Peran neutral endopeptidase terhadap inflamasi saluran napas atas pada penderita obstructive sleep apnea

Abstract

Latar belakang: Obstructive sleep apnea (OSA) pada anak yang berhubungan dengan excessivedaytime somnolance (EDS), gagal tumbuh, kelainan kardiovaskular, gagal napas, dan kematian,prevalensinya terus meningkat. Inflamasi berperan pada patogenesis penyakit tersebut.

Tujuan:Mengetahui peran neutral endopetidase (NEP) terhadap inflamasi pada penderita OSA dan hubungannyadengan mediator inflamasi subtance P (SP), interleukin-4 (IL-4), dan tumor necrosis factor α (TNF-α).

Metode: Penelitian potong lintang dilakukan pada pada 36 pasien hipertrofi tonsil dan adenoid selamaMei 2013-2015. Diagnosis OSA ditegakkan dengan polisomnografi, dan kadar NEP, SP, IL-4 dan TNF-αyang berasal dari tonsil maupun adenoid dengan imunohistokimia.

Hasil: Terdapat 21 penderita OSA(58,3%) dan 15 subjek tidak OSA (41,7%), dari total 36 sampel. Dijumpai hubungan yang bermaknaantara SP tonsil dan SP adenoid dengan OSA, serta IL-4 tonsil dengan OSA (p<0,05). Walau kadar NEPtonsil dan NEP adenoid lebih sedikit pada OSA, serta IL-4 adenoid, TNF-α tonsil dan adenoid lebihbesar pada OSA, perbedaan tersebut tidak bermakna (P>0,05). Dijumpai juga hubungan yang bermaknaantara SP tonsil dengan IL-4 tonsil dan SP tonsil dengan TNF-α tonsil (p<0,05).

Kesimpulan: Terdapathubungan yang tidak bermakna antara NEP dan OSA, namun ditemukan hubungan yang bermakna antaraSP dan IL-4 dengan OSA.

Kata kunci : Obstructive sleep apnea, neutral endopeptidase, substance P, interleukin-4

ABSTRACT

Background: The prevalence of obstructive sleep apnea (OSA) in children, which can lead toexcessive daytime somnolance (EDS), failure to thrive, cardiovascular disorders and respiratory failureand death, continues to rise. Inflammation is associated with OSA.

Purpose: To identify the role of neutralendopeptidase (NEP) to inflammation in obstructive sleep apnea (OSA), and its association to inflammatorymediator subtance P (SP), interleukin-4 (IL-4) and tumor necrosis factor-α (TNF-α).

Methods: A crosssectionalstudy had been done to 36 adenotonsilar hypertrophy child patients with OSA during the periodof time from May 2013-2015. OSA was diagnosed based on polisomnografi and the level of NEP, SP, IL-4and TNF-α by imunohistochemistry.

Results: We found 21 subjects had OSA (58.3%) and 15 subjects didnot have OSA (41.7%), from total sample 36. There were significant associations between SP tonsil, SPadenoid and IL-4 tonsil with OSA (p<0.05). Although the number of NEP level in OSA was smaller thannon OSA and IL-4 adenoid, TNF-α tonsil and TNF-α adenoid OSA were found greater than non OSA,but the difference between them were not significant (p>0.05).

Conclusion: This study did not found asignificant correlation between NEP with OSA but there were significant correlations between SP andIL-4 with OSA.

Keywords: Obstructive sleep apnea, neutral endopeptidase, substance P, interleukin-4

Alamat Korespondensi: Hatmansjah, SMF THT RSUP Persahabatan, Jl. Persahabatan Raya No. 1,Jakarta, Email: hatmansjah@yahoo.com