Disertasi

Integritas Sawar Mukosa Intestinal pada Kasus Luka Bakar Studi terhadap Perubahan Metabolisme Glutamin dan Seng di Plasma dan Intraseluler. = Intestinal Mucosal Barrier Integrity in Burn Injury A Study of Glutamine and Zinc Metabolic Changes in Plasma and Intracellular Levels.

Pada luka bakar dapat terjadi gangguan sirkulasi dan respon stres terhadap trauma yang menyebabkan peningkatan permeabilitas intestinal akibat kerusakan tight junction dan enterosit, sehingga berisiko menyebabkan translokasi mikroorganisme. Trauma luka bakar juga dapat menyebabkan penurunan kadar glutamin dan seng, yang berperan dalam mempertahankan sawar mukosa intestinal. Penelitian ini bertujuan untuk menyempumakan tatalaksana resusitasi pasien luka bakar yang sudah baku dengan resusitasi intestinal dan terapi nutrien spesifik yang diharapkan dapat menurunkan angka morbiditas dan mortalitas. Penelitian ini mengunakan rancangan cross sectional, dilakukan di Unit Pelayanan Khusus Luka Bakar RSUPNCM, Jakarta. Subyek penelitian terdiri dari 23 subyek luka bakar dan 30 subyek kontrol orang sehat. Pemeriksaan yang dilakukan meliputi penanda sawar mukosa intestinal, kadar glutamin, dan seng di plasma dan intraseluler. Terdapat 12 subyek dengan luka bakar sedang dan 11 subyek dengan luka bakar berat. Terdapat 19 subyek yang menderita luka bakar akibat api, bahan kimia dan air panas serta 4 subyek akibat listrik. Sebanyak 7 subyek kasus luka bakar menderita trauma inhalasi dan 7 subyek meninggal akibat disfungsi organ muItipel. Integritas sawar mukosa intestinal pada kasus luka bakar, yang dinilai dengan menggunakan tes laktulosafmanitol (L/M), intestinal fatty acids binding protein (I-FABP), dan endotoxin-core antibody (EndoCAb) IgM lebih rendah bermakna dibandingkan kontrol. Kadar glutamin intraseluler, seng plasma dan intraseluler pada subyek kasus luka bakar lebih rendah bermakna, sedangkan kadar glutamin plasma lebih rendah tetapi tidak berbeda bermakna dibandingkan kontrol. Penelitian ini memperlihatkan bahwa I-F ABP berkorelasi dengan mioglobin (r = 0,546, P = 0,007). Kadar seng plasma berkorelasi dengan albumin (r = 0,929, P < 0,001), mioglobin (r = -0,626, P = 0,001), ureum (r = - 0,606, P = 0,002) dan asam laktat (r = -0,252, P = 0,010). Analisis statistik memperlihatkan bahwa luas luka bakar berkontribusi terhadap kadar I-FABP (p = 0,025) dan seng plasma (p = 0,001). Disimpulkan bahwa integritas sawar mukosa intestinal, kadar glutamin dan seng di plasma dan intraseluler lebih rendah pada subyek luka bakar dibandingkan kontrol.
Kata kunci: Luka bakar, integritas sawar mukosa intestinal, glutamin, seng.



Burn injury results in an increase in intestinal permeability due to tight junctions and enterocytes damage following circulatory disturbances and as stress response to trauma. Alterations in intestinal mucosal barrier integrity lead to translocation of microorganisms. Burn injury causes glutamine and zinc levels to decline substantially; glutamine and zinc have been known as their important roles in intestinal barrier integrity. This study aimed to complement guidelines of burn resuscitation including intestinal resuscitation and specific nutrient therapy which might favor in a decline in morbidity and mortality rate of burns. This study was a comparative cross-sectional study that was conducted at Burn Intensive Care Unit, RSUPNCM, Jakarta. This study included 23 burn subjects (16 males, 7females) and 30 healthy subjects as control (15 males, 15 females). markers of intestinal mucosal barrier, plasma and intracellular levels of glutamine and zinc were measured. Twelve and eleven subjects suffered moderate burn injury and severe burn injury, respectively. Nineteenth subjects were caused by fire, chemical, and hot water. 4 subjects were caused by electricity. Seven subjects had inhalation trauma and 7 subjects died because of multiple organ dysfunction. The intestinal barrier permeability was increased measured using lactuloselmannitol test, intestinal fatty acids binding protein (I-FA BP), and IgM endotoxin-core antibody (EndoCAb). Intracellular glutamine, plasma and intracellular zinc levels in bum subjects l-I'ereSignificantly lower than counterparts, while intracellular glutamine level did not Significantly differ ill both groups. This study documented a correlation between I-FABP and myoglobin (r = 0,546, P = 0,007). Plasma zinc level was correlated with albumin (r = 0,929, P < 0,001) and myoglobin (r = - 0,626, P = 0,001). Plasma zinc level was also correlated with ureum (r = -0,606, P = 0,002) and lactic acid (r =-0,252, p = 0,010). Statistical analysis showed that burn size markedly influenced I-FABP (p = 0,025) and plasma zinc level (p = 0,001). Inconclusion, intestinal mucosal barrier integrity, glutamine and zinc level in plasma and intracellular are lower than the control subjects.
Keywords: burn injury, intestinal mucosal barrier integrity, glutamine, zinc.