JUMLAH LEUKOSIT SEBAGAI INDIKATOR KELUARAN PENYAKIT STROKE ISKEMIK (LEUKOCYTE COUNT AS OUTPUT INDICATOR OF ISCHEMIC STROKE DISEASE)

Muhibbi, Sholihul (2004) JUMLAH LEUKOSIT SEBAGAI INDIKATOR KELUARAN PENYAKIT STROKE ISKEMIK (LEUKOCYTE COUNT AS OUTPUT INDICATOR OF ISCHEMIC STROKE DISEASE). Masters thesis, Program Pendidikan Pasca sarjana Universitas Diponegoro.

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Abstract

Background And Purpose: Patients with acute ischemic stroke, had been comprehended that there was inflammation reaction precedes producing proinflamatory cytokin IL-1 and TNF at ischemic area that will make the leukocyte conscription. The existence of leukocyte at ischemic area will caused the heavier of severity of the lesion (reperfusion injury) through the plugging mechanism, expenditure vasoconstriction, hydrolytic enzyme release, free radical, and lipid peroxides release. Measurement of blood leukocyte count at 12 - 72 hours onset is expected could be utilized as one indicator of disease severity which assessed by NIHSS score at first day, the tenth day, and score changing among the first and the tenth day. Methods: Sixty seven patients with first time of acute ischemic stroke within 12 -72 hours onset, were enumerated the leukocyte count and NIHSS score, at the tenth days onset the leukocyte count and NIHSS score was also measured. In order can interpretated clinically, NIHSS data was transformed become the clinical form. Improvement of neurological deficit was assessed from the difference score among early and the tenth days value. It was conducted compare mean test among of first leukocyte count and second, relation test among first times leukocyte count and its various outcome too. Result: In acute phase of ischemic stroke, leukocyte count 8,623 + 785 and at tenth days leukocyte count 8,466 + 722 sig. < 0.001. There was strong relation among early leukocyte count with the early score NIHSS, NIHSS score at tenth days, difference of NIHSS score at first and tenth days, early clinical value of NIHSS, and NIHSS score clinically at tenth days by p < 0.001. There was a significant correlation among early leukocyte count with difference of early clinical value of NIHSS fist and tenth day (p < 0.022). Blood leukocyte > 8,650 cell/mm3 was determine os cut of point for prediction of worse stroke outcome sensitivity 83.3% with RR = 3.171 (CI 95%, 0,392 — 25,636). Conclusion: There was difference of the leukocyte count in stroke patient with acute phase ischemic, the leukocyte count in 12 - 72 hours onset can be utilized as indicator of its outcome. The leukocyte count more than 8,650 at acute ischemic stroke patient signed the worsening outcome. Latar belakang dan Tujuan. Pada pasien stroke iskemik akut telah dipahami terdapat reaksi inflamasi yang dimulai dengan diproduksinya sitokin proinflamasi seperti IL-1 dan TNF pada daerah iskemik yang akan menimbulkan pengerahan leukosit. Adanya leukosit pada daerah iskemik dapat menimbulkan lesi lebih berat (reperfusion injury) melalui mekanisme plugging, pengeluaran vasokonstriksi, melepaskan enzim hidrolitik, lipid peroksidase dan pelepasan radikal bebas. Melalui pengukuran jumlah leukosit darah tepi pada 12 — 72 jam onset diharapkan bisa dipergunakan sebagai indikator beratnya penyakit yang dinilai dengan skoring NIHSS hari pertama, ke sepuluh, dan perubahan skor diantaranya. Metoda. Enam puluh tujuh pasien yang pertama kali mengalami stroke iskemik akut dengan onset 12 — 72 jam dilakukan penghitungan jumlah leukosit dan skor NIHSS, pada hari ke 10 onset dilakukan penghitungan jumlah leukosit dan skor NIHSS ulang. Agar dapat diartikan secara klinis dilakukan transformasi data NIHSS menjadi bentuk klinis Perkembangan defisit neurologis dinilai dari selisih skor yang didapat nilai awal dan hari ke 10. Dilakukan uji beda rerata antara jumlah leukosit pertama dan kedua, dilaksanakan juga uji hubungan antara jumlah leukosit pertama dengan berbagai keluarannya. Hasil. Jumlah leukosit pada pasien stroke iskemik fase akut 8.623 + 785 dan jumlah leukosit hari ke sepuluh 8.466 + 722 dengan p < 0,001. Didapatkan hubungan yang kuat antara jumlah leukosit awal dengan skor 1\111-1SS awal, skor NIHSS hari ke sepuluh, selisih skor NIHSS awal-hari ke sepuluh, nilai klinis NIHSS awal, dan nilai klinis NIHSS hari ke sepuluh dengan p <0,001 serta didapatkan hubungan antara jumlah leukosit awal selisih nilai klinis NIHSS awalhari ke sepuluh p <0,022. Jumlah leukosit yang mengisyaratkan perburukan keluaran > 8.650, sensitivitas 83,3% dengan RR = 3,171 (CI 95%, 0,392 — 25,636) Simpulan. Terdapat perubahan jumlah leukosit pada pasien stroke iskemik akut, jumlah leukosit 12 — 72 jam onset dapat dipergunakan sebagai indikator keluaran penyakitnya. Jumlah leukosit > 8.650 pada pasien stroke iskemik akut mengisyaratkan pemburulcan keluarannya.

Item Type:Thesis (Masters)
Subjects:R Medicine > R Medicine (General)
Divisions:Postgraduate Program > Master Program in Biomedical Science
ID Code:12343
Deposited By:Mr UPT Perpus 1
Deposited On:30 May 2010 14:35
Last Modified:05 Aug 2010 16:24

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