Pengaruh Suplementasi Besi Pada Tuberculosis Paru Dengan Anemia Defisiensi Besi  

Oleh:

Sanusi, Himawan ; Adam, John MF. ; Benyamin, Fachruddin

Jenis: Article from Journal - ilmiah nasional
Dalam koleksi: MEDICINUS (Scientific Journal of Pharmaceutical Development and Medical Application) vol. 23 no. 02 (Jun. 2010), page 7-16.
Topik: interferon-gamma; interleukin-12; iron supplementation; tuberculosis

Ketersediaan

Perpustakaan FK Nomor Panggil: M56.K.01 Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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Isi artikel

Background. Prevalence of Lung Tuberculosis (TB) in Indonesia is about 0.15% ¬0.26%. Iron supplement on the TB patients with iron deficiency ane¬mia (IDA) has several effects such as activating monocyte derived macrophage (MDM) and interferon-gamma (IFN-?), with a positive feed-back mechanism pushing interleukin-12 (IL -12). The objective of this research is to find out the influence of iron supplement on reco¬very responses, immune responses, and resistance on the TB patients with IDA without chronic disease anemia, no acute or chronic infec¬tions, and good nutrition status. Method. Randomized clinical trial with simple randomized pre-test - post-test control group design on 252 respondents in a triple blind manner. The respondents are those having the category 1 active pulmonary TB with IDA according the World Health Organization (WHO) standard, recei¬ving the directly observed treatmenshortcourse (DOTS) strategy treat¬ment. The experimental group consists of 126 respondents, treated with a therapy of 2 RHZE/4 R3H3 and 3 x 200 mg sulfate ferrosus con¬taining 60 mg ferro-sulfate hepta-hydrate for the first 2 months, and 3 times a week for the next 4 months. The control group consists of 126 respondents, treated with a therapy of 2 RHZE I 4 R3H3 and pla¬cebo. Independent variable was iron supplementation, while depen¬dent variable were Acid FastBaccili (AFB) smears, IFN-?, IL-12, MDR-TB, hemoglobin, serum tranferrin Receptor (sTfR), and Body Mass Index (BMI). Data analysis is conducted with SPSS t-test Version 15 (2007). Results. The pre-therapy data normality test is executed to find out the ages, IFN-?, IL-12, hemoglobin, sTfR, and BMI by using the Kolmogorov¬-Smirrnov test. Only the normally-distributed IL-12 data on both con¬trol and experimental groups (p>0.05).Furthert analysis used the non¬parametric analytic except for IL-12. Thus, the post-therapy data show that all variables showed at least one of the groups (control group or experimental group) is not normally-distributed (p<0.05). The analysis results of delta data of study variables between the control group vs. experimental group are: 1) increased sputum AFB conver¬sion in the experimental group + 100% (p<0,05). 2) increased IFN-? in the experimental group + 324,84% (p<0,05). 3) increased IL-12 in the experimental group +364,42% (p<0,05). 4) decreased MDR-TB in the experimental group -100% (p<0,05). 5) increased haemoglobin in the experimental group +47,96% (p<0,05). 6) decreased sTfR in the experi-mental group -68,54% (p<0,05) .7) increased BMI in the experimental group +45,63% (p<0,05). 8) inhibited single - basa mutation CCT-Ar¬ginin, and multiple - basa mutation histidin-Ieusin GGC TGA DNA MTB. 9) haemoglobine threshold for MDR-TB risk was 9,5gr%, sTfR 60,26 pg/ml, IFN-? 14,58 pg/ml, IL-12 15,56 pg/ml, and BMl less than 18,5 kg/m2. 10) haemoglobine highest risk threshold was 15 gr% to prevent infection MTB worsening. The results of logarithmic data t-test of all variables are highly significant (p<0.00), except BMI was significantly increases (p<0.05); Mann-Whitney test of delta data, highly significant differences were found (p<0.00).ln the control group 9 multiple-basa mutations as the causes of MDR-TB were found. Conclusions. Iron supplement on the TB with IDA increases: sputum AFB conver¬sion, IFN-?, IL -12, hemoglobin, BMI, decreases sTfR and MDR-TB. In other group which no iron supplementation there are 9 multiple-basa mutations as the causes of MDR-TB.

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