HUBUNGAN KADAR MALONDIALDEHID PLASMA DENGAN KELUARAN KLINIS STROKE ISKEMIK AKUT

Abstract

Latar belakang : Metabolisme asam arakhidonat oleh enzim siklooksigenase dan lipooksigenase yang terjadi 6 – 48 jam awitan stroke merupakan sumber utama radikal bebas yang timbul lambat. Radikal bebas bereaksi dengan polyunsaturated fatty acid di otak melalui reaksi peroksidasi lipid dengan produk akhir utama MDA. Aktifitas stres oksidatif kembali ke tingkat normal pada hari ke-5 awitan stroke dengan pemeriksaan SOD serial. Kadar MDA plasma diharapkan berhubungan dengan keluaran klinis penderita stroke iskemik akut saat masuk dan hari ke-5. Metode penelitian : Merupakan penelitian observasional dengan pendekatan kohort pada Agustus 2007 – Januari 2008 di RSUP. Dr.Kariadi Semarang. Empat puluh tiga pasien yang pertama kali mengalami stroke iskemik akut dengan awitan kurang 48 jam saat masuk telah dilakukan pemeriksan kadar MDA plasma dan penilaian skor NIHSS saat masuk dan pada hari ke-5 awitan stroke. Analisis yang digunakan ialah uji korelasi Rank Spearman dan uji Chi-Square. Hasil : Analisis hubungan kadar MDA plasma dan skor NIHSS : saat masuk : p= 0.404, r=0,130 ; pada hari ke-5: p=0,784,r=-0,030. Analisis hubungan kategori kadar MDA plasma (normal atau lebih dari normal) dengan kategori keluaran klinis (ringan atau sedang-berat) : saat masuk : p = 0,521, PR (prevalence ratio) = 1,242, CI (Confidence interval) = 0,783-1,970; hari ke-5 : p = 0,937 ,PR = 0,840, CI = 0,379- 1,861. Analisis hubungan kategori kadar MDA plasma saat masuk dengan kategori keluaran klinis hari ke-5 : p=0.902, RR(relative risk)= 1,144 ,CI = 0,617 – 2,121. Simpulan : Kadar MDA plasma mempunyai hubungan sangat lemah dengan keluaran klinis dan kategori kadar MDA plasma saat masuk bukan merupakan risiko terhadap keluaran klinis yang lebih buruk pada hari ke-5. Background : The metabolism of arachidonic acid by the enzyme of cyclooxygenase and lipooxygenase that occurs in 6 - 48 hr after onset of stroke is the main source of free radical that evolves lately. The free radical reacts with polyunsaturated fatty acid in the brain through the reaction of lipid peroxidation with the main end-product of MDA. The activity of oxidative stress goes back to normal level in day-5 after onset of stroke according to serial SOD examination. The level of plasma MDA is expected to be assosiated with the clinical outcome in patients with acute ischemic stroke at the time of entry to hospital and at day-5. Method of study : This was observasioal study with propective approach in August 2007 through January 2008 at Dr. Kariadi Hospital Semarang. Fourty-three patients that for the first time experience acute ischemic stroke that initiate less than 48 hours before entry to hospital have underwent measurement of plasma MDA level and of NIHSS scores at the time entry to hospital and at day-5 after onset of stroke. The analysis used here are Rank Spearman correlation test and Chi-Square test. Results : Analysis of correlation between plasma MDA level and NIHSS score: at time of entry : p=0.404, r=0.130 ; at day-5 : p=0.784, r=-0.030. Analysis of correlation between the category of plasma MDA level ( normal or higher than normal) and the category of clinical outcome (mild to moderate-severe) : at the time of entry : p=0.521, PR(prevalence ratio)= 1.242, CI(Confidence interval)= 0.783- 1.970; at day-5 : p=0.937 ,PR = 0.840, CI= 0.379-1.861. Analysis of correlation between the category of plasma MDA level at time of entry and the category of clinical outcome at day-5 : p=0.902, RR(relative risk)= 1.144, CI= 0.617 – 2.121. Conclusion : Plasma MDA level has very weak correlation with the clinical outcome, and the category of plasma MDA level at the time of entry to hospital is not a risk factor for a worse clinical outcome at day-5.