Hasil Pencarian  ::  Simpan CSV :: Kembali

"ABSTRAKLatar belakang: Sindrom nefrotik idiopatik (SNI) relaps anak terjadi karena ketidakseimbangan sel T-helper dan sel T-regulator. Perubahan komposisi bakteri usus besar dapat menyebabkan gangguan integritas usus, responsi imun, mungkin berperan terhadap relaps pada SNI.Tujuan: Untuk mengetahui jenis dan komposisi bakteri usus besar pada SNI remisi dan relaps, hubungan jenis dan komposisi bakteri usus besar dengan IL-8 serum SNI relaps, gangguan integritas usus besar pada SNI relaps.Metode: Penelitian prospektif di Departemen Ilmu Kesehatan Anak, FKUI- RSCM. Penelitian dua tahap yaitu SNI remisi yang diikuti sampai relaps. Diperiksa komposisi bakteri Enterococcus, Bacteroides, Escherichia, Clostridium, Lactobacillus, dan Bifidobacterium usus besar, alpha-1 antitrypsin dan calprotectin feses, IL-8 serum.Hasil: Terdapat 49 subjek yang relaps berumur 2?12 tahun. Proporsi Enterococcus, Bacteroides, Escherichia, Clostridium lebih tinggi pada SNI relaps daripada SNI remisi. Proporsi Bifidobacterium lebih tinggi pada SNI remisi daripada SNI relaps. Terdapat peningkatan alpha-1 antitrypsin pada 51% SNI remisi dan 48% SNI relaps, serta peningkatan calprotectin pada 91.8% SNI remisi dan 95.9% SNI relaps. Median IL-8 serum lebih tinggi pada SNI relaps (13.2 pg/mL) dibandingkan SNI remisi (11.8 pg/mL).Simpulan: Proporsi bakteri menguntungkan Bifidobacterium lebih tinggi pada SNI remisi dibandingkan SNI relaps. Proporsi bakteri patogen lebih tinggi pada SNI relaps dibandingkan dengan SNI remisi. Tidak terdapat hubungan antara jenis dan komposisi bakteri usus besar dengan peningkatan kadar IL-8 serum pada SNI relaps. Pada SNI relaps terdapat gangguan integritas usus besar.

---

ABSTRACT

Backgound: Relapses in idiopathic nephrotic syndrome (INS) may occur due to imbalance of T-helper and regulator T-cells. Alteration of colonic bacteria composition may cause a defect in colonic mucosal integrity and activate the immune system, leading to INS relapse. The aim of this study are to determine the composition of gut bacteria in INS remission and relapse, serum IL-8 in INS relapse, and defective bowel integrity INS relapse.

Methods: This prospective study on children with INS was conducted in two phases, starting in remission and followed up to relapse. Both during remission and during relapse, we collected stool samples from all subjects to examine intestinal bacteria composition comprising Enterococci, Bacteroides, Escherichiae, Clostridia, Lactobacilli, and Bifidobacteria, fecal alpha-1 antitrypsin, and fecal calprotectin. We also collected peripheral blood to measure serum IL-8 levels during remission and relapse.

Results: The proportions of pathogenic bacteria Enteroccocus, Bacteroides, Escherichia, and Clostridium were higher in INS relapse compared to remission. The proportion of the beneficial Bifidobacteria was statistically higher in INS remission compared to relapse. There was an increase of alpha-1 antitrypsin in 51% of INS in remission and 48% in relapse. Fecal calprotectin was increased in 91.8% of INS in remission and 95.9% in relapse. Median serum IL-8 in INS relapse (13.2 pg/mL) was higher than in remission (11.8 pg/mL).

Conclusions: The proportion of Bifidobacteria is higher in INS remission than in relapse, while the proportion of pathogenic bacteria is higher in relapse than in remission. There is no association between the composition of gut bacteria with serum IL-8 increase in relapsing INS. There is a defect in mucosal integrity in relapsing INS as demonstrated by elevated fecal alpha-1-antitrypsin and calprotectin."

