PENGARUH PAPARAN KLORIN TERHADAP SITOLOGI MUKOSA HIDUNG PERENANG DI YOGYAKARTA

Muhammad Amrullah Al Faqih, dr. Siswanto Sastrowijoto, SpTHT-KL, MH.; dr. Luh Putu Lusy Indrawati MKes, SpTHT-KL(K).

2015 | Tesis-Spesialis | S2 Ilmu Penyakit THT

Latar Belakang: Klorin banyak digunakan dalam proses disinfeksi air kolam renang. Renang merupakan salah satu olahraga yang dapat meningkatkan kualitas hidup dan kesehatan. Perenang memiliki prevalensi lebih tinggi terkena gangguan pernafasan, asma, dan radang saluran napas akibat paparan klorin di kolam renang. Hidung secara fisiologis berfungsi sebagai pertahanan lini pertama pada saluran nafas terhadap paparan polutan. Paparan klorin dalam jangka waktu lama dapat menyebabkan hiperreaktifitas dan reaksi inflamasi, akibatnya dapat terjadi perubahan epitel mukosa hidung berupa metaplasia, displasia, dan neoplasia. Tujuan penelitian: Penelitian ini bertujuan untuk mengetahui bukti pengaruh klorin terhadap sitopatologi mukosa hidung perenang dibandingkan bukan perenang di Daerah Istimewa Yogyakarta. Metode: Rancang penelitian potong lintang. Subyek penelitian adalah perenang sebagai kelompok terpapar klorin di kolam renang dan subyek bukan perenang di D.I. Yogyakarta. Masing-masing kelompok berjumlah 28 orang. Dilakukan pengambilan spesimen dari 1/3 anterior konka nasalis inferior dengan sikat sitologi hidung. Dilakukan pemeriksaan papanicolau untuk penilaian sitopatologi mukosa hidung. Analisis statistik yang digunakan adalah uji independent sample t-test dan analisis regresi linier. Hasil: Didapatkan sampel penelitian sebanyak 56 orang. Jenis kelamin laki-laki sebanyak 34 orang (60,7%), sedangkan perempuan sebanyak 22 orang (39,3%). Hasil pengukuran kadar klorin di kolam renang sebesar 3 mg/L. Frekuensi terbesar hasil sitologi tidak normal terdapat pada kelompok terpapar sebanyak 22 orang (39,3%). Pada kelompok yang tidak terpapar sebanyak 17 orang (30,4%)didapatkan hasil sitologi mukosa normal dan sebanyak 11 orang (19,6%)dengan hasil sitologi mukosa tidak normal . Nilai p = 0,003 (p < 0,05); RP = 5,667; 95 CI = 1,743-18,423. Didapatkan perbedaan bermakna secara statistik antara kedua kelompok. Paparan klorin berpengaruh terhadap kejadian sitopatologi mukosa hidung tidak normal. Jika terpapar klorin secara terusmenerus maka berisiko 5,6 kali untuk kejadian sitologi mukosa hidung yang tidak normal (inflamasia, metaplasia, atau displasia). Kesimpulan: terdapat pengaruh paparan klorin terhadap gambaran sitopatologi integritas mukosa hidung pada perenang dibandingkan bukan perenang di Yogyakarta.

Background: Chlorine is widely used in swimming pool for water disinfection process. Swimming is one of the many sport that can improve the quality of life and health. Swimmers have a higher prevalence of respiratory disorder, asthma, and inflammation of the airways due to exposure to chlorine in swimming pools. Nose physiologically has function as a first-line of defense in the upper airway against exposure to pollutants. Exposure to chlorine in the long term can cause hyperreactivity and inflammatory reactions, consequently may change the form of epithelial such as metaplasia, dysplasia, and neoplasia. Objective: The purpose of this study is to determine the evidence of the effect chlorine against nasal mucosas cytopathology of swimmers than non-swimmers in Yogyakarta. Methods: This study was used cross sectional design. Subjects were swimmers as a group exposured to chlorine in the swimming pool and non-swimmers in Yogyakarta. There was 28 subject in each group. The specimens were taken from 1/3 inferior nasal turbinate with nasal cytology brushing. Cytopathology assessment of the nasal mucosa was using Papanicolau examination. The statistical analysis used was the independent sample t-test and linear regression analysis. Result: the subject of this study were 56 people. Consist of 34 male (60.7%), and 22 female (39.3%). Measurements result of free chlorine in the swimming pool was 3 mg/L. The highest frequency of abnormal cytology results contained in the chlorine exposured group as 22 subjects (39.3%). In the unexposured group 17 subjects (30.4%) showed normal mucosa cytology and 11 subjects (19.6%)showed abnormal mucosa cytology. The p value = 0.003 (p < 0.05); RP = 5.667; 95 CI = 1.743 to 18.423. This study has found significant differences statistically between the two groups. Exposured to chlorine had effect on abnormal nasal mucosa cytopathology. Chronic exposured to chlorine had the risk of 5.6 times of abnormality nasal mucosa cytology (inflammation, metaplasia, or dysplasia). Conclusion: chlorines exposure has effect to nasal mucosa a cytopathology integrity features of swimmers than non-swimmers in Yogyakarta.

Kata Kunci : chlorine, nasal mucosa cytologi, swimmer.