Tesis

Korelasi Rasio Sel T-Helper17 Dan Sel T-Regulatory Dengan Status Asam Lemak Tak Jenuh Majemuk Rantai Panjang (Long Chain Polyunsaturated Fatty Acids) Pada Pasien Persalinan Preterm Dibandingkan Dengan Kehamilan Normal = The Correlation Of Ratio T-Helper-17 Cells And T-Regulatory Cells With Long Chain Polyunsaturated Fatty Acids Status In Preterm Labor Patients Compared To Normal Pregnancy.

LATAR BELAKANG: Persalinan preterm adalah suatu sindrom unik dari 70% kasus kelahiran preterm yang masih menjadi penyebab utama morbiditas dan mortalitas neonatal yang melibatkan jaringan maternal dan fetus. Gangguan sistem imun di maternal – fetal interface menjadi salah satu mekanisme terjadinya persalinan preterm dari sisi imunologi, termasuk didalamnya peran sel T terutama sel T-helper17 (Th17) dan Tregulatory (Treg). Metabolisme sel Th17 dan sel Treg juga dipengaruhi oleh LCPUFA, dimana omega-6 bersifat proinflamasi dan omega-3 bersifat antiinflamasi. Hal ini yang menjadi dasar penelitian dilakukan pada kasus persalinan preterm. TUJUAN: Untuk mengetahui adanya perubahan rasio sel Th17/Treg dan kaitannya dengan perubahan status LCPUFA pada pasien persalinan preterm dibandingkan dengan kehamilan normal. METODE: Penelitian analitik observasional dengan desain potong lintang ini dilakukan terhadap pasien persalinan preterm dan kehamilan normal usia kehamilan 24 – 36+6 minggu di RSUPN Cipto Mangunkusumo dan RSPPNPB Soedirman Kemhan RI bulan September – Nopember 2024. Subjek dilakukan pemeriksaan klinis, USG transabdominal dan tranvaginal, dan pemeriksaan laboratorium (flowsitometri sel Th17 dan sel Treg dan status LCPUFA). HASIL: Sebanyak 45 subjek terbagi dalam 2 kelompok yaitu kelompok persalinan preterm 23 subjek dan kelompok kehamilan normal 22 subjek. Pada kelompok persalinan preterm, median usia kehamilan 32,5minggu, mayoritas terjadi pada multigravida, 3 subjek diantaranya lahir (gagal tokolitik), dan median panjang serviks 19,5mm. Pemeriksaan flowsitometri, didapatkan median sel Th17 0,29%, median sel Treg 2,77%, dan median rasio Th17/Treg 0,11, dimana semuanya lebih rendah dari kelompok normal tanpa perbedaan bermakna. Pada status LCPUFA, ada peningkatan bermakna kadar DGLA (49,67 nmol/L, p 0,002) dan penurunan bermakna rasio LA/DGLA (10,14, p 0,005), akan tetapi tidak ada perbedaan bermakna pada komponen LCPUFA lainnya. Terdapat korelasi negatif sedang kadar LA dengan jumlah sel T dan korelasi negatif sedang Indeks Omega-6 (IO6) dengan jumlah sel T pada kelompok persalinan preterm. Tidak ada korelasi bermakna antara status LCPUFA terhadap sel Th17, sel Treg, dan rasio sel Th17/Treg. KESIMPULAN: Pada kelompok persalinan preterm, terjadi penurunan jumlah sel Th17, jumlah sel Treg, dan rasio sel Th17/Treg tanpa perbedaan bermakna. Akan tetapi, ada perbedaan bermakna kadar DGLA dan rasio LA/DGLA, serta ada korelasi bermakna antara kadar LA terhadap jumlah sel T dan IO6 terhadap jumlah sel T. Tidak ada korelasi bermakna rasio sel Th17/Treg dan status LCPUFA pada kasus persalinan preterm.
KATA KUNCI: persalinan preterm, T-helper17, T-Regulatory, Rasio Th17/Treg, LCPUFA


BACKGROUND: Preterm labour is a unique syndrome happened in 70% cases of preterm birth of which still the main cause of neonatal morbidity and mortality involving maternal and fetal tissues. Immune system disorder at maternal – fetal interface is one of the mechanism of preterm labour, including the role of T cells especially T-helper17 (Th17) cells and T-regulatory (Treg) cells. Th17 and Treg metabolisms are also influenced by LCPUFA status, whereas omega-6 is a proinflammatory and omega-3 is an antiinflammatory. These are the reason of studying this on preterm labour. OBJECTIVES: To know the alteration of Th17/Treg cells ratio and their correlation to the alteration of LCPUFA status in preterm labour patients compared to normal pregnancy. METHODS: This analytic observational study using cross-sectional design are conducted to 24 – 36+6 weeks gestational age (wga) of preterm labour and normal pregnancy patients in Cipto Mangunkusumo National Central Public Hospital and Commander in Chief Soedirman’s National Defense Central Hospital on September – November 2024. All subjects were did physical obstetric examinations, transabdominal and transvaginal US examination, and laboratorium examination (Th17-Treg flowcytometry and LCPUFA status). RESULTS: Total 45 subjects were divided into 2 groups of which 23 subjects in preterm labour and 22 subjects in normal pregnancy group. On preterm labour group we found the median of gestational age were happened at 32,5 wga, majority occured in multigravid patients, 3 of those had delivered due to failed of tocolysis, and median of cervical length were 19,5 mm. With flowcytometry examination found the median Th17 cells total were 0,29%, median Treg cells total were 2,77%, and median Th17/Treg cells ratio were 0,11, all of them are lower compared to normal pregnancy group (no significant difference). On LCPUFA status, found significant increase of DGLA level (49,67 nmol/L, p 0,002) and significant decrease of LA/DGLA ratio (10,14, p 0,005), with no significant difference in other component of LCPUFA. There were moderately negative correlation between LA level and T cells total and moderately negative correlation between Omega- 6 Index and T cells total in preterm labour. There were no significant correlations between LCPUFA status to Th17 cells, Treg cells, and Th17/Treg ratio. CONCLUSION: In preterm labour group, the total of Th17 cells, Treg cells, and Th17/Treg cells ratio were decreasing without significant difference. However, there were significant difference at level of DGLA and LA/DGLA ratio, and there were significant correlation betweeen LA level and T cells total and between omega-6 index and T cells total. There were no significant correlation between Th17/Treg cells ratio and LCPUFA status in preterm labor group.
KEYWORDS: preterm labour, T-helper17, T-Regulatory, Th17/Treg ratio, LCPUFA status