PENGARUH POLYPHENOLS TEH HIJAU TERHADAP KAPASITAS PRODUKSI IFN-γ OLEH SEL MONONUKLEAR DARAH TEPI AKIBAT RADIOTERAPI PADA PENDERITA KARSINOMA NASOFARING THE EFFECT OF GREEN TEA POLYPHENOLS TO THE IFN-γ PRODUCTION CAPACITY BY PERIPHERAL BLOOD MONONUCLEAR CELLS AS A RESULT OF A RADIOTHERAPY TO THE NASOPHARYNGEAL CARCINOMA PATIENTS

Abstract

Latar Belakang: Polyphenols teh hijau terbukti merupakan scavenger radikal bebas yang dapat mencegah penurunan produksi IL-2 dan IFN-γ, sebagai mediator yang dapat meningkatkan aktivitas imun seluler. Radioterapi pada karsinoma nasofaring bisa menurunkan produksi IFN-γ oleh sel-sel mononuklear. Tujuan: Membuktikan pengaruh polyphenols teh hijau terhadap produksi IFN-γ oleh sel mononuklear akibat radioterapi pada penderita karsinoma nasofaring. Metode: Studi randomized pre-post test control group design ini menggunakan penderita karsinoma nasofaring WHO tipe 2 dan 3 yang memenuhi kriteria inklusi dan eksklusi di klinik dan bangsal THT-KL RSDK sebagai sampel, yang dibagi menjadi dua kelompok, 20 penderita kelompok kontrol (radioterapi + plasebo) dan 20 penderita kelompok perlakuan (radioterapi + polyphenols teh hijau). Dosis 1972 mg epigallocathecin gallate polyphenols teh hijau dibagi dua; dosis pertama diberikan 1,5-3 jam sebelum radioterapi dan kedua kedua pada 10 jam sesudah radioterapi. Pemeriksaan IFN-γ dengan metode ELISA, sedang untuk sel-sel imun dengan metode autoanalyzer dengan Coulter HMX hematology analyzer. Analisa statistik dengan uji beda Independent t test dan Pair t test serta non parametrik Mann-Whitney U test dan Wilcoxon signed rank test. Hasil: Kadar IFN-γ antara dua kelompok sebelum radioterapi berbeda bermakna (p=0,029) (kontrol 197 pg, perlakuan 500pg), sedangkan hitung limfosit (p=0,862) (kontrol 1088/µL, perlakuan 1016/µL) dan monosit (p=0,987) (kontrol 668 µL/, perlakuan 667/µL) tidak berbeda bermakna. Kadar IFN-γ antara kedua kelompok setelah radioterapi berbeda bermakna (p=0,045) (kontrol 127 pg, perlakuan 192 pg), sedangkan hitung limfosit (p=0,120) (kontrol 408/µL, perlakuan 652/µL) dan monosit (p=0,216) (kontrol 421/µL, perlakuan 524/µL) tidak berbeda bermakna. Kadar IFN-γ kelompok perlakuan sebelum radioterapi tidak berbeda bermakna (p=0,084), sedangkan hitung limfosit (p=0,000) dan monosit (p=0,000) berbeda bermakna. Kadar IFN-γ (p=0,031), hitung limfosit (p=0,000) dan monosit (p=0,000) pada kelompok kontrol sebelum dan sesudah radioterapi berbeda bermakna Simpulan: Polyphenols teh hijau terbukti menghambat penurunan kadar IFN-γ pada penderita karsinoma nasofaring yang mendapat radioterapi. Background: The green tea polyphenols is proven to be a free radical scavenger that inhibits the decreaseing-production of IL-2 and IFN-γ, which function as mediators in increasing the immunocellular activities. Radiotherapy of nasopharyngeal carcinoma may reduce mononuclear IFN-γ production. Objective: The aim of this study is to prove the effect of green tea polyphenols to mononuclear’s IFN-γ production in radiotherapy of nasopharyngeal carcinomas. Methods: The randomized pre and post test control group designs used patients with nasopharyngeal carcinoma WHO type 2 and 3 to fulfill the inclusion and exclusion criteria at the clinic and ward of ear, nose, throath, head and neck surgery departement of Kariadi hospital as samples. There were 40 sample divided into control and treated groups. The control group was treated by radiotherapy plus placebo, while the treated group was exposed to radiotherapy added with 1972 mg epigallocathecin gallate divided into two doses. The first dose was given 1,5-3 hours before radiotherapy, and the second was 10 hours later. All blood samples were examined before and after treatment. The IFN-γ levels were measured using ELISA and the mononuclear cells were counted using Coulter HMX hematology analyzer. The statistical analysis was concluded using parametric Independent t test and Pair t test as well as non-parametric Mann-Whitney U test test and Wilcoxon signed rank test for differentiation test. Result: The IFN-γ levels between two groups before radiotherapy were significantly different (p=0,029) (control group 197 pg, treated group 500pg), while the lymphocyte (p=0,862) (control group 1088/µL, treated group 1016/µL) and monocyte (p=0,987) (control group 668/µL, treated group 667/µL), were not significantly different. The IFN-γ (p=0,045) (control group 127 pg, treated group 192 pg), level between two groups after radiotherapy was significantly different however the lymphocyte (p=0,120) (control group 408/µL, treated group 652/µL) and monocyte (p=0,216) ) (control group 421/µL, treated group 524/µL), were not significantly different. The IFN-γ levels in treated group before and after radiotherapy were not significantly different (p=0,084), while the lymphocyte (p=0,000) and monocyte (p=0,000), were significantly different. The IFN-γ (p=0,031), lymphocyte (p=0,000) and monocyte (p=0,000) levels in control group before and after radiotherapy were significantly different. Conclusion: The study prove that green tea polyphenols significantly inhibit the decreasing of mononuclear’s IFN-γ production in radiotherapy of nasopharyngeal carcinomas.