PENGARUH RECOMBINANT HUMAN ERYTHROPOIETIN TERHADAP JUMLAH OSTEOBLAS, OSTEOKLAS DAN KADAR HEMOGLOBIN PADA PENYEMBUHAN FRAKTUR TULANG MANDIBULA Studi Eksperimental pada Fraktur Mandibula Tikus Sprague-Dawley

LUCAS PEDRO BERNADO TAHAPARY, drg Rahardjo SU, Sp.BM; drg. Poerwati Soetji R., Sp.BM

2015 | Tesis-Spesialis | SP ILMU BEDAH MULUT

Recombinant human erythropoietin (rHuEPO) biasanya digunakan pada terapi anemia akibat penyakit ginjal tahap akhir, walaupun demikian reseptor RHuEPO juga ditemukan pada jaringan lain sehingga rHuEPO memiliki efek selain membentuk eritrosit. Manfaatnya dalam penyembuhan tulang masih diperdebatan. Penelitian ini bertujuan mengetahui pengaruh rHuEPO terhadap jumlah osteoblas, jumlah osteoklas dan kadar hemoglobin pada penyembuhan fraktur mandibula. Duapuluh subyek tikus Sprague-Dawley dibuat fraktur inkomplet di simfisis mandibula. Sepuluh subyek kelompok perlakuan mendapatkan injeksi subkutaneus 40 IU rHuEPO alpha selama tujuh hari sedangkan sepuluh subyek kelompok kontrol diinjeksi NaCl 0,9%. Hari ke 7 dan ke 14, lima subyek perlakuan dan lima subyek kontrol diperiksa kadar hemoglobinnya, lalu didekpitasi dan dibuat preparat histologis HE untuk dihitung jumlah osteoblas dan osteoklasnya. Uji T-paired dan ANOVA untuk analisis data berdasar hari pengamatan, sedangkan uji T-Independent untuk data berdasar kelompok. Hasil uji statistik menunjukan bahwa ada perbedaan bermakna (p<0,05) jumlah osteoblas dan osteoklas hari 7 dibandingkan hari 14. Uji berdasar kelompok diperoleh perbedaan signifikan jumlah osteoblas (p=0,003), jumlah osteoklas (p=0,011) hari 7 dan jumlah osteoklas (p=0,001) hari 14. Kadar hemoglobin hari 7 memiliki perbedaan signifikan dibandingkan hari 0 (p=0,001a dan p=0,000b). Injeksi rHuEPO meningkatkan jumlah osteoblas dan osteoklas serta kadar hemoglobi hari 7, pada hari ke 14 hanya osteoklas meningkat bermakna sedangkan osteoblas tidak dan hemoglobin kembali ke nilai basal.

OBJECTIVE: Recombinant human erythropoietin (rHuEPO) is usually used as treatment choice for anemia due to end stage renal disease, but RHuEPO has reseptor in other tissues, so it has non erythroid effect. Its benefits in bone healing is still debated. This study aims to determine the effect of rHuEPO on the number of osteoblasts, osteoclasts and hemoglobin level in mandible fracture healing model. STUDY DESIGN: A controlled incomplete fracture mandibular symphysis was created surgically in twenty subjects of Sprague-Dawley rats. Ten subjects treatment group receive subcutaneous injection of 40 IU rHuEPO alpha for seven days, while ten subjects control got NaCl 0.9%. Hemoglobin of five subjects treatment group and five control were examined, then decapitated for HE histological evaluation on 7th and 14th day respectively. ANOVA and Paired T-test for hemoglobin data analysis based on study day, while the T-Independent test for number osteoblasts and osteoclast data based on study group. RESULT: There were a significant difference on number of osteoblasts and osteoclasts 7th day compared to 14th day (p<0.05). Based on group, it revealed a significant difference in the number of osteoblasts (p=0.003), osteoclasts (p = 0.011) on 7th day, and osteoclasts number (p = 0.001) 14th day. Hemoglobin on 7th day had a significant difference compared to day 0 (p=0,001a and p=0,000b). CONCLUTION: Administration of rHuEPO enhance the number of osteoblasts and osteoclasts as well as hemoglobin on 7th day. On 14th day, only osteoclast number had significant difference and hemoglobin returned to baseline.

Kata Kunci : osteoblasts, osteoclasts, recombinant human erythropoietin (rHuEPO), hemoglobin, mandibular fractures