Pengaruh Suplementasi Kalsium Terhadap Kadar Timbal Darah dan Memori Jangka Pendek Anak yang Terpapar Timbal Secara Kronis

Abstract

Objective : Lead poisoning can irreversibly impair the children’s brain, even with blood lead levels (BLLs) as low as 5 g/dL. Lead competes with Ca2+ in calmodulin binding and disturb the enzyme activity in transcription of genes which affected nervous system. The purpose of this study is to determine the effects of calcium supplementation to decrease BLLs of children at high risk for chronic lead poisoning and to determine it’s effects on short term memory. Methods : Children aged 8 – 12 years lived in the highest traffic density in Medan randomly included in this quasi-experimental study, clinical trial design, divided into two groups (control and group received tablet contain 400 mg oral calcium twice daily for three months). Examination of Blood Lead Levels before and after 3 months of supplementation, as well as the measurement of short-term memory is done by members of the research team who did not know whether the objects included a sample that gets the treatment (got calcium supplements) or not; using the digit span forward test tools, and picture search tools Descriptive statistics were calculated at the beginning and after 3 months of the supplementation. Potential trend change in the levels of lead in the blood is assessed using the paired t test; comparison of two treatment with non pairedt-tests , p< 0.05 was considered significant. Results : The highest Blood Lead levels over all before treatment was 12 μg/dL, the highest after 3 months was 1.9 μg/dL. Blood Lead levels were found in the group treatment after supplementation for 3 months, which means in statistics (beginning; end 2.1; 0.01, p < 0.01). The median decreased of blood lead levels in the Group's treatment is as much as 2.09 μg/dL. Found an increase in score memory picture statistically significantof treatment group (beginning 61.4 ± 24.83; end of 15.97 ± 76.21, p < 0.01). There was an increased score of Digital Memory Span on treatment group of statistically significant (beginning; end, 5; 7, p < 0.01). The relationship between the changes in the levels of lead in blood samples was found with a score of memory picture (of correlation being) and digital memory span (of correlation is weak) (R-0516, 0251 and p. < 0.05) Conclusion : Oral calcium supplementation during a three-month doses of 400 mg, twice a day for children who are exposed to chronic lead can reduce blood lead levels significantly and improve short-term memory.

Tujuan : Keracunan timbal dapat merusak otak anak-anak secara ireversibel, bahkan dengan kadar timbal darah serendah 5 μg/dL. Timbal bersaing dengan Ca2+ di calmodulin binding dan mengganggu aktivitas enzim dalam transkripsi gen yang mempengaruhi sistem saraf. Tujuan dari penelitian ini adalah untuk menentukan efek suplementasi kalsium untuk menurunkan kadar timbal darah anak-anak berisiko tinggi keracunan timbal kronis dan untuk menentukan efeknya pada memori jangka pendek. Metode : Anak-anak berusia 8 – 12 tahun tinggal di daerah dengan kepadatan lalu lintas tertinggi di Medan diikut sertakan secara acak dalam penelitian kuasieksperimental ini. Penelitian berdesain uji klinis, dimana sampel dibagi menjadi dua kelompok (kelompok kontrol dan kelompok yang mendapat suplemen tablet mengandung 400 mg kalsium dua kali sehari selama tiga bulan). Pemeriksaan kadar timbal darah dilakukan awal dan setelah 3 bulan pemberian suplementasi, demikian pula pemeriksaan memori jangka pendek oleh anggota tim peneliti yang tidak mengetahui apakah objek termasuk sampel yang mendapat perlakuan (mendapat suplemen kalsium) atau tidak. Pemeriksaan memori jangka pendek dilakukan dengan menggunakan tes digit span forward, dan picture search berbasis internet. Statistik deskriptif dihitung pada awal dan setelah 3 bulan pemberian suplemen. Trend potensial perubahan kadar timbal dalam darah dinilai menggunakan uji t berpasangan; perbandingan antara dua perlakuan dengan t-tes tidak berpasangan, p <0.05 dianggap signifikan. Hasil : Kadar timbal darah tertinggi sebelum perlakuan adalah 12 μg/dL. Dijumpai penurunan kadar timbal darah kelompok perlakukan setelah pemberian suplemen selama 3 bulan yang bermakna secara statistik (awal 2.1 μg/dL , akhir 0.01 μg/dL, p < 0.01). Median penurunan kadar timbal darah pada kelompok perlakuan adalah 2.09 μg/dL. Dijumpai peningkatan skor memory picture yang bermakna secara statistik pada kelompok perlakuan (awal 61.4 ± 24.83; akhir 76.21 ± 15.97, p< 0.01). Dijumpai peningkatan skor Memory Digital Span pada kelompok perlakuan yang bermakna secara statistik (awal 5, akhir 7, p <0.01).Terdapat hubungan yang bermakna antara perubahan kadar timbal darah sampel dengan skor memory picture (korelasi sedang) dan memory digital span (korelasi lemah) (R -0.516, dan 0.251, p <0.05) Kesimpulan : Suplementasi kalsium oral dosis 400 mg, dua kali sehari selama tiga bulan untuk anak-anak yang terpapar timbal kronis dapat mengurangi kadar timbal darah dan memperbaiki memori jangka pendek secara signifikan.