Tesis

Modulasi Aksis HPA dan Faktor Pembentukan Ulkus Lambung pada Pemberian Terapi Oksigen Hiperbarik: Kajian pada Model Tikus Cedera Kepala Traumatik = Modulation of the HPA Axis and Factors Involved in Gastric Ulcer Formation With Hyperbaric Oxygen Therapy: A Study on A Traumatic Brain Injury Rat Model.

Latar Belakang: Cedera kepala traumatik dapat menyebabkan disfungsi aksis hipotalamus-pituitari-adrenal (HPA) serta meningkatkan faktor agresif pembentukan ulkus lambung melalui peningkatan aktivitas enzim H+/K+ ATPase, pepsin serta peningkatan stress oksidatif di lambung. Terapi oksigen hiperbarik (TOHB) dianggap memiliki potensi protektif dalam mengurangi kerusakan jaringan dan peradangan terkait cedera. Metode: Penelitian eksperimental in vivo ini menggunakan model tikus yang mengalami cedera kepala untuk menguji pengaruh TOHB terhadap modulasi aksis HPA dan faktor pembentukan ulkus lambung melalui kadar hormon adreno corticotropic hormone (ACTH) dan kortikosteron serta aktivitas enzim H+/K+- ATPase, pepsin, serta parameter stres oksidatif lambung pada kelompok dengan berbagai perlakuan pemberian TOHB (2 dan 3 ATA) dan waktu observasi berbeda (3,7 dan 14 hari). Hasil: Terapi oksigen hiperbarik secara signifikan menurunkan kadar ACTH terutama pada hari ke 7 setelah cedera kepala. Kadar kortikosteron plasma tidak berbeda signifikan antar kelompok, meski kelompok TOHB cenderung lebih tinggi, menandakan regulasi aksis HPA yang efektif. Tidak ditemukan ulkus lambung, namun ditemukan erosi pada kelompok cedera kepala (kontrol perlakuan) serta kelompok TOHB ATA 2 hari ke-3 setelah cedera kepala, serta ditemukan infiltrasi sel inflamasi akut dan kronik pada kelompok cedera kepala. TOHB cenderung menurunkan aktivitas enzim H+/K+- ATPase terutama pada hari ke-3. TOHB cenderung menurunkan aktivitas pepsin terutama pada hari ke 3 dan 7. Terdapat penurunan signifikan kadar MDA lambung pada kelompok TOHB dibanding kontrol perlakuan, namun tidak berbeda signifikan dari kelompok normobarik (1 ATA) di hari yang sama. Kadar GSH pada kelompok TOHB cenderung lebih tinggi dibandingkan kelompok normobarik. Kesimpulan: TOHB dapat memodulasi kadar ACTH dan memiliki potensi melindungi komplikasi pada lambung akibat cedera kepala traumatik.
Kata Kunci: Cedera kepala traumatik, Terapi oksigen hiperbarik, Aksis HPA, Ulkus lambung


Background: Traumatic brain injury can cause dysfunction of the hypothalamicpituitary-adrenal (HPA) axis and increase aggressive factors in gastric ulcer formation through elevated activity ofH+/K+ ATPase enzyme, pepsin, and increased oxidative stress in the stomach. Hyperbaric oxygen therapy (HBOT) is considered to have protective potential in reducing tissue damage and inflammation associated with the injury. Methods: This in vivo experimental study used a rat model of brain injury to examine the effects of HBOT on the regulation of the HPA axis and factors involved in gastric ulcer formation by measuring adrenocorticotropic hormone (ACTH) and corticosterone levels, as well as the activity of H+/K+ ATPase enzyme, pepsin, and gastric oxidative stress parameters in groups receiving different HBOT treatments (2 and 3 ATA) and varying observation times (3, 7, and 14 days). Results: Hyperbaric oxygen therapy significantly decreased ACTH levels in days 7 after brain injury. Plasma corticosterone levels did not differ significantly among groups, although HBOT groups tended to have higher levels, indicating effective HPA axis regulation. No gastric ulcers were found, but erosions were observed in the brain injury group (treatment control) and in the 2 ATA HBOT group on day 3 after injury; acute and chronic inflammatory cell infiltration was found in the brain injury group. HBOT tended to reduce H+/K+ ATPase enzyme activity notably on day 3. HBOT demonstrates a tendency to reduce pepsin activity, particularly on the third and seventh days. Significant reductions in gastric MDA levels were found in HBOT groups compared to treatment controls, but did not significantly differ from the normobaric group on the same day. The GSH levels in the HBOT group tend to be higher compared to the normobaric group. Conclusion: HBOT can modulate the HPA axis and protect against gastric complications resulting from traumatic brain injury.
Keywords: Traumatic brain injury, Hyperbaric oxygen therapy, HPA axis, Gastric ulcer