Pengaruh Perioperative Albumin Infusion dan Diet Normal Protein terhadap Perubahan Sitokin Proinflamsi (TNFα, IL1 and IL6) dan CRP - , Utariani; Raharjo, E.; Perdanakusuma, D.S (Majalah Anestesia dan Critical Care, 2014)
Malnutrisi dapat mempengaruhi sitokin proinflamasi TNF, IL1, IL6 dan CRP perioperatif, sehingga dapat meningkatkan morbiditas dan mortalitas. Sedangkan patofisiologi interaksi ini masih belum jelas. Penelitian ini dirancang untuk menganalisis peran perioperatif albumin infus dan protein diet pada perubahan sitokine proinflamasi TNFa, IL1, IL6 dan CRP. Penelitian eksperimental murni dilakukan dengan menggunakan dua puluh lima tikus Sprague Dawley diacak dan dibagi menjadi 5 kelompok; kelompok kontrol (A) yang diberi diet protein normal, kelompok hipoalbuminemia diberikan infus albumin praoperasi (B), kelompok hipoalbuminemia dengan perioperatif diet protein normal (C), kelompok hipoalbuminemia diberiinfus albumin pasca operasi (D) dan hypoabuminemia dengan diet rendah protein (E). Metode pemeriksaan Elisa digunakan untuk mengukur plasma TNF, IL1, IL6, dan CRP. Penelitian ini menunjukkan hasil diet protein rendah praoperasimeningkatkan TNF, IL1, IL6 dan CRP secara signifikan. Sedangkan pemberian infus albumin dan diet protein normal praoperasi menurunkan TNF, IL1, IL6 dan CRP secara signifikan, pemberian infus albumin praoperasi dan pasca operasi terjadi perubahan penurunan TNF, IL1, IL6, dan CRP namun tidak signifikan. Simpulan penelitian ini adalah pemberian infus Albumin dan diet protein normal menurunkan sitokin proinflamasi (TNF , IL1 , IL6), dan CRP secara signifikan. Hal ini juga berarti dapat menurunkan morbiditas dan mortalitas . Kata kunci: Diet protein, perioperatif albumin, sitokin proinflamasi Protein malnutrition may affect perioperative TNFα, IL1 ,IL6 and CRP,that increases morbidity and mortality. The pathophysiology of this interaction is still unclear. This study was designed to analyze the role of perioperative albumin infusion and protein diet on the changes of TNFα, IL1, IL6 and CRP. The laboratory experimental research with post test only-control group design was conducted. Twenty five Sprague Dawley Rats were randomized and divided into 5 groups; control group which was given normal protein diet, hypoalbuminemia group given preoperative albumin infusion, hypoalbuminemia with perioperative normal protein diet, hypoalbuminemia group given postoperative albumin infusion and hypoabuminemia with low protein diet. Four incisions were made on the rats for operation model. Elisa method was used to measure plasma TNFα, IL1, IL6 and CRP. This study showed that as the result of preoperative low protein diet, TNFα, IL1, IL6 and CRP increased significantly. The albumin infusion and normal protein diet then decreased the TNFα, IL1 and CRP significantly, whereas the changes were not significant in preoperative and postoperative albumin infusion. conclution from this research is Albumin infusion and normal protein diet significantly decrease proinflammatory cytokines (TNFα, IL1, IL6) and CRP on hypoalbuminemia state. It can be suggested that they also decrease the morbidity and mortality. Key words: Perioperative albumin, proinflammatory cytokines, protein diet Reference Stadelman W.K, Digenis A.G, Tobin G.R. Impediments to wound healing. Am J Sung 176 (suppl ZA): 1998. 395–475. Hunt TK, Hort H, Hussain Z, Physiology of wound healing. Adv skiva wound care. 2000 13 (2): 6–11. Demling RH. Nutrition, Anabolism, and the Wound Healing Process: An Overview. Plasty. 2009 .9: 65–94. Bistrian BR, Blackburn GL, Hallowell E, Heddle R, 1974. Protein status of general surgical patients. JAMA 230:858–60. Bistrian BR. Blackburn GL, Vilale J, Cochran D, Naylor J. Prevalence of malnutrition in general medical patients. JAMA. 1976 235:1567–70. Hill GL. Impact of nutritional support on the clinical outcome of the surgical patient.Clin Nutr. 1994.13: 331–40. Gibbs J, Cullin, Henderson W, Daley J, Hur K, Khuri SF. Preoperative serum albumin level as a predictor of operative mortality and morbidity. ARCH Surgery. 