Peran Terapi Adjuvan Vitamin D3 Terhadap Kadar T Regulator dan Gejala Klinis Penderita Rinitis Alergi Yang Mendapat Imunoterapi Subkutaneus Initial Build Up Dose

Melati Sudiro, Teti Madiadipoera, Budi Setiabudiawan, Thaufiq S. Boesoirie

Abstract


Imunoterapi spesifik (ITS) merupakan pilihan terapi pada rinitis alergi yang tidak memberikan respons perbaikan klinis dengan medikamentosa. Peran zat adjuvan diduga dapat meningkatkan efektivitas dan efikasi ITS. Penelitian ini bertujuan menganalisis peran adjuvan vitamin D3 pada ITS terhadap percepatan timbulnya respons imun toleran. Penelitian analitik komparatif numerik dua kelompok tidak berpasangan dengan rancangan uji klinis acak terkontrol ganda ini dilakukan di Klinik Rinologi-Alergi THT-KL RSUP dr. Hasan Sadikin Bandung sejak Mei 2016–April 2017. Sampel terdiri atas 18 pasien menerima ITS+kalsitriol dan 18 pasien menerima ITS+plasebo yang memenuhi kriteria penelitian diambil secara consecutive sampling. Dilakukan pemeriksaan jumlah sel Tregulator dengan flowcitometry pada baseline, minggu ke-8 dan 15 dan skor gejala hidung.  Analisis dengan Uji Mann-Whitney, uji Friedman, uji T berpasangan dan analisis Post hoc. Perbandingan kenaikan rerata median jumlah sel Treg kelompok intervensi dengan kontrol pada minggu ke 8 menunjukkan nilai p=0,04, rerata MFI Treg pada kelompok intervensi dengan kontrol nilai p=0,002. Analisis post hoc terhadap MFI Treg menunjukkan peningkatan pada kelompok intervensi dengan p=0,001 pada minggu ke-8. Disimpulkan perubahan di tingkat imunologi mulai terjadi pada minggu ke-8, tetapi perbaikan gejala klinis terlihat setara.

Kata kunci: Imunoterapi spesifik, rinitis alergi, sel t-toleran perifer, sel T-regulator, vitamin D3

 

 The Role of Adjuvant Therapy with Vitamin D3 on T-Regulator  in Allergic Rhinitis Patient with Subcutaneus Immunotherapy

Allergen-specific immunotherapy (AIT) is a potentially disease-modifying therapy that is useful for the treatment of allergic rhinitis especially in those who do not response to pharmacotherapy. Currently, the role of adjuvan is expected to increase clinical efficacy in AIT.  The aim of this study was to analyze the role of adjuvan vitamin D3 in AIT to induction immune tolerance.  The study was an unpaired comparative analytic research with a randomized controlled trial design, conducted at Rhinology-Allergy Clinic ORL-HNS dr. Hasan Sadikin Hospital Bandung from May 2016–April 2017. Eighteen subjects given AIT+ calcitriol and 18 subjects recieve AIT+placebo meet Research’s criteria, were taken by consecutive sampling. All subjects evaluated for Treg cells by flow citometry at baseline, week 8, week 15 and nasal symptoms score. Statistical analysis in this study was Mann-Whitney test, Friedman test, T-Paired test and Post hoc analysis. There was a significant different of Treg cells average results in intervention group and control at week 8 with p-value = 0.04. The mean delta value shows of MFI Treg shows significant differences within intervention group (p=0.002). Post hoc analysis results show there were significant increasing MFI Treg in the intervention group at week 8 (p=0,001). As a conclusion, immunology changes start in week eight, but the improvement of clinical symptoms looks similar.

Key words: Allergic rhinitis, peripheral t-cell tolerance, regulatory t(treg) cell allergen specific  immunotherapy, vitamin D3


Keywords


Imunoterapi spesifik, rinitis alergi, sel t-toleran perifer, sel T-regulator, vitamin D3

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