PPDS

Abnormalitas fungsi kognitif pada anak thalassemia mayor masih kontroversial dan diduga berkaitan dengan anemia kronis dan tingginya kadar feritin serum. Kadar feritin serum yang tinggi dapat masuk melalui sawar darah otak dengan mekanisme yang belum jelas dan diduga menjadi penyebab gangguan fungsi kognitif akibat neurogenerasi sel oleh radikal bebas dari besi. Tujuan : Mengetahui korelasi kadar feritin serum dan fungsi kognitif anak thalassemia mayor. Metode : Studi potong lintang. Subyek penelitian adalah anak dengan thalassemia mayor usia 5-<16 tahun. Pengukuran kadar feritin dilakukan dengan metode ELFA, tes fungsi kognitif dengan tes WISC. Hasil : Enam puluh tiga anak diteliti. Nilai abnormal pada verbal IQ 36,5%, performance IQ 46,0% dan full IQ 46,0%. Rerata kadar feritin serum adalah 4082,13 (+3141,71) μg/L. Terdapat korelasi antara kadar feritin serum dan performance IQ (r = -0,284, p = 0,024), namun tidak terdapat korelasi bermakna antara kadar feritin serum dengan verbal IQ (r = -0,034, p = 0,789) dan full IQ (r = -0,165, p = 0,195). Analisis regresi linier multivariat menunjukkan variabel yang berkontribusi terhadap performance IQ adalah kadar feritin serum (β= - 0,001, p = 0,011, 95% CI -0,003 sd -0,0003), frekuensi transfusi (β= 8,969, p = 0,021, 95% CI 1,387 sd 16,550), dan status pendidikan anak (β= 15,816, p = 0,023, 95% CI 2,222 sd 29,410). Status pendidikan anak berkorelasi dengan full IQ (β= 18,038, p = 0,018, 95% CI 3,242 sd 32,834). Simpulan : Tingginya kadar feritin serum berkorelasi dengan rendahnya fungsi kognitif pada anak thalassemia mayor secara spesifik pada performance IQ.

Cognitive abnormalities in thalassemia major is controversial and hypothetically related to chronic anemia and high levels of serum ferritin. High serum ferritin can go through blood brain barrier by unclear mechanisms and may cause impaired cognitive function by neurogeneration from iron free radicals. Objective : To determine the correlation between serum ferritin levels and cognitive function in thalassemia major children. Methods : Cross-sectional design. Subjects were children with thalassemia major aged 5-<16 years old. Ferritin measurements performed by ELFA and cognitive function by WISC test. Results : Sixty three children was included. Abnormal value in verbal IQ were 36.5%, performance IQ were 46.0% and full IQ were 46.0%. Mean serum ferritin level was 4082.13 (+3141.71) μg/L. There was correlation between serum ferritin levels and performance IQ (r = -0.284, p = 0.024), but no significant correlation with verbal IQ (r = -0.034, p = 0.789) and a full IQ (r = - 0.165, p = 0.195). Multivariate linear regression analysis showed, variables which have contribution in performance IQ were serum ferritin levels (β = -0.001, p = 0.011, 95% CI - 0.003 to -0.0003), frequency of transfusions (β = 8.969, p = 0.021, 95% CI 1.387 to 16.550), and children’s educational status (β = 15.816, p = 0.023, 95% CI 2.222 to 29.410). Children’s educational status was correlated with full IQ (β = 18.038, p = 0.018, 95% CI 3.242 to 32.834). Conclusions : High serum ferritin level correlated with low cognitive function in thalassemia major children specifically in performance IQ.

Kata Kunci : thalassemia mayor, kadar feritin serum, fungsi kognitif