Tesis

Hubungan Keseimbangan Treg dan Th17 terhadap Derajat Tekanan Arteri Pulmonal Pada Penderita Defek Septum Atrium Sekundum dengan Hipertensi Paru = The Association of Treg and Th17 Balance to Pulmonary Artery Pressure Degree in Patients in Secundum Atrial Septal Defect with Pulmonary Hypertension.

Latar Belakang: Hipertensi paru merupakan komplikasi umum pada pasien dengan defek septum atrium (DSA) tipe sekundum, dan semakin diakui keterlibatan mekanisme imunologis dalam patogenesisnya. Sel T regulator (Treg) dan sel T helper 17 (Th17) mewakili dua jalur imunologis yang berlawanan, ketidakseimbangannya diduga berperan dalam proses remodeling vaskular dan derajat hipertensi paru. Tujuan: Menganalisis hubungan antara rasio sel Treg dan Th17 dengan tekanan arteri pulmonal pada pasien dewasa dengan defek septum atrium tipe sekundum. Metode: Studi ini melibatkan 60 pasien dengan DSA sekundum. Pemeriksaan kadar sel Treg dan Th17 dilakukan menggunakan flowcytometry, sementara kateterisasi jantung kanan dilakukan untuk menilai parameter hemodinamik pulmonal seperti rerata tekanan arteri paru (mPAP), resistensi vaskular pulmonal (PVR), dan rasio aliran pulmonal - sistemik (Qp/Qs). Hasil: Didapatkan nilai median Treg 34,3%, T intermediate 54,8%, dan rerata Th17 sebesar 0.50%. Rasio Treg/Th17 tidak menunjukkan korelasi signifikan dengan mPAP, PVR, maupun rasio PVR/SVR. Terdapat korelasi negatif yang signifikan dengan fraksi ejeksi ventrikel kiri (FEVKi) (β = -0,198; p = 0,036) dan korelasi positif signifikan antara kadar Treg dan FEVKi dengan metode perhitungan Simpson (β = 0,003; p = 0,027). Kesimpulan: Meskipun rasio Treg dengan Th17 tidak berhubungan signifikan dengan derajat keparahan hipertensi paru pada pasien dengan DSA sekundum, peningkatan kadar Treg berkorelasi signifikan dengan FEVKi yang mengindikasikan peran potensial Treg dalam adaptabilitas vaskular pulmonal. Penelitian lebih lanjut diperlukan untuk mengeksplorasi profil molekuler dan sitokin yang terlibat dalam interaksi imunologis ini.
Kata kunci: Treg, Th17, defek septum atrium, hipertensi paru, imunoregulasi.


ackground: Pulmonary hypertension is a common complication in patients with secundum atrial septal defect (ASD), and the involvement of immunological mechanisms in its pathogenesis is increasingly recognized. Regulatory T cells (Treg) and T helper 17 cells (Th17) represent two opposing immunological pathways, and their imbalance is suspected to contribute to vascular remodelling processes. Objective: To analyse the relationship between ratio of Treg and Th17 cells and pulmonary artery pressure in adult patients with secundum type atrial septal defect. Methods: This study involving 60 patients with secundum ASD. Levels of Treg and Th17 cells were measured using flowcytometry, while right heart catheterization was performed to assess pulmonary hemodynamic parameters, including mean pulmonary artery pressure (mPAP), pulmonary vascular resistance (PVR), and flow ratio of pulmonal – systemic (Qp/Qs). Results: The median Treg level was 34.3 %, T Intermediate 54.8%, and Th17 level of 0,50%. The Treg and Th17 ratio showed no significant correlation with mPAP, PVR, or PVR/SVR ratio. There was a significant negative correlation with left ventricular ejection fraction (LVEF) (β = -0.198; p = 0.036) and a significant positive correlation between Treg levels and LVEF with Simpson’s method (β = 0.003; p = 0.027). Conclusion: Although the Treg to Th17 ratio was not significantly associated with the severity of pulmonary hypertension in patients with secundum ASD, elevated Treg levels were significantly correlated with LVEF indicating potential role of Treg in pulmonary vascular adaptability. Further studies are needed to explore the molecular profiles and cytokines involved in this immunological interaction.
Keywords: Treg, Th17, atrial septal defect, pulmonary hypertension, immunoregulation.