Korelasi Peningkatan Kadar Neuron Spesific Enolase dengan Derajat Keparahan dan Luaran Fungsional Pasien Stroke Infark Aterotrombotik Akut

Abstract

Pada stroke iskemik terjadi kerusakan neuronal serta penurunan glikolisis aerob akibat menurunnya kadar glukosa. Neuron specific enolase (NSE) yang terdapat pada jaringan neuronal banyak tidak terpakai sehingga kadarnya meningkat. Pada kerusakan neuronal serta gangguan membran sel, sawar darah otak terganggu sehingga NSE berdifusi kedalam ekstraselular dan cairan serebrospinal. Peningkatan kadar NSE serum juga berhubungan dengan volume infark dan luasnya kerusakan otak. Penelitian ini bertujuan untuk mengetahui peningkatan kadar NSE pasien stroke infark aterotrombotik akut, serta korelasinya dengan derajat keparahan stroke dan luaran fungsional. Rancangan penelitian adalah observational analytic dengan pendekatan kohort. Pasien stroke infark aterotrombotik fase akut sebagai kasus, sedangkan kontrolnya orang sehat. Penelitian dilakukan di Rumah Sakit Dr. Hasan Sadikin Bandung, mulai Februari sampai Agustus 2008. Pemeriksaan kadar NSE serum dan penilaian tingkat keparahan stroke berdasarkan National Institutes of Health Stroke Scale (NIHSS) dilakukan saat masuk rumah sakit, sedangkan luarannya dinilai pada hari ketujuh dengan indeks Barthel. Analisis yang digunakan adalah analisis bivariat dengan uji statistik Mann-Whitney dan uji Pearson. Dari 43 kasus dan 43 kontrol, didapatkan perbedaan kadar NSE serum yang bermakna rata-rata=11,41 [5,07] ng/mL berbanding 8,93 [3,03] ng/mL (p=0,019). Terdapat korelasi yang bermakna peningkatan kadar NSE serum dengan derajat keparahan yang dinilai berdasarkan skala NIHSS (p=0,024), juga dengan luaran fungsional (p=0,012). Nilai akurasi paling tinggi terdapat pada kadar NSE serum 12ng/mL, dengan sensitivitas 42% dan spesifisitas 84%. Kesimpulan dari penelitian ini adalah kadar NSE serum berkolerasi dengan derajat keparahan serta keluaran fungsional penderita stroke infark. [MKB. 2010;42(2):62-8].

Kata kunci: Kadar neuron specific enolase,stroke infark, NIHSS, Indeks Barthel

Correlation of Serum Neuron Specific Enolase with Severity and Functional Outcome in Acute Atherothrombotic Infarction Stroke Patients

Neuronal damage and decreasing aerobic glicolysis process in ischaemic stroke are caused by lowering level of blood glucose. The amount of neuronal intrasitoplasmic glicolytic enolase enzyme, also known as neuron specific enolase, increases in blood circulation because it is not used anymore in damage neuron. So the mechanism failure in blood-brain barrier, as result of neuronal and cell membrane damage, causes NSE diffusion to extracellular and cerebrospinal fluid, then NSE level increases in blood serum and cerebrospinal fluid in acute cerebral infarction. Elevating NSE level is also connected with infarct volume and the extent of brain damage. The aim of this study was to evaluate connection between upgrading NSE serum level in acute atherothrombotic-stroke infarction patients, level of stroke incompatibility, and functional outcome. The method of study was observational analytic with kohort study. Subjects of study were divided into case group consisted of acute atherothrombotic-stroke infarction patients and control group consisted the healthy person. The data was collected in Hasan Sadikin Hospital between February to August 2008. Evaluating patients was performed to get descriptions on NSE serum level, level stroke incompability measuring by NIHSS scoring at the first time entering the hospital, and Barthel index scoring at seventh day of treatment. This study was analyzed by bivariat analysis using Mann Whitney statistic test and Pearson correlation test. There were 43 patients in each group. There was a significantly difference in NSE serum level on case group (mean was 11.41 [5.07] ng/mL) in comparison to those on control group (mean was 8.93 [3.03] ng/mL), p=0.019 . There was a significantly correlation between raising NSE serum level on case group and level of stroke incompatibility measuring by NIHSS scoring and also with functional outcome according to Barthel index scoring. The highest accuration value of NSE serum level was 12 ng/mL with 42% sensitivity and 84% specificity. The conclusion was neuron specific enolase serum level has correlation with severity and functional outcome in acute atherothrombotic infarction stroke patients. [MKB. 2010;42(2):62-8].

Key words: Neuron specific enolase serum level, stroke infarction, NIHSS, Barthel index

DOI: http://dx.doi.org/10.15395/mkb.v42n2.218