1999.134: 36–42. Pirlich M, Herbert L, Helga G, 2003. Research profile on biomedExperts. Digestive Disease. 21(3):245–251; DOI 10.1150/000073342. Shenkin AS. Serum prealbumin Serum Prealbumin: is it a Marker of Nutritional Status or of Risk of Malnutrition? Clinical Chemistry. 2006. 52: 2177–79. Doweiko JP, Nompleggi DJ. Role of Albumin in Human Physiology and pathophysiology. J Parenter Enteral Nutr. 1999 15: 207–11, 476–83. Uhing. The albumin controversy. Clinics in Perinatology. 2004; 31(3): 475–88 Gines P, Arroyo V, Rodes J. Complications of cirrhosis: ascites, hyponatremia, hepatorenal syndrome, and spontaneous bacterial and Management. Penyunting: Bacon BR, Di Bisceglie AM, Churchil Livingstone, New York. 2000 Hlm 238. Cochrane Injuries Group Albumin Reviewers, 1998. Human Albumin Administration in Critically ill Patien: Systemic review of randomized Controlled Trial. Br. Med J. 317, 235. Gabay C, Kushner I, 1999. Acut-phase protein and other systemic responses to inflammation. N Engl J Me. 340:448–54. Alfonso Martin, Cueto Manzano, 2001. Hypoalbumin in dialysis patiens a malnutrition or an inflammation marker ?. Review artikel Larevista de Inves clinica. 53(2): pp 152–8. Pei-Ra Ling, Bruce R, Bistrian, 2003. Effect of Protein malnutrition on IL6-mediated signalingin the liver and the systemic acutphase respon in rats. Am J Physiol Regul Integr comp physiol. 287: R 801–8; DOI 10.1152/ajpregu 00715. Amati L, 2003. Nutrition and Immunity :Laboratory and clinical aspects. Curr pharm.9: 1924–31. Brown P, 2003. Malnutrition Leading Cause of Death in post war Angola. Bull World Health Organ. 81: 849–50 Moldawer LL, Hamaway KT, Bistrian BR, Georgieff M, Drabik M, Dinarello CA, Blackburn GL, 1985. A therapeutic use for interleukin-1 in the protein-depleted animal. BrJ Rheumatol. 24: 220–3. Sydney Tang, Joseph CK, Leung, Abe K, Chan KW, Chan LYY, Chan TM and Lai KN, 2003. Albumin stimulates interleukin-8. Expression in proximal tubular epithelial cell. J chin invest. 15:1114(4): 515–27; DOI 10.1172/ JC 1200316079. Cooper BA, Penne EL, Bartlett LHand Pallock CA, 2004. Protein malnutrition and hypoalbuminemia as predictor of vascular events and mortality in ESRD. Am J Kidney Dis. 43: 61–6. Kadir yildirim, 2004. Association between Acut phase reactant level and Disease Activity score (DAS 28) in patient with Rheumatoid Arthritis. Annal of clinical and Laboratory Sciens. 34: 423–6. Dulger H, Arik M, Sekeroglu MR, Tarakgloglu M, Noyan T, Cesur Y, Balahoroglu R, 2002. Pro-inflammatory cytokines in Turkish children with protein-energy malnutrition. Mediators of Inflammation, 11: 363–5. DOI: 10.1080/092935021000051566. Crevel R, Ottenhoff THM, Meer JWM, 2002. Innate immunity to Mycobacterium tuberculosis. Clinical Microbiology Reviews, 15:294-309. DOI: 10.1128/CRM.15.2.294–309. Karyadi E, Dolmans WM, West CE, Van Crevel R, Nelwan RH, Amin Z, Gross R, Van der Ven J, Van der Meer JW, 2007. Cytokines related to nutritional status in patients with untreated pulmonary tuberculosis in Indonesia. Asia PAC J Clin Nutr;16(2): 218–26. Coutinho HM, Leenstra T, Luz P, Acosta, Li SU, Jarilla B, Jiz MA, Langdon GC, Olveda RM, Mcgarvey ST, Kurtis JD, and Friedman JF, 2006. Pro-inflammatory cytokines and c-reactive protein are associated with undernutrition in the context of schistosoma japonicum infection. Am J Trop Med Hyg. 75(4):720–6. Manelli JC, Badetti C, Botti G, 1998. A reference standard for plasma proteins is required for nutritional assessment of adult burn patients. Burns; 24: 337–45. Kaysen GA, 2006. Association between inflammation and Malnitrition as Risk Factor of Cardiovascular Disease. Blood Purif. 24: 51–55; DOI: 10.1159/000089437. Holzheimer RG, Steinmetz W, 2000. Local and Systemic Concentration of Pro and Anti Inflamtory cytokines in Human Wounds. Eur J Med Res. 3: 347–355.