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Abstrak :
Pendahuluan Karsinoma nasofaring (KNF) merupakan jenis keganasan yang unik dengan distribusi geografis dan etnis tertentu. Daerah Cina Selatan dan Asia Tenggara memiliki insidens kejadian yang tinggi. Indonesia memiliki insidens 5,66 kasus per 100.000 penduduk per tahun. Salah satu penyebab kematian pasien dengan keganasan adalah trombosis. Kadar soluble Platelet-selectin (sP-selectin) yang tinggi dalam plasma, hasil dari aktivasi sel-sel endotel dan trombosit, adalah prediktor kejadian trombosis.

Tujuan Mengetahui kadar sP-selectin pada berbagai stadium karsinoma nasofaring dan korelasinya dengan hitung trombosit.

Metode Dilakukan studi potong lintang pada 60 kasus karsinoma nasofaring yang baru terdiagnosis di Rumah Sakit Cipto Mangunkusumo pada periode Maret hingga November 2012. Kadar sP-selectin diukur dengan teknik Enzyme Linked Immunosorbent Assay.

Hasil Rerata usia adalah 43,9 tahun dengan rasio laki-laki terhadap perempuan 3:1. Jenis patologi terbanyak adalah karsinoma tidak berdiferensiasi (83,3%). Sepuluh persen pasien mengalami trombositosis. Median kadar sP-selectin adalah 45,73 ng/mL dengan rentang interkuartil: 42,02-57,66 ng/mL. Secara statistik terdapat perbedaan kadar sP-selectin diantara stadium IVC dengan stadium lainnya (stadium IVB, p = 0,001 dan kelompok stadium I-IVA, p < 0,001). Hitung trombosit tidak berkorelasi dengan sP-selectin (r: 0,185; p = 0,158).

Simpulan Terdapat perbedaan kadar sP-selectin pada berbagai stadium karsinoma nasofaring. Hitung trombosit tidak berkorelasi dengan kadar sP-selectin. ......Background Nasopharyngeal carcinoma (NPC) is an unique malignancy because of its geographical and ethnic patterns. South China and South East Asia have the highest incidence, while in Indonesia is about 5.66 cases per 100,000 populations per year. Thrombosis is one of the complications of malignancy. High plasma levels of soluble Platelet-Selectin (sP-selectin) produced by activated endothelial cells and platelets, are predictive of thrombosis.

Objective To measure sP-selectin levels in various stages of nasopharyngeal carcinoma and its correlation with platelet count.

Methods This was a cross sectional study including 60 patients with newly diagnosed nasopharyngeal carcinoma at Cipto Mangunkusumo Hospital, Jakarta, Indonesia in period of April to November 2012. Soluble P-selectin levels in various stages of NPC measured with Enzyme Linked Immunosorbent Assay was compared and correlated with platelets count.

Results From 60 patients of NPC, the mean age was 43.9 years with ratio of men to women was 3:1. The most prevalence histopathology was undifferentiated carcinoma (83.3%). Ten percent of the patients had thrombocytosis. The median level of sP-selectin was 45.73 ng/mL (inter quartile range: 42.02-57.66). Soluble P-selectin levels were statistically significantly higher among patients with stage IVC than other stages (with stage IVB, p = 0.001 and with group of stage I-IVA, p < 0.001). There was no correlation between platelet count and sP-selectin levels (r = 0.185; p = 0.158).

Conclusion There were different levels of sP-selectin between various stages of nasopharyngeal carcinoma. There was no correlation between platelets count and sP-selectin levels.

