Tesis

Sensitivitas dan Spesifisitas Pemeriksaan Stimulated Skin Wrinkle terhadap Sudoscan dalam Mendeteksi Neuropati Otonom pada Kusta Multibasiler = Sensitivity and Specificity of Stimulated Skin Wrinkle Examination against Sudoscan to detect Autonomic Neuropathy in Multibacillary Leprosy.

Latar Belakang: Kusta merupakan penyakit infeksi yang paling sering menyebabkan neuropati perifer. Neuropati otonom adalah salah satu neuropati perifer yang perlu menjadi perhatian karena memiliki gejala subklinis dan berkontribusi memperberat kecacatan. Deteksi dini neuropati otonom dengan pemeriksaan yang sederhana penting dilakukan untuk mencegah kecacatan lebih lanjut. Metode penelitian: Penelitian berupa uji sensitivitas dan spesifisitas pemeriksaan Stimulated Skin Wrinkle (SSW) terhadap Sudoscan pada penderita kusta tipe multibasiler yang telah di diagnosis di poliklinik Kulit dan Kelamin RS Cipto Mangunkusumo. Anamnesis, pemeriksaan fisik, SSW dengan krim Eutectic mixture of local anesthetic (EMLA), Sudoscan dan elektroneurografi dilakukan pada setiap subjek penelitian. Hasil dianalisis untuk mendapatkan sensitivitas dan spesifisitas. Hasil: Diperoleh 70 subyek penelitian. Prevalensi gangguan otonom berdasarkan pemeriksaan SSW, Sudoscan dan klinis berturut-turut sebesar 64.3%, 32.9% dan 85.7%. Gangguan otonom terbanyak adalah anhidrosis yang disertai dengan kerontokan rambut. Berdasarkan kurva ROC pemeriksaan SSW terhadap Sudoscan dalam mendeteksi neuropati otonom, didapatkan nilai AUC sebesar 0,779. Setelah diuji dengan tabel 2x2 didapatkan nilai sensitivitas 95.7%, spesifisitas 51.1%, nilai prediksi positif 48.9% dan nilai prediksi negatif 96%. Kesimpulan: Pemeriksaan SSW dapat menjadi pemeriksaan penyaring yang sederhana dalam mendeteksi neuropati otonom pada kusta tipe multibasiler, dengan sensitivitas yang tinggi.
Kata kunci: Neuropati otonom, kusta multibasiler, SSW, Sudoscan.



Background: Leprosy is the most common infectious disease that causes peripheral neuropathy. Autonomic neuropathy is a form of peripheral neuropathy that warrants concern because the manifestation may be subclinical yet significantly contributes to disability worsening. It is important to have a simple method for early detection of autonomic neuropathy in attempt to prevent further disability. Method: The study consists of sensitivity and specificity testing of the Stimulated Skin Wrinkle (SSW) examination upon Sudoscan among multibacillary leprosy patients previously diagnosed in the Dermatology & Venerealogy Outpatient Clinic in Cipto Mangunkusumo Hospital. History, physical examination, SSW with Eutectic mixture of local anesthetic (EMLA) cream, Sudoscan and elektroneurografi was performed upon every subject. Results are analyzed to obtain sensitivity and specificity level. Results: 70 subjects were included in the study. Prevalence of autonomic disturbance as diagnosed by SSW, Sudoscan and clinically are 64.3%, 32.9% dan 85.7% respectively. The most frequently found autonomic disturbance is anhidrosis with hair loss. Based on the ROC curve of the SSW examination against Sudoscan in detecting autonomic neuropathy, the obtained AUC value is 0.779. After further testing with chi square, the following values were obtained: sensitivity 95.7%, specificity 51.1%, positive predictive value is 48.9%, and negative predictive value 96%. Conclusion: The SSW examination is a simple screening method in detecting autonomic neuropathy among multibacillary leprosy patients, and it yields results with high sensitivity.
Keywords: autonomic neuropathy, multibacillary leprosy, SSW, Sudoscan