Skripsi

Hubungan Anemia dengan Durasi Gejala Tuberkulosis pada Pasien Tuberkulosis (TB) Paru = Relationship between Anemia and Duration of Tuberculosis Symptoms in Lung Tuberculosis Patients.

Pendahuluan : Indonesia menempati peringkat kedua tertinggi insiden TB terbanyak di dunia, dengan prevalensi TB sekitar 0,24%. Tingginya kasus TB di Indonesia disebabkan oleh iklim Indonesia yang tropis, serta lingkungan yang padat, kotor, basah, kumuh, dan miskin sehingga memudahkan bakteri Mycobacterium Tuberculosis (MTB) untuk tumbuh. Jenis TB yang banyak ditemukan di Indonesia adalah TB paru. Anemia penyakit kronis adalah salah satu komplikasi tersering dari TB paru. Berdasarkan beberapa penelitian, anemia ini dapat meningkatkan kejadian komplikasi dan mortalitas pada pasien TB paru sehingga perlu diteliti lebih mendalam. Jadi, dilakukan penelitian tentang hubungan anemia dengan durasi gejala TB.
Metode : Penelitian ini menggunakan desain studi studi potong lintang. Sampel penelitian dikumpulkan dari rekam medis pasien RSUP Persahabatan melalui teknik consecutive sampling. Pasien TB paru dikelompokan menjadi tiga kelompok berdasarkan durasi gejala tuberkulosis yang dialami ( ≥ 3 bulan, 1-3 bulan, dan < 1 bulan), dengan jumlah subjek pada setiap kelompok adalah 49, 57, dan 44 subjek. Data dianalisis dengan uji ki kuadrat, kemudian dikur Odds Ratio (OR) dari setiap kelompok.
Hasil : Prevalensi anemia pada 150 subjek penelitian adalah 58,67%, dengan proporsi pada kelompok durasi gejala ≥ 3 bulan, 1-3 bulan, dan < 1 bulan secara berturutturut adalah 83,67%, 54,39%, dan 36,36%. Tidak terdapat perbedaan bermakna kejadian anemia pada pasien TB paru dengan durasi gejala 1-3 bulan terhadap < 1 bulan (p=0,072;OR = 2,09; IK95% 0,93-4,67). Namun, terdapat perbedaan bermakna kejadian anemia antara pasien TB paru kelompok durasi gejala ≥ 3 bulan terhadap < 1 bulan (p < 0,001;OR = 8,97; IK95% 3,38-23,78).
Diskusi : Tingginya prevalensi anemia pada pasien TB paru disebabkan oleh beberapa mekanisme. Pertama, TNF-alfa dan IL-6 pada infeksi TB paru menyebabkan disregulasi homeostasis ion Fe 2+ melalui peningkatan hepcidin dan DMT 1, serta penurunan ferroportin 1. Hal ini menyebabkan malabsorpsi ion Fe 2+ dan peningkatan uptake ion Fe 2+ oleh makrofag. Kedua, penurunan produksi eritropoetin akibat inhibisi oleh IFN-gamma. Ketiga, penurunan respon CFU terhadap eritropoetin. Akibatnya, terjadi penurunan produksi Hb yang semakin memburuk pada pasien dengan durasi gejala lebih panjang. Selain itu, terjadi penurunan IMT yang memperburuk anemia.
Kesimpulan : Prevalensi anemia pada pasien TB paru termasuk tinggi. Pada kelompok durasi gejala yang lebih panjang, proporsi kejadian anemia meningkat. Oleh karena itu, edukasi pada masyarakat perlu dilakukan untuk meningkatkan pemahaman tentang gejala TB paru dan pentingnya datang ke rumah sakit sesegera mungkin apabila mengalami gejala TB paru.
Kata kunci: Tuberkulosis paru, durasi gejala, anemia, hemoglobin


Introduction : Indonesia is the country with the second highest incidence of tuberculosis (TB) in the world, with an approximate prevalence of 0,24%. The high number of TB cases in Indonesia is due to its tropical climate and its dense, dirty and humid environment, which makes it easier for Mycobacterium tuberculosis (MTB) bacteria to grow. Lung tuberculosis is the most common form of TB in Indonesia. One of the most frequent complications of lung TB is anemia, which can increase the occurrence of complications and mortality among TB patients according to several studies. Therefore, a study about the relationship between anemia occurrence and duration of TB symptoms in lung TB patients in conducted.
Method : This is a cross-sectional study that uses consecutive sampling. The data was taken from medical records of patients diagnosed with lung TB in Persahabatan Central General Hospital during the year 2014-2018. Lung TB patiens were grouped according to their duration of symptoms ( ≥ 3 months, 1-3 months and < 1 month). The number of subjects enrolled in each group were 49, 57 and 44 respectively. The data was analysed with chi-square test and the Odds Ratio (OR) was calculated for each group, using the < 1 month group as a reference.
Result : The prevalence of anemia in lung TB patiens in the study is 58,67%. The proportion of lung TB patients who had anemia in each group were 83,67%, 54,39% and 36,36% respectively. There is no significant relation between the duration of symptoms and anemia occurrence between the 1-3 month group and the < 1 month group (p = 0,072; OR = 2,09; CI 95% = 0,93 – 4,67). However, there is a significant relation between the duration of symptoms and anemia occurrence between the ≥ 3 month group and < 1 month group (p < 0,001; OR = 8,97; CI 95% = 3,38 – 23,78).
Discussion : The high prevalence of anemia in Lung TB patiens can be caused by several mechanism. The first mechanism is iron homeostasis dysregulation due to the high levels of TNF-alpha and IL-6. These cytokines increase hepcidin levels and DMT 1 transporter expression and decrease ferroportin 1 expression, which cause iron malabsorption and macrophage iron retention. The second mechanism is decreased erythropoetin production due to inhibiton by IFN-gamma. The third mechanism is decreased CFU response to erythropoetin. As a result, Hb production is decresed in lung TB patients, which is more severe in patients with longer duration of symptoms. BMI reduction may also play a role in anemia occurrence in lung TB patients.
Conclusion : The prevalence of anemia in lung TB patients is high, with a higher prevalence in the groups with longer duration of symptoms. This finding urges education to increase public knowledge about TB symptoms and the importance of seeking medical care immediately.
Keywords: Lung tuberculosis, duration of symptoms, anemia, hemoglobin