Abstrak :
Latar Belakang : Infeksi sering didapatkan pada pasien kenker nasofaring yang menjalani kemoterapi. Infeksi disebabkan oleh rusaknya barier fisik karena efek kemoterapi atau efek kemoterapi yang akan menurunkan imunitas tubuh,Infeksi pasca kemoterapi akan menunda kemoterapi berikutnya, akibatnya respon kemoterapi menjadi tidak optimal. Tujuan : Mendapatkan data status imunitas selular primer dan sekunder, pasca kemoterapi neoajuvan 3 siklus, data kekerapan infeksi dan perbandingan kekerapan infeksi pada pasien KNF stadium lanjut yang mendapatkan kemoterapi neoadjuvan 3 siklus pada pasien kanker nasofaring stadium lanjut, antara yang imunitas selular menurun dan yang tidak menurun. Metode : Penelitian one group before and after observasional, 1 kelompok tanpa kontrol selama 3 bulan di gedung A lantai 8 RSCM, juli ndash; september 2015.Penurunan rerata jumlah lekosit, netrofil, CD4 , CD8, kejadian infeksi dianalisis bivariat dengan uji T berpasangan atau uji Mann Whitney.Penelitian ini juga melihat kekerapan kejadian infejsi post kemoterapi neoadjuvan.Penelitian ini menggunakan tingkat kemaknaan 0,005, interval kepercayaan 95. Hasil : Tidak ada penurunan status imunitas selular primer, lekosit p=0,356 dan netrofil p=0,289.Terdapat penurunan status imunitas selular sekunder, CD 4 P=0,002, CD 8 P=0,001, dengan ratio CD 4 /CD 8 tidak berubah rerata CD 4 sudah rendah sejak sebelum kemoterapi.Mukositis oral dan pneumonia merupakan infeksi yang kerap didapatkan. CD4 yang rendah pada kelompok sebelum kemoterapi meningkatkan potensi infeksi selama dan sesudah kemoterapi neoadjuvan.Penurunan imunitas seluler sekunder nilai rerata jumlah CD4 berhubungan dengan peningkatan kejadian infeksi pasca siklus ke 2 p=0,016. Kesimpulan : Tidak terdapat penurunan imunitas selular primer dan didapatkan penurunan imunitas selular sekunder pada pasien karsinoma nasofaring stadium lanjut yang menjalani kemoterapi neoadjuvan 3 siklus.Pada pasien dengan penurunan imunitas selular sekunder terdapat peningkatan kejadian infeksi mukositis oral dan pneumonia CD 4 yang rendah merupakan prediktor kejadian infeksi. Penurunan imunitas selular sekunder hanya akan meningkatkan kejadian infeksi pasca siklus ke 2 kemoterapi neoadjuvan. ......Background: The infections especially in a the oropharynx often get on cancer patients nasopharyngeal .One of the causes of infection include breakdowns physical mucous barier because the tumor growth or because the effects of chemotherapy and radiation .Chemotherapy and radiation will result in side effects namely the inflammation and ulceration mouth and the oropharynx mucous called mukositis oral.selama endure chemotherapy, besides mukositis oral, infections of the also often found .Chemotherapy resulted in an emphasis on cell production immune response that result in the lekopenia with rob possibilities infection become larger. The purpose: To asess of immunity cellular status on advanced stage nasaofaringeal patient to get 3 cycle neoadjuvan chemotherapy and assess the incident lung infection and tumor area after undergoing 3 cycle neoadjuvan chemotherapy. The methode: Research one group before and after observational use 1 group without control. The research was done during the three months in the building a floor 8 Ciptomangunkusumo Hospital juli september 2015. The Data on the background respondents will be analyzed by a sort of descriptive set by using analysis univariat.hubungan between chemotherapy neoadjuvan and an immune response cellular will be analyzed bivariat by test wilcoxon sign rank test. In this research also be seen the proportion of the infection before pre and post chemotherapy neoadjuvan .This research using level evidence 0.05 to the interval trust 95. Results: From 17 subject of research , 12 subjects 70,6 is laki laki , women made up subjects 29,4 .Median age patient is 46,7 , 10 patients 58,8 less than median age , 7 patients 42,2 more of age median.stadium 4a obtained on 4 patients 23,5 patients , while stadium 4 b obtained on 13 patients 76,5 .Seen from the infection after chemotherapy neoadjuvan 9 subjects 52,8 never would have experienced infection , 8 subjects 47,2 experienced infection. Looks the relationship between chemotherapy neoadjuvan 3 cycle in immunity cellular p 0,007 on cds 4 and p 0,005 on cds 8 , the immunity cellular decline in the infection look after chemotherapy neoadjuvan cycle to 2 p 0,016 on cds 4 while after cycle to 3 not seen the relationship between chemotherapy neoadjuvan 3 cycle in the infection .Count of leukosit and lymphocytes cannot be used to predict a decrease in an immune response cellular after undergoing 3 cycle neoadjuvan chemotherapy. Conclusions: Immune response decreased on advanced stage nasopharynx carcinoma patient are undergoing 3 cycle neoadjuvan chemotherapy neoadjuvan 3 . The Decreased of cellular immune response has played of increased infection in the lung and tumor area post 2 cycle neoadjuvan chemotherapy.