Tesis

Faktor yang berhubungan dengan fraktur kompresi vertebra pada anak dengan talasemia mayor = Vertebral Compression Fractures and its Associated Factors in Children with Thalassemia Major.

Latar belakang: Talasemia mayor memiliki berbagai komplikasi yang dapat meningkatkan morbiditas dan mortalitas. Osteoporosis merupakan komplikasi yang sering dialami dan penyebabnya multifaktorial. Osteoporosis dapat menyebabkan terjadinya fraktur kompresi vertebra dan berujung pada kecacatan. Adanya gambaran fraktur kompresi vertebra dapat menjadi kriteria diagnostik osteoporosis pada anak. Hingga saat ini belum terdapat penelitian di Indonesia yang mencari prevalens fraktur kompresi vertebra pada anak talasemia mayor dan faktor risiko yang memengaruhinya. Metode: Penelitian dengan desain studi potong lintang menggunakan data sekunder pada populasi anak talasemia mayor berusia 7-18 tahun dilakukan di Pusat Talasemia RSUPN Cipto Mangunkusumo. Hasil penelitian: Didapatkan 115 subjek (54% lelaki, 66% talasemia -β homosigot). Prevalens fraktur kompresi vertebra sebesar 54,8% dengan 71,4% mengalami fraktur di regio lumbal. Tidak ada subjek dengan fraktur yang memiliki keluhan nyeri maupun riwayat trauma sebelumnya. Hipovitaminosis D terjadi pada 82,6% (defisiensi 33,9%, insufisiensi 48,7%) subjek dengan median kadar vitamin D [(25(OH)D] sebesar 15,1 (8-36,2) ng/mL. Rerata kadar hemoglobin pra-transfusi sebesar 8,79 ± 0,81 g/dL. Median kadar feritin serum adalah 5018,8 (798,538.750,3) ng/mL. Sebesar 12,2% subjek mengalami gizi buruk dan 49,6% mengalami gizi kurang. Tidak didapatkan hubungan yang bermakna secara statistik antara rerata kadar Hb pra-transfusi, rerata feritin serum, kadar vitamin D, kalsium darah, kalsium ion, lama sakit, jenis kelamin dan jenis kelasi besi yang digunakan terhadap kejadian fraktur kompresi vertebra. Terdapat hubungan yang bermakna antara status gizi terhadap kejadian fraktur kompresi vertebra. Pada gizi buruk didapatkan aOR = 21,44, IK95% = 1,03-443,44, p = 0,047 dan pada gizi kurang didapatkan aOR = 0,81, IK 95% = 0,22-2,98, p = 0,008. Kesimpulan: Pemeriksaan foto polos vertebra dapat digunakan untuk mendeteksi adanya osteoporosis pada anak talasemia mayor. Pada penelitian ini didapatkan status gizi berhubungan dengan kejadian fraktur kompresi vertebra. Perlu dilakukan penelitian lebih lanjut untuk mencari faktor risiko lainnya.


Background: Thalassemia major has various complications that can increase morbidity and mortality. Osteoporosis is a common complication and has multifactorial pathogenesis. Osteoporosis can cause vertebral compression fractures and lead to disability. The presence of a vertebral compression fracture is a diagnostic criterion for osteoporosis in children. There has been no study in Indonesia for the prevalence of vertebral compression fractures in children with thalassemia major and its associated factors. Methods: A cross-sectional study design using secondary data on a population of children with thalassemia major aged 7-18 years was conducted at the Thalassemia Center at Cipto Mangunkusumo National Hospital. Result: This study obtained 115 subjects (54% male, 66% homozygous -β thalassemia). The prevalence of vertebral compression fractures was 54.8% with 71.4% at the lumbar region. There were no subjects with fractures who had complaints of pain or a history of previous trauma. Hypovitaminosis D occurred in 82.6% (33.9% deficiency, 48.7% insufficiency) subjects with the median of vitamin D level [25(OH)D] was 15.1 (8-36.2) ng/mL. The mean pre-transfusion hemoglobin level was 8.79 ± 0.81 g/dL. Median serum ferritin level was 5018.8 (798.5-38750.3) ng/mL. Severe malnourish occurred in 12.2% subjects and moderate malnourish in 49,6% subjects. There was no significant relationship between pre-transfusion Hb levels, mean serum ferritin, vitamin D levels, blood calcium, calcium ions, length of illness, gender and type of iron chelation on the incidence of vertebral compression fractures. There is a significant relationship between nutritional status and the incidence of vertebral compression fractures. In severe malnutrition aOR = 21.44, 95%CI =1.03-443.44, p value = 0.047 and in moderate malnutrition aOR = 0.81, 95%CI = 0.22-2.98, p value = 0.008. Conclusion: Plain radiographs of the vertebrae can be used to detect osteoporosis in children with thalassemia major. In this study, nutritional status was associated with the incidence of vertebral compression fractures. Further research is needed to consider the other risk factors.