Model Estimasi National Institutes of Health Stroke Scale Berdasarkan Pemberian Suplementasi Vitamin A dan D, Melalui Modulasi Interleukin-1β dan Interleukin-10 pada Stroke Iskemik Akut

Abstract

Latar Belakang: Dalam dekade terakhir, sejumlah penelitian telah meneliti hubungan antara konsentrasi vitamin D serum dan risiko kejadian serebrovaskular. Selain vitamin D, bukti terbaru menunjukkan bahwa vitamin A juga merupakan faktor risiko penyakit serebrovaskular. Reseptor vitamin A dapat berinteraksi dengan reseptor lain yang memiliki efek neuroprotektif seperti vitamin D, terhadap stroke. Meskipun banyak penelitian telah menyarankan sinergi vitamin A dan D, masih belum ada penelitian yang menilai suplemen kombinasi pada stroke iskemik akut dan hubungannya dengan penanda inflamasi dan luaran klinis. Tujuan: Untuk mengetahui pengaruh suplementasi kombinasi vitamin A dan D pada pasien Stroke Iskemik Akut terhadap kadar IL-1β dan IL-10 serum, juga luaran klinis dengan menggunakan NIHSS. Metode: Penelitian kohort prospektif dilakukan di RS Haji Adam Malik di Medan dan sampel dibagi menjadi 4 grup yaitu grup yang diberi suplemen vitamin A dan D, grup yang hanya diberi suplemen vitamin D, grup yang hanya diberi suplemen vitamin A, dan grup yang diberi plasebo. Sebanyak 80 subjek yang memenuhi syarat untuk penelitian ini akan diperiksa kadar serum vitamin A, vitamin D, IL- 1β, IL-10, dan NIHSS saat masuk dan setelah 8 minggu pengobatan diperiksa ulang untuk menentukan efek dari suplementasi. Hasil: Dijumpai peningkatan yang signifikan pada kadar serum vitamin A dan vitamin D setelah suplementasi menggunakan kombinasi vitamin A + D (p = 0,01) dibandingkan dengan kelompok lain. Juga, penurunan signifikan kadar IL-1β dan IL-10 serum ditemukan pada kelompok kombinasi (masing-masing p < 0,001 dan p = 0,01). Terakhir, peningkatan NIHSS terbesar (ditandai penurunan terbesar) ditemukan pada kelompok kombinasi vitamin A + D. Simpulan: Pemberian suplemen vitamin A dan D kombinasi menghasilkan perbaikan status vitamin A dan D, penurunan IL-1β dan IL-10 serum dan akhirnya perbaikan luaran klinis pada pasien stroke iskemik.

Background: In the last decade, a number of studies have examined the relationship between serum vitamin D concentration and the risk of cerebrovascular events. Besides vitamin D, the latest evidence shows that vitamin A is also a risk factor for cerebrovascular disease. Vitamin A receptors can interact with other nuclear receptors that have neuroprotective effects such as vitamin D, against stroke. Although many studies have suggested the synergism of vitamin A and D, there is still no study that evaluates combined supplementation in acute phase ischemic stroke, and the relationship to inflammatory markers and outcome. Objective: To determine the effect of combined vitamin A and D supplementation for Acute Ischemic Stroke patients to serum IL-1β and IL-10 levels, also clinical outcome by using the National Institutes of Health Stroke Scale (NIHSS). Methods: A prospective cohort study was conducted in Haji Adam Malik Hospital in Medan and samples were divided into 4 groups i.e. group that was given vitamin A and D supplementation, group that was given vitamin D supplementation only, group that was given vitamin A supplementation only, and group that was given a placebo. A total of 80 subjects eligible for this study would be examined for serum levels of vitamin A, vitamin D, IL-1β, IL-10, and NIHSS on admission, and after 8 weeks of treatment were re-examined to determine the effects of supplementation. Results: There were significant increments on vitamin A and vitamin D serum level after supplementation using combination of vitamin A + D (p = 0.01) compared to other groups. Also, significant decrements of both IL-1β and IL-10 serum levels were found in the combination group (p < 0.001 and p = 0.01 respectively). Lastly, the greatest improvement of NIHSS (marked the greatest decrement) was observed in the vitamin A + D combination group. Conclusion: Administration of combined vitamin A and D supplementation was associated with improvement of vitamin A and D status, decreased IL-1β and IL-10 serum and ultimately improvement of clinical outcome in ischemic stroke patients.