DISFUNGSI OTONOM PADA KERACUNAN KRONIS PESTISIDA ORGANOFOSFAT

HARDIAN, DR., Prof.dr. Sri Kadarsih S, AIFM, MSc. Ph.D.; Dr. Med. Dr. Indwiani Astuti .

2016 | Disertasi | S3 Ilmu Kedokteran

Latar belakang Pajanan pestisida organofosfat dalam bentuk tunggal atau campuran secara kronis dapat menyebabkan disfungsi otonom yang berhubungan dengan rendahnya aktifitas asetilkolinesterase eritrosit dan kadar asetilkolinesterase plasma dan tingginya kadar nerve growth factor (NGF) plasma. Metode Penelitian kasus-kontrol dilakukan di Kecamatan Ngablak, Magelang. Kelompok kasus adalah petani holtikultura dengan disfungsi otonom (n=26). Kelompok kontrol subyek yang tidak mengalami disfungsi otonom (n=26). Pemeriksaan aktifitas asetilkolinesterase eritrosit dilakukan dengan pemeriksaan metode reactive paper kit, pemeriksaan kadar asetilkolinesterase plasma dan kadar NGF plasma dilakukan dengan metode ELISA. Disfungsi otonom dinilai dengan Ewing test dan derajat disfungsi otonom dinilai dengan Autonomic Dysfunction Score (ADS). Uji statistik yang digunakan adalah uji t-tidak berpasangan, uji Mann-Whitney, uji Chi Square, uji Fisher-Exact, analisis ROC, uji tegresi logistik. Hasil Aktifitas asetilkolinesterase eritrosit pada subyek dengan disfungsi otonom adalah 59,6,40 lebih rendah secara bermakna dibanding subyek tanpa disfungsi otonom 63+-15,20% (p=0,04). Kadar astilkolinesterase plasma subyek dengan disfungsi otonom 4,36+-0,952, subyek tanpa disfungsi otonom 8,31+-0,742 (p<0,001). Kadar NGF subyekdisfungsi otonom 3129,7 +-1241,12 pg/mL, subyek tanpa disfungsi otonom 556,6+-533,44 pg/mL (p<0,001). Derajat disfungsi otonom berkorelasi negatif dengan aktifitas asetilkolinesterase eritrosit (r= -0,33; p=0,02) dan kadar asetilkolinesterase plasma (r= -0,87; p<0,001). Derajat disfungsi otonom berkorelasi positif dengan kadar NGF plasma (r= 0,77; p<0,001). Kesimpulan Pada keracunan kronis organofosfat dijumpai aktifitas asetilkolinesterase eritrosit dan kadar asetilkolinesterase yang rendah serta kadar NGF yang tinggi. Aktifitas asetilkolinesterase eritrosit, kadar asetilkolinesterase plasma dan kadar NGF berhubungan dengan derajat berat disfungsi otonom.

Background Chronic exposure of single or mix organophosphate pesticide may cause autonomic nerve dysfunction that related to low level of erythrocyte acetylcholinesterase, low level plasma acetylcholinesterase concentration and high plasma NGF concentration Methods A case-control study was conducted in Ngablak District, Magelang regency. Subjects on case group were 26 farmer with autonomic dysfunction and subjects on control group were 26 farmer without autonomic dysfunction. Activity of erythrocye acetylcholinesterase was measured by reactive paper kit. The level of plasma acetylcholinesterase and NGF were measured by ELISA method. Autonomic dysfunction was determined by Ewing Test and the severity of autonomic dysfunction was assessed by Autonomic Dysfunction Score (ADS). Others data were collected by spesific questionnaire. Independent t-test, Mann-Whitney, chi square, Fisher-exact test, ROC and multivariate logistic regression analysis were used for data analysis. Results Activity of erythrocye acetylcholinesterase of autonomic dysfunction group was 59,6+-2,40 %, significantly lower than without autonomic dysfunction group 63,0+-15,20% (p=0,04). The levels of plasma acetylcholinesterase of subjects with autonomic dysfunction was 4.36+- 0.952, significantly lower than subjects without autonomic dysfunction was 8.31 +-0.742 (p <0.001). Levels of NGF on subjects with autonomic dysfunction was 1241.12 +-3129.7 pg / mL, significantly higher than subjects without autonomic dysfunction was 556, 6+- 533.44 pg/mL (p <0.001). Degree of autonomic dysfunction were negatively correlated to activity of erythrocye acetylcholinesterase (r= -0,33; p=0,02) and plasma level of acetylcholine-esterase (r= -0,87; p<0,001). Degree of autonomic dysfunction were positevely correlated to plasma NGF level (r= 0,77; p<0,001). Conclusion Chronic exposure of organophosphate cause lower erythrocyte acetylcholineesterase activity and lower of plasma level of acetylcholineesterase and high NGF blood level. Activity of erythrocyte acetylcholineesterase activity and lower of plasma level of acetylcholineesterase and high NGF blood level correlated to degree of autonomic dysfunction.

Kata Kunci : Organofosfat, disfungsi otonom, asetilkolinesterase, NGF, Organophosphate, autonomic dysfunction, acetylcholinesterase