Tesis

Korelasi Kadar 25-hidroksi Vitamin D dengan Derajat Keparahan Kutil Anogenital di RSUPN Cipto Mangunkusumo Jakarta = Correlation between 25-hydroxy Vitamin D Levels and Severity of Anogenital Warts at Dr. Cipto Mangunkusumo National General Hospital Jakarta.

Pendahuluan: Kutil anogenital (KA) adalah kutil yang disebabkan oleh infeksi virus papiloma humanus (VPH) di sekitar anus dan genital. Gangguan sistem imun dapat memperparah derajat keparahan KA. Terdapat fungsi vitamin D sebagai imunomodulator dan efeknya sebagai antivirus. Penelitian yang menilai kadar 25(OH)D pada derajat keparahan KA belum ditemukan. Tujuan: Penelitian ini bertujuan untuk melihat kadar 25(OH)D serum pada pasien dengan KA, serta melihat korelasi kadar 25(OH)D serum dan status vitamin D dengan derajat keparahan kutil anogenital. Metode: Penelitian merupakan studi observasional analitik dengan desain potong lintang untuk melihat kadar 25(OH)D serum dengan derajat keparahan KA. Subjek penelitian dipilih dengan metode consecutive sampling. Sebanyak 50 pasien dengan KA yang memenuhi kriteria inklusi diambil untuk mengikuti studi dan dilakukan pencatatan tentang onset, rekurensi, infeksi HIV, bentuk klinis KA, pengukuran derajat keparahan KA, serta pemeriksaan kadar 25(OH)D serum. Hasil: Median usia pasien adalah 27 tahun (rentang 19 - 60 tahun), dengan mayoritas adalah populasi laki-laki yang berhubungan seks dengan laki-laki (LSL) sebanyak 24 (48%) pasien. Infeksi HIV ditemukan pada 27 (54%) pasien KA. Median kadar 25(OH)D serum pada subjek adalah 21,25 ng/ml (rentang 11 - 72,5 ng/ml). Sebanyak 22 pasien KA (44%) berada pada status defisiensi, 16 (32%) pada status insufisiensi, dan 12 (24%) pada status sufisiensi. Derajat keparahan KA paling banyak ditemukan pada derajat 1 (40%). Analisis statistik menunjukan tidak adanya korelasi signifikan antara total volume KA dengan kadar vitamin D (r=0,081; p=0,573). Korelasi antara derajat keparahan KA dengan kadar 25(OH)D serum juga tidak bermakna (r=0,104; p=0,472). Uji korelasi antara derajat keparahan KA dengan status vitamin D tidak bermakna secara statistik (p=0,244). Hasil tambahan melaporkan tidak ada korelasi yang signifikan antara total volume KA maupun derajat keparahan KA dengan kadar 25(OH)D serum atau status vitamin D pada subkelompok orang dengan HIV (ODHIV) maupun non-ODHIV. Simpulan: Kadar 25(OH)D serum pada pasien KA di RSCM adalah 21,25 (11 – 72,5) ng/ml. Sebanyak 76% pasien dengan KA mempunyai vitamin D yang kurang. Kadar 25(OH)D serum tidak berkorelasi terhadap derajat keparahan KA.
Kata kunci: Keparahan, kutil anogenital, vitamin D, kadar 25(OH)D serum


Background: Anogenital warts (AGW) are warts caused by Human Papillomavirus (HPV) infection around the anus and genitals. Impaired immune system function can worsen the degree of AGW severity. Immune system impairment can influence the severity of AW. Vitamin D is known to function as an immunomodulator and has antiviral effects. Studies that examine 25(OH)D serum levels in relation to the severity of AW have not yet been found. Aim: This study aims to determine serum 25(OH)D levels in patients with AGW and to examine the correlation between serum 25(OH)D levels and vitamin D status with the degree of AGW severity. Method: The study was an analytic observational study with a cross-sectional design to examine 25(OH)D serum levels and the degree of AGW severity. Research subjects were selected using the consecutive sampling method. A total of 50 AGW patients who met the inclusion criteria were recruited for the study, and data regarding onset, recurrence, HIV infection, clinical variation of AGW, measurement of AGW severity, and serum 25(OH)D level examination were recorded. Results: The median age of patients was 27 years (range 19 – 60 years), with the majority being men who have sex with men (MSM) reaching 24 (48%) patients. HIV infection was found in 27 (54%) of the research samples. The median serum 25(OH)D level in the subjects was 21.59 ng/ml (range 11 – 72.5 ng/ml). A total of 22 AGW patients had vitamin D deficiency, 16 (32%) in an insufficient status, and 12 patients (24%) in a sufficient status. The highest degree of AGW severity was found in Grade 1 severity (40%). Statistical analysis showed no significant correlation between the total volume of AGW and vitamin D levels (r=0.081; p=0.573). The correlation between the severity of AW and serum 25(OH)D levels was also non-significant (r=0.104; p=0.472). Furthermore, there is no correlation between the severity of AW and vitamin D status was not statistically significant (p=0.244). Additional results reported no significant correlation between the total volume of AGW or the degree of AGW severity with serum 25(OH)D levels or vitamin D status in the subgroup of people with HIV (PLHIV) and non-PLHIV. Conclusions: The serum 25(OH)D level in AGW patients at Dr. Cipto Mangunkusumo National General Hospital was 21.25 (11 – 72.5) ng/ml. A total of 76% of patients with AGW had a vitamin D deficiency/insufficiency. This study found serum 25(OH)D levels did not correlate with the degree of AGW severity.
Keywords: Severity, anogenital warts, vitamin D, serum 25(OH)D level