"Kebocoran plasma sistemik pada sepsis dapat mengakibatkan berbagai komplikasi dari renjatan sampai kematian. Belum ada teknik andal untuk menilai kebocoran plasma sistemik pada anak. Degradasi glikokaliks, ditandai meningkatnya sindekan-1 dalam darah, menyebabkan perubahan permeabilitas vaskular sistemik. Pada glomerulus bermanifestasi sebagai albuminuria sehingga kenaikan rasio albumin-kreatinin (ACR) urin berpotensi menggambarkan kebocoran plasma sistemik. Sampai saat ini belum ada rujukan nilai sindekan-1 dan ACR urin sebagai penanda kebocoran plasma sistemik pada anak. Penelitian ini bertujuan untuk mengetahui peran ACR urin dan nilai rujukan ACR urin sebagai penanda kebocoran plasma sistemik pada anak sepsis dan mengkaji kaitannya dengan sindekan-1.Penelitian ini terdiri atas studi deskriptif pada anak sehat dan penelitian longitudinal prospektif dengan rancangan potong lintang berulang terhadap anak sepsis, dilakukan di RSUP Cipto Mangunkusumo Jakarta, RSUP H. Adam Malik Medan dan RSUP Kariadi Semarang dalam rentang waktu Maret–Desember 2015. Dilakukan pemeriksaan sindekan-1 dan ACR urin pada pasien sepsis yang dirawat di instalasi rawat intensif anak pada hari rawatan ke-1, 2, 3 dan 7, dan mencatat skor Pediatric Logistic Organ Dysfunction pada hari rawatan ke-1 dan 3.Tiga puluh subjek sehat dan 49 subjek sepsis diikutsertakan dalam penelitian. Pada kelompok sehat didapati median ACR urin 10,5 (3–88) mg/g dan rerata sindekan-1 sebesar 27,7 (SB 2,24) ng/mL. Sindekan-1 di atas persentil 90 (41,42 ng/mL) ditetapkan sebagai batasan kebocoran plasma sistemik. Didapati 40 orang (81,6%) subjek sepsis dengan sindekan-1 > 41,42 ng/mL dan 33 orang (67,3%) menunjukkan ACR urin > 300 mg/g pada hari rawatan 1. Didapati koefisien korelasi (r) 0,32 (P < 0,001) antara ACR urin dan sindekan-1. Area under the curve ACR urin terhadap kebocoran plasma sistemik diperoleh sebesar 65,7% (95% IK 54,5–77%; P = 0,012). ACR urin > 157,5 mg/g ditetapkan sebagai cut-off point kebocoran plasma sistemik dengan sensitivitas 77,4% dan spesifisitas 48%. ACR urin dapat digunakan sebagai penanda kebocoran plasma sistemik, peningkatan ACR urin akan mengikuti peningkatan sindekan-1.

---

Systemic plasma leakage during sepsis can cause several complications from shock to death. There is no feasible measurement of systemic plasma leakage in children. Glycocalyx degradation, marked by increased serum syndecan-1, alters vascular permeability. In the glomerulus this can manifest as albuminuria, therefore elevated urinary albumin-creatinine ratio (ACR) potentially provides an index of systemic plasma leakage. Nowadays. there is no reference value of syndecan-1 and urinary ACR as a marker of systemic plasma leakage in pediatric population. This study aims to analyze the role of urinary ACR and to determine its reference value as a marker of systemic plasma leakage in pediatric sepsis, by analyzing its correlation with syndecan-1.

This study consisted of descriptive study on healthy children and longitudinal prospective study with repeated cross-sectional design on septic children, was conducted at Cipto Mangunkusumo Hospital Jakarta, Haji Adam Malik Hospital Medan and Kariadi Hospital Semarang from March to December 2015. We examined serum syndecan-1 and urinary ACR of septic patients in pediatric intensive care unit on day 1, 2, 3 and 7. Pediatric Logistic Organ Dysfunction (PELOD) score were recorded on day 1 and 3.

Thirty healthy subjects and 49 septic subjects were recruited. In the healthy group, median of urinary ACR was 10.5 (3–88) mg/g and mean of syndecan-1 was 27.7 + 2.24) ng/mL. Syndecan-1 more than 90th percentile (41.42 ng/mL) was determined as systemic plasma leakage. Forty (81.6%) septic subjects had syndecan-1 > 41.42 ng/mL and 33 (67.3%) subjects had urinary ACR > 300 mg/g on day 1. Correlation coefficient (r) between urinary ACR and syndecan-1 was 0.32 (P < 0.001). Area under the curve of urinary ACR and plasma leakage was 65.7% (95% CI 54.5–77%; p = 0.012). Urinary ACR > 157.5 mg/g was determined as cut-off point of systemic plasma leakage with sensitivity 77.4% and specificity 48%. Urinary ACR can be used as marker of systemic plasma leakage. Increased urinary ACR would indicate increased syndecan-1."