PENGARUH GLUTATION PEROKSIDASE MIMETIK PERORAL TERHADAP KADAR GLUTATION PEROKSIDASE DAN MALONDIALDEHID DARAH SERTA NILAI EMISI OTOAKUSTIK PADA PRAJURIT DENGAN RISIKO TRAUMA AKUSTIK AKIBAT LEDAKAN MERIAM HOWITZER 105 - Effect Of Orally Administered Glutathione Peroxidase Mimetic Towards Glutathione And Malondialdehyde Blood Level And Otoacoustic Emissions Result In Soldiers With Acoustic Trauma Risk Caused By Howitzer 105 Artillery Weapon Blast
Authors: Sasongko Sigit 
Published: May 2018

AbstrakBising impulsif berlebihan mengakibatkan kerusakan mekanik maupun metabolik (stres oksidatif) pada struktur telinga dalam (koklea), sehingga terjadi trauma akustik (TA). Stres oksidatif yang disebabkan peningkatan radikal bebas ROS/RNS di dalam organ Korti, mengakibatkan apoptosis serta nekrosis sel-sel rambut koklea. Stres oksidatif ditandai oleh peningkatan malondialdehid (MDA), penurunan enzim glutation peroksidase (GPx), dan hasil emisi otoakustik abnormal (refer), Mekanisme pertahanan tubuh terhadap stres oksidatif dilakukan oleh enzim anti oksidan endogen (Superoksid dismutase/SOD, katalase/CAT dan GPx). Mekanisme kerja seluler  glutation peroksidase mimetik sama dengan GPx. Penelitian bertujuan untuk mengetahui pengaruh glutation peroksidase mimetik terhadap kadar glutation peroksidase dan malondialdehid darah serta nilai emisi akustik pada prajurit dengan risiko TA akibat ledakan meriam Howitzer 105. Rancangan penelitian adalah clinical trial pre and post design, randomized, double blind and placebo controllel, yang dilakukan pada 34 orang prajurit siswa Tamtama baru Pusdik Armed saat latihan menembak meriam Howitzer 105 pada tanggal 7-10 Juli 2014 di Cimahi dan Batujajar. Subjek penelitian dibagi dua, yakni kelompok perlakuan dan kontrol. Kelompok perlakuan diberi glutation peroksidase mimetik (Ebselen SPI 1005) 1x200 mg peroral saat latihan, sedangkan kelompok kontrol diberi plasebo. Kedua kelompok diukur kadar MDA dan GPx darah serta hasil audiometri nada murni dan nilai emisi otoakustik (DPOAEs) sebelum dan setelah latihan menembak. Data dianalisis menggunakan uji parametrik dan non parametrik, dan besarnya manfaat perlakuan dihitung menggunakan Number Needed to Treat (NNT, 95%CI). Kemaknaan hasil ditentukan berdasarkan nilai p < 0,05. Hasil penelitian menunjukkan kejadian TA menggunakan pemeriksaan audiometri nada murni pada kelompok kontrol sebanyak 23,5%, dan pada kelompok perlakuan sebanyak 0%, sedangkan menggunakan pemeriksaan DPOAEs pada kelompok kontrol sebanyak 47,1% abnormal/refer dan pada kelompok perlakuan 100% normal/pass, dan perbedaan ini secara statistik bermakna  (p<0,05).Pemberian Ebselen SPI 1005 pada kelompok perlakuan meningkatkan 82,4% kadar GPx eritrosit (NNT, 95%CI=1,889 [1,1593,016]; p=0,004), meningkatkan 88,2% kadar GPx plasma (NNT, 95%CI=1,417 [0,970-1,775]; p<0,001), menurunkan 100% kadar MDA eritrosit (NNT, 95%CI = 1,417 [0,994-1,836]; p<0,001), dan menurunkan 94,1% kadar MDA plasma (NNT, 95%CI=2,125 [1,29-3,904]; p=0,01), serta menghasilkan 100% nilai DPOAEs normal/pass (NNT, 95%CI = 2,125 [1,335-3,987]; p=0,01). Penelitian ini menyimpulkan bahwa pemberian Ebselen SPI 1005 pada prajurit dengan risiko trauma akustik selama pelaksanakan latihan menembak meriam Howitzer 105, meningkatkan kadar GPx darah, menurunkan kadar MDA darah, dan menghasilkan nilai DPOAEs normal/pass. Kata kunci : Ebselen, Emisi otoakustik, GPx, MDA,Trauma akustik.AbstractExcessive noise exposure may cause mechanical and metabolic (oxidative stress) to the inner ear structure (cochlea), resulting in acoustic trauma (TA). Oxidative stress which caused by increasing of free radical ROS/RNS in the organs of Corti, causing apoptosis and necrosis of cochlear hair cell. Oxidative stress was characterized by increasing of malondialdehyde (MDA), decreasing of glutathione peroxidase (GPx) enzyme, and abnormal otoacoustic emission value (refer). Defense mechanism toward oxidative stress was mediated by endogenous antioxidant enyzme (superoxide dismutase/SOD, catalase/CAT, and GPx). Cellular mechanism of glutation peroxidase mimetic was similar as Gpx. Aim of this study was to determine the impact of glutathione peroxidase mimetic to glutathione peroxidase and malondialdehyde level in blood, also otoacoustic emission value on soldiers with risk of TA due to explosion of Howitzer 105 artillery weapon. The design of this study was clinical trial pre and post design, randomized, double blind and placebo controlled, on 34 new recruit soldiers in Artillery Academy of Indonesian Army, during the soldiers were trained to firing Howitzer 105 artillery weapon, from 7th-10th July 2014 in Cimahi and Batujajar. Subjects were divided into 2 groups, the exposure group (group given treatment) and control group. Exposure group was given glutathione peroxidase mimetic (Ebselen SPI 1005) 200mg, orally once daily during the training, meanwhile control group was given. Malondialdehyde and Glutathione Peroxidase level in blood, pure tone audiometry and otoacoustic emission value (DPOAEs) was measured from those two groups, before and after firing training. The data was analyzed using parametric and non parametric, with Number Needed to Treat (NNT, 95%CI) and significance value (p<0.05). The results of this study showed the number of acoustic trauma events in controle group based on pure tone audiometry test was 23.5%, exposure group was 0%, and based on DPOAEs test the controle group showed 47.1% abnormal/refer, exposure group showed 100% normally/pass, and this difference stastically significance (p<0.051). The group which was given Ebselen SPI 1005 showed increasing 82.4% erythrocyte GPx level (NNT, 95%CI=1.889 [1.159-3.016]; p=0.004), showed increasing 88.2% plasma GPx level (NNT, 95%CI=1.417 [0.9701.775]; p<0.001), decreasing 100% erythrocyte MDA level (NNT, 95%CI = 2.125 [1.335-3.987]; p=0.01), showed decreasing 94.1% plasma MDA level (NNT, 95%CI=2.125 [1.29-3.904]; p=0.01), and resulting 100% in normal/pass DPOAEs value (NNT, 95%CI = 2.125 [1.335-3.987]; p=0.01). This study concluded that giving Ebselen SPI 1005 to soldiers with risk of acoustic trauma during the firing Howitzer 105 artillery weapon, increasing GPx level in blood, decreasing MDA level in blood, and resulting normally DPOAEs value ( pass )Keywords : Acoustic trauma, Ebselen, GPx, MDA, Otoacoustic emission