HUBUNGAN ANTARA KADAR SUPEROKSID DISMUTASE (SOD) DENGAN ARUS PUNCAK EKSPIRASI PADA ANAK ASMA

Arie Kurniasih, Prof. dr. Madarina Julia, MPH, Ph.D, SpA(K)

2014 | Tesis | S2 Ked.Klinik/MS-PPDS

Pendahuluan: Pasien asma mempunyai risiko yang besar untuk mendapatkan serangan asma selama hidupnya. Asma adalah penyakit kronis yang melibatkan beberapa sel sebagai mediator radang, reactive oxygen species (ROS) dan sitokin. Proses peradangan akan meningkat dengan adanya stress oksidatif. Superoxide dismutase (SOD) adalah enzim pertahanan pertama saluran pernapasan terhadap stress oksidatif. Aktivitas SOD akan berkurang selama serangan asma episode sering, dimana pada saat stress oksidatif meningkat. Berkurangnya kadar SOD mempunyai korelasi dengan kenaikan obstruksi saluran pernapasan dan bronkospasme. Tujuan: Untuk mengetahui korelasi antara kadar SOD dan arus puncak ekspirasi, serta untuk melihat pengaruh kadar SOD dalam menyebabkan serangan asma. Metode: Dilakukan penelitian cross sectional di RS Dr. Sardjito pada Januari hingga April 2011. Subjek penelitian adalah anak penderita asma umur 6-18 tahun. Sampel darah diukur untuk mengetahui kadar SOD dan dilakukan pengukuran arus puncak ekspirasi dengan flowmeter. Hubungan antara kadar SOD dan arus puncak ekspirasi dianalisis dengan korelasi pearson. Analisis multivariat dilakukan untuk mengetahui variabel yang berpengaruh terhadap arus puncak ekspirasi. Studi prospektif dilakukan dengan mengikuti apakah terjadi serangan asma setelah satu bulan pengukuran SOD. Hasil: 39 pasien asma yang mengikuti penelitian, mendapatkan hasil bahwa tidak terdapat hubungan antara superoxide dismutase dengan arus puncak ekspirasi, r (95% CI)= 0,289 (-0,025- 0,47), p=0,074. Umur mempunyai hubungan dengan arus puncak ekspirasi, ß (95%CI) = 0,5 (3,10- 11,57), p = 0,01. Kadar SOD yang rendah meningkatkan risiko terjadinya serangan asma pada bulan berikutnya, RR(95% CI) = 5,5 (1,6 - 18,9), p=0,009. Simpulan: Tidak terdapat hubungan antara kadar superoxide dismutase dengan arus puncak ekspirasi. Penelitian ini menunjukkan ada hubungan antara umur dengan arus puncak ekspirasi dan hubungan antara kadar SOD yang rendah dengan risiko terjadinya serangan asma pada bulan berikutnya.

Background: Asthmatic children have a risk to get asthma attack during their life. Asthma is a chronic inflammatory process which involve variety of cells such as inflammatory mediators, reactive oxygen species (ROS) and cytokines. The inflammatory process would be exacerbated in the presence of oxidative stress. Superoxide dismutase (SOD) is the first important enzyme to protect the respiratory tract against oxidative stress. SOD activity reduce during frequent asthma exacerbations due to increased of stress oxidant. The decreased of SOD has correlation with increased of airway obstruction and bronchospasm.Objective: To asses the correlation between the levels of SOD and peak expiratory flow, second objective was to determine the impact of level SOD in predicting asthma attack. Methods: A cross sectional study was conducted at Dr. Sardjito hospital on January to April 2011. Research subjects were asthmatic children aged 6 -18 years. Blood samples were taken to measure the level of SOD at the same time with peak expiratory flow measurement. The relationship between SOD levels and peak expiration flow was analyzed by pearson correlation. Multivariate analysis was done to determine variable affecting in peak expiratory flow. Prospective study was also performed, children were followed one month after the blood samples were obtained. Results: Of thirty-nine patients enrolled in this study. There was no correlation between levels of superoxide dismutase and peak expiratory flow, r (95% CI) = 0,289 (-0,025 – 0,47), p = 0,074. Age of asthmatic children has relation with peak expiratory flow, ß (95%CI) = 0,5 (3,10 – 11,57), p = 0,01. There was lower level of superoxide dismutase caused a risk of asthma attack, RR (95% CI) = 5,5 (1,6 –18,9), p = 0,009. Conclusions: There was no relationship between the levels of superoxide dismutase with peak expiratory flow. This study showed no correlation between age and peak expiratory flow and the relationship between low SOD levels with risk of asthma attacks in the next month

Kata Kunci : asma, superoksid dismutase, arus puncak ekspirasi, cross- sectional, studi prospektif.