Pengaruh Pemberian Vitamin D Terhadap Perbaikan Foto Toraks Pada Pasien TB Paru Etnik Batak di Kota Medan dihubungkan dengan Polimorfisme ApaI Gen Reseptor Vitamin D

Abstract

Pulmonary tuberculosis is one of health problems in Southeastern Asia and Indonesia. Indonesia occupied the country fifth TB patients the in the world. Based on the previous studies whether there are differences polymorphism genes affected susceptibility of someone to M. Tuberculosis in culture, ethnic and different population. The contribution of polimorfsime genes RVD Apa1 by the provision of enough vitamin D able to respond to cathelicidin to help macrophages reduce M. tuberculosis growth through elevated levels of cathelicidin intracellular. The objective of the research was to analyze the influence of vitamin D on improvement photo thoracic of Bataknese patients pulmonary tuberculosis was connected to polymorphism genes RVD Apa1. This research used design blinded randomized controlled trial method. The research was did at Public Health Center in Medan to 42 Bataknese patients pulmonary tuberculosis with polymorphism genes RVD Apa1, group was given vitamin D was 21 patients and plasebo was 21 patients. The provision of vitamin D by a dose of 2.5 mg (100.000 IU) for 4 times (weekly 0, 2, 4, 6). Polymorphism RVD genes were analysed using PCR-RFLP technic. The result was the frequency of genotip AA 1 (4.8%), Aa 8 (38.1%) and aa 12 (57.1%), in the group was given vitamin D; AA 3 (14.3%), Aa 7 (33.3%) and aa 11 (52.4%) in the group was given placebo. There was significant influence of levels of vitamin D before and after treatment. The results was the group was given vitamin D p = 0.00, the difference average levels of vitamin D 29,27+22 ng/ml, while the group was given placebo p = 0.27, the difference average levels of vitamin D 1.36+5.53ng/ml. Improvement thoracic photos was analysed from the results of a photograph of the thoracic pulmonary before and after treatment. The results was in group was given vitamin D (66.7%), while in group was given placebo (33.3%). Relationship between Polymorphism and improvement thoracic photos was analysed and there was no relationship improvement thoracic photo and polymorphism, p = 1,000. The conclution of the research was showed the indonesian population ethnic batak there was no significant influence Polymorphism RVD genes on improvement thoracic photo. In the provision of vitamin D there was difference meaningful levels of vitamin D before and after treatment.

TB Paru merupakan salah satu masalah kesehatan di Asia Tenggara dan Indonesia. Indonesia menduduki negara urutan kelima penderita TB paru di dunia. Berdasarkan hasil penelitian sebelumnya ternyata ada perbedaan polimorfisme gen sangat mempengaruhi kerentanan seseorang terhadap M. Tuberculosis pada budaya, etnik dan populasi yang berbeda. Peranan polimorfsime gen RVD Apa1 dengan pemberian vitamin D yang cukup mampu merespon cathelicidin untuk membantu makrofag menekan pertumbuhan M. tuberculosis melalui peningkatan kadar cathelicidin intraseluler. Penelitian ini bertujuan untuk mengetahui pengaruh vitamin D terhadap perbaikan foto toraks pada penderita TB paru etnik Batak dihubungkan dengan polimorfisme gen RVD Apa1. Penelitian ini menggunakan metode design blinded randomized controlled trial. Penelitian dilakukan di Puskesmas wilayah kota Medan terhadap 42 pasien penderita TB paru yang memiliki polimorfisme gen RVD Apa dengan etnik Batak, kelompok vitamin D 21 orang dan plasebo 21 orang. Pemberian vitamin D dengan dosis 2,5 mg (100.000 IU) selama 4 kali (minggu 0, 2, 4, 6). Polimorfisme gen RVD dianalisa menggunakan tehnik PCR-RFLP. Hasil adalah frekuensi genotip AA 1 (4.8%), Aa 8 (38.1%) dan aa 12 (57.1%), pada kelompok intervensi vitamin D, AA 3 (14.3%), Aa 7 (33.3%) dan aa 11 (52.4%) pada kelompok yang diberikan plasebo. Terdapat perbedaan bermakna kadar vitamin D sebelum dan sesudah perlakuan. Hasil pada kelompok vitamin D p=0.00, perbedaan rerata kadar vitamin D 29,27+22 ng/ml, sedangkan kelompok plasebo p=0.27, perbedaan rerata kadar vitamin D 1.36+5.53ng/ml. Perbaikan foto toraks dianalisa dari hasil foto toraks paru sebelum dan sesudah perlakuan. Hasil pada kelompok vitamin D (66,7%), sedangkan pada kelompok plasebo (33,3%). Hubungan polimorfisme dengan perbaikan foto toraks dianalisa dan hasilnya tidak terdapat hubungan perbaikan foto toraks dengan polimorfisme, p=1.000. Kesimpulan pada populasi Indonesia etnik Batak tidak ada pengaruh antara polimorfisme ApaI gen RVD terhadap perbaikan foto thoraks. Pada pemberian vitamin D terdapat perbedaan bermakna kadar vitamin D sebelum dan sesudah perlakuan.