Pustaka Ilmiah Universitas Padjadjaran

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Perubahan Kadar Limfosit T CD4+ dan CD8+ pada Penderita Tuberkulosis Anak Sebelum dan Sesudah Terapi Obat Antituberkulosis Fase Intensif

Pendahuluan: Imunitas seluler berperan penting dalam proteksi bakteri intraseluler Mycobacterium tuberculosis. Pengobatan TB diharapkan mampu meningkatkan kadar limfosit CD4 dan CD8+ sebagai limfosit protektif dominan namun perubahan profil limfosit darah pada tuberkulosis (TB) anak masih belum jelas. Penelitian ini pun bertujuan untuk menilai perubahan kadar se T CD4+ dan CD8+ sebelum dengan sesudah terapi antituberkulosis fase intensif pada TB anak. Metode: Penelitian kuasi eksperimental dengan rancangan one group pre-post design ini dilaksanakan di RSUP Dr. Hasan Sadikin, Bandung, pada Januari-Juni 2013 terhadap penderita TB berusia 2-14 tahun dengan batang tahan asam (+) dan seronegatif HIV, serta belum mendapatkan terapi. Kadar limfosit darah T CD4+ dan CD8+ diperiksa dengan menggunakan flow cytometri sebelum dan sesudah 2 bulan terapi antituberkulosis. Uji statistik Wilcoxon digunakan untuk menganalisis perubahan kadar sel CD4+ tersebut, sedangkan CD8+ dianalisis dengan uji t berpasangan. Hasil: Dari 17 subyek (usia <5 tahun: 3 orang) yang diikutsertakan, 10 anak memiliki status gizi sangat buruk. Jenis TB yang ditemukan ialah TB paru (n=9), TB milier (n=4), meningitis TB (n=2), spondilitis TB (n=1), dan TB abdomen (n=1). Kadar limfosit T CD4+ sebelum dan sesudah terapi adalah 32% vs 34% (p=0,255). Kadar limfosit T CD8+ adalah 23,9% (SB 7,3) vs 27,6% (SB 7,69) (p=0,031). Kesimpulan: Tidak terdapat peningkatan kadar limfosit T CD4+ sesudah pemberian OAT fase intensif, sedangkan kadar limfosit T CD8+ meningkat. J Indon Med Assoc. 2013;63:353-7. Introduction: Cellular immunity plays a central role in defenses against intracellular bacteria Mycobacterium tuberculosis. Antituberculosis treatment could be expected to increase T CD4+ and CD8+ lymphocytes as dominant protective lymphocytes. However, the changes of lymphocyte profile blood in childhood tuberculosis (TB) still unclear. This study aimed to evaluate changes of CD4+ and CD8+ T lymphocytes level before and after 2 months antituberculosis in childhood TB. Methods: This was a quasi experimental study with one-group pre-post design, conducted from January-June 2013 to subjects with childhood TB aged 2-14 years with positive acid fast bacilli and seronegative HIV who did not received antituberculosis at Dr. Hasan Sadikin Hospital, Bandung. CD4+ and CD8+ lymphocytes blood examined using flow cytometri before and after 2 months treatment. Wilcoxon test used to analyze the CD4+ changes, while CD8+ had analyzed using the paired t test. Results: Of a total 17 subjects (age<5 years: 3 children), 10 children had a severely wasted nutrition status. Type of TB we found were pulmonary TB (n=9), milliary TB (n=4), meningitis TB n=2), spondylitis TB (n=1), and abdominal TB (n=1). Levels of T CD4+ lymphocytes before and after treatment were 32% vs 34% (P=0,255). Levels of CD8+ were [23.9 (SD 7.3) vs 27.6 (SD 7.69)] (P=0.031). Conclusion: There no increased in T CD4+ lymphocytes level after 2 months treatment, while CD8+ has increased apparently.